Dedicated ventilator units may be the next thing in hospitals

Ventilation has been a life-saving treatment for seriously ill patients for many years. And more and more, hospitals overseas are incorporating dedicated ventilator units with multidisciplinary teams into their facilities.

Critical care has been an important aspect in patient care, and this has become evident during the Covid-19 pandemic, which was perhaps the greatest challenge seen in this lifetime. This has made the healthcare industry hugely resilient. If we look at the past three years, adaptability, collaboration, and innovation come to mind. Today, hospitals are also modified from the earlier established protocols during Covid-19 to provide resource-intensive care to patients besides providing routine hospital care.

Some countries in the presence of unforeseen Covid-19 pandemic have experienced lower total deaths, though higher numbers of Covid-19-related infections. Results here suggest that one of the explanations is the critical role of ventilator technology in clinical health environment to cope with the initial stage of Covid-19 pandemic crisis. These findings suggest that a forward-thinking and technology-oriented strategy in healthcare sector, based on investments in high-tech ventilator devices and other new medical technologies, can help clinicians deliver effective care and reduce negative effects of present and future respiratory infectious diseases, in particular when new drugs and appropriate treatments are missing in clinical environment to face unknown respiratory viral agents.

Having said that, long dependence on mechanical ventilation is an emerging health problem, especially after critical illness. Around 40 percent of patients entering the intensive care unit (ICU) require mechanical ventilation and 20 percent of these patients are expected to have increased ICU stays due to difficulty in weaning.

It has become vital to incorporate a multidisciplinary approach for patients receiving prolonged mechanical ventilation (PMV). Patients receiving PMV generally exceed the median length of stay in a hospital, and have a disproportionate readmission rate as compared to those ICU patients who do not require PMV. Typically, these patients are treated by a dedicated team within the ICU led by a pulmonologist who is responsible for making decisions and writing orders.

While a focus on the lungs is important when treating ventilated patients, moving to a multidisciplinary approach with respiratory therapists leading patient treatment, along with a dedicated team of physical therapists, occupational therapists, speech pathologists, acute care trained nurses, and dedicated case managers is suggested for future care models. This allows for more time with the patient, which enables early mobility and enhanced rehabilitation opportunities.

Studies show that a dedicated, multidisciplinary weaning unit for PMV patients not only reduces overall length of stay but also shows an improvement in patient survival, functional status, reduction in ventilator days or mechanical ventilation at discharge, and quality of life. This clearly illustrates an increased need for dedicated ventilator care units within the hospitals.

There are numerous reasons why patients are placed on ventilator care. Often, respiratory failure is secondary to the trauma that requires the use of PMV. That is why it is important to have a dedicated team who knows how to properly care for patients with varying primary health issues, including trauma, stroke and congenital heart failure.

Indian market dynamics
The Indian ventilators market in 2022 is estimated at 12300 units, valued at ₹813.5 crore. The imported ICU ventilators continue to dominate the segment with 83-percent share by value and a 73-percent share by volume.

The refurbished ventilators are a dying category and are neither preferred by the buyer nor the authorities.

The indigenous ventilators are yet to make a serious comeback. The huge number of systems procured by the government in 2020 had kept public hospitals away in 2021. However, now bids are being invited again and along with the replacement market, the market is gradually calibrating and getting back to the pre-Covid level. The semi-urban sector is also looking up. Allied Medical and Skanray are the major vendors catering to this segment. Backed by its newly set up 200,000 sq. ft. of production floor space at Bhiwadi, a wider product range and a larger sales team, Allied Medical is gaining share steadily. The manufacturer is also one of the approved manufacturers to have qualified for the PLI scheme. The Make in India thrust has enabled offering a lower cost of ownership, a better control on after-sales service and spare parts.

In 2022, UVENT and Aeon Medical fared well, considering they were not there pre Covid. Three brands that had a setback in this segment are Philips, and to some extent Medtronic Covidien and Nihon Kohden. In June 2022, Philips Respironics, in line with the FDA regulation, had to recall all V60 and V60 Plus ventilators because an internal power fluctuation could cause the ventilator to shut down unintentionally, either with or without any visible or audible alarms. The power fluctuation caused a reboot of the backup alarm controller, which would lead to a complete shutdown of the ventilator without warning. Affected ventilators would cease ventilation either with or without alarms. Such failures led to patients being deprived of oxygen for an extended time, which could cause serious adverse health consequences and death, was the explanation. As of April 14, 2022, there had been reports of four injuries and one death associated with the use of the recalled devices. The recall targeted 49,680 V60 devices and 6991 V60 Plus devices for a total of 56,671 devices, manufactured and distributed between May 1, 2009, and December 22, 2021. Philips had already faced a recall of these models in March after it was discovered that some of the V60 and V60 Plus units were assembled with a faulty adhesive, leading to power failure.

