The surging ventilator market

Through technological innovations, ventilators have become indispensable tools, influencing healthcare facility organizations and patient outcomes.

2024 has been an eventful year for the ventilator industry. In February 2024, Medtronic announced that shutting down the ventilator business was ultimately in the company’s interest, and the savings would increase investments in the new unit, particularly in remote patient monitoring.

“The business became increasingly unprofitable throughout the last year. The growth slowed even more, and the dynamics within the segment are changing, moving to lower acuity ventilators. Our unique and worthy contributions are more in the higher acuity, hospital-based products,” said CEO Geoff Martha on an earnings call recently.

The company has exited the ventilator market and combined the remaining PMRI businesses into a new unit called Acute Care and Monitoring, which includes pulse oximeter, remote patient monitoring, airway management and respiratory monitoring products.

Philips, on the other hand, has been grappling with the fallout of its recall of millions of breathing devices and ventilators for three years, as fears of large litigation bills lopped off about two-thirds of its market value. The devices were recalled in April 2021 because of concerns that foam used could degrade and become toxic, carrying potential cancer risks. In April 2024, Philips announced the final details of a consent decree reached with US authorities in January, spelling out the improvements it needs to make at its Respironics plants in the United States.

That said, the global ventilators market is one of the fastest-growing segments in the medical devices market. Air pollution, changing lifestyles, and an aging population are the main causes of respiratory illnesses that are on the rise. This spike is the main cause of the rising demand for ventilators, underscoring the vital function that these medical devices play in respiratory health management.

Respiratory care is changing due to the incorporation of intelligent elements like data analytics and remote monitoring. The Covid-19 epidemic has brought attention to how important ventilators are for treating respiratory distress. Governments and medical facilities are strengthening and re-evaluating their ventilator capacity. New hospitals and healthcare facilities are being established. The growing use of ventilators is a direct result of this development, particularly in developing nations.

With chronic illnesses becoming more common, the ventilator market is expected to see strong growth in sales over the next few years. It is also anticipated that the number of pediatric healthcare facilities will contribute significantly to market sales profits due to the growth in preterm deliveries, which require intensive nursery care for the infant with enough medicines and appropriate breathing.

Indian market dynamics
The Indian market for ventilators is estimated at ₹820 crore and 10,600 units in 2023. Post Covid, there has been a shift in the demand pattern. With a huge number of machines having been bought in the two Covid years, the market for the low-end has almost saturated. It is the high-end and the mid-end imported machines that are in demand now.

The new generation of high-end ventilators in Indian ICUs is revolutionizing respiratory care. They incorporate lung-protective ventilation strategies to mitigate ventilator-associated lung injury. Invaluable tools offer advanced respiratory support, enhancing patient care and empowering clinicians to deliver optimal ventilation therapy tailored to individual patient needs.

Advanced ventilation modes dynamically adapt to changes in a patient’s condition and respiratory mechanics. They provide app-based systems, a secondary user interface outside the hazardous environment, advanced monitoring and analytics, integrated connectivity and data management, and seamless ventilation.

The indigenous machines did well in 2023. This may partly be attributed to the stringent requirement by GeM and partly to the CDSCO having tightened the conditions for import licenses. Another factor contributing to growth is the increasing manufacturing of ventilators under the Make in India campaign, which promises to reduce prices and significantly improve affordability. The popular brands are Skanray, Allied Medical, and Neumovent. Noccarc, Medisearch, IndoVent, Max, LifeLine Biz, Trivitron, Air Liquide, Narang Medical Limited, AVI Healthcare, Medion, OneBreath Inc. and AgVa also have a presence in the market.

Hospitals do not prefer transport ventilator machines, as they are relatively expensive. The machine must offer features similar to those for an air ambulance. The ambulances find they cannot afford such an expensive machine and opt for the BiPAP machines. This alternative is resorted to, albeit the machines only offer nuanced support and do not control the patient’s breathing. The 2023 market for BiPAP machines is estimated at 6000 units.

The refurbished market, as expected, is a dying segment.

A single factor driving ventilator growth in the country is the deteriorating AQI levels in Tier-I cities. Urbanization and industrial expansion have worsened air pollution in India, leading to more respiratory diseases like chronic obstructive pulmonary disease (COPD). According to an estimate by The Lancet, 37.9 million people in India have asthma, and frequently experience respiratory issues. Add to this, the rising prevalence of respiratory disease among the geriatric population, along with an increasing rate of premature births.

India is gradually emerging as a preferred destination for medical tourism. This can stimulate investment in cutting-edge healthcare technology. Its world-class healthcare facilities attract patients from other countries, contributing to the demand for advanced medical equipment, including ventilators.

Improving healthcare access in rural areas is a priority. This expansion may lead to an increased demand for ventilators as more people gain access to critical care services.

