Open-source ventilator#COVID-19 pandemic

The policy of using both free and open source software (FOSS) and open source hardware theoretically allows community-wide peer-review and correction of bugs and faults in open source ventilators, which is not available in closed source hardware development. In early 2020 during the COVID-19 pandemic, a review of open source ventilators stated that "the tested and peer-reviewed systems lacked complete documentation and the open systems that were documented were either at the very early stages of design ... and were essentially only basically tested ..." The author speculated that the pandemic would motivate development that would significantly improve the open source ventilators, and that much work, policies, regulations, and funding would be needed for the open source ventilators to achieve medical-grade standards.

{{see also|Ventilator-associated lung injury}}

A number of features are required for an invasive mechanical ventilator to be safely used on a patient:{{cite web |author1=Real Engineering |title=A Guide To Designing Low-Cost Ventilators for COVID-19 |website=YouTube |url=https://www.youtube.com/watch?v=7vLPefHYWpY |date=4 April 2020}}

• a way of measuring and controlling the volume pumped and the breath rate to avoid volutrauma;
• monitoring for inspiratory pressure, respiratory rate (bpm), and inspiratory-to-expiratory time (I/E) ratio
• for non-sedated patients, an "assist" mode that, instead of forcing air in at a fixed frequency, only increases the pressure when the patient inhales;
• for ARDS, support for setting positive end-expiratory pressure (PEEP) to avoid alveoli collapse;{{cite journal|last1= Manzano |first1= F| title= Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients |journal=Crit Care Med | year= 2008 | volume= 36 | issue= 8 | pages= 2225–31 | pmid=18664777 | doi=10.1097/CCM.0b013e31817b8a92 |last2= Fernández-Mondéjar |first2= E |last3= Colmenero |first3= M |last4= Poyatos |first4= ME |last5= Rivera |first5= R|last6= Machado |first6= J |display-authors= 4| last7= Catalán |first7= I |last8= Artigas |first8= A|s2cid= 19906324}}{{cite journal |last1=Pfeilsticker |first1=FJDA |last2=Serpa Neto |first2=A |title='Lung-protective' ventilation in acute respiratory distress syndrome: still a challenge? |journal=Journal of Thoracic Disease |date=August 2017 |volume=9 |issue=8 |pages=2238–2241 |doi=10.21037/jtd.2017.06.145 |pmid=28932514|pmc=5594148 |doi-access=free }}
• humidification to avoid drying and cooling the alveoli.{{cite journal |last1=Restrepo |first1=R. D. |last2=Walsh |first2=B. K. |title=Humidification During Invasive and Noninvasive Mechanical Ventilation: 2012 |journal=Respiratory Care |date=1 May 2012 |volume=57 |issue=5 |pages=782–788 |doi=10.4187/respcare.01766|pmid=22546299 |doi-access=free }}

The requirements for non-invasive ventilation are less strict.

File:PVP-1 Prototype Ventilator.jpg ventilators were developed during the COVID-19 pandemic. These cheaper alternatives shown various balances between complete reproduction of state of the art medical ventilators with pressure curve, humidification, mechanisation, vitals monitoring, cost effectiveness, supply chain availability for parts in time of medical shortage, ease of assembly, and other aspects.]]

