View source for Ventilator

{{About|one type of machine used to assist breathing|the broader article, on both positive- and negative-pressure devices|Mechanical ventilation<!-- note: "medical respirator" redirects here mainly due to historical confusion-->|respiratory PPE worn on the face|Respirator|ventilation subjects|Ventilation (disambiguation){{!}}Ventilation}}
{{Other uses}}
{{Short description|Device that provides mechanical ventilation to the lungs}}
{{Infobox medical equipment
| name = Medical ventilator
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| image = Hamilton C6.jpg
| caption = Hamilton C6 Ventilator
| alt = 
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| specialty = Pulmonology
| intervention = 
| MedlinePlus = 
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A '''ventilator''' is a type of [[breathing apparatus]], a class of [[health technology|medical technology]] that provides [[mechanical ventilation]] by moving breathable air into and out of the [[lungs]], to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators may be [[computer]]ized [[microprocessor control|microprocessor-controlled]] machines, but patients can also be ventilated with a simple, hand-operated [[bag valve mask]].  Ventilators are chiefly used in [[intensive-care medicine]], [[home care]], and [[emergency medicine]] (as standalone units) and in [[anesthesiology]] (as a component of an [[anesthesia machine]]).

Ventilators are sometimes called "respirators", a term commonly used for them in the 1950s (particularly the [[Forrest Bird#Mechanical ventilators|"Bird respirator"]]). However, contemporary medical terminology uses the word "[[respirator]]" to refer to a face-mask that protects wearers against hazardous airborne substances.<ref>
{{cite journal
 |author= Center for Devices and Radiological Health |date= 2019-02-08 |title= Personal Protective Equipment for Infection Control - Masks and N95 Respirators
 |journal= FDA 
 |url= https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm055977.htm
 |archive-url= https://web.archive.org/web/20100304192046/http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/GeneralHospitalDevicesandSupplies/PersonalProtectiveEquipment/ucm055977.htm
 |url-status= dead
 |archive-date= March 4, 2010
 |access-date= 2017-03-08
}}
</ref>

==Function==
[[File:Ventilators.jpg|thumb|A standard setup for a ventilator in a hospital room. The ventilator pushes warm, moist air (or air with increased oxygen) to the patient. Exhaled air flows away from the patient.]]
In its simplest form, a modern [[positive pressure ventilation|positive pressure ventilator]], consists of a compressible [[air]] reservoir or turbine, air and [[oxygen]] supplies, a set of valves and tubes, and a disposable or reusable "patient circuit". The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient. If a turbine is used, the turbine pushes air through the ventilator, with a flow valve adjusting pressure to meet patient-specific parameters. When over pressure is released, the patient will exhale passively due to the [[lung]]s' elasticity, the exhaled air being released usually through a [[one-way valve]] within the patient circuit called the patient manifold.

Ventilators may also be equipped with monitoring and alarm systems for patient-related parameters (e.g., pressure, volume, and flow) and ventilator function (e.g., air leakage, power failure, mechanical failure), backup batteries, oxygen tanks, and remote control. The pneumatic system is nowadays often replaced by a computer-controlled [[turbopump]].

=== Ventilator pressures labeled ===
[[File:Ventilator pressures labeled.png|thumb|Ventilator pressures labeled]]
Modern ventilators are electronically controlled by a small [[embedded system]] to allow exact adaptation of pressure and flow characteristics to an individual patient's needs. Fine-tuned ventilator settings also serve to make ventilation more tolerable and comfortable for the patient. In Canada and the United States, [[respiratory therapists]] are responsible for tuning these settings, while biomedical technologists are responsible for the maintenance.  In the United Kingdom and Europe the management of the patient's interaction with the ventilator is done by [[Critical care nursing|critical care]] nurses.

The patient circuit usually consists of a set of three durable, yet lightweight plastic tubes, separated by function (e.g. inhaled air, patient pressure, exhaled air). Determined by the type of ventilation needed, the patient-end of the circuit may be either noninvasive or invasive.

