User Manual
307 Pages
Preview
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SLE5000 / SLE4000 User manual Version 4.3 software
Software/Manual application Information:
Note: This manual has been written for use with model G to N ventilators. It is also applicable to model A to F ventilators that have had the software upgraded to Version 4.3, but the user must note that there are hardware differences.
Contact Information: SLE Limited Twin Bridges Business Park 232 Selsdon Road South Croydon Surrey CR2 6PL Telephone:
+44 (0)20 8681 1414
Fax:
+44 (0)20 8649 8570
E-mail:
Web site:
www.sle.co.uk
(E-mail’s should be addressed to the Service Manager)
All rights reserved. No part of this publication may be reproduced, stored in any retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopy, recording or otherwise, without prior permission of SLE. © Copyright SLE 11/12/2009. Manual : SLE Part Nº:
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UM0092 Issue 14 N6626/05/UK/V4.3
How To Use The SLE5000/SLE4000 Infant Ventilator The warnings on pages 32 to 37 must be read and understood before using the SLE5000/SLE4000 ventilator. Failure to do so could lead to injury or death of the patient. 1
MAKE SURE THAT THE VENTILATOR BACK-UP POWER SUPPLY IS FULLY CHARGED: Page 149.
2
PERFORM THE FUNCTIONAL TESTS: Page 98.
3
SETUP THE VENTILATOR IN THE CHOSEN MODE: Page 170.
4
THE VENTILATOR IS READY FOR USE.
For more information see “Technical Section”, page 230.
For trouble shooting see “Troubleshooting Chart”, page 216.
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Contents 1. Introduction ...14 1.1. About This Manual ...14 1.2. Intended Use ...14 1.2.1. Intended Users ...14 2. What’s New in version 4.3 ...15 2.1. TTVplus mode ...15 2.2. TTVplus Leak compensation ...15 2.3. HFO mean compensation...15 2.4. Automatic termination sensitivity leak compensation in PSV modes ...15 2.5. Reduced nuisance alarms in CPAP mode (when the flow sensor is not connected)...15 2.6. Battery monitoring ...15 2.6.1. Model A to D ventilators...15 2.6.2. Model E to N ventilators...15 2.7. Pre-mute facility...15 2.8. Rise time control sensitivity change ...15 3. Description of the Ventilation Modes ...16 3.1. CPAP (with a flow sensor)...16 3.1.1. CPAP with Apnoea Backup ...16 3.1.2. CPAP with TTVplus (Targeted Tidal Volume) for Back Up Breaths. ...16 3.2. CPAP (without a flow sensor)...17 3.3. CMV ...18 3.3.1. CMV with TTVplus (Targeted Tidal Volume)...18 3.4. PTV ...19 3.4.1. PTV with TTVplus (Targeted Tidal Volume) ...19 3.5. PSV ...20 3.5.1. PSV with TTVplus (Targeted Tidal Volume) ...21 3.6. SIMV...22 3.6.1. SIMV with PSV ...23 3.6.2. SIMV with TTVplus (Targeted Tidal Volume)...23 3.7. HFO (SLE5000 only) ...24 3.8. HFO+CMV (SLE5000 only) ...24 3.9. Overview of Conventional Ventilation Modes ...25 3.10. Detailed description of TTVplus, HFO MAP Compensation & Automatic Leak Compensation in PSV modes...26 3.10.1. TTVplus ...26 3.11. HFO mean compensation...27 3.12. Automatic Leak Compensation in PSV modes...27 3.13. Technical Description ...28 4. User/Owner Responsibility ...29 5. Warnings ...32 5.1. Operational Warnings...32 5.2. Clinical Warnings...37 Page 5 of 308
