PuritanBennett980Ventilator OperatorsManual en US PT00101843A00
PuritanBennett980Ventilator OperatorsManual en US PT00101843A00
PuritanBennett980Ventilator OperatorsManual en US PT00101843A00
TM
Puritan Bennett
980 Series Ventilator
Copyright Information
©2012–2019 Covidien. COVIDIEN, COVIDIEN with logo, and Covidien logo and Positive Results for Life are U.S. and interna-
tionally registered trademarks of Covidien AG. ™* brands are trademarks of their respective owners. Other brands are trade-
marks of a Covidien company.
The information contained in this manual is the sole property of Covidien and may not be duplicated without permission.
This manual may be revised or replaced by Covidien at any time and without notice. Ensure this manual is the most current
applicable version. If in doubt, contact Covidien’s technical support department or visit the Puritan Bennett™ product
manual web page at:
www.medtronic.com/covidien/support/product-manuals
Click Acute Care Ventilation > PuritanBennett™ 980 Ventilator> then follow the prompts to select the desired manual.
While the information set forth herein is believed to be accurate, it is not a substitute for the exercise of professional judg-
ment.
The ventilator should be operated and serviced only by trained professionals. Covidien’s sole responsibility with respect to
the ventilator and software, and its use, is as stated in the limited warranty provided.
Nothing in this document shall limit or restrict in any way Covidien’s right to revise or otherwise change or modify the
equipment (including its software) described herein, without notice. In the absence of an express, written agreement to
the contrary, Covidien has no obligation to furnish any such revisions, changes, or modifications to the owner or user of
the equipment (including its software) described herein.
Table of Contents
1 Introduction
2 Product Overview
i
2.9.1 Primary Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-14
2.10 GUI Controls and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15
2.10.1 Control Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-15
2.10.2 GUI Touch Screen Reset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-16
2.10.3 Visual Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-16
2.10.4 On-screen Symbols and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19
2.10.5 Audible Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-22
2.11 Breath Delivery Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-23
2.11.1 BDU Controls and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-24
2.11.2 Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-33
2.12 Additional Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-33
2.13 Special Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-34
2.14 Color Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-34
2.15 Pneumatic Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-35
3 Installation
ii
3.9.1 SST (Short Self Test) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-41
3.9.2 Flow Sensor Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-47
3.9.3 Extended Self Test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-50
3.9.4 EST Test Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-52
3.9.5 EST Test Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-55
3.10 Operation Verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-56
4 Operation
iii
4.11.3 SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-32
4.11.4 Procedure Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-32
4.11.5 Ventilation Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-32
4.11.6 Safety Valve Open (SVO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-32
4.11.7 Ventilator Inoperative (Vent Inop) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-33
4.12 Ventilator Shutdown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-33
6 Performance
iv
6.5.9 AC POWER LOSS Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-29
6.5.10 APNEA Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-30
6.5.11 CIRCUIT DISCONNECT Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-30
6.5.12 LOSS OF POWER Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-31
6.5.13 DEVICE ALERT Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-31
6.5.14 HIGH CIRCUIT PRESSURE (1PPEAK) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-31
6.5.15 HIGH DELIVERED O2% (1O2%) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-32
6.5.16 HIGH EXHALED MINUTE VOLUME (1VE TOT) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-32
6.5.17 HIGH EXHALED TIDAL VOLUME (1VTE) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-32
6.5.18 HIGH INSPIRED TIDAL VOLUME (1VTI) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-32
6.5.19 HIGH RESPIRATORY RATE (1fTOT) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-33
6.5.20 INSPIRATION TOO LONG Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-33
6.5.21 LOW CIRCUIT PRESSURE (3PPEAK) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-33
6.5.22 LOW DELIVERED O2% (3O2%) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-34
6.5.23 LOW EXHALED MANDATORY TIDAL VOLUME (3VTE MAND) Alarm . . . . . . . . . . . . . . . . . . . . . .6-34
6.5.24 LOW EXHALED SPONTANEOUS TIDAL VOLUME (3VTE SPONT) Alarm . . . . . . . . . . . . . . . . . . .6-35
6.5.25 LOW EXHALED TOTAL MINUTE VOLUME (3VE TOT) Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-35
6.5.26 PROCEDURE ERROR Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-35
6.5.27 SEVERE OCCLUSION Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-35
6.6 Monitored Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-36
6.6.1 Total Exhaled Minute Volume (VE TOT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-36
6.6.2 Exhaled Spontaneous Minute Volume (VE SPONT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-36
6.6.3 Exhaled Tidal Volume (VTE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-36
6.6.4 Proximal Exhaled Minute Volume (VE TOTY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.5 Proximal Exhaled Tidal Volume (VTEY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.6 Exhaled Spontaneous Tidal Volume (VTE SPONT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.7 Exhaled Mandatory Tidal Volume (VTE MAND) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.8 Exhaled mL/kg Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.9 Inspired Tidal Volume (VTI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.10 Proximal Inspired Tidal Volume (VTIY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-37
6.6.11 Delivered mL/kg Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.12 I:E Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.13 Mean Circuit Pressure (PMEAN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.14 Peak Circuit Pressure (PPEAK) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.15 End Inspiratory Pressure (PI END) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.16 End Expiratory Pressure (PEEP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.17 Intrinsic PEEP (PEEPI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-38
6.6.18 PAV-based Intrinsic PEEP (PEEPI PAV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.19 Total PEEP (PEEPTOT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.20 Plateau Pressure (PPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.21 Total Respiratory Rate (fTOT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.22 PAV-based Lung Compliance (CPAV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.23 PAV-based Patient Resistance (RPAV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.24 PAV-based Lung Elastance (EPAV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-39
6.6.25 Spontaneous Rapid Shallow Breathing Index (f/VT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-40
v
6.6.26 Spontaneous Inspiratory Time Ratio (TI/TTOT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-40
6.6.27 Spontaneous Inspiratory Time (TI SPONT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-40
6.6.28 PAV-based Total Airway Resistance (RTOT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-40
6.6.29 Static Compliance (CSTAT) and Static Resistance (RSTAT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-40
6.6.30 Dynamic Compliance (CDYN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
6.6.31 Dynamic Resistance (RDYN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
6.6.32 C20/C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
6.6.33 End Expiratory Flow (EEF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
6.6.34 Peak Spontaneous Flow (PSF) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
6.6.35 Displayed O2% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
6.6.36 Inspiratory Time Constant (3TauI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-42
7 Preventive Maintenance
8 Troubleshooting
9 Accessories
vi
10 Theory of Operations
vii
10.13.3 Annunciating Occlusion and Disconnect Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-40
10.14 Respiratory Mechanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-40
10.14.1 Inspiratory Pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-41
10.14.2 Expiratory Pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-43
10.14.3 Negative Inspiratory Force (NIF) Maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-44
10.14.4 P0.1 Maneuver (Occlusion Pressure) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-45
10.14.5 Vital Capacity (VC) Maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-46
10.15 Ventilator Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-46
10.15.1 Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-46
10.15.2 Circuit Type and Predicted Body Weight (PBW) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-47
10.15.3 Ventilation Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-48
10.15.4 Mode and Breath Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-49
10.15.5 Respiratory Rate (f) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-50
10.15.6 Tidal Volume (VT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-51
10.15.7 Peak Inspiratory Flow (VMAX) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-51
10.15.8 Plateau Time (TPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-51
10.15.9 Flow Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-51
10.15.10 Flow Sensitivity (VSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-52
10.15.11 Pressure Sensitivity (PSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-52
10.15.12 Inspiratory Pressure (PI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-53
10.15.13 Inspiratory Time (TI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-53
10.15.14 Expiratory Time (TE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
10.15.15 I:E Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
10.15.16 High Pressure (PH) in BiLevel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
10.15.17 Low Pressure (PL) in BiLevel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
10.15.18 High Time (TH) in BiLevel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
10.15.19 Low Time (TL) in BiLevel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
10.15.20 TH:TL Ratio in BiLevel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
10.15.21 PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
10.15.22 Pressure Support (PSUPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
10.15.23 Volume Support (VT SUPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56
10.15.24 % Supp in TC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56
10.15.25 % Supp in PAV+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56
10.15.26 Rise Time% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56
10.15.27 Expiratory Sensitivity (ESENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-57
10.15.28 Disconnect Sensitivity (DSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-57
10.15.29 High Spontaneous Inspiratory Time Limit (2TI SPONT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-58
10.15.30 Humidification Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-58
10.15.31 Humidifier Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-59
10.16 Safety Net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-59
10.16.1 User Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-59
10.16.2 Patient Related Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-61
10.16.3 System Related Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-61
10.16.4 Background Diagnostic System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-61
10.17 Power On Self Test (POST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-63
viii
10.18 Short Self Test (SST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-63
10.19 Extended Self Test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-64
11 Specifications
A BiLevel 2.0
B Leak Sync
ix
B.7.1 Inspired Tidal Volume (VTL) Accuracy During Leak Sync . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-6
B.7.2 Exhaled Tidal Volume (VTE) Accuracy During Leak Sync . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7
B.7.3 %LEAK Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7
B.7.4 CIRCUIT DISCONNECT Alarm During Leak Sync . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7
C PAV™+
D NeoMode 2.0
x
E Proximal Flow
F Trending
Glossary
Index
xi
Page Left Intentionally Blank
xii
List of Tables
xiii
Table 10-3. Spontaneous Breath Delivery Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-19
Table 10-4. Maximum Pressure Adjustments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-21
Table 10-5. Inspiratory and Expiratory Pause Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-42
Table 10-6. Values for VT Based on Circuit Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-48
Table 10-7. Peak Flow and Circuit Type (Leak Sync Disabled) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-48
Table 10-8. Modes and Breath Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-49
Table 10-9. Illustrated Modes and Breath Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-50
Table 10-10. Safety PCV Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-60
Table 10-11. Inspiratory Backup Ventilation Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-62
Table 11-1. Performance Verification Equipment Uncertainty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1
Table 11-2. Physical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2
Table 11-3. Pneumatic Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3
Table 11-4. Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3
Table 11-5. Electrical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-5
Table 11-6. RS-232 Pinout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6
Table 11-7. Nurse Call Pinout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6
Table 11-8. Environmental Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-6
Table 11-9. Ventilator Settings Range and Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-7
Table 11-10. Alarm Settings Range and Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-14
Table 11-11. Patient Data Range and Resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-17
Table 11-12. Delivery Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-23
Table 11-13. Monitoring (Patient Data) Accuracy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-23
Table 11-14. Computed Value Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-24
Table 11-15. Electromagnetic Emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-26
Table 11-16. Electromagnetic Immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-26
Table 11-17. Immunity to Proximity Fields RF Wireless Communications Equipment. . . . . . . . . . . . . . . . . . 11-29
Table 11-18. AIM Standard Test Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-30
Table 11-19. Recommended Separation Distances for RF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-31
Table 11-20. Recommended Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-32
Table B-1. Maximum Leak Compensation Flow Based on Patient Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-2
Table B-2. DSENS Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-5
Table C-1. Absolute limits for PAV+ Monitored Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-7
Table C-2. PAV+ Work of Breathing Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-10
Table C-3. Default PBW-based Resistance Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-19
Table D-1. Recommended Breathing Circuits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7
Table D-2. Allowable NeoMode Ventilator Settings and Ventilation Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7
Table D-3. Delivered Volume Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11
Table D-4. Monitored Inspired Volume (VTI) Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11
Table D-5. Monitored Exhaled Tidal Volume (VTE) Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11
Table E-1. Proximal Flow Option Patient Data Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-6
Table E-2. Proximal Flow Option SST tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-8
Table E-3. Proximal Flow Sensor Volume Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13
Table E-4. Proximal Flow Sensor Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-14
Table E-5. Proximal Flow Option Component Part Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-14
Table F-1. Trended Ventilator Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-3
xiv
Table F-2. Trended Patient Data Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-4
Table F-3. Sampling Periods for Selected Time Scales. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-7
Table F-4. Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-8
xv
Page Left Intentionally Blank
xvi
List of Figures
xvii
Figure 4-9. Vent Setup Button—“NIV” Indicating NIV Ventilation Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-23
Figure 4-10. 2TI SPONT Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-24
Figure 4-11. Default NIV Alarm Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-25
Figure 4-12. RM in Menu Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-26
Figure 4-13. Respiratory Maneuver Tabs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-27
Figure 4-14. More Settings Screen with O2 Sensor Enabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-30
Figure 5-1. Incompatible USB Device Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3
Figure 5-2. Comm Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-4
Figure 5-3. Port Locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17
Figure 6-1. Alarm Message Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-5
Figure 7-1. EVQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-7
Figure 7-2. EVQ Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-8
Figure 7-3. EVQ Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-8
Figure 7-4. Exhalation Valve Diaphragm Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-9
Figure 7-5. Exhalation Filter Seal Removal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-9
Figure 7-6. Pressure Sensor Filter Removal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-10
Figure 7-7. Immersion Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11
Figure 7-8. EVQ Reprocessing Kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12
Figure 7-9. Installing the Pressure Sensor Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13
Figure 7-10. Installing the Exhalation Filter Seal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13
Figure 7-11. Installing the Diaphragm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-14
Figure 7-12. Installing the EVQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-15
Figure 8-1. Log Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-4
Figure 9-1. Ventilator with Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2
Figure 9-2. Additional Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2
Figure 10-1. Inspiration Using Pressure Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-5
Figure 10-2. Inspiration Using Flow Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6
Figure 10-3. Breath Activity During Time-triggered Inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7
Figure 10-4. Exhalation via the Airway Pressure Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8
Figure 10-5. Exhalation via the Percent Peak Flow Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9
Figure 10-6. Square Flow Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10
Figure 10-7. Descending Ramp Flow Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11
Figure 10-8. Ideal Waveform Using Square Flow Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-14
Figure 10-9. Ideal Waveform Using Descending Ramp Flow Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15
Figure 10-10. Ideal Waveform Using Pressure Control Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-16
Figure 10-11. ET Tube Target Pressure vs. Flow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-24
Figure 10-12. Tracheostomy Tube Target Pressure vs. Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-25
Figure 10-13. No Patient Inspiratory Effort Detected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-26
Figure 10-14. Patient Inspiratory Effort Detected . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-26
Figure 10-15. Combined VIM and PIM Breaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-27
Figure 10-16. Mandatory and Spontaneous Intervals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-28
Figure 10-17. PIM Delivered Within Mandatory Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-28
Figure 10-18. PIM Not Delivered Within Mandatory Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-29
Figure 10-19. Apnea Interval Equals Breath Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-34
Figure 10-20. Apnea Interval Greater Than Breath Period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-34
xviii
Figure 10-21. Apnea Interval Less Than Breath Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-35
Figure 10-22. Apnea Ventilation in SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-36
Figure A-1. Spontaneous Breathing at PL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
Figure A-2. BiLevel Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2
Figure A-3. BiLevel Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3
Figure A-4. BiLevel with Pressure Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5
Figure A-5. Spontaneous and Synchronous Intervals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7
Figure A-6. APRV With Spontaneous Breathing at PH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-8
Figure B-1. Enabling Leak Sync . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-3
Figure B-2. GUI Screen when Leak Sync is Enabled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-4
Figure B-3. Leak Sync Monitored Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-5
Figure B-4. Circuit Disconnect During VC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-7
Figure C-1. Ventilator Setup Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4
Figure C-2. Graphics displays in PAV+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-11
Figure C-3. Use of Default Lung Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-18
Figure D-1. Installing the Neonatal Filter and Door. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-3
Figure D-2. How to Connect the Breathing Circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-6
Figure D-3. CPAP Setup Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-9
Figure E-1. Proximal Flow Sensor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-4
Figure E-2. Sample GUI screen Showing Proximal Flow Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-5
Figure E-3. Message During Autozero and Purge Processes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-7
Figure E-4. Attaching Proximal Flow Sensor to Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-9
Figure E-5. Enabling/Disabling the Proximal Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-10
Figure E-6. Attaching the Proximal Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-11
Figure E-7. Manual Purge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-12
Figure E-8. Alarm Message—Prox Inoperative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-13
Figure F-1. Accessing Trending via the Menu Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-2
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Page Left Intentionally Blank
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1 Introduction
1.1 Overview
This manual contains information for operating the Puritan Bennett™ 980 Series Ventilators.
Before operating the ventilator system, thoroughly read this manual. The latest version of this
manual is available on the Internet at:
www.medtronic.com/covidien/support/product-manuals
Click Acute Care Ventilation > PuritanBennett™ 980 Ventilator, then follow the prompts to select
the desired manual.
To order an additional copy of this manual, contact Covidien Customer Service or your local rep-
resentative.
Documentation is available online at the URL above. Covidien makes available all appropriate
information relevant to use and service of the ventilator. For further assistance, contact your
local Covidien representative.
• The Puritan Bennett™ 980 Series Ventilator Operator’s Manual—Provides basic information on
operating the ventilator and troubleshooting errors or malfunctions. Before using the ventilator,
thoroughly read this manual.
• The Puritan Bennett™ 980 Series Ventilator Service Manual—Provides information to Covidien-
trained service technicians for use when testing, troubleshooting, repairing, and upgrading the ven-
tilator.
1-1
Introduction
Symbol Description
Serial number
Part number
Manufacturer
This side up
Fragile
Atmospheric pressure limitations: 70 kPa to 106 kPa (10.2 psi to 15.4 psi)
Keep dry
CSA certification mark that signifies the product has been evaluated to the
applicable ANSI/Underwriters Laboratories Inc. (UL) and CSA standards for
use in the U.S. and Canada.
Symbol Description
U.S. federal law restricts this device to sale by or on the order of a physician.
This section contains safety information for users, who should always exercise appropriate caution
while using the ventilator.
Symbol Definition
WARNING
Warnings alert users to potential serious outcomes (death, injury, or adverse events) to
the patient, user, or environment.
Caution
Cautions alert users to exercise appropriate care for safe and effective use of the prod-
uct.
Note
Notes provide additional guidelines or information.
WARNING:
Explosion hazard—Do not use in the presence of flammable gases. An oxygen-rich environment
accelerates combustibility.
WARNING:
To avoid a fire hazard, keep all components of the system away from all sources of ignition (such
as matches, lighted cigarettes, flammable medical gases, or heaters). Oxygen-rich environments
accelerate combustibility.
WARNING:
In case of fire or a burning smell, immediately take the following actions if it is safe to do so:
disconnect the patient from the ventilator and disconnect the ventilator from the oxygen supply,
facility power, and all batteries. Provide alternate method of ventilatory support to the patient, if
required.
WARNING:
Replacement of batteries by inadequately trained personnel could result in an unacceptable risk,
such as excessive temperatures, fire, or explosion.
WARNING:
To minimize fire hazard, inspect and clean or replace, as necessary, any damaged ventilator parts
that come into contact with oxygen.
WARNING:
To prevent electrostatic discharge (ESD) and potential fire hazard, do not use antistatic or
electrically conductive hoses or tubing in or near the ventilator breathing system.
WARNING:
To ensure proper operation and avoid the possibility of physical injury, only qualified medical
personnel should attempt to set up the ventilator and administer treatment with the ventilator.
WARNING:
In case of ventilator failure, the lack of immediate access to appropriate alternative means of
ventilation can result in patient death. An alternative source of ventilation, such as a self-inflating,
manually-powered resuscitator (as specified in ISO 10651-4 with mask) should always be available
when using the ventilator.
WARNING:
Patients on mechanical ventilation should be monitored by clinicians for proper patient
ventilation.
WARNING:
The ventilator system is not intended to be a comprehensive monitoring device and does not
activate alarms for all types of conditions. For a detailed understanding of ventilator operations,
be sure to thoroughly read this manual before attempting to use the ventilator system.
WARNING:
To prevent patient injury, do not use the ventilator if it has a known malfunction. Never attempt
to override serious malfunctions. Replace the ventilator and have the faulty unit repaired by
trained service personnel.
WARNING:
To prevent patient injury, do not make unauthorized modifications to the ventilator.
WARNING:
To prevent injury and avoid interfering with ventilator operation, do not insert tools or any other
objects into any of the ventilator’s openings or ports.
WARNING:
The audio alarm volume level is adjustable. The operator should set the volume at a level that
allows the operator to distinguish the audio alarm above background noise levels. See To adjust
alarm volume, page 3-37 for instructions on alarm volume adjustment.
WARNING:
Do not pause, disable, or decrease the volume of the ventilator’s audible alarm if patient safety
could be compromised.
WARNING:
If increased pressures are observed during ventilation, it may indicate a problem with the
ventilator. Check for blocked airway, circuit occlusion, and run SST.
WARNING:
The LCD panel contains toxic chemicals. Do not touch broken LCD panels. Physical contact with a
broken LCD panel can result in transmission or ingestion of toxic substances.
WARNING:
If the graphical user interface (GUI) display/LCD panel is blank or experiences interference and
cannot be read, check the patient, then verify via the status display that ventilation is continuing
as set. Because breath delivery is controlled independently from the GUI, problems with the display
will not, by themselves, affect ventilation. The ventilator, however, should be replaced as soon as
possible and repaired by qualified service personnel.
WARNING:
The Puritan Bennett™ 980 Series Ventilator contains phthalates. When used as indicated, very
limited exposure to trace amounts of phthalates may occur. There is no clear clinical evidence that
this degree of exposure increases clinical risk. However, to minimize risk of phthalate exposure in
children and nursing or pregnant women, this product should only be used as directed.
WARNING:
Although the 980 Series Ventilator meets the standards listed in Chapter 11, the internal lithium-
ion battery of the device is considered to be Dangerous Goods (DG) Class 9 - Miscellaneous, when
transported in commerce. The 980 Series Ventilator and the associated lithium-ion battery are
subject to strict transport conditions under the Dangerous Goods Regulation for air transport
(IATA: International Air Transport Association), International Maritime Dangerous Goods code for
sea and the European Agreement concerning the International Carriage of Dangerous Goods by
Road (ADR) for Europe. Private individuals who transport the device are excluded from these
regulations although for air transport some requirements may apply.
WARNING:
Do not position the ventilator next to anything that blocks or restricts the gas inlet or cooling air
circulation openings, gas exhaust port, fan intake, or alarm speaker, as this may:
• limit the air circulation around the ventilator, potentially causing overheating;
• limit the ventilator's ability to exhaust patient exhaled gas leading to potential harm;
WARNING:
To avoid injury, do not position the ventilator in a way that makes it difficult to disconnect the
patient.
WARNING:
To ensure proper operation, do not position the ventilator in a way that makes it difficult to access
the AC power cord.
WARNING:
Do not use the ventilator in a hyperbaric chamber. It has not been validated for use in this
environment.
WARNING:
Do not use the ventilator in the presence of strong magnetic fields. Doing so could cause a
ventilator malfunction.
WARNING:
Do not use the ventilator during radiotherapy (i.e. cancer treatment using ionizing radiation), as
doing so could cause a ventilator malfunction.
WARNING:
To avoid the risk of ventilator malfunction, operate the ventilator in an environment that meets
specifications. See Table 11-8. on page 11-6.
WARNING:
Do not use the ventilator as an EMS transport ventilator. It has not been approved or validated for
this use.
WARNING:
Before activating any part of the ventilator, be sure to check the equipment for proper operation
and, if appropriate, run SST as described in this manual. See To run SST, page 3-43.
WARNING:
Check for leaks in the ventilator breathing system by running SST prior to ventilating a patient.
WARNING:
Lock the ventilator’s casters during use to avoid the possibility of extubation due to inadvertent
ventilator movement.
WARNING:
The ventilator accuracies listed in Table 11-12. , Table 11-13. , and Table 11-14. are applicable only
under specified operating conditions. See Table 11-8. on page 11-6 for environmental
specifications. If the ventilator is operated outside specified ranges, the ventilator may supply
incorrect information and the accuracies listed in the aforementioned tables do not apply. A
hospital biomedical technician must verify the ventilator is operated in the environmental
conditions specified.
WARNING:
To avoid the risk of electrical shock:
Use only Covidien batteries, adapters, and cables.
• Do not use batteries, adapters or cables with visible signs of damage.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment, the
clinician should carefully select the ventilation mode and settings to use for that patient, based on
clinical judgment, the condition and needs of the patient, and the benefits, limitations, and
characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best for
the patient's current needs.
WARNING:
Avoid nuisance alarms by applying appropriate alarm settings.
WARNING:
To prevent inappropriate ventilation, select the correct Tube Type (ET or Tracheostomy) and tube
inner diameter (ID) for the patient’s ventilatory needs. Inappropriate ventilatory support leading
to over-or under-ventilation could result if an ET tube or trach tube setting larger or smaller than
the actual value is entered.
WARNING:
Setting expiratory volume alarms to OFF increases the risk of not detecting a low returned volume.
WARNING:
Setting any alarm limits to OFF or extreme high or low values can cause the associated alarm not
to activate during ventilation, which reduces its efficacy for monitoring the patient and alerting
the clinician to situations that may require intervention.
WARNING:
To prevent electrostatic discharge (ESD) and potential fire hazard, do not use antistatic or
electrically conductive hoses or tubing in or near the ventilator breathing system.
WARNING:
Adding accessories to or removing accessories from the ventilator breathing system (VBS) can
change the pressure gradient across the VBS and affect ventilator performance. Ensure that any
changes to the ventilator circuit configurations do not exceed the specified values for circuit
compliance and for inspiratory or expiratory limb total resistance. See Table 11-4. on page 11-3. If
adding accessories to or removing accessories from the VBS, always run SST to establish circuit
compliance and resistance prior to ventilating the patient.
WARNING:
Use of a nebulizer or humidifier can lead to an increase in the resistance of inspiratory and
exhalation filters. Monitor the filters frequently for increased resistance or blockage.
WARNING:
During transport, the use of breathing tubing without the appropriate cuffed connectors may
result in the circuit becoming detached from the ventilator.
WARNING:
The added gas from an external pneumatic nebulizer can adversely affect spirometry, delivered
O2%, delivered tidal volumes, and breath triggering. Additionally, aerosolized particulates in the
ventilator circuit can lead to an increase in exhalation filter resistance.
WARNING:
Carefully route patient tubing and cabling to reduce the possibility of patient entanglement or
strangulation.
WARNING:
Always use filters designed for use with the Puritan Bennett™ 980 Series Ventilator. Do not use
filters designed for use with other ventilators. See Table 9-1. for relevant filter part numbers.
WARNING:
To avoid liquid entering the ventilator, empty the expiratory condensate vial before fluid reaches
the maximum fill line.
WARNING:
Accessory equipment connected to the analog and digital interfaces must be certified according
to IEC 60601-1. Furthermore, all configurations shall comply with the system standard IEC 60601-
1-1. Any person who connects additional equipment to the signal input part or signal output part
of the ventilator system configures a medical system, and is therefore responsible for ensuring the
system complies with the requirements of the system standard IEC 60601-1-1. If in doubt, consult
Covidien Technical Services at 1 800 255 6774 or your local representative.
WARNING:
Do not use HMEs (heat and moisture exchangers) and heated humidifiers together. This may result
in the HME absorbing water and becoming obstructed, resulting in high airway pressures.
WARNING:
Do not use nitric oxide, helium or mixtures containing helium with the ventilator. It has not been
validated for use with these gas mixtures.
WARNING:
To avoid the risk of ventilator malfunction, do not use the ventilator with anesthetic gases.
WARNING:
For proper ventilator operation, use only clean, dry, medical grade gases when ventilating a
patient.
WARNING:
Use of only one gas source could lead to loss of ventilation or hypoxemia if that one gas source fails
and is not available. Therefore, always connect at least two gas sources to the ventilator to ensure
a constant gas supply is available to the patient in case one of the gas sources fails. The ventilator
has two connections for gas sources: air inlet, and oxygen inlet.
WARNING:
Use of the ventilator in altitudes higher or barometric pressures lower than those specified could
compromise ventilator operation. See Table 11-8. on page 11-6 for a complete list of
environmental specifications.
WARNING:
The ventilator should be connected to a gas pipeline system compliant to ISO 7396-1:2007
because:
• Installation of the ventilator on a non-ISO 7396-1:2007 compliant gas pipeline system may
exceed the pipeline design flow capacity.
• The ventilator is a high-flow device and can interfere with the operation of other equipment
using the same gas source if the gas pipeline system is not compliant to ISO 7396-1:2007.
WARNING:
Patients receiving mechanical ventilation may experience increased vulnerability to the risk of
infection. Dirty or contaminated equipment is a potential source of infection. It is recognized that
cleaning, sterilization, sanitation, and disinfection practices vary widely among health care
institutions. Always follow your hospital infection control guidelines for handling infectious
material. Follow the instructions in this manual and your institution’s protocol for cleaning and
sterilizing the ventilator and its components. Use all cleaning solutions and products with caution.
Follow manufacturer’s instructions for individual cleaning solutions. See Chapter 7.
WARNING:
To prevent infection and contamination, always ensure inspiratory and exhalation bacteria filters
are installed before ventilating the patient.
WARNING:
Never attempt to reuse single-use components or accessories. Doing so increases risk of cross-
contamination and reprocessing of single-use components or accessories may compromise
functionality leading to possible loss of ventilation.
WARNING:
To ensure proper operation and avoid the possibility of physical injury, this ventilator should only
be serviced by qualified technicians who have received appropriate Covidien-provided training
for the maintenance of this ventilator.
WARNING:
Follow preventive maintenance according to specified intervals listed in these tables. See
Table 7-1. on page 7-2 and Table 7-4. on page 7-15.
1.3.12 Cautions
Caution:
To prevent possible equipment damage, ensure the casters are locked to prevent inadvertent
movement of the ventilator during routine maintenance, or when the ventilator is on an incline.
Caution:
Do not use sharp objects to make selections on the display or keyboard.
Caution:
To ensure optimal performance, keep the GUI touch screen and keyboard clean and free from
foreign substances. See Table 7-2. on page 7-4.
Caution:
To avoid moisture entering the ventilator and possibly causing a malfunction, Covidien
recommends using a wall air water trap when using piped medical air from a facility-based air
compressor.
Caution:
Use only the cleaning agents specified. See Table 7-2. on page 7-4 for approved cleaning agents.
Caution:
Clean the compressor inlet filter according to the interval listed in Chapter 7. See Table 7-1. on
page 7-2.
Caution:
Do not block cooling vents.
Caution:
Ensure proper connection and engagement of exhalation and inspiratory filters.
Caution:
Follow instructions for proper GUI and BDU (breath delivery unit) mounting as described in the
Puritan Bennett™ 980 Series Ventilator Installation Instructions.
Caution:
To prevent possible damage to electronic circuitry, do not connect the GUI to the BDU while power
is applied.
Caution:
Follow proper battery installation instructions as described in this manual.
Caution:
When transferring the ventilator from storage conditions, allow its temperature to stabilize at
ambient conditions prior to use.
Caution:
Remove extended and primary batteries from ventilator prior to transporting in a vehicle. Failure
to do so could result in damage to the ventilator.
1.3.13 Notes
Note:
Federal law (U.S.A.) restricts the sale of this device except by or on the order of a physician.
Note:
When using non-invasive ventilation (NIV), the patient’s actual exhaled volume may differ from the exhaled
volume reported by the ventilator due to leaks around the mask.
Note:
When utilizing a closed-suction catheter system, the suctioning procedure can be executed using existing
mode, breath type, and settings. To reduce potential for hypoxemia during the procedure, elevated
delivered oxygen can be enabled using the Elevate O2 control. See To adjust the amount of elevated O2
delivered for 2 minutes, page 3-36.
For technical information and assistance, to order parts, or to order an operator’s manual or
service manual, contact Covidien Technical Services at 1 800 255 6774 or a local Covidien repre-
sentative. The Puritan Bennett™ 980 Series Ventilator Service Manual includes information necessary
to service or repair the ventilator when used by qualified service personnel.
When calling Covidien Technical Services, or a local Covidien representative, have the BDU and
GUI serial numbers available, as well as the firmware version number of the ventilator system.
The ventilator’s configuration is available by touching the wrench icon on the GUI screen, then
touching the Options tab. Have this information available whenever requesting technical assis-
tance.
Manufacturer’s address
Covidien USA
2101 Faraday Ave.
Carlsbad, CA 92008
Phone: 1 800 255 6774 option 4
Email: [email protected]
For online technical support, visit the SolvITSM Center Knowledge Base at
solvitcenter.puritanbennett.com/ and follow the prompts.
The SolvIT Center provides answers to frequently asked questions about the ventilator system and
other Puritan Bennett products 24 hours a day, 7 days a week.
The ventilator is equipped with an on-screen help system that enables users to select an item on
the screen and display a description of that item. Follow the procedure below to access and use
on-screen help.
Help topics on the ventilator are called tooltips. If a tooltip is available, a glowing blue outline
appears around the item in question.
To access tooltips
1. Touch the item in question for a period of at least 0.5 second, or drag the help icon (the question mark icon
appearing at the lower right of the GUI screen) to the item in question. A tooltip appears with a short
description of the item. Most screen items have tooltips associated with them, providing the operator with
access to a multitude of help topics.
3. Touch “close” to close the dialog, or let it fade away after 5 seconds.
Note:
Dragging the help icon causes the tooltip to display in its unexpanded state.
Note:
Dragging the help icon and pausing causes a tooltip to display. Continue dragging to another item to
dismiss the last tooltip and display another tooltip.
Other Resources
Additional resources for information about the ventilator can be found in the
Puritan Bennett™ 980 Series Ventilator Service Manual and appendices in this manual for BiLevel 2.0,
Leak Sync, PAV+, NeoMode 2.0, Proximal Flow, and Trending functions.
• XXXXX is a sequential number that resets at the beginning of each new year.
Serial numbers are located on labels on the back panels of the GUI and BDU, and in various loca-
tions on product options.
1.7 Manufacturer
Covidien llc, 15 Hampshire Street, Mansfield, MA 02048 USA.
2.1 Overview
This chapter contains introductory information for the Puritan Bennett™ 980 Series Ventilator.
Note:
• Items shown in bold-italic font are contained as entries in the glossary.
• Items shown in bold font are physical hardware features (e.g., to patient port, exhaust port)
Communication between the ventilator’s graphical user interface (GUI) and the breath deliv-
ery unit (BDU) occurs continuously via independent central processing units (CPUs).
See Figure 2-12. on page 2-36 and Figure 2-13. on page 2-38 and their associated reference des-
ignators when reading the following paragraphs.
Gas delivery starts with the ventilator connected to wall (or bottled) air and oxygen. Gas travels
to the mix module where gas pressures are regulated by their respective proportional solenoid
valves (PSOLs). The PSOLs meter the gases according to the ventilator settings entered, then
the gases flow through individual air and oxygen flow sensors into the mix manifold and accu-
mulator for mixing. The individual gas pressures are continuously monitored both before and
after they are mixed in the mix manifold and accumulator assemblies. The mixed gas then flows
to the inspiratory pneumatic system where it flows through the breath delivery flow sensor and
then the inspiratory PSOL for delivery to the patient.
Before the gas reaches the patient, it passes through an internal inspiratory bacteria filter, then
through an external inspiratory bacteria filter attached to the ventilator’s gas outlet (the to
patient port) where the breathing circuit is attached. When the gas returns from the patient, it
flows through the expiratory limb of the breathing circuit, to the from patient port on the exha-
lation bacteria filter (which includes a condensate vial) before flowing through the exhalation
flow sensor and exhalation valve (EV). A gas exhaust port allows exhaled gas to exit the venti-
lator and flow to the room.
The ventilator recognizes the patient’s breathing effort using pressure triggering (P-Trig) or
flow triggering (V-Trig). During pressure triggering, as the patient inhales, the airway pressure
decreases and the inspiratory pressure transducer (PI) monitors this pressure decrease. When
the pressure drops to at least the value of the pressure sensitivity (PSENS) setting, the ventilator
delivers a breath. During flow triggering, the difference between inspiratory and expiratory
2-1
Product Overview
flows is monitored. As the patient inhales, the exhalation flow sensor measures less flow, while the
delivery flow sensor measurement remains constant. When the difference between the two mea-
surements is at least the value of the operator-set flow sensitivity (VSENS), the ventilator delivers a
breath. If the patient is not inhaling, any difference between delivered flow and expiratory flow is
due to flow sensor inaccuracy or leaks in the ventilator breathing circuit. To compensate for leaks,
which can cause autotriggering, the clinician can increase the VSENS setting or enable Leak Sync.
Note:
Leak Sync is a software function that is enabled by the clinician. Details on its operation are provided in
Appendix B.
A backup pressure triggering threshold of 2 cmH2O is also in effect. This provides enough pres-
sure sensitivity to avoid autotriggering, but will still allow the ventilator to trigger with acceptable
patient effort.
The exhalation valve controls positive end expiratory pressure (PEEP) using feedback from the
expiratory pressure transducer (PE). The valve controller also cycles the ventilator into the expira-
tory phase if the expiratory pressure measurement (PE) equals or exceeds the operator-set high
circuit pressure limit. The PE measurement also controls when the safety valve (SV) opens. If PE
measures 110 cmH2O or more in the ventilator breathing circuit, the safety valve opens, allowing
the patient to breathe room air (if able to do so) through the valve.
• Puritan Bennett™ 980 Neonatal Ventilator — The Neonatal model ventilates neonatal patients
with predicted body weights from 0.3 kg to 7.0 kg, and with tidal volumes for mandatory volume-con-
trolled breaths from 2 mL to 315 mL.
• Puritan Bennett™ 980 Universal Ventilator — The Universal model ventilates neonatal, pediatric,
and adult patients with predicted body weights from 0.3 kg to 150 kg, and with tidal volumes for man-
datory volume-controlled breaths from 2 mL to 2500 mL.
To ventilate neonatal patients on the Pediatric–Adult or Universal models, the NeoMode 2.0 soft-
ware option is required. For details regarding the NeoMode 2.0 software option, see Appendix D.
The estimated service life of the ventilator is approximately 10 years, provided the preventive
maintenance schedule stated in the Puritan Bennett™ 980 Series Ventilator Service Manual is fol-
lowed; however, service life of individual units may vary.
• Type BF
• Mobile
• Internally powered
• IP 21 equipment
• Continuous operation
• Not suitable for use with flammable medical gases (not AP or APG)
See Table 2-3. on page 2-9 for a description of the meaning of the IP classification.
The ventilator system uses a graphical user interface (GUI) and breath delivery unit (BDU) for
entering patient settings and delivering breaths to the patient. The GUI contains electronics
capable of transferring the clinician’s input (by touching the screen) to the BDU where pneumatic
and electronic systems, respectively, generate the breathing parameters.
Note:
Intended typical usage may be defined to include the following for the ventilator system:
Hospital Use — Typically covers areas such as operating rooms, special procedure areas, intensive and
critical care areas within the hospital and in hospital-type facilities. Hospital-type facilities include
skilled nursing facilities, surgicenters, and sub-acute centers.
Intra-hospital transport — Includes transport of a patient within the hospital or hospital-type facility. All
external hospital transportation (i.e. ambulance or aircraft) is excluded.
Note:
Federal law (U.S.A) restricts the sale of this device except by or on the order of a physician.
2.4 Contraindications
Do not operate the ventilator in a magnetic resonance imaging (MRI) environment.
Note:
The ventilator has no components made of natural rubber latex.
Note:
The components in the gas pathway that can become contaminated with bodily fluids or expired gases
during both normal and single fault conditions are:
• External inspiratory filter
The typical ventilator system ships with the packing list shown in Table 2-1. Depending upon the
ventilator system purchased, your list may vary.
Quantity Item
1 Inspiratory filter
1 DC compressor (optional)
1 Power cord
1 Operator’s manual CD
Quantity Item
1 Flex arm
1 Drain bag
See Table 2-4. on page 2-11 for symbols found on the GUI or BDU. The “Do Not Push” symbol
found on the GUI, only, is shown in this table.
Symbol Description
To patient port
Software option labels are applied to the grid located on the back of the ventilator, as shown in
Figure 2-4. (item 4) and Figure 2-5. (item 1).
Table 2-3. lists the symbols and descriptions found on the BDU or base labels.
Symbol Description
U.S. federal law restricts this device to sale by or on the order of a physician.
User must consult instructions for use. Symbol is also found on “Do not
obstruct” labels on both left and right sides of the ventilator, and on label
indication supply gas connections.
Keep away from fire or flame. Oxygen rich environments accelerate com-
bustibility.
Symbol Description
Authorized to bear the CSA certification mark signifying the product has
been evaluated to the applicable ANSI/Underwriters Laboratories Inc. (UL)
and CSA standards for use in the US and Canada.
Symbol Description
Symbol Description
Serial number.
The GUI incorporates a 15 inch display that rotates throughout a 170° angle about a vertical axis
in either direction. The GUI can also be tilted up to 45° from vertical.
The clinician enters ventilation parameters via the GUI’s touch screen, also known as the ventila-
tor’s primary display. The GUI’s keys activate other ventilator functions including screen bright-
ness, display lock, alarm volume, manual inspiration, inspiratory pause, expiratory pause, alarm
reset, and audio paused.
The GUI displays the following information depending on the state of the ventilator:
• Ventilator, apnea, and alarm settings
• Patient data
• Waveforms
The GUI bezel has eight off-screen control keys as shown in Table 2-5.
Display brightness key—Adjusts the GUI screen brightness. Press the key and turn the
knob to adjust the brightness.
Display lock key—Actuates a lock to prevent inadvertent settings changes to the venti-
lator (including the knob function) while the display is locked. The display lock is useful
when cleaning the touch screen. Press the key again to unlock the display.
Also use the display lock key to reset the GUI touch screen as described in GUI Touch
Screen Reset (2.10.2).
Alarm volume key—Adjusts the alarm volume. The alarm volume cannot be turned off.
Manual inspiration key—In A/C, SIMV, and SPONT modes, delivers one manual breath to
the patient in accordance with the current mandatory breath parameters. In BiLevel
mode, transitions from low pressure (PL) to high pressure (PH) (or vice versa). To avoid
breath stacking, a manual inspiration is not delivered during inspiration or during the
restricted phase of exhalation. See Manual Inspiration (10.7.5) on page 10-18 for informa-
tion on the restricted phase of exhalation.
The Manual inspiration key can be used to deliver mandatory breaths to the patient or to
run an inspiratory pause maneuver in SPONT mode. The manual inspiration key cannot
be used to run an expiratory pause maneuver in SPONT mode.
Inspiratory pause key—Initiates an inspiratory pause maneuver, which closes the inspira-
tory and exhalation valves and extends the inspiratory phase of a mandatory breath for
the purposes of measuring end inspiratory pressure (PI END) for calculation of plateau
pressure (PPL), static compliance (CSTAT), and static resistance (RSTAT).
Expiratory pause key—Initiates an expiratory pause maneuver, which extends the expi-
ratory phase of the current breath to measure total PEEP (PEEPTOT).
Alarm reset key—Clears active alarms or resets high-priority alarms and cancels an active
audio paused interval. An alarm reset is recorded in the alarm log if there is an active
alarm. DEVICE ALERT alarms cannot be reset.
Audio paused key—Pauses alarms for 2 minutes. Cancel the audio paused function by
touching the on-screen Cancel button.
On rare occasions, the GUI touch screen may become unresponsive. If you observe an unrespon-
sive GUI, inaccurate GUI responses, or unintended GUI responses, reset the touch screen to
restore proper touch screen functionality.
To reset the touch screen
1. Touch the display lock key on the GUI bezel to lock the screen. The locked padlock icon appears on the
screen and the display lock key illuminates.
2. Touch the display lock key again. Doing so displays a progress bar below the locked padlock icon, after
which time the locked icon will “unlock,” indicating a successful GUI touch screen reset.
Alternatively, ensure that a patient is not connected to the ventilator and power cycle the venti-
lator.
Note:
Do not touch the screen during the unlock period.
Note:
The manual GUI touch screen reset described in this section is different than the automatic 30-second
transient reset of the GUI described in Table 2-9.
Table 2-6. shows the GUI’s visual indicators. See Figure 4-1. on page 4-3 for area names.
The audio paused function has two visual indicators—the audio paused key on the GUI bezel
glows yellow during an audio paused interval, and a visual countdown timer appears, showing
the amount of time the audio paused interval has remaining.
Symbol Description
Symbol Description
Symbol Description
Touch an on-screen symbol briefly (0.5 second) to display a tooltip on the GUI screen. The tooltip
contains a definition of the symbol and other descriptive text, available with either short or long
descriptions. The short description expands to show more information by touching “more” on the
tooltip dialog or collapses by touching “less”. The tooltip closes by touching “close” or fades in 5
seconds if left alone. Expanding the tooltip dialog prevents the tooltip from timing out. Touching
outside the tooltip causes the dialog to close.
Table 2-7. summarizes the ventilator’s symbols and abbreviations.
Note:
Table 2-7. is subject to change.
TA Apnea interval
TE Expiratory time
TH:TL High pressure time to low pressure time ratio (in BiLevel)
TI Inspiratory time
PI Inspiratory pressure
VT Tidal volume
VC Vital capacity
VS Volume support
A tone sounds when a button on the GUI is touched, and also when settings are accepted.
Audible indicators include pitched tones, beeps, and key clicks. Key clicks sound whenever a key
on the GUI is pressed. Various tones annunciate patient alarms.
Note:
Pressing the audio paused key pauses alarms for the 2-minute audio paused period.
Caregivers may choose to pause alarms by pressing the audio paused key. A 2-minute count-
down timer appears on the GUI during the audio paused interval. Cancel the audio paused func-
tion by touching Cancel.
Click each icon in Table 2-8. to listen to a sample of the corresponding tones:
Note:
To hear the tones, Adobe Reader version 10 or higher must be installed on your computer.
Get Adobe Reader, free.
Function Description
Low priority alarm tone A series of two tones. Sounds when a low priority
alarm occurs.
Medium priority alarm tone A repeating series of three tones. Sounds when a
medium priority alarm occurs.
High priority alarm tone A repeating series of five tones. Sounds when a high
priority alarm occurs.
Soft bound tone One tone. Sounds when a soft bound is reached
when making changes to ventilator settings. A soft
bound is a selected value that exceeds or goes
below its limit and requires acknowledgment to
continue.
Hard bound tone (invalid entry) The invalid entry sound occurs when a hard bound
is reached when making changes to ventilator set-
tings. A hard bound defines the upper or lower limit
of the setting, where the setting cannot be adjusted
higher or lower.
The clinician enters ventilation parameters via the GUI’s touch screen. See Figure 2-1. on page
2-5. The keys activate other ventilator functions. See Table 2-5. on page 2-15.
BDU Controls
• On/Off switch—Lift the switch cover and turn the ventilator on or off.
• Service mode button—Press and release this button when the Covidien splash screen appears on the
status display after powering on the ventilator to enter Service mode. See Figure 2-10. , item 1.
Note:
The Covidien splash screen shows the Covidien logo and appears momentarily as a banner on the status
display. See Table 2-9. for an image of the splash screen.
BDU AC Indicator
The status display and the AC power indicator are the only visual indicators on the BDU. The AC
indicator illuminates green whenever the ventilator is connected to AC power. All other visual
indicators on the ventilator are on the GUI. See Typical Status Display Indicators and Messages, page
2-27 for a description of the status display indicators and symbols. See the next section for a
summary of the information appearing on the status display.
Status Display
The status display is a separate display located on the BDU. See Figure 2-3. , item 6 on page 2-7.
The status display provides the following information according to the state of the ventilator:
During normal ventilation the status display shows:
• Current power source (AC or DC)
• Circuit pressure graph displaying pressure units, 2PPEAK alarm setting and current PPEAK and PEEP
values
Note:
The status display provides a redundant check of ventilator operation.If the GUI stops operating for any
reason, ventilation continues as set.
Figure 2-11. shows a sample of the status display during normal ventilation (compressor option
not installed).
Note:
Status display images are shown without the optional DC compressor installed.
Table 2-9. lists indicators and messages that appear on the status display:
The continuous tone alarm is the only audible indicator in the BDU, and is described in Table 2-10.
Indicator Description
Continuous tone alarm A continuous tone annunciated when there is a Ventilator Inoperative (vent inop) condi-
(Immediate priority) tion. This alarm lasts for a minimum of 2 minutes.
2.11.2 Connectors
• Exhalation port (from patient) — The expiratory limb of the patient circuit attaches to the inlet of
the exhalation bacteria filter. This port is compatible with a standard 22mm (OD) conical connection.
• Proximal flow sensor — A keyed pneumatic connector for the proximal flow sensor is provided with
a locking feature to prevent inadvertent disconnection. The proximal flow sensor measures flow and
pressure at the patient wye. The proximal flow sensor is an optional sensor. Details on operation are
provided in Appendix E.
• Standard interface connectors — USB, HDMI, and Ethernet connectors are provided. The USB con-
nector allows images to be captured on an external USB storage device and allows communication
with an external patient monitor via serial-over-USB protocol, and the HDMI connector allows the GUI
image to be displayed on an external video display device. The Ethernet connector is used by service
personnel to upload new software and options. See Port Use (5.5.1) on page 5-17 for more information.
See To configure Comm ports, page 5-4 for information on serial-over-USB data transfer when configur-
ing Comm ports for external devices.
WARNING:
Use of the compressor in altitudes higher or barometric pressures lower than those specified could
compromise ventilator or compressor operation. See Table 11-8. on page 11-6 for environmental
specifications.
Table 2-11. Color Legend
Color or Description
symbol
Atmosphere
Vacuum
Water
Note:
Both the compressor and the Proximal Flow option are hardware options.
Figure 2-12. and Figure 2-13. illustrate the ventilator’s pneumatics with and without the optional
Proximal Flow option. The Proximal Flow option is only for use with neonatal patients.
2 Solenoid valve, options supply (SOL2) 29 Solenoid valve, compressor unload (SOL7)
15 Flow sensor assembly, exhalation valve 42 Pressure sensor, air gas inlet (PAir)
17 Filter, exhalation pressure line (F5) 44 Check valve, compressor air inlet (CVCAir)
23 Check valve, patient gas delivery (CVD) 50 Pressure sensor, oxygen gas inlet (PO2)
26 Flow sensor, patient gas delivery (FSD) 53 Relief valve, mix accumulator (RVMA
5 Humidifier
Note:
Items enclosed by the dotted line represent components internal to the ventilator.
3.1 Overview
This chapter contains information for the installation and set up of the Puritan Bennett™ 980
Series Ventilator. Before operating the ventilator system thoroughly read this operator’s manual.
Topics include:
• Safety reminders
• Ventilator setup
• Battery information
WARNING:
Explosion hazard—Do not use in the presence of flammable gases. An oxygen-rich environment
accelerates combustibility.
WARNING:
To ensure proper operation and avoid the possibility of physical injury, only qualified medical
personnel should attempt to set up the ventilator and administer treatment with the ventilator.
WARNING:
To prevent electrostatic discharge (ESD) and potential fire hazard, do not use antistatic or
electrically conductive hoses or tubing in or near the ventilator breathing system.
WARNING:
Use only gas supply hoses approved by Covidien. Other hoses may be restrictive and may cause
improper ventilator operation.
3-1
Installation
WARNING:
To avoid possible injury, lock the ventilator’s casters prior to installing or removing ventilator
components.
Caution:
To ensure optimum performance, Covidien recommends preventive maintenance be performed
by qualified biomedical engineers per the schedule specified. See Table 7-4. on page 7-15.
Note:
U.S. federal law restricts this device to sale by or on the order of a physician.
Ventilator setup, including a successful EST, should have already been completed by qualified
service personnel. This manual does not include ventilator assembly instructions.
Using AC Power
The ventilator is normally AC-powered. See Connecting the Ventilator to AC Power (3.5.1) on page
3-5 to connect the ventilator to AC power.
WARNING:
Use only Covidien batteries. Using other manufacturer’s brands could result in the batteries
operating the ventilator for less than the specified amount of time or could cause a fire hazard.
WARNING:
One primary battery must be installed at all times in the BDU’s primary battery slot for proper
ventilator operation. The ventilator will not complete the startup process without the primary
battery installed. See Figure 3-13. on page 3-20 to identify battery slots.
The ventilator’s primary battery must be installed by qualified service personnel (as it is shipped
separately) before patient use. The ventilator will not complete power on self test (POST) if the
battery is not present, and ventilation is prohibited. Ensure the battery is fully charged before
placing the ventilator into service.
The ventilator employs a battery backup system if AC power becomes unavailable or drops below
approximately 90 volts. A new, fully charged battery provides at least 1 hour of power to the ven-
tilator assuming ambient temperature of 20°C (68°F) to 25°C (77°F), PBW=70 kg, and at factory
default ventilator settings.
The battery back-up systems for the ventilator and compressor contain one primary battery each.
Backup power is supplied to the ventilator in the event of an AC power loss.
One extended battery receptacle is available for the ventilator and one extended battery recep-
tacle is available for the compressor. If both primary and extended ventilator and compressor bat-
teries are present, these batteries can power the ventilator and compressor for 2 hours (1 hour for
the primary battery and 1 hour for the extended battery) under the environmental conditions
described above. When using battery power, the ventilator and compressor operate from their
extended batteries, if present, first and then switch to the primary batteries. The ventilator and
compressor primary and extended batteries are charged whenever the ventilator is plugged into
AC power (the ventilator does not have to be powered up). If the ventilator or compressor is oper-
ating on battery power, the status display shows which battery is in use and its charge level, and
the remaining time the battery will operate before charging is required again.