By region, South India dominates the Indian ventilator market. However, North India is anticipated to witness a high growth. Several North Indian states, such as Uttar Pradesh, Delhi, and Bihar, have been investing significantly in boosting healthcare expenditures to strengthen infrastructure for public health emergencies.

India’s critical care ventilator market accounted for approximately 21 percent of the Asia-Pacific market in 2023. It is set to grow at a CAGR of 4 percent between 2023 and 2033, according to GlobalData.

Global market dynamics
The global market for ventilators is valued at USD 3 billion in 2023, growing at a CAGR of 4.9 percent during 2024 to 2030, as per Grand View Research report.

In recent years, the global market has evolved significantly with technological advancements, including the development of advanced portable ventilators and improvements in the sensor technologies used in ventilators. The demand for multimodal ventilators has been on the rise due to their versatility and ability to cater to a wide range of patients’ needs within a single device. These ventilators offer various ventilation modes and settings, making them suitable for treating patients with diverse respiratory conditions, from mild to severe.

The flexibility of multimodal ventilators has become essential in adapting to rapidly changing patient requirements, allowing healthcare providers to transition between modes seamlessly as patient conditions evolve. This adaptability, combined with features, such as advanced monitoring capabilities and user-friendly interfaces, has made multimodal ventilators a preferred choice in modern healthcare settings, where they optimize patient care while streamlining equipment management and reducing the need for multiple specialized devices.

The mechanical ventilator market is currently experiencing moderate growth with an accelerating pace, propelled by a growing geriatric population, a substantial patient pool with respiratory disorders, and the introduction of technologically advanced devices. This segment is witnessing an upswing in mergers and acquisitions, with companies strategically utilizing multiple acquisitions to bolster product portfolios, extend their global presence, diversify offerings, integrate technologies, and strengthen their positioning within the industry.

The integration of smart technology and digital sensors plays a pivotal role in augmenting therapy management, contributing significantly to the market’s momentum.

Segment insights. In 2023, the transport and portable mechanical ventilator segment held a market share of 38.51 percent, with the fastest CAGR of 5.4 percent from 2024 to 2030. The market growth can be attributed to the efficiency of mechanical ventilators in various applications across diverse care delivery settings. The evolution of cost-effective, patient-friendly, and portable devices further fuels their increasing adoption.

Portable ventilators have diverse applications, ranging from home care to ambulatory centers, and the market for point-of-care (POC) treatment is expanding, driven by an increase in medical emergencies, which is a key factor for the growth of this segment.

The non-invasive ventilation mode segment held the largest market share of 57.7 percent in 2023, with the fastest CAGR of 5.1 percent from 2024 to 2030. The growth of the segment is attributed to its wide range of applications and its ability to provide precise and higher concentrations of oxygen.

Extensive research and development investments, combined with rising per capita income, are driving the growth of the healthcare sector. The surge in the prevalence of respiratory diseases is a key factor fuelling the overall market growth for continuous positive airway pressure (CPAP) devices.

Regional insights. North America dominated the market with a revenue share of over 43.21 percent in 2023. The increasing prevalence of respiratory conditions, such as chronic obstructive pulmonary disease (COPD), asthma, and sleep apnea, is driving the therapeutic respiratory devices market in the region. Moreover, key market players are employing strategies, such as acquisitions, collaborations, expansions, and new product launches, to extend their product offerings and geographical reach.

The Asia-Pacific region is projected to witness significant growth at a CAGR of 7 percent over the forecast period. The segment growth is attributed to the high burden of respiratory disorders and the high risk of lifestyle factors, such as smoking and allergies, resulting in several respiratory conditions. In addition, government initiatives and collaborations among the vendors to manufacture advanced ventilators are also propelling the region’s growth.

Some of the prominent players operating in the global mechanical ventilators market include Medtronic, Abbott, Schiller AG, Allied Medical LLC, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Nihon Kohden Corporation, Philips, ResMed, Getinge AB, Air Liquide, GE Healthcare, and Hamilton Medical.

Technological advancements
In recent years, the field of mechanical ventilation has been constantly evolving, and technological advancements and emerging trends are improving patient outcomes and expanding access to care.

Pressure-regulated volume control. PRVC ventilation is considered an advancement in mechanical ventilation technology due to its more sophisticated and adaptive approach to ventilatory support compared to traditional modes. It combines volume and pressure strategies to deliver pressure-controlled breaths targeted to a specific tidal volume (VT).

The ventilator adjusts pressure levels based on the patient’s ventilatory needs, considering factors like lung compliance, airway resistance, and respiratory effort. PRVC aims to optimize alveolar recruitment, patient comfort, and synchrony between the patient and the ventilator, while minimizing the risk of lung injury. It automatically adapts to changes in lung conditions on a breath-by-breath basis and provides a lung protective strategy for patients with conditions like acute respiratory distress syndrome (ARDS).

