3: Intensive Care Ventilators


Section 3: Intensive Care Ventilators


Information in this section is taken from the ventilator operator’s manuals, brochures, and websites created by the manufacturers.


Vyaire Medical Avea


The Avea ventilator (Figure 10-15) is designed for intensive care ventilation of neonatal, pediatric, and adult patients.

A photo shows an Avea ventilator set-up that consists of a display screen with buttons and knobs mounted on a bright blue stand on four wheels. The top part of the stand contains notches and handles for other parts of the ventilator to be fitted into it and the body of the stand below this is a long, narrow column.

FIGURE 10-15 Avea ventilator.


Reproduced with permission from Vyaire.


Operator Interface

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.

A labeled illustration shows the display interface of the Avea ventilator. The control buttons and knobs are numbered A to W and explained in the figure caption.

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. @@ Main. W. Alarm status LEDs.


Reproduced with permission from CareFusion.

Description

Modes

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.


Description


TABLE 10-7 Controls and Mode Names for Avea Ventilator

A table describes the controls and mode names for Avea ventilator. A table describes the controls and mode names for Avea ventilator.

*Available with Vsync activated for adult or pediatric patients only.


**Available for adult and pediatric patients only.

Description

TABLE 10-8 Classification of Modes for Avea

A table describes the classification of modes for Avea. A table describes the classification of modes for Avea. A table describes the 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.

Description

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.


Airway Pressure Release Ventilation/Biphasic


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time or patient synchronized by flow sensitivity).

    • Within-breath settings:

      • Operator-set PEEP (called Pres Low), peak inspiratory pressure (called Pres High), rise time, inspiratory time (called Time High), and expiratory time (called Time Low)

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow). Spontaneous breaths are permitted both between and during mandatory breaths.

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: None

Artificial Airway Compensation

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.



  • Within-breath settings:

    • Operator-set percent support (of resistive load) along with artificial airway tube diameter and tube type
    • Ventilator-set inspiratory pressure as a function of patient-generated inspiratory flow

  • Between-breath targets: None

CPAP/Pressure Support


  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

CPAP/Pressure Support with Volume Limit


  • Mandatory breaths: Patient triggered (pressure or flow sensitivity) and machine cycled (volume). Note that, when a patient-triggered breath exceeds the set volume limit, inspiration is terminated. Thus, the breath is patient triggered but machine cycled and thus classified as mandatory because the patient has lost some control over timing and size. This condition is indicated by a yellow alarm status indicator.

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, inspiratory time, and volume limit

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Infant Nasal CPAP


  • Available for neonatal patient size setting only
  • Designed to work with standard two-limbed neonatal patient circuits and nasal prongs
  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (inspiratory flow)

    • Within-breath settings:

      • Operator-set CPAP

  • Between-breath targets: None

Infant Nasal IMV


  • Available for neonatal patient size setting only
  • Designed to work with standard two-limbed neonatal patient circuits and nasal prongs
  • Mandatory breaths: Machine triggered (preset frequency) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, inspiratory rise time, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Pressure A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and inspiratory time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Pressure A/C with Flow Cycle


  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow).

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and cycle sensitivity (% peak flow)

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Pressure A/C with Machine Volume


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, tidal volume, inspiratory pressure, rise time, and inspiratory time
      • Ventilator switches from pressure control to volume control if inspiratory flow decays to a machine-determined threshold before preset tidal volume is reached. Inspiration continues at constant flow for preset inspiratory time.

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Pressure A/C with Volume Guarantee


  • Available for neonatal patient size setting only
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Not allowed
  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Not allowed
  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control A/C with Flow Cycle


  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set rise time and cycle sensitivity (% peak inspiratory flow)
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control SIMV with Flow Cycle


  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and cycle sensitivity (% peak flow)
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Pressure SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Pressure SIMV with Volume Guarantee


  • Available for neonatal patient size setting only
  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Time Cycled Pressure Limited A/C


  • Available for neonatal patient size setting only
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, peak inspiratory flow, rise time, and inspiratory time. Inspiration is delivered at the set inspiratory flow only until the inspiratory pressure target is reached. Flow decays exponentially after that.

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Time Cycled Pressure Limited A/C with Flow Cycle


  • Available for neonatal patient size setting only.
  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, peak inspiratory flow, and inspiratory time. Inspiration is delivered at the set inspiratory flow only until the inspiratory pressure target is reached. Flow decays exponentially after that.

