2 OVERVIEW OF VENTILATOR

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2 Overview of Ventilator 2 2 OVERVIEW OF VENTILATOR 2.1 PATIENT UNIT 2. GENERAL The Patient Unit contains the pneumatics and electronics for mixing and delivering gas to the patient. The power supply and battery back-up are contained in the Patient Unit and a control cable connects the Patient Unit to the User Interface. All connections are found on the side of the Patient Unit. The electrical cord is plugged into the mains and the gas hoses are connected to either the wall, gas cylinders and/or to the Compressor Mini Air and O 2 supply 2. Mains supply 3. User interface 4. Patient unit 5. Expiratory inlet 6. Servo Guard/Servo Duo Guard, viral/bacterial filter (optional) 7. Inspiratory outlet 8. Patient breathing system 9. Module compartment 1 SVX-128_EN 1

3 2 Overview of Ventilator When mounted on the SERVO-i Mobile Cart (A), the Patient Unit can be rotated up to 180 o, depending on which side of the patient s bed the ventilator is to be placed (B). Alternatively, the Patient Unit can be removed from the Mobile Cart and mounted onto a SERVO-i Holder (C) or a SERVO-i Shelf base (D). A B C SVX-037_EN D A. SERVO-i Mobile Cart B. Rotation of Patient Unit C. SERVO-i Holder D. SERVO-i Shelf Base 2

4 Overview of Ventilator EXTERNALLY ACCESSIBLE PARTS See next page for part descriptions... 3

5 2 Overview of Ventilator A B 1. Handle 2. Gas inlet for air 3. Gas inlet for O 2 4. Air/Luft 5. O 2 6. Model number 7. Serial number 8. Manufacturing information 9. Equipotentiality terminal, Label 10. Fuse label T 2.5AL 11. Mains power voltage 12. Mains supply inlet connector with fuse 13. Cooling fan with filter 14. Alarm output connection (option) 15. External + 12 V DC inlet 16. Fuse for external DC power supply 17. Optional connector 18. User Interface connector 19. RS232 connector 20. Expiratory outlet 21. Cover, inspiratory channel 22. Expiratory inlet Plug-in batteries and battery lock Important: To guarantee reliable battery backup, two fully charged battery modules should be installed at all times. 24. Module compartment Note: The slots are numbered (1, 2, 3... from top to bottom). 25. Nebulizer connector (only for Servo Ultra Nebulizer) Nebulizer Connector for nebulizer 26. Inspiratory outlet 4

6 Overview of Ventilator GAS FLOW THROUGH THE PATIENT UNIT The gases are mixed and delivered in the patient unit. It is essential that the flow delivery is fast and accurate, as it is mandatory to immediately sense the patient s inspiratory effort so that synchrony between the patient and the ventilator is achieved. This is even more important in infants as delays in gas delivery will make the patient susceptible to thoracoabdominal asynchrony. 5

7 2 Overview of Ventilator INSPIRATORY CHANNEL The Inspiratory section of the Patient Unit conveys the breathing gas from its inlets for Air and O 2 supply, to the patient breathing system ISI_0052_XX 1 1. Gas inlet for air 2. Gas inlet for O 2 3. The air and O 2 gas modules regulate the inspiratory gas flow and gas mixture. 4. The gases are mixed in the inspiratory mixing section. 5. The O 2 cell/o 2 sensor is mounted in a housing on the Inspiratory Pipe and measures the oxygen concentration. 6. A pressure transducer measures the pressure of the mixed gas delivered to the patient. The transducer connection is protected by a bacterial filter. 7. The Inspiratory Pipe delivers the mixed gas to the patient system's inspiratory tubing. A safety valve is also located in the Inspiratory Pipe. 6

8 Overview of Ventilator REGULATION OF INSPIRATORY GAS FLOW AND MIXTURE IN GAS MODULES SVX9003X 1. The filters protect the ventilator from any particles in the gas that is delivered to the gas modules. A non-return valve is located in the filter cover, and this valve suppresses short pressure drops in the gas supply. 2. The inspiratory valve temperature sensor measures the temperature of the supplied gas and is located in the gas flow. The output signal of this sensor compensates for gas density variations due to temperature. 3. The supply pressure transducer measures the pressure of the supplied gas. 4. A differential pressure transducer in the gas modules calculates flow delivery. 5. The plastic nozzle unit contains a valve diaphragm that regulates the gas flow through the gas modules and which is controlled by the inspiratory solenoid. 6. The current supplied to the inspiratory solenoid is regulated so that the gas module delivers a gas flow in accordance with settings on the User Interface. 7

