Making ventilators?

[Rosehip10]

Government says wants engineering firms to urgently start making medical equipment. Peston (itv) asks chief executive of rolls Royce (one of few large uk firms who may be able to do something like this rapidly) "has anyone been in touch at all?

Exec "no"

There is a lot of social guilt about this virus from Chinese business communities. I expect a big proportion of ventilators (like face masks) may be donated by Chinese billionaires with links to the UK.

Okay so even if they make all of these ventilators where are all of the extra medical and nursing staff going to come from to operate them? Look after the patient, take blood samples to monitor their gas exchange and titrate the ventilatory settings accordingly? It’s not just a case of putting someone on a ventilator and that’s it.

Where are the additional anaesthetic drugs going to come from to keep these patients sedated whilst they are ventilated, the infusion pumps to deliver these drugs? The medical gasses - oxygen and air supplies the ventilators need to run.

Absolute madness to just suggest companies just ‘make more ventilators’!

Don't you need someone to make the factory machinery to make the ventilators first? Isn't that going to cost billions and take months in itself?

All seems a bit of a silly points scoring exercise which is very wide of the mark.

Why ask someone from an unrelated engineering company about thus, rather than one of the several British medical equipment manufacturers who already make the damned things?

(Google 'Kompass medical equipment manufacture' if you want company specific information)

It makes the government look like they have been asleep. Even if this was a reasonable idea they should have been doing it in January.

They are acting like they have months before they have a significant number of cases, other countries' experience shows that they do not.

If you were desperately ill would you prefer a ventilator that helped or one that can't be used as it is waiting the correct paperwork?

Would you buy a car that had failed its MOT? A car seat that hadn’t been safety tested? Get in a lift that had never been inspected?

But you want desperately sick people to be put on ventilators knocked up on a car production line and never tested or inspected?

Have they been caught out?

'We're talking to engineering businesses' sounds a lot like the 'we're talking to the supermarkets' a couple of weeks ago.

But wrapped in that irony is a hope that they genuinely are. And what's with the going to ask private hospitals etc ? Why aren't the private hospitals all offering?

China can build a hospital in a week but the combined ability of the UK cant make some ventilators?

How long does it take for a doctor/nurse to be trained how to use a ventilator? Surly doctors are highly able at learning at speed. And now many people on ventilators can 1 doctor/nurse monitor at a time?

I'm going to bite. I have used lots of different types of ventilators, lots of patients use them at home as well. Yes the state of the art ones are feats of engineering but a simple CPAP machine much less so. If needed and obviously not ideally you could ventilate someone with a bike pump. I actually think something simple could be put together by an engineering firm in a couple of weeks.

Parker Hannifin is the company to ask. I bet they were contacted - they build the machines to build a lot of hospital equipement.

Like this, not complicated and apears to be in stock. Mr Hancock needs to get googling.

Omg this thread is the most ridiculous thing. Though many of you are making sensible points.

Op. Why in gods name would an engine/car factory such as rolls Royce have the design, the individual components, the ability, the machines let alone the staff to suddenly start building ventilators. The type used in ITU are incredibly expensive, specific machines that are highly calibrated because they can be incredibly dangerous to patients if used incorrectly. They may as well ask you or your milk man to make them, it's just as big of a leap!!!

As pp has said, needs must a patient can be manually ventilated. But that's tiring 1:1 work and takes the nurses away from doing other things.

The gov will hopefully have spoken to ACTUAL manufacturers of ventilators and asked them to increase the manufacturing. But given all the parts pretty much will come from overseas I think that might take some time.

Next problem: who pays for them (normally individual trusts) if they don't have the money they need to do business cases. This takes time. Next problem who determine who gets to use them? Even if you have a central pot and hospitals put forward their case to use one for x patient they have, that will have to be weighed up against the next hospital bidding to use one. Again takes time.

I get you're scared and frustrated at the lack of planning, we all are. But try and calm down and use a sense of common sense x

hopefulhalf you can bag somebody with your bare hands. The point is you need to be able to leave people on these ventilators for days on end, without them failing (or speeding up or slowing down, or increasing or decreasing tidal volume over time). 100% reliably.

And for that level of reliability you need testing.

I assume you work in ITU/theatres so you’re aware of this, but you are likely have have understaffed HDU/ITU beds due to staff sickness and increased bed pressures, so it’s not safe to assume you’ll have 1:1 nursing even for the sickest patients - it might be 1:4, or even worse if we are really opening up elective theatres (not just recovery) as overspill ITUs (as per my own trust’s major incident plan). Adding a second level of risk, by bringing in untested MacGyvered ventilators would be fucking madness.

Like this, not complicated and apears to be in stock. Mr Hancock needs to get googling

Everything I’ve read suggests the patients need intubation not NIV.

Ginfilled will all patients need ITU style machines though ? Some (most ?) will just need a bit of NIV I would have thought. Which are very user friendly and not dangerous at all.

NICU mainly though I have done PICU. I stand corrected about the NIV, an Italian Dr was talking about CPAP I thought the main problem was a sought of viral pneumonitis +/- pleural effusion so a bit of CPAP might be enough. Ready to be wrong.

Sort of obvs

Anyway we will all find out soon

I presumed they meant making parts that could be used th and possibly lending man power to a company that already makes them. And maybe forcibly taking materials that could be used on your product and ventilstors.
Thry csnt suddenly even have the tools to make the parts and yool msking in this country is almost vanished.

The BBC have just had Dr Max Jonas on, University Hospital Southampton, on answering this exact question. So we dont have UK companies that make these ventilators but we do have companies that make the parts for them. They are just shipped abroad to be assembled.

He said there was no reason why the UK couldn't make them here, we do have the skills. Rolls Royce, JCB etc do have some expertise and experience in this field as RR currently make systems for delivering gas into aeroplanes so we can breath at 30,000 ft. So if they were given blueprints they could build something 'rugged' and 'luxurious'.

CPAP definitely not recommended as it creates an aerosol of virus into the air. Manual ventilation was widely used in the polio epidemics by shifts of medical students. Manual ventilation unlikely to be practical either as these patients will have very stiff non compliant lungs.

From this article

@hopefulhalf I certainly hope the need would be for NIV rather than ITU genre! Much better for all around. I thought the implication was for the more acute though? Must be mistaken.

However NIV is still 1:1 nursing isn't it? And given the nursing numbers on wards even if you had the machines, the staff capacity would be the limiting factor I think.

I don't know what the solution is. Too underfunded and underresourced nhs for too long.

Let's keep washing hands and isolating and hopefully make it through!

I don't know it's all guesswork. Our trust is talking 1:4 critical care, I think I assumed that would be uncomplcated NIV.

I read somewhere that China has already given its spare ventilators to Italy. Not sure if that’s true but would make sense.