Covidien 800 840 ventilator Operator's and Technical Reference Manual

Operator’s and Technical Reference Manual
Puritan Bennett
TM
800 Series Ventilator System
To obtain information about a warranty, if any, contact Covidien Technical Services at
1.800.635.5267 or your local representative.
Purchase of this instrument confers no express or implied license under any Covidien
patent to use the instrument with any ventilator system that is not manufactured or
licensed by Covidien.
Copyright Information
Copyright 2011 Covidien. All rights reserved. The Puritan Bennett™ 840 Ventilator
System is manufactured in accordance with Covidien proprietary information. U.S.
Patents 5,271,389; 5,319,540; 5,339,807; 5,771,884; 5,791,339; 5,813,399; 5,865,168;
5,881,723; 5,884,623; 5,915,379; 5,915,380; 6,024,089; 6,161,539; 6,220,245; 6,269,812;
6,305,373; 6,360,745; 6,369,838; 6,553,991; 6,668,824; 6,675,801; 7,036,504; 7,117,438;
RE39225. COVIDIEN, COVIDIEN with logo, the Covidien 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.
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.
You should ensure you have the most current applicable version of this manual; if in
doubt, contact Covidien or visit the Puritan Bennett™ product manual web page at:
http://www.puritanbennett.com/serv/manuals.aspx
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 its use, is as stated in
the limited warranty provided.
Nothing in this manual 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.
Preface
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. They include:
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.
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Preface
Warnings, cautions, and notes
Please take the time to familiarize yourself with the following safety
considerations, special handling requirements, and regulations that
govern the use of the Puritan Bennett™ 840 Ventilator System.
•
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.
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.
•
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.
•
To avoid a fire hazard, keep matches, lighted cigarettes, and all
other sources of ignition (e.g., flammable anesthetics and/or
heaters) away from the Puritan Bennett™ 840 Ventilator System
and oxygen hoses.
Do not use oxygen hoses that are worn, frayed, or contaminated
by combustible materials such as grease or oils. Textiles, oils, and
other combustibles are easily ignited and burn with great
intensity in air enriched with oxygen.
In case of fire or a burning smell, immediately disconnect the
ventilator from the oxygen supply, facility power, and backup
power source.
•
When handling any part of the Puritan Bennett™ 840 Ventilator
System, always follow your hospital infection control guidelines
for handling infectious material.
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
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
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Preface
pathogens as they relate to our products should be brought to
the attention of your lab Pathologist as well as your infection
control personnel and/or risk committee.
•
Patients on life-support equipment should be appropriately
monitored by competent medical personnel and suitable
monitoring devices.
The Puritan Bennett™ 840 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 lifesupport equipment.
iv
•
For a thorough understanding of ventilator operations, be sure
to thoroughly read this manual before attempting to use the
system.
•
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.
•
Do not use sharp objects to make selections on the graphic user
interface (GUI) display or keyboard.
•
US federal law restricts this device to sale by or on the order of a
physician.
•
Check the ventilator periodically as outlined in 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.
•
An alternative source of ventilation should always be available
when using the Puritan Bennett™ 840 Ventilator System.
•
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/or 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/or breath type.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Preface
Warranty
The Puritan Bennett™ 840 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 graphic user interface (GUI), breath delivery unit (BDU), backup
power source (BPS), and compressor contain a specific year of
manufacture applicable only 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 02048
USA
Authorized representative
Covidien Ireland Limited
IDA Business & Technology Park
Tullamore
Electromagnetic susceptibility
The Puritan Bennett™ 840 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 the ESD
requirements of this standard.
However, even at this level of device immunity, certain transmitting
devices (cellular phones, walkie-talkies, 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
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Preface
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 Puritan Bennett™ 840 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 your local representative.
This manual describes possible ventilator alarms and what to do if
they occur. Consult with your institution’s biomedical engineering
department in case of interrupted ventilator operation, and before
relocating any life support equipment.
Customer assistance
For further assistance contact your local Covidien representative.
For online technical support, visit the
SolvITSM Center Knowledge Base at
http://www.puritanbennett.com
The SolvIT Center provides answers to
frequently asked questions about the Puritan Bennett™ 840
Ventilator System and other Covidien products 24 hours a day, 7 days
a week.
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Preface
Preface
This manual is divided into two parts: the operator’s manual and the
technical reference. The operator’s manual describes how to operate
the Puritan Bennett™ 840 Ventilator System. It also provides product
specifications and accessory order numbers. The technical reference
includes background information about how the ventilator
functions, including details on its operating modes, self-tests, and
other features. In the table of contents and index, the prefix OPidentifies page numbers in the operator’s manual, and the prefix TRidentifies page numbers in the technical reference.
Any references to the software options BiLevel, Volume Ventilation
Plus (VV+) which includes 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. Contact Covidien for questions about
the applicability of the information.
Some illustrations and images are shown with a ready-to-assemble
(RTA) cart, Puritan Bennett 800 Series Ventilator Compressor Mount
Cart, or a Puritan Bennett 800 Series Ventilator Pole Cart. Please 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.
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2
Table of Contents
Operator’s Manual
1 Introduction
OP 1-1
1.1 Technical description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-4
1.1.1 General background. . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-4
1.1.2 Pressure and flow triggering . . . . . . . . . . . . . . . . . . . . OP 1-5
1.1.3 Breathing gas mixture . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-5
1.1.4 Inspiratory pneumatics . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-6
1.1.5 Patient circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-6
1.1.6 AC mains and backup power system . . . . . . . . . . . . . . OP 1-7
1.1.7 Ventilator emergency states . . . . . . . . . . . . . . . . . . . . OP 1-8
1.2 Graphic user interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-9
1.3 User interface controls and indicators. . . . . . . . . . . . . . . . OP 1-11
1.3.1 Onscreen symbols and abbreviations . . . . . . . . . . . . OP 1-18
1.4 Ventilator system labeling symbols . . . . . . . . . . . . . . . . . . OP 1-23
2 How to set up the Puritan Bennett™ 840 ventilator
OP 2-1
2.1 How to connect the electrical supply . . . . . . . . . . . . . . . . . OP 2-4
2.2 How to connect the air and oxygen supplies . . . . . . . . . . OP 2-10
2.3 How to connect the patient circuit components . . . . . . . OP 2-13
2.3.1 How to select and connect a patient circuit . . . . . . . OP 2-14
2.3.2 How to install the expiratory filter and
collector vial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-17
2.3.3 How to install the flex arm . . . . . . . . . . . . . . . . . . . . OP 2-20
2.3.4 How to install the humidifier. . . . . . . . . . . . . . . . . . . OP 2-22
2.3.5 How to use the ventilator cart . . . . . . . . . . . . . . . . . OP 2-24
3 How to run Short Self Test (SST)
3.1
3.2
3.3
3.4
3.5
OP 3-1
Introduction to SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-1
When to run SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-2
SST components and requirements . . . . . . . . . . . . . . . . . . . OP 3-3
SST Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-4
SST Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-12
3.5.1 How to interpret individual SST test results . . . . . . . OP 3-14
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Table of Contents
3.5.2 SST outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-15
4 How to use the Puritan Bennett™ 840 ventilator
OP 4-1
4.1 Structure of user interface . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-2
4.2 Patient setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3
4.2.1 How to ventilate with most recent control
parameters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3
4.2.2 How to ventilate with new control parameters . . . . . OP 4-4
4.2.3 Patient data and current settings . . . . . . . . . . . . . . . . OP 4-7
4.2.4 Ideal Body Weight (IBW) . . . . . . . . . . . . . . . . . . . . . . . OP 4-9
4.3 How to change the main ventilator control parameters . OP 4-16
4.4 Ideal Body Weight (IBW), vent type, mode, and
other changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-16
4.5 How to select a constant timing variable during
respiratory rate changes . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-18
4.6 How to change apnea ventilation settings . . . . . . . . . . . . OP 4-20
4.7 How to set alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-21
4.8 How to change other settings . . . . . . . . . . . . . . . . . . . . . . OP 4-22
4.9 Expiratory pause maneuvers. . . . . . . . . . . . . . . . . . . . . . . . OP 4-24
4.10 Inspiratory pause maneuvers . . . . . . . . . . . . . . . . . . . . . . OP 4-25
4.11 How to interpret inspiratory pause maneuver
results for static compliance and resistance . . . . . . . . . . OP 4-26
4.12 How to use NIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-27
4.12.1 NIV intended use. . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-27
4.12.2 NIV breathing interfaces. . . . . . . . . . . . . . . . . . . . . . OP 4-28
4.12.3 NIV setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-29
4.12.4 High spontaneous inspiratory time limit setting . . OP 4-31
4.12.5 Apnea setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-32
4.12.6 Alarm setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-32
4.12.7 Changing patient from INVASIVE to
NIV Vent Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-33
4.12.8 Changing patient from NIV to INVASIVE
Vent Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-34
4.12.9 NIV patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-35
5 How to handle alarms
OP 5-1
5.1 Ventilator alarm classifications. . . . . . . . . . . . . . . . . . . . . . . OP 5-1
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Table of Contents
5.2
5.3
5.4
5.5
5.6
Alarm silence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-2
Alarm reset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-4
Alarm log. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-5
Alarm volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-6
Alarm messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-7
6 How to view graphics
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
OP 6-1
Graphics display function . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-1
How to set up a graphics display . . . . . . . . . . . . . . . . . . . . . OP 6-3
Graphics display details and calculations . . . . . . . . . . . . . . OP 6-4
How to adjust displayed graphics . . . . . . . . . . . . . . . . . . . . OP 6-5
The graphics display FREEZE function . . . . . . . . . . . . . . . . . OP 6-6
How to print patient data graphics . . . . . . . . . . . . . . . . . . . OP 6-7
Automatic display of graphics . . . . . . . . . . . . . . . . . . . . . . . OP 6-7
When graphics are not accessible . . . . . . . . . . . . . . . . . . . . OP 6-7
7 Preventive maintenance
OP 7-1
7.1 How to dispose of used parts. . . . . . . . . . . . . . . . . . . . . . . . OP 7-1
7.2 How to clean, disinfect and sterilize parts . . . . . . . . . . . . . OP 7-2
7.2.1 How to clean components . . . . . . . . . . . . . . . . . . . . . . OP 7-7
7.3 Disinfection and sterilization . . . . . . . . . . . . . . . . . . . . . . . . OP 7-8
7.4 Preventive maintenance procedures for the operator . . . OP 7-11
7.4.1 Total operational hours . . . . . . . . . . . . . . . . . . . . . . . OP 7-11
7.4.2 Inspiratory and expiratory bacteria filters . . . . . . . . OP 7-13
7.4.3 Daily or as required: collector vial and drain bag. . . OP 7-15
7.4.3.1 How to remove the collector vial . . . . . . . . . . . OP 7-15
7.4.3.2 How to remove the drain bag . . . . . . . . . . . . . . OP 7-15
7.4.4 Daily or as required: in-line water traps . . . . . . . . . . OP 7-16
7.4.5 Every 250 hours: compressor inlet filter . . . . . . . . . . OP 7-17
7.4.6 Every year: ventilator inspection . . . . . . . . . . . . . . . . OP 7-17
7.4.7 Every year or as necessary: oxygen sensor . . . . . . . . OP 7-18
7.4.7.1 Oxygen sensor replacement procedure . . . . . . OP 7-18
7.5 Additional preventive maintenance procedures . . . . . . . OP 7-23
7.6 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-24
7.7 Repacking and shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-25
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Table of Contents
A Specifications
OP A-1
A.1 Physical characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-2
A.2 Environmental requirements . . . . . . . . . . . . . . . . . . . . . . . OP A-4
A.3 Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-5
A.4 Electrical specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-5
A.5 Compliance and approvals . . . . . . . . . . . . . . . . . . . . . . . . . OP A-9
A.5.1 Manufacturer’s Declaration . . . . . . . . . . . . . . . . . . . OP A-10
A.6 Technical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-19
A.7 Ranges, resolutions, and accuracies. . . . . . . . . . . . . . . . . OP A-25
A.7.1 Recommended limits . . . . . . . . . . . . . . . . . . . . . . . . OP A-26
A.7.2 Software options . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-27
B Part numbers
OP B-1
C Pneumatic schematic
OP C-1
D Alarm and oxygen sensor calibration testing
OP D-1
D.1 Alarm test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP D-1
D.2 Oxygen sensor calibration test. . . . . . . . . . . . . . . . . . . . . . OP D-7
E Remote alarm and RS-232 ports
OP E-1
E.1 Remote alarm port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-2
E.2 RS-232 port . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3
E.3 How to configure the RS-232 ports . . . . . . . . . . . . . . . . . . . OP E-4
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Table of Contents
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Table of Contents
Technical Reference
1 Introduction to breath delivery
TR 1-1
2 Detecting and initiating inspiration
TR 2-1
2.1 Internally triggered inspiration . . . . . . . . . . . . . . . . . . . . . .
2.1.1 Pressure sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.1.2 Flow sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.1.3 Time-cycled inspiration. . . . . . . . . . . . . . . . . . . . . . . . .
2.2 Operator-triggered inspiration . . . . . . . . . . . . . . . . . . . . . .
3 Detecting and initiating exhalation
TR 2-2
TR 2-2
TR 2-4
TR 2-5
TR 2-6
TR 3-1
3.1 Internally initiated exhalation . . . . . . . . . . . . . . . . . . . . . . .
3.1.1 Time-cycled exhalation. . . . . . . . . . . . . . . . . . . . . . . . .
3.1.2 End-inspiratory flow method. . . . . . . . . . . . . . . . . . . .
3.1.3 Airway pressure method . . . . . . . . . . . . . . . . . . . . . . .
3.2 Backup limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2.1 Time limit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.2.2 High circuit pressure limit . . . . . . . . . . . . . . . . . . . . . .
3.2.3 High ventilator pressure limit . . . . . . . . . . . . . . . . . . .
4 Mandatory breath delivery
TR 3-1
TR 3-1
TR 3-2
TR 3-2
TR 3-3
TR 3-3
TR 3-4
TR 3-4
TR 4-1
4.1 Comparison of pressure- and volume-based
mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2 Compliance compensation for volume-based
mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3 BTPS compensation for volume-based
mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4 Manual inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TR 4-1
TR 4-4
TR 4-5
TR 4-6
5 Spontaneous breath delivery
TR 5-1
6 Assist/control (A/C) mode
TR 6-1
6.1 Breath delivery in A/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-1
6.2 Rate change during A/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-3
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6.3 Changing to A/C mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 6-3
7 Synchronous intermittent mandatory ventilation
(SIMV)
7.1
7.2
7.3
7.4
TR 7-1
Breath delivery in SIMV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-3
Apnea ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-4
Changing to SIMV mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-5
Rate change during SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-7
8 Spontaneous (SPONT) mode
TR 8-1
8.1 Breath delivery in SPONT . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 8-1
8.2 Changing to SPONT mode . . . . . . . . . . . . . . . . . . . . . . . . . . TR 8-2
9 Apnea ventilation
TR 9-1
9.1
9.2
9.3
9.4
Apnea detection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-1
Transition to apnea ventilation . . . . . . . . . . . . . . . . . . . . . . TR 9-3
Key entries during apnea ventilation . . . . . . . . . . . . . . . . . TR 9-3
Resetting apnea ventilation . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
9.4.1 Resetting to A/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
9.4.2 Resetting to SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-4
9.4.3 Resetting to SPONT . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 9-5
9.5 Phasing in new apnea intervals . . . . . . . . . . . . . . . . . . . . . . TR 9-5
10 Detecting occlusion and disconnect
TR 10-1
10.1 Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-1
10.2 Disconnect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 10-3
10.3 Occlusions and disconnect annunciation . . . . . . . . . . . . . TR 10-5
11 Phasing in setting changes
TR 11-1
12 Ventilator settings
TR 12-1
12.1
12.2
12.3
12.4
12.5
xiv
Apnea ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-1
Circuit type and Ideal Body Weight (IBW) . . . . . . . . . . . TR 12-2
Disconnect sensitivity (DSENS) . . . . . . . . . . . . . . . . . . . . . . TR 12-3
Expiratory sensitivity (ESENS) . . . . . . . . . . . . . . . . . . . . . . . TR 12-4
Expiratory time (TE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-4
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12.6 Flow pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-4
12.7 Flow sensitivity (VSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-5
12.8 High spontaneous inspiratory time limit (2TI SPONT). . . . TR 12-6
12.9 Humidification type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-6
12.10 I:E ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7
12.11 Ideal body weight (IBW). . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7
12.12 Inspiratory pressure (PI) . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7
12.13 Inspiratory time (TI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-7
12.14 Mode and mandatory breath type . . . . . . . . . . . . . . . . TR 12-8
12.15 O2% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-12
12.16 Peak inspiratory flow (VMAX) . . . . . . . . . . . . . . . . . . . . TR 12-13
12.17 PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13
12.17.1 PEEP restoration . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-13
12.18 Plateau time (TPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-14
12.19 Pressure sensitivity (PSENS) . . . . . . . . . . . . . . . . . . . . . . TR 12-14
12.20 Pressure support (PSUPP) . . . . . . . . . . . . . . . . . . . . . . . . TR 12-14
12.21 Respiratory rate (f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-15
12.22 Rise time % . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-15
12.23 Safety ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-17
12.24 Spontaneous breath type . . . . . . . . . . . . . . . . . . . . . . . TR 12-17
12.25 Tidal volume (VT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-18
12.26 Vent type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-18
13 Alarms
TR 13-1
13.1 Alarm handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-1
13.1.1 Alarm messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-3
13.1.2 Alarm summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-4
13.2 AC POWER LOSS alarm . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-20
13.3 APNEA alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-20
13.4 CIRCUIT DISCONNECT alarm. . . . . . . . . . . . . . . . . . . . . . TR 13-21
13.5 DEVICE ALERT alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-22
13.6 High circuit pressure (↑PPEAK) alarm . . . . . . . . . . . . . . . TR 13-22
13.7 High delivered O2% (↑O2%) alarm . . . . . . . . . . . . . . . . TR 13-23
13.8 High exhaled minute volume (↑V E TOT) alarm . . . . . . . TR 13-23
13.9 High exhaled tidal volume (↑VTE) alarm . . . . . . . . . . . . TR 13-24
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13.10 High inspired tidal volume alarm (↑VTI, ↑VTI MAND,
↑VTI SPONT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-24
13.11 High respiratory rate (↑fTOT) alarm . . . . . . . . . . . . . . . TR 13-25
13.12 INSPIRATION TOO LONG alarm . . . . . . . . . . . . . . . . . . TR 13-25
13.13 Low circuit pressure alarm (↓PPEAK) . . . . . . . . . . . . . . . TR 13-25
13.14 Low delivered O2% (↓O2%) alarm . . . . . . . . . . . . . . . . TR 13-26
13.15 Low exhaled mandatory tidal volume
(↓VTE MAND) alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-27
13.16 Low exhaled spontaneous tidal volume
(↓VTE SPONT) alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-27
13.17 Low exhaled total minute volume (↓VE TOT) alarm. . . TR 13-27
13.18 PROCEDURE ERROR alarm . . . . . . . . . . . . . . . . . . . . . . TR 13-28
14 Patient data
TR 14-1
14.1 Delivered O2%. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-1
14.2 End expiratory pressure (PEEP). . . . . . . . . . . . . . . . . . . . . TR 14-2
14.3 End inspiratory pressure (PI END). . . . . . . . . . . . . . . . . . . . TR 14-2
14.4 Exhaled minute volume (VE TOT) . . . . . . . . . . . . . . . . . . . TR 14-3
14.5 Exhaled tidal volume (VTE) . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4
14.6 I:E ratio (I:E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-4
14.7 Intrinsic (auto) PEEP (PEEPI) and total PEEP (PEEPTOT) . . TR 14-4
14.8 Mean circuit pressure (PMEAN) . . . . . . . . . . . . . . . . . . . . . TR 14-5
14.9 Peak circuit pressure (PPEAK) . . . . . . . . . . . . . . . . . . . . . . . TR 14-5
14.10 Plateau pressure (PPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 14-6
14.11 Spontaneous minute volume (VE SPONT) . . . . . . . . . . . . TR 14-6
14.12 Static compliance and resistance (CSTAT and RSTAT) . . . . TR 14-6
14.13 Total respiratory rate (fTOT) . . . . . . . . . . . . . . . . . . . . . TR 14-13
15 Safety net
15.1
15.2
15.3
15.4
15.5
15.6
15.7
15.8
xvi
TR 15-1
Patient problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-2
System faults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-2
Ongoing background checks . . . . . . . . . . . . . . . . . . . . . . TR 15-3
Hardware monitoring circuitry. . . . . . . . . . . . . . . . . . . . . TR 15-4
Power on self test (POST) . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
Short self test (SST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
Extended self test (EST). . . . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
Oxygen sensor calibration . . . . . . . . . . . . . . . . . . . . . . . . TR 15-5
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15.9 Exhalation valve calibration . . . . . . . . . . . . . . . . . . . . . . .
15.10 Ventilator inoperative test . . . . . . . . . . . . . . . . . . . . . . .
15.11 Flow sensor offset calibration . . . . . . . . . . . . . . . . . . . .
15.12 Atmospheric pressure transducer calibration . . . . . . . .
16 Power on self test (POST)
16.1
16.2
16.3
16.4
16.5
16.6
TR 15-6
TR 15-6
TR 15-6
TR 15-6
TR 16-1
Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
POST characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
POST following power interruptions. . . . . . . . . . . . . . . .
POST fault handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
POST system interface. . . . . . . . . . . . . . . . . . . . . . . . . . . .
POST user interface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TR 16-1
TR 16-2
TR 16-3
TR 16-4
TR 16-4
TR 16-5
17 Short self test (SST)
TR 17-1
18 Extended self test (EST)
TR 18-1
18.1 EST results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-2
18.2 EST failure handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-3
18.3 EST safety considerations . . . . . . . . . . . . . . . . . . . . . . . . . TR 18-3
19 RS-232 commands
TR 19-1
19.1 RSET command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-1
19.2 SNDA command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-1
19.3 SNDF command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-8
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2
Figures
Operator’s Manual
Figure 1-1.
Figure 1-2.
Figure 2-1.
Figure 2-2.
Figure 2-3.
Figure 2-4.
Figure 2-5.
Figure 2-6.
Figure 2-7.
Figure 2-8.
Figure 2-9.
Figure 2-10.
Figure 2-11.
Figure 2-12.
Figure 2-13.
Figure 2-14.
Figure 2-15.
Figure 3-1.
Figure 4-1.
Figure 4-2.
Puritan Bennett™ 840 Ventilator System block
diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-4
Puritan Bennett™ 840 Ventilator System Graphic
User Interface (GUI). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-10
How to lift the ventilator components . . . . . . . . . . . . . . . OP 2-3
How to connect the ventilator power cord . . . . . . . . . . . . OP 2-6
Ventilator power switch, AC indicator, and AC panel . . . OP 2-7
Power cord storage on the RTA cart . . . . . . . . . . . . . . . . . OP 2-8
Power cord storage on the newer
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart and Puritan Bennett™ 800 Series
Ventilator Pole Cart (shown) . . . . . . . . . . . . . . . . . . . . . . . OP 2-9
How to connect the air and oxygen supplies . . . . . . . . . OP 2-12
How to connect the patient circuit . . . . . . . . . . . . . . . . . OP 2-16
How to install the expiratory filter and collector vial. . . OP 2-17
How to use the collector vial with or without the
drain bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-19
How to install the flex arm on RTA cart . . . . . . . . . . . . . OP 2-20
How to install the flex arm on the newer
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart or Puritan Bennett™ 800 Series
Ventilator Pole Cart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-21
How to install the humidifier (Fisher & Paykel™*
version shown) for ventilators mounted on RTA carts . . OP 2-23
Location of cart lot number label . . . . . . . . . . . . . . . . . . OP 2-25
How to lock and unlock the RTA cart’s front wheels . . . OP 2-26
How to lock and unlock the Puritan Bennett™ 800
Series Ventilator Compressor Mount Cart or
Puritan Bennett™ 800 Series Ventilator Pole
Cart front wheels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 2-26
Test button location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-5
Touch screen user interface . . . . . . . . . . . . . . . . . . . . . . . . OP 4-2
Ventilator Startup screen . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-3
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
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Figures
Figure 4-3.
Figure 4-4.
Figure 4-5.
Figure 4-6.
Figure 4-7.
Figure 4-8.
Figure 4-9.
Figure 5-1.
Figure 5-2.
Figure 5-3.
Figure 5-4.
Figure 6-1.
Figure 6-2.
Figure 7-1.
Figure 7-2.
Figure 7-3.
Figure 7-4.
Figure 7-5.
Figure A-1.
Figure B-1.
Figure B-2.
Figure B-3.
Figure C-1.
Figure E-1.
Figure E-2.
Figure E-3.
xx
Touch screen appearance during normal ventilation
(shown with alarm silence and 100% O2/CAL
in progress). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-8
TI (or TH) selected as the constant during rate change . . OP 4-19
Alarm setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-22
New patient setup screen — NIV . . . . . . . . . . . . . . . . . . . OP 4-29
NIV ventilator settings screen . . . . . . . . . . . . . . . . . . . . . . OP 4-31
New patient default alarm settings . . . . . . . . . . . . . . . . . OP 4-32
More patient data screen — NIV . . . . . . . . . . . . . . . . . . . OP 4-35
Alarm indicators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-1
Alarm Silence in Progress indicator (lower screen) . . . . . . OP 5-3
Alarm log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-5
Alarm message format . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-8
Pressure-volume loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-2
Flow-volume loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 6-3
How to empty the collector vial and seal
the drain bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-16
806 compressor with inlet filter . . . . . . . . . . . . . . . . . . . . OP 7-17
Dislodge the O2 sensor access cover . . . . . . . . . . . . . . . . . OP 7-20
Open O2 sensor access port. . . . . . . . . . . . . . . . . . . . . . . . OP 7-20
Locate O2 sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-21
Recommended patient circuit configurations . . . . . . . . . OP A-17
Ventilator accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-2
Ventilator accessories (Puritan Bennett™ 800 Series
Ventilator Compressor Mount Cart shown) . . . . . . . . . . . OP B-12
Puritan Bennett™ 840 Ventilator System shown
mounted on Puritan Bennett™ 800 Series Ventilator
Pole Cart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP B-20
Pneumatic schematic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP C-1
Remote alarm and RS-232 ports . . . . . . . . . . . . . . . . . . . . . OP E-1
Remote alarm port pinout (view from back of GUI) . . . . . OP E-2
RS-232 serial port pinout. . . . . . . . . . . . . . . . . . . . . . . . . . . OP E-3
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Figures
2
Figures
Technical Reference
Figure 2-1.
Figure 2-2.
Figure 2-3.
Figure 3-1.
Declaring inspiration using pressure sensitivity . . . . . . . . . TR 2-3
Declaring inspiration using flow sensitivity. . . . . . . . . . . . . TR 2-4
Time-cycled inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 2-6
Initiating exhalation using the end-inspiratory flow
method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-2
Figure 3-2. Initiating exhalation using the airway
pressure method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 3-3
Figure 6-1. A/C mode, no patient effort detected . . . . . . . . . . . . . . . . . TR 6-2
Figure 6-2. A/C mode, patient effort detected. . . . . . . . . . . . . . . . . . . . TR 6-2
Figure 6-3. A/C mode, VIM and PIM breaths . . . . . . . . . . . . . . . . . . . . . TR 6-2
Figure 7-1. SIMV breath cycle (mandatory and spontaneous
intervals) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2
Figure 7-2. SIMV breath cycle, PIM delivered within
mandatory interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2
Figure 7-3. SIMV breath cycle, PIM not delivered within
mandatory interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-2
Figure 7-4. Apnea ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . TR 7-5
Figure 9-1. Apnea interval equals breath period . . . . . . . . . . . . . . . . . . TR 9-2
Figure 9-2. Apnea interval greater than breath period. . . . . . . . . . . . . TR 9-2
Figure 9-3. Apnea interval less than breath period . . . . . . . . . . . . . . . . TR 9-3
Figure 12-1. Puritan Bennett™ 840 Ventilator System modes
and breath types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-11
Figure 13-1. Alarm message format (upper GUI screen) . . . . . . . . . . . . TR 13-3
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2
Tables
Operator’s Manual
Table 1-1:
Table 1-2:
Table 1-3:
Table 2-1:
Table 3-1:
Table 3-2:
Table 3-3:
Table 4-1:
Table 4-2:
Table 4-3:
Table 4-4:
Table 4-5:
Table 4-6:
Table 4-7:
Table 5-1:
Table 7-1:
Table 7-2:
Table 7-3:
Table 7-4:
Table A-1:
Table A-2:
Table A-3:
Table A-4:
Table A-5:
Table A-6:
Table A-7:
Controls and indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-11
BDU indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 1-17
Symbols and abbreviations . . . . . . . . . . . . . . . . . . . . . . . . OP 1-18
Patient circuit and IBW values . . . . . . . . . . . . . . . . . . . . . OP 2-15
SST test sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-8
Individual SST test results . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-14
Overall SST outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 3-15
Ideal Body Weight (IBW) based on patient height
(cm to kg) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-9
Determining IBW based on patient height
(ft., in. to lb.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 4-12
Soft bound ranges for Ideal Body Weight and
tube Internal Diameter (ID) . . . . . . . . . . . . . . . . . . . . . . . OP 4-14
Patient circuit and IBW values . . . . . . . . . . . . . . . . . . . . . OP 4-15
Monitored ventilator control parameters . . . . . . . . . . . . OP 4-16
Automatic settings changes —
INVASIVE to NIV on same patient . . . . . . . . . . . . . . . . . . OP 4-33
Automatic settings changes —
NIV to INVASIVE on same patient . . . . . . . . . . . . . . . . . . OP 4-34
Alarm messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 5-9
Procedures to clean, disinfect, and sterilize parts . . . . . . . OP 7-3
Disinfection and sterilization procedures . . . . . . . . . . . . . OP 7-9
Operator preventive maintenance procedures
and frequency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-12
Service preventive maintenance procedures
and intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP 7-23
Physical characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-2
Environmental requirements . . . . . . . . . . . . . . . . . . . . . . . OP A-3
Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-3
Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-4
Compliance and approvals . . . . . . . . . . . . . . . . . . . . . . . . . OP A-6
Electromagnetic Emissions . . . . . . . . . . . . . . . . . . . . . . . . . OP A-8
Electromagnetic Immunity . . . . . . . . . . . . . . . . . . . . . . . . . OP A-8
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xxiii
Tables
Table A-8:
Table A-9:
Table A-10:
Table A-11:
Table A-12:
Table A-13:
Table A-14:
Table A-15:
Table A-16:
Table B-1:
Table B-2:
Table B-3:
xxiv
Electromagnetic Immunity – conducted and
radiated RF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .OP A-10
Recommended separation distances between
portable and mobile RF communications equipment
and the Puritan Bennett™ 840 Ventilator System . . . . . . OP A-12
Compliant cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-12
Technical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-14
Patient circuit configurations . . . . . . . . . . . . . . . . . . . . . . OP A-17
Ventilator settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-19
Alarm settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-30
Patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP A-34
Other Screens — displayed data . . . . . . . . . . . . . . . . . . . . OP A-37
Ventilator parts and accessories . . . . . . . . . . . . . . . . . . . . . OP B-3
Ventilator parts and accessories . . . . . . . . . . . . . . . . . . . . OP B-13
Ventilator Pole Cart and accessories . . . . . . . . . . . . . . . . . OP B-21
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Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Tables
2
Tables
Technical Reference
Table 4-1:
Table 4-2:
Table 5-1:
Table 12-1:
Table 13-1:
Table 13-2:
Table 13-3:
Table 14-1:
Table 19-1:
Table 19-2:
Comparison of pressure- and volume-based
mandatory breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-2
Compliance volume factors . . . . . . . . . . . . . . . . . . . . . . . . . . TR 4-5
Spontaneous breath delivery characteristics . . . . . . . . . . . TR 5-1
Modes and breath types . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 12-9
Alarm urgency levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-2
Alarm summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-4
Applicability of high inspired tidal volume
alarm symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 13-24
Inspiratory pause maneuver displays . . . . . . . . . . . . . . . . . TR 14-9
MISCA response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-2
MISCF response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TR 19-9
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xxvi
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Introduction
1
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 Puritan Bennett™ 840 Ventilator System facilitates
work of breathing management, offers selectable
modes of breath delivery, and assists the practitioner in
the selection of 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 ventilation of the patient.
The SmartAlert system intercepts alarms, or events,
provides specific information about the cause, and
prompts the user with actions to resolve the reported
condition(s).
The breath delivery unit (BDU) comprises the
pneumatics and the patient circuit.
Introduction
The ventilator uses two independent Central Processing Units (CPUs):
•
Breath delivery unit (BDU) CPU
•
Graphic user interface (GUI) CPU
The BDU CPU uses the ventilator control parameters, selected by the
practitioner, to deliver breaths to the patient. The BDU 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 BDU
CPU and prevents simultaneous failure of control and monitor
functions when a single fault is reported.
The Puritan Bennett™ 840 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.
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 (BPS) 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 at least 60 minutes (30 minutes on
ventilators built prior to July 2007), which allows transport of the
patient and the ventilator within the healthcare facility. The 803
extended BPS (available after October 2009) can power the
ventilator for at least four hours under the same conditions. The
same conditions apply, respectively, to the one-hour or four-hour BPS
assembly in the Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart and the one-hour or four-hour batteries in the
Puritan Bennett™ 800 Series Ventilator Pole Cart.
This manual tells you how to operate and perform simple
maintenance for the Puritan Bennett™ 840 Ventilator System.
Become familiar with this manual and accompanying labels before
attempting to operate or maintain the ventilator.
OP 1-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
To ensure optimum performance of the Puritan Bennett™ 840
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 your representative.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-3
Introduction
1.1
Technical description
1.1.1 General background
The practitioner uses the GUI touch screens, the off-screen keys, and
GUI knob to select the ventilator control parameters and input data
(see Figure 1-1). The GUI CPU processes this information and stores it
in ventilator memory. The BDU CPU uses this 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 and data
integrity.
Graphic user
interface (GUI)
Inspiratory
module:
PSOLs
Safety valve
Oxygen sensor
Pressure transducers
Flow sensors
Exhalation
module:
Active exhalation valve
Pressure transducer
Flow sensor
Air
regulator
Oxygen
regulator
Air
supply
Expiratory
filter
Collector
vial
(Expiratory
limb)
Patient
circuit
Oxygen
supply
(Inspiratory
limb)
Inspiratory
filter
Humidification
device
Figure 1-1. Puritan Bennett™ 840 Ventilator System block diagram
OP 1-4
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
1.1.2 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.
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 is at least the operator-selected value for
flow sensitivity, the ventilator delivers a breath.
If the patient is not inhaling, 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 which can
cause autotriggering, the operator can increase the flow sensitivity
setting.
As a backup method of triggering inspiration, a pressure sensitivity
of 2 cmH2O is also in effect. This setting is the most sensitive setting
still large enough to avoid autotriggering, yet will trigger with
acceptable patient effort.
1.1.3 Breathing gas mixture
Air and oxygen from cylinders, wall supplies, or compressor (air only)
enter the ventilator through hoses and fittings (the fittings are
available in several versions). Once inside the ventilator, air and
oxygen are regulated to pressures appropriate for the ventilator,
then mixed according to the selected O2%.
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 here, using a galvanic oxygen
sensor. The galvanic sensor generates a voltage proportional to the
oxygen concentration. The ventilator reports an alarm if the O2
sensor is enabled and monitored oxygen concentration is more than
seven percent above or below the O2% setting, or below 18% after
the concentration stabilizes.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-5
Introduction
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.
1.1.4 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), which
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 BDU CPU uses to control the PSOLs.
As a result, the ventilator supplies mixed breathing gas to the
patient, based on the practitioner-set 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.
1.1.5 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
OP 1-6
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
system monitors the exhaled gas leaving the patient circuit for
spirometry.
NOTE:
The Puritan Bennett™ 840 Ventilator System does not have
the capability to reduce pressure below the PEEP pressure
during the expiratory phase.
Throughout the respiratory cycle, pressure transducers monitor
inspiratory, expiratory, and atmospheric pressures. The temperature
of the exhaled gas is heated to a temperature above its dew point to
prevent condensation in the exhalation compartment. Refer to
Appendix C for a detailed diagram of the ventilator’s pneumatic
system and patient circuit.
1.1.6 AC mains and backup power system
The ventilator derives its power to operate from the AC mains (wall)
power or the backup power system (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 power-off.
The ventilator connects to the 802 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 at least 60 minutes (30 minutes on ventilators built
prior to July 2007). The 803 extended BPS can power the ventilator
for at least 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 4-070212-85) 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.
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 Puritan Bennett™ 800
Series Ventilator Compressor Mount Cart and has a four-hour BPS or
the ventilator is mounted on a Puritan Bennett™ 800 Series
Ventilator Pole Cart with a four-hour battery, the software version,
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-7
Introduction
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 one-hour BPS or one-hour battery are equivalent to the
description given for the 802 BPS.
1.1.7 Ventilator emergency states
Emergency states include ventilator inoperative and safety valve
open (SVO). When a ventilator inoperative condition occurs, it
always includes the SVO state. A SVO state can also occur
independent of a ventilator inoperative condition.
The following describe the two ventilator emergency states:
•Safety valve open (SVO): The ventilator
enters a SVO state if both air and oxygen
supplies are lost, or an occlusion is
detected, or the ventilator enters the
Ventilator Inoperative condition.
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-urgency 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 to 120 cmH2O.
•Ventilator inoperative: 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 ventilator inoperative condition
occurs, the ventilator inoperative indicator
on the front face of the BDU illuminates
and the ventilator enters the SVO state,
which in turns sounds a high-urgency alarm.
OP 1-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
If a ventilator inoperative condition occurs, immediately remove
the ventilator from use until qualified service personnel evaluate
and correct the Vent Inop condition.
If the ventilator declares a ventilator inoperative state, the power
on self test (POST) must first verify 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.
1.2
Graphic user interface
This section describes the graphic user interface (GUI), the GUI keys,
the GUI indicators, and the symbols you see on the GUI.
The graphic user interface (GUI) of the Puritan Bennett™ 840
Ventilator System comprises the DualView touch screens, the offscreen keys located below the touch screens, and a knob. Use the
knob to set a given ventilator control parameter to 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.
Figure 1-2 identifies the components of the GUI, and the location of
information on the DualView touch screens.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-9
Introduction
Upper screen:
monitored
information
(alarms,
patient data)
Vital patient data
Alarm and ventilator status
Status
indicators
Assorted patient data,
including graphical displays
Active alarm log, if applicable
Primary patient parameters
Lower screen:
ventilator
control
parameters
Setup of ventilator control
parameters, alarm limits,
breath timing parameters,
and other parameters
Prompt
Symbol definitions area
Off-screen CLEAR
keys
key
ACCEPT
key
Knob
Figure 1-2. Puritan Bennett™ 840 Ventilator System
Graphic User Interface (GUI)
OP 1-10
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
1.3
User interface controls and indicators
Descriptions of the controls and indicators on the graphic user
interface are given in Table 1-1 below.
Table 1-1: Controls and indicators
Control or
indicator
Function
Screen lock key: When the yellow light on the screen lock key is lit,
the screen or 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 sound for two
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 twominute interval times out. High-urgency 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 two 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-11
Introduction
Table 1-1: Controls and indicators
Control or
indicator
Function
Alarm reset key: Clears active alarms or resets high-urgency alarms
and cancels an active alarm silence, and is recorded in the alarm
log. 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%
O2/CAL 2 min key and newer ventilators use the INCREASE O2 2 min
key. Delivers 100% oxygen (if available) for two minutes and
calibrates the oxygen sensor. The green light on this key illuminates
and a message (100% O2 Cal in Progress) on the lower touch screen
indicates 100% O2 delivery is active. If you press the O2 key again,
the system restarts the two-minute delivery interval. Press CANCEL
to stop the calibration. See page TR 15-5 for information on
calibrating the oxygen sensor.
Use the procedure in Section D.2 to test the oxygen sensor
calibration.
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 (PEEPL) to High PEEP (PEEPH) (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 inspiratory pause maneuver in
SPONT mode.
OP 1-12
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
Table 1-1: Controls and indicators
Control or
indicator
Function
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
PEEPTOT and PEEPI (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 of the EXP PAUSE
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, 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. Section 4.9 on page OP 4-24
describes in detail how to use the EXP PAUSE key.
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. The
inspiratory pause maneuver provides a means to measure the
patient’s static lung-thoracic compliance (CSTAT), static resistance
(RSTAT), and plateau pressure (PPL). 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 CSTAT and RSTAT at the end of the plateau and displays
the values at the end of the maneuver. PPL is computed and
updated continuously during the plateau, and its value is frozen at
the end of the plateau. Section 4.10 on page OP 4-25 describes in
detail how to use the INSP PAUSE key.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-13
Introduction
Table 1-1: Controls and indicators
Control or
indicator
Function
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-urgency alarm indicator ( ! ! ! ): This alarm indicator
blinks rapidly if active; it is steadily lit if autoreset.
Yellow medium-urgency alarm indicator ( ! ! ): This alarm indicator
blinks slowly if active; it turns off if autoreset.
Yellow low-urgency 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 1-14
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Introduction
Table 1-1: Controls and indicators
Control or
indicator
Function
Gray normal ventilator operation indicator: No ventilator
inoperative condition exists when indicator is not illuminated.
Red ventilator inoperative 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.
Gray normal GUI operation indicator: No loss of GUI condition
exists when indicator is not illuminated.
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 1-15
Introduction
Table 1-1: Controls and indicators
Control or
indicator
Function
Green BPS ready indicator: The ventilator senses the BPS is
installed, operational, and has at least two (2) minutes of
estimated run time.
On battery power indicator: When the yellow bar to the right of a
lit BPS ready indicator (battery symbol) 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 (if available) is off.
Green compressor ready indicator: The compressor logic 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.
Green compressor operating indicator: When symbol to
the right of a lit compressor unit ready indicator is lit, compressor is
supplying air to the ventilator. This indicator does not light unless
the compressor is actually supplying air to the ventilator.
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The indicators on the breath delivery unit are shown in Table 1-2.
Table 1-2: BDU indicators
Red ventilator inoperative 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.
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.
Red loss of GUI indicator: The ventilator has detected a
malfunction that prevents the GUI from reliably displaying or
receiving information.
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OP 1-17
Introduction
1.3.1 Onscreen symbols and abbreviations
Touch an onscreen symbol to display its definition in the lower left
corner of the lower screen. Table 1-3 summarizes the symbols and
abbreviations the ventilator uses.
For example, if you touch:
VMAX
L
21.8 min
The symbol definition area shows this message:
VMAX = Peak flow
Table 1-3: Symbols and abbreviations
Symbol or
abbreviation
(blinking)
Definition
Additional active alarms related to the monitored information are
active. The symbol blinks when there is not enough screen area to
display all active alarms.
