BACKGROUND AND OBJECTIVES

Mechanical ventilators are essential albeit expensive equipment to support critically ill patients who have gone into respiratory failure. Adequate numbers should always be available to ensure that a hospital provides the optimal care to patients but the number of patients requiring them at any one time is unpredictable. Finding therefore the best balance in providing adequate ventilator numbers while ensuring the financial sustainability of a hospital is important.

A quantitative method using Monte Carlo Simulation was used to identify the optimal strategy for acquiring ventilators in a large private tertiary medical center in Metro Manila. The number of ventilators needed to provide ventilator needs 90% of the days per month (27/30) was determined using historical data on ventilator use over a period of four years. Four acquisition strategies were investigated: three ownership strategies (outright purchase, installment, and staggered purchase) and a rental strategy. Return on Investment (ROI), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), Net Present Value (NPV), and Payback period (or Breakeven Point) for each strategy were determined to help recommend the best strategy. A qualitative survey was also conducted among doctors, nurses, and respiratory therapists who were taking care of patients hooked to ventilators to find out their experiences comparing hospital-owned and rental ventilators.

It was found that a total of 11 respirators were needed by the hospital to ensure that enough respirators were available for its patients at least 90% of the days in any month based on the previous four-year period. This meant acquiring three more ventilators as the hospital already owned eight. Among the strategies studied, projected over a 10-year period, the installment strategy (50% down payment with 0% interest over a 5-year period) proved to be the most financially advantageous with ROI = 9.36 times, IRR = 97% per year, MIRR = 26% per year, NPV = ₱39,324,297.60 and Payback period = 1.03 years). A more realistic installment strategy with 15% (paid quarterly or annually) and 25% annual interest rates were also explored with their financial parameters quite like but not as good as the 0% interest. The outright purchase of three ventilators came in lower (ROI = 4.53 times, IRR = 55% per year, MIRR = 19% per year, NPV = ₱38,064,297.60 and Payback period = 1.81 years) followed last by staggered purchase with ROI = 3.56 times, IRR = 64% per year, MIRR = 28% per year, NPV = ₱29,905,438.08, and payback period of 2.06 years. As there was no investment needed for the rental strategy, the only financial parameter available for it is the NPV which came out as ₱21,234,057.60.

The qualitative part of the study showed that most of the healthcare workers involved in the care of patients attached to the ventilator were aware of the rental ventilators. The rental ventilators were generally described as of lower functionality and can more easily break down. The respondents almost uniformly expressed a preference for the hospital-owned ventilators.

This analysis showed that the best ventilator ownership strategy from a purely financial perspective for this hospital is by installment with a 50% down payment and 0% interest. Moderate rates of 15% and 25% interest per year were also good. These were followed by outright purchase and lastly by staggered purchase. The rental strategy gave the lowest cumulative 10-year income compared to any of the ownership strategies, but may still be considered good income because the hospital did not make any investment. However, it seems that most of the healthcare workers involved in taking care of patients on ventilators thought the rental ventilators were of lower quality and preferred the hospital-owned ventilators.

Background and Objectives: Mechanical ventilators are essential albeit expensive equipment to support critically ill patients who have gone into respiratory failure. Adequate numbers should always be available to ensure that a hospital provides the optimal care to patients but the number of patients requiring them at any one time is unpredictable. Finding therefore the best balance in providing adequate ventilator numbers while ensuring the financial sustainability of a hospital is important. Methods: A quantitative method using Monte Carlo Simulation was used to identify the optimal strategy for acquiring ventilators in a large private tertiary medical center in Metro Manila. The number of ventilators needed to provide ventilator needs 90% of the days per month (27/30) was determined using historical data on ventilator use over a period of four years. Four acquisition strategies were investigated: three ownership strategies (outright purchase, installment, and staggered purchase) and a rental strategy. Return on Investment (ROI), Internal Rate of Return (IRR), Modified Internal Rate of Return (MIRR), Net Present Value (NPV), and Payback period (or Breakeven Point) for each strategy were determined to help recommend the best strategy. A qualitative survey was also conducted among doctors, nurses, and respiratory therapists who were taking care of patients hooked to ventilators to find out their experiences comparing hospital-owned and rental ventilators. Results: It was found that a total of 11 respirators were needed by the hospital to ensure that enough respirators were available for its patients at least 90% of the days in any month based on the previous four-year period. This meant acquiring three more ventilators as the hospital already owned eight. Among the strategies studied, projected over a 10-year period, the installment strategy (50% down payment with 0% interest over a 5-year period) proved to be the most financially advantageous with ROI = 9.36 times, IRR = 97% per year, MIRR = 26% per year, NPV = ₱39,324,297.60 and Payback period = 1.03 years). A more realistic installment strategy with 15% (paid quarterly or annually) and 25% annual interest rates were also explored with their financial parameters quite like but not as good as the 0% interest. The outright purchase of three ventilators came in lower (ROI = 4.53 times, IRR = 55% per year, MIRR = 19% per year, NPV = ₱38,064,297.60 and Payback period = 1.81 years) followed last by staggered purchase with ROI = 3.56 times, IRR = 64% per year, MIRR = 28% per year, NPV = ₱29,905,438.08, and payback period of 2.06 years. As there was no investment needed for the rental strategy, the only financial parameter available for it is the NPV which came out as ₱21,234,057.60. The qualitative part of the study showed that most of the healthcare workers involved in the care of patients attached to the ventilator were aware of the rental ventilators. The rental ventilators were generally described as of lower functionality and can more easily break down. The respondents almost uniformly expressed a preference for the hospital-owned ventilators. Conclusion This analysis showed that the best ventilator ownership strategy from a purely financial perspective for this hospital is by installment with a 50% down payment and 0% interest. Moderate rates of 15% and 25% interest per year were also good. These were followed by outright purchase and lastly by staggered purchase. The rental strategy gave the lowest cumulative 10-year income compared to any of the ownership strategies, but may still be considered good income because the hospital did not make any investment. However, it seems that most of the healthcare workers involved in taking care of patients on ventilators thought the rental ventilators were of lower quality and preferred the hospital-owned ventilators.
Ventilators, Mechanical

