Leoni Plus PräSent Hfo Eng
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Leoni Plus PräSent Hfo Eng Leoni Plus PräSent Hfo Eng Presentation Transcript

  • Welcome!
    • Heinen + Löwenstein GmbH
    • Arzbacher Straße 80
    • D-56130 Bad Ems
    • Tel. +49 (0) 2603 9600-0
    • Fax +49 (0) 2603 960050
    • www.hul.de
  • Leoni Ventilators Leoni mobil Leoni 2 Leoni plus
  • Mode of Operation
    • The Leoni neonatal and pediatric ventilator functions according to the constant flow generator principle .
    • A constant gas flow of mixed Oxygen/Air is delivered to the patient via a hose system.
    • The desired concentration of the inhaled gas mixture is produced by a valve bank .
    • During the inspiration phase, the expiratory valve on the end of the hose system is closed, so that the flow must go towards the patient .
    • Exhalation is effected by opening the expiratory valve. The lung then deflates due to the pressure decrease .
  • Specifications x x   Lopps: F/P, V/P, F/V x x   Curves: Pressure / Volume / Flow     x Curves: Pressure x x   Volume trigger x     Touch screen, removeable x     TFT Colour screen   x x LCD Display x x x Integrated battery x x x VIVE x x x Electronic gas blender x x x O 2 Monitor Leoni plus Leoni 2 Leoni mobil
  • Ventilation modes x x x Manual Ventilatory Drive x     Volume Guarantee x x   Volume Limit x     HFOV x x   SIMV - PSV x x   SIPPV - PSV x x   SIMV x x   SIPPV x x x IPPV x x x CPAP Leoni plus Leoni 2 Leoni mobil
  • Leoni plus Ventilation modes
    •  CPAP
    •  IPPV / IMV
    •  SIPPV
    •  SIMV
    •  PSV SIPPV
    • PSV SIMV
    • HFOV
  • CPAP Ventilation mode
    •  Demand-CPAP
    •  With support frequency
  • IMV/IPPV Ventilation mode
    •  IMV
  • IPPV Ventilation mode
    •  I PPV
  • SIPPV Ventilation mode
    •  Leakage com- pensated volume trigge- ring
    •  Trigger sensi- tivity related to VTi (5 – 30 %)
  • SIMV Ventilation mode
    •  Leakage com- pensated volume triggering
  • PSV Ventilation mode
    •  PSV SIPPV
    •  PSV SIMV
  • HFOV Ventilation mode
    •  HFOV on the membrane prin- ciple with recruit- ment breath function
  • Setting ranges   IPPV/ IMV SIMV SIPPV CPAP Breath rate FREQUENCY [BPM] 6 .. 200 2 .. 100 2 .. 100 - Inspiration time I-TIME [sec] 0.10 .. 2.00 0.10 .. 2.00 0.10 .. 2.00 - Expiration time E-time [sec] 0.20 .. 10.00 0.50 .. 30.00 0.20 .. 30.00 - Inspiratory Flow INSP FLOW [l/min] 1 .. 32 1 .. 32 1 .. 32 - Expiratory Flow E Flow [l/min] 2 .. 10 2 .. 10 2 .. 10 -
  • Setting ranges   IPPV/ IMV SIMV SIPPV CPAP           Inspiratory Pressure P INSP [cmH2O] 6 .. 60 6 .. 60 6 .. 60 - Backup Pressure P-BACK [cmH2O] - - - 6 .. 60 Positive End Expiratory Pressure PEEP [cmH2O] 0 .. 20 0 .. 20 0 .. 20 - CPAP [cmH2O] - - - 1 .. 20
  • Setting ranges   IPPV/ IMV SIMV SIPPV CPAP           O 2 Concentration OXYGEN [%] 21 .. 100 21 .. 100 21 .. 100 21 .. 100 O 2 Concentration Oxygen flush O2-Flush [%] 23 .. 100 23 .. 100 23 .. 100 23 .. 100 Volume trigger TRIGGER [% VTi] - 10 .. 30 10 .. 30 -
  • Setting ranges   HFOV Mean Pressure Pmean [cmH2O] 10 .. 30 High Frequency HFFreq [Hz] 5 .. 20 High Frequency Amplitude HFAmpl [cmH2O] 5 .. 80 Recruitment Frequency FreqRec [1/min] 0 .. 10 Recruitment Inspiration Time TI Rec [s] 0.1 .. 3
  • Casing front
    • Control Panel
    • Touch Screen
    • Rotary Pulse Encoder
    • Inspiratory Connection
    • Expiratory Connection
    • Pressure Gauge Connection
    • HFOV- Connection
    2 1 3 5 7 6 4
  • Casing rear
    • Earth Connection
    • Serial Interface
    • Ethernet Connection
    • Flow Sensor Connection
    • Oxygen Connection
    • O 2 Sensor Access
    • Compressed Air Connection
    • Mains Connection
    • Nurse Call
    3 2 1 9 5 6 7 8 4
  • Accessories
    • Proximal Pressure Line
    • Expiration Hose
    • Inspiration Hose
    • Y-Piece
    • Flow Sensor
    • Test Lung
    • Flow Sensor Cable
    • HFOV Hose with Filter
    8
  • Control panel
    •  Mode / Home
    •  Loops
    •  Curves
    •  Alarm Limits
    •  Power Failure LED
    •  Battery Operation LED
    •  Alarm LED
    •  Alarm Mute Button
    •  StandBy
    •  Manual Ventilatory Drive
    •  Rotary Encoder
    •  ON/OFF
    •  Start Ventilation
    •  Numerical Values Switch-Over
  • Start Screen
    • Flow Sensor
    • Flow Sensor Calibration
    • Oxygen Sensor Calibration
    • Main Menu Bar
    • Calibration Button
  • Main Sreen
    • Alarm Bar
    • Curves
    • Softkeys
    • Numerical Values
  • Curve Display
    • Flow Curve
    • Pressure Curve
    • Volume Curve
    • Curves freely scalable
    • 3 Curves at the same time
  • Loop Screen
    • Flow over Pressure
    • Flow over Volume
    • Volume over Pressure
    • Full-screen presentation possible
    • Loops freely scalable
    • Up to 3 loops at the same time
  • Alarm limits
    • Manual Adjustment
    • Autoset Adjustment
    • Alarm Logbook Function
  • Simultaneous Presentation
    • Simultaneous Presentation of:
    • Loops
    • Curve Screen
    • Alarm Limits
    • Monitoring
  • HFO Leoni plus
    • High-frequency ventilation (HFV) as a ventilatory therapy has
    • reached increasing clinical application over the past ten years. The
    • term comprises several methods. High-frequency jet ventilation
    • must be differentiated from high-frequency oscillatory ventilation
    • (HFOV or HFO). In this booklet I concentrate on high-frequency
    • oscillatory ventilation. Therefore, the difference in meaning notwithstanding,
    • I use both acronyms, HFV and HFO, interchangeably.
