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Servo i 1.1

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Servo i 1.1

  1. 1. Servo i ventilator Charles Gomersall Dept of Anaesthesia & Intensive Care The Chinese University of Hong Kong Prince of Wales Hospital Version 1.1
  2. 2. 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.
  3. 3. Navigation What’s different from a 300A?
  4. 4. 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?
  5. 5. A quick tour
  6. 6. Menu touch pad Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values !
  7. 7. Using the menu touch pad Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values
  8. 8. Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values
  9. 9. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept
  10. 10. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept
  11. 11. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  12. 12. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  13. 13. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  14. 14. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  15. 15. Text and alarm messages appear here
  16. 16. Start breath O 2 breaths Exp. hold Insp. hold Alarm pofile Additional settings Additional values Fixed keys
  17. 17. Silence/pre-silence alarms <ul><li>Silences or pre-silences alarms for 2 minutes </li></ul>Start breath O 2 breaths Exp. hold Insp. hold Alarm pofile Additional settings
  18. 18. Silence/pre-silence alarms <ul><li>Silences or pre-silences alarms for 2 minutes </li></ul><ul><li>After silencing an alarm the Alarm silence symbol is shown with the remaining time </li></ul>Start breath O 2 breaths Exp. hold Insp. hold Alarm pofile 1:58
  19. 19. Silence/pre-silence alarms <ul><li>When alarms are pre-silenced a pre-silence symbol is shown as well as the remaining mute time </li></ul>0:55
  20. 20. Alarm profile <ul><li>Press this button to: </li></ul><ul><ul><li>Display upper and lower alarm limits </li></ul></ul><ul><ul><li>Adjust preset limits </li></ul></ul><ul><ul><li>Adjust the alarm sound level </li></ul></ul>
  21. 21. Additional values Alarm profile 100 % Alarm sound level 40 Upper 5.0 Lower 40.0 5 30 3 Pressure cm H 2 O Minute Ventilation l/min Respiratory Rate b/min End Exp. Pressure cmH 2 O Autoset Cancel Accept
  22. 22. Save <ul><li>Saves: </li></ul><ul><ul><li>Current curve values </li></ul></ul><ul><ul><li>Current parameter values </li></ul></ul><ul><ul><li>Setting values </li></ul></ul><ul><li>10 secs before and 10 secs after pressing key </li></ul>
  23. 23. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status 700 ml -70 70 l/min 50 cmH 2 O T Recording
  24. 24. Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status
  25. 25. Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status Menu Alarm Review Options Compliance comp. Copy data Biomed Panel lock Change patient category Close
  26. 26. Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status Menu Alarm Review Options Compliance comp. Copy data Biomed Panel lock Change patient category Close Recorded waveforms Trends
  27. 27. Additional values Mode Volume Control Automode Admit patient Nebulizer Status Recorded waveforms 12/25/02 14:32:10 Settings Cursor Close 50 cmH 2 O -70 70 l/min 700 ml 40 cmH 2 O 0 l/min 475 ml 0.0 s
  28. 29. Trends graphs 14:32 Recording saved Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  29. 30. Additional values Mode Volume Control Automode Admit patient Nebulizer Status Recorded waveforms 12/25/02 14:32:10 Settings Cursor Close 50 cmH 2 O -70 70 l/min 700 ml 40 cmH 2 O 0 l/min 475 ml 0.0 s
  30. 31. Trends graphs 14:42 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  31. 32. Trends graphs 14:42 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  32. 33. Trends graphs 14:42 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  33. 34. Trends graphs 14:32 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  34. 35. Trends graphs 14:38 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  35. 36. Trends graphs 14:32 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  36. 37. Trends graphs 14:38 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  37. 38. Trends graphs 14:38 Cursor Hours 1 Close   14:00 15:00 l/min 2 l/min 20 ml 800 0 0 0 Vee MVi MVe VTi VTe 0 10.5 10.0 300 296
  38. 39. i <ul><li>This function is not currently available </li></ul>
  39. 40. Main rotary dial SIEMENS Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values !
