Brazilian recommendations of mechanical ventilation 2013
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1 ELECTRONIC SUPPLEMENTARY MATERIAL Brazilian recommendations of mechanical ventilation 2013 Recomendações brasileiras de ventilação mecânica Parte I Carmen Sílvia Valente Barbas, Alexandre Marini Ísola, Augusto Manoel de Carvalho Farias, Alexandre Biasi Cavalcanti, Ana Maria Casati Gama, Antonio Carlos Magalhães Duarte, Arthur Vianna, Ary Serpa Neto, Bruno de Arruda Bravim, Bruno do Valle Pinheiro, Bruno Franco Mazza, Carlos Roberto Ribeiro de Carvalho, Carlos Toufen Júnior, Cid Marcos Nascimento David, Corine Taniguchi, Débora Dutra da Silveira Mazza, Desanka Dragosavac, Diogo Oliveira Toledo, Eduardo Leite Costa, Eliana Bernardete Caser, Eliezer Silva, Fabio Ferreira Amorim, Felipe Saddy, Filomena Regina Barbosa Gomes Galas, Gisele Sampaio Silva, Gustavo Faissol Janot de Matos, João Claudio Emmerich, Jorge Luis dos Sanots Valiatti, José Mario Meira Teles, Josué Almeida Victorino, Juliana Carvalho Ferreira, Luciana Passuello do Vale Prodomo, Ludhmila Abrahão Hajjar, Luiz Cláudio Martins, Luiz Marcelo Sá Malbouisson, Mara Ambrosina de Oliveira Vargas, Marco Antonio Soares Reis, Marcelo Brito Passos Amato, Marcelo Alcântara Holanda, Marcelo Park, Marcia Jacomelli, Marcos Tavares, Marta Cristina Paulette Damasceno, Murillo Santucci César Assunção, Moyzes Pinto Coelho Duarte Damasceno, Nazah Cherif Mohamad Youssef, Paulo José Zimmermann Teixeira, Pedro Caruso, Péricles Almeida Delfino Duarte, Octavio Messeder, Raquel Caserta Eid, Ricardo Goulart Rodrigues, Rodrigo Francisco de Jesus, Ronaldo Adib Kairalla, Sandra Justino, Sérgio Nogueira Nemer, Simone Barbosa Romero, Verônica Moreira Amado Table 1 - Available ventilators for noninvasive ventilation Manufacturer/Model Context of use Available modes Special modes Observations Philips BIPAP A30 Specific for NIV AVAPS Auto-trak TRILOGY-100 NIV and IMV PSV,PCV and VCV AVAPS Dixtal Oximetry coupling Auto-trak Heated humidification DX3012 NIV and IMV PSV, PCV, VCV,SIMV, CPAP Active and passive humidification Philips respironics BIPAP-vision, focus and ST Specific for NIV BIPAP and CPAP Auto-trak Slope adjustment FIO 2 in vision Resmed Stellar NIV and IMV PSV with automatic pressure adjustment ivaps Covidien Covidien 840 NIV module Spontaneous + PSV A/C and SIMV Servo FIO 2 Portable Data download Slope and expiratory sensitivity can be adjusted in PSV Servo I NIV module Spontaneous and PSV FIO 2 Adjustment of slope and expiratory cycling Ventilator Carina Specific for NIV VC-SIMV Auto-Flow PC-BIPAP PC-AC SPN-PS (VG) SPN-CPAP SPN-CPAP Apnea ventilation 1-hour internal battery, 9-hour external battery Automatic triggering and slope Memory card and trends can be coupled 6-8 hour battery, volumetric capnography, preset values for diseases, mask adjustment Possible back up with manual ventilation and/or Vf and automatic leak EVITA XL Special module for NIV PSV Automatic adjustments Engstron Pro VNI and VMI Multiple modes of ventilation Internal battery and automatic adjustments Alliance Care fusion-vela Special module for NIV PSV 6-hour battery Continue...
