Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile SaveTrends...

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12-25 15:32

Charles Gomersall 2003

Servoi ventilator

Charles GomersallDept of Anaesthesia & Intensive CareThe Chinese University of Hong Kong

Prince of Wales Hospital

Version 1.1

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Disclaimer

Although considerable effort has been taken to ensure that the material in this tutorial

accurately reflects the information provided by Maquet AB in its publications the author

takes no responsibility for the accuracy of the information in this tutorial nor for any adverse

event that occurs as a result of using this tutorial. Users are advised to consult the

manual that accompanies their ventilator. Please note that this tutorial has not been

endorsed by Maquet AB.

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Navigation

What’s different from a 300A?

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Setting the mode

Changing parameters

Advanced

Modes

Starting up

User interface – a quick tour

Alarms

Click on “Maquet” to end the tutorial at any stage

What’s different from a 300A?

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A quick tour

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Additionalsettings

Additionalvalues

!

Menu touch pad

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ModeVolume Control Automode Admit

patient Nebulizer Status

Additionalsettings

Additionalvalues

Using the menu touch pad

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Additionalsettings

Additionalvalues

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Additionalvalues

Set ventilation mode Volume control Automode Ti =1.33 s (33%)

Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

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Text and alarm messages appear here

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Startbreath

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Alarmpofile

Additionalsettings

Additionalvalues

Fixed keys

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Startbreath

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Alarmpofile

Additionalsettings

Silence/pre-silence alarms• Silences or pre-

silences alarms for 2 minutes

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AlarmpofileSilence/pre-silence

alarms• Silences or pre-

silences alarms for 2 minutes

• After silencing an alarm the Alarm silence symbol is shown with the remaining time

1:58

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Silence/pre-silence alarms• When alarms are pre-

silenced a pre-silence symbol is shown as well as the remaining mute time

0:55

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Alarm profile• Press this button to:

– Display upper and lower alarm limits

– Adjust preset limits– Adjust the alarm sound level

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Additionalvalues

Alarm profile

100%

Alarm sound level

40Upper

5.0

Lower

40.0

5 30

3

Pressurecm H2O

Minute Ventilationl/min

Respiratory Rateb/min

End Exp. PressurecmH2O

Autoset

Cancel Accept

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Save• Saves:

– Current curve values– Current parameter values– Setting values

• 10 secs before and 10 secs after pressing key

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Startbreath

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Insp.hold

Additionalsettings

Additionalvalues



700 ml

-70

70 l/min

50 cmH2O

TRecording

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Additionalsettings

Additionalvalues



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Additionalsettings

Additionalvalues



MenuAlarm

Review

Options

Compliancecomp.

Copy data

Biomed

Panel lock

Changepatient category

Close

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Additionalsettings

Additionalvalues



MenuAlarm

Review

Options

Compliancecomp.

Copy data

Biomed

Panel lock

Changepatient category

Close

Recordedwaveforms

Trends

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Additionalvalues



Recorded waveforms 12/25/02 14:32:10

Settings Cursor Close

50 cmH2O

-70

70 l/min

700 ml

40cmH2O

0l/min

475ml

0.0 s

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Startbreath

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Trends graphs

14:32 Recording saved

Cursor Hours 1 Close

14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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Additionalvalues



Recorded waveforms 12/25/02 14:32:10

Settings Cursor Close

50 cmH2O

-70

70 l/min

700 ml

40cmH2O

0l/min

475ml

0.0 s

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Trends graphs

14:42


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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Trends graphs

14:42


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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Trends graphs

14:42


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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breathsExp.hold

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Trends graphs

14:32


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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Trends graphs

14:38


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

O2

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Trends graphs

14:32


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

O2

breathsExp.hold

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Trends graphs

14:38


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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Trends graphs

14:38


14:00 15:00

l/min2

l/min20

ml800

0

0

0

Vee

MViMVe

VTiVTe

0

10.510.0

300296

Startbreath

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i• This function is not currently

available

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SIEMENS

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Additionalsettings

Additionalvalues

!

Main rotary dial

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Additionalsettings

Additionalvalues

.

Using the main rotary dial

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Additionalsettings

Additionalvalues

.

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Additionalsettings

Additionalvalues

.

Startbreath

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept.

Startbreath

O2

breathsExp.hold

Insp.hold

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept.

Startbreath

O2

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Insp.hold

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept.

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

Startbreath

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

Startbreath

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

.

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept .

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Additionalvalues


Tidal volume

550

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept .

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Startbreath

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Additionalsettings

Additionalvalues

!

Measured values appear here

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues

Pmean 12PEEP 6RR (b/min)

15

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

7.48.5

6.0VTi 501VTe 493

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues


15

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

7.48.5

6.0VTi 501VTe 493

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues


15

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

5.28.5

6.0VTi 356VTe 346

Expiratory MinuteVolume Low

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues


31

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

8.58.5

6.0VTi 292VTe 274

Respiratory Rate: High

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues


31

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

8.58.5

6.0VTi 292VTe 274

Respiratory Rate: High

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Insp.hold

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues


15

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

7.48.5

6.0VTi 501VTe 493

Startbreath

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Pplat (cmH2O)

34

40

Additionalsettings

Additionalvalues


15

30

5O2 (%)

42

48

36I:E 1:2.

0MVe (l/min)

7.48.5

6.0VTi 501VTe 493

Startbreath

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Additionalsettings

Nextpage

Ppeak

Pplat

Pmean

PEEP

RR

O2

Vee

I:E

MVe

MVi

VTi

VTe

34

24

12

5

15

21

0

1:2.0

7.0

7.5

501

471

Startbreath

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Additionalsettings

Nextpage

Ppeak

Pplat

Pmean

PEEP

RR

O2

Vee

I:E

MVe

MVi

VTi

VTe

34

24

12

5

15

21

0

1:2.0

7.0

7.5

501

471

Startbreath

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Insp.hold

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Additionalsettings

Nextpage

E

C static

PEEPtot

Re 24

Ri 17

C dyn 16

Tc

WOB tot 922

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Additionalsettings

Nextpage

E

C static

PEEPtot

Re 24

Ri 17

C dyn 16

Tc

WOB tot 922

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Additionalsettings

Nextpage

E

C static

PEEPtot

Re 24

Ri 17

C dyn 16

Tc

WOB tot 922

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Alarmprofile

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Additionalsettings

Additionalvalues

!

Special function keys

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Special function keys• Start breath

– Activates a set breath

• O2 breaths

– Changes the FiO2 to 1.0 for one minute

– Can be interrupted by re-pressing within one minute

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Special function keys• Expiratory hold

– Produces an expiratory pause hold for measuring total PEEP

– Lasts as long as the key is pushed up to a maximum of 30 secs

• Inspiratory hold– Produces an inspiratory pause hold for

measuring plateau pressure– Lasts as long as the key is pushed up to

a maximum of 30 secs

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Direct access knobs

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ModePressure Control Automode Admit


Additionalsettings

Additionalvalues

O2 conc.

30PEEP

5Resp. rate

15PC above PEEP

15mmHgb/min% cm H2O

Direct access knobs

• Parameter controlled by each direct access knob depends on ventilation mode selected

• Turn the knob to the desired value shown in the box above the knob

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Additionalsettings

Additionalvalues

PEEP

5Resp. rate

15PC above PEEP

15O2 conc.

30mmHgb/min% cm H2O

Direct access knobs



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ModePressureControl Automode Admit


Additionalsettings

Additionalvalues

PEEP

5Resp. rate

15PC above PEEP

15O2 conc.

30mmHgb/min% cm H2O

Direct access knobs



PC above PEEP

15mmHg

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Additionalsettings

Additionalvalues

PEEP

5Resp. rate

15Tidal volume

500O2 conc.

30mlb/min% cm H2O

Direct access knobs

• If the bar in the box is white the setting is within what is generally considered safe limits

PC above PEEP

15mmHg

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Additionalsettings

Additionalvalues

PEEP

5Resp. rate

15Tidal volume

500O2 conc.

30mlb/min% cm H2O

Direct access knobs

• If the bar turns yellow the setting is outside what are generally considered safe limits

%

PC above PEEP

31mmHg

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Additionalsettings

Additionalvalues

PEEP

5Resp. rate

15Tidal volume

500O2 conc.

30mlb/min% cm H2O

Direct access knobs

• If the bar turns red the setting is significantly outside what are generally considered safe limits

• An audible alarm and alarm message is given

%

PC above PEEP

60mmHg

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Additionalsettings

Additionalvalues

PEEP

5Resp. rate

15Tidal volume

500O2 conc.

30mlb/min% cm H2O

Direct access knobs

• When you come to a safety limit the knob is inactive for 2 seconds in order to make you aware that you have passed a safety limit

%

PC above PEEP

60mmHg

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Additionalsettings

Additionalvalues

O2 conc.