  40. 41. Using the main rotary dial Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values .
  41. 42. Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values .
  42. 43. Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values .
  43. 44. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  44. 45. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  45. 46. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  46. 47. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  47. 48. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  48. 49. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  49. 50. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  50. 51. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  51. 52. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 550 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept .
  52. 53. Measured values appear here Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values !
  53. 54. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 15 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 7.4 8.5 6.0 VTi 501 VTe 493 Pplat (cmH 2 O) 34 40
  54. 55. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 15 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 7.4 8.5 6.0 VTi 501 VTe 493 Pplat (cmH 2 O) 34 40
  55. 56. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 15 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 5.2 8.5 6.0 VTi 356 VTe 346 Expiratory MinuteVolume Low Pplat (cmH 2 O) 34 40
  56. 57. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 31 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 8.5 8.5 6.0 VTi 292 VTe 274 Respiratory Rate: High Pplat (cmH 2 O) 34 40
  57. 58. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 31 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 8.5 8.5 6.0 VTi 292 VTe 274 Respiratory Rate: High Pplat (cmH 2 O) 34 40
  58. 59. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 15 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 7.4 8.5 6.0 VTi 501 VTe 493 Pplat (cmH 2 O) 34 40
  59. 60. Additional settings Additional values Pmean 12 PEEP 6 RR (b/min) 15 30 5 O 2 (%) 42 48 36 I:E 1:2.0 MVe (l/min) 7.4 8.5 6.0 VTi 501 VTe 493 Pplat (cmH 2 O) 34 40
  60. 61. Additional settings Next page Ppeak Pplat Pmean PEEP RR O 2 Vee I:E MVe MVi VTi VTe 34 24 12 5 15 21 0 1:2.0 7.0 7.5 501 471
  61. 62. Additional settings Next page Ppeak Pplat Pmean PEEP RR O 2 Vee I:E MVe MVi VTi VTe 34 24 12 5 15 21 0 1:2.0 7.0 7.5 501 471
  62. 63. Additional settings Next page E C static PEEPtot Re 24 Ri 17 C dyn 16 Tc WOB tot 922
  63. 64. Additional settings Next page E C static PEEPtot Re 24 Ri 17 C dyn 16 Tc WOB tot 922
  64. 65. Additional settings Next page E C static PEEPtot Re 24 Ri 17 C dyn 16 Tc WOB tot 922
  65. 66. Start breath O 2 breaths Exp. hold Insp. hold Alarm profile Save Trends i Additional settings Additional values ! Special function keys
  66. 67. Special function keys <ul><li>Start breath </li></ul><ul><ul><li>Activates a set breath </li></ul></ul><ul><li>O 2 breaths </li></ul><ul><ul><li>Changes the FiO 2 to 1.0 for one minute </li></ul></ul><ul><ul><li>Can be interrupted by re-pressing within one minute </li></ul></ul>
  67. 68. Special function keys <ul><li>Expiratory hold </li></ul><ul><ul><li>Produces an expiratory pause hold for measuring total PEEP </li></ul></ul><ul><ul><li>Lasts as long as the key is pushed up to a maximum of 30 secs </li></ul></ul><ul><li>Inspiratory hold </li></ul><ul><ul><li>Produces an inspiratory pause hold for measuring plateau pressure </li></ul></ul><ul><ul><li>Lasts as long as the key is pushed up to a maximum of 30 secs </li></ul></ul>
  68. 69. Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values ! Direct access knobs
  69. 70. Direct access knobs <ul><li>Parameter controlled by each direct access knob depends on ventilation mode selected </li></ul><ul><li>Turn the knob to the desired value shown in the box above the knob </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values O 2 conc. 30 PEEP 5 Resp. rate 15 PC above PEEP 15 mmHg b/min % cm H 2 O
