ICU mechanical ventilators, technological advances vs. user friendliness: the right picture is worth a thousand numbers

Richard, Jean Christophe; Kacmarek, Robert M.

doi:10.1007/s00134-009-1581-6

Cited by 17 publications

(12 citation statements)

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“…In order to address concerns over instructor-led manufacturer training [37], this study employed exploration-based training [38] to increase realism and alignment with the delivery of training in real conditions (which was confirmed during the pilot study). Participants were given a set of learning objectives and asked to familiarize themselves with each of the four ventilators until they felt they would be comfortable using them on a real patient.…”

Section: Methodsmentioning

confidence: 99%

The usability of ventilators: a comparative evaluation of use safety and user experience

et al. 2016

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BackgroundThe design complexity of critical care ventilators (CCVs) can lead to use errors and patient harm. In this study, we present the results of a comparison of four CCVs from market leaders, using a rigorous methodology for the evaluation of use safety and user experience of medical devices.MethodsWe carried out a comparative usability study of four CCVs: Hamilton G5, Puritan Bennett 980, Maquet SERVO-U, and Dräger Evita V500. Forty-eight critical care respiratory therapists participated in this fully counterbalanced, repeated measures study. Participants completed seven clinical scenarios composed of 16 tasks on each ventilator.Use safety was measured by percentage of tasks with use errors or close calls (UE/CCs). User experience was measured by system usability and workload metrics, using the Post-Study System Usability Questionnaire (PSSUQ) and the National Aeronautics and Space Administration Task Load Index (NASA-TLX).ResultsNine of 18 post hoc contrasts between pairs of ventilators were significant after Bonferroni correction, with effect sizes between 0.4 and 1.09 (Cohen’s d). There were significantly fewer UE/CCs with SERVO-U when compared to G5 (p = 0.044) and V500 (p = 0.020). Participants reported higher system usability for G5 when compared to PB980 (p = 0.035) and higher system usability for SERVO-U when compared to G5 (p < 0.001), PB980 (p < 0.001), and V500 (p < 0.001). Participants reported lower workload for G5 when compared to PB980 (p < 0.001) and lower workload for SERVO-U when compared to PB980 (p < 0.001) and V500 (p < 0.001). G5 scored better on two of nine possible comparisons; SERVO-U scored better on seven of nine possible comparisons. Aspects influencing participants’ performance and perception include the low sensitivity of G5’s touchscreen and the positive effect from the quality of SERVO-U’s user interface design.ConclusionsThis study provides empirical evidence of how four ventilators from market leaders compare and highlights the importance of medical technology design. Within the boundaries of this study, we can infer that SERVO-U demonstrated the highest levels of use safety and user experience, followed by G5. Based on qualitative data, differences in outcomes could be explained by interaction design, quality of hardware components used in manufacturing, and influence of consumer product technology on users’ expectations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1431-1) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

The usability of ventilators: a comparative evaluation of use safety and user experience

et al. 2016

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“…6 According to the literature, the most recent sophisticated emergency and transport ventilators do actually have technical capacities closer to those of standard ICU devices. 7,18 The technological evolution of more complex devices should also be accompanied by the emergence of evolved human/machine interfaces, in order to decrease mental work load and reduce task failures.…”

Section: Human/machine Interface Differences and The Potential Impactmentioning

confidence: 99%

“…2,3 An optimal device for emergency care should provide adequate technical performance, combined with optimal ergonomics (ie, an easy-to-use and user-friendly human/machine interface). 4,5 Significant improvement in the technical performance of emergency and transport ventilators has been observed during the last decade, 6 and more recent devices have demonstrated technical performance similar to that of ICU ventilators. 7 Although older generation emergency and transport ventilators usually display low performance and are the cheapest devices, they also provide little monitoring and a rather simple human/machine interface.…”

Section: Introductionmentioning

confidence: 99%

“…More recent emergency and transport ventilators do provide a more evolved human/machine interface as well as depicting ventilator curves. 5,6 Four studies have demonstrated that the human/machine interface design could be associated with user error and a delay in the performance of basic tasks. 1,[8][9][10] However, an objective comparison of emergency and transport ventilators should also take into account the fact that devices significantly differ in terms of technology and cost and cannot all be compared with each other.…”

Section: Introductionmentioning

confidence: 99%

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A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators

Marjanovic

L’Her

2016

Respir Care

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BACKGROUND: Mechanical ventilation is an important part of emergency medicine and is frequently used for transportation. Human errors during ventilator settings are frequent and may be associated with high morbidity/mortality. The aim of the study was to provide a complete ergonomic evaluation of emergency and transport ventilators, taking into account objective and subjective human-machine interface assessments and individual mental work load. METHODS: We performed a prospective bench ergonomic evaluation of 13 emergency and transport ventilators, using standardized conditions and a global methodological approach. The study was performed in an evaluation laboratory dedicated to respiratory care, and 12 emergency physicians unfamiliar with the tested devices were included in the evaluation. The ventilators were classified into 3 categories (simple, sophisticated, and ICU-like). Objective chronometric evaluations were conducted considering 9 tasks, and subjective evaluations were performed (ease of use, willingness to use, and user-friendliness of monitoring) using Likert scales. Mental work load evaluation was performed using the NASA Task Load Index scale. RESULTS: Overall task failure rate represented 4% of all attempts. Setting modifications, ventilation mode changes, and powering down durations were different between simple and other emergency and transport ventilator categories (P < .005). There was no difference between ventilator categories for the ease of use and userfriendliness of the monitoring. In contrast, the willingness to use was lower for simple devices, compared with sophisticated and ICU-like emergency and transport ventilators (2.9 ؎ 1.4 vs 3.9 ؎ 1.2, P ‫؍‬ .002 and 4.3 ؎ 1, P < .001). No differences were observed between devices regarding the mental work load, except for several specific devices in the sophisticated category. CONCLUSIONS: A comprehensive ergonomic evaluation provides valuable information while investigating operational friendliness in emergency and transport ventilators. The choice of a device not only depends on its technical characteristics but should take into account its clinical operational setting and ergonomics in order to decrease mental work load. Sophisticated emergency and transport ventilators should only be used by clinicians who demonstrate expertise in mechanical ventilation.

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“…Ventilators play an important role in the anaesthetic management of patients, as well as in the treatment of patients in the Intensive Care Unit (ICU), as they provide artificial support of respiratory function (Richard et al 2002, Hopper et al 2007, Richard and Kacmarek 2009, Thille et al 2009). There are differences between the ventilators used in anaesthesia and those used in the ICU.…”

mentioning

confidence: 99%

Mechanical ventilation. Part II: Basic principles and function of ventilators.

Pavlidou

Savvas

Anagnostou

2017

J Hellenic Vet Med Soc

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Mechanical ventilation is the process of supporting respiration by manual or mechanical means. When normal breathing is inefficient or has stopped, mechanical ventilation is life-saving and should be applied at once. The ventilator increases the patient's ventilation by inflating the lungs with oxygen or a mixture of air and oxygen. Ventilators play an important role in the anaesthetic management of patients, as well as in the treatment of patients in the ICU. However, there are differences between the anaesthetic ventilators and the ventilators in ICU. The main indication for mechanical ventilation is difficulty in ventilation and/or oxygenation of the patient because of any respiratory or other disease. The aims of mechanical ventilation are to supply adequate oxygen to patients with a limited vital capacity, to treat ventilatory failure, to reduce dyspnoea and to facilitate rest of fatigued breathing muscles. Depression of the central nervous system function is a pre-requirement for mechanical ventilation. Some times, opioids or muscle relaxants can be used in order to depress patient's breathing. Mechanical ventilation can be applied using many different modes: assisted ventilation, controlled ventilation, continuous positive pressure ventilation, intermittent positive pressure ventilation and jet ventilation. Furthermore, there are different types of automatic ventilators built to provide positive pressure ventilation in anaesthetized or heavily sedated or comatose patients: manual ventilators (Ambu-bag), volumecontrolled ventilators with pressure cycling, volume-controlled ventilators with time cycling and pressure-controlled ventilators. In veterinary practice, the ventilator should be portable, compact and easy to operate. The controls on most anaesthetic ventilators include settings for tidal volume, inspiratory time, inspiratory pressure, respiratory rate and inspiration: expiration (I:E) ratio. The initial settings should be between 10-20 ml/kg for tidal volume, 12-30 cmH2 0 for the inspiratory pressure and 8-15 breaths/min for the respiratory rate. Mechanical ventilation is a very important part of treatment in the ICU, but many problems may arise during application of mechanical ventilation in critically ill patients. All connections should be checked in advance and periodically for mechanical problems like leaks. Moreover, complications like lung injury, pneumonia, pneumothorax, myopathy and respiratory failure can occur during the course of mechanical ventilation causing difficulty in weaning.

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ICU mechanical ventilators, technological advances vs. user friendliness: the right picture is worth a thousand numbers

Cited by 17 publications

References 9 publications

The usability of ventilators: a comparative evaluation of use safety and user experience

The usability of ventilators: a comparative evaluation of use safety and user experience

A Comprehensive Approach for the Ergonomic Evaluation of 13 Emergency and Transport Ventilators

Mechanical ventilation. Part II: Basic principles and function of ventilators.

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