Johns Hopkins engineers develop 3D-printed ventilator splitters
In response to a pressing need for more ventilators to treat critically ill COVID-19 patients, a team led by Johns Hopkins University engineers is developing and prototyping a 3D-printed splitter that will allow a single ventilator to treat multiple patients. Though medical professionals have expressed concerns about the safety and effectiveness of sharing ventilators, the team has designed this tool to address those concerns.
“There is an emphasis right now on using engineering to develop open-source solutions to many aspects of the COVID-19 crisis, but especially for ventilator design and production,” said Sung Hoon Kang, an assistant professor of mechanical engineering at the Johns Hopkins Whiting School of Engineering who is leading a team that includes ICU intensivists and pulmonary specialists at the Johns Hopkins School of Medicine. “One approach is to use one ventilator to treat multiple patients. While this is feasible, it must be safe for all the patients. That means ensuring that each patient gets the care they need, without shortchanging anyone. This is what we set out to create.”
A serious lung condition called acute respiratory distress syndrome, or ARDS, is the leading cause of death for COVID-19 patients. In individuals with ARDS, fluid builds up in the lungs, limiting the amount of oxygen in the bloodstream and depriving vital organs of the oxygen they need to function properly. The condition must be managed by a ventilator.
As the COVID-19 outbreak spreads, many health care facilities are grappling with a shortage of the machines needed to treat the sickest patients. Such shortages have already effectively crashed the health care system in Italy, which currently reports the world's highest number of COVID-19-related fatalities at more than 13,000.
Helen Xun shows off two forms of ventilator splitters she is helping to design and 3D print
Image : Will Kirk / Johns Hopkins University
Some medical professionals have expressed concerns about the practice of sharing ventilators.
First, hooking up several patients to the same ventilator could spread germs and create a chance for cross-contamination.
Another concern is that a ventilator shared by multiple people wouldn't give all of them the necessary level of oxygen, which could lead to poor patient outcomes and high mortality rates.
According to Kang, the team's new design aims to safeguard against these risks. The new design includes an air-flow controller and flow meters, allowing clinicians to monitor and adjust air flow for each patient.
The air volume controller is a key addition because each intubated patient requires different flow control.
The team is also adding a filter designed to prevent cross-contamination between patients—important because early reports suggest that those exposed to multiple infected people experience worse outcomes.
The splitter also must be easy to deploy, given the urgency of the need.
Christopher Shallal prepares a 3D printer
Image : Will Kirk / Johns Hopkins University
“We need a robust design, but one that can be produced with a relatively simple manufacturing process 3D printing,” says Christopher Shallal, a member of the team and a junior majoring in biomedical engineering.
“We are also considering the different conditions and settings where people may be printing the ventilator splitters. For instance, they may not have a high-resolution printer available.
So we are keeping scalability in mind as we design.”
Splitting ventilators is an experimental emergency treatment that has been used before under dire circumstances, such as during the aftermath of the 2017 Las Vegas shooting, when splitters were used to stabilize injured but otherwise healthy young adults.
But splitting a ventilator to treat multiple patients in varying stages of lung failure presents a new and somewhat daunting set of design challenges, according to Julie Caffrey, assistant professor of plastic and reconstructive surgery at Johns Hopkins Medicine and a member of the team.
“Using the same ventilator settings for ARDS patients with different lung compliances could be very unsafe. One patient might receive too much air; the other might not receive enough,” Caffrey explains.
“With ARDS, ventilator strategies for improving survival are often used to administer low tidal volume and higher pressure. If you can't manage that, you risk causing further trauma to lungs that are already very crippled.
It's very important that when we split a ventilator, we can still set the ventilator to that specific patient.”
The team has produced the prototype and hopes to finalize and start testing their design on model lungs within weeks. Once approved by the FDA, they plan to publish their open-source design for others to use.
“The goal here is to quickly get this technology to hospitals around the world—and right to the people who need it the most,” says Helen Xun, a member of the team and a third-year medical student at the Johns Hopkins School of Medicine.
Johns Hopkins University (DU Consortium)
The LHC-JHU Bayview site have been collaborating for years to conduct field studies which have helped to better understand the epidemiology of chronic respiratory diseases (chronic obstructive pulmonary disease and asthma) with regards to environmental exposures in the low-income urban community in East Baltimore. Our team has a vast experience implementing and conducting clinical trials/multicenter studies (ie:
- Subpopulations & Intermediate Outcome Measure in COPD – SPIROMICS (NIH/5111453)
- Genetic Epidemiology of Chronic Obstructive Pulmonary Disease: The COPDGene® Study: Phase 3 (U01 HL089897)
- Obesity Enhances Susceptibility to Pollutant Effects in Asthma (P50ES018176)
- Motivational interviewing and air cleaners for smokers with COPD (MOVE COPD) (R01ES029512)
- Pulmonary Trials Cooperative (PTC) Redefining Therapy IN early COPD (RETHINC) trial (NHLBI/ COPD Foundation)
- Intervention Trial to Reduce Nitrogen Dioxide and Carbon Monoxide Concentrations in Baltimore Cit (FR-5200-N-01A).