Battery Charging
Batteries requiring charging are charged whenever the ventilator is connected to AC power,
whether operating or not.
The ventilator and compressor charge their primary batteries first, then their extended batteries.
The time required to charge a single battery (either primary or extended) is approximately 6 hours
at room temperature whether the ventilator is turned off (but connected to AC power) or operat-
ing, but charging time can vary based on temperature or depletion state of the battery. The status
display provides the batteries’ capacities.
Green LED bars located on the ends of both primary and extended batteries (if installed) scroll
upwards indicating battery charging. A white LED bar represents the battery is in use and a round
LED indicator illuminates red if there is a battery fault. When running on battery power, battery
capacity is determined by the number of green LED bars illuminated. See Figure 3-12. on page
3-19 to view the LEDs. See page 3-18 for information on interpreting the battery capacity. Green
LED bars do not scroll if the battery is not charging or is in use.
The compressor’s battery charging system (if a compressor is present) operates independently
from the ventilator’s charging system and batteries are charged in parallel.
If a battery fault occurs, the fault is annunciated, charging of the faulty battery discontinues, but
charging of any other non-faulty battery continues. A faulty battery will cause annunciation of the
error and battery power will not be available from that battery.
The ventilator status display indicates the charge level of the installed batteries, the presence of
one or more battery faults, and which battery is being charged.
The ventilator operates no differently when its batteries are charging than it does when the bat-
teries are fully charged.
The ventilator continues operating as set when the ventilator switches from AC power to battery
power and illuminates an indicator on the status display alerting the operator that the ventilator
is now operating on battery power and AC POWER LOSS alarm annunciates. A medium priority
alarm annunciates when the remaining run-time for the ventilator drops to 10 minutes and a high
priority alarm annunciates when the remaining time drops to 5 minutes.
Note:
Power outlet access and power cord position—Ensure that the power outlet used for the ventilator is
easily accessible; disconnection from the outlet is the only way to completely remove power from the
ventilator.
To connect the power cord to AC power
1. Plug the ventilator into a properly grounded power outlet rated for at least 15 A.
2. Verify the connection by checking the AC indicator below the power switch on the front of the BDU.
See Figure 2-9. on page 2-24 for the power switch and AC indicator locations.
3. Replace the power cord retainer, using the hex nuts and spacers removed during disassembly. See Fig-
ure 3-3. on page 3-6 or Figure 3-4. on page 3-7.
Note:
Your ventilator may have either combination of power cord and retainer.
Use the power cord hook located at the back of the ventilator for power cord storage.
WARNING:
For proper ventilator operation, and to avoid the risk of electric shock, connect the ventilator to a
grounded, hospital-grade, AC electrical outlet.
The ventilator can be connected to hospital grade wall or bottled air and oxygen. See
Figure 3-5. on page 3-8. Both air and O2 supply pressure ranges must be between 241.3 kPa to
599.8 kPa (35 psig and 87 psig) and the average flow requirement for both gases is 60 L/min at
280 kPa (40.61 psi). The transient will not exceed 200 L/min for ≥3 seconds.
WARNING:
Due to excessive restriction of the Air Liquide™, SIS, and Dräger™ hose assemblies, reduced
ventilator performance levels may result when oxygen or air supply pressures <345 k Pa (50 psi)
are employed.
Gas cross flow from one high pressure input port of one type of gas to another high pressure
input port of a different gas will not exceed 100 mL/h under normal or single fault conditions. If,
during a single fault condition, cross flow exceeds 100 mL/h, an audible alarm annunciates.
WARNING:
Use of only one gas source could lead to loss of ventilation or hypoxemia if that one gas source fails
and is not available. Therefore, always connect at least two gas sources to the ventilator to ensure
a constant gas supply is available to the patient in case one of the gas sources fails. The ventilator
has two connections for gas sources: air inlet, and oxygen inlet. See Table 6-5. on page 6-16 for
alarms that occur due to a loss of gas supplies.
To connect the gas sources
1. Connect the oxygen hose to the oxygen inlet fitting (item 1) as shown. Ensure use of a medical grade
oxygen source.
2. Connect the air hose to the air inlet fitting (item 2) See Figure 3-5. on page 3-8.
WARNING:
To prevent a potential fire hazard and possible damage to the ventilator, ensure the connections
to the gas supplies are clean and unlubricated, and there is no water in the supply gas. If water is
suspected, use an external wall air water trap to prevent damage to the ventilator or its
components.
The ventilator system can be purchased with the following gas inlet fittings for both air and O2:
BOC, DISS, female, NIST, Air Liquide, SIS, and Dräger.
See Table 9-1. on page 9-3 for part numbers of gas hoses.
The ventilator is shipped with internal and external inspiratory filters. See Table 9-1. on page 9-3
for the part numbers of exhalation filters. To prevent infection and contamination, both inspirato-
ry and exhalation filters must be used with the ventilator.
WARNING:
To reduce the risk of infection, always use the ventilator with inspiratory and exhalation bacteria
filters.
WARNING:
Do not attempt to use inspiratory or exhalation filters designed for use with ventilators other than
the Puritan Bennett 980 Series Ventilator. See Table 9-1. on page 9-3 for relevant part numbers.
WARNING:
Refer to the filter’s instructions for use (IFU) for details such as cleaning requirements, filtration
efficiency, proper filter usage, and maximum filter resistance, particularly when using aerosolized
medications.
Caution:
Ensure both inspiratory and exhalation filters are properly attached to the ventilator.
Note:
Refer to the inspiratory filter IFU for information on proper use and handling of the filter.
To install the inspiratory filter
1. Attach the inspiratory filter to the to patient port.
2. Ensure the direction of flow arrow is pointing outward, toward the patient circuit’s inspiratory limb.
Note:
Refer to the inspiratory filter IFU for information on proper use and handling of the filter.
Note:
Refer to the exhalation filter IFU for information on proper use and handling of the filter and for emptying
the condensate vial for adult and pediatric patients. See Appendix D for information on emptying the
condensate vial when using neonatal exhalation filters.
WARNING:
Do not reuse disposable inspiratory or exhalation filters, and dispose of the filters according to
your institution’s policy for discarding contaminated waste.
To install the adult/pediatric exhalation filter
1. If necessary, remove the expiratory limb of the patient circuit from the exhalation filter.
2. Raise the exhalation filter latch to unlock (item 3).See Figure 3-6. on page 3-11. This raises the exhala-
tion valve assembly and allows the filter door to swing away from the ventilator.
5. Insert the new filter by sliding the filter along the tracks in the door. Ensure the from patient port
aligns with the cutout in the door and points away from the ventilator.
WARNING:
Do not operate the exhalation filter latch during patient ventilation. Opening the latch during
ventilation will result in a patient disconnect condition and corresponding alarm.
Note:
To prevent EVQ misalignment and potential damage, ensure there is an exhalation filter in place any time
the ventilator is transported from one location to another.
3. Remove the existing exhalation filter door by lifting it off of the pivot pins.
Note:
The condensate vial is removable for discarding accumulated liquid, by turning the vial clockwise to
remove and counterclockwise to install.
To install the neonatal exhalation filter assembly
1. With the door still open, push the neonatal filter assembly straight up into the adapter.
2. Attach the drain bag tube to the condensate vial’s drain port.
3. Hang the drain bag on the holder located on the ventilator’s accessory rail, as shown in Figure 3-8. on
page 3-13. See Table 9-1. on page 9-3 for the part number of the drain bag holder.
Figure 3-8. Drain Bag
See Figure 3-9. on page 3-15 or Figure 3-10. on page 3-16 to connect the adult, pediatric, or neo-
natal patient circuits, respectively.
WARNING:
Use patient circuits of the lowest compliance possible with the ventilator system to ensure optimal
compliance compensation and to avoid reaching the compliance compensation limit. See Table 3-
1. for circuit types corresponding with predicted body weight (PBW).
Note:
Refer to the patient circuit’s IFU for information on proper use and handling and care and maintenance of
the circuit.
A list of breathing system components and accessories is provided. See Table 9-1. on page 9-3.
Use only Covidien components and accessories in the patient circuit.
Follow your institution’s protocol for safe disposal of the patient circuit.
Follow the patient circuit’s IFU for cleaning and disinfection information for reusable circuits.
Orient the patient circuit by hanging the patient circuit on the circuit management supports pro-
vided with the flex arm.
5 Condensate vial
5 Condensate vial
WARNING:
Do not attempt to sterilize single-use circuits.
3.6.1 Batteries
WARNING:
Use only Covidien batteries. Using other manufacturer’s brands or remanufactured batteries
could result in the batteries operating the ventilator for less than the specified amount of time or
could cause a fire hazard.
WARNING:
To reduce the risk of infection due to cross-contamination, using a damp cloth, disinfect the
batteries with one of the solutions listed before installation and whenever transferring to or from
another ventilator. During use, clean external surfaces of batteries as necessary. See Table 7-2. on
page 7-4. Do not spray disinfectant directly onto the battery or its connector.
WARNING:
Although the Puritan Bennett 980 Ventilator meets the standards listed in Chapter 11, the internal
lithium-ion battery of the device is considered to be Dangerous Goods (DG) Class 9 -
Miscellaneous, when transported in commerce. As such, the Puritan Bennett 980 Ventilator and
the associated lithium-ion battery are subject to strict transport conditions under the Dangerous
Goods Regulation for air transport (IATA: International Air Transport Association), International
Maritime Dangerous Goods code for sea and the European Agreement concerning the
International Carriage of Dangerous Goods by Road (ADR) for Europe. Private individuals who
transport the device are excluded from these regulations although for air transport some
requirements may apply.
WARNING:
To avoid the risk of fire, explosion, electric shock, or burns, do not short circuit, puncture, crush,
heat above 60°C, incinerate, disassemble the battery, or immerse the battery in water.
Caution:
Ensure that the batteries are oriented properly. See Figure 3-12. on page 3-19.
Figure 3-11. Battery
1 Battery connector
Primary Batteries
The ventilator’s primary battery is located in the rearward battery receptacle on the right side of
the BDU. The compressor’s primary battery is located in the rearward battery receptacle in the
compressor base. See Figure 3-13. on page 3-20. The primary battery may be “hot swapped,” that
is it can be replaced while the ventilator is operating.
To install or replace the primary battery in the BDU or compressor
1. With the battery not installed in the ventilator, or if the ventilator is turned off and not connected to
AC power, check the charge level by pressing the charge level button on the battery and verifying the
charge level LEDs illuminate. See Figure 3-12. on page 3-19. for the location of the charge level button.
Five green LED segments illuminate, indicating ≥90% battery capacity. From bottom to top, the first
LED indicates ≥10% capacity, the second LED indicates ≥25% capacity, the third LED indicates≥50%
capacity, and the fourth LED indicates ≥75% capacity. An illuminated red LED at the top of the battery
indicates a battery fault. If no LEDs illuminate it means there is <10% battery capacity remaining.
2. If the charge level is sufficient, orient the battery as shown in Figure 3-13. on page 3-20, face the front
of the ventilator and locate the battery compartments on the right side of the appropriate module. The
receptacle towards the rear of the ventilator houses the primary battery while the receptacle towards
the front of the ventilator houses the extended battery.
3. The primary battery is fastened in place with a thumbscrew (item 3). Loosen the thumbscrew approx-
imately four to five turns to allow battery installation.
4. Insert the battery and push into its receptacle all the way until it clicks, indicating it is latched. The
battery will only fit into the slot one way.
5. Tighten the thumbscrew to secure the battery and prevent the primary battery from being removed.
Note:
Remove either primary battery by reversing the steps. After loosening the thumbscrew, slide the
battery ejector to the left to eject the battery.
3 BDU and compressor primary battery 6 BDU primary battery (positioned for instal-
thumbscrews lation)
Extended batteries
The extended battery receptacle is located forward of the primary battery. Like the primary bat-
tery, the extended battery may be hot swapped.
To install or remove an extended battery in either the BDU or compressor
1. Properly orient the battery as shown in Figure 3-13. on page 3-20.
2. Push the battery into the forward receptacle in the BDU all the way until it clicks, indicating the battery
is latched.
Note:
Remove the battery by sliding the battery ejector to the left. The battery ejects itself from its receptacle.
There is no thumbscrew for extended batteries.
Note:
See Battery Charging, page 3-3 for battery charging information when batteries are installed in the
ventilator.
Performance testing on a sample of new batteries and batteries charged and discharged at least
1000 times was completed to demonstrate that the ventilator’s LOW BATTERY alarms remain
effective. Testing demonstrated that the batteries have a minimum of 10 minutes time remaining
from the activation of the low battery alarm and a minimum of 5 minutes time remaining from
the critically low battery alarm until ventilator shutdown. See Table 2-9. on page 2-27 for images
of the Status Display during low battery and critically low battery conditions.
Performance testing on a sample of new batteries and batteries charged and discharged at least
1000 times was completed to demonstrate the expected run time of the ventilator on battery.
This testing was performed for both typical ventilator settings and adult high demand ventilator
settings.
The typical ventilator settings used were:
• Ventilator settings
– PEEP=8 cmH2O
– PEEP=35 cmH2O
– PEEP=39 cmH2O / Total PEEP (PEEPTOT) during expiratory pause =49 cmH2O
The run time does not vary significantly between typical and heavy load settings. The ventilator
can be expected to run approximately 75 minutes at typical settings with new batteries. When
running batteries nearing end of life (batteries with 1000 charge/discharge cycles were used for
this data) the run time can be expected to be approximately 55 minutes.
Battery life for both primary and extended batteries is approximately 3 years. Actual battery life
depends on the history of use and ambient conditions. As the batteries age with use, the time the
ventilator will operate on battery power from a fully charged battery will decrease. Replace the
battery every 3 years or sooner if battery operation time is insufficient for your usage.
The battery is considered electronic waste and must be disposed of according to local regula-
tions. Follow local governing ordinances and recycling plans regarding disposal or recycling of
the battery.
Use the flex arm to support the patient circuit between the patient and the ventilator. See
Figure 3-14. on page 3-24, which illustrates flex arm installation into the sockets provided.
3. Hang the patient circuit using the circuit management supports included with the flex arm.
4. Remove the flex arm by first removing the patient circuit, then unfastening the flex arm from the
threaded fastener in the handle.
3.6.7 Humidifier
Use the humidifier to add heat and moisture to the inhaled gas. Connect the humidifier to a hos-
pital grade electrical outlet. Choose the humidifier (type and volume appropriate for the patient).
The humidifier may be mounted with the humidifier bracket as shown in Figure 3-15. on page
3-26. See Table 9-1. on page 9-3 for the part number of the humidifier bracket.
WARNING:
Selection of the incorrect humidifier type or volume during SST or during patient ventilation can
affect the accuracy of delivered volume to the patient by allowing the ventilator to incorrectly
calculate the compliance correction factor used during breath delivery. This can be a problem, as
the additional volume required for circuit compressibility compensation could be incorrectly
calculated, resulting in over- or under-delivery of desired volume.
WARNING:
To ensure proper compliance and resistance calculations, perform SST with the humidifier and all
accessories used for patient ventilation installed in the ventilator breathing system.
WARNING:
Follow the humidifier manufacturer’s IFU when using a humidifier with patient ventilation.
Caution:
Follow the humidifier manufacturer’s IFU for proper humidifier operation.
To install the humidifier bracket, attach it to the ventilator’s accessory rail by placing it behind the
railing and fastening the bracket clamp to the bracket with four 5/32 inch hex screws, capturing the railing
between the bracket and the clamp. Ensure that the humidifier mounting slots are facing outward from
the ventilator.
3. Install the chamber to the humidifier, connect the patient circuit, then run SST.
Note:
Complete instructions for the humidifier bracket and humidifier installation are given in the Puritan
Bennett™ 980 Series Ventilator Humidifier Bracket Installation Instructions, which include humidifier bracket
part numbers and descriptions.
Normal mode is the default mode used for patient ventilation. The ventilator enters Normal mode
after it has been turned on and POST completes, the ventilator is set up, and breath delivery
parameters have been entered. The clinician may choose to select Quick Start which uses default
values or institutionally configured breath delivery settings after PBW has been entered. Entry into
Normal mode is not allowed if a primary battery is not detected in the ventilator BDU, a major
POST fault occurs, or there is an uncorrected major system fault, or uncorrected short self test
(SST) or extended self test (EST) failures or non-overridden alerts.
During Normal mode, the omni-directional LED on the top of the GUI appears green in color, in a
steadily lit state. If an alarm occurs, the LED flashes in a color corresponding to the priority of the
alarm. See Table 6-2. on page 6-14 for details regarding alarm priority. If another alarm occurs con-
currently with an existing alarm, the LED displays the color corresponding to the highest priority
level. If the alarm de-escalates, the latched area (located on either side of the alarm LED indicator)
of the alarm LED displays the color of the highest priority alarm while the center of the LED dis-
plays the color of the current alarm’s priority. For more information on specific alarms, touch the
logs icon in the constant access icons area of the GUI.
Quick Start is an extension of Normal mode, where institutionally configured default settings are
applied after the patient’s PBW or gender and height are entered and Quick Start is touched to
begin ventilation.
Stand-By state can be used when the clinician needs to disconnect the patient for any reason
(prior to transporting a patient, for example). The ventilator enters Stand-By state if a request is
made by the clinician, a patient is disconnected within a fixed time period determined by the ven-
tilator software, and the clinician confirms the patient has been disconnected intentionally. If a
patient becomes disconnected from the patient circuit after the time period elapses, an alarm
sounds and the patient-disconnect sequence is initiated. In Stand-By state, gas output is reduced
to 10 L/min to limit gas consumption and to allow for detection of patient reconnection, and O2
concentration becomes 100% for adult and pediatric circuit types and 40% for neonatal circuit
types. Stand-By state is available in all ventilation modes except during inspiratory and expiratory
BUV, occlusion status cycling (OSC), safety valve open (SVO), or ventilator inoperative (vent
inop) conditions.
Note:
Do not block patient circuit wye while in Stand-By state. If the wye is blocked, the ventilator detects a
patient connection and will attempt to resume normal ventilation.
To enter Stand-By state
1. Touch the Menu tab on the left side of the GUI. The menu appears.
2. Touch Stand-By. A Stand-By state pending dialog appears instructing the clinician to disconnect the
patient circuit. A timer starts allowing 30 seconds to disconnect the patient.
3. Disconnect the patient circuit and confirm the disconnection by touching Confirm. A timer starts
allowing 30 seconds for confirmation of disconnect.
• Ventilator settings can be changed, if desired, and will be applied upon patient reconnection.
• The ventilator displays an indicator that it is in Stand-By State, and a timer indicating the elapsed time
the ventilator has been in Stand-By state.
The ventilator automatically exits Stand-By state when patient reconnection is detected, the cli-
nician completes patient setup (if ventilation was mistakenly started before setup was complete),
or the ventilator power is cycled.
Prior to entering Stand-By state, the ventilator measures pressure and flow in the patient circuit
to determine if a patient is attached. If a patient is detected, the ventilator continues ventilation
as set prior to the request, alerts the operator that Stand-By state is pending, and requests the
patient be disconnected. A countdown timer appears alerting the operator of the time remaining
to disconnect the patient. After the patient is disconnected, the ventilator requests confirmation
of the disconnection.
When the ventilator enters Stand-By state, a message appears on the GUI, any active alarms are
silenced and reset and the associated alarm reset entries are logged in the Alarm Event Log. Alarm
detection is suspended, and breath delivery is suspended while a bias flow is maintained for
patient detection. During Stand-By state, the ventilator displays the elapsed time the patient has
been without ventilation. As the ventilator maintains a bias flow for patient detection, it resumes
ventilation at the previous settings when the patient is reconnected. There is no need to touch
Exit Stand-By. Reconnecting the patient returns the ventilator to normal operation. During Stand-
By state, patient data values are not displayed and the LED located at the top of the GUI cycles
between yellow and green. Entry into and exit from Stand-By state are recorded in the General
Event log.
WARNING:
Before entering Service mode, ensure a patient is not connected to the ventilator. Ventilatory
support is not available in Service mode.
Service mode is used for extended self test (EST), ventilator calibration, configuration, software
upgrades, option installation (all of which must be performed by qualified service personnel), and
for making adjustments to institutional settings. All information stored in the individual logs is
available in Service mode. Service mode logs include:
• System Diagnostic
• System Comm.
• EST/SST Diagnostic
• Settings
• Alarms
• General Event
• Service
• Patient Data
See the Puritan Bennett™ 980 Series Ventilator Service Manual for details about Service mode logs.
A patient must not be attached to the ventilator when entering Service mode. Specific actions
must be performed to enter this mode, prior to POST completion.
3. Press and release the Service mode button (TEST) at the back of the ventilator, when the Covidien
splash screen appears on the status display after powering on the ventilator. See Figure 3-17. on page
3-31. See Table 2-9. on page 2-27 for an image of the splash screen. The ventilator prompts to confirm
no patient is attached.
5. Confirm that a patient is not connected to the ventilator by touching the corresponding button. The
message SERVICE MODE VENTILATION SUPPORT IS NOT AVAILABLE appears on the graphical user
interface.
See the Puritan Bennett™ 980 Series Ventilator Service Manual for information on the keys that are
disabled during EST.
In addition to allowing SST to be run, Service mode also allows configuration of various items.
Table 3-2. lists institutionally and operator-configurable items.
WARNING:
If the ventilator fleet in your institution uses multiple institutionally configured presets or defaults,
there can be risks of inappropriate alarm settings.
The ventilator is shipped configured with factory defaults for new patient parameters which can
be configured to suit institutional preferences. The operator may configure any desired parameter
as long as this option has not been locked out and rendered unavailable. When configuring the
ventilator, it displays the parameters associated with the operator’s last configuration.
Table 3-2. lists the factory-configured settings, the institutionally configurable settings, and the
operator-configurable settings.
Table 3-2. Ventilator Configuration
Vital patient X X X X
data banner
Large font X X X X
patient data
panel
Waveform X X X X
layout
Display bright- X X X
ness (Light set-
tings)
Alarm volume X X X X
Elevate O2 X X X X
control
Date/time X X X X
format
New patient X X X
startup
defaults
(including
PBW, ventila-
tion type,
mode, manda-
tory type,
trigger type,
O2%, elevate
O2)
Opacity X X X X
Caution:
Do not lean on the GUI or use it to move the ventilator. Doing so could break the GUI, its locking
mechanism, or tip the ventilator over.
Prior to ventilating a patient, configure the GUI so it is capable of displaying all the desired param-
eters, information, and patient data. This eliminates the necessity for taking the patient off the
ventilator, as configuration of many of the items requires the unit to be in Service mode.
To perform institutional configuration
1. Enter Service mode, and confirm no patient is attached by touching Confirm. See
Service Mode (3.7.4) on page 3-30 for instructions on entering Service mode.
2. Touch Configuration at the top of the screen in Service mode. A list of buttons appears allowing con-
figuration of the corresponding parameters.
3. See the next sections for specific instructions on institutional configuration of each parameter.
2. Touch Configuration at the top of the screen in Service mode. A list of buttons appears allowing con-
figuration of the corresponding parameters.
3. Select the desired modified setting from the left-hand menu options.
4. Touch Default.
The display can be configured in various ways. See Table 3-2. on page 3-32 for the parameters that
are factory-configured, institutionally configurable and operator-configurable. Once the factory-
or institutionally configurable items have been configured, they remain the default values.
Factory-configured values cannot be changed, however, if the parameters listed in the referenced
table are institutionally configured, then those values remain in memory as default settings. If
changes are made to operator-configurable parameters, they remain in memory during a venti-
lator power cycle as long as the same patient is set up when returned to ventilation. If a new
patient is set up, the factory-configured values or institutionally configured values (if the parame-
ter has been configured) are used. No alarm settings are institutionally configurable, which pre-
vents changes to factory default alarm settings. However, the default mL/kg ratio is institutionally
configurable, which can affect the default alarm setting values. Always review the alarm defaults
prior to beginning ventilation, and set appropriately.
The date and time may be configured to the institution’s preference. The time can be specified as
12-hour or 24-hour time in HH:MM:SS format with 1-hour and 1-minute resolutions, respectively.
The date formats are:
• DD-MMM-YYYY where DD is a two-digit day format, MMM is a three-letter abbreviation for the month,
and YYYY is a four-digit representation of the year.
• MM-DD-YYYY where MM is a two-digit month format, DD is a two-digit day format, and YYYY is a four-
digit representation of the year.
The settable date corresponds to the number of days in the set month and accounts for leap
years.
To institutionally configure the ventilator’s date and time settings
1. Perform steps 1 and 2 of the section To perform institutional configuration, page 3-33.
4. Touch Hour and turn the knob to enter the correct hour.
6. Touch the button corresponding to the date format desired (DD-MM-YYYY or MM-DD-YYYY).
Pressure Units
2. Touch Light Settings. Sliders appear to adjust the screen brightness and keyboard backlight.
3. Move the sliders to increase or decrease the brightness and backlight levels. Alternatively, turn the
knob to increase or decrease the brightness and backlight levels.
2. Slide the brightness slider or turn the knob to adjust the brightness level.
3. Dismiss the slider by touching anywhere on the GUI screen or allow to time out in 5 seconds.
2. Touch the button corresponding to adult, pediatric, or neonatal new patient defaults.
3. Touch the Ventilation Type, Mode, Mandatory Type, and Trigger Type buttons corresponding to the
desired parameters.
4. Configure the default PBW and mL/kg ratio, Elevate O2 and O2% by touching its button and turning
the knob.
Elevate O2
Note:
The Elevate O2 control adds a percentage of O2 to the breathing mixture for 2 minutes. The additional
percentage is shown on the icon in the constant access icon area. The allowable range is 1% to 100%.
To adjust the amount of elevated O2 delivered for 2 minutes
1. In the vent setup dialog in Normal mode, touch the Elevate O2 icon in the constant access icons area
of the GUI screen. The icon glows and a dialog appears with a countdown timer, Elev O2 button high-
lighted and ready for changes, and Extend, Stop, and Close buttons.
2. Turn the knob to increase or decrease the amount of oxygen by the amount shown on the button. The
allowable range is +1% to +100% oxygen.
3. Touch Extend to extend the 2-minute interval. Touching Extend restarts the 2-minute countdown
timer.
4. Touch Stop to stop additional oxygen from being delivered and dismiss the countdown timer.
• During LOSS OF AIR SUPPLY or LOSS OF O2 SUPPLY alarm conditions, the Elevate O2 function is can-
celed if in progress, and is temporarily disabled until the alarm condition no longer exists.
• During Safety PCV, the Elevate O2 control has no effect. During circuit disconnect and Stand-By states
(when the ventilator is turned on but not ventilating) the Elevate O2 function affects the currently
delivered oxygen concentration, not the set oxygen concentration.
Alarm Volume
WARNING:
The audio alarm volume level is adjustable. The operator should set the volume at a level that
allows the operator to distinguish the audio alarm above background noise levels.
To institutionally configure the alarm volume
1. Perform steps 1 and 2 of the section To perform institutional configuration, page 3-33.
2. Touch Alarm Volume Defaults. A screen appears allowing configuration of the alarm volume by circuit
type.
3. Slide the alarm slider for each circuit type (adult, pediatric, or neonatal) or turn the knob to configure
the alarm volume. The volume settings range from 1 (minimum) to 10 (maximum).
2. Dismiss the slider by touching anywhere on the GUI screen or allow to time out in 5 seconds.
Note:
A sample alarm tone sounds for verification at each volume level change. If necessary, re-adjust the
alarm volume by moving the alarm volume slider to increase or decrease the volume.
Note:
The alarm volume reverts to the institutionally configured default alarm volume or factory default if the
ventilator’s power is cycled.
Patient data are displayed in the Vital Patient Data banner. The operator can configure the banner
for displaying the desired patient data. See Figure 4-1. on page 4-3. A total of 14 values may be
configured at one time, with eight values visible, and six more visible by scrolling the values using
the left- and right- pointing arrows in the patient data area.
Two pages of additional patient data may be viewed by touching or swiping down on the patient
data tab at the top of the GUI. Choose the respective buttons to view page one or page two. Addi-
tional patient data values may not be changed.
To institutionally configure patient data displayed on the GUI
1. Perform steps 1 and 2 of the section To perform institutional configuration, page 3-33.
2. Touch Patient Data Defaults. Five layout preset buttons appear along with a list of parameters and
descriptions.
3. Touch a preset button and individually select a parameter from the scrollable list below to appear in
that preset’s vital patient data banner. Use the right- and left- pointing arrows to configure default
values for all available parameters.Additionally, touch the padlock icon above each patient data
parameter on the data banner to allow (unlocked) or restrict (locked) operator configurablity of that
parameter during normal ventilation.
4. When done configuring the selected preset, touch Accept and select another preset to configure, if
desired.
2. Touch the button corresponding to the replacement parameter. The existing parameter is replaced
with the new parameter.
To improve visibility of patient data, a screen is available that appears with a larger font. Up to 14
data values may be displayed which include:
• Institutional default patient data values (if configured)
• Remaining user selected patient data values (up to 14, including waveforms and loops)
2. Touch Large Font Patient Data Defaults. Five layout presets appear along with a list of parameters and
descriptions.
3. Touch a preset button and individually select a parameter for each of the desired patient data values.
4. Choose the desired scalar and loop waveforms for the large font patient data display. Waveform
thumbnails appear in the three right-most cells of the large font data panel.
5. Touch any of the padlock icons along the right-most edge of the selected layout to prevent operator
configurability of the selected row.
2. Swipe the additional patient data banner’s tab downward or touch the additional patient data ban-
ner’s tab. Patient data appear in a larger font.
3. Swipe the large font patient data panel tab upward or touch the tab to return to the banner to its
normal font size.
The large font patient data parameters are configured in the same way as described in the patient
data configuration section above.
Waveforms
Green waveforms denote a mandatory inspiration, yellow waveforms denote exhalation, and
orange waveforms denote a spontaneous inspiration.
The GUI can be configured to display up to three waveforms and two loops simultaneously in the
waveform area. See Figure 4-1. on page 4-3. The allowable waveforms include flow vs. time, pres-
sure vs. time and volume vs. time. Allowable loops include pressure vs. volume and flow vs.
volume. The waveforms display 60 seconds of information and can be shown in a redrawing
format, or paused with the ability to enable a cursor to trace the waveform by turning the knob.
The ventilator-generated waveforms provide immediate and dynamic qualitative information to
the clinician about the subtleties of ventilation in real time. In many cases the shape and character
of the drawn graphics for volume, flow, and pressure can provide advanced and early warning to
the clinician of potential problems such as air leaks, air-trapping, breath asynchrony, over-disten-
sion, and flow mismatching.
The scalar waveforms are not intended to represent a patient physiological parameter nor a qual-
ifiable characteristic of gas (air and O2) delivered to, or removed from, the human body.
Symbol Definition
VT CIRC The VT CIRC waveform is reflective of the volume going into and out of the breathing
circuit throughout the breath cycle. The volume values expressed by the VT CIRC
waveform are not compensated for circuit compliance or BTPS.
The scale representing measured volume (mL) can be set from a minimum range of
–1 m,L to 2 mL to a maximum range of –2000 mL to 6000 mL.
VCIRC VCIRC waveform displays the total inspiratory and expiratory flow throughout the
breath cycle measured by the ventilator's internal (inspiratory and expiratory) flow
sensors. The flow values expressed by the waveforms are not compensated for circuit
compliance or BTPS.
The scale representing measured flow (L/min) can be set from a minimum range of
–2 L/min to 2 L/min, to a maximum range of –200 L/min to 200 L/min.
PCIRC PCIRC waveform displays the total circuit pressure at the wye of the breathing circuit
throughout the breath cycle measured by the ventilator's internal (inspiratory and
expiratory) pressure sensors.
The scale representing pressure (cmH2O or hPa) can be set from a minimum range of
–2 (cmH2O or hPa) to 10 (cmH2O or hPa) to a maximum range of –20 (cmH2O or hPa)
to 120. (cmH2O or hPa).
2. Touch Graph Defaults. Five layout presets appear along with a list of parameters and descriptions.
3. Touch a layout preset button. The parameter button outline glows, signifying that it can be changed.
If more than one parameter can be changed, touch that parameter to make its outline glow.
4. Select the parameter from the list whose waveform is desired to appear on the waveforms screen.
6. Touch the padlock icon above each graphic layout to prevent operator configuration of the selected
layout.
2. Touch the desired waveform icons to display. The selected waveforms appear on the GUI screen and
the dialog closes.
2. Turn the knob to change the value. For each axis, turn the knob to the right to decrease the values, and
turn to the left to increase the values.
To pause waveforms
1. Touch the pause icon, located below the waveforms area. The icon glows yellow and allows the breath
to complete. A cursor appears and travels along the waveform while turning the knob, displaying the
x- and y-axis values.
See To capture GUI screens, page 5-2 for information on storing waveforms.
Opacity
4. Touch the padlock icon at the right side of the screen to allow or prevent operator adjustment of the
screen opacity.
Note:
The opacity icon can be found on the vent setup screen and on any of the respiratory mechanics
maneuvers screens.
WARNING:
Always disconnect the patient from the ventilator prior to running SST or EST. If SST or EST is
performed while a patient is connected, patient injury may occur.
WARNING:
Check for circuit occlusion and run SST if increased pressures are observed during ventilation.
WARNING:
When changing any accessories in the patient circuit or changing the patient circuit itself, run SST
to check for leaks and to ensure the correct circuit compliance and resistance values are used in
ventilator calculations.
Note:
When extending ventilator circuits for neonatal patients, the resulting ventilator breathing system (VBS)
compliance may trigger a COMPLIANCE LIMITED VT alarm such that the VC+ or VS software will not
continue to update the pressure target during breath delivery. In this case the user can change the breath
type to pressure control (PC) or pressure support (PS).
When a patient is not attached to the ventilator, run SST to check the patient circuit for:
• Gas leaks
• When adding accessories to or removing accessories from the breathing system (such as a humidifier
or water trap)
• After installing a new exhalation flow sensor (see Flow Sensor Calibration, page 3-47).
No external test equipment is required, and SST requires minimal operator participation.
Humidification type and volume can be adjusted after running SST, however the ventilator makes
assumptions when calculating resistance and compliance if these changes are made without re-
running SST. For optimal breath delivery, run SST after changing humidification type and humid-
ifier volume.
SST results are recorded in the SST results log, viewable in Service mode and in Normal mode
using the configuration (wrench) icon.
Required Equipment
• Humidifier, if applicable
• Two gas sources (air and oxygen) connected to the ventilator at a pressure between 241.3 kPa and
599.8 kPa (35 psi and 87 psi)
To run SST
1. Ensure a patient is not connected to the ventilator.
2. So that the ventilator does not detect a patient connection, ensure that the breathing circuit wye is
not attached to a test lung or covered in any way that would cause an increase in pressure at the wye.
3. Turn the ventilator on using the power switch located at the front of the BDU, below the status display.
The ventilator runs POST when the power switch is turned on. Ensure the ventilator is operating on full
AC power. Otherwise, SST test failures may result.
4. Wait at least 15 minutes to allow the ventilator to warm up and stabilize to ensure accurate results.
5. At the ventilator startup screen, touch SST or the configure icon (wrench) displayed in the lower right
area of the GUI. The SST history log appears along with Patient Setup, Run Leak Test, and Run All SST
buttons.
6. Connect the patient circuit, filters/condensate vial, and all accessories to be used in patient ventilation.
Ensure the patient wye is not blocked.
7. Touch Run All SST to perform all SST tests or touch Run Leak Test to perform the SST Leak test of the
ventilator breathing circuit.
9. After accepting, touch the Circuit Type button corresponding to the patient circuit type used to
perform SST and to ventilate the patient (adult, pediatric, or neonatal.
10. Touch the Humidification Type button corresponding to the humidification type used for patient ven-
tilation. If no humidifier is used, touch HME. If a humidifier is used, touch Humidification Volume and
turn the knob to enter the volume. See Table 3-4. for adult and pediatric patients or Table 3-5. for neo-
natal patients to determine the correct volume to enter.
12. Follow the prompts. Certain SST tests require operator intervention, and will pause indefinitely for a
response. See Table 3-3. and Table 3-6. for a summary of the SST tests and test step results, respective-
ly.
13. After each test, the ventilator displays the results. If a particular test fails, the test result appears on the
screen and a choice to repeat the test or perform the next test is given. When all of the SST tests are
complete, the SST status screen displays the individual test results.
14. To proceed to patient set up, (if SST did not detect an Alert or failure) touch Exit SST, then touch Accept
or cycle the ventilator’s power.
Table 3-3. SST Tests
SST Flow Sensor Cross Check Test Tests O2 and air flow sensors
SST Exhalation Valve Performance Calibrates the exhalation valve and creates a table for use during
calculations
SST Exhalation Filter Test Checks for exhalation filter occlusion and exhalation compartment
occlusion.
SST circuit Resistance Test Checks for inspiratory and expiratory limb occlusions, and calculates
and stores the inspiratory and expiratory limb resistance parame-
ters.
SST circuit Compliance Test Calculates the attached patient circuit compliance.
SST Prox (if the Proximal Flow option Verifies functionality of the proximal flow subsystem
is installed)
Note:
If you are running SST for a neonatal circuit with a humidifier, enter the volume listed in the shaded column
in Table 3-5.
Note:
For neonatal patient types, the SST Humidifier Volumes listed in Table 3-5. must be entered during SST or
when specifying the humidifier volume.
SST Results
SST reports results for each individual test.Three status indicators identify the SST results and
actions to take for each.
• Pass — The individual SST test has met its requirements.
• Alert — Alerts occur when the ventilator detects one or more non-critical faults.
• Failed — The individual SST test did not meet its requirements.
Alert The test result is not ideal, but is not criti- When the system prompts, touch one of
cal. these buttons:
If SST is in progress, it halts further testing • Repeat Test
and prompts for decision. • Next Test1
• Exit SST
Failed The ventilator has detected a critical Eliminate leaks in the ventilator breathing
problem and SST cannot complete until system and re-run SST. Otherwise, service
the ventilator passes the failed test. the ventilator and re-run SST.
1. WARNING—Completing SST with an Alert status for an individual test produces an Override SST button. Overriding an Alert in SST
may result in ventilator performance outside of the stated specification for accuracy. Choose to override the Alert status and autho-
rize ventilation only when absolutely certain this cannot create a patient hazard or add to risks arising from other hazards. To over-
ride the alert, touch Override SST, then touch Accept.
SST Outcomes
PASS All SST tests passed. Touch Patient Setup to set up the patient
for ventilation:
OVERRIDDEN The ventilator detected one or more Check the patient circuit to determine
faults. Choose to override the ALERT the problem or restart SSTwith a different
status and authorize ventilation only patient circuit.
when absolutely certain this cannot
create a patient hazard or add to risks
arising from other hazards.
FAIL One or more critical faults were detected. Check the patient circuit to determine
The ventilator enters the SVO state and the problem or restart SST with a different
cannot be used for normal ventilation patient circuit.
until SST passes.
WARNING:
Overriding an Alert in SST may result in ventilator performance outside of the stated specification
for accuracy. Choose to override the ALERT status and authorize ventilation only when absolutely
certain this cannot create a patient hazard or add to risks arising from other hazards.
A single circuit-leak test can be run without changing the SST outcome.
If a complete SST is interrupted and ventilation was allowed before starting SST, normal ventila-
tion is allowed if all of the following conditions are met:
• SST did not detect any failures or alerts before the interruption
• There were no changes to the circuit type at the start of the interrupted SST
During SST, the ventilator displays the current SST status, including the test currently in progress,
results of completed tests. Test data are available in Service mode where applicable or are dis-
played on the screen. The ventilator logs SST results, and that information is available following a
power failure. The audio paused and alarm reset keys are disabled during SST, as well as the
manual inspiration, inspiratory pause, and expiratory pause keys.
Note:
After replacement of the exhalation flow sensor, the flow sensor calibration may be performed with the
ventilator in Normal mode. It is not necessary for the ventilator to be in Service mode for this calibration.
Note:
A gold standard test circuit (part number 4-018506-00) is required for calibrating the exhalation flow
sensor.
After installing a new exhalation flow sensor, upon power-up and POST completion, the ventilator
detects the new flow sensor. The GUI displays the messages shown in Figure 3-18. alerting you
that the flow sensor requires calibration. For instructions on exhalation flow sensor installation,
see EVQ Replacement, page 7-14.
2. Touch the Flow Sensor Calibration button. The ventilator prompts you to remove the inspiratory filter
and to connect the test tubing, as shown in Figure 3-20.
4. Calibration lasts approximately 8 1/2 minutes. When calibration passes, the screen shown in Figure 3-
21. appears,
Figure 3-21. Successful Calibration
5. Upon successful calibration, SST must be run. The GUI provides a button to run SST, as shown in Fig-
ure 3-21.
Figure 3-22. SST Prompts
7. Touch the Run All SST button, and follow the prompts as described in To run SST, page 3-43.
WARNING:
Adding accessories to or removing accessories from the ventilator can change the pressure
gradient across the VBS and affect ventilator performance. Ensure that any changes to the
ventilator circuit configurations do not exceed the specified values for circuit compliance and
for inspiratory or expiratory limb total resistance. See Table 11-4. on page 11-3. If adding
accessories to or removing accessories from the VBS, always run SST to establish circuit
compliance and resistance prior to ventilating the patient.
The ventilator’s extended self test (EST) function is designed to verify the ventilator’s operational
subsystem integrity.
All required software support to perform EST is resident on the ventilator. EST requires approxi-
mately 10 minutes to complete.
Note:
SST is not part of the EST test suite. To determine patient circuit resistance and compliance, run SST.
EST Prerequisites
Follow all identified guidelines when performing EST. Inspect all equipment required for any self
test to ensure it is not damaged in any way.
1. Collect all required equipment prior to performing any self test of the ventilator. Successful self test is
not possible without the use of the listed equipment.
4. Connect the ventilator to AC power using the hospital-grade power cord until completion of any self
test.
6. Ensure both air and oxygen sources register pressure between 241 kPa to 599 kPa (35 psi and 87 psi).
To perform EST or to access additional service functions, the ventilator must be in Service mode.
See Service Mode (3.7.4) on page 3-30.
Note:
While in the Service mode, normal ventilation is not allowed.
WARNING:
Always disconnect the ventilator from the patient before running EST. Running EST while the
ventilator is connected to the patient can injure the patient.
WARNING:
A fault identified during this test indicates the ventilator or an associated component is defective.
Rectify the fault and perform any required repairs prior to releasing the ventilator for patient use,
unless it can be determined with certainty that the defect cannot create a hazard for the patient,
or add to the risks that may arise from other hazards.
• Every 6 months
During EST, the ventilator displays the current EST status, including the test currently in progress,
results of completed tests, and measured data (where applicable). The ventilator logs EST results,
and that information is available following a power failure. The ventilator disables several
offscreen keys located on the bezel of the GUI during EST:
• Audio paused
• Alarm reset
• Manual inspiration
• Inspiratory pause
• Expiratory pause
• Number 1 stopper
• Air and oxygen sources, both at 241kPa to 599 kPa (35 psi to 87 psi)
Note:
Attempts to run EST with a neonatal filter can cause some EST tests to fail.
Note:
If using Air Liquide™, Dräger™, and SIS air/oxygen hose assemblies, certain EST tests may fail when using
supply pressures less than 345 kPa (50 psi) based on excessive hose restriction.
Note:
If the ventilator has not reached normal operating temperature from recent usage, allow it to warm up for
at least 15 minutes in Service mode prior to running EST to ensure accurate testing.
To perform EST
1. Review and perform all self test prerequisites. See EST Prerequisites, page 3-50.
2. Collect the appropriate equipment. See Equipment for EST, page 3-52.
4. Verify that all calibration tests under the Calibration tab have passed.
5. Touch the Self Test tab from the horizontal banner at the top of the monitoring screen.
6. Touch the EST tab from the menu options on the left side.
7. Touch Run All to run all tests in sequence or select the desired individual test.
8. Choose one of the available options: touch Accept to continue; touch Cancel to go back to the previ-
ous screen; or touch Stop to cancel EST.
9. Follow the prompt to remove the inspiratory filter and connect the gold standard circuit.
11. Follow prompts to complete EST. The EST tests require operator intervention, and will pause indefinite-
ly for a response.
12. At the Disconnect O2 prompt, disconnect the high pressure oxygen source.
13. At the Disconnect air prompt, disconnect the high pressure air source.
14. At the Connect air and O2 prompt, connect both high pressure air and oxygen sources.
15. Touch Run All or select the desired individual test. After each test, the ventilator displays the results.
16. If a particular test fails, either repeat the test or perform the next test.
17. When all of the EST tests complete, review test results by touching each individual test listed on the
left side of the GUI.
19. Touch Confirm at the prompt to return to normal ventilation mode. The ventilator reruns POST and
then displays the ventilator startup screen.
Table 3-8. EST Tests
Zero Offset Tests inspiratory and expiratory pressure transducers and Follow prompts
flow sensors at ambient pressure.
Mix Accumulator Verifies mix accumulator pressure sensor and overpres- None
sure switch function.
Flow Sensor Cross Verifies all flow sensors and PSOLs at specified flow vol- None
Check Test umes.
Exhalation Valve (EV) Verifies exhalation valve.current and loopback current are None
Loopback within range.
Exhalation Valve (EV) Verifies current versus pressure values in flash memory None
Pressure Accuracy correspond with actual installed exhalation valve.
Exhalation Valve (EV) Verifies the exhalation valve operates within specifica- None
Performance tions of the last exhalation valve calibration.
Exhalation Valve (EV) Verifies the velocity transducer is sending a signal and the None
Velocity Transducer control circuit recognizes it. It does not verify the quality
of the signal.
Backup Ventilation Verifies backup ventilation systems: mix, inspiratory, and None
exhalation.
GUI Audio Tests GUI alarm indicators, cycling through each alarm Follow prompts
status indication.
BD Audio Verifies BD audible alarm is functional. Also verifies power Follow prompts
fail capacitor can operate loss-of-power alarm.
Offscreen Key Test Verifies GUI bezel key function. Follow prompts
Ventilator Battery Tests ventilator battery and power distribution. Follow prompts
Compressor Battery Tests compressor battery function, as well as compressor Follow prompts
power system and fan function.
ALERT The test result is not ideal, but is not crit- When the system prompts, select:
ical. Repeat Test,
If EST is in progress, it halts further Next Test1, or
testing and prompts for decision. Stop,
then touch Accept.
NEVER RUN Test still requires successful PASS. Run all EST tests.
1. WARNING—Completing EST with an ALERT status for an individual test produces an Override EST button. Choose to override the
ALERT status and authorize ventilation only when absolutely certain this cannot create a patient hazard or add to risks arising from
other hazards. To override the alert, touch Override EST, then touch Accept.
OVERRIDDEN ALERT status overridden by user. Repair the ventilator and rerun EST.
FAIL One or more critical faults were detect- Repair the ventilator and rerun EST.
ed. The ventilator enters the SVO state
and cannot be used for normal ventila-
tion until SST passes. Service is required.
WARNING:
Choose to override the ALERT status and authorize ventilation only when absolutely certain this
cannot create a patient hazard or add to risks arising from other hazards.
4.1 Overview
This chapter describes Puritan Bennett™ 980 Series Ventilator operation and includes sections
on:
• Setting up the ventilator
4-1
Operation
WARNING:
To avoid interrupted ventilator operation or possible damage to the ventilator, always use the
ventilator on a level surface in its proper orientation.
To set up the ventilator
1. Connect the ventilator to the electrical and gas supplies. See Figure 3-3. on page 3-6, Figure 3-4. on
page 3-7, and Figure 3-5. on page 3-8.
2. Connect the patient circuit to the ventilator. See the figures on pages 3-11 and 3-16 to connect the
adult/pediatric or neonatal patient circuits, respectively.
3. Turn the ventilator on using the power switch. See Figure 2-9. on page 2-24.
4. Before ventilating a patient, run SST to calculate the compliance and resistance with all items included
in the patient circuit. See To run SST, page 3-43.
• Circuit pressure graph displaying PPEAK, PEEP, and pressure-related alarm settings
See Status Display, page 2-25 for information about displayed items during Service mode.
The GUI is used to interact with the ventilator while it is ventilating a patient or in any of its oper-
ating modes.
Caution:
Do not lean on the GUI or use it to move the ventilator. Doing so could break the GUI, its locking
mechanism, or tip the ventilator over.
1. Prompt area — Located beneath the waveforms. Any prompts or messages related to soft or hard
bounds display here. Examples include soft bound and hard bound messages, PAV+ startup messages,
oxygen sensor calibration-in-progress messages, and various other informational messages.
2. Menu tab — Located on the left side of the GUI screen. Swiping the tab to the right and touching
Setup causes the Vent, Apnea, Alarm, and More Settings tabs to appear. Touching those tabs opens
screens so that changes to ventilator settings, apnea settings, alarm settings, and more settings can be
made.
3. Waveform area — Located in the center of the GUI screen. Shows various breath waveforms. See
Waveforms, page 3-39 for information on how to configure graphics.
4. Breath Phase Indicator — During normal ventilation, the GUI displays a breath indicator in the
upper left corner that shows the type of breath [Assist (A), Control (C), or Spontaneous (S)] currently
being delivered to the patient, and whether it is in the inspiratory or expiratory phase. The breath indi-
cator is updated at the beginning of every inspiration, and persists until the next breath type update.
During inspiration, assist (A) and control (C) breath indicators glow green and spontaneous (S) breath
indicators glow orange, each appearing in inverse video where the indicator appears black surround-
ed by the colored glow. See Figure 4-1. on page 4-3. During the expiratory phase the breath indicators
appear as solid colors (green during assist or control breaths and orange during spontaneous breaths).
5. Vital Patient data banner — Located across the top of the GUI screen. The patient data banner dis-
plays monitored patient data and can be configured to show desired patient data. See Vital Patient
Data, page 3-37 for information on configuring patient data for display.
6. Alarm banners — Located on the right side of the GUI screen. Indicates to the operator the alarms
that are active, and are shown in a color corresponding to priority (high is red and flashing, medium is
yellow and flashing, low is yellow and steady).
7. Constant access icons — Located at the lower right of the GUI screen. This area allows access to
home (house), configure (wrench), logs (clipboard), elevate oxygen percentage (O2), and help (ques-
tion mark) icon. These icons are always visible regardless of the function selected on the GUI.
8. Constant access area — Consists of the current settings area and the constant access icons. This area
allows access to any of the patient setup variables shown in these areas. Touching an icon causes the
particular menu for that variable to appear.
9. Current settings area — Located at the lower center of the GUI screen. The ventilator’s current active
settings display here. Touching any of the current settings buttons causes a dialog to appear, allowing
changes using the knob.
10. Vent setup button — Located at the lower left of the GUI screen. Touching this button allows access
to the ventilator setup screen.
Note:
A soft bound is a selected value that exceeds its recommended limit and requires acknowledgment to
continue. Hard bounds have minimum and maximum limits beyond which values cannot be selected,
however if the desired value is equal to a settings hard bound, then it is allowable.
Screen Opacity
The opacity control enables the operator to adjust the opacity of the displayed information
between 50% and 100%. At 50%, the displayed image is semi-transparent, and at 100%, the dis-
played image is opaque. The opacity value remains as set if power is cycled and if the same patient
is ventilated. If a new patient is ventilated, the opacity defaults to 85%. See To adjust the screen
opacity, page 3-41 for instructions on adjusting this feature.
Pushpin Feature
The pushpin feature prevents a dialog from closing under certain conditions when it is pinned.
Like the opacity control, the pushpin appears on the settings screen after a new patient begins
ventilation.
Figure 4-2. Pushpin Icon
1 2
Display Brightness
2. Slide the brightness slider to the right to increase the brightness level or to the left to decrease the
brightness level. Alternatively, turn the knob to increase or decrease the brightness level. The control
disappears from the screen in approximately 5 seconds.
Display Lock
The primary display provides a display lock key to prevent inadvertent changes to settings. When
active, the display lock disables the touch screen, knob, and off-screen keys (other than the display
lock key) and illuminates an LED on the display bezel. An image of the display lock icon appears
transparently over anything displayed on the GUI, should the operator attempt to use the GUI.
Any new alarm condition disables the display lock and enables normal use of the GUI.
To lock and unlock the display
1. Press the display lock key on the GUI. The keyboard LED illuminates and a transparent locked icon
appears on the screen, indicating display lock.
2. To unlock the display, press the display lock key again. The display lock LED turns off and an unlocked
image briefly appears on the screen.
The GUI incorporates a gesture-based interface where features can be actuated with the fingers
using different motions. Table 4-1. explains gestures used with the GUI.
