I work in a Level II Nursery. We have an older Star (and Star Synch). We plan to upgrade in the future, but I have a question for those of you more versed in Neonatal Ventilation.

It seems to me that the Demand Flow would be better than using the Continuous Flow (for intubated patients anyway). From my perspective this would be better because then a higher flow setting could better get in the set breaths and there would be less expiratory resistance. I saw a video about a newer star (950 I think it was) where the breath flow and the demand were separated--and about 4-6 was recommended for the demand flow also.

Also, does anyone use the Star Synch and then use the Assist Control mode? It seems to me this would be even better as then each breath would be more uniformly unloaded. ??

Rumor has it we'll be upgrading to Drager Babylogs (cuz that is what the Level 1 Nursery we transport to AND whom oversees/runs the Level II Nursery uses---so no need to argue about that decision here!).

Does Volume Guarantee work in both PS and PC modes? If so, wouldn't SIMV with VG for PS breaths really be better called A/C? Or is it just more palatable for it to still be called SIMV?

Jeff, The Babylog has a function called "VIVE"....Variable Inspiratory and Variable Expiratory Flow. Allows the clinicial to use a low flow during the expiratory phase and a higher during inspiration. This is also useful in transport situtations to conserve gas. Also, the Babylog has leak compensation (esp. useful with PSV) and many other features.

When in PSV the "rate" is a backup safty net...in other words if the infant is triggering at a higher rate than the set it will all be PS, if the spont. rate drops, the SIMV will kick in. The baby's rate picks back up and it is pure PSV. There isn't the typical SIMV and PS....as far as what you call it....does it really matter as long as all users know what is happening? Manufactors are unlikey to ever have uniform names for their modes...marketing as much as anything.

As far as demand VS. constant flow...I suppose that the lack of any delay and added work that may be associated with a demand flow make that less desirable. The Evitas with the NeoFlow option also have a cont. flow when in neonatal mode. I don't know if that is necessary or if it is just to quell doubts about the possibility of a delay and added WOB. Maybe technology hasn't gotten to the point that demand flow is responsive to micropremmie needs???? With the flowsensor at the wye, accurate measurement of volumes with a constant flow is possible. I think, personally, this is the best method. See the thread regarding 840s in NeoMode for why I think that way.

Paul

In the SIMV/VG mode only the SIMV breaths are using the VG. All spont. breaths are what the patient wants.