VORTRAN
®
Medical
5/26/2017
VORTRAN
®
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2
VENT™ User’s Guide
Page 20
VII. Clinical Reference
A
. Berthieaume, Dave Swift RRT, Evaluation of the Vortran Automatic Resuscitator and the Vortran Airway
Pressure Monitor in the MRI Environment. Respiratory Care, Vol. 8. 2 - April-May 2013
INTRODUCTION:
The magnetic resonance imaging (MRI, 3 Tesla strength) scanner creates a unique electromagnetic
environment that allows high fidelity images of patients. With critically ill patients requiring mechanical ventilation, this
environment produces some unique challenges in management of ventilation and monitoring of ventilation. Currently, there
are a limited number of ventilatory devices that can provide mechanical ventilation in the MRI environment.
METHODS:
To determine if the Vortran Automatic Resuscitator (VAR Plus model) can be safely utilized in the MRI
environment. To evaluate, if the Vortran Airway Pressure Monitor (VAPM) can deliver accurate monitoring capability
within the MRI environment. The VAR-Plus performance was verified in a bench top setting, within the MRI core (with
and without extension lines) and outside of the MRI core (with and without extension lines). The VAPM was used in
parallel to verify the VAR-plus performance.
RESULTS:
The VAR-plus consistently delivered the RATE (within one bpm) and pressure set using a static lung
compliance & resistance model. The VAPM unit consistently monitored the set rate. However the unit’s ability to monitor
the inspiratory time was limited by rounding up at the 0.05 mark (ex. Ti of 0.56 displays as 0.6 and 0.45 displays as 0.4). The
VAPM (Vortran Airway Pressure Monitor) is not designed to be used within the immediate magnetic field of the MRI
machine. The magnetic field interferes with its operation and the authors recommend that it not be used within the magnetic
field - it does provide effective remote monitoring capability for the VAR-plus.
CONCLUSION:
The VAR-plus can effectively function, according to established performance characteristics, within the
MRI environment. The unit is not impacted by the electromagnetic field of the MRI scanner. The VAPM provides an
effective remote monitor for ventilation within the MRI environment (outside of the magnetic field) for adult and pediatric
populations not requiring very low inspiratory times.
Robert Kohler, EMT-P, The Control of End Tidal CO2. Respiratory Therapy, Vol. 7 No. 2 - April-May 2012
INTRODUCTION:
Pre-hospital care can be defined as efforts to achieve or maintain homeostasis. The ability to monitor and
control CO2, a key component of the buffering system, is an essential means to that end. Because of CO2, a key component of
the buffering system, has a direct effect on the pH of the body, the ability to monitor and control End Tidal CO2 (ETCO2), is
essential in order to maintain homeostasis.
Recently the American Heart Association has issued new guidelines defining a narrow range of optimal oxygen saturation for
many situations. Based on these recommendations proper patient care mandates that we have the ability to control both
components of ventilation. This pilot study examines the feasibility of controlling the End Tidal CO2 during 911 ground
ambulance operations.
MATERIAL AND METHODS:
There were 2 ventilation adjuncts available, the choice of either was not defined or dictated
by the protocol and was the clinician’s choice.
The control: an adult bag valve mask (BVM) as manufactured by Life Support Products #L770 with a bag volume of 1488 ml,
valve dead space of 7.8 mil (not including mask) and a patient connection of 22 mm outside diameter, 15 mm inside diameter
with no pop off valve.
The study: An oxygen powered disposable PIP cycled automatic resuscitator that regulated: Respiratory Rate, Tidal Volume,
Peek Inspiratory Pressure (PIP). Peak End Expiratory Pressure was variable at 20% of the selected PIP. The VAR-Plus model
PCM (VORTRAN Automatic Resuscitator) was used.
In December of 2009 Stamford EMS Paramedics began a program of training using manufacturer’s competency requirements
and guidelines from FCCS course curriculum. Clinical targets were FiO2 of 100% at a rate of 10-12 bpm and a PIP range
from 20-25cm/H2O. Paramedics were not restricted to these targets and were instructed to vary settings to meet the patient’s
needs. ETCO2 was monitored via Side Stream filter line capnography as manufactured by Microstream and available on the
Lifepak 12s currently in use. January through September of 2010, 152 intubated patients were reviewed. 46 met the criteria of
any patient greater than 10 kg with an intrinsic pulse and in respiratory arrest whether idiopathic or clinician induced as an
example from Rapid Sequence Induction. One patient was excluded due to a metabolic aberration. The remaining cases were
split, with 1,012 specific ETCO2 samplings evenly distributed over 23 cases using a BVM (as the control) and with 1,270
specific ETC) 2 samplings evenly distributed over 22 cases using the VAR. The first 4 minutes of data records from all cases
were excluded to compensate for procedural anomalies experienced while securing the airway. Data for all cases in each
group were combined for the calculation of standard deviation (Sd). The Sd was also calculated for each individual case. The
difference in the quantity of records had no statistical significance on results in a test analysis.
RESULTS:
After 9 months, ETCO2 values in the control group reflected a Standard deviation of 16.97 while the test group
ventilated with the VAR reflected as standard deviation of 14.09. In addition the study group trended lower as time progressed
while the control group did not.
CONCLUSION:
Although data is still being collected, these initial values show that despite the dynamic environment of the
pre hospital setting, with a minimum of additional training the pre-hospital provider can more accurately control ETCO2 with
a disposable PIP cycled respirator than with a Bag Valve Mask.