Global market scenario
The global market for mechanical ventilators is valued at USD 3.3 billion in 2022, and projected to record over 1-percent CAGR from 2023–2032. Of that, intensive care ventilators are predicted to reach USD 2.7 billion and adult ventilators USD 3.1 billion by 2032. The enormous patient pool with asthma and chronic obstructive pulmonary disease (COPD), along with the changing lifestyle, is increasing the deployment of adult ventilators. These units have in-built compressors, automated humidification, data monitoring, and invasive/non-invasive ventilation systems. These are extremely useful in complicated surgical procedures and treatment of chronic illnesses.

Invasive ventilation technology for mechanical ventilation generates some health problems as lung injury, alveolar overdistension that leads to inflammatory processes and fluid accumulation in lungs, ventilator-associated pneumonia etc.

The growth in the market is expected due to the packages of emergency relief accepted by governments around the world. Higher healthcare spending, developed healthcare infrastructure, demand for critical patient care, and new technological developments are some of the factors contributing to the growth of mechanical ventilator market.

Portable and transportable ventilators market is also witnessing a steady growth, and is the segment expected to grow with the highest CAGR till 2030.

Growing prevalence of chronic diseases like COPD, bronchitis, asthma, rise in geriatric population disorders, increasing level of pollution, changing lifestyles of people, and growing number of unintentional cases are driving the demand for ventilators. It is projected that the clinical benefits provided by mechanical ventilators for the diagnosis, treatment, and mitigation of chronic respiratory illnesses will boost equipment deployment.

Risks linked with ventilators as acute respiratory distress syndrome (ARDS), sepsis, ventilator-associated pneumonia (VAP), atelectasis, and pulmonary edema are common. Other risks associated with the use of medical ventilators include patient and physician resistance to technological transfer. Diseases, such as barotrauma, lung injury, pneumonia, and the high cost of medical ventilators, are some of the factors that are hampering the growth of the global market for ventilators. The lack of standardized nomenclature for various ventilation modes also limits the global market for ventilators.

To reduce these risks, companies are developing advanced equipment. Advancements emphasize the most urgent needs for improvement and most promising directions of future development. Mechanical ventilators are becoming more sophisticated, and expanding their application from the intensive care unit (ICU) to the respiratory medicine ward and even to patients’ homes for long-term treatments. Today, the evolution is rapid, with new devices and an increased number of ventilation modes and strategies being introduced to improve outcomes, patient-ventilator interaction, and patient care.

The technical performance in new ventilators has been improved manifold, and contributes to a better understanding of respiratory physiology and pathophysiology and of how different ventilation strategies interact with the respiratory system.

Rise in the prevalence of lung and respiratory diseases among patients, such as COPD and bronchial asthma, which also causes postoperative complications after surgery and necessitates a consistent demand for high-frequency ventilators, and a surge in preterm birth rates across the world, is driving the growth of the global high-frequency ventilators (HFV) market.

HFV is considered a novel approach to mechanical breathing due to its capacity to deliver small, frequent breaths at high frequencies. In recent years, the usage of HFVs has accelerated, and they have been successfully applied in a variety of clinical settings, including new-born and adult intensive care units.

Studies have shown that low-tidal volume and low-pressure HFV can reduce ventilator-induced lung injury (VILI) in patients with ARDS. The application of non-invasive HFV in patients with acute respiratory failure is another development in HFV technology. This less invasive method has demonstrated potential improvements in oxygenation, a decreased need for intubation, and a shorter hospital stay. Another kind of HFV that is gaining priority in neonatal and pediatric intensive care units is high-frequency oscillatory ventilation (HFOV).

As per a report by Research Dive, the market for HFV is steady. It is expected to grow at a CAGR of 5.8 percent from 2022 to 2031. The reason for this growth is attributed to the increase in the prevalence of respiratory disorders, rising demand for advanced respiratory care devices, and advancement in technology. HFV has revolutionized the field of mechanical ventilation as it is a safer and more effective substitute for traditional mechanical ventilation. Recent technological advances have made HFV a promising therapy for people suffering from respiratory problems. It is anticipated that as the area of HFV advances, it will become increasingly important in the treatment of respiratory failure in seriously ill patients.

