The focus has shifted toward improved technologies that prevent lung injury, reduce the time that patients have to spend on mechanical ventilation, and improved synchrony between the patient and ventilator
Ventilator technology today offers a great deal of improvements with respect to enhanced patient safety, automated weaning systems, data connectivity to central alarms and information systems, as well as features to augment patient-ventilator synchrony. User interfaces have been designed to streamline the interpretation of data and customize information to the bedside clinician. Owing to major breakthroughs in hardware and software technology, ventilators have made a quantum leap in capabilities over the previous generation. The pneumatics on many older ventilators have proven to be sound, but in conjunction with advanced electronics and software potential, ventilators can now offer much more in terms of advanced care.
In 2014, the Indian ventilator market was estimated at 6500 units in terms of volume and Rs.266.75 crore in terms of value.
The market for imported equipment was estimated at Rs.217 crore, with 3950 units of sales. GE, Draeger Medical, Maquet Medical, Philips, and Schiller dominate this segment. Other aggressive players include Philips, Mindray, Skanray, Air Liquide, Carefusion, and Hamilton.
The refurbished ventilators market, in 2014, generated a sales of 750 units, amounting to Rs.18.75 crore. These ventilators are preferred by small hospitals and nursing homes in tier-II and tier-III cities, and semi-urban and rural areas. Major players in this segment include Zigma, SOMA, Max Meditech, Fabian HFO (Acutronic Medical Systems), Technomed, and Unitech. This segment is also catered to by resellers/importers who import the products from the United States, the United Kingdom, Germany, and Australia.
Transport, Ambulatory, and Chinese ventilators constitute 7.7 percent of this market, estimated at Rs.5 crore.
The indigenous market, estimated at 1300 units, accounting for Rs.26 crore, is dominated by Max Meditech and Medisys. Air Liquide and Schiller also have some presence in this segment.
The global ventilators market has witnessed significant growth in the past two decades in the wake of technological innovation. While the increasing prevalence of chronic obstructive pulmonary disease (COPD) will continue to be the primary driver of market growth, new technologies will also make a crucial contribution. Another key reason for the growth of the market is the increasing preference for home-care ventilators and portable ventilators.
Asia is likely to witness high growth rate in the ventilators market in next few years with an emerging economy and improvement in healthcare technologies in the region. Growing demographics and economies in the developing countries such as India and China are expected to offer good opportunities. In these emerging economies, a rise in new hospitals has led to a surge in the number of ICU beds equipped with ventilators. In addition, the integration of physiological principles in system would offer novel avenues for the global ventilators market.
Intensive-care mechanical ventilators are the most widely used type and hold the dominant share in the mechanical ventilators market. The increasing preference for non-invasive ventilation in the developed world will be another significant trend.
Companies are adopting several development strategies to increase their market share in the mechanical ventilators market. Innovation and development of new technologies in the healthcare sector would help the manufacturers to increase their market share. Companies are trying to explore the opportunities in developing economies by adopting agreement and acquisition as key strategies. Product launch is another strategy used by various companies to retain their position in the mechanical ventilators market.
Mechanical ventilators have evolved significantly in the last decade. Advances in technology, an increased understanding of the physiology, and effects of mechanical ventilation have had a profound impact on ventilators use. Innovations in equipment design and functionatity are being developed to improve patient outcomes and increase ease of use for clinicians by addressing two key objectives of simplifying function and mitigating harm.
Advancements in Technology
Modern ventilators offer increased accuracy and flexibility in modes of ventilation. Volume and pressure targets are controlled more accurately and reduce the risk of barotrauma, volutrauma, and atelectasis. The flexibility of modern modes and mode adjuncts, for instance, pressure support ventilation (PSV) for spontaneous breathing and the ability to more accurately control adjuncts like peak inspiratory pressures, allow for increased safety in the increased use of supraglottic devices, ambulatory procedures, and refined adjuncts such as regional anesthesia. Other benefits of new ventilators include single-switch activation and an ability to enter the patient's weight for recommended appropriate ventilator settings. Assisted and controlled ventilation is no longer limited to volume-controlled and pressure-controlled modes. Other forms of ventilation include extracorporeal membrane oxygenation (ECMO) and neurally adjusted ventilator assist (NAVA). With NAVA, bipolar electrodes detect signals traveling down the phrenic nerve to the diaphragm, and use this signal as the stimulus to initiate mechanical ventilations. This allows for very precise volume delivery and a decreased chance of pressure-related complications. Ventilators available today feature volume guarantee in pressure control and in time cycled pressure limited for neonatal specific ventilation. Proximal flow sensing allows for accurate monitoring in the neonatal intensive care unit which facilitates reliable triggering to help improve patient synchrony.