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Time Cycled Pressure Limited A/C with Flow Cycle and Volume Guarantee


  • Available for neonatal patient size setting only
  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, peak inspiratory flow, and inspiratory time. Inspiration is delivered at the set inspiratory flow only until the inspiratory pressure target is reached. Flow decays exponentially after that.

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set cycle sensitivity (% peak inspiratory flow)
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set average tidal volume

Time Cycled Pressure Limited A/C with Volume Guarantee


  • Available for neonatal patient size setting only
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, peak inspiratory flow, and inspiratory time. Inspiration is delivered at the set inspiratory flow only until the inspiratory pressure target is reached. Flow decays exponentially after that.

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set cycle sensitivity (% peak inspiratory flow)
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set average tidal volume

Time Cycled Pressure Limited SIMV


  • Available for neonatal patient size setting only
  • Mandatory breaths: Machine triggered (preset frequency or patient synchronized using pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, peak inspiratory flow, and inspiratory time. Inspiration is delivered at the set inspiratory flow only until the inspiratory pressure target is reached. Flow decays exponentially after that.

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Time Cycled Pressure Limited SIMV with Volume Guarantee


  • Available for neonatal patient size setting only
  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set cycle sensitivity (% peak inspiratory flow)
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set tidal volume

Volume A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow, tidal volume, and pause time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Volume A/C with Demand Flow


  • Activation of Demand Flow makes this mode a form of IMV, not A/C. See spontaneous breaths below.
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (tidal volume or inspiratory pause time) or patient cycled (flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory flow, tidal volume, and inspiratory pause time
      • Ventilator-set inspiratory pressure if inspiration switches from volume control to pressure control due to the dual-targeting scheme (see spontaneous breaths below)

  • Spontaneous breaths: Because this mode uses dual targeting, if the patient’s inspiratory effort is large enough, inspiration will switch from volume control with time cycling to pressure control with flow cycling. If inspiration happened to also be patient triggered, the breath would be classified as spontaneous (i.e., patient triggered and cycled) and would be very similar to a breath in the Pressure Support mode. This possibility of spontaneous breaths appearing between mandatory breaths is the reason this mode is a form of IMV, instead of CMV.
  • Between-breath targets: None

Volume A/C with Vsync and Flow Cycle


  • Vsync is available only for adult and pediatric patients.
  • Activation of Vsync makes this mode a form of pressure control, not volume control, because inspiratory pressure is preset within each breath. Vsync is a form of adaptive targeting that allows the ventilator to adjust inspiratory pressure between breaths to achieve an average preset tidal volume.
  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% of peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak flow, rise time, and cycle sensitivity (% peak flow)
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Volume A/C with Vsync


  • Vsync is available only for adult and pediatric patients.
  • Activation of Vsync makes this mode a form of pressure control, not volume control, because inspiratory pressure is preset within each breath. Vsync is a form of adaptive targeting that allows the ventilator to adjust inspiratory pressure between breaths to achieve an average preset tidal volume.
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (volume or inspiratory pause time)

    • Operator-set PEEP, frequency, peak flow, and rise time
    • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Not allowed
  • Between-breath targets: Operator-set tidal volume

Volume IMV with Demand Flow


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or inspiratory pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory flow, tidal volume, and inspiratory pause time
      • Ventilator-set inspiratory pressure if inspiration switches from volume control to pressure control due to the dual-targeting scheme (see spontaneous breaths below)

  • Spontaneous breaths: Because this mode uses dual targeting, if the patient’s inspiratory effort is large enough, inspiration will switch from volume control with time cycling to pressure control with flow cycling.
  • Between-breath targets: None

Volume SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow, tidal volume, and pause time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Volume SIMV with Vsync


  • Vsync is available only for adult and pediatric patients.
  • Activation of Vsync makes this mode a form of pressure control, not volume control, because inspiratory pressure is preset within each breath. Vsync is a form of adaptive targeting that allows the ventilator to adjust inspiratory pressure between breaths to achieve an average preset tidal volume.
  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow, tidal volume, and pause time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Special Features

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).


Manufacturer’s Specifications

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


Description


Vyaire Medical Vela


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.

A photo shows a blue box-like ventilator device mounted on top of a rod.

