An interview with Christopher Varga, Ph.D., Senior Engineering Fellow at Vyaire Medical

We first met Dr Christopher Varga at the 2018 Simcenter Conference in Prague. Christopher is a Senior Engineering Fellow and Senior Director of Research and Development at Vyaire Medical.

In Prague Chris gave an impressive presentation that showed how Vyaire is using simulation to design better ventilation equipment that supports breathing through every stage of life, and across all patient morphologies. In 2020 we realised just how critical that work was, as Vyaire ventilation and respiration equipment was deployed across the world to help seriously ill patients win their fight against COVID-19. We caught up with Christopher again earlier this year to talk about the continued evolution of the healthcare industry and how it has impacted how products are brought to market.

Tell us a little bit about your career path and what you do currently

Sure. I had an interesting path to where I am today. I did my PhD in Mechanical and Aerospace Engineering at the University of California, San Diego, doing mostly experimental work on how to make tiny, tiny droplets for combustion applications, for things like rockets and missile propulsion. At the same time, I was falling in love with a lot of the medical projects that my advisor, the late Juan Lasheras was working on that were adjacent to my PhD work. I tried as much as I could to get involved in the medical stuff that he was doing with this thought in my head that maybe when I was done with my PhD, I could find an application for what I was doing in medicine. Luckily there was a small company called Inhale Therapeutics at the time, they were developing the world's first inhaled insulin and they needed somebody who knew how to make small droplets. You need to make tiny, tiny drug solution or suspension droplets if you're going to spray dry them into powders that are going to get into the deep lung. So, I went to work there and that was my entrance into healthcare. I spent several years there with a small team of other scientists making equipment to make these specialized pharmaceutical powders. I've been in the healthcare industry ever since applying all of the engineering knowledge I have that was originally focused on aerospace applications, but applying it to healthcare applications.

I then moved to the company I'm at now, which has gone through many different names and ownership changes, but today we are called Vyaire Medical and I've been at the company for almost 14 years now. We're a pure play respiratory company. So everything that you can think of that relates to taking care of people's breathing, most of the products you would encounter, we make something in the space.

Image provided by Christopher Varga

I’ve spent the last 14 years working across all of our different franchises and businesses developing both big equipment, like lung function testing equipment, mechanical ventilators and things of that sort as well as all the smaller consumable devices like oxygen masks, nebulizers, ventilation circuits, humidifiers and things like that which support patient breathing. Most recently I have been working on software products that help our clinician customers to simplify their workflows and take better care of their patients in the ICUs in particular. Today, I lead our innovation efforts in digital health at Vyaire and while for the last few years these efforts have primarily been focused in the mechanical ventilation space, the business is growing and becoming more broadly encompassing of all of our franchises.

In the time that you've been in the healthcare industry, what are the biggest changes you have seen?

Well, number one, regulatory scrutiny has grown. And because of this, products require more testing and it’s taking longer to bring innovations to market. There are certainly ongoing efforts being made to streamline regulations to support rapid innovation but nevertheless the time from product inception to market launch has grown.

And then the other big change I've seen of course is the advancement in technology in terms of how we can design and build things. Being able to simulate products before you ever build a prototype just puts so much power into the hands of the engineer today. Power that we didn't have when you had to build something, test it and build it again and test it and you couldn't even build it fast. So rapid prototyping, simulation and those technical advances have just changed the way we make products in a fascinating and awesome way.

14 years ago, when you first started, did people take you seriously instantly or did you have to do some kind of evangelizing to make sure people understand that simulation was a relevant part of the product design and approval process?

There was definitely an effort that was required. 14 years ago, at least in certain spaces in healthcare, there was not a lot of simulation happening. I think we had maybe one engineer that was dabbling a little in simulation at the time I joined the company. We were doing mostly build, test, go back to the drawing board, et cetera. When I first started to bring simulations into presentations, I remember there were a lot of folks, particularly in the non-engineering functions, that thought that this, the images or the simulations, were more like movies or just marketing propaganda.

