The Ministry of Health is considering the idea of abandoning imported ventilators. This idea was submitted to the Ministry of Industry and Trade, which offered to support the domestic manufacturer. The department believes that Russian production can fully cover the needs of hospitals. Doctors interviewed by The Insider believe that Russian ventilators still have a number of shortcomings, and the lack of competition will finally deprive manufacturers of an incentive to make better products. In addition, there are cases when domestic equipment exploded and this led to the death of patients and the evacuation of entire hospital buildings.
As the anesthesiologist Vadim Sizov told The Insider, there are a number of difficulties with Russian ventilators, in particular, with one of the most popular: Aventa-M, which is manufactured by the Radioelectronic Technologies Concern (KRET). For example, according to Sizov, this device may not work correctly without informing the doctor or nurse:
“When we use artificial lung ventilation, we set a number of parameters, and it [the Aventa-M device] may not reach these parameters, but at the same time it will not notify that something is happening. A conventional device signals, for example, insufficient inspiratory depth, which can lead to an increase in carbon dioxide levels. And here you don’t even know that it doesn’t work correctly.”
Sizov doubts that Russia can make its own high-quality ventilators:
“What Russia can do is assemble devices from foreign components. If we talk about alternatives to big giants like Dräger or GE, there are a bunch of Chinese analogues that produce normal equipment that you can work on. I have no idea where in Russia they make enough plastic or print circuit boards. Obviously they don't do it themselves. If the components are brought from China, then it is not so difficult, but there is also logistics. How much time will it take? How smoothly will consumables be supplied?
The doctor notes that in Russia during the covid period, a lot of high-quality foreign devices were purchased, which, with proper maintenance, will work for a very long time. Another thing is that there are not so many specialists in the country who can service such devices.
“A lot of technology is already here, they need to be maintained – flow sensors, an oxygen sensor, and so on. The question is how to maintain the current fleet, because the devices cost 5-6 million dollars. Probably, they can be replaced by assembling your devices from Chinese components, but how long will it take? ”He argues.
Another doctor with 15 years of experience, a specialist in respiratory support and artificial lung ventilation, who wished to remain anonymous, believes that if we introduce a ban on the use of imported ventilators in Russia, this will remove the competitive factor in the work of the free market:
“When we do not have the opportunity to choose between different manufacturers, different companies, the quality of Russian equipment will be reduced, because there is no need to create something better when everyone is already buying great. There will be no incentive to create something at the level of the European and American markets.
The decline in the quality of ventilators will have rather deplorable consequences. Again, there is an example that thundered throughout the country – a fire in a hospital due to the ignition of equipment. The equipment failed, the patient died or was injured along with others. At least there was an evacuation from the department and the corps. This is a disaster for the hospital – the evacuation of the entire building. So reducing the quality of respiratory equipment is absolutely impossible.”
In May 2020, a fire broke out in one of the hospitals in St. Petersburg due to a short circuit in the Aventa-M ventilator manufactured by KRET. The fire killed six people. On May 9, a fire broke out in the Spasokukotsky hospital in Moscow. The building for the treatment of those infected with coronavirus caught fire. One person died. After that, it was reported that Roszdravnadzor checks the quality and safety of ventilators in hospitals in Moscow and St. Petersburg, where the fires occurred. In Russia, the use of Aventa-M devices was suspended for some time after these cases. It also became known that the United States abandoned Russian ventilators after fires in Russian hospitals.
According to the specialist, so far he is dissatisfied with the quality of Russian respiratory equipment, “although it is worth noting some progress in what is being created compared to what it was 10-15 years ago.” At the same time, he, like the anesthesiologist Vadim Sizov, draws attention to the problem with “feedback” – the information that the device transmits to the doctor:
“What is being created now is, in principle, satisfactory, that is, three points out of five. It works, but there are nuances that make this work difficult, for example, the so-called feedback from the equipment. The information that comes to the doctor does not quite correspond to the true state of the patient. This may influence decision making in the management of the patient. Wrong decisions may be made and the patient's condition may worsen. Some devices that require subtle interaction between the patient and the device do not provide this subtle interaction. Patients complain about the inability to adapt to breathing with this device, and when a foreign device is connected, all these problems are solved. As a doctor, I make a decision in favor of my patient and, if possible, choose better equipment, which I hope to continue to do.”
The doctor notes that this is not the first attempt to ban the import of foreign equipment, until last time the doctors managed to defend this issue. If this time the decision is nevertheless made, he proposes to start replacing the devices in those hospitals where officials and the president are treated:
If such an attempt is accepted, I want, first of all, the respiratory equipment to be replaced in the Central Clinical Hospital, in the hospital of the Presidential Administration and all medical centers that service the bureaucracy and the first persons of the state. And in addition to ventilators, I would like to see domestic, Chinese or Indian drug provision, although the quality of the latter is even better than that of Russia. That is, I would like people who adopt this law to start with themselves. And if they have the opportunity to travel to Western countries to receive medical care, I would like them not to have such an opportunity. If I'm not mistaken, this is spelled out in a certain law on medical care for officials, i.e. they have the right at the expense of the state to be treated in foreign clinics. I would like them to set an example, renounce such a right and be treated in domestic medical institutions using domestic equipment. If they are ready to start themselves, their relatives and children, then this will be a strong step that will contribute to the integration of domestic equipment and improve its quality. But I am afraid that this will not be accepted, and will only affect ordinary Russian hospitals where ordinary citizens are treated.”