Showing posts with label Ruby Hall Clinic. Show all posts
Showing posts with label Ruby Hall Clinic. Show all posts

Thursday, September 12, 2024

Journey of indigenous ICU ventilator development project

Indigenous ICU ventilator - Make in India

As COVID-19 continues its relentless march across the globe, India has seen a sharp rise in cases threatening to overwhelm our hospitals and push our healthcare systems beyond their limits. Four months ago, when a national survey sounded the alarm, saying there were only 47,000 ventilators in the country, with imports costly and difficult, several minds decided to come together. The national appeal to promote ‘Make in India’ had to come to fruition. Moreover, it was the need of the hour to develop ventilators to address this very shortage.

Covid-19 warriors at Ruby Hall Clinic ICU, Pune
Covid-19 frontline warriors at ICU, Ruby Hall Clinic

Innovate2BeatCOVID Grand Challenge

In March 2020, the Marico Innovation Foundation (MIF) under the leadership of Dr. Raghunath Mashelkar, announced the #Innovate2BeatCOVID Grand Challenge. It was then that Nocca Robotics and IIT Kanpur reached out to me for assistance. The challenge — they wanted us to guide and mentor them as they took up the task of developing an ICU ventilator. As an intensivist, I myself was in the midst of preparing our ICU at Ruby Hall Clinic, Pune to brace for the impact of Covid-19 pandemic, but looked at this challenge as an opportunity that would not only address the ventilator shortage but one which could significantly and positively impact the Make in India endeavour. I strongly believe that every innovative idea starts from powerful inspiration, and it was this very inspiration that propelled me to mentor and supervise the team.

Noccarc V310 ventilator by Nocca Robotics
Noccarc V310 ventilator by Nocca Robotics

Ventilator functioning

Firstly, it is important to establish the functionality of ventilators and how they are poised to help in times of a respiratory crisis. At its core, a ventilator is a simple machine, blowing oxygen-rich air into a body and removing carbon dioxide–loaded exhalations. The challenge for the engineering team was to ensure that it does that job consistently, and can precisely measure the volume, pressure, and timing of the breaths passing through a patient. If the air pressure entering a patient’s lungs is too low, the lungs could partially collapse and oxygen levels could drop dangerously, and if it’s too high, it could turn fatal. To add to it, a COVID-infected lung is very delicate and has a dynamically changing status. This is where patient safety plays a huge role.

Team Nocca Robotics with Team Ruby Hall Clinic ICU
Dr. Sanjay Pathare, Medical Director along with Team ICU gratefully receiving two Noccarc V310 ventilators from Nocca Robotics team

Development & Testing

The speed with which the team developed this technology was incredible, but then came the next challenge of testing and validating this technology. After all, a patient’s life would be on the line and this ventilator would be the bridge between life and death. As a mentor, I oversaw every step of the process. Right from the concepts of fundamentals and functionality to conducting countless studies and endurance rests —every step was crucial. It successfully passed all stringent electrical safety, performance and calibration tests. Now, the most important aspect was having the ventilator tested in a clinical setting to ensure patient safety. During the 28-day study at our ICU, our team monitored the machine round-the-clock. In fact, there was a point of time when our fellow, Dr. Nipun Gupta volunteered to administer the ventilator on himself. We were quick to notice that the device enabled him to breathe comfortably for several hours. Thereafter, it was also tested on a couple of patients with critical lung infections making it clinically validated.

Dr. Prachee Sathe explains the working of the ventilator
Dr. Prachee Sathe explains the working of the ventilator 

Award

Sure, it’s been a journey of grit and perseverance. Three months of this collaborative work resulted in the development of the Noccarc V310, an ICU ventilator that emerged victorious amongst 1500 entries in the #Innovate2BeatCOVID Challenge. This ventilator project emerged as India’s top 3 innovative ‘Ventilators and Other Respiratory Solutions’ and was awarded.  It was indeed a moment of pride for us to see our efforts come to fruition! I am also honoured that Nocca Robotics donated two ventilators to our institute. This gesture by Nocca Robotics will help us in the taking on the enormous challenge of ever increasing influx of coronavirus patients.

