GE CARESCAPE R860 (01) PDF MANUAL

GE CARESCAPE R860 (01) PDF SUMMARY:

Before using the CARESCAPE® R860 system, what should users do?

• Complete all of the preoperative tests.
• Test all other system components.

How can users access step-by-step instructions for using the CARESCAPE® R860 system?

Refer to the User’s Reference manual.

What should users read before using the CARESCAPE® R860 system?

Read each component’s User’s Reference manual.

Where can users find all Warnings and Cautions related to the CARESCAPE® R860 system?

In the User’s Reference Manual.

What is the unit of measurement for FiO2?

%

What does FiO2 represent?

The percentage of oxygen that the ventilator delivers to the patient.

What is the unit of measurement for EtO2?

%

What does EtO2 represent?

The percentage of oxygen exhaled, measured at the end of expiration.

What are the units of measurement for EtCO2?

%, kPa, or mmHg

What does EtCO2 represent?

The percentage of carbon dioxide exhaled, measured at the end of expiration.

What is the unit of measurement for FI-ET O2?

%

What does FI-ET O2 represent?

The difference between inspiratory and expiratory concentrations of oxygen.

What are the units of measurement for C?

ml/cmH2O, ml/kPa, or ml/mbar

What does C represent?

The compliance of the patient’s respiratory system measured during the breath cycle.

What are the units of measurement for Cstat?

ml/cmH2O, ml/ kPa, or ml/mbar

What does Cstat represent?

The static compliance of the patient’s respiratory system measured during an inspiratory hold.

What are the units of measurement for Raw?

cmH2O/l/s, kPa/l/s, or mbar/l/s

What does Raw represent?

The average inspiratory and expiratory airway resistance measured during the breath cycle.

What are the units of measurement for PEEPe+i?

cmH2O, kPa, or mbar

What does PEEPe+i represent?

The sum of extrinsic and intrinsic positive end expiratory pressures.

What is the unit of measurement for Time Constant?

ms

What does Time Constant represent?

The time needed for the lungs to deflate by a certain amount or a percentage of volume.

What are the Time Constant percentages of volume exhaled?

• One Time Constant allows 63% of volume to be exhaled.
• Two Time Constants allow for 86% of volume to be exhaled.
• Three Time Constants allow for 95% of volume to be exhaled.
• Four Time Contants allow for 98% of volume to be exhaled.

What are the units of measurement for Static PEEPi?

cmH2O, kPa, or mbar

What does Static PEEPi represent?

The pressure above PEEPe that remains in the patient’s lungs, measured at the end of the expiratory phase during an expiratory hold.

What is the unit of measurement for MVexp spont?

l/min

What does MVexp spont represent?

The volume of gas the patient exhales per minute with spontaneous breaths.

What is the unit of measurement for RR spont?

/min

What does RR spont represent?

The number of spontaneous breath cycles the patient completes per minute.

What is the unit of measurement for VTexp spont?

ml

What does VTexp spont represent?

The volume of gas the patient exhales with a spontaneous breath.

What is the unit of measurement for MVexp mech?

l/min

What does MVexp mech represent?

The volume of gas the patient exhales per minute with mechanical breaths.

What is the unit of measurement for RR mech?

/min

What does RR mech represent?

The number of mechanical breath cycles the patient completes per minute.

What is the unit of measurement for VTexp mech?

ml

What is the unit of measurement for RSBI?

/min/l

What does RSBI represent?

The rapid shallow breathing index is calculated by dividing the spontaneous breath rate by the tidal volume, averaged over one minute. The RSBI reflects the frequency and depth of the patient’s breath cycles. A high RSBI value indicates that patient’s breath cycles are more frequent and shallow. RSBI is calculated in spontaneous breathing modes (CPAP/PS, VS, NIV, and SBT).

What is the unit of measurement for Weight?

kg

What does Weight represent?

The calculated ideal body weight for adult patients. The entered weight of the patient for pediatric patients.

What is the unit of measurement for MVexp/kg?

l/min/kg

What does MVexp/kg represent?

The volume of gas the patient exhales per minute per the patient’s ideal body weight.

What is the unit of measurement for VTexp/kg?

ml/kg

What does VTexp/kg represent?

The volume of gas the patient exhales in a breath per the patient’s ideal body weight.

What is the unit of measurement for MVexp spont/kg?

l/min/kg

What does MVexp spont/kg represent?

The volume of gas the patient exhales per minute with spontaneous breaths per the patient’s ideal body weight.

What is the unit of measurement for VTexp spont/kg?

ml/kg

What does VTexp spont/kg represent?

The volume of gas the patient exhales in a spontaneous breath per the patient’s ideal body weight.

What are the units of measurement for C/kg?

ml/kPa/kg, ml/ cmH2O/kg, or ml/ mbar/kg

What does C/kg represent?

The dynamic compliance of the patient’s lungs per the patient’s calculated ideal body weight.

What is the unit of measurement for VO2/kg?

ml/min/kg

What does VO2/kg represent?

The volume of oxygen a patient inhales (consumes) per minute per the patient’s set weight.

What is the unit of measurement for VCO2/kg?

ml/min/kg

What does VCO2/kg represent?

The volume of carbon dioxide a patient exhales (produces) per minute per the patient’s set weight.

What are the units of measurement for EE?

kcal/d or kJ/d

What does EE represent?

The amount of energy the patient expends per day in calories.

What is the unit of measurement for RQ?

N/A

What does RQ represent?

The ratio between the amount of carbon dioxide the patient produces and oxygen the patient consumes.

What is the unit of measurement for VO2?

ml/min

What does VO2 represent?

The volume of oxygen a patient inhales (consumes) per minute.

What is the unit of measurement for VCO2?

ml/min

What does VCO2 represent?

The volume of carbon dioxide a patient exhales (produces) per minute.

What is the unit of measurement for VO2/m2?

ml/min/m2

What does VO2/m2 represent?

The volume of oxygen a patient inhales (consumes) per minute per square meter of body surface area.

What is the unit of measurement for VCO2/m2?

ml/min/m2

What does VCO2/m2 represent?

The volume of carbon dioxide a patient exhales per minute per square meter of body surface area.

What are the units of measurement for Ppeak?

cmH2O, kPa, or mbar

What does Ppeak represent?

The highest pressure level measured during the inspiratory phase.

What are the units of measurement for Pplat?

cmH2O, kPa, or mbar

What does Pplat represent?

The pressure level measured after the inspiratory phase and before the expiratory phase (during an inspiratory pause).

What are the units of measurement for Pmean?

cmH2O, kPa, or mbar

What does Pmean represent?

The average pressure level measured during the breath cycle.

What are the units of measurement for PEEPe?

cmH2O, kPa, or mbar

What does PEEPe represent?

The pressure on the patient’s airway at the end of the expiratory phase.

What are the units of measurement for PEEPi?

cmH2O, kPa, or mbar

What does PEEPi represent?

The pressure that remains on the patient’s airway at the end of the expiratory phase due to incomplete expiration. PEEPi is measured above PEEPe.

What is the unit of measurement for VTinsp?

ml

What does VTinsp represent?

The volume of gas the patient inhales per breath.

What is the unit of measurement for MVinsp?

l/min

What does MVinsp represent?

The volume of gas the patient inhales per minute.

What is the unit of measurement for VTexp?

ml

What does VTexp represent?

The volume of gas the patient exhales per breath.

What is the unit of measurement for MVexp?

l/min

What does MVexp represent?

The volume of gas the patient exhales per minute.

What is the unit of measurement for Leak?

%

What does Leak represent?

The percentage of volume leaked from the patient circuit.

What is the unit of measurement for I:E?

N/A

What does I:E represent?

The ratio of inspiratory time to expiratory time.

What is the unit of measurement for Tinsp?

s

What does Tinsp represent?

The duration of the inspiratory phase of the breath cycle.

What is the unit of measurement for Texp?

s

What does Texp represent?

The duration of the expiratory phase of the breath cycle.

What is the unit of measurement for RR?

/min

What does RR represent?

The number of breath cycles a patient completes per minute.

What is the unit of measurement for Cycle Time?

s

What does Cycle Time represent?

The sum of the duration of inspiratory and expiratory phases.

What size and type is the ventilator display?

15-inch touchscreen display

What does the ventilator display provide?

Audible and visual alarms, integrated key pad, and a Trim Knob control.

What type of battery does the display unit use and what are the specifications?

Panasonic CR2477/BN battery (1000 mAh and 3V).

How do users select menu options or settings?

Touch only one touch point at a time to make sure the correct selection is made. Touch the setting or press the Trim Knob to confirm settings.

What type of gestures does the touchscreen allow?

Swipe gestures to move from one workspace to another workspace.

What should not be used to activate the touchscreen?

Pencils, pens, or other objects.

What will prevent the touchscreen from functioning properly?

Tape or paper stuck to the display surface.

What can degrade the performance of the touchscreen?

Liquids.

What should users do if liquids come in contact with the display?

Lock the touchscreen and clean the display. Unlock the touchscreen once the display has been cleaned to resume use of the touchscreen.

What should users avoid doing to the touchscreen?

Applying excessive force.

What does the integrated alarm light provide?

A visual alarm when an alarm condition occurs.

When does the alarm light also provide a visual indicator?

When Audio Pause is active and alarm audio is silenced.

How do users utilize the Trim Knob control?

Turn the Trim Knob clockwise or counterclockwise to change a setting. Press the Trim Knob to confirm a setting.

What are the Hard keys (key pad) and how are they used?

Press the Audio Pause, Increase O2, Snapshot, Lock/ Unlock, or Home hard keys to access the associated features.

What is the function of the Audio Pause key?

Press to silence alarms for 120 seconds.

When does the green LED illuminate?

When the ventilator is connected to the main power supply.

What does it indicate when the internal battery is charging?

When the LED is lit.

What does the user interface incorporate?

The Menu, Current Patient menu, alarm management, and Favorites procedures at the top of the display. The patient status (airway pressure bar) and workspace/monitoring area are located in the middle of the display. The navigation bar, message areas, battery status, standby, and quick keys are located at the bottom of the display.

What does the Favorites feature provide?

Short-cuts for up to four procedures (as selected by the user). Use to select specific procedures such as Increase O2, Inspiratory Hold, Expiratory Hold, and Manual Breath.

Where can users find instructions for setting Favorites?

See “Setting Favorites” in the “Operation” section.

What does the airway pressure bar show?

A dynamic view of the patient airway pressure, Pmax, Ppeak, PEEP, FiO2, and VTexp.

How can users collapse (hide) the airway pressure bar from view?

Use the tab on the pressure bar.

How do users open the corresponding view in the Navigation section?

Select an icon.

Where can users find detailed information about navigating the user interface?

See “Navigating the user interface.”

What information does the Additional Information section show?

Current time and additional setting information.

What does the Main power indicator show?

Whether the ventilator is connected to the main power supply or is running on battery. Also shows battery status when running on battery.

How do users put the ventilator in Standby (pause/stop ventilation)?

Select the Standby quick key.

Where can users find more information about Standby mode?

See “Standby” in the “Operation” section.

How do users change the corresponding ventilator settings using the Quick Keys?

Select to change the corresponding ventilator setting. Turn the Trim Knob to make a change. Select the quick key or press the Trim Knob to activate the change. When a quick key setting is selected, a Trim Knob visual cue indicates the change may be made by turning the Trim Knob and pressing to confirm the setting.

What information does the Current Mode and Mode Settings section show?

Shows the active ventilation mode.

How do users access ventilation modes and change mode settings?

Select the Current Mode and Mode Settings.

What type of information does the General Messages section show?

Notices, procedure status, and system status information to the user.

Where can users find more information about General messages?

See “General messages” in the “Alarms and troubleshooting” section.

What does the Monitoring area display?

