• To ensure the ventilator’s safe operation, always run the prescribed tests and calibrations before using the ventilator on a patient. If the ventilator fails any tests, remove it from clinical use immediately. DO NOT use the ventilator until necessary repairs are completed and all tests are successful. Ensure the ventilator is set up for the appropriate patient conditions with the appropriate breathing circuit parts, including the appropriate flow sensor, as described in

Chapter 2.

• Confirm a flow sensor calibration has been performed before you use the ventilator .

• It is the clinician’s responsibility to ensure that all ventilator settings are appropriate, even when “automatic” features such as automatic alarm setting, ASV, MinVol adjustment, PEEP adjustment or Oxygen adjustment are used.

This section introduces how to set up the device for ventilation on a patient. Prepare the ventilator as instructed in Chapter 2,

Setting up the ventilator. Be familiar with the Ventilation Cockpit. Use the touch screen and buttons comfortable to select,

activate, and confirm parameters. For details, see section 2.17.

5-2

624074/07

5.2 Setting up the patient

WARNING

• Ensure you choose the correct patient profile of gender, adult, pediatric, and neonatal. Correct selections prevent possible hyper- or hypoventilation.

• Entering a substantially wrong height/IBW input will lead to a deviation of rate setting.

Please check your entered value carefully on the standby window, or after start of the ventilation on the dynamic lung screen.

624074/07

NOTE:

• If you selected New patient , the basic screen will open with the default settings for mode, control, and the alarm settings. If you selected Last patient , the settings you see are the last active ventilator parameters in use.

• Default patient group for New patient and default settings for each patient group (mode and controls) are operator-configurable. See the Configuration chapter.

• If an inadvertent setting is made but has not yet been confirmed, it will automatically be canceled after 30 seconds. Alternatively, the setting window closes after 3 min, again canceling your settings.

• Start up values for automatic buttons are not user configurable.

To set up the ventilator for a new patient:

1. Start up the ventilator (Figure 5-1).

2. Make sure the ventilator is configured with the appropriate

breathing circuit parts, as described in section 2.7. Chapter

6, Neonatal ventilation, includes additional information you might find valuable when ventilating a neonatal patient.

5-3

5 Ventilator settings

3. Start up the ventilator (Figure 5-1). The default settings are

displayed.

4. Choose the appropriate patient setting:

•Select New patient to start with new settings.

•Select Last patient to start up with the last active ventilation parameters in use.

5. If you selected New patient , adjust the settings for the patient type, gender, and height. The ideal body weight

(IBW) is automatically calculated and displayed

6. Select Start to begin ventilation.

The device sets defaults and makes assumptions based on the patient profile (neonatal, pediatric, or adult). See the top righthand corner of the screen to verify the mode and patient

profile. To determine the patient profile, see Table 2-1.

The ventilation counter also starts.

5-4

Figure 5-1. Patient setup window

1. The IBW, based on Pennsylvania Medical Center (adults) and Traub SL.

Am J Hosp Pharm 1980 (pediatric patients), is calculated as:

Pediatric: IBW (kg) = 0.0033 x Patient height 2 (cm) + 0.3237 x Patient height (cm) + 14.386 cm x kg/cm

Adult male: IBW (kg) = 0.9079 x Patient height (cm) – 88.022 cm x kg/cm

Adult female: IBW (kg) = 0.9049 x Patient height (cm) – 92.006 cm x kg/cm

624074/07

5.3 Patient window

Once you have started ventilation, the Patient window provides the basic patient profile, include gender, height, and time on ventilator. The following sections provide details.

5.3.1 Patient window: Changing patient gender and height

You can change the patient’s gender or height from the

Patient window.

1. Open the Patient

window (Figure 5-2).

2. Change Gender , or select Patient height to adjust the value.

For details on the Ventilation Timer, see the next section,

5.3.2.

3. Close the window.

624074/07

Figure 5-2. Patient window

1 Patient information (gender and IBW)

2 ventilation timer

3 Reset button resets ventilation timer to 0

5-5

5 Ventilator settings

5.3.2 Patient window: Ventilation timer

The Patient window displays a timer that shows how long

the patient has been ventilated. See Figure 5-2.

The timer records time as follows.

• The timer starts when you start ventilation.