9 2 Overview of Ventilator INSPIRATORY PIPE From the gas modules the gas flows to the connector muff and to the inspiratory pipe. The Inspiratory Pipe comprises: housing and locking lever for the O 2 cell and its bacteria filter or an O 2 sensor housing for the safety valve connection for measurement of the inspiratory pressure THE O 2 CELL 1 The O 2 cell (1) gives an output voltage proportional to the partial pressure of oxygen inside the inspiratory pipe. O 2 Air This cell is automatically calibrated each time a Pre-use check is performed. If the ventilator has been continually used for a long time, it is possible to temporarily adjust the reading of the O 2 concentration during ventilation. 8

10 Overview of Ventilator O 2 SENSOR The O 2 sensor is non-disposable and measures the O 2 concentration. No maintenance is required with the O 2 sensor, which is easy to install and environmentally friendly. PRINCIPLE OF O 2 SENSOR OPERATION The technique for the O 2 sensor is similar to the one in the expiratory cassette, with one transducer transmitting an ultrasonic pulse through the gas and the other one receiving the pulse. The measured time difference between the transmission and the reception of the pulse is then used for calculation of the sound velocity, which is then used for calculating the O 2 concentration. A temperature sensor inside the O 2 sensor measures the gas temperature and this measurement is also used when calculating the O 2 concentration. 9

11 2 Overview of Ventilator SAFETY VALVE 1 The axis of the safety valve solenoid controls the opening and closing of the safety valve membrane in the Inspiratory Pipe. The safety valve (1) will open if the pressure exceeds approximately 117 cmh 2 O. The solenoid will remain open during non-operational conditions. 10

12 Overview of Ventilator EXPIRATORY CASSETTE Gas from the patient breathing system goes through the expiratory channel which is designed to give the lowest possible expiratory resistance for the patient. The Expiratory cassette comprises: The patient breathing system's expiratory tubing is connected to the expiratory inlet. The inlet also contains a moisture trap. 2. The gas flow through the expiratory channel is measured by the ultrasonic flowmeter. The ultrasonic flowmeter is located on the expiratory pipe, on the outside of which is an electronic heating foil. This foil reduces condensation and maintains a stable temperature in the expiratory gas. 3. The expiratory pressure is measured by the expiratory pressure transducer (located inside the ventilator). The transducer is protected by a bacterial filter inside the expiratory cassette. 4. The pressure (PEEP) is regulated by the expiratory valve. The expiratory valve consists of a membrane in the cassette that is controlled by the expiratory valve coil. The valve is fully opened as long as no power is supplied to the coil. 5. Gas from the patient system leaves the ventilator via the expiratory outlet. The outlet contains a non-return valve. Note: The expiratory cassette can be exchanged between different SERVO-i ventilator systems. Always perform a Pre-use check after exchanging an expiratory cassette. 11

13 2 Overview of Ventilator 2.1 ULTRASONIC FLOWMETER The ultrasonic flowmeter is a measuring device for the expiratory gas flow, and comprises two ultrasonic transducers/receivers. ISI_0060_XX The transducer on the left-hand side sends out ultrasonic sound that reflects against the inner wall of the measuring channel, and is received by the transducer on the right-hand side (now acting as a receiver). The time taken from sending to receiving in downstream flow is measured. The transducer on the right-hand side (which was previously a receiver), now emits ultrasonic sound upstream which is received by the transducer on the left-hand side. Once again, the time taken from sending to receiving is measured. The time difference between the downstream and the upstream time measurements provide the flow information. 12

14 Overview of Ventilator THE USER INTERFACE GENERAL Via the ergonomically designed User Interface it is possible to carry out all SERVO-i functionality and access the information necessary for operating the SERVO-i ventilator. The screen is splash-proof and screen brightness is automatically adjusted depending on the ambient light level. Please do not use sharp tools or instruments on the screen. Data is shown as waveforms and/or in numerical format. Measured value boxes are always visible even while the ventilator is being set up, and alarm limits are shown adjacent to the measured values. 13

15 2 Overview of Ventilator OVERVIEW - FRONT OF USER INTERFACE Via the User Interface, the ventilator can be operated by: - pressing the soft keys on the touch screen - using the Main Rotary Dial to either select settings and/or change values - turning the Direct Access Knobs to instantly adjust vital parameters - pressing the Fixed Keys for fast access to certain functions a 3b 3c 3d 3e 4a 4b 4c 4d 7c 4e 4f g 4 4h 4i a 7b 7c 7d 6a 6b 6c 6d See next page for description of User Interface elements. 14