2 ...continuation Intermed : IX-5 Special module for NIV A/C, SIMV, CPAP, PSV Adjustment of inspiratory and : Inter 7 plus Special module for NIV A/C, SIMV, CPAP, PSV Adjustment of inspiratory and VIVO VIVO 40 (pressure up to 40 cmh 2 0) and VIVO 30 (pressure up to 30 cmh 2 0) Breas I-sleep 20 (pressure up to 20 cmh 2 0) Special module for NIV PSV, PCV and CPAP Adjustment of inspiratory and Special module for NIV CPAP Adjustable slope with up to 5 simultaneous curves 3-hour internal battery External battery Humidification system Heated humidifier BIPAP - bilevel positive air pressure; NIV - noninvasive ventilation; AVAPS - average volume assured pressure support; IMV - invasive mechanical ventilation; PSV - pressure support ventilation mode; VCV - volume led ventilation mode; PCV - pressure led ventilation mode; SIMV - synchronized inspiratory mandatory ventilation; CPAP - continuous positive air pressure; ivaps - intelligent volume-assured pressure support; FIO2 - fraction of inspired oxygen; Vf - respiratory rate; SPN-PS (VG) - spontaneous - pressure support (volume guarantee); SPN - spontaneous - pressure support; A/C - assist/. Table 2 - Basic ventilators (without curve monitoring) Manufacturer/Model Age range Context of use Available modes Flow (VCV) Special modes Observations Taema Osiris Ad, Ped Transport A-C (VCV) Continuous Bio-Vent CrossVent CV-3 / CV-4 Ad, Ped ICU, Transport A-C (VCV), SIMV, Continuous Omni-Tech Omni-Vent Ad, Ped Transport A-C (VCV) Can be used in MRI Allows for hyperbaric ventilation Allied EPV 200 Ad Transport A-C (VCV) Continuous Allied Life Support Autovent 2000, 3000 & 4000 Ad Transport A-C (VCV), CPAP/ spontaneous Continuous Oxylog 2000 Plus Ad Transport A-C (VCV), SIMV, CPAP/spontaneous Continuous Oxylog 3000 Ad, Ped Transport A-C (VCV), PCV, SIMV, Continuous Oxylog 3000 Ad, Ped Transport A-C (VCV), PCV, SIMV, Continuous Capnometry Optional: auto-flow Bi-Level 40 Ad, Ped Transport A-C (VCV), PCV, SIMV, CPAP/ spontaneous, PSV Continuous K. Takaoka Mini-ventil 600 Ad Transport A-C (VCV) Continuous MicroTak 920 Ad, Ped Transport A-C (VCV), SIMV, CPAP/spontaneous Continuous Leistung PR 4D-02 Ad, Ped Transport A-C (VCV) Continuous Time-cycled Res Med VS III Ad, Ped ICU, NIV A-C (VCV), PCV, SIMV, Continuous Newport HT 70 Ad, Ped Transport A-C (VCV), PCV, SIMV, Continuous Decelerating Vent-Logos rise time % expiratory time-psv VLP E Ad Transport A-C (VCV) Continuous VLP P Ad Transport A-C (VCV) Continuous Ad - use in adults; Ped - use in children (non-newborn); A-C - assist ; VCV - volume led ventilation mode; SIMV - synchronized inspiratory mandatory ventilation; CPAP - continuous positive air pressure; PCV - pressure led ventilation mode; PSV - pressure support ventilation mode; MRI - magnetic resonance imaging; transport - use for transportation of patients under invasive mechanical ventilation; ICU - appropriate for use in intensive care unit; NIV - use for noninvasive ventilation.
