2004 OPEN FORUM Abstracts
SYNCHRONIZED MINIMUM MANDITORY VENTILATION WITH THE Pneupac paraPAC ‘medic’200D VENTILATOR.
Mark Rose RRT, Roger Smith RRT, William
R. Watson BMET, Mike Trevino RRT, Gary Weinstein MD FCCP,
Presbyterian Hospital of Dallas.
BACKGROUND: Transporting ventilated patients in today’s environment, presents unique challenges to even the most seasoned respiratory therapists. The Pneupac paraPAC ‘medic’ 200D ventilator is designed to provide spontaneous breathing without stacking of breaths via Synchronized Minimum Mandatory Ventilation (SMMV). According to the manufacturer; “when ‘CMV/Demand’ is selected, the ventilator cycles at the set frequency but if a spontaneous breath is taken during an exhalation phase then this is taken from an internal demand valve. If breathing is at an adequate level for an adult, cycling will be inhibited as long as this breathing level is maintained. If breathing becomes inadequate, CMV will be restored, synchronized with the last breath.” The purpose of this study is to determine the accuracy of this application.
METHODS: A two compartment lung model, (Michigan Instruments 5600i), was used to simulate spontaneous respirations as described by (Katz et al, Chest, 88, 4, 1985). A properly calibrated Fluke Vt Plus HF Gas Flow Analyzer was utilized to verify volumes, flows and pressures. The 200D ventilator settings were as follows; ‘CMV/Demand’ mode, f:8bpm, Vt:800cc with the air mix on. The Michigan Instruments Breath Simulation Module was set to deliver a measured f:12bpm and tidal volumes ranging from 80-1000cc.
RESULTS: Spontaneous tidal volumes of 80-100cc were virtually ignored by the 200D. Spontaneous volumes ranging from 200-453cc were supported, however, no appreciable stacking of the mechanical breath nor cycle time interference was noted. CMV ventilation from the 200D was inhibited at a spontaneous Vt:470cc and remained inhibited with subsequent increases to as high as Vt:1000cc. During our test, we found that spontaneous tidal volumes above 1000cc produced erratic inspiratory flow, indicating that we were nearing its peak flow capabilities.
CONCLUSION:. It should be noted that in patients that have high spontaneous tidal volumes, this ventilator may not meet their individual flow needs. The manufacturer recommends sedation for that particular patient population. This ventilator offers respiratory therapists the capability of effectively transporting critically ill ventilated patients to and from the myriad of tests ordered in today’s critical care environment. The Pneupac paraPAC ‘medic’ 200D transport ventilator, when used according to the manufacturer’s recommendations, appears to perform as expected.