Enhancing Monitoring Capabilities

By combining cutting-edge technology of actuators, sensors, and digital electronics together with sophisticated data processing algorithms, the modern ventilator can adjust its action in real time.

Mechanical ventilators, or breathing machines, are now the trademark tool of intensive care medicine and a cornerstone of anesthesiology practice. Various research efforts have been devoted in recent years to improve technologies for assessing physiological variables at the bedside and to incorporate into ventilators these enhanced monitoring capabilities for providing the clinicians with the information needed to properly tailor ventilation. 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. 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.

In the last few years, there has been a great deal of interest in adoption of portable ventilators during situations such as respiratory emergencies and multiple causality owing to various technological advancements that have made these portable devices more acceptable in healthcare. Improvements in monitoring also allowed the possibility of using real-time variables to control the action of the machine, with the intermittent mandatory ventilation mode opening the development of assisted mechanical ventilation as a way to manage the weaning of patients from periods of volume-controlled ventilation. Modern ventilators will achieve this by combining cutting-edge technology of actuators, sensors, and digital electronics together with sophisticated data processing algorithms.

Indian Market Dynamics
The Indian ventilators market in 2016 is estimated at 7100 units valued at Rs. 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 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 on Schiller and Mindray. The Andhra Pradesh government placed an order for 100 units on Air Liquide, which was later increased to 200 units. 2017 saw a 147 units order awarded to Mindray and 25 numbers to Air Liquide by the Karnataka government. The Center had invited a bid for 100 units, which is yet to be closed.

Global Market Dynamics
The global ventilators market is estimated at USD 690.8 million in 2016 and is expected to reach USD 1012 million by 2021, reflecting a 5-year compound annual growth rate (CAGR) of 7.9 percent, states RNR Market Research. Critical care ventilators contributed the most toward the global market. In terms of percentage share contribution, the segment is anticipated to account for a 48.2 percent share by 2021. The portable ventilators segment is expected to exhibit the strongest CAGR of 7.6 percent from 2016 to 2021 by value. The noninvasive mechanical ventilators market share is expected to grow at a rapid pace because of patients’ convenience and less side effects along with faster recovery provided by these ventilators.

Geographically, North America and Europe have been leading the global mechanical ventilators market. The Asia-Pacific market is immensely lucrative and is expected to showcase high growth rates over the next 5 years. This rapid growth can be attributed to factors such as the rise in awareness about general healthcare, an increase in medical expenditure, a rise in per capita income, and the development of healthcare infrastructure in emerging economies such as India, China, Japan, and Thailand.

The global ventilators market is consolidated at the top with five companies accounting for more than half of the global market share. The major players in the market include Philips Healthcare, ResMed, Medtronic, Becton, Dickinson and Company, and Getinge Group.

Emerging Trends
Effective ventilators define the breathing pattern with high accuracy by combining cutting-edge technology of actuators, sensors, and digital electronics together with sophisticated data-processing algorithms.

In modern ventilators, all relevant ventilation variables are measured by appropriate sensors that provide information to the control unit in order to adjust, in real time, the valves/turbines for delivering the desired ventilation mode. Thermal flow sensors micromachined on a single silicon chip are available and offer the advantages of presenting high sensitivity and accuracy, a wide measurement range, fast response, low temperature and gas composition sensitivity, low dead space, and resistance.

Over the past few years, leading market players have reshaped the ventilators market with the cutting-edge technologies and new product launches to sustain their position worldwide. These technologies offer advanced ventilator breathing circuits that provide exceptional performance in an easy-to-use system, increasing the effectiveness of patient care and reducing the amount of intervention required. The new products employ unique algorithms that offer therapy to patients’ individual breathing needs by adjusting to a patient’s respiratory rate and target each patient’s alveolar ventilation, auto-adjusting pressure support as needed to maintain that target and stabilize ventilation. With the in-built leak management technologies, these devices maintain patient–ventilator synchrony to ensure effective ventilation.

With the increase in the preference for homecare ventilation and portable ventilators, the demand for portable critical care ventilators has increased. This shift in the demand has been the driving force for the leading market players to come up with innovative portable ventilator models. These ventilators drive air into the breathing circuit with a motor-driven piston or turbine.

Road Ahead
Many respiratory therapists work extensively with mechanical ventilation and face daily challenges in its administration to patients – making it vital to explore ideas that might improve processes, technology, and overall patient care. Further advances in microprocessor-controlled ventilation integrated with the complexity of new ventilator modes will provide the multidisciplinary team opportunities to improve the care of the critically ill ventilator patients in the future. The ventilators will continue to be an evolving modality in the critical care environment, owing to continuous development of both pathology severity and treatments.