Covidien 840 Ventilator System Operator's & Technical Reference Manual
Below you will find brief information for Ventilator 800 840. The Ventilator 800 840 is a medical device that is designed to provide mechanical ventilation for patients who are unable to breathe on their own. It is capable of providing both pressure- and volume-controlled ventilation, as well as a variety of other ventilation modes. The Ventilator 800 840 also offers a number of features to help reduce the risk of complications, such as alarms for low air pressure and high circuit pressure.
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Puritan Bennett
TM
800 Series Ventilator
Copyright Information
COVIDIEN, COVIDIEN with logo, and positive results for life are U.S and internationally registered trademarks of COVIDIEN
AG. All other brands are trademarks of a Covidien company or of their respective owners.
© 2011–2016 Covidien.
The information contained in this manual is the sole property of Covidien and may not be duplicated without permission.
This manual may be revised or replaced by Covidien at any time and without notice. Ensure this manual is the most current applicable version. If in doubt, contact Covidien’s technical support department or visit the Puritan Bennett™ product manual web page at: www.medtronic.com/covidien/support/product-manuals
Click Acute Care Ventilation > Puritan Bennett™ 840 Ventilator then follow the prompts to select the desired manual.
While the information set forth herein is believed to be accurate, it is not a substitute for the exercise of professional judgment.
The ventilator should be operated and serviced only by trained professionals.
Covidien’s sole responsibility with respect to the ventilator and software, and its use, is as stated in the limited warranty provided.
Nothing in this document shall limit or restrict in any way Covidien’s right to revise or otherwise change or modify the equipment (including its software) described herein, without notice. In the absence of an express, written agreement to the contrary, Covidien has no obligation to furnish any such revisions, changes, or modifications to the owner or user of the equipment (including its software) described herein.
™* Trademark of its respective owner.
Proportional Assist and PAV are registered trademarks of The University of Manitoba, Canada. Used under license. Other brands are trademarks of a Covidien company.
Table of Contents
Operator’s Manual
OP 1 Introduction
OP 2 How to Set up the Puritan Bennett™ 840 Ventilator
OP 3 How to Run Short Self Test (SST)
i
ii
OP 5
OP 6
OP 4 How to use the Puritan Bennett™ 840 Ventilator
How to Handle Alarms
How to View Graphics
OP 7
Preventive Maintenance
OP A Specifications
OP B
Part Numbers
iii
iv
OP C
OP D
OP E
Pneumatic Schematic
Alarm and Oxygen Sensor Calibration Testing
Remote Alarm and RS-232 Ports
Technical Reference
TR 1 Introduction to Breath Delivery
TR 2
Detecting and Initiating Inspiration
TR 3 Detecting and Initiating Exhalation
TR 9
TR 6
TR 7
TR 8
TR 4
Mandatory Breath Delivery
TR 5
Comparison of Pressure- and Volume-based Mandatory Breaths . . . . . . . . . . . TR 4-1
Compliance Compensation for Volume-based Mandatory Breaths . . . . . . . . . . TR 4-3
BTPS Compensation for Volume-based Mandatory Breaths . . . . . . . . . . . . . . . . TR 4-4
Spontaneous Breath Delivery
Assist/control (A/C) Mode
Synchronized Intermittent Mandatory Ventilation
Spontaneous (SPONT) Mode
Apnea Ventilation
v
vi
TR 10
TR 11
Detecting Occlusion and Disconnect
Phasing in Setting Changes
TR 12
Ventilator Settings
TR 13 Alarms
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-15
LOW EXHALED MANDATORY TIDAL VOLUME Alarm . . . . . . . . . . . . . . . . . . . . .TR 13-20
LOW EXHALED SPONTANEOUS TIDAL VOLUME Alarm . . . . . . . . . . . . . . . . . . .TR 13-20
LOW EXHALED TOTAL MINUTE VOLUME Alarm . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-21
TR 14 Patient Data
TR 15
Safety Net
vii
viii
TR 16
Power on Self Test (POST)
TR 17
TR 18
TR 19
Glossary
Index
Short Self Test (SST)
Extended Self Test (EST)
RS-232 Commands
List of Figures
Operator’s Manual
Figure OP 2-12. How to Install the Humidifier (Fisher & Paykel™* version shown) for Ventilators
Figure OP 2-15. How to Lock and Unlock the
Compressor Mount Cart or Pole Cart Front Wheels. . . . . . OP 2-21
ix
x
Figure OP B-3. Puritan Bennett™ 840 Ventilator System Shown Mounted on
Technical Reference
List of Tables
Operator’s Manual
Table OP A-9. Recommended Separation Distances Between Portable and Mobile RF
Communications Equipment and the Puritan Bennett™ 840 Ventilator System . . . . . . . OP A-10
xi
xii
Technical Reference
Applicability
The information in this manual applies to Puritan Bennett™ 840 Ventilator versions manufactured or updated after August 2005. Some of this information may not apply to earlier versions. Contact your Covidien representative if in doubt.
Definitions
This manual uses three special indicators to convey information of a specific nature:
WARNING:
Indicates a condition that can endanger the patient or the ventilator operator.
Caution:
Indicates a condition that can damage the equipment.
Note:
Indicates points of particular emphasis that make operation of the ventilator more efficient or convenient.
Warnings, Cautions, and Notes
Take the time to familiarize yourself with the safety considerations listed in this section, special handling requirements, and regulations that govern the use of the ventilator system.
WARNING:
The ventilator contains phthalates. When used as indicated, very limited exposure to trace amounts of phthalates may occur. There is no clear clinical evidence that this degree of exposure increases clinical risk. However, to minimize risk of phthalate exposure in children and nursing or pregnant women, this product should only be used as directed.
WARNING:
The user of this product shall have sole responsibility for any ventilator malfunction due to operation or maintenance performed by anyone not trained by Covidien.
WARNING:
To ensure proper servicing and avoid the possibility of physical injury, only qualified personnel should attempt to service or make authorized modifications to the ventilator.
WARNING:
To avoid an electrical shock hazard while servicing the ventilator, be sure to remove all power to the ventilator by disconnecting the power source and turning off all ventilator power switches.
WARNING:
To avoid a fire hazard, keep matches, lighted cigarettes, and all other sources of ignition (e.g., flammable anesthetics or heaters) away from the ventilator system and oxygen hoses.
Operator's and Technical Reference Manual xiii
xiv
WARNING:
Do not use oxygen hoses that are worn, frayed, or contaminated by combustible material such as grease or oils. Textiles, oils, and other combustibles are easily ignited and burn with great intensity in oxygen-enriched air.
WARNING:
In case of fire or a burning smell, immediately disconnect the ventilator from the oxygen supply, the facility power, and the backup power source.
WARNING:
When handling any part of the ventilator system, always follow your hospital guidelines for handling infectious material.
WARNING:
Covidien recognizes cleaning, sterilization, sanitation, and disinfection practices vary widely among health care institutions. It is not possible for Covidien to specify or require specific practices that will meet all needs, or to be responsible for the effectiveness of cleaning, sterilization, and other practices carried out in the patient care setting. As a manufacturer,
Covidien does not have any guidelines or recommendations regarding specific pathogens as they relate to the usage of our products. In regards to transmission of any specific pathogen, Covidien can offer the specifications of our products as well as our recommendations for cleaning and sterilization. Any further clarification regarding pathogens as they relate to our products should be brought to the attention of your lab pathologist as well as your infection control personnel or your risk committee.
WARNING:
Patients on life-support equipment should be appropriately monitored by competent medical personnel and suitable monitoring devices.
WARNING:
The ventilator system is not intended to be a comprehensive monitoring device and does not activate alarms for all types of dangerous conditions for patients on life-support equipment.
WARNING:
For a thorough understanding of ventilator operations, be sure to thoroughly read this manual before attempting to use the system.
WARNING:
Before activating any part of the ventilator, be sure to check the equipment for proper operation and, if appropriate, run SST as described in this manual.
WARNING:
An alternative source of ventilation should always be available when using the ventilator system.
Operator's and Technical Reference Manual
WARNING:
Check the ventilator periodically according to the Puritan Bennett™ 840 Ventilator System Service
Manual; do not use if defective. Immediately replace parts that are broken, missing, obviously worn, distorted, or contaminated.
WARNING:
This ventilator offers a choice of breath delivery modes and types. Throughout the patient’s treatment, the clinician should carefully select the ventilation mode and breath type to use for that patient. This selection should be based on the clinician’s clinical judgment, considering the condition and needs of the individual patient, as such condition and needs change from time to time and considering the benefits, limitations, and operating characteristics of each mode and breath type.
Caution:
Do not use sharp objects to make selections on the graphical user interface (GUI) display or keyboard.
Note:
Items shown in bold font are physical hardware features (e.g., to patient port, from patient port).
Note:
U. S. federal law restricts this device to sale by or on the order of a physician.
Operator's and Technical Reference Manual xv
xvi
Warranty
The ventilator system is warranted against defects in material and workmanship in accordance with the Covidien Medical Equipment Warranty supplied with your ventilator. Keep a maintenance record to ensure the validity of the warranty.
Year of Manufacture
The GUI and breath delivery unit (BDU), backup power source (BPS) and compressor contain a specific year of manufacture applicable for that assembly. The year of manufacture is indicated by the fifth and sixth digits of the serial number, which is located at the back panel of the GUI, BDU, and BPS, and the side panel of the compressor.
Manufacturer
Covidien llc
15 Hampshire Street
Mansfield, MA 02408
USA
Electromagnetic Susceptibility
The ventilator system complies with the requirements of IEC 60601-1-2:2004 (EMC Collateral Standard), including the E-field susceptibility requirements at a level of 10 volts per meter, at frequencies from 80 MHz to 2.5 GHZ, and with the ESD requirements of this standard.
However, even at this level of device immunity, certain transmitting devices (cellular phones, twoway radios, cordless phones, paging transmitters, etc.) emit radio frequencies that could interrupt ventilator operation if operated in a range too close to the ventilator. It is difficult to determine when the field strength of these devices becomes excessive.
Practitioners should be aware radio frequency emissions are additive, and the ventilator must be located a sufficient distance from transmitting devices to avoid interruption. Do not operate the ventilator in a magnetic resonance imaging (MRI) environment.
WARNING:
Accessory equipment connected to the power receptacle, analog, and digital interfaces must be certified according to IEC 60601-1. Furthermore, all configurations shall comply with the system standard IEC 60601-1-1. Any person who connects additional equipment to the power receptacle, signal input part, or signal output part of the ventilator configures a medical system, and is therefore responsible for ensuring the system complies with the requirements of the system standard IEC 60601-1-1. If in doubt, consult Covidien Technical Services at 1 800 255 6774 or contact your local Covidien representative.
This manual describes possible ventilator alarms and what to do if alarms occur. Consult with your institution’s biomedical engineering department in case of interrupted ventilator operation, and before relocating any life support equipment.
Operator's and Technical Reference Manual
Customer assistance
For further assistance call Covidien Technical Services at 1 800 255 6774 or contact your local Covidien representative.
For online technical support, visit the SolvIt
SM
Center Knowledge Base at solvitcenter.puritanbennett.com/ and follow the prompts.
The SolvIT Center provides answers to frequently asked questions about the ventilator system and other Covidien products 24 hours a day, 7 days a week.
Preface
This manual is divided into two parts: the operator’s manual and the technical reference manual.
The operator’s manual describes how to operate the ventilator system. It also provides product specifications and accessory order numbers. The technical reference manual includes background information about how the ventilator functions, including details on its operating modes, self-tests, and other features. In the table of contents, list of figures, list of tables, and index, the prefix OP- identifies page numbers, figure numbers, and table numbers in the operator’s manual, and the prefix TR- identifies the same items in the technical reference manual.
Any references to the software options BiLevel, Volume Ventilation Plus (VV+) (which include VC+ and VS breath types), NeoMode, Proportional Assist™* Ventilation (PAV™*+), Tube Compensation
(TC), Respiratory Mechanics (RM), and Trending in this manual assume that the option has been installed on the ventilator. If these options aren’t installed, then references to their functions do not apply.
While this manual covers the ventilator configurations currently supported by Covidien, it may not be all-inclusive and may not be applicable to your ventilator. Within the USA, contact Covidien at 1 800 255 6774 for questions about the applicability of the information.
Some illustrations and images are shown with a ready-to-assemble (RTA) cart, a Puritan Bennett™
800 Series Ventilator Compressor Mount Cart, or a Puritan Bennett™ 800 Series Ventilator Pole
Cart. Note that these images are for illustrative purposes only, and regardless of which cart you have, the required information is provided.
The term “RTA cart” refers to the ready-to-assemble cart and any earlier cart versions.
Operator's and Technical Reference Manual xvii
Page Left Intentionally Blank xviii Operator's and Technical Reference Manual
OP 1 Introduction
OP 1.1
Overview
The intended use of the Puritan Bennett™ 840 Ventilator System is for acute and subacute care of infant, pediatric, and adult patients. Software options, available from Covidien, provide additional ventilation functions.
The ventilator facilitates work of breathing management, offers selectable modes of breath delivery, and assists the practitioner in selecting the most appropriate ventilator control parameters for the patient. The user interface is intuitive and easy to operate for those with prior knowledge of ventilator operation.
The user interface includes DualView touch screens that display monitored patient data for easy assessment of the patient’s condition. The touch screens also display the current ventilator control parameters.
The SandBox area on the touch screen allows the practitioner to preview the selected ventilator control parameters prior to active patient ventilation.
The SmartAlert system intercepts alarms, or events, provides specific information about the cause, and prompts the user with actions to resolve the reported conditions.
The breath delivery unit (BDU) comprises the pneumatics and the patient circuit.
•
The ventilator uses two independent central processing units (CPUs):
Breath delivery (BD) CPU
•
Graphic user interface (GUI) CPU
The BD CPU uses the ventilator control parameters, selected by the practitioner, to deliver breaths to the patient. The BD CPU also runs continuous and extensive operational background checks to ensure proper operation of the ventilator.
The GUI CPU monitors the ventilator and the ventilator/patient interaction. The GUI CPU also monitors the operation of the BD CPU and prevents simultaneous failure of control and monitor functions when a single fault is reported.
The ventilator system supplies mandatory or spontaneous breaths with a preset level of positive end expiratory pressure (PEEP), trigger sensitivity, and oxygen concentration. A mandatory breath can either be pressure- or volume-controlled, but it is always pressure-controlled in the optional BiLevel mode. A spontaneous breath allows patient inspiratory flows of up to 200 L/ min, with or without pressure support.
OP 1-1
Introduction
The optional 806 compressor unit provides compressed air to the BDU, and can be used in place of wall or bottled air. The compressor unit is powered through and communicates with the BDU.
The 802 backup power source or 803 extended backup power source provides DC power to the
BDU and GUI in the event AC power is lost. A new, fully charged BPS runs the ventilator (without a compressor or a humidifier) for a minimum of 60 minutes (30 minutes on ventilators built prior to July 2007), which allows patient and ventilator transport within the healthcare facility. The 803
BPS (available after October 2009) can power the ventilator for a minimum of 4 hours under the same conditions. The same conditions apply, respectively, to the 1-hour or 4-hour BPS assembly in the compressor-mount cart and the 1-hour or 4-hour batteries in the pole cart.
This manual tells you how to operate and perform simple maintenance for the ventilator system.
Become familiar with this manual and accompanying labels before attempting to operate or maintain the ventilator.
To ensure optimum performance of the ventilator system, Covidien strongly recommends certified biomedical engineering technicians, or other personnel with equivalent experience and training in the service of this type of equipment perform periodic maintenance on the ventilator.
For more information, contact Covidien Technical Services in the U.S. at 1 800 255 6774. Outside of the U.S., contact your local Covidien representative.
OP 1.2
Indications for Use
The 840 ventilator provides continuous ventilation to patients requiring respiratory support. The
840 Ventilator System is intended for patients with an ideal body weight (IBW) as low as 0.3 kg
(with expanded NeoMode option).
The 840 ventilator (with expanded NeoMode option) is intended for use in hospitals and hospitaltype facilities. It may be used during hospital and hospital-type facility transport provided that electrical power and compressed gas are supplied.
OP 1.3
Technical Description
OP 1.3.1
General Background
The practitioner uses the GUI touch screens, the off-screen keys, and the GUI knob to select the ventilator control parameters and enter data (see
information and stores it in ventilator memory. The BDU CPU uses the stored information to control and monitor the flow of gas to and from the patient.
The two CPUs communicate to transfer and verify any new ventilator control parameters or alarm limits. Each CPU then performs continuous background verification of operational integrity and data integrity.
OP 1-2
Figure OP 1-1. Puritan Bennett™ 840 Ventilator System Block Diagram
Technical Description
1
2
3
4
5
6
GU)
Exhalation module: active exhalation valve, pressure transducer, flow sensor
Expiratory filter
Collector vial
Expiratory limb
Patient circuit
7
8
Inspiratory limb
Humidification device
9 Inspiratory filter
10 Air regulator
11 Oxygen regulator
12 Inspiratory module: PSOLs, safety valve, oxygen sensor, pressure transducers, flow sensor
OP 1.3.2
Pressure and Flow Triggering
The ventilator uses flow or pressure triggering to recognize patient effort. When pressure triggering is in effect, the ventilator monitors pressure in the patient circuit. As the patient draws gas from the circuit and airway pressure drops by at least the value selected for pressure sensitivity, the ventilator delivers a breath.
OP 1-3
Introduction
When flow triggering (Flow-by) is in effect, the ventilator monitors the difference between the inspiratory and expiratory flow sensor measurements. As the patient inhales, the ventilator measures less exhaled flow while the delivered flow remains constant. The result is an increase in the difference between the inspiratory and expiratory flows. When the difference equals the operator-selected value for flow sensitivity, the ventilator delivers a breath.
If the patient is not inhaling, any difference between the delivered flow and the exhaled flow is due to sensor inaccuracy or leaks in the patient system. To compensate for leaks in the patient system, which can cause autotriggering, the operator can increase the flow sensitivity setting.
As a backup method of triggering inspiration, a pressure sensitivity of 2 cmH
2
O is also in effect.
This setting is the most sensitive setting that is still large enough to avoid autotriggering, yet will trigger with acceptable patient effort.
OP 1.3.3
Breathing Gas Mixture
Air and oxygen from cylinders, wall supplies, or a compressor (air only) enter the ventilator through hoses and fittings (the fittings are available in several configurations). Once inside the ventilator, air and oxygen are regulated to pressures appropriate for the ventilator, then mixed according to the selected O
2
%.
The ventilator delivers the mixed air and oxygen through the inspiratory module and out to the patient. The oxygen concentration of the delivered gas is monitored in the inspiratory module, using a galvanic oxygen sensor. The galvanic sensor generates a voltage proportional to the oxygen concentration. The ventilator reports an alarm if the O
2
sensor is enabled and monitored oxygen concentration is more than seven percent higher or lower than the O
2
% setting, or lower than 18% after the concentration stabilizes.
The inspiratory manifold also includes a safety valve to relieve patient pressure if necessary (for example, if the patient circuit is kinked or occluded). The inspiratory module also corrects for gas temperature and humidity, based on the practitioner-set humidification type.
OP 1.3.4
Inspiratory Pneumatics
Ventilator inspiratory pneumatics consist of two parallel circuits: one for oxygen and one for air.
The primary elements of the inspiratory pneumatics are two proportional solenoid valves (PSOLs) that control the flow of gas delivered to the patient. Air and oxygen flow sensors, along with pressure signals from the patient circuit, provide feedback that the BD CPU uses to control the PSOLs.
As a result, the ventilator supplies mixed breathing gas to the patient, based on the practitionerset ventilator control parameters. The mixed air and oxygen passes through the patient circuit external to the ventilator.The system delivers the breathing gas mixture to the patient at the patient wye, located in the external patient circuit.
OP 1-4
Technical Description
OP 1.3.5
Patient Circuit
•
•
•
•
•
The patient circuit comprises the components external to the ventilator that route gas between the ventilator and the patient. These components include:
An inspiratory filter that protects against contamination between the patient and ventilator
A humidification device (optional) in line with the patient circuit
The inspiratory and expiratory limbs of the patient circuit that conduct the breathing gas to and from the patient
A collector vial that protects the expiratory pneumatics from bulk moisture in the exhaled gas
An expiratory filter that limits the escape of microorganisms and particulates in the patient’s exhaled gas into the room air or inside the ventilator exhalation pneumatics
The ventilator actively controls the exhalation valve that the software accurately positions throughout the patient’s inspiration and exhalation.The exhalation valve allows the ventilator to deliver aggressive breaths while pressure overshoots are minimized, PEEP is controlled, and excess patient pressures are relieved. The exhalation system monitors the exhaled gas leaving the patient circuit for spirometry.
Note:
The ventilator system does not have a capability to reduce pressure below the PEEP pressure during the expiratory phase.
Throughout the respiratory cycle, pressure transducers monitor inspiratory pressure, expiratory pressure, and atmospheric pressure. The temperature of the exhaled gas is heated to a temperature > its dew point to prevent condensation in the exhalation compartment. Refer to Appendix
OP C
for a detailed diagram of the ventilator’s pneumatic system and the patient circuit.
OP 1.3.6
AC Mains and Backup Power System
The ventilator derives its power to operate from the AC mains (wall) power or the BPS. The design of the BDU integral power supply protects against excessive voltages, temperatures, or current draws. A power cord retainer prevents accidental disconnection of the BDU from the AC mains. A power switch cover on the front face of the BDU protects against spills and accidental AC poweroff occurrences.
The ventilator connects to the 802 BPS or 803 BPS, which supplies DC power to the ventilator if
AC power is lost. A fully charged 802 BPS operating under nominal ambient conditions, can power the ventilator for a minimum of 60 minutes (30 minutes on ventilators built prior to July 2007). The
803 extended BPS can power the ventilator for a minimum of 4 hours under the same conditions.
Neither BPS powers the compressor unit or the humidifier, if present. The 803 BPS must be used on Covidien 840 ventilators with software version AB or higher (part number
4-0070212-85) or equivalent. The operation and alarms of the 803 BPS are identical to the 802 BPS.
The GUI indicates when the ventilator is operating on the BPS, rather than AC mains.
OP 1-5
Introduction
When AC power is connected, it recharges the BPS. The BPS continues to recharge from the AC power during normal ventilator operation. If the ventilator is mounted on a compressor-mount cart and has a 4-hour BPS or if the ventilator is mounted on a pole cart with a 4-hour battery, the software version, battery life, and operating conditions are the same as described for the 803 BPS.
The battery life and operating conditions for each cart with a 1-hour BPS or 1-hour battery are equivalent to the description given for the 802 BPS.
OP 1.3.7
Ventilator Emergency States
Emergency states include Ventilator Inoperative (Vent Inop) and Safety Valve Open (SVO). When a vent inop condition occurs, it always includes the SVO state. An SVO state can also occur independent of a vent inop condition.
•
The following list describes the two ventilator emergency states:
Safety valve open (SVO)—The ventilator enters the SVO state if both air and oxygen supplies are lost, an occlusion is detected, or the ventilator enters the vent inop state.
The safety valve open (SVO) state allows the patient to breathe room air unassisted by the ventilator. The ventilator remains in the SVO state until the condition that caused the emergency state is corrected.
When the ventilator enters the SVO state, the SVO indicator on the front face of the BDU illuminates, and a high-priority alarm sounds.
•
In case of a malfunction that prevents software from opening the safety valve, there is also an analog circuit that opens the safety valve if system pressure exceeds 100 cmH
2
O to 120 cmH
2
O.
Ventilator Inoperative (Vent Inop): The ventilator declares a ventilator inoperative condition if a hardware failure or critical software error occurs that could compromise safe ventilation of the patient.
When a vent inop condition occurs, the vent inop indicator on the front face of the BDU illuminates and the ventilator enters the SVO state, which in turns sounds a high-priority alarm.
If a vent inop condition occurs, immediately remove the ventilator from use until qualified service personnel evaluate and correct the vent inop condition.
If the ventilator declares a vent inop state, the power on self test (POST) must first verify that power levels to the ventilator are acceptable and the functions of the major electronics systems are satisfactory before normal ventilation can resume. Qualified service personnel must repair the ventilator to correct the problem and execute EST successfully before normal ventilation is allowed.
OP 1.4
Graphic User Interface
This section describes the GUI, the GUI keys, the GUI indicators, and the symbols you see on the
GUI.
The ventilator system’s GUI comprises the DualView touch screens, the off-screen keys located below the touch screens, and a knob. Use the knob to set a given ventilator control parameter to
OP 1-6
Graphic User Interface its desired value. Press the ACCEPT key—the off-screen key above and right of the knob—to enter the selected value or parameter into memory.
identifies the components of the GUI, and the location of information on the
DualView touch screens.
Figure OP 1-2. Puritan Bennett™ 840 Ventilator System GUI
OP 1-7
Introduction
4
5
6
7
1
2
3
8
Vital patient data 9
Alarms and ventilator
Upper screen: monitored information
(alarms, patient data)
10
11
Assorted patient data, including graphical 12
Active alarm log, if applicable
Primary patient
13
14
15 Lower screen: ventilator control parameters
Setup of ventilator control parameters, alarm limits, breath timing parameters, and other parameters
Symbol definitions
Prompt area
Off-screen keys
Knob
ACCEPT key
CLEAR key
Status
OP 1.5
User Interface Controls and Indicators
Descriptions of the controls and indicators on the graphic user interface are given in
Table OP 1-1. Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
Screen lock key: When the yellow light on the screen lock key is lit, the screen and off-screen controls (including the knob and ACCEPT key) have no effect when touched until you press the screen lock key again. New alarms automatically unlock the screen and controls.
The screen lock allows you to clean the touch screen and prevents inadvertent changes to settings and displays.
Alarm volume key: Allows you to adjust the alarm volume when you hold down this key while turning the knob. You cannot turn off the alarm volume.
Alarm silence key: Turns off the audible alarm for 2 minutes. The yellow light on the alarm silence key illuminates during the silence period. An ALARM
SILENCE IN PROGRESS indicator displays on the lower touch screen, along with a CANCEL button, if there is not a higher-priority alarm display active. To exit out of the alarm silence, touch the CANCEL button.
The system automatically exits the alarm silence when the 2-minute interval times out. High priority alarms such as Device Alerts, Safety Valve Open,
Occlusion, and loss of either gas supply cancel the alarm silence.
Each time you press the alarm silence key, the silence period resets to 2 minutes. Each time you press the alarm silence key (whether or not there is an active alarm), the keypress is recorded in the alarm log.
OP 1-8
User Interface Controls and Indicators
Table OP 1-1. Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
Alarm reset key: Clears active alarms or resets high-priority alarms and cancels an active alarm silence. Each time you press the reset key, it is recorded in the alarm log, if there is an active alarm. You cannot reset a DEVICE
ALERT alarm.
Information key: Displays basic operating information about the ventilator.
Press the key to display a menu of information topics, then touch the button corresponding to the desired topic. Browse topical information using the , , and buttons located in the information header.
Oxygen sensor calibration key: Older ventilators use the 100% O
2
/CAL 2 min key and newer ventilators use the INCREASE O
2
2 min key. Delivers 100% oxygen (if available) for 2 minutes and calibrates the oxygen sensor. The green light on this key illuminates and a message (100% O
2
Cal in Progress) on the lower touch screen indicates 100% O
2
delivery is active. If you press the O
2
key again, the system restarts the 2-minute delivery interval. Press
CANCEL to stop the calibration. See page
TR 15-4
for information on calibrating the oxygen sensor.
Manual inspiration key: In A/C, SIMV, and SPONT modes, delivers one manual breath to the patient in accordance with the current mandatory breath parameters. In BILEVEL mode, transitions from low PEEP (PEEP
L
) to high PEEP (PEEP
H
) (or vice versa). To avoid breath stacking, a manual inspiration is not delivered during inspiration or during the restricted phase of exhalation.
You can use the MANUAL INSP key to supplement minute volume or to assist measurement of a patient data parameter, such as peak inspiratory pressure, or to run an INSP PAUSE maneuver in SPONT mode.
Expiratory pause key: Causes the ventilator to seal the patient’s breathing circuit when the expiratory phase of a designated breath, mandatory or spontaneous, is followed by a time-cycled mandatory inspiration. An expiratory pause is used to estimate PEEP
TOT
and PEEP
I
(autoPEEP).
The ventilator performs two types of pause maneuver: automatic, which you initiate by a momentary press of the EXP PAUSE key, and manual, which you control by a continuous press on the key. An automatic pause performs the maneuver until the pressure stabilizes, then takes its measurements. The pause lasts at least 0.5 second and does not exceed 3.0 seconds.
During a manual pause maneuver, the ventilator takes its measurements as soon as the pressure stabilizes or the pause ends. The ventilator continues the maneuver until you release the EXP PAUSE key. The pause cannot exceed 20 seconds.
Expiratory Pause Maneuvers (OP 4.10)
on page
OP 4-17
describes, in detail, how to use the EXP PAUSE key.
OP 1-9
Introduction
Table OP 1-1. Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator Function
Inspiratory pause key: Causes the ventilator to seal the patient’s breathing circuit at the conclusion of the gas delivery phase of a designated, volume- or pressure-based mandatory inspiration. This inspiratory pause maneuver provides a means to measure the patient’s static lung-thoracic compliance
(C
STAT
), static resistance (R
STAT
), and plateau pressure (P
PL
). The inspiratory pause maneuver maintains the inflated state of the lungs.
The ventilator performs two types of pause maneuver: automatic, which is initiated by the momentary press of the INSP PAUSE key, and manual, which you control by a continuous press on the key.
An automatic pause performs the maneuver until the pressure stabilizes, then the system takes its measurements. The pause event lasts at least 0.5 second but no longer than 2.0 seconds.
In a manual pause, the maneuver continues until you release the INSP PAUSE key, but cannot exceed 7 seconds. The ventilator computes C
STAT
and R
STAT at the end of the plateau and displays the values at the end of the maneuver.
P
PL
is computed and updated continuously during the plateau, and its value is frozen at the end of the plateau. Section
Expiratory Pause Maneuvers (OP
4.10)
on page
OP 4-17
describes, in detail, how to use the INSP PAUSE key.
Knob: Adjusts the value of a setting. A highlighted button on a touch screen means the knob is linked to that setting. Where applicable, a clockwise turn of the knob increases the highlighted value, and a counterclockwise turn of the knob decreases the highlighted value.
Clear: Cancels a proposed ventilator parameter value change.
Accept: Applies and saves new ventilator parameter value(s).
Red high-priority alarm indicator ( ! ! ! ): This alarm indicator blinks rapidly if active; it is steadily lit if autoreset.
Yellow medium-priority alarm indicator ( ! ! ): This alarm indicator blinks slowly if active; it turns off if autoreset.
Yellow low-priority alarm indicator ( ! ): This indicator is steadily lit if active; it turns off if autoreset.
Green normal ventilator operation indicator: When ventilation is active and no alarm states exist, this indicator is steadily lit. This indicator is off if the ventilator is not in a ventilation mode, for example, during service mode or short self test (SST).
OP 1-10
User Interface Controls and Indicators
Table OP 1-1. Puritan Bennett™ 840 Ventilator System GUI Controls and Indicators
Control or indicator
VENT INOP
Function
Red ventilator inoperative (VENT INOP) indicator: The ventilator cannot support ventilation and requires service. The ventilator enters the safe state
(safety ventilation) and discontinues detection of new patient data or alarm conditions. Qualified service personnel must repair the ventilator to correct the problem and execute EST successfully before normal ventilation is allowed. This indicator is accompanied by an audio signal and cannot be reset.
SAFETY VALVE OPEN
Red safety valve open (SVO) indicator: The ventilator has entered its safe state and opened its safety valve to allow the patient to breathe unassisted from room air.
BATTERY READY
Green BPS ready indicator: The ventilator senses that the BPS is installed, operational, and that it has a minimum of 2 minutes of estimated run time.
BATTERY ON
COMPRESSOR READY
Green compressor ready indicator: The compressor cable and air supply hose are connected to the ventilator. The compressor is up to operating pressure but not supplying gas to the ventilator. The compressor motor turns on intermittently to keep the compressor chamber pressurized.
COMPRESSOR ON
Battery on power indicator: When the yellow bar to the right of a lit BPS ready indicator is lit, the ventilator is operating on BPS, and AC power is insufficient to support ventilator operation. During BPS operation, power to the compressor unit and the humidifier outlet is off.
Green compressor operating indicator: When lit, compressor is supplying air to the ventilator. This indicator does not light unless the compressor is actually supplying air to the ventilator.
The indicators on the breath delivery unit are shown in
Table OP 1-2. BDU Indicators
Control or indicator
VENT INOP
Function
Red ventilator inoperative (VENT INOP) indicator: The ventilator cannot support ventilation and requires service. The ventilator enters the safe state
(safety ventilation) and discontinues detection of new patient data or alarm conditions. Qualified service personnel must repair the ventilator to correct the problem and execute EST successfully before normal ventilation is allowed. This indicator is accompanied by an audio signal and cannot be reset.
SAFETY VALVE OPEN
Red safety valve open (SVO) indicator: The ventilator has entered its safe state and opened its safety valve to allow the patient to breathe unassisted from room air.
DISPLAY
(GUI)
INOP
Red loss of GUI indicator: The ventilator has detected a malfunction that prevents the GUI from reliably displaying or receiving information. If you encounter a loss of the GUI display, see
Table TR 13-3.
on page
TR 13-14
for a list of recommended actions.
OP 1-11
Introduction
OP 1.5.1
Onscreen Symbols and Abbreviations
Touch an onscreen symbol to display its definition in the lower left corner of the lower screen. summarizes the symbols and abbreviations the ventilator uses. For example, if you touch:
The symbol definition area shows this message:
V
MAX
= Peak flow
OP 1-12
User Interface Controls and Indicators
Table OP 1-3. Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations
Symbol, icon, or abbreviation Definition
Blinking icon indicates that additional alarms related to the monitored information are active. The symbol blinks when there is not enough screen area to display all active alarms.
2
4
The upper alarm limit.
The lower alarm limit.
Touch to access the alarm log.
Alarm log contains events not yet viewed.
Rise time percent.
Flow pattern.
The value you selected for a ventilator control parameter exceeds its recommended limit (soft bound) and requires acknowledgment to continue
or the value selected exceeds its allowable minimum or maximum limit (hard bound).
Touch to view more patient data.
Touch to view patient data graphics.
Touch to view additional screens.
X-axis (time or pressure) adjustment of patient data graphics.
Y-axis (pressure, volume, or flow) adjustment of patient data graphics.
OP 1-13
Introduction f f
TOT
1 f
TOT
GUI
HME
I:E
P
PEAK
PEEP
PEEP
H
PEEP
I
PEEP
L
PEEP
TOT
PEEP
P
MEAN
1
P
PEAK
2
P
PEAK
3
P
PEAK
4
P
PEAK
O
2
O
2
1
O
2
%
3
O
2
%
PC
A/C
AV
C
STAT
E
SENS
EST
Table OP 1-3. Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations (Continued)
Symbol, icon, or abbreviation Definition
Baseline pressure (PEEP) adjustment.
Assist control ventilation mode
Apnea ventilation
Static compliance
Spontaneous expiratory sensitivity percentage
Extended self test
Respiratory rate (ventilator control parameter)
Total respiratory rate (monitored parameter)
High respiratory rate alarm
Graphic user interface
Heat-moisture exchanger
Inspiratory to expiratory ratio
Monitored oxygen percentage (patient data)
Oxygen percentage (ventilator control parameter)
High delivered O
2
% alarm
Low delivered O
2
% alarm
Pressure control (mandatory breath type)
Mean circuit pressure
High circuit pressure alarm
High circuit pressure alarm limit
Low circuit pressure alarm
Low circuit pressure alarm limit
Peak circuit pressure (patient data)
Positive end-expiratory pressure (ventilator control parameter)
High PEEP (ventilator control parameter, BILEVEL mode only)
Intrinsic PEEP (patient data)
Low PEEP (ventilator control parameter, BILEVEL mode only)
Total PEEP (patient data)
End expiratory pressure (patient data)
OP 1-14
User Interface Controls and Indicators
Table OP 1-3. Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations (Continued)
Symbol, icon, or abbreviation
P
I
P
I END
P
PL
POST
SST
T
A
T
E
T
H
T
I
1
T
I SPONT
2
T
I SPONT
T
L
T
PL
V
E SET
V
E SPONT
1V
E TOT
3V
E TOT
VC
V
MAX
V
SENS
V
T
PS
P
SENS
P
SUPP
P-TRIG
1
P
VENT
R
STAT
SIMV
SPONT
Definition
Inspiratory pressure
End inspiratory pressure (patient data)
Plateau pressure
Power on self test
Pressure support (spontaneous breath type)
Pressure sensitivity
Pressure support (ventilator control parameter)
Pressure triggering
High ventilator pressure alarm
Static resistance
Synchronized intermittent mandatory ventilation mode
Spontaneous ventilation mode
Short self test
Apnea interval
Expiratory time
High PEEP time (BILEVEL mode only)
Inspiratory time
High spontaneous inspiration time alarm
High spontaneous inspiration time alarm limit
Low PEEP time (BILEVEL mode only)
Plateau time
Set minute volume (calculated from ventilator control parameters)
Exhaled spontaneous minute volume
High exhaled minute volume alarm
Low exhaled minute volume alarm
Volume control (mandatory breath type)
Peak flow (ventilator control parameter)
Flow sensitivity
Tidal volume (ventilator control parameter)
OP 1-15
Introduction
Table OP 1-3. Puritan Bennett™ 840 Ventilator System Symbols and Abbreviations (Continued)
Symbol, icon, or abbreviation Definition
V
TE
3
V
TE MAND
3
V
TE SPONT
V
TI
1
V
TI
Exhaled tidal volume
Low exhaled mandatory tidal volume alarm
Low exhaled spontaneous tidal volume alarm
Inspired tidal volume
High inspired (mandatory or spontaneous) tidal volume alarm*
V
TI MAND
1
V
TI MAND
Inspired mandatory tidal volume
High inspired mandatory tidal volume alarm*
V
TI SPONT
Inspired spontaneous tidal volume
1
V
TI SPONT
High inspired spontaneous tidal volume alarm*
V
-TRIG
Flow triggering
*Refer to
HIGH INSPIRED TIDAL VOLUME Alarm (TR 13.11)
on page
TR 13-1
8
for information regarding inspired tidal volume alarms.
OP 1.6
Ventilator System Labeling Symbols
The following symbols appear on the various components of the ventilator system.
Note:
All labels shown are examples, and may not reflect the exact configuration of your ventilator.
Symbol or icon
Table OP 1-4. Labeling Symbols
Definition
Power switch positions: ON represents the power on position and represents the power off position. The power switch, located on the BDU front panel, turns the
BDU and the GUI on and off. When the power switch is in the off position, the BPS continues to charge if AC power is present.
Refer to manual: When this icon appears on the product, it means refer to documentation for information.
OP 1-16
Symbol or icon
Table OP 1-4. Labeling Symbols (Continued)
Definition
Type B equipment, per IEC 60601-1
Ventilator System Labeling Symbols
SN
Potential equalization point (ground): Provides a means of connection between the equipment and the potential equalization busbar of the electrical connection.
A common grounding point for the entire ventilator.
Indicates the degree of protection provided by enclosure
(drip-proof)
CSA certification mark signifies the product has been evaluated to the applicable ANSI/ Underwriters Laboratories
Inc. (UL) and CSA standards for use in the US and Canada.
Serial number
802 BPS charging status indicator: When the ventilator is operating on mains power, the top symbol (green LED next to gray battery icon) on the front of the BPS indicates the 802 BPS is charged, and the bottom symbol (yellow
LED next to gray battery icon) on the front of the BPS indicates the BPS is charging.
803 BPS charging status indicator: Indicates the charging status of the 803 BPS. A yellow LED next to the partially full battery icon indicates the battery is charging.
A green LED next to the full battery icon indicates the battery is charged.
Charging status indicator on the compressor-mount
cart: Indicates the charging status of the BPS. A yellow
LED next to the partially full battery icon indicates the battery is charging. A green LED next to the full battery icon indicates the battery is charged.
Battery indicator label: Indicates a 1-hour battery is installed in the compressor-mount cart.
OP 1-17
Introduction
Symbol or icon
Table OP 1-4. Labeling Symbols (Continued)
Definition
Battery indicator label: Indicates a 4-hour battery is installed in the compressor-mount cart.
Charging status indicator on the pole cart: Indicates the charging status of the battery. A yellow LED next to the partially full battery icon indicates the battery is charging. A green LED next to the full battery icon indicates the battery is charged.
Battery indicator label: Indicates a 1-hour battery is installed in the pole cart.
Battery indicator label: Indicates a 4-hour battery is installed in the pole cart.
DATA KEY
TEST
PTS 2000
DISPLAY
(GUI)
Ventilator circuit breaker
Compressor & humidifier circuit breaker
Data key connection:
CAUTION: Do not remove the data key. The data key enables software options, and stores ventilator operational hours, compressor unit operational hours, and the serial numbers for the BDU and GUI. The ventilator will not operate without its factory-installed data key.
TEST button: After you touch the SST onscreen button
(available only during ventilator startup), you must press the TEST button within 5 seconds in order to access SST.
Puritan Bennett™ PTS 2000 Performance Test System connection: For use by qualified service personnel only, to run performance verification tests.
GUI connection.
Circuit breaker for ventilator power supply, located in the
BDU.
Ventilator circuit breaker for compressor and humidifier.
Alternating current (at AC inlet and AC power indicator).
OP 1-18
Ventilator System Labeling Symbols
Table OP 1-4. Labeling Symbols (Continued)
Symbol or icon
Compressor outlet:
Definition
Maximum allowed output to auxiliary mains socket (compressor electrical connection).
5.6 A max
BPS electrical connection.
Exhalation filter latch unlock/lock.
Exhalation filter latch open indicator: This red indicator is located on the surface behind the closed latch, and is easily visible when the latch is open.
GUI mounting latch unlock/lock.
IOIOI
Remote alarm port.
RS-232 port.
Susceptible to electrostatic discharge.
Electric shock hazard.
Explosion hazard.
Fire hazard.
OP 1-19
Introduction
Symbol or icon
Table OP 1-4. Labeling Symbols (Continued)
Definition
802 BPS product information label
803 BPS product information label
GUI product information label
GUI ports label
Remote alarm and RS-232 port (9.4 inch GUI only). Refer to Appendix
OP E
for GUI remote alarm and RS-232 port specifications.
OP 1-20 Operator's and Technical Reference Manual
Ventilator System Labeling Symbols
Table OP 1-4. Labeling Symbols (Continued)
Symbol or icon Definition
Humidifier electrical label
(This label not visible unless the cover plate over the humidifier electrical connection is removed.)
BDU gas inlet label
BDU to patient label
Compressor gas connection label
OP 1-21
Introduction
Symbol or icon
Table OP 1-4. Labeling Symbols (Continued)
Definition
Compressor information label
BDU information label
OP 1-22 Operator's and Technical Reference Manual
Table OP 1-4. Labeling Symbols (Continued)
Definition Symbol or icon
BDU cooling vent label
Ventilator System Labeling Symbols
BDU I/O disconnect label
BDU exhaust information label
OP 1-23
Introduction
Table OP 1-4. Labeling Symbols (Continued)
Definition Symbol or icon
BPS electrical connection label
Compressor lint filter label
Expiratory limb connector on exhalation filter
OP 1-24
OP 2 How to Set up the Puritan Bennett™ 840
Ventilator
OP 2.1
Overview
•
•
•
Chapter
describes how to set up the Puritan Bennett™ 840 Ventilator System:
How to connect the electrical supply
How to connect the air and oxygen supplies
How to connect the patient circuit and accessories
A Covidien customer service engineer (CSE) must first install the ventilator and run extended self test (EST), which calibrates the exhalation valve, flow sensors, and atmospheric pressure transducer, before you connect a patient to the ventilator for the first time.
WARNING:
When you lift the ventilator, use assistance and appropriate safety precautions.
shows the proper technique to lift each ventilator component.
WARNING:
To avoid interrupted ventilator operation or possible damage to the ventilator, always use the ventilator on a level surface in its proper orientation.
WARNING:
To avoid the possibility of injury to the patient and ensure proper ventilator operation, do not attach any device to the port labeled EXHAUST unless the device is specifically authorized by
Covidien.
WARNING:
To minimize the increased risk of fire due to an oxygen enriched environment, do not use the ventilator in a hyperbaric chamber.
WARNING:
To avoid raising the oxygen concentration of room air, use the ventilator in an adequately ventilated room.
OP 2-1
How to Set up the Puritan Bennett™ 840 Ventilator
Figure OP 2-1. How to Lift the Ventilator Components
OP 2-2
1
2
3 Lift the GUI from the base and the handle Lift the BDU from horizontal surfaces as shown
Use two people to lift the compressor from the base and the handles
Caution:
Do not connect or disconnect the ventilator’s GUI, backup power source (BPS), or compressor while the power switch is on or the ventilator is connected to AC power.
Caution:
All components must be securely mounted and connected by qualified service personnel according to the appropriate Covidien installation instructions.
Caution:
Do not obstruct the BDU, GUI, or compressor cooling vents or fan vents.
Connecting the Electrical Supply
Caution:
To avoid possible damage to ventilator components, do not use the horizontal surfaces of the ventilator to place or stack objects.
Note:
Before you use the ventilator for the first time, wipe the ventilator exterior clean and sterilize its components according to the instructions in Chapter
OP 7
. Follow your institution’s protocol for cleaning and sterilizing the ventilator and its components.
OP 2.2
Connecting the Electrical Supply
WARNING:
To minimize the risk of electrical shock, always connect the ventilator power cord into a grounded
AC power outlet.
WARNING:
In the US, always connect the ventilator to an AC receptacle marked “Hospital Only” or “Hospital
Grade” to ensure proper grounding of the ventilator.
WARNING:
The 802 or 803 BPS must always be installed if you are using an RTA cart. Without the BPS, the ventilator is not protected against low or lost AC power. Do not use the ventilator unless a BPS with at least minimal charge is installed.
WARNING:
If you are using a newer compressor mount cart or pole cart, you must ensure you connect the battery backup system harness to the ventilator.
WARNING:
Do not disconnect the battery backup system, GUI, or compressor from the ventilator while in use.
WARNING:
When possible, connect the ventilator to an outlet connected to the hospital emergency backup power system. Refer to section
OP A.5
for ventilator electrical specifications.
Normally the ventilator system is mains-powered. The 802 or 803 BPS or battery backup system in newer compressor mount carts and pole carts operates the ventilator when AC power is lost or drops below a minimum level.
A new, fully charged 802 BPS can operate the ventilator (without the compressor or a humidifier) for a minimum of 60 minutes (30 minutes on ventilators built prior to July 2007); allowing the ventilator to be used for transport purposes within the healthcare facility. A new, fully charged 803
OP 2-3
How to Set up the Puritan Bennett™ 840 Ventilator
BPS (available after October 2009) can operate the ventilator (without the compressor or a humidifier) for a minimum of 4 hours. The same conditions apply, respectively, to the 1-hour or 4-hour
BPS assemblies in the compressor mount cart and the pole cart.
WARNING:
The 802 or 803 BPS and the battery backup systems in the compressor mount cart and the pole cart are intended for short-term use only, and are not intended as primary alternative power sources.
The BPS and battery backup systems are intended to power the BDU and GUI only. In case of AC power loss, power is not available to run either the compressor or the humidifier.
If you turn on the ventilator after it has been unplugged for an extended period, the LOW
BATTERY alarm may sound. If this occurs, recharge the 802 or 803 BPS or battery backup system in the compressor mount cart or pole cart by leaving it connected to a ventilator connected to
AC power for up to 8 hours (ventilator does not need to be turned on). Because of the larger battery capacity, the 803 BPS or 4-hour BPS or battery in the compressor mount cart or pole cart may take up to 20 hours to recharge. If, after turning the ventilator back on, the LOW BATTERY alarm is still active or if the INOPERATIVE BATTERY alarm is active, qualified service personnel must replace the battery. The batteries should be recharged whenever they have been depleted.
Leaving them in a discharged state for longer than 24 hours may reduce their capacity. The same conditions apply, respectively, to the 1-hour or 4-hour BPS assemblies in the compressor mount cart and the pole cart.
shows how to connect the power cord to AC power. Built-in power cord retainer
tabs protect against accidental disconnection. Ensure the power cord is securely fastened into the
AC receptacle prior to operation. to remove the cord, squeeze the tabs on the top and bottom of the plug and pull outward.
Figure OP 2-2. How to Connect the Ventilator Power Cord
OP 2-4
Connecting the Electrical Supply
1 Power cord from AC power 2 Power cord retainer tabs. Squeeze tabs and pull outward to disconnect cord.
shows the power switch and AC indicator. When illuminated, the AC indicator indicates the ventilator is receiving AC power and the 802 and 803 BPS, and battery backup systems in the compressor mount cart and the pole cart will be recharged as needed. The AC indicator is independent of the power switch, and the power switch does not turn off AC power to the ventilator power supply. When both the power switch and AC indicator are on, power is available for the humidifier and compressor.
Figure OP 2-3. Ventilator Power Switch, AC Indicator, and AC Panel
1
2
3
4
AC power connection
Ventilator power supply circuit breaker
Ventilator power switch
AC power indicator
5
6
7
8
AC panel
Humidifier and compressor circuit breaker
Compressor connection
Potential equalization (ground) point
If the ventilator power supply circuit breaker (located on the ventilator's AC panel,
opens but AC power is still present and the ventilator is operating on BPS, power is still available
OP 2-5
How to Set up the Puritan Bennett™ 840 Ventilator to the humidifier and compressor connectors (although ventilator software disables compressor operation).
When the power cord is not in use, wrap the power cord around the hook on the back of the cart for convenient storage (
). The power cord is stored the same way
on the compressor mount cart and the pole cart.
OP 2-6
Figure OP 2-4. Power Cord Storage on the RTA Cart
Connecting the Electrical Supply
OP 2-7
How to Set up the Puritan Bennett™ 840 Ventilator
Figure OP 2-5. Power Cord Storage on the Newer Compressor Mount Cart and Pole Cart (shown)
OP 2.3
Connecting the Air and Oxygen Supplies
The ventilator system can use air and oxygen from cylinder or wall supplies. Follow these steps to connect the air and oxygen supplies:
OP 2-8
Connecting the Air and Oxygen Supplies
1.
Ensure the supply pressures are 241kPa to 690 kPa (35 psi to 100 psi), and the hospital gas piping system complies with ISO 7396:1987, Non-flammable Medical Gas Pipeline Systems, or an equivalent standard. Gas hoses must meet the requirements of EN 739:1998, Low-pressure Hose Assemblies for use with Medical Gases, and NFPA 99:2002, Standard for Healthcare Facilities.
2.
Connect the supply hoses to the inlet connectors at the rear of the ventilator (see
WARNING:
Connect only air to the air inlet, and only oxygen to the oxygen inlet. Do not attempt to switch air and oxygen or connect any other gas.
WARNING:
Always connect at least two gas sources to the ventilator to ensure a constant gas supply is available to the patient. There are three gas source connections: the compressor, air inlet, and oxygen inlet.
WARNING:
Do not use anti-static or electrically conductive hoses is the ventilator breathing system.
WARNING:
Use only gas supply hoses recommended by Covidien. Other hoses may be restrictive and may cause improper ventilator operation.
Caution:
To prevent damage to the ventilator, ensure the connections to the air and oxygen supplies are clean and unlubricated, and there is no water in the air or oxygen supply gas. If you suspect water in the air supply gas, use an external wall air water trap to prevent water damage to the ventilator or its components.
Caution:
The ventilator has not been validated by the manufacturer for use with nitric oxide, helium, or gas mixtures with helium.
Note:
When you connect a pressurized air or oxygen source, the ventilator air and oxygen regulators have a maximum bleed rate of 3 L/min, even when the ventilator is not in use. Always take this bleed rate into account when calculating air and oxygen usage.
When the air and oxygen hoses are not in use, you can wrap them around the hook on the back of the cart for convenient storage (
).
OP 2-9
How to Set up the Puritan Bennett™ 840 Ventilator
Figure OP 2-6. How to Connect the Air and Oxygen Supplies
1
2
Air inlet connector
Oxygen inlet connector
3
4
Air hose (from air supply)
Oxygen hose (from oxygen supply)
OP 2.4
Connecting the Patient Circuit Components
WARNING:
The use of filters on the inspiratory gas outlet and expiratory gas inlet are intended to protect the gas pathway from contamination by body fluids or expired gases. To minimize the risk of bacterial contamination or component damage, inspiratory and expiratory filters must always be handled with care and connected to the ventilator during use.
WARNING:
To minimize the risk of patient injury, use only patient circuits qualified for use in oxygen-enriched environments with the ventilator system. Do not use anti-static or electrically conductive tubing in the ventilator breathing system. To ensure a leak-tight connection, only use connectors and
OP 2-10
Connecting the Patient Circuit Components
tubes with ISO standard cone and socket fittings (or use adapters to connect barbed cuff fittings to ISO-standard fittings).
WARNING:
If you use an external, pneumatically-powered nebulizer with the ventilator system, it adds flow to the patient circuit and can adversely affect spirometry, delivered O
2
%, delivered tidal volumes, and breath triggering. Additionally, aerosolized particulates in the ventilator circuit can lead to an increase in exhalation filter resistance.
WARNING:
Use one of the patient circuits listed in Appendix
OP B
to ensure the maximum pressure/flow values specified by IEC 60601-2-12:2001 are not exceeded (see
Table OP A-11.
on page
OP A-11
for patient circuit testing specifications). Using a circuit with a higher resistance does not prevent ventilation, but can cause a short self test (SST) fault or compromise the patient’s ability to breathe through the circuit.
Note:
Covidien recommends you run short self test (SST) every 15 days, between patients, and when you change the patient circuit (particularly when you change the circuit type, for example, from adult to pediatric or neonatal).
Note:
Covidien recognizes the protocol for running SST varies widely among health care institutions. Covidien does not specify or require specific practices that will meet the needs of all institutions, nor is Covidien responsible for the effectiveness of institutional practices.
OP 2.4.1
Selecting and Connecting a Patient Circuit
Use low-compliance patient circuits to ensure optimum compliance compensation, and use pediatric patient circuits when the patient ideal body weight (IBW) is greater than 7 kg (15 lb) but less than or equal to 24 kg (53 lb). Use the NeoMode software option and neonatal patient circuits for patients whose IBW is less than or equal to 7 kg.
For patients whose IBW is less than or equal to 24 kg, the compliance compensation volume limit is four times the set tidal volume, in addition to the set tidal volume. To avoid activating a severe occlusion alarm, only use neonatal patient circuits with the NeoMode software option.
shows IBW values and patient circuit types. The “Allowed but not recommended”
ranges require an override.
WARNING:
Recommended ranges exist to ensure patient safety. Only those with the expertise to judge the appropriate circumstances should override the recommended ranges.
OP 2-11
How to Set up the Puritan Bennett™ 840 Ventilator
Table OP 2-1. Patient circuit and IBW values
Recommendation
Recommended
Allowed but not recommended
Ideal body weight (IBW) in kg (lb)
Neonatal: 0.3 kg–7.0 kg (0.66 lb–15 lb)*
Pediatric: 7.0 kg–24 kg (15 lb–53 lb)
Adult: 25 kg–150 kg (55 lb–330 lb)
*Assumes NeoMode 2.0 software option is installed
Neonatal: Not applicable
Pediatric: 3.5 kg–6.5 kg (7.7 lb–14.3 lb), and 25 kg–35 kg (55 lb–77 lb)
Adult: 7 kg–24 kg (15 lb–53 lb)
shows how to connect the patient circuit, including the inspiratory filter, humidifier
(if used), inspiratory limb, patient wye, expiratory limb, collector vial, and expiratory filter.
Figure OP 2-7. How to Connect the Patient Circuit
OP 2-12
1
2
3
4
5
From patient
Expiratory filter
Expiratory limb of patient circuit
Patient wye
Collector vial
6
7
8
9
10
Inspiratory limb of patient circuit
Humidifier
Tubing
Inspiratory filter
To patient
Connecting the Patient Circuit Components
WARNING:
To ensure all patient circuit connections are leak-tight, always perform a circuit leak test by running SST each time you install the expiratory filter on the ventilator.
WARNING:
Adding accessories to the ventilator can increase system resistance. Ensure any changes to the recommended ventilator circuit configurations do not exceed the specified values for inspiratory and expiratory resistance (Appendix
OP A
). If adding accessories to the patient circuit, always run
SST to measure circuit compliance before beginning patient ventilation.
OP 2.4.2
Installing the Expiratory Filter and Collector Vial
Install the expiratory filter and collector vial as follows:
1.
Place the expiratory filter latch in the up position (see
2.
Slide the expiratory filter into the housing area with the expiratory limb connection facing you.
3.
Push the expiratory filter latch down; it will position the filter properly.
4.
Attach the expiratory limb of the patient circuit to the filter’s expiratory limb connection.
If you do not use a drain bag, be sure to cap the collector vial drain port on the expiratory filter
).
Figure OP 2-8. How to Install the Expiratory Filter and Collector Vial
1
2
Pull the latch up to install filter, pull down to hold filter and collector vial in place.
Slide the filter rim onto these tracks
4
5
6 3 Filter housing area
If you use a drain bag:
Expiratory filter
Expiratory limb connection (from
patient)
Collector vial
OP 2-13
How to Set up the Puritan Bennett™ 840 Ventilator
1.
Install the expiratory filter. (Refer to the instructions above.)
2.
Install the clamp on the drain bag tubing, ensuring the clamp is closed.
3.
Uncap collector vial drain port at the base of the collector vial.
4.
Connect the collector bag tubing to the vial drain port.
5.
Connect the other end of tubing to drain bag.
6.
If the ventilator is mounted on the cart, place the drain bag in the cart drawer (if you have an older style ready-to-assemble cart) or hang the drain bag on the button provided on the side of the newer style ventilator compressor mount cart or pole cart (
WARNING:
Do not attempt to clean, reprocess, or reuse the drain bag as this poses the risk of infection to medical personnel and the patient.
Figure OP 2-9. How to Use the Collector Vial With or Without the Drain Bag
OP 2-14
Connecting the Patient Circuit Components
1 Clamp
2
Place the drain bag in the cart drawer of the RTA cart or hang the drain bag on the button provided. The collector vial drain port must be capped if you do not use a drain bag on the side of the cart
Drain bag
4
5 The collector vial drain port must be capped if you do not use a drain bag.
3 Tubing
Note:
Check the inspiratory and expiratory limbs of the patient circuit, the collector vial, and the in-line water traps regularly for water buildup. Under certain conditions, they can fill quickly. Empty and clean the collector vial and in-line water traps as necessary.
OP 2.4.3
Installing the Flex Arm
The flex arm supports the patient circuit between the ventilator and the patient.
show how to install the flex arm onto one of the two (in ready-to-assemble carts) or four (in newer compressor mount cart or pole cart) threaded sockets on the ventilator cart.
OP 2-15
How to Set up the Puritan Bennett™ 840 Ventilator
Figure OP 2-10. How to Install the Flex Arm on the RTA Cart
OP 2-16
1 Flex arm 2 Threaded socket (one of two)
Connecting the Patient Circuit Components
Figure OP 2-11. How to Install the Flex Arm on the Newer Compressor Mount Cart or Pole Cart
1 Flex arm 2 Threaded socket (one of four)
Caution:
Use only the cart handles to move the ventilator. Do not pull or push the ventilator with the flex arm.
OP 2-17
How to Set up the Puritan Bennett™ 840 Ventilator
Flex arm replacement parts can be found in the Puritan Bennett™ 840 Ventilator System Service
Manual.
OP 2.4.4
Installing the Humidifier
An electrical outlet for a humidifier is located on the front of the BDU.
shows how to install a Fisher & Paykel™* humidifier onto the ventilator for ventilators mounted on RTA carts.
Separate humidifier installation instructions are shipped with humidifier mounting kits listed in
Table OP B-2.
and
Table OP B-3.
of appendix
OP B
for humidifiers mounted on compressor mount carts and pole carts, respectively.
WARNING:
When using a Fisher & Paykel™* humidifier with the Puritan Bennett™ 840 ventilator, use the appropriate Fisher & Paykel™* humidifier chambers for adult, pediatric, and neonatal patients.
WARNING:
Take proper precautions to prevent water/condensate from splashing into the patient circuit during circuit disconnects and high peak flow rate conditions.
WARNING:
To avoid possible patient injury or damage to the ventilator system, follow your institution’s protocol for proper patient circuit condensate management.
Caution:
Qualified service personnel must first install the humidifier mounting hardware.
Caution:
To avoid equipment damage to the ventilator due to liquid ingress:
Install the plug cover when the humidifier is plugged into the ventilator.
•
•
Install the flat cover plate over the humidifier electrical outlet on the front of the BDU when the humidifier is not plugged into the ventilator.
Note:
To ensure uninterrupted ventilator operation, do not install a humidifier whose maximum current capabilities exceed 2.3 A, with a maximum power consumption of 270 VA.
Note:
When you install a Fisher & Paykel™* humidifier, make sure the humidifier has a right-angle electrical plug.
A short power cord is preferable.
OP 2-18
Connecting the Patient Circuit Components
Note:
To ensure ventilator occlusion detection operates properly, do not use Puritan Bennett™ Cascade humidifiers with the Puritan Bennett™ 840 Ventilator System.
Note:
If you have further questions about humidifiers qualified for use with the ventilator system, contact
Technical Services or your local Covidien representative.
