Advice
The technology
The technology
PulmoVista 500 (Drager UK Ltd) is a non-invasive imaging device for monitoring lung ventilation. Pulmonary function needs to be regularly assessed during ventilation therapy. The technology uses electrical impedance tomography to measure regional gas distribution in real time. The company claims the technology can assess continuous regional ventilation distribution and changes in end-expiration lung volumes (the volume of gas left in the lungs after exhaling). These are indicators of pulmonary function.
A silicone belt with 16 integrated electrodes is put around a person's chest and is connected to the PulmoVista 500. An alternating current is applied to a pair of electrodes and the resulting surface potential is recorded. The process is repeated in the adjacent electrode pair and continues around the belt creating a voltage profile. The resistance, or impedance, experienced by the current is affected by the ventilation of the lungs. The voltage profile is reconstructed using an algorithm to display regional impedance as a 2‑dimensional cross-sectional image of the lungs. The impedance represents variations in lung ventilation and end-expiratory lung volume. The device can monitor for up to 24 hours at a time. To use the PulmoVista 500 additional consumables are needed, including an electrode belt and patient cable (both available in sizes S to XXL), a reference electrode, a trunk cable and electrocardiogram (ECG) electrodes.
The PulmoVista 500 is for people having ventilation therapy in critical care. The technology should not be used in people with pacemakers, implantable cardioverter-defibrillators, implantable pumps, people with uncontrolled body movements or pregnant women. The technology should also not be used in people with damaged skin, fractures or lesions in the region where either the patient interface or electrodes will be placed.
Innovations
The PulmoVista 500 is a non-invasive imaging device to monitor regional gas distribution continuously in real time at the bedside. Investigations in standard care include arterial blood gas analysis, chest X-ray, lung ultrasound and CT scans. This technology aims to be less invasive than current care, using no ionising radiation or invasive tests, and be more convenient because it is used at the bedside, and report real-time monitoring. The company claims the technology could result in fewer scans.
Current care pathway
NICE's guideline on acutely ill adults in hospital recommends that people should be routinely monitored using track and trigger systems in line with their monitoring plan. Physiological parameters used by track and trigger systems include, heart rate, respiratory rate, blood pressure, consciousness, oxygen saturation and temperature. People in critical care needing intubation and ventilation are reviewed by a clinician. The ventilation therapy will be prescribed based on the person's medical history, blood gas measure and imaging results such as chest X-rays, CT scans and lung ultrasound. The patient's clinical status and cardiorespiratory measures are continuously monitored and reviewed by clinicians. The ventilation therapy is adjusted accordingly. Blood gas analyses and track and trigger parameters are used to manage ventilation therapy. In cases when imaging is needed, people may be transported from critical care to imaging departments for chest X-rays, CT or MRI scans. Some imaging techniques give patients ionising radiation. Ultrasound machines are also commonly used in critical care to monitor fluid in the lungs. Many are portable and can be used at the person's bedside. Some people need prolonged periods of mechanical ventilation, when this is suitable this can be given less invasively. NICE's guideline on chronic obstructive pulmonary disease in over 16s recommends clinicians also consider non-invasive ventilation for people that come off invasive ventilation slowly. Physiotherapy should also be considered to support the rehabilitation of people that have had ventilation therapy.
Population, setting and intended user
PulmoVista 500 is for people with impaired respiratory function having mechanical ventilation therapy in critical care. The technology is used by healthcare professionals and is for use on critical care wards at the person's bedside for continuous monitoring and real-time interpretation.
The company will provide training to staff using the technology. This is included in the technology cost.
Costs
Technology costs
The price of the device ranges from £20,000 to £30,000 depending on patient numbers and usage and has a lifespan of 7 years. Annual replacement of consumables is recommended and will cost between £2,500 and £5,000 per year.
The technology is estimated to cost approximately £79 per examination. This cost is based on a 10‑bed critical care unit admitting approximately 1,500 people per year, with an estimated use of PulmoVista 500 in 10% of admissions. This includes the cost of consumables and maintenance.
Costs of standard care
The costs of routine care procedures in the NHS for people having ventilatory support are summarised in table 1. Costs are from the 2019/20 national tariff payment system.
Table 1 UK NHS procedure costs
|
Description |
National tariff |
Additional information |
|
Non-invasive ventilatory support assessment |
£712 |
Cost for ordinary elective spell of up to 5 days. |
|
MRI |
£108 |
Per scan of 1 area, without contrast. |
|
CT scan |
£69 |
Per scan of 1 area, without contrast. |
|
Ultrasound |
£39 |
Per scan of less than 20 minutes, without contrast. |
|
X-ray |
£26 |
Per scan. |
Resource consequences
The resource impact of the technology would be greater than NHS standard care. However, the company claims the technology could result in savings from fewer CT or MRI scans and blood gas analyses. The company also claims the technology results in reduced incidence of ventilator-induced lung injury, which could reduce the length of hospital stay.
Healthcare professionals will need training to use the technology. Training is included in the cost of the device.