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<runner>
posted
Is this a good vent. to buy? Is this vent.present any problems or difficulty in the use of it?I need a very reliable and very functional vent. that can provide various modes such as APRV ,PRVC, A/C, SIMV, etc.
 
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<light>
posted
I personally don't think you can go wrong with the Servoi or Drager E4(lets please try and not argue the merits of each). In my opinion the Servoi is in the top of the class when it comes to userfriendlyness, patient friendlyness and usefullness.
 
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<brandx>
posted
I would agree with Mr Light; the Servo-i and Drager Ventilators are very friendly. I personally find the PB 840 very cumbersome to set up; especially their Bi-Level.
 
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Junior Member
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the only problem I have seen with the Servoi is the alarm volumes. we had a patient on this vent at a hospital I worked in and during the night shift the patient became disconnected, the janitor was cleaning the floors at the time and no one heard the alarm. When we checked the alarm profile the next day, the patient was off of the vent for over 10 mins. We did end up getting volume enhancers for this vent. Just something to keep in mind, maybe they provide the vol. enhancers on all of them now? otherwise a good ventilator.
 
Posts: 2 | Registered: December 24, 2005Reply With QuoteReport This Post
<YoDog>
posted
I've had the opportuity to work with the PB 840 for almost 4 years and now the Servo-i for the past 6 months. I find the Servo-i to have been cheaply built, very finiky to water in the circuit, and no where near as versital as the 840. The inability to select different wave form in volume ventilation, lack of knowing exactly what the sensitivity is set at especially when dealing with leaky chect tubes, and the inability to shut the alarms off when your at the bedside are very irritating. Though I personnally have not worked with the Drager, my friends at the local university hospital, (who worked with me for a few years, say they do also like the Drager as much as they did the 840.
 
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<rt_yogi>
posted
In response to yodog and with all due respect, I would like to respond to your posting. We all have different experiences with ventilators but in the 3 years that I have been working with the servo-i I have not had any problems with water in the circuit. As a matter of fact, there is an article hanging in our department which looked at the effects of rain out on ventilators and found there were no problems associated with the servo-i. It looked at a few different vents and even found that the water may cause the esprit to shut down. (I know we arent talking about the esprit)
As far as not being able to select different waveforms in volume ventilation, why would you need to? With PRVC, I dont see the need and if for some reason you decide to use volume control the patient can always get the flow they need unlike the 840 although they will tell you thats not the case but we found out the hard way that patients can be flow starved with the 840. If you doubt me then please breath on it. I encourage all RTs to breath on the vents they use.
One thing that concerns me is you wanting to shut off alarms. Alarms are there to tell you that something may be wrong with your patient or at the very least there is a change in his/her condition. Fix the problem and the alarm will go away. Just my thoughts
 
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<otherRT>
posted
To yogi: Patients get flow starved in volume control ON ANY VENT when they exeed the set flow. I've seen patients in "PRVC" get flow starved very quickly when they exceed the set volume. That must mean that the Servo-i is an inferior machine, right? Oh, wait, lots of vents do "PRVC" now. And lots of vents do volume control. They must all be inferior! Don't buy any of them!
The opinions of people who bought the machine are biased ones. They're more likely to tell you why they love it (or try bashing the competition like yogi) and less likely to tell you the downsides.
 
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Picture of light
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Other RT,
Are your sure the patients that you say are flow starved are not really pressure starved. In PRVC as we all know as the patient inhales fast flow rates and bigger breaths than the set VT the vent will decrease the pressure trying to get to the set VT, this inturn makes the patients WOB increase, which many times can mimic Flow starved, when it is really pressure that they need. Many times also these patients are volume hungary and not VT hungary but FRC hungary and by increasing the PEEP their hunger goes away. Just like when you get kicked in the gut (get the air knocked out of you) you gasp repeadly for air, the normal person would say they can't catch their breath, but we as RCP proffesionals know they are actually trying to get their FRC back.

