Ventilators in Anesthesia

Well, it has always been my understanding that anesthesia ventilators are just "automatic bag squeezers". They are just plain old time cycled positive pressure deliverers.

Most times you really don't need anything else. Our patients need artificial ventilation because of the state we have produced. It's not like they have respiratory failure and poor gas exchange, like the chronically ventilated patients in ICU. So why have a fancy-dancy ventilator if you don't need it? It is overkill.

I guess technology is progressing, and now it is more cost feasible to have a fancier ventilator, that has lots of exotic settings. It makes sense, since we are bringing sicker and sicker patients to the OR. Sometimes those chronic vent patients need anesthesia, and a more sophisticated ventilator could improve our ability to care for them.

This is just my personal overview. Perhaps others will have additional and/or different insight.

loisane crna

I guess my first thought on this issue, is whether the technology and cost needed is really necessary. The vast majority of people undergoing surgery would not be needing high tech ventilation.

Our Dragers have Pressure control mode, along with AC, which is great. I'm having trouble considering what percentage of patients would need more than this. Perhaps it's me who has not keep up with the advances in ventilator technology.

the narcomed 6000 has the piston vent in it. and yes i have used the simv to get the patients co2 up and get them breathing on their own. however i have also been "practicing" "old school" technique of hand vent. the machines are nice but if there is a leak detected good luck trying to find it. also the co2 absorber is not readily visible and can turn plumb purple before you know it.

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Don't work anesthesia, but I've noticed when I've taken our babies to the OR that they use the "old fashioned" vents even on them - if they were on room air and stable prior to surgery. When the sicker and/or smaller babies who are vented go to the OR, we handbag on our way down and the RT brings their current vent along so that they can remain on their hi-tech system during surgery.

I have had pts who were requiring high vent support ( high peep (>20), High pressure settings, and inverse I:E ratios) that required surgery. We either did the surgery at the bedside or transported the pt to the OR on their own vent.

Obviously, it is not ideal to be transporting these patients to the OR, but sometimes they do need to go. I think this is a fairly rare occurance and the majority of people going to the OR do not require a high-tech vent.

http://www.datex-ohmeda.com/products/anelifesupport_aestiva.htm

Click on SmartVent ventilator under related links

Datex Ohmeda makes ventilators for anesthesia machines with all the bells and whistles of the best ICU ventilator.

At our instituion we occassionally bring in a reg vent used in ICU if problems with oxygenation arise. Many times we call RT to bring in a vent to put the pt on Bilevel so we can administer higher pressures and controll them better. Since we also do 10-15 thoracoabdominal AA a week all pt have double lumen Carlins ETT because the left lungs are not ventilated during parts of the operation. In these cases we sometimes have two vents in the room.