Medical air transportation with T-bird ventilator : don’t forget to input the cabin altitude!...

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