• When you enter Standby , the timer pauses. It picks up again from the last value when you exit Standby and return to active ventilation.

• When you select New Patient in the Patient Setup window, the timer resets to 0.

• When you select Last Patient in the Patient Setup window, the timer continues from the last total time recorded.

• When you select the Reset button, the timer resets to 0.

To get an accurate count of how long a patient has been ventilated, we recommend you reset the timer to 0 once the patient is initially connected to the ventilator.

When the timer is reset, an entry is made to the Event log recording the time of the reset, as well as how long the ventilator had been running prior to the reset.

To reset the timer to 0:

1. Open the Patient

window (Figure 5-2).

2. Select the Reset button. The timer starts again at

0d 0h 0min.

3. Close the window.

5-6

624074/07

5.4 Modes window: Setting the ventilation mode

NOTE:

• For details on modes, see the following chapters or materials:

Adaptive Support Ventilation (ASV

)

INTELLiVENT

-ASV

Noninvasive ventilation

Modes of ventilation

• Table 5-1 describes which modes apply to which

patient profiles.

See the top right-hand corner of the screen for the active ventilation mode. To change the mode use these steps:

1. Open the Modes window.

2. Select a mode. The mode framed in the color yellow within the mode group is the apnea backup mode for that particular group of modes.

Confirm the mode. The Controls window opens automatically. Review and confirm the control settings

(see Section 5.5.2). If the control settings are not con-

firmed after 3 minutes, the window automatically closes. If this happens, the new mode selection will not be valid, and the previous settings remain in effect.

624074/07

5-7

5 Ventilator settings

Figure 5-3. Modes window

1 Active mode

2 Backup mode for mode group framed in yellow

3 New selected mode

4 Boxes enclose mode group

5-8

Table 5-1. Ventilation modes and patient types

Mode

(S)CMV – Synchronized controlled mandatory ventilation

SIMV – Synchronized intermittent mandatory ventilation

SPONT – Pressure support mode

P-CMV – Pressure-controlled mandatory ventilation

Adult

(> 30 kg

IBW)

Pediatric

(3 to 42 kg

IBW)

Infant/neonatal

( ≤ 10 kg IBW)

624074/07

Table 5-1. Ventilation modes and patient types

Mode

APVcmv – Pressure-controlled mandatory ventilation with adaptive pressure ventilation

P-SIMV – Pressure-controlled synchronized intermittent mandatory ventilation

APVsimv – Pressure-controlled synchronized intermittent mandatory ventilation with adaptive pressure ventilation

ASV

– Adaptive support ventilation

DuoPAP – dual positive airway pressure mode

APRV – airway pressure release ventilation

NIV – noninvasive ventilation

NIV-ST nCPAP-PS

Adult

(> 30 kg

IBW)

Pediatric

(3 to 42 kg

IBW)

Infant/neonatal

( ≤ 10 kg IBW)

624074/07

5-9

5 Ventilator settings

5.5 Controls window: Settings including apnea backup ventilation

NOTE:

• The Controls window displays control settings applicable to the mode; apnea backup ventilation

(Backup) control settings, and timing parameters based on timing settings (for control breaths only);

see Figure 5-4. If INTELLiVENT

-ASV is active the

Controls window further shows calculated MinVol,

Vt, IBW and the controllers; see Figure 5-5.

• To use adaptive support ventilation (ASV),

INTELLiVENT

-ASV or noninvasive ventilation (NIV and NIV-ST), see Appendix C and Appendix D for more details. For INTELLiVENT, see the INTEL-

LiVENT

-ASV manual.

Description: Set controls and apnea backup ventilation from the Controls window. For control setting ranges and stan-

dard settings, see Table A-5. For control settings applicable to

the different ventilation modes, see Table A-6.

5.5.1 Adjusting and confirming control settings without mode change

NOTE:

If INTELLiVENT

-ASV is active the ventilation and oxygenation controllers are displayed on the pulsing circles on the right of the cockpit screen.

Procedure: Change the control settings at any time as described:

1. Open the Controls window.

2. Select a parameter and adjust the value. As this change does not involve apnea, the change takes effect as soon as you confirm the setting change. Repeat this step for other parameters.

