How to choose an ICU ventilator: standards, modes, running costs
16 June 2026
An ICU ventilator keeps breathing for a patient who cannot, so nobody should pick one by counting modes in a brochure. The real questions are different. Who will you ventilate: adults, children, preterm babies? Will the unit move patients? What gas supply does the ward have, how will you humidify, and who will service the machine five years from now? This guide covers how to choose a ventilator for intensive care: which standard applies to a critical care ventilator, what lung-protective ventilation asks of the hardware, the running cost of circuits and humidifiers, and what to check in the paperwork before you sign.
How a ventilator works, in two paragraphs
Mechanical ventilation in the ICU today uses positive pressure: the ventilator pushes a gas mixture into the airway. In volume-controlled modes the clinician sets the tidal volume, and airway pressure varies with resistance and compliance. Pressure-controlled modes work the other way round. You set the inspiratory pressure and time, and the delivered volume varies. PEEP, the pressure held at the end of expiration, can be added in any mode. Rate, FiO2, I:E ratio and trigger sensitivity are set separately.
The main modes rest on those two principles: assist-control by volume or pressure, pressure support (PSV), often used during weaning, and SIMV. The MSD Manual states plainly that, according to studies, SIMV doesn't make weaning easier and doesn't improve comfort, so it's no reason to pay more. For procurement the takeaway is simple. The ventilator must deliver small volumes accurately and display pressure and flow waveforms. It also needs an inspiratory hold so the clinician can measure plateau pressure.
Which standard applies to an ICU ventilator
International safety requirements for ventilators are split by where the device works. ISO 80601-2-12:2023 covers critical care ventilators: used in a professional healthcare facility, operated by a healthcare professional, for patients who may be fully ventilator-dependent. It allows such a ventilator to keep working during transport inside the hospital. Emergency medical services and transfers between facilities have their own standard, ISO 80601-2-84:2023, and anaesthesia ventilators fall under ISO 80601-2-13. ISO/TR 21954:2018 is a technical report on matching the means of ventilation to the intended patient and use environment, and to the operator.
In practice, ask the supplier for the declaration or test reports and check which standard the model was tested against. A ventilator for an ICU bed should comply with ISO 80601-2-12. A portable ventilator for ambulance crews and inter-hospital transfers is usually tested to ISO 80601-2-84.
Lung-protective ventilation and what it demands of the machine
In 2000 the ARDS Network published a trial of 861 patients with acute lung injury and ARDS. A tidal volume of 6 ml per kilogram of predicted body weight with plateau pressure kept at 30 cm H2O or less was compared with the traditional 12 ml/kg. Mortality was 31.0% against 39.8%, and the trial was stopped early. The joint ATS/ESICM/SCCM guideline of 2017 set 4 to 8 ml/kg of predicted body weight and lower inspiratory pressures for all ARDS patients, and strongly recommends prone positioning for more than 12 hours a day in severe ARDS.
For the engineer and the buyer, that turns into concrete requirements:
- accurate delivery and measurement of small tidal volumes, including in short adult patients;
- an inspiratory hold manoeuvre with plateau pressure on screen;
- a wide PEEP range and fine FiO2 adjustment;
- predicted body weight calculated from height and sex in the settings, so nurses don't do the arithmetic by hand;
- circuits long enough, and secure fixings, for patients turned prone.
Neonatology works differently. The 2022 European Consensus Guidelines on respiratory distress syndrome advise starting non-invasive support from birth and avoiding intubation where possible. So a neonatal unit needs CPAP equipment as well as invasive neonatal ventilators. In the Finer catalogue that means the Giulia neonatal ventilator, the SIRIO BABY 200 transport ventilator for moving infants in an incubator, the pneumatic Baby Start for delivery rooms and the Bubble CPAP FOG 2140 humidifiers.