  70. 71. Direct access knobs <ul><li>Parameter controlled by each direct access knob depends on ventilation mode selected </li></ul><ul><li>Turn the knob to the desired value shown in the box above the knob </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values PEEP 5 Resp. rate 15 PC above PEEP 15 mmHg b/min % cm H 2 O O 2 conc. 30
  71. 72. Direct access knobs <ul><li>Parameter controlled by each direct access knob depends on ventilation mode selected </li></ul><ul><li>Turn the knob to the desired value shown in the box above the knob </li></ul>Mode PressureControl Automode Admit patient Nebulizer Status Additional settings Additional values PEEP 5 Resp. rate 15 PC above PEEP 15 mmHg b/min % cm H 2 O O 2 conc. 30 PC above PEEP 15 mmHg
  72. 73. Direct access knobs <ul><li>If the bar in the box is white the setting is within what is generally considered safe limits </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min % cm H 2 O mmHg O 2 conc. 30 PC above PEEP 15
  73. 74. Direct access knobs <ul><li>If the bar turns yellow the setting is outside what are generally considered safe limits </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min % cm H 2 O % mmHg O 2 conc. 30 PC above PEEP 31
  74. 75. Direct access knobs <ul><li>If the bar turns red the setting is significantly outside what are generally considered safe limits </li></ul><ul><li>An audible alarm and alarm message is given </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min % cm H 2 O % mmHg O 2 conc. 30 PC above PEEP 60
  75. 76. Direct access knobs <ul><li>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 </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min % cm H 2 O % mmHg O 2 conc. 30 PC above PEEP 60
  76. 77. Direct access knobs <ul><li>NB When you turn a direct access knob the changes in ventilation take place from the next breath without additional confirmation </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values O 2 conc. 30 PEEP 5 Resp. rate 15 PC above PEEP 15 mmHg b/min % cm H 2 O
  77. 78. Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values ! Mains indicator
  78. 79. Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values ! Start/stop ventilation (standby)
  79. 80. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Waveform area
  80. 81. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status 700 ml -70 70 l/min 50 cmH 2 O T
  81. 82. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status T 700 ml -70 70 l/min 50 cmH 2 O
  82. 83. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status T 700 ml -70 70 l/min 50 cmH 2 O
  83. 84. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status T 700 ml -70 70 l/min 50 cmH 2 O
  84. 85. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status T 700 ml -70 70 l/min 50 cmH 2 O
  85. 86. Start breath O 2 breaths Exp. hold Insp. hold Additional settings Additional values Mode Volume Control Automode Admit patient Nebulizer Status T 700 ml -70 70 l/min 50 cmH 2 O
  86. 87. Start breath O 2 breaths Exp. hold Insp. hold Main screen Menu Quick start Alarm profile Save Trends i Additional settings Additional values ! Patient category
  87. 88. What’s different from a Servo 300/300A?
  88. 89. Volume control Pressure support User interface Volume support Apnoea time Inspiratory rise time Automode SIMV
  89. 90. Volume control
  90. 91. Volume control <ul><li>300 and 300A </li></ul><ul><ul><li>If patient’s breathing effort reaches 2 cm H 2 O below preset PEEP ventilator permits a higher flow </li></ul></ul><ul><ul><li>pressure is then regulated to 2 cm H 2 O above PEEP </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>If a pressure drop of  3 cm H 2 O is detected during inspiration the ventilator switches to pressure support, resulting in increased flow </li></ul></ul><ul><ul><li>When flow  to calculated target level flow maintained until set tidal volume delivered </li></ul></ul>
  91. 92. Volume support
