I'm a respiratory medicine fellow working in a respiratory unit in the UK. My training was in Ireland and I feel this should be mandatory watching for ventilation trainees. Doctors as a whole are sadly drifting away from bedside medicine and favouring looking at data. Lots of computer based work. It's a move in the wrong direction. Thanks for this video. I am so inspired and will remember your words re spending time in the room. Keep up the great work 🙂
We just received out Hamilton. Eager to try this mode. Thank you for explaining it so well. Technology is amazing but it DOES NOT replace "eyes" or time on the patient!
I use this mode as often as I am able. ASV takes a good understanding of several modes and mechanics of ventilation. I personally believe when the vent is doing to thinking for you it is even more important to know what your patient is doing and monitoring thoroughly to identify trends. I haven't seen a change in the amount of time spent with the patient.
It gets very deep on its math formula algorithms. ASV utilizes the Mead's Formula (minimum force of Breathing and thr Otis Formula(minimum work of breathing) both have a relationship with deadspace and alveolar ventilation regarding its time constant. I got this from the Hamilton vent youtube, its very involved so thank you Joe for simplifying with your videos.
Recently moved from Florida to Washington state. Had no exp with it at all until I moved. They use it about 30-40% of the time, depending on the therapist that day. Very very common to see it used. Still getting familiar with it myself, coming from using the Servo i.
We use ASV at our hospital to wean primarily. This mode is an intelligent mode which uses algorithm to best fit the patient’s needs so to speak. It also uses Otis formula to calculate RR. Thank you!
I am starting a travel contract at a hospital that uses Hamilton G5 vents and I have never used them before. I was told to look up this mode of ventilation by another traveler who has used it. It sounds awesome, but I’m unsure of how you can control SBTs and weaning trials when the vent does it automatically. Typically you want to know how long a patient tolerates PSV before extubation or a trach collar trial. Is there a way to look at what the vent has been doing in one of the screens? Thank you! Your videos have been a great refresher!!
We just received a Hamilton T1 and been doing research on ASV. So, this is my understanding pertaining to the % question you have. After you dial the patient's gender and height, the ventilator calculates a normal minute ventilation target for the patient. Depending why the patient is on the ventilator and the support they need, that minute ventilation may be just fine as a target and the ventilator will adjust frequency and tidal volume to achieve optimal ventilation. But if the patient requires more ventilatory support (larger tidal volume and or frequency), you would increase the minute ventilation % to provide it. The change would go from 7 ml/kg to 9 ml/kg. Basically a new target for the ventilator. Also, vice versa. Hope that helps!
We have a new open heart protocol where we are using 140% minute ventilation. My question is what happens if that doesn't give enough volume? Say the patient isn't fully awake yet? Then what? 140% is already kind of high.
Lack of knowledge and comfort. Also, from a post-op perspective, ease and decreased time of transition from full mechanical support to spontaneous breathing based off of when the patient is ready, not when we think they're ready. Honestly, not sure why that same principle doesn't apply to other conditions. Great question. Are you seeing it used much? Thanks RT for watching and commenting.
You seem to hold a bit of a grudge against MDs, so the last part of the video turned a bit into a rant. I see where you coming from as unfortunately quite a number of docs are arrogant and condescending towards nurses and RT. About reduced time spent at the bedside when using closed-loop modes. I totally agree that the goal cannot be to further reduce face-to-face time. However, the reality is that many hospitals (at least outside the US) both lack the personnel and expertise for good respiratory care. In this case a closed-loop mode can actually improve care quite a bit. In Europe for instance the role of respiratory therapist is hardly existent. That’s a pity because you guys are crucial for a good patient care! Keep up the good work.
I so appreciate this perspective. It actually illustrates my ignorance of global disparities in regards to access/availability of adequately trained resources and professionals. Your points are will taken! Also, my ending rant wasn't well articulated either. My frustration lies more in the manufacturers of these devices for which typically fall into the hands and operation of nurses, respiratory therapists, etc. I wish the manufacturers of these great devices would utilize the end user experts in production of their educational and promotional content. Having said that, I also realize that as respiratory therapists, we haven't done our part in contributing our knowledge and skills to be recognized as "experts" of these devices. So why would, or should, they seek us out? Again, I greatly appreciate this insightful comment. Thank you for watching and commenting! Reach out anytime. respiratorycoach@gmail.com
@@RespiratoryCoach I guess the promotional material mostly targets administrators/doctors as they tend to be the guys in the hospitals on the purchasing committees.
