800 Series Ventilator System Operator’s Manual Addendum Rev B Respiratory Mechanics option

Respiratory Mechanics option Any RM maneuver is canceled automatically upon declaration of any of the following alarms:

1PPEAK alarm • 1PVENT alarm • 1VTI SPONT, 1VTI MAND, 1VTI

•

Negative Inspiratory Force (NIF) maneuver The Negative Inspiratory Force (NIF) maneuver is a coached maneuver where the patient is prompted to draw a maximum inspiration against an occluded airway (the inspiratory and expiratory valves are fully closed). A NIF maneuver is canceled if: •

Disconnect is detected

•

Occlusion is detected

•

SVO is detected

•

Apnea is detected

•

Communications with the GUI is lost

•

The maneuver has been active for 30 seconds

•

Inspiration Too Long alarm is declared

When a NIF maneuver is activated, a single Pressure-Time waveform is automatically displayed. This screen displays as long as the screen remains frozen. During a NIF maneuver, the circuit pressure is displayed on the waveforms screen and regularly updated, producing a real-time display. When an active NIF maneuver ends successfully, the calculated NIF result is displayed on the waveforms screen and on the maneuver panel. The NIF value displayed represents the maximum negative pressure from PEEP. When a NIF maneuver ends, a PEEP restoration breath is delivered to the patient, then normal breath delivery resumes.

Respiratory Mechanics Option

2

10015769 Rev. B (4/07)

Respiratory Mechanics option P0.1 Maneuver (Occlusion Pressure) P0.1 is the negative airway pressure (delta pressure change) generated during the first 100 ms of an occluded inspiration. It is an estimate of the neuromuscular drive to breathe. When a P0.1 maneuver ends successfully, the calculated airway pressure is displayed on the waveforms screen and on the maneuver panel. A P0.1 maneuver is canceled if the maneuver has been requested for 7 seconds. When the P0.1 maneuver ends normally or abnormally, control is relinquished to the previously active breath scheduler.

Vital Capacity (VC) Maneuver The Vital Capacity (VC) maneuver is a coached maneuver where the patient is prompted to draw a maximum inspiration (regardless of the current settings) and then to slowly and fully exhale. When the Vital Capacity maneuver becomes active, the 840 ventilator delivers a spontaneous inspiration in response to patient effort (with PSUPP = 0, Rise time % = 50, and ESENS = 25), and then allows for a full exhalation effort. When a Vital Capacity maneuver is requested, a single VolumeTime waveform is automatically displayed. This screen displays as long as the screen remains frozen. A Vital Capacity maneuver is canceled if: •

Disconnect is detected

•

Occlusion is detected

•

SVO is detected

•

Apnea is detected

•

Communications with the GUI is lost

•

The maneuver has been requested for 5 seconds

•

The maneuver as been active for 15 seconds

•

The operator terminates it

10015769 Rev. B (4/07)

Respiratory Mechanics Option

3

Respiratory Mechanics option When an active VC maneuver ends successfully, the calculated expiratory volume is displayed on the waveforms screen and on the maneuver panel. Table 1 describes the RM maneuvers and the range, resolution, and accuracy for each. Table 1: RM monitored data Maneuver

Function

Range, resolution, accuracy

NIF

Measures maximum inspiratory force against an occluded airway.

Range: -50 to 0 cmH2O Resolution: 0.1 cmH2O NIF > -10 cmH2O 1 cmH2O for NIF ≤ -10 cmH2O Accuracy: ± (2 + 4% of reading) cmH2O for flows < 60 L/min

P0.1

Measures pressure generated during the first 100 ms of inspiration against an occluded airway.

Range: -20 to 0 cmH2O Resolution: 0.1 cmH2O for P0.1 > -10 cmH2O 1 cmH2O for P0.1 ≤ -10 cmH2O Accuracy: ± (2 + 4% of reading) cmH2O

VC

Measures maximum lung volume.