6. Ventilator Description ... 40 7. Description of Symbols and Buttons ... 43 8. User Interface ... 50 8.1. User Interface Sections... 50 8.2. Description of User Interface Indicators... 51 8.3. Description of User Interface Controls ... 51 8.3.1. Examples of Control Use... 52 8.4. Description of the Mode Panel in Ventilation OFF Mode ... 54 8.4.1. Mode Panel in Ventilation OFF Mode ... 54 8.4.2. Mode Select Button ... 54 8.4.3. Oxygen Alarm Test... 55 8.5. Services Panel ... 55 8.5.1. Flow... 56 8.5.2. Oxygen ... 56 8.5.3. Wave Shaping ... 56 8.5.4. Alarm Volume... 57 8.6. More Options Panel ... 57 8.6.1. Language Toggle ... 58 8.7. Version Information Panel... 60 8.7.1. Monitor Services... 60 8.7.2. Controller Services ... 61 8.8. Mode Panel Functions in a Ventilation Mode... 62 8.8.1. Standby Button (All modes)... 63 8.8.2. Apnoea Setup for CPAP... 63 8.8.3. Apnoea Setup for PTV, PSV and SIMV ... 65 8.8.4. TTVplus for CPAP, PSV, PTV & SIMV... 65 8.8.5. Set Trigger for CPAP, PSV, PTV & SIMV ... 66 8.8.6. Pressure Support in PSV ... 66 8.8.7. Pressure Support in SIMV... 67 8.8.8. HFO Activity (SLE5000 Only)... 67 8.9. Alarm Panel ... 68 8.10. Default Waveform Windows... 70 8.11. Alarm and Breath Detection Thresholds ... 72 8.12. How to Set an Alarm Threshold ... 73 8.13. Ventilation Parameters... 76 8.14. Lung Mechanics and Measurement Panel... 78 8.15. The Pause Button ... 80 8.16. Night Button and Screen Lock ... 80 9. Loops, Trends & Waveforms ... 82 9.1. Waveforms... 82 9.2. Loops ... 84 9.2.1. Storing and Retrieving Loops. ... 84 9.3. Trends... 86 9.3.1. Description of Trend Windows ... 86 10. Ventilator Set-up ... 88
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10.1. Preparing the Ventilator for Use ...88 11. Ventilator Power Up and Power Down. ...92 11.0.1. Mains power indicator...92 11.0.2. Powering up and down. ...92 11.0.3. Turning ON the ventilator...92 11.0.4. Turning OFF the ventilator...92 12. Back-up Battery Charging ...93 12.1. Battery indicator ...93 12.1.1. For model A to D ventilators running version 4.3 software. ...94 12.1.2. For model E to N ventilators running version 4.3 software. ...94 13. Extended storage ...95 13.0.1. Screw cap fuse holder ...95 13.0.2. Drawer type fuse holder...96 14. Quick Setup ...98 14.0.1. Complete Power Fail Alarm Test. ...99 14.0.2. Back-up alarm speaker test ...99 14.0.3. Calibration of the Flow Sensor...100 14.0.4. Apnoea Alarm ...102 14.0.5. Leak / Block Alarm...103 14.0.6. High Pressure Alarm...103 14.0.7. Low Tidal Volume ...103 14.0.8. Low Oxygen Alarm Test ...104 14.0.9. Functional Test of HFO+CMV Mode...105 15. Functional Testing ...108 15.1. Stage 1 Functional testing ...109 15.1.1. Complete Power Fail Alarm Test. ...109 15.1.2. Back-up alarm speaker test ...110 15.1.3. Setting FiO2 ...110 15.1.4. Functional Testing with No Flow Sensor ...110 15.1.5. Calibration of the Flow sensor ...110 15.1.6. Oxygen Alarm Test ...112 15.1.7. Function and Alarm Testing...114 15.1.8. High Pressure Alarm...118 15.1.9. Low Alarm...118 15.1.10. Breath Not Detected Alarm...119 15.1.11. Leak / Block Alarm...120 15.1.12. Mains Failure Alarm...120 15.1.13. Gas Supply Alarms ...121 15.1.14. Flow Sensor Disconnect Alarm...122 15.1.15. Cycle Fail Alarm...122 15.1.16. Functional Test of HFO Mode...124 15.1.17. Functional Test of HFO+CMV Mode...126 15.1.18. Pressure Change Alarm ...128 15.2. Stage 2 Functional testing ...129 Page 7 of 308