Waveforms, measured data, and settings.

How do I quickly access options such as the System menu, Procedures, Lung Mechanics, Suction, and Nebulizer?

Use the Menu Select option.

How do I enter the Current Patient menu?

Select the Current Patient menu.

What does the Current Patient menu allow?

It allows:

• Entry of the patient ID using an alphanumeric keyboard.
• Selection of tube type and diameter.

What are the entered values for patient gender, height, and weight used to calculate?

• BSA (body surface area)
• IBW (ideal body weight)

How do I view alarms, alarm history, alarm setup, and alarm help?

Select Alarm management.

What happens when an alarm occurs for measured data?

The number and alarm limits are shown with a border around them.

What does the color of the border and the alarm limit indicate?

The priority of the alarm.

How do I open the Alarm Setup menu?

Select within the border of the active alarm.

How do I adjust an alarm limit?

1. Select the alarm limit that needs adjustment.
2. Use the Trim Knob to adjust the setting.
3. Confirm the changes.

When is Standby displayed?

• Upon system startup
• When the Standby quick key is selected

What color are the Standby quick key and the patient status (airway pressure) bar when the system is in Standby?

Tan

Where is the “Standby” message displayed when in the Present/Patient Status workspace?

In the navigation bar.

What is Standby used for?

• Stopping ventilation to the patient
• Selecting a New or Previous patient
• Performing a System Check
• Parking/Unparking the patient circuit

What does the Setup button access?

The password-protected Configuration (Super User) and Service menus.

What happens when New Patient is selected?

You can enter patient information.

What does selecting Circuit Setup allow?

It allows selection of HME or Humidifier for adult and pediatric patient types.

What happens when the Standby (hand icon) is selected?

The Standby menu displays.

In what situation does the Standby menu automatically display?

If the Patient detected alarm occurs.

What message displays when the circuit is parked?

“Patient circuit is occluded and ventilator is in Standby.”

What happens when you select Start Ventilation?

Patient ventilation starts.

What does the System Check selection do?

Performs a ventilator system check.

What kind of information is accessed by selecting Information?

Information regarding the system check status and troubleshooting.

What happens when you select Previous Patient?

The previous patient’s ventilator settings and patient information will be used.

What happens when you select Current Patient?

The Current Patient menu opens, allowing use of the current patient’s ventilator settings and patient information.

How do I access the Configuration (Super User) and Service menus?

Select Setup.

Is there a password requirement to enter the Configuration (Super User) and Service menus?

Yes, a password is required.

Who should I contact to obtain the password for the Configuration (Super User) and Service menus?

A training representative.

What does the main Menu provide quick access to?

Ventilator features and options.

What options can be accessed through the main Menu?

• System menu
• Procedures
• Lung Mechanics
• Nebulizer
• Suction

What does the System menu allow access to?

• Data source
• Module type and version
• Calibrations (Paux Zero and Purge Flow)
• Display brightness

What information is shown in the System menu?

• Software version
• Running hours
• Altitude
• O₂ supply pressure
• Air supply pressure
• Battery status

What is accessible through the Procedures menu?

• The Assign Favorites menu
• The following procedures:
  • Manual Breath
  • Increase O₂
  • Inspiratory Hold
  • Expiratory Hold
  • Auto PEEP

What is accessible through the Lung Mechanics menu?

• The Assign Favorites menu
• The following procedures:
  • P_0.1
  • Negative Inspiratory Force (NIF)
  • Vital Capacity

What can be accessed through the Nebulizer menu?

The Aerogen and Pneumatic Nebulizer procedures.

What does the Suction menu provide access to?

• The Assign Favorites menu
• The Suction procedure

What settings are contained in the System menu?

Settings for:

• Data source selection
• Calibration options
• Display brightness
• System information

How do I access the System menu?

Select Menu > System.

Where can the Airway Module type and software version number be found?

Under data source.

How do I select the Data Source?

Select either Ventilator or Airway Module.

What is the Data Source selection for Neonatal?

Select Ventilator or NFS.

What Calibrations can be selected?

• Airway Module
• Paux Zero
• Purge Flow

What does selecting Airway Module do?

Calibrates the airway module.

What does a green check mark indicate when selecting Paux Zero?

Paux Zeroing calibration was successful.

What does selecting Purge Flow allow?

The Purge Flow check box may be checked or unchecked when performing a Paux Zero.

When will continuous purge flow come from the Paux outlet?

When the Purge Flow check box is selected.

What does a white check mark indicate?

Purge Flow is active.

How do I adjust the Display Brightness?

Select Display Brightness.

What are the available brightness levels?

Levels 1 (low) to 5 (high).

What system information can be viewed?

• Software version
• Service packet version
• Running hours
• Altitude
• O₂ supply pressure
• Air supply pressure
• Battery status

How do I change a setting?

1. Touch the setting.
2. Change the value by turning the Trim Knob or selecting a menu item.
3. Touch the setting or push the Trim Knob to confirm the setting.

What does the Trim Knob graphic indicate?

That the use of the Trim Knob is necessary to change or confirm a setting.

How do I cancel or back out of a setting change?

• Select X in the lower right corner of the menu.
• Touch outside of the setting twice.
• Select the Home hard key.
• Wait for the selection to time out.

How can ventilation and alarm setting changes be cleared?

By selecting the Home hard key prior to confirming a setting.

What three different workspaces does the ventilator user interface utilize?

• Past/Historical trends
• Present/Patient status
• Future/Clinical decision support

What do the workspaces contain?

Views (circle icons) that contain different configurations of data and functions.

What happens when a workspace is selected?

The correlating view icons are displayed.

How do I go to a new workspace?

• Use a swipe gesture.
• Touch a workspace icon.

How is a swipe gesture performed?

Touch the display and move your fingertip left or right.

What happens when you navigate away from a workspace and then navigate back?

The display will show the last view that was displayed from the workspace.

Will a view display if it is not supported by the current patient type or if the software is not installed?

No.

What views does the Present/Patient Status workspace show?

• Basic
• Basic Waveform
• Advanced Waveform
• Splitscreen
• Charting

What does the Present/Patient Status workspace allow the user to do?

Choose the view in which they would like to see patient data displayed.

How do I display the corresponding view?

Touch the icon.

How can I view and move to Past (Historical trends) and Future (Clinical decision support) workspaces?

Use a swipe gesture.

What is the Basic view used for?

To see measured data in a large format that can be easily viewed from a distance.

What is permanently displayed in the Basic view?

The patient status (airway pressure) bar.

What does the patient status (airway pressure) bar allow for?

Easy viewing of:

• Patient airway pressure
• Tidal volume
• FiO₂

What is the Basic Waveform view used to see?

• Patient waveforms
• Measured data

What can be done to expand the monitoring area when the Paw and Flow waveforms are displayed?

The airway pressure bar may be collapsed.

What does the Advanced Waveform view allow the user to see?

Additional measured data associated with the patient waveforms.

Can the airway pressure bar be collapsed to expand the monitoring area in the Advanced Waveform view?

Yes, when the Paw and Flow waveforms are displayed.

What does the Splitscreen view allow the user to see?

• Spirometry
• Measured data
• Waveforms

How do I change settings in the Splitscreen view?

Select the upper right corner of the spirometry waveform.

Is the airway pressure bar collapsible in the Splitscreen view?

Yes, it may be collapsed to expand the monitoring area when the Paw and Flow waveforms are displayed.

What can be viewed in the Charting view?

A complete list of patient data.

What is permanently displayed in the Charting view?

The airway pressure bar.

What information does the airway pressure bar in the Charting view allow for easy viewing of?

• Patient airway and pressure settings
• Tidal volume
• FiO₂

What information does the Past/Historical Trends workspace show?

Information for the following views:

• Graphical trends
• Numerical trends
• Trends log
• Snapshot trends

How do I display the corresponding view in the Past/Historical Trends workspace?

Touch the icon.

How do I view and move to Present/Patient status or Future/Clinical Decision Support workspaces from the Past/Historical Trends workspace?

Use a swipe gesture.

What is the Graphical Trends view used to review?

• Historical waveforms
• Patient trends

What does the Numerical Trends view allow the user to review?

• Patient ventilation modes and settings
• Measured data
• Alarm settings

What can be reviewed using the Trends Log?

• Patient alarms and settings
• Events that have occurred during ventilation

What is the Snapshot Trends view used to view?

Saved patient data.

What views are shown in the Future/Clinical Decision Support workspace if the software is installed?

• SBT
• FRC
• Spirometry
• Metabolics
• Calculations

How do I display the corresponding view in the Future/Clinical Decision Support workspace?

Touch the view icon.

How do I move to the Present/Patient Status or Past/Historical Trends workspaces and associated views from the Future/Clinical Decision Support workspace?

Use a swipe gesture.

How do I use the SB T view?

Use the SB T view to evaluate spontaneous breathing trial data.

How do I use the FRC view?

Use the FRC view to evaluate and review patient respiratory data.

How do I use the Spirometry view?

Use the Spirometry view to evaluate and review graphs and data from spirometry and spirodynamic measurements.

How do I use the Metabolics view?

Use the Metabolics view to evaluate and review metabolics measurements.

How do I use the Calculations view?

Use the Calculations view to calculate and review data based on the ventilator, measured data, and laboratory blood gas analysis data.

What is the purpose of the shared information section?

The shared information section provides information for adult, pediatric, and neonatal patient types.

What are the connections on the back of the ventilator?

The back of the ventilator has the following connections:

• Ethernet connection (not supported)
• Ethernet connection (not supported)
• USB connection (not supported)
• USB connection (Service connection)
• Display Unit connection
• VGA (not for clinical use)
• Module bay connection
• Main power inlet and fuse holder
• Power switch
• Equipotential stud
• Module bay mounting thumbscrews
• Oxygen supply connection (pipeline)
• O2 high-pressure inlet filter (optional)
• Air high-pressure inlet filter
• Air supply connection (pipeline)
• Retaining channel
• Ventilator unit fan filter
• Port 4 (Nurse call)
• Patient circuit support arm
• Port 1 (neonatal flow sensor connection)
• Port 2 (not supported)
• Port 3 (exhalation valve heater connection)
• Port 6 (RS232 Serial communication port)
• Port 5 (RS232 Serial communication port)
• Display unit fan filter

What type of breathing tubes and masks should not be used?

Do not use antistatic or electrically conductive breathing tubes or masks.

What precaution should be taken when connecting the breathing circuit?

Check all connections to the breathing circuit to make sure that there are no unintended connections made to other equipment, especially equipment that delivers fluids, as the patient could be harmed.

What is the function of the inspiratory safety guard?

The inspiratory safety guard is required to connect the breathing circuits to the ventilator and must be used at all times during ventilation.

When should the exhalation valve heater be used?

The exhalation valve heater should be used when an active humidifier with a heated expiratory limb is used.

What are the guidelines for the use of expiratory filters in conjunction with heated humidifiers?

Consult your hospital guidelines for proper use of expiratory filters in conjunction with heated humidifiers.

What is the precaution when using the HMEF500?

To prevent excessive resistance in the breathing circuit, the HMEF500 should not be used for adult patients.

How do I connect a HME (heat and moisture exchanger)?

To connect a HME, follow these steps:

1. Connect the inspiratory safety guard to the inspiratory port.

2. Attach the inspiratory limb of the patient circuit to the inspiratory safety guard.

3. Attach the expiratory limb of the patient circuit to the expiratory port or expiratory filter (if used).

4. Connect the Pedi-lite(+) or D-lite(+) sensor to the patient wye (if used).

   • Use a 5 ml (minimum) spacer and elbow when using the Pedi-lite(+) or D-lite(+) sensor.

