Dräger Medical. Savina. Intensive Care Ventilator. Instructions for Use Software 2.n. mt78799

Transcription

1 Dräger Medical D Savina Intensive Care Ventilator mt78799 Instructions for Use Software 2.n

2 How to work with these instructions for use The header line... contains the main chapter title. To help you find your way rapidly around the manual. The page body... contains the instructions for use in a combination of text and illustrations. The information is expressed directly in terms of actions which enable users to familiarise themselves with the operation of the machine by hands-on activity. Bedienkonzept Keys for routine and additional functions 1 Frequently used keys for routine functions are positioned on the right-hand side of the front panel: Tasten Taste für Routine- 2 min key und for Zusatzfunktionen suppressing the audible alarm 1 Häufig tone for benutzte 2 minutes, Tasten für Routinefunktionen befinden sich Alarm auf der Reset rechten key Seite for resetting der Frontplatte: or acknowledging alarm messages and for testing the LEDs and audible alarm tone, Taste» lock 2 key min«for zum protecting Unterdrücken against des inadvertent akustischen or Alarms unauthorised für 2 Minuten modification of the settings. Taste»Alarm Reset«zum Rücksetzen oder Bestätigen von 2 Alarm-Meldungen, Keys for additional und functions zum Prüfen are positioned der Lampen on und the des left-hand Alarmtons side of the front panel: Taste» Lock«zum Schutz gegen unbeabsichtigte oder unautorisierte Nebul. Änderung key for der switching Einstellungen. the medicament nebuliser on / off, 2 Tasten O2 Y suction für Zusatzfunktionen key to start/end befinden the sich oxygen auf der enrichment linken Seite program, der Frontplatte: Insp. hold key for manually activated inspiration and Taste for extending» Verneb.«the inspiration zum Einschalten/Ausschalten time. des Medikamentenverneblers Taste»O2 Y Absaug.«zum Starten/Beenden des Oxygenierungsprogramms Taste»Insp. hold«für eine manuell ausgelöste Inspiration und eine Verlängerung der Inspiration. Information window on screen D D D D Savina Savina Savina Savina The left-hand column... contains the text which provides explanations and guides the user with brief and clear instructions in an ergonomic sequence for confusion free use of the machine. Bullet points indicate the working steps. In many cases, numbers are used to highlight the relation between the working step described, the associated illustration(s) and the sequence of operations. During setting of a ventilation parameter, the Savina calculates the derived parameters and displays them in the information window on the main screen page. Info-Fenster im Bildschirm Während The information der Einstellung window eines disappears Beatmungsparameters when the parameter errechnet setting is Savina confirmed. die neuen abgeleiteten Parameter und zeigt sie im Info-Fenster am Bildschirm in der Hauptseite an. Das Info-Fenster verschwindet, wenn die Einstellung des Parameters bestätigt wurde. Power switch 3 To switch the apparatus on/off. Located on the back of the apparatus. Netzschalter To switch on: 3 Zum Ein / Ausschalten des Gerätes. Turn power switch to = ON. Auf der Rückseite des Gerätes. Gerät einschalten: Netzschalter auf» «schalten = EIN The right-hand column... contains the illustration(s) which directly relate to the text opposite and show the user where to find the items concerned. The focus is on the elements mentioned in the text. Non-essentials are omitted. Screen dumps are also used to guide the user and confirm the working steps

3 Contents Contents For your safety and that of your patients 5 Safety tips Intended Use 7 Areas of use Operating Concept 9 Controls, Parameter setting, Structure of the screen pages Operation 17 Ventilation modes, Alarm limits and alarm priorities, Curves, Measured values, Special functions Configuration 47 Contrast, Volume, Measured values line, Language, Apnoea ventilation ON/OFF Fault Cause Remedy 55 Fault analysis and correction chart Care 67 Dismantling, Cleaning, Maintenance Preparation 79 Assembly, Checking readiness for operation Description 97 Description of ventilation modes, Bibliography What s what 109 Display, Abbreviations, Symbols Technical data 117 Environmental conditions, Performance data, Measured value displays, Operating data Order List 125 Index 128 3

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5 For your safety and that of your patients For your safety and that of your patients Strictly follow the instructions for use Any use of the apparatus requires full understanding and strict observation of these instructions. The apparatus is only to be used for purposes specified here. Maintenance This apparatus should only be inspected, serviced and maintained by trained service personnel. We recommend that a service contract be obtained with DrägerService and that all repairs also be carried out by them. Only authentic Dräger spare parts may be used for maintenance. Observe chapter "Maintenance Intervals". Liability for proper function or damage The liability for the proper function of the apparatus is irrevocably transferred to the owner or operator to the extent that the apparatus is serviced or repaired by personnel not employed or authorized by DrägerService or if the apparatus is used in a manner not conforming to its intended use. Dräger cannot be held responsible for damage caused by non-compliance with the recommendations given above. The warranty and liability provisions of the terms of sale and delivery of Dräger are likewise not modified by the recommendations given above. Dräger Medical AG & Co. KGaA Accessories Do not use accessory parts other than those in the order list. Not for use in areas of explosion hazard This apparatus is neither approved nor certified for use in areas where combustible or explosive gas mixtures are likely to occur. Safe connection with other electrical equipment Electrical connections to equipment which is not listed in these instructions for use should only be made following consultation with the respective manufacturer or an expert. 5

6 For your safety and that of your patients Precautions This equipment must only be used under the supervision of qualified medical staff, so that if any faults or malfunctions occur, help is available immediately. This equipment must not be used with flammable gases or anaesthetic agents. Danger of fire! Do not use the apparatus in conjunction with nuclear spin tomography (MRT, NMR, NMI). The apparatus may malfunction, causing danger to the patient. Do not use the equipment in hyperbaric chambers. The apparatus may malfunction, causing danger to the patient. Avoid pollutants in the ambient air. Savina uses ambient air for ventilation. Pollutants would enter the patient s body. Interference with operation of the apparatus may be caused by the use of high-frequency electrical surgical equipment, defibrillators or short-wave treatment equipment, thereby putting the patient at risk. Do not use mobile phones within a distance of 10 metres from the equipment. Mobile phones can cause interference with electrical and electronic medical apparatus, thereby putting patients at risk! * Appropriate Monitoring The built-in monitoring facilities of the Savina ensure appropriate monitoring of ventilation therapy and therefore detect any undesirable changes in the following ventilation parameters: airway pressure, Paw expiratory minute volume, MV inspiratory O2 concentration, FiO2 inspiratory breathing gas temperature, T apnoea tachypnoea monitoring Changes in these parameters may be caused by: acute changes in the patient s condition incorrect settings and faulty handling equipment malfunctions failure of power and gas supplies In the event of a problem with the integrated monitoring: separate monitors must be used. Back-up ventilation with an independent manual ventilation device If a fault is detected in the Savina so that its life-support functions are no longer assured: start ventilation using an independent ventilation device without delay, if necessary with PEEP and/or increased inspiratory O2 concentration (e.g. with the Dräger Resutator 2000). The following points should be noted if ventilating while travelling: Do not place Savina on the bed while travelling. Ensure the apparatus cannot fall or be knocked over. * Dräger medical equipment fulfils the interference resistance requirements according to the product-specific standards or EN (IEC ). However, depending on the design of the mobile phone and circumstances of use, field strengths may occur in the immediate environment of a mobile phone that exceed the limits of the above standards and therefore cause interference. 6 Protect the apparatus from splashes and rain, to avoid risk of malfunction. Savina is not splashproof. During transport conditions, e.g. in an aircraft, hoses may start to vibrate and thus affect the flow measurement. When using Savina in combination with other products or during transport, the operator must secure the equipment appropriately to comply with the relevant basic requirements of Directive 93/42/EC.

