Having worked with both I would say its a tough question. I agree you sort of need to look at the needs of your facility. Certainly both companies offer great service, and on site training. Both are very responsive vents.
I think the Servo may offer a stronger platform for further RandD. For example NAVA when it comes online promises to bring a whole new realm to patient ventilator interfacing which should markedly reduce WOB and response. On the otherhand the 840 PAV is an interesting approach to similar issues. The Servo using some form of fandangled opposing ultrasonic transducer.
I like the layout of the 840 much more than the Servo. I like the split screen allowing you to see your changes then accept them without interfering with your waveforms. The graphics package in the "I" is not "buffered" so you get a more raw picture which is great.
Both can do NonInvasive well. The I in my opinion does it better. It is set up as a separate mode and presets many of the alarms and bias flow ect.
Both are versatile with respect to patient population.
With regard to cleaning. The I is extremely simple only having really one cartrige to sterilize. The rest of course being disposable. The 840 about the same with a slightly more cumbersome exhalation setup does have a watertrap which the I does not.
As with many vents this day and age, I think it really comes down to splitting hairs. You can pretty much go with your prefs on this one. I am oblivious to pricing I know they ain't cheep. My only final though is that McKay has seems to have some excellent adjunts on the horizon.
Background Used everything from a Servo 900A to a Bird Mark VII, an Emerson Post Op to the 804.
There is a lot of personal preference. None are very bad. Some are very good. Others are really good but misunderstood.
Personally, I love the PB-840 w BiLevel. Give me Bi-Level and I can ventilate anything from a rat to Giraffe, anything inbetwee Human or otherwise.
The Siemens 900-C was my all-time favorite. Once you understand it, you can do nearly anything. However, the 840 with Bi-Level can not be beat. Getting the docs to understand pressure ventilation is a chore. The nurses are worse. But when the epiphany hits, you won't have any problems.
I am speaking from someone who had a great many issues with PB. The MA II, MA 2+2, SA-1, SA-2, etc.. The 840 was actually well thoughtout.
Bid Screen, Touch Screen, Flow Control Valves second to none and Bi-Level. If you start with conventional ventilation, move to pressure control, wean to SIMV, then to CPAP - You don't understand the physiology behind the 840.
Start Pressure Control early, titrate to Bi-level, watch the Mean Pressure as a primary monitoring tool for the ventilator and transition to CPAP when the pressure is appropriate. Then titrate the CPAP until you extubate. Now you are getting somewhere.
Also, watch your Cardiac Ouput and the Urine. Kick up the fluids and the Inotrops and when you begin to wean by dropping the mean airway pressure, wean the fluids and the inotropes as well. Mean Airway Pressure amd Mean Arterial pressure should stay in the same proportional range: Not equal but proportional. Failure to do this and the patient will fail most of the time by going into pulmonary edema. This is especially true if you try going from Bi-Level or Pressure control right to Conventional ventilation. I have worked with extreme high risk cases -open chest, closed chest, multimple chest tubes, etc.
Another point: Most time the people who have no trouble with this type of ventilation are thos that have significant ventilation with infants and preemies and those forced to ventilate a patient solely with a Bird Mark VII for a prolonged period of time. Why? Because they know and understand pressure ventilation inside and out. There are still a few of us left.
Best I can offer as to the choice. Siemens, also, had issue with their ventilator imports a while back. Backorders are not a good thing. University of Maryland Shock Trauma Center used to be a Siemen's shop but lost out to Drager a few years ago. I believe the 840 is a totally domestic ventilator.
breathe on each ventilator and the choice will be extremely obvious.
breathe on each one and the choice will be very obvious
I work with servo I's and 840's. Whenever we use the heated circuits on the servo's we have to change filters every 4h's which is connected to the Exp. end of the circuit and the other end is connected to the vent. The 840 has a different drain system where once a shift we drain what water is there. On the servo it isn't possible. This is a big issue when someone is on high amounts of PEEP and we have to break the circuit to change the filter. Can anyone tell me what we are doing wrong or is this an ongoing problem. thanks
Personal preference may tell you what is the most popular but it will tell you very little about performance. If you want to get into the details of how ventilators compare to one another in terms of triggering, pressurization and flow delivery then check out this site.
This is an unbiased look at what really matters to the patient and not what the enduser is comfortable with. You might have a bit of trouble navigating through the French but Ventilation is easy to spot. Also a great comparison done but this group (Andrew D. Marchese; Daniel W. Chipman BS, RRT; Pedro de la Oliva MD, PhD; Robert M. Kacmarek PhD, RRT ) looking at neonatal options and how they compare on Adult vents. It was a poster presentation done at this years AARC. If you cant find it let me know and I can email it to you.
Remember its not always the vents fault sometimes the problem is with the driver.
There is really no comparison. Yes, the 84o is an adequate vent. However it's old. That platform has been out since early 2000. There is nothing new on it. The Servo i is constantly adding and adapting. Now you can get it for MRI and nava has just become available. All the other platforms are stagnant and playing catch up. If you want state of the art and a multitude of options I would go with the Servo i.
