OSWEGO — From doctors, to nurses, to scientists, to technology professors at SUNY Oswego, people are finding and creating new ways to fight the coronavirus pandemic. The ventilator is not a new invention. It first appeared in 1928 as the “iron lung.” It breathes for a patient who cannot breathe, and it was made to breathe for one patient at a time.
In 2006, a study concluded that one ventilator could be adapted in such a way as to breathe for two patients at once and possibly even four. But the risks are considerable, along with the ethical considerations, as the more patients hooked up to one ventilator, the riskier it gets.
According to Oswego Health’s Director of Respiratory Therapy, Kristina Marks, the state ordered all hospitals to assess their ventilators and “see if we would be able to take one ventilator and somehow connect two patients to it. So, what we did,” Marks said, “is we looked at the equipment that we had, and unfortunately, we didn’t have the pieces right on hand, because it’s not typical that you would do that. Typically, the best care would be one ventilator, one patient. But, in an emergency situation, we wanted to be prepared to take care of any patient that walked in the door.”
Easier said than done, it was found, after Marks and staff looked to company after company for the parts that would make this transition possible.
“There’s a multitude of different brands and styles of ventilators,” Marks said. “So, the specific circuit (tubing going to and from the patient) and the specific ventilator that we had, we had to order two pieces in order to make that connection work, and no matter how we tried to order from how many companies, either they were not available, because everyone across the country was preparing and doing the same thing, or they just didn’t have them.”
3D printing was suggested and can make the necessary parts. But, it’s a slow process, and COVID doesn’t wait.
Enter SUNY Oswego Technology Professor Daniel Tryon, a guy who had “not even been to a hospital to see a ventilator working.” Yet, he’s the guy who saves the day.
“Everybody was hearing about this ventilator crisis,” Tryon said, “and the governor of New York was really making a big deal. There were several sites around the world that started working on 3D printing these adapters to maybe make this happen, and it seems like it was all based on that 2006 study that demonstrated it could in fact work.
“We tried to reach out to the hospital. I think it was kind of early on, because we have a pretty neat 3D printer, a pretty high-end machine that I figured could probably do this kind of work. Nobody wanted to do this. It was sort of like, hey listen, this is not a solution that anybody wants, but knowing that 3D printing takes some time, it seemed prudent to think maybe we should start inquiring, because what was happening was everybody was saying ‘we’re not going to split ventilators, we’re not going to split ventilators’ in all these hot spots.
“It wasn’t but three, four, five days later and all of a sudden, they changed to ‘we’re seriously thinking about splitting ventilators.’ It was just not good. Anyway, that’s when we got connected with Kristina Marks, and she actually sent me a couple of photographs of some pieces and parts from a ventilator, and I was mostly curious, I didn’t realize ventilators used the standardized tubing, so I reached out to them wondering what models and makes do you folks even have, thinking that I’d be able to do a little research and find out what does that mean in terms of the shapes and the sizes of these splitters?
“So, I think we kind of happened upon each other about the same time, thinking the same way about worst-case scenarios. The next day, or the day after that, I found that the same doctors that had done the 2006 study were using these crazy adapters made from plumbing parts.The tubing, although it seems like it’s fairly standard across ventilators, wasn’t the same size as anything you could buy in tubes, or hoses, or anything like that.
“But then when they found that darn CTS version of CPVC pipe, and the diameters were correct, then it became somewhat easier to say, hey listen, if you can find these parts at your Home Depot, you can fabricate these things. It’s so surreal watching some of these videos, and these doctors literally going to Home Depot to get parts.
“I mean, what is happening? It wasn’t that complicated a fabrication, because now there is this standard tubing that would work, so, it’s literally, find the stuff, cut it to length, deburr it, and fabricate these things, instead of the process of 3D printing, basically something very similar, because it’s all about those inside diameters and outside diameters matching up with whatever kind of ventilators you have.
“Now, the one thing that’s neat about the 3D printing group, and hopefully they don’t see the light of day either, there are some folks out there that are not only printing connectors that will let two patients use a ventilator, but you can print a three-, a four- a five-, or a six-pipe adapter. So, the 3D printing models would let you split a ventilator across three people, four people, five people, or even six people, which just seems like a nightmare scenario.”
Tryon solved Oswego Health’s problem in one day.
“When the CPVC solution came out, it was a case of I quick got online and did a search at Lowe’s and Home Depot and a bunch of places, and sure enough, Home Depot down in Clay was the only place that had this stuff,” Tryon recounted. “So, I told my wife to hop in the car and head toward Home Depot and I’d fill her in as she got there. So, I put an order in for some pieces and parts.