FIGURE 10-17 Vela ventilator.


Reproduced with permission from Vyaire.

Description

Operator Interface

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.

A photo shows the interface of a Vela ventilator showing the display screen with waveforms and alphanumeric values. Buttons and a control knob are seen to the right side of the screen. A connecting port is seen below the screen. A short flat white tube with different shaped connectors on both ends is seen fitted into two ports.

FIGURE 10-18 Vela operator interface.


Reproduced with permission from Vyaire.


Modes

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.


Description


Reproduced with permission from Mandu Press Ltd.


TABLE 10-11 Primary Controls and Mode Names for the Vela

A table describes controls and mode names for the Vela.

Reproduced with permission from Mandu Press Ltd.

Description

TABLE 10-12 Classification of Modes for the Vela

A table describes the 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.

Description

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.


Airway Pressure Release Ventilation/Biphasic


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time or patient synchronized by flow sensitivity)

    • Within-breath settings:

      • Operator-set PEEP (called Pres Low), peak inspiratory pressure (called Pres High), rise time, inspiratory time (called Time High), and expiratory time (called Time Low)

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow). Spontaneous breaths are permitted both between and during mandatory breaths.

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: None

CPAP/Pressure Support


  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Noninvasive Positive Pressure Ventilation A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and inspiratory time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Noninvasive Positive Pressure Ventilation/CPAP/Pressure Support


  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Noninvasive Positive Pressure Ventilation SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Pressure A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and inspiratory time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Pressure A/C (with Assured Volume)


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, tidal volume, inspiratory pressure, rise time, and inspiratory time
      • Ventilator switches from pressure control to volume control if inspiratory flow decays to a machine-determined threshold before preset tidal volume is reached. Inspiration continues at constant flow for preset inspiratory time.

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Pressure A/C (with Flow Cycle)


  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and cycle sensitivity (% peak flow)

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Pressure Regulated Volume Control A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Not allowed
  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control (with Flow Cycle)


  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and cycle sensitivity (% peak flow)
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control SIMV (with Flow Cycle)


  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and cycle sensitivity (% peak flow)
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Pressure Regulated Volume Control SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, rise time, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Pressure SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, rise time, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Volume A/C


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow, tidal volume, and pause time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Volume A/C (with Vsync and Flow Cycle)


  • Vsync is available for adult and pediatric patients only.
  • Activation of Vsync makes this mode a form of pressure control, not volume control, because inspiratory pressure is preset within each breath. Vsync is a form of adaptive targeting that allows the ventilator to adjust inspiratory pressure between breaths to achieve an average preset tidal volume.
  • Activation of Flow Cycle makes this mode a form of IMV, not A/C. Flow cycling makes every breath patient cycled. Hence, every patient-triggered breath is spontaneous (i.e., patient triggered and cycled), whereas every machine-triggered breath is mandatory (i.e., machine triggered and patient cycled) by definition.
  • Mandatory breaths: Machine triggered (preset frequency) and patient cycled (% of peak inspiratory flow)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak flow, rise time, and cycle sensitivity (% peak flow)
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: Operator-set tidal volume

Volume A/C (with Vsync)


  • Vsync is available for adult and pediatric patients only.
  • Activation of Vsync makes this mode a form of pressure control, not volume control, because inspiratory pressure is preset within each breath. Vsync is a form of adaptive targeting that allows the ventilator to adjust inspiratory pressure between breaths to achieve an average preset tidal volume.
  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (volume or inspiratory pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak flow, rise time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Not allowed
  • Between-breath targets: Operator-set tidal volume

Volume SIMV


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow, tidal volume, and pause time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Volume SIMV (with Vsync)


  • Vsync is available for adult and pediatric patients only.
  • Activation of Vsync makes this mode a form of pressure control, not volume control, because inspiratory pressure is preset within each breath. Vsync is a form of adaptive targeting that allows the ventilator to adjust inspiratory pressure between breaths to achieve an average preset tidal volume.
  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow, tidal volume, and pause time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, rise time, and cycle sensitivity (% peak inspiratory flow)

  • Between-breath targets: None

Special Features

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.


Manufacturer’s Specifications

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


Description


Vyaire Medical bellavista 1000


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.