Swipe Quickly brush the Opening or closing dialogs or Swipe toward the center of the screen to open
screen surface with panels that slide in and out dialogs or panels. Swipe toward the side of the
the fingertip. from the screen sides or top, screen (or upward if viewing the additional
moving waveform data, patient data or large font patient data panels)
expanding or collapsing toolt- to close.
ips, scrolling lists, or alarm To move a paused waveform, swipe in the
banners, maximizing or mini- desired direction.
mizing waveforms. Swipe upward anywhere on a waveform to
maximize it, and swipe downward on the max-
imized waveform to minimize it.
Swipe a tooltip upward to expand to a long
description and downward to collapse to a
short description. A downward swipe any-
where in the patient data area opens the addi-
tional patient data panel, and another swipe
on the additional patient data tab displays the
large font patient data panel.
Double-tap Rapidly touch the Maximizing or minimizing the Double-tapping maximizes the viewable
screen surface viewable area of a dialog, con- waveform area or shows the long description
twice with one trol, or waveform, expanding of a tooltip. Double-tapping again minimizes
finger. or collapsing tooltips the viewable waveform area or shows the
short description of a tooltip. If the control is
configurable, double tapping produces the
configuration pop-up menu.
Drag Move the fingertip Changing x- and y- axis scales, Touch the axis and drag to the right to increase
over the screen moving the waveform cursor, the waveform x-axis scale, and to the left to
surface without moving scrollbars, scrolling decrease. Touch the axis and drag upward to
losing contact. lists. Scrolling speed varies increase the y-axis scale and downward to
depending upon how far decrease.
outside the list boundary the To move the cursor (when the waveform is
finger is positioned. paused), touch the cursor and drag it right or
left. The graph responds similarly.
Scroll a list by dragging the scrollbar right or
left or up or down. The list scrolls according to
the direction of the finger movement.
An automatic scrolling feature starts if the
finger is dragged from the inside of a list to
outside its boundary. The farther outside the
boundary the finger is dragged, the faster the
list scrolls.
Drag and Touch and drag an Dragging help icon to Drag the help icon, located at the lower right of
drop item to another describe an onscreen item. the GUI screen, to the item in question and
location and lift drop. If a blue glow appears, a tooltip is avail-
finger to drop. able and appears with information about that
item (for example, a control or symbol).
WARNING:
Prior to patient ventilation, select the proper tube type and tube ID.
Caution:
To prevent possible damage to electronic circuitry, do not connect the GUI to the BDU while power
is applied.
Caution:
Do not set containers filled with liquids on the ventilator, as spilling may occur.
After turning on the ventilator, it will display a Covidien splash screen, and run power on self test
(POST). After the splash screen appears, the ventilator gives a choice to ventilate the same patient
or a new patient, or run SST.
Ventilation parameters are entered via the GUI using the following general steps:
1. Touch the setting displayed on the GUI.
2. Turn the knob to the right to increase or to the left to decrease the value.
3. Touch Accept to apply the setting or Accept ALL to apply several settings at once.
Note:
Quick Start allows for rapid setup and initiation of mechanical ventilation. Review Quick Start parameters
and ensure they are consistent with institutional practice before using this feature.
To use Quick Start
1. Touch New Patient.
3. Turn the knob to adjust the patient’s PBW or gender and height (if gender is selected, the height selec-
tion becomes available).
5. Connect the circuit wye adapter to the patient's airway or interface connection. The patient is ventilat-
ed with the institutionally configured or factory configured Quick Start defaults according to the PBW
or gender/height entered, and circuit type used during SST. There is no prompt to review the settings
and the waveforms display appears.
Note:
Connecting the circuit wye adapter to the patient's airway or interface connection prior to making the
ventilation settings causes the ventilator to begin ventilation using Safety Pressure Control Ventilation
(Safety PCV) and annunciate a PROCEDURE ERROR alarm. As soon as the ventilator receives confirmation
of its settings (by touching Accept or Accept ALL), it transitions out of safety PCV, resets the alarm, and
delivers the chosen settings. See Table 10-10. on page 10-60 for a listing of these settings.
To resume ventilating the same patient
1. Touch Same Patient on the GUI screen. The previous ventilator settings appear for review prior to
applying the settings to the patient.
2. If the settings are acceptable, touch START to confirm. To change any settings, touch the setting, turn
the knob to increase or decrease the value of the setting, and touch Accept to confirm. To make several
settings changes at once, make the desired changes, then touch Accept ALL to confirm. The appear-
ance of the settings changes from white, non-italic font showing the current setting to yellow italics
(noting the pending setting). After the settings are accepted, the appearance changes back to white
non-italic font.
2. Enter the patient’s PBW or gender and height (if gender is selected, the height selection becomes
available). The ventilator settings screen appears allowing entry of ventilation parameters.
See Figure 4-3. If the default ventilator settings are appropriate for the patient, touch Quick START to
confirm the settings. Otherwise, touch a ventilator setting and turn the knob to adjust the parameter.
Continue this process for all parameters needing adjustment.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment, the
clinician should carefully select the ventilation mode and settings to use for that patient based on
clinical judgment, the condition and needs of the patient, and the benefits, limitations, and
characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best for
the patient's current needs.
The following ventilator settings appear at the new patient setup screen:
• Predicted Body Weight (PBW)—Adjust the patient’s PBW, or select the patient’s gender and height.
See Predicted Body Weight (PBW) Calculation (4.6) on page 4-19.
– Non-invasive (NIV)—Ventilation using non-vented full-face masks, nasal masks, infant nasal
prongs, or uncuffed ET tubes. See Non-invasive Ventilation (NIV) (4.7) on page 4-20.
• Mode — Specify the breathing mode (A/C (assist/control), SIMV (synchronized intermittent mandato-
ry ventilation), SPONT (spontaneous ventilation), BiLevel or CPAP. CPAP is only available when the
circuit type is neonatal and the ventilation type is NIV. See Table 11-9. on page 11-7, Mode setting.
• Mandatory type — Select PC (pressure control), VC (volume control), or VC+ (volume control plus)
• Spontaneous type — If SIMV or BiLevel was selected as the mode, specify PS (pressure support) or TC
(tube compensation. If SPONT was selected as the mode, specify PS (pressure support), TC (tube com-
pensation), VS (volume support) or PAV+ (proportional assist ventilation).
Note:
VS, PAV+, and TC are only available during invasive ventilation.
• Trigger type — Select pressure- triggering (P-Trig) or flow-triggering (V-Trig). Pressure triggering is
not available when the ventilation type is NIV. If ventilating a neonatal patient, only flow triggering is
available.
• Swipe the Menu tab on the left side of the GUI and touch Setup.
1 Setup button
4. Continue in this manner until all changes are made, then touch Accept or Accept ALL.
5. Touch START. Ventilation does not begin until the breathing circuit is connected to the patient’s
airway. After ventilation begins, waveforms begin plotting on the displayed waveforms axes. See
Waveforms, page 3-39 for information on setting up the graphics display.
If changes to any settings are required, return to the vent setup screen as described above, or
touch a setting icon in the current settings area. See Figure 4-1. , item 9.
Note:
A yellow triangle icon appears on tabs and buttons displayed on the GUI containing unread or unviewed
items. When the item containing the icon is touched, the icon disappears.
Note:
To make any settings changes after completing patient setup, touch the Vent tab on the left side of the
Setup dialog and make settings changes as described above. The current setting appears in white font and
changes to yellow italics to note the new value is pending.Touch Accept or Accept ALL to confirm a single
change or a batch of changes. Once the settings are accepted, their appearance changes to white font.
Note:
Selecting Quick Start, Accept, Accept ALL or Start from the setup dialog implements all settings in all four
setup tabs (Vent Setup, Apnea, Alarms, and More Settings) and dismisses the setup dialog.
Tube Compensation
Tube compensation (TC) is a spontaneous breath type selected during ventilator setup. It allows
the ventilator to deliver additional positive pressure to overcome the resistance imposed by the
patient’s artificial airway.
See To enter settings into the ventilator, page 4-10 for more information on setting up the ventilator.
See Table 11-9. on page 11-7 for details of specific TC settings.
To enable TC
1. Touch the Vent tab on the GUI screen. See Figure 4-5. on page 4-10.
4. Finish setting up the ventilator as described (see page 4-10 for information on entering ventilator set-
tings).
5. Select the tube type (either endotracheal or tracheostomy) and set the tube ID to correspond to
patient settings.
6. After making the changes, touch Accept ALL to apply the new settings, or Cancel to cancel all changes
and dismiss the dialog.
WARNING:
To prevent inappropriate ventilation with TC, select the correct Tube Type (ET or Tracheostomy)
and tube inner diameter (ID) for the patient’s ventilatory needs. Inappropriate ventilatory support
leading to over-or under-ventilation could result if an ET tube or trach tube setting larger or
smaller than the actual value is entered.
To select new settings for the tube
1. Touch the vent setup button on the GUI screen to display the ventilator setup screen.
5. Touch Accept ALL to apply the new settings, or Cancel to cancel all changes and dismiss the dialog.
Note:
The tube type and tube ID indicators flash if TC is a new selection, indicating the need for entry of the
correct tube type and tube ID.
Note:
A humidifier Volume button appears below the selection only if Non-heated Expiratory Tube or
Heated Expiratory Tube is selected as the humidifier type.
2. Turn the knob to enter a value equal to the dry volume of the humidifier chamber being used.
3. Touch Accept or Accept ALL to apply the new settings, or Cancel to cancel all changes and dismiss the
dialog.
Table 4-2. lists the allowable ventilator settings according to patient type and ventilation type.
Mode A/C, SIMV, A/C, SIMV, A/C, SIMV, A/C, SIMV, A/C, SIMV, A/C, SIMV,
SPONT, BiLevel SPONT SPONT, BiLevel SPONT SPONT, SPONT, CPAP
BiLevel
Mandatory PC, VC, VC+ PC, VC PC, VC, VC+ PC, VC PC, VC, VC+ PC, VC
type
Trigger type V-Trig, P-Trig V-Trig V-Trig, P-Trig V-Trig V-Trig V-Trig
Note:
To use neonatal ventilator settings, the NeoMode 2.0 software option must be installed on the ventilator,
or a Puritan Bennett™ 980 Neonatal Ventilator must be in use.
After making the necessary changes to the ventilator settings touch the Apnea tab on the left side
of the setup dialog. Although changing the apnea settings is not required, confirm the default set-
tings are appropriate for the patient. Apnea ventilation allows pressure control or volume control
breath types. Parameters in pressure-controlled apnea breaths include f, PI, TI O2%, and TA.
Volume controlled apnea breath parameters are f, VT, VMAX, flow pattern, O2%, and TA.
Note:
If Quick Start is chosen, the Apnea tab on the vent setup screen shows a yellow triangle, indicating the
apnea settings have not been reviewed.
2. Enter the desired apnea settings in the same manner as for the ventilator settings.
During apnea pressure ventilation, apnea rise time% is fixed at 50%, and the constant parameter
during a respiratory rate change is TI.
After accepting the apnea settings, the display returns once more to show the waveforms. Return
to the vent setup dialog and touch the Alarms tab on the left side of the GUI screen or touch the
alarm icon in the constant access icons area of the GUI screen. The alarms screen appears with the
default alarm settings. See Figure 4-7. on page 4-15. Review and adjust the alarm settings appro-
priately for the patient.
Note:
If Quick Start is chosen, the alarms tab on the dialog shows a yellow triangle, indicating the alarm settings
have not been reviewed.
Note:
The default alarm settings cannot be changed. The clinician can adjust alarm settings by following the
procedure below. The alarm settings are retained in memory when the ventilator’s power is cycled and
same patient is selected.Otherwise, current settings revert to new patient defaults when a new patient is
selected.
Note:
There is an additional alarm setting for TC, PAV+, VS, and VC+ breath types: high inspired tidal volume
(2VTI). This alarm condition occurs when the inspired tidal volume is larger than the setting value. A 1VTI
alarm will also cause breath delivery to transition to the expiratory phase to avoid delivery of excessive
inspiratory volumes.
WARNING:
Prior to initiating ventilation and whenever ventilator settings are changed, ensure the alarm
settings are appropriate for the patient.
WARNING:
Setting any alarm limits to OFF or extreme high or low values, can cause the associated alarm not
to activate during ventilation, which reduces its efficacy for monitoring the patient and alerting
the clinician to situations that may require intervention.
See To adjust alarm volume, page 3-37 to ensure alarm volume is adjusted properly.
Note:
A sample alarm tone sounds for verification at each volume level change. Readjust the alarm volume by
moving the alarm volume slider to increase or decrease the alarm volume.
Note:
Do not block the patient wye while the ventilator is waiting for a patient connection. Otherwise the
blockage could imitate a patient connection.
During ventilator operation, the alarm screen appears with indicators to let the operator know the
current patient data value for each parameter (item 1), the parameter alarm settings (items 2 and
3), recent range of patient data values for the last 200 breaths (item 4). If an alarm occurs, the slider
and corresponding limit button show a color matching the alarm’s priority. See Figure 4-8. on
page 4-16.
1 Pointers show current value of patient 3 Low alarm setting (in this case
data corresponding to the alarm parame- 4VTE SPONT)
ter
2 High alarm setting (in this case 4 Range of patient data values for the partic-
2VTE SPONT) ular parameter during the last 200 breaths
If, during ventilation, settings changes are necessary that don’t involve changes to PBW, mode,
breath types, or trigger types, the current settings area located at the lower portion of the GUI
screen can be used. See Figure 4-1. on page 4-3 for the location of the current settings area.
2. Touch and turn the knob for any other settings that need to be changed.
The ventilator settings and the alarm settings chosen remain in memory after the a power cycle,
as long as the same patient is chosen when the ventilator is set up again. If a new patient is being
ventilated, the ventilator and alarm settings revert to their default values. If all power is lost (both
AC and battery), the ventilator and alarm settings in effect prior to the power loss are automati-
cally restored if the power loss duration is 5minutes or less. If the power loss lasts longer than 5
minutes, ventilation resumes in Safety PCV. Ventilator and alarm settings must be reset for the
patient being ventilated. See Table 10-10. on page 10-60 for a list of these settings.
To use the Previous Setup button
1. To return to the previous setup, touch the vent setup button then touch Previous Setup on the GUI
screen. The ventilator restores the main control and breath settings previously used, as well as the
alarm and apnea settings, and prompts a review by highlighting the previous values in yellow. The
ventilator, alarm, and apnea settings tab text is also shown in yellow and the tabs show a yellow trian-
gle, indicating there are previous settings that have not been reviewed.
Previous Setup disappears when the previous settings are confirmed and re-appears when venti-
lating with new settings.
A breath timing graph appears at the bottom of the setup screen which illustrates the relationship
between inspiratory time, expiratory time, I:E ratio, respiratory rate, and the effects on breath
timing due to flow pattern, tidal volume, and VMAX during mandatory PC, VC, BiLevel, or VC+
breaths. With BiLevel, PC and VC+ breaths, three padlock icons are located underneath the breath
timing graph allowing the operator to select, from left to right, TI, I:E ratio, or TE as the constant
variable during rate changes (or TH, TH:TL ratio, or TL in BiLevel). If the ventilation mode is SPONT,
the padlock icons do not appear, and the breath timing graph only displays TI for a manual inspi-
ration. If the mandatory type is VC, the icons do not appear, but the breath timing graph displays
TI, I:E ratio, and TE.
3. Touch Accept.
Note:
Any repeated values noted in the tables are the result of decimal rounding.
WARNING:
Use only non-vented patient interfaces with NIV. Leaks associated with vented interfaces could
result in the ventilator’s inability to compensate for those leaks, even if Leak Sync is employed.
WARNING:
Full-face masks used for non-invasive ventilation should provide visibility of the patient's nose
and mouth to reduce the risk of emesis aspiration.
WARNING:
When using NIV, the patient’s exhaled tidal volume (VTE) could differ from the ventilator’s
monitored patient data VTE reading due to leaks around the interface. To avoid this, ensure Leak
Sync is enabled.
Non-invasive ventilation (NIV) is used when the clinician determines a mask or other non-invasive
patient interface rather than an endotracheal tube would result in the desired patient outcome.
NIV is intended for use by neonatal, pediatric, and adult patients possessing adequate neural-ven-
tilatory coupling and stable, sustainable, respiratory drive.
Covidien has successfully tested the following non-vented interfaces with NIV:
• Full-face mask: Puritan Bennett™* Benefit full face mask (large), ResMed Mirage™* non-vented full face
mask (medium)
• Infant nasal prongs: Sherwood Davis & Geck Argyle™* CPAP nasal cannula (small), Hudson RCI™*
infant nasal CPAP system (number 3)
• Uncuffed neonatal ET tube: Mallinckrodt uncuffed tracheal tube, Murphy (3.0 mm)
NIV can be initiated from either the New Patient Setup screen during vent startup or while the
patient is being ventilated invasively. See Table 4-3. for NIV patient setup information.
1. Turn on the ventilator. 1. Touch or swipe the menu tab on the left side of the
GUI.
2. Select New Patient.
2. Touch Vent Setup.
3. Enter patient’s PBW or gender and height.
3. Perform steps 4 through 7 as if setting up the venti-
4. Touch NIV ventilation type. lator for a new patient.
5. Select mode. 4. Review the settings, including apnea and alarm set-
tings, and change if necessary.
6. Select breath type.
3. With the NIV interface open to ambient (not connected to the patient), use the patient data leak value
to quantify the leak in L/min.
4. Set the DSENS (in L/min) below the leak rate (in L/min).
5. Periodically assess the leak rate, especially with PEEP changes, and adjust the DSENS setting as needed.
WARNING:
For proper ventilation when changing the ventilation type on the same patient, review the
automatic settings changes described. Adjust appropriately based on the relevant tables.
Some ventilator settings available during invasive ventilation are not available during NIV. See
Table 4-4. for automatic settings changes when changing ventilation type from invasive to NIV.
Breath Mode: SIMV or SPONT High TI SPONT (2TI SPONT) limit setting available
Alarm settings: 4PPEAK (if applicable), 4VE TOT, 4VTE Alarm settings: 4PPEAK, 4VE TOT, 4VTE MAND, 4VTE
MAND, 4VTE SPONT, INSPIRATION TOO LONG (not user- SPONT default to NIV new patient values. See
settable) Table 11-10. on page 11-14. INSPIRATION TOO LONG
alarm not available.
Note:
In any delivered spontaneous breath, either invasive or NIV, if pressure support is set to 0 cmH2O, there is
always a target inspiratory pressure of 1.5 cmH2O applied.
When in NIV, the vent setup button’s appearance changes, letting the operator know the ventila-
tion type is NIV.
Table 4-5. shows automatic settings changes made when changing ventilation type from NIV to
invasive.
NIV includes a setting in SIMV or SPONT modes for high spontaneous inspiratory time limit (2TI
SPONT). When a patient’s inspiratory time reaches or exceeds the set limit, the ventilator transitions
from inspiration to exhalation, and the 2TI SPONT symbol appears at the lower left on the GUI
screen, indicating the ventilator has truncated inspiration (shown in Figure 4-10. ). The 2TI SPONT
setting does not restrict changes to PBW; if the PBW is decreased, 2TI SPONT may decrease auto-
matically to remain within its allowable limits.
WARNING:
No audible alarm sounds in conjunction with the visual 2TI SPONT indicator, nor does the indicator
appear in any alarm log or alarm message.
It is possible the target inspiratory pressure may not be reached if the 2TI SPONT setting is not long
enough, or if system leaks are so large as to cause the ventilator to truncate the breath at the
maximum allowable2TI SPONT setting.
Note:
To reduce the potential for not reaching the target pressure, minimize the leaks in the system and increase
the rise time% or decrease the ESENS setting, if appropriate.
Set the patient’s apnea parameters as described. See Apnea Settings (4.5.2) on page 4-13. NIV does
not change the way apnea parameters are set.
The system initially sets most alarm settings based on the patient’s PBW. Review all alarm settings,
and change as necessary, but startup does not require confirmation of the settings. Alarm settings
are made in exactly the same way in NIV as for invasive ventilation.
Touch the Alarms tab at any time during ventilation to show the current limits and the monitored
patient value shown in white on the indicating arrows for each alarm. If an alarm is occurring, the
indicator LED color changes based on alarm priority. See Table 6-2. on page 6-14 for colors and
meanings of alarms and their priorities.
Note:
The upper and lower limits of an alarm cannot conflict with each other.
Note:
The upper limits for the spontaneous exhaled tidal volume and mandatory exhaled tidal volume alarms
are always the same value. Changing the upper limit of one alarm automatically changes the upper limit
of the other.
2. Touch RM.
5. Accept or reject the maneuver results. If the result is accepted, its value is saved.
An inspiratory pause maneuver closes the inspiration and exhalation valves and extends the inspi-
ratory phase of a single, mandatory breath for the purpose of measuring end inspiratory circuit
pressure and plateau pressure (PPL). Then lung static compliance (CSTAT), and static resistance
(RSTAT) of the respiratory system are calculated. Pressures on either side of the artificial airway are
allowed to equilibrate, which determine the pressure during a no-flow state. A request for an
inspiratory pause is rejected during apnea ventilation, safety PCV, OSC, BUV, and in Stand-by state.
Inspiratory pause maneuvers are allowed in A/C, SIMV, BiLevel and SPONT modes. If an inspiratory
pause maneuver has already occurred during the breath, a second inspiratory pause maneuver is
not allowed.
Inspiratory pause maneuvers can be classified as automatic or manual. The automatic inspira-
tory pause maneuver lasts at least 0.5 second but no longer than 3 seconds. A manual inspiratory
pause maneuver starts by pressing and holding the inspiratory pause key. The pause maneuver
lasts for the duration of the key-press (up to 7 seconds).
To perform an automatic inspiratory pause maneuver
1. Press and release the inspiratory pause key on the GUI bezel or touch and release Start if performing
an inspiratory pause maneuver from the GUI screen as shown in Figure 4-13. on page 4-27. The venti-
lator performs the inspiratory pause maneuver and displays PPL, CSTAT, and RSTAT along with the date
and time.
2. Touch Accept or Reject to save or dismiss results. If Accept is touched, the results are displayed.
Cancel an automatic inspiratory pause maneuver by touching Cancel on the GUI screen.
To perform a manual inspiratory pause maneuver
1. Press and hold the inspiratory pause key on the GUI bezel or touch and hold Start on the GUI screen if
performing an inspiratory pause from the GUI screen as shown above. The ventilator prompts that the
maneuver has started, and to release to end the maneuver. The ventilator performs the inspiratory
pause maneuver and displays PPL, CSTAT, and RSTAT along with the date and time.
2. Touch Accept or Reject to save or dismiss results. If Accept is touched, the results are displayed.
Cancel a manual inspiratory pause maneuver by releasing the inspiratory pause key.
An expiratory pause maneuver extends the expiratory phase of the current breath for the
purpose of measuring end expiratory lung pressure (PEEPTOT) or total PEEP. It has no effect on the
inspiratory phase of a breath, and only one expiratory pause per breath is allowed. For I:E ratio cal-
culation purposes, the expiratory pause maneuver is considered part of the expiratory phase.
During an expiratory pause maneuver, both inspiratory and exhalation valves are closed, allowing
the pressures on both sides of the artificial airway to equilibrate. This allows intrinsic PEEP (PEEPI)
to be calculated. PEEPI equals PEEPTOT minus the set PEEP level. An expiratory pause maneuver
can be either automatically or manually administered, and is executed at the next mandatory
breath in A/C, SIMV, or BiLevel modes. In SIMV, the breath cycle in which the pause maneuver
becomes active (when the next scheduled ventilator-initiated mandatory (VIM) breath occurs)
will be extended by the amount of time the pause is active. For A/C and SIMV, the expiratory
pause maneuver is scheduled for the next end-of-exhalation prior to a mandatory breath. In
BiLevel the expiratory pause maneuver is scheduled for the next end-of-exhalation prior to a tran-
sition from PLto PH. During the expiratory pause maneuver, PEEPI and PEEPTOT equilibration time
values are displayed and regularly updated because stabilization of one of these values can indi-
cate the pause can be ended. During the expiratory pause maneuver, the apnea interval TA is
extended by the amount of time the pause maneuver is active. Expiratory pause maneuver
requests are ignored if the ventilator is in apnea ventilation, safety PCV,OSC, BUV, and Stand-By
state. Additionally, SEVERE OCCLUSION alarms are suspended during expiratory pause maneu-
vers. If flow triggering is active, backup pressure sensitivity (PSENS) detects patient breathing effort.
Maximum duration for a manual expiratory pause maneuver is 15 seconds and 3 seconds for an
automatic expiratory pause maneuver.
During a manual or automatic expiratory pause maneuver, PEEPI and PEEPTOT appear on the GUI
with the next VIM to allow the clinician to view when these values are stabilized, indicating the
maneuver can be ended.
Touch Cancel on the GUI screen to cancel the expiratory pause maneuver.
To perform other respiratory maneuvers, touch the corresponding tab on the desired maneuver,
and follow the prompts on the GUI screen.
• Neonatal—40% O2
• Pediatric/adult—100% O2
Note:
The oxygen sensor has three states: Enabled, Disabled, and Calibrate. The oxygen sensor is enabled at
ventilator startup regardless if New Patient or Same Patient setup is selected.
To enable or disable the O2 sensor
1. Touch the vent setup button.
2. Touch the More Settings tab. The more settings screen appears.
3. Touch the button corresponding to the desired O2 sensor function (Enabled or Disabled).
4. Touch Accept.
The O2% setting can range from room air (21% O2) up to a maximum of 100% oxygen. The sensor
reacts with oxygen to produce a voltage proportional to the partial pressure of the mixed gas. As
ambient atmosphere contains approximately 21% oxygen, the sensor constantly reacts with
oxygen and always produces a voltage. The useful life of the cell can also be shortened by expo-
sure to elevated temperatures and pressures. During normal use in the ICU, the oxygen sensor
lasts approximately 1 year—the interval for routine preventive maintenance.
Because the oxygen sensor constantly reacts with oxygen, it requires periodic calibration to
prevent inaccurate O2% alarm annunciation. Once a calibrated oxygen sensor and the ventilator
reach a steady-state operating temperature, the monitored O2% will be within three percentage
points of the actual value for at least 24 hours. To ensure the oxygen sensor remains calibrated,
recalibrate the oxygen sensor at least once every 24 hours.
Typically, the clinician uses an O2 analyzer in conjunction with the information given by the ven-
tilator. If a NO O2 SUPPLY alarm occurs, compare the O2 analyzer reading with the ventilator’s O2
reading for troubleshooting purposes. The ventilator automatically switches to delivering air, only
(21% oxygen).
The oxygen sensor should be calibrated every 24 hours and before use. The calibration function
provides a single-point O2 sensor calibration.
To calibrate the O2sensor
1. Touch the vent setup button.
3. Touch Calibrate for the O2 sensor. The calibration procedure results in 100% O2 being delivered
through the breathing circuit for the 2-minute calibration period. See Figure 4-14. on page 4-30.
3. Connect the ventilator oxygen hose to another known 100% O2 source (for example, a second
medical-grade oxygen cylinder).
4. Set O2% to each of the following values, and allow 1 minute after each for the monitored value to sta-
bilize: 21%, 40%, 90%
5. Watch the GUI screen to ensure the value for O2 (delivered O2%) is within 3% of each setting within 1
minute of selecting each setting.
The first strategy is to detect potential problems before the ventilator is placed on a patient. POST
checks the integrity of the ventilator's electronics and prevents ventilation if a critical fault is
found. (See the Puritan Bennett™ 980 Series Ventilator Service Manual for a complete description of
POST). POST may detect major or minor system faults which manifest themselves as device alerts.
See DEVICE ALERT Alarm (6.5.13) on page 6-31 for more information.
A technical fault occurs if a POST or background test has failed. See Power On Self Test (POST) (10.17)
on page 10-63. Based on the test that failed, the ventilator will either ventilate with current set-
tings, ventilate with modified settings, or enter the vent inop state. A technical fault cannot be
cleared by pressing the alarm reset key. It can only be cleared by correcting the fault that caused
it or if alarm reset criteria have been met.
4.11.3 SST
In addition to characterizing the ventilator breathing circuit, SST performs basic checks on the
ventilator's pneumatic system including the breath delivery PSOL, the flow sensors and the exha-
lation valve. Faults detected during SST must be corrected before ventilation can be started.
A procedure error occurs when the ventilator senses a patient connection before ventilator setup
is complete. The ventilator provides ventilatory support using default Safety Pressure Controlled
Ventilation (Safety PCV) settings. See Table 10-10. on page 10-60.
During ventilation, the ventilator performs frequent background checks of its breath delivery sub-
system (see Safety Net (10.16) on page 10-59). In the event that certain critical components in the
pneumatics fail, Ventilation Assurance provides for continued ventilatory support using one of
three backup ventilation (BUV) strategies, bypassing the fault to maintain the highest degree of
ventilation that can be safely delivered (see Background Diagnostic System (10.16.4) on page 10-61
for a full description of the backup ventilation strategies).
Note:
Do not confuse BUV with Safety PCV, which occurs when a patient is connected before ventilator setup is
complete, or with apnea ventilation, which occurs in response to patient apnea.
In the event of a serious fault occurring that cannot be safely bypassed, the ventilator, as a last
resort, reverts to a safe state. In Safe State, the ventilator opens the safety valve and the exhalation
valve, allowing the patient to breathe room air (if able to do so), provided the patient circuit is not
occluded, and the inspiratory PSOL valve is closed. During SVO, the patient (if connected) can
breathe room air through the safety valve after it releases pressure in the patient circuit. The
patient exhales through the exhalation valve with minimal resistance and the exhalation valve
also acts like a check valve, limiting gas from being drawn in through the exhalation filter or expi-
ratory limb of the circuit. SVO conditions are logged into the event and alarm logs as are the
events leading to the SVO condition. If the condition causing SVO clears, the ventilator clears the
SVO state. Patient data do not display on the GUI, but graphics are still plotted. During SVO, the
ventilator ignores circuit occlusions and disconnects. If the condition causing SVO can only be
corrected by servicing the ventilator, the SVO alarm cannot be reset by pressing the alarm reset
key.
Vent Inop occurs when the ventilator detects a catastrophic error and prevents all other safety
states from operating. Vent inop limits pressure to the patient as the ventilator enters the SVO
state, disables (closes) the gas mixing PSOL valves, and purges the gas mixing system accumula-
tor. The safety valve is opened, a vent inop indicator illuminates, a high priority alarm annunciates
from the primary alarm, and the secondary alarm (continuous tone) is activated. The ventilator
can only exit the vent inop state by power cycling and successfully passing EST. The vent inop
alarm cannot be reset with the alarm reset key. All detection and annunciation of patient data
alarm conditions is suspended.
During a vent inop condition, the inspiratory and expiratory pressure drop measured at the
patient wye does not exceed 6.0 cmH2O at 30 L/min.
5.1 Overview
This chapter describes the features of the Puritan Bennett™ 980 Series Ventilator designed to
provide output to the clinician. This includes language, methods of displaying and transferring
data, types of displayed data, and types of external device ports. Connectivity to an external
patient monitoring system is also included.
5.2 Language
The language used on the ventilator is configured at the factory.
• Waveform data—RS-232 port, USB port with USB to serial conversion capability (per Comm port
configuration)
• Results from DCI commands—RS-232 port, USB port with USB to serial conversion capability (per
Comm port configuration)
5-1
Product Data Output
Caution:
The USB interface should be used for saving screen captures and interfacing with an external
patient monitor. It should not be used to provide power to other types of devices containing a USB
interface.
Caution:
Only compatible USB devices should be used, otherwise GUI performance may be impacted.
A 128 MB flash drive storage device formatted in the 32-bit file format is required for downloading
images from the USB ports. The USB device listed in Table 9-1. is the ONLY compatible USB device
currently available for use on the PB980. To order a compatible USB device, contact Covidien
Technical Services at 800 255 6774 or a local Covidien representative.
To capture GUI screens
1. Navigate to the desired screen from which you wish to capture an image (for example, the waveforms
screen). There is no need to pause the waveform before performing the screen capture.
2. Touch the screen capture icon in the constant access icons area of the GUI screen. If desired, navigate
to another screen and repeat steps 1 and 2 for up to 10 images. If another image is captured, increasing
the queue to 11 images, the newest image overwrites the oldest image so there are always only 10
images available.
Note:
If the camera icon appears dim, it means that the screen capture function is currently processing
images and is unavailable. When processing is finished, the camera icon is no longer dim and the
screen capture function is available.
2. Touch Screen Capture. A list of screen captures appears, identified by time and date. A slider also
appears if more images than shown are present.
3. Insert a passive USB storage device (flash drive) into one of the USB ports at the rear of the ventilator.
The proper orientation of the USB device is with metal contacts facing the test button. See Figure 5-
3. on page 5-17. If more than one USB storage device is installed in the ventilator, touch the button of
the destination USB device where the image will be copied. If an incompatible device is inserted, the
port becomes disabled until the device is removed, and removal is confirmed by touching the confirm
button. The message shown in Figure 5-1. appears.
Note:
Removal of the external USB storage device while screenshot files are being written to it may result in
incomplete file transfer and unusable files.
5. Touch Copy. The image is stored on the destination USB storage device.
6. Alternatively, touch Select All, and all images in the list are stored on the USB device and can then be
viewed and printed from a personal computer.
Note:
The file format of screen captures is PNG.
2. Touch the Comm Setup tab. The Comm Setup screen appears allowing three ports to be configured.
These ports can be designated as DCI, DCI 2.0, Philips, Spacelabs, or Waveforms.
Note:
Waveforms can be selected on any port, but only on one port at a time.
Configuring the Comm port allows the ventilator to communicate with devices listed in the
Comm Setup screen, or to capture waveform data (in ASCII format) from the ventilator.
To configure Comm ports
1. Touch COM1, COM2, or COM3.
3. Select the desired baud rate. If waveforms was selected, the baud rate automatically becomes config-
ured to 38 400.
Connect the device to the previously configured port. See Figure 5-3. on page 5-17 for a descrip-
tion and the locations of the Comm ports.
Note:
When a USB port is configured as a Comm port, it is necessary to use a USB-to-serial adapter cable. This
adapter must be based on the chipset manufactured by Prolific. For further information, contact your
Covidien representative.
Selecting waveforms when configuring a Comm port allows the ventilator to continuously trans-
mit pressure, flow, and sequence numbers in ASCII format from the selected serial port, at a baud
rate of 38 400 bits/s, and the operator- selected stop bits, and parity. A sample of pressure and
flow readings is taken every 20 ms. This sample of readings is transmitted on the selected serial
port at the end of each breath at breath rates of 10/min and higher. For longer duration breaths,
at least the first 8 seconds of the breath is transmitted.
The format of the data is as follows:
• The beginning of inspiration is indicated by “BS, S:nnn,<LF>” where 'BS’ identifies the Breath Start,
‘S:nnn’ is a sequence number incremented at every breath, and <LF> is a line feed character.
• The fff, and ppp fields show the breath flow and pressure data.
• The end of exhalation is indicated by: “BE<LF>” where ‘BE’ indicates Breath End, and <LF> is a line feed
character.
The ventilator system offers commands that allow communication to and from the ventilator
using a Comm port. Commands to the ventilator from a remote device include:
• RSET: See RSET Command (5.4.5)
Note:
The ventilator responds only if it receives a carriage return <CR> after the command string.
The RSET command clears data from the ventilator receive buffer. The ventilator does not send a
response to the host system. Enter the RSET command exactly as shown:
RSET<CR>
The SNDA command instructs the ventilator to send information on ventilator settings and mon-
itored patient data to the host system. Enter the SNDA command exactly as shown:
SNDA<CR>
When the ventilator receives the command SNDA<CR>, it responds with the code MISCA, fol-
lowed by ventilator settings and monitored patient data information.
1 2 3 4 5 6 7
1 Response code to SNDA command 5 Data field, left-justified and padded with
spaces
Fields not available are marked as “Not used.” Underscores represent one or more spaces that pad
each character string.
Table 5-1. lists MISCA responses to SNDA commands.
Table 5-1. MISCA Response
Component Description
Field 6 Ventilator ID to allow external hosts to uniquely identify each Puritan Bennett™ 980
Series Ventilator (18 characters)
Field 9 Mode (CMV___, SIMV__, CPAP__ or BILEVL) (CMV = A/C) setting (6 characters)
Component Description
Field 41 Expiratory component of monitored value of I:E ratio, assuming inspiratory component
of 1 (6 characters)
Field 51 Low exhaled tidal volume (mandatory or spontaneous) alarm status* (6 characters)
Component Description
Field 63 Static compliance (CSTAT) from inspiratory pause maneuver in mL/cmH2O (6 characters)
Field 64 Static resistance (RSTAT) from inspiratory pause maneuver in cmH2O/L/s (6 characters)
Component Description
Field 96 Inspiratory component of I:E ratio or High component of H:L (BiLevel) setting (6 charac-
ters)
Field 97 Expiratory component of I:E ratio setting or Low component of H:L (BiLevel) (6 charac-
ters)
Field 100 Constant during rate setting change for pressure control mandatory breaths
(I-TIME or I/E___ or______) (6 characters) (where ______ represents TE or PCV not
active)
SNDF is a command sent from an external host device to the ventilator system instructing it to
transmit all ventilator settings data, monitored patient data, and alarm settings and occurrences.
Enter the SNDF command exactly as shown:
SNDF<CR>
When the ventilator receives the command SNDF<CR>, it responds with the code MISCF, fol-
lowed by ventilator settings, monitored patient data, and alarm information.
The MISCF response follows this format:
1 2 3 4 5 6 7
1 Response code to SNDF command 5 Data field, left-justified and padded with
spaces
4 Start of transmission (02 hex) * 1229 if Philips is selected for serial port in
communication setup
Note:
Non-applicable fields will either contain zero or be blank.
Table 5-2. MISCF Response
Component Description
1225* Number of bytes between <STX> and <CR> (4 characters) *1229 if Phillips is selected
for the Comm port in Communication Setup
Field 6 Ventilator ID to allow external hosts to uniquely identify each Puritan Bennett™ 980
Series Ventilator (18 characters)
Component Description
Field 29 Inspiratory component of Apnea I:E ratio (if apnea mandatory type is PC) (6 characters)
Field 30 Expiratory component of Apnea I:E ratio (if apnea mandatory type is PC) (6 characters)
Field 35 Low inspiratory pressure alarm setting (4PPEAK in cmH2O or OFF (6 characters)
Field 36 High exhaled minute volume alarm setting (2VE TOT) in L/min or OFF (6 characters)
Field 37 Low exhaled minute volume alarm setting (4VE TOT) in L/min or OFF (6 characters)
Field 38 High exhaled mandatory tidal volume alarm setting (2VTE MAND) in mL or OFF (6 char-
acters)
Field 39 Low exhaled mandatory tidal volume alarm setting (4VTE MAND) in mL or OFF (6 char-
acters)
Field 40 High exhaled spontaneous tidal volume alarm setting (2VTE SPONT) in mL or OFF (6
characters)
Field 41 Low exhaled spontaneous tidal volume alarm setting (4VTE SPONT) in mL or OFF (6 char-
acters)
Field 42 High respiratory rate alarm setting (2fTOT) in breaths/min or OFF (6 characters)
Component Description
Field 48 Inspiratory component of I:E ratio setting or High component of H:L ratio setting (6
characters)
Field 49 Expiratory component of I:E ratio setting or Low component of H:L ratio setting (6 char-
acters)
Field 50 Constant during rate change setting (I-time, I/E, or E-time) (6 characters)
Field 53 Humidification type setting (Non-heated exp tube, Heated exp tube, or HME) (18 char-
acters)
Field 59 Expiratory sensitivity (ESENS) setting in % or L/min for PAV+ breath type (6 characters)
Field 64 High pressure time (TH) setting (in BiLevel) in seconds (6 characters)
Field 65 High spontaneous inspiratory time limit setting (2TI SPONT) in seconds (6 characters)
Field 67 Low pressure time (TL) setting (in BiLevel) in seconds (6 characters)
Component Description
Field 72 Monitored patient exhaled minute volume (VE TOT) in L/min (6 characters)
Field 75 Monitored expiratory component of monitored value of I:E ratio, assuming inspiratory
component of 1 (6 characters)
Field 89 Monitored exhaled spontaneous minute volume (VE SPONT) in L/min (6 characters)
Field 90 Monitored intrinsic PEEP (PEEPI) from expiratory pause maneuver in cmH2O (6 charac-
ters)
Field 91 Monitored total PEEP (PEEPTOT) from expiratory pause maneuver in cmH2O (6 charac-
ters)
Field 92 Monitored static compliance (CSTAT) from inspiratory pause maneuver in mL/cmH2O (6
characters)
Field 93 Monitored static resistance (RSTAT) from inspiratory pause maneuver in cmH2O/L/s (6
characters)
Field 94 Monitored plateau pressure (PPL) from inspiratory pause maneuver in cmH2O (6 char-
acters)
Component Description
Field 107 High exhaled minute volume alarm* (1VE TOT) (6 characters)
Field 117 Low exhaled mandatory tidal volume alarm* (3VTE MAND) (6 characters)
Field 118 Low exhaled minute volume alarm* (3VE TOT) (6 characters)
Field 119 Low exhaled spontaneous tidal volume (3VTE SPONT) alarm* (6 characters)
Component Description
Field 154 Spontaneous exhaled tidal volume (VTE SPONT) in liters (6 characters)
Component Description
Field 161 ETCO2 when COM port is set to DCI 2.0 (6 characters)
WARNING:
To avoid possible injury, only connect devices that comply with IEC 60601-1 standard to any of the
ports at the rear of the ventilator, with the exception of passive memory storage devices (“flash
drives”) and serial-to-USB adapter cables. If a serial-to-USB adapter cable is used, it must be
connected to an IEC 60601-1-compliant device.
Figure 5-3. Port Locations
2 Ethernet port
6 HDMI port
7 Service port
See Data Transfer (5.4) on page 5-1 for data transfer details.
RS-232 Port
2. Make the appropriate connection to a monitoring device. A gender changer, null modem cable or
socket saver may be required. Consult with the institution’s Information Technology professional as
required.
3. Ensure to specify the baud rate, parity, and data bits in the ventilator communication setup to correctly
match the parameters of the monitoring device.
4. A monitor designed to use this port is required for obtaining data from the ventilator. Set up the mon-
itoring device to receive ventilator data. These data can include waveform data.
5. Program the remote device to send the appropriate RS-232 commands as described in the next sec-
tion.
See Table 5-1. on page 5-6 and Table 5-2. on page 5-10 for MISCA and MISCF responses to SNDA
and SNDF commands, respectively.
Ethernet Port
The Ethernet port is used by service personnel for accessing various logs and updating ventilator
software.
A remote alarm or nurse call interface is available on the ventilator system that can be used to
remotely annunciate the alarm status of the ventilator. Medium and high priority alarms are
remotely annunciated. The nurse call connector is located at the back of the ventilator, as shown.
See Figure 5-3. on page 5-17.
See the remote alarm manufacturer’s instructions for use for information regarding proper nurse
call connection.
USB Ports
The USB ports are used for screen captures, or receiving serial data when a USB port has been con-
figured as a serial port. This is also known as transferring data via a serial-over-USB protocol. See
Communication Setup (5.4.2) on page 5-3 for Comm setup configuration. Screen captures require
an external USB memory storage device (“flash drive”) for screen captures. Instructions for using
this port for screen captures are given. See To capture GUI screens, page 5-2.
HDMI Port
An external display can be used via connection with the HDMI port.
To use the HDMI port with an external display
1. Connect one end of an HDMI cable to the HDMI port at the back of the ventilator
(Figure 5-3. on page 5-17, item 6).
2. Connect the other end of the cable to the external display. An HDMI to DVI adapter may be used.
3. Turn the device on. The appearance of the GUI now displays on the external display device.
Service Port
Note:
Not all patient monitors are compatible with the Puritan Bennett™ 980 Series Ventilator.
6.1 Overview
This chapter contains detailed information about Puritan Bennett™ 980 Series Ventilator perfor-
mance including:
• Ventilator settings
WARNING:
Use of the ventilator or compressor in altitudes higher or barometric pressures lower than those
specified could compromise ventilator or compressor operation. See Table 11-8. on page 11-6
for a complete list of environmental specifications.
6-1
Performance
The clinician enters the ventilation type, specifying how the patient will be ventilated; invasively
or non-invasively (NIV). The ventilation type optimizes the alarm limits for NIV patients, and dis-
ables some settings for NIV ventilation.
6.4.2 Mode
Available ventilation modes are mandatory (A/C) or spontaneous (SPONT) modes, as well as two
“mixed” modes: SIMV and BiLevel.
• A/C (Assist-Control) — A/C mode guarantees delivery of a minimum number of mandatory breaths
based on the frequency (f) set by the clinician. Breaths in A/C can be patient-initiated (PIM) or ventila-
tor-initiated (VIM).
• SPONT (Spontaneous) — SPONT mode delivers only spontaneous breaths that are all patient-initi-
ated.
• BiLevel — BiLevel is also a mixed mode that overlays the patient’s spontaneous breaths onto the
breath structure for PC mandatory breaths. Two levels of pressure, PL and PH are employed. The breath
cycle interval for both SIMV and BiLevel modes is 60/f where f is the respiratory rate set by the operator.
• CPAP — CPAP is available only when circuit type is neonatal and ventilation type is NIV. CPAP mode
allows spontaneous breathing with a desired PEEP level. To limit inadvertent alarms associated with
the absence of returned volumes in nasal CPAP breathing, CPAP does not make volume alarm settings
available.
Mandatory breath types for A/C and SIMV modes include volume controlled (VC), pressure con-
trolled (PC), or volume control plus (VC+) breath types, also called mandatory type.
• VC (Volume Control) — The ventilator delivers an operator-set tidal volume.
• VC+ (Volume Control Plus) — Volume control plus is a mandatory, pressure controlled breath type
that does not restrict flow during the inspiratory phase, and automatically adjusts the inspiratory pres-
sure target from breath to breath to achieve the desired tidal volume despite changing lung condi-
tions. See Mandatory Breath Delivery (10.7) on page 10-13 for more information on VC+.
• Pressure Trigger (P-Trig) — Changes in circuit pressure cause the ventilator to deliver a breath.
These pressure changes relate to the pressure sensitivity (PSENS) set by the operator. If the patient
makes an effort to inspire, the airway pressure drops. If the pressure drops by at least the value of PSENS,
the ventilator delivers a breath.
• Flow Trigger (V-Trig) — Changes in flow in the circuit cause the ventilator to deliver a breath. The
breath delivery and exhalation flow sensors measure gas flow in the ventilator breathing system. As
the patient inspires, the delivered flow remains constant and ventilator exhalation flow sensor mea-
sures decreased flow. When the difference between the two flow measurements is at least the opera-
tor-set value for flow sensitivity (VSENS), the ventilator delivers a breath.
• Time Trigger — The ventilator delivers a ventilator-initiated mandatory (VIM) breath after a specific
amount of time elapses.
• Operator Trigger (OIM) — The operator presses the manual inspiration key. An operator initiated
mandatory breath is also called an OIM breath. During an OIM breath, the breath delivered is based on
the current settings for a mandatory breath.
Spontaneous breathing modes such as SIMV, BiLevel, and SPONT include the following breath
types (called spontaneous types):
• PS (Pressure Support) — The ventilator delivers an operator-set positive pressure above PEEP (or
above PL in BiLevel) during a spontaneous breath. If SIMV is selected as the mode, PS is automatically
selected for spontaneous type.
• VS (Volume Support) — The ventilator delivers an operator-set positive pressure above PEEP during
a spontaneous breath and automatically adjusts the pressure level from breath to breath to consistent-
ly deliver the set tidal volume.
• TC (Tube Compensation) — Additional positive pressure delivered to the patient during sponta-
neous breaths to overcome resistance of the artificial airway.
• PAV+ (Proportional Assist Ventilation) — A software function that allows the ventilator to reduce
the work of breathing (WOB) by assisting the patient’s inspiration by an operator-set amount propor-
tional to the breathing effort generated by the patient. See Appendix C for more information on PAV+.
• Operator Trigger (OIM) — As the operator can only initiate a mandatory breath by pressing the
manual inspiration key, spontaneous mode allows OIMs, but the breath delivered is based on the
current apnea breath settings.
See Inspiration—Detection and Initiation (10.4) on page 10-4 for details on the different trigger
methods.
6.5 Alarms
WARNING:
The ventilator system is not intended to be a comprehensive monitoring device and does not
activate alarms for all types of conditions. For a detailed understanding of ventilator operations,
be sure to thoroughly read this manual before attempting to use the ventilator system.
WARNING:
Setting any alarm limits to OFF or extreme high or low values can cause the associated alarm not
to activate during ventilation, which reduces its efficacy for monitoring the patient and alerting
the clinician to situations that may require intervention.
This manual uses the following conventions when discussing alarms:
A description or name of an alarm without specifying the alarm setting is denoted with an upward
or downward pointing arrow (1 or 3) preceding the specific alarm name. An alarm setting is
denoted as an upward or downward pointing arrow with an additional horizontal limit symbol (2
or 4) preceding the specific alarm. Some alarm conditions actually limit breath delivery such as
1PPEAK and 1VTI by truncating inspiration and transitioning to the expiratory phase. These alarm
conditions are denoted as alarm limits. See Table 6-1. on page 6-6.
Alarms are visually annunciated using an indicator on the top of the GUI, which has a 360° field of
view. If an alarm occurs, this indicator flashes at a frequency and color matching the alarm priority.
The alarms also appear as colored banners on the right side of the GUI screen. If an alarm occurs,
this indicator appears in the color matching the alarm priority (yellow for low (!) and medium (!!)
priority; red for high (!!!) priority). For technical alarm and non-technical alarm details, see the
respective tables on page 6-16 and page 6-26.
An alarm is defined as a primary alarm if it is the initial alarm. A dependent alarm arises as a result
of conditions that led to the primary alarm. This is also referred to as an augmentation. An aug-
mentation strategy is built into the ventilator software to handle occurrences where the initial
cause of the alarm has the potential to precipitate one or more additional alarms. When an alarm
occurs, any subsequent alarm related to the cause of this initial alarm augments the initial alarm
instead of appearing on the GUI as a new alarm. The initial alarm’s displayed analysis message is
updated with the related alarm’s information, and the Alarm Log Event column shows the initial
alarm as Augmented.
A primary alarm consists of a base message, analysis message, and a remedy message. The base
message describes the primary alarm. The analysis message describes the likely cause of the alarm
and may include alarm augmentations. The remedy message provides information on what to do
to correct the alarm condition.
Alarm banners, when dragged leftward from the right side of the GUI, display messages for the
indicated active alarms. Figure 6-1. shows the alarm message format.
2 Analysis message
A latched alarm is one whose visual alarm indicator remains illuminated even if the alarm condi-
tion has autoreset. Latched alarm indicators are located on the sides of the omni-directional LED.
A latched alarm can be manually reset by pressing the alarm reset key. If no alarms are active, the
highest priority latched alarm appears on the omni-directional LED on the GUI. A lockable alarm
is one that does not terminate an active audio paused function (it does not sound an audible alert
during an active audio paused function), while a non-lockable alarm cancels the audio paused
period and sounds an audible alert. All patient data alarms and the CIRCUIT DISCONNECT alarm
are lockable alarms.
Note:
When a new lockable alarm occurs, the alarm will not start to sound audibly if the previous lockable alarm
was silenced.
The following rules define how alarm messages are displayed:
• Primary alarms precede any dependent alarms.
• The system adds dependent alarms to the analysis messages of each active primary alarm with which
they are associated. If a dependent alarm resets, the system removes it from the analysis message of
the primary alarm.
• The priority level of a primary alarm is equal to or greater than the priority level of any of its active
dependent alarms.
• If a primary alarm resets, any active dependent alarms become primary unless they are also dependent
alarms of another active primary alarm. This is due to different reset criteria for primary and dependent
alarms.
• The system applies the new alarm limit to alarm calculations from the moment a change to an alarm
limit is accepted.
• The priority level of a dependent alarm is based solely on its detection conditions (not the priority of
any associated alarms.
• When an alarm causes the ventilator to enter OSC or safety valve open (SVO), the patient data display
(including waveforms) is blanked. The elapsed time without ventilatory support (that is, since OSC or
SVO began) appears on the GUI screen. If the alarm causing OSC or SVO is autoreset, the ventilator
resets all patient data alarm detection algorithms.
The alarm reset function can be used for any non-technical alarm. See Alarm Handling (6.5.8) on
page 6-13 for an explanation of technical vs. non-technical alarms. Alarm reset reinitializes the
algorithm the ventilator uses to initially detect the alarm except for A/C POWER LOSS, COMPRES-
SOR INOPERATIVE, LOW BATTERY, NO AIR SUPPLY, NO O2 SUPPLY, PROCEDURE ERROR alarms and
active battery alarms. If the cause of the alarm still exists after the alarm reset key is pressed, the
alarm becomes active again. The ventilator logs all actuations of the alarm reset key.
WARNING:
Do not pause, disable, or decrease the volume of the ventilator's audible alarm if patient safety
could be compromised.
