Technical Innovation in Critical Care in a World of Constraints: Lessons from the COVID-19 Pandemic

Abstract

The COVID-19 crisis was characterized by a massive need for respiratory support, which has unfortunately not been met globally. This situation mimicked those which gave rise to critical care in the past. Since the polio epidemic in the 50's, the technological evolution of respiratory support has enabled health professionals to save the lives of critically-ill patients worldwide every year. However, much of the current innovation work has turned around developing sophisticated, complex, and high-cost standards and approaches whose resilience is still questionable upon facing constrained environments or contexts, as seen in resuscitation work outside intensive care units, during pandemics, or in low-income countries. Ventilatory support is an essential life-saving tool for patients with respiratory distress. It requires an oxygen source combined to a ventilatory assistance device, an adequate monitoring system, and properly trained caregivers to operate it. Each of these elements can be subject to critical constraints, which we can no longer ignore. The innovation process should incorporate them as a prima materia, whilst focusing on the core need of the field using the concept of frugal innovation. Having a universal access to oxygen and respiratory support, irrespective of the context and constraints, necessitates: i) developing cost-effective, energy-efficient, and maintenance-free oxygen generation devices; ii) improving the design of non-invasive respiratory devices (for example, with oxygen saving properties); iii) conceiving fully frugal ventilators and universal monitoring systems; iv) broadening ventilation expertise by developing end-user training programs in ventilator assistance. The frugal innovation approach may give rise to a more resilient and inclusive critical care system. This paradigm shift is essential for the current and future challenges.

Keywords: COVID-19; constraint; frugal; innovation; respiratory support.

Figure 1.

Ventilatory support facing pandemics. (A) Iron lungs at Rancho Los Amigos Hospital in Downey, California, in 1953. Reprinted by permission from Reference (59). (B) A young patient with poliomyelitis being manually ventilated by a medical student during the poliomyelitis epidemic in Copenhagen in 1953. Reprinted from reference (60). (C) Patients in the emergency room of the Nossa Senhora da Conceicao hospital during the COVID-19 outbreak in Porto Alegre, Brazil, in 2021. Reprinted by permission from (61).

Figure 2.

Frugal innovation principles. Frugal innovation consists in transforming constraints into an opportunity to innovate by focusing on the core need and removing all that is superfluous.