E-book: draeger_review_99_1_en
Lung Function Dräger Review Novel imaging technique offers live insights 99.1 Micrometers Precision in manufacturing ventilators Nasal Masks The Magazine for Technology in Medicine February 2010 Breathing easy at last Concepts for safeguarding therapy and care Obesity For patients crying out for gentler solutions. For non-invasive, think Dräger. Your patients’ level of comfort has a significant effect on how quickly they heal. That’s why Dräger supports you with a broad portfolio of gentle, non-invasive applications. For example: the Jaundice Meter JM-103 allows bilirubin (TcB) to be screened painlessly and without the necessity of drawing blood. For ventilation, monitoring or screening – whenever gentle solutions are an option – Dräger is a preferred choice. That has been our objective for more than 100 years. FOR MORE INFORMATION, VISIT W W W.DR AEGER.COM/ NON-INVASIVE 1606-2009 C on t en t s 20,000 calories roughly a day sustain the world’s heaviest man, who weighs nearly 450 kilograms. read more about obesity starting on page 8. COver PHOTOgraPH: geT T y iMageS RaineR Weisflog D-11034-2009 D-12115-2009 16 14 8 At tentive ADipose ADAptive e xper ien Ce Fo Cu s ou t Loo k 4 people who perform 8 weighty Challenge Obesity presents 20 respiratory Cycle in 90 images She has worked in New york City new challenges for doctors and nursing The novel imaging technique emergency rooms for 27 years; staff — but solutions are in sight. electrical impedance tomography offers he has worked in the mines of australia live insights. for 28 years. r ep o r t 14 nasal Masks enhance patients’ Quality serv i Ce of Life The nasal mask is liberating 23 where and who? Dräger worldwide, ne w s 6 news from the world of Dräger to anyone who has ever had to wear a Publishing information Dräger is buying back the 25 percent stake full-face mask for several days due in Dräger Medical ag & Co. Kg held to respiratory insufficiency, for example. CLose -u p 24 85,000 revolutions per Minute by Siemens. THC test for DrugTest 5000 compress the air in the ventilator. with even greater sensitivity. insig h t 16 precision Down to the Last TestCenter reaccredited and a new but how does this central component of Micrometer is required to manufacture subsidiary in Finland. the Zeus ie anesthesia system work? long-lasting and reliable ventilators. 3 Dräger review 99.1 February 2010 E xpE r i En c E Peo Pl e w h o P e rfo rm What Moves Us — Dräger Worldwide Susan Schwartz, chief certified registered nurse Anesthetist, new York city / U.S. “after 27 years working as a nurse in New york City there is not too get onto the operating room schedule that week. i was so moved that i much that can challenge me. So when i was asked to join a pediatric vowed to make it a yearly mission and to do more charitable work. medical mission to latin america i jumped at the offer. i graduated from Columbia university School of Nursing anesthesia. when we entered the medical compound in honduras i was stunned i practically grew up with Dräger. they have been with me every step of at the number of children who had arrived for the screening. the facial my career. So you can imagine my sheer joy when i saw a Narkomed 1a deformities on these children, which included cleft lips and palates, were in the or in San Pedro Sula honduras on that first day. it was like meet- more severe than i was prepared for. i was humbled when they gave us ing a dear old friend in a foreign country. Dräger was watching over my a standing ovation just as we stepped off the bus. shoulder and that was very comforting to me in a strange place. these children came from all over honduras, brought by their parents i really don’t like to talk much about what i did, as it is small in com- and siblings, often on foot, or by hitching a ride. many camped outside parison to what those less fortunate must endure on a daily basis. i am of the makeshift hospital, sleeping in the dirt and eating out of the gar- writing this only to inspire others to share their gifts. you will get more bage just to be there in the morning in the hope that their child would in return than you give and your life will be more meaningful.” PhotograPhy: D-11037-2009, DaviD white; text: Silke umbaCh 4 Dräger review 99.1 february 2010 R ubR ik t he m a Peter Hatswell, mine safety and rescue specialist, blue Mountains / Australia “When you’re underground, the most important rule is ‘Pay atten- managed to get both of them out after two weeks, and before that tion.’ You have to develop an intuitive awareness of possible dan- we were able to talk with them. ‘I won’t be happy until I’ve sent you gers. Monitor your environment, the atmosphere, ground condi- two to a hospital,’ I called out to them. It might sound strange to tions, and the like. Take a noise that I’ve known for years — does want someone to be in the hospital, but that’s how it was. I’ll never it sound just a bit different today? There are outstanding safety forget the relief we felt the day we got them out. Our decades of devices in our mines, early warning systems that are almost per- experience had paid off. My father was the fire chief in our small fect, but the most important element is people’s attitude. I’ve been town near Sydney. Today I’m the captain and I’m in charge of safety, at home and down in the mine out in the desert. We have to de- working in mines for 28 years now. tect gases — but the main thing, which is even more important un- I’ve trained hundreds of miners in mine rescue techniques all derground than aboveground, is that we have to be able to breathe over Australia. In many cases I know the people who are waiting to get help or even to be rescued. That’s what happened in Beacons- and have faith in the apparatus we use. That’s why I complete a field, Tasmania, in 2006. A part of the gold mine there collapsed, training program in apparatus maintenance every year. The thing I trapping two miners 1,000 meters under the surface. I knew one appreciate most of all about Dräger technology is its reliability. But of them personally — and not just him, I knew his whole family. We I guess just about everybody will tell you that.” 5 Drägerheft 384 februar 2010 News D-11046-2009 D-11045-2009 Marko wittich and Johan Kinnula, Dräger suomi Oy. Boosting group earnings for 2010: buyback of minority stake in Dräger Medical. Dräger Repurchases New subsidiary siemens stake in Finland October 2009 saw the launch of a new Dräger at the end of 2009, Dräger announced that it was to buy back the 25 percent subsidiary in Helsinki, Finland. For more than half a stake in Dräger Medical ag & Co. Kg held by Siemens ag, Munich. “Purchasing century before, the trading company Liitin Oy had this stake at an acceptable price will boost group earnings in 2010. This move represented Dräger’s business interests in the country also reduces complexity and allows us to establish ourselves as an integrated tech- with both great commitment and success. Now all nology group,” said Stefan Dräger, Chairman of the executive board of Dräger- business activities are being managed by the new werk verwaltungs ag, in explanation of the decision. in a joint declaration, Dräger emphasized that the buyback would change nothing subsidiary, Dräger Suomi Oy, which has taken over the for customers: “employees from both companies will still be on hand to provide entire workforce, customer base, and inventory. “we expert advice.” Dräger and Siemens will continue to invest heavily in product innova- already have our own subsidiaries in the other Scandi- navian countries, and this move will further strengthen tions in the coming years as well as develop and supply joint solutions. “we are our business activities in the region,” says Marko already working closely with Siemens to successfully implement projects in a wide wittich, vice