The audio paused feature temporarily mutes the audible portion of an alarm for 2 minutes. After
the 2-minute period, if the alarm condition still exists, the alarm sounds again. Pressing the audio
paused key again restarts the 2-minute interval during which an alarm is muted. An LED within
the key illuminates and a count-down timer appears on the GUI next to an audio paused indicator
symbol, indicating an active audio paused function. The audio paused feature does not allow the
audible alarm to be turned off; the audible portion of the alarm is temporarily muted for 2 min-
utes. The GUI’s omni-directional LED flashes during an active alarm state and during an audio
paused period and its appearance changes with the priority if the alarm escalates. Pressing the
alarm reset key cancels an audio paused interval. If the condition that caused the alarm still exists,
the alarm activates again.
An alarm volume key is available for setting the desired alarm volume. The alarm volume is auto-
matically set to the factory default setting of 10 (maximum) or to the institutional default setting
based on circuit type if it has been so configured. When setting the alarm volume, a sample tone
is generated, allowing the practitioner to decide the appropriate alarm volume for the surround-
ing ambient conditions. If a high priority alarm occurs, the alarm volume increases one increment
from its current volume level if it is not acknowledged within 30 seconds. If a high priority alarm
is not acknowledged within 60 seconds, the audible alarm volume escalates to its maximum
volume.
See To adjust alarm volume, page 3-37 for instructions on adjusting the alarm volume.
WARNING:
The audio alarm volume level is adjustable. The operator should set the volume at a level that
allows the operator to distinguish the audio alarm above background noise levels. See To adjust
alarm volume, page 3-37.
Testing the alarms requires oxygen and air sources and stable AC power. Test the alarms at least
every 6 months, using the procedures described.
Required Equipment
• Test lung (P/N 4-000612-00)
If the alarm does not annunciate as indicated, verify the ventilator settings and repeat the test. The
alarm tests check the operation of the following alarms:
• CIRCUIT DISCONNECT
• SEVERE OCCLUSION
• AC POWER LOSS
• APNEA
• NO O2 SUPPLY
1. Disconnect the patient circuit from the ventilator and turn the ventilator off for at least 5 minutes.
PBW: 70 kg
Ventilation type: invasive
Mode: A/C
Mandatory type: VC
Trigger type: V-Trig
5. Set the following new patient settings:
f: 6.0 1/min
VT: 500 mL
VMAX: 30 L/min
TPL: 0 s
Flow pattern: square
VSENS: 3 L/min
O2%: 21%
PEEP: 5 cmH2O
6. Set the following apnea settings:
TA: 10 s
f: 6.0 1/min
O2%: 21%
VT: 500 mL
7. Set the following alarm settings:
2PPEAK: 70 cmH2O
fTOT: OFF
4VE TOT: 1 L/min
2VE TOT: 3.5 L/min
9. Connect an adult patient circuit to the ventilator and attach a test lung to the patient wye.
Note:
To ensure proper test results, do not touch the test lung or patient circuit during the CIRCUIT DISCONNECT
alarm test.
CIRCUIT DISCONNECT alarm test
1. Allow the ventilator to deliver at least four breaths. During the inspiratory phase of a breath, disconnect
the inspiratory filter from the to patient port. The ventilator annunciates a CIRCUIT DISCONNECT alarm
after the inspiratory filter is disconnected.
2. Connect the inspiratory filter to the to patient port to autoreset the alarm.
VT: 500 mL
VMAX: 30 L/min
2PPEAK: 20 cmH2O
2. After one breath, the ventilator annunciates a HIGH CIRCUIT PRESSURE (1PPEAK) alarm. If the alarm does
not sound, check the patient circuit for leaks.
2PPEAK: 50 cmH2O
2. Press the alarm reset key to reset all alarms.
4. Disconnect the ventilator breathing circuit from the from patient port and block the gas flow.
5. While maintaining the occlusion, ensure the safety valve open indicator appears on the status display,
the GUI shows the elapsed time without normal ventilation support, and the test lung inflates and
deflates rapidly with small pulses as the ventilator delivers trial pressure-based breaths.
2. Connect the power cord to AC facility power. The AC POWER LOSS or LOW BATTERY alarm autoresets.
2PPEAK: 70 cmH2O
Mode: SPONT
Spontaneous type: PS
2. The GUI annunciates an APNEA alarm within 10 s after touching Accept.
3. Squeeze the test lung twice to simulate two subsequent patient-initiated breaths. The APNEA alarm
autoresets.
Note:
To avoid triggering a breath during the apnea interval, do not touch the test lung or patient circuit.
Note:
For the apnea alarm test, the exhaled tidal volume (VTE) displayed in the patient data area must be greater
than half the delivered volume shown on the volume-time plot in the graphics display for apnea to
autoreset. See Apnea Ventilation (10.12) on page 10-33 for a technical description of apnea ventilation.
LOW EXHALED SPONTANEOUS TIDAL VOLUME alarm test
1. Make the following patient and alarm settings changes:
3. Slowly squeeze the test lung to simulate spontaneous breaths. The ventilator annunciates a LOW
EXHALED SPONTANEOUS TIDAL VOLUME (3VTE SPONT) alarm at the start of the fourth consecutive
spontaneous inspiration.
Mode: A/C
4VTE SPONT: OFF
5. Press the alarm reset key to reset the 3VTE SPONT alarm.
2. Connect the oxygen inlet supply. The NO O2 SUPPLY alarm autoresets within two breaths after oxygen
is reconnected.
PSENS: 2 cmH2O
O2%: 100%
2. Make the following apnea settings changes:
TA: 60 s
3. Attach the ventilator’s oxygen gas hose to a known air supply (for example, a medical grade air cylin-
der) or a wall air outlet.
4. attach the ventilator’s air gas hose to a known medical oxygen supply.
5. Observe the GUI screen. The delivered O2% display should decrease, and the ventilator should annun-
ciate a medium priority 3O2% alarm within 60 seconds and a high priority 3O2% alarm within 2 min-
utes.
7. Observe the GUI screen. The delivered O2% display should increase, and the ventilator should annun-
ciate a medium priority 1O2% alarm within 60 seconds and a high priority 1O2% alarm within 2 min-
utes.
8. Remove the air gas hose from the oxygen supply and reconnect the hose to a known medical air
supply.
9. Remove the oxygen gas hose from the air supply and reconnect the hose to a known oxygen supply.
WARNING:
Before returning the ventilator to service, review all settings and set appropriately for the patient
to be ventilated.
When an alarm occurs, the omni-directional LED at the top of the GUI flashes in a color corre-
sponding to the alarm priority, an audible series of tones sounds, and an alarm banner displays on
the GUI. See Figure 4-1. on page 4-3. When the alarm banner appears, it displays its base message.
Touching the individual alarm causes an expanded explanation to appear, containing analysis
and remedy messages, and may contain a link to the alarm log or the alarms settings screen.
Touch the link to display requested information. The omni-directional LED remains steadily lit and
may appear multicolored, meaning that multiple alarms with varying priority levels have
occurred. During an event that causes multiple alarms, the ventilator simultaneously displays the
two highest priority active alarms.
The delay time from the moment the alarm condition first occurs until the alarm is annunciated
is imperceptible.
For alarm conditions relayed via the serial port, the overall delay is dependent upon the polling
rate of the external device. The delay from the time the serial port is polled by the external device,
until the alarm message leaves the serial port does not exceed 3 seconds. An example of an exter-
nal device is a patient monitor.
Current alarm settings are saved in the ventilator’s non-volatile memory (NVRAM). If the alarm
settings are changed by another clinician, those settings become applicable. For example, there
are no operator-selectable default alarm settings.
The ventilator system’s alarm handling strategy is intended to
• Detect and call attention to legitimate causes for caregiver concern as quickly as possible, while mini-
mizing nuisance alarms.
• Identify the potential cause and suggest corrective action for certain types of alarms. However, the cli-
nician must make the final decision regarding any clinical action.
Ventilator alarms are categorized as high priority, medium priority, or low priority, and are classi-
fied as technical or non-technical.
The ventilator is equipped with two alarms—the primary alarm and secondary alarm. The primary
alarm annunciates high, medium, and low priority alarms when they occur. The secondary alarm
(also named immediate priority in Table 6-2. ) is a continuous tone alarm and annunciates during
vent inop conditions or complete loss of power. This alarm is powered by a capacitor and lasts for
at least 120 seconds.
Table 6-2. lists alarm priority levels and their visual, audible, and autoreset characteristics. An
alarm autoresets when the condition causing the alarm no longer exists.
Table 6-2. Alarm Priority
High: Immediate atten- Flashing red omni- High-priority audible Visual alarm does not
tion required to ensure directional LED located alarm (a sequence of auto reset. Visual alarm
patient safety. on the top of the GUI, five tones that repeats indicators remain
red alarm banner on GUI twice, pauses, then steadily illuminated fol-
screen, red bar next to repeats again). lowing an autoreset.
alarm setting icon on The alarm reset key
Alarms screen. must be pressed to
extinguish visual indica-
tor.
Medium: Prompt atten- Flashing yellow omni- Medium-priority LED indicator turns off
tion necessary. directional LED located audible alarm (a repeat- and autoreset is entered
on the top of the GUI, ing sequence of three into the alarm log.
yellow alarm banner on tones).
GUI screen, and yellow
bar next to alarm setting
icon on Alarms screen.
Low: A change in the Steadily illuminated Low-priority audible LED indicator turns off
patient-ventilator yellow omni-directional alarm (two tones, non- and autoreset is entered
system has occurred. LED located on the top repeating). into the alarm log.
of the GUI, yellow alarm
banner on GUI screen,
and yellow bar next to
alarm setting icon on
Alarms screen.
A technical alarm is one that is caused by a violation of any of the ventilator’s self monitoring con-
ditions, such as failure of POST or a fault detected by the ventilator’s background diagnostic
system. Technical alarms cannot be reset by pressing the alarm reset key. (See
Background Diagnostic System (10.16.4) on page 10-61). Technical alarms fall into eight categories,
shown in Table 6-3.
See Table 6-4. for a list of ventilator technical alarms, their meaning, and what to do if they occur.
See Table 11-10. for the settings, ranges, and resolutions of all of the ventilator alarms.
DEVICE ALERT Various. Technical alarm category Follow remedy message dis-
is described. See Table 6-3. .on played on GUI.
page 6-15. More information for
the particular technical alarm can
be found in the System diagnos-
tic log, a link to which is provided
on the expanded alarm banner.
APNEA (patient Medium Apnea ventila- Check patient & set- The set apnea inter-
data alarm) tion. Breath inter- tings. val has elapsed
val > apnea without the ventila-
interval. tor, patient, or opera-
tor triggering a
High Extended apnea breath. Resets after
duration or multi- patient initiates a
ple apnea events. third consecutive
breath. Possible
dependent alarm:
3VE TOT
1PPEAK (patient Low Last breath ≥ set Check patient, Measured airway
data alarm) limit. circuit & ET tube. pressure ≥ set limit.
Ventilator truncates
Medium Last 3 breaths ≥ current breath unless
set limit. already in exhalation.
Possible dependent
High Last 4 or more
breaths ≥ set alarms: 3VTE MAND,
limit. 3VE TOT, 1fTOT.
Corrective action:
Check patient. Check
tube type/ID setting.
Consider reducing%
Supp setting or
increasing 2PPEAK.
3PPEAK (patient Low Last 2 breaths, Check for leaks. Peak inspiratory pres-
data alarm) pressure ≤ set sure ≤ alarm setting.
limit. (Available only when
mandatory type is
Medium Last 4 breaths, VC+* or when venti-
pressure ≤ set lation type is NIV.
limit Target pressure = the
low limit: PEEP+3
High Last10 or more
cmH2O. Ventilator
breaths, pressure
≤ set limit cannot deliver target
volume. Possible
dependent alarms:
1fTOT.
Corrective action:
Check patient and
settings; check for
leaks.
* Because the VC+ pressure control algorithm does not allow the target inspiratory pressure to fall below
PEEP+3 cmH2O, attempting to set the 4PPEAK alarm limit at or below this level will turn the alarm off.
1O2% (patient Medium Measured O2% > Check patient, gas The O2% measured
data alarm) set for ≥30 s but sources, O2 analyzer during any phase of a
<2 min & ventilator. breath cycle is 7%
(12% during the first
High Measured O2% > hour of operation) or
set for ≥2 min. more above the O2%
setting for at least 30
seconds. (These per-
centages increase by
5% for 4 minutes fol-
lowing a decrease in
the O2% setting.)
3O2% (patient High Measured O2% < Check patient, gas The O2% measured
data alarm) set O2%. sources, O2 analyzer during any phase of a
& ventilator. breath cycle is 7%
(12% during the first
hour of operation) or
more below the O2%
setting for at least 30
seconds, or below
18%. (These percent-
ages increase by 5%
for 4 minutes follow-
ing an increase in the
O2% setting.)
1VTE (patient data Low Last 2 breaths ≥ Check settings, Exhaled tidal volume
alarm set limit. changes in patient's ≥ set limit. Alarm
R & C. updated whenever
Medium Last 4 breaths ≥ exhaled tidal volume
set limit. is recalculated. Possi-
ble dependent alarm:
High Last 10 or more
breaths ≥ set 1VE TOT
limit.
1VE TOT (patient Low VE TOT ≥ set limit Check patient & set- Expiratory minute
data alarm) for ≤30 s tings. volume ≥ set limit.
Alarm updated
Medium VE TOT ≥ set limit whenever an exhaled
for >30 s minute volume is
recalculated. Possible
High VE TOT ≥ set limit dependent alarm:
for >120 s 1VTE.
1fTOT (patient data Low fTOT ≥ set limit for Check patient & set- Total respiratory
alarm) ≤30 s. tings. rate≥ set limit. Alarm
updated at the
Medium fTOT ≥ set limit for beginning of each
>30 s. inspiration. Reset
when measured
High fTOT ≥ set limit for respiratory rate falls
>120 s. below the alarm
limit. Possible depen-
dent alarms: 3VTE
MAND, 3VTE SPONT,
3VE TOT.
INSPIRATION TOO Low Last 2 spont Check patient. Inspiratory time for
LONG (patient breaths = PBW Check for leaks. spontaneous breath
data alarm) based TI limit. ≥ PBW-based limit.
Ventilator transitions
Medium Last 4 spont to exhalation. Resets
breaths = PBW when TI falls below
based TI limit. PBW-based limit.
Active only when
High Last 10 or more ventilation type is
spont breaths = invasive.
PBW based TI
limit.
PAV STARTUP TOO Low PAV startup not Check for leaks, Unable to assess
LONG (patient complete for ≥45 shallow breathing, & patient’s resistance
data alarm) (occurs s. settings for and compliance
only if PAV+ is in 1VTIand 1PPEAK. during PAV startup.
use) Medium PAV startup not Possible dependent
complete for ≥90
alarms 3VTE SPONT,
s.
3VE TOT,1fTOT.
High PAV startup not Corrective action:
complete for Check patient.
≥120 s. (Patient’s inspiratory
times may be too
short to evaluate
resistance and com-
pliance.) Check that
selected humidifica-
tion type and empty
humidifier volume
are correct.
PAV R & C NOT Low R and/or C over Check for leaks, Unable to assess
ASSESSED (patient 15 minutes old. shallow breathing, & resistance or compli-
data alarm) (occurs settings for tube ID, ance during PAV+
Medium R and/or C over
only if PAV+ is in 1VTI and 1PPEAK. steady-state. Startup
use) 30 minutes old. was successful, but
later assessments
were unsuccessful.
Corrective action:
Check patient.
(Patient’s inspiratory
times may be too
short to evaluate
resistance and com-
pliance.) Check that
selected humidifica-
tion type and empty
humidifier volume
are correct.
LOW BATTERY Medium Vent main Replace or allow Resets when battery
battery opera- recharge vent main has ≥10 minutes of
tional time <10 battery. operational time
minutes. remaining or when
AC power is restored.
LOW BATTERY Medium Vent main battery Replace or allow Resets when main
operational time recharge vent main battery or compres-
<10 minutes and battery and com- sor battery has ≥10
compressor pressor battery. minutes of opera-
battery opera- tional time remain-
tional time <10 ing or when AC
minutes. power is restored.
LOW BATTERY High Vent main battery Replace or allow Resets when battery
operational time recharge vent main has ≥5 minutes of
<5 minutes. battery. operational time
remaining or when
AC power is restored.
LOW BATTERY High Vent main battery Replace or allow Resets when main
operational time recharge vent main battery or compres-
<5 minutes and battery and com- sor battery has ≥5
compressor pressor battery. minutes of opera-
battery opera- tional time remain-
tional time < 5 ing or when AC
minutes. power is restored
3VTE MAND Low Last 2 mand Check for leaks, Exhaled mandatory
(patient data breaths ≤ set changes in patient's tidal volume≤ set
alarm) limit. R & C. limit. Alarm updated
whenever exhaled
Medium Last 4 mand mandatory tidal
breaths ≤ set volume is recalculat-
limit. ed. Possible depen-
High Last 10 or more dent alarms: 3VE TOT,
mand breaths ≤ 1fTOT.
set limit.
3VTE SPONT Low Last 4 spont Check patient & set- Exhaled sponta-
(patient data breaths ≤ set limit tings. neous tidal volume ≤
alarm) set limit. Alarm
Medium Last 7 spont updated whenever
breaths ≤ set limit exhaled sponta-
neous tidal volume is
High Last 10 or more
recalculated. Possible
spont breaths ≤
dependent alarms:
set limit
3VE TOT, 1fTOT.
1VTI (patient data Low Last spont breath In TC, VS, or PAV+: Delivered inspiratory
alarm) ≥ set limit. volume ≥ inspiratory
Check patient and limit. Ventilator tran-
Medium Last 3 spont sitions to exhalation.
settings.
breaths ≥ set Possible dependent
limit.
alarms: 3VTE SPONT,
High Last 4 or more 3VE TOT, 1fTOT.
spont breaths ≥ Corrective action:
set limit. Check for leaks.
Check for the correct
tube type.
Check the VT SUPP or
% Supp setting. In
PAV+, check for
patient agitation,
which can cause mis-
calculation of RPAV
and CPAV. Consider
reducing% Supp set-
ting. Check 2VTI.
3VE TOT (patient Low VE TOT ≤ set limit Check patient & set- Total minute volume
data alarm) for ≤30 s. tings. ≤ set limit. Alarm
updated whenever
Medium VE TOT ≤ set limit exhaled minute
for >30 s. volume is recalculat-
ed. Possible depen-
High VE TOT ≤ set limit dent alarms: 3VTE
for >120 s. MAND, 3VTE SPONT,
1fTOT.
VOLUME NOT Low Last 2 spont (or Check patient & Insp target pressure
DELIVERED (not mand) breaths setting for 1PPEAK. > (PPEAK– PEEP–3
adjustable) pressure > max cmH2O), when spon-
(patient data allowable level. taneous type is VS or
alarm) mandatory type is
Medium Last 10 or more
VC+. Ventilator
spont (or mand)
cannot deliver target
breaths, pressure
volume. Possible
> max allowable
dependent alarms:
level.
For VC+ breaths:
3VTE MAND 3VE TOT
1fTOT. For VS breaths:
3VTE SPONT, 3VE TOT,
1fTOT.
Corrective action:
Check patient and
settings.
PROX INOPERA- Low Data from Proxi- Check proximal flow Data obtained from
TIVE (if Proximal mal Flow Sensor sensor connections the proximal flow
Flow Sensor is in are not being and tubes for occlu- sensor are invalid,
use) used. sions or leaks. non-existent, or
unreasonable based
on current ventilator
settings or purge
lines are occluded.
Alarm resets when
condition is correct-
ed. Data for real time
waveforms and mon-
itored volumes are
obtained from inter-
nal sensors.
AC POWER LOSS The ventilator or compressor is Monitor the battery charge level
running on battery power. to ensure there is enough power
remaining to operate the ventila-
tor or compressor.
APNEA (patient data alarm) The time between patient Check patient and settings.
breaths exceeds the set apnea
interval.
CIRCUIT DISCONNECT The patient circuit has become Re-connect the patient circuit, or
disconnected or there is a large eliminate the leak.
leak in the patient circuit.
Compliance limited VT (patient Compliance volume required to Check patient and circuit type.
data alarm) compensate delivery of a VC, VC+, Inspired volume may be less than
or VS breath exceeds the set.
maximum allowed for three con-
secutive breaths.
COMPRESSOR INOPERATIVE Air pressure not detected in the Service or replace compressor.
compressor’s accumulator. Status
display indicates the compressor
is inoperative.
1PPEAK (patient data alarm) The measured airway pressure is • Check the patient.
≥ set limit. Reduced tidal volume • Check the patient circuit.
likely. • Check the endotracheal tube.
3PPEAK (patient data alarm) The peak inspiratory pressure in Check for leaks in the patient
the patient circuit ≤ alarm set- circuit and VBS.
ting.This alarm is only available
when NIV is the selected ventila-
tion type or when VC+ is the
selected mandatory type during
invasive ventilation.*
* Because the VC+ pressure control algorithm does not allow the target inspiratory pressure to fall below
PEEP+3 cmH2O, attempting to set the 4PPEAK alarm setting at or below this level will turn the alarm off.
1O2% (patient data alarm) The O2% measured during any Check the patient, the air and
phase of a breath cycle is 7% (12% oxygen supplies, the oxygen ana-
during the first hour of operation) lyzer, and the ventilator.
or more above the O2% parame-
ter for at least 30 seconds.The per-
centage window increases by 5%
for 4 minutes after increasing the
set O2% value.
3O2% (patient data alarm) The O2% measured during any • Check the patient, the air and
phase of a breath cycle is 7% (12% oxygen supplies, the oxygen ana-
during the first hour of operation) lyzer and the ventilator.
or more below the O2% parame- • Calibrate the oxygen sensor. See
ter for at least 30 seconds. The Oxygen Sensor Calibration (4.10.2)
percentage window increases by on page 4-31 for details regarding
5% for 4 minutes after increasing calibrating the oxygen sensor.
the set O2% value. • Use an external O2 monitor and
disable the O2 sensor.
1VTE (patient data alarm) Exhaled tidal volume ≥ alarm • Check patient settings.
setting for the last two breaths. • Check for changes in patient’s
resistance and compliance.
1VE TOT (patient data alarm) Minute volume ≥ alarm setting. Check patient settings.
1fTOT (patient data alarm) The breath rate from all breaths is Check the patient and the ventila-
≥ alarm setting. tor settings.
1PVENT (patient data alarm) The inspiratory pressure trans- • Check the patient, the patient
ducer has measured a pressure circuit (including filters), and the
>110 cmH2O in VC, TC, or PAV+. endotracheal tub. Ensure that the
The ventilator transitions to exha- ET tube ID is the correct size.
lation. A reduced tidal volume is • Check the ventilator flow and
likely. volume settings.
• Rerun SST.
• Obtain and alternate ventilation
source.
• Remove the ventilator from clin-
ical use and obtain service.
INOPERATIVE BATTERY The battery charge is inadequate Replace the battery or install an
after 6 hours of attempted charge extended battery.
time or the battery system is non-
functional.
INSPIRATION TOO LONG (patient The PBW-based inspiratory time • Check the patient.
data alarm) for the last two spontaneous • Check the patient circuit for
breaths exceeds the ventilator-set leaks.
limit. Active only when ventilation • Check rise time% and ESENS set-
type is invasive. tings.
LOSS OF POWER The ventilator power switch is on, • Check the integrity of the AC
but there is insufficient power power and battery connections.
from the mains AC and the bat- • Obtain alternate ventilation, if
tery. There may not be a visual necessary.
indicator for this alarm, but an • Use an extended battery. If the
independent audio alarm (imme- loss if power event has been
diate priority) sounds for at least resolved, turn the power switch
120 seconds. off and back on again to reset the
alarm.
LOW BATTERY Medium priority alarm indicating Recharge the battery, by plug-
<10 minutes of battery power ging the ventilator into AC power
remaining to operate the ventila- or replace the battery, or install an
tor or compressor. extended battery.
High priority alarm indicating <5
minutes of battery power remain
to operate the ventilator or com-
pressor.
3VTE MAND (patient data alarm) The patient’s exhaled mandatory • Check the patient.
tidal volume is ≤ alarm setting for • Check for leaks in the patient cir-
the last two mandatory breaths. cuit.
• Check for changes in the
patient’s resistance and compli-
ance.
3VTE SPONT (patient data alarm) The patient’s exhaled sponta- • Check the patient.
neous tidal volume is ≤ alarm • Check the ventilator settings.
setting for the last two sponta-
neous breaths.
3VE TOT (patient data alarm) The minute volume for all breaths • Check the patient.
is ≤ alarm setting. • Check the ventilator settings.
NO AIR SUPPLY The air supply pressure is less than • Check the patient.
the minimum pressure required • Check the air and oxygen sourc-
for correct ventilator operation. es.
The ventilator delivers 100% O2 if • Obtain alternate ventilation, if
available. If an oxygen supply is necessary.
not available, the safety valve
opens. The ventilator displays the
elapsed time without ventilator
support. This alarm cannot be set
or disabled.
1VTI (patient data alarm) Delivered inspiratory volume ≥ • Check patient and ventilator set-
high inspiratory volume limit tings.
• Check for leaks, tube type/ID,
and % Supp
settings, and patient agitation.
• Ventilator transitions to exhala-
tion.
VOLUME NOT DELIVERED (patient Insp target pressure> (PPEAK– Check patient and 2PPEAK setting
data alarm PEEP–3 cmH2O), when sponta-
neous type is VS or when manda-
tory type is VC+.
PAV STARTUP TOO LONG Unable to assess resistance or Check for leaks, shallow breath-
(occurs only if PAV+ function is in compliance during PAV+ startup. ing, and settings for 2VTI and
use)
2PPEAK.
PAV R & C NOT ASSESSED Unable to assess resistance or Check for leaks, shallow breath-
(occurs only if PAV+ function is in compliance during PAV+ steady- ing, and settings for tube ID, 2VTI
use) state.
and 2PPEAK
PROX INOPERATIVE A malfunction occurred with the Replace the proximal flow sensor
proximal flow sensor or the pneu- or purge its pneumatic lines. Does
matic lines are occluded. not affect data from the ventila-
tor’s delivery or exhalation flow
sensors.
The AC POWER LOSS alarm indicates the ventilator power switch is on and the ventilator is being
powered by the battery and an alternate power source may soon be required to sustain normal
ventilator operation. The ventilator annunciates a medium-priority LOW BATTERY alarm when the
ventilator has less than 10 minutes of battery power remaining. The ventilator annunciates a high-
priority LOW BATTERY alarm when less than 5 minutes of battery power are estimated available.
The compressor is a DC device, in which AC power is converted to DC power, and it has its own
primary and extended batteries (if the extended battery was purchased). If AC power is lost, there
is no conversion to DC power for the compressor as in normal operation, but the compressor sup-
plies air, providing the charge level of its batteries is sufficient.
The APNEA alarm indicates neither the ventilator nor the patient has triggered a breath for the
operator-selected apnea interval (TA). TA is measured from the start of an inspiration to the start
of the next inspiration and is based on the ventilator’s inspiratory detection criteria. TA can only
be set via the apnea ventilation settings.
The APNEA alarm autoresets after the patient initiates two successive breaths, and is intended to
establish the patient's inspiratory drive is reliable enough to resume normal ventilation. To ensure
the breaths are patient-initiated (and not due to autotriggering), exhaled volumes must be at
least half the inspired VT. (This avoids returning to normal ventilation if there is a disconnect.)
The CIRCUIT DISCONNECT alarm indicates the patient circuit is disconnected at the ventilator or
the patient side of the patient wye, or a large leak is present. The methods by which circuit dis-
connects are detected vary depending on breath type. Time, pressure, flow, delivered volume,
exhaled volume, and the DSENS setting may be used in the circuit disconnect detection algo-
rithms. See Disconnect (10.13.2) on page 10-38 for a complete discussion of the CIRCUIT DISCON-
NECT detection methods.
The CIRCUIT DISCONNECT alarm sensitivity is adjusted via the DSENS setting. During a CIRCUIT DIS-
CONNECT condition, the ventilator enters an idle state and delivers a base flow of oxygen to
detect a reconnection.
When the ventilator determines the patient circuit is reconnected, the CIRCUIT DISCONNECT
alarm autoresets and normal ventilation resumes without having to manually reset the alarm (for
example, following suctioning).
A disconnected patient circuit interrupts gas delivery and patient monitoring. Notification of a
patient circuit disconnect is crucial, particularly when the patient cannot breathe spontaneously.
The ventilator does not enter apnea ventilation when a disconnect is detected to avoid changing
modes during a routine suctioning procedure.
Note:
When utilizing a closed-suction catheter system, the suctioning procedure can be executed using existing
mode, breath type and settings. To reduce potential for hypoxemia during the procedure, elevate the
oxygen concentration using the Elevate O2 control. See To adjust the amount of elevated O2 delivered for 2
minutes, page 3-36.
This alarm alerts the operator that there is insufficient battery power and no AC power to support
ventilator or compressor operation. The alarm annunciates as long as theventilator’s power
switch is in the on position, and lasts for at least 120 seconds.
A DEVICE ALERT alarm indicates a background test or power on self test (POST) has failed.
Depending on which test failed, the ventilator either continues to ventilate according to current
settings, or ventilates with modified settings, or enters the ventilator inoperative state. The DEVICE
ALERT alarm relies on the ventilator’s self-testing and notifies the clinician of an abnormal condi-
tion requiring service. See Background Diagnostic System (10.16.4) on page 10-61.
The 1PPEAK alarm indicates the currently measured airway pressure is equal to or greater than the
set limit. The 2PPEAK limit is active during all breath types and phases to provide redundant
patient protection (for example, to detect air flow restrictions downstream of the pressure-
sensing device). The 2PPEAK limit is active in all normal ventilation modes. The 1PPEAK alarm new
patient default values are separately configurable for neonatal, pediatric, and adult patients.
The2PPEAK limit is not active during a SEVERE OCCLUSION alarm.
The 1PPEAK alarm truncates inspiration and transitions the ventilator into the expiratory phase. The
limit cannot be set less than:
• PEEP+7 cmH2O
• PEEP+ PI +2 cmH2O
• PEEP+PSUPP +2 cmH2O
• 4PPEAK
The 2PPEAK limit cannot be disabled. The ventilator phases in changes to the 2PPEAK limit imme-
diately to allow prompt notification of a high circuit pressure condition.
The minimum 2PPEAK limit (7 cmH2O) corresponds to the lowest peak pressures not due to auto-
triggering anticipated during a mandatory breath. The maximum 2PPEAK limit (100 cmH2O) was
selected because it is the maximum pressure required to inflate very low-compliance lungs.
The ventilator allows circuit pressure to rise according to a computed triggering profile for the
initial phase of PC and PS breaths without activating the 1PPEAK alarm. This triggering profile helps
avoid nuisance alarms due to possible transient pressure overshoot in the airway when aggres-
sive values of rise time% are selected. A brief pressure overshoot measured in the patient circuit
is unlikely to be present at the carina.
The 1O2% alarm indicates the measured O2% is at or above the error percentage above the O2%
setting for at least 30 seconds to eliminate transient O2% delivery variation nuisance alarms. The
1O2% alarm detects malfunctions in ventilator gas delivery or oxygen monitor. The ventilator
declares a 1O2% alarm after 30 seconds. Although the ventilator automatically sets the 1O2%
alarm limits, the oxygen sensor can be disabled. (The error percentage is 12% above setting for
the first hour of ventilator operation, 7% above the setting after the first hour of operation, and an
additional 5% above the setting for the first 4 minutes following a decrease in the setting.)
The ventilator automatically adjusts the 1O2% alarm limit when O2% changes due to 100% O2,
apnea ventilation, occlusion, circuit disconnect, or a NO AIR SUPPLY or NO O2 SUPPLY alarm. The
ventilator checks the 1O2% alarm limit against the measured oxygen percentage at 1-second
intervals.
The 1VE TOT alarm indicates the measured exhaled total minute volume for spontaneous and
mandatory breaths is equal to or greater than the alarm setting. The 1VE TOT alarm is effective
immediately upon changing the setting, to ensure prompt notification of prolonged high tidal
volumes.
The 1VE TOT alarm can be used to detect a change in a patient's breathing pattern, or a change in
compliance or resistance. The 1VE TOT alarm can also detect too-large tidal volumes, which could
lead to hyperventilation and hypocarbia.
The 1VTE alarm indicates the measured exhaled tidal volume for spontaneous and mandatory
breaths is equal to or greater than the set 2VTE alarm. The 1VTE alarm is updated whenever a new
measured value is available.
The 1VTE alarm can detect increased exhaled tidal volume (due to greater compliance and lower
resistance) and prevent hyperventilation during pressure control ventilation or pressure support.
Turn the 1VTE alarm OFF to avoid nuisance alarms. (Hyperventilation due to increased compliance
is not a concern during volume-based ventilation, because the tidal volume is fixed by the clini-
cian's choice and the ventilator’s compliance-compensation algorithm.)
The 1VTI alarm indicates the patient’s inspired volume exceeds the set limit. When this condition
occurs, the breath terminates and the alarm sounds. The ventilator displays monitored inspired
tidal volume values in the patient data area on the GUI screen. When ventilation type is NIV, there
is no high inspired tidal volume alarm or setting available, but the monitored inspired tidal
volume (VTI) may appear in the patient data area on the GUI screen.
The 1fTOT alarm indicates the measured breath rate is greater than or equal to the 2fTOT alarm set-
ting. The 1fTOT alarm is updated whenever a new total measured respiratory rate is available.
The 1fTOT alarm can detect tachypnea, which could indicate the tidal volume is too low or the
patient's work of breathing has increased. The ventilator phases in changes to the 2fTOT limit
immediately to ensure prompt notification of a high respiratory rate condition.
The INSPIRATION TOO LONG alarm, active only when ventilation type is invasive, indicates the
inspiratory time of a spontaneous breath exceeds the following time limit:
• (1.99 + 0.02×PBW) seconds (adult and pediatric circuits)
where PBW is the current setting for predicted body weight in kg.
When the ventilator declares an INSPIRATION TOO LONG alarm, the ventilator terminates inspira-
tion and transitions to exhalation. The INSPIRATION TOO LONG alarm applies only to spontaneous
breaths and cannot be set or disabled.
Because leaks (in the patient circuit, around the endotracheal tube cuff, or through chest tubes)
and patient-ventilator mismatch can affect accurate exhalation detection, the INSPIRATION TOO
LONG alarm can act as a backup method of safely terminating inspiration. If the INSPIRATION TOO
LONG alarm occurs frequently, check for leaks and ensure ESENS and rise time% are properly set.
WARNING:
Because the VC+ pressure control algorithm does not allow the target inspiratory pressure to fall
below PEEP+3 cmH2O, attempting to set the 4PPEAK alarm limit at or below this level will turn the
alarm off.
The 3PPEAK alarm indicates the measured maximum airway pressure during the current breath is
less than or equal to the set alarm level during a non-invasive inspiration or during a VC+ inspira-
tion.
The 3PPEAK alarm is active for mandatory and spontaneous breaths, and is present only when ven-
tilation type is NIV or mandatory type is VC+. During VC+, the 3PPEAK alarm can be turned off. The
3PPEAK alarm can always be turned off during NIV. The 4PPEAK alarm limit cannot be set to a value
greater than or equal to the 2PPEAK alarm limit.
In VC+, whenever PEEP is changed, 3PPEAK is set automatically to its new patient value, PEEP+4
cmH2O when PEEP≥16 cmH2O, or PEEP+3.5 cmH2O when PEEP<16 cmH2O.
There are no alarms dependent upon 3PPEAK and the 3PPEAK alarm does not depend on other
alarms.
The3O2% alarm indicates the measured O2% during any phase of a breath is at or below the error
percentage below the O2% setting, or less than or equal to 18%, for at least 30 seconds. Although
the ventilator automatically sets the 3O2% alarm, replace (if necessary) or disable the oxygen
sensor to avoid nuisance alarms. (The error percentage is 12% below setting for the first hour of
ventilator operation following a reset, 7% below setting after the first hour of operation, and an
additional 5% below setting for the first 4 minutes following an increase in the setting.)
The ventilator automatically adjusts the 3O2% alarm limit when O2% changes due to apnea ven-
tilation, circuit disconnect, or a NO O2 SUPPLY or NO AIR SUPPLY alarm. The 3O2% alarm is dis-
abled during a safety valve open (SVO) condition. The ventilator checks the 3O2% alarm against
the measured oxygen percentage at 1-second intervals.
The 3O2% alarm can detect malfunctions in ventilator gas delivery or the oxygen monitor, and
can ensure the patient is adequately oxygenated. The ventilator declares a 3O2% alarm after 30
seconds to eliminate nuisance alarms from transient O2% delivery variations. The O2% measured
by the oxygen sensor is shown in the patient data area. See Vital Patient Data, page 3-37 to include
O2% if it is not displayed.
The alarm indicates the measured exhaled mandatory tidal volume is less than or equal to the
4VTE MAND alarm setting. The 3VTE MAND alarm updates when a new measured value of exhaled
mandatory tidal volume is available.
The3VTE MAND alarm can detect an obstruction, a leak during volume ventilation, or a change in
compliance or resistance during pressure-based ventilation (that is, when the same pressure is
achieved but tidal volume decreases). There are separate alarms for mandatory and spontaneous
exhaled tidal volumes for use during SIMV, SPONT, and BiLevel. The ventilator phases in a change
to the 3VTE MAND alarm immediately to ensure prompt notification of a low exhaled tidal volume
condition.
The 3VTE SPONT alarm indicates the measured exhaled spontaneous tidal volume is less than or
equal to the 4VTE SPONT alarm setting. The alarm updates when a new measured value of exhaled
spontaneous tidal volume is available.
The 3VTE SPONT alarm can detect a leak in the patient circuit or a change in the patient’s respiratory
drive during a single breath. The 3VTE SPONT alarm is based on the current breath rather than on
an average to detect changes as quickly as possible. There are separate alarms for mandatory and
spontaneous exhaled tidal volumes for use during SIMV and BiLevel. The ventilator phases in a
change to the 4VTE SPONT alarm limit immediately to ensure prompt notification of a low exhaled
tidal volume condition.
The 3VE TOT alarm indicates the measured minute volume (for mandatory and spontaneous
breaths) is less than or equal to the 4VE TOT alarm setting. The 3VE TOT alarm updates with each
new calculation for exhaled minute volume.
The 3VE TOT alarm can detect a leak or obstruction in the patient circuit, a change in compliance
or resistance, or a change in the patient's breathing pattern. The 3VE TOT alarm can also detect
too-small tidal volumes, which could lead to hypoventilation and hypoxia (oxygen desaturation).
The ventilator phases in changes to the 4VE TOT alarm limit immediately to ensure prompt notifi-
cation of prolonged low tidal volumes.
The ventilator declares a PROCEDURE ERROR alarm if it is powered up (either by turning on the
power switch or if power is regained following a power loss of at least 5 minutes) and the venti-
lator detects a patient attached before Ventilator Startup is complete. Until confirmation of the
ventilator settings, the ventilator annunciates a high-priority alarm and enters Safety PCV. See
Table 10-10. on page 10-60.
The PROCEDURE ERROR alarm requires confirmation of ventilator settings after restoration of ven-
tilator power, in case a new patient is attached to the ventilator. Safety PCV is an emergency mode
of ventilation providing ventilation according to displayed settings until settings confirmation,
and is not intended for long-term patient ventilation.
A severe occlusion alarm occurs when gas flow in the ventilator breathing system is severely
restricted. The ventilator enters Occlusion Status Cycling (OSC) where the ventilator periodically
attempts to deliver a pressure-based breath while monitoring inspiratory and expiratory breath
phases for a severe occlusion. If an occlusion is not detected, the ventilator considers the occlu-
sion condition reset, clears the occlusion alarm, and continues ventilation with the settings in use
before the occlusion occurred. The ventilator indicates an occlusion was detected.
Note:
If no value is displayed, then the ventilator is in a state where the value cannot be measured.
Note:
All displayed patient volume data represent lung volumes expressed under BTPS conditions.
The following sections contain descriptions of all patient data parameters shown in the patient
data displays.
The BTPS and compliance compensated sum of exhaled gas volumes from both mandatory and
spontaneous breaths for the previous 1-minute interval.
The BTPS- and compliance-compensated sum of exhaled spontaneous volumes for the previous
minute.
The volume of the patient’s exhaled gas for the previous mandatory or spontaneous breath. Dis-
played VTE is both compliance-and BTPS compensated, and updates at the next inspiration.
The BTPS- and compliance-compensated sum of exhaled spontaneous volumes for the previous
minute, measured by the proximal flow sensor (for neonatal patients, only).
The exhaled tidal volume for the previous breath measured by the proximal flow sensor (for neo-
natal patients, only). VTEY is updated at the beginning of the next inspiration.
The exhaled volume of the last spontaneous breath, updated at the beginning of the next inspi-
ration following a spontaneous breath.
The exhaled volume of the last mandatory breath, updated at the beginning of the next inspira-
tion following a mandatory breath. If the mode is SPONT and the ventilator has not delivered
mandatory breaths in a time period of greater than 2 minutes (for example via a manual inspira-
tion), the VTE MAND patient data indicator becomes hidden.The indicator reappears when the
value updates.
Inspired tidal volume (VTI) is the BTPS- and compliance-compensated volume of inspired gas for
all pressure-based or NIV breaths, updated at the beginning of the following expiratory phase. VTI
is displayed when data are available.
Proximal inspired tidal volume (VTIY) is the inspired tidal volume for a mandatory or spontaneous
breath measured by the proximal flow sensor (for neonatal patients, only). VTIY is updated at the
beginning of the following expiratory phase and is displayed when data are available.
I:E ratio is the ratio of inspiratory time to expiratory time for the previous breath, regardless of
breath type, updated at the beginning of the next inspiration. When I:E ratio is ≥1:1, it is displayed
as XX:1. Otherwise it is displayed as 1:XX.
Note:
Due to limitations in setting the I:E ratio in PC ventilation, the monitored data display may not exactly
match the I:E ratio setting.
Mean circuit pressure (PMEAN) is the average circuit pressure for a complete breath period, includ-
ing both inspiratory and expiratory phases whether mandatory or spontaneous. The displayed
value can be either positive or negative.
Peak circuit pressure (PPEAK) is the maximum circuit pressure at the patient wye during the previ-
ous breath, including both inspiratory and expiratory phases.
End inspiratory pressure (PI END) is the pressure at the end of the inspiratory phase of the current
breath.
End expiratory pressure (PEEP) is the pressure at the end of the expiratory phase of the previous
breath, updated at the beginning of the next inspiration. During an expiratory pause maneuver,
the displayed value includes any active lung PEEP.
Intrinsic PEEP (PEEPI) is an estimate of the pressure above the PEEP level at the end of an exhala-
tion. PEEPI is determined during an expiratory pause maneuver.
PAV-based intrinsic PEEP (PEEPI PAV) is an estimate of intrinsic PEEP, updated at the end of a spon-
taneous PAV+ breath.
Total PEEP (PEEPTOT) is the estimated pressure at the circuit wye during the expiratory pause
maneuver.
Plateau pressure (PPL) is the pressure measured and displayed during an inspiratory pause maneu-
ver.
Total respiratory rate (fTOT) is the total number of mandatory and spontaneous breaths per minute
delivered to the patient.
For a PAV+ breath, CPAV is the change in pulmonary volume for an applied change in patient
airway pressure, measured under zero-flow conditions and updated upon successful completion
of each calculation. CPAV is displayed on the waveform screen.
For a PAV+ breath, RPAV is the change in pulmonary pressure for an applied change in patient lung
flow and updated upon successful completion of each calculation. RPAV is displayed on the wave-
form screen.
For a PAV+ breath, EPAV is the inverse of CPAV and is updated upon successful completion of each
calculation.
Spontaneous rapid shallow breathing index (f/VT) is an indication of the patient’s ability to breathe
spontaneously. High values generally mean the patient is breathing rapidly, but with low tidal vol-
umes. Low values generally indicate the inverse.
In SPONT mode, spontaneous inspiratory time ratio (TI/TTOT) is the percentage of a spontaneous
breath consumed by the inspiratory phase. Updated at the successful completion of a sponta-
neous breath.
Spontaneous inspiratory time (TI SPONT) is the duration of the inspiratory phase of a spontaneous
breath and updated at the end of each spontaneous breath. TI SPONT is only calculated when the
breathing mode allows spontaneous breaths and the breaths are patient-initiated.
For a PAV+ breath, RTOT is the change in pulmonary pressure for an applied change in total airway
flow and updated upon the successful completion of each calculation. If the RPAV value appears
in parentheses as described at the beginning of this section, the RTOT value also appears in paren-
theses.
CSTAT is an estimate of the elasticity of the patient’s lungs, expressed in mL/cmH2O. It is computed
during a mandatory breath.
RSTAT is the total inspiratory resistance across the artificial airway and respiratory system, dis-
played at the start of the next inspiration after the inspiratory pause maneuver. It is an estimate of
how restrictive the patient’s airway is, based on the pressure drop at a given flow, expressed in
cmH2O/L/s. RSTAT is computed during a VC mandatory breath with a square flow waveform.
CSTAT is calculated using this equation:
V pt
C STAT = ------------------------------- – C ckt
P ckt – PEEP
Total expiratory volume (patient and The pressure in the patient circuit mea-
V pt breathing circuit) PEEP sured at the end of expiration
RSTAT is calculated using this equation after CSTAT is computed and assuming a VC breath type
with a square waveform:
C ckt
1 + --------------- P PEAK – P PL
C STAT
R STAT = ------------------------------------------------------------------
-
V· pt
C ckt Compliance of the breathing circuit P PL Mean pressure in the patient circuit over
during the pause maneuver (derived from the 100 ms interval defining the pause
SST) mechanics plateau
During the pause, the most recently selected graphics are displayed and frozen, to determine
when inspiratory pressure stabilizes. CSTAT and RSTAT are displayed at the start of the next inspira-
tion following the inspiratory pause and take this format:
CSTAT xxx
or
RSTAT yyy
Special formatting is applied if the software determines variables in the equations or the resulting
CSTAT or RSTAT values are out of bounds:
• Parentheses ( ) signify questionable CSTAT or RSTAT values, derived from questionable variables.
• RSTAT ------ means resistance could not be computed, because the breath was not of a mandatory, VC
type with square flow waveform.
CDYN is a dynamic estimate of static compliance for each mandatory breath delivered.
RDYN is a dynamic estimate of static resistance for each mandatory breath delivered.
6.6.32 C20/C
C20/C is the ratio of compliance of the last 20% of inspiration to the compliance of the entire inspi-
ration.
End expiratory flow (EEF) is a measurement of the end expiratory flow for an applicable breath.
Peak spontaneous flow is a measurement of the maximum inspiratory spontaneous flow for an
applicable spontaneous breath
Displayed O2% is the percentage of oxygen in the gas delivered to the patient, measured at the
ventilator’s outlet, upstream of the inspiratory filter. It is intended to provide a check against the
set O2% for alarm determination, and not as a measurement of oxygen delivered to the patient.
O2% data can be displayed as long as the O2 monitor is enabled. If the monitor is disabled, dashes
(--) are displayed. If a device alert occurs related to theO2 monitor, a blinking 0 is displayed.
The 3TauI parameter is three times the product of the patient’s resistance and compliance, and is
used to determine the adequacy of the set inspiratory time (pressure ventilation), or the inspira-
tory time determined by the flow pattern, tidal volume, (VT), peak flow (VMAX), and plateau time
(TPL) settings (volume ventilation).
7.1 Overview
This chapter contains information on maintenance of the Puritan Bennett™ 980 Series Ventila-
tor. It includes:
• How to perform routine preventive maintenance procedures, including frequency
• How to clean, disinfect, or sterilize the ventilator and its main components
WARNING:
To ensure proper ventilator operation, perform Preventive Maintenance intervals as specified in
Table 7-1. on page 7-2 and Table 7-4. on page 7-15.
7-1
Preventive Maintenance
Patient circuit: inspiratory and Several times a day or as required • Check both limbs for water accu-
expiratory limbs by the institution's policy. mulation.
• Empty and clean.
Condensate vial (disposable), Several times a day or as required Check and empty as needed.
water trap by the institution’s policy.
Oxygen sensor calibration Daily or as necessary From the ventilator setup screen,
touch the More Settings tab. To
calibrate the oxygen sensor,
touch Calibrate in the oxygen
sensor area of the screen.
See Oxygen Sensor Calibration
Testing (4.10.3) on page 4-31 for
information on testing the
oxygen sensor calibration.
Disposable drain bag and tubing Discard when filled to capacity or N/A
(single unit) when changing the patient circuit.
Disposable patient circuit tubing Discard. Discard per the institution’s pro-
tocol.
Disposable exhalation filter • After each patient use Replace with a new filter. Discard
• After 15 days of continuous use used filter according to the insti-
tution’s protocol.
Drain bag clamp After each patient use Wipe clean with a cloth damp-
ened with one of the cleaning
agents listed in Table 7-2.
Neonatal door/adapter When gas pathway surfaces are Disinfect per Table 7-3.
visibly soiled or per institutional
guidelines.
When exterior surfaces of door are Surface clean per Surface Cleaning
soiled. of Exterior Surfaces (7.4).
Exhalation flow sensor assembly Per institutional guidelines, or if Disinfect. See Component Clean-
(EVQ) SST flow sensor cross check fails. ing and Disinfection (7.5) on page
DO NOT STERILIZE the exhalation 7-4 and Exhalation Flow Sensor
flow sensor assembly. Assembly (EVQ) Disinfection (7.5.1)
on page 7-6. Run flow sensor cali-
bration and SST.
Every 100 disinfection cycles. A dis- Replace. Discard used flow sensor
infection cycle is defined as one according to the institution’s pro-
disinfection event as described in tocol. Run flow sensor calibration
Exhalation Flow Sensor Assembly and SST.
(EVQ) Disinfection (7.5.1) on page 7-
6.
Compressor inlet air filter Every 250 hours Wash in mild soapy water and
rinse thoroughly. Let air dry.
Note:
If problems occur after exhalation flow sensor replacement, reseat or readjust the flow sensor, and check
the patient circuit integrity. If the problem persists, replace the flow sensor.
Caution:
Use specified cleaning and disinfecting agents and procedures for the appropriate part as
instructed. Follow cleaning procedures outlined in Surface Cleaning of Exterior Surfaces (7.4)
through Exhalation Flow Sensor Assembly (EVQ) Disinfection (7.5.1).
2. Wipe the GUI, BDU, and base, removing any dirt or foreign substances.
4. If necessary, vacuum any cooling vents on the GUI and BDU with an electrostatic discharge (ESD)-safe
vacuum to remove any dust.
Ventilator exterior (including Wipe clean with a cloth damp- • Do not allow liquid or sprays to
touch screen and flex arm) ened with one of the cleaning penetrate the ventilator openings
agents listed below or equivalent. or cable connections.
Use a damp cloth and water to • Do not attempt to sterilize the
rinse off chemical residue as nec- ventilator by exposure to eth-
essary. ylene oxide (ETO) gas.
• Mild dish washing detergent • Do not use pressurized air to
solution clean or dry the ventilator, includ-
• Isopropyl alcohol (70% solution) ing the GUI cooling vents.
•Bleach (10% solution) • Do not submerge the ventilator
• Window cleaning solution (iso- or pour cleaning solutions over or
propyl alcohol and ammonia) into the ventilator.
• Ammonia (15% solution)
• Hydrogen peroxide (3% solu-
tion)
• Formula 409™* cleaner (Clorox
Company)
• CaviCide™* surface disinfectant
(Metrex Research Corporation)
• Control III™* germicide (Maril
Products, Inc.)
• Mr. Muscle Window & Glass (SC
Johnson
• Sani Cloths (PDI, Inc.)
• [Propan-2-ol, Isopropanol, Iso-
propyl Alcohol]1
WARNING:
To avoid microbial contamination and potential performance problems, do not clean, disinfect, or
reuse single-use or disposable components. Discard per local or institutional regulations.
Risks associated with reuse of single-patient use items include but are not limited to microbial
cross-contamination, leaks, loss of part integrity, and increased pressure drop. When cleaning
reusable components, do not use hard brushes or implements that could damage surfaces.
Reusable patient circuit tubing Disinfect per manufacturer’s • Inspect for nicks and cuts and
instructions for use. replace if damaged.
• Run SST to check for leaks when
reinstalling the circuit or when
installing a new circuit.
Breathing circuit in-line water Disinfect per manufacturer’s • Inspect water traps for cracks
traps instructions for use. and replace if damaged.
• Run SST to check for leaks when
reinstalling the circuit or when
installing a new circuit.
Breathing circuit components Disinfect per manufacturer’s • Inspect components for nicks
instructions for use. and cuts and replace if damaged.
• Run SST to check for leaks when
reinstalling the circuit or when
installing a new circuit.
