Information in this section is taken from the ventilator operator’s manuals, brochures, and websites created by the manufacturers. The Avea ventilator (Figure 10-15) is designed for intensive care ventilation of neonatal, pediatric, and adult patients. FIGURE 10-15 Avea ventilator. Reproduced with permission from Vyaire. The Avea has an operator interface that uses a touch screen, buttons, and a control knob (Figure 10-16). Screen displays show ventilator settings, alarm settings, and monitored values using waveforms or digital values. Settings are entered by touching a virtual button on the screen to select the desired setting, turning the knob to select the setting value, and then pressing the ACCEPT button to finalize the setting. The real buttons provide various features related to menu navigation, alarm silencing, suctioning, temporary (2 minutes) 100% oxygen delivery, manual breath trigger, and expiratory hold. FIGURE 10-16 Avea operator interface. A. Alarm silence (LED). B. Alarm reset. C. Alarm limits. D. Manual breath. E. Suction (LED). F. Increase O2. G. Data dial. H. Accept. I. Cancel. J. Expiratory hold. K. Inspiratory hold. L. Nebulizer. M. Patient size. N. Panel lock (LED). O. Print. P. Set-up. Q. Advanced settings (LED). R. Mode. S. Event. T. Freeze. U. Screens. Reproduced with permission from CareFusion. Modes are selected by pressing the virtual button with the desired mode name. There are 10 basic mode names but a variety of advanced settings (Table 10-6). Some of these advanced settings actually change the mode (Table 10-7), resulting in many more modes by classification (Table 10-8). TABLE 10-6 Advanced Mode Settings for Avea Advanced Setting Action Volume Limit For pressure control modes, this sets a volume cycle threshold. Note that volume cycling of a Pressure Support breath changes it from spontaneous to mandatory. Machine Volume For pressure control modes, this allows a volume target and flow and activates dual targeting. The operator sets the target volume, and the ventilator calculates the target flow as the volume divided by the set inspiratory time. If flow decays to this flow target and the volume has not been delivered, then inspiration switches to volume control with constant flow until the volume has been delivered. Inspiratory time remains constant. Machine Volume overrides Flow Cycle setting if activated. Flow Cycle For pressure control modes, this changes the cycle criterion from time to flow and sets the threshold for inspiratory flow termination as a percentage of peak flow. Demand Flow For volume control modes, this sets a ventilator-determined pressure target and activates dual targeting. If inspiratory pressure decreases 2 cm H2O (due to patient inspiratory effort), volume control switches to pressure control. If the set volume is delivered and flow is equal to the set flow, inspiration is volume cycled. Otherwise, inspiration is flow cycled at 25% of peak flow. Vsync Switches the mode from volume control to pressure control with adaptive targeting. Inspiratory pressure is automatically adjusted to maintain an average tidal volume equal to the set volume. TABLE 10-7 Controls and Mode Names for Avea Ventilator *Available with Vsync activated for adult or pediatric patients only. **Available for adult and pediatric patients only. TABLE 10-8 Classification of Modes for Avea Control variables: PC = pressure control, VC = volume control. Breath Sequences: CMV = continuous mandatory ventilation, CSV = continuous spontaneous ventilation, IMV(1) = intermittent mandatory ventilation type 1 where mandatory breaths are delivered at the set frequency, IMV(2) = intermittent mandatory ventilation type 2 where mandatory breaths may be suppressed by spontaneous breath frequency, IMV(3) = intermittent mandatory ventilation type 3 where mandatory breaths may be suppressed by spontaneous minute ventilation, IMV(4) = intermittent mandatory ventilation where mandatory breaths may be suppressed in dual targeting by switch volume cycling to flow cycling. Targeting scheme abbreviations: s = set point, d = dual, r = servo, b = biovariable, a = adaptive, o = optimal, i = intelligent. NA = not available. Reproduced with permission from Mandu Press Ltd., Cleveland, OH. The advanced settings increase both flexibility and confusion. For example, the mode named Volume Control A/C is classified as volume control continuous mandatory ventilation with set-point targeting (VC-CMVs). However, adding the Vsync and Flow Cycle advanced settings to this mode turns it into pressure control intermittent mandatory ventilation with adaptive and set-point targeting (PC-IMVa,s)—a very different mode indeed. When Artificial Airway Compensation is turned on, the ventilator automatically calculates the pressure drop across the endotracheal tube and adjusts the airway pressure to deliver the set inspiratory pressure to the distal (carina) end of the endotracheal tube. This calculation takes into account flow, gas composition (heliox or nitrogen/oxygen), fraction of inspired oxygen (Fio2), tube diameter, length, and pharyngeal curvature based on patient size (neonatal, pediatric, or adult). This compensation occurs only during inspiration. Artificial Airway Compensation is active in all Pressure Support and Flow Cycled Pressure Control breaths. Backup ventilation: Apnea Backup Ventilation is available in Assist Control, SIMV, CPAP/PSV, and APRV/Biphasic modes. Gas volume compensation: The Avea supports compensation for BTPS and atmospheric temperature and pressure, dry (ATPD) conditions. When the Circuit Compliance option is active, the volume of gas delivered during a volume-controlled or volume-targeted breath is increased to include the set volume plus the volume lost due to the compliance effect of the circuit. Circuit Compliance is active for the set tidal volume during volume control ventilation, the target tidal volume in PRVC mode, and machine volume. It is active only in adult and pediatric applications. Leak compensation: The ventilator incorporates a leak compensation system. This system compensates for baseline leaks at the patient interface. Miscellaneous: The Avea offers a port to allow independent lung ventilation (ILV). Independent lung ventilation allows two ventilators to be synchronized to the same breath rate (the rate control set on the master ventilator), whereas all other primary and advanced controls for each ventilator can be set independently. Master and slave ventilators need not operate in the same mode during ILV. This ventilator is unique in its ability to monitor esophageal pressure with an optional esophageal balloon and calculate related respiratory system mechanics from the signal. The Avea also allows volumetric capnography using an optional exhaled CO2 monitor. The ventilator supports flow measurements at the airway using either a hot wire flow sensor or a pressure differential flow sensor. The Avea can deliver heliox blended gas instead of medical air. By simply changing a connector on the back panel, the ventilator identifies the gas input and adjusts to accommodate the change. All volumes (numeric and graphic) are automatically compensated for accurate display. Nebulizer: The ventilator supplies blended gas to the nebulizer port for an in-line jet nebulizer. Delivery of the nebulized gas is synchronized with the inspiratory phase of a breath and lasts for 20 minutes. Neonatal ventilation: The Avea offers Infant Nasal CPAP, designed to work with standard two-limbed neonatal patient circuits and nasal prongs. There is also a Nasal Intermittent Mandatory Ventilation mode (PC-IMVs,s), which provides time-triggered, time-cycled mandatory breaths that are pressure controlled. Noninvasive ventilation: The only explicitly noninvasive modes on the Avea are the neonatal modes Infant Nasal CPAP and a Nasal Intermittent Mandatory Ventilation mode (PC-IMVs,s). The manufacturer’s specifications are provided in Table 10-9. TABLE 10-9 Specifications for the Avea Ventilator Setting Category Setting Range Pressure Inspiratory pressure 0–90 cm H2O Pressure support 0–90 cm H2O PEEP 0–50 cm H2O Volume Tidal volume 0.025–2.50 L Flow Inspiratory flow 3–150 L/min Waveform Square/descending ramp Time Inspiratory time 0.2–5.0 s Mandatory breath frequency 1–150/min Adjustable rise time Yes Sensitivity Trigger Sensitivity (pressure) 0.1–20.0 cm H2O Trigger Sensitivity (flow) 0.1–20.0 L/min Alarm Category Setting Range Pressure High peak pressure 10–105 cm H2O Low peak pressure 3–99 cm H2O Low PEEP 0–60 cm H2O Volume High exhaled tidal volume 0.002–3.0 L Low exhaled tidal volume 0–3.0 L Flow High exhaled minute volume 0–75 L/min Low exhaled minute volume 0–50 L/min Time Apnea interval 6–60 s High rate 1–200/min Other O2 sensor Enabled/disabled Monitored Parameters Setting Range Exhaled tidal volume Inspired tidal volume Spontaneous tidal volume Mandatory tidal volume Delivered machine volume % Leak Minute volume Spontaneous minute volume Breath rate Inspiratory time Exhalation time I:E ratio Rapid shallow breathing index Peak inspiratory pressure Mean airway pressure Plateau pressure PEEP Air inlet gas supply pressure Oxygen inlet gas supply pressure Delivered % O2 Dynamic compliance Respiratory system compliance Respiratory system resistance Peak inspiratory flow rate Peak expiratory flow rate Lung compliance CCW Total inspiratory resistance Peak expiratory resistance Airway resistance Rlung ΔPaw ΔPes AutoPEEP ΔAutoPEEP AutoPEEPES Ptp Plat Ptp PEP Maximum negative airway pressure WOBV WOBP WOBT The Vela ventilator (Figure 10-17) is intended to provide continuous or intermittent ventilatory support for the care of adult and pediatric patients weighing at least 11 lb (5 kg). The ventilator is suitable for use in institutional and transport settings. It is not intended for use as an emergency medical transport ventilator or home care applications. FIGURE 10-17 Vela ventilator. Reproduced with permission from Vyaire. The Vela has an operator interface that uses a touch screen, buttons, and a control knob (Figure 10-18). Screen displays show