prehospital c pap usage

[EMS828]

I would like to hear from anyone who has used a c pap prehospital. The issue i ran into is that i was tranfering a patient from a hospital to another hospital that was on a c pap. i had a full tnk of O2 (2000psi). By the time i got to my destination which was about a 30-35 minute ride time I used 1500psi. I personally think that this is a little much usage of O2, when sometimes we only have 500-1000psi sometimes in our tanks. Most of our prehospital transports are sometimes 35-45 minutes. Any thoughts or problems with the c paps anybody uses. (i am not sure of the odel or maker of the machine)

thanks

ems828

[Ridryder 911]

We use CPAP at least daily on several types of patients. We no longer just use on CHF but on majority of pulmonary congestion. It has reduced our admissions about in half, as well ICU admission three fourth's and elective intubations to nearly neal.

It is true it uses a lot of oxygen. Some CPAPs are beter than others. We use Emergent Portovent and appears to be conservative and easy to use.

Here is the link for some articles in regards to CPAP, that you might find helpful.

http://www.merginet.com/index.cfm?pg=airway&fn=CPAPuser

http://www.emsresponder.com/features/artic...=11&id=6076

R/r 911

[clintonmedic378]

On my service, we use CPAP for patients with COPD or CHF that present with a SA02 less than 90%. I have used CPAP twice over the last year and found it to be very beneficial. I agree that it does take up a lot of oxygen and if you have the long transport times, you should have an extra oxygen bottle on board or really watch your oxygen in the main line.

[triemal04]

CPAP does burn through and O2 cylinder pretty fast, (some systems more so than others apparently), but it is most definitely worth it. Since it's been introduced here it's kept me from having to intubate several pt's that I would have had to awhile back.

It has made me a lot more conscious of what the levels are in my O2 cylinders; generally speaking once our main tank (M) drops below about 800psi I start looking to change it. Same goes for the D-tanks we carry. If you can switch out your tanks at a higher level (especially if you run a lot of respiratory calls) then start doing that, and if you know you're going on a transfer involving CPAP, get a fresh tank and several spare D's.

Trust me, having CPAP on the car, even if it makes for a bit more work, is very much worth it.

[fallout]

All CPAP uses a good bit of oxygen. I find the Whisperflow by Respironics burns through oxygen very quickly, to the point a D cylinder will last for 3-5 minutes before it is completely drained.

The Port-O-vent CPAPos, I can't remember the manufacturer off the top of my head, I've seen have a D cylinder last 10-15 minutes.

But, whatever the cost, CPAP is worth the price in reducing patient mortality, avoiding intubation and reducing or eliminating time spent in an ICU bed. Numerous studies are available that verify my statement regarding patient mortality. A google scholar search for non-invasive positive pressure support should return some of them.

As far as logistically, I bring several spare D cylinders if I will have the patient for a long time, then run the CPAP off the D-cylinder, only switching to my main while I change the regulator to a full D-cylinder.

[fiznat]

Yeah like others have said, CPAP tends to use up a lot of oxygen to power the device properly.

To be clear, what size tank are you referring to? 2000psi in one tank is not the same amount of gas as 2000psi in another, differently sized tank. Did you really go through an entire M tank in 30 minutes, or were you using a smaller sized bottle?

[captainstandup]

We switched from M cylinders to dual H cylinders on each truck for both the oxygen and medical air. Our ventilators ( I-vents) are electrically powered (instead of oxygen or air powered) and have a great deal of adjustment in terms of FiO2 etc, which based on the clinical presentation of a given patient can be very helpful. I agree CPAP can be rather "O2 thirsty" but honestly oxygen is likely the cheapest drug you carry although wrestling those H tanks can be challenging. Hey how bad is blue anyway?

[JakeEMTP]

wrestling those H tanks can be challenging.

Not if you have one of these on your ambulance 8)! We have one on our newest unit. Well worth the money and the County gets a break on their Workers Comp because of it.

http://www.ziamatic.com/3000-ots.HTM

Yeah, CPAP use quite a bit of O2. As others have stated, carrying extra cylinders with you is the way to go for long transports.

[VentMedic]

The O2 cylinders you have available and transport distance should be discussed prior to any service purchasing a CPAP device. I use the term device because very few prehospital CPAP gadgets qualify as a machine. The salesperson or clinical trainer for the CPAP device or machine should have thoroughly discussed all ups and downs to using that particular CPAP device. The manufacturers did do elaborate studies and do have all the information for O2 consumption of their product. If you know the flow required from your tank, you can do the math with the cylinder factor.

The other thing to consider, which is dependent on the machine or device you are using, is what happens to total flow if you adjust the FiO2. Different systems will have different venturi type entrainment systems which can dramatically affect total flow to the patient by just changing the FiO2. Many systems are dependent on room air entrainment for total flow thus a higher FiO2 can actually decrease the total flow to a patient requiring more minute volume than the device can provide at the higher FiO2. A 15 liter flow is not much for someone in distress that wants 25 liters for MV.

CPAP has been around for more than 50 years. I've used it for transport for almost 30 years through various ventilators and flow generators. Some of the ventilators were more gas efficient than some of the CPAP devices on the market now.

Good article link listed below that shows some of the factors looked at when selecting CPAP units. These things should be asked of a clinical salesperson as they pertain to you patient population and transport time. Due to fatique from work of breathing for the patient, we would not consider using any of the prehospital devices in the ED for any longer than a switchover to a hospital machine or a quick post op recovery.

http://www.cardinal.com/mps/focus/respirat...3%20Branson.asp

[Novisen]

Hello!

We have used the Wisperflow with a fixed flow output for the last 15 years. Often you don´t have to use 15 liters/min to get enough flow to the patient. I use 12 liters whenever I can. If every O2 cylinder in the ambulance is full we have atleast 300 minutes to get to the hospital when using 15 liters/min. http://whisperflow.respironics.com/Features.asp

I´dont see any benefits with having a CPAP with variable flow. Alveolar ventilation is improved in a matter of minutes and saturation is always about 95-98% in five minutes even when the patient have an saturation at 60%. High PaO2 can reduce coronary flow and reduce Cardiac output.

And then I hope someone can explain M-tank, D.cylinder, PSI etc.? Thanks!

In Sweden we have cylinders with 2.5 liters and 5 liters in ambulances. They are filled with a pressure of 210bar=3000PSI. Thats 525 liters and 1050liters. http://en.wikipedia.org/wiki/Bar_%28unit%29