Noninvasive methods, such as [[Continuous positive airway pressure|continuous positive airway pressure (CPAP)]] and [[non-invasive ventilation]], which are adequate for patients who require a ventilator only while sleeping and resting, mainly employ a nasal mask. Invasive methods require [[intubation]], which for long-term ventilator dependence will normally be a [[tracheotomy]] cannula, as this is much more comfortable and practical for long-term care than is larynx or nasal intubation.<gallery widths="300" heights="200">
File:Closed circuit ventilators.gif|Closed circuit ventilator system are used to provide O<sub>2</sub>-enriched air to the patient.
File:Open circuit ventilator.gif|Open circuit ventilators are used to provide normal ambient air with normal O<sub>2</sub> ratio to the patient.
File:Biology of ventilation.gif|At physiological level, ventilators renew the [[Atmosphere of Earth|air]] and its critical [[Breathing|O<sub>2</sub>/CO<sub>2</sub> exchange]] to [[pulmonary alveolus]]. 
</gallery>

=== Safety-critical system ===
As failure may result in death, mechanical ventilation systems are classified as [[safety-critical system]]s, and precautions must be taken to ensure that they are highly reliable, including their [[power-supply|power supply]]. Ventilatory failure is the inability to sustain a sufficient rate of CO<sub>2</sub> elimination to maintain a stable pH without mechanical assistance, muscle fatigue, or intolerable dyspnea.<ref>Marini, John J., Dries, David J... ''Critical Care Medicine: The Essentials and More''. 5th Edition. Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103 USA:Lippincott Williams & Wilkins; 2019.  Available from: Books@Ovid at http://ovidsp.ovid.com.  Accessed January 12, 2021.</ref> Mechanical ventilators are therefore carefully designed so that no [[single point of failure]] can endanger the patient. They may have manual backup mechanisms to enable hand-driven respiration in the absence of power (such as the mechanical ventilator integrated into an [[anaesthetic machine]]). They may also have safety valves, which open to atmosphere in the absence of power to act as an anti-suffocation valve for spontaneous breathing of the patient. Some systems are also equipped with compressed-gas tanks, air compressors or backup batteries to provide ventilation in case of power failure or defective gas supplies, and methods to operate or call for help if their mechanisms or software fail.<ref>{{cite news |last1=Johnson |first1=Carolyn Y. |last2=Cha |first2=Ariana Eunjung |title=The dark side of ventilators: Those hooked up for long periods face difficult recoveries |url=https://www.washingtonpost.com/health/2020/04/03/coronavirus-survivors-recovery |access-date=8 April 2020 |newspaper=[[The Washington Post]] |language=en}}</ref>  [[Power outage|Power failures]], such as during a natural disaster, can create a life-threatening emergency for people using ventilators in a home care setting.<ref name=":3">{{Cite web|last=Huff|first=Charlotte|date=2021-05-12|title=The People in Danger the Minute the Power Goes Out|url=https://slate.com/technology/2021/05/climate-change-power-grid-home-medical-care-electricity.html|access-date=2021-05-18|website=[[Slate (magazine)|Slate]]|language=en}}</ref>  Battery power may be sufficient for a brief loss of electricity, but longer power outages may require going to a hospital.<ref name=":3" />

== History ==
{{more citations needed section|date=April 2020}}
The history of mechanical ventilation begins with various versions of what was eventually called the [[Negative pressure ventilator|iron lung]], a form of noninvasive negative-pressure ventilator widely used during the [[Poliomyelitis|polio]] epidemics of the twentieth century after the introduction of the "Drinker respirator" in 1928, improvements introduced by [[John Haven Emerson]] in 1931,<ref name="pmid18189086">{{cite journal |last=Geddes |first=LA |year=2007 |title=The history of artificial respiration |journal=IEEE Engineering in Medicine and Biology Magazine |pmid=18189086 |doi=10.1109/EMB.2007.907081 |volume=26 |issue=6 |pages=38–41|bibcode=2007IEMBM..26f..38G |s2cid=24784291 }}</ref> and the [[Both respirator]] in 1937. Other forms of noninvasive ventilators, also used widely for polio patients, include [[Biphasic Cuirass Ventilation]], the [[rocking bed]], and rather primitive positive pressure machines.<ref name="pmid18189086" />

In 1949, John Haven Emerson developed a mechanical assister for anaesthesia with the cooperation of the anaesthesia department at [[Harvard University]]. Mechanical ventilators began to be used increasingly in anaesthesia and intensive care during the 1950s. Their development was stimulated both by the need to treat polio patients and the increasing use of [[muscle relaxant]]s during anaesthesia. Relaxant drugs paralyse the patient and improve operating conditions for the surgeon but also paralyse the respiratory muscles. In 1953 [[Bjørn Aage Ibsen]] set up what became the world's first Medical/Surgical ICU utilizing muscle relaxants and controlled ventilation.<ref>{{cite journal 
|author1=P. G. Berthelsen |author2=M. Cronqvist |title=The first intensive care unit in the world: Copenhagen 1953 
|journal=Acta Anaesthesiologica Scandinavica
|year=2003
|volume=47
|issue=10
|pages=1190–1195
|doi=10.1046/j.1399-6576.2003.00256.x|pmid=14616314 |s2cid=40728057 }}</ref>