ventilator settings, alarm settings, and monitored values using waveforms or digital values. Settings are entered by touching a virtual button on the screen to select the desired setting, turning the knob to select the setting value, and then pressing the ACCEPT button to finalize the setting. The real buttons provide various features related to menu navigation, alarm silencing, suctioning, temporary (2 minutes) 100% oxygen delivery, manual breath trigger, and expiratory hold. FIGURE 10-18 Vela operator interface. Reproduced with permission from Vyaire. Modes are selected by pressing the virtual button with the desired mode name. There are 11 basic mode names, but there are a variety of advanced settings (Table 10-10). Some of these advanced settings actually change the mode (Table 10-11), resulting in 17 different modes by classification (Table 10-12). TABLE 10-10 Advanced Mode Settings for the Vela Advanced Setting Action Volume Limit When the volume delivered in a pressure control mode exceeds the preset limit, inspiration is terminated. Assured Volume For pressure control modes, this sets a volume target and flow and activates dual targeting. The operator sets the target volume and the ventilator calculates the target flow as the volume divided by the set inspiratory time. If flow decays to this flow target and the volume has not been delivered, then inspiration switches to volume control with constant flow until the volume has been delivered. Inspiratory time remains constant. Flow Cycle For pressure control modes, this changes the cycle criterion from time to flow and sets the threshold for inspiratory flow termination as a percentage of peak flow. Demand Flow For volume control modes, this sets a ventilator-determined pressure target and activates dual targeting. If inspiratory pressure decreases 2 cm H2O (due to patient inspiratory effort), volume control switches to pressure control. If the set volume is delivered and flow is equal to the set flow, inspiration is volume cycled. Otherwise, inspiration is flow cycled at 25% of peak flow. Vsync Switches the mode from volume control to pressure control with adaptive targeting. Inspiratory pressure is automatically adjusted to maintain an average tidal volume equal to the set volume. Reproduced with permission from Mandu Press Ltd. TABLE 10-11 Primary Controls and Mode Names for the Vela Reproduced with permission from Mandu Press Ltd. TABLE 10-12 Classification of Modes for the Vela Control variables: PC = pressure control, VC = volume control. Breath Sequences: CMV = continuous mandatory ventilation, CSV = continuous spontaneous ventilation, IMV(1) = intermittent mandatory ventilation type 1 where mandatory breaths are delivered at the set frequency, IMV(2) = intermittent mandatory ventilation type 2 where mandatory breaths may be suppressed by spontaneous breath frequency, IMV(3) = intermittent mandatory ventilation type 3 where mandatory breaths may be suppressed by spontaneous minute ventilation, IMV(4) = intermittent mandatory ventilation where mandatory breaths may be suppressed in dual targeting by switch volume cycling to flow cycling. Targeting scheme abbreviations: s = set point, d = dual, r = servo, b = biovariable, a = adaptive, o = optimal, i = intelligent. NA = not available. Reproduced with permission from Mandu Press Ltd. The advanced settings increase both flexibility and confusion. For example, the mode named Volume Control A/C is classified as volume control continuous mandatory ventilation with set-point targeting (VC-CMVs). However, adding the Vsync and Flow Cycle advanced settings to this mode turns it into pressure control intermittent mandatory ventilation with adaptive and set-point targeting (PC-IMVa,s)—a very different mode indeed. Backup ventilation: Apnea ventilation is available when APRV/BiPhasic, CPAP/PSV, or NPPV/CPAP/PSV mode is selected. Apnea backup is active in all SIMV and CPAP modes. Gas volume compensation: The Vela supports compensation for BTPS. Leak compensation: The NPPV Leak Compensation function ensures that any gas flow leakage around a mask (nonvented) or tracheal tube up to 40 L/min, in addition to the set bias flow, is automatically determined and compensated for. The determination of leakage amount is made during exhalation after all patient exhalation has occurred. Subsequently, leak compensation adjusts bias flow to maintain PEEP and establish a new baseline for patient triggering. Miscellaneous: The Vela allows volumetric capnography using an optional exhaled CO2 monitor. Nebulizer: The ventilator supplies 100% oxygen to the nebulizer port when an in-line jet nebulizer is attached. Delivery of the nebulized gas is synchronized with the inspiratory phase of a breath. The manufacturer’s specifications are provided in Table 10-13. TABLE 10-13 Specifications for the Vela Ventilator Setting Category Setting Range Pressure Inspiratory Pressure 1–100 cm H2O Pressure Support 1–60 cm H2O PEEP 0–35 cm H2O Volume Tidal Volume 0.05–2.0 L Flow Inspiratory Flow 10–140 L/min