Without artificial airway though oral, nasal or airway incision, the bi-level positive airway pressure (Bi-PAP) has been widely employed for respiratory patients. In an effort to investigate the therapeutic effects and measures for the respiratory patients under the noninvasive Bi-PAP ventilation, a therapy system model was designed for virtual ventilation experiments. In this system model, it includes a sub-model of noninvasive Bi-PAP respirator, a sub-model of respiratory patient, and a sub-model of the breath circuit and mask. And based on the Matlab Simulink, a simulation platform for the noninvasive Bi-PAP therapy system was developed to conduct the virtual experiments in simulated respiratory patient with no spontaneous breathing (NSB), chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The simulated outputs such as the respiratory flows, pressures, volumes, etc, were collected and compared to the outputs which were obtained in the physical experiments with the active servo lung. By statistically analyzed with SPSS, the results demonstrated that there was no significant difference ( P > 0.1) and was in high similarity ( R > 0.7) between the data collected in simulations and physical experiments. The therapy system model of noninvasive Bi-PAP is probably applied for simulating the practical clinical experiment, and maybe conveniently applied to study the technology of noninvasive Bi-PAP for clinicians.
Humans ; Respiration, Artificial/methods* ; Positive-Pressure Respiration/methods* ; Respiration ; Ventilators, Mechanical ; Lung

At present, the passive simulated lung including the splint lung is an important device for hospitals and manufacturers in testing the functions of a respirator. However, the human respiration simulated by this passive simulated lung is quite different from the actual respiration. And it is not able to simulate the spontaneous breathing. Therefore, including" the device simulating respiratory muscle work "," the simulated thorax" and" the simulated airway", an active mechanical lung to simulate human pulmonary ventilation was designed:3D printed human respiratory tract was developed and connected the left and right air bags at the end of the respiratory tract to simulate the left and right lungs of the human body. By controlling a motor running to drive the crank and rod to move a piston back and forth, and to deliver an alternating pressure in the simulated pleural, and so as to generate an active respiratory airflow in airway. The experimental respiratory airflow and pressure from the active mechanical lung developed in this study are consistent with the target airflow and pressure which collected from the normal adult. The developed active mechanical lung function will be conducive to improve the quality of the respirator.
Adult ; Humans ; Lung/physiology* ; Respiration ; Pulmonary Ventilation ; Respiration, Artificial ; Ventilators, Mechanical

Oxygen therapy is an effective clinical method for the treatment of respiratory disorders, oxygen concentrator as a necessary medical auxiliary equipment in hospitals, its research and development has been a hot spot. The study reviewed the development history of the ventilator, introduced the two preparation technique of the oxygen generator pressure swing absorption (PSA) and vacuum pressure swing adsorption (VPSA), and analyzed the core technology development of the oxygen generator. In addition, the study compared some major brands of oxygen concentrators on the market and prospected the development trend of oxygen concentrators.
Oxygen ; Oxygen Inhalation Therapy ; Hospitals ; Ventilators, Mechanical ; Equipment Design

OBJECTIVES: To study the application value of transport ventilator in the inter-hospital transport of critically ill children. METHODS: The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes. RESULTS: There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05). CONCLUSIONS The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.
Child ; Humans ; Critical Illness ; Respiration, Artificial/adverse effects* ; Intensive Care Units, Pediatric ; Ventilators, Mechanical ; Prognosis