7 Intended Use Intended Use

8 Intended Use Intended Use Savina 1 Long-term ventilator for intensive care. For patients requiring 50 ml tidal volume upwards. With the following ventilation modes IPPV Intermittent Positive Pressure Ventilation controlled and assisted constant-volume ventilation. IPPVAssist Assisted constant-volume ventilation. CPPV Continuous Positive Pressure Ventilation Ventilation with continuous positive airway pressure. IRV Inversed Ratio Ventilation Ventilation with inversed inspiration/expiration ratio. PLV Pressure Limited Ventilation AutoFlow 2 (optional) for the automatic optimization of inspiratory flow and minimizing of the airway pressure and to permit spontaneous breathing throughout the breathing cycle. SIMV Synchronized Intermittent Mandatory Ventilation Procedure for weaning patients off the ventilator after they have started spontaneous breathing. PLV Pressure Limited Ventilation AutoFlow (optional) for the automatic optimization of inspiratory flow and minimizing of the airway pressure and to permit spontaneous breathing throughout the breathing cycle. NIV non-invasive ventilation (optional) For ventilation with a nose or face mask to support noninvasive ventilation therapies. Choice available between mask ventilation and ventilation of intubated patients. Special modes: Apnoea Ventilation For switching over automatically to volume-controlled mandatory ventilation, if breathing stops. With monitoring for airway pressure, Paw, expiratory minute volume, MV, inspiratory O2 concentration, FiO2, inspiratory breathing gas temperature, T, apnoea, tachypnoea monitoring to detect rapid, shallow spontaneous breathing. Areas of Use In the Intensive Care ward or in the recovery room. During secondary transport from one hospital to another. During transfer of ventilated patients within the hospital. During transfer flights 4. CPAP Continuous Positive Airway Pressure Spontaneous breathing with positive airway pressure. SB Spontaneous Breathing Spontaneous breathing ASB Assisted Spontaneous Breathing Pressure-assisted spontaneous breathing. BIPAP 3 (optional) Biphasic Positive Airway Pressure Pressure-controlled ventilation combined with free spontaneous breathing during the complete breathing cycle, and adjustable pressure assist on CPAP level. 1 Savina is a registered trade mark of Dräger 2 AutoFlow is a registered trade mark of Dräger 3 Licensed trade mark. 4 Additional permits not covered by CE certification may be necessary for mobile use (in aircraft, etc.). 8

9 Operating Concept Ventilation Controls Setting ventilation parameters Selecting the ventilation mode Screen Operating Controls Keys for routine and additional functions Information window on screen Power switch Screen Pages Structure of the screen pages Main page "Settings" screen page "Alarms" screen page "Values" screen page "Configuration" screen page »Standby«key

10 Operating Concept Operating Concept Ventilation Controls 1 Keys for selecting the ventilation modes: IPPV SIMV CPAP/ASB BIPAP (optional) 2 Keys for selecting/setting ventilation parameters: Tidal volume VT Inspiration time Tinsp Frequency f O2-concentration O2 Inspiratory pressure Pinsp Pressure support PASB Positive End-Expiratory Pressure PEEP 3 Central "turn and push" rotary knob for setting the parameters and for selecting screen parameters. To set = turn the rotary knob To confirm setting = press the rotary knob. D Savina Setting ventilation parameters 2 To select a ventilation parameter = press the corresponding parameter key. The yellow LED in the key lights up. 3 To set the value of the ventilation parameter = turn the rotary knob. The value is displayed next to the parameter key. 3 To confirm the value = press the rotary knob. The yellow LED in the key goes out. The new value of the parameter becomes effective on confirmation. Derived parameters are displayed in an information window on the main screen page during the setting procedure. Selecting the ventilation mode 1 Hold down the appropriate key for about 3 seconds or press the appropriate key briefly and 3 confirm = press the rotary knob The selected ventilation mode will now be activated. For detailed instructions on setting the ventilation modes, see pages 19 onwards. 10

11 Operating Concept Screen Operating Controls 1 Screen page selection keys:» «key for setting the screen and display brightness to bright or dark D Savina»Curves «key for selecting the main page to display the pressure/flow curve»set «key for selecting the "Setting" screen page in order to set other ventilation parameters,»alarm «key for selecting the "Alarms" screen pages in order to set and display the alarm limits,»values «key for selecting the "Measured values" screen page in order to display the measured values, 1 2»Config. «key for selecting the "Configuration" screen page, for system settings such as alarm volume, screen brightness Central "turn and push" rotary knob for selecting and setting the options displayed on the screen. To select/set = turn the rotary knob, to confirm = press the rotary knob. Changing screen pages To change to the next page: press the same key again. To change to another page: press the corresponding key. To change to the main page: press»curves «key. 11

12 Operating Concept Keys for routine and additional functions 1 Frequently used keys for routine functions are positioned on the right-hand side of the front panel:» 2 min«key for suppressing the audible alarm tone for 2 minutes,»alarm Reset«key for resetting or acknowledging alarm messages and for testing the LEDs and audible alarm tone,» lock«key for protecting against inadvertent or unauthorised modification of the settings. 2 Keys for additional functions are positioned on the left-hand side of the front panel: D D Savina Savina» Neb.«key for switching the medicament nebuliser on / off,»o2 Y suction«key to start/end the oxygen enrichment program,»insp. hold«key for manually activated inspiration and for extending the inspiration time Information window on screen During setting of a ventilation parameter, the Savina calculates the derived parameters and displays them in the information window on the main screen page. The information window disappears when the parameter setting is confirmed Power switch 3 To switch the apparatus on/off. Located on the back of the apparatus. To switch on: Turn power switch to» «= ON

13 Operating Concept Screen Pages Structure of the screen pages 1 Ventilation mode display field 2 Alarm message display field 3 Curves and measured values display field 4 Measured values display field 5 Information bar Main page Displays a pressure curve and displays three measured values. To configure combination of measured values, see page 49. or: Displays a flow curve and displays three measured values. To configure combination of measured values, see page