3 Table 3 - Ventilators with basic resources and with curves Manufacturer/Model Age range Context of use Extend XT Ad, Neo ICU A-C (VCV), PCV, SIMV, Available modes Flow (VCV) Monitoring Special modes Observation Continuous, Capnography Intermed Inter-5 Plus Ad, Ped ICU A-C (VCV), PCV, SIMV, Continuous, Curves Separate monitor Savina 300 Ad, Ped ICU A-C (VCV), PCV, SIMV, Ventil Pulmonar 101 Ad, Ped ICU, home A-C (VCV), PCV, SIMV, Hamilton Galileo Gold Ad, Ped ICU A-C (VCV), PCV, SIMV, Raphael Color Ad, Ped ICU, ER A-C (VCV), PCV, SIMV, T-1 Ad, Ped Transport A-C (VCV), PCV, SIMV, MR-1 Ad, Ped Transport A-C (VCV), PCV, SIMV, K-Takaoka Smart Ad, Neo ICU, ER A-C (VCV), PCV, SIMV, Carmel Ad, Neo ICU A-C (VCV), PCV, SIMV, Leistung Luft 1-g Ad, Ped ICU, ER A-C (VCV), PCV, SIMV, Luft 2-g Ad, Ped ICU A-C (VCV), PCV, SIMV, PR - 4g Ad, Ped Transport A-C (VCV), PCV, SIMV, Magnamed Fleximag Ad, Neo ICU, ER A-C (VCV), PCV, SIMV, Oxymag Ad, Neo Transport A-C (VCV), PCV, SIMV, Neumovent GraphNet T5 Ad, Ped ICU, ER A-C (VCV), PCV, SIMV, Newport e360 Ad ICU, ER A-C (VCV), PCV, SIMV, Continuous, Curves BiLevel Auto-Flow Continuous, Curves PRVC, volume guaranteed Continuous, ASV,, automatic tube Continuous, ASV,, automatic tube ivent MRI: can be used in MRI Automatic P-V curve, P0.1 Continuous, Curves ASV Automatic P-V curve Capnometry Barometric pressure (air transportation) Continuous, Curves ASV For MRI Extra monitor Continuous, BiLevel, orotracheal tube Continuous, Curves PSV: rise time & time adjustment (% flow), PCV volume guaranteed P0.1 PiMax Continuous, Curves Continuous, MMV, BiLevel, PSV volume guaranteed, Continuous, Curves Capnometry Continuous, Curves BiLevel, PSV: rise time Capnography (optional) Continuous, Curves BiLevel, Capnography (optional) Continuous, Curves Continuous, BiLevel, PSV: rise time & time adjustment (% flow), Ad - use in adults; Ped - use in children (non-newborn); Neo - use in neonatology; ICU - appropriate for use in ICU; PSV - pressure support ventilation mode; VCV - volume led ventilation mode; PCV - pressure led ventilation mode; SIMV - synchronized inspiratory mandatory ventilation; CPAP - continuous positive air pressure; - airway pressure release ventilation; PRVC - pressure regulated volume led; ASV - adaptative support ventilation; MMV - minute mandatory ventilation; ER - use in emergency room.
