#348 - 🚀 CPAP with Purpose: Supporting Babies in the Delivery Room and the NICU (Part 3)

Hello Friends 👋

In this Tech Tuesday episode, Ben speaks with Laurence Gulliver, General Manager for Humidification at Fisher & Paykel Healthcare. With nearly two decades at the company and a background in mechanical engineering and product development, Laurence has helped guide innovations that have shaped respiratory support for neonatal, pediatric, and adult patients worldwide.

The conversation explores the role of humidification in neonatal respiratory care and why it is often overlooked despite its impact on mucociliary function, secretion management, bronchoconstriction, and thermoregulation. Laurence explains the engineering challenges of delivering consistent humidity through ventilator circuits, the burden of condensation management, and how newer platforms like the F&P 950 are designed to improve performance and usability.

They also discuss Fisher & Paykel’s approach to product development, which relies heavily on feedback from caregivers to ensure technology addresses real-world challenges. The episode closes with a broader look at CPAP therapy, opportunities for further innovation in a seemingly simple modality, and the global vision that drives Fisher & Paykel to design solutions adaptable to diverse healthcare settings.

This conversation highlights how thoughtful engineering and collaboration with caregivers translate into meaningful improvements in neonatal outcomes.

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This episode is part of a special three-part series on the use of CPAP, supported by Fisher & Paykel Healthcare. Their sponsorship makes possible the logistical production of this podcast series but does not involve curation, moderation, or influence over the content of the discussions.

Fisher & Paykel Healthcare offer a full neonatal care continuum which helps provide the best start possible to our precious babies worldwide.

Watch the design matters video series and discover what drives the innovation behind their neonatal interfaces https://www.fphcare.com/hospital/infant-respiratory/support/design-matters/

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Short Bio: Laurence Gulliver is the General Manager overseeing the humidification portfolio at Fisher & Paykel Healthcare. With nearly 20 years at F&P, he brings a blend of technical expertise and strategic leadership to products serving adult, pediatric, and neonatal patients. Holding a Mechanical Engineering degree and an MBA, Laurence began in product development and gained international experience in the UK before returning to lead key engineering and management roles. He has played a pivotal role in the development of products like Optiflow Junior and the F&P humidifier platforms, driving global clinical impact.

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The transcript of today's episode can be found below 👇

Ben CourchiA (00:00.915)

Hello, everybody. Welcome back to the Incubator podcast. We are back today for an episode of Tech Tuesday, and I am joined in the studio today by Lawrence Gulliver. Lawrence, welcome to the podcast.

Laurence Gulliver (00:14.254)

Thanks very much for having me,

Ben CourchiA (00:16.337)

No, thank you. For the people who are not familiar with your work, you're the general manager overseeing the humidification portfolio at Fisher and Pichal Healthcare. With nearly 20 years at Fisher and Pichal, you bring a blend of technical expertise, strategic leadership to product serving at the same time adults, but also pediatric and neonatal patients. You have a degree in mechanical engineering and an MBA. You began in product development. You've had international experience, both in the UK

before returning to Fisher and PyCal. You've played a pivotal role in the development of products that we use in the NICU, such as the OptiFlow Jr. and the Fisher and PyCal Humidifier platforms, which have had a global clinical impact. Lawrence, it's a pleasure to have you on the podcast today.

Laurence Gulliver (01:04.866)

Thanks very much, Ben, and thanks for the very kind intro. And of course, I hasten to add how much my role is only a very small part of everything that we create as part of a team here.

Ben CourchiA (01:17.869)

in the bio, we blow that up tremendously. If it was on our bios alone, we are the single agents of revolutions around the world. So no, I understand that. I think that in your background, though, there's a piece of it that I think is quite interesting and it's your focus really on the development of humidifier platforms. I know that...

Laurence Gulliver (01:20.502)

Yeah. Thank you.

Laurence Gulliver (01:27.918)

Yeah.

Ben CourchiA (01:43.421)

For many of us, especially those with interest in respiratory disease, this is an aspect of the delivery of respiratory support that is critical. And I think that sometimes can be a little bit overlooked. And what I mean by that is that I see often, especially with my younger colleagues, that we will rush to a vent or to a non-invasive sort of interface to see if we can troubleshoot. And somehow the humidifier is often checked last, even though it's such a critical piece, especially in babies that have tracheostomies and stuff like that.

Can you tell us a little bit from a mechanical engineering standpoint, the importance of delivering appropriately humidified air and what is the challenge of doing so with babies that are connected through tubing to their respiratory support?

Laurence Gulliver (02:31.532)

Yeah, OK, I'll shall try. And I think if I break that down, you know, into the importance of humidity and the challenges, I think you'll know that Fisher and Pako Healthcare, you know, we've been delivering humidity for 55 years. It's where we started and we always want to be the market leaders in that space. And certainly when the air nates, there are some clear benefits. And I'm also glad that you said through an engineering lens, because that's the lens I bring rather than clinical.

