EMS-Friendly BiPAP?

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FiremanMike

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Is anyone out there aware of any EMS oriented BiPAP machines on the market? The only units I have seen outside of the hospital are all-in-one vent/cpap/bipap machines that were too complicated for most users.

Certainly there must be something out there?

Thanks in advance!
 
hometownmedic5

hometownmedic5

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So instead of raising competence, we simplify procedures so anybody can do it.

:smh:

A better argument is that the vents that do bipap are too expensive due to having unnecessary features for the emergent setting. At least with that argument, we aren't dumbing down our practice, we're being budget conscious.

And no, I don't know of an EMS friendly BiPap device.
 
VFlutter

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Why would you not want a vent? So you are going to place the patient on Bipap and then if they get intubated you just bag them until you get to the hospital?

Get a Revel and get some training.
 
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FiremanMike

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We have <5 minutes to the ER, it is rare that we progress from CPAP to RSI, I imagine that BiPAP usage will pan out similarly.

I don't need a vent, I need a simple to use BiPAP machine.
 
hometownmedic5

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Chase said:
Why would you not want a vent? So you are going to place the patient on Bipap and then if they get intubated you just bag them until you get to the hospital?

Get a Revel and get some training.
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Naturally I can't speak for anywhere but here, but in MA, We can't initiate mechanical ventilation in the field; so I get not having a vent on a 911 truck if they have the same policy.
 
ThadeusJ

ThadeusJ

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A non-vent Bilevel (as BiPAP is actually a brand name of a Respironics product) is still in the future (I'm convinced the technology, knowledge and materials are out there,) but there still isn't a small, oxygen conserving device Bilevel on the market. It should also be note that (as far as I have seen), there are no verified studies that show that Bilevel has better patient outcomes than straight CPAP.

Trying to get one of those disposable CPAP devices to offer Bilevel is the golden egg.
 
VentMonkey

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FiremanMike said:
I would like an intermediate option for our COPD patients that are refractory to CPAP.
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Other than this, can you elaborate and justify why you absolutely need a Bi-level device for such a short ETA?

Most prehospital CPAP's aren't equipped to handle BiPAP, and are disposable. An actual ventilator is most likely your only other option.
NomadicMedic said:
How about a little sedation?
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Also, this^^^. It seems much more practical for your service, but only you'd know best.
 
VentMonkey

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Not for nothing, but the OP's thread title indicates that the BiPAP would need to be "EMS friendly", which to me screams watered down.

Now, there isn't a whole lot of critical thinking that goes along with understanding IPAP, EPAP, airway pressures, and the like, but it sounds as if a watered down BiPAP is useless without a bit more education of the advanced airway variety. Again, hardly a dig at anyone, but Bi-level airway pressures and their mechanics isn't something taught in most (basic) paramedic schools.

Should, or could it be? Absolutely, but just because you want some more intermediate (by the way, again, please share with us your reasoning and rationale for wanting such a device) airway pressure device for 5 minutes doesn't mean the cost allocations, let alone medical justifications are or would be warranted.

So, again, why would any standard ALS service need BiPAP vs. CPAP? If anything maybe you could justify purchasing ventilators for the entire department, upping the departments airway knowledge, take on vent-dependent IFT's, and recoup some money that way. Then you'd also have a machine capable of delivering BiPAP.
 
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CWATT

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I'm new to mechanical ventilation, but is there really any benefit to BiPAP for paintents with symptoms refractory to CPAP? It's my understanding the primary benefit to BiPAP is patient comfort (allowing them to exhale against a lower pressure).
 
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FiremanMike

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There was a time when I would have fervently agreed with all of you, and in the back of my truck such a patient would have been likely to have received some rocketamine and a tube.

My role now is different and I have a much more in depth understanding of the knowledge/skill base of the providers at my department as well as a different understanding of what is done once these patients arrive at the hospitals. PCRs that I review where I say "grr, why wasn't this pateint RSI'd, certainly they were emergently intubated in the ED" are nowhere near as frequently intubated in the ED as I would have previously thought/expected.

I had done my own google searches prior to posting this thread and was unable to find a device short of a full ventilator that will allow for BiPAP, but I was hoping someone on here had come across the "golden egg" as was previously mentioned. While it is a lofty goal to state that all EMS providers should, given the right training, become competent and confident with the transport ventilators on the market, I believe it underestimates the complexity of these units. Excluding those of you that are working in critical care settings, can you honestly say that you'd be comfortable throwing a Zoll 731 on the trucks and be confident that all of your providers would be competent in how to use it? For me personally, it took a great deal of effort to learn and feel comfortable with the transport ventilators that I have used. This a skill set that requires personal motivation to stay current, which is something that (if we're being honest with ourselves) isn't as prevalent in EMS as it should be.

My desire for a BiPAP is for obstructive airway exacerbations where CPAP isn't cutting it and inspiratory pressure support would be beneficial. I am no longer an "RSI everyone" guy, but I'm also not a "No one should get RSI'd in the field" guy either. With that said, if we can prevent an RSI through less invasive means, I think we should make an effort at doing so. My understanding of BiPAP as well as what I've been able to gather from care these folks are receiving in the ED is that BiPAP could be that answer.
 
ThadeusJ

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CWATT said:
I'm new to mechanical ventilation, but is there really any benefit to BiPAP for paintents with symptoms refractory to CPAP? It's my understanding the primary benefit to BiPAP is patient comfort (allowing them to exhale against a lower pressure).
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Actually the role of Bilevel is to increase the inspiratory support (thus decreasing the inspiratory Work of Breathing, or WOBi) while maintaining the baseline lower pressure which would otherwise be provided in your CPAP setting (recruiting alveoli by increasing the expiratory Work of Breating, or WOBe).

The goal of preventing intubation rates using a non-invasive device has long been established in hospitals and thankfully now in the pre-hospital community. 10-15 years ago when it was first introduced to EMS (10 years max in Canada), a lot of hospital based healthcare professionals were certain that this initiative would crash and burn. Its unfortunate that the degree of respiratory distress seen in patients is such a huge grey area that you see immediate results with the not-so-bad patients (accompanied by the "Why are you bringing this patient here, they're fine" pushback) while also seeing a futile attempt to buy a tube for those patients who waited a few too many days before calling ya'll. I'm glad it seems to be working and is still expanding to BLS services across North America.

I would love to see an updated economic impact statement on its use.
 
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FiremanMike

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NomadicMedic

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I guess the question is, would you feel more comfortable recommending a bit of sedation be provided than putting a ReVel on the truck?

With 5 minute transports, if you're not looking for a vent, I think you might out of luck. If CPAP isn't the answer, then you'll need to find a workaround. I still say a bit of versed makes the process of CPAP for an anxious patient significantly more palatable and usually fixes the issues that i have with compliance.
 
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FiremanMike

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NomadicMedic said:
I guess the question is, would you feel more comfortable recommending a bit of sedation be provided than putting a ReVel on the truck?

With 5 minute transports, if you're not looking for a vent, I think you might out of luck. If CPAP isn't the answer, then you'll need to find a workaround. I still say a bit of versed makes the process of CPAP for an anxious patient significantly more palatable and usually fixes the issues that i have with compliance.
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It's not a matter of CPAP compliance, but the physiological differences between obstructive airway issues which would benefit from inspiratory pressure support versus CHF which only really needs increased PEEP.
 
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