Transport ventilators, also known as portable ventilators, are mechanical ventilation devices 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 noninvasive means.

Rescuers around the world still reach for a bag valve mask (BVM) to manually ventilate a patient in respiratory distress during transport. A BVM is a handheld device that functions as a face mask with a bag and valve attached — when a rescuer squeezes the bag, they are able to deliver room air or air from an attached oxygen tank to a patient. However, the BVM operator must control the pace of the air delivered, which can prove to be problematic since moving a patient not only disrupts a patient's breathing pattern but also interferes with a rescuer's ability to focus on them.

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 only needs to apply a mask or tube to the patient, select the appropriate settings, and allow the machine to deliver air to the patient. Automatic transport ventilators ensure that patients are breathing properly no matter where they are.

Using Transport Ventilators for Patient Care

Although smaller transport ventilators are beginning to appear in many ambulances, helicopters, and fixed-wing aircraft, automatic transport ventilators are primarily used for transporting patients in an inter- or intra-hospital setting. Here are a few common scenarios where 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 certain operations
• Transporting intensive care patients to another hospital

Since they can be used for a variety of patients, transport ventilators are a mainstay within modern hospitals. They are the most effective way to ensure a patient is breathing properly while they are being moved. However, care teams should follow a standard procedure during transport scenarios 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. By ensuring this ahead of time, the ventilator can be applied almost 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 the impending transport conditions. Before you begin moving the patient, make sure they are positioned in a way that is comfortable and does not impede airflow. Keep an eye out for any adverse symptoms during the transport process, and 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, a stationary ventilator or bag valve mask doesn't deliver the same benefits as an automatic transport ventilator. Care teams often call for a transport ventilator due to several key benefits:

• Easy to maneuver — When the care team needs to move a patient, a transport ventilator can be affixed to their bed.
• User-friendly interface and controls — A quality transport ventilator will make it easy for care teams to calibrate and select settings.
• Automatic air delivery — Transport ventilators study a patient's breathing patterns and deliver the appropriate amount of oxygen, reducing the opportunity to over or under ventilate the patient.
• Requires less intervention — When a hospital is busy or short-staffed, having more care professionals available can save time and capacity.
• Variety of modes — Portable ventilators come equipped with a variety of modes to optimally manage the patient, including Assist/Control (A/C), continuous positive airway pressure (CPAP), bilevel (BL), and synchronized intermittent mandatory ventilation (SIMV).
• Advanced monitoring — Transport ventilators can monitor aspects of a patient's health while they are intubated and deploy alarms if the patient is at risk.

Operating an Automatic Transport Ventilator

Before operating any ventilator, care teams should refer to the official product manual for specific guidance. Not all ventilators have the same functions and capabilities. However, there are some general guidelines that care teams should 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, pediatric, or mask CPAP, and select an operating mode if necessary.

Now, 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.

Once the ventilator is working properly, apply it to the patient using the appropriate connector — this may include an endotracheal tube, a trach tube, a subglottic airway, or a laryngeal mask. Then, enable alarms and select the right mode. For ZOLL^® ventilators, this includes:

• 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) — Patients receive constant positive airway pressure while breathing spontaneously.
• BL (bilevel) — The ventilator will provide two pressure settings to assist patients that are breathing spontaneously: a higher inhalation pressure (IPAP) and a lower exhalation pressure (EPAP).

After you've selected a mode and started the ventilation process, keep an eye on the ventilator's interface and parameter windows. This will help your team ensure the patient is 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 either allow you to control or measure breaths per minute.
• Vt (tidal volume) — Tidal volume describes how much air is delivered to the patient with each breath. Care teams 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. The care 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 change a patient's blood pressure due to an increase in intrathoracic pressure. Blood pressure should be monitored to ensure a patient's health during the entire intubation process.

If these parameters are within acceptable ranges, and the ventilator is properly applied to the patient, then it is safe to assume the patient is being ventilated. However, care teams should regularly monitor and evaluate the patient while listening for alarms. If an alarm sounds or the parameters are not in their acceptable ranges, consult a respiratory therapist to ensure the patient is ventilating properly.