Ventguy,
Maryland university went to all servoi, but maryland shocktrauma center still uses and has the drager vents. Maryland shock trauma center is where Dr. Habashi mainly practices from what I know.

How many threads a year do we see with this as a topic? The best vent is the one that fits your institutions needs from a clinical, PM, support, and financial standpoint. All this subjective, Rep lurking behind a name, posting is a waste of bandwidth.

For the record, Dräger Evita Series ventilators have been, and remain, in use at R Adams Cowley Shock Trauma Center since 1994. The first Dräger ventilators used at the Shock Trauma Center were the Evita 1 where the current practice of APRV was developed (initial settings, P Low of 0, flow pattern analysis, Drop and Stretch™ weaning, etc.). The Dräger ventilators have proven themselves, logging 6,000+ hours per ventilator, per year. The Dräger ventilator remains the mainstay for ventilation at the Shock Trauma Center. We are, and have been, completely satisfied with the Dräger product which continues perform at a high level. The purchase of the Servo I was purely a political decision (by the way it is an election year so don't forget to vote).

Dräger will always be the leader, not the follower, in ventilation; particularly in the area of promoting and enhancing spontaneous ventilation. Dräger was the first ventilator to have an active breathing system (Evita 1, circa 1987).

Ten years would elapse before other manufacturers would come to produce imitations of the active exhalation system. Unfortunately, many manufacturers who have tried to follow Dräger's lead simply do not understand spontaneous breathing and APRV. This is evident by the contamination of PSV into APRV by other manufacturers. The addition of PSV to APRV negates several key concepts of APRV and the benefits of spontaneous breathing, which remains the main purpose of APRV.

Currently, some ventilator manufacturers incorporate Pressure Support Ventilation (PSV) above P High. However, some key points should be noted:

"¢PSV above P High may lead to significant elevation in trans-pulmonary pressure
"¢ PSV distends the lung above P High; the trans-pulmonary pressure will not be completely reflected in the airway pressure as the pleural pressure remains unknown
"¢PSV negates the purpose of APRV, which is to reduce airway pressure and limit lung distension during ventilation:
During APRV, ventilation results as airway pressure is lowered from P High (release phase) dissociating the
traditional requirement of elevating airway pressure, lung volume, and distension for tidal ventilation
The addition of PSV contradicts limiting lung inflation to the P High level
"¢The major advantage of APRV is the preservation and promotion of spontaneous breathing
"¢The addition of PSV to APRV eliminates the benefits of spontaneous breathing by altering sinusoidal spontaneous breaths to decelerating assisted mechanical breaths
"¢Ultimately, the addition of PSV during APRV defeats improvements in distribution of ventilation and V/Q matching associated with unassisted spontaneous breathing
"¢The addition of PSV to APRV complicates the mode by requiring a trigger. The presence of a trigger may cause auto-cycling with air leaks or suction. The trigger also makes NIV APRV more unstable and increases leak related alarms.

We plan to stay with the Dräger product (Evita 4 and soon Evita XL) as the new innovations Dräger is currently developing will continue to separate the wheat from the chafe.
I welcome anyone with interest to visit me at the Shock Trauma Center to see for themselves our approach to ventilation.


N M Habashi,M.D.
Medical Director Multi-Trauma ICU
R A Cowley Shock Trauma Center

quote:

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Originally posted by tphiff:
Hopefully there will be a study published from the people in Maryland concerning their comparison study between the Servo i and the Drager vent. From what i've heard the Drager performed so bad the physicians have stopped the 6 week trial. This was to be a trial testing Bi-vent against APRV

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As the Medical Director of the Multi-Trauma ICU at Maryland's Shock Trauma Center where Dräger ventilators are used, I find it fascinating you know details and the outcome of a study conducted at my institution which does not exist.
Do you have any facts regarding the nonsense you are stating? Do you have names of the physicians you claimed stopped this imaginary study as I would be involved in any ventilator study at Shock Trauma?
Providing, reiterating or disseminating misinformation does not enlighten anyone.

NM Habashi,M.D.
Medical Director Mulit-Trauma ICU
R A Cowley Shock Trauma Center

quote:

Dräger will always be the leader, not the follower, in ventilation; particularly in the area of promoting and enhancing spontaneous ventilation.

I guess no-one should put their input in now?
As far as which is my favorite vent.. it would be the Servo-i ventilator. We trialed both the Drager XL and the Servo-i and am happy to say went with the Servo-i.
(One of the reasons we went with the i, and thus the quote, was the fact that the Clinician (RT) had a better opportunity to "promote and enhance" spontaneous breathing using modes such as Volume Support and Auto-mode.)
We all have our opinions. Bottom line is to trial the vents out for yourself and find which one best fits your needs.

btrdaddy,

I think you may have misunderstood Dr. Habashi's point. I believe he was addressing the issues brought up by tphiff and like everyone else in this forum is entitled to his opinion as you stated. He prefers the Draeger, you prefer the Servoi; no harm, no foul.

All new generation ventilators promote/enhance spontaneous breathing, but I still believe Draeger is at the forefront with their version of "the open breathing system".

Marcus

Excellent point. "their version of the "open breathing system"".. you prefer a leaky expiratory valve over a true expiratory valve?Are you aware that the Servo has a true open breathing system? Have you ever worked with the Servo's Open Lung Tool or the Auto-mode feature?
I understand Dr Habashi's comments but also I aware his ties with the ICON group and Drager so his comments are a bit Biased. I am a therapist that trialed both ventilators and saw the difference...
But YOU ARE RIGHT... we all have our opinions.
peace

btrdaddy,

What is your definition of a "True Open Breathing System?" Does the Servoi allow the patient to breathe spontaneously during any part of the respiratory cycle in all modes of ventilation?

Our facility is getting away from paralytics, so the Open Lung Tool offered by most ventilator companies does nothing for us; just another marketing gimic.

Maquet manual states the following:

"During Pressure Control Ventilation, if the patient tries to exhale during inspiration, the expiratory valve will allow exhalation as long as the pressure is more than 3 cmH20 above the set pressure limit" page 63.

I may need some clarification on this, but that does not sound like a "True Open Breathing System".

Its great reading all the comments. My question is where is all the discussion on the AVEA? Isn't anyone talking about this vent, is anyone using this vent? I hear its superior to both the Drager and the Servo?