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

Excerpt

Over the last two decades, technological developments have lead to significant improvements of the performances by ICU ventilators [1‐4]. At the same time, the presentation of data and the interface of the ventilator with the clinician have also changed dramatically. In the 1980s all ventilators were mechanical in their operation [5]. All parameters were controlled by simple, and in most cases, easily accessible knobs that the clinician simply turned to the desired setting or mode. Today’s ICU ventilators are composed primarily of a series of microprocessors controlling a gas delivery platform [1‐5]. As a result, the capabilities of today’s ICU ventilators are markedly greater than previous generations of ventilators. New modes are available, closed loop control is increasingly being used, monitoring capabilities are expanded and the user interface is different. Indeed, almost all of the newest generation of ICU ventilators incorporate a computer screen as the basis of their user interface [5]. Many have layers of menus that the user must navigate in order to make changes in ventilator settings, and many require multiple steps to make a simple change in any ventilator parameter [4, 5]. All of this has made the user interface more and more complex for the untrained individual to understand and master. As a consequence, decision making and safety may be a challenge in routine practice. It has been emphasized that human error is responsible of the majority of medical accidents [6] and that most of these accidents are considered avoidable [7]. In this context, the development of user-machine interfaces specifically designed to facilitate cognitive processes may increase the ease of care giver interactions and reduce the number of accidents. …