2021 International Conference on Radar, Antenna, Microwave, Electronics, and Telecommunications

High-Flow and High-Pressure Oxygen Mixing

for Ventilator System
2021 International Conference on Radar, Antenna, Microwave, Electronics, and Telecommunications (ICRAMET) | 978-1-6654-2816-3/21/$31.00 ©2021 IEEE | DOI: 10.1109/ICRAMET53537.2021.9650464

Eko Joni Pristianto Deni Permana Kurniadi Hana Arisesa

Research Center for Electronics and
Telecommunications
National Research and Innovation Agency
of Indonesia
Bandung, Indonesia
ekojonip5@gmail.com
Research Center for Electronics and Research Center for Electronics and
Telecommunications Telecommunications
National Research and Innovation Agency National Research and Innovation Agency
of Indonesia of Indonesia
Bandung, Indonesia Bandung, Indonesia
dennypermana69@gmail.com hana003@lipi.go.id

Dayat Kurniawan Erry Dwi Kurniawan Yusuf Nur Wijayanto

Research Center for Electronics and
Telecommunications
National Research and Innovation Agency
of Indonesia
Bandung, Indonesia
daya004@lipi.go.id
Research Center for Electronics and
Telecommunications
National Research and Innovation Agency
of Indonesia
Bandung, Indonesia
erry.2k@gmail.com
Research Center for Electronics and
Telecommunications
National Research and Innovation Agency
of Indonesia
Bandung, Indonesia
ynwijayanto@gmail.com

Budi Prawara
Research Center for Electrical Power and
Mechatronics
National Research and Innovation Agency
of Indonesia
Bandung, Indonesia
budi006@lipi.go.id

Abstract— The treatment of patients with acute respiratory
failure due to COVID-19 needs ventilator machine support to
provide oxygenation and ventilation processes. The most
critical control in the machine is how to provide precision-
inspired oxygen fraction (FiO2) to the patients during the
treatment. Generally, the low-flow nasal cannula can provide 4-
6 liters per minute of supplemental oxygen with approximately
37 - 45% FiO2. In this paper, we present high-flow and high-
pressure oxygen mixing to provide up to 100% FiO2 and 60
liters per minute. The proposed system also employs the close-
loop feedback control to achieve a desirable FiO2 set point. It
can be used for a Continuous Positive Airway Pressure (CPAP)
and Bilevel Positive Airway Pressure (BiPAP) ventilator
systems with oxygen as well as a High Flow Nasal Cannula
(HFNC) system for acute respiratory patient’s syndrome.
Keywords—C-BiPAP ventilator, FiO2, high flow, high
pressure, oxygenation.
I. INTRODUCTION
Overcoming the COVID-19 pandemic caused by the
severe acute respiratory syndrome coronavirus 2 (SARS-
CoV-2) virus has become one of the main priorities. The
virus attacks human respiration and can cause the emergence
of other comorbidities that can lead to death. The researcher
is still working on the medicine on patients infected with the
virus. Some new antiviral drugs have been deemed effective
in clinical trials study. However, regulators are moving
swiftly to consider the general use of the drugs. It is needed
to complete medical studies to determine whether any of
these medications are effective against COVID-19. One of
the medical devices used for COVID-19 sufferers is a
ventilator that helps pump oxygen into the lung to support
the breathing system. Breathing problems can become severe
enough to require treatment for the patient COVID-19.
A ventilator, specifically a medical ventilator, is one of
the medical devices needed to support the healing of
COVID-19 patients. The medical instrument serves to
provide ventilation for airflow that can be pressurized, flow-
regulated, volume-controlled and can be enriched with
oxygen gas needed for COVID-19 patients who have
difficulty breathing. With the help of using a ventilator, it is
hoped that COVID-19 patients will maintain their breath
until the patient's health recovers.
There are various types of ventilators that have different
functions. Some ventilators are purely mechanical, some
ventilators use electronics, and some are somewhere in
between. In operation, some ventilators still use mechanical
switch interfaces, and some use digital as a whole, some are
a combination of the two. In terms of appearance, some
ventilators have a very minimal appearance, so only limited
parameters are displayed. There are modern types of
ventilators that have used a complete screen so that various
controlled parameters can be displayed, and graphs are added
to determine the patient's vital signs.
Adequate and precision oxygenation are essential factors
to support patient recovery. Excessive inspired oxygen
fraction leads to the intoxication of the patient. Hence, the
mixin g process needs to be precisely maintained. Several
methods have been reported. Automated Close Loop Control
has been implemented in several works employing several
algorithms such as PID, Fuzzy, and neuro-Fuzzy, etc [1-4].
In the High-Flow Nasal Cannula (HFNC) therapy, stable
and precise FiO2 is needed for the treatment such as infant
and neonatal patients [5, 6] as well as COVID-19 patients [7,
8]. The exactly inspired oxygen fraction is also substantial to
be accurately determined such in the Non-Invasive Positive
Pressure Ventilation (NIPPV) and Continuous Positive