On March 16, 2020,{{cite web|url=https://twitter.com/OSVentilator/status/1239533725349797888|title=Join this Open Source Ventilator Project to give your time and expertise to help develop low-cost ventilators to fight #COVID19. 3D printing and testing is underway so all help is welcomed. Fast action needed.|website=Twitter.com|access-date=23 July 2022}} the Open Source Ventilator Ireland (OSV) group was formed{{Cite web |title=Open Source Ventilator Ireland |url=https://opensourceventilator.ie/ |url-status=dead |website=Opensourceventilator.ie |access-date=2022-07-20 |archive-date=2021-11-15 |archive-url=https://web.archive.org/web/20211115083721/https://opensourceventilator.ie/ }}{{cite web | url=https://www.forbes.com/sites/alexandrasternlicht/2020/03/18/theres-a-shortage-of-ventilators-for-coronavirus-patients-so-this-international-group-invented-an-open-source-alternative-thats-being-tested-next-week/?sh=627f73333ba0 | title=There's a Shortage of Ventilators for Coronavirus Patients, So This International Group Invented an Open Source Alternative That's Being Tested Next Week | website=Forbes }}{{cite web | url=https://www.rte.ie/news/2020/0320/1124495-irish-project-tackles-global-ventilator-shortage/ | title=Irish project tackles global ventilator shortage | date=20 March 2020 | last1=Bromwell | first1=Philip | website=RTÉ.ie }} initially with the goal of building a focus team in Ireland to begin development on what was termed the “Field Emergency Ventilator (FEV)”. Inspired by the initial efforts of the Open Source Medical Supplies (OSCMS),{{Cite web|url=https://opensourcemedicalsupplies.org/|title=Open Source Medical Supplies|website=Opensourcemedicalsupplies.org|access-date=23 July 2022}} which initially focused on developing open ventilators but quickly refocusing mainly on the local production of Personal Protective Experiment (PPE).{{Cite news |last=Bambury |first=Brent |title=Robotics engineer crowd-sources designs for COVID-19 medical supplies to help out-of-stock hospitals |work=CBC |url=https://www.cbc.ca/radio/day6/futures-on-hold-3d-printed-medical-gear-rem-s-mike-mills-choir-choir-choir-the-story-of-purell-and-more-1.5502663/robotics-engineer-crowd-sources-designs-for-covid-19-medical-supplies-to-help-out-of-stock-hospitals-1.5502671}} OSV Ireland partnered with the OpenLung team{{Cite web |title=Open Lung |url=https://openlung.org/|website=Openlung.org }}{{cite web | url=https://www.hackster.io/news/open-source-ventilator-openlung-projects-aim-to-address-the-covid-19-ventilator-shortfall-c7a5ee2f8e58 | title=Open Source Ventilator, OpenLung Projects Aim to Address the COVID-19 Ventilator Shortfall |website=Hackster.io}} in Canada, who were developing and publishing open source designs via GitLab.{{Cite web|url=https://gitlab.com/open-source-ventilator|title=OpenLung · GitLab|website=GitLab.com|access-date=23 July 2022}} The group quickly grew amassing volunteer engineers, designers and medical professionals with the goal of developing new, low resource medical interventions to support a perceived lack of mechanical ventilation equipment globally. The well-known Bag Valve Mask (BVM) quickly became the core functional component of their design,{{cite web | url=https://www.teamosv.com/ventilator-osv/ | title=Ventilator |website=Teamosv.com}} with the goal of utilizing 3D printed and traditionally manufactured components for localized assembly of the systems to maximise potential manufacturing capabilities around the globe. The Open Source Ventilator Ireland (OSV) group evolved into TeamOSV, to fully incorporate both ventilator and other covid related medical equipment.

The FOSS Initiative OpenVentilator.io project began on March 19, after two weeks of research.{{Cite web|url=https://popsolutions.co/en_US/openventilator|title=OpenVentilator|website=PopSolutions.co|access-date=23 July 2022|archive-date=26 February 2021|archive-url=https://web.archive.org/web/20210226185258/https://popsolutions.co/en_US/openventilator|url-status=dead}} Jeremias Almadas {{Cite web|url=https://www.facebook.com/jeremias.almada|title=Facebook|website=Facebook.com|access-date=23 July 2022}} had posted some drafts he made on the Open Source COVID-19 Medical Supplies forum.{{Cite web|url=https://www.facebook.com/groups/opensourcecovid19medicalsupplies/|title=Open Source Medical Supplies Community | Facebook|website=Facebook.com|access-date=23 July 2022}} Marcos Mendez contacted him to join efforts to develop a solution that could be reproduced on a very high scale.{{cite web|url=https://www.linkedin.com/in/marcos-m%C3%A9ndez-7987232b/?originalSubdomain=br|title=Marcos Méndez|website=Linkedin.com|access-date=23 July 2022}} {{Self-published source|date=June 2022}} This project later became the "OpenVentilator Spartan Model". {{citation needed|date=July 2020}}

With the COVID-19 pandemic a new challenge had just arisen, this was no longer to manufacture ventilator, after all, these are manufactured since biblical times,{{Cite web|url=https://time.com/5815499/ventilator-history/|title = The Long History of the Ventilator, a Machine You Never Want to Need}} including since the 1960s models like the Bird MK VII {{cite web |last1=Evelin Stainoff |first1=Ingrid |title=Bird Mark 7 |website=GitHub |url=https://github.com/popsolutions/openventilator/blob/master/00_Documentation/Research/Scientific/Mark%20VII.pdf |access-date=29 March 2022 |language=Portuguese |date=24 August 2004}} were already consolidated with an enviable engineering that is very simple.

