I would like to respond to Ventqueen's comments.
1) In regards to the Servo-i's poor/limited response to neonatal ventilation. The servo-i can ventilate anything from 500 grams to 250 kg's. I seen a slide of the vent attatched to a 25 gram rat in an respiratory physiology lab, and the rat is spont. triggering the vent. The Servo-i is able to compensate for compressible circuit volume loss so there is no need for a proximal sensor( the company is making one for those neonatoligist who like them. The statement reguarding the insp/exp volumes being inaccurate(even stated in user manual)ALL VENTS have volume and pressure variences. The servo-i has one of the tightest variences. The servo-i does not have ATC because when you turn the ATC on you are adding PS to the vent without the physician knowing. ATC is nothing more than PS and all vents have PS. You are wrong about the Servo-i not being able to compensate for a leak. They have Insp cycle off, which compensates for leaks on spont. breaths.(Mandatory breaths cycle off based on set I-time) You can do an NIF on the servo-i just as you can on other vents. My question is why would any therapist report a single breath NIF to a physician.(not a true NIF)I'm not sure where you were trying to go with the statement "spont. breathing in PRVC is poor". The servo-i looks at your patients change in complience 2000 times a second and adjusts the flow to deliver the ordered Vt in the set I-time at the lowest pressure possible. Depending on the size of your patient leak you should use Pressure ventilation instead of Volume ventilation. This is true with any vent. That being said you can use PRVC on patients with leaks. The expiratory cassett is not that expensive when you compare it to the cost of changing your proximal sensor on the XL. Each servo-i comes with 2 cassetts and each one is guaranteed to last 10 million breaths. The only difference between the servo-i Bi-vent and APRV is the servo-i can set a PS above Phigh seperate from the PS at Plow. On all other vents, the PS levels are the same for Phigh and Plow.(including the XL)The servo-i is a great vent that can be used on any patient population.

iwould like to add to the above that the e-vent`s insperation also has seperate ps levels for p-hi & p-lo this if i remember right is on it since 2002 and on servoi with ver-2.0 only
regards;

To Novice-

The servo-i has had the ability to set PS above Phigh and Plow at different levels since it came out with Bi-vent.

Whoa!!!!! I think Dr Downs would take issue with you stating that Dr. Habashi developed APRV!!!!! Dr Downs developed ARRV when Dr Habashi was an intern!!!!

By the way...open lung tool on the Maquet is a nice best Peep manuever, that's all. Not that that is bad, but it's no breakthough technology!!!

Also, Length is not a issue in ATC to any great degree at all. Remember your Respiratory equations from RT 101? The bigger issue with ATC is the accumulation of secretions that no company accounts for.

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Originally posted by ventqueen:
I disagree with smd44, it would be the Drager Evita XL, hands down. It now has the open lung tool that you can set to measure this procedure in a low flow state which is more accurate then the Servo i. It also has the ATC option that works during inspiration, expiration, and now if you would like only during the spont. breath.
Drager has a clinical and educational group (ICON) available 24 hours a day. ICON is run by Dr. Habashi who developed APRV. Everyone copies his method of using APRV including Servo i.

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Dr. Smetana,

I am sorry, you are correct Dr. Downs developed APRV. At our facility we use APRV the way it has been suggested by Dr. Habashi. When we first used APRV we weren't sure how to use it and so we would set it up like PC,
Thigh 2 or 3 and Tlow of 1 second. We have had great success using shorter Tlow's.

Again I do apologize for my previous statement.

No literature supports using PS on the PeepH.

quote:

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Originally posted by novice:
iwould like to add to the above that the e-vent`s insperation also has seperate ps levels for p-hi & p-lo this if i remember right is on it since 2002 and on servoi with ver-2.0 only
regards;

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Why would you say their clinical priciples are sound? I do not understand what you mean by that? You say their in house experience shows that. What does that mean? How is it high performance? Who has studied it's performance? Have there been published studies on it's performance (ie flow, pressure charecterisitcs)? If it has been recently introduced in the SEA, there is really no way to say that it is a cost effective machine, is there?. Where is it's track record? It's repair record? It's failure record?