Nikhil Kurule, CEO, Nocca Robotics hands over Letter of Appreciation along with two ventilators to Dr. Prachee Sathe and team at Ruby Hall Clinic ICU, Pune
Nikhil Kurule, CEO, Nocca Robotics hands over Letter of Appreciation along with two ventilators to Dr. Prachee Sathe and team at ICU, Ruby Hall Clinic

Key features of Noccarc V310 ventilator

The Noccarc V310 is a turbine-based ventilator which consists of all modes required by doctors. In addition to being a state-of-the-art ICU ventilator for complex respiratory failure, it has some of the most unique features including the HFNC (high-flow nasal cannula), BiPAP (bilevel positive airway pressure) and CPAP (continuous positive airway pressure) modes. This machine has PRVC (pressure-regulated volume control) mode as well apart from offering both volume and pressure control. The most unique feature of this ventilator is that it comes with a UV chamber. When a virus-infected patient on a ventilator breathes out, he exhales air filled with virus loads, making it hazardous for all of us. The UV filter chamber kills the virus making it a safer environment.

Appreciation

Letter of Appreciation from Nocca Robotics
Letter of Appreciation from Nocca Robotics

At a time when many indigenous ventilators are being rejected due to lack of clinical validation and feasibility, the fact that our team has been part of a project that has seen the light of the day is indeed heartwarming. As a doctor, it makes me beam with pride that we managed to create synergy between our desire to provide wholehearted care in times of crisis along with fostering the spirit of local innovation - that too, when we are managing the onslaught of the COVID crisis. As a human being, it gives me hope that there will indeed be a brighter COVID-free tomorrow.

Letter of Appreciation from IIT Kanpur
Letter of Appreciation from IIT Kanpur

Gratitude

My sincere gratitude to Nocca Robotics and IIT Kanpur for the opportunity to be part of this project and the faith they reposed in us. I would like to specifically thank the following :
  • Dr. Amitabh Bandopadhyay, KENT Entrepreneurship & Innovation Chair Professor, IIT Kanpur
  • Dr. Abhay Karandikar, Director, IIT Kanpur
  • Mr. Rakesh Bhargava, Former Chairman, FK Oncology Ltd.
  • Mr. Nikhil Kurule, Co-founder & CEO, Nocca Robotics Pvt. Ltd.
  • Mr. Tushar Agarwal, Sr. Product Manager, Nocca Robotics Pvt. Ltd.
  • Ms. Aditi Kumar, Technical & Operations Head, Bioprograms SIIC, IIT Kanpur
  • Dr. Tanima Baronia, Sr. Consultant in-charge, ICU, Ruby Hall Clinic
  • Dr. Sandhya Zambare, Intensivist, ICU, Ruby Hall Clinic
  • Dr. Arun Kumar P, Jr. Consultant, ICU, Ruby Hall Clinic
  • Dr T R Jadhav , ICU senior consultant 
  • Dr. Nipun Gupta, Fellow DNB Critical Care, ICU, Ruby Hall Clinic
  • Brother Dinesh Divakar, Brother in-charge, ICU Ruby Hall Clinic
  • Sister Urmila Nalawade, Sister in-charge, ICU, Ruby Hall Clinic
  • Mr. Mahesh Bhosale, Biomedical Engineer, Ruby Hall Clinic
  • Mr. Bomi Bhote, CEO, Ruby Hall Clinic
  • Dr. Purvez Grant, Managing Trustee, Ruby Hall Clinic
Ruby Hall Clinic, Pune
Ruby Hall Clinic, Pune




Wednesday, July 31, 2024

Unique Dussehra celebration at ICU

Dussehra Pooja


One of my favourite yearly events in the ICU goes like this. It has been a great tradition to worship the instruments and equipment in the ICU on the occasion of Dusshera like Shastra Pujan (शस्त्र पूजन).

Dussehra pooja at Ruby Hall Clinic ICU (2020)
Dr. Sharad Yadav performing Dussehra pooja with ICU team

While we perform rituals to honour our equipment and apparatus which is used for extending our professional services to our patients , we pray, may our means and efforts be honest, pure and with up to date functionality and knowledge when we treat our patients ! 


