WHAT’S THE POINT?
PRODUCT OF OUTSTANDING INTEREST
PRODUCT OF OUTSTANDING INTEREST
Brendan G. Cooper1, Wilfried De Backer2 and Paolo Pelosi3
1
Head of ERS Allied Respiratory Professionals Assembly
B.G. COOPER ET AL.
2
Head of ERS Clinical Physiology and Integrative Biology Assembly
3
Head of ERS Respiratory Intensive Care Assembly
Over the last 20 years, design and SELECTION CRITERIA
innovation in the field of respiratory
medicine have improved the quality of Up to three devices could be nomi-
patient care enormously. The digital nated per Assembly, and were judged
revolution has spawned enormous on ease of use, shortening patient
advances in telecommunications, pathway, cost effectiveness, etc.
diagnostic testing, therapeutic devices, (table 1). The six highest-scoring
and all kinds of patient monitoring devices were then compared by the
and electronic diaries to help manage judging panel of four (three Assembly
chronic respiratory disease. This Heads and the Advising Editor of the
tireless search for improvement has ERS Buyers’ Guide) and the manufac-
led to more reliable results and timely turers of the four top-scoring devices
diagnosis, greater comfort for the were invited to attend the POINT
patient, and greatly improved life session at the ERS Annual Congress.
expectancy and quality of life, where We are delighted to present those
possible, faster recovery and rehabili- products to you and the reasons why
tation, and, of course, time, space and we have chosen to highlight them in
cost savings for our practices. this article and at the Lunchtime
The European Respiratory Society Programme Session ‘‘Product of
has created this award to recognise the Outstanding Interest’’ at 13:15–
importance of innovation in this area 14:30 h on Tuesday September 4, 2012
of medicine and to reward those in room C6.
whose efforts have led to such
advances. The award is aimed at
encouraging new innovation and DIAGNOSTIC DEVICES
application of current ideas into
solving the challenges of modern The first two nominated devices fall
respiratory healthcare. into the diagnostic category.
Correspondence Early this year, the 11 Assemblies of
B.G. Cooper the ERS were asked to nominate PneumaScanTM
Lung Function and Sleep (Office 2)
devices or equipment that embodied
Lung Investigation
University Hospitals Birmingham NHS innovation, either having the potential The PneumaScanTM (PneumaCare
Foundation Trust for or already demonstrating signifi- Limited, Cambridge, UK) (fig. 1) uses
Queen Elizabeth Hospital Birmingham cant improvement in patient care. what the manufacturers call ‘‘struc-
Mindelsohn Way
Edgbaston Each product was scored and a selec- tured light plethysmography’’ to mea-
Birmingham B15 2WB tion committee identified four out- sure breathing and even spirometry
UK standing products based on parameters remotely from the patient.
E-mail comparative scoring by an impartial A chequered light pattern is projected
[Link]@[Link] selection group. onto the patient’s chest and cameras
BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
5
TABLE 1. Selection process instrument footprint and is highly
portable. PneumaScanTM allows the
Assembly Heads invited to nominate products
capture of important parameters for
PRODUCT OF OUTSTANDING INTEREST
Products selected and scored by Assembly Heads the determination of static and
dynamic lung volumes; these are the
Six highest-scoring devices chosen by POINT Selection Panel parameters of slow (expiratory reserve
POINT Selection Panel scored all nominations volume, and inspiratory and expira-
B.G. COOPER ET AL.
tory vital capacity) and forced (forced
Top four selected for POINT session vital capacity, forced expiratory
volume in 1 s and mean maximal
Vote to select a winner
expiratory flow) breathing man-
oeuvres. PneumaScanTM also has low
then record breathing and measure PneumaScanTM uses three-dimen- running costs because it has few
dimensions to produce images and sional (3D) imaging systems, similar moving parts.
measures of ventilation (fig. 2). to your children’s Xbox (MicrosoftÕ , PneumaScanTM’s dynamic 3D-
There have been several remote Redmond, WA, USA) gaming system, imaging approach provides novel
‘‘light’’ systems developed in recent that enable clinicians to access many information and a fresh clinical
years, but for clinical purposes, they different patient types that may pre- perspective on intrathoracic motion
appear to be more cumbersome, viously have been difficult to measure. during a breath, which has implica-
expensive and prone to practical errors Using the PneumaScanTM, patients can tions for both diagnostics and critical
than this one. This system is inge- be assessed while breathing naturally care monitoring.
