Ventilators recomendations

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.
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Any idea what the HT70 costs?
 
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.
 
@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.
 
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.
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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.
 
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.
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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.
 
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.
 
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.
 
hometownmedic5 said:
Semantics.

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

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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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. :(:eek:

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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