[[File:East-Radcliffe Respirator Wellcome L0001305.jpg|alt=A machine with hoses and gauges on a wheeled cart|thumb|An East-Radcliffe respirator model from the mid-twentieth century]]
In the United Kingdom, the East Radcliffe and Beaver models were early examples. The former used a [[Sturmey-Archer]] bicycle [[hub gear]] to provide a range of speeds, and the latter an automotive [[windscreen wiper]] motor to drive the bellows used to inflate the lungs.<ref name="pmid13320798">{{cite journal |vauthors=Russell WR, Schuster E, Smith AC, Spalding JM |date=April 1956 |title=Radcliffe respiration pumps |journal=[[The Lancet]] |pmid=13320798 |doi=10.1016/s0140-6736(56)90597-9 |volume=270 |issue=6922 |pages=539–41}}</ref> Electric motors were, however, a problem in the operating theatres of that time, as their use caused an explosion hazard in the presence of flammable anaesthetics such as [[diethyl ether|ether]] and [[cyclopropane]]. In 1952, Roger Manley of the [[Westminster Hospital]], London, developed a ventilator which was entirely gas-driven and became the most popular model used in Europe. It was an elegant design, and became a great favourite with European anaesthetists for four decades, prior to the introduction of models controlled by electronics. It was independent of electrical power and caused no explosion hazard. The original Mark I unit was developed to become the Manley Mark II in collaboration with the Blease company, which manufactured many thousands of these units. Its principle of operation was very simple, an incoming gas flow was used to lift a weighted bellows unit, which fell intermittently under gravity, forcing breathing gases into the patient's lungs. The inflation pressure could be varied by sliding the movable weight on top of the bellows. The volume of gas delivered was adjustable using a curved slider, which restricted bellows excursion. Residual pressure after the completion of expiration was also configurable, using a small weighted arm visible to the lower right of the front panel. This was a robust unit and its availability encouraged the introduction of positive pressure ventilation techniques into mainstream European anesthetic practice.

The 1955 release of [[Forrest Bird]]'s "Bird Universal Medical Respirator" in the United States changed the way mechanical ventilation was performed, with the small green box becoming a familiar piece of medical equipment.<ref name=AboutBird>{{cite web |last=Bellis |first=Mary |title=Forrest Bird invented a fluid control device, respirator & pediatric ventilator |publisher=About.com |url=http://inventors.about.com/od/bstartinventors/a/Forrest_Bird.htm |archive-url=https://archive.today/20130101223131/http://inventors.about.com/od/bstartinventors/a/Forrest_Bird.htm |url-status=dead |archive-date=January 1, 2013 |access-date=2009-06-04 }}</ref> The unit was sold as the Bird Mark 7 Respirator and informally called the "Bird". It was a [[Pneumatics|pneumatic]] device and therefore required no [[electrical power]] source to operate.

In 1965, the Army Emergency Respirator was developed in collaboration with the Harry Diamond Laboratories (now part of the [[United States Army Research Laboratory|U.S. Army Research Laboratory]]) and [[Walter Reed Army Institute of Research]]. Its design incorporated the principle of fluid amplification in order to govern pneumatic functions. Fluid amplification allowed the respirator to be manufactured entirely without moving parts, yet capable of complex resuscitative functions.<ref>{{cite book |date=1965 |title=Army R, D & A. |publisher=Development and Engineering Directorate, HQ, U.S. Army Materiel Development and Readiness Command |url=https://books.google.com/books?id=sTrO77DCgkwC&q=Army+Emergency+Respirator,+HDL&pg=RA6-PA33}}</ref> Elimination of moving parts increased performance reliability and minimized maintenance.<ref name=":0">{{cite journal |last1=Mon |first1=George |last2=Woodward |first2=Kenneth E. |last3=Straub |first3=Henrik |last4=Joyce |first4=James |last5=Meyer |first5=James |date=1966 |title=Fluid Amplifier-Controlled Medical Devices |journal=SAE Transactions |issn=0096-736X |jstor=44554326 |volume=74 |pages=217–222}}</ref> The mask is composed of a [[poly(methyl methacrylate)]] (commercially known as [[Poly(methyl methacrylate)|Lucite]]) block, about the size of a pack of cards, with machined channels and a cemented or screwed-in cover plate.<ref name=":1">{{cite web |title=Army Research and Development Monthly Magazine |volume=6 |number=9 |url=https://asc.army.mil/docs/pubs/alt/archives/1965/Sep_1965.PDF}}</ref> The reduction of moving parts cut manufacturing costs and increased durability.<ref name=":0" />

