What vent mode is best?

[Clipper1]

Puritan Bennett 840. Not sure what you're getting at with your second question? Are you asking what I would do in that case? I would drop my TV (though honestly everyone should probably be at that 6-8cc/kg regardless of process) and increase my expiratory times (and yes this is simplified).

And yes. This is how I view ventilators. A tool. One that should be used as infrequently and for as short as time as humanly possible. So, yes, the moment a patient goes on the vent my very next thought is how do I get them off this damn thing as quickly and safely as possible.

Am I concerned about patient comfort? Of course, and I can make all kinds of great adjustments to try and improve patient comfort, though lets be honest if it were me or mine, I would just rather have some appropriate sedation/analgesia. But that isn't what this is about. This was about overall decision of using SIMV vs. A/C. And where I am, with these vents, there is no difference.

Where are you using the PB 840? This is an ICU ventilator. PB 840 also uses the term BiLevel and not APRV.

Saying all patients should be on 6 - 8 ml will depend on the ventilator and the patient. If the machine is able to adjust for compressible volume loss the great. If it is a single limb transport ventilator you might think you are giving 6 cc but might only be giving 2 - 3 ml.

The lack of understanding of the disease process, the age differences (children, adult, geriatric), ventilator concepts and the ventilator you are using is what makes people get stuck on a ventilator.

When some use SIMV the patient get stuck on the vent for more days than they should as they drop the mandatory rate slowly. With AC they so spontaneous breathing trials every day by just placing the patient on PSV to exercise their breathing. Some might even just go to flow by to mimic a t-piece trial. The flow patterns are less irregular and the wean is quicker which is as soon as the patient achieves a consistent spontaneous effort. I can't imagine any doctor wanting to keep a patient in PACU for days as they walk down the SIMV rate. Maybe this is why some ICUs are full and why their vent days are long when compared to other hospitals.

BTW, the correct abbreviation for ventilator volume is ml and not cc.

 

[Aidey]

Years of working in critical care and doing critical care transports with various ventilators.

You still didn't answer his question. It says right in Expatmedic's profile that he is a NRP, a nationally registered Paramedic. We still have no idea what your training/education level is.

 

[Clipper1]

You still didn't answer his question. It says right in Expatmedic's profile that he is a NRP, a nationally registered Paramedic. We still have no idea what your training/education level is.

I thought I had made that clear in some of my previous posts. Others have figured it out.

RN - Registered Nurse

This is an anonymous forum. Why do you make some post their credentials and not others? If you want specifics this should be a closed forum and the license numbers used for ID like the critical care and professional association forums.

You should not single out members because of your own bias against nurses or anyone else who is not an EMT or Paramedic. There are other professionals who are involved in EMS on a daily bases either directly or indirectly.

 

[RocketMedic]

Um...I dont understand a lot of the terminology tossed about here, but here goes. At EMSA, I had an AEV Impact 731 with CPAP, BiPAP, AC and SIMV. I generally used AC with my underlying rate set at 12, volume to 6-8mL per ideal kg, pressure set to 40. Now at REACT, I have a pneumatic ParaPack vent with only a rate, volume, max pressure and two-position FiO2. CPAP is a separate unit, CPAP only. How do I use this as anything other than a BVM?

 

[Clipper1]

I have a pneumatic ParaPack vent with only a rate, volume, max pressure and two-position FiO2. CPAP is a separate unit, CPAP only. How do I use this as anything other than a BVM?

This ventilator has a more sensitive triggering mechanism for it to function in the AC mode by delivering each breath requested. But you can also adjust ITime to increase rate and allow more flow. This ventilator is actually comfortable for spontaneously breathing patients. But, it is at a disadvantage for CC patients if it doesn't have graphics unless you know the patient well which is why it is popular for inhouse transports and it is MRI compatible. We do have a couple for inhouse along with the LTV 1200s which are used for the ER Trauma/Resus bays and more complex ICU transports to CT Scan, OR etc.

The Autovent which was mentioned earlier only gives the set rate at the I:E and does not vary which is why the patient must not breathe spontaneous.

 

[Aidey]

I thought I had made that clear in some of my previous posts. Others have figured it out.

