IntelliVent ASV En

INTELLiVENT-ASV

Operators Manual

624470/00

Software version

2.2X

0 1 9 7

624470/00

www.hamilton-medical.com [email protected]/00 iii 2012 HAMILTON MEDICAL AG. All rights reserved. Printed in Switzerland. No part of this publication may be reproduced or stored in a database or retrieval system, nor transmitted, in any form or by any means, electronic, mechanical, by photocopy-ing, recording, or otherwise, without the prior written permis-sion of HAMILTON MEDICAL.

Definitions

WARNING

Alerts the user to the possibility of injury, death, or other serious adverse reactions associated with the use or misuse of the device.

CAUTION

Alerts the user to the possibility of a problem with the device associated with its use or misuse, such as device malfunction, device failure, damage to the device, or damage to other property.

NOTE:Emphasizes information of particular importance.

Manufacturer Distributor in USA

HAMILTON MEDICAL AGVia Crusch 8CH-7402 BonaduzSwitzerlandPhone: (+41) 81 660 60 10Fax: (+41) 81 660 60 [email protected]

HAMILTON MEDICAL, Inc.4990 Energy WayP.O. Box 30008Reno, NV 89520, USAPhone: (775) 858-3200Toll-free: (800) 426-6331Fax: (775) 856-5621

iv 624470/00

1.4.3 INTELLiVENT-ASV trend . . . . . . . . . . . . . . . . . . . 1-491.4.4 Graphical INTELLiVENT-ASV indicators . . . . . . . . 1-51624470/00 vTable of Contents

1 INTELLiVENT-ASV . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

1.1.1 Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-31.1.2 Ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-41.1.3 Oxygenation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-41.1.4 Quick Wean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

1.2 Indications for use and contraindications . . . . . . . . . . . . . 1-61.2.1 Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . 1-61.2.2 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . 1-6

1.3 INTELLiVENT-ASV in clinical use . . . . . . . . . . . . . . . . . . . . 1-71.3.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-71.3.2 Step 1: Before connecting the patient to

INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . . . . . 1-81.3.3 Step 2: Preparing the ventilator for

INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . . . . . 1-91.3.4 Step 3: Determining patient profile for

INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . . . . . 1-91.3.5 Step 4: The INTELLiVENT window: Selecting

ventilation and oxygenation management . . . . . 1-101.3.5.1 Patient Conditions . . . . . . . . . . . . . . 1-121.3.5.2 Normal patient: No condition is

selected . . . . . . . . . . . . . . . . . . . . . . 1-141.3.5.3 ARDS patient . . . . . . . . . . . . . . . . . . 1-161.3.5.4 Chronic Hypercapnia patient . . . . . . 1-171.3.5.5 Patient with chronic hypercapnia and

ARDS (mixed condition) . . . . . . . . . . 1-191.3.5.6 Patients with brain injury . . . . . . . . . 1-201.3.5.7 Quick weaning . . . . . . . . . . . . . . . . . 1-231.3.5.8 Recruitment management . . . . . . . . 1-241.3.5.9 PEEP limit from HLI index . . . . . . . . . 1-25

1.3.6 Step 5: Alarm Settings . . . . . . . . . . . . . . . . . . . . 1-271.4 Monitoring INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . 1-36

1.4.1 INTELLiVENT-ASV symbols . . . . . . . . . . . . . . . . . 1-361.4.2 Horizon, Map, Guide . . . . . . . . . . . . . . . . . . . . . 1-43

Table of Contents1.5 Management of %MinVol . . . . . . . . . . . . . . . . . . . . . . .1-521.5.1 Management of %MinVol (passive patient). . . . .1-531.5.2 Management of %MinVol (active patient). . . . . .1-56

1.6 Management of PEEP and Oxygen . . . . . . . . . . . . . . . . .1-621.6.1 Management of PEEP/Oxygen for passive and

active patients. . . . . . . . . . . . . . . . . . . . . . . . . . .1-651.6.2 Emergency increase of oxygen . . . . . . . . . . . . . .1-721.6.3 Patient condition rules (during ventilation) . . . . .1-72

1.7 Assessing results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-741.8 Open loop: Manual management of

ventilation and oxygenation1-751.9 Heart-Lung Interaction . . . . . . . . . . . . . . . . . . . . . . . . . .1-771.10 Remarks: Sensor failure, standby, calibration . . . . . . . . . .1-79

1.10.1 Ventilation management. . . . . . . . . . . . . . . . . . .1-791.10.1.1 PetCO2 is not available . . . . . . . . . . .1-801.10.1.2 Disconnection or flow sensor failure

resolved in 5 minutes or less . . . . . . .1-801.10.1.3 Disconnection or flow sensor failure

resolved in more than 5 minutes . . . .1-811.10.1.4 Standby . . . . . . . . . . . . . . . . . . . . . . .1-81

1.10.2 Oxygenation management . . . . . . . . . . . . . . . . .1-811.11 Technical data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-831.12 Data logging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-881.13 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-90

2 Quick Wean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3

2.1.1 Quick Wean modes. . . . . . . . . . . . . . . . . . . . . . . .2-42.2 Quick Wean in clinical use. . . . . . . . . . . . . . . . . . . . . . . . .2-7

2.2.1 Quick Wean workflow . . . . . . . . . . . . . . . . . . . . .2-72.2.2 Key terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-112.2.3 About the Quick Wean parameters . . . . . . . . . . .2-122.2.4 Indications of use . . . . . . . . . . . . . . . . . . . . . . . .2-14

2.3 Enabling/Disabling Quick Wean and automated SBTs . . .2-142.3.1 Enabling/Disabling Quick Wean. . . . . . . . . . . . . .2-142.3.2 Enabling/Disabling automated SBTs. . . . . . . . . . .2-17vi 624470/00

2.4 Conditions for starting weaning activities . . . . . . . . . . . . 2-182.4.1 About %MinVol calculations . . . . . . . . . . . . . . . 2-192.4.2 Parameters monitored to determine weaning

readiness (To start group) . . . . . . . . . . . . . . . . . 2-202.4.3 User-modifiable parameters: SBT Controls

window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-232.4.3.1 Changing Quick Wean settings . . . . . 2-26

2.4.4 Quick Wean Vent Status window. . . . . . . . . . . . 2-262.4.5 Quick Wean window (view 4) . . . . . . . . . . . . . . 2-30

2.4.5.1 Displaying the Quick Wean window (view 4) . . . . . . . . . . . . . . . . . . . . . . 2-31

2.5 Conducting an SBT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-322.5.1 Monitoring pulse and breath rate increases . . . . 2-342.5.2 Monitoring PetCO2 increases . . . . . . . . . . . . . . . 2-36

2.6 Conditions for aborting an SBT . . . . . . . . . . . . . . . . . . . 2-362.7 Conditions for successfully completing an SBT . . . . . . . . 2-392.8 About Quick Wean alarms and messages . . . . . . . . . . . . 2-392.9 Configuring Quick Wean . . . . . . . . . . . . . . . . . . . . . . . . 2-41

2.9.1 Changing the SBT Controls window default settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-44

2.9.2 Restoring factory default configuration settings 2-452.10 Quick Wean parameters. . . . . . . . . . . . . . . . . . . . . . . . . 2-462.11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-55

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . .Glossary-1

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1624470/00 vii

Table of Contentsviii 624470/00

patient) 1-56624470/00 1-11 INTELLiVENT-ASV1.1 Introduction 1-3

1.1.1 Intended Use 1-3

1.1.2 Ventilation 1-4

1.1.3 Oxygenation 1-4

1.1.4 Quick Wean 1-5

1.2 Indications for use and contraindications 1-6

1.2.1 Indications for Use 1-6

1.2.2 Contraindications 1-6

1.3 INTELLiVENT-ASV in clinical use 1-7

1.3.1 Introduction 1-7

1.3.2 Step 1: Before connecting the patient to INTELLiVENT-ASV 1-8

1.3.3 Step 2: Preparing the ventilator for INTELLiVENT-ASV 1-9

1.3.4 Step 3: Determining patient profile for INTELLiVENT-ASV 1-9

1.3.5 Step 4: The INTELLiVENT window: Selecting ventilation and oxygenation management 1-10

1.3.6 Step 5: Alarm Settings 1-27

1.4 Monitoring INTELLiVENT-ASV 1-36

1.4.1 INTELLiVENT-ASV symbols 1-36

1.4.2 Horizon, Map, Guide 1-43

1.4.3 INTELLiVENT-ASV trend 1-49

1.4.4 Graphical INTELLiVENT-ASV indicators 1-51

1.5 Management of %MinVol 1-52

1.5.1 Management of %MinVol (passive patient) 1-53

1.5.2 Management of %MinVol (active

1 INTELLiVENT-ASV1.6 Management of PEEP and Oxygen 1-62

1.6.1 Management of PEEP/Oxygen for passive and active patients 1-65

1.6.2 Emergency increase of oxygen 1-72

1.6.3 Patient condition rules (during ventilation) 1-72

1.7 Assessing results 1-74

1.8 Open loop: Manual management of ventilation and oxygenation 1-75

1.9 Heart-Lung Interaction 1-77

1.10 Remarks: Sensor failure, standby, calibration 1-79

1.10.1 Ventilation management 1-79

1.10.2 Oxygenation management 1-81

1.11 Technical data 1-83

1.12 Data logging 1-88

1.13 References 1-901-2 624470/00

1.1 Introduction

INTELLiVENT-ASV offers the operator fully automatic manage-ment of ventilation and oxygenation based on physiologic input from the patient. The following paragraphs give a short overview of the automatic management of ventilation and oxy-genation provided by INTELLiVENT-ASV.

Additional sections provide a detailed step-by-step description how to start INTELLiVENT-ASV by selecting the patient profile and various patient conditions to a description of how INTEL-LiVENT-ASV works.

