Leoni Plus PräSent Hfo Eng

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Leoni Plus PräSent Hfo Eng

  1. 1. Welcome! <ul><li>Heinen + Löwenstein GmbH </li></ul><ul><li>Arzbacher Straße 80 </li></ul><ul><li>D-56130 Bad Ems </li></ul><ul><li>Tel. +49 (0) 2603 9600-0 </li></ul><ul><li>Fax +49 (0) 2603 960050 </li></ul><ul><li>www.hul.de </li></ul>
  2. 2. Leoni Ventilators Leoni mobil Leoni 2 Leoni plus
  3. 3. Mode of Operation <ul><li>The Leoni neonatal and pediatric ventilator functions according to the constant flow generator principle . </li></ul><ul><li>A constant gas flow of mixed Oxygen/Air is delivered to the patient via a hose system. </li></ul><ul><li>The desired concentration of the inhaled gas mixture is produced by a valve bank . </li></ul><ul><li>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 . </li></ul><ul><li>Exhalation is effected by opening the expiratory valve. The lung then deflates due to the pressure decrease . </li></ul>
  4. 4. 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
  5. 5. 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
  6. 6. Leoni plus Ventilation modes <ul><li> CPAP </li></ul><ul><li> IPPV / IMV </li></ul><ul><li> SIPPV </li></ul><ul><li> SIMV </li></ul><ul><li> PSV SIPPV </li></ul><ul><li>PSV SIMV </li></ul><ul><li>HFOV </li></ul>
  7. 7. CPAP Ventilation mode <ul><li> Demand-CPAP </li></ul><ul><li> With support frequency </li></ul>
  8. 8. IMV/IPPV Ventilation mode <ul><li> IMV </li></ul>
  9. 9. IPPV Ventilation mode <ul><li> I PPV </li></ul>
  10. 10. SIPPV Ventilation mode <ul><li> Leakage com- pensated volume trigge- ring </li></ul><ul><li> Trigger sensi- tivity related to VTi (5 – 30 %) </li></ul>
  11. 11. SIMV Ventilation mode <ul><li> Leakage com- pensated volume triggering </li></ul>
  12. 12. PSV Ventilation mode <ul><li> PSV SIPPV </li></ul><ul><li> PSV SIMV </li></ul>
  13. 13. HFOV Ventilation mode <ul><li> HFOV on the membrane prin- ciple with recruit- ment breath function </li></ul>
  14. 14. 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 -
  15. 15. 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
  16. 16. 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 -
  17. 17. 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
  18. 18. Casing front <ul><li>Control Panel </li></ul><ul><li>Touch Screen </li></ul><ul><li>Rotary Pulse Encoder </li></ul><ul><li>Inspiratory Connection </li></ul><ul><li>Expiratory Connection </li></ul><ul><li>Pressure Gauge Connection </li></ul><ul><li>HFOV- Connection </li></ul>2 1 3 5 7 6 4
  19. 19. Casing rear <ul><li>Earth Connection </li></ul><ul><li>Serial Interface </li></ul><ul><li>Ethernet Connection </li></ul><ul><li>Flow Sensor Connection </li></ul><ul><li>Oxygen Connection </li></ul><ul><li>O 2 Sensor Access </li></ul><ul><li>Compressed Air Connection </li></ul><ul><li>Mains Connection </li></ul><ul><li>Nurse Call </li></ul>3 2 1 9 5 6 7 8 4
  20. 20. Accessories <ul><li>Proximal Pressure Line </li></ul><ul><li>Expiration Hose </li></ul><ul><li>Inspiration Hose </li></ul><ul><li>Y-Piece </li></ul><ul><li>Flow Sensor </li></ul><ul><li>Test Lung </li></ul><ul><li>Flow Sensor Cable </li></ul><ul><li>HFOV Hose with Filter </li></ul>8
  21. 21. Control panel <ul><li> Mode / Home </li></ul><ul><li> Loops </li></ul><ul><li> Curves </li></ul><ul><li> Alarm Limits </li></ul><ul><li> Power Failure LED </li></ul><ul><li> Battery Operation LED </li></ul><ul><li> Alarm LED </li></ul><ul><li> Alarm Mute Button </li></ul><ul><li> StandBy </li></ul><ul><li> Manual Ventilatory Drive </li></ul><ul><li> Rotary Encoder </li></ul><ul><li> ON/OFF </li></ul><ul><li> Start Ventilation </li></ul><ul><li> Numerical Values Switch-Over </li></ul>
