CARESCAPE Modular Monitors User Manual Sw Ver 2 Dec 2012

The information in this manual applies to the software version listed on the first page of the manual. Due to continuing product innovation, specifications in this manual are subject to change without notice. For technical documentation purposes, the abbreviation GE is used for the legal entity names, GE Medical Systems Information Technologies, Inc. and GE Healthcare Finland Oy.

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Contents 1

About this manual ...39 Intended use of this manual... 39 Intended markets of this manual ... 39 Intended audience of this manual ... 39 Training requirements ... 39 Manual conventions ... 39 Monitor naming conventions ... 40 Acquisition module naming conventions ... 40 Illustrations and names ... 41 Related documents... 41 Ordering manuals ... 41 Trademarks ... 42 Third party trademarks ... 42 Manufacturer responsibility ... 42

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Safety ...43 Safety message signal words... 43 System safety... 43 System warning safety messages ... 43 Accessories warnings ... 43 Cables warnings... 44 Defibrillation warnings... 44 Electrical warnings ... 44 Equipment warnings ... 45 Site requirement warnings ... 46 System caution safety messages ... 46 Loss of data ... 46 Electrical caution... 46 Site requirement cautions ... 47 Notice safety messages ... 47 Safety symbols ... 47 Indications for use... 48

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B850 indications for use ... 48 B650 indications for use ... 49 B450 indications for use ... 49 Indications for use safety precautions ... 50 Indications for use warnings ... 50 Indications for use cautions ... 50 Training requirements ... 50 Electromagnetic compatibility ... 51 EMC warnings... 51 EMC cautions ... 51 ESD safety precautions ... 52 3

System introduction ...53 Monitor and module compatibility limitations ... 53 System safety precautions ... 53 System warnings... 53 System caution... 54 B850 system components... 55 B850 processing unit front view... 56 B850 processing unit back view... 56 B850 module frames F7 and F5 ... 57 B850 Tram-Rac frames 2A and 4A... 58 B650 system components... 58 B650 monitor front panel ... 59 B650 monitor side views... 60 B650 monitor back panel ... 60 B650 pivoting module frame ... 61 B450 system components... 62 B450 monitor front panel ... 64 B450 monitor side views... 64 B450 monitor back panel ... 65 Monitor battery ... 65 Inserting and removing the B650 monitor battery ... 66 Inserting and removing the B450 monitor battery ... 67 Checking the battery charge with monitor software... 67

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Monitor battery charge symbols on screen... 68 Battery test button ... 68 Alarm light ... 69 Displays... 69 Acquisition modules... 70 PSMP front view... 70 PDM front view ... 71 TRAM module front view... 72 Single-parameter Tram-Rac front view ... 72 Modules and parameters ... 73 Barcode reader ... 77 Keyboard ... 77 Mouse ... 77 Remote control and keypad ... 78 Recorders and laser printers ... 78 About the Unity Network Interface Device (ID)... 78 CIC Pro Clinical Information Center... 79 CARESCAPE Central Station ... 79 iCentral ... 80 Remote alarm box (nurse call)... 80 iPanel software application ... 81 Equipment symbols ... 81 User interface symbols ... 89 4

Monitoring basics ...93 Module compatibility limitations ... 93 Identical modules... 93 Connecting and removing modules: B850... 94 Connecting a PDM or PSM to a frame... 94 Removing a PDM or PSM from a frame ... 94 Connecting other E-modules than the PSM to a frame ... 94 Removing other E-modules than PSM from a frame ... 95 Connecting TRAM modules to a Tram-Rac housing ... 95 Removing TRAM modules from a Tram-Rac housing ... 95 Connecting and removing modules: B650... 96