The bistable fluid amplifier design allowed the respirator to function as both a respiratory assistor and controller. It could functionally transition between assistor and controller automatically, based on the patient's needs.<ref name=":1" /><ref name=":0" /> The dynamic pressure and turbulent jet flow of gas from inhalation to exhalation allowed the respirator to synchronize with the breathing of the patient.<ref>{{cite web |date=October 1965 |title=Fluid Amplification Symposium |volume=III |url=https://apps.dtic.mil/dtic/tr/fulltext/u2/623457.pdf|archive-url=https://web.archive.org/web/20191105192113/https://apps.dtic.mil/dtic/tr/fulltext/u2/623457.pdf|archive-date=November 5, 2019}}</ref>

Intensive care environments around the world revolutionized in 1971 by the introduction of the first SERVO 900 ventilator (Elema-Schönander), constructed by [[Björn Jonson]]. It was a small, silent and effective electronic ventilator, with the famous SERVO feedback system controlling what had been set and regulating delivery. For the first time, the machine could deliver the set volume in volume control ventilation.

===Microprocessor ventilators===
[[Microprocessor control]] led to the third generation of [[intensive care unit]] (ICU) ventilators, starting with the [[Drägerwerk|Dräger]] EV-A<ref>{{cite web |title=Dräger - die Geschichte des Unternehmens |website=Dräger |url=https://www.draeger.com/Corporate/Content/draeger_die_geschichte_des_unternehmens.pdf |access-date=March 22, 2020}}</ref> in 1982 in Germany which allowed monitoring the patient's [[Breathing#Respiratory disorders|breathing curve]] on an [[LCD monitor]]. One year later followed [[Puritan Bennett]] 7200 and Bear 1000, SERVO 300 and Hamilton Veolar over the next decade. [[Microprocessors]] enable customized gas delivery and monitoring, and mechanisms for gas delivery that are much more responsive to patient needs than previous generations of mechanical ventilators.<ref>{{cite journal |last=Kacmarek |first=Robert M. |date=August 2011 |title=The Mechanical Ventilator: Past, Present, and Future |journal=[[Respiratory Care (journal)|Respiratory Care]] |issn=0020-1324 |doi=10.4187/respcare.01420 |volume=56 |issue=8 |pages=1170–1180|pmid=21801579 |doi-access=free }}</ref>
<!--
In 1991, the SERVO 300 ventilator series was introduced, enabling treatment of all patient categories from adult to neonate with one ventilator. The SERVO 300 series had a unique gas delivery system with rapid flow-triggering response.

In 1999, the new LTV (Laptop Ventilator) Series was significantly smaller than other ventilators of the time, weighing approximately 6.4 kg (14 lb) and about the size of a laptop computer. This design kept the same functionality of the in-hospital ventilators while allowing patient mobility.

A modular concept was introduced with SERVO-i in 2001, with one ventilator model throughout the ICU department, instead of a fleet of various models and brands for different user needs. With the modular ventilator, ICU departments could choose the modes and options, software and hardware needed for a particular patient category.

In the twenty-first century small portable ventilators like the SAVe II have been manufactured for forward combat use.<ref name=Automedx>{{cite web |title=SAVe II The Smallest and Easiest to Use Pre-hospital Ventilator |publisher=Automedx |website=Automedx |url=http://automedx.com/save-ii/ |access-date=March 31, 2019}}</ref>-->

== Open-source ventilators ==
{{Main|Open-source ventilator}}
An [[Open source|open-source]] ventilator is a disaster-situation ventilator made using a freely-licensed design, and ideally, freely-available components and parts. Designs, components, and parts may be anywhere from completely reverse-engineered to completely new creations, components may be [[Jury rigging|adaptations]] of various inexpensive existing products, and special hard-to-find and/or expensive parts may be 3D printed instead of sourced.<ref>{{cite web |last=Bender |first=Maddie |date=2020-03-17 |title=People Are Trying to Make DIY Ventilators to Meet Coronavirus Demand |website=[[Vice (magazine)|Vice]] |url=https://www.vice.com/en/article/people-are-trying-to-make-diy-ventilators-to-meet-coronavirus-demand/ |access-date=2020-03-21}}</ref><ref>{{cite web |last=Toussaint |first=Kristin |date=2020-03-16 |title=These Good Samaritans with a 3D printer are saving lives by making new respirator valves for free |website=Fast Company |url=https://www.fastcompany.com/90477940/these-good-samaritans-with-a-3d-printer-are-saving-lives-by-making-new-respirator-valves-for-free |access-date=2020-03-17}}</ref>

