Philips V200 Users Manual Esprit Ventilator Operator’s
V200 to the manual 7870606e-e8cc-4025-8a1a-00eacf0d58c8
2015-02-05
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Respironics V200 Ventilator Operator’s Manual 1057983 50 For Technical Support and Customer Service, contact: USA and Canada: 1-800-345-6443 or 724-387-4000 Respironics Europe, Africa, Middle East: +33-1-47-52-30-00 Respironics Asia Pacific: +852-3194-2280 Facsimile: 724-387-5012 USA Respironics California, Inc. 2271 Cosmos Court Carlsbad, CA 92011 Email and web addresses service@philips.com clinical@philips.com www.philips.com\healthcare Authorized European address Respironics Deutschland GmbH Gewerbestrasse 17 D-82211 Herrsching Germany +49-8-15-29-30-60 EC REP © 2009 Respironics and its affiliates. All rights reserved. This work is protected under Title 17 of the United States copyright code and is the sole property of Respironics. No part of this document may be copied or otherwise reproduced, or stored in any electronic information retrieval system, except as specifically permitted under United States copyright law, without the prior written consent of Respironics. Table of Contents REF 1057983 A 1. Introduction and Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 2. Warnings, Cautions, and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 Summary of Warnings, Cautions, and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 3. Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 4. Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 Unpacking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 Inspection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2 List of Parts and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2 Repacking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3 Ventilator Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 Backup Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 Inspiratory Bacteria Filter Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-16 Heated Expiratory Bacteria Filter Installation . . . . . . . . . . . . . . . . . . . . . . . . . 4-18 Oxygen Source Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20 Patient Circuit Flex Arm Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-22 5. Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Back Panel Connections and Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 Connecting AC Power Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 Power On/Off. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4 Entering Diagnostic Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5 User Configuration Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7 Backup Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-11 Extended Self Test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12 6. Connecting Additional Equipment . . . . . . . Communication Interface . . . . . . . . . . . . . . . . Connecting Serial Communications Devices . . . Connecting Remote Alarm Port . . . . . . . . . . . . Connecting Humidifier . . . . . . . . . . . . . . . . . . Connecting the Patient Circuit . . . . . . . . . . . . Connecting the Analog Port . . . . . . . . . . . . . . .. .. .. .. .. .. .. 6-1 6-1 6-2 6-2 6-3 6-5 6-7 7. Operating Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilator Breath Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Modes Common to VCV and PCV. . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilation Modes Common to NPPV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Emergency Modes of Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1 7-1 7-1 7-1 7-3 7-6 7-7 . . . . . . . .. .. .. .. .. .. .. Respironics V200 Ventilator Operator’s Manual . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . iii Contents 8. Operating Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Front Panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilator Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Settings Screens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Selecting a New Ventilation Breath Type (VCV, PCV, or NPPV) . Selecting the Mode (A/C-SIMV-CPAP or Spont-Spont/T) . . . . . Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Patient Data Screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Monitor Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Preoperational Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Testing Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . Where To Go For Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1 Introduction . . . Visual Alarms . . Audible Alarms . Alarm Reset . . . Alert Messages . Alarm Indicators 10. .. .. .. .. .. .. . . . . . . .. .. .. .. .. .. . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . .. .. .. .. .. .. . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . . . . . . . . .... .... .... .... .... .... .... .... .... .... .... .... .... .... . 8-1 . 8-1 . 8-3 8-11 8-14 8-23 8-26 8-27 8-28 8-29 8-31 8-32 8-34 8-34 ........................... ........................... ........................... ........................... ........................... ........................... 9-1 9-1 9-2 9-3 9-4 9-9 Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 General Information . . . Cleaning . . . . . . . . . . . Sterilization . . . . . . . . Bacteria Filters . . . . . . Periodic Maintenance . Storage. . . . . . . . . . . . Repairs. . . . . . . . . . . . iv .. .. .. .. .. .. . . . . . . . . . . . . . . .. .. .. .. .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-10 11. Diagnostics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1 Entering Diagnostic Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2 Diagnostic Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-3 Extended Self Test (EST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-4 Self Test. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-10 12. Technical Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Breath Types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Volume Ventilation Settings, Ranges and Resolution . . . . . . . . . . . . . . . . . Pressure Control Ventilation Settings, Ranges and Resolution . . . . . . . . . . Non-Invasive Positive Pressure Ventilation Settings, Ranges and Resolution Apnea Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Value Entry Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Respironics V200 Ventilator Operator’s Manual .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12-1 12-1 12-1 12-1 12-2 12-3 12-3 12-4 REF 1057983 A Contents Patient Data Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5 Front Panel Keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6 Level Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Calculated Values from Expiratory Hold Maneuver. . . . . . . . . . . . . . . . . . . . . . 12-7 Interface Ports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-7 Environmental Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8 Environmental Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-8 Connectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-9 Filters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10 Measuring and Display Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10 AC Power and Battery Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-10 Leakage Current . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11 Compliance and Approvals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11 Power Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-11 Dimensions and Weights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12 Electromagnetic Compatibility Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . 12-12 Pneumatic System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-17 Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-18 13. Options and Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-1 Oxygen Sensor Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Assemble O2 Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Attaching the Sensor to the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O2 Sensor Tee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-3 13-3 13-4 13-5 13-5 External Battery Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-7 Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8 Power Consumption Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8 External Battery/Backup Battery Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-8 Battery Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10 Battery Charging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-10 Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-11 Battery Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-11 Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-12 Oxygen Manifold Option . . Kit Contents . . . . . . . . . . Assembly Instructions . . . Replacement Parts: . . . . . Using the Manifold . . . . . REF 1057983 A .. .. .. .. .. . . . . . .. .. .. .. .. . . . . . .. .. .. .. .. .. .. .. .. .. . . . . . .. .. .. .. .. .. .. .. .. .. . . . . . .. .. .. .. .. Respironics V200 Ventilator Operator’s Manual . . . . . .. .. .. .. .. .. .. .. .. .. . . . . . .. .. .. .. .. .. .. .. .. .. . . . . . .. .. .. .. .. . . . . . .. .. .. .. .. .. .. .. .. .. . . . . . . 13-13 13-13 13-14 13-17 13-17 v Contents Graphics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Starting Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Using Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Replotting and Scrolling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rescaling the Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Freeze Feature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Save and Overlay Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inspiratory Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarms During Graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-19 13-19 13-19 13-20 13-20 13-22 13-23 13-24 13-25 Communications Option (Com1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Print Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VueLink Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Configuring the VueLink Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Analog Output (Chart Recorder) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-27 13-27 13-29 13-30 13-36 RS-232 Communications Option 2 (Com2) . . . . . . . . . . . . . RS-232 Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commands Transmitted to the Ventilator . . . . . . . . . . . . . . . Transmission of Data from the Ventilator . . . . . . . . . . . . . . . SNDA, Send Variable Length Ventilator Settings Report Respiratory Mechanics Option. . . . . . . . . . . . . . . . Accessing Respiratory Mechanics Data . . . . . . . . . Vital Capacity Maneuver . . . . . . . . . . . . . . . . . . . . MIP/P0.1 Maneuver. . . . . . . . . . . . . . . . . . . . . . . Static C and R Maneuver . . . . . . . . . . . . . . . . . . . Alarms and Error Messages. . . . . . . . . . . . . . . . . . Compliance (C) and Resistance (R) Computations. . . . . . . . . .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. . . . . . . . . . . .. .. .. .. .. .. .. .. .. .. . . . . . .. .. .. .. .. . . . . . .. .. .. .. .. . . . . . 13-39 13-39 13-40 13-40 13-40 .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. . . . . . . . ... ... ... ... ... ... ... 13-51 13-51 13-52 13-54 13-56 13-58 13-65 Trending Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-69 Accessing Trending Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-69 Selecting Parameters for Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-72 Using the Manual Rescale Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-74 Changing the Cursor Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-74 Selecting the Time Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-75 Using the +2 Hrs/-2 Hrs buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-76 Using the Zoom Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-76 Using the Rescale Button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-76 Using the View 1/View 2 buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-77 Using the Clear button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-77 Alarms during Trending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-77 PCMCIA Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-77 Trending Not Available. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-78 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-78 vi Respironics V200 Ventilator Operator’s Manual REF 1057983 A Contents Flow-Trak® Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-83 On the Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-84 Breath Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-85 Inspiratory Hold. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-85 Respiratory Mechanics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-85 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-86 Respiratory Profile Monitor Interface (NICO-Esprit) Option. . . . . . . . . . . . . . . System Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hardware Setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RS-232 Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Trended NICO Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Neonatal Option . . . . . . . System Requirements . . . Changing Patient Types . . Percent Leak. . . . . . . . . . Patient Leak Values . . . . . . 13-87 13-87 13-88 13-91 13-92 13-96 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-97 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-98 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-101 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-102 Speaking Mode Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-103 Warnings, Cautions, and Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-103 Patient Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-104 Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-106 Starting Speaking Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-106 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-109 Displayed Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-111 Trended Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-112 Discontinue Speaking Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13-115 Auto-Trak Sensitivity™. . . . . . . . . . . Introduction . . . . . . . . . . . . . . . . . . Compatible Patient Interfaces . . . . . . How to Select Auto-Trak. . . . . . . . . . Turning Auto-Trak Off . . . . . . . . . . . Triggering and Cycling with Auto-Trak Leak Detection and Compensation. . . REF 1057983 A .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . . . . . . .. .. .. .. .. .. .. Respironics V200 Ventilator Operator’s Manual . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. ............. ............. ............. ............. ............. ............. ............. . 13-117 13-117 13-117 13-118 13-121 13-121 13-121 vii Contents A. RS-232 Communications Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RS-232 Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Commands Transmitted to the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Transmission of Data from the Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ventilator Report Command and Response (VRPT) . . . . . . . . . . . . . . . . . . . . . . Volume Control Ventilation Settings Report (VCVS) . . . . . . . . . . . . . . . . . . . . . . Pressure Control Ventilation Settings Report (PCVS) . . . . . . . . . . . . . . . . . . . . . Non-Invasive Positive Pressure Ventilation Settings Report (NPVS) . . . . . . . . . . . Patient Data Report (PTDT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alarm Status Report (ALRM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unrecognized Commands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. Customer Service & Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 . A-1 . A-1 . A-1 . A-1 . A-1 A-11 A-14 A-16 A-18 A-21 A-24 Customer Service. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 Warranty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 Options and Accessories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-2 C. Alarm Testing Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary-1 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1 viii Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 1. Introduction and Intended Use The Respironics V200 Ventilator is a microprocessor-controlled, electrically powered mechanical ventilator. It is intended for use by qualified medical personnel to provide continuous or intermittent ventilatory support for adult, pediatric, and neonatal patients as prescribed by a physician. The ventilator is intended for use in either invasive or non-invasive applications in institutional environments. The Respironics V200 Ventilator meets applicable safety requirements, consensus guidelines, U.S.A. regulatory statutes, and international regulatory standards for life support/mechanical ventilation devices. Please read this manual thoroughly and become familiar with the ventilator's operation before using it on a patient. For additional information about accessories or related equipment, such as humidifiers and remote alarm systems, refer to the appropriate instruction manual prior to operating the accessory with the ventilator. Advanced troubleshooting, calibration, and maintenance instructions are included in the Esprit /V200 Ventilator Service Manual, P/N 580-1000-02. All maintenance and repair work should be performed by qualified biomedical technicians who have received appropriate training and authorization to provide maintenance, repair, and service for the ventilator. REF 1057983 A WARNING: Patients on life-support equipment should be visually monitored by competent medical personnel, since life-threatening circumstances may arise that may not activate alarms. Heed all appropriate alarms and follow the instructions and warnings in this operator’s manual. Always check lifesupport equipment for proper operation before use. WARNING: Do not use in the presence of flammable anesthetics. Possible explosion hazard. CAUTION: Federal law (USA) restricts this device to sale by or on the order of a physician. NOTE: Follow the setup instructions in this manual before placing the Respironics V200 Ventilator into service. If you have questions, contact Respironics Customer Service at 1-800-345-644 Respironics V200 Ventilator Operator’s Manual 1-1 Chapter 1 Introduction and Intended Use (This page is intentionally blank.) 1-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 2. Warnings, Cautions, and Notes Throughout this manual the following definitions apply: WARNING: A condition that could cause injury to a patient or operator if the operating instructions in this manual are not followed correctly. CAUTION: A condition that could cause damage to, or shorten the service life of, the Respironics V200 Ventilator. NOTE: Important information concerning the construction or operation of the Respironics V200 Ventilator. Additional Warnings, Cautions, and Notes pertaining to options and accessories are included in the documentation for each option or accessory. Refer to Chapter 13, “Options and Accessories”. Summary of Warnings, Cautions, and Notes REF 1057983 A Warnings • Patients on life-support equipment should be visually monitored by competent medical personnel, since life-threatening circumstances may arise that may not activate alarms. Heed all appropriate alarms and follow the instructions and warnings in this operator’s manual. Always check life-support equipment for proper operation before use. • Do not use in the presence of flammable anesthetics. Possible explosion hazard. • One person alone should not attempt to lift the ventilator or remove it from the shipping carton or the cart. At least two people are required to avoid possible personal injury or damage to the equipment. • To reduce the chance of contamination or infection, always use an inspiratory and expiratory filter when the ventilator is in operation. Refer to manufacturer’s instructions and follow institutional infection control guidelines when replacing the inspiratory and expiratory filter. • Do not use anti-static or conductive hoses or conductive patient tubing. • The expiratory filter housing may be hot if removed from the ventilator immediately after use. Wait 15 minutes after turning off Respironics V200 Ventilator Operator’s Manual 2-1 Chapter 2 Warnings, Cautions, and Notes ventilator power before removing the heated expiratory bacteria filter. Exercise caution when handling the filter housing. 2-2 • All oxygen connections should be carefully inspected to ensure that leaks are not present. Excessive leaks can result in higher than normal ambient oxygen concentrations and create a potentially hazardous oxygen-enriched environment. • Worn/frayed oxygen hoses or oxygen hoses contaminated by hydrocarbon greases or oils should not be used since an oxygen leak or intense fire could result. • Care in the routing of the oxygen inlet hose should be exercised to ensure it is not exposed to mechanisms that could cause damage by cutting or heating/melting. • The cover plate for the PCMCIA slot at the back of the ventilator must be replaced after the adapter and card are installed. This is to protect the ventilator. • AC power is applied to the humidifier from the ventilator humidifier outlet (only available on 100-120 VAC ventilators). Under no circumstances does the Respironics V200 Ventilator provide control for the humidifier. To ensure patient safety, it is important that any humidifier used with the ventilator include an acceptable temperature control and monitoring mechanism, as well as a temperature display and appropriate alarm capabilities (refer to ISO 8185). • To avoid electrical shock hazard, connect the ventilator to a properly grounded AC power outlet. • The ventilator front panel LEDs will indicate the power source that is being used. If the ventilator is plugged in and the MAINS LED is not lit, either the circuit breaker is off or the wall power outlet is not functioning. • The two circuit breakers (MAINS/Humidifier) located on the back of the ventilator are covered to prevent unintentional ventilator power-off. Do not use the circuit breaker to power the ventilator on/off. The power switch is located on the front of the ventilator below the front panel. • Always turn the ventilator power OFF before connecting additional equipment. • Use only Respironics approved cables when connecting to the remote alarm port. Be sure to fully insert the cable into the remote alarm port and into the remote alarm. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 2 Warnings, Cautions, and Notes REF 1057983 A • When using the Remote Alarm Port be sure to fully test the Remote Alarm Port and cable by: • Verifying that annunciated alarms on the ventilator are also annunciated on the remote alarm. • Verifying that disconnecting the cable from the Remote. Alarm port results in an alarm notification at the Remote Alarm. • Verifying that disconnecting the cable from the remote alarm results in an alarm notification at the Remote Alarm. • Ensure that an alternative means of ventilation (that is, a resuscitator or similar device) is available while the ventilator is in use on a patient. • The ventilator complies with the requirements of IEC 601-1-2 (EMC collateral standard), including the E-field susceptibility requirements at a level of 10 volts per meter. However, even at this level of immunity, certain transmitting devices (cellular phones, walkie-talkies, etc.) emit radio frequencies that could disrupt ventilator operation if operated in a range too close to the ventilator. • DO NOT operate the ventilator in a Magnetic Resonance Imaging (MRI) environment. • Vent Inop is a serious condition, which is indicated by both visual and audible alarms. If the ventilator is attached to a patient when Vent Inop occurs, the patient must be supported with another means of life support ventilation. • When the battery low indicator is flashing red, operation of the ventilator from battery power should be discontinued. • For patient safety the HIP Limit Setting should be set as close to the peak inspiratory pressure as patient conditions allow. • DO NOT perform the preoperational procedure when the ventilator is on a patient. • You will be warned if the compliance is 9.0 ml/cmH2O (hPa) or larger. Patients should not be put on a patient circuit that does not meet this requirement. • A high priority, visual and audible alarm indicates a potentially life-threatening condition and immediate response is required. • When the safety valve open indicator is lit, the ventilator does not provide any ventilatory support to the patient. Immediately use a backup means of ventilatory support. • Visually monitor the patient and ventilator during the Alarm Silence period to ensure that alarms do not go undetected. Allowing alarm conditions to continue without intervention may result in harm to the patient and/or ventilator. • Do not expose expiratory and inspiratory bacteria filters or reusable patient tubing to ETO gas. Respironics V200 Ventilator Operator’s Manual 2-3 Chapter 2 Warnings, Cautions, and Notes 2-4 • Disposable or single-patient filters must be discarded between patients. Do not chemically disinfect or expose single patient use bacteria filters to ETO gas. • The patient must be disconnected from the ventilator before entering the Diagnostic Mode since normal ventilation is suspended. • Do not use a ventilator that has failed SST without verifying operational readiness by other means. Doing so may place a patient at risk. • Never initiate SST while the patient is connected to the ventilator. The high airway pressures generated during SST can injure a patient. • Never initiate EST while the patient is connected to the ventilator. The high airway pressures and gas flows generated during EST can injure a patient. • Do not use a ventilator that has failed EST without verifying operational readiness by other means. Doing so may place a patient at risk. • Remove the ventilator from service and contact trained service personnel if any diagnostic codes appear with the exception of: 1, 3, 2000, 3000, 5000, 5002, 8003, or 8004. • Use of a ventilator that has not passed SST or EST is against the strongest recommendation of Respironics. • Please contact Respironics Customer Service at 1-800-345-6443 or consult your service manual if any diagnostic codes are encountered. • When connecting a humidifier to the humidifier outlet (available only on 100-120 VAC ventilators) allowable leakage current values may be exceeded. • The use of accessories, cables, and transducers other than those specified may result in increased EM emissions or decreased immunity of the system. • We recommend that you use an oxygen monitor that complies with ISO-7767; Oxygen Monitors or Monitoring Patient Breathing Mixtures - Safety Requirements. This requirement ensures that the desired fraction of inspired oxygen (FiO2) is delivered to the patient. • The batteries (backup battery) in the battery compartment are non-spillable sealed lead acid. Recycle or dispose of batteries properly. • Do not connect the DC power cord from the backup battery while the Respironics V200 is functioning as a ventilator. Always turn the Power On/Off switch to off ( ). Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 2 Warnings, Cautions, and Notes • Backup battery operating life may be affected by battery age and the number of times it has been discharged and recharged. Over time the battery will degenerate and will not provide the same amount of operating time per charge that is available from a fully charged new battery. Use only the Respironics backup battery P/ N 1059956. • Titrate the EPAP level such that the masks air entrainment valve (if present) remains closed to room air. Always evaluate and monitor patient condition when adjusting EPAP or other settings. • The backlight lamps in the monitor display contain mercury, which must be recycled or disposed of in accordance with local, state, or federal laws. (Within this system, the backlight lamps in the monitor display contain mercury.) Cautions REF 1057983 A • Federal law (USA) restricts this device to sale by or on the order of a physician. • Be sure to check all exterior parts of the ventilator. Problems found during inspection should be corrected and/or reported to Respironics before using the ventilator. • Always ship the ventilator using the original packing material. If the original material is not available, contact your Respironics representative to order replacements. • Do not operate the ventilator without a properly functioning expiratory filter and heater. Doing so may cause damage to delicate ventilator components, such as the expiratory flow sensor, which may lead to inaccurate spirometry or a Vent Inop condition. • The ventilator oxygen filter should be replaced annually as a part of preventive maintenance. • The PCMCIA card should only be removed by trained service personnel once power to the ventilator is off. • To avoid the possibility of damage to the ventilator, do not connect a humidifier whose maximum rating exceeds 3 amps. Ensure that the humidifier power cord is free from defects and any obvious wear, and is properly grounded. A humidifier connection is only available on 100-120VAC ventilators. • Before connecting the ventilator to the AC power source, ensure that the total electrical load does not exceed the ampere rating of the AC branch circuit, especially when using the ventilator with other electrical equipment. An AC branch circuit includes all outlets serviced by a single circuit breaker. If the maximum current drain through a branch circuit exceeds the circuit breaker’s rating, the branch circuit will open, causing the Respironics V200 Ventilator Operator’s Manual 2-5 Chapter 2 Warnings, Cautions, and Notes ventilator to lose power. For further information, consult a service technician or a trained biomedical technician. 2-6 • The ventilator is shipped with a power cord that complies with electrical safety standards. Do not use substitute power cords unless specifically instructed to do so by an authorized distributor or qualified personnel. Do not modify the power cord or connect it with electrical extension cords or outlet adapters. • To prevent the risk of excessive leakage due to external equipment being connected to the ventilator via the communication ports, a means for external separation of the conductive earth paths must be provided. • All equipment used and connected to the ventilator communications ports (analog, parallel, and serial) must comply with the medical electrical equipment (IEC601-1) or other applicable standards. • The remote alarm port is intended to connect only to SELV (safety extra low voltage and ungrounded system with basic insulation to ground), in accordance with IEC60601-1. To prevent damage to the remote alarm, the signal input should not exceed the maximum rating of 24 VAC or 36 VDC at 500 mA with a minimum current of 1 mA. • Failure to protect the expiratory filter from damage by using inappropriate patient circuit configurations may cause damage to delicate ventilator components, such as the expiratory flow sensor, which may lead to inaccurate spirometry or a Vent Inop condition. • If clinical conditions do not require setting the HIP Limit above 60 cmH2O, we recommend the setting normally be adjusted to 60 cmH2O or less in order to prolong the operating life of the blower and to maximize backup battery run time. • The ventilator alarm indicators and the Alerts insert should be monitored closely during the Alarm Silence period to ensure that unexpected alarms are noticed. • If an alarm persists for no apparent reason, contact Respironics Customer Service at 1-800-345-6443. • Care should be taken when cleaning the touch display. (Refer to Figure 8-2 on page page 8-3). A soft moist cloth should be used that does not drip water and/or soap solution when in contact with the display. After cleaning and rinsing with a damp cloth, remove all moisture with a dry, soft cloth. Never allow solutions of any kind to collect on the bottom bezel of the display. Never use a brush or device that can cause abrasion to clean the touch display or its bezel; they will cause irreparable damage. • Do not remove any screws from the cooling filter area. Removing screws from this area will result in damage to internal components. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 2 Warnings, Cautions, and Notes REF 1057983 A • Follow the detergent manufacturer’s instructions. Exposure to detergent solution stronger than necessary can shorten the useful life of the product. Rinse parts thoroughly to remove all detergent residues. Wipe parts dry. Detergent residue can cause blemishes or fine cracks, especially on parts exposed to elevated temperatures during sterilization. • Autoclavable parts will withstand repeated steam autoclaving at temperatures not to exceed 135° C (275ºF). • DO NOT autoclave the ventilator. • Formaldehyde, phenol-based, and quaternary ammonium compound (QUATS) disinfectants are not recommended because these agents can cause cracking and crazing of plastic parts. Exposure of components to disinfectant concentrations stronger than required or for excessive time may shorten product life. Parts should be thoroughly rinsed and dried to prevent spotting and blemishes when exposed to elevated temperatures. • DO NOT allow liquid to penetrate the ventilator rear or front panel. DO NOT attempt to sterilize the ventilator by exposing to ETO gas. DO NOT steam-autoclave. • Troubleshooting and repair should be performed only by a qualified service technician. • If the optional external O2 sensor is in-line, it must be calibrated during EST. • Diagnostic codes should only be cleared by qualified personnel. • To prevent contamination of the O2 sensor, always locate it between the ventilator gas output port and the inspiratory bacteria filter. • PVC O2 (P/N 8-100498-00) and Ultem® (P/N 1020380) Sensor Tees cannot be autoclaved or chemically disinfected. • When inserting the battery tray into the cart’s center column, make sure not to crimp cable connections between the battery tray and cart. • The backup battery is designed to be charged only by the Respironics V200 Ventilator. Under no circumstances should an attempt be made to charge it in any other way. • If the ventilator will not be used for 30 days or more, the backup battery should be preserved. Either disconnect the backup battery from the ventilator or keep the ventilator plugged into an active electrical outlet. Respironics V200 Ventilator Operator’s Manual 2-7 Chapter 2 Warnings, Cautions, and Notes Notes 2-8 • Follow the setup instructions in this manual before placing the Respironics V200 Ventilator into service. If you have questions, contact Respironics Customer Service at 1-800-345-644 • Save the shipping container in case the backup battery has to be returned to Respironics. • We recommend that before using the ventilator for the first time, wipe the exterior clean and disinfect or sterilize its components according to the instructions in Chapter 10, “Care and Maintenance” or the component manufacturer’s instructions. • Follow institutional infection control guidelines when replacing the inspiratory or expiratory bacteria filter. • When adding attachments or other components or subassemblies to the breathing system, for example, an HME or humidifier, ensure that the inspiratory and expiratory resistances (measured at the patient connection port) do not exceed 6 cmH2O (hPa) at a flow of 60 L/min for adults, 30L/min for pediatrics. • High humidity and aerosol medications may reduce expiratory filter life, increase expiratory resistance, and/or cause filter damage. Review ventilator patient graphics frequently for changes in expiratory resistance. Consult filter manufacturer recommendations regarding duration of use, maintenance, and removal and disposal of expiratory filter. • The ventilator should only be connected to an appropriate medical grade 100% O2 gas source capable of delivering a regulated 40 to 90 PSIG (276-620 kPa). • The ventilator is shipped with the appropriate gas fittings and hoses for the intended environment, i.e. DISS (U.S.A. and Canada), Ohmeda (Germany), NIST (UK), Air Liquide (France), SIS (Australia). • All volumes entered into the ventilator are assumed to be BTPS (Body Temperature atmospheric Pressure Saturated (with H2O)) volumes unless otherwise noted. All volumes reported by the ventilator are reported as BTPS volumes. All pressures are assumed to be relative to atmospheric pressure unless otherwise noted. • The Air Inlet Filter houses a reusable foam filter that should be periodically cleaned. Refer to Chapter 10, “Care and Maintenance”, for more information on filter changes. • Unless the Mains Circuit Breaker is turned OFF, electrical power is applied to the ventilator even though the front panel switch is in the OFF position. With the Mains Circuit Breaker ON, if the backup battery is connected, the ventilator will charge the battery if it requires a charge. