The Servo Story

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© ® ™ Maquet Getinge Group - Maquet Critical Care AB

"Getinge buys Siemens

  Life Support Systems"

"Getinge buys

Siemens Life Support Systems

for EUR 150 Million

August 18, 2003
 

Sweden's Getinge AB Friday said it has agreed to buy

Siemens Life Support Systems, a division of Siemens

Medical Solutions, for about EUR 150 million.

In addition, Getinge said it will assume net assets

worth about EUR 50 million.

It said the cost of integrating Siemens LSS is

expected to be at most EUR 25 million, resulting in a

goodwill value of around EUR 175 million.

Assuming that the necessary approval from the

relevant competition authorities is obtained

according to plan, then Siemens LSS will be

consolidated into Getinge's accounts from October

this year.

The financing of the acquisition will be carried out

using Getinge's existing credit facilities.

Getinge said Siemens LSS is expected to contribute

to profits before tax of EUR 10 million-EUR 12 million

in 2004 and EUR 17 million-EUR 20 million in 2005.

The long-term goal is for Siemens LSS' operating

margin after goodwill to be 15%, and a business that

is expected to generate sales this year of EUR 205

million.

Siemens LSS is a division of Siemens Medical

Solutions, one of the largest suppliers to the

healthcare industry in the world.

Siemens LSS develops, manufactures and markets

ventilators and anesthesia equipment for the hospital

market.

Siemens LSS is expected to generate a sales

turnover of around EUR 205 million during the

current financial year, which ends on 30 September.

Siemens LSS employs around 720 people worldwide,

of which around 400 work at the headquarters in

Solna, Sweden, where the division's center for

product development, manufacturing and marketing

is also located.

Siemens LSS sells medical technology equipment to

around 100 countries annually, having its own sales

companies on all significant markets.

Siemens LSS, along with the German company

Dräger Medical, is the global market leader for

ventilation machines for the hospital market, with a

market share of almost 30%.

In the anesthesiology product area LSS' market share

is around 6% globally and puts the company in third

place after Instrumentarium of Finland and Dräger of

Germany.

Over the past few years Siemens LSS has shown

sound volume growth driven by successful product

launches of ventilation machines.

The operating margin for current activities is around

11%."

Source: PCBnewsline

Forty years of innovation

in ventilation

The polio outbreak in the 1950s and

the beginning of modern Ventilation Therapy

In the early Fifties, the last great polio outbreak spread from North

America to Europe.

Scandinavia was particularly affected by the epidemic, with more

than 2.900 patients succumbing to the disease in Copenhagen

alone from July to December, 1952.

At that time, mechanical ventilation was not yet available to treat

the victims, who quickly succumbed to the disease as a result of

respiratory paralysis.

Production of copious amounts of thick phlegm and saliva led to

patients becoming cyanotic because of oxygenation failure.

Iron lungs were considered the most advanced technology of the

period, but still proved ineffective against polio

The final stages of the disease were characterized by high

temperature, high blood pressure and a high level of CO₂ in the

plasma.

Many patients were treated in cylindrical iron lungs, which

encased the patient from neck to foot.

The iron lungs worked by applying and releasing negative

pressure so that the patient's chest wall expanded during

inspiration and passively contracted during expiration.

But even the iron lungs, the most advanced technology available

at that time, could not save patients, and the high mortality rates

continued.

Nurses worked day and night providing manual

ventilation - a tactic that saved many lives

At one of the major hospitals in Copenhagen, chief physician

Henry Cai Alexander Lassen approached anesthesiologist Björn

Ibsen to discuss possible solutions.

Based on his experience in anesthesiology, Ibsen suggested

controlling the ventilation manually.

By placing a tracheal cannula, they would be able to remove

secretions in the patient's airway.

A balloon was then connected to the cannula and the patient

ventilated by means of manual inflation of the lungs.

As manual ventilation began to save patients in the polio wards,

staff delivered bedside hand ventilation in two-hour shifts, round

the clock.

Extra oxygen was given to patients from gas cylinders connected

to the bags.

The doctor could control the tidal volume and the rate by

squeezing the balloon, and monitor patient comfort by simply

asking them how they felt.

Ventilation after the epidemic

The first mechanical respirators

The experience with hand ventilation for polio victims soon led to

the development of mechanical ventilators.

But the first generation of ventilators had several drawbacks,

including being noisy and bulky.

A piston pump connected to bellows was commonly used to

deliver the tidal volume, with a gearbox providing variation in the

respiratory rate.

Because of their large internal compressible volume, they were

not "precision" ventilators and could never be used on children.

Monitoring was only available through spot-checks, and changes

in patient compliance and resistance could induce large changes

in tidal volume delivery.

Sophisticated ventilation nomograms were produced, based on

body weight and length, to guide the setting of the ventilator.

These nomograms usually had a "safety" margin built in, which

frequently led to severe hyperinflation and hyperventilation of the

patient.

The Servo

Lund University Hospital in the South of Sweden had a long

history of inventing ventilators, including the Barospirator (an

iron lung variant) from the 1920s, Cuirass ventilators from the

1940s, and the Lundia ventilator from the 1950s.

In 1967, Clinical Physiologist Björn Jonson was busy testing what

he thought was the ultimate new ventilator design.

His initial sparring partner was Professor of Otolaryngology

(diseases of the ear, nose and throat), Sven Ingelstedt, who was

convinced that ventilators should be flow controlled - but

considered it virtually impossible to achieve.

In contrast to the design of commercially available ventilators, the

new model was based on a very low compressible volume and

had few moving parts.

It also featured a separate gas delivery and monitoring system

with a feedback loop to accurately regulate the flow delivered to

the patient.