Inlet air filter bowl Wash the bowl with mild soap • Avoid exposing the inlet air filter
solution, if needed. bowl to aromatic solvents, espe-
cially ketones.
• Replace if cracks or crazing are
visible.
Battery Wipe with a damp cloth using Do not immerse the battery or
one of the cleaning agents listed. get the contacts wet.
See Table 7-2. on page 7-4.
Cooling fan filter Clean every 250 hours or as nec- Wash in mild soap solution, rinse,
essary. and air dry.
2. Thoroughly rinse parts in clean, warm water (tap water is acceptable) and wipe dry.
3. Clean or disinfect ventilator surfaces and component parts per the procedures listed for each compo-
nent. See Table 7-2. and Table 7-3. on pages 7-4 and 7-5 for lists of acceptable cleaning and disinfect-
ing agents.
4. Visually inspect the components for cracks or other damage prior to use.
Note:
Steps 1 through 3 above do not apply to the EVQ. See Exhalation Flow Sensor Assembly (EVQ) Disinfection
(7.5.1) for disinfection instructions.
Whenever replacing or reinstalling a component, run SST before ventilating a patient.
Note:
Follow the institution’s infection control protocol for handling, storage, and disposal of potentially bio-
contaminated waste.
Caution:
To avoid damaging the hot film wire, do not insert fingers or objects into the center port when
disinfecting the EVQ.
The EVQ contains the exhalation flow sensor electronics, exhalation valve diaphragm, exhalation
filter seal, and pressure sensor filter. The exhalation flow sensor electronics consist of the hot film
wire and the thermistor.
Caution:
To avoid damage to the exhalation flow sensor element:
• Do not touch the hot film wire or thermistor in the center port.
• Do not vigorously agitate fluid through the center port while immersed.
• Do not forcefully blow compressed air or any fluid into the center cavity.
WARNING:
Damaging the flow sensor’s hot film wire or thermistor in the center port can cause the ventilator’s
spirometry system to malfunction.
Figure 7-1. EVQ
Figure 7-2. EVQ Components
Removal
2. With thumb inserted into the plastic exhalation port and four fingers under the EVQ, pull it down until
it snaps out. To avoid damaging the flow sensor element, do not insert fingers into the center
port.
Figure 7-3. EVQ Removal
WARNING:
Prior to cleaning and disinfection, remove and dispose of the disposable components of the
exhalation flow sensor assembly. See To reassemble the EVQ components, page 7-12 for re-
assembly instructions.
To remove disposable components of the EVQ
1. Remove and discard the exhalation valve diaphragm, the exhalation filter seal, and the pressure sensor
filter. Lift the exhalation filter seal out of the exhalation flow sensor to remove it.
2. Dispose of removed items according to the institution’s protocol. Follow local governing ordinances
regarding disposal of potentially biocontaminated waste.
Disinfection
WARNING:
Do not steam autoclave the EVQ or sterilize with ethylene oxide gas. Either process could cause the
ventilator’s spirometry system to malfunction when reinstalled in the ventilator.
WARNING:
Use only the disinfectants described. See Table 7-3. on page 7-5. Using disinfectants not
recommended by Covidien may damage the plastic enclosure or electronic sensor components,
resulting in malfunction of the ventilator’s spirometry system.
WARNING:
Follow disinfectant manufacturer’s recommendations for personal protection (such as gloves,
fume hood, etc.) to avoid potential injury.
1. Presoak the EVQ in the enzymatic solution. See Table 7-1. on page 7-2. The purpose for this presoak is
to break down any biofilm that may be present. Follow manufacturer’s instructions regarding duration
of soak process.
Caution:
Do not use any type of brush to scrub the EVQ, as damage to the flow sensing element could
occur.
3. Prepare the chemical disinfectant according to the manufacturer’s instructions or as noted in the insti-
tution’s protocol. See Table 7-3. on page 7-5 for the proper disinfecting agents.
4. Immerse the exhalation flow sensor in the disinfectant solution, oriented as shown in Figure 7-7. , and
rotate to remove trapped air bubbles in the its cavities. Keep immersed for the minimum time period
by the manufacturer or as noted in the institution’s protocol.
Figure 7-7. Immersion Method
5. At the end of the disinfecting immersion period, remove and drain all disinfectant. Ensure all cavities
are completely drained.
Rinsing
1. Rinse the EVQ using clean, deionized water in the same manner used for the disinfection step.
2. Drain and repeat rinsing three times with clean, deionized water.
WARNING:
Rinse according to manufacturer’s instructions. Avoid skin contact with disinfecting agents to
prevent possible injury.
3. After rinsing in deionized water, immerse in a clean isopropyl alcohol bath for approximately 15 sec-
onds. Slowly agitate and rotate to empty air pockets.
Drying
1. Dry in a low temperature warm air cabinet designed for this purpose. Covidien recommends a con-
vective drying oven for this process, with temperature not exceeding 60°C (140°F).
Caution:
Exercise care in placement and handling in a dryer to prevent damage to the assembly’s flow
sensor element.
Inspection
2. Inspect electrical contacts for contaminating film or material. Wipe clean with a soft cloth if necessary.
3. Inspect the hot film wire and thermistor in the center port for damage and for contamination.DO NOT
ATTEMPT TO CLEAN EITHER OF THESE. If contamination exists, rinse again with deionized water. If
rinsing is unsuccessful or hot film wire or thermistor is damaged, replace the EVQ.
2. Remove the exhalation filter seal from the kit and turn the assembly so its bottom is facing up.
3. Install the seal into the exhalation flow sensor as shown in Figure 7-10. Ensure that the seal fits com-
pletely within the recess and sits flat.
4. Remove the diaphragm from the kit and install it. See Figure 7-11.
1. Replace the EVQ any time if cracked or damaged in use. If a malfunction occurs during SST or EST, first
readjust or reseat the exhalation flow sensor. If SST or EST errors still occur, replace the exhalation flow
sensor.
2. Replace the assembly if damage to the hot film wire or thermistor in the center port is noted.
2. Install the exhalation filter by sliding it onto the tracks in the door, and orienting the filter’s from
patient port through the hole in the door.
3. Close the exhalation filter door and lower the exhalation filter latch.
7.5.4 Storage
1. Pretest the EVQ before storage by installing it into the ventilator and running SST to test the integrity
of the breathing system. See To run SST, page 3-43.
2. After performing SST, remove the assembly and place it into a protective bag or similar covered con-
tainer.
When ventilator location changes Atmospheric pressure transducer Perform atmospheric pressure
by 1000 feet of altitude transducer calibration.
Every 3 years, or when battery test Primary battery Replace primary batteries (venti-
fails, or when EST indicates lator and compressor). Actual
battery life has been exhausted battery life depends on the
history of use and ambient condi-
tions.
Every 10 000 operational hours Internal inspiratory filter Replace. Do not attempt to auto-
clave or reuse.
Every year from date of installa- Oxygen sensor • Replace the oxygen sensor as
tion, or sooner as needed. needed.
• Calibrate after replacement.
• Actual sensor life depends on
operating environment. Opera-
tion at higher temperature or
O2% levels will result in shorter
sensor life.
7.9 Documentation
Qualified service personnel should manually enter the service date, time, and nature of repair/pre-
ventive maintenance performed into the log using a keyboard on the GUI.
To manually document a service or preventive maintenance activity
1. Enter Service Mode.
4. Touch Add Entry, and using the buttons to the right of each line, complete the entry.
2. Recharge batteries prior to patient ventilation. If batteries are older than 3 years, use new batteries.
8.1 Overview
This chapter contains information regarding ventilator logs on the Puritan Bennett™ 980 Series
Ventilator.
WARNING:
To avoid a potential electrical shock, do not attempt to correct any electrical problem with the
ventilator while it is connected to AC power.
8-1
Troubleshooting
• Settings Log — The settings log records changes to ventilator settings for retrospective analysis of
ventilator-patient management. The time and date, old and new settings. and alarm resets are record-
ed. A maximum of 500 settings changes can be stored in the log. The settings log is cleared when the
ventilator is set up for a new patient. The settings log is accessible in normal ventilation mode and
Service mode.
• Patient Data Log — This log records every minute (up to 4320 patient data entries) consisting of date
and time of the entry, patient data name, and the patient data value during ventilator operation. It is
cleared when the ventilator is set up for a new patient. Three tabs are contained in the patient data log:
– Vital Patient data — The log contains the same information that the clinician has configured in
the patient data banner at the top of the GUI. If the patient data parameters in the banner are
changed, these changes are reflected the next time the patient data log is viewed.
– Additional Patient Data – 1 — This log corresponds to the patient data parameters set on page
one of the additional patient data banner. A total of 15 parameters are stored here, consisting of
date and time of the entry (recorded every minute), patient data name, and the patient data value
during ventilator operation.
– Additional Patient Data – 2 — This log corresponds to the patient data parameters set on page
two of the additional patient data banner. A total of 10 parameters are stored here, consisting of
date and time of the entry (recorded every minute), patient data name, and the patient data value
during ventilator operation.
• Diagnostic Log — The Diagnostic Log is accessible during normal ventilation and Service modes and
contains tabs for the System Diagnostic Log (default), the System Communication Log, and the EST/
SST Diagnostic Log. The diagnostic log contains tabs for the following:
– System Diagnostic Log — The System Diagnostic Log contains the date and time when an
event occurred, the type of event, the diagnostic codes associated with each fault or error that
occurred, the type of error that occurred, and any notes. The diagnostic log is not cleared when
the ventilator is set up for a new patient.
– System Communication Log — This log contains information generated by the ventilator’s
communication software. See the Puritan Bennett™ 980 Series Ventilator Service Manual, 10128204,
for a description of information contained in the System Communication Log.
– EST/SST Diagnostic Log — The EST/SST diagnostic log displays the time, date, test/event,
system code, type, and notes.
• EST/SST Status Log — The EST and SST status log displays the time, date, test, test status (passed or
failed).
• General Event Log — The general event log contains ventilator-related information not found in any
other logs. It includes date and time of compressor on and off, changes in alarm volume, when the
ventilator entered and exited Stand-By, GUI key presses, respiratory mechanics maneuvers, O2 calibra-
tion, patient connection, elevate O2, and warning notifications. The General event log can display up
to 256 entries and is not cleared upon new patient setup.
• Service Log — The service log is accessible during normal ventilation and Service modes and con-
tains the nature and type of the service, reference numbers specific to the service event (for example,
sensor and actuator ID numbers), manual and automatic serial number input, and the time and date
when the service event occurred. It is not cleared upon new patient setup.
Figure 8-1. Log Screen
Ventilator logs can be saved by entering Service mode, and downloading them via the Ethernet
port. See the Puritan Bennett™ 980 Series Ventilator Service Manual for instructions on downloading
ventilator logs.
9.1 Overview
This chapter includes accessories that can be used with the Puritan Bennett™ 980 Series Venti-
lator. See Table 9-1. on page 9-3 for part numbers of any items available through Covidien.
The following commonly available accessories from the listed manufacturers can be used with
the ventilator system:
• Filters—DAR/Covidien, Puritan Bennett
• Patient Circuits—commonly available breathing circuits with standard ISO 15 mm/22 mm connec-
tion for neonatal, pediatric, and adult patients. Manufacturers include Fisher & Paykel, DAR, and
Hudson RCI/Teleflex.
• Patient Monitoring Systems—See Connectivity to External Systems (5.9) on page 5-19 for informa-
tion on systems that can be used with the ventilator
WARNING:
The Puritan Bennett™ 980 Series Ventilator contains phthalates. When used as indicated, very
limited exposure to trace amounts of phthalates may occur. There is no clear clinical evidence
that this degree of exposure increases clinical risk. However, to minimize risk of phthalate
exposure in children and nursing or pregnant women, this product should only be used as
directed.
9-1
Accessories
Figure 9-2. Additional Accessories
See Figure 9-1. on page 9-2 and Figure 9-2. for the parts listed in the following table:
Note:
Occasionally, part numbers change. If in doubt about a part number, contact your local Covidien
representative.
Note:
The ventilator is designed with a semi-automated short self test (SST) procedure that, in addition to other
tests, measures compliance, resistance, and leak for the ventilator breathing circuit assembly (inspiratory
filter, breathing circuit, humidifier chamber ([as applicable}, exhalation filter, and exhalation flow sensor).
Reference SST (Short Self Test), page 3-41.
When SST is performed according to the instructions provided in SST (Short Self Test) (3.9.1), a
ventilator breathing circuit assembly that passes SST for a particular patient type (adult, pediatric,
or neonatal) will allow the ventilator to operate within specification for that same patient type.
Refer to Table 11-4. for acceptable compliance and resistance ranges.
Assy, patient circuit, adult dual heated wire, disposable, for F&P 304S14300
MR850 (Medtronic/DAR)
Adapter cable: 111/1149
Assy, patient circuit, single heated wire, adult, disposable, for F&P 304S14402Z
MR850 (Medtronic/DAR)
Adapter cable: 111/1146
Ventilator breathing circuit, adult, dual heated, no water traps, 870-35 KIT
disposable (Hudson RCI/Teleflex)1
Assy, patient circuit, with single water trap, heated insp. limb, 306S8987
pediatric, disposable, F&P MR850 (Medtronic/DAR)
Adapter cable: 111/1146
Assy, patient circuit, dual heated wire, pediatric, disposable, F&P 5505850
MR850 (Intersurgical)1
19
Ventilator breathing circuit, pediatric, dual heated, disposable 780-24
(Hudson RCI/ Teleflex)1
Assy, patient circuit, neonatal, single heated wire, disposable, not 307/8682
for incubator use, for F&P MR850 (Medtronic/DAR)
Adapter cable: 111/1146
Not shown Gold standard test circuit, 21 inch (for performing EST) 4-018506-00
Hardware options
Software options
10.1 Overview
This chapter provides specific details on breath delivery functions of the
Puritan Bennett™ 980 Series Ventilator. The chapter is organized as shown below.
10-1
Theory of Operations
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment, the
clinician should carefully select the ventilation mode and settings to use for that patient based on
clinical judgment, the condition and needs of the patient, and the benefits, limitations, and
characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best for
the patient's current needs.
The gas supplies to which the ventilator are connected must be capable of delivering 200 L/min
flow with the supply pressure between 241.8 kPa to 599.8 kPa (35 psig and 87 psig). These sup-
plies may be compressed air from an external source (wall or bottled) air or oxygen. (An optional
compressor is available to be used as an external air source.)
Air and oxygen hoses connect directly to fittings at the rear of the breath delivery unit (BDU). The
flow of each gas is metered by a proportional solenoid (PSOL) valve to achieve the desired mix in
the mix module. The flow through each PSOL is monitored by separate flow sensors to ensure the
accuracy of the mix. The mixed gases then flow to the inspiratory module.
The blended gas in the inspiratory module is metered by the breath delivery PSOL and monitored
by the breath delivery flow sensor to ensure that the gas is delivered to the patient according to
the settings specified by the operator. Delivered tidal volumes are corrected to standard respira-
tory conditions (BTPS) to ensure consistent interpretation by the clinician. The inspiratory module
also incorporates the safety valve, which opens to vent excess pressure and allows the patient to
breathe room air (if able to do so) in the event of a serous malfunction.
An optional compressor, capable of delivering flows of 140 L/min (BTPS) and minute volumes of
up to 40 L/min (BTPS), can be connected to the ventilator. Gas mixing occurs in the accumulator,
protected by a relief valve. A one-way valve allows a maximum reverse flow into the gas supply
system up to 100 mL/min under normal conditions.
Air and O2 gases travel through PSOLs, flow sensors, and one-way valves, and are mixed in the mix
module (according to the operator-set O2 concentration), which also has a pressure-relief valve.
From here, the gas flows through another PSOL, to the inspiratory pneumatic system, where it
passes by a safety valve, then through a one-way valve, an internal bacteria filter, an external bac-
teria filter, through the humidifier, if used, and then to the patient via the connected breathing
circuit.
During exhalation, the gas flows through the expiratory limb of the breathing circuit, through a
condensate vial, a bacteria filter, through the exhalation flow sensor, through the exhalation valve,
and out the exhaust port. The exhalation valve actively controls PEEP while minimizing pressure
overshoots and relieving excess pressures.
Pressure transducers in the inspiratory pneumatic system (PI) and exhalation compartment (PE)
monitor pressures for accurately controlling breath delivery.
Disturbances
Feedback Signal
Note:
In the diagram above, the “plant” is the patient and the connected breathing circuit.
• Time-triggering
• Operator-initiated
If the ventilator detects a drop in pressure at the circuit wye or when there is a decrease in base
flow measured at the exhalation valve, the patient is said to trigger the breath. Mandatory breaths
triggered by the patient are referred to as PIM or patient-initiated mandatory breaths.
All spontaneous breaths are patient-initiated, and are also triggered by a decrease in circuit pres-
sure or measured base flow indicating the patient is initiating an inspiration.
Another term, autotriggering, is used to describe a condition where the ventilator triggers a
breath in the absence of the patient’s breathing effort. Autotriggering can be caused by inappro-
priate ventilator sensitivity settings, water in the patient circuit, or gas leaks in the patient circuit.
If pressure triggering (P-Trig) is selected, the ventilator transitions into inspiration when the pres-
sure at the patient circuit wye drops below positive end expiratory pressure (PEEP) minus the
operator-set sensitivity level (PSENS). See Figure 10-1. As the patient begins the inspiratory effort
and breathes gas from the circuit (event 5, the A-B interval), pressure decreases below PEEP. When
the pressure drops below PEEP minus PSENS (event 6), the ventilator delivers a PIM breath. The
pressure-decline time interval between events A and B determines how aggressive the patient’s
inspiratory effort is. A short time interval signifies an aggressive breathing effort. The A-B interval
is also affected byPSENS. A smaller PSENS setting means a shorter A-B time interval. (The minimum
PSENS setting is limited by autotriggering, and the triggering criteria include filtering algorithms
that minimize the probability of autotriggering.)
If flow triggering (V-Trig) is selected the BDU provides a constant gas flow through the ventilator
breathing circuit (called base flow) during exhalation. The base flow is 1.5 L/min greater than the
value selected for flow sensitivity (VSENS). See Figure 10-2. on page 10-6 where the top graphic
represents expiratory flow and the bottom graphic represents inspiratory flow.]
The ventilator’s breath delivery flow sensor measures the base flow delivered to the circuit and
the exhalation flow sensor measures the flow entering the exhalation valve. The ventilator moni-
tors patient flow by measuring the difference between the inspiratory and exhaled flow measure-
ments. If the patient is not inspiring, any difference in measured flows is due to leaks in the
breathing system or flow sensor inaccuracy. The clinician can compensate for leaks in the breath-
ing system by increasing VSENS to a value equal to desired VSENS + leak flow.
As the patient begins the inspiratory effort and inspires from the base flow, less exhaled flow is
measured, while the delivered flow remains constant. See Figure 10-2. (event A). As the patient
continues to inspire, the difference between the delivery and exhalation flow sensor measure-
ments increases. The ventilator initiates an inspiration when the difference between the two flow
measurements is greater than or equal to the operator-set flow sensitivity value. See Figure 10-2. ,
(event B).
As with pressure triggering, the time delay between onset of the patient’s effort and actual gas
delivery depends on:
• How quickly the exhaled flow declines (that is, the aggressiveness of the inspiratory effort). The more
aggressive the inspiratory effort, the shorter the interval.
• The flow sensitivity value. The smaller the value, the shorter the delay.
During flow triggering, a backup pressure sensitivity of 2 cmH2O is present to detect a breath
trigger in the event that the flow trigger fails.
The ventilator measures the time interval for each breath and breath phase. If the ventilator is in
Assist/Control (A/C) mode (where the ventilator delivers breaths based on the breath rate setting),
a VIM or ventilator initiated mandatory breath is delivered after the appropriate time interval. The
duration of the breath in seconds (Tb) is 60/f.
If the operator presses the manual inspiration key, an OIM (operator-initiated mandatory) breath
is delivered. The ventilator will not deliver an OIM under the following conditions:
• During an active inspiration, whether mandatory or spontaneous
See Manual Inspiration (10.7.5) later in this chapter for information on the restricted phase of exha-
lation.
If expiratory sensitivity (ESENS) is set to a value too low for the patient-ventilator combination, a
forceful expiratory effort could cause circuit pressure (PPEAK) to rise to its limit. The ventilator mon-
itors circuit pressure throughout the inspiratory phase, and initiates an exhalation when the pres-
sure equals the inspiratory pressure (PI) target value + an incremental value. This transition to
exhalation occurs during spontaneous pressure-based ventilation and in volume support (VS).
Note:
The allowable incremental value above the target pressure is 1.5 cmH2O once a portion of inspiration time
(Tn) has elapsed. Before Tn, the incremental value is higher to allow for transient pressure overshoots. For
the first 200 ms of inspiration, the incremental pressure is 10% of the target pressure, up or 8 cmH2O,
whichever is greater. From 200 ms to Tn, the incremental pressure decreases in a linear fashion from the
initial value to 1.5 cmH2O.
3 Start breath
For spontaneous breath types including PS (pressure supported), TC (tube compensated), and VS
(volume supported, the ventilator captures the value of the delivered peak inspiratory flow, then
monitors the inspiratory flow decline until the value of current flow to peak flow (expressed as a
percentage) is less than or equal to the set ESENS value. The ventilator then cycles from inspiration
into exhalation.
See Figure 10-5. for an example of exhalation using this method.
3 Trigger 7 VMAX×ESENS/100
Note:
PAV+ uses a flow-based cycling method, also called ESENS, but it is expressed in L/min rather than in % of
VMAX
In pressure ventilation, the set inspiratory time (TI) defines the duration of the inspiratory phase.
In volume ventilation, TI depends on the tidal volume (VT) setting, peak flow (VMAX), flow pattern,
and plateau time (TPL). The ventilator cycles into exhalation when the set TI (pressure ventilation)
or computed TI (volume ventilation) lapses.
There are four backup methods for preventing excessive duration or pressure during inspiration:
• Time limit — For adult and pediatric patients, the time limit method ends inspiration and begins
exhalation when the duration of a spontaneous inspiration is greater than or equal to
[1.99 s +0.02× PBW (kg)] s.
• High circuit pressure limit — During any type of inspiration, inspiration ends and exhalation begins
when the monitored airway pressure (PCIRC) is greater than or equal to the set high circuit pressure
limit.
• High ventilator pressure limit — The ventilator transitions from inspiration to exhalation if the high
ventilator pressure (2PVENT) limit of 110 cmH2O is reached.
• High inspired tidal volume limit — The high inspired tidal volume limit terminates inspiration and
commences exhalation during VC+, VS, tube compensated (TC), or proportionally assisted (PAV+)
breaths if the delivered volume is greater than or equal to 2VTI.
Note:
The ventilator does not generate subatmospheric airway pressures during exhalation.
Compliance compensation accounts for the gas volume not actually delivered to the patient
during inspiration. This gas is known as the compliance volume, VC. VC is the gas lost to pressur-
izing the breathing circuit and includes the volumes of the patient circuit, any accessories such as
a humidifier and water traps, and internal ventilator gas passages.
3 Set VMAX 6 TI
2 Actual VMAX 6 TI
In the ventilator, an iterative algorithm automatically computes the compliance volume. There is
a maximum tubing to- patient compliance ratio to reduce the potential for over-inflation due to
an erroneous patient compliance estimation. The maximum ratio is determined by the selected
patient circuit type and predicted body weight (PBW):
C pt ckt
Factor = ---------------
C pt
V C = C pt ckt ( P wye – P )
Compliance of the patient circuit P Pressure at the end of the current exhalation
C pt ckt
where:
Factor = linear interpolation of the values in Table 10-1. for adult, pediatric, and neonatal circuit
types. Factor is calculated as:
Adult patient circuit type Pediatric patient circuit type Neonatal patient circuit type
Note:
Compliance compensation calculations are also in effect during exhalation to ensure spirometry accuracy.
If the patient’s compliance decreases beyond the limits of compliance compensation, the venti-
lator relies on the 2PPEAK alarm setting to truncate the breath and switch to exhalation.
Volumes and flows are BTPS-compensated, that is, they are reported by the ventilator at existing
barometric pressure, 37°C (98.6°F), and fully saturated with water vapor.
T b = 60 ⁄ f
If, during Tb, patient effort is detected, a PIM breath is initiated and a new breath period starts. If
no patient effort is detected before Tb lapses, the next breath delivered is a VIM, and a new breath
period starts.
See Table 11-9. on page 11-7 for details on the following VC+ settings:
• Expiratory time (TE)
• I:E ratio
• Rise time%
Volume Control is the control scheme that controls the flow with for the purpose of supplying a
predetermined volume (set by the practitioner) to the patient. There are two basic flow wave
forms to administer this volume: the square waveform that guarantees a constant flow during
the inspiration time, or the descending ramp waveform whose slope and initial value are deter-
mined to provide the required volume target. See Figure 10-8. and Figure 10-9. The inspiration
time is determined indirectly by the characteristics of the selected flow wave.
Pressure Control is the control scheme by which the pressure is controlled at the circuit wye to
reach a constant level (set by the practitioner) during inspiration, and a PEEP level during exhala-
tion. See Figure 10-10. on page 10-16. This level is maintained for a time given by the set inspira-
tion time, following followed by an exhalation regulated by the exhalation valve until the PEEP
level is reached. As flow is not predetermined, the supplied volume varies depending on the
patient's pulmonary response.
4 Target pressure
10.7.3 VC+
VC+ Startup
Up to three test breaths are delivered prior to ventilating the patient with VC+ breaths. The deliv-
ered VC+ test breaths are volume control (VC) breaths (if Leak Sync is disabled) using the VC+ set-
tings for VT and inspiratory time and a ramp flow pattern. Delivered peak flows are calculated
based on SST tubing compliance, assuming an end-inspiratory pressure of 15 cmH2O above PEEP.
After each test breath, the measured delivered volume and the end-inspiratory pressure and end-
expiratory pressure are used to estimate the patient’s lung compliance to determine the VC+
pressure target to achieve the set VT.
In VC+, if pressure and volume measurements from the test breaths are not valid, then a PC breath
is delivered with PI of 15 cmH2O for pediatric and adult patients or 10 cmH2O for neonatal patients
using the TI and rise time% settings in VC+.
Note:
To allow for optimal function of startup and operation of VC+ in the ventilator it is important not to block
the tubing while the patient is undergoing suctioning or other treatment that requires disconnection from
the ventilator. The ventilator has a disconnect detection algorithm that suspends ventilation while the
patient is disconnected.
After VC+ startup, the ventilator will make adjustments to the target pressure to deliver the set
volume (VT). To reach the desired volume promptly, the maximum allowed pressure adjustments
for an adult or pediatric patient will be greatest during the first five breaths following startup or a
change in VT or VT SUPP. The values of the maximum pressure adjustments for each patient type
are summarized in Table 10-2.
Less than five breaths ±10.0 cmH2O ±6.0 cmH2O ±3.0 cmH2O
after:
VC+ startup or change
in VT
See Table 6-5. on page 6-16 for details on the following VC+ alarms:
• VOLUME NOT DELIVERED
• COMPLIANCE LIMITED VT
During VC+, inspiratory target pressure cannot be lower than PEEP+3 cmH2O and cannot exceed
2PPEAK −3 cmH2O.
If PC or VC+ is selected as the mandatory type, adjust rise time% for optimum flow delivery into
the lungs. Patients with high impedance (low compliance, high resistance) may benefit from a
lower rise time% whereas patients with low impedance may better tolerate a more aggressive rise
time setting. The rise time% setting specifies the speed at which the inspiratory pressure reaches
95% of the target pressure. The rise time setting applies to PS (including a setting of 0 cmH2O), PC,
VC+, or BiLevel breaths.
To match the flow demand of an actively breathing patient, observe simultaneous pressure-time
and flow-time curves, and adjust the rise time% to maintain a smooth rise of pressure to the target
value. A rise time% setting reaching the target value well before the end of inspiration can cause
the ventilator to supply excess flow to the patient. Whether this oversupply is clinically beneficial
must be evaluated for each patient. Generally, the optimum rise time% for gently breathing
patients is less than or equal to the default (50%), while optimum rise time% for more aggressively
breathing patients can be 50% or higher.
WARNING:
Under certain clinical circumstances (such as stiff lungs, or a small patient with a weak inspiratory
drive), a rise time% setting above 50% could cause a transient pressure overshoot and premature
transition to exhalation, or pressure oscillations during inspiration. Carefully evaluate the
patient’s condition before setting the rise time% above the default setting of 50%.
When pressed, the manual inspiration key delivers one OIM breath to the patient, using set breath
delivery parameters. The ventilator will not allow a manual inspiration during the restricted phase
of exhalation or when the ventilator is in the process of delivering a breath (whether mandatory
or spontaneous). All manual inspiration attempts are logged in the General Event log.
The restricted phase of exhalation is the time period during the expiratory phase where an inspi-
ration trigger is not allowed. The restricted phase of exhalation is defined as the first 200 ms of
exhalation or the time it takes for expiratory flow to drop to ≤50% of the peak expiratory flow, or
the time it takes for the expiratory flow to drop to ≤0.5 L/min (whichever is longest). The restricted
phase of exhalation will end after 5 seconds of exhalation have elapsed regardless of the mea-
sured expiratory flow rate.
Note:
In any delivered spontaneous breath, either invasive or NIV, there is always a target inspiratory pressure of
at least 1.5 cmH2O applied.
During spontaneous breathing, the patient's respiratory control center rhythmically activates the
inspiratory muscles. The support type setting allows selection of pressure-assist to supplement
the patient's pressure-generating capability.
Characteristic Implementation
Pressure or flow during inspiration Pressure rises according to the selected rise time%
Spontaneous type =PS and PSUPP<5 cmH2O and PBW setting, with target pressure equal to the
effective pressure +PEEP:
PSUPP Effective pressure (cmH2O)
0 1.5
1 2.2
2 2.9
3 3.6
4 4.3
Pressure or flow during inspiration Pressure rises according to the selected rise time%
Spontaneous type =PS and PSUPP≥5 cmH2O and PBW setting, and target pressure equals
PSUPP+PEEP.
Pressure or flow during inspiration Pressure rises according to the selected rise time%
Spontaneous type =VS and PBW setting, and target pressure equals the
pressure determined during the test breath or pres-
sure target determined from assessment of deliv-
ered volume from the previous breath. For more
information on VS, see Volume Support (VS) (10.8.2)
on page 10-20.
Exhalation valve during inspiration Adjusts to minimize pressure overshoot and main-
tain the target pressure.
Characteristic Implementation
Inspiratory valves during exhalation For pressure triggering: set to deliver a bias flow of
1 L/min.
For flow triggering: set to deliver base flow near the
end of expiratory flow.
Exhalation valve during exhalation Adjusts to maintain the operator-selected value for
PEEP.
Pressure Support is a type of spontaneous breath, similar to PC, by which the pressure is con-
trolled to reach a constant value, preset by the practitioner, once an inspiratory effort is detected.
This target value is held until the detection of end of inspiration. Subsequently, the exhalation
valve control initiates the exhalation, driving the pressure to the PEEP level.
• Rise time%
Technical Description
the target volume. Conversely, VS increases inspiratory pressure if the patient's respiratory drive
becomes compromised.
In the absence of leaks or changes in patient resistance or compliance, Volume Support achieves
and maintains a steady, breath-to-breath tidal volume within five breaths of VS initiation or start-
up.
During VS, the inspiratory pressure target cannot be lower than PEEP+1.5 cmH2O, and cannot
exceed 2PPEAK −3 cmH2O.
VS Startup
Test breaths are delivered prior to ventilating the patient with VS breaths. The delivered VS test
breaths are pressure support breaths using a PSUPP value of 15 cmH2O for pediatric and adult
patients or 10 cmH2O for neonatal patients. The test breaths use the ESENS and rise time% settings
in VS. After each test breath, the measured delivered volume and the end-inspiratory pressure and
end-expiratory pressure are used to estimate the patient’s lung compliance to determine the VS
pressure target to achieve the set VT.
In VS, if pressure and volume measurements from test breaths are not valid, VS startup continues
delivering test breaths until the pressure and volume measurements are valid.
Note:
To allow for optimal function of startup and operation of VS in the ventilator it is important not to block
the tubing while the patient is undergoing suctioning or other treatment that requires disconnection from
the ventilator. The ventilator has a disconnect detection algorithm that suspends ventilation while the
patient is disconnected.
After VS startup, the ventilator makes adjustments to the target pressure in order to deliver the set
volume (VT SUPP). To reach the desired volume promptly, the maximum allowed pressure adjust-
ments for an adult or pediatric patient will be greatest during the first five breaths following
startup or a change in VT SUPP. The values of the maximum pressure adjustments for each patient
type are summarized in Table 10-4.
Less than five breaths ±10.0 cmH2O ±6.0 cmH2O ±3.0 cmH2O
after:
VS startup or change in
VT SUPP
• COMPLIANCE LIMITED VT
For details on the spontaneous inspired tidal volume patient data parameter available during VS
breaths, see Table 11-9. on page 11-7.
Technical Description
TC is a spontaneous mode enhancement that assists patients’ spontaneous breaths not already
supported by specific pressure-based breath types (such as PS, VS, and PAV+) by delivering posi-
tive pressure proportional to the flow-based, resistive pressure developed across the artificial
airway. TC causes the sensation of breathing through an artificial airway to diminish because the
TC algorithm instructs the ventilator to develop just the correct amount of forward pressure to
offset (cancel) the back pressure developed across the artificial airway during the inspiratory
phase. The degree of cancellation can be set by the clinician and is adjustable between 10% an
100% in increments of 5%.
TC can support all unsupported spontaneous breaths for patients with predicted body weights
≥7.0 kg (15.4 lb), and for endotracheal/tracheostomy tubes with an inside diameter (ID) of ≥4.5
mm. TC can be used within SPONT, BiLevel or SIMV, all of which permit unsupported spontaneous
breaths. With BiLevel selected, TC supports spontaneous breaths at both pressure levels.
TC checks the flow rate every 5 ms, using an internal lookup table that contains the flow-to-pres-
sure relationship of the selected artificial airway, and is used to calculate the amount of pressure
needed to overcome all or part of the resistance of the artificial airway. Based on the TC setting
and the instantaneous flow measurement, the ventilator’s PSOL valves are continually adjusted,
adjusting the circuit pressure to match the changing tube-pressure compensation requirements.
For details of the 1PCOMP, 1PVENT, and 1VTI alarms associated with TC, see Table 6-5. on page 6-16.
For details of the inspired tidal volume (VTI) monitored patient data parameter a associated with
TC, see Table 11-11. on page 11-17.
The ventilator uses soft bound and hard bound values for estimated tube inside diameter (ID)
based on PBW. Soft bounds are ventilator settings that have reached their recommended high or
low limits. When adjusting the tube size, if the inside diameter does not align with a valid predict-
ed body weight, a Continue button appears. Setting the ventilator beyond these soft bounds
requires the operator to acknowledge the prompt by touching the Continue button before con-
tinuing to adjust the tube size.The limit beyond which the tube ID cannot be adjusted is called a
hard bound, and the ventilator emits an invalid entry tone when a hard bound is reached.
WARNING:
Greater than expected ventilatory support, leading to unknown harm, can result if the specified
tube type or tube ID is smaller than the actual tube type or tube ID.
Ventilator Settings/Guidelines
The estimation of settings to use with TC is aided by an understanding of: the ventilator settings,
the data used for determination of the compensation values, and the specified performance or
accuracy of the TC function.
The setting for 2PPEAK must take the estimated tube compensation into consideration. The target
pressure (compensation) at the patient wye is derived from the knowledge of the approximate
airway resistance of the ET or tracheostomy tube being used. The compensation pressure in
cmH2O for available tube sizes and gas flows is shown. See Figure 10-11. on page 10-24 and
Figure 10-12. on page 10-25. The estimated compensation must be added to the value of PEEP for
calculation and setting of 2PPEAK.
Specified Performance
k × ( P E END – P TR ) × V· dt
W = -----------------------------------------------------------------
V· dt
PAV+ is another available type of spontaneous breath. For detailed description of the operating
theory, see Appendix C.
Tb = 60 ⁄ f
where:
Tb= breath period (seconds)
f = set respiratory rate (breaths per minute)
The inspiratory phase length is determined by the current breath delivery settings. At the end of
the inspiratory phase, the ventilator enters the expiratory phase as determined by the following
equation:
T E = Tb – T I
where:
TE= length of the expiratory phase (seconds)
TI= length of inspiratory phase including plateau time, TPL(seconds)
Figure 10-13. illustrates A/C breath delivery when there is no patient inspiratory effort detected (all
inspirations are VIMs).
1 VIM 2 Tb
Figure 10-14. shows A/C breath delivery when patient inspiratory effort is detected. The ventilator
allows PIM breaths to be delivered at a rate greater than or equal to the set respiratory rate.
1 PIM 2 Tb set
Figure 10-15. illustrates A/C breath delivery when there are both PIM and VIM breaths. delivered.
1 VIM 3 Tb set
2 PIM
If changes to the respiratory rate are made, they are phased in during exhalation only. The new
breath period depends on the new respiratory rate, is based on the start of the current breath, and
follows these rules:
• The current breath’s inspiratory time is not changed.
• A new inspiration is not delivered until at least 200 ms of exhalation have elapsed.
• The maximum time t until the first VIM for the new respiratory rate is delivered is 3.5 times the current
inspiratory time or the length of the new breath period (whichever is longer), but t is no longer than
the old breath period.
• If the patient generates a PIM after the ventilator recognizes the rate change and before time t, the
new rate begins with the PIM.
Switching to A/C mode from any other mode causes the ventilator to phase in a VIM and set the
start time for the beginning of the next A/C breath period. Following this VIM, and before the next
A/C period begins, the ventilator responds to the patient’s inspiratory efforts by delivering man-
datory breaths.
The first A/C breath (VIM breath) is phased in while following these rules:
• The breath is not delivered during an inspiration.
• The ventilator ensures the apnea interval elapses at least 5 seconds after the beginning of exhalation.
• Any other specially scheduled event (for example, a respiratory mechanics maneuver or any pause
maneuver) is canceled and rescheduled at the next interval.
When the first VIM of the new A/C mode is delivered depends on the mode and breath type active
when the mode change is requested.
1 Tb= SIMV breath period (includes Tm and Ts 3 Ts= Spontaneous interval (VIM delivered if no PIM
delivered during Tm
2 Tm= Mandatory interval (reserved for a PIM
breath)
The first part of the period is the mandatory interval (Tm) which is reserved for a PIM. If a PIM is
delivered, the Tm interval ends and the ventilator switches to the second part of the period, the
spontaneous interval (Ts), which is reserved for spontaneous breathing for the remainder of the
breath period. At the end of an SIMV breath period, the cycle repeats. If a PIM is not delivered
during the mandatory interval, the ventilator delivers a VIM at the end of the mandatory interval,
then switches to the spontaneous interval. Figure 10-17. shows an SIMV breath period where a
PIM is delivered within the mandatory interval. Any subsequent trigger efforts during Ts yield
spontaneous breaths. As shown, Tm transitions to Ts when a PIM is delivered.
Figure 10-18. shows an SIMV breath period where a PIM is not delivered within the mandatory
interval.
1 VIM 3 Ts
In SIMV, mandatory breaths are identical to those in A/C mode if the ventilator’s respiratory rate
setting is greater than the patient’s natural respiratory rate. Spontaneous breaths are identical to
those in SPONT mode if the ventilator setting for respiratory rate is significantly below the
patient’s natural respiratory rate. Patient triggering must meet the requirements for pressure and
flow sensitivity.
The procedure for setting the respiratory rate in SIMV is the same as in A/C mode. Once the respi-
ratory rate (f) is set, the SIMV interval period Tb in seconds is:
Tb = 60 ⁄ f
During the mandatory interval, if the patient triggers a breath according to the current setting for
pressure or flow sensitivity, the ventilator delivers a PIM. Once a mandatory breath is triggered, Tm
ends, Ts begins, and any further trigger efforts yield spontaneous breaths. During the sponta-
neous interval, the patient can take as many spontaneous breaths as allowed. If no PIM or OIM is
delivered by the end of the mandatory interval, the ventilator delivers a VIM and transitions to the
spontaneous interval at the beginning of the VIM.
The SIMV breathing algorithm delivers one mandatory breath each period interval, regardless of
the patient’s ability to breathe spontaneously. Once a PIM or VIM is delivered, all successful patient
efforts yield spontaneous breaths until the cycle interval ends. The ventilator delivers one manda-
tory breath during the mandatory interval, regardless of the number of successful patient efforts
detected during the spontaneous interval. (An OIM delivered during the mandatory interval sat-
isfies the mandatory breath requirement, and causes Tm to transition to Ts.)
The maximum mandatory interval for any valid respiratory rate setting in SIMV is defined as the
lesser of:
• 0.6× the SIMV interval period (Tb)
• 10 s
Switching the ventilator to SIMV from any other mode, causes the ventilator to phase in a VIM and
set the start time for the next SIMV period. Following this VIM, but before the next SIMV period
begins, the ventilator responds to successful patient inspiratory efforts by delivering spontaneous
breaths. The first SIMV VIM breath is phased in according to the following rules:
• The VIM breath is not delivered during an inspiration or during the restricted phase of exhalation.
• If the current mode is A/C, the first SIMV VIM is delivered after the restricted phase of exhalation plus
the shortest of the following intervals, referenced to the beginning of the last or current inspiration:
3.5×TI, current TA, or the length of the current breath period.
• If the current mode is SPONT, and the current or last breath type was spontaneous or OIM, the first
SIMV VIM is delivered after the restricted phase of exhalation plus the shortest of the following inter-
vals, referenced to the beginning of the last or current inspiration: 3.5×TI, or current TA.
• If the current mode is BiLevel in the PH state and the current breath is mandatory, the PEEP level will
be reduced to PL once the expiratory phase is detected.
The time t until the first VIM of the new A/C mode is the lesser of:
– PEEP transition time +2.5× the duration of the active gas delivery phase
• If the current mode is BiLevel in the PH state and the current breath is spontaneous:
– The PEEP level will be reduced once the expiratory phase is detected.
The time t until the first VIM of the new A/C mode is the lesser of:
– PEEP transition time +2.5× the duration of the spontaneous inspiration
– The start time of the spontaneous breath + the length of the apnea interval (TA)
• If the current mode is BiLevel in the PL state and the current breath is mandatory, the time t until the
first VIM of the new A/C mode is the lesser of:
– PEEP transition time +2.5× the duration of the active gas delivery phase
• If the current mode is BiLevel in the PL state and the current breath is spontaneous and the sponta-
neous start time has occurred during PL, the time t until the first VIM of the new A/C mode is the lesser
of:
• If the current mode is BiLevel in the PL state and the current breath is spontaneous and the sponta-
neous start time has occurred during PH, the time t until the first VIM of the new A/C mode is the lesser
of:
– The start time of the spontaneous breath + the length of the apnea interval (TA)
If the command to change to SIMV occurs after the restricted phase of exhalation has ended, and
before a next breath or the apnea interval has elapsed, the ventilator delivers the first SIMV VIM at
the moment the command is recognized.
The point at which the new rate is phased in depends on the current phase of the SIMV interval
and when the rate change command is accepted. If the rate change occurs during the mandatory
interval, the maximum mandatory interval is that for the new or old rate, whichever is less. If the
patient generates a successful inspiratory effort during the spontaneous interval, the ventilator
responds by delivering a spontaneous breath.
Respiratory rate changes are phased in during exhalation only. The new SIMV interval is deter-
mined by the new respiratory rate and is referenced to the start of the current SIMV period inter-
val, following these rules:
• Inspiratory time (TI) of current breath is neither truncated nor extended.
• The new inspiration is not delivered until 200 ms of exhalation have elapsed.
• VS
• TC
• PAV+
The inspiratory phase begins when the ventilator detects patient effort during the ventilator’s
expiratory phase. Breath delivery during the inspiratory phase is determined by the settings for
pressure support, PEEP, rise time%, and expiratory sensitivity, unless the breath is an OIM breath.
If TC or PAV+ is selected as the spontaneous type, breath delivery during the inspiratory phase is
determined by the settings for% support (% Supp), expiratory sensitivity, tube ID, and tube type.
Note:
Given the current ventilator settings, if PAV+ would be an allowable spontaneous type (except that tube
ID <6 mm) then PAV+ becomes selectable. If selected, tube ID is set to its New Patient default value based
on the PBW entered. An attention icon for tube ID appears.
If volume support (VS) is selected as the spontaneous type, breath delivery during the inspiratory
phase is determined by rise time%, volume support level (VT SUPP), expiratory sensitivity, and PEEP.
Inspiratory pause maneuvers are only possible during OIM breaths, and expiratory pause maneu-
vers are not allowed during SPONT.
• 1PPEAK
If the operator changes to SPONT mode during an A/C or SIMV inspiration (mandatory or sponta-
neous), the inspiration is completed, unaffected by the mode change. Because SPONT mode has
no special breath timing requirements, the ventilator then enters the expiratory phase and waits
for the detection of patient inspiratory effort, a manual inspiration, or apnea detection.
The ventilator declares apnea when no breath has been delivered by the time the operator-
selected apnea interval elapses, plus a small increment of time (350 ms). This increment allows
time for a patient who has begun to initiate a breath to trigger inspiration and prevent the venti-
lator from declaring apnea when the apnea interval is equal to the breath period.
The apnea timer resets whenever an inspiration begins, regardless of whether the inspiration is
patient-triggered, ventilator-triggered, or operator-initiated. The ventilator then sets a new apnea
interval beginning from the start of the current inspiration. To hold off apnea ventilation, another
inspiration must be delivered before (the current apnea interval +350 ms) elapses. Apnea detec-
tion is suspended during a disconnect, occlusion, or safety valve open (SVO) state.
Apnea is not declared when the apnea interval setting equals or exceeds the breath period. For
example, if the respiratory rate setting is 4/min, an apnea interval of 15 seconds or more means
apnea cannot be detected. The ventilator bases apnea detection on inspiratory (not expiratory)
flow, and allows detection of a disconnect or occlusion during apnea ventilation. Apnea detection
is designed to accommodate interruptions to the typical breathing pattern due to other ventila-
tor features that temporarily extend the inspiratory or expiratory intervals (rate changes, for exam-
ple) but still detect a true apnea event.
Figure 10-19. shows an apnea breath where TA equals the breath period.
1 Tb0 3 PIM
1 Tb0 4 VIM
3 PIM
5 Apnea VIM
When apnea is declared, the ventilator delivers apnea ventilation according to the current apnea
ventilation settings and displays the apnea settings on the graphical user interface (GUI). Regard-
less of the apnea interval setting, apnea ventilation cannot begin until inspiration of the current
breath is complete and the restricted phase of exhalation has elapsed.
All apnea and non-apnea settings remain active on the GUI during apnea ventilation. Both non-
apnea and apnea settings changes are phased in according to the applicable rules. If apnea ven-
tilation is active, new settings are accepted but not implemented until non-apnea ventilation
begins. Allowing key entries after apnea detection allows adjustment of the apnea interval at
setup, regardless of whether apnea has been detected. During apnea ventilation, the manual
inspiration key is active, but expiratory pause and inspiratory pause keys are not active. The
increase O2 control is active during apnea ventilation, because apnea detection is likely during
suctioning.
The apnea respiratory rate must be ≥60/TA. Additionally, apnea settings cannot result in an I:E
ratio >1.00:1.
Apnea ventilation is intended as an auxiliary mode of ventilation when there is insufficient breath
delivery to the patient over a specified period of time. Apnea ventilation can be reset to normal
ventilation by the operator (by pressing the alarm reset key) or the patient (autoreset). It is also
reset when a rate change is made that renders apnea ventilation inapplicable.
If the patient regains inspiratory control, the ventilator returns to the operator-selected mode of
non-apnea ventilation. The ventilator determines whether the patient has regained respiratory
control by monitoring triggered inspirations and exhaled volume. If the patient triggers two con-
secutive inspirations, and the exhaled volume is equal to or greater than 50% of the delivered
volume (including any compliance volume), the ventilator resets to non-apnea ventilation.
Exhaled volume is monitored to avoid resetting due to autotriggering caused by large leaks in the
patient circuit.
The following strategy is designed to allow SIMV to avoid triggering apnea ventilation if a VIM
breath can be delivered instead:
• If the apnea interval (TA) elapses at any time during the mandatory interval, the ventilator delivers a VIM
rather than beginning apnea ventilation.
Figure 10-22. shows an illustration of how SIMV is designed to deliver a VIM rather than trigger
apnea ventilation, when possible.
1 Tb 5 TA
2 Last breath (PIM) 6 Tm (If TA elapses during Tm, the ventilator delivers a VIM
rather than beginning apnea ventilation
3 VIM 7 Ts
4 Tm max
How a new apnea interval is phased in depends on whether or not apnea ventilation is active. If
apnea ventilation is active, the ventilator accepts and implements the new setting immediately.
During normal ventilation (that is, apnea ventilation is not active), these rules apply
• If the new apnea interval setting is shorter than the current (or temporarily extended) apnea interval,
the new value is implemented at the next inspiration.
• If the new apnea interval setting is longer than the current (or temporarily extended) apnea interval,
the old interval is extended to match the new interval immediately.
10.13.1 Occlusion
The ventilator detects severe patient circuit occlusions to protect the patient from excessive
airway pressures, or from receiving little or no gas. Occlusions require immediate attention to
remedy.
The ventilator detects a severe occlusion if:
• The inspiratory or expiratory limb of the breathing circuit is partially or completely occluded (conden-
sate or secretions collected in a gravity-dependent loop, kinked or crimped tubing, etc.).
• The ventilator exhaust port is blocked or resistance through the port is too high.
• The exhalation valve fails in the closed position (occlusion detection at the from patient port begins
after 195 ms of exhalation has passed).
• The exhalation valve fails in the closed position and the pressure in the exhalation limb is less than 2
cmH2O.
• Silicone tubing is attached to the exhaust port of the ventilator (i.e., for metabolic monitoring purpos-
es).
The ventilator checks the patient circuit for occlusions during all modes of breathing (except
Stand-By state and safety valve open) at delivery of every breath. Once the circuit check begins,
the ventilator detects a severe occlusion of the patient circuit within 200 ms. The ventilator checks
the exhaust port for occlusions during the expiratory phase of every breath (except during dis-
connect and safety valve open). Once the exhaust port check begins, the ventilator detects a
severe occlusion within 100 ms following the first 200 ms of exhalation. All occlusion checking is
disabled during pressure sensor autozeroing.
When an occlusion is detected, an alarm sounds, the ventilator enters the OSC (occlusion status
cycling) state and displays a message indicating the length of time the patient has gone without
ventilation (how long the ventilator has been in OSC). This alarm has the capability to autoreset,
as occlusions such as those due to patient activity (for example, crimped or kinked tubing) can
correct themselves.
Once a severe occlusion is detected, the ventilator acts to minimize airway pressure. Because any
severe occlusion places the patient at risk, the ventilator minimizes the risk while displaying the
length of time the patient has been without ventilatory support. Severe occlusion is detected
regardless of what mode or triggering strategy is in effect. When a severe occlusion is detected,
the ventilator terminates normal ventilation, terminates any active audio paused interval, annun-
ciates an occlusion alarm, and enters the safe state (exhalation and inspiratory valve deenergized
and safety valve open) for 15 seconds or until inspiratory pressure drops to 5 cmH2O or less,
whichever comes first.
During a severe occlusion, the ventilator enters OSC, in which it periodically attempts to deliver a
pressure-based breath while monitoring the inspiratory and expiratory phases for the existence
of a severe occlusion. If the severe occlusion is corrected, the ventilator detects the corrected con-
dition after two complete OSC breath periods during which no occlusion is detected. When the
ventilator delivers an OSC breath, it closes the safety valve and waits 500 ms for the safety valve
to close completely, delivers a breath with a target pressure of 15 cmH2O for 2000 ms, then cycles
to exhalation. This breath is followed by a mandatory breath according to the current settings, but
with PEEP =0 and O2% equal to 100% for adult/pediatric circuit types or 40% for neonatal circuits.
During OSC (and only during OSC), the 2PPEAK (high circuit pressure) alarm limit is disabled to
ensure it does not interfere with the ability of the ventilator to detect a corrected occlusion. When
the ventilator does not detect a severe occlusion, it resets the occlusion alarm, rreestablishes PEEP,
and reinstates breath delivery according to current settings.
Inspiratory and expiratory pause maneuvers, and manual inspirations are suspended during a
severe occlusion. Pause maneuvers are canceled by a severe occlusion. During a severe occlusion,
ventilator settings changes are possible. Severe occlusions are not detected when the ventilator
is in the safety valve open (SVO) state.
A corrected occlusion is detected within 15 seconds.
10.13.2 Disconnect
A circuit disconnect condition is detected when the ventilator cannot ensure that a patient is
receiving sufficient tidal volume (due to a large leak or disconnected patient circuit). This discus-
sion applies when Leak Sync is disabled.