  • Indications for HFV
    • Since the early eighties results on oscillatory ventilation have been
    • published in numerous case reports and studies. Yet there are
    • only few controlled studies based on large numbers of patients.
    • In newborns HFV has first been
    • employed as a rescue treatment. The goal of this type of ventilation
    • is to improve gas exchange and at the same time reduce pulmonary
    • barotrauma.
    • Oscillatory ventilation can be tried when conventional ventilation
    • fails, or when barotrauma has already occurred or is imminent.
    • In the first place this applies to pulmonary diseases with reduced
    • compliance. The efficacy of HFV for these indications has been
    • proven in the majority of clinical studies. In severe lung failure,
    • HFV was a feasible alternative to ECMO
    • When to switch from conventional ventilation to HFV must certainly
    • be decided by the clinician in charge, according to their experience.
    • Some centres meanwhile apply HFV as a primary treatment
    • for RDS in the scope of studies. Likewise, in cases of congenital
    • hernia and during surgical correction, HFV has been successfully used
    • as a primary treatment
  • Indications; HFV+IMV
    • Also in different kinds of surgery, especially in the
    • region of the larynx and the trachea, HFV has proven
    • its worth. Moreover, in primary pulmonary hypertension
    • of the newborn HFV can improve oxygenation and
    • Ventilation.
    • Always observing the contraindications
    • in our NICU we follow this proven procedure: If conventional
    • ventilation* fails, we will switch over to HFV. We will assume
    • failure of conventional ventilation, if maintaining adequate blood
    • gas tensions (pO2 > 50mmHg, SaO2 > 90%; pCO2 < 55 to
    • 65 mmHg) requires peak inspiratory pressures (PIP) in excess of
    • certain limits. Those depend on gestational age and bodyweight:
    • In small prematures we consider using HFV at PIP higher than
    • 22 mbar. With PIP going beyond 25 mbar we regard HFV even
    • as a necessity.
    • In more mature infants the pressure limits are somewhat higher
  • Combining HFV and IMV, and sustained inflation
    • Oscillatory ventilation on its own can be used in the CPAP mode,
    • or with superimposed IMV strokes, usually at a rate of 3 to 5
    • strokes per minute.
    • The benefit of the IMV
    • breaths is probably due to the opening of uninflated lung units to
    • achieve further ‘volume recruitment’.
    • Sometimes very long inspiratory times (15 to 30 s) are suggested
    • for these sustained inflations (SI). By applying them about every
    • 20 minutes compliance and oxygenation have been improved and
    • atelectases prevented.
  • Combining HFV and IMV, and sustained inflation
    • Especially after volume loss by deflation during suctioning
    • the lung soon can be reopened with a sustained inflation. However,
    • whether these inflation manoeuvres should be employed
    • routinely is subject of controversial discussions.
    • In most of the clinical studies no sustained inflations were applied.
    • In animal trials no increased incidence of barotrauma was found.
    • Prevention of atelectases, which might occur under HFV with
    • insufficient MAP, is the primary benefit of combining HFV and IMV.
    • HFV superimposed to a normal IMV can markedly improve CO2
    • washout (‘flushing the deadspace’ by HFV) at lower peak pressures
  • Indications; HFV+IMV
    • Effect of a sigh manoeuvres through
    • sustained inflation (SI):
    • prior to the SI the intrapulmonary volume equals
    • V1 at the MAP level (point a);
    • the SI manoeuvres temporarily increases pressure
    • and lung volume according to the
    • pressure-volume curve;
    • when the pressure has returned to the previous MAP level,
    • pulmonary volume remains on a higher level, V2
    • (point b),
    • because the decrease in pressure occurred on the expiratory
    • limb of the PV loop.
    • Pressure
    • Volume
  • Standard Accessories
    • Hose system, heated and non-heated
    Flow Sensor / Y-Piece / Connecting cable Expiration valve / Expiration membrane Oxygen cell HFOV Hose
  • Total System
  • Thank you very much for your open interest
    • Heinen + Löwenstein GmbH
    • Arzbacher Straße 80
    • D-56130 Bad Ems
    • Tel. +49 (0) 2603 9600-0
    • Fax +49 (0) 2603 960050
    • www.hul.de