Respiratory support

Sufficient oxygen must always be carried. The amount needed for a transfer should be calculated including the patient's requirements and gas required to drive ventilators and suction machines. An allowance of several hours of extra oxygen supply is necessary for safety. Oxygen is usually supplied in cylinders. Those of a useful size, i.e. containing over 600 liters, are bulky and heavy, but are readily available and familiar to staff. Liquid oxygen supplies are smaller and lighter; they are used by some transfer teams but require costly special containers and filling equipment.

A self-inflating manual resuscitation bag and a portable mechanical ventilator must always be available. Hand ventilation may cause hypo- or hyperventilation, and therefore a mechanical ventilator should be used routinely ( Hurst ei a/ 1989). The portable ventilator must be robust, reliable, and versatile. It should offer a wide range of tidal volumes, frequencies, and inspiratory-to-expiratory ratios, and be able to deliver positive end-expiratory pressure. Most portable ventilators are gas driven and deliver either 100 per cent oxygen or an air mix of 45 to 65 per cent. Recent models offer continuous positive airway pressure and synchronized ventilation which some patients will tolerate, thus requiring less sedation.

There should be a variable-pressure limitation valve and a display of the airway pressure. A disconnection alarm is essential, but often is not included in the ventilator itself. Capnography is desirable.

Other equipment required to maintain and secure the airway is listed in Table 1.

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