Integration of volume capnogram. A graphical representation of exhaled carbon dioxide concentration over time to ventilators has emerged as a valuable tool for assessing ventilation status and helps guide clinical decision making.

The resulting capnogram curve helps assess respiratory function, influenced by factors, such as CO₂ production, cardiac output, pulmonary perfusion, and alveolar ventilation. End-tidal CO₂ (ETCO₂) is normally slightly lower than arterial blood PCO₂, but this gradient can increase in conditions like pulmonary embolism.

Capnography is extensively used in various medical settings beyond laparoscopic surgery, including confirming endotracheal tube position, monitoring respiratory circuit integrity, assessing CPR effectiveness, evaluating mask ventilation, monitoring during sedation, and assisting in mechanical ventilation. Its broad utility underscores its importance in critical care and anesthesia management.

The integration of volume capnography, offering a comprehensive assessment of respiratory function, complements the valuable clinical insights provided by tidal capnography.

Tidal capnography, displayed on ventilator screens or bedside monitors, offers valuable clinical insights in neonatal care. Clinicians can use CO₂ waveforms to identify complications and pulmonary pathology, such as dislodged or blocked endotracheal tubes. These waveforms complement other monitoring techniques, and aid in identifying ventilation asynchrony.

Continuous tidal capnography, being non-invasive and providing real-time information, holds promise in neonatal intensive care, particularly during non-invasive respiratory support.

However, its limitations, such as its inability to monitor CO₂ in high-frequency ventilation modes, lead to potential inaccuracies. Overall, tidal capnography serves as a practical tool for diagnosis and troubleshooting at the bed side, enhancing respiratory monitoring and patient care in neonates.

IoMT. The integration of the Internet of Medical Things (IoMT) into ventilator technology represents a significant advancement in healthcare. By incorporating modern technologies like IoT, cloud computing, and embedded systems, ventilators can become more than just life-support devices – they can become intelligent systems capable of providing personalized care and real-time monitoring.

For instance, by leveraging IoT-based wearable devices and smart sensors, ventilators can continuously gather data on a patient’s respiratory status, including parameters like end-tidal CO₂ levels measured by a capnograph. This data can then be transmitted securely to healthcare providers, allowing for remote monitoring and timely intervention in case of any abnormalities. Additionally, cloud computing can enable the storage and analysis of vast amounts of ventilator data, facilitating insights into patient trends and outcomes.

Furthermore, the incorporation of technologies like Bluetooth low energy and robotics can enhance the functionality of ventilators, enabling features, such as automated adjustments based on patient condition or seamless integration with other medical devices in the care environment.

Novel developments
Low-cost mechanical ventilator. Villanova University engineers have developed NovaVent, an affordable mechanical ventilator priced at less than USD 800. It is designed to deliver continuous mandatory ventilation (CMV) using readily available components, offering a high-efficiency and budget-friendly alternative to traditional ventilators.

Its patented design allows for the regulation of tidal volume, critical for adequate ventilation while minimizing lung injury, with performance comparable to pricier counterparts. NovaVent has been awarded a patent, and initial tests conducted on lung simulators have validated its effectiveness. Professor C. Nataraj highlights the broader applications of NovaVent beyond Covid-19, emphasizing its importance in treating various medical conditions. The engineers aim to make this life-saving technology accessible to all, regardless of socioeconomic status, through collaboration with like-minded partners.

Fluorescence-based sensor. Researchers at the Fraunhofer Institute for Physical Measurement Techniques (IPM) have developed a fluorescence-based sensor to directly measure oxygen levels in breath, providing real-time and accurate data. This innovation aims to address the limitations of traditional pulse oximeters, which can be unreliable.

Based on the principle of fluorescence quenching, the sensor determines oxygen concentration by measuring the fluorescence of a coating exposed to short-wave light. This method allows for precise measurements, down to individual breaths. The sensor, attached to a breathing mask or ventilator tube, surpasses existing technologies in accuracy and cost-effectiveness. It enables continuous monitoring of oxygen concentrations and has potential applications in various settings, including hospitals, emergency care, and home use for patients with lung disease. Ongoing research focuses on optimizing the sensor’s performance and exploring potential cross-sensitivities and environmental influences.

Outlook
The trajectory of ventilator technology propels us toward an era of unprecedented possibilities in healthcare. As we harness the potential of emerging technologies like IoT and robotics, coupled with innovative solutions, such as low-cost ventilators and fluorescence-based sensors, we are poised to reshape the landscape of critical care. This forward-looking approach promises enhanced patient outcomes and fosters a future where access to life-saving respiratory support is more equitable and widespread.