16 Overview of Ventilator 2 DESCRIPTION OF USER INTERFACE ELEMENTS 1. Patient Category 2. Waveform area (displays curves, loops and trends) 3. Menu Touch Pad a. Mode (showing active mode of ventilation) b. Automode (optional) c. Admit patient d. Nebulizer (optional) e. Status 4. Fixed keys for immediate access to special windows a. Bell - Silence/Pre-silence alarm b. Alarm Profile c. Save d. Trends e. Information (not implemented) f. Neural access g. Quick access h. Menu i. Main screen 5. Main Rotary Dial 6. Fixed keys for initiating special ventilatory functions a. Start breath b. O 2 breaths c. Expiratory hold d. Inspiratory hold 7. Direct Access knobs (for immediate adjustments to vital parameters) a. O 2 concentration b. PEEP level c. Respiratory Rate d. Tidal/Minute volume/pressure above PEEP/NAVA level 8. Mains indicator (green) 9. Standby indicator (yellow) 10. Start/Stop (Standby) ventilation key 11. On/Off switch (located on the back) 12. Slot for PC card 13. Luminescence detector (adjusts screen brightness automatically) 14. Informative text messages (a purple/pink symbol indicates patient triggering) 15. Alarm messages 16. Values - measured values 17. Additional Values touch pad 18. Additional Settings touch pad 15

17 2 Overview of Ventilator OVERVIEW - BACK OF THE USER INTERFACE Loudspeaker 2. Cable reel for control cable 3. Slot for PC card e.g. Ventilation Record Card 4. Screen rotation locking lever 5. Locking screw for mounting onto mobile cart (alternatively) 6. Control cable (2.9 m) between User Interface and Patient Unit 7. Service connector 8. On/Off switch 9. Locking arm to tilt the screen 16

18 Overview of Ventilator EXPLANATION OF USER INTERFACE ELEMENTS PATIENT CATEGORY (1) The symbols shown here indicates which patient category has been selected. The category can either be Adult or Infant and the choice affects pressure and flow regulation, safety limits, defaults and scaling WAVEFORM AREA (2) The waveform area monitors two to four parameters: 1. Pressure 2. Flow 3. Volume 4. CO 2 (optional) 5. Edi (optional) Pressure and flow curves are mandatory. The Measured value box shows measured/calculated values in figures. 17

19 2 Overview of Ventilator MENU TOUCH PAD (3) MODE (3A) 3a 7c Shows the current mode of ventilation. When this soft key is pressed, then the Set Ventilation Mode window is shown. To see all the available ventilation modes on the SERVO-i, press the current ventilation mode key (in this case PRVC ) to enter the Select Ventilation Mode window. 18

20 Overview of Ventilator 2 VENTILATION MODE PARAMETER SETTINGS After pressing the soft key for the chosen ventilation mode, the Set Ventilation Mode window appears with the current parameter settings for this mode. The window has an Accept and a Cancel soft key. Pressing the Accept soft key applies the new ventilator parameter settings. Pressing the Cancel soft key closes the window without applying the settings, and the ventilator will continue to ventilate with the original parameter settings. Some values, which are derived from parameter settings, are shown in the upper right field of the Set Ventilation Mode window to help the clinician adjust the parameter settings. These values include inspiration time in seconds/ I:E ratio and calculated inspiratory flow (depending on mode). 19

21 2 Overview of Ventilator PARAMETER BOXES Parameter boxes are soft keys showing the parameter name together with a value and its unit. Moreover, there is a bar that graphically represents the numeric value, which gives the clinician feedback about the parameter ranges. Color of bar white yellow red Explanation the parameter setting is within what is generally considered to be the safe range. then the setting is slightly beyond the safe range. then the setting is significantly beyond the safe range. This graphical representation makes it easy to set parameters and alerts the user if any parameter settings are outside the normal range. There is also a help-text in the upper left-hand corner of the screen if any parameter setting exceed the normal range. To set a parameter, use the Main Rotary Dial. Press either the soft key Accept to apply the new ventilation settings or Cancel. 20

22 Overview of Ventilator 2 AUTOMODE (OPTIONAL) - (3B) 3b 7c Automode is an interactive mode of ventilation where the combined control and support function of the ventilator adapts to the patient s breathing capacity. When this option is chosen, a green light is activated in the menu touch pad when the patient breathes spontaneously. 21

23 2 Overview of Ventilator ADMIT PATIENT (3C) 3c 7c By pressing the soft key Admit Patient the clinician can either enter new patient data or amend existing patient details, such as: Name ID Birth date Date of admission Height Weight Important: For an Adult the weight is given in kilograms and for Infant the weight is given in grams. 22

24 Overview of Ventilator 2 When Name and ID are selected a keyboard appears on the display screen and the information can be entered using the relevant soft keys. Press Close keyboard to return to the menu and continue entering patient data. Similarly, when Birth date, Admit date, Height and Weight are selected, a numeric keyboard appears on the display screen. Press Close keyboard to return to the menu and continue with admission. When all data has been entered press either Accept or Cancel. 23