14 Operating Concept "Settings" screen page Analog bar display of the airway pressure Paw Setting menu for setting the supplementary ventilation parameters»trigger«,»flowacc«,»autoflow«, Setting menu for setting apnoea ventilation, with the parameters»vtapnoea«,»fapnoea«, Setting menu for setting the sigh (only in ventilation mode IPPV). Settings 1/1: Menu comprises a single page. To select parameters = turn rotary knob. The selected parameter is indicated by a bold frame. To activate parameter for setting = press rotary knob. The active parameter appears light on a dark background. To set parameter = turn rotary knob, to confirm = press rotary knob. For detailed instructions on setting the ventilation modes, see pages 19 onwards. "Alarms" screen page For displaying the alarm limits associated with the measured values. For setting the alarm limits. For detailed operating instructions, see "Setting alarm limits" on page 30. "Values" screen page For displaying all the measured values in the current ventilation mode. Detailed instructions for use, see "Displaying Curves and Measured Values", page 33. Values 1/2: Page 1 of 2 available pages

15 Operating Concept "Configuration" screen page For setting equipment parameters: Screen contrast Alarm volume Displayed measured values Manual calibration for the O2 sensor 2 FiO2 and Flow Monitoring ON/OFF Pmax ON/OFF Plateau ON/OFF Language, date and time MEDIBUS protocol Configuration 1/4: Page 1 of 4 available pages of the Configuration menu Changing screen pages To change to the next page: press the same key again. To change to another page: press the corresponding key for that page. To change to the main page for pressure curves: press»curves «key. Detailed instructions for use, see "Configuration", pages 47 onwards.»standby«key 1 Positioned at bottom right of the front panel. To keep the apparatus operational, e.g. after pre-setting. or to switch on ventilation. D 2 Savina 1 To switch to standby: 1 Hold down» Standby«key for at least 3 seconds and 2 to confirm = press»alarm Reset«key. To switch on ventilation: 1 Press» Standby«key briefly

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17 Operation Starting Up Setting Ventilation Modes IPPV, IPPVAssist, CPPV SIMV, SIMV/ASB BIPAP, BIPAP/ASB (Optional) CPAP, CPAP/ASB Apnoea ventilation Setting Alarm Limits In the event of an Alarm Warning Caution Advisory Suppressing the audible alarm Displaying Curves and Measured Values Displaying measured values NIV Non-invasive ventilation Mask ventilation (optional) Special functions Manual inspiration Medicament nebulization Oxygen enrichment for bronchial suction Calibrating Calibrating O2 sensors At high ambient temperature In the event of a power supply failure In the event of a gas failure

18 Operation Operation Run equipment check according to checklist, see page 96. Starting Up Switching on 1 Turn the main switch on the back of the apparatus to» «The Savina now runs through a power-up self-test procedure. Wait for the 12-second test phase to be completed. At the end of the test phase, the apparatus automatically starts ventilation with the last ventilation mode set and the associated ventilation parameters. 1 0 During the self-test the start-up page appears, showing the software version. After this, the main page appears. 2 Check the settings in the display fields next to the parameter keys and adjust as necessary To adjust ventilation parameters: Either D 2 Savina 2 Change the ventilation parameters after the Savina has started ventilation 4 or 3 Press the» Standby«switch to set the Savina on standby, 4 Confirm = press»alarm Reset«key. 2 Change the ventilation parameters and 3 press the» Standby«switch to return to ventilation

19 Operation Setting Ventilation Modes Setting the ventilation parameters 1 Press the appropriate ventilation mode key. The yellow LED in the key will light up. D 1 Savina 2 Set the desired value = turn the rotary knob, confirm value = press the rotary knob The yellow LED in the key will go out. If the setting is at the upper or lower limit of the adjustment range for a parameter, the figure in the parameter key display will start flashing, indicating that confirmation is required. Press rotary knob in order to confirm extreme values. To set value = turn rotary knob, to confirm = press rotary knob 2 Parameter settings for the active ventilation mode do not become operative until confirmed. If you fail to confirm the new settings within 15 seconds, the previous settings will remain operative Extreme settings Certain ventilation parameters are limited by Savina to a threshold value. Extreme values can only be set after confirmation by pressing the rotary knob. Parameter Threshold Range Pinsp Y 50 mbar 0 to 100 mbar Pmax Y 50 mbar 0 to 100 mbar PEEP Y 20 mbar 0 to 35 mbar PASB 0 to 35 mbar PASB+PEEP PASB+PEEP Sigh Y 30 mbar Y 50 mbar 0 to 35 mbar Sigh+PEEP Y 20 mbar FlowAcc X 20 mbar/s 5 to 200 mbar/s f, Tinsp * 2 to 80 bpm 0.2 to 10 s Y I:E > 1:1 X I:E < 1:3 * Limitation of f and Tinsp is determined by I:E ratio Confirmation is not necessary when the values are returned to the normal range. 19

20 Operation To activate the ventilation mode 1 Hold down the appropriate ventilation mode key for about 3 seconds D 2 Savina or 1 Briefly press the appropriate ventilation mode key 3 confirm = press the rotary knob The new ventilation mode selected is now operative. Ventilation always starts with the last settings. 1 3 To set parameters for another ventilation mode 1 Press the key for the new ventilation mode briefly. The yellow LED will flash. 2 In the block of parameter keys, the LEDs for the additional parameters relevant to the new ventilation mode will start flashing. Constantly lit parameter keys indicate ventilation parameters that are operative in the active ventilation mode. Any change and confirmation of these parameters immediately affects the active ventilation mode. 2 Press the relevant parameter key which has its LED constantly lit Set the desired value = turn the rotary knob, confirm value = press the rotary knob, the yellow LED for that parameter key will go out. 3 To activate ventilation mode = press rotary knob. If parameter setting is interrupted, Savina does not reset the parameters set and confirms back to the old value. To protect the settings against modification 4 Press» Lock «key; the yellow LED will light up. The parameter keys, the ventilation mode keys and the screen settings are now protected against alteration. Before setting a new value: 4 Press» Lock «key. The yellow LED will go out. D 4 Savina

