DRAFT Ventilator Rapid Reference version 2.4.pdf
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The document provides a comprehensive reference guide for the Zoll Z Vent automatic transport ventilator, including inventory requirements, operational tests, and patient circuit setup for various age groups. It outlines necessary equipment, alarm checks, ventilation settings for different patient sizes, and procedures for handling complications during ventilation. Additionally, the document includes detailed tidal volume calculations and adjustments for adult and pediatric patients, along with specific guidelines for emergency scenarios like arrest and metabolic acidosis.
DRAFT Ventilator Rapid Reference version 2.4.pdf
- 1. Zoll Z Vent Automatic Transport Ventilator Rapid Reference Revised: 6.5.24
- 2. Inventory List Item Quantity Main Compartment Vent (Clean, turns on, passes “Daily Operational Check”?) 1 ea. - Confirm Battery Level > 50% White or Green oxygen supply hose with quick connect male adaptor 1 ea. Power Cable (Confirm Function in Daily Operational test) 1 ea. Top Compartment CPAP Masks (Small , Med, Large) 1 ea. CPAP Harness 2 ea. Nebulizer 1 ea. Extra regulator and “pig tail” female quick connect adaptor 1 ea. Rear Compartment TEST Vent Circuit (clearly marked) 1 ea. Test Lung 1 ea. ADULT/PED Vent Circuit (in package, sealed) 1 ea. HEPA Bacterial/viral Filters 2-4 ea. Laminated Vent reference charts 1 set In the Unit (Wall, cot, etc) O2 tank with regulator and “pig tail” female quick connect adaptor , full (<1900 PSI) 1 ea. Extra ADULT/PED Vent Circuit (in package, sealed) 1 ea. Extra INFANT/PED Vent Circuit (in package, sealed) 1 ea. Extra CPAP Masks (Small , Med, Large) 1 ea. Extra CPAP Harness 2 ea. DRAFT ONLY
- 3. START HERE: Start Up & Operational Test To perform the Start Up procedure, do the following: 1) Connect appropriate patient circuit (Adult or Pedi). 2) Turn on ventilator; select the proper setting (e.g. Adult, Pediatric, CPAP, Custom) 3) After a breath or two, release the patient port while allowing the ventilator to operate. The PATIENT DISCONNECT alarm should activate. 4) Close the patient port with a clean gloved hand. • The HIGH AIRWAY PRESSURE LIMIT ALARM should activate after 2 breaths that reach the PIP High Limit. • If the AIRWAY PRESSURE HIGH ALARM fails to activate, check to determine that all of the circuit connections are secure, the exhalation valve is closing during inhalation, and that the High Airway Pressure Limit is set to 35 cm H2O or less. 5) Connect the Test Lung and adjust settings for your patient. Visually confirm the ventilator is functioning properly prior to placing on your patient. Keep BVM with Mask in arms reach of the patient at all times in case of complications For Daily Operational Test continue below: 6) Press the Manual Breath button; gas should flow out of the patient connection each time the button is pressed 7) With no other alarms occurring, remove external power from the ventilator. • The EXTERNAL POWER - LOW / DISCONNECT alarms should activate. Reconnect external power to reset alarms. • If either the HIGH AIRWAY PRESSURE, PATIENT DISCONNECT, or EXTERNAL POWER LOW / DISCONNECT alarms fail to activate, continue to manually ventilate the patient, check the patient circuit for leaks or a faulty exhalation valve and repeat the Operational Test. 8) Confirm Battery level
- 4. ADULT MALE: 15+ years /Over 4’7” ADULT MALE: 15+ years /Over 4’7” Height I/PBW KG Est. Vt 4ml/kg Est. Vt 6ml/kg Est. Vt 8ml/kg Est. Vt 10ml/kg Est. Mv 100-200ml/kg Revert to 4'7" tidal volume for all Pts below 4'7" Add 20ml for each 1" for each 1" above 6'8" *For Vt < 200 ml, use Infant/Ped Circuit or set at Vt @ 200 ml 4'7" 39 156 234 312 390 4700 9400 4'8" 41 164 246 328 410 4100 8200 4'9" 43 172 258 344 430 4300 8600 4'10 45 180 270 360 450 4500 9000 4'11 48 192 288 384 480 4700 9400 5'0" 50 200 300 400 500 5000 10000 5'1" 52 208 312 416 520 5200 10400 5'2" 55 220 330 440 550 5500 11000 5'3" 57 228 342 456 570 5700 11400 5'4" 59 236 354 472 590 5900 11800 5'5" 62 248 372 496 620 6200 12400 5'6" 64 256 384 512 640 6400 12800 5'7" 66 264 396 528 660 6600 13200 5'8" 68 272 408 544 680 6800 13600 5'9" 71 284 426 568 710 7100 14200 5'10" 73 292 438 584 730 7300 14600 5'11" 75 300 450 600 750 7500 15000 6'0" 78 312 468 624 780 7800 15600 6'1" 80 320 480 640 800 8000 16000 6'2" 82 328 492 656 820 8200 16400 6'3" 85 340 510 680 850 8500 17000 6'4" 87 348 522 696 870 8700 17400 6'5" 89 356 534 712 890 8900 17800 6'6" 91 364 546 728 910 9100 18200 6'7" 94 376 564 752 940 9400 18800 6'8" 96 384 576 768 960 9600 19200 Source: Adapted from ARDSNET www.ardsnet.org