I don't mean to pick on the poster or the e-vent, but these inncessant discussions on what is the best vent are never backed up by anything but opinion, no facts, no studies, no hard data. There is a post here that says "It may come down to personal opinion", and that is the most honest answer I have ever seen on this board regarding this subject!!!

As for the E-vent, all I know about it is that rep in my area say that it was designed by Puritan Bennett, and "It is really a PB vent that was taken with them when they left". Yet, I know it was designed by 2 people who used to work for PB from reading posts from those very people on this very board. They did not "take" it with them, nor did PB have anything to do with the development or design of the vent at all. Perhaps the folks who developed it took ideas with them, but it was not a vent that they wheeled out the door!!!! I would find that hard to believe!!!

It was being marketed to us under false pretenses in my hospital, and I did not appreciate it.

This is in no way a slight against the e-vent, or the company, just the rep who demonstrated it to us.

quote:

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Originally posted by Ventman 67:
Whilst the eVent Inspiration has only recently arrived here in Australia (A near 100% NPB 840 - Drager Evita market) it has gained wide acceptance across SEA across numerous clinical sites.

Well worth a look. The clinical principles are certainly sound and the company demonstrates its in-house experience through this. As the company states they are offering a high performance, cost effective, low maintenance ventilation solutions.

For 90% of the global ventilation community that more than meets their needs.

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This response is for Oldtimer.

Your comment comparing ATC and pressure support ventilation is why off. ATC or TC is completely different from pressure support. Last time I checked you had to trigger a pressure supported breath which delivered a SET PRESSURE regardless of patient flow demand. This PS Breath is delivered with a decelerating flow of gas; completely different from the way ATC works.

I would suggest reading Dr. Habashi's comments under the heading "Which is your favorite vent" for a detailed explaination on why PSV is inferior to ATC. And are you serious with this comment:

"The servo-i does not have ATC because when you turn the ATC on you are adding PS to the vent without the physician knowing."? Boy the servo-i is outdated with this logic.

Point of ventilator order, (gavel pounds on desk, coughs, grabs a jelly bean off desk before spitting into spittoon).....

Without depositing myself directly into the argument, I would like to point out that

TC (Tube Compensation) on the PB 840 does provide Pressure Support ONLY up to the level calculated to negate the ET tube resistance--taking into account the ENTERED ET or trache tube size AND the measured patient flow demand. It only can be activated in Spont or SIMV mode. But once so activated, what is provided is a variable level of pressure support ONLY up to the tube compensation point. The breath must start by patient flow, and then ends by the flow termination criteria. That's pressure support.

By contrast Automatic Tube Compensation (ATC) on the Drager Vent will project ANY PRESSURE TARGET set to the calculated tracheal value. If the patient is in PCV the set Pi will then be increased to compensate for the combination of entered ET/trache size and measured patient flow. Ditto with any PS, or hybrid PC/VC breaths in SIMV or CMV when Autoflow is active.
On the expiratory side the ventilator will drop any set peep so that the calculated tracheal will hold sway as the target throughout the expiratory period. (One can disable this feature if set peep is wanted to be kept on for airway splinting).

ATC can be pressure support, pressure control, or even volume control if you agree that correct classification of the PC/VC hybrids is volume control. As it works on the exp side also I would call it a "pressure target projector". If we ever get ventilators with PAV or the P0.1 Controller this will be a concept we'll all have to become handy with.

TC and ATC are not the same thing. Different ventilators, different philosophies of application, different trade-offs in terms of risk/benefit.

Council you may call your next witness.....(a crying Evita vent steps to the witness stand and under cross examination is asked ala Regis "is this your carinal answer"?)

Then did you hear what Miss Evita Ventilator said during her cross exam?

She belted out a

"Don't get too high on me before I wean ya"

Get it?

Evita,

Dont' Cry for Me Argentina.