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 2 Warnings, Cautions, and Notes REF 1057983 A • To disconnect the ventilator from MAINS power, remove the AC plug from the wall power receptacle. The MAIN switch/circuit breaker is covered to prevent unintentional ventilator turn off. • If the operator sets the %O2 setting to 100%, the 100% O2 indicator does not light. The 100% O2 indicator only lights when the 100% O2 front panel key has been pressed. • The ventilator selects its power source based on the following prioritization: AC power (if present), external battery, then backup battery. • The ventilator may automatically reset certain types of alarm conditions once the causes of the alarms are corrected. After an automatic reset, the ventilator will clear the audible alarm and will display a Low Urgency Alarm alert in the Alert Message Insert to inform the operator that an alarm condition existed. When this situation occurs, use ALARM RESET to clear the visual alarm indicator. • For optimal performance and battery life of a newly purchased backup battery, establish full backup battery charge by plugging the ventilator into AC power for eight (8) hours maximum, or until the charging indicator light turns off, and then unplug the unit. • To monitor backup battery performance and life, run the ventilator on battery power for at least 20 minutes at typical settings once a month. Recharge the battery when the test is complete. • If the 100% O2 key is pressed and a 100% O2 gas source is not available, the Low O2 alarm will be active for the two-minute 100% O2 delivery period. • Manual breaths are not permitted during the inspiratory phase of a breath (whether manual or spontaneous). Pressing the MANUAL BREATH key during these times will not result in the delivery of a manual breath. • Some settings buttons appear active despite the fact they are not being used in the ACTIVE MODE. This is because the setting is used in Apnea Ventilation or when manual inspiration is pressed. The operator should always choose a value for an active button that is appropriate for the patient being ventilated. • When the active mode is set to NPPV, the HIP Limit Setting will automatically be adjusted to 10 cmH2O above the current IPAP setting. • Pt. Leak only appears on Patient Data block on Settings screen. • The V200 Ventilator keeps a distinct set of alarm limits for each ventilation breath type (VCV, PCV and NPPV). • Any of the changes made in the screen shown in Figure 8-18, do not take effect until the operator switches to the new ventilation breath type (in this case Pressure Control). Respironics V200 Ventilator Operator’s Manual 2-9 Chapter 2 Warnings, Cautions, and Notes 2-10 • If the EXP HOLD key is held continuously, and the expiratory hold maneuver exceeds 5 seconds, the ventilator automatically terminates the expiratory hold maneuver and begins a new inspiratory period. • If Auto PEEP as calculated in Equation 1: Auto-PEEP = Expiratory Pause Pressure – End Expiratory Pressure, is negative, Auto-PEEP will be displayed as “—.” • All components of the patient circuit must not have leaks in order to pass SST. • If time is found to be incorrect more than once in the preoperational procedure, an internal battery may have to be replaced. Contact qualified service personnel or call Respironics Customer Service at 1-800-345-6443. • Because conditions and practices in health care institutions vary, this manual can only describe general guidelines. It is the user’s responsibility to ensure the validity and effectiveness of the methods used. • Because some environments cause a quicker collection of lint and dust than others, inspect and clean the fan filters more often than every 250 hours if necessary. • The “Hardware” function and EST in the Diagnostics Mode should only be run by qualified personnel. • A “restart” is an infrequent event. • The gas return port on the ventilator is a cylindrical port which requires mating to a specified expiratory filter to seal the expiratory limb. • The humidifier power connection is available only on 100-120VAC ventilators. • Record O2 sensor manufacturing or warranty numbers and installation date for future reference. Save manufacturers instruction about end of life replacement. • To ensure accurate O2 monitoring, check O2 sensors periodically and replace as per manufacturer specification. • Sensor performance and expected operating life information is outlined in the sensor manufacturer’s instructions for use. Thoroughly review all O2 sensor instructions prior to installation and use with the Respironics V200 Ventilator. • O2 sensor calibration is performed during EST. If recalibration of the O2 sensor is required, follow the instructions in “Extended Self Test (EST)” on page 11-4 for running EST. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 2 Warnings, Cautions, and Notes REF 1057983 A • Medical electrical equipment needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided in Chapter 12, “Technical Specifications”. • Speaking Mode is available ONLY in invasive ventilation mode. Respironics V200 Ventilator Operator’s Manual 2-11 Chapter 2 Warnings, Cautions, and Notes (This page is intentionally blank.) 2-12 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 3. Symbols The following symbols appear on the Respironics V200 Ventilator, accessories, documentation, and packaging. Additional symbols pertaining to options and accessories are included in the documentation for each option or accessory. Refer to Chapter 13, “Options and Accessories”. Symbols Symbol Description READ THE USER MANUAL OR ACCOMPANYING DOCUMENTS ATTENTION ON condition for part of the equipment. When pressed, the ventilator will operate from the MAINS voltage if connected or from the backup battery if the battery charge is within operating specifications. OFF condition for part of the equipment PROTECTIVE EARTH (ground) POTENTIAL EQUALIZATION CONNECTOR used to connect the equipment to an electrical installation earth busbar TYPE B applied part, which indicates equipment that provides a particular degree of protection against electric shock, particularly with regards to allowable leakage current and of the protective earth connection SUITABLE FOR ALTERNATING CURRENT DIRECT CURRENT DRIP PROOF Chart recorder ANALOG OUTPUT. Pin 12 signals an unsilenced high or medium urgency alarm: 0 VDC= active alarm, 1.5 VDC = no alarm or silenced alarm. (Voltage signal for flow and pressure reserved for future use.) DC BATTERY CONNECTION Table 3-1: Symbols (Sheet 1 of 5) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 3-1 Chapter 3 Symbols Symbols (Continued) Symbol Description DC BATTERY CONNECTION HOT SURFACE warning EUROPEAN CONFORMITY REMOTE ALARM connection RS-232 serial output PARALLEL PORT printer connection ALARM SILENCE (Silences alarm for two minutes) BRIGHTNESS ADJUST AUDIO ALARM VOLUME CONTROL ACCEPT ALARM RESET 100% OXYGEN Located between the ALARM RESET and 100% O2 buttons, this symbol indicates that the two keys (ALARM RESET AND 100% O2) must be pressed simultaneously for approximately five seconds to enter Diagnostic Mode Table 3-1: Symbols (Sheet 2 of 5) 3-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 3 Symbols Symbols (Continued) Symbol Description MANUAL BREATH EXPIRATORY HOLD SCREEN LOCK (Symbol version of the front panel only) Illuminates yellow to indicate backup battery IN USE (backup) (Symbol version of the front panel only) llluminates yellow to indicate backup battery CHARGING (Symbol version of the front panel only) Flashes red to indicate that the backup battery is LOW (Symbol version of the front panel only) MAINS battery indicator (Symbol version of the front panel only) EXTERNAL BATTERY is in use DANGEROUS VOLTAGE—electrical shock hazard The portion of the circuit breaker that must be pushed in to turn the CIRCUIT BREAKER OFF The portion of the circuit breaker that must be pushed in to turn the CIRCUIT BREAKER ON CANADIAN STANDARDS ASSOCIATION approval. DATE OF MANUFACTURE MANUFACTURER Table 3-1: Symbols (Sheet 3 of 5) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 3-3 Chapter 3 Symbols Symbols (Continued) Symbol Description The product must be disposed of in accordance with the WEEE directive. SEALED, NON-SPILLABLE LEAD ACID BATTERY. MUST BE RECYCLED Pb SEALED, NON-SPILLABLE LEAD-ACID BATTERY. MUST BE RECYCLED Pb RECYCLE THIS SIDE UP AT LEAST TWO PEOPLE ARE REQUIRED TO LIFT THE VENTILATOR TO AVOID POSSIBLE PERSONAL INJURY OR DAMAGE TO THE EQUIPMENT. KEEP DRY +60C LIMIT TEMPERATURE TO BETWEEN-20 AND 60 ºC (-4 AND 140 ºF) -20C 500-1060 hPa FRAGILE Table 3-1: Symbols (Sheet 4 of 5) 3-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 3 Symbols Symbols (Continued) Symbol Description STORE AT 10%-95% RELATIVE HUMIDITY % 10-95 Do not stack > 2 high 2 Table 3-1: Symbols (Sheet 5 of 5) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 3-5 Chapter 3 Symbols (This page is intentionally blank.) 3-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4. Getting Started Unpacking The Respironics V200 Ventilator has been carefully packaged to assure safe shipping. In addition, the packing container has been designed for easy unpacking. Do not discard packing materials. Before unpacking the ventilator, examine the shipping carton(s) for visible damage. If the shipping carton(s) arrives damaged or if you suspect the contents are damaged, contact the carrier for an inspection report. If any damage is evident, we recommend that you photograph the carton(s) before the shipment is unpacked. Report any damage to the shipping container or ventilator to your local authorized Respironics distributor and to the carrier. Save all packing material after removing the ventilator. In the event that the ventilator or backup battery needs to be repacked and reshipped, use the original packing material or order replacement material from a Respironics representative. NOTE: The contents of the shipping carton may vary. Top Foam Insert Respironics V200 Ventilator Center Foam Insert Bottom Foam Insert Figure 4-1: Unpacking/Repacking the Ventilator WARNING: REF 1057983 A One person alone should not attempt to lift the ventilator or remove it from the shipping carton or the cart. At least two people are required to avoid possible personal injury or damage to the equipment. Respironics V200 Ventilator Operator’s Manual 4-1 Chapter 4 Getting Started NOTE: Medical electrical equipment needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided in Chapter 12, “Technical Specifications”. Unpacking Instructions Refer to Figure 4-1. • Tools Required: Box knife 1. Using a box knife, cut a slit in packaging tape on top of shipping carton. 2. Remove accessories box and optional flex arm box (not shown). 3. Remove top foam insert from inside carton. 4. Roll the plastic shipping bag (not shown) off the ventilator. 5. Gently lift ventilator from the bag and carton. 6. Remove patient circuit package (not shown). 7. Store carton, foam insert, and plastic bag in safe place for possible future use. Inspection After unpacking the ventilator, inspect its cabinet exterior for damage, including cracks and scratches or blemishes. Inspect the front panel for scratches, chips, abrasions or other deformities. CAUTION: List of Parts and Accessories Be sure to check all exterior parts of the ventilator. Problems found during inspection should be corrected and/or reported to Respironics before using the ventilator. Using the packing list that accompanies the ventilator, take an inventory of the entire shipment before assembling the ventilator. In case of discrepancies, immediately contact Respironics Customer Service at 1-800-345-6443. The Esprit/V200 Ventilator Service Manual, P/N 580-1000-02, is available for qualified personnel. It includes block diagrams, components parts lists, descriptions, calibration instructions, and other information that will assist appropriately qualified personnel to repair those parts of the equipment that are designated by the manufacturer as repairable. For more information contact Respironics Customer Service at 1-800-345-6443. 4-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started NOTE: Repacking We recommend that before using the ventilator for the first time, wipe the exterior clean and disinfect or sterilize its components according to the instructions in Chapter 10, “Care and Maintenance” or the component manufacturer’s instructions. Should the ventilator need to be returned to Respironics for servicing, or shipped elsewhere for any reason, instructions for repacking are listed below. The following instructions should be followed closely to avoid damage to the ventilator. WARNING: One person alone should not attempt to lift the ventilator or remove it from the shipping carton or the cart. At least two people are required to avoid possible personal injury or damage to the equipment. CAUTION: Always ship the ventilator using the original packing material. If the original material is not available, contact your Respironics representative to order replacements. Repacking Instructions Refer to Figure 4-1. • Tools Required: Heavy duty packaging tape 1. Open carton so that bottom foam insert is facing up. 2. Place backup battery in the bottom foam insert if it is being shipped. 3. Place center foam insert into box on top of the bottom foam insert. 4. If you are also shipping the flex arm, place it in its box (not shown) and place the box in the bottom of the center foam insert. 5. Remove all power cords and accessory items from the ventilator. 6. Set the open ventilator shipping bag (not shown) in the box on the middle foam insert. 7. Gently place the ventilator into the open bag. Check to ensure that the ventilator is firmly positioned into bottom foam insert. Close plastic bag over the ventilator. 8. Replace accessories box (not shown) in the center foam insert beside the ventilator (if also being shipped). 9. Place top foam insert onto ventilator. Ensure snug fit. 10. Close top flaps of carton and seal with heavy-duty packaging tape. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-3 Chapter 4 Getting Started Ventilator Positioning For information about mounting the ventilator on a table top, see the Esprit Operator’s Manual (580-1000-01). If the ventilator is on a cart, lock the cart wheels as needed as shown in Figure 4-2. Figure 4-2: Locking Ventilator Wheel Backup Battery 4-4 The ventilator will automatically switch to operating on backup battery power when the AC power fails or the system is disconnected from AC mains power. A fully charged backup battery will operate the ventilator for approximately 30 minutes, dependent upon the specific ventilator setting. WARNING: The batteries (backup battery) in the battery compartment are non-spillable sealed lead acid. Recycle or dispose of batteries properly. WARNING: Do not connect the DC power cord from the backup battery while the Respironics V200 is functioning as a ventilator. Always turn the Power On/ Off switch to off ( ). WARNING: Backup battery operating life may be affected by battery age and the number of times it has been discharged and recharged. Over time the battery will degenerate and will not provide the same amount of operating time per charge that is available from a fully charged new battery. Use only the Respironics backup battery P/ N 1059956. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started Backup Battery Removal and Installation Required Tool: Philips screwdriver Remove the backup battery from the internal packaging material and shipping bag. Do not discard packing materials until the backup battery has been installed on the ventilator and its operation has been confirmed. NOTE: Save the shipping container in case the backup battery has to be returned to Respironics. Figure 4-3 illustrates the backup battery assembly. Figure 4-3: Backup Battery 1. Before the backup battery is installed, disconnect AC power and any attached equipment. Disconnect the backup battery cable connector from the rear panel of the ventilator by rotating the connector's collar nut counterclockwise while pulling back on the connector. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-5 Chapter 4 Getting Started Figure 4-4: Disconnecting the Battery Cable 2. Remove the rear cable channel cover from the cart by gently prying it back from the top of the center column, freeing it from the column. Rear cable channel cover Figure 4-5: Removing the Rear Cable Channel Cover 4-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started 3. Loosen the ventilator mounting screws (4) from the underside of the cart, and remove the ventilator from the cart. WARNING: One person alone should not attempt to lift the ventilator or remove it from the shipping carton or the cart. At least two people are required to avoid possible personal injury or damage to the equipment. Mounting screws Figure 4-6: Removing the Ventilator from the Cart REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-7 Chapter 4 Getting Started 4. Remove the screws (4) holding the battery tray to the cart. Battery tray mounting screws Figure 4-7: Removing the Battery Tray 5. Gently pull up the battery tray and remove it from the cart. Figure 4-8: Removing the Battery Tray 4-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started 6. If a battery is present in the battery tray, disconnect the old battery from the battery tray’s cable. Figure 4-9: Disconnecting the Old Battery from the Battery Tray’s Cable 7. Undo the straps, remove the old battery if present, and place the new battery in the battery tray. Figure 4-10: Inserting Battery Into Tray REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-9 Chapter 4 Getting Started 8. Position the D ring on the straps as shown below. NOTE: If the D rings are not positioned properly, the excess strap will interfere with the tray’s channel guide. Figure 4-11: Positioning the D Rings on the Battery Straps 9. Connect the battery to the battery tray’s cable. Figure 4-12: Connecting the Battery to the Battery Tray’s Cable 10. Insert the battery tray into the cart’s center column by mating the battery tray’s channel guide to the tray’s channel guide of the center column. CAUTION: 4-10 When inserting the battery tray into the cart’s center column, make sure not to crimp cable connections between the battery tray and cart. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started Figure 4-13: Installing the Battery Tray 11. Slide the battery halfway down the center column, and insert the circular right angle battery connector into the cutout. Pull the cable downward as the tray is fully inserted into the cart's center column. Figure 4-14: Inserting the Circular Right Angle Battery Connector Into the Cutout REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-11 Chapter 4 Getting Started 12. Fasten the battery tray to the cart using the 4 screws used when the tray was removed. Battery tray mounting screws Figure 4-15: Battery Tray Mounting Screws 13. Set the ventilator back on the cart, ensuring that the four ventilator feet meet the four circular recesses on the top of the cart. Tighten the four mounting screws that were loosened in step 3. 4-12 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started 14. Routing the backup battery cable from the tray between the rear of the ventilator and the rear handle of the cart, connect the cable to the circular battery connector on the back of the ventilator. Snap the rear channel cover back into place. Battery backup connector Figure 4-16: Backup Battery Connector 15. Plug the ventilator into an AC outlet. 16. Allow the backup battery to charge as required (see “Battery Charging” on page 4-15). 17. When charging is complete, attach a patient circuit and turn the ventilator on in the diagnostics mode. Select the User Config touch key and enable the Backup Battery confirmation feature (refer to Chapter 5, “Backup Battery”). 18. Run SST (refer to Chapter 11, “Diagnostics”). 19. After SST has been successfully completed, exit the diagnostics mode and power up the ventilator in the normal ventilation mode. 20. While the ventilator is cycling, unplug the AC power from the wall. 21. The ventilator should continue ventilation without interruption of any kind. 22. The ventilator should have the “In Use” indicator (text version of front panel) or the battery symbol (symbol version of the front panel) on and a non-silenceable, non-resettable audible alarm should sound every 60 seconds. "Backup Battery On" is displayed while the ventilator consumes power from the backup battery. 23. Plug the AC wall power back in and the ventilator should continue ventilation without interruption of any kind. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-13 Chapter 4 Getting Started Backup Battery Operation When the backup battery is attached and the Respironics V200 Ventilator is operating in normal ventilation mode anytime there is a loss of AC power, the ventilator will automatically switch to battery power and continue ventilation without interruption. Whenever the ventilator is powered by the backup battery, it will generate a non-silenceable, non-resettable alarm that creates an alarm sound every 60 seconds. During this state, the front panel indicator labeled “In Use” (text version of the front panel as shown in Figure 4-17), or the battery symbol (symbol version of the front panel as shown in Figure 4-18) will illuminate yellow continuously. In addition, "Backup Battery On" is displayed. Figure 4-17: Backup Battery Front Panel Indicators — Text Version Figure 4-18: Backup Battery Front Panel Indicators — Symbol Version Operation will continue in this state until the battery capacity is nearly expended. When the battery has only about 5 minutes of operation left, an audible, nonresetable, HIGH priority alarm will sound. When this happens, the red, front panel indicator labeled “Low” (text version of the front panel as shown in Figure 4-17), or the low battery symbol (symbol version of the front panel as shown in Figure 4-18) and the high priority alarm LED will flash continuously. In addition, "Low Backup Battery" is displayed. WARNING: When the battery low indicator is flashing red, operation of the ventilator from the battery power should be discontinued. When power is finally depleted, the ventilator will open the Safety Valve and terminate ventilation in an orderly fashion. In this state, the front panel displays "Backup Battery Depleted-Connect AC & Cycle Power." The backup alarm emits a continuous tone, the high priority alarm LED flashes, and the Safety Valve, Vent Inop, and Battery Low front panel indicators remain lit until power from the Backup Battery is completely gone. Battery Capacity There is a great deal of variability in the power consumption of the ventilator depending on altitude, ventilator settings, and the age and amount of charge on the backup battery. These parameters will determine the exact amount of time the ventilator can operate from the backup battery. 4-14 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started Battery Charging When the ventilator is plugged into a viable AC supply, it will charge the backup battery if the Mains Circuit Breaker is on and the machine is operating as a ventilator, or in diagnostic mode or the Power ON/OFF switch is OFF ( ). Charging time will depend on the amount of charge the batteries require. A fully discharged backup battery will be fully recharged within 10 hours. If the backup battery does not reach a full charge within 10 hours, contact Respironics Customer Service. While the ventilator is charging, the front panel indicator labeled “Charging” (text version of the front panel as shown in Figure 4-17) or the charging battery symbol (symbol version of the front panel as shown in Figure 4-18) will be on continuously. When the backup battery is fully charged, the indicator will turn off. NOTE: For optimal performance and battery life of a newly purchased backup battery, establish full backup battery charge by plugging the ventilator into AC power for eight (8) hours maximum, or until the charging indicator light turns off, and then unplug the unit. NOTE: To monitor backup battery performance and life, run the ventilator on battery power for at least 20 minutes at typical settings once a month. Recharge the battery when the test is complete. CAUTION: The backup battery is designed to be charged only by the Respironics V200 Ventilator. Under no circumstances should an attempt be made to charge it in any other way. CAUTION: If the ventilator will not be used for 30 days or more, the backup battery should be preserved. Either disconnect the backup battery from the ventilator or keep the ventilator plugged into an active electrical outlet. Warranty Respironics warrants the backup battery to be free from defects in material and workmanship for a period of one year from the date of purchase, provided that the unit is operated under conditions of normal use as described in this operator’s manual. At its discretion, Respironics will make replacements, repairs or issue credits for equipment or parts that are found to be defective. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-15 Chapter 4 Getting Started Inspiratory Bacteria Filter Installation The inspiratory bacteria filter (4) in Figure 4-19, mounts on the gas outlet port (1) located in the lower right corner on the front of the ventilator. If the optional O2 sensor (2) will be used, it will be connected to the gas outlet port (1) before the inspiratory bacteria filter is connected. For more information regarding the optional O2 sensor, refer to Chapter 13, “Options and Accessories”. 5 4 3 2 1 Flow 5 4 3 2 1 Figure 4-19: Inserting Disposable Inspiratory Bacteria Filter 4-16 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started WARNING: To reduce the chance of contamination or infection, always use an inspiratory and expiratory filter when the ventilator is in operation. Refer to manufacturer’s instructions and follow institutional infection control guidelines when replacing the inspiratory and expiratory filter. WARNING: Do not use anti-static or conductive hoses or conductive patient tubing. NOTE: Follow institutional infection control guidelines when replacing the inspiratory or expiratory bacteria filter. NOTE: When adding attachments or other components or subassemblies to the breathing system, for example, an HME or humidifier, ensure that the inspiratory and expiratory resistances (measured at the patient connection port) do not exceed 6 cmH2O (hPa) at a flow of 60 L/min for adults, 30L/min for pediatrics. Inspiratory Bacteria Filter Installation Instructions Refer to Figure 4-19. 1. Locate the gas outlet port (1) on the front panel. 2. If the optional O2 sensor (2) will be used, connect it to the gas outlet port (1). 3. Remove the inspiratory bacteria filter from the filter package and inspect for cracks or potential leaks. Discard the filter if it is cracked, has moisture inside, or is otherwise unserviceable. 4. Some bacteria filters provide an arrow or other mark to indicate the direction of flow. The flow indicator should be pointed away from the ventilator, toward the patient circuit connection Insert inspiratory filter inlet (4) into either • the optional O2 sensor (2) using the 22mm connector (3) or • the gas outlet port (1) if the optional O2 sensor (2) is not used. 5. Connect inspiratory limb of patient circuit (5) to bacteria filter (4). REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-17 Chapter 4 Getting Started Heated Expiratory Bacteria Filter Installation Figure 4-20: Installing Expiratory Bacteria Filter WARNING: The expiratory filter housing may be hot if removed from the ventilator immediately after use. Wait 15 minutes after turning off ventilator power before removing the heated expiratory bacteria filter. Exercise caution when handling the filter housing. CAUTION: Do not operate the ventilator without a properly functioning expiratory filter and heater. Doing so may cause damage to delicate ventilator components, such as the expiratory flow sensor, which may lead to inaccurate spirometry or a Vent Inop condition. WARNING: Vent Inop is a serious condition, which is indicated by both visual and audible alarms. If the ventilator is attached to a patient when Vent Inop occurs, the patient must be supported with another means of life support ventilation. NOTE: Follow institutional infection control guidelines when replacing the inspiratory or expiratory bacteria filter. NOTE: When adding attachments or other components or subassemblies to the breathing system, for example, an HME or humidifier, ensure that the inspiratory and expiratory resistances (measured at the patient connection port) do not exceed 6 cmH2O (hPa) at a flow of 60 L/min for adults, 30L/min for pediatrics. Heated Expiratory Bacteria Filter Installation Instructions Refer to Figure 4-20. 4-18 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started 1. Locate the heated expiratory bacteria filter (1) and receiving compartment (6) in the lower center of front panel. 2. Turn knob (2) counterclockwise to unlatch retaining bracket (3). 3. Open retaining bracket (3) by pulling it out and away from the ventilator. 4. Use tabs (4) to gently pull the heater housing (5) away from the ventilator. 5. Ensure that ventilator has been turned off for 15 minutes. If not, allow the heater housing (5) to cool before touching it with fingers. 6. Gently remove the heater housing (5). Tap filter input port (7) if the filter does not come out easily. 7. Insert the new expiratory bacteria filter (1) into the heater housing (5). 8. Reinstall housing (5) and filter (1) into receiving compartment (6), then close retaining bracket (3). 9. Ensure that the retaining bracket (3) is securely closed and turn knob (2) clockwise to secure latch. 10. Connect the exhalation limb and water collection system of the patient circuit (not shown) to the inlet port of the exhalation filter (7). NOTE: REF 1057983 A High humidity and aerosol medications may reduce expiratory filter life, increase expiratory resistance, and/or cause filter damage. Review ventilator patient graphics frequently for changes in expiratory resistance. Consult filter manufacturer recommendations regarding duration of use, maintenance, and removal and disposal of expiratory filter. Respironics V200 Ventilator Operator’s Manual 4-19 Chapter 4 Getting Started Oxygen Source Connection Figure 4-21: O2 Gas Connections and Filter 4-20 WARNING: All oxygen connections should be carefully inspected to ensure that leaks are not present. Excessive leaks can result in higher than normal ambient oxygen concentrations and create a potentially hazardous oxygen-enriched environment. WARNING: Worn/frayed oxygen hoses or oxygen hoses contaminated by hydrocarbon greases or oils should not be used since an oxygen leak or intense fire could result. WARNING: Care in the routing of the oxygen inlet hose should be exercised to ensure it is not exposed to mechanisms that could cause damage by cutting or heating/melting. CAUTION: The ventilator oxygen filter should be replaced annually as a part of preventive maintenance. NOTE: The ventilator should only be connected to an appropriate medical grade 100% O2 gas source capable of delivering a regulated 40 to 90 PSIG (276-620 kPa). NOTE: The ventilator is shipped with the appropriate gas fittings and hoses for the intended environment, i.e. DISS (U.S.A. and Canada), Ohmeda (Germany), NIST (UK), Air Liquide (France), SIS (Australia). Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 4 Getting Started Oxygen Source Connection Instructions Refer to Figure 4-21. 1. Locate the O2 filter with water trap (1) located in the lower left corner of the rear panel. 2. Ensure that the O2 filter and water trap (1) are properly attached to the ventilator. Inspect the bowl (1) for cracks or potential leaks. Ensure all connections are tight. 3. Inspect the O2 hose (2), hose connector (3) and the hose connector mate (4). 4. Check the oxygen gas supply. Clean, adjust pressure, and drain condensate from any water traps, filters, or regulators in the O2 supply lines. 5. Connect O2 gas connector (3) to the ventilator O2 filter with DISS hose connector (4). 6. If gas source is not already turned on, turn it on and verify that no O2 gas is leaking. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 4-21 Chapter 4 Getting Started Patient Circuit Flex Arm Installation A patient circuit flex arm is provided for use on the ventilator. The patient circuit flex arm may be installed on either the left or right side rail on the cart. 3 1 5 2 4 Figure 4-22: Patient Circuit Flex Arm Installation Patient Circuit Flex Arm Installation Instructions Refer to Figure 4-22. 1. Slide flex arm bracket (1) on to the side rail of the cart (one per side). 2. Tighten black screw knob (2) on flex arm bracket. 3. Insert base of flex arm (3) into flex arm bracket and tighten. 4. Place patient circuit hose clamp (4) into the flex arm clamp (5) and tighten. 4-22 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 5. Setup Back Panel Connections and Controls 1.RS-232 Serial Port 2. Remote Alarm Nurse Call 3. Parallel Printer Port 4. PCMCIA Card Slot 5. Analog Port 6. DC Battery Connector 7. AC Inlet 17. Cooling Fan Inlet 8 Humidifier AC Circuit Breaker 9. Circuit Breaker Cover (not shown) 16. Potential Equalization Connection 10. Mains Circuit Breaker 15. O2 Inlet Filter and Water Trap 11. Humidifier AC Outlet 14. O2 Inlet Connector 12. Air Inlet Duct and Filter 13. Elapsed Time Meter Figure 5-1: Back Panel 1. 232 Serial Port: Connection source for devices capable of serial communication. Refer to Chapter 6, “Connecting Additional Equipment”. 2. Remote Alarm Nurse Call: Connection source for remote alarm devices. 3. Parallel Printer Port: For use with the Communications Option. Refer to Chapter 13, “Options and Accessories”. 4. PCMCIA Card Slot: (PC Card) For use with the Trending Option. Refer to Chapter 13, “Options and Accessories”. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 5-1 Chapter 5 Setup WARNING: The cover plate for the PCMCIA slot at the back of the ventilator must be replaced after the adapter and card are installed. This is to protect the ventilator. CAUTION: The PCMCIA card should only be removed by trained service personnel once power to the ventilator is off. 5. Analog Port: Pin 12 signals an unsilenced high or medium urgency alarm. Other pins are used by the Communications Option. Refer to Chapter 13, “Options and Accessories”. 6. DC Battery Connector: Connection source for battery power cord. 7. AC Inlet: Connection for AC power cord. 8. Humidifier AC Circuit Breaker: Circuit breaker for AC power applied to a humidifier. WARNING: AC power is applied to the humidifier from the ventilator humidifier outlet (only available on 100-120 VAC ventilators). Under no circumstances does the Respironics V200 Ventilator provide control for the humidifier. To ensure patient safety, it is important that any humidifier used with the ventilator include an acceptable temperature control and monitoring mechanism, as well as a temperature display and appropriate alarm capabilities (refer to ISO 8185). CAUTION: To avoid the possibility of damage to the ventilator, do not connect a humidifier whose maximum rating exceeds 3 amps. Ensure that the humidifier power cord is free from defects and any obvious wear, and is properly grounded. A humidifier connection is only available on 100120VAC ventilators. 9. Circuit Breaker Cover: Circuit breaker cover (not shown) protects the Humidifier AC Circuit Breaker and Mains Circuit Breaker switches. 10. Mains Circuit Breaker: Circuit breaker for main AC circuit. 11. Humidifier AC Outlet: Connection for Humidifier AC power cord. 12. Air Inlet Duct and Filter: Filters room air drawn into the ventilator internal air source. 13. Elapsed Time Meter: Records time when the Power On/Off Switch is on ( ). 14. O2 Inlet Connector: Connection for oxygen hoses. 15. O2 Inlet Filter and Water Trap: Filters oxygen entering the ventilator. 16. Potential Equalization Connection: Common grounding point. 17. Cooling Fan Inlet: Allows cooling air to enter the ventilator. 