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.
|Posts: 171 | Location: Palo Alto, CA USA | Registered: November 14, 2002||
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 MontrÃ©al 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...
|Posts: 49 | Location: Ste-Agathe-Des-Monts, QuÃ©bec, Canada | Registered: October 14, 2005||
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.
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
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