4 Table 4 - Ventilators with curve monitoring and advanced resources Manufacturer/Model Age range Context of use Basic modes Monnal T-75 Ad, Neo ICU Yes Continuous, Viasys Vela Ad, Ped ICU Yes Continuous, Viasys Avea Ad, Neo ICU Yes Continuous, Intermed i X5 Ad, Neo ICU Yes Continuous, Intermed Inter-7 Plus Ad, Neo ICU Yes Continuous, Evita 4 Ad, Ped ICU Yes Continuous, Evita XL Ad, Neo ICU Yes Continuous, Engstron Carestation Ad, Neo ICU Yes Continuous, Engstron Pro Ad, Neo ICU Yes Continuous, Hamilton C-3 Ad, Ped ICU, ER Yes Continuous, C-2 Ad, Ped ICU, ER Yes Continuous, S-1 Ad, Ped ICU Yes Continuous, G-5 Ad, Neo ICU Yes Continuous, K Takaoka Color Ad, Neo ICU Yes Continuous, Maquet Getinge Servo-i Ad, Ped ICU Yes Continuous, Servo-S Ad, Ped ICU Yes Continuous, Flow (VCV) Monitoring Special modes Observations BiLevel CPAP, PRVC Capnography (% flow), PRVC, V-PSV, PSV: rise time & time adjustment (% flow), Vsync, PRVC, AAC (tube ) (% flow), TGI, tube (% flow), VAPS, BiLevel, TGI, (BiPEEP) MMV, Auto-Flow,, PPS (optional), ATC - tube Auto-Flow, automatic tube, Smart Care Variable SP, BiLevel, PC-, Recruitment maneuver, Low flow maneuver BiLevel (% flow), Automatic tube,, PC-volume guaranteed adjustment (% flow), automatic orotracheal tube,, PC-volume guaranteed Capnography Capnography Measures P0.1, Pimax, WOB (esophageal) Measures P0.1 Measures P0.1 Capnography, PiMax, Vd/Vt Capnography, oximetry, Lung protection package (optional) P0.1, PiMax, Measures FRC, indirect calorimetry Curves ASV, Volumetric capnometry (optional), ASV, APV, Tube, P0.1 Automatic P-V curve, Volumetric capnometry (optional), ASV, Automatic P-V curve, capnography, ASV, BiLevel,, APV Allows heliox (optional), Volumetric capnography (optional), Curves MMV, PSV-volume guaranteed, BiLevel, tube NAVA (optional), AutoMode, adjustment (% flow), PRVC, adjustment (% flow), PRVC, P0.1, PiMax, Capnometry Capnography, PO.1, WOB (in-line) PO.1 Continue...
5 ...continuation Mindray Synovent E3 Ad, Ped Hospital, ICU, ER Yes Continuous, Synovent E5 Ad, Ped ICU Yes Continuous, Neumovent GraphNet Advance Ad, Neo ICU Yes Continuous, Philips Dixtal DX-3012 Plus Ad, Ped ICU Yes Continuous, Dixtal DX-3012 Ad, Ped ICU Yes Continuous, Puritan Bennett 840 Ad, Ped ICU Yes Continuous, Bilevel, PSV, optional automatic expiratory trigger, rise time, time adjustment, tube PRVC,, Bilevel, PSV, optional automatic expiratory trigger, rise time, time adjustment, tube PRVC, Capnography BiLevel, PS-volume guaranteed, MMV, PSV: rise time & time adjustment (% flow), BiLevel, PS-Vol Gar, MMV, PSV: rise time & time adjustment (% flow), adjustment (% flow), PAV-Plus, automatic tube, Capnography, P0.1, WOB, PiMax, enables connectivity with the hospital system (Bnelink/HL7) Capnography, P0.1, WOB, PiMax, low flow maneuver, enables connectivity with the hospital system (Bnelink/HL7), displays 4 simultaneous curves (P/T, V/T, F/T and capnography) PO.1, Capnography Capnography, PO.1, PiMax Ad - use in adults; Ped - use in children (non-newborn); Neo - use in neonatology; ICU - appropriate for use in ICU; PSV - pressure support ventilation mode; Bipap - bilevel positive air pressure; VCV - volume led ventilation mode; PCV - pressure led ventilation mode; SIMV - synchronized inspiratory mandatory ventilation; CPAP - continuous positive air pressure; ivaps - intelligent volume-assured pressure support; - airway pressure release ventilation; PRVC - pressure regulated volume led; ASV - adaptative support ventilation; MMV - minute mandatory ventilation; ER - use in emergency room; VAPS - volume assured pressure support ventilation mode; Pimax - maximal inspiratory pressure; FRC - functional residual capacity; NAVA - neurally adjust ventilatory assist; PAV - proportional assist ventilation; APV - adaptative pressure ventilation; PS - pressure support. Table 5 - Mode-dedicated ventilators HFOV (adults) Manufacturer/Model SensorMedics 3100 B Age range Ad, Ped HFOV - high frequency oscillatory ventilation; Ad - use in adults; Ped - use in children (non-newborn).
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