21 Operation IPPV, IPPVAssist, CPPV Intermittent Positive Pressure Ventilation Volume-controlled ventilation with a fixed mandatory minute volume MV, set with the tidal volume VT and frequency f. For patients unable to breathe spontaneously, see page 98 for details. Intermittent Positive Pressure Ventilation, Assist For patients with partial spontaneous breathing. Paw FlowAcc with plateau Tplat Pplat FlowAcc without plateau PEEP t Continuous Positive Pressure Ventilation Ventilation with continuous positive airway pressure. This mode is not displayed on the screen as a ventilation mode. Set IPPV by means of the keys for the ventilation parameters: Tidal volume»vt«, Inspiration time»tinsp«, Frequency»f«, O2 concentration»o2«, Positive end-expiratory pressure»peep«. If PEEP is greater than 0 the airway pressure remains constantly in the positive range (CPPV). Flow Tinsp T= 1 f Te Tinsp t Pressure limit Pmax The pressure peak can be avoided in IPPV and IPPVAssist by setting a pressure limit. Thereby the PLV ventilation mode can be reached (Pressure Limited Ventilation). To set the pressure limit Pmax: Set Pmax to ON, see page 51. Set pressure limit value by means of»pinsp«key. When setting the pressure limit, ensure that the tidal volume VT is still being applied, as otherwise Savina will display a "!! Tidal volume low" message. Then: Set pressure limit higher, or Increase inspiration time»tinsp.«, or Increase»FlowAcc«, This can be set on-screen: Set flow metering by means of»flowacc«on screen page»settings 1/1«

22 Operation Flow Acceleration FlowAcc By setting the FlowAcc, the pressure and flow increase at the start of inspiration can be changed. To set FlowAcc: Press»Settings «key, screen page»settings 1/1«appears. Select line»flowacc«on screen = turn rotary knob, to confirm = press rotary knob. To set value = turn rotary knob Setting range: 5 to 200 mbar/sec FlowAcc high: steep pressure and flow increase To confirm setting = press rotary knob. A recommended start-up setting for FlowAcc is 35 mbar/s. IPPV can be extended using the following ventilation parameters: Trigger Sigh AutoFlow (optional) Trigger (IPPVAssist) To synchronize the mandatory ventilation strokes with the patient s efforts to breathe in. The actual frequency may be higher than the ventilation frequency f set. 1 The green LED lights up if the Savina detects attempted spontaneous breathing by the patient. The trigger can be switched off if spontaneous breathing by the patient is not expected or desired. To set the trigger, see page Savina

23 Operation Activating/setting the trigger 1 Press»Settings «key. 2 To release»trigger«for setting = press rotary knob. The field appears bright against a dark background. 2 To set value = turn rotary knob Low value = high sensitivity To confirm = press rotary knob. 3 Savina The ventilation mode IPPVAssist is displayed on the screen. 3 The green LED lights up if the Savina detects attempted spontaneous breathing When changing over from IPPV to SIMV, BIPAP or CPAP/ASB, the last active trigger value remains effective. To switch off the trigger: Set a value less than 1. Display in trigger field: OFF 2 To confirm = press rotary knob. The ventilation mode IPPV is displayed on the screen. Sigh To prevent atelectasis. Atelectasis can be prevented by activating the sigh function and setting the sigh in the form of an intermittent PEEP. When the sigh function is activated, the end-expiratory pressure is increased by the set intermittent PEEP for 2 ventilation strokes every 3 minutes. Activating/setting the sigh Press»Settings «key. On the screen, to select the» Sigh«line = turn the rotary knob. To release» Sigh«for setting = press the rotary knob. The field appears bright against a dark background. Set a value between 1 and 35 mbar = turn rotary knob, to confirm = press rotary knob. The sigh set is added to the PEEP

24 Operation Deactivating the sigh Set a value less than 1. OFF appears in the " Sigh", to confirm = press rotary knob. The sigh function is deactivated. AutoFlow (optional) Automatic optimization of the inspiration flow. The inspiration flow is decelerated and regulated by AutoFlow *, so that at the selected tidal volume VT, with the current compliance a minimum airway pressure is reached and pressure peaks are avoided. Savina supplies additional inspiration flow when the patient breathes in restricted by the alarm limit VTi >. The patient can also breathe out during the inspiratory plateau phase. The inspiratory pressure is limited by the Paw > alarm limit To switch AutoFlow ON and OFF Press»Settings «key. Select line»autoflow«on screen = turn rotary knob. To release»autoflow«for setting = press rotary knob. To set»autoflow ON«= turn rotary knob, to confirm = press rotary knob To set alarm limits, see page 30. * For a detailed description of AutoFlow, page

25 Operation SIMV, SIMV/ASB Synchronized Intermittent Mandatory Ventilation * Assisted Spontaneous Breathing ** Paw without ASB pressure support with ASB pressure support Fixed mandatory minute volume MV, set with the tidal volume VT and frequency f. The patient can breathe spontaneously between the mandatory ventilation strokes. Spontaneous breathing can be assisted by ASB. FlowAcc PEEP FlowAcc high FlowAcc low For patients with insufficient spontaneous breathing or patients being weaned from artificial ventilation by progressive reduction of the mandatory proportion of the total minute volume. Set SIMV by means of the ventilation parameter keys: Tidal volume»vt«, Inspiration time»tinsp«, Frequency»f«, O2 concentration»o2«, positive end-expiratory pressure»peep«. Flow Tinsp T= 1 f Trigger window t t The following can be set on the screen: Sensitivity»Trigger«(for synchronization of mandatory ventilation strokes) on screen page»settings 1/1«Set flow metering by means of»flowacc«on screen page»settings 1/1«. AutoFlow (optional) ON/OFF. Pressure limit Pmax The pressure peak can be avoided in SIMV and SIMV/ASB by setting a pressure limit To set the pressure limit Pmax: Set Pmax to ON, see page 51. Set pressure limit value by means of»pinsp«key. When setting the pressure limit, ensure that the tidal volume VT is still being applied, as otherwise Savina will display a "!! Tidal Volume low". Then: Set pressure limit higher by means of»pinsp«, or Increase inspiration time»tinsp«, or Increase FlowAcc Additional functions: Pressure support» PASB above PEEP«Apnoea ventilation To set apnoea ventilation, see page 28. * For a detailed description of SIMV, see page 102. ** For a detailed description of ASB, see page

26 Operation BIPAP, BIPAP/ASB (Optional) Biphasic Positive Airway Pressure Assisted Spontaneous Breathing Pressure-controlled ventilation combined with free spontaneous breathing during the complete breathing cycle, supported by adjustable additional pressure at CPAP level. The mandatory proportion of the total minute volume MV is set by means of the inspiration pressure Pinsp, PEEP and frequency f. without spontaneous breathing Paw FlowAcc high FlowAcc FlowAcc Pinsp with spontaneous breathing FlowAcc low ASB pressure support FlowAcc high FlowAcc low Adaptable to a wide range of patients, from those unable to breathe spontaneously at all to those breathing spontaneously before extubation. Suitable for weaning patients from artificial ventilation by progressively reducing the mandatory fraction of the minute volume MV and by reducing the additional artificial pressure support PASB above PEEP. For details see "BIPAP" description, page 104. PEEP Flow Tinsp 1 f Trigger window t t Set BIPAP by means of the ventilation parameter keys: Inspiration time»tinsp«, Frequency»f«, O2 concentration»o2«, Inspiration pressure»pinsp«, Positive end-expiratory pressure»peep«. The following can be set on the screen: Sensitivity»Trigger«(for synchronization with spontaneous breathing) To set the trigger, page 23 FlowAcc can be set on screen on screen page»settings 1/1«. FlowAcc is effective both for BIPAP strokes and pressure support» PASB above PEEP«Additionally for BIPAP/ASB: Pressure support» PASB above PEEP«BIPAP, BIPAP/ASB can be supplemented with apnoea ventilation: To set apnoea ventilation, see page 28. To set alarm limits, see page

