2001 OPEN FORUM Abstracts
An Investigation to Determine the Compatibility of the Hamilton Galileo Ventilator and the Jet Bunnell in a Neonatal Lung Model
Jim Keenan BS RRT,Troy Lynch RRT. Respiratory Care Service, Primary Children?s Medical Center,Salt Lake City, Utah.
Introduction: Our facilityis in the process of reevaluating the standard of care ventilator for our levelIII NICU. The Bunnell Jet ventilator is often used in tandem with our currentstandard ventilator for patients meeting jet ventilation criteria. The reevaluationprocess must insure that whatever ventilator standard is chosen, that it iscompatible with the Jet Bunnell. Hamilton Medical Inc. has recently come outwith neonatal software upgrades for their Galileo ventilator. The package includestime-cycled pressure-limited modes with a neonatal flow sensor. Since this ventilatoris one of many that is being considered we decided to do a bench test to determineits compatibility with the Jet Bunnell since it had not been previously reportedin the literature.
Methods: Testing consistedof ventilating an IngMar Medical Neonatal test lung using the Galileo and theJet in tandem under two test conditions. Each test condition was performedusing a triple lumen 3.0 and 4.0 ETT. In test condition one, PIP was variedon the Galileo from 5 to 35 cmH20 in 5 cmH2O increments. The jet PIP was operatedat 5 cmH2O higher than the Galileo and also increased in 5 cmH2O increments,along with the Galileo, to 40 cmH2O. All other ventilator settings remainedthe same. These setting were: Galileo: time cycled - pressure limited SIMV,rate: 5, Peep; 5, inspiratory time: 0.4 sec., flow: 6 Lpm, trigger 1.5 Lpm.Jet: rate 420 with an on-time of 0.02 sec. In test condition two the Jet ratewas varied at rates of 300, 420, and 500. All other ventilator settings remainedthe same. These setting were: Galileo: time cycled - pressure limited SIMV,PIP: 20 cmH2O, rate: 5, Peep; 5, inspiratory time: 0.4 sec., flow: 6 Lpm, trigger1.5 Lpm. Jet: PIP: 25 cm H2O with an on-time of 0.02 sec. Data was gatheredfor approximately 5 min. for each variable test condition. All measured andmonitored Galileo data was captured using the Galileo Data Logger software package.
Results: Both ventilatorsoperated efficiently under these test conditions. All measured and monitoreddata from the Galileo were consistent, reproducible, and within acceptable limits.Upon initial investigation under test condition one, it was discovered thatthe PIP of the Galileo must always be at least one cmH2O below the PIP of theJet. If not, the Galileo would report a sensor malfunction. During the alarmcondition the Galileo continued to function appropriately. This may be of concern,as some clinicians prefer to ventilate with conventional PIP?s the same or higherthan the jet.
Discussion: When new neonatalventilator technology becomes available it is important to consider all aspectsof its operation. Those facilities that promote the use of Bunnell Jet ventilationmust consider if the two devices are compatible. In addition, many NICU?s arerecognizing the benefit of flow sensor monitoring technology. The sensor andoften its location create more difficulties when the jet us used.
Conclusion: We feel that itis safe to use the Hamilton Galileo in tandem with the Bunnell jet as long asit is clinically acceptable to use jet PIP?s greater than the Galileo.