25 2 Overview of Ventilator If the data is accepted, then a message appears with the information that the patient data and event log recorded prior to the latest Standby will be deleted. 24

26 Overview of Ventilator 2 NEBULIZER (OPTIONAL) - (3D) 3d 7c Pressing the Nebulizer soft key turns the nebulizer on or off. It is possible to set the duration of nebulization to between 5 and 30 minutes. The default time is 10 minutes. During nebulization the time remaining is displayed in the nebulizer touch pad. The nebulizer is automatically disabled during battery operation. 25

27 2 Overview of Ventilator STATUS (3E) 3e 7c When the Status soft key is pressed, technical information about the ventilator, installed modules and the outcome of the Pre-use check is presented on the screen. The icon on the Status soft key displays which power source is currently active, i.e. Mains, Ext. 12V, or plug-in battery. When the plug-in batteries are in use, the remaining time in minutes is also shown. 26

28 Overview of Ventilator 2 GENERAL Information is displayed about: Version System version System SW version Serial no. Total operating time Next Preventive Maintenance Battery backup time Barometric pressure Air pressure O 2 pressure Pre-use check Patient circuit test Previous pre-use check 27

29 2 Overview of Ventilator O 2 CELL Information is displayed about: Article number Serial number Batch number Date of first use Last calibration Estimated remaining capacity (in %) O 2 SENSOR Article no. Serial no. Date of first use Last calibration 28

30 Overview of Ventilator 2 EXPIRATORY CASSETTE Information is displayed about: Article number Serial number Date of first use Total operating time (in hours) Remaining membrane capacity (in %) 29

31 2 Overview of Ventilator BATTERIES The following information is displayed about each of the battery modules mounted in the ventilator: Usable backup time for the ventilator. (see Note ) Slot number Serial number Charge indicator* Remaining operating time in minutes Activity instruction (displayed next to the remaining operating time in minutes.) * Boxes filled Relative charge Notes: 0 <10% 1. The total usable backup time is the sum % of the estimated operation time displayed for each battery module, % minus 10 minutes % 2. This time is also displayed during battery % operation on the Status soft key and in the Status window. 30

32 Overview of Ventilator 2 MODULES Information is displayed about which modules are installed in the ventilator, e.g.: CO 2 Module Y Sensor Measuring Edi Module CO 2 MODULE Information is displayed about: Module serial number Module software version Module hardware version Sensor Serial number Last verification or Cell zeroing depending on which procedure was chosen. 31

33 2 Overview of Ventilator Y SENSOR MEASURING The Y Sensor Measuring function allows for the measurement of pressure and flow as close as possible to the patient. Information is displayed about: Module serial number Module software version Module hardware version Sensor type EDI MODULE Information is displayed about: Module serial number Module software version Module hardware version Last test result Last test time Edi Catheter 32

34 Overview of Ventilator 2 INSTALLED OPTIONS Information displayed about which options are installed in the ventilator, e.g: Automode Open Lung Tool Alarm output connector NIV Nasal CPAP Software version 3 Low MV alarm audio off Heliox Nebulizer CO 2 Analyzer Y Sensor Measuring NAVA PRE-USE CHECK Information displayed about the outcome and the parameters/functions checked during the Pre-use check (2 pages). 33

35 2 Overview of Ventilator FIXED KEYS (4) Alarm Profile Save Trends i Neural access BELL (4A) 4a If the Bell fixed key is pressed, alarms are silenced, an alarm silence symbol is shown (i.e. a crossed-over bell) and the remaining time is indicated. 7c Alarms can cause patients stress which is why it is important to pre-silence alarms where appropriate e.g. before disconnecting the patient tube system. 34

36 Overview of Ventilator 2 If the Bell fixed key is simultaneously pressed and held for more than two seconds, then alarms are pre-silenced, and an alarm silence symbol with two bells is shown. Pre-silencing can be cancelled by pressing the Bell fixed key for more than two seconds once again. 35

37 2 Overview of Ventilator ALARM PROFILE (4B) When the "Alarm profile" fixed key is pressed, the "Alarm profile" window appears on the screen together with the current alarm settings. 4b 7c From this window the following actions can be carried out: setting up alarm profiles for different parameters. adjusting pre-set alarm limits selecting Autoset limits adjusting the sound level 36

38 Overview of Ventilator 2 In spontaneous modes of ventilation an alarm setting for apnea time is available. 37

39 2 Overview of Ventilator ALARM LIMITS The SERVO-i has either factory or customer-configured alarm limit default values. These limits are valid until they are adjusted either before or after connection to a patient. When an alarm limit is exceeded, the corresponding measured value box flashes: red for a high priority alarm (1) or yellow for a medium priority alarm (2). Alarm limits are shown in small figures to the right of the corresponding measured value (3), and an arrow indicates which setting has caused the alarm (4). 1. High priority alarm 2. Medium priority alarm 3. Alarm limits 4. Setting which caused the alarm 38

