Jimma University (JU)

Jimma Institute of Technology (JiT)

Design of low cost, rapidly producible and affordable mechanical ventilator for COVD-19
Patients

Proposal Document submitted to: Vice President for research and community service

Werkinesh Hailu (Project Principal Investigator)

Co-Investigators

1. Alemitu Homa
2. Shimelis Nigusu
3. Addisu Kidanamarium
4. Solomon W/Tsadik
5. Abel Worku

May, 2020

Jimma- Ethiopia
Executive Summary

Corona virus disease 2019 (COVID-19), caused by a novel corona virus (SARS-CoV-2), is in part
so dangerous because it threatens to overwhelm our medical infrastructure at the regional level,
causing spikes in mortality rates. At the end of 2019, a series of pneumonia cases of unknown
cause emerged in Wuhan (Hubei, China). Within the e x i s t i n g medical infrastructure, there are
critical technologies that are generally available, but simply do not exist in a high enough density
to handle the excessive volume of patients associated with pandemics. Thus, people die
unnecessarily throughout the world because of a combination of COVID-19 infections and the
lack of access to some of these technologies.

Mechanical ventilators are essential for treating both influenza and COVID-19 patients in
severe acute respiratory failure. Past studies have shown that intensive care units (ICUs) will
not have sufficient resources to treat all patients requiring ventilator support during a massive
pandemic. The ventilators used in modern hospitals are highly functionally and technologically
sophisticated, their acquisition costs are correspondingly high (as muchas$30,000). High costs
render such technologically sophisticated mechanical prohibitively expensive for use in
resource-poor countries. Additionally, these ventilators are often fragile and vulnerable during
continued use, requiring costly service contracts from the manufacturer.
In this proposed solution a mechanical ventilator which is robust, low cost and rapidly produced
with locally manufacturing firm’s setups will be designed. The proposed solution is a low cost
and portable ventilator that provides positive pressure ventilation for covid-19 patients who
needs assistance during breathing complication due to respiratory truck damages. The device
consists of mechanical, electrical and control units to delivery medical gases like oxygen and
air to the patients suffering from breathing difficulties due to corona disease. This proposed
solution uses positive pressure to blow air into the lung of patient. The amount of air the patients
receives can be monitored and controlled by sensors and valves connected into the system. The
overall of this device will be finalized within two months with the total budget of 159,423ETB.
 1. Introduction

1.1 Background of the Project

Corona virus disease 2019 (COVID-19), caused by a novel corona virus (SARS-CoV-2), is in
part so dangerous because it threatens to overwhelm our medical infrastructure at the regional
level, causing spikes in mortality rates. At the end of 2019, a series of pneumonia cases of
unknown cause emerged in Wuhan (Hubei, China) [1]. A few weeks later, in January 2020, deep
sequencing analysis from lower respiratory tract samples identified a novel virus severe acute
respiratory syndrome corona virus 2 (SARS-CoV-2) as causative agent for that observed
pneumonia cluster [2]. On February 11th, 2020, the World Health Organization (WHO)
Director-General, Dr. Tedros Adhanom Ghebreyesus, named the disease caused by the SARS-
CoV-2 as “COVID-19”, and by March 11th, 2020 when the number of countries involved was
114, with more than 118,000 cases and over 4000 deaths, the WHO declared the pandemic status
[3]. Within the medical infrastructure, there are critical technologies that are generally available,
but simply do not exist in a high enough density to handle the excessive volume of patients
associated with pandemics. Thus, people die unnecessarily throughout the world because of a
combination of COVID-19 infections and the lack of access to some of these technologies.
Ventilators are an example of technologies that are currently in critical short supply.
Mechanical ventilators are essential for treating both influenza and COVID-19 patients in
severe acute respiratory failure. Past studies have shown that intensive care units (ICUs) will
not have sufficient resources to treat all patients requiring ventilator support during a massive
pandemic.