5-10

624074/07

3. Select or deselect Backup when required (for details see apnea backup functions).

If Backup is selected, check and modify (when required) the active settings for apnea backup ventilation, which are displayed in the window. Backup will be displayed at the top right-hand corner of the screen after the window is closed.

624074/07

Figure 5-4. Controls window

1 Control settings applicable to the mode

2 Trigger type selector (select and activate to select type)

3 Apnea backup ventilation enabled or disabled, and if

enabled, backup mode and selected control settings for

backup ventilation

4 Timing parameters, based on the timing settings (if control

breaths are permitted in the selected mode):

• Rate and I:E:

Equivalent to the settings in Table 5-2

• Ttotal: Total breath cycle time

• TI: Duration of inspiratory phase, including any Pause

5-11

5 Ventilator settings

• TE: Duration of expiratory phase

• Pause: Duration of pause or plateau

• IRV (when applicable): Indicates that the insufflation +

Pause time settings > 50% of total breath time

• Vt/kg: Tidal volume per kg Ideal Body Weight

5.5.2 Adjusting and confirming control settings after mode change

NOTE:

After a mode change, the apnea backup settings are immediately activated without confirmation. This occurs immediately even when the mode change is canceled.

Description: After you select a different mode, the Controls

window automatically opens (Figure 5-5). Review and confirm

these proposed settings, or the mode change will not be accepted.

Procedure: Change the control settings at any time as described:

1. Select a parameter and adjust the value. Repeat for any other desired parameters.

2. Select or deselect Backup

as desired (see Section 5.5.3

for details on how apnea backup functions).

If Backup is selected, check and modify as desired the active settings for apnea backup ventilation, which are displayed in the window. Backup will be displayed at the top right-hand corner of the screen after the selection is confirmed.

Confirm your entire selection.

5-12

624074/07

Figure 5-5. Controls window after mode change

624074/07

Figure 5-6. INTELLiVENT

-ASV mode window

5-13

5 Ventilator settings

5.5.3 About apnea backup ventilation

WARNING

HAMILTON MEDICAL recommends that apnea backup ventilation be enabled whenever a mode that allows spontaneous breathing is selected.

NOTE:

• When enabling apnea backup ventilation, verify appropriate apnea backup control settings in the

Controls window.

• ASV® and INTELLiVENT

-ASV always work with lung-protective rules strategies (C.3.3) and therefore do not require additional backup ventilation.

This device provides apnea backup ventilation, a mechanism that minimizes possible patient injury due to apnea or cessation of respiration. Apnea can occur in all modes except

(S)CMV, P-CMV, APVcmv, and ASV

. When the device is set to one of these modes and no inspiratory efforts are detected, or control breaths are delivered during an operator-set interval, it declares apnea.

If apnea backup ventilation is enabled, ventilation continues.

The device’s apnea backup is bi-directional. This mean that ventilation automatically resumes in the original support mode if the apnea episode ends.

When apnea backup ventilation is enabled , Backup is displayed at the top right-hand corner of the touch screen. Apnea backup ventilation provides ventilation after the apnea time passes with no breath attempts detected (set the Apnea time in the Alarms -> Limits 1 window). When this occurs, the device automatically (and immediately) switches into apnea backup ventilation.

5-14

624074/07

This action sounds a medium-priority alarm, displays Apnea ventilation, and provides ventilation as described in this table:

If the original support mode is...

SIMV

SPONT, P-SIMV,

DuoPAP, APRV, NIV

APVsimv

NIV-ST the HAMILTON-

G5 enters this backup mode

(S)CMV

P-CMV

APVcmv

P-CMV and ventilates using these settings

Control settings shown in the Controls window. (Settings shown are from original mode (where possible), or they are standard settings.)

If the patient triggers two consecutive breaths, the device reverts to ventilation in the original support mode and at the original settings, and it displays Apnea ventilation ended .

After apnea backup ventilation is enabled or disabled, it retains this status in all applicable modes. Apnea backup ventilation requires no clinician intervention, although you can freely change the mode during apnea backup ventilation, either switching to a new mode or accepting the backup mode as the new mode.

When apnea backup ventilation is disabled, the high-priority alarm message Apnea is displayed when apnea occurs.

To verify a setting or to change backup control settings, open the Controls window.