Figure OP 2-12. How to Install the Humidifier (Fisher & Paykel™* version shown) for Ventilators Mounted on RTA Carts
1
2
BDU
Plug cover
3
4
Humidifier
Mounting bracket on front of ventilator
OP 2.4.5
Using the Ventilator Cart
Three optional carts are available for use with the Puritan Bennett™ 840 ventilator: the RTA (readyto-assemble) cart, the Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart, and the
Puritan Bennett™ 800 Series Ventilator Pole Cart. The RTA cart can be used with the 802 or 803 BPS, and newer compressor mount carts can be used with a BPS having a 1-hour battery or an optional
OP 2-19
How to Set up the Puritan Bennett™ 840 Ventilator
4-hour battery. The pole cart also has a 1-hour or optional 4-hour battery as part of its battery backup system.
WARNING:
Install only ventilator BDUs with serial numbers starting with 3512 onto the newer compressor mount cart and pole cart. Other ventilator serial numbers are not compatible with the newer carts.
The compressor mount cart and pole cart may not be available in all regions. Contact your local
Covidien representative for more information.
To locate the cart’s lot number, a label is applied underneath the cart handle on the cart’s spine weldment (
Figure OP 2-13. Location of Cart Lot Number Label
1 Cart lot number label
WARNING:
Lock the cart’s wheels prior to installing or removing ventilator components.
show how to lock and unlock the cart’s front wheels.
WARNING:
To avoid interrupted ventilator operation or damage to ventilator components, use the cart to move the ventilator. Do not use the cables, the power cord, GUI, or patient circuit components to push or pull the ventilator.
OP 2-20
Connecting the Patient Circuit Components
Figure OP 2-14. How to Lock and Unlock the RTA Cart’s Front Wheels
1 Locked position: Press small tab down to unlock.
2 Unlocked position: Press large tab down to lock
Figure OP 2-15. How to Lock and Unlock the
Compressor Mount Cart or Pole Cart Front Wheels
1 Unlocked position: Lift up to unlock 2 Locked position: Press down to lock
OP 2-21
How to Set up the Puritan Bennett™ 840 Ventilator
Page Left Intentionally Blank
OP 2-22
OP 3 How to Run Short Self Test (SST)
OP 3.1
Overview
•
•
•
•
•
Chapter
tells you:
When to run SST
Required equipment for SST
SST tests and their functions
How to set up and run SST
How to understand the results of
SST
OP 3.2
Introduction to SST
•
•
•
•
•
SST uses an internal, programmed sequence of tests to:
Verify proper function of the flow and pressure sensors
Check the patient circuit for gas leaks
Measure the expiratory filter resistance
Measure patient circuit resistance
Measure patient circuit compliance
SST requires approximately 3 minutes to complete.
WARNING:
Always disconnect the ventilator from the patient before you run SST. If you run SST while the ventilator is connected to the patient, physical injury to the patient may occur.
WARNING:
An ALERT reported by SST indicates the ventilator or a related component has a defect. Repair the ventilator or related component before you use the ventilator on a patient, unless you can determine with certainty the defect cannot create a hazard for the patient, or add to the risks that may occur from other hazards.
OP 3-1
How to Run Short Self Test (SST)
WARNING:
When you run SST, configure the patient circuit exactly as it will be used on the patient (for example, with same accessories). If you add accessories to the patient circuit after you run SST, you must rerun SST with the new accessories before you begin to ventilate the patient.
OP 3.3
When to Run SST
Note:
Covidien recognizes health care institutions may have their own ventilator protocols. However, Covidien is not responsible for the effectiveness of any institution’s protocols. Nor can Covidien specify, or require, specific practices to meet the internal needs of every health care institution.
•
Covidien recommends running SST when one or more of the listed events occurs:
When you replace the patient circuit and the exhalation filter after 15 days of use
•
•
•
•
•
•
When you are ready to connect a new patient to the ventilator
When you connect a different patient circuit to the ventilator
When you install a new or sterilized expiratory filter
When you change the patient circuit type
When you change the humidification device type
When you remove or add accessories to the patient circuit, such as a humidifier, water trap, or drain bag
•
•
•
Use SST at any time, provided a patient is not attached to the ventilator to:
Check the patient circuit for gas leaks
Calculate patient circuit compliance and resistance
Calculate expiratory filter resistance
After SST begins, the system prompts you to prepare the ventilator to conduct certain tests. The system waits indefinitely at a prompt until you take action and respond appropriately.
OP 3.4
SST Components and Requirements
•
•
When you conduct SST, you must have available the components and equipment you will use on the patient:
Patient tubing
Expiratory filter and collector vial
OP 3-2
SST Procedure
•
•
•
Inspiratory filter
Humidifier, as applicable
Other accessories (e.g., water traps, drain bag), as applicable
•
•
Additional requirements include:
A number 1 rubber stopper to block the airway at the patient wye
Two gas sources (air and oxygen) connected to the ventilator
•
Each gas source pressure must be between 241 kPa to 690 kPa (35 psi to 100 psi)
Caution:
To prevent SST failures due to leaks, ensure any circuit components such as collector vial drain port cap (if not using a drain bag), the seal between the expiratory filter and collector vial, and water trap (if used) seals are properly installed.
Caution:
If you are using a drain bag, ensure the tubing is properly installed on the collector vial drain port and the tubing is clamped. If the drain bag tubing is not clamped during SST, large leaks and large compliance values are possible which may cause SST to report ALERTs or FAILUREs.
Wait at least 10 minutes after you turn on the ventilator before you run SST. The warm up time of
10 minutes will stabilize the ventilator and ensure the accuracy of the SST tests.
OP 3.5
SST Procedure
WARNING:
Always disconnect the ventilator from the patient before you run SST. If you run SST while the ventilator is connected to the patient, physical injury to the patient may occur.
To run SST
1.
Turn the power switch (located on the front of the BDU). The system conducts the POST (power-on self test) and displays the ventilator startup screen.
2.
Allow the ventilator to stabilize for ten10 minutes with the power on.
3.
Install the patient circuit, and the expiratory and inspiratory filters you will use to ventilate the patient.
Caution:
The patient circuit must be unobstructed and properly connected to the ventilator to ensure accurate circuit resistance measurement.
OP 3-3
How to Run Short Self Test (SST)
4.
At the ventilator startup screen, touch the SST button (lower touch screen), then press the TEST button
(on the left side of the BDU) within five5 seconds. (Refer to
ton.) The system displays the SST Setup screen (lower touch screen).
Note:
You must press the TEST button within five5 seconds of touching the SST button or SST will not start.
Figure OP 3-1. Test Button Location
OP 3-4
Caution:
Do not press the test button when powering up the ventilator. This may cause the ventilator to enter Service Mmode. If you enter Service Mmode, do not attempt to run Eextended Sself
Ttest (EST) with a patient circuit. Doing so will cause EST to fail. If EST fails, the ventilator will remain in a Vvent Iinop state until EST successfully passes.
If you accidentally enter Service Mmode, exit Service Mmode by touching the EXIT button on the lower GUI screen and then pressing the ACCEPT key.
5.
Touch the PATIENT CIRCUIT key in the lower touch screen, then use the knob to select either Adult,
Pediatric, or Neonatal (if NeoMode software option is installed) patient circuit.
6.
Touch the HUMIDIFICATION TYPE key in the lower touch screen, then use the knob to select the humidification type you will use for patient ventilation. If you will not use a humidifier, set the humidification type to HME.
7.
Press ACCEPT to complete your selection of the patient circuit and humidification types.
WARNING:
Incorrectly specifying the patient circuit type or changing the patient circuit type after you have run SST can affect the accuracy of the compliance calculation, the measured exhaled tidal volume, and delivered/measured inspired tidal volumes. You must rerun SST when you change the circuit type. Compliance calculation and tidal volume accuracy may also be
SST Procedure
affected by incorrectly specifying or changing the humidifier after running SST. If you change humidifiers, ensure you change the humidification type as described in Section 4.8
Setting
Alarms
, page OP 4-14. For optimum accuracy, rerun SST using the new humidifier.
8.
The ventilator automatically starts the test sequence. Refer to
for details regarding each
SST test step. The SST flow sensor, expiratory filter, circuit resistance, and compliance calibration tests require your intervention. The system will wait indefinitely for your response. Otherwise you don’t need to do anything unless a test result is ALERT or FAILURE, or SST is complete.
9.
As each test is performed, the SST Status screen shows test results (see
WARNING:
To ensure reliable SST results, do not repeat an individual test with a different patient circuit if the test result is FAILURE or ALERT. If you suspect a defective patient circuit, replace the patient circuit and restart SST from the beginning.
10.
You can touch EXIT SST during SST to halt testing. You can touch EXIT SST again to resume testing, or press ACCEPT to restart the ventilator (if SST has not detected an ALERT or FAILURE).
WARNING:
To ensure correct compensation for circuit resistance and compliance, do not exit SST until the entire SST is successfully completed. Do not begin normal ventilation until the entire SST is successfully completed with the correct patient circuit installed.
11.
When all of the tests in SST are complete, the SST Status screen displays all individual test results and
SST outcome.
summarizes overall SST outcomes and how to proceed in each case.
12.
To begin normal ventilation (if SST has not detected an ALERT or FAILURE), touch EXIT SST, then press
ACCEPT.
13.
The ventilator reruns POST.
14.
The ventilator displays the ventilator startup screen. Proceed with ventilator startup to configure the system for the patient.
OP 3-5
How to Run Short Self Test (SST)
Table OP 3-1. SST Test Sequence
SST Setup
Test step Function
The system prompts you to specify the patient circuit type and humidification type you will use for patient ventilation.
Comments
1. Specify the patient circuit type.
2. Specify the humidification type.
You can select one of three humidification types:
• Heated expiratory tube
• Non-heated expiratory tube
• HME (heat-moisture exchanger)
3. For non-HME humidifiers, specify the dry humidifier volume.
Use the specified volume, not the compressible volume, of the humidifier.
4. Press the ACCEPT key.
WARNING: Select the correct patient circuit type and humidification type. Otherwise, faulty occlusion detection and erroneous expiratory spirometry can result.
NOTE:
The HUMIDIFIER VOLUME button is not visible on the touch screen if you select HME.
SST Flow Sensor Test
The system prompts you to connect the patient circuit to the inspiratory filter.
Use
Figure OP 2-7.
on page
OP 2-
12
to connect the patient circuit.
1. Connect the patient circuit to the inspiratory filter— but without the humidifier.
2. Press ACCEPT to begin the test.
NOTE:
Do not run the Flow Sensor Test with a humidifier installed, even if you will use a humidifier when you begin patient ventilation.
The system prompts you to block the patient wye.
3. Block the wye with a number 1 stopper.
4. Press ACCEPT.
The system checks the accuracy of the inspiratory and expiratory flow sensors.
After the test completes, the system prompts you to connect the humidifier.
If the status of the SST Flow
Sensor Test is FAILURE, you cannot use the OVERRIDE function.
NOTE:
If you will use a humidifier during patient ventilation, connect the humidifier to the patient circuit after the system passes the SST Flow Sensor Test. Refer to
Figure OP 2-7.
on page
OP 2-12
for connection information.
Circuit Pressure Test The system verifies proper function of the BDU pressure sensors.
If the status of the Circuit Pressure
Test is FAILURE, you cannot use the OVERRIDE function.
OP 3-6
SST Procedure
Test step
Circuit Leak Test
Circuit Resistance
Table OP 3-1. SST Test Sequence (Continued)
Expiratory Filter Resistance Test
Function
The system determines the ability of the circuit to hold pressure.
The system displays the drop in circuit pressure over a 10-second interval.
The system prompts you to detach circuit tubing from the expiratory filter.
At the conclusion of the Expiratory Filter Resistance Test, the system displays the pressure drop across the expiratory filter.
The system prompts you to reattach the patient circuit.
The system prompts you to unblock the patient wye.
The system displays the pressure drop across the inspiratory and expiratory limbs.
The reported pressure drop includes the effect of all devices installed on each limb, such as filters, water traps, or a humidifier.
Comments
If the system reports ALERT and you choose to override the alert status, the result can be improper compliance compensation, inaccurate tidal volume delivery, or autotriggering during patient ventilation. If the test detects excessive leaks, the system reports a FAILURE.
1. Detach the patient circuit from the expiratory filter.
2. Press ACCEPT to begin the test.
If the system reports an ALERT for the Expiratory Filter Resistance
Test and you override the ALERT, an inaccurate patient pressure estimation can result.
The system will report a FAILURE if the test detects an exhalation compartment occlusion or an expiratory filter occlusion.
If you do not correctly follow the prompts to disconnect and connect the patient circuit, the system will report a FAILURE.
3. Reattach the patient circuit to the expiratory filter.
4. Press ACCEPT to begin the next test.
1. Remove the stopper from the wye.
2. Press ACCEPT to begin the test.
If the system reports an ALERT for the pressure drop across the two limbs and you override the ALERT, an inaccurate patient pressure estimation can result.
The system reports a FAILURE if the test detects excessive high or low limb resistance, or if you do not follow the prompt to unblock the wye.
OP 3-7
How to Run Short Self Test (SST)
Test step
Compliance Calibration
Table OP 3-1. SST Test Sequence (Continued)
Function
The system prompts you to block the patient wye.
If you selected a humidification type of either Heated exp tube or
Non-heated exp tube, the ventilator prompts you to indicate if there is water in the humidifier.
The system displays the compliance of the patient circuit.
The system prompts you to unblock the patient wye.
Comments
1. Block the wye with a number 1 stopper.
2. Press ACCEPT to begin the patient circuit compliance test.
3. Press ACCEPT to indicate YES or
CLEAR to indicate NO, as appropriate, to indicate whether or not there is water in the humidifier.
If the system reports an ALERT for the patient circuit compliance and you override the ALERT, improper compliance compensation or inaccurate tidal volume delivery can result.
The system reports a FAILURE if the test detects an out-of-range compliance condition.
4. Remove the stopper from the patient wye.
5. Press ACCEPT to complete the
SST test sequence.
OP 3.6
SST Results
The Puritan Bennett™ 840 Ventilator System uses four status categories to characterize the individual SST test results, and the overall SST outcome.
ALERT
You can override an ALERT reported for an individual test if you can determine with certainty the defect in the ventilator or related component cannot create a hazard for the patient, or add to the risks arising from other hazards.
Note:
If an ALERT is reported and you exit SST without overriding the ALERT, the ventilator will enter the safety valve open (SVO) state and cannot be used for normal ventilation until SST passes or the ALERT is overridden.
FAILURE
When the system declares a FAILURE for an individual test in the SST sequence, the ventilator enters the SVO state. When a ventilator experiences a FAILURE, immediately remove the equipment from clinical use until qualified service personnel have completed and verified the necessary repairs.
OVERRIDDEN
OP 3-8
SST Results
OVERRIDDEN is a final status of the overall SST outcome and indicates you used the override feature when the system reported an ALERT condition. (The ventilator must have ended the test with an ALERT condition.)
PASS
Pass is the final status of the overall SST outcome in which no alerts or failures were detected.
Refer to
to learn how to interpret and respond to each of these SST status categories.
OP 3.6.1
Interpreting Individual SST Test Results
SST reports a test result status for each of the individual tests. Use
to interpret SST test results and to determine how to respond.
If the test status is:
PASSED
ALERT
FAILURE
Table OP 3-2. Individual SST Test Results
it means:
The system did not detect a fault for the individual test.
The test result is not ideal, but is not critical.
If SST is in progress, it halts further testing and prompts you to make a decision.
Do this:
You do not need to do anything, unless you are prompted by the ventilator.
When the system prompts you, touch one of these buttons, then press ACCEPT:
EXIT SST Discontinue SST
A critical problem has been detected, and SST cannot complete until the ventilator passes the failed test.
RESTART SST Repeat SST from the beginning
NEXT Proceed to the next test
REPEAT Repeat the test
Touch one of these buttons, then press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Repeat SST from the beginning
REPEAT Repeat the test
OP 3.6.2
SST Outcomes
When SST has completed all of the tests, use
OP 3-9
How to Run Short Self Test (SST)
If the SST outcome is:
PASSED
ALERT
FAILURE
Table OP 3-3. Overall SST Outcomes
It means:
All tests passed.
Do this:
Touch one of these buttons, then press ACCEPT:
EXIT SST Exit SST and begin normal ventilation
One or more faults were detected. If you can determine with certainty this cannot create a hazard for the patient, or add to the risks which may arise from other hazards, you can choose to override the ALERT status and authorize ventilation.
RESTART SST Repeat SST from the beginning
Touch one of these buttons, then press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Repeat SST from the beginning
One or more critical faults were detected. The ventilator enters the SVO state and cannot be used for normal ventilation until SST passes. Service is required.
OVERRIDE Press ACCEPT to override the ALERT, as allowed by your institution’s protocol. Touch EXIT
SST, then press ACCEPT to begin normal ventilation.
Restart SST with a different patient circuit. Touch one of these buttons, then press ACCEPT:
EXIT SST Discontinue SST
RESTART SST Press ACCEPT to repeat SST from the beginning. If the failure persists, contact qualified service personnel.
OP 3-10
OP 4 How to use the
Puritan Bennett™ 840 Ventilator
OP 4.1
Overview
•
•
•
•
•
•
•
•
•
•
Chapter
provides the listed information:
How the Puritan Bennett™ 840 Ventilator System user interface is structured
How to start up the ventilator for a new or previous patient
How to change main settings
How to change other settings
How to set the humidification type, expiratory sensitivity, and disconnect sensitivity
How to enable or disable the oxygen sensor
How to select and set the variable that remains constant when the breath rate setting is changed
How to set the alarm limits
How to perform inspiratory and expiratory pause maneuvers
How to interpret inspiratory pause maneuver displays
•
How to use non-invasive ventilation (NIV)
Note:
The DualView touch screens use light beams to detect where you touch the screen. To avoid a DEVICE
ALERT alarm, do not place any foreign substances or objects on the screen.
OP 4-1
How to use the Puritan Bennett™ 840 Ventilator
OP 4.2
Structure of the User Interface
The following buttons are available on the upper and lower touch screens. These buttons appear across the bottom portion of each of the two screens.
Figure OP 4-1. Touch Screen User Interface
Upper screen
Display graphics
More patient data (e.g., O
2
%,
P
I END
)
Alarm log
(time, event, priority, alarm, analysis)
Active alarms Other screens Trending (if option is installed)
Diagnostic code log
(system diagnostic, system information,
EST/SST diagnostic logs)
Operational log (compressor, ventilator hours)
SST result log Ventilator configuration, revisions, serial numbers, part numbers, installed options)
Test summary
(time, date, outcome of
SST, EST)
Lower screen
Current/proposed setup (vent type, mode, breath types, trigger type, settings
Current/proposed apnea setup
Current/proposed alarm settings
Other screens
Communication setup (printer/DCI, baud rate, data bits, parity mode)
Time/date change More settings
(humidification type, O
2
sensor enable/disable, disconnect sensitivity, humidifier volume, and access to additional options)
OP 4-2
Patient Setup
OP 4.3
Patient Setup
WARNING:
Always complete the patient setup before you attach a patient to the ventilator. If you attach a patient before the setup procedure is complete, the ventilator issues a procedure error and initiates the safety ventilation mode.
When you turn on the ventilator, the ventilator automatically runs POST (power on self test). After
POST passes, the system displays the ventilator startup screen (
screen. The prompt area, located in the lower right corner of the lower screen, contains setup instructions.
Figure OP 4-2. Ventilator Startup Screen
OP 4-3
How to use the Puritan Bennett™ 840 Ventilator
OP 4.3.1
Ventilating With the Most Recent Control Parameters
To continue ventilation with the most recent ventilator control parameters, touch Same Patient and press ACCEPT. Ventilation does not begin until a patient is connected. A flashing reminder arrow prompts you to consider the previous tube ID and tube type if the prior Spontaneous Type used these parameters.
OP 4.3.2
Ventilating With New Control Parameters
Refer to
Table OP A-12.
for the descriptions, ranges, resolutions, accuracies, and new patient values of the available ventilator control parameters.
1.
Touch the New Patient button to select new ventilator control parameters for patient ventilation. If you want to return to the ventilator startup screen, touch the RESTART button.
2.
The system displays the new patient settings screen with the following buttons, and uses the rotary knob or drop-down menus to display the available selections.
IBW: Ideal body weight. Turn the knob to adjust the IBW. The proposed value is highlighted.
WARNING:
Always enter the IBW appropriate for the patient. The system uses the patient’s IBW to automatically set certain values, alarm limits, and parameter boundary limits for several initial parameters. (The IBW values correlated with patient height are listed in
) If you are changing IBW to a new value, all settings not currently applicable shall be automatically adjusted, if necessary, to their new patient value or to the minimum or maximum allowable value for the new IBW.
•
•
•
•
Vent Type: Determines the ventilation type
INVASIVE — conventional ventilation using either endotracheal (ET) or tracheostomy (trach) tubes
NIV (non-invasive) — ventilation using full-face masks, nasal masks, infant nasal prongs, or uncuffed
ET tubes (see
for specific information on how to use NIV)
•
•
•
Mode: Determines the type and sequence of breath delivery
A/C (Assist Control)
SIMV (synchronized intermittent mandatory ventilation)
SPONT (spontaneous)
CPAP (continuous positive airway pressure, available only with the NeoMode software option when vent type is NIV)
BILEVEL (available only with the BiLevel software option when vent type is invasive)
OP 4-4
Patient Setup
Mandatory Type:
Determines the type of mandatory breath control
•
PC (Pressure Control)
•
•
VC (Volume Control)
VC+ (Volume Control Plus available only with the Volume Ventilation Plus (VV+) software option when vent type is invasive)
•
•
(If the selected mode is SPONT, the mandatory type applies to manual inspirations only.)
Spontaneous Type: Determines type of support for spontaneous breaths
PS (Pressure Support)
TC (Tube Compensation Tube Compensation available only with the TC software option when
Vent Type is INVASIVE)
•
•
VS (Volume Support Volume Support available only with the VV+ software option when vent type is invasive)
PA (Proportional Assist™
1 available only with the PAV™*+ software option when vent type is invasive)
•
NONE
(If the selected mode is A/C, the Spontaneous Type button does not appear.)
Trigger Type: Determines the method used to detect patient inspiratory effort
•
•
P-TRIG (Pressure) (not available when vent type is NIV or when using the NeoMode option)
V
-TRIG (Flow)
3.
Touch the button and turn the knob to adjust the desired settings. When you complete your settings changes, touch CONTINUE. (You must touch the IBW button first before the CONTINUE button appears.)
Touch the button and turn the knob to adjust the desired settings. When you complete your settings changes, touch CONTINUE.
4.
The final new patient settings screen appears. Touch the button of each parameter you want to change, then turn the knob to select its value. To cancel this change, press the CLEAR key. To cancel all changes and start over, touch the RESTART button.
1.
Proportional Assist and PAV are registered trademarks of The University of Manitoba, Canada. Used under license.
OP 4-5
How to use the Puritan Bennett™ 840 Ventilator
Note:
The ventilator control parameter you are setting may be dependent upon other ventilator settings that determine its boundaries. Refer to the prompt area on the lower GUI screen (
Figure OP 1-1.
) for more information.
5.
Press ACCEPT to put all of your ventilation control settings into effect. Normal ventilation begins once a patient is connected.
6.
The Apnea Setup screen appears. Apnea settings are automatically determined based on IBW, circuit type, and mandatory breath type, but you can change them. If you change any apnea settings, press
ACCEPT to apply.
Although you are not required to change or confirm apnea settings, you should verify they are appropriate for the patient prior to ventilation.
WARNING:
Set the apnea interval (T
A
) to a value less than the expected or current breath period interval as a way of allowing the patient to initiate breaths while protecting the patient from the consequences of apnea.
7.
Press the ALARM SETUP button to review the current alarm limit settings on the alarm settings screen.
Ensure they are appropriate for the patient. To change any limit, touch the button and turn the knob.
To cancel, touch PROPOSED ALARM. To apply the settings, press the ACCEPT key.
You may choose to calibrate the ventilator’s oxygen sensor at this point. Press the 100% O
2
/ CAL 2 min or INCREASE O
2
2 min key located on the keyboard below the touch screens. See page
TR 15-4
for more information on calibrating the oxygen sensor.
During the oxygen sensor calibration, the ventilator delivers 100% oxygen (if available) for
2 minutes and calibrates the oxygen sensor in the BDU.
The ventilator always monitors the delivery of oxygen to the patient unless you disable the oxygen sensor. Touch the MORE SETTINGS button to access oxygen sensor disable or enable functions.
8.
After you accept the ventilation control parameters, you can attach a patient to the ventilator. Ventilation only begins when the ventilator senses that a patient is attached.
If you attach a patient before completing setup, the ventilator initiates safety ventilation mode and annunciates a PROCEDURE ERROR alarm that is reset once you complete the patient setup.
WARNING:
Each patient circuit type is appropriate for a specified range of IBW values. This information is summarized in
The recommended ranges exist to ensure patient safety. Only
those with expertise to judge the appropriate circumstances should override the recommended ranges.
OP 4-6
Patient Setup
OP 4.3.3
Patient Data and Current Settings
•
•
•
The top of the upper screen shows vital patient data. (Out-of-range data flashes to alert you.) The current breath type is indicated in the upper left corner:
C = Control
S = Spontaneous
A = Assist
You can access additional patient data when you touch the MOREPATIENT DATA button.
You can display the definitions for any symbol used in the patient data, alarm log, or settings areas by touching the symbol. The symbol definitions appear at the bottom of the lower touch screen.
Current ventilator control settings are displayed across the top of the lower touch screen (
2
/CAL 2 min key or the INCREASE O
2
2 min key, the lower touch screen automatically displays the IN PROGRESS indicator. If you touch the Alarm Silence key, the IN PROGRESS indicator will appear if there is no other higher-priority display active. Press the CANCEL button for either indicator to cancel the alarm silence or oxygen sensor calibration in progress.
OP 4-7
How to use the Puritan Bennett™ 840 Ventilator
Figure OP 4-3. Touch Screen Appearance During Normal Ventilation (shown with alarm silence and 100% O
2
/CAL in progress)
OP 4-8
3
4
1
2
Vital patient data area
Breath type (C= Control)
Alarm area
Patient data (upper screen)
7
8
5
6
Subscreen area
Main ventilator control settings
Ventilator settings (lower screen)
Subscreen area
Patient Setup
OP 4.3.4
Other Changes
The system initially sets most upper and lower alarm limits based on the patient’s IBW. After entering the IBW, review and change these alarm settings as needed.
mation needed to determine the patient’s IBW using the patient’s height.
Table OP 4-1. Ideal Body Weight (IBW) Based on Patient Height
6
6
6
6
6
6
5
6
6
6
6
5
5
5
5
5
5
ft
Patient height in
5
6
9
10
7
8
7
8
9
5
6
3
4
1
2
11
0
IBW (lb)
121
126
130
134
141
146
150
154
161
165
172
176
183
187
194
201
207
7
8
7
7
7
7
7
7
8
8
8
7
7
7
7
6
6
ft
Patient height in
10
11
2
3
0
1
1
2
3
9
10
11
0
7
8
4
5
IBW (lb)
300
309
317
324
331
269
278
287
293
238
245
251
258
212
217
225
231
The new patient tube ID value is the high value tube ID for the chosen IBW in
OP 4-9
How to use the Puritan Bennett™ 840 Ventilator
28–31
32–35
36
37–42
43–49
50
55
60
7–10
11–13
14–16
17–18
19–22
23–24
25–27
65
70
75
80–100
110–130
140–150
Table OP 4-2. Soft Bound Ranges for Ideal Body Weight (IBW) and Tube Internal Diameter (ID)
IBW (kg)
<7.0
Low value tube ID in mm
At this IBW, tube ID is not an allowable setting
NONE
8.0
8.0
8.5
9.0
7.0
7.0
7.5
7.5
6.0
6.5
6.5
7.0
5.0
5.5
5.5
6.0
NONE
NONE
NONE
5.0
High value tube ID in mm
At this IBW, tube ID is not an allowable setting
4.5
5.0
5.5
6.0
6.0
7.5
7.5
7.5
8.0
6.5
6.5
7.0
7.0
9.5
NONE
NONE
NONE
8.5
9.0
9.0
9.5
The patient circuit type you specify during SST determines several default settings and the ranges available for ventilator operation (
OP 4-10
Changing the Main Ventilator Control Parameters
Table OP 4-3. Patient Circuit and IBW Values
Recommendation
Recommended
Allowed but not recommended
(operator override required)
Ideal body weight (IBW) in kg (lb)
Neonatal patient circuit: 0.3–7.0 kg (0.66–15 lb)
1
*
Pediatric patient circuit: 7.0–24 kg (15–53 lb)
Adult patient circuit: 25 kg–150 kg (55–330 lb)
*IBW range assumes NeoMode 2.0 software option is installed
Neonatal patient circuit: Not applicable
Pediatric patient circuit: 3.5 kg–6.5 kg (7.7 lb–14.3 lb) and 25 kg–35 kg (55 lb–77 lb)
Adult patient circuit: 7.0 kg–24 kg (15 lb–53 lb)
1.
To use a neonatal patient circuit, the ventilator must have both the NeoMode software option and the NeoMode hardware installed.
OP 4.4
Changing the Main Ventilator Control Parameters
The main ventilator control parameters are the buttons displayed at the top of the lower screen.
Follow these steps to change main parameters:
1.
Touch button of the parameter you want to change.
2.
Turn the knob to the set the desired value. To cancel this change, press the CLEAR key to go back to the previous value.
3.
Repeat steps 1 and 2 for each parameter you want to change.
4.
To cancel your changes, press the CANCEL ALL button, or press ACCEPT to apply the new ventilator control parameters.
The lower screen displays monitored control parameters
other control parameters that affect them.
Set minute volume
(
V
E SET
)
Volume per weight ratio
(V
T
/IBW)
V
T SUPP
/IBW
Table OP 4-4. Monitored Ventilator Control Parameters
Displayed along with the breath timing bar whenever you select or change the respiratory rate (f) or volume control parameters.
Displayed when you select or change the tidal volume (V
T
, when breath type is VC) or target volume
(V
T
, when breath type is VC+).
Volume per weight ratio: displayed when you select or change the target support volume (V
T SUPP
, when breath type is VS) control parameter.
OP 4-11
How to use the Puritan Bennett™ 840 Ventilator
OP 4.5
Other Changes
1.
Touch the VENT SETUP button on the lower screen. The current vent setup screen appears.
2.
To change ventilation setup (IBW, vent type, mode, mandatory breath type, spontaneous type, or trigger type), touch its button then turn the knob to set the value. Proposed changes are highlighted.
To cancel the change just made, press the CLEAR key to go back to the previous setting. Press PRO-
POSED SETUP to cancel all changes and start over.
3.
Once you change IBW, you cannot change the mode, vent type, mandatory type, or spontaneous type, but you can, however, change the trigger type. If you change the IBW back to its original value, you can change any of the main control settings again. Similarly, if you change any of the main control settings, the GUI will prevent you from changing the IBW until you change the main control settings back to their original values. Also, if you are ventilating with TC or PA as the spontaneous type, you must ensure the tube ID specified is appropriate for the new IBW.
Note:
•
The intent of allowing IBW to be changed was ventilator settings would not be automatically changed. An exception is when tube ID <6 mm.
•
•
Given the current ventilator settings, if PAV™* would otherwise be an allowable spontaneous type
(except that tube ID <6 mm), then PAV™* becomes selectable.
If PAV™* is selected when tube ID <6 mm, tube ID shall be automatically set to its new patient value, based on the new IBW (see
for tube ID ranges corresponding with IBW).
An attention icon for tube ID (whether new or unchanged) displays whenever PAV™* is selected.
4.
After making any necessary changes, touch CONTINUE. Appropriate settings for the ventilation setup selected appear on the lower screen.
5.
For each ventilator setting you want to change, touch its button, then turn the knob to set its value.
To cancel this value, press the CLEAR key. Press PROPOSED SETUP to cancel all changes and start over.
6.
After making all necessary changes, review the control parameters, then press ACCEPT to apply all the new control parameters at the same time.
Note:
Once the changes are in effect, the PREVIOUS SETUP button appears at the bottom of the lower screen when you press VENT SETUP. This allows you to restore the entire previous setup (including alarm and apnea settings) in effect immediately before you made settings changes using the ventilator setup screen.
To restore the previous setup, touch PREVIOUS SETUP, then press ACCEPT.
OP 4-12
Constant Timing Variable During Rate Changes
OP 4.6
Constant Timing Variable During Rate Changes
•
•
If pressure control (PC or VC+ is the mandatory breath type in the ventilator setup, or if you have selected BILEVEL mode, you can select one of three available timing variables to be held constant when the respiratory rate setting changes. The selected timing variable is the one held constant during rate changes, and also the only one of the three timing variables you can adjust directly.
•
The three available timing variables for PC or VC+ mandatory breaths are defined as follows:
T
I
represents the inspiratory time. This timing variable determines the inspiratory interval for PC mandatory breaths.
I:E represents the inspiratory to expiratory ratio. This timing variable determines the ratio of inspiratory time to expiratory time for PC mandatory breaths.
T
E
represents the expiratory time. This timing variable determines the duration of expiration for PC mandatory breaths.
•
•
The three available timing variables for BILEVEL mode are defined as follows:
T
H
represents the time interval for the high PEEP level (PEEP
H
).
T
H
:T
L
determines the ratio of the high PEEP time interval to the low PEEP time interval for BiLevel breaths.
•
T
L
represents the time interval for the low PEEP level (PEEP
L
).
Follow these steps to view or change the timing variable held constant during respiratory rate changes:
1.
Touch VENT SETUP.
2.
Touch CONTINUE. A graphic of the breath timing bar appears in the lower screen, with a lock icon above each of the three timing variables (
Figure OP 4-4. T
I
(or T
H
) Selected as the Constant During Rate Change
1
2
T
I
or T
H
I:E or T
H
:T
L
3 T
E
or T
L
OP 4-13
How to use the Puritan Bennett™ 840 Ventilator
3.
Touch the lock icon of the timing variable you want to remain constant when the respiratory rate setting changes. The lock icon of your selection should now be a closed lock, as it appears above the
T
I
/T
H
In addition, the current value of your selected timing variable is highlighted within the breath timing graphic, and both this variable name and its current value are displayed in a highlighted box under the ventilator control parameter PC.
4.
Turn the knob to set the value of your constant timing variable.
5.
Review the selected timing variable and its value. Make changes if necessary, then press ACCEPT.
Note:
You can change the value of the constant timing variable at any time, but the value does not change as a result of changing the respiratory rate setting. For example, if you select T
I
to remain constant during rate change, you can still change the value of T
I
. Otherwise, the value of T
I
does not change (and the values of
I:E and T
E
do change) when you change the respiratory rate setting. This also holds true for the BiLevel variables T
H
, T
H
:T
L
, and T
L
.
OP 4.7
Changing Apnea Ventilation Settings
1.
Touch the APNEA SETUP button on the lower screen. The current Apnea Setup screen appears.
2.
If you select the apnea mandatory type setting (CHANGE VC/PC button), a button appears indicating the current mandatory type setting. Touch the button to reveal a drop-down menu of the available selections with the current selection highlighted. If desired, turn the knob to select a new mandatory type, then press CONTINUE to review the settings applicable to the chosen apnea mandatory type.
3.
For each setting you want to change, touch its button, then turn the knob to set its value. Proposed changes are highlighted. Press PROPOSED APNEA to cancel changes and start over.
Note:
The CHANGE VC/PC button disappears when you change other apnea settings until you press the
ACCEPT key to apply the changes.
4.
Once you’ve made any changes you want, review the settings, then press ACCEPT to apply all the new settings at the same time.
OP 4.8
Setting Alarms
The system initially sets most alarm settings based on the patient’s IBW. You should review all alarm settings, but you are not required to confirm or change them at startup.
1.
Touch the ALARM SETUP button (lower screen) to view the current alarm setup (see
).
The pointer to the left of each bar shows the current patient data value for each parameter, and high-
OP 4-14
Setting Alarms lighted blocks represent the recent range of corresponding patient data. The buttons to the right of each bar show the alarm limit(s) for each parameter.
2.
Touch the button for each alarm limit you want to change.
3.
Turn the knob to set the value you want (the active alarm limit button moves up or down with the selected value). Proposed values are highlighted. You can change more than one alarm setting before applying the changes. To cancel the last change made, press the CLEAR key to go back to the previous setting. Press PROPOSED ALARM to cancel all changes and start over.
Note:
•
You cannot set the upper and lower limits of an alarm to conflict with each other.
•
The upper limits for the spontaneous exhaled tidal volume and mandatory exhaled tidal volume alarms are always the same value. Changing the upper limit of one alarm automatically changes the upper limit of the other.
Figure OP 4-5. Alarm Setup
4.
Once you have made all of the desired changes and have reviewed the settings, press ACCEPT to apply.
OP 4-15
How to use the Puritan Bennett™ 840 Ventilator
You can touch the ALARM SETUP button at any time during ventilation to show the current limits and the monitored patient value (shown inside the white arrows in
) for each alarm limit.
OP 4.9
Changing Other Settings
The Other Screens button allows you to configure the communications (RS-232) ports, set or change the time and date, and access settings for the humidifier, oxygen (O
2
) sensor, and disconnect sensitivity.
To configure the communications ports, refer to Appendix
OP E
.
The Time/Date Change button allows you to set the current time of day and calendar date. The date format is selectable and includes a check for correct number of days in a month. For example, you cannot enter February 30.
Available date formats are:
DD MMM ‘YY (DD.MM) (default)
‘YY MMM DD (MM-DD)
‘YY/MM/DD (MM-DD)
MM/DD/’YY (MM-DD)
MM/DD/’YY (MM/DD)
DD/MM/’YY (DD.MM)
The time is shown in hours and minutes in a 24-hour clock format.
To set or change the time and date
1.
Touch the Other Screens button, then touch the Time/Date Change button.
2.
Touch the Date Format button and turn the knob to select your desired date format.
3.
Touch the corresponding button and turn the knob to change the values for day, month, year, hour, and minute. To cancel your changes, touch the Other Screens button again.
4.
Press ACCEPT to apply the new settings.
•
•
•
The More Settings button leads to settings that usually change infrequently. Three settings, listed below, are available:
Humidification type
Oxygen (O
2
) sensor
D
SENS
(disconnect sensitivity)
OP 4-16
Expiratory Pause Maneuvers
To change humidification type, humidifier volume (for non-HME humidifiers), or disconnect sensitivity (D
SENS
), or to enable or disable the O
2
sensor, and to change tube type or tube ID when using the TC option, follow these steps:
1.
Touch the Other Screens button, then touch the More Settings button.
2.
Touch the button of a parameter you want to change, then turn the knob to set the parameter value.
(You can change multiple parameters and then apply the changes all at once.)
For non-HME humidifiers, touch the Humidifier Volume button, then turn the knob to select the dry humidifier volume. (The Humidifier Volume button is not visible when HME is selected.) To leave settings unchanged, touch the Other Screens button again.
3.
Review the proposed parameters.
4.
Press ACCEPT to apply the new settings.
OP 4.10
Expiratory Pause Maneuvers
Pressing the EXP PAUSE key seals the breathing circuit during the expiratory phase of a designated breath. The designated breath can be mandatory or spontaneous, and must be followed by a mandatory inspiration. The expiratory pause maneuver allows pressure in the patient’s lungs to equilibrate with the pressure in the ventilator breathing circuit, and results in elevated circuit pressure if intrinsic PEEP (PEEP
I
) is present. An expiratory pause maneuver is used to estimate PEEP
TOT and PEEP
I
.
•
There are two types of expiratory pause maneuvers:
An automatic expiratory pause maneuver begins when you press the EXP PAUSE key momentarily. An automatic pause maneuver continues until the pressure stabilizes. An automatic expiratory pause maneuver lasts at least 0.5 second, but no longer than 3.0 seconds.
•
An automatic expiratory pause maneuver is most appropriate for patients whose airways remain open throughout exhalation. To cancel an automatic expiratory pause maneuver, press the CANCEL button on the lower screen.
A manual expiratory pause maneuver begins when you press and hold the EXP PAUSE key down. The manual expiratory pause maneuver continues until you release the key, up to a maximum of 20 seconds.
A manual expiratory pause maneuver is most appropriate for patients whose near end-expiratory flow shows signs of obstruction.
The most recently selected graphics are displayed and frozen when an expiratory pause maneuver begins, so you can see when the expiratory pressure stabilizes. At the end of the maneuver, the system displays the values for PEEP
I
and PEEP
TOT
.
OP 4-17
How to use the Puritan Bennett™ 840 Ventilator
Note:
•
If the patient triggers breaths during the waiting period prior to the start of the expiratory pause maneuver, the ventilator will wait approximately 1 minute while it detects the appropriate conditions to start the maneuver. If the conditions are not met during the wait period, the ventilator cancels the maneuver.
•
•
If the patient initiates a breath or an alarm occurs during the expiratory pause maneuver, the ventilator cancels the maneuver, and returns to normal ventilation. A message appears in the graphics display indicating the maneuver has been canceled.
The high pressure alarm condition and the action taken by the ventilator as a result of the high pressure alarm violation are active during expiratory pause maneuvers.
OP 4.11
Inspiratory Pause Maneuvers
When you press the INSP PAUSE key, the breathing circuit seals after the end of the gas delivery phase of a designated, volume- or pressure-based mandatory inspiration. This allows pressure in the lungs to equilibrate with the pressure in the breathing circuit, which results in a pressure plateau. An inspiratory pause maneuver begins at the end of gas delivery (VC breath) or when the set inspiratory time (T
I
) elapses (PC or VC+ breath). The maneuver begins at the end of the gas delivery phase of the current or the next breath.
This maneuver allows you to measure the patient’s static lung thoracic compliance (C
STAT
), static resistance (R
STAT
), and plateau pressure (P
PL
), or to maintain the inflated state of the lungs.
•
There are two types of inspiratory pause maneuver:
An automatic inspiratory pause maneuver begins when you press the INSP PAUSE key momentarily.
An automatic inspiratory pause maneuver continues until the pressure stabilizes, and lasts at least 0.5 second but no longer than 2.0 seconds.
•
Use an automatic inspiratory pause maneuver to measure C
STAT
, R
STAT
(only on square wave, VC breaths), and P
PL
. To cancel an automatic inspiratory pause maneuver, press the CANCEL button on the lower screen.
A manual inspiratory pause maneuver begins when you press and hold the INSP PAUSE key down, and continues until the INSP PAUSE key is released, up to a maximum of 7 seconds.
Use a manual pause to maintain lung inflation; for example, during an X-ray.
If you select a plateau time (T
PL
), you can extend the inspiratory pause maneuver or T
PL
. For example, during an automatic inspiratory pause maneuver, T
PL
can be extended to up to 2.0 seconds.
If T
PL
exceeds 2.0 seconds and the inspiratory pause maneuver ends before T
PL
elapses, the plateau lasts the full T
PL
interval. During a manual inspiratory pause maneuver, the maneuver lasts the T
PL
setting or the manual interval, but never longer than 7 seconds.
OP 4-18
Interpreting Pause Maneuver Results
It is possible to compute C
STAT
and R
STAT
with invalid data. For example, a leak can prevent the achievement of a plateau, or the lungs may not be empty when an inspiration begins. While the inspiratory pause maneuver is in progress, software checks the quality of the data, and indicates when estimates for C
STAT
and R
STAT
are questionable.
The most recently selected graphics are displayed and frozen when an inspiratory pause maneuver begins, so you can assess the inspiratory pressure. P
PL
is continuously updated and displayed during the inspiratory pause. C
STAT
and R
STAT
are displayed at the start of the next inspiratory phase. The value of R
STAT
is computed and displayed only if the mandatory breath type is VC with a square flow waveform.
Note:
The high pressure alarm condition and the action taken by the ventilator as a result of the high pressure alarm violation are active during inspiratory pause maneuvers.
OP 4.12
Interpreting Pause Maneuver Results
•
•
•
Compliance (C
STAT
) is an estimate of the elasticity of the patient’s lungs; it is expressed in mL/cmH
2
O. Resistance (R
STAT
) is the total inspiratory resistance across the artificial airway and respiratory system. It is an estimate of how restrictive the patient’s airway is, based on the pressure drop at a given flow. It is expressed in cmH
2
O/L/second. These values are computed during an operator-initiated inspiratory pause maneuver, in which the inspiratory valves and exhalation valve are closed. C
STAT
is computed during a mandatory breath. R
STAT
is computed during a VC mandatory breath with a square waveform.
During the pause maneuver, the most recently selected graphics are displayed and frozen, so you can see when inspiratory pressure stabilizes. C
STAT
and R
STAT
are displayed at the start of the next inspiration following the inspiratory pause maneuver. They take this format:
C
STAT
xxx or
R
STAT
yyy
•
If the software determines variables in the equations or the resulting C
STAT
or R
STAT
values are out of bounds, it identifies the questionable C
STAT
and R
STAT
values with special formatting and text messages:
Parentheses ( ) signify questionable C
STAT
or R
STAT
values, derived from questionable variables.
Flashing C
STAT
or R
STAT
values are out of bounds.
Asterisks (******) mean variables fall below noise-level bounds.
R
STAT
(------) means resistance could not be computed, because the breath was not of a mandatory, VC type with a square flow waveform.
OP 4-19
How to use the Puritan Bennett™ 840 Ventilator
Refer to
End Expiratory Pressure (TR 14.3)
for detailed information on static compliance and resistance.
Table TR 14-1.
summarizes the significance and possible corrective actions for the C
STAT and R
STAT
displays.
OP 4.13
Using NIV
When setting up or changing ventilation control parameters, you must select NIV (non-invasive ventilation) using the VENT TYPE button that appears on the new patient setup or current setup screens.
Choosing NIV allows ventilation with various non-invasive interfaces and with uncuffed endotracheal tubes in NeoMode.
OP 4.13.1
NIV Intended Use
NIV is intended for use by neonatal, pediatric, and adult patients possessing adequate neural-ventilatory coupling and stable, sustainable, respiratory drive.
OP 4.13.2
NIV Breathing Interfaces
Covidien has successfully tested the following non-vented interfaces with NIV:
Full-face Mask: Puritan Bennett™ Benefit Full Face Mask (large, part number 4-005253-00),
ResMed Mirage™* Non-Vented Full Face Mask (medium)
Nasal Mask: ResMed Ultra Mirage™* Non-vented Mask (medium)
Infant Nasal Prongs: Sherwood Davis & Geck Argyle™* CPAP Nasal Cannula (small), Hudson
RCI™* Infant Nasal CPAP System (Number 3)
Uncuffed neonatal ET tube: Mallinckrodt™ Uncuffed Tracheal Tube, Murphy (3.0 mm)
WARNING:
Use only non-vented patient interfaces with NIV.
WARNING:
Full-faced masks used for non-invasive ventilation should provide visibility of the patient's nose and mouth to reduce the risk of emesis aspiration.
WARNING:
Do not ventilate patients intubated with cuffed endotracheal or tracheostomy tubes using NIV
Vent Type.
OP 4-20
Using NIV
OP 4.13.3
NIV Setup
NIV can be initiated from either the new patient setup screen during vent start-up or while the patient is being ventilated invasively.
shows the new patient setup screen when NIV
is the selected vent type.
Figure OP 4-6. New Patient Setup Screen—NIV
1
2
3
IBW button: button used to set the patient’s ideal body weight
Vent type button: button used to select between INVASIVE or NIV
4
5
Breath mode: Only A/C, SIMV, and SPONT modes are allowed with NIV.
6
Mandatory Type: Only VC and PC are available with NIV.
Spontaneous Type: Only PS or NONE are available with NIV when SIMV or SPONT breath mode is selected.
Trigger Type: Only flow triggering is available with NIV.
Refer to the sections
Changing from Invasive to NIV Vent Type
, page OP 4-25 for information on automatic settings changes that occur
when switching between vent types.
Follow these steps to set up the ventilator for NIV:
OP 4-21
How to use the Puritan Bennett™ 840 Ventilator
To set up a new patient: To set up a patient currently being ventilated:
1. Touch the VENT SETUP button. Proceed to step 3.
1. Turn the ventilator on.
Select NEW PATIENT
3. Enter the patient’s Ideal
Body Weight (IBW).
4. Touch the VENT TYPE button and turn the rotary knob to change to NIV.
5. Touch the MODE button and turn the rotary knob to select A/C, SIMV, or SPONT. (BILEVEL mode is not available with NIV.).
6. Touch the MANDATORY TYPE button and turn the knob to choose pressure control (PC) or volume control (VC). (VC+ is not available with NIV.)
7. If either SIMV or SPONT was selected in step 5, touch the SPONTANEOUS TYPE button and turn the knob to select PS or NONE. (TC, PA, and VS are not available with NIV.)
NOTE:
With NIV selected as Vent Type, the only allowable trigger type is flow triggering (
V
-TRIG).
8. Touch CONTINUE and adjust settings as needed. See
High Spontaneous Inspiratory Time Limit
4-23, for information on the high spontaneous inspiratory time limit ventilator setting.
NOTE:
With NIV selected as Vent Type, the DISCONNECT SENSITIVITY (D
SENS
) button appears on the Settings screen set to OFF. If desired, touch the button and turn the knob to set a value. To change the disconnect sensitivity after you have applied the ventilator settings, touch the OTHER SCREENS button, then the
MORE SETTINGS button and make your changes.
shows the NIV settings screen.
9. Press ACCEPT to apply the settings. Review the apnea and alarm settings as described below.
Note:
During NIV, the exhaled volume of the patient can differ from the measured exhaled volume due to leaks around the patient interface.
It is recommended that CO
2
monitoring equipment is provided for the measurement of expiratory carbon dioxide concentration.
For CO
2
monitoring equipment setup and connection to the ventilator, please refer to the CO
2 monitoring equipment manufacturers' instructions for use.
OP 4-22
Figure OP 4-7. NIV Ventilator Settings Screen
Using NIV
1
2
3 Note D
SENS
defaults to OFF “N” in header indicates NIV Vent Type
2
T
I SPONT
setting button
OP 4.13.4
High Spontaneous Inspiratory Time Limit
NIV includes a setting in SIMV or SPONT modes for high spontaneous inspiratory time limit (
2
T
I
SPONT
). When a patient’s inspiratory time reaches or exceeds the set limit, the ventilator transitions from inspiration to exhalation, and the
2
T
I SPONT
symbol appears on the upper GUI screen, indicating the ventilator has truncated the breath (see
). The
2
T
I SPONT
setting does not restrict changes to IBW; if the IBW is decreased,
2
T
I SPONT
may be decreased automatically to remain within its allowable limits.
WARNING:
No audible alarm sounds in conjunction with the visual
2
T
I SPONT
indicator, nor does the indicator appear in any alarm log or alarm message.
It is possible the target inspiratory pressure may not be reached if the
2
T
I SPONT
setting is not long enough, or if system leaks are so large as to cause the ventilator to truncate the breath at the maximum allowable
2
T
I SPONT
setting.
Note:
To reduce the potential for not reaching the target pressure, minimize the leaks in the system and increase the rise time% or decrease the E
SENS
setting, or both, if appropriate.
OP 4-23
How to use the Puritan Bennett™ 840 Ventilator
OP 4.13.5
Apnea Setup
Set the patient’s apnea parameters as described in
Changing Apnea Ventilation Settings (OP 4.7)
page
. NIV does not change the way apnea parameters are set.
OP 4.13.6
Alarm Setup
Touch the ALARM SETUP button to display the current alarm settings and change the alarm settings as needed. A low circuit pressure (
3
P
PEAK
) alarm is available during NIV to detect potential circuit disconnects or large system leaks based upon pressure measurements in the patient circuit. Refer to
Table OP 5-1.
,
Table OP A-13.
, and
Table TR 13-2.
for more information regarding the
3
P
PEAK
alarm. The
3
P
PEAK
alarm may be turned OFF, if desired.
screen with new patient default settings.
Figure OP 4-8. New Patient Default Alarm Settings
1
4
P
PEAK alarm limit
Yellow background with black letters on lower GUI screens indicates NIV vent type and current breath mode
2
WARNING:
With NIV selected as the Vent Type, the new patient value for each of the following alarm limits is
OFF:
2
f
TOT
4V
E TOT
4
V
TE MAND
4
V
TE SPONT
Additionally, the
4
P
PEAK
alarm can be set to OFF.
Ensure you have set these alarms appropriately before connecting the patient to the ventilator.
OP 4-24
OP 4.13.7
Changing from Invasive to NIV Vent Type
Some ventilator settings available during invasive ventilation are not available during NIV.
Table OP 4-5. Automatic Settings Changes—Invasive to NIV on the Same Patient
Current invasive setting
Breath Mode: BILEVEL
Breath Mode: SIMV or SPONT
Mandatory Type: VC+
Spontaneous Type: Any type except NONE or PS
New NIV setting
Breath mode: A/C
High T
I SPONT
(
2
T
I SPONT
) limit setting available
Mandatory type:
Adult/pediatric: VC
Neonatal: PC
Spontaneous type: PS
If Spontaneous Type set to NONE or PS during invasive ventilation, NIV spontaneous type does not change.
NOTE:
In any delivered spontaneous breath, either invasive or NIV, if Pressure Support is set to NONE or 0, there is always a target inspiratory pressure of 1.5 cmH
2
O applied.
Trigger type: Pressure
Alarm settings:
4
P
PEAK
MAND
,
4
V
TE SPONT settable)
(if applicable),
4V
E TOT
,
4
V
TE
, INSPIRATION TOO LONG (not user-
Trigger type: Flow
(flow triggering is the only allowable trigger type during NIV)
Alarm settings:
4
P
PEAK
,
4V
E TOT
,
4
V
TE MAND
,
4
V
TE
SPONT
default to NIV new patient values (see
Table OP
A-13.
). INSPIRATION TOO LONG alarm not available.
D
SENS
D
SENS
setting defaults to OFF.
OP 4.13.8
Changing from NIV to Invasive Vent Type
Using NIV
D
SENS
Table OP 4-6. Automatic Settings Changes—NIV to Invasive on the Same Patient
New invasive setting Current NIV setting
Ventilator settings:
2
T
I SPONT
Alarm settings:
4
P
PEAK
,
4V
E TOT
,
4
V
TE MAND
,
4
V
TE
SPONT
N/A
Alarm settings: Default to new patient values dependent upon selected invasive ventilator settings (see
Table OP A-13.
). INSPIRATION TOO LONG alarm becomes available.
D
SENS
setting defaults to invasive new patient value
(see
Table OP A-13.
)
OP 4-25
How to use the Puritan Bennett™ 840 Ventilator
WARNING:
When changing the vent type on the same patient, review the automatic settings changes
OP 4.13.9
NIV Patient Data
Displayed patient data during NIV is different from data displayed during invasive ventilation.
During NIV, the upper GUI screen indicates that NIV is the selected vent type by displaying a yellow “NIV” indicator on the More Patient Data subscreen. Inspired tidal volume (V
TI
) is displayed in the vital patient data area, and the monitored PEEP value is shown when you press the MORE
PATIENT DATA button.
Figure OP 4-9. More Patient Data Screen — NIV
OP 4-26
1
2
During NIV, V
TI
appears in the vital patient data area instead of PEEP
NIV and
2
T
I SPONT
appears in the more patient data subscreen. Hidden if two or more alarms are present
3 PEEP moved to more patient data subscreen during NIV.
OP 5 How to Handle Alarms
OP 5.1
Overview
•
•
•
Chapter
provides the listed information:
What The ventilator alarms are
What to do if a ventilator alarm occurs
What The ventilator alarm indicators are
•
What The ventilator alarm classifications are
WARNING:
Setting any alarm limits to OFF or extreme high or low values can cause the associated alarm not to activate during ventilation, which reduces its efficacy for monitoring the patient and alerting the clinician to situations that may require intervention.
OP 5.2
Ventilator Alarm Classifications
Alarms on the Puritan Bennett™ 840 Ventilator System are classified as high- medium-, or lowpriority.
Figure OP 5-1. Alarm Indicators
OP 5-1
How to Handle Alarms
3 Low-priority alarm indicator.
1
2
High-priority alarm indicator
Medium-priority alarm indicator
•
•
High-priority alarms require immediate attention to ensure patient safety. During a high-priority alarm, the red high priority indicator flashes rapidly, the high-priority audible alarm (a sequence of five tones that repeats twice, pauses, then repeats again) sounds, and the top of the upper screen flashes an alarm message. If a high-priority alarm goes away spontaneously (autoresets), its indicator remains lit
(not flashing) until you press the alarm reset key.
Medium-priority alarms require prompt attention. During a medium-priority alarm, the yellow medium-priority indicator flashes slowly, the medium-priority audible alarm (a repeating sequence of three tones) sounds, and the upper screen flashes an alarm message. If a medium-priority alarm autoresets, the indicator turns off and the autoreset is entered in the alarm history log.
•
Low-priority alarms tell you that there has been a change in the patient-ventilator system. During a low-priority alarm, the yellow low-priority indicator lights, the low-priority audible alarm (two tone, non-repeating) sounds, and the upper screen displays an alarm message. If a low-priority alarm autoresets, the indicator turns off and the autoreset is entered in the alarm history log.
Note:
You can change an alarm parameter even when alarms are active. You do not need to press the alarm reset key or wait for the alarm to autoreset. If the alarm had escalated to high priority and you change its setting, the high-priority alarm indicator remains lit until the reset key is pressed.
OP 5.3
Alarm Silence
WARNING:
Never leave patient unattended when the alarm silence is active.
Press the alarm silence key to mute the alarm sound for 2 minutes. The key lights during the silence period, and turns off if the ALARM RESET key is pressed. An ALARM SILENCE IN PROGRESS indicator displays on the lower touch screen, along with a CANCEL button, if there is not a higherpriority alarm display active. To exit out of the alarm silence, touch the CANCEL button or press
ALARM RESET.
The system automatically exits the alarm silence when the 2-minute interval times out. A new high-priority alarm (non- patient data related) (e.g., occlusion) cancels the alarm silence and the alarm sound turns on. Patient data alarms (e.g. INSPIRATION TOO LONG, V
TE MAND
) and CIRCUIT
DISCONNECT alarms do not cancel an alarm silence.
Each time you press the alarm silence key, the silence period resets to 2 minutes. Each time you press the alarm silence key (whether or not there is an active alarm), the keypress is recorded in the alarm log. The ventilator makes another entry into the alarm log when the alarm silence ends
OP 5-2
Alarm Reset
(whether due to an elapsed alarm silence interval, the detection of a high-priority alarm, or an alarm reset).
If no higher-priority screens are displayed on the lower screen (i.e., Vent setup, Apnea setup, Alarm setup, Other Screens or a new high priority non-patient data related alarm), the Alarm Silence in
Progress indicator appears (
Figure OP 5-2. Alarm Silence in Progress Indicator (lower screen)
OP 5.4
Alarm Reset
•
•
•
•
•
•
•
•
•
Pressing the ALARM RESET key resets the detection algorithms of all active alarms, except for the listed alarms:
AC POWER LOSS
COMPRESSOR INOPERATIVE
DEVICE ALERT
INOPERATIVE BATTERY
LOW AC POWER
LOW BATTERY
NO AIR SUPPLY
NO O
2
SUPPLY
O
2
SENSOR
OP 5-3
How to Handle Alarms
•
•
PROCEDURE ERROR
SCREEN BLOCK
If you press the ALARM RESET key, there is no effect on the 100% O
2
/CAL 2 min function, if it is active. The ventilator makes an entry into the alarm log when an active alarm is reset, and when an alarm silence is terminated by pressing the alarm reset key. No key press is recorded unless there is an active alarm.
If an alarm condition persists, the alarm becomes active again, according to the detection algorithm for that alarm. For example, if the APNEA alarm is active, the alarm reset key resets the apnea detection algorithm to its initial state and returns the ventilator to normal ventilation.
If you press the alarm reset key, the system cancels the alarm silence, if active (this avoids silencing an alarm condition that arises shortly after pressing the alarm reset key). If you press the alarm reset key, the system clears any high-priority alarm that has autoreset (and the steadily lit highpriority alarm indicator turns off).
The alarm reset key returns the ventilator to normal operation if an alarm condition has been resolved, without having to wait for alarm detection algorithms to reset the alarm. The ventilator reannunciates any alarm condition that persists after pressing the alarm reset key.
OP 5.5
Alarm Log
), touch the alarm log button on the upper screen. The alarm
log shows alarm events (including timestamped alarms, silences, and resets) in order of occurrence, with the most recent event at the top of the list.
Figure OP 5-3. Alarm log
OP 5-4
1 Indicates the log includes unread entries 3 Touch symbols to see definition at bottom of lower screen
How to Handle Alarms
•
•
PROCEDURE ERROR
SCREEN BLOCK
If you press the ALARM RESET key, there is no effect on the 100% O
2
/CAL 2 min function, if it is active. The ventilator makes an entry into the alarm log when an active alarm is reset, and when an alarm silence is terminated by pressing the alarm reset key. No key press is recorded unless there is an active alarm.
If an alarm condition persists, the alarm becomes active again, according to the detection algorithm for that alarm. For example, if the APNEA alarm is active, the alarm reset key resets the apnea detection algorithm to its initial state and returns the ventilator to normal ventilation.
If you press the alarm reset key, the system cancels the alarm silence, if active (this avoids silencing an alarm condition that arises shortly after pressing the alarm reset key). If you press the alarm reset key, the system clears any high-priority alarm that has autoreset (and the steadily lit highpriority alarm indicator turns off).
The alarm reset key returns the ventilator to normal operation if an alarm condition has been resolved, without having to wait for alarm detection algorithms to reset the alarm. The ventilator reannunciates any alarm condition that persists after pressing the alarm reset key.
OP 5.5
Alarm Log
To view the alarm log (
Figure OP 5-3.
), touch the alarm log button on the upper screen. The alarm log shows alarm events (including timestamped alarms, silences, and resets) in order of occurrence, with the most recent event at the top of the list.