5. Connect the HME.

   • Place the HME between the SpiroDynamics catheter (if used), but after the Pedi-lite(+) and D-lite(+) sensor (if used).
   • The HME should be removed when a nebulizer is active. Replace the HME when the nebulizer is not in use.

6. Connect the circuit elbow to the HME (if used).

To disconnect, follow the instructions in reverse order.

What is the ventilator designed to work with?

The ventilator is designed to work with active humidification.

What humidifier is recommended?

GE Healthcare recommends the use of the Fisher & Paykel MR850 humidifier.

What should I never do with the filter and humidifier?

Never position any filter in the inspiratory limb downstream of a humidifier.

What may happen when adding attachments or other components to the ventilator?

When adding attachments or other components to the ventilator, the pressure gradient across the breathing circuit may change.

How do I connect the humidifier?

To connect the humidifier, follow these steps:

1. Slide the humidifier heater onto the accessory rail (do not plug in).

2. Press down on the light blue lever of the humidifier and slide the water chamber into the humidifier heater. Release the light blue part of the humidifier heater.

3. Unwrap the water feed line from the humidifier water chamber and puncture the water reservoir.

   • The water reservoir should be elevated above the humidifier at all times and water should flow down into the humidifier.

4. Use the short blue circuit tubing from the humidifier circuit pack and connect one end to the inspiratory safety guard and the other end to the appropriate port on the humidifier chamber.

5. Connect the longer piece of blue circuit tubing to the remaining port on the humidifier. Connect the end of the white circuit tubing to the expiratory port or expiratory filter (if used).

6. Connect the heater wire to the humidifier heater, then connect the two leads to the ends of the patient circuit (the shorter lead to the blue tube).

7. Connect the temperature probe to the humidifier heater, connecting the keyed lead to the end of the blue tube of the patient circuit and the other to the patient wye for adults (near the patient wye on the blue tube for pediatric/neonatal).

   • The thermal operating temperature of the humidifier is 18-26° C according to the manufacturer.

8. Turn on the ventilator and perform the System Check.

   • See “System Check” in the Operation section for more information.

9. If the System Check passes, plug in the humidifier and attach the exhalation valve heater.

   • See “Connecting the exhalation valve heater”.

To disconnect, follow the instructions in reverse order.

What is the Aeroneb Professional Nebulizer System?

The Aeroneb Professional Nebulizer System is a portable medical device for multiple patient use that is intended to aerosolize physician-prescribed solutions and suspensions for inhalation to patients on and off ventilation or other positive pressure breathing assistance.

What nebulizer systems does the CARESCAPE R860 support?

The CARESCAPE R860 supports the Aeroneb Professional Nebulizer System (Aeroneb Pro and Aeroneb Solo) by Aerogen.

How do the Aeroneb Pro and Aeroneb Solo operate?

Both nebulizer devices operate in-line using the ventilator nebulizer menu and nebulizer cable.

Are the Aeroneb Pro and Aeroneb Solo purchasable parts?

Yes, the Aeroneb Pro and Aeroneb Solo are purchasable parts.

What patient types can the Aeroneb Pro and Aeroneb Solo be used with?

The Aeroneb Pro and Aeroneb Solo (disposable) may be used with neonatal, pediatric, and adult patients in acute and subacute care environments.

How do both nebulizer models operate?

Both nebulizer models operate without changing the patient ventilator parameters and can be refilled without interrupting ventilation.

What types of breathing circuits can the nebulizers be used with?

The nebulizers may be used with a neonatal, pediatric, or adult breathing circuit.

What is specific to the breathing circuit type?

The T-adapter for the nebulizer is specific to the breathing circuit type.

What should not be used between the nebulizer and the patient airway?

Do not use a filter, heat-moisture exchanger, or heat-moisture exchanger filter between the nebulizer and the patient airway.

What can increase flow resistance when a nebulizer is active?

Use of a heat-moisture exchanger or nebulizer in the breathing circuit can substantially increase flow resistance when a nebulizer is active.

What should be monitored frequently for increased resistance and blockage?

Monitor the breathing system filter frequently for increased resistance and blockage.

What may happen when using an external pneumatic nebulizer?

Use of an external pneumatic nebulizer may significantly impact volume delivery and monitoring, decrease trigger sensitivity, and cause alarms if external flow is introduced and Pneumatic Nebulizer Flow Compensation is not used.

What is recommended when using a nebulizer?

It is strongly recommended to use an expiratory filter when a nebulizer is used to help protect the expiratory flow sensor.

What is Tube compensation?

When a patient is intubated, the endotracheal or tracheostomy tube creates resistance in the airway. Tube compensation provides additional pressure to compensate for the difference between the lung pressure and breathing circuit pressure during the inspiratory phase of pressure-controlled and pressure-supported breaths.

What does Tube compensation do?

Tube compensation can be used to offset all or a percentage of the additional resistive pressure created by the endotracheal tube.

What are the requirements to set Tube compensation?

To set Tube compensation, a Tube Type and Tube Diameter must be set in the New Patient or Current Patient menu.

What is the warning when using Tube compensation?

Tube compensation increases the pressure delivered to the patient. The pressure delivered with tube compensation is limited to Pmax – 5 cmH2O. Make sure that Pmax is set appropriately for the patient when using tube compensation.

How do I set Tube Compensation?

To set Tube Compensation, select Current Mode > Mode Settings and select Tube Comp. A general message shows when tube compensation is on.

What are the options for tube compensation?

The options for tube compensation are: Endotrach, Trach, or —. When — is selected, the ventilator will not compensate for tube resistance.

What is Assist control?

Assist control allows the ventilator to synchronize mechanical breaths to the patient’s spontaneous efforts and the patient to trigger additional mechanical breaths to the set respiratory rate in the following ventilation modes:

• A/C VC
• A/C PC
• A/C PRVC

What happens when the patient initiates a breath with assist control enabled?

When the patient initiates a breath with assist control enabled, the ventilator delivers a breath based on the mode settings. After a patient-initiated mechanical breath, the ventilator may delay the delivery of the next mechanical breath to prevent two mechanical breaths from being delivered consecutively (breath stacking).

To set Assist Control, what should you select?

Select Current Mode > Mode Settings and select Assist Control (On or Off).

What happens when the ventilator detects a leak in the breathing circuit and leak compensation is active?

When the ventilator detects a leak in the breathing circuit, and leak compensation is active, the ventilator will respond in the following ways:

• Flow and volume waveforms and measured volume data are adjusted to account for leaks.
• In the following volume-controlled modes, the ventilator adjusts the tidal volume delivered to compensate for leaks:
  • A/C VC
  • A/C PRVC
  • SIMV VC
  • SIMV PRVC
  • BiLevel VG
  • VS

What does the maximum tidal volume adjustment depend on?

The maximum tidal volume adjustment depends on the patient type:

• Adult – 25% of the set tidal volume
• Pediatric – 100% of the set tidal volume or 100 ml, whichever is less
• Neonatal – 100% of the set tidal volume

What does trigger compensation adjust?

Trigger compensation adjusts the flow trigger to compensate for leaks, reducing the need to manually adjust the Insp Trigger setting to prevent auto-triggering.

What modes is trigger compensation available in?

Trigger compensation is available in all ventilation modes.

To set trigger compensation, what should you select?

Select Current Mode > Mode Settings, and select Trigger Comp.

When is backup mode available?

Backup mode is available if the ventilator detects insufficient ventilation in modes that allow spontaneous breaths.

When does the ventilator automatically enter the set Backup mode?

When enabled, the ventilator automatically enters the set Backup mode if either of the following occur:

• The Apnea alarm is activated.
• The patient’s expired minute volume (MVexp) is below 50% of the set low MVexp alarm.

Where is the set Backup mode shown?

The set Backup mode is shown under the Backup mode check box in Current Mode > Mode Settings.

To enable Backup mode, what should you select?

Select the check box.

Where are Backup settings adjusted?

Adjust Backup settings in Current Mode > Mode Settings > Backup Settings.

In what ventilation modes is Backup mode available?

Backup mode is available in the following ventilation modes:

• SIMV VC
• SIMV PC
• SIMV PRVC
• BiLevel
• BiLevel VG
• CPAP/PS
• VS
• APRV

What ventilation modes may be set as the Backup mode?

The following ventilation modes may be set as the Backup mode:

• A/C VC
• A/C PC
• A/C PRVC
• SIMV VC
• SIMV PC
• SIMV PRVC
• BiLevel
• BiLevel VG

Who is NIV mode intended to be used on?

NIV mode is intended to be used on spontaneously breathing patients.

What does the patient do during NIV mode?

During NIV mode, the patient draws spontaneous breaths as the ventilator maintains the set PEEP level and provides pressure support (PS).

Why are flow and pressure triggers applied simultaneously in NIV mode?

Because flow triggers are affected by patient circuit leaks, flow and pressure triggers are applied simultaneously in NIV mode.

What does the ventilator use to improve trigger detection when a flow trigger is set by the user?

The ventilator uses a simultaneous pressure trigger to improve trigger detection.

What alarms may be disabled to prevent nuisance alarms when large patient circuit leaks are present?

The MVexp low, Apnea Time, and Leak Limit alarms may be disabled to prevent nuisance alarms when large patient circuit leaks are present.

What kind of alarm is active when any of the MVexp low, Apnea Time, and Leak Limit alarms are disabled?

A medium priority alarm is active when any of these alarms is disabled.

What should you select to acknowledge and de-escalate the medium priority alarm?

Select Audio Pause to acknowledge and de-escalate this alarm.

What is recommended if the Apnea Time, Leak Limit, or MVexp low alarms are disabled?

If the Apnea Time, Leak Limit, or MVexp low alarms are disabled, additional monitoring, such as SpO2, ECG, and CO2, is recommended to prevent the patient from hypoventilating.

What happens if the patient does not meet the set Minimum Rate for spontaneous breaths?

If the patient does not meet the set Minimum Rate for spontaneous breaths, the ventilator delivers a backup breath based on the Backup Tinsp and Backup Pinsp settings.

What indicates that the patient has stopped triggering breaths if the ventilator does not detect any spontaneous breaths within the set Patient Effort time?

A high priority alarm indicates that the patient has stopped triggering breaths.

What should the ventilator be provided with while in non-invasive ventilation?

While in non-invasive ventilation, the ventilator is to be provided with CO2 monitoring equipment that complies with ISO 80601-2-55 or ISO 21647.

What is recommended if the Apnea Time, Leak Limit, or MVexp low alarms are set to Off?

If the Apnea Time, Leak Limit, or MVexp low alarms are set to Off, additional monitoring such as SpO2 or ECG is also recommended to protect the patient from hypoventilation.

What settings may be set if desired in NIV mode?

Leak Comp and Trigger Comp may be set if desired.

What settings are available in NIV mode?

The following settings are available in NIV mode:

Category	Setting
Main Parameters	FiO2, PEEP, PS
Patient Synchrony	Tsupp, Insp Trigger, Exp Trigger, Bias Flow, Rise Time
Safety	PMax, Backup Pinsp
Minimum Rate	Backup Tinsp

What characteristics should the patient demonstrate before using NIV mode?

Before using NIV mode, the patient should demonstrate all of the following characteristics:

• Is responsive
• Breathes spontaneously
• Has a controlled airway
• Requires pressure support ventilation

What is SBT mode intended to be used for?

SBT mode is intended to be used to evaluate the patient’s ability to breathe spontaneously during a specified duration of time.

What setting limits must be entered prior to the SBT evaluation?

Prior to the SBT evaluation, the following setting limits must be entered:

• SBT Duration
• Apnea Time
• High and low MVexp alarm
• High and low RR alarm

What does the patient do during SBT mode?

During SBT mode, the patient initiates spontaneous breaths as the ventilator maintains the set PEEP level and provides pressure support (PS).

To set a pressure support level for spontaneous breaths, what should you select and enter?

