20 Years Experience with Breas Ventilators

An Interview with Stefano Nava, MD, University Hospital Sant’ Orsola, Bologna, Italy

Breas met with Stefano Nava, MD, a leading proponent and researcher of Noninvasive Ventilation who leads the respiratory and critical care unit at the University Hospital Sant’ Orsola in Bologna, Italy. We spoke about his 20 years of experience with Breas ventilators and how he has seen NIV improve the quality of patient’s lives. Here is an excerpt of the conversation:

Q. Please tell us about yourself and your career as a physician, where you are working today, and so on, and your relationship with Breas?

A. I graduated from Pavia University, one of the oldest Italian universities. My career as a physician started in 1979 when I was attending the Respiratory Unit of the University of Pavia. Then when I graduated in 1982, my professor sent me for a three-year fellowship in Montreal, Canada at McGill University. McGill is very famous for pulmonary physiology and also mechanical ventilation. When I came back to my country, I first worked in a small hospital and then I moved to Pavia. And I spent some time in Belgium. Then I came back to Pavia. Then I took a sabbatical in Boston, and finally in 2010 I moved to the University of Bologna and I ran a busy unit.

At Bologna, we have a respiratory ward with 20 beds, including sleep studies, a very busy outpatient clinic and an eight-bed respiratory intensive care unit. My field of interest is obviously respiratory medicine, but with particular interest in respiratory insufficiency, chronic and acute. We studied various aspects of invasive and noninvasive mechanical ventilation, including sleep, respiratory mechanics and clinical outcomes. About 20 years ago I started my relationship with Breas working on different projects.

Q. In those 20 years and in all the experience you have with Breas, how does Breas compare to other players in the ventilation market?

A. Well, Breas is one of those companies that are developing very good high-quality noninvasive and invasive ventilators.

I have a very good experience and relationship with the Breas team since the start. And it must also be said that even 20-years-ago Breas were already quite innovative. They were reliable both in the ventilation systems and the quality of ventilation, and last, but not least … the patients were really satisfied with the Breas ventilator. When I think about the good old days, I remind myself how much a ventilator has been improved in 20 years – not only the shape, but in the monitoring system, in the algorithms. 25 years ago we were pioneers of this kind of chronic application, and also acute application of mechanical ventilation in our patients.

Q. What is your impression about Breas and the educational efforts they are doing, like for example, EducationbyBreas.com, or any other efforts?   

A. Breas is a well-known company around the world. First of all, they manufacture a very good product. Second, because they advertise themselves quite well. They are always present in the major medical meetings, especially those devoted to home mechanical ventilation. They support events, I think, all over the world, educational events, and more, I would say, advanced events. But I’m part of a group that joins together periodically and discusses not only what should we do in the future, but also how to improve, I would say, the treasure of knowledge on mechanical ventilation with particular aims, at least to home care ventilation.

So altogether, with Breas and with all my other colleagues, they are all well-known colleagues with a lot of expertise in the field, we decided to do several initiatives. One is that we put together a website based on the Breas website where we try to explain the basics of home mechanical ventilation (including) our experience, for example, in the last few months with COVID. Some of us developed a booklet on How to Read Ventilator Waveforms and How to Apply NIV. So I think in this aspect, Breas is way ahead of most of the other companies.

Q. In your experience, do the the Breas technologies and algorithms, that have been developed over the years for noninvasive ventilation, fulfill your expectations in the hospital and at home?

A. Well, I think the major feature that you want to ask from a ventilator that is going to follow the patient at home is reliability. The Breas ones in general are reliable. They match very well to the patient’s demand. They improve tolerance and therefore we use this device when the patient is left alone at home. Otherwise, you can send the patient with a vent home, but if the patient feels bad with this interaction with the ventilator, then after a while, and I saw this with so many of these patients, they leave the ventilator aside, and they don’t use it.

Remember, the compliance to the ventilator is strongly dependent on how good the ventilator matches the patient demand. In this aspect, Breas ventilators are extremely good.

Q. Thank you. Of course, you have your experience, or yourself, as an expert. But it’s also important to look at your staff, your nursing staff or therapists. What is their view and their thoughts about the Breas ventilators?

A. Let me start not with nurses and respiratory therapists, but with medical students or fellows. Medical students, when they come to the hospital for the first time, they don’t know a clue about ventilation. Nothing. They are looking at the ventilator like a monster, or something like that. Even fellows, first year fellows, they are exposed to night shift or something like that without a lot of experience, I found the ease-of-use to be extremely important in this situation. It is clear that a young student, a young fellow, needs to study. I mean, you can apply things, touching buttons, hoping that something is working. But when they know the basics of mechanical ventilation, what they are telling me is, “Oh, listen, this is quite easy to set. It is quite easy to understand how good the synchrony between the patient is and what I set on the ventilator.” This is, I think, the strongest way to demonstrate, I would say, the appeal of the Breas ventilator.

