An essential element of the ICU equipment is the monitoring equipment that keeps track of some of the patient vitals especially when they are ventilated and sedated but also during their recovery phase to ensure the regime of ventilation is optimised for their condition. Ventilators already provide their set of patient parameters, but usually patient monitors are separate devices as they continue to be useful after the patient can resume breathing on their own unassisted.
One of the key parameters for COVID-19 patient is the amount of oxygen in their bloodstream (SpO2), measured by pulse oximetry which uses optics within a finger clamp. Pulse oximetry tends to be used for the duration of the patient’s stay in ICU.
Modern patient monitors provide many more patient parameters all the way to breathing waveforms to enable clinicians to fine tune their care of the patients.
Innovating in a pandemic
Beyond the Ventilator Challenge mentioned above, the pandemic inspired engineers around the country to many innovations. This section list only a few of the innovations the authors are aware if and doesn’t mean to single them out from all the great work which is taking place.
Bioengineers at DNA Nudge developed the COVID Nudge< test from scratch during the pandemic.
A team at Imperial College in London developed JAMVENT, a low-cost emergency ventilator, developed in response to the COVID-19 outbreak. Its design is based on simple pneumatic components, but it is able to perform all the tasks required of an ICU ventilator for COVID-19 patients.
Management of the pandemic in hospitals
Personal protective equipment
The COVID-19 pandemic has evidenced the fragility of society and the need for effective and practical ways to protect it. For the general public, the use of face masks as personal protection equipment (PPE) remain the most practical line of defence against SARS-CoV-2 as well as other respiratory viral infections.
However, for the wide range of multidisciplinary health care workers more protection is required, as surgical or respirator masks, and these are not intended to be worn for so long as is required in an NHS shift. There is an environmental cost to these disposable items, they do not fit all face shapes, the mask-face seal can be broken while talking, and they apply pressure to the sensitive face skin which can cause discomfort and tissue injury.
From the patients' and carers' perspectives, they also obscure the face, which disadvantages people with hearing impairments who rely on lip reading - as well as a human face being reassuring.
Therefore, there is great need to develop new practical PPE technologies that can protect the population while ensuring a functioning society. Several groups of engineers have been developing enhanced PPE technologies including powered air purifying respirators (PAPRs), similar to the commercially available devices were in short supply or removed from sale at the start of the pandemic.
These have benefits:
- being potentially more protective, as all the breathed air is filtered
- because they include a hood which protects the face from droplets and self-infection by touching;
- avoiding mechanical loads on the delicate facial skin
- being cleanable and reusable, so presenting a lower potential cost, and less plastic waste
- being a more inclusive device, as they should fit all users, and permit lip reading and the care benefits of seeing your healthcare worker's face.
One example, the 'PeRSo' device, has received approval by HSE and BSI and was used in University Hospital Southampton in the first wave of the pandemic. The engineers involved released the design and
specification Open Source.
Role of clinical engineers
Clinical engineers are pivotal in the use of technology as part of patient care, from procurement, to maintenance but also, and this is a little less known, working with clinician to produce innovative devices to enable novel treatments.
Rather than attempting to do them justice in many words, the reader is encouraged to watch the feature hosted by Vivienne Parry, that was put together by IPEM and IFBM for the recent Clinical Engineering Day 2020.