For ICU it is not a holiday but celebration of our work ethics. Even though it was COVID times, Dusshera 2020 was not an exception, having pooja with "all precautions".


Dnyan (ज्ञान) - Initiation on the path to Knowledge


Vidyarambham (विद्यारंभम) of Dnyan by Dr. Prachee Sathe


Many of our staff were away from families and home for months on end since COVID started. Physical distance from the families could not stop us from being a great big family working day in and day out in critical care areas. On the day of Dusshera there was a surprise waiting for me in my office.

A small bright child of two and a half years, waiting for  something very important to happen in his life.
"Dnyan (ज्ञान)" (son of Dinesh,  nursing incharge of our ICU, who hails from Kerala),  was eagerly waiting for his Vidyarambham (विद्यारंभम) ! 

I was so touched to be with him and his parents, to hold his tiny hand and write in rice grains his first letters "Shri Ganeshay Namah (
श्री गणेशाय नमः)" ! I was full of joy to initiate him on his path of exploration of Dnyan (ज्ञान).

Gift of Saraswati (सरस्वती)

There was an unexpected gift on my way from a dear friend Manju, depicting "Saraswati (सरस्वती)". It was done beautifully ! 

Gift received on Dussehra 2020 - Saraswati (सरस्वती)

New normal begins

We all were reviewing the situation of CORONA in last few days, realising the regressing curve in Pune, Maharashtra and India. Hospitals were closing COVID wards. Ultimately  our ICU had some vacant beds after the tumultuous six months !!  It was a great moment to announce with great deliberation that we are going to close one of the COVID ICUs, to restart non covid aka "normal" ICU!  Everyone rejoiced .


Of Course, we should not let the guard down. The last thing we want is a second wave.

Be aware, be safe !










































Tuesday, April 14, 2020

Basic clinical needs for ventilation of COVID-19 patients

Clinical needs for a ventilator for COVID-19 patient

This video titled "Basic clinical needs for a ventilator to ventilate a COVID 19 patient" is an introductory video , intended to help biomedical entrepreneurs to understand the the basic requirements to create a ventilatory machine to handle ARDS / difficult lung /in COVID19. For doctors who want to learn how to ventilate, there are other modules.


Need is the mother of Invention, when it comes to ventilators

Pandemics are testing times. Great to see Indian Govt taking charge of the situation so proactively at various levels of this disaster management. In response to the facts like shortcomings of health infra , scarcity of the life saving ventilators, big business houses, innovators , biomedical engineers, medicos are all trying to stand up to the situation. Hopefully it should see some significant developments in Indian scenario of critical care medicine for availability ,cost effectiveness and capacity building.

While it is absolutely true that the ventilators evolved from iron lungs to synchronised lung protective machines, it happened only with better and better understanding of the pathophysiology of diseased lungs prompting mechanical changes in the ventilators over the years. Many intensivists are facing the queries regarding new prototypes of ventilators coming up, how much ever the efforts are lauded , haste in making crude prototypes should not cause harm than help to tide over the crisis.

Video to encourage Make in India

Here is a video created in line with the specifications given by Govt of India for ventilators as an effort to explain the details to courageous groups coming forward to “Make in India” ! This video was created with encouragement from Dr L S Shashidhara, Professor and Dean (Research), Ashoka University, Sonipat, 131029 India and Professor, Indian Institute of Science Education and Research (IISER) Pune (Currently, on Lien at Ashoka University) The video was shot at the ICU at Ruby Hall Clinic and features the following intensivists - Dr. Prachee Sathe (Director, ICU), Dr. Tanima Baronia (Senior Consultant, In charge, ICU) and Dr. Arunkumar (Consultant)


Cost effectiveness is a great determinant of acceptance of treatment modality in our country and obviously of the outcomes. But when it comes to lifesaving treatments like artificial ventilators, imported from other countries, it becomes disproportionately high expenditure in the bill of a critically ill patient ,who so ever bears it. It can be very painful for a sensitive intensivist to explain the “COST” of life to patient family.

Life after COVID-19


The life is not going to be the same after COVID-19 and Critical Care Medicine and ICUs also are hopefully going to change for the better for the common man! Let us welcome the new developments, with concern for quality at the same time !