  92. 93. Minute volume <ul><li>300 or 300A </li></ul><ul><ul><li>If RR < set RR (ie minute vol. < set minute vol.) </li></ul></ul><ul><ul><li>new target V T is calculated (based on preset minute volume) & used to regulate insp. pressure </li></ul></ul><ul><ul><li>Max. V T =150% of preset </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Neither RR nor minute volume are set </li></ul></ul><ul><ul><li>Inspiratory pressure is regulated purely based on preset V T </li></ul></ul>
  93. 94. Inspiratory rise time <ul><li>300 and 300A </li></ul><ul><ul><li>Inspiratory rise time set as a % of breath cycle time, which is in turn dependent on set RR </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Inspiratory rise time set as </li></ul></ul><ul><ul><ul><li>% in control and SIMV modes </li></ul></ul></ul><ul><ul><ul><li>absolute time (s) in support modes. (NB. As a result the proportion of inspiration taken up by rise time will increase with RR) </li></ul></ul></ul>
  94. 95. I-E cycling <ul><li>300 and 300A </li></ul><ul><ul><li>I-E cycling occurs when inspiratory flow = 5% of maximum inspiratory flow </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>I-E cycling occurs when inspiratory flow = set % of maximum inspiratory flow </li></ul></ul><ul><ul><li>Set % = inspiratory cycle-off </li></ul></ul>
  95. 96. Apnoea back-up <ul><li>300 and 300A </li></ul><ul><ul><li>Apnoea > 20 secs (adults)  pressure regulated volume control </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Apnoea > set apnoea time  Back-up mode (volume control) </li></ul></ul>
  96. 97. Pressure support
  97. 98. Apnoea back-up <ul><li>300 and 300A </li></ul><ul><ul><li>None </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Apnoea > set apnoea time  Back-up mode (pressure control) </li></ul></ul>
  98. 99. Inspiratory rise time <ul><li>300 and 300A </li></ul><ul><ul><li>Inspiratory rise time set as a % of breath cycle time, which is in turn dependent on set RR </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Inspiratory rise time set as an absolute time (in seconds). </li></ul></ul><ul><ul><li>NB. As a result the proportion of inspiration taken up by rise time will increase with RR </li></ul></ul>
  99. 100. I-E cycling <ul><li>300 and 300A </li></ul><ul><ul><li>I-E cycling occurs when inspiratory flow = 5% of maximum inspiratory flow </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>I-E cycling occurs when inspiratory flow = set % of maximum inspiratory flow </li></ul></ul><ul><ul><li>Set % = inspiratory cycle-off </li></ul></ul>
  100. 101. Inspiratory rise time
  101. 102. Inspiratory rise time <ul><li>300 and 300A </li></ul><ul><ul><li>Always set as a % of cycle time </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Set as a % of cycle time control modes and SIMV </li></ul></ul><ul><ul><li>Set as an absolute time in support modes </li></ul></ul>
  102. 103. Apnoea time <ul><li>300 and 300A </li></ul><ul><ul><li>Preset </li></ul></ul><ul><ul><ul><li>Adult 20 s </li></ul></ul></ul><ul><ul><ul><li>Paediatric 15 s </li></ul></ul></ul><ul><ul><ul><li>Neonate 10 s </li></ul></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Adjustable in volume support, pressure support/CPAP and SIMV modes </li></ul></ul><ul><ul><li>Press “Alarm profile” to set time </li></ul></ul><ul><ul><ul><li>Adult 15-45 s </li></ul></ul></ul><ul><ul><ul><li>Infant 5-15 s </li></ul></ul></ul>
  103. 104. SIMV <ul><li>300 and 300A </li></ul><ul><ul><li>SIMV cycle = </li></ul></ul><ul><ul><li>SIMV period = </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>SIMV cycle = </li></ul></ul><ul><ul><li>SIMV period = set breath cycle time </li></ul></ul>
  104. 105. SIMV <ul><li>300 and 300A </li></ul><ul><ul><li>Mandatory (SIMV) breath given at end of SIMV period if patient does not trigger ventilator during SIMV period </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Mandatory (SIMV) breath given after 90% of SIMV period if patient does not trigger ventilator in initial 90% of SIMV period </li></ul></ul>
