Transport ventilators and transport pumps

[akroeze]

Just wondering what different people use. I know they aren't all that common in EMS but I also know there as some areas that equip their units with them.

[chbare]

I worked for a ground service that had an Autovent 2000 back in the days when ventilators were a rate, fiO2 of 1, and a Vt. Scary when I look back. I currently work for a service that uses the Crossvent 4.

The most common pump I find is the minimed. We use it as well. They are fickle and diifficult with any air in the tubing, but small and allow for three lines a pump.

Take care,

chbare.

[VentMedic]

I worked for a ground service that had an Autovent 2000 back in the days when ventilators were a rate, fiO2 of 1, and a Vt. Scary when I look back. I currently work for a service that uses the Crossvent 4

For a ground EMS service, the Autovent would be more appropriate. For interfacility transport of Critical Care patients, no it would not be appropriate.

The Crossvent would not be practical for the already dead code situation.

Ventilators still utilize FiO2, Vt and rate. Much more than that and the personnel will require much more training (U.S. Paramedics). Some have the ability to titrate FiO2 and some don't. Some may not have the blender but might utilize a manual venturi to drop the FiO2 with entrainment to conserve the O2 tank.

We use the Pulmonetic 1200 but stictly for interfacility specialty and CCT.

Some of the less complex CCT teams use the paraPAC which some dislike because you have to understand I:E ratio in relation to the rate and I-time for your volume calculations. It is a rugged piece of technology that can get less intense respiratory patients from point A to point B.

The pumps will vary from for the different specialty teams as adult ICU and NICU have different equipment preferences.

Sigma Spectrum and Baxter products are our most common and a few Medsystem III pumps also in service. It used to be Baxter, Baxter, Baxter until their tubing and syringes could be adapted to other pumps.

[akroeze]

For a ground EMS service, the Autovent would be more appropriate. For interfacility transport of Critical Care patients, no it would not be appropriate.

The Crossvent would not be practical for the already dead code situation.

Ventilators still utilize FiO2, Vt and rate. Much more than that and the personnel will require much more training (U.S. Paramedics). Some have the ability to titrate FiO2 and some don't. Some may not have the blender but might utilize a manual venturi to drop the FiO2 with entrainment to conserve the O2 tank.

We use the Pulmonetic 1200 but stictly for interfacility specialty and CCT.

Some of the less complex CCT teams use the paraPAC which some dislike because you have to understand I:E ratio in relation to the rate and I-time for your volume calculations. It is a rugged piece of technology that can get less intense respiratory patients from point A to point B.

The pumps will vary from for the different specialty teams as adult ICU and NICU have different equipment preferences.

Sigma Spectrum and Baxter products are our most common and a few Medsystem III pumps also in service. It used to be Baxter, Baxter, Baxter until their tubing and syringes could be adapted to other pumps.

So what would you recommend as a transport ventilator for a 911 EMS unit to use?

[VentMedic]

The ATVs (Automatic Transport Ventilators) are recommended by the American Heart Association (AHA).

Most of these little vents are no brainers if used for the post code patient.

However, it still depends on the expertise/training/education/oversight of the providers. Some have difficulty keeping the tube in the trachea with their hands on the tube. Many services don't use ETCO2. Some wouldn't recognize compliance changes or situations of pneumo, secretions or kinked/obstructed tube. The ATVs are so simplistic that they will not alert the provider with sophisticated alarms.

For ventilation of a post code patient, it may be beneficial to provide consistant ventilation and allow for hands to be freed up for other tasks.

For other than post code patients, some EMS services may not have access to enough meds and paralytics to keep a patient comfortable on a transport vent. ATVs have limited capability when it comes to flow, demand valve responsiveness and resistance. The patient will then fight the ventilator (asynchronous) and ventilation will be ineffective.

[chbare]

For a ground EMS service, the Autovent would be more appropriate. For interfacility transport of Critical Care patients, no it would not be appropriate.

The Crossvent would not be practical for the already dead code situation.

Ventilators still utilize FiO2, Vt and rate. Much more than that and the personnel will require much more training (U.S. Paramedics). Some have the ability to titrate FiO2 and some don't. Some may not have the blender but might utilize a manual venturi to drop the FiO2 with entrainment to conserve the O2 tank.

We use the Pulmonetic 1200 but stictly for interfacility specialty and CCT.

Some of the less complex CCT teams use the paraPAC which some dislike because you have to understand I:E ratio in relation to the rate and I-time for your volume calculations. It is a rugged piece of technology that can get less intense respiratory patients from point A to point B.

The pumps will vary from for the different specialty teams as adult ICU and NICU have different equipment preferences.

Sigma Spectrum and Baxter products are our most common and a few Medsystem III pumps also in service. It used to be Baxter, Baxter, Baxter until their tubing and syringes could be adapted to other pumps.

The service did interhospital transports. A typical transport would be around an hour.

Take care,

chbare.

[Niftymedi911]

The serivce I currently work for uses the CareVent by O Two Medical systems and Medsystem III IV pumps on all of our 9-1-1 trucks. Our interfacility transfer trucks house the Eagle Vent and the Medsystem III IV pumps.

The Carevent is really simple, easy, and a hella great to use. You just set the respiratory rate and match the corresponding tidal volume and the vent does the rest. If PEEP is an issue, we have our PEEP generators which are dial in. You can start at 5 and go up from there. They plug right into the circuit tubing at the ETT adaptor for the vent. It's an awsome tool.

The only gripe I have with the Medsystem III IV pump is it's so dang sensitive to air bubbles. When your running code 3 down the road, you can't waste your time by sitting right next to the pump to restart the flow everytime because the pump detected an air bubble.

The Eagle vents are awsome. Set it and forget it. Some detailed training is required, but in all honesty, it should be considered while in Paramedic school.

We also just introduced the Res-Q-pod. It's A MUST.... the thing is a brilliant idea. Increase the pressure in the chest to allow ventricular filling, increase arterial and brain perfusion. It doesn't work as good as the auto pulse, but it sure as hell works. Accoding to AHA it's a class IIa according to CPR guidelines. Which apprently is ranked higher to use then your Class III which are your Epi, Atropine, etc. I suggest check it out.

[VentMedic]

The Eagle vents are awsome. Set it and forget it. Some detailed training is required, but in all honesty, it should be considered while in Paramedic school.

Carevent (ATV) is good for ventilating the post code or heavily sedated/paralyzed patient.

My biggest complaint about the Eagle vent is its misleading "Plateau Pressure". Too many believe it is the same Plateau Pressure that reflects the pressure applied to the small airways and alveoli which is used for Cstat determination. They think it is the same Pplat that is used in determining ARDS.

No ventilator should ever be "set and forgot".

PEEP generators and ATVs are a sticky issue especially if you can not determine the actual amount of PEEP the lungs are seeing along with its relationship to total flow, demand valve functioning or work of breathing. A resistive valve is okay but not nearly the same as internal PEEP.

If the ATV is used post code rarely is it a lung situation that is requiring PEEP to get the oxygenation levels up. It is a pump problem. Even on the ICUs we will shut off the PEEP until we can get BP MAP to an adequate level and enough appropriate pressors hanging to hold up to the application of PEEP and/or aggressive ventilation and oxygenation.

[Niftymedi911]

Carevent (ATV) is good for ventilating the post code or heavily sedated/paralyzed patient.

No ventilator should ever be "set and forgot".

Vent, you know what I meant by that................

There are certain situations like, a CHF'er post code, or even a respiratory arrest CHFer who will need the PEEP to aid in respiration. I'm not saying we use the PEEP dial for regular use, just stating it's capabilities.