# Ventilators recomendations



## zacdav89 (Apr 5, 2017)

I am Looking at making a proposal for ventilators for  ground critical care. The big ones I am considering are  the revel, and the ltv series. The ve t would need to be able to function well for icu level transfers. If you have used these vents what are your thoughts about them?  Do you recomend them? If not what are you using currently and what do you like about it? 

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## VFlutter (Apr 5, 2017)

Use the revel. Works great and is easy to use. Did not like the LTV.


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## zacdav89 (Apr 5, 2017)

Chase said:


> Use the revel. Works great and is easy to use. Did not like the LTV.


What about the LTV did you not like?  

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## TransportJockey (Apr 6, 2017)

The LTV is overcomplicated. I used the LTV1200 at AMR and I liked it, but a lot of our medics had issues. The T1 looks amazing and I want it. We are movign to the Zoll EMV+ vents here


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## NomadicMedic (Apr 6, 2017)

I liked the LTV1200. After I sat down and read the manual and played with it, I understood it. I think a lot of medics just want to fiddle with the knob. That doesn't work. 

I do like the revel. Wish we had one here.


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## VentMonkey (Apr 6, 2017)

Look no further, OP. I present to you the prehospital super-vent...

https://www.hamilton-medical.com/en...LTON-T1.html?gclid=CL2Rq-PWkNMCFZy4wAodP3MHrg


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## zacdav89 (Apr 6, 2017)

VentMonkey said:


> Look no further, OP. I present to you the prehospital super-vent...
> 
> https://www.hamilton-medical.com/en...LTON-T1.html?gclid=CL2Rq-PWkNMCFZy4wAodP3MHrg


I have seen the t1. Several flight agencies and hospital Ers are using them. They seem like a do anything system and have the newer hybrid modes. I see the price point as a tough sell as we are just starting in the cct arena. Any recommendations on why the t1 would be worth the extra cost of others? 

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## VentMonkey (Apr 6, 2017)

zacdav89 said:


> I see the price point as a tough sell as we are just starting in the cct arena.


I can't quote a price, nor do I know what you're being given by their reps. What I can say is that when we began shopping the market for a new vent we looked at several others to include the ReVel, none of which matched the T1's price. Our base manager and I were both surprised by this.


zacdav89 said:


> Any recommendations on why the t1 would be worth the extra cost of others?


I don't know that I would call it a "do anything" vent, but their selling point is the ASV mode, which as the name implies, literally adapts to the patients respiratory status.

It has all of the other standard modes of ventilation you would come to expect with any other ventilator out there (PRVC, SIMV, NIV) and has an array of diagrams, and parameters to peruse through and adjust accordingly.

Also, their "dynamic lung" feature is not only kind of cool, but quite helpful with exhibiting the compliance of the lungs themselves. If you're truly interested in pitching to your program, take a look at the link, and perhaps forward it to your program manager(s).


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## zacdav89 (Apr 6, 2017)

VentMonkey said:


> I can't quote a price, nor do I know what you're being given by their reps. What I can say is that when we began shopping the market for a new vent we looked at several others to include the ReVel, none of which matched the T1's price. Our base manager and I were both surprised by this.
> 
> I don't know that I would call it a "do anything" vent, but their selling point is the ASV mode, which as the name implies, literally adapts to the patients respiratory status.
> 
> ...


Thank you I'll look into it

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## VentMonkey (Apr 7, 2017)

zacdav89 said:


> Thank you I'll look into it.


No problem, I forgot about this ventilator. While I have no clue what pricing is, nor do I possess any firsthand knowledge or experience with it, it does look worth some research.

It appears to be a European company (as is Hamilton), and delivers the standard modes up to and including PRVC, which alone was the one mode we wanted for our service when switching vents. 

https://www.weinmann-emergency.com/products/emergency-ventilators/transport-ventilator-medumat-t/

Also, IIRC, the LTV and ReVel are both made by Carefusion. The ReVel is essentially the 1200's upgraded big brother to include---you guessed it---PRVC. 