Waveform Square/descending ramp Time Inspiratory Time 0.3–10 s Mandatory Breath Frequency 2–80/min Adjustable Rise Time Yes Sensitivity Trigger Sensitivity (pressure) Trigger Sensitivity (flow) 1–20 L/min Cycle Sensitivity (flow) Alarm Category Setting Range Pressure High Pressure 5–120 cm H2O Low Pressure 2–60 cm H2O Flow Low Minute Volume 0.1–99.9 L/min Time High Breath Rate 3–150/min Apnea Interval 10–60 s Other O2 Sensor Enabled/Disabled High ETco2 5–150 mm Hg Low ETco2 1–150 mm Hg Monitored Parameters Setting Range Vte Vti Spontaneous Vt Mandatory Vt Ve Spontaneous Ve Spontaneous Rate Rate Inspiratory Time Expiratory Time I:E Ratio Peak Pressure Mean Pressure PEEP O2 The bellavista 1000/1000e ventilator (Figure 10-19) is intended to provide positive pressure ventilatory support to adult and pediatric and optionally infant and neonatal patients. FIGURE 10-19 bellavista ventilator. © 2020 Vyaire Medical, Inc. Used with permission. The bellavista has a unique operator interface in that it is entirely based on a touch screen (no buttons or knobs) (Figure 10-20). Screen displays change according to the context of the operation, such as initial ventilator operation verification, entering ventilator settings, entering alarm settings, and reviewing monitored values, including waveforms or digital values. Settings are entered by touching virtual buttons on the screen to select and adjust the desired setting. There are several navigation buttons, and the display also supports left and right swiping. FIGURE 10-20 The bellavista operator interface. © 2020 Vyaire Medical, Inc. Used with permission. As part of the monitoring display, the ventilator features an animated lung view (Figure 10-21). This display shows red layers in the lungs to visualize decreased compliance compared to normal. Hyperinflation is also visualized. Red layers on the trachea and bronchi represent increased resistance compared to normal. Patient-triggered breaths are represented by a purple illumination of the diaphragm. The bar on the left turns green when compliance and resistance are within the normal range. Digital representations of Cstat, Rinsp, %Spont, and P0.1 are also displayed. FIGURE 10-21 The bellavista animated lung view. © 2020 Vyaire Medical, Inc. Used with permission. Modes are selected by pressing the virtual button with the desired mode name. The bellavista introduces some new concepts for setting modes (Table 10-14). SingleVent corresponds to ventilation with a conventional ventilator with one ventilation mode, settings, and monitoring. Day/Night is used with patients who require ventilation support that is different at night from during the day. This feature allows the operator to set two ventilation modes separately, sound intensity and screen brightness. The bellavista switches to and from a timed basis (or manually on request) between Day (settings for the day) and Night (settings for the night). DualVent is a feature that makes it possible to switch between the two set modes. TABLE 10-14 Mode Configurations for bellavista *Available for adult/pediatric ventilation only. Courtesy of Vyaire medical. Note that DualVent produces a type 2 intermittent mandatory ventilation breath sequence (i.e., mandatory breaths may be suppressed by spontaneous breaths). There are also some unique features applied to modes, depending on the control variable. For all volume control modes, the tidal volume is adapted to the currently measured tidal volume, which is calculated as the average of the inspired and expired volumes. Adaptation is breath based. The increment per breath is limited to 30% of the difference between set and actual tidal volumes. That creates the following advantages: Furthermore, a feature called Pressure Limited Ventilation (PLV) is always activated in volume control modes. As soon as the inspiratory pressure rises to 5 cm H2O below the set peak inspiratory pressure alarm, the inspiratory pressure is kept at that level until the set tidal volume has been reached, at the latest, the end of the set inspiratory time. If the set tidal volume cannot be reached, an appropriate alarm message appears (Figure 10-22). Note: This feature is what the taxonomy of modes refers to as dual targeting, meaning that the ventilator may switch from volume control to pressure control during a single breath. FIGURE 10-22 Dual targeting in volume control modes. For pressure control modes, there is an automatic pressure rise that minimizes the pressure rise rate, prevents pressure overshoots, and maximizes peak flow. For Pressure Support breaths, there is an automatic cycle algorithm that uses three separate criteria simultaneously for switching from inspiration to expiration: Some pressure control modes offer adaptive targeting, called TargetVent. The ventilator determines the compliance for each breath and sets the inspiratory pressure for the next breath to achieve the selected target volume. The bellavista offers Automatic Tube Compensation (ATC) for both volume control and pressure control modes. ATC