Humidification and circuits over the device's life
The American Association for Respiratory Care (AARC) 2012 guideline recommends humidification for every patient on invasive ventilation. An active humidifier should deliver 33 to 44 mg H2O/L at 34 to 41 °C at the circuit Y-piece, and a passive heat and moisture exchanger (HME) at least 30 mg H2O/L. There's an important catch. With low tidal volumes, which is exactly what lung-protective ventilation uses, HMEs are not recommended because they add dead space and raise PaCO2. Passive humidification is not recommended for non-invasive ventilation either.
For the budget, that means heated humidifiers with their chambers, plus heated-wire circuits, for the beds where ARDS patients will lie. HME filters are for transport and short periods of ventilation. Ask for a separate line in the quote with the cost of one patient's consumables set. That's the circuit with its chamber and filters, plus the flow sensor if it's disposable. Multiply it by the expected number of patients a year and you'll see the real cost of ownership.
Gas supply, battery, alarms: what the engineer checks
A turbine ventilator compresses room air itself, so it doesn't need a medical air pipeline, and oxygen comes from the central supply or a cylinder. The turbine models in our catalogue, such as T80 and CWH-3010A, work this way. A pneumatic ventilator needs both pipelines at working pressure. Before buying, the engineer should compare the ventilator's oxygen pressure and flow requirements with what the ward's system actually delivers, especially when every bed is ventilated at once.
The battery in an ICU ventilator covers the switch to a generator and transfers inside the hospital. Our product cards list battery operation of up to 6, 10 or 14 hours depending on the model, and 6.5 hours for the portable SIRIO S2/T, which weighs 3.7 kg. For transport ventilators, the UK Intensive Care Society (ICS) 2019 guidance sets a minimum: disconnection and high-pressure alarms, PEEP, adjustable FiO2, I:E ratio, respiratory rate, tidal volume. Pressure-controlled ventilation, pressure support plus CPAP are listed as desirable.
Alarms are tested against IEC 60601-1-8, the general standard for alarm systems in medical electrical equipment. At the demo, ask to see what a high-priority alarm looks and sounds like, how fast the ventilator reacts to a circuit disconnection, and whether alarm settings survive a power-off.
ICU, transport, neonates: one ventilator or several
A universal model for infants through adults, like the FALCO 202 EVO, makes training simpler and keeps the consumables store small. A large ICU ventilator such as the Servo-i is built for adults and children in intensive care, neonates included. Transport needs a separate lightweight unit: the SIRIO S2/T portable ventilator, the FALCO 202 EVO TRANSPORT in a shock-resistant case, or the PG VENT for emergency care.
ICS advises standardising equipment across a network, so patients aren't taken off monitoring or infusions because leads and transducers don't fit. Capnography is mandatory when an intubated patient is transferred. If the transport ventilator doesn't measure EtCO2 itself, add a separate RICAP capnograph or a transport monitor with a capnography module from our patient monitors.
ICUs also need non-invasive ventilation often. The 2017 ERS/ATS guideline covers it for COPD exacerbations and cardiogenic pulmonary oedema, in the post-operative period, during weaning, after extubation. Check whether the ICU model has a mask NIV mode or whether you'll need a separate device.
What to prepare before talking to a supplier
To get a quote that fits the job rather than the price list, have this ready before you call:
- The number of beds that need invasive ventilation, and separately the places for non-invasive ventilation.
- Patient age groups and the smallest neonatal weight you treat.
- The modes your doctors use every day, plus two or three they'd like.
- Gas supply: whether there's a medical air pipeline, oxygen pressure, outlets per bed.
- Transport needs inside the hospital and between facilities.
- How you'll humidify, and roughly how many circuits, filters or chambers you use a year.
- The ventilators, monitors or capnographs you already have, so that cables and sensors match and training stays the same.
If you're equipping an ICU or a new department from scratch, see our turnkey solutions. In those projects ventilators usually sit next to anaesthesia machines for the operating theatre, along with monitors and defibrillators. Finer's doctors and engineers will help draft the tender specification. We deliver and commission the equipment and train your staff. Call 0 800 334 585 or use the form on the contacts page.