  105. 106. Automode <ul><li>300A </li></ul><ul><ul><li>Ventilator shifts from control to spontaneous mode if patient triggers 2 consecutive breaths </li></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Ventilator shifts from control to spontaneous mode if patient triggers ventilator </li></ul></ul>
  106. 107. Automode <ul><li>300A </li></ul><ul><ul><li>Ventilator shifts from spontaneous to control mode after a set period of apnoea: </li></ul></ul><ul><ul><ul><li>Adult 12 s </li></ul></ul></ul><ul><ul><ul><li>Paediatric 8 s </li></ul></ul></ul><ul><ul><ul><li>Neonate 5 s </li></ul></ul></ul><ul><li>Servo i </li></ul><ul><ul><li>Ventilator shifts from control to spontaneous mode after trigger time-out period </li></ul></ul><ul><ul><li>Increases with each successive breath until the set trigger timeout limit is reached </li></ul></ul>
  107. 108. Setting the mode
  108. 109. Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values
  109. 110. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) Tidal volume 500 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. pause 10 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept
  110. 111. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Volume control  Automode Ti =1.33 s (33%) . 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
  111. 112. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept
  112. 113. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept
  113. 114. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept
  114. 115. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 conc. 40 I:E 1:2.0 T. Insp. rise 5 Trigger sensitivity V Basic I:E Trigger . Cancel Accept PC above PEEP 18
  115. 116. <ul><li>If the bar in the box is white the setting is within what is generally considered safe limits </li></ul>PC above PEEP 18
  116. 117. <ul><li>If the bar turns yellow the setting is outside what are generally considered safe limits </li></ul>PC above PEEP 31
  117. 118. <ul><li>If the bar turns red the setting is significantly outside what are generally considered safe limits </li></ul>PC above PEEP 60
  118. 119. Inspiratory rise time <ul><li>Can be altered to increase patient comfort </li></ul><ul><li>Some patients find sudden “bolus” of gas uncomfortable </li></ul><ul><li>Excessively long rise time can result in receiving preset levels of ventilatory support for relatively short periods </li></ul>
  119. 120. Inspiratory rise time <ul><li>Control modes and SIMV </li></ul><ul><ul><li>Rise time set as a % of cycle time </li></ul></ul><ul><ul><li>SIMV </li></ul></ul><ul><ul><ul><li>Cycle time is set </li></ul></ul></ul><ul><ul><li>Control modes </li></ul></ul><ul><ul><ul><li>Cycle time = 60/RR </li></ul></ul></ul>
  120. 121. Inspiratory rise time <ul><li>Support modes </li></ul><ul><ul><li>Rise time set as an absolute time </li></ul></ul><ul><ul><li>Proportion of inspiratory time that is taken up by rise time increases as cycle time shortens (ie increased RR) </li></ul></ul>
  121. 122. Triggering
  122. 123. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 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
  123. 124. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 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
  124. 125. Mode Volume Control Automode Admit patient Nebulizer Status Additional settings Additional values Automode
  125. 126. Automode <ul><li>When automode has been selected the soft key turns white </li></ul>
  126. 127. <ul><li>Control mode </li></ul>Additional settings Additional values Mode Volume Control Automode Volume support Admit patient Nebulizer Status O 2 conc. 30 PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min cm H 2 O % Automode Volume support
  127. 128. <ul><li>Control mode </li></ul>Additional settings Additional values Mode Volume Control Automode Volume support Admit patient Nebulizer Status O 2 conc. 30 PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min cm H 2 O % Automode Volume support
  128. 129. <ul><li>Support mode </li></ul>Additional settings Additional values Mode Volume Control Automode Volume support Admit patient Nebulizer Status O 2 conc. 30 PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min cm H 2 O % Automode Volume support