compensates for tube resistance by increasing ventilation pressure in the breathing circuit during inspiration on a flow-dependent basis or reducing it during expiration. Compensation can be set for 10% to 100%, based on the input diameter of the artificial airway. ATC is active for both inspiration and expiration in pressure control modes but for expiration only in volume control modes. Finally, a sigh function can be enabled for most adult ventilation modes. The amplitude of a sigh is set as a percentage of the inspiratory pressure (for pressure control modes) or as a percentage of the tidal volume (for volume control modes). Sighs are displayed as pressure curves with filled stripes (Figure 10-23). Modes for the bellavista are shown in Table 10-15. FIGURE 10-23 Sigh feature during pressure control modes. TABLE 10-15 Classification of Modes for the bellavista Control variables: PC = pressure control, VC = volume control. Breath Sequences: CMV = continuous mandatory ventilation, CSV = continuous spontaneous ventilation, IMV(1) = intermittent mandatory ventilation type 1 where mandatory breaths are delivered at the set frequency, IMV(2) = intermittent mandatory ventilation type 2 where mandatory breaths may be suppressed by spontaneous breath frequency, IMV(3) = intermittent mandatory ventilation type 3 where mandatory breaths may be suppressed by spontaneous minute ventilation, IMV(4) = intermittent mandatory ventilation where mandatory breaths may be suppressed in dual targeting by switch volume cycling to flow cycling. Targeting scheme abbreviations: s = set point, d = dual, r = servo, b = biovariable, a = adaptive, o = optimal, i = intelligent. NA = not available. This mode is similar to Adaptive Support Ventilation mode on the Hamilton ventilators. The mode called beLevel is a highly flexible ventilation mode and can be set like CPAP, P-A/C, PC-SIMV, PSV, or APRV, depending on the application. The nCPAP mode is for spontaneously breathing neonates. It can be configured to be flow or pressure based. For flow-based nCPAP, the operator sets a constant flow, and pressure is generated by the nasal interface (i.e., CPAP pressure is proportional to flow). For pressure-based nCPAP, again the airway pressure is generated by the nasal interface, but flow is regulated automatically by the ventilator to generate the operator-set CPAP level. Like nCPAP, this mode is designed for neonates. It is a form of pressure control intermittent mandatory ventilation with unrestricted spontaneous breathing. This mode differs from Pressure Assist/Control in that all breaths are machine triggered. Spontaneous efforts are ignored. The clinical utility of this mode is questionable, except perhaps for cardiopulmonary resuscitation where chest compressions might cause false triggering. This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths. This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths. This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths. It is like the Spontaneous/Timed mode in that spontaneous breaths will suppress mandatory breaths if the spontaneous breath frequency is higher than the set mandatory breath rate. This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths. It is like the Spontaneous/Timed mode in that spontaneous breaths will suppress mandatory breaths if the spontaneous breath frequency is higher than the set mandatory breath rate. This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths. While this mode is classified the same as Pressure Assist/Control and Pressure-Controlled Ventilation (i.e., PC-CMVs), it is unlike them in that patient inspiratory efforts between mandatory breaths do not allow the patient to inspire, not even unsupported spontaneous breaths, such as PC-SIMV. The clinical utility of this mode is questionable, except perhaps for cardiopulmonary resuscitation, where chest compressions might cause false triggering. All volume control modes on the bellavista use dual targeting (called Pressure Limited ventilation), rather than set-point targeting as used with conventional volume control modes. This mode differs from Volume-Controlled Assist/Control in that all breaths are machine triggered. Spontaneous efforts are ignored. The clinical utility of this mode is questionable. All volume control modes on the bellavista use dual targeting (called Pressure Limited ventilation), rather than set-point targeting as used with conventional volume control modes. All volume control modes on the bellavista use dual targeting (called Pressure Limited ventilation), rather than set-point targeting as used with conventional volume control modes. Strictly speaking, this is not a mode of ventilation. HFOT delivers gas flow to the patient through a nasal cannula or tracheostomy. On-screen help: A help button provides access to the user manual during ventilation. Communications: There is a Display Port connection for service only. Lung recruitment tool: The lung recruitment maneuver inflates the lungs temporarily, to open collapsed lung units. Separate