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Removing a PSM or PDM from the B650... 96 Connecting a PDM or PSM to the B650... 96 Connecting other E-modules than PSM to the B650 ... 96 Removing other E-modules than PSM from the B650 ... 97 Connecting and removing modules: B450... 97 Connecting a PDM or PSM to the B450... 97 Removing a PDM or PSM from the B450... 98 Connecting other E-modules than PSM to the B450 ... 98 Removing other E-modules than PSM from the B450 ... 98 Main keys... 98 Main screen layout... 101 An example of a menu... 102 Menu options... 102 Selecting menu options with a touchscreen ... 103 Selecting menu options with the Trim Knob control... 103 Selecting menu options with a mouse... 103 Data field entries ... 103 Entering data with the on-screen keyboard... 103 Entering data with a keyboard ... 103 Putting the monitor into operation ... 104 Operation warnings ... 104 Operation caution ... 104 Monitor installation points to note... 104 Turning on the monitor... 105 Performance check... 105 Message about PDM service ... 105 Pre-monitoring checklist... 105 Supply mains interruption ... 106 Power failure alarm... 106 5

Setting up the monitor before use...107 Normal screen and other pages ... 107 Selecting the normal screen (main page) ... 107 Selecting pages ... 107 Adjusting sound volumes ... 108

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Brightness settings ... 108 B850 display brightness... 108 Adjusting the display brightness automatically ... 108 Adjusting the display brightness manually... 108 Adjusting the alarm light brightness... 109 Setting the keyboard light to turn on automatically ... 109 Turning the keyboard light on manually... 109 Screen setup modifications... 109 Parameter windows ... 109 Selecting parameters to the screen... 110 Waveform field safety precautions... 110 Selecting the display mode for IP waveforms ... 111 Setting up a split screen... 111 Locked alarm and parameter settings ... 111 Color selections ... 112 Parameter configurations... 112 Setting up printing options ... 112 Checking the PDM battery status ... 113 Checking the monitor battery status... 113 Setting the touchscreen off ... 113 B850 with several screens... 113 Other setup changes ... 113 6

Starting and ending monitoring ...115 Monitor and module compatibility... 115 Software packages and terminology... 115 About the user default settings... 115 Invasive pressure labels and PDM or TRAM... 115 Starting monitoring... 116 About the combination monitoring mode... 117 Entering patient data... 118 Entering patient data with the monitor ... 118 Entering patient data with a barcode reader... 119 About the roving functionality... 119 Roving between units... 120

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Roving between beds... 120 Adding new units and beds (manual roving) ... 120 Entering administrative information... 121 Loading patient information from the CARESCAPE Network (ADT server) ... 121 Loading patient data and trend data from the S/5 Network ... 121 About standby... 122 Starting standby... 122 End of standby... 123 About continuing monitoring ... 123 How to continue monitoring when a case is not active/patient is discharged ... 123 How to continue monitoring when a case is active/patient is admitted ... 124 About case reset/patient discharge ... 125 Pending software or setting activation... 125 Residual physiological data... 125 Resetting a case/discharging a patient... 125 Resetting a case/discharging a patient in combination monitoring mode ... 126 7

Alarms ...127 Alarm warnings ... 127 Alarm cautions ... 129 Alarm overview ... 129 Alarm types... 129 Alarm conditions ... 129 Alarm priority levels... 130 Alarm priority escalation... 130 Physiological alarms’ activation criteria ... 130 Broadcast only alarms... 131 Checking alarm function... 133 Alarm indications ... 133 Alarm icons on the screen ... 133 Description of alarm and information messages... 134 Setting the alarm light brightness... 135

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Audible alarm signals... 135 Audible and visual alarm signals... 136 Auditory information signals ... 136 Audible alarms off behavior ... 136 Pause audio behaviors ... 137 Pausing alarms for 5 minutes... 138 Activating all audible alarms ... 138 Technical alarms’ deactivation with the pause audio key ... 139 Apnea alarms’ deactivation with the pause audio key... 139 Pause audio with combination monitoring ... 139 Breakthrough alarms... 139 Latched alarms ... 140 Setting parameter alarm limits ... 140 Alarm locks ... 140 Alarm guard limits ... 140 Setting arrhythmia alarms ... 141 Selecting parameter alarm priority levels ... 141 Setting alarm limits automatically ... 142 Default auto alarm limits ... 143 Returning the default alarm limits ... 143 Turning off all local alarm indicators (sleep mode) ... 144 Remote management of alarms... 144 Alarm settings after a power loss ... 144 Alarm data stored in Clinical logs ... 145 Stored alarm data during a power cycle or power loss ... 145 8