15.2.1. Functional Test of CMV Mode... 129 15.2.2. Functional Test of PSV Mode... 134 15.2.3. Functional Test of SIMV Mode ... 137 16. Stage 1 Check List ... 143 17. Stage 2 Check list ... 145 18. Operational Considerations ... 148 18.1. General ... 148 18.1.1. Ventilation OFF Mode ... 148 18.1.2. CPAP Mode without a Flow Sensor and with the Apnoea alarm set to “OFF”... 148 18.1.3. Gas Input Pressures... 148 18.1.4. Mode Memory On Power Up... 148 18.1.5. Back Up Battery Power ... 149 18.1.6. Parameter Memory... 149 18.1.7. BPM or Backup, Measured and Set Parameters ... 149 18.1.8. Tidal Volume Parameter Resolution... 149 18.1.9. HFO, Mean and Delta P Parameters ... 150 18.1.10. Displayed FiO2 ... 150 18.1.11. HFO Mean compensation ... 150 18.1.12. Max Ti in PSV... 150 18.1.13. Breath Detection... 151 18.1.14. Targeted Tidal Volume, Vte (TTV) ... 151 18.1.15. Overshoot... 152 18.1.16. Wave Shaping ... 153 18.1.17. Flow sensor removal for suctioning or re-calibration, pausing ventilation ... 154 18.1.18. Flow sensor removal for suctioning or re-calibration but continuing ventilation ... 155 18.1.19. BPM Tot. Measurement. ... 156 18.2. Alarms... 157 18.2.1. High and Low Alarm Operation ... 157 18.2.2. Minute Volume Alarm Threshold ... 158 18.2.3. Cycle Fail Alarm Threshold ... 158 18.2.4. Sub-ambient Pressure Alarm in Non HFO Modes ... 158 18.2.5. HFO Only Ventilator Set Threshold Alarms (SLE5000 only)... 159 18.2.6. Patient Leak Alarm ... 160 18.2.7. Reset Contamination Alarm ... 160 18.3. Patient Circuits, Humidification and Nitric Oxide Therapy ... 161 18.3.1. Autofeed Humidification chambers... 161 18.3.2. Nitric Oxide Therapy... 162 18.3.3. Nebulization of Medication ... 163 19. Flow and Pressure Triggering ... 166 19.1. Breath Detection Threshold (Flow Triggering) ... 166 19.2. Breath Trigger Sensitivity (Pressure Triggering)... 167 19.3. Setting the Pressure Trigger Level in CPAP, SIMV, PTV and PSV... 168
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20. Basic Set-up ...170 20.1. Pre Set-up Checks ...170 20.2. Setting the FiO2 ...171 20.3. CPAP Set-up ...172 20.3.1. Actions After Connection to Patient in CPAP ...173 20.3.2. Interactive and limiting controls in CPAP ...173 20.3.3. TTVplus (Volume targeting) of backup breaths in CPAP...174 20.3.4. Ventilation without a flow sensor connected...175 20.3.5. Ventilation with the Apnoea alarm turned “OFF” ...175 20.4. CMV Set-up ...176 20.4.1. Actions After Connection to Patient in CMV ...177 20.4.2. Interactive and limiting controls in CMV...177 20.4.3. TTVplus (volume targeting) all mechanical breaths in CMV. ...178 20.4.4. Ventilation Without a Flow Sensor Connected. ...178 20.5. PTV Set-up ...179 20.5.1. Actions after connection to patient in PTV...180 20.5.2. Interactive and limiting controls in PTV. ...181 20.5.3. TTVplus (Volume targeting) of all triggered and mechanical breaths in PTV. ...181 20.5.4. Ventilation Without a Flow Sensor Connected. ...182 20.6. PSV Set-up...183 20.6.1. Actions After Connection to Patient in PSV ...184 20.6.2. Interactive and limiting controls in PSV...185 20.6.3. TTVplus (Volume targeting) of all triggered and mechanical breaths in PSV. ...185 20.6.4. Ventilation Without a Flow Sensor Connected. ...186 20.7. SIMV Set-up ...187 20.7.1. Actions After Connection to Patient in SIMV ...188 20.7.2. Interactive and limiting controls in SIMV. ...189 20.7.3. TTVplus (Volume targeting) of all synchronized and mechanical breaths in SIMV...189 20.7.4. Ventilation Without a Flow Sensor Connected. ...191 20.8. HFO Only Set-up (SLE5000 only) ...192 20.8.1. Actions After Connection to Patient in HFO...193 20.8.2. Ventilation Without a Flow Sensor Connected. ...193 20.9. HFO+CMV Set-up (SLE5000 only) ...194 20.9.1. Actions After Connection to Patient in HFO+CMV...195 20.9.2. Limiting controls in HFO+CMV ...195 20.9.3. Ventilation Without a Flow Sensor Connected. ...195 21. N5201 & N5301 Flow Sensor ...198 21.1. Calibration of the Flow Sensor ...198 21.2. Cleaning and Sterilization of the N5201 Sensor...200 22. Frequently Asked Questions ...204 22.1. Ventilator Related Questions...204 22.1.1. What range of patients is the ventilator designed to ventilate? ...204