  22. 22. Start Screen <ul><li>Flow Sensor </li></ul><ul><li>Flow Sensor Calibration </li></ul><ul><li>Oxygen Sensor Calibration </li></ul><ul><li>Main Menu Bar </li></ul><ul><li>Calibration Button </li></ul>
  23. 23. Main Sreen <ul><li>Alarm Bar </li></ul><ul><li>Curves </li></ul><ul><li>Softkeys </li></ul><ul><li>Numerical Values </li></ul>
  24. 24. Curve Display <ul><li>Flow Curve </li></ul><ul><li>Pressure Curve </li></ul><ul><li>Volume Curve </li></ul><ul><li>Curves freely scalable </li></ul><ul><li>3 Curves at the same time </li></ul>
  25. 25. Loop Screen <ul><li>Flow over Pressure </li></ul><ul><li>Flow over Volume </li></ul><ul><li>Volume over Pressure </li></ul><ul><li>Full-screen presentation possible </li></ul><ul><li>Loops freely scalable </li></ul><ul><li>Up to 3 loops at the same time </li></ul>
  26. 26. Alarm limits <ul><li>Manual Adjustment </li></ul><ul><li>Autoset Adjustment </li></ul><ul><li>Alarm Logbook Function </li></ul>
  27. 27. Simultaneous Presentation <ul><li>Simultaneous Presentation of: </li></ul><ul><li>Loops </li></ul><ul><li>Curve Screen </li></ul><ul><li>Alarm Limits </li></ul><ul><li>Monitoring </li></ul>
  28. 28. HFO Leoni plus <ul><li>High-frequency ventilation (HFV) as a ventilatory therapy has </li></ul><ul><li>reached increasing clinical application over the past ten years. The </li></ul><ul><li>term comprises several methods. High-frequency jet ventilation </li></ul><ul><li>must be differentiated from high-frequency oscillatory ventilation </li></ul><ul><li>(HFOV or HFO). In this booklet I concentrate on high-frequency </li></ul><ul><li>oscillatory ventilation. Therefore, the difference in meaning notwithstanding, </li></ul><ul><li>I use both acronyms, HFV and HFO, interchangeably. </li></ul>
  29. 29. Indications for HFV <ul><li>Since the early eighties results on oscillatory ventilation have been </li></ul><ul><li>published in numerous case reports and studies. Yet there are </li></ul><ul><li>only few controlled studies based on large numbers of patients. </li></ul><ul><li>In newborns HFV has first been </li></ul><ul><li>employed as a rescue treatment. The goal of this type of ventilation </li></ul><ul><li>is to improve gas exchange and at the same time reduce pulmonary </li></ul><ul><li>barotrauma. </li></ul><ul><li>Oscillatory ventilation can be tried when conventional ventilation </li></ul><ul><li>fails, or when barotrauma has already occurred or is imminent. </li></ul><ul><li>In the first place this applies to pulmonary diseases with reduced </li></ul><ul><li>compliance. The efficacy of HFV for these indications has been </li></ul><ul><li>proven in the majority of clinical studies. In severe lung failure, </li></ul><ul><li>HFV was a feasible alternative to ECMO </li></ul><ul><li>When to switch from conventional ventilation to HFV must certainly </li></ul><ul><li>be decided by the clinician in charge, according to their experience. </li></ul><ul><li>Some centres meanwhile apply HFV as a primary treatment </li></ul><ul><li>for RDS in the scope of studies. Likewise, in cases of congenital </li></ul><ul><li>hernia and during surgical correction, HFV has been successfully used </li></ul><ul><li>as a primary treatment </li></ul>