5-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 5 Setup NOTE: All volumes entered into the ventilator are assumed to be BTPS (Body Temperature atmospheric Pressure Saturated (with H2O)) volumes unless otherwise noted. All volumes reported by the ventilator are reported as BTPS volumes. All pressures are assumed to be relative to atmospheric pressure unless otherwise noted. NOTE: The Air Inlet Filter houses a reusable foam filter that should be periodically cleaned. Refer to Chapter 10, “Care and Maintenance”, for more information on filter changes. Connecting AC Power Cord 2 3 1 Circuit Breaker Cover not shown. Figure 5-2: AC Power Cord Retaining Bracket REF 1057983 A WARNING: To avoid electrical shock hazard, connect the ventilator to a properly grounded AC power outlet. CAUTION: Before connecting the ventilator to the AC power source, ensure that the total electrical load does not exceed the ampere rating of the AC branch circuit, especially when using the ventilator with other electrical equipment. An AC branch circuit includes all outlets serviced by a single circuit breaker. If the maximum current drain through a branch circuit exceeds the circuit breaker’s rating, the branch circuit will open, causing the ventilator to lose power. For further information, consult a service technician or a trained biomedical technician. CAUTION: The ventilator is shipped with a power cord that complies with electrical safety standards. Do not use substitute power cords unless specifically instructed to do so by an authorized distributor or qualified personnel. Do not modify the power cord or connect it with electrical extension cords or outlet adapters. Respironics V200 Ventilator Operator’s Manual 5-3 Chapter 5 Setup Connecting AC Power Cord Instructions Refer to Figure 5-2. • Tools Required: Small Phillips screwdriver 1. Ensure that the ventilator is properly positioned on a secure table top, wall mount, or pedestal. 2. Connect the AC Power Cord (1) to the AC inlet (3) located on the rear panel. (Refer to Figure 5-1.) 3. After cord is fully inserted, tighten the retaining bracket screw (2) so that the power cord cannot be inadvertently disconnected from the ventilator. Power On/Off The ON/OFF ( / ) switch is located in the lower portion of the front panel, and is recessed to avoid inadvertent access. When the switch is in OFF ( ) position, the ventilator does not provide mechanical ventilation. If the AC plug is connected and the Mains circuit breaker (refer to Figure 5-1) is ON ( ), AC power is active and the green Mains circuit indicator on the front panel, is illuminated. Vent Inop Safety Valve Power On/ Off Switch Figure 5-3: On/Off Switch 5-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 5 Setup Turning the Ventilator On 1. Ensure that the Mains Circuit Breaker (refer to Figure 5-1), located on the ventilator back panel, is in the ON ( ) position. 2. For 120V applications, if a humidifier is attached to the ventilator, ensure that the Humidifier AC Circuit Breaker (refer to Figure 5-1), located on the ventilator back panel, is in the ON ( ) position. A humidifier connection is only available on 100-120VAC ventilators. 3. Press the Power ON/OFF switch to the ON ( WARNING: ) position (left side up). The ventilator front panel LEDs will indicate the power source that is being used. If the ventilator is plugged in and the MAINS LED is not lit, either the circuit breaker is off or the wall power outlet is not functioning. Turning the Ventilator Off 1. Press the Power ON/OFF Switch to the OFF ( up). Entering Diagnostic Mode ) position (right side WARNING: The two circuit breakers (MAINS/Humidifier) located on the back of the ventilator are covered to prevent unintentional ventilator power-off. Do not use the circuit breaker to power the ventilator on/off. The power switch is located on the front of the ventilator below the front panel. NOTE: Unless the Mains Circuit Breaker is turned OFF, electrical power is applied to the ventilator even though the front panel switch is in the OFF position. With the Mains Circuit Breaker ON, if the backup battery is connected, the ventilator will charge the battery if it requires a charge. NOTE: To disconnect the ventilator from MAINS power, remove the AC plug from the wall power receptacle. The MAIN switch/circuit breaker is covered to prevent unintentional ventilator turn off. The Diagnostic Mode is used for: 1. Running tests of the operation of the ventilator that can only be run when a patient is not attached to the machine. 2. Setting altitude, time and date, and circuit compliance. 3. Other more detailed service/maintenance functions. 4. Calibration of inline Oxygen Sensor, during EST only. Some of these functions are discussed in detail in Chapter 12, “Technical Specifications”. The functions of the Diagnostic Mode that are used to make the machine ready for use as a ventilator when it is first put into service are explained here. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 5-5 Chapter 5 Setup Entering Diagnostic Mode 1. To access the Diagnostic Mode, simultaneously press the ALARM RESET and 100% O2 keys on the front panel for approximately five seconds while turning the ventilator power on. The following message will appear on the screen: Figure 5-4: Warning in Diagnostic Mode 2. Press the OK button to enter the Diagnostic Mode. The following screen appears: Figure 5-5: Main Screen in Diagnostic Mode 5-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 5 Setup User Configuration Screen The buttons across the top and bottom bars are used to select the Diagnostic Mode functions. To set up the machine for the first time for operation as a ventilator, USER CONFIG should be selected. When this button is pressed, the following screen appears. Figure 5-6: User Configuration Screen The User Configuration screen allows the operator to: • Set the date and time • Activate or deactivate the automatic patient circuit compliance compensation feature • Set the proper altitude • Set 24 Hrs/AM PM time display • Activate or deactivate backup battery check at startup Date and Time The real-time clock and calendar will last for approximately 2.5 years. When the ventilator is received, the clock’s time will have to be changed to that of the existing time zone. The date should be checked and changed if necessary. Setting Date and Time Format To set time (Figure 5-8) or date (Figure 5-7): 1. Press the desired date or time button (month, day, year, hour, minute, second). 2. When the window insert appears, press the INCREASE or DECREASE button, or rotate the control knob to change the value of the selected parameter. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 5-7 Chapter 5 Setup 3. Press the ACCEPT button to confirm the change and return to the User Config screen. Press the CANCEL button to leave the value unchanged. Window insert to change the value of Month Figure 5-7: Setting the Date Window insert to change the value of Hour Figure 5-8: Setting the Time 4. After the date and time values have been set, the changes will be shown on the screen. 5. Press the APPLY DATE and APPLY TIME buttons to activate the change. 5-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 5 Setup Apply Date button Apply Time button Figure 5-9: User Configuration Screen After Date and Time are Set 6. The 24 HR CLOCK button allows the operator or technician to set the displayed time in an AM/PM (e.g., 1:15 PM) or 24 Hr. (e.g., 13:15) format. When the 24 HR CLOCK button has a white background, time is displayed in the 24 Hr. format; when it has a gray background, time is displayed in the AM/PM format. 7. Press the 24 HR CLOCK button to toggle between AM/PM and 24 Hr. formats. Observe the time display in the lower right hand corner of the diagnostic screen to confirm the format. Altitude The User Configuration screen in the Diagnostic Mode is used to input the altitude of the location of the ventilator. To enter Diagnostic Mode, follow the instructions “Entering Diagnostic Mode” on page 5-6. At Figure 5-5 select USER CONFIG and the screen in Figure 5-10 appears. Pressing the ALTITUDE button enables you to set the altitude to that of the present geographical location of the ventilator. This factor ensures a more accurate tidal volume delivery. Setting Altitude To adjust the altitude: 1. Verify the altitude using an altimeter, if available, or estimate the altitude in feet (or meters) above sea level. 2. Press the ALTITUDE button. 3. When the window insert appears, select either feet or meters. Press the INCREASE or DECREASE button, or rotate the control knob, to change the value. The longer the increase and decrease are touched, the faster the value will change. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 5-9 Chapter 5 Setup 4. Press ACCEPT to accept the changed value. Press the CANCEL button to leave the value unchanged. Window insert to change the value of Altitude Figure 5-10: Setting Altitude Enabling/Disabling Tubing Compliance The operator can activate or deactivate “tubing compliance compensation” in the User Configuration screen. To enter Diagnostic Mode, follow the instructions for “Entering Diagnostic Mode” on page 5-6. At Figure 5-5, select USER CONFIG and the screen in Figure 5-11 appears. Figure 5-11: Compliance Activated 5-10 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 5 Setup You can have the ventilator compensate the volumes delivered in volume controlled, mandatory breaths with the tubing compliance volume by activating the COMPLIANCE button (Figure 5-11). Circuit compliance is activated when this button has a white background. When the function is activated the exhaled volumes reported by the ventilator will also be tubing compliance compensated. Backup Battery You can have the ventilator confirm the backup battery is connected each time that the machine powers on. Pressing the BKUP BATTERY button (Figure 512) allows this confirmation feature, which is identified by an active button with a white background. Backup Battery (confirm at startup) button active Figure 5-12: Backup Battery Activated From then on when the machine powers on, it searches for a backup battery. If the backup battery is connected to the ventilator, the startup is normal. If the backup battery is not connected, the ventilator displays a message at startup and a 5002 Diagnostic Code will be logged. Figure 5-13: No Backup Battery Connected message REF 1057983 A Respironics V200 Ventilator Operator’s Manual 5-11 Chapter 5 Setup Press the OK button to clear the message from the screen. You may continue to use the ventilator without the backup battery or power off the ventilator and reconnect the backup battery. WARNING: Always turn the ventilator power OFF before connecting additional equipment. To turn this feature off, enter Diagnostic Mode and deactivate the messaging feature by pressing the BKUP BATTERY button. 1. Power off the ventilator. 2. Power on the ventilator while holding down the ALARM RESET and 100% O2 keys simultaneously for approximately 5 seconds. 3. A message appears on the ventilator screen asking the user to ‘Verify that the patient is disconnected prior to proceeding.’ Press OK to enter Diagnostic Mode. 4. Once you’ve entered Diagnostic Mode, select USER CONFIG button, which takes you to the User Config screen. 5. Press the BKUP BATTERY button. The background color should return to blue signifying that this feature has been deactivated. Extended Self Test (EST) We recommend that you run an Extended Self Test (EST) upon receipt of the ventilator to ensure that there has been no shipping damage to the system. We also recommend that you run EST between patients to verify the overall functional integrity of the ventilator. Refer to chapter 11 for instructions on running EST. If EST was run successfully and all configuration information has been entered, the ventilator is ready to be used. Follow the recommended “Preoperational Procedure” on page 8-32 once a patient has been selected. To exit the Diagnostics Mode you must turn the Power On/Off switch OFF ( and then turn it ON ( ). 5-12 Respironics V200 Ventilator Operator’s Manual ) REF 1057983 A Chapter 6. Connecting Additional Equipment Communication Interface WARNING: Always turn the ventilator power OFF before connecting additional equipment. CAUTION: To prevent the risk of excessive leakage due to external equipment being connected to the ventilator via the communication ports, a means for external separation of the conductive earth paths must be provided. CAUTION: All equipment used and connected to the ventilator communications ports (analog, parallel, and serial) must comply with the medical electrical equipment (IEC601-1) or other applicable standards. The ventilator provides three communications interfaces: one serial RS-232 port, an analog output port, and a parallel port. (The parallel port is reserved for use by the Communications Option.) Parallel Analog Remote Alarm AC Power Cord Serial Circuit Breaker (cover not shown) Humidifier AC Outlet Figure 6-1: Ports and Outlets on the Rear Panel REF 1057983 A Respironics V200 Ventilator Operator’s Manual 6-1 Chapter 6 Connecting Additional Equipment Connecting Serial Communications Devices The serial port is designed to transmit data on a one device to one device serial communications channel. In the connection between the two devices, the ventilator assumes the “slave” role and responds to commands transmitted to it via the serial port by the external “master.” The serial communications port uses a standard RS-232, null modem, pin configuration. The ventilator assumes the serial communications is set up for: • 19,200 bits/second baud rate • 8 data bits • no parity bit • 1 stop bit The ventilator is sent commands that are 4 ASCII characters from the external device and responds with a fixed format message. The commands and the responses are specified in Appendix A, “RS-232 Communications Protocol”. Connecting Remote Alarm Port The ventilator is equipped with a remote alarm port enabling ventilator alarm conditions to be sounded at remote locations away from the ventilator. Pressing ALARM SILENCE deactivates the remote alarm. The ventilator signals an alarm using a normally open or normally closed relay contact. The deenergized state of the relay represents an alarm state (any Medium or High Priority alarm) and the energized state represents no alarms. The remote alarm port is a standard ¼ inch, female, phono jack (ring, tip, sleeve) connector. NO Ring NC Tip Common Remote alarm connector & cable Sleeve Figure 6-2: Remote Alarm Port The port is configured to work with the Normally Open (NO), Normally Closed (NC), and Respironics (LifeCare) systems. Each requires specific cabling identified in Table 6-1:. 6-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 6 Connecting Additional Equipment Remote Alarm Cable Kits System Part Number Remote Alarm Cable Kit (Normally Open Protocol) 1003741 Remote Alarm Cable Kit (Normally Closed Protocol) 1003742 Remote Alarm Cable Kit — Respironics (LifeCare) 1003743 Table 6-1: Remote Alarm Cable Kits Connecting Humidifier WARNING: Use only Respironics approved cables when connecting to the remote alarm port. Be sure to fully insert the cable into the remote alarm port and into the remote alarm. WARNING: When using the Remote Alarm Port, be sure to fully test the Remote Alarm Port and cable by: • Verifying that annunciated alarms on the ventilator are also annunciated on the remote alarm. • Verifying that disconnecting the cable from the Remote Alarm port results in an alarm notification at the Remote Alarm. • Verifying that disconnecting the cable from the remote alarm results in an alarm notification at the Remote Alarm. CAUTION: The remote alarm port is intended to connect only to SELV (safety extra low voltage and ungrounded system with basic insulation to ground), in accordance with IEC60601-1. To prevent damage to the remote alarm, the signal input should not exceed the maximum rating of 24 VAC or 36 VDC at 500 mA with a minimum current of 1 mA. We recommend only those humidifiers that comply with ISO 8185 for use on the ventilator. You should consult with the manufacturer(s) of the active humidification system (humidifier and patient circuit components) for their most recent recommendations regarding circuit configurations. Additionally, unless specifically contraindicated by these manufacturers’ recommendations, we recommend the use of a drop-down tube and water collection vial (water trap) placed between the expiratory filter and the expiratory limb of the patient circuit. This is necessary to prevent damage to the expiratory filter. Reference P/N 1006241 Water Collection System, or equivalent. CAUTION: REF 1057983 A Failure to protect the expiratory filter from damage by using inappropriate patient circuit configurations may cause damage to delicate ventilator components, such as the expiratory flow sensor, which may lead to inaccurate spirometry or a Vent Inop condition. Respironics V200 Ventilator Operator’s Manual 6-3 Chapter 6 Connecting Additional Equipment WARNING: Vent Inop is a serious condition, which is indicated by both visual and audible alarms. If the ventilator is attached to a patient when Vent Inop occurs, the patient must be supported with another means of life support ventilation. When connecting a humidifier to the patient circuit, follow the setup procedure supplied by the humidifier manufacturer. The following steps should be followed to electrically connect the humidifier to the ventilator (for 100120 VAC ventilators). For ventilators using voltage other than 100-120 VAC, the humidifier must be connected to another AC outlet. 1. Remove the cover of the humidifier AC power outlet on the back of the ventilator (Figure 6-3). (Circuit Breaker Cover not shown) Humidifier AC Outlet Cover Figure 6-3: Humidifier AC Outlet Cover 2. Connect the humidifier AC plug to the humidifier AC power outlet. (Circuit Breaker Cover not shown) Humidifier AC Plug Figure 6-4: Humidifier AC Plug 6-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 6 Connecting Additional Equipment 3. Run any test procedures recommended by the humidifier manufacturer before the ventilator and humidifier are used on a patient. WARNING: Connecting the Patient Circuit AC power is applied to the humidifier from the ventilator humidifier outlet (only available on 100-120 VAC ventilators). Under no circumstances does the Respironics V200 Ventilator provide control for the humidifier. To ensure patient safety, it is important that any humidifier used with the ventilator include an acceptable temperature control and monitoring mechanism, as well as a temperature display and appropriate alarm capabilities (refer to ISO 8185). 1. The humidifier should be connected between the inspiratory bacteria filter (Figure 6-5) and the inspiratory limb of the patient circuit that leads to the patient wye (Figure 6-6). 2. Follow steps illustrated by Figure 6-5, Figure 6-6, and Figure 6-7. Figure 6-5: Ventilator Gas Outlet Port to Humidifier Patient Circuit Connection REF 1057983 A Respironics V200 Ventilator Operator’s Manual 6-5 Chapter 6 Connecting Additional Equipment Figure 6-6: Humidifier Outlet to Patient Wye Connection Figure 6-7: Expiratory Limb of Patient Circuit to Water Trap Connection (Shows Down Tube between Ventilator and Water Trap) 6-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 6 Connecting Additional Equipment When connecting a patient circuit without a humidifier (for example, when using a heat and moisture exchanger), refer to Figure 6-8. Figure 6-8: Patient Circuit Connections Without Humidifier Connecting the Analog Port REF 1057983 A The analog output port adds a second remote alarm output. Pin 12 (fourth pin from the top left is pin 12) signals an unsilenced high or medium urgency alarm: • 0 VDC = active alarm • 1.5 VDC = no alarm or silenced alarm Respironics V200 Ventilator Operator’s Manual 6-7 Chapter 6 Connecting Additional Equipment The Communications option provides additional signals on this port. Refer to Chapter 13, “Options and Accessories”. Analog Port (Circuit breaker cover not shown) Figure 6-9: Analog Port 6-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 7. Operating Theory Introduction This chapter describes the ventilator’s breath delivery capabilities. It includes a system overview and descriptions of the ventilation modes and available breath types. For descriptions of button settings and general operating instructions, refer to Chapter 8, “Operating Instructions”. System Overview The ventilator is a microprocessor-controlled ventilator capable of delivering a mixture of air and oxygen to a patient’s lungs in a predetermined manner to augment or replace the work normally performed by the patient’s respiratory system. The ventilator performs breath delivery via two different patient interfaces: Ventilator Breath Types • endotracheal tube or tracheostomy tube (invasive ventilation) • face mask, nasal mask, nasal pillows, or mouthpiece with a seal (noninvasive ventilation) The ventilator provides the following ventilation breath types: • Volume Control Ventilation (VCV) – invasive ventilation • Pressure Control Ventilation (PCV) – invasive ventilation • Non-Invasive Positive Pressure Ventilation (NPPV) – non-invasive ventilation During mechanical ventilation, the operator selects one of the ventilation modes. The selected ventilation breath type, along with the selected mode, the patient breathing effort, and the ventilator settings determine the type of breath delivered. Each ventilation breath type has its own settings, alarms, and monitor screens. (Refer to Chapter 8, “Operating Instructions”.) Volume Control Ventilation (VCV) In Volume Control Ventilation, breaths may be controlled by the ventilator (mandatory) or triggered by the patient (spontaneous). When controlled by the ventilator, breaths will be flow controlled and time cycled, thus delivering an operator (TIDAL VOLUME) set volume. In Volume Control Ventilation, the flow pattern can be selected between square and descending ramp waveforms. Refer to Figure 7-1. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 7-1 Chapter 7 Operating Theory Figure 7-1: Volume Control Ventilation (VCV) Waveform Pressure Control Ventilation (PCV) In Pressure Control Ventilation, breaths may be controlled by the ventilator (mandatory) or by the patient (spontaneous). When controlled by the ventilator, breaths are pressure limited and time cycled, resulting in an operator set (PRESSURE) pressure being delivered for an operator set (I-TIME) period of time. Refer to Figure 7-2. Figure 7-2: Pressure Control Ventilation (PCV) Waveform 7-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 7 Operating Theory Ventilation Modes Common to VCV and PCV In Volume Control Ventilation and Pressure Control Ventilation, the operator can select between ventilation modes of Assist/Control, SIMV, and CPAP. Assist Control Ventilation (A/C) With the Assist/Control mode (refer to Figure 7-1 or Figure 7-2), a minimal rate and tidal volume (or inspiratory pressure) are set by the operator. The patient can trigger the ventilator at a more rapid rate, but the operator set tidal volume (or inspiratory pressure) is delivered during each breath. The ventilator delivers only mandatory breaths. Assisted breaths may be either pressure or flow triggered. If the trigger setting is adjusted so that the patient cannot trigger the ventilator, all breaths will be delivered by the ventilator at the operator set rate and tidal volume (or pressure). Synchronized Intermittent Mandatory Ventilation (SIMV) SIMV is a ventilation mode where the patient is allowed to breathe spontaneously and the machine attempts to deliver volume (VCV) or pressure (PCV) mandatory breaths in synchrony with the patient’s effort at the operator set rate and volume (or pressure). This is accomplished by a combination of spontaneous and mandatory windows that open and close. The type of breath delivered depends upon whether the event during the window is patient initiated, operator initiated or time initiated. This logic is illustrated in Table 71: “SIMV Logic”. SIMV Logic Current SIMV State Next SIMV State Inputs Ventilator Response Mand Window Time Trigger (breath period timer expires) Deliver mandatory breath using operator settings for mandatory breath type; Restart breath period Mand Window Mand Window Patient Trigger; Operator Trigger Deliver mandatory breath using operator settings for mandatory breath type Spont Window Spont Window Patient Trigger Deliver a spontaneous breath using operator settings for spontaneous breath type Spont Window Spont Window Operator Trigger Deliver a mandatory breath using operator settings for mandatory breath type Spont Window Spont Window Time Trigger (breath period elapses) Restart breath period timer Mand Window Table 7-1: SIMV Logic REF 1057983 A Respironics V200 Ventilator Operator’s Manual 7-3 Chapter 7 Operating Theory Continuous Positive Airway Pressure (CPAP) CPAP is a spontaneous mode of ventilation. No mandatory breaths are delivered. Throughout the breath cycle, an operator set pressure is provided. The level of pressure delivered during CPAP is the baseline pressure, or PEEP (Positive end Expiratory Pressure). Refer to Figure 7-3. Figure 7-3: Continuous Positive Airway Pressure (CPAP) Pressure Support Ventilation (PSV) In Pressure Support Ventilation, the patient’s spontaneous efforts are assisted by the ventilator at an operator set level of inspiratory pressure. Inspiration is initiated by the patient and terminated when the inspiratory flow falls below an operator set percentage of the peak flow during this breath. During Pressure Support, the patient determines the respiratory rate, and the patient and ventilator determine the inspiratory time and tidal volume. Refer to Figure 7-4. Figure 7-4: Pressure Support Ventilation (PSV) 7-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 7 Operating Theory Positive End Expiratory Pressure (PEEP) The PEEP pressure is the operator set baseline pressure maintained during exhalation. All breaths are referenced to this baseline pressure and the resulting pressure is in addition to the baseline pressure. Refer to Figure 7-5. Figure 7-5: Positive End Expiratory Pressure (PEEP) Rise Time Setting Rise Time applies to all pressure targeted breaths — PSV, PCV, and IPAP in NPPV. The operator can adjust the velocity of pressurization to better match the patient’s demand for flow. Refer to Figure 7-6. Figure 7-6: Rise Time Patient Initiated Breath Triggering Patient initiated breaths can be flow or pressure triggered in A/C, SIMV, CPAP for Pressure or Volume breath types, or flow triggered in NPPV. The pressure trigger level determines the amount of pressure below the baseline pressure that the patient must create in order for the ventilator to deliver a breath. The Flow Trigger level is the amount of flow that the patient must inspire from the base flow in order for the ventilator to deliver a breath. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 7-5 Chapter 7 Operating Theory Patient Leak Display Estimated patient leak (Pt Leak) is displayed in LPM and updated at each breath. Pt Leak is the average leak rate during a breath (delivered volume minus exhaled volume divided by the breath time). Pt Leak is estimated breath by breath. If the physical characteristics of the leak change, there will be a corresponding change in the actual leak flow, which will be detected and leak estimation will be updated in subsequent breaths. Physical characteristics of leaks are determined by a number of factors, for example, the size and shape of the leak (such as a gap in the seal between the mask and face). Leaks that may occur during invasive ventilation are usually undesirable and are not compensated to allow easier leak detection. Ventilation Modes Common to NPPV Non-Invasive Positive Pressure Ventilation (NPPV) In Non-Invasive Ventilation, gas is delivered to the patient via a nasal mask, full face mask, nasal pillows, or mouthpiece with a lip seal. The operator determines whether the mode is totally spontaneous (Spont Ventilation Mode) or spontaneous with a backup rate (Spont/T Ventilation Mode). Spontaneous Ventilation Mode (Spont) In Spontaneous Ventilation Mode, the operator sets the pressure during exhalation (EPAP) and the target pressure during inspiration (IPAP). The patient triggers the breath based on the Flow Trigger setting. Exhalation is determined by the setting E-Trigger, which is a percentage of peak flow during the breath. Refer to Figure 7-7. Spontaneous/Timed Ventilation Mode (Spont/T) In the Spontaneous/Timed Ventilation Mode, the patient can breathe spontaneously, or receive machined controlled breaths. The machine controlled breaths are delivered for a set inspiratory time at a set breath rate. In Spont/T mode, every patient initiated breath is spontaneous and restarts the breath period timer. If the patient triggers a breath before the breath period elapses, the ventilator delivers a spontaneous supported breath (based upon the settings). If the breath period elapses without a patient trigger, the ventilator delivers a ventilator initiated mandatory breath at the set IPAP level. Patient initiated, time cycled breaths are not delivered in Spont/T mode. Refer to Figure 7-7. 7-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 7 Operating Theory Figure 7-7: Spont/T Mode Emergency Modes of Ventilation The ventilator has the following two emergency modes of ventilation that are entered in response to certain alarm conditions: • Apnea Ventilation • Safety Valve Open Apnea Ventilation Apnea ventilation provides an emergency mode of ventilation if the ventilator does not deliver a breath for an operator set interval of time. The apnea time can be set between 10 and 60 seconds. Upon entering this mode of ventilation, the ventilator will alarm and immediately start using the Apnea Rate setting specified by the operator. In PCV and VCV, the ventilator will begin delivering breaths in Assist/Control (A/C), but with the operator set Apnea Rate. In NPPV, the ventilator will deliver only machine controlled breaths either at the operator set Apnea Rate or in response to patient effort. In Apnea ventilation, the alarms used are the ones used for machine controlled breaths for the ventilation breath type (VCV, PCV and NPPV) the ventilator was using when Apnea occurred. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 7-7 Chapter 7 Operating Theory Parameters Used in Apnea Ventilation, Settings, and Alarm Limits VCV Settings Tidal Volume Peak Flow PEEP I-Trigger (pressure/flow) Flow pattern O2 % Insp Hold Apnea Rate Alarm Limits High Pressure Low Insp Pressure Low PEEP Low Mandatory Tidal Volume High Rate High Exhaled Minute Volume Low Exhaled Minute Volume PCV NPPV Inhalation Pressure Inhalation Time PEEP I-Trigger (pressure/flow) Rise Time O2 % Apnea Rate IPAP EPAP Inhalation Time Rise Time I-Trigger (flow) E-Cycle O2% Apnea Rate High Pressure Low Insp Pressure Low PEEP Low Mandatory Tidal Volume High Rate High Exhaled Minute Volume Low Exhaled Minute Volume Low Pressure Low EPAP Low Tidal Volume High Rate Low Exhaled Minute Volume High Leak Table 7-2: Parameters Used in Apnea Ventilation, Settings, and Alarm Limits The ventilator will reset out of Apnea Ventilation if the operator presses the Alarm Reset button, or if the patient triggers two successive breaths. Safety Valve Open (SVO) Safety valve open is an emergency mode of ventilation that allows the patient to breathe through the system whenever any of the following occur: 1. An occlusion is detected. (The ventilator resumes normal breathe delivery if the occlusion is removed.) 2. Loss of both the air supply and the oxygen supply occurs. (The ventilator resumes normal breath delivery if the gas supply is made available.) 3. The Ventilator Inoperative state (Vent InOp) is entered due to a hardware malfunction that prevents breath delivery. (The ventilator will not resume normal breath delivery in this case. Call for service.) During 1. 2. 3. 4. 5. 6. 7-8 SVO: The safety valve is opened, The exhalation valve is opened, The air and oxygen valves remain closed, A high priority alarm is activated, The Safety Valve Open indicator is illuminated, The Normal indicator is turned off. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8. Operating Instructions Overview WARNING: Ensure that an alternative means of ventilation (that is, a resuscitator or similar device) is available while the ventilator is in use on a patient. WARNING: The ventilator complies with the requirements of IEC 601-1-2 (EMC collateral standard), including the E-field susceptibility requirements at a level of 10 volts per meter. However, even at this level of immunity, certain transmitting devices (cellular phones, walkie-talkies, etc.) emit radio frequencies that could disrupt ventilator operation if operated in a range too close to the ventilator. WARNING: DO NOT operate the ventilator in a Magnetic Resonance Imaging (MRI) environment. There are three ventilation breath types: • Volume Control Ventilation (VCV) • Pressure Control Ventilation (PCV) • Non-Invasive Ventilation (NPPV) Each has mandatory or machine controlled breaths and each has patient controlled or spontaneous breaths. Each ventilation breath type has its own settings that are mutually exclusive from the other ventilation modes.1 • In VCV, you can select either A/C, SIMV, or CPAP mode. • In PCV, you can select either A/C, SIMV, or CPAP mode. • In NPPV, you can select Spont/T or Spont mode. Alarms are specific to the ventilation breath type. Alarm limits in one ventilation breath type are mutually exclusive from the alarm limits of the other ventilation breath types. The ventilator is easy to use because all mode settings and alarm limits are selected using the same three-step process: 1. Select the parameter to be changed by pressing the associated button. The screen shown in Figure 8-1 appears. 1. Set O2 and patient type are exceptions that can be changed only in the active mode and applies to all modes. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-1 Chapter 8 Operating Instructions Increase bar, the farther from the middle the bar is pushed the faster the value changes. Similarly for the decrease bar. Digital value of setting to be changed Figure 8-1: Entering Settings and Alarm Parameters 2. Press the INCREASE bar or DECREASE bar until the desired value appears in the digital window, or use the front panel control knob to increase or decrease the displayed value. 3. Press the ACCEPT button (or FRONT PANEL ACCEPT key) to enter the value and return to the previous display. Press the CANCEL button to leave the value unchanged. NOTE: 8-2 All volumes entered into the ventilator are assumed to be BTPS (Body Temperature atmospheric Pressure Saturated (with H2O)) volumes unless otherwise noted. All volumes reported by the ventilator are reported as BTPS volumes. All pressures are assumed to be relative to atmospheric pressure unless otherwise noted. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions The Front Panel Alarm Status Indicators The text version of the ventilator’s front panel includes the indicators and controls shown in Figure 8-2. The symbol version of the front panel is shown in Figure 8-3. Vent Inop Safety Valve Touch Display Power Status Indicators Front Panel Keys Level Controls Power On/Off Switch Figure 8-2: Front Panel — Text Version REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-3 Chapter 8 Operating Instructions Alarm Status Indicators Vent Inop Safety Valve Touch Display Power Status Indicators Front Panel Keys Level Controls Power On/Off Switch Figure 8-3: Front Panel — Symbol Version 8-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Alarm Status Indicators The alarm status indicators located at the top of the ventilator alert you to the ventilator’s alarm conditions. (Refer to Chapter 9, “Alarms” for more detailed descriptions.) Normal Alarm High Alarm Med/Low VENT INOP SAFETY VALVE Figure 8-4: Alarm Status Indicators Alarm Status Indicators Alarm Indicator Status Description Normal Green No active or auto reset alarm condition exists. High Flashing red A high priority alarm condition exists. Med/Low Flashing yellow A medium priority alarm condition exists. Continuous yellow Vent Inop Red (active) A low priority alarm condition exists. In addition, indicates auto reset conditions The ventilator is not capable of supporting mechanical ventilation and requires service. During Vent Inop, the ventilator opens the safety valve to enable the patient to breathe room air spontaneously. The ventilator also discontinues detection of new alarm conditions during Vent Inop. WARNING: Vent Inop is a serious condition, which is indicated by both visual and audible alarms. If the ventilator is attached to a patient when Vent Inop occurs, the patient must be supported with another means of life support ventilation. Safety Valve Red (active) The safety valve is open and the ventilator is not in operation. This is a high priority alarm condition. When the Safety Valve indicator is illuminated, the ventilator is not providing ventilatory support to the patient. The safety valve opens to allow the patient to breathe spontaneously through the ventilator circuit. The patient must be capable of creating a spontaneous breath in order to breathe through the safety valve. Table 8-1: Alarm Status Indicators REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-5 Chapter 8 Operating Instructions Power Status Indicators Power status indicators alert you to the status of the backup battery. The text version of the power status indicators is shown in Figure 8-5. The symbol version of the power status indicators is shown in Figure 8-6. NOTE: The ventilator selects its power source based on the following prioritization: AC power (if present), external battery, then backup battery. Figure 8-5: Power Status Indicators — Text Version Figure 8-6: Power Status Indicators — Symbol Version Power Status Indicators Battery Indicator Status Description In Use Yellow (active) The ventilator is running on backup battery power. The backup battery is used when there is no AC power and no other battery is available. Charging Yellow (active) The backup battery is charging. The battery should not be considered a fully charged power source when this indicator is illuminated. The Charging indicator will stay on for the duration of the charging cycle, which can last up to ten hours. Once the battery has fully charged, the Charging indicator will turn off. Low Flashing red The backup battery has approximately 5 minutes of power remaining. WARNING: When the battery low indicator is flashing red, operation of the ventilator from battery power should be discontinued. Table 8-2: Power Status Indicators (Sheet 1 of 2) 8-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Power Status Indicators (Continued) Battery Indicator Status Description Mains Green The ventilator is connected to an AC power source and the rear panel Mains circuit breaker is on ( I ). Ext. Battery Yellow Continuously illuminated when the external battery is in use. NOTE: The external battery is an optional accessory. See “Options and Accessories” on page 13-1 for more information. Table 8-2: Power Status Indicators (Sheet 2 of 2) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-7 Chapter 8 Operating Instructions Front Panel Keys The front panel keys enable you to initiate ventilator functions. The keys that include an indicator ( ) also provide operational status of the function that it performs. The text version of the front panel keys is shown in Figure 8-7. The symbol version of the front panel keys is shown in Figure 8-8. (Refer to Chapter 9, “Alarms” for more detailed information on the alarm keys and buttons). Figure 8-7: Front Panel Keys — Text Version Figure 8-8: Front Panel Keys — Symbol Version Front Panel Keys Key Symbol Definition Description Screen Lock Function: Locks and unlocks the graphic display (touch screen). When the screen lock is activated, all on-screen buttons are disabled until the touch screen is unlocked. This prevents inadvertent setting and display changes via the touch screen. MANUAL BREATH, 100% O2, EXP. HOLD, ALARM RESET, and ALARM SILENCE keys are still active keys. Indicator: Illuminates green when active. Accept Function: Enables you to accept selected settings on the front panel graphical display. Table 8-3: Front Panel Keys (Sheet 1 of 3) 8-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Front Panel Keys (Continued) Key Symbol Definition Description Alarm Silence Function: Disables the audio alarm for two minutes. When Alarm Silence is pressed before the end of a two-minute period, the two-minute timer is reset. Alarms that cannot be silenced are listed in Table 9-1: “Alarm Alert Messages” on page 9-5. Indicator: Illuminated yellow when the audible alarm has been disabled; is active and stays on for two minutes when the ALARM SILENCE button is pressed. If ALARM SILENCE is active, and a new alarm condition occurs, which involves exceeding an active alarm limit, the visual alarm functions will be active. (Refer to “Alarm Silence” on page 9-2.) ALARM RESET clears ALARM SILENCE. If a medium or high priority alarm exists after ALARM RESET clears ALARM SILENCE, the audible alarm will begin. Alarm Reset Function: Clears the visual indicator for auto reset alarms, certain active alarms (see “Alarm Reset” on page 9-3), and reset of apnea ventilation back to the active mode of ventilation (see “Apnea Ventilation” on page 827). Alarm Reset also terminates ALARM SILENCE. NOTE: The ventilator may automatically reset certain types of alarm conditions once the causes of the alarms are corrected. After an automatic reset, the ventilator will clear the audible alarm and will display a Low Urgency Alarm alert in the Alert Message Insert to inform the operator that an alarm condition existed. When this situation occurs, use ALARM RESET to clear the visual alarm indicator. 100% O2 Function: Press once to deliver 100% O2 to the patient for two minutes. Subsequent button presses will reset the timer to two minutes. NOTE: If the 100% O2 key is pressed and a 100% O2 gas source is not available, the Low O2 alarm will be active for the two-minute 100% O2 delivery period. Indicator: Illuminated green; is active only when the 100% O2 front panel button has been pressed and the ventilator is delivering 100% O2 to the patient; remains on for the duration of 100% O2 delivery (two minutes). NOTE: If the operator sets the %O2 setting to 100%, the 100% O2 indicator does not light. The 100% O2 indicator only lights when the 100% O2 front panel key has been pressed.. Table 8-3: Front Panel Keys (Sheet 2 of 3) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-9 Chapter 8 Operating Instructions Front Panel Keys (Continued) Key Symbol Definition Description Manual Breath Function: Delivers an operator-initiated, mandatory (OIM) breath. Delivery of the breath is based on the current ventilation breath type settings. NOTE: Manual breaths are not permitted during the inspiratory phase of a breath (whether manual or spontaneous). Pressing the MANUAL BREATH key during these times will not result in the delivery of a manual breath. Expiratory Hold Enables calculations of Auto-PEEP from an expiratory hold maneuver. (See “Special Procedures” on page 8-31.) Table 8-3: Front Panel Keys (Sheet 3 of 3) Front Panel Level Controls The front panel level controls enable you to adjust ventilator settings, brightness, and volume. Front Panel Controls Control Definition Description Adjust Control Used in conjunction with the front panel graphical display and touch screen to enter operator-selected values for ventilator settings and alarms. Display Increases or decreases the brightness of the touch screen Brightness display Audible Alarm Volume Increases or decreases the audible alarm volume. The minimum audible alarm volume is dictated by international standards. The audible alarm volume control will not turn the audible alarm volume lower than the minimum decibel level dictated by these standards. It is not possible to turn the audible alarm volume off. On/Off Switch Located near the front panel, the On/Off switch is recessed to avoid inadvertent or accidental access. When the switch is in off ( ) position, the ventilator does not provide mechanical ventilation, although AC power is active and the green Mains indicator is illuminated. Table 8-4: Front Panel Controls 8-10 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Ventilator Screens Front Panel Touch Display The front panel display allows you to select ventilation modes, breath types, settings, alarms, and access patient data. The front panel display is a touch screen that lets you select settings and data so you can monitor the status of the patient, ventilator, and control ventilator operation. There are two different categories of screens: • Ventilator Screens that appear when the machine is functioning as a ventilator • Diagnostic Screens that appear when the machine is not functioning as a ventilator and is running internal tests (Refer to Chapter 11, “Diagnostics”, for more information about displaying ventilator diagnostic information.). Common Ventilator Screen Components Except for the patient data screen, screen configurations are determined by the selected ventilation breath type. Figure 8-9 shows the elements that are common to all ventilator (non-diagnostic) screens: the top bar, bottom bar, and manometer. Top Bar Manometer Bottom Bar Figure 8-9: Elements Common to All Operational Screens (VCV settings shown) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-11 Chapter 8 Operating Instructions Figure 8-10 shows the top bar and describes its buttons. Active Mode: push to display the settings for the active ventilation mode and breath type. Active Alarms: push to show current alarm settings for the active ventilation mode and breath type. Patient Data: push to show the Patient Data screen. Monitor: push to display the monitor screen (ventilator settings and patient data). Figure 8-10: Top Bar (common to all operational screens) Figure 8-11 shows the bottom bar and describes its buttons. VCV Settings: push to display VCV settings screen, which allows you to view and change settings for volume controlled ventilation. NPPV Settings: push to display NPPV settings screen, which allows you to view and change settings for noninvasive positive pressure ventilation. PCV Settings: push to display PCV settings screen, which allows you to view and change settings for pressure controlled ventilation. Respiratory Mechanics button: selects option if installed. Option: for use in the future. Graphics button: selects option if installed. Printer: Available if Communications option is installed. Figure 8-11: Bottom Bar (common to all operational screens) Buttons in the bottom bar have two states, “selected” and “not selected”. In the “selected” state, the button has a white background and black letters (see VCV SETTINGS in Figure 8-11). In the “not-selected” state the button has a gray background and black letters (see PCV SETTINGS, and NPPV SETTINGS in Figure 8-11). In the upper bar the buttons PATIENT DATA, ALARM SETTINGS, and MONITOR are also the “selected/not-selected” type. When one of these “selected/not-selected” buttons is selected, it indicates that the screen is being used to display the information described by the name of the button on the screen. Making a setting screen “selected” (for a breath type that is not active), is the first step to activate that ventilation breath type (Refer to “Selecting a New Ventilation Breath Type (VCV, PCV, or NPPV)” on page 8-23.) 8-12 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Figure 8-12 shows the real time manometer displays. Waveform: airway pressure versus time Indicator Upper limit of real time display determined by High Pressure alarm setting High pressure alarm setting press this button to modify HIP. Zero pressure line Breath Indicator Manometer with Waveform Manometer only (for mode setting screens) Figure 8-12: Manometer (common to operational screens) Table 8-5: “Breath Indicator” describes the breath indicator. Breath Indicator Breath Symbol Description Mand Operator or ventilator triggered mandatory breath. Assist Patient triggered mandatory breath. Plateau Inspiratory hold, can be set at the end of the inspiratory phase of a VCV breath type. Support Patient triggered spontaneous breath with PSV>0 or IPAP>EPAP. Spont Patient triggered spontaneous breath, PSV=0 or IPAP = EPAP. Exhale Indicates exhalation phase of any breath. Table 8-5: Breath Indicator REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-13 Chapter 8 Operating Instructions Pressing the HIP indicator on the screen (Figure 8-12) will immediately allow the operator to modify the high pressure limit for VCV or PCV. In NPPV, the high pressure limit is automatically set to 10 cmH2O (hPa) above IPAP. The HIP indicator does not appear near the manometer in NPPV. HIP Settings Screens The buttons in the middle of the settings and alarm limit screens all have two states: active and inactive. Active settings have a gray background with black letters (Figure 8-13). An active setting is currently being used to control ventilation or as an alarm limit. Inactive setting buttons have a gray background with gray letters. Inactive settings are not currently being used to control ventilation or as an alarm limit. In both states the button can be pressed and an insert window will appear that will allow the operator to change the value of the setting (Figure 8-1). NOTE: Some settings buttons appear active despite the fact they are not being used in the ACTIVE MODE. This is because the setting is used in Apnea Ventilation or when manual inspiration is pressed. The operator should always choose a value for an active button that is appropriate for the patient being ventilated.. Pressing the ACTIVE MODE button displays the settings screen for the currently selected ventilation breath type and mode (Chapter 7, “Operating Theory”, for more information on ventilation modes, breath types, and controls). For example, in Figure 8-13 the current breath type is VCV and the mode is A/ C. Because A/C does not allow the ventilator to deliver any spontaneous breaths, any settings that apply to spontaneous breaths are not active and are grayed out. In Figure 8-13, PSV is grayed out, indicating that it isn’t active, but you can still push this button and change the PSV value. The PSV value will become active only if the SIMV or CPAP mode is selected. 8-14 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Ventilation mode: A/C, SIMV, or CPAP. Spont or Spont/T are available during NPPV Ventilation control settings: VCV, PCV, or NPPV Figure 8-13: VCV Settings Screen (VCV active) Selecting Settings Follow these steps to adjust ventilator control settings: 1. Push VCV SETTINGS, PCV SETTINGS, or NPPV SETTINGS. 2. Push the button for the control settings you want to select. The ventilator displays the current value for that parameter in an insert that allows the operator to adjust the settings value. (Figure 8-14). 3. Press the bar to increase or decrease the setting to the value you want or use the front panel knob to adjust the value of the setting. 4. Press the screen ACCEPT button or the front panel ACCEPT button to activate the new setting or CANCEL to leave the setting unchanged. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-15 Chapter 8 Operating Instructions Push this bar to increase the value Current or new value displayed digitally and graphically Push this bar to decrease the value Press ACCEPT to activate the new setting Press CANCEL to leave the setting unchanged Figure 8-14: Changing a Setting When a value is entered, as shown in Figure 8-14, the ventilator checks to assure that the value has been accepted by the operator, is within limits, and will not cause other settings to be out of limits. If the new value causes these limits to be exceeded, a diagnostic message will be displayed. (Refer to “Value Entry Message” on page 12-4 for more details about the diagnostic messages). Selecting Alarm Limits Follow these steps to adjust currently active alarm limits: 1. Push ALARM SETTINGS. The ventilator displays the alarm limits for the currently active ventilation mode (Figure 8-15). 2. Push the button for the alarm limit you want to adjust. The ventilator displays the current value for that alarm limit in a display insert, similar to Figure 8-14. 3. Press the bar or use the front panel knob to adjust the value. 4. Press ACCEPT to activate the new alarm limit or CANCEL to leave it unchanged. 8-16 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Active ventilation mode and breath type button displayed Indicates this screen is for VCV alarms Push button of alarm you want to adjust Figure 8-15: Setting Alarm Limits That Are Currently Active The High Pressure Alarm Setting may be accessed through the Alarms Settings Screen or through the HIP Indicator adjacent to the manometer in the PCV and VCV Settings, Alarm Settings, Patient Data, and Monitor Screens. WARNING: For patient safety the HIP Limit Setting should be set as close to the peak inspiratory pressure as patient conditions allow. CAUTION: If clinical conditions do not require setting the HIP Limit above 60 cmH2O, we recommend the setting normally be adjusted to 60 cmH2O or less in order to prolong the operating life of the blower and to maximize backup battery run time. NOTE: When the active mode is set to NPPV, the HIP Limit Setting will automatically be adjusted to 10 cmH2O above the current IPAP setting. Follow these steps to adjust alarm limits that are not currently active: 1. Depending on the alarm limits you wish to review, push the VCV SETTINGS, PCV SETTINGS, or NPPV SETTINGS button that has a gray background and black letters (not active). REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-17 Chapter 8 Operating Instructions ACTIVATE button Figure 8-16: PCV Setting while NPPV is the active breath type 2. From the control settings screen, push the ACTIVATE button. Refer to Figure 8-16. The ventilator displays a prompt insert (Figure 8-17). Figure 8-17: Change Breath Type Insert Window for PCV 3. Select the REVIEW ALARMS button to display the alarm settings for PCV (Figure 8-18). 4. Notice that all the alarm buttons (Figure 8-18) are grayed out, indicating that the alarm limits are not currently active. The ventilator displays the current value for that set of alarm limits. Push the button for the alarm limit you want to adjust. NOTE: The ventilator keeps a distinct set of alarm limits for each ventilation breath type (VCV, PCV and NPPV). 5. Press the bar or use the front panel knob to adjust the value (as shown in Figure 8-14). 6. Press ACCEPT to activate the new alarm limit or CANCEL to leave it unchanged. 8-18 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Grayed out buttons indicate that the alarm limits are not active Push button of alarm setting to adjust Press this ACTIVATE button to switch to the ventilation breath type indicated. The ventilation breath type on this button indicates which alarm set is shown on this Figure 8-18: Setting Alarm Limits That Are Not Currently Active NOTE: Any of the changes made in the screen shown in Figure 8-18, do not take effect until the operator switches to the new ventilation breath type (in this case Pressure Control). Selecting Waveforms (VCV only) Two inspiratory flow waveforms for mandatory VCV breaths are available: descending ramp and square wave (Figure 8-19). The selected waveform is highlighted and defines the inspiratory flow for all mandatory VCV breaths, whether they are initiated by the patient, the ventilator, or the operator. The waveform selection is not applicable to PCV or NPPV. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-19 Chapter 8 Operating Instructions Descending ramp and square wave act as mutually exclusive select/non-select buttons. Push this button to select descending ramp waveform Push this button to select square waveform Figure 8-19: Selecting Waveforms (descending ramp selected) Selecting Adult/Pediatric Buttons You can configure ventilation for adult or pediatric patients (Figure 8-20) from the active ventilation type screen. Selecting adult or pediatric tailors the ventilator’s breath delivery algorithms to the selected adult/pediatric patient type. Selecting adult or pediatric does not change how the screens work, and does not change ventilator or alarm settings. The patient type selection determines flow output at various rise time settings for PCV, PSV, and IPAP. In addition, the “I-Time too long” alarms and time out for spontaneous breaths are set to 3.5 seconds for the adult setting and 2.5 seconds for the pediatric setting. Peak flow is limited to 100 LPM in all pressure-based breaths when using the pediatric setting. Push this button to select controls Push this button to select pediatric controls Figure 8-20: Selecting Adult/Pediatric Controls (adult selected) 8-20 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Selecting the Inspiratory Trigger (I-Trigger) The I-Trigger setting determines how inspiratory effort is detected (by measuring a drop in airway pressure or an increase in patient inspiratory flow) and when inspiration begins. • In VCV and PCV, you can select a pressure or flow I-Trigger. • In NPPV, the I-Trigger is always Flow. Follow these steps to set the I-Trigger: 1. Push the VCV SETTINGS, PCV SETTINGS, or NPPV SETTINGS button. 2. Push the I-TRIGGER button. The inspiratory trigger window insert (Figure 8-21) appears. 3. In VCV and PCV: select Pressure or Flow. (Because only the flow trigger is available in NPPV, the Pressure and Flow buttons do not appear in this insert in NPPV.) 4. Adjust and change the value as described above. You can select Pressure or Flow in VCV or PCV. In NPPV, only Flow I- Trigger is available (these buttons do not appear). Figure 8-21: Inspiratory Trigger Window Settings with Calculated Values Certain window inserts that are used to modify values of settings can also have calculated results in them (Figure 8-22). When the settings window insert being displayed is VCV Rate, the calculated minute volume that results from the rate and tidal volume settings is displayed along with the rate value. This is also the case when the tidal volume setting window insert is displayed. When the setting window insert for PCV Rate is REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-21 Chapter 8 Operating Instructions displayed, the calculated value for the I:E ratio that will result from the PCV rate value is also displayed. When the setting window insert for VCV Apnea Rate is displayed, the calculated minute ventilation that will exist if the ventilator goes into Apnea Ventilation in VCV is shown. When the setting window insert for PCV Apnea Rate is displayed, the I:E Ratio shown is the I:E Ratio that will exist if the ventilator goes into Apnea Ventilation in PCV. PCV Settings Window Insert VCV Settings Window Insert Setting to be changed on the top. Setting that is calculated as the setting above changes, below. I:E Ratio is the parameter that is calculated and displayed in certain PCV setting window inserts. These are PCV Rate, PCV I-Time, and PCV VE is the parameter that is calculated and displayed in certain VCV setting window inserts. These Figure 8-22: Settings Window Inserts With Calculated Results Rate and Apnea Rate Settings Relationship For all breath types, VCV, PCV, and NPPV, the ventilator ensures the Apnea Rate setting is equal to or greater than the set Rate up to 20 BPM. When set rate is equal to the Apnea Rate and less than 20 BPM increasing the Set Rate increases the Apnea Rate equally up to 20 BPM. Above 20 BPM the Apnea Rate can be greater than or less than the Set Rate, down to 20 BPM. 8-22 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Changing IPAP or EPAP in NPPV When changing the IPAP or EPAP settings in NPPV, the difference between IPAP and EPAP is displayed in the window insert as PSV. Figure 8-23: Changing IPAP or EPAP in NPPV Selecting a New Ventilation Breath Type (VCV, PCV, or NPPV) Follow these steps to select the ventilation breath type: 1. Press the button for the new breath type you want to select from the bottom bar (Figure 8-24) [PCV in this example]. Figure 8-24: Ventilation Control Buttons (PCV settings selected) 2. The setting screen for the selected breath type appears. All of the settings are grayed out, indicating that they are not currently active. However, you can use the grayed out buttons to change the settings as necessary, (with the exception of Set O2 and patient type, which can be changed only in the active mode). For example, if you press PCV SETTINGS when the current breath type is NPPV, all the PCV settings are grayed out (Figure 8-25) because NPPV is currently active. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-23 Chapter 8 Operating Instructions ACTIVATE button Figure 8-25: Settings Screen (PCV settings, PCV not currently active) 3. Press the ACTIVATE button. The prompt in Figure 8-26 is displayed on the screen. Figure 8-26: Prompt when Activate is pressed and PCV settings selected 4. At • • • this prompt the operator can: Move directly into PCV by pressing the OK button, or Review the PCV alarm settings, or Change nothing and return to the PCV settings screen by pressing the CANCEL button. If the OK button is pressed, the ventilator immediately begins operations in PCV, the PCV settings become active and screen in Figure 8-27(a) appears. (a) 8-24 Respironics V200 Ventilator Operator’s Manual Press the OK button and go to this screen. REF 1057983 A Chapter 8 Operating Instructions (b) Press the Review Alarms button to go to this screen. (c) Press the Cancel button and return to this screen. Figure 8-27: Destination Screens after Activate Prompt If the REVIEW ALARMS button is pressed the ventilator immediately displays the screen shown in Figure 8-27(b) appears. If the CANCEL button is pressed, the ventilator returns to the settings screen for the selected breath type as shown in Figure 8-27(c). 5. If the operator elects to review alarm settings, the alarm settings screen for the destination mode is shown (Figure 8-28). All the alarm limits are grayed out in this screen, because the selected breath type (PCV), is not yet active. However the grayed out buttons can be used to adjust values as seems appropriate for the patient. Press to activate new breath type. Figure 8-28: Alarm Limits Screen (PCV active) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-25 Chapter 8 Operating Instructions 6. If the operator reviews alarm settings and then activates the new breath type, the ventilator uses the new breath type and displays the alarm settings of the new breath type (Figure 8-29). Active mode and breath type ALARM SETTINGS button is selected indicating the alarm settings shown are for the active breath type Indicates the active breath type alarms Alarm limits no longer grayed out, indicating that the selected breath type is active Figure 8-29: Alarm Limits Screen (PCV inactive) Selecting the Mode (A/C-SIMV-CPAP or Spont-Spont/T) Summary—Ventilation Modes and Availability Ventilation Mode Available during… A/C VCV or PCV Assist/control: all breaths are mandatory, and are triggered by operator, patient, or ventilator. SIMV VCV or PCV Synchronous intermittent mandatory ventilation: breaths can be mandatory or spontaneous. Mandatory breaths are triggered by operator, patient, or ventilator. PSV is available. CPAP VCV or PCV Continuous positive airway pressure: all patient triggered breaths are spontaneous, and can be pressure supported. PSV is available. The MANUAL BREATH key can be used to initiate a mandatory breath. Spont NPPV Spontaneous ventilation: all breaths are spontaneous and patient triggered. The MANUAL BREATH key can be used to initiate a mandatory breath. Spont/T NPPV Spontaneous Timed ventilation: breaths can be spontaneous or mandatory. The MANUAL BREATH key can be used to initiate a mandatory breath. Description Table 8-6: Summary—Ventilation Modes and Availability 8-26 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions The ventilation mode buttons are the selected/not-selected type. Follow these steps to select the mode: 1. Press the button for the mode you want to select (the active mode is highlighted) from the top bar: • • If VCV or PCV breath types are active, you can select A/C, SIMV, or CPAP mode (Figure 8-30). If NPPV is active, you can select Spont/T or Spont. Figure 8-30: Ventilation Mode buttons (A/C and Spont/T active as shown) 2. The ventilator asks you to confirm the mode change (Figure 8-31). Press YES to confirm, or press NO to leave the mode as is. Figure 8-31: Mode Change Confirmation Message 3. Once you confirm a mode change, the ventilator changes the mode selected to active (Figure 8-32). Figure 8-32: Ventilation Mode buttons (SIMV and Spont shown as active) Apnea Ventilation Apnea ventilation provides an emergency mode of ventilation if the ventilator does not deliver a breath for an operator set interval of time. The apnea time can be set between 10 and 60 seconds. Upon entering this mode of ventilation, the ventilator will immediately start using the Apnea Rate setting specified. In PCV and VCV, the ventilator will begin delivering breaths in Assist/ Control (A/C), but with the operator set Apnea Rate. In NPPV, the ventilator will deliver only machine controlled breaths either at the set Apnea Rate or in response to patient effort. In Apnea ventilation, the alarms used are the ones used for machine controlled breaths in the active breath type (VCV, PCV and NPPV) that the ventilator was in, when Apnea occurred. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-27 Chapter 8 Operating Instructions Patient Data Screen You can view the patient data screen (Figure 8-33) by pressing the PATIENT DATA button in the top bar. The format of this screen is the same in VCV, PCV, and NPPV. Table 8-7: “Patient Data Definitions: Range, Units & Resolution” summarizes the definitions, display ranges, and resolution for patient data parameters. Figure 8-33: Patient Data Screen Patient Data Definitions: Range, Units & Resolution Parameter Description Display Range Resolution PIP Peak Inspiratory Pressure The maximum airway pressure during inspiration. -20.0 to 130 cmH2O (hPa) 0.1 for -20.0 to 99.9 1 for 100 to 130 MAP Mean Airway Pressure The average of airway pressure during one full breath cycle. -20.0 to 120 cmH2O (hPa) 0.1 for -20.0 to 99.9 1 for 100 to 130 Pe End Pressure at End Expiration The pressure measured at the end of expiration. -20.0 to 99.9 cmH2O (hPa) 0.1 Pi End Pressure at End Inspiration The pressure measured at the end of inspiration (or at the end of Insp Hold if it is >0). -20.0 to 130 cmH2O (hPa) 0.1 for -20.0 to 99.9 1 for 100 to 130 Tidal Vol. Exhaled Tidal Volume The volume exhaled at each breath. Compliance compensated (if enabled). 0 to 9999 ml (BTPS) 1 Table 8-7: Patient Data Definitions: Range, Units & Resolution (Sheet 1 of 2) 8-28 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Patient Data Definitions: Range, Units & Resolution (Continued) Parameter Description Display Range Resolution Spont VE Spontaneous Minute Volume The spontaneous ventilation normalized to one minute. Compliance compensated (if enabled). 0.00 to 99.9 L (BTPS) 0.01 for 0.00 to 9.99 0.1 for 10.0 to 99.9 Total VE Exhaled Minute Volume The total volume exhaled by the patient in one minute. Compliance compensated (if enabled.) 0.00 to 99.9 L (BTPS) 0.01 for 0.00 to 9.99 0.1 for 10.0 to 99.9 % O2 Delivered O2 One second average of O2 sensor reading (if O2 sensor is installed). 0.0 to 110% 0.01 for 0.00 to 9.99 1 for 100 to 110 Spont Rate Spontaneous Respiratory Rate The respiratory rate of spontaneous breaths. 0.0 to 150 Bpm 0.1 for 0.0 to 9.9 1 for 10 to 150 Total Rate Total Respiratory Rate The respiratory rate for all breaths. 0.0 to 150 Bpm 0.1 for 0.0 to 9.9 1 for 10 to 150 F/Vt Rapid Shallow Breathing Index The ratio of the respiratory rate to exhaled tidal volume for spontaneous breaths. 0 to 150 Bpm/ L 1 I:E Ratio I:E Ratio The ratio of inspiratory time to expiratory time. 9.9:1 to 1:99 0.1 for 9.9:1 to 1:9.9 one (1) for 1:10 to 1:99 Table 8-7: Patient Data Definitions: Range, Units & Resolution (Sheet 2 of 2) NOTE: Pt. Leak only appears on Patient Data block on Settings screen. Monitor Screen The monitor screen (Figure 8-34) is the default screen, and is automatically displayed if the screen has not been touched for 15 minutes. The screen can also be viewed by pressing the MONITOR button. The screen is shown in Figure 8-34. The patient data and settings displayed on this screen depend on the active breath type (Refer to Table 8-8: “Monitor Screen Settings Displayed” and Figure 8-34.) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 8-29 Chapter 8 Operating Instructions This screen is displayed in VCV. This screen is displayed in PCV. This screen is displayed in NPPV. Figure 8-34: Monitor Screen Monitor Screen Settings Displayed Ventilation Breath Type Monitor Screen Settings Displayed VCV Rate, Peak Flow, Tidal Volume, PEEP, %O2, Pressure Support PCV Rate, Inspiration Time, Pressure, PEEP, %O2, Pressure Support NPPV Rate, IPAP, EPAP, %O2 Table 8-8: Monitor Screen Settings Displayed 8-30 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions Special Procedures Auto-PEEP Calculation The ventilator allows the operator to calculate Auto-PEEP from an expiratory hold procedure. This function is active only at the end of a mandatory breath and is not available in the emergency ventilation mode. Expiratory hold is initiated by pressing the EXP HOLD key on the front panel. When exhalation ends in the breath during which the EXP HOLD key is being pressed, an expiratory hold maneuver will begin and will continue only as long as the key is pressed. During the expiratory hold maneuver, the screen shown in Figure 8-35 below will appear. Pressure versus time waveform. Figure 8-35: Expiratory Hold Maneuver While the EXP HOLD key is held, the exhalation valve and the air and O2 valves will be closed. During this period there is no flow of gas into or out of the patient circuit from the ventilator. You can monitor the airway pressure by watching the EXPIRATORY PAUSE PRESSURE digital display, and by watching the pressure versus time waveform. When you determine the airway pressure has stabilized, the EXP HOLD key should be released. If the key is held for 5 seconds, the ventilator will automatically terminate the maneuver and perform the calculation if stability was achieved. The ventilator then calculates AutoPEEP as shown in the equation below: • REF 1057983 A Auto-PEEP = Expiratory Pause Pressure - End Expiratory Pressure NOTE: If the EXP HOLD key is held continuously, and the expiratory hold maneuver exceeds 5 seconds, the ventilator automatically terminates the expiratory hold maneuver and begins a new inspiratory period. NOTE: If Auto PEEP as calculated in Equation 1: Auto-PEEP = Expiratory Pause Pressure – End Expiratory Pressure, is negative, Auto-PEEP will be displayed as “—.” Respironics V200 Ventilator Operator’s Manual 8-31 Chapter 8 Operating Instructions Preoperational Procedure The preoperational procedure verifies that the ventilator is ready for use on a patient. WARNING: Ensure that an alternative means of ventilation (that is, a resuscitator or similar device) is available while the ventilator is in use on a patient. WARNING: DO NOT perform the preoperational procedure when the ventilator is on a patient. Follow these steps: 1. Follow the setup procedures in Chapter 5, “Setup”, to prepare the ventilator for use. 2. Connect the patient circuit to be used on the next patient. 3. Install any components that are to be used in line with the patient circuit (for example, humidifier, O2 monitor, or airway temperature monitors). NOTE: All components of the patient circuit must not have leaks in order to pass SST. 4. Ensure that the ventilator is not on a patient! 5. Hold down the ALARM RESET and 100% O2 keys while the ventilator is powered up. The operator must confirm that the machine should be in Diagnostic Mode (Figure 8-36). Figure 8-36: Entering Diagnostic Mode 6. Press OK to clear the Warning message and enter Diagnostic Mode. 8-32 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 8 Operating Instructions 7. Push USER CONFIG to check time, time format, date and altitude and set compliance compensation as required (Figure 8-37). NOTE: If time is found to be incorrect more than once in the preoperational procedure, an internal battery may have to be replaced. Contact qualified service personnel or call Respironics Customer Service at 1-800-345-6443. 8. Press START SST to begin Short Self Test, and follow the screen prompts. Use a cap to plug the patient port of the patient circuit wye at the prompt. 9. During SST, as each test is performed, the ventilator displays test results (Figure 8-37). Do not proceed until the ventilator completes SST without failures. Push USER CONFIG to set time, date, altitude, compliance compensation enable, and time format. Any failures detected during SST are listed here. Figure 8-37: SST Results WARNING: REF 1057983 A You will be warned if the compliance is 9.0 ml/cmH2O (hPa) or larger. Patients should not be put on a patient circuit that does not meet this requirement. Respironics V200 Ventilator Operator’s Manual 8-33 Chapter 8 Operating Instructions Altitude set Date set Compliance compensation enable/disable Time format (12 or 24_hour) set Time set Backup Battery (confirm at startup) enable/disable Figure 8-38: User Config Screen 10. Once you have reviewed all the parameters on the User Config screen, the ventilator is ready for patient use. Turn the ventilator off, then on, without holding down any front panel keys. 11. Ventilator settings from the previous use are in effect at power up. Select appropriate settings for the next patient as described in this chapter. Alarm Testing Procedure A procedure is available if the operator wants to test the operation of alarms. We recommend following the preoperational procedure. (Refer to C, “Alarm Testing Procedure”.) Where To Go For Help For clinical or technical support, contact Respironics Customer Service at 1-800-345-6443. 