30PEEP

5Resp. rate

15PC above PEEP

15mmHgb/min% cm H2O

Direct access knobs

• NB When you turn a direct access knob the changes in ventilation take place from the next breath without additional confirmation

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Additionalvalues

!

Mains indicator

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Additionalvalues

!

Start/stop ventilation (standby)

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Additionalsettings

Additionalvalues

Waveform area

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Additionalsettings

Additionalvalues



700 ml

-70

70 l/min

50 cmH2O

T

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Additionalsettings

Additionalvalues



T

700 ml

-70

70 l/min

50 cmH2O

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Additionalsettings

Additionalvalues



T

700 ml

-70

70 l/min

50 cmH2O

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Additionalsettings

Additionalvalues



T

700 ml

-70

70 l/min

50 cmH2O

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Additionalsettings

Additionalvalues



T

700 ml

-70

70 l/min

50 cmH2O

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Additionalsettings

Additionalvalues



T

700 ml

-70

70 l/min

50 cmH2O

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Additionalsettings

Additionalvalues

!

Patient category

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What’s different from a Servo 300/300A?

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Volume control

Pressure support

User interface

Volume support

Apnoea time

Inspiratory rise time

AutomodeSIMV

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Volume control

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Volume control• 300 and 300A

– If patient’s breathing effort reaches 2 cm H2O below preset PEEP ventilator permits a higher flow

– pressure is then regulated to 2 cm H2O above PEEP

• Servoi

– If a pressure drop of 3 cm H2O is detected during inspiration the ventilator switches to pressure support, resulting in increased flow

– When flow to calculated target level flow maintained until set tidal volume delivered

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Volume support

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Minute volume• 300 or 300A

– If RR < set RR (ie minute vol. < set minute vol.)

– new target VT is calculated (based on preset minute volume) & used to regulate insp. pressure

– Max. VT =150% of preset

• Servoi

– Neither RR nor minute volume are set

– Inspiratory pressure is regulated purely based on preset VT

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Inspiratory rise time• 300 and 300A

– Inspiratory rise time set as a % of breath cycle time, which is in turn dependent on set RR

• Servoi

– Inspiratory rise time set as

• % in control and SIMV modes

• absolute time (s) in support modes. (NB. As a result the proportion of inspiration taken up by rise time will increase with RR)

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I-E cycling• 300 and 300A

– I-E cycling occurs when inspiratory flow = 5% of maximum inspiratory flow

• Servoi

– I-E cycling occurs when inspiratory flow = set % of maximum inspiratory flow

– Set % = inspiratory cycle-off

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Apnoea back-up• 300 and 300A

– Apnoea > 20 secs (adults) pressure regulated volume control

• Servoi

– Apnoea > set apnoea time Back-up mode (volume control)

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Pressure support

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Apnoea back-up• 300 and 300A

– None

• Servoi

– Apnoea > set apnoea time Back-up mode (pressure control)

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– Inspiratory rise time set as a % of breath cycle time, which is in turn dependent on set RR

• Servoi

– Inspiratory rise time set as an absolute time (in seconds).

– NB. As a result the proportion of inspiration taken up by rise time will increase with RR

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I-E cycling• 300 and 300A

– I-E cycling occurs when inspiratory flow = 5% of maximum inspiratory flow

• Servoi

– I-E cycling occurs when inspiratory flow = set % of maximum inspiratory flow

– Set % = inspiratory cycle-off

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Inspiratory rise time

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– Always set as a % of cycle time

• Servoi

– Set as a % of cycle time control modes and SIMV

– Set as an absolute time in support modes

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Apnoea time• 300 and 300A

– Preset• Adult 20 s• Paediatric 15 s• Neonate 10 s

• Servoi

– Adjustable in volume support, pressure support/CPAP and SIMV modes

– Press “Alarm profile” to set time

• Adult 15-45 s• Infant 5-15 s

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SIMV• 300 and 300A

– SIMV cycle =

– SIMV period =

• Servoi

– SIMV cycle =

– SIMV period = set breath cycle time

rate resp preset60

rate SIMV60

rate CMV60

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SIMV• 300 and 300A

– Mandatory (SIMV) breath given at end of SIMV period if patient does not trigger ventilator during SIMV period

• Servoi

– Mandatory (SIMV) breath given after 90% of SIMV period if patient does not trigger ventilator in initial 90% of SIMV period

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Automode• 300A

– Ventilator shifts from control to spontaneous mode if patient triggers 2 consecutive breaths

• Servoi

– Ventilator shifts from control to spontaneous mode if patient triggers ventilator

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Automode• 300A

– Ventilator shifts from spontaneous to control mode after a set period of apnoea:

• Adult 12 s• Paediatric 8 s• Neonate 5 s

• Servoi

– Ventilator shifts from control to spontaneous mode after trigger time-out period

– Increases with each successive breath until the set trigger timeout limit is reached

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Setting the mode

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Additionalsettings

Additionalvalues

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Additionalvalues


Tidal volume

500

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. pause

10

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

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Additionalvalues


.