The upper alarm limit
The lower alarm limit
Press to access the alarm log
Alarm log contains events not yet viewed
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Introduction
Table 1-3: Symbols and abbreviations
Symbol or
abbreviation
Definition
Rise time percent
P
%
Flow pattern
RAMP SQUARE
The value you selected for a ventilator control parameter exceeds
its recommended limit (soft bound) and requires
acknowledgement to continue
or
The value selected exceeds its allowable minimum or maximum
limit (hard bound)
Press to view more patient data
Press to view patient data graphics
Press to view additional screens
X-axis (time or pressure) adjust of patient data graphics
Y-axis (pressure, volume, or flow) adjust of patient data graphics
Baseline pressure (PEEP) adjust
A/C
Assist/control ventilation mode
AV
Apnea ventilation
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OP 1-19
Introduction
Table 1-3: Symbols and abbreviations
Symbol or
abbreviation
CSTAT
Definition
Static compliance
ESENS
Spont expiratory sensitivity percentage
EST
Extended self test
f
Respiratory rate (ventilator control parameter)
f TOT
Total respiratory rate (monitored)
↑ f TOT
High respiratory rate alarm
GUI
Graphic user interface
HME
Heat-moisture exchanger
I:E
Inspiratory to expiratory ratio
O2
Monitored oxygen percentage (patient data)
O2
Oxygen percentage (ventilator control parameter)
1O2%
High delivered O2% alarm
↓O2%
Low delivered O2% alarm
PC
Pressure control (mandatory breath type)
PMEAN
Mean circuit pressure
↑ PPEAK
High circuit pressure alarm
2PPEAK
High circuit pressure alarm limit
3PPEAK
Low circuit pressure alarm
4PPEAK
Low circuit pressure alarm limit
PPEAK
Peak circuit pressure (patient data)
PEEP
Positive end expiratory pressure (ventilator control parameter)
PEEPH
High PEEP (ventilator control parameter, BILEVEL mode only)
PEEPI
Intrinsic PEEP (patient data)
PEEPL
Low PEEP (ventilator control parameter, BILEVEL mode only)
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Table 1-3: Symbols and abbreviations
Symbol or
abbreviation
PEEPTOT
PEEP
PI
PI END
Definition
Total PEEP (patient data)
End expiratory pressure (patient data)
Inspiratory pressure (ventilator control parameter)
End inspiratory pressure (patient data)
PPL
Plateau pressure (patient data)
POST
Power on self test
PS
Pressure support (spontaneous breath type)
PSENS
Pressure sensitivity
PSUPP
Pressure support (ventilator control parameter)
P-TRIG
Pressure triggering
↑ P VENT
High internal ventilator pressure alarm
RSTAT
Static resistance
SIMV
Synchronous intermittent mandatory ventilation mode
SPONT
Spontaneous ventilation mode
SST
Short self test
TA
Apnea interval
TE
Expiratory time
TH
High PEEP time (BILEVEL mode only)
TI
Inspiratory time
1TI SPONT
High spontaneous inspiration time alarm
2TI SPONT
High spontaneous inspiration time alarm limit
TL
Low PEEP time (BILEVEL mode only)
TPL
Plateau time
VE SET
Set minute volume (calculated from ventilator control parameters)
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OP 1-21
Introduction
Table 1-3: Symbols and abbreviations
Symbol or
abbreviation
Definition
VE SPONT
Exhaled spontaneous minute volume
1VE TOT
High exhaled minute volume alarm
3VE TOT
Low exhaled minute volume alarm
VC
Volume control (mandatory breath type)
VMAX
Peak flow (ventilator control parameter)
VSENS
Flow sensitivity
VT
Tidal volume
VTE
Exhaled tidal volume
1 VTE
High exhaled tidal volume alarm
3 VTE MAND
Low exhaled mandatory tidal volume alarm
3VTE SPONT
Low exhaled spontaneous tidal volume alarm
VTI
Inspired tidal volume
1 VTI
High inspired (mandatory or spontaneous) tidal volume alarm*
VTI MAND
1 VTI MAND
VTI SPONT
1 VTI SPONT
V-TRIG
Inspired mandatory tidal volume
High inspired mandatory tidal volume alarm*
Inspired spontaneous tidal volume
High inspired spontaneous tidal volume alarm*
Flow triggering
*Refer to Technical Reference Section 13.10 for information regarding inspired tidal
volume alarms.
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1.4
Ventilator system labeling symbols
The following symbols appear on the various components of the
Puritan Bennett™ 840 Ventilator System.
NOTE:
All labels shown are examples, and may not reflect the exact
configuration of your ventilator.
Power switch positions: I represents the power on position and
. represents power off position. The power switch, located on the
BDU front panel, turns ON/OFF the BDU and the GUI. When the
power switch is in the off position, the BPS continues to charge if
AC power is present.
Refer to manual: When this symbol appears on the product, it
means refer to documentation for information.
Type B equipment, per IEC 60601-1
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)
Signifies compliance with the Medical Device Directive, 93/42/EEC
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OP 1-23
Introduction
CSA certification mark that signifies the product has been
evaluated to the applicable ANSI/Underwriters Laboratories Inc.
(UL) and CSA standards for use in the US and Canada.
Date of manufacture label
1996-05
SN
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 802 BPS indicates the 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 Puritan Bennett™ 800 Series
Ventilator 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 one-hour battery is installed in
the Puritan Bennett™ 800 Series Ventilator Compressor Mount
Cart.
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Battery indicator label: Indicates a four-hour battery is installed in
the Puritan Bennett™ 800 Series Ventilator Compressor Mount
Cart.
Charging status indicator on Puritan Bennett™ 800 Series
Ventilator Pole Cart: Indicates the charging status of the battery. A
yellow indicator next to the partially full battery icon indicates the
battery is charging. A green indicator next to the full battery icon
indicates the battery is charged.
Battery indicator label: Indicates a one-hour battery is installed in
the Puritan Bennett™ 800 Series Ventilator Pole Cart
Battery indicator label: Indicates a four-hour battery is installed in
the Puritan Bennett™ 800 Series Ventilator Pole Cart
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
PTS 2000
TEST (service) button: After you touch the Short Self Test (SST)
onscreen key (available only during ventilator startup), you must
press the TEST button within 5 seconds in order to access SST.
PTS 2000 Performance Test System connection, for use by qualified
service personnel only.
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OP 1-25
Introduction
GUI connection
Circuit breaker for ventilator power supply, located in the BDU.
Ventilator circuit breaker for compressor and humidifier
NOTE:
A humidifier connection is only available on 100 - 120 V
ventilators.
Alternating current (at AC inlet and AC power indicator)
Maximum allowed output to auxiliary mains socket (compressor
electrical connection)
BPS electrical connection
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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 filter latch is open.
GUI mounting latch unlock/lock
Remote alarm port
IOIOI
RS-232 port
Susceptible to electrostatic discharge
Electric shock hazard
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OP 1-27
Introduction
Explosion hazard
Fire hazard
802 BPS product information label
803 BPS product information label
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GUI product information label
GUI ports label
Remote alarm and RS-232 port (9.4-inch GUI only). Refer to Appendix E for GUI remote
alarm and RS-232 port specifications.
Humidifier electrical label
(This label not visible unless cover plate over humidifier electrical connection is
removed. A humidifier connection is only available on 100 - 120 V ventilators.)
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Introduction
BDU gas inlet label
BDU To patient label
Compressor gas connection label
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Introduction
Compressor information label
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Introduction
BDU information label
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Introduction
BDU cooling vent label
BDU I/O disconnect label
BDU exhaust information label
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OP 1-33
Introduction
BPS electrical connection label
Compressor lint filter label
Expiratory limb connector on exhalation filter
From patient
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OP 1-34
SECTION
How to set up the Puritan Bennett™ 840 ventilator
Chapter 2 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 an 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.
2
How to set up the Puritan Bennett™ 840 ventilator
Warning
• When you lift the ventilator, use assistance and appropriate
safety precautions. Figure 2-1 shows the proper technique
to lift each ventilator component.
• To avoid interrupted ventilator operation or possible
damage to the ventilator, always use the ventilator on a
level surface in its proper orientation.
• 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.
• To minimize the increased risk of fire due to an oxygenenriched environment, do not use the ventilator in a
hyperbaric chamber.
• To avoid raising the oxygen concentration of room air, use
the ventilator in an adequately ventilated room.
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Lift GUI from
base and
handle
Lift the BDU
from horizontal
surfaces as shown.
Lift the GUI from
the base and the handle.
Use two people to lift
the compressor from
the base and the handles.
Figure 2-1. How to lift the ventilator components
Caution
• Do not connect or disconnect the ventilator’s graphic user
interface (GUI), backup power source (BPS), or compressor
while the power switch is on or the ventilator is connected
to AC power.
• All components must be securely mounted and connected
by qualified service personnel according to the appropriate
Covidien installation instructions.
• Do not obstruct the breath delivery unit (BDU), GUI, or
compressor cooling vents or fan vents.
• To avoid possible damage to ventilator components, do not
use the horizontal surfaces of the ventilator to place or
stack objects.
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OP 2-3
How to set up the Puritan Bennett™ 840 ventilator
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 7 of this manual.
Follow your institution’s protocol for cleaning and sterilizing
the ventilator and its components.
2.1
How to connect the electrical supply
Warning
• To minimize the risk of electrical shock, always connect the
ventilator power cord into a grounded AC power outlet.
• 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.
• If you are using a newer Puritan Bennett™ 800 Series
Ventilator Compressor Mount Cart or Puritan Bennett™ 800
Series Ventilator Pole Cart, you must ensure you connect
the battery back-up system harness to the ventilator.
• Do not disconnect the battery back-up system, GUI, or
compressor from the ventilator while in use.
• When possible, connect the ventilator to an outlet
connected to the hospital emergency back-up power
system. Refer to Section A.4 for ventilator electrical
specifications.
Normally the Puritan Bennett™ 840 Ventilator System is
mains-powered. The 802 or 803 BPS or battery backup system in
newer Puritan Bennett™ 800 Series Ventilator Compressor Mount
Cart and Puritan Bennett™ 800 Series Ventilator Pole Cart 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 at least 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,
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fully charged 803 BPS (available after October 2009) can operate the
ventilator (without the compressor or a humidifier) for at least four
hours. The same conditions apply, respectively, to the one-hour or
four-hour BPS assembly in the Puritan Bennett™ 800 Series
Ventilator Compressor Mount Cart and the one-hour or four-hour
batteries in the Puritan Bennett™ 800 Series Ventilator Pole Cart.
Warning
The 802 or 803 BPS and the battery backup systems in the
Puritan Bennett™ 800 Series Ventilator Compressor Mount
Cart and the Puritan Bennett™ 800 Series Ventilator 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 back up system in the
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart or
Puritan Bennett™ 800 Series Ventilator Pole Cart by leaving it
connected to a ventilator connected to AC power for up to eight
hours (ventilator does not need to be turned on). Because of the
larger battery capacity, the 803 BPS or four-hour BPS or battery in
the Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart
or Puritan Bennett™ 800 Series Ventilator 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 one-hour or four-hour BPS assembly in the
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart and
the one-hour or four-hour batteries in the Puritan Bennett™ 800
Series Ventilator Pole Cart.
Figure 2-2 shows how to connect the power cord to AC power. Builtin power cord retainer tabs protect against accidental disconnection.
Ensure the power cord is securely fastened into the AC receptacle
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OP 2-5
How to set up the Puritan Bennett™ 840 ventilator
prior to operation. To remove the cord, squeeze the tabs on the top
and bottom of the plug and pull outward.
Power
cord
To AC power
Power cord retainer tabs.
Squeeze tabs and pull
outward to disconnect
power cord.
Figure 2-2. How to connect the ventilator power cord
Figure 2-3 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
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart and
the Puritan Bennett™ 800 Series Ventilator 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.
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Ventilator
power supply
circuit breaker
AC power
connection
AC panel
AC indicator
Ventilator
power switch
Humidifier
and compressor
circuit breaker
Potential
equalization
(ground
point)
Compressor
connection
Figure 2-3. Ventilator power switch, AC indicator, and AC panel
If the ventilator power supply circuit breaker (located on the
ventilator's AC panel, Figure 2-3) opens but AC power is still present
and the ventilator is operating on BPS, power is still available to the
humidifier and compressor connectors (although ventilator software
disables compressor operation).
NOTE:
A humidifier connection is only available on 100 - 120 V
ventilators.
When the power cord is not in use, wrap the power cord around the
hook on the back of the cart for convenient storage (Figure 2-4 and
Figure 2-5). The power cord is stored the same way on the
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart and
the Puritan Bennett™ 800 Series Ventilator Pole Cart.
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OP 2-7
How to set up the Puritan Bennett™ 840 ventilator
Figure 2-4. Power cord storage on the RTA cart
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How to set up the Puritan Bennett™ 840 ventilator
Figure 2-5. Power cord storage on the newer
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart and
Puritan Bennett™ 800 Series Ventilator Pole Cart (shown)
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OP 2-9
How to set up the Puritan Bennett™ 840 ventilator
2.2
How to connect the air and oxygen supplies
The Puritan Bennett™ 840 Ventilator System can use air and oxygen
from cylinder or wall supplies. Follow these steps to connect the air
and oxygen supplies:
1. Ensure the supply pressures are 35 to 100 psi (241 to 690 kPa),
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.
Warning
Due to excessive restriction of certain hose assemblies (listed
in Table B-1), reduced ventilator performance may result
when oxygen or air supply pressures < 50 psi (345 kPa) are
employed.
2. Connect the supply hoses to the inlet connectors at the rear of
the ventilator (see Figure 2-6).
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.
• 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.
• Do not use anti-static or electrically conductive hoses in the
ventilator breathing system.
• Use only gas supply hoses recommended by Covidien.
Other hoses may be restrictive and may cause improper
ventilator operation.
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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.
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
(Figure 2-6).
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OP 2-11
How to set up the Puritan Bennett™ 840 ventilator
Air inlet
connector
Oxygen
inlet
connector
Oxygen hose
(from oxygen
supply)
Air hose
(from air
supply)
Figure 2-6. How to connect the air and oxygen supplies
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2.3
How to connect the patient circuit components
Warning
• 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.
• To minimize the risk of patient injury, use only patient
circuits qualified for use in oxygen-enriched environments
with the Puritan Bennett™ 840 Ventilator System. Do not
use antistatic or electrically conductive tubing in the
ventilator breathing system. To ensure a leak-tight
connection, only use connectors and tubes with ISOstandard cone and socket fittings (or use adapters to
connect barbed cuff fittings to ISO-standard fittings).
• If you use an external, pneumatically-powered nebulizer
with the Puritan Bennett™ 840 Ventilator System, it adds
flow to the patient circuit and can adversely affect
spirometry, delivered O2%, delivered tidal volumes, and
breath triggering. Additionally, aerosolized particulates in
the ventilator circuit can lead to an increase in exhalation
filter resistance.
• Use one of the patient circuits listed in Appendix B to
ensure the maximum pressure/flow values specified by
IEC 60601-2-12:2001 are not exceeded (see Table A-11 on
page OP A-20 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.
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OP 2-13
How to set up the Puritan Bennett™ 840 ventilator
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 circuit type, for
example, from adult to pediatric or neonatal).
•
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.
2.3.1 How to select and connect 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.
Table 2-1 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.
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Table 2-1: Patient circuit and IBW values
Recommendation
Recommended
Allowed but not
recommended
Ideal body weight (IBW) in kg (lb)
Neonatal: 0.3-7.0 kg (0.66-15 lb)*
Pediatric: 7.0-24 kg (15-53 lb)
Adult: 25-150 kg (55-330 lb)
*Assumes NeoMode 2.0 software option is
installed
Neonatal: Not applicable
Pediatric: 3.5-6.5 kg (7.7-14.3 lb), and
25-35 kg (55-77 lb)
Adult: 7-24 kg (15-53 lb)
Figure 2-7 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.
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OP 2-15
How to set up the Puritan Bennett™ 840 ventilator
(From patient)
Expiratory
filter
Patient wye
Expiratory limb
of patient circuit
(To patient)
Inspiratory
filter
Tubing
Collector
vial
Inspiratory limb
of patient circuit
Humidifier
Figure 2-7. How to connect the patient circuit
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 A).
If adding accessories to the patient circuit, always run SST to
measure circuit compliance before beginning ventilation of
the patient.
OP 2-16
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to set up the Puritan Bennett™ 840 ventilator
2.3.2 How to install 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 Figure 2-8).
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 2-9).
2
1
3
4
5
6
Figure 2-8. How to install the expiratory filter and collector vial
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 2-17
How to set up the Puritan Bennett™ 840 ventilator
Item
Description
1
Pull latch up to install filter, pull down to hold filter and
collector vial in place
2
Slide the filter rim onto these tracks
3
Filter housing area
4
Expiratory filter
5
Expiratory limb connection (from patient)
6
Collector vial
If you use a drain bag:
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 Puritan Bennett™ 800 Series Ventilator
Compressor Mount Cart or Puritan Bennett™ 800 Series
Ventilator Pole Cart (Figure 2-9).
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 2-18
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to set up the Puritan Bennett™ 840 ventilator
Place the drain bag
in the drawer of the RTA cart
or hang the drain bag on
the button provided on the side of the
cart
Drain bag
Tubing
Clamp
The collector vial drain port
must be capped if you do not
use a drain bag
Figure 2-9. How to use the collector vial with
or without the drain bag
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 2-19
2.3.3 How to install the flex arm
The flex arm supports the patient circuit between the ventilator and
the patient. Figure 2-10 and Figure 2-11 show how to install the flex
arm onto one of the two (in ready-to-assemble carts) or four (in
newer Puritan Bennett™ 800 Series Ventilator Compressor Mount
Cart or Puritan Bennett™ 800 Series Ventilator Pole Cart) threaded
sockets on the ventilator cart.
Flex arm
Threaded socket
(one of two)
Figure 2-10. How to install the flex arm on RTA cart
OP 2-20
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to set up the Puritan Bennett™ 840 ventilator
Flex arm
Threaded
socket
(one of four)
Figure 2-11. How to install the flex arm on the newer
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart or
Puritan Bennett™ 800 Series Ventilator Pole Cart
Caution
Use only the cart handles to move the ventilator. Do not pull
or push the ventilator with the flex arm.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 2-21
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.
2.3.4 How to install the humidifier
An electrical outlet for a humidifier is located on the front of the
BDU. Figure 2-12 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 B-2 and Table B-3 of
Appendix B for humidifiers mounted on Puritan Bennett™ 800
Series Ventilator Compressor Mount Carts and Puritan Bennett™ 800
Series Ventilator Pole Carts, respectively.
Warning
• When using a Fisher & Paykel™* humidifier with the
Puritan Bennett™ 840 Ventilator System, use the
appropriate Fisher & Paykel™* humidifier chambers for
adult, pediatric, and neonatal patients.
• Take proper precautions to prevent water/condensate from
splashing into the patient circuit during circuit disconnects
and high peak flow rate conditions.
• 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.
• 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.
OP 2-22
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to set up the Puritan Bennett™ 840 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.
•
When you install a Fisher & Paykel™* humidifier, make sure
the humidifier has a right-angle electrical plug. A short power
cord is preferable.
•
To ensure ventilator occlusion detection operates properly, do
not use Puritan Bennett™ Cascade humidifiers with the
Puritan Bennett™ 840 Ventilator System.
•
If you have further questions about humidifiers qualified
for use with the Puritan Bennett™ 840 Ventilator System,
contact your representative.
•
A humidifier connection is only available on 100 - 120 V
ventilators.
BDU
Plug cover
Humidifier
Mounting
bracket on
front of
ventilator
Figure 2-12. How to install the humidifier
(Fisher & Paykel™* version shown)
for ventilators mounted on RTA carts
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 2-23
How to set up the Puritan Bennett™ 840 ventilator
2.3.5 How to use the ventilator cart
Three optional carts are available for use with the Puritan Bennett 840
ventilator: the RTA (ready-to-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 Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart can be used with a BPS having a one-hour battery or an
optional four-hour battery. The Puritan Bennett™ 800 Series Ventilator
Pole Cart also has a one-hour or optional four-hour battery as part of its
battery backup system.
Warning
Install only ventilator BDUs with serial numbers starting with
3512 onto the newer Puritan Bennett 800 Series Ventilator
Compressor Mount Cart and Puritan Bennett™ 800 Series
Ventilator Pole Cart. Other ventilator serial numbers are not
compatible with the newer carts.
The Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart
and the Puritan Bennett™ 800 Series Ventilator Pole Cart may not be
available in all regions. Please 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 2-13).
OP 2-24
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to set up the Puritan Bennett™ 840 ventilator
Lot number label
Figure 2-13. Location of cart lot number label
Warning
Lock the cart’s wheels prior to installing or removing
ventilator components.
Figure 2-14 and Figure 2-15 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 2-25
How to set up the Puritan Bennett™ 840 ventilator
Press large tab
down to lock
Press small tab
down to unlock
Unlocked position
Locked position
Figure 2-14. How to lock and unlock the RTA cart’s front wheels
Press down to lock
Lift up to unlock
Unlocked position
Locked position
Figure 2-15. How to lock and unlock the
Puritan Bennett™ 800 Series Ventilator Compressor Mount Cart or
Puritan Bennett™ 800 Series Ventilator Pole Cart front wheels
OP 2-26
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
How to run Short Self Test (SST)
Chapter 3 tells you:
3.1
•
When to run SST
•
Required equipment for SST
•
How to set up and run SST
•
The SST tests and their functions
•
How to understand the results of SST
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 three minutes to complete.
3
How to run Short Self Test (SST)
Warning
3.2
•
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.
•
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.
•
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
installed before you begin to ventilate the patient.
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 events
below occurs:
OP 3-2
•
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
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to run Short Self Test (SST)
•
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.
3.3
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
•
Inspiratory filter
•
Humidifier, as applicable
•
Other accessories (e.g. water traps, drain bag), as applicable
Additional requirements include:
•
A No. 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 35-100 psi (241 to 690 kPa)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 3-3
How to run Short Self Test (SST)
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.
• 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 ten minutes after you turn on the ventilator before you
run SST. The warm up time of ten minutes will stabilize the ventilator
and ensure the accuracy of the SST tests.
3.4
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.
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 ten minutes with the power
on.
3. Install the patient circuit, 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 3-4
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
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 five seconds. (Refer to Figure 3-1 for location of TEST
button.)
The system displays the SST Setup screen (lower touch screen).
NOTE:
You must press the TEST button within five seconds of touching
the SST button or SST will not start.
Test button
Figure 3-1. Test button location
Caution
Do not press the test button when powering up the ventilator.
This may cause the ventilator to enter Service Mode. If you
enter Service Mode, do not attempt to run Extended Self Test
(EST) with a patient circuit. Doing so will cause EST to fail. If
EST fails, the ventilator will remain in a Ventilator Inoperative
state until EST successfully passes.
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 3-5
How to run Short Self Test (SST)
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
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.
For optimum accuracy, rerun SST using the new humidifier.
8. The ventilator automatically starts the test sequence. Refer to
Table 3-1 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 Table 3-2).
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.
OP 3-6
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to run Short Self Test (SST)
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. Table 3-3
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 3-7
How to run Short Self Test (SST)
Table 3-1: SST test sequence
Test step
SST Setup
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.
OP 3-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to run Short Self Test (SST)
Table 3-1: SST test sequence
Test step
SST Setup
(cont)
Function
Comments
The system prompts you
to connect the patient
circuit to inspiratory
filter.
Use Figure 2-7 on
page OP 2-16 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
No. 1 stopper.
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.
4. Press ACCEPT.
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 2-7 on page OP 2-16 for
connection information.
Circuit
Pressure Test
The system verifies
proper function of the
BDU pressure sensors.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
If the status of the Circuit
Pressure Test is FAILURE,
you cannot use the
OVERRIDE function.
10067720 Rev. B
OP 3-9
How to run Short Self Test (SST)
Table 3-1: SST test sequence
Test step
Function
Comments
Circuit Leak
Test
The system determines
the ability of the circuit
to hold pressure.
The system displays the
drop in circuit pressure
over a 10 second
interval.
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.
Expiratory
Filter
Resistance
Test
The system prompts you
to detach circuit tubing
from the expiratory
filter.
1. Detach the patient
circuit from the
expiratory filter.
At the conclusion of the
Expiratory Filter
Resistance Test, the
system displays the
pressure drop across the
expiratory filter.
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.
The system prompts you
to reattach the patient
circuit.
3. Reattach the patient
circuit to the expiratory
filter.
2. Press ACCEPT to begin
the test.
4. Press ACCEPT to begin
the next test.
OP 3-10
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to run Short Self Test (SST)
Table 3-1: SST test sequence
Test step
Circuit
Resistance
Compliance
Calibration
Function
Comments
The system prompts you
to unblock the patient
wye.
1. Remove the stopper
from the 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.
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.
The system prompts you
to block the patient
wye.
1. Block the wye with a
No. 1 stopper.
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.
3. Press ACCEPT to indicate
YES or CLEAR to indicate
NO, as appropriate, to
indicate whether or not
there is water in the
humidifier.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
2. Press ACCEPT to begin
the test.
2. Press ACCEPT to begin
the patient circuit
compliance test.
10067720 Rev. B
OP 3-11
How to run Short Self Test (SST)
Table 3-1: SST test sequence
Test step
Compliance
Calibration
(cont)
Function
Comments
The system displays the
compliance of the
patient circuit.
ALERT for the patient circuit
The system prompts you
to unblock the patient
wye.
3.5
If the system reports an
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.
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.
OP 3-12
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to run Short Self Test (SST)
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
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 Table 3-2 and Table 3-3 to learn how to interpret and
respond to each of these SST status categories.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 3-13
How to run Short Self Test (SST)
3.5.1 How to interpret individual SST test results
SST reports a test result status for each of the individual tests. Use
Table 3-2 to interpret SST test results and to determine how to
respond.
Table 3-2: Individual SST test results
If the test
status is:
It means:
Do this:
PASSED
The system did not
detect a fault for
the individual test.
You do not need to do anything, unless you are
prompted by the ventilator.
ALERT
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.
When the system prompts you, touch one of
these buttons, then press ACCEPT:
EXIT SST
RESTART SST
NEXT
REPEAT
FAILURE
A critical problem
has been detected,
and SST cannot
complete until the
ventilator passes the
failed test.
10067720 Rev. B
Repeat SST from the
beginning
Proceed to the next test
Repeat the test
Touch one of these buttons, then press ACCEPT:
EXIT SST
RESTART SST
REPEAT
OP 3-14
Discontinue SST
Discontinue SST
Repeat SST from the
beginning
Repeat the test
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to run Short Self Test (SST)
3.5.2 SST outcomes
When SST has completed all of the tests, use Table 3-3 to determine
how to proceed.
Table 3-3: Overall SST outcomes
If the SST
outcome
is:
It means:
Do this:
PASSED
All tests passed.
Touch one of these buttons, then press ACCEPT:
EXIT SST
RESTART SST
ALERT
FAILURE
Exit SST and begin normal
ventilation
Repeat SST from the
beginning
One or more faults
were detected. If
you can determine
with certainty that
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.
Touch one of these buttons, then press ACCEPT:
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.
Restart SST with a different patient circuit.
Touch one of these buttons, then press ACCEPT:
EXIT SST
RESTART SST
OVERRIDE
EXIT SST
RESTART SST
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Discontinue SST
Repeat SST from the
beginning
Press ACCEPT to override
the ALERT, as allowed by
your institution’s protocol.
Touch EXIT SST, then press
ACCEPT to begin normal
ventilation.
Discontinue SST
Press ACCEPT to repeat SST
from the beginning. If the
failure persists, contact
qualified service personnel.
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OP 3-16
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
How to use the Puritan Bennett™ 840 ventilator
Chapter 4 tells you:
•
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.
4
How to use the Puritan Bennett™ 840 ventilator
4.1
Structure of 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 touch screens.
Upper screen
Display More patient Alarm log
Active alarms Other screens Trending (if
Option is
graphics data (e.g. O2%, (time, event,
installed)
urgency, alarm,
PI END)
analysis)
Diagnostic
code log
(system
diagnostic,
system
information,
EST/SST
diagnostic
logs)
Operational
time 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
vent setup (vent
type, mode,
breath types,
trigger type,
settings)
Current/proposed Current/proposed Other screens
apnea setup
alarm settings
Communication
Time/date
setup (printer/DCI, change
baud rate, data bits,
parity mode)
More settings
(humidification type,
O2 sensor enable/
disable, disconnect
sensitivity, humidifier
volume, and access
to additional options)
Figure 4-1. Touch screen user interface
OP 4-2
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4.2
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 (see Figure 4-2) on the lower screen. The
prompt area, located in the lower right corner of the lower screen,
contains setup instructions.
Figure 4-2. Ventilator Startup screen
4.2.1 How to ventilate with 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.
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OP 4-3
How to use the Puritan Bennett™ 840 ventilator
4.2.2 How to ventilate with new control parameters
Refer to Table A-12 in Appendix A 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 Table 4-1 and Table 4-2.) 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
Section 4.12 for specific information on how to use NIV)
Mode: Determines the type and sequence of breath delivery
• A/C (Assist/Control)
• SIMV (Synchronous Intermittent Mandatory Ventilation)
• SPONT (Spontaneous)
OP 4-4
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• CPAP (Continuous Positive Airway Pressure, available only
with NeoMode software option when Vent Type is NIV)
• BILEVEL (available only with BiLevel software option when
Vent Type is INVASIVE)
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 available only with the TC software
option when Vent Type is INVASIVE)
• VS (Volume Support available only with the VV+ software
option when Vent Type is INVASIVE)
• PA (Proportional Assist™* 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 will display.)
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OP 4-5
How to use the Puritan Bennett™ 840 ventilator
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.
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 1-2) 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.
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.
8. You may choose to calibrate the ventilator’s oxygen sensor at this
point. Press the 100% O2 / CAL 2 min or INCREASE O2 2 min key
located on the keyboard below the touch screens. See page TR
15-5 for more information on calibrating the oxygen sensor.
During the oxygen sensor calibration, the ventilator delivers
100% oxygen (if available) for two minutes and calibrates the
oxygen sensor in the Breath Delivery Unit (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.
9. After you accept the ventilation control parameters, you can
attach a patient to the ventilator. Ventilation only begins when
the ventilator senses a patient is attached.
OP 4-6
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How to use the Puritan Bennett™ 840 ventilator
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 Table 4-4.
The recommended ranges exist to ensure patient safety. Only
those with expertise to judge the appropriate circumstances
should override the recommended ranges.
4.2.3 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 MORE
PATIENT 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 (Figure 4-6). If you press the 100% O2/CAL 2 min
key or INCREASE O2 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 higherpriority display active. Press the CANCEL button for either indicator to
cancel the alarm silence or oxygen sensor calibration in progress.
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OP 4-7
How to use the Puritan Bennett™ 840 ventilator
Vital patient data area
Breath type
(C = Control)
Alarm area
Patient data
(upper screen)
Subscreen area
Main ventilator
control settings
Ventilator settings
(lower screen)
Subscreen area
Figure 4-3. Touch screen appearance during normal ventilation
(shown with alarm silence and 100% O2/CAL in progress)
OP 4-8
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How to use the Puritan Bennett™ 840 ventilator
4.2.4 Ideal Body Weight (IBW)
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. Table 4-1 and Table 4-2 below provide the
information needed to determine the patient’s IBW using the
patient’s height. The New Patient Value is the tube I D high value for
the chosen IBW in Table 4-3.
Table 4-1: Ideal Body Weight (IBW) based
on patient height (cm to kg)
Patient
height
(cm)
IBW
(kg)
Patient
height
(cm)
IBW
(kg)
Patient
height
(cm)
IBW
(kg)
52
3.5
92
14
129
31
55
4
95
15
131
32
57
4.5
98
16
133
33
60
5
100
17
134
34
62
5.5
103
18
136
35
65
6
105
19
138
36
67
6.5
107
20
139
37
69
7
110
21
141
38
71
7.5
112
22
142
39
73
8
114
23
144
40
75
8.5
116
24
145
41
77
9
118
25
147
42
79
9.5
120
26
148
43
80
10
122
27
150
44
84
11
124
28
151
45
87
12
126
29
153
46
90
13
127
30
154
47
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OP 4-9
How to use the Puritan Bennett™ 840 ventilator
Table 4-1: Ideal Body Weight (IBW) based
on patient height (cm to kg) (cont)
OP 4-10
Patient
height
(cm)
IBW
(kg)
Patient
height
(cm)
IBW
(kg)
Patient
height
(cm)
IBW
(kg)
155
48
182
70
204
92
157
49
183
71
205
93
158
50
184
72
206
94
159
51
185
73
207
95
161
52
186
74
208
96
162
53
187
75
209
97
163
54
188
76
210
98
164
55
189
77
211
99
166
56
190
78
211
100
167
57
192
79
212
101
168
58
193
80
213
102
169
59
194
81
214
103
171
60
195
82
215
104
172
61
196
83
216
105
173
62
197
84
217
106
174
63
198
85
218
107
175
64
198
86
218
108
176
65
199
87
219
109
178
66
200
88
220
110
179
67
201
89
221
111
180
68
202
90
222
112
181
69
203
91
223
113
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to use the Puritan Bennett™ 840 ventilator
Table 4-1: Ideal Body Weight (IBW) based
on patient height (cm to kg) (cont)
Patient
height
(cm)
IBW
(kg)
Patient
height
(cm)
IBW
(kg)
Patient
height
(cm)
IBW
(kg)
223
114
234
127
244
140
224
115
235
128
244
141
225
116
235
129
245
142
226
117
236
130
246
143
227
118
237
131
247
144
228
119
238
132
247
145
228
120
238
133
248
146
229
121
239
134
249
147
230
122
240
135
249
148
231
123
241
136
250
149
232
124
241
137
251
150
232
125
242
138
233
126
243
139
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OP 4-11
How to use the Puritan Bennett™ 840 ventilator
Table 4-2: Determining IBW based
on patient height (ft., in. to lb.)
Patient height
OP 4-12
ft
in.
1
9
1
IBW
(lb)
Patient height
IBW
(lb)
ft
in.
8
3
6
44
10
9
3
7
46
1
11
10
3
8
49
2
0
11
3
9
51
2
1
13
3
10
53
2
2
14
3
11
57
2
3
15
4
0
60
2
4
17
4
1
62
2
5
18
4
2
66
2
6
19
4
3
68
2
7
21
4
4
71
2
8
22
4
5
75
2
9
24
4
6
79
2
10
26
4
7
82
2
11
29
4
8
86
3
0
31
4
9
90
3
1
33
4
10
93
3
2
35
4
11
97
3
3
37
5
0
101
3
4
40
5
1
104
3
5
42
5
2
108
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Table 4-2: Determining IBW based
on patient height (ft., in. to lb.) (cont)
Patient height
ft
in.
5
3
5
IBW
(lb)
Patient height
IBW
(lb)
ft
in.
112
7
1
231
4
117
7
2
238
5
5
121
7
3
245
5
6
126
7
4
251
5
7
130
7
5
258
5
8
134
7
7
269
5
9
141
7
8
278
5
10
146
7
9
287
5
11
150
7
10
293
6
0
154
7
11
300
6
1
161
8
0
309
6
2
165
8
1
317
6
3
172
8
2
324
6
4
176
8
3
331
6
5
183
6
6
187
6
7
194
6
8
201
6
9
207
6
10
212
6
11
218
7
0
225
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OP 4-13
How to use the Puritan Bennett™ 840 ventilator
Table 4-3: Soft bound ranges for Ideal Body Weight and tube
Internal Diameter (ID)
IBW (kg)
< 7.0
OP 4-14
Low value tube ID in mm
High value tube ID in mm
At this IBW, tube ID is not an At this IBW, tube ID is not an
allowable setting
allowable setting
7-10
NONE
4.5
11-13
NONE
5.0
14-16
NONE
5.5
17-18
NONE
6.0
19-22
5.0
6.0
23-24
5.0
6.5
25-27
5.5
6.5
28-31
5.5
7.0
32-35
6.0
7.0
36
6.0
7.5
37-42
6.5
7.5
43-49
6.5
8.0
50
7.0
8.0
55
7.0
8.5
60
7.0
9.0
65
7.5
9.0
70
7.5
9.5
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Table 4-3: Soft bound ranges for Ideal Body Weight and tube
Internal Diameter (ID) (cont)
IBW (kg)
Low value tube ID in mm
High value tube ID in mm
75
8.0
9.5
80-100
8.0
NONE
110-130
8.5
NONE
140-150
9.0
NONE
The patient circuit type you specify during SST determines several
default settings and the ranges available for ventilator operation
(Table 4-4.)
Table 4-4: Patient circuit and IBW values
Recommendation
Ideal body weight (IBW) in kg (lb)
Recommended
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: 25-150 kg (55-330 lb)
*IBW range assumes NeoMode 2.0 software option
is installed
Allowed but not
recommended
(operator override
required)
Neonatal patient circuit: Not applicable.
Pediatric patient circuit: 3.5-6.5 kg (7.7-14.3 lb) and
25-35 kg (55-77 lb)
Adult patient circuit: 7.0-24 kg (15-53 lb)
1. To use a neonatal patient circuit, the ventilator must have both the NeoMode
software option and the NeoMode hardware installed.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
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OP 4-15
How to use the Puritan Bennett™ 840 ventilator
4.3
How to change 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 parameter(s).
The lower screen displays monitored control parameters (Table 4-5)
if you select or change other control parameters that affect them.
Table 4-5: Monitored ventilator control parameters
4.4
Set minute
volume
(VE SET)
Displayed along with the breath timing bar
whenever you select or change the respiratory rate
(f) or volume control parameters.
Volume per
weight ratio
(VT/IBW)
Displayed when you select or change the tidal
volume (VT , when breath type is VC) or target
volume (VT , when breath type is VC+).
VT SUPP/IBW
Volume per weight ratio: displayed when you select
or change the target support volume (VT SUPP ,
when breath type is VS) control parameter.
Ideal Body Weight (IBW), vent type, mode, and 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 PROPOSED SETUP to
cancel all changes and start over.
OP 4-16
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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 Table 4-3 for tube ID ranges corresponding
with IBW).
An attention icon for tube ID (whether new or unchanged)
displays whenever PAV™* is selected.
3. After making any necessary changes, touch CONTINUE.
Appropriate settings for the ventilation setup selected appear on
the lower screen.
4. 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.
5. After making all necessary changes, review the control
parameters, then press ACCEPT to apply all the new control
parameters at the same time.
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OP 4-17
How to use the Puritan Bennett™ 840 ventilator
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.
4.5
How to select a constant timing variable during
respiratory 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:
•
TI 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.
•
TE 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:
OP 4-18
•
TH represents the time interval for the high PEEP level (PEEPH)
•
TH:TL determines the ratio of the high PEEP time interval to the
low PEEP time interval for BiLevel breaths.
•
TLrepresents the time interval for the low PEEP level (PEEPL).
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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 4-4).
TI or TH
I:E or
TH:TL
TE or TL
Figure 4-4. TI (or TH) selected as the constant during rate change
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 TI/TH timing variable in Figure 4-4.
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.
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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 TI to remain constant
during rate change, you can still change the value
of TI. Otherwise, the value of TI does not change
(and the values of I:E and TE do change) when you
change the respiratory rate setting. This also holds
true for the BiLevel variables TH, TH:TL, and TL.
4.6
How to change 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.
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4.7
How to set 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 Figure 4-5). The pointer to the left of each bar
shows the current patient data value for each parameter, and
highlighted 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.
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Figure 4-5. Alarm setup
4. Once you have made all of the desired changes and have
reviewed the settings, press ACCEPT to apply.
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 Figure 4-5) for each alarm
limit.
4.8
How to change 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 (O2) sensor, and disconnect sensitivity.
To configure the communications ports, refer to Appendix E Remote
alarm and RS-232 ports.
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.
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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 (O2) sensor
•
DSENS (disconnect sensitivity)
To change humidification type, humidifier volume (for non-HME
humidifiers), or disconnect sensitivity (DSENS), or to enable or disable
the O2 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.)
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To leave settings unchanged, touch the Other Screens button
again.
3. Review the proposed parameters.
4. Press ACCEPT to apply the new settings.
4.9
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 (PEEPI) is present. An expiratory pause is used to
estimate PEEPTOT and PEEPI.
There are two types of expiratory pause maneuvers:
•
An automatic pause begins when you press the EXP PAUSE key
momentarily. An automatic pause maneuver continues until the
pressure stabilizes. An automatic expiratory pause 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 pause begins when you press and hold the EXP PAUSE
key down. The manual expiratory pause 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 PEEPI and PEEPTOT.
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NOTE:
• If the patient triggers breaths during the waiting
period prior to the start of the Expiratory Pause
maneuver, the ventilator will wait approximately
one 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.
4.10 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 (TI) 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 lungthoracic compliance (CSTAT), static resistance (RSTAT), and plateau
pressure (PPL), or to maintain the inflated state of the lungs.
There are two types of inspiratory pause maneuver:
•
An automatic pause begins when you press the INSP PAUSE key
momentarily. An automatic pause maneuver continues until the
pressure stabilizes, and lasts at least 0.5 second but no longer
than 2.0 seconds.
Use an automatic pause to measure CSTAT, RSTAT (only on square
wave, VC breaths), and PPL. To cancel an automatic inspiratory
pause maneuver, press the CANCEL button on the lower screen.
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•
A manual pause 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 (TPL), you can extend the inspiratory
pause or TPL. For example, during an automatic pause, TPL can be
extended to up to 2.0 seconds. If TPL exceeds 2.0 seconds and the
pause maneuver ends before TPL elapses, the plateau lasts the full
TPL interval. During a manual pause, the pause lasts the TPL setting or
the manual interval, but never longer than 7 seconds.
It is possible to compute CSTAT and RSTAT 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
pause maneuver is in progress, software checks the quality of the
data, and indicates when estimates for CSTAT and RSTAT are
questionable.
The most recently selected graphics are displayed and frozen when
an inspiratory pause maneuver begins, so you can assess the
inspiratory pressure. PPL is continuously updated and displayed
during the inspiratory pause. CSTAT and RSTAT are displayed at the
start of the next inspiratory phase. The value of RSTAT is computed
and displayed only if the mandatory breath type is VC with square
flow waveform.
4.11 How to interpret inspiratory pause maneuver results
for static compliance and resistance
Compliance (CSTAT) is an estimate of the elasticity of the patient’s
lungs; it is expressed in mL/cmH2O. Resistance (RSTAT) 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
cmH2O/L/second. These values are computed during an operatorinitiated inspiratory pause, in which the inspiratory valves and
exhalation valve are closed. CSTAT is computed during a mandatory
breath. RSTAT is computed during a VC mandatory breath with a
square waveform.
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During the pause, the most recently selected graphics are displayed
and frozen, so you can see when inspiratory pressure stabilizes. CSTAT
and RSTAT are displayed at the start of the next inspiration following
the inspiratory pause. They take this format:
CSTAT xxx
or
RSTAT yyy
If the software determines variables in the equations or the resulting
CSTAT or RSTAT values are out of bounds, it identifies the questionable
CSTAT and RSTAT values with special formatting and text messages:
•
Parentheses ( ) signify questionable CSTAT or RSTAT values, derived
from questionable variables.
•
Flashing CSTAT or RSTAT values are out of bounds.
•
Asterisks (******) mean variables fall below noise-level bounds.
•
RSTAT(------) means resistance could not be computed, because the
breath was not of a mandatory, VC type with square flow
waveform.
