Performance Comparison of 15 Transport Ventilators
Daniel W Chipman RRT, Maria P Caramez MD, Eriko Miyoshi MD, Joseph P Kratohvil RRT, and Robert M Kacmarek PhD RRT FAARC
BACKGROUND: Numerous mechanical ventilators are designed and marketed for use in patient transport. The complexity of these ventilators differs considerably, but very few data exist to compare their operational capabilities. METHODS: Using bench and animal models, we studied 15 currently available transport ventilators with regard to their physical characteristics, gas consumption (duration of an E-size oxygen cylinder), battery life, ease of use, need for compressed gas, ability to deliver set ventilation parameters to a test lung under 3 test conditions, and ability to maintain ventilation and oxygenation in normal and lung-injured sheep. RESULTS: Most of the ventilators tested were relatively simple to operate and had clearly marked controls. Oxygen cylinder duration ranged from 30 min to 77 min. Battery life ranged from 70 min to 8 hours. All except 3 of the ventilators were capable of providing various FIO2 values. Ten of the ventilators had high-pressure and patient-disconnect alarms. Only 6 of the ventilators were able to deliver all settings as specifically set on the ventilator during the bench evaluation. Only 4 of the ventilators were capable of maintaining ventilation, oxygenation, and hemodynamics in both the normal and the lung-injured sheep. CONCLUSIONS: Only 2 of the venti- lators met all the trial targets in all the bench and animal tests. With many of the ventilators, certain of the set ventilation parameters were inaccurate (differed by > 10% from the values from a cardiopul- monary monitor). The physical characteristics and high gas consumption of some of these ventilators may render them less desirable for patient transport. Key words: transport, mechanical ventilation, ven- tilator, positive end-expiratory pressure, PEEP, fraction of inspired oxygen, FIO2. [Respir Care 2007;52(6): 740–751. © 2007 Daedalus Enterprises]
Patients who require ventilatory support are frequently transported from one hospital location to another. Portable
transport ventilators are also required in ambulances and in forward military positions. In addition, the threat of bioterrorism requires health care systems to be able and rapidly with very little notice to accept and ventilate large numbers of patients.
Daniel W Chipman RRT, Maria P Caramez MD, Eriko Miyoshi MD, Joseph P Kratohvil RRT, and Robert M Kacmarek PhD RRT FAARC are affiliated with the Department of Respiratory Care, Massachusetts Gen- eral Hospital, Boston, Massachusetts. Maria P Caramez MD is also af- filiated with the Department of Anesthesia, Massachusetts General Hos- pital, Boston, Massachusetts. Robert M Kacmarek PhD RRT FAARC is also affiliated with Harvard Medical School, Boston, Massachusetts.
This study was partly funded by a grant from the United States Army, DAMD 17–02-2–0006.
Daniel W Chipman RRT presented a version of this report at the OPEN FORUM of 51st International Respiratory Congress of the American As- sociation for Respiratory Care, held December 3–6, 2005, in San Anto- nio, Texas.
To provide ventilatory support under the above-defined conditions requires that transport ventilators be appropri- ately designed, though this does not mean they must be equivalent to intensive care unit ventilators.1 Transport ventilators must incorporate certain characteristics to be of use in the above-defined settings.1–3 First, they must be able to ventilate patients with healthy or acutely or chron- ically injured lungs. Second, they must be portable and easy to operate. Third, they must be able to deliver a high fraction of inspired oxygen (FIO2). Fourth, in forward mil- itary positions they must be able to operate on an internal battery for a long period, and without compressed gas.
Conflict of interest: Robert M Kacmarek PhD RRT FAARC has received research grants and honoraria from Respironics, Maquet Medical, Tyco Puritan Bennett, and Hamilton Medical. Daniel W Chipman RRT is a paid consultant for and has received lecture honoraria from Maquet Med- ical.
Correspondence: Robert M Kacmarek PhD RRT FAARC, Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Bos- ton MA 02114. E-mail: firstname.lastname@example.org.
RESPIRATORY CARE JUNE 2007 VOL 52 NO 6