The VAR® is a small automatic gas-powered resuscitator intended to provide pressure-limited, flow controlled ventilatory support for short-term emergency ventilatory support for both breathing and non-breathing patients while being monitored by a clinician or trained operator. The VAR® is a single patient, multiple use device.
Which mode the VAR® is in is simply a function of where the rate dial has been adjusted. Turn the rate dial clockwise until it is in pressure support (assisted breathing) mode. For pressure control (mandatory breathing) mode, turn the rate dial counter clockwise.
The VAR® is pressure cycled on PIP and PEEP. Therefore, as soon as the patient’s pressure drops to PEEP, inhalation will start whether this occurs because exhalation has been completed or the patient draws a breath. Compared to time cycled ventilators, the sensitivity would be zero in the pressure control mode. In the pressure support mode, the sensitivity may be set as light as 1 cm H2O or less; therefore, the patient’s work of breathing will be minimal. If greater effort by the patient is desired, it may be increased by turning the rate dial clockwise. Be sure to use a manometer when performing this procedure.
You can use any breathing gas from the hospital wall outlet or gas cylinder.
Tidal volume may be estimated by using the tidal volume chart included with the instructions. The VAR® runs on a continuous fixed flow rate of gas (inspiratory flow) of up to 40 L/min (667 mL/second) when connected to a 50 PSIG gas source with associated flowmeter and control valve. Tidal volume is the inspiratory time multiplied by the flow rate (example: 1 second i-time X 667 mL/second = 667 mL tidal volume).
PEEP setting on the VAR® is automatically set at about 1/5th of the selected PIP. It is good clinical practice to use a manometer to verify any pressure setting. PIP indications on the pressure dial are approximate only and ranges between 15 and 50 cm H2O, and PEEP ranges between 2 and 9 cm H2O respectively.
A manometer may be connected to the VAR® by placing a 22 mm fitting between the modulator and patient connector tee (see enclosed instructions). Although the pressure dial indicates typical PIP and PEEP is about 1/5th of PIP, a manometer is recommended because it provides valuable information to the clinician on what is occurring with the patient.
Yes. An extension kit with connecting tubing is available for MRI patient set up (refer to Technical Bulletin 082098 – MRI safe).
“Operator-powered resuscitator” – Bag-Valve-Mask (BVMs) are the most commonly used devices for emergency short term ventilator support. They are typically disposable and are used extensively in the pre-hospital and inter-hospital markets. Manual resuscitators are labor intensive and are unable to deliver consistent ventilatory support. When used with a mask or endotracheal tube, they require the clinician to use both hands. They do not require being connected to a gas supply to provide ventilatory support but are almost always used in conjunction with compressed oxygen to increase the patient’s FiO2. Although they appear easy to use, many studies have shown that they all deliver insufficient tidal volume and often deliver respiratory rates which are too high, resulting in significant adverse affects on the patients (refer to Clinical References in Section VII). Nevertheless, many clinicians, when questioned about the use of manual resuscitators, feel certain that they deliver a consistent tidal volume of 750 mL per breath and that the ventilatory support they deliver is superior because of the feel they get through their hands when squeezing the bag.
It depends. As long as the PercussiveNEB® is cycling during exhalation at a rate appropriate for clearance and is well tolerated by the patient, then the flow is acceptable. If not, a flow meter will need to be used.
All float/ball type 15 L/min flowmeters tested by VORTRAN Medical will provide sufficient flow when dialed all the way open. Under such circumstances the ball indicates a flow only slightly higher than 15 L/min, but it is actually delivering a lot more flow.
The nebulizer has an output of 1 mL/min during inhalation when the patient is actually receiving aerosol. During exhalation the output of the nebulizer is less so it is normal to have liquid left over in the reservoir. Actual outputs will vary with each patient. It is important that liquid is present in the nebulizer reservoir during the entire course of treatment.
The PercussiveNEB® is single patient, multiple use and totally disposable.
Under normal operating condition, your device should last about 100 hours of operation. If you do two – 15 minutes per day, it will last about 90 days.
The VORTRAN-IPPB™ is pressure cycled between PIP and PEEP. Therefore, as soon as the patient draws a breath to the baseline PEEP (1/10th of PIP) inhalation will start. Sensitivity may be set as light as 1 cm H2O or less.
The VORTRAN-IPPB™ is inherently safe but is not equipped with a redundant pop-off valve. Therefore, the VORTRAN-IPPB™ should never be used with an endotracheal tube and used cautiously with a mask.
Tidal volume may be determined by using the tidal volume chart included with the instructions. Tidal volume is the inspiratory time multiplied by the flow rate.
Yes, when connected directly to a 50 PSIG source, the maximum flow is 40 L/min (± 10%).