40 Overview of Ventilator 2 SAVE (4C) The fixed key Save can be used either to: 4c 7c save one recording, or copy the screen onto a Ventilation Record Card RECORDING When the Save fixed key is pressed, then the current curve values over a 20-second period (10 seconds before and 10 seconds after pressing Save ), are recorded and stored in the memory, together with parameter values. The message Recording is shown above the curves. 39

41 2 Overview of Ventilator If recording is started immediately after altering the settings, then the values from the previous breath may be displayed. This is because the new settings are implemented at the start of the first breath after the operator has accepted the change. Note: Recorded data can be displayed later via the "Menu" fixed key. Recorded data will be erased when the Admit Patient soft key is pressed. During the Start-up procedure, the question Do you want to delete patient data, trends and event log? will appear. This ensures that the recording and any other patient data is kept if there has been a temporary shutdown. Only one recording at a time can be saved. A new recording is saved in the memory and replaces the earlier stored values. Note: The ventilator settings and numeric values recorded during a 20-second sequence can be saved on a Ventilation Record Card (PC-Card). It is possible to store several recordings by exporting them one at a time to the Ventilation Record Card (Chapter 7 "Patient Data"). 40

42 Overview of Ventilator 2 TRENDS (4D) Data can be recorded over a period of time up to 24 hours, and the time resolution is displayed in the trend graph. When the Trend fixed key is pressed, the Trend graphs window appears on the screen. 7c4d Notes: 1. Please note that the Trend graphs window can also be accessed via the fixed key Menu. 2. The Trend graphs window and recorded waveforms are described in more detail in Chapter 7 Patient Data. 41

43 2 Overview of Ventilator NEURAL ACCESS (4F) 7c 4f The "Neural access" fixed key opens a menu with the following choices: Edi Catheter positioning NAVA preview Neuro Vent. Tool NVT scales 42

44 Overview of Ventilator 2 QUICK ACCESS (4G) 7c 4g The circular Quick Access fixed key gives access to: Suction Support Loops Waveform scales Waveform configuration Open Lung Tool Open Lung Tool Scales 43

45 2 Overview of Ventilator SUCTION SUPPORT There are three phases of suction support: phase 1 - Preparation phase phase 2 - Disconnect phase (ventilation discontinued, alarms deactivated) phase 3 - Post-oxygen phase 44

46 Overview of Ventilator 2 LOOPS Loops are graphs that show two measured values: one measured value (x-axis) against another measured value (y-axis). Loops are updated breath-by-breath, and there are two types of loop available: volume-pressure flow-volume REFERENCE LOOPS It is possible to store a reference loop to which the latest loop is presented as an overlay. If desired, the user can present multiple loops (i.e. the latest three loops) on the screen, together with the reference loop. 1. = current loop 2. = reference loop 3. = time for reference loop 4. = press to save reference loop 5. = overlay x 2 45

47 2 Overview of Ventilator WAVEFORM SCALING (SCALES) The following scales can be set manually: Pressure scale (cmh 2 O) Flow scale (l/min) Volume scale (ml) CO 2 (Vol. %) Edi scale (microvolt) Sweep speed (mm/s) The sweep speed mm/s can be set to 5, 10, or 20 mm/s (default). WAVEFORM CONFIGURATION In SERVO-i versions 1.2 and above it is possible to view 2, 3 or 4 curves simultaneously, although pressure and flow curves are mandatory. 46

48 Overview of Ventilator 2 OPEN LUNG TOOL (OLT) Using the OLT it is possible to observe the following parameters graphically breath-by-breath: End Inspiratory Pressure (EIP) PEEP Inspiratory tidal volume Expiratory tidal volume Dynamic Compliance i Tidal CO 2 elimination (optional) OPEN LUNG TOOL SCALES The scaling can be set manually: Pressure scale (cmh 2 O) Volume scale (ml) Compliance scale (ml/cmh 2 O) VTCO 2 scale (ml) 47

49 2 Overview of Ventilator MENU (4H) 7c 4h The circular Menu fixed key gives access to the menu window. Alarm Review Options Compensate Copy Biomed Panel lock Change patient category 48

50 Overview of Ventilator 2 ALARM By pressing the Alarm soft key the following functions are accessible: Profile History Silence alarm (See Chapter 4 Alarms for more information). REVIEW By pressing the Review soft key the following functions are accessible: Trends Recorded waveforms Event log View configuration (See Chapter 7 Patient data for more information). 49

51 2 Overview of Ventilator TRENDS Data can be recorded over a period of time up to 24 hours, the time resolution is displayed in the trend graph. RECORDED WAVEFORMS Data recorded after pressing the Save fixed key is displayed as Recorded waveforms and can also be accessed via the trend graphs. 50

