Demand Valve for Pulmonary Edema?

[Dustdevil]

I must admit I am not up to speed on "resistances and retards," but I will make sure I am.

Stick around here and you will learn more than you ever wanted to know about retards.

I know I have. :?

As to your original question, I agree that a demand valve is not at all what you are looking for. Plus five for some pretty serious and intelligent research. But, while your theories make a little sense on the surface, they don't really bear out. In the hands of a very experienced and very educated provider, a demand valve can be a useful tool for emergency ventilation. Personally, I love them. The risks involved seem to be grossly overstated because, frankly, they have to be or else too many idiots will misuse the devices. But I don't think they have any place in general field EMS these days. And they don't provide any of the benefits you say you are looking for.

The list of more useful things to spend that kind of money on is long and distinguished.

[CivilDefense2002]

Yeah, I can see that providing PAP during inspiration wouldn't be anywhere near a replacement for CPAP. Maybe a slight benefit, but the collapse of the airways during expiration would probably make it negligable. Might be something to do a research study upon in the future. I'd be interested to know if it does do anything of utility.

I still feel the research shows demand valve is the way to go over BVM. I think it'll also save us a lot of money over the long-term. A BVM costs $25 each generally. Demand valve $400. You only need to use 16 BVMs to equal to the cost of the demand valve. You also have to factor in the oxygen savings due to having continous flow in a BVM, and demand flow with the MTV. On the other hand, the demand valve needs to be serviced at least yearly, and costs for that need to be factored in.

But, the big thing for me is that I find them way easier to use than BVM, it's therefore simpler to gain proficiency with (especially important for the new first responders and EMTs in my service), and most importantly the research shows better results with their use than BVM... Seems like the obvious best choice, even if it does end up being slightly more expensive.

CivilDefese2002

[VentMedic]

Yeah, I can see that providing PAP during inspiration wouldn't be anywhere near a replacement for CPAP. Maybe a slight benefit, but the collapse of the airways during expiration would probably make it negligable. Might be something to do a research study upon in the future. I'd be interested to know if it does do anything of utility.

There are mountains of research on this already. More mountains being generated every day in research hospitals on the subject.

PAP - Positive Airway Pressure is part of the CPAP - Continuous PAP. You have to grasp an understanding of the specific physics of gas properties or basic flow principles. Taking a small phrase out of context can skew the whole purpose of these concepts.

I still feel the research shows demand valve is the way to go over BVM.

The demand valve has only specific uses in EMS. The BVM can be the superior tool depending on the skill of the practitioner. But, you definitely don't want the unskilled or poorly trained using a Demand Valve.

BVM is the better choice. Not saying that you can't still have a couple of Demand Valves around.

[AZCEP]

One of the biggest problems with the demand valve is it's ease of use.

The uneducated, uninitiated provider can and will over inflate the lungs causing all types of problems.

If you have a choice, or a need for an alternative ventilation source, pick a good ventilator with the functions you need. Definitely more expensive on the front end, but you will get many years with fewer problems from the people using them.

[Richard B the EMT]

Reading the updates on this string reminded me of something.

There was a time that, instead of a Bag Valve Mask with reservour, they had a fitting that the demand valve fit into, so the "demand" of the "football" expanding would suck the O2 into itself from the demand valve. Figure the O2 would only be what was needed, and not the wasted O2 flowing out of the BVM between ventilations.

Something must have been wrong with it, or BVMs would still be set up to accept this type arrangement.

[CBEMT]

I can't believe we're still talking about this as a serious option.

[Dustdevil]

I can't believe we're still talking about this as a serious option.

Meh... he seems to have had his mind made up before ever posting this topic.

Not sure why he wanted opinions. :?

[VentMedic]

Reading the updates on this string reminded me of something.

There was a time that, instead of a Bag Valve Mask with reservour, they had a fitting that the demand valve fit into, so the "demand" of the "football" expanding would suck the O2 into itself from the demand valve. Figure the O2 would only be what was needed, and not the wasted O2 flowing out of the BVM between ventilations.

Something must have been wrong with it, or BVMs would still be set up to accept this type arrangement.

I remember those. It was like a BVM with power assist. It delivered a seriously big tidal volume effortlessly. Too effortlessly. One could get carried away and hyperventilate a patient down to a PaCO2 of 1 and a pH of 8.0.

[chbare]

And a K+ of 1.2.

Take care,

chbare.

[CivilDefense2002]

Not sure why he wanted opinions. :?

Opinions and links to research on the anecdotes I've heard about its use in PE was what I was looking for. From the lack of any research, and the great info posted here, seems like those anecdotes are just that.

Thanks for all the help.

CivilDefense2002