8-34 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 9. Alarms Introduction The Respironics V200 Ventilator provides an easy-to-use hierarchical alarm system that includes both visual and audible alarms. When the ventilator detects an operating condition that requires attention, it generates an alarm. The alarm system communicates three levels of urgency and priority: • High Urgency: Alerts the operator that immediate response is required. (red flashing indicator) • Medium Urgency: Alerts the operator that prompt response is required. (yellow flashing indicator) • Low Urgency: Alerts the operator to a change in the ventilator status. (yellow continuous indicator) In most cases, the alarm will have the following audible and visual components: Visual Alarms • an indicator is illuminated • a sequence of tones sounds • a screen alert window appears with a message in it The ventilator includes alarm and status indicators located on the front panel to provide a visual summary of active alarm conditions. Each of these indicators is illuminated by either a red, green, or yellow light, which will flash or remain illuminated, depending on the alarm condition. Normal Alarm High Alarm Med/Low VENT INOP SAFETY VALVE Figure 9-1: Alarm Status Indicators Pressing the ALARM RESET key on the front panel clears the visual indicators for active or auto-reset alarms. If the alarm condition reoccurs, the visual indicator illuminates again. Alarm messages also appear in an Alert insert that appears in any screen whenever there is a low, medium, or high urgency alarm active (Figure 9-2). REF 1057983 A Respironics V200 Ventilator Operator’s Manual 9-1 Chapter 9 Alarms Alarm Insert Figure 9-2: Alarm Alerts Audible Alarms When an alarm condition exists, the ventilator will generate a sequence of audible tones to alert the operator. The sequence varies according to the urgency and priority level of the alarm: • High Urgency: The ventilator emits a repeating sequence of five tones. • Medium Urgency: The ventilator emits a repeating sequence of three tones. • Low Urgency: No audible tone emitted. (Med/Low indicator illuminates and alarm messages appear in the front panel Alerts window) When more than one alarm is active, only the highest urgency level alarm is audibly annunciated. Procedures for silencing audible alarms are described below. Alarm Silence To silence alarms, perform the following: • Press the ALARM SILENCE key on the front panel. The audible tone will cease and the alarm silence indicator will illuminate and remain lit for two minutes. Specific alarms that cannot be silenced are listed in Table 9-1: “Alarm Alert Messages”. When ALARM SILENCE is pressed before the end of the two-minute period, the two-minute timer is reset, and alarm silence begins anew. Pressing ALARM SILENCE multiple times does not give multiple two-minute silence periods. If new alarms occur during alarm silence, all visual alarm annunciation continues. If the Alerts insert is not present, it will appear. The message for any alarms that occur during the alarm silence period will appear in the Alerts insert if there are fewer than three messages currently displayed or the new 9-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 9 Alarms message is higher priority than one of the currently displayed messages. The highest three priority messages will be displayed. ALARM SILENCE is immediately terminated if ALARM RESET is pressed. Any medium or high priority alarm that is active will immediately begin audible annunciation. CAUTION: Alarm Reset The ventilator alarm indicators and the Alerts insert should be monitored closely during the Alarm Silence period to ensure that unexpected alarms are noticed. Automatic Alarm Reset (Auto-Reset) When the alarm conditions that have caused a medium or high level alarm clear, the audible alarm will terminate automatically (auto-reset). However, after an alarm condition has been corrected, you must press the ALARM RESET key to clear all visual alarm indicators. Operator-Initiated Alarm Reset You can clear active and auto-reset alarms by pressing the ALARM RESET key. This clears the alarm messages in the Alerts insert for active and auto-reset alarms. If the alarm condition reoccurs, the alarm restarts at its initial level of urgency and elevates as described in Table 9-1: “Alarm Alert Messages” on page 9-5. For you to clear an apnea alarm, the ALARM RESET key may be pressed. Once it has been pressed, the ALARM RESET will cancel an existing apnea alarm and return ventilation to the active mode. If the condition that triggered the apnea alarm persists after the ALARM RESET key has been pressed, the apnea alarm will re-trigger. If the patient triggers two successive breaths in apnea ventilation, the ventilator will automatically reset out of apnea ventilation. CAUTION: If an alarm persists for no apparent reason, contact Respironics Customer Service at 1-800-345-6443. Alarm Reset Terminates Alarm Silence If ALARM SILENCE is active when ALARM RESET is pressed, the ALARM SILENCE period will terminate and any active medium or high priority alarms will become audible. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 9-3 Chapter 9 Alarms Alarm Volume Control Under the left hand bottom edge of the front panel is a partially exposed round control that enables you to control the volume of audible alarms (Figure 9-3). Alarm Volume Control Knob Figure 9-3: Alarm Volume Control The volume control can be adjusted between a minimum and maximum setting to suit the particular clinical situation. Alert Messages When the ventilator detects an alarm condition, it presents an Alert insert below the Patient Data box in the middle of the screen. While the alarm is active (i.e. visual and audible alarms are still present), the message in the Alert insert appears in bold-faced type. Once the alarm condition has been corrected, the message automatically switches to regular face type. Pressing ALARM RESET clears alarm messages. When the operator presses the ALARM RESET button (described above), the alarm messages disappear from the alert window. When the ventilator detects more than three alarm conditions, the three highest priority alert messages will be displayed. Alert messages, along with the corresponding alarm descriptions, are listed in Table 9-1: “Alarm Alert Messages”. 9-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 9 Alarms Alarm Alert Messages Alert Message Description Air Source Fault A high urgency alarm indicates the internal air source is not functioning properly, patient ventilation continues using the 100% O2 gas source if available. Call for service. Cannot be silenced or manually reset. Apnea The ventilator triggers a medium urgency alarm condition and enters Apnea Ventilation mode if no inspiration is started within the operator set apnea interval while in a nonemergency breathing mode. It is elevated to high urgency after one minute of Apnea Ventilation. Audible Alarm Failed Primary audible alarm is defective. Alarm cannot be manually reset. Bad ADC Wrap Sensor Alarm cannot be silenced or manually reset. Call for service. Bad Bat Volt Sensor Alarm cannot be silenced or manually reset. Call for service. Bad Int O2 Sensor Alarm cannot be silenced or manually reset. Call for service. Bad Int Temp Sensor Alarm cannot be silenced or manually reset. Call for service. Battery Backup On Indicates the backup battery is the power source for ventilator operation. Alarm cannot be silenced. Exp Valve Stuck Open Alarm cannot be silenced or manually reset. Call for service. Gas Supplies Lost SVO A high urgency alarm indicates the oxygen and air source are no longer operable. Safety valve opens. Check O2 source and internal air source. Call for service. Cannot be silenced or manually reset. High Inspiratory Pressure Indicates that circuit pressure exceeds the high pressure limit. When High Inspiratory Pressure condition occurs, the ventilator immediately cycles into the exhalation phase and illuminates the low priority indicator. Then on the second consecutive breath with a pressure violation, sounds the audible alarm, lights the Alarm High indicator, and displays High Inspiratory Pressure message. High Internal O2 Oxygen concentration internal to the enclosure is beyond allowable levels. Indicative of an internal O2 leak. Alarm cannot be silenced or manually reset. High Leak Rate The average estimated leak from the previous breath has exceeded the set High Leak alarm limit (alarm applies to NPPV mode only). Medium urgency, escalates to high urgency after 60 seconds. The alarm cancels when the estimated leak from the previous breath equals or falls below the alarm setting, if the ventilation type changes from NPPV to another ventilation mode or if the alarm is reset by the clinician. Table 9-1: Alarm Alert Messages (Sheet 1 of 4) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 9-5 Chapter 9 Alarms Alarm Alert Messages (Continued) Alert Message Description High Minute Volume Indicates total minute ventilation (VE) measured in exhalation is higher than the set limit. This alarm is available in Volume Control and Pressure Control modes. It is elevated to high urgency after one minute. High O2 A high urgency alarm indicates that the monitored O2 concentration is at least 6% above the set value (%O2) for 30 seconds. Verify operation of the O2 sensor. Alarm cannot be manually reset. High Respiratory Rate The ventilator triggers a medium urgency alarm if the total respiratory rate is greater than the operator-set High Respiratory Rate limit. The ventilator evaluates this alarm condition at the start of inspiration, after calculating the total respiratory rate including the just completed breath. It is elevated to high urgency after one minute. High Temperature Internal temperature monitor detects higher than allowed temperatures inside the enclosure. Alarm cannot be silenced or manually reset. I-Time Too Long The ventilator triggers a medium urgency alarm to indicate that a spontaneous breath has exceeded the maximum allowed inspiratory time of 3.5 seconds (2.5 seconds in Pediatric mode). The alarm is elevated to high urgency after two consecutive breaths that meet the alarm criteria. Low Backup Battery If the backup battery is low, a high priority alarm will be triggered. Immediately connect an AC power source to avoid a loss of power. Provide AC power and/or replace the backup battery. Alarm cannot be silenced or manually reset. 5 minutes or less of battery run time remains. Low EPAP If the Exhalation Positive Airway Pressure is less than the operator set Low EPAP Pressure limit for one second, the ventilator signals a medium urgency condition. If the Low EPAP alarm remains active for one minute, the ventilator elevates the alarm to high urgency. Note: A Low EPAP setting of zero (0) will disable this alarm. Note: If an inspiration is triggered immediately after the mandatory minimum exhalation time of 200 msec, this alarm will not be activated unless this condition occurs for three consecutive breaths. Table 9-1: Alarm Alert Messages (Sheet 2 of 4) 9-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 9 Alarms Alarm Alert Messages (Continued) Alert Message Description Low Insp Pressure If the peak airway pressure during any mandatory inhalation is less than the Low Insp Pressure limit, the ventilator will immediately signal a high priority alarm. Note: If an inspiration is triggered immediately after the mandatory minimum exhalation time of 200 msec, this alarm will not be activated unless this condition occurs for three consecutive breaths. Low Minute Volume Indicates the measured patient minute ventilation (VE) is below the set limit. It is elevated to high urgency after one minute. Note: A Low Minute Volume setting of zero (0) will disable this alarm. Low O2 A high urgency alarm indicates that the monitored O2 concentration is 18% or at least 6% below set value for 30 seconds. Verify operation of the O2 sensor. Alarm cannot be manually reset. Low O2 Supply A high urgency alarm indicates that O2 gas supply is below acceptable levels and the %O2 setting is above 21%. Check O2 gas connections and inlet filter. Alarm cannot be manually reset. Low PEEP If PEEP is less than the operator set Low PEEP limit for one second during exhalation, triggers a medium priority alarm. If the Low PEEP alarm remains active for one minute, the alarm moves to high priority. Note: A Low PEEP setting of zero (0) will disable this alarm. Note: If an inspiration is triggered immediately after the mandatory minimum exhalation time of 200 msec, this alarm will not be activated unless this condition occurs for three consecutive breaths. Low Tidal Volume The ventilator triggers a medium urgency alarm to indicate that the NPPV (mandatory or spontaneous breath) tidal volume is less than the set limit. It is elevated to a high urgency alarm after one minute. Note: A Low Tidal Volume setting of zero (0) will disable this alarm. Table 9-1: Alarm Alert Messages (Sheet 3 of 4) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 9-7 Chapter 9 Alarms Alarm Alert Messages (Continued) Alert Message Description Low Vt Mandatory The ventilator triggers a medium urgency alarm to indicate that the VCV or PCV mandatory tidal volume is less than the set limit. It is elevated to high urgency after one minute. Note: A Low Vt setting of zero (0) will disable this alarm. Note: If an inspiration is triggered immediately after the mandatory minimum exhalation time of 200 msec, this alarm will not be activated unless this condition occurs for three consecutive breaths. Low Vt Spontaneous The ventilator triggers a medium urgency alarm to indicate that the VCV or PCV spontaneous tidal volume is below the set alarm limit. It is elevated to high urgency after one minute. Note: A Low Vt setting of zero (0) will disable this alarm. O2 Valve Stuck Closed Alarm cannot be silenced or manually reset. Call for service. Occlusion - SVO Safety Valve opens. The ventilator triggers a high urgency alarm to indicate that an occlusion has been detected in the patient circuit. Check circuit tubing for crimped hoses or blockage. Check filters and humidification devices to ensure they are functioning properly. Alarm cannot be manually reset. Restart The ventilator has restarted. If the ventilator repeatedly restarts on its own, call for service. Using Default Altitude Ventilator is using default altitude. Using Default Compliance Ventilator is using default compliance. Using Default Settings Ventilator is using default settings. Table 9-1: Alarm Alert Messages (Sheet 4 of 4) 9-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 9 Alarms Alarm Indicators Normal Alarm High Alarm Med/Low Vent Inop Safety Valve Figure 9-4: Alarm and Status Indicators Normal The Normal indicator remains lit with a steady green light as long as there are no active or auto reset alarm conditions present. Alarm High The Alarm High indicator visually indicates a high priority alarm. When a high priority alarm condition exists, this indicator flashes red and an audible five tone sequence sounds until the condition is corrected or reset. WARNING: A high priority, visual and audible alarm indicates a potentially lifethreatening condition and immediate response is required. Alarm Med/Low The Alarm Med/Low indicator visually indicates a medium or low priority alarm. When a medium priority alarm condition exists, this indicator will flash yellow and an audible three tone sequence will be heard until the condition is corrected. When a low priority alarm condition exists, this indicator remains lit with a steady yellow light, until the alarm is reset. Vent Inop The Vent Inop indicator signals the operator that the ventilator is not capable of supporting ventilation and requires service. During a ventilator inoperative condition, the ventilator enters a safe state, where the safety valve is opened and new alarm condition detection is discontinued. If the ventilator is attached to a patient when this condition is detected, the ventilator must be replaced immediately. WARNING: REF 1057983 A Vent Inop is a serious condition, which is indicated by both visual and audible alarms. If the ventilator is attached to a patient when Vent Inop occurs, the patient must be supported with another means of life support ventilation. Respironics V200 Ventilator Operator’s Manual 9-9 Chapter 9 Alarms When a ventilator inoperative condition is detected, the Vent Inop indicator will display a steady red light, and the ventilator will sound a five-tone audible alarm sequence. The Vent Inop alarm cannot be reset by an operator. It cannot be auto-reset or silenced. The ventilator must be serviced by a qualified service representative, in order for the Vent Inop audible and visual alarms to be cleared. Safety Valve This indicator signals that the Safety Valve is open and the ventilator is not providing breath support to the patient. It is accompanied by a five-tone audible alarm sequence and a Safety Valve Open message in the touch screen display. The Safety Valve opens automatically whenever the ventilator is not able to provide breath support to the patient. It allows the patient to spontaneously breathe room air through the ventilator system. The Safety Valve Open condition is normal during start-up and restart, and it automatically turns off when the start-up sequence is complete. If this condition occurs at any other time, it cannot be reset. Immediately use an alternative ventilation source and call for service. WARNING: When the safety valve open indicator is lit, the ventilator does not provide any ventilatory support to the patient. Immediately use a backup means of ventilatory support. Alarm Silence The indicator ( ) on the Alarm Silence key will illuminate with a steady yellow light whenever the operator presses the alarm silence control. The indicator remains lit for two minutes after the Alarm Silence key is pressed. If Alarm Silence is active and an alarm takes place that involves an operator alarm limit being exceeded, the alarm will be anunciated visually, but Alarm Silence will continue to be active and the Alarm Silence timer will continue to time out. Alarms that can not be silenced are listed in Table 9-1: “Alarm Alert Messages” on page 9-5. If Alarm Reset is pressed at any time during the Alarm Silence period, the Alarm Silence period is terminated. If any high or medium priority alarm condition exists after pressing Alarm Reset, an audible alarm sounds. WARNING: 9-10 Visually monitor the patient and ventilator during the Alarm Silence period to ensure that alarms do not go undetected. Allowing alarm conditions to continue without intervention may result in harm to the patient and/or ventilator. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 10. Care and Maintenance General Information Procedures for ventilator cleaning, sterilizing, and periodic maintenance must be performed to ensure consistent ventilator operation. Institutional policies may also provide guidelines, procedures, and schedules for cleaning and sterilizing equipment before, during and after patient use. In addition, recommended methods and time frames for performing all necessary care and maintenance procedures for the ventilator are presented in this section. Respironics recognizes that cleaning, sterilization, sanitation and disinfecting practices vary widely among health care institutions. It is not possible for Respironics to specify or require specific practices that will meet all needs, or to be responsible for the effectiveness of cleaning, sterilization, and other practices carried out in the patient care setting. General procedures for cleaning and sterilizing the ventilator are described in the following sections. Some ventilator parts must be disassembled before cleaning and sterilizing. (Refer to “Removing and Replacing Internal Air Source Inlet Filter” on page 10-10.) Cleaning REF 1057983 A When cleaning parts, avoid the use of hard brushes or other instruments likely to cause surface damage. CAUTION: Care should be taken when cleaning the touch display. (Refer to Figure 8-2 on page page 8-3). A soft moist cloth should be used that does not drip water and/or soap solution when in contact with the display. After cleaning and rinsing with a damp cloth, remove all moisture with a dry, soft cloth. Never allow solutions of any kind to collect on the bottom bezel of the display. Never use a brush or device that can cause abrasion to clean the touch display or its bezel; they will cause irreparable damage. CAUTION: Follow the detergent manufacturer’s instructions. Exposure to detergent solution stronger than necessary can shorten the useful life of the product. Rinse parts thoroughly to remove all detergent residues. Wipe parts dry. Detergent residue can cause blemishes or fine cracks, especially on parts exposed to elevated temperatures during sterilization. Respironics V200 Ventilator Operator’s Manual 10-1 Chapter 10 Care and Maintenance Sterilization WARNING: Do not expose expiratory and inspiratory bacteria filters or reusable patient tubing to ETO gas. NOTE: Because conditions and practices in health care institutions vary, this manual can only describe general guidelines. It is the user’s responsibility to ensure the validity and effectiveness of the methods used. Do not clean, disinfect, sterilize or reuse disposable products. Steam Autoclaving The O2 sensor tee (P/N 1001736) and the O2 sensor coupling (P/N 1002505) may be steam autoclaved. The PVC O2 sensor tee, P/N 8-100498-00 (gray in color), cannot be autoclaved. CAUTION: Autoclavable parts will withstand repeated steam autoclaving at temperatures not to exceed 135° C (275ºF). 1. Ensure that the part has been disassembled, cleaned, and partially reassembled, as applicable. 2. Separately wrap the part in muslin or equivalent paper wrapper. 3. Steam autoclave according to the autoclave manufacturers instructions. In many institutions it may be routine to place a biological indicator in the autoclave load as a subsequent test for sterility. 4. Aseptically store parts until used. CAUTION: DO NOT autoclave the ventilator. Chemical Disinfecting The O2 sensor tee (P/N 1001736) and the O2 sensor coupling (P/N 1002505) may be chemically disinfected.The PVC O2 sensor tee, P/N 8-100498-00 (gray in color), cannot be chemically disinfected. For chemically disinfected parts, reassemble after disinfecting. 10-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 10 Care and Maintenance CAUTION: Formaldehyde, phenol-based, and quaternary ammonium compound (QUATS) disinfectants are not recommended because these agents can cause cracking and crazing of plastic parts. Exposure of components to disinfectant concentrations stronger than required or for excessive time may shorten product life. Parts should be thoroughly rinsed and dried to prevent spotting and blemishes when exposed to elevated temperatures. 1. Separately immerse each part in the chemical disinfectant, i.e. ammonia (15% solution), bleach (10% solution) or commercial, hospital grade disinfectant, etc. Follow the disinfectant manufacturers directions for the solution concentration, immersion times, and other conditions for disinfecting. The use of a laminar air flow hood during the chemical disinfecting process is recommended. 2. Thoroughly rinse and dry each part. 3. Aseptically reassemble (as required) and store the part until use. Ventilator Exterior Wipe the ventilator exterior clean with a damp cloth and mild detergent. Do not use liquid or aerosol bactericide. Do not allow moisture to come in contact with the touch panel screen or to collect between the keypad and front bezel assembly. CAUTION: DO NOT allow liquid to penetrate the ventilator rear or front panel. DO NOT attempt to sterilize the ventilator by exposing to ETO gas. DO NOT steam-autoclave. CAUTION: Care should be taken when cleaning the touch display. (Refer to Figure 8-2 on page page 8-3). A soft moist cloth should be used that does not drip water and/or soap solution when in contact with the display. After cleaning and rinsing with a damp cloth, remove all moisture with a dry, soft cloth. Never allow solutions of any kind to collect on the bottom bezel of the display. Never use a brush or device that can cause abrasion to clean the touch display or its bezel; they will cause irreparable damage. Patient Circuit Support Arm Wipe the patient circuit support arm clean with alcohol or bactericide. O2 Gas Supply Filter/Water Trap Wipe the exterior of the O2 gas supply filter/water trap with a mild solution of soap and water. Rinse and dry parts. Do not steam-autoclave, chemically disinfect, or expose to ETO gas. Do not allow liquid to migrate into the inlet port. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 10-3 Chapter 10 Care and Maintenance Reusable Patient Circuit Tubing, Couplings, and Connectors Disassemble and clean manually followed by steam-autoclave. Follow all institutional guidelines for autoclaving. Visually inspect tubing for nicks, cuts and holes prior to use with the ventilator. Reusable In-line Water Traps Disassemble and clean water traps as per the manufacturers instructions. Inspect for cracks or leaks prior to use with the ventilator. Replace if cracked or leaking. Bacteria Filters Bacteria filters are typically used on the inspiratory and expiratory port connections on the front of the ventilator. Filter locations are illustrated below. Expiratory Filter Inspiratory Filter Figure 10-1: Inspiratory and Expiratory Bacteria Filter Locations The inspiratory filter port is a 22mm standard connector. Use the filter supplied with the ventilator. The expiratory port includes a heated exhalation compartment. Use the filter supplied with the ventilator. WARNING: 10-4 Disposable or single-patient filters must be discarded between patients. Do not chemically disinfect or expose single patient use bacteria filters to ETO gas. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 10 Care and Maintenance Removing and Replacing Inspiratory Bacteria Filter Follow the steps outlined below to remove and replace the inspiratory bacteria filter. Figure 10-2: Removing and Replacing Inspiratory Bacteria Filter 1. Disconnect circuit tubing (1) from inspiratory bacteria filter outlet (2). 2. Disconnect filter (3) from the gas outlet (4). If optional O2 sensor is installed, ensure it is not dislodged. When used, O2 sensor is located between gas outlet (4) and filter (3). 3. Insert new filter onto the gas outlet (4) with flow direction indicator (on the filter) pointing away from the ventilator. 4. Reconnect circuit tubing (1) to new filter outlet (2). Removing and Replacing Expiratory Bacteria Filter Refer to the illustration below and follow the steps outlined below to remove and replace the expiratory bacteria filter. WARNING: REF 1057983 A The expiratory filter housing may be hot if removed from the ventilator immediately after use. Wait 15 minutes after turning off ventilator power before removing the heated expiratory bacteria filter. Exercise caution when handling the filter housing. Respironics V200 Ventilator Operator’s Manual 10-5 Chapter 10 Care and Maintenance Figure 10-3: Removing and Replacing Expiratory Bacteria Filter 1. Disconnect circuit tubing from filter inlet (not shown). 2. Unscrew knob (1) to unlatch retaining bracket (2). 3. Open retaining bracket (2). 4. Use tabs (3) to gently remove heater housing (5) and filter (4) from the ventilator. 5. Do not touch heater housing. If ventilator has not been turned off and heater housing has not been allowed to cool, it may be hot to the touch. 6. Carefully remove filter (4) from heater housing (5). 7. Tap filter input port (6) if filter (4) cannot be easily removed from housing (5). 8. Insert new filter into housing (5). 9. Reinstall housing (5) and new filter and close retaining bracket (2). 10. Connect circuit. 10-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 10 Care and Maintenance Periodic Maintenance This section includes detailed operator maintenance. Schedule for Periodic Maintenance Frequency During ventilator setup Component • Inspiratory bacteria filter • Ventilator and patient circuit components • Inspiratory and expiratory filters At least daily, and as recommended by filter manufacturers • Inspiratory and expiratory filters Maintenance • Check filter for occlusions, cracks and tears. • Perform SST (Short Self-Test) whenever circuit components are changed • Perform EST (Extended Self-Test) between patient uses • Ensure that the ventilator functions normally with both filters in place • Monitor performance of filters and replace as needed. Review ventilator patient graphics frequently for changes in expiratory resistance which may indicate degradation of expiratory filter. • Follow filter manufacturer recommendations regarding duration of use, maintenance (for reusable filters), removal and disposal. Note that high humidity and aerosol medications may reduce expiratory filter life, increase expiratory resistance, and/or cause filter damage. CAUTION: Do not operate the ventilator without a properly functioning expiratory filter and heater. Doing so may cause damage to delicate ventilator components, such as the expiratory flow sensor, which may lead to inaccurate spirometry or a Vent Inop condition. WARNING: Vent Inop is a serious condition which is indicated by both visual and audible alarms. If the ventilator is attached to a patient when Vent Inop occurs, the patient must be supported with another means of life support ventilation. At least daily • Oxygen supply water trap and filter • Check and empty as required every shift At least every 250 hours • Air Inlet & Fan Filters • Inspect and clean. Some environments cause a quicker collection of lint and dust than others, requiring maintenance more frequently than every 250 hours. Annually • Annual preventive maintenance kit (P/N 1034840). Kit contents are subject to change. • Install annual preventive maintenance kit. • Clean ventilator interior and exterior • Complete performance verification procedure CAUTION: The annual preventive maintenance procedure is to be performed only by a qualified service technician REF 1057983 A Respironics V200 Ventilator Operator’s Manual 10-7 Chapter 10 Care and Maintenance 12,500 hours • 12,500 hour preventive maintenance kit (P/N 1001733). Kit contents are subject to change. • Install 12,500 hour preventive maintenance kit • Clean ventilator interior and exterior • Complete performance verification procedure CAUTION: The 12,500 hour preventive maintenance procedure is to be performed only by a qualified service technician. As required • External oxygen sensor • Backup Battery • Replace and recalibrate new sensor by running Extended Self-Test • For charging and maintenance instructions, see “Backup Battery” on page 4-4. Table 10-1: Schedule for Periodic Maintenance Removing Cooling Filter 1 2 Figure 10-4: Removing Cooling Filter Refer to Figure 10-4. 1. Remove black filter retaining bracket (1). (Pry off if necessary.) 2. Wash filter (2) in soapy water. 3. Dry thoroughly before reinstalling. CAUTION: 10-8 Do not remove any screws from the cooling filter area. Removing screws from this area will result in damage to internal components. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 10 Care and Maintenance Removing and Replacing O2 Input Filter Element 1 5 4 3 2 Figure 10-5: Removing and Replacing O2 Input Filter Element Refer to Figure 10-5. 1. Disconnect O2 Hose (1). 2. Unscrew filter housing (3). 3. Unscrew filter element retaining screw (4). 4. Remove and replace filter element (5). 5. Reconnect filter element retaining screw (4). 6. Reinstall filter housing (3). 7. Reconnect O2 hose (1). 8. Check system for leaks prior to patient use. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 10-9 Chapter 10 Care and Maintenance Removing and Replacing Internal Air Source Inlet Filter 1 2 Pull filter out from underside of duct. Figure 10-6: Removing and Replacing Internal Air Source Inlet Filter Refer to Figure 10-6. Figure 10-6 shows exploded view of the duct (2) and filter (1), but it does not have to be disassembled. 1. Move the ventilator so that there is easy access to the underside of the internal air source duct (2). 2. The internal air source filter (1) can be removed manually. The filter can be reached from under the internal air source duct (2) as indicated by the arrow. 3. Wash internal air source filter (1) with mild soap and water. 4. Rinse thoroughly then pat dry. 5. Reinstall internal air source filter (1) from underneath the duct (2) in the same fashion it was removed. Storage If you need to store the ventilator for fifteen days or more, ensure that the altitude, temperature and humidity of the storage site fall within the following ranges: • Environmental Temperature: -20 to 60°C (-4 to 140° F) • Relative Humidity: 10 to 100% noncondensing • Maximum Altitude: 6,560 m (20,000 ft.) Repairs For technical service or repairs not included in this chapter, refer to the Esprit/ V200 Ventilator Service Manual, P/N 580-1000-02 or contact Respironics Customer Service at 1-800-345-6443. 10-10 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 11. Diagnostics The Diagnostic Mode allows you to: REF 1057983 A • Run short self test (SST) • Run extended self test (EST) • Run hardware diagnostics to help you troubleshoot SST or EST failures • Check the software revision of the ventilator • Set • • • • • Check diagnostic codes. user configuration, including: time and date compliance compensation enable/disable local altitude and time format backup battery (confirm at startup) enable/disable WARNING: The patient must be disconnected from the ventilator before entering the Diagnostic Mode since normal ventilation is suspended. CAUTION: Troubleshooting and repair should be performed only by a qualified service technician. NOTE: The “Hardware” function and EST in the Diagnostics Mode should only be run by qualified personnel. Respironics V200 Ventilator Operator’s Manual 11-1 Chapter 11 Diagnostics Entering Diagnostic Mode To enter Diagnostic Mode, hold down the ALARM RESET and 100% O2 keys for approximately 5 seconds while you turn on the ventilator. A message appears on the ventilator prompting you to confirm that the patient is disconnected before entering Diagnostic Mode (Figure 11-1). Press OK to enter Diagnostic Mode. Figure 11-1: Entering Diagnostic Mode Once you’ve entered Diagnostic Mode, you can select any of diagnostic functions by pressing its button. Change values in Diagnostic Mode the same way you change ventilator settings. 11-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 11 Diagnostics Diagnostic Functions Short Self Test (SST) SST verifies the integrity of the patient circuit tubing by measuring its leak rate and compliance. SST also tests critical hardware components, including the safety valve, flow sensors, and autozero solenoids. Perform SST before every patient circuit change. If SST passes, the ventilator and all attached components are ready for use. WARNING: Do not use a ventilator that has failed SST without verifying operational readiness by other means. Doing so may place a patient at risk. WARNING: Never initiate SST while the patient is connected to the ventilator. The high airway pressures generated during SST can injure a patient. Equipment required to run SST: • Patient circuit to be used on the next patient including any devices installed in line with the circuit (such as a humidifier, O2 sensors, and/or temperature sensor). • Plug or cap for the patient wye Follow these steps to run SST: 1. Connect the circuit to be used on the next patient to the ventilator. 2. Press the SST button (Figure 11-1) on the diagnostic screen. 3. Press the Start SST button to begin the test. 4. When prompted, unplug the patient wye and press the OK button. 5. When prompted, plug the patient wye and press the OK button. 6. When SST completes successfully, press the OK button. When SST is completed, the calculated circuit compliance is displayed on the screen. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 11-3 Chapter 11 Diagnostics Extended Self Test (EST) EST verifies the overall functional integrity of the ventilator by testing all critical hardware subsystems and components. Perform EST between patients as part of preventive maintenance, a performance verification, or if the operational integrity of the ventilator is in question. EST is typically run by qualified trained personnel. WARNING: Never initiate EST while the patient is connected to the ventilator. The high airway pressures and gas flows generated during EST can injure a patient. WARNING: Do not use a ventilator that has failed EST without verifying operational readiness by other means. Doing so may place a patient at risk. CAUTION: If the optional external O2 sensor is in-line, it must be calibrated during EST. Equipment required to run EST: • Patient circuit • Plug for the patient wye • High pressure O2 source Follow these steps to run EST: 1. Enter Diagnostic Mode as described “Entering Diagnostic Mode” on page 11-2. 