In the thread "Communicating with ventilated patients" Jeff Whitnack discussing a communication option built in to vents stated "If I had my way the ventilators would come out the door with such devices attached (and in languages from Spanish to Vietnamese)". This is them type of concept I am interested in. What would it take to make a better vent? Thinking inside and outside the box. I recently had an opportunity to visit with Dr. Miguel Divo from the Boston area, and he offered this really creative idea, he wanted to be able to access the monitored parameters and graphics via a remote access connection via the internet. My printer can be accessed via a URL address, why not some sort of secure access to vents remotely from the WWW. Also what new functions do you consider a waste and which ones really make a difference in your practice. For me I want a ventilator alarm when there is disynchrony present. I would like a simple indication that the HME resistance is elevated or the in-line suction cath is not completely withdrawn. How about a thumbnail potential interpretation of waves and loops that displays with the graphics on request much like my EKG machine which provides a potential interpretation and what it is seeing that indicates that interpretation. Of the more recent functions that I appreciate is the ability to control rise time and the breath termination point for PS breaths. I can come up with some more I am sure, but I want to see what you think so this is just priming the pump. I will be getting more acquainted with the manufacturers and I am looking for some ideas to pass on for new functions that you would find useful. What do you think??

Gary, this technology has been developed and is about to be released by Genesis Medical Systems. Call me and we can discuss it.

Gary,

"I recently had an opportunity to visit with Dr. Miguel Divo from the Boston area, and he offered this really creative idea, he wanted to be able to access the monitored parameters and graphics via a remote access connection via the internet. My printer can be accessed via a URL address, why not some sort of secure access to vents remotely from the WWW"

It has already been done according to this link:

http://intensivecareonline.com/pro_iisis.cfm

Marcus

quote:

new functions that you would find useful. What do you think??

Ireally appreciate the info and the links, but I am looking to stimulate some thoughtful discussion. Again what do you think?

I'm hoping we come out with more recruitment ability, automated manuevers, ability to measure FRC easily, optimal peep recommendations via the vent...

Great ideas! Thanks Edgar D. Heres another I thought of: how about a machine that can do negative APRV, wouldn't recruitment and cardiac output improve if the gas was drawn into the lungs rather that pushed? Might be difficult to manage, but it can't be worse than proning. What do you think??

I don't know if sur a parameter exists, but do any respirator, in a pressure control mode, automatically ajusts the inspiratory time to the time constant of the patient, optimising tidal volume and preventing a unwanted "plateau"; or, in an constant flow mode, this could prevent the derecruitement/overdistension process when inspiratory time (via the flow) is not ajusted again to the time constant of the patient?

Just a taught...

Regarding Edgar's ideas:
GE has recently released the InView package for the Engstrom Carestation. With that you can:
Measure the FRC (metabolic module uses nitrogen washout/washin technique that is fully aitomated)
Perform a series of FRCs at different PEEP levels. You can tell the machine to perform a number of measurements within a given range and it will automatically manipulate the PEEP levels and vary O2 to give you the results.
Measure true tracheal pressure, and have a calculated alveolar compliance curve plotted inside the tracheal pressure loop.
Get accurate intrinsic PEEP measurements not dependent on the tube related factors
Have the machine calculate recruited volume at different PEEP levels

Seems like an answer to your question. I am a GE rep though so my advise is a little biased

However I have tried the package out on several patient already and the attending physicians were extremely impressed

Thanks RVK. We don't mind hearing from reps, as long as you are touting your stuff and not knocking the competition too hard. Sometimes new bells and whistles leave you wondering if they were added to give the reps a new hook to sell with or if they were added to improve results at the bedside. It takes time to seperate the wheat from the chaff, but the Carestation does seem to be a tool that offers some interesting features, which are about results. I am easily impressed, but from the little I have seen and heard this machine is destined to assist in production of many great outcomes. There are many factors that go into a vent purchase decision. Each machine seems to offer strengths and weaknesses, features that one loves and another just can't abide, each with excellent reasons. Thanks for the disclaimer about being a rep. Just curious from any reps or others who have assisted in vent purchase decisions, are you recomending the Capital Equipment Decision Tool found on this site? If not check it out. It is amazing. I think it could assist with about any decision, even personal. Mmm? The blond or the brunette? I recently was consulted on a vent purchasing decision, which I will discuss once the decision has been finalized, but we used the elements in the supporting documents as a starting point and cutsomized from there. It really gave an excellent overview of each machine and allowed some really great objective assessments to be developed very efficiently. From the rep side, this tool can really assist your clients in getting the equipment that exactly meets thier needs, and the same from the client side. It is free for anyone. When it was added to the site the plan was for it to be for subscribers after a period of free use. That may come yet, but for now it is there for everyone for FREE. Register yourself and check it out. Here's my next dream function idea: how about a machine that beeps me with a message based on set criteria so if I have to leave the unit I am posted on ventilator events remotely. I still wouldn't go far from my patients, but sometimes within one ICU you can be pretty remote from one patient while caring for another, and picking up on subtle changes from a distance might get you to the bedside in time to prevent or intervene in potential problems before the have a chance to excelate. Someone's probably going to tell me it is already out there, go for it! What do you think??

Bernouli is a device like this that I have seen at nationals. It links all the vents then sends alerts to PDA's on vent issues. I believe it also allows for remote looks at the vent settings and graphics from a secured internet connection, so that pulmonologist or care coordinators can look at it.