The drawback I found with their products was no graphs, which I prefer. It may also help many other paramedics not familiar with vent management "paint the clinical picture", good luck.


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## hometownmedic5 (Apr 8, 2017)

Hamilton, hands down. Layout, ease of use, capabilities. It's the total package. 

It's also 30 grand, so there's that. In a system where they might need to buy one or two, it might be doable. At my company, we run 14 transfer trucks, so we have at least 16 vents. I can't swear to the actual number, but that's in the ball park. We use the HT70. To switch now would be a half million dollar capital expenditure, which isn't happening until they mandate some change that requires new vents.


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## VentMonkey (Apr 20, 2017)

Three week thread bump...

OP, if you're still trying to convince your service, or for anyone interested in enticing their service to get familiar with the Hamilton, they have a free online "college" that provides tutorials, quizzes, and simulators*.

http://college.hamilton-medical.com/

*No, I am not a Hamilton rep.


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## zacdav89 (Apr 20, 2017)

Thank you  for all the info!I am working  to get a hold of reps for both Hamilton and the revel as I am going to do a preposal comparing them both. 

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## CANMAN (Apr 24, 2017)

If people think an LTV is complicated then I don't see how the Hamilton wouldn't be mind blowing... Also the Revel is a very similar platform to the LTV series.

Here's the questions I would ask yourself to make a decision between Revel and Hamilton T1
1. Are mostly of your missions run of the mill vented patients like: PRVC, AC, CMV, SIMV, PSV, BiPAP, etc
2. What is your budget, and do you invoice bill for supplies/disposables?

Here's what I would say. My services has the Hamilton T1's. If you want a vent to do everything under the sun and be able to transport any patient possible from a respiratory standpoint, go with the Hamilton. When I say everything under the sun, the Hamilton does so much, has different nomenclature, and will show you more information then you ever knew was possible and can get some people overwhelmed and into trouble pretty quickly. If you want a compact package that will get you by for 95% of IFT runs, have cheaper initial cost, and cheaper disposables cost, then go with the Revel.

The Revel will not do a true BiLevel and APRV like the Hamilton can. The Hamilton is overly chunky and there isn't a great way to package it for RW transports but for ground where you could put it behind the head of the cot on a equipment catch all it would be ok. It's large, heavy, and cumbersome, but you can toss a pre-ECMO patient on APRV on it and have zero issues. If your program is doing those type of missions on a regular basis then Hamilton is your vent, otherwise I am Revel all the way for ease of use, compactness, and cost.


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## VentMonkey (Apr 24, 2017)

@CANMAN how do you guys mount your vent? We have ours on a pole (only manufacturer I am aware of that makes a mount for the T1) between the medic and nurses seats.


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## SpecialK (Apr 25, 2017)

Do you blokes know of something easy to use and dirt cheap? Like so cheap it's like made by Extreme Poverty Medical Ltd and qualifies for food stamps?

I would love, love for ground RSI Officers to have access to a small mechanical ventilator but the ambulance service is very poor so while getting new medicines is relatively easy, new equipment, particularly which will only be used on a small number of patients seems quite difficult.

Thanks.


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## hometownmedic5 (Apr 25, 2017)

You could probably pick up an autovent 3000 for around a grand. They're O2 hogs and have zero features, but for a paralyzed patient short term, that could work for you.


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## VentMonkey (Apr 25, 2017)

SpecialK said:


> Do you blokes know of something easy to use and dirt cheap?


I'm not quite sure about the dirt cheap part, but it's probably the most inexpensive hands free device I know of.

http://www.vortran.com/new-products/go2vent/


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## CANMAN (Apr 27, 2017)

VentMonkey said:


> @CANMAN how do you guys mount your vent? We have ours on a pole (only manufacturer I am aware of that makes a mount for the T1) between the medic and nurses seats.



Hey man, there really isn't a "great" option in my opinion, or at least anything that I have seen. Unless programs are spending a crap ton of money on custom fab stuff. 