“She managed to get down there and buy the tees and the pipe and stuff and so, by the time she got back, I’d studied that whole document and the videos and set up some tooling just to get all the dimensions right and then started cutting the pipe, and deburring it, and making it according to that spec, and later that same day we had a batch of these things to send down to Kristina to take a look. What’s strange about it is the size,” Tryon said of his Home Depot find. “CPVC pipe is used for water plumbing systems in houses and commercial buildings, but what’s unique about that specific stuff is it’s the same size as copper tubing. So, you can use it in combination with copper. The inside diameter of the fittings is the same as copper pipe and the inside of the fittings, the walls, are slightly tapered. They kind of create a wedge fit. So, you have to use it just with its own same-size CPVC pipe or with copper. But it also, because of that tapered fit, makes it great for sort of a wedge fit with the low-pressure pneumatic application that the ventilators are using.”
It worked perfectly, and not only did Marks’ test prove Tryon’s adaptors worked, the FDA approved its use.
“The FDA, during this crisis, and only during this crisis, they won’t object to physicians trying this or using this technique, which sort of makes you pause,” Tryon said. After all, according to Kristina Marks, a two-person ventilator had never even been tested on human adults.
“They’d done it on sheep,” she said, “but they had not done it on people.”
Nevertheless, the fact that it all worked, and with simple, readily-available parts from Home Depot, has given Tryon a ray of optimism in a trying time.
“This is a classic crisis kind of situation where all of a sudden this strange thing from afar challenges your thinking on everything,” he said. “In the future, I’m sure, the machines will have provisions for doing this, but who would have ever thought, why would you want a ventilator that could handle more than one patient? That’s just silly. But next year, it won’t be as silly, it’ll probably just be a standard capability of those machines.
“This is bringing out the creativity and ingenuity of a lot of really smart people,” he continued. “So, if there is a bright spot in the middle of a crisis, it’s the fact that you get to see some neat creativity being applied in a fast way to a common problem. When this is all over, we’ll probably be able to see some pretty neat innovative things that people experimented with that will probably drive the next wave of medical devices.”
Marks and Tryon may not just be riding that wave, they very well may be leading it. They’re already working on their next great innovation: the intubation shield.
“Tomorrow I’m going to fabricate for the hospital some pretty neat intubation shields,” Tryon said. “There’s a whole different approach to shielding the healthcare folks from the patient during intubation/extubation. Right now, the current technology is there’s a box, a big square acrylic box that you put over the head of the patient when you do the intubations, because they’re spraying saliva and phlegm or whatever.
“You’re trying to contain that. But the box has quite a few limitations because all the hoses and things have to come up from the patient’s feet area up into the box, and the doctor’s working through two small holes in the end of the box, and so he can’t grab things from the outside and he can’t get any assistance from anybody because this box is this big, rigid thing.
“So, he’s using this simple little shield, which sits over the head of the patients, and then you create a tent that’s clear plastic that then drapes over the patient. So, now, the hoses and whatever can come in from the sides, and an assistant can actually help working through the plastic, they can manipulate the patient, because now you’ve got a thin film rather than this big, rigid plastic box. So, I fabricated a prototype of that and sent it down to them. They really like it. They prefer that it was just a little bit bigger, so I have some plastic coming tomorrow that I’ll be able to fabricate a bunch of them. Marks said the staff is thrilled with the results.”
“Those intubation shields, those are huge,” she said. “For COVID-19, the concern for the healthcare worker is the particles that happen during certain procedures. One of the things Dan’s working on is a shield to protect the healthcare worker for when those particles are being generated. For example, when you do an intubation, you’re right near the patient’s mouth, which is ground zero for the virus being transferred, so what we want to do is create some sort of a physical barrier between the healthcare worker and the patient that has that virus.
“And what Dan was able to do, and again, materials are very limited, he was able to give us a shield, which is a beautiful shield, the physicians absolutely love it, and it protects them quite a bit from when they’re doing these procedures and intubating the patient. So, they really, really like it. And the nice thing about it is it’s visually very easy for them to use, it’s very easy to clean. It was a really nice project. It really makes us feel much more comfortable and able to function a little easier with those patients.
“We needed the shield for certain types of patients,” Marks explained, “and we just weren’t able to get our hands on that material. So, that’s where SUNY Oswego came in and said, ‘Well, let’s make it for you’ and made us a few of them. They were just fantastic to work with, and I hope there’s something in the future, if it improves patient care and helps in any way, I hope that maybe it’s a collaboration we can continue.”
As a result of Tryon’s ventilator adaptation, Marks said, “we’re prepared. If we need to do it, we would rather do the best care for the patient, but if we had to do it to save lives, that’s exactly what we would do. If it happened today, we are prepared. We’re all set.”
And it’s been quite the experience for Tryon, not only creating a much-improved shield to protect healthcare workers, but coming up with a ventilator adaptation he called “the project that we hope never gets used.”
He summed it all up this way: “It’s certainly been unique,” he said, “and it’s been stimulating creatively, but, boy, on one hand you hope your work never gets utilized, but on the other hand, it’s kind of nice to be able to do what we can do to help some folks that quite obviously are fighting some pretty tough battles in some pretty nasty trenches.”