RN - Registered Nurse

This is an anonymous forum. Why do you make some post their credentials and not others? If you want specifics this should be a closed forum and the license numbers used for ID like the critical care and professional association forums.

You should not single out members because of your own bias against nurses or anyone else who is not an EMT or Paramedic. There are other professionals who are involved in EMS on a daily bases either directly or indirectly.

We don't make some post their credentials and not others. It is fully within the right of the membership to request someone reveal their level of training, however we won't make people comply. There is nothing wrong with wanting to know where information is coming from.

How can we single out members and have a bias against someone who isn't an EMT or Paramedic if we have no idea what their training level is? From reading your posts you could have been anything from an EMT going through nursing school to a Nurse Anesthetist.

 

[ExpatMedic0]

Well thank you for your advise and also your information regarding the topic on vent modes. Your more than welcome to participate in topics on the EMS forum as an RN, so please do not worry about that.

Since you where kind enough to offer advise, I would like to repay the favor. My advise to you from one provider to another.... If your bedside manner is anything like your persona on here, my advise to you would be to work on that. That is not a personal attack on you, its just your coming across a little harsh in most of your post, maybe you do not even realize it. No need to have a superiority complex and put down others. No one should be afraid to post information on this forum.

Secondly, If you would like to share knowledge and give advise to other health care providers on here, its helpful for us to know who we are speaking with. There are some extremely knowledgeable EMT Basics and even patients who post material on this forum. I do not see why you are so reluctant to brandish your RN title.

If you would like to participate in discussions and share your knowledge I think that is great. I might even learn a thing or to, I am not ashamed to admit that. However, if I (or many of the others) are to take you seriously, and not just as a troll, maybe turn that frown upside down a little :wub:

I thought I had made that clear in some of my previous posts. Others have figured it out.

RN - Registered Nurse

This is an anonymous forum. Why do you make some post their credentials and not others? If you want specifics this should be a closed forum and the license numbers used for ID like the critical care and professional association forums.

You should not single out members because of your own bias against nurses or anyone else who is not an EMT or Paramedic. There are other professionals who are involved in EMS on a daily bases either directly or indirectly.

 

[ExpatMedic0]

I don't know any of your background either but sometimes by the posts you can tell if they are just BS or might actually have some idea what they are talking about. But then you might not have enough background to understand which then might lead to your own confusion.

To think you know it all and no one else does it ignorant and arrogant. It also seem you want to believe EMTs and Paramedics are the only ones in health care who know anything or that the opinions and education of an RN who may have spent years in a critical care unit either stationary or mobile is useless.

Well I am not sure if I should be flattered that you are actually taking the time to read my post, or insulted.
I do not know it all, far from it..... the thing is... I can admit that with a smile on my face

 

[Clipper1]

Well thank you for your advise and also your information regarding the topic on vent modes. Your more than welcome to participate in topics on the EMS forum as an RN, so please do not worry about that.

Since you where kind enough to offer advise, I would like to repay the favor. My advise to you from one provider to another.... If your bedside manner is anything like your persona on here, my advise to you would be to work on that. That is not a personal attack on you, its just your coming across a little harsh in most of your post, maybe you do not even realize it. No need to have a superiority complex and put down others. No one should be afraid to post information on this forum.

Secondly, If you would like to share knowledge and give advise to other health care providers on here, its helpful for us to know who we are speaking with. There are some extremely knowledgeable EMT Basics and even patients who post material on this forum. I do not see why you are so reluctant to brandish your RN title.

If you would like to participate in discussions and share your knowledge I think that is great. I might even learn a thing or to, I am not ashamed to admit that. However, if I (or many of the others) are to take you seriously, and not just as a troll, maybe turn that frown upside down a little :wub:

What's with the double standard? Your post says it all. "Gee the mean nurse is picking on the EMTs and Paramedics again". If you can't stand your ground through showing reason you resort to personal attacks. That also includes some of forum managers.

One thing I can not stand is those who argue about something but haven't read what they have posted as a reference which clearly contradicts what they are stating or those who refuse to seek out more than hearsay or what they have read on these anonymous open forums.