During the 2019–2020 [[COVID-19 pandemic]], various kinds of ventilators have been considered. Deaths caused by [[Coronavirus disease 2019|COVID-19]] have occurred when the most severely infected experience [[acute respiratory distress syndrome]], a widespread inflammation in the lungs that impairs the lungs' ability to absorb oxygen and expel carbon dioxide. These patients require a capable ventilator to continue breathing.

Among ventilators that might be brought into use for treating people with COVID-19, there have been many concerns. These include current availability,<ref>{{Cite news|url=https://www.npr.org/sections/health-shots/2020/03/14/815675678/as-the-pandemic-spreads-will-there-be-enough-ventilators|title=As The Pandemic Spreads, Will There Be Enough Ventilators?|last=NEIGHMOND|first=PATTI|date=March 14, 2020|newspaper=[[NPR]]|access-date=April 6, 2020}}</ref><ref>{{Cite web|url=https://www.nsmedicaldevices.com/analysis/coronavirus-ventilators-global-demand/|title=880,000 more ventilators needed to cope with coronavirus outbreak, says analyst|last=Parker|first=Thomas|date=March 25, 2020|website=NS Medical Devices|access-date=April 6, 2020}}</ref> the challenge of making more and lower cost ventilators, effectiveness,<ref>{{Cite web|url=https://www.physiciansweekly.com/mortality-rate-of-covid-19-patients-on-ventilators/|title=Mortality rate of COVID-19 patients on ventilators|date=March 30, 2020|website=Physician's Weekly|access-date=April 6, 2020}}</ref> [[functional design]], safety,<ref>{{Cite web|url=https://www.aarc.org/wp-content/uploads/2017/03/Issue-Paper-Safe-Initiation-and-Management-of-Mechanical-Ventilation.pdf|title=SAFE INITIATION AND MANAGEMENT OF MECHANICAL VENTILATION|date=2016|website=American Association for Respiratory Care|access-date=April 6, 2020}}</ref><ref>{{Cite web|url=https://www.ecri.org/components/HDJournal/Pages/Mechanical-Ventilation-of-SARS-Patients-2003-SARS-Outbreak.aspx|title=Mechanical Ventilation of SARS Patients: Lessons from the 2003 SARS Outbreak|date=February 18, 2020|website=ECRI|access-date=April 6, 2020}}</ref> portability,<ref>{{Cite web|url=https://techcrunch.com/2020/03/30/medtronic-is-sharing-its-portable-ventilator-design-specifications-and-code-for-free-to-all/|title=Medtronic is sharing its portable ventilator design specifications and code for free to all|last=Etherington|first=Darrell|date=March 30, 2020|website=TechCrunch|access-date=April 6, 2020}}</ref> suitability for infants,<ref>{{Cite web|url=https://www.bemesonline.com/bird-v-i-p-standard-infant-and-pediatric-ventilator/|title=Bird V.I.P Standard Infant and Pediatric Ventilator|website=BemesOnline|access-date=April 6, 2020}}</ref> assignment to treat other illnesses, and operator training.<ref>{{Cite journal |title=Ventilator Safety|last=Williams|first=LM|date=January 30, 2020 |journal=StatPearls [Internet] |pmid = 30252300}}</ref> Deploying the best possible mix of ventilators can save the most lives.

Although not formally open-sourced, the Ventec V+ Pro ventilator was developed in April 2020 as a shared effort between [[Ventec Life Systems]] and [[General Motors]], to provide a rapid supply of 30,000 ventilators capable of treating COVID-19 patients.<ref>{{Cite news|url=https://www.bloomberg.com/news/articles/2020-04-08/gm-secures-almost-500-million-u-s-contract-to-make-ventilators|title=GM Lands U.S. Ventilator Contract Worth Almost $500 Million|last=Welch|first=David|date=April 8, 2020|newspaper=[[Bloomberg News|Bloomberg]]}}</ref><ref>{{Cite web|url=https://www.cbs.com/shows/60_minutes/video/2k2z4ed0BCIM83C6xBVtHgi9E3bEAwuL/on-the-line-outbreak-science-the-unseen-enemy/|title=60 Minutes|date=April 26, 2020|website=cbs.com|at=On the Line, Outbreak Science, The Unseen Enemy, S52 E30, At 7 minutes 10 seconds}}</ref>