  129. 130. Mode Volume Control Automode Admit patient Nebulizer Status Additional values Set ventilation mode Pressure control  Automode Ti =1.33 s (33%) PC above PEEP 18 Resp. Rate 15 PEEP 5 O 2 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
  130. 131. Automode <ul><li>Automode can only be set in association with the following modes of ventilation </li></ul><ul><ul><li>Volume control </li></ul></ul><ul><ul><li>Pressure regulated volume control </li></ul></ul><ul><ul><li>Pressure control </li></ul></ul>
  131. 132. Modes Volume control Pressure control Pressure support/CPAP Volume support PRVC SIMV Automode Back up ventilation
  132. 133. Volume control <ul><li>volume preset assist/control ventilation </li></ul><ul><li>ventilator delivers preset volume in preset inspiratory time with preset pause time and preset flow pattern </li></ul><ul><ul><li>when triggered by the patient’s respiratory efforts </li></ul></ul><ul><ul><li>as determined by the preset ventilatory rate </li></ul></ul>
  133. 134. Volume control 700 ml -70 70 l/min 50 cmH 2 O
  134. 135. Volume control <ul><li>Ventilator will deliver breaths to ensure preset frequency is achieved </li></ul><ul><li>In general preset volume is delivered according to preset waveform for all breaths </li></ul><ul><li>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 </li></ul>
  135. 136. Volume control <ul><li>Flow is usually dependent on preset volume and the inspiratory time. </li></ul><ul><li>Inspiratory time is determined by the I:E ratio and the respiratory rate </li></ul><ul><li>If the flow does not meet patient demand the flow is automatically increased. </li></ul>
  136. 137. Volume control <ul><li>If a pressure drop of  3 cm H 2 O is detected during inspiration the ventilator switches to pressure support, resulting in increased flow </li></ul><ul><li>When flow  to calculated target level flow maintained until set tidal volume delivered </li></ul>
  137. 138. Volume control Time Flow Insp. time Pause time Exp time
  138. 139. Volume control Time Flow Insp. time Pause time Exp time
  139. 140. Pressure control <ul><li>Pressure preset assist/control ventilation </li></ul><ul><li>Similar to volume control except pressure is preset </li></ul><ul><li>Inadequate flow unlikely to be a problem </li></ul>
  140. 141. Pressure control PEEP PC above PEEP Pressure Flow
  141. 142. Pressure control <ul><li>Theoretical decrease in risk of barotrauma </li></ul><ul><li>Improved oxygenation due to decelerating flow pattern </li></ul><ul><li>Risk of hypoventilation as lung compliance falls </li></ul><ul><ul><li>monitor tidal and minute volumes </li></ul></ul>
  142. 143. Pressure regulated volume control <ul><li>Preset tidal volume delivered in preset inspiratory time at preset frequency </li></ul><ul><li>Ventilator automatically adapts inspiratory pressure control level to changes in mechanical properties of chest </li></ul><ul><li>Inspiratory pressure constant </li></ul><ul><li>Inspiratory flow decelerating </li></ul>
  143. 144. PRVC Pressure Flow Volume
  144. 145. PRVC Pressure Flow Volume Upper Pressure limit 5 cm H 2 O
  145. 146. PRVC <ul><li>Has the advantages of pressure control ventilation without the disadvantage of potential hypoventilation/over-ventilation as chest compliance changes </li></ul>
  146. 147. PRVC <ul><li>With automode off: </li></ul><ul><ul><li>PRVC </li></ul></ul><ul><li>With automode on: </li></ul><ul><ul><li>PRVC if patient is apnoeic </li></ul></ul><ul><ul><li>VS if patient is triggering the ventilator </li></ul></ul>
  147. 148. PRVC <ul><li>In this mode the pressure is titrated to the tidal volume </li></ul><ul><li>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) </li></ul>
  148. 149. Volume support <ul><li>Every breath is patient triggered </li></ul><ul><li>Pressure square wave with decelerating flow </li></ul><ul><li>Ventilator automatically titrates pressure to achieve preset tidal volume with the lowest possible pressure </li></ul>