Refer to Section 14.12 in the Technical Reference portion of this
manual for detailed information on static compliance and resistance.
Table 14-1 summarizes the significance and possible corrective
actions for the CSTAT and RSTAT displays.
4.12 How to use 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.
4.12.1 NIV intended use
NIV is intended for use by neonatal, pediatric, and adult patients
possessing adequate neural-ventilatory coupling and stable,
sustainable, respiratory drive.
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4.12.2 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 (No. 3)
Uncuffed neonatal ET tube: Mallinckrodt™ Uncuffed Tracheal Tube,
Murphy (3.0 mm)
Warning
OP 4-28
•
Use only non-vented patient interfaces with NIV.
•
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.
•
Do not ventilate patients intubated with cuffed
endotracheal or tracheostomy tubes using NIV Vent Type.
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4.12.3 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.
Figure 4-6 shows the New Patient Setup screen when NIV is the
selected Vent Type.
1
5
2
3
4
1. Vent Type Button: New button used to select between INVASIVE or NIV.
2. Breath Mode: Only A/C, SIMV, and SPONT modes are allowed with NIV.
3. Mandatory Type: Only VC and PC are available with NIV.
4. Spontaneous Type: Only PS or NONE are available with NIV when SIMV
or SPONT breath mode is selected.
5. Trigger Type: Only Flow Triggering is available with NIV.
Figure 4-6. New patient setup screen — NIV
Refer to the sections “Changing patient from INVASIVE to NIV Vent
Type” on page OP 4-33 and “Changing patient from NIV to INVASIVE
Vent Type” on page OP 4-34 for information on automatic settings
changes that occur when switching between Vent Types.
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Follow these steps to set up the ventilator for NIV:
To set up a new patient:
1. Turn the ventilator on.
To set up a patient currently being
ventilated:
1. Touch the VENT SETUP button.
Proceed to step 3.
2. 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 knob to select AC, 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. Press CONTINUE and adjust settings as needed. See Section 4.12.4,
below, for information on the high spontaneous inspiratory time limit
ventilator setting.
NOTE:
With NIV selected as Vent Type, the DISCONNECT SENSITIVITY
(DSENS ) 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.
Figure 4-7 shows the NIV settings screen.
9. Press ACCEPT to apply the settings. Review the apnea and alarm settings
as described below.
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“N” in header
indicates NIV
Vent Type.
2TI SPONT
setting button.
Note DSENS
defaults to
OFF.
Figure 4-7. NIV ventilator settings screen
4.12.4 High spontaneous inspiratory time limit setting
NIV includes a setting in SIMV or SPONT modes for High
Spontaneous Inspiratory Time limit (2TI SPONT). When a patient’s
inspiratory time reaches or exceeds the set limit, the ventilator
transitions from inspiration to exhalation, and the 1TI SPONT symbol
appears on the upper GUI screen, indicating the ventilator has
truncated the breath (see Figure 4-9). The 2TI SPONT setting does not
restrict changes to IBW; if the IBW is decreased, 1TI SPONT may be
decreased automatically to remain within its allowable limits.
Warning
No audible alarm sounds in conjunction with the visual
1TI 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 2TI 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 2TI SPONT setting.
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NOTE:
To reduce the potential for not reaching the target pressure,
minimize the leaks in the system and increase the Rise time % and/or
decrease the ESENS setting, if appropriate.
4.12.5 Apnea setup
Set the patient’s apnea parameters as described in Section 4.6. NIV
does not change the way apnea parameters are set.
4.12.6 Alarm setup
Touch the ALARM SETUP button to display the current alarm settings
and change the alarm settings as needed. A low circuit pressure
(3PPEAK) 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 5-1, Table A-13, and Table 13-2
for more information regarding the 3PPEAK alarm. The 3PPEAK alarm
may be turned OFF, if desired. Figure 4-8 shows the NIV alarm screen
with new patient default settings.
Yellow
background with
black letters on
lower GUI screens
indicates NIV Vent
Type and current
breath mode.
4PPEAK
alarm
limit
Figure 4-8. New patient default alarm settings
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Warning
With NIV selected as the Vent Type, the new patient value for
each of the following alarm limits is OFF:
2fTOT
4VE TOT
4VTE MAND
4VTE SPONT
Additionally, the 4PPEAK alarm can be set to OFF.
Ensure you have set these alarms appropriately before
connecting the patient to the ventilator.
4.12.7 Changing patient from INVASIVE to NIV Vent Type
Some ventilator settings available during INVASIVE ventilation are
not available during NIV.
Table 4-6: Automatic settings changes — INVASIVE to NIV on
same patient
Current INVASIVE setting
New NIV setting
Breath Mode: BILEVEL
Breath mode: A/C
Breath Mode: SIMV or SPONT
High TI SPONT (2TI SPONT) limit setting
available
Mandatory Type: VC+
Mandatory type:
Adult/pediatric: VC
Neonatal: PC
Spontaneous Type: Any type
except NONE or PS
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 cmH2O applied.
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Table 4-6: Automatic settings changes — INVASIVE to NIV on
same patient (cont)
Current INVASIVE setting
New NIV setting
Trigger type: Pressure
Trigger type: Flow
(Flow triggering is the only allowable
trigger type during NIV)
Alarm settings: 4PPEAK (if
applicable), 4VE TOT, 4VTE MAND ,
4VTE SPONT , INSPIRATION TOO
LONG (not user-settable)
Alarm settings: 4PPEAK, 4VE TOT,
4VTE MAND , 4VTE SPONT default to NIV
new patient values (see Table 13-3).
INSPIRATION TOO LONG alarm not
available.
DSENS
DSENS setting defaults to OFF.
4.12.8 Changing patient from NIV to INVASIVE Vent Type
Table 4-7: Automatic settings changes — NIV to INVASIVE on
same patient
Current NIV setting
New INVASIVE setting
Ventilator settings: 2TI SPONT
N/A
Alarm settings:
4PPEAK , 4VE TOT, 4VTE MAND ,
4VTE SPONT
Alarm settings: Default to new patient
values dependent upon selected
INVASIVE ventilator settings (see Table
A-13). INSPIRATION TOO LONG alarm
becomes available.
DSENS
DSENS setting defaults to INVASIVE new
patient value (see Table A-12).
Warning
When changing the Vent Type on the same patient, review
the automatic settings changes described in Tables 4-6 and
4-7 and adjust appropriately.
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4.12.9 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 (VTI) is displayed in the vital patient data area, and the
monitored PEEP value is shown when you press the MORE PATIENT
DATA button.
During NIV, VTI
appears in Vital
patient data area
instead of PEEP.
NIV and 1TI SPONT
indicators on More
patient data
subscreen. Hidden if
two or more alarms
present.
PEEP moved to
More patient data
subscreen during
NIV.
Figure 4-9. More patient data screen — NIV
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SECTION
How to handle alarms
5
Chapter 5 tells you:
5.1
•
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
Ventilator alarm classifications
Alarms on the Puritan Bennett™ 840 Ventilator System
are classified as high- medium-, or low-urgency.
Figure 5-1 shows the location of the alarm indicators on
the GUI and the symbol used for each of the alarm
classifications.
High-urgency alarm indicator
Medium-urgency alarm indicator
Low-urgency alarm indicator
Figure 5-1. Alarm indicators
•
High-urgency alarms require immediate attention to
ensure patient safety. During a high-urgency alarm,
How to handle alarms
the red high-urgency indicator flashes rapidly, the high-urgency
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-urgency alarm goes
away spontaneously (autoresets), its indicator remains lit (not
flashing) until you press the alarm reset key.
•
Medium-urgency alarms require prompt attention. During a
medium-urgency alarm, the yellow medium-urgency indicator
flashes slowly, the medium-urgency audible alarm (a repeating
sequence of three tones) sounds, and the upper screen flashes an
alarm message. If a medium-urgency alarm autoresets, the
indicator turns off and the autoreset is entered in the alarm
history log.
•
Low-urgency alarms tell you that there has been a change in the
patient-ventilator system. During a low-urgency alarm, the
yellow low-urgency indicator lights, the low-urgency audible
alarm (two tone, non-repeating) sounds, and the upper screen
displays an alarm message. If a low-urgency 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 urgency and you
change its setting, the high urgency alarm
indicator remains lit until the reset key is pressed.
5.2
Alarm silence
Warning
Never leave patient unattended when the alarm silence is active.
Press the alarm silence key to mute the alarm sound for two 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
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not a higher-priority 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 twominute interval times out. A new high-urgency 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,
VTE MAND) and circuit disconnect alarms do not cancel an alarm
silence.
Each time you press the alarm silence key, the silence period resets to
two 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 (whether due to an elapsed alarm silence interval,
the detection of a high-urgency 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
urgency non-patient data related alarm), the Alarm Silence in
Progress indicator appears (Figure 5-2).
Figure 5-2. Alarm Silence in Progress indicator (lower screen)
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How to handle alarms
5.3
Alarm reset
If you press the ALARM RESET key, the system resets the detection
algorithms of all active alarms, except for these:
•
AC POWER LOSS
•
COMPRESSOR INOPERATIVE
•
DEVICE ALERT
•
INOPERATIVE BATTERY
•
LOW AC POWER
•
LOW BATTERY
•
NO AIR SUPPLY
•
NO O2 SUPPLY
•
O2 SENSOR
•
PROCEDURE ERROR
•
SCREEN BLOCK
If you press the ALARM RESET key, there is no effect on the 100%
O2/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-urgency alarm that has autoreset (and the
steadily lit high-urgency alarm indicator turns off).
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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.
5.4
Alarm log
To view the alarm log (Figure 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.
Alarm log button
(indicates log
includes unread entries)
Touch symbols to Touch scroll bar, then
see definition at turn knob to scroll
bottom of lower through log
screen
Figure 5-3. Alarm log
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:
•
an alarm is detected
•
an alarm changes urgency level
•
an alarm autoresets
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 5-5
How to handle alarms
•
you press the alarm reset key when there is an active alarm
•
you press the ALARM SILENCE key
•
the alarm silence times out
•
an alarm reset terminates the alarm silence
•
a new high-urgency alarm terminates the alarm silence
The alarm log stores a maximum of 80 of the most recent entries.
When you complete a NEW PATIENT setup, the system erases the
previous patient’s alarm log.
5.5
Alarm volume
The off-screen alarm volume key adjusts the volume of all audible
alarms, regardless of urgency 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-urgency 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
re-adjust the alarm volume.
Refer to Section A.4 for alarm volume specifications.
OP 5-6
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to handle alarms
5.6
Alarm messages
The upper screen displays the two highest-urgency 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 Puritan Bennett™
840 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.”
Figure 5-4 shows how an alarm message is displayed on the upper
screen. Table 5-1 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 5-7
How to handle alarms
The base message identifies
the alarm. Touch alarm
symbol to view definition
on lower screen.
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 highestpriority active
alarm messages
are displayed here.
}
The remedy
message suggests
how to resolve
the alarm condition.
Touch flashing more alarms
button to view messages for up
to six additional active alarms.
Figure 5-4. Alarm message format
OP 5-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
It means...
Do this...
AC POWER
LOSS
The power switch is ON,
AC power is not available,
and the ventilator is being
powered by the BPS.
• Prepare for power loss.
• Obtain alternate
ventilation source.
• Check the integrity of
AC power source.
• Obtain service, if
necessary.
APNEA
The set apnea interval has
elapsed without the
ventilator, patient, or
operator triggering a
breath. The ventilator has
entered apnea
ventilation.
• Check the patient.
• Check the ventilator
control parameters.
CIRCUIT
DISCONNECT
There is a disconnection in
the patient circuit. The
ventilator switches to idle
mode and displays the
length of time without
ventilator support.
• Check the patient.
• Reconnect the patient
circuit.
• Press the alarm reset
key.
COMPLIANCE
LIMITED VT
The compliance
compensation limit has
been reached. The
inspired volume may be
less than the control
parameter value.
• Check the patient.
• Verify the selected
patient circuit type and
the installed patient
circuit match.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 5-9
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
It means...
Do this...
The compressor is unable
to maintain sufficient
supply pressure, due to
low AC power, AC power
loss, or compressor
malfunction.
• Check the patient.
• Obtain 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.
The compressor is not
connected properly to the
BDU.
• Check the patient.
• Reconnect the
compressor air hose,
compressor power
cable, and compressor
data cable.
DEVICE ALERT
The POST or a
background test has
detected a problem.
• Check the patient.
• If prompted to do so,
obtain alternate
ventilation and obtain
service.
1PPEAK
The measured airway
pressure is equal to or
greater than the set limit.
Reduced tidal volume
likely.
• Check the patient.
• Check the patient
circuit.
• Check the
endotracheal tube.
COMPRESSOR
INOPERATIVE
(High circuit
pressure)
OP 5-10
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
1O2%
(High
delivered
O2%)
1VTE
(High
exhaled tidal
volume)
↑ VE TOT
(High
exhaled total
minute
volume)
1fTOT
(High
respiratory
rate)
It means...
Do this...
The O2% measured
during any phase of a
breath cycle is 7% (12%
during the first hour of
operation) or more above
the set O2% parameter
for at least 30 seconds.
When you decrease the
set O2% parameter, the
percentages increase by
5% for the next four
minutes of ventilation.
• Check the patient, the
air and oxygen
supplies, the oxygen
analyzer, and the
ventilator.
The patient’s exhaled tidal
volume for any breath is
equal to or greater than
the set limit.
• Check the patient and
the ventilator control
parameters.
• Check for changes in
patient compliance or
resistance.
The patient’s expiratory
minute volume is equal to
or greater than the set
limit.
• Check the patient and
the ventilator control
parameters.
The breath rate from all
breaths is greater than or
equal to the set limit.
• Check the patient and
the ventilator control
parameters.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 5-11
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
It means...
Do this...
(High
internal
ventilator
pressure)
The inspiratory pressure
transducer has measured
a pressure of at least
100 cmH2O.
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/or volume settings.
• Re-run SST.
• Obtain alternate
ventilation source.
• Remove the ventilator
from clinical use and
obtain service.
INOPERATIVE
BATTERY
The BPS is installed but is
not functioning.
• Remove the ventilator
from clinical use and
obtain service.
INSPIRATION
TOO LONG
The IBW-based inspiratory
time for a spontaneous
breath exceeds the
ventilator-set limit. Active
only when Vent Type is
INVASIVE.
• Check the patient.
• Check the patient
circuit for leaks.
• Check Rise time and
ESENS settings.
LOSS OF
POWER
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.
• Check the integrity of
the AC power and BPS
connections.
• Obtain alternative
ventilation if necessary.
• Turn the power switch
off to reset alarm.
1PVENT
OP 5-12
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
It means...
Do this...
LOW AC
POWER
The mains AC power
dropped below 80% of
the nominal voltage for at
least one second. The
error message signals the
AC power has dropped
significantly, and a more
severe power drop may
be imminent.
The ventilator turns off
the compressor (if
installed), but otherwise
operates normally.
• Prepare for possible
loss of power.
• Check the integrity of
the AC power
connection.
• Check the AC power
supply.
LOW BATTERY
The BPS is installed, but it
has less than two minutes
of operational time
remaining.
• Replace the BPS or
allow it to recharge
during normal
ventilator operation.
3O2%
The O2% measured
during any phase of a
breath cycle is 7% (12%
during the first hour of
operation) or more below
the O2% parameter for at
least 30 seconds.
The percentage window
increases by 5% for four
minutes after you increase
the set O2% value.
• Check the patient, the
air and oxygen
supplies, the oxygen
analyzer, and the
ventilator.
• Calibrate oxygen
sensor (press 100%
O2/CAL 2 min key). See
page TR 15-5 for
information on
calibrating the oxygen
sensor.
• Use an external O2
monitor and disable
the O2 sensor.
(Low
delivered
O2%)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 5-13
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
3PPEAK
(Low circuit
pressure)
It means...
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.
Do this...
• Check the breathing
system for leaks.
Warning
Because the VC+
pressure control
algorithm does not
allow the target
inspiratory pressure
to fall below PEEP +
5 cmH2O, attempting
to set the 4PPEAK
alarm limit at or
below this level will
turn the alarm off.
3VTE MAND
(Low exhaled
mandatory
tidal volume)
3VTE SPONT
(Low exhaled
spontaneous
tidal volume)
OP 5-14
10067720 Rev. B
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 resistance
or compliance.
The patient’s exhaled
spontaneous tidal volume
is less than or equal to the
set limit.
• Check the patient.
• Check the ventilator
control parameters.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
It means...
Do this...
↓VE TOT
(Low exhaled
total minute
volume)
The minute volume for all
breaths is less than or
equal to the set limit.
• Check the patient.
• Check the ventilator
control parameters.
NO AIR
SUPPLY
The air supply pressure is
less than the minimum
pressure required for
correct ventilator
operation. The ventilator
delivers 100% O2 if
available. O2% delivery
may be compromised.
If an oxygen supply is not
available, the safety valve
opens. The ventilator
displays the elapsed time
without ventilator
support. This alarm
cannot be set or disabled.
• Check patient.
• Check the air and
oxygen sources.
• Obtain alternative
ventilation if necessary.
NO O2 SUPPLY
The oxygen supply
pressure is less than the
minimum pressure
required for correct
ventilator operation. The
ventilator delivers 100%
air if available. O2%
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 5-15
How to handle alarms
Table 5-1: Alarm messages
When you
see this
message...
OP 5-16
It means...
Do this...
O2 SENSOR
Background checks have
detected a problem with
the oxygen sensor (sensor
failure or it is out of
calibration). Patient
ventilation is unaffected.
• Press 100% O2 CAL or
INCREASE O2 2 min to
recalibrate the oxygen
sensor.
• Disable the oxygen
sensor
• Replace the oxygen
sensor.
PROCEDURE
ERROR
The patient is attached
before ventilator startup
is complete. Safety
ventilation is active.
• Provide alternate
ventilation if necessary.
• Complete ventilator
startup procedure.
SCREEN
BLOCK
A possible blocked beam
or touch screen fault.
• Remove obstruction
from the touch screen
or obtain service.
SEVERE
OCCLUSION
The patient circuit is
severely occluded. The
ventilator enters occlusion
status cycling. The elapsed
time without ventilatory
support is displayed.
If the NeoMode is in use,
the ventilator delivers
40% O2 if available.
• Check the patient.
• Obtain alternative
ventilation.
• Check patient circuit
for bulk liquid, crimps,
blocked filter.
• If problem persists,
remove ventilator from
use and obtain service.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
How to view graphics
6
Chapter 6 tells you:
6.1
•
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.
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
Figure 6-1 shows an example of a pressure-volume loop.
How to view graphics
Inspiratory area
Figure 6-1. Pressure-volume loop
The flow-volume loop can be used with or without the Respiratory
Mechanics (RM) software option (Figure 6-2).
Scaling is selectable by the user, from -2000 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.
OP 6-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to view graphics
Figure 6-2. Flow-volume loop
6.2
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.
1. Touch the GRAPHICS button at the lower
left of the upper screen. Graphics
appear.
PLOT SETUP
Shadow Trace
Enabled
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 6-3
How to view graphics
Plot 1
Pressure-Time
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.
If you select pressure-volume, which uses
the entire screen, the PLOT 2 button
disappears.
Plot 2
Flow-Time
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.
CONTINUE
6.3
6. Touch CONTINUE to display the graphics
you have selected. You do not need to
touch ACCEPT.
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
(PCARI) 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
(PLUNG) 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.
OP 6-4
•
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.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to view graphics
6.4
How to adjust displayed graphics
•
0.0
cm
H2O
To move the baseline on a pressurevolume 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 6-5
6.5
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.
FREEZE
NOTE:
The screen freezes automatically
when INSP 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
pressure-volume display shows only the
most recent full breath within the 48second freeze period.
Graphics remain frozen even if you
switch to another screen (for example,
MORE ALARMS) and then return to the
graphics screen.
UNFREEZE
OP 6-6
10067720 Rev. B
3. Touch the UNFREEZE button at any time
to view current graphics.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
How to view graphics
6.6 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:
PRINT
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
communications settings must match. Refer to
Section E.4 for instructions on how to
configure the RS-232 port, and Section E.4 for
information on cables and printers.
6.7
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.
6.8
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 6-7
How to view 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 6-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
Preventive maintenance
Chapter 7 tells you:
•
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 7 to
your institution's policies and protocol.
Covidien recommends only qualified personnel perform
additional maintenance procedures. Contact Covidien
technical support or your local representative for
additional information.
7.1
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.
7
Preventive maintenance
7.2
How to clean, disinfect and sterilize parts
Table 7-1 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.
• To avoid patient exposure to sterilizing agents, be sure to
sterilize parts in accordance with the techniques described
in Table 7-1. Exposure to sterilizing agents may reduce the
useful life of some parts.
• Handle filters with care, to minimize the risk of bacterial
contamination or physical damage.
• 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
effectiveness 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.
OP 7-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Table 7-1: Procedures to clean, disinfect, and sterilize parts
Part
Ventilator
exterior
(including
touch screen
and flex arm)
Procedure
Comments
Wipe clean with a damp cloth and
mild soap solution or with one of the
chemicals listed below 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
graphic user interface (GUI) to
remove dust.
• 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.
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-3
Preventive maintenance
Table 7-1: Procedures to clean, disinfect, and sterilize parts
Part
Patient circuit
tubing
Procedure
Disassemble and clean, then
autoclave, pasteurize, or chemically
disinfect.
Single-patient use patient circuits:
Discard.
Comments
• If you
submerge the
patient circuit
in liquid, use
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 circuit is
installed.
Caution
Steam sterilization is a viable sterilization method
for 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.
In-line water
traps
OP 7-4
10067720 Rev. B
Disassemble and clean, then
autoclave, pasteurize, or chemically
disinfect.
Inspect water
traps for cracks.
Replace traps if
damaged.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Table 7-1: Procedures to clean, disinfect, and sterilize parts
Part
Procedure
Comments
Couplings and
connectors
Autoclave, pasteurize, or chemically
disinfect.
• If you
submerge the
couplings and
connectors in
liquid, use
pressurized
air to blow
moisture
from the
inside of the
components
before use.
• Inspect
components
for nicks and
cuts. Replace
if damaged.
Expiratory
collector vial
Reusable expiratory filter assembly:
Clean, then autoclave or chemically
disinfect the collector vial.
Single-patient use expiratory filter
assembly: Discard.
Inspect the
collector vial for
cracks. Replace
collector vial if
damaged.
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10067720 Rev. B
OP 7-5
Preventive maintenance
Table 7-1: Procedures to clean, disinfect, and sterilize parts
Part
OP 7-6
Procedure
Comments
Expiratory and
inspiratory
bacteria filters
Reusable filters: Autoclave.
Single-patient use: Discard.
Before discarding, disinfect or
sterilize according to your
institution’s protocol.
• Effective
sterilization
of 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.
Drain bag,
tubing, and
clamp
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.
• Do not
autoclave
clamp.
• Replace
clamp if
visibly
damaged.
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Table 7-1: Procedures to clean, disinfect, and sterilize parts
Part
Procedure
Comments
Air inlet filter
bowl
Wash the bowl exterior with mild
soap solution if needed.
Other
accessories
Follow manufacturer’s instructions.
• Avoid
exposure of
the air inlet
filter bowl to
aromatic
solvents,
especially
ketones.
• Replace if
cracks or
crazing are
visible.
7.2.1 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-7
Preventive maintenance
7.3
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.
Table 7-2 summarizes disinfection and sterilization procedures.
Caution
Formaldehyde and phenol-based disinfectants are not
recommended because they can cause plastic parts to crack
and craze.
OP 7-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Table 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
Chemical disinfection
Place the parts in a
heat pasteurizer at 76
to 79 °C (169 to 174 °F)
for 30 minutes.
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. Disassemblethe
component.
1. Disassemble the
component.
1. Disassemble the
component.
2. Clean the
component
parts. (See
Section 7.2.1
for details.)
2. Clean the
component parts.
(See Section 7.2.1
for details.)
2. Clean the component
parts. (See
Section 7.2.1 for
details.)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-9
Preventive maintenance
Table 7-2: Disinfection and sterilization procedures
Autoclave
sterilization
OP 7-10
Pasteurization
Chemical disinfection
3. Wrap each
component
part in muslin
or equivalent
paper for
autoclaving.
3. Place parts in the
heat pasteurizer
and pasteurize.
3. Place parts in the
cleaning solution to
disinfect.
4. Place the
wrapped
parts in the
steam
autoclave and
sterilize.
4. Inspect the
pasteurized parts
for damage.
Discard the
component if you
detect damage.
4. Inspect the
disinfected parts for
damage. Discard the
component if you
detect damage.
5. Inspect the
sterilized
parts for
damage.
Discard the
component if
you detect
damage.
5. Reassemble the
component.
5. Reassemble the
component.
6. Reassemble
the
component.
6. Install the
component on the
ventilator.
6. Install the component
on the ventilator.
7. Install the
component
on the
ventilator.
7. Run SST.
7. Run SST.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Table 7-2: Disinfection and sterilization procedures
Autoclave
sterilization
Pasteurization
Chemical disinfection
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.
7.4
Preventive maintenance procedures for the operator
Table 7-3 summarizes preventive maintenance procedures and the
frequency Covidien recommends. The operator should routinely
perform these preventative maintenance procedures at the
recommended intervals. Instructions for the preventative
maintenance procedures follow Table 7-3.
7.4.1 Total operational hours
Determine the total number of operational hours of the ventilator
and the compressor as follows:
1. Press OTHER SCREENS on the touch screen of the ventilator.
2. Press 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-11
Preventive maintenance
Table 7-3: Operator preventive maintenance
procedures and frequency
Frequency
Several times
a day or as
required by
your
institution’s
policy
Part
Maintenance
Patient circuit:
inspiratory and
expiratory limbs
• Check both limbs for water
build-up
• Empty and clean each limb
as necessary
Inspiratory and
expiratory bacteria
filters
• 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 an SST to check the
resistance of the expiratory
filter.
Daily or as
necessary
OP 7-12
10067720 Rev. B
Collector vial, water
traps, and drain bag
Check and empty as needed.
Oxygen sensor
Press the 100% O2/CAL 2 MIN
key or INCREASE O2 2 min key
to calibrate the oxygen sensor.
Refer to Appendix D in this
manual to test the oxygen
sensor calibration.
Air inlet filter bowl
• Replace the bowl if it is
cracked.
• If any sign of moisture is
visible, remove ventilator
from use and contact service
or maintenance.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Table 7-3: Operator preventive maintenance
procedures and frequency
Frequency
Part
Maintenance
Every 250
hours (or
more often, if
required)
Compressor inlet
filter
Clean.
Every year or
as needed
Reusable expiratory
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.
Oxygen sensor
• Replace the oxygen sensor
as needed.
• Actual sensor life depends
on operating environment.
Operation at higher
temperature or O2% levels
will result in shorter sensor
life. Refer to Appendix D for
the oxygen sensor
replacement procedure.
Reusable inspiratory
bacteria filters
• Replace the filter.
• Sterilize between patients
and circuit changes, or
according to your
institution’s policy.
• Sterilize before
nondestructive disposal.
Every year
maximum or
as needed
7.4.2 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-13
Preventive maintenance
•
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 one 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 one 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 cmH2O (4 hPa) or less at 60 L/min flow or 0.5
cmH2O (0.5 hPa) or less at 30 L/min flow can indicate a ruptured
filter. Discard the filter.
•
Filter resistance greater than 4 cmH2O at 100 L/min flow or
greater than 2 cmH2O (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 cmH2O (0.6 hPa) or less at 60 L/min flow or
0.3 cmH2O (0.3 hPa) or less at 30 L/min flow can indicate a
ruptured filter. Discard the filter.
•
Filter resistance greater than 2.4 cmH2O (2.4 hPa) at 60 L/min flow
or 1.2 cmH2O (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 7-14
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
7.4.3 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.
• 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
reusable collector vials. Discard single-use collector vials.
•
To avoid increased expiratory resistance, empty the collector vial
before liquid reaches the maximum fill line (see Figure 7-1).
Under certain conditions, the collector vial can fill in as little as
two (2) hours.
7.4.3.1 How to remove the collector vial
1. Turn the ring at the bottom of the exhalation filter to release the
vial.
2. Replace the empty vial.
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.
7.4.3.2 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 Figure 7-1.)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-15
Preventive maintenance
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.
NOTE:
The clamp is reusable. Be sure to remove it before
you discard the bag.
Tubing
Drain bag
Clamp
Disconnect
here Collector vial drain
port must be capped
if not using drain bag
Install fitting onto
tab to seal drain bag
before disposal
Figure 7-1. How to empty the collector vial and seal the drain bag
7.4.4 Daily or as required: in-line water traps
Drain as required.
OP 7-16
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
7.4.5 Every 250 hours: compressor inlet filter
The compressor inlet filter provides pre-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 inlet filter, gently pull at one corner.
2. Wash the filter in a mild soap solution.
3. Rinse filter well and dry thoroughly to ensure an unrestricted
flow of air through the compressor compartment.
Replace 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.
Inlet
filter
Figure 7-2. 806 compressor with inlet filter
7.4.6 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-17
Preventive maintenance
7.4.7 Every year or as necessary: oxygen sensor
The ventilator’s oxygen sensor has a nominal life of one year. Its
actual life depends on the operating environment. Operation at
higher temperatures or FIO2 levels can result in shorter sensor life.
The Puritan Bennett™ 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
replacement of the oxygen sensor by qualified service personnel.
7.4.7.1 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.
OP 7-18
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
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
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-19
Preventive maintenance
ventilator, have the ventilator repaired or contact Covidien
Technical Support or your local representative for additional
assistance.
1. Locate the flexible oxygen sensor access cover on the top edge of
the cabinet.
2. Firmly push the center of the lower flap of the access cover until
the lower flap is dislodged from the cabinet.
Figure 7-3. Dislodge the O2 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.
Figure 7-4. Open O2 sensor access port
OP 7-20
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
NOTE:
The access cover is permanently attached to the
instrument by a retaining strap.
Sensor cable
connector
Oxygen sensor
Figure 7-5. Locate O2 sensor
4. Locate the small white tab next to the sensor cable connector
inside of the recessed top of the sensor. Press this tab away from
the sensor cable connector to release the sensor cable connector.
Continue to depress this tab while you gently pull the connector
from the oxygen sensor.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-21
Preventive maintenance
Cover
retaining
strap
Sensor
cable
Sensor
cable
connector
Access cover
Check valve
housing
Connector
release tab
Oxygen sensor
5. Unscrew (counter-clockwise) and remove the oxygen sensor.
6. Remove the replacement oxygen sensor and its O-ring from the
packaging.
7. Slide the O-ring onto the threaded base of the sensor. Seat the
O-ring at the base of the sensor, above the threads.
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.
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,
orienting the ridge on the cable connector towards the white
release tab on the oxygen sensor. Align the pins of the sensor
with the cable connector and push the connector into place.
OP 7-22
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
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% O2/CAL 2 min or
INCREASE O2 2 min key. See page TR 15-5 for more information
on calibrating the oxygen sensor. Verify this calibration passes.
14. Run an SST to check the system before you place a patient on the
ventilator.
7.5
Additional preventive maintenance procedures
There are additional preventive procedures that must be performed
only by qualified service personnel.
Table 7-4 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-23
Preventive maintenance
Table 7-4: Service preventive maintenance
procedures and intervals
Frequency
7.6
Part
Maintenance
Every 6
months
Entire ventilator
Run Extended Self Test
(EST).
Every year
Atmospheric pressure
transducer, expiratory
valve, flow sensors, and
vent inop test
Perform calibration/test.
Entire ventilator
Run performance
verification. This includes
running an electrical safety
test and inspecting
ventilator for mechanical
damage and for label
illegibility.
When
ventilator
location
changes by
1000 feet of
altitude
Atmospheric pressure
transducer
Perform atmospheric
pressure transducer
calibration.
Every 2 years
or as
necessary
BPS internal battery pack
Replace BPS internal
battery pack.
Actual BPS life depends on
the history of use and
ambient conditions.
Every
10,000 hours
Various parts
Install appropriate
preventive maintenance
kits.
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 A).
OP 7-24
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Preventive maintenance
Caution
• Disconnect the oxygen supply if you do not intend to use
the ventilator immediately.
• 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.
7.7
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP 7-25
This page is intentionally blank.
OP 7-26
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
Specifications
Appendix A 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.
A
A.1
Physical characteristics
Table A-1: Physical characteristics
Weight
OP A-2
10067720 Rev. B
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 (43.0 lb)
RTA Cart: 15.5 kg (34.2 lb)
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart (with one-hour BPS): 31.6 kg (69.7 lb)
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart (with four-hour BPS): 37.7 kg (83.1 lb)
Puritan Bennett™ 800 Series Ventilator Pole Cart (with
one-hour battery): 34.4 kg (75.8 lb)
Puritan Bennett™ 800 Series Ventilator Pole Cart (with
four-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)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-1: Physical characteristics
Dimensions
BDU: 330 mm high x 457 mm wide x 254 mm deep
(13 in. high x 18 in. wide x 10 in. deep)
GUI: 460 mm high x 394 mm wide x 170 mm deep
(18.1 in. high x 15.5 in. wide x 6.7 in. deep)
802 BPS: 83 mm high x 244 mm wide x 254 mm deep
(3.25 in. high x 9.6 in. wide x 10 in. deep)
803 BPS (extended BPS): 95 mm high x 438 mm wide x
260 mm deep includes housing and bracket
(3.75 in. high x 17.25 in. wide x 10.25 in. deep)
RTA Cart: 998 mm high x 582 mm wide x 602 mm deep
(39.3 in. high x 22.9 in. wide x 23.7 in. deep)
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart:
1041 mm high x 686 mm wide x 839 mm deep
(41 in. high x 27 in. wide x 33 in. deep with wheels in
outermost position)
Puritan Bennett™ 800 Series Ventilator Pole Cart:
1041mm high x 686 mm wide x 839 mm deep
(41 in. high x 27 in. wide x 33 in. deep with wheels in
outermost position)
804 Compressor (no longer available):
417 mm high x 458 mm wide x 362 mm deep
(16.4 in. high x 18 in. wide x 14.25 in. deep)
806 Compressor:
425 mm high x 458 mm wide x 362 mm deep
(17 in. high x 18 in. wide x 14.25 in. deep)
Connectors
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)
Inspiratory/
expiratory
filters
See filter instruction sheets for complete specifications.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-3
Table A-1: Physical characteristics
A.2
Gas mixing
system
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: 35 to 100 psi (241 to 690 kPa)
Air/oxygen regulator bleed: Up to 3 L/min.
Alarm
volume
45 dB(A) to 85 dB(A)
Environmental requirements
Table A-2: Environmental requirements
OP A-4
Temperature
Operating: 10 to 40 °C (50 to 104 °F) at 10 to 95%
relative humidity, noncondensing
Storage: -20 to 50 °C (-4 to 122 °F) at 10 to 95% relative
humidity, noncondensing
Atmospheric
pressure
Operating: 700 to 1060 hPa (10.2 to 15.4 psi)
Storage: 500 to 1060 hPa (7.3 to 15.4 psi)
Altitude
Operating: -443 to 3280 m (-1350 to 10,000 ft)
Storage: Up to 6560 m (20,000 ft)
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
A.3
Pneumatic specifications
Table A-3: Pneumatic specifications
Oxygen and
air
inlet
supplies
Pressure: 241 to 690 kPa (35 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 < 50 psi (345 kPa)
are employed.
Flow: Maximum of 200 L/min
Oxygen
sensor life
The oxygen sensor should be replaced one year
after the date of its manufacture, or as often as
necessary. Actual sensor life depends on operating
environment; operation at higher temperature or
O2% levels can shorten the sensor life.
Gas mixing
system
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: 35 to 100 psi
(241 to 690 kPa)
Air/oxygen regulator bleed: Up to 3 L/min
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-5
A.4
Electrical specifications
Table A-4: Electrical specifications
Input power
Ventilator operation without compressor:
100 V~, 50 Hz; 5.1 A
100 V~, 60 Hz; 5.1 A
120 V~, 60 Hz; 4.5 A
220 - 240 V~, 50 Hz; 1.5 A
220 - 240 V~, 60 Hz; 1.5 A
Ventilator operation with compressor:
100 V~, 50 Hz; 10.7 A
100 V~, 60 Hz; 10.7 A
120 V~, 60 Hz; 10.1 A
220 - 240 V~, 50 Hz; 4.1 A
220 - 230 V~, 60 Hz; 4.1 A
Mains overcurrent release:
Ventilator: 5 A, 100-120 V~; 5 A, 220-240 V~
Auxiliary mains: 10 A, 100-120 V~; 5 A, 220-240 V~
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 (humidifier
connection only available on 100 - 120 V ventilators):
• Mode: A/C
• Mandatory type: PC
• IBW: 85 kg
• fTOT: 20/min
• PSUPP: 30 cmH2O
• TI: 1 second
• Rise time percent: 50%
• O2%; 50%
• PPEAK:50 cmH2O
• PSENS: 3 cmH2O
OP A-6
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-4: Electrical specifications
Leakage current Earth leakage current:
At 100 to 120 V~ operation: 300 μA
At 220 to 240 V~ operation: 500 μA
Enclosure/patient leakage current:
100 to 120 V~ operation: 100 μA maximum
220 to 240 V~ operation: 100 μA maximum
Humidifier leakage current:
100 to 120 V~ operation: 50 μA maximum
220 to 240 V~ operation: 100 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)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-7
Table A-4: Electrical specifications
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 to 50 °C (-4 to 122 °F),
25 to 85% relative humidity; avoid direct sunlight.
Recharge requirements:
Every 6 months when storage temperature is -20 to 29 °C
(-5 to 84 °F)
803 Extended
Every 3 months when storage temperature is 30 to 40 °C
Backup Power
(86 to 104 °F)
Source and
Every 2 months when storage temperature is 41 to 50 °C
newer
Puritan Bennett™ (105 to122 °F).
800 Series
24 V DC, 17 Ah
Ventilator carts
Operating time (for a new, fully charged battery): At least
with four-hour
four hours. Actual duration depends on ventilator
BPS or battery
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 to 50 °C (-4 to 122 °F),
25 to 85% relative humidity; avoid direct sunlight.
Recharge requirements:
Every 6 months when storage temperature is -20 to 29 °C
(-5 to 84 °F)
Every 3 months when storage temperature is 30 to 40 °C
(86 to 104 °F)
Every 2 months when storage temperature is 41 to 50 °C
(105 to122 °F).
802 Backup
Power Source
(BPS) and
newer
Puritan Bennett™
800 Series
Ventilator carts
with one-hour
BPS or battery
NOTE:
BPS battery life specifications are approximate. To
ensure maximum battery life, maintain full charge and
minimize the number of complete discharges.
OP A-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
A.5
Compliance and approvals
The Puritan Bennett™ 840 Ventilator System was developed in
accordance with pertinent FDA guidances and North American and
International standards (Table A-5).
The ventilator’s IEC 60601-1/EN 60601-1 classification is Protection
class I, Type B, internally powered, IPX1 drip-proof equipment,
continuous operation.
Table A-5: Compliance and approvals
Standards/certifications
Configurations
Certification
agency
North America
Authorized to bear the CSA
certification mark with NRTL/C
indicator, 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
120 V, 60 Hz
220-240 V, 50 Hz
220-240 V, 60 Hz
IEC 60601-1-2:2007
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Canadian
Standards
Association
(CSA)
Manufacturer
self-certification
10067720 Rev. B
OP A-9
Table A-5: Compliance and approvals
Standards/certifications
Configurations
Certification
agency
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
100 V, 50/60 Hz
120 V, 60 Hz
220 – 240 V, 50 Hz
220 – 240 V, 60 Hz
Canadian
Standards
Association
(CSA)
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
Manufacturer
self- certification
220-240 V, 50 Hz
220-240 V, 60 Hz
TÜV Product
Service
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
Manufacturer
self- certification
A.5.1 Manufacturer’s Declaration
The following tables contain the manufacturer’s declarations for the
Puritan Bennett™ 840 Ventilator System electromagnetic emissions,
electromagnetic immunity, recommended separation distances
between ventilator and portable and mobile RF communications
equipment, and a list of compliant cables.
OP A-10
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
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 re-orienting the equipment.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-11
Table A-6: Electromagnetic Emissions
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.
Emissions Test
Electromagnetic environment–
guidance
Compliance
Radiated RF emissions
CISPR 11
Group 1
Class A
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.
Conducted RF emissions
CISPR 11
Group 1
Class A
Harmonic emissions
IEC 61000-3-2
Class A
Voltage fluctuations/
flicker emissions
IEC 61000-3-3
Complies
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.
Table 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
OP A-12
10067720 Rev. B
IEC 60601-1-2
test level
Compliance
level
Electromagnetic
environment–guidance
± 6 kV contact
± 6 kV contact
± 8 kV air
± 8 kV air
Floors should be wood,
concrete, or ceramic
tile. If floors are covered
with synthetic material,
the relative humidity
should be at least 30%.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-7: Electromagnetic Immunity (cont)
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
Electrical fast
transient/burst
IEC 61000-4-4
IEC 60601-1-2
test level
Compliance
level
Electromagnetic
environment–guidance
± 2 kV for
power supply
lines
± 2 kV for
power supply
lines
± 1 kV for input/
output lines
± 1 kV for input/
output lines
Surge
IEC 61000-4-5
± 1 kV
lines/lines
± 2 kV
lines/earth
± 1 kV
lines/lines
± 2 kV
lines/earth
Mains power quality
should be that of a
typical commercial or
hospital environment.
Voltage dips,
short interruptions and voltage variations
on power supply
input lines
IEC 61000-4-11
< 5% UT
(> 95% dip in UT
for 0.5 cycle)
< 5% UT
(> 95% dip in UT
for 0.5 cycle)
40% UT
(60% dip in UT
for 5 cycles)
40% UT
(60% dip in UT
for 5 cycles)
70% UT
(30% dip in UT
for 25 cycles)
70% UT
(30% dip in UT
for 25 cycles)
< 5% UT
(> 95% dip in UT
for 5 s)
< 5% UT
(> 95% dip in UT
for 5 s)
Mains power quality
should be that of a typical commercial or hospital environment. If the
user of the
Puritan Bennett™ 840
Ventilator System
requires continued
operation during power
mains interruptions, it is
recommended the
Puritan Bennett™ 840
Ventilator System be
powered from an uninterruptible power supply or a battery.
3 A/m
3 A/m
Power frequency
(50/60 Hz)
magnetic field
IEC 61000-4-8
Mains power quality
should be that of a
typical commercial or
hospital environment.
Power frequency magnetic fields should be at
levels characteristic of a
typical location in a typical commercial or hospital environment.
NOTE:
UT is the AC mains voltage prior to application of the test level.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-13
Table 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
Conducted RF
IEC 61000-4-6
Radiated RF
IEC 61000-4-3
IEC 60601-1-2
test level
Compliance
level
3 Vrms
150 kHz to
80 MHz outside
ISM bandsa
3 Vrms
150 kHz to
80 MHz outside
ISM bands
10 Vrms
inside ISM
bandsa
10 Vrms
inside ISM bands
10 V/m
80 MHz to
2.5 GHz
10 V/m
80 MHz to
2.5 GHz
Electromagnetic
environment–guidance
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 recommended
separation distance
calculated from the
equation applicable to
the frequency of the
transmitter.