Figure OP 5-3. Alarm log
OP 5-4
1
2
Indicates the log includes unread entries 3
Alarm log button 4
Touch symbols to see definition at bottom of lower screen
Touch scroll bar, then turn knob to scroll through log
Alarm Volume
•
•
•
•
•
•
•
A question mark in a triangle appears on the ALARM LOG button if the log includes an event not yet viewed. To scroll through the alarm log, touch the scroll bar located at the right side of the alarm log, then turn the knob.
•
The ventilator makes a time-stamped entry into the alarm log whenever the listed items occur:
An alarm is detected
An alarm changes priority level
An alarm autoresets
The alarm reset key is pressed when there is an active alarm
The ALARM SILENCE key is pressed
The alarm silence times out
An alarm reset terminates the alarm silence
A new high-priority alarm terminates the alarm silence
The alarm log stores a maximum of the 80 most recent entries. When you complete a NEW
PATIENT setup, the system erases the previous patient’s alarm log.
OP 5.6
Alarm Volume
The off-screen alarm volume key adjusts the volume of all audible alarms, regardless of priority level. To adjust alarm volume, press and hold the alarm volume key while turning the knob. The sound you hear when making an adjustment is equivalent in volume to the sound of an audible alarm, and is distinct from the sounds of low-, medium-, and high-priority audible alarms. This sound continues as long as you hold down the key, and takes priority over active audible alarms.
The selected alarm volume remains unchanged after ventilator power is cycled. Because an alarm can require immediate clinical attention, you cannot turn alarm volume off.
WARNING:
The selectable alarm volume range is designed to ensure you can discern a ventilator alarm above background noise levels. Consider the existing noise levels and verify you have properly adjusted the alarm volume by pressing and holding the alarm volume key. If necessary, use the procedure described above to readjust the alarm volume.
for alarm volume specifications.
OP 5-5
How to Handle Alarms
OP 5.7
Alarm Messages
The upper screen displays the two highest-priority active alarms. An alarm icon flashes on the
MORE ALARMS button if there are other active alarms. Touch the MORE ALARMS button to view a full screen of up to eight active alarms.
Each alarm message consists of a base message, an analysis message (supplementary information that includes any associated alarm conditions), and a remedy message that suggests corrective actions.
An alarm augmentation scheme is built into the ventilator system software to handle situations where the initial cause of an alarm has the potential to precipitate one or more related alarms.
When an alarm occurs, any subsequent alarm related to the cause of this initial alarm “augments” the initial alarm instead of appearing on the upper GUI screen as a new alarm. The initial alarm’s displayed analysis message is updated with the related alarm’s information, and the Alarm Log
Event column shows the initial alarm as “Augmented.”
shows how an alarm message is displayed on the upper screen.
lists possible alarm messages.
Note:
When more than one alarm is active and their alarm messages vary in their degree of seriousness, you should assume the most serious message is applicable.
Figure OP 5-4. Alarm Message Format
OP 5-6
Alarm Messages
1
2
The analysis message gives the root cause of the alarm. May also include dependent alarms that have arisen due to the initial alarm
The base message identifies the alarm.
Touch the alarm symbol to view definition on the lower screen.
3
4
Touch the flashing more alarms button to view messages for up to six additional active alarms
The two highest priority active alarm messages are displayed here
When you see this message…
AC POWER LOSS
APNEA
CIRCUIT DISCONNECT
COMPLIANCE LIMITED V
T
COMPRESSOR INOPERATIVE
DEVICE ALERT
Table OP 5-1. Alarm Messages
It means…
The power switch is ON, AC power is not available, and the ventilator is being powered by the BPS.
Do this…
• Prepare for power loss.
• Obtain alternate ventilation source.
• Check integrity of AC power source.
• Obtain service.
• Check the patient.
• Check the ventilator control parameters.
The set apnea interval has elapsed without the ventilator, patient, or operator triggering a breath. The ventilator has entered apnea ventilation.
There is a disconnection in the patient circuit. The ventilator switches to idle mode and displays the length of time without ventilator support.
The compliance compensation limit has been reached. The inspired volume may be less than the control parameter value.
The compressor is unable to maintain sufficient supply pressure, due to low AC power, AC power loss, or compressor malfunction.
The compressor is not connected properly to the BDU.
The POST or a background test has detected a problem.
• Check the patient.
• Reconnect the patient circuit.
• Press the alarm reset key.
• Check the patient.
• Verify that the selected patient circuit type and the installed patient circuit match.
• Check the patient.
• Obtains alternative ventilation source.
• If due to low or no power, alarm resets when full AC power is restored.
• If due to compressor malfunction, remove ventilator from use and obtain service.
• Check the patient.
• Reconnect the compressor air hose, compressor power cable, and compressor data cable.
• Check the patient.
• If prompted to do so, obtain alternate ventilation and obtain service.
OP 5-7
How to Handle Alarms
1
Table OP 5-1. Alarm Messages (Continued)
When you see this message…
P
1
O
2
% (high delivered O
2
%)
The O
2
% measured during any phase of a breath cycle is 7% (12% during the first hour of operation) or more above the set O
2
% parameter for at least 30 seconds
When you decrease the set O
2
% parameter, the percentages increase by 5% for the next 4 minutes of ventilation.
1
V
TE
(high exhaled tidal volume)
The patient’s exhaled tidal volume for any breath is equal to or greater than the set limit.
1V
PEAK
(high circuit pressure)
E TOT
(high exhaled total minute volume)
It means…
The measured airway pressure is equal to or greater than the set limit. Reduced tidal volume likely.
The patient’s exhaled minute volume is equal to or greater than the set limit.
Do this…
• Check the patient.
• Check the patient circuit.
• Check the endotracheal tube.
• Check the patient, the air and oxygen supplies, the oxygen analyzer, and the ventilator.
• Check the patient and the ventilator control parameters.
• Check for changes in patient compliance or resistance.
• Check the patient and the ventilator control parameters.
1 f
TOT
(high respiratory rate)
• Check the patient and the ventilator control parameters.
1
P
VENT
(high internal ventilator pressure)
The breath rate from all breaths is greater than or equal to the set limit.
The inspiratory pressure transducer has measured a pressure of at least 100 cmH
2
O. The ventilator transitions to exhalation. A reduced tidal volume is likely.
• Check the patient, the patient circuit (including filters), and the endotracheal tube. Ensure the ET tube ID is the correct size. Check the ventilator flow and volume settings.
• Rerun SST.
• Obtain alternate ventilation source.
• Remove the ventilator from clinical use and obtain service.
INOPERATIVE BATTERY
INSPIRATION TOO LONG
LOSS OF POWER
The BPS is installed but is not functioning.
The IBW-based inspiratory time for a spontaneous breath exceeds the ventilator-set limit. Active only when Vent Type is INVASIVE.
The ventilator power switch is on, but there is insufficient power from the mains AC and the BPS.
There may not be a visual indicator for this alarm, but an independent audio alarm sounds for at least 120 seconds.
• Remove the ventilator from clinical use and obtain service.
•Check the patient.
Check the patient circuit for leaks.
Check rise time and E
SENS
settings.
• Check the integrity of the AC power and BPS connections.
• Obtain alternative ventilation, if necessary.
Turn the power switch off to reset alarm.
OP 5-8
Alarm Messages
When you see this message…
LOW AC POWER
Table OP 5-1. Alarm Messages
It means…
The mains AC power dropped below 80% of the nominal voltage for at least 1 second. The error message signals the AC power has dropped significantly, and a more severe power drop may be imminent.
Do this…
• Prepare for possible loss of power.
• Check the integrity of the AC power connection.
• Check the AC power supply.
LOW BATTERY
3
O
3
P
2
% (low delivered O
2
%)
PEAK
(low circuit pressure)
The ventilator turns off the compressor (if installed), but otherwise operates normally.
The BPS is installed, but it has less than 2 minutes of operational time remaining.
The O
2
% measured during any phase of a breath cycle is 7% (12% during the first hour of operation) or more below the O
2
% parameter for at least 30 seconds.
The percentage increases by 5% for 4 minutes after you increase the set O
2
% value.
Replace the BPS or allow it to recharge during normal ventilator operation.
• Check the patient, the air and oxygen supplies, the oxygen analyzer, and the ventilator.
• Calibrate oxygen sensor (press
100% O
2
/CAL 2 min key or
INCREASE O
2
2 min key). See page
TR 15-4
for more information on calibrating the oxygen sensor.
• Use an external O
2
monitor and disable the O
2
sensor.
• Check the breathing system for leaks.
The peak inspiratory pressure in the patient circuit has dropped below the set alarm limit.
This alarm is only available when
NIV is the selected Vent Type or when VC+ is the selected Mandatory type during INVASIVE ventilation.
WARNING: Because the VC+ pressure control algorithm does not allow the target inspiratory pressure to fall below
PEEP+5 cmH
2
O, attempting to set the
4
P
PEAK
alarm limit at or below this level will turn the alarm off.
3
V
TE MAND
(low exhaled mandatory tidal volume)
The patient’s exhaled mandatory tidal volume is less than or equal to the set limit.
• Check the patient.
• Check for leaks in the patient circuit.
• Check for changes in the patient’s resistance or compliance.
OP 5-9
How to Handle Alarms
Table OP 5-1. Alarm Messages
When you see this message…
3
V
TE SPONT
(low exhaled spontaneous tidal volume)
3V
E TOT
(low exhaled total minute volume)
NO AIR SUPPLY
NO O
2
SUPPLY
It means…
The patient’s exhaled spontaneous tidal volume is less than or equal to the set limit.
The minute volume for all breaths is less than or equal to the set limit.
The air supply pressure is less than the minimum pressure required for correct ventilator operation.
The ventilator delivers 100% O
2
if available. O
2
% delivery may be compromised.
If an oxygen supply is not available, the safety valve opens. The ventilator displays the elapsed time without ventilatory support.
This alarm cannot be set or disabled.
Do this…
• Check the patient.
• Check the ventilator control parameters.
• Check the patient.
• Check the ventilator control parameters.
• Check the patient.
• Check the air and oxygen sources.
• Obtain alternative ventilation, if necessary.
The oxygen supply pressure is less than the minimum pressure required for correct ventilator operation. The ventilator delivers
100% air if available. O
2
% delivery may be compromised.
If an air supply is not available, the safety valve opens. The ventilator displays the elapsed time without ventilatory support. This alarm cannot be set or disabled.
• Check the patient.
• Check the oxygen and air sources.
• Obtain alternative ventilation, if necessary.
O
2
SENSOR
PROCEDURE ERROR
SCREEN BLOCK
Background checks have detected a problem with the oxygen sensor (sensor failure or it is out of calibration). Patient ventilation is unaffected.
The patient is attached before ventilator startup is complete.
Safety ventilation is active.
A possible blocked beam or touch screen fault.
• Press the 100% O
2
CAL 2 min or
INCREASE O
2
2 min key to recalibrate the oxygen sensor. See page
TR 15-4
for more information on calibrating the oxygen sensor.
• Disable the oxygen sensor.
• Replace the oxygen sensor.
• Provide alternate ventilation, if necessary.
• Complete ventilator startup procedure.
Remove obstruction from the touch screen or obtain service.
OP 5-10
Alarm Messages
When you see this message…
SEVERE OCCLUSION
Table OP 5-1. Alarm Messages
It means…
The patient circuit is severely occluded. The ventilator enters occlusion status cycling. The elapsed time without ventilatory support is displayed.
If the NeoMode software option is in use, the ventilator delivers 40%
O
2
, if available.
Do this…
• Check the patient.
• Obtain alternative ventilation.
• Check the patient circuit for bulk liquid, crimps, blocked filter.
• If the problem persists, remove ventilator from use and obtain service.
OP 5-11
How to Handle Alarms
Page Left Intentionally Blank
OP 5-12
OP 6 How to View Graphics
OP 6.1
Overview
•
•
•
Chapter
provides the listed information for the Puritan Bennett™ 840 Ventilator System:
How to set up graphic displays of patient data.
How to freeze a graphic display of patient data.
How to adjust the vertical and horizontal scales of a graphic display.
OP 6.2
Graphics Display Function
•
•
•
•
•
The graphics function displays real-time patient data. Five patient data formats are available:
Pressure-time curve
Flow-time curve
Volume-time curve
Pressure-volume loop
Flow-volume loop
shows an example of a pressure-volume loop.
OP 6-1
How to View Graphics
Figure OP 6-1. Pressure-volume Loop
1 Inspiratory area
The flow-volume loop can be used with or without the Respiratory Mechanics (RM) software option (
Scaling is selectable by the user, from –2000 mL to 6000 mL for volume (x-axis), and up to 200 L/ min for flow (y-axis). The plot begins at the start of inspiration with the inspiratory flow curve plotted above the x-axis, and the expiratory flow curve plotted below the x-axis.
Note:
Traditionally, Flow-Volume loops are presented with inspired flow plotted below the horizontal axis, and exhaled flow plotted above, with the plot beginning at the start of exhalation.
Figure OP 6-2. Flow-volume Loop
OP 6-2
How to Set Up a Graphics Display
OP 6.3
How to Set Up a Graphics Display
You can choose to display one or two time curves in a single graph. However, if you choose the pressure-volume loop, it uses the entire screen when it is displayed, so you cannot select a second waveform for display in this instance.
To set up a graphics display
1.
Touch the GRAPHICS button at the lower left of the upper screen. Graphics appear.
2.
Touch PLOT SETUP at the upper left of the screen.
3.
If TC or PA is selected as Spontaneous Type, touch the Shadow Trace button and turn the knob to disable or enable the Shadow Trace feature.
4.
Touch PLOT 1: A drop-down menu of available selections appears with the current selection highlighted. Turn the knob to select the graphics display function.
5.
Touch PLOT 2, if applicable. Turn the knob to highlight the selection from the drop-down menu. If you select NONE, only one enlarged plot (with higher resolution) appears.
6.
Touch CONTINUE to display the graphics you have selected. You do not need to touch ACCEPT.
OP 6.4
Graphics Display Details and Calculations
•
•
•
If you select the pressure-volume loop, the loop for the next full breath is displayed, then the graphics display is updated every other breath.
The pressure-time curve shows an estimate of carinal pressure (P cari
) as a shaded area within the waveform when the TC option is active and shadow trace is enabled.
The pressure-time curve shows an estimate of lung pressure
•
(P
LUNG
) as a shaded area within the waveform when the PA option is active and shadow trace is enabled.
Note:
The graphic displays of carinal and lung pressures are estimates, not actual measurements.
•
•
The inspiratory area is calculated based on the area inside the loop to the left of the baseline.
Curves (pressure-time, flow-time, and volume-time) are drawn on the screen at the start of a breath, beginning with the last ½ second of the previous breath.
OP 6-3
How to View Graphics
OP 6.5
How to Adjust Displayed Graphics
•
Perform the listed steps, as required:
To move the baseline on a pressure-volume loop, touch the baseline pressure button, then use the knob to position the baseline.
•
The default position of the baseline is the positive end-expiratory pressure (PEEP) parameter. If the PEEP parameter changes, the baseline resets to PEEP.
To adjust vertical and horizontal scales, touch the arrow buttons, then turn the knob to select. You do not need to touch ACCEPT.
OP 6.6
The Graphics Display FREEZE Function
Follow these steps to freeze graphics on the screen so you can view them for an extended period of time.
1.
Touch FREEZE. The screen flashes the message FREEZING, the UNFREEZE button appears, and the scaling buttons disappear. Plotting continues until the screen is full.
Note:
The screen freezes automatically when IINSP PAUSE and EXP PAUSE maneuvers are performed.
2.
After the screen is filled with data and frozen, the other on-screen scaling buttons reappear. You can now redo the plot setup and adjust the scales for the last 48 seconds of frozen data. The pressurevolume display shows only the most recent full breath within the 48-second freeze period.
Graphics remain frozen even if you switch to another screen (for example, MORE ALARMS) and then return to the graphics screen.
3.
Touch the UNFREEZE button at any time to view current graphics.
OP 6.7
How to Print Patient Data Graphics
When graphics are frozen, the PRINT button appears in the upper left corner of the screen. Follow these steps to print frozen graphics on the screen:
1.
Touch the PRINT button. The flashing message PRINTING replaces the PLOT SETUP, UNFREEZE, and
PRINT buttons. You may stop printing by touching the CANCEL button.
2.
After all of the graphics data has been sent to the printer, the PLOT SETUP, UNFREEZE, and PRINT buttons reappear.
Note:
To print graphics, you must have a printer attached to RS-232 serial port 1, the RS-232 serial port must be configured with PRINTER as the selected device, and the printer and ventilator communications
OP 6-4
Automatic Display of Graphics settings must match. Refer to
RS-232 Port (OP E.3)
on page
OP E-2
for instructions on how to configure the RS-232 port, and
How to Configure the RS-232 Ports (OP E.4)
on page
OP E-3
for information on cables and printers.
OP 6.8
Automatic Display of Graphics
Whenever you press the EXP PAUSE or the INSP PAUSE key, the most recently selected graphics are displayed and frozen. You can then observe when expiratory or inspiratory pressure stabilizes.
OP 6.9
When Graphics are not Accessible
•
When certain conditions exist, the graphics display is not accessible:
If the ventilator goes into apnea ventilation or safety ventilation, patient data graphics are not displayed. However, you can touch the GRAPHICS button to redisplay graphics.
•
If you touch the MORE PATIENT DATA, ALARM LOG, MORE ALARMS, or OTHER SCREENS button, any currently displayed graphics disappear.
If you touch the graphics button while graphics are already displayed, the graphics screen disappears.
Unless the screen has been frozen, the waveform plots will be erased.
OP 6-5
How to View Graphics
Page Left Intentionally Blank
OP 6-6
OP 7 Preventive Maintenance
OP 7.1
Overview
•
•
•
•
Chapter
provides the listed information:
How to clean, disinfect, and sterilize the Puritan Bennett™ 840 Ventilator System components and accessories.
How to perform routine preventive maintenance procedures.
How to store the ventilator for an extended period of time.
How to repack and ship the ventilator.
To ensure proper ventilator operation, perform the maintenance procedures at the recommended intervals. You should adapt all procedures given in Chapter
policies and protocol.
Covidien recommends only qualified personnel perform additional maintenance procedures.
Contact Covidien technical support or your local representative for additional information.
OP 7.2
How to Dispose of Used Parts
Discard all parts removed from the ventilator during the maintenance procedures in accordance with your institution’s protocol. Sterilize parts before nondestructive disposal. Follow local governing ordinances and recycling plans regarding disposal or recycling of device components.
OP 7.3
How to Clean, Disinfect, and Sterilize Parts
describes how to clean, disinfect, and sterilize ventilator components.
WARNING:
Do not attempt to remove, clean, or flush the flow sensor with liquids or pressurized air.
OP 7-1
Preventive Maintenance
WARNING:
To avoid patient exposure to sterilizing agents, be sure to sterilize parts in accordance with the techniques described in
Exposure to sterilizing agents may reduce the useful life of some parts.
WARNING:
Handle filters with care, to minimize the risk of bacterial contamination or physical damage.
WARNING:
Always follow your institution’s infection control guidelines.
Note:
Covidien recognizes sanitation practices vary widely among health care institutions. It is not possible for
Covidien to either specify or require specific practices to meet all needs. Covidien is not responsible for the
5effectiveness of procedures used to clean, disinfect, and sterilize parts, or other practices carried out in the patient care environment. This manual can only provide general guidelines to clean, sterilize, and disinfect parts. It is the user’s responsibility to ensure the validity and effectiveness of the methods used.
Table OP 7-1. Procedures to Clean, Disinfect, and Sterilize Parts
Part
Ventilator exterior (including touch screen and flex arm)
Procedure
Wipe clean with a damp cloth and mild soap solution or with one of the chemicals listed or its equivalent. Use a damp cloth and water to rinse off chemical residue as necessary.
• Mild dishwashing detergent
• Isopropyl alcohol (70% solution)
• Bleach (10% solution
• Window cleaning solution (with isopropyl alcohol and ammonia)
• Ammonia (15% solution)
• Hydrogen peroxide (3% solution)
• Formula 409™* cleaner (Clorox
Company)
• Amphyl™* disinfectant (Reckitt
Benckiser Inc.)
• Cavicide™* surface disinfectant
(Metrex Research Corporation)
• Control III™* germicide (Meril
Products Inc.)
• Glutaraldehyde (3.4% solution)
Vacuum the vents at the back of the GUI to remove dust.
Comments
• Do not allow liquid or sprays to penetrate the ventilator or cable connections.
• Do not attempt to sterilize the ventilator by exposure to ethylene oxide (ETO) gas.
• Do not use pressurized air to clean or dry the ventilator, including the GUI vents.
OP 7-2
How to Clean, Disinfect, and Sterilize Parts
Table OP 7-1. Procedures to Clean, Disinfect, and Sterilize Parts
Part Procedure Comments
Caution:
• To avoid damaging filter materials used on the back of the GUI, do not use hydrogen peroxide to
clean the GUI. (This is applicable to the 9.4 inch GUI, which is an earlier version of the GUI.
• To prevent damage to ventilator labeling and ventilator surfaces in general, use only the listed chemicals to clean the ventilator exterior.)
Patient circuit tubing
In-line water traps
Couplings and connectors
Expiratory collector vial
Expiratory and inspiratory bacteria filters
Disassemble and clean, then autoclave, pasteurize, or chemically disinfect. Single-patient use patient circuits: Discard.
Disassemble and clean, then autoclave, pasteurize, or chemically disinfect.
Autoclave, pasteurize, or chemically disinfect.
• If you submerge the patient circuit in liquid, used pressurized air to blow the moisture from inside the tubing before use.
• Inspect for nicks and cuts, and replace if damaged.
• Run SST to check for leaks when a new patient circuit is installed.
Caution:
Steam sterilization is a viable sterilization method for 840 ventilator patient circuits supplied by Covidien, but it may shorten the tubing’s life span. Discoloration (yellowing) and decreased tubing flexibility are expected side effects of steam sterilizing this tubing.
These effects are cumulative and irreversible.
Inspect water traps for cracks.
Replace traps if damaged.
Inspect the collector vial for cracks. Replace collector vial if damaged.
Inspect the collector vial for cracks. Replace collector vial if damaged.
Reusable expiratory filter assembly: Clean, then autoclave or chemically disinfect the collector vial. Single-patient use expiratory filter assembly: Discard.
Reusable filters: Autoclave.
Single-patient use: Discard.
Before discarding, disinfect or sterilize according to your institution’s protocol.
• Effective sterilization of Covidien inspiratory and expiratory filters occurs by steam autoclaving at
132°C (270°F) for 20 minutes for gravity displacement cycles.
• Do not chemically disinfect or expose to ETO gas.
• Check filter resistance before reuse.
• Follow manufacturer’s recommendations for reusability.
Compressor inlet filter Clean every 250 hours or as necessary: wash in mild soap solution, rinse, and air-dry.
Replace filter element if torn or damaged.
OP 7-3
Preventive Maintenance
Air inlet filter bowl
Other accessories
Table OP 7-1. Procedures to Clean, Disinfect, and Sterilize Parts
Part
Drain bag, tubing, and clamp
Procedure
Discard the drain bag when filled to capacity or when you change the patient circuit.
Clean and autoclave the reusable tubing.
Wipe the reusable clamp with alcohol or pasteurize.
Wash the bowl exterior with mild soap solution if needed.
Follow manufacturer’s instructions.
Comments
• Do not autoclave the clamp.
• Replace the clamp if visibly damaged.
• Avoid exposure of the air inlet filter bowl to aromatic solvents, especially ketones.
• Replace if cracks or crazing are visible.
N/A
OP 7.3.1
How to Clean Components
Do not clean or reuse single-patient use or disposable components. When cleaning reusable components, do not use hard brushes or other implements that could damage surfaces.
1.
Wash the parts in warm water and mild soap solution.
2.
Rinse the parts thoroughly in clean, warm water (tap water is acceptable) and wipe dry.
3.
After you clean the components, inspect them for damage, such as cracks and crazing. Replace any damaged components.
Whenever you replace or reinstall parts on the ventilator, always run short self test (SST) before you begin to ventilate a patient.
Caution:
Follow the soap manufacturer's instructions. Product exposure to soap solution more highly concentrated than necessary can shorten the useful life of the product. Soap residue can cause blemishes or fine cracks, especially on parts exposed to elevated temperatures during sterilization.
OP 7.4
Disinfection and Sterilization
Do not disinfect, sterilize, or reuse single-patient use or disposable components.
When you sterilize reusable tubing, coil the tubing in a large loop.
Avoid kinks and do not cross the tubing. The tubing lumen should be free of any visible droplets before you wrap it in muslin or equivalent paper, in preparation for the autoclave.
summarizes disinfection and sterilization procedures.
OP 7-4
Disinfection and Sterilization
Caution:
Formaldehyde and phenol-based disinfectants are not recommended because they can cause plastic parts to crack and craze.
Table OP 7-2. Disinfection and Sterilization Procedures
Autoclave sterilization
Effective sterilization occurs by steam autoclaving at 132°C
(270°F) for 20 minutes for gravity displacement cycles. Follow the steam sterilizer manufacturer’s instructions.
Pasteurization
Place the parts in a heat pasteurizer at 76°C to 79°C (169 to 174 °F) for 30 minutes.
Chemical disinfection
Immerse the parts in disinfectant, and follow the manufacturer’s instructions. Acceptable disinfectants include the following or their equivalents:
• Ammonia (15% solution)
• Amphyl™*
• Bleach (10% solution)
• Cavicide™*
• Cidex™*
• Control III™*
Isopropyl alcohol (70% solution)
NOTE:
The exposure of the parts to more concentrated disinfectant for excessive time may shorten the life of the product.
1. Disassemble the component.
2. Clean the component parts.
(See
3. Place parts in the cleaning solution to disinfect.
1. Disassemble the component.
2. Clean the component parts.
(See
1. Disassemble the component.
2. Clean the component parts.
(See
3. Wrap each component part in muslin or equivalent paper for autoclaving.
4. Place the wrapped parts in the steam autoclave and sterilize.
3. Place parts in the heat pasteurizer and pasteurize.
4. Inspect the pasteurized parts for damage. Discard the component if you detect damage.
5. Reassemble the component.
5. Inspect the sterilized parts for damage. Discard the component if you detect damage.
6. Reassemble the component.
6. Install the component on the ventilator.
7. Run SST.
7. Install the component on the ventilator.
8. Run SST.
NOTE:
To prevent the occurrence of spots and blemishes on parts exposed to elevated temperatures, thoroughly rinse and dry parts prior to autoclave sterilization or pasteurization.
4. Inspect the disinfected parts for damage. Discard the component if you detect damage.
5. Reassemble the component.
6. Install the component on the ventilator.
7. Run SST.
OP 7-5
Preventive Maintenance
OP 7.5
Preventive Maintenance Procedures for the Operator
summarizes preventive maintenance procedures and the frequency Covidien rec-
ommends. The operator should routinely perform these preventive maintenance procedures at the recommended intervals. Instructions for the preventive maintenance procedures follow
OP 7.5.1
Total Operational Hours
Determine the total number of operational hours of the ventilator and the compressor as follows:
1.
Touch OTHER SCREENS on the touch screen of the ventilator.
2.
Touch OPERATIONAL TIME LOG to obtain operational hours.
Caution:
To avoid component damage due to excessive wear, perform preventive maintenance and replace components at recommended intervals. You may find it convenient to note anticipated replacement dates for all components based on typical use rates or recommended intervals.
Table OP 7-3. Operator Preventive Maintenance Procedures and Frequency
Frequency
Several times a day or as required by your institution’s policy
Part
Patient circuit: inspiratory and expiratory limbs
Inspiratory and expiratory bacteria filters
Collector vial, water traps, and drain bag
Maintenance
• Check both limbs for water build-up.
• Empty and clean each limb as necessary.
• Inspect the filters for damage and replace if necessary. If you replace a filter, rerun SST before you return the ventilator to clinical use.
• Check the resistance across inspiratory and expiratory filters as follows:
– before every use
– after 15 days of continuous use in the exhalation limb
– whenever you suspect excess resistance
Run SST to check the resistance of the expiratory filter.
Check and empty as needed.
OP 7-6
Preventive Maintenance Procedures for the Operator
Table OP 7-3. Operator Preventive Maintenance Procedures and Frequency (Continued)
Frequency
Daily or as necessary Oxygen sensor
Part
Air inlet filter bowl
Maintenance
Press the 100% O
2
/CAL 2 MIN key or INCREASE O
2
2 min key to calibrate the oxygen sensor. See page
TR 15-4
for more information on calibrating the oxygen sensor.
Refer to Appendix
OP D
to test the oxygen sensor calibration.
• Replace the bowl if it is cracked.
• If any sign of moisture is visible, remove ventilator from use and contact service or maintenance.
Clean.
Every 250 hours (or more often, if required)
Every year or as needed
Compressor inlet filter
Reusable expiratory bacteria filters
Every year after the ventilator’s first use, or as necessary.
Every year maximum or as needed
Oxygen sensor
Reusable inspiratory bacteria filters
Inspect and replace if you see cracks or crazing. Sterilize between patients and circuit changes, or according to your institution’s policy. Sterilize before nondestructive disposal.
• Replace the oxygen sensor as needed. When replacing the sensor, follow the information contained on the replacement oxygen sensor’s package for expiration or install-by dates and information provided in the oxygen sensor’s instructions for use. Document the replacement of the oxygen sensor and the date replacement is required according to the institution’s protocol.
• Actual sensor life depends on operating environment. Operation at higher temperature or
O
2
% levels will result in shorter sensor life. Refer to
sensor.
• Replace the filter.
• Sterilize between patients and circuit changes, or according to your institution’s policy.
• Sterilize before nondestructive disposal.
OP 7-7
Preventive Maintenance
OP 7.5.2
Inspiratory and Expiratory Bacteria Filters
WARNING:
The use of nebulized medication can cause a build-up of exhalation flow resistance and may even block the expiratory filter. Inspect and test expiratory filters at patient setup and frequently while in use.
•
Inspect the inspiratory and expiratory filters before every use and after 15 days of continuous use in the exhalation limb.
•
•
•
•
Run SST to check the resistance across the inspiratory and expiratory filters before every use and after
15 days of continuous use in the exhalation limb.
At every patient circuit change, autoclave reusable filters or discard and replace single-patient use filters.
Replace reusable inspiratory filters after 1 year of service (maximum). Check filter resistance after each autoclave. Discard filter if it exceeds recommended filter resistance.
Replace reusable expiratory filters after a maximum of 1 year of service. When you put a new filter into service, write the anticipated replacement date on the filter.
•
•
Acceptable resistance for inspiratory filters:
Filter resistance of 4 cmH
2
O (4 hPa) or less at 60 L/min flow or 0.5 cmH
2
O (0.5 hPa) or less at 30 L/min flow can indicate a ruptured filter. Discard the filter.
Filter resistance greater than 4 cmH
2
O at 100 L/min flow or greater than 2 cmH
2
O (2 hPa) at 30 L/min flow can indicate an occluded filter.
For reusable filters, autoclave and check the resistance again. For single-patient use filters, discard and replace with a new filter.
•
Acceptable resistance for expiratory filters:
Filter resistance of 0.6 cmH
2
O (0.6 hPa) or less at 60 L/min flow or 0.3 cmH
2
O (0.3 hPa) or less at 30 L/ min flow can indicate a ruptured filter. Discard the filter.
•
Filter resistance greater than 2.4 cmH
2
O (2.4 hPa) at 60 L/min flow or 1.2 cmH
2
O (1.2 hPa) at 30 L/min flow can indicate an occluded filter.
For reusable filters, autoclave and check the resistance again. For single-patient use filters, discard and replace with a new filter.
OP 7-8
Preventive Maintenance Procedures for the Operator
OP 7.5.3
Daily or as Required: Collector Vial and Drain Bag
WARNING:
Empty the collector vial before fluid reaches the maximum fill line. Collector vial overflow can allow fluid to enter the filter or patient circuit, and can increase flow resistance.
WARNING:
If you remove the collector vial while the patient is connected to the ventilator, the result can be loss of circuit pressure, ventilator autotriggering, or direct contact with biohazardous liquid.
•
When you change the patient circuit, autoclave or disinfect the resuable collector vials. Discard singleuse collector vials.
•
To avoid increased expiratory resistance, empty the collector vial before liquid reaches the maximum fill line (see
). Under certain conditions, the collector vial can fill in as little as 2 hours.
How to Remove the Collector Vial
1.
Turn the ring at the bottom of the exhalation filter to release the vial.
2.
Empty the vial and replace it with a clean vial (see
3.
Turn the ring to lock the vial into place on the expiratory filter.
Note:
If you remove the collector vial during normal ventilation, the ventilator will annunciate a CIRCUIT
DISCONNECT alarm.
How to Remove the Drain Bag
1.
Squeeze the clamp to drain liquid from the collector vial into the drain bag.
2.
When the drain bag is full, disconnect the bag from the tubing.
3.
Install the bag fitting onto tab to seal the bag before disposal.
4.
Discard bag. (See
)
Discard the drain bag and tubing every 24 hours (or as needed), and at every circuit change.
WARNING:
Do not attempt to clean, reprocess, or reuse the drain bag as this poses the risk of infection to medical personnel and the patient.
OP 7-9
Preventive Maintenance
Note:
The clamp is reusable. Be sure to remove it before you discard the bag.
Figure OP 7-1. How to Empty the Collector Vial and Seal the Drain Bag
OP 7.5.4
Daily or as Required: In-line Water Traps
Drain as required.
OP 7.5.5
Every 250 Hours: Compressor Inlet Filter
The compressor inlet filter provides pre8-filtration for the compressor inlet silencer filter. The inlet filter is located in the upper portion of the front panel of the compressor.
Remove and clean the filter more often than the recommended preventive maintenance schedule of every 250 hours, if necessary. Some environments can cause particulate to collect more quickly.
1.
To remove the inlet filter, gently pull at one corner.
2.
Wash the filter in a mild soap solution.
3.
Rinse the filter well and dry thoroughly to ensure an unrestricted flow of air through the compressor compartment.
Replace the filter if it is damaged.
4.
To install the inlet filter, align the clean dry filter over the opening in the front panel of the compressor.
Gently tuck in the edges of the filter.
OP 7-10
Preventive Maintenance Procedures for the Operator
Figure OP 7-2. 806 Compressor with Inlet Filter
1 Inlet filter
OP 7.5.6
Every Year: Ventilator Inspection
Inspect the ventilator exterior for evidence of mechanical damage and for label illegibility. If damage or label illegibility is noted, have a qualified service person service the ventilator.
Every Year or as Necessary: Oxygen Sensor
The ventilator’s oxygen sensor has a nominal life of 1 year. Its actual life depends on the operating environment. Operation at higher temperatures or FiO
2
levels can result in shorter sensor life.
The 840 BDU with a removable cover located on the right hand top edge of the BDU allows the operator to conveniently replace the oxygen sensor.
Earlier 840 ventilators that do not have this access cover require oxygen sensor replacement by qualified service personnel.
OP 7-11
Preventive Maintenance
Oxygen Sensor Replacement Procedure
WARNING:
To prevent bodily injury or death, do not attempt any ventilator service while a patient, or other person, is connected to the ventilator.
WARNING:
To prevent possible personal injury, always disconnect air and oxygen sources from the ventilator before replacing the oxygen sensor.
WARNING:
To prevent electrical shock hazard and possible personal injury, always disconnect electrical power sources before replacing the oxygen sensor.
WARNING:
Use personal protective equipment whenever exposure to toxic fumes, vapor, dust particles, blood pathogens, and other transmittable diseases and hazardous material can be expected. If in doubt, consult an environmental, health, and safety specialist or an industrial hygienist before performing routine maintenance procedures.
WARNING:
When you replace the oxygen sensor, be sure to familiarize yourself with, and adhere to all posted and stated safety warning and caution labels on the ventilator and its components. Failure to adhere to such warnings and cautions at all times may result in injury or property damage.
WARNING:
To prevent possible personal injury, never attempt to push or pull a ventilator installed on a cart, while the brakes are set on the casters.
WARNING:
To prevent possible personal injury and equipment damage, make sure the brakes on the casters are locked to prevent inadvertent movement of the ventilator during routine maintenance.
WARNING:
To prevent possible personal injury and equipment damage, have someone assist you when lifting the ventilator or any of its major components.
WARNING:
Investigate and determine the cause of any detected ventilator abnormality. Before you place a patient on the ventilator, have the ventilator repaired or contact Covidien Technical Support or your local representative for additional assistance.
Locate the flexible oxygen sensor access cover on the top edge of the cabinet.
1.
OP 7-12
Preventive Maintenance Procedures for the Operator
2.
Firmly push the center of the lower flap of the access cover until the lower flap is dislodged from the cabinet.
Figure OP 7-3. Dislodge the O
2
Sensor Access Cover
3.
Pinch the bottom and top flaps of the access cover firmly together and pull the access cover away from the cabinet to remove. The oxygen sensor is the white component mounted in the check valve housing.
OP 7-13
Preventive Maintenance
Figure OP 7-4. Open O
2
Sensor Access Port
Note:
The access cover is permanently attached to the instrument by a retaining strap.
Figure OP 7-5. Locate O
2
Sensor
OP 7-14
Preventive Maintenance Procedures for the Operator
3
4
1
2
Access cover cover retaining strap
Sensor cable
Sensor cable connector
5
6
7
Connector release tab
Oxygen sensor
Check valve housing
4.
Locate the locking tab on the oxygen sensor connector. Press this tab away from the sensor cable connector, while gently pulling the connector to release.
5.
Unscrew (counter-clockwise) and remove the oxygen sensor.
6.
Remove the replacement oxygen sensor from the packaging.
7.
Verify that the o-ring is pre-installed on the threaded base of the oxygen sensor.
Caution:
The o-ring must be properly seated on the oxygen sensor before installation in the ventilator.
Failure to properly seat the o-ring can result in leaks.
8.
Insert the threaded base of the oxygen sensor into the check valve housing and screw (clockwise) the oxygen sensor into the housing until snug.
OP 7-15
Preventive Maintenance
Caution:
Finger-tighten the oxygen sensor without using excessive force. If the sensor is overtightened, the sensor body can crack. Ensure the sensor is not cross-threaded as it is screwed into the check valve housing.
9.
Connect the sensor cable connector to the oxygen sensor connector, orienting the ridge on the cable connector towards the release tab on the oxygen sensor connector. Align the pins of the sensor connector with the cable connector and push the connector into place.
10.
Replace the access port cover by first sliding the top flap of the cover into the opening on the top of the ventilator cabinet.
11.
Then, using both thumbs, simultaneously press the two outside corners of the lower flap at the cabinet’s edge, fitting them into the cabinet opening.
12.
Continue to use both thumbs and firmly press the lower flap into place. Work your thumbs around the flap from the outside corners to the bottom center to seal the access cover.
Ensure the cover properly seals the cabinet opening.
13.
Calibrate oxygen sensor by pressing 100% O
2
/CAL 2 min key or INCREASE O
2
2 min key. See page
TR
15-4
for more information on calibrating the oxygen sensor.Verify that this calibration passes.
14.
Run SST to check the system before you place a patient on the ventilator.
OP 7.6
Additional Preventive Maintenance Procedures
There are additional preventive procedures that must be performed only by qualified service personnel.
provides a summary of these preventive maintenance intervals and procedures.
Complete details for each service preventive maintenance procedure are contained in the Puritan
Bennett™ 840 Ventilator System Service Manual.
Table OP 7-4. Service Preventive Maintenance Procedures and Intervals
Frequency
Every 6 months
Every year
Part
Entire ventilator
Atmospheric pressure transducer, expiratory valve, flow sensors, and vent inop test
Entire ventilator
Run EST.
Maintenance
Perform calibration/test.
Run performance verification.
This includes running an electrical safety test and inspecting ventilator for mechanical damage and for label illegibility.
OP 7-16
Storage
Table OP 7-4. Service Preventive Maintenance Procedures and Intervals (Continued)
Frequency
When ventilator location changes by 1000 feet of altitude
Every 2 years or as necessary
Every 10 000 hours
Part
Atmospheric pressure transducer Perform atmospheric pressure transducer calibration.
BPS internal battery pack
Maintenance
Replace BPS internal battery pack.
Actual BPS life depends on the history of use and ambient conditions.
Various parts Install appropriate preventive maintenance kits.
OP 7.7
Storage
If you are storing the ventilator for 6 months or longer, Covidien recommends disconnecting the
BPS or recharging it every 3 to 6 months, depending on storage temperatures (see specifications,
Appendix
OP A
).
Caution:
Disconnect the oxygen supply if you do not intend to use the ventilator immediately.
Caution:
To avoid damaging the ventilator, do not place the cart on its back or side with the breath delivery unit (BDU) or GUI installed. To store or move the cart on its back or side, disconnect and remove the GUI and BDU from the cart first.
Note:
An audible alarm will sound for at least 2 minutes after power is lost if no batteries are connected.
OP 7.8
Repacking and Shipping
If it is necessary to ship the ventilator for any reason, use the original packing materials. If those materials are not available, order a repacking kit. Refer to the Puritan Bennett™ 840 Ventilator
System Service Manual for repacking instructions.
OP 7-17
Preventive Maintenance
Page Left Intentionally Blank
OP 7-18
OP A Specifications
OP A.1
Overview
•
•
•
•
•
•
Appendix
provides the following specifications for the Puritan Bennett™ 840 Ventilator
System:
Physical
Environmental
Power
Compliance and approvals
Technical
Ranges, resolutions, and accuracies for ventilator settings, alarm settings, and monitored data
OP A.2
Physical Characteristics
Weight
Table OP A-1. Physical Characteristics
Breath delivery unit (BDU): 19.5 kg (43.0 lb)
Graphic user interface (GUI): 6.7 kg (14.7 lb)
802 Backup power source (BPS) (for use with RTA cart):
7.6 kg (16.8 lb)
803 Extended BPS (for use with RTA cart): (with battery pack, mounting bracket, and backstop) 19.5 kg (43 lb)
RTA Cart: 15.5 kg (34.2 lb)
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart (with 1-hour BPS): 31.6 kg
(69.7 lb)
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart (with4-hour BPS): 37.7 kg
(83.1 lb)
Puritan Bennett™ 800 Series Ventilator Pole Cart (with 1-hour battery): 34.4 kg (75.8 lb)
Puritan Bennett™ 800 Series Ventilator Pole Cart (with 4-hour battery): 40.5 kg (89.3 lb)
804 compressor unit (no longer available): 31.6 kg (69.7 lb)
806 compressor unit (100 V, 120 V): 23.6 kg (52 lb)
806 compressor unit (220 V): 24.5 kg (54 lb)
OP A-1
Specifications
Dimensions
Table OP A-1. Physical Characteristics (Continued)
BDU: 330 mm high by 457 mm wide by 254 mm deep (13 in. high by18 in. wide by 10 in. deep)
GUI: 460 mm high by 394 mm wide by 170 mm deep
(18.1 in. high by 15.5 in. wide by 6.7 in. deep)
802 BPS: 83 mm high by 244 mm wide by 254 mm deep
(3.25 in. high by 9.6 in. wide by 10 in. deep)
803 BPS (extended BPS for use with RTA cart): 95 mm high by 438 mm wide by 260 mm deep includes housing and bracket
(3.75 in. high by 17.25 in. wide by 10.25 in. deep)
RTA Cart: 998 mm high by 582 mm wide by 602 mm deep
(39.3 in. high by 22.9 in. wide by 23.7 in. deep)
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart: 1041 mm high by 686 mm wide by 839 mm deep (41 in. high by 27 in. wide by 33 in. deep with wheels in outermost position)
Puritan Bennett™ 800 Series Ventilator Pole Cart: 1041mm high xby 686 mm wide xby
839 mm deep (41 in. high xby 27 in. wide xby 33 in. deep with wheels in outermost position)
804 Compressor (no longer available): 417 mm high by 458 mm wideby362 mm deep
(16.4 in. high by 18 in. wide by 14.25 in. deep)
806 Compressor: 425 mm high by 458 mm wide by 362 mm deep (17 in. high by 18 in. wide by 14.25 in. deep)
Connectors
Gas mixing system
Alarm volume
Inspiratory limb connector: ISO 22-mm conical male
Expiratory limb connector (on expiratory filter): ISO 22-mm conical male
Air and oxygen inlets: DISS male, DISS female, NIST, Air Liquide™*, or SIS fitting (depending on country and configuration)
Range of flow from the mixing system: Can be set to 150 L/min standard temperature and pressure, dry (STPD).
Additional flow is available (up to 30 L/min for neonatal circuit type, up to 80 L/min for pediatric circuit type, and up to 200 L/min for adult circuit type) for compliance compensation.
Leakage from one gas system to another:
Meets standard operating pressure range: 241 kPa to 690 kPa (35psi to 100 psi)
Air/oxygen regulator bleed: Up to 3 L/min
45 dB(A) to 85 dB(A)
OP A.3
Environmental Requirements
Temperature
Atmospheric pressure
Altitude
Table OP A-2. Environmental Requirements
Operating: 10°C to 40°C (50°F to 104°F) at 10% to 95% relative humidity, noncondensing
Storage: –20°C to 50°C (–4°F to 122°F) at 10% to 95% relative humidity, noncondensing
Operating: 700 hPa to 1060 hPa (10.2 psi to 15.4 psi)
Storage: 500 hPa to 1060 hPa (7.3 psi to 15.4 psi)
Operating: (–443 m to 3280 m) (–1350 ft to 10 000 ft)
Storage: 6560 m (up to 20 000 ft)
OP A-2
Pneumatic Specifications
OP A.4
Pneumatic Specifications
Table OP A-3. Pneumatic Specifications
Oxygen and air inlet supplies
Pressure: 241 kPa to 690 kPa (35 psi to 100 psi)
WARNING:
Due to excessive restriction of the Air Liquide™*, SIS, and Dräger™* hose assemblies, reduced ventilator performance levels may result when oxygen or air supply pressures <345 kPa (50 psi) are
employed.
Oxygen sensor life
Gas mixing system
Flow: Maximum of 200 L/min
The oxygen sensor’s life is 1 year, nominal after the ventilator’s first use. When replacing the sensor, follow the information contained on the replacement oxygen sensor's package for expiration or install-by dates and information provided in the oxygen sensor's instructions for use. Document the replacement of the oxygen sensor and the date replacement is required according to the institution’s protocol. Actual sensor life depends on operating environment; operation at higher temperature or O
2
% levels can shorten the sensor life.
Range of flow from the mixing system: Can be set to 150 L/min standard temperature and pressure, dry (STPD). Additional flow is available (up to 30 L/min for neonatal circuit type, up to 80 L/min for pediatric circuit type, and up to 200 L/min for adult circuit type) for compliance compensation.
Leakage from one gas system to another:
Meets standard IEC 60601-2-12:2001.
Operating pressure range: 241 kPa to 690 kPa (35 psi to 100 psi) air/oxygen regulator bleed: up to 3 L/min
OP A-3
Specifications
OP A.5
Electrical Specifications
Table OP A-4. Electrical Specifications
Input power Ventilator operation without compressor:
120 V~, 60 Hz; 4.5 A
Ventilator operation with compressor:
120 V~, 60 Hz; 10.1 A
Mains overcurrent release:
Ventilator: 5 A
Auxiliary mains: 10 A
NOTE:
The input power specifications listed above are for ventilators with Fisher & Paykel.* MR730 humidifiers, and set up with the following ventilator parameters at 22°C ambient temperature:
• Mode: A/C
• Mandatory type: PC
• IBW: 85 kg
• f
TOT
: 20/min
• P
SUPP
: 30 cmH
2
O
• T
I
: 1 second
• Rise time%: 50%
• O
2
%: 50%
• P
PEAK
: 50 cmH
2
O
• P
SENS
: 3 cmH
2
O
Leakage current Earth leakage current: 300 μA
Enclosure/patient leakage current: 100 μA maximum
Humidifier leakage current: 50 μA maximum
Patient auxiliary leakage current: Not applicable
WARNING:
In the event of a defective earth conductor, an increase in patient leakage current to a value that exceeds the allowable limit may occur if you connect equipment to the auxiliary mains socket outlet(s) (that is, the humidifier or compressor connection).
Alarm volume 45 dB(A) to 85 dB(A)
802 backup power source
(BPS) and newer
Puritan Bennett™ 800 Series ventilator carts with 1-hour battery
24 V DC, 7 Ah
Operating time (for a new, fully charged battery):
At least 60 minutes (30 minutes on ventilators built prior to July 2007). Actual duration depends on ventilator settings, battery age, and level of battery charge.
Recharge time:
Automatically recharges within 8 hours maximum while ventilator is connected to AC power.
Shelf life: 24 months from date of manufacture.
Storage conditions: Store at –20°C to 50°C (–4°F to 122°F), 25% to 85% relative humidity; avoid direct sunlight.
Recharge requirements:
Every 6 months when storage temperature is –20°C to 29°C(–5°F to 84°F)
Every 3 months when storage temperature is 30°C to 40°C (86°F to 104°F)
Every 2 months when storage temperature is 41°C to 50°C (105°F to 122°F).
OP A-4
Compliance and Approvals
Table OP A-4. Electrical Specifications
803 extended backup power source and newer carts with
4-hour BPS or battery
24 V DC, 17 Ah
Operating time (for a new, fully charged battery):
At least 4 hours. Actual duration depends on ventilator settings, battery age, and level of battery charge.
Recharge time: Automatically recharges within 20 hours maximum while ventilator is connected to AC power.
Shelf life: 24 months from date of manufacture.
Storage conditions: Store at –20°C to 50°C (–4°F to 122°F), 25% to 85% relative humidity; avoid direct sunlight.
Recharge requirements:
Every 6 months when storage temperature is –20°C to 29°C (–5°F to 84°F)
Every 3 months when storage temperature is 30°C to 40°C (86°F to 104°F)
Every 2 months when storage temperature is 41°C to 50°C (105°F to122°F).
NOTE:
BPS battery life specifications are approximate. To ensure maximum battery life, maintain full charge and minimize the number of complete discharges.
OP A.6
Compliance and Approvals
The ventilator system was developed in accordance with pertinent FDA guidances and North
American and International standards (
The ventilator’s IEC 60601-1/EN 60601-1 classification is protection class I, type B, internally powered, IPX1 drip-proof equipment, continuous operation.
OP A-5
Specifications
Table OP A-5. Compliance and Approvals
Standards/certifications
North America
Authorized to bear the CSA certification mark, signifying the product has been evaluated to the applicable ANSI/ Underwriters Laboratories Inc. (UL) and CSA standards for use in the US and
Canada. CSA Std. No. 601-1-M90
CSA 601-1 Supplement 1:1994
CSA Std. No. 60601-2.12-1994 UL
No. 60601-1 (1st Edition) IEC
60601-1:1988 IEC 60601-1
Amendment 1:1991 IEC 60601-1
Amendment 2:1995 IEC 60601-2-
12:2001
Configurations
120 V, 60 Hz
220–240 V, 50 Hz
220–240 V, 60 Hz
Certification agency
Canadian Standards Association
(CSA)
Manufacturer self-certification
Canadian Standards Association
(CSA)
IEC 60601-1-2:2007
International
CB scheme certification:
IEC 60601-1:1988
IEC 60601-1
Amendment 1:1991
IEC 60601-1 Amendment 2:1995
IEC 60601-2-12:2001
IEC 60601-1-2: 2001+A1:2004
100 V, 50/60 Hz
120 V, 60 Hz
220–240 V, 50 Hz
220–240 V, 60 Hz
100 V, 50/60 Hz
120 V, 60 Hz
220–240 V, 50 Hz
220–240 V, 60 Hz
European
Approved to the type test requirements of Annex III of the
Medical Device Directive.
EN 60601-1:1990
EN 60601-1 Amendment 1:1993
EN 60601-1 Amendment 11:1993
EN 60601-1 Amendment 12:1993
EN 60601-1
Amendment 2:1995
EN 60601-1 Amendment 13:1996
IEC 60601-2-12:2001
EN 60601-1- 2:2001+A1:2006
220–240 V, 50 Hz
220–240 V, 60 Hz
Manufacturer self- certification
TÜV Product Service
Manufacturer self- certification
OP A-6
Compliance and Approvals
OP A.6.1
Manufacturer’s Declaration
The following tables contain the manufacturer’s declarations for the ventilator system electromagnetic emissions, electromagnetic immunity, recommended separation distances between ventilator and portable and mobile RF communications equipment, and a list of compliant cables.
WARNING:
Portable and mobile RF communications equipment can affect the performance of the Puritan
Bennett™ 840 Ventilator System. Install and use this device according to the information contained in this manual.
WARNING:
The Puritan Bennett™ 840 Ventilator System should not be used adjacent to or stacked with other equipment, except as may be specified elsewhere in this manual. If adjacent or stacked use is necessary, the Puritan Bennett™ 840 Ventilator System should be observed to verify normal operation in the configurations in which it will be used.
Note:
This is a class A product and is intended to be used in a hospital environment only. If used outside of the hospital environment, this equipment may not offer adequate protection to radio-frequency communication services. The user may be required to take mitigation measures, such as relocating or reorienting the equipment.
Table OP A-6. Electromagnetic Emissions
The Puritan Bennett™ 840 Ventilator System is intended for use in the electromagnetic environment specified below. The customer or the operator of the Puritan Bennett™ 840 Ventilator System should assure that it is used in such an environment.
Emissions test Compliance Electromagnetic environment—guidance
Radiated RF emissions
CISPR 11
Conducted RF emissions
CISPR 11
Harmonic emissions IEC 61000-3-2
Voltage fluctuations/flicker emissions
IEC 61000-3-3
Group 1
Class A
Group 1
Class A
Class A
Complies
The Puritan Bennett™ 840 Ventilator System uses RF energy only for its internal functions. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment.
The Puritan Bennett™ 840 Ventilator System is suitable for use in all establishments including domestic establishments and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic purposes.
OP A-7
Specifications
Table OP A-7. Electromagnetic Immunity
The Puritan Bennett™ 840 Ventilator System is intended for use in the electromagnetic environment specified below. The customer or the user of the Puritan Bennett™ 840 Ventilator System should ensure it is used in such an environment.
Immunity test
Electrostatic discharge
(ESD) IEC 61000-4-2
IEC 60601-1-2 test level
±6 kV contact
±8 kV air
Compliance level
±6 kV contact
±8 kV air
Electromagnetic environment—guidance
Floors should be wood, concrete, or ceramic tile.
If floors are covered with synthetic material, the relative humidity should be at least 30%.
Electrical fast transient/ burst IEC 61000-4-4
Surge IEC 61000-4-5
±2 kV for power supply lines
±1 kV for input/ output lines
±1 kV lines/lines
±2 kV lines/earth
±2 kV for power supply lines
±1 kV for input/ output lines
±1 kV lines/lines
± 2 kV lines/earth
Mains power quality should be that of a typical hospital environment.
Voltage dips, short interruptions and voltage variations on power supply input lines IEC/EN
61000-4-11
<5% U
T
(>95% dip in U
T
) for 0.5 cycle
40% U
T
(60% dip in U
T for 5 cycles)
70% U
T
(30% dip in U
T for 25 cycles)
<5% U
T
(>95% dip in U
T
for 5 s)
<5% U
T
(>95% dip in U
T
for 0.5 cycle)
40% U
T
(60% dip in U
T for 5 cycles)
70% U
T
(30% dip in U
T for 25 cycles)
<5% U
T
(>95% dip in U
T
for 5 s)
Mains power should be that of a typical hospital environment. If the operator of the Puritan
Bennett™ 840 Ventilator
System requires continuous operation during power mains interruptions, it is recommended that the Puritan
Bennett™ 840 Ventilator
System be powered from an uninterruptible power supply or a battery.
Power frequency
(50/60 Hz) magnetic field
IE/EN 61000-4-8
3 A/m 3 A/m Power frequency magnetic fields should be at levels characteristic of a typical location in a typical commercial or hospital environment.
NOTE: U
T
is the AC mains voltage prior to application of the test level.
OP A-8
Compliance and Approvals
Table OP A-8. Electromagnetic Immunity—Conducted and Radiated RF
The Puritan Bennett™ 840 Ventilator System is intended for use in the electromagnetic environment specified below. The customer or the user of the Puritan Bennett™ 840 Ventilator System should ensure it is used in such an environment.
Immunity test IEC 60601-1-2 test level
Compliance level Electromagnetic environment—guidance
Conducted RF IEC/EN
61000-4-6
3 Vrms
150 kHz to 80 MHz outside ISM bands
1
1 Vrms
159 kHz to 80 MHz outside ISM bands
Portable and mobile RF communications equipment should be used no closer to any part of the
Puritan Bennett™ 840
Ventilator System, including cables, than the separation distance calculated from the equation applicable to the frequency of the transmitter.
Recommended separation distance
d
= 0.35 P
10 Vrms inside ISM bands
1
1 Vrms inside ISM bands
d
= 1.2 P
Radiated RF IEC/EN
61000-4-3
10 V/m
80 MHz to 2.5 GHz
10 V/m Modulation of
80% AM @ 2 Hz
80 MHz to 2.5 GHz
d
= 1.2 P
80 MHz to 800 MHz
d
= 2.3 P
800 MHz to 2.5 GHz
Where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the separation distance in meters (m)
2
. Field strengths from fixed transmitters, as determined by an electromagnetic site survey
3
, should be less than the compliance level in each frequency range
4
. Interference may occur in the vicinity of equipment marked with the following symbol:
NOTE 1 At 80 MHz and 800 MHz, the higher frequency range applies
NOTE 2 these guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.
1.
The ISM (industrial, scientific and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz; 13.553 MHz to 13.567 MHz;
26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
2.
The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz are intended to decrease the likelihood mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas. For this reason, an additional factor of 10/3 is used in calculating the separation distance for transmitters in these frequency ranges.
OP A-9
Specifications
3.
Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio,
AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the
980 Series Ventilator is used exceeds the applicable RF compliance level above, the 980 Series Puritan Bennett™ 840 Ventilator System should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the ventilator.
4.
Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 10 V/m.
Table OP A-9. Recommended Separation Distances Between Portable and Mobile RF Communications Equipment and the
Puritan Bennett™ 840 Ventilator System
The Puritan Bennett™ 840 Ventilator System is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the Puritan Bennett™
840 Ventilator System can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ventilator as recommended below, according to the maximum output power of the communications equipment.
150 kHz to 80
MHz outside ISM bands
150 kHz to 80
MHz in ISM bands
80MHz to 800
MHz
800 MHz to 2.5
GHz
Rated maximum output power of transmitter (W)
d
= 0.35 P
d
= 1.2 P
d
= 1.2 P
d
= 2.3 P
0.01
0.1
1
10
0.035
0.11
0.35
1.1
Separation distance according to frequency of transmitter (m)
0.12
0.38
1.2
3.8
0.12
0.38
1.2
3.8
0.23
0.73
2.3
7.3
100 3.5
12 12 23
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.
NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
NOTE 2 The ISM (industrial, scientific, and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to
6.795 MHz; 13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
NOTE 3 An additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5
GHz to decrease the likelihood mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas.
NOTE 4 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people.
OP A-10
Technical Specifications
Table OP A-10. Compliant Cables
Covidien does not supply remote alarm (nurse call) or serial port cables. To maintain compliance to International Electromagnetic Compatibility (EMC) standards, Covidien recommends using shielded cables for these applications.
The use of accessories and cables other than those specified, with the exception of parts sold by Covidien as replacements for internal components, may result in increased emissions or decreased immunity of the
Puritan Bennett™ 840 Ventilator System.
3 m (10 ft) 4-078107-00, 4-078107-SP Power cord, latching,
North America
4-078108-00, 4-078108-SP Power cord, latching,
Europe
3 m (10 ft)
4-078109-00, 4-078109-SP Power cord, latching,
Japan
4-078110-00, 4-078110-SP Power cord, latching, Australia
4-071421-00 Power cord, Denmark
3 m (10 ft)
3 m (10 ft)
3 m (10 ft)
4-071422-00 Power cord, India/S. Africa
4-071423-00 Power cord, Israel
4-078144-00 Power cord, UK
4-078107-00, 4-078107-SP Power cord, latching,
North America
4-031323-00 Power cord, Italy
3 m (10 ft)
3 m (10 ft)
3 m (10 ft)
3 m (10 ft)
4-031325-00 Power cord, Switzerland
4-075864-00 Cable assembly, GUI to BDU
4-071441-00 Cable assembly, GUI to BDU
3 m (10 ft)
3 m (10 ft)
3 m (10 ft)
3 m (10 ft)
OP A.7
Technical Specifications
Note:
When the ventilator system pressure units are set to hPa, pressure delivery and spirometry are subject to an additional 2% error.