Select Current Mode > Mode Settings and enter a PS value.

To evaluate the Spontaneous Breathing Trial, what should you select?

Select Clinical Decision Support > SBT.

What are the Main Parameters settings in SBT mode?

• FiO2
• PEEP
• PS

What are the Patient Synchrony settings in SBT mode?

• Insp Trigger
• Exp Trigger
• Bias Flow
• PS Rise Time

What is the Safety setting in SBT mode?

• Pmax

What are the Stop Criteria settings in SBT mode?

• RR
• MVexp
• Apnea Time

How do you turn on power to the ventilator?

1. Plug the power cord into an electrical outlet.
   • The LED indicator illuminates (green) to indicate the main power is connected.
2. Press the power switch on the back of the ventilator to the On position.
   • The start-up screen appears while the system runs a series of automated self tests.
   • When the self tests pass, the system goes into Standby and the display shows the Standby menu.
   • If the self tests fail, the display shows an alarm.
3. Listen for two distinctly different audio tones to sound to make sure the primary speaker and backup buzzer are working properly.
4. Watch and verify the alarm light on the top of the display unit cycles through the following colors: blue, red, and yellow.

What should you do if both the primary and backup audio tones do not sound or the alarm lights do not function correctly when the ventilator is powered on?

If both the primary and backup audio tones do not sound or the alarm lights do not function correctly when the ventilator is powered on, take the ventilator out of service. Contact an authorized service representative to repair the system.

When may the ventilator be turned off?

The ventilator may only be turned off when in Standby, Configuration (Super User), or Service.

What happens if the ventilator is turned off during ventilation?

If the ventilator is turned off during ventilation, an alarm sounds and ventilation and monitoring continue. This ensures the ventilator cannot be accidentally shut off during ventilation.

How do you turn off power to the ventilator?

1. Disconnect the patient from the breathing circuit.
2. Select Standby. Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.
3. Select Pause Ventilation.
   • Monitoring and ventilation will stop.
4. Press the power switch on the back of the ventilator to the Off position.

What are the instructions for preparing the ventilator for a New Patient?

After powering on the ventilator the Standby menu displays.

1. Select NEW PATIENT.
2. Select Adult, Pediatric, or Neonatal patient type.
3. Select Patient ID (identification).
   • Enter up to 10 characters and then select Confirm. (Only English alpha-numeric characters may be entered).
   • To protect patient privacy, do not use the patient’s name when entering the patient ID (identification). Consider the facility’s privacy policies when entering the patient ID.
4. Select Gender (male or female).
5. Select Height.
6. Select Weight.
   • The ventilator calculates and displays the patient weight in kilograms, the BSA (Body Surface Area), IBW (Ideal Body Weight), and a suggested VT (Tidal Volume).
   • IBW is available for adult patients only.
7. Select (Endotrach, Trach, or —). When — is selected, the ventilator will not compensate for tube resistance.
8. Select Tube Diameter.
9. Verify and confirm settings.

When does the Previous Patient button show?

The Previous Patient button shows upon power up of the ventilator when previous patient data exists.

What does Previous Patient allow the clinician to do?

Previous Patient allows the clinician to use the patient settings and alarm limits that were previously used and view trends and historical data. For example, if a patient is extubated, but fails to progress and needs to be re-intubated, the clinician may use the previous patient settings.

How do you access the Previous Patient data?

From the Standby menu, select PREVIOUS PATIENT.

When is Previous Patient data saved?

Previous Patient data is only saved when a normal shutdown sequence is performed. Abrupt or unexpected power loss will prevent this data from being saved.

When do you use the Current Patient menu?

Use this menu to update settings or change patient type from Pediatric to Adult or Adult to Pediatric. If Neonatal is installed, patient types may be changed from Neonatal to Pediatric or Pediatric to Neonatal.

How do you access the Current Patient menu?

1. Select Standby.
2. Select Current Patient. The Current Patient menu shows.
3. Select the desired patient type and adjust settings.

When should the System Check be performed?

The ventilator should be fully cleaned and prepared for a patient before performing the System Check.

How does the System Check run?

When started, the System Check runs automatically. Selecting the information icon will show the active progress in the System Check Details menu. The steps will show a green check mark (pass) or a red X (fail). When each check is completed, the next check begins.

What does a General Warning icon in the System Check indicate?

A General Warning icon in the System Check indicates that a check has not been performed or completed for the current patient. Both the yellow warning icon and the yellow Start Ventilation button serves as a visual warning that a System Check needs to be performed.

What is recommended to help ensure the proper function of the system?

To help ensure the proper function of the system, it is highly recommended to complete the System Check between patients.

Should the patient be connected to the ventilator while completing the System Check?

The patient must not be connected to the ventilator while completing the System Check.

What should the System Check be completed with?

Complete the System Check with the breathing circuit and accessories that will be used during ventilation.

What happens if a System Check is not completed for the current patient?

If a System Check is not completed for the current patient, the system uses the compliance and resistance data from the last completed system check for the set patient type for all internal compensations. If the current breathing circuit differs significantly from the previous circuit, differences in ventilation parameters due to changes in the compensation process are possible.

What is the result of failing to complete a System Check?

Failure to complete a System Check may result in inaccurate delivery and monitoring. This may result in risk to the patient.

At what pressure is the circuit leak measured?

The circuit leak is measured at 25 cmH2O.

What is the resistance?

The resistance is the measured resistance of the inspiratory limb of the patient circuit.

When will the Circuit Check fail?

If the circuit leak is greater than 0.5 l/min or resistance or compliance measurements cannot be calculated, the Circuit Check will fail.

What may happen if the circuit leak is greater than 0.5 l/min or if the exhalation flow sensor is changed after the System Check?

The expiratory tidal volume may have decreased accuracy.

What happens if the relief valve failure alarm activates after the System Check?

If the relief valve failure alarm activates after the System Check then the ventilator will not allow ventilation until the relief valve portion of the System Check has passed.

How do I use the Circuit Setup menu?

Use the Circuit Setup menu to select settings that must be compensated for in patient circuit measurements. The HME and Humidifier (must include a heated expiratory limb) settings are selected in the Circuit Setup. For adult and pediatric patient types, the default selection is HME. For the neonatal patient type, the Circuit Setup menu is not available and the Humidifier selection will always be used.

What does the warning say about changing the Circuit Setup?

Changing the Circuit Setup will invalidate the current System Check results. Changing the patient circuit after completion of System Check will affect volume delivery and exhaled volume measurements. If any change is made to Circuit Setup or the patient circuit, repeat the System Check. Circuit Setup should be checked when setting up a New Patient or a change has been made to the patient’s circuit setup. A yellow warning icon will replace the previous System Check status icon (pass or fail) when a change has been made in the Circuit Setup menu. The yellow warning icon indicates that a System Check should be performed.

What are the steps for selecting Circuit Setup?

1. Select Circuit Setup. The Circuit Setup menu displays.
2. Select the check box for the HME or Humidifier. Settings are confirmed when the setting is changed.
3. Select X to close the menu.

What are the steps for running a system check?

1. From Standby, select SYSTEM CHECK. The Run System Check menu shows.
2. Attach the breathing circuit and all accessories that will be used to ventilate the patient. Complete the System Check using the appropriate flow sensor per patient type. For example, use the neonatal flow sensor when completing a System Check for a neonatal patient.
3. Occlude the patient wye using the occlusion port.
4. Select Start. The System Check starts and shows the results of each check. The system runs the following checks:
   • Paw transducer check
   • Barometric pressure check
   • Relief valve check
   • Exhalation valve check
   • Expiratory flow sensor check
   • Air flow sensor check
   • Oxygen sensor check
   • O2 flow sensor check
   • Resistance check
   • Circuit measurements check (circuit leak, compliance, and resistance)
5. Select the information icon to see the System Check Details menu. The System Check starts and shows the results of each check.

What is important to note about the Resistance Check?

When performing the Resistance Check, the wye-piece and all breathing accessories such as: D-lite (+)/Pedi-lite(+) sensor and HME should remain on the occlusion port.

What should you do when performing the system check?

Follow all on-screen system check instructions.

What do the check marks mean when running the system check?

As the System Check runs, the results of each check are displayed as a green check mark (pass) or red X (fail).

What does a help icon mean during the system check?

If a check fails, a Help icon displays next to the failed check (red X). Select the Help icon to view possible causes and help for troubleshooting a failure.

What happens when the system check is complete?

When the System Check is complete, the Final Result line will display the patient type icon, a green check mark (pass) or red X (fail), and the date and time of the System Check.

What is the data source used for?

The data source is used to obtain patient monitoring parameters from either the ventilator or the airway module.

What are the steps for setting the ventilator data source?

1. Select Menu > System. The System menu shows.
2. Select Data Source.
3. Select Ventilator or Airway Module to confirm settings.

What does the Ventilator Data icon indicate?

If Ventilator is selected as the data source, the Ventilator Data icon displays in the lower right corner of the display; the internal sensors of the ventilator will be the source for monitored data.

What does the Airway Module (Patient) data icon indicate?

If Airway Module is selected as the data source and an airway module is installed and warmed up, the Airway Module (Patient) data icon displays in the lower right corner of the display. The airway module will be the first source for monitored data. If data is not available through the airway module, monitored data will come from the internal ventilator sensors.

What are the ventilator data source icons?

• Ventilator data icon
• Airway Module (Patient) data icon

What happens when Airway Module is selected as the data source?

When Airway Module is selected as the data source, the data source icon will not be updated until the module is able to provide data. This may take 2 to 5 minutes when a module is first installed into the module bay. Only data available from the installed airway module will be displayed on the ventilator, all other data will be from the ventilator. For example, if a module capable of measuring CO2 and O2 only is installed, CO2 and O2 data displayed will be from the module, all other data will be from the ventilator.

What is the system menu?

The System menu contains settings for data source selection, calibration options, display brightness, and system information.

What are the steps for using the system menu?

1. Select Menu > System. The Airway Module type and software version number are shown under data source.
2. Select Data Source (Ventilator or Airway Module). For Neonatal; select Ventilator or NFS.
3. Select Calibrations (Airway Module, Paux Zero, or Purge Flow).
   • Select Airway Module to calibrate the airway module.
   • Select Paux Zero. A green check mark indicates Paux Zeroing calibration was successful.
   • Select Purge Flow. The Purge Flow check box may be checked or unchecked when performing a Paux Zero. Continuous purge flow will come from the Paux outlet when the Purge Flow check box is selected. A white check mark indicates Purge Flow is active.
4. Select Display Brightness to adjust the brightness level of the user interface. Select brightness level of 1 (low) to 5 (high).
5. View system information: software version, service packet version, running hours, altitude, O2 supply pressure, air supply pressure, and battery status.

How do I set a ventilation and backup mode?

Ventilation modes are selected through the Current Mode button. The selected ventilation mode shows with the corresponding mode settings. Ventilation modes may be changed in Standby or during ventilation. Ventilation mode settings should be set prior to connecting a patient to the ventilator.

What are the steps for setting a ventilation and backup mode?

1. Select Current Mode.
2. Select the desired ventilation mode. The title of the vent mode shows in the Mode Settings menu along with the parameters for that mode. Depending upon the facility default setup for ventilation modes, the Mode Settings menu may contain two icons. The partial list icon represents the facility’s set ventilation modes and the full list icon represents the full set of ventilation modes available. Select the appropriate icon to see available ventilation modes.
3. Select Assist Control, Leak Comp, or Trigger Comp if desired. Assist Control is only available in the following ventilation modes: A/C VC, A/C PC, and A/C PRVC.
4. Set the desired settings for the ventilation mode and confirm. When ventilator settings are confirmed, the Mode Settings menu closes and the selected ventilation mode shows in Current Mode.
5. To set a Backup Mode, select Current Mode.
6. Select Backup Settings. Set the desired settings for the backup mode and confirm.
7. Confirm all ventilation mode settings.

