EvitaXL

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Ventilation Modes Volume-controlled ventilation with PLV and AutoFlow ® Ventilation Modes Volume-controlled ventilation with PLV and AutoFlow ® AutoFlow is a new additional function that regulates inspiratory flow during the mandatory ventilation stroke in the constant-volume ventilation modes IPPV, SIMV and MMV. To explain the improvement achieved by this function, the conventional methods are explained first: Classic constant-volume mandatory ventilation stroke In mandatory ventilation strokes without AutoFlow, the »Insp.Flow« parameter restricts the inspiration flow. If the inspiration flow is so high that the set tidal volume VT is attained before the inspiration time Tinsp has fully elapsed, the inspiration valve closes, and the breathing gas supply stops. The expiration valve also remains closed until the end of the inspiration time Tinsp. This phase, the inspiratory pause, can be identified in the curve PAW (t) as the plateau PPlat. This type of mandatory ventilation stroke, which for technical reasons is found in the same form in almost all intensive care ventilators, has two serious drawbacks: — If the lungs are extremely non-homogeneous, the pressure peaks can lead to the overdistension of specific lung areas, and — the limited inspiration flow and closed inspiration and expiration valves during the inspiratory pause can cause the patient to "fight" the machine. Manual pressure limitation Pmax EvitaXL can prevent pressure peaks, while maintaining the set tidal volume VT, by means of the pressure limit Pmax. The tidal volume VT remains constant as long as a pressure plateau PPlat is still detectable and the flow curve shows a brief zero flow between inspiration and expiration. EvitaXL performs this function by reducing the Insp. Flow on reaching the set Pmax value. If the tidal volume VT can no longer be attained with the selected pressure Pmax, due to reduced compliance, the alarm "Volume not constant" is automatically generated. 208 Instructions for Use EvitaXL PAW Flow Insp. pause PPlat Tinsp Te 1 f Insp. flow Pmax (configurable) t PEEP t 005
AutoFlow ® The AutoFlow function can be activated in the »Add. settings« menu. AutoFlow takes over the task of setting both »Insp. Flow« and »Pmax«. Once AutoFlow has been activated, Pmax and Insp. Flow can no longer be set. With AutoFlow, the inspiration flow is automatically adjusted to changes in lung conditions (C, R) and to the spontaneous breathing demand of the patient. Always set the alarm limit »PAW W« in order to generate an alarm in the event of an increase in airway pressure with reduced compliance. The maximum applied pressure is limited to 5 mbar below the upper pressure limit. Typically, the selected inspiration time Tinsp is much longer than the lung filling time. The inspiration pressure Pinsp corresponds to the minimum value calculated from the tidal volume VT and compliance C of the lung. The inspiration flow is automatically controlled so that there is no pressure peak caused by the resistances of the tube and the airways. The plateau pressure PPlat varies with changes in compliance C, as is normal in all constant-volume ventilation strokes. With AutoFlow these variations occur in maximum steps of 3 mbar between ventilation strokes. If the tidal volume VT is reached (inspiration flow = 0) before the inspiration time Tinsp has fully elapsed, the control system for the inspiration and expiration valves ensures that the patient can breathe in and out during the remaining inspiration time, even during a constant pressure plateau PPlat. If the patient breathes in or out during mandatory inspiration, the plateau pressure PPlat is not changed for this ventilation stroke: only the inspiration and expiration flow are adapted to the patient's demand. The individually applied tidal volume VT may differ from the set tidal volume VT in specific ventilation strokes, but on average over time a constant tidal volume VT is supplied. Any overstepping of the tidal volume VT can be limited by the alarm limit »VTi W«. If the set alarm limit is exceeded once, EvitaXL generates an advisory message(!); if the alarm limit is exceeded three times in a row, it generates an alarm (!!!). In the above examples the volume is actively limited to the alarm limit value »VTi W« by switching over to the PEEP level. ● Set the alarm limits MV < and MV > adequately in order to avoid excessive or insufficient flow following rapid changes in compliance. A set inspiration time Tinsp shorter than the lung filling time can be recognised from the flow curve: the flow at the end of the inspiration time has not dropped to zero. In this case, it must be decided whether the current condition of the patient permits prolongation of the inspiration time Tinsp in order to reduce the peak pressure even further. Ventilation Modes Volume-controlled ventilation with PLV and AutoFlow ® Instructions for Use EvitaXL 209 PEEP PAW Flow Tinsp Te 1 f VT Pinsp = f (VT,C) without spontaneous breathing with spontaneous breathing PAW > t t 017
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EvitaXL Intensive Care Ventilator S
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Contents Contents For Your Safety a
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For Your Safety and that of Your Pa
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Intended Medical Application Intend
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Lung Protection Package (optional)
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Operating concept Operating concept
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The screen... displays all the most
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To set the ventilation mode and ven
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To set ventilation parameters direc
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PressureLink* Linked adjustment of
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Preparing for use Preparing for use
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1 lock it in position = pull tab un
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Using HME, bacterial filters and ho
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1 Hang the hinged arm from the rail
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Fitting CO2 cuvette and CO2 sensor
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Gas supply ● Screw the connecting
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Connecting the nurse call (optional
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Preparing the child test lung 84 09
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● Touch the screen key »Check«.
