Yes, sorry, it’s complicated. There are still some factors to work out before it’s clear what we should do. I’ve asked Dr Bankov some more questions and will report back when we have that information. Then we can decide what to do.
From my latest exchange with Dr. Bankov:
Sleep apnea mashines are useful for us. Actually they do a ventilation when the patient “forget” to breath. Only the mask costs something like 100-150 USD.
CPAP/BiPAP mashines should be certified but they can be operated by any doctor and in some cases even by the pacient.
In the end, I could also simply ask you: should we order all those masks or not? Will they be useful?
Yes, if we have idea about what kind of ventilator will blow them
So this is where we stand now. Based on pessimistic projections, we could see as high as 300,000 active transmitters in Bulgaria at the peak, which means 20% would require hospitalization. That would mean 60,000 entering hospitals that are already busy over the period of a week. In this extreme case, these masks will be useful as long as there are sleep apnea or CPAP machines to plug them into.
I assume that we can always 3D print various adapters for different machines as needed.
What we don’t have, as-yet. is an understanding of what types of CPAP / sleep apnea machines are available to Bulgaria, and if they are generally sold with or without the mask component. Is that something someone can look into?
Apparently these masks can be used for protection of the medical staff. I am sending photos of the usage and the type of filter needed.
I don’t know if this is at all valuable here, but I’d bundle this solution with one of these chemicals you put on the inside of your swimming goggles (or spit also works in lack of a more sophisticated alternative). When I’ve used these masks they tend to get very foggy from ones breath, especially if you’re doing something intensively like one might in an ICU.
@Nato, thanks for sharing these. I think we are talking about different things here @salim. The oxygen masks that @Bo_RSNTR and her team are prototyping are type of isolating masks that can be used for protection by medical staff.
There is another possible use which @salim talks about having discussed it with Dr. Bankov - oxygen mask is also one of the elements of CPAP/BiPAP machines alongside the ventillator for airway pressure itself and a hose. This machines can be used for patients who are in not that severe conditions if I am getting this correctly. I will try tomorrow to get in touch with manufacturing producers here in Bulgaria to ask them if they can sell only ventillator + hose (and if there is much price difference for a whole package.)
At last, it is good to underline what Dr. Bankov has told Salim - that these machines need to be certified to be used by medical personnel and DIY would not work in this case.
Actually, they were originally designed for CPAP. From the introduction on original project’s website:
Doctor Favero shared with us an idea to fix the possible shortage of hospital C-PAP masks for sub-intensive therapy, which is emerging as a concrete problem linked to the spread of Covid-19: it’s the construction of an emergency ventilator mask, realized by adjusting a snorkeling mask already available on the market.
This was also the first indended use in Bulgaria, as the pessimisstic projects show we may have up to 60,000 requiring CPAP at the peak. (Useful parameters - establishing timelines for shortages in our countries)
The use for medical staff that Nato mentioned was a secondary addition. The first I saw of it was his comment above.
I think the protection of medical staff is very useful, and can be a fast win.
I don’t want to lose sight of the CPAP use though, and I’d like that evaluation to proceed urgently, since we urgently need to decide on that in order to secure inventory, or we risk losing that option.
Just to clarify- we are working on the second option @peter.minkov oxygen mask as one of the elements of [CPAP/BiPAP machines] and I am coordinating for another team that uses the masks for the first option too. So, plz, keep me updated on your communication with the manufacturers.
Hi @Bo_RSNTR, @salim, sorry for this late reply - I have been busy all day at work and also went to donate blood as there is now shortage of donors since people tend to stay at home. I tried to contact some of the stores that sell CPAP/BiPAP machines but apparently none of them replied by phone. I have sent them an email and would write back to you as soon as I have one.
I have asked them 3 questions:
Do they sell CPAP/BiPAP machines without oxygen masks and how much would this reduce from the original price?
Since CPAP/BiPAP machines have three elements - the device itself, a hose and the mask I have asked if the hose nozzles are standard ones and if they can send pictures so we know if the end of our Decathlon-originating masks needs to be adjusted?