We have a custom tray made out of thin sheet metal with a buckle on that which secured the vent in between both aft facing seats in our 135's. Our mechanics fab'ed that up. That's where it lives when not in use, some people put it back in there and secure it for the patient leg of transport when in use, other's do not. Problem with that is you can't really see the screen well/have to pull it out to troubleshoot alarms. Some provider's will hang it from the window sill next to the patient care seat, other's will hang it with the hooks onto the folded up patient care seat. We ride with our third "patient care seat" up pretty much all the time. Not my preference but the way my new program does alot of things I have had to learn to adapt. Really isn't a great way to secure it due to it's size in HEMS transport that I am aware of. 

Ground we secure it to the back of the cot with a strap.


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## Tigger (Apr 27, 2017)

VentMonkey said:


> I'm not quite sure about the dirt cheap part, but it's probably the most inexpensive hands free device I know of.
> 
> http://www.vortran.com/new-products/go2vent/


I think that's about it for "disposable" vents. We have them at a few of my jobs but they're rarely used. They do work ok and have a built in PEEP valve.


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## Tigger (Apr 27, 2017)

hometownmedic5 said:


> Hamilton, hands down. Layout, ease of use, capabilities. It's the total package.
> 
> It's also 30 grand, so there's that. In a system where they might need to buy one or two, it might be doable. At my company, we run 14 transfer trucks, so we have at least 16 vents. I can't swear to the actual number, but that's in the ball park. We use the HT70. To switch now would be a half million dollar capital expenditure, which isn't happening until they mandate some change that requires new vents.


Any idea what the HT70 costs?


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## CANMAN (Apr 28, 2017)

Tigger said:


> Any idea what the HT70 costs?



Believe they are about 14 new, anywhere from 8800-7500 for refurb depending on condition.


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## Tigger (Apr 28, 2017)

We're looking at getting a new vent as we slowly starting doing CCT. I think I can get a grant for 10-15k and we're only going to get one. I know nothing about vents except that the HT70 used at the placed I started in MA and was well liked and relatively easy to learn. The "CCT Coordinator" wants a Revel but I was instructed to research other options. That would seem to be a better job for the "CCT Coordinator" but what do I know.


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## VentMonkey (Apr 28, 2017)

@Tigger it really depends on several factors. What kind of transports will you primarily be doing? Trach patients being discharged to SNF's? High-level ICU patients that require specialty modes such as APRV? Both?

Check out the links to the vents I've posted and run them by your coordinator. Again, Hamilton has an online free "college" complete with a simulator that will familiarize you with all of the modes that they offer. 

It's literally the closest prehospital vent to an ICU vent on the market now. This may not necessarily be what your program is looking for though. The ReVel is no slouch, and is (TMK) a very reliable, and trusted IFT vent.


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## Tigger (Apr 28, 2017)

VentMonkey said:


> @Tigger it really depends on several factors. What kind of transports will you primarily be doing? Trach patients being discharged to SNF's? High-level ICU patients that require specialty modes such as APRV? Both?
> 
> Check out the links to the vents I've posted and run them by your coordinator. Again, Hamilton has an online free "college" complete with a simulator that will familiarize you with all of the modes that they offer.
> 
> It's literally the closest prehospital vent to an ICU vent on the market now. This may not necessarily be what your program is looking for though. The ReVel is no slouch, and is (TMK) a very reliable, and trusted IFT vent.


Frankly it will be mostly used on mostly dead ROSC patients, which the Parapac can handle. However we do a fair amount of "rescue" from the local community ED to larger facilities about 40 minutes away. Ground CCT is almost non existent here so we are trying to step up and provide better care for the patients. The hospital has an ED doc and that's about it (no ICU) so frankly I am just happy to show up to them not just bagging the patient in the ED. I'm not sure we really need something like the T1 but like I said, I don't know much about vents but I get the money soooo.


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## Carlos Danger (Apr 29, 2017)

Tigger said:


> Frankly it will be mostly used on mostly dead ROSC patients, which the Parapac can handle. However we do a fair amount of "rescue" from the local community ED to larger facilities about 40 minutes away. Ground CCT is almost non existent here so we are trying to step up and provide better care for the patients. The hospital has an ED doc and that's about it (no ICU) so frankly I am just happy to show up to them not just bagging the patient in the ED. I'm not sure we really need something like the T1 but like I said, I don't know much about vents but I get the money soooo.