What are the limit indicators?

When adjusting ventilation mode settings, yellow and red visual indicators show when parameters are approaching their setting limits. Green visual indicators show the parameters are appropriate for the setting limits.

What is the warning for starting patient ventilation?

Ventilation will not start until ‘Start Ventilation’ is selected.

What should you do before starting patient ventilation?

Ensure that the ventilator battery is fully charged before starting patient ventilation.

What are the steps for starting patient ventilation?

1. From Standby, select START VENTILATION. If the Start Ventilation button is green, a System Check has been completed for the current patient and when selected, will start ventilation. If the Start Ventilation button is yellow, the Complete System Check warning alert will display the following: Select Continue to bypass System Checkout and start ventilation. Select Cancel to remain in Standby.
2. After ventilation has started, connect the breathing circuit to the patient.

What is the Standby function?

Pausing ventilation.

What is the warning about the Standby function?

The patient will not be ventilated when in Standby.

What are the steps for using Standby?

1. Disconnect the patient from the breathing circuit.
2. Select Standby. Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.
3. Select Pause Ventilation. Monitoring and ventilation will stop.

What does the Park Circuit function do?

Park Circuit allows the patient circuit to be occluded without the ventilator alarming while in Standby. When the patient circuit is positioned on the occlusion port the display activates the PARK CIRCUIT selection.

What is the warning for Park Circuit?

The patient will not be ventilated while the circuit is parked and in Standby.

What are the steps for using Park Circuit?

1. Disconnect the patient from the breathing circuit.
2. Select Standby. Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.
3. Select Pause Ventilation. Monitoring and ventilation will stop.
4. Occlude the patient circuit using the occlusion port.
5. Select PARK CIRCUIT. The display will show: Patient circuit is occluded and the ventilator is in Standby.

When can ventilation adjustments be made?

Ventilation modes and setting adjustments may be changed while in Standby or while ventilating.

What are the steps for changing ventilation modes?

1. Select the Current Mode. The Mode Settings menu shows.
2. Select the desired mode from the list. Use the scroll bar to view additional modes.
3. Confirm setting.

How many favorite procedures can be set?

Up to four Favorite procedures may be selected to show on the upper-right corner of the user interface.

What are the steps for setting Favorites?

1. Select Menu.
2. Select Procedures, Lung Mechanics, or Suction menus.
3. Select Assign Favorites. The Assign Favorites menu shows with a list of the following procedures: Increase O2, Suction, Auto PEEP, Inspiratory Hold Expiratory Hold, P 0.1, NIF, Vital Capacity, and Manual Breath.
4. Select up to four Favorites. Favorites show in the upper right corner of the display.

Which Favorite procedures begin automatically after they are selected?

The following Favorite procedures begin automatically after they are selected: Manual Breath, Suction, and Increase O2.

What do the audible and visual indicators tell you about an alarm?

Audible and visual indicators tell the priority of the alarm.

What are the alarm priority levels?

Priority	Color	Light	Tone
High	Red	Flashes red	Series of five tones, twice
Medium	Yellow	Flashes yellow	Series of three tones
Low	Blue	Solid blue	Single tone

What do medium and high priority alarms do?

For medium and high priority alarms, the alarm tone is repeated until audio pause is selected or the alarm condition is resolved.

What happens when high priority alarms are not resolved within the set high alert audio time limit?

When high priority alarms are not resolved within the set high alert audio time limit, the pitch and volume of the tone increases to the maximum audio level.

What happens when more than one alarm occurs at the same time?

When more than one alarm occurs at the same time, the alarm bar, alarm light, and audible alarm tone indicates the highest priority alarm. The color on the right side of the alarm light shows the priority of the alarm. The left side of the alarm light is blue when audio pause is active.

What happens to some medium priority and high priority alarms when audio pause is selected?

Some medium priority and high priority alarms are de-escalated and change to low priority alarm when audio pause is selected. Until the de-escalated alarm condition is resolved, the low priority alarm stays active.

What if a problem occurs that is not listed in the troubleshooting table?

If a problem occurs that is not listed, see “Repair policy” in the “Cleaning and maintenance” section for more information.

What should I do if the main power indicator is not on?

Problem	Solution
The electrical power cord is not connected correctly.	Connect the power cord. Loosen the power cord retaining clamp and make sure plug is fully seated. Then tighten the retaining clamp.
The inlet circuit breaker (switch) is off.	Turn the circuit breaker on.
The power cord is damaged.	Replace the power cord.
The electrical outlet that the power cord is connected to has no power.	Use a different electrical outlet.
An internal fuse is open.	Contact an authorized service representative to repair the ventilator.
The display unit cable is loose.	Turn the ventilator switch off, and then disconnect from the main power. Check and tighten the display unit connectors.

What should I do if the ventilator cannot be turned off?

Problem	Solution
The ventilator is not in Standby.	Set the ventilator to Standby, and then turn the system off.

What should I do if the backup audio alarm turns on?

Problem	Solution
A system failure has occurred.	Contact an authorized service representative to repair the ventilator.
The display unit cable is loose.	Turn the ventilator switch off, and then disconnect from the main power. Check and tighten the display unit connectors.

What should I do if an alarm shows although the data is within range?

Problem	Solution
The alarm is from the ventilator but the value shown is from the airway module.	Calibrate the airway module. Go to Menu > System and change the selection for Data Source.
The Ppeak high alarm conditions are checked before the display view is updated.	No action required. In some situations the ventilator will react to a transient high pressure before the data can be sampled and shown on the display.

What should I do if the ventilator does not deliver set VT in A/C VC or SIMV VC modes?

Problem	Solution
The Plimit setting prevents the full VT from being delivered in the inspiratory period.	Change the VT setting. Change the Plimit setting.

What should I do if the ventilator does not deliver set VT in A/C PRVC, SIMV PRVC, or BiLevel VG modes?

Problem	Solution
Pmax alarm limit is limiting delivered inspiratory pressure.	Change the VT setting. Change the Pmax setting.
The ventilator is at minimum allowed delivery.	Change the VT setting. Change the Pmin setting.

What should I do if the ventilator transitions to Backup mode?

Problem	Solution
MVexp low, Apnea alarm, RR alarm, and insufficient patient ventilation.	Change ventilation settings.

What should I do if there is a short delay in the breath cycle at the PEEP pressure level?

Problem	Solution
Automatic pressure transducer zeroing interference.	No action required. The situation will be corrected when zeroing is complete.
Automatic flow sensor zeroing interference.

What should I do if the ventilator is automatically triggering a breath?

Problem	Solution
The breathing circuit leak rate is higher than the flow trigger level.	Enable Trigger Compensation. Check the breathing circuit for leaks. Turn Leak Comp On. Increase the Flow triggering level or change from Flow triggering to Pressure triggering.
	Make sure the correct patient type is selected.

Symptom: VT, compliance and resistance values are not accurate.

• Solution: Complete System Check with the same breathing circuit that will be used on the patient.

Symptom: System Check fails.

• Solution: Clean expiratory flow sensor.
• Solution: Clean neonatal flow sensor.
• Solution: Replace D-lite flow sensor.
• Solution: Replace D-lite spirometry sensing lines.
• Solution: Calibrate gas module.
• Solution: Make sure the water trap is tightly secured.
• Solution: Check the breathing circuit for leaks.
• Solution: Do a System Check and let it complete.

Symptom: Patient circuit not connected to the ventilator.

• Solution: Attach the patient circuit to the inspiratory and expiratory ports.

Symptom: Patient wye is not occluded correctly.

• Solution: Make sure the patient wye is occluded completely with the leak test plug.

Symptom: Expiratory flow sensor has failed.

• Solution: Clean or replace the flow sensor. Make sure flow sensor is connected correctly.

Symptom: Exhalation valve and seals are not seated correctly.

• Solution: Remove and replace the exhalation valve.

Symptom: A connection port on the patient circuit is open.

• Solution: Make sure all connection ports are occluded.

Symptom: Leak in patient circuit is very large.

• Solution: Check the breathing circuit for leaks.

Symptom: Touchscreen does not respond.

• Solution: Press the Lock hard key at the bottom of the display unit.
• Solution: Contact an authorized service representative to repair the ventilator.

What is the part replacement schedule?

• The table shows recommended part replacement intervals. Replace the part at the interval or number of cleaning cycles, whichever occurs first. *Visually inspect parts to determine if cleaning or replacement is needed. Look for deformation, cracks, or discoloration.

  Interval	Cleaning Cycles
  Exhalation Valve Assembly	12 months
  Exhalation Valve Diaphragm	12 months
  Expiratory flow sensor	6 months
  Neonatal flow sensor	6 months
  Aerogen Aeroneb Pro Nebulizer and T-adapters	12 months
  Cart-mounted water trap	*As needed
  Water trap connector tubing (hytrel tubing)	*As needed
  Display and ventilator fan filters	*As needed
  Compressor air inlet filter	*As needed
  D-lite sensor	*As needed
  Pedi-lite sensor	*As needed
  Inlet filter bowl	*As needed

How do I remove the exhalation valve assembly?

1. Make sure the expiratory flow sensor has been removed, if not remove the expiratory flow sensor from the exhalation valve assembly.
2. Push down on the latch, as shown below, and then pull the exhalation valve assembly away from the ventilator.
3. Remove the water trap and empty it. Make sure to save the o-ring from the water trap.
4. Lift the edge of the diaphragm to remove it from the exhalation valve housing. Make sure to save the seal.

What should I do before re-assembling or using the exhalation valve assembly?

• Check for visible cracks, discoloration, or other degradation
• Replace any worn components
• Perform System Check

When should the system be calibrated?

• Performance is questionable, such as a System Check failure.
• Internal components are serviced or replaced.
• Every six months. For best performance of the system, calibrate more frequently.

What scheduled maintenance should be done?

• Do the scheduled maintenance as shown in the table. Processing and disassembly instructions are available later in this section.

  Interval	Maintenance
  During cleaning and setup	Inspect the parts for damage and replace or repair, as necessary.
  As necessary	Empty the water trap on the exhalation valve housing.
  	Empty the water trap on the air pipeline inlet fitting and replace the filter.
  	Clean and replace the expiratory flow sensor.
  	Clean or replace the neonatal flow sensor.
  Monthly	Remove and clean fan filters for the display unit, vent housing, airway module, and compressor.
  Every two months	Calibrate the airway module, if one is installed.
  Every six months	Calibrate the O2 Flow Control Valve*
  	Calibrate the Air Flow Control Valve*
  	Calibrate the Exhalation Valve*
  	Check performance of internal battery. **
  Annually	Schedule an annual service and maintenance check for the ventilator, airway module, and compressor.

What is the overview of neonatal ventilation?

• The neonatal option on the CARESCAPE R860 provides ventilation for neonatal patients weighing down to 0.25 kg. Using an optional neonatal flow sensor at the patient wye, which connects to the ventilator with a cable, allows for more accurate flow and volume monitoring in the neonatal patient type.

What are the features available with the neonatal option?

• The calculated tidal volume per unit of weight is displayed while adjusting the tidal volume setting.
• The volume delivered per unit of weight can be displayed during ventilation for continuous monitoring.
• Safety-related limits have been imposed on ventilation settings and alarm limits for the intended patient population. Information presented in other sections of this manual applies to all patient types, including neonatal. Exceptions are detailed in this section.

How do I connect the Neonatal Flow Sensor (NFS)?

1. Connect the neonatal flow sensor cable connector to to port 1 on the back of the ventilator.
2. Connect the neonatal flow sensor to the cable.
3. Connect the neonatal flow sensor to the patient breathing circuit.
4. Connect the neonatal flow sensor to the patient airway connection.