I suppose that the benefits, there's a few interesting ones, maybe the last I speak about is the most interesting. So of course, cilia function, I think your listeners will be familiar with the mucosillary transport and how that's impacted positively and negatively by having the right amount of humidity or not, respectively, and subsequent secretion thickening that can occur of that mucous and the...

and the negative impact that can have on patient outcomes, prevention of that through humidity. There's other things like bronchoconstriction, but I think perhaps the one I find the most interesting for neonates that's potentially unique to neonates is thermoregulation. And this is where put my engineering hat on. The enthalpy of evaporation required to turn liquid water into gaseous or vapor water, that energy comes from somewhere.

Ben CourchiA (03:45.043)

Mmm.

Laurence Gulliver (03:55.853)

And that comes from the patient often if the humidity is inadequate. And I think we know all the links we go to for those neonates to keep them warm. They've come from this warm environment. We put them in an incubator. do everything we can to keep them warm. I think humidity is part of that thermoregulation, just preventing heat loss through evaporative heat loss.

Ben CourchiA (04:20.081)

Yeah, and I think that's such a critical aspect of the care that we provide. And then I feel like we are always struggling with the idea of we would like to deliver warm air to our patients, but yet the device is then transmitting this warm air through a piece of tubing. And then there's the issues of condensation. And then we're always worried about having to battle maybe these droplets that can accumulate. And so how do you guys navigate

how to actually be the most effective, especially as, in my opinion, they've been to different NICUs. And it feels like the temperature is never the same when you go from one area of the NICU to another.

Laurence Gulliver (05:01.422)

Well, that's certainly one of the challenges and perhaps we look back on the challenges of the patient themselves, the baby themselves, but the environment certainly when it comes to condensate, think condensate's a really interesting thing. It's perhaps even a bit misunderstood. I think where it's accurately understood is that it's a nuisance and that it's a burden on caregivers. And over the years, we've done a number of things through, you know, all the way back

even introducing heater wires and then improved insulation. Of course, now we have things like a vac or to get the liquid water out of the expiritual and all sorts of things to manage condensate. But I think our systems are getting better and better. The reason I said I think condensate is a bit misunderstood is I think for lot of caregivers, they feel like condensate may only occur if sufficient humidity is being delivered and it's

some excess humidity is being lost as condensate, and that's far more often than not not the case at all. Condensate has really lost humidity. if condensate's occurring and having that burden of managing it is one thing, but it's also humidity that's not being delivered to the patient and you're not getting that optimum humidity. Again, I think we're improving more and more.

Maybe as a bit of a side note, I think I had an interesting conversation with a head nurse in a NICU the other day saying, and they'd adopted our new Fisher and Pico F &P 950 humidification system. She was laughing and saying, nurses now don't understand what rain out means, what condensate means, because they've understood their environment and taken all of the things that can cause condensate out, and they've just got to set up where condensate management is not

of their vernacular, it's not part of their day to day. I thought that was obviously really great news, but also quite funny to think that, you know, there's a generation of nurses hopefully that don't have the same idea of the burden of condensate. But perhaps I'm digressing. I think the local situation... Sorry, go ahead.

Ben CourchiA (07:06.995)

Mm.

No, I think you're not. I think you're bringing up also maybe an interesting point that I'd to dig further in. You mentioned the new system for neonates, the FNP950. I haven't had the pleasure of using it, but I've seen some pictures of it, and it looks like it's almost... You've broken the traditional humidifier in half almost. It seems like the top part remains and the bottom is gone. Can you tell us a little bit about...

What is the innovation that goes into this particularly new circuit and what does it do different than the prior ones?

Laurence Gulliver (07:48.399)

Yeah, well, the 950 has actually been out for a while in some of our global markets, and we've had it out for a little over a year in the US. I guess the way that the 950 was introduced to me was it really is a computer at the bedside, and that's different to what previous generations of humidifiers have been. And it really unlocks a lot of potential in terms of dealing with complexity.

taking inputs and dealing with a lot of complexity through algorithms and adapting to be able to deliver the best performance, which is high humidity, low condensate, but also with minimal caregiver intervention. So I'll talk to you all day about the performance of the 950, but I also think it's easy to overlook from a usability perspective. Some of the key improvements are around, for example.

Ben CourchiA (08:33.885)

Hmm.

Laurence Gulliver (08:47.084)

We have fewer alarms, and when an alarm occurs, it's really informative about how to address that. That might seem like a trivial thing, but I think when you're a caregiver, you mentioned earlier, you know, if a humidifier is next to a ventilator, I actually think if people don't have to worry about the humidifier, if they don't have to think about it, that's fantastic. If it can trust, if people can trust that it's doing what it needs to do and it fades into the background, perfect. So.