President at Dräger (safety division). range of areas, integrating the technological solutions of both companies and in doing so offering additional benefits for our customers,” said Dräger, who noted, for The Finnish workforce, which will now have direct example, that the diagnosis and therapy solutions of both companies complement access to the training programs offered within the each other. Dräger also identified considerable potential for joint projects with group, is looking to increase the company’s already Siemens in the area of safety technology. substantial market share among fire departments Dräger emphasized that medium-term investment plans will remain unchanged by as well as to tap new market potential. “First and fore- the buyback: “we will implement our investments as well as our research and development most, we’re banking on further growth in the areas of service and aftersales,” explains wittich, who sees budget as planned.” He also noted that the turnaround program will play a major role the company’s nationwide service as a major plus in reducing the company’s breakeven point and also free up funds for investments in factor in this sparsely populated country. The business the future. The transaction is still awaiting the approval of antitrust authorities. interests of Dräger’s medical division in Finland are currently being represented by the group’s Swedish subsidiary together with a Finnish specialist dealer. 6 Dräger review 99.1 February 2010 ST-12047-2008 MT-1824-2008 The Dräger TestCenter ensures certified quality. Fast testing for THC: reliable results within a mere eight minutes. Accreditation Gives Cus- Faster Testing and Increased tomers Added Assurance Sensitivity for THC Dräger operates its own TestCenter (cf. Dräger Thanks to a new antibody-based technology, the Dräger DrugTest 5000 Test Kit now review 96.1; pp. 28 ff.), which five years ago was has a detection sensitivity of five nanograms of THC per milliliter of saliva. “That’s awarded “accredited laboratory” status under a significant advance on the previous cut-off of 25 nanograms per milliliter,” explains the aegis of the german accreditation Council. This Dr. Stefan Steinmeyer, drug test expert at Dräger. Moreover, testing time has fallen certifies that all test and documentation procedures from 12 to around eight minutes. That’s all it takes to detect THC, the active ingredient in all seven of the center’s testing areas are conduct- in marihuana, at a concentration equivalent to one cube of sugar dissolved in around ed by trained operatives in line with the latest a million liters of water. in field tests, the number of positive identifications increased by a factor of almost three compared to the previous test. “That will increase safety scientific standards. “at the end of 2009, following an on the road and also in the workplace,” says Steinmeyer. in another study*, the belgian extensive external audit, we received a new certi- Criminological institute has also confirmed the test’s increased detection sensitivity ficate confirming our accreditation for a further five for THC. belgium is planning new legislation this year to replace blood tests with tests years,” says Dr. Manfred reh, Deputy Director at using saliva samples. the TestCenter. This accreditation is valid worldwide and gives Spain, too, is working on a similar law — the implementation of which is possible customers the assurance that products developed and thanks to this highly sensitive test that is also fully suitable for use in the field. Such a manufactured by Dräger are tested according to the test must not only function in the laboratory but also has to prove itself as part of an latest standards. “That’s quite some challenge, particu- entire system, in series production, and, most importantly of all, in everyday operations. larly with respect to the assessment of the biocom- all of which is the case with the new test kit. Despite the significant improvements, patibility of the materials used in products,” reh ex- the new product was launched without the usual fanfare, with both price and item number plains. Conducted every five years, the major audit remaining unchanged. given that the test now meets practically any conceivable is a substantial procedure and this time involved a total sensitivity requirements, developers are now concentrating on making it even faster. of seven auditors visiting Lübeck. “but it’s well worth * S.M.r. wille, et al., evaluation of on-site oral fluid screening using Drugwipe-5+, rapidSTaT and DrugTest 5000 for the detection of drugs of abuse in drivers, Forensic Sci. int., 2009 all the effort,” says reh, “because this accreditation is accepted worldwide.” 7 Dräger review 99.1 February 2010 Weighty Challenge being overWeIghT is becoming a growing trend worldwide. above a certain threshold, it leads to problems for more than just the persons afflicted. Hospitals and the health care system will have to adapt if they are to accommodate this trend. when classic diets fail, surgery is often the only way to reduce obesity — and the operation is by no means easy. There are days when Nurse Karin Hasewinkel has no choice but to overweight patients are not anticipate the unexpected right from the an uncommon outset. Everything is just a little bit differ- sight to doctors. ent when a patient weighing more than 150 kilograms is scheduled to undergo surgery at Klinikum Südstadt Hospital in Rostock, Germany. As a precaution, the anesthesia nurse prepares a special cart with a range of items such as extra long needles capable of providing access to the hard-to-reach veins under the thick layers of fat. The cart also includes a special video laryn- goscope, whose tip is connected via fiber- glass to a camera. “The fat often impedes our view of the laryngeal area” explains Hasewinkel. “And that makes intuba- tion problematic.” When the patient’s neck circumference measures more than 60 centimeters, it is anything but easy to hyperextend the neck for intuba- tion. “I also have a laryngeal mask ready in case intubation fails entirely,” says the nurse. The doctor only needs to slip this over the larynx rather than insert it into the trachea. IN brIef as the number of patients with obesity continues to grow, so do the challenges facing in patient therapy and care. anesthesia PHoTograPHy: rainer weisFlog is just one of them. The article describes from a general perspective how the health care sys- tem is addressing this growing problem. initial experiences are very encouraging — not just for doctors and nurses, but also for patients. 8 Dräger review 99.1 February 2010 Fo c u s ObeSi T y lin signals that our fat storage cells are Prepping the patient for anesthesia is 30 have no higher rate of mortality than full and our blood sugar level high. Doc- only one of many situations that pres- lean people, and that, on average, slightly tor Jens Brüning, who works in Cologne, ent hospitals with particular problems overweight people more frequently sur- Germany, has discovered that both insu- when patients are severely overweight. vive a wasting disease such as cancer or lin and leptin bind to special receptors Much of the equipment and appliances a stay in intensive care. Particularly in old on the nerve cells in the brain to dampen used at a hospital — including everything age, then, it seems that being slightly over- hunger. Manfred Hallschmid, who works from blood pressure cuffs and scales to weight can even have its advantages. at the University of Lübeck’s Institute of operating tables — are designed for pa- At the same time, there remains no Endocrinology, has discovered that the tients with a maximum weight of be- doubt that disease and mortality increase brains of obese persons are resistant to tween 150 and 180 kilograms. However, with a BMI of 30 or above. A person mea- this effect of