|Brent Chamblee, BS, CRT||Cyndy Miller, RRT||Ulf Solback|
RT invited three manufacturers to give their perspective on the latest trends in technology in ventilation. eVent Medical, Aliso Viejo, Calif, was founded in 2000 as a manufacturer of ventilator and respiratory care products. Last year, the company became a subsidiary of Kobayashi Medical America, LLC, whose parent company is Kobayashi Pharmaceutical Japan. Brent Chamblee, BS, CRT, is a marketing and product manager at eVent. Newport Medical Instruments, Costa Mesa, Calif, was founded in 1981 as a privately owned ventilator company with distribution to some 116 countries. Cyndy Miller, RRT, is director of clinical education at Newport. Respironics, Murrysville, Pa, was founded 30 years ago and is best known for its noninvasive ventilation and sleep-disordered breathing products. The company’s product portfolio also includes critical care ventilators, cardiorespiratory monitoring systems, respiratory drug delivery devices, home oxygen systems, and neonatal care products. Ulf Solback is vice president of marketing, Critical Care Business Unit at Respironics.
Chamblee: Since the advent of processor-driven ventilation technology, several new modes of ventilation have been developed. While modes are important, it is what’s inside the device (hardware and software control) that provides high-end performance features and capabilities. Advanced ventilators, at a minimum, are using proportional solenoid (PSOL) valves with active control of exhalation to ensure precision and flexible breath delivery, as well as improved synchrony.
Miller: Processors are more powerful than they used to be, so they enable ventilators to handle more complicated tasks and respond faster to patient needs. By working with their clinical partners, ventilator manufacturers can explore ways in which the latest technologies can be used on their products to improve patient care while simplifying the user interface.
Solback: The advent of the microprocessor revolutionized ventilator technology because it enabled ventilators to process and respond quickly to patient information, allowing much greater patient-ventilator synchrony. Twenty years ago, mechanical pressure sensors and analog control systems could not respond to a patient’s spontaneous efforts. With sedatives and paralytics, patients were made to adapt to the machine, but with today’s devices, the machines adapt to the patient.
With our current monitoring technology, caregivers observe physiological changes before they present as clinical manifestations. For example, our NICO2 Respiratory Profile Monitor can detect changes in alveolar ventilation long before the patient shows clinical signs of weaning fatigue. This allows the clinician to intervene sooner and prevents the need for recovery periods as we liberate patients from the ventilator.
Chamblee: We, as manufacturers of life-support products, know we can assist users and the health care system by providing flexible, reliable, cost-effective solutions. Manufacturers are always working to expand and improve their products’ capabilities. In the case of an existing customer, upgrades come in two categories: software upgrades that enhance existing functionality and upgrades that provide additional functionality. In either of these situations, manufacturers are providing customers the ability to improve the capabilities of their existing ventilator fleet without the necessity to purchase new devices. Another way manufacturers are aiding in cost reduction is with the production of more reliable products, longer warranty periods, decreased product maintenance (PM) costs, and the utilization of disposable or reusable components.
Miller: Manufacturers strive to achieve the right balance of clinical benefits and cost. By investing significant R&D efforts into developing clinically proficient ventilators with high value, low purchase price, low product maintenance, and training, we can offer our customers feature-rich, easy-to-use, dependable ventilators at a low cost of ownership.
Solback: While new technologies can increase capital spending and overall health care costs, many new technologies reduce these costs, so I don’t think we will necessarily see a de-featuring of ventilation products, but I do think institutions will look more closely at the benefits new features provide. If a new technology can be shown to improve outcomes and reduce costs, then health care institutions will find a way to justify the investment. But we will also see less expensive devices provide the same or better care than yesterday’s most advanced devices. For instance, the use of noninvasive ventilation has grown rapidly in the last 10 years, and noninvasive ventilators cost considerably less than most invasive ventilators, so they make sense from a capital budget perspective.
