VentWorld    VentWorld    ventworld.infopop.cc  Hop To Forum Categories  RC Professionals    Servo i versus PB 840
Page 1 2 3 4 5 
Go
New
Find
Notify
Tools
Reply
  
Servo i versus PB 840
 Login/Join
 
Member
posted Hide Post
I read a lot of BS on this site. It comes from people who think they know a lot. In reality they know their own little universe. It is not my responsibility to enlighten you. It is your responsibility to go out and read the current literature in a reputable journal (not Respiratory Care Rag Mag).
If you find no need for new technology and forward thinking, just stick with what you have. You will be fine. Your patient on the other hand may not. I for one look forward to the day where my patient can give me feedback. Is the support too much, too little, how's my sedation level? I am not the one connected to tubes and wires, poked and proded all day long. I would much rather be taken care of a therapist that didn't think I was 'just fine and dandy' when I have an ETT stuck in my throat. And yes Servo was the first vent to have Pressure Support. That is an undeniable fact.
 
Posts: 21 | Registered: December 10, 2007Reply With QuoteReport This Post
Member
Picture of JeffWhitnack
posted Hide Post
For all the ranting and raving...you aren't advocating doing anything about the ET tube. You want to affix a fine and dandy attachment to the end of an NG tube. Look I'm all for discussing NAVA--in fact I am actually quite willing to look at it as a potential positive feature, at least for some patients.

It might also exist at the interface between research and widespread clinical applications (like indirect calorimetry, potentially volumetric capnography--things which, while perhaps not adopted widespread will affect practice by a certain clinical mass of use and understanding).

I just arrive at the discussion asking "what's the problem with current trigger mechanisms"?. But when you pose some ordinate position, after exposing a BASIC lack of knowledge of PAV....
 
Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002Reply With QuoteReport This Post
Member
posted Hide Post
Please read the Article:
New Modes of Mechanical Ventilation:Proportional assist ventilation,neurally adjusted ventilatory assist, fractal assist ventilation.
Written by Navalesi, Curr Opin Crit Care 9:51-58 2003

You also keep referring to the NG tube. It really isn't that big of deal as you are making it seem. Most ICU patients have one. Why not tap into this accessory to gain valuable knowledge about the inner workings of our patients.

An answer to your question about trigger. There isn't anything wrong with them. Most vents are pretty good and responsive on the front end. It's on the end of the breath where we as clinicians fail miserably in setting inspiratory time and cycle off. However, it's not our fault since with current technology we don't know where to set it.

You blasted the 300 for having a preset cycle off of 5%. That was in the past. All vents now have an wide adjsutable range. Where do most RT's set it? The default, never to be looked at again! Now who should 'hang their heads in shame'.

You say I don't talk about how to get the ETT out. I say let's try at all costs not to put it in. Maybe Nava will help us in the future to do bipap or NCPAP better. Avoiding intubation all together.

If you want to know the specifics about Nava you need to do a lit search and find articles and read how the signal is obtained. What happens if the NG moves? Why may this be a more ideal way to ventilate? I have a lot of articles, but I challenge you to go out and find the information for youself. Isn't that what we tell our kids? Look it up.

Nava is a complex technology. Many will not understand or use this new fangled contraption. I know my Grandma never learned to use a computer. It just won't be in the cards for some clinicians.
 
Posts: 21 | Registered: December 10, 2007Reply With QuoteReport This Post
Member
MSN does not support status - click here for the profile.
posted Hide Post
Interesting thoughts. I believe Pressure Support was first introduced and invented by the Ebgstrom. (the bag in the box vent) PAV has been studied quite extensively and not published in Respiratory Care. The work was done by Dr. Magdy Younes (sp.). I believe the problem is related to how the 840 translates that technology to it's technology. Dr. Younes used and piston based vent I believe while the 840 is psols. The background research was probably much larger. Let's hope that the Respiratory Care professional community lead the way towards verifying new available technology versus letting the engineers at the ventilator company selling us.
 
Posts: 32 | Location: Powder Springs, GA | Registered: January 18, 2003Reply With QuoteReport This Post
Member
MSN does not support status - click here for the profile.
posted Hide Post
I meant Engstrom. Sorry
 
Posts: 32 | Location: Powder Springs, GA | Registered: January 18, 2003Reply With QuoteReport This Post
Member
Picture of JeffWhitnack
posted Hide Post
Seatac,

I agree the NG tube PLACEMENT may not be that big of an idea IF the patient is intubated--though with the current "Peg 'em, Trache 'em" that also may be not as prevelant in some places and patients. But then you are also advocating/speculating that NAVA could be used non-invasively.

