840 Series Ventilator System Operator’s Manual Addendum Rev D NeoMode Option

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840 NeoMode Option

Labels/Symbols This label appears on the front of the mounting plate.

Label Definition Symbol or abbreviation

Definition From Patient (Breathing Circuit)

Installing mounting plate and filter assembly Follow these steps to install the mounting plate and expiratory filter (Figure 1): 1. With the exhalation filter latch in the up position (A), slide the mounting plate (B) with label facing out completely onto the two tracks (C) in the filter housing. 2. Push latch down to secure the mounting plate. 3. Install the filter’s ventilator connector (D) into the mounting plate so that the breathing circuit connector (E) faces out. 4. Attach the expiratory limb of the breathing circuit to the breathing circuit connector (E)

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C

A

B

D

E

8-00388

Figure 1. Installing the mounting plate and expiratory filter Warning To ensure that all breathing circuit connections are leak-tight, perform a circuit leak test by running SST every time you install the filter on a ventilator.

Caution Adding accessories to the ventilator can increase system resistance and compliance. Do not add or remove accessories to the breathing circuit after running SST (which measures circuit resistance and compliance).

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840 NeoMode Option NOTE: • If the ventilator has not reached operating temperature from recent usage, allow it to warm up for at least 10 minutes before running SST to ensure accurate testing. •

Check the inspiratory and expiratory limbs of the breathing circuit and in-line water traps regularly for water buildup. Under certain conditions, they can fill quickly. Empty and clean the in-line water traps as necessary. Reference manufacturer’s instructions for additional information.

Respiratory mechanics If the display is not in parentheses or there is no comment (see Section 14.12, Table 14-1 of the 840 Ventilator System Operator’s and Technical Reference Manual), the accuracy of displayed compliance and resistance is as follows: •

Resistance (R): ± (3 cmH2O/L/s + 20% of actual value).

•

Compliance (C): ± (1 mL/cmH2O + 20% of actual value).

Connecting the breathing circuit Warning Use one of the ventilator breathing circuits listed in Table 5, or their equivalent. This ensures that maximum pressure/flow values specified by EN794-1 are not exceeded. Using a circuit with a higher resistance does not prevent ventilation, but can cause SST fault or compromise the patient’s ability to breathe through the circuit. Figure 2 shows how to connect the breathing circuit.

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840 NeoMode Option

(From patient) Expiratory filter

Patient wye

Expiratory limb of breathing circuit

(To patient) Inspiratory filter Collector vial

Inspiratory limb of breathing circuit

8-00006

Humidifier

Figure 2. Connecting the breathing circuit

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840 NeoMode Option

Descriptions and ranges: settings, alarms, and monitored data This section summarizes the ventilator settings (Table 1), alarm settings (Table 2), and monitored data (Table 3) associated with the NeoMode option. Accuracies are listed only if they differ from those in the 840 Ventilator System Operator’s and Technical Reference Manual. Table 4 correlates ideal body weight (IBW) to patient length. Warning Monitor the patient closely if volume alarms are disabled: there is no audible annunciation for out-of-range volumes when volume alarms are disabled. Table 1: Ventilator settings Setting Apnea interval (TA)

Function/Details Function: Defines the interval after which the ventilator declares apnea. Range: 10 to 60 s. New patient value: 10 s. Resolution: 1 s.

Apnea respiratory rate (f)

Function: Same as for non-apnea. Range: 2.0 to 40/min. New patient value: 20/min. Resolution: 0.1/min for < 10/min. 1/min for ≥ 10/min.

Apnea tidal volume (VT)

Function: Same as for non-apnea. Range: 5 to 315 mL. New patient value: the greater of 5 mL or (7.25 × IBW). Resolution: 1 mL for 5 to 100 mL. 5 mL for 100 to 400 mL.