The challenge now was to design an item that solves a problem on a global scale. Manufactured on a very large scale and with parts found in small towns and villages. These were the premises assumed by some projects like OpenVentilator.io.

On March 18, Medtronic had opened its code and files for manufacturing its main pulmonary ventilation equipment.{{Cite web|url=https://www.medtronic.com/us-en/e/open-files.html|title = Register to Download Ventilator Files|website=Medtronic.com}} The issue was on a scale that Medtronic would not be able to fulfill at the global level, nor at the regional level. The same was already happening with Philips, GE and Drager, world leaders in the manufacture of this type of equipment. It would not make sense to reinvent something that had already been studied for 100 years. The problem was also not an engineering problem, but a logistical and scale problem so that these projects that were to emerge were applicable and achievable. Manufacturing should be decentralized, focused on the regional resources of each individual on planet earth. Nine out of ten Brazilian cities do not even have an ICU bed, let alone an electronics store and or an Ambu factory. The African situation had already been proclaimed a catastrophe.{{Cite web|url=http://www.rfi.fr/en/africa/20200403-lack-of-covid-19-treatment-and-critical-care-could-be-catastrophic-for-Africa|title=Lack of Covid-19 treatment and critical care could be catastrophic for Africa|website=Rfi.fr|date=3 April 2020}}

Several projects are beginning to emerge in this area, many of them with an engineering approach, many others following strict validations with the regulations.{{citation needed|date=July 2020}}

There are few projects that have an [analysis of complex thinking:pt:Edgar Morin{{Circular reference|date=November 2020}} within the global economic-political stagnation.{{Cite web|url=https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depression/|title=The Great Lockdown: Worst Economic Downturn Since the Great Depression|website=Blogs.imf.org|access-date=23 July 2022}}

A major worldwide design effort began during the COVID-19 pandemic after a Hackaday project was started, in order to respond to expected ventilator shortages causing higher mortality among severe patients. This project aims to build a continuous positive airway pressure device.{{cite web |last=Coetzee |first=Gerrit |date=2020-03-12 |title=Ultimate Medical Hackathon: How Fast Can We Design and Deploy an Open Source Ventilator? |publisher=Hackaday |url=https://hackaday.com/2020/03/12/ultimate-medical-hackathon-how-fast-can-we-design-and-deploy-an-open-source-ventilator/ |access-date=2020-03-17}}{{Primary source inline|date=March 2020}}

On March 19, the MakAir open source ventilator project{{Cite web |url=https://github.com/makers-for-life/makair |publisher=GitHub |title=makers-for-life/makair |language=en|access-date=2021-02-18}} was started by a team of software engineers in France, using 3D printing to quickly iterate on a prototype, with the goal of letting an established manufacturer produce the final ventilators for a cost nearing €2,000. The team built a working prototype in one month,{{Cite web |url=https://journal.valeriansaliou.name/makair-series-the-inception-of-an-open-source-ventilator-project/ |title=The Inception of an Open Source Ventilator Project|website=Journal.valeriansaliou.name |date=14 February 2021 |language=en|access-date=2021-02-18}} at the end of which a successful 12 hour ventilation test on a pig was performed. The project received official support{{Cite web|url=https://www.defense.gouv.fr/fre/actualites/articles/le-ministere-des-armees-soutient-le-projet-makair-un-respirateur-artificiel-simplifie-dedie-au-traitement-du-covid-19|website=Ministère des Armées|title=Le ministère des Armées soutient le projet MakAir|language=fr|access-date=2021-02-18}} from the French Army's investment branch, Agence Innovation Défense of Direction générale de l'armement, granting the project €426,000 to help fund clinical trials. Groupe SEB agreed{{Cite web|url=https://www.groupeseb.com/en/news/together-face-covid-19|publisher=Groupe SEB|title=Together to face COVID-19|language=en|access-date=2021-02-18}} to manufacture the MakAir ventilator in their facilities in Vernon, France. As of December 2020, the MakAir ventilator project is still active on the engineering side, with full support for both pressure and volume controlled ventilation modes, and on the medical side with ongoing clinical trials at CHU Nantes{{Cite web|url=https://ichgcp.net/clinical-trials-registry/NCT04475185|website=ICH GCP|title=Safety and Effectiveness Assessment of the MakAir Artificial Ventilator |language=en|access-date=2021-02-18}} on human patients.