A photo shows a complete ventilator setup with a display monitor mounted on the flat top of a stand on four wheels. A long adjustable metal rod is connected to this top surface of the stand. Flexible blue and white tubes are seen connected to the device, and a white grid holder basket can be seen above the legs of the stand.

FIGURE 10-19 bellavista ventilator.


© 2020 Vyaire Medical, Inc. Used with permission.


Operator Interface

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.

A photo shows a side view of the display screen of a ventilator with an image of a pair of lungs and a waveform above it. Touchscreen buttons and tabs are seen below and next to this display. A small box can be seen connected to the back of this screen.

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.

An image shows the display screen of a ventilator with an image of a pair of lungs on it. Different touchscreen buttons and tabs are seen below and next to this image along with parameters and values displayed in small boxes.

FIGURE 10-21 The bellavista animated lung view.


© 2020 Vyaire Medical, Inc. Used with permission.


Modes

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

A table describes the mode configurations for Bellavista.

*Available for adult/pediatric ventilation only.


Courtesy of Vyaire medical.

Description


  • DualVent A: The patient is breathing spontaneously. Modes that allow spontaneous breaths are available for selection. If no breath is triggered by the patient for an adjustable apnea time, bellavista automatically switches over to DualVent B (with no alarm).
  • DualVent B: The patient does not have adequate spontaneous breathing and requires mandatory ventilation. If the patient triggers an adjustable number of breaths in succession, bellavista automatically switches over to DualVent A.

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:



  • Accurate volume delivery based on proximal measurement
  • Compensation for leakage and pneumatic nebulizer volume
  • Automatic compensation for breathing circuit compliance

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.

Two graphical illustrations one above the other show pressure and flow waveforms for volume control and pressure control modes.

FIGURE 10-22 Dual targeting in volume control modes.

Description

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:



  • Differential flow trigger: Active expiratory effort on the part of the patient is recognized by a rapid drop in flow.
  • Limit for expiration: The fuller the lungs, the lower the flow. As an expiratory trigger, the ratio of increasing tidal volume to decreasing flow reduces the risk of hyperinflation.
  • Differential pressure trigger: Substantial expiratory effort on the part of the patient (e.g., coughing) results in a sudden pressure rise that immediately initiates 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.

A graph depicts the sigh features (on the x-axis) against pressure control values (on the y-axis).

FIGURE 10-23 Sigh feature during pressure control modes.

Description

TABLE 10-15 Classification of Modes for the bellavista

A table provides a classification of modes for the bellavista. A table provides a 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.

Description

Adaptive Ventilation Mode

This mode is similar to Adaptive Support Ventilation mode on the Hamilton ventilators.



  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set patient height and gender, % minute ventilation to support, PEEP, maximum inspiratory pressure, and pressure rise time
      • Ventilator-set inspiratory pressure, inspiratory time, and frequency

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set flow cycle threshold
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Ventilator-set tidal volume and minute ventilation

Airway Pressure Release Ventilation


  • Mandatory breaths: Machine triggered (preset frequency that results from THigh and TLow settings) and machine cycled (TLow setting) or synchronized with patient spontaneous breath expiratory flow (THigh may be altered up to ±1 second)

    • Within-breath settings:

      • Operator-set inspiratory pressure (called PHigh), PEEP (called PLow), and pressure rise time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow). May occur during THigh.

    • Within-breath settings:

      • Operator-set inspiratory pressure (Pressure Support at the upper level, relative to PHigh) and flow cycle threshold

  • Between-breath targets: None

beLevel

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.



  • Mandatory breaths: Machine triggered (preset frequency that results from THigh and TLow settings) and machine cycled (TLow setting) or synchronized with patient spontaneous breath expiratory flow (THigh may be altered up to ±1 second).

    • Within-breath settings:

      • Operator-set inspiratory pressure relative to atmospheric pressure (called PHigh), PEEP (called PLow), and pressure rise time.

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow). May occur during Thigh.

    • Within-breath settings:

      • Operator-set inspiratory pressure (Pressure Support relative to PEEP) and flow cycle threshold. Pressure support can be set for the spontaneous breaths separately. If PEEP + PSupport is greater than PHigh, pressure support is also administered at the upper level.

  • Between-breath targets: None

CPAP


  • Mandatory breaths: Not permitted
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set constant positive airway pressure

  • Between-breath targets: None

Nasal CPAP

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.