On the other side, nurses are happy because, if you set the alarms well, and as leak compensation is very good, they are not bothered too much, especially during the night hours because of leaks, unless the patient is agitated obviously. It’s relatively easy to perform disinfection and to clean them when you change a ventilator from one patient to the other.

Concerning the respiratory therapists, when they receive an order to set the vent, they claim it is really easy to set, very understandable. I find that the ease-of-use also means they are easy to start ventilation and set the parameters that one wants to apply.

And I can tell that some of the other home care ventilators are very, very complicated, even to switch on. It is not easy to do that. And last, but not least, the screen is small. It’s small as all the other home care ventilators, if they have a screen. Not all home care ventilators have a screen. The Breas traces are very clear and colored, so the screen resembles that of the ICU ventilators on a smaller scale.

Q. If somebody would ask you, Professor Nava, we are considering to start using Breas Vivo ventilators in our practice, what would you tell them?

A. I would say “Go ahead, because the ventilators they sell are reliable,” as I said before. I mean, reliability is the best thing. It never breaks. They are easy to use. We never receive major complaints from the patient. I think that having said all of this, I would say, “Really go for it.” I worked with several ventilators, and I found that Breas, by far, the company is able to quickly respond to your questions. What does quickly respond mean? How fast you respond to a need of a clinician. That depends also on a home care provider obviously. But, for example, when you have some technical questions for example, how a specific algorithm is working, or you do not understand very well the mode of ventilation, or how the alarm or the numbers means, they very quickly respond.

Q. Thank you. Thank you for the time. Thank you for this interview. I don’t know if there is anything else.

A. If I can make a little story of a patient (a) COPD patient with emphysema, a young guy. At that point in time, he was 54, a former heavy smoker. He was facing once an acute exacerbation of COPD. So, he came to our unit. We had a Vivo ventilator available, so we wanted to ventilate him with NIV and the guy was really fighting. He said, “No. I don’t want that. I don’t want to be ventilated.” So, we convinced him. We sedated him, applied NIV and after a while he got better and we weaned him from the ventilator.

So, six months later he came back. He needed once more NIV. So, at this point in time, he was more compliant, and the time of recovery was short. So we suggested since he was severely hypercapnic with a PaCO2 of 75mmHg, we said, “Why don’t we think together to go home with this ventilator?” It was a Vivo ventilator. He said, “No way. No way. Absolutely no way. It’s too demanding. Disrupt my family. I don’t want my friends to see me if they come and visit me with a ventilator close to my bed. I don’t want to disturb my wife. So, I don’t want it.”

Once more, three months later, he was admitted to another hospital. His wife called me. She was desperate. She said, “They want to intubate my husband. He doesn’t want that. He wants to come to your unit because he thinks that you can manage with NIV. He doesn’t want to be intubated.” So, he refused. He wrote, “I don’t want to be intubated.” So, they discharged him, and they transferred him to our hospital. Well, once more, he underwent NIV, still with a Breas ventilator. At the end of the day, he asked, “Doc, could you please provide to me this vent that it can follow me at home?”

So, to make a long story short, he was so satisfied. Since, in the following three years, he was admitted only one time. Why was he admitted one time in three years, but he was admitted two times a year before? One of his daughters was an announcer at the local television. He invited me and other colleagues in the television program, explaining what NIV was and how good was life under NIV, and so forth. So, it was a big opportunity. The guy died a couple of years ago, but we strongly believe that we gave him five years of good quality of life, and this is what mattered.

We cannot treat emphysema. We cannot, I would say, definitely get rid of the disease. In this patient, we needed to improve the quality of life. Having two times a year an ICU admission deteriorates the quality of life a lot.

So this is just to say the journey of the patient, but he was, at one point in time, not convinced to be ventilated at home, and then with time he was very satisfied to go on television and tell the people how good it was. And he was asking, I remember, I want this ventilator. 

Well, I have many patients, that they ask me, “Doc, please, I can’t stand at home this vent. Please prescribe me a Vivo, like the one that was used when I was in the hospital.” This is just to say that not all the ventilators are the same.

Q: Well, that’s an impressive patient story. And you are absolutely right. It’s about the quality of life. It’s not about life only.

A: Yeah. You know people are only concerned about improving the duration of life. That is good. But if you improve quality of life and you keep being admitted to the ICU, I don’t know if it is a good quality of life or not. So, this patient was really impressive because he kept going for seven or eight years without major problems.

Yes, that’s amazing. As you say, there are parts that can’t be cured. Mechanical ventilation is not a cure. But it should help to buy time or to improve quality of life in these things, of course.

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