5.6 Additions window

This section discusses the Additions window and the choices you can select. You can enable or disable the sigh function, set tube resistance compensation (TRC) or use the cuff pressure controller, IntelliCuff

, function from the Additions window.

For detailed information on the cuff pressure function, see

Section 3.5.

624074/07

5-15

5 Ventilator settings

5.6.1 Sigh: Enabling/disabling the sigh function

Description: The sigh function delivers a sigh breath every

50 breaths, with a higher-than-normal pressure or volume.

In volume-controlled modes, sigh breaths have a tidal volume

50% higher than non-sigh breaths, up to a maximum of

2000 ml.

In pressure-controlled modes, sigh breaths are delivered at a pressure up to 10 cmH2O higher than non-sigh breaths, as permitted by the high Pressure alarm limit. During sigh breaths, the high Pressure and Vt alarm limits remain active to help protect the patient from excessive pressures and volumes.

Procedure: Enable or disable the sigh function as follows:

1. Open the Additions -> Sigh window.

5-16

Figure 5-7. Sigh window

2. Select or deselect the Sigh function.

Close the window.

624074/07

5.6.2 TRC: Setting tube resistance compensation

WARNING

• Always use the correct tube type and size setting to avoid endangering the patient. To prevent possible patient injury due to inappropriate compensation, make sure to set these appropriately.

• TRC can induce autotriggering. If autotriggering occurs, first check the patient, breathing circuit, and other settings as possible causes before lowering the Compensate setting or disabling TRC.

624074/07

NOTE:

• TRC is intended for use with spontaneously breathing patients.

• TRC is disabled during heliox administration.

• When TRC is enabled, the displayed Ppeak can be higher than the set PEEP/CPAP plus Pcontrol/Psupport. This is due to the additional pressure required to work against the tube resistance. Observe closely at the calculated tracheal pressure, which is simultaneously displayed as an orange-colored waveform.

• The tracheal pressure waveform displayed is calculated from the proximal flow and pressure signals rather than measured .

• 100% compensation means that all resistance due to the tube itself is compensated. Internal resistance

(for example, from secretions) and the external resistance (for example, from a tube kink) is not compensated.

Description: To reduce the patient’s work of breathing while on the HAMILTON-G5, the ventilator’s tube resistance compensation (TRC) feature offsets the flow resistance imposed by the tracheal (ET) or tracheostomy tube.

5-17

5 Ventilator settings

TRC is active during exhalation in volume modes, and in both inspiration and exhalation in the other modes. It is available for neonatal, pediatric and adult patients.

Procedure: Enable or disable TRC and adjust the settings as described:

1. Open the Additions -> TRC window.

5-18

Figure 5-8. TRC window

2. Select ET tube (endotracheal tube), Trach tube (tracheostomy tube), or Disable TRC .

3. If you selected ET tube or Trach tube , adjust the Tube size (tube ID) and Compensate settings. If the ET tube is shortened, lower the Compensate setting.

Confirm the entire selection.

When TRC is enabled, this displays the orange tracheal pressure waveform. Ptrach is shown with the yellow airway

pressure waveform, Paw (Figure 5-9), and

Et tube or Trach tube is displayed toward the bottom of the right-hand corner of the Cockpit touch screen.

624074/07

Figure 5-9. Ptrach and Paw waveforms (with TRC active)

1 Paw waveform (shown in yellow)

2 Calculated Ptrach waveform (shown in orange)

5.6.3 Table of control settings, additions, and ranges

ETS

Table 5-2. Control settings, mode additions, and ranges

Parameter

Backup

Definition

Provides ventilation after the adjustable apnea time passes without breath attempts.

Applies in SIMV, P-SIMV, APV-SIMV,

SPONT, DuoPAP, APRV, and NIV modes.

(Expiratory trigger sensitivity)

Represents the percent of peak inspiratory flow at which the ventilator cycles from inspiration to exhalation.

When you increase the ETS setting this results in a shorter inspiratory time, which can be beneficial in patients with

COPD. The ETS setting lets you match the inspiratory time of pressure-supported breaths to the patient’s neural timing.

Applies to spontaneous breaths.

Range

Enabled or disabled

5 to 70% (of inspiratory peak flow)

624074/07

5-19

5 Ventilator settings

Table 5-2. Control settings, mode additions, and ranges

Parameter

Flow pattern

Flowtrigger

(l/min)

Definition

Flow pattern for gas delivery.