I and my profession have been bashed here and I have tried to play nice. I must reveal my credentials but I don't see others being made to do the same every time they come to post.

If I do put up my full credentials I will be bashed for showing off education. Also, I have already taken note here how those who have put RN on their profile are treated here.

It truly is a no win situation for RNs on these forums. Nursing sites don't have any objection when an EMT or Paramedic enters a discussion.

 

[Aidey]

What's with the double standard? Your post says it all. "Gee the mean nurse is picking on the EMTs and Paramedics again". If you can't stand your ground through showing reason you resort to personal attacks. That also includes some of forum managers.

One thing I can not stand is those who argue about something but haven't read what they have posted as a reference which clearly contradicts what they are stating or those who refuse to seek out more than hearsay or what they have read on these anonymous open forums.

I and my profession have been bashed here and I have tried to play nice. I must reveal my credentials but I don't see others being made to do the same every time they come to post.

If I do put up my full credentials I will be bashed for showing off education. Also, I have already taken note here how those who have put RN on their profile are treated here.

It truly is a no win situation for RNs on these forums. Nursing sites don't have any objection when an EMT or Paramedic enters a discussion.

There is no double standard, Expat was trying to be helpful and give you advice on how to communicate better so that your posts don't come off as abrasive. No one is accusing RNs of picking on EMTs and Paramedics. No one is bashing you or RNs. You were not forced to reveal your credentials, it was a polite request that you could have easily refused. No one is ever going to "bash" someone for having a good education.

I think if you ask the other RNs and RN students on this board, they will not report the same feeling of persecution like you seem to feel.

 

[ExpatMedic0]

 

[RocketMedic]

I don't think EMTLife is a forum where we criticize people for being educated, Clipper1.

 

[RocketMedic]

This ventilator has a more sensitive triggering mechanism for it to function in the AC mode by delivering each breath requested. But you can also adjust ITime to increase rate and allow more flow. This ventilator is actually comfortable for spontaneously breathing patients. But, it is at a disadvantage for CC patients if it doesn't have graphics unless you know the patient well which is why it is popular for inhouse transports and it is MRI compatible. We do have a couple for inhouse along with the LTV 1200s which are used for the ER Trauma/Resus bays and more complex ICU transports to CT Scan, OR etc.

The Autovent which was mentioned earlier only gives the set rate at the I:E and does not vary which is why the patient must not breathe spontaneous.

http://www.smiths-medical.com/catal...eupac/para-pac/pneupac-parapac-mri-p200d.html

That's what I have to work with, coming from http://www.impactinstrumentation.com/731.html .

How do I adjust I:E time on the Parapac? This thing literally only lets me set pressure, rate and FiO2.

 

[shfd739]

http://www.smiths-medical.com/catal...eupac/para-pac/pneupac-parapac-mri-p200d.html

That's what I have to work with, coming from http://www.impactinstrumentation.com/731.html .

How do I adjust I:E time on the Parapac? This thing literally only lets me set pressure, rate and FiO2.

Looks like the Parapac is a set IE with no way to adjust.

We just got the 731s to replace 754s..So nice and can be setup/tweaked for the majority of the patients we transport. Wasnt always the case with the 754s.

 

[Carlos Danger]

I think if you ask the other RNs and RN students on this board, they will not report the same feeling of persecution like you seem to feel.

Persecution? No.

A bit of a double standard, in terms of how little RN-->medic criticism is tolerated vs. medic-->RN criticism? Yeah, I'd say so.

I suppose it's understandable though, this being an EMS forum and all.

 

[Carlos Danger]

The best vent mode is dependent on the clinical situation. In most cases, it really doesn't matter if you do AC vs. SIMV vs. PRVC, or even pressure vs. volume limited. Assuming set parameters are reasonable, of course.

We used an LTV-1200 on most transports and I found SIMV to work well in most patients, usually volume limited but pressure limited was sometimes helpful. Pressure support was helpful in some patients, as well.

We also had a Maquet Servo-i available. During the swine flu outbreak a few years ago, I transported some of the sickest patients I've ever seen on the Servo-i. Often they would ventilate much better on APRV than on the PRVC that we usually found them on at the referring facility.