1.1.1 Intended UseINTELLiVENT-ASV is intended for use with all current and future mechanical ventilators from HAMILTON MEDICAL AG (except MR-related equipment).

INTELLiVENT-ASV provides fully automated closed-loop ventila-tion and oxygenation based on physiologic input from the patient. It provides continuous dynamic monitoring and control of the patient's ventilation needs based on specified clinician targets and changing patient conditions. INTELLiVENT-ASV continuously monitors patient conditions, and automatically adjusts ventilation and oxygenation parameters to keep the patient within target ranges, with minimal clinician interaction, from intubation until extubation.

INTELLiVENT-ASV also provides tools to promote early weaning as part of the closed-loop control.

The use of INTELLiVENT-ASV is designed for use with all adults, and pediatric patients from 7 kg; it is not available for neonatal applications. INTELLiVENT-ASV can be used in the hospital and during primary and secondary transport. INTELLiVENT-ASV can-not be used in an MRI environment, as the required sensors are not currently available without metal components. 624470/00 1-3

1 INTELLiVENT-ASV1.1.2 Ventilation %MinVol management operates in two modes, automatic

and manual. For manual %MinVol management, see Sec-tion 1.8. The %MinVol management automatically sets the minute volume (%MinVol) depending on either of the fol-lowing:

The measured end-tidal CO2 partial pressure (PetCO2), if the patient is passive

The difference between targeted and actual respiratory rate, if the patient is active and PetCO2 is on or below the target range

The target PetCO2 that is set depends on:

The patients treatment level (Peak inspiratory pressure)

The pathology and treatment profile of the patient entered by the operator the user has the possibility to select ARDS, chronic hypercapnia and brain injury

The PetCO2 target shift set by the user

Whether weaning is to be promoted (user setting)

The optimal rate is defined by the Otis equation as it is in ASV. For details, see the ASV appendix in the device Opera-tors Manual.

1.1.3 Oxygenation The PEEP/Oxygen management operates in two modes,

automatic and manual. The automatic PEEP/Oxygen man-agement sets the oxygen and PEEP values according to the

Measured O2 saturation (SpO2)

Haemodynamic state of the patient

Various patient conditions

For details, see Section 1.3.5.1.

The patients conditions and the applied PEEP determine the expected SpO2 range for the patient.1-4 624470/00

The optimal relationship between PEEP and oxygen used during automatic PEEP/oxygen management is based on the ARDSnet guidance when increasing the therapy, and the OPEN lung concept when decreasing the treatment. See Section 1.13.

In manual mode, the operator keeps the SpO2 in the target range by adjustments of the PEEP or the oxygen, or both, based on the HLI and SpO2 monitoring values and on clinical practice.

NOTE:If PEEP/CPAP control is automated, the PEEP high and low limit control is activated. When activated, the Oxy-genation maps show two red dotted lines, one showing the upper PEEP limit and one showing the lower. If auto-mated control is not active, only the upper PEEP limit line is displayed.

Note that a mix of Oxygenation map images are used in this manual, some showing both lines, some showing only the upper limit. For details on PEEP limits, see Sec-tion 1.3.5.9.

1.1.4 Quick WeanQuick Wean is integrated into INTELLiVENT-ASV, and when activated, provides closed-loop, continuous dynamic moni-toring and control of patient conditions to initiate spontaneous breathing trials (SBT). It is used to evaluate patients muscle strength and breathing performance, thereby helping you gauge the potential for extubation.

For details, refer to the Quick Wean chapter.624470/00 1-5

1 INTELLiVENT-ASV1.2 Indications for use and contraindications

1.2.1 Indications for Use

NOTE:

Use the INTELLiVENT-ASV (or fully closed-loop con-trol) for adult and pediatric patients only.

Use INTELLiVENT-ASV for intubated patients.

Be sure you are familiar with the installation and con-figuration of the CO2 and SPO2 sensors. Review the associated information in the device Operators Manual.

1.2.2 Contraindications

WARNING

Do not use INTELLiVENT-ASV if

The patient weight is under 7 kg

There is a high leakage

The INTELLiVENT-ASV target ranges for PetCO2 and SpO2 cannot be set according to the hospi-tal protocol or to the patients condition

Heliox gas is not compatible with INTELLiVENT-ASV.

Do not use the INTELLiVENT-ASV automatic PEEP/oxygen adjustment if a high carboxyhae-moglobin or methaemoglobin value is expected or clearly evidenced, or if the difference bet-ween SaO2 and SpO2 is greater than 5%.1-6 624470/00

1.3 INTELLiVENT-ASV in clinical use

1.3.1 Introduction

WARNING

Additional ventilator-independent patient monitoring (for example, bedside vital moni-toring or a blood gas analyzer (BGA)) must be used during INTELLiVENT-ASV ventilation. Check PaCO2 against displayed PetCO2, and SaO2 against SpO2.

The %MinVol and PEEP/Oxygenation adjust-ment is a completely automatic application on patients.

The physician is responsible for final decisions.

INTELLiVENT-ASV is a fully closed-loop solution for patients oxygenation and ventilation. ASV serves as the basic ventilation mode to complete a fully closed-loop solution. In combination, INTELLiVENT-ASV addresses all applications from intubation through extubation with simplicity for early weaning.

The figures shown below present the ASV concept and the INTELLiVENT-ASV concept.

Figure 1-1. ASV Concept in clinical use624470/00 1-7

1 INTELLiVENT-ASVFigure 1-2. INTELLiVENT-ASV concept in clinical use

Figures 1-1 and 1-2 show that INTELLiVENT-ASV is built on the ASV concept, where the operator sets a %MinVol and the ASV management implements it by adjusting the Vt, RR and the Ti. For details, see the ASV appendix in the device Operators Man-ual.

1.3.2 Step 1: Before connecting the patient to INTELLiVENT-ASV Prepare the device for clinical use.

Important: Familiarize yourself with the procedures con-tained in the Preparing for ventilation chapter of the venti-lator Operators Manual. This includes, but is not limited to, performing the pre-operational procedures and testing where required.1-8 624470/00

1.3.3 Step 2: Preparing the ventilator for INTEL-LiVENT-ASV Prepare the device with a mainstream CO2 sensor and one

or two SpO2 sensors.

For details, refer to the chapters, Preparing the ventilator and Pulse oximetry in the device Operators Manual.

1.3.4 Step 3: Determining patient profile for INTELLiVENT-ASV

WARNING

To prevent possible hyper- or hypo-ventilation, ensure the correct patient profile is selected.

Entering a substantially wrong height/IBW input will lead to a deviation of rate setting and %MinVol start values.

Important: In this step, the term patient profile is separate from the term patient condition/s used in other parts of this manual. In this use, patient profile refers only to gender, height (IBW), adult or pediatric selections.

To specify the profile and patient settings:

1. Configure the patient profile.

2. Touch the appropriate adult, pediatric, gender and height (IBW) buttons.

3. Touch the INTELLiVENT tab to open the INTELLiVENT win-dow.624470/00 1-9

1 INTELLiVENT-ASVFigure 1-3. Startup screen initial patient profile

1.3.5 Step 4: The INTELLiVENT window: Selecting ventilation and oxygenation management

NOTE:During ventilation, INTELLiVENT-ASV is available from every mode by touching the INTELLiVENT tab.

1. Select whether the management of %MinVol, PEEP/CPAP and Oxygen should be automatic or manual.

2. Select the patient condition. See Section 1.3.5.1 for more information on the patient conditions and their effects.

3. Select whether to enable Quick Wean, any auto recruit-ment options and the PEEP limit control. For details, see the Quick Wean chapter, as well as Sections 1.3.5.8 and 1.3.5.9.

4. Touch Continue. The Alarms window automatically opens. For details, see Step 5: Alarm Settings. 1-10 624470/00

The Continue button and the Alarms window only appear at start up, or after a mode change. Coming from the ASV mode, the Controls window appears. See Figure 1-4.

Figure 1-4. INTELLiVENT window1 Open/close for supporting Ventilation Map window

2 Touch INTELLiVENT tab to close3 Selection of automatic/manual management of %MinVol,

PEEP/CPAP and oxygen

4 Patient conditions

5 Enable/disable Quick Wean

6 PEEP limit control (upper and lower limits)624470/00 1-11

1 INTELLiVENT-ASV7 Target shift Use the Target Shift function to shift the CO2 target range for CO2 elimination (in accordance with the PaCO2 value from the blood gas analysis) and shift the SpO2 target ranges (in accordance with the SaO2 value from the blood gas analysis) for oxygenation)

8 Open or close for Quick Wean control window

9 Automatic recruitment

1.3.5.1 Patient Conditions

The examples provided in this section are of a single patient condition and include the consequences for ventilation and oxygenation at the very start of ventilation.

The starting Pasv limit, maximal allowed inspiratory pressure level = PEEP+Pinsp (Pressure high limit = P ASV limit + 10mmHg), is set depending on the patient conditions. The PEEP/Oxygen automatic adjustment has boundaries during ventilation, controlled by the patient conditions and HLI. Note that you can set the PEEP high and low limits when it is auto-matically controlled.

