{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:59:40Z","timestamp":1791093580170,"version":"4.1.0"},"reference-count":37,"publisher":"European Respiratory Society (ERS)","issue":"6","license":[{"start":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T00:00:00Z","timestamp":1587340800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2020,4,8]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Current pricing of commercial mechanical ventilators in low-\/middle-income countries (LMICs) markedly restricts their availability, and consequently a considerable number of patients with acute\/chronic respiratory failure cannot be adequately treated. Our aim was to design and test an affordable and easy-to-build noninvasive bilevel pressure ventilator to allow a reduction in the serious shortage of ventilators in LMICs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The ventilator was built using off-the-shelf materials available<jats:italic>via<\/jats:italic>e-commerce and was based on a high-pressure blower, two pressure transducers and an Arduino Nano controller with a digital display (total retail cost &lt;75\u2005USD), with construction details provided open source for free replication. The ventilator was evaluated, and compared with a commercially available device (Lumis 150 ventilator; Resmed, San Diego, CA, USA): 1) in the bench setting using an actively breathing patient simulator mimicking a range of obstructive\/restrictive diseases; and b) in 12 healthy volunteers wearing high airway resistance and thoracic\/abdominal bands to mimic obstructive\/restrictive patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The designed ventilator provided inspiratory\/expiratory pressures up to 20\/10\u2005cmH<jats:sub>2<\/jats:sub>O, respectively, with no faulty triggering or cycling; both in the bench test and in volunteers. The breathing difficulty score rated (1\u201310 scale) by the loaded breathing subjects was significantly (p&lt;0.005) decreased from 5.45\u00b11.68 without support to 2.83\u00b11.66 when using the prototype ventilator, which showed no difference with the commercial device (2.80\u00b11.48; p=1.000).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The low-cost, easy-to-build noninvasive ventilator performs similarly to a high-quality commercial device, with its open-source hardware description, which will allow for free replication and use in LMICs, facilitating application of this life-saving therapy to patients who otherwise could not be treated.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.00846-2020","type":"journal-article","created":{"date-parts":[[2020,4,21]],"date-time":"2020-04-21T04:25:19Z","timestamp":1587443119000},"page":"2000846","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":80,"title":["Low-cost, easy-to-build noninvasive pressure support ventilator for under-resourced regions: open source hardware description, performance and feasibility testing"],"prefix":"10.1183","volume":"55","author":[{"given":"Onintza","family":"Garmendia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A.","family":"Rodr\u00edguez-Lazaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Otero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phuong","family":"Phan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandrina","family":"Stoyanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8651-5176","authenticated-orcid":false,"given":"Anh Tuan","family":"Dinh-Xuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8195-6036","authenticated-orcid":false,"given":"David","family":"Gozal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Navajas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josep M.","family":"Montserrat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon","family":"Farr\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,4,20]]},"reference":[{"key":"2024102101344625000_55.6.2000846.1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02426-2016"},{"key":"2024102101344625000_55.6.2000846.2","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jcrc.2018.01.007","article-title":"Non-invasive ventilation in children and adults in low- and low-middle income countries: a systematic review and meta-analysis","volume":"47","author":"Mandelzweig","year":"2018","journal-title":"J Crit Care"},{"key":"2024102101344625000_55.6.2000846.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0116949"},{"key":"2024102101344625000_55.6.2000846.4","first-page":"3","article-title":"The toughest triage \u2013 allocating ventilators in a pandemic","volume":"50","author":"Truog","year":"2020","journal-title":"N Engl J Med"},{"key":"2024102101344625000_55.6.2000846.5","doi-asserted-by":"crossref","unstructured":"Wang D , Hu B , Hu C , et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; e201585. doi:10.1001\/jama.2020.1585.","DOI":"10.1001\/jama.2020.1585"},{"key":"2024102101344625000_55.6.2000846.6","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.07.042994"},{"key":"2024102101344625000_55.6.2000846.7","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1164\/rccm.201808-1452LE","article-title":"Novel approach for providing pediatric continuous positive airway pressure devices in low-income, under resourced regions","volume":"199","author":"Farr\u00e9","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102101344625000_55.6.2000846.8","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02290-2018"},{"key":"2024102101344625000_55.6.2000846.9","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.02010"},{"key":"2024102101344625000_55.6.2000846.10","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2279"},{"key":"2024102101344625000_55.6.2000846.