27 Operation CPAP, CPAP/ASB Continuous Positive Airway Pressure Assisted Spontaneous Breathing For patients breathing spontaneously in an adequate manner. Spontaneous breathing at a raised pressure level, to increase the functional residual capacity FRC. Spontaneous breathing can be assisted with additional pressure by ASB. Set CPAP by means of the ventilation parameter keys: O2 concentration»o2«positive end-expiratory pressure»peep«additionally, for CPAP/ASB: Pressure support» PASB above PEEP«The following can be set on the screen: FlowAcc for pressure support ASB on screen page»settings 1/1«Sensitivity»Trigger«(for synchronising attempted spontaneous breathing with ASB pressure support) on screen page»settings 1/1«. CPAP, CPAP/ASB can be supplemented with the following ventilation parameters and ventilation modes: Trigger By setting the trigger sensitivity, the assisting ventilator support is synchronised with the patient s own spontaneous breathing attempts. To set the trigger, see page 23. Apnoea ventilation To set apnoea ventilation, see page 28. To set alarm limits, see page

28 Operation Apnoea ventilation For automatic switchover to volume-controlled mandatory ventilation if the patient stops breathing. Apnoea ventilation can be provided for all ventilation modes with spontaneous breathing. If the patient stops breathing, Savina activates an alarm after the set apnoea alarm time TApnoea and starts volume-controlled mandatory ventilation with: inspiration /expiration ratio I:E = 1:2 and the set ventilation parameters: Frequency»fApnoea«Tidal volume»vtapnoea«the patient can breathe spontaneously during apnoea ventilation. The frequency»fapnoea«remains constant. Paw Flow FlowAcc Apnoea alarm time TApnoea > t = 1 fapnoea Start of apnoea ventilation t t To set apnoea ventilation Press»Settings «key. Screen page 1/1 appears. If apnoea ventilation is activated, the»vtapnoea«and»fapnoea«lines are visible. In this case A = apnoea ventilation standby appears at the right on the main screen page. If apnoea ventilation is deactivated, instead of the»fapnoe«line the display shows:»apn-vent. OFF«. To activate apnoea ventilation: Select»Apn-Vent. OFF«line = turn rotary knob Activate = press rotary knob. Set a value of at least 2 bpm = turn rotary knob. The»VTApnoea«and»fApnoea«lines appear. To select lines = turn rotary knob, activate = press rotary knob. To set value = turn rotary knob, confirm = press rotary knob To deactivate apnoea ventilation: Set a value less than 2 in the»fapnoea«line = turn rotary knob, confirm = press rotary knob

29 Operation Setting apnoea time TApnoea on the "Alarms" screen page Press»Alarms «key. Display: screen page»alarms 1/1«On the screen select the line»tapnoea «= turn rotary knob, activate = press rotary knob. Set the desired value = turn rotary knob, confirm = press rotary knob To end apnoea ventilation: Press the»alarm Reset«key. Savina carries on ventilating in the original ventilation mode and associated ventilation parameters. D Savina During Savina settings, the status of switched on apnoea ventilation is displayed for 6 seconds by a special information page where, in principle, apnoea ventilation is possible. when changing over the ventilation mode, when switching on Savina, when reducing the frequency, if the cycle time is then longer than TApnoea To set alarm limits, see page

30 Operation Setting Alarm Limits Press»Alarms «key. Example display: screen page»alarms1/1«this page displays all the alarm limits that can be set. < = lower alarm limit > = upper alarm limit Alarm Setting Range Paw > 10 to 100 mbar MV > 2 to 41 L/min MV < 0.5 to 40 L/min TApn. > 15 to 60 sec ftot > 10 to 120 bpm VTi > 0.06 to 4 L Example; setting the upper alarm limit for Paw. On the screen, select the line»paw «= turn the rotary knob, to release for setting = press rotary knob. Set the desired value = turn the rotary knob, confirm = press the rotary knob. The lower alarm limit does not have to be set for the airway pressure Paw, because it is automatically coupled to the PEEP setting. The alarm limits do not have to be set for the O2 concentration. These limits are automatically coupled to the O2 concentration setting: Lower alarm limit: Setting 4 vol. % (at settings up to 60 vol. %) Setting 6 vol. % (at settings from 60 to 100 vol. %) Upper alarm limit: Setting +4 vol. % (at settings up to 60 vol. %) Setting +6 vol. % (at settings from 60 to 100 vol. %) A specific screen page»alarms 2/2«appears in the optional mode»mask/niv«. See "NIV Non-invasive ventilation", page

31 Operation In the event of an Alarm 1 the red or yellow LED flashes. 2 the alarm message is displayed in the right-hand corner of the top line of the screen. Savina classifies the alarm in three priority classes, marks the text with exclamation marks according to the priority class and generates various alarm tone sequences. D 2 1!!! = Warning (red LED flashes)!! = Caution (yellow LED flashes)! = Advisory (yellow LED lights up and remains continuously lit) Savina displays a message for your guidance in the information line when certain alarm messages occur. Warning Top priority message 1 Red LED flashes. Warning messages are marked with three exclamation marks and appear white on a dark background. Example:!!! Apnoea Savina generates a five-tone sequence that is sounded twice and repeated every 7.5 seconds. Caution Medium priority message 1 Yellow LED flashes. Caution messages are marked with two exclamation marks. Example:!! Check settings Savina generates a 3-tone sequence that is repeated every 20 seconds. 31

32 Operation Advisory Low priority message 1 Yellow LED lights up and remains lit. Advisory messages are marked with one exclamation mark. Example:! Flow monitoring off Savina generates a two-tone sequence that sounds only once. D To remedy the faults, please refer to the "Troubleshooting" section starting on page 56. When the fault has been remedied the audible alarm is switched off. Caution messages (!!) and advisory messages (!) disappear automatically from the screen. Warning messages (!!!) remain black on a white background on the screen and need to be acknowledged: 2 Press the»alarm Reset«key. 3 The message is erased from the screen Suppressing the audible alarm for max. 2 minutes: 4 Press the» «key. Its yellow indicator LED lights up and the alarm tone will be muted for about 2 minutes. If the cause of the alarm has not yet been remedied, the audible alarm will sound again after about 2 minutes. If you wish to reactivate the audible alarm before the end of this 2-minute muting period: 4 Press the» «key again. The yellow LED will now go out. The message remains on the screen. The alarm tone sounds only once when a higher priority alarm occurs during the period, when the audible alarm is muted. 32