On March 20, 2020, Irish Health Services{{Cite web|url=https://www.forbes.com/sites/alexandrasternlicht/2020/03/18/theres-a-shortage-of-ventilators-for-coronavirus-patients-so-this-international-group-invented-an-open-source-alternative-thats-being-tested-next-week/|title=There's A Shortage Of Ventilators For Coronavirus Patients, So This International Group Invented An Open Source Alternative That's Being Tested Next Week|last=Sternlicht|first=Alexandra|website=Forbes|language=en|access-date=2020-03-21}} began reviewing the designs from the Open Source Ventilator Ireland project.{{Cite web|url=https://thehill.com/policy/technology/488637-irish-health-officials-to-review-3d-printed-ventilator|title=Irish health officials to review 3D-printed ventilator|last=Rodrigo|first=Chris Mills|date=2020-03-20|website=The Hill|language=en|access-date=2020-03-21}} A prototype is being designed and tested in Colombia.{{Cite web|url=https://colombiareports.com/colombia-close-to-having-worlds-first-open-source-and-low-cost-ventilator-to-beat-covid-19/|title=Colombia close to having world's first open source and low-cost ventilator to 'beat Covid-19'|last=colombiareports|date=2020-03-21|website=Colombia News {{!}} Colombia Reports|language=en-US|access-date=2020-03-21}}

File:MIT E-Vent Unit 002 Setup Image by MD.jpg

The University of Minnesota Bakken Medical Device Center initiated a collaboration with various companies to bring a ventilator alternative to the market that works as a one-armed robot and replaces the need for manual ventilation in emergency situations. The Coventor device was developed in a very short time and approved on April 15, 2020, by the FDA, only 30 days after conception. The mechanical ventilator is designed for use by trained medical professionals in intensive care units and easy to operate. It has a compact design and is relatively inexpensive to manufacture and distribute. The cost is only about 4% of a normal ventilator. In addition, this device does not require pressurized oxygen or air supply, as is normally the case. A first series is manufactured by Boston Scientific. The plans are to be freely available online to the general public without royalties.{{cite web|title=FDA approves production of device designed at University of Minnesota to help COVID-19 patients breathe|website=Star Tribune|url=https://www.startribune.com/fda-approves-production-of-device-designed-at-university-of-minnesota-to-help-covid-19-patients-breathe/569673172/|last=Joe Carlson|date=2020-04-16|language=en}}{{cite web|title=FDA authorizes production of a new ventilator that costs up to 25x less than existing devices|website=techcrunch.com|publisher=Verizon Media|url=https://techcrunch.com/2020/04/15/fda-authorizes-production-of-a-new-ventilator-that-costs-up-to-25x-less-than-existing-devices/|last=Darrell Etherington|date=2020-04-16|language=en}}

The Polish company Urbicum reports successful testing{{Cite web|url=https://ventilaid.org|title=VentilAid -open source ventilator, that can be made anywhere locally|last=urbicum|date=2020-03-23|website=VentilAid|language=en-US|access-date=2020-03-23}} of a 3D-printed, open source prototype device called VentilAid. The makers describe it as a last resort device when professional equipment is missing. The design is publicly available.{{Cite web|url=https://gitlab.com/Urbicum/ventilaid|title=GitHub - VentilAid / VentilAid |last=urbicum|date=2020-03-23|website=VentilAid|language=en-US|access-date=2020-03-23}} The first Ventilaid prototype requires compressed air to run.{{citation needed|date=July 2020}}