settings are available for recruitment and assessment maneuvers. The assessment maneuver begins with expiration at PStart. After that, pressure is increased to PMax. Afterward, the pressure is slowly or quickly reduced to PEnd. The recruitment maneuver begins with expiration at PStart. After that, pressure is increased to PMax. After an optional recruitment pause the pressure is reduced to PEEPEnd. After that, ventilation continues with PEEPEnd as the new PEEP (Figure 10-24). FIGURE 10-24 Lung recruitment maneuver. Backup ventilation: Apnea ventilation is available in nIPPV, PCV, P-A/C, PC-SIMV, S/T, T, VCV, V-A/C, and VC-SIMV modes. Gas volume compensation: The bellavista is unique in that it does not correct to conventional gas conditions (e.g., ATPD or BTPS). Instead, it uses ambient pressure, 77 °F (25 °C). As for humidity compensation, gas volume is normalized to 100% relative humidity if the circuit is humidified, and it is normalized to the ambient humidity for a nonhumidified circuit. Leak compensation: Leak compensation is active for both invasive and noninvasive modes (≥120 L/min). Miscellaneous: The ventilator supports optional volumetric capnography and esophageal pressure monitoring. Nebulizer: There is an integrated pneumatic nebulizer. Selected specifications are listed in Table 10-16. TABLE 10-16 Manufacturer’s Specifications for the bellavista The e360T ventilator (Figure 10-25) is designed to provide invasive or noninvasive ventilatory support and monitoring for infant, pediatric, and adult patients with respiratory failure or insufficiency. It is electrically controlled and pneumatically powered (requires external gas sources). FIGURE 10-25 e360T ventilator. © 2014 Covidien. All rights reserved. Used with permission of Medtronic. The e360T ventilator has an operator interface that uses a touch screen, buttons, and a control knob (Figure 10-26). Screen displays change according to the context of the operation, such as initial ventilator operation verification; entering ventilator settings; entering alarm settings; and reviewing monitored values, including waveforms or digital values. Settings are entered by touching a real button on the face panel or a virtual button on the screen to select the desired setting, turning the knob to select the setting value, and then pressing the ACCEPT button to finalize the setting. The real buttons provide various functions, such as selecting the modes, breath type, and basic settings; menu navigation; alarm silencing; temporary (3 minutes) 100% oxygen delivery; and manual breath trigger. FIGURE 10-26 Medtronic e360T operator interface. 1. Alarm silence. 2. Alarm reset. 3. Graphical user interface. A. Graphical user interface status bar. B. Main display area. C. Data sets bar. D. Data set touch button. E. Graphical user interface touch buttons. 4. Alarm lamp. 5. Alarms screen menu. 6. Graphical user interface screen buttons. 7. Pressure bar graph. 8. Ventilation controls. 9. Adjustment knob. 10. Accept button. 11. Special functions. 12. Modes/breath types. 13. Power indicators. © 2014 Medtronic. All rights reserved. Used with permission of Medtronic. Modes are selected by pressing the Volume Control or Pressure Control buttons repeatedly until the desired ventilatory pattern is highlighted. Biphasic Pressure Release Ventilation is selected by choosing Pressure Control plus A/CMV or SIMV ventilatory pattern and then selecting Open Exhalation Valve from the Advanced Data Set screen (see Figure 10-26). Volume target pressure control is selected by choosing a volume control or pressure control A/CMV or SIMV ventilatory pattern and then selecting volume target from the Advanced Data Set screen (see Figure 10-26). The modes available on the e360T are shown in Table 10-17. TABLE 10-17 Classification of Modes for the e360T Control variables: PC = pressure control, VC = volume control. Breath Sequences: CMV = continuous mandatory ventilation, CSV = continuous spontaneous ventilation, IMV(1) = intermittent mandatory ventilation type 1 where mandatory breaths are delivered at the set frequency, IMV(2) = intermittent mandatory ventilation type 2 where mandatory breaths may be suppressed by spontaneous breath frequency, IMV(3) = intermittent mandatory ventilation type 3 where mandatory breaths may be suppressed by spontaneous minute ventilation, IMV(4) = intermittent mandatory ventilation where mandatory breaths may be suppressed in dual targeting by switch volume cycling to flow cycling. Targeting scheme abbreviations: s = set point, d = dual, r = servo, b = biovariable, a = adaptive, o = optimal, i = intelligent. NA = not available. Reproduced with permission from Mandu Press Ltd. Backup ventilation: Backup ventilation is initiated when the low minute ventilation alarm threshold is reached. If the current mode is A/CMV or SIMV, backup ventilation employs the current Control Panel settings except for Respiratory Rate, which increases to 1.5 times the current setting (15 breaths/min minimum, 100 breaths/min maximum). If the current