insulin. given the current trend toward obe- suring 1.80 meters crosses the line into sity, these limits are increasingly prov- obesity or adiposity when he or she reg- Every weight is unique ing insufficient. With the increase in it, isters 98 kilograms on the scales. Every hospitals must do more to prepare for fifth person in Germany is now obese. The Scientists believe that each person has severe overweight patients. These pa- well-intentioned advice to “simply” eat an individual setpoint — a weight that tients also require special care, not the less is usually not worth a great deal. the body strives to maintain. Although least because they frequently often have Many obese people suffer tremendously the setpoint is basically determined by psychological problems. Whether the under their condition and are constantly our genes, it is also influenced by our issue is ventilation, mobilization or trying new diets in a desperate attempt environment. The childhood years are daily body care — these high-risk patients to get their weight down. But whereas it is critical in this regard. Prof. Stephan require an increased level of attention in relatively easy for thin people to moderate Herpertz, M.D., who works at the Ruhr almost every area. their eating, overweight people often suf- University of Bochum, Germany, studies fer their entire lives from addiction-like the psychosocial aspects of being over- The flip side of prosperity cravings for food. weight. In the course of his work, he Researchers and doctors are just now How can things actually be allowed to get has come to the conclusion that “most beginning to understand why that is. The to that point? Why is it that some people people have a point of no return.” If an bowel, fatty tissue, and the brain commu- simply find it impossible to stop eating? 11-year-old child is obese, there is a 70 nicate using a complex system of messen- To a certain extent, extra weight on the percent chance that the person will be ger substances in order to ensure that the hips is the flip side of prosperity. Two out overweight when he or she becomes an body enjoys energy equilibrium through- of three men in Germany are now over- adult. The setpoint gradually shifts up- out a person’s life. Fat cells, for exam- weight; among women this figure is one ward with age, and the body responds to ple, produce leptin, a hormone that reg- in two. Persons having a body mass index a short-term drop in weight with strong ulates appetite. The more fat, the more (BMI) of 25 or above are considered over- feelings of hunger. To be sure, there are leptin the body produces. The problem weight. For a person 1.80 meters tall, the often psychological reasons for how far is that most obese people have developed threshold is thus 81 kilograms. Above this the setpoint shifts upward. What’s more, an insensitivity to it over the course of weight there is an increased occurrence the desire to eat is also strongly influ- time. Ghrelin, a hormone produced by of diabetes, high blood pressure, and cor- enced by learned patterns of behavior, the bowel, is found at higher levels in the onary and circulatory diseases. More re- such as the association of food with sol- blood when our bellies are empty and cent studies, however, show that people ace, relaxation, or sociability. Sugar, for nudges us toward the refrigerator. Insu- instance, can be used to mitigate chronic > with a BMI in the range between 25 and 9 Dräger review 99.1 February 2010 In times of economic turmoil, people pay less attention to their health > stress, and this positive association be- ficult while at rest that there are only spiratory tract is very limited,” says Prof. very slight reserves for an emergency. An- comes indelibly ingrained in the brain of Ochiai. “In other words, even a slight in- other aggravating factor is that the ab- persons who have been benefiting from crease in soft tissue as a result of obe- dominal cavity is inflated with CO2 dur- such a “therapy” for years on end. sity can more easily lead to a closure of ing the laproscopic procedures that are “The demographic shift alone means the upper respiratory tract,” says the doc- often performed today. The result is addi- that adiposity will continue to increase,” tor, who for the last ten years has also tional pressure on the lungs. “Due to the says Anke Tempelmann, an adiposity ex- regularly provided medical care to sumo high back pressure, you need a good ven- pert at AOK, Germany’s largest health wrestlers in Japan. tilator,” says Wagner. “A minimal ventila- insurer with roughly 24 million mem- Ventilation is particularly critical tion pressure must be maintained at all bers. The more older people there are, times. At the same time, it’s vital to avoid the more overweight people there will Every operation or stay in intensive care is a high peak pressure that could damage be. “There will also be an increase in the associated with increased risks for obese the lungs.” Because of their restricted occurrence of the ancillary diseases asso- people, with ventilation being particu- lung function, obese patients face a ciated with obesity, such as Type 2 diabe- larly problematic — especially for those greater risk of sections of the lungs col- tes, fat metabolism disorders, coronary with a BMI of 40 or above. At this point lapsing. “It is often necessary to reopen disease, joint arthritis, and gall stones.” one speaks of morbid obesity, a condition collapsed alveoli at the start of ventila- A BMI of between 30 and 35 reduces life which affects 1 percent of all women and tion in order to reduce the back pressure expectancy by two to four years, on aver- 2 percent of all men in Germany. Obese of the lungs,” explains Michael Wilken- age. A BMI of 40 to 45 costs eight to ten people have a higher metabolism and ing, the Director of Anesthesia Product years, on average. basal metabolic rate. As a consequence, Management at Dräger. “It’s a bit like However, individual suffering and they use more oxygen. But whereas the blowing up a new balloon for the first loss of quality of life cannot be expressed heart, stomach, liver, and other organs time. However, the ‘AutoFlow’ ventila- in numbers. Nor is the problem still re- grow along with the layer of fat, the size tion mode of the Primus or Zeus is well stricted to Europe and the U.S., with of the lungs remains unchanged. Doc- suited to ventilating obese patients in or- increasing numbers of obese persons tors at the University of Chicago mea- der to avoid peak pressures during venti- now being registered in developing and sured the oxygen consumption of people lation and maintain a minimum volume emerging nations. with an average BMI of 53. Even at rest, under changing pressure conditions.” Even in Japan, which has tradition- the morbidly obese patients used 60 per- ally been a lean society, doctors are be- cent more oxygen than people of normal Hospitals are adjusting coming increasingly concerned. “In weight. Furthermore, the ability of the times of economic turmoil, people stop lungs to expand is reduced and breath- Regardless of whether the issue is a good paying attention to healthy eating and ex- ing work is more difficult. ventilation and anesthesia device, spe- “The masses of fat compress the ercise,” reports Ryoichi Ochiai, Profes- cial beds, wheelchairs, or larger MRI lungs,” explains Adjunct Professor Klaus sor of Anesthesiology at the Toho Univer- machines — hospitals have already taken Wagner, M.D., Chief Physician of the sity School of Medicine in Tokyo. Even steps to ensure they can provide obese Clinic for Anesthesiology and Intensive though only 3 percent of the popula- patients with appropriate treatment in Medicine at Klinikum Südstadt in Ros- tion of Japan is currently obese, there many areas. Caregivers are also adapting tock. “On the operating table, the belly are some special risks associated with to the challenge. “We have to be particu- also forces the diaphragm upward.” Asian anatomy. “A study in Japan showed larly careful with skin care and change As a result, breathing is already so dif- the bed linens more frequently because > that the bony capacity of the upper re- 10 Dräger review 99.1 February 2010 Fo c u s ObeSi T y D-11039-2009 D-11038-2009 An operation is the only thing that helps some adiposity patients. Here at Klinikum südstadt Hospital in Rostock, Germany, preparations are underway for a biliopancreatic diversion, a procedure that reduces the amount of food the stomach can hold to only 200 to 300 milliliters. D-11040-2009 D-11041-2009 constant monitoring and the utmost care are prerequisites for the long-term success of an operation. The basic principles were developed in 1976 by Professor Nicola scopinaro of the university of Padua, Italy. The laproscopic procedure via trocar is shown at the right. 