In other words, it could be flow controlled.

Jonson knew he needed a partner with strong knowledge of

modern electronics to commercialize his idea.

Sven-Gunnar Olsson, an ECG salesman at Elema-Schönander with

an engineering background, joined him.

Together, they started the project to build and commercialize the

first electronically controlled ventilator.

Anaesthesiologist Lars Nordström also came aboard as clinical

teacher, assuring adaptation to daily clinical use as well as initial

testing.

Sven Ingelstedt, Björn Jonson and Lars Nordström

celebrating a prototype milestone in 1970

The Servo revolution

The project was given a lot of freedom, and experimentation

continued in an environment that fostered cross-institutional

teamwork.

They also had financial support from a company that recognized

the potential to add another technological landmark to their

portfolio, which already included the ECG printer and the

pacemaker.

The earliest commercial version

of the Servo Ventilator - "Servo 900"

The Servo 900 was introduced at the Scandinavian Society of

Anesthesiologists in June, 1971 - and immediately revolutionized

intensive care ventilation.

Small, silent and featuring the famous Servo Feedback System to

control gas delivery, the Servo 900 meant clinicians could now

reliably achieve targeted volumes and respiratory rates for

individual patients.

For the very first time, the ventilator cycle could be controlled with

no effect on gas delivery due to changes in resistance or

compliance.

Boldly going where

no other ventilator could go before

The Servo 900 really did change everything.

Maybe a little too well, especially in the beginning.

In one memorable case, the nurse at St. Eriks Hospital in

Stockholm responsible for initial testing found the Servo 900

pushed into a corner on arrival each morning.

Apparently, the lack of noise caused staff to panic - they simply

did not believe the machine was working!

The low noise also prompted a request from hospitals in

Germany.

They insisted the Servo 900 have a small glass "window" over the

pneumatic section, so they could visually confirm the ventilator

was working correctly.

Nevertheless, the benefits obviously outweighed any initial

concerns.

For instance, the Servo 900 was the first ventilator to display

Airway Pressures, Minute Ventilation and Respiratory Rate

adequately.

Sven Gunnar Olsson was awarded Honorary Doctor of Medicine at the

University of Lund in 1986 for his pioneering efforts in technological

development and contributions to science

The system's extensive monitoring and alarms were real

breakthroughs in mechanical ventilation.

Combined with the Servo Feedback System controlling what had

been set and regulating delivery, clinicians now had

unprecedented treatment opportunities.

The Servo Ventilator set the standard for all modern ventilators -

in fact, its unique principles are still the backbone of the Servo-i^®

series ventilators in use today.

Respiratory research also got a boost from the Servo 900.

By connecting the ventilator to an analog printer, it was now

possible to get printouts of pressure and flow curves in real time.

This was a milestone in bedside respiratory research, and the

Servo 900 became the preferred ventilator for the applied

respiratory sciences.

Servo offered clinicians more ventilation and monitoring capabilities,

enabling its use  with a wider range of patients - including children

Naturally, the sophisticated breathing parameter settings,

monitoring and alarm systems of the Servo ventilator were

unfamiliar to most clinicians.

Sven-Gunnar Olsson initiated an extensive programme of training

and user documentation, developed in close collaboration with

researchers and hospital personnel, to bring everyone up to

speed.

The user documentation and training programs of the Servo 900

and the Servo 300/PCM Patient Care Manager were awarded prizes

for best practice in the industry, and their high standards are still

reflected in the documentation and training development of

today's Servo Ventilators.

Some of the national and international awards assigned to Servo

Ventilator's User Documentation and Training Programs

Luciano Russo, a formal teacher of Visual Communications and Non-

Verbal Languages, the unconventional manager whose visionary

creativity and innovative methods were warmly adopted and fully

supported by Division Manager Sven-Gunnar Olsson to be

successfully applied to the under many aspects "revolutionary",

highly knowledge and know-how based industrial and medical project

He created, inspired and managed the professional team of highly

skilled clinical, technical and marketing communicators which, in

close collaboration with physicians, paramedical and technical staff at

state-of-the-art hospitals and departments around the world, actively

supported R&D and Quality Assurance in generating their traditionally

functionality-focused Technical Requirements Specification - TRS

rather starting the process from an innovative user and usability-

centered "User Requirement Specification" - URS, resulting in the

design of more user "friendly" man-machine interfaces - that is user

"accessible, compatible, adaptable and supporting" at such an extent

to become safe, reliable, effective, not only "easy-to-use" but

"difficult-to-misuse"

Such a "cultural" process was interdisciplinary sustained by an

unprecedented in-house and on-the-field training effort all along a

crucial 15-years period of time - from late 70s until the 90s - supported

by condensed picture-based training material, starting from at the

time poorly known "basic" Physiology of Respiration, and specific

"user" documentation for sales people, maintenance technicians, ICU

and OR doctors and nurses (intensive care and anesthesia) published

in 8 different languages - English, German, French, Spanish, Italian

and Swedish as a standard, with special editions in Russian and

Japanese - greatly contributing to the worldwide success of the

"Limitless Servo Ventilator System", reaching up to a 35-40 percent

share of the global intensive care market

Appointed as coaching in-house coaching consultant, Luciano Russo

was soon offered to join the Ventilator Division, later Life Support

Systems, at Siemens-Elema, Solna, Stockholm, at first as Information

Manager (SV 900B), then Manager Marketing Communications and

Manager Marketing Research (SV 900C and 900D), eventually

Manager Pre-Marketing - Special Projects EV-X (SV 300 and Servo

PCM - Patient Care Manager) in deep synergy with R&D and Manager

User Support (SV 300)