The following table gives you an overview of the rules and settings for startup and during ventilation.1-12 624470/00

Effe

ct

Pati

ent

Co

nd

itio

n

Ven

tila

tio

nO

xyg

enat

ion

Wea

nin

g

(Def

ault

)R

ecru

it-

men

t (D

efau

lt)

PEEP

Li

mit

a-ti

on

s b

yH

LI(D

efau

lt)

Star

tup

V

alu

e %

Min

Vo

l [%

]

Acc

epta

ble

R

ang

e Sp

on

-ta

neo

us

Bre

ath

d=

%M

inV

ol/

K

P A

SV

Lim

itO

2 St

artu

p

Val

ue

[%]

PEEP

St

artu

p

Val

ue

[mb

ar]

No

rmal

100

K =

10

30A

uto-

mat

ic 6

0A

uto-

mat

ic 5

Dis

able

dD

isab

led

Dis

able

d

AR

DS

120

K =

10

35A

uto-

mat

ic 1

00A

uto-

mat

ic 5

Dis

able

dD

isab

led

Dis

able

d

Ch

ron

ic

Hyp

erca

pn

ia90

K =

10

25A

uto-

mat

ic 4

0M

anua

lD

isab

led

Dis

able

dD

isab

led

AR

DS+

Ch

ron

ic

Hyp

erca

pn

ia11

0K

= 1

030

Aut

o-m

atic

80

Man

ual

Dis

able

dD

isab

led

Dis

able

d

Bra

in In

jury

No

Effe

ct(s

ee n

ote

1)K

= 1

5se

e no

te 2

Aut

o-m

atic

60

Man

ual

Dis

able

dD

isab

led

Dis

able

d

Wea

nin

g--

-d=

1,5

x (%

Min

Vol/K

)--

---

---

---

---

---

-

Not

e 1:

The

Sta

rtup

val

ue is

tak

en f

rom

the

pat

ient

s co

nditi

on (N

orm

, ARD

S, C

OPD

and

so

on).

Not

e 2:

Br

ain

Inju

ry o

nly:

28

+

Chr

onic

Hyp

erca

pnia

: 25

+

ARD

S: 3

0

+ M

ixed

: 28

Not

e 3:

PEE

P ad

just

men

t ra

nge

0-5

cmH

2O624470/00 1-13

1 INTELLiVENT-ASVThe figures in the following sections display the rules and set-tings for startup and during ventilation in detail.

The Pasv limit should be adjusted by the operator before the start of ventilation. When a change in patient conditions occurs, Plimit is changed to the new patient conditions and the operator is notified by a text message.

1.3.5.2 Normal patient: No condition is selected

Ventilation:

The startup value for the %MinVol is 100%

For a spontaneously breathing patient, the acceptable range of the spontaneous breathing rate is d=%MinVol/10

The startup value for Pasv limit is 30 cmH2O (if previ-ously ventilated with ASV, the settings are not be changed)

Figure 1-5 shows the range of acceptable PetCO2 values.

Figure 1-5. Acceptable PetCO2 Range Normal Patient

Oxygenation:

The startup value for PEEP is 5 cmH2O

The startup value for oxygen is 60%

Figure 1-6 shows the range of acceptable values.1-14 624470/00

Figure 1-6. Acceptable SpO2 Ranges Normal Patient (the PEEP limit in the figures is an example and is the

default PEEP limit)

Figure 1-7. Acceptable SpO2 Ranges Normal Patient (upper and lower PEEP limits enabled)

Recruitment maneuvers, weaning strategy, and HLI are deacti-vated by default.624470/00 1-15

1 INTELLiVENT-ASV1.3.5.3 ARDS patient

WARNING

Set Chronic Hypercapnia and ARDS only if the patient is suffering from one of these conditions. If in doubt, leave unchecked.

Acute Respiratory Distress Syndrome (ARDS) presents as an acute, severe injury to most segments of the lung.

Ventilation:



The startup value for Pasv limit is 35 cmH2O


Figure 1-8. Acceptable PetCO2 Range ARDS Patient

Oxygenation:



Figure 1-9 shows the range of acceptable values.1-16 624470/00

Figure 1-9. Acceptable SpO2 Ranges ARDS (the PEEP limit in the figures is an example and is the default PEEP

limit)

Recruitment maneuvers, weaning strategy, and HLI are deactivated by default.

1.3.5.4 Chronic Hypercapnia patient

The term chronic hypercapnia describes a patient with chroni-cally high arterial CO2 values, usually as a result of obstruction in airways due to chronic bronchitis, emphysema, or both.

Ventilation:

The startup value for %MinVol is 90%



Figure 1-10 shows the range of acceptable PetCO2 values.624470/00 1-17

1 INTELLiVENT-ASVFigure 1-10. Acceptable PetCO2 Range Chronic Hypercapnia Patient

Oxygenation:

No startup value for PEEP since PEEP must be set manually


Figure 1-11 shows the range of acceptable values.

Figure 1-11. Acceptable SpO2 Ranges Chronic Hypercap-nia (the PEEP limit in the figures is an example and corre-

sponds to the default PEEP limit)1-18 624470/00

Recruitment maneuvers are inactive. Weaning strategy is dis-abled by default. PEEP limitation by the HLI is not activated by default as PEEP has to be set manually.

1.3.5.5 Patient with chronic hypercapnia and ARDS (mixed condition)

Ventilation:





Figure 1-12. Acceptable PetCO2 Range Mixed Chronic Hypercapnia/ARDS

Oxygenation:



Figure 1-13 shows the range of acceptable values.624470/00 1-19

1 INTELLiVENT-ASVFigure 1-13. Acceptable SpO2 Ranges Mixed Chronic Hypercapnia/ARDS (the PEEP limit in the figure is an example and corresponds to the default PEEP limit)

Recruitment maneuvers are inactive. Weaning strategy and PEEP limitation by the HLI are disabled by default.

1.3.5.6 Patients with brain injury

WARNING

Always set brain injury if you are sure that the patient has this condition. If the patient suffers from a brain injury but brain injury is not set, increased CO2 levels and high cranial pressure might result. Carefully monitor intracranial pres-sure when available.

CAUTION

If brain injury is set but the patient should be nor-mally ventilated, the patient will be slightly hyper-ventilated and increased peak pressures might occur.1-20 624470/00

Ventilation:

The startup value for the %MinVol is 100%, or, if com-bined with ARDS/Chronic Hypercapnia, the correspond-ing ARDS/Chronic Hypercapnia value


The startup value for Pasv limit is:

28 cmH2O for brain injury only and for mixed conditions (ARDS and Chronic Hypercapnia) (see Figure 1-14).

30 cmH2O for brain injury combined with ARDS (see Figure 1-15).

25 cmH20 for brain injury combined with Chronic Hypercapnia (see Figure 1-16).

Figure 1-14. Acceptable PetCO2 Range Brain Injury Patient only and mixed conditions

(Pasv limit = 28 cmH2O)624470/00 1-21

1 INTELLiVENT-ASVFigure 1-15. Acceptable PetCO2 Range Brain Injury Patient and ARDS (Pasv limit = 30 cmH2O)

Figure 1-16. Acceptable PetCO2 Range Brain Injury Patient and Chronic Hypercapnia (Pasv limit = 25 cmH2O)1-22 624470/00

Oxygenation:

There is no startup value for PEEP as this is manually set


The range of acceptable values is the range for a normal patient, a patient suffering from chronic hypercapnia or ARDS, or a patient with a mixed condition, depending on the setting.

Recruitment maneuvers are inactive. Weaning strategy is dis-abled by default. PEEP limitation by the HLI is inactive as PEEP has to be set manually.

1.3.5.7 Quick weaning

CAUTION

Check patient condition periodically to assess whether the patient is able to be weaned.

NOTE:If no CO2 signal is available and the patient is breathing actively, %MinVol is controlled via the spontaneous breathing rate.

Quick Wean is integrated into INTELLiVENT-ASV, and when activated, provides closed-loop, continuous dynamic moni-toring and control of patient conditions to evaluate the patients potential readiness for extubation, including the pos-sibility of conducting fully controlled spontaneous breathing trials (SBTs).

For details, see the Quick Wean chapter of this guide. 624470/00 1-23

1 INTELLiVENT-ASV1.3.5.8 Recruitment management

WARNING

Check for pneumothorax before ventilating the patient. Automatic PEEP adjustment can lead to an increase in ventilation pressure levels.

Recruitment is a strategy for re-expanding collapsed lung tis-sue, and then maintaining higher PEEP to prevent subsequent de-recruitment. To recruit collapsed lung tissue, sufficient pressure must be imposed to exceed the critical opening pres-sure of the affected lung.

The operator can select:

Passive Pt: Auto recruitment does not happen when spontaneous breathing is detected

No Recruitment: No auto recruitment is conductedThe automatic recruitment maneuver in INTELLiVENT-ASV con-sists of 20 sec CPAP with a pressure level of 40 cmH2O. The trigger is set to 15 l/min and Pmax is set to 50 cmH2O.

Recruitment maneuvers occur after two consecutive automatic increases of PEEP of 1 cmH2O. This means the recruitment maneuver cycle occurs once every 12 minutes. The operator receives an alarm notification as soon as a recruitment maneuver is performed (see Table 1-2). See the next figure for a graphic description of a recruitment cycle.1-24 624470/00

Figure 1-17. Recruitment maneuver cycle

Important: During the recruitment maneuver, all patient alarms are suppressed and the recruitment maneuver is can-celled if a flow sensor failure or any pneumatic disconnection is detected.

No recruitment maneuver takes place if:

HLI > 15% and HLI is used for PEEP limit

PEEP is manually changed

1.3.5.9 PEEP limit from HLI index

The device assesses the interaction between airway pressure and haemodynamics by analyzing the Pulse Oximeter Plethys-mogram. The Heart-Lung interaction (HLI) index is calculated from the plethysmogram.

The PEEP limit control allows you to define an absolute high limit that the PEEP controller cannot exceed. If enabled, you can also specify an absolute low limit that it cannot fall below, as shown in Table 1-1. The low limit can be set only when CPAP/PEEP control is automated. 624470/00 1-25

1 INTELLiVENT-ASVFigure 1-18. PEEP limit control

If HLI index is activated, it defines an upper limit for the PEEP according to Figure 1-19:

Figure 1-19. PEEP Upper limit graph

Table 1-1. PEEP limit control settings

PEEP Limit Control Range

Defaults Minimum difference between High and Low limit

5 to 25 cmH2O Low limit: 5 cmH2OHigh limit: 25 cmH2O

No less than 2 cmH2O1-26 624470/00

If the HLI value is not available for more than 6 minutes, the PEEP limit set by the user in the INTELLiVENT window is taken as the upper limit on PEEP.