This is not affected by patient pressure or other limitations as long as the peak inspiratory flow or pressure limit is not exceeded.

Applies to volume-controlled mandatory breaths.

The patient’s inspiratory flow triggers the ventilator to deliver a breath. When the Flowtrigger is selected, the device generates a continuous and constant base flow from the inspiratory outlet to the expiratory outlet during the later part of exhalation. Base flow is essential for flow trigger. This base flow ranges from 4 to 30 l/min, as follows:

• For Flowtrigger values < 1 l/min:

2 l/min

• For Flowtrigger values > 2 l/min:

2 x Flowtrigger setting

Applies to all breaths in all modes, if selected.

Range

Sine, square,

100% decelerating, 50% decelerating

0.1 to 15 l/min

NOTE:

If autotriggering occurs, first check the patient, breathing circuit, and other settings as possible causes before decreasing the trigger sensitivity.

Male, Female Gender

(Adults only!)

Sex of patient.

Used to compute ideal body weight

(IBW).

5-20

624074/07

Table 5-2. Control settings, mode additions, and ranges

Parameter

I:E

Loudness

Definition

Ratio of inspiratory time to expiratory time.

Applies to mandatory breaths, if the ventilator is so configured.

Alarm loudness.

Range

1:9.0 to 4.0:1

1 to 10

NOTE:

If the alarm loudness was set to

< 5 before the ventilator was powered OFF, the loudness setting will default to 5 when the device is powered ON.

%MinVol Percentage of minute volume to be delivered. The device uses the %Min-

Vol, Patient height, and Gender settings to calculate the target minute ventilation.

The %MinVol for a normal patient might be 100% (100 ml/min/kg body weight for adults and 200 ml/min/kg body weight for pediatric patients); for a COPD patient, 90%; for an ARDS patient, 120%; and for other patients,

110%. Add 20% if body temperature

> 38.5 °C (101.3 °F) and 5% per 500 m

(1640 ft) above sea level.

Applies in ASV

mode (see Appendix

C) and in INTELLiVENT

-ASV. In INTEL-

LiVENT

-ASV the %MinVol can be set manual or automatic (range in automatic mode: 50%-200% (see the

INTELLiVENT

-ASV manual).

25 to 350%

624074/07

5-21

5 Ventilator settings

Table 5-2. Control settings, mode additions, and ranges

Parameter

Oxygen

Definition

Oxygen concentration to be delivered.

Applies to all breaths in all modes.

In INTELLiVENT

-ASV Oxygen can be set manual or automatic (see the

INTELLiVENT

-ASV manual).

NOTE:

Oxygen alarms are suppressed for 30 seconds after an Oxygen setting change.

Range

21 to 100%

P-ASV limit

Patient

Patient height

(Adults only!)

Pause

Maximum pressure set by ASV

and

INTELLiVENT

-ASV, always equal to

Pmax-10. Thus P-max and P-ASV limit co-vary.

Patient Profile.

PEEP+5 to

110 cmH2O

Patient height. It determines the ideal body weight (IBW), which is used in

ASV

, INTELLiVENT

-ASV and Intelligent Panel calculations.

Inspiratory pause or plateau, as a percentage of total breath cycle time.

After the required gas is delivered (after the operator-set Vt is reached), gas remains in the lungs and exhalation is blocked during the Pause time. The use of a Pause increases the residence time of gas in the patient’s lungs.

Applies to volume-controlled mandatory breaths, when the device is configured in this way.

Adult, Pediatric, Neonatal,

Male, Female

30 to 250 cm

(12 to

100 inch.)

0 to 70% (of cycle time)

5-22

624074/07

Parameter

Pcontrol

Peak flow

PEEP/CPAP

Phigh

Plow

Table 5-2. Control settings, mode additions, and ranges

P-ramp

Definition

Pressure (above PEEP/CPAP) to be applied during the inspiratory phase.

Applies to mandatory breaths in P-CMV and P-SIMV.

Peak (maximum) inspiratory flow.

Applies to volume-controlled mandatory breaths, when the device is configured in this way.