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840 NeoMode Option Table 1: Ventilator settings (continued) Setting Apnea peak flow (VMAX)

Function/Details Function: Same as for non-apnea. Range: 1.0 to 30 L/min. New patient value: IBW based. Resolution: 0.1 L/min for flows of 1 to 20 L/min. 1 L/min for flows 20 L/min and above.

Flow pattern

Function: The gas flow pattern of mandatory volume-controlled breaths. Range: Square or descending ramp. New patient value: Descending ramp.

Flow sensitivity (VSENS)

Function: The flow inspired by the patient that triggers the ventilator to deliver a mandatory or spontaneous breath (when flow triggering is selected). Range: 0.1 to 10 L/min. New patient value: 1.0 L/min. Resolution: 0.1 L/min.

Ideal body weight (IBW)

Function: Indicates an approximate value for patient’s body weight assuming normal fat and fluid levels. Determines absolute limits on tidal volume and peak flow. Determines new patient settings for tidal volume, peak flow, and volume related alarms. Changes to IBW are only allowed during ventilator startup. Range: ≥ 0.5 kg (1.1 lb.) ≤ 7.0 kg (15 lb.). New patient value: 3.0 kg. Resolution: 0.1 kg for 0.5 to 3.5 kg. 0.5 kg for 3.5 to 7 kg.

Inspiratory time (TI )

Function: Sets the duration of inspiration during pressure control (PC) mandatory breaths. Range: 0.20 to 8.00 s. New patient value: Based on VT and VMAX. Resolution: 0.01 s/breath when mandatory type = PC. 0.02 s/breath when mandatory type = VC.

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840 NeoMode Option Table 1: Ventilator settings (continued) Setting

Function/Details

Mandatory type

Function: Sets the type of mandatory breath: volume control (VC) or pressure control (PC). Range: VC or PC. New patient value: PC.

Mode

Function: Defines ventilatory mode, which defines breath timing and allowable breath types: A/C allows VC or PC mandatory breaths. SPONT allows only spontaneous breaths (with or without pressure support, PS), except for manual inspirations. SIMV allows mandatory breaths (VC or PC) and spontaneous breaths (with or without PS). BILEVEL (optional) allows PC mandatory breaths and spontaneous breaths (with or without pressure support). BILEVEL establishes two levels of positive airway pressure. Range: A/C, SIMV, SPONT, or BILEVEL. New patient value: SIMV.

O2%

Function: Sets the percentage of oxygen in the delivered gas. Range: 21 to 100%. New patient value: 40%. Resolution: 1%.

NOTE: A significant change to the O2% setting can cause the VTE (exhaled tidal volume) to be transiently displayed as lower or higher than the actual exhaled volume. This is a result of initial spirometry calculations and does not reflect actual volume exhaled by the patient.

Peak flow (VMAX)

Function: Sets the peak (maximum) inspiratory flow during VC mandatory breaths. Range: 1.0 to 30 L/min. New patient value: IBW based. Resolution: 0.1 L/min for flows of 1 to 20 L/min. 1 L/min for flows 20 L/min and above.

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840 NeoMode Option Table 1: Ventilator settings (continued) Setting Respiratory rate (f)

Function/Details Function: Sets the minimum number of mandatory breaths the patient receives per minute. Active in A/C, SIMV, and BiLevel. Range: 1.0 to 150/min. New patient value: 20/min. Resolution: 0.1/min for 1.0 to 10/min. 1/min for 10 to 150/min.

Spontaneous Type

Function: Sets the type of spontaneous breath: pressure supported (PS), not pressure supported (NONE). (The Tube Compensation (TC) option is not available in NeoMode.) Range: PS or NONE. New patient value: PS.

Tidal volume (VT)

Function: Sets the volume of gas delivered to the patient’s lungs during a mandatory volume-based breath. Actual delivered volume is corrected for body temperature and pressure, saturated (BTPS) and to include breathing circuit compliance. Range: 5 to 315 mL. New patient value: the greater of 5 mL or (7.25 × IBW). Resolution: 1 mL for 5 to 100 mL. 5 mL for 100 to 400 mL. Accuracy: ± (4 mL + 10% of setting) for neonatal circuits.