mode is SPONT, the ventilator delivers pressure control mandatory breaths with the following settings: Backup ventilation terminates when the measured minute ventilation exceeds the set minute ventilation alarm threshold by more than 10%. Gas volume compensation: With Compliance Compensation for Volume Control, mandatory breaths can be selected ON or OFF from the Patient Setup screen. When compensation is ON, inspiratory and expiratory tidal volumes are displayed as if they were being monitored at the patient’s airway. When compensation is OFF, inspiratory and expiratory tidal volumes represent volumes monitored at the main flow outlet and exhalation valve. Inspiratory and expiratory tidal volume displayed values will not look any different with compensation ON or OFF, even though inspiratory and expiratory tidal volume monitored values are different. Actual delivered/monitored values will be bigger with compensation ON, but you will not see it in the displayed value. The extra flow/volume that is added in and delivered to the patient to compensate for the volume that is lost in the tubing is subtracted from both the displayed values. Leak compensation: The e360T provides 3 L/min of bias flow through the breathing circuit between breaths (i.e., during the exhalation period). This flow facilitates both flow triggering and the stabilization of baseline pressure and flow to minimize auto-triggering of breaths. The Leak Comp (Automatic Leak Compensation/Baseline Pressure Management) function allows the user to select whether he or she wants the e360 to compensate for leaks over and above the 3 L/min bias flow. Compensation is factory preset to ON, and the selection is retained after power down. When compensation is ON, the e360 automatically adjusts the bias flow to between 3 and 8 L/min for Ped/Infant selection and 3 and 15 L/min for Adult selection to maintain an end-expiratory base flow of 3 L/min. When compensation is OFF, bias flow is 3 L/min, regardless of leaks. If there is no leak, bias flow remains at 3 L/min whether compensation is ON or OFF. Noninvasive ventilation: The e360 ventilator can be used for invasive (intubated patient) or noninvasive (mask) ventilation. When the Non Invasive button is activated, the ventilator automatically provides leak compensation/baseline pressure management with a bias flow range of 3 to 25 L/min to accommodate the potential for bigger airway leaks around the nonvented mask (when Non Invasive is not activated and Leak Comp is ON, bias flow is only 3–8 L/min Ped/Infant and 3–15 L/min Adult). The low minute ventilation and the disconnect alarms can be set to OFF while Non Invasive is activated. All other alarms, such as the apnea alarm, remain operative and cannot be set to OFF. If the low minute ventilation or disconnect alarm is OFF when Non Invasive is deactivated, the alarms are automatically turned back on, with the low minute ventilation alarm set to the lowest value and the disconnect alarm set to the highest value. Non Invasive can be used with any mode of ventilation. It is factory preset to OFF, and the setting returns to OFF after power down. The manufacturer’s specifications are provided in Table 10-18. TABLE 10-18 Specifications for the Medtronic e360T Ventilator Setting Category Setting Range Pressure Inspiratory Pressure 0–80 cm H2O Pressure Support 0–60 cm H2O PEEP 0–45 cm H2O Volume Tidal Volume 0–3.0 L Flow Inspiratory Flow 1–180 L/min Waveform Square/descending ramp Time Inspiratory Time 0.1–5.0 s Mandatory Breath Frequency 1–120/min Adjustable Rise Time Yes Sensitivity Trigger Sensitivity (pressure) 0 to –5 cm H2O Trigger Sensitivity (flow) 0.1–2.0 L/min Cycle Sensitivity (flow) 5%–55% and AUTO Alarm Category Setting Range Pressure High Airway Pressure 5–120 cm H2O Low Airway Pressure 3–95 cm H2O Volume Disconnect Threshold 20%–95% Flow High Expiratory Minute Volume 0.02–60 L/min Low Expiratory Minute Volume 0.01–50 L/min Time Apnea 5–60 s High Total Respiratory Rate 10–120/min or OFF Other O2 Sensor Enabled/Disabled Monitored Parameters Setting Range Cdyn Effective Static Compliance Fio2 Inspiratory Flow Expiratory Flow I:E Ratio Baseline Pressure Peak Airway Pressure Inspiratory Minute Volume Expiratory Minute Volume MVE & MVE spont Monitored Parameters Setting Range PEEP/CPAP Total PEEP Mean Pressure Peak Pressure Plateau Pressure Expiratory Resistance Compliance Respiratory Rate RR spont & RR tot Inspiratory Resistance Expiratory Resistance Rapid Shallow Breathing Index (RSBI) Inspiratory Time Tidal Volume Time Constant Expiratory Tidal Volume Inspiratory Tidal Volume VTe %Var WOBimp P0.1/NIF © 2014 Medtronic. All rights reserved. Used with permission of Medtronic. The Puritan Bennett 840 ventilator (Figure 10-27) is designed for invasive and noninvasive ventilation of adult, pediatric, and neonatal patients. It is electrically controlled and pneumatically powered (requires external compressor). FIGURE 10-27 Medtronic PB 840 ventilator. © 2014 Medtronic. All rights reserved. Used with permission of Medtronic.