  149. 150. Volume support Pressure Flow Volume Upper Pressure limit 5 cm H 2 O 10 cm H 2 O
  150. 151. Volume support Pressure Flow Volume Upper Pressure limit 5 cm H 2 O 10 cm H 2 O Maximum inspiratory flow Set % of max inspiratory flow
  151. 152. Volume support <ul><li>If apnoea time is exceeded ventilator automatically: </li></ul><ul><ul><li>Alarms and switches to Back up mode (volume control with default settings) if Automode is off </li></ul></ul><ul><ul><ul><li>Remains in Back up mode until alarm is reset </li></ul></ul></ul>
  152. 153. Pressure support/CPAP <ul><li>With both PS and PEEP >0 </li></ul><ul><ul><li>pressure support ventilation with PEEP </li></ul></ul><ul><li>With PEEP = 0 </li></ul><ul><ul><li>pressure support ventilation </li></ul></ul><ul><li>With PS = 0 </li></ul><ul><ul><li>PS of 2 cmH 2 O plus PEEP </li></ul></ul>
  153. 154. Pressure support <ul><li>inspiratory assist </li></ul><ul><li>constant preset airway pressure supplied during inspiration </li></ul>
  154. 155. Pressure support PEEP PS above PEEP Pressure Flow Volume Maximum inspiratory flow Set % of max inspiratory flow
  155. 156. Pressure support PEEP PS above PEEP Pressure Flow Volume
  156. 157. Pressure support <ul><li>allows patient to control inspiratory and expiratory times, inspiratory flow and tidal volumes. This control can improve patient comfort </li></ul><ul><li>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 </li></ul>
  157. 158. Pressure support <ul><li>pressure support of 3.5-14.5 cmH 2 O required to overcome the additional work of breathing due to breathing through ETT and demand valve. Patients who require pressure support of < 6 cmH 2 O can probably be extubated </li></ul><ul><li>may unload respiratory muscles and reduce diaphragmatic fatigue </li></ul>
  158. 159. Pressure support <ul><li>disadvantages: </li></ul><ul><ul><li>V T and minute ventilation variable, excessively large V T may be delivered </li></ul></ul><ul><ul><li>high initial flow and termination algorithm may be unsuitable for severe airflow obstruction </li></ul></ul>
  159. 160. Back-up ventilation <ul><li>Operates in association with volume support and pressure support/CPAP </li></ul><ul><li>Does not operate when Automode is on </li></ul>
  160. 161. Back-up ventilation Pressure support/ CPAP Pressure control Default pressure = PS or 20 cmH 2 O Default I:E ratio Default respiratory rate Default inspiratory rise time Apnoea> set apnoea time
  161. 162. Back-up ventilation Volume support Volume control V T = set V T Default I:E ratio Default respiratory rate Default inspiratory rise time Apnoea> set apnoea time
  162. 163. <ul><li>patient can breathe spontaneously but also receives a set number of volume controlled mechanical breaths </li></ul><ul><li>volume controlled breaths are synchronized with the patient’s breathing to prevent the possibility of a mechanical breath on top of a spontaneous breath </li></ul><ul><li>remaining breaths are pressure supported </li></ul>SIMV (VC) & PS
  163. 164. SIMV Pressure Flow PEEP Time Pressure support above PEEP Trig Trig Time
  164. 165. SIMV (VC) + PS <ul><li>If the patient is apnoeic the ventilator delivers volume controlled breaths at the preset SIMV rate </li></ul><ul><li>If the patient triggers the ventilator the response of the ventilator depends on the point in the ventilator cycle at which triggering occurs </li></ul>
  165. 166. SIMV (VC) & PS <ul><li>Time is split up into a series of SIMV cycles </li></ul><ul><li>duration of each SIMV cycle = </li></ul>
  166. 167. SIMV (VC) & PS <ul><li>Each SIMV cycle is made up of 2 parts: </li></ul><ul><ul><li>SIMV period </li></ul></ul><ul><ul><ul><li>=breath cycle time </li></ul></ul></ul><ul><ul><li>spontaneous period </li></ul></ul>
  167. 168. SIMV period Volume controlled breath SIMV cycle Pressure supported breath T T
  168. 169. Volume controlled breath 90% of SIMV period
  169. 170. SIMV (PC) + PS <ul><li>Very similar to SIMV (VC) &PS except that controlled breaths are pressure rather than volume controlled </li></ul>
