Vents of Choice

[grumpy1]

What types of ventilators are you critical care types using out there. Ground service I work for is looking to buy new vents and I am wanting some possible feedback, suggestions of those being using by others.

I read the rules and don't think it's against any since this is going to be opinionated and not endorsements. If it is against the rules I am sure the moderators will politely remove it and I understand.

Thanks

 

[reaper]

Do a search. I think this was discussed a few months back. Don't remember what was the outcome was.

 

[grumpy1]

I struck out on the search

 

[reaper]

Vent will come along and be able to give you the best answer.

 

[VentMedic]

I couldn't find that thread either on the search.

The LTV 1200 is my choice as it can do peds and adults. The PEEP is internal (big plus). Higher flow capability and still gets decent gas mileage.

But, as will any new piece of equipment, it will depend on the education, experience and comfort level of the team.

 

[traumateam1]

BVM!!! lol

 

[VentMedic]

BVM!!! lol

Here's a good article for you to read if you ever consider getting into critical care transport. It lists several good references that also make for good reading.

http://www.ncrcb.org/NCRCB Newsletter volume 3 issue 2.pdf

[FONT=Arial,Bold]Manual Positive Pressure Ventilation Versus Mechanical Positive Pressure Ventilation[/FONT]
[FONT=Arial,Italic]By David W. Garrard RRT, RCP, CCEMT-P, PNCCP[/FONT]​

 

[traumateam1]

Thanks Vent,
That was a good read. I am thinking about critical care, but haven't decided whether or not to go that far. Still young with lots of time to decide

 

[jedirye]

My service carries one of the models of Eagle Vents, I want to say 754. I really haven't used it too much though.

-rye

 

[triemal04]

Ventmedic-

Out of curiosity, while fully understanding the mechanics of ventilation and the physiology behind it is extremely important for any paramedic, in an urban environment (with shorter transports, say average 10 minutes) do you think that a vent on par with the LTV 1200 is fully neccasary? The one I've seen (I want to say it was a 1300 but may have been 1200 can't remember) had excellent features one it, including reducing the percentage of O2 (I think), minute volume, and adjustable PEEP among others. For critical care transports or longer transports I can definetly see the need for this, and while it would be great if all ground based could use something at this level, how much of a problem do you see with a vent that has adjustable tidal volume, rate, and alarms for increased pressure with shorter transport times?

 

[VentMedic]

That depends on the type of patient you are transporting. If it is a critical care patient from one ICU vent to another, something like the LTV would be better since the patient will probably be on serious drips as well as running a complex ventilator protocol. Some adjustments on both the drips and the vent may be necessary to get through the transport. So, more options and much more pharmacology knowledge would be required. The two go hand in hand and cannot be treated as separate entities.

The AHA is recommending the use of ATVs in prehospital. Those are fine for EMS with the nearly dead intubated post code patient. I don't advise trying to move critical care patients with one. Our intensivists would probably not be secure in allowing you to even take a patient from our ICU with an ATV because they would also wonder if your other knowledge is just as simplistic. But, if you show up with a sophisticated piece of equipment and spend an hour trying to set it up , well then the same holds true again.

Popular ATV - showing up on some EMS trucks.

http://www.carevent.com/prod_atv.htm

There even one for the EMT for CPR which essentially has the same theory as the old demand valve but now with regulated features.

http://www.otwo.com/pdf/CAREvent%20EMT%20Automatic%20Ventilator.pdf

What I find is people don't educate themselves first before looking for ventilators. They buy the vent and then learn how to turn the knobs on it. It is very much like buying a car and just as expensive. If you don't have some idea about the features and their function first you could end up with a less than practical ventilator for your purpose. Or, you can get sold more ventilator than you need.

As far a rate and tidal volume, that is the very basis for ventilation. You would not ventilate a small framed shorter patient that is 5' and 50 kg the same as a 120 kg 6'4" man. Of course, with PEEP, even on the adjustable BVMs I have seen people get carried away and crank it to 20 cm H2O to "better oxygenate" someone who has no BP.

The Eagle Univent 754 has one deceiving feature that is poorly understood. It states it has a Plateau Pressure feature but it is just a mathmatical number derived from the PIP and not a true measure of lung compliance.

In a noisy environment, I love the manometer. It gives me some indication of what the patient is doing at a glance. I've heard of some CCTs still having the Eagle 706 in use.

At least a high pressure and disconnect alarm would be nice. Although what I have found is people put a patient on a vent and think that is it for the duration. Some forget to recheck and assess after moving and during transport. If you have an ETCO2 monitor inline that will tell you alot if it has a graph.

So, type of patient, length of transport, knowledge of the transport personnel, durability and gas mileage are just some of the things to consider. Having more knobs to turn and bells or whistles will not make une a better knobologist or clinician if the education or purpose for the machine is not there.

Sophisticated vents like the LTV are used for Flight and ground CCTs that do serious ICU transports without borrowing an RN from the hospital. The Paramedics either have extended their training to where they can manage, and not just monitor the drips, and make ventilator adjustments skillfully as well. But then, some of these teams will always have an RN as part of the team and/or RRT in some areas. The LTV is a favorite for Pedi Specialty transport teams. Specialty transports would also have to consider the best ventilator to run other gases such as heliox or Nitric Oxide.

The LTV is not the only high end transport ventilator. There are others. I just like its ease of carrying also.

 

[TheAfterAffect]

For my paid company I work on the CC truck, We bring a nurse with us for CC Jobs. But we carry the LTV 1200 and even as EMT's we were given a crash course on the basic operation and set up of the LTV 1200 by the Nursing Director just so we had an idea of what was going on and incase we got a newbie nurse we could guide them a little bit.

We used to carry the 1000 on our rig, But the 1200 is alot easier and well put together. The Nurses love the Internal PEEP and the option of Same Patient/New Patient right when you turn it on. Since alot of our jobs are Wait and Returns with the CC's, once we get to the facility we can transfer them over to their vent, and recharge ours in the rig w/o having to worry about losing the settings.

The only issue we've had with the 1200 so far was just that our rig has been given more and more Vent Dependant PT's and our tubing supply keeps running low quickly