These are machines which mechanically assist patients inspire and exhale, allowing the exchange
of oxygen and carbon dioxide to occur in the lungs, a process referred to as artificial respiration.
While the ventilators used in modern hospitals in the United States are highly functionally and
technologically sophisticated, their acquisition costs are correspondingly high (as much as
$30,000). High costs render such technologically sophisticated mechanical prohibitively
expensive for use in resource-poor countries. Additionally, these ventilators are often fragile and
vulnerable during continued use, requiring costly service contracts from the manufacturer. In
developing countries, this has led to practices such as sharing of ventilators among hospitals and
purchasing of less reliable refurbished units. Since medical resources in these countries are
concentrated in major urban centers, in some cases rural and outlying areas have no access at a l l
to mechanical ventilators. Therefore the need for an inexpensive transport ventilator is therefore
paramount. Thus motivated by the aforementioned needs, we going to design a mechanical
ventilator which is robust, low cost and rapidly produced with locally manufacturing firm’s
setups.

1.2 Significance of the Project

The project will have very high impact in decreasing COVID-19 mortality by 26% which has
been occurred due to the lack of ventilator machine in health centers as the number of patients
need this machine is very high during pandemic. Up on the successful implementation of this
project, the device will be employed in different health care provider facilities so that it will
reduce the amount of national budget allocated to buy commercial ventilators from global
market. More importantly, as a long term plan, each and every components of the device will be
manufactured in our country despite some sensitive components like different sensors and
processing units will be imported. Once the business venture is started, almost all parts will be
manufactured locally, so that it will have positive financial impact on the country economy and
job creation.

1.3 Statement of the Problem

The COVID-19 outbreak is proving to be an unprecedented disaster to the low high income
countries, like Ethiopia. Within the low income country’s medical infrastructure, there are
critical technologies that are generally available, but simply do not exist in a high enough density
to handle the excessive volume of patients associated with pandemics .Thus, people die
unnecessarily throughout the country because of a combination of COVID-19 infections and the
lack of access to some of these technologies. Additionally, these ventilators are often fragile
and vulnerable during continued use, requiring costly service contracts from the
manufacturer. In developing countries, this has led to practices such as sharing of ventilators
among hospitals and purchasing of less reliable refurbished units. Since medical resources in
these countries are concentrated in major urban centers, in some cases rural and outlying areas
have no access at all to mechanical ventilators. , There is a paramount need for mechanical
ventilator which is low cost, and portable and easily affordable by wider community particular
living in low resource setting areas like rural areas of our country.

1.4 Objectives

1.4.1 General Objective

The main objective of this project is to design a robust, rapidly producible and low cost
mechanical ventilator which assists covid-19 patients during these pandemic.

1.4.2 Specific Objectives

1. To design the mechanical part of the ventilator on Auto CAD software and
real Environment
2. To assemble the Electrical and mechanical components of the device