How do I disconnect the Neonatal Flow Sensor (NFS)?

• To disconnect, follow the steps in reverse order.

What are the basics of the neonatal ventilation modes?

• The ventilator provides several standard modes for invasive ventilation and non-invasive modes (nCPAP for neonates).
• Invasive ventilation modes provide a range of patient support, from fully controlled mechanical breaths to pressure supported breaths for spontaneously breathing patients.
• Non-invasive modes are intended to be used for spontaneously breathing patients only.
• See ventilation mode descriptions for details about the settings and features each mode provides. The primary difference between setting up a patient for invasive and non-invasive ventilation is the accessories used.
• Invasive ventilation is delivered through an artificial airway (e.g., endotracheal tube), which is inserted into the patient’s trachea.
• Non-invasive ventilation is delivered using positive-pressure ventilation through an accessory such as a nasal mask or mouthpiece. These accessories are often attached to the patient’s head to increase the quality of the airway seal to minimize airway leaks. Non-invasive ventilation masks should be non-vented and must not include an entrainment (inspiratory) valve. Patient circuits for use with non-invasive ventilation must be dual-limb with connections for both the inspiratory and expiratory ports of the ventilator.

Describe mechanical and spontaneous breaths

• The ventilator offers multiple ventilation modes, which support mechanical and spontaneous breaths. Mechanical breaths are controlled by the ventilator. The ventilator uses the selected mode settings to determine the characteristics of the breath such as timing, volume, and pressure. Depending on which mode is set, mechanical breaths are initiated by the ventilator or the patient.
• Ventilator-initiated: the ventilator uses the set respiratory rate to initiate a breath.
• Patient-initiated: the patient activates the set inspiratory trigger (flow or pressure) to initiate a breath.
• Spontaneous breaths are initiated and controlled by the patient. In ventilation modes with a PS setting, spontaneous breaths are pressure-supported at the PS level. The segment colored orange in the waveform represents the breath trigger.

Describe the ventilation mode settings.

• Ventilation mode settings are separated into four categories:
  • Main Parameters
  • Breath Timing
  • Patient Synchrony
  • Safety
• Each ventilation mode has a unique set of settings. See each ventilation mode description for a list of applicable settings. Quick Keys on the lower portion of the display provide access to ventilation mode settings that are likely to be adjusted frequently. The remaining settings can be adjusted in the Current Mode > Mode Settings menu.
• When changing ventilation modes, some settings may change if the two modes do not share the same limits or increments.
  • When the setting is greater than the maximum value allowed in the new mode, the maximum value is set.
  • When the setting is less than the minimum value of the new numeric range, the minimum value is set.
  • When the setting is between increments, the value is rounded to the increment above or below it.

What is the definition of the Main Parameter FiO2?

• Fraction of inspired oxygen. The percentage of oxygen that the ventilator delivers to the patient.

What is the definition of the Main Parameter PEEP?

• Positive End Expiratory Pressure. The pressure that the ventilator holds in the patient’s lungs during the expiratory phase.

What is the definition of the Main Parameter VT?

• Tidal Volume. The volume of gas that the ventilator delivers with each volume-regulated or controlled breath.

What is the definition of the Main Parameter Pinsp?

• Inspiratory Pressure. The pressure above PEEP that is maintained during the inspiratory phase of a pressure-regulated breath. In BiLevel mode, Pinsp is the pressure above PEEP at which the patient can spontaneously breathe.

What is the definition of the Main Parameter PS?

• Pressure Support. The pressure above PEEP that is maintained during a pressure-supported breath.

What is the definition of the Main Parameter Plow?

• Low Pressure. The low pressure level at which the patient can spontaneously breathe in APRV mode. This setting is equivalent to PEEP in other modes.

What is the definition of the Main Parameter Phigh?

• High Pressure. The high pressure level at which the patient can spontaneously breathe in APRV mode.

What is the definition of the Breath Timing Rate?

• Respiratory rate. The number of breaths delivered to the patient in one minute.

What is the definition of the Breath Timing Flow?

• Inspiratory flow. The rate at which the gas is delivered to the patient during the inspiratory phase of a volume-controlled breath.

What is the definition of the Breath Timing I:E?

• Inspiratory time: Expiratory time. The ratio of inspiratory time to expiratory time.

What is the definition of the Breath Timing Tinsp?

• Inspiratory Time. The time in seconds that the ventilator uses to deliver the inspiratory phase of the breath cycle.

What is the definition of the Breath Timing Insp Pause?

• Inspiratory Pause. The percentage of the inspiratory phase during which the breath is held and no additional flow is delivered by the ventilator during volume controlled breaths.

What is the definition of the Breath Timing Tpause?

• Pause Time. The period in seconds at the end of the inspiratory phase during which the breath is held and no additional flow is delivered by the ventilator during volume controlled breaths.

What is the definition of the Breath Timing Thigh?

• High Time. The time in seconds that the ventilator holds the high pressure level in APRV mode.

What is the definition of the Breath Timing Tlow?

• Low Time. The time in seconds that the ventilator holds the low pressure level in APRV mode.

What is the definition of the Patient Synchrony Insp Trigger?

• Inspiratory Trigger. The patient effort required to initiate the inspiratory phase of a breath. The trigger can be set as either a positive flow value (Flow Trigger) or a negative pressure deflection below PEEP (Pressure Trigger).

What is the definition of the Patient Synchrony Exp Trigger?

• Expiratory Trigger. The percentage of peak flow at which the pressure supported breath inspiratory phase ends and the expiratory phase begins.

What is the definition of the Patient Synchrony Rise Time?

• Rise Time. The time in milliseconds for pressure to reach 90% of the set inspiratory pressure.

What is the definition of the Patient Synchrony PS Rise Time?

• Pressure Support Rise Time. The time in milliseconds for pressure to reach 90% of the set pressure support level.

What is the definition of Bias Flow?

The continuous flow that is circulated through the patient circuit during the expiratory phase of the breath cycle. The bias flow may be increased above this setting by the ventilator for some FiO2 settings.

What is the definition of Tsupp Pressure Support Time?

The maximum inspiratory time for a pressure-supported breath.

What is the definition of Pmax Maximum Pressure?

The maximum pressure allowed in the patient breathing circuit. Once reached, the inspiratory phase ends, and the ventilator immediately begins the expiratory phase.

What is the definition of Plimit Pressure Limit?

The pressure at which the breath is limited and held for the remaining inspiratory time in a volume-controlled breath.

What is the definition of Pmin Minimum Pressure?

The minimum target pressure offset from PEEP allowed in PRVC, VS, SIMV PRVC, and BiLevel VG modes.

What is the definition of Minimum Rate?

The minimum number of breaths per minute a patient must draw before the ventilator delivers a backup breath.

What is the definition of Backup Pinsp Backup Inspiratory Pressure?

The pressure above PEEP that the ventilator maintains as it delivers a mechanical breath in CPAP/PS and NIV modes.

What is the definition of Backup Tinsp Backup Inspiratory Time?

The time in seconds that the ventilator uses to deliver the inspiratory phase for a mechanical breath in VS, CPAP/PS and NIV modes.

What is Positive end expiratory pressure (PEEP)?

PEEP is the low pressure maintained in the patient’s airway during the expiratory phase. PEEP prevents the patient’s lungs from collapsing at the end of expiration. Maintaining a PEEP level improves the possibility of increasing oxygenation. PEEP (or the equivalent setting of Plow) is available in all ventilation modes.

What is Pressure support?

Pressure support provides additional pressure during the inspiratory phase of spontaneous breaths in spontaneous breathing modes. The PS setting is available in the following ventilation modes:

• CPAP/PS
• SIMV VC
• SIMV PC
• SIMV PRVC
• BiLevel
• BiLevel VG
• NIV
• SBT

The maximum duration of the inspiratory phase for pressure-supported breaths is Tsupp or 4 seconds for adults, 1.5 seconds for pediatrics, and 0.8 seconds for neonates.

When does the inspiratory phase of pressure-supported breaths end?

When one of the following occurs:

• Set Exp Trigger is detected.
• Set VT is delivered (VS mode only).
• Pressure exceeds PEEP + PS + 2.5 cmH2O.
• Set Tsupp is reached.

What is Flow and pressure triggering?

The ventilator detects a patient’s spontaneous breathing effort based on changes in flow or pressure.

What is Flow trigger?

A breath is delivered when the patient’s inspiratory effort reaches the Insp Trigger setting.

What is Pressure trigger?

A breath is delivered when the patient’s negative airway pressure (below PEEP) reaches the Insp Trigger setting.

How do you set a flow or pressure trigger?

Adjust the Insp Trigger setting.

How do you set a flow trigger?

Select Current Mode, select the trigger setting, set a positive value using the Trim Knob and confirm.

How do you set a pressure trigger?

Select Current Mode, select the trigger setting, set a negative value using the Trim Knob and confirm.

When does the ventilator synchronize mechanical breaths with patient triggers?

In the following modes:

• SIMV VC
• SIMV PC
• SIMV PRVC
• BiLevel
• BiLevel VG

And when assist control is active in the following modes:

• A/C VC
• A/C PC
• A/C PRVC

What are Breath timing preferences?

The parameters used to represent the timing of a delivered breath or inspiratory phase of a delivered breath may be selected by the facility.

Note Timing and Flow default settings may be changed by a Super User. See the “Configuration menu (Super User)” section for more information.

What are the available settings based on the ventilation mode and Timing and Flow selections?

Timing	I:E	I:E	Tinsp	Tinsp	Tpause	Flow	On	Off	On	Off	On
A/C VC	I:E	Flow	I:E	Insp Pause	Tinsp	Flow	Tinsp	Insp Pause	Tpause	Flow
A/C PC	I:E	I:E	Tinsp	Tinsp	Tinsp
A/C PRVC	I:E	I:E	Tinsp	Tinsp	Tinsp
SIMV VC	Tinsp	Flow	Tinsp	Insp Pause	Tinsp	Flow	Tinsp	Insp Pause	Tpause	Flow
SIMV PC	Tinsp	Tinsp	Tinsp	Tinsp	Tinsp
SIMV PRVC	Tinsp	Tinsp	Tinsp	Tinsp	Tinsp
BiLevel	Tinsp	Tinsp	Tinsp	Tinsp	Tinsp
BiLevel VG	Tinsp	Tinsp	Tinsp	Tinsp	Tinsp
APRV	Thigh	Tlow	Thigh	Tlow	Thigh	Tlow	Thigh	Tlow	Thigh	Tlow
CPAP/PS	Backup Tinsp	Backup Tinsp	Backup Tinsp	Backup Tinsp	Backup Tinsp
VS	Backup Tinsp	Backup Tinsp	Backup Tinsp	Backup Tinsp	Backup Tinsp
NIV	Backup Tinsp	Backup Tinsp	Backup Tinsp	Backup Tinsp	Backup Tinsp
nCPAP	Tinsp	Tinsp	Tinsp	Tinsp	Tinsp

Note: Selecting a breath timing for the modes listed in the table will not affect other ventilation modes.

What is Tube compensation?

When a patient is intubated, the endotracheal or tracheostomy tube creates resistance in the airway. Tube compensation provides additional pressure to compensate for the difference between the lung pressure and breathing circuit pressure during the inspiratory phase of pressure-controlled and pressure-supported breaths. Tube compensation can be used to offset all or a percentage of the additional resistive pressure created by the endotracheal tube.

Note: To set Tube compensation, a Tube Type and Tube Diameter must be set in the New Patient or Current Patient menu.

WARNING Tube compensation increases the pressure delivered to the patient. The pressure delivered with tube compensation is limited to Pmax – 5 cmH2O. Make sure that Pmax is set appropriately for the patient when using tube compensation.

