By Philip Neuwirth, BS, MICP, CCEMTP, FP-C
All patients I have ever transported on BiPAP have been initiated at the sending facility. Generally the patient’s are on “stand-alone” BiPAP machines and not mechanical ventilators. This is a very important distinction between the two devices; the EPAP and IPAP setting are different. They’re different because BiPAP machines are said to be “absolute” or “vented” machines, which means the IPAP and EPAP are separate and not in addition to each other. The ReVel Ventilator is said to be additive, or “closed” which means the IPAP is in addition to the PEEP. So, in step #2 below, you will see CareFusions recommendation to adjust the IPAP/EPAP on the ReVel, based on the patients current setting from a stand-alone BiPAP machine.
So now that you understand those differences, the KEY TO SUCCESS is managing patient ANXIETY. I can’t stress this enough. If the patient has been using a stand-alone vented system, transferring them to a mechanical ventilator is going to feel different, and will take some coaching on your part. I will provide you with 5 steps to help make your patients more comfortable.
- The ReVel Ventilator requires a non-vented mask. If the patient is on a non-vented mask or a mask that has closable vents, use the same mask. So, if you are taking their mask, be sure the vents are closed. If you can’t close the vents, you can’t use that mask. CPAP masks are non-vented.
- Given the difference between “Absolute” and “Additive”, CareFusion recommends the following initial setting adjustments: If patients initial IPAP is >12, drop by 4 and if their IPAP is <12, drop by 2. Many Emergency Departments use “Stand-Alone” BiPAP machines. If you’re transferring a patient from an ICU/CCU the patient may be on BiPAP using a mechanical ventilator, like the LTV1200. In that case settings will be the same. If you are unsure if the ventilator is “Absolute” or “Additive”, ask the RT before setting your ReVel. Once those settings are initiated, you may need to adjust your IPAP / EPAP based on patient hemodynamics and comfort.
- Turn alarms, Low-Pressure and Low Min Volume off ( — ). These alarms will only increase your patients anxiety.
- Decrease “Rise-Time” to “2” (ReVel defaults to 4).
- Increase “Flow Termination” to 40%. (ReVel defaults to 25%)
To learn how to change these settings, refer to the ReVel Operators Manual.
If you are interested in additional Ventilator Education, I would recommend an easy to understand book, written by Eric Bauer FP-C from FlightBridgeED called, “Ventilation Management, A Pre-Hospital Perspective”
“If you don’t train like you fight, you will fight the way you train, so train as if someone’s life depends upon it—because it probably will” Dr J Cain, J Wilson, MICP