In today’s ventilators, clinicians are looking for some distinctive features like reduced time spent on ventilators, simplified use of the device, and ability to integrate clinically useful information into the healthcare system, both directly and digitally. They foresee improved patient care as the main goal, along with the cost-saving feature.

Automation is another aspect through which clinicians can save their time and they do not have to be present at bedside all the time. In fact, a large proportion of the new solutions is software-based and allows automatic responses by the ventilators, typically within parameters that can be set and adjusted as determined by the clinicians. Europe and the US are both adopting automation and adapting to the new automatic protocols. However, complete automation is not yet on their list.

Clinicians can use help not only with ventilation adjustments but also with management of the data produced by the machine. It is no longer enough to be given numbers – clinicians want information. Automobile speedometer might be equivalent to waveforms and graphics, but new pictures can add 1000 words. Vendors offer graphic options on ventilators that give real-time feedback to help optimize device settings or incorporate color to enhance display identification.

Manufacturers have introduced a number of innovations to reduce alarm fatigue, a serious concern for many facilities. Some are designed to create fewer alarms, such as features that reduce leakage, others help to manage the alarms themselves. Smart alarms enable priority settings, graphical alarms provide visual information to indicate urgency, others send alerts remotely to better divide work among personnel.

Another innovation that has been making rounds is the ease of connectivity. Connectivity extends everywhere, not just within the facility. Covidien has launched its vital sync platform, which sends integrated ventilator data (as well as pulse oximeter and capnography data) to a central station or to any web-enabled mobile device, including laptops, tablets, and smartphones.

Therefore, connectivity to access real-time data quickly helps clinicians to take immediate healthcare decisions, as well as long-term care decisions. To top it all, if the ventilator or software system provides this information automatically, without requiring clinicians’ analyses, it will be more beneficial. With the growing importance in technologies like machine learning, augmented reality, 5G, and digitization, the ventilator industry in the last three years alone has seen significant changes. However, not all innovations are equal, nor do they follow a constant upward trend. Instead, their evolution takes the form of an S-shaped curve that reflects their typical lifecycle from early emergence to accelerating adoption, before finally stabilizing and reaching maturity.

A key innovation that has been evident is the remotely monitored ventilators in artificial intelligence. Remote ventilator monitoring systems allow healthcare professionals to monitor patient’s vital signs and ventilator data from anywhere in the healthcare facility. These devices use software to adjust the settings remotely according to the requirement, thereby reducing risk of infection to the healthcare staff. According to GlobalData, there are 40+ companies, spanning technology vendors, established medical devices companies, and up-and-coming start-ups engaged in the development and application of remotely monitored ventilators.

In terms of application diversity, that measures the number of different applications identified for each relevant patent, Art Medical leads the pack, followed by Weinmann Emergency Medical Technology and Somne. By means of geographic reach, that refers to the number of different countries each relevant patent is registered in and reflects the breadth of geographic application intended, ranging from global to local, Hamilton Bonaduz held the top position, while Johnson & Johnson and Air Liquide are in second and third spots, respectively.

Koninklijke Philips is one of the leading patent filers in the field of remotely monitored ventilators. Some other key patent filers in the field include ResMed, Medtronic, Baxter International and Fisher & Paykel Healthcare.

The other entries of a total 42 companies are Air Liquide, Art Medical, Asahi Kasei, Autonomous Healthcare, Becton Dickinson and Co, BMC Medical, CareFusion 207, DEKA Research and Development, Dragerwerk, Drive DeVilbiss Healthcare, eVent Medical, Fisher & Paykel Healthcare, Freespira, General Electric, Getinge, Hamilton Bonaduz, Johnson & Johnson, Loewenstein Medical Technology, Pneuma Respiratory, Senzime, Separation Design Group, Shenzhen Mindray Bio-Medical Electronics, Somne, Teijin, Teleflex, Terumo, Vyaire Medical, Weinmann Emergency Medical Technology, and Weinmann Geraete Fuer Medizin.

Remotely monitored ventilators ensure the safety, viability, performance, sustainability, and versatility required to meet the needs of various patients and caregivers. Remotely monitored ventilators have become the preferred choice for both patients and physicians due to the Covid-19 pandemic, and this trend is expected to continue as the pandemic has led to an unprecedented need for remote patient monitoring.

A forward-thinking and technology-oriented strategy in healthcare sector, investments in high-tech ventilator devices and other new medical technologies, can help clinicians deliver effective care and reduce negative effects of present and future respiratory infectious diseases, when new drugs and appropriate treatments are missing in the clinical environment to face unknown respiratory viral agents.