Sounds like a LTV1200 would work perfect for your purposes. It is a very capable vent, and probably much cheaper than the more modern models.


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## CANMAN (Apr 29, 2017)

Remi said:


> Sounds like a LTV1200 would work perfect for your purposes. It is a very capable vent, and probably much cheaper than the more modern models.



Second this....


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## hometownmedic5 (Apr 29, 2017)

Under those circumstances, a basic vent will most likely do you just fine.

That being said, it will work fine until it doesn't. I don't see fancy vent modes coming out of the ER often, and if you're not doing icu transfers that will eliminate most of the unusual stuff too; but to say it will never happen is probably presumptuous. If your sending facilities are willing to work with you, you can get it done. 

If all of your patients are unresponsive with or without heavy sedation, you don't need anything beyond an LTV or HT70 to get it done.


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## Carlos Danger (Apr 29, 2017)

I'm not sure I'd call the LTV 1200 a "basic" vent. It's not as advanced as the Hamilton, but it'll do pretty much anything that you need it to, even if you do routinely do real CCT transports. Most of the newer vents advantage comes in the form of ease-of-use, not necessarily capability. There aren't many patients who really need APRV, for instance, and those that do should be being transported by a dedicated CCT crew.


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## hometownmedic5 (Apr 29, 2017)

Semantics. 

When compared to say the ATV, it's advanced as hell. When compared to the T1, its basic.


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## Carlos Danger (Apr 29, 2017)

hometownmedic5 said:


> Semantics.
> 
> When compared to say the ATV, it's advanced as hell. When compared to the T1, its basic.



As an ICU vent, OK. The adaptive mode is pretty rad. 

But for transport, there is no feature that the T1 has that the LTV doesn't that would likely be of any benefit at all in 99% of transports.


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## VentMonkey (Apr 29, 2017)

ASV isn't without controversy. More often than not it seems easier for us to keep the patient on PRVC for either scene or IFT calls. 

I don't recall if the LTV 1200 offers PRVC, but in lieu of that A/C, and SIMV should (respectively) suffice with the different levels of your patients comatose states; it really is a workhorse vent. 

The Oxylog actually grew on me quite a bit as well. It was the first vent I learned on.


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## RocketMedic (May 2, 2017)

I'm actually a fan of this: http://otwo.com/automatic-transport-ventilators/eseries-ventilators/e700-ventilator-2/

It's cheap, less-finicky than a Zoll, and works.


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## CANMAN (May 12, 2017)

Remi said:


> As an ICU vent, OK. The adaptive mode is pretty rad.
> 
> But for transport, there is no feature that the T1 has that the LTV doesn't that would likely be of any benefit at all in 99% of transports.



ASV can be great for certain patient populations, but can be a nightmare for others. When we first rolled out the Hamilton's most of our patient's were being transitioned over to ASV for transport. You have to be careful in patient's with acidosis, tachypnea, and neuro patient's because ASV will usually change their rate/MV and your titrations are setting a % MV instead of directly controlling rate/TV/etc. Increasing the % MV often will just increase your tidal volumes in ASV. I prefer to use traditional settings for IFT flights, and use ASV on scenes. ASV does do a great job at sensing lung compliance and adapting to tight/sick lung patients though.


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## VentMonkey (May 12, 2017)

CANMAN said:


> ASV can be great for certain patient populations, but can be a nightmare for others. When we first rolled out the Hamilton's most of our patient's were being transitioned over to ASV for transport. *You have to be careful in patient's with acidosis, tachypnea, and neuro patient's because ASV will usually change their rate/MV and your titrations are setting a % MV instead of directly controlling rate/TV/etc*. Increasing the % MV often will just increase your tidal volumes in ASV. I prefer to use traditional settings for IFT flights, and use ASV on scenes. ASV does do a great job at sensing lung compliance and adapting to tight/sick lung patients though.