11 Dräger review 99.1 February 2010 Fo cu s O b eS i T y > obese patients perspire more heavily. This softens the skin, and infections can de- velop easily in the folds,” says Henriette Claussen, Deputy Director of Nursing at Sachsenhausen Hospital in Frankfurt am Main, Germany. The hospital has special- ized in the surgical treatment of people with obesity. “Like anorexics, these peo- ple’s perception of their own bodies is im- paired,” reports Claussen. “They are often not aware that they can barely climb the stairs anymore.” At the same time, there is a lot to talk about, so Klinikum Sach- senhausen hired a nutrition advisor and a psychologist. “Many patients have sur- rendered every last bit of personal respon- sibility; we have to be very patient,” says Claussen. Another thing needed is simply more hands. Normally three nurses work together to lift one obese patient. “But sometimes, this particular exercise has required as many as six.” Obese patients come to Klinikum Sachsenhausen to have surgery as a means of combatting their massively ex- cess weight. In general, they are still able to care for themselves, are middle-aged and are dedicated and motivated. The situation is different for people who de- spite massive obesity are only admitted to the hospital as the result of an acute emergency, such as a fall. These people have often lived in isolation and were no longer able to adequately care for them- selves. It is only in the hospital that they become fully aware of their situation. D-11042-2009 “These patients are often very ashamed. Sometimes they try to downplay their sit- uation with jokes,” reports Heike Förster. The patient will soon be able to eat normally again. The digestive tract has been shortened by approximately 50 centimeters, resulting in the malassimilation of fat. The nurse is an instructor at Bildungs- 12 Dräger review 99.1 February 2010 Unlike a conservative therapy, a bypass produces permanent weight loss akademie und Wissenschaft GmbH in Es- hospitals in Germany now offer out- to a section of the small intestine. After sen, Germany, where in 2010 she began patient programs that help obese par- the surgery, patients are only able to in- teaching a special course for nurses and ticipants lose a lot of weight in an ini- gest a small amount of food, feel “full” caregivers on caring for obese people. tial phase in which they use powdered more quickly, and are also no longer able Förster also provides information on how foods manufactured by a major food to digest a portion of the food. “We now to mobilize the patients as quickly as pos- company. The group meets once a week use a bypass in 70 percent of our proce- sible and how to more effectively prevent for a year. The powdered food is grad- dures,” says Stubbig. an impending case of bedsores, pneumo- ually replaced with normal food, and Weight loss following such a proce- nia, or thrombosis. “Caregivers will in- they receive psychological counseling. dure is generally permanent, with BMI creasingly find themselves confronting Exercise programs are also offered. Ac- values typically dropping from 45 to an this particular challenge,” says Förster. cording to one study, the participants lose average of 27. Like all operations, how- “Adiposity is a disease, and it requires our an average of 20 kilograms after one year. ever, there are risks associated with the utmost professional attention.” Follow-up exams six months after com- procedure. A U.S. study found that two pletion of the program show that the par- in 1,000 patients die. Every fifth pa- Burden on the health care system ticipants have already regained an aver- tient suffers some form of complication Health care systems also have a large age of 11 kilograms. Longer-term studies ranging from vomiting to infections in burden to bear. In fact, the direct and are not available. Given the dubious bal- the abdominal cavity while still in the indirect consequential costs of adiposity ance and the high cost of roughly 3,000 hospital. in Germany are currently estimated to euros per year, it’s no wonder that the “I think that the number of surgi- be approximately 13 billion euros a year. German health insurers generally do not cal weight loss procedures will increase The single largest item in this calcula- pay for the program. even further in the future,” says Pat- tion is the treatment of Type 2 diabetes. The few weight-reduction medica- rick McQuillan, Professor of Anesthesi- Other costs are incurred in relation to tions officially approved by the author- ology at the Penn State Hershey Med- coronary and circulatory diseases, ities have also not proven to be very ef- ical Center, Pennsylvania, USA. More arthritis, invalidity, and the inability of fective so far. Surgical methods are very than 200,000 surgical procedures for sufferers to work. successful, however. “The conservative the treatment of obesity are performed In the U.S., diseases associated with therapy only works in individual cases; each year in the U.S. “It would be better being severely overweight are estimated unfortunately, the majority of extremely if the conventional methods worked, of to cost the economy some 103 billion obese patients can only be helped with course,” says McQuillan. “However, sur- euros a year. Given this massive sum, surgical procedures,” says Dr. Konrad gery is often the only option.” it is natural to ask why more isn’t be- Stubbig, M.D., Chief of Anesthesiology German hospitals will also have to ing done to combat obesity. The answer at Krankenhaus Sachsenhausen, Frank- increasingly adjust to accommodate se- is relatively simple: there are very few furt am Main, Germany. The clinic spe- verely overweight people. They are high- effective solutions. cializes in bariatric surgery. One of the risk patients for whom an operation is The most successful of the conven- most effective of such surgical weight particularly dangerous. However, it is also often their last hope. Dr. Birgit Herden tional methods are concepts in which loss methods is gastric bypass, an oper- the participants receive intensive psy- ation that requires a great deal of expe- Further information online, including: chological support. In addition, they rience on the part of the surgeon. Basi- Product information change their eating habits and undergo cally, the surgeon isolates a small section www.draeger.com/99/obesity behavior and exercise therapy. Many of the stomach, which is then connected 13 Dräger review 99.1 February 2010 R e p oR t Ni v Nasal Masks enhance patients’ Quality of Life Tubes, machines, and a closed mouth: as a rule, people on ventilators are lost for words. However, new studies show that NAsAL MAsks can change this — and other things besides. HARM kLAAs heaves a long sigh of no possibility of any verbal communica- of chronic bronchitis. She was immedi- relief. Henriette, his wife, smiles back at tion between the couple, who have been ately given non-invasive ventilation (NIV) him. Now that her mouth is free again, he married for 34 years — three days of silent with a face mask (full-face mask) cov- can feed her the tangerine segments she looks, and machines, and hope. ering nose and mouth. After a success- likes so much. She can eat and talk to her Henriette Klaas was admitted to the ful response to this treatment, the doc- husband. For three whole days, there was hospital with respiratory failure as a result tors have now switched her over to a nasal MT-2812-2008 Adjustable nasal masks provide a custom fit and help enhance the effectiveness of non-invasive ventilation. 