Range: 0 to 6000 mL Resolution: 0.1 mL for 0 to 9.9 mL 1 mL for 10 to 6000 mL Accuracy: For TI < 600ms: ± [10 + (10% x 600/TE ms of setting)] mL For TI > 600 ms: ± [10 + (10% of setting)] mL where TE = time to exhale 90% of volume.

Respiratory Mechanics Option

4

10015769 Rev. B (4/07)

Respiratory Mechanics option

Access and Use When a NIF, P0.1, or VC maneuver is requested, a single PressureTime or Volume-Time waveform is displayed in the Waveforms area of the Patient Data screen. Scaling is appropriate to the requested maneuver. Following a completed maneuver, the waveform is frozen and the measured value for the maneuver is displayed above the displayed waveform. To access and use the RM options: 1. On the lower GUI screen, touch the OTHER SCREENS button to access the RM options, Figure 1.

Figure 1. Accessing RM options 2. Touch the corresponding button to select the desired RM maneuver (NIF, P0.1, or VC).

10015769 Rev. B (4/07)

Respiratory Mechanics Option

5

Respiratory Mechanics option NIF Maneuver To perform a NIF maneuver: 1. Touch the NIF Maneuver button,

.

2. Touch and hold the START button, as directed on the screen, Figure 2.

Figure 2. Beginning a NIF maneuver 3. To complete the maneuver, release the START button. 4. Observe the screen display following the successful NIF maneuver, Figure 3.

Respiratory Mechanics Option

6

10015769 Rev. B (4/07)

Respiratory Mechanics option

Figure 3. NIF Maneuver results display 5. If you want to store the data for recall later, touch the ACCEPT button on the right side of the screen, as shown in Figure 4 (or initiate another maneuver). If not, touch REJECT. If you do not touch either button, the data are stored automatically. The data storage area displays the three most recently accepted maneuver results.

Figure 4. Accept or reject NIF data

10015769 Rev. B (4/07)

Respiratory Mechanics Option

7

Respiratory Mechanics option P0.1 Maneuver To perform a P0.1 maneuver: 1. Touch the P0.1 Maneuver button,

.

2. To activate the maneuver, touch the START button, as directed on the screen, Figure 5.

Figure 5. Beginning a P0.1 maneuver 3. Once the maneuver is activated, the ventilator will wait for up to seven seconds for the patient to take a breath and complete the maneuver. 4. Observe the screen display following the successful P0.1 maneuver, Figure 6.

Respiratory Mechanics Option

8

10015769 Rev. B (4/07)

Respiratory Mechanics option

Figure 6. P0.1 Maneuver results display 5. If you want to store the data for recall later, touch the ACCEPT button on the right side of the screen, as shown in Figure 7 (or initiate another maneuver). If not, touch REJECT. If you do not touch either button, the data are stored automatically. The data storage area displays the three most recently accepted maneuver results.

Figure 7. Accept or reject P0.1 data

10015769 Rev. B (4/07)

Respiratory Mechanics Option

9

Respiratory Mechanics option VC Maneuver To perform a VC maneuver: 1. Touch the VC Maneuver button,

.

2. To begin the maneuver, touch the START button, as directed on the screen, Figure 8.

Figure 8. Beginning a VC maneuver 3. A maximum inspiratory effort followed by a maximum expiratory effort will complete the maneuver. 4. Observe the screen display following the successful VC maneuver, Figure 9.

Respiratory Mechanics Option

10

10015769 Rev. B (4/07)

Respiratory Mechanics option

Figure 9. VC Maneuver Results Display 5. If you want to store the data for recall later, touch the ACCEPT button on the right side of the screen, as shown in Figure 10 (or initiate another maneuver). If not, touch REJECT. The data storage area displays the three most recently accepted maneuver results.

Figure 10. Accept or Reject VC data

10015769 Rev. B (4/07)

Respiratory Mechanics Option

11

Respiratory Mechanics option Respiratory Mechanics Calculations RM calculations of lung function and performance are automatically displayed on the Respiratory Mechanics subscreen of the More Patient Data display: •

Dynamic Compliance (CDYN) and Dynamic Resistance (RDYN)

•

Peak Spontaneous Flow

•

Peak Expiratory Flow

•

End Expiratory Flow

1. To access calculated values, press the MORE PATIENT DATA button, . 2. Observe the standard data subscreen, as shown in Figure 11.