In the case of chronic hypercapnia or brain injury, the operator sets the PEEP manually.

If the operator manually limits the PEEP, the operator can change the default value of 15 cmH2O to between 10 cmH2O and 24 cmH2O.

If both the HLI-defined PEEP limit and operator-defined PEEP limit are used, the PEEP is limited to the lower value.

1.3.6 Step 5: Alarm Settings

WARNING

Set all alarms to clinically acceptable values, especially pressures, ExpMinVol, SpO2 and CO2.

To prevent patient injury, review all alarm settings periodically.

CAUTION

With the alarm silence button, the physiological CO2 and SpO2 alarm can be suppressed for < 120 seconds.

The alarm setting window appears automatically after confirm-ing the INTELLiVENT-ASV settings on startup, when a new patient is selected, or from a mode other than ASV. The pres-sure limit is 30 cmH2O (alarm limit 40 cmH2O), if using a new patient with INTELLiVENT-ASV. Depending on the selected patient condition, the pressure limit has a specific default value. This can be adjusted in the Alarms window.624470/00 1-27

1 INTELLiVENT-ASVFigure 1-20. Alarm Settings (on startup)

1. Make alarm selections according to patient conditions, weaning strategy, recruitment strategy and PEEP limitation.

2. When selections are complete, touch the Confirm button to set the alarm.

Touch Cancel and the Standby window appears again.Note the following about special INTELLiVENT-ASV alarms:

PetCO2 (low and high): Low and high monitored PetCO2. If either limit is reached, a medium-priority alarm sounds.

Range:Low: OFF, 0 to 99 mmHg/0 to 13.2 kPaHigh: OFF, 1 to 100 mmHg/1 to 13.3 kPa

SpO2 (low and high): Low and high monitored SpO2. If either limit is reached, a medium-priority alarm is sounded. If the SpO2 falls below 85% of the set alarm limit, a high-priority alarm is generated.

Range:Low: OFF, 70 to 99% 1-28 624470/00

HLI (high): High HLI is monitored. If the specified high limit is reached, a medium-priority alarm is generated.

Range:High: OFF, 0 to 40%

Ensure the measurements for O2, SpO2, and CO2 are acti-vated and the corresponding alarms are set correctly.

Table 1-2. Alarm conditions

Alarm Definition Complete these actions

Check INTELLiVENT-ASV PEEP limit setting

HLI 10% andVT/kg 6 ml or (Ppeak exp pressure 10 cmH2O) and PEEP 10 cmH2O

Verify if patient is haemody-namic stable. Alarm is reset when HLI limitation is deacti-vated.

CO2 sensor faulty

Low priority.

CO2 sensor signal indicates a hardware error; or a third-party sensor is installed.

Disconnect the sensor from the CO2 module. Wait 10 seconds, and reconnect. Then recalibrate the sensor. Install a new CO2 sensor, if error persists. Ensure the sensor is a genuine HAMIL-TON MEDICAL sensor.

FiO2 oscilla-tion

Medium priority.

Large up and down changes of FiO2 in a short period of time.

Check patient. Set PEEP and oxygen to manual control.

FiO2 set to 100% due to low satura-tion

Medium priority.

INTELLiVENT-ASV has increased oxygen to 100%.

Observe the patient.Silence the alarm; this also resets the alarm.

High HLI Medium priority.

Measured HLI > alarm limit.

Verify the haemodynamic status of the patient and adjust the alarm limits if needed.

High PetCO2 Medium priority.

PetCO2 > the set alarm limit.

Observe the patient. Verify and adjust the ventilator settings, including alarms.624470/00 1-29

1 INTELLiVENT-ASVLow PetCO2 Medium priority.

PetCO2 < the set alarm limit.

Observe the patient. Verify ven-tilator settings, including alarm settings.

MV oscilla-tion

Medium priority.

Large up and down changes of %MinVol over a short period of time.

Switch %MinVol to manual control.

No haemo-dynamic sta-tus available

Medium priority.

HLI for > 6 minutes invalid, SpO2 measurement ON, and HLI used by the con-troller.

Inspect the pulse oximeter attachment location on the patient. Verify the pulse oxime-ter plethysmogram.

No haemo-dynamic sta-tus available

Low priority.

HLI for > 6 minutes invalid, SpO2 measurement ON, High HLI alarm limits on and HLI not used by the controller.

Inspect the pulse oximeter attachment location on the patient. Verify the pulse oxime-ter plethysmogram.

Oxygenation adjustment OFF (no SpO2)

Medium priority.

PEEP or Oxygen automatic, SpO2 invalid and needed for at least the last 60 sec-onds.

Set PEEP and Oxygen to manual control.

Oxygenation adjustment OFF (no SpO2)

Low priority.

PEEP or Oxygen automatic, SpO2 invalid and needed for at least the last 30 sec-onds.

Set PEEP and Oxygen to manual control.

Oxygenation Controller on Limit

Low priority.

SpO2 too low and PEEP and/or Oxygen cannot be further increased.

Observe patient.Set Oxygen and/or PEEP to manual control or resolve prob-lem.


Alarm Definition Complete these actions1-30 624470/00

%MinVol automation off

Operator Message.

Patient weight is set below 7 kg and %MinVol is in automatic mode.

none

PEEP auto-mation off

Operator Message.

Patient weight is set below 7 kg and PEEP is in auto-matic mode.

none

PEEP manual Operator Message.

Chronic Hypercapnia only (but no ARDS) and/or brain injury selected.

none

PEEP oscilla-tion

Medium priority.

Large up and down changes in PEEP over a short period of time.

Check patient. PEEP set to manual control.

Recruitment in progress

Low priority.

Recruitment maneuver in progress.

Wait. Observe patient.

SpO2: sen-sor error (left slot)

Medium priority.

Hardware problem with sensor adapter.

Replace left sensor adapter.

SpO2: patient dis-connected (left slot)

Medium priority.

Probe is detached from patient or not properly attached to patient.

Probe malfunction.

Check whether left probe is attached properly to patient.

Replace left probe.


Alarm Definition Complete these actions624470/00 1-31

1 INTELLiVENT-ASVSpO2: no sensor (left slot)

Medium priority.

Probe is disconnected from adapter.

Adapter is disconnected from ventilator.

Cable defective.

Connect left probe to adapter.

Connect left sensor adapter to ventilator.

Replace left adapter and/or left probe.

SpO2: light interference (left slot)

Medium priority.

Light interference in sensor probe

Cover left probe with blanket or change attachment site on patient.

Replace left probe.

SpO2: poor signal (left slot)

Medium priority.

Pulse from left SpO2 sensor not found

Verify left probe attachment, check if left probe site is prop-erly perfused.

SpO2 left sensor adapter faulty

Operator Message.

Hardware problem with left sensor adapter. Second SpO2 sensor still working normally.

Replace left sensor adapter.

SpO2 left sensor dis-connected

Operator Message.

Left probe is disconnected from adapter. Adapter is disconnected from ventila-tor. Cable defective. Sec-ond SpO2 sensor still working normally.

Connect left probe to adapter. Connect left sensor adapter to the ventilator. Replace left adapter and/or probe.

SpO2 left sensor probe faulty

Operator Message.

Left probe is detached from patient or properly attached to patient. Probe malfunction. Second SpO2 sensor still working nor-mally.

Check left probe is attached properly to patient. Replace left probe.



SpO2 left sensor light interference

Operator Message.

Light interference in left sensor probe. Second SpO2 sensor still working nor-mally.

Cover left probe with blanket or change attachment site on patient. Replace left probe.

SpO2: poor signal (left slot)

Operator Message.

Pulse from left SpO2 sensor not found. Second SpO2 sensor still working nor-mally.

Verify left probe attachment, check if left probe site is prop-erly perfused.

SpO2: sen-sor error (right slot)

Medium priority.

Hardware problem with sensor adapter.

Replace right sensor adapter.

SpO2: patient dis-connected (right slot)

Medium priority.

Probe malfunction. Probe is detached from patient or not properly attached to patient.

Verify if right probe is attached properly to patient.

Replace right probe.

SpO2: no sensor (right slot)

Medium priority.

Probe is disconnected from adapter. Adapter is discon-nected from ventilator. Cable defective.

Connect right probe to adapter.

Connect right sensor adapter to ventilator.

Replace right adapter and/or probe.

SpO2: light interference (right slot)

Medium priority.

Light interference in sensor probe

Cover right probe with blanket or change attachment site on patient.


SpO2: poor signal (right slot)

Medium priority.

Pulse from right SpO2 sen-sor not found.

Verify right probe attachment, check if right probe site is prop-erly perfused



1 INTELLiVENT-ASVSpO2 right sensor adapter faulty

Operator Message.

Hardware problem with right sensor adapter. Sec-ond SpO2 sensor still work-ing normally.

Replace right sensor adapter.

SpO2 right sensor dis-connected

Operator Message.

Right probe is discon-nected from adapter. Adapter is disconnected from ventilator. Cable defective. Second SpO2 sensor still working nor-mally.

Connect right probe to adapter. Connect right sensor adapter to the ventilator. Replace right adapter and/or probe.

SpO2 right sensor probe faulty

Operator Message.

Right probe is detached from patient or properly attached to patient. Probe malfunction. Second SpO2 sensor still working nor-mally.

Check whether right probe is attached properly to patient. Replace right probe.

SpO2 right sensor light interference

Operator Message.