niously clever, well made and the or performing spirometric man-
result of endless clinical translational oeuvres without the need to interact MorpheusÕ Ox
research. While it has strong potential with or be in contact with the device.
for uses in a variety of arenas, its exact One can imagine burns patients, The MorpheusÕ Ox is the flagship
clinical niche has yet to be fully trauma patients or immunocompro- product of WideMed (Herzliya,
established, but its very existence has mised patients being measured or Israel); it uses a computer-aided scor-
prompted some novel research and monitored remotely. ing solution (fig. 3). Like standard
clinical applications, most logically, in PneumaScanTM provides precise oximetry devices, MorpheusÕ Ox uses
the operating theatre, on intensive determination of key respiratory photoplethysmography (PPG) and
therapy units and burns units, or for parameters using noninvasive mea- measures blood oxygen saturation,
bed-bound patients, this offers enor- surements and can lower infection then uses automatic sleep scoring
mous possibilities. risk, which therefore provides reduced software to produces an accurate and
sterilisation requirements reliable sleep study diagnosis, includ-
Furthermore, it enables measurement ing sleep/wake, apnoea–hypopnoea
while the patent is supine, sitting or index and Cheyne–Stokes respiration.
standing, as the device has a compact WideMed has developed a unique
FIGURE 1. PneumaScanTM (PneumaCare FIGURE 2. In structured light plethysmography, a chequered light pattern projected onto
Limited, Cambridge, UK). the patient’s chest and cameras record breathing and measure dimensions to produce
BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
6
PRODUCT OF OUTSTANDING INTEREST
B.G. COOPER ET AL.
FIGURE 4. Puritan BennettTM 560
Ventilator (Covidien plc, Dublin, Ireland).
FIGURE 3. MorpheusÕ Ox (WideMed, Herzliya, Israel). efficiency, due to their easy-to-use
features. They also look smart and
mobile telephone application capable progression of the disease. their intuitive use reduced staff train-
of recording and transmitting the data Furthermore, more patients develop ing issues (fig. 4). While these devices
collected during the test. end-stage disease with hypercapnic are not unique, they certainly are a
There has always been much con- respiratory failure. The use of non- worthy addition to the respiratory
troversy about the use of overnight invasive ventilation (NIV) for the specialists ventilatory arsenal.
pulse oximetry to screen for sleep treatment of these patients is not yet These new portable, lightweight
breathing disorders. This new sleep evidence based, since clearly not all ventilators are compact and have long-
breathing disorder screener has added patients benefit from the treatment. lasting internal lithium-ion batteries, a
a whole new dimension to the use of Some, however, clearly do, and it is a long operating time with a real battery
oximetry to screen of sleep disordered challenge to come up with persona- indicator and external power options.
breathing. A clever algorithm has been lised approaches for this treatment, This makes them versatile in the
developed to interpret the oximetry and to detect and treat the most hospital or home environment.
and pulse signals to better determine responsive patients. One of the factors Like most ventilators in their class,
the nature of the sleep breathing that may determine response is the the Puritan BennettTM 520 and 560
events. MorpheusÕ Ox is simple for ability of the patient to improve ventilators have multiple alarms, data
the patient to use; its wristwatch size ventilation/perfusion matching after management capabilities delivered via
enables it to perform a sleep test in the NIV. Those who do will improve gas their Respiratory Insight software and
comfort of the patient’s own bedroom, exchange and probably also quality of a USB memory device that enables the
and it is therefore comfortable and less life. Beyond a physiological response, easy transfer of patient information
intrusive than multichannel or the patient tolerating the treatment for from a home ventilator to a clinician’s
polysomnography systems. a longer period is absolutely crucial. computer.
