Specifications for simple open source mechanical

ventilator
Julian Botta, Johns Hopkins Emergency Medicine Resident PGY-3
Twitter: @julianbotta

This is a living document intended to give non-clinicians/non-respiratory therapists an idea

of key ventilator features and one proposed simplified design. I encourage other
healthcare professionals who are very familiar with ventilators and their use to give me
feedback using the comments feature to improve these specifications.
I’d like to thank those who have helped me improve this document.

IMPORTANT WARNING: The content discussed in this document is for the design of
a ventilator to be used exclusively by trained medical professionals. Attempting to
use a ventilator or any similar device without medical supervision can result in
death or permanent disability.

PLEASE DO NOT MAKE EDITS TO THE DOCUMENT. YOU MAY MAKE COMMENTS
IF YOU ARE A MEDICAL PROFESSIONAL BUT DO NOT EDIT.
I don’t have time to clean this document up constantly.

Recommended by user Solvaip 3/21:

LINK: Rapidly manufactured ventilator system specification
“A ventilator with lower specifications than this is likely to provide no clinical benefit and
might lead to increased harm, which would be unacceptable for clinicians and would,
therefore, not gain regulatory approval.”

Basic Concepts of design:

Pulmonary ventilation is the exchange of air between the lungs and the ambient
surroundings. Inspiration occurs when the diaphragm and intercostal muscles contract to
expand the thoracic cavity - creating negative gauge pressure that causes ambient air to
enter the lungs. Expiration occurs when the diaphragm relaxes and tissue elasticity causes
the thoracic cavity to contract and expel air. Mechanical ventilation assists natural
respiration by delivering air to the lungs and controlling its release through an endotracheal
tube that is placed through the vocal cords into the trachea.

Mechanical ventilation carries certain risks, which should be considered in the

design of any machine: pneumothorax or alveolar damage can arise from
overpressure. There is also risk of developing ventilator-associated pneumonia, so
care must be taken to keep the ventilator circuit clean. Prolonged assistance with a
mechanical ventilator causes atrophy of diaphragm function, so patients must
sometimes be weaned from the ventilator by reducing its level of assistance to the
patient.

The rest breathing rate in adults is 12 to about 20 cycles per minute. The total lung
capacity of an adult male is about 6 liters but the tidal volume (exchange in each breathing
cycle) is typically only about 0.5 liter, however this varies based on lung size (which
correlates to Ideal Bodyweight, IBW, calculated based on height).
In Acute Respiratory Distress Syndrome (ARDS), many areas of the lung are collapsed
and much harder to stretch (referred to as reduced lung compliance). This means the
effective size of the lung is much smaller and attempting to give an average breath
exposes the healthy portions of the lung to much higher pressures. High pressures in the
lungs in turn cause barotrauma, which worsens ARDS. It is therefore critical in ARDS to
measure and control airway pressures. Below is a diagram explaining different airway
pressures:

The resistive pressure is an indicator of the resistance or the air passages between the
pressure sensor in the ventilator and the alveoli (microscopic air sacs that make up the
lungs), while the plateau pressure is an indicator of the pressure at the alveoli. In ARDS,
resistive pressure is typically low, while plateau pressures tend to be high and must be
carefully monitored, with adjustments to settings to reduce them.

Hardware:
Connection to endotracheal tube: 15mm inner diameter universal connector (ideally
slightly conical, slightly wider at the opening to allow for an easy friction-fit while being
smooth to allow easy removal, ~15-20mm long)

Ventilator linkage: short-length corrugated tubing (easy flexibility but should not expand or
collapse with internal pressures -100 to +100cmH2O (+/-1.42 PSI), ~50cm, 15mm outer
diameter universal (cylindrical, 15-20mm long). Because this design does not use separate
channels for inhalation and exhalation, the tubing should have minimal volume so as not to
contribute to dead space, while being wide enough to avoid adding significant flow
resistance (at least 15mm internal diameter).

In-line pressure sensor: a low-cost disposable pressure sensor capable of sensing -100 to
+100 cmH2O, with a sampling rate of at least 10 times/second, ideally 100 times/second.
The sensor should be shielded from moisture that condenses in the tubing. The portion
that will be exposed to the patient’s exhalations will have to be disposable or easily
decontaminated (if a thin, flexible diaphragm could be used to conduct pressure
accurately, this may lower the cost).