Companies are focusing on developing multimodal ventilators, which act as a one-stop solution for critical care physicians handling a wide range of ICU procedures. Manufacturers are increasingly turning their attention toward improved technologies that prevent lung injury, and reduce the time that patients have to spend on mechanical ventilation.
Improved user-interface. Improvements in the structural design that is combined with technological innovation and a wider range of usage settings on mechanical ventilators has greatly changed the construction, nature of use, and rate of use of disposable apparatus in the devices. An easy access to all the tools necessary for monitoring and evaluating patient vitals and managing ventilator settings, in just a few swipes of the screen has improved workflow efficiency. The ability to customize workspaces and analyze waveforms across an entire 72-hour window is providing users the ability to turn data into information pertaining to clinical decisions.
Manufacturers have developed customized technology that can be adjusted simply and quickly to respond to patient needs. The current crop of ventilators combine personalized, simplified therapy with powerful wireless connected care capabilities for patients with respiratory challenges who are not dependent on continuous ventilation. The built-in wireless connectivity provides quick access to a wide range of therapy parameters. This data, along with therapy statistics and trend data useful for home titration and monitoring, is automatically and securely transmitted to a cloud-based patient management system.
Non-invasive ventilation. This has become a standard of care for the management of acute respiratory failure, but there is a risk of leaks around the mask that may interfere with ventilator performance. Moreover, dedicated NIVs have exhibited more standardized behavior with an ability to avoid auto-triggering or delayed cycling while keeping a short triggering delay despite the presence of leaks. Non-invasive ventilators are specially designed for critically ill patients suffering from respiratory failure, congestive cardiac failure patients and newborn infants.
Major factors influencing the adoption of NIVs include inherent benefits such as reduced infection risk, patient's ability to swallow and speak, and minimized need for sedation. Combination of invasive and non-invasive ventilation modes as well as flexible mask options helps facilitate quick therapy transitions and keeps patients as comfortable as possible, providing the benefit of two technologies in one product.
Automatic transport ventilators. Ease-of-use and minimal needs when it comes to maintenance and repair are key factors to consider in any ventilator product. Advances in technology continue to create ventilators that are smaller, more user-friendly, and easily adaptable to the pre-hospital environment and foster the development of critical care medicine.
Smaller, user-friendly portable ventilators show great potential for more widespread use in the pre-hospital setting. Pre-hospital use of non-invasive ventilation methods (CPAP, BiPAP, and PAV) has been shown to reduce in-hospital mortality rates. The addition of automatic transport ventilators with greater ability to customize settings for CPAP, BiPAP, and PAV would allow pre-hospital personnel to deliver respiratory support tailored to each patient's specific needs.
Currently, the use of a portable mechanical ventilator is a mainstay of critical care patient transport via both air and ground. The potential benefits of widespread automatic transport ventilator use on advanced life support (ALS) ambulances are significant. There has been a gradual introduction of automatic transport ventilators as an addition to ALS protocols. These simplified ventilators provide more consistent minute volume than traditional positive pressure ventilation with a bag-valve device. There is also evidence that the use of automatic transport ventilators may allow paramedics to complete other tasks related to patient care, as they are not directly involved in manual ventilation. Prolonged manual ventilation with a bag-valve device is harmful and often increases patient mortality. The introduction of automatic transport ventilators into ambulances could have significant impact on patient outcomes, particularly in rural areas with longer transport times.
The advances in ventilator modalities - in conjunction with a better understanding of patient physiology and the effects of positive pressure ventilation on the body - have revolutionized the mechanical ventilation process. Compact, rugged computing modules lay the framework for lifesaving advancements in today's ventilator technologies. Increased ventilator control is paving the way for optimum patient health as well as reduced hospital stays and associated costs. Innovations in ventilators continue to adapt to a rapidly changing environment. Each improvement focuses on safety while providing another option in delivering the best form of ventilation based on the patient's condition and need.