5: Neonatal Ventilators


Section 5: Neonatal Ventilators


Dräger Babylog VN500


The Dräger Babylog VN500 (Figure 10-71) is intended for the ventilation of neonatal patients from 0.88 lb (0.4 kg) up to 22 lb (10 kg) and pediatric patients from 11 lb (5 kg) up to 44 lb (20 kg) body weight.

A photo shows a Babylog ventilator set-up with a display monitor mounted on top of a stand on four wheels. A digital screen shows waveforms and alphanumeric displays. Below the monitor, another box-like section of the ventilator is seen that has notches and flexible tubes connected to it. A long, flexible metal arm is connected to the section with hooks on the end which hold the free ends of the tubes.

FIGURE 10-71 Babylog VN500 ventilator.


© Drägerwerk AG & Co. KGaA, Lubeck. All rights reserved.


Operator Interface

The Babylog VN500 has an operator interface similar to the Dräger Infinity V500, which uses a touch screen, buttons, and a control knob (Figure 10-34). 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 virtual button on the screen to select the desired setting, turning the rotary knob to select the setting value, and then pressing the knob to finalize the setting. Other buttons provide various features related to menu navigation and alarm silencing.


The Babylog VN500 has a unique interface for monitoring the patient’s pulmonary status, called Smart Pulmonary View (Figure 10-35). This is a graphic display of the compliance and resistance as well as of the spontaneous and mandatory minute volume.


Modes

Modes on the Babylog VN500 are selected by mode name (e.g., Pressure Control A/C and Spontaneous Proportional Pressure Support) using tabs on the touch screen. When the tab is selected, the relevant ventilator setting screens are displayed. The setting screens are also tabbed, giving access to basic settings (e.g., tidal volume for volume control modes and inspiratory pressure for pressure control modes) and additional settings. The additional settings include simple things, such as trigger sensitivity or automatic tube compensation, as well as complicated things, such as activating Volume Guarantee. There are no volume control modes available on the Babylog VN500. Table 10-64 shows the modes available on the Babylog VN500.


TABLE 10-64 Modes of Ventilation for the Babylog VN500

A table describes the modes of ventilation for the Babylog VN500. A table describes the modes of ventilation for the Babylog VN500.

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

Pressure Control Assist Control


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

    • Within-breath settings:

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

  • Spontaneous breaths: Permitted during mandatory breath but not between mandatory breaths
  • Between-breath targets: None

Pressure Control Assist Control with Volume Guarantee


  • Mandatory breaths: Machine triggered (preset frequency) or patient triggered (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: Permitted during mandatory breath but not between mandatory breaths
  • Between-breath targets: Operator-set tidal volume

Pressure Control Airway Pressure Release Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) and machine cycled (inspiratory time). Patient triggering of mandatory breaths is possible using the AutoRelease feature. This triggers inspiration once a preset expiratory flow threshold is reached. When AutoRelease is turned on, the switch from PHigh to PLow is synchronized with the patient’s breathing. Thus, with AutoRelease, what were formerly machine-triggered and machine-cycled (mandatory) breaths are converted to patient-triggered and patient-cycled (spontaneous) breaths.

    • Within-breath settings:

      • Operator-set PEEP (called PLow), peak inspiratory pressure (called PHigh), rise time, inspiratory time (called THigh), and expiratory time (called TLow). The inspiratory trigger sensitivity may also be set (using AutoRelease) as a percentage of peak expiratory flow.

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

    • Within-breath settings:

      • Automatic tube compensation

  • Between-breath targets: None

Pressure Control Continuous Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) and machine cycled (inspiratory time) and patient trigger efforts are ignored. Spontaneous breaths are permitted both between and during mandatory breaths. Because of this feature, the mode is classified as a form of intermittent mandatory ventilation, not continuous mandatory ventilation, despite the name given by Dräger.

    • Within-breath settings:

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

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

    • Within-breath settings:

      • None

  • Between-breath targets: None

Pressure Control Continuous Mandatory Ventilation with Volume Guarantee


  • Mandatory breaths: Machine triggered (preset frequency) and machine cycled (inspiratory time). Spontaneous breaths are permitted both between and during mandatory breaths. Because of this feature, the mode is classified as a form of intermittent mandatory ventilation, not continuous mandatory ventilation, despite the name given by Dräger.

    • Within-breath settings:

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

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

    • Within-breath settings:

      • None

  • Between-breath targets: Operator-set tidal volume

Pressure Control Mandatory Minute Volume Ventilation with Volume Guarantee


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (flow sensitivity) and machine cycled (inspiratory time). Mandatory breaths are suppressed if minute ventilation from spontaneous breaths is above preset minute ventilation target (i.e., product of tidal volume and frequency).

    • Within-breath settings:

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

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

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: Operator-set tidal volume. The settings for tidal volume and frequency constitute a between-breath target for minimum minute ventilation. Mandatory breaths are suppressed if minute ventilation from spontaneous breaths is this target.

Pressure Control Pressure Support Ventilation


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

    • Within-breath settings:

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

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

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: None

Pressure Control Pressure Support Ventilation with Volume Guarantee


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

    • Within-breath settings:

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

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

    • Within-breath settings:

      • Operator-set rise time
      • Ventilator-set inspiratory pressure

  • Between-breath targets: Operator-set tidal volume

Pressure Control Synchronized Intermittent Mandatory Ventilation


  • Mandatory breaths: Machine triggered (preset frequency) or patient synchronized (flow sensitivity) and machine cycled (inspiratory time). Spontaneous breaths are permitted both between and during mandatory breaths.

    • Within-breath settings:

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

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

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: None

Pressure Control Synchronized Intermittent Mandatory Ventilation with Volume Guarantee


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

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: Operator-set tidal volume

Spontaneous Continuous Positive Airway Pressure/Pressure Support


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

    • Within-breath settings:

      • Operator-set inspiratory pressure and rise time

  • Between-breath targets: None

Spontaneous Continuous Positive Airway Pressure/Volume Support


  • Mandatory breaths: Not allowed
  • 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

Spontaneous Proportional Pressure Support

Dec 19, 2021 | Posted by in RESPIRATORY | Comments Off on 5: Neonatal Ventilators
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