- 5. ADULT Female: 15+ years /Over 4’7” ADULT Female:15+ years /Over 4’7” Height I/PBW KG Est. Vt 4ml/kg Est. Vt 6ml/kg Est. Vt 8ml/kg Est. Vt 10ml/kg Est. Mv 100-200ml/kg Revert to 4'7" tidal volume for all ADULT Pts below 4'7" Add 20ml for each 1" for each 1" above 6'8" *For Vt < 200 ml, use Infant/Ped Circuit or set at Vt @ 200 ml 4'7" 34 136 204 272 340 3400 6800 4'8" 36 144 216 288 360 3600 7200 4'9" 39 156 234 312 390 3900 7800 4'10" 41 164 246 328 410 4100 8200 4'11" 43 172 258 344 430 4300 8600 5'0" 46 184 276 368 460 4600 9200 5'1" 48 192 288 384 480 4800 9600 5'2" 50 200 300 400 500 5000 10000 5'3" 52 208 312 416 520 5200 10400 5'4" 55 220 330 440 550 5500 11000 5'5" 57 228 342 456 570 5700 11400 5'6" 59 236 354 472 590 5900 11800 5'7" 62 248 372 496 620 6200 12400 5'8" 64 256 384 512 640 6400 12800 5'9" 66 264 396 528 660 6600 13200 5'10" 68 272 408 544 680 6800 13600 5'11" 71 284 426 568 710 7100 14200 6'0" 73 292 438 584 730 7300 14600 6'1" 75 300 450 600 750 7500 15000 6'2" 78 312 468 624 780 7800 15600 6'3" 80 320 480 640 800 8000 16000 6'4" 82 328 492 656 820 8200 16400 6'5" 85 340 510 680 850 8500 17000 6'6" 87 348 522 696 870 8700 17400 6'7" 89 356 534 712 890 8900 17800 6'8" 92 368 552 736 920 9200 18400 Source: Adapted from ARDSNET www.ardsnet.org
- 6. PEDS < 14 years old /Under 4’7 PEDS < 14 years old /Under 4’7 PEDIATRIC: > 14 years old / Under 4'7"" Age I/PBW KG Est. Vt 4ml/kg Est. Vt 6ml/kg Est. Vt 8ml/kg Est. Vt 10ml/kg Est. Mv 100-200ml/kg BPM <1 < 5kg CONTRAINDICATED 1 10 40 60 80 100 1000 2000 30 (25-45/min) 2 12 48 72 96 120 1200 2400 30 (25-45/min) 3 14 56 84 112 140 1400 2800 25 (20-30/min) 4 16 64 96 128 160 1600 3200 25 (20-30/min) 5 18 72 108 144 180 1800 3600 25 (20-30/min) 6 25 100 150 200 250 2500 5000 25 (20-30/min) 7 28 112 168 224 280 2800 5600 20 (16-25/min) 8 31 124 186 248 310 3100 6200 20 (16-25/min) 9 34 136 204 272 340 3400 6800 20 (16-25/min) 10 37 148 222 296 370 3700 7400 20 (16-25/min) 11 40 160 240 320 400 4000 8000 20 (16-25/min) 12 43 172 258 344 430 4300 8600 20 (16-25/min) 13 46 184 276 368 460 4600 9200 16 (range 10 - 20) 14 49 196 294 392 490 4900 9800 16 (range 10 - 20) For Grey Area consider Adult IPBW charts For Vt > 300 ml , use Adult/Ped Circuits For children whose height is over 4”7 USE ADULT CHARTS
- 7. HOW TO USE DURING CPR (1) Select Custom in start-up menu. (2) Confirm at FIO2 at 100. (3) Confirm PIP ALARM of 100. (4) Confirm PEEP to 3-5. (5) Set Vt to 6 ml/kg I/PBW (Use Chart) (6) Confirm BPM to 8. (7) Confirm mode for AC (v). (8) Confirm trigger to –6.0. Will observe reduced tidal volumes when breath and compression occur simultaneously. (9) If ROSC occurs -> Return to standard settings and Set mode to SIMV (v). (10)If ROSC occurs: Do not forget to sedate appropriately
- 8. D.O.P.E.R.S. D - Displacement of tube: – Attach end-tidal CO2 to verify tube placement (Mandatory) – Check depth (cm at lip). O- Obstruction of tube/circuit : – Use suction catheter to remove mucus from tube and make sure patient is not biting down. – Insure that inline suction catheter is not partially blocking ETT tube. P– Pneumothorax : – Auscultate, assess, visualize chest wall, and perform needle decompression if needed. E- Equipment failure : – Connect to BVM to buy time to evaluate your patient and the ventilator. – Check O2 levels and flow rate R- Rigidity/Resistance to Ventilation – Evaluate sedation and paralysis – Evaluate for Pneumo and Stacked Breaths S- Stacked breaths - Auto-PEEP especially in COPD/Asthma: – Disconnect from ventilator and allow open circuit exhalation. – Increase I:E ratio (1:4), Decrease Respiratory rate or Tidal volume (or both) if tolerated. – Consider bronchodilators and/or ETT suctioning. – Consider opening circuit to atmosphere and allowing exhalation.