52 Overview of Ventilator 2 EVENT LOG All events such as ventilation modes, alarms and settings can be reviewed in chronological order. VIEW CONFIGURATION In this window it is possible to see the configuration of: Alarms General Units Displayed values Startup configuration 51

53 2 Overview of Ventilator OPTIONS The CO 2 module, etco 2 Capnostat III sensor and airway adapter are not included in the normal Pre-use check. It is therefore recommended to verify the CO 2 sensor by pressing the "CO 2 calibration" soft key. (See Chapter 9 CO 2 Analyzer for more information). 52

54 Overview of Ventilator 2 COMPENSATE It is possible to compensate for both gas type and compliance. The circuit compliance value is calculated either during the Pre-use check or the Patient circuit test. The calculated value is displayed in the window. Circuit compliance compensation in ml/cmh 2 O The date of the latest calibration A message Do you want to deactivate/activate compliance compensation? appears on the screen. To activate or deactivate, press the appropriate soft key. 53

55 2 Overview of Ventilator COPY Copy data It is strongly recommended to use a Ventilation Record Card when copying all patient data and log files. Copy screen By pressing the Copy Screen soft key it is possible to configure the Save fixed key so that it captures the image on the User Interface. This image will be saved onto the PC card for later analysis, teaching purposes, and research. Configure the Save fixed key to make screen copies by pressing the soft keys Copy and then Copy Screen (See Chapter 7 Patient data for more information). 54

56 Overview of Ventilator 2 BIOMED DURING VENTILATION O 2 cell adaptation If the ventilator has been in continuous use for a longer period of time, the measured O 2 concentration may drop due to normal degradation of the O 2 cell. In order to avoid a nuisance alarm in this situation, it is possible to temporarily adjust the reading of the O 2 concentration during ventilation. By pressing the soft key O 2 cell adaptation, the measured O 2 concentration will be adapted in relation to the set O 2 concentration. This adjustment will only remain valid until the ventilator is switched off. Note: This soft key function is not needed or available when the O 2 sensor is installed. 55

57 2 Overview of Ventilator Biomed via Standby mode The Biomed window can also be accessed from Standby mode, for example to alter the Startup configuration. The following functions are accessible via the Biomed window after entering the access code: Service Edit configuration Copy configuration Set date and clock Change access code Start MCare Remote Service 56

58 Overview of Ventilator 2 Service To be accessed by technical personnel only. Edit configuration The following parameters can be edited from the Edit configuration window: Alarm sound level Adult alarm limits Infant alarm limits Displayed values NIV adult alarms NIV infant alarms Startup configuration 57

59 2 Overview of Ventilator Alarm sound level In the Set default alarm sound level window it is possible to set the alarm sound level as a default. Adult alarm limits In the Edit invasive default adult alarm limits window it is possible to adjust default adult alarm limits. 58

60 Overview of Ventilator 2 Infant alarm limits In the Edit invasive default infant alarm limits window it is possible to adjust default infant alarm limits. Displayed values In the Displayed values window it is possible to configure the default displayed measured values. 59

61 2 Overview of Ventilator NIV adult alarms In the Edit NIV default adult alams window it is possible to configure the default NIV adult alarms. NIV infant alarms In the Edit NIV default infant alams window it is possible to configure the default NIV infant alarms. 60

62 Overview of Ventilator 2 Startup configuration In the Edit startup configuration window it is possible to change the Startup configuration. Copy configuration Via the Copy configuration menu it is possible to copy both the system and customer configuration to another ventilator via a PC card. If the user selects Copy to card then the successful copying procedure is confirmed on the screen. When the user selects Copy from card then the configuration is copied to the SERVO-i. 61

63 2 Overview of Ventilator Set date and clock The date and time can be set In the Set date and clock window. Change access code The access code to gain access to the Biomed window can be changed in the Change access code window. 62

64 Overview of Ventilator 2 PANEL LOCK By pressing the soft key Panel lock all settings and the touch screen are locked (except for the crossed "Bell" symbol i.e. the "Silence/Pre-silence alarm). To unlock press the fixed key Main screen. 63

65 2 Overview of Ventilator CHANGE PATIENT CATEGORY By pressing the soft key Change patient category, the patient category can be changed whilst the ventilator is in running mode. The patient category symbol will start to flash. Note: When the Tidal Volume is below 100 ml, then it is not possible to change from the Infant to Adult range. The ventilator tries to transfer the settings and alarm limits from the present patient category to the new patient category. However, when this is not possible the ventilator selects those values that are the closest. By pressing Yes the patient category symbol changes to the newly selected patient category and the category is changed. It is important to verify the settings and, if necessary, adjust them. To close the window press "Accept". The message Check alarm limits is displayed. The alarm profile may need to be adjusted. 64