Table OP A-11. Technical Specifications
Maximum limited pressure 127.5 cmH
2
O (125 hPa)
Maximum working pressure
100 cmH
90 cmH
2
2
O (98.1 hPa), ensured by high pressure limit
O (pressure-based ventilation)
OP A-11
Specifications
Table OP A-11. Technical Specifications (Continued)
Measuring and display devices
Pressure
Type: Silicon solid-state differential pressure transducer
Sensing position: Inspiratory and expiratory limbs (used to algorithmically approximate circuit wye pressure)
Measurements:
Mean circuit pressure
Range: –20 cmH
2
O to 120 cmH
2
O (–20.4 hPa to 122 hPa)
Peak circuit pressure
Range: –20 cmH
2
O to 130 cmH
2
O (–20.4 hPa to 133 hPa)
Volume
Type: Hot film anemometer
Sensing position: Exhalation compartment
Measurements:
Exhaled tidal volume
Range: 0 mL to 6,000 mL
Total minute volume
Range: 0 L to 99.9 L
Oxygen
Type: Galvanic cell
Sensing position: Inspiratory manifold
Measurement: Delivered % O
2
Range: 0% to 103%
Display of settings, alarms, and monitored data
Type: Two liquid crystal display (LCD) touch screens
25 L/min to 75 L/min
Minute volume (
V
E TOT
) capability
Results of ventilator patient circuit testing
(using circuits identified for use with the Puritan Bennett™ 840 Ventilator
System (
Inspiratory pressure drop from inlet of open safety valve to outlet port without inspiratory filter:
At 5 standard liters per minute (SL/min): 0.06 cmH
2
O
At 30 SL/min: 0.28 cmH
2
O
At 60 SL/min: 0.95 cmH
2
O
Inspiratory pressure drop across inspiratory filter:
At 5 SL/min: 0.17 cmH
2
O
At 30 SL/min: 0.56 cmH
2
O
At 60 SL/min: 1.37 cmH
2
O
Inspiratory pressure drop from inlet of open safety valve with inspiratory filter:
At 5 SL/min: 0.17 cmH
2
O
At 30 SL/min: 0.84 cmH
2
O
At 60 SL/min: 2.32 cmH
2
O
Pressure drop across 1.68 m (5.5 ft) inspiratory or expiratory limb with water trap, to patient wye:
Neonatal patient circuit
1
: Not applicable (no water trap)
Pediatric patient circuit at 30 SL/min: 0.73 cmH
2
O
Adult patient circuit at 60 SL/min: 1.05 cmH
2
O
OP A-12
Technical Specifications
Table OP A-11. Technical Specifications (Continued)
Results of ventilator patient circuit testing
(using circuits identified for use with the Puritan Bennett™ 840 Ventilator
System (cont.)
Pressure drop across 1.22 m (4 ft) inspiratory or expiratory limb without water trap, to patient wye:
Neonatal patient circuit at 5 SL/min: 0.45 cmH
2
O (inspiratory limb)
Neonatal patient circuit at 5 SL/min: 0.40 cmH
2
O (expiratory limb)
Pediatric patient circuit at 30 SL/min: 0.56 cmH
2
O
Adult patient circuit at 60 SL/min: 0.70 cmH
2
O
Pressure drop across Fisher & Paykel™* humidifier and lead-in tube:
Neonatal patient circuit at 5 SL/min: 0.14 cmH
2
O
Pediatric patient circuit at 30 SL/min: 0.28 cmH
2
O
Adult patient circuit at 60 SL/min: 0.93 cmH
2
O
Total inspiratory pressure drop:
Neonatal patient circuit with neonatal filter/ vial at 5 SL/min:
0.76 cmH
2
O
Pediatric patient circuit with water traps at 30 SL/min: 1.85 cmH
2
O
Pediatric patient circuit without water traps at 30 SL/min: 1.68 cmH
2
O
Adult patient circuit with water traps at 60 SL/min: 4.30 cmH
2
O
Adult patient circuit without water traps at 60 SL/min: 3.95 cmH
2
O
Expiratory pressure drop across exhalation compartment:
At 5 SL/min:
0.21 cmH
2
O (with neonatal filter and vial)
At 30 SL/min: 1.5 cmH
2
O
At 60 SL/min: 3.40 cmH
2
O
Total expiratory pressure drop:
Neonatal patient circuit with neonatal filter and vial at 5 SL/min: 0.61 cmH
2
O
Pediatric patient circuit with water traps at 30SL/min: 2.23 cmH
2
O
Pediatric patient circuit without water traps at 30 SL/min: 2.06 cmH
2
O
Adult patient circuit with water traps at 60 SL/min: 4.45 cmH
2
O
Adult patient circuit without water traps at 60 SL/min: 4.10cmH
2
O
Internal volume:
Inspiratory pneumatics: 50 mL±5 mL
Expiratory pneumatics: 1000 mL±25 mL (including expiratory filter and collector vial)
The ventilator system automatically adjusts for volume losses due to gas compressibility (that is, automatic compliance compensation), subject to a maximum delivered volume of 2500 mL.
Patient circuit testing specifications are with the ventilator powered off, and are based on the recommended configurations shown in
(heated wire configuration) and
(non-heated wire configuration).
Patient circuit part numbers are listed in Appendix
OP B
.
To ensure that compliance compensation functions correctly, the user must run SST with the circuit configured as intended for use on the patient.
Bacteria filter efficiency 99.97% for nominal particle size of 0.3 μm (micron) at 100 L/min
1.
Use only a neonatal patient circuit in conjunction with the NeoMode software option and the NeoMode hardware.
OP A-13
Specifications
OP A.8
Patient Circuit Configurations
and
show the recommended patient circuit configurations.
Figure OP A-1. Heated Wire Configuration
1
2
3
4
PB Re/Flex or D/Flex inspiratory filter
To patient connector
PB Re/X 800 or D/X 800 expiratory filter and collector vial
Drain bag/tubing
5
6
7
Expiratory limb (smooth-bore tubing)
Patient wye
Nebulizer (for position only)
8 Inspiratory limb (smooth-bore tubing)
Figure OP A-2. Non-heated Wire Configuration
OP A-14
1
2
3
4
5
PB Re/Flex or D/Flex inspiratory filter
To patient connector
PB Re/X 800 or D/X 800 expiratory filter and collector vial
Expiratory limb (smooth-bore tubing)
Water trap
6
7
8
9
Patient wye
Nebulizer (for position only)
Water trap
Inspiratory limb (smooth-bore tubing)
Ranges, Resolutions, and Accuracies
Note:
Refer to the NeoMode option addendum for the recommended neonatal patient circuit configurations.
OP A.9
Ranges, Resolutions, and Accuracies
•
•
•
•
contains ranges, resolutions, and accuracies for ventilator settings. It also contains, where applicable, dependent ventilator settings.
contains alarm settings.
contains patient data.
contains descriptions of other displayed data including diagnostic codes, operational time, software revision level, and date/time setting.
OP A.9.1
Recommended Limits
Some settings have recommended limits you can override, called soft bounds. When you enter a proposed setting that exceeds the recommended limits, the ventilator sounds an alert and asks you for confirmation to override the recommended range.
WARNING:
The displayed pressure values are estimates and are not directly measured pressures. Displayed pressures are often good approximations of the actual pressure at the wye, but under some conditions, such as partial occlusions of the inspiratory limb, the displayed pressures will be closer to the pressure at the inspiratory port.
If the clinical circumstances suggest the validity of the displayed pressure estimates is questionable, examine the breathing circuit. Correct any occlusion and rerun SST. You can also use a separate portable manometer to measure the pressure.
OP A.9.2
Software Options
Refer to the appropriate software option addendum for information regarding ventilator settings, alarm settings, and monitored data specific to an installed ventilation option, which include:
BILEVEL (BiLevel option)
NeoMode (NeoMode option)
NeoMode Update (updated NeoMode option)
NeoMode 2.0 (NeoMode option capable of delivering tidal volumes as low as 2 mL)
TC (Tube Compensation option)
LC (Leak Compensation option)
OP A-15
Specifications
VS, VC+ (Volume Ventilation Plus option)
PAV+ (Proportional Assist™* Ventilation option
RM (Respiratory Mechanics option)
Trending (Trending option)
Setting
Apnea ventilation
Apnea expiratory time (T
E
)
Apnea flow pattern
Apnea I:E ratio
Apnea inspiratory pressure (P
I
)
Table OP A-12. Ventilator Settings
Function
A safety mode initiated if the patient does not receive a breath for an elapsed time exceeding the apnea interval.
Same as expiratory time for nonapnea ventilation.
Range, resolution, accuracy
See individual apnea settings.
The gas flow pattern of mandatory volume controlled (VC breaths.
Flow pattern is not selectable when the mandatory type is PC or VC+.
.Sets the ratio of inspiratory time to expiratory time. Applicable to pressure control (PC) mandatory breaths in SIMV, VC+, BILEVEL or A/C only.
Sets the inspiratory pressure at the patient wye (above PEEP) during a pressure control (PC) mandatory breath.
Range: ≥0.2 second
Resolution:
Same as for non-apnea.
Accuracy:
Same as for non-apnea
Range:
Square or descending ramp
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
All circuit types: Descending ramp
Range: ≤1.00:1
Resolution: 1 for 1:299 to 1:100
0.1 for 1:99.9 to 1:10.0
0.01 for 1:9.99 to 4.00:1
Accuracy:
„±0.01 second of the inspiratory time determined by the I:E ratio and respiratory rate settings
Depends on: T
I
, T
E
or T
H
, T
L
.
Range: 5 cmH
2
O to 90 cmH
2
O;
P
I
+PEEP<90 cmH
2
O;
P
I
+PEEP+2 cmH
2
≤
2
P
PEAK
O;
Resolution: 1.0 cmH
2
O
Accuracy: ±3.0 (+2.5% of setting) cmH
2
O, measured at patient wye
(end inspiratory pressure after 1 second) when rise time percent is
100%
New patient value:
15 cmH
2
O
Depends on: PEEP,
2
P
PEAK
OP A-16
Ranges, Resolutions, and Accuracies
Setting
Apnea inspiratory time (T
I
)
Apnea interval (T
Apnea O
2
%
A
)
Apnea mandatory type
Table OP A-12. Ventilator Settings (Continued)
Function
Sets the duration of inspiration during pressure control (PC or VC+) mandatory breaths. Not settable in
VC, but T
I
is displayed on breath timing bar and changes based upon changes to VC settings.
Defines apnea time interval after which the ventilator declares apnea.
T
A
≥60/f
A
.
Range, resolution, accuracy
Range:
0.20 s to 8.00 s
T
H
0.2 s to 30 s (BILEVEL mode only)
Resolution:
0.01 s when mandatory breath type is PC or VC+; 0.02 s when mandatory breath type is VC
Accuracy: ±0.01 s
New patient value:
Based on circuit type, IBW, and VC settings
Depends on: I:E, f, T
E
Range: 10 s to 60 s
Resolution: 1 s
Accuracy: +0.350 s
New patient value:
Neonatal: 10 s
Pediatric: 15 s
Adult: 20 s
Sets the type of mandatory breath: volume control (VC), pressure control (PC), or volume control plus
(VC+). VC+ is only available with
INVASIVE Vent type selected and with the Volume Ventilation Plus
(VV+) option installed, when the mode is A/C or SIMV.
Sets the percentage of oxygen in the delivered gas.
Range: VC, PC, or VC+
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Neonatal: Same as non-apnea mandatory type when non-apnea mandatory type is PC or VC. PC when non-apnea mandatory type is VC+.
Pediatric/adult: Same as nonapnea mandatory type when non-apnea mandatory type is PC or VC. VC when non-apnea mandatory type is VC+.
Range:
21% to 100%, and not below nonapnea O
2
%
Resolution: 1%
Accuracy: ±3% by volume over the entire breath
New patient value:
Neonatal: 40%
Pediatric/adult: 100%
OP A-17
Specifications
Setting
Apnea peak inspiratory flow
(
V
MAX
)
Apnea respiratory rate (f)
Table OP A-12. Ventilator Settings (Continued)
Function
Sets the peak (maximum) inspiratory flow during VC mandatory breaths.
Same as respiratory rate for nonapnea ventilation. Apnea f ≥60/T
A
.
Range, resolution, accuracy
Range:
Neonatal:
≥1.0 L/min to ≤30 L/min
Pediatric:
≥3.0 L/min to ≤60 L/min
Adult:
≥3.0 L/min to ≤150 L/min
Resolution:
0.1 L/min for flows of 1 L/min to
20 L/min; 1 L/min for flows of 20
L/min and above
Accuracy:
±(0.5+10% of setting) L/min Body temperature and pressure, saturated (BTPS) after the first 100 ms of inspiration and without compliance compensation
New patient value:
When circuit type is adult and flow pattern is descending ramp:
2×0.435×IBW.
When flow pattern is square:
0.435×IBW.
When circuit type is pediatric and flow pattern is square:
MAX(0.572×IBW), 3.0.
When flow pattern is descending ramp: 2×0.572×IBW.
When circuit type is neonatal:
MAX (2×0.750×IBW) 1.0Depends
on: circuit type, IBW, V
T
, f, flow pattern, T
PL
, I:E, T
E
Range: 2.0/min to 40/min
Resolution:
0.1/min for 2.0 /min to 9.9/min
1/min for 10/min to 40/min
Accuracy:
±0.1/min (+ 0.6% of setting)
New patient value:
Neonatal: 20/min
Pediatric: 14/min
Adult: 10/min
OP A-18
Ranges, Resolutions, and Accuracies
Setting
Apnea tidal volume (V
T
)
Constant during rate change
Disconnect sensitivity (D
SENS
)
Table OP A-12. Ventilator Settings (Continued)
Function
Sets the volume of gas delivered to the patient’s lungs during a mandatory volume-based apnea breath
(VC only is allowed during apnea ventilation).
Apnea tidal volume is compensated for body temperature and pressure, saturated (BTPS) and the compliance of the patient circuit.
Range, resolution, accuracy
Range:
Neonatal: 3 mL to 315 mL*
Pediatric/adult: 25 mL to 2500 mL (IBW-based range is 1.16×IBW minimum; 45.7×IBW maximum)
Resolution:
0.1 mL for 3 mL to 5 mL*
1 mL for 5 mL to 100 mL
5 mL for 100 mL to 400 mL
10 mL for 400 mL to 2500 mL
Accuracy: Compliance- and BTPScompensated:
For T
I
<600 ms:
± 10 mL (+ 10%×(600 ms/T
I
) of setting)
For T
I
>600 ms:
± 10 mL (+10% of setting)
New patient value: MAX (3 mL,
(7.25×IBW))*
*Assumes NeoMode 2.0 software option is installed.
Specifies which of the three breath timing variables is directly operatoradjustable and remains constant when the set respiratory rate changes. Applicable in pressure control (PC) ventilation and Volume
Control Plus ventilation (VC+) only.
Timing variables:
T
I
, I:E ratio, or T
E
; T
H
, T
L
, T
H
:T
L
in
BILEVEL
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Inspiratory time
NOTE:
You can change the value of the selected variable at any time, but the value does not change as a result of changing the respiratory rate setting.
Sets the allowable loss (in %) of returned volume which, if exceeded, causes the ventilator to annunciate a CIRCUIT DISCONNECT alarm.
The greater the setting, the more returned volume must be lost before CIRCUIT DISCONNECT is annunciated. For example, a setting of 95% means more than 95% of the returned volume must be lost before the ventilator detects a disconnected circuit.
Range: 20% to 95%
Resolution: 1%
Accuracy: Not applicable
New patient value:
(invasive vent type): 75%,
(NIV vent type): OFF
OP A-19
Specifications
Table OP A-12. Ventilator Settings (Continued)
Setting
Expiratory sensitivity (E
SENS
Expiratory time (T
Flow pattern (available only when mandatory type is VC)
Flow sensitivity (
V
E
)
SENS
)
)
High spontaneous inspiratory time limit (
2
T
I SPONT
) (available when vent type is NIV, only)
Humidification type
Function
The percent of peak inspiratory flow at which the ventilator cycles from inspiration to exhalation for spontaneous breaths.
Sets the expiratory period for pressure control (PC orVC+) mandatory breaths.
The gas flow pattern of mandatory volume controlled (VC) breaths.
Flow pattern is not selectable when the mandatory type is PC or VC+.
Range, resolution, accuracy
Range: 1% to 80%
(1 L/min to 10 L/min when spontaneous type is PA)
Resolution: 1%
Accuracy: Not applicable
New patient value: 25%
(3 L/min when spontaneous type is PA)
Range: T
E
≥0.2 s
Resolution: 0.01 s
Accuracy: ±0.01 s
New patient value:
60/f (new patient)–T
I
(new patient) seconds
Depends on: I:E ratio, T
I
, f
Range:
Square or descending ramp
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
All circuit types: Descending ramp
The flow inspired by the patient triggers the ventilator to deliver a mandatory or spontaneous breath
(when flow triggering is selected).
Sets the maximum inspiratory time allowed during non-invasive ventilation. If the inspiratory time reaches the set limit, the ventilator transitions to exhalation.
Indicates the type of humidification device used on the ventilator. Type can be changed duringSST and normal ventilation (see the More
Settings screen).
Range:
Neonatal: 0.1 to ≤10 L/min
Pediatric/adult:
0.2 L/min to ≤20 L/min
Resolution: 0.1 L/min
Accuracy: Not applicable
New patient value:
Neonatal: 0.5 L/min
Pediatric: 2.0 L/min
Adult: 3.0 L/min
Range:
Neonatal:
≥0.2 s to (1+(0.1×IBW)) sec
Pediatric/adult:
≥0.4 s to (1.99+(0.02×IBW)) s
New patient value:
Neonatal:
(1+(0.1×IBW)) s
Pediatric/adult: (1.99+(0.02×
IBW)) s
Depends on: Circuit type, IBW
Range:
HME, non-heated expiratory tube, or heated expiratory tube
Resolution: Not applicable
Accuracy: Not applicable
New patient value: Previous setting
OP A-20
Ranges, Resolutions, and Accuracies
Setting
Humidifier volume
Ideal body weight (IBW)
I:E ratio or T
H
:T
L
in BILEVEL
Table OP A-12. Ventilator Settings (Continued)
Function
The empty volume of the currently installed humidifier (specified volume, not compressible volume).
Indicates an approximate value for patient’s body weight, assuming normal fat and fluid levels. The IBW establishes the absolute limits on tidal volume and peak flow. The ventilator uses IBW to determine the initial new patient settings for tidal volume, peak flow, and volume-related alarms.
Sets the ratio of inspiratory time to expiratory time. Applicable to pressure control (PC) mandatory breaths in SIMV, VC+, BILEVEL or A/C only.
Range, resolution, accuracy
Range:
HME, non-heated expiratory tube, or heated expiratory tube
Resolution: Not applicable
Accuracy: Not applicable
New patient value: Previous setting
Range:
Neonatal: 0.3 kg (0.66 lb) to 7.0 kg*(15 lb)
Pediatric:
3.5 kg (7.7 lb) to 35 kg(77 lb)
Soft bounds at 7 kg and 24 kg
Adult:7.0 kg (15 lb) to 150 kg (330 lb) soft bound at 25 kg
Resolution:
0.1 kg for 0.3 kg to 3.5 kg*
0.5 kg for 3.5 kg to 10 kg
1.0 kg for 10 kg to 50 kg
5 kg for 50 kg to 100 kg
10 kg for 100 kg to 150 kg
Accuracy: Not applicable
New patient value:
Neonatal: 3.0 kg
Pediatric: 15.0 kg
Adult: 50 kg
Depends on: Circuit type
*Assumes NeoMode 2.0 software option is installed.
Range:
1:299≤I:E≤4.00:1
1:299 <T
H
:T
L
<149:1
(BILEVEL mode only)
Resolution:1 for 1:299 to 1:100
0.1 for 1:99.9 to 1:10.0
0.01 for 1:9.99 to 4.00:1
Accuracy:
±0.01 second of the inspiratory time determined by the I:E ratio and respiratory rate settings
Depends on: T
I
, T
E
or T
H
, T
L
OP A-21
Specifications
Setting
Inspiratory pressure (P
I
)
Inspiratory time (T
I
)
Mandatory type
Table OP A-12. Ventilator Settings (Continued)
Function
Sets the inspiratory pressure at the patient wye (above PEEP) during a pressure control (PC) mandatory breath.
Sets the duration of inspiration during pressure control (PC orVC+) mandatory breaths. Not settable in
VC, but T
I
is displayed on breath timing bar and changes based upon changes to VC settings.
Sets the type of mandatory breath: volume control (VC), pressure control (PC), or volume control plus
(VC+). VC+ is only available with invasive vent type selected and with the Volume Ventilation Plus
(VV+) option installed, when the mode is A/C or SIMV.
Range, resolution, accuracy
Range: 5 cmH
2
O to 90 cmH
2
O;
P
I
+PEEP<90 cmH
2
O;
P
I
+PEEP+2 cmH
2
≤
2
P
PEAK
O;
Resolution: 1.0 cmH
2
O
Accuracy: ±3.0 (+2.5% of setting) cmH
2
O, measured at patient wye
(end inspiratory pressure after 1 second) when rise time% is 100%
New patient value:
15 cmH
2
O
Depends on: PEEP,
2
P
PEAK
Range:
0.20 s to 8.00 s
T
H
0.2 s to 30 s (BILEVEL mode only)
Resolution:
0.01 s when mandatory breath type is PC or VC+; 0.02 s when mandatory breath type is VC
Accuracy: ±0.01 s
New patient value:
Based on circuit type, IBW, and VC settings
Depends on: I:E, f, T
E
Range: VC, PC, or VC+
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Neonatal: PC
Pediatric/adult: VC
OP A-22
Mode
Setting
O
2
%
Ranges, Resolutions, and Accuracies
Table OP A-12. Ventilator Settings (Continued)
Function
Defines ventilatory mode, which defines the allowable breath types:
A/C allows PC (pressure control) or
VC (volume control) or VC+ mandatory breaths. When Vent Type is NIV,
A/C allows PC or VC mandatory breaths, only.
SIMV allows mandatory breaths (PC,
VC orVC+) and spontaneous breaths (with or without PS or TC).
When Vent Type is NIV, SIMV allows
PC or VC mandatory breaths and spontaneous breaths with or without PS.
SPONT allows only spontaneous breaths [with or without pressure support (PS), tube compensation
(TC), volume support (VS), or Proportional Assist™* (PA)], except for manual inspirations, which may be
PC or VC mandatory breaths. These same settings are also allowed when Vent Type is NIV, except that
TC, VS, and PA are not available.
BILEVEL (optional)
Range, resolution, accuracy
Range:
A/C, SIMV, SPONT, CPAP (optional), or BILEVEL (optional)
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Neonatal: SIMV
Pediatric/adult: A/C
NOTE:
Ventilator settings unique to the BILEVEL mode are described in the
BiLevel option addendum to this manual.
Sets the percentage of oxygen in the delivered gas.
Range: 21% to 100%
Resolution: 1% O
2
Accuracy:
± 3% by volume over the entire breath
New patient value:
Neonatal: 40%
Pediatric/adult: 100%
NOTE:
A significant change to the O
2
% setting can cause the V
TE
(exhaled tidal volume) to be transiently displayed as lower or higher than the actual exhaled volume. This is a result of initial spirometry calculations and does not reflect actual volume exhaled by the patient.
OP A-23
Specifications
Setting
Patient circuit type
Peak inspiratory flow (
V
MAX
)
Table OP A-12. Ventilator Settings (Continued)
Function
Indicates the type of circuit used on the ventilator. Setting can be changed only during SST.
Range, resolution, accuracy
Range:
neonatal, pediatric, or adult neonatal is only available with the
NeoMode software option installed
Resolution: Not applicable
Accuracy: Not applicable
NOTE:
To ensure optimum compliance compensation, specify pediatric patient circuit when patient IBW≤24 kg.
Sets the peak (maximum) inspiratory flow during VC mandatory breaths.
Range:
Neonatal:
≥1.0 L/min to ≤30 L/min
Pediatric:
≥3.0 L/min to ≤60 L/min
Adult:
≥3.0 L/min to ≤150 L/min
Resolution:
0.1 L/min for flows of 1 L/min to
20 L/min; 1 L/min for flows of 20
L/min and above
Accuracy:
±(0.5+10% of setting) L/min Body temperature and pressure, saturated (BTPS) after the first 100 ms of inspiration and without compliance compensation
New patient value:
When circuit type is adult and flow pattern is descending ramp:
2×0.435×IBW.
When flow pattern is square:
0.435×IBW.
When circuit type is pediatric and flow pattern is square:
MAX(0.572×IBW), 3.0.
When flow pattern is descending ramp: 2×0.572×IBW.
When circuit type is neonatal:
MAX (2×0.750×IBW) 1.0Depends
on: circuit type, IBW, V
T
, f, flow pattern, T
PL
, I:E, T
E
OP A-24
Ranges, Resolutions, and Accuracies
PEEP
Setting
Plateau time (T
PL
)
Pressure sensitivity (P
SENS
)
Pressure support (P
SUPP
)
Table OP A-12. Ventilator Settings (Continued)
Function
Sets the positive end expiratory pressure, defined as the positive pressure targeted in the patient circuit during exhalation (also called baseline).
Sets the extension of a VC mandatory breath during which gas delivery stops and exhalation is blocked.
Increases the residence time of delivered gas in the patient’s lungs.
Sets the pressure drop below PEEP required to begin a patient-initiated breath (when pressure triggering is selected).
Sets the inspiratory assist pressure
(above PEEP) at the patient wye during a spontaneous breath, when spontaneous breath type is pressure support (PS).
Range, resolution, accuracy
Range: 0 to cmH
2
O 45 cmH
2
O
Resolution:
0.5 cmH
2
O for 0 cmH
2
O to 19.5 cmH
2
O; 1 cmH
2
O for 20 cmH
2
O to 45 cmH
2
O
Accuracy:
±(2.0+4% of setting) cmH
2
O measured at patient wye
PEEP measured with returned flow: <5 L/min
New patient value:
3 cmH
2
O
Depends on:
2
P
PEAK
, P
I
Range: 0.0 s to 2.0 s
Resolution: 0.1 s
Accuracy: ±0.01 s
New patient value:
0.0 s
Depends on: V
T
, f, flow pattern,
V
MAX
, I:E, T
E
Range:
0.1 cmH
2
O to 20 cmH
2
O below
PEEP
Resolution: 0.1 cmH
2
O
Accuracy: Not applicable
New patient value:
2 cmH
2
O
Range: 0 cmH
2
O to 70 cmH
2
O;
P
SUPP
+PEEP≤90 cmH
2
O;
P
SUPP
+PEEP+2 cmH
2
O ≤
2
P
PEAK
Resolution: 1 cmH
2
O
Accuracy:±(3.0+2.5% of setting) cmH
2
O measured at patient wye
(end inspiratory pressure after 1 second)
New patient value:
0 cmH
2
O
Depends on:
2
P
PEAK
OP A-25
Specifications
Setting
Respiratory rate (f)
Rise time percent P%
Safety ventilation (safe state)
NOTE: Safety ventilation is not a ventilator setting.
Table OP A-12. Ventilator Settings (Continued)
Sets the minimum number of mandatory breaths the patient receives per minute. Active in A/C, SIMV, and
BILEVEL.
Function Range, resolution, accuracy
Range:
Neonatal: 1.0/min to 150/min
Pediatric/adult:
1.0/min to 100/min
Resolution:
0.1/min for 1.0/min to 10/min;
1/min for 10/min to 150/min
Accuracy:
±(0.1+0.6% of setting) 1/min averaged over 60 s or 5 breaths, whichever occurs last
New patient value:
Neonatal: 20/min
Pediatric: 14/min
Adult: 10/min
Sets how quickly inspiratory pressure rises to achieve the set (target) inspiratory pressure in pressure control (PC) or pressure support (PS) breaths. A higher value means the target pressure is reached more quickly.
Range: 1% to 100%
Resolution: 1%
Accuracy: Not applicable
New patient value: 50%
WARNING:
Under certain clinical circumstances, for example, stiff lungs or high airway resistance a rise time percent >50% could cause a transient pressure overshoot and premature transition to exhalation. Carefully evaluate the patient’s condition before setting the rise time percent above the default setting of 50%.
A safe mode of ventilation becomes active if you connect the patient circuit before you complete ventilator startup. (You cannot modify the default safety ventilation settings.)
Safety ventilation annunciates a high priority PROCEDURE ERROR alarm and sets these alarm limits:
High circuit pressure =20 cmH
2
O
Low exhaled minute volume =0.05
L
All other alarms are inactive.
Safety ventilation settings include:
Mode = A/C
Mandatory type = PC
Respiratory rate =16/min
Inspiratory time =1 s
Inspiratory pressure =10 cmH
2
O
PEEP=3 cmH
2
O
Trigger type = pressure
Pressure sensitivity =2 cmH
2
O
Rise time percent =50%
O
2
%=100% or 40% in NeoMode
(21% if O
2
not available)
OP A-26
Ranges, Resolutions, and Accuracies
Setting
Spontaneous type
Tidal volume (for VC) or Target volume (for VC+) (V
T
)
Table OP A-12. Ventilator Settings (Continued)
Function
Sets the type of spontaneous breath: not pressure supported (NONE), pressure supported (PS), tube compensated (TC), volume supported (VS), or proportionally assisted (PA). TC is only available with the Tube Compensation option when the patient circuit type is pediatric or adult. PA is only available with the PAV.*+ option when the circuit type is adult,
IBW≥25.0 kg, and tube I.D.≥6.0 mm.
VS is only available with the Volume
Ventilation Plus option.
Sets the volume of gas delivered to the patient’s lungs during a mandatory volume based breath. Tidal volume is compensated for body temperature and pressure, saturated (BTPS) and the compliance of the patient circuit.
Range, resolution, accuracy
Range:
When vent type is invasive:
Neonatal: PS, NONE, VS
Pediatric: NONE, PS, TC, VS
Adult: NONE, PS, TC, VS, PA
When vent type is NIV: neonatal/pediatric/adult:
PS, NONE
Resolution: Not applicable
Accuracy: Not applicable
New patient value: PS
Range:
Neonatal: 2 mL to 315 mL*
Pediatric/adult: 25 mL to 2500 mL (IBW-based range is 1.16×IBW minimum; 45.7×IBW maximum)
Resolution:
0.1 mL for 2 mL to 5 mL*
1 mL for 5 mL to 100 mL
5 mL for 100 mL to 400 mL
10 mL for 400 mL to 2500 mL
Accuracy:
Compliance- and BTPS-compensated:
For T
I
<600 ms:
±10 mL (+10% ×(600 ms/ T
I
) of setting)
For T
I
>600 ms:
±10 mL (+10% of setting)
New patient value:
Neonatal:
MAX (2 mL, (7.25×IBW)); when circuit type = neonatal and mandatory type = VC+* MAX (3 mL,
(7.25×IBW)); when circuit type = neonatal and mandatory type =
VC* Pediatric/adult: (7.25×IBW)
Depends on: circuit type, IBW, f,
V
MAX
, flow pattern, T
PL
, I:E, T
E
*Assumes NeoMode 2.0 software option is installed
OP A-27
Specifications
Trigger type
Setting
Vent type
Setting
Apnea interval (T
A
)
High circuit pressure limit
(
2
P
PEAK
)
O
2
sensor
Table OP A-12. Ventilator Settings (Continued)
Function
Determines whether flow or pressure triggers patient breaths. See also flow sensitivity and pressure sensitivity.
Allows user to select invasive or non-invasive ventilation type based upon the type of breathing interface used. Invasive: ET or Trach tubes NIV: masks, infant nasal prongs, or uncuffed ET tubes.
Range, resolution, accuracy
Range:
Neonatal:
Flow (
V
-TRIG)
Pediatric/adult:
Invasive vent type:
Pressure (P-TRIG) or flow(
V
-TRIG)
NIV vent type:
Flow (
V
-TRIG)
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Flow (
V
-TRIG)
Range: Invasive or NIV (non-Invasive)
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Invasive
Table OP A-13. Alarm Settings
Function
Sets the maximum time from the start of one inspiration to the start of the next inspiration, after which the ventilator enters apnea ventilation. Press the APNEA button to change the T
A
setting.
Sets the maximum circuit pressure (relative to ambient) allowed during inspiration. When the high circuit pressure limit is reached during inspiration, the ventilator halts inspiration and begins exhalation.
Enabling theO
2
sensor will allow the High/Low delivered O
2
% alarm to function. This alarm indicates the O
2
% measured during any phase of a breath cycle is higher or lower than the internally programmed limits. The alarm limits are automatically adjusted during 100% O
2
suction, apnea ventilation, patient circuit disconnect, low pressure gas inlet, and when the O
2
% setting is changed.
Range and resolution
Range: MAX (10 s, 60/ Apnea f) seconds
Resolution: 1 second
New patient value:
Neonatal: 10 seconds
Pediatric: 15 seconds
Adult: 20 seconds
Range: 7 cmH
2
O to 100 cmH
Resolution: 1 cmH
2
New patient value:
Neonatal: 30 cmH
2
O
O
Pediatric/adult: 40 cmH
2
O
2
O
Range:
O
2
sensor Enabled, Disabled, or
Calibration
New patient value:
Enabled
NOTE: Alarm only occurs if O
2 sensor is Enabled.
OP A-28
Ranges, Resolutions, and Accuracies
Setting
High exhaled minute volume limit (
2V
E TOT
)
High exhaled tidal volume limit
(
2
V
TE
)
High respiratory rate limit (
2 f
Table OP A-13. Alarm Settings
Function
Sets the maximum exhaled minute volume limit for spontaneous or mandatory breaths.
Sets the maximum exhaled tidal volume limit for spontaneous or mandatory breaths.
TOT
)
Sets the maximum breath rate limit.
Range and resolution
Range: OFF or
≥0.10 L/min and > low exhaled minute volume limit and
Neonatal: ≤10 L/min
Pediatric: ≤30 L/min
Adult: ≤100 L/min
Resolution:
0.005 L for 0.100 L to 0.495 L
0.05 L for 0.50 L to 4.95 L
0.5 L for 5.0 L to 100.0 L
New patient value:
Neonatal:
[(20×0.001 L/mL ×(7.25 mL/kg
×IBW)×1.30)+0.05]
Pediatric:
[(14×0.001 L/mL ×(7.25 mL/kg
×IBW)×1.30)+0.05]
Adult:
[(10×0.001 L/mL ×(7.25 mL/kg
×IBW)×1.30)+0.05]
Range: OFF or
> low exhaled spontaneous tidal volume limit > low exhaled mandatory tidal volume limit and
Neonatal: 5 mL to 500 mL
Pediatric: 25 mL to 1500 mL
Adult: 25 mL to 3000 mL
Resolution:
1 mL for 5 mL to 100 mL
5 mL for 100 mL to 400 mL
10 mL for 400 mL to 3000 mL
New patient value:
MAX [(7.25 mL/kg ×IBW×1.30)], 5 mL
Range:
OFF or
Neonatal:
10/min to 170/min
Pediatric/adult:
10/min to 110/min
Resolution: 1/min
New patient value: OFF
OP A-29
Specifications
Setting
Low exhaled mandatory tidal volume limit (
4
V
TE MAND
)
Low exhaled minute volume limit
(
4V
E TOT
)
Table OP A-13. Alarm Settings
Function
Sets the minimum exhaled mandatory tidal volume limit.
Sets the minimum exhaled minute volume limit for mandatory and spontaneous breath types.
Range and resolution
Range:
OFF or
≥1 mL < high exhaled tidal volume limit and
Neonatal: ≤300 mL
Pediatric: ≤1000 mL
Adult: ≤2500 mL
Resolution: 1 mL for 1 mL to 100 mL
5 mL for 100 mL to 400 mL
10 mL for 400 mL to 2500 mL
New patient value (invasive vent type):
(7.25 mL/kg ×IBW×0.70)
New patient value (NIV Vent
Type): OFF
Range: OFF or < high exhaled minute volume limit and
Neonatal: OFF or 0.010 L/min to
10 L/min
Pediatric: 0.05 L/min to 30 L/min
Adult: 0.05 L/min to 60 L/min
Resolution:
0.005 L/min for 0.010 L/min to
0.495 L/min
0.05 L/min for 0.05 L/min to 4.95
L/min
0.5 L/min for 5.0 L/min to 60.0 L/ min
New patient value (invasive vent type):
Neonatal:
MAX [((20×0.001 L/mL ×(7.25 mL/ kg ×IBW)×0.70)–0.05), 0.01]
Pediatric:
[(14×0.001 L/mL ×(7.25 mL/kg
×IBW×0.70)–0.05]
Adult:
[(10×0.001 L/mL ×(7.25 mL/kg
×IBW)×0.70)–0.05)
New patient value (NIV vent
type): OFF
OP A-30
Ranges, Resolutions, and Accuracies
Setting
Low exhaled spontaneous tidal volume limit (
4
V
TE SPONT
)
Low circuit pressure alarm limit
(
4
P
PEAK
)
Table OP A-13. Alarm Settings
Function
Sets the minimum exhaled spontaneous tidal volume limit.
Sets the minimum allowable circuit pressure. Available only during NIV or when VC+ is selected as Mandatory Type in invasive ventilation.
Range and resolution
Range: OFF or ≥1 mL < high exhaled tidal volume limit and
Neonatal: ≤300 mL
Pediatric: ≤1000 mL
Adult: ≤2500 mL
Resolution:
1 mL for 1 mL to 100 mL
5 mL for 100 mL to 400 mL
10 mL for 400 mL to 2500 mL
New patient value
(invasive vent type):
(7.25 mL/kg ×IBW×0.70)
New patient value (NIV vent type or when spontaneous type is PA):
OFF
Range:
NIV: OFF to
2
P
PEAK
–1 cmH
2
O
VC+: PEEP to
2
P
PEAK
–1 cmH
2
O
NOTE: When VC+ is selected,
4
P
PEAK
can be set to OFF only if
PEEP is set to 0.
New patient value:
PEEP+6 cmH
2
O
Resolution:
0.5 cmH
2
O for pressures <20 cmH
2
O 1 cmH
2
O for pressures
≥20 cmH
2
O
Breath type
Parameter
Table OP A-14. Patient Data
Function
Indicates the type of breath and its delivery phase, either inspiratory or expiratory. The background is light during inspiration, dark during exhalation. This display stays on throughout the entire breath cycle, and is updated at the beginning of each inspiration and exhalation. The breath indicator display is not synchronized with the exhaled tidal volume
(V
TE
) display, which applies to the previous breath cycle.
Range, resolution, accuracy
Type: Control (C), assist (A), or spontaneous (S)
Phase: Inspiratory or expiratory
Resolution: Not applicable
Accuracy: Not applicable
OP A-31
Specifications
Parameter
Delivered O
2
% (O
2
%)
End expiratory pressure
(PEEP)
End inspiratory pressure (P
I END
)
Exhaled minute volume (
V
E TOT
)
Table OP A-14. Patient Data
Function
Indicates the percentage of oxygen in the gas delivered to the patient, measured at the ventilator outlet upstream of the inspiratory filter. The high and low O
2
% alarms are set internally and are based on the set O
2
% value.
Indicates the pressure at the end of the expiratory phase of the previous breath. Updated at the beginning of the next inspiration.
If expiratory pause is active, the displayed value reflects the level of any active lung PEEP.
Indicates the pressure at the end of the inspiratory phase of the current breath. Updated at the beginning of the expiratory phase. If plateau is active, the displayed value reflects the level of end-plateau pressure.
Displays a calculated total of the volumes exhaled by the patient for mandatory and spontaneous breaths for the previous 1- minute interval. The displayed value is compliance- and BTPS compensated. Exhaled minute volume updates at the beginning of the next inspiration.
Range, resolution, accuracy
Range: 0% to 103%
Resolution: 1% O
2
Accuracy: ±3% O
2
of full scale
Range: –20.0 cmH cmH
2
O
Resolution:
0.1 cmH
2
O for –20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
Accuracy:
2
O to 130
±(2+4% of reading) cmH
2
O relative to the pressure measured at the exhalation side of the patient wye
Range: –20.0 cmH
2
O to 130 cmH
2
O
Resolution:
0.1 cmH
2
O for–20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
Accuracy:
±(2+4% of reading) cmH
2
O relative to the patient wye for pressure control breaths with inspiratory times of 1 second or longer
Range: 0.00 L to 99.9 L
Resolution: 0.01 L for 0.00 L to
9.99 L
0.1 L for 10.0 L to 99.9 L
Accuracy:
For T
E
<600 ms:
±10× respiratory rate
(+ 10% ×(600 ms/T
E
) of reading) mL
For T
E
>600 ms: ±10× respiratory rate (+10% of reading) mL
OP A-32
Parameter
Exhaled tidal volume (V
TE
)
I:E ratio
Intrinsic PEEP (PEEP
I
)
Peak circuit pressure (P
PEAK
)
Ranges, Resolutions, and Accuracies
Table OP A-14. Patient Data
Function
Indicates the volume exhaled by the patient for the previous mandatory or spontaneous breath.
The displayed value is compliance- and BTPS-compensated.
Exhaled tidal volume updates at the beginning of the next inspiration.
Range, resolution, accuracy
Range: 0 mL to 6000 mL
Resolution:
0.1 mL for 0.0 mL to 9.9 mL
1 mL for 10 mL to 6000 mL
Accuracy:
For T
I
<600 ms: ±(10+10% (600 ms/T
E
) of setting) mL
For T
I
>600 ms: ±(10+10% of setting) mL Compliance- and BTPScompensated
T
E
= time to exhale 90% of exhaled volume
NOTE: A significant change to the O
2
% setting can cause the V
TE
(exhaled tidal volume) to be transiently displayed as lower or higher than the actual exhaled volume. This is a result of initial spirometry calculations and does not reflect actual volume exhaled by the patient.
Indicates the ratio of inspiratory time to expiratory time for the previous breath, regardless of type. Updated at the beginning of the next inspiration.
Due to limitations in setting the I:E ratio in PC ventilation, the monitored data display and the setting may not match precisely.
Indicates a calculated estimate of the pressure above the PEEP level at the end of exhalation. Determined during an expiratory pause maneuver.
Range: 1:599 to 149:1
Resolution:
0.1 for 1:9.9 to 9.9:1
1 for 1:599 to 1:10 and 10:1 to
149:1
Accuracy: ±1%
Indicates the maximum pressure during the previous breath, relative to the patient wye, including the inspiratory and expiratory phases. Updated at the end of inspiration.
Range: –20.0 cmH
2
O to 130 cmH
2
O
Resolution:
0.1 cmH
2
O for –20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
Range: –20.0 cmH
2
O to 130 cmH
2
O
Resolution:
0.1 cmH
2
O for –20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
OP A-33
Specifications
Spontaneous minute volume
(
V
E SPONT
)
Parameter
Mean circuit pressure (P
Plateau pressure (P
MEAN
)
Spontaneous inspiratory time
(T
I SPONT
)
PL
)
Rapid shallow breathing index
(f/V
T
)
Table OP A-14. Patient Data
Function
Indicates the average circuit pressure over the previous 1-minute interval, regardless of type.
Updated at the beginning of the next inspiration.
Displays the pressure in the ventilator breathing circuit at the end of an inspiratory pause maneuver.
An estimate of the pressure in the patient’s lungs. P
PL
updates continuously.
Range, resolution, accuracy
Range: –20.0 cmH
2
O to 130 cmH
2
O
Resolution:
0.1 cmH
2
O for –20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
Accuracy:
±(3+4% of reading) cmH
2
O
Range: –20.0 cmH
2
O to 130 cmH
2
O
Resolution:
0.1 cmH
2
O for –20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
Accuracy:
± (2+4% of reading) cmH
2
O
Range: 0.0 1/min-L to 600 1/min-
L
Resolution:
0.1 for f/V
T
<10 1/min-L
1 for f/V
T
≥ 0 1/min-L
Accuracy: Not applicable
Displays the ratio of respiratory rate to inspired volume measurements on the MORE PATIENT
DATA screen. Available for spontaneous breaths (SPONT mode) only. Accessible during normal ventilation by touching the MORE
PATIENT DATA button on the upper GUI screen.
Displays the measured patient inspiratory time on the MORE
PATIENT DATA screen. Available for spontaneous breaths only.
Accessible during normal ventilation by pressing the MORE
PATIENT DATA button on the upper GUI screen.
Displays a calculated total of the volumes exhaled by the patient for spontaneous breaths for the previous 1-minute interval. Values for mandatory breaths during this period are not included. The displayed value is compliance- and
BTPS-compensated. Updated at the beginning of the next inspiration.
Range: 0.00 s to 10.00 s
Resolution: 0.01 s
Accuracy: Not applicable
Range: 0.00 L to 99.9 L
Resolution:
0.01 L for 0.00 L to 9.99 L
0.1 L for 10.0 L to 99.9 L
Accuracy:
For T
E
<600 ms: ±10× respiratory rate +10% (600 ms/T
E
) of reading] mL
For T
E
>600 ms: ±(10× respiratory rate +10% of reading) mL
OP A-34
Ranges, Resolutions, and Accuracies
Table OP A-14. Patient Data
Parameter
Spontaneous percent inspiratory time (T
I
/T
TOT
)
Static compliance (C
STAT
)
Static resistance (R
STAT
)
Total PEEP (PEEP
TOT
)
Total respiratory rate (f
TOT
)
Function
Displays the ratio of the inspiratory time to total breath cycle time measurements on the MORE
PATIENT DATA screen. Available for spontaneous breaths (SPONT mode) only. Accessible during normal ventilation by pressing the MORE PATIENT DATA button on the upper screen.
Displays an estimate of the elasticity of the patient’s lungs.
Range, resolution, accuracy
Range: 0.00 to 1.00
Resolution: 0.01
Displays an estimate of restrictiveness of the patient’s airway.
Displays the pressure during an expiratory pause maneuver. It is an estimate of the total pressure at the end of exhalation, referenced to atmosphere.
Displays a calculated value of the number of mandatory and spontaneous breaths delivered to the patient for the previous 1-minute interval. f
TOT
updates at the beginning of the next inspiration.
Range: 0 mL/ cmH
2
O to 500 mL/ cmH
2
O
Resolution:
0.1 mL/cmH
2
O for 0 mL/cmH
2
O to 9.9 mL/cmH
2
O
1 mL/cmH
2
O for 10 mL/cmH
2
O to 500 mL/cmH
2
O
Accuracy:
±(1+20% of actual value) mL/ cmH
2
O for 1 mL/cmH
2
O to 100 mL/cmH
2
O
Range: 0 cmH
2
O/L/s to 500 cmH
2
O/L/s
Resolution:
0.1 cmH
2
O/L/s for 0 cmH
2
O/L/s to
9.9 cmH
2
O/L/s
1 cmH
2
O/L/s for 10 cmH
2
O/L/s to
500 cmH
2
O/L/s
Accuracy:
±(3+20% of actual value) cmH
2
O/
L/s (Does not apply if C
STAT
<5 mL/cmH
2
O or
V
MAX
<20 L/min)
Range: –20.0 cmH
2
O to 130 cmH
2
O
Resolution:
0.1 cmH
2
O for–20.0 cmH
2
O to 9.9 cmH
2
O
1 cmH
2
O for 10 cmH
2
O to 130 cmH
2
O
Range: 0/min to 200/min
Resolution:
0.1/min for 0.0/min to 9.9/min
1/min for 10/min to 200/min
Accuracy: ±0.8/min
OP A-35
Specifications
Table OP A-15. Other Screens—Displayed Data
Data displayed Function
In Service mode, touch the button at the bottom of the upper GUI screen, or during normal ventilation, touch the Other Screens button at the bottom of the upper GUI screen to reveal the following buttons for other displayed data:
Diagnostic codes
Operational time
SST results
Information to assist qualified service personnel to troubleshoot the ventilator.
Displays operational times for the ventilator and compressor. Use this information to schedule operator maintenance procedures and preventive maintenance conducted by qualified service personnel. The accuracy of reported operational times is ±2% over
10 000 hours.
Displays results from each test performed during the most recent SST.
Ventilator configuration
Test summary
Displays the GUI and BDU serial numbers and software revision levels, compressor serial number, SAAS firmware revision level, and installed software options. Upgrades or modifications change the software revision level information.
Displays overall outcomes for most recently performed SST and EST.
OP A-36
OP B Part Numbers
OP B.1
Overview
This appendix lists user-replaceable 840 ventilator parts and accessories.
shows
Puritan Bennett™ 840 Ventilator System parts corresponding to the part numbers listed in
shows the same accessories mounted on the ventilator with the compressor mount cart shown.
lists those ventilator parts and accessories.
shows the ventilator mounted on the pole cart, and
accessories.
Note:
(except for the wall air water trap and humidifier mounting kit) and
may be ordered for ventilators mounted on pole carts.
and
contain part numbers for humidifier, wall air water trap, and cylinder mounting kits used with
ventilators mounted on the compressor mount cart and the pole cart, respectively.
Note:
The ventilator has been validated for use with the accessories listed in this manual. The use of accessories not listed in this manual may result in degraded performance. It is the responsibility of the user’s organization to ensure the compatibility of the ventilator with all of the parts used to connect the patient before use.
OP B-1
Part Numbers
Figure OP B-1. Ventilator Accessories
OP B-2
Item number
1
2
5
6
3
4
7
Table OP B-1. Ventilator Parts and Accessories
Description
Flex arm assembly
Seal, expiratory filter
Power cord, North America
Hose assembly, oxygen, DISS, for USA
Hose assembly, air, for USA (DISS)
RTA Cart, ventilator
Inspiratory bacteria filter, 22 mm ISO connectors, disposable
(D/Flex, carton of 12)
Inspiratory bacteria filter, 22 mm ISO connectors, reusable (Re/Flex, each)
Part number
4-032006-00
4-070311-00
4-071420-00
4-001474-00
4-006541-00
4-076102-00
4-074601-00
4-074600-00
Item number
8
8 (cont)
Table OP B-1. Ventilator Parts and Accessories (Continued)
Description
Ventilator breathing circuit, adult, reusable.
Includes:
Tube, adult, 120 cm (2 included)
Tube, adult, 40 cm (2 included)
Tube, adult, 15 cm (2 included)
Wye, adult, with temperature port
Water trap, in-circuit (2 included)
Adapter, 22 mm male by 22 mm male
Tube hanger
Wye, adult, reusable
Ventilator breathing circuit, adult, reusable, with heated wire, for use with Fisher & Paykel™* humidifiers
1
.
Includes:
Tube, adult, 15 cm (2 included)
Tube, adult, 150 cm (2 included)
Wye, adult, with temperature port
Adapter, 22 mm male by 22 mm male
Tube hanger
Adapter, hose heater
Temperature probe, dual-airway
Heater wire, inspiratory limb
Heater wire, expiratory limb
Draw wire, 1.5-m
Ventilator breathing circuit, pediatric, reusable.
1
Includes:
Tube, pediatric, 120 cm (2 included)
Tube, pediatric, 40 cm (2 included)
Tube, pediatric, 15 cm (2 included)
Wye, pediatric, straight
Water trap, in-circuit (2 included)
Adapter, 22 mm male/15 mm female, with temperature port
Adapter, 22 mm male/15 mm female (2 included)
Part number
G-061208-SP
G-061213-00
G-061235-00
G-061223-00
Overview
OP B-3
Part Numbers
Item number
Table OP B-1. Ventilator Parts and Accessories (Continued)
Description
Tube hanger
Adapter, 15 mm male by 15 mm male
Adapter, 22 mm male/15 mm female by 22 mm male/15 mm female
Ventilator breathing circuit, pediatric, reusable, with heated wire, for
Fisher & Paykel™* humidifiers.
1
Includes:
Tube, pediatric, 15 cm (2 included)
Tube, pediatric, 150 cm (2 included)
Wye, pediatric, straight
Adapter, 15mm male by 15-mm male
Adapter, 22 mm male/15 mm female by 22 mm male/15 mm female
Tube hanger
Adapter, hose heater
Temperature probe, dual-airway
Heater wire, inspiratory limb
Heater wire, expiratory limb
Draw wire, 1.5 m
Adapter, 22 mm male/15 mm female, with temperature port
Adapter, 22 mm male/15 mm female (2 included)
Ventilator breathing circuit, adult, disposable
1
Includes:
Trach elbow
Patient wye w/o port
Tube connector
Ventilator tube, 72 in. (183 cm)
Rubber cuff, ventilator tube
Wye port cap
Protective cap
Tube hanger
Part number
G-061237-00
6-003030-00
OP B-4
Table OP B-1. Ventilator Parts and Accessories (Continued)
Item number
9
10
11
12
13
14
15
--
--
--
Description
Test lung
Drain cap
Collector vial, reusable (Re/X800, each)
Tubing, drain bag, single-patient use (package of 10)
Drain bag, single-patient use (package of 25)
Clamp, reusable (carton of 5)
Expiratory bacteria filter, 22 mm ISO connectors, with collector vial, single-patient use (D/X800, carton of 12)
Wall air water trap kit, cart-mount, DISS male (Includes water trap, bracket with mounting hardware, and interconnect hose)
1
Mounting kit, Fisher & Paykel™* 480/730 humidifier
1
Mounting kit, Hudson RCI™* ConchaTherm™* humidifier (Includes only parts that allow humidifier to be plugged into ventilator.
Contact Hudson RCI™* to obtain brackets to install humidifier to ventilator cart.)
1
--
--
--
Operator’s manual, US English
1
Service manual, English
1
Oxygen sensor (To be replaced every year or as necessary. See the section
Every Year or as Necessary: Oxygen Sensor
, page OP 7-11.)
1
--
--
Filter, compressor inlet
1
Test (gold standard) hose, 21 inches (53 cm) (for use with EST)
1
--
--
Cable assembly, GUI-to-BDU extension, 10 ft
1
Mask assembly, large (for non-invasive ventilation)
1
1.
Not shown in
Part number
4-000612-00
4-074613-00
4-074647-00
4-048493-00
4-048491-00
4-048492-00
4-076887-00
4-075315-00
4-075313-00
4-075312-00
10067721
10067703
10097559
4-074374-00
4-018506-00
4-071441-00
4-005253-00
Overview
OP B-5
Part Numbers
Figure OP B-2. Ventilator Accessories (compressor mount cart shown)
OP B-6
Item number
1
2
3
4
5
6
7
8
Table OP B-2. Ventilator Parts and Accessories
Flex arm assembly
Seal, expiratory filter
Power cord, North America
Description
Hose assembly, oxygen, DISS, for USA
Hose assembly, air, for USA (DISS)
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart with
1-hour battery
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart with
4-hour battery
Inspiratory bacteria filter, 22 mm ISO connectors, disposable
(D/Flex, carton of 12)
Inspiratory bacteria filter, 22 mm ISO connectors, reusable (Re/Flex, each)
Part number
4-032006-00
4-070311-00
4-071420-00
4-001474-00
4-006541-00
10046822
10046823
4-074601-00
4-074600-00
Item number
9
Table OP B-2. Ventilator Parts and Accessories (Continued)
Description Part number
Ventilator breathing circuit, adult, reusable. G-061208-SP
Includes:
Tube, adult, 120 cm (2 included)
Tube, adult, 40 cm (2 included
Tube, adult, 15 cm (2 included)
Wye, adult, with temperature port
Water trap, in-circuit (2 included)
Adapter, 22 mm male by 22 mm male
Tube hanger
Wye, adult, reusable
Ventilator breathing circuit, adult, reusable, with heated wire, for use with Fisher & Paykel™* humidifiers
1
.
G-061213-00
G-061235-00
Includes:
Tube, adult, 15 cm (2 included)
Wye, adult, with temperature port
Adapter, 22 mm male by 22 mm male
Tube hanger
Adapter, hose heater
Temperature probe, dual-airway
Heater wire, inspiratory limb
Heater wire, expiratory limb
Draw wire, 1.5 m
Ventilator breathing circuit, pediatric, reusable.
1
Includes:
Tube, pediatric, 120 cm (2 included)
Tube, pediatric, 40 cm (2 included)
Tube, pediatric, 15 cm (2 included)
Wye, pediatric, straight Water trap, in-circuit (2 included)
Adapter, 22 mm male/15 mm female, with temperature port
Adapter, 22 mm male/15 mm female (2 included)
Tube hanger
Adapter, 15 mm male by 15 mm male
G-061223-00
Overview
OP B-7
Part Numbers
Item number
10
11
12
Table OP B-2. Ventilator Parts and Accessories (Continued)
Description
Adapter, 22 mm male/15 mm female by 22 mm male/15 mm female
Ventilator breathing circuit, pediatric, reusable, with heated wire, for
Fisher & Paykel™* humidifiers.
1
Includes:
Tube, pediatric, 15 cm (2 included)
Tube, pediatric, 150 cm (2 included)
Wye, pediatric, straight
Adapter, 15 mm male by 15 mm male
Adapter, 22 mm male/15 mm female by 22 mm male/15 mm female
Tube hanger
Adapter, hose heater
Temperature probe, dual-airway
Heater wire, inspiratory limb
Heater wire, expiratory limb
Draw wire, 1.5 m
Adapter, 22 mm male/15 mm female, with temperature port
Adapter, 22 mm male/15 mm female (2 included)
Ventilator breathing circuit, adult, disposable
1
Includes:
Trach elbow
Patient wye w/o port
Tube connector
Ventilator tube, 183 cm (72 in.)
Rubber cuff, ventilator tube
Wye port cap
Protective cap
Tube hanger
Test lung
Drain cap
Collector vial, reusable (Re/X800, each)
Part number
G-061237-00
6-003030-00
4-000612-00
4-074613-00
4-074647-00
OP B-8
Table OP B-2. Ventilator Parts and Accessories (Continued)
Item number
13
14
15
16
--
Description
Tubing, drain bag, single-patient use (package of 10)
Drain bag, single-patient use (package of 25)
Clamp, reusable (carton of 5)
Expiratory bacteria filter, 22 mm ISO connectors, with collector vial, single-patient use (D/X800, carton of 12)
Wall Air Water Trap kit
1
--
--
--
--
--
Humidifier Mounting kit
1
Cylinder Mounting kit
1
Operator’s manual, US English
1
Service manual, English
1
Oxygen sensor (To be replaced every year or as necessary. See
Every
Year or as Necessary: Oxygen Sensor
on page
OP 7-11
)
1
--
--
Filter, compressor inlet
1
Test (gold standard) hose, 21 inches (53 cm) (for use with EST)
1
--
--
Cable assembly, GUI-to-BDU extension, 10 ft
1
Mask assembly, large (for Non-invasive ventilation)
1
1.
Not shown in
Part number
4-048493-00
4-048491-00
4-048492-00
4-076887-00
10045588
10045589
10045586
10067721
10067703
10097559
4-074374-00
4-018506-00
4-071441-00
4-005253-00
Overview
OP B-9
Part Numbers
Figure OP B-3. Puritan Bennett™ 840 Ventilator System Shown Mounted on Puritan Bennett™ 800 Series Ventilator Pole Cart
OP B-10
Item number
1
2
--
Table OP B-3. Ventilator Pole Cart and Accessories
Description Part number
Puritan Bennett 800 Series Ventilator Pole Cart with 1-hour battery 10046826
Puritan Bennett 800 Series Ventilator Pole Cart with 4-hour battery 10046827
Kit, humidifier mounting
1 10042364
Table OP B-3. Ventilator Pole Cart and Accessories (Continued)
Description Item number
--
--
Kit, cylinder mounting
1
Kit, wall air water trap
1
1.
Not shown in
Part number
10045578
10045588
Overview
OP B-11
Part Numbers
Page Left Intentionally Blank
OP B-12
OP C Pneumatic Schematic
OP C.1
Overview
This chapter provides a pneumatic schematic of the Bennett™ 840 Ventilator System. See
Note:
Items shown are called out in red, enabling easier viewing.
OP C-1
Pneumatic Schematic
Figure OP C-1. Pneumatic Schematic
OP C-2
25
26
27
28
21
22
23
24
29
30
31
12
13
14
15
10
11
8
9
16
17
18
19
20
6
7
4
5
Item
1
2
3
CV 3
OS
NO
SOL1
C
PI
NC
PSOL2
PA
Q1
SV
Reference Designator
N/A
N/A
N/A
N/A
NC
C
SOL 2
NO
EXH HTR
CV5
F9
ECV
PE
Q3
EV
WT
WT
N/A
F8
PSOL1
Table OP C-1. Pneumatic Components
Description
Circuit wye
Expiratory module
Inspiratory module
Compressor module
Normally closed
Common
Autozero solenoid, exhalation
Normally open
Exhalation filter heater
Check valve
Expiratory filter
Expiratory collector vial
Expiratory pressure transducer
Exhalation flow sensor
Exhalation valve
Water trap
Water trap
Humidifier
Inspiratory filter
Proportional solenoid valve, O
2
Inspiratory check valve
Oxygen sensor
Normally open
Autozero solenoid, inspiratory
Common
Inspiratory pressure transducer
Normally closed
Proportional solenoid valve, air
Atmospheric pressure transducer
Flow sensor, oxygen
Safety valve
Overview
OP C-3
Pneumatic Schematic
57
58
59
60
53
54
55
56
61
62
49
50
51
52
45
46
47
48
41
42
43
44
37
38
39
40
Item
32
33
34
35
36
Table OP C-1. Pneumatic Components (Continued)
F12
HB
WT2
HE
F13
PC
R1/F11
F10
NO
SOL3
F2
WT1
M/C
RV
PS1
F3
F1
PS2
Reference Designator
TP1
F7
Q2
TP2
F6
REG2
F4
CV4
CV2
N/A
REG1
F5
N/A
Description
Pressure valve. oxygen/air
Filter, pneumatic noise, oxygen
Flow sensor, air
Pressure valve. oxygen/air
Filter, pneumatic noise, air
Vent
Regulator, oxygen
Screen, filter, oxygen impact
Vent
Regulator, air
Screen, filter, air impact
Check valve, compressor
Check valve, air
Oxygen pressure switch
Inlet filter, oxygen
Filter, oxygen impact
Pressure switch
Filter, air
Water trap, air
Motor/compressor
Relief valve
Filter, intake silencer
Housing base
Water trap, compressor
Heat exchanger
Silencer
Compressor pressure transducer
Restrictor/filter
Compressor filter
Normally open
Unloading solenoid
OP C-4
Item
63
64
65
66
Table OP C-1. Pneumatic Components (Continued)
Reference Designator
C
N/A
NC
N/A
Description
Common
Dryer
Normally closed
Accumulator
Overview
OP C-5
Pneumatic Schematic
Page Left Intentionally Blank
OP C-6
OP D Alarm and Oxygen Sensor Calibration Testing
OP D.1
Overview
Test the alarms and the oxygen sensor calibration on the Puritan Bennett™ 840 Ventilator
System as required, using the procedures contained in this chapter.
