Leoni plus neonatal ventilator

[Guest jminski]

Please the leoni plus is a new ventilator to north america , I have be told that it is very simular to the Babylog even has a vg type mode. would anyone like to share their experiences with this ventilator. In my nicu we use vg option always so the leoni plus vz mode would be it's counter point. Thank you:

[Stefan Johansson]

Well, I have limited but some experience with the Leoni+, and as I understand there's not really a volume set ventilator, but a pressure controlled ventilator where you can set a (tidal) volume upper limit.

Maybe someone else with more experience have better input than this.

[ammar]

all kinds of mode ventilation on the LEONI+ are limited and controlled pressure. But you have the possibility to use the option (if it is installed on the machine!) of Guarented Volume. you set the desired volume and you set else the high inspiratory pressure limit. So the machine will try to give the fixed volume with the minimal pressure that can never be more than the limit set.

[mr_raider]

We are looking at this unit in our NICU as a possible replacement for some ageing ventilators. CUrrently we use nothing but Babylogs. We had the Leoni on trial for a week and were satisfied with it's performance in CPAP, non-invasive and conventional ventilation.

We did not get a chance to try the HFOV function, since no one was sick enough that week. Does any one have experience with HFOV on the Leoni Plus?

My main concern is that it will be unable to vibrate > 2kg babies just like the Babylog can't. We don't have Sensormedics 3100 in house, so it's a big issue.

[ctestolin]

Leoni+ doesn't habe an allarm on VG as Babylog. Manufacter told us they Are implementing that (important) alla

[Padkaer]

We are looking at this unit in our NICU as a possible replacement for some ageing ventilators. CUrrently we use nothing but Babylogs. We had the Leoni on trial for a week and were satisfied with it's performance in CPAP, non-invasive and conventional ventilation.

We did not get a chance to try the HFOV function, since no one was sick enough that week. Does any one have experience with HFOV on the Leoni Plus?

My main concern is that it will be unable to vibrate > 2kg babies just like the Babylog can't. We don't have Sensormedics 3100 in house, so it's a big issue.

My unit will need new ventilators in the not to distant future.

We are currently using Babylog 8000s for conventional ventilation and have a single Sensormedics for rescue HFO. We would like our new ventilators to be able to handle the full spectrum of neonatal ventilation including HFO. If it is suitable to be used by our transportation team as well, that would be a big plus. It must be able to vibrate babys < 5 kg effectively and if it can handle bigger than that, it would also be an advantage, as we also serve as PICU.

The candidates so far are the SLE 5000, the Stephanie and the Leoni.

I have only encountered the Stephanie shortly but my impression is, that while being a technically very competent ventilator, it seems very hard to learn to use “well”.

The SLE 5000 I have some experience with and am quite enthusiastic about it, especially the HFO modus which seems just as powerful as the Sensormedics and much easier to use. The touch screen controls work beautifully and it is the closest to a “plug and play” ventilator I have ever encountered.

This weekend however I was introduced to the Leoni plus ventilator, and at first glance it seems it might be even better than the SLE 5000. It caries the advantage of all the ventilation modes being named the same as in the Babylog, it is even easier to use than the SLE and the noise level is very, very low.

Comments and thoughts on the three ventilators would be very welcome. Are there other candidates we also need to consider?

I have heard rumours that Karolinska currently are using seven Leoni in their unit and three on their transportation teams. Does anyone know if that is true, and whom we might contact at their unit, to learn about their experiences with the model?

Kind Regards

Edited September 20, 2009 by Padkaer

[Guest RogerinBC]

I have been using the Leoni plus here in Canada for about 8 months. We have a unit population of primarily premature infants. I have been very happy with the performance of this ventilator, and have used it in conventional and HFOV modes.

Our Leoni plus ventilators in Canada have been modified from the European models by a Canadian company BomiMed, and so I am not sure how much of my experiences will be directly applicable.

The main points I'd remark on are...

Conventional - the VG (VT target on the Leoni) works well. The target can be less than 2 ml (which seems to be more and more an issue as the babies get smaller and smaller).

Sensitivity can be volume or flow-based.

HFOV - you can set the I:E to 1:1, 1:1.5, 1:2 or 1:3.

You can use volume targeting in HFO!! It adjusts the amplitude to achieve set volume. I think this is huge. It does it consistently and without large amplitude swings. It has changed our HFO methodology in that CO2 removal is now increased with increased HFO frequency, as VT remains consistent.

The 80 cmH2O max amplitude has been more than adequate for the babies we have oscillated. The recommendations are that you could oscillate up to 5 kg with a compressible circuit, and 10 kg with a non-compressible tygon-tubing set-up.

Being able to use the normal circuit (F&P corrugated disposable) has eliminated a lot of the issues HFOV caused regarding nursing care. Able to reposition baby as per routine care. Lower risk of unintended extubation.