3. To test the overall functionality of the prototype as per design criteria

4. To evaluate the performance of the final prototype against different

design benchmarks

2. Literature Review

2.1 History of Mechanical Ventilation

The history of mechanical ventilation can be traced back to the term ‘‘artificial respiration’’
identified in Biblical, Egyptian and Greek references. Artificial respiration continued to be
experimented with throughout history until the early 19th century, with the development of the
‘‘iron lung.’’ The iron lung was the first practical mechanical ventilator device that improved
patient outcomes including patient survival during the poliomyelitis epidemics in the mid-1950s
[4, 5].This device was an airtight metal cylindrical tank that required the patient to be placed
inside in the supine position. The patient’s head was exposed out of the device. Negative
pressure then was generated with a mechanical pump to make the patient’s chest rise.
Although this device was lifesaving for many patients, it was very clumsy and impractical based
upon its crude mechanical design. Other devices then spawned from this method of ventilation
included cuirass devices which required the patient upper torso to be encased into a crude shell
or compartment that also worked based upon the negative-pressure model. These devices had
limited utility but some models are still utilized around the world for patients with
neuromuscular diseases who require ventilator support.
The peer-reviewed literature itself is currently limited, but there has been some research on low-
cost ventilation, even if the source is not available. First, a field portable ventilator system for
domestic and military emergency medical response has been conceptually designed, but does not
include enough information to construct it (e.g. the software was written in assembly language
and not shared)91 This article does contain design considerations that may be useful for open
source
designers. A new, compact and low-cost mask respirator concept has been developed and prototyped
successfully. The blower unit was able to provide adequate ventilation to the test lungs. In addition, the
integrated sensor for airway pressure was able to detect airway occlusion and leakages. It is a relatively
low-power device and could be operated wirelessly with batteries. It pro-vides a cross-sectional view
of the blower unit and some details, but again, not enough to be considered full open hardware or to be
easily replicated. It should be noted, however, that many of the components are within RepRap-class 3-
D printing capabilities.

In addition, research has been undertaken on a pre-stage public access ventilator (PAV)

93. The PAV is made up of several low cost technologies including a self-designed turbine and a range
of sensors for differential pressure, flow, and FiO2, FiCO2 and three-axis acceleration
measurements. The PAV was tested under three conditions to show that it was adequate for an
automatic emergency system: 1) pressure-controlled ventilation (PCV), 2) PCV with controlled leakage
and 3) PCV with simulated air-way occlusion. The PAV was tested for and showed effective
ventilation for tidal volume, breathing frequency and inspiratory pressure. Similarly, there has been a
proposal to replace artificial manual breathing unit (AMBU) bags with electric blowers to act as
emergency ventilators

In contrast, another approach is to build a low-cost ventilator utilizing an AMBU bag that is not based
on constant blower use95. The study by Mukaram Shahid showed the AMBU setup was able to
perform all the functions of a conventional commercial ventilator for a far lower cost (<$100US
excluding labor). The automated AMBU device was able to adjust the breathing rate and the volume of
the air, which is comparable to older ventilators. However, it was also able to regulate the inspiration to
expiration ratio and PEEP rate. Shahid’s system comes with two modes:
1) mandatory ventilation (as in older models) and 2) assisted ventilation (as with most current
systems). Thus, the medical personnel can choose to use either the built-in triggering mechanism (assist
boosted mode), which alters the respiration pattern once it detects a change in air pressure, or set a time
interval for the respiration pattern.
 3. Materials and Methods

In this section we briefly explain how the proposed solution works and the materials
required building the body of the product. The proposed solution is a low cost and portable
ventilator that provides positive pressure ventilation for covid-19 patients who needs
assistance during breathing complication due to respiratory truck damages. The device
consists of mechanical, electrical and control units to delivery medical gases like oxygen and
air to the patients suffering from breathing difficulties due to corona disease. This proposed
solution uses positive pressure to blow air into the lung of patient. The amount of air the
patients receives can be monitored and controlled by sensors and valves connected into the
system as indicted in figure 1 below. If the patient’s conditions are fragile, the monitor indicates
alarm to the operator to avoid faults.

Figure 1 the general schematic diagram of proposed solution

Figure 2 the mechanical part that designed on AutoCAD Software

3.1 Lists of Materials Needed

1. Ambu Bag

2. Patient Circuit

3. Arduino Microcontroller

4. LCD Display

5. Motor Drivers

6. Stepper Motors

7. Pressure sensors

8. Oxygen sensors

9. Pot-Meters

10. Gear motor

11. Solenoid Valves

Work Plan: Table 1: Work plan of the project

Activity Time o

May

WK W
1

Team preparation
and organization

Developing specification
for items/components
required
Start developing the
program that integrates all
parts
Design the first prototype

Evaluation and testing of

the design at each stage
Improving the
prototype design
Report preparation
Budget