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-011-2416-9"},{"key":"2024102101344625000_55.6.2000846.12","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.2111050"},{"key":"2024102101344625000_55.6.2000846.13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.130.2.350"},{"key":"2024102101344625000_55.6.2000846.14","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00031-2015"},{"key":"2024102101344625000_55.6.2000846.15","doi-asserted-by":"crossref","first-page":"e0151530","DOI":"10.1371\/journal.pone.0151530","article-title":"Novel approach to simulate sleep apnea patients for evaluating positive pressure therapy devices","volume":"11","author":"Isetta","year":"2016","journal-title":"PLoS One"},{"key":"2024102101344625000_55.6.2000846.16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1183\/23120541.00004-2016","article-title":"Technology for noninvasive mechanical ventilation: looking into the black box","volume":"2","author":"Farr\u00e9","year":"2016","journal-title":"ERJ Open Res"},{"key":"2024102101344625000_55.6.2000846.17","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1152\/japplphysiol.00877.2017","article-title":"Mimicking a flow-limited human upper airway using a collapsible tube: relationships between flow patterns and pressures in a respiratory model","volume":"125","author":"Zhu","year":"2018","journal-title":"J Appl Physiol"},{"key":"2024102101344625000_55.6.2000846.18","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.4.1050"},{"key":"2024102101344625000_55.6.2000846.19","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1513\/AnnalsATS.201312-465OI","article-title":"Chest wall strapping. An old physiology experiment with new relevance to small airways diseases","volume":"11","author":"Eberlein","year":"2014","journal-title":"Ann Am Thorac Soc"},{"key":"2024102101344625000_55.6.2000846.20","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200006000-00042"},{"key":"2024102101344625000_55.6.2000846.21","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/00003246-200105000-00018","article-title":"Breathing pattern and perception at different levels of volume assist and pressure support in volunteers","volume":"29","author":"Mols","year":"2001","journal-title":"Crit Care Med"},{"key":"2024102101344625000_55.6.2000846.22","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1125-5"},{"key":"2024102101344625000_55.6.2000846.23","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04141"},{"key":"2024102101344625000_55.6.2000846.24","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1164\/rccm.201709-1921PP","article-title":"Nasal positive airway pressure and sleep apnea. Reflections on an experimental method that became a therapy","volume":"198","author":"Sullivan","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102101344625000_55.6.2000846.25","doi-asserted-by":"publisher","DOI":"10.1378\/chest.127.5.1784"},{"key":"2024102101344625000_55.6.2000846.26","doi-asserted-by":"crossref","first-page":"e0151625","DOI":"10.1371\/journal.pone.0151625","article-title":"When breathing interferes with cognition: experimental inspiratory loading alters timed up-and-go test in normal humans","volume":"11","author":"Nierat","year":"2016","journal-title":"PLoS One"},{"key":"2024102101344625000_55.6.2000846.27","doi-asserted-by":"crossref","first-page":"9990","DOI":"10.1038\/s41598-017-11045-y","article-title":"Interferences between breathing, experimental dyspnoea and bodily self-consciousness","volume":"7","author":"Allard","year":"2017","journal-title":"Sci Rep"},{"key":"2024102101344625000_55.6.2000846.28","unstructured":"MedTech Europe . The European Medical Technology Industry \u2013 in figures 2019. www.medtecheurope.org\/wp-content\/uploads\/2019\/04\/The-European-Medical-Technology-Industry-in-figures-2019-2.pdf Date last accessed: 24 March 2020."},{"key":"2024102101344625000_55.6.2000846.29","unstructured":"Spence P , Babitt J , Welch J , et al. As change accelerates, how can medtechs move ahead and stay there? Pulse of the industry 2017. www.ey.com\/Publication\/vwLUAssets\/ey-as-change-accelerates-how-can-medtechs-move-ahead-and-stay-there\/$FILE\/ey-as-change-accelerates-how-can-medtechs-move-ahead-and-stay-there.pdf Date last accessed: 24 March."},{"key":"2024102101344625000_55.6.2000846.30","unstructured":"Fuhr T , George K , Pai J . The business case for medical device quality. www.mckinsey.com\/~\/media\/McKinsey\/dotcom\/client_service\/Public%20Sector\/Regulatory%20excellence\/The_business_case_for_medical_device_quality.ashx Date last accessed: 24 March 2020."},{"key":"2024102101344625000_55.6.2000846.31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4236\/me.2015.61001","article-title":"Quantifying the value of open source hardware development","volume":"6","author":"Pearce","year":"2015","journal-title":"Modern Econ"},{"key":"2024102101344625000_55.6.2000846.32","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.hlpt.2017.09.001","article-title":"Maximizing returns for public funding of medical research with open-source hardware","volume":"6","author":"Pearce","year":"2017","journal-title":"Health Policy Technol"},{"key":"2024102101344625000_55.6.2000846.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmjinnov-2015-000080"},{"key":"2024102101344625000_55.6.2000846.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmjinnov-2015-000069"},{"key":"2024102101344625000_55.6.2000846.35","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.socscimed.2018.01.008","article-title":"Rethinking health sector procurement as developmental linkages in East Africa","volume":"200","author":"Mackintosh","year":"2018","journal-title":"Soc Sci Med"},{"key":"2024102101344625000_55.6.2000846.36","unstructured":"De Maria C , Mazzei D , Ahluwalia A . Open source biomedical engineering for sustainability in African healthcare: combining academic excellence with innovation. Proceedings of the ICDS, The Eighth International Conference on Digital Society, 2014; 48\u201353."},{"key":"2024102101344625000_55.6.2000846.37","doi-asserted-by":"crossref","first-page":"30175","DOI":"10.3402\/gha.v9.30175","article-title":"Engineering, global health, and inclusive innovation: focus on partnership, system strengthening, and local impact for SDGs","volume":"9","author":"Clifford","year":"2016","journal-title":"Glob Health Action"}],"container-title":["European Respiratory Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1183\/13993003.00846-2020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T07:32:11Z","timestamp":1740382331000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.ersnet.org\/lookup\/doi\/10.1183\/13993003.00846-2020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,20]]},"references-count":37,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,4]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1183\/13993003.00846-2020"],"URL":"https:\/\/doi.org\/10.1183\/13993003.00846-2020","relation":{},"ISSN":["0903-1936","1399-3003"],"issn-type":[{"value":"0903-1936","type":"print"},{"value":"1399-3003","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,20]]}}}