Cancel Accept

Select ventilation mode

Volume control

Pressure control

Pressure Support/CPAP

PRVC

Volume Support

SIMV (PRVC)Pressure Support

SIMV (Press. Control)Pressure Support

SIMV (Vol. Control)Pressure Support

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Additionalvalues

Set ventilation mode Pressure control Automode Ti =1.33 s (33%)

PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

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Additionalvalues


PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

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Additionalvalues


PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

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Additionalvalues


PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

PC above PEEP

18

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• If the bar in the box is white the setting is within what is generally considered safe limits

PC above PEEP

18

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• If the bar turns yellow the setting is outside what are generally considered safe limits

PC above PEEP

31

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• If the bar turns red the setting is significantly outside what are generally considered safe limits

PC above PEEP

60

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Inspiratory rise time• Can be altered to increase

patient comfort• Some patients find sudden

“bolus” of gas uncomfortable• Excessively long rise time can

result in receiving preset levels of ventilatory support for relatively short periods

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Inspiratory rise time• Control modes and SIMV

– Rise time set as a % of cycle time– SIMV

• Cycle time is set

– Control modes• Cycle time = 60/RR

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Inspiratory rise time• Support modes

– Rise time set as an absolute timeProportion of inspiratory time that

is taken up by rise time increases as cycle time shortens (ie increased RR)

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Triggering

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Additionalvalues


PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

Trigger sensitivity.

V-20 0

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Additionalvalues


PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

Trigger sensitivity

-2-20 0

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Additionalsettings

Additionalvalues

Automode

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Automode• When automode has been

selected the soft key turns white

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Additionalsettings

Additionalvalues

ModeVolume Control

AutomodeVolume support

Admitpatient Nebulizer Status

O2 conc.

30PEEP

5Resp. rate

15Tidal volume

500mlb/mincm H2O%


• Control mode

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Additionalsettings

Additionalvalues

ModeVolume Control



O2 conc.

30PEEP

5Resp. rate

15Tidal volume

500mlb/mincm H2O%


• Control mode

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Additionalsettings

Additionalvalues

ModeVolume Control



O2 conc.

30PEEP

5Resp. rate

15Tidal volume

500mlb/mincm H2O%


• Support mode

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Additionalvalues


PC above PEEP

18

Resp. Rate

15

PEEP

5

O2 conc.

40

I:E

1:2.0

T. Insp. rise

5

Trigger sensitivity

V

Basic I:E Trigger

.

Cancel Accept

Insp. cycle off

5

Trigger timeout

7

PS above PEEP

20

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Automode• Automode can only be set in

association with the following modes of ventilation– Volume control– Pressure regulated volume control– Pressure control

Click on a mode to find out more about it or on the return button to return to the previous menu

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ModesVolume control

Pressure control Pressure support/CPAP

Volume support

PRVC SIMV

Automode Back up ventilation

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Volume control• volume preset assist/control

ventilation• ventilator delivers preset volume in

preset inspiratory time with preset pause time and preset flow pattern– when triggered by the patient’s

respiratory efforts– as determined by the preset ventilatory

rate

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Volume control

700 ml

-70

70 l/min

50 cmH2O

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Volume control• Ventilator will deliver breaths to

ensure preset frequency is achieved• In general preset volume is delivered

according to preset waveform for all breaths

• With the Servo i it possible for the patient to obtain a higher inspiratory flow and tidal volume from the ventilator than is pre-set

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Volume control• Flow is usually dependent on preset

volume and the inspiratory time.• Inspiratory time is determined by the

I:E ratio and the respiratory rate• If the flow does not meet patient

demand the flow is automatically increased.

