Is it true that the Servo i is adding a flow sensor at the wye for the neonatal population? I would then use the servo i in our NICU. It is a good ventilator. The Evita XL has released new software 6.0 with new features. Is anyone aware of them? We have XLs but haven't upgraded to 6.0 University of Maryland Hospital didn't get rid of the dragers after purchasing the Servo i. The servo i replaced there servo 900c. (I was a traveller at this facility when they were purchased.)
We like the Avea ventilator with the heliox feature for the pediatric ICU. Any opinions on the Avea for neonates?
I heard rumor too that Servo-i was adding a flow sensor at the wye for the neonate modes. With the History of that company I will believe that rumor when I see it. I use to be a clinical apps person for them and they will do anything they can from adding a component outside the box. As a company they feel that this jepardizes the integrity of the machine.
As for the Avea the hospital that I work at just got done evaluating the Avea against the Hamilton Galieo, Evita XL and the Babylog. This evaluation was to see who got contract sources for the nursery in the whole health system. They went with Viasys(VIP) and the Draeger(Babylog). Maninly due to cost and the modes that we most commonly use. We ordered Babylogs and so did several of the other instituitions with in out system. Mainly because of the accruacy of the volue measurements and the quality of the sensors. I hope this helps.
I know the Avea uses about 4x's the about of heliox needed due to its blending system, so be careful about that ( we administer directly through the Servo w/o difficulty or waste). As for the Servo flow sensor, I looked on their Website and found that they are adding the flow sensor along with continous flow Cpap. We use all Servo i's here but we do not do Neo's. I agree with you though Cindy, I would definitly use the Servo in the Nicu.
Please post the evidence that APRV has been "perfected". Also, any evidence that the brand of ventilator that one uses can improve patient outcomes (like duration of ventilation or survival to discharge) would be appreciated as well.
I know of no mode of ventilation that has been "perfected", but I know of modes that may make a difference. One of those being APRV.
You may find this article interesting:
Other Approaches to open-lung ventilation: Airway pressure release ventilation. Habashi, N; Crit Care Med 2005 Vol. 33, No 3 (Suppl.)
He describes some nice outcomes utilizing this mode at his facility; 50,000+ patient hours logged ANNUALLY since 1994 and they are reporting lower mortality rates than the ARDSnet study (21.4% vs 31%). They also report a reduction in sedation requirements and the elimination of NMBA's.....
Thanks for the reply. The word "perfected" was used by ventqueen and posted December 23, 2004 to this topic. I've read that article. It makes a great case for APRV the way Habashi implements it. I would argue that one institutions clinical experience and data on APRV does not constitute compelling evidence. The best available evidence for lung protective ventilation is considered to be the ARDSNet protocol (http://www.ardsnet.org). Habashi himself states in that article you reference that there has not yet been "an adequately designed and powered study to demonstrate a reduction in mortality and ventilator days with APRV compared with optimal lung protective conventional ventilation".
The exact quote is, "An adequately designed and powerful study to demonstrate a reduction in mortality and ventilator days with APRV compared with optimal lung protective conventional ventilation has not YET been performed." I believe Habashi would love to have a study comparing the ARDSnet to APRV.
I also have to politely disagree with you when you state that one institutions clinical experience and data on APRV does not constitute compelling evidence. Follow me here; 50,000 patient hours annually since 1994 on APRV....that comes out to 550,000 APRV patient hours or 22,916 days, or 62 years of patient APRV experience. If that is not compelling, I don't know what is!!!?????
Marcus, Thanks for the reply. I did not change the context of the quote. The quote says "or" where I said "and". I apologize. The quote also says "powered" where you said "powerful". I'll tell you what is compelling: A randomly controlled, large, multi-center trial. An "adequately designed and powered study" is considered better evidence than a retrospective study. I do hope that study gets done; APRV is widely hailed as the superior lung protective stategy; and Dr. Habashi gets the appropriate credit for his hard work. "Follow me here:" is not a professional way to present your point of view. I can read. I can do numbers, too. We call it cypherin'.
I to apologize for the typo (thumbs must have got in the way). I also agree that a randomly controlled, larger multi-center trial is what is needed.
If APRV continues its current ascent to the "Lung Protective" summit, I foresee this very study to be a real possibility.
If I offended you with my "cypherin", I apologize; that was not my intent. I was attempting to show the validity of the findings of this particular instituiton...which in my eyes remain compelling.