ECG ...147 ECG compatibility limitations... 147 ECG safety precautions ... 147 ECG warnings ... 147 ECG cautions ... 149 ECG measurement limitations... 149 ECG points to note ... 149 ECG measurement setup... 150 ECG equipment to patient connection... 150

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Preparing the patient’s electrode sites ... 150 Applying the electrodes to the patient... 150 3– lead or 5–lead ECG electrode placement ... 151 6–lead ECG electrode placement ... 151 10–lead ECG electrode placement for cardiac monitoring ... 152 Standard resting 10–lead ECG electrode placement ... 153 Checking the ECG measurement ... 154 About the ECG analog output signal... 154 About the combination monitoring mode... 155 Selecting the ECG source... 156 Using the ECG measurement ... 156 The first three displayed ECG leads... 156 Selecting the Va ECG lead... 157 Selecting the Vb ECG lead... 157 Changing to an ECG cable with fewer leadwires ... 158 Deactivating the ECG leads off alarm ... 158 Selecting the beat source ... 158 Setting the beat volume... 158 Setting the beep tone during bradycardia and HR low alarms... 159 Variable beat tone... 159 Aspect ratio and different display sizes ... 159 Selecting the ECG waveform size ... 159 Selecting the hemodynamic waveform sweep speed... 160 Printing all ECG waveforms ... 160 Selecting the ECG waveform filter... 160 Setting the QRS width ... 161 Selecting the leads for ECG analysis ... 161 Relearning the patient’s QRS pattern... 161 Setting the primary HR source ... 162 Showing a second HR value in the HR parameter window ... 162 Showing ST in the HR parameter window ... 163 Showing PVC in the HR parameter window ... 163 Showing QT in the HR parameter window... 163 Displaying the ECG grid... 163

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ECG alarm limits ... 163 Selecting the HR alarm range ... 164 ECG alarm priorities ... 165 ECG measurement practicalities... 165 Alternate pulse rate source ... 165 PDM IntelliRate algorithm ... 165 TRAM, E-modules, and telemetry transmitters Auto algorithm... 165 ECG troubleshooting ... 166 12 lead analysis... 166 Intended use of 12RL Interpolated 12 lead ECG analysis ... 166 Intended use of 12SL ECG analysis ... 166 Intended use of ACI-TIPI... 167 12 lead ECG analysis points to note... 167 Entering data for a 12 lead ECG analysis ... 167 Entering data for an ACI-TIPI 12 lead ECG analysis ... 168 Enabling and disabling the 12SL ACS... 168 Entering the Location ID for 12SL... 168 Setting automatic 12 lead ECG analysis measurements... 169 Setting the 12 lead ECG analysis display format... 169 Generating a 12 lead ECG analysis report during an ST alarm condition ... 169 Performing a 12 lead ECG analysis ... 169 A 12 lead report and the MUSE database ... 170 Sending a 12 lead ECG report to the MUSE database ... 170 Viewing or printing saved 12 lead ECG reports ... 170 About the 12 lead ECG analysis program ... 171 About the 12RL ECG analysis program ... 171 12 lead ECG analysis troubleshooting ... 172 Pacemaker detection... 172 Pacemaker detection warnings ... 172 Pacemaker detection points to note... 173 Selecting the pacemaker detection ... 173 Pacemaker detection troubleshooting ... 174 Arrhythmia monitoring ... 175