PEEP (positive end expiratory pressure) and CPAP (continuous positive airway pressure), baseline pressures applied during the expiratory phase.

Applies to all breaths in all modes except APRV. In INTELLiVENT

-ASV,

PEEP can be set to manual or automatic. For details, see the INTEL-

LiVENT

-ASV manual.

High positive airway pressure level.

P high setting is total desired airway pressure, including PEEP/CPAP or P low.

Applies to all breaths in DuoPAP and

APRV modes.

Low positive airway pressure level.

Applies to all breaths in APRV mode.

Pressure ramp. Time constant required for inspiratory pressure to rise to the set

(target) pressure.

The P-ramp setting lets you fine-tune the initial flow output during a pressure-controlled or pressure-supported breath to match the ventilator flow to the patient’s demand.

Range

3 to

100 cmH2O

1 to 180 l/min

0 to

50 cmH2O

0 to

50 cmH2O

0 to

50 cmH2O

25 to 200 ms

624074/07

5-23

5 Ventilator settings

Table 5-2. Control settings, mode additions, and ranges

Parameter

P-ramp

( count.

)

Definition

Short P-ramp settings (50 ms) provide higher initial flow rates and result in faster attainment of the target pressure. This can benefit patients with elevated respiratory drive. Short P-ramp settings have been correlated with reduced work of breathing in certain patients.

Set P-ramp to achieve a square (rectangular) pressure profile.

Applies to all breaths in pressure modes.

Range

25 to 200 ms

NOTE:

To prevent possible pressure overshoot in pediatric applications, it is recommended that

P-ramp be set to at least 75 ms.

Psupport

P-trigger

Pressure (above PEEP/CPAP) to be applied to a patient-triggered breath during the inspiratory phase.

Applies to spontaneous breaths.

Pressure trigger. The pressure drop below PEEP/CPAP required to begin a patient-initiated breath.

Applies to all breaths in all modes, if selected.

NOTE:

If autotriggering occurs, first check the patient, breathing circuit, and other settings as possible causes before decreasing the trigger sensitivity.

0 to

100 cmH2O

0.1 to

10 cmH2O

(below PEEP/

CPAP)

5-24

624074/07

Sigh

Table 5-2. Control settings, mode additions, and ranges

Parameter

Rate

T high

%TI

Ti max

Definition

Respiratory frequency or number of breaths per minute.

Applies to mandatory breaths in

(S)CMV, P-CMV, SIMV, P-SIMV,

APVcmv, APVsimv, and DuoPAP modes.

Breaths delivered at a regular interval, with a higher-than-normal pressure or volume.

Duration of high airway pressure level.

Applies to all breaths in DuoPAP and

APRV modes.

Time to deliver the required gas (time to reach the operator-set Vt or Pcontrol value).

Applies to mandatory breaths, if the ventilator is so configured.

The high limit on the TI value is 10 seconds. This is due to a safety algorithm ensuring a minimum exhalation phase.

Time to deliver the required gas (time to reach the operator-set Vt or Pcontrol value), as a percentage of the total breath cycle.

Applies to mandatory breaths, if the ventilator is so configured.

The high limit on the TI value is 10 seconds. This is due to a safety algorithm ensuring a minimum exhalation phase.

Maximum inspiratory time.

Adult/Pediatric/ Neonatal: Applies for spontaneous breaths in non-invasive ventilation modes. Neonatal: Applies for all spontaneous breaths.

Range

1 to 150 b/min enabled or disabled

0.1 to 30 s

0.1 to 10 s

10 to 80% (of cycle time)

0.25 to 3.0 s

624074/07

5-25

5 Ventilator settings

Tlow

TRC

Table 5-2. Control settings, mode additions, and ranges

Parameter

Tip

Definition

Inspiratory pause or plateau time.

After the required gas is delivered (after the operator-set Vt is reached), gas remains in the lungs and exhalation is blocked during the Tip time.

The use of a Tip increases the residence time of gas in the patient’s lungs.

Applies to volume-controlled mandatory breaths, when the device is configured in this way.

Duration of low airway pressure level.

Applies to all breaths in APRV mode.

Tube resistance compensation. Reduces the patient’s work of breathing by offsetting tube resistance.