14 Dräger review 99.1 February 2010 D-12182-2009 D-12187-2009 D-12191-2009 Form follows function: Using a pump ball (center), the mask cushion (left) is inflated with enough air (right) to create an effective seal with the patient’s face. The mask swivel can be rotated through 360 degrees. mask. “The relief after the first three a change of mask. He therefore sees big of invasive ventilation via endotracheal days was enormous; I was finally able to potential for the use of nasal masks not tube can be reduced and the anesthetic breathe properly again. But after a while only in hospitals but also in the homecare generally required for intubation becomes I began to feel claustrophobic because environment — for example, in the treat- unnecessary. of the face mask,” whispers Henriette ment of patients with chronic respiratory If there are no contraindications to Klaas, still visibly weakened by her con- failure who are already used to NIV. mask ventilation, Girault would initial- dition. “But with this nasal mask I now In the light of this study, it is very fit- ly recommend the use of a face mask feel a lot better.” ting that Dräger has been expanding its in cases of ARF: “With a face mask, it’s Studies show that this procedure can NIV mask portfolio by two nasal mask much easier for patients to get accus- be highly recommended. Together with lines: the ClassicStar, which has been tomed to NIV.” The study demonstrated his colleagues, Dr. Christophe Girault available since mid-2009, and the NovaS- an overall success rate for NIV in over from the University Hospital in Rouen tar, which is projected for market launch 80 percent of cases — i.e. for four out of (France) has investigated the influence later this year. The development of these five patients intubation was unneces- of the initial choice of mask on the clini- new masks has focused on maximizing sary. Of the patients initially ventilated cal effectiveness and tolerance of NIV in patient comfort and minimizing air leak- with a nasal mask, 75 percent had to be cases of acute respiratory failure (ARF). age. The single-patient use ClassicStar switched to a face mask within a short A total of 90 patients were divided into nasal mask is equipped with an adjust- space of time because of air leaks. two groups, the one ventilated with face able mask cushion, which also helps to From the third day onward, howev- masks, the other with nasal masks. The ensure an effective seal, and the multi- er, more substantial problems with the results of the study (“Interface strategy patient use NovaStar nasal mask with a face masks began to emerge. Patients during noninvasive positive pressure ven- soft silicone-gel cushion and a pliable felt uncomfortable with the mask, and tilation for hypercapnic acute respiratory ring incorporated into the mask body, there were complications involving the failure” in Critical Care Medicine, Janu- which allows the mask to be adjusted to skin, ears, nose, and throat. “Switch- ary 2009, Vol. 37, No. 1; pp. 124 ff.) con- the shape of the patient’s face precisely. ing to a nasal mask in such cases — or, firmed what Girault had already observed even better, before these complica- A custom fit is crucial for success during many years of clinical experience. tions arise — can avoid such problems,” “We knew that nasal masks can cause lots As Girault explains, continuous enhance- explains Girault. He recommends chang- of problems due to air leaks, particular- ment of the ventilators and improvement ing over to a nasal mask whenever the ly in the early stages of NIV. Our aim was of the masks is a key factor in the use NIV lasts longer than 48 hours and pro- to show that it is therefore better to start of NIV: “A perfect mask fit is crucial for vided that the patient is stable. off with a face mask in cases of acute ensuring a greater acceptance and toler- Henriette Klaas has gotten used respiratory failure, but that the patient ance of NIV and is therefore fundamen- to being ventilated with a nasal mask. can be switched to a nasal mask later tal to the success and effectiveness of this Although she is still struggling with her on,” says Girault. “The study shows that form of therapy.” condition and the respiratory failure has nasal masks can be just as effective as a In many cases, invasive ventilation every appearance of becoming chronic, face mask, provided the patient cooper- and the resulting complications can be she’s positive about the future. That’s ates.” The main problem is that patients avoided with the use of NIV (cf. Dräge because the doctors have said that there’s with a nasal mask also breathe through Review 96.1; pp. 10 ff.). Even more impor- a good chance that she will be able to their mouths, and that leads to air leakag- tantly, the risk of ventilator associat- continue using the nasal mask — at home Isabell spilker es via this opening, thereby necessitating ed pneumonia, a possible complication with her husband. 15 Dräger review 99.1 February 2010 Dräger produces life- D-11031-2009 saving equipment — such as this valve — in-house. I nsI g h t v en t il ator proDu ct ion Precision Down to the Last Micrometer ventilators can make the difference between life and death, as patients’ lives depend on technology that must function reliably and perfectly. Such technology is produced by Dräger in lübeck, where Michael Stäbler manages the ventilator production unit like a hIghLy effIcIent PrecIsIon workshoP. stäbLer greets his guests with which are as fine as human hair. The a handshake whose grip feels like a vise. thicker wire is used for the working coil, A qualified precision mechanic, Stäbler and the thinner one is wound in the spi- oversees production of not only ventila- ral groove formed by the winding of the tors but also critical components for oth- thicker wire. er devices. “For these, we serve as the Both coils are wound around an alu- supplier to all Dräger production loca- minum core and fixed with an adhesive tions,” he says. that is also used for automobile brake One ventilator in the room bears the disks. “Things get hot here, as they do D-11032-2009 label “Made in Germany.” When asked if where the brake disks operate — and like manufacturing in Germany still makes the technology used for brakes, this tech- business sense, Stäbler takes a key com- nology is also a matter of life and death,” never out of breath: Michael stäbler. ponent produced in Lübeck out of a box. Stäbler explains as he places the compo- “This part consists of a drive unit and a one millimeter, and it does this through- nent, which looked like a simple technical valve that we could never procure any- out the entire service life of the ventilator, device when he took it out but now seems where else on the global market with this which can operate for ten to 15 years. This like a technical marvel, back into the box level of quality,” he explains. The central drive unit is made of an annular gap mag- from which it came. component of a ventilator, the drive unit net in whose circular-shaped gap a coil flexible production through that Stäbler is showing us, precisely reg- can move back and forth ever so slight- buffered stockpiling ulates the valve, which