33 Operation Displaying Curves and Measured Values On the main page the airway pressure curve, or flow curve and three relevant measured values are displayed. To change the curve display Press»Curves «key. Example: flow curve The combination of measured values in the measured value line can be configured, see page 49. Displaying measured values Press»Values «key. The screen page»values1/2«appears or, in»mask/niv«mode,»values 1/3«. The airway pressure is indicated by a bar display. The other measured values are displayed numerically. Displaying other measured values Press»Values «key again. The screen page»values2/2«appears or, in»mask/niv«mode,»values 2/3«. When ventilating without plateau, the value Tinsp will appear instead of Tplat

34 Operation In»Mask/NIV«mode, another page can be displayed»values 3/3« NIV Non-invasive ventilation Mask ventilation (optional) Installing the NIV option This should only be done by experts, following the corresponding installation instructions. Using NIV * When masks are used, the dead space increases. Follow the mask manufacturer s directions. Never ventilate an intubated patient in the»mask/niv«mode. After changing over from»mask/niv«to»tube«mode, check the alarm limits. Avoid high airway pressures. Risk of aspiration. All ventilation modes are selectable in»mask/niv«mode. Selecting»Mask/NIV«mode Switch apparatus to standby = hold down» Standby«key for about 3 seconds. Press»Alarm Reset«to switch off the audible alarm. Select»Patient Connection«line = press rotary knob, Select»Mask/NIV«line = press rotary knob, Confirm = press rotary knob. * For a detailed description of NIV, see page

35 Operation The following advisory message appears briefly: Setting the ventilation parameters Proceed as in»tube«mode In the»mask/niv«mode, the»tinsp«key has an extended function: In addition to setting the inspiration time in the mandatory ventilation modes IPPV, SIMV or BIPAP, it is also used to set the maximum duration of the ASB strokes during pressuresupported ventilation. Set Tinsp or the maximum duration of the ASB strokes, 0.2 to max. 4 s. Automatic trigger leakage compensation Savina compensates for detection of trigger leakage caused by the patient up to 25 L/min. Automatic compensation of set tidal volume Savina compensates up to 100 % of the measured minute volume for leaks detected. Monitoring in the»mask/niv«mode Only switch off alarms if the safety of the patient will not be compromised by the absence of an alarm. To avoid artefacts in the case of very big leaks, the following alarms may be switched off: MV minute volume lower alarm limit VTi inspiratory tidal volume upper alarm limit TApnoea apnoea monitoring upper alarm limit To switch off (for example MV ): Reduce»MV «until the message appears:»mv off? Press and turn rotary knob«. Confirm = press rotary knob. Continue turning the rotary knob until OFF appears in the display. Confirm = press rotary knob. 35

36 Operation If an alarm limit has been switched off, an advisory message will constantly be displayed, e.g.:! MV low Alarm off The apparatus does not display the following warning messages in the»mask/niv«mode: ASB > 4 s Leakage Setting TDisconnect A delay»tdisconnect«from 0 to 60 seconds can be set for the»airway pressure low«alarm in the»mask/niv«mode. In the event of disconnection this delays the activation of the alarm by the time set. Press the»alarms «key until the screen page»alarms 2/2«appears. Activate the»tdisconnect«line to set. Set TDisconnect = turn the rotary knob, confirm = press the rotary knob Selecting»Tube«mode Switch apparatus to standby = hold down» Standby«key for about 3 seconds. Press»Alarm Reset«to switch off the audible alarm. To select, activate»patient Connection«line = press rotary knob, Select»Tube«= turn rotary knob, Confirm = press rotary knob. The advisory message appears briefly. When switching over to»tube«mode, Savina automatically selects the default alarm limits for the alarms previously switched off in»mask/niv«mode Check alarm limits after changing from»mask/niv«mode to»tube«mode. 36

37 Operation Special functions Manual inspiration This function may be used in all modes except CPAP spontaneous breathing without ASB pressure support. Regardless of the start time, an automatic ventilation stroke can be prolonged by up to a maximum of 15 seconds. Or: Between two automatic ventilation strokes, a ventilation stroke can be manually started and held for a maximum of 15 seconds. The pattern of the manually started ventilation stroke depends on the ventilation mode in use. For IPPV, SIMV: volume-controlled ventilation stroke, defined by the»vt«and»tinsp«settings. For BIPAP: pressure-controlled ventilation stroke, defined by the»pinsp«and»tinsp«settings. For CPAP/ASB: pressure-assisted ventilation stroke, defined by the» PASB above PEEP«setting. 1 Press and hold down the»insp. hold«key for as long as inspiration is required. Either an automatic ventilation stroke that has just begun will be accordingly prolonged, or a new ventilation stroke can be started and held for a maximum of 15 seconds. D 1 Savina

38 Operation Medicament nebulization Applicable in every ventilation mode. Will only function with O2 supply between 2.7 to 6 bar. Savina applies the medicament aerosol in synchronization with the inspiration only in the inspiratory flow phase and automatically maintains the minute-volume constant. Savina automatically turns the nebulizer off after 30 minutes. The flow sensor will be automatically heat-cleaned and calibrated after the aerosol treatment to prevent false results during flow measurement. Danger of fire! Do not nebulize flammable medicaments. Since Savina uses pure oxygen for the medicament nebulization, an increase of the desired inspiratory O2 concentration may be caused. Due to the inability of Savina to measure this O2 concentration increase, an incorrect O2 reading will be displayed. Only use medicament nebulizer (white centerpiece). Use of other pneumatic medicament nebulizers may result in considerable discrepancies in the minute-volume reading! Connect your O2 supply 2.7 to 6 bar from the medical O2 pipeline system or from a cylinder, to the side of Savina. Prepare the medicament nebulizer in accordance with the accompanying instructions for use. 1 Connect the nebulizer to the inspiratory side of the Y-piece (temperature sensor side). 2 Connect the inspiration hose to the medicament nebulizer. 1 2 Swivel the medicament nebulizer to the vertical position Using clamps, route the nebulizer hose back to the ventilator along the ventilation hose. 3 Connect the nebulizer hose to the spigot at the front side of Savina. Fill the medicament nebulizer in accordance with the accompanying instructions for use

39 Operation During medicament nebulization do not use a heat and moisture exchanger (HME). Risk of increased breathing resistance. 1 Hold down» Neb.«key, until the yellow lamp lights up. On-screen advisory message:! Nebulizer on The nebulizer is in operation for 30 minutes; nebulization only in the inspiratory flow phase. If medicament nebulization needs to be stopped prematurely: 1 Press» Neb.«key again. The yellow lamp goes out, the nebulizer is switched off. D 1 Savina The flow sensor will be automatically heat-cleaned and calibrated by Savina. On-screen information: Flow calibration Remove any left-over medicament from the medicament nebulizer. Follow the instructions for use of the medicament nebulizer. Take into account the effect of aerosols on sensors and filters. The measuring function of the flow sensor may be impaired. The flow resistance of filters is liable to increase and may impair ventilation. Do not place microbial filters on the nebulizer outlet during nebulization! Risk of increased breathing resistance! 39