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Arrhythmia monitoring warnings... 175 Arrhythmia measurement limitations... 176 Setting the arrhythmia category to alarm... 177 Setting arrhythmia alarms... 177 Setting the alarm pause interval... 177 Setting the SVT length... 178 Setting HR for SVT ... 178 Arrhythmia alarm messages ... 178 About the arrhythmia detection... 180 Arrhythmia troubleshooting ... 181 ST detection... 182 About the ST analysis... 182 ST detection measurement limitations ... 183 ST detection points to note... 183 Starting the ST detection ... 183 Selecting leads to the ST window... 183 Changing the displayed ST leads ... 183 Adjusting the ST point manually... 183 Adjusting the isoelectric measurement (ISO) point ... 184 Adjusting the J point ... 184 About the realtime QRS/ST complexes ... 184 About the reference QRS ... 185 Saving a reference QRS manually... 185 Automatic saving of reference QRS complexes ... 185 Selecting a saved reference QRS complex for display... 185 Erasing a reference QRS ... 185 Printing a realtime QRS/ST report ... 186 Viewing QRS and ST in a split screen ... 186 Selecting the ST time scale ... 186 ST trend display ... 186 Displaying QRS complexes and ST trends for other leads ... 186 Reviewing ST trends ... 187 Printing an ST trend report ... 187 Ischemic burden... 187

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ST alarm limits ... 188 QT detection ... 189 9

Impedance respiration...191 Impedance respiration compatibility limitations ... 191 Respiration safety precautions ... 191 Respiration warnings ... 191 Respiration cautions ... 192 Respiration measurement limitations... 192 Respiration points to note ... 192 Respiration measurement setup... 193 Respiration equipment to patient connection... 193 Preparing the patient’s respiration electrode sites ... 193 Respiration lead and breath detection ... 193 Respiration lead I electrode placement ... 194 Respiration lead II electrode placement ... 195 Respiration lead RL-LL electrode placement... 195 Respiration measurement checks... 196 Respiration measurement on the monitor screen... 196 Using the respiration measurement ... 196 Turning on the respiration measurement... 196 Selecting the respiration lead... 196 Selecting the respiration waveform size manually ... 196 Selecting the respiration waveform size automatically... 196 Selecting the waveform speed... 197 Selecting the waveform sensitivity ... 197 Relearning the respiration pattern... 197 Turning on or off the respiration rate alarm... 197 Setting the respiration alarm limits... 197 Apnea alarms’ deactivation with the pause audio key... 198 Setting the apnea alarm delay ... 198 Enabling the respiration cardiac artifact alarm ... 198 Respiration alarm priorities ... 198 Turning off the respiration measurement ... 198 Respiration measurement description ... 199

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Respiration measurement with PSM... 199 Respiration measurement with PDM and TRAM ... 199 How to interpret the respiration values... 199 Respiration troubleshooting ... 199 10 Pulse oximetry...201 SpO2 compatibility limitations ... 201 SpO₂ safety precautions ... 201 SpO2 warnings... 201 SpO2 cautions ... 204 SpO2 measurement limitations ... 204 SpO2 points to note ... 204 SpO₂ measurement guidelines... 205 GE Ohmeda technology and sensor measurement guidelines... 205 Masimo SET technology and sensor measurement guidelines... 205 Nellcor OxiMax technology and sensor measurement guidelines... 206 SpO₂ measurement setup ... 207 SpO2 equipment to patient connection ... 207 Preparing the SpO2 connection... 207 Checking the SpO2 measurement ... 207 Using the SpO₂ measurement... 208 Primary and secondary SpO2 measurement sources... 208 Changing the SpO2 waveform size... 208 Changing the SpO2 waveform scale ... 209 Selecting the SpO2 hemodynamic sweep speed... 209 Selecting the SpO2 as the primary heart rate source ... 209 Showing the SpO2 pulse rate... 209 Adjusting the SpO2 pulse beep tone volume ... 209 Variable beat tone... 210 Masimo SET data averaging and updating ... 210 Selecting the SpO2 averaging time ... 210 Selecting the Masimo SpO2 sensor sensitivity level ... 210 Nellcor OxiMax data averaging and updating ... 211 Selecting the SpO2 response time ... 211