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 Pressure (CPAP) for obstructive sleep apnea syndrome
patients (OSAS), with acute respiratory failure breathing [9,
10]. This work reported the method to provide inspired
oxygen fraction applicable for high-flow and high-pressure
oxygen air mixing, which is suitable not only for Continuous-
Bilevel Positive Airway Pressure (C-BiPAP) but also High-
Flow Nasal Cannula (HFNC) therapy. C-BiPAP ventilator
can deliver a single pressure as CPAP (Continuous Positive
Airway Pressure) mode or deliver two pressures: an inhale
pressure and an exhale pressure as BiPAP (Bilevel or two-
level Positive Airway Pressure) mode. These two pressures
are known as inhalation positive airway pressure (IPAP), and
exhalation positive airway pressure (EPAP).
II. METHODS
Fig. 1 shows a block diagram of the proposed ventilator’s
pneumatic system which consists of several functional
modules. The ventilator system was developed by the
Research Center for Electronics and Telecommunication,
National Research and Innovation Agency of Indonesia,
named Smart & Innovated Ventilator Indonesia (Si-
Venesia).
The gas source consists of two inputs, which are input
source from an oxygen inlet and an ambient air inlet. The two
sources are used to provide an inspired oxygen fraction in the
mixing module before delivering to the patient. In the first
source, oxygen gas will be regulated by a gas regulator to
maintain the pressure around 3-5 bar.
Then, a proportional valve is used to control the oxygen
flow to the mixer. The module proportional valve was
developed by us and is responsible for providing the required
oxygen flow. The DC motor controlled proportional valve
based on a self-locking gearbox (Indonesian Patent
Application P00202105266) maintains the oxygen flow for
controlled inspired oxygen fraction production. High rpm
DC motor and high ratio gearbox used (JGY370 - 3RPM),
lead to the high-resolution flow oxygen as 0.1 L/min can be
achieved.
Fig. 1. System block diagram ventilator.
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A filter and oxygen sensors are also installed to filtrate
and monitor the oxygen flow. An oxygen flow sensor is used
to provide the oxygen feedback as the input to the closed-
loop feedback control system to achieve a desirable oxygen
flow. The second source, ambient air from free air, is filtered
and blown by a motor-controlled blower and air filter. A
brushless centrifugal DC motor blower (OLOEY WM7040-
24) is used to supply adequate ambient airflow and pressure,
provides high pressure (up to 7.5 KPa) and high airflow (up
to 240L/min) to deliver airflow and pressure into the oxygen
baffle.
The In-Line Flow Restrictor (ILFR) valve is used to
control the airflow to the mixer (oxygen baffle). Then, the
oxygen and air are mixed and circulated in the oxygen baffle
to provide precision-inspired oxygen fraction (FiO2) to the
patients during the treatment.
After that, the Pressure Release Valve (PRV) valve is
controlled to provide the desired high-flow and high-pressure
oxygen mixing. The outlet of this system is added air filter
before the exhaled air from the patient is thrown into the free
air. An oxygen fraction flow and pressure sensor are used to
provide the feedback as the input to the closed-loop feedback
control system to achieve a desirable oxygen fraction flow
and pressure.
There is a minimum of two important parameters for the
outputs in ventilator, that is oxygen fraction and pressure. To
maintain those two parameters, we set the desired set point
using databases. The database consists of the data of oxygen
flow, ambient air flow, and opening/closing valve. while the
FIO2 sensor is used to monitor the level of the oxygen
fraction produced. All the modules are controlled by a
microprocessor in the data and signal processing unit.
Table I shows specific medical parameters of the
developed Si-Venesia ventilator. Where, this is a standard
parameter that must be met on a ventilator.
 TABLE I. MEDICAL PARAMETERS OF THE DEVELOPED SI-VENESIA