Recommended
separation distance
d = 0.35 P
d = 1.2 P
d = 1.2 P 80 MHz to
800 MHz
d = 2.3 P 800 MHz to
2.5 GHz
OP A-14
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-8: Electromagnetic Immunity – conducted and
radiated RF (cont)
where P is the maximum output power rating of the transmitter in watts (W)
according to the transmitter manufacturer and d is the recommended separation
distance in meters (m)b.
Field strengths from fixed RF transmitters, as determined by an electromagnetic
site surveyc, should be less than the compliance level in each frequency ranged.
Interference may occur in the vicinity of equipment marked with the following
symbol:
NOTE:
• At 80 MHz and 800 MHz, the higher frequency range
applies.
• These guidelines may not apply in all situations.
Electromagnetic propagation is affected by absorption and
reflection from structures, objects, and people.
a
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.
b
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 recommended separation distance for transmitters in these frequency ranges.
c Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) tele-
phones 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 Puritan Bennett™ 840 Ventilator System is
used exceeds the applicable RF compliance level above, the 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.
d Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 10 V/m.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-15
Table 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.
Separation distance according to frequency of transmitter (m)
Rated
maximum
output
power of
transmitter
(W)
150 kHz to
80 MHz
outside ISM
bands
d = 0.35 P
OP A-16
150 kHz to
80 MHz in
ISM bands
80 MHz to
800 MHz
800 MHz to
2.5 GHz
d = 1.2 P
d = 1.2 P
d = 2.3 P
0.01
0.035
0.12
0.12
0.23
0.1
0.11
0.38
0.38
0.73
1
.35
1.2
1.2
2.3
10
1.1
3.8
3.8
7.3
100
3.5
12
12
23
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-9: Recommended separation distances between
portable and mobile RF communications equipment and the
Puritan Bennett™ 840 Ventilator System (cont)
For transmitters rated at a maximum output power not listed above, the
recommended separation distance d in meters (m) can be determined 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.
NOTES:
• At 80 MHz and 800 MHz, the separation distance for the
higher frequency range applies.
• 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.
• 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.
• These guidelines may not apply in all situations.
Electromagnetic propagation is affected by absorption
and reflection from structures, objects, and people.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-17
Table A-10: Compliant cables
Covidien does not supply remote alarm (nurse call) or serial port cables.
In order to maintain compliance to International Electromagnetic
Compatibility (EMC) standards, Covidien recommends using shielded
cables for these applications.
Warning
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.
OP A-18
4-078107-00, 4-078107-SP
Power cord, latching, North America
10 ft (3 m)
4-078108-00, 4-078108-SP
Power cord, latching, Europe
10 ft (3 m)
4-078109-00, 4-078109-SP
Power cord, latching, Japan
10 ft (3 m)
4-078110-00, 4-078110-SP
Power cord, latching, Australia
10 ft (3 m)
4-071421-00
Power cord, Denmark
10 ft (3 m)
4-071422-00
Power cord, India/S. Africa
10 ft (3 m)
4-071423-00
Power cord, Israel
10 ft (3 m)
4-078144-00
Power cord, UK
10 ft (3 m)
4-078107-00, 4-078107-SP
Power cord, latching, North America
10 ft (3 m)
4-031323-00
Power cord, Italy
10 ft (3 m)
4-031325-00
Power cord, Switzerland
10 ft (3 m)
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-10: Compliant cables (cont)
Covidien does not supply remote alarm (nurse call) or serial port cables.
In order to maintain compliance to International Electromagnetic
Compatibility (EMC) standards, Covidien recommends using shielded
cables for these applications.
Warning
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.
A.6
4-075864-00
Cable assembly, GUI to BDU
3 ft (91 cm)
4-071441-00
Cable assembly, GUI to BDU
10 ft (3 m)
Technical specifications
NOTE:
When the Puritan Bennett™ 840 Ventilator System pressure units are set
to hPa, pressure delivery and spirometry are subject to an additional 2%
error.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-19
Table A-11: Technical specifications
Maximum limited
pressure
127.5 cmH2O (125 hPa)
Maximum working
pressure
100 cmH2O (98.1 hPa), ensured by high pressure
limit
90 cmH2O (pressure-based ventilation)
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 to 120 cmH2O, (-20.4 to 122 hPa)
Peak circuit pressure
Range: -20 to 130 cmH2O (-20.4 to 133 hPa)
Volume:
Type: Hot film anemometer
Sensing position: Exhalation compartment
Measurements:
Exhaled tidal volume
Range: 0 to 6,000 mL
Total minute volume
Range: 0 to 99.9 L
Oxygen measurement:
Type: Galvanic cell
Sensing position: Inspiratory manifold
Measurement: Delivered % O2
Range: 0 to 103%
Display of settings, alarms, and monitored data:
Type: Two liquid crystal display (LCD) touch
screens
Minute volume
(VE TOT ) capability
OP A-20
10067720 Rev. B
25 to 75 L/min
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-11: Technical specifications (cont)
Results of ventilator
patient circuit
testing (using circuits
identified for use
with the Puritan
Bennett™ 840
Ventilator System
(Figure A-1.))
Inspiratory pressure drop from inlet of open
safety valve to output port without inspiratory
filter:
At 5 standard liters per minute (SL/min):
0.06 cmH2O
At 30 standard liters per minute (SL/min):
0.28 cmH2O
At 60 SL/min: 0.95 cmH2O
Inspiratory pressure drop across inspiratory
filter:
At 5 SL/min: 0.17 cmH2O
At 30 SL/min: 0.56 cmH2O
At 60 SL/min: 1.37 cmH2O
Inspiratory pressure drop from inlet of open
safety valve with inspiratory filter:
At 5 SL/min: 0.17 cmH2O
At 30 SL/min: 0.84 cmH2O
At 60 SL/min: 2.32 cmH2O
Pressure drop across 1.68 m (5.5 ft) inspiratory or
expiratory limb with water trap, to patient wye:
Neonatal patient circuit1: Not applicable (no
water trap)
Pediatric patient circuit at 30 SL/min:
0.73 cmH2O
Adult patient circuit at 60 SL/min: 1.05 cmH2O
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 cmH2O (inspiratory limb)
Neonatal patient circuit at 5 SL/min:
0.40 cmH2O (expiratory limb)
Pediatric patient circuit at 30 SL/min:
0.56 cmH2O
Adult patient circuit at 60 SL/min: 0.70 cmH2O
1
Use only a neonatal patient circuit in conjunction with the NeoMode software
option and the NeoMode hardware.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-21
Table A-11: Technical specifications (cont)
Results of ventilator
patient circuit
testing (cont)
Pressure drop across Fisher & Paykel™*
humidifier and lead-in tube:
Neonatal patient circuit at 5 SL/min:
0.14 cmH2O
Pediatric patient circuit at 30 SL/min:
0.28 cmH2O
Adult patient circuit at 60 SL/min: 0.93 cmH2O
Expiratory pressure drop across exhalation
compartment:
At 5 SL/min: 0.21 cmH2O (with neonatal filter
and vial)
At 30 SL/min: 1.5 cmH2O
At 60 SL/min: 3.40 cmH2O
Total inspiratory pressure drop:
Neonatal patient circuit with neonatal filter/
vial at 5 SL/min: 0.76 cmH2O
Pediatric patient circuit with water traps at
30 SL/min: 1.85 cmH2O
Pediatric patient circuit without water traps
at 30 SL/min: 1.68 cmH2O
Adult patient circuit with water traps at
60 SL/min: 4.30 cmH2O
Adult patient circuit without water traps at
60 SL/min: 3.95 cmH2O
Total expiratory pressure drop:
Pediatric patient circuit with water traps at
30 SL/min: 2.23 cmH2O
Pediatric patient circuit without water traps
at 30 SL/min: 2.06 cmH2O
Adult patient circuit with water traps at
60 SL/min: 4.45 cmH2O
Adult patient circuit without water traps at
60 SL/min: 4.10 cmH2O
OP A-22
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-11: Technical specifications (cont)
Internal volume:
Inspiratory pneumatics: 50 mL ± 5 mL
Expiratory pneumatics: 1000 mL ± 25 mL
(including expiratory filter and collector vial)
The Puritan Bennett™ 840 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.
NOTE:
• Patient circuit testing specifications are with the ventilator
powered off, and are based on the recommended configurations
shown in Figure A-1 (heated wire humidifier without water traps
and non-heated wire humidifier with water traps). Patient circuit
part numbers are listed in Appendix B.
• To ensure 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
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-23
1
3
2
4
5
8
7
6
(Heated wire)
1
2
3
4
5
9
7
8
6
(Non-heated wire)
Figure A-1. Recommended patient circuit configurations
NOTE:
Refer to the NeoMode option addendum for the
recommended neonatal patient circuit configurations.
OP A-24
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-12: Patient circuit configurations
Heated wire configuration
Item
Description
1
Patient wye
2
Expiratory limb (smooth-bore tubing)
3
Drain bag/tubing
4
PB Re/X 800 or D/X 800 expiratory filter and collector
vial
5
To patient connector
6
PB Re/Flex or D/Flex inspiratory filter
7
Inspiratory limb (smooth-bore tubing)
8
Nebulizer (for position only)
Non-heated wire configuration
Item
Description
1
Patient wye
2
Water trap
3
Expiratory limb (smooth-bore tubing)
4
PB Re/X 800 or D/X 800 expiratory filter and collector
vial
5
To patient connector
6
PB Re/Flex or D/Flex inspiratory filter
7
Inspiratory limb (smooth-bore tubing)
8
Water trap
9
Nebulizer (for position only)
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-25
A.7
Ranges, resolutions, and accuracies
• Table A-13 contains ranges, resolutions, and accuracies for
ventilator settings. It also contains, where applicable, dependent
ventilator settings.
• Table A-14 contains alarm settings.
• Table A-15 contains patient data.
• Table A-16 contains descriptions of other displayed data including
diagnostic codes, operational time, software revision level, and
date/time setting.
A.7.1 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-26
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
A.7.2 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)
VS, VC+ (Volume Ventilation Plus Option)
PAV+ (Proportional Assist™* Ventilation Plus Option)
RM (Respiratory Mechanics Option)
Trending (Trending Option)
Table A-13: Ventilator settings
Setting
Function
Range, resolution, accuracy
Apnea
ventilation
A safety mode initiated if
the patient does not
receive a breath for an
elapsed time exceeding
the apnea interval.
See individual apnea settings
Apnea
expiratory
time (TE)
Same as expiratory time
for non-apnea
ventilation.
Range: TE ≥ 0.2 second
Apnea flow
pattern
Same as flow pattern for
non-apnea ventilation.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Resolution: Same as for nonapnea
Accuracy: Same as for nonapnea
See flow pattern below.
10067720 Rev. B
OP A-27
Table A-13: Ventilator settings (cont)
OP A-28
Setting
Function
Range, resolution, accuracy
Apnea I:E ratio
Same as I:E ratio for nonapnea ventilation.
Range: ≤ 1.00:1
Resolution: See I:E ratio
below.
Accuracy: See I:E ratio
below.
Apnea
inspiratory
pressure (PI)
Same as inspiratory
pressure for non-apnea
ventilation.
See inspiratory pressure
below.
Apnea
inspiratory
time (TI)
Same as inspiratory time
for non-apnea
ventilation.
See inspiratory time below.
Apnea interval
(TA)
Defines apnea time
interval after which the
ventilator declares apnea.
TA ≥ 60/fA
Range: 10 to 60 seconds
Resolution: 1 second
Accuracy: + 0.350 second
New patient value:
Neonatal: 10 s
Pediatric: 15 s
Adult: 20 s
Apnea
mandatory
type
Same as mandatory type
for non-apnea
ventilation.
See mandatory type below.
New patient value:
Neonatal: Same as nonapnea mandatory type
when non-apnea
mandatory type is PC or
VC. PC when non-apnea
mandatory type is VC+.
Pediatric/Adult: Same as
non-apnea mandatory
type when non-apnea
mandatory type is PC or
VC. VC when non-apnea
mandatory type is VC+.
Apnea O2%
Same as O2% for nonapnea ventilation.
Range: 21 to 100%, and not
below non-apnea O2%
Resolution: 1%
Accuracy: See O2% below.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Function
Range, resolution, accuracy
Apnea peak
inspiratory
flow (VMAX)
Same as peak inspiratory
flow for non-apnea
ventilation.
See peak inspiratory flow
below.
Apnea
respiratory
rate (f)
Same as respiratory rate
for non-apnea
ventilation.
Apnea f ≥ 60/TA
Range: 2.0 to 40/min
Resolution:
0.1/min for 2.0 to 9.9/min
1/min for 10 to 40/min
Accuracy:
±0.1/min (+0.6% of
setting)
New patient value:
Neonatal: 20/min
Pediatric: 14/min
Adult: 10/min
Apnea tidal
volume (VT)
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:
Neonatal: 3 mL to 315 mL*
Pediatric/Adult: 25 mL to
2500 mL (IBW-based range
is 1.16 x IBW minimum;
45.7 x IBW maximum)
Resolution:
0.1 mL for 3 to 5 mL*
1 mL for 5 to 100 mL
5 mL for 100 to 400 mL
10 mL for 400 to 2500 mL
Accuracy:
Compliance- and
BTPS-compensated:
For TI < 600 ms:
± 10 mL (+ 10% x
(600 ms/TI) of setting)
For TI > 600 ms:
± 10 mL (+ 10% of setting)
New patient value: MAX
(3 mL, (7.25 * IBW))*
*Assumes NeoMode 2.0
software option is installed
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-29
Table A-13: Ventilator settings (cont)
Setting
Constant
during rate
change
Function
Specifies which of the
three breath timing
variables is directly
operator-adjustable and
remains constant when
the set respiratory rate
changes. Applicable in
pressure control (PC)
ventilation and Volume
Control Plus ventilation
(VC+) only.
Range, resolution, accuracy
Timing variables:
Inspiratory time, I:E ratio,
or expiratory time; TH, TL,
TH:TL 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.
Disconnect
sensitivity
(DSENS)
OP A-30
10067720 Rev. B
Sets the allowable loss (in
%) of returned volume
which, if exceeded, causes
the ventilator to detect a
CIRCUIT DISCONNECT
alarm. The greater the
setting, the more
returned volume must be
lost before CIRCUIT
DISCONNECT is detected.
For example, a setting of
95% means more than
95% of the returned
volume must be lost
before the ventilator
detects a CIRCUIT
DISCONNECT alarm.
Range: 20 to 95%
Resolution: 1%
Accuracy: Not applicable
New patient value (INVASIVE
Vent Type): 75%
New patient value (NIV Vent
Type): OFF
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Function
Range, resolution, accuracy
Expiratory
sensitivity
(ESENS)
The percent of peak
inspiratory flow at which
the ventilator cycles from
inspiration to exhalation
for spontaneous breaths.
Range: 1 to 80% (1 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)
Expiratory
time (TE)
Sets the expiratory period
for pressure control (PC or
VC+) mandatory breaths.
Range: TE ≥ 0.2 second
Resolution: 0.01 second
Accuracy: ±0.01 second
New patient value:
60/f (new patient) - TI (new
patient) seconds
Depends on: I:E ratio, TI, f
Flow pattern
(available only
when
mandatory
type is VC)
The gas flow pattern of
mandatory volumecontrolled (VC) breaths.
Flow pattern is not
selectable when the
mandatory type is PC or
VC+.
Range:
Square or descending
ramp
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Descending ramp
All circuit types:
Descending ramp
Flow sensitivity The flow inspired by the
(VSENS)
patient triggers the
ventilator to deliver a
mandatory or
spontaneous breath
(when flow triggering is
selected).
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Range:
Neonatal:
0.1 to ≤ 10 L/min
Pediatric/Adult:
0.2 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
10067720 Rev. B
OP A-31
Table A-13: Ventilator settings (cont)
Setting
OP A-32
Function
Range, resolution, accuracy
High
spontaneous
inspiratory
time limit
(2TI SPONT)
(Available
when Vent
Type is NIV,
only)
Sets the maximum
inspiratory time allowed
during non-invasive
ventilation. If the
inspiratory time reaches
the set limit, the
ventilator transitions to
exhalation.
Range:
Neonatal:
≥0.2 sec to (1 + (0.1 x IBW)) sec
Pediatric/Adult:
≥ 0.4 sec to (1.99 + (0.02 x
IBW)) sec
New patient value:
Neonatal:
(1 + (0.1 x IBW)) sec
Pediatric/Adult:
(1.99 + (0.02 x IBW)) sec
Depends on: Circuit type,
IBW
Humidification
type
Indicates the type of
humidification device
used on the ventilator.
Type can be changed
during SST and normal
ventilation (see the More
Settings screen).
Range:
HME, non-heated
expiratory tube, or heated
expiratory tube
Resolution: Not applicable
Accuracy: Not applicable
New patient value: Previous
setting
Humidifier
volume
The empty volume of the
currently installed
humidifier (specified
volume, not compressible
volume).
Range: 100 mL to 1000 mL
Resolution: 10 mL
New patient value: Previous
setting
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Ideal body
weight (IBW)
Function
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Range, resolution, accuracy
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 to 3.5 kg*
0.5 kg for 3.5 to 10 kg
1.0 kg for 10 to 50 kg
5 kg for 50 to 100 kg
10 kg for 100 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
10067720 Rev. B
OP A-33
Table A-13: Ventilator settings (cont)
Setting
OP A-34
Function
Range, resolution, accuracy
I:E ratio
or
TH:TL in
BILEVEL
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:
1:299 ≤ I:E ≤ 4.00:1
1:299 < TH:TL < 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: TI, TE or TH, TL
Inspiratory
pressure (PI)
Sets the inspiratory
pressure at the patient
wye (above PEEP) during
a pressure control (PC)
mandatory breath.
Range: 5 to 90 cmH2O;
PI + PEEP < 90 cmH2O;
PI + PEEP + 2 cmH2O
≤ 2PPEAK
Resolution: 1.0 cmH2O
Accuracy:
± 3.0 (+ 2.5% of setting)
cmH2O, measured at patient
wye (end inspiratory
pressure after 1 second)
when Rise Time Percent is
100%
New patient value:
15 cmH2O
Depends on: PEEP, 2PPEAK
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Function
Range, resolution, accuracy
Inspiratory
time (TI)
Sets the duration of
inspiration during
pressure control (PC or
VC+) mandatory breaths.
Not settable in VC, but TI
is displayed on breath
timing bar and changes
based upon changes to
VC settings.
Range:
0.20 to 8.00 seconds
TH 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, TE
Mandatory
type
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: VC, PC, or VC+
Resolution: Not applicable
Accuracy: Not applicable
New patient value:
Neonatal: PC
Pediatric/Adult: VC
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-35
Table A-13: Ventilator settings (cont)
Setting
Mode
OP A-36
10067720 Rev. B
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 or VC+)
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) allows
PC mandatory breaths
and spontaneous breaths
(with or without PS or
TC). BILEVEL establishes
two levels of positive
airway pressure. BILEVEL
is not available when
Vent Type is NIV.
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
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Mode (cont)
Function
Range, resolution, accuracy
NOTE:
Ventilator settings unique to the BILEVEL mode are
described in the BiLevel option addendum to this
manual.
O2%
Sets the percentage of
oxygen in the delivered
gas.
Range: 21 to 100%
Resolution: 1% O2
Accuracy:
±3% by volume over the
entire breath
New patient value:
Neonatal: 40%
Pediatric/Adult: 100%
NOTE:
A significant change to the O2% setting can cause the
VTE (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.
Patient circuit
type
Indicates the type of
circuit used on the
ventilator. Setting can be
changed only during SST.
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-37
Table A-13: Ventilator settings (cont)
Setting
Peak
inspiratory
flow (VMAX)
Function
Range, resolution, accuracy
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 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 x 0.435 x IBW. When flow
pattern is Square: 0.435 x
IBW. When circuit type is
Pediatric and flow pattern is
Square: MAX(0.572 x IBW),
3.0. When flow pattern is
Descending Ramp: 2 x 0.572
x IBW. When circuit type is
Neonatal: MAX (2 x 0.750 x
IBW) 1.0
Depends on: Circuit type,
IBW, VT, f, flow pattern, TPL,
I:E, TE
OP A-38
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Function
Range, resolution, accuracy
PEEP
Sets the positive endexpiratory pressure,
defined as the positive
pressure targeted in the
patient circuit during
exhalation (also called
baseline).
Range: 0 to 45 cmH2O
Resolution:
0.5 cmH2O for 0 to
19.5 cmH2O
1 cmH2O for 20 to
45 cmH2O
Accuracy:
± (2.0 + 4% of setting)
cmH2O measured at
patient wye
PEEP measured with
returned flow: < 5 L/min
New patient value: 3 cmH2O
Depends on: 2PPEAK, PI
Plateau time
(TPL)
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.
Range: 0.0 to 2.0 seconds
Resolution: 0.1 second
Accuracy: ±0.01 second
New patient value: 0.0
seconds
Depends on: VT, f, flow
pattern, VMAX, I:E, TE
Pressure
sensitivity
(PSENS)
Sets the pressure drop
below PEEP required to
begin a patient-initiated
breath (when pressure
triggering is selected).
Range:
0.1 to 20 cmH2O below
PEEP
Resolution: 0.1 cmH2O
Accuracy: Not applicable
New patient value: 2 cmH2O
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-39
Table A-13: Ventilator settings (cont)
OP A-40
Setting
Function
Range, resolution, accuracy
Pressure
support (PSUPP)
Sets the inspiratory assist
pressure (above PEEP) at
the patient wye during a
spontaneous breath,
when spontaneous breath
type is pressure support
(PS).
Range: 0 to 70 cmH2O;
PSUPP + PEEP ≤ 90 cmH2O;
PSUPP + PEEP + 2 cmH2O
≤ 2PPEAK
Resolution: 1 cmH2O
Accuracy:
± (3.0 + 2.5% of setting)
cmH2O measured at
patient wye (end
inspiratory pressure after
1 second)
New patient value: 0 cmH2O
Depends on: 2PPEAK
Respiratory
rate (f)
Sets the minimum
number of mandatory
breaths the patient
receives per minute.
Active in A/C, SIMV, and
BILEVEL.
Range:
Neonatal: 1.0 to 150/min
Pediatric/Adult: 1.0 to
100/min
Resolution:
0.1/min for 1.0 to 10/min
1/min for 10 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
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Rise time
percent
P%
Function
Range, resolution, accuracy
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%.
Safety
ventilation
(safe state)
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 highurgency PROCEDURE
ERROR alarm and sets
these alarm limits:
High circuit pressure =
20 cmH2O
Low exhaled minute
volume = 0.05 L
All other alarms are
inactive.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Safety ventilation settings
include:
Mode = A/C
Mandatory type = PC
Respiratory rate = 16/min
Inspiratory time = 1 s
Inspiratory pressure =
10 cmH2O
PEEP = 3 cmH2O
Trigger type = pressure
Pressure sensitivity =
2 cmH2O
Rise time percent = 50%
O2% = 100% or 40% in
NeoMode (21% if O2 not
available)
10067720 Rev. B
OP A-41
Table A-13: Ventilator settings (cont)
Setting
Spontaneous
type
OP A-42
10067720 Rev. B
Function
Range, resolution, accuracy
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.
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
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-13: Ventilator settings (cont)
Setting
Function
Range, resolution, accuracy
Tidal volume
(for VC) or
Target volume
(for VC+)
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:
Neonatal: 2 mL to 315 mL*
Pediatric/Adult: 25 mL to
2500 mL (IBW-based range
is 1.16 x IBW minimum;
45.7 x IBW maximum)
Resolution:
0.1 mL for 2 to 5 mL*
1 mL for 5 to 100 mL
5 mL for 100 to 400 mL
10 mL for 400 to 2500 mL
Accuracy:
Compliance- and BTPScompensated:
For TI < 600 ms:
± 10 mL (+ 10% x
(600 ms/TI) of setting)
For TI > 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*
(VT)
Pediatric/Adult: (7.25 X IBW)
Depends on: Circuit type,
IBW, f, VMAX, flow pattern,
TPL, I:E, TE
*Assumes NeoMode 2.0
software option is installed
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-43
Table A-13: Ventilator settings (cont)
Setting
OP A-44
Function
Range, resolution, accuracy
Trigger type
Determines whether flow
or pressure triggers
patient breaths.
See also flow sensitivity
and pressure sensitivity.
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)
Vent Type
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: INVASIVE or NIV
(non-invasive)
Resolution: Not applicable
Accuracy: Not applicable
New patient value: INVASIVE
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-14: Alarm settings
Setting
Function
Range, resolution, accuracy
Apnea
interval (TA)
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 TA setting.
Range: MAX (10 s,
60/ Apnea f s)
Resolution: 1 second
New patient value:
Neonatal: 10 seconds
Pediatric: 15 seconds
Adult: 20 seconds
High circuit
pressure limit
(2PPEAK)
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.
Range: 7 to 100 cmH2O
Resolution: 1 cmH2O
New patient value:
Neonatal: 30 cmH2O
Pediatric/Adult: 40
cmH2O
O2 sensor
Enabling the O2 sensor
will allow the High/Low
delivered O2% alarm to
function. This alarm
indicates the O2%
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%
O2 suction, apnea
ventilation, patient
circuit disconnect, low
pressure gas inlet, and
when the O2% setting is
changed.
Range:
O2 sensor Enabled,
Disabled, or Calibration
New patient value: Enabled
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
NOTE:
Alarm only occurs if O2
sensor is Enabled.
10067720 Rev. B
OP A-45
Table A-14: Alarm settings (cont)
OP A-46
Setting
Function
Range, resolution, accuracy
High exhaled
minute
volume limit
(2VE TOT )
Sets the maximum
exhaled minute volume
limit for spontaneous or
mandatory breaths.
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 to 0.495
0.05 L for 0.50 to 4.95 L
0.5 L for 5.0 to 100.0 L
New patient value:
Neonatal:
[(20 x 0.001 L/mL x (7.25
mL/kg x IBW) x 1.30) + 0.05]
Pediatric:
[(14 x 0.001 L/mL x (7.25
mL/kg x IBW) x 1.30) + 0.05]
Adult:
[(10 x 0.001 L/mL x (7.25
mL/kg x IBW) x 1.30) + 0.05]
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-14: Alarm settings (cont)
Setting
Function
Range, resolution, accuracy
High exhaled
tidal volume
limit
(2VTE)
Sets the maximum
exhaled tidal volume
limit for spontaneous or
mandatory breaths.
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 to 400 mL
10 mL for 400 to 3000 mL
New patient value:
MAX [(7.25 mL/kg x IBW x
1.30), 5] mL
High
respiratory
rate limit
(2fTOT )
Sets the maximum
breath rate limit.
Range:
OFF
or
Neonatal:
10/min to 170/min
Pediatric/Adult:
10/min to 110/min
Resolution: 1/min
New patient value: OFF
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-47
Table A-14: Alarm settings (cont)
OP A-48
Setting
Function
Range, resolution, accuracy
Low exhaled
mandatory
tidal volume
limit
(4VTE MAND)
Sets the minimum
exhaled mandatory tidal
volume limit.
Range:
OFF
or
≥ 1 mL
< high exhaled tidal
volume limit
and
Neonatal: ≤ 300 mL
Pediatric: ≤ 1000 mL
Adult: ≤ 2500 mL
Resolution:
1mL for 1 to 100 mL
5 mL for 100 to 400 mL
10 mL for 400 to 2500 mL
New patient value
(INVASIVE Vent Type):
(7.25 mL/kg x IBW x 0.70)
New patient value (NIV
Vent Type): OFF
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-14: Alarm settings (cont)
Setting
Function
Range, resolution, accuracy
Low exhaled
minute
volume limit
(4VE TOT)
Sets the minimum
exhaled minute volume
limit for mandatory and
spontaneous breath
types.
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 to
0.495 L/min
0.05 L/min for 0.05 to
4.95 L/min
0.5 L/min for 5.0 L to 60.0
L/min
New patient value
(INVASIVE Vent Type):
Neonatal:
MAX [((20 x 0.001 L/mL x
(7.25 mL/kg x IBW) x 0.70) 0.05), 0.01]
Pediatric:
[(14 x 0.001 L/mL x (7.25
mL/kg x IBW) x 0.70) - 0.05]
Adult:
[(10 x 0.001 L/mL x (7.25
mL/kg x IBW) x 0.70) - 0.05)
New patient value (NIV
Vent Type): OFF
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-49
Table A-14: Alarm settings (cont)
Setting
Function
Range, resolution, accuracy
Low exhaled
spontaneous
tidal volume
limit
(4VTE SPONT)
Sets the minimum
exhaled spontaneous
tidal volume limit.
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 to 100 mL
5 mL for 100 to 400 mL
10 mL for 400 to 2500 mL
New patient value
(INVASIVE Vent type):
(7.25 mL/kg x IBW x 0.70)
New patient value (NIV
Vent Type or when
Spontaneous Type is PA):
OFF
Low circuit
pressure
alarm limit
(4PPEAK)
Sets the minimum
allowable circuit
pressure. Available only
during NIV or when VC+
is selected as Mandatory
Type in INVASIVE
ventilation.
Range:
NIV: OFF to 2PPEAK - 1
cmH2O
VC+: PEEP to 2PPEAK - 1
cmH2O
NOTE:
When VC+ is selected,
4PPEAK can be set to OFF
only if PEEP is set to 0.
New patient value:
PEEP + 6 cmH2O
Resolution:
0.5 cmH2O for pressures
< 20 cmH2O
1 cmH2O for pressures
≥ 20 cmH2O
OP A-50
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-15: Patient data
Parameter
Function
Range, resolution, accuracy
Breath type
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 (VTE)
display, which applies to
the previous breath cycle.
Type: Control (C), assist (A),
or spontaneous (S)
Phase: Inspiration or
exhalation
Resolution: Not applicable
Accuracy: Not applicable
Delivered
O2%
(O2%)
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 O2% alarms are
set internally and are
based on the set O2%
value.
Range: 0 to 103%
Resolution: 1% O2
Accuracy: ±3% O2 of full
scale
End
expiratory
pressure
(PEEP)
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.
Range: -20.0 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to 130
cmH2O
Accuracy:
± (2 + 4% of reading)
cmH2O relative to the
pressure measured at the
exhalation side of the
patient wye
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-51
Table A-15: Patient data (cont)
Parameter
OP A-52
Function
Range, resolution, accuracy
End
inspiratory
pressure
(PI END)
Indicates the pressure at
the end of the inspiratory
phase of the current
breath. Updated at the
beginning of the
exhalation phase. If
plateau is active, the
displayed value reflects
the level of end-plateau
pressure.
Range: -20.0 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to 130
cmH2O
Accuracy:
± (2 + 4% of reading)
cmH2O relative to the
patient wye for pressure
control breaths with
inspiratory times of 1
second or longer
Exhaled
minute
volume
(VE TOT)
Displays a calculated
total of the volumes
exhaled by the patient
for mandatory and
spontaneous breaths for
the previous one-minute
interval. The displayed
value is compliance- and
BTPS-compensated.
Exhaled minute volume
updates at the beginning
of the next inspiration.
Range: 0.00 to 99.9 L
Resolution:
0.01 L for 0.00 to 9.99 L
0.1 L for 10.0 to 99.9 L
Accuracy:
For TE < 600 ms:
±10 x respiratory rate
(+10% x (600 ms/TE) of
reading) mL
For TE > 600 ms: ±10 x
respiratory rate (+10%
of reading) mL
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-15: Patient data (cont)
Parameter
Function
Range, resolution, accuracy
Exhaled tidal
volume (VTE)
Indicates the volume
exhaled by the patient for
the previous mandatory or
spontaneous breath.
The displayed value is
compliance- and BTPScompensated. Exhaled
tidal volume updates at
the beginning of the next
inspiration.
Range: 0 to 6000 mL
Resolution:
0.1 mL for 0.0 to 9.9 mL
1 mL for 10 to 6000 mL
Accuracy:
For TI < 600 ms: ± (10 +
10% (600 ms/TE) of
setting) mL
For TI > 600 ms: ± (10 +
10% of setting) mL
Compliance- and
BTPS-compensated
TE = time to exhale 90%
of exhaled volume
NOTE:
A significant change to the O2% setting can cause the
VTE (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.
I:E ratio
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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
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%
10067720 Rev. B
OP A-53
Table A-15: Patient data (cont)
OP A-54
Parameter
Function
Range, resolution, accuracy
Intrinsic PEEP
(PEEPI)
Indicates a calculated
estimate of the pressure
above the PEEP level at
the end of exhalation.
Determined during an
expiratory pause
maneuver.
Range: -20.0 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to
130 cmH2O
Peak circuit
pressure
(PPEAK)
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 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to 130
cmH2O
Mean circuit
pressure
(PMEAN)
Indicates the average
circuit pressure over the
previous one-minute
interval, regardless of
type. Updated at the
beginning of the next
inspiration.
Range: -20.0 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to
130 cmH2O
Accuracy:
± (3 + 4% of reading)
cmH2O
Plateau
pressure (PPL)
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. PPL
updates continuously.
Range: -20.0 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to 130
cmH2O
Accuracy:
± (2 + 4% of reading)
cmH2O
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-15: Patient data (cont)
Parameter
Function
Range, resolution, accuracy
Rapid
shallow
breathing
index
(f/VT)
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.
Range: 0.0 to 600 1/min-L
Resolution:
0.1 for f/VT < 10 1/min-L
1 for f/VT ≥ 10 1/min-L
Accuracy: Not applicable
Spontaneous
inspiratory
time
(TI SPONT)
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.
Range: 0.00 to 10.00 s
Resolution: 0.01 s
Accuracy: Not applicable
Spontaneous
minute
volume
(VE SPONT)
Displays a calculated
total of the volumes
exhaled by the patient
for spontaneous breaths
for the previous oneminute interval. Values
for mandatory breaths
during this period are
not included. The
displayed value is
compliance- and BTPScompensated. Updated
at the beginning of the
next inspiration.
Range: 0.00 to 99.9 L
Resolution:
0.01 L for 0.00 to 9.99 L
0.1 L for 10.0 to 99.9 L
Accuracy:
For TE < 600 ms: ± [10 x
respiratory rate +
10% (600 ms/TE) of
reading] mL
For TE > 600 ms: ± (10 x
respiratory rate +10% of
reading) mL
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-55
Table A-15: Patient data (cont)
OP A-56
Parameter
Function
Spontaneous
percent
inspiratory
time
(TI/TTOT)
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.
Range: 0.00 to 1.00
Resolution: 0.01
Static
compliance
(CSTAT)
Displays an estimate of
the elasticity of the
patient’s lungs.
Range: 0 to 500 mL/cmH2O
Resolution:
0.1 mL/cmH2O for
0 to 9.9 mL/cmH2O
1 mL/cmH2O for 10 to
500 mL/cmH2O
Accuracy:
± (1 + 20%) of actual
value mL/cmH2O for
1 to 100 mL/cmH2O
Static
resistance
(RSTAT)
Displays an estimate of
restrictiveness of the
patient’s airway.
Range: 0 to 500 cmH2O/L/s
Resolution:
0.1 cmH2O/L/s for 0 to
9.9 cmH2O/L/s
1 cmH2O/L/s for 10 to
500 cmH2O/L/s
Accuracy:
± (3 + 20%) of actual
value cmH2O/L/s
(Does not apply if
CSTAT < 5 mL/cmH2O or
VMAX < 20 L/min)
10067720 Rev. B
Range, resolution, accuracy
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table A-15: Patient data (cont)
Parameter
Function
Range, resolution, accuracy
Total PEEP
(PEEPTOT)
Displays the pressure
during an expiratory
pause maneuver. It is an
estimate of the total
pressure at the end of
exhalation, referenced
to atmosphere.
Range: -20.0 to 130 cmH2O
Resolution:
0.1 cmH2O for -20.0 to
9.9 cmH2O
1 cmH2O for 10 to
130 cmH2O
Total
respiratory
rate (fTOT)
Displays a calculated
value of the number of
mandatory and
spontaneous breaths
delivered to the patient
for the previous oneminute interval. fTOT
updates at the
beginning of the next
inspiration.
Range: 0 to 200/min
Resolution:
0.1/min for 0.0 to 9.9/min
1/min for 10 to 200/min
Accuracy: ±0.8/min
Table A-16: 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
Information to assist qualified service personnel to
troubleshoot the ventilator.
Operational
time
Displays operational times for the ventilator and
compressor. Use this information to schedule operator
maintenance procedures and preventative maintenance
conducted by qualified service personnel. The accuracy
of reported operational times is ± 2% over 10,000
hours.
SST Results
Displays results from each test performed during the
most recent SST.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP A-57
Table A-16: Other Screens — displayed data (cont)
Data
displayed
OP A-58
Function
Ventilator
configuration
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.
Test summary
Displays overall outcomes for most recently performed
SST and EST.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
Part numbers
This appendix lists user-replaceable parts and
accessories. Figure B-1 shows Puritan Bennett™ 840
Ventilator System parts corresponding to the part
numbers listed in Table B-1. Figure B-2 shows the same
accessories mounted on the ventilator (Puritan Bennett™
800 Series Ventilator Compressor Mount Cart shown).
Table B-2 lists those ventilator parts and accessories.
Figure B-3 shows the ventilator mounted on the Puritan
Bennett™ 800 Series Ventilator Pole Cart, and Table B-3
lists the parts and accessories.
NOTE:
Accessories listed in Table B-1 (except for the wall
air water trap and humidifier mounting kit) and
Table B-2 may be ordered for ventilators
mounted on Puritan Bennett 800 Series
Ventilator Pole Carts. Table B-2 and Table B-3
contain part numbers for humidifier, wall air
water trap, and cylinder mounting kits used with
ventilators mounted on the Puritan Bennett 800
Series Ventilator Compressor Mount Cart and the
Puritan Bennett 800 Series Ventilator Pole Cart.
B
1
6
4
5
10
12
8
14
9
11
7
13
15
2
3
Figure B-1. Ventilator accessories
OP B-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-1: Ventilator parts and accessories
Item
number
Description
Part number
1
Flex arm assembly
4-032006-00
2
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 x 22-mm male
Tube hanger
Wye, adult, reusable
G-061208-SP
Ventilator breathing circuit, adult, reusable,
with heated wire, for Fisher & Paykel™*
humidifiers.* Includes:
Tube, adult, 15-cm (2 included)
Tube, adult, 150-cm (2 included)
Wye, adult, with temperature port
Adapter, 22-mm male x 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
G-061213-00
G-061235-00
*Not shown in Figure B-1
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-3
Table B-1: Ventilator parts and accessories
Item
number
2
(cont)
Description
Part number
Ventilator breathing circuit, pediatric,
reusable.* 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 x 15-mm male
Adapter, 22-mm male/15-mm female x
22-mm male/15-mm female
G-061223-00
Ventilator breathing circuit, pediatric,
reusable, with heated wire, for Fisher &
Paykel™* humidifiers.*
Includes:
Tube, pediatric, 15-cm (2 included)
Tube, pediatric, 150-cm (2 included)
Wye, pediatric, straight
Adapter, 15-mm male x 15-mm male
Adapter, 22-mm male/15-mm female x
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)
G-061237-00
*Not shown in Figure B-1
OP B-4
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-1: Ventilator parts and accessories
Item
number
2
(cont)
3
Description
Part number
Ventilator breathing circuit, adult,
disposable*
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
6-003030-00
Test lung
4-000612-00
*Not shown in Figure B-1
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-5
Table B-1: Ventilator parts and accessories
Item
number
4
Description
Part number
Hose assembly, oxygen, DISS, for USA
4-001474-00
Hose assembly, oxygen, for France (Air
Liquide™*)
4-074697-00
Warning
Due to excessive restriction of this
hose assembly, reduced ventilator
performance may result when supply
pressures < 50 psi (345 kPa) are
employed.
Hose assembly, oxygen, for United Kingdom/
Ireland (NIST/BOC)
4-074698-00
Hose assembly, oxygen, for Netherlands
(NIST)
4-074700-00
Hose assembly, oxygen, for Israel, Japan,
Saudi Arabia (DISS)
4-074702-00
Hose assembly, oxygen, for Egypt, India, Italy,
Kuwait, Poland, Portugal, South Africa (DISS)
4-074705-00
Hose assembly, oxygen, for Switzerland
(DISS)
4-074708-00
Hose assembly, oxygen, for Canada (DISS)
4-074710-00
*Not shown in Figure B-1
OP B-6
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-1: Ventilator parts and accessories
Item
number
4
(cont)
Description
Part number
Hose assembly, oxygen, for Australia/New
Zealand (SIS)
4-074711-00
Warning
Due to excessive restriction of this
hose assembly, reduced ventilator
performance may result when supply
pressures < 50 psi (345 kPa) are
employed.
Hose assembly, oxygen, for Germany (DISS/
Dräger™*)
4-074715-00
Warning
Due to excessive restriction of this
hose assembly, reduced ventilator
performance may result when supply
pressures < 50 psi (345 kPa) are
employed.
5
Hose assembly, air, for USA (DISS)
4-006541-00
Hose assembly, air, for France (Air Liquide™*)
4-074696-00
Warning
Due to excessive restriction of this
hose assembly, reduced ventilator
performance may result when supply
pressures < 50 psi (345 kPa) are
employed.
*Not shown in Figure B-1
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-7
Table B-1: Ventilator parts and accessories
Item
number
5
(cont)
Description
Part number
Hose assembly, air, for United Kingdom/
Ireland (NIST/BOC)
4-074713-00
Hose assembly, air, for Netherlands (NIST)
4-074701-00
Hose assembly, air, for Israel, Japan, Kuwait,
Poland, Portugal, South Africa (DISS)
4-074703-00
Hose assembly, air, for Saudi Arabia (DISS)
4-074704-00
Hose assembly, air, for Egypt, India, Italy
(DISS)
4-074706-00
Hose assembly, air, for Switzerland (DISS)
4-074707-00
Hose assembly, air, for Canada (DISS)
4-074709-00
Hose assembly, air, for Australia/New
Zealand (SIS)
4-074712-00
Warning
Due to excessive restriction of this
hose assembly, reduced ventilator
performance may result when supply
pressures < 50 psi (345 kPa) are
employed.
Hose assembly, air, for Germany (DISS/
Dräger™*)
4-074714-00
Warning
Due to excessive restriction of this
hose assembly, reduced ventilator
performance may result when supply
pressures < 50 psi (345 kPa) are
employed.