S.no Items Cost in Birr Justification

Material Cost for working
1 Material Cost 50,000
prototype model
2 Transportation Cost
This is a transportation
cost for purchasing of
From Jimma to Addis materials from Addis
3 persons *3,000(2 round trip) birr
2.1. Ababa (Round trip) via Ababa. We use plane
=18,000
plane transportation due to the
urgent of the project
purpose to be developed.
Subtotal 18,000 ETB
3 Personnel
It is cost paid for two
Perdeim for technical
3.1. 4*206 ETB*30day = 24,720 persons during purchasing
personnel
and collecting of material.
Labor fee paid for wood
3.2. Labor fee 3 persons*171* 20days = 10,260 workers for construction
of casing
Perdeim payment made
for evaluators during the
3.3. Evaluation fee 4 persons *171*20 days = 13,680 first and second round
evaluation according to
the work plan
Perdiem for design and
3.4. Manufacturing 2 persons *171*20 days=6,840
supervision
Perdiem for component
3.5. 2persons*171*15 days=5,130
testers
Perdiem for stakeholder
3.7. 5 persons *171*8days = 6,840
meetings
Preparation of
3.8. 3 persons *171*10days=5,130
operational guideline
3.9 Communication cost 6*100birr=600
Subtotal 74,210 ETB
4 Stationery
4.1. Color Printing Cost 100 pages*10birr = 2000 Cost needed for printing
4.2. Photocopy Cost 3 copy*100pages*2 birr= 600
4.3. Binding Cost 3*40=120 the report
Subtotal 2,720 ETB
5 TOTAL 144,930 ETB
Contingency (10%) 14,493
Grand Total 159,423ETB
4. Expected Outcome.

1. Effective functionality of the deice should be maintained

2. Continuously reliable during operation

3. Accurate and distinctive output for every setting

4. Proper patient’s safety should be achieved

5. Easily manufactured in local manufacturing firms setups

5. References

1. H. Güler and F. Ata, "The intelligent tidal volume control," National Conference on

Electrical, Electronics and Computer Engineering, Bursa, 2010, pp.229-233.

2. L. D'Orsi, A. Borri and A. De Gaetano, "Modelling the ventilator-patient interaction: A

pressure-cycled control strategy," 2017 IEEE 56th Annual Conferenceon Decision and

Control(CDC),Melbourne,VIC,2017,pp.5032- 5037,D10.1109/CDC.2017.8264404

3. R. Robert, P. Micheau, O. Avoine, B. Beaudry, A. Beaulieu and H. Walti, "A Regulator

for Pressure-Controlled Total-Liquid Ventilation," in IEEE Transactions on Biomedical

Engineering, vol. 57, no. 9, pp. 2267-2276, Sept. 2010,D10.1109/TBME.2009.2031096

4. M. Borrello, "Adaptive Control of a Proportional Flow Valve for Critical Care

Ventilators," 2018 Annual American Control Conference (ACC), Milwaukee, WI, 2018,

pp.104-109,D10.23919/ACC.2018.8431425

5. Pressure Volume Controlled Mechanical Ventilator: Modeling and Simulation Fikret

YALÇINKAYA1, Mustafa E. YILDIRIM 2, Hamza ÜNSAL3, Kırıkkale University,

Faculty of Engineering, Department of Electrical & Electronics Engineering, 71450,

Kırıkkale,Turkey
6. K.Y.Volyanskyy, W.M.HaddadandJ .M.Bailey, "Pressure-andWork-Limited

Neuroadaptive Control for Mechanical Ventilation of Critical Care Patients," in IEEE

Transactions on Neural Networks, vol. 22, no. 4, pp. 614- 626, April

2011,D10.1109/TNN.2011.2109963

7. M.Borrello,"Modelingandcontrolofsystemsforcriticalcareventilation," Proceedings of the

2005, American Control Conference, 2005. Portland, OR, USA, 2005, pp. 2166-2180

vol.3,D10.1109/ACC.2005.1470291