When a disconnect is detected, an alarm sounds, the ventilator indicates that a disconnect has
been detected, and displays a message indicating the length of time the patient has gone
without ventilation.
Patient data are not displayed during a circuit disconnect condition.
The ventilator monitors the expiratory pressure and flow, delivered volume, and exhaled volume
to declare a disconnect using any of these methods
• The ventilator detects a disconnect when the expiratory pressure transducer measures no circuit pres-
sure and no exhaled flow during the first 200 ms of exhalation. The ventilator postpones declaring a
disconnect for another 100 ms to allow an occlusion (if detected) to be declared first, because it is pos-
sible for an occlusion to match the disconnect detection criteria.
• Despite many possible variations of circuit disconnections or large leaks, it is possible for a patient to
generate some exhaled flow and pressure. The ventilator then uses the disconnect sensitivity (DSENS,
the percentage of delivered volume lost during the expiratory phase of the same breath to declare a
disconnect) setting to detect a disconnect.
• If the disconnect occurs during a spontaneous breath, a disconnect is declared when the inspiration
is terminated by maximum inspiratory time (or the 2TI SPONT limit setting when ventilation type is non-
invasive [NIV]) and the ventilator detects inspiratory flow rising to the maximum allowable.
• If the disconnect occurs at the endotracheal tube, the exhaled volume will be much less than the deliv-
ered volume for the previous inspiration. The ventilator declares a disconnect if the exhaled volume is
lower than the DSENS setting for three consecutive breaths. The DSENS setting helps avoid false detec-
tions due to leaks in the circuit or the patient’s lungs, and the three-consecutive-breaths requirement
helps avoid false detections due to a patient out-drawing the ventilator during volume control (VC)
breaths.
• Flow less than a value determined using the DSENS setting and pressure less than 0.5 cmH2O detected
for 10 consecutive seconds during exhalation.
WARNING:
When ventilation type is NIV, and DSENS setting is turned OFF, the system may not sound an alarm
for leaks and some disconnect conditions.
Once the ventilator detects a patient circuit disconnect, the ventilator declares a high-priority
alarm and discontinues breath delivery, regardless of what mode (including apnea) was active
when the disconnect was detected. If there is an active audio paused interval when the discon-
nect occurs, the audio paused interval is not canceled. The ventilator displays the length of time
the patient has been without ventilatory support. During the disconnect, the exhalation valve
closes, idle flow (10 L/min flow at 100% O2% or 40% O2 in NeoMode, if available with Leak Sync
disabled and 20 L/min with Leak Sync enabled) begins, and breath triggering is disabled. A
message appears identifying how long the patient has gone without ventilatory support.
The ventilator monitors both expiratory flow and circuit pressures to detect reconnection. The
ventilator declares a reconnect if any of the following criteria are met for the applicable time inter-
val:
• Exhaled idle flow within the reconnect threshold is detected.
• Inspiratory and expiratory pressures are both above or both below reconnect threshold levels or,
If the disconnect condition is corrected, the ventilator detects the corrected condition within 1
second.
Ventilator triggering, apnea detection, expiratory and inspiratory pause maneuvers, manual inspi-
rations, and programmed maneuvers or one-time events are suspended during a patient circuit
disconnect condition. Spirometry is not monitored during a disconnect, and all alarms based on
spirometry values are disabled. During a disconnect condition, ventilator settings changes are
possible.
If the disconnect alarm is autoreset or manually reset, the ventilator reestablishes PEEP. Once PEEP
is reestablished, the ventilator reinstates breath delivery according to settings in effect before the
disconnect was detected.
Circuit disconnect detection is not active during OSC, SVO, or prior to patient connection.
Occlusion and disconnection cannot be declared at the same time. Therefore, the ventilator
annunciates only the first event to be declared.
• Safety PCV
• SVO
• When any other respiratory maneuver has already taken place during the same breath
The GUI also displays any maneuver request, distinguishing between requests that are accepted
or rejected, and any maneuver that has begun, ended, or has been canceled.
When a maneuver is selected, a GUI information panel is opened, displaying the maneuver name,
user prompts and controls, and recent calculated results.
Any maneuver is canceled automatically upon declaration of any of the following alarms:
• 1PPEAK alarm
• 1PVENT alarm
• 1VTI
The following respiratory mechanics maneuvers are not available in BiLevel ventilation:
• P0.1—Occlusion pressure
• VC—Vital capacity
Note:
Inspiratory pause and expiratory pause maneuvers can be performed directly by pressing the respective
keys on the GUI or by swiping the Menu tab on the left side of the GUI. For more information on how to
perform respiratory mechanics maneuvers from the Menu tab, see Respiratory Mechanics Maneuvers (4.9)
on page 4-26.
An inspiratory pause maneuver extends the inspiratory phase of a single mandatory breath for the
purpose of measuring end inspiratory circuit pressure which is used to calculate static compliance
of the patient’s lungs and thorax (CSTAT), static resistance of the respiratory system (RSTAT), and
inspiratory plateau pressure (PPL). To calculate these pressures, the inspiratory and exhalation
valves are closed, allowing pressures on both sides of the artificial airway to equalize, revealing the
actual lung inflation pressure during a no-flow condition. An inspiratory pause maneuver can be
either automatically or manually administered, and is only available during the next mandatory
breath in A/C, SIMV, BiLevel or SPONT modes. In BiLevel, an inspiratory pause maneuver is sched-
uled for the next inspiration prior to a transition from PH to PL. Only one inspiratory pause maneu-
ver is allowed per breath. An inspiratory pause maneuver cannot occur during apnea ventilation,
safety PCV, stand-by state, occlusion, and SVO.
An automatic inspiratory pause maneuver begins when the inspiratory pause key is pressed
momentarily or the maneuver is started from the GUI screen. See Respiratory Mechanics Maneuvers
(4.9) on page 4-26 for more information on performing respiratory mechanics maneuvers from
the Menu tab on the GUI rather than using the keys on the GUI. The pause lasts at least 0.5 second
but no longer than 3 seconds. A manual inspiratory pause maneuver starts by pressing and
holding the inspiratory pause key. The pause lasts for the duration of the key press (up to 7 sec-
onds).
An active manual inspiratory pause maneuver is considered complete if any of the following
occur:
• The inspiratory pause key is released and at least 2 seconds of the inspiratory pause maneuver have
elapsed or pressure stability conditions have been detected for not less than 0.5 second.
A manual inspiratory pause maneuver request (if the maneuver is not yet active) will be canceled
if any of events 1 through 10 in Table 10-5. occur.
4 A disconnect is detected
5 Occlusion is detected
6 Apnea is detected
14 BUV is entered
During a manual inspiratory pause maneuver, the maneuver is terminated if any of events 1, 3, 5,
6, 12, or 13 occur.
An inspiratory pause maneuver is ignored if the ventilator is in apnea ventilation, safety PCV, OSC,
SVO, BUV, or Stand-By state.
An active automatic inspiratory pause maneuver is terminated and exhalation begun if any of
events1 through12, or 14 occur.
The active automatic inspiratory pause maneuver is considered complete if the pause duration
reaches 3 seconds or pressure stability conditions have been detected for not less than 0.5
second.
An automatic inspiratory pause maneuver request (if the maneuver is not yet active) will be can-
celed if any of events1 through 9, 11, 12, 14, or 15 occur.
Other characteristics of inspiratory pause maneuvers include:
• During an inspiratory pause maneuver, the apnea interval (TA) is extended by the duration of the inspi-
ratory pause maneuver.
• If the ventilator is in SIMV, the breath period during which the next scheduled VIM occurs will also be
extended by the amount of time the inspiratory pause maneuver is active.
• All activations of the inspiratory pause control are logged in the Patient Data log.
• When calculating I:E ratio, the inspiratory pause maneuver is considered part of the inspiratory phase.
• The expiratory time remains unchanged, and will result in a change in the I:E ratio for the breath that
includes the inspiratory phase.
Once the inspiratory pause maneuver is completed the operator can review the quality of the
maneuver waveform and accept or reject the maneuver data.
An expiratory pause maneuver extends the expiratory phase of a single breath to measure end
expiratory lung pressure (PEEPTOT) and allows intrinsic PEEP (PEEPI) to be calculated as PEEPTOT
minus set PEEP. The pressures on either side of the artificial airway are allowed to equalize by
closing the inspiratory and exhalation valves. Expiratory pause maneuvers are available in A/C,
SIMV, and BiLevel modes. For A/C and SIMV, the expiratory pause maneuver is scheduled for the
next end-of-exhalation prior to a mandatory breath. In BiLevel, the expiratory pause maneuver
occurs at the next end-of-exhalation prior to a transition from PL to PH. Only one expiratory pause
maneuver per breath is allowed, and the expiratory pause maneuver request is rejected if an inspi-
ratory pause maneuver has already taken place during the same breath.
A request for an expiratory pause maneuver is ignored in apnea ventilation, safety PCV, SPONT,
OSC, BUV, and Stand-By. See To access respiratory mechanics maneuvers, page 4-26 for more infor-
mation on performing these maneuvers from the GUI screen rather than using the keys on the
GUI.
Either manual or automatic expiratory pause maneuvers can occur. A momentary press of the
expiratory pause key begins an automatic expiratory pause maneuver, which lasts at least 0.5
second, but no longer than 3.0 seconds. A manual expiratory pause maneuver starts by pressing
and holding the expiratory pause key and lasts for the duration of the key-press (up to 15 sec-
onds).
An active manual expiratory pause maneuver is terminated if any of events1 through 12 occur
(see Table 10-5. on page 10-42).
An active manual expiratory pause maneuver is complete if the expiratory pause key is released
and at least 3 seconds of the expiratory pause maneuver have elapsed, pressure stability condi-
tions have been detected for ≥0.5 second, or pause duration lasts 15 seconds.
An active automatic expiratory pause maneuver is terminated if any of events1, 3, or 11
through13 in Table 10-5. occur.
An active automatic expiratory pause maneuver is complete if pause duration reaches 3 seconds
or pressure stability conditions have been detected for ≥0.5 second, or pause duration lasts 15
seconds.
The automatic expiratory pause maneuver request (the maneuver is not yet active) is canceled if
events 1 through 9, 11, 12, or 15 in Table 10-5. occur.
The automatic expiratory pause maneuver is terminated and inspiration begun if any of events
1, 3, or 11 through13 in Table 10-5. occur.
Other characteristics of expiratory pause maneuvers include:
• During an active manual expiratory pause maneuver, severe occlusion detection is suspended.
• When calculating I:E ratio, the expiratory pause maneuver is considered part of the expiratory phase.
• During the expiratory pause maneuver, the inspiratory time remains unchanged, so the I:E ratio is
changed for the breath that includes the expiratory pause maneuver.
• All activations of the expiratory pause control are logged in the Patient Data log.
Once the expiratory pause maneuver is completed the operator can review the quality of the
maneuver waveform and accept or reject the maneuver data.
The negative inspiratory force (NIF) maneuver is a coached maneuver where the patient is
prompted to draw a maximum inspiration against an occluded airway (the inspiratory and exha-
lation valves are fully closed).
A NIF maneuver is canceled if:
• Disconnect is detected.
• Occlusion is detected.
• SVO is detected.
• The maneuver has been active for 30 seconds and an inspiration is not detected.
When a NIF maneuver is activated, a single pressure-time waveform grid is automatically dis-
played. During a NIF maneuver, the circuit pressure displays on the waveforms screen and is reg-
ularly updated, producing a real-time display.
When an active NIF maneuver ends successfully, the calculated NIF result appears on the wave-
forms screen and on the maneuver panel. The NIF value displayed represents the maximum neg-
ative pressure from PEEP.
When a NIF maneuver ends, a PEEP restoration breath is delivered to the patient, then normal
breath delivery resumes.
P0.1 is the negative airway pressure (delta pressure change) generated during the first 100 ms of
an occluded inspiration. It is an estimate of the neuromuscular drive to breathe.
When a P0.1 maneuver ends successfully, the calculated airway pressure displays on the wave-
forms screen and on the maneuver panel. A P0.1 maneuver is terminated if 7 seconds elapse and
a trigger has not been detected to activate the maneuver.
A P0.1 maneuver is canceled if:
• Disconnect is detected.
• Occlusion is detected.
• SVO is detected.
The vital capacity (VC) maneuver is a coached maneuver where the patient is prompted to draw
a maximum inspiration (regardless of the current settings) and then to slowly and fully exhale.
When the vital capacity maneuver becomes active, the ventilator delivers a spontaneous inspira-
tion in response to patient effort (with PSUPP=0, Rise time% =50, and ESENS=0), and then allows for
a full exhalation effort.
When a vital capacity maneuver is requested, a single volume-time waveform grid is automatical-
ly displayed. A vital capacity maneuver is canceled if:
• Disconnect is detected.
• Occlusion is detected.
• SVO is detected.
• The maneuver as been active for 15 seconds and inspiration is not detected.
• Cancel is touched.
When an active VC maneuver ends successfully, the calculated expiratory volume displays on the
waveforms screen and on the maneuver panel and a PEEP restoration breath is delivered.
Apnea ventilation is a backup mode and starts if the patient fails to breathe within the apnea inter-
val (TA) set by the operator.TA defines the maximum allowable length of time between the start
of inspiration and the start of the next inspiration. Available settings include mandatory type (PC
or VC). For PC breaths the allowable settings are:
• Apnea interval (TA)
• Flow pattern
• O2%
During apnea ventilation with PC selected as the mandatory type, rise time% is fixed at 50%, and
the constant parameter during a rate change is inspiratory time (TI).
If apnea is possible (that is, if (60/f)>TA) increasing the non-apnea O2% setting automatically
changes apnea ventilation O2% if it is not already set higher than the new non-apnea O2%. Apnea
ventilation O2% does not automatically change by decreasing the non-apnea O2%. Whenever
there is an automatic change to an apnea setting, a message appears on the GUI, and the apnea
settings screen appears.
During apnea ventilation, changes to all non-apnea ventilation settings are allowed, but the new
settings do not take effect until the ventilator resumes normal ventilation. Being able to change
TA during apnea ventilation can avoid immediately re-entering apnea ventilation once normal
ventilation resumes.
Because the minimum value for TA is 10 seconds, apnea ventilation cannot take place when non-
apnea f is greater than or equal to 5.8/min.The ventilator does not enter apnea ventilation if TA is
equal to the breath period interval. Set TA to a value less than the expected or current breath
period interval as a way of allowing the patient to initiate breaths while protecting the patient
from the consequences of apnea.
Together, circuit type and PBW (displayed in lb or kg) provide the basis for new patient values and
absolute limits on various ventilator settings such as tidal volume VT) and Peak flow (VMAX). Run
SST to change the circuit type. Table 10-6. gives the minimum, maximum, and new patient
default values for VT based on circuit type.
For more information on VT calculations based on PBW and circuit type, see Table 11-9. on page
11-7, VT setting.
Neonatal 30 L/min
Pediatric 60 L/min
PBW determines constants for breath delivery algorithms, some user-settable alarms, the high
spontaneous inspiratory time limit setting (2TI SPONT) in NIV, and the non-settable INSPIRATION
TOO LONG alarm.
There are two ventilation type choices—invasive and NIV (non-invasive). Invasive ventilation is
conventional ventilation used with endotracheal or tracheostomy tubes. All installed software
options, breathing modes, breath types, and trigger types are available during invasive ventila-
tion.
NIV interfaces include non-vented full-faced or nasal masks or nasal prongs. See NIV Breathing
Interfaces (4.7.2) on page 4-20 for a list of interfaces that have been successfully tested with NIV).
NIV enables the ventilator to handle large system leaks associated with these interfaces by provid-
ing pressure-based disconnect alarms, minimizing false disconnect alarms, and replacing the
INSPIRATION TOO LONG alarm with a high spontaneous inspiratory time limit (2TI SPONT) setting
and visual indicator.
The following list shows the subset of invasive settings active during NIV:
• Mode — A/C, SIMV, SPONT. (BiLevel is not available during NIV.)
During NIV alarm setup, the clinician may set alarms to OFF and must determine if doing so is
appropriate for the patient’s condition.
Specifying the mode defines the types and sequences of breaths allowed for both invasive and
NIV ventilation types.
SIMV Invasive: PC, VC, or VC+ Pressure supported (PS) or TC. Each new breath begins with a manda-
NIV: VC or PC tory interval, during which a patient
effort yields a synchronized mandatory
breath. If no patient effort is detected
during the mandatory interval, the ven-
tilator delivers a mandatory breath. Sub-
sequent patient efforts before the end
of the breath yield spontaneous breaths.
SPONT Not allowed (PC or VC Invasive: Pressure supported All spontaneous (except for manual
allowed only for manual (PS), Tube compensated (TC), inspirations).
inspirations). Volume supported (VS), Pro-
portionally assisted (PAV+)
NIV: PS
Breath types must be defined before settings can be specified. There are only two categories of
breath type: mandatory and spontaneous. Mandatory breaths are volume controlled (VC) or pres-
sure controlled (PC or VC+). The ventilator currently offers spontaneous breaths that are pressure
supported (PS) volume supported (VS), tube compensated (TC), or proportionally assisted (PAV+).
Table 10-9. shows the modes and breath types available on the ventilator.
Mandatory Spontaneous
PC VC VC+ PS TC VS PAV+
The mode setting defines the interaction between the ventilator and the patient.
• Assist/control (A/C) mode allows the ventilator to control ventilation within boundaries specified by
the practitioner. All breaths are mandatory, and can be PC, VC, or VC+
• Spontaneous (SPONT) mode allows the patient to control ventilation. The patient must be able to
breathe independently, and exert the effort to trigger ventilator support.
• Synchronized Intermittent Mandatory Ventilation (SIMV) is a mixed mode that allows a combination of
mandatory and spontaneous interactions. In SIMV, the breaths can be spontaneous or mandatory,
mandatory breaths are synchronized with the patient's inspiratory efforts, and breath delivery is deter-
mined by the f setting.
• BiLevel is a mixed mode that combines both mandatory and spontaneous breath types. Breaths are
delivered in a manner similar to SIMV mode with PC selected, but providing two levels of pressure. The
patient is free to initiate spontaneous breaths at either pressure level during BiLevel.
Changes to the mode are phased in at the start of inspiration. Mandatory and spontaneous
breaths can be flow or pressure triggered.
The ventilator automatically links the mandatory type setting to the mode setting. During A/C or
SIMV modes, once the operator has specified volume or pressure, the ventilator displays the
appropriate breath parameters. Changes in the mandatory type are phased in at the start of inspi-
ration.
The f setting determines the minimum number of mandatory breaths per minute for ventilator-
initiated mandatory breaths in A/C, SIMV, and BiLevel modes.If the mode is A/C or SIMV and VC is
the breath type, specifying VMAX and flow pattern determines TI, TE, and I:E. In PC breaths, speci-
fying TI automatically determines the other timing variables. See Inspiratory Time (TI) (10.15.13) on
page 10-53 for an explanation of the interdependencies of f, TI, TE, and I:E. Changes to the f setting
are phased in at the start of inspiration.
The ventilator does not accept a proposed f setting if it would cause the new TI or TE to be ≤0.2
second, the TI to be ≥8 seconds, or I:E ratio ≥4.00:1. The ventilator also applies these restrictions
to a proposed change to the apnea respiratory rate, except that apnea I:E cannot exceed 1.00:1.
An exception to this rule occurs in BiLevel ventilation where the proposed f setting will allow the
I:E ratio to be ≥4.00:1 only until the minimum TL is reached.
The VT setting determines the volume of gas delivered to the patient during a VC mandatory
breath. The delivered VT is compensated for BTPS and patient circuit compliance. Changes to the
VT setting are phased in at the start of inspiration. The VT setting only affects the delivery of man-
datory breaths.
When proposing a change to the VT setting, the ventilator compares the new value with the set-
tings for f, VMAX, flow pattern, and TPL. If the proposed setting would result in an I:E ratio that
exceeds 4.00:1 or a TI≥8 seconds or ≤0.2 second, or a TE≤0.2 second, the ventilator disallows the
change.
The VMAX setting determines the maximum rate of delivery of tidal volume to the patient during
mandatory VC breaths, only. Changes to VMAX are phased in at the start of inspiration. Mandatory
breaths are compliance compensated, even at the maximum VMAX setting. Circuit compliance
compensation does not cause the ventilator to exceed the ventilator’s maximum flow capability.
When proposing a change to the VMAX setting, the ventilator compares the new value with the
settings for VT, f, flow pattern, andTPL. It is impossible to set a new VMAX that would result in an I:E
ratio that exceeds 4.00:1, or a TI≥8.0 seconds or ≤0.2 second, or a TE≤0.2 second.
The TPL setting determines the amount of time inspiration is held in the patient's airway after
inspiratory flow has ceased. TPL is available only during VC mandatory breaths (for A/C and SIMV
mode, and operator-initiated mandatory breaths). TPL is not available for PC mandatory breaths.
Changes to the TPL setting are phased in at the start of inspiration.
When proposing a change to the TPL setting, the ventilator computes the new I:E ratio and TI,
given the current settings for VT, f, VMAX, and flow pattern. It is impossible to set a new TPL that
would result in an I:E ratio that exceeds 4.00:1, or a TI≥8 seconds or ≤0.2 second, or aTE ≤0.2
second. For the I:E ratio calculation, TPL is considered part of the inspiratory phase.
The flow pattern setting defines the gas flow pattern of volume-controlled (VC) mandatory
breaths only. The selected values for VT and VMAX apply to both the square or descending ramp
flow patterns. If VT and VMAX and are held constant, TI approximately halves when the flow pattern
changes from descending ramp to square (and approximately doubles when flow pattern
changes from square to descending ramp), and corresponding changes to the I:E ratio also occur.
Changes in flow pattern are phased in at the start of inspiration.
The settings for flow pattern, VT, f, TPL, and VMAX are interrelated. If any setting change would
cause any of the following, the ventilator does not allow that change
• I:E ratio >4:1
• TI >8.0 s or TI <0.2 s
• TE <0.2 s
The VSENS setting defines the rate of flow inspired by a patient that triggers the ventilator to
deliver a mandatory or spontaneous breath. When V-Trig is selected, a base flow of gas (1.5 L/min)
travels through the patient circuit during the ventilator’s expiratory phase. Once a value for flow
sensitivity is selected, the ventilator delivers a base flow equal to VSENS+1.5 L/min (base flow is not
user- selectable). When the patient inhales and their inspiratory flow exceeds the VSENS setting, a
trigger occurs and the ventilator delivers a breath. Reductions to VSENS are phased in immediately,
while increases are phased in at the start of exhalation.
When VSENS is active, it replaces pressure sensitivity (PSENS). The VSENS setting has no effect on the
PSENS setting. VSENS can be active in any ventilation mode (including pressure supported, volume
controlled, pressure controlled, and apnea ventilation). When VSENS is active, a backup PSENS
setting of 2 cmH2O is in effect to detect the patient's inspiratory effort, even if the flow sensors do
not detect flow.
Although the minimum VSENS setting of 0.2 L/min (adult/pediatric circuit types) or 0.1 L/min (neo-
natal circuit type) can result in autotriggering, it can be appropriate for very weak patients. The
maximum setting of 20 L/min (adult/pediatric circuit types) or 10 L/min (neonatal circuit type) is
intended to avoid autotriggering when there are significant leaks in the patient circuit.
The PSENS setting selects the pressure drop below baseline (PEEP) required to begin a patient-ini-
tiated breath (either mandatory or spontaneous). Changes to PSENS are phased in immediately.
The PSENS setting has no effect on the VSENS setting and is active only if the trigger type is P-Trig.
Lower PSENS settings provide greater patient comfort and require less patient effort to initiate a
breath. However, fluctuations in system pressure can cause autotriggering at very low settings.
The maximum PSENS setting avoids autotriggering under worst-case conditions if patient circuit
leakage is within specified limits.
The PI setting determines the pressure at which the ventilator delivers gas to the patient during a
PC mandatory breath. The PI setting only affects the delivery of PC mandatory breaths. The select-
ed PI is the pressure above PEEP. (For example, if PEEP is set to 5 cmH2O, and PI is 20 cmH2O, the
ventilator delivers gas to the patient at 25 cmH2O.) Changes to the PI setting are phased in at the
start of inspiration.
The sum of PEEP+PI+2 cmH2O cannot exceed the high circuit pressure (2PPEAK) limit. To increase
this sum of pressures, first raise the 2PPEAK limit before increasing the settings for PEEP or PI. The
minimum value for PI is 5 cmH2O and the maximum value is 90 cmH2O.
The TI setting determines the time during which an inspiration is delivered to the patient for PC
mandatory breaths. The ventilator accepts a setting as long as the resulting I:E ratio and TE settings
are valid. Changes to TI phase in at the start of inspiration. Directly setting TI in VC mandatory
breaths is not allowed.
The ventilator rejects settings that result in an I:E ratio ≥4.00:1, a TI≥8 seconds or ≤0.2 second, or
a TE≤0.2 second to ensure the patient has adequate time for exhalation.
Setting f and TI automatically determines the value for I:E and TE.
60 ⁄ f – T I = T E
This equation summarizes the relationship between TI, I:E, TE, and breath period time
If the f setting remains constant, any one of the three variables (TI, I:E, or TE) can define the inspi-
ratory and expiratory intervals. If the f setting is low (and additional spontaneous patient efforts
are expected), TI can be a more useful variable to set than I:E. As the f setting increases (and the
fewer patient-triggered breaths are expected), the I:E setting becomes more relevant. Regardless
of which variable is chosen, a breath timing bar always shows the interrelationship between TI, I:E,
TE, and f.
The TE setting defines the duration of exhalation for PC and VC+ mandatory breaths, only.
Changes to the TE setting are phased in at the start of exhalation. Setting f and TE automatically
determines the value for I:E ratio and TI. See Inspiratory Time (TI) (10.15.13) on page 10-53 for an
explanation of the interdependencies of f, TI, TE, and I:E.
The I:E ratio setting is available when I:E is selected as the constant during rate change. The I:E
setting determines the ratio of inspiratory time to expiratory time for mandatory PC breaths. The
ventilator accepts the specified range of direct I:E ratio settings as long as the resulting TI and TE
settings are within the ranges established for mandatory breaths. Changes to the I:E ratio phase
in at the start of inspiration. Directly setting the I:E ratio in VC mandatory breaths is not allowed.
See Inspiratory Time (TI) (10.15.13) on page 10-53 for an explanation of the interdependencies of f,
TI, TE, and I:E.
Setting f and I:E automatically determine the values for TI and TE. The maximum I:E ratio setting of
4.00:1 is the maximum that allows adequate time for exhalation and is intended for inverse ratio
pressure control ventilation.
The pressure level entered by the operator for the inspiratory phase of the mandatory breath in
BiLevel ventilation.
The pressure level entered by the operator for the expiratory phase of the mandatory breath in
BiLevel ventilation.
The duration of time (in seconds) the ventilator maintains the set high pressure level in BiLevel
ventilation.
The duration of time (in seconds) the ventilator maintains the set low pressure level in BiLevel ven-
tilation.
The ratio of TH to TL in BiLevel ventilation, similar to I:E ratio when ventilating a patient without
BiLevel.
10.15.21 PEEP
This setting defines the positive end-expiratory pressure (PEEP), also called baseline airway pres-
sure. PEEP is the positive pressure maintained in the patient circuit during exhalation. Changes to
the PEEP setting are phased in at the start of exhalation.
The sum of
• PEEP+7 cmH2O
cannot exceed the 2PPEAK limit. To increase the sum of pressures, first raise the 2PPEAK limit before
increasing the settings for PEEP, PI, or PSUPP.
If there is a loss of PEEP from occlusion, disconnect, safety valve open, or loss of power conditions,
PEEP is reestablished (when the condition is corrected) by the ventilator delivering a PEEP resto-
ration breath. The PEEP restoration breath is a 1.5 cmH2O pressure-supported breath with exha-
lation sensitivity of 25%, and rise time% of 50%. A PEEP restoration breath is also delivered at the
conclusion of vent startup. After PEEP is restored, the ventilator resumes breath delivery at the
current settings.
Note:
PEEP restoration breath parameters are not user adjustable.
The PSUPP setting determines the level of positive pressure above PEEP applied to the patient's
airway during a spontaneous breath. PSUPP is only available in SIMV, SPONT, and BiLevel, in which
spontaneous breaths are allowed. The PSUPP setting is maintained as long as the patient inspires,
and patient demand determines the flow rate. Changes to the PSUPP setting are phased in at the
start of inspiration. The pressure support setting affects only spontaneous breaths.
The sum of PEEP+PSUPP+2 cmH2O cannot exceed the 2PPEAK limit. To increase the sum of pres-
sures, first raise the 2PPEAK limit before increasing the settings for PEEP or PSUPP. As the 2PPEAK
limit is the highest pressure considered safe for the patient, a PSUPP setting that would cause a
1PPEAK alarm requires reevaluating the maximum safe circuit pressure.
Volume support (VT SUPP) is defined as the volume of gas delivered to the patient during sponta-
neous VS breaths. Changes to the to the VT SUPP setting are phased in at the start of inspiration.
10.15.24 % Supp in TC
In TC, the % Supp setting represents the amount of the imposed resistance of the artificial airway
the TC breath type will eliminate by applying added pressure at the patient circuit wye. For exam-
ple, if the % Supp setting is 100%, TC eliminates 100% of the extra work imposed the by the airway.
At 50%, TC eliminates 50% of the added work from the airway. TC is also used with BiLevel, and is
available during both PH and PL phases.
In PAV+, the % Supp setting represents the percentage of the total work of breathing (WOB) pro-
vided by the ventilator. Higher inspiratory demand yields greater support from the ventilator. The
patient performs the remaining work. If the total WOB changes (resulting from a change to resis-
tance or compliance) the percent support remains constant.
The rise time% setting allows adjustment of the speed at which the inspiratory pressure reaches
95% of the target pressure. Rise time settings apply to PS (including a setting of 0 cmH2O), VS, PC,
VC+, or BiLevel breaths. The higher the value of rise time%, the more aggressive (and hence, the
more rapid) the rise of inspiratory pressure to the target (which equals PEEP+PI (or PSUPP)). The rise
time% setting only appears when pressure-based breaths are available. The range of rise time% is
1% to 100%. A setting of 50% takes approximately half the time to reach 95% of the target pres-
sure as a setting of 1.
• For mandatory PC, VC+, or BiLevel breaths, a rise time setting of 1 produces a pressure trajectory reach-
ing 95% of the inspiratory target pressure (PEEP + PI) in 2 seconds or 2/3 of the TI, whichever is shortest.
• For spontaneous breaths (VS, or PS), a rise time setting of 1 produces a pressure trajectory reaching
95% of the inspiratory target (PEEP+PSUPP) in (0.4×PBW-based TI TOO LONG ×2/3) seconds.
• When both PC and PS breaths are active, the slopes and thus the pressure trajectories can appear to
be different. Changes to TI and PI cause PC pressure trajectories to change. Changes in rise time% are
phased in at the start of inspiration.
• When PSUPP=0, the rise time% setting determines how quickly the ventilator drives circuit pressure to
PEEP+1.5 cmH2O.
The ESENS setting defines the percentage of the measured peak inspiratory flow at which the ven-
tilator cycles from inspiration to exhalation in all spontaneous breath types. When inspiratory flow
falls to the level defined by ESENS, exhalation begins. ESENS is a primary setting and is accessible
from the GUI screen. Changes to ESENS are phased in at the next patient-initiated spontaneous
inspiration.
ESENS complements rise time%. Rise time% should be adjusted first to match the patient's inspi-
ratory drive, and then the ESENS setting should cause ventilator exhalation to occur at a point most
appropriate for the patient. The higher the ESENS setting, the shorter the inspiratory time. Gener-
ally, the most appropriate ESENS is compatible with the patient's condition, neither extending nor
shortening the patient's intrinsic inspiratory phase.
ESENS in a PAV+ breath is expressed in L/min instead of percent.
Leak Sync disabled: Disconnect sensitivity (DSENS) is defined as the percentage of returned
volume lost due to declaring a leak, above which the ventilator declares a CIRCUIT DISCONNECT
alarm. When DSENS is set to its lowest value (20%) it has the highest sensitivity for detecting a leak
or disconnect. Conversely, when DSENS is set to its highest value (95%), the ventilator is least sen-
sitive to declaring a leak or disconnect, because greater than 95% of the returned volume must
be lost before the alarm annunciates. During NIV, the DSENS value is automatically set to OFF,
which means that returned volume loss is not considered and the alarm will not sound.
Leak Sync enabled: Disconnect sensitivity (DSENS) is defined as the leak at PEEP value in L/min
above which the ventilator declares a CIRCUIT DISCONNECT alarm. The lowest setting is most sen-
sitive to detecting and declaring a disconnect and vice versa.
To set DSENS with NIV interfaces when Leak Sync is enabled
1. After adjusting the patient settings, start ventilation.
3. With the NIV interface open to ambient (not connected to the patient), use the patient data leak value
to quantify the leak in L/min.
4. Set the DSENS (in L/min) below the leak rate (in L/min).
5. Periodically assess the leak rate, especially with PEEP changes, and adjust the DSENS setting as needed.
Note:
If DSENS is set to OFF during NIV, the ventilator is still capable of declaring a CIRCUIT DISCONNECT alarm.
Note:
DSENS cannot be turned OFF if Leak Sync is enabled.
Changes to DSENS are phased in at the start of inspiration.
The high spontaneous inspiratory time limit setting (2TI SPONT) is available only in SIMV or SPONT
modes during NIV, and provides a means for setting a maximum inspiratory time after which the
ventilator automatically transitions to exhalation. The default 2TI SPONT setting is based upon
circuit type and PBW.
For pediatric/adult circuit types, the new patient default value is
(1.99+(0.02×PBW)) s.
For neonatal circuit types, the new patient default value is ((1.00+(0.10×PBW) s.
The 2TI SPONT indicator appears on the primary display at the beginning of a ventilator-initiated
exhalation and remains visible for as long as the ventilator truncates breaths in response to the
2TI SPONT setting. The 2TI SPONT indicator disappears when the patient’s inspiratory time returns
to less than the 2TI SPONT setting, or after 15 seconds has elapsed after the beginning of exhalation
of the last truncated breath. Changes to 2TI SPONT are phased in at the start of inspiration.
The humidification type setting sets the type of humidification system (heated expiratory tube,
non-heated expiratory tube, or heat-moisture exchanger (HME) used on the ventilator and can be
changed during normal ventilation or short self test (SST). Changes in humidification type phase
in at the start of inspiration.
SST calibrates spirometry partly based on the humidification type. Changing the humidification
type without rerunning SST can affect the accuracy of spirometry and delivery.
The accuracy of the exhalation flow sensor varies depending on the water vapor content of the
expiratory gas, which depends on the type of humidification system in use. Because the tempera-
ture and humidity of gas entering the exhalation filter differ based on the humidification type
being used, spirometry calculations also differ according to humidification type. For optimum
accuracy, rerun SST to change the humidification type.
The dry, compressible volume in mL of the humidification chamber for the humidification type
entered during SST. Humidifier volume is only entered if a humidifier is used.
The ventilator is designed to prevent the operator from implementing settings that are clearly
inappropriate for the patient's predicted body weight (PBW). Each setting has either soft bounds
(can be overridden) or hard bounds (no override allowed) that alert the operator to the fact that
the settings may be inappropriate for the patient. In the event that the patient is connected
without any parameters being specified, the ventilator enters Safety PCV, a safe mode of ventila-
tion regardless of the circuit type in use (neonatal, pediatric, or adult) or patient's PBW. Safety PCV
is entered after POST, if a patient connection is made prior to settings confirmation. Safety PCV
uses new patient default settings with exceptions shown in Table 10-10.
PBW Neonatal: 3 kg
Pediatric:15 kg
Adult: 50 kg
Mode A/C
Mandatory type PC
TI Neonatal: 0.3 s
Pediatric: 0.7 s
Adult: 1 s
PI 15 cmH2O
PEEP 3 cmH2O
PSENS 2 cmH2O
1PPEAK 20 cmH2O
Note:
In Safety PCV, expiratory pause maneuvers are not allowed.
In case of patient problems, the ventilator remains fully operative and annunciates the appropri-
ate alarm. The detection, response, and priority of each patient-related alarm is determined by the
actual patient problem. See Alarms (6.5) on page 6-4 for a comprehensive description of the
patient alarm system.
The ventilator is designed to prevent system faults. Its modular design allows the breath delivery
unit (BDU) to operate independently of the graphical user interface (GUI) and several modules of
the breath delivery sub-system have redundancy that, if certain faults occur, provides for ventila-
tory support using settings that do not depend on the suspect hardware. System faults include
the following:
• Hardware faults (those that originate inside the ventilator and affect its performance)
• Soft faults (faults momentarily introduced into the ventilator that interfere with normal operation
The ventilator has an extensive system of continuous testing processes. If an error is detected in
the background diagnostic system, the ventilator notifies the operator by posting an entry in the
diagnostic log. If the ventilator experiences an anomaly that causes an unintended reset, the ven-
tilator will recover from that reset and deliver a breath within 3 seconds without any operator
intervention. After recovering from a reset, the ventilator uses the same settings that were in
effect before the reset occurred.
The background test process compares monitored values of ventilator functions with expected
values of ventilator sensors under normal conditions regardless of whether the ventilator is in
Stand-By or is ventilating a patient. The ventilator will continue to ventilate the patient with the
highest level of support possible, and may revert to one of the states described. See Ventilator Pro-
tection Strategies (4.11) on page 4-31.
Background tests include
• Periodically initiated tests performed at intervals of a specific number of machine cycles. These tests
check hardware components directly affecting breath delivery, safety mechanisms, and the GUI, and
detect and correct corruption of control variable data.
• Boundary checks performed at every analog measurement. These checks verify measurement circuit-
ry, including sensors.
Ventilation Assurance is a safety net feature invoked if the background diagnostics detect a
problem with certain components in either the gas mix subsystem, the inspiratory subsystem, or
the expiratory subsystem. Each subsystem has a backup ventilation strategy that allows ventila-
tion to continue by bypassing the suspect components giving the operator time to replace the
ventilator.
Mix backup ventilation (BUV) is invoked if the measured gas mix is significantly different from the
set mix, if the accumulator pressure is out of range or if a fault is indicated in the mix PSOLs or flow
sensors. During Mix BUV, the normal mix controller is bypassed and ventilation continues as set,
except that the gas mix reverts to 100% oxygen or air, depending on where the fault indication
was detected. Backup circuits then control the pressure in the accumulator to keep it in the
proper range for the Inspiratory Module.
Inspiratory BUV is invoked if background diagnostics detect a problem in the inspiratory module
(PSOL or flow sensor signal out of range). In Inspiratory BUV, ventilation continues with the set-
tings listed in Table 10-11.
Mode A/C
Mandatory type PC
f Neonatal: 25 1/min
Pediatric: 16 1/min
Adult: 16 1/min
TI Neonatal: 0.3 s
Pediatric: 0.7 s
Adult: 1 s
PEEP 3 cmH2O
TPL 0s
During Inspiratory BUV, the delivery PSOL is disabled, but gas delivery is achieved via an inspirato-
ry BUV solenoid valve, the gas flow being created by pressure in the mix accumulator.
Exhalation BUV is invoked if problems with the exhalation valve driver are detected. A backup
analog circuit is enabled to control the exhalation valve though the more advanced control fea-
tures (active exhalation valve control) are not functional.
Note:
During Mix and Inspiratory BUV, gas supply to installed options is disabled.
Entry into BUV is logged in the alarm log and system diagnostic log, and the status display pro-
vides an indicator that the ventilator is in BUV and which subsystem is affected.
When in BUV, a high priority alarm is annunciated, and the GUI displays an alarm banner indicat-
ing BUV, displays blank fields for patient data, and displays a pressure waveform.
If the ventilator cannot provide any degree of reliable ventilatory support and fault monitoring,
then the ventilator sounds an alarm and enters the safety valve open (SVO) emergency state.
During SVO, the ventilator deenergizes the safety valve, exhalation, and inspiratory valves, annun-
ciates a high-priority alarm, and turns on the SVO indicator. During SVO, a patient can sponta-
neously inspire room air (if able to do so) and exhale. Check valves on the inspiratory and
expiratory sides minimize rebreathing of exhaled gas during SVO. During SVO the ventilator:
• Displays the elapsed time without ventilatory support
Visible indicators on the ventilator's GUI and status display illuminate when the ventilator is in the
SVO state. Other safeguards built into the ventilator include a one-way valve (check valve) in the
inspiratory pneumatic circuit allowing the patient to inhale through the safety valve with limited
resistance. This check valve also limits exhaled flow from entering the inspiratory limb to reduce
the possibility of rebreathing exhaled CO2 gas.
WARNING:
Do not enter Service mode with a patient attached to the ventilator. Serious injury could result.
11.1 Overview
This chapter contains the following specifications for the Puritan Bennett™ 980 Series Ventilator:
• Physical
• Electrical
• Interface
• Environmental
• Performance (ranges, resolution, and accuracies for ventilator settings, alarm settings, and patient
data)
WARNING:
Due to excessive restriction of the Air Liquide™, SIS, and Dräger™ hose assemblies, reduced
ventilator performance levels may result when oxygen or air supply pressures <345 kPa (50 psi)
are employed.
11-1
Specifications
During breath delivery performance verification for flow and pressure based measurements, the
equipment inaccuracy is subtracted from the acceptance specification as follows:
• Net acceptance gain = requirement specification gain – measurement uncertainty gain
For derived parameters, such as volume, compliance, etc., the individual sensor uncertainties are
combined and applied as applicable to determine the acceptance limits.
Table 11-2. Physical Characteristics
Weight Ventilator: 51.26 kg (113 lb) including BDU, GUI, standard base, and
primary battery
BDU only: 31.3 kg (69 lb)
Ventilator and compressor: 71.2 kg (157 lb) including BDU, GUI, ventila-
tor and compressor primary batteries, base assembly, and compressor
Compressor: 40.4 kg (89 lb) including base assembly
BDU only: 31.3 kg (69 lb)
Pendant configuration: 34.5 kg (76 lb) including BDU, GUI, primary
battery
Pendant configuration, BDU only: 27.2 kg (60 lb)
Pendant configuration, GUI only: 5.7 kg (12.6 lb)
A-weighted sound pressure level, At a distance of 1 meter, does not exceed 48 dBA at 5 L/min
ventilator
A-weighted sound pressure level, At a distance of 1 meter does not exceed 54 dBA at 5 L/min
ventilator and compressor
Inspiratory/ exhalation filters See filter instructions for use for complete specifications
Table 11-2. Physical Characteristics
Table 11-3. Pneumatic Specifications
Oxygen and air inlet supplies Pressure: 241 kPa to 600 kPa (35 psi to 87 psi)
Flow: Maximum of 200 L/min
Oxygen sensor life Up to 1 year. Operating life varies depending on oxygen usage and
ambient temperature.
Table 11-4. Technical Specifications
Maximum limited pressure (PLIM max) A fixed pressure limit to the safety valve limits circuit
pressure to <125 cmH2O (123 hPa) at the patient
wye.
Maximum working pressure (PW max) PWmax is ensured by the high pressure limit (2PPEAK)
when PI is <100 cmH2O (98.07 hPa).
Response time to change in FiO2 setting from 21% to <18 s for volumes >150 mL
90% O2 (measured at the patient wye) <19 s for volumes ≥30 mL but ≤150 mL
<50 s for volumes ≥2 mL but <30 mL
Minute volume (VE TOT) capability, compressor Up to 40 L/min BTPS, including compliance com-
pensation
Results of ventilator testing using circuits identified for use with the ventilator system
Internal inspiratory filter particle filtration efficiency >99.97% retention of particles 0.3 μm nominal at 100
L/min flow
Internal inspiratory filter resistance 0.2 cmH2O < resistance <2.2 cmH2O at 30 L/min flow
0.2 cmH2O < resistance <1.7 cmH2O at 15 L/min flow
Combined inspiratory limb resistance 0.2 cmH2O < resistance <5.5 cmH2O at 30 L/min flow
0.2 cmH2O < resistance <1.7 cmH2O at 15 L/min flow
Exhalation filter resistance (pediatric/adult, dispos- < 2.0 cmH2O at 30 L/min when new
able) < 1.7 cmH2O at 15 L/min when new
Exhalation filter particle filtration efficiency, pediat- Maximum of 0.03% penetration of particles 0.3 μm
ric/adult, disposable nominal at 30 L/min flow
Exhalation filter bacterial/viral filtration efficiency >99.999% bacterial filtration efficiency/99.99% viral
neonatal, disposable) filtration efficiency
Exhalation filter particle filtration efficiency (neona- > 99.70% retention of particles 0.3 μm nominal at 30
tal, disposable) L/min flow
Exhalation filter resistance (neonatal, disposable) < 0.58 cmH2O at 2.5 L/min when new
Circuit compliance (acceptable ranges of VBS com- ADULT: 1.3 mL/cmH2O to 4.2 mL/cmH2O
pliance for each patient type) PEDIATRIC: 0.9 mL/cmH2O to 3.0 mL/cmH2O
NEONATAL: 0.4 mL/cmH2O to 1.5 mL/cmH2O
Inspiratory limb circuit resistance (acceptable ranges ADULT (at 60 L/min): 1.15 cmH2O to 11.0 cmH2O
of VBS inspiratory limb resistance for each patient PEDIATRIC (at 30L/min): 0.46 cmH2O to 4.5 cmH2O
type) NEONATAL (at 10 L/min): 0.37 cmH2O to 4.5 cmH2O
(6.0 cmH2O for Prox)
Expiratory limb circuit resistance (acceptable ranges ADULT (at 60 L/min): 1.15 cmH2O to 11.0 cmH2O
of VBS expiratory limb resistance for each patient PEDIATRIC (at 30 L/min): 0.46 cmH2O to 4.5 cmH2O
type) NEONATAL (at 10 L/min): 0.37 cmH2O to 4.5
cmH2O(6.0 cmH2O for Prox)
Alarm volume (primary) Range: High priority alarm volume range (dBA): 58
Measurement uncertainty: ±3 dBA (volume setting 1) to 86 (volume setting 10)
Medium priority alarm volume range (dBA): 52
(volume setting 1) to 78 (volume setting 10)
Low priority alarm volume range (dBA): 50
(volume setting 1) to 76 (volume setting 10)
Measured 1 m from front, rear, and sides of ventilator
See Alarm Volume Key (6.5.4) on page 6-8 for alarm
volume behavior during an alarm condition.
Resolution: 1
Alarm volume (secondary) Minimum 64 dBA measured 1 m from front, rear, and
Measurement uncertainty: ±3 dBA sides of ventilator.
Table 11-5. Electrical Specifications
Electrical ratings, ventilator and compressor 100 V~, 50–60 Hz, 8.25 A
120 V~, 50–60 Hz, 6.0 A
220–240 V~, 50–60 Hz, 3.0 A
Table 11-6. RS-232 Pinout
5 GND Ground
Pin Configuration
2 Relay common
4 Not connected
Table 11-8. Environmental Specifications
Temperature 10°C to 40°C (50°F to 104°F) Ventilator –20°C to 70°C (-68°F to 158°F)
10°C to 35°C (50°F to 95°F) Internal Battery
Charger
Atmospheric Pressure 70 kPa to 106 kPa (10.15 psi to (15.37 psi) 50 kPa to 106 kPa (7.25 psi to
15.37 psi)
Altitude –411.5 m to 3048 m (–1350 ft to 10 000 ft) 6096 m max (20 000 ft max)
Table 11-8. Environmental Specifications
Note:
When using the compressor, reduced dryer performance may be expected if relative humidity exceeds
50% when temperature is 40°C.
When using the compressor, reduced dryer performance may be expected if temperature exceeds 32.8°C
when relative humidity is 95%.
Note:
The limits marked on the device label represent out-of-box storage conditions as follows:
• Temperature: 10°C to 40°C (50°F to 104°F)
See Table 11-9. for ranges and resolutions for ventilator settings. See Table 11-10. on page 11-14
for alarm settings, and Table 11-11. on page 11-17 for displayed patient data parameters.
Apnea expiratory time (TE) For mandatory PC apnea Range: 0.20 s to 59.8 s
breaths, the time interval Resolution: 0.01 s
between the end of inspira-
tion and the beginning of
the next inspiration.
Apnea flow pattern The flow shape of the deliv- Range: square, descending ramp
ered mandatory volume-
based (VC) apnea breath.
Apnea inspiratory pressure The pressure above PEEP at Range: 5 cmH2O to 90–PEEP cmH2O
(PI) which gas is delivered to the Resolution: 1 cmH2O
patient during mandatory
PC apnea breaths.
Apnea inspiratory time (TI) Same as inspiratory time for Range: 0.20 s to 8 s
non-apnea ventilation Resolution: 0.01 s in PC or VC+, 0.02 s
in VC
Apnea interval (TA) The time after which the Range: 10 s to 60 s or OFF in CPAP
ventilator transitions to Resolution: 1 s
apnea ventilation
TA ≥ 60/fA
Apnea peak inspiratory flow The maximum rate of tidal Range: When mandatory type is VC:
(VMAX) volume delivery during NEONATAL: 1 L/min to 30 L/min
mandatory volume-based PEDIATRIC: 3.0 L/min to 60 L/min
apnea breaths. ADULT: 3.0 L/min to 150 L/min
Resolution: 0.1 L/min for flows
<20 L/min (BTPS); 1 L/min for flows ≥20
L/min (BTPS)
Apnea respiratory rate (fA) Sets the number of volume- Range: 2.0 1/min to 40 1/min
or pressure-based breaths Resolution: 0.1 1/min for 2.0 1/min to
per minute for ventilator ini- 9.9 1/min; 1 1/min for 10 1/min to
tiated mandatory (VIM) 40 1/min
apnea breaths
Apnea tidal volume (VT) Sets the volume of gas deliv- Range:
ered to the patient’s lungs NEONATAL: 3 mL to 315 mL
during a mandatory, PEDIATRIC/ADULT: ≥25 mL to
volume-controlled apnea 2500 mL
breath. Apnea tidal volume Resolution: 0.1 mL for values <20 mL;
is compensated for body 0.5 mL for values ≥20 mL and <25 mL; 1
temperature and pressure, mL for values ≥25 mL and <100 mL; 5
saturated (BTPS) and the mL for values ≥100 mL and <400 mL; 10
compliance of the patient mL for values ≥400 mL
circuit.
Circuit type Specifies the circuit for Range: NEONATAL, PEDIATRIC, ADULT
which compliance and resis-
tance values during SST
have been calculated
Constant during rate Specifies which of the three Range: I:E ratio, TI, TE for PC or VC+
change operator-adjustable breath breaths; TH:TL ratio, TH,TL in BiLevel
timing variables remains
constant when respiratory
rate is changed.
Disconnect sensitivity Leak Sync disabled: The per- Range: (Leak Sync disabled):20% to
(DSENS) centage of returned volume 95% or OFF
lost, above which the venti- Range: (Leak Sync enabled):
lator declares a CIRCUIT DIS- NEONATAL: 1 L/min to 15 L/min
CONNECT alarm. PEDIATRIC: 1 L/min to 40 L/min
Leak Sync enabled: The leak ADULT: 1 L/min to 65 L/min
at PEEP value in L/min above Resolution: (Leak Sync disabled):1%
which the ventilator Resolution: (Leak Sync enabled)
declares a CIRCUIT DISCON- 0.5 L/min for values<10 L/min; 1 L/min
NECT alarm. for values ≥10 L/min
Expiratory sensitivity (ESENS) The percentage of VMAX Range: 1% to 80% when spontaneous
that, when reached, causes type is PS or VS
the ventilator to cycle from 1 L/min to 10 L/min when spontaneous
inspiration to exhalation type is PAV+
during spontaneous, pres- Resolution:1% when spontaneous
sure-based breaths type is PS, TC, or VS; 1 L/min when spon-
taneous type is PAV+.
Flow pattern The flow shape of the deliv- Range: square, descending ramp
ered mandatory or VC
breath
Height The patient’s height Range: 19.5 cm to 280 cm; 7.5 in. to
110 in.
Resolution: 0.5 cm for heights <35 cm;
1 cm for heights <254 cm; 2 cm for
heights ≥254 cm; 0.25 in. for heights
<14 in.; 0.5 in. for heights <100 in.; 1 in.
for heights ≥100 in.
See Predicted Body Weight (PBW) Calcu-
lation (4.6) on page 4-19.
Inspiratory pressure (PI) The pressure above PEEP at Range: 5 cmH2O to 90 cmH2O
which gas is delivered to the Resolution:1 cmH2O
patient during mandatory
PC breaths.