Note:
When performing the alarm tests, use a ventilator configured for use with an adult patient circuit.
OP D.2
Alarm Test
•
•
•
•
•
•
•
•
•
•
•
Alarm tests require an oxygen and air source and stable AC facility power. High and low delivered O
2
alarm testing requires a length of adult disposable flex tubing and a length of low-pressure oxygen supply tubing with an oxygen connector on one end. If any alarm does not annunciate as indicated, verify ventilator setup, ventilator settings, and repeat the alarm test.
Alarm testing checks the operation of the following alarms:
CIRCUIT DISCONNECT
LOW EXHALED MANDATORY TIDAL VOLUME (
3
V
TE MAND
)
LOW EXHALED TOTAL MINUTE VOLUME (
3V
E TOT
)
HIGH VENTILATOR PRESSURE (
1
P
VENT
)
HIGH CIRCUIT PRESSURE (
1
P
PEAK
)
SEVERE OCCLUSION
AC POWER LOSS
APNEA
LOW EXHALED SPONTANEOUS TIDAL VOLUME (
3
V
TE SPONT
)
NO O
2
SUPPLY
LOW DELIVERED O
2
% (
3
O
2
%)
OP D-1
Alarm and Oxygen Sensor Calibration Testing
•
HIGH DELIVERED O
2
% (
1
O
2
%)
1.
Disconnect the patient circuit from the ventilator and turn off the ventilator for at least 5 minutes.
2.
Turn the ventilator on. The ventilator automatically runs power on self test (POST).
3.
In the GUI lower subscreen, select NEW PATIENT.
4.
Set up the ventilator for a new patient as follows:
5.
IBW: 70 kg
Vent Type: Invasive
Mode: A/C
Mandatory type: VC
Trigger type:
V
-TRIG
Set new patient settings as follows:
6.
f: 6/min
V
T
: 500 mL
V
MAX
: 30 L/min
T
PL
: 0 seconds
Flow pattern: square
V
SENS
: 3 L/min
O
2
: 21%
PEEP: 5 cmH
2
O
Set apnea settings as follows:
7.
T
A
: 10 seconds
f: 6.0/min
O
2
: 21%
V
T
: 500 mL
Set alarm settings as follows:
2
P
PEAK
: 70 cmH
2
O
f
TOT
: OFF
4V
E TOT
: 1 L/min
2V
E TOT
: 3.5 L/min
4
V
TE MAND
: 300 mL
2
V
TE MAND
: OFF
4
V
TE SPONT
: OFF
OP D-2
Alarm Test
8.
2
V
TE SPONT
: OFF
Set the graphics display to a volume-time plot (for use in APNEA alarm test).
9.
Connect an adult patient circuit to the ventilator and attach a test lung (P/N 4-000612-00) to the patient wye.
Note:
To ensure proper test results, do not touch the test lung or patient circuit during the next three steps.
10.
CIRCUIT DISCONNECT alarm test:
Allow the ventilator to deliver at least four breaths. during the inspiratory phase of a breath, disconnect the inspiratory filter from the to patient port. The ventilator annunciates a CIRCUIT DISCONNECT alarm after the inspiratory filter is disconnected.
Connect the inspiratory filter to the to patient port.
11.
LOW EXHALED MANDATORY TIDAL VOLUME alarm test:
Set V
T
to 200 mL. The ventilator annunciates a LOW EXHALED MANDATORY TIDAL VOLUME (
3
V
TE
MAND
) alarm on the third consecutive breath after ACCEPT is pressed.
Press the alarm reset key to reset the alarm.
12.
LOW EXHALED TOTAL MINUTE VOLUME alarm test:
Set the
4 V
E TOT
alarm limit to 3.45 L/min. The ventilator annunciates a LOW EXHALED TOTAL MINUTE
VOLUME alarm on the next breath after ACCEPT is pressed.
13.
HIGH VENTILATOR PRESSURE alarm test:
Set patient and alarm settings as follows:
V
T
: 1000 mL
V
MAX
: 100 L/min
2
P
PEAK
: 100 cmH
2
O
4V
E TOT
: 0.050 L/min
2V
E TOT
: OFF
4
V
TE MAND
: OFF
Allow the ventilator to deliver at least four breaths.
Remove the test lung and block the wye. The GUI annunciates a HIGH VENTILATOR PRESSURE alarm
(
1
P
VENT
) during the first breath after blocking the wye.
Unblock the wye and attach the test lung to the patient wye. The alarm autoresets (may take several breaths to autoreset.)
OP D-3
Alarm and Oxygen Sensor Calibration Testing
14.
HIGH CIRCUIT PRESSURE alarm test:
Set patient and alarm settings as follows:
V
MAX
: 30 L/min
2
P
PEAK
: 20 cmH
2
O
After one breath the ventilator annunciates a HIGH CIRCUIT PRESSURE alarm (
1
P
PEAK
). If the alarm does not sound, check the patient circuit for leaks.
15.
SEVERE OCCLUSION alarm test:
Set patient and alarm settings as follows:
V
T
: 500 mL
2
P
PEAK
: 50 cmH
2
O
Press the alarm reset key to reset all alarms.
Slowly pinch the patient circuit expiratory limb at any point until the GUI annunciates a SEVERE
OCCLUSION alarm. While you maintain the occlusion, ensure the safety valve open indicator lights, the upper screen shows the elapsed time without normal ventilation support, and the test lung inflates periodically as the ventilator delivers pressure-based breaths.
Release the expiratory limb. The ventilator should return to normal ventilation within three breaths.
Press the alarm reset key to reset all alarms.
16.
AC POWER LOSS alarm test:
Allow the ventilator to deliver at least four breaths, press the alarm reset key to reset all alarms, then disconnect the power cord for AC facility power.
If the BPS is charged, the GUI annunciates an AC POWER LOSS alarm. If less than 2 minutes of battery backup are available, the GUI annunciates a LOW BATTERY alarm. if a BPS is not installed, the BDU annunciates a LOSS OF POWER alarm.
Connect the power cord to AC facility power. The AC POWER LOSS, LOW BATTERY, or LOSS OF POWER alarm autoresets.
17.
APNEA alarm test:
Set patient and alarm settings as follows:
2
P
PEAK
: 70 cmH
2
O
Mode: SPONT
Spontaneous type: PS
Note:
To avoid triggering a breath during the apnea interval, do not touch the test lung or patient circuit.
OP D-4
Alarm Test
The GUI annunciates an APNEA alarm within 10 seconds after pressing ACCEPT.
Squeeze the test lung twice to simulate two subsequent patient-initiated breaths. The APNEA alarm autoresets.
Note:
The exhaled tidal volume (V
TE
) displayed in the monitored patient data area must be greater than half the delivered volume shown on the volume-time plot in the graphics display in order for apnea to autoreset (refer to Chapter
TR 9
for a technical description of apnea ventilation.
Let the ventilator return to apnea ventilation.
18.
LOW EXHALED SPONTANEOUS TIDAL VOLUME alarm test:
Set patient and alarm settings as follows:
19.
Trigger type: P-TRIG
P
SENS
: 4.0 cmH
2
O
4
V
TE SPONT
: 2500 mL
Press the alarm reset key of reset the apnea alarm.
Slowly squeeze the test lung to simulate spontaneous breaths. The ventilator annunciates a LOW
EXHALED SPONTANEOUS TIDAL VOLUME alarm at the start of the third consecutive spontaneous inspiration.
Set up patient as follows:
Mode: P-TRIG
4
V
TE SPONT
: OFF
Press the alarm reset key to reset the
4
V
TE SPONT
alarm.
NO O
2
SUPPLY alarm test:
Disconnect the oxygen inlet supply. The ventilator annunciates a NO O
2
SUPPLY alarm within one breath.
Connect the oxygen inlet supply. The NO O
2
SUPPLY alarm autoresets within 2 breaths after oxygen is reconnected
20.
LOW DELIVERED O
2
% and HIGH DELIVERED O
2
% alarm tests:
Set patient and alarm settings as follows:
P
SENS
: 2 cmH
2
O
O
2
%: 100%
Set apnea settings as follows:
T
A
: 60 seconds
OP D-5
Alarm and Oxygen Sensor Calibration Testing
Replace the inspiratory filter with a 6 inch piece of adult disposable flex tubing with a ¼ inch slit in its side, about 3 inches from the end. Insert a length of low-pressure oxygen supply tubing into the slit and about 1½ inches into the
to patient
port.
Attach the other end of the oxygen supply tubing to a known air supply (for example, a medical-grade air cylinder.
Set the flow from the air supply to 1 L/min, and watch the upper GUI screen. the value for O
2
(delivered
O
2
%) should decrease, and the ventilator should annunciate a
3
O
2
% alarm within 30 seconds.
Remove the oxygen supply tubing from the air supply and attach it to a known 100% O
2
source (for example, a medical-grade oxygen cylinder). Set O
2
% to 21%. Set the flow from the oxygen source to
1L/min, and watch the upper GUI screen. The value for O
2
(delivered O
2
%) should increase, and the ventilator should annunciate a
1
O
2
% alarm within 30 seconds.
Remove the disposable flex tubing and oxygen supply tubing, replace the inspiratory filter and standard patient circuit, then press the alarm reset key to clear all alarms.
OP D.3
Oxygen Sensor Calibration Test
Test the oxygen sensor calibration as follows:
1.
Connect the ventilator’s oxygen hose to a known 100% O
2
source (for example, a medical-grade oxygen cylinder). Press the 100% O
2
/CAL 2 min key or the INCREASE O
2
2 min key to calibrate the oxygen sensor. Proceed to the next step once the key light turns off.
2.
Connect the ventilator oxygen hose to another known 100% O
2
source (for example, a second medical-grade oxygen cylinder).
3.
Set O
2
% to each of the following values, and allow 1 minute after each for the monitored value to stabilize:
4.
21%
40%
90%
Watch the upper screen to ensure the value for O
2
(delivered O
2
%) is within 3% of each setting within
1 minute of selecting each setting.
OP D-6
OP E Remote Alarm and RS-232 Ports
OP E.1
Overview
Appendix
tells you how to use the Puritan Bennett™ 840 Ventilator System’s remote alarm
(nurse call) and the three RS-232 communication ports. The remote alarm and RS-232 ports are located on the rear of the GUI.
Figure OP E-1. Remote Alarm and RS-232 Ports
1
2
RS-232 port 3
RS-232 port 2
3
4
Remote alarm
RS-232 port 1
WARNING:
To ensure the ventilator is properly grounded and to protect against electrical hazard, always connect the ventilator AC power cord to a grounded wall power outlet (even if the ventilator is operating from the 802 or 803 BPS (Backup Power Source) or Puritan Bennett™ 800 Series
Ventilator battery backup system when the ventilator is connected to an external device via the
RS-232 or remote alarm ports.
Caution:
To prevent the risk of excessive enclosure leakage current from external equipment connected to the RS-232 and remote alarm ports, a means for external separation of the conductive earth paths must be provided. Refer to the Puritan Bennett™ 840 Ventilator System Service Manual for
OP E-1
Remote Alarm and RS-232 Ports
information and instructions for construction of cable assemblies providing electrical separation, or contact Covidien for assistance.
OP E.2
Remote Alarm Port
The ventilator’s remote alarm (nurse call) annunciates medium- and high-priority alarm conditions at locations away from the ventilator (for example, when the ventilator is in an isolation room). The ventilator signals an alarm using a normally open or a normally closed signal. The ventilator asserts a remote alarm when there is an active medium- or high-priority alarm condition, unless the alarm silence function is active.
Note:
The remote alarm also annunciates when the ventilator
power switch is turned off.
Figure OP E-2. Remote Alarm Pinout (view from back of GUI)
OP E-2
1
2
Normally closed (NC)
Relay common
3
4
Normally open (NO)
Not connected
Note:
Allowable current is 100 mA at 12 V DC (minimum) and 500 mA at 30 V DC (maximum).
OP E.3
RS-232 Port
The RS-232 serial ports are 9-pin male connectors configured as data terminal equipment (DTE).
. shows the serial port pinout.
Figure OP E-3. RS-232 Serial Port Pinout
How to Configure the RS-232 Ports
OP E.4
How to Configure the RS-232 Ports
The RS-232 ports must be configured to select the attached device, baud rate, data bits, and parity. Follow these steps to configure the RS-232 ports:
1.
From the VENTILATOR SETTINGS screen, press the OTHER SCREENS button.
2.
Press the Communications Setup button. The Current Communication Screen appears.
NOTE: For reference only. Drawing not to scale. Some detail has been omitted for clarity.
3.
Touch the button for port 1 then turn the knob to select the attached device (DCI, PRINTER,
SPACELABS, OR PHILLIPS). Choose DCI if the attached device is a ventilator monitor or CliniVision handheld device, Printer for a printer, SpaceLabs for a SpaceLabs™* ventilator monitor, or Phillips for Phillips™* IntelliBridge™*. If you want to select real-time waveforms, choose either port 2 or 3 and the
Waveforms setting.
OP E-3
Remote Alarm and RS-232 Ports
4.
Touch the BAUD RATE button, then turn the knob to select the baud rate (1200, 2400, 4800, 9600,
19 200, or 38 400). The baud rate will automatically switch to 38 400 if you are setting the ventilator for real-time waveforms.
5.
Touch the DATA BITS button, then turn the knob to select the data bits (7 or 8).
6.
Touch the PARITY MODE button, then turn the knob to select parity (NONE, EVEN, or ODD).
Note:
The allowable selections for data bits and parity mode are shown here:
Data bits
7
8
Parity Mode
None, Even, Odd
None
7.
Press ACCEPT to apply the changes, or press the OTHER SCREENS button to cancel the changes.
8.
Real-time waveforms continuously transmits pressure, flow, and sequence numbers in ASCII format from the selected serial port (2 or 3), at a baud rate of 38 400 pulses/s, and the operator selected stop bits, and parity. A line of pressure and flow readings is taken every 20 msec. The collection of readings shall be transmitted on the selected serial port at the end of each breath at breath rates of 10/min and higher. For longer duration breaths, at least the first 8 seconds of the breath is transmitted.The format of the data is as follows: The beginning of inspiration is indicated by: "BS, S:nnn,<LF>" where 'BS’ identifies the Breath Start, ‘S:nnn’ is a sequence number incremented at every breath, and <LF> is a line feed character. The fff, and ppp fields show the breath flow and pressure data. The end of exhalation is indicated by: "BE<LF>" where ‘BE’ indicates Breath End, and <LF> is a line feed character. The pressure will be less than the ventilator setting if there is a leak in the test lung or circuit.
OP E.5
Printers and Cables
The following equipment can be used to print graphical displays from the ventilator system:
OP E.5.1
Printers
RS-232 serial printers using the Hewlett-Packard PCL5 communication protocol can be used with the ventilator system. Printers using the HP PCL5 communication protocol, but with other connector interfaces such as USB or parallel, may be able to be used with the appropriate RS-232 serial converter cable.
OP E.5.2
Cables
A serial cable (DB9 to DB9 or DB25 connectors) is required to connect to RS-232 serial printers. An
RS-232 serial-to-parallel converter cable (DB9 to 36-pin Centronics male connectors) is required
OP E-4
RS-232 Port Commands for use with a printer connected to a parallel port. An RS-232 serial-to-USB converter cable (DB9 to USB connectors) is needed to use a printer connected via a USB port. These cables must contain electronics to convert the RS-232 signals into the appropriate signals read by parallel or
USB printers, and may need to be configured to match the baud rate, parity, and data bits of the printer.
To set up the ventilator, printer, and cable for printing:
1.
Determine the baud rate, parity, and data bits configuration of the printer you are using. Refer to your printer’s operator’s manual for this information.
2.
Configure serial port 1 for a printer as in
the printer.
3.
If using a converter cable, configure it to use the same settings as the printer and the ventilator system.
Refer to the instructions supplied with your cable.
4.
With the printer turned OFF, connect the cable to the ventilator system and the printer.
5.
Turn the printer ON.
6.
Print the desired graphics display as described in
The Graphics Display FREEZE Function (OP 6.6)
on page
OP 6-4
.
OP E.6
RS-232 Port Commands
Refer to Chapter
TR 19
for information regarding RS-232 port command protocol.
OP E-5
Remote Alarm and RS-232 Ports
Page Left Intentionally Blank
OP E-6
TR 1 Introduction to Breath Delivery
TR 1.1
Overview
The Puritan Bennett™ 840 Ventilator System delivers and measures exhaled volumes to the specified accuracies when using conventional humidification, heated-wire systems, or heatmoisture exchangers (HMEs). In volume control (VC) ventilation, the ventilator compliancecompensates tidal volumes to ensure the clinician-set tidal volume is delivered to the lung.
Regardless of mode and breath type, all expiratory volumes are compliance-compensated. Both inspiratory and expiratory volumes are reported in body temperature and pressure, saturated
(BTPS) units.
Oxygen and air connect directly to the breath delivery unit (BDU), supplying gas to each of two proportional solenoid (PSOL) valves. Software controls each valve independently and, according to the operator-set O
2
%, mixes the breathing gas as it is delivered. Mixed breathing gas passes by a safety valve, then through a one-way valve, bacteria filter, and humidification device on the way to the patient. Exhaled gas is directed to the exhalation compartment, which includes a collector vial, bacteria filter, a one-way valve, a flow sensor, and an active exhalation valve (“active” means the exhalation valve can open and close in precise increments throughout inspiration and exhalation, allowing the ventilator to deliver breaths aggressively while minimizing pressure overshoots, controlling PEEP, and relieving excess pressures). The ventilator does not normally use the safety valve to regulate pressure.
Rather than measure flow and pressure in the harsh environment of the patient wye, the ventilator uses two flow sensors at the delivery (“to patient”) side of the BDU to deliver and measure inspired flow, and a flow sensor in the exhalation compartment (“from patient”) to measure exhaled flow. Circuit pressure referenced to the wye fitting is measured by two pressure transducers: one in the exhalation compartment, and one in the inspiratory pneumatic system, just downstream of the PSOLs.
For the purposes of calculating patient data (including waveforms), the ventilator uses the inspiratory and expiratory pressure transducers to calculate “wye” pressure. All sensors (including flow, pressure, and temperature sensors) are monitored continuously by background tests to ensure gas delivery and exhalation occur according to ventilator settings.
TR 1-1
Introduction to Breath Delivery
Page Left Intentionally Blank
TR 1-2
TR 2 Detecting and Initiating Inspiration
TR 2.1
Overview
•
•
To deliver a mandatory or spontaneous breath, the Puritan Bennett™ 840 Ventilator System breath delivery unit (BDU) uses the operator settings in conjunction with one of the following triggering strategies to initiate a mandatory or spontaneous breath:
Internal triggering: Patient effort or a clock signal. A clock signal can be based on a ventilator setting
(for example, respiratory rate or apnea interval) or breath timing within a mode (for example, in SIMV the ventilator delivers a mandatory breath if the patient doesn't initiate a breath in the early part of a breath interval). A clock signal can also occur during alternate ventilation modes such as apnea ventilation, ventilation during occlusion, and safety ventilation.
Operator triggering: The operator presses MANUAL INSP.
The BDU does not allow a second mandatory inspiration during a mandatory or spontaneous inspiration. To prevent autotriggering and allow a minimum expiratory time, a mandatory breath cannot be delivered during the restricted phase of exhalation. The restricted phase of exhalation is complete when either 1) or 2) and 3) (below) have occurred, or if 4) occurs regardless of the conditions described in 1) through 3):
1.
Measured expiratory flow falls to less than 50% of the peak expiratory flow
2.
Expiratory flow is less than or equal to 0.5 L/min
3.
The first 200 ms of exhalation (regardless of breath type) have elapsed
4.
aAt least 5 seconds of exhalation have elapsed
A mandatory breath can be delivered if a mandatory inspiration is internally time-cycled, regardless of the exhaled flow rate.
TR 2.2
Internally Triggered Inspiration
•
•
•
The ventilator triggers inspiration internally based on:
Pressure sensitivity
Flow sensitivity
Time-cycling
TR 2-1
Detecting and Initiating Inspiration
•
Other software-generated signals
Mandatory breaths triggered using pressure or flow sensitivity are called patient-initiated mandatory (PIM) breaths. The ventilator is designed to prevent autotriggering when pressure sensitivity is greater than 1 cmH
2
O, or when flow sensitivity is greater than 1 L/min for neonatal or pediatric patients or 1.5 L/min for adult patients, or 1.5 L/min for neonatal and pediatric patients, and 2.0 L/ min for adult patients if using a compressor.
TR 2.2.1
Pressure Sensitivity
•
When pressure triggering (P-TRIG) is selected, the ventilator initiates breaths based on the monitored pressure at two locations in the patient circuit: inspiratory pressure (P
I
) is monitored inside the inspiratory manifold downstream of the proportional solenoid (PSOL) valves, and expiratory pressure (P
E
) is monitored just after the expiratory check valve.
•
As the patient draws gas from the circuit (event A), airway pressure drops below baseline (
). When airway pressure drops below baseline by the value selected for pressure sensi-
tivity (event B), the ventilator initiates a patient-triggered inspiration. The A-B interval depends on two factors:
How quickly circuit pressure declines (that is, the aggressiveness of the inspiratory effort). The more aggressive the inspiratory effort, the shorter the A-B interval.
The pressure sensitivity (P
SENS
) setting. The smaller the setting, the shorter the A-B interval. (The minimum P
SENS
setting is limited by autotriggering, and the triggering criteria include filtering algorithms that minimize the probability of autotriggering.)
Figure TR 2-1. Declaring Inspiration Using Pressure Sensitivity
TR 2-2
1
2
Exhalation
Inspiration
4
5
Event B: Patient-triggered inspiration begins
A-B interval
Internally Triggered Inspiration
3 Event A: (patient inspires) 6 Operator-set pressure sensitivity
TR 2.2.2
Flow Sensitivity
When flow triggering (
V
-TRIG) is selected, the BDU maintains a constant flow of gas through the patient circuit (called base flow) during the latter part of exhalation. The value of this base flow is
1.5 L/min greater than the operator-selected value for flow sensitivity (state A), shown in
Figure TR 2-2. Declaring Inspiration Using Flow Sensitivity
1
2
3
4
Software-set base flow (L/min)
Start of patient effort
Event A; flow is decreasing
Event B: gas delivery begins
5
6
7
Operator-set flow sensitivity
1.5 L/min
Flow delivered to patient
The ventilator’s inspiratory flow sensors measure the delivered flow, and the expiratory flow sensor measures the exhaled flow. The ventilator indirectly measures patient flow (assuming minimal leaks) by monitoring the difference between the two flow measurements. If the patient is not inspiring, any difference between the delivered and exhaled flow is due to sensor inaccuracy or leaks in the patient system. To compensate for leaks in the patient system, the operator can increase the flow sensitivity, which ideally equals desired flow sensitivity + leak flow.
As the patient inspires from the base flow, the ventilator measures less exhaled flow (event B), while delivered flow remains constant. As the patient continues to inspire, the difference between the two flows measured by the inspiratory and expiratory transducers increases.
The ventilator declares an inspiration when the flow inspired by the patient (that is, the difference between the measured flows) is equal to or greater than the operator-selected value for flow sen-
TR 2-3
Detecting and Initiating Inspiration
•
• sitivity (event C). As with pressure triggering, the delay between the start of patient effort and gas delivery depends on two factors:
How quickly exhaled flow declines (that is, the aggressiveness of the inspiratory effort). The more aggressive the inspiratory effort, the shorter the interval.
The flow sensitivity (
V
SENS
) setting. The smaller the setting, the shorter the interval.
When flow triggering is selected, the patient experiences flow during the interval between the start of patient effort and the beginning of gas delivery. When pressure triggering is selected, the patient experiences an isometric effort during this interval.
As a backup method of triggering inspiration, a pressure sensitivity of 2 cmH
2
O is also in effect.
This setting is the most sensitive setting still large enough to avoid autotriggering, yet triggers with acceptable patient effort.
TR 2.2.3
Time-cycled Inspiration
The ventilator monitors time intervals from a specific event (for example, triggering a PIM or the transition from inspiration to exhalation). During A/C in the absence of patient effort, the ventilator delivers one inspiration at the beginning of every breath period, as shown in
Such a breath is called a ventilator-initiated mandatory (VIM) breath. If the patient's inspiratory efforts generate a pressure or flow trigger before the breath cycle has elapsed, the ventilator delivers a PIM.
Figure TR 2-3. Time-cycled Inspiration
1
2
Breath activity (VIM)
Breath activity (PIM)
3 Time period (Tb)=(60/f)
TR 2-4
Operator-triggered Inspiration
TR 2.3
Operator-triggered Inspiration
•
•
•
Mandatory breaths triggered when the operator presses the MANUAL INSP key are called operator-initiated mandatory (OIM) breaths. The ventilator does not deliver an OIM during:
An ongoing inspiration
The restricted phase of exhalation
Occlusion and disconnect alarm conditions
TR 2-5
Detecting and Initiating Inspiration
Page Left Intentionally Blank
TR 2-6
TR 3 Detecting and Initiating Exhalation
TR 3.1
Overview
The Puritan Bennett™ 840 Ventilator System can declare exhalation based on internal methods or backup limits.
TR 3.2
Internally Initiated Exhalation
•
•
•
Internal exhalation initiation methods include:
The time-cycling method
The end-inspiratory flow method
The airway pressure method
TR 3.2.1
Time-cycled Exhalation
The time-cycling method uses a specified inspiratory time to terminate inspiration and transition to exhalation. The ventilator terminates inspiration based on the set or computed value for inspiratory time. The time-cycling method operates during pressure- and volume-based mandatory breaths.
For pressure-based (including VC+) mandatory breaths, the inspiratory time (T
I
) directly defines the length of the inspiratory phase. For volume-based mandatory breaths, the settings for tidal volume, peak flow, flow pattern, and plateau time define the inspiratory time. Compliance compensation increases peak flow as necessary to ensure the set tidal volume is delivered to the patient, in the inspiratory time prescribed.
TR 3.2.2
End Inspiratory Flow Method
During spontaneous breaths (with or without pressure support), the ventilator preferentially uses measurements of end-inspiratory flow to initiate exhalation. The ventilator monitors delivered flow throughout the inspiratory phase. Regardless of whether the patient begins to exhale, delivered flow decreases due to the decreasing pressure gradient from the patient wye to the alveoli (event A in
). When end-inspiratory flow is equal to or less than (peak flow×E
SENS
%)/100, the ventilator initiates exhalation (event B).
TR 3-1
Detecting and Initiating Exhalation
Figure TR 3-1. Initiating Exhalation using the End-inspiratory Flow Method
TR 3-2
3
4
1
2
Inspiratory flow (0 L/min)
Inspiration
Trigger
Event A: delivered flow begins to decrease
(
V
MAX
)
7
5
6
Event B: Ventilator initiates exhalation
Inspiratory flow (L/min) without expiratory trigger
V
MAX
×E
SENS
/100
TR 3.2.3
Airway Pressure Method
If expiratory sensitivity (E
SENS
) is set to a value too low for the patient-ventilator combination, a vigorous expiratory effort could cause circuit pressure (P
PEAK
) to rise to the pressure cycling threshold. The ventilator monitors circuit pressure throughout the inspiratory phase, and initiates an exhalation when the pressure equals the inspiratory pressure target value + an incremental
shows an example of an exhalation initiated using the airway pressure
method.
Note:
The allowable incremental value above the target pressure is 1.5 cmH
2
O once a portion of inspiration time
(Tn) has elapsed. Before Tn, the incremental value is higher to allow for transient pressure overshoots. For the first 200 ms of inspiration, the incremental pressure is 10% of the target pressure, up to a maximum of
8 cmH
2
O. From 200 ms to Tn, the incremental pressure decreases in a linear fashion from the initial value to 1.5 cmH
2
O.
Figure TR 3-2. Initiating Exhalation using the Airway Pressure Method
Backup Limits
1
2
3
Pressure target
Pressure target + incremental value (n)
Start breath
4
5
200 ms
Tn
TR 3.3
Backup Limits
In addition to the internal methods of declaring exhalation, backup limits are intended to prevent inspirations of excessive duration or pressure. If a particular breath is subject to more than one backup limit, exhalation is declared by whichever limit is violated first.
TR 3.3.1
Time Limit
The time limit applies only to spontaneous breaths, which normally have no inspiratory time limit.
If exhalation has not been declared by the time 1.99+0.02×IBW seconds (adult and pediatric circuit type) or 1.0+0.1×IBW seconds (neonatal circuit type) of inspiration have elapsed, the ventilator initiates exhalation. When Vent type is NIV, the high spontaneous inspiratory time limit setting (
2
T
I SPONT
) serves as the time limit for initiating exhalation.
TR 3.3.2
High Circuit Pressure Limit
The high circuit pressure limit applies to all breaths. if the airway pressure equals or exceeds the high circuit pressure limit during any inspiration, (except during occlusion status cycling, OSC) the ventilator terminates the inspiration and initiates exhalation.
TR 3-3
Detecting and Initiating Exhalation
TR 3.3.3
High Ventilator Pressure Limit
The high ventilator pressure limit applies to volume-based mandatory breaths and spontaneous
TC or PA breaths only. If the inspiratory pressure equals or exceeds 100 cmH
2
O, the ventilator transitions to exhalation.
TR 3-4
TR 4 Mandatory Breath Delivery
TR 4.1
Overview
•
•
•
describes the following aspects of mandatory breath delivery on the
Puritan Bennett™ 840 Ventilator System:
Pressure- and volume-based mandatory breaths (includesVC+)
Compliance and body temperature and pressure, saturated (BTPS) compensation for volume-based mandatory breaths
Manual inspirations
TR 4.2
Comparison of Pressure- and Volume-based Mandatory
Breaths
compares pressure- and volume-based breath delivery.
Note:
As a general rule, when there are multiple methods of detection, inspiration or exhalation is initiated by the method that declares it first.
TR 4-1
Mandatory Breath Delivery
Table TR 4-1. Comparison of Pressure- and Volume-based Mandatory Breaths
Characteristic
Inspiratory detection
Pressure or flow during inspiration
Exhalation valve during inspiration
Inspiratory valves during inspiration
Expiratory detection
Pressure or flow during exhalation
Inspiratory valve during exhalation
Exhalation valve during exhalation
Pressure-based
Pressure sensitivity, flow sensitivity (including the pressure trigger backup), or time-cycling. Inspiration can also be operator-triggered using MANUAL INSP.
Pressure is targeted to the sum of the operator-selected PEEP+ inspiratory pressure. The maximum flow is 200 L/min when using an adult circuit, 80 L/min when using a pediatric circuit, and 30 L/min for neonatal circuits.
The wye pressure trajectory depends upon the settings for inspiratory pressure, inspiratory time, and rise time%. The flow delivery profile is a function of the rise time% setting the patient’s compliance and resistance, and the patient’s inspiratory effort (if any). As the rise time% setting is increased from minimum to maximum, the time to achieve the pressure target decreases.
Adjusts to minimize pressure overshoot and maintain target pressure.
Adjust flow to maintain target pressure.
Exhalation is initiated by the timecycling method. When the time elapsed since the beginning of inspiration equals the inspiratory time (an operator-selected value), the ventilator initiates exhalation.
The high pressure limit can also initiate exhalation as a backup strategy.
Volume-based
See pressure-based.
Inspiratory flow trajectories are defined by the settings for tidal volume, peak inspiratory flow, and flow pattern (including compliance compensation). The maximum setting for peak flow is
150 L/min for adult circuit type, 60
L/min for pediatric circuit type, and 30 L/min for neonatal circuit type. Additional flow is available
(up to 200 L/min) for compliance compensation.
Closed.
Adjusts to achieve target flow trajectory.
The operator specifies tidal volume, peak flow, flow pattern, and plateau time, and the ventilator computes an inspiratory time.
Exhalation is initiated when the computed inspiratory time has elapsed. The
1
P
PEAK
and
1
P
VENT alarms can also declare exhalation as a backup strategy.
Pressure is controlled to PEEP. If flow-triggering is selected, base flow is reestablished near the end of expiratory flow. Various strategies operate to minimize autotriggering.
For pressure triggering: near the end of expiratory flow, opens to establish 1 L/min bias flow. For flow triggering: set to deliver base flow.
Adjusts to maintain the operator-selected value for PEEP.
TR 4-2
Compliance Compensation for Volume-based Mandatory Breaths
TR 4.3
Compliance Compensation for Volume-based Mandatory
Breaths
When the ventilator delivers a volume of gas into the patient circuit, not all of the gas actually enters the patient's respiratory system. Part of the delivered volume, called the compliance volume (VC), remains in the patient circuit.
VC=C pt ckt
(P end insp
–P end exh
) where:
C pt ckt
is the compliance of the patient circuit
P end insp is the pressure at the patient wye at the end of the current inspiration
P end exh is the pressure at the patient wye at the end of the current exhalation
For volume ventilation, practitioners often compute VC to estimate the loss of volume in the patient circuit, then increase the V
T
setting by that amount. Increasing the tidal volume by a single increment to compensate for compliance volume provides only partial compensation, and requires extra effort and understanding on the part of the practitioner. In addition, P end insp
and
P end exh
can change with time.
In the Puritan Bennett™ 840 Ventilator System, an iterative algorithm automatically computes the compliance volume. For all flow patterns, compliance compensation does not change inspiratory time (T
I
). Compliance compensation is achieved by increasing flow (increasing the amplitude of the flow patterns). Keeping T
I
constant maintains the original I:E ratio.
There is a maximum compliance volume to reduce the potential for overinflation due to an erroneous compliance volume calculation. The maximum compliance volume is determined by the selected patient circuit type and ideal body weight (IBW), and is summarized by this equation:
V comp,max
=Factor × tidal volume where:
V comp,max
is the maximum compliance volume
Factor is the linear interpolation of the values in
for adult and pediatric patient circuit types, or for neonatal circuit type: MIN(10, MAX(2.5, 1.0+(2.0/0.3×IBW))) for example, let the neonate IBW=1 kg
1.
Calculate 1.0+(2.0/0.3×1)=7.67
2.
Compare result with 2.5 and use the maximum value: 7.67>2.5
3.
Compare result from previous step with 10 and use the minimum value: 7.67<10
Compliance volume factor for a neonatal circuit with IBW=1 kg is 7.67.
TR 4-3
Mandatory Breath Delivery
Table TR 4-2. Compliance Volume Factors
Adult patient circuit type
IBW (kg) Factor
≤10
15
5
4.6
30
60
≥150
3.4
2.75
2.5
Pediatric patient circuit type
IBW (kg)
≤10
11
12.5
15
≥30
Factor
5
3.5
2.9
2.7
2.5
TR 4.4
BTPS Compensation for Volume-based Mandatory Breaths
The goal of volume ventilation is to deliver a specified volume of gas of known oxygen concentration to the patient is lungs. Since gas volume depends on gas temperature, pressure, and composition, clinicians report and specify tidal volume under the conditions of body temperature
(37°C), existing barometric pressure, and fully saturated with water vapor (100% humidity). This is called body temperature and pressure, saturated (BTPS). All volumes (flows) set or reported by the ventilator are at existing barometric pressure, 37°C, and fully saturated with water vapor (BTPS).
Graphics data are not BTPS-compensated.
TR 4.5
Manual Inspiration
A manual inspiration is an operator-initiated mandatory (OIM) inspiration. When the operator presses MANUAL INSP, the ventilator delivers the currently specified mandatory breath (if permitted), either volume- or pressure-based. A volume-based manual inspiration is compliance-compensated.
TR 4-4
TR 5 Spontaneous Breath Delivery
TR 5.1
Overview
lists various breath delivery characteristics and how they are implemented during spontaneous breaths (available in SIMV, SPONT, and BILEVEL modes).
Note:
As a general rule, when there are multiple methods of detection, inspiration or exhalation is initiated by the method that declares it first.
Pressure or flow during inspiration
Spontaneous type = PS
P
SUPP
<5 cmH
2
O
Pressure or flow during inspiration Spontaneous type = PS
P
SUPP
≥5 cmH
2
O
Table TR 5-1. Spontaneous Breath Delivery Characteristics
Characteristic
Inspiratory detection
Pressure or flow during inspiration
Spontaneous type = NONE
Implementation
Either pressure or flow sensitivity, whichever is selected.
Pressure rises according to the selected rise time% and IBW setting, with target pressure 1.5 cmH
2
O above PEEP to improve work of breathing.
Pressure rises according to the selected rise time% and IBW setting, with target pressure equal to the effective pressure +PEEP (cmH
2
O):
P
SUPP
Effective Pressure
0 1.5
1 2.2
2 2.9
3 3.6
4 4.3
Pressure rises according to the selected rise time% and IBW setting, and target pressure equals
P
SUPP
+PEEP.
TR 5-1
Spontaneous Breath Delivery
Expiratory detection
Table TR 5-1. Spontaneous Breath Delivery Characteristics
Characteristic
Inspiratory flow profile
Exhalation valve during inspiration
Inspiratory valves during inspiration
Pressure or flow during exhalation
Inspiratory valve during exhalation
Exhalation valve during exhalation
Implementation
The inspiratory flow profile is determined by patient demand and the rise time% setting. As the rise time% setting is increased from minimum to maximum, the time to achieve the pressure target decreases. The maximum available flow is up to 30 L/ min for neonatal circuit types, 80 L/min for pediatric circuit types, and up to 200 L/min for adult circuit types.
Adjusts to minimize pressure overshoot and maintain the target pressure.
Adjust to maintain target pressure.
Because the exhalation valve acts as a relief valve venting any excess flow, inspiratory flow can be delivered aggressively and allows improved work of breathing.
The end-inspiratory flow or airway pressure method, whichever detects exhalation first. Time backup and the
1
P
PEAK
alarm are also available as backup strategies.
Pressure is controlled to PEEP.
For pressure triggering: set to deliver a bias flow of
1
L/min.
For flow triggering: set to deliver base flow.
For pressure triggering: set to deliver a bias flow of 1
L/min near.
For flow triggering: set to deliver base flow near the end of expiratory flow.
Adjusts to maintain the operator-selected value for
PEEP.
TR 5-2
TR 6 Assist/control (A/C) Mode
TR 6.1
Overview
In A/C mode, the Puritan Bennett™ 840 Ventilator System delivers only mandatory breaths.
When the ventilator detects patient inspiratory effort, it delivers a patient-initiated mandatory
(PIM) breath (also called an assisted breath). If the ventilator does not detect inspiratory effort, it delivers a ventilator-initiated mandatory (VIM) breath (also called a control breath) at an interval based on the set respiratory rate. Breaths can be pressure- or flow-triggered in A/C mode.
TR 6.2
Breath Delivery in A/C
In A/C mode, the ventilator calculates the breath period (T b
) as:
T b
=60/f where:
T b
is the breath period in seconds f is the set respiratory rate in breaths per minute
The length of the inspiratory phase depends on the current breath delivery settings. The ventilator transitions to the expiratory phase at the end of the inspiratory phase. The ventilator calculates the length of the expiratory phase as:
T
E
=T b
–T
I where:
T
E
is the length of the expiratory phase in seconds
T b
is the breath period in seconds
T
I
is the length of the inspiratory phase in seconds (including T
PL
, plateau time)
shows A/C breath delivery when no patient inspiratory effort is detected and all
inspirations are VIMs.
TR 6-1
Assist/control (A/C) Mode
Figure TR 6-1. A/C Mode, No Patient Effort Detected
1 VIM 2 T b
shows A/C breath delivery when patient inspiratory effort is detected. The ventilator delivers PIM breaths at a rate greater than or equal to the set respiratory rate.
Figure TR 6-2. A/C Mode, Patient Effort Detected
1 PIM 2 T b
set
shows A/C breath delivery when there is a combination of VIM and PIM breaths.
Figure TR 6-3. A/C Mode, VIM and PIM Breaths
TR 6-2
1
2
VIM
PIM
3 T b
set
TR 6.3
Rate change During A/C
•
•
Changes to the respiratory rate setting are phased in during exhalation only. The new breath period, based on the new respiratory rate, is based on the start of the current breath, and follows these rules:
The inspiratory time of current breath is not changed.
A new inspiration is not delivered until at least 200 ms of exhalation have elapsed.
Changing to A/C Mode
•
•
The maximum time t until the first VIM for the new respiratory rate will be delivered is 3.5 times the current inspiratory time or the length of the new breath cycle (whichever is greater), but t is no longer than the old breath period.
If the patient generates a PIM after the ventilator recognizes the rate change and before time t, the new rate begins with the PIM.
TR 6.4
Changing to A/C Mode
•
•
•
•
•
Switching the ventilator to A/C from any other mode causes the ventilator to phase in a VIM and set the start time for the beginning of the next A/C breath cycle. Following this VIM, and before the next A/C cycle begins, the ventilator responds to the patient’s inspiratory efforts by delivering mandatory breaths.
•
The first A/C breath (the VIM breath) is phased in according to these rules:
The breath is not delivered during an inspiration.
The breath is not delivered during the restricted phase of exhalation.
The ventilator ensures the apnea interval elapses at least 5 seconds after the beginning of exhalation.
Any other specially scheduled event (such as a respiratory mechanics maneuver or any pause maneuver) is canceled and rescheduled at the next interval.
•
When the first VIM of the new A/C mode is delivered depends on the mode and breath type active when the mode change is requested.
If the current mode is SIMV or SPONT and the current or last breath type is spontaneous or an OIM, the time t until the first VIM of the new A/C mode is whichever is less:
–
3.5× the current inspiratory time
–
The length of the apnea interval
If the mode is SIMV and the current or last breath is or was mandatory (but not an OIM), the time t until the first VIM of the new A/C mode is whichever is less:
–
3.5× the current inspiratory time
–
The length of the apnea interval
–
The length of the current breath cycle
If the current mode is BILEVEL in the PEEP
H
state and the current breath is mandatory:
– the PEEP level will be reduced once the exhalation phase is detected.
The time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the active gas delivery phase
TR 6-3
Assist/control (A/C) Mode
•
•
•
•
–
The length of the apnea interval
–
The length of the current breath cycle
If the current mode is BILEVEL in the PEEP
H
state and the current breath is spontaneous:
– the PEEP level will be reduced once the exhalation phase is detected.
The time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the spontaneous inspiration
–
The start time of the spontaneous breath + the length of the apnea interval
If the current mode is BILEVEL in the PEEP
L
state and the current breath is mandatory, the time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the active gas delivery phase
–
The length of the apnea interval
–
The length of the current breath cycle
If the current mode is BILEVEL in the PEEP
L
state and the current breath is spontaneous and the spontaneous start time has occurred during PEEP
L
, the time t until the first VIM of the new A/C mode is the lesser of:
–
3.5× the duration of the spontaneous inspiration
–
The length of the apnea interval
If the current mode is BILEVEL in the PEEP
L
state and the current breath is spontaneous and the spontaneous start time has occurred during PEEP
H
, the time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the spontaneous inspiration
–
The start time of the spontaneous breath + the length of the apnea interval
TR 6-4
TR 7 Synchronized Intermittent Mandatory
Ventilation
TR 7.1
Overview
SIMV is a mixed ventilatory mode allowing both mandatory and spontaneous breaths. The mandatory breaths can be volume- or pressure-based, and the spontaneous breaths can be pressure-assisted (for example, when pressure support is in effect). You can select pressure- or flowtriggering in SIMV.
The SIMV algorithm is designed to guarantee one mandatory breath each SIMV breath cycle.
This mandatory breath is either a patient-initiated mandatory (PIM) breath (also called an assisted breath) or a ventilator-initiated mandatory (VIM) breath (in case the patient's inspiratory effort is not sensed within the breath cycle).
shows, each SIMV breath cycle (T
b
) has two parts: the first part of the cycle is the mandatory interval (T m
) and is reserved for a PIM. If a PIM is delivered, the Tm interval ends and the ventilator switches to the second part of the cycle, the spontaneous interval (T s
), which is reserved for spontaneous breathing throughout the remainder of the breath cycle. At the end of an SIMV breath cycle, the cycle repeats. If a PIM is not delivered, the Puritan Bennett™ 840 Ventilator System delivers a VIM at the end of the mandatory interval, then switches to the spontaneous interval.
Figure TR 7-1. SIMV Breath Cycle (mandatory and spontaneous intervals)
1
2
T b
= SIMV breath period (includes Tm and
T s
T m
= Mandatory interval (reserved for a
PIM breath)
3 T s
= Spontaneous interval (VIM delivered if no PIM delivered during T m
shows an SIMV breath cycle where a PIM is delivered within the mandatory inter-
val.
TR 7-1
Synchronized Intermittent Mandatory Ventilation
Figure TR 7-2. SIMV Breath Cycle, PIM Delivered Within Mandatory Interval
1 PIM 3 T s
(subsequent trigger efforts during T s yield spontaneous breaths)
T b
2 T m
(Tm transitions to T s
when a PIM is delivered)
4
shows an SIMV breath cycle where a PIM is not delivered within the mandatory
interval.
Figure TR 7-3. SIMV Breath Cycle, PIM Not Delivered Within Mandatory Interval
TR 7-2
1
2
VIM
T m
(VIM delivered at end of T m
if no PIM delivered during T m
3
4
T s
T b
TR 7.2
Breath Delivery in SIMV
Mandatory breaths in SIMV are identical to mandatory breaths in A/C mode, and spontaneous breaths in SIMV are identical to spontaneous breaths in SPONT mode. Patient triggering must meet the requirements for flow and pressure sensitivity.
The procedure for setting the SIMV respiratory rate is the same as in A/C. Once the respiratory rate
(f) is set, the SIMV interval cycle (T b
) in seconds is:
T b
=60/f
The SIMV breathing algorithm delivers one mandatory breath each cycle interval, regardless of the patient’s ability to breath spontaneously. Once a PIM or VIM is delivered, all successful patient
Apnea Ventilation in SIMV efforts yield spontaneous breaths until the cycle interval ends. The ventilator delivers one mandatory breath during the mandatory interval, regardless of the number of successful patient efforts detected during the spontaneous interval. (An OIM delivered during the mandatory interval satisfies the mandatory breath requirement, and causes T m
to transition to T s
.)
During the mandatory interval, if the patient triggers a breath according to the current setting for pressure or flow sensitivity, the ventilator delivers a PIM. Once a mandatory breath is triggered, T m ends, T s
begins, and any further trigger efforts yield spontaneous breaths. During the spontaneous interval, the patient can take an unlimited number of spontaneous breaths. If no PIM or OIM is delivered by the end of the mandatory interval, the ventilator delivers a VIM and transitions to the spontaneous interval at the beginning of the VIM.
•
The maximum mandatory interval for any valid respiratory rate setting in SIMV is defined as whichever is less:
0.6 × the SIMV interval cycle (T b
)
•
10 seconds
In SIMV, the interval from mandatory breath to mandatory breath can be as long as 1.6
×
the SIMV cycle interval (but no longer than the cycle interval +10 seconds). At high respiratory rates and too large tidal volumes, breath stacking (the delivery of a second inspiration before the first exhalation is complete) is inevitable. In volume ventilation, breath stacking during inspiration and early exhalation leads to hyperinflation and increased airway and lung pressures, which can be detected by a high pressure limit alarm. In pressure control ventilation (with inspiratory pressure remaining constant), breath stacking leads to reduced tidal volumes, which can be detected by the low tidal volume and minute ventilation alarms.
If a spontaneous breath occurs toward the end of the spontaneous interval, inspiration or exhalation can still be in progress when the SIMV interval ends. No VIM, PIM, or OIM is allowed during the restricted phase of exhalation. In the extreme, one or more expected mandatory breaths could be omitted. When the expiratory phase of the spontaneous breath ends, the ventilator reverts to its normal criteria for delivering mandatory breaths.
In SIMV mode it is possible for the respiratory rate to drop temporarily below the f setting (unlike
A/C mode, in which f
TOT
is always greater than or equal to the f setting). If the patient triggers a breath at the beginning of a breath cycle, then does not trigger another breath until the maximum mandatory interval for the following breath has elapsed, a monitored respiratory rate less than the respiratory rate setting can result.
TR 7.3
Apnea Ventilation in SIMV
•
The following strategy is designed to allow SIMV to avoid triggering apnea ventilation if a VIM breath can be delivered instead:
If the apnea interval (T
A
) elapses at any time during the mandatory interval, the ventilator delivers a VIM rather than begin apnea ventilation.
TR 7-3
Synchronized Intermittent Mandatory Ventilation
•
If T
A
elapses during the spontaneous interval, apnea ventilation begins.
shows how SIMV is designed to deliver a VIM rather than trigger apnea ventilation
when possible.
Figure TR 7-4. Apnea Ventilation in SIMV
TR 7-4
1
2
3
4
T b
Last breath (PIM)
5
6
T
A
Tm (If T
A
elapses during Tm, the ventilator delivers a VIM rather than beginning apnea ventilation
T s
VIM
T m max
7
TR 7.4
Changing to SIMV Mode
•
•
•
•
Switching the ventilator to SIMV from any other mode causes the ventilator to phase in a VIM and set the start time for the next SIMV cycle. Following this VIM, and before the next SIMV cycle begins, the ventilator responds to successful inspiratory efforts by delivering spontaneous breaths. The first SIMV VIM breath is phased in according to these rules:
The VIM breath is not delivered during an inspiration or during the restricted phase of exhalation.
If the current mode is A/C, the first SIMV VIM is delivered after the restricted phase of exhalation plus the shortest of the following intervals, referenced to the beginning of the last or current inspiration: 3.5
×T
I
, current T
A
, or the length of the current breath cycle.
If the current mode is SPONT, and the current or last breath type was spontaneous or OIM, the first
SIMV VIM is delivered after the restricted phase of exhalation plus the shortest of the following intervals, referenced to the beginning of the last or current inspiration: 3.5×T
I
, or current T
A
.
If the current mode is BILEVEL in the PEEP
H
state and the current breath is mandatory:
– the PEEP level will be reduced once the exhalation phase is detected.
The time t until the first VIM of the new A/C mode is the lesser of:
Changing to SIMV Mode
•
•
•
•
–
PEEP transition time +2.5× the duration of the active gas delivery phase
–
The length of the apnea interval
–
The length of the current breath cycle
If the current mode is BILEVEL in the PEEP
H
state and the current breath is spontaneous:
–
The PEEP level will be reduced once the exhalation phase is detected.
The time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the spontaneous inspiration
–
The start time of the spontaneous breath + the length of the apnea interval
If the current mode is BILEVEL in the PEEP
L
state and the current breath is mandatory, the time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the active gas delivery phase
–
The length of the apnea interval
–
The length of the current breath cycle
If the current mode is BILEVEL in the PEEP
L
state and the current breath is spontaneous and the spontaneous start time has occurred during PEEP
L
, the time t until the first VIM of the new A/C mode is the lesser of:
–
3.5× the duration of the spontaneous inspiration
–
The length of the apnea interval
If the current mode is BILEVEL in the PEEP
L
state and the current breath is spontaneous and the spontaneous start time has occurred during PEEP
H
, the time t until the first VIM of the new A/C mode is the lesser of:
–
PEEP transition time +2.5× the duration of the spontaneous inspiration
–
The start time of the spontaneous breath + the length of the apnea interval
If the command to change to SIMV occurs after the restricted phase of exhalation has ended, and before a next breath or the apnea interval has elapsed, the ventilator delivers the first SIMV VIM the moment the command is recognized.
TR 7-5
Synchronized Intermittent Mandatory Ventilation
TR 7.5
Rate Change During SIMV
•
•
A change to the respiratory rate is phased in during exhalation only. The new SIMV interval is determined by the new respiratory rate and is referenced to the start of the current SIMV cycle interval, following these rules:
Inspiratory time of the current breath is neither truncated nor extended.
The new inspiration is not delivered until 200 ms of exhalation have elapsed.
•
•
The time until the new SIMV interval begins is:
Whichever is greater: the new SIMV cycle interval or 3.5× the last or current T
I
Not greater than the current SIMV cycle interval
The point at which the new rate is phased in depends on the current phase of the SIMV interval and when the rate change command is accepted. If the rate change occurs during the mandatory interval, the maximum mandatory interval is that for the new or old rate, whichever is less. If the patient generates a successful inspiratory effort during the spontaneous interval, the ventilator responds by giving a spontaneous breath.
TR 7-6
TR 8 Spontaneous (SPONT) Mode
TR 8.1
Overview
In spontaneous (SPONT) mode, inspiration is usually initiated by patient effort. Breaths are initiated via pressure- or flow- triggering, whichever is currently active. An operator can also initiate a manual inspiration during SPONT. VIM breaths are not possible in SPONT mode.
TR 8.2
Breath Delivery in SPONT
The inspiratory phase begins when the Puritan Bennett™ 840 Ventilator System detects patient effort during exhalation. Unless the breath is an OIM breath, breath delivery during the inspiratory phase is determined by the settings for pressure support, PEEP, rise time%, and expiratory sensitivity.
If tube compensation (TC) or Proportional Assist™* (PA) is selected as the spontaneous type, breath delivery during the inspiratory phase is determined by the settings for % support, expiratory sensitivity, tube I.D., and tube type.
If volume support (VS) is selected as the spontaneous type, breath delivery during the inspiratory phase is determined by rise time%, volume support level (V
T SUPP
), expiratory sensitivity, and
PEEP.
Inspiratory pause maneuvers are only possible following OIM breaths, and expiratory pause maneuvers are not allowed during SPONT.
TR 8.3
Changing to SPONT Mode
If the operator changes to SPONT mode during an A/C or SIMV inspiration (mandatory or spontaneous), the inspiration is completed unaffected by the mode change. Because SPONT mode has no special breath timing requirements, the ventilator then enters the exhalation phase and waits for the detection of patient inspiratory effort, a manual inspiration, or apnea detection.
TR 8-1
Spontaneous (SPONT) Mode
Page Left Intentionally Blank
TR 8-2
TR 9 Apnea Ventilation
TR 9.1
Overview
•
•
•
The Puritan Bennett™ 840 Ventilator System’s apnea detection strategy follows these rules:
Apnea is not declared when the apnea interval setting equals or exceeds the breath period. For example, if the respiratory rate setting is 4/min, an apnea interval of 15 seconds or more means apnea cannot be detected.
The ventilator bases apnea detection on inspiratory (not expiratory) flow, and allows detection of a disconnect or occlusion during apnea ventilation.
Apnea detection is designed to accommodate interruptions to the typical breathing pattern due to other ventilator features (for example, expiratory pause), but still detect a true apnea event.
TR 9.2
Apnea Detection
The ventilator declares apnea when no breath has been delivered by the time the operatorselected apnea interval elapses, plus a small increment of time (350 ms). This increment allows time for a patient who has begun to initiate a breath to trigger inspiration and prevent the ventilator from declaring apnea when the apnea interval is equal to the breath period.
The apnea timer resets whenever an inspiration begins, regardless of whether the inspiration is patient-, ventilator-, or operator-initiated. The ventilator then sets a new apnea interval beginning from the start of the current inspiration. To hold off apnea ventilation, another inspiration must be delivered before (the current apnea interval +350 ms) elapses. Apnea detection is suspended during a disconnect, occlusion, or safety valve open (SVO) state.
shows an apnea interval equal to the breath period.
TR 9-1
Apnea Ventilation
Figure TR 9-1. Apnea Interval Equals Breath Period
1
2
T b0
T b1
3
4
PIM
T
A
(apnea interval)
shows an apnea interval greater than the breath period.
Figure TR 9-2. Apnea Interval Greater than Breath Period
1
2
3
T b0
T b1
PIM
4
5
VIM
T
A
(apnea interval)
shows an apnea interval less than the breath period.
Figure TR 9-3. Apnea Interval Less than Breath Period
TR 9-2
Transition to Apnea Ventilation
3
4
5
1
2
T b0
T b1
PIM
6
7
8
Dashed line indicates a PIM to avoid apnea 9
Apnea VIM
Apnea interval
Apnea T b0
Apnea ventilation
T b
(T
A
<T b
TR 9.3
Transition to Apnea Ventilation
When apnea is declared, the ventilator delivers apnea ventilation according to the current apnea ventilation settings and displays the apnea settings on the upper screen of the graphic user interface (GUI). Regardless of the apnea interval setting, apnea ventilation cannot begin until inspiration is complete and the restricted phase of exhalation has elapsed.
TR 9.4
Key Entries During Apnea Ventilation
All apnea and non-apnea settings remain active on the GUI during apnea ventilation. Both nonapnea and apnea settings changes are phased in according to the applicable rules (see Chapter
TR 11
for information on phasing in settings). If apnea ventilation is active, new settings are accepted but not implemented until non-apnea ventilation begins. Allowing key entries after apnea detection allows you to adjust the apnea interval at setup, regardless of whether apnea has been detected. During apnea ventilation, the MANUAL INSP key is active, but the EXP PAUSE and INSP
PAUSE keys are not active. The 100% O
2
/CAL 2 min key or INCREASE O
2
2 min key is active during apnea ventilation, because apnea detection is likely during suctioning.
TR 9.5
Resetting Apnea Ventilation
Apnea ventilation is intended as a backup mode of ventilation when there is no patient inspiratory effort. Apnea ventilation can be reset to normal ventilation by the operator (manual reset) or the patient (autoreset). It is also reset when a rate change is made that renders apnea ventilation inapplicable.
If the patient regains inspiratory control, the ventilator returns to the operator-selected mode of non-apnea ventilation. The ventilator determines whether the patient has regained respiratory control by monitoring triggered inspirations and exhaled volume. If the patient triggers two consecutive inspirations, and the exhaled volume is equal to or greater than 50% of the delivered volume (including any compliance volume), the ventilator resets to non-apnea ventilation.
Exhaled volume is monitored to avoid resetting due to autotriggering caused by large leaks in the patient circuit.
TR 9-3
Apnea Ventilation
TR 9.6
Resetting to A/C
•
•
•
Switching to A/C from apnea ventilation causes the ventilator to deliver a VIM and set the start time for the beginning of the first A/C cycle. The second VIM breath is phased in according to these rules:
The VIM is not delivered during an inspiration.
The VIM is not delivered until the first 200 ms of exhalation have elapsed and the expiratory flow is
≤50% of peak expiratory flow.
The time until the first VIM is delivered is 3.5 times the apnea inspiratory time, or the apnea breath period, whichever occurs first.
TR 9.7
Resetting to SIMV
•
•
•
Switching to SIMV from apnea ventilation causes the ventilator to deliver a VIM and set the start time for the beginning of the first SIMV cycle. Unless the patient triggers a synchronized PIM first, the VIM breath is phased in according to these rules:
The VIM is not delivered during an inspiration.
The VIM is not delivered during the restricted phase of exhalation.
The time until the first VIM is delivered is 3.5 times the apnea inspiratory time, or the apnea breath period, whichever occurs first.
TR 9.8
Resetting to SPONT
Once the ventilator switches to SPONT from apnea ventilation, the apnea interval begins at the start of the last or current apnea breath. The ventilator waits for detection of inspiratory effort, a manual inspiration, or apnea detection. If a valid breath is not delivered before the apnea interval elapses, the ventilator reenters apnea ventilation.
TR 9.9
Phasing in New Apnea Intervals
•
•
These rules apply to apnea settings:
The apnea respiratory rate must be greater than or equal to 60/T
A
.
Apnea settings cannot result in an I:E ratio greater than 1.00:1.
How a new apnea interval is phased in depends on whether or not apnea ventilation is active. If apnea ventilation is active, the ventilator accepts and implements the new setting immediately.
During normal ventilation (that is, apnea ventilation is not active), these rules apply:
TR 9-4
Phasing in New Apnea Intervals
•
•
If the new apnea interval setting is shorter than the current (or temporarily extended) apnea interval, the new value is implemented at the next inspiration.
If the new apnea interval setting is longer than the current (or temporarily extended) apnea interval, the old interval is extended to match the new interval immediately.
TR 9-5
Apnea Ventilation
Page Left Intentionally Blank
TR 9-6
TR 10 Detecting Occlusion and Disconnect
TR 10.1
Overview
The Puritan Bennett™ 840 Ventilator System detects severe patient circuit occlusions to protect the patient against excessive airway pressures over extended periods of time. The ventilator is also designed to detect patient circuit disconnects because they can cause the patient to receive little or no gas from the ventilator, and require immediate clinical attention.
TR 10.2
Occlusion
•
The ventilator detects a severe occlusion if:
The inspiratory or expiratory tube is partially or completely occluded (condensate or secretions collected in a gravity-dependent loop, kinked or crimped tubing, etc.).
•
•
•
•
•
The ventilator EXHAUST port or device attached to it is fully blocked.
The exhalation valve fails in the closed position (occlusion detection at the from patient port begins after 200 ms of exhalation has passed).
The ventilator does not declare a severe occlusion if:
The pressure difference between the inspiratory and the expiratory transducers is less than or equal to 5 cmH
2
O.
The exhalation valve fails in the closed position and the pressure in the exhalation limb is less than
2 cmH
2
O.
Silicone tubing is attached to the EXHAUST port of the ventilator (e.g., for metabolic monitoring purposes).
The ventilator checks the patient circuit for occlusions during all modes of breathing (except idle mode and safety valve open) at every breath delivery cycle. Once the circuit check begins, the ventilator detects a severe occlusion of the patient circuit within 200 ms. The ventilator checks the EXHAUST port for occlusions during the expiratory phase of every breath (except during disconnect and safety valve open). Once the EXHAUST port check begins, the ventilator detects a severe occlusion within 100 ms following the first 200 ms of exhalation. All occlusion checking is disabled during pressure sensor autozeroing.
TR 10-1
Detecting Occlusion and Disconnect
The ventilator uses different algorithms for detecting occlusions in the breathing circuit and at the exhalation exhaust port. For occlusions of the breathing circuit, a pressure-drop limit threshold has been established based on circuit type (Adult, Pediatric, or Neonatal) and the maximum of the inspiratory or expiratory flows. For occlusions at the exhalation exhaust port, a pressure-drop limit threshold has been established using exhaled flow, expiratory pressure and PEEP values. During ventilation, the actual pressure-drops across the patient circuit and expiratory valve are continuously monitored and compared with their respective limit threshold values. If the actual values exceed their threshold limit values for specified time intervals, a severe occlusion is detected.