  170. 171. SIMV (PRVC) + PS <ul><li>Very similar to SIMV (VC) &PS except that controlled breaths are PRVC breaths rather than volume controlled breaths </li></ul>
  171. 172. Automode <ul><li>Active in VC, PC and PRVC modes </li></ul><ul><li>When automode is on ventilator switches between control and spontaneous modes based on presence or absence of triggering </li></ul>
  172. 173. Automode Pressure control Volume control PRVC Pressure support Volume support Volume support Apnoea Triggering Apnoea Triggering Apnoea Triggering
  173. 174. Automode <ul><li>Trigger timeout </li></ul><ul><ul><li>= duration of apnoea before ventilator switches from support mode to control mode </li></ul></ul><ul><ul><li>The limit increases with each successive breath until the set trigger timeout limit is reached </li></ul></ul>
  174. 175. Automode <ul><li>When automode has been selected the soft key turns white </li></ul>
  175. 176. <ul><li>Control mode </li></ul>Additional settings Additional values Mode Volume Control Automode Volume support Admit patient Nebulizer Status O 2 conc. 30 PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min cm H 2 O % Automode Volume support
  176. 177. <ul><li>Control mode </li></ul>Additional settings Additional values Mode Volume Control Automode Volume support Admit patient Nebulizer Status O 2 conc. 30 PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min cm H 2 O % Automode Volume support
  177. 178. <ul><li>Support mode </li></ul>Additional settings Additional values Mode Volume Control Automode Volume support Admit patient Nebulizer Status O 2 conc. 30 PEEP 5 Resp. rate 15 Tidal volume 500 ml b/min cm H 2 O % Automode Volume support
  178. 179. Changing the parameters
  179. 180. Changing parameters <ul><li>Direct access knobs </li></ul><ul><li>Additional settings </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values O 2 conc. 30 PEEP 5 Resp. rate 15 PC above PEEP 15 mmHg b/min % cm H 2 O
  180. 181. Changing parameters <ul><li>Direct access knobs </li></ul><ul><li>Additional settings </li></ul>Mode Pressure Control Automode Admit patient Nebulizer Status Additional settings Additional values O 2 conc. 30 PEEP 5 Resp. rate 15 PC above PEEP 15 mmHg b/min % cm H 2 O
  181. 182. Alarms This module will be available in later versions of this tutorial
  182. 183. Starting up
  183. 185. Pre-use check
  184. 186. Additional settings Additional values Standby Do you want to start Pre-use check? Yes No to start ventilation Press
  185. 187. Additional settings Additional values Standby Do you want to start Pre-use check? Yes No to start ventilation Press
  186. 189. Pre-use check <ul><li>Do not use the ventilator if it does not pass the pre-use check </li></ul>
  187. 190. Check batteries
  188. 192. Status Additional settings Additional values
  189. 193. Status Additional settings Additional values Status General O 2 cell Exp. cassette Modules Options Pre-use check 401 kPa*100 O 2 pressure 394 kPa*100 Air Pressure 1023 hPa Barometric pressure 312 min Battery backup time 1423 hours Next Preventative Maintenance 167 hours Operating time Passed: 2002-02-06 14:52 Pre-use check 2017 Serial no. Universal Version
  190. 194. Status Additional settings Additional values Status General O 2 cell Exp. cassette Modules Options Pre-use check 401 kPa*100 O 2 pressure 394 kPa*100 Air Pressure 1023 hPa Barometric pressure 312 min Battery backup time 1423 hours Next Preventative Maintenance 167 hours Operating time Passed: 2002-02-06 14:52 Pre-use check 2017 Serial no. Universal Version
  191. 195. Status Additional settings Additional values Status General O 2 cell Exp. cassette Modules Options Pre-use check 52 min, Slot position 6 Battery 52 min, Slot position 5 Battery 52 min, Slot position 4 Battery 49 min, Slot position 3 Battery 51 min, Slot position 2 Battery 52 min, Slot position 1 Battery Modules status
  192. 196. Advanced This module will be available in later versions of this tutorial
  193. 197. Alarm messages <ul><li>This module will be available in a later version of this tutorial </li></ul>

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