OBJECTIVE: To investigate the effect of different fraction of inspired oxygen (FiO₂) baseline levels before endotracheal intubation on the time of expiratory oxygen concentration (EtO₂) reaching the standard in emergency patients with the EtO₂ as the monitoring index. METHODS: A retrospective observational study was conducted. The clinical data of patients receiving endotracheal intubation in the emergency department of Peking Union Medical College Hospital from January 1 to November 1 in 2021 were enrolled. In order to avoid interference with the final result due to inadequate ventilation caused by non-standard operation or air leakage, the process of the continuous mechanical ventilation after FiO₂ was adjusted to pure oxygen in patients who had been intubated was selected to simulate the process of mask ventilation under pure oxygen before intubation. Combined with the electronic medical record and the ventilator record, the changes of the time required to reach 0.90 of EtO₂ (that was, the time required to reach the standard of EtO₂) and the respiratory cycle required to reach the standard after adjusting FiO₂ to pure oxygen under different baseline levels of FiO₂ were analyzed. RESULTS: 113 EtO₂ assay records were collected from 42 patients. Among them, 2 patients had only one EtO₂ record due to the FiO₂ baseline level of 0.80, while the rest had two or more records of EtO₂ reaching time and respiratory cycle corresponding to different FiO₂ baseline level. Among the 42 patients, most of them were male (59.5%), elderly [median age was 62 (40, 70) years old] patients with respiratory diseases (40.5%). There were significant differences in lung function among different patients, but the majority of patients with normal function [oxygenation index (PaO₂/FiO₂) > 300 mmHg (1 mmHg ≈ 0.133 kPa), 38.0%]. In the setting of ventilator parameters, combined with the slightly lower arterial partial pressure of carbon dioxide of patients [33 (28, 37) mmHg], mild hyperventilation phenomenon was considered to be widespread. With the increased in FiO₂ baseline level, the time of EtO₂ reaching standard and the number of respiratory cycles showed a gradually decreasing trend. When the FiO₂ baseline level was 0.35, the time of EtO₂ reaching the standard was the longest [79 (52, 87) s], and the corresponding median respiratory cycle was 22 (16, 26) cycles. When the FiO₂ baseline level was increased from 0.35 to 0.80, the median time of EtO₂ reaching the standard was shortened from 79 (52, 78) s to 30 (21, 44) s, and the median respiratory cycle was also reduced from 22 (16, 26) cycles to 10 (8, 13) cycles, with statistically significant differences (both P < 0.05). CONCLUSIONS The higher the FiO₂ baseline level of the mask ventilation in front of the endotracheal intubation in emergency patients, the shorter the time for EtO₂ reaching the standard, and the shorter the mask ventilation time.
Aged ; Humans ; Male ; Middle Aged ; Female ; Intubation, Intratracheal ; Respiration ; Ventilators, Mechanical ; Arteries ; Blood Gas Analysis

The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient's state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator's stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.
Humans ; Ventilators, Mechanical ; Respiration, Artificial ; Neural Networks, Computer

In order to effectively treat respiratory diseases, a non-invasive positive pressure ventilator system is designed, the overall structure design of the system is proposed, and the hardware construction is completed. The breathing state of the patient is identified by the threshold triggering method of the flow rate of change, and the calculation of the flow rate of change is realized by the least squares method. At the same time, the breathing parameters are calculated in real time according to the flow-time and pressure-time characteristic curves. In addition, CMV, CPAP, BiPAP and PSV ventilation modes are also implemented. Finally, the parameter measurement accuracy and ventilation mode setting tests are carried out. The results show that the calculation of key breathing parameters provided by the system meets the relevant standards, and supports the stable output of 4 ventilation modes at the same time, provides breathing treatment for patients, and meets the basic functional requirements of the ventilator.
Humans ; Ventilators, Mechanical ; Respiration

Ventilator is an important medical instrument which can replace the function of autonomous ventilation artificially. Its safety and reliability are related to the health and even life safety of patients. With the publishing of the new national standard and international standard for ventilators, higher requirements are put forward for the detection and evaluation. This study mainly introduces an automatic test system for ventilator performance. The test system is based on PF-300 air-flow analyzer of Imtmedical and standard simulation lung. The automatic switch module of simulation lung is developed, and the automatic test system of ventilator is designed using the software development platform based on Python. It can not only automatically test all ventilation control parameters and monitoring parameters of the ventilator, but also realize automatic data recording, form reports and data analysis, and improve the efficiency and quality of inspection, detection and quality control.
Humans ; Reproducibility of Results ; Ventilators, Mechanical ; Computer Simulation ; Data Analysis ; Quality Control