Objective evaluation of neonatal ventilators.

Choosing which ventilator to purchase can dramatically affect what type of care patients get, practitioners’ working environment, and the hospital’s “bottom line.” Choosing a ventilator is a complicated process, often confounded by competing stakeholders. Trying to balance the desires of the hospital management, physicians, and respiratory therapists can be tricky. Getting the right equipment for the patient can be even more difficult in the neonatal intensive care unit (NICU), because few ventilators are made especially for premature babies. Objective data and tools are critical for guiding the acquisition of new ventilators, or even deciding to continue on with the existing fleet.1 Published information on the value and effectiveness of individual devices and features is limited. Improved patient outcomes due to technology innovation are difficult to demonstrate.2 In October 2001, Chatburn and Primiano published in RESPIRATORY CARE3 a ventilator-evaluation tool to guide intensive care unit ventilator purchases. They devised a checklist scoring system to objectively evaluate ventilators based on technical features, operator interface, and customer service. That system uses objective data to allow stakeholders to compare devices “head to head” in a datacentered way. The balanced approach to the evaluation includes such important details as the maintenance costs, which might otherwise be overlooked by an evaluation committee. Although slightly limited by the fact that it was not designed specifically for the NICU, and that new ventilator features have become available, Chatburn and Primiano’s tool is still highly relevant today. Scores for each device with the desired new features included can be incorporated in the evaluation by adding them to the Optional Functions section. The ventilator-evaluation tool can provide a score based on the availability of a feature on a ventilator, but it can’t help in the evaluation of the clinical effectiveness of features and systems. Issues especially important to clinicians in the NICU, such as the work of breathing imposed by the machine and circuitry, monitoring and accuracy of delivered tidal volumes, and the functioning and effectiveness of the ventilator modes, must be evaluated in the laboratory and with clinical trials. In this issue of the Journal,4 DiBlasi et al report a laboratory investigation of the ventilator-imposed expiratory resistance of 4 neonatal ventilators. One of the ventilators they tested was a neonatalonly device that was cleared by the United States Food and Drug Administration in the early 1990s and is in widespread use in NICUs around the world. The other three are so called “cradle-to-grave” ventilators, all of which were cleared by the Food and Drug Administration after 2000. Are the newer devices superior? Are neonatal-only ventilators more effective for infants in the NICU, regardless of the ventilator’s release date? These important questions have yet to be answered.