The document provides an overview of mechanical ventilation using the Medumat Standard 2 ventilator. It discusses the ventilator's modes of ventilation including IPPV, CPAP, BiPAP, PCV, SIMV, and PRVC. It also covers initial setup based on patient height and weight, ventilator strategies, adjusting settings to optimize oxygenation and ventilation, ventilator curves and alarms, troubleshooting, and the use of non-invasive ventilation with CPAP and BiPAP modes. The primary mode discussed for most patients is IPPV, and adjustments to settings like respiratory rate and PEEP/FiO2 are recommended to maintain normocarbia and optimal oxygenation.

1. Basics of Mechanical Ventilation and Use of
the Medumat Standard 2 Ventilator

2. Introduction
• With the purchase of a modern transport ventilator we are able to
offer improved control and monitoring of ventilation to our patients.
The following presentation seeks to introduce these capabilities to
you in an operational and clinical context.
• The presentation is meant to be used in conjunction with provided
independent study materials and education program which will help
us get better at ventilation but also get better at ventilation with our
new equipment.

3. Modes of Ventilation
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The Standard 2 is able to provide the following modes of Mechanical
Ventilation.
-IPPV
-CPAP
-BiPAP
-PCV
-SIMV
-PRVC
Currently the vast majority of our patients are sedated/paralyzed and
the most appropriate mode to use is IPPV. IPPV is a mandatory
volume controlled mode and is functionally the same as the mode
used on our previous generation of ventilators. All “emergency
modes” utilize IPPV as the default ventilation mode.

4. Initial Set-Up
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Calculating the approximate height of the adult patient is
important as the ventilator will calculate the optimal tidal
volume based on IDEAL BODY Weight (IDW) which is a
function of height
IBW=50 + (0.9 x Ht-152.4)
A reasonable Tidal Volume is 6-8 ml/kg
For toddlers and young children under 124 cm
ideal tidal volumes are based on approximate
weight
Tidal Volume= 10ml/kg
The Standard 2 Ventilator cannot deliver accurate
tidal volumes below 85 ml

5. Ventilator Strategies
• The majority of our patients can be managed with a “lung-protective” ventilation
strategy. This strategy aims to prevent barotrauma by limiting tidal volume.
• Patients with obstructive lung disease may require a different approach to
ventilation and are at higher risks of complications due to ongoing
bronchoconstriction. The respiratory rate and I:E ratio can be titrated to allow
time for the patient to exhale

6. Adjusting our Settings
• Effective Ventilation and Oxygenation requires regular re-assessment
of the patient AND the ventilator
• In the absence of impending complications we should consider adjusting our
vent to optimize EtC02 & Oxygenation
• In general our goal is normocarbia and assuming a fixed tidal volume adjustment of the
respiratory rate can accomplish that
• Both hyperoxia and hypoxia are undesirable. Adjustment of PEEP and Fi02 can help
maintain this balance. The Standard 2 is only able to provide “Air-Mix” or 100% Oxygen

7. Emergency Modes
• The Weinneman Standard 2 comes with 3 “Emergency Modes” these are ventilation modes which
automatically initiate IPPV for a standardized patient. The ARHT Ventilators “Emergency Modes”
will be customized to mirror recommendations in the SJA CPGS and are suitable for our “standard
patients”
Emergency
Mode
ADULT CHILD (25 KG) PEDIATRIC (12.5 KG)
VT 600 200 100
Frequency 12 20 30
I:E Ratio 1:2 1:2 1:2
PEEP 5 5 0
P Max 40 35 30

8. Display Curves
• Unlike our current modules which have an analog pressure gauge only, the Standard 2 is able to
provide a digital Pressure Gauge, a Pressure/Time Curve and Flow/Time Curve. It is possible to
select which curves are displayed however the preset will be to display both Pressure/Time and
Flow/Time.

9. Pressure Gauge
Solid Green: Indicates the
pressure applied by the ventilator
during the respiratory cycle
Dotted Red Line: Indicated the
maximum pressure under current
settings

10. Pressure/Time Curve
The Pressure/Time Curve gives us a graphic representation of the changes in pressure applied to the lung.
The morphology of this curve changes based on the ventilation mode and based on the compliance of
the patient’s lungs and airway resistance. Advanced interpretation may able to help troubleshoot
ventilator problems. The ventilator is also able to measure plateau pressures and leak which may be
helpful during ventilator emergencies.

11. Pressure/Time Curve
• An example of when the Pressure/Time Curve may help us ventilate a
patient
• The curve below is of a patient who due to extended transport time is
beginning to make respiratory efforts and is “fighting” the vent.

12. Flow/Time Curve
The Flow/Time Curve allows us the follow the flow in both the inspiratory and
expiratory phase. Positive deflections indicate inspiratory flow and negative
deflections indicate expiratory flow

13. Flow/Time Curve
• An example of when ventilator curves can help us is if we consider dynamic
hyperinflation
• In the curve below the expiratory flow curve never reaches the baseline suggesting that
the patient does not have sufficient time to exhale as may happen in patients with
bronchoconstriction

14. Troubleshooting
• Mechanical Ventilation troubleshooting can be approached if we
consider a 3 part model and that problems can occur in any of those
three parts
• Part 1: The Patient (Sensorium, Airway, Cardiopulmonary System)
• Part 2: Patient-Machine Connection (ETT tube; ventilator circuit and
connectors)
• Part 3: The Ventilator & Oxygen Source

15. Troubleshooting
• DOPE Mnemonic
• D isplacement of endotracheal tube
• O bstruction of endotracheal tube
• P neumothorax
• E quipment Failure
• ARHT Emergency Checklists
• EtCO2 Morphology and Ventilator Curves may be helpful
• When in doubt switch to BVM

16. Ventilator Alarms
Clinically Important Ventilator Alarms
- High Airway Pressure
- Low Airway Pressure
- Apnea
- Increased PEEP
- Low Oxygen Pressure
In addition some causes of abnormal
EtC02 values/trends as well Hypoxia can
be addressed or be due to mechanical
ventilation and the patient/ventilator
interface

17. Airway Pressure Alarm

18. Non-Invasive Ventilation (NIV)
• A new capability with the Standard 2 is NIV. The two NIV modes are CPAP
and BiPaP which can provide ventilator support and potentially avoid
intubation in a subset of our patients
• CPAP mode is a means of providing continuous pressure without the use of
a BVM and PEEP valve. This can be helpful for CHF patients and is described
in the SJA CPG’s
• BiPAP provides both continuous pressure support as well as inspiratory
pressure. This can be helpful for selected patients including those with CHF,
CORD/Asthma Patients and Neuromuscular disorders
• NIV may also be useful as means of pre-oxygenation prior to RSI in a subset
of patients

19. Successful use of NIV is highly dependent on…
1) Patient Selection
2) Consideration of Contraindications
3) Proper Mask-Fitting
4) Continuous Monitoring and Patient Re-
Assessment
5) Being Prepared to Intubate if Necessary

20. Non-Invasive Ventilation