Ventilators are the most powerful symbols of modern medical technology and progress, which have allowed more patients to survive acute critical illness than ever before. Today's ventilators are common in hospitals, long-term care centers, emergency centers, and even patients' homes, helping save hundreds and thousands of lives every day by providing respiratory ventilation.
Even though the concept of ventilation dates back to the 14th century, it is only in the last century that it has been widely introduced into routine clinical practice. Since their initial appearance, ventilators have become more sophisticated and have foundapplication ranging from the intensive care unit (ICU) to the respiratory medicine ward and even to patients' homes for long-term treatments. This was the result of combined advancements in respiratory physiology, pathophysiology, and clinical management of patients together with technological progress in mechanical, electronic, and biomedical engineering.
Nowadays, this evolution is rapid, with new devices and an increased number of ventilation modes and strategies being introduced to improve outcomes, patient–ventilator interactions, and patient care. Engineering has played and is still playing a relevant role in this process, not only in improving the technical performance of the ventilators, but also in contributing to a better understanding of respiratory physiology and pathophysiology, and how different ventilation strategies interact with the respiratory system.
Indian Market Dynamics
The Indian ventilators market in 2016 is estimated at 7,100 units valued at 360 crore. The imported equipment continues to dominate the segment and is gaining traction as institutions are wary of compromising with this critical care equipment. The ambulatory and transport models too are seeing a gradual increase in demand. In India, refurbished and indigenous ventilators, available at competitive prices, continue to cater to a niche segment.
High-performance turbine-based models are gradually being preferred over compressor ventilators. On an average, trigger function and pressurization quality are better with turbine-based ventilators. A shorter triggering delay, a shorter inspiratory delay, and a higher PTP (the amount of assistance received by the patient during the initial part of the effort) are some other factors in the turbine-based ventilator's favor.
Very few tenders were finalized in 2016. The Gujarat government placed an order for 50 machines each to Schiller and Mindray. The Andhra Pradesh government placed an order for 100 units to Air Liquide, which was later increased to 200 units. 2017 saw a 147-units order awarded to Mindray and 25 units to Air Liquide by the Karnataka government. The Center had invited a bid for 100 units, which is yet to be closed.
Recent Market Trends
The global ventilators market is expected to witness steady growth over the next 5 years, chiefly because of rapid technological innovations in the design and portability of the devices.
The ventilators market is increasingly witnessing a huge shift from invasive ventilators toward the use of noninvasive ventilators because these ventilators make the routine activities easier by decreasing the strain of breathing, unlike invasive ventilators that cause adverse effects on patients. Also, since noninvasive ventilation systems have a faster recovery time, involve shorter hospital stays, and eliminate the use of the endotracheal tube, they can be used in both acute and chronic respiratory failure. With the increasing use of noninvasive ventilators to treat various other respiratory conditions such as chronic obstructive pulmonary disease (COPD), pneumonia, asthma, and acute respiratory disease, the global medical ventilators market is expected to witness considerable growth over the next few years.
Transport and portable ventilators are also witnessing high growth owing to their extension from ambulatory to home care. Hospitals are promoting the use of portable ventilators to provide faster and continuous care to patients even prior to their arrival in the premises. Portable units fulfill the need of patients to obtain home care, thereby increasing its popularity. Upgrading of technological and production systems leading to the development of smaller, highly compact, and robust ventilators providing high performance is expected to propel their growth.
Another trend gaining momentum in the market is ventilators with automatic adaptation. The concept of adaptive ventilation was developed to increase patient comfort. Adaptive ventilation changes according to the needs of the patient, breath by breath. In adaptive ventilation, the patient decides the need, and the machine adapts to the need. Vendors are developing new ventilators with automatic adaption.
The Challenge of Delivering Accurate Ventilation
Probably not every ventilator user knows how to use most of the features of their ventilator. Perhaps this statement is a little frightening, but it is very close to the truth for some. Not only are they under-utilized, but often their main functions are handled improperly. When a piece of life-support equipment is not used correctly it can cause serious damage to the health of the patient. Mechanical ventilation is a fundamental part of critical care, and the accuracy of ventilatory settings is of utmost importance. When dealing with unstable patients, a bad technological performance may cause a patient harm, while low tidal volume (VT) and high positive expiratory pressure (PEEP) are key points for protective ventilation.
The question that must be asked is what leads to such poor use of ventilators by professionals who use this equipment? Besides technical performance, the major aspect of a device's reliability is its usability. Usability is defined as the extent to which a device can be used by specified users to achieve specific goals effectively, efficiently, and satisfactorily, in a specified context of use. Usability is mainly related to the quality of human–machine interface. Improved interface seems mandatory to limit human errors that could exacerbate morbidity and mortality.
Human error has been demonstrated to be a leading cause of morbidity and death during medical care. Many devices have interfaces that are so poorly designed and difficult to use that they can increase the risks associated with the medical equipment and device-induced human error. Human error may be to some extent inevitable and caused equally by human performance and machine performance. In order to limit the number of errors, computing technology and human–machine interface development should be designed to correspond to human characteristics of reasoning and memory constraints. An interface with a human-centered design increases efficiency and satisfaction and decreases the rate of medical error.
The developer and manufacturer of mechanical ventilators should support the creation process of the equipment based on the needs and experiences of the users. Developers and manufacturers should utilize the ideas, knowledge, needs, and experience of professional primary users when designing mechanical ventilators. Thus, fabricating devices which have better usability, are more user-friendly, and are more efficient than current models.
However, given individual physicians' heterogeneity, the perfect ventilator may be a difficult goal to achieve, and even with experience, some element of frustration and/or temporal workload may still occur. This is the contemporary challenge that requires manufacturers and users of ventilators who are all in the end part of the same team whose goal is to save lives when they are most threatened.