- 9. Adult Standard Adults: 6 -20 (12 Default) Titrated for effect Adjust I:E as needed to prevent air trapping HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode PEEP 5 6 ml/kg I/PBW I:E 1:3.0 12 Trigger -2.0 SIMV(v) or AC (v) FiO2: 1.0 (100%) -> Titrated to FiO2 0.5 (50%) if tolerated while targeting SpO2 94-99% PIP to 35. PEEP: 2-10 cm H20 (5 Default) Set Vt based on Ideal Predicted Bodyweight (Adults) or age based guidelines (PEDS). When indicated: Select ADULT from start menu. Start at FIO2 at 100 and titrate to SPO2 of 94%. Adjust PEEP to 5. Set Vt to 6 ml/kg I/PBW Adjust BPM. Select mode for A/C (v) or SIMV (v). DRAFT ONLY
- 10. Adult Obstructive: (Asthma, COPD, etc) Adults: 10 -20 (12 Default) Adjust I:E to 1:4 , titrated 1:6 as needed and allowed by BPM limits HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode PEEP 5 8 ml/kg I/PBW I:E 1:4.0 12 Trigger -2.0 AC (V) FiO2: 1.0 (100%) -> Titrated to FiO2 0.5 (50%) if tolerated while targeting SpO2 94-99% PIP to 35. PEEP: 2-10 cm H20 (5 Default) Set Vt based on Ideal/Predicted Bodyweight (Adults) or age based guidelines (PEDS). 4-8 ml/kg I/PBW (8ml/kg default) When indicated: Select ADULT from start menu. Start at FIO2 at 100 and titrate to SPO2 of 94%. Adjust PEEP to 5. Set Vt to 8 ml/kg I/PBW Adjust BPM. Adjust I:E to 1:4 Select mode for A/C (v) or SIMV (v). DRAFT ONLY
- 11. Adult Metabolic Acidosis Adjust I:E as needed to prevent air trapping. Rapid Resp rates may limit I:E HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode PEEP 5 6 ml/kg I/PBW I:E 1:3.0 12 Trigger -2.0 SIMV(v) Adjust BPM and Vt to meet MINUTE VOLUME DEMANDS Start at 9L/min (Range 9-10) Alternate: 100-200 ml/kg/min When indicated: Select ADULT from start menu. Start at FIO2 at 100 and titrate to SPO2 of 94%. Adjust PEEP to 5. Set Vt to 8 ml/kg I/PBW. Titrate PRN. Adjust BPM and Vt to meet MINUTE VOLUME DEMANDS Select mode for SIMV (v). DRAFT ONLY
- 12. Select CUSTOM SETTINGS in start up menu. Confirm at FIO2 at 100. Confirm PIP ALARM to 100. Confirm PEEP to 3-5. Set Vt to 6 ml/kg I/PBW (Use Chart) Confirm BPM to 8. Confirm mode for AC (v). Confirm trigger to –6.0. 8 -> Titrated for effect (6-10/min) Adjust I:E as needed to prevent air trapping HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode PEEP 5 SEE CHART I:E 1:3.0 8 Trigger OFF/ -6.0 AC (V) FiO2: 1.0 (100%) -> Titrated to FiO2 0.5 (50%) if tolerated while targeting SpO2 94-99% PIP ALARM to 100. PEEP: Do not exceed 5 cm H2O Set Vt based on Ideal Predicted Bodyweight (Adults) or age based guidelines (PEDS). Adult Cardiac Arrest (CUSTOM) DRAFT ONLY
- 13. Adult POST ROSC Adults: 6 -20 (12 Default) Titrated for effect Adjust I:E as needed to prevent air trapping HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode PEEP 5 SEE CHART I:E 1:3.0 12 Trigger -2.0 FiO2: 1.0 (100%) -> Titrated to FiO2 0.5 (50%) if tolerated while targeting SpO2 94-99% PIP to 35. PEEP: 2-10 cm H20 (5 Default) Set Vt based on Ideal Predicted Bodyweight (Adults) or age based guidelines (PEDS). When patient has return of spontaneous circulation. Turn vent off and on again. Select ADULT from start menu. Start at FIO2 at 100 and titrate to SPO2 of 94%. Adjust PEEP to 5. Set Vt to 6 ml/kg I/PBW Adjust BPM to 12 BPM Select mode for A/C (v) or SIMV (v). SIMV(v) or AC (v) DRAFT ONLY