*Not shown in Figure B-1
OP B-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-1: Ventilator parts and accessories
Item
number
6
Description
Part number
Power cord, for North America
4-071420-00
Power cord, for Japan
4-071424-00
Power cord, for Australia
4-031320-00
Power cord, for continental Europe
4-031321-00
Power cord, for Denmark
4-071421-00
Power cord, for India/South Africa (old
British-style plug with round prongs)
4-071422-00
Power cord, for Israel
4-071423-00
Power cord, for Italy
4-031323-00
Power cord, for Switzerland
4-031325-00
Power cord, for United Kingdom
4-031322-00
7
RTA Cart, ventilator
4-076102-00
8
Expiratory bacteria filter, 22-mm ISO
connectors, with collector vial, single-patient
use (D/X800, carton of 12)
4-076887-00
Expiratory bacteria filter, 22-mm ISO
connectors, reusable (Re/X800, each)*
4-070305-00
9
Collector vial, reusable (Re/X 800, each)
4-074647-00
10
Drain bag, single-patient use (package of 25)
4-048491-00
11
Tubing, drain bag, single-patient use
(package of 10)
4-048493-00
12
Clamp, reusable (carton of 5)
4-048492-00
13
Drain cap
4-074613-00
14
Seal, expiratory filter
4-070311-00
*Not shown in Figure B-1
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-9
Table B-1: Ventilator parts and accessories
Item
number
15
Description
Part number
Inspiratory bacteria filter, 22-mm ISO
connectors, disposable (D/Flex, carton of 12)
4-074601-00
Inspiratory bacteria filter, 22-mm ISO
connectors, reusable (Re/Flex, each)
4-074600-00
Wall Air Water Trap kit, RTA cart-mount, DISS
male (Includes water trap, bracket with
mounting hardware, and interconnect
hose)*
4-075315-00
Mounting kit, Fisher & Paykel™* 480/730
humidifier*
4-075313-00
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.)*
4-075312-00
Operator’s and technical reference manual,
English*
10067720
Operator’s and technical reference manual,
French*
10068817
Operator’s and technical reference manual,
German*
10068816
Operator’s and technical reference manual,
Italian*
10068821
Operator’s and technical reference manual,
Japanese*
10068818
Operator’s and technical reference manual,
Portuguese*
10068839
Operator’s and technical reference manual,
Spanish*
10068819
*Not shown in Figure B-1
OP B-10
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-1: Ventilator parts and accessories
Item
number
Description
Part number
Operator’s and technical reference manual,
Czech*
10068850
Operator’s and technical reference manual,
Greek*
10068896
Operator’s and technical reference manual,
Slovakian*
10068851
Operator’s and technical reference manual,
Hungarian*
10068840
Operator’s and technical reference manual,
Turkish*
10068852
Service manual, English*
10067703
Oxygen sensor (To be replaced every year or
as necessary. See Section 7.4.7 on page OP 718)*
4-072214-00
Filter, compressor inlet*
4-074374-00
Test (gold standard) hose, 21 inches (53 cm)
(for use with EST)*
4-018506-00
Cable assembly, GUI-to-BDU extension, 10 ft*
4-071441-00
Mask assembly, large (for Non-invasive
ventilation)*
4-005253-00
*Not shown in Figure B-1
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-11
6
1
4
5
11
13
9
15
10
12
14
16
7, 8
2
3
Figure B-2. Ventilator accessories
(Puritan Bennett™ 800 Series Ventilator
Compressor Mount Cart shown)
OP B-12
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-2: Ventilator parts and accessories
Item
number
Description
Part number
1
Flex arm assembly
4-032006-00
2
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 x 22-mm male
Tube hanger
Wye, adult, reusable
G-061208-SP
G-061213-00
Ventilator breathing circuit, adult, reusable, with heated
wire, for Fisher & Paykel™* humidifiers.* Includes:
Tube, adult, 15-cm (2 included)
Tube, adult, 150-cm (2 included)
Wye, adult, with temperature port
Adapter, 22-mm male x 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
G-061235-00
*Not shown in Figure B-2
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-13
Table B-2: Ventilator parts and accessories (cont)
Item
number
2
(cont)
Description
Part number
Ventilator breathing circuit, pediatric, reusable.*
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 x 15-mm male
Adapter, 22-mm male/15-mm female x
22-mm male/15-mm female
G-061223-00
Ventilator breathing circuit, pediatric, reusable, with
heated wire, for Fisher & Paykel™* humidifiers.*
Includes:
Tube, pediatric, 15-cm (2 included)
Tube, pediatric, 150-cm (2 included)
Wye, pediatric, straight
Adapter, 15-mm male x 15-mm male
Adapter, 22-mm male/15-mm female x
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)
G-061237-00
*Not shown in Figure B-2
OP B-14
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-2: Ventilator parts and accessories (cont)
Item
number
2
(cont)
Description
Part number
Ventilator breathing circuit, adult, disposable*
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
6-003030-00
3
Test lung
4-000612-00
4
Hose assembly, oxygen, DISS, for USA
4-001474-00
Hose assembly, oxygen, for France (Air Liquide™*)
4-074697-00
Warning
Due to excessive restriction of this hose assembly,
reduced ventilator performance may result when
supply pressures < 50 psi (345 kPa) are employed.
Hose assembly, oxygen, for United Kingdom/Ireland (NIST/
BOC)
4-074698-00
Hose assembly, oxygen, for Netherlands (NIST)
4-074700-00
Hose assembly, oxygen, for Israel, Japan, Saudi Arabia
(DISS)
4-074702-00
Hose assembly, oxygen, for Egypt, India, Italy, Kuwait,
Poland, Portugal, South Africa (DISS)
4-074705-00
Hose assembly, oxygen, for Switzerland (DISS)
4-074708-00
Hose assembly, oxygen, for Canada (DISS)
4-074710-00
*Not shown in Figure B-2
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-15
Table B-2: Ventilator parts and accessories (cont)
Item
number
4
(cont)
Description
Hose assembly, oxygen, for Australia/New Zealand (SIS)
Part number
4-074711-00
Warning
Due to excessive restriction of this hose assembly,
reduced ventilator performance may result when
supply pressures < 50 psi (345 kPa) are employed.
Hose assembly, oxygen, for Germany (DISS/Dräger™*)
4-074715-00
Warning
Due to excessive restriction of this hose assembly,
reduced ventilator performance may result when
supply pressures < 50 psi (345 kPa) are employed.
5
Hose assembly, air, for USA (DISS)
4-006541-00
Hose assembly, air, for France (Air Liquide™*)
4-074696-00
Warning
Due to excessive restriction of this hose assembly,
reduced ventilator performance may result when
supply pressures < 50 psi (345 kPa) are employed.
Hose assembly, air, for United Kingdom/Ireland (NIST/BOC)
4-074713-00
Hose assembly, air, for Netherlands (NIST)
4-074701-00
Hose assembly, air, for Israel, Japan, Kuwait, Poland,
Portugal, South Africa (DISS)
4-074703-00
Hose assembly, air, for Saudi Arabia (DISS)
4-074704-00
Hose assembly, air, for Egypt, India, Italy (DISS)
4-074706-00
Hose assembly, air, for Switzerland (DISS)
4-074707-00
Hose assembly, air, for Canada (DISS)
4-074709-00
*Not shown in Figure B-2
OP B-16
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-2: Ventilator parts and accessories (cont)
Item
number
5
(cont)
Description
Part number
Hose assembly, air, for Australia/New Zealand (SIS)
4-074712-00
Warning
Due to excessive restriction of this hose assembly,
reduced ventilator performance may result when
supply pressures < 50 psi (345 kPa) are employed.
Hose assembly, air, for Germany (DISS/Dräger™*)
4-074714-00
Warning
Due to excessive restriction of this hose assembly,
reduced ventilator performance may result when
supply pressures < 50 psi (345 kPa) are employed.
6
Power cord, for North America
4-071420-00
Power cord, for Japan
4-071424-00
Power cord, for Australia
4-031320-00
Power cord, for continental Europe
4-031321-00
Power cord, for Denmark
4-071421-00
Power cord, for India/South Africa (old British-style plug
with round prongs)
4-071422-00
Power cord, for Israel
4-071423-00
Power cord, for Italy
4-031323-00
Power cord, for Switzerland
4-031325-00
Power cord, for United Kingdom
4-031322-00
7
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart with one-hour battery
10046822
8
Puritan Bennett™ 800 Series Ventilator Compressor
Mount Cart with four-hour battery
10046823
*Not shown in Figure B-2
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-17
Table B-2: Ventilator parts and accessories (cont)
Item
number
9
Description
Part number
Expiratory bacteria filter, 22-mm ISO connectors, with
collector vial, single-patient use (D/X800, carton of 12)
4-076887-00
Expiratory bacteria filter, 22-mm ISO connectors, reusable
(Re/X800, each)*
4-070305-00
10
Collector vial, reusable (Re/X 800, each)
4-074647-00
11
Drain bag, single-patient use (package of 25)
4-048491-00
12
Tubing, drain bag, single-patient use (package of 10)
4-048493-00
13
Clamp, reusable (carton of 5)
4-048492-00
14
Drain cap
4-074613-00
15
Seal, expiratory filter
4-070311-00
16
Inspiratory bacteria filter, 22-mm ISO connectors,
disposable
(D/Flex, carton of 12)
4-074601-00
Inspiratory bacteria filter, 22-mm ISO connectors, reusable
(Re/Flex, each)
4-074600-00
Wall Air Water Trap kit*
10045588
Humidifier Mounting kit*
10045589
Cylinder Mounting kit*
10045586
*Not shown in Figure B-2
OP B-18
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-2: Ventilator parts and accessories (cont)
Item
number
Description
Part number
Operator’s and technical reference manual, English*
10067720
Operator’s and technical reference manual, French*
10068817
Operator’s and technical reference manual, German*
10068816
Operator’s and technical reference manual, Italian*
10068821
Operator’s and technical reference manual, Japanese*
10068818
Operator’s and technical reference manual, Portuguese*
10068839
Operator’s and technical reference manual, Spanish*
10068819
Operator’s and technical reference manual, Czech*
10068850
Operator’s and technical reference manual, Greek*
10068896
Operator’s and technical reference manual, Slovakian*
10068851
Operator’s and technical reference manual, Hungarian*
10068840
Operator’s and technical reference manual, Turkish*
10068852
Service manual, English*
10067703
Oxygen sensor (To be replaced every year or as necessary.
See Section 7.4.7 on page OP 7-18)*
4-072214-00
Filter, compressor inlet*
4-074374-00
*Not shown in Figure B-2
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-19
1,2
Figure B-3. Puritan Bennett™ 840 Ventilator System
shown mounted on
Puritan Bennett™ 800 Series Ventilator Pole Cart
OP B-20
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Table B-3: Ventilator Pole Cart and accessories
Item
number
Description
Part number
1
Puritan Bennett™ 800 Series Ventilator Pole Cart with onehour battery
10046826
2
Puritan Bennett™ 800 Series Ventilator Pole Cart with
four-hour battery
10046827
Kit, humidifier mounting*
10042364
Kit, cylinder mounting*
10045578
Kit, wall air water trap*
10045588
* Not shown in Figure B-3
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP B-21
This page is intentionally blank.
OP B-22
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
Pneumatic schematic
Figure C-1. Pneumatic schematic
C
This page is intentionally blank.
OP C-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Alarm and oxygen sensor calibration testing
D
Test the alarms and the oxygen sensor calibration as
required, using the procedures below.
NOTE:
When performing the alarm tests, use a
ventilator configured for use with an
adult patient circuit.
D.1
Alarm test
Alarm tests require an oxygen and air source and stable
AC facility power. High and low delivered O2 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
(3VTE MAND)
•
LOW EXHALED TOTAL MINUTE VOLUME (3VE TOT)
•
HIGH VENTILATOR PRESSURE (1PVENT)
•
HIGH CIRCUIT PRESSURE (1PPEAK)
•
SEVERE OCCLUSION
•
AC POWER LOSS
•
APNEA
•
LOW EXHALED SPONTANEOUS TIDAL VOLUME (3VTE SPONT)
•
NO O2 SUPPLY
•
LOW DELIVERED O2% (3O2%)
•
HIGH DELIVERED O2% (1O2%)
1. Disconnect patient circuit from ventilator and turn off ventilator
for at least 5 minutes.
2. Turn the ventilator on. Ventilator automatically runs power on
self test (POST).
3. In the GUI lower subscreen, select NEW PATIENT.
4. Set up new patient as follows:
IBW: 70 kg
Vent Type: INVASIVE
Mode: A/C
Mandatory Type: VC
Trigger Type: V- TRIG
5. Set new patient settings as follows:
f: 6/min
VT: 500 mL
VMAX : 30 L/min
TPL: 0 seconds
Flow pattern: SQUARE
VSENS: 3 L/min
O2 : 21%
PEEP: 5 cmH2O
6. Set apnea settings as follows:
TA: 10 seconds
f: 6.0/min
O2: 21%
OP D-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
VT: 500 mL
7. Set alarm settings as follows:
2PPEAK : 70 cmH2O
fTOT : OFF
4VE TOT: 1 L/min, 2VE TOT: 3.5 L/min
4VTE MAND: 300 mL, 2VTE MAND: OFF
4VTE SPONT: OFF, 2VTE SPONT: OFF
8. 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 VT to 200 mL.
The ventilator annunciates a LOW EXHALED MANDATORY TIDAL
VOLUME (3VTE 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 4VE 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.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP D-3
13. HIGH VENTILATOR PRESSURE alarm test:
Set patient and alarm settings as follows:
VT : 1000 mL
V MAX : 100 L/min
2PPEAK :100 cmH2O
4V E TOT: 0.050 L/min, 2V E TOT: OFF
4VTE 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
(1PVENT) 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).
14. HIGH CIRCUIT PRESSURE alarm test:
Set patient and alarm settings as follows:
VMAX: 30 L/min
2PPEAK: 20 cmH2O
After one breath, the ventilator annunciates a HIGH CIRCUIT
PRESSURE alarm (↑PPEAK). If alarm does not sound, check the
patient circuit for leaks.
15. SEVERE OCCLUSION alarm test:
Set patient and alarm settings as follows:
VT : 500 mL
2PPEAK: 50 cmH2O
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.
OP D-4
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
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 from 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 up patient and alarm settings as follows:
2PPEAK: 70 cmH2O
Mode: SPONT
Spontaneous Type: PS
NOTE:
To avoid triggering a breath during the apnea interval, do not
touch the test lung or patient circuit.
The GUI annunciates an APNEA alarm within 10 seconds after
pressing ACCEPT.
Squeeze the test lung twice to simulate two subsequent patientinitiated breaths. The APNEA alarm autoresets.
NOTE:
The exhaled tidal volume (VTE) 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 Technical Reference Chapter 9 for
a technical description of apnea ventilation).
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP D-5
Let the ventilator return to apnea ventilation.
18. LOW EXHALED SPONTANEOUS TIDAL VOLUME alarm test:
Set patient and alarm settings as follows:
Trigger type: P-TRIG
PSENS: 4.0 cmH2O
4VTE SPONT: 2500 mL
Press the alarm reset key to 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: A/C
4VTE SPONT: OFF
Press the alarm reset key to reset the 4VTE SPONT alarm.
19. NO O2 SUPPLY alarm test:
Disconnect the oxygen inlet supply.
The ventilator annunciates a NO O2 SUPPLY alarm within one
breath.
Connect the oxygen inlet supply.
The NO O2 SUPPLY alarm autoresets within 2 breaths after
oxygen is reconnected.
20. LOW DELIVERED O2% and HIGH DELIVERED O2% alarm test:
Set patient and alarm settings as follows:
PSENS: 2 cmH2O
O2: 100%
Set apnea settings as follows:
TA: 60 seconds
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.
OP D-6
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
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 O2 (delivered O2%) should decrease,
and the ventilator should annunciate a ↓O2% alarm within 30
seconds.
Remove the oxygen supply tubing from the air supply and attach
it to a known 100% O2 source (for example, a medical-grade
oxygen cylinder). Set O2% to 21%. Set the flow from the oxygen
source to 1 L/min, and watch the upper GUI screen. The value for
O2 (delivered O2%) should increase, and the ventilator should
annunciate a 1O2% alarm within 30 seconds.
Remove the disposable flex tubing and oxygen supply tubing,
replace inspiratory filter and standard patient circuit, then press
the alarm reset key to clear all alarms.
D.2
Oxygen sensor calibration test
Test the oxygen sensor calibration as follows:
1. Connect the ventilator’s oxygen hose to a known 100% O2 source
(for example, a medical-grade oxygen cylinder). Press the 100%
O2/CAL 2 min key or INCREASE O2 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% O2
source (for example, a second medical-grade oxygen cylinder).
3. Set O2% to each of the following values, and allow one minute
after each for the monitored value to stabilize:
21%
40%
90%
4. Watch the upper screen to ensure the value for O2 (delivered
O2%) is within 3% of each setting within one minute of selecting
each setting.
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP D-7
This page is intentionally blank.
OP D-8
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Remote alarm and RS-232 ports
E
Appendix E 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.
RS-232 port 2
Remote alarm port
RS-232 port 3
RS-232 port 1
Figure E-1. Remote alarm and RS-232 ports
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 information and
instructions for construction of cable assemblies providing
electrical separation, or contact Covidien for assistance.
E.1
Remote alarm port
The ventilator’s remote alarm (nurse call) annunciates medium- and
high-urgency 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-urgency alarm condition, unless the alarm
silence function is active.
NOTE:
The remote alarm also annunciates when the ventilator power
switch is turned off.
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3
2
4
1
Figure E-2. Remote alarm port pinout (view from back of GUI)
Pin
Signal
1
Normally closed (NC)
2
Relay common
3
Normally open (NO)
4
Not connected
NOTE:
Allowable current is 100 mA at 12 V DC (minimum) and
500 mA at 30 V DC (maximum).
E.2
RS-232 port
The RS-232 serial ports are 9-pin male connectors configured as data
terminal equipment (DTE). Figure E-3 shows the serial port pinout.
1
2
6
3
7
4
8
5
9
Figure E-3. RS-232 serial port pinout
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
10067720 Rev. B
OP E-3
Pin
E.3
Signal
1
Not connected
2
Receive data (RxD)
3
Transmit data (TxD)
4
Data terminal ready (DTR),
terminated high
5
Ground (GND)
6
Not connected
7
Request to send (RTS)
8
Clear to send (CTS)
9
Not connected
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.
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2. Press the Communications Setup button. The Current
Communication Screen appears.
Current Communication Setup
1
2
3
Baud Rate
Baud Rate
Baud Rate
Data bits
Data bits
Data bits
Parity Mode
Parity Mode
Parity Mode
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.
4. Touch the BAUD RATE button, then turn the knob to select the
baud rate (1200, 2400, 4800, 9600, 19200, or 38400). The baud rate
will automatically switch to 38400 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).
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OP E-5
NOTE: The allowable selections for data bits and parity mode are
shown here:
Data bits
Parity Mode
7
None, Even, Odd
8
None
7. Press ACCEPT to apply the changes, or press the OTHER SCREENS
button to cancel the changes.
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 38400 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
eight 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.
E.4
Printers and cables
The following equipment can be used to print graphical displays
from the Puritan Bennett™ 840 Ventilator System:
Printers
RS-232 serial printers using the Hewlett-Packard PCL5
communication protocol can be used with the Puritan Bennett™
840 Ventilator System. Printers using the HP PCL5 communication
protocol, but with other connector interfaces such as USB or parallel,
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may be able to be used with the appropriate RS-232 serial converter
cable.
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 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 Section E.3 using the
same settings as the printer.
3. If using a converter cable, configure it to use the same settings as
the printer and the Puritan Bennett™ 840 Ventilator System.
Refer to the instructions supplied with your cable.
4. With the printer turned OFF, connect the cable to the
Puritan Bennett™ 840 Ventilator System and the printer.
5. Turn the printer ON.
6. Print the desired graphics display as described in Section 6.6 on
page OP 6-7.
E.5
RS-232 port commands
Refer to Technical Reference Chapter 19 for information regarding
RS-232 port command protocol.
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Introduction to breath delivery
The Puritan Bennett™ 840 Ventilator System delivers
and measures exhaled volumes to the specified
accuracies when using conventional humidification,
heated-wire systems, or heat-moisture exchangers
(HMEs). In volume control (VC) ventilation, the
ventilator compliance-compensates 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 O2 %,
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
1
Introduction to breath delivery
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.
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Detecting and initiating inspiration
To deliver a mandatory or spontaneous breath, the
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
a) or b) and c) (below) have occurred, or if d) occurs
regardless of the conditions described in a) through c):
a Measured expiratory flow falls to less than 50%
of the peak expiratory flow
b Expiratory flow is less than or equal to 0.5 L/min
2
Detecting and initiating inspiration
c The first 200 ms of exhalation (regardless of breath type) have
elapsed
d at 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.
2.1
Internally triggered inspiration
The ventilator triggers inspiration internally based on:
•
pressure sensitivity
•
flow sensitivity
•
time-cycling
•
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 cmH2O, 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.
2.1.1 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 (PI ) is monitored inside the
inspiratory manifold downstream of the proportional solenoid
(PSOL) valves, and expiratory pressure (PE ) is monitored just after the
expiratory check valve.
As the patient draws gas from the circuit (event A), airway pressure
drops below baseline (Figure 2-1). When airway pressure drops
below baseline by the value selected for pressure sensitivity (event
B), the ventilator initiates a patient-triggered inspiration. The A-B
interval depends on two factors:
•
TR 2-2
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.
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Detecting and initiating inspiration
•
The pressure sensitivity (PSENS) setting. The smaller the setting,
the shorter the A-B interval. (The minimum PSENS setting is
limited by autotriggering, and the triggering criteria include
filtering algorithms that minimize the probability of
autotriggering.)
Exhalation
Inspiration
A
Circuit
pressure
(cmH2O)
PEEP (baseline)
Operator-set
pressure sensitivity
B
Flow from
BDU
(L/min)
Patient
inspires
Patient-triggered
inspiration begins
time
Figure 2-1. Declaring inspiration using pressure sensitivity
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TR 2-3
Detecting and initiating inspiration
2.1.2 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 2-2.
A
Exhaled
flow
(L/min)
B
C
Operator-set
flow
sensitivity
Software-set
base flow
(L/min)
1.5 L/min
0
Base flow and
flow sensitivity
Delivered
flow
(L/min)
Software-set
base flow
(L/min)
0
Start of
Gas delivery
patient effort
begins
time
Figure 2-2. Declaring inspiration using flow sensitivity
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
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Detecting and initiating inspiration
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 sensitivity
(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 (VSENS ) 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 cmH2O is also in effect. This setting is the most sensitive setting
still large enough to avoid autotriggering, yet triggers with
acceptable patient effort.
2.1.3 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 Figure 2-3. Such a breath is called a ventilatorinitiated 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.
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10067720 Rev. B
TR 2-5
Detecting and initiating inspiration
VIM
PIM
VIM
Breath
activity
Tb
Tb = 60
__
Tb
Tb
f
Figure 2-3. Time-cycled inspiration
2.2
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:
TR 2-6
•
an ongoing inspiration
•
the restricted phase of exhalation
•
occlusion and disconnect alarm conditions
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Detecting and initiating exhalation
The Puritan Bennett™ 840 Ventilator System can
declare exhalation based on internal methods or
backup limits.
3.1
Internally initiated exhalation
Internal exhalation initiation methods include:
•
the time-cycling method
•
the end-inspiratory flow method
•
the airway pressure method
3.1.1 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 (TI) 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.
3
Detecting and initiating exhalation
3.1.2 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
Figure 3-1). When end-inspiratory flow is equal to or less than (peak
flow x ESENS %)/100, the ventilator initiates exhalation (event B).
A (delivered flow begins to decrease)
Peak
flow
Without
expiratory
trigger
Inspiratory
flow 0
(L/min)
Peak flow x ESENS
100
B (ventilator initiates exhalation)
Trigger
Inspiration
time
Figure 3-1. Initiating exhalation using the end-inspiratory flow
method
3.1.3 Airway pressure method
If expiratory sensitivity (ESENS) is set to a value too low for the
patient-ventilator combination, a vigorous expiratory effort could
cause circuit pressure (PPEAK) 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 value. Figure 3-2
shows an example of an exhalation initiated using the airway
pressure method.
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Detecting and initiating exhalation
NOTE:
The allowable incremental value above the target pressure is
1.5 cmH2O 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 cmH2O. From 200 ms to Tn, the incremental
pressure decreases in a linear fashion from the initial value to
1.5 cmH2O.
Pressure target
+ incremental value
1.5 cmH2O
Pressure
target
Circuit
pressure
(cmH2O)
Start
breath
200 ms
Tn
time
Figure 3-2. Initiating exhalation using the airway pressure method
3.2
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.
3.2.1 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 x IBW seconds (adult and pediatric circuit type)
or 1.0 + 0.1 x IBW seconds (neonatal circuit type) of inspiration have
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10067720 Rev. B
TR 3-3
Detecting and initiating exhalation
elapsed, the ventilator initiates exhalation. When Vent type is NIV,
the high spontaneous inspiratory time limit setting (2TI SPONT) serves
as the time limit for initiating exhalation.
3.2.2 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.
3.2.3 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 cmH2O, the ventilator
transitions to exhalation.
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Mandatory breath delivery
Chapter 4 describes the following aspects of mandatory
breath delivery:
4.1
•
Pressure- and volume-based mandatory breaths
(includes VC+)
•
Compliance and body temperature and pressure,
saturated (BTPS) compensation for volume-based
mandatory breaths
•
Manual inspirations
Comparison of pressure- and volume-based
mandatory breaths
Table 4-1 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.
4
Mandatory breath delivery
Table 4-1: Comparison of pressure- and volume-based
mandatory breaths
Characteristic
Pressure-based
Volume-based
Inspiratory
detection
Pressure sensitivity, flow
sensitivity (including the
pressure trigger backup), or
time-cycling. Inspiration can
also be operator-triggered
using MANUAL INSP.
See pressure-based.
Pressure or
flow during
inspiration
Pressure is targeted to the
sum of the operatorselected 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 flowdelivery 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.
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.
Exhalation
valve during
inspiration
Adjusts to minimize
pressure overshoot and
maintain target pressure.
Closed.
Inspiratory
valves during
inspiration
Adjust flow to maintain
target pressure.
Adjusts to achieve target flow
trajectory.
TR 4-2
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Mandatory breath delivery
Table 4-1: Comparison of pressure- and volume-based
mandatory breaths
Characteristic
Pressure-based
Volume-based
Expiratory
detection
Exhalation is initiated by the
time-cycling 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.
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
↑PPEAK and ↑PVENT alarms can also
declare exhalation as a backup
strategy.
Pressure or
flow during
exhalation
Pressure is controlled to PEEP. If flow-triggering is selected, base flow
is re-established near the end of expiratory flow. Various strategies
operate to minimize autotriggering.
Inspiratory
valve during
exhalation
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.
Exhalation
valve during
exhalation
Adjusts to maintain the operator-selected value for PEEP.
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TR 4-3
Mandatory breath delivery
4.2
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 = Cpt ckt (Pend insp - Pend exh)
where:
Cpt ckt
is the compliance of the patient circuit
Pend insp
is the pressure at the patient wye at the end of the
current inspiration
Pend 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 VT 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, Pend insp and Pend 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 (TI). Compliance compensation is achieved by
increasing flow (increasing the amplitude of the flow patterns).
Keeping TI 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:
Vcomp,max = Factor x Tidal volume
where:
Vcomp,max
TR 4-4
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is the maximum compliance volume
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Mandatory breath delivery
Factor
is the linear interpolation of the values in Table 4-2
for adult and pediatric patient circuit types, or for
neonatal circuit type:
MIN(10, MAX(2.5, 1.0 + (2.0/0.3 x IBW)))
For example, let the neonate IBW = 1 kg
1. Calculate 1.0 + (2.0/0.3 x 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.
Table 4-2: Compliance volume factors
Adult patient circuit type
4.3
Pediatric patient circuit type
IBW (kg)
Factor
IBW (kg)
Factor
≤ 10
5
≤ 10
5
15
4.6
11
3.5
30
3.4
12.5
2.9
60
2.75
15
2.7
≥ 150
2.5
≥ 30
2.5
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’s 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,
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TR 4-5
Mandatory breath delivery
37°C, and fully saturated with water vapor (BTPS). Graphics data is
not BTPS-compensated.
4.4
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.
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Puritan Bennett™ 800 Series Ventilator System Technical Reference
Spontaneous breath delivery
Table 5-1 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.
Table 5-1: Spontaneous breath delivery
characteristics
Characteristic
Implementation
Inspiratory detection
Either pressure or flow sensitivity,
whichever is selected.
Pressure or flow during
inspiration
Spontaneous type =
NONE
Pressure rises according to the
selected rise time % and IBW
setting, with target pressure
1.5 cmH2O above PEEP to
improve work of breathing.
5
Spontaneous breath delivery
Table 5-1: Spontaneous breath delivery
characteristics (cont)
TR 5-2
10067720 Rev. B
Characteristic
Implementation
Pressure or flow during
inspiration
Spontaneous type = PS
PSUPP < 5 cmH2O
Pressure rises according to the
selected rise time % and IBW
setting, with target pressure
equal to the effective pressure +
PEEP:
PSUPP Effective Pressure (cmH2O)
0
1.5
1
2.2
2
2.9
3
3.6
4
4.3
Pressure or flow during
inspiration
Spontaneous type = PS
PSUPP ≥ 5 cmH2O
Pressure rises according to the
selected rise time % and IBW
setting, and target pressure
equals PSUPP + PEEP.
Inspiratory flow profile
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.
Exhalation valve
during inspiration
Adjusts to minimize pressure
overshoot and maintain the
target pressure.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Spontaneous breath delivery
Table 5-1: Spontaneous breath delivery
characteristics (cont)
Characteristic
Implementation
Inspiratory valves
during inspiration
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.
Expiratory detection
The end-inspiratory flow or
airway pressure method,
whichever detects exhalation
first. Time backup and the ↑PPEAK
alarm are also available as backup
strategies.
Pressure or flow during
exhalation
Pressure is controlled to PEEP.
For pressure triggering: set to
deliver a bias flow of 1 L/min near
the end of expiratory flow.
For flow triggering: set to deliver
base flow.
Inspiratory valve
during exhalation
For pressure triggering: set to
deliver a bias flow of 1 L/min near
the end of expiratory flow.
For flow triggering: set to deliver
base flow near the end of
expiratory flow.
Exhalation valve
during exhalation
Adjusts to maintain the operatorselected value for PEEP.
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Puritan Bennett™ 800 Series Ventilator System Technical Reference
Assist/control (A/C) mode
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.
6.1
Breath delivery in A/C
In A/C mode, the ventilator calculates the breath period
(Tb) as:
Tb = 60/f
where:
Tb 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:
TE = Tb - TI
where:
TE
is the length of the expiratory phase in seconds
6
Assist/control (A/C) mode
Tb
is the breath period in seconds
TI
is the length of the inspiratory phase in seconds (including
TPL, the plateau time)
Figure 6-1 shows A/C breath delivery when no patient inspiratory
effort is detected and all inspirations are VIMs.
VIM
VIM
Tb
VIM
Tb
Tb
Figure 6-1. A/C mode, no patient effort detected
Figure 6-2 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.
PIM
PIM
Tb set
PIM
PIM
Tb set
Tb set
Figure 6-2. A/C mode, patient effort detected
Figure 6-3 shows A/C breath delivery when there is a combination of
VIM and PIM breaths.
PIM
VIM
Tb set
PIM
Tb set
VIM
Tb set
Figure 6-3. A/C mode, VIM and PIM breaths
TR 6-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Assist/control (A/C) mode
6.2
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:
6.3
•
The inspiratory time of current breath is not changed.
•
A new inspiration is not delivered until at least 200 ms of
exhalation have elapsed.
•
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.
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
five 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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 6-3
Assist/control (A/C) mode
•
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 x current inspiratory time, or
− 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 x current inspiratory time, or
− the length of the apnea interval, or
− the length of the current breath cycle.
•
If the current mode is BILEVEL in the PEEPH 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 x duration of the active gas delivery
phase, or
− the length of the apnea interval, or
− the length of the current breath cycle.
•
If the current mode is BILEVEL in the PEEPH 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 x duration of the spontaneous inspiration, or
− the start time of the spontaneous breath + the length of the
apnea interval.
•
If the current mode is BILEVEL in the PEEPL 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 x duration of the active gas delivery
phase, or
− the length of the apnea interval, or
− the length of the current breath cycle.
TR 6-4
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Assist/control (A/C) mode
•
If the current mode is BILEVEL in the PEEPL state and the current
breath is spontaneous and the spontaneous start time has
occurred during PEEPL, the time t until the first VIM of the new
A/C mode is the lesser of:
− 3.5 x duration of the spontaneous inspiration, or
− the length of the apnea interval.
•
If the current mode is BILEVEL in the PEEPL state and the current
breath is spontaneous and the spontaneous start time has
occurred during PEEPH, the time t until the first VIM of the new
A/C mode is the lesser of:
− PEEP transition time + 2.5 x duration of the spontaneous inspiration, or
− the start time of the spontaneous breath + the length of the
apnea interval.
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Puritan Bennett™ 800 Series Ventilator System Technical Reference
Synchronous intermittent mandatory ventilation (SIMV)
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 flow-triggering 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).
As Figure 7-1 shows, each SIMV breath cycle (Tb) has two
parts: the first part of the cycle is the mandatory interval
(Tm) 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 (Ts),
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.
7
Synchronous intermittent mandatory ventilation (SIMV)
Tb = SIMV breath cycle
(includes Tm and Ts)
Tb
Tm
Ts
Tm = Mandatory interval
(reserved for a PIM breath)
Ts = Spontaneous interval
(VIM delivered if no PIM
delivered during Tm)
Figure 7-1. SIMV breath cycle (mandatory and spontaneous intervals)
Figure 7-2 shows an SIMV breath cycle where a PIM is delivered
within the mandatory interval.
PIM
(Subsequent trigger efforts during Ts
yield spontaneous breaths)
Tm
Tm transitions to Ts when a PIM is delivered
Ts
Tb
Figure 7-2. SIMV breath cycle, PIM delivered within mandatory interval
Figure 7-3 shows an SIMV breath cycle where a PIM is not delivered
within the mandatory interval.
VIM
VIM delivered at end of Tm
if no PIM delivered during Tm
Tm
Ts
Tb
Figure 7-3. SIMV breath cycle, PIM not delivered within mandatory interval
TR 7-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Synchronous intermittent mandatory ventilation (SIMV)
7.1
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 (Tb) in
seconds is:
Tb = 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 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 Tm to transition to Ts.)
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, Tm
ends, Ts 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 x the SIMV interval cycle (Tb), or
•
10 seconds.
In SIMV, the interval from mandatory breath to mandatory breath
can be as long as 1.6 x the SIMV cycle interval (but no longer than
the cycle interval + 10 seconds). At high respiratory rates and toolarge 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
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 7-3
Synchronous intermittent mandatory ventilation (SIMV)
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 fTOT 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.
7.2
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 (TA) elapses at any time during the
mandatory interval, the ventilator delivers a VIM rather than
begin apnea ventilation.
•
If TA elapses during the spontaneous interval, apnea ventilation
begins.
Figure 7-4 shows how SIMV is designed to deliver a VIM rather than
trigger apnea ventilation when possible.
TR 7-4
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Synchronous intermittent mandatory ventilation (SIMV)
If TA elapses during Tm,
ventilator delivers a VIM
rather than begins
apnea ventilation.
VIM
Last
breath
Tb
Tm, max
TA
Tm, max
TA
Tb
Tm
Tb
Ts
Figure 7-4. Apnea ventilation in SIMV
7.3
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 x TI, current TA, 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 x TI, or current TA.
•
If the current mode is BILEVEL in the PEEPH 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 x duration of the active gas delivery
phase, or
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 7-5
Synchronous intermittent mandatory ventilation (SIMV)
− the length of the apnea interval, or
− the length of the current breath cycle.
•
If the current mode is BILEVEL in the PEEPH 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 x duration of the spontaneous inspiration, or
− the start time of the spontaneous breath + the length of the
apnea interval.
•
If the current mode is BILEVEL in the PEEPL 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 x duration of the active gas delivery
phase, or
− the length of the apnea interval, or
− the length of the current breath cycle.
•
If the current mode is BILEVEL in the PEEPL state and the current
breath is spontaneous and the spontaneous start time has
occurred during PEEPL, the time t until the first VIM of the new
A/C mode is the lesser of:
− 3.5 x duration of the spontaneous inspiration, or
− the length of the apnea interval.
•
If the current mode is BILEVEL in the PEEPL state and the current
breath is spontaneous and the spontaneous start time has
occurred during PEEPH, the time t until the first VIM of the new
A/C mode is the lesser of:
− PEEP transition time + 2.5 x duration of the spontaneous inspiration, or
− 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 7-6
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Synchronous intermittent mandatory ventilation (SIMV)
7.4
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 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 x the last
or current TI,
•
but 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.
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TR 7-7
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TR 7-8
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Puritan Bennett™ 800 Series Ventilator System Technical Reference
Spontaneous (SPONT) mode
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.
8.1
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 (VT SUPP),
expiratory sensitivity, and PEEP.
Inspiratory pauses are only possible following OIM
breaths, and expiratory pauses are not allowed during
SPONT.
8
Spontaneous (SPONT) mode
8.2
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 8-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Apnea ventilation
The Puritan Bennett™ 840 Ventilator System’s apnea
detection strategy follows these rules:
9.1
•
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.
Apnea detection
The ventilator declares apnea when no breath has been
delivered by the time the operator-selected 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,
9
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.
Figure 9-1 shows an apnea interval equal to the breath period.
PIM
PIM
Apnea interval
Tb1
Tb0
Figure 9-1. Apnea interval equals breath period
Figure 9-2 shows an apnea interval greater than the breath period.
PIM
VIM
Tb0
Tb1
Apnea interval
Figure 9-2. Apnea interval greater than breath period
TR 9-2
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Apnea ventilation
Figure 9-3 shows an apnea interval less than the breath period.
PIM or OIM needed to block apnea ventilation
PIM
to avoid
apnea
PIM
Tb0
Apnea
Apnea
VIM
VIM
Apnea Tb0
Apnea interval
Apnea Tb1
Apnea ventilation
Tb (TA < Tb)
Figure 9-3. Apnea interval less than breath period
9.2
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.
9.3
Key entries during apnea ventilation
All apnea and non-apnea settings remain active on the GUI during
apnea ventilation. Both non-apnea and apnea settings changes are
phased in according to the applicable rules (see Technical Reference
Chapter 11 for information on phasing in settings). If apnea ventilation
is active, new settings are accepted but not implemented until nonapnea 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% O2/CAL 2 min key or INCREASE O2 2 min key is
active during apnea ventilation, because apnea detection is likely
during suctioning.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 9-3
Apnea ventilation
9.4
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.
9.4.1 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.
9.4.2 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:
TR 9-4
•
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.
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Apnea ventilation
9.4.3 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 re-enters apnea
ventilation.
9.5
Phasing in new apnea intervals
These rules apply to apnea settings:
•
The apnea respiratory rate must be greater than or equal to
60/TA.
•
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:
•
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.
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Detecting occlusion and disconnect
10
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.
10.1 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 cmH2O.
The exhalation valve fails in the closed position and
the pressure in the exhalation limb is less than
2 cmH2O.
Silicone tubing is attached to the EXHAUST port of the
ventilator (e.g. for metabolic monitoring purposes).
Detecting occlusion and disconnect
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.
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 pressuredrops 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 cmH2O or less,
whichever comes first.
During a severe occlusion, the ventilator enters occlusion status
cycling (OSC), in which it periodically attempts to deliver a pressurebased 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
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Detecting occlusion and disconnect
breath with a target pressure of 15 cmH2O 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 O2% equal to
100% (adult/pediatric) or 40% (neonatal). During OSC (and only
during OSC), the 2PPEAK (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.
10.2 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 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 (DSENS, 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 2TI SPONT limit setting when
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Detecting occlusion and disconnect
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 DSENS setting
for 3 consecutive breaths. The DSENS setting helps avoid false
detections due to leaks in the circuit or the patient’s lungs, and
the 3 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 DSENS setting and
pressure less than 0.5 cmH2O detected for 10 consecutive seconds
during exhalation.
Warning
When Vent Type is NIV, and DSENS 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-urgency 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 cancelled. 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% O2 (or 40% O2 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 to 1000 ms.
Flow or pressure triggering, apnea detection, expiratory and
inspiratory pause, manual inspirations, and programmed maneuvers
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Detecting occlusion and disconnect
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.
If the disconnect alarm is autoreset or manually reset, the ventilator
re-establishes 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.
10.3 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.
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Phasing in setting changes
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
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.
11
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Ventilator settings
12
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 A-12 in Appendix A of this manual.
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 acknowledgement to proceed beyond the
recommended limit. Most setting limits are restricted by
ideal body weight (IBW), circuit type, or the
interrelationship with other settings.
12.1 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 (TA) currently in effect. TA 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), O2%, mandatory type
(volume control, VC, or pressure control, PC), tidal
volume (VT), flow pattern, peak inspiratory flow ( VMAX),
inspiratory pressure (PI), and inspiratory time (TI). If the
apnea mandatory breath type is VC, plateau time (TPL) is
0.0 seconds. If the apnea mandatory breath type is PC,
Ventilator settings
rise time % is 50%, and TI is constant during rate change.
Because the minimum value for TA 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 TA is equal
to the breath cycle interval. You can set TA 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 O2% must be set equal to or greater than nonapnea ventilation O2%.
•
Minimum apnea f is (60/TA).
•
Apnea ventilation settings cannot result in an I:E ratio greater
than 1.00:1.
If apnea is possible (that is, if (60/f) > TA) and you increase the nonapnea O2% setting, apnea ventilation O2% automatically changes to
match if it is not already set higher than the new non-apnea O2%.
Apnea ventilation O2% does not automatically change if you
decrease the non-apnea O2%. 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 TA and all non-apnea
settings, but the new settings do not take effect until the ventilator
resumes normal ventilation. Being able to change TA during apnea
ventilation can avoid immediately re-entering apnea ventilation
once normal ventilation resumes.
12.2 Circuit type and Ideal Body Weight (IBW)
Together, the circuit type and IBW settings determine the new
patient values and absolute limits on various apnea and non-apnea
settings including VT and VMAX . 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).
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Based on the circuit type and IBW, the ventilator calculates VT
settings as follows:
Circuit
type
New patient
default VT
Minimum VT
Maximum VT
Neonatal
greater of 2 mL or
7.25 mL/kg x IBW
2 mL
Pediatric
7.25 mL/kg x IBW
25 mL
45.7 mL/kg x IBW
and < VTI MAND
alarm limit setting
in VC+
Adult
7.25 mL/kg x IBW
1.16 mL/kg x IBW
Based on the circuit type, the ventilator calculates VMAX settings as
follows:
•
Maximum VMAX = 30 L/min for Neonatal patient circuits
•
Maximum VMAX = 60 L/min for Pediatric patient circuits
•
Maximum VMAX = 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 (2TI SPONT).
12.3 Disconnect sensitivity (DSENS)
The DSENS setting defines the percentage of returned volume lost,
above which the ventilator declares a CIRCUIT DISCONNECT alarm.
When DSENS is set to its lowest value (20%), it has the highest
sensitivity for detecting a disconnect or leak. When DSENS is set to its
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 DSENS setting is OFF, which is equivalent to a returned
volume loss of 100%.
NOTE:
If DSENS is set to OFF during NIV, the ventilator is still capable
of declaring a CIRCUIT DISCONNECT alarm.
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12.4 Expiratory sensitivity (ESENS)
The ESENS 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 ESENS,
exhalation begins. ESENS is active during every spontaneous breath.
ESENS is a primary setting and is accessible from the lower GUI screen.
Changes to the ESENS setting are phased in any time during
inspiration or exhalation.
ESENS complements rise time %. Rise time % should be adjusted to
match the patient's inspiratory drive, and the ESENS setting should
cause ventilator exhalation at a point most appropriate for the
patient. The higher the ESENS setting, the shorter the inspiratory
time. Generally, the most appropriate ESENS is compatible with the
patient's condition, neither extending nor shortening the patient's
intrinsic inspiratory phase.