I had to explain to them that, "No, we're solving the fundamental governing equations here and this is real stuff that you're seeing!" That took some time. But I think what happened is people started to recognize how powerful those tools were and how we could much more rapidly iterate through concepts. And when you can validate results against experimental tests, people were like, “We’ve got to train more people on this.” Or “We've got to keep this subscription going.” So yeah, it took a little time and then it just grew and grew and now it's part of everything we do really.

What are you working on right now?

So right now I am working on the development of mobile apps for clinicians, in particular, doctors, nurses, and respiratory therapists that are in the hospital taking care of ventilated patients in the ICU. Mobile apps that support their workflows, protocols and clinical decisions. When a patient is put on a ventilator, the first thing you focus on is stabilizing them and then getting them off the ventilator because it's not a good place to be. It's not a natural way to breathe. So weaning is crucial, but weaning is also complex because it involves a kind of a dance between respiratory support and sedation medication. Sedation makes ventilation more comfortable for the patient but can also make it more challenging to get them breathing on their own again.

So, one set of tools we provide in our mobile applications helps with this dance and aids the clinician in coordinating spontaneous breathing and awakening trials. Broadly speaking we are providing clinical decision support tools that the clinician can access on their mobile device, along with critical patient information. This helps them know who to see, when and why.

I assume that is data driven. You have to collect large amounts of data to be able to make those choices automatically.

So today we utilize fairly simplistic rules and thresholds. If this, then that type logic. More sophisticated algorithms are certainly coming in the future, but yeah, of course we have to look at all the data flowing from the ventilator as well as the data coming from the infusion pumps and the boluses of drugs that they're getting. And our system is continuously analyzing these data streams, and then providing those insights.

Do you think there is a shift in the industry towards personalized healthcare? We know Vyaire Medical led the way in creating masks to fit different head morphologies, do you see this as the future of healthcare?

So I think there's a few things. Personalized ventilation is one of our focus areas. By this I mean a shift from using, let's say broad guidelines to set conditions for a patient on the ventilator to enabling ventilation tailored to that patient, according to their lung condition, their lung morphology, and to really do more adaptive ventilation for their individual condition. And that can involve a few different things. One is of course having algorithms on the ventilator that can detect and adapt. So one of our flagship ventilators, our bellavista™ has an adaptive ventilation mode that recalculates each breath, to determine the ideal condition for the next breath.

And then outside of that, today we have the power and the tools for example to image the lung, segment it and run simulations. If you had the ability to do that, of course in real time, or closer to real time, then you could provide really personalized ventilation because now you're not just measuring external parameters of the patient’s breathing, you're getting inside the patient and seeing what's happening. With simulation and modeling we have the potential to provide respiratory care that is much more personalized which is incredibly exciting.

Everyone is tired of talking about COVID and the pandemic, but I can remember talking to you during the midst of the pandemic and it was all hands to deck. Vyaire Medical did a fantastic job innovating in real time to deal with the production issues around deploying ventilators. Have you learned any lessons from all that and do you think you're more prepared for the next pandemic, whatever that might be?

I think that the short answer is yes, absolutely. We learned so much, I think in that timeframe about production, testing, supply chain, how to really dig into things when we had to. I think we're just now much more lean, we're much smarter about how we source, et cetera. Yeah. We're prepared for something like this to happen again.

Which I think is one of the benefits of kind of getting through the whole experience, isn't it? The whole world just about surviving and everybody's more aware of the risks and prepared to invest more in the solutions as well. One last question… Do you have any pearls of wisdom you want to impart? Anything you want to put out into the world?

[Laughs] I mean, maybe just that I think laughter is the fuel for a lot of different things. I think that we can never be too serious about ourselves or things we're doing, even if they're super important like building healthcare products. I just think laughing is a big part of my life and being silly. And I think it powers a lot of successful things. Just being able to laugh.

Image provided by Vyaire Medical