Air Collective Forum

Ventilators vs. Oxygen Masks (Import Update for Bulgaria)

Hey guys, I’ve got an important update – some bad news, and some good news about our initiative in Bulgaria.

Dr. Alexander Simidchiev, a pulmonologist, just called me. He is one of the people who has been advising and supporting us very strongly in the past week. He told me that today he received new piece of information after talking to professor Oleg Hinkov who is one of the most prominent experts in the field.

In brief, even if we are successful in building and producing enough ventilators, it won’t help. The reason is that in Bulgaria there are 1400 ventilators and only 100 specialists that are capable of running these machines and the respective treatment of patients in a proper way.

Apparently anaesthesiologist-reanimators who can work with the ventilators have a different profile from the respective intensivists who are the doctors who have to take care about the recovery of (COVID) patients in critical state.

I won’t go into all the details, but he said that even if we are able to produce (or the government buys) enough ventilators, this won’t help. In fact more ventilators would worsen the problem, as incompetent doctors will have to work with them. He said that the potential detriment is far worse than the absence of respirators.

Now, the good news. We can still address the problem. Dr. Simidchiev suggested that we can focus on machines for oxygen therapy instead. He said that it would make more sense to make ordinary oxygen masks available to a wider number of people and hospitals.

So, I propose that we still continue our initiative with building ventilators, as countries around the world will still need them, but probably in Bulgaira we’ll have to pivot a bit. I’ll do some more research and get back to all of you.

P.S. This is professor Oleg Hinkov who was also consulted on the topic:


This is useful to know - helps better direct our effort.

Anne found an Italian project that converts Decathlon sports equipment into oxygen masks. It has been tested in hospitals already.

We will search for more such projects and add them to the library. If you find any please, add them using the link below the kanban board on

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I’ve been reading these comments and opinions over the last days too.
Generally for any of these to be of help there’s a need for an equipped ICU bed and a specialist anaesthesiologist-reanimators as you’ve pointed out.
The ventilator is just a part of the equipment puzzle, where you also need things like monitors, blood oxygen level tracking and other equipment and improper use of a ventilator can indeed be more harmful to the patient than the decease and it can cause further spread. You also need negative pressure room ventilation etc.
I’ve seen discussions of how medical staff might reorganise themselves where a limited number of specialist can work with other doctors and nurses in the hospital in teams, so they overlook a lot more patients grouped together.
I think globally speaking this effort is very meaningful even beyond the current pandemic and it’s worth maintaining focus on open source easy to build ventilators.

From everything I’ve read doctors are suggesting that a higher priority for them at the moment is to ensure protective gear for medical staff and there are numerous projects and initiatives around that.
One of the cooperation projects around ventilators already pivoted in that direction. (the google doc for whoever doesn’t have FB here )
I think the focus of the current effort is still meaningful.

What you’re also saying that there are different types of shortages for patients that are hospitalised, but are not in intensive care. Like the oxygen machines. I agree that it might be more meaningful to make impact there.

Hey Lino, Just so you knw, Nato is aware of that. He’s been in touch with a number of doctors and responsive staff all week. (He’s the Vice Char of Sofia Tech Park so has been able to make contact.) He was just providing the high level update for the engineers working in Bulgaria, as they have been working on BVMs and more general-purpose pumps.

Our approach here is to find a balance of parallel projects because as the situation changes, and is different in different places, different devices are more or less appropriate. There are still some places prefering BVMs, some accepting only intubation devices. It seems now though, that oxygen therapy is the lowest common demonator where there will be a constraint on intensiviologists.

We are not taking a position on one tech other the other, just keeping information flowing so teams can be informed and make their own decisions in their own context.

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Response from Dr. Benkov, a doctor in Bulgaria who has been very active supporting a number of projects already:

Our goal is NIV (Non-invasive ventilation) because:

  1. The use of DIY clinical ventilators with intubation is very problematic and as we understand, there are not enough doctors to agree to this. In addition, their use is only possible by highly specialized resuscitators.
  2. The use of NIV is possible by any doctor, even in some cases by the patient himself.

The latest WHO recommendations for the treatment of ARDS,really emphasized that NIV is not a recommended method, but it is not rejected. This is for ARDS.

In patients who have not yet developed ARDS, NIV has an important therapeutic and preventative effect towards ARDS. The CPAP or BIPAP mode provides prevention of alveoli atelectasis. The additional oxygen supply improves gas exchange. In most ways, NIVs are like clinical ventilators. The difference is that the air is fed through a mask. Since parameter control is important the mask must also be leak-proof. / I wrote earlier about ventilated and non-ventilated masks and their price.

These are the reasons why I consider this direction important.

We need a mask and apparatus that can control the volume and pressure supplied. I wrote earlier about the technical parameters.

Regarding oxygen therapy

We can do nothing to help with oxygen therapy in Bulgaria. There is no shortage of bottles (and we can not produce them or sieves anyway) and there is no shortage of O2 gas.

Here, there is oxygen in huge quantities, and is cheap. The bottles are used everywhere for technical purposes and are numerous. In oxygen therapy the mask does not matter, a plastic hose can also be used. This therapy is useful for patients with respiratory problems. The shortage will be on the next step - when a ventilation will be required. And if DIY clinical ventilators would be not accepted the only choice for us is NIV for the light and pre ARDS cases. That means of course that their number should be much much higher that the number of invasive ventilators.

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@Bo_RSNTR The above is relevant to the Decathlon oxygen therapy mask.

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A post was merged into an existing topic: Working on the Decathlon oxygen therapy mask

From what I’ve seen in Bulgarian hospitals they often even have centralised O2 supply that goes through the walls to many of the hospital beds. That’s just a non-informed empiric observation though, but indeed looks like O2 bottles are not a problem. I reckon that’d be the case in most developed from a healthcare perspective markets too.

When discussing with @Nitesh last week though he made the point this is not the case in most places in Africa for example and they’ve been working on a oxygen concentration solution that works authonomosly for that purpose. Not sure if relevant for any of the projects here, but thought to mention it.
Nitesh, correct me if I got this wrong please.