I have used the Servo I a bit. The NIV mode isn't something I have used a lot. It does make some inherant changes to Alarms, Trigger, and demand as mentioned by Seatac.
As mentioned by Renton you will need a non-vented mask or the excessive leak will cause a great deal of pressure flux. The flapper valve in the mask then become the biggest problem. At lower pressures the valve will be prolematic in any ventilator. The circuits we use are generally disposable doubles with an HME at the mask.
In our situation we generally use Visions for NIV, but I can't see any reason not to use a vent for the same. I have done this really well with an LTV. In actual fact the LTV and Servo I should outperform a Vision though we are told the Vision is a tertiary vent. I am told that Servo I is a great device for NIV and works also particularly well in neo populations.
We began using the Servo for NIV on ICU and ED patients only in November 2007 and have had wonderful results. There is a learning curve for physicians in understanding that on the Servo the PS is set not the IPAP as on the Vision. We use the Vision on our stepdown unit a majority of the time. I agree that using the Servo for all NIV doesn't make sense but I do agree that it could replace all ICU NIV machines.
Can people tell me how they charge the patient when doing NIV on the vent (obviously a vent charge), NIV with a standard BIPAP ( we charge the patient for every 4h using) and also BIPAP using a Vision? Do hospitals charge all three as a vent charge? Also with a Servo i, we use heated wire circuits on vented patients. We are having problems with water condensation collecting. We were told by the rep. to keep the heater on 37 degrees. We use a filter on the end of the exp circuit which is connected to the vent. This filter gets so wet that we have to change filters every 4hr.s. On the PB 840 all you can drain the water but with the Servo there is not the same option. Can we do anything different with this so we wouldn't need to break the circuit every 4hr.s to change the filter? thanks
Please look at the my post on the Servo discussion explaining our servo-i circuit.
Heliox coming soon for the SV-I; maybe NIV to be used in conjunction.
It's used all the time at our facility. Our ServoI has two NIPPV modes, one with back rate and one without.
hello new on the forum let me say hello to all people here
i use niv since 1988 first with puritan bennett 7200 , after i used evita (different one , last was evita 2 dura and evita 4)
these two last years i moved and now use servo i
let me say that niv is easier (for me !!) with evita than servo i
when using now niv with servo I rather use "pressure support in invasive mode" than niv mode (orange screen in france) , i noticed that some patients who are not confortable and efficient with NIV mode of servo i , feel much better with invasive mode , i think that it is easier to manage with triggers and slope
but some patients are fine with niv mode so i leave them but i will say that it's 1 patient in NIV mode compared to 3 patients with pressure support(invasive) for non invasive ventilation
i frequently notice that if pressure arise too quickly then vocal cords shut and patient didn't receive any pressure in trachea , it s important too to care with expiratory trigger , some patients are likely to have a too short time of pressure and then a low tidal volume
i am dissapointed that servo i didn't offer the ability oy limiting inspiratory time as evita does (in niv mode)
While most critical vents do a ok job of NIV you still have the problem of a double limb circuit and the resistance that goes with it and the inability of any vent except the Esprit to automatically compensate for leaks on every breath like the Vision and respond to what the patient is doing vs what we want the vent to do
You should breath on your critical care vents in niv and then breath on a Vision and see which one you want to have if YOU need it someday. If you don't know how to use a Vision right call the respironics rep and get a CEU for it
I know the Drager E4 and XL have leak compensation, Draeger Medical's leak compensation will compensate for leaks up to 200% of the set Vt or up to 30L/min for
pediatric patients, but you state only the Esprit does it breath to breath. Then how does the Drager do it?
I have only used it on the PB 840. I ave had good luck with NIV on the 840. There are more settings than the Vision but if you get a good mask seal and adjust your esense and max Itime parameters, it works well. The Vision remains the gold standard but when we run short, the 840 has worked well for me. The older RTs refuse to try it and are convinced it won't work. I imagine it's not much different on the I or 840