Light interference in right sensor probe. Second SpO2 sensor still working nor-mally.

Cover right probe with blanket or change attachment site on patient.


SpO2: poor signal (right slot)

Operator Message.

Pulse from right SpO2 sen-sor not found. Second SpO2 sensor still working normally.

Verify right probe attachment, check if right probe site is prop-erly perfused.

SpO2 too high

Low priority.

Measured SpO2> alarm limit




SpO2 too low

High priority.

Monitored SpO2 is below 88% and alarm limit.


SpO2 too low

Medium priority.

Monitored SpO2 is below alarm limit.


Ventilation adjustment OFF (no PetCO2)

Low priority.

%MinVol automatic and 2. highest value of PetCO2 during last 8 breaths invalid and PetCO2 needed by controller since > 30 seconds and < 60 seconds.

Set %MinVol to manual con-trol, or resolve problem causing CO2 measurement error

Ventilation adjustment OFF (no PetCO2)

Medium priority.

%MinVol automatic and 2. highest value of PetCO2 during last 8 breaths invalid and PetCO2 needed by controller for at least the last 60 seconds.

Set %MinVol to manual control or resolve problem causing CO2 measurement error.

Ventilation Controller on Limit

Low priority.

%MinVol cannot be fur-ther increased.

Observe patient.Set %MinVol to manual control or resolve problem.



1 INTELLiVENT-ASV1.4 Monitoring INTELLiVENT-ASV

1.4.1 INTELLiVENT-ASV symbolsTable 1-3 lists information about single graphical elements and their colors and meanings.1-36 624470/00

Tab

le 1

-3. S

ing

le g

rap

hic

ele

men

ts

INTE

LLiV

ENT-

ASV

Sym

bo

lC

olo

rA

/MD

escr

ipti

on

Act

ion

/Val

ues

Co

mm

ents

---

---

Clo

se s

ymbo

lC

lose

s w

indo

ws

Use

d w

hen

chan

ging

IN

TELL

iVEN

T-A

SV.

du

ring

vent

ilatio

n

to

clos

e th

e IN

TELL

iVEN

T w

indo

w t

ouch

the

Close b

utto

n, t

he

chan

ges

are

then

sav

ed

and

put

in e

ffec

t

du

ring

star

tup

the

chan

ges

are

not

save

d (t

he b

utto

n is

equ

al t

o th

e Cancel

but

ton

durin

g th

e st

artu

p)

---

---

Vie

w s

elec

tion

Cha

nges

the

vie

w o

f th

e IN

TELL

iVEN

T w

in-

dow

---

---

CO

2 ad

just

-m

ent

knob

Ope

rato

r can

adj

ust t

he

targ

et v

alue

de

crea

se b

y a

max

. of

15m

mH

g fo

r Pe

tCO

2

in

crea

se b

y a

max

. of

10m

mH

g fo

r Pe

tCO

2 624470/00 1-37

1 INTELLiVENT-ASV---

---

SpO

2 ad

just

-m

ent

knob

Ope

rato

r can

adj

ust t

he

targ

et v

alue

de

crea

se b

y a

max

. of

2% f

orSp

O2

in

crea

se b

y a

max

. of

5% f

orSp

O2

---

---

Free

ze b

utto

nA

ctua

l rea

ding

is f

roze

n

---

---

Vie

w s

elec

tion

Cha

nges

the

vie

w

betw

een

horiz

ons

and

map

s

---

---

INTE

LLiV

ENT-

ASV

Tre

nd d

is-

play

Dis

play

s th

e hi

stor

y of

ve

ntila

tion

and

oxyg

en-

atio

n m

anag

emen

t

See

sect

ion

1.4.

Yello

wA

& M

Patie

nt s

ymbo

lIn

dica

tes

whe

re in

the

ho

rizon

/map

the

pa

tient

isar

rang

ed

Red

(1 b

ar)

A &

MQ

I In

dex

Abs

ent

sens

or v

alue

sC

ontr

olle

r fr

eeze

s an

d an

al

arm

is g

ener

ated

indi

cat-

ing

the

auto

mat

ic m

anag

e-m

ent

is t

urne

d O

FF.

Tab

le 1

-3. S

ing

le g

rap

hic

ele

men

ts

INTE

LLiV

ENT-

ASV

Sym

bo

lC

olo

rA

/MD

escr

ipti

on

Act

ion

/Val

ues

Co

mm

ents1-38 624470/00

Gre

en

(4 b

ars)

A &

MQ

I In

dex

Best

sen

sor

valu

es

Whi

teA

Sens

or v

alue

Dis

play

ed in

whi

te,

PetC

O2

is o

nly

used

as

aba

ckup

val

ue

In t

his

case

the

ven

tilat

ion

man

agem

ent

is b

ased

on

the

fSpo

nt. O

nly

if Pe

tCO

2 ex

ceed

s th

e up

per

limit

the

man

agem

ent j

umps

bac

k to

ad

just

the

%M

inVo

l bas

ed

on t

he P

etC

O2

agai

n.

See

Sect

ion

1.5.

Gho

sted

A/M

Sens

or v

alue

ab

sent

No

spon

t br

eath

Whi

teA

Sens

or v

alue

Spon

t br

eath

det

ecte

d by

the

flo

w s

enso

r an

d us

ed a

s ph

ysio

logi

c in

put

Red

AC

ritic

al S

pO2

valu

eSp

O2

is b

elow

88%

A

ND

the

set

ala

rm li

mit

See

Tabl

e 1-

2.

Tab

le 1

-3. S

ing

le g

rap

hic

ele

men

ts

INTE

LLiV

ENT-

ASV

Sym

bo

lC

olo

rA

/MD

escr

ipti

on

Act

ion

/Val

ues

Co

mm

ents624470/00 1-39

1 INTELLiVENT-ASVWhi

teA

/MSe

nsor

val

ue

abse

ntN

o se

nsor

val

ue c

an b

e de

tect

ed

low

QI

di

scon

nect

ion

Red

A/M

Mon

itorin

g va

lue

abse

ntN

o H

LI v

alue

ava

ilabl

e

Whi

teA

Trea

tmen

t va

lue

Whi

teA

Trea

tmen

t va

lue

Whi

teA

Incr

ease

arr

owIn

dica

tes t

hat t

reat

men

t ha

s to

be

incr

ease

dN

o ar

row

if p

atie

nt is

in

targ

etzo

ne

Whi

teA

Dec

reas

e ar

row

Indi

cate

d th

at t

reat

-m

ent

has

to b

e de

crea

sed

No

arro

w if

pat

ient

is in

ta

rget

zone

Tab

le 1

-3. S

ing

le g

rap

hic

ele

men

ts

INTE

LLiV

ENT-

ASV

Sym

bo

lC

olo

rA

/MD

escr

ipti

on

Act

ion

/Val

ues

Co

mm

ents1-40 624470/00

---

ATi

me

to in

crea

seC

ount

s do

wn

the

time

toin

crea

se

---

ATi

me

to

decr

ease

Cou

nts

dow

n th

e tim

e to

dec

reas

e

Solid

blu

e ci

rcle

MM

anua

l m

anag

emen

tIn

dica

tes

that

the

ope

r-at

or h

as t

o m

anag

e th

e ve

ntila

tion

Up

Rota

t-in

g C

ircle

AA

utom

atic

m

anag

emen

tIn

dica

tes

that

INTE

L-Li

VEN

T-A

SV is

man

ag-

ing

the

patie

nt a

nd is

in

crea

sing

the

tre

at-

men

t or

tre

atm

ent

has

been

incr

ease

d.

If th

e ro

tatin

g ci

rcle

s %

Min

Vol,

PEEP

or

Oxy

gen

are

sele

cted

, the

INTE

L-Li

VEN

T ta

b op

ens.

Tab

le 1

-3. S

ing

le g

rap

hic

ele

men

ts

INTE

LLiV

ENT-

ASV

Sym

bo

lC

olo

rA

/MD

escr

ipti

on

Act

ion

/Val

ues

Co

mm

ents624470/00 1-41

1 INTELLiVENT-ASVDow

n Ro

tatin

g C

ircle

AA

utom

atic

m

anag

emen

tIn

dica

tes

that

INTE

LLi-

VEN

T-A

SV is

man

agin

g th

e pa

tient

and

is

decr

easi

ng t

he t

reat

-m

ent

or t

reat

men

t ha

s be

en d

ecre

ased

.

If th

e ro

tatin

g ci

rcle

s %

Min

Vol,

PEEP

or

Oxy

gen

are

sele

cted

, the

INTE

LLi-

VEN

T ta

b op

ens.

Solid

red

ci

rcle

AN

o au

tom

atic

m

anag

emen

t

Froz

en s

tate

Indi

cate

s th

at n

o se

nsor

va

lue

is p

rese

nt

QI

Se

nsor

dis

conn

ecte

d

Whi

teRe

crui

tmen

t sy

mbo

lIn

dica

tes

that

a r

ecru

it-m

ent

man

euve

r w

ill b

e pe

rfor

med

aft

er t

he

next

PEE

P in

crea

se.

Cou

nts

dow

n th

e tim

e to

man

euve

r.

No

sym

bol i

f re

crui

tmen

t is

di

sabl

ed o

r if n

o re

crui

tmen

t is

perf

orm

ed.

Whi

teA

Recr

uitm

ent

in

prog

ress

Mes

sage

dis

play

ed, a

nd

coun

t-do

wn

timer

indi

-ca

ting

dura

tion

of

man

euve

r

Loca

ted

clos

e to

the

PEE

P/C

PAP

cont

rolle

r

Tab

le 1

-3. S

ing

le g

rap

hic

ele

men

ts

INTE

LLiV

ENT-

ASV

Sym

bo

lC

olo

rA

/MD

escr

ipti

on

Act

ion

/Val

ues

Co

mm

ents1-42 624470/00

1.4.2 Horizon, Map, GuideMonitor the %MinVol and PEEP/Oxygen management using the Ventilation/Oxygenation Horizon, Ventilation/Oxygenation Map and Ventilation/Oxygenation Guide windows, which pro-vide detailed information on CO2 elimination and oxygenation.

