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Editorial
Health Care Policy and Law
November 14, 2022

The Philips Respironics Recall of Ventilators and Positive Airway Pressure Machines—Breakdowns in Medical Device Surveillance

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
  • 3Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
  • 4Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
  • 5Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
JAMA Intern Med. 2023;183(1):5-8. doi:10.1001/jamainternmed.2022.5141

In June 2021, Philips Respironics (Philips) initiated one of the largest medical device recalls in history, affecting more than 10 million devices in the United States and 15 million devices worldwide.1 Philips recalled 14 models of ventilators and positive airway pressure machines (both bilevel positive airway pressure [BPAP] and continuous positive airway pressure [CPAP] machines) using polyester-based polyurethane (PE-PUR) sound abatement foam owing to concerns that foam degradation could harm patients through inhalation of toxic particles and emissions. The US Food and Drug Administration (FDA) categorized this recall as Class I (the most severe designation), indicating reasonable probability that device use could cause serious adverse health consequences or death.

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Surveillance and ISO specifications for apnea therapy devices
Michael Twery, Ph.D. | Individual
Guidance from the International Organization for Standardization (ISO) figures prominently in developing medical devices and FDA surveillance of safety. Prior to 2020, the applicable standard for sleep apnea breathing therapy equipment required "biocompatible" (medical grade) plastic only in the “gas pathways through which gas flows at respiratory pressures between the intake and the patient-connection port” (ISO 18562-1:2017). Sound abatement foam placed in the gas pathway BEFORE the pump is at the same or lower pressure as room air.

Standards were updated in ISO 80601-2-70:2020(en) after the potential risks of degrading plastic were widely reported, and
subsequently adopted by FDA in 2021 (https://www.federalregister.gov/d/2021-26635/p-22). In this ISO update "...air coming from the “gas pathways” shall be evaluated for biocompatibility" (https://www.iso.org/obp/ui/#iso:std:iso:80601:-2-70:ed-2:v1:en).

ISO and ANSI standards represent the collective expertise of bioengineers and developers world-wide. In the case of apnea therapy devices, realizing improved FDA surveillance would extend to surveillance and studying manufacturing "standards" for medical devices. Enhancing FDA resources and depth of device expertise to this degree would be an ambitious undertaking.
CONFLICT OF INTEREST: None Reported
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