2. Connect a patient circuit to the ventilator. 3. Press the EST button on the diagnostic screen (Figure 11-1). 4. Press START EST to begin EST. 5. Follow the prompts. 6. When EST completes successfully, press the OK button. Hardware The hardware function allows a trained service technician to operate critical components separately to help identify a faulty component in the event that the ventilator fails SST, EST, or performance verification testing. For more information on the Hardware function, see the Esprit/V200 Ventilator Service Manual, P/N 580-1000-02. Software The software function displays the ventilators serial number, software part numbers, and version numbers and the part numbers of other critical components. 11-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 11 Diagnostics User Config The User Config function allows you to: • Set the date and time when first setting up the ventilator. • Set the altitude for the location of the ventilator. This setting allows for more accurate tidal volume delivery. • Enable or disable the automatic patient circuit compliance compensation feature. Compliance compensation corrects the delivered volumes of VCV mandatory breaths for patient circuit compliance. It also corrects all exhaled volume for patient circuit compliance volume. The COMPLIANCE button is grey when compliance compensation is disabled and white when compliance compensation is enabled. • Set the time format (AM/PM or 24 hour). • Enable or disable the confirmation that the backup battery is connected each time that the machine powers on. Diagnostic Codes The Diagnostic Codes function allows you to review the diagnostic log in ventilator memory. To view the diagnostic codes, press the DIAGNOSTIC CODE button on the diagnostic screen. The ventilator displays the following information: REF 1057983 A • Number: Diagnostic codes are numbered in reverse order of occurrence (most recent first). • Code: The number assigned to a specific diagnostic code; used in determining the cause of a possible failure. • Repeat: If the same code occurs consecutively, this parameter will be incremented rather than creating a new entry in the log. For example, if the diagnostic code 1002 occurs three consecutive times, it is logged as diagnostic code 1002 and the repeat column is 2. The repeat column increments until a different diagnostic code occurs. • Time: Diagnostic codes are time stamped in hour:minute:second format (for example: 09:15:23). When the same diagnostic code repeats, the time stamp represents the most recent occurrence of the diagnostic code. • Date: Diagnostic codes are date stamped in month/day/year format (for example: 03/12/98). When the same diagnostic code repeats, the date stamp represents the most recent occurrence of the diagnostic code. • Corrupted: The microprocessor cross checks the data in memory prior to display. If it determines that the memory contents have been corrupted, it logs a YES indicating that the memory contents validity is suspect. Respironics V200 Ventilator Operator’s Manual 11-5 Chapter 11 Diagnostics Diagnostic codes associated with EST and SST are only recorded the first time the failure is encountered. The log holds the last 20 diagnostic codes. The screen can only display 10 codes at a time. Press NEXT PAGE button to see the next group of codes or PREV PAGE to view the previous group. The CLEAR CODES button allows a qualified service technician to delete codes from the log. Because diagnostic codes provide the primary means of fault diagnosis, they should only be cleared by or under the advice of qualified personnel. CAUTION: Diagnostic codes should only be cleared by qualified personnel. Table 11-1: “Diagnostic Codes and Descriptions”, summarizes some diagnostic codes and their descriptions. The codes and descriptions for SST and EST are identical except that SST codes are preceded by a 2 and EST codes are preceded by a 3. For example, if code 106 occurred during an SST, it would be logged as 2106. If it occurred during an EST, it would be logged as 3106. WARNING: Remove the ventilator from service and contact trained service personnel if any diagnostic codes appear with the exception of: 1, 3, 2000, 3000, 5000, 5002, 8003, or 8004. WARNING: Use of a ventilator that has not passed SST or EST is against the strongest recommendation of Respironics. Diagnostic Codes and Descriptions Code Description 1 Normal mode startup 3 Diagnostic Startup 2XXX Short Self Test 2000 SST Passed 2106 Patient Circuit Leak 2107 Inh Pressure Too Low 2110 Check Valve 3 Leak 2125 Inhalation Pressure/Exhalation Pressure Disagreement 2128 Circuit Compliance Out of Range 2129 Pressure Leak Out of Range 2130 Safety Valve Cannot Open 2131 Patient Wye Not Blocked Table 11-1: Diagnostic Codes and Descriptions (Sheet 1 of 4) 11-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 11 Diagnostics Diagnostic Codes and Descriptions (Continued) Code Description 2134 Cannot Calibrate Air Flow Sensor 2135 Cannot Calibrate O2 Flow Sensor 2136 Cannot Calibrate Exh Flow Sensor 2137 Verify Failure—Air Flow Sensor Cal 2138 Verify Failure—O2 Flow Sensor Cal 2139 Verify Failure—Exh Flow Sensor Cal 2140 Cannot Erase Flow Sensor Tables 2141 Cannot Open Inh Autozero Solenoid 2142 Cannot Open Exh Autozero Solenoid 2152 Patient Wye Not Unblocked 3XXX Extended Self Test 3000 EST Passed 3100 Canceled By User 3101 Air Stepper Motor Outside Range 3102 O2 Stepper Motor Outside Range 3103 Air Flow Outside Range 3104 O2 Flow Outside Range 3105 Exh Flow Outside Range 3106 Patient Circuit Leak 3107 Inh Pressure Too Low 3108 Exh Pressure Outside Range 3109 Check Valve 2 Leak 3110 Check Valve 3 Leak 3111 O2 Not Connected 3112 O2 Not Disconnected 3113 FiO2 Sensor Sample Out of Range 3114 FiO2 Sensor Average Out of Range 3115 Primary Audio Not Sounding 3116 Backup Audio Not Sounding 3117 Crossover Circuit Fault 3118 Blower Off Switch Failure 3119 Blower DAC Failure 3120 Pressure Relief Valve Cracking Pressure Too High 3121 Pressure Relief Valve Cracking Flow Not Stable 3122 Pressure Relief Valve Cracking Pressure Too Low Table 11-1: Diagnostic Codes and Descriptions (Sheet 2 of 4) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 11-7 Chapter 11 Diagnostics Diagnostic Codes and Descriptions (Continued) Code Description 3123 O2 Valve Cracking Flow Outside Range 3124 O2 Valve Full Flow Outside Range 3125 Air Flow Sensor/Exh Flow Sensor Disagreement or Inhalation Pressure/Exhalation Pressure Disagreement 3126 O2 Flow Sensor/Exh Flow Sensor Disagreement 3127 Heated Filter Backpressure Out of Range 3128 Circuit Compliance Out of Range 3129 Pressure Leak Out of Range 3130 Safety Valve Cannot Open 3131 Patient Wye Not Blocked 3132 keyboard Failure 3133 Rotary Knob Failure 3134 Cannot Calibrate Air Flow Sensor 3135 Cannot Calibrate O2 Flow Sensor 3136 Cannot Calibrate Exh Flow Sensor 3137 Verify Failure—Air Flow Sensor Cal 3138 Verify Failure—O2 Flow Sensor Cal 3139 Verify Failure—Exh Flow Sensor Cal 3140 Cannot Erase Flow Sensor Tables 3141 Cannot Open Inh Autozero Solenoid 3142 Cannot Open Exh Autozero Solenoid 3143 Air Step Position for Open—Outside Range 3144 Air Step Position for Midpoint—Outside Range 3145 Air Step Position for Close—Outside Range 3146 O2 Step Position for Open—Outside Range 3147 O2 Step Position for Midpoint—Outside Range 3148 O2 Step Position for Close—Outside Range 3149 Exh Step Position for Open—Outside Range 3150 Exh Step Position for Midpoint—Outside Range 3151 Exh Step Position for Close—Outside Range 3152 Patient Wye Not Unblocked 3153 Touchscreen Failure 3154 LED Indicator Failure 3155 Remote Alarm Not Sounding 3156 Inh. Transducer Autozero Failure 3157 Exh. Transducer Autozero Failure Table 11-1: Diagnostic Codes and Descriptions (Sheet 3 of 4) 11-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 11 Diagnostics Diagnostic Codes and Descriptions (Continued) Code Description 3158 Exhalation Valve initial pressure —Outside Range 3159 Exhalation Valve final pressure —Outside Range 3160 Exhalation Valve flow —Outside Range 5XXX Safety Valve Open or Backup Battery Not connected 5000 Occlusion - Safety Valve Open Alarm 5001 Gas Supplies Lost - Safety Valve Open Alarm 5002 Backup Battery Not Connected 8XXX Software Diagnostic information 8003 Software Option Button Failure 8004 Insufficient Blower Current Table 11-1: Diagnostic Codes and Descriptions (Sheet 4 of 4) WARNING: Please contact Respironics Customer Service at 1-800-345-6443 or consult your service manual if any diagnostic codes are encountered. Information The Information function is reserved for future expansion. Option The Option function is reserved for future expansion. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 11-9 Chapter 11 Diagnostics Self Test Introduction The Respironics V200 ventilator has an extensive system of checks designed into the system to ensure that it operates safely and detects fault conditions that can compromise the performance of the system as a ventilator. These checks include hardware that checks the integrity of the software and software that checks the hardware to ensure that it is operating within normal ranges. These checks are described below. Self-Test Hardware The self-test hardware involves hardware components that check the integrity of the software. The hardware components that perform these checks are the watchdog timer and the bus activity monitor. • Watchdog Timer: The watchdog timer is a timer that the software must reset. If the timer times out, it causes a reset that restarts the ventilator as if the power switch had been turned on. Normally the software resets the watchdog timer and it never times out. • Bus Activity Monitor: The bus activity monitor is a timer similar to the watchdog timer. The bus activity monitor timer is a timer that only times out if there has been no activity on the microprocessor bus. If there is no activity on the bus, it would indicate there is a malfunction of some kind and the microprocessor is restarted in the same way that the watchdog timer does. Power On Self Test (POST) POST is the test that the ventilator does when the machine power is turned on or if there has been a potential fault detected by the watchdog timer or the bus activity monitor. POST has the constraint that it must be able to run safely when the ventilator has a patient attached. POST checks the integrity of critical system electronics such as the self test hardware and microprocessor electronics. POST also tests other critical ventilator components that can be tested. A primary objective of POST is to ensure that the watchdog timer and the bus activity monitor hardware are working and will catch software malfunctions. These are critical components of the safety system and therefore POST tests these components every time it runs. POST also checks all critical digital hardware, including the processor, program memory, data memory, and functions of various measurement systems. POST also checks pneumatic components that can be safely tested with the safety valve open. If all of these tests pass, the Respironics V200 ventilator will operate as a ventilator. 11-10 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 11 Diagnostics Built-In Test When the Respironics V200 ventilator is operating as a ventilator, it is constantly making reasonableness checks on the operation of the hardware to ensure that failures have not occurred and that the hardware appears to be operating normally. Also, while the microprocessor is operating, there is execution time available that is not required for ventilator operation. When execution time is available, the microprocessor runs many of the hardware tests that are run during POST. These include Program memory, RAM memory, and other measurements that can be tested without interfering with the operations of the ventilator. The ventilator’s safety system of hardware checking software and software checking hardware means that the ventilator only operates as a ventilator if the extensive constraints of the safety system are met. Restart During normal operation, the ventilator performs background checks to ensure the integrity of the system. If a problem is detected, the ventilator enters the “restart” sequence, in which it opens the safety valve while it performs additional integrity checks. Restart is 10 to 20 seconds, depending upon the reason for the restart. The ventilator sounds an alarm and displays a visual message indicating the unit is in a restart sequence. In some cases, a countdown timer will display the number of seconds remaining until the ventilator completes the restart cycle. If, during the restart sequence, an actual problem is confirmed, the ventilator enters the “Vent Inop” state, in which it activates audible and visual alarms while the safety valve remains open. Alternatively, if at the end of the restart sequence the ventilator determines it is safe to continue operation, the unit will return to normal ventilation. NOTE: REF 1057983 A A “restart” is an infrequent event. Respironics V200 Ventilator Operator’s Manual 11-11 Chapter 11 Diagnostics (This page is intentionally blank.) 11-12 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 12. Technical Specifications Breath Types Breath Types Volume Controlled Ventilation VCV Pressure Controlled Ventilation PCV Non-Invasive Positive Pressure Ventilation NPPV Apnea Ventilation Table 12-1: Breath Types Modes Modes Assist/Control (A/C) VCV, PCV SIMV VCV,PCV CPAP VCV, PCV Spont/T NPPV Spont NPPV Table 12-2: Modes Volume Ventilation Settings, Ranges and Resolution Resolution is one unit unless otherwise noted (cmH2O is considered numerically equivalent to hPa). Volume Ventilation Settings, Ranges & Resolution Setting Range Respiratory Rate 1 to 80 Bpm Tidal Volume 50 to 2500 mL Peak Inspiratory Flow 3 to 140 Lpm (Compliance compensated, actual to 200 Lpm) PEEP 0 to 35 cmH2O (hPa) PSV Pressure 0 to 100 cmH2O (hPa) Table 12-3: Volume Ventilation Settings, Ranges and Resolution (Sheet 1 of 2) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 12-1 Chapter 12 Technical Specifications Volume Ventilation Settings, Ranges & Resolution (Continued) Setting Range Inspiratory Trigger (I-trigger) Pressure Sensitivity -20 to -0.1 cmH2O (hPa) (Resolution is 0.1 cmH2O (hPa)) Flow Sensitivity 0.5 to 20 LPM (Resolution is 0.1 LPM) Expiratory Trigger (E-Cycle) % Peak Flow 10 to 80% of inspiratory peak flow Rise Time 0.1 to 0.9 seconds (Resolution is 0.1 second) %O2 21% to 100% Insp. Hold 0 to 2.0 seconds (Resolution is 0.1 second) Flow Waveform Descending ramp, square Patient Type Adult/Pediatric Table 12-3: Volume Ventilation Settings, Ranges and Resolution (Sheet 2 of 2) Pressure Control Ventilation Settings, Ranges and Resolution Resolution is one unit unless otherwise noted (cmH2O is considered numerically equivalent to hPa). Pressure Control Ventilation Settings, Ranges & Resolution Setting Range Apnea Rate 1-80 Bpm Respiratory Rate 1 to 80 Bpm PCV Pressure 5 to 100 cmH2O (hPa) (Relative to PEEP) Inspiratory Time 0.1 to 9.9 seconds (Resolution is 1 second) PEEP 0 to 35 cmH2O (hPa) PSV Pressure 0 to 100 cmH2O (hPa) (Relative to PEEP) Inspiratory Trigger (I-trigger) Pressure Sensitivity Flow Sensitivity -20 to -0.1 cmH2O (hPa) (Resolution is 0.1 cmH2O (hPa)) 0.5 to 20 LPM from base flow of 3 LPM above sensitivity (Resolution is 0.1 LPM) Expiratory Trigger (E-Cycle) % Peak Flow 10 to 80% of inspiratory peak flow Table 12-4: Pressure Control Ventilation Settings, Ranges & Resolution (Sheet 1 of 2) 12-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 12 Technical Specifications Pressure Control Ventilation Settings, Ranges & Resolution (Continued) Setting Range Rise Time 0.1 to 0.9 seconds %O2 21% to 100% Patient Type Adult/Pediatric Table 12-4: Pressure Control Ventilation Settings, Ranges & Resolution (Sheet 2 of 2) Non-Invasive Positive Pressure Ventilation Settings, Ranges and Resolution Resolution is one unit unless otherwise noted (cmH2O is considered numerically equivalent to hPa). Non-Invasive Positive Pressure Ventilation Settings, Ranges & Resolution Setting Range Respiratory Rate 1 to 80 Bpm EPAP 2 to 25 cmH2O (hPa) IPAP 2 to 35 cmH2O (hPa) Inspiratory Time 0.1 to 9.9 seconds (Resolution is 0.1 second) Rise Time 0.1 to 0.9 seconds Inspiratory Trigger (I-trigger) Flow Sensitivity 0.5 to 20 LPM from base flow of 3 LPM above sensitivity (Resolution is 0.1 LPM) Expiratory Trigger (E-Cycle) % Peak Flow 10 to 80% of inspiratory peak flow %O2 21% to 100% Apnea Rate 1-80 Bpm Patient Type Adult/Pediatric Table 12-5: Non-Invasive Positive Pressure Ventilation Settings, Ranges and Resolution Maximum delivered flow during pressure controlled breaths in NPPV is limited to 100 LPM for the pediatric patient type. Apnea Ventilation Apnea ventilation is considered equivalent to Assist Control with Apnea Rate in VCV and PCV. In NPPV, only mandatory breaths are delivered, triggered either at the Apnea Rate or by the patient. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 12-3 Chapter 12 Technical Specifications Value Entry Message If you enter a value that is outside the operational limits of the ventilator, you will be shown a message window on the screen. Once you acknowledge the message, the ventilator returns to the value modification display without changing the value. Assist/Control Ventilation Value Entry Reasonability Checks Item Limit Exceeded Message Apnea Rate I:E Ratio>3:1 I:E Ratio must be less than or equal to 3:1. Check Vt, Peak Flow, or Insp. Hold Peak Flow I:E Ratio>3:1 I:E Ratio must be less than or equal to 3:1. Check Vt, Apnea Rate, or Insp. Hold. Tidal Volume I:E Ratio>3:1 I:E Ratio must be less than or equal to 3:1. Check Flow, Apnea Rate, or Insp. Hold. Insp. Hold I:E Ratio>3:1 I:E Ratio must be less than or equal to 3:1. Check Vt, Apnea Rate or Peak Flow. Waveform I:E Ratio>3:1 I:E Ratio must be less than or equal to 3:1. Check Vt, Peak Flow or Apnea Rate. I-Time I-Time>9 sec. I-Time must be less than or equal to 9 sec. Check Vt, Peak Flow, Insp. Hold or Waveform. Table 12-6: Assist/Control Ventilation Value Entry Reasonability Checks Pressure Control Ventilation Value Entry Reasonability Checks Item Limit Exceeded Message Changed Apnea Rate I:E Ratio>4:1 I:E Ratio must be less than or equal to 4:1.Check ITime. Readjust the Apnea Rate or adjust I-Time or Rate. I-Time I:E Ratio>4:1 I:E Ratio must be less than or equal to 4:1.Check Apnea Rate. Readjust the I-Time or adjust Apnea Rate or Rate. I-Time I-Time I Time Rise Time must be less than I-Time. Decrease the Rise Time or increase the I-Time. Table 12-7: Pressure Control Ventilation Value Entry Reasonability Checks 12-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 12 Technical Specifications Non-Invasive Ventilation Value Entry Reasonability Checks Item Limit Exceeded Message Changed Apnea Rate I:E Ratio>4:1 I:E Ratio must be less than or equal to 4:1. Check ITime. Readjust the Apnea Rate or adjust I-Time or Rate. I-Time I:E Ratio>4:1 I:E Ratio must be less than or equal to 4:1. Check Apnea Rate. Readjust the I-Time or adjust Apnea Rate or Rate. IPAP IPAP IPAP EPAP must be less than or equal to IPAP. Readjust EPAP lower or adjust IPAP higher. Rise Time Rise Time>I Time Rise Time must be less than I-Time. Decrease the Rise Time or increase the I-Time. Table 12-8: Non-Invasive Ventilation Value Entry Reasonability Checks General Value Entry Reasonability Checks Item Limit Exceeded Message Changed Apnea Apnea Rate 95% dip in UT) for 0.5 cycle <5% UT (>95% dip in UT) for 0.5 cycle 40% UT (60% dip in UT) for 5 cycles 40% UT (60% dip in UT) for 5 cycles 70% UT (30% dip in UT) for 25 cycles 70% UT (30% dip in UT) for 25 cycles 5% UT (>95% dip in UT) for 5 sec 5% UT (>95% dip in UT) for 5 sec IEC 61000-4-5 Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11 Power Frequency (50/60Hz) magnetic field 3 A/m 3 A/m Electromagnetic Environment Guidance Floors should be wood, concrete or ceramic tile. If floors are covered with synthetic material, the relative humidity should be at least 30%. Mains power quality should be that of a typical hospital environment Mains power quality should be that of a typical hospital environment Mains power quality should be that of a typical hospital environment. If the user of the ventilator requires continued operation during power mains interruptions, it is recommended that the ventilator be powered from an external battery. Power frequency magnetic fields should be at levels characteristic of a typical location in a typical hospital environment. IEC 61000-4-8 NOTE: UT is the a.c. mains voltage prior to application of the test level. Table 12-27: EMC Declaration - Immunity REF 1057983 A Respironics V200 Ventilator Operator’s Manual 12-13 Chapter 12 Technical Specifications Guidance and Manufacturer's Declaration - Electromagnetic Immunity The ventilator is intended for use in the electromagnetic environment specified below. The user of the ventilator should assure that it is used in such an electromagnetic environment. Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Environment - Guidance Portable and mobile RF communications equipment should be used no closer to any part of the ventilator, including cables, than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter.Recommended separation distance Table 12-29: “EMC Declaration - Recommended Distances”. Conducted RF IEC 61000-4-6 3 Vrms150 kHz to 80 MHz outside ISM bandsa 3Vrms 3.5 d = ------V1 P 10 Vrms 12 d = -----V2 P 12 d = -----E1 P 80Mhz to 800Mhz 23 d = -----E1 P 800Mhz to 2.5GHz 10 Vrms Radiated RF IEC 61000-4-3 150kHz to 80 MHz in 10 V/m 80Mhz to 2.5GHz 10 V/m where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer and d is the recommended separation distance in meters (m).b Field strengths from fixed RF transmitters, as determined by an electromagnetic site survey,c should be less than the compliance level in each frequency range.d Interference may occur in the vicinity of equipment marked with the following symbol: Table 12-28: EMC Declaration - Immunity 12-14 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 12 Technical Specifications Guidance and Manufacturer's Declaration - Electromagnetic Immunity NOTE 1 At 80 MHz and 800 MHz, the higher frequency range applies. NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. a The ISM (industrial, scientific and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz; 13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz. b The compliance levels in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz are intended to decrease the likelihood that mobile/ portable communications equipment could cause interference if it is inadvertently brought into patient areas. For this reason, an additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in these frequency ranges. c Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the ventilator is used exceeds the applicable RF compliance level above, the ventilator should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the ventilator. d Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 1 V/m. Table 12-28: EMC Declaration - Immunity REF 1057983 A Respironics V200 Ventilator Operator’s Manual 12-15 Chapter 12 Technical Specifications Recommended Separation Distances Between Portable and Mobile RF Communications Equipment and the Respironics V200 Ventilator The ventilator is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The user of the ventilator can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the ventilator as recommended below, according to the maximum output power of the communications equipment Separation Distance According to Frequency of Transmitter (Meters) 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz in ISM Bands Rated Maximum Output Power of Transmitter (Watts) 150 kHz to 80 MHz Outside ISM Bands 0.01 0.12 0.12 0.12 0.23 0.1 0.38 0.38 0.38 0.74 1 1.20 1.20 1.20 2.30 12 d = -----V2 P 12 d = -----E1 P 23 d = -----E1 10 3.80 3.80 3.79 7.40 100 12.00 12.00 12.00 23.00 P For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can be determined using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2 The ISM (industrial, scientific and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz;13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz. NOTE 3 An additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range 80 MHz to 2.5 GHz to decrease the likelihood that mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas. NOTE 4 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people. Table 12-29: EMC Declaration - Recommended Distances 12-16 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 12 Technical Specifications Pneumatic System Internal Blower Inspiratory Module w/SV and PRV O2 Inlet To Patient Oxygen Assembly Expiratory Gas to Atmosphere Exhalation Valve Assembly Heated Exhalation Filter Assy From Patient System Electromechanical Controls User Interface Figure 12-1: Pneumatic System REF 1057983 A Respironics V200 Ventilator Operator’s Manual 12-17 Chapter 12 Technical Specifications Labels Ventilator Labels Label Description On/Off Switch Label Heated Expiratory Filter Label Gas Return Label Gas Outlet Label Serial Port, Remote Alarm Nurse Call, parallel printer port Label Keep Covered Label Analog port Potential Equalization Connector DC Battery Connection Label AC Power Label Humidifier Outlet Label Power Switch on Front Label Circuit Breakers Label 12-18 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 12 Technical Specifications Ventilator Labels (Continued) Oxygen Inlet Label Emergency Air Intake Label Cooling Inlet Label Date of Manufacture/Manufacturer Label 1059179 REV A Manufacturer Label Respironics California, Inc. Authorized Representative: 2271 Cosmos Court Respironics Deutschland GmbH Carlsbad, CA 92011 Gewerbestrasse 17 D-82211 Herrsching Germany MADE IN THE U.S.A. Covered by one or more of the following patents: 6,543,449. Other patents pending. Mercury disposal warning label WARNING: Lamps in display contain mercury - Dispose of properly. Warning Label Attention Label Hot and Attention Label REF 1057983 A Respironics V200 Ventilator Operator’s Manual 12-19 Chapter 12 Technical Specifications Ventilator Labels (Continued) Air Intake Label WARNING: Air Intake - Do Not Obstruct! Protective Earth (Ground) Label 12-20 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13. Options and Accessories Introduction This chapter lists and describes the Respironics V200 ventilator options and accessories. Options and Accessories Page Reference Part Number Software Options Communications 13-27 1010525 Flow-Trak 13-83 1019026 Graphics 13-19 1003772a Neonatal 13-97 1016851 Respiratory profile monitor interface (NICO-Esprit Interface) 13-87 1022488 Respiratory Mechanics 13-51 1006600 RS-232 Communications 2 13-39 1015725 Trending 13-69 1013446 Speaking Mode 13-103 1046805 Auto-Trak 13-117 1061450 Hardware Accessories AC Power Cord 1001832a Backup Battery 1059956 External Battery 13-6 1059955 Vuelink Cable 1006912 V200 Cart 1060495 Flex Arm Assembly 1003781 Flex Arm Bracket 1002497 Humidifier Bracket Kit, Hudson CONCHATHERM IV 1061390 Humidifier Mounting Adapter, Hudson CONCHATHERM Series III/IV 1002231 O2 Cylinder Holder Kit 1060815 O2 High Pressure Hose 1001664a O2 Manifold 13-13 1060785 O2 Sensor Kit 13-3 1002541 O2 Sensor Kit, PVC 13-3 1032037 Respiratory Profile Monitor Mounting Kit 1060784 RS-232 serial communications 3’ cable (NICO-Esprit) 1018292 Table 13-1: Options and Accessories (Sheet 1 of 2) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-1 Chapter 13 Options and Accessories Options and Accessories (Continued) Remote Alarm Cable Kit (Normally Open Protocol) 1003741 Remote Alarm Cable Kit (Normally Closed Protocol) 1003742 Remote Alarm Cable Kit — Respironics (LifeCare) 1003743 Test Lung 1001737 Reusable Items Reusable Exhalation Bacteria Filter Omni (Single) 1002970 Reusable Inspiratory Bacteria Filter (Single) 1003847 Reusable Patient Circuit Kit, Adult Kit includes: 1 - Reusable Inspiratory Bacteria Filter 1 - Reusable Exhalation Bacteria Filter 2 - Water Traps 2 - Coupling, Straight Silicone 1003058 Reusable Patient Circuit Kit, Pediatric Kit includes: 1 - Reusable Inspiratory Bacteria Filter 1 - Reusable Exhalation Bacteria Filter 2 - Water Traps 2 - Coupling, Straight Silicone 1003059 Reusable Vial System, Water Collection 1021884 1003847 1002970 1003648 500-1000-43 1003847 1002970 1003648 500-1000-43 Disposable Items Disposable Exhalation Bacteria Filter (pkg of 12) 1002240 Disposable Inspiratory Bacteria Filter (Single) 1014047 Disposable Inspiratory Bacteria Filter (pkg of 10) 0342077 Disposable Patient Circuit, Adult Kit includes: 1 - Disposable Inspiratory Bacteria Filter 1 - Disposable Exhalation Bacteria Filter 2 - Coupling, Straight Silicone 1003698a Disposable Vial System, Water Collection 1006241 1014047 1002240 500-1000-43 Documentation Respironics V200 Operator’s Manual CD Respironics V200 Operator’s Manual (included on CD) 1062476 1057983b Respironics V200 Service Manual CD Respironics V200 Operator’s Manual (included on CD) 1062500 580-1000-02 Table 13-1: Options and Accessories (Sheet 2 of 2) a.The part number varies with the country to which the ventilator is delivered. b. The part number varies by language. WARNING: 13-2 The use of accessories, cables, and transducers other than those specified may result in increased EM emissions or decreased immunity of the system. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Oxygen Sensor Option The optional Oxygen sensor (O2 sensor) may be installed to allow monitoring of delivered O2 to the inspiratory limb of the patient circuit. The ventilator will accept the MSA MiniOX® O2 and Analytical Industries Inc. sensors, P/N 1001454. Figure 13-1: O2 Sensor exploded view Assemble O2 Sensor Refer to Figure 13-1 for the following instructions. MSA MiniOX O2 1. Remove the O2 sensor (a) from the package. Discard the o-ring and adapter (not shown) provided with the sensor. 2. Place flat gasket (b) into the threaded hole of the O2 Sensor Tee (c). 3. Screw the O2 sensor (b) into the O2 sensor tee (c). 4. Insert one end of the O2 sensor cord (d) into ventilator. Insert other end of O2 sensor cord (d) into the sensor. Fasten each end with knurled collars. Analytical Industries Inc. 1. Remove the O2 sensor (a) from the package. 2. Screw the O2 sensor (b) into the O2 sensor tee (c). 3. Insert one end of the O2 sensor cord (d) into ventilator. Insert other end of O2 sensor cord (d) into the sensor. Fasten each end with knurled collars. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-3 Chapter 13 Options and Accessories Attaching the Sensor to the Ventilator The O2 sensor attaches to the gas outlet port located below the front panel on the ventilator’s lower right corner. Figure 13-2: O2 Sensor Orientation 1. Rotate the sensor assembly so that the sensor is pointing up. 5 4 3 5 4 3 2 2 1 1 Flow Figure 13-3: Connecting O2 Sensor and Patient Circuit 2. Connect the T-fitting (2) to the gas outlet port (1). 3. Insert the inspiratory bacteria filter (4) into the T-fitting (2) using the 22mm connector (3) if necessary. Some bacteria filters provide an arrow or other mark to indicate the direction of flow. The flow indicator should be pointed away from the ventilator, toward the patient circuit connection. CAUTION: 13-4 To prevent contamination of the O2 sensor, always locate it between the ventilator gas output port and the inspiratory bacteria filter. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 4. Connect inspiratory limb of patient circuit (5) to bacteria filter (4). 5. Ensure that all connections are tight. Warranty NOTE: Record O2 sensor manufacturing or warranty numbers and installation date for future reference. NOTE: To ensure accurate O2 monitoring, check O2 sensors periodically and replace as per manufacturer specification. NOTE: Sensor performance and expected operating life information is outlined in the sensor manufacturer’s instructions for use. Thoroughly review all O2 sensor instructions prior to installation and use with the ventilator. NOTE: O2 sensor calibration is performed during EST. If recalibration of the O2 sensor is required, follow the instructions for “Extended Self Test (EST)” in Chapter 11. Respironics warrants the O2 sensor to be free from defects in material and workmanship for a period of one year from the date of purchase, provided that the unit is operated under conditions of normal use as described in this operator’s manual. At its discretion, Respironics will make replacements, repairs, or issue credits for equipment or parts that are found to be defective. O2 Sensor Tee The External Oxygen Sensor Adapters (P/Ns 8-100498 and 1020380) are also referred to as O2 Sensor Tees. The PVC adapter is gray, the Ultem® is clear with an amber tint, and both are compatible with the MSA and Analytical Industries External Oxygen Sensors. Both tees are compatible with all ventilators. Both tees have 22mm female/male connections; therefore the 22mm malemale adapter (P/N 1002505) is not needed when using this adapter. CAUTION: PVC O2 (P/N 8-100498-00) and Ultem® (P/N 1020380) Sensor Tees cannot be autoclaved or chemically disinfected. 8-100498-00 PVC (Gray) 1020380 Ultem® (Clear) Figure 13-4: Sensor Tee REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-5 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A External Battery Option The V200 External Battery is designed for use with a Respironics V200 Ventilator equipped with a backup battery. External battery Figure 13-5: Ventilator with External Battery Installed REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-7 Chapter 13 Options and Accessories Installation Contact Respironics Customer Service at 1-800-345-6443 to arrange installation or refer to the installation section of the Ventilator External Battery Service Instructions (1013569). WARNING: Power Consumption Sequence Do not lift the external battery. If the battery needs to be removed from the cart, contact Respironics Customer Service at 1-800-345-6443. When AC power becomes unavailable, the ventilator consumes power from the battery systems as follows: • With the external battery installed and turned ON and backup battery installed: External battery power is consumed first until depleted. Backup battery power is then used until depleted. An audible alarm sounds when the backup battery is in use. The ventilator will not operate when both batteries are depleted. • With backup battery installed only: Backup battery power is used until depleted. An audible alarm sounds when the backup battery is in use. The ventilator will not operate when the battery is depleted. AC power can be restored to the ventilator at any time during battery use. When AC power is restored the ventilator consumes AC power only, and both batteries begin recharging. (See “Battery Charging” on page 13-10). External Battery/ Backup Battery Operation The external battery must be turned ON in order for the external battery to be used. Make sure the ON/OFF switch located on the external battery (Figure 136) is in the ON (I) position. When AC power becomes unavailable, the ventilator automatically switches to external battery operation without interruption in ventilation. When the external battery is depleted, the ventilator automatically switches to backup battery power. 