DR.UPENDRA BAITHA ASSIST. PROF. DEPT. OF EMERGENCY MEDICINE AIIMS, NEW DELHI

1. Disposable Ventilator-A dream
or reality
DR.UPENDRA BAITHA
ASSIST. PROF.
DEPT. OF EMERGENCY MEDICINE
AIIMS, NEW DELHI

2. Lack of Ventilators during H1N1
Sales
1st
Qtr
2nd
Qtr

3. Hospital – Manual Resuscitators Used

4. Power cut kills patient in ICU

5. Manual Resuscitation by Nursing Staff

6. Challenges faced in hospital
environment
 Ventilation during CPR*
 Lack of transport ventilators
 Training for ventilators
 Ventilation during MRI / CT
 Inconsistency in manual ventilation
 Lack of Medical Ventilators in routine or mass casualty
*CPR – Cardio Pulmonary Resuscitation

7. Risk Associated with Manual Devices
• Inconsistent delivery during transport and CPR
• Pile up of breaths
• Barotrauma
• Risk of gastric insufflation
• Over-inflation of lungs leading to (ARDS)

8. Vortran Automatic Resuscitator (Var®)
( Disposable Ventilator )

9. Features of VAR®
 Plastic Body: Light weight, Transparent, Disposable
 Easy to use: Minimal training required
 Respiration Rate & Tidal Volume controls
 MRI / CT Compatible
 Pressure cycled ventilation
 Gas powered – No power back up required
 FiO2 50% or 100%
 In line pressure manometer to measure PIP & PEEP
 Use with Endotracheal (ET) Tube or mask

10. Ventilation Modes
Pressure Cycled
(IPV* Mode)
for mandatory
breathing
Apneic patients - who can not
breathe at all
Pressure Support
(CPAP** Mode)
for spontaneous breathing
Patients who can trigger / initiate
breath
*IPV – Intrapulmonary Percussive Ventilation ** CPAP – Continuous Positive Airway Pressure

11. VAR® comes packaged with
• Automatic Resuscitator
• 22 ID* flex tube
• O2 Hosing
*ID- Inner Diameter

12. VAR® Parts
ManometerModulator Patient Tee

13. VAR® Part No. 1 - Modulator
Respiration Rate (RR) Dial
Peak Inspiratory Pressure
(PIP) Dial
Modulator: To control the Peak Inspiratory Pressure
and Respiration Rate
Peak Inspiratory Pressure (PIP) :: Tidal Volume (Vt)

14. VAR® Part No. 2 - Pressure Manometer
Manometer: Inline manometer to measure the
pressures delivered to the patient in cm H 02

15. VAR® Part No. 3 - Patient Connection
Port
Patient Tee: Includes Oxygen supply port (FiO )*,
redundant pop-off valve,
patient connection port.
2
Redundant pop-off valve
Patient connection port
Oxygen supply port (FiO )
2
*FiO2- Fraction of inspired Oxygen
(50% or 100% Oxygen)

16. VAR® set up – Step 1
1st Step - Choose 50% or 100% FiO2
Connect O2 hose to VAR, then to a High flow
Flowmeter and set flow to 10 - 15LPM to
start.
*Supply Pressure Required: 50 + 5 psig

17. FiO2 setting
100% FiO2
Connect the O2 hose on
green cap
50% FiO2
Remove the green cap and
then connect O2 hose

18. VAR® set up – Step 2
2nd Step – Set PIP
Once there is flow to the device set the
desired PIP or Peak Inspiratory Pressure
using the rectangular dial marked here.

19. Changing the Peak Inspiratory Pressure
(PIP)
T - Shape knob or
Rectangular Knob
15 ~ 25 25 ~ 35 35 ~ 45
cm H2O
Rotation:
Clockwise – Increase PIP
Anti Clockwise – Decrease PIP
15 20 25 30 35 40 45

20. VAR® set up – Step 3
3rd Step – Connect to Patient
Now that the function test is done and
movement of manometer has been
verified, connect to the patient.

21. VAR® set up – Step 4
4th Step – Adjust Breath Rate / Select Mode
Last step is to adjust the Breath Rate as per
the requirement.

22. Pressure Cycled Ventilation
5
10
15
20
30
40
60
Inhalation
Exhalation
PIP = 25 cm H2O
PEEP = 5 cm H2O
PEEP is preset to 1/5th or 20% of PIP
Pulmonary
Modulation
Technique

23. Patient Safety – Pop off Valve
• The VAR® is equipped with a safety pop – off
valve which pops out at pressures exceeding
60 cm H2O to avoid Baro-Trauma or Tracheo-
Bronchial Injury (TBI).

24. Applications (1 / 5)
• Automatic, hands free ventilation during:
– Inter-facility, intra-facility transports
– ER or ICU, replacing manual resuscitators (bags)
– MRI or CT procedure
– Emergency back-up ventilator for home, hospital
or alternative care facilities
– Patient transport in Ambulance
– Disaster management or field hospital

25. Applications (2 / 5)
• Cost Saving – Single patient use/disposable
resuscitator:
– Eliminates cost of capital equipment
– Reduces labour intensity associated with manual
resuscitators (bags)
– Save on maintenance and repair cost
– Save rental cost on ventilator
– Save therapist time for getting and setting up
ventilator for short-term use

26. Applications (3 / 5)
• Convenient – Lightweight, disposable, single
patient use resuscitator:
– Easy to store – no large ventilator to take up limited
ER/ICU space
– Quick set-up and easy operation with no clean up
cost or recycling time required
– No missing pieces of ventilator when needed
– Flexible usage with mask or ET tube
– Use in-line with HME and/or Bacteria filter

27. Applications (4 / 5)
• Reliable – Delivers consistent and reliable
pressure cycled short term ventilatory
support:
– High pressure pop-off safety valve reduces
potential of pneumothorax.
– Technology minimizes gas trappings to reduce the
potential for barotrauma

28. Applications (5 / 5)
• Safety – Promotes safe and efficient hospital
transports by:
– Eliminating the need for a manual resuscitator
and/or additional ventilation
– Freeing up the EMT’s hands to perform other
critical functions
– Ideal for use with chest
compression/Cardiopulmonary Resuscitation
(CPR)

29. Dismantle
• In the chance of an occlusion in the VAR. The
VAR can be taken apart in sections. Remove
the Modulator to allow the flow of gas to
push out the contaminate.

30. Quality Standards
• FDA* approved
• Meets ASTM** requirements
• Meets CSM*** ventilatory assistance mandate
• certified
• ISO 13485:2003
* FDA : Food & Drug Administration
** ASTM : American Society for Testing & Materials
*** CSM I: Centre for Medicare & Medicaid services
: Conformité Européenne

31. Airway Pressure Monitor (APM)
• For digital display of Patient’s respiratory parameters
• Connects to VAR®
• LCD Screen
• Easy to setup
• Visual & Audible Alarms
• Portable
• Adult & Pediatric Models

32. Airway Pressure Monitor (APM)
Peak Inspiratory Pressure (PIP)
Positive End Expiratory Pressure (PEEP)
Respiration Rate (RR)
Inspiration Time (IT)
Expiration Time (ET)
I:E Ratio
Non Cycling Alarm
High Rate Alarm
High Pressure Alarm
Display
Alarms

33. E surge kit
• Prepare for a major
Ventilator Emergency
• Use a single gas source for
multiple ventilators in Mass
Casualty Incidents (MCI)
7 ventilators (VAR®)
using
1 Oxygen Supply

34. O2
Supply
Multi output Manifold
E surge kit

35. THANK YOU