Once a severe occlusion is detected, the ventilator acts to minimize airway pressure. Because any severe occlusion places the patient at risk, the ventilator minimizes the risk while displaying the length of time the patient has been without ventilatory support. Severe occlusion is detected regardless of what mode or triggering strategy is in effect. When a severe occlusion is detected, the ventilator terminates normal ventilation, terminates any active alarm silence, annunciates an occlusion alarm, and enters the safe state (exhalation and inspiratory valve de-energized and safety valve open) for 15 seconds or until inspiratory pressure drops to 5 cmH
2
O or less, whichever comes first.
During a severe occlusion, the ventilator enters occlusion status cycling (OSC), in which it periodically attempts to deliver a pressure based breath while monitoring the inspiration and expiration phases for the existence of a severe occlusion. If the severe occlusion is corrected, the ventilator detects the corrected condition after two complete OSC breath cycles during which no occlusion is detected. When the ventilator delivers an OSC breath, it closes the safety valve and waits 500 ms for the safety valve to close completely, delivers a breath with a target pressure of 15 cmH
2
O for 2000 ms, then cycles to exhalation. This breath is followed by a mandatory breath according to the current settings, but with PEEP=0 and O
2
% equal to 100% (adult/pediatric) or 40% (neonatal). During OSC (and only during OSC), the
1
P
PEAK
(high circuit pressure) alarm limit is disabled to ensure it does not interfere with the ability of the ventilator to detect a corrected occlusion. When the ventilator does not detect a severe occlusion, it resets the occlusion alarm, re-establishes
PEEP, and reinstates breath delivery according to current settings.
Apnea detection, inspiratory and expiratory pause, and manual inspirations are suspended during a severe occlusion. Pause maneuvers are canceled by a severe occlusion. During a severe occlusion, you can change ventilator settings.
TR 10.3
Disconnect
The ventilator bases its disconnect detection strategy on variables specific to each breath type.
The ventilator’s disconnect detection strategy is designed to detect actual disconnects (at the inspiratory limb, expiratory limb, or patient wye) while rejecting false detections.
•
The ventilator monitors the expiratory pressure and flow, delivered volume, and exhaled volume to declare a disconnect using any of these methods:
The ventilator detects a disconnect when the expiratory pressure transducer measures no circuit pressure and no exhaled flow during the first 200 ms of exhalation. The ventilator postpones declaring a
TR 10-2
Disconnect
•
•
• disconnect for another 100 ms to allow an occlusion (if detected) to be declared first, because it is possible for an occlusion to match the disconnect detection criteria.
Despite many possible variations of circuit disconnections and/or large leaks, it is possible for a patient to generate some exhaled flow and pressure. The ventilator then uses the disconnect sensitivity
(D
SENS
, the percentage of delivered volume lost during the exhalation phase of the same breath to declare a disconnect) setting to detect a disconnect.
If the disconnect occurs during a spontaneous breath, a disconnect is declared when the inspiration is terminated by maximum inspiratory time (or the
2
T
I SPONT
limit setting when vent type is NIV) and the ventilator detects inspiratory flow rising to the maximum allowable.
If the disconnect occurs at the patient side of the endotracheal tube, the exhaled volume will be much less than the delivered volume for the previous inspiration. The ventilator declares a disconnect if the exhaled volume is lower than the D
SENS
setting for three consecutive breaths. The D
SENS
setting helps avoid false detections due to leaks in the circuit or the patient’s lungs, and the three consecutive breaths requirement helps avoid false detections due to a patient out-drawing the ventilator during volume control (VC) breaths.
•
Flow less than a value determined using the D
SENS
setting and pressure less than 0.5 cmH
2
O detected for 10 consecutive seconds during exhalation.
WARNING:
When vent type is NIV, and D
SENS
setting is turned OFF, the system may not detect large leaks and some disconnect conditions it would declare as alarms during INVASIVE ventilation.
Once the ventilator detects a patient circuit disconnect, the ventilator declares a high-priority alarm and enters idle mode, regardless of what mode (including apnea) was active when the disconnect was detected. If there is an active alarm silence when the disconnect occurs, the alarm silence is not canceled. The ventilator displays the length of time the patient has been without ventilatory support. During idle mode, the exhalation valve opens, idle flow (10 L/min flow at
100% O
2
(or 40% O
2
in NeoMode), if available) begins, and breath triggering is disabled.
The ventilator monitors both expiratory flow and circuit pressures to detect reconnection. The ventilator declares a reconnect if any of the following criteria are met for the applicable time interval: exhaled idle flow within the reconnect threshold is detected; inspiratory and expiratory pressures are both above or both below reconnect threshold levels; or inspiratory pressure rises to a reconnect level. If the disconnect condition is corrected, the ventilator detects the corrected condition within 100 ms to 1000 ms.
Flow or pressure triggering, apnea detection, expiratory and inspiratory pause, manual inspirations, and programmed maneuvers or one-time events are suspended during a patient circuit disconnect condition. Spirometry is not monitored during a disconnect, and all alarms based on spirometry values are disabled. During a disconnect condition, you can change ventilator settings.
TR 10-3
Detecting Occlusion and Disconnect
If the disconnect alarm is autoreset or manually reset, the ventilator reestablishes PEEP. Once PEEP is reestablished, the ventilator reinstates breath delivery according to settings in effect before the disconnect was detected. Pause maneuvers are canceled during a disconnect.
TR 10.4
Occlusions and Disconnect Annunciation
Occlusion and disconnection cannot be declared at the same time. Therefore, the ventilator annunciates only the first event to be declared. If an occlusion occurs during idle mode, however, it can be detected if the breathing circuit becomes disconnected at the wye or expiratory filter.
TR 10-4
TR 11 Phasing in Setting Changes
TR 11.1
Overview
•
•
•
•
•
•
These rules govern how the Puritan Bennett™ 840 Ventilator System phases in setting changes:
Individual settings are handled separately and phased in according to the rule for each setting.
Batch settings and individual settings not yet phased in are merged together. If there are conflicting
Breath delivery batch settings are phased in according to the phase-in requirements of the individual settings. Settings are phased in using the most economical manner, applying the most restrictive rules.settings, the most recently entered value is used.
Breath delivery batch settings are phased in according to the phase-in requirements of the individual settings. Settings are phased in using the most economical manner, applying the most restrictive rules.
Apnea interval, flow sensitivity, pressure sensitivity, exhalation sensitivity, and disconnect sensitivity are considered batch-independent and are phased in according to their individual rules.
During non-apnea ventilation, apnea-specific settings are ready when apnea ventilation begins.
During apnea ventilation, non-apnea settings are ready when normal ventilation begins. Apnea settings and shared settings (for example, PEEP) are phased in according to batch setting rules.
TR 11-1
Phasing in Setting Changes
Page Left Intentionally Blank
TR 11-2
TR 12 Ventilator Settings
TR 12.1
Overview
This chapter provides supplementary information about selected ventilator settings for the
Puritan Bennett™ 840 Ventilator System. For settings ranges, resolutions, new patient values, and accuracy of all ventilator settings, see
Table OP A-12.
on page
OP A-16
.
Current settings are saved in non-volatile memory. All ventilator settings have absolute limits, which are intended to prevent settings outside the permissible operational range of the ventilator. Some settings require an acknowledgment to proceed beyond the recommended limit.
Most setting limits are restricted by ideal body weight (IBW), circuit type, or the interrelationship with other settings.
TR 12.2
Apnea Ventilation
•
•
Apnea ventilation is a backup mode. Apnea ventilation starts if the patient fails to breathe for a time that exceeds the apnea interval (T
A
) currently in effect. T
A
is an operator setting that defines the maximum allowable time between the start of inspiration and the start of the next inspiration. Apnea ventilation settings include respiratory rate (f), O
2
%, mandatory type (volume control, VC, or pressure control, PC), tidal volume (V
T
), flow pattern, peak inspiratory flow (
V
MAX
), inspiratory pressure (P
I
), and inspiratory time (T
I
). If the apnea mandatory breath type is VC, plateau time (T
PL
) is 0.0 seconds. If the apnea mandatory breath type is PC, rise time% is 50%, and T
I
is constant during rate change.
Because the minimum value for T
A
is 10 seconds, apnea ventilation cannot be invoked when non-apnea f is greater than or equal to 5.8/min. The ventilator does not enter apnea ventilation if T
A
is equal to the breath cycle interval. You can set T
A
to a value less than the expected or current breath cycle interval as a way of allowing the patient to initiate breaths while protecting the patient from the consequences of apnea.
•
Apnea settings are subject to these rules:
Apnea ventilation O
2
% must be set equal to or greater than non-apnea ventilation O
2
%.
Minimum apnea f is (60/T
A
).
Apnea ventilation settings cannot result in an I:E ratio greater than 1.00:1.
TR 12-1
Ventilator Settings
If apnea is possible (that is, if (60/f)>T
A
) and you increase the non-apnea O
2
% setting, apnea ventilation O
2
% automatically changes to match if it is not already set higher than the new non-apnea
O
2
%. Apnea ventilation O
2
% does not automatically change if you decrease the non-apnea O
2
%.
Whenever there is an automatic change to an apnea setting, a message is displayed on the graphic user interface (GUI), and the subscreen for apnea settings appears.
During apnea ventilation you can change T
A
and all non-apnea settings, but the new settings do not take effect until the ventilator resumes normal ventilation. Being able to change T
A
during apnea ventilation can avoid immediately reentering apnea ventilation once normal ventilation resumes.
TR 12.3
Circuit Type and IBW
Together, the circuit type and IBW settings determine the new patient values and absolute limits on various apnea and non-apnea settings including V
T
and
V
MAX
. You must run SST to change the circuit type. While IBW is being set or viewed, its value is displayed in kilograms (kg) and pounds
(lb).
Based on the circuit type and IBW, the ventilator calculates V
T
settings as follows:
Circuit type
Neonatal
Pediatric
Adult
New patient default V
T
Greater of 2 mL or 7.25 mL/kg×IBW
7.25 mL/kg×IBW
7.25 mL/kg×IBW
Minimum V
T
2 mL
25 mL
1.16 mL/kg×IBW
Maximum V
T
45.7 mL/kg×IBW and
<V
TI MAND
alarm limit setting in VC+
•
•
•
Based on the circuit type, the ventilator calculates settings as follows:
Maximum
V
MAX
=30 L/min for neonatal patient circuits
Maximum
V
MAX
=60 L/min for pediatric patient circuits
Maximum
V
MAX
=150 L/min for adult patient circuits
The IBW setting also determines the constants used in breath delivery algorithms, some user-settable alarms, the non-settable INSPIRATION TOO LONG alarm, and the high spontaneous inspiratory time limit setting (
2
T
I SPONT
).
TR 12.4
Disconnect Sensitivity
The disconnect sensitivity (D
SENS
) setting defines the percentage of returned volume lost, above which the ventilator declares a CIRCUIT DISCONNECT alarm. When D
SENS
is set to its lowest value
(20%), it has the highest sensitivity for detecting a disconnect or leak. When D
SENS
is set to its
TR 12-2
Expiratory Sensitivity highest value (95%), the ventilator has the least sensitivity for detecting a circuit disconnection, as greater than 95% of the returned volume must be lost before the alarm occurs. During NIV, the default D
SENS
setting is OFF, which is equivalent to a returned volume loss of 100%.
Note:
If D
SENS
is set to OFF during NIV, the ventilator is still capable of declaring a CIRCUIT DISCONNECT alarm.
TR 12.5
Expiratory Sensitivity
The expiratory sensitivity (E
SENS
) setting defines the percentage of the projected peak inspiratory flow at which the ventilator cycles from inspiration to exhalation. When inspiratory flow falls to the level defined by E
SENS
, exhalation begins. E
SENS
is active during every spontaneous breath. E
SENS is a primary setting and is accessible from the lower GUI screen. Changes to the E
SENS
setting are phased in any time during inspiration or exhalation.
E
SENS
complements rise time%. Rise time% should be adjusted to match the patient's inspiratory drive, and the E
SENS
setting should cause ventilator exhalation at a point most appropriate for the patient. The higher the E
SENS
setting, the shorter the inspiratory time. Generally, the most appropriate E
SENS
is compatible with the patient's condition, neither extending nor shortening the patient's intrinsic inspiratory phase.
TR 12.6
Expiratory Time
The expiratory time (T
E
) setting defines the duration of exhalation for PC mandatory and VC+ breaths only. Changes to the T
E
setting are phased in at the start of inspiration. Setting f and T
E automatically determines the value for I:E ratio and T
I
.
TR 12.7
Flow Pattern
The flow pattern setting defines the gas flow pattern of volume controlled (VC) mandatory breaths. The selected values for V
T
and
V
MAX
apply to either the square or descending ramp flow pattern. If V
T
and
V
MAX
are held constant, T
I
approximately halves when the flow pattern changes from descending ramp to square (and approximately doubles when flow pattern changes from square to descending ramp), and corresponding changes to the I:E ratio also occur. Changes in flow pattern are phased in during exhalation or at the start of inspiration.
The settings for flow pattern, V
T
, f, and
V
MAX
are interrelated, and changing any of these settings causes the ventilator to generate new values for the other settings. If any setting change would cause any of the following, the ventilator does not allow you to select that setting and displays a limit-violation message:
TR 12-3
Ventilator Settings
•
•
•
I:E ratio >4:1
TI>8.0 seconds or T
I
<0.2 second
T
E
<0.2 second
TR 12.8
Flow Sensitivity
The flow sensitivity (
V
SENS
) setting defines the rate of flow inspired by a patient that triggers the ventilator to deliver a mandatory or spontaneous breath. When
V
SENS
is on, a base flow of gas travels through the patient circuit. The patient inhales from the base flow. When the patient's inspiratory flow equals the
V
SENS
setting, the ventilator delivers a breath. Once a value for flow sensitivity is selected, the ventilator delivers a base flow equal to
V
SENS
+1.5 L/min (base flow is not user-selectable). Changes in
V
SENS
are phased in at the start of exhalation or during inspiration.
For example, if you select a
V
SENS
of 4 L/min, the ventilator establishes a base flow of 5.5 L/min through the patient circuit. When the patient inspires at a rate of 4 L/min, the corresponding 4 L/ min decrease in the base flow triggers the ventilator to deliver a breath.
When
V
SENS
is active, it replaces pressure sensitivity (P
SENS
). The
V
SENS
setting has no effect on the
P
SENS
setting.
V
SENS
can be active in any ventilation mode (including pressure supported, volume controlled, pressure controlled, and apnea ventilation). When
V
SENS
is active, a backup P
SENS setting of 2 cmH
2
O is in effect to detect the patient's inspiratory effort, even if the flow sensors do not detect flow.
Although the minimum
V
SENS
setting of 0.2 L/min (adult/pediatric circuit types) or 0.1 L/min (neonatal circuit type) can result in autotriggering (that is, when the ventilator delivers a breath based on fluctuating flows not caused by patient demand), it can be appropriate for very weak patients.
The maximum setting of 20 L/min (adult/pediatric circuit types) or 10 L/min (neonatal circuit type) is intended to avoid autotriggering when there are significant leaks in the patient circuit. The selected
V
SENS
is phased in during inspiration or at the start of exhalation in case the patient cannot trigger a breath using the previous sensitivity setting.
TR 12.9
High Spontaneous Inspiratory Time Limit
The high spontaneous inspiratory time limit setting (
1
T
I SPONT
) is available only in SIMV or SPONT modes during NIV, and provides a means for setting a maximum inspiratory time after which the ventilator automatically transitions to exhalation. It replaces the non-settable INSPIRATION TOO
LONG alarm active when vent type is invasive. The
2
T
I SPONT
setting is based upon circuit type and
IBW. For neonatal circuit types, the new patient default value is:
(1+(0.1×IBW)) seconds
For pediatric/adult circuit types, the new patient default value is:
TR 12-4
Humidification Type
(1.99+(0.02x IBW)) seconds
The
1
T
I SPONT
indicator appears at the beginning of a ventilator-initiated exhalation and remains visible for as long as the ventilator truncates breaths in response to the
2
T
I SPONT
setting. The
1
T
I
SPONT
indicator disappears when the patient’s inspiratory time returns to less than the
2
T
I SPONT setting, or after 15 seconds has elapsed after the beginning of exhalation of the last truncated breath.
TR 12.10
Humidification Type
The humidification type setting allows you to select the type of humidification system [heated expiratory tube, non-heated expiratory tube, or heat-moisture exchanger (HME)] being used on the ventilator and can be changed during normal ventilation or short self test (SST). Changes in humidification type are phased in at the start of inspiration.
SST calibrates spirometry partly based on the humidification type. If you change the humidification type without rerunning SST, then the accuracy of spirometry and delivery may be affected.
The output of the exhalation flow sensor varies depending on the water vapor content of the expiratory gas, which depends on the type of humidification system in use. Because the temperature and humidity of gas entering the expiratory filter differ based on the humidification type, spirometry calculations also differ according to humidification type. For optimum accuracy, rerun
SST to change the humidification type.
TR 12.11
I:E Ratio
The I:E setting defines the ratio of inspiratory time to expiratory time for mandatory PC breaths.
The ventilator accepts the specified range of direct I:E ratio settings as long as the resulting T
I
and
T
E
settings are within the ranges established for mandatory breaths. You cannot directly set the
I:E ratio in VC mandatory breaths. Changes in the I:E ratio are phased in at start of inspiration.
Setting f and I:E automatically determines the value for T
I
and T
E
. The maximum I:E ratio setting of
4.00:1 is the maximum that allows adequate time for exhalation and is intended for inverse ratio pressure control ventilation.
TR 12.12
Ideal Body Weight
Refer to
Circuit Type and IBW (TR 12.3)
TR 12.13
Inspiratory Pressure
The inspiratory pressure (P
I
) setting determines the pressure at which the ventilator delivers gas to the patient during a PC mandatory breath. The P
I
setting only affects the delivery of PC man-
TR 12-5
Ventilator Settings datory breaths. The selected P
I
is the pressure above PEEP. (For example, if PEEP is set to 5 cmH
2
O, and P
I
is 20 cmH
2
O, the ventilator delivers gas to the patient at 25 cmH
2
O.) Changes to the P
I setting are phased in during exhalation or at the start of inspiration.
The sum of PEEP+P
I
+2 cmH
2
O cannot exceed the high circuit pressure (
2
P
PEAK
) limit. To increase this sum of pressures, you must first raise the
2
P
PEAK
limit before increasing the settings for PEEP or P
I
.
TR 12.14
Inspiratory Time
The inspiratory time (T
I
) setting defines the time during which an inspiration is delivered to the patient for PC mandatory breaths. You cannot set T
I
in VC mandatory breaths. The ventilator accepts a T
I
setting as long as the resulting I:E ratio and T
I
settings are valid. Changes in the T
I
are phased in at the start of inspiration.
The ventilator rejects T
I
settings that result in an I:E ratio greater than 4.00:1, a T
I
greater than 8 seconds or less than 0.2 second, or a T
E
less than 0.2 second to ensure the patient has adequate time for exhalation. (For example, if the f setting is 30/min, a T
I
setting of 1.8 seconds would result in an I:E ratio of 9:1—which is out of range for I:E ratio settings.)
Inspiratory time is offered in addition to I:E ratio because the T
I
setting is commonly used for pediatric and infant ventilation and may be a more useful setting at lower respiratory rates. Setting f and T
I
automatically determines the value for I:E and T
E
(60/f –T
I
=T
E
). This equation summarizes the relation between T
I
, I:E, T
E
and cycle time (60/f):
T
I
=(60/f) [(I:E)/(1+I:E)]
If the f setting remains constant, any one of the three variables (T
I
, I:E, or T
E
) can define the inspiratory and expiratory intervals. If the f setting is low (and additional spontaneous patient efforts are expected), T
I
can be a more useful variable to set than I:E. As the f setting increases (and the fewer patient-triggered breaths are expected), the I:E setting becomes more relevant. Regardless of which variable you choose to set, a breath timing bar always shows the interrelationship between T
I
, I:E, T
E
, and f.
TR 12.15
Mode and mandatory Breath Type
Specifying the mode defines the types and sequences of breaths allowed for both INVASIVE and
NIV Vent Types, as summarized in
TR 12-6
Mode and mandatory Breath Type
A/C
SIMV
SPONT
Mode
Table TR 12-1. Puritan Bennett™ 840 Ventilator Modes and Breath Types
Sequence Mandatory breath type
INVASIVE: VC, VC+, or PC
NIV: VC or PC
Spontaneous breath type
Not allowed
INVASIVE: PC, VC, or VC+
NIV: VC or PC
INVASIVE: Pressure supported (PS), Tube compensated (TC), or none
(that is, CPAP breath)
NIV: PS or none
All mandatory (ventilator-, patient-, or operator-initiated)
Each new breath begins with a mandatory interval, during which a patient effort yields a synchronized mandatory breath. If no patient effort is seen during the mandatory interval, the ventilator delivers a mandatory breath. Subsequent patient efforts before the end of the breath yield spontaneous breaths.
All spontaneous (except for manual inspirations)
Not allowed (PC or VC allowed only for manual inspirations)
PC
INVASIVE: pressure supported (PS), tube compensated (TC), volume supported (VS), proportionally assisted (PA), or none (that is, CPAP breath)
NIV: PS or none
PS. TC, or none BILEVEL
(INVASIVE Vent Type only)
CPAP PC or VC N/A
Combines mandatory and spontaneous breathing modes. Refer to the BiLevel Software
Option Addendum for more information.
All spontaneous (except for manual inspirations)
Refer to the NeoMode
Option Addendum for more information on
Neo nCPAP
Breath types must be defined before settings can be specified. There are only two kinds of breath type: mandatory and spontaneous. Mandatory breaths are volume controlled (VC) or pressure controlled (PC or VC+). The ventilator system currently offers spontaneous breaths that are pressure supported (PS), volume supported (VS), tube compensated (TC), proportionally assisted (PA), or not pressure supported (that is, the “classic” CPAP breath with no pressure support).
shows the modes and breath types available on the ventilator system.
TR 12-7
Ventilator Settings
PC
Table TR 12-2. Illustrated Modes and Breath Types
Mandatory
VC VC+
A/C, SIMV, SPONT, BiLevel
PS TC
Spontaneous
VS PAV+
•
•
•
•
The mode setting defines the interaction between the ventilator and the patient.
Assist/control (A/C) mode allows the ventilator to control ventilation within boundaries specified by the practitioner. All breaths are mandatory, and can be PC, VC, or VC+.
Spontaneous (SPONT) mode allows the patient to control ventilation. The patient must be able to breathe independently, and exert the effort to trigger ventilator support.
Synchronized intermittent mandatory ventilation (SIMV) is a mixed mode that allows a combination of mandatory and spontaneous interactions. In SIMV, the breaths can be spontaneous or mandatory, mandatory breaths are synchronized with the patient's inspiratory efforts, and breath delivery is determined by the f setting.
BiLevel is a mixed mode that combines both mandatory and spontaneous breath types. Breaths are delivered in a manner similar to SIMV mode with PC selected, but providing two levels of PEEP. The patient is free to initiate spontaneous breaths at either PEEP level during BiLevel.
Changes to the mode are phased in at start of inspiration. Mandatory and spontaneous breaths can be flow- or pressure-triggered.
The ventilator automatically links the mandatory type setting to the mode setting. During A/C or
SIMV modes, once the operator has specified volume or pressure, the ventilator displays the appropriate breath parameters. Changes in the mandatory type are phased in during exhalation or at start of inspiration.
TR 12.16
O
2
%
The ventilator's oxygen sensor uses a galvanic cell to monitor O
2
%. This cell is mounted on the inspiratory manifold of the BDU and monitors the percentage of oxygen in the mixed gas (not the actual oxygen concentration in the gas the patient inspires). Changes to the O
2
% setting are phased in at the start of inspiration or the start of exhalation.
The O
2
% setting can range from room air (21%) up to a maximum of 100% oxygen. The galvanic cell reacts with oxygen to produce a voltage proportional to the partial pressure of the mixed gas.
The life of the cell can also be shortened by exposure to elevated temperatures and pressures.
Because the galvanic cell constantly reacts with oxygen, it requires periodic calibration to prevent inaccurate O
2
% alarm annunciation. The ventilator calibrates its oxygen sensor at the end of the
2-minute time interval started by pressing the 100% O
2
/CAL 2 min key or the INCREASE O
2
2 min key. See page
TR 15-4
for more information on calibrating the oxygen sensor. Canceling the 100%
O
2
/CAL operation prior to the end of the 2-minute interval will result in the O
2
sensor not being
TR 12-8
Peak Inspiratory Flow calibrated. Once a calibrated oxygen sensor and the ventilator reach a steady-state operating temperature, the monitored O
2
% will be within 3 percentage points of the actual value for at least
24 hours. To ensure the oxygen sensor remains calibrated, press the 100% O
2
/CAL 2 min key or INCREASE O
2
2 min key at least once every 24 hours.
Note:
The expected response time of the 840 ventilator to a full range change in the O
2
% setting between 21% and 100% may vary according to the type of patient connected to the ventilator (adult, pediatric, neonate) but should not exceed 14 seconds.
TR 12.17
Peak Inspiratory Flow
The peak inspiratory flow (
V
MAX
) setting determines the maximum rate of delivery of tidal volume to the patient during mandatory VC breaths. Changes in
V
MAX
are phased in during exhalation or at the start of inspiration. The
V
MAX
setting only affects the delivery of mandatory breaths. Mandatory breaths are compliance-compensated even at the maximum
V
MAX
setting.
When you propose a change to the
V
MAX
setting, the ventilator compares the new value with the settings for V
T
, f, flow pattern, and T
PL
. It is impossible to set a new that would result in an I:E ratio that exceeds 4.00:1, or a T
I
greater than 8.0 seconds or less than 0.2 second, or a T
E
less than 0.2 second.
TR 12.18
PEEP
This setting defines the positive end-expiratory pressure (PEEP), also called baseline pressure.
PEEP is the positive pressure maintained in the patient circuit during exhalation. Changes to the
PEEP setting are phased in at start of exhalation (if PEEP is increased or decreased) or at start of inspiration (only if PEEP is decreased).
The sum of:
PEEP+7 cmH
2
O
PEEP+P
I
+2 cmH
2
O (if PC is active)
PEEP+P
SUPP
+2 cmH
2
O (if PS is in use) cannot exceed the limit. To increase the sum of pressures, you must first raise the limit before increasing the settings for PEEP, P
I
, or P
SUPP
.
TR 12-9
Ventilator Settings
TR 12.19
PEEP Restoration
If there is a loss of PEEP from occlusion, disconnect, Safety Valve Open, or loss of power conditions,
PEEP is re-established (when the condition is corrected) by the ventilator delivering a PEEP restoration breath. The PEEP restoration breath is a 1.5 cmH
2
O pressure supported breath with exhalation sensitivity of 25%, and rise time% of 50%. A PEEP restoration breath is also delivered at the conclusion of Vent Startup. After PEEP is restored, the ventilator resumes breath delivery at the current settings.
TR 12.20
Plateau Time
The plateau time (T
PL
) setting defines the amount of time inspiration is held in the patient's airway after inspiratory flow has ceased. is available only during VC mandatory breaths (for A/C and SIMV mode, and operator-initiated mandatory breaths). is not available for PC mandatory breaths.
Changes to the setting are phased in at the start of inspiration or during exhalation.
When you propose a change to the T
PL
setting, the ventilator computes the new II:E ratio and T
I
, given the current settings for V
T
, f,
V
MAX
, and flow pattern. It is impossible to set a new T
PL
that would result in an I:E ratio that exceeds 4:1, or a T
I
greater than 8 seconds or less than 0.2 second, or a T
E
less than 0.2 second. For an I:E ratio calculation, T
PL
is considered part of the inspiratory phase.
TR 12.21
Pressure Sensitivity
The pressure sensitivity (P
SENS
) setting selects the pressure drop below baseline (PEEP) required to begin a patient-initiated breath (either mandatory or spontaneous). Changes in are phased in any time during exhalation or inspiration. The setting has no effect on the setting and is active only if the trigger type is P-TRIG.
Lower P
SENS
settings provide greater patient comfort and require less patient effort to initiate a breath. However, fluctuations in system pressure can cause autotriggering at very low settings.
The maximum setting avoids autotriggering under worst-case conditions if patient circuit leakage is within specified limits.
The ventilator phases in a new P
SENS
setting immediately (rather than at the next inspiration) in case the patient cannot trigger a breath using the previous sensitivity setting.
TR 12.22
Pressure Support
The pressure support (P
SUPP
) setting determines the level of positive pressure supplied to the patient's airway during a spontaneous breath. P
SUPP
is only available in SIMV, SPONT, and BILEVEL, in which spontaneous breaths are allowed. The level of P
SUPP
is in addition to PEEP.
TR 12-10
Respiratory Rate
The P
SUPP
setting is maintained as long as the patient inspires, and patient demand determines the flow rate. Changes to the P
SUPP
setting are phased in during exhalation or at the start of inspiration. Pressure support affects only spontaneous breaths.
The sum of PEEP+P
SUPP
+2 cmH
2
O cannot exceed the
1
P
PEAK
limit. To increase the sum of pressures, you must first raise the
1
P
PEAK
limit before increasing the settings for PEEP or P
SUPP
. Since the
1
P
PEAK
limit is the highest pressure considered safe for the patient, a P
SUPP
setting that would cause a
1
P
PEAK
alarm requires you to first reevaluate the maximum safe circuit pressure.
TR 12.23
Respiratory Rate
The respiratory rate (f) setting determines the minimum number of mandatory breaths per minute for ventilator-initiated mandatory breaths (PC, VC, and VC+). For PC mandatory and VC+ breaths, setting f and any one of the following parameters automatically determines the value of the others: I:E, T
I
, and T
E
. Changes to the f setting are phased in at the start of inspiration.
The ventilator does not accept a proposed f setting if it would cause the new T
I
or T
E
to be less than 0.2 second, the T
I
to be greater than 8 seconds, or I:E ratio greater than 4.00:1. (The ventilator also applies these restrictions to a proposed change to the apnea respiratory rate, except that apnea I:E cannot exceed 1.00:1.)
TR 12.24
Rise Time%
•
•
•
•
The rise time% setting allows you to adjust how quickly the ventilator generates inspiratory pressure for pressure-based breaths (that is, spontaneous breaths with PS (including a setting of 0 cmH
2
O)), PC mandatory, or VC+ breaths. The higher the value of rise time%, the more aggressive
(and hence, the more rapid) the rise of inspiratory pressure to the target (which equals PEEP+P
I
(or P
SUPP
)). The rise time% setting only appears when pressure-based breaths are available (when
PC is selected or spontaneous breaths are available).
For PC breaths, the lowest rise time setting produces a pressure trajectory reaching 95% of the inspiratory target pressure (PEEP+P
I
) in 2 seconds or 2/3 of the T
I
, whichever is shortest.
For spontaneous breaths, the lowest rise time setting produces a pressure trajectory reaching 95% of the inspiratory target (PEEP+P
SUPP
) in an interval that is a function of IBW.
When both PC and spontaneous breaths are active, the inspiratory pressure targets as well as the pressure trajectories can be different. Changes to T
I
and P
I
cause PC pressure trajectories to change.
Changes in rise time% are phased in during exhalation or at start of inspiration.
When P
SUPP
=NONE, the rise time% setting determines how quickly the ventilator drives circuit pressure to PEEP+1.5 cmH
2
O.
TR 12-11
Ventilator Settings
You can adjust rise time% for optimum flow delivery into lungs with high impedance (that is, low compliance and high resistance) or low impedance (that is, high compliance and low resistance).
To match the flow demand of an actively breathing patient, observe simultaneous pressure-time and flow-time curves, and adjust the rise time% to maintain a smooth rise of pressure to the target value. A rise time% setting reaching the target value well before the end of inspiration can cause the ventilator to supply excess flow to the patient. Whether this oversupply is clinically beneficial must be evaluated for each patient. Generally, the optimum rise time for gently breathing patients is less than or equal to the default (50%), while optimum rise time% for more aggressively breathing patients can be 50% or higher.
WARNING:
Under certain clinical circumstances (such as stiff lungs, or a small patient with a weak inspiratory drive), a rise time% setting above 50% could cause a transient pressure overshoot and premature transition to exhalation, or oscillatory pressures during inspiration. Carefully evaluate the patient's condition (watch the patient's pressure-time and flow-time curves) before setting the rise time% above the default setting of 50%.
TR 12.25
Safety Ventilation
Safety ventilation is intended as a safe mode of ventilation, regardless of the type of patient (adult, pediatric, or neonate) attached. It is invoked during the power-on initialization process, or if power has been removed from the ventilator for 5 minutes or more and circuit connection is sensed before ventilator startup is complete.
Safety ventilation settings use the “new patient” settings, with these exceptions:
TR 12-12
Spontaneous Breath Type
Mode: A/C f: 16/min
Ventilator settings
Mandatory type: PC
T
I
: 1 s
P
I
: 10 cmH
2
O
PEEP: 3 cmH
2
O
Trigger type: P-TRIG
Rise time%: 50%
P
SUPP
: 2 cmH
2
O
O
2
%: 100% or 40% if in NeoMode (21%if oxygen not available)
Alarm limits
2
P
PEAK
: 20 cmH
2
O
2V
E TOT
: High alarm limit OFF, low alarm limit: 0.05 L
2
V
TE
: OFF
2 f
TOT
: OFF
4
V
TE MAND
: OFF
4
V
TE SPONT
: OFF
TR 12.26
Spontaneous Breath Type
The spontaneous breath type setting determines whether spontaneous breaths are pressureassisted using pressure support (PS). A setting of NONE for spontaneous breath type is equivalent to a pressure support setting of 0 cmH
2
O.
Once you have selected the spontaneous breath type, you can choose the level of pressure support (P
SUPP
) and specify the rise time% and E
SENS
. Changes to the spontaneous breath type setting are phased in during exhalation or the start of inspiration.
Note:
In any delivered spontaneous breath, either invasive or NIV, there is always a target inspiratory pressure of
1.5 cmH
2
O applied, even if pressure support is set to NONE or 0.
During spontaneous breathing, the patient's respiratory control center rhythmically activates the inspiratory muscles. The support type setting allows you to select pressure support to supplement the patient's pressure-generating capability.
TR 12.27
Tidal Volume
The tidal volume (V
T
) setting determines the volume of gas delivered to the patient during a VC mandatory breath. The delivered V
T
is compensated for BTPS and patient circuit compliance.
Changes to the V
T
setting are phased in during exhalation or at the start of inspiration. The V
T setting only affects the delivery of mandatory breaths.
TR 12-13
Ventilator Settings
When you propose a change to the V
T
setting, the ventilator compares the new value with the settings for f,
V
MAX
, flow pattern, and T
PL
. If the proposed V
T
setting is within the acceptable range but would result in an I:E ratio that exceeds 4.00:1 or a T
I
greater than 8 seconds or less than 0.2 second, or a T
E
less than 0.2 second, the ventilator disallows the change.
TR 12.28
Vent Type
There are two vent type choices—invasive and NIV (non-invasive). Invasive ventilation is conventional ventilation used with cuffed endotracheal or tracheostomy tubes. All installed software options, breath modes, breath types, and trigger types are available during invasive ventilation.
NIV interfaces include non-vented full-faced or nasal masks, nasal prongs, or uncuffed ET tubes
(refer to
NIV Breathing Interfaces (OP 4.13.2)
on page
OP 4-20
for a list of interfaces that have been successfully tested with NIV).
WARNING:
Do not ventilate patients intubated with cuffed endotracheal or tracheostomy tubes using NIV vent type.
NIV enables the ventilator to handle large system leaks associated with these interfaces by providing pressure-based disconnect alarms, minimizing false disconnect alarms, and replacing the
INSPIRATION TOO LONG alarm with a high spontaneous inspiratory time limit (
2
T
I SPONT
) setting and visual indicator.
•
The following list shows the subset of invasive settings active during NIV:
Mode—A/C, SIMV, SPONT. (BiLevel is not available during NIV.)
•
•
•
Mandatory type—PC or VC. (VC+ is not available during NIV.)
Spontaneous type—PS or None. (TC and VS are not available during NIV.)
Trigger type—Flow triggering. (pressure triggering is not available during NIV.)
When transitioning to and from NIV, automatic settings changes take effect based upon the allowable modes and breath types.
Changing from Invasive to NIV Vent Type (OP 4.13.7)
on page
OP
4-25
and
Changing from NIV to Invasive Vent Type (OP 4.13.8)
on page
OP 4-25
provide details regarding these automatic settings changes.
During NIV alarm setup, the clinician may set alarms to OFF and must determine if doing so is appropriate for the patient’s condition.
TR 12-14
TR 13 Alarms
TR 13.1
Overview
This chapter discusses the ventilator’s alarm handling strategy and provides supplementary information about selected ventilator alarms for the Puritan Bennett™ 840 Ventilator System. For settings ranges, resolutions, and new patient values of all alarms (see
Table OP A-13.
on page
OP
A-2
8
).
Current alarm settings are saved in nonvolatile memory. All ventilator settings have absolute limits, which are intended to prevent settings outside the safe or permissible operational range of the ventilator. These limits may be fixed or depend on other settings, such as ideal body weight (IBW).
TR 13.2
Alarm Handling
•
•
•
•
The ventilator’s alarm handling strategy is to:
Detect and call attention to legitimate causes for caregiver concern as quickly as possible, while minimizing nuisance alarms.
Identify the cause and suggest corrective action for an alarm where possible.
Make it easy to discern an alarm’s priority level.
Allow quick and easy alarm setup.
Alarm annunciations include a priority level, which is an estimate of how quickly a caregiver must respond to ensure patient protection.
summarizes alarm priority levels.
TR 13-1
Alarms
Priority level
High: Hazardous situation requiring immediate response
Medium: Abnormal situation requiring prompt response
Low: Change in status, informing clinician
Table TR 13-1. Alarm Priority Levels
Visual indication
Red flashing
Yellow flashing
Yellow, steadily lit
Normal: No alarm conditions active (may include autoreset alarms)
Green, steadily lit
Audible indication
High-priority tone
(repeating sequence of five tones; sequence repeats twice, pauses, then repeats again)
Medium priority tone
(repeating sequence of three tones)
Low-priority tone (two tone, non-repeating)
None
Autoreset handling
If all high-priority alarm conditions return to normal, the audible indicator turns off, the red high-priority indicator switches from flashing to steadily lit, and autoreset is entered in the alarm history log.
Press the alarm reset key to turn off the visual indicator.
If all medium-priority alarm conditions return to normal, the audible and visual indicators turn off and autoreset is entered into the alarm history log.
If all low-priority alarm conditions return to normal, the audible and visual indicators turn off and autoreset is entered in the alarm history log.
Not applicable.
TR 13.2.1
Alarm messages
In addition to displaying the priority level of an alarm, the ventilator displays alarm messages for the two highest-priority active alarms near the top of the graphic user interface (GUI) upper
shows the format for alarm messages.
TR 13-2
Figure TR 13-1. Alarm messages format (upper GUI screen)
Alarm Handling
1 The analysis message gives the root cause of the alarm. May also include dependent alarms that have arisen due to the initial alarm.
The two highest priority active alarm messages are displayed here.
4
5
Touch flashing MORE ALARMS button to view messages for up to six additional active alarms.
2 The base message identifies the alarm.
Touch alarm symbol to view definition on lower screen.
3 The remedy message suggests how to resolve the alarm condition.
•
•
•
•
•
The following rules define how alarm messages are displayed:
If the ventilator is interfaced to an external device to collect data for trending and other monitoring purposes, that external data is not considered in alarm handling.
Initial alarms, called primary alarms, precede any dependent alarms, those alarms arising from primary alarms.
The system adds dependent alarms to the analysis messages of each active primary alarm with which they are associated. If a dependent alarm resets, the system removes it from the analysis message of the primary alarm.
The priority level of a primary alarm is equal to or greater than the priority level of any of its active dependent alarms.
An alarm cannot be a dependent alarm of any alarm that occurs subsequently.
TR 13-3
Alarms
•
•
•
•
If a primary alarm resets, any active dependent alarms become primary unless they are also dependent alarms of another active primary alarm.
The system applies the new alarm limit to alarm calculations from the moment of change to an alarm limit.
The priority level of a dependent alarm is based solely on its detection conditions (not the priority of any associated alarms).
When an alarm causes the ventilator to go to idle mode, occlusion status cycling (OSC), or safety valve open (SVO), the patient data display (including waveforms) is blanked. The elapsed time without ventilatory support (that is, since idle mode, OSC, or SVO began) is displayed on the upper GUI screen. If the alarm causing idle mode, OSC, or SVO is autoreset, the ventilator resets all patient data alarm detection algorithms.
TR 13.2.2
Alarm Summary
summarizes ventilator alarms, including priority, messages, and other information.
Base message
AC POWER
LOSS
APNEA
(patient data alarm)
Priority
Low
Medium
Medium
High
Table TR 13-2. Alarm Summary
Analysis message
Operating on battery.
Operational time <
2 minutes.
Remedy message
Prepare for power loss.
Apnea ventilation.
Breath interval > apnea interval.
Extended apnea duration or multiple apnea events.
Check patient & settings.
Comments
Power switch on, AC power not available, ventilator operating on BPS.
BPS operating indicator turns on. Resets when AC power is restored.
The set apnea interval has elapsed without the ventilator, patient, or operator triggering a breath.
Resets when patient initiates two consecutive breaths. Possible dependent alarm:
3V
E TOT
.
TR 13-4
Base message
CIRCUIT
DISCONNECT
COMPLIANCE
LIMITED V
T
(patient data alarm)
COMPRESSOR
INOPERATIVE
Alarm Handling
Priority
High
High
Low
Low
Low
Low
Low
Table TR 13-2. Alarm Summary (Continued)
Analysis message
No ventilation.
No ventilation.
Compliance compensation limit reached.
Remedy message
Check patient/ ventilator status.
Check patient.
Reconnect circuit.
Inspired volume may be < set.
Check patient and circuit type.
Comments
Ventilator has recovered from unintended power loss lasting more than 5 minutes, detects circuit disconnect, and switches to idle mode; upper screen displays elapsed time without ventilator support. Resets when ventilator senses reconnection.
Ventilator detects circuit disconnect and switches to idle mode; upper screen displays elapsed time without ventilator support. Resets when ventilator senses reconnection.
Compliance volume required to compensate delivery of a volume controlled breath exceeds the maximum allowed for three of the last four breaths.
Compressor ready indicator turns off. Resets when full AC power is restored.
No compressor air.
No operation during low AC power.
No compressor air.
No operation during AC power loss.
No compressor air.
No remedy message displayed
Ventilator turns off compressor. Resets when full
AC power is restored.
N/A Replace compressor
Compressor ready indicator turns off.
Alarm occurs when there are no LOW AC POWER and no AC POWER LOSS alarms for <15 seconds
and time since power-on
>10 seconds.
TR 13-5
Alarms
Base message
DEVICE ALERT
Priority
Low
Low
Low
Low
Medium
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Remedy message
Breath delivery not affected.
Service required.
Replace & service ventilator.
Ventilation continues as set.
Breath delivery not affected. Compromised spirometry.
Breath delivery not affected. Possible compromise of other functions.
Ventilation continues as set.
Service required.
Replace & service ventilator.
Medium
Medium
Medium
Medium
Comments
Background checks have detected a problem.
Resets when ventilator passes EST.
POST has detected a problem. Resets when ventilator passes POST.
Ventilation continues as set.
Breath delivery not affected. Compromised spirometry.
Ventilation continues as set. Only O
2 available.
Breath delivery not affected. Compromised spirometry.
Check patient.
Replace & service ventilator.
Background checks have detected a problem.
Accuracy of exhalation flow sensor temperature may be affected. Resets when ventilator passes
EST.
Background checks have detected a problem.
Accuracy of oxygen flow sensor temperature may be affected, ventilator using nominal value.
Resets when ventilator passes EST.
Background checks have detected a problem persisting for over 10 minutes. Resets when ventilator passes EST.
Background checks have detected a problem. Ventilator delivers 100% O
2
.
Resets when ventilator passes EST.
Background checks have detected a problem.
Accuracy of exhalation flow sensor temperature may be affected. Resets when ventilator passes
EST.
TR 13-6
Base message
DEVICE ALERT
(cont)
Alarm Handling
Priority
Medium
High
High
High
High
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Ventilation continues as set. Only air available.
Breath delivery not affected.
Unable to determine status of breath delivery.
Ventilation continues as set.
Ventilation continues as set.
Ventilation continues as set. Delivery/spiro may be compromised.
Remedy message
Replace & service ventilator.
Replace & service ventilator.
Check patient.
Replace & service ventilator.
Replace & service ventilator.
Replace & service ventilator.
Replace & service ventilator.
Comments
Background checks have detected a problem. Ventilator delivers 21% O
2
.
Resets when ventilator passes EST.
Background checks have detected a problem. Loss of GUI indicator lights.
Setting changes disabled.
Resets when ventilator passes EST. See
for a list of recommended actions.
Background checks have detected a problem. Loss of GUI indicator lights.
Resets when communication between GUI and
BDU is reestablished.
Background checks have detected a problem. Loss of GUI indicator lights.
Alarms, setting changes, and monitored data disabled. Resets when ventilator passes EST. See
mended actions.
Background checks have detected a problem.
Setting changes, monitored data, and alarms disabled. Resets when ventilator passes EST.
Background checks have detected a problem.
Setting changes not allowed. Resets when ventilator passes EST.
TR 13-7
Alarms
Base message
DEVICE ALERT
(cont)
Priority
High
High
High
High
High
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Breath delivery not affected. Compromised spiro. Trig = pres.
Ventilation continues as set. Compromised air delivery.
Ventilation continues as set. Compromised O
2 delivery.
Power loss & recovery occurred with a pre-existing
Device Alert.
Ventilation continues as set, except
O
2
% = 21.
Remedy message
Check patient.
Replace & service ventilator.
Ventilation continues as set, except
O
2
% = 100.
Check patient.
Replace & service ventilator.
Replace & service ventilator. Check patient.
Replace & service ventilator. Check patient.
Check Alarm log.
EST required.
Check patient.
Replace & service ventilator.
Comments
Background checks have detected a problem and flow triggering was selected. Accuracy of exhalation flow sensor temperature may be affected. Resets when ventilator passes EST.
Background checks have detected a problem. Ventilator delivers 100% O
2 instead of set O
2
%. Resets when ventilator passes
EST.
Background checks have detected a problem.
Accuracy of air flow sensor temperature may be affected, ventilator using nominal value.
Resets when ventilator passes EST.
Background checks have detected a problem.
Accuracy of oxygen flow sensor temperature may be affected, ventilator using nominal value.
Resets when ventilator passes EST.
Background checks have detected a problem. Loss of GUI indicator lights.
Resets when ventilator passes EST.
Background checks have detected a problem. Ventilator delivers 21% O
2 instead of set O
2
%. Resets when ventilator passes
EST.
TR 13-8
Base message
DEVICE ALERT
(cont)
1
P
PEAK
(patient data alarm)
3
P
PEAK
(patient data alarm)
1
O
2
% (patient data alarm)
Alarm Handling
Priority
High
High
High
Low
Medium
High
Low
Medium
High
Medium
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
No ventilation.
Safety Valve Open.
No ventilation.
Safety Valve Open.
Remedy message
Provide alternate ventilation.
Replace & service ventilator.
Check patient.
Replace & service ventilator.
No ventilation.
Safety Valve Open.
Provide alternate ventilation.
Replace & service ventilator.
Comments
Last breath≥ set limit.
Last 3 breaths ≥ set limit.
Last 4 or more breaths ≥ set limit.
Last 2 breaths, pressure ≤ set limit.
Last 4 breaths, pressure ≤ set limit.
Last 10 or more breaths, pressure
≤ set limit.
Measured O
2
% > set for≥30 s but <
2 min.
Measured O
2
% > set for ≥2 min.
Check patient circuit & ET tube.
Check for leaks.
Check patient, gas sources, O
2
analyzer & ventilator.
The O
2
% measured during any phase of a breath cycle is 7% (12% during the first hour of operation) or more above the O
2
% setting for at least 30 seconds. (These percentages increase by
5% for 4 minutes following a decrease in the O
2
% setting.) Alarm updated at 1-second intervals.
Background checks have detected a problem.
Safety valve open indicator lights. Upper screen displays elapsed time without ventilator support. Resets when ventilator passes EST.
Background checks have detected a problem. Ventilator inoperative and safety valve open indicators light. Message may not be visible. If possible, upper screen displays elapsed time without ventilator support. Resets when ventilator passes
EST.
Measured airway pressure ≥ set limit. Ventilator truncates current breath unless already in exhalation. Possible dependent alarms:
3
V
TOT
,
1 f
TOT
.
TE MAND
,
3V
E
Peak inspiratory pressure
≤ set limit. (Available only when Vent Type is NIV or during invasive ventilation when mandatory type is VC+.)
TR 13-9
Alarms
1V
1
P
Base message
1
V
TE
(patient data alarm)
E TOT
(patient data alarm)
1 f
TOT
(patient data alarm)
VENT
(patient data alarm)
INOPERATIVE
BATTERY
INSPIRATION
TOO LONG
(patient data alarm)
Priority
Low
Medium
High
Low
Medium
High
Low
Medium
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Last 2 breaths ≥ set limit.
Last 4 breaths ≥ set limit.
Last 10 or more breaths ≥ set limit.
V
E TOT
≥ set limit for ≤ 30s.
V
E TOT
≥ set limit for > 30s.
V
E TOT
≥ set limit for > 120s.
f
TOT
≥ set limit for
≤ 30s.
f
TOT
≥ set limit for
> 30s.
f
TOT
≥ set limit for
> 120s.
Remedy message
Check settings, changes in patient’s R & C.
Check patient & settings.
Check patient & settings.
Low
Medium
High
Low
Low
Medium
High
Comments
Exhaled tidal volume ≥ set limit. Alarm updated whenever exhaled tidal volume is recalculated.
Possible dependent alarm:
1V
E TOT
.
Expiratory minute volume ≥ set limit. Alarm updated whenever an exhaled minute volume is recalculated. Possible dependent alarm:
1
V
TE
.
1 breath ≥ limit.
2 breaths ≥ limit.
3 or more breaths
≥ limit.
Check patient circuit & ET tube.
Inadequate charge or nonfunctional battery system.
Last 2 spont breaths = IBW basedT
I
limit.
Last 4 spont breaths = IBW based T
I
limit.
Last 10 or more spont breaths =
IBW basedT
I
limit.
Service/replace battery.
Check patient.
Check for leaks.
Total respiratory rate ≥ set limit. Alarm updated at the beginning of each inspiration. Reset when measured respiratory rate falls below the alarm limit. Possible dependent alarms:
3
V
TE MAND
,
3
V
TE
SPONT
,
1V
E TOT
.
Inspiratory pressure >100 cmH
2
O and mandatory type = VC or spontaneous type = TC or PA. Ventilator truncates current breath unless already in exhalation. Possible dependent alarms:
3
V
TE
MAND
,
3V
E TOT
,
1 f
TOT
.
BPS installed but not functioning. Resets when
BPS is functional.
Inspiratory time for spontaneous breath ≥ IBWbased limit. Ventilator transitions to exhalation.
Resets when T
I
falls below
IBW-based limit. Active only when Vent Type is invasive.
TR 13-10
Base message
LOSS OF
POWER
LOW AC
POWER
LOW BATTERY
3
O
2
% (patient data alarm)
3
V
TE MAND
(patient data alarm)
Alarm Handling
Priority
High
Low
Low
High
Low
Medium
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Remedy message
Comments
Ventilator currently not affected.
Measured O
2
% < set O
2
%.
Last 2 mand. breaths ≤ set limit.
Last 4 mand. breaths ≤ set limit.
Last 10 or more mand. breaths ≤ set limit.
Power interrupt possible.
Operational time <
2 minutes.
Replace or allow recharge.
Check patient, gas sources, O
2
analyzer & ventilator.
Check for leaks, changes in patient’s R & C.
The ventilator power switch is on and there is insufficient power from
AC and the BPS (if installed). There may not be a visual indicator for this alarm, but an independent audio alarm on the BDU sounds for at least 120 seconds. Alarm annunciation can be reset by turning power switch to off position.
Mains (AC) power has dropped below 80% of nominal for 1 second.
Ventilator continues operation as close to settings as possible. Resets when there is no low AC power signal for 1 second.
Resets when BPS has more than approximately
2 minutes of operational time remaining.
The O
2
% measured during any phase of a breath cycle is 7% (12% during the first hour of operation) or more below the O
2
% setting for at least 30 seconds, or below 18%. (These percentages increase by 5% for 4 minutes following an increase in the O
2
% setting.) Alarm updated at 1-second intervals.
Exhaled mandatory tidal volume ≤ set limit. Alarm updated whenever exhaled mandatory tidal volume is recalculated.
Possible dependent alarms:
1V
E TOT
,
1 f
TOT
.
TR 13-11
Alarms
Base message
3
V
TE SPONT
(patient data alarm)
3V
E TOT
(patient data alarm)
NO AIR
SUPPLY
NO AIR
SUPPLY and
NO O
2
SUPPLY
Priority
Low
Medium
High
Low
Medium
High
Low
Low
High
High
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Last 2 spont breaths ≤ set limit.
Last 4 spont breaths ≤ set limit.
Last 10 or more spont breaths ≤ set limit.
V
E TOT
≤ set limit for ≤ 30s.
V
E TOT
≤ set limit for > 30s.
V
E TOT
≤ set limit for > 120s.
Ventilation continues as set. Only O
2 available.
Compressor inoperative. Ventilation continues as set. Only O
2
available.
Ventilation continues as set except
O
2
% = 100.
Compressor inoperative. Ventilation continues as set, except O
2
% =
100.
No ventilation.
Safety Valve Open.
Remedy message
Check patient & settings.
Check patient & settings.
Check air source.
Provide alternate ventilation. Check both gas sources.
Comments
Exhaled spontaneous tidal volume ≤ set limit.
Alarm updated whenever exhaled spontaneous tidal volume is recalculated. Possible dependent alarms:
3V
E TOT
,
1 f
TOT
.
Total minute volume≤ set limit. Alarm updated whenever exhaled minute volume is recalculated. Possible dependent alarms:
3
V
TE MAND
,
3V
E TOT
,
1 f
TOT
.
Operator-set O
2
% equals
100%. Ventilator delivers
100% O
2
. Resets if air supply connected.
Check patient & air source.
Operator-set O
2
% <
100%. Ventilator delivers
100% O
2
instead of set
O
2
%. Resets if air supply connected.
Safety valve open indicator lights. Upper screen displays elapsed time without ventilator support. Safety valve closes and indicator turns off if either gas supply is connected. Individual gas supply alarm resets when corresponding supply is connected.
TR 13-12
Base message
NO O
2
SUPPLY
O
2
SENSOR
PROCEDURE
ERROR
SCREEN
BLOCK
SEVERE OCLU-
SION
Alarm Handling
Priority
Low
High
Low
High
Medium
High
Table TR 13-2. Alarm Summary (Continued)
Analysis message
Ventilation continues as set. Only air available.
Ventilation continues as set, except
O
2
% = 21.
Ventilation unaffected.
Patient connected before setup complete.
Possible blocked beam or touch screen fault.
Little/no ventilation.
Remedy message
Check O
2
source.
Comments
Check patient & O
2 source.
Operator-set O
2
% equals
21%. Resets if O
2
supply connected.
Operator-set O
2
% >21%.
Ventilator delivers 21%
O
2
instead of set O
2
%.
Resets if oxygen supply connected.
O
2
sensor out of calibration/ failure. Press 100% O
2
CAL or INCREASE
O
2
2 min. Replace or disable.
Provide alternate ventilation. Complete setup process.
Remove obstruction or service ventilator.
Check patient.
Provide alternate ventilation. Clear occlusions; drain circuit.
Background checks have detected a problem.
Resets when operator successfully calibrates oxygen sensor, or disables oxygen sensor. See page
TR 15-4
for more information on calibrating the oxygen sensor.
Ventilator begins safety ventilation. Resets when ventilator startup procedure is complete.
Background checks have detected a problem.
Resets when ventilator passes EST or when blockage is removed.
Ventilator enters occlusion status cycling (OSC) and upper screen displays elapsed time without ventilator support.
TR 13-13
Alarms
Symptom
Loss of GUI display
(upper and lower
Loss of display (upper, lower, or both) and …
Loss of GUI display
(upper, lower, or both) and …
Table TR 13-3. Loss of GUI Display
Alarm condition
• Loss of GUI indicator
DISPLAY (GUI) INOP
• High priority audible alarm
No alarm messages displayed
• Ventilation continues as set.
• Breath delivery not affected.
• Audible alarms not affected.
• Alarm status indicator panel functions.
• VENT INOP displayed on BDU
VENT INOP
Ventilator function
• Ventilation continues as set.
• Breath delivery not affected.
• Audible alarms not affected.
Ventilator is not providing breaths, ventilator assistance, or supplemental oxygen.
Recommended action
• Verify the patient’s respiratory and physiological stability.
• Confirm the patient is receiving ventilator support by observation of the expansion and contraction of the patient’s chest.
• Assess current patient status by review of other monitoring indicators
(e.g., oxygen saturation, heart rate, blood pressure, etc.).
• Promptly transfer the patient to an alternate source of ventilation consistent with your institutional protocol.
• Remove the affected ventilator from use until it has been serviced.
Verify the patient’s respiratory and physiological stability.
• Confirm the patient is receiving ventilator support by observation of the expansion and contraction of the patient’s chest.
• Assess current patient status by review of other monitoring indicators
(e.g., oxygen saturation, heart rate, blood pressure, etc.).
• Promptly transfer the patient to an alternate source of ventilation consistent with your institutional protocol.
• Remove the affected ventilator from use until it has been serviced.
Immediately transfer the patient to an alternate source of ventilation.
TR 13-14
AC POWER LOSS Alarm
TR 13.3
AC POWER LOSS Alarm
The AC POWER LOSS alarm indicates the ventilator power switch is on and the ventilator is being powered by the backup power source (BPS). The ventilator annunciates a low-priority alarm when the ventilator has been operated by the BPS for at least 3 seconds and at least 2 minutes of BPS power are available. The ventilator annunciates a medium-priority alarm when less than 2 minutes of BPS power are estimated available.
The AC POWER LOSS alarm indicates the ventilator is being powered by the BPS and an alternate power source may soon be required to sustain normal ventilator operation. During an AC POWER
LOSS condition, power to the humidifier and compressor is not available.
TR 13.4
APNEA Alarm
The APNEA alarm indicates neither the ventilator nor the patient has triggered a breath for the operator-selected apnea interval (T
A
). T
A
is measured from the start of an inspiration to the start of the next inspiration and is based on the ventilator’s inspiratory detection criteria. T
A
can only be selected via the apnea ventilation settings.
The APNEA alarm autoresets when the patient initiates two successive breaths, and is intended to establish the patient's inspiratory drive is reliable enough to resume normal ventilation. To ensure the breaths are patient-initiated (and not due to autotriggering), exhaled volumes must be at least half the V
T
(this avoids returning to normal ventilation if there is a disconnect).
The ventilator monitors breathing from the start of inspiration to the start of inspiration and allows the ventilator to declare apnea when the patient fails to take a breath, rather than when he or she fails to exhale on schedule.
TR 13.5
CIRCUIT DISCONNECT Alarm
The CIRCUIT DISCONNECT alarm indicates the patient circuit is disconnected at the ventilator or the patient side of the patient wye, or a large leak is present. The methods by which circuit disconnects are detected vary depending on breath type. Time, pressure, flow, delivered volume, exhaled volume, and the D
SENS
setting may be used in the circuit disconnect detection algorithms. See
Occlusion (TR 10.2)
on page
TR 10-1
for a complete discussion of the CIRCUIT DISCON-
NECT detection methods.
You can set the sensitivity of the CIRCUIT DISCONNECT alarm by adjusting the D
SENS
setting.
During a CIRCUIT DISCONNECT condition, the ventilator enters idle mode and delivers a 10 L/min flow of oxygen to detect a reconnection.
When the ventilator determines the patient circuit is reconnected, the CIRCUIT DISCONNECT alarm autoresets and normal ventilation resumes without having to manually reset the alarm (for example, following suctioning).
TR 13-15
Alarms
A disconnected patient circuit interrupts gas delivery and patient monitoring. Notification of a patient circuit disconnect is crucial, particularly when the patient cannot breathe spontaneously.
The ventilator does not enter apnea ventilation when a disconnect is detected to avoid changing modes during a routine suctioning procedure.
TR 13.6
DEVICE ALERT Alarm
A DEVICE ALERT alarm indicates a background test or power on self test (POST) has failed.
Depending on which test failed, the ventilator either declares an alarm and continues to ventilate according to current settings, or ventilates with modified settings, or enters the ventilator inoperative state. The DEVICE ALERT alarm relies on the ventilator’s self-testing and notifies you of an abnormal condition requiring service.
TR 13.7
HIGH CIRCUIT PRESSURE Alarm
•
The high circuit pressure (
1
P
PEAK
) alarm indicates the currently measured airway pressure is equal to or greater than the set
2
P
PEAK
limit. The
2
P
PEAK
limit is active during mandatory and spontaneous breaths, and during inspiration and exhalation. The
2
P
PEAK
limit is active in all normal ventilation modes. The
2
P
PEAK
limit is not active during a SEVERE OCCLUSION alarm.