NOTE: Accuracy is least at low tidal volumes. During ventilation of a test lung under various simulated conditions, the average volume delivered was 3.1 mL at a volume setting of 5 mL, with the following distribution: • 68.2% of the delivered volumes were between 2.7 and 3.5 mL. • 95.5% of all volumes were between 2.3 and 3.9 mL. • 99.7% of all volumes were between 1.9 and 4.3 mL. • Only 0.3% were outside of the latter range.

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840 NeoMode Option Table 1: Ventilator settings (continued) Setting Trigger type

Function/Details Function: Determines whether breaths are triggered based on flow or pressure. See flow sensitivity. Range: Flow (V-TRIG) only. New patient value: V-TRIG.

Table 2: Alarm settings Setting

Function/Details

NOTE: Violation of a set alarm limit activates the applicable alarm condition.

High circuit pressure limit (1PPEAK)

Function: Sets the maximum circuit pressure (relative to ambient) allowed during inspiration. Stops inspiration and begins exhalation. Range: 7 to 100 cmH2O. New patient value: 30 cmH2O. Resolution: 1 cmH2O.

High exhaled minute volume limit (2VE TOT)

Function: Sets the maximum exhaled minute volume limit (including mandatory and spontaneous breaths). Range: OFF or ≥ 0.10 L/min or > low exhaled minute volume limit and ≤ 10 L/min. New patient value: Based on IBW. Resolution: 0.005 L/min for 0.010 to 0.50 L/min. 0.05 L/min for 0.50 to 5.0 L/min. 0.5 L/min for 5.0 to 10.0 L/min.

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840 NeoMode Option Table 2: Alarm settings (continued) Setting High exhaled tidal volume limit (2VTE)

Function/Details Function: Sets the maximum exhaled tidal volume limit for spontaneous or mandatory breaths. Range: OFF or > low exhaled spontaneous tidal volume limit > low exhaled mandatory tidal volume limit and 5 mL to 500 mL. New patient value: Based on IBW. Resolution: 1 mL for 5 mL to 100 mL. 5 mL for 100 mL to 400 mL. 10 mL for 400 mL to 500 mL.

High respiratory rate limit (2fTOT)

Function: Sets the maximum breath rate limit. Range: OFF or 10/min to 170 /min. New patient value: OFF. Resolution: 1 /min.

Low exhaled mandatory tidal volume limit (4VTE MAND)

Function: Sets the minimum exhaled mandatory tidal volume limit. Range: OFF or ≥ 1 mL < high exhaled tidal volume limit and ≤ 300 mL. New patient value: Based on IBW. Resolution: 1 mL for 1 to 100 mL. 5 mL for 100 to 300 mL.

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840 NeoMode Option Table 2: Alarm settings (continued) Setting Low exhaled minute volume limit (4VE TOT)

Function/Details Function: Sets the minimum exhaled minute volume limit for all breaths. Range: < high exhaled minute volume limit and OFF or 0.01 L/min to 10 L/min. New patient value: Based on IBW. Resolution: 0.005 L/min for 0.01 to 0.50 L/min. 0.05 L/min for 0.50 to 5.0 L/min. 0.5 L/min for 5.0 to 10.0 L/min.

Low exhaled spontaneous tidal volume limit (4VTE SPONT)

Function: Sets the minimum exhaled spontaneous tidal volume limit. Range: OFF or ≥ 1 mL < high exhaled tidal volume limit and ≤ 300 mL. New patient value: Based on IBW. Resolution: 1 mL for 1 to 100 mL. 5 mL for 100 to 300 mL.