On March 21, 2020, the New England Complex Systems Institute (NECSI) began maintaining a strategic list of open source designs being worked on.{{Cite web|url=https://medium.com/@brucefenton/ventilator-project-update-march-21th-2020-bd2ef9d587e0|title=Ventilator Project Update: March 21th, 2020 [sic]|last=Fenton|first=Bruce|date=March 21, 2020|website=Medium|access-date=March 27, 2020}}{{Cite web|url=https://github.com/PubInv/covid19-vent-list|title=A list projects to make emergency ventilators in response to COVID-19, focusing on free-libre open source|website=GitHub|access-date=March 27, 2020}} The NECSI project considers manufacturing capability, medical safety and need for treating patients in various conditions, speed dealing with legal and political issues, logistics and supply.{{Cite web|url=https://medium.com/@brucefenton/we-need-ventilators-we-need-you-to-help-build-them-30805e5ee2ea|title=We need Ventilators - We Need You to Help Get Them Built |last=Fenton|first=Bruce|date=March 14, 2020|website=Medium|access-date=March 27, 2020}} NECSI is staffed with scientists from Harvard, MIT, and others who have an understanding of pandemics, medicine, systems, risk, and data collection.

Massachusetts Institute of Technology began an emergency project to design a low-cost ventilator that uses a bag valve mask as the main component. Other groups and companies, such as Monolithic Power Systems, also developed designs based on this concept.{{Cite web|url=https://www.monolithicpower.com/en/mps-open-source-ventilator|title=MPS Open Source Ventilator|website=monolithicpower.com|access-date=2020-04-29}}

The Oxysphere project develops open blueprints for a positive pressure ventilation hood.{{Cite web|url=https://oxysphere.org/|title=Oxysphere – OpenHardware Ventilation Project – Let us Stop Covid together|access-date=2020-03-31|archive-url=https://web.archive.org/web/20200513134407/https://oxysphere.org/|archive-date=2020-05-13|url-status=dead}}

On April 23, 2020, NASA reported building, in 37 days, a successful COVID-19 ventilator (named VITAL ("Ventilator Intervention Technology Accessible Locally") which is currently undergoing further testing. NASA is seeking fast-track approval by the United States Food and Drug Administration for the new ventilator.{{cite news |last1=Good |first1=Andrew |last2=Greicius |first2=Tony |title=NASA Develops COVID-19 Prototype Ventilator in 37 Days |url=https://www.nasa.gov/feature/jpl/nasa-develops-covid-19-prototype-ventilator-in-37-days |date=23 April 2020 |work=NASA |access-date=24 April 2020 }}{{cite news |last=Wall |first=Mike |title=NASA engineers build new COVID-19 ventilator in 37 days |url=https://www.space.com/nasa-covid-19-ventilator-passes-test.html |date=24 April 2020 |work=Space.com |access-date=24 April 2020 }}

On May 29, 2020, NASA revealed the "Eight US Manufacturers Selected to Make NASA COVID-19 Ventilator."{{Cite web|title=Eight US Manufacturers Selected to Make NASA COVID-19 Ventilator|url=https://www.jpl.nasa.gov/news/news.php?feature=7668|access-date=2020-06-02|website=NASA Jet Propulsion Laboratory (JPL)}}

The U.S. companies selected for licenses are:

• {{not a typo|Vacumed}}, a division of Vacumetrics, Inc. in Ventura, California
• Stark Industries, LLC in Columbus, Ohio
• MVent, LLC, a division of Minnetronix Medical, in St. Paul, Minnesota
• iButtonLink, LLC in Whitewater, Wisconsin
• Evo Design, LLC in Watertown, Connecticut
• DesignPlex Biomedical, LLC in Fort Worth, Texas
• ATRON Group LLC in Dallas
• Pro-Dex, Inc. in Irvine, California

Israeli engineers created an open source ventilator {{Cite web|url=https://qz.com/1836451/israeli-team-creates-open-source-hack-for-making-covid-19-ventilators/|title=Israeli engineers created an open source hack for making Covid-19 ventilators|website=Qz.com|date=11 April 2020 }}

{{multiple image |header=NASA VITAL Ventilator |align=center | caption_align=center |direction=horizontal |width= |image1=PIA23891-NASA-VITAL-Team-20200430.jpg |caption1=Engineering team |width1=250 |image2=PIA23775-NASA-VITAL-Ventilator-20200430.jpg |caption2=Front view |width2=245 |image3=DSC_0509-Edit-cr.jpg |caption3=Side view |width3=310|footer= }}

