The Servo Story











































Testi e immagini originali, marchi commerciali della pagina

© ® ™ 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



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



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



Over the past few years Siemens LSS has

shown sound volume growth driven by

successful product launches of ventilation



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,




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

































































At one of the major hospitals in Copenhagen, chief

physician Henry Cai Alexander Lassen approached

anesthesiologist Björn Ibsen to discuss possible



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




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



Sven-Gunnar Olsson, an ECG salesman at Elema-

Schönander with an engineering background, joined




Together, they started the project to build and

commercialize the first electronically controlled



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



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



Respiratory research also got a boost from the Servo




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




























































































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






























































































































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)