Has anyone used this mode on the Servo I? Our Bio-med guy is suggesting that our dept use this and phase out our visions. We are not to optimistic about this approach so any info would be helpful.

I haven't used the NIV mode on Servo I, but have used other NIV options on ventilators at times (LTV, Evita) plus used NIV on 7200 (put in PC mode for reliable time termination).

Assuming that the Servo I's NIV mode works as good, or even a bit better, than the Vision....

We have trouble keeping track of all our NIV devices as it is. It seems everyone is getting ordered on it...even a 95 year old whom doesn't know which planet he is on at 2AM, etc. We regulary have to do a "recruitment manuever" and go pull the units and leave notes "you patient has refused/not tolerated Bipap now for X amount of nights". Sometimes even our ER unit gets pulled for one of these absurd utilizations. About half the OSA patients, people with jobs, paying taxes, etc., end up not tolerating CPAP/Bipap and yet we're expected to "convince" these patients in a way that "sticks" through the night.

So for us to "phase out" our Visions and replace with ICU vents would create a "great sucking sound" as the ICU cupboard would be bare.

Main problem with using ICU vent for NIV is that you are forced to use a double limb circuit and it would add more pull and oppose a more comfortable fit. You might want to check if the Limbo Circuit (single limb one for ventilators where exp flow and insp flow are wrapped around each other), which I believe is made by Vital Signs. Google Limbo Ventilatory Ciruit and you'll see it.

The bonus of being able to use an ICU vent for NIV is when you know the patient will need it post extubation (and you have enough vents to hannld workload easily), or if your ICU Bipap has been placed on floor patient, that cupboard being bare, etc.

The only bonus I can see for using ICU vents on floor patients is that when some demented bozo orders it on a patient whom is DNR/DNI and has opted for comfort care then you can call a ventilator a ventilator more assuredly, the idiocy would be more starkly displayed.

But to phase out your Visons? Unless those Servo I vents cost less than Visions (hah hah)...I suspect that rep hasn't been in clinincal practice for awhile.

Oops sorry, it was your Bio Med guy whom is suggesting this?????!!!!

He must have some one dimensional view of clinical reality.

We had tried the Servo i on patients for NIV and it did not work real well. It just does not keep up with variable leaking. I am not sure if you have equipment not in use but most of our NIV devices are pretty busy. It's economically smart (if that's the right term) to utilize inexpensive Bipaps as much as possible. We would view the Servo i as a back up when we run out of Bipap devices. I used to be in the "one ventilator for all things" mind-set but real life doesn't seem to benefit patient care. Now, if I was in a small hopsital with limited resources I could see the concept being better suited. As Jeff said, most people can barely tolerate the therapy and if you device doesn't respond to flow and leaks properly it enhances the nightmare. The Servo i is a great ventilator for intubated patients or in controlled leak scenerios.

I agree with both of my collegues (JeffWhitnack and BMac). NIV should be done with an NIV vent (the right tool for the right task). I had only failures with "normal" vents in a emergency setting (CHF, COPD, etc)

Plus, no vent can compare with a Vision with the PAV option. Yes, it is a little bit tricky to set up, but once you (and your patient) had a taste of it, you will not want to go back to a "ST" mode.

Servo I with NAVA might to the same, and maybe better, but who has the technology ? (In Canada, only Toronto and Montréal have the "real" device). You will still need the double limb tubing.

You should have no trouble confronting your biomed with this issue.

Hope this helps...

Speaking of BioMed sticking their noses into clinical situations....let me relate a story for humor's sake.

A while back (I heard about it) we had this patient whom quickly decompensated and then coded. She was on the 840 and must have taken a big deep gasping breath followed by super decreased lung compliance. The vent gave that "circuit disconnect" alarm and then chattered a bit (flow sensitivity at 3 and rebound). The MD at the scene is known for hysterical outbursts and blamed the ventilator "malfunction" for everything. The vent was changed, no difference, etc. But then Biomed had to do this total inspection of it all. Then later a nurse got on the bandwagon and declared some vent to be the problem, necessitating another needless change and delay in figuring out the true cause of the problem.

So I was talking with the BioMed guy about all this ridiculous behavior and came up with an expanded role for BioMed. Why stop with just the equipment?! Perhaps BioMed could expand it's hospital role by going deeper into the psychological basis/professional deficiency basis for people blaming the equipment as a scapegoat? In the above mentioned case we came up with the idea of BioMed then creating a mandatory group meeting whereby probing psychological questions, etc., would kick it off. We thought of writing an aritcle for some BioMed Journal..."Going Beyond the Equipment....Fixing the Psyche of Clinicians" as BioMed engineers were then also encouraged to get degrees in psychology....The BioMedical Psychologist becoming a new clinical entity.

The NIV option on the Servoi/s can be a great option. Success with the use of it is tied to good training. It functions much differently than the Vision and that can be confusing to users. One issue many have is that it requires use of a non-vented face mask. If you try to run NIV on the Servoi with a vented mask you will not be successful. Contrary to what has been stated, the function was designed specifically for NIV. The leakage compensation is 40lpm and in adult the patient can have up to 200lpm of total flow with very stable FiO2 and a full complement of alarms. Many find they need lower pressures when using the Servoi for NIV due to efficient flow delivery. A less costly option is the ServoS. It is the cousin of the i with less bells and whistles. You might be suprised at the cost for a fully functional ICU vent, with NIV, compared to the Vision. I'm not sure I would advocate the using the Servo on the floors, but certainly in the ICU allowing easy transition from intubation to NIV and back if necessary.

Seatac,

I haven't used the Servo I, just seen it at conferences. When you use it for NIV what type of mask, straps, double limbed circuit, etc. do you use? Affixing a double limbed circuit to a mask strapped to a face is my biggest problem when using a regular vent for NIV. But I can imagine that a ventilator would potentially have higher flow capabilities and response times. And perhaps less deadspace, or better flushing of exhaled CO2.

Jeff,
Both Respironics and Resmed make non-vented masks in the same style as the vented (just different produt numbers). They utilize the same headgear as well. Resmend just released their non-disposable version that I have heard is very nice. However, I'm not sure how readily available it is. I have used both the Limbo and dual limb circuit. Both seem to work fine, but I do prefer the Limbo due to it's weight and single tube design.
If you have ever heard Bob Kacmereck speak on NIV I am a firm believer in his teachings. The essentials are good staff education, good mask fit, and starting with low settings. For starting settings he recomends starting with low peep and zero pressure. The pressure shoud be titrated to achieve the desired results; Vt, SaO2 and CO2 removal. This point is very important in regards to the Servoi. If you try to put a patient immediately on 12/5 (PC of 7, Peep 5) with the Servoi they may feel overwhelmed. The delivery of flow is so much more responsive. Also don't forget to titrate the inspiratory cycle off to help with those pesky leaks. Most spont. breathing patients will appreciate a setting of 40 to 70%.

Correction to the last post. No matter how you try to make it perfect it never is. I intended to say Resmed just released a DISPOSABLE version. Up until recently they only provided a non-disposable version. Also, forgiveness for the other typos, produt=product.