itself consists of ly in a manner similar to what happens a small ruby sphere that perfectly seals in a loudspeaker when electricity flows Stäbler then explains how he and his team a double-clamped sapphire ring. To this through a coil wire and then causes a not only produce ventilators in double-digit end, the two-valve components are ground membrane to oscillate with the help of a numbers week after week for diverse mar- specifically to fit each other, which is why magnet. The drive unit, like a loudspeak- kets under these demanding conditions they can only be used as a pair. er, is thus an electromagnetic converter. with regard to precision and quality. He Its design is almost like that of the Holy also tells us that they can now significant- Air flows at the speed of sound Grail, as the unit not only has to safely ly increase their output with absolutely no When the drive unit lifts the sphere, which and precisely move the plunger extreme- loss to quality. So what’s the secret? “Out- is held by a catching box over a plunger, ly often but also constantly provide the put numbers and fast delivery are the fac- air or oxygen can flow in precise dosages system software with data on the exact tors that determine who gets the order,” through the gap thus created. “Flow” is location of the plunger at every point in Stäbler says. That’s why he not only put perhaps not the right term here, since its stroke, which measures only one mil- together an efficient core team of work- the gas is subjected to five 5 of pressure. limeter. “We work here with a precision ers but also took steps to ensure that this “When it shoots out, it reaches a speed measured in micrometers,” says Stäbler, team could be expanded in a flexible man- approaching that of sound,” says Stäbler pointing to a winding machine used to ner. That’s what makes his unit a precision with the serenity of a man whose technolo- produce the coils for the displacement workshop where it’s not just about process- gy can control such forces of nature even sensor of the parallel mixer. es but also the workers’ qualifications and in the tiniest spaces. The coil for the valve drive is made sense of responsibility. The drive unit uses high-frequency sig- at another workstation that houses two This system is based on strict adher- ence to a structured timetable for produc- > nals to lift the sphere in the valve by only rolls of copper wire in two thicknesses, 17 Dräger review 99.1 February 2010 In s I g h t v e n t il ato r p ro D u ct io n D-11033-2009 teamwork: An optimal workstation layout safeguards quality. > tion. “Basically, we differentiate between two types of manufacturing: customer- anonymous production, which extends to the modular level, and subsequent cus- tomer-specific production, where the modules are combined with the devices that display the attributes ordered by the customer.” Each Savina ventilator consists of several hundred individual parts com- bined into several main components that are “built to store” as buffers to ensure continuous production even when unit output requirements change. Deter- mining the appropriate stockpiling level D-11034-2009 D-11035-2009 always involves balancing costs and deli- very speed. “Our internal forecasts are generally very good here,” Stäbler says. high concentration: the wristband conducts static charges away from the workpiece (left). the ventilation devices undergo long-term tests (right). Information is the key Each module is built in Lübeck by expe- rienced specialists, partly on one of the so-called clean workbenches, where a fil- tering system reduces to 100 the usual amount of 350,000–450,000 dust parti- cles (measuring more than 0.5 microm- eters) per cubic foot (approx. 28.3 liters). The “normal” workstations, on the other hand, are arranged in a square around the central assembly area. These work- stations are designed as flexible tables to which materials are sent from behind. “This enables us to quickly rearrange the workstations depending on require- ments. We also have supply lines that can be lowered from a suspended ceil- ing, which makes us even more flexible,” D-11036-2009 Stäbler explains. This concept also opti- mizes each individual process step. Speaking of optimization, there is “turnkey” here means that when customers remove the packaging, they have their completely assembled, tailor-made ventilators. also a continual review process at each 18 Dräger review 99.1 February 2010 In the end, turnkey delivery shows that customer utility is considered from the very beginning production point to determine how the with the newly trained employees who are thing they put their mind to,” he says. The targets for product reliability and quality used to address peaks in demand. important thing is to carefully examine can be reached even more efficiently. “We The finished devices are put through the potential obstacles that might prevent don’t have any burning desire to produce stringent and complex internal testing them from doing so — and then eliminate any components here that we can procure procedures that begin with high-voltage them. This in turn requires creativity, or at the same quality on the market,” says stability checks at 1,500 volts. After that, “thinking outside the box.” That’s also the Stäbler, who considers himself in com- each unit is operated at full load for 12 title of a book Stäbler now mentions. The petition with external suppliers when it hours in a hot room with a temperature of book’s cover shows how one can link nine comes to providing other Dräger produc- 40 °C. “Ventilators like the Savina in par- points arranged in a square using only tion locations with components. Never- ticular are often used in countries where four lines by thinking “outside the box.” theless, there’s no getting around the fact such temperatures are common,” Stäbler Another important ingredient for success that critical parts, such as the electrome- explains. The latter test is followed by a is team spirit — not just in production but chanical components, must be manu- check of all mechanical, electrical, safety, also as an element of cooperation with factured in Lübeck. Even so, efficiency operational, and command functions that other company units and departments. potential can constantly be exploited at lasts for at least 75 minutes. “We use qual- Stäbler also likes to show international the Lübeck unit. Stäbler recalls a com- ified experts for these,” says Stäbler, add- customers touring the production lines plete cleanroom that was only needed for ing that such specialists must have perfect in Lübeck how quality and reliability are the production of just 20 percent of all knowledge of the testing stipulations for produced at the facility. components: “That’s why we introduced obtaining approval in various countries If one were looking for a single word the ‘clean workbenches,’ which speed- around the world. to describe the concept behind this high- ed up production and made things less tech, precision workshop production Key moments stressful for our employees.” operation, one might come up with the The workforce does in fact form the Savinas are delivered with the exact con- term “flow.” This term would apply not core of Dräger’s high-quality produc- figurations specified in their orders. It’s only to things like the precisely channeled tion — along with the technology, of course. literally a turnkey delivery. To prove the flow of air through the ruby sphere and Stäbler relies here on a collegial concept point, Stäbler reaches for a hex key that the sapphire ring inside the ventilator, that involves experts who look beyond their comes with every device: “It’s always a but also to the “flow” that was described specialized areas. “Information is the ‘key moment’ for us when we see how by American psychologist Mihaly Csik- key — everyone needs