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Volume control• If a pressure drop of 3 cm H2O is

detected during inspiration the ventilator switches to pressure support, resulting in increased flow

• When flow to calculated target level flow maintained until set tidal volume delivered

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Volume control

Time

Flow

Insp.time

Pausetime

Exp time

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Volume control

Time

Flow

Insp.time

Pausetime

Exp time

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Pressure control• Pressure preset assist/control

ventilation• Similar to volume control

except pressure is preset• Inadequate flow unlikely to be a

problem

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Pressure control

PEEP

PC above PEEP

Pre

ssu

reFl

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Pressure control• Theoretical decrease in risk of

barotrauma• Improved oxygenation due to

decelerating flow pattern• Risk of hypoventilation as lung

compliance falls– monitor tidal and minute volumes

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Pressure regulated volume control• Preset tidal volume delivered in preset

inspiratory time at preset frequency• Ventilator automatically adapts

inspiratory pressure control level to changes in mechanical properties of chest

• Inspiratory pressure constant• Inspiratory flow decelerating

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PRVCPre

ssu

reFl

ow

Volu

me

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PRVCPre

ssu

reFl

ow

Volu

me

Upper Pressure limit

5 cm H2O

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PRVC• Has the advantages of pressure control

ventilation without the disadvantage of potential hypoventilation/over-ventilation as chest compliance changes

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PRVC

• With automode off:– PRVC

• With automode on:– PRVC if patient is apnoeic– VS if patient is triggering the

ventilator

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PRVC• In this mode the pressure is

titrated to the tidal volume• should not be used in a

situation where the inspiratory tidal volume leaving the ventilator is not an accurate reflection of delivered tidal volume (eg circuit leak, uncuffed tube)

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Volume support• Every breath is patient

triggered• Pressure square wave with

decelerating flow• Ventilator automatically titrates

pressure to achieve preset tidal volume with the lowest possible pressure

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Volume supportPre

ssu

reFl

ow

Volu

me


5 cm H2O

10 cm H2O

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Volume supportPre

ssu

reFl

ow

Volu

me


5 cm H2O

10 cm H2O

Maximum inspiratory

flowSet % of maxinspiratory flow

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Volume support• If apnoea time is exceeded

ventilator automatically:– Alarms and switches to Back up

mode (volume control with default settings) if Automode is off

• Remains in Back up mode until alarm is reset

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Pressure support/CPAP• With both PS and PEEP >0

– pressure support ventilation with PEEP

• With PEEP = 0– pressure support ventilation

• With PS = 0– PS of 2 cmH2O plus PEEP

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Pressure support• inspiratory assist• constant preset airway

pressure supplied during inspiration

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Pressure support

PEEP

PS above PEEP

Pre

ssu

reFl

ow

Volu

me

Maximum inspiratory

flowSet % of maxinspiratory flow

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Pressure support

PEEP

PS above PEEP

Pre

ssu

reFl

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Volu

me

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Pressure support• allows patient to control inspiratory

and expiratory times, inspiratory flow and tidal volumes. This control can improve patient comfort

• can be combined with SIMV or CPAP or used on its own in patients whose gas exchange is improving and in whom weaning is being attempted

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Pressure support• pressure support of 3.5-14.5 cmH2O

required to overcome the additional work of breathing due to breathing through ETT and demand valve. Patients who require pressure support of < 6 cmH2O can probably be extubated

• may unload respiratory muscles and reduce diaphragmatic fatigue

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Pressure support• disadvantages:

– VT and minute ventilation variable, excessively large VT may be delivered

– high initial flow and termination algorithm may be unsuitable for severe airflow obstruction

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Back-up ventilation

• Operates in association with volume support and pressure support/CPAP

• Does not operate when Automode is on

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Back-up ventilation

Pressuresupport/

CPAP

Pressure controlDefault pressure = PS or 20 cmH2ODefault I:E ratioDefault respiratory rateDefault inspiratory rise time

Apnoea>set apnoea time

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Back-up ventilation

Volumesupport

Volume controlVT = set VT

Default I:E ratioDefault respiratory rateDefault inspiratory rise time

Apnoea>set apnoea time

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• patient can breathe spontaneously but also receives a set number of volume controlled mechanical breaths

• volume controlled breaths are synchronized with the patient’s breathing to prevent the possibility of a mechanical breath on top of a spontaneous breath

• remaining breaths are pressure supported

SIMV (VC) & PS

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SIMV

Pressure

Flow

PEEPTime

Pressure support above PEEP

Trig Trig

Time

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SIMV (VC) + PS• If the patient is apnoeic the

ventilator delivers volume controlled breaths at the preset SIMV rate

• If the patient triggers the ventilator the response of the ventilator depends on the point in the ventilator cycle at which triggering occurs