How do you set Tube Compensation?

Select Current Mode > Mode Settings and select Tube Comp.

A general message shows when tube compensation is on.

Note: The options for tube compensation are: Endotrach, Trach, or —. When —is selected, the ventilator will not compensate for tube resistance.

What is Assist control?

Assist control allows the ventilator to synchronize mechanical breaths to the patient’s spontaneous efforts and the patient to trigger additional mechanical breaths to the set respiratory rate in the following ventilation modes:

• A/C VC
• A/C PC
• A/C PRVC

When the patient initiates a breath with assist control enabled, the ventilator delivers a breath based on the mode settings. After a patient-initiated mechanical breath, the ventilator may delay the delivery of the next mechanical breath to prevent two mechanical breaths from being delivered consecutively (breath stacking).

Note Under certain conditions, such as high spontaneous breathing rates or high leakage, the rate of mechanical breaths may not meet the set respiratory rate. A general message shows when assist control is off. When assist control is off, the patient is able to draw spontaneous breaths at the set PEEP level between mechanical breaths.

How do you set Assist Control?

Select Current Mode > Mode Settings and select Assist Control (On or Off).

What is Leak compensation?

WARNING The exhaled volume of the patient can differ from the measured exhaled volume due to leaks.

When the ventilator detects breathing circuit leaks, leak compensation does two or three functions depending on the selected ventilation mode.

In all modes what does Leak compensation do?

• Flow and volume waveforms and measured volume data are adjusted to account for leaks.

In the following volume-controlled modes, the ventilator adjusts the tidal volume delivered to compensate for leaks:

• A/C VC
• A/C PRVC
• SIMV VC
• SIMV PRVC
• BiLevel VG
• VS

The maximum tidal volume adjustment is limited to 100% of the set tidal volume for the neonatal patient type.

• *Neonatal – 100% of the set tidal volume

How do you set leak compensation?

Select Current Mode > Mode Settings and select Leak Comp.

A general message shows when leak compensation is on.

What is Trigger compensation?

Leaks can cause the ventilator to initiate breaths automatically (auto-triggering). Trigger compensation adjusts the flow trigger to compensate for leaks, reducing the need to manually adjust the Insp Trigger setting to prevent auto-triggering. Trigger compensation is available in all ventilation modes.

How do you set trigger compensation?

Select Current Mode > Mode Settings, and select Trigger Comp.

What is Backup mode?

Backup mode is available if the ventilator detects insufficient ventilation in modes that allow spontaneous breaths.

When is Backup mode enabled?

When enabled, the ventilator automatically enters the set Backup mode if either of the following occur:

• The Apnea alarm is activated.
• The patient’s expired minute volume (MVexp) is below 50% of the set low MVexp alarm.

The set Backup mode is shown under the Backup mode check box in Current Mode > Mode Settings .

How do you enable Backup mode?

Select the check box.

Backup settings are a subset of available settings in each ventilation mode.

How do you adjust Backup settings?

Adjust Backup settings in Current Mode > Mode Settings > Backup Settings.

Note: Settings that are not designated as Backup settings remain at the current value when the ventilator transitions to the set Backup mode.

WARNING Ensure that all users at the facility have been trained and notified of the facility default Backup mode settings. Before deactivating backup ventilation for a specific mode, ensure that all users at the facility have been trained and notified of these settings.

Backup mode is available in the following ventilation modes:

• SIMV VC
• SIMV PC
• SIMV PRVC
• BiLevel
• BiLevel VG
• CPAP/PS
• VS
• APRV

What ventilation modes may be set as the Backup mode?

• A/C VC
• A/C PC
• A/C PRVC
• SIMV VC
• SIMV PC
• SIMV PRVC
• BiLevel
• BiLevel VG

What is Nasal continuous positive airway pressure (nCPAP)?

The nCPAP mode is a purchasable option.

The nCPAP mode is intended for non-invasive ventilation of neonatal patients only.

WARNING Before using nCPAP mode, the patient should demonstrate all of the following characteristics:

• Is responsive
• Breathes spontaneously
• Has a controlled airway
• Requires pressure support ventilation
• Patient needs oxygen therapy

While in nCPAP ventilation, the ventilator is to be provided with CO2 monitoring equipment that complies with ISO 80601-2-55 or ISO 21647.

If the Apnea Time, Leak Limit, or MVexp low alarms are disabled, additional monitoring, such as SpO2, ECG, and CO2, is recommended to prevent the patient from hypoventilating while ventilating in the neonatal patient type without the neonatal flow sensor. The Patient Disconnected alarm is not enabled during nCPAP mode. The Apnea, Circuit Leak, MVexp low, and PEEPe low alarms are the primary disconnection notifications. To make sure that the ventilator detects a patient disconnect, set the PEEPe Low limit correctly for the patient’s condition.

Note: The neonatal flow sensor is not used during nCPAP.

What does the nCPAP mode allow a clinician to do?

The nCPAP mode allows a clinician to set a FiO2 and Bias Flow rate for gas through the patient circuit. The clinician can also set a level of PEEP to be maintained in the patient circuit and a respiratory rate for mechanical breaths. The mechanical breaths delivered are time cycled, but are synchronised with a patient trigger where necessary. The clinician will set the inspiratory pressure inspiratory time for the time cycled breaths. The Bias Flow rate, set by the clinician will be used to maintain PEEP and for the inspiratory phase of the time cycled mechanical breaths. Insufficient setting of the Bias Flow rate may cause an inability to reach or maintain the set PEEP and or inspiratory pressure during the mechanical breaths.

During nCPAP, what does the patient do?

During nCPAP, the patient draws spontaneous breaths through a nasal interface as the ventilator maintains the set inspiratory pressure. If large patient circuit leaks are present, the user may disable the MVexp low, Apnea Time, and Leak Limit alarms.

Important: Backup ventilation is not available while using nCPAP mode.

What are the available settings in nCPAP mode?

Category	Setting
Main Parameters	FiO2
	PEEP
	Pinsp
Breath Timing	Rate
	Tinsp
Patient Synchrony	Bias Flow
	Insp Trigger
Safety	Pmax

What are the invasive neonatal ventilation modes?

The following invasive ventilation modes are available for neonatal patients. See “Ventilation modes” for detailed information.

• A/C VC
• A/C PC
• A/C PRVC
• SIMV VC
• SIMV PC
• CPAP/PS
• BiLevel
• SIMV PRVC
• BiLevel VG
• APRV
• VS
• SBT

Note: BiLevel, SIMV PRVC, BiLevel VG, APRV, and VS are purchasable options.

How do you turn on power to the ventilator?

1. Plug the power cord into an electrical outlet.

• The LED indicator illuminates (green) to indicate the main power is connected.

2. Press the power switch on the back of the ventilator to the On position.

• The start-up screen appears while the system runs a series of automated self tests.
• When the self tests pass, the system goes into Standby and the display shows the Standby menu.
• If the self tests fail, the display shows an alarm. See “List of alarms” and “Troubleshooting” in the “Alarms and troubleshooting” section or “List of alarms – Neonatal” in the “Neonatal alarms and troubleshooting”.

3. Listen for two distinctly different audio tones to sound to make sure the primary speaker and backup buzzer are working properly.

4. Watch and verify the alarm light on the top of the display unit cycles through the following colors: blue, red, and yellow.

WARNING If both the primary and backup audio tones do not sound or the alarm lights do not function correctly when the ventilator is powered on, take the ventilator out of service. Contact an authorized service representative to repair the system.

How do you turn off power to the ventilator?

The ventilator may only be turned off when in Standby, Configuration (Super User), or Service. If the ventilator is turned off during ventilation, an alarm sounds and ventilation and monitoring continue. This ensures the ventilator cannot be accidentally shut off during ventilation.

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

How do you prepare the ventilator for a new patient?

After powering on the ventilator, the Standby menu will display. Select NEW PATIENT. Select the patient type from the options of Adult, Pediatric, or Neonatal. Select Patient ID (identification) and enter up to 10 characters, then select Confirm. To protect patient privacy, do not use the patient’s name when entering the patient ID (identification). Consider the facility’s privacy policies when entering the patient ID. Select Gender (male or female). Select Height. Select Weight. The ventilator will calculate and display the patient weight in kilograms, the BSA (Body Surface Area), IBW (Ideal Body Weight), and a suggested VT (Tidal Volume). IBW is available for adult patients only. Select (Endotrach, Trach, or —). When — is selected, the ventilator will not compensate for tube resistance. Select Tube Diameter. Verify and confirm settings.

What does the Previous Patient button do?

The Previous Patient button shows upon power up of the ventilator when previous patient data exists. Previous Patient allows the clinician to use the patient settings and alarm limits that were previously used and view trends and historical data. For example, if a patient is extubated, but fails to progress and needs to be re-intubated, the clinician may use the previous patient settings.

How do you select the Previous Patient data?

From the Standby menu, select PREVIOUS PATIENT.

What is important to note about the Previous Patient data?

Previous Patient data is only saved when a normal shutdown sequence is performed. Abrupt or unexpected power loss will prevent this data from being saved.

How do you update settings or change the patient type?

Select Standby. Select Current Patient. The Current Patient menu will show. Select the desired patient type and adjust settings.

What should you do before performing the System Check?

The ventilator should be fully cleaned and prepared for a patient before performing the System Check.

How do you run the System Check?

When started, the System Check runs automatically. Selecting the information icon will show the active progress in the System Check Details menu. The steps will show a green check mark (pass) or a red X (fail). When each check is completed, the next check begins.

What does the General Warning icon indicate in the System Check?

A General Warning icon in the System Check indicates that a check has not been performed or completed for the current patient. Both the yellow warning icon and the yellow Start Ventilation button serve as a visual warning that a System Check needs to be performed.

What is recommended to help ensure the proper function of the system?

To help ensure the proper function of the system, it is highly recommended to complete the System Check between patients.

Should the patient be connected to the ventilator while completing the System Check?

The patient must not be connected to the ventilator while completing the System Check.

What happens if you change the patient circuit after completion of the System Check?

Changing the patient circuit after completion of System Check will affect volume delivery and exhaled volume measurements. If any change is made to the patient circuit, repeat the System Check.

With what should you complete the System Check?

Complete the System Check with the breathing circuit and accessories that will be used during ventilation.

What happens if a System Check is not completed for the current patient?

If a System Check is not completed for the current patient, the system uses the compliance and resistance data from the last completed system check for the set patient type for all internal compensations. If the current breathing circuit differs significantly from the previous circuit, differences in ventilation parameters due to changes in the compensation process are possible.

What is the risk of failure to complete a System Check?

Failure to complete a System Check may result in inaccurate delivery and monitoring. This may result in risk to the patient.

How do you run a neonatal system check?

From Standby, select SYSTEM CHECK. The Run System Check menu will show. Attach the neonatal flow sensor to the breathing circuit and all accessories that will be used to ventilate the patient. Occlude the patient wye using the occlusion port. Select Start. The System Check starts and shows the results of each check. The system runs the following checks:

• Paw transducer check
• Barometric pressure check
• Relief valve check
• Exhalation valve check
• Expiratory flow sensor check
• Air flow sensor check
• Oxygen sensor check
• O2 flow sensor check
• Neonatal flow sensor check
• Resistance check
• Circuit measurements check (circuit leak, compliance, and resistance)

What is important to note when performing the Neonatal Flow Sensor Check?

When performing the Neonatal Flow Sensor Check, remove the occlusion from the neonatal flow sensor, keeping the flow sensor attached to the patient circuit.

How do you view the System Check Details menu?

Select the information icon. The System Check starts and shows the results of each check. Follow all on-screen system check instructions.

What do the green check marks and the red Xs indicate as the System Check runs?