Nothing new on the 840? What about PAV. what about the fact that the 840 had many of the features of the Servoi 8 years ago and Servoi is the one playing catch up?
The Drager has had a simuair platform for years and is still one of the top vents and can do what ever the I does aside from NAVA and it has not had that big of a bang yet from the clinical sites that have had the opportunity to use it. and if you just want to compare features the Drager has Smartcare and the ability to do PPS simulair to PAV.
Most of the new generation vents are all adaptable because they are software based. Adding new things does not make it better though. New software upgrades offered by the company might only change a few user details but cost hundreds to thousands of dollars per vent.
My suggestion is to bring the 840, servoi, Drager XL and avea in to your hospital and let your staff try them out. Which ever vent they feel more comfortable using, go with it.
IMO Drager XL, Servoi, Avea, 840.
Well I guess we have a debate going. Always fun and entertaining. First let's look at the Evita/XL. Why would you mention PPS? It's not even FDA approved for the US. What about Smart Care? Great idea if you don't have RT's and weaning protocols. It was developed in Europe where nurses run the vents along with IV's, meds, bowel care, etc. It is based upon one docs idea of weaning and uses ETCO2 as it's basis for changes. What if there is a shunt or leak? It also does not go across all patient populations or disease processes. Now let's look at PAV. It is not new. It has been around since the 90's and stil has yet to gain mainstream acceptance. Poll 840 users and there are a lot of them. No one uses it. It requires an ETT of 6.0 or above and you can have NO leak. One big problem with PAV is as the patient starts to pull harder the vent assumes that it needs to decrease support. What if that patient is actually in trouble and needs more support? A mathematical calculation cannot differentiate that. Now NAVA. New and exciting. You can actually see the patients physiological response to changes made on the vent. That's the difference with NAVA. It goes based upon the physiological response of the patient. Novel idea, thinking about what the patient needs. Do you remember pulse oximetry in the 80's? We triaged patients to it. Now it's a standard of care. I would like for you to en-Light-en me on how you would know the response from clinical sites? I think you should also en-Light-en yourself on the technology of NAVA. If you blow it off you are not as smart as you think you are. NAVA just became available for purchase and many of us Servo-heads are very much interested. Time will tell if it's better. I'm sure all of the old timers said the same thing about pressure support when SERVO introduced it back in the 80's.
The bottom line is that the majority of RT's are only interested in turning knobs, writing down numbers they don't understand and calling it a day at the end of 12 hours. Any vent will do with that scenario. Why even bother with trying them out? Just buy the cheapest one and call it a day.
I need to clear up a mistake. PAV DOES NOT decrease support the more the patient draws in! The opposite. This is funny because at a recent state conference a ServoI clinical rep described NAVA as PAV advanced to neural triggering.
PAV increases the PS and/or Volume per the per cent settings and follows patient demand. I haven't used it, but my main problem with it is that people will now use it to "wean" the support settings--in yet another bizzare subversion of the Vent Discontinuation Guidelines. Just as with Smartcare and that absurd AutoMode (PRVC to VS...whoopee!).
The fact that PAV requires a 6 or above ET tube means I guess that it's not ready for peds or neonates, nothing less.
I also find it funny that one is slamming PAV for not being used. It really hasn't been clinically available since the 90's.
Let's all hold our breaths and see how prevalent NAVA will be in 10 years...or 30.
I'm not sure if Servo did introduce PS or not. I don't care. But they should hang their PS heads in shame for having the 300 PS'f flow termination be 5% of the peak. If Servo is the "father" of PS then they did a bit of infanticide!
I don't like Smartcare for "weaning" because it's a solution based on an old mindset. And I agree that the ETCO2 dependency is a bit of a potential problem. If I were still using Dragers and had Smartcare, and the docs set on PS reductions ala weaning...I would want to turn it on it's head and use it to just assure that the support didn't go too low.
As far as NAVA goes. The patient can tell us "what he needs" a variety of ways. But it's also up to us to "tell" the patient what he needs---say the patient goes apneic, etc. Or if the patient is on ARDSnet and is generating a very large VT some people feel that is just as bad and it's best to sedate the patient (I know this is controversial, but some feel that way and won't see a benefit to NAVA).
So what is the big problem NAVA is supposed to solve? And is it worth the potential extra device, cost, monitoring, etc.? I use Pressure Trigger negative 1 and set risetime to match patient demand. I try to use VC+ (PRVC or Automode equivelant) and most of the time the patient is fine and dandy. We keep the patients on A/C and try to have them assisting the vent. We do a daily SBT. I fail to see how NAVA would be of any clinical benefit. Attaching a "hitchhiker" to the NG tube? (what if it migrates, gets pullled up or out, cardiac oscillations or pacing, phrenic nerve paralysis, etc.?). But I'm willing to be enlightened. How can one see the patient's "phsyiological response" any better with NAVA? I don't mean the benefit. If one is using PS as the standard mode and reducing it ala weaning concept of old, then yes you are very tempted to then come in and rescue the patient from the distress you've dumped in their lap. Flow trigger, Smartcare, now NAVA enhanced trigger, etc.
Fledge the patient instead of wean and this silliness could disappear!