40 Operation Oxygen enrichment for bronchial suction Will only function with O2 supply between 2.7 to 6 bar. To prevent hypoxia during bronchial suction, an O2 enrichment program during removal of secretions is provided with Savina. After the program has started, during the oxygen enrichment phase Savina ventilates in the selected ventilation mode for up to 180 seconds with 100 Vol.% oxygen. When the ventilator is disconnected for suction, Savina automatically interrupts ventilation. During the suction phase, the alarms "!!!Apnoea", "!!!Fail to cycle", "!!!Airway pressure low" and "!!!MV low" are suppressed so that the suction routine is not disrupted. After suction and automatically recognized reconnection, Savina ventilates 120 seconds with 100 Vol.% O2. During suction and for two minutes afterwards, the lower alarm limit for the minute volume is disabled. Connect your O2 supply 2.7 to 6 bar from the medical pipeline system or from the O2 cylinder to Savina Before suction 1 Hold down»o2 Y suction«key until the yellow lamp lights up. In the set ventilation mode, Savina ventilates with 100 Vol.% O2. In case PEEP has not been set higher than 4 mbar, an automatic setting of 4 mbar will come into effect. This PEEP will enable Savina to detect any subsequent disconnection. The other ventilation parameters remain unchanged. Message in the information line on screen: O2 enrichment 100% 180 s D 1 Savina The remaining time is continuously displayed on screen. The oxygen enrichment lasts for a maximum of 180 seconds. During this time, Savina waits for the suction to be disconnected. If there is no disconnection after 180 seconds, Savina will terminate the oxygen enrichment program

41 Operation After suction disconnection During the period of disconnection Savina supplies a minimal flow of 100 Vol.% O2 in order to automatically detect the end of the disconnection phase. The time available for suction is continuously displayed in the information line on screen (example): Execute suction and reconnect 120 s If suction is ended and the system is reconnected within the displayed time, Savina starts the final O2 enrichment. After reconnection After reconnection has taken place, Savina ventilates once more in the set ventilation mode, however, for final O2 enrichment 120 seconds more with 100 Vol.% O2. Message in the information line on screen: Final O2 enrichment 100% 120 s The remaining time is continuously displayed on screen. In case the O2 enrichment has to be interrupted: 1 Press the»o2 Y suction«key again D Savina 1 Automatic discontinuation of oxygen enrichment If after 120 seconds no reconnection follows, Savina stops the O2 enrichment program. All alarms are immediately reactivated. Savina immediately continuous ventilating in the set ventilation mode

42 Operation Calibrating The saved calibration/zeroing values remain stored even when the machine is switched off. Automatic calibration of the pressure sensors The pressure sensors for measuring the airway pressure are calibrated automatically. Automatic calibration of the flow sensor The flow sensor will be automatically calibrated in the following circumstances: when the apparatus is switched on every 24 hours during operation after changing the flow sensor after medicament nebulisation after bronchial suction after changing the O2 concentration. Savina uses a full inspiration phase for calibration. Short inspiration times are extended to about one second. Message in the information line on the screen: Flow calibration in progress After calibration is complete, the following message appears in the information line: Flow-calibration ok If calibration is unsuccessful, the following message appears: "Flow-calibration failed". The expiratory part of the flow curve does not appear and no measured values are displayed for VTe, MV or PEEP. Then Exchange flow sensor. Always pay special attention to successful flow calibration. Without a usable flow measurement, neither O2 calibration nor O2 enrichment for bronchial suction is possible. 42

43 Operation Calibrating O2 sensors Savina uses one O2 sensor for O2 control and display (sensor 1) and a second, separate O2 sensor for O2 monitoring (sensor 2). The O2 sensor for O2 control and display (sensor 1) is automatically calibrated by Savina: when the apparatus is switched on after 8 hours operation when the O2 sensor is replaced if sensor 1 and sensor 2 differ from each other by more than 2% by volume when the air pressure changes by more than 200 hpa, e.g. during transfer flights by helicopter when the temperature changes by more than 10 o C. During automatic calibration, the following message appears in the information line on the screen: O2 calibration active After calibration is complete, the following message appears: O2 calibration ok The O2 sensor for O2 monitoring (sensor 2) has to be calibrated manually: once per month, if the following alarms occur:!!! FiO2 high or!!! FiO2 low or!!! O2 measurement inop. Manual calibration can be carried out in any ventilation mode, see page

44 Operation At high ambient temperature In ambient temperatures over 35 o C Savina displays an advisory message:! Temperature high To prevent the breathing gas becoming too hot, Savina reduces the maximum speed of the built-in blower as the ambient temperature rises. If high inspiratory pressures are set at the same time, e.g. over 80 mbar, the result may be that high flows, e.g. 180 L/min, can no longer be achieved. Even at slower speeds, the breathing gas delivered by the blower is warmed. To ensure that the breathing gas temperature at the Y-piece remains under 41 o C, an inspiratory hose length of not less than 1.1 m should be maintained as a cooling section. If the temperature sensor built into Savina reaches over 40 o C, an alarm will be activated!!! Temperature high If an operational temperature sensor * is used in the Y-piece, Savina will warn of breathing gas temperatures of 40 o C or higher by activating the alarm!!! Breathing gas temp. high In both cases, Savina continues ventilating the patient. Lower the ambient temperature. In the event of a power supply failure If all external and internal power sources fail, an intermittent audible alarm sounds. Either immediately reconnect power supply or Disconnect patient and continue ventilating using an independent ventilator. In the event of a gas failure In normal operating mode, Savina uses ambient air to ventilate the patient with the aid of a blower and O2 from the medical gas pipeline system or from an O2 cylinder. In the event of O2 failure Savina replaces the missing proportion of O2 with ambient air and generates an alarm. The minute volume remains constant. The inspiratory O2 concentration FiO2 drops to 21 Vol.%. * See Order List on page 126. Only use temperature sensors with blue leads. 44

45 Operation If the patient needs an inspiratory O2 concentration higher than 21 Vol.%: reconnect the O2 supply without delay. In the event of blower failure Savina cannot carry on ventilating. Continue ventilating without delay, using an independent ventilator. 45

46 46

47 Configuration Setting the screen contrast Adjusting the volume of the audible alarm Configuring the measured values line Manual calibration for O2 sensor FiO2- or flow monitoring ON/OFF Pmax ON/OFF Plateau ON/OFF Selecting the language Setting the date and time Configuring the MEDIBUS protocol Displaying the device values