Range

0 to 8 s

0.1 to 30 s

NOTE:

If autotriggering occurs, first check the patient, breathing circuit, and other settings as possible causes before lowering the

Compensate setting or disabling TRC.

Tube type/TRC disabledTube

Endotracheal (ET) tube, tracheostomy

(Trach) tube, or TRC off.

size

Compensate

Inner diameter (ID) of tube.

Percentage of compensation.

ET tube, Trach tube, Disable

3.0 to 10.0 mm (adult),

2.5 to 5.0 mm

(neonates)

10 to 100%

5-26

624074/07

Table 5-2. Control settings, mode additions, and ranges

Parameter

Trigger off

Definition

Prevents the ventilator from recognizing a patient trigger.

Applies to all breaths in (S)CMV,

P-CMV, and APVcmv modes, if selected.

WARNING

Never set the trigger off for spontaneously breathing patients without sound clinical reasons, as this will minimize patient-ventilator asynchrony.

Range

Enabled or disabled

Vtarget

Tidal volume delivered during inspiration.

Applies to volume-controlled mandatory breaths.

Target tidal volume to be delivered during inspiration. The device meets the

Vtarget by adjusting the inspiratory pressure by 1 cmH2O per breath.

Applies to breaths in APVcmv and

APVsimv modes.

2 to 2000 ml

1. Refer to Appendix B for details on breath timing profiles in the HAMILTON-G5.

5.7 Alarms window

You can set alarm limits, adjust the alarm loudness, and view active alarms at the Alarms window.

624074/07

5-27

5 Ventilator settings

5.7.1 Limits: Setting alarm limits

WARNING

• Ensure the alarm limits are appropriately set before you place the patient on the device preventing possible patient injury.

• Although you can set all alarms rapidly using the Auto alarm function, some settings are not appropriate under all clinical conditions. HAM-

ILTON MEDICAL recommends: you set the alarms manually when possible. If circumstances require to use the Auto alarm function, verify the correctness of the settings at the earliest opportunity.

NOTE:

• Always ensure the high pressure alarm is correctly set. This alarm provides a safety pressure limit for the device to appropriately adjust the inspiratory pressure necessary to achieve the target tidal volume.

The maximum available inspiratory pressure for

INTELLiVENT

-ASV, ASV

, APVcmv and APVsimv is

10 cmH2O below the high pressure limit, indicated by a blue colored band on the pressure waveform display. Set the high pressure limit to a safe value

(example, 45 cmH2O, this limits the pressure target to a maximum of 35 cmH2O). When the high pressure alarm is set too low, it can lack enough margin for the device to adjust its inspiratory pressure to deliver the target tidal volume.

• In the ASV

and the INTELLiVENT

-ASV controls window, the high pressure alarm will be changed by adjusting the Pasv limit (pressure target 10 cmH2O below high pressure alarm limit).

5-28

624074/07

• You can selectively enable or disable some adjustable alarms during configuration (see Appendix J, Configuration). At the minimum, the high pressure, low

ExpMinVol, and apnea time alarms are always active.

• The number to the left of the line through each alarm column is the current measured value. The circled numbers at the top and bottom of the alarm columns represent the alarm settings.

• After a power interruption of up to 30 seconds, the device restores the last settings, including alarm settings.

You can access the Alarms window and change alarm settings at any time, without affecting ventilation.

The device offers two alarm-setting options:

• Manually set individual alarm limits.

• Use the Auto alarm function. Choosing Auto sets all alarm

limits. Table 5-3 lists the Auto alarm settings.

To review and adjust alarms:

1. Open the Alarms

window (Figure 5-10). The

Limits 1 window is displayed.

624074/07

Figure 5-10. Alarm Limits 1 window

If the Pulse Rate alarm and/or one or more of the Masimo parameters is enabled in configuration, the Alarms ->

Limits 2 window is active. Select the Limits 2 tab to display the window.

5-29

5 Ventilator settings

Figure 5-11. Alarm Limits 2 window

2. To set an alarm individually, select the alarm button and adjust the value. Repeat for any other alarm.

To set the alarms automatically, select the Auto button.

3. Close the window.

5.7.2 Loudness: Adjusting alarm loudness

NOTE:

• If the alarm loudness was set to < 5 before the ventilator was powered off, the loudness setting will default to 5 when the HAMILTON-G5 is powered on.