I think the 950 has a lot of technology, which again, as an engineer, I'm happy to talk through, but it's not technology for technology's sake. It's really anchored on the insights that we have through the caregivers that we work with, through the ability to see firsthand some of the challenges that patients, that caregivers are facing. And then we think about flexing our muscles in terms of coming out with great technology. It has to be to improve care and outcomes.

And the 950 does, you know, it measures the environment. It's got integrated probes. Those are all technologies. But why? For usability, for ease of setup. It's got a big screen. Great. Why? Because it helps for dealing with alarms if they arise. I think you get my point. It's technology not for technology's sake, but really to help the caregiver.

Ben CourchiA (09:53.906)

Yeah.

Ben CourchiA (10:06.791)

Yeah, it does. mean, I've seen obviously videos and pictures and like you said, it looks like you have a little computer there where, and it seems that you have a lot more information from the humidifier than previously. I think one of the aspects that you mentioned is so interesting to bring technology, not for technology's sake, but to actually address the needs of caregivers. How do you guys go about surveying the landscape and understanding a little bit what are the pressure points of the

the NICU nurses, the physicians, of the nurse practitioners, and so on, in order to then tailor your objectives to these particular issues that are brought up to you.

Laurence Gulliver (10:48.034)

Yeah, I'm actually really glad that I get a chance to talk about this for a number of reasons, because I really think this is a key thing, especially when it comes to providing care for neonates. Our channel has to be through the caregivers and the relationships that we have with neonatologists, with RTs, with nurses, with all of those people that give us that feedback and those insights.

If I jump to the end, I really don't like the idea of an engineer designing something in an air-conditioned office in Auckland that goes into NICUs around the world. It really needs to be an engineer who's informed by the information that's going on around the world. so I think the punchline is we really rely on the insights from caregivers. And that kind of touches on something you asked earlier, which is around the challenges. This is quite, again, unique for neonates where

Ben CourchiA (11:41.788)

Mm-hmm.

Laurence Gulliver (11:46.287)

If you think about premature babies, well, typically, almost exclusively, the only place that premature babies exist is in a neonatal intensive care unit. And so we need to have access to that unit, to the caregivers, and we really rely on them for the insights. The other thing that's interesting about that patient is they can't speak for themselves. They can't say, that's a bit uncomfortable or that's a bit

I'm getting a bit tired of that. So we have to again rely on caregivers, also parents, the people around the neonate to infer those things. So I guess that's one thread. the other thread, so one thread is to say the importance of that relationship. And the other thread is just to acknowledge we know that our role is to put the best possible tools in the hands of those caregivers.

Ben CourchiA (12:46.022)

Mm-hmm.

Laurence Gulliver (12:46.274)

to do their job, which is to improve care and outcomes. We always want to make their lives easier through usability, through improved care and outcomes from the tools. But we understand it's in the hands of the caregivers that that happens. it's a really long-winded answer. But for me, I'm rambling on because I think it's really important that connection that we have to those people to get the insights to put the...

products in their hands.

Ben CourchiA (13:17.831)

That's very, very happy to hear that. And I think that it will come as no surprise to most of our listeners. My next question was relating again to maybe innovation and the products that you guys deliver. I think that for us, especially as we've talked to the past several episodes about CPAP specifically, it feels like CPAP has one extreme advantage over so many other

Laurence Gulliver (13:26.734)

you

Ben CourchiA (13:47.089)

non-invasive respiratory support is the fact that it's so simple. It's such a simple way of actually generating positive and expiratory pressure. And so I'm wondering, from your engineering standpoint, do you guys take a look at CPAP in general and think there's still room for innovation, even though it's such a simple system? Or do you think that we've peaked and maybe that's it? That's the most optimal way of delivering CPAP. I'm just curious, without getting into details, I don't want you to break any NDAs or anything like that, but...

Do you guys see this as really still having a lot of potential that we could see with coming through with innovation down the road?

Laurence Gulliver (14:24.046)

The short answer is absolutely yes. Absolutely. think our business is really actually structured to get teams to really have a depth of understanding about what the clinicians and what the caregivers are trying to do with the babies and other patients as well, of course.

Ben CourchiA (14:27.548)

Yeah.

Laurence Gulliver (14:48.59)

We think that we can continue to improve the different therapies that we help provide. We've been doing humidification for 55 years. We think there's a long runway and continued improvement opportunities in something that we've been doing for 55 years. And whether that's from, you mentioned CPAP being very simple to use and easy to use, usability is really important. We believe ease of use for caregivers is

is a really key element to patients getting the best care that they can. I think that we can, the FMP950 humidifiers made a really good leap forward on that. But we're not done. We really believe that we can continue to improve in that humidification space. Your question was about CPAP. Absolutely the same answer applies. I think we've got a great system that has been adopted because of the reasons you talked about, but...