The Ventilation/Oxygenation Horizon panels display the physio-logical input (PETCO2, SPO2). In addition, a capnogram and pulse oximetry are displayed as waveforms in the Ventilation/Oxygenation Horizon panel. The Ventilation Horizon displays the patients spontaneous breathing rates in a second horizon-tal panel.

The Ventilation/Oxygenation Guide describes all ventilation and oxygenation management actions in automatic mode. Infor-mation is displayed during manual ventilation control (that is, how the automation would act as if it was active).

To access these panels, click the View navigation buttons in the top right of the screen.

Figure 1-21. Ventilation Horizon (active patient)

1 Ventilation Horizon window

2 Floater

3 Ventilation Horizon

4 Spont target range624470/00 1-43

1 INTELLiVENT-ASV5 Capnogram

6 Spont value

7 PetCO2 value

8 Quality indicator

Figure 1-22. Ventilation Horizon (passive patient)

1 Patient symbol

2 Ventilation Horizon window

3 Ventilation Horizon

4 Increase zone

5 Target zone

6 Decrease zone

7 Capnogram

8 PetCO2 value

9 Quality indicator1-44 624470/00

Figure 1-23. Oxygenation Horizon

1 Oxygenation Horizon window

2 Target zone

3 Increase zone

4 Patient symbol

5 Decrease zone

6 Plethysmogram

7 Perfusion index (PI) value (only with Masimo pulse oximeter)

8 SpO2 value

9 Quality indicator624470/00 1-45

1 INTELLiVENT-ASVFigure 1-24. Ventilation Map

1 Patient symbol

2 Ventilation Map

3 Ventilation Map window

4 Spont status

5 Indicator decrease

6 Target line

7 Increasing zone

8 Target zone

9 Decreasing zone

10 Pasv limit

11 Pressure high (alarm) limit1-46 624470/00

Figure 1-25. Oxygenation map

1 Patient symbol

2 Oxygenation Map

3 Oxygenation Map window

4 Tabs

5 Indicator decrease

6 Increasing zone

7 Target zone

8 Decreasing zone

9 Indicator increase

10 Emergency zone

The maps display detailed information on the automatic management of the ventilation and oxygenation. Oxygenation management is represented by two different maps, PEEP/SpO2, and PEEP/O2.624470/00 1-47

1 INTELLiVENT-ASVFigure 1-26. Oxygenation map (Open lung concept)

1 Patient symbol

2 Oxygenation Map


4 Decreasing target path

5 PEEP limit

6 Increasing target path

Figure 1-27. Oxygenation map (ARDSnet)1-48 624470/00

1 Patient symbol

2 Oxygenation Map


4 Increasing target path

5 PEEP limit

6 Decreasing target path

1.4.3 INTELLiVENT-ASV trendTo display and review how the automatic management of %MinVol and PEEP/Oxygen performed during the previous 1 hr, 3 hrs, 12 hrs, 24 hrs, or 96 hrs trend, touch the Trend but-ton on the right side of the INTELLiVENT-ASV graphs.

The INTELLiVENT-ASV trend only works in the maps. The trend is available in either automatic or manual management. See a description of the trend in Figure 1-28 and Figure 1-29.

Figure 1-28. Trend CO2

1 Patient symbol plus, small values (yellow) indication of patients actual location and actual sensor values

2 %MinVol at a certain time

3 Trend button (accessible only in view 2/2)

4 fSpont at a certain time624470/00 1-49

1 INTELLiVENT-ASV5 Past PetCO2 value

6 Past Ppeak value

Figure 1-29. Trend O2

1 Oxygen at a certain time

2 History (patient history regarding SpO2 and PEEP)

3 Patient symbol plus, small values (yellow) indication of patients actual location and actual sensor values at a certain time

4 Scrollable time bar (fine-tune/scroll to specific time previous 24 h)

5 Actual SpO2 value

6 Actual PEEP value

The case above shows a patient having a SpO2 of 94% and a PEEP of 5 cmH2O (indicated by the patient symbol and the small yellow numbers inside the map) in the present. At 11:48, the patient had a SpO2 of 97% a PEEP of 5cmH2O (indicated by the small orange cross and the large white numbers outside the map).1-50 624470/00

1.4.4 Graphical INTELLiVENT-ASV indicatorsFigure 1-30 describes the graphical items that indicate if INTEL-LiVENT-ASV is managing the patient automatically or manually.

Figure 1-30. Graphical INTELLiVENT-ASV Indicators

1 Color difference (light blue) in automatic management

2 Highlighted frame in automatic mode

3 Rotating circle in automatic management (blue)

4 Solid blue circle in manual mode

5 Color difference (dark blue) in manual management624470/00 1-51

1 INTELLiVENT-ASV1.5 Management of %MinVol

WARNING

Inspect CO2 adapters/sensors regularly. Patient secretions in airway adapters might lead to an incorrect PetCO2 reading.

DO NOT use the sidestream CO2 sensor with the automatic management of the %MinVol.

The minute volume adjustment operates based on the dif-ferent concept depending on whether the patient is able to trigger the breath (active), or not (passive).

All ASV safety limits are active:

Prevention of apnea

Prevention of baro- and volutrauma

Prevention of AutoPEEP

Prevention of dead-space ventilation

The limits for %MinVol for the automatic management are shown in Table 1-4. As soon as a limit for the automatic management of %MinVol is reached, an alarm message is displayed (see Table 1-2).

Table 1-4. %MinVol Limits

Minimum MinVol [%] EtCO2 available 70

EtCO2 not available 100

Maximum MinVol [%] EtCO2 available 200

EtCO2 not available 2001-52 624470/00

1.5.1 Management of %MinVol (passive patient)End-tidal CO2 partial pressure (PetCO2), available when the CO2 sensor is connected, is the maximum partial pressure of CO2 exhaled during a tidal breath (just before the start of inspi-ration). This represents the final portion of air that was involved in the exchange of gases in the alveolar area.

Under common clinical conditions, this represents a reliable index of CO2 partial pressure in the arterial blood. It has been shown that under normal conditions, PaCO2 is about 3-5 mmHg higher than PetCO2.

Under special clinical conditions (including massive ventilation/ perfusion problems, shunt) the difference between PetCO2 and PaCO2 might increase. A change in the PaCO2-PetCO2 differ-ence can be taken into account by shifting the range of accept-able PetCO2 values in the INTELLiVENT window using the Target Shift control. See Section 1.7 for details.

To get the most accurate approximation to PaCO2, the second highest PetCO2 value out of 8 breaths is used. The optimal ranges of PetCO2 depend on the operator-defined patient con-ditions (Section 1.3.5.1), on the PetCO2 Target Shift value set be the user in INTELLiVENT window and on the actual level of ventilator support. Within these ranges, and based on the PetCO2 response from the patient, the %MinVol is adjusted.

When PetCO2 is above the zone of acceptable PetCO2 ranges, the minute ventilation is increased. If the PetCO2 is below the acceptable ranges, the %MinVol is decreased.

Only minor adjustments are made if PetCO2 is in the accept-able ranges to promote early weaning. For details on Quick Wean, see the Quick Wean chapter of this guide.

The absolute limits for %MinVol are 70% (minimum) and 200% (maximum) of the physiological %MinVol value. The minute volume management for passive patients adjusts CO2 according to the following table.624470/00 1-53

1 INTELLiVENT-ASV

PetC

PetC%MiO2 too high (Position on curve is above upper limit) -> %MinVol is increased.

O2 in range (Position on curve is between the limits) -> Automatically maintained nVol is increased. Intention: Decreasing Pinsp1-54 624470/00

PetCOdecre

No PePetCO2 too low (Position on curve is below the lower PetCO2 limit) -> Automatic ase of %MinVol

tCO2 available Controller freezes and the alarm ventilation management off (no 2) appears624470/00 1-55

1 INTELLiVENT-ASV1.5.2 Management of %MinVol (active patient)When a patient is spontaneously triggering the breaths, the ventilator adjusts the target minute ventilation, based on the spontaneous breathing rate of the patient. The spontaneous breathing rate (fSpont) is compared with target rate as defined by ASV rate (calculated using Otis's equation). If the patient complies with RULE 1 and if the patients rate is above the zone of acceptable spont rate (danger of patient fatigue), the %MinVol increases. If the patient complies with RULE 1 and if the patientss rate is below the zone, the %MinVol decreases.

RULE 1 Active Patient: The %MinVol management starts to adjust the %MinVol based on the rate if five consecutive spontaneous breaths occur and the PetCO2 value is inside or below the range.

As the ventilation management is running based on the rate, it checks RULE 2 continuously. If the device does not comply with RULE 2, it will continue to adjust the rate for the %MinVol based on the spontaneous breathing rate of the patient.

RULE 2 Passive Patient: Five consecutive mechanical breaths or the PetCO2 value exceeds the upper limit by at least 3 mmHg.

In this case, the %MinVol is adjusted on the PetCO2 input. These rules are displayed in the following flow chart.

RULE 3 %MinVol is only changed when PetCO2 is avai-lable and the patient had 5 consecutive spontaneous breaths.

When PetCO2 is not available, the red controller freezes.1-56 624470/00

Figure 1-31. Flowchart for rules of management of %MinVol, active patient624470/00 1-57

1 INTELLiVENT-ASV

RateWhile the patient is active, the patients spontaneous rate is detected by the Flow Sensor, and the PetCO2 value is only used for additional safety on active patients in the background to avoid excessive PetCO2 values.