- 14. CPAP BPM number represents the patients respiratory rate HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode PS 0 PEEP 5 Rise TIme 5 % Cycle 40% Trigger -2.0 CPAP FiO2: 1.0 (100%) -> Titrated to FiO2 0.5 (50%) if tolerated while targeting SpO2 94-99% CPAP start at 3-5 • Max 10 cmH2O Select Mask CPAP in the Start-up Menu. Adjust FIO2 to 100% Multiple PRESS and SELECT the PIP button to set PEEP LEVEL at 5. (PEEP = CPAP in CPAP mode) DRAFT ONLY
- 15. ADULT BiLevel (BiPAP) PRESS AND HOLD BPM Button to adjust RISE TIME and % Cycle HR stby SpO2 stby FIO2 100 PIP Vt BPM Mode IPAP 9 EPAP 5 Rise TIme 5 % Cycle 40% Trigger -2.0 BL FiO2: 1.0 (100%) -> Titrated to FiO2 0.5 (50%) if tolerated while targeting SpO2 94-99% IPAP: Start at 9 (15 for COPD/Asthma) • (10-20 cmH2O) • Max 20 cmH2O EPAP: Start at 5 • (5-10 cmH2O) • Max 10 cmH2O Select Mask CPAP in Start-up Menu. PRESS and HOLD MODE button to set Mode to BL. PRESS and HOLD BPM button to setup Rise Time, % Cycle and Trigger. Begin at IPAP of 9 and EPAP of 5. Once Pt is comfortable with BIPAP increase IPAP/EPAP as needed. Cycle defaults to 25% (25-40%). This is likely low for many patients. Adjust to 40% for asynchrony , discomfort or tachypnea DRAFT ONLY
- 16. BVM → HEPA → NEB → Barrel Conn. → ETCO2 → In line suction → ETT Estimated Dead Space 110 ml (190 ml WITH HEPA FILTER) BVM HEPA FILTER (If not in PEEP valve) In Line Suction ETT Tube to PT ETCO2 Neb Chamber and T Piece Barrel Connector Flexible respiratory tubing
- 17. VENT (w/ HEPA) → NEB → Barrel Conn. → ETCO2 → In line suction → ETT Estimated Dead Space 110 ml Vent Circuit HEPA FILTER In Line Suction ETT Tube ETCO2 Neb Chamber and T Piece Barrel Connector Flexible respiratory tubing
- 18. VENT (W/ HEPA) → NEB → Corr. Tubing → Elbow Conn. → ETCO2 → ETT. Estimated Dead Space 90 ml Vent Circuit HEPA FILTER ETT Tube ETCO2 Neb Chamber and T Piece Elbow Connector Flexible respiratory tubing
- 19. CPAP -> HEPA -> ETCO2 -> NEB -> MASK CPAP Valve ETCO2 Patient Mask HEPA Filter Neb Chamber and T Piece DRAFT ONLY
- 20. Dead Space Estimates (Approximate Volumes) ETCO2 • Side Stream/in line (Zoll): 10 ML • Colormetric Adult 20 ml • Colormetric Pedi 5 ml LMA • Size 1- 9 ml • Size 2- 9 ml • Size 3- 20 ml • Size 4- 20 ml ETT • 7.0- 10 ml • 8.0- 12 ml • 9.0- 15 ml Nebulizer • Complete Set Up 100 ml (T-piece/Corrugated tubing/5 mm Barrel Connector) • Neb chamber: 20 ml • Corrugated tubing 50 ml • T-piece 20 ml • 5 mm Barrel Connector: 10 ml Misc. • HEPA VIRAL/BACTERIAL Filter 80 ML • Elbow Connector 10 ml • In Line Steri-Suction 10 ML DRAFT ONLY
- 22. DRAFT ONLY