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Nellcor OxiMax Saturation Seconds alarm management ... 211 Setting the SpO2 alarms and alarm limits... 213 Deactivating the SpO2 probe off alarm ... 213 SpO2 alarm priorities ... 213 Stopping the SpO2 measurement ... 213 How to interpret the SpO₂ values... 214 SpO2 signal strength ... 214 SpO2 waveform quality ... 214 SpO2 waveform stability ... 214 SpO2 wavelengths and optical output power ... 215 SpO2 measurement and interference... 215 SpO2 troubleshooting... 216 11 Non-invasive blood pressure...219 NIBP compatibility limitations ... 219 NIBP safety precautions ... 219 NIBP warnings ... 219 NIBP cautions ... 220 NIBP measurement limitations ... 221 NIBP points to note ... 221 NIBP measurement setup... 222 NIBP equipment to patient connection... 222 NIBP module keys... 222 Preparing the NIBP patient connection ... 222 Checking the NIBP measurement ... 222 NIBP measurement on screen ... 223 Manual NIBP measurements... 223 Starting or stopping a single NIBP measurement from the main menu ... 223 Starting or stopping a single NIBP measurement from the NIBP Setup menu ... 223 Starting or stopping a single NIBP measurement with the PSM module key ... 223 Automatic NIBP measurements... 224 Automatic NIBP measurements and monitor clock synchronization ... 224

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Setting the cycle time between NIBP measurements... 224 NIBP Auto mode ... 224 STAT mode ... 225 Venous stasis... 225 NIBP cuffs ... 226 NIBP cuff selection and placement ... 226 Selecting NIBP cuff size... 226 Initial NIBP cuff inflation pressure ... 227 Selecting the cuff inflation limits ... 227 NIBP volume and display settings... 227 Adjusting the NIBP measurement completion tone volume ... 227 Setting the NIBP display format ... 228 NIBP alarms... 228 Setting NIBP alarms ... 228 Silenced NIBP alarms ... 228 NIBP recheck after alarm violation ... 228 NIBP measurement description ... 228 NIBP measurement technologies... 229 TRAM modules’ NIBP technology ... 230 PDM modules’ NIBP technology ... 231 PSM modules’ NIBP technology... 231 NIBP calibration... 232 NIBP troubleshooting... 233 12 Invasive pressures ...235 Invasive pressures compatibility limitations ... 235 Invasive pressure safety precautions ... 235 Invasive pressure warnings ... 235 Invasive pressure measurement limitations ... 235 Invasive pressure points to note ... 235 Invasive pressure measurement setup ... 236 Invasive pressure equipment to patient connection ... 236 Invasive pressure module keys ... 236 Connecting the invasive pressure transducer and cable ... 237 Checking the invasive pressure measurement ... 237

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Invasive pressure measurement on the monitor screen... 237 Selecting the display mode for IP waveforms ... 238 Using the invasive pressure measurement ... 238 Invasive pressure measurement mapping ... 238 Invasive pressure analog output... 239 About zeroing the invasive pressure transducers... 239 Zeroing the invasive pressure transducers ... 240 Selecting an invasive pressure channel label... 240 Selecting the size of the invasive pressure waveform ... 240 Optimizing the invasive pressure waveform scale... 240 Selecting the hemodynamic waveform sweep speed... 241 Selecting the invasive pressure noise reduction filter... 241 Selecting the displayed invasive pressure format... 241 Selecting invasive pressure as the primary heart rate source ... 241 Variable beat tone... 242 Selecting the ventilation mode... 242 Showing the pulse rate in the invasive pressure parameter window ... 242 Showing the CPP value in the ICP parameter window... 242 Selecting Smart BP... 243 Compensating for intra-aortic balloon pump (IABP) waveform irregularities... 243 Selecting the invasive pressure response time ... 243 Using the IP channel standby... 244 Using the invasive pressure waveform cursor ... 244 Setting an arterial invasive pressure disconnection alarm ... 244 Setting invasive pressure alarm limits ... 244 Invasive pressures alarm priorities ... 245 Systolic pressure variation and pulse pressure variation... 245 Changing the SPV source ... 245 Measuring SPV manually ... 245 PA catheter insertion ... 246 Selecting the PA catheter insertion mode ... 246 Pulmonary capillary wedge pressure (PCWP) measurement... 246