A major worldwide design effort began during the [[COVID-19 pandemic|2019-2020 coronavirus pandemic]] after a [[Hackaday]] project was started,<ref>{{cite web |last=Coetzee |first=Gerrit |date=2020-03-12 |title=Ultimate Medical Hackathon: How Fast Can We Design And Deploy An Open Source Ventilator? |website=Hackaday |url=https://hackaday.com/2020/03/12/ultimate-medical-hackathon-how-fast-can-we-design-and-deploy-an-open-source-ventilator/ |access-date=2020-03-17}}</ref>{{Primary source inline|date=March 2020}} in order to respond to [[COVID-19 pandemic related shortages|expected ventilator shortages]] causing higher mortality rate among severe patients.

On March 20, 2020, the [[Health Service Executive|Irish Health Service]]<ref>{{Cite web|url=https://www.forbes.com/sites/alexandrasternlicht/2020/03/18/theres-a-shortage-of-ventilators-for-coronavirus-patients-so-this-international-group-invented-an-open-source-alternative-thats-being-tested-next-week/|title=There's A Shortage Of Ventilators For Coronavirus Patients, So This International Group Invented An Open Source Alternative That's Being Tested Next Week|last=Sternlicht|first=Alexandra|website=[[Forbes]]|language=en|access-date=2020-03-21}}</ref> began reviewing designs.<ref>{{Cite web|url=https://thehill.com/policy/technology/488637-irish-health-officials-to-review-3d-printed-ventilator|title=Irish health officials to review 3D-printed ventilator|last=Rodrigo|first=Chris Mills|date=2020-03-20|website=[[The Hill (newspaper)|The Hill]]|language=en|access-date=2020-03-21}}</ref> A prototype is being designed and tested in [[Colombia]].<ref>{{Cite web|url=https://colombiareports.com/colombia-close-to-having-worlds-first-open-source-and-low-cost-ventilator-to-beat-covid-19/|title=Colombia close to having world's first open source and low-cost ventilator to 'beat Covid-19'|last=colombiareports|date=2020-03-21|website=Colombia News {{!}} Colombia Reports|language=en-US|access-date=2020-03-21}}</ref>

The Polish company Urbicum reports successful testing<ref>{{Cite web|url=https://ventilaid.org|title=VentilAid -open-source ventilator, that can be made anywhere locally|last=urbicum|date=2020-03-23|website=VentilAid|language=en-US|access-date=2020-03-23}}</ref> of a 3D-printed open-source prototype device called VentilAid. The makers describe it as a last resort device when professional equipment is missing. The design is publicly available.<ref>{{Cite web|url=https://gitlab.com/Urbicum/ventilaid|title=GitLab - VentilAid / VentilAid|last=urbicum|date=2020-03-23|website=VentilAid|language=en-US|access-date=2020-03-23}}</ref> The first Ventilaid prototype requires compressed air to run.

On March 21, 2020, the [[New England Complex Systems Institute]] (NECSI) began maintaining a strategic list of open source designs being worked on.<ref>{{Cite web|url=https://medium.com/@brucefenton/ventilator-project-update-march-21th-2020-bd2ef9d587e0|title=Ventilator Project Update: March 21th, 2020|last=Fenton|first=Bruce|date=March 21, 2020|website=Medium|access-date=March 27, 2020}}</ref><ref>{{Cite web|url=https://github.com/PubInv/covid19-vent-list|title=A list projects to make emergency ventilators in response to COVID-19, focusing on free-libre open source|website=GitHub|access-date=March 27, 2020}}</ref> The NECSI project considers manufacturing capability, medical safety and need for treating patients in various conditions, speed dealing with legal and political issues, logistics and supply.<ref name=":2">{{Cite web|url=https://medium.com/@brucefenton/we-need-ventilators-we-need-you-to-help-build-them-30805e5ee2ea|title=We need Ventilators - We Need You to Help Get Them Built|last=Fenton|first=Bruce|date=March 14, 2020|website=Medium|access-date=March 27, 2020}}</ref> NECSI is staffed with scientists from Harvard and MIT and others who have an understanding of pandemics, medicine, systems, risk, and data collection.<ref name=":2" />