Table 3: Monitored data Data Exhaled tidal volume (VTE)

Function/details Function: The volume exhaled by the patient for the previous mandatory or spontaneous breath. The displayed value is corrected for body temperature and pressure, saturated (BTPS) and to include breathing circuit compliance. Updated at the beginning of the next inspiration. Range: 0 to 6000 mL. Accuracy: ± (4 mL + 10% of actual) for neonatal circuits.

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Table 4: IBW and patient length IBW

Length

IBW

Length

0.5 kg / 1.2 lb

26 cm / 10¼ in.

2.4 kg / 5.3 lb

46 cm / 18¼ in.

0.6 kg / 1.4 lb

29 cm / 11¼ in.

2.5 kg / 5.6 lb

47 cm / 18½ in.

0.7 kg / 1.6 lb

31 cm / 12 in.

2.6 kg / 5.8 lb

47 cm / 18½ in.

0.8 kg / 1.8 lb

32 cm / 12¾ in.

2.7 kg / 6.0 lb

48 cm / 18¾ in.

0.9 kg / 2.0 lb

34 cm / 13½ in.

2.8 kg / 6.2 lb

48 cm / 19 in.

1.0 kg / 2.3 lb

35 cm / 14 in.

2.9 kg / 6.4 lb

49 cm / 19¼ in.

1.1 kg / 2.5 lb

37 cm / 14½ in.

3.0 kg / 6.7 lb

49 cm / 19¼ in.

1.2 kg / 2.7 lb

38 cm / 15 in.

3.1 kg / 6.9 lb

50 cm / 19½ in.

1.3 kg / 2.9 lb

39 cm / 15¼ in.

3.2 kg / 7.1 lb

50 cm / 19¾ in.

1.4 kg / 3.1 lb

40 cm / 15¾ in.

3.3 kg / 7.3 lb

50 cm / 19¾ in.

1.5 kg / 3.4 lb

41 cm / 16 in.

3.4 kg / 7.5 lb

51 cm / 20 in.

1.6 kg / 3.6 lb

41 cm / 16¼ in.

3.5 kg / 7.8 lb

51 cm / 20¼ in.

1.7 kg / 3.8 lb

42 cm / 16½ in.

4.0 kg / 8.9 lb

53 cm / 21 in.

1.8 kg / 4.0 lb

43 cm / 16¾ in.

4.5 kg / 10 lb

55 cm / 21¾ in.

1.9 kg / 4.2 lb

44 cm / 17 in.

5.0 kg / 12 lb

57 cm / 22¼ in.

2.0 kg / 4.5 lb

44 cm / 17¼ in.

5.5 kg / 13 lb

59 cm / 23 in.

2.1 kg / 4.7 lb

45 cm / 17½ in.

6.0 kg / 14 lb

60 cm / 23¾ in.

2.2 kg / 4.9 lb

45 cm / 17¾ in.

6.5 kg / 15 lb

62 cm / 24½ in.

2.3 kg / 5.1 lb

46 cm / 18 in.

7.0 kg / 16 lb

64 cm / 25¼ in.

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Part numbers Table 5 lists the parts and accessories for the NeoMode option shown in Figure 1. Table 5: Ventilator parts and accessories Item number 1

Description

Part number

Ventilator breathing circuit, neonatal, disposable (DAR)

307/6922

Ventilator breathing circuit, neonatal, disposable, 4 feet (Allegiance Healthcare Corporation)

7441-4S2

Expiratory bacteria filter (DAR), disposable

DAR part number 351P19005 Order part number 4-076408-00 (Box of 12)

Expiratory bacteria filter reusable, 22-mm ISO (Neo Re/x800™) not pictured

4-076407-00

3

Inspiratory bacteria filter, 22-mm ISO connectors, disposable (D/Flex, carton of 12)

4-074601-00

4

Mounting plate*

4-076405-00

2

* For information on cleaning and disinfection, follow the same instructions that are recommended for the ventilator exterior in the 840 Ventilator System Operator’s and Technical Reference Manual. Autoclaving is not recommended.

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2 3

1

8-00137

Figure 1. Ventilator accessories

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