66 Overview of Ventilator 2 MAIN SCREEN (4I) 7c 4 i Return to the main screen by pressing the "Main screen" fixed key. This action cancels current work from any position in the Menu or dialog windows. 65

67 2 Overview of Ventilator MAIN ROTARY DIAL (5) The Main Rotary Dial is a hardware dial that provides a means of selecting on-screen elements and changing values. 7c 5 To change a setting, turn the Main Rotary Dial until the desired menu touch pad is marked with a blue frame. When the dial is pressed to confirm that the correct touch pad is highlighted, then this touch pad is highlighted in white with a blue frame. Change the values by first turning the dial until the desired value is reached, and then press the dial to confirm the new settings. 66

68 Overview of Ventilator SPECIAL FUNCTION KEYS (6) Start breath O 2 breaths Exp. hold Insp. hold START BREATH (6A) When the Start breath fixed key is pressed the system delivers a breath according to the current parameter settings. 7c 6a 5 The breath cycle starts, at the earliest, 100ms into the expiration phase of the previous breath, and a message Operator-initiated breath is displayed at the top-left of the User Interface, indicating that a breath has been initiated. Information about the Start breath activation is logged together with the date and time. Start breath can be used to start up a sequence in SIMV (Synchronized Intermittent Mandatory Ventilation). 67

69 2 Overview of Ventilator O 2 BREATHS (6B) Press the fixed key O 2 breaths when it is desirable to give the patient 100% oxygen for a short time. 7c 6b 5 The system delivers 100% oxygen for one minute, and the message Oxygen breaths active is displayed on the User Interface. Alarms are pre-muted. After one minute the O 2 parameter setting returns to the previous value which is shown on the screen. O 2 breaths can be cancelled by re-pressing the fixed key O 2 breaths. 68

70 Overview of Ventilator 2 EXPIRATORY HOLD (6C) 7c 6c 5 When the expiration phase is completed, the expiratory and inspiratory valves close for as long as the fixed key Exp. hold is depressed (up to a maximum of 30 seconds). The message Exp. hold active is displayed on the top left-hand side of the User Interface. Expiratory hold provides a measurement of the end expiratory pause pressure. Moreover, by pressing the "Exp hold" fixed key, a calculation of total PEEP will be carried out. The fixed keys "Exp. hold" and "Insp. hold" are used for the calculation of Static compliance. 69

71 2 Overview of Ventilator INSPIRATORY HOLD (6D) 7c 5 6d When the inspiration phase is completed, the inspiratory and expiratory valves close for as long as the fixed key Insp. hold is depressed (up to a maximum of 30 seconds). The message Insp. hold active appears on the User Interface. Inspiratory hold provides a measurement of the end inspiratory pressure. Moreover, it is possible to determine the Pplat by pressing the Insp. hold fixed key. The fixed keys "Exp hold" and "Insp hold" are used for the calculation of static compliance. 70

72 7c Overview of Ventilator DIRECT ACCESS KNOBS (7) 7 By turning the Direct Access Knobs it is possible to immediately adjust the vital parameters named below. O 2 concentration PEEP level Respiratory Rate Tidal/Minute volume/pressure above PEEP/NAVA level However, which of these parameters is available depends on the ventilation mode. Whether Tidal volume or Minute Volume appears depends on how the ventlator is configured. In Pressure modes of ventilation, then PC (Pressure control) above PEEP or PS (Pressure support) above PEEP will appear instead of Tidal/Minute Volume. 71

73 2 Overview of Ventilator ADJUSTING THE PARAMETERS Turn the knob to the desired value shown in the corresponding Set parameter box above the knob (1) O 2 conc. PEEP Resp. Rate Tidal Volume Color of Bar white (2) yellow (3) red (4) Explanation the setting is within what are generally considered to be safety limits. the setting is too low or too high compared to safety limits (advisory information). the setting is significantly outside the safety limits" (advisory warning, accompanied by an audible signal and an advisory message). Note: When a Direct Access Knob is turned, then ventilation changes accordingly from the next breath without additional confirmation. Note: When a safety limit is reached, the Direct Access Knob will be inactive for 2 seconds. This is a safety precaution intended to highlight the fact that a safety limit has been exceeded. 72

74 Overview of Ventilator MAINS INDICATOR (8) A green lamp indicates that the mains is connected (1). Note: The plug-in batteries continue to charge when connected to the mains supply STANDBY IND./START-STOP VENTILATION (9,10) A yellow lamp indicates the system is in Standby mode (2). When in Standby mode, push the function key (3) to start ventilation. Return to Standby mode by pressing the function key and confirm. 73

