Adaptive Support Ventilation: Set it & forget it?

http://blog.poplabs.com/2008/07/set-it-and-forget-it-why-roncos-showtime-rotisserie-cant-run-your-marketing-campaign/

I once mentioned in a previous posting (Adaptive Support Ventilation: the Pareto Principle of Mechanical Ventilation) that “ASV requires little operator input and provides substantial benefits”. However this does not mean “set it & forget”, a phrase I  over-heard from an ASV in-service.

 This is not a Ronco Rotisserie Oven ® this is a mechanical ventilator and the operator needs to be engaged and assess patient-ventilator interaction.

Here are some areas of focus:

Switching from Pressure Control to Volume Control Ventilation

During patient ventilator transports one may have to switch from pressure control (PC-CMV) to volume control (VC-CMV) ventilation, because the available transport ventilator does not have PC-CMV. Another reason is the operator is unfamiliar with PC-CMV.

Here are the steps and additional considerations to safely switch the patient over.

Obtaining Pulmonary mechanics with the PB840 Ventilator

In my opinion I believe the PB840 ventilator is an outdated platform. One thing that frustrates me is that additional functions/features cost the purchaser extra, where on most ventilators these functions are standard.

Examples:

-Trending

-P0.1

-No low flow lung mechanics tool.

The only thing I believe is useful is Proportional Assist Plus, however this is still a software upgrade charge.

Another frustration when using the PB840 is obtaining pulmonary mechanics measurements correctly.

When properly obtaining these measurements one has to place the patient in VC-CMV (volume controlled ventilation) and perform an additional three steps.

Here are the steps:

1. Place the patient in VC mode (if the patient is in another mode)

2. Change the flow waveform setting to a Square (constant) flow waveform pattern.

3. Change the flow setting value to obtain a I-time which matches the previous set I-time.

4. Perform an inspiratory pause, by pressing the inspiratory pause button (insp pause)

Capnography the Importance of Perfusion

Capnography/ETCO2 monitoring (ETCO2) has been used for many years in the operating room to confirm endo-tracheal tube placement and to evaluate the patient’s ventilatory status. Since the technology has become more portable and affordable, it has migrated to intensive care units, emergency rooms, ambulances, and even step down units. Due to this prevalence Capnography/End-tidal carbon dioxide monitoring is becoming the “fifth” vital sign [1].