to know what share of happy customers are to get this little tool. szentmihalyi to explain a form of work the final product is accounted for by his or For them, it’s not just a hexagon-shaped organization that is desirable. Such a sys- her work,” he says. Such a concept requires piece of steel. Instead, it also shows them tem is characterized by employees who that the employees take on responsibility. that we thought about customer utility at “lose themselves” in tasks that are aimed Final assembly workers therefore often every stage of the production process.” at meaningful objectives and require the decide for themselves whether they want to Customers simply open the device’s out- workers to exercise independent think- build the product completely on their own er packaging, after which the Savina can ing and a sense of responsibility. From or divide the individual steps among them- more or less immediately be rolled to the very first handshake, it was clear that selves. “Long-standing employees naturally wherever it’s needed. Stäbler subscribes to this philosophy. And tend to want to do the complete assembly Back in his office, Stäbler turns to now it’s equally evident that he has sys- themselves,” says Stäbler, who adds that the issues of quality, creativity, and lead- tematically implemented it in his unit’s Nils Schiffhauer such an approach cannot be employed ership: “Basically, anyone can do any- daily work. 19 Dräger review 99.1 February 2010 Respiratory Cycle in 90 images Targeted recruitment maneuvers can help to reopen collapsed areas of the lungs. However, until now suitable information for immediately determining the success of such maneuvers has not been available. eleCtRiCal impedanCe tomogRaphy (eiT) is intended to close this gap. it determines the regional distribution of ventilation in the lungs — continuously, without radiation, and directly at the patient’s bedside. What goes on inside a per- information that previously wasn’t avail- maneuvers with temporarily high ven- son’s body? In the course of time, new able.” In theory, Dr. Gommers knows tilation pressure. These regions of the technical methods have provided fasci- exactly the data he needs to treat these lungs are subsequently stabilized by set- nating insights that have facilitated the patients. Perhaps that’s not so surpris- ting optimal positive end-expiratory pres- examination, therapy, and monitoring of ing given that he spent many years work- sure (PEEP). patients. Pulse oximetry is a technique ing on the research team of the experi- However, the practical implemen- that enables the easy measurement of mental anesthesiologist Prof. Burkhard tation of this method had long proved arterial oxygen saturation by measur- Lachmann. It was during this period that to be difficult. “For the doctor to venti- ing light absorption. A clip fastened to a he codeveloped the Open Lung Concept. late with the right pressure at the right finger or another part of the body deter- This concept provides important usage time,” explains Gommers, “he or she mines the attenuation of certain wave- patterns for doctors when they have to has to know pretty quickly how the vari- lengths of light as it passes through the make collapsed (“atelectatic”) regions ous regions of the lungs respond to the respective part of the body. of the lungs accessible for gas exchange individual recruitment maneuvers.” Although this technique was almost again by using targeted recruitment That has not been possible up until now completely unknown 25 years ago, today it is very difficult to imagine how rescue services or an intensive care unit (ICU) could operate without it. Pulse oxime- try has also established itself outside of hospitals. Amateur pilots and moun- tain climbers, for example, use it to help avoid altitude sickness. the right pressure at the right time Today experts are predicting that electri- cal impedance tomography, or EIT, will follow a similar path. Armed with this imaging method, it is possible to deter- mine the regional distribution of venti- lation in the lungs. “EIT has proved to be an efficient method for guiding ven- tilation therapy in patients with serious pulmonary diseases in such a way that consequential damage can be prevent- ed,” says Dr. Diederik Gommers, who is the vice chairman of the Adult Intensive Care Unit at Erasmus Clinical Center in D-11028-2009 Rotterdam, The Netherlands. “Especial- ly in difficult cases where it’s vital to act some of the 90 images of a respiratory cycle: White indicates the best-ventilated quickly, EIT provides us with up-to-date 20 Dräger review 99.1 FebruarY 2010 O u t lOO k in t ensi v e C are Me DiC in e because no suitable method has been assessing the success of targeted recruit- words, FRC provides a doctor with clues, available. Although computed tomogra- ment maneuvers. This is because FRC whereas EIT provides additional informa- phy (CT) provides a very detailed tomo- measurements reflect the entire lung tion and more specific guidance. graphic image of the lungs, the patient rather than what is happening in a par- 16 electrodes measure resistance must first be transported from the ICU ticular region of the lung as the result of to the CT department — often a difficult the maneuver. With this method, the gas EIT provides a means of analyzing ven- and complex procedure. In addition, it volume remaining in the lungs following tilation distribution in the lungs — the is not possible to carry out continuous a normal expiration at rest is measured data is continuously displayed as imag- measurements because this method uses at regular intervals. EIT, like FRC, pro- es, waveforms, and parameters. To do so, it uses the fact that the air content x-rays. Consequently, physiological pro- vides information about end expiratory influences the bioelectrical properties cesses such as respiration cannot be por- lung volume, but with the added bene- of pulmonary tissue. The more air that trayed dynamically. fit that EIT provides information about is contained in the pulmonary tissue, Functional residual capacity (FRC) is the response to recruitment maneuvers the greater is the electrical resistance, > also of only limited use when it comes to in specific regions of the lungs. In other regions, black the nonventilated regions. Blue regions are in between these two states. 21 Dräger review 99.1 FebruarY 2010 O u t lOOk in t en s i v e C a re Me DiC in e D-28357-2009c that condition the measured data so that only the relevant changes in bioimped- ance as a result of ventilation are con- the display is the window into the lungs: It shows respiratory sidered. In other words, such things as function at a glance in intuitively identifiable colors. changes in the resistance between the electrodes and the skin don’t play a role. Other disturbance variables, such as car- diac activity, can be subtracted so that > which in this case is specifically referred the ventilation distribution in the lungs the healthcare personnel can concen- to as “impedance.” in an intuitively understandable manner trate on the processes relevant to venti- In order to determine this impedance, with the help of color coding. lation. The software also had to be writ- Dräger has developed a solution in which The three colors selected (black, ten in such a way that the measured data 16 electrodes are first placed around the blue, and white) represent the ventila- can be continuously analyzed and visual- patient’s chest. Tiny electrical currents tion of the lungs at a specific point in ized in real time bedside without delay. are then applied to the body through one time in the individual regions of the This was an important prerequisite, as electrode pair and the resulting voltag- lungs. White represents the regions any demand for off-side analysis would es at the remaining electrode pairs are that are best ventilated; nonventilated substantially diminish the practical ben- measured. These voltages change in rela- regions are black. The blue areas rep- efits of EIT. tion to the amount of air present in the resent regions that are in a transitory Professor Ola Stenqvist, an anesthe- patient’s chest. Because the position at phase between black and white or vice tist at Salhgrenska University Hospi- which the current is applied to the body versa. Finally, arranging the images tal in Göteborg, Sweden, has been fol- during an EIT rotates around the chest, chronologically results in an informa- lowing the advancements in this area the voltage measurement locations also tive, dynamic image showing how these very closely. He first became acquaint- change. As is the case with CT images, areas grow and recede in rhythm with ed with the concept of EIT in the mid- the measured values obtained after one the patient’s respiration. 