13-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories On/Off switch Figure 13-6: External Battery On/Off Switch WARNING: The external battery ON/OFF switch must be in the ON (I) position to ensure operation during a power failure. When this switch is in the OFF (O) position, the external battery is disabled. Switch off ONLY when connecting or disconnecting cables or when the ventilator or external battery is in storage for more than 2 weeks and is not connected to AC power. When the external battery is in use, the External Battery indicator ( ) is continuously illuminated. If the ventilator switches to backup battery operation, the In Use (text version of the front panel) or (symbol version of the front panel) indicator illuminates, and the ventilator sounds an audible alarm every 60 seconds (the alarm cannot be reset or silenced). When approximately five minutes of backup battery power remains, the ventilator sounds a high urgency audible alarm (a repeating sequence of five tones) that cannot be reset, and the red Low (text version of the front panel) or ( ) (symbol version of the front panel) and Alarm High indicators flash. WARNING: REF 1057983 A When the ventilator Battery Low indicator flashes red, less than five minutes of battery power remains. Immediately connect AC power or provide an alternate source of ventilation. Respironics V200 Ventilator Operator’s Manual 13-9 Chapter 13 Options and Accessories Battery Capacity The external battery is used with the backup battery. Under optimal running conditions, both batteries together can operate the ventilator for up to four hours. However, ventilator power consumption varies according to environmental conditions and ventilator settings. Battery capacity varies with the age and charge level of the battery. The external battery should be kept fully charged to ensure maximum capacity when needed. CAUTION: Battery Charging Battery operating life depends on battery age and number of discharges and recharges. Over time the battery degenerates and provides less operating time per charge than a fully-charged new battery. Use a Respironics External Battery P/N 1059955 only. The external battery is designed to be recharged only as described here. Do not use any other method to recharge the battery. In order for the external battery to charge, the system must be connected to a viable AC power source. The ventilator can be operating or in standby mode. A new external battery fully charges within 15 hours. The time required to recharge depends on the original charge level of the battery. When the external battery is connected to a functioning AC power source, the MAINS indicator located on the front of the ventilator is lit and the green AC indicator on the external battery is lit (Figure 13-7). The yellow “Battery Charging” indicator on the external battery has the following indication modes: • Continuous ON - Battery is in deep charge mode • Flashing - Battery is approaching full charge • Off-Battery is fully charged AC indicator Battery charging indicator Figure 13-7: External Battery Indicator Lights If the external battery does not reach full charge within 15 hours, contact Respironics Customer Service at 1-800-345-6443. 13-10 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Testing Battery Specifications CAUTION: The External Battery is designed to recharge only as described here. Do not use any other method to recharge the External Battery. CAUTION: If the ventilator is expected to be stored for more than 2 weeks, the external battery ON/OFF switch should be set to the OFF (O) position to avoid discharging the external battery. This switch must be placed in the ON (I) position when the ventilator is removed from storage and returned to use. The external battery should be tested during the regular preventative maintenance cycle of the ventilator or as required by your institutional procedures. Perform the External Battery Verification Procedure included in the External Battery Service Instructions (1013569). Part Number: 1059955 Model: V200 External Battery Type: Lead Acid* Output: 24 V, 33AH Class: 1 Recharge Time: ~ 15 hours Charge Hold: ~ 14 days at 20 C Storage Conditions: -20 C to 60 C at 10%-95% relative humidity *Batteries are considered hazardous waste and must be disposed of according to local regulations. It is unlawful to dispose of these batteries except through a regionally approved recycling center. For additional information, contact Respironics Customer Service at 1-800-345-6443. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-11 Chapter 13 Options and Accessories Warranty Respironics warrants the Respironics V200 external battery to be free from defects in material and workmanship for a period of twelve months from the date of installation, provided that the unit is operated under conditions of normal use as described in this operator’s manual. At its discretion, Respironics will make replacements, repairs, or issue credits for equipment or parts that are found to be defective. This warranty does not apply to any unit or individual parts which have been repaired or altered in any way that, in Respironics judgment, affect its ability or reliability, or which has been subjected to misuse, negligence, abuse, or accident. Unauthorized service and/or failure to perform periodic maintenance may void this warranty. This warranty does not cover damage that may occur in shipment. This warranty takes precedence over all other warranties, expressed or implied. This warranty also takes precedence over all other obligations or liabilities on the part of Respironics including, but not limited to, contingent or consequential damages, such as costs of repairing or replacing other property which may be damaged as a direct result of Respironics V200 Ventilator operation. This warranty, and the rights and obligations described herein, is construed under and governed by the laws of the State of California, U.S.A. 13-12 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Oxygen Manifold Option The oxygen manifold allows two O2 cylinders and one wall oxygen supply line to be used as inputs to the ventilator. Each of the three inlets has a checkvalve that prevents pressure loss when disconnecting from the wall or cylinders. This allows quick, easy transfer between oxygen supplies without interruption of flow. Easy transfer of oxygen supply facilitates patient transport within the facility and allows replacement of one cylinder while operating from the other. Figure 13-8: Oxygen Manifold Assembly Kit Contents REF 1057983 A • (1) Oxygen Manifold Assembly • (1) Oxygen Manifold Bracket with Grommet • (2) 24-inch Medical Hose Assemblies - Oxygen • (1) 4.0mm Allen wrench • (2) M6 x 10mm BUTTON HEAD SCREWS, SOC CAP Respironics V200 Ventilator Operator’s Manual 13-13 Chapter 13 Options and Accessories Assembly Instructions WARNING: The Oxygen Manifold is for oxygen use only. WARNING: Maximum inlet pressure: 90 PSIG Minimum inlet pressure: 50 PSIG at 200 SLPM WARNING: Keep all hoses within the limits of the ventilator footprint to prevent a tripping or snag hazard. CAUTION: Use this kit with the Respironics V200 Ventilator only. CAUTION: Do not use the oxygen manifold or oxygen hoses to move the ventilator. 1. Lock the front wheels of the ventilator. Figure 13-9: Locking Ventilator Wheel 13-14 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 2. Attach the oxygen manifold assembly to the ventilator by threading the adapter fitting onto the oxygen inlet elbow fitting. Using the manifold for leverage, rotate the oxygen inlet elbow fitting until the manifold assembly is vertical, as shown in Figure 13-10. nifold5 en Ma0441 OxygP/N 10 Exprit ly Kit -Use With r On For ntilato Ve TION y CAU n Onl IRO RESP S NIC ® R e: E ge ND Rang Oxy Use Pressure0 SLPM O2 CYLI 20 ing at at Oper-90 PSIC ECTION NN 50 L CO WAL O2 CYLINDER Figure 13-10: Ventilator With Oxygen Manifold REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-15 Chapter 13 Options and Accessories 3. Position the manifold support bracket so that the Wall O2 connection of the manifold fits snugly into the manifold support bracket grommet. Using the Allen wrench, attach the bracket to the cart using the two M6 x 10mm screws. ld nifo n Ma 4415 100 Oxyge P/N Exprit Kit -Use WithOnly For tilator Ven N ® RES PIR ONICS IO ly CAUT en On e: ER ND Rang Oxyg Use Pressure SLPM O2 CYLI ting at 200 Opera90 PSIC ECTION 50CONN WALL ER O2 CYLIND Wall O2 connection Figure 13-11: Attaching Manifold Support Bracket 4. If you will be using O2 cylinders, connect either or both of the oxygen hoses from the O2 cylinders to the left and right inlets of the oxygen manifold assembly. These inlets are marked "O2 Cylinder". Figure 13-12: Completed Manifold Assembly 13-16 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 5. When using oxygen from a wall supply, attach a wall oxygen hose (not included) to the center inlet of the oxygen manifold assembly. Replacement Parts: Using the Manifold The following replacement parts can be ordered from Respironics: • Check Valve Assembly (PN 1007190) • 24-inch Medical Hose Assemblies - Oxygen (PN 1006655) • Bracket and Hardware Kit (PN 1062294) To Use Wall Supply Oxygen Connect the wall oxygen supply to the manifold. Close the O2 cylinder valves. Oxygen is delivered to the ventilator from all sources that are active. Therefore, if the O2 cylinder valves are open while oxygen is being delivered from the wall supply, the cylinders can be depleted of oxygen. To avoid depleting the O2 cylinders, shut off the cylinder valves when using the wall oxygen supply. WARNING: If using wall oxygen supply, close the O2 cylinder valves to avoid depleting the cylinders. To Use O2 Cylinders Open the O2 cylinder valves and disconnect the wall oxygen supply. Transport Use When preparing for intra-facility transport use, first open the O2 cylinder valves and then disconnect the wall oxygen supply. When transport is complete, reconnect the wall oxygen supply and then close the O2 cylinder valves. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-17 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-18 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Graphics The Graphics software enhances the display screens with graphical data of the patient’s flow, pressure, and volume. The Graphics software offers a choice of screens: • The Waveform screen displays two windows displaying pressure, flow, or volume within a specified time scale. • The Loops screen displays three windows: a waveform window (pressure, flow, or volume), a flow/volume loop window, and a pressure/volume loop window. Graphics is available in all ventilation types. Starting Graphics To enter the graphics screens, press the Graphics icon button in the lower right corner of the screen (Figure 13-13). Figure 13-13: VCV Settings Screen and the Graphics Icon Button Using Graphics Press the WAVEFORMS button to view two waveforms, or press the LOOPS button to view one waveform and two loops (Figure 13-14 shows a Waveforms screen). 1. For each waveform, press the FLOW, PRESSURE, or VOLUME button. 2. Press the 7 sec, 14 sec, or 21 sec button to select the waveforms time scale. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-19 Chapter 13 Options and Accessories Figure 13-14: Waveform Screens Replotting and Scrolling Rescaling the Display You can select one of two plotting methods for waveforms: • Replotting selects a waveform that is drawn from left to right, then clears and restarts from the left edge (similar to an oscilloscope). • Scrolling selects a waveform that is drawn from left to right, then continuously shifts to the left to display the most recent data at the right edge of the screen (similar to a stripchart). Press RESCALE (Figure 13-15) to allow software to adjust the vertical scales for waveforms and vertical and horizontal scales for loops. Rescaling is available for waveforms and loops, in normal and during Freeze operation. For optimum viewing, press RESCALE at the end of exhalation. Rescale button Figure 13-15: Rescale Button 13-20 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Figure 13-16 shows waveforms before and after rescaling. (a) BEFORE Rescale (b) AFTER Rescale Figure 13-16: Waveforms Screen (a) Before and (b) After Rescale Follow these steps to change scales manually: 1. Touch the upper or lower portion of the scale you want to change. 2. Press the INCREASE or DECREASE bar or turn the knob to adjust the scale range. 3. Press ACCEPT (onscreen button or offscreen key). Figure 13-17 shows an example of how to adjust an upper scale limit. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-21 Chapter 13 Options and Accessories Press the INCREASE or DECREASE bar or turn knob to adjust scale range Upper portion of Scale Lower portion of Scale Figure 13-17: Manually Adjusting a Scale Freeze Feature The FREEZE button (Figure 13-18) pauses the Waveforms or Loops windows for extended viewing when the waveform window is full. Freeze button Figure 13-18: Freeze Button Once the Freeze feature is in effect, each graphics window shows numeric data for the cursor position on the waveform display. To adjust the cursor position (and select which breath appears on the loops windows) and view the exact flow/pressure and volume at different points of each breath, press the arrow button or turn the knob. Press the CONTINUE button to unfreeze graphics. Figure 13-19 shows a frozen Loops display. 13-22 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Cursor position selects waveform and position (and corresponding points on loops) Use arrow buttons or knob to set cursor position. Continue button unfreeze graphics Figure 13-19: Frozen Loops Display with Numeric Data Windows Save and Overlay Features Follow these steps to save a frozen loop for later reference against future data (for example, before and after bronchodilator therapy): 1. Press the FREEZE button to save the Loops screen. 2. Use the arrow buttons or knob to select a breath. 3. Press the SAVE button. 4. Press CONTINUE to unfreeze the screen. 5. Press the OVERLAY button to superimpose a gray image of the saved loop on the current display (the Overlay feature works on frozen or unfrozen displays). 6. Press the SINGLE VIEW button to view current graphics without the saved loops. Figure 13-20 illustrates the Overlay feature REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-23 Chapter 13 Options and Accessories SAVE button OVERLAY icon button SINGLE VIEW icon button Figure 13-20: Loops Display with Overlay Feature Active Inspiratory Area The Loops screen includes a window for the inspiratory area (Figure 13-21F). This window displays a numeric value that represents the ventilator imposed work of breathing, and is only calculated and displayed for a frozen loop. If the ventilator is supporting the entire breath, the Insp Area window displays “0.000”. If the Insp Area window shows dashes (“– – – –”), the ventilator is not calculating inspiratory area because the loops are not frozen. Dashes indicate Inspiratory are not calculated (loop not frozen) Figure 13-21: Loops Screen with Inspiratory Area Window 13-24 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Alarms During Graphics If an alarm occurs during Graphics, an Alerts window (Figure 13-22) lists the active alarms. Figure 13-22: Graphics Screen with Alerts window REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-25 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-26 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Communications Option (Com1) The Communications option allows the Respironics V200 Ventilator to: • Print out the ventilator's screen contents. • Communicate with a Philips/Agilent/HP VueLink module. • Connect another device, such as a chart recorder, via the analog output port. Using the Communications option does not affect ventilation or monitoring. The Communications option button (a printer icon) is displayed in the lower right corner of the screen (Figure 13-23). The printer icon is gray if the Communications option is not installed, not available, or a print is in progress. Figure 13-23: Communications-Print Option Button (Printer Icon) Print Screen The Communications-Print option allows the ventilator to print out the screen contents to an attached printer. The printer must be connected to the ventilator’s parallel port and use PCL3 or PCL5 printer language. Connecting to a Printer Figure 13-24 shows how to connect a ventilator to a printer. Use a standard 25-pin parallel printer cable to connect the ventilator to the printer. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-27 Chapter 13 Options and Accessories Parallel Printer Port Ventilator (Back Panel) Parallel Printer Cable Figure 13-24: Connecting the Ventilator to a Printer Printing a Screen To print a screen, touch the printer icon in the lower right corner of the screen. While the ventilator processes the print screen request, the screen freezes (typical freeze time of 30-60 seconds, depending on ventilator settings) and the printer icon turns gray. Ventilation and monitoring continue uninterrupted although the screen does not update during this time. Certain screens and popup menus cover the printer icon and are not available for printing. The print screen function is also not available any other time the printer icon is gray. Canceling a Print Screen Request To cancel a print screen request (e.g. during an alarm), touch the frozen screen at any location. Any contact with the touch screen (including the gray printer icon) while the printer icon is gray cancels the print in progress. Print Screen Messages Table 13-2 summarizes print screen messages that can occur. The actual message displayed depends on the connected printer. For example, if a printer turns itself offline when it is out of paper, the error message may indicate that the printer is offline rather than out of paper. 13-28 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Message Corrective action Print aborted: Printer paper empty Load paper and retry print screen. Print aborted: Printer offline Check printer, cycle power to printer, retry print screen. Print aborted: Printer error Check printer, retry print screen if printer is busy, cycle power to printer. Print canceled: Touching the screen while a print is in progress will cancel the Print. Avoid touching the screen while the printer icon is dimmed unless intending to cancel the print in progress. Print unavailable: Print in progress None required: retry print screen when current print is complete. Table 13-2: Print Screen Messages and Corrective Actions VueLink Compatibility The Communications option allows the ventilator to communicate with a Philips/Agilent/HP Component Monitoring System (CMS) via the VueLink module M1032A #A02. Once the ventilator and VueLink module are connected, the VueLink module automatically updates the monitor's screen to display ventilator parameters, provided the CMS is configured for an Open Interface device. For more information on configuring, see "Configuring the VueLink Module". Displayed parameters are determined by the ventilation mode selected on the ventilator. Any time the mode of ventilation is changed, the CMS will revert to the Standard Parameter Interface (SPI) screen. Pressing the button on the VueLink Module will then activate the CMS screen with more ventilator information. If any alarms are active, alarm messages are also displayed. The CMS can only display one patient alarm and one ventilator alarm (called an inop on the CMS) at a time. Alarms are listed in order of priority as defined by the ventilator. Data displayed on the VueLink system is for reference purposes only. Decisions for patient care should not be based solely on the data displayed on the VueLink system. Connecting to the VueLink Module The Communications option enables the ventilator to connect to a VueLink module, using: • a VueLink cable (Respironics part number 1006912). • a VueLink module M1032A #A02 (for connection to devices using the open device driver; contact Philips sales representative for ordering information). Figure 13-25 shows how to connect a ventilator to a VueLink module. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-29 Chapter 13 Options and Accessories RS-232 Serial Port Analog Port CMS Ventilator (Back Panel) VueLink cable VueLink module Figure 13-25: Connecting a Ventilator to a VueLink Module Configuring the VueLink Module A VueLink Ventilator Module M1032A #A02, is required for communication with the ventilator. The VueLink Module can communicate to three different protocols for external devices: VueLink Interface, Analog Interface, or VueLink Open Interface. The ventilator uses the VueLink Open Interface. Refer to the VueLink Handbook provided with the VueLink module for configuration directions for an Open Interface device. For reference purposes only, below are configuration directions from the "Agilent M1032A VueLink Module Handbook", Fourth Edition, 08/2000. Configuration Overview The VueLink Module must be configured during installation. Additional configuration will be required whenever a new device driver is preselected for availability in Monitoring Mode. The VueLink Module can be configured for up to three preselected device drivers. Changing modes The CMS must be in Configuration Mode to preselect devices. To do this, follow the steps below. 1. Turn on the ventilator in ventilation mode and connect it to a VueLink Module as shown in Figure 13-23. 13-30 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 2. Press "Monitor Setup" on a Standard Control Panel, or "Instrument Config." on a Classic Control Panel of the Component Monitoring System (CMS). 3. Highlight "Operating Modes" on the displayed window and press "Confirm". The current operating mode will appear in the task window (for example, "Operating Mode - Monitoring") along with a prompt for the password. 4. Enter the password, 1245. If the password is entered correctly, the "Change OpMode" key will be highlighted. 5. Press "Change OpMode" and select "Config" or "Monitor". 6. Press "Confirm". a. If "Config" was selected in step 5, the display will become blank and the message "Config mode active - NO MONITORING!" will appear at the top of the screen. Continue with the "Preselecting Devices" section below. b. If "Monitor" was selected in step 5, the VueLink system will begin to display data. Make sure that the LED next to "Open Device" is lit while in Monitoring mode to display ventilator data. If it is not lit, press the button on the VueLink Module, select "Open Interface" and press confirm. Pressing the button on the VueLink Module will then display the Standard Parameter Interface (SPI) screen. Pressing the VueLink Module button a second time will activate the ventilator screen with more information. Preselecting Devices Once in Configuration Mode, the Open device must be selected as one of the three preselected devices for the VueLink Ventilator Module. To do this, follow the steps below. 1. Press "Module Setup" or "Module Config" on the CMS. 2. Highlight "VENTILTR", "OPEN INTRFACE", OR "ESPRIT VENT" and press "Confirm". 3. Note: Only one of the above choices will be available at a time. The choice depends on how the module is already configured. 4. Verify "Prefer'd Module" is set to "Ventiltr" and choose whether device alarms should be Accepted or Ignored. Press "Module Config". 5. Highlight "Open Interface M1032-TU1AA" by using the arrow keys or pressing "Next Device". 6. Press "On/Off Preselect" if "On" is not already displayed beside this item. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-31 Chapter 13 Options and Accessories NOTE: If "On/Off Preselect" is pressed a second time, the preselection is switched off. NOTE: If there are already three devices preselected, one of the preselected devices must be turned "off" before adding a new one. 7. Press "Store Preselect", then "Confirm". 8. Attach the adhesive label containing "Open Device" to the VueLink module. The adhesive labels MUST be placed on the module in the same order as they appear in the Preselection Task Window. 9. When the above steps have been completed, change the CMS to Monitoring mode (see "Changing Modes"). For more information about the VueLink module, refer to the VueLink Module Handbook. Information Sent to the VueLink System Once the CMS detects that the ventilator is connected to the module, the CMS automatically displays ventilator parameters. The active type of ventilation determines what data the CMS displays. Table Figure 13-24 defines CMS displays and equivalent Respironics V200 Ventilator information. Available CMS on message CareNet V200 equivalent Comments Volume control ventilation (VCV) parameters Mode and type of ventilation will always be displayed. X AWF Flow Delivered flow. X AWP Pressure Delivered pressure. AWV Volume Delivered volume. sPSV set PSV Set pressure support ventilation. X X 13-32 sPEEP set PEEP Set positive end expiratory pressure. PIP PIP Measured peak inspiratory pressure. MnAwP MAP Measured mean airway pressure. Pplat Pi End Measured end inspiratory (plateau) pressure. PEEP Pe End Measured positive end expiratory pressure. SpMV Spont VE Measured spontaneous minute volume. sTV set TV Set tidal volume. MV VE Measured minute volume. PtLeak Pt Leak Estimated patient leak. TV Vt Measured tidal volume. sFIO_2 set %O2 Set oxygen percentage (fractional inspired oxygen). Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Available CMS on message CareNet X X V200 equivalent Comments FIO_2 %O2 Measured oxygen percentage (fractional inspired oxygen). sPkFl set Peak Flow Set peak flow. RiseTi Rise Time Set rise time. sAWRR set Rate Set (airway) respiratory rate. SpAWRR Spont Rate Measured spontaneous respiratory rate. AWRR Rate Measured (airway) respiratory rate. F/TV F/Vt Ratio of frequency to tidal volume (rapid shallow breathing index). Pressure control ventilation (PCV) parameters Mode and type of ventilation will always be displayed. X AWF Flow Delivered flow. X AWP Pressure Delivered pressure. AWV Volume Delivered volume. sPSV set PSV Set pressure support ventilation. sPEEP set PEEP Set positive end expiratory pressure. PIP PIP Measured peak inspiratory pressure. MnAwP MAP Measured mean airway pressure. Pplat Pi End Measured end inspiratory (plateau) pressure. PEEP Pe End Measured positive end expiratory pressure. sPVcP set pressure Set PCV pressure. SpMV Spont VE Measured spontaneous minute volume. MV VE Measured minute volume. PtLeak Pt Leak Estimated patient leak. TV Vt Measured tidal volume. sFIO_2 set %O2 Set oxygen percentage (fractional inspired oxygen). FIO_2 %O2 Measured oxygen percentage (fractional inspired oxygen). sInsTi set I-Time Set inspiratory time. RiseTi Rise Time Set rise time. sAWRR set Rate Set (airway) respiratory rate. SpAWRR Spont Rate Measured spontaneous respiratory rate. AWRR Rate Measured (airway) respiratory rate. F/TV F/Vt Ratio of frequency to tidal volume (rapid shallow breathing index). X X X X Noninvasive positive pressure ventilation (NPPV) parameters Mode and type of ventilation will always be displayed. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-33 Chapter 13 Options and Accessories Available CMS on message CareNet V200 equivalent Comments X AWF Flow Delivered flow. X AWP Pressure Delivered pressure. AWV Volume Delivered volume. sIPAP set IPAP Set inspiratory positive airway pressure. sEPAP set EPAP Set expiratory positive airway pressure. PIP PIP Measured peak inspiratory pressure. MnAwP MAP Measured mean airway pressure. Pplat Pi End Measured end inspiratory (plateau) pressure. SpMV Spont VE Measured spontaneous minute volume. MV VE Measured minute volume. PtLeak Pt Leak Estimated patient leak. X TV Vt Measured tidal volume. sFIO_2 set %O2 Set oxygen percentage (fractional inspired oxygen). X FIO_2 %O2 Measured oxygen percentage (fractional inspired oxygen). sInsTi set I-Time Set inspiratory time. RiseTi Rise Time Set rise time. sAWRR set Rate Set (airway) respiratory rate. SpAWRR Spont Rate Measured spontaneous respiratory rate. AWRR Rate Measured (airway) respiratory rate. F/TV F/Vt Ratio of frequency to tidal volume (rapid shallow breathing index). X OCCL/ Disconnec t Occlusion - SV Open/SM Occlusion/ Disconnect Occlusion, safety valve open. SM occlusion, disconnect. Red Alarm. X APNEA Apnea Apnea detected. Red Alarm. X LOW INSP PRESS Low Insp. Pressure Low inspiratory pressure limit violation. Red Alarm. X LOW O2 SUPPLY Low O2 Supply Oxygen supply below acceptable level. Red Alarm. X HIGH INSP PRESS High Pressure High pressure limit violation. Yellow Alarm. X LOW O2% Low O2 Low measured oxygen concentration. Yellow Alarm. X LOW EXH MV Low exhaled minute volume. Yellow Alarm. X X Alarms 13-34 Low Minute Volume Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Available CMS on message CareNet V200 equivalent Comments X HIGH LEAK RATE High Leak Rate High leak alarm limit violation. Yellow Alarm. X LOW EXH MAND TV Low Vt Mandatory Low mandatory tidal volume limit violation. Yellow Alarm. X HIGH EXH MV High Minute Volume High exhaled minute volume limit violation. Yellow Alarm. X LOW EXH TV Low Tidal Volume Low exhaled tidal volume limit violation. Yellow Alarm. X LOW EXH TV-SPNT Low Vt Spontaneous Low spontaneous tidal volume limit violation. Yellow Alarm. X INS TI TOO LONG I-Time Too Long Maximum inspiratory time exceeded. Yellow Alarm. X HIGH RESP RATE High Respiratory Rate High respiratory rate limit violation. Yellow Alarm. X HIGH O2% High O2 High measured oxygen concentration. Yellow Alarm. X LOW PEEP/ EPAP Low PEEP Low PEEP limit violation. Yellow Alarm. X LOW PEEP/ EPAP Low EPAP Low EPAP limit violation. Yellow Alarm. X BACKUP BATT ON Battery In Use indicator on ventilator front panel Ventilator has switched from AC power to Backup Battery operation. Yellow Alarm. X LOSS OF GAS-SVO Gas Supplies Lost-SVO Oxygen and air sources lost, safety valve open. X LOW BACKUP BATT Low Backup Battery Low Backup Battery voltage. X ALARM FAILURE Audible Alarm Failed Audible alarm failure. X AIR FAULT Air Source Fault Internal air source failure. X O2 VALVE STUCK O2 Valve Stuck Closed Defective oxygen valve. X EXH VALVE STUCK Exp Valve Stuck Open Defective exhalation valve. Inops REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-35 Chapter 13 Options and Accessories Available CMS on message CareNet V200 equivalent Comments X HIGH INT TEMP High Temperature Temperature within ventilator enclosure exceeds maximum limit. X HIGH INT O2% High Internal O2 Oxygen concentration within ventilator enclosure exceeds maximum limit. NOTE: The following alarm messages are not displayed on the CMS: Analog Output (Chart Recorder) Bad ADCWrap Sensor ERROR Bad Bat Volt Sensor Service Due Bad Int O2 Sensor Using Default Altitude Bad Int Temp Sensor Using Default Compl Battery Charging Using Default Settings The Communications-Print option enables the ventilator to send ventilator data to a chart recorder or similar device using the analog output port. Data displayed via the chart recorder is for reference purposes only. Decisions for patient care should not be based solely on the data displayed via the chart recorder. Table 13-3 summarizes the Analog Output pinout. Respironics V200 Ventilator Analog Output Port Pinout Pin Number 13-36 Signal 1 Flow signal return 2 Volume signal return 3 Pressure signal return 4 Alarm signal return 5 Nebulizer signal return 9 Flow (0 V = -200 LPM, 5 V = 200 LPM) 10 Volume (0 V = 0 ml, 5 V = 2500 ml) 11 Pressure (0 V = -20 cmH2O, 5 V = 120 cmH2O) 12 Alarm (0 V = active alarm, 1.5 V = no alarm or silenced alarm) Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Respironics V200 Ventilator Analog Output Port Pinout 13 Nebulizer (0 V = exhalation phase, 5 V = inhalation or plateau phase) 14 No data 15 No data NOTE: All analog outputs = 0 V at power up. Voltages have a linear relationship to the corresponding values. For example, 2.5 V on pin 9 = 0 LPM, 2.5 V on pin 11 = 70 cmH2O. NOTE: The resolution of the analog output is 0 to 5 V in 256 increments. Table 13-3: Ventilator Analog Output Port Pinout REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-37 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-38 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories RS-232 Communications Option 2 (Com2) The Respironics V200 Ventilator allows the transmission of data from the ventilator to the RS-232 communications interface. The Com2 option allows the ventilator to communicate with data systems The ventilator has two communications options, Com1 and Com2, which work exclusively of one another. RS-232 Configuration WARNING: It is the responsibility of the end user to validate the compatibility and use of information transmitted from the ventilator with the device to be connected to the ventilator. WARNING: The data provided via the Com2 option is for reference only. Decisions for patient care should be based on the clinician’s observations of the patient. When the Com2 option is installed, the RS-232 communications port is configured for all communications functions in the following manner: • Baud Rate 9,600 • Data Bits 8 • Parity None • Stop Bits 1 NOTE: In diagnostics mode, with Com2 installed, the baud rate is 19,200. To properly use the Com2 option, connect the communications cable to the 9-pin serial connection on the back of the ventilator. Serial Port Connection Figure 13-26: 9-pin serial port connection REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-39 Chapter 13 Options and Accessories Commands Transmitted to the Ventilator Commands are transmitted as a series of four ASCII characters followed by a carriage return. Valid commands will be stored and response transmissions will be sent in the order the corresponding commands were received. Transmission of Data from the Ventilator Unless stated otherwise, all fields will be left justified and six (6) characters in length. A comma will separate each field, except for the field following the start code. Each data transmission shall be terminated with a carriage return. In the following subparagraphs, a space is designated as “◆”. When data is unavailable, the output field shall contain “◆◆◆◆◆◆” SNDA , Send Variable Length Ventilator Settings Report When the ventilator receives SNDA followed by a carriage return, it will respond by transmitting the information shown in Table 13-4: “Ventilation Report”. The ventilator responds to the SNDA command by returning a string with a variable length. The second and third fields define the length of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of fields between the start and stop codes. The fourth field is the start code, 02H. The last field in the string is the stop code, 03H, indicating the end of the message. NOTE: The SNDA command is only available in Normal mode. Ventilation Report Description Example Resolution Range Units Comments Command Name MISCA N/A N/A N/A 5 character field Number of characters between the start and stop codes 706 N/A N/A N/A 3 character field Number of fields between the start and stop codes 97 N/A N/A N/A 2 character field Start Code 0x02 N/A N/A N/A ASCII Start Transmission Character (STX) Time of request 13:45 N/A N/A N/A 24 hour clock, hh:mm N/A N/A N/A 18 character field. Outputs example value. Not used Table 13-4: Ventilation Report (Sheet 1 of 10) 13-40 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Ventilation Report Description Example Not used Resolution Range Units Comments N/A N/A N/A Outputs example value. Date FEB 23 1997 N/A N/A N/A 12 character field, MMM DD YYYY Mode setting CMV N/A CMV SIMV CPAP N/A Assist/Control = CMV, Spont/Timed = SIMV, Spont = CPAP Active Respiratory Rate setting 12.0 0.1 or 1 1.0 – 9.0 10 – 80 BPM Outputs when mode is CPAP or Spont. VCV Tidal Volume setting 0.50 0.01 0.05 – 2.50 L VCV Peak Flow setting 5 1 3 – 140 LPM Oxygen Concentration setting 100 1 21 – 100 % Pressure Trigger setting 0.5 0.1 0.1 – 20.0 cm H2O Outputs value from active type (VCV or PCV). When active type is NPPV then outputs the VCV value. PEEP or EPAP setting 0.0 0.1 0.0 – 35.0 cm H2O Uses PEEP setting from active ventilation type (VCV or PCV). When active type is NPPV uses EPAP setting. VCV Insp. Hold Setting 0.1 0.0 – 2.0 Sec Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. 0.0 VCV Apnea Interval setting 10 1 10 – 60 sec VCV Apnea Tidal Volume setting (same as Tidal Volume setting) 0.50 0.01 0.05 – 2.50 L Outputs VCV Tidal Volume setting Table 13-4: Ventilation Report (Sheet 2 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-41 Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units VCV Apnea Respiratory Rate setting 12.0 0.1 or 1 1.0 – 9.0 10 – 80 BPM Apnea Peak Flow setting (same as Peak Flow setting) 5 1 3 – 140 LPM Outputs VCV Peak Flow setting VCV Apnea Oxygen Concentration setting (same as Oxygen Concentration setting) 21 1 21 – 100 % Outputs Oxygen Concentration setting Pressure Support setting 0 1 0 – 100 cm H2O Outputs value from active ventilation type (VCV or PCV). When active type is NPPV then IPAP – EPAP is used. VCV Flow Pattern setting SQUARE N/A SQUARE, RAMP N/A Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. N/A ON OFF N/A Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. 