Transport ventilators, also known as portable ventilators, are mechanical ventilation devices that are designed specifically for emergency or transport scenarios. Like stationary ventilators, they help patients breathe by delivering either oxygen-enriched gas or room air into a patient's respiratory system through invasive or non-invasive means.

Rescuers around the world generally use a bag valve mask (BVM) to manually ventilate patients in respiratory distress during transport. A BVM is a handheld device that comprises a face mask with a bag and valve attached. When a rescuer squeezes the bag, the device delivers room air or air from an attached oxygen tank to a patient.

However, using a BVM to ventilate a patient can be challenging, even for experienced rescuers. That's because the rescuer must carefully control the pace of ventilations, and the process of moving a patient often disrupts their breathing pattern and can interfere with the rescuer's ability to focus.

Transport ventilators, also known as automatic transport ventilators, can be configured to offer optimal breathing patterns and automatically deliver the oxygen and tidal volume a patient needs. A transport ventilator operator can simply apply a mask or tube to the patient and select the appropriate settings, and the machine will deliver air to the patient. Automatic transport ventilators ensure that patients are properly oxygenated in a wide range of environments.

Using Transport Ventilators for Patient Care

Although smaller transport ventilators are increasingly being used in ambulances, helicopters, and fixed-wing aircraft, automatic transport ventilators are primarily used for transporting patients in inter- or intra-hospital settings. Here are a few common scenarios in which a portable ventilator may be used:

• Providing ventilatory support to an ICU patient
• Transporting a patient to and from the operating room
• Helping patients breathe during surgical procedures
• Transporting intensive care patients between facilities

A mainstay of modern hospitals, transport ventilators provide the most effective way to ensure a patient is receiving appropriate oxygen levels while they are being moved. Care teams should follow a standard procedure to ensure patients can be transported safely and efficiently.

Before use, make sure your ventilator is fully charged, properly connected, and is generally in full working order. Ensuring this in advance enables you to apply the ventilator immediately in case of an emergency.

After the patient has been outfitted with a transport ventilator, they should be moved to a portable bed that is suitable for transport. Before moving the patient, make sure they are positioned comfortably and that airflow is not impeded. Watch for any adverse symptoms during the transport process, and if necessary, immediately take measures to reorient the patient or ventilator to ensure they are receiving enough oxygen.

The Benefits of Automatic Transport Ventilators

All ventilators help care teams maintain the four functions behind basic life support: ventilation, oxygenation, circulation, and perfusion. However, an automatic transport ventilator offers several key benefits over stationary ventilators and bag valve masks:

• Easy to manoeuvre — The transport ventilator can be affixed to a patient's bed, making it easier for teams to move the patient.
• User-friendly interface and controls — A quality transport ventilator makes it easy for care teams to calibrate and select settings.
• Automatic air delivery — Transport ventilators analyze a patient's breathing patterns and deliver the appropriate amount of oxygen, reducing the likelihood of over- or under-ventilating the patient.
• Requires less intervention — Less oversight means more care professionals are available in busy, often understaffed hospital environments.
• Variety of modes — Portable ventilators are equipped with a variety of modes to optimally manage different patient needs, including Assist/Control (A/C), continuous positive airway pressure (CPAP), bilevel (BL), and synchronized intermittent mandatory ventilation (SIMV).
• Advanced monitoring — Transport ventilators can monitor key aspects of a patient's condition while they are intubated and issue an alert if the patient is at risk.

Operating an Automatic Transport Ventilator

Before operating any ventilator, refer to the official product manual for specific guidance. Not all ventilators include the same functions and capabilities. However, there are some general guidelines to follow when using a ventilator.

All ventilators require basic setup. The first step is to ensure the ventilator is operationally ready: It should be fully charged, and all circuits and filters should be attached appropriately. Next, select a default ventilation value, such as adult, paediatric, or mask CPAP, and select an operating mode if necessary.

Then test the ventilator using a test lung that has no leaks or occlusions. If the test lung behaves like a real lung, then your ventilator is working properly.

Once you've verified that your ventilator is working correctly, detach the test lung. The ventilator should now be ready for use — but keep a bag valve mask nearby in case the machine malfunctions.

Apply the ventilator to the patient using the appropriate connector — this may be an endotracheal tube, a trach tube, a subglottic airway, or a laryngeal mask. Then enable alarms and select the mode. For ZOLL^® ventilators, modes include:

• AC (assist/control) — The patient receives either controlled or assisted breaths. Assisted breaths are based on either the volume or pressure target.
• SIMV (synchronized intermittent mandatory ventilation) — The patient receives controlled breaths based on a set breathing rate. The care team can choose to support spontaneous breaths when needed.
• CPAP (continuous positive airway pressure) — The patient receives constant positive airway pressure while breathing spontaneously.
• BL (bilevel) — The ventilator will provide one of two pressure settings to assist patients who are breathing spontaneously: a higher inhalation pressure (IPAP) or a lower exhalation pressure (EPAP).

After you've selected a mode and started the ventilation process, keep watch on the ventilator's interface and parameter windows to ensure the patient remains appropriately ventilated. For ZOLL ventilators, track the following parameters:

• BPM (breaths per minute) — This describes how often a patient breathes in a minute. Depending on the selected ventilation mode, this parameter will allow you to either control or measure breaths per minute.
• Vt (tidal volume) — Tidal volume describes how much air is delivered to the patient with each breath. You can control or measure a patient's tidal volume, depending on the mode selected.
• PIP (peak inspiratory pressure) — This parameter displays the highest amount of pressure in the patient's chest and the ventilator circuit when a patient's lungs fill with air. PIP helps the care team determine if there are problems with the ventilator or if the patient's condition is deteriorating.
• PEEP (positive end expiratory pressure) — When a patient releases a breath, ventilators can ensure positive pressure remains in their airway by opening and closing the exhalation valve. This protects against ventilation-induced injury.
• FiO₂ (fraction of inspired oxygen) — This describes the percentage of oxygen that patients receive in the air they breathe. Natural air is usually 21% oxygen, but patients who struggle to breathe often receive more oxygen.
• SpO₂ (pulse oximetry) — The SpO₂ parameter uses a sensor to determine how much oxygen is in a patient's blood. Low SpO₂ can indicate hypoxemia, while an above-normal reading indicates hyperoxemia. Your team should resolve any abnormal pulse oximetry readings to prevent complications.
• HR (heart rate) — This ventilator displays a patient's heart rate and triggers an alarm if it falls out of a normal range. Consult the attending physicians or a respiratory therapist if the patient has an abnormal heart rate.
• BP (blood pressure) — Ventilators can increase intrathoracic pressure, causing a change in blood pressure. The patient's blood pressure should be monitored during the entire intubation process.

If the ventilator is properly applied and the parameters listed above are within acceptable ranges, the patient is likely being ventilated safely and effectively. However, it's important to regularly monitor and evaluate patients and remain alert to alarms during ventilation. If an alarm sounds or parameters fall outside acceptable ranges, consult a respiratory therapist to ensure the patient is ventilating properly.

Learn More

Want to learn more about how ventilators can help COVID-19 patients? Check out our COVID-19 resource hub. If you'd like to learn more about how to use a ZOLL ventilator, visit our Z Vent® training page.