What is their current stock? Can they rent these devices to hospital for some months until the epidemic is over? What would be the rent price per device per month?
Please do let me know if all these question make sense to you and add something in case I missed it.
P.S. @Nato do we have any idea how much of these machines Bulgarian hospitals currently have at their disposal?
@Petar.Minkov One of the things we are also doing with @Bo_RSNTR is to get in touch with companies selling CPAP machines. We are only at the beginning of contacting them so all the questions you have asked are relevant, but we still don’t know their answers.
As for the number of such ventilators in Bulgarian hospitals I have read stats between 1400 and 2000. I don’t know if they have machines especially for CPAP, as it is just one of the modes that ventilators have. I am expecting to receive info regarding the exact number of ventilators in each hospitals. I’ll share it here whenever I have it.
Thanks for this fast reply, Nato! I will share manufacturers’reply as soon as I have one.
Can we find the STL from the second picture? I guess now is more important to produce the dongle for protective purposes than for CPAP? Also can we source the filters too?
Here is what I have found: https://www.thingiverse.com/thing:4236194
I guess this HME filter diameter should be standard one.
I can check! Will come back to you!
Hi, ours are Model A. Checked.
With regards to the mask for CPAP purposes:
I am test printing the valve/dongle from isinnova’s original files and found that the walls are thin and this is not ok.
Here is what I have found as a solution - https://www.thingiverse.com/thing:4239470
I will test print and give feedback
With regards to the mask for medical staff protection:
I think I am on the right track to get all this together.
I have found stock of HME filters from Drager. I will get the exact number in stock soon.
I would need support on the STL file - I want to make sure that I can print safe dongles with proper thickness so that no air can flow in and out of it.
I guess we need to produces as many as we can from these (mask + dongle + filter).
Great! We already printed a few too. Could you add yourself in the shared file as a potential printing unit if so? So that we have a list if /when we need to centralize the printing process and act fast. Do you have the link?
Lady on the phone told me that masks for CPAP machines are rather cheap (~6BGN even though upon checking I found that this is not the case actually - they are indeed starting from $100) whereas the expensive masks which we might want to produce are for BiPAP ST machines. Masks for those type of machines should have a standard 22mm hose and they can even send us a model to check if our masks would do the job. Generally, those machines are expensive (starting from 3000BGN) but monthly rent is around 300BGN. It is important to underline here that match is 1:1 - one device with one mask simultaneously. However, masks are for single-use so it actually makes sense to produce more of them.
She also told me that hospitals do provide oxygen therapy via a centralised system. She suggested to ask the medical personnel what the stream/volume of pure oxygen is per minute - only if it is under 10litres per minute it makes sense according to her to rent/buy CPAP/BiPAP machines. If it higher than than that what will be needed are more oxygen bottles since one patient is ‘attached’ to one bottle and the sleep appnea devices won’t work with higher stream of oxygen. They can provide also oxygen bottles but they need charging as far as I understood her correctly.
That all being said, I would appreciate if we are all on the same page re:
- Do Bulgarian hospitals have enough CPAB/BiPAP machines?
- Do they need more such devices to be bought/rented or they need only supply of oxygen masks for single-use which work alongside CPAP/BiPAP?
- Do we need to 3D-print masks for both CPAP/BiPAP machines?
- Do we instead need to supply oxygen bottles (if stream of oxygen is above 10l/minute or this is non-sense)?
Sorry, those questions might be stupid but I just want to ensure we have a shared understanding of hospital needs and how we can best address those.
Ivor here, medical doctor from Croatia.
We made this - https://pandemija.info/respiratoreng/
Hopefully somebody will find it useful.
@lino can you give a link of such thing that absorbs the moisture and maybe an idea of where can they be sourced in larger quantities?
I think this could be a solution here, although used for cameras:
Can we find something similar locally?
Also I have found anti fog spray that can be used too here: