Medical air transportation with T-bird ventilator :
don’t forget to input the cabin altitude!
Jean-Pierre Tourtier , Thomas Leclerc, Marc Borne Military hospital Val-de-Grâce, Paris, France
Servicede Santédes Armées
Introduction (1):
Ventilator T-bird VS02 cabin altitude value should be manually input
Hypobaric Vt set vs Vt delivered With input of cabin altitude Without input of cabin altitude
Introduction (2):
Methods (1):
� Cabin altitude simulation
Methods (2): �
Altitude simulated: 1500 m (4000 feet)
2500 m (6700 feet)
3000 m (3000 feet)
Methods (3): �
Lung simulation: VT1 Bioteck
Normal lung:(resistance : 5.6 cm H2O/L/min ; compliance : 50 ml/cm H2O)
Methods (4): �
Ventilation parameters:Vt set (ml) 700, 400
Respiratory rate 12
I/E 1/2
Fi02 (%) 21,50,90
Methods (5): �
Measurements: Actual Vt: Fleisch pneumotachograph / computer Actual respiratory rate Statistical analyze: 3 measures Mean +- SD t test (Vt set vs Vt delivered): p <0.05
Results (1): T-bird VS02 with input
of cabin altitude Vt=400 ml
Results (2): T-bird VS02 without input
of cabin altitude Vt=400 ml
Results (3): T-bird VS02 with input
of cabin altitude Vt=700 ml
Results (4): T-bird VS02 with input
of cabin altitude Vt=700 ml
Discussion (1):T-bird VSO2: is it a « good » ventilator
for air transport ?
With altitude: Vt decreased Significantly: at 1500 m > 10%: at 2500 m don’t forget to input the cabin altitude!
Discussion (2):What is a « good » ventilator
for ground transport? Lightweight package Small volume Various possible settings Settings: respected EASY TO OPERATE
Evaluations Benchmarking Chipman et al. Performance comparison of 15 transport ventilators. Resp Care 2007
Discussion (3): specific stresses of flight
Vibration Electromagnetic radiation Electrical safety Thermal and humidity conditions Hypobaric
Discussion (3): How to evaluate ?
Laboratory evaluation Vibration Electromagnetic radiation Electrical safety Thermal and humidity conditions Hypobaric Few studies, no benchmarkingFlynn et al. The performance of Dräger Oxylog ventilators at simulated altitude
Anaesth Intensive Care 2008
Rodriquez et al. Effects of simulated altitude on ventilator performance. J Trauma 2009
Discussion (4): How to bring the evaluation
to its completion ?
Real life
Systematic declaration of major dysfunction
Analyze of ventilators failures Root Cause Analysis Br Med J 2000; 320 :777-781Ann Fr Anesth Réanim 2002; 21 : 509 - 516
Conclusion
Highly specialized ventilators: ≠ T-bird VS02
Evaluation laboratory testing real life
Highly trained personnelJohannigman JA. Critical care aeromedical teams (Ccatt): then, now and what's next
J Trauma 2007
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