On March 24, 2020, the U.S. Secretary of Health and Human Services (HHS) enacted Emergency Use Authorizations{{Cite journal|url=https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations|title=Emergency Use Authorizations|first=Center for Devices and Radiological|last=Health|date=April 6, 2020|journal=FDA|via=fda.gov}} to allow the use of additional devices, including: "Ventilators, positive pressure breathing devices modified for use as ventilators (collectively referred to as 'ventilators'), ventilator tubing connectors, and ventilator accessories." This was done in accordance with its February 4 declaration[https://www.phe.gov/Preparedness/legal/prepact/Pages/COVID19.aspx "Notice of Declaration under the Public Readiness and Emergency Preparedness Act for medical countermeasures against COVID-19"] {{Webarchive|url=https://web.archive.org/web/20200425015411/https://www.phe.gov/Preparedness/legal/prepact/Pages/COVID19.aspx |date=2020-04-25 }}. Department of Health and Human Services Office of the Secretary". for medical countermeasures against the coronavirus disease 2019, and the equipment is subject to the FDA's "criteria for safety, performance and labeling."

• {{section link|Shortages related to the COVID-19 pandemic|Improvised ventilators}}

{{Reflist|refs=

{{cite journal | last1 =Pearce | first1 =Joshua M. | title = A review of open source ventilators for COVID-19 and future pandemics [version 1; peer review: 1 approved] | journal = F1000Research | volume =9 | pages =218 | year = 2020 | doi =10.12688/f1000research.22942.1 | pmid =32411358 | pmc =7195895 | doi-access = free }}

}}

{{External links|date=January 2023}}

• An [https://web.archive.org/web/20200326091215/https://gitlab.com/open-source-ventilator/OpenLung/-/issues/76 overview] of open source ventilator initiatives and open regulatory standards.
• [https://opensourceventilator.ie Open Source Ventilator community] and other COVID supplies, with 2000+ members; 8th design iteration as of March 26.
• [https://openventilator.io The OpenVentilator.Io Spartan Model]
• [https://www.opensourceagainstcovid19.org/ Opensource against covid19.]
• Development status, concept and features comparison for open source ventilators projects [https://docs.google.com/spreadsheets/d/1FA_tSr2jVEGb1-I2UJGqF33Tn55rlWWfMto5w-PDPJg/edit#gid=0 in a single table].
• [https://www.youtube.com/watch?v=vdLXp7uGFX4 Open-source ventilator design], Vanderbilt University
• [https://opensource.com/article/20/3/open-hardware-covid19 7 open hardware projects working to solve COVID-19.]
• [https://www.opensourceagainstcovid19.org Open Source Against COVID-19]
• [https://www.facebook.com/groups/opensourcecovid19medicalsupplies/ Open Source COVID19 Medical Supplies]
• {{Cite web| title = Emergency ventilator for COVID-19 crisis approved by the Spanish medicine agency| editor = OxyGEN Project| access-date = 2020-04-13| url = https://www.oxygen.protofy.xyz}}
• [https://www2.kuet.ac.bd/icmiee2018/files/ICMIEE18-318.pdf Automation of Bag-Valve-Mask (BVM) using arms and servo-motors.] (PDF)
• {{Cite journal| doi = 10.1183/13993003.00846-2020| issn = 0903-1936| last1 = Garmendia| first1 = Onintza| last2 = Rodríguez-Lazaro| first2 = Miguel A.| last3 = Otero| first3 = Jorge| last4 = Phan| first4 = Phuong| last5 = Stoyanova| first5 = Alexandrina| last6 = Dinh-Xuan| first6 = Anh Tuan| last7 = Gozal| first7 = David| last8 = Navajas| first8 = Daniel| last9 = Montserrat| first9 = Josep M.| last10 = Farré| first10 = Ramon| title = Low-cost, easy-to-build non-invasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing| journal = European Respiratory Journal| access-date = 2020-04-21| date = 2020-01-01| volume = 55| issue = 6| pages = 2000846| url = https://erj.ersjournals.com/content/early/2020/04/16/13993003.00846-2020| pmid = 32312862| pmc = 7173672}}

{{COVID-19 pandemic}}

Category:Respiratory therapy

Category:Medical pumps

Category:Open access (publishing)

Category:Open-source hardware