The machine is super quiet. When we started HFO with the Leoni, we would have RT's come through the unit to see it and express disappointment that it wasn't still on. Only it was, they just couldn't hear it working.

You can switch from HFO to conventional without breaking the circuit (there is an extra piece that needs to be in-line to oscillate, but you don't have to remove it when switching back to conventional).

Other points - Touchscreen with 1, 2, or 3 waveforms continuously.

Can trend waveforms back 72 hours

Proximal flow sensor has its roots in the old NVM-1. Simple tests show it to be very accurate.

Proximal pressure sensor line now has a purge flow that helps prevent moisture build-up

We have had several upgrades to our ventilator's software/capabilities since we bought it. BomiMed has been very responsive to issues and suggestions we have brought up. My staff are comfortable with the Babylog, and the only other ventilator we have introduced in the last 10 years had enough issues regarding ease-of-use and lack of volume targeting (volume bracketing is, in my opinion, a poor substitute) that the Babylog has had a near monopoly on our ventilated babies. That being said, the Leoni was quickly accepted by the staff, and the user interface proved quite natural.

There is a non-invasive CPAP/BiPhasic mode (no sychronization) that uses an interface called the "Neo-Jet" I haven't seen or had any experience with this.

All other modes that you would expect are there.

I like this machine. One issue that we have come up against. The Leoni flow sensor does not compression-fit tightly enough to the "micro-steam" sidestream EtCO2 adapter, so we can't use them together.

I am happy to answer any further questions in this thread.

Edited March 12, 2010 by RogerinBC
looking into situation further

[mr_raider]

Yeah we've had ours in for a few months now, and we are going to order three more. I should add that the new software revision adds SIMV + PS capability.

A great dedicated neonatal ventilator, and far superior to the cradle to grave hybrid jobs that Draeger, Viasys and Maquet have been peddling as of late.

[Padkaer]

We tested the Leoni Plus, the SLE 5000 and the Stephanie in our unit in December. The process was a bit forced as our administration delightfully had found unexpected funds for the acquisition of 2 new neonatal ventilators, but with the catch that the deal had to be sealed in the budget year 2009 – meaning we had 3 weeks to make up our minds….

We ended up buing two Stephanies, a decision that was done with a rare and almost unanimously, agreement amongst the registrars. It was however a close race and given more time, I can’t say that, we wouldn’t have chosen differently. Basically all 3 machines are very good and dedicated neonatal ventilators that should do the job in most tertiary neonatal units.

I can’t speak for all, but my main reasons for ending up on the side off the Stephanie where these

1) Technical back-up. Stephanies organization made by far the most convincing effort on demonstrating the will and capability on not just selling us a ventilator, but also making it work in our unit afterwards. So far they haven’t disappointed.

2) Design. While the exteriors of the Stephanie indisputably are dated and the user interface almost as user unfriendly as that of the old babylog 8000, an experienced neonatologist should still be able to use it after a couple off hours training. The machine has all the ventilatory possibilities that comes with the Leoni (except HFO volume guaranty – returning to that later) and the SLE, and it has some major design advantages compared to those two machines. Naming a couple –we have found that the building in of the humidifier and the flow-sensor into the interior off the machine is not just an technical oddity, but a real advantage in every day ventilation as is substantially reduces the pressure damping in the tubing system and combined with direct control of the temperature in the tubing enables us to deliver almost a 100% moisturized air into our patients with minimal rainout.

3) Economics – not being able to go into details, I can say as much as they gave us a very good deal….

So right now our two new Stephanies are running in our unit along with the 7 old babylog 8000s . The later will however still need replacement in the eminent future so I am reading with great interest when comments arise on all the possible candidates. I am especially interested to hear if anyone has hands on experience with both the Stephanie and the Leoni and is able to compare them head to head ?

Kind Regards

Jesper

PS. Concerning volume guarantee in HFO, I agree that it could possibly be huge and perhaps the most interesting new thing in neonatal ventilation in a decade. I am very enthusiastic about HFO and if this new technology works ( we didn`t have the time to properly test the mode) it should IMHO substantially minimize the risks of hypocapnia and associated PVL when using HFO and could be the factor that tilted the scale to the side of HFO in invasive ventilation of neonates.

Edited March 23, 2010 by Padkaer

[mr_raider]

we did our first run of HFOV this week on a 1 kilo baby, and we realize it needs some getting used to. The baby had PIE so we are using a low MAP (8 cmH2O), 11 HZ, 33:66 ratio, and amplitude between 40 and 45. Some questions:

1. what is the optimal Frequency (Hz) for different weights?

2. Is this a reasonable range of amp in a 1 kilo baby? It seems high, but that's in comparison to the 3100A

3. what is the preferred I:E ration in HFOV? 1:1 like the babylog or 1:2 like the 3100a?