Nasal Intermittent Positive Pressure Ventilation

Like nCPAP, this mode is designed for neonates. It is a form of pressure control intermittent mandatory ventilation with unrestricted spontaneous breathing.



  • Machine triggered (preset frequency) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure, inspiratory time, frequency, and PEEP

  • Spontaneous breaths: Unrestricted and unsupported spontaneous breathing

    • Within-breath settings:

      • Operator-set PEEP

  • Between-breath targets: None

Pressure Assist/Control Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure, inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: None
  • Between-breath targets: None

Pressure-Controlled Ventilation

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.



  • Mandatory breaths: Machine triggered (preset frequency) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure, inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: None
  • Between-breath targets: None

Pressure Assist/Control Ventilation Plus TargetVent


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set average tidal volume, inspiratory time, frequency, pressure rise time, and PEEP
      • Ventilator-set inspiratory pressure to achieve the average tidal volume target

  • Spontaneous breaths: None
  • Between-breath targets: Ventilator-set inspiratory pressure to achieve average tidal volume target

Pressure-Controlled Synchronized Intermittent Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP), inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

Pressure-Controlled Synchronized Intermittent Mandatory Ventilation Plus TargetVent


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set average tidal volume, inspiratory time, frequency, pressure rise time, and PEEP
      • Ventilator-set inspiratory pressure to achieve the average tidal volume target

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

Pressure Support Ventilation (Backup Off)

This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths.



  • Mandatory breaths: None
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

Pressure Support Ventilation (Backup Off) Plus TargetVent

This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths.



  • Mandatory breaths: None
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set average tidal volume target and flow cycle threshold
      • Ventilator-set inspiratory pressure to achieve tidal volume target

  • Between-breath targets: Operator-set tidal volume

Pressure Support Ventilation (Backup On)

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.



  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP), inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

Pressure Support Ventilation (Backup On) Plus TargetVent

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.



  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP), inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set average tidal volume target and flow cycle threshold
      • Ventilator-set inspiratory pressure to achieve tidal volume target

  • Between-breath targets: Operator-set tidal volume

Spontaneous


  • Mandatory breaths: None
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

Spontaneous Plus TargetVent

This mode differs from conventional Pressure Support because a backup rate can be set for mandatory breaths.



  • Mandatory breaths: None
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set average tidal volume target and flow cycle threshold
      • Ventilator-set inspiratory pressure to achieve tidal volume target

  • Between-breath targets: Operator-set tidal volume

Spontaneous/Timed


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP), inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

Spontaneous/Timed Plus TargetVent


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP), inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set average tidal volume target and flow cycle threshold
      • Ventilator-set inspiratory pressure to achieve tidal volume target

  • Between-breath targets: Average tidal volume

Timed

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.



  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set inspiratory pressure, inspiratory time, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: None
  • Between-breath targets: None

Volume-Controlled A/C

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.



  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or inspiratory time)

    • Within-breath settings:

      • Operator-set tidal volume, inspiratory time, plateau time (as % of total cycle time), flow waveform, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: None
  • Between-breath targets: None

Volume-Controlled Ventilation

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.



  • Mandatory breaths: Machine triggered (preset frequency) and machine cycled (tidal volume or inspiratory time)

    • Within-breath settings:

      • Operator-set tidal volume, inspiratory time, plateau time (as % of total cycle time), flow waveform, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: None
  • Between-breath targets: None

Volume-Controlled Synchronized Intermittent Mandatory Ventilation

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.



  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (tidal volume or inspiratory time)

    • Within-breath settings:

      • Operator-set tidal volume, inspiratory time, plateau time (as % of total cycle time), flow waveform, frequency, pressure rise time, and PEEP

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure (relative to PEEP) and flow cycle threshold

  • Between-breath targets: None

High-Flow Oxygen Therapy (HFOT)

Strictly speaking, this is not a mode of ventilation. HFOT delivers gas flow to the patient through a nasal cannula or tracheostomy.


Special Features

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).

A graphical illustration depicts a waveform that represents inflation and deflation of the lungs during ventilation.

FIGURE 10-24 Lung recruitment maneuver.

Description

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.


Manufacturer’s Specifications

Selected specifications are listed in Table 10-16.


TABLE 10-16 Manufacturer’s Specifications for the bellavista

A table describes manufacturer’s specifications for the bellavista. A table describes manufacturer’s specifications for the bellavista.
Description

Medtronic e360T


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).