This^^^. Also, when we did our in-service with the Hamilton rep she echoed the highlighted statement, and advised against patients with chest tubes, as well as those with erratic respiratory rates.

Traditionally, the mode the patients are initially on should suffice with adjustments made accordingly. In the rare instance one comes across a truly sick ARDS patient who would require something along the lines of APRV, and/ or inverse ratios, that is something I would definitely want no part of without a very well-versed RT's, or preferably, an intensivists consult.

It is a fascinating pitch for it to "adapt" along with the patients condition. But again, for most critical care patients, and the time spent it doesn't seem all that practical.


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## CANMAN (May 13, 2017)

VentMonkey said:


> This^^^. Also, when we did our in-service with the Hamilton rep she echoed the highlighted statement, and advised against patients with chest tubes, as well as those with erratic respiratory rates.
> 
> Traditionally, the mode the patients are initially on should suffice with adjustments made accordingly. In the rare instance one comes across a truly sick ARDS patient who would require something along the lines of APRV, and/ or inverse ratios, that is something I would definitely want no part of without a very well-versed RT's, or preferably, an intensivists consult.
> 
> It is a fascinating pitch for it to "adapt" along with the patients condition. But again, for most critical care patients, and the time spent it doesn't seem all that practical.



Yes I agree. When dealing with sick lung patient's I always figure out if the current therapy is working or not, and if it's not is it something we can make some changes to and improve or not so much. Around my way alot of our transfers that present with that picture are pre-ECMO patients going to get cannulated and can be a bear to move. With that being said, sometimes these community hospitals just aren't great at vent management with these patients and some tweaking is what they need. In these patients we will sometimes try positional ventilation or prone and switch to APRV to get them moving.


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## VentMonkey (May 19, 2017)

@CANMAN re: the Hamilton pre-op check for your guys' scene calls.

How does your program go about doing it? Are you folks generally asking the on scene crews if an induction is needed that way the pre-op check can be done in-flight, and tubing connected for a smoother transition onced induced, and loaded into the helicopter?

I'm still trying to find the most efficient way to go about doing it. It seems to me en route to the scene knowing that the patient will most likely require an induction, then correctly setting it up while perhaps gauging parameters would be most feasibly consistent. 

Recall, I'm in a 407, so space is somewhat limited, thanks.


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## CANMAN (May 20, 2017)

VentMonkey said:


> @CANMAN re: the Hamilton pre-op check for your guys' scene calls.
> 
> How does your program go about doing it? Are you folks generally asking the on scene crews if an induction is needed that way the pre-op check can be done in-flight, and tubing connected for a smoother transition onced induced, and loaded into the helicopter?
> 
> ...



No, unfortunately we do not get any information on our scene calls at all. It's a crazy practice, but I am newer to this program and "trying" to go with some of the flow. It's been a tough transition for me and completely different culture and atmosphere compared to my previous program. I followed the all-mighty dollar, and while I have much more time at home and it has allowed me to buy a new home with my wife and such the daily operations are a struggle. There is a handful of us that are working to make some significant changes however, it's old guard vs. new guard right now and very much a "this is the way we have always done it" type place. 

We don't know if it's going to be an RSI, trauma vs. medical, etc on our scenes. That's mainly because we don't do a ton of scenes, and the places we do go to are so po-dunk that you could ask a simple question like " Adult or Ped's and is an airway needed" and get a 15 minute report that ties up the radio while trying to get a LZ brief or maintain sterile on final into the zone. That being said our current practice is to bag to the aircraft, and during vent setup, then place them on the vent. In a perfect world we would have a circuit already setup and pre-op checks already performed on the circuit, and you could just run a tightness test real quick if you wanted. Once the flow sensor is calibrated it shouldn't need to be done again, even if the circuit sits for a day or two. 

We were running some super cheap dual limb disposable circuit, which was a huge PITA because it's like a cheap garden house and ALWAYS gets tangled. I have FINALLY talked the management team into switching to Hamilton single limb circuits, which if you aren't already using them are a total dream!


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