does anybody have any info. on this ? i was informed by a drager rep. when babylog 8000 fist came out that the ve should be atleast = to the vi or alittle above this setting, this to ensure enough flow , on the exhalation phase to minimize noenates wob. But recently i was approach with another therory of this would increase resistance therfore increasing the wob. I know that the flow set is not what is delivered to the neonate if is not needed to reach the set PIP. i would appreciate any info. or opinions RE: this.......thx.
remember as long as were sucking air we have a chance...)
Hi "Shock a Bra" (is that how you pronounce it?)
Anyway, I have some information on this topic, email me at firstname.lastname@example.org and I can send you the specifics "from the horse's mouth".
In short, most of the resistance on exh comes from the ET tube, so no need to reduce VE from VI.
BUT, if using PSV then lowering VI less than VE may allow the cycling flow criteria (15% of peak) to not cut off the breath too soon, limiting VT. It's essentially a way to then lower the risetime.
I only work in Lvl 2 Nursery and we don't really separate the VI from the VE much. But when we got our Babylogs I looked into this.
i appreciate your response.
sorry it's taken me such along time 2 get back here.
i'll write you on your other e- address as you request, too get the facts.
hows cali. i'm a born and raised cali. RRT
Our nicu just purchased these vents. The last night a 31 weeker was on simv&vg. I kept on getting a low VT alarm and could not figure out how to trouble shoot it. I increase pip, went up on VT. I talked with other RT's and they said to increase insp. time, another said increase alarm delay. Any suggestions out there?
Hard to say without being there/having more specific information.
If the flow sensor doesn't see the set alarm threshold VT for the specified delay it's going to alarm.
At the baby the cause could be that the Ti is too short, the flow too low, too low of a Peak Pressure Limit (Pi setting which functions as an upper limit in VG, as opposed to a target when VG is off), or perhaps too big an ET tube leak.
Problem could be with flow sensor, overly sensitive alarms, etc.
Did you bag the baby and run the vent with the test lung? That would be one path to troubleshoot. Check that there is no leak in circuit, that the dialed in VT can be delivered to the test lung with the specified Ti, Pi, flow, etc.
Our local Drager rep tells a tale whereby he was called out to troubleshoot a Babylog on a patient. The vent worked stellar on the test lung. On the baby and the baby was breathing around the ET tube. The baby was stable and didn't apparently need the vent.
Hey jeff... Are you familiar with the NOdomo?.. Our NICU tried having one and with all the inservice and everything.. too complicated to use.. In the end we returned the machine and got INOVENT and INOX instead. any comment?
ric mandanas jr
c/o rt dept.
hamad medical corp.
p.o. box 3050
Hadn't heard of that system before. Typed it into Google and got a description. Is it an Australian company? I know another company, Pulmonox in Canada, has an NO system as well (though I believe mostly used for transport). I believe in most other countries NO is considered just a gas and not a drug, so is WAY less expensive.
Yes, the INOVENT system is impressive in it's clinical simplicity, if also impressive in cost.
Why not just look into nebulizing Flolan?
I am glad you got rid of NoDomo. I wonder who tried to sell it to you? It is a Draeger device which failed miserably and was discontinued in 2001. When working perfectly it was very accurate. However that was very rare (again I am stating that as a former Draeger employee who has returned to clinical fold).
As far as VTlow alarm on babylog VG it is usually a combination of 2 factors: flow and peak pressure. Generally Draeger suggested adjusting flow in VG until the rise time was about 1/3 of the total Ti. Often that fixed the problem (more flow = more Tv, not that I have to tell RT forum that). If that fails, titrate Pinsp and flow until the desired Vt is reached, and remember that the Pinsp on VG is really Pmax, i.e. it is not the absolute setting, but rather pressure "limit", and if the lung compliance improves, actual Pinsp will be lower than the set.
As far as ViVe: do not invoke the name of the devil and he will not come. Leave it alone. Not a single one of the clinicians I worked with ever found a plausible use for it in a real life situation. Use the KISS principle
Has anyone heard that VIVE should nobe used with VG. I've had a clinician from Drager tell me this years ago but I can't remember the reason. Thanks
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