The 300A PS's 5% Flow termination WOULD be a thing of the past IF those vents were no longer being used clinically anywhere. Such is not the case. I find it ironic that one of the things being advocated for NAVA is that it can help patients signal even when auto-peep is such that it prevents triggering. First the combination of 300 PS breath termination AND AutoMode has been proven in a study to instill auto peep and that problem. Just go and look at any patient on PS on a 300A and look at the end insp pressure blip....now NAVA will either fix that, or add to the auto peep if not fixed first.

I have gotten a copy of the article you cited and briefly read it over once. It seems to tout the PAV concept as a good goal, but then comes in and says that the best way to implement PAV is via NAVA patient/vent synchrony.

The article also, I believe, starts out with a premise I bascially disagree with. It seems to think there is some divide between "control modes" and "partial support modes". Technology, if not mode labeling and vent advertising, has made a mockery of this basic concept. Many patients on supposed control modes are triggering the breaths. It is an artificial divide which keeps us chasing our tails (be it breath termination or the quest for the ever better mode for partial support).
 
Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002Reply With QuoteReport This Post
Member
posted Hide Post
You are possibly correct. 'Invented' was probably not the correct choice of words. However, Servo was the first to bring Pressure support to market on a ventilator. What do we know about pressure support? Not much. There has never been a large randomized controlled trial regarding it. Still it's a widely accepted practice. We think we know how to set it, 5, 10, 15, but in reality it's just guess. What about Ardsnet. It told us 6 ml/kg is better than 12 ml/kg, that's all. What about 8 or 10 ml/kg. ArdsNet cost our government, i.e. the taxpayer a lot of money. I doubt we will see a study of that magnitude again.

Things we see on vents are not the brain child of an engineer at the company. It usually starts with a scientist. That scientist then has to present a business case to the ventilator company so they want to make it part of the vent. PAV, SmartCare, ASV, in their infancy were thought up by someone in the medical community. The engineers then have to write the software and programs to make it work. Then you have the FDA to deal with. Anyway I am looking forward to Nava and what additional information it will provide.

I'm sure this whole thread is getting very tedious for some to read.
 
Posts: 21 | Registered: December 10, 2007Reply With QuoteReport This Post
Member
Picture of JeffWhitnack
posted Hide Post
I replied to above thread, but apparently waitng to be approved. I have several articles about NAVA (inlcuding the one cited) and will get back in more detail after having read them. Perhaps in separate thread for discussion.
 
Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002Reply With QuoteReport This Post
Member
Picture of JeffWhitnack
posted Hide Post
Will try again what I posted earlier.

The 300A is not totally in the past. Many hospitals still use them..

Chest. 2003;124:2275-2282.
Practice Variation in Respiratory Therapy Documentation During Mechanical Ventilation
"...ventilators were available at each hospital. The most common were as follows: model 7200 (Puritan Bennett; Pleasanton, CA); and Servo 300A and 900C "

To my knowledge there has been no recall to fix that 5% flow termination problem. So it is not at all in the past. I don't know if there are any NAVA studies in which the Servo 300A and PS were studied. If so I would find it both ironic and comical that a device was invented which seems superior in fixing a previous device's problem.

As far as the NG tube. Yes many, even most, ICU patients do have an NG. But they get dislodged, get pulled out, etc. And you seem to be advocating NAVA for NIV interface. Does that mean these patients will now all need NG's also?

I briefly read the paper you cited. I will get back in more detail as regards NAVA. But I disagree most vehmently with the paper's separation between control and partial support modes. This is a mental construct of a separation based on much older technology. Now a patient can actually be on what was used to be considered full support (A/C for instance) and, provided the patient triggers some breaths, it's actually partial support.

The article was also interesting in that it clearly portrays NAVA as being akin to a house built upon a PAV foundation.
 
Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002Reply With QuoteReport This Post
Member
posted Hide Post
Mr Whitnack,

That you have the audacity to discount a published article in a critical care journal by Paolo Navalesi is laughable. Let compare your published data to his. However I do give you props for actually reading it.
Don't be so incredulous about an NG tube. Walk through your ICU and look at sick patients. They all have one. It's not that out of this world.
I honestly don't care which came first. PAV or Nava. They are all tring to acomplish the same idea. I am not a PB user. Stopped using them in the late 90's. By the time I retire or go do something else I will never be. I have no interest in using PAV. I do have interest in using Nava.
I also don't think you know as much as you propose to. But then again neither do I.
Peace.
 
Posts: 21 | Registered: December 10, 2007Reply With QuoteReport This Post
  Powered by Social Strata Page 1 2 3 4 5  
 

VentWorld    VentWorld    ventworld.infopop.cc  Hop To Forum Categories  RC Professionals    Servo i versus PB 840

© Copyright Equipment Simulations LLC, 2000-10. All rights reserved.