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22.1.2. Can the ventilator be used without a flow sensor?... 204 22.1.3. How often must the flow sensor be calibrated?... 204 22.1.4. What does “SENSOR CONTAMINATION” mean? ... 204 22.1.5. What is Standby mode used for? ... 204 22.1.6. What happens when the Pause button is pressed? ... 205 22.1.7. What is the operating time of the battery?... 205 22.1.8. What is the battery charging time?... 205 22.1.9. What is the difference between PTV and PSV?... 205 22.1.10. When looking at the parameter settings, what do I record? ... 205 22.1.11. Where do I set the Trigger Sensitivity? ... 205 22.2. Mode Related Questions ... 206 22.2.1. What is meant by Targeted Tidal Volume? ... 206 22.2.2. What are appropriate Tidal Volumes?... 206 22.2.3. What is the meaning of Compliance and Resistance?... 206 22.2.4. How do I minimise the Apnoea alarm in CPAP? ... 206 22.2.5. In TTVplus some of the breaths exceed the set TTVplus. Why?... 206 22.2.6. Why is there no SET value for MAP and dp in HFO mode? ... 207 22.3. Patient Circuits... 207 22.3.1. What is the difference between the BC2188/400 and BC5188/400 patient circuit? ... 207 22.3.2. Why is a restrictor necessary? ... 207 22.3.3. What happens if the restrictor is placed in the expiratory limb instead of the inspiratory limb? ... 207 22.3.4. Should bacterial filters be used on the expiratory limb?... 207 22.3.5. When using the INOSYS Nitric Oxide therapy and the ventilator what scavenging filters do I need?... 207 22.3.6. How often does the exhalation block and silencer need to be autoclaved? ... 207 22.3.7. How do I clean the exhalation block and scavenging system after using NO? ... 208 23. Commonly Seen Alarms ... 210 23.0.1. High Pressure Alarm ... 210 23.0.2. Low Pressure Alarm ... 210 23.0.3. Breath Not Detected... 210 23.0.4. Low Tidal Volume... 210 23.0.5. Unexpected Rise or drop in Mean P (SLE5000 only)... 211 23.0.6. Unexpected Rise or Drop in Max P (SLE5000 only) ... 211 23.0.7. Unexpected Rise or Drop in Min P (SLE5000 only) ... 211 23.0.8. Continuing Positive Pressure ... 211 23.0.9. Leaking Fresh Gas ... 211 23.0.10. High Patient Leak ... 212 23.0.11. Clean Flow Sensor ... 212 23.0.12. Faulty Flow Sensor... 212 23.0.13. Calibration Fail ... 213 23.0.14. Calibrate Flow Sensor ... 213 23.0.15. Apnoea (volume) ... 213
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24. Trouble Shooting Chart ...216 24.1. Ventilator Related Problems...216 24.2. Ventilation Related Problems ...225 25. Secondary Language Selection ...230 25.1. Activation of Language Selection Program ...230 26. Oxygen Calibration Routines ...232 26.1. One Point O2 Calibration ...232 26.2. Two Point O2 Calibration ...232 27. Preventative Maintenance and Overhaul Schedule ...233 28. RS232 ...234 28.1. Warnings for RS232 ...234 28.2. Location of RS232 Port ...234 28.3. Overview ...235 28.3.1. Data and Pinout Description. ...235 28.3.2. Cable ...235 28.3.3. Parameter Descriptions and Format...236 28.3.4. List of Parameters...236 28.3.5. Table of Current Alarm Condition Codes...239 28.4. RS232 Connection Settings and Testing Data Output ...241 29. Alarms ...242 29.1. Alarm Protocols ...242 29.2. Alarm Sounds ...242 29.3. Alarm Descriptions and Actions to be Taken...243 29.4. Software and System Fail Protocols...262 30. Bacterial Filters ...263 30.1. Bacterial filter, SLE Part Nº:N2029 (Autoclavable)...263 30.2. Bacterial filter, SLE Part Nº: N2587 (Single use)...264 30.2.1. Precautions When Using Bacterial Filter N2587...264 31. Patient Circuits ...265 31.1. Warnings for Patient Circuit Use. ...265 31.2. Generic 10mm Re-usable Patient Circuit ...266 31.2.1. Sterilising of the re-usable Patient Circuit...266 31.3. Generic 10mm Single Use Patient Circuit ...268 31.4. Generic Nitric Oxide Delivery Adaptor Kit...270 32. Cleaning, Disinfection and Sterilization ...271 32.1. Preparation of a New Ventilator...271 32.2. Cleaning and Disinfection of an In-service Ventilator ...271 32.2.1. Cleaning, Disinfection & Sterilization Chart ...272 32.3. Cleaning Method ...272 32.4. Disinfection Method ...273 32.5. Sterilization Method ...274
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33. Technical Specification ... 275 33.1. Operating Modes Conventional Ventilation... 275 33.1.1. CPAP... 275 33.1.2. CMV ... 275 33.1.3. PTV ... 275 33.1.4. PSV ... 276 33.1.5. SIMV... 276 33.2. HFO Ventilation... 277 33.2.1. HFO Only ... 277 33.2.2. HFO+CMV... 277 33.2.3. Controls (Via touch screen display)... 278 33.2.4. Controls ... 280 33.3. Measurement ... 281 33.3.1. Flow and Volume... 281 33.3.2. Oxygen Concentration... 281 33.3.3. Pressure ... 282 33.4. Exhalation Block Port Jet Sizes ... 282 33.5. Alarms... 283 33.5.1. User settable Alarms ... 283 33.5.2. Obligatory Alarms (non adjustable by user) ... 284 33.6. Patient circuits... 284 33.7. Outputs ... 285 33.8. Gas supplies ... 286 33.8.1. Oxygen supply... 286 33.8.2. Air supply... 286 33.8.3. Input pressures and ventilator performance... 286 33.8.4. Flows ... 286 33.9. Power, Dimensions, Classification etc. ... 287 33.10. Classification... 287 33.11. Environmental Storage Conditions ... 287 34. EMC compliance ... 288 35. Pneumatic Unit Schematic SLE4000 Model H, K & N ... 289 36. Pneumatic Unit Schematic SLE5000 Model G, G-R, J, L & M ... 290 37. Ventilator Labelling ... 291 37.1. SLE4000 model H to N ... 291 37.2. SLE5000 Model G to M... 292 38. Consumables and Accessories ... 294 39. Glossary of Abbreviations Used in this Manual ... 300 40. Index ... 303
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Introduction
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1. Introduction 1.1 About This Manual This user manual details the operation of the SLE4000 and SLE5000 infant ventilators. The difference between an SLE4000 and SLE5000 ventilator is that the SLE5000 has two extra modes of operation, these being HFO and HFO+CMV. The user manual will from this point onwards refer to the SLE4000 and SLE5000 as “the ventilator”. Where the user manual details an operation or mode: specifically HFO or HFO+CMV then a statement will appear stating, “SLE5000 only”. The SLE4000 and SLE5000 infant ventilators are identical except for the following, A. Overlays. (SLE5000 overlays are blue, SLE4000 overlays are green).
B. Installed software. (Start up screens and Mode select panels.)
Note: HFO and HFO+CMV modes are not available on the SLE4000 infant ventilator. Note: All the graphics within this manual have been produced with the N6647 test lung and are not representative of actual clinical data.
1.2 Intended Use The ventilator is designed for use on patients up to 20kg, in conventional ventilation. In high frequency oscillation ventilation up to 20kg, dependant on lung condition (SLE5000 only). 1.2.1 Intended Users The ventilator is to be used by appropriately trained and authorised personnel only. In this manual they will be referred to as the “User”.