12.5 Expiratory time (TE)
The TE setting defines the duration of exhalation for PC mandatory
and VC+ breaths only. Changes to the TE setting are phased in at the
start of inspiration. Setting f and TE automatically determines the
value for I:E ratio and TI.
12.6 Flow pattern
The flow pattern setting defines the gas flow pattern of volumecontrolled (VC) mandatory breaths. The selected values for VT and
VMAX apply to either the square or descending ramp flow pattern. If
VT and VMAX are held constant, TI 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.
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The settings for flow pattern, VT, f, and VMAX 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:
•
I:E ratio > 4:1
•
TI > 8.0 seconds or TI < 0.2 second
•
TE < 0.2 second
12.7 Flow sensitivity (VSENS)
The VSENS setting defines the rate of flow inspired by a patient that
triggers the ventilator to deliver a mandatory or spontaneous
breath. When VSENS 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 VSENS setting, the ventilator
delivers a breath. Once a value for flow sensitivity is selected, the
ventilator delivers a base flow equal to VSENS + 1.5 L/min (base flow
is not user-selectable). Changes in VSENS are phased in at the start of
exhalation or during inspiration.
For example, if you select a VSENS 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 VSENS is active, it replaces pressure sensitivity (P SENS ). The
VSENS setting has no effect on the PSENS setting. VSENS can be active in
any ventilation mode (including pressure supported, volume
controlled, pressure controlled, and apnea ventilation). When VSENS
is active, a backup PSENS setting of 2 cmH2O is in effect to detect the
patient's inspiratory effort, even if the flow ensors do not detect
flow.
Although the minimum VSENS 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 VSENS is phased in during inspiration
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Ventilator settings
or at the start of exhalation in case the patient cannot trigger a
breath using the previous sensitivity setting.
12.8 High spontaneous inspiratory time limit (2TI SPONT)
The high spontaneous inspiratory time limit setting 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 2TI SPONT
setting is based upon circuit type and IBW. For neonatal circuit types,
the new patient default value is:
(1 + (0.1 x IBW)) sec
For pediatric/adult circuit types, the new patient default value is:
(1.99 + (0.02 x IBW)) sec
The 1TI SPONT indicator appears at the beginning of a ventilatorinitiated exhalation and remains visible for as long as the ventilator
truncates breaths in response to the 2TI SPONT setting. The 1TI SPONT
indicator disappears when the patient’s inspiratory time returns to
less than the 2TI SPONT setting, or after 15 seconds has elapsed after
the beginning of exhalation of the last truncated breath.
12.9 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
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humidification type. For optimum accuracy, rerun SST to change the
humidification type.
12.10 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 TI and TE 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 TI and TE.
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.
12.11 Ideal body weight (IBW)
Refer to Section 12.2.
12.12 Inspiratory pressure (PI)
The PI setting determines the pressure at which the ventilator
delivers gas to the patient during a PC mandatory breath. The PI
setting only affects the delivery of PC mandatory breaths. The
selected PI is the pressure above PEEP. (For example, if PEEP is set to 5
cmH2O, and PI is 20 cmH2O, the ventilator delivers gas to the patient
at 25 cmH2O.) Changes to the PI setting are phased in during
exhalation or at the start of inspiration.
The sum of PEEP + PI + 2 cmH2O cannot exceed the high circuit
pressure (2PPEAK) limit. To increase this sum of pressures, you must
first raise the 2PPEAK limit before increasing the settings for PEEP or
P I.
12.13 Inspiratory time (TI)
The TI setting defines the time during which an inspiration is
delivered to the patient for PC mandatory breaths. You cannot set TI
in VC mandatory breaths. The ventilator accepts a TI setting as long
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as the resulting I:E ratio and TE settings are valid. Changes in TI are
phased in at the start of inspiration.
The ventilator rejects TI settings that result in an I:E ratio greater
than 4.00:1, a TI greater than eight seconds or less than 0.2 second,
or a TE less than 0.2 second to ensure the patient has adequate time
for exhalation. (For example, if the f setting is 30/min, a TI 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 TI
setting is commonly used for pediatric and infant ventilation and
may be a more useful setting at lower respiratory rates. Setting f and
TI automatically determines the value for I:E and TE (60/f - TI = TE ).
This equation summarizes the relation between TI , I:E, TE , and cycle
time (60/f):
TI = (60/f) [(I:E)/(1 + I:E)]
If the f setting remains constant, any one of the three variables (TI ,
I:E, or TE ) can define the inspiratory and expiratory intervals. If the f
setting is low (and additional spontaneous patient efforts are
expected), TI 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 TI , I:E, TE , and f.
12.14 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
Table 12-1.
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Table 12-1: Modes and breath types
Mode
Mandatory
breath type
Spontaneous
breath type
Sequence
A/C
INVASIVE:
VC, VC+, or
PC
NIV: VC or
PC
Not allowed
All mandatory (ventilator-,
patient-, or operatorinitiated)
SIMV
INVASIVE:
PC, VC, or
VC+
NIV: VC or
PC
INVASIVE:
Pressuresupported (PS),
Tubecompensated
(TC), or none
(that is, CPAP
breath)
NIV: PS or none
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.
SPONT
Not allowed
(PC or VC
allowed
only for
manual
inspirations)
INVASIVE:
pressure
supported (PS),
tube
compensated
(TC), volume
supported (VS),
proportionally
assisted (PA), or
none (that is,
CPAP breath)
NIV: PS or none
All spontaneous (except for
manual inspirations)
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Table 12-1: Modes and breath types
Mode
Mandatory
breath type
Spontaneous
breath type
Sequence
BILEVEL
(INVASIVE
Vent
Type
only)
PC
PS, TC, or none
Combines mandatory and
spontaneous breathing
modes. Refer to the BiLevel
Software Option Addendum
for more information.
CPAP
PC or VC
N/A
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 Puritan Bennett™ 840 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). Figure 12-1 shows the modes and
breath types available on the Puritan Bennett™ 840 Ventilator
System.
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Mode
(A/C, SIMV, SPONT, BILEVEL)
Mandatory
PC
VC
Spontaneous
VC+
None
PS
TC
VS
PA
Settings Settings Settings Settings Settings Settings Settings Settings
Figure 12-1. Puritan Bennett™ 840 Ventilator System modes and
breath types
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.
•
Synchronous 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.
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Changes to the mode are phased in at start of inspiration.
Mandatory and spontaneous breaths can be flow- or pressuretriggered.
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.
12.15 O2%
The Puritan Bennett™ 840 Ventilator System's oxygen sensor uses a
galvanic cell to monitor O2%. 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 O2% setting are phased in at the
start of inspiration or the start of exhalation.
The O2% 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. Since
ambient atmosphere contains approximately 21% oxygen, the
galvanic cell constantly reacts with oxygen and always produces a
voltage. Constant exposure to 100% O2 would drain the cell in
approximately 7,500 hours (44.5 weeks of constant use). Constant
exposure to room air (21% O2) would drain the cell in approximately
35,000 hours (4 years and 4 weeks of constant use). The life of the
cell can also be shortened by exposure to elevated temperatures and
pressures. During normal use in the ICU, cell life easily exceeds
10,000 hours — the interval for routine preventive maintenance.
Because the galvanic cell constantly reacts with oxygen, it requires
periodic calibration to prevent inaccurate O2% alarm annunciation.
The Puritan Bennett™ 840 ventilator calibrates its oxygen sensor
at the end of the 2-minute time interval started by pressing the
100% O2/CAL 2 min or INCREASE O2 2 min key. See page TR 15-5 for
more information on calibrating the oxygen sensor. Cancelling the
100% O2/CAL operation prior to the end of the 2-minute interval will
result in the O2 sensor not being calibrated. Once a calibrated
oxygen sensor and the Puritan Bennett™ 840 ventilator reach a
steady-state operating temperature, the monitored O2% will be
within 3 percentage points of the actual value for at least 24 hours.
TR 12-12
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Ventilator settings
To ensure the oxygen sensor remains calibrated, press the 100% O2/
CAL 2 min key or INCREASE O2 2 min key at least once every 24
hours.
12.16 Peak inspiratory flow (VMAX )
The VMAX setting determines the maximum rate of delivery of tidal
volume to the patient during mandatory VC breaths. Changes in
VMAX are phased in during exhalation or at the start of inspiration.
The VMAX setting only affects the delivery of mandatory breaths.
Mandatory breaths are compliance compensated, even at the
maximum VMAX setting.
When you propose a change to the VMAX setting, the ventilator
compares the new value with the settings for VT , f, flow pattern, and
TPL . It is impossible to set a new VMAX that would result in an I:E ratio
that exceeds 4.00:1, or a TI greater than 8.0 seconds or less than 0.2
second, or a TE less than 0.2 second.
12.17 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 cmH2O, or
•
PEEP + PI + 2 cmH2O (if PC is active), or
•
PEEP + PSUPP + 2 cmH2O (if PS is on)
cannot exceed the 2P PEAK limit. To increase the sum of pressures, you
must first raise the 2P PEAK limit before increasing the settings for
PEEP, PI, or PSUPP.
12.17.1 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 cmH2O pressurePuritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 12-13
Ventilator settings
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.
12.18 Plateau time (TPL)
The TPL setting defines the amount of time inspiration is held in the
patient's airway after inspiratory flow has ceased. TPL is available
only during VC mandatory breaths (for A/C and SIMV mode, and
operator-initiated mandatory breaths). TPL is not available for PC
mandatory breaths. Changes to the TPL setting are phased in at the
start of inspiration or during exhalation.
When you propose a change to the TPL setting, the ventilator
computes the new I:E ratio and TI , given the current settings for VT ,
f, VMAX , and flow pattern. It is impossible to set a new TPL that
would result in an I:E ratio that exceeds 4:1, or a TI greater than
eight seconds or less than 0.2 second, or a TE less than 0.2 second.
For I:E ratio calculation, TPL is considered part of the inspiration
phase.
12.19 Pressure sensitivity (PSENS)
The P SENS setting selects the pressure drop below baseline (PEEP)
required to begin a patient-initiated breath (either mandatory or
spontaneous). Changes in P SENS are phased in any time during
exhalation or inspiration. The P SENS setting has no effect on the
VSENS 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 P SENS settings.
The maximum P SENS 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 12-14
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Ventilator settings
12.20 Pressure support (PSUPP)
The 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. 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 cmH2O cannot exceed the ↑PPEAK limit.
To increase the sum of pressures, you must first raise the ↑PPEAK limit
before increasing the settings for PEEP or P SUPP . Since the ↑PPEAK
limit is the highest pressure considered safe for the patient, a P SUPP
setting that would cause a ↑PPEAK alarm requires you to first reevaluate the maximum safe circuit pressure.
12.21 Respiratory rate (f)
The 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, TI , and TE. 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 TI or TE to be less than 0.2 second, the TI to be greater than
eight 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.)
12.22 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 cmH2O)),
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 + PI (or PSUPP)). The rise time
% setting only appears when pressure-based breaths are available
(when PC is selected or spontaneous breaths are available).
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 12-15
Ventilator settings
•
For PC breaths, the lowest rise time setting produces a pressure
trajectory reaching 95% of the inspiratory target pressure (PEEP +
PI) in 2 seconds or 2/3 of the TI, whichever is shortest.
•
For spontaneous breaths, the lowest rise time setting produces a
pressure trajectory reaching 95% of the inspiratory target (PEEP +
PSUPP) 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 TI and PI cause PC pressure
trajectories to change. Changes in rise time % are phased in
during exhalation or at start of inspiration.
•
When PSUPP = NONE, the rise time % setting determines how
quickly the ventilator drives circuit pressure to PEEP + 1.5 cmH2O.
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 12-16
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Ventilator settings
12.23 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:
Ventilator settings
Alarm limits
Mode: A/C
2PPEAK : 20 cmH2O
Mandatory type: PC
2VE TOT : High alarm limit OFF,
low alarm limit: 0.05 L
f: 16 /min
2V TE : OFF
TI: 1 s
2f TOT : OFF
PI: 10 cmH2O
↓VTE MAND: OFF
PEEP: 3 cmH2O
↓VTE SPONT: OFF
Trigger type: P-TRIG
Rise time %: 50%
PSUPP: 2 cmH2O
O2%: 100% or 40% if in
NeoMode (21% if oxygen not
available)
12.24 Spontaneous breath type
The spontaneous breath type setting determines whether
spontaneous breaths are pressure-assisted using pressure support
(PS). A setting of NONE for spontaneous breath type is equivalent to
a pressure support setting of 0 cmH2O.
Once you have selected the spontaneous breath type, you can
choose the level of pressure support (P SUPP ) and specify the
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 12-17
Ventilator settings
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 cmH2O 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.
12.25 Tidal volume (VT)
The VT setting determines the volume of gas delivered to the
patient during a VC mandatory breath. The delivered VT is
compensated for BTPS and patient circuit compliance. Changes to
the VT setting are phased in during exhalation or at the start of
inspiration. The VT setting only affects the delivery of mandatory
breaths.
When you propose a change to the VT setting, the ventilator
compares the new value with the settings for f, VMAX , flow pattern,
and TPL. If the proposed VT setting is within the acceptable range but
would result in an I:E ratio that exceeds 4.00:1 or a TI greater than
eight seconds or less than 0.2 second, or a TE less than 0.2 second, the
ventilator disallows the change.
12.26 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.
TR 12-18
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Ventilator settings
NIV interfaces include non-vented full-faced or nasal masks, nasal
prongs, or un-cuffed ET tubes (refer to Section 4.12.2 on page OP 428 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 Puritan Bennett™ 840 ventilator to handle large
system leaks associated with these interfaces by providing pressurebased disconnect alarms, minimizing false disconnect alarms, and
replacing the INSPIRATION TOO LONG alarm with a High
Spontaneous Inspiratory Time limit (2TI 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.
Operator’s Manual Section 4.12.7 and Section 4.12.8 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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 12-19
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This page is intentionally blank.
TR 12-20
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Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
13
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 A-13 in
Appendix A of this manual.
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).
13.1 Alarm handling
The Puritan Bennett™ 840 Ventilator System’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 urgency level.
•
Allow quick and easy alarm setup.
Alarms
Alarm annunciations include a level of urgency, which is an estimate
of how quickly a caregiver must respond to ensure patient
protection. Table 13-1 summarizes alarm urgency levels.
Table 13-1: Alarm urgency levels
Urgency
level
TR 13-2
Visual
indication
Audible
indication
Autoreset handling
High:
Hazardous
situation
requiring
immediate
response
Red
flashing
High-priority
tone
(repeating
sequence of
five tones;
sequence
repeats twice,
pauses, then
repeats again)
If all high-urgency alarm
conditions return to normal,
the audible indicator turns
off, the red high-urgency
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.
Medium:
Abnormal
situation
requiring
prompt
response
Yellow
flashing
Mediumpriority tone
(repeating
sequence of
three tones)
If all medium-urgency alarm
conditions return to normal,
the audible and visual
indicators turn off and
autoreset is entered into the
alarm history log.
Low:
Change in
status,
informing
clinician
Yellow,
steadily lit
Low-priority
tone (two
tone, nonrepeating)
If all low-urgency alarm
conditions return to normal,
the audible and visual
indicators turn off and
autoreset is entered in the
alarm history log.
Normal:
No alarm
conditions
active (may
include
autoreset
alarms)
Green,
steadily lit
None
Not applicable.
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
13.1.1 Alarm messages
In addition to displaying the urgency 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 screen.
Figure 13-1 shows the format for alarm messages.
The base message identifies
the alarm. Touch alarm
symbol to view definition
on lower screen.
The analysis message gives the root
cause of the alarm. May also include
dependent alarms.
}
The two highestpriority active
alarm messages
are displayed here.
The remedy
message suggests
how to resolve
the alarm condition.
Touch flashing MORE ALARMS
button to view messages for up to
six additional active alarms.
Figure 13-1. Alarm message format (upper GUI screen)
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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-3
Alarms
•
The urgency level of a primary alarm is equal to or greater than
the urgency level of any of its active dependent alarms.
•
An alarm cannot be a dependent alarm of any alarm that occurs
subsequently.
•
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 urgency level of a dependent alarm is based solely on its
detection conditions (not the urgency 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.
13.1.2 Alarm summary
Table 13-2 summarizes ventilator alarms, including urgency,
messages, and other information.
Table 13-2: Alarm summary
Base message Urgency
AC POWER
LOSS
TR 13-4
10067720 Rev. B
Low
Analysis
message
Remedy
message
Operating on Prepare
battery.
for power
loss.
Medium Operational
time
< 2 minutes.
Comments
Power switch on, AC
power not available,
ventilator operating
on BPS. BPS
operating indicator
turns on. Resets
when AC power is
restored.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Analysis
message
Remedy
message
Medium Apnea
ventilation.
Breath
interval
> apnea
interval.
Check
patient &
settings.
The set apnea
interval has elapsed
without the
ventilator, patient,
or operator
triggering a breath.
Resets when patient
initiates 2
consecutive breaths.
Possible dependent
alarm: ↓VE TOT .
Base message Urgency
APNEA
(patient data
alarm)
CIRCUIT
DISCONNECT
Comments
High
Extended
apnea
duration or
multiple
apnea events.
High
No
ventilation.
Check
patient/
ventilator
status.
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.
High
No
ventilation.
Check
patient.
Reconnect
circuit.
Ventilator detects
circuit disconnect
and switches to idle
mode; upper screen
displays elapsed
time without
ventilator support.
Resets when
ventilator senses
reconnection.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-5
Alarms
Table 13-2: Alarm summary
Base message Urgency
TR 13-6
Analysis
message
Remedy
message
Comments
COMPLIANCE
LIMITED V T
(patient data
alarm)
Low
Inspired
Compliance
compensation volume
limit reached. may be
< set.
Check
patient
and circuit
type.
Compliance volume
required to
compensate delivery
of a volume
controlled breath
exceeds the
maximum allowed
for 3 of the last
4 breaths.
COMPRESSOR
INOPERATIVE
Low
No
compressor
air. No
operation
during low
AC power.
Compressor ready
indicator turns off.
Resets when full AC
power is restored.
Low
No
compressor
air. No
operation
during A/C
power loss.
Ventilator turns off
compressor. Resets
when full AC power
is restored.
Low
No
compressor
air.
Compressor ready
indicator turns off.
Low
N/A
10067720 Rev. B
No
remedy
message
displayed
Replace
Alarm occurs when
compressor. there are no LOW
AC POWER and no
AC POWER LOSS
alarms for
< 15 seconds AND
time since power-on
> 10 seconds.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Analysis
message
Remedy
message
Low
Breath
delivery not
affected.
Service
required.
Low
Ventilation
continues as
set.
Low
Breath
delivery not
affected.
Compromised
spirometry.
Low
Breath
delivery not
affected.
Possible
compromise
of other
functions.
Base message Urgency
DEVICE
ALERT
Medium Ventilation
continues as
set.
Comments
Background checks
have detected a
problem. Resets
when ventilator
Replace & passes EST.
service
ventilator.
Service
required.
POST has detected a
problem. Resets
when ventilator
passes POST.
Replace & Background checks
service
have detected a
ventilator. problem. Accuracy
of exhalation flow
sensor temperature
may be affected.
Resets when
ventilator passes EST.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-7
Alarms
Table 13-2: Alarm summary
Base message Urgency
DEVICE
ALERT (cont)
Analysis
message
Medium Ventilation
continues as
set.
10067720 Rev. B
Comments
Replace & Background checks
service
have detected a
ventilator. problem. Accuracy
of oxygen flow
sensor temperature
may be affected,
ventilator using
nominal value.
Resets when
ventilator passes EST.
Medium Breath
delivery not
affected.
Compromised
spirometry.
Background checks
have detected a
problem persisting
for over 10 minutes.
Resets when
ventilator passes EST.
Medium Ventilation
continues as
set. Only O2
available.
Background checks
have detected a
problem. Ventilator
delivers 100% O2.
Resets when
ventilator passes EST.
Medium Breath
delivery not
affected.
Compromised
spirometry.
TR 13-8
Remedy
message
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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Base message Urgency
DEVICE
ALERT (cont)
Analysis
message
Medium Ventilation
continues as
set. Only air
available.
Remedy
message
Comments
Replace & Background checks
service
have detected a
ventilator. problem. Ventilator
delivers 21% O2.
Resets when
ventilator passes EST.
High
Breath
delivery not
affected.
High
Unable to
determine
status of
breath
delivery.
Check
patient.
Replace &
service
ventilator.
High
Ventilation
continues as
set.
Replace & Background checks
service
have detected a
ventilator. problem. Loss of GUI
indicator lights.
Alarms, setting
changes, and
monitored data
disabled. Resets
when ventilator
passes EST.
Background checks
have detected a
problem. Loss of GUI
indicator lights.
Setting changes
disabled. Resets
when ventilator
passes EST.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Background checks
have detected a
problem. Loss of GUI
indicator lights.
Resets when
communication
between GUI and
BDU is reestablished.
10067720 Rev. B
TR 13-9
Alarms
Table 13-2: Alarm summary
Base message Urgency
DEVICE
ALERT (cont)
TR 13-10
10067720 Rev. B
Analysis
message
Remedy
message
Comments
High
Ventilation
continues as
set.
High
Ventilation
Replace &
continues as
service
set. Delivery/ ventilator.
spiro may be
compromised.
Background checks
have detected a
problem. Setting
changes not
allowed. Resets
when ventilator
passes EST.
High
Breath
delivery not
affected.
Compromised
spiro.
Trig = pres.
Check
patient.
Replace &
service
ventilator.
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.
High
Ventilation
continues as
set, except
O2% = 100
Check
patient.
Replace &
service
ventilator.
Background checks
have detected a
problem. Ventilator
delivers 100% O2
instead of set O2%.
Resets when
ventilator passes EST.
Replace & Background checks
service
have detected a
ventilator. problem. Setting
changes, monitored
data, and alarms
disabled. Resets
when ventilator
passes EST.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Analysis
message
Remedy
message
High
Ventilation
continues as
set.
Compromised
air delivery
Replace &
service
ventilator.
Check
patient.
Background checks
have detected a
problem. Accuracy
of air flow sensor
temperature may be
affected, ventilator
using nominal value.
Resets when
ventilator passes EST.
High
Ventilation
continues as
set.
Compromised
O2 delivery
Replace &
service
ventilator.
Check
patient.
Background checks
have detected a
problem. Accuracy
of oxygen flow
sensor temperature
may be affected,
ventilator using
nominal value.
Resets when
ventilator passes EST.
High
Power loss &
recovery
occurred with
a pre-existing
Device Alert.
Check
Alarm log.
EST
required.
Background checks
have detected a
problem. Loss of GUI
indicator lights.
Resets when
ventilator passes EST.
High
Ventilation
continues as
set, except
O2% = 21.
Check
patient.
Replace &
service
ventilator.
Background checks
have detected a
problem. Ventilator
delivers 21% O2
instead of set O2%.
Resets when
ventilator passes EST.
Base message Urgency
DEVICE
ALERT (cont)
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Comments
10067720 Rev. B
TR 13-11
Alarms
Table 13-2: Alarm summary
Base message Urgency
DEVICE
ALERT (cont)
↑PPEAK
(patient data
alarm)
TR 13-12
10067720 Rev. B
Analysis
message
High
No
ventilation.
Safety Valve
Open.
High
No
ventilation.
Safety Valve
Open.
High
No
ventilation.
Safety Valve
Open.
Low
Last breath
≥ set limit.
High
Last 4 or
more breaths
≥ set limit.
Remedy
message
Comments
Provide
alternate
ventilation.
Replace &
service
ventilator.
Background checks
have detected a
problem. Safety
valve open indicator
lights. Upper screen
displays elapsed
time without
Check
ventilator support.
patient.
Resets when
Replace & ventilator passes EST.
service
ventilator.
Provide
alternate
ventilation.
Replace &
service
ventilator.
Check
patient,
circuit &
Medium Last 3 breaths ET tube.
≥ set limit.
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:
↓V TE MAND , ↓VE TOT,
↑ f TOT .
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Base message Urgency
3PPEAK
(patient data
alarm)
Low
Analysis
message
Remedy
message
Last 2
Check for
breaths,
leaks.
pressure ≤ set
limit.
Medium Last 4
breaths,
pressure ≤ set
limit.
High
↑O2%
(patient data
alarm)
(patient data
alarm)
Peak inspiratory
pressure ≤ set limit.
(Available only when
Vent Type is NIV or
during INVASIVE
ventilation when
Mandatory Type is
VC+.)
Last 10 or
more breaths,
pressure ≤ set
limit.
Check
patient,
gas
sources,
O2
analyzer &
ventilator.
The O2% measured
during any phase of
a breath cycle is 7%
(12% during the first
hour of operation)
or more above the
O2% setting for at
least 30 seconds.
(These percentages
increase by 5% for
4 minutes following
a decrease in the
O2% setting.) Alarm
updated at 1-second
intervals.
Last 2 breaths Check
≥ set limit.
settings,
changes in
Medium Last 4 breaths patient’s
≥ set limit.
R & C.
Exhaled tidal volume
≥ set limit. Alarm
updated whenever
exhaled tidal volume
is recalculated.
Possible dependent
alarm: 1VE TOT.
Medium Measured
O2% > set for
≥ 30s but
< 2 min.
High
↑ V TE
Comments
Measured
O2% > set
for ≥ 2 min.
Low
High
Last 10 or
more breaths
≥ set limit.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-13
Alarms
Table 13-2: Alarm summary
Base message Urgency
↑ VE TOT
(patient data
alarm)
Low
Analysis
message
VE TOT ≥ set
limit for
≤ 30s.
Remedy
message
Check
patient &
settings.
Expiratory minute
volume ≥ set limit.
Alarm updated
whenever an
exhaled minute
volume is
recalculated.
Possible dependent
alarm: ↑ V TE.
Check
patient &
settings.
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:
↓VTE MAND ,
↓VTE SPONT , VE TOT .
Check
patient,
circuit &
ET tube.
Inspiratory pressure
> 100 cmH2O and
mandatory type =
VC or spontaneous
type= TC or PA.
Ventilator truncates
current breath
unless already in
exhalation. Possible
dependent alarms:
↓VTE MAND,
↓VE TOT , ↑fTOT.
Medium VE TOT ≥ set
limit for
> 30s.
↑fTOT (patient
data alarm)
High
VE TOT ≥ set
limit for
> 120s.
Low
fTOT ≥ set
limit for
≤ 30s.
Medium fTOT ≥ set
limit for
> 30s.
↑PVENT
(patient data
alarm)
High
fTOT ≥ set
limit for
> 120s.
Low
1 breath
≥ limit.
Medium 2 breaths
≥ limit.
High
TR 13-14
10067720 Rev. B
3 or more
breaths
≥ limit.
Comments
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Base message Urgency
INOPERATIVE
BATTERY
INSPIRATION
TOO LONG
(patient data
alarm)
Low
Inadequate
charge or
nonfunctional
battery
system.
Remedy
message
Service/
replace
battery.
Check
Last 2 spont
breaths = IBW patient.
based TI limit. Check for
leaks.
Medium Last 4 spont
breaths = IBW
based TI limit.
Low
High
LOSS OF
POWER
Analysis
message
Last 10 or
more spont
breaths = IBW
based TI limit.
High
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Comments
BPS installed but not
functioning. Resets
when BPS is
functional.
Inspiratory time for
spontaneous breath
≥ IBW-based limit.
Ventilator
transitions to
exhalation. Resets
when TI falls below
IBW-based limit.
Active only when
Vent Type is
INVASIVE.
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 sounds for at
least 120 seconds.
Alarm annunciation
can be reset by
turning power
switch to off
position.
10067720 Rev. B
TR 13-15
Alarms
Table 13-2: Alarm summary
Base message Urgency
TR 13-16
Analysis
message
Remedy
message
Comments
LOW AC
POWER
Low
Ventilator
currently not
affected.
Power
interrupt
possible.
LOW
BATTERY
Low
Operational
time < 2
minutes.
Replace or Resets when BPS has
allow
more than
recharge. approximately
2 minutes of
operational time
remaining.
↓O2%
(patient data
alarm)
High
Measured
O2% < set
O2%.
Check
patient,
gas
sources,
O2
analyzer &
ventilator.
10067720 Rev. B
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.
The O2% measured
during any phase of
a breath cycle is 7%
(12% during the first
hour of operation)
or more below the
O2% setting for at
least 30 second, or
below 18%. (These
percentages increase
by 5% for 4 minutes
following an
increase in the O2%
setting.) Alarm
updated at 1-second
intervals.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Base message Urgency
↓VTE MAND
(patient data
alarm)
↓VTE SPONT
(patient data
alarm)
Analysis
message
Remedy
message
Low
Last 2 mand. Check for
breaths ≤ set leaks,
limit.
changes in
patient‘s
Medium Last 4 mand. R & C.
breaths ≤ set
limit.
High
Last 10 or
more mand.
breaths ≤ set
limit.
Low
Last 2 spont
Check
breaths ≤ set patient &
limit.
settings.
Medium Last 4 spont
breaths ≤ set
limit.
↓VE TOT
(patient data
alarm)
High
Last 10 or
more spont
breaths ≤ set
limit.
Low
VE TOT ≤ set
limit for
≤ 30s.
Check
patient &
settings.
Medium VE TOT ≤ set
limit for
> 30s.
High
VE TOT ≤ set
limit for
> 120s.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Comments
Exhaled mandatory
tidal volume ≤ set
limit. Alarm updated
whenever exhaled
mandatory tidal
volume is
recalculated.
Possible dependent
alarms:
↑ VE TOT , ↑fTOT .
Exhaled
spontaneous tidal
volume ≤ set limit.
Alarm updated
whenever exhaled
spontaneous tidal
volume is
recalculated.
Possible dependent
alarms:
3VE TOT, ↑fTOT.
Total minute volume
≤ set limit. Alarm
updated whenever
exhaled minute
volume is
recalculated.
Possible dependent
alarms:
↓VTE MAND,
↓VTE SPONT , ↑fTOT.
10067720 Rev. B
TR 13-17
Alarms
Table 13-2: Alarm summary
Base message Urgency
NO AIR
SUPPLY
NO AIR
SUPPLY
and NO O2
SUPPLY
TR 13-18
10067720 Rev. B
Analysis
message
Low
Ventilation
continues as
set. Only O2
available.
Low
Compressor
inoperative.
Ventilation
continues as
set. Only O2
available.
High
Ventilation
continues as
set except
O2% = 100
High
Compressor
inoperative.
Ventilation
continues as
set, except
O2% = 100.
High
No
ventilation.
Safety Valve
Open.
Remedy
message
Check air
source.
Comments
Operator-set O2%
equals 100%.
Ventilator delivers
100% O2. Resets if
air supply
connected.
Check
Operator-set O2%
patient & < 100%. Ventilator
air source. delivers 100% O2
instead of set O2%.
Resets if air supply
connected.
Provide
alternate
ventilation.
Check
both gas
sources.
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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
Table 13-2: Alarm summary
Base message Urgency
NO O2
SUPPLY
O2 SENSOR
PROCEDURE
ERROR
Analysis
message
Remedy
message
Comments
Low
Ventilation
continues as
set. Only air
available.
Check O2
source.
Operator-set O2%
equals 21%. Resets if
O2 supply
connected.
High
Ventilation
continues as
set, except
O2% = 21.
Check
patient &
O2 source
Operator-set O2%
> 21%. Ventilator
delivers 21% O2
instead of set O2%.
Resets if oxygen
supply connected.
Ventilation
unaffected.
O2 sensor
out of
calibration
/failure.
Press
100% O2
CAL or
INCREASE
O2 2 min,
replace or
disable.
Background checks
have detected a
problem. Resets
when operator
successfully
calibrates oxygen
sensor, or disables
oxygen sensor.
Patient
connected
before setup
complete.
Provide
alternate
ventilation.
Complete
setup
process.
Ventilator begins
safety ventilation.
Resets when
ventilator startup
procedure is
complete.
Low
High
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-19
Alarms
Table 13-2: Alarm summary
Analysis
message
Base message Urgency
SCREEN
BLOCK
SEVERE
OCCLUSION
Medium Possible
blocked beam
or touch
screen fault.
High
Little/no
ventilation.
Remedy
message
Comments
Remove
obstruction
or service
ventilator.
Background checks
have detected a
problem. Resets
when ventilator
passes EST or when
blockage is removed.
Check
patient.
Provide
alternate
ventilation.
Clear
occlusions;
drain
circuit.
Ventilator enters
occlusion status
cycling (OSC) and
upper screen
displays elapsed
time without
ventilator support.
13.2 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-urgency 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-urgency 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.
13.3 APNEA alarm
The APNEA alarm indicates neither the ventilator nor the patient has
triggered a breath for the operator-selected apnea interval (TA). TA is
measured from the start of an inspiration to the start of the next
TR 13-20
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
inspiration and is based on the ventilator’s inspiratory detection
criteria. TA 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 VT (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/she fails
to exhale on schedule.
13.4 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 DSENS setting may be
used in the circuit disconnect detection algorithms. See Section 10.2
on page TR 10-3 for a complete discussion of the CIRCUIT
DISCONNECT detection methods.
You can set the sensitivity of the CIRCUIT DISCONNECT alarm by
adjusting the DSENS 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).
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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-21
Alarms
13.5 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.
13.6 High circuit pressure (↑PPEAK) alarm
The 1P PEAK alarm indicates the currently measured airway pressure
is equal to or greater than the set 1P PEAK limit. The 1P PEAK limit is
active during mandatory and spontaneous breaths, and during
inspiration and exhalation. The 1P PEAK limit is active in all normal
ventilation modes. The 1P PEAK limit is not active during a SEVERE
OCCLUSION alarm.
The 1P PEAK limit cannot be set less than:
PEEP + 7 cmH2O, or
PEEP + PI + 2 cmH2O, or
PEEP + PSUPP + 2 cmH2O
nor can it be set less than or equal to 4P PEAK.
You cannot disable the 2P PEAK limit. The ventilator phases in
changes to the 2P PEAK limit immediately to allow prompt
notification of a high circuit pressure condition.
The minimum 2P PEAK limit (7 cmH2O) corresponds to the lowest
peak pressures not due to autotriggering anticipated during a
mandatory breath. The maximum 2P PEAK limit (100 cmH2O) 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 2P PEAK 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 13-22
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
The 2P PEAK alarm is active throughout inspiration and exhalation to
provide redundant patient protection (for example, to detect
occlusions downstream of the pressure-sensing device).
13.7 High delivered O2% (↑O2%) alarm
The ↑O2% alarm indicates the measured O2% during any phase of a
breath is at or above the error percentage above the O2% setting for
at least 30 seconds. Although the ventilator automatically sets the
↑O2% 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 four minutes following a
decrease in the setting.)
The ventilator automatically adjusts the ↑O2% alarm limit when
O2% changes due to 100% O2, apnea ventilation, occlusion, circuit
disconnect, or a NO AIR/O2 SUPPLY alarm. The ventilator checks the
↑O2% alarm limit against the measured oxygen percentage at 1second intervals.
The ↑O2% alarm detects malfunctions in ventilator gas delivery or
oxygen monitor. The ↑O2% alarm limit automatically adjusts during
100% O2 suction, apnea ventilation, patient circuit disconnect, or
low air inlet pressure because O2% changes are expected under
those circumstances. The ventilator declares a ↑O2% alarm after 30
seconds to eliminate transient O2% delivery variation nuisance
alarms.
13.8 High exhaled minute volume (↑VE TOT ) alarm
The ↑VE TOT alarm indicates the measured exhaled total minute
volume for spontaneous and mandatory breaths is equal to or
greater than the set 2VE TOT limit. The ↑VE TOT alarm is updated
whenever a new value is available.
The ↑VE TOT alarm can be used to detect a change in a patient's
breathing pattern, or a change in compliance or resistance. The
↑VE TOT alarm can also detect too-large tidal volumes, which could
lead to hyperventilation and hypocarbia.
The ↑VE TOT alarm is effective immediately upon changing the
setting, to ensure prompt notification of prolonged high tidal
volumes.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-23
Alarms
13.9 High exhaled tidal volume (↑VTE) alarm
The ↑VTE alarm indicates the measured exhaled tidal volume for
spontaneous and mandatory breaths is equal to or greater than the
set ↑VTE limit. The ↑VTE alarm is updated whenever a new measured
value is available.
The ↑VTE 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 ↑VTE 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 compliancecompensation algorithm.)
13.10 High inspired tidal volume alarm (↑VTI, ↑VTI MAND,
↑VTI SPONT)
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. The ventilator system displays monitored inspired
tidal volume values in the patient data area on the GUI screen. Table
13-3 shows the symbol corresponding to the ventilator settings in
effect.
Table 13-3: Applicability of high inspired tidal volume alarm
symbols
TR 13-24
Alarm symbol
Alarm setting or
patient data symbol
↑VTI
VTI
↑VTI MAND
VTI MAND
VC+
↑VTI SPONT
VTI SPONT
VS or TC
10067720 Rev. B
Mandatory or spontaneous
type setting
VC+ and TC (concurrently)
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
When Vent Type is NIV, there is no high inspired tidal volume alarm
or setting available, but the monitored inspired tidal volume (VTI)
appears in the patient data area on the GUI screen.
13.11 High respiratory rate (↑fTOT) alarm
The ↑fTOT alarm indicates the measured breath rate is greater than
or equal to the set ↑fTOT limit. The ↑fTOT alarm is updated whenever
a new total measured respiratory rate is available.
The ↑fTOT 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 ↑fTOT limit immediately to
ensure prompt notification of a high respiratory rate condition.
13.12 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 this time limit:
(1.99 + 0.02 x IBW) seconds (adult and pediatric circuits)
(1.0 + 0.10 x 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 ESENS and rise time % are properly set.
13.13 Low circuit pressure alarm (↓PPEAK)
The 3P 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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
10067720 Rev. B
TR 13-25
Alarms
The 3P 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 cmH2O, the 3P PEAK alarm can
be turned OFF. The 3P PEAK alarm can always be turned OFF during
NIV. The 4P PEAK alarm limit cannot be set to a value greater than or
equal to the 2P PEAK alarm limit.
Warning
Because the VC+ pressure control algorithm does not allow
the target inspiratory pressure to fall below PEEP + 5 cmH2O,
attempting to set the 4PPEAK alarm limit at or below this level
will turn the alarm off.
Whenever PEEP is changed, 3P PEAK is set automatically to its New
Patient value, PEEP + 6 cmH2O.
There are no alarms dependent upon 3P PEAK, and the 3P PEAK alarm
does not depend on other alarms.
13.14 Low delivered O2% (↓O2%) alarm
The ↓O2% alarm indicates the measured O2% during any phase of a
breath is at or below the error percentage below the O2% setting, or
less than or equal to 18%, for at least 30 seconds. Although the
ventilator automatically sets the ↓O2% 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
four minutes following a increase in the setting.)
The ventilator automatically adjusts the ↓O2% alarm limit when
O2% changes due to apnea ventilation, circuit disconnect, or a
NO O2/AIR SUPPLY alarm. The ↓O2% alarm is disabled during a safety
valve open (SVO) condition. The ventilator checks the ↓O2% alarm
against the measured oxygen percentage at 1-second intervals.
The ↓O2% alarm can detect malfunctions in ventilator gas delivery or
the oxygen monitor, and can ensure the patient is adequately
oxygenated. The ↓O2% alarm limit is automatically adjusted during
apnea ventilation, patient circuit disconnect, or low gas inlet
pressures because O2% changes are expected under those
circumstances. The ventilator declares a ↓O2% alarm after
30 seconds to eliminate nuisance alarms due to transient O2%
TR 13-26
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Alarms
delivery variations. You can view the O2% measured by the oxygen
sensor by touching the More Patient Data button on the upper GUI
screen.
13.15 Low exhaled mandatory tidal volume (↓VTE MAND)
alarm
The 3VTE MAND alarm indicates the measured exhaled mandatory
tidal volume is less than or equal to the 3VTE MAND limit. The
3VTE MAND alarm is updated whenever a new measured value of
exhaled mandatory tidal volume is available.
The 3VTE MAND alarm can detect an obstruction, a leak during volume
ventilation, or a change in compliance or resistance during pressurebased 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 3VTE MAND
alarm immediately to ensure prompt notification of a low exhaled
tidal volume condition.
13.16 Low exhaled spontaneous tidal volume (↓VTE SPONT)
alarm
The 3VTE SPONT alarm indicates the measured exhaled spontaneous
tidal volume is less than or equal to the 3VTE SPONT limit. The
3VTE SPONT alarm is updated whenever a new measured value of
exhaled spontaneous tidal volume is available.
The 3VTE SPONT alarm can detect a leak in the patient circuit or a
change in the patient’s respiratory drive during a single breath. The
3VTE 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 3VTE SPONT
alarm limit immediately to ensure prompt notification of a low
exhaled tidal volume condition.
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Alarms
13.17 Low exhaled total minute volume (↓VE TOT) alarm
The ↓VE TOT alarm indicates the measured minute volume (for
mandatory and spontaneous breaths) is less than or equal to the set
↓VE TOT limit. The ↓VE TOT alarm is updated whenever a new value for
exhaled minute volume is calculated. You cannot turn off the ↓VE TOT
alarm.
The ↓VE 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 ↓VE TOT alarm can also detect toosmall tidal volumes, which could lead to hypoventilation and
hypoxia (oxygen desaturation).
The ventilator phases in changes to the ↓VE TOT alarm limit
immediately to ensure prompt notification of prolonged low tidal
volumes.
13.18 PROCEDURE ERROR alarm
The ventilator declares a PROCEDURE ERROR alarm if 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-urgency
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.
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Patient data
14
Chapter 14 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 A-14 on page OP A-45.
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
one-minute averaging is reset if you change a ventilator
setting directly affecting that information.
14.1 Delivered O2%
The ventilator measures the percentage of oxygen in
the gas at the ventilator outlet, upstream of the
inspiratory filter. Delivered O2% is displayed on the GUI
in the More Patient Data screen. Delivered O2% is used
to detect ↑O2% and ↓O2% alarms.
The delivered O2% parameter independently checks the
O2% setting. The delivered O2% measurement monitors
the O2% at the ventilator (not the O2% delivered to the
patient). If the oxygen mix is affected downstream of
the inspiratory filter (for example, by nebulization),
delivered O2% does not reflect that change. Delivered
O2% is measured upstream of the inspiratory filter to
avoid having to sterilize the oxygen sensor.
Patient data
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).
14.2 End expiratory pressure (PEEP)
PEEP is the pressure measured at the end of the exhalation 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.
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 PEEP 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.
14.3 End inspiratory pressure (PI END)
PI END is the pressure measured at the end of the inspiratory phase of
the current breath, whether mandatory or spontaneous. PI END is
updated at the beginning of the exhalation phase. The ventilator
displays negative PI END values. If plateau is active, the PI END display
indicates the pressure at the end of the plateau.
PI END is the last value in inspiration of the low-pass filtered airway
pressure. The accuracy of the PI 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, PI END is usually the same as peak circuit
pressure (PPEAK). For pressure-based breaths, PI END is more indicative
of the pressures actually exerted on the lungs (PPEAK), on the other
hand, only shows a pressure spike and is not as meaningful for
pressure ventilation). The PI END is the plateau pressure when a
plateau follows mandatory breath delivery. Plateau pressure can be
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Patient data
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 cmH2O.