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SIMV (VC) & PS• Time is split up into a series of

SIMV cycles• duration of each SIMV cycle =

rate SIMV preset60

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SIMV (VC) & PS• Each SIMV cycle is made up of

2 parts:– SIMV period

• =breath cycle time

– spontaneous period

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SIMV periodVolume controlled breath

SIMV cycle

Pressure supported breath

T T

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Volume controlled

breath

90% of SIMV period

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SIMV (PC) + PS• Very similar to SIMV (VC) &PS

except that controlled breaths are pressure rather than volume controlled

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SIMV (PRVC) + PS• Very similar to SIMV (VC) &PS

except that controlled breaths are PRVC breaths rather than volume controlled breaths

Startbreath

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Automode• Active in VC, PC and PRVC

modes• When automode is on ventilator

switches between control and spontaneous modes based on presence or absence of triggering

Startbreath

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Automode

Pressurecontrol

Volumecontrol

PRVC

Pressuresupport

Volumesupport

Volumesupport

Apnoea

Triggering

Apnoea

Triggering

Apnoea

Triggering

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Automode• Trigger timeout

– = duration of apnoea before ventilator switches from support mode to control mode

– The limit increases with each successive breath until the set trigger timeout limit is reached

Startbreath

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Automode• When automode has been

selected the soft key turns white

Startbreath

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Additionalsettings

Additionalvalues

ModeVolume Control



O2 conc.

30PEEP

5Resp. rate

15Tidal volume

500mlb/mincm H2O%


• Control mode

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Additionalsettings

Additionalvalues

ModeVolume Control



O2 conc.

30PEEP

5Resp. rate

15Tidal volume

500mlb/mincm H2O%


• Control mode

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Additionalsettings

Additionalvalues

ModeVolume Control



O2 conc.

30PEEP

5Resp. rate

15Tidal volume

500mlb/mincm H2O%


• Support mode

Startbreath

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Changing the parameters

Startbreath

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Additionalsettings

Additionalvalues

O2 conc.

30PEEP

5Resp. rate

15PC above PEEP

15mmHgb/min% cm H2O

Changing parameters

• Direct access knobs• Additional settings

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Additionalsettings

Additionalvalues

O2 conc.

30PEEP

5Resp. rate

15PC above PEEP

15mmHgb/min% cm H2O

Changing parameters

• Direct access knobs• Additional settings

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AlarmsThis module will be available in later versions of this tutorial

Startbreath

O2

breathsExp.hold

Insp.hold

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Starting up

Startbreath

O2

breathsExp.hold

Insp.hold

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Startbreath

O2

breathsExp.hold

Insp.hold

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Pre-use check

Startbreath

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breathsExp.hold

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Additionalsettings

Additionalvalues

Standby

Do you want to start Pre-use check?

Yes No

to start ventilationPress

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Additionalsettings

Additionalvalues

Standby

Do you want to start Pre-use check?

Yes No

to start ventilationPress

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Startbreath

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Pre-use check

•Do not use the ventilator if it does not pass the pre-use check

Startbreath

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Check batteries

Startbreath

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breathsExp.hold

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Startbreath

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Status

Additionalsettings

Additionalvalues

Startbreath

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Status

Additionalsettings

Additionalvalues

Status

General

O2 cell

Exp. cassette

Modules

Options

Pre-use check

Version Universal

Serial no. 2017

Pre-use check Passed: 2002-02-06 14:52

Operating time 167 hours

Next Preventative Maintenance

1423 hours

Battery backup time 312 min

Barometric pressure 1023 hPa

Air Pressure 394 kPa*100

O2 pressure 401 kPa*100

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Status

Additionalsettings

Additionalvalues

Status

General

O2 cell

Exp. cassette

Modules

Options

Pre-use check

Version Universal

Serial no. 2017

Pre-use check Passed: 2002-02-06 14:52

Operating time 167 hours

Next Preventative Maintenance

1423 hours

Battery backup time 312 min

Barometric pressure 1023 hPa

Air Pressure 394 kPa*100

O2 pressure 401 kPa*100

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Status

Additionalsettings

Additionalvalues

Status

General

O2 cell

Exp. cassette

Modules

Options

Pre-use check

Modules status

Battery 52 min, Slot position 1






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AdvancedThis module will be available in later versions of this tutorial

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Alarm messages• This module will be available in

a later version of this tutorial

Date post:	20-Jan-2016
Category:	Documents
Upload:	caitlin-malone
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Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile SaveTrends...

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