  30. 30. Indications; HFV+IMV <ul><li>Also in different kinds of surgery, especially in the </li></ul><ul><li>region of the larynx and the trachea, HFV has proven </li></ul><ul><li>its worth. Moreover, in primary pulmonary hypertension </li></ul><ul><li>of the newborn HFV can improve oxygenation and </li></ul><ul><li>Ventilation. </li></ul><ul><li>Always observing the contraindications </li></ul><ul><li>in our NICU we follow this proven procedure: If conventional </li></ul><ul><li>ventilation* fails, we will switch over to HFV. We will assume </li></ul><ul><li>failure of conventional ventilation, if maintaining adequate blood </li></ul><ul><li>gas tensions (pO2 > 50mmHg, SaO2 > 90%; pCO2 < 55 to </li></ul><ul><li>65 mmHg) requires peak inspiratory pressures (PIP) in excess of </li></ul><ul><li>certain limits. Those depend on gestational age and bodyweight: </li></ul><ul><li>In small prematures we consider using HFV at PIP higher than </li></ul><ul><li>22 mbar. With PIP going beyond 25 mbar we regard HFV even </li></ul><ul><li>as a necessity. </li></ul><ul><li>In more mature infants the pressure limits are somewhat higher </li></ul>
  31. 31. Combining HFV and IMV, and sustained inflation <ul><li>Oscillatory ventilation on its own can be used in the CPAP mode, </li></ul><ul><li>or with superimposed IMV strokes, usually at a rate of 3 to 5 </li></ul><ul><li>strokes per minute. </li></ul><ul><li>The benefit of the IMV </li></ul><ul><li>breaths is probably due to the opening of uninflated lung units to </li></ul><ul><li>achieve further ‘volume recruitment’. </li></ul><ul><li>Sometimes very long inspiratory times (15 to 30 s) are suggested </li></ul><ul><li>for these sustained inflations (SI). By applying them about every </li></ul><ul><li>20 minutes compliance and oxygenation have been improved and </li></ul><ul><li>atelectases prevented. </li></ul>
  32. 32. Combining HFV and IMV, and sustained inflation <ul><li>Especially after volume loss by deflation during suctioning </li></ul><ul><li>the lung soon can be reopened with a sustained inflation. However, </li></ul><ul><li>whether these inflation manoeuvres should be employed </li></ul><ul><li>routinely is subject of controversial discussions. </li></ul><ul><li>In most of the clinical studies no sustained inflations were applied. </li></ul><ul><li>In animal trials no increased incidence of barotrauma was found. </li></ul><ul><li>Prevention of atelectases, which might occur under HFV with </li></ul><ul><li>insufficient MAP, is the primary benefit of combining HFV and IMV. </li></ul><ul><li>HFV superimposed to a normal IMV can markedly improve CO2 </li></ul><ul><li>washout (‘flushing the deadspace’ by HFV) at lower peak pressures </li></ul>
  33. 33. Indications; HFV+IMV <ul><li>Effect of a sigh manoeuvres through </li></ul><ul><li>sustained inflation (SI): </li></ul><ul><li>prior to the SI the intrapulmonary volume equals </li></ul><ul><li>V1 at the MAP level (point a); </li></ul><ul><li>the SI manoeuvres temporarily increases pressure </li></ul><ul><li>and lung volume according to the </li></ul><ul><li>pressure-volume curve; </li></ul><ul><li>when the pressure has returned to the previous MAP level, </li></ul><ul><li>pulmonary volume remains on a higher level, V2 </li></ul><ul><li>(point b), </li></ul><ul><li>because the decrease in pressure occurred on the expiratory </li></ul><ul><li>limb of the PV loop. </li></ul><ul><li>Pressure </li></ul><ul><li>Volume </li></ul>
  34. 34. Standard Accessories <ul><li>Hose system, heated and non-heated </li></ul>Flow Sensor / Y-Piece / Connecting cable Expiration valve / Expiration membrane Oxygen cell HFOV Hose
  35. 35. Total System
  36. 36. Thank you very much for your open interest <ul><li>Heinen + Löwenstein GmbH </li></ul><ul><li>Arzbacher Straße 80 </li></ul><ul><li>D-56130 Bad Ems </li></ul><ul><li>Tel. +49 (0) 2603 9600-0 </li></ul><ul><li>Fax +49 (0) 2603 960050 </li></ul><ul><li>www.hul.de </li></ul>

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