As the System Check runs, the results of each check are displayed as a green check mark (pass) or red X (fail). If a check fails, a Help icon displays next to the failed check (red X).

How do you troubleshoot a failure?

Select the Help icon to view possible causes and help for troubleshooting a failure.

What happens when the System Check is complete?

When the System Check is complete, the Final Result line will display the patient type icon, a green check mark (pass) or red X (fail), and the date and time of the System Check.

What settings does the System menu contain?

The System menu contains settings for data source selection, NFS calibration options, display brightness and system information.

What should you do after every day of continuous use?

Calibrate the Neonatal Flow Sensor after every day of continuous use.

How do you access the System menu?

Select Menu > System.

What are the Data Source options?

Select Data Source (Ventilator or NFS).

What are the calibration options and what do they indicate?

Select Calibrations (NFS, Paux Zero, or Purge Flow).

• Select NFS to calibrate the Neonatal Flow Sensor. A green check mark indicates the NFS calibration was successful.
• Select Paux Zero. A green check mark indicates Paux Zeroing calibration was successful.
• Select Purge Flow. The Purge Flow check box may be checked or unchecked when performing a Paux Zero. Continuous purge flow will come from the Paux outlet when the Purge Flow check box is selected. A white check mark indicates Purge Flow is active.

How do you adjust the brightness level of the user interface?

Select Display Brightness to adjust the brightness level of the user interface. Select brightness level of 1 (low) to 5 (high).

What system information can be viewed?

Software version, Service Pack version, Running hours, Altitude, O2 pressure, Air pressure, and Battery status.

What is the data source used for?

The data source is used to obtain patient monitoring parameters from either the ventilator or the Neonatal Flow Sensor (NFS).

What is recommended while ventilating in the neonatal patient type without the neonatal flow sensor?

While ventilating in the neonatal patient type without the neonatal flow sensor, additional patient monitoring such as SpO2, ECG, and CO2 are recommended.

What happens to flow and volume accuracy when not using the neonatal flow sensor for the neonatal patient type?

Flow and volume accuracy are decreased when not using the neonatal flow sensor for the neonatal patient type.

How do you set the ventilator data source?

Select Menu >System. The System menu shows. Select Ventilator or NFS and confirm settings. If the ventilator is selected as the data source the Ventilator Data icon displays, the internal flow sensors of the ventilator will be used for flow and volume monitoring. If the NFS is selected as the data source the Patient Data icon displays, the neonatal flow sensor will be used for flow and volume monitoring.

How are ventilation modes selected?

Ventilation modes are selected through the Current Mode button. The selected ventilation mode shows with the corresponding mode settings.

When may ventilation modes be changed?

Ventilation modes may be changed in Standby or during ventilation.

When should ventilation mode settings be set?

Ventilation mode settings should be set prior to connecting a patient to the ventilator.

How do you set a ventilation and backup mode?

Select Current Mode. Select the desired ventilation mode. The title of the vent mode shows in the Mode Settings menu along with the parameters for that mode. Depending upon the facility default setup for ventilation modes, the Mode Settings menu may contain two icons. The partial list icon represents the facility’s set ventilation modes and the full list icon represents the full set of ventilation modes available. Select the appropriate icon to see available ventilation modes. Select Assist Control, Leak Comp, or Trigger Comp if desired. Assist Control is only available in the following ventilation modes: A/C VC, A/C PC, and A/C PRVC. Set the desired settings for the ventilation mode and confirm. When ventilator settings are confirmed, the Mode Settings menu closes and the selected ventilation mode shows in Current Mode. To set a Backup Mode, select Current Mode. Select Backup Settings. Set the desired settings for the backup mode and confirm. Confirm all ventilation mode settings.

What do the yellow and red visual indicators show when adjusting ventilation mode settings?

When adjusting ventilation mode settings, yellow and red visual indicators show when parameters are approaching their setting limits. Green visual indicators show the parameters are appropriate for the setting limits.

When will ventilation start?

Ventilation will not start until ‘Start Ventilation’ is selected.

What should you ensure before starting patient ventilation?

Ensure that the ventilator battery is fully charged before starting patient ventilation.

How do you start patient ventilation?

From Standby, select START VENTILATION. If the Start Ventilation button is green, a System Check has been completed for the current patient and when selected, will start ventilation. If the Start Ventilation button is yellow, the Complete System Check warning alert will display the following: Select Continue to bypass System Checkout and start ventilation. Select Cancel to remain in Standby. It is recommended that System Check is completed prior to starting ventilation.

What should you do after ventilation has started?

Connect the breathing circuit to the patient.

When will the patient not be ventilated?

The patient will not be ventilated when in Standby.

How do you pause ventilation?

Disconnect the patient from the breathing circuit. Select Standby. Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed. Select Pause Ventilation. Monitoring and ventilation will stop.

What does Park Circuit allow?

Park Circuit allows the patient circuit to be occluded without the ventilator alarming while in Standby. When the patient circuit is positioned on the occlusion port the display activates the PARK CIRCUIT selection.

Will the patient be ventilated while the circuit is parked and in Standby?

The patient will not be ventilated while the circuit is parked and in Standby.

How do you activate Park Circuit?

Disconnect the patient from the breathing circuit. Select Standby. Select Pause Ventialtion to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed. Select Pause Ventilation. Monitoring and ventilation will stop. Occlude the patient circuit using the occlusion port. Select PARK CIRCUIT. The display will show: Patient circuit is occluded and the ventilator is in Standby.

When can ventilation modes and setting adjustments be changed?

Ventilaltion modes and setting adjustments may be changed while in Standby or while ventilating.

How do you change ventilation modes?

Select the Current Mode. The Mode Settings menu shows. Select the desired mode from the list. Use the scroll bar to view additional modes. Confirm setting.

How many Favorite procedures can be selected?

Up to four Favorite procedures may be selected to show on the upper-right corner of the user interface.

How do you set Favorites?

Select Menu. Select Procedures, Lung Mechanics, or Suction menus. Select Assign Favorites. The Assign Favorites menu shows with a list of the following procedures: Increase O2, Suction, Auto PEEP, Inspiratory Hold Expiratory Hold, P 0.1, NIF, Vital Capacity, and Manual Breath. Select up to four Favorites. Favorites show in the upper right corner of the display. The following Favorite procedures begin automatically after they are selected: Manual Breath, Suction, and Increase O2.

What do the audible and visual indicators tell you about the alarm?

Audible and visual indicators tell the priority of the alarm. For medium and high priority alarms, the alarm tone is repeated until audio pause is selected or the alarm condition is resolved. When high priority alarms are not resolved within the set high alert audio time limit, the pitch and volume of the tone increases to the maximum audio level. When more than one alarm occurs at the same time, the alarm bar, alarm light, and audible alarm tone indicates the highest priority alarm. The color on the right side of the alarm light shows the priority of the alarm. The left side of the alarm light is blue when audio pause is active. Some medium priority and high priority alarms are de-escalated and change to low priority alarm when audio pause is selected. Until the de-escalated alarm condition is resolved, the low priority alarm stays active.

What are the Alarm Priority Audible and Visual Indicators?

Priority	Color	Light	Tone
High	Red	Flashes red	Series of five tones, twice
Medium	Yellow	Flashes yellow	Series of three tones
Low	Blue	Solid blue	Single tone

What could occur when using the ventilator?

Possible problems could occur when using the ventilator.

What should you do if a problem occurs that is not listed in the table?

See “Repair policy” in the “Cleaning and maintenance” section for more information.

What should you do if the main power indicator is not on?

• Connect the power cord.
• Loosen the power cord retaining clamp and make sure the plug is fully seated. Then tighten the retaining clamp.
• Turn the circuit breaker on.
• Replace the power cord.
• Use a different electrical outlet.
• Contact an authorized service representative to repair the ventilator.
• Turn the ventilator switch off, and then disconnect from the main power. Check and tighten the display unit connectors.

What should you do if the ventilator cannot be turned off?

Set the ventilator to Standby, and then turn the system off.

What should you do if the backup audio alarm turns on?

• Contact an authorized service representative to repair the ventilator.
• Turn the ventilator switch off, and then disconnect from the main power. Check and tighten the display unit connectors.

What should you do if an alarm shows although the data is within range?

• Calibrate the airway module.
• Go to Menu > System and change the selection for Data Source.

What should you do if the Ppeak high alarm conditions are checked before the display view is updated?

No action required. In some situations the ventilator will react to a transient high pressure before the data can be sampled and shown on the display.

What should you do if the ventilator does not deliver set VT in A/C VC or SIMV VC modes?

• Change the VT setting.
• Change the Plimit setting.

What should you do if the ventilator does not deliver set VT in A/C PRVC, SIMV PRVC, or BiLevel VG modes?

• Change the VT setting.
• Change the Pmax setting.
• Change the VT setting.
• Change the Pmin setting.

What should you do if the ventilator transitions to Backup mode?

Change ventilation settings.

What should you do if there is a short delay in the breath cycle at the PEEP pressure level?

No action required. The situation will be corrected when zeroing is complete.

What should you do if there is automatic flow sensor zeroing interference?

No action required. The situation will be corrected when zeroing is complete.

What should you do if the ventilator is automatically triggering a breath?

• Enable Trigger Compensation.
• Check the breathing circuit for leaks.
• Turn Leak Comp On.
• Increase the Flow triggering level or change from Flow triggering to Pressure triggering.
• Make sure the correct patient type is selected.

What should you do if VT, compliance and resistance values are not accurate?

• Complete System Check with the same breathing circuit that will be used on the patient.
• Clean the expiratory flow sensor.
• Clean the neonatal flow sensor.
• Replace the D-lite flow sensor.
• Replace the D-lite spirometry sensing lines.
• Calibrate the gas module.
• Make sure the water trap is tightly secured.
• Attach the patient circuit to the inspiratory and expiratory ports.
• Make sure the patient wye is occluded completely with the leak test plug.
• Clean or replace the flow sensor. Make sure the flow sensor is connected correctly.
• Remove and replace the exhalation valve.
• Make sure all connection ports are occluded.
• Check the breathing circuit for leaks.
• Do a System Check and let it complete.

What should you do if the touchscreen does not respond?

• Press the Lock hard key at the bottom of the display unit.
• Contact an authorized service representative to repair the ventilator.

What should you do if there is auto-triggering?

• Increase the Insp Trigger setting.
• Set a pressure Insp Trigger.
• Enable trigger compensation.
• Check the patient interface.
• Check the expiratory flow sensor.

What should you do if there is no triggering or missed triggers?

• Decrease the flow Insp Trigger setting.
• Increase the pressure Insp Trigger setting.

What should you do when processing the neonatal flow sensor?

Calibrate the Neonatal Flow Sensor after every day of continuous use.

What precautions should be taken when cleaning the neonatal flow sensor?

• Do not use compressed air or a water jet to clean the neonatal flow sensor.
• Do not use an automated washer to clean or disinfect flow sensors.
• Do not insert anything into the flow sensor to clean internal surfaces. Damage may occur to the flow sensor.
• See the shared “Cleaning and maintenance” section for detailed cleaning instructions.

When should you calibrate the Neonatal Flow Sensor?

Calibrate the Neonatal Flow Sensor after every day of continuous use.

When can the neonatal flow sensor be manually calibrated?

The neonatal flow sensor can only be manually calibrated when the neonatal flow sensor is not set as the data source.

How do you calibrate the neonatal flow sensor?

1. Select Menu > System.
2. Under Data Source, select Ventilator.
3. Hold the flow sensor between thumb and index finger to occlude both ports at the same time.
4. Under Calibration, select NFS.
5. Under Data Source, select NFS.
6. Connect the flow sensor to the patient circuit.

What indicates whether calibration is complete?

When the calibration is complete, a green check mark (pass) or red X (fail) will appear next to NFS.