1990s and has been a Dräger develop- 360-degree rotation can be used to com- “This provides us with complete- ment partner since 2002. And because pute a tomographic image that provides ly new insights into what is happen- Dräger already offers a user-friendly information about the distribution of air ing inside the patient’s lungs,” says Dr. solution with its current EIT prototype, inside the chest (in the dorsal and ven- Gommers when he is asked to describe it is conceivable that he — just like his tral lung regions). his experience with EIT prototypes from colleague Dr. Gommers — would like to But that is by no means the end of the Dräger. “What’s more, thanks to the high- use EIT for more than just research pur- story. To resolve the change in the distri- ly sensitive equipment we are able to opti- poses in the future. bution of air with respect to time, EIT mize the fine adjustment of the ventilator The intensive care community is requires more than just a single snapshot. directly at the patient’s bedside.” eagerly anticipating the introduction, in Instead — depending on the settings — 30 2010, of a commercial EIT solution from Software is an important factor images are captured every second and Dräger. Says Stenqvist: “I believe that this respiration is continuously displayed as It is the software that converts the mea- product will represent a great advance in a dynamic image. One respiratory cycle sured data into comprehensible imag- daily clinical practice as far as treating lasting approximately three seconds gene- es which make the solution so usable. mechanically ventilated patients is con- Frank Grünberg rates a sequence of 90 images that show It was necessary to develop algorithms cerned.” 22 Dräger review 99.1 FebruarY 2010 S erv ic e SAleS in GerMAny HeADQUArTerS: Dräger Medical Deutschland GmbH Moislinger Allee 53–55 23558 lübeck, Germany Tel. +49 180 52 41 318* Fax +49 451 882 7 2002 www.draeger.com * within Germany: 0.14 euros/min from Deutsche Telekom fixed-line phones eAST cenTrAl reGiOnS ASiA / PAciFic Dräger Medical Deutschland GmbH Dräger Medical Deutschland GmbH Dräger Medical South East Asia eUrOPA nOrTH / cenTrAl Antonstr. 14 Max-Planck-Ring 25 Pte. Ltd. Dräger Medical AG & AG Co. KG 01097 Dresden 65205 Wiesbaden 25 International Business Park Moislinger Allee 53-55 Tel. +49 351 80 702 0 Tel. +49 6122 50 90 # 04-27/29 German Centre 23558 Lübeck, Germany Fax +49 351 80 702 41 Fax +49 6122 509 49 609916 Singapore Tel. +49 451 882 0 Tel. +65 65 72 43 88 SOUTH AUSTriA Fax +49 451 882 2080 Fax +65 65 72 43 99 Dräger Medical Deutschland GmbH Dräger Medical Austria GmbH eUrOPe SOUTH Vor dem Lauch 9 Perfektastraße 67 MiDDle eAST, AFricA, Dräger Médical S.A.S. 70567 Stuttgart 1230 Wien cenTrAl AnD SOUTH AMericA Parc de Haute Technologie d’Antony 2 Tel. +49 711 72 593 0 Tel. +43 1 609 04 0 Dräger Medical AG & Co. KG 25, rue Georges Besse Fax +49 711 72 593 98 Fax +43 1 699 45 97 Dubai Healthcare City 92182 Antony Cedex, France P.O. Box 505108 WeST SWiTZerlAnD Tel. +33 1 46 11 56 00 Dubai, United Arab Emirates Dräger Medical Deutschland GmbH Dräger Medical Schweiz AG Fax +33 1 40 96 97 20 Block A-102, 1st floor Im Teelbruch 103 Waldeggstraße 38 Tel. +971 4 36 247 62 90 66 463 45219 Essen 3097 Liebefeld Bern Fax +971 4 36 247 61 Tel. +49 2054 104 0 Tel. +41 31 978 74 74 Fax +49 2054 104 206 Fax +41 31 978 74 01 IMPRINT Publisher: Drägerwerk ag & Co. Kgaa, Corporate Communications editorial Address: Moislinger allee 53–55, 23542 Lübeck / draegerreview@draeger.com, www.draeger.com editor in chief: björn wölke, Tel.: +49 451 882-2009, Fax: +49 451 882-3197 Publishing House: tellus PubLiSHiNg gMbH editorial consultant: Nils Schiffhauer (responsible according to press law) Art Direction, Design, and Picture editing: redaktion 4 gmbH Translation: TransForm gmbH Printing: Dräger + wullenwever print+media iSSn 1869-7305 The articles in Dräger review provide information on products and their possible applications in general. They do not constitute any guarantee that a product has specific properties or of its suitability for any specific purpose. all specialist personnel are required to make use exclusively of the skills they have acquired through their education and training and through practical experience. The views, opinions, and statements expressed by the persons named in the texts as well as by the external authors of the articles do not necessarily correspond to those of Drägerwerk ag & Co. Kgaa. Such views, opinions, and statements are solely the opinions of the respective person. Not all of the products named in this magazine are available worldwide. equipment packages can vary from country to country. we reserve the right to make changes to products. The current information is available from your Dräger representative. © Drägerwerk ag & Co. Kgaa, 2010. all rights reserved. This publication may not be reproduced, stored in a data system, or transmitted in any form or using any method whether electronic or mechanical, by means of photocopying, recording, or any other technique in whole or in part without the prior permission of Drägerwerk ag & Co. Kgaa. 23 Dräger review 99.1 February 2010 Clos e - up An EsT h EsI A 6 8 1 9 4 5 7 3 2 10 D-11044-2009 Compressing the Air at 85,000 rpm The TurboVent2 (second generation) ventilator is a component of the The impeller 5 is made from extremely stable polyether ether ketone Zeus Infinity Empowered anesthesia system from Dräger. The ventilator (PEEK). It is pressed onto the motor and sucks in a gas mixture of module is plugged into the Zeus housing 1 by 18 spring contacts (cod- oxygen, anesthetic and breathing gas from the connector 6 , compress- ing pins) 2 , which ensure that it cannot be incorrectly connected. The ing it to a pressure of up to 100 millibars in a chamber 7 , the contours central element of the radial fan is the gas-tight encapsulated, brushless of which designed for an optimum flow. Among other advantages, this DC electric motor 3 which is mounted using a low-vibration silicone ensures a lower airway resistance for a further-improved free breathing. membrane 4 . It is operated in sync with the physiological breathing The connector 8 carries the compressed air onward. Both connectors frequency and reaches a speed of up to 85,000 revolutions per minute. are mounted on bellows 9 for minimum vibration. This design effec- The motor is designed for minimum inertia with maximum torque, and tively reduces possible coupling of vibration to the anesthesia system. A fan 10 mounted in the Zeus housing 1 cools the corrosion-resistant manufactured with the smallest imbalance possible. It accelerates from module, which can be sterilized as a unit in a steam autoclave — a fea- 0 to 20,000 rpm within 100 milliseconds and is thus capable of track- ture which is almost certainly unmatched worldwide. ing spontaneous breathing efforts. =
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