Outages: Non-Electric Ventilator Offers Relief In Respiratory Failure Treatment

 

Outages: A non-electric ventilator offers relief in the treatment of respiratory failure

The COVID-19 pandemic has affected healthcare facilities around the world. Many hospitals have run out of beds and medical supplies, basically mechanical ventilators and medical oxygen. The growing number of infections and deaths has everyone on their feet. This has made scientists think about finding effective treatment methods and vaccines against the virus. At the height of the pandemic, a team of engineers from Loughborough University in England, led by a Nigerian biomedical engineer, Dr. Yusuf Bilesanmi, invented a low-cost, non-electric ventilator that can help COVID-19 patients with breathing problems.

The ventilator, called ShiVent, has four unique functions, according to a 2021 report published on the university's website. It is designed to be easy to use by the average healthcare professional, requiring approximately 30 minutes of training; can be made at a very small fraction of the cost of the average fan; suitable for hospitals with unreliable power supply and requires one-third the oxygen consumption of high-flow oxygen systems.

ShiVent was tested at Loughborough's National Center for Sports and Exercise Medicine (NCSEM), Leicester Royal Infirmary Hospital and had a preliminary clinical trial of functionality at Glenfield Hospital. It has also undergone pre-clinical trials in India, Rwanda and Nigeria (Lagos State) which attracted a N5m grant from the Lagos State Government.

The ShiVent is modeled on the principles of bubble continuous positive airway pressure (CPAP), a non-invasive ventilator used for newborns previously developed by Dr Yusuf Shittu of the Nuffield Hospital in Leicester. Shittu is the co-inventor of ShiVent. Others are Gaurav Nanajkar, Pawel Nycz and Ricardo Nasciment.

“The ventilator connects patients to an existing oxygen source and mixes air with a high-flow oxygen supply. The patient inhales oxygen to fill the lungs and then exhales into the water column, creating pressure on the backside that keeps their airway open,” Bilesanmi told Daily Trust. He said the clinical trial would be conducted in Lagos by December 2023 and if successful, massive production for the market would follow.

Why ShiVent fits into the Nigerian healthcare industry

Ventilators are instrumental in the treatment of chronic respiratory conditions such as asthma, pneumonia, hypoxemia, and chronic obstructive pulmonary disease (a lung disease characterized by persistent airflow limitation). These diseases are common in Nigeria and other African countries, so ShiVent is relevant even after COVID. The World Health Organization (WHO) estimates that more than 90% of COPD deaths occur in low- and middle-income countries, including Nigeria.

Africa is plagued by an energy deficit. The World Bank has revealed that some 600 million people in sub-Saharan Africa (43% of the region's population) do not have access to energy in 2022. About 85 million of Nigeria's more than 200 million people do not have access to the electricity grid. The country currently generates 5,000 megawatts – almost 15% of the 33,000 MW that the Association of Electricity Distributors of Nigeria says is needed for stable electricity.

Almost half of the population lives in rural areas without access to electricity and this always has an impact on healthcare in these communities. The hospital is trying to power generators to power medical equipment such as mechanical ventilators to treat patients.

Before the 2020 pandemic, with many hospitals scrambling to help, there was a shortage of oxygen in Nigeria, leading to many preventable deaths. The Federal Ministry of Health has published that more than 625,000 deaths occur each year from diseases associated with hypoxemia - insufficient oxygen in the blood or low oxygen saturation of the blood. This situation eventually gave birth to the National Medical Oxygen Policy in 2017 as a way to improve access to life-saving medical oxygen for patients in the country.

“Based on currently available data, at least 30 public sector oxygen stations have been established in Nigeria, of which 21 are said to be operational; six are of unknown status and three are out of service. Additionally, in a 2015 case study of four plants, factors such as insufficient power supply and wear and tear on the lines supplying oxygen to hospital wards were threats to optimizing the use of these plans,” the policy document states. Little has changed. In many hospitals, especially those owned by the state, there is still a shortage of medical oxygen, for which patients pay extra.

"It is designed for resource-poor areas where mechanical ventilators are rare and expensive, with unreliable electricity supply and limited expertise," Bilesanmi said. “At the peak of COVID, Lagos was consuming around 400 bottles of oxygen per day at 15 liters of oxygen per minute. The ShiVent only requires 5 to 12 liters per minute depending on the patient's respiratory status,” he added.

Dr Muyiwa Rotimi, a consultant anesthetist and critical care physician at the Lagos University Teaching Hospital (LUTH), where the non-electric ventilator has been pre-clinically tested, said the device will be very resourceful in managing respiratory problems when it is finally ready. . Rotimi, who is the director of the Intensive Care Unit (ICU) at LUTH, explained that the ShiVent would save lives in low- and middle-income countries that face erratic power supply.

He said: "It is particularly effective when the patient is in respiratory failure." It can help in both urban and suburban hospitals. If a patient is in distress in the suburbs, they can be deployed until they are referred to another hospital. Sometimes the patient may not even need a referral depending on the extent of the respiratory problem. “It's user-friendly. Some devices can confuse you when you work with them, and if you're not careful, you can do more harm than good to the patient if you press the wrong button.

“It can also be used anywhere: on the ward, in the emergency room, in the recovery room and at the scene of an accident if oxygen is available. It doesn't necessarily have to be in an intensive care unit, unlike electric ventilators. “It also conserves oxygen. When you power an electric ventilator, it comes with a high flow and needs enough oxygen to drive it, but the ShiVent works at low pressure. The higher the pressure, the higher the oxygen consumption.

“The assessors submitted their comments and corrections were made. We are now at the approval level. We will then do a clinical trial and make it official. With what we have done and the positive reviews from other countries, we don't expect any opposite result.” However, Rotimi said the device has its limits. Hypothetically, if a patient is at zero and needs to get to 100, the ShiVent could only help the patient 60-70%, he explained.

“It can handle mild, moderate and early severe respiratory failure, but it cannot be used in unconscious patients and patients without respiratory distress. Patients must have respiratory effort before deployment. If the respiratory effort is 12-16 breaths per minute and the patient is doing 32-40 (rapid breathing) because they are asthmatic or have pneumonia, it will slow down the breathing and bring them into balance,” he said. A professor of paediatrics and member of the West African College of Physicians, Mustafa Asani, said that if the invention is successful, it will be suitable for hospitals in Nigeria.

“Where you cannot guarantee constant electricity supply like Nigeria, such an invention is required because the ventilator is very important for the care of patients with respiratory problems,” he added. Kamilu Karaye, a cardiologist and professor of medicine at Bayero University Kano, noted that the non-electric ventilator is an invention of the government and should be adopted by other stakeholders as one of the potential solutions to the power outage in hospitals.

He stated: 'Such an invention will be great for us in Nigeria because most of our hospitals today are powered by generators which are shut down for several hours due to high fuel prices. The fan will make a lot of sense if it comes to reality. It will help patients.