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Showing the PCWP value in the PA window ... 247 Taking a manual PA wedge measurement... 247 Taking an automated PA wedge measurement... 247 Starting a new PA wedge measurement ... 248 Other selections in the Wedge menu... 248 Calibrating the invasive pressure measurement with PDM and TRAM ... 248 Invasive pressure calibration with E-modules ... 249 Invasive pressure practicalities ... 249 Invasive pressure parameters... 249 Intra-aortic balloon pump ... 249 Invasive pressure troubleshooting... 252 13 Temperature...255 Temperature compatibility limitations... 255 Temperature safety precautions... 255 Temperature warnings ... 255 Temperature measurement limitations... 255 Temperature points to note... 255 Temperature measurement setup... 256 Temperature equipment to patient connection... 256 Preparing the patient for temperature measurement... 256 Checking the temperature measurement ... 257 Temperature measurement on the monitor screen ... 257 Using the temperature measurement... 257 Temperature mappings ... 257 Starting the temperature measurement ... 258 Changing the temperature site label ... 258 Displaying the delta value between two temperature channels ... 258 Setting temperature alarms ... 258 Stopping the temperature measurement... 259 Temperature practicalities ... 259 Temperature troubleshooting ... 259 14 Cardiac output ...261 C.O. safety precautions ... 261

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C.O. warnings... 261 C.O./CCO cautions ... 261 C.O. measurement limitations ... 261 C.O. points to note ... 261 C.O. measurement setup ... 262 C.O. equipment to patient connection with an in-line probe... 262 C.O. equipment to patient connection with a bath probe ... 263 C.O. module key ... 263 Preparing the C.O. measurement ... 263 Checking the C.O. measurement... 264 Using the C.O. measurement... 264 Entering patient data for the C.I. value ... 264 C.O. measurement modes ... 264 C.O. trial measurements... 266 Editing the C.O. average... 266 Canceling a C.O. measurement ... 266 C.O. catheter selections ... 266 Selecting the C.O. injectate probe type ... 267 Setting a C.O. right ventricular ejection fraction (REF) measurement ... 267 Selecting the C.O. scale ... 268 Selecting what to show with C.O. ... 268 Setting the Tblood alarm ... 268 Adjusting the SvO2 from the cardiac output menu ... 268 Editing calculations ... 268 Adjusting the wedge from the cardiac output menu... 269 Stopping the cardiac output measurement ... 269 C.O. practicalities... 269 Cardiac output washout curve... 269 How to improve the C.O. accuracy... 269 C.O. troubleshooting... 270 15 Mixed venous oxygen saturation (SvO₂)...275 SvO2 compatibility limitations ... 275 SvO₂ safety precautions ... 275

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SvO2 warnings ... 275 SvO2 measurement limitations ... 275 SvO2 points to note ... 276 SvO₂ measurement setup ... 276 SvO2 equipment to patient connection... 276 Checking the SvO2 measurement ... 276 SvO2 measurement on screen... 276 Using the SvO₂ measurement ... 277 SvO2 calibration in vitro ... 277 Calibrating SvO2 in vivo... 278 Updating the Hb value for SvO2 measurement... 278 Setting the SvO2 alarms ... 278 Stopping the SvO2 measurement... 278 SvO2 measurement description ... 279 SvO2 troubleshooting... 279 16 Airway gases ...281 Airway gases compatibility limitations ... 281 Airway gases safety precautions ... 281 Airway gases warnings... 281 Airway gases cautions ... 283 Airway gases measurement limitations ... 283 Airway gases points to note ... 283 Airway gases measurement setup ... 284 Airway gases equipment to patient connections with CARESCAPE respiratory modules ... 284 Airway gases equipment to patient connections with compact airway modules, anesthesia setup ... 285 Airway gases equipment to patient connections with compact airway modules, critical care setup ... 285 Airway gases equipment to patient connections with E-miniC, critical care setup ... 286 Airway gases measurement setup ... 286 CARESCAPE respiratory module connectors ... 287 Compact airway module connectors ... 287 E-miniC module connectors ... 288

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