The lower limit of the range of acceptable spontaneous breath-ing rate is equal to the ASV rate; the upper limit of the range is equal to ASV rate + d.

d=%MinVol/k where k is 15 in brain injured patients, and 10 in all other patients.

If Quick Wean is activated, the range of acceptable PetCO2 is increased by 5 mmHg, and the value 2 is added to the ASV rate to define the low spontaneous breathing rate for the rate con-troller. For setting the high limit, d is multiplied by a factor of 1.5. In addition, the PetCO2 limit is increased by 5 mmHg.

%MinVol management for active patients adjusts %MinVol as shown in the following pages. The rate controller bar is dis-played on the Ventilation Map or Ventilation Horizon window; if no spontaneous breathing is detected, the bar is dimmed.

too high (Position on bar is above upper limit) -> Automatically increases %MinVol1-58 624470/00

Rate

Rate %Minin range (Position on bar is between limits) -> %MinVol is maintained

too low (Position on bar is below the lower limit) -> Automatic decrease of Vol624470/00 1-59

1 INTELLiVENT-ASV

PetClimit)patie

No spto theates aO2 > (3mmHg+PetCO2 limit) -> If PetCO2 is > (+3mmHg than the PetCO2 upper , the ventilation management based on the PetCO2 is started again even if the nt breathes spontaneously

ontaneous rate available -> Controller returns to managing ventilation according PetCO2 input. If CO2 is not available, the controller stops management and gener-n alarm.1-60 624470/00

No PetCO2 available -> Controller freezes.624470/00 1-61

1 INTELLiVENT-ASV1.6 Management of PEEP and Oxygen

WARNING

SpO2 measurement can be incorrect if

the patients carboxyhaemglobin or methaemo-globin increases abnormally

dye is injected into the blood

use of electrosurgical unit

measuring at a site with venous pulse

there is body movement

the pulse wave is small (insufficient peripheral circulation)

In case of anemia and blood loss the SpO2 sen-sor is unable to detect tissue hypoxia.

Skin pigmentation can affect the SpO2 value. Verify SpO2 by checking the plethysmographic wave from and the quality index of the mea-sured SpO2 value.

Attach the pulse oximetry sensor carefully, and check the position periodically. Do not diagnose patients based solely on the data from the pulse oximeter. Overall judgment must be made by a physician who understands the limitations and characteristics of the pulse oximeter, and who can read the biomedical signals acquired by other instruments.

Use disposable probes only once. They cannot be sterilized and can cause cross infection.

If the attachment site is unclean, clean the attachment site before attaching the probe. If there is nail polish on the attachment site, remove the polish. Otherwise, the amount of transmitted light decreases, and measured value can be incorrect or measurement unable to be performed.1-62 624470/00

Normal external light does not affect measure-ment, but strong light such as a surgical light or sunlight can affect measurement. If the measur-ing site is affected, cover it with a blanket.

Make sure that there is no light interference when attaching more than on probe.

Turn off the power of mobile phones, small wireless devices and other devices which pro-duce strong electromagnetic interference around a patient (except for devices allowed by the hospital administrator). Radio waves from devices such as mobile phones or other small wireless equipment.

Keep the patient away from the cable as much as possible. If the cable coils around the patient by their body movement, the patient can get injured. If this happens, remove the cable promptly.

To avoid poor circulation, do not wrap the tape too tight. Check the blood circulation condition by observing the skin color and congestion at the skin peripheral to the probe attachment site. Even for short-term monitoring, there can be burn or pressure necrosis from poor blood circulation, especially on neonates or low birth weight infants whose skin is delicate. Accurate measurement cannot be performed on a site with poor peripheral circulation.

Never use the SpO2 adapter in the presence of any flammable anesthetic gas or high concen-tration oxygen atmosphere. Failure to comply with this warning can cause explosion or fire.

Never use the SpO2 adapter in a hyperbaric oxy-gen chamber. Failure to comply with this warn-ing can cause explosion or fire.624470/00 1-63

1 INTELLiVENT-ASV When not measuring SpO2, disconnect the SpO2 adapter from the device. Otherwise, noise from the probe sensor can interfere and incorrect from the probe sensor can interfere and incor-rect data is displayed on the screen.

Before monitoring SpO2 through the SpO2 adapter, confirm that the operators manual of the device to which the SpO2 is connected allows the use of the SpO2 adapter. The safety of the attachment section (including the SpO2 adapter and the probe) depends on the specifi-cations of the connected device. If the SpO2 adapter is used with an instrument or SpO2 probe other than the specified ones, the patient and the operator can get an electrical shock and the SpO2 adapter can be become hot.

CAUTION

Detach SpO2 sensor before defibrillation.

If the probe is attached to same limb that is used for NIBP measurement or an IPB catheter, the blood circulation at the attachment site is affected and the measurement might not be correct. Attach the probe to a limb where the blood circulation is not affected.

Do not pull or bend the probe cable, and do not let caster feet run over the probe cable. Failure to follow these cautions may cause cable dis-continuity, short circuit, skin burn on the patient and incorrect measurement date. Replace any broken probe with a new one.

Redness or skin irritation may appear on the attachment site. Take extreme care of patients with weak skin. In case of redness or skin irrita-tion, change the attachment site or stop using the probe.1-64 624470/00

NOTE:

The emergency increase of Oxygen remains in place for all cases while the Oxygen control is set to auto-matic.

The PEEP/Oxygen controller can only adjust the Oxygen between 30 and 100%.

The PEEP controller can only operate between 5 and 25 cmH20.

With some models, a second SpO2 sensor can be used on the ventilator to increase the availability and accuracy of SpO2 measurement. For details, see the ventilator Operators Manual chapter, Pulse oximetry.

The lung-protective rules for Oxygenation management use the ARDSnet table when increasing the treatment, and the Open-Lung concept when decreasing the treatment. The Heart-Lung Interaction (HLI) is derived from the Plethysmo-graphic curve. If HLI is above 15%, it is limiting the maximally allowed PEEP, if activated. For details, see Section 1.13.

1.6.1 Management of PEEP/Oxygen for passive and active patientsUsing the SpO2 signal, retrieved from the pulse oximeter, the difference between the actual and the target SpO2 value is cal-culated. This calculation, together with the HLI value and the operators input, is used to determine the treatment action.

The PEEP/Oxygen automatic management consists of two steps. They are:

The operators input and the actual treatment (PEEP) define the SpO2 target range. The SpO2 signal and the SpO2 target range are used to define the treatment action (increase, decrease, no change of treatment).624470/00 1-65

1 INTELLiVENT-ASV The system decides, depending on the actual combination of PEEP and oxygen on the PEEP/Oxygen curve, if PEEP, oxy-gen or both (when the currently used PEEP/Oxygen combi-nation lies already on the PEEP/Oxygen curve) are increased. The relationship between PEEP and oxygen is based on the ARDSnet guidance for increasing therapy (Figure 1-32, target path bold) and the open lung concept for decreasing therapy (Figure 1-33, target path bold).

Figure 1-32. Increase of oxygenation support (ARDSnet guidance)

Figure 1-33. Decrease of Oxygenation (Open Lung concept)1-66 624470/00

The device adjusts PEEP/Oxygen and, as a result, the oxygen-ation of the patient is affected. The physiological input and the controller action are shown on the following pages.

SpO2 too high (Position of SpO2 is above upper SpO2 limit) -> Decrease oxygen support

Position on OPEN LUNG curve:

1. Above curve: automatic decrease of Oxygen stepwise to the PEEP/Oxygen curve.

2. On Curve: automatic decrease of PEEP and Oxygen to follow the PEEP/Oxygen curve.

3. Below curve: automatic decrease of PEEP stepwise to the PEEP/Oxygen curve.624470/00 1-67

1 INTELLiVENT-ASVSpO2 in range Position of SpO2 is between SpO2 limits and oxygen setting is > 5% above PEEP/Oxygen curve -> Decrease oxygen support as long as SpO2 is in range and oxygen has been automatic for > 60 min (weaning).1-68 624470/00

SpO2 too low (Position SpO2 is below lower SpO2 limit) -> Increase oxygen support.

Position on ARDSnet guidance curve:

1. Above curve: Change PEEP stepwise to get on the curve

2. On curve: increase of PEEP stepwise to PEEP limit and increase of oxygen to follow the PEEP/Oxygen curve

3. Below curve: automatic increase of Oxygen, stepwise to a value on the PEEP/Oxygen curve 624470/00 1-69

1 INTELLiVENT-ASVSpO2 critically low (Position represents a critical condition) -> Emergency increase of oxygen (see next paragraph)

Indication on screen:1-70 624470/00

No SpO2 available -> Controller freezes and the alarm Oxygenation Management off (no SpO2) appears.

Indication on screen:624470/00 1-71

1 INTELLiVENT-ASV1.6.2 Emergency increase of oxygenThis safety feature continuously monitors the patients SpO2 to avoid dangerous desaturation (as depicted in Figure 1-34) in the background, and can react immediately to deliver the patient 100% oxygen upon detection. The safety feature is activated when the physiologic SpO2 value of the patient falls below the lowest acceptable value, triggering the 100% oxy-gen response when oxygen control is set to automatic. In this case, an alarm message is displayed indicating that the Oxygen value was set to 100% (see Table 1-2).

Figure 1-34. Oxygenation Map where emergency management of Oxygen occurs

1.6.3 Patient condition rules (during ventilation)The device adjusts PEEP and oxygen as described in Table 1-5.1-72 624470/00

Table 1-5. Patient condition rules during ventilation

Oxygenation Management

Definition of action The case if ...

Decrease oxygen step-wise

Decreases oxygen by 5% of current Oxygen value every 60 sec-onds.