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2. What’s New in version 4.3 2.1 TTVplus mode The expiratory volume is displayed in the TTVplus window on a breath by breath basis. The pressure is adjusted to maintain a stable Vt at the set Ti. Delivered volume is leak compensated automatically to maintain a stable Vt.
2.2 TTVplus Leak compensation There is adjustable leak compensation of up to 20% (available only when TTVplus is ON).
2.3 HFO mean compensation The set mean airway pressure in HFO mode can now be stabilised as the Delta P is increased, by the use of the optional mean compensation. There is the facility to switch the mean compensation OFF.
2.4 Automatic termination sensitivity leak compensation in PSV modes If a large leak is present in the respiratory circuit, it may prevent the flow from being terminated in PSV mode. If the leak flow is above the selected termination sensitivity level the flow would not terminate as the flow would never reach the termination level. A new algorithm has been added that will compensate for the leak and enables the termination levels below leak flow to be terminated at the leak flow level.
2.5 Reduced nuisance alarms in CPAP mode (when the flow sensor is not connected) When the flow sensor is removed in CPAP mode, the ability to detect patient effort and therefore Apnoea is compromised. The ability to disable the Apnoea alarm reduces the incidence of nuisance alarms when CPAP mode is used non-invasively.
2.6 Battery monitoring This has been added to allow the user to determine the status of the battery. The battery level on discharging is only available if the new M0910 or M0915 power supply is fitted. 2.6.1 Model A to D ventilators For model A to D ventilators, the battery status monitor shows only that the battery is fully charged, discharged or is charging. 2.6.2 Model E to N ventilators For model E to N ventilators, the battery status monitor shows that the battery is fully charged, partially discharged, fully discharged or is charging. An icon is present to show if the unit is connected to the mains electricity supply.
2.7 Pre-mute facility The user can now pre-mute the alarm sounder for 1 minute. Not all alarms can be premuted.
2.8 Rise time control sensitivity change The sensitivity of the wave shape control has been increased compared to previous versions of software.
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3. Description of the Ventilation Modes The ventilator has the ability to be used as either a pressure controlled, volume targeted ventilator, as a pressure limited, time cycled ventilator, and the SLE5000 as a high frequency oscillation ventilator.
3.1 CPAP (with a flow sensor) Continuous Positive Airway Pressure The ventilator generates a continuous positive airway pressure at a level set by the User. The apnoea alarm will sound if the patient has not made any breath attempts within the set apnoea period. User sets the following:• CPAP • Apnoea alarm time • Backup breaths ON or OFF • Manual breath parameters (Ti and PIP) • Fi02 • • • •
Flow breath detection threshold (Set Trigger) - The patient effort required to satisfy the apnoea alarm High and low pressure alarm thresholds Tidal volume, high and low alarm thresholds Minute volume, high and low alarm thresholds
3.1.1 CPAP with Apnoea Backup This is as for basic CPAP mode but if the patient does not make a breath attempt within the Apnoea time then a pressure limited, time cycled backup breath is provided. The user turns ON the backup breaths function. 3.1.2 CPAP with TTVplus (Targeted Tidal Volume) for Back Up Breaths. This is as for basic CPAP with Apnoea Support, where the inspiratory phase shall be terminated if the set volume has been delivered by the back up breath, over the set Ti. The User sets the following:• Enables Targeted Tidal Volume (Vte (TTV)) and selects volume to be delivered • Max PIP • Max Ti • Leak compensation
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3.2 CPAP (without a flow sensor) The ventilator generates a continuous positive airway pressure at a level set by the User. User sets the following:• CPAP • Apnoea Alarm ON/OFF • Manual Breath parameters (Ti and PIP) • Fi02 • • •
High and low pressure alarm thresholds Tidal volume, high and low alarm thresholds Minute volume, high and low alarm thresholds
See “CPAP Mode without a Flow Sensor and with the Apnoea alarm set to “OFF”” on page 148 of the “Operational Considerations” chapter for information on disabling the Apnoea alarm and action to be taken. Warning: If apnoea alarm is disabled when the ventilator is used in CPAP mode without a flow sensor. The ability for the ventilator to deliver backup breaths is also disabled. Backup breaths are disabled as they require the Apnoea alarm to be triggered. Manual breaths can still be delivered. When the Apnoea is turned “OFF”, an alternative method of detecting an Apnoeaic episode must be used. The ventilator will not alarm or provide mechanical backup breaths. Note: The Apnoea alarm is automatically enabled when the flow sensor is connected and calibrated or if the user leaves CPAP mode and enters any other ventilatory mode.