Section 3: Intensive Care Ventilators
Vyaire Medical Avea
Operator Interface
Main. W. Alarm status LEDs.
Modes
Airway Pressure Release Ventilation/Biphasic
Artificial Airway Compensation
CPAP/Pressure Support
CPAP/Pressure Support with Volume Limit
Infant Nasal CPAP
Infant Nasal IMV
Pressure A/C
Pressure A/C with Flow Cycle
Pressure A/C with Machine Volume
Pressure A/C with Volume Guarantee
Pressure Regulated Volume Control A/C
Pressure Regulated Volume Control A/C with Flow Cycle
Pressure Regulated Volume Control SIMV with Flow Cycle
Pressure Regulated Volume Control SIMV
Pressure SIMV
Pressure SIMV with Volume Guarantee
Time Cycled Pressure Limited A/C
Time Cycled Pressure Limited A/C with Flow Cycle
Time Cycled Pressure Limited A/C with Flow Cycle and Volume Guarantee
Time Cycled Pressure Limited A/C with Volume Guarantee
Time Cycled Pressure Limited SIMV
Time Cycled Pressure Limited SIMV with Volume Guarantee
Volume A/C
Volume A/C with Demand Flow
Volume A/C with Vsync and Flow Cycle
Volume A/C with Vsync
Volume IMV with Demand Flow
Volume SIMV
Volume SIMV with Vsync
Special Features
Manufacturer’s Specifications
Vyaire Medical Vela
Operator Interface
Modes
Airway Pressure Release Ventilation/Biphasic
CPAP/Pressure Support
Noninvasive Positive Pressure Ventilation A/C
Noninvasive Positive Pressure Ventilation/CPAP/Pressure Support
Noninvasive Positive Pressure Ventilation SIMV
Pressure A/C
Pressure A/C (with Assured Volume)
Pressure A/C (with Flow Cycle)
Pressure Regulated Volume Control A/C
Pressure Regulated Volume Control (with Flow Cycle)
Pressure Regulated Volume Control SIMV (with Flow Cycle)
Pressure Regulated Volume Control SIMV
Pressure SIMV
Volume A/C
Volume A/C (with Vsync and Flow Cycle)
Volume A/C (with Vsync)
Volume SIMV
Volume SIMV (with Vsync)
Special Features
Manufacturer’s Specifications
Vyaire Medical bellavista 1000
Operator Interface
Modes
Adaptive Ventilation Mode
Airway Pressure Release Ventilation
beLevel
CPAP
Nasal CPAP
Nasal Intermittent Positive Pressure Ventilation
Pressure Assist/Control Ventilation
Pressure-Controlled Ventilation
Pressure Assist/Control Ventilation Plus TargetVent
Pressure-Controlled Synchronized Intermittent Mandatory Ventilation
Pressure-Controlled Synchronized Intermittent Mandatory Ventilation Plus TargetVent
Pressure Support Ventilation (Backup Off)
Pressure Support Ventilation (Backup Off) Plus TargetVent
Pressure Support Ventilation (Backup On)
Pressure Support Ventilation (Backup On) Plus TargetVent
Spontaneous
Spontaneous Plus TargetVent
Spontaneous/Timed
Spontaneous/Timed Plus TargetVent
Timed
Volume-Controlled A/C
Volume-Controlled Ventilation
Volume-Controlled Synchronized Intermittent Mandatory Ventilation
High-Flow Oxygen Therapy (HFOT)
Special Features
Manufacturer’s Specifications
Medtronic e360T
Operator Interface
Modes
Biphasic Pressure Release Assist Control Mandatory Ventilation
Biphasic Pressure Release Synchronized Intermittent Mandatory Ventilation
Pressure Control Assist Control Mandatory Ventilation
Pressure Control Spont
Pressure Control Synchronized Intermittent Mandatory Ventilation
Volume Control Assist Control Mandatory Ventilation
Volume Control Spont
Volume Control Synchronized Intermittent Mandatory Ventilation
Volume Target Pressure Control Assist Control Mandatory Ventilation
Volume Target Pressure Control Spont
Volume Target Pressure Control Synchronized Intermittent Mandatory Ventilation
Special Features
Manufacturer’s Specifications
Medtronic PB 840
Operator Interface

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