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Leak test This test must be perform
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Ventilation while transferring a pa
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Operation Starting up . . . . . . .
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Starting up Switching on ● Switch
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Setting new ventilation parameters
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IPPV Intermittent Positive Pressure
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To view additional text information
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ILV ILV = Independent Lung Ventilat
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Setting the Master and Slave device
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ILV: Master and Slave Synchronisati
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BIPAP, BIPAP/ASB Biphasic Positive
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BIPAPAssist Biphasic Positive Airwa
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CPAP-ASB Continuous Positive Airway
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No initial values for PPS To protec
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To review, activate or set: In the
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Apnoea Ventilation For automatic sw
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AutoFlow for automatic regulation o
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-----------------------------------
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PLV* Pressure Limited Ventilation S
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Selecting application mode »Mask«
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Setting alarm limits ● Press key
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Remedy the fault ● Refer to the l
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Displaying graphics The following r
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Freeze To freeze the current real-t
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Display 1 hr trend ● Touch the fu
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Display logbook Changes, events and
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Additional functions Medicament neb
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Switch on the medicament nebuliser:
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EvitaXL ventilates the patient in t
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Expiration Hold This function may b
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Set the interval ● Touch the scre
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Negative Inspiratory Force NIF The
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Measuring procedure ● Touch the s
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Measurement analysis After the meas
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● Press the key » Sensor Paramet
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O2 sensor calibration — After rep
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CO2 zero calibration Only possible
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● Place the test filter in the CO
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Calibrating the CO2 sensor — If t
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Resetting CO2 calibration — If ca
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Selecting Standby Mode — To perfo
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O2 Therapy (optional) During the O2
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Switching on O2 Therapy ● Touch t
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Configuration Configuration . . . .
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Day/night function for screen brigh
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Define the trends to be recorded
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Define customised values and settin
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Lock the screen configuration again
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Select units Specific national unit
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Specific initial therapy values ●
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Set initial values for VT and f…
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Define start-up values for special
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Fault — Cause — Remedy Fault -
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Message Cause Remedy Apnoea !!! Pat
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Message Cause Remedy Exp. hold inte
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Message Cause Remedy Leakage Not di
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Message Cause Remedy Fault - Cause
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Message Cause Remedy Tidal volume h
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Preparing Preparing . . . . . . . .
Page 157 and 158: Medicament nebuliser (optional) 1 R
Page 159 and 160: The expiration valve is only disman
Page 161 and 162: As for ventilation hoses, water tra
Page 163 and 164: Assembling Mounting the expiration
Page 165 and 166: Maintenance/Disposal Maintenance/Di
Page 167 and 168: Replace cooling air filter — Clea
Page 169 and 170: Mains power/DC power operation Main
Page 171 and 172: Use of the power supplies Operation
Page 173 and 174: Connecting an external battery Note
Page 175 and 176: Operation with mains power The vent
Page 177 and 178: Evita 4 Link (optional) Evita 4 Lin
Page 179 and 180: Preparation The interface board may
Page 181 and 182: Select printer protocol ● See "Se
Page 183 and 184: What's what What's what . . . . . .
Page 185 and 186: Front connections 1 » « Gas outle
Page 187 and 188: Technical Data Technical Data . . .
Page 189 and 190: APRV Airway Pressure Release Ventil
Page 191 and 192: Performance characteristics Control
Page 193 and 194: Frequency Measurement Breathing fre
Page 195 and 196: Monitoring Expiratory minute volume
Page 197 and 198: Materials used Part Appearance Mate
Page 199 and 200: Technical Data Equipment outputs An
Page 201 and 202: LUST protocol LUST: List-controlled
Page 203 and 204: End of telegram "EOT" Status telegr
Page 205 and 206: 23 FiO2 high 24 FiO2 low 25 MV low
Page 207: Description Ventilation Modes . . .
Page 211 and 212: SIMV Synchronised Intermittent Mand
Page 213 and 214: Response times longer than 15 secon
Page 215 and 216: BIPAPAssist Biphasic Positive Airwa
Page 217 and 218: PPS (optional) In ventilation mode
Page 219 and 220: The difference between measured val
Page 221 and 222: Unlimited volume compensation is in
Page 223 and 224: Tube type Inside diameter of tube (
Page 225 and 226: Rapid-Shallow-Breathing RSB The Rap
Page 227 and 228: Low Flow PV-Loop The Low Flow PV-Lo
Page 229 and 230: Screen configurations Screen config
Page 231 and 232: Screen configurations Screen config
Page 233 and 234: Abreviation Explanation P 0.1 100 m
Page 235 and 236: Bibliography [1] Baum, M., Benzer,
Page 237 and 238: Special ASCII characters used Chara
Page 239 and 240: Instructions for Use EvitaXL 239
Page 241 and 242: For paediatric ventilation Item No.
Page 243 and 244: Name/Description Order No. For CO2
Page 245 and 246: New features in EvitaXL SW 6.n Indi
Page 247 and 248: Index A Abbreviations . . . . . . .
Page 249 and 250: Performance characteristics . . . .
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