A photo shows the set-up of the e360T ventilator with a display monitor mounted on top of a stand on five wheels. A thin adjustable metal rod is connected to a square-shaped unit with control buttons and knobs just below the display screen. Flexible white tubes are seen connected to lower part of this device, and a small white panel can be seen on the rod above the legs of the stand.

FIGURE 10-25 e360T ventilator.


© 2014 Covidien. All rights reserved. Used with permission of Medtronic.


Operator Interface

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.

A labeled illustration shows the display interface of the Medtronic e360T ventilator. The control buttons and knobs are numbered 1 to 13 and the display screen contains labels A to E, which are explained in the figure caption.

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.

Description

Modes

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

A table describes the 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.

Description

Biphasic Pressure Release Assist Control Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, slope rise, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow) allowed during inflation period but not allowed between breaths
  • Between-breath targets: None

Biphasic Pressure Release Synchronized Intermittent Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency), patient synchronized (pressure or flow sensitivity), and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, slope rise, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow)

    • Within-breath settings:

      • Operator-set inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)

  • Between-breath targets: None

Pressure Control Assist Control Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, slope rise, and inspiratory time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Pressure Control Spont


  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow or Auto)

    • Within-breath settings:

      • Operator-set inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)

  • Between-breath targets: None

Pressure Control Synchronized Intermittent Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency), patient synchronized (pressure or flow sensitivity), and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, inspiratory pressure, slope rise, and inspiratory time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow or Auto)

    • Within-breath settings:

      • Operator-set inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)

  • Between-breath targets: None

Volume Control Assist Control Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (tidal volume or inspiratory time plus pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow and flow waveform or inspiratory time, tidal volume, and pause time

  • Spontaneous breaths: Not allowed
  • Between-breath targets: None

Volume Control Spont


  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow or Auto)

    • Within-breath settings:

      • Operator-set inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)

  • Between-breath targets: None

Volume Control Synchronized Intermittent Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency), patient synchronized (pressure or flow sensitivity), and machine cycled (tidal volume or pause time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, peak inspiratory flow and flow waveform or inspiratory time, tidal volume, and pause time

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow or Auto)

    • Within-breath settings:

      • Operator-set inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)

  • Between-breath targets: None

Volume Target Pressure Control Assist Control Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (pressure or flow sensitivity) and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, maximum inspiratory pressure, slope rise, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Not allowed
  • Between-breath targets: Operator-set tidal volume

Volume Target Pressure Control Spont


  • Mandatory breaths: Not allowed
  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow or Auto)

    • Within-breath settings:

      • Operator-set maximum inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set tidal volume

Volume Target Pressure Control Synchronized Intermittent Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency), patient synchronized (pressure or flow sensitivity), and machine cycled (inspiratory time)

    • Within-breath settings:

      • Operator-set PEEP, frequency, maximum inspiratory pressure, slope rise, and inspiratory time
      • Ventilator-set inspiratory pressure

  • Spontaneous breaths: Patient triggered (pressure or flow sensitivity) and patient cycled (% peak inspiratory flow or Auto)

    • Within-breath settings:

      • Operator-set maximum inspiratory pressure, slope rise, and cycle sensitivity (% peak inspiratory flow or Auto)
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set tidal volume

Special Features

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:



  • Inspiratory pressure: 15 cm H2O above PEEP setting
  • Inspiratory time: 0.6 second Ped/Infant; 1.0 second Adult
  • Respiratory rate: 20 breaths/min Ped/Infant; 12 breaths/min Adult

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.


Manufacturer’s Specifications

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


Description


© 2014 Medtronic. All rights reserved. Used with permission of Medtronic.


Medtronic PB 840


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).

A photo shows the Medtronic PB 840 ventilator set-up which has a display monitor mounted on top of a stand on four wheels. A digital display screen shows waveforms and alphanumeric displays. Below the monitor, on a middle rung of the stand, another box-like section of the ventilator is seen that has flexible white tubes connected to it and other connection ports.

FIGURE 10-27 Medtronic PB 840 ventilator.


© 2014 Medtronic. All rights reserved. Used with permission of Medtronic.


Operator Interface

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Dec 19, 2021 | Posted by in RESPIRATORY | Comments Off on 3: Intensive Care Ventilators
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