Figure 11. Standard data subscreen 3. Touch the Respiratory Mechanics button in the lower right corner of the subscreen, as shown in Figure 11.

Respiratory Mechanics Option

12

10015769 Rev. B (4/07)

Respiratory Mechanics option 4. Observe the calculated RM values, Figure 12.

Figure 12. RM More Patient Data screen

10015769 Rev. B (4/07)

Respiratory Mechanics Option

13

Respiratory Mechanics option

Technical Discussion Respiratory Mechanics Calculations The Respiratory Mechanics option calculates and displays clinical indicators that may be useful in assessing the patient's current pulmonary condition lung and chest wall impedance, airway integrity, flow demand, and potential for Auto-PEEP. The RM calculations displayed in the RM subscreen of the More Patient Data screen are: •

Dynamic Compliance and Resistance

•

Peak Expiratory Flow rate

•

End Expiratory Flow rate

These calculations are performed on every qualified breath (e.g., they are not calculated during Apnea Ventilation, Severe Occlusion, nor during PEEP restoration breaths). •

Peak Spontaneous Flow rate - This value is calculated for spontaneous inspirations only.

In addition to the above calculations, currently available calculations are also displayed on the RM subscreen as the data become available. These include: •

Static Compliance (CSTAT)

•

Static Resistance (RSTAT)

•

Intrinsic PEEP (PEEPI)

•

Rapid Shallow Breathing Index (f/VT)

Refer to the 840 Ventilator Operator’s and Technical Reference Manual for more information on these calculated parameters.

General characteristics applicable to the display of RM calculations When no spontaneous breaths have occurred for a period greater than 2 minutes, the spontaneous RM patient data indicators in the RM Subscreen are not shown. The indicators reappear when their value is updated (when the next spontaneous breath is measured).

Respiratory Mechanics Option

14

10015769 Rev. B (4/07)

Respiratory Mechanics option When no mandatory breaths have occurred for a period greater than 2 minutes, the mandatory RM patient data indicators in the RM Subscreen are not shown. The indicators reappear when their value is updated (when the next mandatory breath is measured). Respiratory Mechanics calculations are not performed under the following conditions: •

When vent type is NIV

•

When mode is BILEVEL

•

During Apnea ventilation, OSC, disconnect, or Safety PCV

•

If there is a loss of patient data monitoring functions

Dynamic Compliance (CDYN) and Dynamic Resistance (RDYN) NOTE: The presence of auto-PEEP may affect the accuracy of RDYN and CDYN calculations. RM estimates the compliance and resistance of the patient’s lungs and chest wall. The measurement of CDYN and RDYN indicate the impedance characteristics of the lungs, chest wall and conducting airways. Changes in either of these values may reveal changes in the elastic properties of the lung and/or chest wall or in the ability of the conducting airways to accommodate a particular flow of gas. Dynamic Compliance and Dynamic Resistance are calculated only for mandatory breaths.

Peak Expiratory Flow (PEF) rate Peak Expiratory Flow is the maximum flow rate observed during exhalation, excluding the first 100 ms of data. PEF can be used as an indicator of obstructed airways.

End Expiratory Flow (EEF) rate End Expiratory Flow is the rate of expiratory flow that occurs at the end of exhalation and can be used to determine whether expiratory time is adequate to prevent gas trapping and intrinsic PEEP.

10015769 Rev. B (4/07)

Respiratory Mechanics Option

15

Respiratory Mechanics option The End Expiratory Flow rate is calculated as the expiratory flow that occurs when either flow integration terminates during exhalation or when a new breath is initiated.

