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Humans of Manufacturing: Heroes

Unused Sleep Apnea Machines Come Out of the Closet to Provide Respiratory Support to COVID-19 Patients

In times of need, manufacturing is driven by a philosophy John Lennon said best, “There are no problems, only solutions.” Today, manufacturers have pivoted to produce the critical supplies and equipment necessary to battle COVID-19 at a rate never seen before. SME’s Humans of Manufacturing Heroes Edition tells the stories of the teams, companies and partnerships adapting to produce the tools needed to fight this global pandemic. Going behind the scenes to share how these once-in-a-lifetime transformations are happening and the people making it all possible.

Grace O’Connell, UC Berkeley associate professor of mechanical engineering
Grace O’Connell, UC Berkeley associate professor of mechanical engineering (Photo/Paul Lee)

Start with an engineer who manages an environmental capital group and uses a sleep apnea machine to help him breathe at night. Add the dean of the College of Engineering at the University of California, Berkeley (UC Berkeley), an engineering professor who focuses on how tendons and ligaments fail, an engineer who works with flow mechanics, and physicians from UC San Francisco. Collect unused CPAP and BiPAP machines. Finally, add a Lego® mentality.

What do you get? A way to convert CPAP and BiPAP sleep apnea machines to devices that can safely provide respiratory support to COVID-19 patients with breathing difficulties caused by the novel coronavirus.

A caveat: these converted machines are not ICU ventilators. But they can be used both to treat patients with mild to medium breathing difficulties and patients who are being weaned off ventilators – reserving the limited number of ventilators for the critically ill.

“When this pandemic started, some of the companies that make parts for ventilators received seven years of orders within one month,” Grace O’Connell, UC Berkeley associate professor of mechanical engineering said. “A lot of the companies that make ventilators were increasing their production. But they didn’t anticipate being able to meet the need for another couple of months. It was a big challenge to the supply chain.”

The idea for the conversion began in mid-March with Bryan Martel, managing director of the Environmental Capital Group, which funds research into climate change. Martel also uses a BiPAP machine, O’Connell said.

Because sleep apnea machines are often uncomfortable, one-third to one-half of people who have CPAP or BiPAP machines don’t use them, according to a 2017 study from the National Center for Biotechnology Information.

“A lot of those machines are sitting in people’s closets,” O’Connell said. “There’s a very low compliance rate with these devices.”

While that noncompliance is troubling for treating sleep apnea, Martel saw an opportunity for the unused machines to help fight the pandemic.

The challenge was making the machines safe for COVID-19 patients. While CPAP and BiPAP machines are designed to provide breathing support, they are not designed to prevent the spread of contagious illnesses. “The biggest concern was leakage of contaminated air from the devices,” O’Connell said.

Designers started with a CAD model, “following steps that I teach in my design classes,” O’Connell said. “Then we picked a design to go forward and worked on ways to make it simpler.”

The team reduced the original nine-component design down to six parts: a total face mask, two filters, an inline adaptor to add oxygen, a hose, and the machine. Philips Respironics which makes CPAP mask components, donated some parts, O’Connell said.

“You have all these options — how do you put them together? The end result was almost like a LEGO® design.”
Grace O’Connell, Associate Professor of Mechanical Engineering at University of California, Berkeley

The total face mask used by the team is not commonly used by sleep apnea patients but was chosen for the project because it goes around the eyes, improving the seal and preventing leaks, O’Connell said.

Next, they added two filters, one for inhaled air and the other for exhaled.

“We looked at filtering the air inhaled and exhaled by the patient,” O’Connell said. “If you’re giving them air infected by COVID, that means they are inhaling higher amounts of the virus.”

Another key design component was an inline adaptor that allows for oxygen to be added, she said. Oxygen concentration in the air is about 21 percent. By adding oxygen, the percentage can be boosted as high as 80 percent, which is important for patients with pneumonia (which COVID-19 can cause) because the fluid in their lungs prevents them from getting enough oxygen.

Increasing the air pressure was another step. CPAP and BiPAP machines at home offer less than 15 percent the pressure of a hospital grade ventilator. By going into the clinical menu, it is possible to boost the pressure for home machines by over 70 percent.

All these steps contribute to creating machines that can serve as a bridge between ventilator use and patients breathing on their own.

BIPAP Total Face Mask Circuit

“Converted sleep apnea machines don’t replace ventilators,” O’Connell said. “We think of them as a bridge in an emergency when you don’t have enough ventilators.”

The modified devices also are excellent for sleep apnea patients in nursing homes, where infection rates have been high, to prevent further spread of the virus, O’Connell said.

With the help of a web designer, the UC Berkeley team created a website, VentilatorSOS, for people to donate unused CPAP and BiPAP machines. In late April, the team already had nearly 3,000 machines in its registry.

The team created the first prototype at the end of March and the final design in mid-April, she said.

“You have all these options—how do you put them together? The end result was almost like a LEGO® design,” O’Connell said.

By the end of April, the team had converted and shipped 10 sleep apnea machines. Some are in use at the University of Miami Hospital; others are being used at the University of California San Francisco Medical Center, and others are destined for a hospital in Ecuador, O’Connell said.

The team is partnering with a non-profit, Survivors for Good, to move out of the lab and increase production, she said. The next step is to make the conversion kits.

“In terms of so many different people working together, this was really amazing,” O’Connell said. “This is the only time I’ve seen such a well-executed collaboration among people with such a wide range of expertise.”

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