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Which is your favourite ventilator?
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<respkid>
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I was always told size didn't matter!!
 
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<YoDog>
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I haven't been around too long, started back in 74, but my experience with the ventilator choices would have me going for the PB 7200. Now I must admit that I have never worked with the Newport Wave and my experience with the Hamilton is limited to a couple of years with the Veolar. I think I spelled that right. Anyway, the 7200 was a solid ventilator and we had the opportunity to use the BICOR for a year long study on work of breathing conducted in our surgical ICU. During this time we also had the Bear, Servo 900C, Bird 8400 STi, and Bird VIP. The bottom line was that we were able to more effectively adjust the settings on the 7200 to synchronize and control the work of breathing. The VIP came in a close 2nd. The 900C was by far the worst especially when the patient had hyperpnea/tachypnea that was neurologically mediated.

Since the discussion also touched on the SERVO-i and Tyco-PB 840, I'll throw in my 2 cents on that. I worked with the fully loaded 840 for about 4 years in a busy military medical center. When I retired from the military this past August I went to work at the Medical College of Georgia where The primary ventilator for adults is the SERVO-i. Although I've learned to make the SERVO do most of what I needed to optimize ventilation for my patients, I would rather have the 840 as my primary tool. If I haden't just come off a 12 hour shift and then several hours spent with a family member in the hospital, I might try to go into a lenghtly dissertation on the funtional reasons to support my choice.

Somebody in the line of folks said it's all about preference. Though I think that may be valid to some extent, I will go a step further. Gil Davis (RT extrodinare and director of RT at Good Samaritan hospital in Phoenix back in the early 80's) once told me that a good therapist should know his or her equipment well enough that they can make it do what thay need, when they need to. This is aptly demonstrated in the numerous small studies where some author is able to show the advantage provided to the patient by the use of some new mode, and then ventilator manufacturers rush to add it as an update to their ventilator. Since these are usually some sort of retro-fit to the technology of their ventilator, it may or may not do exactly what the original author did. Then of course the original group copyrights or patents the name of the mode so the other ventilator companies have to call it something else. Richard Branson has spent some time discussing all these new modes and what they really do so I won't beat that mule anymore. I fully believe that 85% of our patients will survive their ventilator experience in spite of us and what we do. It's that remaining 15% that needs us to tweak that ventilator with a clear understanding of what our equipment can and cannot do.

Does one mode work better that another? I think there is mounting evidence such as with Spontaneous Breating Trials vs Pressure Support vs SIMV. Now we have a fair amount of literature that supports the use of APRV in ALI/ARDS and when we at Eisenhower Army Medical Center started using it with the 840 our success rate was so good that we stopped using the occilator and still had improved outcome ratios. Could we have done even better with the Drager or some other ventilator? Perhaps, but we learned how to do it with ours. Someday we may find out that one kind of exhalation valve, or other widget works better than another. Untill then, those of use who are in the position to leverage with hospital administrators to give us the money to buy or upgrade our fleet of ventilators must ensure that whatever our choice is, the staff is completely confident in their ability to manipulate those settings, and know how to tell if it's doing what it's supposed to. Only then will we be able to provide the physician and patient the kind of professional support they deserve.
 
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Hate to bring back an old beast but Absrand and Brand X never answered the question? Does the Evita quit compensating for tubing compliance volume loss when the flowsensor is turned OFF?

The answer to come on Tuesday. Hint: answer rhymes with Jess.
 
Posts: 25 | Location: Montreal, Canada | Registered: November 26, 2002Reply With QuoteReport This Post
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Picture of Bill C
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The 900C like the early 7200 were both good vents, but by today's standards both have become obsolete.
The 900C is able to work with adults and peds as well as doing a crude form of Press reg.
 
Posts: 74 | Registered: June 14, 2006Reply With QuoteReport This Post
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quote:
Originally posted by starsmed:


I have to agree with Chris, none of the above. Would go with Drager XL, or PB 840
 
Posts: 1 | Registered: November 08, 2007Reply With QuoteReport This Post
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If anyone is still delving into this issue check out this site.

http://www.reamondor.aphp.fr/index.php?page=posters_respi


Performance of ICU ventilators during pressure support ventilation mode: a bench study (ESICM 2006)
HOW ICU VENTILATORS COMPENSATE FOR COMPRESSED GAS VOLUME: A BENCH TEST (ESICM 2007)

Non-bias evaluations of ventilators.

Majority of the comments regarding this topic are more often then not based on personal preference. This of course if valid as one has to feel comfortable with whatever equipment they happen to be using. Ventilator performance is measurable but in the end does a few milliseconds difference matter to patient outcomes.
 
Posts: 6 | Registered: May 11, 2006Reply With QuoteReport This Post
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