As for flow hungary on any vent in VC, have you breathed on the servoi in VC and overcome the set flowrate (like yogi stated they have done), if so what happened?


Light
 
Posts: 104 | Location: Springfield, MO | Registered: March 08, 2004Reply With QuoteReport This Post
<rt_yogi>
posted
other rt: i hear what you are saying about defending a purchase. I've purchased 840s as well as servo-is. patients can get the flow they desire as long as its less than 200lpm in volume control on the servo and they can not get more than what is set on the 840. this is NOT opinion it is FACT. Breathe on the vents...please
 
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<YoDog>
posted
To Yogi, other rt and light. I respect your opinions and comments. I do not get offended by differing opinions and believe we are all on this web site to exchange ideas and cross reference with peers so that we can provide the best care we can. That being said, I should offer a bit of backround. Before I arrived at this institution the RT leadership convinced the attending physicians that all patients should be ventilated in PRVC. Since about 80% of the patients we ventilate will survive in spite of the mode we use, it's the remaining 20% that require us to think. PRVC or VV+ on the 840 can effectively ventilate a great number of patinets with a high level of comfort but, it has been well documented to reduce the support it provides when a patient becomes tachypneac, or more precisely, hyperpneac (think neuro here more than a primary pulmonary patients). Some of our physicians then want us to go to Volume Control. It would be nice to be able to select a decelerating ramp with some of these folks then use a flow that exceeds their demand which you can do quite well if you take the time to learn to read the graphics. My personal bias is for the graphics on the 840. What I have done is convince the physician to switch to pure pressure support with 0% rise time and most patients calmed down nicely. If the respiratory pattern was a bit irratic then Automode worked well but it appeared that not many of the staff were familier enough with Automode and I was told by the manager not to use that mode untill we could get all of the staff properly inserviced on its use. Mind you this ventilator has been here for almost 2 years and I've only been here 6 months so I was a bit miffed that so many of the staff were not familiar with its use and it has been almost 4 months since the inservice was requested (I even volunteered to teach the class) but nothing yet.

On the issue of rainout and sensitivity of the expiratory cassette to excess moisture, I need to point out that there are attending physicians who insist that all ventilator patients get placed on bronchodialator Tx via SVN. We were getting frequent error messages from the expiratory cassette until we changed to a new type of filter to attach between the expiratory limb of the circuit and expiratory cassette. New tubing with inproved heating on the expiratory limb has also helped. This is a problem I never had with the 840. I've been successful in getting most of the attending physicians to change to MDIs.

Next, I agree that alarms need to be good and loud, or very annoying, to make sure you know when something bad is happening to your patient, but I don't need it allarming when I'm in the patient's room dealing with the problem or just suctioning the patient. That is when I'd like to push a button and get the alarms to shut down temporarily. Perhaps your familiar with OSHA guidelines for noise exposure for employees and you'll find that the 100% setting on the SVI exceeds the safe exposure levels. Now add to that the consideration of what affect it has on the patients lying in that bed for several days or longer. I also admit to a personal bias to the manner in which the 840 changes the alarm as the urgency increases.

Lastly I'd like to address the issue of breathing on the ventilator and will tell you I have placed myself on every ventilator I've ever worked with except for the SVI. Mea Culpa and I promise to do that as soon as I'm back from holiday and will let you know how I felt. I've always used a moutnpiece attached to a 7.5 mm I.D. tube so I would get a sense of just how hard a patient had to work. I must admit that it makes a difference what version of software is on the 840 put I found it fairly easy to get the air flow I demanded.

Bottom line yogi, a good RT should know his/her equipment and be able to take advantage of it's capabilities to be as effective as possible in being the bridge bwtween 2 highly complex items; e.g. patient+RT+ventilator. Maybe I need more experience with the SVI (I know that breathing on it is going to be my next step), but if I was going to standardize my fleet of ventilators, the 840 rate much higher for me than the SVI. A lot also goes along with the support we got from our Tyco rep. Thanks for your thoughts.
 
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