The displayed range includes low pressures that can occur when the
patient "out-draws" the ventilator and the high pressures in lowcompliance patients. The 130 cmH2O maximum allows the ventilator
to measure pressure overshoots of breaths truncated at the
maximum high pressure limit (100 cmH2O).
14.4 Exhaled minute volume (VE TOT)
VE TOT is an estimate of the sum of volumes exhaled for mandatory
and spontaneous breaths over the previous one-minute interval.
VE 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 (VT) settings, VE TOT is
updated at the beginning of each new inspiration or at
ten-second intervals, whichever comes first. The ventilator uses this
formula to compute VE TOT based on up to eight breaths:
VE TOT = 60 x (total VT in t seconds)/t
where t is the time in seconds since the computation started.
After the first minute, the ventilator computes VE TOT 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 ten-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 VE TOT computation is based on full and partial breaths that
occurred during the preceding one-minute period. If the one-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 one minute.
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TR 14-3
Patient data
For example, if eight full breaths and part of a ninth breath occur in
the last minute,VE 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, VE TOT continues to be updated every
ten seconds, and automatically decrements.
14.5 Exhaled tidal volume (VTE)
VTE 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 VTE is computed based on a five-breath average. It is
updated at the beginning of the next inspiratory phase.
VTE 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.
14.6 I:E ratio (I:E)
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.
14.7 Intrinsic (auto) PEEP (PEEPI) and total PEEP (PEEPTOT)
PEEPTOT and PEEPI are determined during an operator-initiated
expiratory pause, in which the PSOL valves and exhalation valves are
closed. PEEPTOT is the pressure measured during the pause
maneuver. It is an estimate of the total pressure at the end of
exhalation, referenced to atmosphere. PEEPI 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.
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Patient data
14.8 Mean circuit pressure (PMEAN)
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.
14.9 Peak circuit pressure (PPEAK)
PPEAK 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 PPEAK values. The ventilator displays the most positive value
of the low-pass filtered airway pressure measured during the
inspiratory phase.
PPEAK can be used to evaluate trends in lung compliance and
resistance. For volume-based breaths, PPEAK is usually the same as
end inspiratory pressure (PI END). For pressure-based breaths, PI END is
more indicative of the pressures actually exerted on the lungs (PPEAK,
on the other hand, may only show a pressure spike and may not be
meaningful for pressure ventilation).
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 lowcompliance patients and pressure overshoots of breaths truncated at
the maximum high pressure limit (100 cmH2O).
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TR 14-5
Patient data
14.10 Plateau pressure (PPL)
PPL 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), PPL is
the best estimate of the pressure in the patient’s lungs.
Beginning with the start of the pause maneuver, PPL is displayed and
updated continuously. At the end of the maneuver PPL, along with
the other pause data, is “frozen,” enabling you to view all of the
data together. Pressing “UNFREEZE” causes the data to be discarded.
14.11 Spontaneous minute volume (VE SPONT)
VE SPONT is the sum of spontaneous exhaled volumes, normalized to
one minute. The displayed VE SPONT is compliance- and BTPScompensated. As more mandatory breaths are delivered, the
displayed VE SPONT is computed and updated whenever VE TOT is
computed and updated. The computation for VE SPONT is the same as
for VE TOT , except only spontaneous breaths are included, and the
one-minute interval is not extended unless the partial breath is a
spontaneous breath. (See exhaled minute volume for details.)
VE SPONT can help determine how much ventilation takes place solely
due to spontaneous breathing, and does not include patientinitiated mandatory breaths. Minute volume establishes a patient's
ventilatory adequacy, and VE SPONT indicates how much of total
ventilation is due to the patient's efforts. VE SPONT can be used to
assess whether a patient being ventilated in SIMV is ready to be
weaned.
14.12 Static compliance and resistance (CSTAT and RSTAT)
C (or CSTAT, static compliance) is an estimate of the elasticity of the
patient’s lungs; it is expressed in mL/cmH2O. R (or RSTAT, 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 cmH2O/L/second. These values are computed during an
operator-initiated inspiratory pause, in which the PSOL valves and
exhalation valve are closed. CSTAT is computed during a mandatory
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breath. RSTAT is computed during a VC mandatory breath with a
square waveform.
CSTAT is computed from this equation:
VEXH
C STAT =
PPL END - PEEP
- CC
where: VEXH 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
CC is the compliance of the Ventilator Breathing System (VBS)
during the pause maneuver (derived from SST)
RSTAT is computed from this equation once CSTAT is computed
(assuming the breath type was VC with square flow waveform):
[1 +
RSTAT =
CC
C STAT
]
(PPEAK - PPL MID)
VPAT
where:
CC is as given above
CSTAT is as given above
PPL MID is the mean pressure in the patient circuit over the 100-ms
interval that defines the pause-mechanics plateau
PPEAK is the pressure in the patient circuit at the end of the
square flow waveform
VPAT is the flow into the patient during the last 100 ms of the
waveform
During the pause, the most recently selected graphics are displayed
and frozen, so you can see when inspiratory pressure stabilizes. CSTAT
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TR 14-7
Patient data
and RSTAT are displayed at the start of the next inspiration following
the inspiratory pause. They take this format:
CSTAT xxx
or
RSTAT yyy
If the software determines variables in the equations or the resulting
CSTAT or RSTAT values are out of bounds, it identifies the questionable
CSTAT and RSTAT values with special formatting and text messages:
•
Parentheses ( ) signify questionable CSTAT or RSTAT values, derived
from questionable variables.
•
Flashing CSTAT or RSTAT values are out of bounds.
•
Asterisks (******) mean variables fall below noise-level bounds
•
RSTAT------ means resistance could not be computed, because the
breath was not of a mandatory, VC type with square flow
waveform.
Refer to Table 14-1 for further troubleshooting.
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Patient data
Table 14-1: Inspiratory pause maneuver displays
Compliance
(CSTAT)
Resistance
(RSTAT) (if
displayed)
CSTAT (******)
Meaning
Corrective action
RSTAT (******)
CSTAT < 0.1
mL/cmH2O or
patient flow < 0.1
L/min. The low
patient flow is
below the
threshold of
reliable
measurement.
Both CSTAT and
RSTAT are
questionable.
Check the
breathing
waveforms and
monitored
patient data for
underlying cause.
CSTAT (******)
RSTAT (******)
The difference in
pressure between
end plateau and
end exhalation
< 0.1 cmH2O;
below the limits
of reliable
resolution. Both
CSTAT and RSTAT
are questionable.
Check the
breathing
waveforms and
monitored
patient data for
underlying cause.
CSTAT ( 0 )
or
C (500)
RSTAT (
)
Message as
dictated by
other tests
CSTAT ≤ 0
mL/cmH2O or
CSTAT > 500
mL/cmH2O. These
measurements
are outside of
physiological
limits.
Check the
patient-ventilator
interaction, the
breathing
waveforms, and
the patient circuit
for underlying
causes.
CSTAT ( )
Message as
dictated by
other tests
RSTAT ( 0 )
or
RSTAT (500)
RSTAT ≤ 0
cmH2O/L/s or
RSTAT > 500
cmH2O/L/s. These
measurements
are outside of
physiological
limits.
Check the
patient-ventilator
interaction, the
breathing
waveforms, and
the patient circuit
for underlying
causes.
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TR 14-9
Patient data
Table 14-1: Inspiratory pause maneuver displays
Compliance
(CSTAT)
TR 14-10
Resistance
(RSTAT) (if
displayed)
Meaning
Corrective action
CSTAT (xxx)
RSTAT (yyy)
Sub-threshold
input value(s)
CSTAT < 1/3 of
ventilator
breathing system
compliance
(derived from
SST). Both CSTAT
and RSTAT are
questionable.
If the patient’s
IBW ≤ 24 kg,
consider installing
a pediatric
patient circuit.
CSTAT (xxx)
Incomplete
exhalation
RSTAT (yyy)
Incomplete
exhalation
Exhalation was
not complete.
End-expiratory
pressure and total
exhaled flow
values are
questionable.
Check for an
insufficient
expiratory interval.
If possible, shorten
inspiration time
and reduce
respiratory rate.
CSTAT (xxx)
No plateau
RSTAT (yyy)
No plateau
Plateau is not
“flat” (lung and
circuit pressures
did not
equilibrate) or
pause pressure
was excessively
noisy. Both CSTAT
and RSTAT are
questionable.
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.
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Patient data
Table 14-1: Inspiratory pause maneuver displays
Compliance
(CSTAT)
CSTAT (xxx)
Out of range
Resistance
(RSTAT) (if
displayed)
RSTAT (yyy)
Questionable
measurement
Meaning
Corrective action
CSTAT < 1.0
mL/cmH2O. This
results from
questionable
input data. The
value for RSTAT is
also questionable.
Check the
breathing
waveforms and
monitored
patient data for
underlying cause.
CSTAT > 100
mL/cmH2O. This
results from
questionable
input data. The
value for RSTAT is
also questionable.
Check the
breathing
waveforms and
monitored
patient data for
underlying cause.
CSTAT (xxx)
Questionable
measurement
RSTAT (yyy)
Out of range
RSTAT > 150
cmH2O/L/s. This
results from
questionable
input data,
possibly CSTAT.
Check the
breathing
waveforms and
monitored
patient data for
underlying cause.
CSTAT (xxx)
Questionable
measurement
RSTAT (yyy)
Questionable
measurement
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.
Check the
pressure-time
waveform to see
whether the
patient delayed
inspiration until
the end of gas
delivery.
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TR 14-11
Patient data
Table 14-1: Inspiratory pause maneuver displays
TR 14-12
Compliance
(CSTAT)
Resistance
(RSTAT) (if
displayed)
CSTAT (xxx)
Sub-threshold
input value(s)
NA
10067720 Rev. B
Meaning
Corrective action
RSTAT (yyy)
Questionable
measurement
The difference
between the
circuit pressure at
the end of the
plateau and the
pressure at the
end of exhalation
< 0.5 cmH2O. The
value for RSTAT is
questionable.
Check for a highly
compliant lung,
inflated slightly. If
safe to do so,
increase tidal
volume.
RSTAT (yyy)
Out of range
RSTAT < 0.5
cmH2O/L/s. This
results because
the patient flow
or the pressure
difference from
peak to plateau is
questionable.
Check the
breathing
waveforms and
monitored
patient data for
underlying
causes.
RSTAT (yyy)
Questionable
measurement
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 RSTAT is
questionable.
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.
Puritan Bennett™ 800 Series Ventilator System Technical Reference
Patient data
Table 14-1: Inspiratory pause maneuver displays
Compliance
(CSTAT)
NA (cont)
Resistance
(RSTAT) (if
displayed)
RSTAT (yyy)
Subthreshold
input value(s)
Meaning
Corrective action
The difference
between the
circuit pressure at
the end of the
square flow
waveform and at
the end of the
plateau < 0.5
cmH2O. The value
for RSTAT is
questionable.
Check for: low
patient flow
through a
relatively largediameter 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.
Patient flow
< 20 L/min and
CSTAT < 4
mL/cmH2O. The
value for RSTAT is
questionable.
Check for: low
patient flow
through a
relatively largediameter 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.
14.13 Total respiratory rate (fTOT)
fTOT is the number of breaths delivered to a patient normalized to
one minute, whether mandatory or spontaneous, and is updated at
the beginning of each inspiratory phase.
During the first minute of operation after power-up or after a
change to any setting affecting the rate of mandatory breath
delivery, the system updates fTOT at the beginning of each
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TR 14-13
Patient data
inspiration. The ventilator uses this formula to compute fTOT based
on up to eight breaths (or 16 breaths when Spontaneous Type is PA):
Startup fTOT = 60 x (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 fTOT 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
ten-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.
Except for the start-up calculation and the ten-second interval, fTOT
is calculated based on a whole number of breaths. Therefore, the 60second interval is extended to include the next breath initiation. The
ventilator uses this formula to calculate the fTOT:
Post-startup fTOT = 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.
fTOT 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.
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Safety net
15
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 is
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 machinepatient 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
Safety net
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-urgency audible alarm.
15.1 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 urgency of each alarm.
15.2 System faults
The ventilator is designed to prevent system faults. The ventilator is
modular, and it allows the breath delivery unit (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 possible,
depending on the specific system fault. Most system faults are
DEVICE ALERT alarms, and can be high-, medium-, or low-urgency
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-urgency
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:
TR 15-2
•
Displays the elapsed time without ventilatory support.
•
Does not display patient data (including waveforms).
•
Does not detect patient circuit occlusion or disconnect conditions.
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15.3 Ongoing background checks
Ongoing background checks assess the ventilator’s electronics and
pneumatics hardware continuously during ventilation, and include:
•
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:
•
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.
•
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.
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•
Touch screen checks: The ventilator checks for failures in the
touch screen system, including optical obstruction of one or more
LED/photodiode pair.
•
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.
15.4 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.
TR 15-4
•
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 time-outs 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
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Safety net
alarms, the CPU resets, and the ventilator provides the highest
level of ventilatory assistance possible.
•
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.
15.5 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.
15.6 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.
15.7 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.
15.8 Oxygen sensor calibration
The ventilator performs a single-point oxygen sensor calibration
during the 100% suctioning procedure (that is, when you press the
100% O2/CAL 2 min key or INCREASE O2 2 min key), allowing you to
calibrate the oxygen sensor frequently without having to disconnect
the patient. You can also calibrate the oxygen sensor from the More
Settings screen. To perform an oxygen sensor calibration from the
More Settings screen:
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Safety net
1. Touch the OTHER SCREENS button on the lower GUI, then touch
the MORE SETTINGS button.
2. Touch the O2 sensor button and turn the knob to select
Calibration, and press ACCEPT. The progress indicator appears on
the screen. The O2 sensor setting will remain at the setting that
existed before calibration (Disabled or Enabled).
During Oxygen Sensor calibration, the INCREASE O2 2 min LED is
turned OFF.
If the oxygen sensor calibration fails, the ventilator declares an O2
SENSOR alarm that resets when the ventilator successfully calibrates
the oxygen sensor. The ventilator’s oxygen sensor is always active
unless you disable it.
15.9 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.
15.10 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.
15.11 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).
15.12 Atmospheric pressure transducer calibration
This function, available in service mode, calibrates the atmospheric
pressure transducer using an external barometer.
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Power on self test (POST)
16
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 fulllength POST takes under ten seconds (from power on
until Ventilator Startup begins).
The graphic user interface (GUI) and the breath delivery
unit (BDU) subsystems each has its 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.
16.1 Safety
The ventilator does not provide ventilatory support to
the patient during POST. The ventilator alarms if POST
lasts longer than ten seconds or if an unexpected fault is
detected. POST is designed to minimize the delay until
normal ventilation begins and to provide immediate
Power on self test (POST)
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.
16.2 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 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.
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Power on self test (POST)
An alarm turns on if POST lasts more than ten seconds or if POST
restarts three times without completion. The ten-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 ten
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.
16.3 POST following power interruptions
The ventilator executes a normal POST following a long power
interruption (five 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 five 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 (three seconds or less from return of AC power to beginning
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Power on self test (POST)
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.
16.4 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.
16.5 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
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Power on self test (POST)
EST or system level tests. POST software can be updated without
affecting the operational software (GUI and BDU).
Warning
Do not enter Service Mode with a patient attached to the
ventilator. Serious injury could result.
16.6 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.
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Short self test (SST)
17
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 inline water trap, or using a different type or style of
patient circuit). Chapter 3 in the Operator’s Manual part of
this book 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 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.
Short self test (SST)
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 FAILURE. 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:
•
SST did not detect any failures or alerts before the interruption,
and
•
no other errors that would prevent ventilation occurred, and
•
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% O2/CAL 2 min or INCREASE O2 2 min, and EXP PAUSE.
The ? key is functional during SST.
Refer to Chapter 3 How to run Short Self Test (SST) for instructions
on running SST with appropriate patient circuits and accessories.
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Extended self test (EST)
18
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 EST feature allows
individual EST tests to be run in any order, but the full
suite of EST tests must successfully pass before the
ventilator can be used on a patient.
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 include:
•
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
Extended self test (EST)
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).
18.1 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 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 test was run, this message appears in the
Ventilator Test Summary.
•
OUTCOME: All 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.
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Extended self test (EST)
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.
18.2 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.
18.3 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.
Refer to 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 Extended Self Test (EST) with a patient
circuit. Doing so will cause EST to fail. If EST fails, the ventilator
will remain in a Ventilator Inoperative state until EST
successfully passes.
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RS-232 commands
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>.
19.1 RSET command
The RSET command clears data from the ventilator
receive buffer. The ventilator does not send a response
to the host system. Enter the RSET command exactly as
shown:
RSET<CR>
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>
19
RS-232 commands
When the ventilator receives the command SNDA<CR>, it responds
with the code MISCA, followed by ventilator settings and monitored
data information.
The MISCA response follows this format:
MISCA 706 97 <STX> FIELD 5, ..., FIELD 101, <ETX> <CR>
Terminating carriage return
End of transmission (03 hex)
Data field, left-justified and padded with spaces
Start of transmission (02 hex)
Number of data fields between <STX> and <ETX>
Number of bytes between <STX> and <CR>
Response code to SNDA command
The MISCA response (including data fields) is as given in Table 19-1.
The Puritan Bennett™ 840 ventilator follows the same format as the
7200 Series Ventilator. Fields not available in the Puritan Bennett™
840 are marked as “Not used.” Underscores represent one or more
spaces that pad each character string.
Table 19-1: MISCA response
Component
TR 19-2
Description
MISCA
Response to SNDA command (5 characters)
706
The number of bytes between <STX> and <CR>
(3 characters)
97
The number of fields between <STX> and <ETX>
(2 characters)
<STX>
Start of transmission character (02 hex)
Field 5
Ventilator time (HH:MM_) (6 characters)
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Table 19-1: MISCA response
Component
Description
Field 6
Ventilator ID to allow external hosts to uniquely
identify each Puritan Bennett™ 840 Ventilator System
(18 characters)
Field 7
Not used (6 characters)
Field 8
Date (MMM_DD_YYYY_) (12 characters)
Field 9
Mode (CMV___, SIMV__, CPAP__ or BILEVL) (CMV = A/C)
setting (6 characters)
Field 10
Respiratory rate setting in breaths per minute
(6 characters)
Field 11
Tidal volume setting in liters (6 characters)
Field 12
Peak flow setting in liters per minute (6 characters)
Field 13
O2% setting (6 characters)
Field 14
Pressure sensitivity setting in cmH2O (6 characters)
Field 15
PEEP or PEEP Low (in BILEVEL) setting in cmH2O
(6 characters)
Field 16
Plateau time in seconds (6 characters)
Field 17
Not used (6 characters)
Field 18
Not used (6 characters)
Field 19
Not used (6 characters)
Field 20
Not used (6 characters)
Field 21
Apnea interval in seconds (6 characters)
Field 22
Apnea tidal volume setting in liters (6 characters)
Field 23
Apnea respiratory rate setting in breaths per minute
(6 characters)
Field 24
Apnea peak flow setting in liters per minute
(6 characters)
Field 25
Apnea O2% setting (6 characters)
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TR 19-3
RS-232 commands
Table 19-1: MISCA response
Component
TR 19-4
Description
Field 26
Pressure support setting in cmH2O (6 characters)
Field 27
Flow pattern setting (SQUARE or RAMP__)
(6 characters)
Field 28
Not used (6 characters)
Field 29
Not used (6 characters)
Field 30
100% O2 state (ON____ or OFF___) (6 characters)
Field 31
Not used (6 characters)
Field 32
Not used (6 characters)
Field 33
Not used (6 characters)
Field 34
Total respiratory rate in breaths per minute
(6 characters)
Field 35
Exhaled tidal volume in liters (6 characters)
Field 36
Exhaled minute volume in liters (6 characters)
Field 37
Spontaneous minute volume in liters (6 characters)
Field 38
Maximum circuit pressure in cmH2O (6 characters)
Field 39
Mean airway pressure in cmH2O (6 characters)
Field 40
End inspiratory pressure in cmH2O (6 characters)
Field 41
Expiratory component of monitored value of I:E ratio,
assuming inspiratory component of 1 (6 characters)
Field 42
High circuit pressure limit in cmH2O (6 characters)
Field 43
Not used (6 characters)
Field 44
Not used (6 characters)
Field 45
Low exhaled tidal volume limit in liters (6 characters)
Field 46
Low exhaled minute volume limit in liters
(6 characters)
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RS-232 commands
Table 19-1: MISCA response
Component
Description
Field 47
High respiratory rate limit in breaths per minute
(6 characters)
Field 48
High circuit pressure alarm status (NORMAL, ALARM_,
or RESET_) (6 characters)
Field 49
Not used (6 characters)
Field 50
Not used (6 characters)
Field 51
Low exhaled tidal volume (mandatory or
spontaneous) alarm status (NORMAL, ALARM_, or
RESET_) (6 characters)
Field 52
Low exhaled minute volume alarm status (NORMAL,
ALARM_, or RESET_) (6 characters)
Field 53
High respiratory rate alarm status (NORMAL, ALARM_,
or RESET_) (6 characters)
Field 54
No O2 supply alarm status (NORMAL, ALARM_, or
RESET_) (6 characters)
Field 55
No air supply alarm status (NORMAL, ALARM_, or
RESET_) (6 characters)
Field 56
Not used (6 characters)
Field 57
Apnea alarm status (NORMAL, ALARM_, or RESET_)
(6 characters)
Field 58
Not used (6 characters)
Field 59
Not used (6 characters)
Field 60
Ventilator time (HH:MM_) (6 characters)
Field 61
Not used (6 characters)
Field 62
Date (MMM_DD_YYYY_) (12 characters)
Field 63
Static compliance (CSTAT) from inspiratory pause
maneuver in mL/cmH2O (6 characters)
Field 64
Static resistance (RSTAT) from inspiratory pause
maneuver in cmH2O/L/s (6 characters)
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RS-232 commands
Table 19-1: MISCA response
Component
Description
Field 65
Dynamic compliance (CDYN) in mL/cmH2O*
(6 characters)
Field 66
Dynamic resistance (RDYN) in cmH2O/L/s* (6 characters)
Field 67
Negative inspiratory force (NIF) in cmH2O*
(6 characters)
Field 68
Vital capacity (VC) in L* (6 characters)
Field 69
Peak spontaneous flow (PSF) in L/min* (6 characters)
Field 70
Ventilator-set base flow in liters per minute
(6 characters)
Field 71
Flow sensitivity setting in liters per minute
(6 characters)
Field 72
Not used (6 characters)
Field 73
Not used (6 characters)
Field 74
Not used (6 characters)
Field 75
Not used (6 characters)
Field 76
Not used (6 characters)
Field 77
Not used (6 characters)
Field 78
Not used (6 characters)
Field 79
Not used (6 characters)
Field 80
Not used (6 characters)
Field 81
Not used (6 characters)
Field 82
Not used (6 characters)
Field 83
Not used (6 characters)
Field 84
End inspiratory pressure in cmH2O (6 characters)
* These fields will contain data only if the RM software option is installed.
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RS-232 commands
Table 19-1: MISCA response
Component
Description
Field 85
Inspiratory pressure or PEEP High setting in cmH2O
(6 characters)
Field 86
Inspiratory time or PEEP High time setting in seconds
(6 characters)
Field 87
Apnea interval setting in seconds (6 characters)
Field 88
Apnea inspiratory pressure setting in cmH2O
(6 characters)
Field 89
Apnea respiratory rate setting in breaths per minute
(6 characters)
Field 90
Apnea inspiratory time setting in seconds
(6 characters)
Field 91
Apnea O2% setting (6 characters)
Field 92
Apnea high circuit pressure limit in cmH2O
(6 characters)
Field 93
Alarm silence state (ON____ or OFF___) (6 characters)
Field 94
Apnea alarm status (NORMAL or ALARM_)
(6 characters)
Field 95
Severe Occlusion/Disconnect alarm status (NORMAL or
ALARM_) (6 characters)
Field 96
Inspiratory component of I:E ratio or High component
of H:L (Bi-Level) setting (6 characters)
Field 97
Expiratory component of I:E ratio setting or Low
component of H:L (Bi-Level) (6 characters)
Field 98
Inspiratory component of apnea I:E ratio setting
(6 characters)
Field 99
Expiratory component of apnea I:E ratio setting
(6 characters)
Field 100
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)
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TR 19-7
RS-232 commands
Table 19-1: MISCA response
Component
Description
Field 101
Monitored value of I:E ratio (6 characters)
<ETX>
End of transmission character (03 hex)
<CR>
Terminating carriage return
19.3 SNDF command
SNDF is a command sent from an external host device to the
Puritan Bennett™ 840 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 <STX> FIELD 5, ..., FIELD 169, <ETX> <CR>
Terminating carriage return
End of transmission (03 hex)
Data field, left-justified and padded with spaces
Start of transmission (02 hex)
Number of data fields between <STX> and <ETX>
Number of bytes between <STX> and <CR>
Response code to SNDF command
*1229 if “Phillips” is selected for serial port in Communication Setup
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Table 19-2 lists the MISCF message components and their
descriptions.
NOTE:
Non-applicable fields will either contain zero or be
blank.
Table 19-2: MISCF response
Component
Description
MISCF
Response to SNDF command (5 characters)
1225*
Number of bytes between <STX> and <CR>
(4 characters)
*1229 if Phillips is selected for serial port in
Communication Setup
169
Number of fields between <STX> and <ETX>
(3 characters)
<STX>
Start of transmission character (02 hex)
Field 5
Ventilator time (HH:MM_) (6 characters)
Field 6
Ventilator ID to allow external hosts to uniquely identify
each Puritan Bennett™ 840 Ventilator System
(18 characters)
Field 7
Date (MMM_DD_YYYY_) (12 characters)
Field 8
Vent Type (NIV______ or INVASIVE_) (9 characters)
Field 9
Mode (A/C___, SIMV__, SPONT_ or BILEVL) (6 characters)
Field 10
Mandatory Type (PC____, VC____, VC+___) (6 characters)
Field 11
Spontaneous Type (NONE__, PS____, TC____, VS____,
PA____) (6 characters)
Field 12
Trigger Type setting (V-Trig or P-Trig) (6 characters)
Field 13
Respiratory rate setting in bpm (6 characters)
Field 14
Tidal volume setting in L (6 characters)
Field 15
Peak flow setting in L/min (6 characters)
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TR 19-9
RS-232 commands
Table 19-2: MISCF response
Component
TR 19-10
Description
Field 16
O2% setting (6 characters)
Field 17
Pressure sensitivity setting in cmH2O (6 characters)
Field 18
PEEP/CPAP in cmH2O (6 characters)
Field 19
Plateau setting in seconds (6 characters)
Field 20
Apnea interval setting in seconds (6 characters)
Field 21
Apnea tidal volume setting in L (6 characters)
Field 22
Apnea respiratory rate setting in bpm (6 characters)
Field 23
Apnea peak flow setting in L/min (6 characters)
Field 24
Apnea O2% setting (6 characters)
Field 25
PCV apnea inspiratory pressure setting in cmH2O
(6 characters)
Field 26
PCV Apnea Inspiratory Time setting in seconds
(6 characters)
Field 27
Apnea flow pattern setting (SQUARE or RAMP)
(6 characters)
Field 28
Apnea mandatory type setting (PC or VC) (6 characters)
Field 29
Inspiratory component of Apnea I:E ratio (if apnea
mandatory type is PC) (6 characters)
Field 30
Expiratory component of Apnea I:E ratio (if apnea
mandatory type is PC) (6 characters)
Field 31
Support pressure setting (cmH2O)
Field 32
Flow pattern setting (SQUARE or RAMP) (6 characters)
Field 33
100% O2 Suction (ON or OFF) (6 characters)
Field 34
High inspiratory pressure alarm setting (2PPEAK) in
cmH2O (6 characters)
Field 35
Low inspiratory pressure alarm setting (4PPEAK) in
cmH2O or OFF (6 characters)
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Table 19-2: MISCF response
Component
Description
Field 36
High exhaled minute volume (2VE TOT) alarm setting in
L/min or OFF (6 characters)
Field 37
Low exhaled minute volume (4VE TOT) alarm setting in
L/min or OFF (6 characters)
Field 38
High exhaled mandatory tidal volume (2VTE MAND)
alarm setting in mL or OFF (6 characters)
Field 39
Low exhaled mandatory tidal volume (4VTE MAND) alarm
setting in mL or OFF (6 characters)
Field 40
High exhaled spontaneous tidal volume (2VTE SPONT)
alarm setting in mL or OFF (6 characters)
Field 41
Low exhaled spontaneous tidal volume (4VTE SPONT)
alarm setting in mL or OFF (6 characters)
Field 42
High respiratory rate (2fTOT) alarm setting in bpm or
OFF (6 characters)
Field 43
High inspired tidal volume (2VTI) alarm setting in mL
(6 characters)
Field 44
Base flow setting in L/min (6 characters)
Field 45
Flow sensitivity setting in L/min (6 characters)
Field 46
PCV inspiratory pressure (PI) setting in cmH2O
(6 characters)
Field 47
PCV inspiratory time (TI) setting in seconds (6 characters)
Field 48
Inspiratory component of I:E ratio setting or High
component of H:L ratio setting (6 characters)
Field 49
Expiratory component of I:E ratio setting or Low
component of H:L ratio setting (6 characters)
Field 50
Constant during rate change setting (I-time, I/E, or
E-time) (6 characters)
Field 51
Tube I.D. setting in mm (6 characters)
Field 52
Tube type setting (ET or TRACH) (6 characters)
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TR 19-11
RS-232 commands
Table 19-2: MISCF response
Component
TR 19-12
Description
Field 53
Humidification type setting (Non-Heated Exp, Heated
Exp, or HME) (18 characters)
Field 54
Humidifier volume setting in L (6 characters)
Field 55
O2 sensor setting (Enabled or Disabled) (9 characters)
Field 56
Disconnect sensitivity setting in % or OFF (6 characters)
Field 57
Rise time % setting (6 characters)
Field 58
PAV™*+ percent support setting (6 characters)
Field 59
Expiratory sensitivity (ESENS) setting in % or L/min for PA
breath type (6 characters)
Field 60
IBW setting in kg (6 characters)
Field 61
Target support volume (VT SUPP) setting in L
(6 characters)
Field 62
High PEEP (PEEPH) setting in cmH2O (6 characters)
Field 63
Low PEEP (PEEPL) setting in cmH2O (6 characters)
Field 64
High PEEP time (TH) setting in seconds (6 characters)
Field 65
High spontaneous inspiratory time limit (2TI SPONT)
setting in seconds (6 characters)
Field 66
Circuit type setting (ADULT, PEDIATRIC, or NEONATAL)
(9 characters)
Field 67
Low PEEP time (TL) setting in seconds (6 characters)
Field 68
Expiratory time (TE) setting in seconds (6 characters)
Field 69
End inspiratory pressure (PI END) in cmH2O (6 characters)
Field 70
Respiratory rate (fTOT) in bpm (6 characters)
Field 71
Exhaled tidal volume (VTE) in L (6 characters)
Field 72
Patient exhaled minute volume (VE TOT) in L/min
(6 characters)
Field 73
Peak airway pressure (PPEAK) in cmH2O (6 characters)
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Table 19-2: MISCF response
Component
Description
Field 74
Mean airway pressure (PMEAN) in cmH2O (6 characters)
Field 75
Expiratory component of monitored value of I:E ratio,
assuming inspiratory component of 1 (6 characters)
Field 76
I:E ratio (6 characters)
Field 77
Delivered O2% (6 characters)
Field 78
Inspired tidal volume (VTI) in L (6 characters)
Field 79
Intrinsic PEEP (PEEPI) in cmH2O (6 characters)
Field 80
Estimated total resistance (RTOT) in cmH2O/L/s
(6 characters)
Field 81
Estimated patient resistance (RPAV) in cmH2O/L/s
(6 characters)
Field 82
Estimated patient elastance (EPAV) in cmH2O/L
(6 characters)
Field 83
Estimated patient compliance (CPAV) in mL/cmH2O
(6 characters)
Field 84
Normalized rapid shallow breathing index (f/VT//kg)
(6 characters)
Field 85
Rapid shallow breathing index (f/VT) (6 characters)
Field 86
Spontaneous percent inspiratory time (TI/TTOT)
(6 characters)
Field 87
Monitored PEEP in cmH2O (6 characters)
Field 88
Spontaneous inspiratory time (TI SPONT) in seconds
(6 characters)
Field 89
Exhaled spontaneous minute volume (VE SPONT) in L/min
(6 characters)
Field 90
Intrinsic PEEP (PEEPI) from expiratory pause maneuver in
cmH2O (6 characters)
Field 91
Total PEEP (PEEPTOT) from expiratory pause maneuver in
cmH2O (6 characters)
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TR 19-13
RS-232 commands
Table 19-2: MISCF response
Component
Description
Field 92
Static compliance (CSTAT) from inspiratory pause
maneuver in mL/cmH2O (6 characters)
Field 93
Static resistance (RSTAT) from inspiratory pause maneuver
in cmH2O/L/s (6 characters)
Field 94
Plateau pressure (PPL) from inspiratory pause maneuver
in cmH2O (6 characters)
Field 95
High spontaneous inspiratory time (ALERT_ or blank)
(6 characters)
Field 96
Dynamic compliance (CDYN) in mL/cmH2O (6 characters)
Field 97
Dynamic resistance (RDYN) in cmH2O/L/s (6 characters)
Field 98
Peak spontaneous flow (PSF) in L/min (6 characters)
Field 99
Peak expiratory flow (PEF) in L/min (6 characters)
Field 100
End expiratory flow (EEF) in L/min (6 characters)
Field 101
Reserved
Field 102
Negative inspiratory force (NIF) in cmH2O (6 characters)
Field 103
P0.1 pressure change in cmH2O (6 characters)
Field 104
Vital capacity (VC) in L (6 characters)
Field 105
Alarm Silence (ON or OFF) (6 characters)
Field 106
Apnea ventilation alarm* (6 characters)
Field 107
High exhaled minute volume alarm* (1VE TOT)
(6 characters)
Field 108
High exhaled tidal volume alarm* (1VTE) (6 characters)
Field 109
High O2% alarm* (6 characters)
Field 110
High inspiratory pressure alarm* (1PPEAK) (6 characters)
Field 111
High ventilator pressure alarm* (1PVENT) (6 characters)
Field 112
High respiratory rate alarm* (1fTOT) (6 characters)
* Possible responses are: NORMAL, LOW, MEDIUM, HIGH, or RESET.
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Table 19-2: MISCF response
Component
Description
Field 113
AC power loss alarm* (6 characters)
Field 114
Inoperative battery alarm* (6 characters)
Field 115
Low battery alarm* (6 characters)
Field 116
Loss of power alarm* (6 characters)
Field 117
Low exhaled mandatory tidal volume alarm*
(3VTE MAND) (6 characters)
Field 118
Low exhaled minute volume alarm* (3VE TOT)
(6 characters)
Field 119
Low exhaled spontaneous tidal volume (3VTE SPONT)
alarm* (6 characters)
Field 120
Low O2% alarm* (6 characters)
Field 121
Low air supply pressure alarm* (6 characters)
Field 122
Low O2 supply pressure alarm* (6 characters)
Field 123
Compressor inoperative alarm* (6 characters)
Field 124
Disconnect alarm* (6 characters)
Field 125
Severe occlusion alarm* (6 characters)
Field 126
Inspiration too long alarm* (6 characters)
Field 127
Procedure error* (6 characters)
Field 128
Compliance limited tidal volume (VT) alarm*
(6 characters)
Field 129
High inspired spontaneous tidal volume* (3VTI SPONT)
alarm (6 characters)
Field 130
High inspired mandatory tidal volume (1VTI MAND)
alarm* (6 characters)
Field 131
High compensation limit (1PCOMP) alarm* (6 characters)
Field 132
PAV™* startup too long alarm* (6 characters)
* Possible responses are: NORMAL, LOW, MEDIUM, HIGH, or RESET.
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RS-232 commands
Table 19-2: MISCF response
Component
Description
Field 133
PAV™* R and C not assessed alarm* (6 characters)
Field 134
Volume not delivered (VC+) alarm* (6 characters)
Field 135
Volume not delivered (VS) alarm* (6 characters)
Field 136
Low inspiratory pressure (3PPEAK) alarm* (6 characters)
Field 137
Technical malfunction A5* (6 characters)
Field 138
Technical malfunction A10* (6 characters)
Field 139
Technical malfunction A15* (6 characters)
Field 140
Technical malfunction A20* (6 characters)
Field 141
Technical malfunction A25* (6 characters)
Field 142
Technical malfunction A30* (6 characters)
Field 143
Technical malfunction A35* (6 characters)
Field 144
Technical malfunction A40* (6 characters)
Field 145
Technical malfunction A45* (6 characters)
Field 146
Technical malfunction A50* (6 characters)
Field 147
Technical malfunction A55* (6 characters)
Field 148
Technical malfunction A60* (6 characters)
Field 149
Technical malfunction A65* (6 characters)
Field 150
Technical malfunction A70* (6 characters)
Field 151
Technical malfunction A75* (6 characters)
Field 152
Technical malfunction A80* (6 characters)
Field 153
Technical malfunction A85* (6 characters)
Field 154
Spontaneous tidal volume (VTE SPONT) in liters
(6 characters)
* Possible responses are: NORMAL, LOW, MEDIUM, HIGH, or RESET.
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Table 19-2: MISCF response
Component
Description
Field 155
Total work of breathing (WOBTOT) in Joules/L
(6 characters)
Field 156
Leak compensation state (9 characters) (enable, disable,
or blank)
Field 157
%LEAK (6 characters)
Field 158
LEAK @ PEEP (6 characters)
Field 159
VLEAK (6 characters)
Field 160
Reserved
Field 161
Reserved
Field 162
Reserved
Field 163
Reserved
Field 164
Reserved
Field 165
Reserved
Field 166
Reserved
Field 167
Reserved
Field 168
Reserved
Field 169
Reserved
Field 170
Reserved
Field 171
Reserved
<ETX>
End of transmission character (03 hex)
<CR>
Terminating carriage return
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SECTION
Glossary
NOTE:
See Chapter 1 of the Operator’s Manual portion of this book for
definitions of onscreen abbreviations.
A
Amperes (unit of electric current)
A/C
Assist/control mode. A ventilatory mode in which the
ventilator delivers only mandatory breaths (patient-,
ventilator-, or operator-initiated) according to the
current settings.
AC
Alternating current.
alarm log
A record of alarm events (including time-stamped
alarms, silences, and resets) in order of occurrence, with
the most recent event at the top of the list.
alarm message
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).
alarm reset key
Key that clears all alarm indicators and cancels the alarm
silence period.
alarm silence
key
Key that silences alarm sound for two minutes from the
most recent key press, but does not change visual
indicators.
Glossary
Glossary-2
ALERT
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.
apnea
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 (TA).
autoreset
When an alarm becomes inactive (that is, alarm
conditions no longer exist) without pressing the alarm
reset key.
autotriggering
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.
background
checks
Continuously running tests during ventilation that
assess the ventilator’s electronics and pneumatics
hardware.
base flow
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 is 1.5 L/
min greater than the operator-selected value for flow
sensitivity.
batch changes
Changes to multiple settings that go into effect at the
same time. On the Puritan Bennett™ 840 Ventilator
System, no setting changes go into effect until you press
the ACCEPT key.
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Glossary
battery backup system
The system in the Puritan Bennett™ 800 Series
Ventilator Compressor Mount Cart or Puritan Bennett™
800 Series Ventilator Pole Cart that supplies battery
back-up power to the ventilator. The Puritan Bennett™
800 Series Ventilator Compressor Mount Cart has a BPS
with a one-hour battery or an optional four-hour
battery. The one-hour BPS behaves identically to the 802
BPS. The four-hour BPS behaves identically to the 803
BPS. The Puritan Bennett™ 800 Series Ventilator Pole
Cart can be used with a one-hour or four-hour battery
which is installed in the cart base assembly. Similarly, the
one-hour and four-hour batteries behave identically to
the 802 and 803 BPS, respectively.
BD, BDU
Breath delivery or breath delivery unit. The ventilator
component that includes inspiratory and expiratory
pneumatics and electronics. The Puritan Bennett™
840 Ventilator System BDU includes its own
independent CPU that controls ventilation.
BOC
British Oxygen Company, a standard for high pressure
gas inlet fittings.
BPS
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 four
hours (depending on ventilator settings) in the event of
AC power loss.
breath stacking
The delivery of a second inspiration before the first
exhalation is complete.
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.
CE
A certification mark issued under the authority of the
European Common Market that indicates compliance
with the Medical Device Directive, 93/42/EEC.
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Glossary-3
Glossary
Glossary-4
clinical alarm
An alarm that can indicate an abnormal physiologic
condition.
cm
Centimeter (unit of length).
cmH2O
Centimeters of water (unit of pressure approximately
equal to 1 hPa).
compliance
volume
The volume of gas that remains in the patient circuit
and does not enter the patient’s respiratory system.
compressor
On the Puritan Bennett™ 840 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.
constant
during rate
change
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.
CPU
Central processing unit.
CSA
Canadian Standards Association.
DSENS
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 DISCONNECT alarm. The greater the setting,
the more returned volume must be lost before
DISCONNECT is detected.
DC
Direct current.
dependent
alarm
An alarm that arises as a result of another primary
alarm.
DISS
Diameter index safety standard, a standard for high
pressure gas inlet fittings.
DualView
The Puritan Bennett™ 840 Ventilator System’s two
touch screens, which display monitored data separately
from ventilator settings.
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Glossary
ESENS
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 ESENS settings
will result in longer spontaneous inspirations.
EMC
Electromagnetic compatibility.
EN
European norm (referring to the European Common
Market).
EST
Extended self test, a comprehensive test of ventilator
function, intended to be run by qualified service
personnel.
ETO
Ethylene oxide.
EXP PAUSE
Expiratory pause, an operator-initiated maneuver that
closes the inspiration (proportional solenoid) and
exhalation valves during the exhalation phase of a
mandatory breath. The maneuver can be used to
determine intrinsic (auto) PEEP (PEEPI).
f, fTOT
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
(fTOT), the average total number of breaths delivered to
the patient.
FAILURE
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.
flow pattern
The gas flow pattern of mandatory volume-controlled
breaths (the Puritan Bennett™ 840 Ventilator System
offers the choice of square or descending ramp flow
patterns).
Flow-by flow
triggering
The patented flow-triggering strategy used on 800
Series Ventilators.
ft
Feet (unit of length).
gold standard
test circuit
Test circuit designed for use with EST.
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Glossary-5
Glossary
Glossary-6
Graphics
A standard function on the Puritan Bennett™
840 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-urgency
alarm
As defined by international standards organizations, an
alarm that requires immediate attention to ensure
patient safety. When a high-urgency alarm is active, the
red high-urgency indicator ( ! ! ! ) flashes and the highurgency 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.
HME
Heat-moisture exchanger, a humidification device, also
called an artificial nose.
hPa
Hectopascal (unit of pressure, approximately equal to
1 cmH2O).
humidification
type
A setting for the type of humidification system (HME,
non-heated expiratory tube, or heated expiratory
tubing) in use on the ventilator.