Parameter Value
140

Positive end-expiratory pressure (PEEP) 5 – 10 cmH2O 120

Pressure support (PS) 1 – 35 cmH2O
100

Airflow (lpm)
Inspiratory positive airway pressure (IPAP) 5 – 40 cmH2O
Expiratory positive airway pressure (EPAP) 5 – 20 cmH2O
80
Inspiratory: Expiratory ratio (I:E) 1:1; 1:2 ; 1:3
Oxygen fraction (FiO2) 21 – 100% 60

40
Experimental Data
Fitting Curve
20
for Calibration

0
0 20 40 60 80 100 120 140 160 180
PWM Value of Motor Blower

Fig. 3. Measured air flow.

100

Oxygen Fraction (%) 90

80

70
Fig. 2. Test setup.
60
III. EXPERIMENTAL SETTING 50
Fig. 2 shows the setup for testing and measurement in this
40
study. The ventilator needs an oxygen source from a portable
oxygen tank attached to the oxygen inlet. Meanwhile, the air 30 Experimental Data
inlet is used to fetch ambient air from the environment. The Regression Fitting
oxygen inlet can receive the oxygen pressure from 3 – 5 bar. 20 for Calibration

The output-inspired oxygen fraction is attached to the Fluke 10

biomedical VT650 gas flow analyzer. The personal computer
(PC) is used to control and process the data.
The inspired oxygen fraction is produced by mixing the
oxygen flow with the ambient air inside the mixer using an
oxygen baffle (BiPAP Vision PH13606). The amount of the
oxygen flow and ambient airflow automatically using
controlled closed-loop feedback control to achieve a
desirable FiO2. The module proportional valve was
developed by ourselves and is responsible for providing the
required oxygen flow, meanwhile, a brushless centrifugal
DC motor blower (OLOEY WM7040-24) is used to supply
adequate ambient airflow and pressure.
The DC motor controlled proportional valve based on a
self-locking gearbox (Indonesian Patent Application
P00202105266) maintains the oxygen flow for controlled
inspired oxygen fraction production. The closed-loop
feedback control applied in the system adjusts the DC motor
speed to open and close the valve. High rpm DC motor and
high ratio gearbox used (JGY370 - 3RPM) lead to the high-
resolution flow oxygen as 0.1 L/min can be achieved.
The three-phase brushless DC motor blower (OLOEY
WM7040-24) provides high pressure (up to 7.5KPa) and
high airflow (up to 240L/min) to deliver airflow and pressure
into the oxygen baffle.
0 10 20 30 40 50 60
Output Voltage (mV)
Fig. 4. Measured inspired oxygen fraction (FiO2).
IV. DISCUSSION
Fig. 3 shows the experiment results of measured airflow
from ambient. The flow of the air was controlled by changing
the speed of the motor blower. A microcontroller is used to
control the speed using Pulse Width Modulation (PWM)
from 0 - 255. As shown in Figure 3, we can find that the
relation of PWM and airflow is quite linear. Using those data,
we can control the output flow of FiO2 precisely by mixing
the airflow from ambient combined with from oxygen
source.
The inspired oxygen fraction detection use FiO2 flow and
pressure sensor (SIARGO FS6122). The sensor can measure
a uni- or bi-directional flow and pressure from inspiration
and expiration processes. A pressure up to 250 SLPM and
pressure up to 40 gauge can be provided. The accuracy of
pressure reading is 1%. The data and control using I2C
connection with the output is linear DC voltage. Fig. 4 shows

