Oct. 2, 2009

The Best Department winner in ADVANCE's National Respiratory Achievement Awards has earned a reputation for working with cutting-edge technology. We asked Adam North, CRT, department manager, to elaborate on some of the equipment used at Our Lady of the Lake RMC in Baton Rogue, La. To learn more about the competition winners, read Leading the Way.  

Direct Digital Charting by Bridge-Tech Medical Inc. My staff and I have fallen in love with this technology. The therapist points a PDA at the vent, pushes a button, and all the settings move to the PDA. Additional charting is all completed via the PDA and then wirelessly transmitted to the patient's electronic health record. This may be the sexiest device I've seen in 20 years of respiratory therapy. We are working with this company to make it the standard at my hospital.

SensorMedics 3100B by CareFusion. A patient with a history of alcohol abuse came to our hospital in bleak condition. She had leucopenia, and pneumococcal sepsis (ALPS), which has an 80 percent mortality rate. Maximized on conventional vent settings for a couple weeks, the patient's condition had continued to deteriorate. The medical staff planned a conference with the family regarding the removal of life support. But before that meeting took place, a respiratory therapist suggested utilizing the SensorMedics 3100B as a rescue effort; the doctors concurred that it was worth a try. Within hours, the team saw significant improvements in oxygen saturation and the patient's overall condition. She returned to conventional ventilation after four days, and weaned altogether after three weeks, and then transferred to the respiratory care unit. The oscillator management used for this patient was put in writing, and the RTs performed a barrage of training for the pulmonary intensivist and trauma surgeons. Since the protocol's implementation, 13 of 14 adult ARDS patients placed on oscillation have survived to discharge.

Precision Flow by Vapotherm. This product is used in both adults and pediatrics. We are currently purchasing additional units and have contacted Vapotherm regarding the possibility of partnering with them to explore the feasibility of expanding this mode of care to patients outside the current schools of logic. The upgrade from the Vapotherm 3000i to the newer Precision Flow has been instrumental in our staff's desire to expand these services. It has become more affordable and less labor intensive. One of our pediatric intensivist recently said that we always need to have one of these units available to potentially prevent the need for intubations in the pediatric population.

840 Ventilator System by Covidien. We have a fleet of 38 840 ventilators. They are all equipped with every mode of ventilation from neonatal to adult. We have worked to incorporate the use of Tube Compensation (replacing T-Piece Trials), PAV+, VC+, and Bi-level, including inverse I:E ventilation into our everyday practice. Utilizing the same ventilator on all patients helps to facilitate the cross training of personnel and eases the transition from one population to the next. We have a great relationship with Covidien.

The Vest Airway Clearance System by Hill-Rom Services Inc. We have used this product for years with the reusable vest, but we recently entered into a new contract converting us to a disposable product. With the launching of this new product, will come our new airway expansion and clearance protocol. Our current chest physiotherapy protocol is somewhat limiting as to who can qualify for CPT. We feel that patients with co-morbidities that would not normally qualify for CPT may have some benefit. With the therapist ultimately making that decision via protocol, we feel certain that we can benefit more patients with a more effective therapy.

IPV by Percussionaire. As part of the above protocol, IPV plays an equal role to the Hill-Rom Vest. By protocol, IPV is the mode of choice in the ICUs and the Vest is the mode of choice on the floors, although this is interchangeable based on patient compliance and tolerance.

RAPIDPoint 400/405 Systems by Siemens. We have seven 405 analyzers positioned throughout the hospital: two in our cardiac operating rooms, one in our cath lab, with the remainder deployed to the ER, PICU, and adult ICUs. The low maintenance aspects of the machines along with their unique abilities to meet regulatory requirements have made this the product of choice for the past five years. We are expanding this technology to other hospitals in our system and are working on an extension for this contract well into the future. The fact that this machine does not change lot numbers is a tremendous regulatory advantage over the competitors. Having only made two service calls in the past five years for seven analyzers speaks volumes for the instrument's reliability.

Digital Monitoring System by SenTec. This product takes transcutaneous monitoring to the next level with algorithms built in to come as close as possible to the actual PCO₂ via blood gas. We performed testing with SenTec as soon as the technology became available and found it to generally read +/- 4 from your PCO₂. We now have one unit permanently mounted in our trauma room so we are getting PCO₂ readings before we could normally even get a gas drawn. Additionally, this has become almost a standard addition with patients receiving oscillatory ventilation.

Oxinet III Central Station Network by Nellcor. OLOL is one of the larger Oxinet customers in the country with more than 120 monitored beds. This technology remotely sends your patients' pulse ox data to a central monitor at the nurses' station and gives you the ability to have the pulse ox page the assigned nurse in the event of an alarm. Since the installation of this system, we have not had a single negative incident associated with a PCA pump. Anyone on a PCA pump must have this technology.