Peak Spontaneous Flow (PSF) rate Peak Spontaneous Flow is the maximum inspiratory flow rate sampled during a spontaneous inspiration. It is a good predictor of impending air hunger and helps the clinician set peak flow or choose an optimum level of pressure support. Table 2 describes the RM calculated parameters and the range, resolution, and accuracy for each. Table 2: RM calculated data Parameter

Function

Range, resolution, accuracy

Dynamic compliance (CDYN)

Estimates the elastic properties of the lung, chest wall, and airways. Based on least squares estimation algorithm.

Range: 0 to 200 mL/cmH2O Resolution: 0.1 mL/cmH2O for CDYN < 10 mL/cmH2O 1 mL/cmH2O for CDYN ≥ 10 mL/cmH2O Accuracy: ± (1 + 20% measured value) mL/cmH2O

Dynamic resistance (RDYN)

Estimates the resistive characteristics of the lung, chest wall, and airways. Based on least squares estimation algorithm.

Range: 0 to 100 cmH2O/L/s Resolution: 0.1 cmH2O/L/s for RDYN < 10 cmH2O/L/s 1 cmH2O/L/s for RDYN ≥ 10 cmH2O/L/s Accuracy: ± (3 + 20% measured value) cmH2O/L/s

Peak expiratory flow (PEF)

Estimates maximum exhaled flow rate.

Range: 0 to 150 L/min Resolution: 0.1 L/min for PEF < 20 L/min 1 L/min for PEF ≥ 20 L/min Accuracy: ± (0.5 + 10% of actual value)

Respiratory Mechanics Option

16

10015769 Rev. B (4/07)

Respiratory Mechanics option Table 2: RM calculated data (continued) Parameter

Function

End expiratory flow (EEF)

Estimates expiratory flow rate at the end of exhalation.

Range: 0 to 150 L/min Resolution: 0.1 L/min for EEF < 20 L/min 1 L/min for EEF ≥ 20 L/min Accuracy: ± (0.5 + 10% of actual value)

Static compliance (CSTAT)

Estimates the elasticity of the patient’s lungs. Based on the occlusion maneuver.

Range: 0 to 500 mL/cmH2O Resolution: 0.1 mL/cmH2O for 0 to 9.9 mL/cmH2O 1 mL/cmH2O for 10 to 500 mL/cmH2O Accuracy: ± (1 + 20% of actual value) mL/cmH2O for 1 to 100 mL/cmH2O

Static resistance (RSTAT)

Estimates the restrictiveness of the patient’s airway. Based on the occlusion maneuver.

Range: 0 to 500 cmH2O/L/s Resolution: 0.1 cmH2O/L/s for 0 to 9.9 cmH2O/L/s 1 cmH2O/L/s for 10 to 500 cmH2O/L/s Accuracy: ± (3 + 20% of actual value) cmH2O/L/s (Does not apply if CSTAT < 5 mL/cmH2O or VMAX < 20 L/min)

Intrinsic PEEP (PEEPI)

Estimates the pressure above PEEP at the end of exhalation.

Range: -20.0 to 130 cmH2O Resolution: 0.1 cmH2O for -20.0 to 9.9 cmH2O 1 cmH2O for 10 to 130 cmH2O Accuracy: Not applicable

10015769 Rev. B (4/07)

Range, resolution, accuracy

Respiratory Mechanics Option

17

Respiratory Mechanics option Table 2: RM calculated data (continued) Parameter

Function

Peak spontaneous flow (PSF)

Estimates the maximum inspiratory flow rate during a spontaneous breath.

Range: 0 to 200 L/min Resolution: 0.1 L/min for PSF < 20 L/min 1 for PSF ≥ 20 L/min Accuracy: ± (0.5 + 10% of actual value)

Rapid shallow breathing index (f/VT)

Estimates the ratio of respiratory rate to inspired volume measurements.

Range: 0.0 to 600 1/min-L Resolution: 0.1 for f/VT < 10 1/min-L 1 for f/VT ≥ 10 1/min-L Accuracy: Not applicable

Respiratory Mechanics Option

18

Range, resolution, accuracy

10015769 Rev. B (4/07)