Boussignac CPAP and Nebulizer

[Arkymedic]

My service is considering the use of the Boussignac CPAP http://www.vitaid.com/usa/boussignac/index2.html and I was just wondering how many services use these and the results they have. We also are considering the new rubber Ambu holders and was wondering if anyone is using them yet. http://www.lifemedicalsupplier.com/et-tube-holder-wrubber-straps-ref-205314264040-p-474.html

 

[eggshen]

I like them. I have used it multiple times with positive results. Others seem to like it not so much....funny though, they are the ones that are "not sold on CPAP". Be careful though, they break easy in the cold.

Egg

 

[Ridryder911]

I've heard they use quite a bit of oxygen, much more than some others. We field tested several models and personally like the portovent brand. They use much less oxygen and our RT's keep the masks (apparently the patients like them the most).

R/r 911

 

[VentMedic]

I've heard they use quite a bit of oxygen, much more than some others. We field tested several models and personally like the portovent brand. They use much less oxygen and our RT's keep the masks (apparently the patients like them the most).

R/r 911

I like the Portovent system also and the masks which can be adapted to some of the hospital systems are reasonably comfortable. The head harness is also nicer then some of our disposable straps. Although, when we run CPAP by mask through a ventilator, we may still use the Anesthesia strap harness for a seal that won't give way with movement or high flow. I can use the Boussignac CPAP mask in this manner or use it as spare for the BVM.

For transport both in and out of hospital, we use the LTV series of ventilators which can do NIV and are adaptable to pedi and adults.

 

[pa8109]

Our service uses whisperflow CPAP for ALS providers. The county just north of us has a pilot program allowing some BLS services to apply the Boussignac CPAP. I have not seen any pts that this has been used on, as the pilot is relatively new, but I have heard that the results are positive. Its my understanding that they use less O2 than the whisperflow's. I haven't had the oppurtunity to try one out (the Boussignac's).

 

[Webster]

pa8109, are you from Cumberland County?

 

[Markhk]

Our county implemented CPAP in January...one thing is you need to make sure that all your oxygen regulators run on 25 lpm in order to get 10 cm of H20. The system eats up oxygen so you may need to carry in more O2 tanks.

 

[pa8109]

yes, you from perry county?

 

[Webster]

I live in cumberland but work in perry.

 

[MMiz]

pa8109, meet Webster, Webster, meet pa8109. Just so that we can keep this thread on topic, I'd suggest you guys chat it up via PM (Private Message).

 

[Webster]

I didn't mean to hijack the thread. Sorry about that.

 

[Jon]

Moving right along... The ALS service that responds with my vollie squad was talking about switching to these a while ago. The paid transport Co. was also talking about using them. One of the advantages of this system is there is limited "capital" investment... you just need to buy the masks and you use your own oxygen. I think you also are "supposed" to use a manometer with it.. but I'm not sure, and I'm not sure everyone does.

The great thing is that since everything is self-contained and 1-time-use, when you transfer the patient to the ED staff, you don't have to worry about the Pt. getting onto a hospital vent or CPAP machine so that you can take your machine and go back in service... all you have to do is transfer to the hospital's oxygen and leave.

Jon

 

[bonedog]

For transport both in and out of hospital, we use the LTV series of ventilators which can do NIV and are adaptable to pedi and adults.[/QUOTE]

Vent, have you used the LTV 1200?

We have the 1000 which isnot PEEP compensated, just wondered you have used the newer model which is.

 

[VentMedic]

For transport both in and out of hospital, we use the LTV series of ventilators which can do NIV and are adaptable to pedi and adults.

Vent, have you used the LTV 1200?

We have the 1000 which isnot PEEP compensated, just wondered you have used the newer model which is.

If the LTV 1000 was good enough for Superman....B)

We have several 1000 models and are in the process of ordering some 1200s primarily to update the 1000s on transport, OR and ED.

We have a large TBI and SCI rehab as well as a Sub-Acute where we can run over 80 portable ventilators if necessary. We just got burned by one company that initially replaced our fleet of PLV 102s. 40 bad pieces of expensive technology that management had gone with instead of the LTV to save money.

I love the internal PEEP feature as well as the graphics package and the inspiratory hold feature. The inspiratory hold will give an actual plateau unlike the Univent 754's misleading "plateau pressure" button. We can start adjusting our VT, RR and PEEP levels in the ED or at a transferring hospital. Of course, as similar in features to some ICU vents, I always feel better doing a full ARDS protocol on an ICU vent which has more flow, sensitivity and better demand valve performance (but at $45k each of course vs $5k - 9k).

In transport CPAP systems there are big differences in the flow delivery and flow retard valves as well as the O2 concentrations for each PEEP value depending on the entrainment system. That is why I like the stability of delivery on a system like the LTV.

Of course, it is not practical or cost effective for prehospital.

 

[bonedog]

I find the inspiratory hold invaluable for patient safety. I am very comfortable using the vent in volume mode, and use this as one of my parameters.

Recently transported a morbidly obese COPD/CHF patient. Had a chance to use pressure control mode and it was very effective, we were able to decrease the PCO2 from 108 to 56.

I have used it pre-hospital in CPAP mode, wouldn't bother for short transports though.( we often respond to out lying smaller communities that have no physician services, and smaller hospitals with where gp's manage patients until we arrive)


Sounds like most of your patients are trache'd, do you find it makes much difference for your parameters ?

What percentage with your large volume of patients, would you estimate are volume vented?

 

[VentMedic]

We have so many modes with variations of PC and VC that it is hard to distinguish what is which. Each serves a purpose with their pluses and minuses for different patients. PC we use for a rapid inspiratory demand. We prefer volume to titrate down the cc/kg to achieve a target plateau pressure if possible in an ARDS protocol. PC is difficult to control but we may switch to a Bilevel or APRV mode and allow "free breathing" with 2 levels of PEEP applied at different intervals.

The LTV and other portable ventilators are "chronic" with the exception of inter and intra facility transport. The LTV is an excellent ED machine that will keep the patient going until ICU usually unless it is a major chest trauma which may get the HFOV (high frequency oscillating vent). We also prefer an ICU vent for heliox.

Having several different types of ICUs, we can also run well over 100 acute ventilators at any given time as well as several in the ED. That doesn't include Neo ICU or Pedi ICU. You can add at least another 50 to 80 ventilators between those two large ICUs.