75 2 Overview of Ventilator ON/OFF SWITCH (11) From the "Off" position (1), turn the ventilator on by moving the switch to the right (2). The protective cover is released (3) and closes (4). The status of the ventilator is now "On" OFF ON 74

76 Overview of Ventilator SLOT FOR PC CARD (12) There is a PC card slot on the side of the User Interface which can be used for installing software upgrades or using the Ventilation Record Card LUMINESCENCE DETECTOR (13) Depending on the ambient light levels, screen brightness is automatically adjusted using the luminescence detector

77 2 Overview of Ventilator INFORMATIVE TEXT MESSAGES (14) 14 7c A "T" appears between the text messages and alarm messages when the patient triggers a breath. If the trigger is pneumatic (flow/pressure), the color of the "T" is purple (as illustrated above and to the right), while the color used for neural triggering when NAVA is being run is pink. T 76

78 Overview of Ventilator ALARM MESSAGES (15) 15 7c If an alarm limit is exceeded, the measured value box changes color. red for a high priority alarm yellow for a medium priority alarm An arrow (1) indicates which setting has caused the alarm. The current alarm is displayed in the alarm message area (2). If there is more than one alarm, the one with highest priority will be shown. When the bell symbol soft key (3) in the alarm message is pressed, all active alarms are shown. Notes: 1. The O 2 concentration box does not contain information on set alarm limits. The limits are set automatically to set concentration ±6 vol% but never lower than 18 vol%. 2. The PEEP box does not contain information on set End Exp.Pressure Alarm Limits. 77

79 2 Overview of Ventilator MEASURED VALUES (16) 16 7c Measured/calculated values are shown numerically on the right side of the screen, and they are grouped and color-coded according to the curves/loops shown. The variables displayed in the measured value box are listed in Chapter 6 "Numerics". Alarm limits are shown when applicable, in small figures to the right of the corresponding value. If compressible volume compensation is selected an orange box will highlight volume measurement and an orange C will appear in the upper left corner. Three pages of measured values are available. By pressing the soft key Additional Values it is possible to scroll between pages. For a complete table of measured values please refer to Chapter 6 "Numerics". 78

80 Overview of Ventilator ADDITIONAL VALUES (17) 7c 17 The next page shows additional values which are also grouped and color-coded according to the curves/loops shown. To access the third page of additional values press the soft key Next page. Lung mechanics values are shown on the third page. To display some of these calculated values, Inspiratory hold and/or Expiratory hold must be used. 79

81 2 Overview of Ventilator ADDITIONAL SETTINGS (18) 7c 18 To view the additional settings available for the current ventilation mode, press the Additional settings soft key when the additional values are shown on the User Interface. Additional settings are shortcuts for adjusting parameter values while ventilating. The curves and measured values remain visible in an adjacent window so the effects of the adjustments can be observed. The additional settings cannot be accessed if the ventilator is in "Standby" mode. 80

82 Overview of Ventilator 2 CHANGE ADDITIONAL SETTINGS Under the Additional settings window there is a help window which shows values derived from some settings. Note: To confirm the changed settings, press the Main Rotary Dial or the soft key for the actual parameter (the soft key turns grey). Set vital parameters using the Direct Access Knobs. The waveforms and measured values are visible next to the Additional Settings window, thus the effects of the adjustments can be checked immediately. Press the Close soft key to close the window. 81

83 2 Overview of Ventilator TRIGGER SETTING The color of the trigger sensitivity bar depends on the setting: The bar is green for flow triggering The bar is red when there is a risk of self-triggering A white bar indicates that pressure triggering is required PATIENT TRIGGERING A purple T appears between the text messages and alarm messages area when the patient triggers a breath pneumatically. If the breath is neurally triggered in NAVA, the "T" is pink. T The initial part of the pressure or flow curves changes to purple to indicate patient triggering. If the breath is flow triggered, the start of the flow curve turns purple to indicate patient triggering. If the breath is pressure triggered, the start of the pressure curve turns purple to indicate patient triggering. However, if the breath is neurally triggered, the start of the Edi curve turns pink to indicate this. 82

84 Overview of Ventilator CONFIGURATION VIA FIELD SERVICE SYSTEM (FSS) It is possible to configure the SERVO-i to start up with a Tidal Volume based on body weight. It is also possible to change the date format, decimal separator, language, units (e.g. kpa, mmhg etc). In order to access FSS contact the local MAQUET representative. 83

85 2 Overview of Ventilator 84

86 Maquet Critical Care AB All rights reserved. MAQUET reserves the right to modify the design and specifications contained herein without prior notice. Order No. MX-0719 Printed in Sweden Rev: 00 English Maquet Critical Care AB Röntgenvägen 2 SE Solna, Sweden Phone: +46 (0) For local contact: Please visit our website

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