48 Configuration Configuration The following settings for use can be selected in»configuration«mode: Screen contrast Alarm volume Measured values line Manual calibration for O2 sensor 2 FiO2 and flow monitoring ON/OFF Pmax ON/OFF Plateau ON/OFF Language, date and time MEDIBUS protocol. The settings selected in»configuration«mode remain stored until the equipment is switched off. The following information about the equipment can be displayed in»configuration«: Total operating hours Operating hours since the last inspection and maintenance. software version device identification number Setting the screen contrast Press»Config. «key repeatedly until»configuration 1/4«appears. Select the»contrast«line = turn the rotary knob, activate = press the rotary knob To set the contrast = turn the rotary knob. The contrast changes. Confirm = press the rotary knob. The contrast set will now be activated. Adjusting the volume of the audible alarm Display (example): Press»Config. «key repeatedly until»configuration 1/4«appears. Select»Volume«line = turn the rotary knob, activate = press the rotary knob. To adjust the volume = turn the rotary knob, confirm = press the rotary knob After the setting has been confirmed, the alarm tone is sounded once to enable you to judge the volume

49 Configuration Configuring the measured values line Select one of 6 possible combinations of measured values: Press»Config. «key repeatedly until»configuration 1/4«appears. Select»Measured values«line = turn the rotary knob, activate = press the rotary knob. To set the measured values combination = turn the rotary knob, confirm = press the rotary knob. The following combinations of measured values can be selected: 1. VTe ftot MV 2. FiO2 VTe MV 3. Ppeak VTe MV 4. Pmean FiO2 MV 5. Pmean VTe MV 6. Ppeak Pmean VTe Manual calibration for O2 sensor 2 once per month, if the following alarms occur:!!! FiO2 high or!!! FiO2 low or!!! O2 measurement inop. Manual calibration can be carried out in the respective ventilation mode: Press»Config. «key repeatedly until»configuration 2/4«appears. Select»O2 calib.«line = turn rotary knob, to release for setting = press rotary knob. To start O2 calibration = turn rotary knob and select»start«, to confirm = press rotary knob. Message in the information line on screen: Disconnect patient Disconnect patient within the next 30 seconds. If necessary continue ventilating the patient using a separate ventilating appliance

50 Configuration Message in the information line on screen: O2 calibration active After 60 seconds the following appears in the information line: Reconnect patient Immediately reconnect patient. Thereafter appears: O2 calibration ok The O2 calibration is completed, Savina ventilates once more using the original settings. Disconnection and change of O2 concentration would activate the alarms. For this reason Savina turns the alarms off during calibration. If the patient is not reconnected within 30 seconds, Savina continues ventilating and all the alarms are reactivated If the following alarm appears after calibration:!!! O2 measurement inop. or!!! FiO2 low Replace O2 sensor, see page 77. After replacing the O2 sensor: Allow about 20 minutes warm-up time to elapse, then calibrate FiO2- or flow monitoring ON/OFF For instance, when a used O2 or flow sensor cannot be replaced immediately. Use alternative monitoring, as otherwise there will be a restricted monitoring function. Press»Config. «key repeatedly until»configuration 2/4«appears. Select the desired line = turn the rotary knob, confirm = press the rotary knob Set to»on«= turn the rotary knob, confirm = press the rotary knob. The corresponding monitoring is activated. Set to»off«= turn the rotary knob, confirm = press the rotary knob. O2 monitoring and flow monitoring and associated alarms are permanently deactivated. Provide alternative monitoring Display in Alarm line:! Flow monitoring off or! O2 monitoring off 50

51 Configuration Display in information bar: Replace flow monitoring or Replace O2 monitoring or Replace flow monitoring and O2 monitoring Flow monitoring is automatically activated each time Savina is switched on. When flow monitoring is deactivated, Savina does not determine the following measured values: MV MVspont Even when O2 monitoring is deactivated, the devices requires at least sensor 1 for accurate O2 control. Otherwise it delivers inaccurate O2/air mixes. O2 monitoring should only be deactivated when Savina is supplied with air only. O2 monitoring remains deactivated even when the device is switched on again. Display in alarm line:!! O2 monitoring off On acknowledging by pressing the»alarm Reset«key, display:! O2 monitoring off Reactivate the monitor function after replacing the sensor. Pmax ON/OFF To use the pressure limit Pmax in the IPPV, IPPVAssist and SIMV, SIMV/ASB ventilation modes. The pressure limit value is set by means of the»pinsp«key. Savina limits the airway pressure to that set value. Press»Config. «key repeatedly until»configuration 2/4«appears. Select»Pmax«line = turn rotary knob, to release for setting = press rotary knob. To set»on«= turn rotary knob, confirm = press rotary knob. The pressure limit»pmax«is activated. To set»off«= turn rotary knob, confirm = press rotary knob. The pressure limit»pmax«is deactivated

52 Configuration Plateau ON/OFF To switch on and off the inspiratory pause. When the plateau is deactivated, Savina switches to expiration after application of the tidal volume VT. The inspiration time setting Tinsp does not apply. Savina establishes a minimum expiration time of 500 ms and limits the resulting I:E ratio to max. 4:1. Press»Config. «key repeatedly until»configuration 2/4«appears. Select»Plateau«line = turn rotary knob, to release for setting = press rotary knob. To set»on«= turn rotary knob, confirm = press rotary knob. Plateau is activated. To set»off«= turn rotary knob, confirm = press rotary knob. Plateau is deactivated Selecting the language Display (example): Press»Config. «key until»configuration 3/4«appears. Select»Language«line = turn the rotary knob, to release for setting = press rotary knob. The following languages can be selected: German Japanese English Russian US-English Greek French Romanian Italian Polish Spanish Portuguese Chinese Select language = turn the rotary knob, confirm = press the rotary knob. The new language selected is activated immediately. Setting the date and time This has to be done when using the MEDIBUS interface Press»Config. «key repeatedly until»configuration 3/4«appears. Select»dd.mm.yy«line = turn the rotary knob, to release for setting = press rotary knob. Set the day (dd) = turn the rotary knob, confirm = press the rotary knob. Set the month (mm), year (yy), hour (h) and minutes (m) in the same way

53 Configuration Configuring the MEDIBUS * protocol The following parameters can be set: Baudrate Parity check bits Number of stop bits Press»Config. «key repeatedly until»configuration 3/4«appears. Select line for the corresponding interface parameters, e.g. select baudrate = turn the rotary knob, to release for setting = press rotary knob. Set value = turn the rotary knob, confirm = press the rotary knob Displaying the device values Press»Config. «key repeatedly until»configuration 4/4«appears. Savina displays: SW Software version of the device Device-ID specific device identification number Working hours the total number of hours the device has been operating, and h since service the number of working hours since the last inspection and service by trained service personnel. Release code: Numerical code for release of options Return to main page Press the»curves «key. The main page showing a curve appears. * MEDIBUS: Dräger communications protocol for medical appliances. 53