Inspiratory time (TI) The time during which an Range: 0.2 s to 8 s for mandatory PC,
inspiration is delivered to and VC+ breaths, (TPL+0.2 s to 8 s in VC)
the patient during manda- Resolution: 0.01 s for PC or VC+
tory PC or VC+ breaths. breaths; 0.02 s for VC breaths
Leak Sync (leak compensa- Compensates for leaks Range: Enabled or Disabled
tion) during invasive or non-inva-
sive (NIV) ventilation.
mL/kg ratio The default tidal volume/ Range: 5.0 mL/kg to 10 mL/kg
PBW ratio (only adjustable in Resolution: 0.5 mL/kg
Service Mode)
Mode The ventilation mode. The Range: A/C, SPONT, SIMV, BiLevel
mode determines the allow- but not available when ventilation type
able breath types: is NIV; CPAP (only available when circuit
A/C—assist/control—a type is NEONATAL and ventilation type
mandatory mode allowing is NIV))
volume controlled (VC),
pressure controlled (PC), or
VC+ breath types. SPONT—
allows the patient to initiate
the breath. Applicable
SPONT breath types are
pressure support (PS),
volume support (VS), tube
compensated (TC) or PAV+.
SIMV—Synchronized Inter-
mittent Mandatory Ventila-
tion—a mixed ventilatory
mode providing mandatory
breaths and allowing a
patient spontaneous
breaths during the breath
cycle.
BiLevel—a mixed ventilato-
ry mode combining the
attributes of both mandato-
ry and spontaneous breaths
incorporating two pressure
levels, PH and PL.
Peak inspiratory flow (VMAX) The maximum rate of tidal Range: When mandatory type is VC:
volume delivery during NEONATAL: 1 L/min to 30 L/min
mandatory volume-based PEDIATRIC: 3.0 L/min to 60 L/min
breaths. ADULT: 3.0 L/min to 150 L/min
Resolution: 0.1 L/min for values
<20 L/min (BTPS); 1 L/min for values
≥20 L/min (BTPS)
Pressure sensitivity (PSENS) For pressure triggered Range: 0.1 cmH2O to 20.0 cmH2O
breaths, determines the Resolution: 0.1 cmH2O
amount of pressure below
PEEP required to begin a
mandatory or spontaneous
patient initiated breath.
Pressure support (PSUPP) or The positive pressure above Range: 0 cmH2O to 70 cmH2O
PS PEEP (or PL in BiLevel) during Resolution: 1 cmH2O
a spontaneous breath.
Spontaneous type The breath type for patient Range: PS, TC, PAV+, or VS
initiated spontaneous
breaths in SIMV, SPONT, and
BiLevel modes.
TH:TL ratio In BiLevel, specifies the ratio Range: 1:299 to 4:1; in BiLevel TH:TL
of insufflation time to expira- Resolution: 0.01 for <10.00:1 and
tory time >1:10.00; 0.1for [<100.0:1 and ≥10.0:1]
or[≤1:10.0 and >1:100.0]; 1 for <1:100.0
or ≥100:1
Tube type The type of artificial airway Range: Endotracheal (ET), tracheal
used to ventilate the patient. (Trach)
High circuit pressure setting The 2PPEAK alarm indicates the Range: 7 cmH2O to 100 cmH2O
(2PPEAK) patient’s airway pressure ≥ the Resolution: 1 cmH2O
set alarm level
Low circuit pressure setting The 3PPEAK alarm indicates the Range:
(4PPEAK measured airway pressure ≤ NIV: OFF or ≥0.5 cmH2O to
the set alarm limit during an 100 cmH2O
NIV or VC+ inspiration. VC+: ≥PEEP +3.5 cmH2O (with
PEEP ≤16 cmH2O) ≥PEEP +4
cmH2O (with PEEP >16 cmH2O
to 100 cmH2O
Resolution: 0.5 cmH2O for
values <20.0 cmH2O;
1 cmH2O for values ≥20 cmH2O
High exhaled minute volume The 1VE TOT alarm indicates the Range: OFF and
alarm setting (2VE TOT) measured total minute volume NEONATAL: 0.1 L/min to
≥ the set alarm limit. 10 L/min
PEDIATRIC: 0.1 L/min to
30L/min
ADULT: 0.1 L/min to
100 L/min
Resolution: 0.005 L/min for
values <0.50 L/min; 0.05L/min
for values ≥0.5 L/min to
<5.0 L/min; 0.5 L/min for values
≥5.0 L/min
High exhaled tidal volume The 1VTE alarm indicates that Range: OFF and
alarm setting (2VTE) the measured exhaled tidal NEONATAL: 5 mL to 500 mL
volume≥ the set alarm limit for PEDIATRIC: 25 mL to 1500 mL
spontaneous and mandatory ADULT: 25 mL to 3000 mL
breaths. Resolution: 1 mL for values
<100 mL; 5 mL for values
≥100 mL and <400 mL; 10 mL for
values ≥400 mL
High inspired tidal volume The 1VTI alarm indicates the Range: 6 mL to 6000 mL
alarm limit (2VTI) delivered volume of any breath Resolution: 1 mL for values
≥ the set alarm limit. <100 mL; 5 mL for values
≥100 mL to <400 mL; 10 mL for
values ≥400 mL
High respiratory rate alarm The 1fTOT alarm indicates the Range: OFF or
setting (2fTOT) measured breath rate ≥ the set NEONATAL: 10 1/min to
alarm limit. 170 1/min
PEDIATRIC/ADULT: 10 1/min
to 110 1/min
Resolution: 1 1/min
Low exhaled mandatory tidal The 3VTE MAND alarm indicates Range: OFF and
volume alarm setting (4VTE the measured mandatory tidal NEONATAL: 1 mL to 300 mL
MAND) volume ≤ the set alarm limit. PEDIATRIC: 1 mL to 1000 mL
ADULT: 1 mL to 2500 mL
Resolution: 1.0 mL for values
<100 mL; 5 mL for values
≥100 mL and <400 mL; 10 mL for
values ≥400 mL
Low exhaled minute volume The 3VE TOT alarm indicates the Range: OFF when ventilation
alarm setting (4VE TOT) measured exhaled minute type = NIV and
volume ≤ the set alarm limit for NEONATAL: 0.01 L/min to
mandatory and spontaneous 10 L/min
breaths. PEDIATRIC: 0.05 L/min to
30 L/min
ADULT: 0.05 L/min to
60 L/min
Resolution: 0.005 L/min for
values <0.50 L/min;
0.05 L/min for values
≥0.50 L/min and < 5.0 L/min;
0.5 L/min for values >5.0 L/min
Low exhaled spontaneous tidal The 3VTE SPONT alarm indicates Range: OFF and
volume alarm setting (4VTE the measured spontaneous NEONATAL: 1 mL to 300 mL
SPONT) tidal volume ≤ the set alarm PEDIATRIC: 1 mL to 1000 mL
limit. ADULT: 1 to 2500 mL
Resolution: 1 mL for values
<100 mL; 5 mL for values 100 mL
to <400 mL; 10 mL for values
≥400 mL
Breath phase The breath phase indicator dis- Range: Control (C), Assist (A),
plays the breath delivery phase Spontaneous (S)
(inspiratory or expiratory) cur-
rently being delivered to the
patient.
Inspired tidal volume (VTL) The volume inspired for each Range: 0 mL to 6000 mL
during Leak Sync breath when Leak Sync is Resolution: 0.1 mL for values
enabled. <10 mL; 1 mL for values 10 mL to
6000 mL
Inspired tidal volume (VTI) The volume inspired for a pres- Range: 0 mL to 6000 mL
sure- based breath Resolution: 0.01 mL for 0 mL to
9.9 mL, 1 mL for values 10 mL to
6000 mL
Dynamic compliance (CDYN) The result of dividing the deliv- Range: 0 mL/cmH2O to
ered tidal volume by the peak 200 mL/cmH2O
airway pressure. Resolution: 0.1 mL/cmH2O for
values <10 mL/cmH2O;
1 mL/cmH2O for values
≥10 mL/cmH2O
Dynamic resistance (RDYN) The change in pressure per unit Range: 0.0 cmH2O/L/s to
change in flow. 100 cmH2O/L/s
Resolution: 0.1 cmH2O/L/ for
values <10 cmH2O/L/s;
1 cmH2O/ L/s for values
≥10 cmH2O/L/s
End expiratory flow (EEF) The rate of expiratory flow Range: 0 L/min to 150 L/min
occurring at the end of exhala- Resolution: 0.1 L/min for values
tion. <20 L/min; 1 L/min for values
≥ 20 L/min
End expiratory pressure (PEEP) The pressure at the end of the Range: −20.0 cmH2O to
expiratory phase of the previ- 130 cmH2O
ous breath (also applies in Resolution: 0.1 cmH2O between
BiLevel).
−10.0 cmH2O and +10.0 cmH2O;
1 cmH2O for values ≤–10 cmH2O
and ≥10 cmH2O
End inspiratory pressure The pressure at the end of the Range: −20.0 cmH2O to
(PI END) inspiratory phase of the current 130 cmH2O
breath (also applies in BiLevel). Resolution: 0.1 cmH2O for
−20.0 cmH2O to 9.9 cmH2O;
1 cmH2O for values 10 cmH2O to
130 cmH2O
Exhaled mandatory tidal The exhaled volume of the last Range: 0 mL to 6000 mL
volume (VTE MAND) mandatory breath. When the Resolution: 0.1 mL for 0 mL to
mode is SPONT, and no manda- 9.9 mL; 1 mL for 10 mL to 6000
tory breaths have occurred for a mL
time period ≥2 minutes, the VTE
MAND indicator is hidden. Man-
datory breaths can occur during
SPONT mode via manual inspi-
ration.
Exhaled minute volume A calculated sum of the Range: 0.00 L/min to 99.9 L/min
(VE TOT) volumes exhaled by the patient Resolution: 0.01 L/min for
for mandatory and sponta- 0.00 L/min to 9.99 L/min;
neous breaths for the previous 0.1 L/min for 10.0 L/min to
one-minute interval (also 99.9 L/min
applies in BiLevel).
Exhaled spontaneous minute The sum of exhaled sponta- Range: 0 L/min to 99.9 L/min
volume VE SPONT) neous volumes per minute (also Resolution: 0.01 L/min for
applies in BiLevel) 0.00 L/min to 9.99 L/min;
0.1 L/min for 10.0 L/min to
99.9 L/min
Exhaled spontaneous tidal The exhaled volume of the last Range: 0 mL to 6000 mL
volume (VTE SPONT) spontaneous breath. Resolution: 0.1mL for 0 mL to
9.9 mL; 1 mL for 10 mL to
6000 mL
Exhaled tidal volume (VTE) The volume exhaled by the Range: 0 mL to 6000 mL
patient for the previous manda- Resolution: 0.1mL for 0 mL to
tory or spontaneous breath 9.9 mL; 1 mL for 10 mL to
(also applies in BiLevel. 6000 mL
Leak Sync exhaled tidal volume The volume exhaled by the Range: 0 mL to 6000 mL
(VTE) patient for the previous manda- Resolution: 0.1mL for 0 mL to
tory or spontaneous breath 9.9 mL; 1 mL for 10 mL to
during Leak Sync (also applies in 6000 mL
BiLevel).
I:E ratio The ratio of the inspiratory time Range: 1:599 to 149:1
to expiratory time for the previ- Resolution: 0.1 for 9.9:1 to 1:9.9;
ous breath. 1 for 149:1 to 10:1 and 1:10 to
1:599
Mean circuit pressure (PMEAN) The calculated average circuit Range: −20.0 cmH2O to
pressure for an entire breath 100 cmH2O
cycle including both inspiratory Resolution: 0.1 cmH2O for
and expiratory phases (whether
−20.0 cmH2O to 9.9 cmH2O;
the breath is mandatory or
spontaneous). 1 cmH2O for 10 cmH2O to
100 cmH2O
Negative inspiratory force (NIF) The negative pressure generat- Range: ≤0 cmH2O to
ed during a maximally forced ≥–50 cmH2O
inspiratory effort against an
Resolution: 1 cmH2O for values
obstruction to flow.
≤–10 cmH2O; 0.1 cmH2O for
values >–10 cmH2O
PAV based intrinsic PEEP (PEEPI The estimated intrinsic PEEP Range: 0 cmH2O to 130 cmH2O
PAV)
during a PAV+ breath. Intrinsic Resolution: 0.1 cmH2O for
PEEP is an estimate of the pres- values <10 cmH2O; 1cmH2O for
sure above PEEP at the end of
values ≥10 cmH2O
every pause exhalation.
PAV-based lung compliance The calculated change in pul- Range: 2.5 mL/cmH2O to
(CPAV)1 monary volume for an applied 200 mL/cmH2O
change in patient airway pres- Resolution: 0.1 mL/cmH2O for
sure when measured under
values <10 mL/cmH2O; 1 cmH2O
conditions of zero flow during a
PAV+ plateau maneuver. When for values ≥10 mL/cmH2O
PAV+ is selected, the ventilator
displays the current filtered
value for patient compliance,
and updates the display at the
successful completion of each
estimation. CPAV can be dis-
played in the vital patient data
banner. See
Vital Patient Data, page 3-37.
PAV-based lung elastance For a PAV+ breath, EPAV is calcu- Range: 5.0 cmH2O/L to
(EPAV)1 lated as the inverse of CPAV (see 400 cmH2O/L
above). EPAV can be displayed in Resolution: 0.1 cmH2O/L for
the vital patient data banner. values <10 cmH2O/L;
See 1 cmH2O/L ≥10 cmH2O/L
Vital Patient Data, page 3-37.
PAV-based patient resistance The difference between esti- Range: 0.0 cmH2O/L/s to
(RPAV)1 mated total resistance RTOT and 60 cmH2O/L/s
the simultaneously estimated Resolution: 0.1 cmH2O/L/s for
resistance of the artificial airway. values <10 cmH2O/L/s;
When PAV+ is selected, the ven-
1 cmH2O/ L/s for values ≥
tilator displays the current fil-
tered value for patient 10 cmH2O/L/s
resistance, and updates the
display at the successful com-
pletion of each estimation. RPAV
can be displayed in the vital
patient data banner. See Vital
Patient Data, page 3-37.
PAV-based total airway RTOTis an estimated value cap- Range: 1.0 cmH2O/L/s to
resistance (RTOT)1 tured just past peak expiratory 80 cmH2O/L/s
flow and is equal to the pres- Resolution: 0.1 cmH2O/L/s for
sure loss across the patient values <10 cmH2O/L/s;
airway plus respiratory system
1 cmH2O/ L/s for values
(patient airway + ET tube +
expiratory limb of the VBS)/ ≥10 cmH2O/L/s
expiratory flow. This pressure
loss is divided by the expiratory
flow estimated at the same
moment, yielding the estimate
for RTOT.The complete opera-
tion is orchestrated and moni-
tored by a software algorithm.
When PAV+ is selected, the ven-
tilator displays the current fil-
tered value for total resistance,
and updates the display at the
successful completion of each
calculation. RTOTcan be dis-
played in the vital patient data
banner.See
Vital Patient Data, page 3-37.
PAV-based work of breathing The estimated effort needed for Range: 1.0 J/L to10.0 J/L
(WOBTOT) patient inspiration including Resolution: 0.1 J/L
both patient and ventilator.
Peak expiratory flow (PEF) The maximum speed of exhala- Range: 0 L/min to 150 L/min
tion. Resolution: 0.1 L/min for PEF
<20 L/min; 1 L/min for PEF
≥20 L/min
Peak circuit pressure (PPEAK) The maximum pressure during Range: −20.0 cmH2O to
the previous breath, relative to 130 cmH2O
the patient wye, including Resolution: 0.1 cmH2O for
inspiratory and expiratory
values −20.0 cmH2O to
phases.
9.9 cmH2O; 1 cmH2O for values
10 cmH2O to 130 cmH2O
Peak spontaneous flow (PSF) The maximum flow rate Range: 0 L/min to 200 L/min
sampled during a spontaneous Resolution: 0.1 L/min for values
inspiration. <20 L/min; 1 L/min for values
≥ 20 L/min
Plateau pressure (PPL) The pressure measured during Range: −20.0 cmH2O to
an inspiratory pause maneuver. 130 cmH2O
Resolution: 0.1 cmH2O for
values −20.0 cmH2O to
9.9 cmH2O; 1 cmH2O for values
≥10 cmH2O
Proximal exhaled tidal volume For neonatal patients, the Range: 0 mL to 500 mL
(VTEY) exhaled volume of the previous Resolution: 0.1mL for values
breath measured by the proxi- 0 mL to 9.9 mL; 1 mL for values
mal flow sensor) (if installed). 10 mL to 500 mL
Proximal exhaled total minute For neonatal patients, the Range: 0.00 L/min to 99.9 L/min
volume (VE TOTY) exhaled minute volume mea- Resolution: 0.01 L/min for
sured by the proximal flow 0.00 L/min to 9.99 L/min;
sensor) (if installed). 0.1 L/min for 10.0 L/min to
99.9 L/min
Proximal inspired tidal volume For neonatal patients, the Range: 0 mL to 500 mL
(VTIY) inspired volume of the previous Resolution: 1 mL
breath measured by the proxi-
mal flow sensor) (if installed).
Total PEEP (PEEPTOT) The estimated pressure at the Range: –20.0 cmH2O to
circuit wye during an expiratory +130 cmH2O
pause maneuver. Resolution: 0.1 cmH2O for
values <10 cmH2O; 1 cmH2O for
values ≤–10 cmH2O and
≥10 cmH2O
Total respiratory rate (fTOT) The number of mandatory or Range: 1 1/min to 200 1/min
spontaneous breaths/min Resolution: 0.1 1/min for values
delivered to the patient. <10 1/min; 1 1/min for 10 1/min
to 200 1/min
LEAK Exhalation leak. The leak rate at Range: 0 L/min to 200 L/min
PEEP during exhalation. Resolution: 0.1 L/min
Table 11-12. Delivery Accuracy
Tidal volume (VT) For adult and pediatric circuit type For adult and pediatric
settings: circuit type settings:
For TI<600ms: 25 mL to 2500 mL
±(10+10% of setting ×600 ms/TI ms) For neonatal circuit type set-
mL tings: 2 mL to 310 mL
For TI≥600 ms:
±(10+10% of setting) mL.
For neonatal circuit type settings:
For setting of 2 mL VC+ only):
±(1+10% of setting) mL.
For setting of 3 mL to 4 mL:
±(2+10% of setting) mL (delivered
volume shall be ≥1 mL.
For setting of 5 mL to 20 mL:
±(3+15% of setting).
For setting of ≥20 mL:
±(4+10% of setting) mL.
End inspiratory pressure (PI END) ±(2+4% of reading) cmH2O 5 cmH2O to 90 cmH2O
Inspired tidal volume during Leak For adult and pediatric circuit For adult and pediatric circuit
Sync (VTL) type settings: type settings:
For TI≤600ms: 25 mL to 2500 mL
±(10+20% ×600 ms/TI ms of For neonatal circuit type set-
reading) mL. tings: 2 mL to 310 mL
For TI>600 ms:
±(10+20% of reading) mL.
For neonatal circuit type setting:
±(10+20% of reading) mL.
For readings <100 mL, the accu-
racy shall apply when the per-
centage of inspiratory leak
volume is <80%.
Exhaled tidal volume (VTE) during For adult and pediatric circuit For adult and pediatric circuit
Leak Sync type settings: type settings:
For TE≤600ms: 25 mL to 2500 mL
±(10+20% ×600 ms/TE ms of For neonatal circuit type set-
reading) mL. tings: 2 mL to 310 mL
For TE>600 ms:
±(10+20% of reading) mL.
For neonatal circuit type setting:
±(10+20% of reading) mL.
For readings <100 mL, the accu-
racy shall apply when the per-
centage of inspiratory leak
volume is <80%.
PAV-based total airway resis- ±(3+20% of measured value) 5.0 cmH2O/L/s to 50 cmH2O/L/s
tance (RTOT) cmH2O/L/s
WARNING:
The ventilator accuracies listed in this chapter are applicable under the operating conditions
identified. See Table 11-8. on page 11-6.
Operation outside specified ranges cannot guarantee the accuracies listed in the tables above,
and may supply incorrect information.
WARNING:
Portable and mobile RF communications equipment can affect the performance of the ventilator
system. Install and use this device according to the information contained in this manual.
WARNING:
The ventilator system should not be used adjacent to or stacked with other equipment, except as
may be specified elsewhere in this manual. If adjacent or stacked used is necessary, the ventilator
system should be observed to verify normal operation in the configurations in which it will be
used.
WARNING:
Portable RF communications equipment (including peripherals such as antenna cables and
external antennas should be used no closer than 30 cm (12 inches) to any part of the ventilator,
including cables specified by the manufacturer. Otherwise, degradation of the performance of this
equipment could result.
Caution:
This equipment is not intended for use in residential environments and may not provide adequate
protection to radio communication services in such environments.
Note:
The emissions characteristics of this equipment make it suitable for use in industrial areas and hospitals
(CISPR 11 class A). If it is used in a residential environment (for which CISPR 11 class B is normally required)
this equipment might not offer adequate protection to radio-frequency communication services. The user
might need to take mitigation measures, such as relocating or re-orienting the equipment.
Table 11-15. Electromagnetic Emissions
The ventilator is intended for use in the electromagnetic environment specified below. The customer or
the operator of the ventilator should assure that it is used in such an environment.
Table 11-16. Electromagnetic Immunity
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the
operator of the ventilator should assure that it is used in such an environment.
Floors should be
IEC 60601-1-2, wood, concrete, or
Edition 3.0:2007 ±2,4,6,8 kV contact dis- ceramic tile. If floors
charge are covered with
ESD IEC 60601-1-2, N/A
±2,4,8, 15kV air dis- synthetic material,
Edition 4.0:2014
charge the relative humidity
IEC 61000-4-2 should be at least
30%.
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the
operator of the ventilator should assure that it is used in such an environment.
IEC 60601-1-2,
Edition 3.0:2007 5 kHz pulse repeti-
tion rate
IEC 61000-4-4 ±1 kV (I/O)
EFT/burst
IEC 60601-1-2, ±2 kV (AC Mains) 100 kHz pulse repeti-
Edition 4.0:2014 tion rate Mains power quality
should be that of a
IEC 61000-4-4
typical hospital envi-
IEC 60601-1-2, ±0.5 kV, 1 kV line to ronment.
Edition 3.0:2007 line
Surge IEC 60601-1-2, ±0.5 kV, 1 kV & 2 kV line N/A
Edition 4.0:2014 to earth
IEC 61000-4-5
The ventilator is intended for use in the electromagnetic environment specified below. The customer or the
operator of the ventilator should assure that it is used in such an environment.
• 95% minimum
voltage reduction for
0.5 periods (10 ms)
IEC 60601-1-2, • 60% minimum
Edition 3.0:2007 Mains power should
voltage reduction for 5
be that of a typical
IEC 61000-4-11 periods (100 ms)
• 30% minimum hospital environ-
ment. If the operator
voltage reduction for
Voltage dips of the ventilator
25 periods (500 ms)
requires continuous
• UT=0%, 0.5 cycle (0, operation during
45, 90, 135, 180, 225, N/A power mains inter-
IEC 60601-1-2, ruptions, it is recom-
270, and 350°)
Edition 4.0:2014 mended that the
• UT=0%; 1 cycle
IEC 61000-4-11 ventilator be
• UT=70%; 25/30 cycles
powered from an
(@0°)
uninterruptible
IEC 60601-1-2, power supply or a
Edition 3.0:2007 battery.
• UT =0%; 250/300
Interrupts IEC 60601-1-2,
cycles
Edition 4.0:2014
IEC 61000-4-11
NOTE 1 At 80 MHz and 800 MHz, the higher frequency range applies.
NOTE 2 these guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
reflection from structures, objects and people.
1. The ISM (industrial, scientific and medical) bands between 150 kHz and 80 MHz are 6.765 to 6,795 MHz; 13.553 MHz to 13.567 MHz; 26.957 MHz; and 40.66
MHz to 40.70 MHz. The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz are
intended to decrease the likelihood mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas.
For this reason, an additional factor of 10/3 is used in calculating the separation distance for transmitters in these frequency ranges.
• GMRS 460 FM
• FRS 460 ±5 kHz
450 430–470 2 0,3 28
deviation
1kHz sine
710
Pulse
745 704–787 LTE Band 13, 17 modulation 0,2 0,3 9
217 Hz
780
5240
Pulse modu-
5500 5100–5800 WLAN 802.11a/n lation 0,2 0,3 9
217 Hz
5785
The ventilator is intended for use in an electromagnetic environment in which radiated RF distur-
bances are controlled. The customer or the operator of the ventilator can help prevent electromag-
netic interference by maintaining a minimum distance between portable and mobile RF
communications equipment (transmitters) and the ventilator as recommended below, according to
the maximum output power of the communications equipment.
Rated maximum 150 kHz to 80 150 kHz to 80 80MHz to 800 800 MHz to 2.5
output power of MHz outside of MHz inside of MHz GHz
transmitter (W) ISM bands ISM bands
100 11.7 12 12 23
For transmitters rated at a maximum output power not listed above, the recommended separation distance
d in meters (m)1 can be estimated using the equation applicable to the frequency of the transmitter where
P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufac-
turer.
NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorp-
tion and reflection from structures, objects and people.
Field strengths from fixed transmitters, as determined by an electromagnetic site survey2, should be less than
the compliance level in each frequency range3. Interference may occur in the vicinity of equipment marked with
the following symbol:
1. The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz are intended
to decrease the likelihood mobile/portable communications equipment could cause interference if it is inadvertently brought into patient
areas. For this reason, an additional factor of 10/3 is used in calculating the separation distance for transmitters in these frequency ranges.
2. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio,
AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment
due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the
980 Series Ventilator is used exceeds the applicable RF compliance level above, the 980 Series Ventilator should be observed to verify normal
operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the ventilator.
3. . Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 10 V/m.
WARNING:
The use of accessories and cables other than those specified with the exception of parts sold by
Covidien as replacements for internal components, may result in increased emissions or decreased
immunity of the ventilator system.
Table 11-20. Recommended Cables
• Failure to Alarm
A.1 Overview
This appendix describes the operation of the BiLevel 2.0 ventilation mode on the Puritan Ben-
nett™ 980 Series Ventilator.
BiLevel is a mixed mode of ventilation that combines attributes of mandatory and spontaneous
breathing, with the breath timing settings determining which breath type is favored. In BiLevel
Mode, mandatory breaths are always pressure-controlled, and spontaneous breaths can be
pressure-supported (PS) or tube compensated (TC).
Figure A-1. Spontaneous Breathing at PL
1 PCIRC (cmH2O) 4 PH
2 TH 5 PL
3 TL 6 Spontaneous breaths
BiLevel resembles SIMV mode, except that BiLevel establishes two levels of positive airway pres-
sure. Cycling between the two levels can be triggered by BiLevel timing settings or by patient
effort.
A-1
BiLevel 2.0
Figure A-2. BiLevel Mode
2 PL 6 Pressure support
3 PH 7 Time-based transitions
The two pressure levels are called low pressure (PL) and high pressure (PH). At either pressure level,
patients can breathe spontaneously, and spontaneous breaths can be assisted with tube com-
pensation or pressure support. BiLevel monitors mandatory and spontaneous tidal volumes sep-
arately.
Inspiratory time and expiratory time in BiLevel become time high (TH) and time low (TL), respec-
tively. During these inspiratory and expiratory times, PH is maintained during TH and PL is main-
tained during TL.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment, the
clinician should carefully select the ventilation mode and settings to use for that patient based on
clinical judgment, the condition and needs of the patient, and the benefits, limitations, and
characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best for
the patient's current needs.
2. Touch BiLevel. After selecting BiLevel mode, the ventilator uses the PC mandatory breath type, which
cannot be changed.
5. Select desired ventilator settings. The default settings for BiLevel mode appear. To change a setting,
touch its button and turn the knob to set its value. PH must always be at least 5 cmH2O greater than PL.
6. Set TL, TH or the ratio of TH to TL. To select settings that would result in a TH:TL ratio greater than 1:1 or
4:1, you must touch Continue to confirm after reaching the 1:1 and 4:1 limits.
7. Touch Start.
8. Set apnea and alarm settings by touching their respective tabs at the side of the ventilator settings
screen and changing settings appropriately.
Note:
The rise time% setting determines the rise time to reach target pressure for transitions fromPL to PH and
for spontaneous breaths, even when pressure support (PSUPP)=0. Expiratory sensitivity (ESENS) applies to
all spontaneous breaths.
• Spontaneous patient efforts at PH are not pressure supported unless PSUPP>(PH−PL). All spontaneous
breaths (whether or not they are pressure supported) are assisted by a pressure of 1.5 cmH2O.
• If PSUPP+PL is greater than PH+1.5 cmH2O, all spontaneous breaths at PL are assisted by the PSUPP set-
ting, and all spontaneous breaths at PH are assisted by PSUPP−(PH −PL).
• All spontaneous breaths not supported by PS or TC (for example, a classic CPAP breath) are assisted
with an inspiratory pressure of 1.5 cmH2O.
• All spontaneous breaths in PH are assisted by 10 cmH2O of pressure support (PSUPP−(PH − PL)) for the
same total pressure of 25 cmH2O.
1 Pressure (y-axis) 4 PH
During spontaneous breaths, the pressure target is calculated with respect to PL.
To avoid breath stacking, the ventilator does not cycle from one pressure level to another during
the earliest stage of exhalation.
A.8 Specifications
See Table 11-9. on page 11-7 for the following specifications:
• Low pressure (PL)
• TH:TL ratio
• Rise time%
Just as BiLevel attempts to synchronize spontaneous breath delivery with the patient's inspiratory
and expiratory efforts, it also attempts to synchronize the transitions between pressure levels with
the patient's breathing efforts. This allows TH to be extended to prevent transitions to PL during
*. Downs, JB, Stock MC. Airway pressure release ventilation: A new concept in ventilatory support. Crit Care Med 1987;15:459–461
the patient's spontaneous inspiration. Likewise, the TL interval may be extended to prevent a tran-
sition to PH during the patient's spontaneous exhalation.
The trigger sensitivity setting (PSENS or VSENS) is used to synchronize the transition from PL to PH.
The transition from PH down to PL is synchronized with the patient's spontaneous expiratory
effort. The BiLevel algorithm will vary the TL and TH intervals as necessary to synchronize the tran-
sitions between PL and PH to match the patient's breathing pattern.
The actual durations of TH and TL vary according to whether or not the patient makes any spon-
taneous inspiratory efforts during those periods.
To manage synchrony with the patient's breathing pattern, the BiLevel algorithm partitions the
TH and TL periods into spontaneous and synchronous intervals as shown in Figure A-5.
1 Pressure (y-axis) 5 TL
2 TH 6 Synchronous interval
3 PH 7 Spontaneous interval
4 PL
• During TL synchronous intervals, successful inspiratory efforts cause the ventilator to cycle from PL to
PH. If there is no spontaneous (patient) effort, this transition takes place at the end of the TL period.
• During TH synchronous intervals, successful expiratory efforts cause the ventilator to cycle from PH to
PL. If there is no spontaneous exhalation, the transition to the PL level takes place at the end of the TH
period.
If the patient breathes spontaneously at either pressure level, BiLevel monitors and displays the
total respiratory rate, including mandatory and spontaneous breaths. BiLevel also displays the
exhaled tidal volume and total exhaled minute volume for both mandatory and spontaneous
breaths.
Lengthening the TH period and shortening the TL period to only allow incomplete exhalation of
the mandatory breath volume, results in an inverse TH:TLratio. In this breath timing configuration
with TH:TL ratios of greater than 4:1, BiLevel becomes Airway Pressure Release Ventilation (APRV).
APRV is characterized by longer TH periods, short TL periods (usually less than 1 second), and
inverse TH:TL ratios. Because at these breath timing settings, all of the patient-triggered sponta-
neous breaths occur during the TH period, APRV resembles CPAP ventilation with occasional,
short periods of incomplete exhalation referred to as “releases”, which are controlled by the f set-
ting.
In APRV, the PH level is set to optimize pulmonary compliance for spontaneous breathing while
maintaining an elevated mean airway pressure to promote oxygenation, the PL level is set, along
with the TL, to control the expiratory release volume of mandatory breaths to help manage CO2
and alveolar ventilation, and the f setting controls the number of releases per minute which are
used to help manage the patient's CO2 levels. The f setting also impacts the mean airway pressure.
In APRV the operator can configure the BiLevel settings to allow direct control of TL to assure that
changes in the f setting will not inadvertently lengthen the TL period resulting in destabilization
of end-expiratory alveolar volume. With the TL period locked, changes in set f will change the TH
period to accommodate the new f setting while maintaining the set TL period.
In BiLevel, the ventilator establishes two levels of baseline pressure. One level is essentially the
same as the standard PEEP level set for all common modes of ventilation. The second pressure
level is the level established at TH. Both pressure levels permit CPAP, TC and PS breaths. The breath
timing settings determine whether the patient can initiate any of these breath types.
B.1 Overview
This appendix describes the operation of the Puritan Bennett™ 980 Series Ventilator Leak Sync
function. Leak Sync enables the ventilator to compensate for leaks in the breathing circuit while
accurately detecting the patient’s effort to trigger and cycle a breath. Because Leak Sync allows
the ventilator to differentiate between flow due to leaks and flow due to patient respiratory
effort, it provides dynamic compensation and enhances patient-ventilator synchrony. See
Chapter 4 for general parameter and operational information.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment,
the clinician should carefully select the ventilation mode and settings to use for that patient
based on clinical judgment, the condition and needs of the patient, and the benefits, limitations,
and characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best
for the patient's current needs.
B-1
Leak Sync
Changing inspiratory or expiratory sensitivity settings can temporarily correct the problem, but
requires continued frequent clinical intervention to ensure that sensitivity is adjusted appropri-
ately as conditions change (for example, if the patient moves or the circuit leak changes).
Leak Sync adds flow to the breathing circuit to compensate for leaks. The maximum Leak Sync
flow applies to the maximum base flow compensation during exhalation. During pressure-based
inspirations, the total delivered flow (leak flow plus inspiratory flow) is limited by the maximum
total flow.
Table B-1. shows the maximum leak rates at set PEEP pressure that Leak Sync will compensate
based on patient type.
Patient type Maximum leak compensation flow at PEEP Maximum total flow
Pediatric 40 L/min (25 L/min if compressor is the air source) 120 L/min
Adult 65 L/min (25 L/min if compressor is the air source) 200 L/min
WARNING:
With significant leaks, pressure targets may not be reached due to flow limitations.
Note:
The default value for Leak Sync is Disabled when the circuit type is pediatric or adult and the ventilation
type is invasive. Otherwise the default value for Leak Sync is Enabled.
Note:
Leak Sync is not allowed for tube compensated (TC) and Proportional Assist Ventilation (PAV+) breath
types.
• If the ventilator detects a leak during a respiratory mechanics maneuver, the message Leak Detected
is displayed.
• A new leak or change in leak rate is typically quantified and compensated within three breaths. Mon-
itored patient data stabilizes within a few breaths.
• Select inspiratory and expiratory sensitivity settings as usual. If the ventilator auto-triggers, try increas-
ing flow sensitivity (VSENS).
Note:
The absence of the Leak Detected message does not mean there is no leak.
Note:
Leak Sync is automatically enabled when ventilating a new patient and the circuit type is neonatal,
regardless of the ventilation type. If Leak Sync is disabled, it remains disabled when switching between
invasive and NIV ventilation types.
1 LS appears on vent setup button notifying the operator that Leak Sync is enabled
When Leak Sync is enabled, the CIRCUIT DISCONNECT alarm becomes active based on the DSENS
setting, which is the maximum allowable leak rate at set PEEP.
When Leak Sync is disabled, DSENS is automatically set to 75%.
WARNING:
When ventilation type = NIV and Leak Sync is disabled, DSENS is automatically set to OFF.
See Reference Chapter B-2 for a summary of DSENS settings when Leak Sync is enabled. Note that
it is possible to set DSENS below maximum Leak Sync flow.
Table B-2. DSENS Settings
WARNING:
Setting DSENS higher than necessary may prevent timely detection of inadvertent extubation.
When Leak Sync is enabled, three additional parameters are displayed on the More Patient Data
screen and updated for each breath. Display the More Patient Data screen by swiping the tab on
the patient data banner. These leak parameters may also be configured on the patient data
banner and the large font patient data panel.
See Table 11-11. on page 11-17 for information regarding the following monitored patient data
parameters:
• VLEAK
• % LEAK
• LEAK
Displayed values for exhaled tidal volume (VTE) and inspired tidal volume (VTL) are leak-compen-
sated, and indicate the estimated inspired or exhaled lung volume. The accuracies for VTE and VTL
also change when Leak Sync is enabled (see Technical Discussion (B.7) for more information).
Graphic displays of flow during Leak Sync indicate estimated lung flows.
Note:
Inspired tidal volume is labeled as VTL when Leak Sync is enabled, and as VTI when Leak Sync is disabled.
For accuracy when Leak Sync is enabled, see Table 11-13. on page 11-23, VTE parameter.
In Table 11-13. , TE= time to exhale 90% of volume actually exhaled by the patient.
For readings <100 mL, accuracy ranges apply when the percentage of inspiratory leak volume is
<80%, where the percentage of leak volume is:
(Leak volume during inspiration/total delivered inspiratory volume) ×100
The CIRCUIT DISCONNECT alarm is activated if the overall leak volume during the whole breath
exceeds the maximum leak volume derived from the DSENS setting. During VC, the CIRCUIT DIS-
CONNECT alarm is also activated if the end-inspiratory pressure falls below (set PEEP+1 cmH2O)
for three consecutive breaths. The screen shows this alarm message:
If the compressor is in use and the DSENS setting >25 L/min, a DSENSof 25 L/min is used to determine
that the circuit is disconnected. If LEAK >25 L/min, the alarm banner shows the following message:
Check patient. Reconnect circuit. Leak may exceed maximum compensation value for compressor.
Normal operation resumes if the ventilator detects a patient connection.
C.1 Overview
This appendix describes the operation of PAV™*+ software for the Puritan Bennett™ 980 Series
Ventilator.
Proportional Assist™* Ventilation (PAV+) is designed to improve the work of breathing of a spon-
taneously breathing patient by reducing the patient’s increased work of breathing when pul-
monary mechanics are compromised.
The PAV+ breath type differs from the pressure support (PS) breath type in the following way:
PAV+ acts as an inspiratory amplifier; the degree of amplification is set by the % Support setting
(% Supp). PAV+ software continuously monitors the patient’s instantaneous inspiratory flow
and instantaneous lung volume, which are indicators of the patient’s inspiratory effort. These
signals, together with ongoing estimates of the patient’s resistance and compliance, allow the
software to instantaneously compute the necessary pressure at the patient wye to assist the
patient’s inspiratory muscles to the degree selected by the % Supp setting. Higher inspiratory
demand yields greater support from the ventilator.
PAV+ software reduces the risk of inadvertent entry of incompatible settings, such as small pre-
dicted body weight (PBW) paired with a large airway.
*. Proportional Assist and PAV are registered trademarks of The University of Manitoba, Canada. Used under license.
C-1
PAV™+
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment, the
clinician should carefully select the ventilation mode and settings to use for that patient based on
clinical judgment, the condition and needs of the patient, and the benefits, limitations, and
characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best for
the patient's current needs.
WARNING:
PAV+ is not an available breath type in non-invasive ventilation (NIV). Do not use non-invasive
patient interfaces such as masks, nasal prongs, uncuffed ET tubes, etc. as leaks associated with
these interfaces may result in over-assist and patient discomfort.
WARNING:
Breathing circuit and artificial airway must be free from leaks. Leaks may result in ventilator over-
assist and patient discomfort.
WARNING:
Ensure high and low tidal volume alarm thresholds are set appropriately because an
overestimation of lung compliance could result in an under-support condition resulting in the
delivery of smaller than optimal tidal volumes.
C.4 PAV+
WARNING:
Ensure that there are no significant leaks in the breathing circuit or around the artificial airway
cuff. Significant leaks can affect the performance of PAV+ and the accuracy of resistance (R) and
elastance (E) estimates.
WARNING:
Do not use silicone breathing circuits with PAV+: the elastic behavior of a silicone circuit at the
beginning of exhalation can cause pressure-flow oscillations that result in underestimates of
patient resistance.
The act of inspiration requires the patient’s inspiratory muscles to develop a pressure gradient
between the mouth and the alveoli sufficient to draw in breathing gas and inflate the lungs. Some
of this pressure gradient is dissipated as gas travels through the artificial airway and the patient’s
conducting airways, and some of the pressure gradient is dissipated in the inflation of the lungs
and thorax. Each element of pressure dissipation is characterized by a measurable property: the
resistance of the artificial and patient airways, and the compliance (or elastance) of the lung and
thorax.
PAV+ software uses specific information, including resistance of the artificial airway, resistance of
the patient’s airways, lung-thorax compliance, instantaneous inspiratory flow and lung volume,
and the % Supp setting to compute the instantaneous pressure to be applied at the patient con-
nection port (patient wye). PAV+ software randomly estimates patient resistance and compliance
approximately every four to 10 breaths. Every 5 ms, the software estimates lung flow, based on an
estimate of flow at the patient wye, and lung volume, based on the integral of the value of esti-
mated lung flow.
PAV+ begins to assist an inspiration when flow (generated by the patient’s inspiratory muscles)
appears at the patient wye. If the patient ceases inspiration, the assist also ceases. Once inspiratory
flow begins, PAV+ software monitors instantaneous flow and volume every 5 ms and applies the
pressure calculated to overcome a proportion (determined by the % Supp setting) of the pressure
losses dissipated across the resistances of the artificial and patient airways and lung/thorax com-
pliance.
Because the PAV+ algorithm does not know the patient’s mechanics when the PAV+ breath type
is selected, the software performs a startup routine to obtain initial data. At startup, PAV+ software
delivers four consecutive PAV+ breaths, each of which includes an end-inspiratory pause maneu-
ver that yields estimates of the patient’s resistance and compliance. The first breath, however, is
delivered using the predicted resistance for the artificial airway and conservative estimates for
patient resistance and compliance, based on the patient’s PBW.
Each of the next three PAV+ breaths averages stepwise decreased physiologic values with the
estimated resistance and compliance values from the previous breath, weighting earlier esti-
mates less with each successive breath, and yielding more reliable estimates for resistance and
compliance. The fifth PAV+ breath (the first non-startup breath) is delivered using the final esti-
mates with the clinician-set % Supp setting. Once startup is complete, the PAV+ software ran-
domly applies a maneuver breath every four to 10 breaths after the last maneuver breath to re-
estimate patient resistance and compliance. New values are always averaged with former values.
PAV+ graphically displays estimates of patient lung pressure (intrinsic PEEP), patient compliance,
patient resistance, total resistance, total work of inspiration, patient work of inspiration, inspiratory
elastic work (an indicator of lung-thorax work), and inspiratory resistive work.
The % Supp setting ranges from a minimum of 5% (the ventilator performs 5% of the work of
inspiration and the patient performs 95%) to a maximum of 95% (the ventilator performs 95% of
the work and the patient performs 5%), adjustable in 5% increments.
PAV+ also includes alarm limits, safety checks, and logic checks that reject non-physiologic values
for patient resistance and compliance as well as inappropriate data.
Humidification type and volume can be adjusted after running SST, however the ventilator makes
assumptions when calculating resistance and compliance if these changes are made without re-
running SST. For optimal breath delivery, run SST after changing humidification type and humid-
ifier volume.
To set up PAV+
1. At the ventilator setup screen, enter the patient’s gender and height or the patient’s PBW.
7. Select the tube ID. Initially, a default value is shown based on the PBW entered at ventilator startup. If
this ID is not correct for the airway in use, turn the knob to adjust the ID setting.
Note:
If the operator selects an internal diameter that does not correspond to allowable values, touch
Continue to override the tube ID setting. If attempts are made to choose a tube ID less than 6.0 mm
or greater than 10 mm, a hard bound limit is reached, as PAV+ is not intended for use with tubes
smaller than 6.0 mm or larger than 10.0 mm. When touching Dismiss, the setting remains at the last
tube ID selected. Touch Accept or Accept ALL to accept changes, or touch Cancel to cancel changes.
Note:
If Leak Sync is currently enabled, it becomes disabled when PAV+ is selected.
Note:
When the ventilator is used on the same patient previously ventilated using PAV+, the GUI displays an
attention icon and the tube type and tube ID previously used, as a reminder to the clinician to review
those settings during ventilator setup.
The ventilator uses soft bound and hard bound values for estimated tube inside diameters based
upon PBW. Soft bounds are ventilator settings that have reached their recommended high or low
limits. When adjusting the tube size, if the inside diameter does not align with a valid predicted
body weight, a Continue button appears. Setting the ventilator beyond these soft bounds
requires the operator to acknowledge the prompt by touching Continue before continuing to
adjust the tube size. The limit beyond which the tube ID cannot be adjusted is called a hard
bound, and the ventilator emits an invalid entry tone when a hard bound is reached.
WARNING:
Ensure that the correct artificial airway ID size is entered. Because PAV+ amplifies flow, entering a
smaller-than-actual airway ID causes the flow-based pressure assistance to over-support the
patient and could lead to transient over-assist at high values of % Supp. Conversely, entering a
larger-than-actual ID results in under-support. PAV+ software monitors the settings for the PBW
and artificial airway. If the PBW and tube ID settings do not correspond to allowable values,
confirm or correct the settings. Confirming or correcting the actual ID size minimizes the likelihood
that PAV+ will over-support or under-support.
To apply new settings for the artificial airway follow these steps
1. Touch the vent setup button at the lower left of the GUI screen.
2. Touch Tube Type and turn the knob to select Trach or ET to set the tube type.
3. Touch Tube ID and turn the knob to set the tube ID.
4. Touch Accept or Accept ALL to apply the new settings, or Cancel to cancel.
3. For non-HME humidification types, touch Humidifier Volume, then turn the knob to adjust the (empty)
humidifier volume.
WARNING:
To ensure the accuracy of PAV+ breaths and spirometry measurements, run SST following any
change to the humidification type or humidification volume settings. Ensure that the intended
circuit is used with the SST.
After accepting the PAV+ settings, touch the Apnea Setup screen. Adjust the Apnea parameters
as required.
PAV+ includes the high inspired tidal volume (2VTI) and low exhaled spontaneous tidal volume
alarm (4VTE SPONT) alarm limit settings. See PAV+ Alarms (C.4.8) on page C-8.
Note:
Because of the breathing variability that PAV+ allows, the 4VTE SPONT alarm, by default, is turned OFF to
minimize nuisance alarms. To monitor adequate ventilation, use the 3VE TOT alarm condition instead.
To adjust alarm settings
1. Touch the Alarm tab to view the current alarm settings.
3. Turn the knob to adjust the value of the alarm limit. Proposed values are highlighted. You can change
more than one alarm limit before applying the changes.
For a summary of PAV+ ventilator settings for the following parameters, See Table 11-9. on page
11-7:
• % Supp
• Tube type
• Tube ID
• Trigger type
For a summary of the following alarm settings available when PAV+ is active, see Table 11-10. on
page 11-14:
• High inspired tidal volume limit (2VTI)
For the following monitored data associated with PAV+, see Table 11-11. on page 11-17:
• PAV-based lung compliance (CPAV)
25 0 to 50 2.5 to 29 34 to 400
35 0 to 44 3.5 to 41 24 to 286
45 0 to 31 4.5 to 52 19 to 222
55 0 to 24 5.5 to 64 16 to 182
65 0 to 20 6.4 to 75 13 to 156
75 0 to 18 7.4 to 87 11 to 135
85 0 to 17 8.4 to 98 10 to 119
For a summary of the following alarms associated with PAV+, see Table 6-5. on page 6-16:
• High circuit pressure (1PPEAK)
WARNING:
For optimal performance of PAV+, it is important to select the humidification type, tube type, and
tube size that match those in use on the patient.
The instantaneous pressure generated at the patient wye during inspiration is a function of the
patient effort, % Supp setting, tube type and size, patient resistance and elastance, and the instan-
taneously measured gas flow and lung volume. Set 2PPEAK to a safe circuit pressure, above which
truncation and alarm annunciation are appropriate.
Note:
PAV+ has a built-in high pressure compensation (2PCOMP) limit that is determined by the2PPEAK setting
minus 5 cmH2O or 35 cmH2O, whichever is less. If the inspiratory pressure at the patient wye (Piwye) reaches
the 2PCOMP limit, the inspiration is truncated, and the ventilator transitions to exhalation. See page C-17 for
more details regarding 1PCOMP and 1PPEAK.
Performance using PAV+ is ±0.5 Joules/liter (J/L), compared to measured, work during inspiration
at the 75% support (% Supp) level. Work is computed over the entire inspiratory interval. In venti-
lation terms, work (W) is expressed as:
k × ( P × V· ) dt
i i
W = -------------------------------------
-
· i dt
V
When PAV+ is active (the mode is SPONT and the spontaneous breath type is PAV+), a work of
breathing (WOB) graphic is automatically displayed (see Figure C-2. ), which shows:
• An indicator showing the proportion of patient inspiratory work to overcome the elastance (E) of the
lung-thorax and the combined resistance (R) of the artificial airway and the patient.
• Estimates of work of breathing relative to normal, subnormal, and above-normal values, including:
– The estimated total work of breathing (in Joules/L) of the patient and ventilator during inspiration
(WOBTOT).
• PAV-based patient data estimates, including patient resistance (RPAV), lung compliance (CPAV), and
intrinsic PEEP (PEEPI PAV)
Note:
Graphic displays of lung pressure and patient work of breathing are not actual measurements, and are
derived from equations using filtered estimates of pressure and flow.
The WOB graphic is only available when SPONT mode and the PAV+ breath type are selected. The
shadow trace can be enabled or disabled when selecting the graphic display, or after a display is
paused.
The act of pausing does not affect the WOB graphic, but does store the shadow trace. Once
paused, the operator can enable or disable the shadow trace, then view the paused waveform
again with or without the shadow trace.
Table C-2. provides a definition and description of each of the work of breathing (WOB) terms.
WOBTOT Total work of inspiration With the PAV+ breath type active,
the patient and the ventilator
always share the in the work of
breathing. The percent WOBTOT
performed by the ventilator
always equals the % Supp setting
and the percent WOBTOT per-
formed by the patient always
equals (100 minus the % Supp
setting). WOBTOT is the sum of the
work to move the breathing gas
through the artificial airway and
the patient's own airways plus the
work to inflate the patient's elastic
lung-thorax.
WOBPT RESISTIVE Inspiratory resistive work That part of the WOBPT attributed
to moving breathing gas through
resistive elements in the gas path.
When PAV+ is selected, the ventilator acts as an inspiratory amplifier, proportionally assisting the
pressure generating capability of the inspiratory muscles (PMUS).
During spontaneous breathing, PMUS generates a pressure gradient that drives breathing gas
through the artificial airway and the patient’s airways and into the elastic lung-thorax, and is
described by the equation of motion:
EQUATION 1
PMUS Pressure generating capability of R Resistance elements (artificial plus patient air-
patient’s inspiratory muscles ways)
VL Flow through the resistance elements ELUNG-THORAX Elastance of the lung and thorax (1/CLUNG-THORAX)
and into the lungs
If the PAV+ software estimates of patient resistance and elastance (RPAV and (EPAV) remain stable,
this equation could be rewritten as:
EQUATION 2
P MUS = V· L × R airway + V· L × K 1 + V L × K 2
i i i i i
K2 EPAV
PiMUS could then be estimated at every control period if ViL, Riairway, and ViL were also known.
Throughout any inspiration, the individual pressure elements that make up PMUS can be
expressed as:
EQUATION 3
PMUS Pressure generating capability of PFLOWPATIENT Flow based pressure drop across the
patient’s inspiratory muscles patient
PFLOWARTIFICIAL Flow based pressure drop across PVOLUMEPA- Volume based pressure to overcome the
the artificial airway TIENT lung-thorax elastance
AIRWAY
Equations 2 and 3 provide the structure to explain how PAV+ operates. The clinician enters the
type and size of artificial airway in use, and the software uses this information to estimate the resis-
tance of the artificial airway at any lung flow.
Applying a special pause maneuver at the end of selected inspirations provides the information
the software needs to estimate patient resistance (RPAV) and compliance (CPAV, which is convert-
ed to elastance, EPAV). Immediately following the end of the pause event, software captures simul-
taneous values for PLUNG, Pwye, and VE which yield an estimate for RTOT at the estimated flow.
All raw data are subjected to logic checks, and the estimates of RPAV and CPAV are further subject-
ed to physiologic checks. The estimates of RPAV and CPAV are discarded if any of the logic or phys-
iologic checks fail. If CPAV is rejected, RPAV is also rejected.
Valid estimates of RPAV and CPAV are required for breath delivery, and are constantly updated by
averaging new values with previous values. This averaging process smooths data and avoids
abrupt changes to breath delivery. If new values for RPAV and CPAV are rejected, the previous
values remain active until valid new values are obtained. PAV+ software monitors the update
process and generates an escalating alarm condition if the old values do not refresh.