In-line flow sensor: low-cost disposable flow sensor capable of sensing flows 0 to 3L/min,
with a sampling rate of at least 10 times/second, ideally 100 times/second. Will be used to
calculate volume delivered and detect patients taking a spontaneous breath.

Exhalation blocker: allows inhalation freely, but can be used to block exhalation
temporarily for an inspiratory hold (breath hold) maneuver (see below). Can be
accomplished either with a solenoid-actuated one-way valve (must default to unblocked
during power failure), or a spring-loaded button that physically seals the exhalation port
and activates an electronic button to tell the computer to measure a plateau pressure and
alarm if blocked longer than 10 seconds.

Standard bag-valve with addition of a PEEP valve on the exhaust port.

The PEEP valve increases resistance to exhalation, allowing the maintenance of a
pressure ranging from 0 to 30cmH2O (typically 5-15) against exhalation. Typically made
with a spring holding the exhalation flutter valve shut until enough pressure builds up
behind the valve to push it open. The spring is tensioned such that the pressure is
adjustable as specified above.
Many bag-valves come with a PEEP valve, so manufacture of this piece is not a priority,
but PEEP is a crucial element of ventilating patients with many severe lung illnesses.
A very fine filter (N95 spec or higher) over the exhaust port would help make the
environment much safer for the healthcare team.

Bag actuator: It should be possible to generate at least 50cmH2O of pressure relatively

quickly, but with very fine control of the pressure and little momentum. The ventilator has
to be able to stop itself instantly once either a certain pressure threshold or a specific
volume is delivered. It should be able to deliver its maximal breath capacity of at least
900mL in as little as 0.4 seconds.

Bag actuator types:

 Strap: A strap holding the bag against a stationary surface tightens and releases,
pulled by being wrapped around a cylinder by a stepper motor.
 Linear: a piston drives a plate against the bag on a stationary surface
 Clamp: one arm pivots to squeeze the bag against a stationary surface, or two
arms pinch together around the bag
Fig: strap compression: a strap (red) passing over the bag-valve (blue) is pulled by a
stepper motor that turns a drum (small black circle).

Electronics:
Raspberry Pi or possibly an Arduino (Raspberry Pi would likely be able to make this a
more stand-alone device, and more easily improved in the future.)
Screen with touch or knob/button interface
Speaker for alarms
Battery backup (rechargeable, including battery manager)

Software:
Ventilators have different modes, the most basic of which are:
 Volume Control (aka Assist Control): ventilator delivers a breath of a fixed volume.
Does not take pressure into consideration.
 Pressure Control: ventilator delivers a breath until a certain pressure is reached
and stops, does not take delivered volume into consideration.
They also have different features:
 Triggered breaths: when the vent detects the beginning of inhalation, it delivers a
breath
o Detected by beginning of flow towards the patient when no breath is being
delivered (caused by patient inhaling through the circuit
 o There must also be a back-up rate, where the ventilator takes over if the
patient is breathing too slowly or not at all (determined by the amount of
time between breaths)
 Alarms for
o Pressure too high (for volume control modes)
o Volume delivered too low (for pressure control modes, requires setting a
goal minimum volume)
o Power failure
o Tube disconnect (no resistance or change in pressure when giving a
breath)
o Nice to have: alarm for breath stacking (incomplete exhalation causing air
trapping from multiple breaths)
 Inspiratory hold: gives a breath and prevents exhalation temporarily while a button
is pressed
 Measurement and display (ideally numerically and with a graph) of pressure, tidal
(breath) volume, plateau pressure (where the pressure settles during an inspiratory
hold)
 Control over
o Minimum respiratory rate
o Pressure
o Tidal volume
o Inspiratory time
o Mode
o PEEP

Electronic Sensors (added by Juan Enrique Osorio Gutierrez?):

 Pressure Sensors:
o BMP280 Bosch 3.48 USD - Digikey:828-1064-1-ND - Not suitable: minimum
measurement is 4.35 PSI range should be +/-1.42 PSI
o Z3639-ND Omron 7.66 USD - Digikey: Z3639-ND - Analog Output +/- 7.25
PSI - Requires external amp.
 Air Flow Sensors:

o PEEP (not software controlled in this case, see above)

o Tidal volume or pressure (depending on ventilator mode)
o Inspiratory time: time over which a breath is delivered