•
The
2
P
PEAK
limit cannot be set less than any of the listed quantities:
PEEP + 7 cmH
2
O
PEEP + P
I
+ 2 cmH
2
O
•
•
PEEP + P
SUPP
+ 2 cmH
2
O
4
P
PEAK
You cannot disable the
2
P
PEAK
limit. The ventilator phases in changes to the
2
P
PEAK
limit immediately to allow prompt notification of a high circuit pressure condition.
The minimum limit (7 cmH
2
O) corresponds to the lowest peak pressures not due to autotriggering anticipated during a mandatory breath. The maximum limit (100 cmH
2
O) was selected because it is the maximum pressure required to inflate the lungs of a patient with very low-compliance lungs.
The ventilator allows circuit pressure to rise according to a computed triggering profile for the initial phase of PC and PS breaths without activating the alarm. This triggering profile helps avoid nuisance alarms due to possible transient pressure overshoot in the airway when aggressive values of rise time% are selected. A pressure overshoot measured in the patient circuit is unlikely to be present at the carina.
TR 13-16
HIGH DELIVERED O
2
% Alarm
The
2
P
PEAK
alarm is active throughout inspiration and exhalation to provide redundant patient protection (for example, to detect occlusions downstream of the pressure-sensing device).
TR 13.8
HIGH DELIVERED O
2
% Alarm
The high delivered O
2
% (
1
O
2
%) alarm indicates the measured O
2
% during any phase of a breath is at or above the error percentage above the O
2
% setting for at least 30 seconds. Although the ventilator automatically sets the
1
O
2
% alarm limits, you can disable the oxygen sensor. (The error percentage is 12% above setting for the first hour of ventilator operation, 7% above setting after the first hour of operation, and an additional 5% above setting for the first 4 minutes following a decrease in the setting.)
The ventilator automatically adjusts the
1
O
2
% alarm limit when O
2
% changes due to 100% O
2
, apnea ventilation, occlusion, circuit disconnect, or a NO AIR or NO O
2
SUPPLY alarm. The ventilator checks the
1
O
2
% alarm limit against the measured oxygen percentage at 1-second intervals.
The
1
O
2
% alarm detects malfunctions in ventilator gas delivery or oxygen monitor. The
1
O
2
% alarm limit automatically adjusts during 100% O
2
suction, apnea ventilation, patient circuit disconnect, or low air inlet pressure because O
2
% changes are expected under those circumstances.
The ventilator declares a
1
O
2
% alarm after 30 seconds to eliminate transient O
2
% delivery variation nuisance alarms.
TR 13.9
HIGH EXHALED MINUTE VOLUME Alarm
The high exhaled minute volume (
1V
E TOT
) alarm indicates the measured exhaled total minute volume for spontaneous and mandatory breaths is equal to or greater than the set
2V
E TOT
limit.
The
1V
E TOT
alarm is updated whenever a new value is available.
The
1V
E TOT
alarm can be used to detect a change in a patient's breathing pattern, or a change in compliance or resistance. The
1V
E TOT
alarm can also detect too-large tidal volumes, which could lead to hyperventilation and hypocarbia.
The
1V
E TOT
alarm is effective immediately upon changing the setting, to ensure prompt notification of prolonged high tidal volumes.
TR 13.10
HIGH EXHALED TIDAL VOLUME Alarm
The high exhaled tidal volume (
1
V
TE
) alarm indicates the measured exhaled tidal volume for spontaneous and mandatory breaths is equal to or greater than the set
2
V
TE
limit. The
1
V
TE
alarm is updated whenever a new measured value is available.
TR 13-17
Alarms
The
1
V
TE
alarm can detect increased exhaled tidal volume (due to greater compliance and lower resistance) and prevent hyperventilation during pressure control ventilation or pressure support.
You can turn the
1
V
TE
alarm off to avoid nuisance alarms. (Hyperventilation due to increased compliance is not a concern during volume-based ventilation, because the tidal volume is fixed by the clinician's choice and the ventilator’s compliance compensation algorithm.)
TR 13.11
HIGH INSPIRED TIDAL VOLUME Alarm
The high inspired tidal volume alarm indicates the patient’s inspired volume exceeds the set limit.
When this condition occurs, the breath terminates and the alarm sounds. The selected combination of mandatory and/or spontaneous breath type settings determines the symbol appearing in the alarm message, alarm log, and alarm settings screen (
1
V
TI
,
1
V
TI MAND
, or
1
V
TI SPONT
). The ventilator system displays monitored inspired tidal volume values in the patient data area on the GUI
shows the symbol corresponding to the ventilator settings in effect.
Table TR 13-4. Applicability of High Inspired Tidal Volume Alarm Symbols
Alarm symbol
1
V
1
V
1
V
TI
TI MAND
TI SPONT
Alarm setting or patient data symbol
V
TI
V
TI MAND
V
TI SPONT
Mandatory or spontaneous type setting
VC+ and TC (concurrently)
VC+
VS or TC
When Vent Type is NIV, there is no high inspired tidal volume alarm or setting available, but the monitored inspired tidal volume (V
TI
) appears in the patient data area on the GUI screen.
TR 13.12
HIGH RESPIRATORY RATE Alarm
The high respiratory rate (
1 f
TOT
) alarm indicates the measured breath rate is greater than or equal to the set
2 f
TOT
limit. The
1 f
TOT
alarm is updated whenever a new total measured respiratory rate is available.
The
1 f
TOT
alarm can detect tachypnea, which could indicate the tidal volume is too low or the patient's work of breathing has increased. The ventilator phases in changes to the
2 f
TOT
limit immediately to ensure prompt notification of a high respiratory rate condition.
TR 13.13
INSPIRATION TOO LONG Alarm
The INSPIRATION TOO LONG alarm, active only when Vent Type is INVASIVE, indicates the inspiratory time of a spontaneous breath exceeds the listed time limit:
TR 13-18
LOW CIRCUIT PRESSURE Alarm
(1.99+0.02×IBW) seconds (adult and pediatric circuits)
(1.0+0.10×IBW) seconds (neonatal circuits) where IBW is the current setting for ideal body weight in kg.
When the ventilator declares an INSPIRATION TOO LONG alarm, the ventilator terminates inspiration and transitions to exhalation. The INSPIRATION TOO LONG alarm applies only to spontaneous breaths. You cannot set or disable the INSPIRATION TOO LONG alarm.
Because leaks (in the patient circuit, around the endotracheal tube cuff, or through chest tubes) and patient-ventilator mismatch can affect accurate exhalation detection, the INSPIRATION TOO
LONG alarm can act as a backup method of safely terminating inspiration. If the INSPIRATION TOO
LONG alarm occurs frequently, check for leaks and ensure E
SENS
and rise time% are properly set.
TR 13.14
LOW CIRCUIT PRESSURE Alarm
The low circuit pressure (
3
P
PEAK
) alarm indicates the measured maximum airway pressure during the current breath is less than or equal to the set alarm level during a non-invasive inspiration or during a
VC+ inspiration.
The
3
P
PEAK
alarm is active for mandatory and spontaneous breaths, and is present only when Vent
Type is NIV or mandatory type is VC+. During VC+, if the PEEP level is set to 0 cmH
2
O, the
3
P
PEAK alarm can be turned off. The
3
P
PEAK
alarm can always be turned off during NIV. The
4
P
PEAK
alarm limit cannot be set to a value greater than or equal to the
2
P
PEAK
alarm limit.
WARNING:
Because the VC+ pressure control algorithm does not allow the target inspiratory pressure to fall below PEEP+5 cmH
2
O, attempting to set the
4
P
PEAK
alarm limit at or below this level will turn the alarm off.
Whenever PEEP is changed,
3
P
PEAK
is set automatically to its New Patient value, PEEP+6 cmH
2
O.
There are no alarms dependent upon
3
P
PEAK
, and the
3
P
PEAK
alarm does not depend on other alarms.
TR 13.15
LOW DELIVERED O
2
% Alarm
The low delivered O
2
% (
3
O
2
%) alarm indicates that the measured O
2
% during any phase of a breath is at or below the error percentage below the O
2
% setting, or less than or equal to 18%, for at least 30 seconds. Although the ventilator automatically sets the
3
O
2
% alarm, you can disable the oxygen sensor. (The error percentage is 12% below setting for the first hour of ventilator operation, 7% below setting after the first hour of operation, and an additional 5% below setting for the first 4 minutes following a increase in the setting.)
TR 13-19
Alarms
The ventilator automatically adjusts the
4
O
2
% alarm limit when O
2
% changes due to apnea ventilation, circuit disconnect, or a NO O
2
or NO AIR SUPPLY alarm. The
3
O
2
% alarm is disabled during a safety valve open (SVO) condition. The ventilator checks the
3
O
2
% alarm against the measured oxygen percentage at 1-second intervals.
The
3
O
2
% alarm can detect malfunctions in ventilator gas delivery or the oxygen monitor, and can ensure the patient is adequately oxygenated. The
3
O
2
% alarm limit is automatically adjusted during apnea ventilation, patient circuit disconnect, or low gas inlet pressures because O
2
% changes are expected under those circumstances. The ventilator declares a
3
O
2
% alarm after 30 seconds to eliminate nuisance alarms due to transient O
2
% delivery variations. You can view the
O
2
% measured by the oxygen sensor by touching the More Patient Data button on the upper GUI screen.
TR 13.16
LOW EXHALED MANDATORY TIDAL VOLUME Alarm
The low exhaled mandatory tidal volume (
3
V
TE MAND
)alarm indicates the measured exhaled mandatory tidal volume is less than or equal to the
4
V
TE MAND limit. The
3
V
TE MAND alarm is updated whenever a new measured value of exhaled mandatory tidal volume is available.
The
3
V
TE MAND alarm can detect an obstruction, a leak during volume ventilation, or a change in compliance or resistance during pressure-based ventilation (that is, when the same pressure is achieved but tidal volume decreases). There are separate alarms for mandatory and spontaneous exhaled tidal volumes for use during SIMV, SPONT, and BILEVEL. The ventilator phases in a change to the
3
V
TE MAND alarm immediately to ensure prompt notification of a low exhaled tidal volume condition.
TR 13.17
LOW EXHALED SPONTANEOUS TIDAL VOLUME Alarm
The low exhaled spontaneous tidal volume(
3
V
TE SPONT
)alarm indicates the measured exhaled spontaneous tidal volume is less than or equal to the
4
V
TE SPONT
limit. The
3
V
TE SPONT alarm is updated whenever a new measured value of exhaled spontaneous tidal volume is available.
The
3
V
TE SPONT alarm can detect a leak in the patient circuit or a change in the patient’s respiratory drive during a single breath. The
3
V
TE SPONT alarm is based on the current breath rather than on an average to detect changes as quickly as possible. There are separate alarms for mandatory and spontaneous exhaled tidal volumes for use during SIMV. The ventilator phases in a change to the
TR 13-20
LOW EXHALED TOTAL MINUTE VOLUME Alarm
4
V
TE SPONT alarm limit immediately to ensure prompt notification of a low exhaled tidal volume condition.
TR 13.18
LOW EXHALED TOTAL MINUTE VOLUME Alarm
The low exhaled total minute volume (
3V
E TOT
) alarm indicates the measured minute volume (for mandatory and spontaneous breaths) is less than or equal to the set
4V
E TOT limit. The
3V
E TOT alarm is updated whenever a new value for exhaled minute volume is calculated. You cannot turn off the
3V
E TOT alarm.
The
3V
E TOT alarm can detect a leak or obstruction in the patient circuit, a change in compliance or resistance, or a change in the patient's breathing pattern. The
3V
E TOT alarm can also detect too small tidal volumes, which could lead to hypoventilation and hypoxia (oxygen desaturation).
The ventilator phases in changes to the
4V
E TOT alarm limit immediately to ensure prompt notification of prolonged low tidal volumes.
TR 13.19
PROCEDURE ERROR Alarm
The ventilator declares a PROCEDURE ERROR alarm if the ventilator is powered up (either by turning on the power switch or following a power loss of at least 5 minutes) and detects a patient attached before ventilator startup has been completed. Until ventilator settings are confirmed, the ventilator annunciates a high-priority alarm and enters safety ventilation.
The PROCEDURE ERROR alarm is intended to require you to confirm ventilator settings whenever ventilator power is restored, in case a new patient is attached to the ventilator. Safety ventilation is an emergency mode of ventilation providing ventilation according to displayed settings until you have confirmed ventilator settings, and is not intended for long-term patient ventilation.
TR 13-21
Alarms
Page Left Intentionally Blank
TR 13-22
TR 14 Patient Data
TR 14.1
Overview
Chapter
provides supplementary information about selected patient data displayed on the Puritan Bennett™ 840 Ventilator System’s graphic user interface (GUI). For ranges, resolutions, and accuracies of all patient data displays, see
Table OP A-14.
on page
OP A-3
1
.
The ventilator displays patient data on the upper GUI screen. Under-range or over-range patient data flashes the minimum or maximum value. Alarm reset has no effect on patient data collection. Patient data based on 1-minute averaging is reset if you change a ventilator setting directly affecting that information.
TR 14.2
Delivered O
2
%
The ventilator measures the percentage of oxygen in the gas at the ventilator outlet, upstream of the inspiratory filter. Delivered O
2
% is displayed on the GUI in the More Patient Data screen.
Delivered O
2
% is used to detect
1
O
2
% and
3
O
2
% alarms.
The delivered O
2
% parameter independently checks the O
2
% setting. The delivered O
2
% measurement monitors the O
2
% at the ventilator (not the O
2
% delivered to the patient). If the oxygen mix is affected downstream of the inspiratory filter (for example, by nebulization), delivered O
2
% does not reflect that change. Delivered O
2
% is measured upstream of the inspiratory filter to avoid having to sterilize the oxygen sensor.
The measurement range is the full range of possible percentages, including cases where the oxygen percentage is actually lower than the 21% found in room air (as could be the case if gas supplies function improperly).
TR 14.3
End Expiratory Pressure
The end expiratory pressure (PEEP) is the pressure measured at the end of the expiratory phase of the just completed breath, whether mandatory or spontaneous. PEEP is updated at the beginning of the inspiratory phase. If expiratory pause is active, PEEP may reflect the lung PEEP level.
TR 14-1
Patient Data
PEEP is the last value of the low-pass filtered airway pressure during exhalation when the expiratory pause maneuver is active. Otherwise, PEEP is the last low-pass filtered value when flow has reached 0.5 L/min, or when a mandatory breath has interrupted exhalation, whichever occurs first. The accuracy of the PEEP measurement is relative to pressure measured at the exhalation side of the patient wye.
PEEP can be useful for making lung PEEP assessments using the EXP PAUSE key. The ventilator measures when expiratory flow has reached 0.5 L/min, or when exhalation has been interrupted by a mandatory breath, to avoid measuring a patient trigger.
TR 14.4
End Inspiratory Pressure
The end inspiratory pressure (P
I END
)is the pressure measured at the end of the inspiratory phase of the current breath, whether mandatory or spontaneous. P
I END
is updated at the beginning of the exhalation phase. The ventilator displays negative P
I END
values. If plateau is active, the P
I END display indicates the pressure at the end of the plateau.
P
I END
is the last value in inspiration of the low-pass filtered airway pressure. The accuracy of the P
I
END
measurement is relative to the patient wye for pressure control (PC) breaths with inspiratory times of 1 second or longer.
For volume-based breaths, P
I END
is usually the same as peak circuit pressure (P
PEAK
). For pressurebased breaths, P
I END
is more indicative of the pressures actually exerted on the lungs (P
PEAK
, on the other hand, only shows a pressure spike and is not as meaningful for pressure ventilation). The
P
I END
is the plateau pressure when a plateau follows mandatory breath delivery. Plateau pressure can be used to compute lung compliance (stiffness) and resistance to flow. Plateaus are also delivered to overcome blockages, to ventilate under-inflated lungs, and to improve gas distribution.
Plateau pressure is measured after pressure equilibrates. With a small airway in place, the pressure difference due to equilibration can be as much as 20 cmH
2
O.
The displayed range includes low pressures that can occur when the patient “out-draws” the ventilator and the high pressures in low-compliance patients. The 130 cmH
2
O maximum allows the ventilator to measure pressure overshoots of breaths truncated at the maximum high pressure limit (100 cmH
2
O).
TR 14.5
Exhaled Minute Volume
Exhaled minute volume (
V
E TOT
) is an estimate of the sum of volumes exhaled for mandatory and spontaneous breaths over the previous 1-minute interval.
V
E TOT
is BTPS- and compliance-compensated.
During the first minute of operation following power-up or a change to respiratory rate (f) or tidal volume (V
T
) settings,
V
E TOT
is updated at the beginning of each new inspiration or at 10-second
TR 14-2
Exhaled Tidal Volume intervals, whichever comes first. The ventilator uses this formula to compute based on up to eight breaths:
V
E TOT
=60 ×(total V
T
in t seconds)/t where t is the time in seconds since the computation started.
After the first minute, the ventilator computes based on up to eight mandatory and spontaneous exhaled tidal volumes occurring in the past 60 seconds, and updates the computation at the beginning of the next inspiration or the next 10-second interval, whichever comes first. However, if the next inspiration occurs within 0.5 second of the last update, the computation is not updated at that time.
The
V
E TOT
computation is based on full and partial breaths that occurred during the preceding one1-minute period. If the one1-minute period includes a partial breath, then the interval is extended to include the entire breath, and the sum of all tidal volumes over this extended interval is normalized to one1 minute.
For example, if eight full breaths and part of a ninth breath occur in the last minute,
V
E TOT
would be the sum of the nine full breaths normalized by this ratio:
60: (the number of seconds in the extended interval)
If the patient stops breathing,
V
E TOT
continues to be updated every 10 seconds, and automatically decrements.
TR 14.6
Exhaled Tidal Volume
Exhaled tidal volume (V
TE
) is the volume exhaled from the patient’s lungs for a mandatory or spontaneous breath. It is computed by integrating the net flow over the expiratory period, then compliance- and BTPS-compensating that value. The V
TE
is computed based on a five-breath average.
It is updated at the beginning of the next inspiratory phase.
V
TE
is a basic indicator of the patient's ventilatory capacity and can be an indicator of the accuracy of the tidal volume setting for mandatory breaths.
Note:
The ventilator has been validated for use with in-line, closed suction systems. When using in-line, closed suction systems with the ventilator refer to the suction system manufacturer's instructions for use. Take care to completely withdraw the suction catheter from the patient airway and turn off the suction pressure to the catheter.
Following the use of in-line, closed suction systems with the ventilator set to deliver tidal volumes at the lowest settings the displayed, measured exhaled tidal volume values may temporarily exceed the specified accuracy for volume measurement.
TR 14-3
Patient Data
TR 14.7
I:E Ratio
I:E is the ratio of inspiratory time to expiratory time of any breath (mandatory and spontaneous), whether volume- or pressure-based. I:E is updated at the beginning of every inspiratory phase and is computed breath-to-breath (the value is not filtered). The I:E ratio is a fundamental parameter indicating whether a patient's breathing pattern is normal and is displayed according to respiratory care convention.
TR 14.8
Intrinsic (auto) PEEP and Total PEEP
Intrinsic PEEP (PEEP
I
) and total PEEP (PEEP
TOT
) are determined during an operator-initiated expiratory pause, in which the PSOL valves and exhalation valves are closed. PEEP
TOT
is the pressure measured during the pause maneuver. It is an estimate of the total pressure at the end of exhalation, referenced to atmosphere. PEEP
TOT
is an estimate of the pressure above the PEEP level at the end of exhalation.
During the pause, the most recently selected graphics are displayed and frozen, so you can follow and assess when expiratory pressure stabilizes.
TR 14.9
Mean Circuit Pressure
Mean circuit pressure (P
MEAN
)is the average circuit pressure, for an entire breath cycle, including both inspiratory and expiratory phases (whether the breath is mandatory or spontaneous). The ventilator displays negative P
MEAN
values. The P
MEAN
display is updated at the beginning of each inspiration.
The ventilator computes P
MEAN
by averaging all pressure measurements made through an entire breath cycle. Accuracy is relative to pressure measured at the exhalation side of the patient wye and is based on the accuracy of the circuit pressure measurement.
TR 14.10
Peak Circuit Pressure
Peak circuit pressure (P
PEAK
)is the maximum pressure measured during the inspiratory phase of the current mandatory or spontaneous breath and is updated at the end of each inspiration. The ventilator displays negative P
PEAK
values. The ventilator displays the most positive value of the low-pass filtered airway pressure measured during the inspiratory phase.
P
PEAK
can be used to evaluate trends in lung compliance and resistance. For volume-based breaths, P
PEAK
is usually the same as end inspiratory pressure (P
I END
). For pressure-based breaths,
P
I END
is more indicative of the pressures actually exerted on the lungs (P
PEAK
, on the other hand, may only show a pressure spike and may not be meaningful for pressure ventilation).
TR 14-4
Plateau Pressure
The minimum displayed range includes low pressures found when the patient “out-draws” the ventilator. The maximum displayed value allows the ventilator to display the high pressures in low-compliance patients and pressure overshoots of breaths truncated at the maximum high pressure limit (100 cmH
2
O).
TR 14.11
Plateau Pressure
Plateau pressure (P
PL
)is the pressure measured in the ventilator breathing circuit at the end of an inspiratory pause maneuver. Because the pause maneuver is conducted with the ventilator breathing circuit sealed (PSOL valves and exhalation valve closed and assuming a leak-tight system), P
PL
is the best estimate of the pressure in the patient’s lungs.
Beginning with the start of the pause maneuver, P
PL
is displayed and updated continuously. At the end of the maneuver P
PL
, along with the other pause data, are “frozen,” enabling you to view all of the data together. Touching “UNFREEZE” causes the data to be discarded.
TR 14.12
Spontaneous Minute Volume
Spontaneous minute volume (
V
E SPONT
) is the sum of spontaneous exhaled volumes, normalized to 1 minute. The displayed
V
E SPONT
is compliance- and BTPS-compensated. As more mandatory breaths are delivered, the displayed
V
E SPONT
is computed and updated whenever
V
E TOT
is computed and updated. The computation for
V
E SPONT
is the same as for
V
E TOT
, except only spontaneous breaths are included, and the 1-minute interval is not extended unless the partial breath is a spontaneous breath. (See exhaled minute volume for details.)
V
E SPONT
can help determine how much ventilation takes place solely due to spontaneous breathing, and does not include patient-initiated mandatory breaths. Minute volume establishes a patient's ventilatory adequacy, and
V
E SPONT
indicates how much of total ventilation is due to the patient's efforts.
V
E SPONT
can be used to assess whether a patient being ventilated in SIMV is ready to be weaned.
TR 14.13
Static Compliance and Resistance
C (or C
STAT
, static compliance) is an estimate of the elasticity of the patient’s lungs; it is expressed in mL/cmH
2
O. R (or R
STAT
, static resistance) is the total inspiratory resistance across the artificial airway and respiratory system. It is an estimate of how restrictive the patient’s airway is, based on the pressure drop at a given flow; it is expressed in cmH
2
O/L/second. These values are computed during an operator-initiated inspiratory pause, in which the PSOL valves and exhalation valve are closed. C
STAT
is computed during a mandatory breath. R
STAT
is computed during a VC mandatory breath with a square waveform.
TR 14-5
Patient Data
C
STAT
is computed from this equation:
C
STAT
=
P
PL END
EXH
–
PEEP
C
where:
V
EXH
is the total expiratory volume (patient and breathing circuit)
P
PL END
is the pressure in the patient circuit measured at the end of the 100-ms interval that defines the pause-mechanics plateau
PEEP is the pressure in the patient circuit measured at the end of exhalation
C
C
is the compliance of the ventilator breathing system (VBS) during the pause maneuver
(derived from SST)
R
STAT
is computed from this equation once C
STAT
is computed (assuming the breath type was VC with square flow waveform):
R
STAT
=
1 +
C
STAT
PEAK
V·
PAT
–
P
PL MID
where:
C
C
is as given.
C
STAT
is as given.
P
PL MID
is the mean pressure in the patient circuit over the 100-ms interval that defines the pausemechanics plateau.
P
PEAK
is the pressure in the patient circuit at the end of the square flow waveform.
V
PAT
is the flow into the patient during the last 100 ms of the waveform.
TR 14-6
Static Compliance and Resistance
•
•
During the pause, the most recently selected graphics are displayed and frozen, so you can see when inspiratory pressure stabilizes. C
STAT
and R
STAT
are displayed at the start of the next inspiration following the inspiratory pause. They take this format:
C
STAT
xxx or
R
STAT
yyy
•
If the software determines variables in the equations or the resulting C
STAT
or R
STAT
values are out of bounds, it identifies the questionable C
STAT
and R
STAT
values with special formatting and text messages:
Parentheses ( ) signify questionable C
STAT or R
STAT values, derived from questionable variables.
Flashing C
STAT
or
R
STAT values are out of bounds.
Asterisks (******) mean variables fall below noise-level bounds.
•
R
STAT
------ means resistance could not be computed, because the breath was not of a mandatory, VC type with square flow waveform.
See
Compliance (C
STAT
)
C
STAT
(******)
C
STAT
(xxx)
No plateau
Table TR 14-1. Inspiratory Pause Maneuver Displays
Meaning
Resistance (R
STAT
)
if displayed
R
STAT
(******)
R
STAT
(yyy)
No plateau
Corrective action
C
STAT
<0.1 mL/cmH
2
O or patient flow <0.1 L/min.
The low patient flow is below the threshold of reliable measurement.
Both C
STAT
and R
STAT
are questionable.
Plateau is not “flat” (lung and circuit pressures did not equilibrate) or pause pressure was excessively noisy. Both C
STAT
and
R
STAT are questionable.
Check the breathing waveforms and monitored patient data for underlying cause.
If plateau continues to decline, check for a leak in the breathing circuit, possibly around the cuff.
If plateau is unstable, check circuit for moisture condensation or movement.
TR 14-7
Patient Data
Compliance (C
C
STAT
(xxx)
Out of range
STAT
)
C
STAT
(xxx)
Questionable measurement
C
STAT
(xxx)
Questionable measurement
C
STAT
(xxx)
Subthreshold input values
Table TR 14-1. Inspiratory Pause Maneuver Displays
Meaning
Resistance (R
STAT
)
if displayed
R
STAT
(yyy)
Questionable measurement
R
STAT
(yyy)
Out of range
R
STAT
(yyy)
Questionable measurement
R
STAT
(yyy)
Questionable measurement
Corrective action
C
STAT
<1.0 mL/cmH
2
O.
This results from questionable input data. The value for R
STAT
is also questionable.
Check the breathing waveforms and monitored patient data for underlying cause.
C
STAT
>100 mL/cmH
2
O.
This results from questionable input data. The value for R
STAT
is also questionable.
Check the breathing waveforms and monitored patient data for underlying cause.
R
STAT
>150 cmH
2
O/L/s.
This results from questionable input data, possibly C
STAT
.
The pressure rose slowly at the end of the square flow waveform. This suggests the pressures, volumes, and flows involved are minimal and questionable. This is not expected during normal ventilation.
The difference between the circuit pressure at the end of the plateau and the pressure at the end of exhalation <0.5 cmH
2
O. The value for
R
STAT
is questionable.
Check the breathing waveforms and monitored patient data for underlying cause.
Check the pressure-time waveform to see whether the patient delayed inspiration until the end of gas delivery.
Check for a highly compliant lung, inflated slightly. If safe to do so, increase tidal volume.
TR 14-8
Total Respiratory Rate
Compliance (C
STAT
)
N/A
N/A (cont)
Table TR 14-1. Inspiratory Pause Maneuver Displays
Meaning
Resistance (R
STAT
)
if displayed
R
STAT
(yyy)
Out of range
R
STAT
(yyy)
Questionable measurement
R
STAT
(yyy)
Subthreshold input values
Corrective action
R
STAT
<0.5 cmH
2
O/L/s.
This results because the patient flow or the pressure difference from peak to plateau is questionable.
The pressure rose too quickly at the end of the square flow waveform.
This suggests poor patient-ventilator synchrony and the lung was very stiff or the flow very high. The value for R
STAT is questionable.
The difference between the circuit pressure at the end of the square flow waveform and at the end of the plateau
<0.5 cmH
2 for R
STAT
O. The value
is questionable.
Patient flow <20 L/min and C
STAT
<4 mL/ cmH
2
O. The value for
R
STAT
is questionable.
Check the breathing waveforms and monitored patient data for underlying causes.
If the patient’s condition permits, consider reducing the set tidal volume and/or increasing the inspiratory time (equivalent to reducing the peak flow).
Check the pressure-time waveform to see whether the patient may have triggered the mandatory breath, then relaxed toward the end of inspiration.
Check for: low patient flow through a relatively large diameter artificial airway, low absolute flow and a relatively long inspiratory time, or a small patient connected to a breathing circuit with a relatively large compliance.
Check for: low patient flow through a relatively large diameter artificial airway, low absolute flow and a relatively long inspiratory time, or a small patient connected to a breathing circuit with a relatively large compliance.
TR 14.14
Total Respiratory Rate
Total respiratory rate (f
TOT
) is the number of breaths delivered to a patient normalized to 1 minute, whether mandatory or spontaneous, and is updated at the beginning of each inspiratory phase.
TR 14-9
Patient Data
During the first minute of operation after a power-up or after a change to any setting affecting the rate of mandatory breath delivery, the system updates f
TOT
at the beginning of each inspiration.
The ventilator uses this formula to compute based on up to eight breaths (or 16 breaths when spontaneous type is PA):
Startup f
TOT
=[60× (total number of inspirations in t)]/t where t is the time in seconds since the computation started.
After the first minute, the ventilator computes based on up to eight breaths initiated during the last minute and updates the computation at the beginning of the next inspiration or the next 10second interval, whichever comes first. However, if the next inspiration occurs within 0.5 second of the last update, the computation is not updated at that time.
Except for the start-up calculation and the 10-second interval, f
TOT
is calculated based on a whole number of breaths. Therefore, the 60-second interval is extended to include the next breath initiation. The ventilator uses this formula to calculate f
TOT
:
Post-startup f
TOT
=(total whole number of breaths in 60 s +x)/(60 s + x) where x is the number of seconds the 60-second interval was extended to include the next inspiration.
f
TOT
is one of the most sensitive parameters of respiratory function and is an important indicator of ventilatory adequacy. The displayed range can apply where no breaths are delivered to the patient within the last minute, or when the patient is receiving the maximum respiratory rate possible.
TR 14-10
TR 15 Safety Net
TR 15.1
Overview
•
The ventilator’s safety net strategy refers to how the Puritan Bennett™ 840 Ventilator System responds to patient problems and system faults.
Patient problems are declared when patient data isare measured equal to or outside of alarm thresholds and are usually self-correcting or can be corrected by a practitioner. The alarm monitoring system detects and announces patient problems. Patient problems do not compromise the ventilator's performance.
•
System faults include hardware faults (those that originate inside the ventilator and affect its performance), soft faults (faults momentarily introduced into the ventilator that interfere with normal operation), inadequate supply (AC power or external gas pressure), and patient circuit integrity
(blocked or disconnected circuit). System faults are not usually self-correcting and are handled under the assumption they can affect the ventilator's performance. “System” refers to the ventilator, external gas and power supplies, and the machine-patient interconnections.
The ventilator is designed to alarm and provide the highest level of ventilation support possible in case of ventilator malfunction. If the ventilator is not capable of ventilatory support, it opens the patient circuit and allows the patient to breathe from room air (this emergency state is called safety valve open, SVO). Safety mechanisms are designed to be verified periodically or have redundancy. The ventilator is designed to ensure a single-point failure does not cause a safety hazard or affect the ventilator’s ability to annunciate a high-priority audible alarm.
TR 15.2
Patient Problems
In case of patient problems, the ventilator remains fully operative and annunciates the appropriate alarm. The patient problem determines the detection, response, and priority of each alarm.
TR 15.3
System Faults
The ventilator is designed to prevent system faults. The ventilator is modular, and it allows the
BDU to operate independently of the graphic user interface (GUI) or other subsystems not related to breath delivery. If the ventilator detects a system fault and ventilation can continue, it alarms and provides ventilatory support as close to the current settings as pos-
TR 15-1
Safety Net
•
• sible, depending on the specific system fault. Most system faults are DEVICE ALERT alarms, and can be high-, medium-, or low-priority alarms.
•
The ventilator uses these strategies to detect system faults:
Ongoing background checks and hardware monitoring circuitry function during normal operation.
Power on self test (POST) checks the system at power-up.
Short self test (SST) and extended self test (EST) check the ventilator when a patient is not attached to the ventilator.
•
•
If the ventilator cannot provide reliable ventilatory support and fault monitoring, then the ventilator alarms and enters the SVO emergency state. During SVO, the ventilator de-energizes the safety, exhalation, and inspiratory valves, annunciates a high-priority alarm, and turns on the SVO indicator.
•
During SVO, a patient can spontaneously inspire room air and exhale. Check valves on the inspiratory and expiratory sides minimize rebreathing exhaled gas during SVO. During SVO the ventilator:
Displays the elapsed time without ventilatory support.
Does not display patient data (including waveforms).
Does not detect patient circuit occlusion or disconnect conditions.
TR 15.4
Ongoing Background Checks
•
•
•
Ongoing background checks assess the ventilator’s electronics and pneumatics hardware continuously during ventilation, and include the listed checks:
Periodically initiated tests: Tests initiated at intervals of a specified number of machine cycles. These tests check the hardware components directly affecting the breath delivery system, safety mechanisms, and user interface. These tests detect and correct data corruption of control variables.
Boundary checks: Checks performed at every analog measurement. Boundary checks verify measuring circuitry, including sensors.
CPU cross-checks: The ventilator’s GUI central processing unit (CPU) monitors the BDU CPU’s activity.
Cross-checks provide independent verification that each processor is functional. They focus on circuit pressure, breath periodicity, length of inspiration, alarm annunciation, oxygen percentage, and ventilator settings. Communications errors between CPUs are detected and corrected.
•
•
Specific background checks include the listed checks:
Memory tests: RAM (parity-check only), ROM, and nonvolatile memory (NOVRAM) are tested (without corrupting data stored in memory) on an ongoing basis.
Analog-to-digital converter (ADC) reasonability checks: Flow sensors, thermistors, and pressure sensors are checked against predetermined ranges to ensure proper functioning of the system's analog measuring capability and transducers.
TR 15-2
Hardware Monitoring Circuitry
•
•
•
•
•
•
•
•
Voltage calibration check: The ventilator reads the system reference voltage through the ADCs, then uses this reference voltage to scale all analog measurements.
Digital-to-analog converter (DAC) and ADC circuitry checks: Signals from both the expiratory and inspiratory DAC are fed back to the microprocessor through the ADC, and the original DAC input value is compared to the converted ADC signal.
Power supply voltage checks: The ventilator periodically checks system voltages (+12, +15, –15, and
+5 V DC), battery voltage, and the cable and voltage of the speaker.
Pressure transducers: The ventilator periodically checks to ensure transducer drift doesn't exceed system accuracy limits.
Touch screen checks: The ventilator checks for failures in the touch screen system, including optical obstruction of one or more LED/photodiode pairs.
Offscreen keys: The ventilator checks for key stuck.
SmartAlert audio annunciation system (SAAS): The ventilator verifies the SAAS can annunciate alarms properly.
Options: The ventilator periodically checks for the existence of any options, its pass/fail status, and whether or not the option is active. The results of whatever checks an option performs on itself are reported to the BDU and GUI CPUs.
If any of these background tests detects a fault, the ventilator alarms and provides the most appropriate level of ventilatory support consistent with the detected system fault.
TR 15.5
Hardware Monitoring Circuitry
•
•
•
The ventilator has hardware circuitry dedicated to monitoring software activity and power failure problems. The ventilator also has monitoring circuitry built into the CPU.
Watchdog (WD) time-out circuitry: WD time-out circuitry monitors software activity and indicates if software is executed irregularly. WD circuitry is independent of the CPUs and software. In case of irregular software execution, WD circuitry invokes POST. If POST does not confirm an error, the ventilator returns to normal operation to minimize the interruption to normal breath delivery. If three WD timeouts occur within 24 hours, the ventilator alarms and declares a ventilator inoperative state.
Bus time-out monitoring circuitry: Bus time-out circuitry is independent of the CPU and monitors whether any bus activity has taken place for a predetermined time. If no bus activity is detected, bus time-out circuitry invokes POST. If POST does not confirm an error, the ventilator returns to normal operation to minimize the interruption to normal breath delivery. If three bus time-outs occur within
24 hours, the ventilator alarms and declares a ventilator inoperative state.
Built-in CPU monitoring circuitry: Mechanisms are built into the CPU to detect out-of-boundary operation and detect system faults. If the CPU circuitry detects a problem, the ventilator alarms, the CPU resets, and the ventilator provides the highest level of ventilatory assistance possible.
TR 15-3
Safety Net
•
Power fail monitoring: The power fail module monitors the DC power supply. When the power switch is ON and +5 V is out of range ±0.25 V, the ventilator locks access to RAM, enters SVO, closes the proportional solenoid valves (PSOLs), and turns on the ventilator inoperative indicator and audio alarm.
Ventilator alarms monitor AC power.
TR 15.6
Power On Self Test (POST)
POST checks the integrity of the ventilator’s electronic hardware whenever it is powered up. POST detects system faults without operator intervention.
TR 15.7
Short Self Test (SST)
SST is designed to be performed when the patient circuit or humidification system is changed.
SST primarily tests the patient circuit for leaks, calibrates the patient circuit, and measures the resistance of the expiratory filter. SST requires minimal operator participation and no external test equipment.
TR 15.8
Extended Self Test (EST)
EST performs a more thorough system test than POST or SST, and is also intended to detect system faults. EST requires operator participation, but no external test equipment other than the
“gold standard” circuit (the test circuit designed for use with EST). EST can also serve as a confidence check following repair or a temporary problem.
TR 15.9
Oxygen Sensor Calibration
The ventilator performs a single-point oxygen sensor calibration during the 100% suctioning procedure (that is, when you press the 100% O
2
/CAL 2 min key or INCREASE O
2
2 min key), allowing you to calibrate the oxygen sensor frequently without having to disconnect the patient. If the oxygen sensor calibration fails, the ventilator declares an O
2
SENSOR alarm that resets when the ventilator successfully calibrates the oxygen sensor. The ventilator’s oxygen sensor is always active unless you disable it. The 100% O
2
calibration function can be initiated from the INCREASE
O
2
2 min key if the O
2
setting is 80% or above if you are using the NeoMode software option, or from the More Settings screen, at any oxygen concentration.
To perform an oxygen sensor calibration from the More Settings screen
1.
Touch the OTHER SCREENS button on the lower GUI, then touch the MORE SETTINGS button.
2.
Touch the O
2
sensor button and turn the knob to select Calibration, and press ACCEPT. The progress indicator appears on the screen. The O
2
sensor setting will remain at the setting that existed before calibration (Disabled or Enabled).
TR 15-4
Exhalation Valve Calibration
During oxygen sensor calibration, the INCREASE O
2
2 min LED is turned OFF.
TR 15.10
Exhalation Valve Calibration
The exhalation valve calibration, available in service mode, builds a table of digital-to-analog
(DAC) commands corresponding to expiratory pressure levels.
TR 15.11
Ventilator Inoperative Test
The ventilator inoperative test, available in service mode, verifies the ventilator is capable of establishing the ventilator inoperative state. This test verifies the two redundant ventilator inoperative commands separately and ensures each command establishes a ventilator inoperative state.
TR 15.12
Flow Sensor Offset Calibration
This function, available in service mode, calibrates the offsets out of the exhalation flow sensor
(relative to the air and oxygen flow sensors).
TR 15.13
Atmospheric Pressure Transducer Calibration
This function, available in service mode, calibrates the atmospheric pressure transducer using an external barometer.
TR 15-5
Safety Net
Page Left Intentionally Blank
TR 15-6
TR 16 Power on Self Test (POST)
TR 16.1
Overview
POST tests the integrity of the Puritan Bennett™ 840 Ventilator System’s electronic subsystem without operator intervention. It executes when the ventilator powers up, before it enters service mode, or if the ventilator detects selected fault conditions. A full length POST takes under 10 seconds (from power on until ventilator startup begins).
The GUI and the BDU subsystems each have their own POST that tests the major hardware electronics systems. POST does not check the ventilator’s pneumatics, options, or accessories not directly related to ventilation. POST is designed to detect major problems before proceeding to normal ventilation, and to provide a confidence check before a patient is connected to the ventilator.
POST routines are ordered so each routine requires successively more operational hardware than the last. This sequence allows POST to systematically exclude electronic components as causes of system malfunctions.
TR 16.2
Safety
The ventilator does not provide ventilatory support to the patient during POST. The ventilator alarms if POST lasts longer than 10 seconds or if an unexpected fault is detected. POST is designed to minimize the delay until normal ventilation begins and to provide immediate notification in case a fault is detected. The ventilator runs a short version of POST after recovering from a brief power loss.
When a compressor is installed and wall air is not present, there may be a short interval following a successful POST before the compressor achieves operational pressures. If so, the ventilator annunciates a NO AIR SUPPLY alarm, which resets as soon as the compressor charges the system to operational pressure.
TR 16.3
POST Characteristics
Each processor in the ventilator runs its own POST. Upon completion, each processor reports its test results to the GUI processor. POST starts with the software kernel, then tests the hardware that directly interfaces to the kernel. POST then tests the rest of the hardware. Hardware linked
TR 16-1
Power on Self Test (POST)
•
•
•
•
• to each processor through a communication channel is checked once the communication link is verified.
•
The main characteristics of POST are:
The kernel of every subsystem is designed to include the smallest number of components possible, and each kernel can run independently of the rest of the system.
POST verifies system integrity by checking that all main electrical connectors are correctly attached and that interfaces to all electronic subsystems (such as the keyboard or audible alarm) are functional.
POST performs all electrical hardware checks that do not require operator intervention.
POST checks safety hardware, such as the watchdog circuitry and bus time-out monitoring circuitry.
POST’s memory test preserves all data necessary to determine ventilator settings and initializes the remaining memory to a predefined state.
POST can determine what event initiated POST.
Any other processors in the system initiates its own POST and reports the test results to the host processor.
•
•
•
•
•
To ensure there is an alarm if the central processing unit (CPU) fails, audio, visual, and remote alarms are normally on, and turn off once system initialization (that is, the process that occurs between POST completion and the start of ventilation) is completed and communication is established.
An alarm turns on if POST lasts more than 10 seconds or if POST restarts three times without completion. The 10-second timer is a redundant check in case POST fails to alarm upon detecting a fault. The check for three restarts can detect a continuous loop, and prevents breath delivery from being interrupted for more than 10 seconds.
During POST, the ventilator proportional solenoid valves (PSOLs) are closed and the exhalation valve and safety valve are open to allow the patient to breathe room air.
•
Once POST is complete, ventilator startup (following power-up or a power interruption of longer than 5 minutes) or normal ventilation begins, unless service mode is requested or the ventilator detects any of the following:
An uncorrected major system fault.
An uncorrected major POST fault.
An uncorrected short self test (SST) failure or non-overridden SST alert.
An uncorrected extended self test (EST) failure or non-overridden EST alert.
The ventilator is turned on for the first time following a software download, but has not yet successfully completed one of the following: exhalation valve calibration, SST, or EST.
An uncompleted system initialization.
TR 16-2
POST Following Power Interruptions
TR 16.4
POST Following Power Interruptions
The ventilator executes a normal POST following a long power interruption (5 minutes or more) while the power switch is on. The ventilator runs a full POST after a long power interruption under the assumption the patient would have been disconnected and ventilated by other means, and because circumstances that cause a lengthy power loss warrant a full POST.
The ventilator runs a short POST (which tests the BDU only) if power is interrupted for less than 5 minutes. After a short power interruption (during which the status of the patient cannot be assumed), the ventilator resumes normal ventilation as soon as possible, in case the patient remains connected. Running a short POST (3 seconds or less from return of AC power to beginning breath delivery) allows for short power interruptions due to common events (for example, switching to generator power) that do not require a normal POST, and assumes a patient may still be connected to the ventilator. Short POST checks the software kernel, verifies checksums for code, and determines what event invoked POST.
TR 16.5
POST Fault Handling
How the ventilator handles a POST failure depends on which test has failed and whether the failure occurred during the kernel test. Fault information is logged in nonvolatile random access memory (NOVRAM) and is time-stamped. POST failures are classified as minor or major faults:
Minor POST fault: A fault not affecting ventilation or patient safety checks. Normal ventilation is allowed to begin if POST detects a minor fault. A minor fault does not interrupt the regular POST sequence. The ventilator displays POST fault information and logs it into NOVRAM.
Major POST fault: A fault affecting ventilation or patient safety checks. A major fault interrupts the regular sequence of POST. Fault information is sent to the GUI (if possible) and to a set of discrete visual indicators on the GUI and BDU. The ventilator logs major fault information into NOVRAM, if possible, and sends a command to turn on audio, visual, and remote alarms. The safety valve and exhalation valve remain open to allow the patient to breathe room air. The ventilator cannot execute GUI and BDU software until it passes POST.
TR 16.6
POST System Interface
POST is the first process to run when the ventilator turns on. Breath delivery cannot start until the ventilator completes POST with no major POST faults, and until no major system, SST, or EST faults exist. Once POST starts, the ventilator opens the safety valve and exhalation valve to the atmosphere (the default state of the ventilator at power-up or reset), and both remain open until ventilation begins. Minor faults are recorded in NOVRAM without interrupting POST.
Unless prevented by a POST, the transition to service mode can occur upon operator request.
During service mode, the operator can select EST or system level tests. POST software can be updated without affecting the operational software (GUI and BDU).
TR 16-3
Power on Self Test (POST)
WARNING:
Do not enter Service Mode with a patient attached to the ventilator. Serious injury could result.
TR 16.7
POST User Interface
•
•
•
•
POST includes these visual indicators:
An indicator the ventilator is not delivering breaths.
Discrete visual indicators on the BD CPU PCB that indicate the current test and step number.
Illuminated VENT INOP indicator on the BDU to signal the user can press TEST to enter service mode.
If possible, a display of fault information in case POST detects a failure.
If POST detects a major fault, qualified service personnel must run EST and correct the problem.
TR 16-4
TR 17 Short Self Test (SST)
TR 17.1
Overview
SST is a short (about 2 to 3 minutes) and simple sequence of tests that verifies proper operation of breath delivery hardware (including pressure and flow sensors), checks the patient circuit
(including tubing, humidification device, and filters) for leaks, and measures the circuit compliance and resistance. SST also checks the resistance of the exhalation filter. Covidien recommends you run SST every 15 days, between patients, and when you change the patient circuit or its configuration (including changing the humidifier type, adding or removing an in-line water trap, or using a different type or style of patient circuit). Chapter
OP 3
tells you how to run
SST. The Puritan Bennett™ 840 Ventilator System does not begin SST if it senses a patient is connected.
SST prompts you to verify that no patient is attached and asks you to select the patient circuit and humidifier types. SST prompts you to block the wye, then verifies it is blocked. SST then tests the accuracy of the inspiratory and expiratory flow sensors, verifies proper function of pressure sensors, tests the patient circuit for leaks, calculates the compliance compensation for the patient circuit, measures the pressure drop across the expiratory filter, measures the resistance of the inspiratory and expiratory limbs of the patient circuit, then checks the pressure drop across the inspiratory limb.
TR 17.2
SST Results
•
•
•
•
Possible SST outcomes are:
Passed: All tests passed (no faults detected).
ALERT: A fault was detected. If it can be determined with certainty this cannot create a hazard for the patient, or add to the risk which may arise from other hazards, the user can choose to override the
ALERT status and authorize ventilation.
OVERRIDDEN: An ALERT status was overridden, and ventilation is authorized.
FAILURE: One or more critical problems were detected. You cannot skip a test whose result is FAIL-
URE. The ventilator does not allow ventilation until SST runs without failing any tests.
•
If SST is interrupted and ventilation was allowed before you started SST, normal ventilation is allowed if all of the listed items are true:
SST did not detect any failures or alerts before the interruption
TR 17-1
Short Self Test (SST)
•
•
No other errors that would prevent ventilation occurred
You did not change the circuit type at the start of the interrupted SST. (If you did change the patient circuit type, you must successfully complete SST before normal ventilation can begin.)
During SST, the ventilator displays the current SST status, including the test currently in progress, results of completed tests, and measured data (where applicable). The ventilator logs SST results, and that information is available following a power failure. These keys are disabled during SST:
ALARM SILENCE, ALARM RESET, MANUAL INSP, 100% O
2
/CAL 2 min or INCREASE O
2
2 min, and
EXP PAUSE The INFO key is functional during SST.
TR 17.3
SST Failure Handling
As stated previously, a failed SST test does not allow ventilation to begin, and SST must be repeated without failure in order to ventilate a patient.
See Chapter
OP 3
for instructions on running SST with appropriate patient circuits and accessories.
TR 17-2
TR 18 Extended Self Test (EST)
TR 18.1
Overview
EST verifies the integrity of the Puritan Bennett™ 840 Ventilator System’s subsystems using operator participation. EST requires a “gold standard” test circuit. All test resources, including the software code to run EST, are in the ventilator. EST testing, excluding tests of optional equipment (such as the compressor), takes about 15 minutes. A single test feature allows individual
EST tests to be run in any order, but the full suite of EST tests must have successfully passed before the ventilator can be used on a patient.
TR 18.2
EST Functions
•
•
•
EST checks the pneumatics system (including the compressor), memory, safety system, front panel controls and indicators, digital and analog electronics, power supplies, analog out system, transducers, and options.
EST can run only when the ventilator is in service mode. Air and oxygen supplies are required
(the compressor can supply the air source). EST is a comprehensive ventilator test designed to be run by qualified service personnel for periodic and corrective maintenance.
•
The main characteristics of EST are listed:
EST fully tests the ventilator's electrical system, including non-major electronic functions (for example, battery power) and electronics subsystems that require operator intervention (for example, display/keyboard verification, and calibration).
EST checks the pneumatics subsystem, including gas supplies, proportional solenoid (PSOL) valves, flow sensors, circuit pressure accuracy, safety valve, and exhalation valve.
EST tests available options, including the compressor.
Ventilator safe state tests (both GUI and BDU can force the ventilator into a ventilator inoperative state).
TR 18.3
EST Results
The ventilator displays the current test name, automatically runs tests that do not require operator action, prompts the operator to run tests that do require operator action, and displays test
TR 18-1
Extended Self Test (EST)
•
•
•
•
• results. Once a test begins, it runs to completion. If an EST failure or alert occurs, the test name and results are displayed, and you can choose to rerun the test (for a FAILURE or an ALERT), skip to the next test (for an ALERT only), or quit EST.
•
At the end of EST, one of these overall results is displayed:
Passed: All tests passed; normal ventilation can begin.
ALERT: A fault was detected. If it can be determined with certainty this cannot create a hazard for the patient, or add to the risk which may arise from other hazards, the technician can choose to override the ALERT status and authorize ventilation.
OVERRIDDEN: An ALERT status was overridden, and ventilation is authorized.
FAILURE: One or more critical problems were detected. The ventilator does not allow normal ventilation until EST runs without failing any tests.
NEVER RUN: After new ventilator software has been downloaded or a single test EST was run, this message appears in the ventilator test summary.
OUTCOME: All EST tests required. After any single test EST test is run, in order to ventilate a patient, service personnel must perform and successfully pass the full suite of EST tests. This message appears in the Diagnostic Code Log.
The technician must switch the ventilator to service mode, then choose to invoke EST. If the ventilator is powered down in EST after detecting one or more EST failures or alerts, the technician must run EST without a failure or non-overridden alert before the ventilator can begin normal ventilation.
If EST is interrupted and ventilation was allowed before you started EST, normal ventilation is allowed if EST did not detect any failures or alerts before the interruption, and no other errors occurred that would prevent ventilation.
EST is required if there is a major POST failure, a major system failure, or an EST failure or non-overridden alert. (Any minor or major POST fault that occurs outside of the kernel test is logged and time-stamped in nonvolatile memory.) When EST is required, including when a successful Single
EST test is performed, normal ventilation is not allowed. EST is required until EST is completed without failures or non-overridden alerts.
TR 18.4
EST Failure Handling
Ventilator response to EST failures or alerts depends on the type of test. If a failed test (failure or alert) is immediately repeated, the new results replace the previous results in memory. An EST failure or alert interrupts the regular sequence of EST tests.
TR 18-2
EST Safety Considerations
TR 18.5
EST Safety Considerations
To run EST, the technician must switch the ventilator to service mode, then request EST. (The technician can also use service mode to run field tests or upgrade software in the field.) The ventilator cannot provide ventilatory support during service mode, and is designed to prevent a software fault from causing an unrequested transition to service mode. You can enter service mode only upon power up, and a hardware interlock is required before the ventilator can switch to service mode.
See the Puritan Bennett™ 840 Ventilator System Service Manual for instructions and equipment needed to run EST.
Caution:
If you accidentally enter Service mode, exit Service mode by touching the EXIT button on the lower
GUI screen and then pressing the ACCEPT key. Do not attempt to run EST with a patient circuit.
Doing so will cause EST to fail. If EST fails, the ventilator will remain in a vent inop state until EST successfully passes.
TR 18-3
Extended Self Test (EST)
Page Left Intentionally Blank
TR 18-4
TR 19 RS-232 Commands
TR 19.1
Overview
•
•
The Puritan Bennett™ 840 Ventilator System offers commands that allow communication to and from the ventilator using the RS-232 port:
RSET
SNDA
•
SNDF
Note:
The ventilator responds only if it receives a carriage return <CR>.
TR 19.2
SNDA Command
The SNDA command instructs the ventilator to send information on ventilator settings and monitored data to the host system. Enter the SNDA command exactly as shown:
SNDA<CR>
When the ventilator receives the command
SNDA<CR>, it responds with the code MISCA, followed by ventilator settings and monitored data information.
TR 19-1
RS-232 Commands
The MISCA response follows this format:
MISCA
1
706 97
2 3
<STX>
4
FIELD 5, … FIELD 101,
5
<ETX>
6
<CR>
7
1 Response code to SNDA command 5 Data field, left-justified and padded with spaces
End of transmission (03 hex) 2
3
Number of bytes between <STX> and
<CR>
Number of data fields between <STX> and <ETX>
Start of transmission (02 hex)
6
7 Terminating carriage return
4
The MISCA response (including data fields) is as given in
Ventilator System follows the same format as the Puritan Bennett 7200 Series Ventilator. Fields not available in the Puritan Bennett™ 840 Ventilator System are marked as “Not used.” Underscores represent one or more spaces that pad each character string.
Field 7
Field 8
Field 9
Field 10
Field 11
Field 12
Field 13
Field 14
Field 15
Component
MISCA
706
97
<STX>
Field 5
Field 6
Table TR 19-1. MISCA Response
Description
Response to SNDA command (5 characters)
The number of bytes between <STX> and <CR> (3 characters)
The number of fields between <STX> and <ETX> (2 characters)
Start of transmission character (02 hex)
Ventilator time (HH:MM_) (6 characters)
Ventilator ID to allow external hosts to uniquely identify each Puritan Bennett™ 840 Ventilator System (18 characters)
Not used (6 characters)
Date (MMM_DD_YYYY_) (12 characters)
Mode (CMV___, SIMV__, CPAP__ or BILEVL) (CMV = A/C) setting (6 characters)
Respiratory rate setting in breaths per minute (6 characters)
Tidal volume setting in liters (6 characters)
Peak flow setting in liters per minute (6 characters)
O
2
% setting (6 characters)
Pressure sensitivity setting in cmH
2
O (6 characters)
PEEP or PEEP Low (in BILEVEL) setting in cmH
2
O (6 characters)
TR 19-2
SNDA Command
Field 42
Field 43–44
Field 45
Field 46
Field 47
Field 48
Field 49–50
Field 51
Field 31–33
Field 34
Field 35
Field 36
Field 37
Field 38
Field 39
Field 40
Field 41
Component
Field 16
Field 17–20
Field 21
Field 22
Field 23
Field 24
Field 25
Field 26
Field 27
Field 28–29
Field 30
Field 52
Field 53
Table TR 19-1. MISCA Response (Continued)
Plateau time in seconds (6 characters)
Description
Not used (6 characters)
Apnea interval in seconds (6 characters)
Apnea tidal volume setting in liters (6 characters)
Apnea respiratory rate setting in breaths per minute (6 characters)
Apnea peak flow setting in liters per minute (6 characters)
Apnea O
2
% setting (6 characters)
Pressure support setting in cmH
2
O (6 characters)
Flow pattern setting (SQUARE or RAMP__) (6 characters)
Not used (6 characters)
100% O
2
state (ON____ or OFF___) (6 characters)
Not used (6 characters)
Total respiratory rate in breaths per minute (6 characters)
Exhaled tidal volume in liters (6 characters)
Exhaled minute volume in liters (6 characters)
Spontaneous minute volume in liters (6 characters)
Maximum circuit pressure in cmH
2
O (6 characters)
Mean airway pressure in cmH
2
O (6 characters)
End inspiratory pressure in cmH
2
O (6 characters)
Expiratory component of monitored value of I:E ratio, assuming inspiratory component of 1 (6 characters)
High circuit pressure limit in cmH
2
O (6 characters)
Not used (6 characters)
Low exhaled tidal volume limit in liters (6 characters)
Low exhaled minute volume limit in liters (6 characters)
High respiratory rate limit in breaths per minute (6 characters)
High circuit pressure alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
Not used (6 characters)
Low exhaled tidal volume (mandatory or spontaneous) alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
Low exhaled minute volume alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
High respiratory rate alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
TR 19-3
RS-232 Commands
Table TR 19-1. MISCA Response (Continued)
Component
Field 54
Field 55
Field 56
Field 57
Field 58–59
Field 60
Field 61
Field 62
Field 63
Description
No O
2
supply alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
No air supply alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
Not used (6 characters)
Apnea alarm status (NORMAL, ALARM_, or RESET_) (6 characters)
Not used (6 characters)
Ventilator time (HH:MM_) (6 characters)
Field 64
Field 65
Field 66
Field 67
Field 68
Field 69
Field 70
Field 71
Not used (6 characters)
Date (MMM_DD_YYYY_) (12 characters)
Static compliance (C
STAT
) from inspiratory pause maneuver in mL/cmH
2
O (6 characters)
Static resistance (R
STAT
) from inspiratory pause maneuver in cmH
2
O/L/s (6 characters)
Dynamic compliance (C
DYN
) in mL/cmH
2
O* (6 characters)
Dynamic resistance (R
DYN
) in cmH
2
O/L/s* (6 characters)
Negative inspiratory force (NIF) in cmH
2
O* (6 characters)
Vital capacity (VC) in L* (6 characters)
Peak spontaneous flow (PSF) in L/min* (6 characters)
Ventilator-set base flow in liters per minute (6 characters)
Flow sensitivity setting in liters per minute (6 characters)
Field 72–83
Field 84
Field 85
Not used (6 characters)
End inspiratory pressure in cmH
2
O (6 characters)
Inspiratory pressure or PEEP High setting in cmH
2
O (6 characters)
Inspiratory time or PEEP High time setting in seconds (6 characters) Field 86
Field 87
Field 88
Apnea interval setting in seconds (6 characters)
Apnea inspiratory pressure setting in cmH
2
O (6 characters)
Apnea respiratory rate setting in breaths per minute (6 characters) Field 89
Field 90
Field 91
Field 92
Apnea inspiratory time setting in seconds (6 characters)
Apnea O
2
% setting (6 characters)
Apnea high circuit pressure limit in cmH
2
O (6 characters)
Alarm silence state (ON____ or OFF___) (6 characters) Field 93
Field 94 Apnea alarm status (NORMAL or ALARM_) (6 characters)
* These fields will contain data only if the RM software option is installed.
TR 19-4
SNDF Command
Component
Field 95
Field 96
Field 97
Field 98
Field 99
Field 100
Field 101
<ETX>
<CR>
Table TR 19-1. MISCA Response (Continued)
Description
Severe Occlusion/Disconnect alarm status (NORMAL or ALARM_) (6 characters)
Inspiratory component of I:E ratio or High component of H:L (Bi-Level) setting (6 characters)
Expiratory component of I:E ratio setting or Low component of H:L (Bi-Level) (6 characters)
Inspiratory component of apnea I:E ratio setting (6 characters)
Expiratory component of apnea I:E ratio setting (6 characters)
Constant during rate setting change for pressure control mandatory breaths
(I-TIME or I/E___ or______) (6 characters) (where ______ represents E-TIME or PCV not active)
Monitored value of I:E ratio (6 characters)
End of transmission character (03 hex)
Terminating carriage return
TR 19.3
SNDF Command
SNDF is a command sent from an external host device to the ventilator system instructing it to transmit all ventilator settings data, monitored patient data, and alarm settings and occurrences.
Enter the SNDF command exactly as shown:
SNDF<CR>
When the ventilator receives the command
SNDF<CR>, it responds with the code MISCF, followed by ventilator settings, monitored data, and alarm information.
The MISCF response follows this format:
MISCF 1225* 169
1 2 3
<STX>
4
FIELD 5, … FIELD 173,
5
<ETX>
6
<CR>
7
3
4
1
2
Response code to SNDF command
Number of bytes between <STX> and
<CR>
Number of data fields between <STX> and <ETX>
Start of transmission (02 hex)
7
*
5
6
Data field, left-justified and padded with spaces
End of transmission (03 hex)
Terminating carriage return
1229 if Philips is selected for serial port in communication setup
TR 19-5
RS-232 Commands
lists the MISCF message components and their descriptions.
Note:
Non-applicable fields will either contain zero or be blank.
