Page 514 - Clinical Application of Mechanical Ventilation

480 Chapter 14

support for a short time (e.g., less than 30 min), manual ventilation with a resusci-
Manual ventilation often tation bag and oxygen may be sufficient. However, manual ventilation often causes
causes inadvertent hyperven-
tilation, varying tidal volume inadvertent hyperventilation, irregular tidal volume and frequency, and fatigue of
and frequency, and fatigue of the care provider (Gervais et al., 1987; Hurst et al., 1989).
the care provider.
For intrahospital transport of mechanically ventilated patients, a transport
ventilator is preferable to manual ventilation (Nakamura et al., 2003). There are
intrahospital transport: a number of simple and complex transport ventilators available on the market
Moving a patient between two
locations within the hospital. (e.g., Avian and LTV1000 by CareFusion, San Diego, CA; Crossvent 2 by Bio-
Med Devices, Inc., Guilford, CT; Esprit by Respironics, Vista, CA; Model 740
by Covidien-Nellcor Boulder, CO; and Impact 754 Eagle Uni-Vent by Impact
For intrahospital Instrumentation, Inc. West Caldwell, NJ). These FDA-approved transport venti-
transport of mechanically
ventilated patients, a trans- lators are all battery-powered and have similar performance and functions of the
port ventilator is preferable to current ventilators used in the ICU (Austin et al., 2002; Miyoshi et al., 2000).
manual ventilation.
Besides the common features of a ventilator, the following capabilities are de-
sirable on a transport ventilator: PEEP, pressure support ventilation, volume- and
pressure-controlled ventilation, inverse ratio ventilation, display of expired volume,
In pressure control mode,
the expired volume must be and visual and audible alarms, especially for disconnection and airway pressures. For
monitored closely. Decreasing ventilators that operate with only the pressure control mode, the expired volume
compliance or increasing
airflow resistance can lead to must be monitored closely. Decreasing compliance or increasing airflow resistance
decreasing tidal volume.
can lead to decreasing tidal volume (Rola, 2004).
Ground Ambulance and Helicopter. Interhospital transport of mechanically ventilated
patients can be done safely if the patient’s medical condition is optimized before
departure (Reynolds et al., 2002). A ground ambulance or helicopter may be used
for patient transport when the distance is less than 150 miles. Each mode of trans-
portation has its own advantages and disadvantages (Cunningham et al., 1997;
Nichols et al., 1994; Shehey, 1995). Helicopters are preferable when the traffic or
terrain condition precludes a timely arrival at the destination by ground ambu-
lances. Of course, both facilities must have a suitable landing site for helicopters.
Sometimes a propeller-driven aircraft is used for a distance between 100 and
The projected total time 200 miles. Transporting the patient from the departure facility to the takeoff loca-
of transport should be a factor
in deciding which mode of tion and from the landing location to the destination facility may be time-consum-
transportation to use. ing. The projected total time of transport should be a factor in deciding which mode
of transportation to use.

Jet. For distances greater than 200 miles or intercontinental transport, a jet is pre-
ferred. Use of a jet is typically done for nonemergency cases since a jet involves more
resources and higher costs. The condition of patients using a jet for transport is rarely
critical due to the time required for planning and long flight time. Typically, most pa-
tients use jets for transport to tertiary care facilities for advanced diagnostic procedure
and therapeutic care, or from abroad to their home country (Veldman et al., 2001).

Procedures for Interhospital Transport

A written physician order must be obtained prior to transporting a mechanically
ventilated patient. Before departure, equipment and supplies for the patient are

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.