I know the teams are not complacent. It's very much a. We're not done attitude, you know, I think we're always looking for performance improvements and improved understanding of the clinical impact and whether we can tweak things to contribute further to that. And I guess I'll probably tag onto the end of this as well. It's when it comes to neonates and premature's, it's pretty easy to get motivated to continue to improve. You know, I think our teams are.

I really love the idea of helping, if you like, save babies. I think as challenging as it can be to keep that innovation and keep improvement moving, there's a massive tailwind we have, which is if we can help improve babies' outcomes, that's fantastic.

Ben CourchiA (16:36.795)

Yeah, I think that's so cool that basically you're working on the other side of the globe and I'm here in the US and yet our motivation is pretty much identical. I think that's so neat. And then jumping on that actually, I mean, I think that what's also defining the work that you guys do at Fisher & Paykel is that you do have this global vision, which I think is very ambitious obviously because

We know that around the globe we have a lot of variability when it comes to resources and so on and so forth. so why is it so important for you guys to continuously think globally and not just locally?

Laurence Gulliver (17:19.478)

Yeah, that's a challenging question because I think you're right, know, we're sitting in little old New Zealand, but we are a global business and we have, I think, sales in over 130 countries. So we've got a lot of markets with lots of different considerations that really inform what's the best solution for those people, for those caregivers in those different markets.

Things like nursing ratios, for example, vary significantly in different hospitals. Even within a given market, there can be a huge amount of variation of how hospitals are resourced. So I'm getting to the point, which is we are thinking about all those different types of caregivers. I've spoken mainly about the F &P 950. I think that's a great solution.

But we have other solutions that are. Have different features. Maybe they're more geared towards usability than performance. For example, where that's something that within a different hospital is is paramount. You know that's the most important thing so. It's it's it's again. It's a long winded answer, but I think you're right. We are global. We have to think global and we really do have to consider the right solutions for.

quite different end users around the world.

Ben CourchiA (18:50.077)

Thank you for that answer. And before we're getting close to the end of our time together, but I guess I wanted to maybe finish off with something a little bit more personal and ask you a little bit with a background in engineering. feel like I've always been wondering if I had not become a doctor would have gone in engineering. I have a lot of respect for the work being done by engineers. But I'm just wondering what exactly was the

rationale for you joining Fisher and Pichel and maybe working with a team that were in the healthcare space and dealing with pediatric and neonatal patients.

Laurence Gulliver (19:29.506)

Yeah, well, I'm going to give you the honest answer, which is probably the right thing to do anyway. you know, when I was at university, I heard so much about Fisher & Paykel Healthcare. It felt like it might be the obvious route to go down, the obvious company to work for. And so in my mind, I thought I want to see if I can look for other opportunities first. And I...

Ben CourchiA (19:32.317)

Go ahead.

Laurence Gulliver (19:56.591)

did apply for a role as an intern here and I thought I'll give it a try and the rest is history. You know, I think the culture of everybody pulling in the same direction and trying to do something meaningful and positive really just kind of changed my perspective on what I could achieve as an engineer. There's actually a lot of places you can work as an engineer and do really cool, innovative. Fun things. There's lot of places that you can do that, but.

Ben CourchiA (20:00.819)

You

Laurence Gulliver (20:26.774)

For me, and I think for a lot of people who work here, the fact that we have this positive impact for patients, for families, that's the hook. And when I left, I went to medical devices because of that same motivation, and that's why I came back after having worked overseas for a few years. Yeah, I think the engineers really appreciate that there's that kind of element to what we do. And...

Let's not forget engineers love technology and they love toys and they love creating. We get to do all that as well, so I think it ticks a lot of boxes for people.

Ben CourchiA (21:01.957)

Awesome. engineering with purpose is a cheat code, it looks like.

Laurence Gulliver (21:08.674)

Yeah, and hey, you've probably heard the of the phrase of care by design and that's kind of an ethos that we have here that I think is really nice because it talks to the importance that we have around design, but it also shows us how we're motivated to channel our efforts in that space. So I think actually Andy touched that on a previous podcast, Andy Nicol. So that's something that

Ben CourchiA (21:09.789)

giving great things.

Ben CourchiA (21:24.945)

Mm-hmm.

Laurence Gulliver (21:38.478)

I think lot resonates with a lot of people here.

Ben CourchiA (21:41.767)

Well, thank you for sharing that and that personal note, Lawrence. was pleasure to chat with you today. Thank you for all the work you're doing. And we will link to the Fisher and Pikell website in the show notes for people who are interested in learning more about the latest innovation coming from the amazing team in New Zealand. Thank you very much and have a good rest of your day.

Laurence Gulliver (22:02.978)

Thank you so much, Ben, really appreciate it and enjoy talking to you.

Ben CourchiA (22:06.535)

Same, bye.