The [[University of Minnesota|University of Minnesota Bakken Medical Device Center]] initiated a collaboration with various companies to bring a ventilator alternative to the market that works as a one-armed [[robot]] and replaces the need for manual ventilation in emergency situations. The ''Coventor'' device was developed in a very short time and approved on April 15, 2020, by the [[Food and Drug Administration|FDA]], only 30 days after conception. The mechanical ventilator is designed for use by trained medical professionals in [[intensive care unit]]s and easy to operate. It has a compact design and is relatively inexpensive to manufacture and distribute. The cost is only about 4% of a normal ventilator. In addition, this device does not require pressurized oxygen or air supply, as is normally the case. A first series is manufactured by [[Boston Scientific]]. The plans are to be freely available online to the general public without royalties.<ref name=Coventor>{{cite web|title=FDA approves production of device designed at University of Minnesota to help COVID-19 patients breathe|website=startribune.com|publisher=Star Tribune|url=https://www.startribune.com/fda-approves-production-of-device-designed-at-university-of-minnesota-to-help-covid-19-patients-breathe/569673172/|last=Joe Carlson|date=2020-04-16|language=en}}</ref><ref name=Coventor2>{{cite web|title=FDA authorizes production of a new ventilator that costs up to 25x less than existing devices|website=techcrunch.com|publisher=Verizon Media|url=https://techcrunch.com/2020/04/15/fda-authorizes-production-of-a-new-ventilator-that-costs-up-to-25x-less-than-existing-devices/|last=Darrell Etherington|date=2020-04-16|language=en}}</ref>

==COVID-19 pandemic==
{{see also|List of countries by hospital beds#2020 coronavirus pandemic}}
<!---[[File:DSC 0509-Edit-cr.jpg|thumb|NASA Jet Propulsion Laboratory designed ventilator "VITAL"]]--->
The [[COVID-19 pandemic]] has led to [[COVID-19 pandemic related shortages|shortages of essential goods and services]] - from hand sanitizers to masks to beds to ventilators.{{cn|date=November 2021}} Countries around the world have experienced shortages of ventilators.<ref>{{Cite web|url=https://healthmanagement.org/c/icu/news/allocating-ventilators-in-a-pandemic|title=Allocating Ventilators in a Pandemic|date=2020-03-24|website=healthmanagement.org|language=en-US|access-date=2020-03-25}}</ref> Furthermore, fifty-four governments, including many in Europe and Asia, imposed restrictions on medical supply exports in response to the coronavirus pandemic.<ref>{{Cite web|url=https://www.politico.com/newsletters/morning-trade/2020/03/24/export-restrictions-threaten-ventilator-availability-786327|title=Export restrictions threaten ventilator availability|date=2020-03-24|website=politico.com|language=en-US|access-date=2020-03-25}}</ref> 

The capacities to produce and distribute [[Mechanical ventilation|invasive]] and [[Non-invasive ventilation|non-invasive ventilators]] vary by country. In the initial phase of the pandemic, China ramped up its production of ventilators, secured large amounts of donations from private firms, and dramatically increased imports of medical devices worldwide. As a result, the country accumulated a reservoir of ventilators throughout the pandemic in Wuhan. Western Europe and the United States, which outrank China in their production capacities, suffered a shortage of supplies due to the sudden and scattered outbreaks throughout the North American and European continents. Finally, [[Central Asia]], [[Africa]], and [[Latin America]], which depend almost entirely on importing ventilators, suffered severe shortages of supplies.{{cn|date=November 2021}}

Healthcare policy-makers have met serious challenges to estimate the number of ventilators needed and used during the pandemic. When data is often not available for ventilators specifically, estimates are sometimes made based on the number of [[intensive care unit]] beds available, which often contain ventilators.<ref>{{cite web|url=https://www.brookings.edu/blog/up-front/2020/03/24/is-indias-health-infrastructure-equipped-to-handle-an-epidemic/|title=COVID-19 {{!}} Is India's health infrastructure equipped to handle an epidemic?|publisher=Brookings Institution|author1=Prachi Singh|author2= Shamika Ravi|author3=Sikim Chakraborty |date=2020-03-24|access-date=2020-06-07}}</ref>

===United States===
In 2006, president [[George W. Bush]] signed the [[Pandemic and All-Hazards Preparedness Act]], which created the [[Biomedical Advanced Research and Development Authority]] (BARDA) within the [[United States Department of Health and Human Services]]. In preparation for a possible epidemic of respiratory disease, the newly created office awarded a $6 million contract to [[Newport Medical Instruments]], a small company in California, to make 40,000 ventilators for under $3,000 apiece. In 2011, Newport sent three prototypes to the [[Centers for Disease Control]]. In 2012, [[Covidien]], a $12 billion/year medical device manufacturer, which manufactured more expensive competing ventilators, bought Newport for $100 million. Covidien delayed and in 2014 cancelled the contract.