Field 7
Field 8
Field 9
Field 10
Field 11
Field 12
Field 13
Field 14
Field 15
Field 16
Field 17
Field 18
Field 19
Field 20
Field 21
Field 22
Field 23
Field 24
Field 25
Component
MISCF
1225*
169
<STX>
Field 5
Field 6
Table TR 19-2. MISCF Response
Description
Response to SNDF command (5 characters)
Number of bytes between <STX> and <CR> (4 characters)V*1229 if “Phillips is selected for serial port in Communication Setup
Number of fields between <STX> and <ETX> (3 characters)
Start of transmission character (02 hex)
Ventilator time (HH:MM_) (6 characters)
Ventilator ID to allow external hosts to uniquely identify each Puritan Bennett™ 840 Ventilator System (18 characters)
Date (MMM_DD_YYYY_) (12 characters)
Vent Type (NIV______ or INVASIVE_) (9 characters)
Mode (A/C___, SIMV__, SPONT_ or BILEVL) (6 characters)
Mandatory Type (PC____, VC____,VC+___) (6 characters)
Spontaneous Type (NONE__, PS____, TC____, VS____, PA____) (6 characters)
Trigger Type setting (
V
-TRIG or P-TRIG) (6 characters)
Respiratory rate setting in bpm (6 characters)
Tidal volume setting in L (6 characters)
Peak flow setting in L/min (6 characters)
O
2
% setting (6 characters)
Pressure sensitivity setting in cmH
2
O (6 characters)
PEEP/CPAP in cmH
2
O (6 characters)
Plateau setting in seconds (6 characters)
Apnea interval setting in seconds (6 characters)
Apnea tidal volume setting in L (6 characters)
Apnea respiratory rate setting in bpm (6 characters)
Apnea peak flow setting inL/min (6 characters)
Apnea O
2
% setting (6 characters)
PCV apnea inspiratory pressure setting in cmH
2
O (6 characters)
TR 19-6
SNDF Command
Field 42
Field 43
Field 44
Field 45
Field 46
Field 47
Field 48
Component
Field 26
Field 27
Field 28
Field 29
Field 30
Field 31
Field 32
Field 33
Field 34
Field 35
Field 36
Field 37
Field 38
Field 39
Field 40
Field 41
Field 49
Field 50
Field 51
Table TR 19-2. MISCF Response (Continued)
Description
PCV Apnea inspiratory time setting in seconds (6 characters)
Apnea flow pattern setting (SQUARE or RAMP) (6 characters)
Apnea mandatory type setting (PC or VC) (6 characters)
Inspiratory component of ApneaI:E ratio (if apnea mandatory type is PC) (6 characters)
Expiratory component of Apnea I:E ratio (if apnea mandatory type is PC) (6 characters)
Support pressure setting (cmH
2
O)
Flow pattern setting (SQUARE or RAMP) (6 characters)
100% O
2
Suction (ON or OFF) (6 characters)
High inspiratory pressure alarm setting (
2
P
PEAK
) in cmH
2
O (6 characters)
Low inspiratory pressure alarm setting (
4
P
PEAK
) in cmH
2
O or OFF (6 characters)
High exhaled minute volume (
2V
E TOT
) alarm setting in L/min or OFF (6 characters)
Low exhaled minute volume (
4V
E TOT
) alarm setting in L/min or OFF (6 characters
High exhaled mandatory tidal volume (
2
V
TE MAND
) alarm setting in mL or OFF (6 characters)
Low exhaled mandatory tidal volume (
4
V
TE MAND
) alarm setting in mL or OFF (6 characters)
High exhaled spontaneous tidal volume (
2
V
TE SPONT
) alarm setting in mL or OFF (6 characters)
Low exhaled spontaneous tidal volume (
4
V
TE SPONT
) alarm setting in mL or OFF (6 characters)
High respiratory rate (
2 f
TOT
) alarm setting in bpm or OFF (6 characters)
High inspired tidal volume (
2
V
TI
) alarm setting in mL (6 characters)
Base flow setting in L/min (6 characters)
Flow sensitivity setting in L/min (6 characters)
PCV inspiratory pressure (P
I
) setting in cmH
2
O (6 characters)
PCV inspiratory time (T
I
) setting in seconds (6 characters)
Inspiratory component of I:E ratio setting or High component of H:L ratio setting (6 characters)
Expiratory component of I:E ratio setting or Low component of H:L ratio setting (6 characters)
Constant during rate change setting (I-time, I/E, or E-time) (6 characters)
Tube I.D. setting in mm (6 characters)
TR 19-7
RS-232 Commands
Field 66
Field 67
Field 68
Field 69
Field 70
Field 71
Field 72
Field 73
Field 74
Field 75
Component
Field 52
Field 53
Field 54
Field 55
Field 56
Field 57
Field 58
Field 59
Field 60
Field 61
Field 62
Field 63
Field 64
Field 65
Field 76
Field 77
Field 78
Field 79
Field 80
Table TR 19-2. MISCF Response (Continued)
Description
Tube type setting (ET or TRACH) (6 characters)
Humidification type setting (Non-Heated Exp, Heated Exp, or HME) (18 characters)
Humidifier volume setting in L (6 characters)
O
2
sensor setting (Enabled or Disabled) (9 characters)
Disconnect sensitivity setting in % or OFF (6 characters)
Rise time% setting (6 characters)
PAV™*+ percent support setting (6 characters)
Expiratory sensitivity (E
SENS
) setting in % or L/min for PA breath type (6 characters)
IBW setting in kg (6 characters)
Target support volume (V
T SUPP
) setting in L (6 characters)
High PEEP (PEEP
H
) setting in cmH
2
O (6 characters)
Low PEEP (PEEP
L
) setting in cmH
2
O (6 characters)
High PEEP time (T
H
) setting in seconds (6 characters)
High spontaneous inspiratory time limit (
2
T
I SPONT
) setting in seconds (6 characters)
Circuit type setting (ADULT, PEDIATRIC, or NEONATAL) (9 characters)
Low PEEP time (T
L
) setting in seconds (6 characters)
Expiratory time (T
E
) setting in seconds (6 characters)
End inspiratory pressure (P
I END
) in cmH
2
O (6 characters)
Respiratory rate (f
TOT
) in bpm (6 characters)
Exhaled tidal volume (V
TE
) in L (6 characters)
Patient exhaled minute volume (
V
E TOT
) in L/min (6 characters)
Peak airway pressure (P
PEAK
) in cmH
2
O (6 characters)
Mean airway pressure (P
MEAN
) in cmH
2
O (6 characters)
Expiratory component of monitored value of I:E ratio, assuming inspiratory component of 1 (6 characters)
I:E ratio (6 characters)
Delivered O
2
% (6 characters)
Inspired tidal volume (T
I
) in L (6 characters)
Intrinsic PEEP (PEEP
I
) in cmH
2
O (6 characters)
Estimated total resistance (R
TOT
) in cmH
2
O/L/s (6 characters)
TR 19-8
SNDF Command
Table TR 19-2. MISCF Response (Continued)
Component
Field 81
Field 82
Field 83
Field 84
Field 85
Field 86
Field 87
Field 88
Field 89
Field 90
Field 91
Field 92
Field 93
Field 94
Field 95
Field 96
Field 97
Description
Estimated patient resistance (R
PAV
) in cmH
2
O/L/s (6 characters)
Estimated patient elastance (E
PAV
) in cmH
2
O/L (6 characters)
Estimated patient compliance (C
PAV
) in mL/cmH
2
O (6 characters)
Normalized rapid shallow breathing index (f/V
T
//kg) (6 characters)
Rapid shallow breathing index (f/V
T
) (6 characters)
Spontaneous percent inspiratory time (T
I
/T
TOT
) (6 characters)
Monitored PEEP in cmH
2
O (6 characters)
Spontaneous inspiratory time (T
I SPONT
) in seconds (6 characters)
Exhaled spontaneous minute volume (
V
E SPONT
) in L/min (6 characters)
Intrinsic PEEP (PEEP
I
) from expiratory pause maneuver in cmH
2
O (6 characters)
Total PEEP (PEEP
TOT
) from expiratory pause maneuver in cmH
2
O (6 characters)
Static compliance (C
STAT
) from inspiratory pause maneuver in mL/cmH
2
O (6 characters)
Static resistance (R
STAT
) from inspiratory pause maneuver in cmH
2
O/L/s (6 characters)
Plateau pressure (P
PL
) from inspiratory pause maneuver in cmH
2
O (6 characters)
High spontaneous inspiratory time (ALERT_ or blank) (6 characters)
Dynamic compliance (C
DYN
) in mL/cmH
2
O (6 characters)
Dynamic resistance (R
DYN
) in cmH
2
O/L/s (6 characters)
Peak spontaneous flow (PSF) in L/min (6 characters) Field 98
Field 99
Field 100
Field 101
Field 102
Field 103
Peak expiratory flow (PEF) in L/min (6 characters)
End expiratory flow (EEF) in L/min (6 characters)
Reserved
Negative inspiratory force (NIF) in cmH
2
O (6 characters)
P
0.1
pressure change in cmH
2
O (6 characters)
Vital capacity (VC) in L (6 characters) Field 104
Field 105
Field 106
Field 107
Field 108
Audio paused (ON or OFF) (6 characters)
Apnea ventilation alarm* (6 characters)
High exhaled minute volume alarm* (
1V
E TOT
) (6 characters)
High exhaled tidal volume alarm* (
1
V
TE
) (6 characters)
* Possible responses are: NORMAL, LOW, MEDIUM, HIGH, or RESET.
TR 19-9
RS-232 Commands
Table TR 19-2. MISCF Response (Continued)
Component
Field 109
Field 110
Field 111
Field 112
Field 113
Field 114
Field 115
Field 116
Field 117
Field 118
Field 119
Field 120
Description
High O
2
% alarm* (
1
O
2
%) (6 characters)
High inspiratory pressure alarm* (
1
P
PEAK
) (6 characters)
High ventilator pressure alarm* (
1
P
VENT
) (6 characters)
High respiratory rate alarm* (
1 f
TOT
) (6 characters)
AC power loss alarm* (6 characters)
Inoperative battery alarm* (6 characters)
Low battery alarm* (6 characters)
Loss of power alarm* (6 characters)
Low exhaled mandatory tidal volume alarm* (
3
V
TE MAND
) (6 characters)
Low exhaled minute volume alarm* (
3V
E TOT
) (6 characters)
Low exhaled spontaneous tidal volume (
3
V
TE SPONT
) alarm* (6 characters)
Low O
2
% (
3
O
2
%) alarm* (6 characters)
Low air supply pressure alarm* (6 characters) Field 121
Field 122
Field 123
Field 124
Field 125
Field 126
Field 127
Field 128
Low O
2
supply pressure alarm* (6 characters)
Compressor inoperative alarm* (6 characters)
Disconnect alarm* (6 characters)
Severe occlusion alarm* (6 characters)
Inspiration too long alarm* (6 characters)
Field 129
Field 130
Field 131
Procedure error* (6 characters)
Compliance limited tidal volume (V
T
) alarm* (6 characters)
High inspired spontaneous tidal volume* (
1
V
TI SPONT
) alarm (6 characters)
High inspired mandatory tidal volume (
1
V
TI MAND
) alarm* (6 characters)
High compensation limit (
1
P
COMP
) alarm* (6 characters)
PAV™* startup too long alarm* (6 characters)
PAV™* R and C not assessed alarm* (6 characters)
Field 132
Field 133
Field 134
Field 135
Field 136
Volume not delivered (VC+) alarm* (6 characters)
Volume not delivered (VS) alarm* (6 characters)
Low inspiratory pressure (
3
P
PEAK
) alarm* (6 characters)
Field 137 Technical malfunction A5* (6 characters)
* Possible responses are: NORMAL, LOW, MEDIUM, HIGH, or RESET.
TR 19-10
Table TR 19-2. MISCF Response (Continued)
Component
Field 138
Field 139
Field 140
Field 141
Field 142
Field 143
Field 144
Field 145
Field 146
Field 147
Field 148
Field 149
Field 150
Description
Technical malfunction A10* (6 characters)
Technical malfunction A15* (6 characters)
Technical malfunction A20* (6 characters)
Technical malfunction A25* (6 characters)
Technical malfunction A30* (6 characters)
Technical malfunction A35* (6 characters)
Technical malfunction A40* (6 characters)
Technical malfunction A45* (6 characters)
Technical malfunction A50* (6 characters
Technical malfunction A55* (6 characters)
Technical malfunction A60* (6 characters)
Technical malfunction A65* (6 characters)
Technical malfunction A70* (6 characters)
Field 151
Field 152
Field 153
Field 154
Field 155
Technical malfunction A75* (6 characters)
Technical malfunction A80* (6 characters)
Technical malfunction A85* (6 characters)
Spontaneous tidal volume (V
TE SPONT
) in liters (6 characters)
Total work of breathing (WOB
TOT
) in Joules/L (6 characters)
Leak compensation state (enable, disable, or blank) (6 characters) Field 156
Field 157
Field 158
Field 159
%LEAK (6 characters)
LEAK @ PEEP (6 characters)
Field 160–171
<ETX>
V
LEAK
(6 characters)
Reserved
End of transmission character (03 hex)
<CR> Terminating carriage return
* Possible responses are: NORMAL, LOW, MEDIUM, HIGH, or RESET.
SNDF Command
TR 19-11
RS-232 Commands
Page Left Intentionally Blank
TR 19-12
Glossary
Note:
See Chapter
OP 1
for definitions of onscreen abbreviations.
A
A/C
AC alarm log alarm message alarm reset key audio paused key
ALERT apnea autoreset autotriggering background checks base flow
Amperes (unit of electric current)
Assist/control mode. A ventilatory mode in which the ventilator delivers only mandatory breaths (patient-,ventilator-, or operator-initiated) according to the current settings.
Alternating current.
A record of alarm events (including time-stamped alarms, pause, maneuvers, and resets) in order of occurrence, with the most recent event at the top of the list.
A message that accompanies alarm annunciation that consists of a base message (which identifies the alarm), an analysis message (which lists the root cause and any associated alarms that may have arisen due to the initial alarm), and a remedy message (which suggests corrective actions).
Key that clears all alarm indicators and cancels the audio paused period.
Key that silences alarm sound for 2 minutes from the most recent key press, but does not change visual indicators.
A category of condition detected during SST or EST. An ALERT may be overridden provided that it can be determined with certainty that the defect in the ventilator or associated component cannot create a hazard for the patient, or add to the risks that may arise from other hazards.
Cessation of breathing. The Puritan Bennett™ 840 Ventilator System declares apnea and begins apnea ventilation when the breath-to-breath interval exceeds the set apnea interval (T
A
).
When an alarm becomes inactive (that is, alarm conditions no longer exist) without pressing the alarm reset key.
The ventilator delivers repeated, unintended breaths triggered by fluctuating flows or pressures as opposed to patient demand. Patient circuit leaks and low flow or pressure sensitivity settings are common causes of autotriggering.
Continuously running tests during ventilation that assess the ventilator’s electronics and pneumatics hardware.
A constant flow of gas through the patient circuit during the latter part of exhalation during flow triggering (
V-TRIG). The value of this base flow is1.5 L/min greater than the operator-selected value for flow sensitivity.
Glossary-1
Glossary-2 batch changes battery backup system
BD, BDU
BOC
BPS constant during rate change
Changes to multiple settings that go into effect at the same time. On the ventilator system, no setting changes go into effect until you press the ACCEPT key.
The system in the compressor mount cart or pole cart that supplies battery backup power to the ventilator. The compressor mount cart has a BPS with a 1-hour battery or an optional 4hour battery. The 1-hour BPS behaves identically to the 802 BPS. The 4-hour
BPS behaves identically to the 803 BPS. The pole cart can be used with a 1-hour or 4-hour battery which is installed in the cart base assembly. Similarly, the 1-hour and 4-hour batteries behave identically to the 802 and 803 BPS, respectively.
Breath delivery or breath delivery unit. The ventilator component that includes inspiratory and expiratory pneumatics and electronics. The BDU includes its own independent
CPU that controls ventilation.
British Oxygen Company, a standard for high pressure gas inlet fittings.
Backup Power Source. The 802 BPS provides DC power to the BDU power supply (which, in turn, supplies power to the GUI) in the event AC power is lost. Depending on ventilator settings, the BPS can supply backup power for at least 60 minutes (30 minutes on ventilators built prior to July 2007) under nominal conditions. The 803 BPS provides DC power to the BDU and GUI for at least 4 hours (depending on ventilator settings) in the event of
AC power loss.
The delivery of a second inspiration before the first exhalation is complete.
breath stacking breaths per minute Unit of respiratory rate (1/min).
BTPS Body temperature and pressure, saturated, 37°C, at ambient barometric pressure, at
100% relative humidity.
clinical alarm An alarm that can indicate an abnormal physiologic condition.
cm cmH
2
O compliance volume compressor
Centimeter (unit of length).
Centimeters of water (unit of pressure approximately equal to 1 hPa).
The volume of gas that remains in the patient circuit and does not enter the patient’s respiratory system.
On the ventilator system, the optional 806 compressor, which provides compressed air to the BDU, and can be used in place of wall or bottled air. The 806 Compressor is powered through and communicates with the BDU.
One of three breath timing variables (inspiratory time, I:E ratio, or expiratory time) that the operator can set to be held constant when the respiratory rate setting changes.
Applies only to the pressure control (PC) mandatory breath type (including VC+ and
BILEVEL). You can change the value of the constant parameter at any time, but the value does not change as a result of changing the respiratory rate setting.
Central processing unit.
CPU
CSA
D
SENS
DC dependent alarm
Canadian Standards Association.
Disconnect sensitivity, a setting that specifies the allowable loss (percentage) of delivered tidal volume, which if equaled or exceeded, causes the ventilator to declare a DIS-
CONNECT alarm. The greater the setting, the more returned volume must be lost before
DISCONNECT is detected.
Direct current.
An alarm that arises as a result of another primary alarm.
DISS
DualView
E
SENS
EMC
EN
EST
ETO
EXP PAUSE f, f
TOT
Diameter index safety standard, a standard for high pressure gas inlet fittings.
The ventilator system’s two touch screens, which display monitored data separately from ventilator settings.
Expiratory sensitivity, the percent of peak inspiratory flow (or flow rate expressed in L/ min in a PA breath) at which the ventilator cycles from inspiration to exhalation for spontaneous breaths. Low settings will result in longer spontaneous inspirations.
Electromagnetic compatibility.
European norm (referring to the European Common Market).
Extended self test, a comprehensive test of ventilator function, intended to be run by qualified service personnel.
Ethylene oxide.
Expiratory pause, an operator-initiated maneuver that closes the inspiration (proportional solenoid) and exhalation valves during the expiratory phase of a mandatory breath.
The maneuver can be used to determine intrinsic (auto) PEEP (PEEP
I
).
Respiratory rate, as a setting (f) in A/C, SIMV, and BILEVEL the minimum number of mandatory breaths the patient receives per minute. As a monitored value (f
TOT
), the average total number of breaths delivered to the patient.
FAILURE flow pattern
A category of condition detected during SST or EST that causes the ventilator to enter the safety valve open state. A ventilator that has experienced a FAILURE requires removal from clinical use and immediate service.
The gas flow pattern of mandatory volume-controlled breaths (the ventilator system offers the choice of square or descending ramp flow patterns).
The patented flow-triggering strategy used on 800 Series Ventilators.
Flow-by flow triggering ft Feet (unit of length).
Test circuit designed for use with EST.
gold standard test circuit
Graphics
HME hPa humidification type
A standard function on the ventilator system that displays real-time patient data, including: pressure-time curve, flow-time curve, volume-time curve, pressure-volume loop.
GUI Graphic user interface, the ventilator component that includes the touch screens, keys, and knob. The GUI includes its own independent CPU that monitors ventilator and patient data. The upper screen displays monitored information, including alarms, monitored data, and graphics. The lower screen shows ventilator settings, symbol definitions, and prompts.
high-priority alarm As defined by international standards organizations, an alarm that requires immediate attention to ensure patient safety. When a high-priority alarm is active, the red high-priority indicator ( ! ! ! ) flashes and the high-priority audible alarm sounds (a repeating sequence of five tones that repeats twice, pauses, then repeats again), and the top of the upper screen shows an alarm message.
Heat-moisture exchanger, a humidification device, also called an artificial nose.
Hectopascal (unit of pressure, approximately equal to 1 cmH
2
O).
A setting for the type of humidification system (HME, non-heated expiratory tube, or heated expiratory tubing) in use on the ventilator.
Glossary-3
Glossary-4
Hz
I:E ratio
Hertz (unit of frequency, indicating cycles per second).
The ratio of inspiratory time to expiratory time. Also, the operator-set timing variable that applies to PC and VC+ mandatory breaths.
IBW idle mode
IEC
INSP PAUSE
Ideal body weight, a ventilator setting that specifies the patient’s body weight assuming normal fat and fluid levels. Determines absolute limits on tidal volume and peak flow, and allows appropriate matching of ventilator settings to patient.
A ventilation mode in effect during a patient circuit disconnect. When the ventilator is in this mode, the exhalation valve opens, idle flow (10 L/min flow at 100% O
2
or at 40% O
2 in NeoMode, if available) begins, and breath triggering is disabled.
International Electrotechnical Commission, a standards organization.
Inspiratory pause, an operator-initiated maneuver that closes the inspiration (proportional solenoid) and exhalation valves at the end of the inspiratory phase of a mandatory breath. The maneuver can be used to determine static compliance (C
STAT
) and resistance
(R
STAT
).
International Standards Organization, a standards organization.
Kilogram (unit of weight).
ISO kg
L
L/min lb low-priority alarm
Liter (unit of volume).
Liters per minute (unit of flow).
Pound (unit of weight).
As defined by international standards organizations, an alarm that indicates a change in the patient-ventilator system. During a low-priority alarm, the yellow low-priority indicator ( ! ) lights, the low priority audible alarm (one tone) sounds, and the upper screen shows an alarm message.
Meter (unit of length).
m maintenance mandatory
All actions necessary to keep equipment in, or restore it to, serviceable condition.
Includes cleaning, servicing, repair, modification, overhaul, inspection, and performance verification.
A breath whose settings and timing are preset; can be triggered by the ventilator, patient, or operator. The ventilator system allows you to select volume-controlled (VC),
VC+, or pressure-controlled (PC) mandatory breaths.
mandatory type The type of mandatory breath: volume control (VC), VC+, or pressure control
(PC).
manual inspiration An OIM breath. Pressing the MANUAL INSP key on the ventilator system delivers one mandatory breath to the patient.
medium-priority alarm
As defined by international standards organizations, an abnormal condition that requires prompt attention to ensure the safety of the patient. When a medium-priority alarm is active, the yellow medium-priority indicator ( ! ! ) flashes, the medium-priority audible alarm (a repeating sequence of three tones) sounds, and the upper screen shows an alarm message.
min mL
Minute (unit of time).
Milliliter (unit of volume).
mode
MRI ms
NOVRAM
O
2
%
Ventilatory mode, the algorithm that determines type and sequence of breath delivery.
The ventilator system offers a choice of assist/control (A/C), spontaneous (SPONT), or synchronized intermittent mandatory ventilation (SIMV), or BILEVEL.
Magnetic resonance imaging.
Millisecond (unit of time).
NIST Non-interchangeable screw thread, a standard for high pressure gas inlet fittings.
normal ventilation The state of the ventilator when breathing is in progress and no alarms are active.
Nonvolatile random access memory. Memory that is preserved even when power to the ventilator is not available.
Both an operator-set and monitored variable. The O
2
% setting determines the percentage of oxygen in the delivered gas. The O
2
% monitored data is the percentage of oxygen in the gas delivered to the patient, measured at the ventilator outlet upstream of the inspiratory filter.
OIM ongoing background checks
OSC
Operator-initiated mandatory breath, a breath that is delivered when the operator presses MANUAL INSP.
Continuously running tests during ventilation that assess the ventilator’s electronics and pneumatics hardware.
Occlusion status cycling. A ventilation mode in effect during a severe occlusion. In this mode, the ventilator periodically attempts to deliver a pressure-based breath while monitoring the inspiratory and expiratory phases for the continuing existence of the occlusion.
OVERRIDDEN
P
MEAN
PEEP
P
P
P
P
P
I
I END
PEAK
SENS
SUPP
P-TRIG patient circuit
The final status of an SST or EST run in which the operator used the override feature. (The ventilator must have ended the test with an ALERT condition.)
Mean circuit pressure, a calculation of the measured average patient circuit pressure over an entire respiratory cycle.
End expiratory pressure, the measured circuit pressure (referenced to the patient wye) at the end of the expiratory phase of a breath. If expiratory pause is active, the displayed value reflects the level of any active lung PEEP.
Inspiratory pressure, the operator-set inspiratory pressure at the patient wye (above
PEEP) during a pressure control (PC) mandatory breath.
End inspiratory pressure, the pressure at the end of the inspiratory phase of the current breath. If plateau is active, the displayed value reflects the level of end plateau pressure.
Maximum circuit pressure, the maximum pressure during the inspiratory phase of a breath.
Pressure sensitivity, the operator-set pressure drop below PEEP (derived from the patient’s inspiratory flow) required to begin a patient-initiated breath when pressure triggering is selected. Not available with NeoMode or when Vent Type is NIV.
Pressure support, a setting of the level of inspiratory assist pressure (above PEEP) at the patient wye during a spontaneous breath (when spontaneous breath type is PS).
Pressure triggering, a method of recognizing patient inspiratory effort in which the ventilator monitors pressure in the patient circuit. The ventilator triggers a breath when the airway pressure drops by at least the value selected for pressure sensitivity (P
SENS
).
The entire inspiratory-expiratory conduit, including tubing, humidifier, and water traps.
Glossary-5
Glossary-6 patient data alarm An alarm condition associated with an abnormal condition of the patient’s respiratory status.
patient problems A definition used by the ventilator’s safety net. Patient problems are declared when patient data are measured equal to or outside of alarm thresholds and are usually selfcorrecting or can be corrected by a practitioner. The alarm monitoring system detects and announces patient problems. Patient problems do not compromise the ventilator's performance.
PC
PEEP
Pressure control; A mandatory breath type in which the ventilator delivers an operatorset inspiratory pressure for an operator-set inspiratory time. Available in A/C and SIMV modes, and for operator-initiated mandatory (OIM) breaths in SPONT mode.
Positive end-expiratory pressure, the minimum level of pressure maintained in the patient circuit throughout ventilation. Both an operator-set and monitored variable. The level of PEEP is also called baseline pressure.
PIM
POST preventive maintenance
Patient-initiated mandatory breath. A mandatory breath that is triggered by patient inspiratory effort.
Power on self test, a self test that the ventilator runs to verify the integrity of ventilator electronics. The ventilator runs POST when it is powered on, following a power loss, or if the ventilator detects internal timing errors.
Procedures that keep the ventilator and its subassemblies in satisfactory operational condition by providing system inspection, detection, and prevention of failures. Procedures include fan and filter replacement, lubrication, calibration, etc.
PS
PSOL
RAM resistance restricted phase of exhalation rise time% s safety net safety ventilation
SandBox
Pressure support, a spontaneous breath type in which the ventilator delivers an operator-set pressure (in addition to PEEP) during the inspiratory phase. Available in SPONT,
SIMV, and BILEVEL modes.
Proportional solenoid valve.
Random access memory.
The flow-dependent pressure drop across a conduit. Measured in cmH
2
O/L/s or hPa/L/s.
The specific time period during the expiratory phase where an inspiration trigger is not allowed. The conditions associated with the restricted phase of exhalation are as follows:
Net flow ≥ 50% of peak net flow (peak net flow is measured after 100 ms of exhalation time have elapsed) or
Expiratory flow is greater than 0.5 L/min and exhalation elapsed time is less than 200 ms
or
Less than 5 seconds of exhalation have elapsed.
A setting that determines the rise time to achieve the set inspiratory pressure in pressure-controlled (PC), VC+, BILEVEL, or pressure-supported (PS) breaths. The larger the value, the more aggressive the rise of pressure.
Second (unit of time).
The ventilator’s strategy for responding to patient problems and system faults.
A mode of ventilation that becomes active if the patient circuit is connected before ventilator startup is complete, or when power is restored after a loss of 5 minutes or more.
Capability that allows you to preview settings before applying them to your patient.
service mode
SIMV
SIS
SmartAlert
SL/min soft bound
SPONT
A ventilator mode that provides a set of services tailored to the needs of testing and maintenance personnel. No ventilation is delivered while the ventilator is in the service mode.
Synchronized intermittent mandatory ventilation, a ventilatory mode in which the ventilator delivers one mandatory breath per breath cycle and as many spontaneous breaths as the patient can trigger during the remainder of the breath cycle.
Sleeved index system, a standard for high pressure gas inlet fittings.
Alarm annunciation system which helps you to quickly determine the priority and root cause of alarm conditions.
Standard liters per minute (unit of flow measured at 0°C (32°F) and 1 atm (14.7 psia) pressure).
A ventilator setting that has reached its recommended high or low limit. Setting the ventilator beyond this limit requires the operator to acknowledge the prompt to continue.
Spontaneous, a ventilatory mode in which the ventilator delivers only spontaneous breaths. In SPONT mode, the patient triggers all breaths delivered by the ventilator with no set mandatory respiratory rate. The patient controls the breath variables, and the breath can be augmented by support pressure.
T b
T
E spontaneous type A setting that determines whether spontaneous breaths are pressure supported (PS), volume-supported (VS), tube-compensated (TC), proportionally assisted (PA), or not
(NONE).
SST
STPD
Short self test, a test that checks circuit integrity, calculates circuit compliance and filter resistance, and checks ventilator function. SST is intended to be run by the operator at specified intervals and whenever a patient circuit is changed. Refer to
Introduction to SST
(OP 3.2)
on page
OP 3-
1
for information on when to run SST.
Standard temperature and pressure, dry. Defined as dry gas at a standard atmosphere
(760 mmHg, 101.333 kPa, approximately 1.0 bar) and °C.
SVO Safety valve open, an emergency state in which the ventilator opens the safety valve so that the patient can breathe room air unassisted by the ventilator. An SVO state does not necessarily indicate a ventilator inoperative condition. The ventilator enters an SVO state if a hardware or software failure occurs that could compromise safe ventilation, both air and oxygen supplies are lost, or an occlusion is detected.
system fault A definition used by the ventilator’s safety net. System faults include hardware faults
(those that originate inside the ventilator and affect its performance), soft faults (faults momentarily introduced into the ventilator that interfere with normal operation), inadequate supply (AC power or external gas pressure), and patient circuit integrity (blocked or disconnected circuit). System faults are not usually self-correcting and are handled under the assumption that they can affect the ventilator's performance.
T
A
Apnea interval, the operator-set variable that defines the breath-to breath interval which, if exceeded, causes the ventilator to declare apnea and enter apnea ventilation.
Breath cycle.
T
I
Expiratory time, the expiratory interval of a breath. Also the operator-set timing variable that determines the expiratory period for pressure-controlled (PC) or VC+ mandatory breaths.
Inspiratory time, the inspiratory interval of a breath. Also, the operator-set timing variable that determines the inspiratory interval for pressure controlled (PC) or VC+ mandatory breaths.
Glossary-7
Glossary-8
T
T
T
V
V
V
V
V
V m
PL s
V-TRIG
E SET
E TOT
MAX
SENS
T
VA
VC
Ventilator breathing system ventilator inoperative
VIM
Mandatory interval portion of an SIMV breath cycle; it is reserved for a PIM.
Plateau time, the amount of time the inspiration phase of a mandatory breath is extended after inspiratory flow has ceased and exhalation is blocked. Increases the residence time of gas in the patient’s lungs.
Spontaneous interval portion of an SIMV breath cycle; it is reserved for spontaneous breathing throughout the remainder of the breath cycle.
Volts (unit of voltage).
Flow triggering, a method of recognizing patient inspiratory effort in which the ventilator monitors the difference between inspiratory and expiratory flow measurements. The ventilator triggers a breath when the difference between inspiratory and expiratory flows increases to a value that is at least the value selected for flow sensitivity (
V
SENS
).
Set mandatory minute volume. This value is calculated from ventilator control parameters (f×V
T
) and is displayed with the breath timing bar on the lower GUI screen whenever their buttons are touched.
Minute volume, the expiratory tidal volume normalized to unit time (L/min). The ventilator system estimates total minute volume based on the previous 60 seconds or eight breaths, whichever interval is shorter. The displayed value is compliance- and BTPS-compensated.
Peak flow, a setting of the peak (maximum) flow of gas delivered during a VC mandatory breath. (Combined with tidal volume, flow pattern, and plateau, constant peak flow defines the inspiratory time.) To correct for compliance volume, the ventilator automatically increases the peak flow.
Flow sensitivity, the rate of flow inspired by the patient that triggers the ventilator to deliver a mandatory or spontaneous breath (when flow triggering is selected).
Tidal volume, the volume inspired and expired with each breath. The delivered by the ventilator system is an operator-set variable that determines the volume delivered to the patient during a mandatory, volume-based breath. is compliance-compensated and corrected to body temperature and pressure, saturated (BTPS).
Volt-amperes (unit of power).
Volume control, a mandatory breath type in which the ventilator delivers an operator-set tidal volume, peak flow, and flow pattern. Available in A/C and SIMV modes, and for operator-initiated mandatory (OIM) breaths in SPONT mode.
Ventilator breathing system. Includes the gas delivery components of the ventilator; the patient circuit with tubing, filters, humidifier, and other accessories; and the Ventilator's expiratory metering and measurement components.
An emergency state that the ventilator enters if it detects a hardware failure or a critical software error that could compromise safe ventilation. During a ventilator inoperative condition, the safety valve opens to allow the patient to breathe room air unassisted by the ventilator. Qualified service personnel must power up the ventilator and run EST before normal ventilation can resume.
Ventilator-initiated mandatory breath. A breath that is delivered at a time determined by the ventilator.
Index
Symbols
TOT
alarm. See High respiratory rate alarm
2
% alarm. See High delivered O
2
% alarm
alarm. See High circuit pressure alarm
PEAK
alarm. See High exhaled total minute volume alarm
2
% alarm. See Low delivered O
2
% alarm
PEAK
alarm. See Low circuit pressure alarm
E TOT
alarm. See Low exhaled total minute volume alarm
TE MAND
alarm. See Low exhaled mandatory tidal volume alarm
TE SPONT
alarm. See Low exhaled spontaneous tidal volume alarm
Numerics
802 Backup Power Source (BPS). See BPS
802 BPS charging status indicator, description . . . . . . . . . . . . . .OP 1-17
803 BPS charging status indicator, description . . . . . . . . . . . . . .OP 1-17
840 Ventilator System
compliance and approvals . . . . . . . . . . . . . . . . . . . . OP A-5–OP A-11
functional description . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-2–OP 1-7
general description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-1–OP 1-2
pneumatic schematic . . . . . . . . . . . . . . . . . . . . . . . . . . OP C-1–OP C-5
specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-1–OP A-36
A
A/C mode. See Assist/control mode
Abbreviations and symbols, onscreen, descriptions OP 1-12–OP 1-16
AC indicator
AC POWER LOSS alarm, description . . . . . . . . . . . . . . . . . . . . . . . TR 13-15
ACCEPT key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-10
Accessories, part numbers . . . . . . . . . . . . . . . . . . . . . . . . .OP B-1–OP B-5
Air hose assembly, part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2
Air regulator assembly (REG2). See Regulator, air
Air supply, how to connect . . . . . . . . . . . . . . . . . . . . . . . .OP 2-8–OP 2-10
Alarm reset key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
Alarm settings, range, resolution, and accuracy . . . OP A-28–OP A-31
Alarm silence key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
Alarm testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP D-1–OP D-6
Alarm volume key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
Alarm volume, how to adjust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-5
dependent, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-3
handling strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-1–TR 13-2
high-priority
how to respond to . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 5-1–OP 5-11
how to set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-14–OP 4-16
how to test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP D-1–OP D-6
low-priority
medium-priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-2
medium-priority
message format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-6, TR 13-3
messages, list . . . . . . . . . . . . . . . . . . . . . . . . OP 5-7, TR 13-4–TR 13-14
primary, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 13-3
rules about how messages are displayed . . . . . . . TR 13-3–TR 13-4
See also name of specific alarm
volume (dB) specifications . . . . . . . . . . . . . . . . . . . . . . OP A-2, OP A-4
APNEA alarm, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-15
Apnea interval (T
A
) setting, function, and range . . . . . . . . . . . . OP A-17
Apnea settings, how to change . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-14
Apnea ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-1–TR 9-5
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-1–TR 12-2
how ventilator detects apnea . . . . . . . . . . . . . . . . . . . . TR 9-1–TR 9-2
how ventilator phases in new apnea intervals . . . . . TR 9-4–TR 9-5
changing to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-3–TR 6-4
rate change during . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-2–TR 6-3
Atmospheric pressure
Atmospheric pressure transducer calibration, description . . .TR 15-5
Auto PEEP parameter. See Intrinsic PEEP
Autoclaving, steps involved in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-5
B
Background checks, description . . . . . . . . . . . . . . . . . . TR 15-2–TR 15-3
Bacteria filter expiratory
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-2–OP 7-4
part numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5
resistance check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
inspiratory
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
part numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2
resistance check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
Bag, drain
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-9–OP 7-10
Barometric pressure
Batteries. See BPS (Backup Power Source)
Battery charging status indicator, description . . . . . . . . . . . . . . OP 1-17
BATTERY ON indicator, description . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11
BATTERY READY indicator, description . . . . . . . . . . . . . . . . . . . . . OP 1-11
BiLevel mode. See addendum to this manual
Index-1
BPS (Backup Power Source)
BPS on indicator, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11
BPS ready indicator, description . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11
Breath trigger type setting, function and range . . . . . . . . . . . . OP A-28
Breath type, patient data function and range . . . . . . . . . . . . . . OP A-31
Breathing circuit. See Patient circuit
C
Calibration
oxygen sensor, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 15-4
Calibration (oxygen) key, description . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
Cart, ventilator
how to use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-19–OP 2-21
Checks, background, description . . . . . . . . . . . . . . . . . .TR 15-2–TR 15-3
Chemical disinfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-4–OP 7-5
caution about phenol and formaldehyde-based disinfectants
Circuit breaker
humidifier and compressor, location . . . . . . . . . . . . . . . . . . . . . OP 2-5
power supply
CIRCUIT DISCONNECT alarm, description . . . . . . . TR 13-15–TR 13-16
Circuit type, relationship with IBW . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-2
Circuit, patient tubing. See Patient circuit
Cleaning, disinfection, and sterilization . . . . . . . . . . . . . OP 7-4–OP 7-5
Cleaning, general guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-4
CLEAR key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-10
Collector vial
how to install . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-13–OP 2-15
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5, OP B-8
Communications
RS-232 port
how to configure . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3–OP E-4
RS-232, commands . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 19-1–TR 19-11
Compliance compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-3
Compliance volume factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-3
Compliance, static (C
STAT
) parameter
description . . . . . . . . . . . . . . . . . .OP 4-19–OP 4-20, TR 14-5–TR 14-9
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-35
Compressor
location of connection to BDU . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-5
Compressor inlet filter
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-10–OP 7-11
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5, OP B-9
COMPRESSOR ON indicator, description . . . . . . . . . . . . . . . . . . .OP 1-11
COMPRESSOR READY indicator, description . . . . . . . . . . . . . . . .OP 1-11
Connectors, specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-2
Console, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-8–OP 1-11
Constants (during rate change)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-19
how to set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-13–OP 4-14
Controls and indicators . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-8–OP 1-11
See also Ventilator settings, Keyboard, Patient data, or name of specific control or indicator
STAT
parameter. See Compliance, static
Current vent setup screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-12
D
D/Flex filter. See Inspiratory filter
D/X800 filter. See Expiratory filter or Collector vial
Date/time
Delivered O
2
% parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-32
Dependent alarm, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-3
Detecting and initiating exhalation . . . . . . . . . . . . . . . . . .TR 3-1–TR 3-4
Detecting and initiating inspiration . . . . . . . . . . . . . . . . . .TR 2-1–TR 2-5
Detecting occlusion and disconnect . . . . . . . . . . . . . . TR 10-1–TR 10-4
DEVICE ALERT alarm, description . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-16
Diagnostic codes display, function . . . . . . . . . . . . . . . . . . . . . . . . OP A-36
Disconnect sensitivity (D
SENS
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-19
Disconnect, how ventilator detects and responds . TR 10-2–TR 10-3
caution about phenol and formaldehyde-based disinfectants
Display. See name of specific display
Drain bag
SENS
setting. See Disconnect sensitivity
E
Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-4–OP A-5
EMC
immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-8, OP A-9
recommended separation distances . . . . . . . . . . . . . . . . . . . OP A-10
End expiratory pressure (PEEP) parameter
Index-2
Index
End inspiratory pressure (P
I END
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-32
Environmental requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-2
setting. See Expiratory sensitivity
Exhalation backup limits
high circuit pressure limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-3
high ventilator pressure limit . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-4
how ventilator detects and initiates . . . . . . . . . . . . . . . TR 3-1–TR 3-4
initiation methods
airway pressure method . . . . . . . . . . . . . . . . . . . . . . . TR 3-2–TR 3-3
Exhalation filter latch open indicator, description . . . . . . . . . . .OP 1-19
Exhalation system, operation of . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
Exhalation valve
calibration, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
Exhaled minute volume (
V
E TOT
) parameter
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-2–TR 14-3
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-32
Exhaled tidal volume (V
TE
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-33
EXP PAUSE key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
Expiratory filter
Expiratory pause maneuvers . . . . . . . . . . . OP 4-17, OP 4-17–OP 4-18
Expiratory sensitivity (E
SENS
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
Expiratory time (T
E
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
Extended self test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-1–TR 18-3
safety considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-3
F
f setting. See Respiratory rate setting
Factor, compliance volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-3
FAILURE, in SST, meaning . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-9, OP 3-10
Faults, system
Filter compressor inlet
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-10–OP 7-11
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5, OP B-9
expiratory
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
part numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5
resistance check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
inspiratory
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
part numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2
resistance check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
Flex arm
how to install . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-15–OP 2-17
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-2, OP B-6
Flow pattern setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-3–TR 12-4
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
Flow sensitivity (
V
SENS
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
in flow triggering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-3–TR 2-4
Flow sensor offset calibration, description . . . . . . . . . . . . . . . . . .TR 15-5
Flow triggering (
V
-TRIG)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-3, TR 2-3–TR 2-4
FREEZE function, in Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-4
parameter. See Total respiratory rate
G
Gold standard test circuit (for EST) . . . . . . . . . . . . . . . . TR 15-4, TR 18-1
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-5, OP B-9
Graphic user interface (GUI)
description of controls and indicators . . . . . . . . . . . OP 1-8–OP 1-11
Graphics
when not accessible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-5
GUI (loss of ) indicator, description . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11
GUI symbols and abbreviations, descriptions . . . . . OP 1-12–OP 1-16
H
Hardware monitoring circuitry, description . . . . . . . . TR 15-3–TR 15-4
High circuit pressure (
1
P
PEAK
) alarm
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-16–TR 13-17
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
High delivered O
2
% (
1
O
2
%) alarm
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
High exhaled minute volume (
1V
E TOT
) alarm
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-29
High exhaled tidal volume (
1
V
TE
) alarm
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-17–TR 13-18
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-29
High inspired tidal volume (
1
V
TI
,
1
V
TI MAND
,
1
V
TI SPONT
) alarm
High respiratory rate (
1 f
TOT
) alarm
Index-3
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-29
High spontaneous inspiratory time limit (
2
T
I SPONT
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
High spontaneous inspiratory time limit
2
T
I SPONT
) setting
High-priority alarm indicator, description . . . . . . . . . . . . . . . . . . OP 1-10
HIP alarm. See High circuit pressure alarm
Hose assembly
Hose, gold standard test (for EST), part number . . . . . OP B-5, OP B-9
How to handle alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-1–OP 5-11
How to run short self test . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-1–OP 3-10
How to view graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-1–OP 6-5
Humidification type setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-5
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
how to change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-16–OP 4-17
Humidifier mounting kit, part number, Fisher & Paykel . . . . . . . OP B-5
Humidifier mounting kit, part number, Hudson RCI . . . . . . . . . OP B-5
Humidifier volume setting, function and range . . . . . . . . . . . . OP A-21
Humidifier, how to install . . . . . . . . . . . . . . . . . . . . . . . . OP 2-18–OP 2-19
I
I:E ratio (I:E) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-33
I:E ratio setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-21
IBW setting. See Ideal body weight
Ideal body weight (IBW) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-21
relationship with circuit type . . . . . . . . . . . . . . . . . . .OP 4-11, TR 12-2
INCREASE O
2
2 min key or 100% O
2
/CAL 2 min key, description OP 1-
Indicator. See name of specific indicator
Inspiration
detecting and initiating . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-1–TR 2-5
triggers flow triggering (
V
-TRIG) . . . . . . . . . . . . . . . . . . . . . . . TR 2-3–TR 2-4
operator triggering (MANUAL INSP) . . . . . . . . . . . . . . . . . . . . TR 2-5
pressure triggering (P-TRIG) . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-2
INSPIRATION TOO LONG alarm, description . . . . . TR 13-18–TR 13-19
Inspiratory filter
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
resistance check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-8
Inspiratory module
oxygen sensor replacement . . . . . . . . . . . . . . . . . . . OP 7-12–OP 7-16
Inspiratory pause maneuvers . . . . . . . . . . . . . . . . . . . . OP 4-18–OP 4-19
Inspiratory pressure (P
I
) setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 12-5–TR 12-6
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22
Inspiratory time (T
I
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22
Installation
collector vial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-13–OP 2-15
flex arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-15–OP 2-17
humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-18–OP 2-19
patient circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-10–OP 2-15
to oxygen and air supplies . . . . . . . . . . . . . . . . . . . . . .OP 2-8–OP 2-10
Intrinsic (auto) PEEP (PEEP
I
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-33
Introduction to breath delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 1-1
K
Keyboard, description . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-8–OP 1-10
L
Labels and symbols, descriptions . . . . . . . . . . . . . . . . OP 1-16–OP 1-24
Leakage current, specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-4
Light. See name of specific light
LIP alarm. See Low circuit pressure alarm
lock key (for screen), description . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
Loss of GUI display, actions to take . . . . . . . . . . . . . . . . . . . . . . . . TR 13-14
Loss of GUI indicator, description . . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-11
LOW BATTERY alarm, after ventilator storage . . . . . . . . . . . . . . . . OP 2-4
Low circuit pressure (
3
P
PEAK
) alarm
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-31
Low delivered O
2
% (
3
O
2
%) alarm
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-19–TR 13-20
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
Low exhaled mandatory tidal volume (
3
V
TE MAND
) alarm
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-30
Low exhaled spontaneous tidal volume (
3
V
TE SPONT
) alarm
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-20–TR 13-21
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-31
Low exhaled total minute volume (
3V
E TOT
) alarm
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-30
Low-priority alarm indicator, description . . . . . . . . . . . . . . . . . . .OP 1-10
Lung mechanics. See Pause mechanics
M
maintenance and service
preventive, service personnel-performed . . . . . . . . . . . . . . . .OP 7-17
schedule, operator-performed . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-7
schedule, service personnel-performed . . . . . . . OP 7-16–OP 7-17
See also 800 Series Ventilator System Service Manual
See also name of specific part
Mandatory breath delivery . . . . . . . . . . . . . . . . . . . . . . . . . .TR 4-1–TR 4-4
Mandatory breath type setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-5
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6–TR 12-8
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22
Index-4
Index
Mandatory breaths
BTPS compensation for volume-based . . . . . . . . . . . . . . . . . . . TR 4-4
comparison of pressure- and volume-based . . . . . . . TR 4-1–TR 4-2
compliance compensation for volume-based . . . . . TR 4-3–TR 4-4
mandatory inspiration (MANUAL INSP), description . . . . . . . TR 4-4
Maneuvers
inspiratory pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-18–OP 4-19
MANUAL INSP (manual inspiration), description . . . . . . . . . . . . . TR 4-4
MANUAL INSP key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
Manufacturer’s declaration . . . . . . . . . . . . . . . . . . . . . . . OP A-7–OP A-10
Mean circuit pressure (P
MEAN
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-34
Mechanics, pause. See Pause mechanics
Medium-priority alarm indicator, description . . . . . . . . . . . . . . .OP 1-10
Messages, alarm, list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 5-7–OP 5-11
Mode assist/control (A/C)
breath delivery in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-1–TR 6-2
changing to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-3–TR 6-4
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-1–TR 6-4
rate change during . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-2–TR 6-3
spontaneous (SPONT)
synchronized intermittent mandatory ventilation (SIMV)
apnea ventilation in . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-3–TR 7-4
breath delivery in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2–TR 7-3
changing to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-4–TR 7-5
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-1–TR 7-6
rate change during . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-6
Mode setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6–TR 12-8
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-23
Monitoring circuitry, description . . . . . . . . . . . . . . . . . . TR 15-3–TR 15-4
More Alarms button, function . . . . . . . . . . . . . . . . . . . . . OP 5-6, TR 13-3
N
New patient settings screen . . . . . . . . . . . . . . . . . . . . . . . . OP 4-4–OP 4-5
NIV. See Non-invasive ventilation
Non-invasive ventilation
breathing interfaces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-20
how to set up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-21–OP 4-23
Normal ventilator operation indicator, description . . . . . . . . . .OP 1-10
Nurse’s call. See Remote alarm port
O
sensor. See Oxygen sensor
O
2
% (delivered) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-32
O
2
% setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-8–TR 12-9
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-23, OP A-32
Occlusion status cycling (OSC), description . . . . . . . . . . . . . . . . .TR 10-2
Occlusion, how ventilator detects and responds . . . TR 10-1–TR 10-2
OIM breaths. See Operator-initiated mandatory breaths
Ongoing background checks. See Background checks
Onscreen symbols and abbreviations, descriptions OP 1-12–OP 1-16
Operator-initiated mandatory (OIM) breaths, description . . . . . TR 2-5
OSC (occlusion status cycling), description . . . . . . . . . . . . . . . . .TR 10-2
Other Screens button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-16
OUTCOME
in EST Single EST test results . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 18-2
Oxygen calibration key, description . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
Oxygen hose assembly, part number . . . . . . . . . . . . . . . .OP B-2, OP B-6
Oxygen regulator assembly (REG1). See Regulator, oxygen
Oxygen sensor
calibration, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 15-4
how to enable/disable . . . . . . . . . . . . . . . . . . . . . . . . OP 4-16–OP 4-17
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-11–OP 7-16
Oxygen supply, how to connect . . . . . . . . . . . . . . . . . . OP 2-8–OP 2-10
P
Part numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2–OP B-11
Pasteurization, steps involved in . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-5
Patient circuit
how to install . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-10–OP 2-15
part numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-3–OP B-8
specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-12–OP A-14
Patient circuit disconnect, how ventilator detects and responds
Patient circuit occlusion, how ventilator detects and responds TR 10-
Patient circuit type setting, function and range . . . . . . . . . . . . OP A-24
Patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 14-1–TR 14-11
Patient data, range, resolution, and accuracy . . . . . OP A-31–OP A-35
Patient problems
Patient-initiated mandatory (PIM) breaths, definition . . . . . . . . . TR 2-2
Pause mechanics
expiratory pause, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
inspiratory pause, description . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-10
intrinsic (auto) PEEP (PEEP
I
) and total PEEP (PEEP
TOT
plateau pressure (P
PL
), description . . . . . . . . . . . . . . . . . . . . . . .TR 14-5
static compliance (C
STAT
) and static resistance (R
STAT
OP 4-19– . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-20, TR 14-5–TR 14-9
PAV™*+ software option. See also Proportional Assist™* (PA) OP A-16
Index-5
Peak circuit pressure (P
PEAK
) parameter
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 14-4–TR 14-5
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-33
Peak inspiratory flow (
V
MAX
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-24
PEEP (positive end expiratory pressure) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
PEEP parameter. See End expiratory pressure
parameter. See Intrinsic (auto) PEEP parameter
parameter. See Total PEEP
Periodic maintenance
schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-17
Phasing in setting changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 11-1
I END
parameter. See End inspiratory pressure
I
setting. See Inspiratory pressure setting
PIM breaths. See Patient-initiated mandatory breaths
Plateau pressure (P
PL
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-34
Plateau time (T
PL
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
MEAN
parameter. See Mean circuit pressure
Pneumatic schematic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP C-2
Port
Positive end expiratory pressure. See PEEP
Potential equalization (ground) point
Power cord, part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2
Power on self test (POST) . . . . . . . . . . . . . . . . . . . . . . . . .TR 16-1–TR 16-4
system interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 16-3–TR 16-4
Power specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-4–OP A-5
Power supply circuit breaker, description . . . . . . . . . . . . . . . . . . . OP 2-5
Power supply, operation of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
Power switch
PEAK
. See Peak circuit pressure
PL
parameter. See Plateau pressure
Pressure sensitivity (P
SENS
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
Pressure support (P
SUPP
) setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10–TR 12-11
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
Pressure transducers, operation of . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
Pressure triggering (P-TRIG)
Preventive Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-1–OP 7-17
performed by operator . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-6–OP 7-7
performed by service personnel . . . . . . . . . . . . . . OP 7-16–OP 7-17
schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-6–OP 7-17
Primary alarm, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-3
PROCEDURE ERROR alarm, description . . . . . . . . . . . . . . . . . . . . TR 13-21
Proportional Assist™* (PA) . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-5, OP A-27
Proportional solenoid valves (PSOLs), operation of . . . . . . . . . . . OP 1-4
setting. See Pressure sensitivity
setting. See Pressure support setting
P-TRIG. See Pressure triggering
Puritan Bennett Technical Services, phone number . . . . . . . . . . OP 1-2
R
Rapid shallow breathing index (f/V
T
), function and range . . OP A-34
Re/Flex filter. See Inspiratory filter
Re/X800 filter. See Expiratory filter
Recommended limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-15
Remote alarm and RS-232 ports . . . . . . . . . . . . . . . . . . . . OP E-1–OP E-5
RESET (alarm) key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
Resistance, static (R
STAT
) parameter
description . . . . . . . . . . . . . . . . . OP 4-19–OP 4-20, TR 14-5–TR 14-9
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-35
Respiratory mechanics. See Pause mechanics
Respiratory rate (f ) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-26
Restricted phase of exhalation . . . . . . . . . . . . . . . . . . . . . .OP 1-9, TR 2-1
Rise time% setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11–TR 12-12
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-26
RS-232 commands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-1–TR 19-11
RS-232 port
how to configure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3–OP E-4
parameter. See Resistance, static
S
Safety valve open (SVO) state, description . . . . . . . . . . OP 1-6, TR 15-2
SAFETY VALVE OPEN indicator, description . . . . . . . . . . . . . . . . .OP 1-11
Index-6
Index
Safety ventilation
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-12–TR 12-13
Schedule of preventive maintenance . . . . . . OP 7-6–OP 7-7, OP 7-16
Screen
current vent setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-12
new patient settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-4–OP 4-5
normal ventilation, illustration . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-8
SCREEN key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
Screen lock key, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
Self tests. See Power on self test (POST), Short self test (SST), or
Sensor, oxygen (OS)
how to enable/disable . . . . . . . . . . . . . . . . . . . . . . . OP 4-16–OP 4-17
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-11–OP 7-16
replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-12–OP 7-16
Serial communications
commands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-1–TR 19-11
how to configure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3–OP E-4
See also 800 Ventilator System Service Manual
Service (TEST) button, description . . . . . . . . . . . . . . . . . . . . . . . . .OP 1-18
Service and repair
Service manual, part number . . . . . . . . . . . . . . . . . . . . . . OP B-5, OP B-9
Setup, ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 2-1–OP 2-21
Short POST, difference between it and full-length POST . . . . . TR 16-3
Short self test (SST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 17-1–TR 17-2
components and requirements . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-2
how to interpret test results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-9
how to run . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 3-1–OP 3-10
procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-3–OP 3-5
test results, description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-8
Silence key (for alarm), description . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
SIMV mode. See Synchronized intermittent mandatory ventilation mode
Soft bound. See Recommended limits
Software revision level display. See Ventilator configuration OP A-36
Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-1–OP A-36
bacteria filter efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-13
electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-4–OP A-5
operating pressure range . . . . . . . . . . . . . . . . . . . . . . . OP A-2, OP A-3
patient circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-12–OP A-14
pneumatic, ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-3
technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-11–OP A-13
SPONT mode. See Spontaneous mode
Spontaneous (SPONT) mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 8-1
breath delivery characteristics . . . . . . . . . . . . . . . . . . . . TR 5-1–TR 5-2
Spontaneous breath delivery . . . . . . . . . . . . . . . . . . . . . . . TR 5-1–TR 5-2
Spontaneous breath type setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-27
Spontaneous inspiratory time (T
I SPONT
Spontaneous minute volume (
V
E SPONT
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-34
Spontaneous percent inspiratory time (T
I
/T
TOT
Static compliance (C
STAT
) parameter
description . . . . . . . . . . . . . . . . .OP 4-19–OP 4-20, TR 14-5–TR 14-9
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-35
Static mechanics. See Pause mechanics
Static resistance (R
STAT
) parameter
description . . . . . . . . . . . . . . . . .OP 4-19–OP 4-20, TR 14-5–TR 14-9
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-35
Steam autoclaving, steps involved in . . . . . . . . . . . . . . . . . . . . . . . OP 7-5
Support arm
how to install . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-15–OP 2-17
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP B-2, OP B-6
SVO state. See Safety valve open state
Switch, power
symbol definitions, displaying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-7
Symbols and abbreviations, onscreen, descriptions OP 1-12–OP 1-16
Symbols and labels, descriptions . . . . . . . . . . . . . . . . . OP 1-16–OP 1-24
Index-7
Synchronized intermittent mandatory ventilation (SIMV) mode
apnea ventilation in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-3–TR 7-4
breath delivery in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2–TR 7-3
changing to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-4–TR 7-5
System faults
T
Target volume (V
T
) setting
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-27
setting. See Expiratory time setting
Technical Services, Puritan Bennett, phone number . . . . . . . . . OP 1-2
TEST (service button, description . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-18
Test lung, part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5, OP B-8
Testing
setting. See Inspiratory time setting
Tidal volume (V
T
) setting
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13–TR 12-14
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-27
Time/date
Total PEEP (PEEP
TOT
) parameter
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-35
Total respiratory rate (f
TOT
) parameter
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .TR 14-9–TR 14-11
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-35
setting. See Plateau time setting
Transducers, pressure, operation of . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
Trap, water, in-line, maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-10
Tubing circuit. See Patient circuit
U
User interface (UI). See Graphic user interface (GUI) or GUI
V
Valve, exhalation
parameter. See Spontaneous minute volume
. See Exhaled minute volume
VENT INOP indicator, description . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11
Vent Type
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
Ventilator breathing circuit. See Patient circuit
Ventilator configuration, function . . . . . . . . . . . . . . . . . . . . . . . . . OP A-36
Ventilator control parameters, how to change . . . . . . . . . . . . . OP 4-11
Ventilator inoperative condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-6
ventilator inoperative indicator, description . . . . . . . . . . . . . . . . OP 1-11
Ventilator inoperative test, description . . . . . . . . . . . . . . . . . . . . .TR 15-5
breath trigger type
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
disconnect sensitivity (D
SENS
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-19
expiratory sensitivity (E
SENS
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
expiratory time (T
E
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
flow pattern
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-3–TR 12-4
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
flow sensitivity (
V
SENS
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
high spontaneous inspiratory time limit (
2
T
I SPONT
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
how changes are phased in . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 11-1
humidification type
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-20
humidifier volume
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-21
I:E ratio
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-21
ideal body weight (IBW)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-21
how to determine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-9
relationship with circuit type . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-2
inspiratory pressure (P
I
)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-5–TR 12-6
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22
inspiratory time (T
I
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22
mandatory breath type
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6–TR 12-8
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-22
mode
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6–TR 12-8
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-23
O
2
%
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-8–TR 12-9
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-23
patient circuit type
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-24
relationship with IBW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-2
peak inspiratory flow (
V
MAX
)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-24
PEEP (positive end expiratory pressure)
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
Index-8
plateau time (T
PL
)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
pressure sensitivity (P
SENS
)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
pressure support (P
SUPP
)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-10–TR 12-11
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-25
respiratory rate (f)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-26
rise time%
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11–TR 12-12
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-26
safety ventilation
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-12–TR 12-13
settings during . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-26
spontaneous breath type
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-27
tidal volume (V
T
)
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13–TR 12-14
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-27
vent type
description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-14
function and range . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-28
Ventilator settings, ranges, resolutions, and accuracies
Ventilator setup, how to change . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 4-12
Ventilator-initiated mandatory (VIM) breath, description . . . . . TR 2-4
Vial, collector
how to install . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-13–OP 2-15
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-9–OP 7-10
part number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5, OP B-8
VIM. See Ventilator-initiated mandatory breath
setting. See Peak inspiratory flow setting
VOL (alarm volume) key, description . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
Volume key (for alarm), description . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-8
setting. See Flow sensitivity setting
T
setting. See Tidal volume
TE
setting. See Exhaled tidal volume
W
Wall Air Water Trap kit, part number . . . . . . . . . . . . . . . . . . . . . . . . . OP B-5
Water trap, in-line, maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . .OP 7-10
Index-9
Page Left Intentionally Blank
Index-10
Part No. 10067721 Rev G 2016-10
© 2011 Covidien.
Covidien, llc
15 Hampshire Street, Mansfield, MA 02048 USA.
www.covidien.com 1 800 635 5267
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Key Features
- Pressure- and volume-controlled ventilation
- Various ventilation modes
- Alarms for low air pressure and high circuit pressure
- Safety features to reduce complications
- Graphics display for monitoring patient data
- Remote alarm port and RS-232 port for connectivity