1/1/2004

This was a transport that was completed on 2/14/03 at 2345 from a local referring hospital’s ICU to Duke’s MICU. The patient was a 71 year old female weighing 102kg. She had been admitted to the hospital’s ICU on 1/29/03 with a diagnosis of lower GI bleed. She was transferred to the hospital’s medical floor where her condition worsened. She was re-admitted to the ICU and eventually was intubated. She became increasingly ventilator dependent and cultures of her bronchial washings grew out yeast. Reaching the limits of treatment from this facility’s ICU, she was accepted to Duke’s Medical Intensive Care Unit for evaluation of possible jet/oscillator ventilator use.

The patient was flown from the referring hospital to Duke. This minimized her “out of hospital” time. The flight time was approximately 15 minutes and the ground time would have been approximately 40 minutes.

Her ventilator settings on the referring facility’s machine were as follows:

• Pressure control 20
• PEEP 10
• RR 8
• FIO₂ 100%
• I time 1.6sec

An ABG was drawn less than an hour before our arrival at the referring facility with the following results: pH 7.53, pCO₂ 44, pO₂ 69, HCO₃ 36.8, BE 12.6.

Following a standard exam prior to transport, she was transferred to our aircraft litter and placed on the LTV 1000. The settings were very similarly matched from the bedside vent. We remembered that in order to achieve a pressure control of 20 (exclusive of PEEP) with a PIP of 30, the pressure control setting on the LTV 1000 had to be set to 30 (inclusive of PEEP). Aside from that all other settings were the same. With these settings, her exhaled tidal volumes were 830-930cc, PIP 30, P_aw 15, and her saturations increased from 95 to 99% during the transport.

An ABG was drawn upon her arrival to Duke’s MICU with the following results: pH 7.50, pCO₂ 42, pO₂ 79, HCO₃ 33, BE 9.

This transport review demonstrates the versatility of the LTV 1000 as compared with other methods (bagging, volume cycled vents, etc.). One of the many wonderful benefits of this ventilator for critical care transport is that it is brought to the bedside of the referring facility and the patient is not removed from it until they reach the bedside of the receiving facility. This patient would not have tolerated short periods of bagging or an entire transport on a volume cycled ventilator. It can also be presumed with some certainty that her ABG results would not have improved, albeit minimally, with any lesser ventilation method.

	2/14/03----2300, prior to LTV1000	2/15/03----0030, after LTV1000
pH	7.53	7.50
pCO2	44	42
pO2	69	79
Bicarb	36.8	33
Base excess	12.6	9