I agree, and for the record, I never said the 300 had "Active" exhalation, I simply said it has what Drager calls autoflow. I believe the specs are almost identical.
Well put Jeff. I came to this site looking for objective information and experience from PB840 and Servo I users. What I found instead is offensive cynicism from therapsits tyring to make themselves look good at anothers expense. How sad for this site and our profession. K
Although my company sells and rents many different manufacturers, I would not personally profit from this. I am only suggesting what many other hospitals have done in this situation. They rent several different types of vents and compare the pro's and con's of each. Along with using the clinical experience of the companies professionals. It is an affordable way to make the absolute right choice.
I agree that this might be a good way to compare, but then how do you get supprt on the products and who teaches the staff, does all the inservicing? Do any of the rental companies offer this service?
I'll go for Galileo. it has all the feature u can uses it for all kind patient and of course it has mode all "asv" here u have enter patient body weight and %mv. even it is good for patient like COPD AND ARDS.. as for my concern Galileo (Hamilton ) is the best.. it has Auto flow also. 30 l/m even siemens 300 has max Auto flow of 4 l/m. and according the user requiremnt it depends first u tell me what kind of ventilator u r looking.. if u have any particular points which u badly require then i can explain to u.. thanku Expecting a reply from ur side..
Neil McIntrye, MD, had something very interesting to say about this at the AARC convention... All of these "new" modes that manufacturer's are putting on their vents work as designed, but none of them make any real difference in patient outcome. Think about that. In fact, there is recent published research that the best weaning method is something we did in the late 70's and early 80's - "T-tube" trials!
I definitely favor pressure support, but most of the other stuff appears to be little more than :"whistles and bells" that add to the price of the ventilator. Yah, they "work" but if thy don't make a difference in patient outcome, why spend the extra money?
Right now, my favorite, because of versatility, is the Pulmonetic Systems LTV series. Not a lot of whistles and bells, just a good all purpose vent. No vent will work in every situation, so you will probably need to choose at least 2.
No one thought that ventilator strategy or style made any difference either until the ARDSnet study showed that just maybe what we do with the ventilator does make a difference. Given the myriad medical and surgical problems patients on mechanical ventilation have, given the fact that ventilators just aren't profitable enough to generate the money to fund the powerful enough studies studies (why it took an NIH study to follow up on Dr. Amato's landmark shot across the bow years ago),is anyone surprised we have no outcome data to justify virtually ANYTHING to do with mechanical ventilation in regards to ultimate outcome? Studies are either considered too unprofitable or would be too unethical. For instance, imagine we had no steroids with which to treat asthmatics. I would imagine then that the prospects would indeed be dim for any asthmatic unlucky enough to get so bad as to need intubation and mechanical ventilation. In an outcome study then it might not matter if one hyperinflated them, flow starved them, or ventilated them ala Tuxen's perspective. They'd all die. But find the magic bullet and the differences will appear. So too with ARDS. Someday perhaps a magical phamacologic bullet will be found. Then those patients more optimally ventilated will show even better survival stats than those not so well ventilated. Until then thousands must be enrolled in very expensive studies.
The other thing is that we often mix ventilator strategy with ventilator modes and ventilator adjuncts (ala protective lung ventilaton/PCV/ATC). I mean come on, if we know that it's not even humane for someone to be on a ventilator and end up being essentially suffocated, then ATC or the pressure/volume hybrids are a blessing. (Imagine your worst doctor, your worst ventilator, your worst RT, all trying to ventilate an ARDS patient with those ARDSnet cards as a guide).
The problem with the "weaning modes" is that we had the whole concept of weaning wrong in the first place. We don't "wean" anyone or anything ever. We fledge them until they are well enough to fly out of the nest. With the long term ventilated patients perhaps at times we do a bit of reconditioning. I consider Automode and MMV (for instance) not to be weaning modes or adjuncts but just automatic breath transition adjuncts. Whether they are used to facilitate liberation from the vent or instill chronic fatigue is in the finger of the knob twirler. Modes or adjuncts which allow the patient to essentially receive FULL ventilatory support and still do spontaneous breathing then are inherently beneficial.
When PS first came out, I remember it also being touted as just another bell or whistle.
From the number of posts and opinions you've probably come to the conclusion that it will ultimately come down to you trying out a few of your own personal top pics and then convincing the "Money" in your hospital to back your decision. You can argue that one vent is actually better then another on many different levels, but in actuality it comes down to personal preference. Example: If you're in a teaching center you'll enjoy color graphics and screen freeze with overlay capability of your waveforms. If you plan on using the vent on all patient pop's you'll need a versatile vent with neo/peds/adult capability, if you transport all over the place, guess what ...you'll need a vent thats portable. Get the point...your personal preference will also reflect hopefully the needs of the patient's that you're serving! Good luck Bud!
I must confess...I had figured that out awhile ago, and was just baiting the trap. It is interesting to see where people fall on this issue, and equally important to see where other people stand. I touchstone my own actions and reactions against others which affords me the chance to map and proceed. Erin...you win the chocolate factory!!!
From a directors point of view, service, support, cost of ownership and, expected lifetime is most important. I have grown weary from the company's who leave town after the sale, charge exorbitant prices for proprietary parts, service, or even a telephone call.
Here are just a few examples, Our equipment is so good we don't even offer service contracts, (however a Lifetime PFT warranty is only $2,400 a year) Cardiac rehab lead wires (only $150 a wire) Blood gas analyzers (disposable electrodes $750 and you must replace every two months) Cath lab service tech is located 6 hours away, so if I want service covered under my 9-5 contract I must call before 3 am. Of course the company is closed at that time. Hemodynamic monitoring company. We need a PO before we will answer that question.
I think that we need to talk more about the ventilator company and not so much the bells and whistles of the individual ventilators.