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3.3 CMV Continuous Mandatory Ventilation In this mode the inspiratory cycle is initiated by the ventilator at a set BPM rate. The breaths can be either time limited and pressure cycled. The User sets the following:• BPM • Positive End Expired Pressure (PEEP) • Peak Inspiratory Pressure (PIP) • Inspiratory Time (Ti) • Fi02 • • •
High and low pressure alarm thresholds Tidal volume, high and low alarm thresholds Minute volume, high and low alarm thresholds
3.3.1 CMV with TTVplus (Targeted Tidal Volume) This is as for basic CMV, but where the inspiratory phase shall be terminated when the set volume has been delivered, over the set Ti. The User sets the following:• • • •
Enables Targeted Tidal Volume (Vte (TTV)) and selects volume to be delivered Max PIP Max Ti Leak compensation
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3.4 PTV Patient Triggered Ventilation In this mode all the patient's breath attempts are pressure supported. Mechanical breaths are delivered at the set parameters (Ti, PEEP and PIP) if no patient effort is recognised. The User sets the following:• Positive End Expired Pressure (PEEP) • Peak Inspiratory Pressure (PIP) • Inspiratory Time (Ti) • Backup breath rate (Backup) • Apnoea alarm time (Only if backup breath rate is 19 breaths per minute or lower)* • Fi02 • • • •
Flow breath detection threshold (Set trigger) - The patient effort required to satisfy the apnoea alarm High and low pressure alarm thresholds Tidal volume, high and low alarm thresholds Minute volume, high and low alarm thresholds *Note: PTV will continue to function as stated, but with breath rates of 20 and above Apnoea alarms will be ignored by the ventilator. Breath rates of 20BPM and above are deemed sufficient to support the patient.
3.4.1 PTV with TTVplus (Targeted Tidal Volume) This is as for basic PTV where the inspiratory phase shall be truncated when the set volume has been delivered (for mechanical back up breaths only), over the set Ti. The User sets the following:• Enables Targeted Tidal Volume (Vte (TTV)) and selects volume to be delivered • Max PIP • Max Ti • Leak compensation
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3.5 PSV Pressure Supported Ventilation This is a pressure limited mode of ventilation in which each breath is patient triggered and supported. The breath is patient triggered, pressure supported and patient terminated. The infant therefore has control of the whole cycle, i.e. the inspiratory time, frequency and minute volume. This form of ventilation is dependant on the use of a flow sensor placed between the ET tube connector and the patient circuit. Changes in flow or volume signal detects spontaneous breathing. The termination sensitivity is also user adjustable from 0% - 50%. Example: 5% termination sensitivity means that the flow has dropped to 5% of the peak flow, at this point pressure support is terminated. Pressure support can be manually adjusted by use of the PIP parameter control. Note: If the user sets the termination sensitivity to OFF the PSV mode behaves as PTV. PSV can be used in the weaning process. Weaning is achieved by reducing the support level as the infant is able to make more effort. In this mode all the patient's breath attempts are pressure supported, but mechanical breaths are delivered at the set parameters (Ti, PEEP and PIP) when a patient effort is recognised. The User sets the following:• Positive End Expired Pressure (PEEP) • Peak Inspiratory Pressure (PIP) • Inspiratory Time (Ti) • Backup breath rate (Backup) • The flow termination sensitivity • Apnoea alarm time (Only if backup breath rate is 19 breaths per minute or lower)* • Fi02 • • • •
Flow breath detection threshold (Set Trigger) - The patient effort required to satisfy the apnoea alarm High and low pressure alarm thresholds Tidal volume, high and low alarm thresholds Minute volume, high and low alarm thresholds *Note: PSV will continue to function as stated, but with breath rates of 20 and above Apnoea alarms will be ignored by the ventilator. Breath rates of 20BPM and above are deemed sufficient to support the patient.
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