Chamblee: eVent Medical’s Inspiration line of ventilators includes infant through adult. Our patented Swiss pneumatic design allows high-performance PSOL valves to provide outstanding breath delivery. Users find exceptional value in our straightforward interface, ease of transport, comprehensive monitoring, and simple preventive maintenance. A unique capability within the Inspiration line is the built-in Mini Web Server that allows display of all settings, monitoring, and alarms on computers, hospital networks, or the Internet using standard hardware and Windows software. Practical advantages include standard 5-hour battery, emergency backup compressor, integral nebulizer, heliox—pending 510(k)—and extreme ease of use. Our Virtual Reporting software allows you to view multiple patients outside the ICU. Your report has become “real time.”
Miller: Newport Medical has developed automated features that address the problems of patient-ventilator breath management mismatching and the dysynchrony that results from it. On some ventilators, the user is required to adjust either the flow-trigger setting and/or the bias-flow setting to re-establish reliable triggering when the breathing-circuit system/airway leak changes. With Newport’s Automatic Leak Compensation/Baseline Pressure Management, bias flow is automatically adjusted and the flow-trigger setting is bias-flow compensated so there is no need to readjust either of them to re-establish reliable triggering when the leak changes. Newport’s president, Dr Hong Lin Du, in partnership with Dr Yoshitsugu Yamada and Dr Marcelo Amato, developed Newport Medical’s patented automated expiratory threshold feature—FlexCycle. FlexCycle optimizes the expiratory threshold setting breath by breath so that patient inspiration is supported without early or late cycling off. This allows a more sophisticated form of pressure support—one that is responsive to each patient’s unique respiratory system characteristics. The Newport e360 Ventilator offers ICU features and performance at a mid-range cost of purchase and ownership. The Newport HT50 offers up to 10 hours of built-in battery life when new and fully charged. You can also use any external battery. This mobile ventilator is a very useful tool for the therapist working in emergency response, post-acute care, post-surgical care, and home care.
Solback: I mentioned the NICO2 Respiratory Profile Monitor and how it is providing information to steer the patient’s ventilator course. Today, respiratory therapists have much less time to refine ventilator settings or assess the patient’s tolerance to weaning. The NICO2 monitor indicates changes in the lungs and quickly provides the clinician with information to make informed decisions regarding the patient’s care.
We recently released a technological breakthrough for the Esprit® Critical Care Ventilator: the Speaking Mode Option. For the first time in ventilator history, a positive pressure ventilator enables speech function without the use of an external one-way valve. The clinician simply deflates the patient’s trach tube cuff and turns on the software option. The Esprit ventilator controls the exhalation valve to force the exhaled gas up through the vocal cords and permit normal speech. It also responds to occlusions to return to the patient’s normal settings.
Chamblee: Our ventilator’s solid pneumatic design has very few moving parts, and thus, it seldom, if ever, has a problem. To get the most consistent results with our ventilators involves a simple start-up calibration of the system and proximal flow sensor. This process takes less than a minute, and once complete, the ventilator is calibrated for patient use or storage.
Miller: Always perform all of the preventive maintenance that is outlined in the product manual. Make sure all preventive and corrective maintenance is done by a factory-trained biomedical technician. Newport’s Technical Service Training schedule is posted on our Web site: www.ventilators.com. Plug your HT50 ventilator into AC power (or external DC power) when it is available during ventilator use and also when the ventilator is not in use. This will extend the useful life of your battery. Newport ventilator’s software-driven, preuse checks can help you avoid confusion by ensuring that the system is calibrated and compensated for your current ventilating conditions.
Solback: We recommend the Respi-Link system for all of our ventilator customers. The Respironics’ Respi-Link system allows online diagnostics and software updates and was recently awarded an industry-wide remote service leadership award. This unique service helps respiratory and biomedical departments maintain the most current functionality for the best patient care.
Tor Valenza is a staff writer for RT. He can be reached at [email protected]