During PAV+, maneuver breaths are randomly performed every four to 10 breaths after the last
maneuver breath. A maneuver breath is a normal PAV+ inspiration with a pause at end inspiration.
Because muscle activity is delayed for at least 300 ms following the end of neural inspiration, the
patient’s respiratory control center does not detect the pause. With this approach, maneuver
breaths are delivered randomly so that their occurrence is neither consciously recognized nor
predictable.
A PAV+ breath begins, after the recognition of a trigger signal, with flow detection at the patient
wye. The sample and control cycle of the ventilator (the value of i in Equation 2) is frequent
enough to yield essentially constant tracking of patient inspiration. At every ith interval, the soft-
ware identifies instantaneous lung flow (ViL), which is impeded by the resistances of the artificial
airway and patient airways) and integrates this flow to yield an estimate of instantaneous lung
volume, (ViL), which is impeded by the elastic recoil of the lung and thorax).
Using the values for instantaneous lung flow and lung volume, PAV+ software calculates each of
the pressure elements in Equation 2, which gives the value of PMUS at each ith interval.
At this point, Equation 2 and the subsequent analysis identifies that an appropriate patient, sup-
ported by PAV+ and with an active PMUS (an absolute requirement) will, within a few breaths,
enable the algorithm to obtain reasonable estimates of RPAV and EPAV. Once these physiologic
data are captured (and over a relatively brief time as they are improved and stabilized), the PAV+
algorithm mirrors the patient's respiratory mechanics, which then allows the ventilator to harmo-
niously amplify PMUS. The key point to recognize is that patient's continuous breathing effort
“drives” the PAV+ support—no effort, no support.
The % Supp setting specifies the amount of resistance- and elastic-based pressure to be applied
at each ith interval at the patient wye.
By taking all of the above information into consideration, EQUATION 2 can be rewritten to include
the% Supp setting recognizing that ViL and ViL are driven by the patient, not by the ventilator. (It
is important to note that the ventilator is not amplifying its own flow—only the flow generated
by PMUS.)
EQUATION 4
P wye = S ( V· L × R airway ) + S ( V· L × K 1 ) + S ( V L × K 2 )
i i i i i
Piwye Pressure generated by the ventilator in S % Supp setting/100 (ranges from 0.05 to
response to the instantaneous values of 0.95
lung flow and lung volume at the wye.
This value is the sum of the three individu-
al pressure elements (in parentheses) in
Equation 4
The pressure gradient driving breathing gas into the patient’s lungs is given by the sum of Piwye
and the patient’s inspiratory effort, therefore:
EQUATION 5
i i i
ΔP GRADIENT = P wye + P MUS
PAV+ software is designed to reduce the risk that hyperinflation may occur. The potential for
hyperinflation could arise if the software were to overestimate actual patient resistance or under-
estimate actual patient lung-thorax compliance (that is, to overestimate actual elastance). If the
software cannot generate valid estimates of RPAV and CPAV, PAV+ cannot start. If, after startup, the
values of RPAV and CPAV cannot be updated with valid new values, the previous values become
less reliable.
The stability of PAV+ is primarily determined by the relationship between the true lung elastance
[EL (true)] and the true lung volume [VL(true)]. Although Piwye (resistive) also plays a part, the fol-
lowing discussion focuses on the elastic component.
At all lung volumes, the true state of the lung and thorax is expressed by:
i i
P L recoil = V L ( true ) × E L ( true )
PiL recoil True lung recoil pressure EL (true) True lung elastance
Over-inflation will not occur as long as Piwye (elastic)<PiL recoil, which is equivalent to the inequal-
ity:
where:
K2=EPAV1
As long as EPAV (estimated) = EPAV (true) and ViL (estimated)=ViL (true) then Pirecoil>Piwye even at
high values of % Supp (i.e. between 85% and 95%).
This means that if the pressure applied to the lung-thorax is never greater than EL (true)× VL, lung
volume will collapse if wye flow vanishes. As long as EPAV (estimated)≤EL (true), ViL (estimated)≤ViL
(true), and RPAV (estimated) ≤ RL(true), PMUS is the modulator of Piwye.
Hyperinflation could occur if the estimated EPAV were greater than the true value of EL. At a high
% Supp setting, Piwye (elastic) could exceed PiL recoil, causing a self-generating flow at the patient
wye, which in turn would cause a self-generating inflation of the lungs. This is part of the reason
that the % Supp setting is limited to 95%.
Likewise, if the estimated RPAV were to exceed the true value of RL at a high % Supp setting, Piwye
(resistive) could exceed the value necessary to compensate for pressure dissipation across the
artificial and patient airways, resulting in early hyperinflation of the lungs. As flow declines after
the first third of inspiration, however, the hyperinflating effect would most likely disappear.
PAV+ software includes these strategies to minimize the possibility of hyperinflation of the lungs:
1. The maximum % Supp setting is limited to 95%.
2. The raw data for RPAV and CPAV are checked for graph/math logic, and estimated mechanics values are
checked against PBW-based physiologic boundaries. These checks reduce the possibility of overesti-
mating patient resistance or underestimating patient compliance, which could lead to potential over-
inflation.
3. The high inspiratory tidal volume limit (2VTI) places an absolute limit on the integral of lung flow
(including leak flow), which equals lung volume. If the value of VTI reaches this limit, the ventilator trun-
cates inspiration and immediately transitions to exhalation.
4. The (2VTI) setting places an upper limit on the value of the PVOLUMEPATIENT component of Piwye (see
Equations 3 and 4). At the beginning of each new inspiration, PAV+ software calculates a value for
PVOLUMEPATIENT as follows:
where P*wye is the unique value for the elastic threshold limit of Piwye that will cause the lung volume
to expand to 75% of (2VTI). When Piwye (elastic)=P*wye (elastic threshold limit), the software stops
increasing Piwye (elastic). This means that any further increase in lung volume must be accomplished
by the patient, which tends to hasten the conclusion of inspiratory effort and avoid truncation due to
lung volume reaching the 2VTI limit.
5. The high inspiratory pressure limit (2PPEAK) applies to all breaths, and is used by PAV+ software to
detect the high compensation pressure condition (1PCOMP):
If the user-adjustable 2PPEAK limit is reached, the ventilator truncates inspiration and immediately tran-
sitions to exhalation. If Piwye (the targeted wye pressure calculated in Equation 4) equals the 1PCOMP
for 500 ms, the inspiration is truncated and exhalation begins. Further, when Piwye=1PCOMP, Piwye is
limited to 1PCOMP. Although this freezes the value of Piwye, patient activity such as coughing could
drive Piwye to 2PPEAK, causing inspiration to end.
The rapid rise of Piwye to the 1PCOMP limit would likely occur in the first third of inspiration, and only if
RPAV were overestimated and % Supp were set above 85%. The 1PCOMP condition guards against over-
inflation due to overestimation of RPAV.
6. The % Supp setting ranges from 5% to 95% in 5% increments. Reducing the level of support decreases
the possibility of over-inflation. A significant decrease could produce a sensation of inadequate sup-
port, and the patient would absorb the additional work of inspiration or require an increase in the level
of support.
A significant increase could cause a surge in the ventilator generated value for Pwye, which in turn
could cause Piwye to reach 2PCOMP and lead to temporary patient-ventilator disharmony. To minimize
this possibility, PAV+ software limits the actual increase in support to increments of 10% every other
breath until the new setting is reached.
7. Spirometry remains active during PAV+ operation. 2VTI can be set high enough to allow spontaneous
sigh breaths, while 4VE TOT and 2VE TOT remain active to reveal changes in minute ventilation.
Because PAV+ cannot operate without valid estimates of RPAV and CPAV, and because those values are
unknown when PAV+ starts, a startup routine obtains these values during four maneuver breaths that
include an end inspiratory pause that provides raw data for RPAV and CPAV, and both estimated values
must be valid. If either value is invalid during any of the four startup breaths, the software schedules a
substitute maneuver breath at the next breath. See PAV+ (C.4) on page C-2.
A low-priority alarm becomes active if a 45-second interval elapses without valid estimates for RPAV
and CPAV. If the condition persists for 90 seconds, the alarm escalates to medium-priority. If the condi-
tion persists for 120 seconds, the alarm escalates to high priority. The 3VE TOT and1fTOT alarms are also
associated with this condition.
Similarly, if RPAV and CPAV cannot be updated with valid values after a successful PAV+ startup, a low-
priority alarm is activated if the condition persists for 15 minutes. If the values still cannot be updated
with valid values after 30 minutes, the alarm escalates to medium priority.
8. If PAV+ estimates a high lung resistance following a sharp spike in the expiratory flow waveform, then
a PBW-based resistance value is used. See Figure C-3. and Table C-3.
D.1 Overview
This appendix describes how to use NeoMode 2.0 software on the Puritan Bennett™ 980 Neo-
natal Ventilator. NeoMode 2.0 enables the use of the ventilator with neonatal patients and is
included with all Puritan Bennett™ 980 Neonatal Ventilators and Puritan Bennett™ 980 Universal
Ventilators. For a Puritan Bennett™ 980 Pediatric–Adult ventilator to be used with neonatal
patients, the NeoMode 2.0 software option must be installed.
D.3 Description
The ventilator determines values for operational variables and allowable settings based on
breathing circuit type and predicted body weight (PBW). The PBW range for neonates is 0.3 kg
to 7.0 kg (0.66 lb to 15 lb). Software controls prevent inadvertent mismatching of patient size
and breathing circuit type. A neonatal breathing circuit connects to a neonatal exhalation filter
that must be used with the neonatal adapter door assembly.
Note:
To enable NeoMode 2.0, select the neonatal breathing circuit type in SST. Breathing circuit type can only
be changed during SST.
WARNING:
The Puritan Bennett™ 980 Series Ventilator contains phthalates. When used as indicated, very
limited exposure to trace amounts of phthalates may occur. There is no clear clinical evidence
D-1
NeoMode 2.0
that this degree of exposure increases clinical risk. However, to minimize risk of phthalate
exposure in children and nursing or pregnant women, this product should only be used as
directed.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment, the
clinician should carefully select the ventilation mode and settings to use for that patient based on
clinical judgment, the condition and needs of the patient, and the benefits, limitations, and
characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best for
the patient's current needs.
WARNING:
Neonatal patients are at risk for hypercarbia or hypoxemia during 3VE TOT alarm conditions.
WARNING:
Disabling the low exhaled minute volume (3VE TOT) alarm increases the patient’s risk of
hypercarbia or hypoxemia.
WARNING:
When using NIV, the patient’s exhaled tidal volume (VTE) could differ from the ventilator’s
monitored patient data value for VTE due to leaks around the interface. To avoid this, ensure Leak
Sync is enabled.
WARNING:
Removing the exhalation filter while the patient is connected to the ventilator can cause a loss of
circuit pressure, ventilator autotriggering, or direct contact with liquid.
Caution:
Do not pull on the door while the exhalation filter latch is closed, as damage to the ventilator can
result.
Note:
See the inspiratory filter and exhalation filter instructions for use for information on filtration efficiency and
filter resistance.
To install the neonatal adapter door
1. Remove the expiratory limb of the patient circuit from the exhalation filter.
3. Remove the existing exhalation filter door by lifting it off of the pivot pins.
WARNING:
To ensure all breathing circuit connections are leak-tight, perform a circuit-leak test by running
SST every time the filter is installed. The circuit-leak test can be performed as an individual test
from the SST startup screen.
WARNING:
Empty the condensate vial before the liquid level reaches the maximum fill line. Condensate vial
overflow can enter the filter or the breathing circuit, and can cause increased expiratory flow
resistance. Change the filter if it appears to be saturated.
WARNING:
The neonatal exhalation filter and condensate vial is a single unit and is for single-patient use,
only. Do not attempts to sterilize the filter assembly.
WARNING:
Adding accessories to or removing accessories from the VBS can change the pressure gradient
across the VBS and affect ventilator performance. Ensure that any changes to the ventilator circuit
configurations do not exceed the specified values for circuit compliance and for inspiratory or
expiratory limb total resistance. See Table 11-4. on page 11-3. If adding accessories to or removing
accessories from the VBS, always run SST to establish circuit compliance and resistance prior to
ventilating the patient.
Note:
If the ventilator has not reached operating temperature from recent usage, allow it to warm up for at least
15 minutes before running SST to ensure accurate testing.
Note:
Check the inspiratory and expiratory limbs of the breathing circuit and in-line water traps regularly for
water buildup. Under certain conditions, they can fill quickly. Empty and clean the in-line water traps as
necessary. See the manufacturer’s IFU for additional information.
WARNING:
To avoid liquid entering the ventilator, empty the condensate vial before the liquid level reaches
the maximum fill line.
The condensate vial assembly is integrated with the neonatal exhalation filter and does not
contain a drain port. Empty the condensate vial when liquid reaches the maximum fill line.
To empty the condensate vial
1. While holding the exhalation filter, twist the condensate vial clockwise approximately one quarter turn
to remove it.
2. Remove the condensate vial by carefully lowering the vial all the way down to the base of the exhala-
tion compartment and then sliding it out.
4. Replace the condensate vial by carefully sliding the vial into position, lifting it upward to the filter
assembly, and turning counterclockwise until it reaches the stop.
Note:
Condensate vial removal may cause the loss of system pressure and a disconnect alarm to sound.
WARNING:
Use one of the ventilator breathing circuits listed. See Table D-1. on page D-7 or their equivalent.
This ensures that maximum pressure and flow values specified by
EN794-1 are not exceeded. Using a circuit with a higher resistance does not prevent ventilation,
but can cause an SST fault or compromise the patient’s ability to breathe through the circuit.
See Figure D-2. on page D-6 to connect the breathing circuit.
5 Condensate vial
Table D-2. lists allowable ventilator settings when using NeoMode and ventilating invasively and
non-invasively.
WARNING:
Always run SST prior to patient ventilation, ensuring that all accessories used during ventilation
are in the ventilator breathing system when SST is run. This ensures correct calculation of
compliance and resistance. See SST (Short Self Test) (3.9.1) on page 3-41 for more information.
See Predicted Body Weight (PBW) Calculation (4.6) on page 4-19 for references to tables of PBW
values associated with patient length in centimeters and inches, respectively.
D.8.2 Elevate O2
In NeoMode 2.0, the elevate O2 control works as described in Chapter 3, except when the venti-
lator is in Stand-By or circuit disconnect states. If the elevate O2 function is used during these con-
ditions, the value chosen for elevate O2 applies to the currently delivered oxygen concentration
(which is 40% O2 in these states) and not the set oxygen concentration.
When using NeoMode 2.0 and ventilating with non-invasive ventilation (NIV), a separate CPAP
mode allows spontaneous breathing with a desired PEEP level. To limit inadvertent alarms asso-
ciated with the absence of returned volumes in CPAP breathing, CPAP does not make volume
alarms available. As some neonates don’t trigger breaths, the default apnea interval, TA, is set to
OFF. Also, some settings changes will initiate a PEEP restoration breath before phasing in those
changes.
Note:
In CPAP, apnea time,TA, can be adjusted, if desired. It merely defaults to OFF to avoid inadvertent alarms.
The message “APNEA DETECTION DISABLED” is displayed at the bottom of the GUI screen. The attention
icons are also displayed.
To set the ventilator for CPAP
1. Select New Patient from the ventilator’s startup screen or touch the Vent Setup button.
4. Touch CPAP.
5. Touch each ventilator setting and turn the knob to select the appropriate ventilator settings. When fin-
ished, touch START or Accept ALL.
6. Complete the setup by setting the apnea parameters and alarm limits from their respective tabs.
Entering CPAP mode from other ventilation modes or ventilation types requires using the NIV
ventilation type. Non-invasive Ventilation (NIV) (4.7) on page 4-20 explains how the ventilator tran-
sitions from invasive to NIV ventilation type.
To enter CPAP mode for an existing patient
1. Touch the Vent Setup button at the lower left of the GUI screen.
Note:
Exhaled minute volume (VE TOT), exhaled tidal volume (VTE SPONT), and inspired tidal volume (VTI) alarms are
disabled upon entry into CPAP.
When changing the mode from CPAP to any other mode, several transition rules take effect:
• The VE TOT, VTE MAND, VTE SPONT, and VTI alarms are set to their respective new patient defaults.
• The apnea interval TA changes from OFF to an apnea interval of 10 s and the new setting is phased in
immediately.
• The VE TOT, VTE MAND, VTE SPONT, and VTI alarm sliders appear in the alarm settings screen according to
their applicability to the selected mode.
See Compliance Compensation in Volume-based Breaths (10.6.1) on page 10-10 for a complete dis-
cussion of compliance compensation. Compliance compensation in NeoMode 2.0 is implement-
ed as described in the aforementioned reference.
Note:
If the patient’s compliance decreases beyond the limits of compliance compensation, the ventilator relies
on the 2PPEAK alarm setting to truncate the breath and switch to exhalation.
WARNING:
Monitor the patient closely if alarms are disabled. There are no audible or visual annunciations for
out-of-range conditions when volume, pressure, or apnea alarms are disabled (turned OFF).
See Table 11-9. Table 11-10. and Table 11-11. for the minimum and maximum ranges for each
ventilator setting, alarm setting, or data value. Most settings, however, are also limited by other
settings or conditions (for example, a low alarm limit is always limited by the corresponding high
alarm limit). Review the prompt area when making settings changes.
Volume accuracy testing in VC+ was conducted to demonstrate performance of delivered and
monitored parameters. Table D-3. , Table D-4. , and Table D-5. provide a summary of the actual
results obtained within the range of 2 mL to 25 mL collected during test execution.
The first column (Set tidal volume) represents the desired volume setting in milliliters (mL). The
second column represents the total number of test points for test cases executed at that specific
setting. The third column is the mean (mean value) of the ventilators and test cases executed for
the setting listed. The fourth column represents the standard deviation (SD) of measurements
taken for the ventilators and test cases executed at the setting listed.
The measurements were taken using instrumentation located at the patient-connection port.
Accessories such as filters and humidifiers were in the circuit during the test. Values were BPTS and
compliance compensated. A sample size of five ventilators was used to conduct the testing.
Testing was conducted at ambient temperature of 22°C ±5°C.
Set tidal volume (mL) Number of test points Mean value (mL) SD
Set tidal volume (mL) Number of test points Mean value (mL) SD
Set tidal volume (mL) Number of test points Mean value (mL) SD
E.1 Overview
This appendix describes the operation of the Proximal Flow option for the Puritan Bennett™ 980
Series Ventilator. The Proximal Flow option is solely used for monitoring flows, pressures, and
tidal volumes and does not control these parameters in any way.
The proximal flow sensor is designed to measure the lower flows, pressures and tidal volumes
at the patient wye typically associated with invasively ventilated neonatal patients.
For general parameter and general ventilator setup information, see Chapter 4.
WARNING:
The Puritan Bennett™ 980 Series Ventilator contains phthalates. When used as indicated, very
limited exposure to trace amounts of phthalates may occur. There is no clear clinical evidence
that this degree of exposure increases clinical risk. However, to minimize risk of phthalate
exposure in children and nursing or pregnant women, this product should only be used as
directed.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient's treatment,
the clinician should carefully select the ventilation mode and settings to use for that patient
based on clinical judgment, the condition and needs of the patient, and the benefits, limitations,
and characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best
for the patient's current needs.
E-1
Proximal Flow
WARNING:
Inspect the proximal flow sensor prior to use, and do not use it if the sensor body, tubing, or
connector are damaged, occluded, or broken.
WARNING:
Do not use the proximal flow sensor if there are kinks in the tubing.
WARNING:
Prior to patient ventilation with the Proximal Flow option, run SST with the exact configuration
that will be used on the patient. This includes a neonatal patient circuit, proximal flow sensor, and
all accessories used with the patient circuit. If SST fails any proximal flow sensor test, check the
patient circuit and the proximal flow sensor for leaks or occlusions and replace the flow sensor, if
necessary. If SST continues to fail, it may indicate a malfunction or a leak within the proximal flow
hardware which could compromise accuracy or increase the likelihood of cross-contamination;
thus, replace the Proximal flow hardware.
WARNING:
Changing ventilator accessories can change the system resistance and compliance. Do not add or
remove accessories after running SST.
WARNING:
If the Proximal Flow option fails to respond as described in this appendix, discontinue use until
correct operation is verified by qualified personnel.
WARNING:
The Proximal flow sensor measures gas flow at the patient wye. The actual volume of gas delivered
to the patient may be affected by system leaks between the patient and the proximal flow sensor,
such as a leak that could occur from the use of an uncuffed endotracheal tube.
WARNING:
Position the proximal flow sensor exactly as described in this appendix or the IFU provided with
the sensor.
WARNING:
Do not position the Proximal flow sensor cables or tubing in any manner that may cause
entanglement, strangulation or extubation which could lead to hypercarbia or hypoxemia. Use
the cable management clips supplied to mitigate this risk.
WARNING:
To reduce the risk of extubation or disconnection, do not apply tension to or rotate the proximal
flow sensor by pulling on the proximal flow sensor’s tubing.
WARNING:
Do not install the proximal flow sensor in the patient circuit if the sensor is not also connected to
the BDU.
WARNING:
Excessive moisture in the proximal flow sensor tubing may affect the accuracy of the
measurements. Periodically check the sensor and tubing for excessive moisture or secretion build-
up.
WARNING:
The proximal flow sensor is intended for single use only. Do not re-use the sensor. Attempts to
clean or sterilize the sensor may result in bioincompatibility, infection, or product failure risks to
the patient.
WARNING:
Install the proximal flow sensor as shown. See Figure E-6. on page E-11. Improper orientation of
the flow sensor could lead to misinterpretation of data or incorrect ventilator settings.
Caution:
Do not use aerosolized medications with the proximal flow sensor. Such medications may damage
the sensor.
Caution:
To prevent damage to pneumatic lines, use supplied cable management clips.
Caution:
Use only Covidien proximal flow sensors with the Proximal Flow option.
Proximal flow sensor — The proximal flow sensor is required for use with the Proximal Flow option. The
sensor is installed near the patient circuit wye. The other end of the sensor connects to the ventilator’s
front panel behind a clear door designed to protect the connection point from exposure to spills or
from sprayed liquids during cleaning and disinfection. See Figure E-1.
Proximal Flow option hardware installation must be performed by qualified service personnel,
using separate installation instructions (part number 10084704).
Inspired and exhaled flows and volumes at the patient wye are measured and identified by the
symbols shown below, and correspond to their non-proximal flow equivalents. These values
appear in the patient data panel if so configured. See Vital Patient Data, page 3-37, and Figure E-2.
VTE SPONTY Exhaled spontaneous tidal volume (at patient circuit wye)
VTE MANDY Exhaled mandatory tidal volume (at patient circuit wye)
VTLY Inspired tidal volume (at patient circuit wye with Leak Sync enabled)
Note:
In the patient data symbols shown in Figure E-2. , the “Y” appears in inverse video, as shown.
Note:
When the Proximal Flow and Leak Sync functions are enabled, the following parameters are available for
display:
• VTLY and VTL
When only the Proximal Flow option is enabled, VTIY and VTI are available for display
When a “Y” appears in the symbol, the data are measured with the proximal flow sensor. When a “Y” is
absent from the symbol, the data are measured by the ventilator’s internal flow sensors.
During autozero or automatic purge processes, the pressure waveforms, when shown display the
current PEEP value and the flow waveform, when shown, displays a value of 0.
Note:
Failure of the ventilator to pass SST does not prevent ventilation, but will prevent measurement with the
proximal flow sensor. The ventilator will use its internal flow sensors for measurement instead of the
proximal flow sensor.
SST Flow Sensor Cross Check Tests O2 and air flow sensors N/A
SST Exhalation Filter Checks for exhalation filter occlu- Ventilator prompts the user to
sion and exhalation compart- block the proximal flow sensor
ment occlusion. outlet during the leak test. When
prompted to reconnect the
patient to the exhalation filter
during the exhalation filter test,
resume blocking the proximal
flow sensor outlet.
During SST the ventilator prompts to attach the proximal flow sensor.
To attach the proximal flow sensor to the patient circuit
1. Verify the proximal flow sensor, pneumatic lines, and connector are not damaged.
2. Open the connector panel door and firmly attach the sensor connector to the receptacle in the BDUs
front connector port labeled Prox Flow.
4. When prompted to attach the proximal flow sensor, unblock the circuit wye and insert the smaller end
of the sensor into the wye.
5. When prompted, cap or seal the larger end of the sensor (marked with “UP” and an arrow).
If SST fails, check the patient circuit and flow sensor connections for leaks or occlusions and
replace the proximal flow sensor, if necessary. Replace the Proximal Flow option hardware if SST
continues to fail, then repeat SST to determine circuit compliance and resistance. See the Puritan
Bennett™ 980 Series Ventilator Hardware Options Installation Instructions, p/n 10084704 for instruc-
tions on replacing the Proximal Flow option hardware.
2. Touch the Options tab. A screen appears containing the Installed Options and Prox tabs.
Note:
If the Proximal Flow option has been disabled or enabled, SST does not have to be re-run unless the
breathing circuit or other breathing system accessories have been changed, removed, or added.
2. Open the connector panel door and firmly attach the sensor connector to the right-most receptacle
in the BDU’s front connector port labeled Prox Flow. See Figure E-4. on page E-9.
To attach the proximal flow sensor between the endotracheal tube and patient circuit
1. Connect the larger end of the sensor (marked with “UP” and an arrow) to the endotracheal tube. See
Figure E-6. Do not force the connection; when the sensor is oriented correctly, insertion requires little
effort.
Note:
If using a heat-moisture exchanger (HME) on the endotracheal tube, place the proximal flow sensor
between the HME and the breathing circuit wye.
2. Connect the smaller end of the sensor to the breathing circuit wye.
3. Ensure that the sensor tubing is positioned in an upward direction, as shown in Figure E-6. If the sensor
needs repositioning, DO NOT rotate it by pulling on the tubing. Reposition as follows:
a. Grasp the sensor’s plastic body with one hand and the breathing circuit wye with the other hand.
b. Rotate the sensor body and wye towards each other until the sensor tubing is upright.
c. Confirm a tight connection between the sensor and breathing circuit wye.
4. Use the three cable management clips provided with the sensor to attach the sensor tubing to the
breathing circuit tubing. Space the clips evenly along the length of the sensor tubing. Twist the ends
of each clip to close.
Note:
When the ventilator is set up for Proximal Flow option operation, the proximal flow sensor can be
switched as necessary. There is no need to run SST after switching sensors unless the breathing circuit
or other ventilator accessories have been changed.
A manual purge may be performed any time the sensor lines contain excessive condensation,
moisture, or secretions.
To perform a manual purge
1. Touch the configure icon on the in the constant access icons area of the GUI.
2. Touch the Options tab. A screen appears containing the Installed Options and Prox tabs.
4. Touch Start that appears next to the text “Prox Manual Purge: To begin touch the Start button”. During
the purge, a message appears in the GUI prompt area stating the purge process is being performed.
See Figure E-3. on page E-7.
Figure E-7. Manual Purge
E.11 Alarms
If the Proximal Flow option becomes inoperable during ventilation, the ventilator annunciates an
alarm and flow sensing reverts to the ventilator’s internal delivery and exhalation flow sensors.
This switch over may be triggered by any of the following events:
• The proximal flow sensor is not detected.
• There is a communication failure between the ventilator and the Proximal Flow option.
If any of these conditions occur, the GUI displays an alarm message similar the one shown in
Figure E-8. Follow the information contained in the remedy message to troubleshoot the alarm.
Measurement Accuracy1
Parameter Specification
Weight 6.6 g
F.1 Overview
This appendix describes the operation of the Puritan Bennett™ 980 Series Ventilator Trending
function.
Trending is a graphically-based ventilator function allowing a combination of a total of six
patient data parameters or ventilator settings to be plotted vs. time. Viewing these data allows
the clinician to determine the effectiveness of the patient’s therapy.
WARNING:
The ventilator offers a variety of breath delivery options. Throughout the patient’s treatment,
the clinician should carefully select the ventilation mode and settings to use for that patient
based on clinical judgment, the condition and needs of the patient, and the benefits, limitations,
and characteristics of the breath delivery options. As the patient's condition changes over time,
periodically assess the chosen modes and settings to determine whether or not those are best
for the patient's current needs.
F-1
Trending
2. Swipe the Menu tab on the left side of the GUI and touch Trending. The default layout appears with
two trended parameters displayed on a 2-hour time scale. Alternatively, touch the layout icon and
touch Trending on the Graphs tab. The default layout appears with two trended parameters displayed
on a 2-hour time scale.
3. Select the parameters to be trended by double-tapping the trended parameter name at the top of the
graph or choose Presets, which automatically populates trended items with preset trended parame-
ters. See Trending Presets (F.8) on page F-10. If you desire a different layout than the two-parameter
default, touch Custom 2 and a drop-down list appears with layouts for one, two, three, four, or six
parameters. Choose the trended parameters for each graph by double-tapping the parameter. A list
of buttons appears with arrows to let you know more parameters may be selected. Touch the desired
button for the parameter to be trended.
To exit Trending
1. Touch the layout icon, then touch any of the waveform layout buttons (1 through 5). The screen will
exit the Trending layout and return to displaying the selected waveforms.
PEEP [PEEP]
Rise Time%
[ ]
Vital Capacity VC
Note:
If a trend parameter is not selected for a particular graph, the minimum and maximum values appear as
dashes (- -).
Eight time scales are available. Time scales of 1, 2, 4, 8, 12, 24, 48, and 72 hours can be viewed. The
time scale is indicated by the slider track at the bottom of the Trending screen. The complete
slider track represents a 72-hour time interval, and the blue shuttle that slides along the track rep-
resents the selected time scale. The selected time scale applies to all displayed trend graphs.
Although data are sampled at periodic intervals, as shown in Table F-3. , the GUI screen is
refreshed every minute for any time scale selected.
1 hour 10 seconds
2 hours 20 seconds
4 hours 40 seconds
8 hours 80 seconds
12 hours 2 minutes
24 hours 4 minutes
48 hours 8 minutes
72 hours 12 minutes
2. Turn the knob to select a time scale. Turning the knob clockwise reduces the time scale, and turning
it counter-clockwise increases the time scale. The relative size of the shuttle indicates the time interval
selected, and the time interval is displayed along the x-axis.
After each time scale change, the graphs refresh with updated parameter values for that time
scale.
F.7.2 Events
Events are either automatic or manual and appear as vertical tick marks on the trend graph
according to their time of occurrence. When the cursor hovers over a tick mark, Event Details
changes from unselectable (gray) to a button containing the event ID numbers associated with
the tick mark. Touching this button causes a dialog to appear with the event ID and its description.
If many IDs are present for a selected time stamp, the user is notified by an ellipsis (…) indicating
more IDs are present.
When the operator modifies the real time clock setting, the system places an event marker in the
trend log to denote a time or date change. The time stamp of this automatic event will be the new
time setting.
Note:
The events listed in Table F-4. are subject to change.
Table F-4. Events
Event ID Description
Manual events
1 Suction
2 Rx: Bronchodilator
3 Rx: Antihistamine
4 Rx: Steroid
5 Rx: Antibiotic
6 Rx: Muco/Proteolytic
7 Blood Gas
8 Circuit Change
9 Start Weaning
10 Stop Weaning
11 Bronchoscopy1
12 X-ray
13 Recruitment maneuver1
14 Other 1
15 Other 2
16 Other 3
17 Surfactant administration2
18 Prone position2
19 Supine position2
22 Manual stimulation2
23 Start transport
24 Stop transport
Table F-4. Events (Continued)
Event ID Description
25 Start N.O Rx
26 Stop N.O Rx
Automatic events
67 Occlusion
68 Circuit Disconnect
69 Apnea Ventilation
70 NIF Accepted
71 P0.1 Accepted
72 VC Accepted
76 Elevate O2
Table F-4. Events (Continued)
Event ID Description
80 Manual Inspiration
88 Backup Ventilation
3. View the event by hovering the cursor over the vertical tick mark and touching Event Details which
now appears as a button containing event IDs. After touching the button, a dialog appears showing
the event ID and its description.
• The clinician may select a trending preset (a preselected group of trended values) for display.
The ventilator offers presets for adult and pediatric patients and a different set of presets for neo-
natal patients. The trending presets are intended to aid clinicians in assessing the effectiveness of
the current therapy but are not intended to determine the course of treatment.
Adult and pediatric trending presets include but are not limited to:
Weaning — f/VT, P0.1, NIF, [VT SUPP], [VT SUPP], CSTAT
2. Touch the desired trending preset. As all trending presets include six parameters, the trend graph
changes to a six-graph layout, populated with the six trended preset parameters described above. The
chosen trended preset appears on the Presets button.
Note:
If a trended preset is selected, it is not possible to change the trended parameters. You must first select a
custom layout, by touching Custom, then double-tapping the parameters you desire to change.
Ventilation Terms
analysis message A message displayed on the GUI screen during an alarm condition, identifying
the root cause of the alarm.
assist breath A mandatory breath triggered by patient inspiratory effort in A/C and SIMV
modes.
assist-control A/C mode A ventilation mode where only mandatory VC, PC, or VC+ breaths are deliv-
ered to the patient.
audio paused (alarm Used interchangeably with the term alarm silence, the 2-minute period that
silence) begins after the audio paused (alarm silence) key is pressed, where the audible
portion of an alarm is muted.
augmented alarm The initial cause of an alarm has precipitated one or more related alarms.
When an alarm occurs, any subsequent alarm related to the cause of this initial
alarm “augments” the initial alarm.
background checks Continuously running tests during ventilation that assess the ventilator’s elec-
tronics and pneumatics hardware.
backup ventilation (BUV) A safety net feature that is invoked if a system fault in the mix subsystem, inspi-
ratory subsystem, or expiratory subsystem occurs compromising the ventila-
tor’s ability to ventilate the patient as set.
base flow A constant flow of gas through the patient circuit during the latter part of
exhalation during flow triggering (V-Trig). The value of this base flow is
1.5 L/min greater than the operator selected value for flow sensitivity.
base message A message given by the ventilator during an alarm condition, identifying the
alarm.
batch changes Changes to multiple settings that go into effect at the same time.
battery back-up system The system for supplying battery back-up power to a device. The ventilator's
battery back-up system consists of a single primary battery to provide up to
1 hour of battery power to the ventilator. An optional extended battery with
the same characteristics as the primary battery is available.
BD, BDU Breath delivery or breath delivery unit. The ventilator component that includes
inspiratory and expiratory pneumatics and electronics.
Glossary-1
BiLevel mode A mixed ventilation mode combining mandatory and spontaneous breaths,
where two levels of pressure are delivered (PL and PH) corresponding to expi-
ratory and inspiratory times TL and TH.
BOC British Oxygen Company. A standard for high pressure gas inlet fittings.
breath stacking The delivery of a second inspiration before the previous exhalation is com-
plete.
BTPS Body temperature and pressure, saturated, 37°C, at ambient barometric pres-
sure, at 100% relative humidity.
compliance volume The volume of gas that remains in the patient circuit and does not enter the
patient's respiratory system.
compressor The compressor provides compressed air, which can be used in place of wall
or bottled air.
constant during rate One of three breath timing variables (inspiratory time, I:E ratio, or expiratory
change time) the operator can hold constant when the respiratory rate setting chang-
es. Applies only to the pressure control (PC) mandatory breath type (including
VC+ and BiLevel).
CPU Central processing unit. The electronic components of the ventilator (BD and
GUI) responsible for interpreting and executing instructions entered by the
operator.
dependent alarm An alarm that arises as a result of another primary alarm (also referred to as an
augmentation).
DSENS Disconnect sensitivity. A setting that specifies the allowable loss (percentage)
of delivered tidal volume, which if equaled or exceeded, causes the ventilator
to declare a DISCONNECT alarm. The greater the setting, the more returned
volume must be lost before DISCONNECT is detected. If the Leak Sync func-
tion is in use, DSENS is the maximum allowable leak rate and is expressed in
terms of L/min.
DISS Diameter index safety standard. A standard for high pressure gas inlet fittings.
ESENS Expiratory sensitivity. A setting that determines the percent of peak inspiratory
flow (or flow rate expressed in L/min in a PAV breath) at which the ventilator
cycles from inspiration to exhalation for spontaneous breaths. Low settings
will result in longer spontaneous inspirations.
expiratory pause an operator-initiated maneuver that closes the inspiration (proportional sole-
noid) and exhalation valves during the expiratory phase of a mandatory
breath. The maneuver can be used to determine intrinsic (auto) PEEP (PEEPI).
exhalation valve (EV) The valve in the expiratory limb of the ventilator breathing system that con-
trols PEEP.
Failure A category of condition detected during SST or EST that causes the ventilator
to enter the safety valve open state. A ventilator experiencing a failure requires
removal from clinical use and immediate service.
flow pattern A setting that determines the gas flow pattern of mandatory volume-con-
trolled breaths.
gold standard test circuit Test circuit designed for use with EST.
GUI Graphical user interface. The ventilator’s touch screen used to enter patient
settings. and alarm settings, including off-screen keys, soft keys, and knobs.
hard bound A ventilator setting that has reached its minimum or maximum limit.
humidification type A setting for the type of humidification system (HME, non-heated expiratory
tube, or heated expiratory tubing) in use on the ventilator.
I:E ratio The ratio of inspiratory time to expiratory time. Also, the operator- set timing
variable that applies to PC and VC+ mandatory breaths.
inspiratory pause An operator-initiated maneuver that closes the inspiration (proportional sole-
noid) and exhalation valves at the end of the inspiratory phase of a mandatory
breath. The maneuver can be used to determine static compliance (CSTAT) and
static resistance (RSTAT).
invasive ventilation Patient ventilation while intubated with an endotracheal (or tracheostomy)
tube.
latched alarm An alarm whose visual alarm indicator remains illuminated after the alarm has
autoreset.
lockable alarm An alarm that does not terminate an active audio paused function.
maintenance All actions necessary to keep equipment in, or restore it to, serviceable condi-
tion. Includes cleaning, servicing, repair, modification, overhaul, inspection,
and performance verification.
mandatory type The type of mandatory breath: volume control (VC), VC+, or pressure control
(PC).
mode Ventilatory mode. The algorithm that determines type and sequence of breath
delivery.
NIST Non-interchangeable screw thread. A standard for high pressure gas inlet fit-
tings.
non-invasive ventilation Patient ventilation without the use of an endotracheal tube; instead using
(NIV) interfaces such as masks, nasal prongs, or uncuffed endotracheal tubes.
non-technical alarm An alarm caused due to a fault in the patient-ventilator interaction or a fault in
the electrical or gas supplies that the practitioner may be able to alleviate.
normal ventilation The state of the ventilator when breathing is in progress and no alarms are
active.
O2% Both a ventilator setting and a monitored variable. The RTOT setting deter-
mines the percentage of oxygen in the delivered gas. The O2% monitored
data is the percentage of oxygen in the gas delivered to the patient, measured
at the ventilator outlet upstream of the inspiratory filter.
ongoing background Continuously running tests during ventilation that assess the ventilator's elec-
checks tronics and pneumatics hardware.
OSC Occlusion status cycling. A state invoked during a severe occlusion. In this
mode, the ventilator periodically attempts to deliver a pressure-based breath
while monitoring the inspiratory and expiratory phases for the continuing
existence of the occlusion.
OVERRIDDEN The final status of an SST or EST run in which the operator used the override
feature. (The ventilator must have ended the test with an ALERT condition.)
Failures cannot be overridden.
patient circuit The entire inspiratory-expiratory conduit, including tubing, humidifier, and
water traps.
patient data alarm An alarm condition associated with an abnormal condition of the patient's
respiratory status.
patient problems A definition used by the ventilator's safety net. Patient problems are declared
when patient data are measured equal to or outside of alarm thresholds and
are usually self-correcting or can be corrected by a practitioner. The alarm
monitoring system detects and announces patient problems. Patient prob-
lems do not compromise the ventilator's performance.
PEEP Positive end expiratory pressure. The measured circuit pressure (referenced to
the patient wye) at the end of the expiratory phase of a breath. If expiratory
pause is active, the displayed value reflects the level of any active lung PEEP.
PEEPI Intrinsic PEEP. Indicates a calculated estimate of the pressure above the PEEP
level at the end of exhalation. Determined during an expiratory pause maneu-
ver.
PI END End inspiratory pressure. The pressure at the end of the inspiratory phase of
the current breath. If plateau is active, the displayed value reflects the level of
end-plateau pressure.
PMEAN Mean circuit pressure, a calculation of the measured average patient circuit
pressure over an entire respiratory cycle.
PPEAK Maximum circuit pressure, the maximum pressure during the inspiratory and
expiratory phases of a breath.
PSENS Pressure sensitivity. The operator-set pressure drop below PEEP (derived from
the patient's inspiratory flow) required to begin a patient-initiated breath
when pressure triggering is selected.
PSUPP Pressure support. A setting of the level of inspiratory assist pressure (above
PEEP) at the patient wye during a spontaneous breath (when spontaneous
breath type is PS).
remedy message A message displayed on the GUI during an alarm condition suggesting ways
to resolve the alarm.
restricted phase of exha- The time period during the expiratory phase where an inspiration trigger is not
lation allowed. The restricted phase of exhalation is defined as the first 200 ms of
exhalation, or the time it takes for expiratory flow to drop to ≤50% of the peak
expiratory flow, or the time it takes for the expiratory flow to drop to
≤0.5 L/min (whichever is longest). The restricted phase of exhalation will end
after 5 seconds of exhalation have elapsed regardless of the measured expira-
tory flow rate.
rise time% A setting that determines the rise time to achieve the set inspiratory pressure
in pressure-controlled (PC), VC+, BiLevel, volume supported (VS) or pressure-
supported (PS) breaths. The larger the value, the more rapid the rise of pres-
sure.
safety net The ventilator's strategy for responding to patient problems and system faults.
safety valve (SV) A valve residing in the ventilator’s inspiratory module designed to limit pres-
sure in the patient circuit. When open, it allows the patient to breathe room air
(if able to do so).
safety ventilation A mode of ventilation active if the patient circuit is connected before ventila-
tor startup is complete, or when power is restored after a loss of 5 minutes or
more.
service mode A ventilator mode providing a set of services tailored to the needs of testing
and maintenance personnel. When in the service mode, the ventilator does
not provide ventilation.
SIS Sleeved index system. A standard for high pressure gas inlet fittings.
soft bound A ventilator setting that has reached its recommended high or low limit,
accompanied by an audible tone. Setting the ventilator beyond this limit
requires the operator to acknowledge a visual prompt to continue.
SPONT Spontaneous. A ventilatory mode in which the ventilator delivers only sponta-
neous breaths. In SPONT mode, the patient triggers all breaths delivered by
the ventilator with no set mandatory respiratory rate. The patient controls the
breath variables, potentially augmented by support pressure.
spontaneous type A setting that determines whether spontaneous breaths are pressure-sup-
ported (PS), tube-compensated (TC), volume-supported (VS), or proportionally
assisted (PAV).
SST Short self test. A test that checks circuit integrity, calculates circuit compliance
and filter resistance, and checks ventilator function. Operator should run SST
at specified intervals and with any replacement or alteration of the patient cir-
cuit.
STPD Standard temperature and pressure, dry. Defined as dry gas at a standard
atmosphere (760 mmHg, 101.333 kPa, approximately 1.0 bar) and 0°C.
system fault A definition used by the ventilator's safety net. System faults include hardware
faults (those that originate inside the ventilator and affect its performance),
soft faults (faults momentarily introduced into the ventilator that interfere with
normal operation), inadequate supply (AC power or external gas pressure),
and patient circuit integrity (blocked or disconnected circuit).
technical alarm An alarm occurring due to a violation of any of the ventilator's self monitoring
conditions, or detected by background checks.
TPL Plateau time. The amount of time the inspiratory phase of a mandatory breath
is extended after inspiratory flow has ceased and exhalation is blocked.
Increases the residence time of gas in the patient's lungs.
VE TOT Minute volume, the expiratory tidal volume normalized to unit time
(L/min). The displayed value is compliance- and BTPS-compensated.
VBS Ventilator breathing system. Includes the gas delivery components of the ven-
tilator the patient circuit with tubing, filters, humidifier, and other accessories;
and the ventilator's expiratory metering and measurement components.
Ventilation Assurance A feature on the 980 Series Ventilator that enables ventilation to continue
when a critical system error occurs, by entering the Backup Ventilation (BUV)
state.
Ventilator Inoperative An emergency state the ventilator enters if it detects a hardware failure or a
(vent inop) critical software error that could compromise safe ventilation. During a venti-
lator inoperative condition, the safety valve opens to allow the patient to
breathe room air (if able to do so) unassisted by the ventilator. Qualified
service personnel must power up the ventilator and run EST before normal
ventilation can resume.
VMAX Peak flow. A setting of the peak (maximum) flow of gas delivered during a VC
mandatory breath. (Combined with tidal volume, flow pattern, and plateau,
constant peak flow defines the inspiratory time.) To correct for compliance
volume, the ventilator automatically increases the peak flow.
VSENS Flow sensitivity. A setting that determines the rate of flow inspired by the
patient that triggers the ventilator to deliver a mandatory or spontaneous
breath (when flow triggering is selected).
VT Tidal volume. A setting that determines the volume inspired and expired with
each breath. The VT delivered by some Puritan Bennett ventilators is an oper-
ator-set variable that determines the volume delivered to the patient during a
mandatory, volume-based breath. VT is compliance-compensated and cor-
rected to body temperature and pressure, saturated (BTPS).
Units of Measure
L/min Liters per minute. A unit of flow or minute volume (volume delivered in one
minute).
SLPM Standard liters per minute. Flow rate at 1 atm pressure (101.325 kPa) and 70°F
(21.1°C).
Technical Abbreviations
AC, also ac Alternating current. The movement of electrical charge that periodically
reverses direction.
DC, also dc Direct current. The movement of electrical charge flowing in a single direction.
NVRAM, also NovRam Non-volatile random access memory. Memory that is kept active across resets
and power cycles and is not normally initialized at startup.
POST Power-on self test. Software algorithms to verify the integrity of application
software and the hardware environment. Power-on self test generally occurs
at power on, after power loss, or when the device detects an internal fault.
Index- 1
extended self test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-64 installation testing (testing prior to ventilating a patient) . .3-41–3-46
F L
filter installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9 Leak Sync function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-1
flow pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-51 low pressure (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
flow sensitivity (VSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-52 low time (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-54
G M
gas failure cross flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 mandatory breath delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13
gestures manual inspiration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-25, 10-18
double-tap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 manufacturer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15
drag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 MISCA response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-6
drag and drop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 MISCF response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9
swipe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 mode and breath type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-49
touch and hold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6 Monitored Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-36
graphical user interface (GUI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-14
GUI control keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-15 N
GUI indicators NeoMode
audible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-22 CPAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-8
visual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16–2-19 ventilator settings and ventilation type . . . . . . . . . . . . . . . . . . . . . . D-7
GUI screen capture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 volume accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11
NIV
H alarm settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-24
hard bound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 apnea settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-24
high pressure (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54 high spontaneous inspiratory time limit setting . . . . . . . . . . . . . 4-23
high spontaneous inspiratory time limit 2TI SPONT ) . . . . . . . . . . . .10-58 setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20
high time (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54 non-invasive ventilation (NIV) . . . . . . . . . . . . . . . . . . . . . . . . . . .4-20–4-25
how to enter service mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-31
how to install accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17–3-27 O
how to use the ventilator system . . . . . . . . . . . . . . . . . . . . . . . . . 4-7–4-19 occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-37
how to use the ventilator’s user interface . . . . . . . . . . . . . . . . . . 4-2–4-6 omni-directional LED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28
how to view ventilator logs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3 on-screen help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
humidification type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-58 on-screen symbols and abbreviations . . . . . . . . . . . . . . . . . . .2-19–2-22
humidifier installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-25 operation verification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-56
humidifier volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-59 oxygen sensor
calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-31
I calibration test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-31
I:E ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54 function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-29
icons
configure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 P
elevate O2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-18 P0.1 maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-45
grid lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 Patient Data Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-36–6-42
help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 patient data range and resolution . . . . . . . . . . . . . . . . . . . . 11-17–11-22
high priority alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19 PAV+ function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1
logs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-17 peak inspiratory flow (VMAX) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-51
low priority alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19 PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
maximize waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 PEEP restoration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
medium priority alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19 percent support (PAV+) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56
pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 percent support (TC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56
restore waveform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-19 Plateau Pressure (PPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-39
screen capture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 plateau time (TPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-51
unread items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 pneumatic diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-35
ventilator setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-17 power on self test (POST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-63
waveform layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-18 preparing the ventilator for use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-33
IEC classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 pressure sensitivity (PSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-52
inspiration — detection and initiation . . . . . . . . . . . . . . . . . . . 10-4–10-7 pressure support (PSUPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
inspiratory pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-41–10-43
Inspiratory pause maneuvers . . . . . . . . . . . . . . . . . . . . . . . . . . 4-27, 10-41 primary battery installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-18
inspiratory pressure (PI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-53 primary display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-14
product assembly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2
inspiratory time (TI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-53 proximal flow option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .E-1
Index-2
Index
pushpin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4 tidal volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-51
tube compensation (TC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-22
Q
quick start use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-7 U
used part disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1
R using battery power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2–3-3
respiratory maneuvers
expiratory pause maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-43 V
inspiratory pause maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-41 VC+
NIF maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-44 maximum pressure adjustments . . . . . . . . . . . . . . . . . . . . . . . . . .10-17
respiratory mechanics maneuvers startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-16–10-17
negative inspiratory force maneuver (NIF) . . . . . . . . . . . . . . . . . 10-44 ventilating a new patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8
P0.1 maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-45 ventilating the same patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8
vital capacity maneuver (VC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-46 ventilation type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-48
respiratory rate (f ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-50 ventilator
rise time% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-56 alarm log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
RS-232 commands available languages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1
RSET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5 BDU controls and indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-24
SNDA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5 BDU front view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7
SNDF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-9 BDU rear label symbols and descriptions . . . . . . . . . . . . . . . 2-9–2-11
BDU rear view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8
S BDU right side view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-12, 2-13
safety net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-59 components list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4
serial commands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5 connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-33
serial number interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14 description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2
settings EST/SST status log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-14 function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-13 gas flow overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2
return to previous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-18 general event log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-9 GUI front view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5
short self test (SST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-63 GUI rear view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6
SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-28 Indications For Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
SIMV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-32 operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7–4-19
soft bound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4 patient data log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
spontaneous (SPONT) mode . . . . . . . . . . . . . . . . . . . . . . . . . 10-32–10-33 service log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3
spontaneous breath delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-18 settings log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
SST system diagnostic log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
how to run . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-43 ventilator logs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2
outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-46 ventilator operating modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28–3-32
results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-45 normal mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28
test sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-43 quick start mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28
status display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-25–2-32 service mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-30
storage for extended periods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-17 Stand-By state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28
surface cleaning of ventilator exterior surfaces . . . . . . . . . . . . . . . . . .7-3 ventilator protection strategies . . . . . . . . . . . . . . . . . . . . . . . . . 4-31–4-33
symbols ventilator settings
BDU rear panel label symbols and descriptions . . . . . . . . . . . . . . .2-9 apnea ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-46
safety symbol definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3 circuit type and PBW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-48
shipping label symbols and descriptions . . . . . . . . . . . . . . . . . . . . .1-2 configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-34–3-41
system related problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-61 disconnect sensitivity (DSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-57
DSENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-57
T ESENS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-57
TC flow pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-52
alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-23 flow sensitivity (VSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-52
monitored patient data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-23 high pressure (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54
PBW and tube ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-23 high spontaneous inspiratory time limit (2TI SPONT ) . . . . . . . .10-58
technical description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-22
high time (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54
tube type, tube ID, humidification . . . . . . . . . . . . . . . . . . . . . . . . . 4-12
humidification type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-58
technical assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
humidifier volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-59
Technical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13
I:E ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54
TH:TL ratio (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-55
inspiratory pressure (PI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-53
Index- 3
inspiratory time (TI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-53
low pressure (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54
low time (BiLevel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-54
mode and breath type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-50
peak inspiratory flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-51
peak inspiratory flow (VMAX) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-51
PEEP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-55
PEEP restoration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-55
percent support (PAV+) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-56
percent support (TC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-56
plateau time (TPL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-51
pressure sensitivity (PSENS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-52
pressure support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-55
pressure support (PSUPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-55
range and resolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-7–11-14
respiratory rate (f ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-50
rise time% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-56
TH:TL ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-55
tidal volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-51
vent type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-49
volume support (VT SUPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-56
ventilator setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
volume support (VT SUPP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-56
VS
maximum pressure adjustments . . . . . . . . . . . . . . . . . . . . . . . . . .10-21
startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-21
W
warranty information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-14
waveform axis scaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-40
Index-4
Part No. PT00101843 Rev A 2019-04
© 2012 Covidien.
Covidien llc
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