Minimal step size is 1%.

Oxygen automati-cally managed

Decreasing oxygen support

Increase oxygen step-wise

Increases oxygen by 10% of current Oxy-gen value every 30 seconds.

Minimal step size is 1%.

Oxygen automati-cally managed

Increasing oxygen support

Increase PEEP stepwise Increases PEEP every 6 minutes by 1 cmH2O

PEEP automatically managed

Increasing PEEP support

PEEP is below the upper PEEP limit

Decrease PEEP step-wise

Decreases PEEP every 6 minutes by 1 cmH2O


Decreasing PEEP support

NOTE:If a lower limit is speci-fied, PEEP will not go below the lower limit. 624470/00 1-73

1 INTELLiVENT-ASV1.7 Assessing results

WARNING

The responsibility for the settings rests solely with the physician.

NOTE:Use the Target Shift control to correct the adjustment of the measured PaCO2 value and a measured PetCO2 value. The values can be shifted by 15 mmHg to the left and by 10 mmHg to the right. After an adjustment of 5 mmHg, the target value can only be set to target val-ues of -15/+10 mmHg by reconfirming using the cursor.

Use the Target Shift control in the oxygenation window to change the target range for the SpO2 measurement. The target range can be shifted by 2% to the left and by 5% to the right.

Note that the emergency range follows the target shift.

Decrease PEEP step-wise

Exception: PEEP decreases quickly every 30 seconds


PEEP is above the upper PEEP limit (if PEEP was set manually above the limit or the PEEP is above the limit allowed by HLI

Table 1-5. Patient condition rules during ventilation

Oxygenation Management

Definition of action The case if ...1-74 624470/00

Figure 1-35. Target shift

After the calculated targets are reached, the ventilation man-agement results need to be assessed. Use the monitored parameters for this purpose. However, to assess respiratory acid-base status, it is recommended that arterial blood gases be measured to monitor the minute volume adjustment.

1.8 Open loop: Manual management of ventilation and oxygenation

WARNING

If oxygen is manually controlled, the rapid response PEEP/Oxygen adjustment is inactive.

The responsibility for the settings rests solely with the physician (operator).

NOTE:You can use INTELLiVENT-ASV in either automatic or manual mode.

References in this section are to the display, Ventilation Guide, shown in Figure 1-36.624470/00 1-75

1 INTELLiVENT-ASVIn open-loop ventilation (manual mode), the operator sets a value for %MinVol, PEEP and Oxygen supported by protocol guidance from the ventilator. The guidance consists of text notes based on the current results of the CO2 and SpO2 mea-surement, and the patients respiratory rate. This guidance informs the operator of what strategy the system would use in the automatic mode to adjust %MinVol and PEEP/Oxygen. The operators use their discretion to determine %MinVol and PEEP/Oxygen on the basis of clinical judgment. Outside the safety limits of the automatic system (70- 200% for %MinVol, 30-100% Oxygen and 5-24 cmH2O for PEEP), there is no guid-ance available.

In Figure 1-36, the Horizon window contains recommenda-tions for adjustment of %MinVol based on PetCO2 and spon-taneous rate (see arrow 1), and for adjustment of PEEP and Oxygen based on SpO2 and current PEEP setting (see arrow 2).

Figure 1-36. Ventilation guide1-76 624470/00

1.9 Heart-Lung Interaction

WARNING

HLI cannot be used in patients with significant cardiac arrhythmias (examples: atrial fibrilla-tion, frequent premature beats, ventricular fibrillation). Due to the irregular time between heart beats in these patients, HLI does not reflect the effect of mechanical ventilation on the stroke volume of the heart.

HLI can be incorrect when:

tidal volume is < 6 ml/kg

patients breath activity is spontaneous

driving pressure is < 10 cmH2O

cardiac dysfunction is present

If there is low transthoracic pressure the sensi-tivity of HLI is decreased.

In case of many changes in PEEP or too many recruitment maneuvers occur, the HLI fluc-tuates.

Low sensitivity of HLI when HR/RR < 3-4

Check plethysmographic curve (patient motion) as well as SpO2 and HLI QI regularly.

To continuously assess the haemodynamic effect of mechanical ventilation, the respiratory variation of the Pulse Oximeter Plethysmogram (POP) is analyzed by the ventilator. From the POP, an index called Heart-Lung Interactions (HLI) is calculated according to the following formula:

HLI = 100*(POPmax POPmin) / ((POPmax + POPmin)/2)POPmax is the maximal and POPmin is the minimal ampli-tude of the pulse oximeter plethysmogram within the same breath. The breath information is extracted from the airway pressure signal delivered by the ventilator. Figure 1-37 illustrates this calculation in detail. 624470/00 1-77

1 INTELLiVENT-ASVThe HLI reflects how much airway pressure interacts with haemodynamics: HLI >15% means high interaction. For reference see Section 1.13.

In cases where HLI >15%, PEEP increase is limited and oxy-gen increase is preferred.

Figure 1-37. Simultaneous pulse oximeter plethysmo-gram and airway pressure recording with POPmax and

POPmin indicated on the plethysmogram

Patients with a high HLI show a higher variation of the POP during the breath cycle (see left top curve in Figure 1-38), indi-cating a higher variation of the arterial pressure during the breath cycle. In contrast, the recordings of patients with low HLI (right column of Figure 1-38) present a low variation of the POP and of the arterial pressure, indicating stable haemody-namics during mechanical ventilation.1-78 624470/00

Figure 1-38. Tracking patients with high (left column) and low (right column) heart-lung index

HLI is:

Reliable in passive patients, partly reliable in actively breath-ing patients

Not reliable if cardiac arrhythmia is present

Signal dependent (artifacts, motion, autoscaling)

1.10 Remarks: Sensor failure, standby, calibration

1.10.1 Ventilation managementCertain situations invoke specific behaviors from INTELLiVENT-ASV. These conditions include:

PetCO2 is not available

Disconnection or flow sensor failure is resolved in 5 minutes or less ( 5 min)

Standby624470/00 1-79

1 INTELLiVENT-ASV1.10.1.1 PetCO2 is not available

When PetCO2 is not available, the sensor value becomes unavailable, or the sensor is switched off, the minute volume adjustment works like ASV with a constant minute ventilation (%MinVol) equal to the last valid automatic %MinVol (frozen state).

The ventilation controller display changes from blue to red.

The alarm, Ventilation Adjustment OFF (no PetCO2), is activated. INTELLiVENT-ASV works like ASV with constant minute ventilation.

When PetCO2 is available again the alarm is cleared and the minute volume adjustment switches back to fully automatic mode.

The controller changes from red into a blue rotating circle again.

ASV optimizes automatic values and calculates the optimal rate and tidal volume.

1.10.1.2 Disconnection or flow sensor failure resolved in 5 minutes or less

When a disconnection or flow sensor failure situation is resolved in 5 minutes or less, the device:

The %MinVol management adjustment pauses for 10 breaths.

The ASV adjustment pauses Pinsp (Pressure support above PEEP for all (mechanical and spontaneous) breaths) and RRIMV (IMV rate calculated by the rate adjustment) remains unchanged) for 4 breaths after reconnection.

If the adjustment is in its initialization phase, it remains there for at least 3 more breaths.1-80 624470/00

1.10.1.3 Disconnection or flow sensor failure resolved in more than 5 minutes

When a disconnection or flow sensor failure is resolved in more than 5 minutes:

The ventilation controller adjustment pauses for 2 minutes.

The ASV adjustment re-initializes. If the adjustment is in its initialization phase, it remains there for at least 3 more breaths.

1.10.1.4 Standby

When returning from Standby with a new patient selected and INTELLiVENT-ASV activated, the %MinVol adjustment reinitial-izes with the default settings. If last patient was selected, the system assumes the %MinVol value from the last patient.

In the event the PetCO2 quality index reads less than 50, the device control display will change from a blue rotating circle to a red non-pulsing circle. Ventilation management stops.

When the PetCO2 quality index is greater than 50, the alarm state will clear and the ventilation management returns to the automatic mode. The device controller display reverts from the red non-pulsing circle to the blue rotating circle.

1.10.2 Oxygenation managementThe PEEP/Oxygen automatic management only operates when a valid SpO2 signal is available. Without an SpO2 measure-ment, the device leaves the settings unchanged and generates a low-priority alarm after 30 seconds, and a medium-priority alarm after 60 seconds. This alarm requires the operator to check the SpO2 signal. If information about the haemodynamic state of the patient (estimated from the heart-lung interaction) is no longer available, automatic control is NOT suspended.

When the HLI is activated but not available for longer than the PEEP decrease interval (6 min), the ventilator management takes the PEEP limits set by the user in the INTELLiVENT win-dow as the upper and lower PEEP limits, and does not go below the specified lower PEEP limit. 624470/00 1-81

1 INTELLiVENT-ASVWhen the alarm condition Oxygenation Adjustment OFF (no SpO2) occurs, this indicates to the operator that the SpO2 sensor values are unavailable or are invalid. The management outputs are frozen (no change), pending operator interven-tion.

In the event the SpO2 quality index reads less than 60, the device control display changes from a blue pulsing circle to a red non-pulsing circle. Oxygenation management stops.

When the SpO2 quality index is greater than 60, the alarm state will clear and oxygen management returns to automatic mode. The device controller display reverts from the red non-pulsing circle to the blue pulsing circle.

The emergency increase of oxygen management is inactive when oxygen is controlled manually.

The oxygen management pauses during

Disconnection (controllers are reactivated with their last set-tings)

O2 flush (controllers are reactivated with their last settings)

Flow sensor calibration (controllers are starting with the set-tings before the calibration)

Tightness test (controllers are starting with the settings before the test)1-82

IntelliVent ASV En

Documents

Transcript of IntelliVent ASV En