• If you decrease the alarm loudness during the night shift, do not forget to return it to its daytime setting!

Adjust the alarm loudness as follows:

1. Open the Alarms -> Loudness

window (Figure 5-12).

2. Adjust the Loudness value as desired.

3. Optionally, select Test to check the loudness.

5-30

624074/07

Figure 5-12. Alarm Loudness window

4. Repeat the process as required.

5. Close the window.

5.7.3 Buffer: Viewing active alarms

See Section 10.3 for a description of the active alarm buffer.

5.7.4 Table of alarm limit settings and ranges

Table 5-3 lists the

Alarms -> Limits 1 window alarm settings and ranges. As the Alarms -> Limits 2 window

displays pulse oximeter-related parameters, see Section F.6.3

for these alarm limits.

624074/07

5-31

5 Ventilator settings

5-32

Parameter

Apnea time

Table 5-3. Alarm limit settings and ranges

ExpMinVol

(low and high)

Definition

The maximum time allowed from the beginning of one inspiration to the beginning of the next inspiration. If the patient does not trigger a breath during this time, an alarm is annunciated.

Apnea backup ventilation will begin, if enabled.

The Apnea alarm is suppressed under these conditions:

• When the ventilator is in the ambient state, standby, or any of these modes is active: (S)CMV, P-CMV,

APVcmv, or ASV

• During flow sensor calibration or the tightness test.

If apnea backup ventilation is not enabled, apnea is detected, and the alarm silence is active, the alarm silence is terminated immediately.

Low and high expiratory minute volume. If either limit is reached, a highpriority alarm is annunciated.

NOTE:

If you do set the ExpMinVol alarm to Off, the pressure alarms become critical, so pay close attention to them and set the low Pressure alarm to an appropriately sensitive level.

Range

10 to 60 s

Low: Off, 0.01 to 49 l/min

High: Off,

0.03 to

50 l/min

HLI (high)

Leak

High HLI.

High leakage. Leak is the percentage of delivered inspiratory volume that is not returned during exhalation on the patient side of the flow sensor.

Off, 0 to 40%

Off, 5 to 80%

624074/07

Parameter

PetCO

(low and high)

Table 5-3. Alarm limit settings and ranges

Pressure (low and high)

Definition

Low and high monitored PetCO

If either limit is reached, a mediumpriority alarm is annunciated.

Low and high monitored pressures at the patient airway (Ppeak). If either limit is reached, a high-priority alarm is annunciated.

In addition, if the high Pressure limit is reached, the HAMILTON-G5 immediately stops gas flow to the patient and relieves pressure until pressure falls to the PEEP/CPAP level. If the airway pressure continues to rise above

120 cmH

O, the mechanical overpressure relief valve opens and the ventilator enters the ambient state.

The HAMILTON-G5 ventilator uses the high Pressure limit as a safety boundary for its inspiratory pressure adjustment.

ASV

, INTELLiVENT

-ASV, APV-cmv and APV-simv do not apply inspiratory pressures higher than 10 cmH

O below the high Pressure limit. An exception is sigh breaths, when ASV

INTELLiVENT

-ASV, APV-cmv and APVsimv can apply inspiratory pressure

3 cmH

O below the high Pressure limit.

In the ASV

and INTELLiVENT

-ASV controls window the high Pressure alarm can also be changed by adjusting the Pasv limit (maximally applicable pressure target 10 cmH

O below high

Pressure alarm limit).

Range

Low: Off, 0 to

99 mmHg/0 to

13.2 kPa

High: Off, 1 to

100 mmHg/1 to 13.3 kPa

Low: 2 to

119 cmH

High: 10 to

120 cmH

624074/07

5-33

5 Ventilator settings

Table 5-3. Alarm limit settings and ranges

Parameter

Rate (low and high)

Definition

Low and high monitored total breath rate (fTotal), including both spontaneous and mandatory breaths. If either limit is reached, a medium-priority alarm is annunciated.

NOTE:

Respiratory rate monitoring on the ventilator requires breath delivery followed by detection of expiratory flow at the proximal flow sensor.

Range

Low: 0 to

128 b/min

High: 2 to

130 b/min

SpO

(low and high)

Vt (low and high)

Low and high. Make sure that the

SpO