WideMed also provides Web-based NIV equipment for COPD patients A neat feature of the Puritan
server software for the MorpheusÕ Ox should thus take into account specific BennettTM 520 and 560 is that the
that is a comprehensive platform for requirements that are needed to make ventilator parameters and alarm
managing cost-effective sleep services, NIV effective, well tolerated and settings are linked to reduce the risk of
including patient’s electronic medical sustained by end-stage COPD clinically inappropriate settings.
records, cardiac and sleep diagnostics patients. Furthermore, oxygen enrichment is
outcomes, and complete workflow With this in mind, the following available using a low-pressure oxygen
management. products of outstanding interest are source by a specific measurement kit
noninvasive ventilators. The portabil- to monitor inspired oxygen levels.
ity of these devices is important for the This makes it a half-way house
THERAPEUTIC DEVICES patient to enjoy a versatile lifestyle. between a home and intensive care
device.
The other nominated devices cover Puritan BennettTM 520 and For these reasons, the Puritan
therapeutic aspects of respiratory care. 560 ventilators BennettTM 520 and 560 enable patients
Chronic obstructive pulmonary to live with greater independence, due
disease (COPD) is becoming a very The Puritan BennettTM 520 and 560 to longer battery time and easier
prevalent disease, mainly because of ventilators (Covidien plc, Dublin, transport facilities, since they can be
aging populations, and current Ireland) help improve patient safety, attached easily to a wheelchair or
medical treatment cannot stop the medical efficacy and healthcare carried in a backpack during travel by
BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
8
trigger artefacts when trigger sensitivity PROPOSE PRODUCTS FOR
is high. Finally, a temporarily increased NEXT YEAR’S
expiratory pressure is produced to COMPETITION
PRODUCT OF OUTSTANDING INTEREST
prevent early collapse of the airways,
which represents the most important We would like to invite you to propose
mechanism that contributes to hyper- products for next year’s Product of
inflation. Outstanding Interest online at www.
B.G. COOPER ET AL.
The clinical experience with [Link]/point The deadline
VENTIlogic LS is limited, but first for proposals is Friday September 21,
experiences are very promising and 2012.
the presence of the specific features for
COPD is encouraging for the use of
NIV in these patients. Therefore, STATEMENT OF INTEREST
Weinmann’s effort to focus on a real
unmet need must be highlighted and, None declared.
FIGURE 5. A Puritan BennettTM ventilator
thus, VENTIlogic LS has been nomi-
(Covidien plc, Dublin, Ireland) attached to
a wheelchair. nated for its innovative approaches
that may benefit many of our termin-
car, boat or aeroplane (fig. 5). With ally ill COPD patients.
their excellent ventilation program-
ming, prescribers will appreciate these
ventilators’ data management capabil- SUMMARY
ities.
Overall, all of the nominated products
VENTIlogic LS meet, to varying levels, the criteria we
set out to evaluate them by. Clearly, it
The VENTIlogic LS (Weinmann is difficult to compare any two devices,
Medical Technology, Hamburg, since it is like ‘‘comparing apples and
Germany) is a new device for NIV in oranges’’, but while it may be hard to
COPD patients (fig. 6). Several specific compare them, all the nominated
approaches were used in its design to devices are beacons of innovation and
adapt treatment for COPD patients. improvement in the patient pathway.
First, algorithms were developed that However, one device will be selected as
may help to avoid additional hyper- the Product of Outstanding Interest
inflation. Hyperinflation is an impor- for 2012 at the ERS Annual Congress
tant feature of end-stage COPD and in Vienna, Austria. We hope that this
aggravation of hyperinflation should will encourage members of the ERS to
be avoided when using NIV. The consider other devices from the
specific algorithm, AirTrap Control, Annual Congress Exhibition for next
automatically regulates frequency and year’s nominations. Moreover, we
expiratory time in order to avoid short expect it will drive our manufacturers
expiratory times. There is also a trigger of medical devices to continue to
lockout that avoids false triggering and innovate and work with clinical col-
leagues to further raise the standard of
equipment in the years ahead. We
hope to see many of you at the ERS
Lunchtime Programme Session
‘‘Product of Outstanding Interest’’ at
13:15–14:30 h on Tuesday September
4, 2012 in room C6.
FIGURE 6. VENTIlogic LS (Weinmann
Medical Technology, Hamburg,
Germany).
BUYERS’ GUIDE TO RESPIRATORY CARE PRODUCTS
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