Hz
Hertz (unit of frequency, indicating cycles per second).
I:E ratio
The ratio of inspiratory time to expiratory time. Also,
the operator-set timing variable that applies to PC and
VC+ mandatory breaths.
IBW
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.
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Glossary
idle mode
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%
O2 or at 40% O2 in NeoMode, if available) begins, and
breath triggering is disabled.
IEC
International Electrotechnical Commission, a standards
organization.
INSP PAUSE
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 (CSTAT) and resistance
(RSTAT).
ISO
International Standards Organization, a standards
organization.
kg
Kilogram (unit of weight).
L
Liter (unit of volume).
L/min
Liters per minute (unit of flow).
lb
Pound (unit of weight).
low-urgency
alarms
As defined by international standards organizations, an
alarm that indicates a change in the patient-ventilator
system. During a low-urgency alarm, the yellow lowurgency indicator ( ! ) lights, the low-urgency audible
alarm (one tone) sounds, and the upper screen shows an
alarm message.
m
Meter (unit of length).
maintenance
All actions necessary to keep equipment in, or restore it
to, serviceable condition. Includes cleaning, servicing,
repair, modification, overhaul, inspection, and
performance verification.
mandatory
A breath whose settings and timing are preset; can be
triggered by the ventilator, patient, or operator. The
Puritan Bennett™ 840 Ventilator System allows you to
select volume-controlled (VC), VC+, or pressurecontrolled (PC) mandatory breaths.
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10067720 Rev. B
Glossary-7
Glossary
Glossary-8
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
Puritan Bennett™ 840 Ventilator System delivers one
mandatory breath to the patient.
mediumurgency alarm
As defined by international standards organizations, an
abnormal condition that requires prompt attention to
ensure the safety of the patient. When a mediumurgency alarm is active, the yellow medium-urgency
indicator ( ! ! ) flashes, the medium-urgency audible
alarm (a repeating sequence of three tones) sounds, and
the upper screen shows an alarm message.
min
Minute (unit of time).
mL
Milliliter (unit of volume).
mode
Ventilatory mode, the algorithm that determines type
and sequence of breath delivery. The Puritan Bennett™
840 Ventilator System offers a choice of assist/control
(A/C), spontaneous (SPONT), or synchronous
intermittent mandatory ventilation (SIMV), or BILEVEL.
MRI
Magnetic resonance imaging.
ms
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.
NOVRAM
Nonvolatile random access memory. Memory that is
preserved even when power to the ventilator is not
available.
O2%
Both an operator-set and monitored variable. The O2%
setting determines the percentage of oxygen in the
delivered gas. The O2% 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
Operator-initiated mandatory breath, a breath that is
delivered when the operator presses MANUAL INSP.
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Glossary
ongoing
background
checks
Continuously running tests during ventilation that
assess the ventilator’s electronics and pneumatics
hardware.
OSC
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 inspiration and expiration phases
for the continuing existence of the occlusion.
OVERRIDDEN
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.)
PMEAN
Mean circuit pressure, a calculation of the measured
average patient circuit pressure over an entire
respiratory cycle.
PEEP
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.
PI
Inspiratory pressure, the operator-set inspiratory
pressure at the patient wye (above PEEP) during a
pressure control (PC) mandatory breath.
PI END
End inspiratory pressure, the pressure at the end of the
inspiration phase of the current breath. If plateau is
active, the displayed value reflects the level of endplateau pressure.
PPEAK
Maximum circuit pressure, the maximum pressure
during the inspiratory phase of a breath.
PSENS
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.
PSUPP
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).
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Glossary-9
Glossary
P-TRIG
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 ( PSENS ).
patient circuit
The entire inspiratory-expiratory conduit, including
tubing, humidifier, and water traps.
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 is 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.
PC
Pressure control; a mandatory breath type in which the
ventilator delivers an operator-set 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.
PEEP
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
Patient-initiated mandatory breath. A mandatory
breath that is triggered by patient inspiratory effort.
POST
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.
preventive
maintenance
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.
Glossary-10 10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Glossary
PS
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.
PSOL
Proportional solenoid valve.
RAM
Random access memory.
resistance
The flow-dependent pressure drop across a conduit.
Measured in cmH2O/L/s or hPa/L/s.
restricted
phase of
exhalation
The specific time period during the exhalation 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
rise time %
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.
s
Second (unit of time).
safety net
The ventilator’s strategy for responding to patient
problems and system faults.
safety
ventilation
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.
SandBox
Capability that allows you to preview settings before
applying them to your patient.
service mode
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.
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10067720 Rev. B Glossary-11
Glossary
SIMV
Synchronous 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.
SIS
Sleeved index system, a standard for high pressure gas
inlet fittings.
SmartAlert
alarm annunciation system which helps you to quickly
determine the urgency and root cause of alarm
conditions.
SL/min
Standard liters per minute (unit of flow measured at
0 °C (32 °F) and 1 atm (14.7 psia) pressure).
soft bound
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.
SPONT
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.
spontaneous
type
A setting that determines whether spontaneous breaths
are pressure-supported (PS), tube-compensated (TC),
volume-supported (VS), proportionally assisted (PA), or
not (NONE).
SST
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 Section 3.2 on page
OP 3-2 for information on when to run SST.
STPD
Standard temperature and pressure, dry. Defined as dry
gas at a standard atmosphere (760 mmHg, 101.333 kPa,
approximately 1.0 bar) and 0 °C.
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Glossary
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.
TA
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.
Tb
Breath cycle.
TE
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.
TI
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.
Tm
Mandatory interval portion of SIMV breath cycle; it is
reserved for a PIM.
TPL
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.
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10067720 Rev. B Glossary-13
Glossary
Ts
Spontaneous interval portion of SIMV breath cycle; it is
reserved for spontaneous breathing throughout the
remainder of the breath cycle.
V
Volts (unit of voltage).
V-TRIG
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 ( VSENS ).
VE SET
Set mandatory minute volume. This value is calculated
from ventilator control parameters (f x VT) and is
displayed with the breath timing bar on the lower GUI
screen whenever their buttons are touched.
VE TOT
Minute volume, the expiratory tidal volume normalized
to unit time (L/min). The Puritan Bennett™ 840
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.
VMAX
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.
V SENS
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).
VT
Tidal volume, the volume inspired and expired with
each breath. The VT delivered by the Puritan Bennett™
840 Ventilator System is an operator-set variable that
determines the volume delivered to the patient during a
mandatory, volume-based breath. VT is compliancecompensated and corrected to body temperature and
pressure, saturated (BTPS).
VA
Volt-amperes (unit of power).
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Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
Glossary
VC
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 (VBS)
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.
ventilator
inoperative
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.
VIM
Ventilator-initiated mandatory breath. A breath that is
delivered at a time determined by the ventilator.
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Glossary-16
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s Manual
SECTION
2
Index
Symbols
↑fTOT alarm. See High respiratory rate
alarm
↑O2% alarm. See High delivered O2%
alarm
↑PPEAK alarm. See High circuit pressure
alarm
↑VE TOT alarm. See High exhaled total
minute volume alarm
? key, description OP 1-12
↓O2% alarm. See Low delivered O2%
alarm
↓PPEAK alarm. See Low circuit pressure
alarm
↓VE TOT alarm. See Low exhaled total
minute volume alarm
↓VTE MAND alarm. See Low exhaled
mandatory tidal volume alarm
↓VTE SPONT alarm. See Low exhaled
spontaneous tidal volume alarm
Numerics
100% O2/CAL 2 min key
description OP 1-12
802 Backup Power Source (BPS). See BPS
803 BPS charging status indicator
description OP 1-24
840 Ventilator System
block diagram OP 1-4
compliance and approvals
OP A-9 – OP A-10
functional description OP 1-4 – OP 1-9
general description OP 1-1 – OP 1-9
pneumatic schematic OP C-1
specifications OP A-1 – OP A-58
A
A/C mode. See Assist/control mode
Abbreviations and symbols, onscreen
descriptions OP 1-18 – OP 1-22
AC indicator
description OP 2-6
location OP 2-7
AC POWER LOSS alarm
description TR 13-20
ACCEPT key, description OP 1-14
Accessories, part numbers OP B-3 – OP B-11
Air hose assembly
part numbers
OP B-7 – OP B-8, OP B-16 – OP B-17
Air regulator assembly (REG2).
See Regulator, air
Air supply, how to connect
OP 2-10 – OP 2-12
Alarm log OP 5-5 – OP 5-6
Alarm reset OP 5-4 – OP 5-5
Alarm reset key, description OP 1-12
Alarm settings, range, resolution, and
accuracy OP A-45 – OP A-50
Alarm silence OP 5-2 – OP 5-3
Alarm silence key, description OP 1-11
Alarm testing OP D-1 – OP D-7
Alarm volume key, description OP 1-11
Alarm volume, how to adjust OP 5-6
Alarms
how to test OP D-1 – OP D-7
See also name of specific alarm
Alarms TR 13-1 – TR 13-28
dependent, description TR 13-3
handling strategy TR 13-1 – TR 13-2
high-urgency OP 5-1, OP 5-2
description TR 13-2
how to read display OP 5-1
how to respond to OP 5-1 – OP 5-16
how to set OP 4-21 – OP 4-22
log OP 5-5 – OP 5-6
low-urgency OP 5-2
description TR 13-2
medium-urgency OP 5-2
description TR 13-2
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
1
Index
message format
OP 5-7 – OP 5-8, TR 13-3
messages, list
OP 5-9 – OP 5-16, TR 13-4 – TR 13-20
primary, description TR 13-3
rules about how messages are
displayed TR 13-3 – TR 13-4
urgency levels TR 13-2
volume (dB) specifications
OP A-4, OP A-7
ALERT, in EST TR 18-2
ALERT, in SST, meaning
OP 3-14, OP 3-15, TR 17-2
Altitude requirements OP A-4
APNEA alarm, description
TR 13-20 – TR 13-21
Apnea interval (TA) setting, function, and
range OP A-28
Apnea settings, how to change OP 4-20
Apnea ventilation TR 9-1 – TR 9-5
description TR 12-1 – TR 12-2
how ventilator detects apnea
TR 9-1 – TR 9-3
how ventilator phases in new apnea
intervals TR 9-5
how ventilator resets TR 9-4 – TR 9-5
how ventilator transitions to TR 9-3
key entries during TR 9-3
Assist/control (A/C) mode TR 6-1 – TR 6-2
breath delivery in TR 6-1 – TR 6-2
changing to TR 6-3 – TR 6-5
definition TR 12-11
rate change during TR 6-3
Atmospheric pressure
requirements OP A-4
Atmospheric pressure transducer
calibration, description TR 15-6
Auto PEEP parameter. See Intrinsic PEEP
Autoclaving, steps involved in OP 7-9
B
Background checks
description TR 15-3 – TR 15-4
Bacteria filter
expiratory
2
10067720 Rev. B
maintenance OP 7-12 – OP 7-14
operation of OP 1-6
part numbers OP B-9, OP B-18
resistance check OP 7-12 – OP 7-14
inspiratory
maintenance OP 7-12 – OP 7-14
operation of OP 1-6
part numbers OP B-10, OP B-18
resistance check OP 7-12 – OP 7-14
Bag, drain
maintenance OP 7-15 – OP 7-16
part number OP B-9, OP B-18
Barometric pressure
requirements OP A-4
Base flow TR 12-5
Batteries. See BPS (Backup Power Source)
Battery charging indicator
description OP 1-24
Battery charging status indicator
description OP 1-24
Battery on indicator, description OP 1-16
Battery ready indicator
description OP 1-16
BiLevel mode. See addendum to this
manual
BPS (Backup Power Source)
how to recharge OP 2-5
specifications OP A-8
use of OP 2-4 – OP 2-5
BPS charging indicator
description OP 1-24
BPS on indicator, description OP 1-16
BPS ready indicator, description OP 1-16
Breath delivery, overview TR 1-1 – TR 1-2
Breath trigger type OP 4-5
Breath trigger type setting, function and
range OP A-44
Breath type, patient data function and
range OP A-51
Breathing circuit. See Patient circuit
C
Cable, printer OP E-7
Calibration
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Index
atmospheric pressure transducer
description TR 15-6
exhalation valve, description TR 15-6
flow sensor offset, description TR 15-6
oxygen sensor, description TR 15-5
Calibration (oxygen) key
description OP 1-12
Cart, ventilator
how to use OP 2-24 – OP 2-26
part number OP B-9, OP B-17
Checks, background
description TR 15-3 – TR 15-4
Chemical disinfection OP 7-8 – OP 7-11
caution about phenol and
formaldehyde-based disinfectants
OP 7-8
steps involved in OP 7-9
Circuit breaker
humidifier and compressor, location
OP 2-7
power supply
description OP 2-7
location OP 2-7
trip point OP A-6
CIRCUIT DISCONNECT alarm, description
TR 13-21
Circuit type
relationship with IBW TR 12-2 – TR 12-3
Circuit, patient tubing. See Patient circuit
Cleaning
disinfection, and sterilization
OP 7-8 – OP 7-11
general guidelines OP 7-7
CLEAR key, description OP 1-14
Collector vial
how to install OP 2-17 – OP 2-19
how to remove OP 7-15
maintenance OP 7-15 – OP 7-16
operation of OP 1-6
part number OP B-9, OP B-18
Communications
remote alarm port OP E-2 – OP E-3
pinout OP E-3
RS-232 port
description OP E-3
how to configure OP E-4 – OP E-6
pinout OP E-3
RS-232, commands TR 19-1 – TR 19-17
Compliance compensation TR 4-5
Compliance volume factor TR 4-5
Compliance, static (CSTAT) parameter
description
OP 4-26 – OP 4-27, TR 14-6 – TR 14-13
function and range OP A-56
Compressor
description OP 1-2
location of connection to BDU OP 2-7
Compressor inlet filter
maintenance OP 7-17
part number OP B-11, OP B-19
Compressor operating indicator
description OP 1-16
Compressor ready indicator
description OP 1-16
Connectors, specifications OP A-3
Console, description OP 1-11 – OP 1-16
Constants (during rate change)
function and range OP A-30
how to set OP 4-18 – OP 4-20
Controls and indicators OP 1-11 – OP 1-16
See also Ventilator settings, Keyboard,
Patient data, or name of specific
control or indicator
CSTAT parameter. See Compliance, static
Current vent setup screen
OP 4-16 – OP 4-18
D
D/Flex filter. See Inspiratory filter
D/X800 filter and collector vial. See
Expiratory filter or Collector vial
Data key, function of OP 1-25
Date/time
display OP 4-22 – OP 4-23
how to change OP 4-23
Delivered O2% parameter
description TR 14-1 – TR 14-2
function and range OP A-51
Dependent alarm, description TR 13-3
Detecting and initiating exhalation
TR 3-1 – TR 3-4
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10067720 Rev. B
3
Index
Detecting and initiating inspiration
TR 2-1 – TR 2-6
Detecting occlusion and disconnect
TR 10-1 – TR 10-5
DEVICE ALERT alarm, description TR 13-22
Diagnostic codes display, function OP A-57
Dimensions, ventilator OP A-3
Disconnect sensitivity (DSENS)
function and range OP A-30
how to set OP 4-23
Disconnect, how ventilator detects and
responds TR 10-3 – TR 10-5
Disinfection OP 7-8 – OP 7-11
caution about phenol and
formaldehyde-based disinfectants
OP 7-8
steps involved in OP 7-9
Display. See name of specific display
Drain bag
how to remove OP 7-15
maintenance OP 7-15 – OP 7-16
part number OP B-9, OP B-18
DSENS setting. See Disconnect sensitivity
E
Electrical specifications OP A-6 – OP A-8
End expiratory pressure (PEEP) parameter
description TR 14-2
End inspiratory pressure (PI END) parameter
description TR 14-2 – TR 14-3
function and range OP A-52
Environmental requirements OP A-4
ESENS setting. See Expiratory sensitivity
EST. See Extended self test
Exhalation
backup limits
high circuit pressure limit TR 3-4
high ventilator pressure limit TR 3-4
time limit TR 3-3 – 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
end-inspiratory flow method TR 3-2
4
10067720 Rev. B
time-cycling TR 3-1
restricted phase of TR 2-1
Exhalation filter latch open indicator,
description OP 1-27
Exhalation system, operation of
OP 1-7, OP A-11
Exhalation valve
calibration, description TR 15-6
operation of OP 1-6
Exhaled minute volume (VE TOT) parameter
description TR 14-3 – TR 14-4
function and range OP A-52
Exhaled tidal volume (VTE) parameter
description TR 14-4
function and range OP A-53
EXP PAUSE key, description OP 1-13
Expiratory filter
maintenance OP 7-12 – OP 7-14
operation of OP 1-6
part numbers OP B-9, OP B-18
resistance check OP 7-12 – OP 7-14
Expiratory pause maneuvers
OP 4-24 – OP 4-25
Expiratory sensitivity (ESENS) setting
description TR 12-4
function and range OP A-31
Expiratory time (TE) setting
description TR 12-4
function and range OP A-31
Extended self test (EST) TR 18-1 – TR 18-3
failure handling TR 18-3
results TR 18-2 – TR 18-3
safety considerations TR 18-3
F
f setting. See Respiratory rate setting
Factor, compliance volume TR 4-5
FAILURE, in EST TR 18-2
FAILURE, in SST TR 17-2
meaning OP 3-14, OP 3-15
Faults, system
definition TR 15-1
how ventilator detects and responds
TR 15-2
Filter
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Index
compressor inlet
maintenance OP 7-17
part number OP B-11, OP B-19
expiratory
maintenance OP 7-12 – OP 7-14
operation of OP 1-6
part numbers OP B-9, OP B-18
resistance check OP 7-12 – OP 7-14
inspiratory
maintenance OP 7-12 – OP 7-14
operation of OP 1-6
part numbers OP B-10, OP B-18
resistance check OP 7-12 – OP 7-14
Flex arm
how to install OP 2-20 – OP 2-21
part number OP B-3, OP B-13, OP B-21
Flow pattern setting
description TR 12-4 – TR 12-5
function and range OP A-31
Flow sensitivity (VSENS) setting
description TR 12-5 – TR 12-6
function and range OP A-31
in flow triggering TR 2-4 – TR 2-5
Flow sensor offset calibration, description
TR 15-6
Flow triggering (V-TRIG)
description OP 1-5, TR 2-4 – TR 2-5
FREEZE function, in Graphics OP 6-6
fTOT parameter. See Total respiratory rate
G
Gold standard test circuit (for EST)
TR 15-5, TR 18-1
part number OP B-11
Graphic user interface (GUI)
description of controls and indicators
OP 1-11 – OP 1-16
how structured OP 4-2
Graphics
curve types OP 6-1
how to print OP 6-7
FREEZE function OP 6-6
setup OP 6-3 – OP 6-4
Shadow trace OP 6-3
when not accessible OP 6-7 – OP 6-8
GUI (loss of) indicator, description OP 1-17
GUI (normal) indicator, description
OP 1-15
GUI symbols and abbreviations
descriptions OP 1-18 – OP 1-22
H
Hardware monitoring circuitry, description
TR 15-4 – TR 15-5
High circuit pressure (↑PPEAK) alarm
description TR 13-22 – TR 13-23
function and range OP A-45
High delivered O2% (↑O2%) alarm
description TR 13-23
function and range OP A-45
High exhaled minute volume (↑VE TOT)
alarm
description TR 13-23
function and range OP A-46
High exhaled tidal volume (↑VTE) alarm
description TR 13-24
function and range OP A-47
High inspired tidal volume (↑VTI, VTI MAND,
VTI SPONT) alarm
description TR 13-24 – TR 13-25
High respiratory rate (↑fTOT) alarm
description TR 13-25
function and range OP A-47
High spontaneous inspiratory time limit
(ƒTI SPONT) setting
description OP 4-31, TR 12-6
function and range OP A-32
High-urgency alarm indicator, description
OP 1-14
HIP alarm. See High circuit pressure alarm
Hose assembly
air, part numbers
OP B-7 – OP B-8, OP B-16 – OP B-17
oxygen, part numbers
OP B-6 – OP B-7, OP B-15 – OP B-16
Hose, gold standard test (for EST), part
number OP B-11
How to handle alarms OP 5-1 – OP 5-16
How to run short self test OP 3-1 – OP 3-15
How to view graphics OP 6-1 – OP 6-8
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
5
Index
Humidification type setting
TR 12-6 – TR 12-7
function and range OP A-32
how to change OP 4-22 – OP 4-24
Humidifier mounting kit, part number
OP B-10
Humidifier volume setting, function and
range OP A-32
Humidifier, how to install
OP 2-22 – OP 2-23
I
I:E ratio (I:E) parameter
description TR 14-4
function and range OP A-53
I:E ratio setting
description TR 12-7
function and range OP A-34
IBW OP 4-4
IBW setting. See Ideal body weight
Ideal body weight (IBW) setting
function and range OP A-33
relationship with circuit type
OP 4-15, TR 12-2 – TR 12-3
tables of values OP 4-9 – OP 4-13
Idle mode TR 10-4
Indicator. See name of specific indicator
INSP PAUSE key, description OP 1-13
Inspiration
detecting and initiating TR 2-1 – TR 2-6
triggers
flow triggering (V-TRIG)
TR 2-4 – TR 2-5
operator triggering (MANUAL INSP)
TR 2-6
pressure triggering (P-TRIG)
TR 2-2 – TR 2-3
time-cycled TR 2-5 – TR 2-6
INSPIRATION TOO LONG alarm
description TR 13-25
Inspiratory filter
maintenance OP 7-12 – OP 7-14
operation of OP 1-6
part numbers OP B-10, OP B-18
resistance check OP 7-12 – OP 7-14
6
10067720 Rev. B
Inspiratory module
operation of OP 1-5 – OP 1-6
oxygen sensor replacement
OP 7-18 – OP 7-23
Inspiratory pause maneuvers
OP 4-25 – OP 4-26
Inspiratory pressure (PI) setting
description TR 12-7
function and range OP A-34
Inspiratory time (TI) setting
description TR 12-7 – TR 12-8
function and range OP A-35
Installation
collector vial OP 2-17 – OP 2-19
flex arm OP 2-20 – OP 2-21
humidifier OP 2-22 – OP 2-23
patient circuit OP 2-13 – OP 2-19
to electrical supply OP 2-5
to oxygen and air supplies
OP 2-10 – OP 2-12
Intrinsic (auto) PEEP (PEEPI) parameter
description TR 14-4
function and range OP A-54
Introduction to breath delivery
TR 1-1 – TR 1-2
K
Key. See name of specific key
Keyboard, description OP 1-11 – OP 1-14
Knob, description OP 1-14
L
Labels and symbols, descriptions
OP 1-23 – OP 1-34
Leakage current, specifications OP A-7
Light. See name of specific light
LIP alarm. See Low circuit pressure alarm
Lock key (for screen), description OP 1-11
Log, alarm OP 5-5 – OP 5-6
Loss of GUI indicator, description OP 1-17
LOW BATTERY alarm, after ventilator
storage OP 2-5
Low circuit pressure (↓PPEAK) alarm
description TR 13-25
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Index
function and range OP A-50
Low delivered O2% (↓O2%) alarm
description TR 13-26 – TR 13-27
function and range OP A-45
Low exhaled mandatory tidal volume
(↓VTE MAND) alarm
description TR 13-27
function and range OP A-48
Low exhaled spontaneous tidal volume
(↓VTE SPONT) alarm
description TR 13-27
function and range OP A-50
Low exhaled total minute volume (↓VE TOT)
alarm
description TR 13-28
function and range OP A-49
Low-urgency alarm indicator, description
OP 1-14
Lung mechanics. See Pause mechanics
M
maintenance and service
preventive OP 7-23 – OP 7-24
schedule OP 7-12 – OP 7-13
See also 840 Series Ventilator System
Service Manual
See also name of specific part
Mandatory breath delivery TR 4-1 – TR 4-6
Mandatory breath type setting
OP 4-5
description TR 12-8 – TR 12-12
function and range OP A-35
Mandatory breaths
BTPS compensation for volume-based
TR 4-5 – TR 4-6
comparison of pressure- and volumebased TR 4-1 – TR 4-3
compliance compensation for volumebased TR 4-4 – TR 4-5
description TR 4-1 – TR 4-6
mandatory inspiration (MANUAL INSP)
description TR 4-6
Maneuvers
expiratory pause OP 4-24 – OP 4-25
inspiratory pause OP 4-25 – OP 4-26
MANUAL INSP (manual inspiration)
description TR 4-6
MANUAL INSP key, description OP 1-12
Manufacturer’s declaration
OP A-10 – OP A-19
Mean circuit pressure (PMEAN) parameter
description TR 14-5
function and range OP A-54
Mechanics, pause. See Pause mechanics
Medium-urgency alarm indicator
description OP 1-14
Messages, alarm, list OP 5-9 – OP 5-16
Mode
assist/control (A/C)
breath delivery in TR 6-1 – TR 6-2
changing to TR 6-3 – TR 6-5
definition TR 12-11
description TR 6-1 – TR 6-2
rate change during TR 6-3
spontaneous (SPONT)
breath delivery in TR 8-1
changing to TR 8-2
definition TR 12-11
description TR 8-1 – TR 8-2
synchronous intermittent mandatory
ventilation (SIMV)
apnea ventilation in TR 7-4 – TR 7-5
breath delivery in TR 7-3 – TR 7-4
changing to TR 7-5 – TR 7-6
definition TR 12-11
description TR 7-1 – TR 7-7
rate change during TR 7-7
Mode setting OP 4-4
description TR 12-8 – TR 12-12
function and range OP A-36
Monitoring circuitry, description
TR 15-4 – TR 15-5
More Alarms button, function
OP 5-7, TR 13-3
More settings screen OP 4-23
N
New patient settings screen OP 4-4 – OP 4-6
NIV. See Non-invasive ventilation
Non-invasive ventilation
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
7
Index
alarms OP 4-32 – OP 4-33
breathing interfaces OP 4-28
how to set up OP 4-29 – OP 4-31
intended use OP 4-27
switching from invasive Vent Type
OP 4-33
switching to invasive Vent Type
OP 4-34
Normal GUI indicator, description OP 1-15
Normal ventilator operation indicator
description OP 1-14
Nurses’s call. See Remote alarm
O
O2 sensor. See Oxygen sensor
O2% (delivered) parameter
description TR 14-1 – TR 14-2
function and range OP A-51
O2% setting
description TR 12-12 – TR 12-13
function and range OP A-37
Occlusion status cycling (OSC)
description TR 10-2
Occlusion, how ventilator detects and
responds TR 10-1 – TR 10-3
OIM breaths. See Operator-initiated
mandatory breaths
Ongoing background checks. See
Background checks
Onscreen symbols and abbreviations
descriptions OP 1-18 – OP 1-22
Operator’s and technical reference manual
part numbers
OP B-10 – OP B-11, OP B-19
Operator-initiated mandatory (OIM)
breaths, description TR 2-6
OSC (occlusion status cycling)
description TR 10-2
Other Screens button OP 4-22 – OP 4-24
OUTCOME
in EST Single EST test results TR 18-2
OVERRIDDEN, in EST TR 18-2
OVERRIDDEN, in SST TR 17-2
Oxygen calibration key
description OP 1-12
8
10067720 Rev. B
Oxygen hose assembly, part numbers
OP B-6 – OP B-7, OP B-15 – OP B-16
Oxygen regulator assembly (REG1). See
Regulator, oxygen
Oxygen sensor
calibration test OP D-7
calibration, description TR 15-5
how to enable/disable
OP 4-23 – OP 4-24
maintenance OP 7-18 – OP 7-23
operation of OP 1-5
part number OP B-11, OP B-19
Oxygen supply
how to connect OP 2-10 – OP 2-12
P
Part numbers OP B-1 – OP B-21
Pasteurization, steps involved in
OP 7-9 – OP 7-10
Patient circuit
how to install OP 2-13 – OP 2-19
operation of OP 1-6
part numbers
OP B-3 – OP B-5, OP B-13 – OP B-15
specifications OP A-21 – OP A-24
Patient circuit disconnect, how ventilator
detects and responds TR 10-3 – TR 10-5
Patient circuit occlusion, how ventilator
detects and responds TR 10-1 – TR 10-3
Patient circuit type setting, function and
range OP A-37
Patient data TR 14-1 – TR 14-14
range, resolution, and accuracy
OP A-51 – OP A-57
Patient problems
definition TR 15-1
how ventilator detects and responds
TR 15-2
Patient setup OP 4-3 – OP 4-15
Patient-initiated mandatory (PIM) breaths
definition TR 2-2
Pause mechanics
expiratory pause, description OP 1-13
inspiratory pause, description OP 1-13
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Index
intrinsic (auto) PEEP (PEEPI) and total
PEEP (PEEPTOT), description TR 14-4
plateau pressure (PPL)
description TR 14-6
static compliance (CSTAT) and static
resistance (RSTAT), description
OP 4-26 – OP 4-27, TR 14-6 – TR 14-13
PAV™*+ software option. See also
Proportional Assist™* (PA) OP A-27
Peak circuit pressure (PPEAK) parameter
description TR 14-5
function and range OP A-54
Peak inspiratory flow (VMAX) setting
description TR 12-13
function and range OP A-38
PEEP (positive end expiratory pressure)
setting
description TR 12-13
function and range OP A-39
PEEP parameter. See End expiratory
pressure
PEEP restoration TR 12-13
PEEPI parameter. See Intrinsic (auto) PEEP
parameter
PEEPTOT parameter. See Total PEEP
Periodic maintenance OP 7-11 – OP 7-24
schedule OP 7-12 – OP 7-13
Phasing in setting changes TR 11-1
PI END parameter. See End inspiratory
pressure
PI setting. See Inspiratory pressure setting
PIM breaths. See Patient-initiated
mandatory breaths
Plateau pressure (PPL) parameter
description TR 14-6
function and range OP A-54
Plateau time (TPL) setting
description TR 12-14
function and range OP A-39
PMEAN parameter. See Mean circuit
pressure
Pneumatic schematic OP C-1
Port
remote alarm OP E-2 – OP E-3
pinout OP E-3
RS-232 OP E-3
pinout OP E-3
Positive end expiratory pressure. See PEEP
Potential equalization (ground) point
description OP 1-23
location OP 2-7
Power cord, part numbers OP B-9, OP B-17
Power input range OP A-6
Power on self test (POST) TR 16-1 – TR 16-5
difference between short and fulllength POST TR 16-3 – TR 16-4
fault handling TR 16-4
following power interruptions
TR 16-3 – TR 16-4
POST characteristics TR 16-2
safety considerations TR 16-1
system interface TR 16-4 – TR 16-5
user interface TR 16-5
Power specifications OP A-6 – OP A-8
Power supply circuit breaker
description OP 2-7
Power supply, operation of OP 1-7
Power switch
description OP 2-6
location OP 2-7
PPEAK. See Peak circuit pressure
PPL parameter. See Plateau pressure
Pressure sensitivity (PSENS) setting
description TR 12-14
function and range OP A-39
Pressure support (PSUPP) setting
description TR 12-15
function and range OP A-40
Pressure transducers, operation of OP 1-7
Pressure triggering (P-TRIG)
description OP 1-5, TR 2-2 – TR 2-3
factors influencing speed of breath
initiation TR 2-2
where pressure is monitored TR 2-2
Preventive Maintenance OP 7-1 – OP 7-25
performed by operator
OP 7-11 – OP 7-23
performed by service personnel
OP 7-23 – OP 7-24
schedule OP 7-12 – OP 7-13
Primary alarm, description TR 13-3
Printers OP E-6
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
9
Index
Printing graphics OP 6-7
PROCEDURE ERROR alarm
description TR 13-28
Proportional Assist™* (PA)
OP 4-5, OP A-42
Proportional solenoid valves (PSOLs)
operation of OP 1-6
PSENS setting. See Pressure sensitivity
PSUPP setting. See Pressure support setting
P-TRIG. See Pressure triggering
R
Rapid shallow breathing index (f/VT)
function and range OP A-55
Re/Flex filter. See Inspiratory filter
Re/X800 filter. See Expiratory filter
Recommended limits OP A-26
REG1. See Regulator, oxygen
REG2. See Regulator, air
Regulator, air OP A-5
Regulator, oxygen OP A-5
Remote alarm and RS-232 ports
OP E-1 – OP E-7
Remote alarm port OP E-2 – OP E-3
pinout OP E-3
Repacking OP 7-25
RESET (alarm) key, description OP 1-12
Resistance, static (RSTAT) parameter
description
OP 4-26 – OP 4-27, TR 14-6 – TR 14-13
function and range OP A-56
Respiratory mechanics. See Pause
mechanics
Respiratory rate (f) setting
description TR 12-15
function and range OP A-40
Restricted phase of exhalation
OP 1-12, TR 2-1
Rise time % setting
description TR 12-15 – TR 12-16
function and range OP A-41
RS-232 commands TR 19-1 – TR 19-17
RS-232 port
description OP E-3
how to configure OP E-4 – OP E-6
10
10067720 Rev. B
pinout OP E-3
RSTAT parameter. See Resistance, static
S
Safety net TR 15-1 – TR 15-6
SAFETY VALVE OPEN (SVO) indicator
description OP 1-15, OP 1-17
Safety valve open (SVO) state
description TR 15-2
Safety valve, operation of OP 1-6
Safety ventilation
description TR 12-17
settings during OP A-41
Schedule of preventive maintenance
OP 7-12 – OP 7-13
Screen
current vent setup OP 4-16 – OP 4-18
more settings OP 4-23
new patient settings OP 4-4 – OP 4-6
normal ventilation, illustration OP 4-8
ventilator startup OP 4-3 – OP 4-4
illustration OP 4-3
Screen lock key, description OP 1-11
Self tests. See Power on self test (POST),
Short self test (SST), or Extended self
test (EST)
Sensor, oxygen (OS)
calibration TR 15-5
how to enable/disable
OP 4-23 – OP 4-24
life expectancy OP A-5
maintenance OP 7-18 – OP 7-23
part number OP B-11, OP B-19
replacement OP 7-18 – OP 7-23
Serial communications
commands TR 19-1 – TR 19-17
description of port OP E-3
how to configure OP E-4 – OP E-6
pinout of port OP E-3
Service OP 7-1 – OP 7-25
See also 840 Series Ventilator System
Service Manual
Service (TEST) button, description OP 1-25
Service and repair
repair guidelines OP 7-18 – OP 7-20
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Index
Service manual, part number
OP B-11, OP B-19
Setup, patient OP 4-3 – OP 4-15
Setup, ventilator OP 2-1 – OP 2-26
Shadow trace OP 6-3
Short POST, difference between it and fulllength POST TR 16-3
Short self test (SST) TR 17-1 – TR 17-2
how to interpret test results
OP 3-14 – OP 3-15
how to run OP 3-1 – OP 3-15
list of tests OP 3-8 – OP 3-12
test results, description OP 3-12
when to run OP 3-2 – OP 3-3
components and requirements OP 3-3
procedure OP 3-4 – OP 3-7
Silence key (for alarm), description OP 1-11
SIMV mode. See Synchronous intermittent
mandatory ventilation mode
Soft bound. See Recommended limits
Software options OP A-27
Software revision level display. See
Ventilator configuration OP A-58
Specifications OP A-1 – OP A-58
air/oxygen regulator bleed
OP A-4, OP A-5
alarm volume OP A-4, OP A-7
bacteria filter efficiency OP A-23
BPS OP A-8
dimensions OP A-3
electrical OP A-6 – OP A-8
environmental OP A-4
flow range OP A-4, OP A-5
gas inlet supplies OP A-5
gas mixing system OP A-5
leakage current OP A-7
maximum limited pressure OP A-20
maximum working pressure OP A-20
measuring and display devices OP A-20
minute volume capability OP A-20
operating pressure range
OP A-4, OP A-5
oxygen sensor life OP A-5
patient circuit OP A-21 – OP A-24
physical OP A-2 – OP A-4
pneumatic, ventilator OP A-5
power OP A-6 – OP A-8
power input range OP A-6
power supply (mains) circuit breaker
OP A-6
technical OP A-19 – OP A-24
temperature OP A-4
ventilator connectors OP A-3
weight OP A-2
altitude OP A-4
atmospheric pressure OP A-4
SPONT mode. See Spontaneous mode
Spontaneous (SPONT) mode TR 8-1 – TR 8-2
breath delivery characteristics
TR 5-1 – TR 5-3
definition TR 12-11
Spontaneous breath delivery
TR 5-1 – TR 5-3
Spontaneous breath type setting OP 4-5
description TR 12-17 – TR 12-18
function and range OP A-42
Spontaneous inspiratory time (TI SPONT)
function and range OP A-55
Spontaneous minute volume (VE SPONT)
parameter
description TR 14-6
function and range OP A-55
Spontaneous percent inspiratory time
(TI/TTOT), function and range OP A-56
SST button, location OP 3-5
SST. See Short self test
Static compliance (CSTAT) parameter
description
OP 4-26 – OP 4-27, TR 14-6 – TR 14-13
function and range OP A-56
Static mechanics. See Pause mechanics
Static resistance (RSTAT) parameter
description
OP 4-26 – OP 4-27, TR 14-6 – TR 14-13
function and range OP A-56
Steam autoclaving
steps involved in OP 7-9
Sterilization OP 7-8 – OP 7-11
Storage, requirements OP 7-24 – OP 7-25
Support arm
how to install OP 2-20 – OP 2-21
part number OP B-3, OP B-13, OP B-21
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
11
Index
SVO state. See Safety valve open state
Switch, power
description OP 2-6
location OP 2-7
symbol definitions, displaying OP 4-7
Symbols and abbreviations, onscreen
descriptions OP 1-18 – OP 1-22
Symbols and labels
descriptions OP 1-23 – OP 1-34
Synchronous intermittent mandatory
ventilation (SIMV) mode TR 7-1 – TR 7-7
apnea ventilation in TR 7-4 – TR 7-5
breath delivery in TR 7-3 – TR 7-4
changing to TR 7-5 – TR 7-6
definition TR 12-11
rate change during TR 7-7
System faults
definition TR 15-1
how ventilator detects and responds
TR 15-2
T
Target volume (VT) setting
function and range OP A-43
TE setting. See Expiratory time setting
TEST (service) button, description OP 1-25
Test lung, part number OP B-5, OP B-15
Testing
alarms OP D-1 – OP D-7
oxygen sensor calibration OP D-7
TI setting. See Inspiratory time setting
Tidal volume (VT) setting
description TR 12-18
function and range OP A-43
Time/date
display OP 4-22 – OP 4-23
how to change OP 4-23
Total PEEP (PEEPTOT) parameter
description TR 14-4
function and range OP A-57
Total respiratory rate (fTOT) parameter
description TR 14-13 – TR 14-14
function and range OP A-57
TPL setting. See Plateau time setting
Transducers, pressure, operation of OP 1-7
12
10067720 Rev. B
Trap, water, in-line, maintenance OP 7-16
Tubing circuit. See Patient circuit OP 2-16
U
User interface (UI). See Graphic user
interface (GUI) or GUI
V
Valve, exhalation
calibration TR 15-6
operation of OP 1-6
VE SPONT parameter. See Spontaneous
minute volume
VE TOT. See Exhaled minute volume
Vent Type OP 4-4
description TR 12-18 – TR 12-19
function and range OP A-44
Ventilator breathing circuit. See Patient
circuit
Ventilator configuration, function OP A-58
Ventilator control parameters, how to
change OP 4-16
Ventilator inoperative condition OP 1-8
Ventilator inoperative indicator
description OP 1-15, OP 1-17
Ventilator inoperative test
description TR 15-6
Ventilator settings TR 12-1 – TR 12-19
apnea ventilation TR 12-1 – TR 12-2
breath trigger type
function and range OP A-44
disconnect sensitivity (DSENS)
description TR 12-3
function and range OP A-30
expiratory sensitivity (ESENS)
description TR 12-4
function and range OP A-31
expiratory time (TE)
description TR 12-4
function and range OP A-31
flow pattern
description TR 12-4 – TR 12-5
function and range OP A-31
flow sensitivity (VSENS)
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Index
description TR 12-5 – TR 12-6
function and range OP A-31
high spontaneous inspiratory time limit
(fTI SPONT)
description TR 12-6
function and range OP A-32
how changes are phased in TR 11-1
humidification type
description TR 12-6 – TR 12-7
function and range OP A-32
humidifier volume
function and range OP A-32
I:E ratio
description TR 12-7
function and range OP A-34
ideal body weight (IBW)
function and range OP A-33
how to determine OP 4-9
relationship with circuit type
TR 12-2 – TR 12-3
inspiratory pressure (PI)
description TR 12-7
function and range OP A-34
inspiratory time (TI)
description TR 12-7 – TR 12-8
function and range OP A-35
mandatory breath type
description TR 12-8 – TR 12-12
function and range OP A-35
mode
description TR 12-8 – TR 12-12
function and range OP A-36
O2%
description TR 12-12 – TR 12-13
function and range OP A-37
patient circuit type
function and range OP A-37
relationship with IBW TR 12-2 – TR
12-3
peak inspiratory flow (VMAX)
description TR 12-13
function and range OP A-38
PEEP (positive end expiratory pressure)
description TR 12-13
function and range OP A-39
plateau time (TPL)
description TR 12-14
function and range OP A-39
pressure sensitivity (PSENS)
description TR 12-14
function and range OP A-39
pressure support (PSUPP)
description TR 12-15
function and range OP A-40
respiratory rate (f)
description TR 12-15
function and range OP A-40
rise time %
description TR 12-15 – TR 12-16
function and range OP A-41
safety ventilation
description TR 12-17
settings during OP A-41
spontaneous breath type
description TR 12-17 – TR 12-18
function and range OP A-42
tidal volume (VT)
description TR 12-18
function and range OP A-43
Vent type
description TR 12-18 – TR 12-19
function and range OP A-44
Ventilator settings, ranges, resolutions,
and accuracies OP A-27 – OP A-44
Ventilator setup, how to change
OP 4-16 – OP 4-18
Ventilator startup screen
OP 4-3 – OP 4-4
illustration OP 4-3
Ventilator-initiated mandatory (VIM)
breath, description TR 2-5 – TR 2-6
Vial, collector
how to install OP 2-17 – OP 2-19
maintenance OP 7-15 – OP 7-16
operation of OP 1-6
part number OP B-9, OP B-18
VIM. See Ventilator-initiated mandatory
breath
VMAX setting. See Peak inspiratory flow
setting
Volume key (for alarm)
description OP 1-11
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
10067720 Rev. B
13
Index
VSENS setting. See Flow sensitivity setting
VT setting. See Tidal volume
VTE. See Exhaled tidal volume
V-TRIG. See Flow triggering
W
Wall Air Water Trap kit
part number OP B-10
Water trap, in-line, maintenance OP 7-16
Weight, ventilator OP A-2
14
10067720 Rev. B
Puritan Bennett™ 800 Series Ventilator System Operator’s and Technical Reference Manual
Part No. 10067720 Rev. B
COVIDIEN, COVIDIEN with logo and Covidien logo are U.S.
and/or internationally registered trademarks of Covidien AG.
™* Trademark of its respective owner.
Proportional Assist and PAV are registered trademarks of
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Other brands are trademarks of a Covidien company.
©2011 Covidien.
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