- Clinical trial of an air purifier intervention to reduce indoor particulate matter and improve cardiovascular outcomes in COPD ( R01ES022607))
In addition to a range of faculty expertise, the investigators have considerable equipment, space, and personnel resources as well, including monitoring equipment for pollutants, lung function equipment, and a large staff of coordinators, assistants, field staff, environmental technicians and phlebotomists. Resources from the Center will be available for the proposed study:
The Lung Health Research Center comprises 1200 square feet of space in the Asthma and Allergy Center. This facility includes interview, examination, blood drawing and processing, secure drug, frozen specimen, and record storage, and lung function testing facilities.
The research area is fully equipped to perform all of the proposed research.
Clinical research and field staff will be based in the Lung Health Research Center where there is ample infrastructure (computers, office space, telephone connections, access to electronic health records), and proximity to study investigators to support the study.
Pulmonary Division Outpatient Clinics (JHOPC): The Johns Hopkins Division of Pulmonary and Critical Care Medicine has 39 clinically active physicians who see 11,176 outpatient visits per year, including approximate 1200 patients with COPD and 1500 with Asthma.
Johns Hopkins Bayview Medical Center (JHBMC) and Pulmonary Care Unit (PCU): JHBMC is a 275-bed community hospital and referral center with a total of about 7,000 admissions per year. JHMBC is located less than 3 miles from the Johns Hopkins Hospital campus (approximately 10 minutes by car).
The Faculty in the Pulmonary and Critical Care Medicine, including Drs. Hansel, serve as Attending physicians at both Johns Hopkins Hospital and the JHBMC. The PCU is a 12-bed specialized care unit within JHBMC designed for adults with respiratory diseases and staffed by Pulmonary Division Faculty.
In the past year there were 1,046 patients admitted with a COPD diagnosis.
*Our team has access to HRCT imaging support from the JHOPC and the JHBMC clinics.
The Johns Hopkins University COPD Precision Medicine Center of Excellence (COPD PMCOE) infrastructure (directed by Dr. Hansel, PI of the current center proposal) will facilitate identification of appropriate patients for the current study, which include over 1,200 who visit our pulmonary clinics yearly and over 1500 with Asthma.
Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Our employees are the strength of our service.
Intrastaff is unique because it's one of the very few agencies where a person has the benefit of being a temporary employee and also feels a member of a large organization. Working at Hopkins means joining a culturally diverse team that includes some of the best nurses, physicians and allied health professionals in the world.
Directly or indirectly, you'll have exposure to cutting-edge technology and groundbreaking medical research.We are currently seeking an NBRC – Registered Respiratory Therapist (RRT) to fullfill a Temporary PRN assignment in the NICU at Bayview Medical Center.Day shift 7am – 7:30pm with weekend work required.Maryland license and RRT required.
BLS required. NRP strongly preferred.
RequirementsCore Respiratory Team Member in the Neonatal Intensive Care Unit (NICU), Labor & Delivery.
Assists NICU with team coverage.Responsibilities include but not limited to general respiratory care and advance care, such as: ventilator management including high frequency ventilation (oscillator/ JET), Nitric Oxide, SiPAP, O2 Therapy, Medication delivery, high-risk deliveries, and computerized documentation.
QualificationsHigh school diploma or equivalent. After July 1, 1998 graduation from a Registered Respiratory Therapy Program approved by the Joint Review Committee for the Certification of Respiratory Therapy Education Programs (JRCRTE)
Registered Respiratory Therapist (RRT) and Maryland license are required. CPR/BLS required. ACLS/ PALS/ NRP preferred.Certification by the NBRC as a Neonatal/ Pediatric Specialist (NPS) is preferred.Must have knowledge of respiratory care and related equipment as gained in a JRCRTE approved respiratory care program and 3-6 months of experience.
Recent Hospital Experience Is Required.Requires the aptitude to be trained and the knowledge to apply all equipment used in respiratory care.
Proficiency in the use and clinical application of equipment includes the following: mechanical ventilators, extra corporeal membrane oxygenation systems (ECMO) surfactant administration; jet and oscillation ventilation equipment; all nebulization; oxygen, mixed gas systems and administration, positive and negative pressure apparatus cardio pulmonary resuscitation airway management systems and equipment and any appropriate equipment used to treat patients with cardio-pulmonary diseases.In age-specific populations, must be familiar with particular patient populations to which the RRT is assigned.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
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