Les ventilateurs de réanimation adulte en 2002 : progrès technologiques, dérives et évaluation

Abstract

The newest generation of intensive care unit ventilators has become more sophisticated. Numerous microprocessors are now used that permit a perfect control of flow and pressure and allow manufacturers to imagine multiple monitoring systems and new modes of ventilation, frequently without the necessary physiological evaluations. Despite a paucity of clinical data, several bench test studies suggest that the newest ventilators outperform the older ones. However, pneumatic systems (pressurization and proportional valves) as well as the user interface of these high-tech based ventilators are still heterogeneous. Because clinical evaluation is not required by regulatory constraints, rigorous bench technical evaluation is the only possible way to assess the efficiency and accuracy of ventilators. The user-ventilator interface can also be evaluated with a lung model. To avoid potentially dangerous situations due to over-sophistication, clinicians should be aware of the exact behavior of new modes of ventilation, especially when they use both pressure and volume to control the breath (dual modes). A smart ventilator able to work as a ˈdo-everything productˈ (i.e., ventilation, monitoring, alarms, physiological investigation, diagnosis, etc.) has now become possible. Partnership between clinicians, physiologists, bioengineers and industrials is a key element of a modern approach to developing ventilators in order to better control the possibilities offered by technology, but not being dominated by it.