BARDA started over again with a new company, [[Philips]], and in July 2019, the [[FDA]] approved the Philips ventilator, and the government ordered 10,000 ventilators for delivery in mid-2020.<ref name="Aura">{{cite news
| author = Nicholas Kulish, Sarah Kliff and Jessica Silver-Greenberg
| title = The U.S. Tried to Build a New Fleet of Ventilators. The Mission Failed. As the coronavirus spreads, the collapse of the project helps explain America's acute shortage.
| newspaper = New York Times
| date = March 29, 2020
| url =  https://www.nytimes.com/2020/03/29/business/coronavirus-us-ventilator-shortage.html
}}</ref>

On April 23, 2020, [[NASA]] reported building, in 37 days, a successful COVID-19 ventilator, named VITAL ("Ventilator Intervention Technology Accessible Locally"). On April 30, NASA reported receiving fast-track approval for emergency use by the [[United States Food and Drug Administration]] for the new ventilator.<ref name="NASA-20200430">{{cite news |last1=Inclán |first1=Bettina |last2=Rydin |first2=Matthew |last3=Northon |first3=Karen |last4=Good |first4=Andrew |title=NASA-Developed Ventilator Authorized by FDA for Emergency Use |url=https://www.jpl.nasa.gov/news/news.php?feature=7655 |date=30 April 2020 |work=[[NASA]] |access-date=1 May 2020 }}</ref><ref name="NASA-20200423">{{cite news |last1=Good |first1=Andrew |last2=Greicius |first2=Tony |title=NASA Develops COVID-19 Prototype Ventilator in 37 Days |url=https://www.nasa.gov/feature/jpl/nasa-develops-covid-19-prototype-ventilator-in-37-days |date=April 23, 2020 |work=[[NASA]] |access-date=April 24, 2020 }}</ref><ref name="SPC-20200424">{{cite news |last=Wall |first=Mike |title=NASA engineers build new COVID-19 ventilator in 37 days |url=https://www.space.com/nasa-covid-19-ventilator-passes-test.html |date=April 24, 2020 |work=[[Space.com]] |access-date=April 24, 2020 }}</ref> On May 29, NASA reported that eight manufacturers were selected to manufacture the new ventilator.<ref name="NASA-20200529">{{cite news |last1=Inclán |first1=Bettina |last2=Rydin |first2=Matthew |last3=Northon |first3=Karen |last4=Good |first4=Andrew |title=Eight US Manufacturers Selected to Make NASA COVID-19 Ventilator |url=https://www.jpl.nasa.gov/news/news.php?feature=7668 |date=May 29, 2020 |work=[[NASA]] |access-date=May 29, 2020 }}</ref>

<gallery>
File:PIA23891-NASA-VITAL-Team-20200430.jpg|Engineering team
File:PIA23775-NASA-VITAL-Ventilator-20200430.jpg|Front view
File:DSC_0509-Edit-cr.jpg|Side view
File:PIA24034-VITAL-Ventilators-20200804.jpg|Stacks of ventilator prototypes
</gallery>

===Canada===

On April 7, 2020, Prime Minister Justin Trudeau announced that the Canadian Federal Government would be sourcing thousands of 'Made in Canada' ventilators. A number of organisations responded from across the country.<ref>{{Cite web|url=https://www.ic.gc.ca/eic/site/icgc.nsf/eng/07711.html|title = Made in Canada ventilators| date=26 November 2020|publisher=Government of Canada }}</ref> They delivered a large quantity of ventilators to the National Emergency Strategic Stockpile. From west to east, the companies include Canadian Emergency Ventilators Inc, Bayliss Medical Inc, Thornhill Medical, Vexos Inc, and CAE Inc.

==See also==
* [[Artificial ventilation]]
* [[Iron lung]] (Tank ventilator)
* [[Bragg-Paul Pulsator|Bragg-Paul ventilator]]
* [[Liquid ventilator]]
* [[Open-source hardware]]
* [[Respiratory therapy]]
* [[SensorMedics high-frequency oscillatory ventilator]]
* [[Two-balloon experiment]]
* [[List of ventilator manufacturers]]
* [[Robert Martensen]]
* [[Joseph Stoddart]]

==References==
{{Reflist}}

==External links==
*{{Commonscatinline}}
*{{wiktionary-inline}}

{{Breathing apparatus|medical}}
{{Mechanical ventilation}}
{{Authority control}}

[[Category:Respiratory therapy]]
[[Category:Medical pumps]]