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 160
140
120
Flow (lpm)
100
80
Min output flow spec
60
40
20
0 0
20 30 40 50 60
Oxygen Fraction (%)
Fig. 5. Measured flow and pressure
the sensor’s output voltage corresponds to the oxygen
fraction (FiO2). The graph shows that the output sensor and
the oxygen fraction have a good correlation. The sensor
works that FiO2 from 20 ~ 100% can be detected, which is
suitable for monitoring bidirectional flow and pressure
oxygen fraction.
Fig. 5 describes the measured flow of the Oxygen (blue
dot line), ambient air (pink dot line), inspired oxygen fraction
(red dot line), and pressure (black start line), which
correspond to the inspired oxygen fraction (FiO2). Minimum
output flow specification is determined at 60 lpm (red dash
line), and minimum output pressure is 20 cmH2O. Based on
the requirement, the Continuous Positive Airway Pressure
(CPAP) therapy need up to 40 cmH2O flow FiO2, meanwhile
above 50 cmH2O flow FIO2 can be used for High-Flow Nasal
Cannula (HFNC) therapy as well.
Both flow oxygen and airflow are used to produce the
oxygen fraction flow. Here we simplified the formula by:
( )= ( _
with the assumption of no leakage in the system. There is no
correlation in the amount of both flows with the output flow
FiO2. To reach, above 100 lpm flow FiO2, the required flow
oxygen and ambient airs are 20 ~ 60 lpm and 115 ~ 85 lpm
respectively. This can produce an oxygen fraction of 20 ~ 60
% and pressure remain flat at 20 cmH2O. However, below
100 lpm flow output (oxygen fraction), increasing flow
oxygen is needed (40 ~ 80 lpm) with decreasing flow
ambient air 120 ~ 0 lpm, this led to the oxygen fraction from
60 up to 100% and pressure stable at 40 cmH2O.
Due to varying input flow oxygen and ambient air to
produce the output flow, it is difficult to use manual
proportional mixing. Here, the mixing process based on
calibrated values is used. These values are measured and
calibrated on the normal operation ventilator using the Fluke
VT650 gas flow meter. All calibrated possible values were
saved in the memory of the data and signal processing unit.
Whenever the required flow, pressure, oxygen fraction is
needed, the system generates the suitable value on the system
to achieve that. With this method, all possible target
parameters output can be easily reached.
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160 V. CONCLUSION
Flow Output (FiO2)
Flow O2
140 High-flow and high-pressure inspired oxygen fractions in
Air Flow
Output Pressure
the Si-Venesia ventilator have been described. The mixing
120 process relied on the amount of oxygen and ambient airflow
Pressure (cmH2O)
to achieve a determined oxygen fraction. The inspired
100
oxygen fraction (FiO2) can be achieved from 20 to 100% (0.2
80 to 1). The flow FiO2 as high as 60 to 120 lpm can be reached,
instantaneously mixed from Oxygen flow from 0 up to 80
60
lpm and ambient airflow from 65 until 120 lpm. The output
40 pressure can be provided from 20 ~ 40 cmH2O (0.28 ~ 0.57
psi). These results are suitable for obstructive sleep apnea
Min output pressure spec 20
syndrome patients using Continuous Positive Airway
Pressure (CPAP) treatment with oxygenation feature as well
70 80 90 100 as High-Flow Nasal Cannula (HFNC) therapy.
ACKNOWLEDGMENT
This research is supported partly by funding from
Konsorsium Riset dan Inovasi untuk percepatan Penanganan
Corona Disease (Covid-19) Lembaga Pengelola Dana
Pendidikan (LPDP) 2020-2021 also partly supported by
annual grant DIPA LIPI 2020.
Authors thanks to Mr. Hery Soepriyadi for his kind
supports and helps during the development and realization of
the Si-Venesia ventilator.
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