100% Oxygen setting ON Comments Measured total respiratory rate 0.0 0.1 or 1 0.0 – 9.9 10 - 150 BPM For values greater than 150 output set to 150. Measured tidal volume 1.15 0.01 0.00 – 9.99 L Outputs for values out of range. Measured total minute volume 0.00 0.01 or 1 0.00 – 9.99 10.0 – 99.9 L For values out of range output set to 99.9. Measured spontaneous minute volume 0.00 0.01 or 0.1 0.00 - 9.99 10.0 – 99.9 L Outputs when ventilation mode is A/C. For values out of range output set to 99.9. Table 13-4: Ventilation Report (Sheet 3 of 10) 13-42 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Comments Measured peak inhalation pressure 0.0 0.1 or 1 0.0 – 99.9 100 – 130 cm H2O Outputs when ventilation mode is CPAP or Spont and No Apnea alarm is present. Measured mean airway pressure 0.9 0.1 or 1 0.0 – 99.9 100 - 130 cm H2O Measured end inhalation pressure 7.7 0.1 or 1 0.0 – 99.9 100 – 130 cm H2O Outputs when Ventilation type is PCV or NPPV, or Ventilation mode is CPAP or Spont, or VCV Insp. Hold setting = 0. Measured I:E ratio 0.2 0.1 0.1 – 9.9 10 - 99 N/A Fractional representation of 1:X.X with one (1) decimal place, e.g., 4:1 = 0.3 High Inhalation Pressure Alarm setting 20 1 10 – 105 cm H2O Outputs high inhalation pressure setting for active ventilation type (PCV or VCV) or IPAP + 10 if NPPV is active. Low Inhalation Pressure Alarm setting 3 1 3 – 105 cm H2O Outputs Low Inhalation Pressure setting for active ventilation type. Low PEEP or Low EPAP Alarm setting 0 1 0 – 35 cm H2O Outputs Low PEEP from active type (VCV or PCV). When active type is NPPV uses Low EPAP. Table 13-4: Ventilation Report (Sheet 4 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-43 Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Comments Low Exhaled Mandatory Tidal Volume Alarm setting 0.00 0.01 0.00 – 2.50 L For VCV and PCV types of ventilation, set to Low Exhaled Mandatory Tidal Volume alarm limit (for A/C and Apnea) and Low Exhaled Spontaneous Tidal Volume Alarm limit (for SIMV and CPAP). When active type of ventilation is NPPV uses Low Exhaled Tidal Volume alarm limit. Low Exhaled Minute Volume Alarm setting 0.0 0.1 0.0 – 60.0 L Low Exhaled Minute Volume alarm limit from active type (VCV, PCV, or NPPV). High Respiratory Rate Alarm setting 0 1 0 – 150 BPM High Respiratory Rate from active type (VCV, PCV, or NPPV). N/A NORMAL, RESET ALARM N/A High Inhalation NORMAL Pressure Alarm status Low Inhalation Pressure Alarm status or Disconnect Alarm status RESET N/A NORMAL, RESET ALARM N/A Low PEEP or Low EPAP Alarm status ALARM N/A NORMAL, RESET ALARM N/A Outputs Low PEEP in VCV and PCV, Low EPAP in NPPV Table 13-4: Ventilation Report (Sheet 5 of 10) 13-44 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Comments Low Exhaled Mandatory/ Spontaneous Tidal Volume Alarm status NORMAL N/A NORMAL, RESET ALARM N/A Outputs ALARM when any of the following alarms are active: Low Mandatory Tidal Volume Alarm, or Low Spontaneous Tidal Volume Alarm, or Low Tidal Volume Alarm Outputs RESET when any of the above alarms are reset and none are active. Outputs NORMAL when none of the above alarms are reset or active. Low Exhaled Minute Volume Alarm status NORMAL N/A NORMAL, RESET ALARM N/A High Respiratory Rate Alarm status NORMAL N/A NORMAL, RESET ALARM N/A Low Oxygen Supply NORMAL Pressure Alarm status N/A NORMAL, RESET ALARM N/A Air Source Inoperative Alarm status NORMAL N/A NORMAL, RESET ALARM N/A Low Battery Alarm status NORMAL N/A NORMAL, RESET ALARM N/A Apnea Alarm status NORMAL N/A NORMAL, RESET ALARM N/A Status of Low Backup Battery Alarm Not used N/A N/A Outputs example value. Not used N/A N/A Outputs example value. N/A 24 hour clock, hh:mm same as field 5 N/A Outputs example value. Time Not used 12:45 N/A N/A N/A Table 13-4: Ventilation Report (Sheet 6 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-45 Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Comments Date FEB 23 1997 N/A N/A N/A 12 character field, MMM DD YYYY Static Compliance 0 1 0 - 350 ml/ cm H2O Outputs when Mechanics option is not installed or no maneuver was performed. Static Resistance 0.0 0.1 or 1 0.1 – 99.9 100 – 400 cm H2O/ L/s Outputs when Mechanics option is not installed or no maneuver was performed. Dynamic Compliance 0 1 0 – 350 ml/ cm H2O Outputs when Mechanics option is not installed. Dynamic Resistance 0.0 0.1 or 1 0.1 –99.9 100 – 400 cm H2O/ L/s Outputs when Mechanics option is not installed. Maximum Inhalation Pressure 0 1 0 – 100 cm H2O Outputs when Mechanics option is not installed or no maneuver was performed. Vital Capacity 0.0 0.1 0.1 – 9.9 L Outputs when Mechanics option is not installed or no maneuver was performed. when the value is out of range output is . Peak Lung Flow 0 1 0 - 200 LPM Outputs when Mechanics option is not installed. 1 0 – 23 LPM Outputs 0 when pressure trigger is active, otherwise outputs Flow trigger plus three (3). Bias Flow 20 Table 13-4: Ventilation Report (Sheet 7 of 10) 13-46 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Comments Flow trigger setting 2 1 1 – 20 LPM Outputs Flow trigger setting of active ventilation type. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. Not used N/A N/A N/A Outputs example value. 0.1 or 1 0.0 – 99.9 100 – 130 cm H2O Outputs when Ventilation type is PCV or NPPV, or Ventilation mode is CPAP or Spont, or VCV Insp. Hold setting = 0. 1 5 – 100 cm H2O Output 0 when VCV is active, PCV Pressure when PCV is active, when NPPV is active Measured end inhalation pressure PCV Pressure Setting 20.0 100 Table 13-4: Ventilation Report (Sheet 8 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-47 Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Comments PCV Inhalation Time Setting 0.10 0.01 0.10 – 9.90 sec Outputs PCV Inhalation Time when PCV or VCV is active, NPPV Inhalation Time when NPPV is active PCV or NPPV Apnea Interval Setting 10 1 10 – 60 sec Outputs PCV Apnea Interval when PCV or VCV is active, NPPV Apnea Interval when NPPV is active PCV Apnea Inhalation Pressure Setting or NPPV Apnea IPAP setting 100 1 5 – 100 cm H2O Outputs PCV Pressure setting when VCV or PCV active, IPAP – EPAP when NPPV active PCV Apnea Respiratory Rate Setting or NPPV Apnea Respiratory Rate Setting 12 0.1 or 1 1.0 - 9.9 10 – 80 BPM Outputs PCV Apnea Rate setting when VCV or PCV active, NPPV Apnea rate when NPPV active PCV Apnea Inhalation Time Setting or NPPV Apnea Inhalation Time Setting 2.00 0.01 0.10 – 9.90 sec Outputs PCV Inhalation Time setting when VCV or PCV active, NPPV Inhalation Time when NPPV active 1 21 – 100 % 100 PCV Apnea Oxygen Concentration Setting or NPPV Apnea Oxygen Concentration PCV Apnea High Inhalation Pressure Setting or NPPV Apnea High Inhalation Pressure Setting 20 1 10 – 105 cm H2O Alarm Silence Status ON N/A ON OFF N/A Apnea Alarm Status NORMAL N/A NORMAL, RESET ALARM N/A Outputs PCV High Inhalation Pressure setting when VCV or PCV active, IPAP + 10 when NPPV active Table 13-4: Ventilation Report (Sheet 9 of 10) 13-48 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Ventilation Report Description Example Resolution Range Units Occlusion Alarm Status or SM Occlusion Alarm Status or I-Time Too Long Alarm Status NORMAL N/A NORMAL, RESET ALARM N/A Comments Not used N/A N/A Outputs example value. Not used N/A N/A Outputs example value. Not used N/A N/A Outputs example value. Not used N/A N/A Outputs example value. N/A Outputs example value. Not used I-TIME N/A I-TIME I:E Ratio 1:99 N/A 9.9:1 - 1:99 N/A measured I:E ratio, expressed as 1:X.X, 1:XX, X.X:1, or XX:1. 0x03 N/A N/A ASCII End Transmission Character (ETX) Stop Code N/A Table 13-4: Ventilation Report (Sheet 10 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-49 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-50 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Respiratory Mechanics Option The Respiratory Mechanics option allows the Respironics V200 Ventilator to perform respiratory mechanics maneuvers, including: Accessing Respiratory Mechanics Data • Vital Capacity (VC): The VC maneuver measures the patient’s lung capacity. It is available only in Volume Control Ventilation (VCV) and Pressure Control ventilation (PCV). • Maximum Inspiratory Pressure (MIP): The MIP maneuver measures the maximum negative pressure resulting from the patient’s inspiratory effort. It is available only in VCV and PCV. MIP is also known as negative inspiratory force (NIF). • Occlusion Pressure at 100 ms (P0.1): The P0.1 maneuver measures the pressure change after the first 100 milliseconds (ms) of an inspiratory phase. It is available only in VCV and PCV. This maneuver is also known as P100. • Static Compliance and Resistance (Static C and R): The static C and R maneuver estimates the compliance and resistance of the patient’s lungs. It is available only in VCV. • Plateau Pressure (Pplat) is a measured value collected during the last saved Static C and R maneuver. • The The and and results of maneuvers are displayed graphically and numerically. Respiratory Mechanics option also displays dynamic compliance resistance, inspiratory time divided by total breath time (TI/TTOT), peak lung flow (Peak L-Flow). Touch the Mechanics icon button at the bottom of the screen (Figure 13-27). Figure 13-27: VCV Settings Screen and Mechanics Icon Button REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-51 Chapter 13 Options and Accessories When you touch the Mechanics icon button, the Patient Status screen appears, see Figure 13-28. This screen displays patient data and includes derived lung mechanics results, weaning parameters, ventilator settings, maneuver date and time stamps, and other patient data. It also provides access to the respiratory mechanics maneuvers via the maneuver buttons on the bottom of the screen. Weaning Parameters Ventilator Settings Maneuver Time Stamps Lung Mechanics Other patient data Maneuver Buttons Figure 13-28: Patient Status Screen Vital Capacity Maneuver The Vital Capacity screen (Figure 13-29) allows you to perform a Vital Capacity maneuver and displays the maneuver results graphically and numerically. The Vital Capacity maneuver is available only in VCV and PCV. It is not available in NPPV. How to perform the Vital Capacity Maneuver 1. Enter the Vital Capacity screen: Touch the Mechanics icon button, then the Vital Capacity button. 2. Touch the Start button. Instruct the patient to inhale to maximum capacity at the next inspiration, then exhale completely, followed by a normal inspiration. Once touched, the Start button changes to Stop. The Stop button allows you to cancel the maneuver at any time. A high-priority alarm automatically cancels the maneuver. 13-52 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 3. At the end of a successful maneuver, a pop-up screen displays the result of the maneuver and asks you to accept or reject the results by touching the Accept or Reject button. 4. At the end of the maneuver (whether successful or cancelled), the Stop button changes to Continue. While the Continue button is displayed, the graph is frozen and can be rescaled. Touch Continue or exit the screen to unfreeze the display. 5. Touch Continue: the button changes to Start and you can repeat the maneuver. WARNING: Perform the Vital Capacity maneuver according to instructions. Because machine-assisted breath delivery, apnea detection, and detection of certain patient alarms are temporarily disabled during a Vital Capacity maneuver, close clinical supervision is recommended. WARNING: Because PEEP is temporarily set to 0 cmH2O during a Vital Capacity maneuver, close clinical supervision is recommended. Flow-Volume and Volume-Time buttons Scale button Rescale button Start button Vital Capacity window Time Stamp Figure 13-29: Vital Capacity Screen REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-53 Chapter 13 Options and Accessories Information type Description Flow-Volume or VolumeTime button Flow-Volume: Displays a real-time flow-volume loop. Volume-Time: Displays a real-time volume-time waveform. Start button Starts the maneuver. Changes to Stop when the maneuver is started. Changes to Continue when the maneuver is complete or when the Stop button is touched. Changes to Start when Continue is touched. Vital Capacity window Displays the most recently accepted VC maneuver results. The date and time of the maneuver appear below the window. Scale (button at left of graphic display) Allows you to adjust graphic scales manually. The default scales for the Vital Capacity screen are –1000 to +1500 mL for volume, -100 to +100 LPM for flow. Default scales are in effect every time you enter the Vital Capacity screen. Rescale button Allows software to adjust the vertical scales for waveforms and vertical and horizontal scales for loops. Table 13-5: Summary of Vital Capacity Screen Information MIP/P0.1 Maneuver The MIP/P0.1 screen (Figure 13.J4) allows you to perform a Maximum Inspiratory Pressure (MIP) or occlusion pressure at 100 ms (P0.1) maneuver. It displays the maneuver results graphically and numerically. The MIP maneuver is available only in VCV and PCV. It is not available in NPPV. How to perform an MIP or P0.1 maneuver 1. Enter the MIP/P0.1 screen: touch the Mechanics icon button, then MIP/P0.1. 2. MIP maneuver: hold down the Start MIP Press & Hold button, and instruct the patient to inhale several times as forcefully as possible. The maneuver automatically ends after 30 seconds or when you release the Start MIP Press & Hold button. (The Start MIP Press & Hold button can be pressed and held at any time during a breath. If pressed during the inhalation phase of a breath, the MIP maneuver will be executed during the exhalation phase of that breath. If pressed during an exhalation, the maneuver will be executed during the same exhalation.) P0.1 maneuver: touch the Start P0.1 button. A message above the graphic display shows the results for the just-completed breath. The maneuver automatically ends after four preselected patient-initiated breaths have occurred or one minute has elapsed, whichever comes first. 3. Once touched, either one of the Start buttons changes to Stop. The Stop button allows you to cancel the maneuver at any time. A highpriority alarm also cancels the maneuver. 4. At the end of a successful maneuver, a pop-up screen displays the result of the maneuver and asks you to accept or reject the results by touching the Accept or Reject button. 13-54 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 5. At the end of the maneuver (whether successful or cancelled), the Stop button changes to Continue. While the Continue button is displayed, the graph is frozen and can be rescaled. Touch Continue or exit the screen to unfreeze the display. 6. Touch Continue: the button changes to Start and you can repeat the maneuver. WARNING: Perform the MIP maneuver according to instructions. Because machine assisted breath delivery, apnea detection, and detection of certain patient alarms are temporarily disabled during a MIP maneuver, close clinical supervision is recommended. WARNING: Because PEEP is temporarily set to 0 cmH2O during a MIP maneuver, close clinical supervision is recommended. Scale button MIP window Start MIP Press & Hold button Rescale button Start P0.1 button P0.1 window Figure 13-30: MIP/P0.1 Screen REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-55 Chapter 13 Options and Accessories Information type Description Start MIP Press & Hold button Starts the MIP maneuver. Changes to Continue when the maneuver is complete or when finger is lifted from the button. Changes to Start when Continue is touched. Start P0.1 button Starts the P0.1 maneuver. Changes to Stop when the maneuver is started. Changes to Continue when the maneuver is complete or when the Stop button is touched. Changes to Start when Continue is touched. MIP window Displays the most recently accepted maneuver results. The date and time of the maneuver appears below each window. P0.1 window Displays the most recently accepted maneuver results. The date and time of the maneuver appears below each window. Scale (button at left of graphic display) Allows you to adjust graphic scales manually. The default scale for the MIP/P0.1 screen is –100 cmH2O to the High Pressure limit. Default scales are in effect every time you enter the MIP/P0.1 screen, and the graph reverts to default scales when the maneuver is complete. Rescale button Allows software to adjust the vertical scales for waveforms and vertical and horizontal scales for loops. The graph cannot be rescaled during the MIP maneuver. Table 13-6: Summary of MIP/P0.1 Screen Information Static C and R Maneuver The Static C and R screen (Figure 13-31) allows you to perform a static compliance and resistance maneuver and displays the maneuver results. The maneuvers are carried out on machine or operator initiated breaths. If the patient triggers a breath when a maneuver is scheduled, the ventilator does not perform the maneuver. Although the maneuver does not require patient effort, patient interference can affect the accuracy of maneuver results. The Static C and R maneuver is available in VCV only. It is not available in PCV and NPPV. NOTE: Depending on the High Pressure limit setting, if the pre-maneuver flow pattern is ramp, delivering a square waveform during the Static C and R maneuver can trigger a High Inspiratory Pressure alarm and cancel the maneuver. Should this happen, adjust alarm settings as needed. How to perform Static C and R maneuver 1. Enter the Static C and R screen: touch the Mechanics icon button, then Static C and R. 2. Touch the Start button. If you do nothing, the maneuver automatically ends at the next mandatory inspiration. Once touched, the Start button changes to Stop. The Stop button allows you to cancel the maneuver at any time. A high-priority alarm automatically cancels the maneuver. 13-56 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 3. At the end of a successful maneuver, a pop-up screen displays the result of the maneuver and asks you to accept or reject the results by touching the Accept or Reject button. 4. At the end of the maneuver (whether successful or cancelled), the Stop button changes to Continue. While the Continue button is displayed, the graph is frozen and can be rescaled. Touch Continue or exit the screen to unfreeze the display. 5. Touch Continue: the button changes to Start and you can repeat the maneuver. 6. Return the active ventilation mode from VCV to the previous mode if necessary. Pressure-Volume and Pressure-Time buttons Scale button Rescale button Start button P Plat window Time Stamp Static C and R Windows Figure 13-31: Static C and R Screen Information type Description Pressure--Volume or Pressure--Time button Pressure--Volume: Displays a real-time pressure-volume loop. Pressure--Time: Displays a real-time pressure-time waveform. Start button Starts the maneuver. Changes to Stop when the maneuver is started. Changes to Continue when the maneuver is complete or when the Stop button is touched. Changes to Start when Continue is touched. Static C and Static R windows Displays the most recently accepted maneuver results. The date and time of the maneuver appear below each window. Table 13-7: Summary of Static C and R Screen Information REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-57 Chapter 13 Options and Accessories Information type Description Pplat window Displays the most recently accepted maneuver results. The date and time of the maneuver appear below each window. Scale (button at left of graphic display) Allows you to adjust graphic scales manually. The default scales for the Static C & R screen are 0 cmH2O to the High Pressure limit for pressure, 0 to Vt + 100 mL for volume. Default scales are in effect every time you enter the Static C and R screen. Rescale button Allows software to adjust the vertical scales for waveforms and vertical and horizontal scales for loops. Table 13-7: Summary of Static C and R Screen Information Alarms and Error Messages If an alarm occurs during Respiratory Mechanics, an Alerts window lists the active alarms. Any active maneuvers are cancelled if a high-priority alarm occurs. If there is a preexisting alarm of any priority when you attempt to start a maneuver, the maneuver cannot be performed and an error message is displayed. Table 13-8: “Respiratory Mechanics Error Messages and Alarms” summarizes error messages and changes that can occur during Respiratory Mechanics. 13-58 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Maneuver Error Messages Temporarily Disabled Alarms VC Measurement out of range Measured volume exceeds 9999 mL. •Low Exhaled Minute Volume Vital Capacity unavailable due to alarm condition Alarm condition exists when maneuver requested. Maneuver cancelled Operator presses Stop button. •Low Exhaled Mandatory Tidal Volume •High Exhaled Minute Volume •Low Exhaled Spontaneous Tidal Volume •Low PEEP Maneuver timed out No inspiration within 20 seconds of starting maneuver. Maneuver cancelled by alarm condition Alarm condition occurs after maneuver begins. MIP Measurement out of range Measured pressures exceed –100 to +200 cmH2O. All patient alarms and the Low O2 alarm are disabled during the MIP maneuver. MIP unavailable due to alarm condition Alarm condition exists when maneuver requested. Maneuver timed out MIP button held down for 30 seconds since starting maneuver. Table 13-8: Respiratory Mechanics Error Messages and Alarms REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-59 Chapter 13 Options and Accessories Maneuver Error Messages Temporarily Disabled Alarms P0.1 Measurement out of range Measured pressures exceed –100 to +200 cmH2O. None: all alarms are active during the P0.1 maneuver. P0.1 unavailable due to alarm condition Alarm condition exists when maneuver requested. Maneuver cancelled Operator presses Stop button and no P0.1 maneuver breaths performed. Maneuver cancelled by alarm condition Alarm condition occurs after maneuver begins. Maneuver timed out One minute elapses with no P0.1 maneuver breaths performed. Table 13-8: Respiratory Mechanics Error Messages and Alarms 13-60 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Maneuver Error Messages Temporarily Disabled Alarms Static C and R Measurement out of range. Check tubing system for leaks Static compliance exceeds 0 to 350 mL/ cmH2O or static resistance exceeds 0 to 400 cmH2O/L/s: None: all alarms are active during the Static C and R maneuver. Static C & R unavailable due to alarm condition Alarm condition exists when maneuver requested. Static C & R only available in VCV Ventilator not in VCV mode. Static C & R unavailable; I-Time less than 200ms Inspiration time must be between 200 ms and 5 seconds. Static C & R unavailable; I-Time greater than 5 seconds Inspiration time must be between 200 ms and 5 seconds. Plateau pressure stability not achieved; Static C & R unavailable Stable plateau pressure cannot be achieved. Maneuver cancelled Operator presses Stop button. Maneuver timed out No machine or operator initiated inspiration within 20 seconds of starting maneuver. Maneuver cancelled by alarm condition Alarm condition occurs after maneuver begins. Table 13-8: Respiratory Mechanics Error Messages and Alarms REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-61 Chapter 13 Options and Accessories Parameter Vital Capacity (VC) maneuver Description Procedure: The clinician instructs the patient to inhale to maximum capacity at the next inspiration, then exhale completely, followed by a normal inspiration. The maneuver automatically ends at the next inspiration (following the maneuver breath) or if 20 seconds elapse without another inspiration. Available in VCV and PCV. Not available in NPPV. During the maneuver: Once the maneuver starts, settings for maneuver breath are mode = CPAP, PEEP = 0 cmH2O (during the start of the next inhalation or exhalation following pressing the start button), and PSV = 0 cmH2O. For the breath following the maneuver breath, PSV = 0 cmH2O and PEEP is restored to its original setting. Pre-maneuver settings are restored during exhalation of the breath following the maneuver breath. Any scheduled breaths that were postponed by the VC maneuver are delivered after the maneuver is complete. Results display: Measured volumes from 0 to 9999 mL are displayed for the VC maneuver: if measured volume exceeds these limits, only a message (no data) is displayed. VC is displayed in mL, and is time-stamped based on ventilator time and date. Range: 0 to 9999 mL Resolution: 1 mL Accuracy: ± 10% of true value Maximum Inspiratory Pressure (MIP) maneuver Procedure: To perform a MIP maneuver, the clinician asks the patient to inhale as forcefully as possible against a closed circuit that allows the patient to exhale through a one-way valve. Available in VCV and PCV. Not available in NPPV. During the maneuver: Once the maneuver starts, settings for maneuver breath are mode = CPAP, PEEP = 0 cmH2O (during the start of the next inhalation or exhalation following pressing the start button), and PSV = 0 cmH2O. For the breath following the maneuver breath, PSV = 0 cmH2O and PEEP is restored to its original setting. Any gas exhaled during an MIP maneuver is not applied to the tidal volume or minute volume calculations. Results display: MIP is displayed in cmH2O, and is time-stamped based on ventilator time and date. Measured pressures from –100 to +200 cmH2O are displayed for the MIP maneuver: If measured pressure exceeds these limits, only a message (no data) is displayed. Range: -100 to +200 cmH2O Resolution: 1 cmH2O Accuracy: ± 10% of true value Table 13-9: Respiratory Mechanics Maneuver Summary and Data Specifications 13-62 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Parameter Occlusion pressure at 100 ms (P0.1) maneuver Description Procedure: No instructions to the patient are required. Available in VCV and PCV. Not available in NPPV. During the maneuver: Settings do not change during the P0.1 maneuver. The ventilator briefly occludes the patient circuit and measures occlusion pressure in the first 100 ms of four preselected patient initiated breaths. If you press Stop during a P0.1 maneuver, results are displayed for the maneuver breaths that did occur. Results display: P0.1 is displayed in cmH2O, and is time-stamped based on ventilator time and date. Measured pressures from –100 to +200 cmH2O are displayed for the P0.1 maneuver: If measured pressure exceeds these limits, only a message (no data) is displayed. Range: -100 to +200 cmH2O Resolution: 1 cmH2O Accuracy: ± (0.5 cmH2O) ± (10%) of true value Table 13-9: Respiratory Mechanics Maneuver Summary and Data Specifications REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-63 Chapter 13 Options and Accessories Parameter Static compliance and resistance (static C and R) maneuver Description Procedure: Patient participation is not required, and patient interference can affect the accuracy of the maneuver. If the patient initiates a breath when a maneuver breath is scheduled, the ventilator does not perform the maneuver. Available in VCV only. Not available in PCV and NPPV. During the maneuver: The ventilator delivers a square waveform, regardless of the current setting. No other settings change during the static C and R maneuver. The maneuver is not performed unless a machine or operator triggered breath is delivered within 20 seconds. The inspiration time must be between 200 ms and 5 seconds for the maneuver to occur, and the maximum plateau duration is 2.5 seconds. Results display: Static compliance is displayed in mL/cmH2O. Static resistance is displayed in cmH2O/L/s. All compliance and resistance values are measured on time or operator triggered mandatory breaths only. During the last saved Static C and R maneuver, Plateau Pressure (Pplat) is measured and displayed as a static value. Static C and R are time-stamped based on ventilator time and date. Static compliance values from 0 to 350 mL/cmH2O and static resistance values from 0 to 400 cmH2O/L/s are displayed: If either value exceeds its limits or a stable plateau pressure cannot be achieved, only a message (no data) is displayed. Range: Static compliance: 0 to 350 mL/cmH2O Static resistance: 0 to 400 cmH2O/L/s Plateau Pressure: -20 to 130 cmH2O Resolution: Static compliance: 1 mL/cmH2O Static resistance: 1 cmH2O/L/s Plateau Pressure: 1 cmH2O Accuracy: Static compliance: ± 1 mL/cmH2O ± 20% of true value Static resistance: ± 3 cmH2O/L/s ± 20% of true value Plateau Pressure: ± (0.5 cmH2O) ± (10%) of true value Inspiratory time divided by total breath time (TI/ TTOT). Calculated inspiratory time divided by total breath time, or percent inspiratory time. An eight-breath running average. Available in VCV, PCV, and NPPV. Applicable to spontaneous and pressure-supported breaths only. If there were no spontaneous or pressure-supported breaths within the last one minute, - - - - is displayed. Table 13-9: Respiratory Mechanics Maneuver Summary and Data Specifications 13-64 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Parameter Description Peak lung flow (Peak L-Flow) The maximum measured inspiratory flow at the patient wye. Available in VCV and PCV. Peak L-Flow is displayed in LPM. An estimation of the compliance and resistance of the patient’s lungs, using the Least Square Estimation algorithm on the equation of motion (P = R • Q + V /C, where Q = lung flow and V = lung volume), performed during each machine or operator initiated inspiration. Dynamic compliance and resistance Dynamic compliance is displayed in mL/cmH2O. Dynamic resistance is displayed in cmH2O/L/s. All compliance and resistance values are estimated on time or operator triggered mandatory breaths only. If there were no machine or operator initiated breaths within the last one minute, - - - - is displayed. These alarms interrupt dynamic compliance and resistance updates: Corrupt Compliance, Corrupt Altitude, High Pressure, Low Insp pressure, Air Source Fault, O2 Valve stuck closed, Exh Valve stuck open, Low Tidal volume, Low PEEP. Dynamic compliance values from 0 to 350 mL/cmH2O and dynamic resistance values from 0 to 400 cmH2O/L/s are displayed: (If either value is above its limit, only + + + is displayed. If either value is below its limit, only - - - is displayed.) Table 13-9: Respiratory Mechanics Maneuver Summary and Data Specifications Compliance (C) and Resistance (R) Computations Dynamic C and R are estimated during ventilator and operator initiated breaths. Static C and R are estimated during a Static C and R maneuver. Dynamic Compliance Dynamic compliance is calculated using these equations: 2 n ∑ Qi Vi n ∑ – 2∗ Qi i=0 i=0 n ∑ Vi 2 i=0 C L = -----------------------------------------------------------------------------------------------n n n n i=0 i=0 i=0 i=0 ∑ Q i V i∗ ∑ P i Q i – ∑ P i V i∗ ∑ V i REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-65 Chapter 13 Options and Accessories Dynamic Resistance Dynamic resistance is calculated using this equation. n n n n i=0 i=0 i=0 i=0 ∑ Qi Vi∗ ∑ Pi Vi – ∑ Pi Qi∗ ∑ Vi R L = -----------------------------------------------------------------------------------------------n 2 ∑ Qi Vi i=0 n – ∑ 2∗ Qi i=0 n ∑ Vi 2 i=0 Where: n = Number of samples taken during for the calculation i = Sample number Qi = Patient flow Vi = Lung volume for the /th sample number = ∫ Qi∗ dt Pi = Pressure sensor measurement for the /th sample number Static C and R Static C and R are calculated using these equations: V C L = -------------------------------( P eplat – P 0 ) ( P ei – ( P eplat – PV plat ⁄ C L ) ) CR L = -----------------------------------------------------------------------Q Lend Where: 13-66 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories CL = The value of the combined compliance of the lungs and chest wall RL = The value of the combined resistance elements between the patient wye and the alveoli of the lungs V = Lung volume Peplat = End of plateau pressure Vplat = Lung volume added during the plateau phase QLend = Patient flow at the end of the delivery phase (beginning of plateau phase) REF 1057983 A P0 = Pressure at the start of inspiration Pei = Pressure at the end of inspiration Respironics V200 Ventilator Operator’s Manual 13-67 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-68 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Trending Option The Trending option allows the ventilator to store and display ventilator information for intervals from 2 to 72 hours. Trended data includes: • Patient data. • Ventilator settings. • Lung mechanics data (most of the data in this category is available only if the Respiratory Mechanics option is installed). • Respiratory profile monitor data (data in this category is available only if the respiratory profile monitor interface (NICO-Esprit) option is installed). All data is date and time-stamped, and 32 parameters are stored for use by the Trending option. You can view three trended parameters at a time, and you can change the displayed parameters and time scale at any time. Accessing Trending Data Touch either the Patient Data button at the top of any settings screen (VCV, PCV, or NPPV) or the Graphics icon button at the bottom of the screen (Figure 13-32). If the Graphics option is not installed, the Graphics button is grayed and Trending is only accessible from the Patient Data screen. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-69 Chapter 13 Options and Accessories Patient Data button Graphics button Figure 13-32: VCV Settings Screen In the Patient Data screen (Figure 13-33) or Graphics screen (not shown), touch the Trending button to display the Trending screen (Figure 13-34). Trending button Figure 13-33: Patient Data Screen 13-70 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories The Trending screen (Figure 13-34) displays three trending waveforms as well as a summary of ventilator settings and patient data. You can change the waveforms and time scale at any time. Parameter select button Manual rescale button Begin trending time Cursor time and date End Trending Time View 1, View 2 buttons Figure 13-34: Trending Screen Summary of Trending Screen Information Information type Description Parameter select buttons Selects which parameter to display in the trending waveform. Manual rescale buttons Selects the upper and lower limits for the displayed parameter. Cursor arrow buttons Changes the position of the cursor. (You can also use the front panel control knob to adjust cursor position.) -2 Hrs and +2 Hrs buttons Shifts the waveform forward or backward by 2 hours without changing the time scale. If you press and hold the buttons, the time scale shifts every ½ second. If less than 2 hours of data exists, the waveform shifts by the time available. The button is grayed if the waveform cannot shift any further. Zoom in/out button Zoom in sets the time scale to 2 hours, with time centered at the cursor position. The button is grayed if the current time scale is 2 hours. Zoom out button returns the time scale to its previous setting. Rescale button Automatically adjusts the vertical axis for all three waveforms for optimal viewing based on the maximum and minimum values for the currently displayed data. Table 13-10: Summary of Trending Screen Information REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-71 Chapter 13 Options and Accessories Time scale button Displays the time scale menu to select from 2 to 72 hours. The button shows the currently selected time scale. View 1 and View 2 buttons Displays either of two user-defined views. Each view consists of three trending waveforms and a time scale. The button shows the active view. Clear button Clears all stored trended data. Table 13-10: Summary of Trending Screen Information Selecting Parameters for Display On the Trending screen (Figure 13-35), a Parameter select button above each waveform shows the name of the currently displayed parameter. To choose a different parameter for display, press the button above the waveform: a Trended Data pop-up window allows you to select another parameter. Parameter select button Trended Data pop-up window Category select buttons Parameter select buttons Figure 13-35: Selecting Parameters for Display on the Trending Screen Four category select buttons (PT Data, Settings, Mech, NICO) appear at the top of the Trended Data pop-up window. Each button, when pressed, displays a different set of Parameter select buttons. There are a total of 78 parameters that are displayed by the four category select buttons. Below is a summary of each category select button. 13-72 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories • The Pt Data category includes measured and calculated patient data parameters. • The Settings category includes ventilator settings. • The Mech category includes lung mechanics data (most of the Mech parameters are available only if the Respiratory Mechanics option is installed). • The NICO category includes data collected from the Respiratory Profile Monitor. This category is available only if the respiratory profile monitor interface (NICO-Esprit) option is installed. NOTE: If any button is grayed out, that particular feature may not be enabled. Contact Respironics Technical Service at 1-800-345-6443. Summary of Trended Data Information Information type Description Pt Data, Settings, or Mech button Selects the category of data to choose from (the current selection is highlighted). Changing the category causes a different set of parameter select buttons to appear. Parameter select button Selects which parameter to display as trended data (the current selection is highlighted in the data category list). For a complete list of parameters, see Table 13.K3. >> button Appears if more than one page of trended data is available for the selected category (the next page displays a << button to return to the previous page). Cancel button Exits the Trended Data pop-up window without making changes. Accept button Confirms the selected parameter and exits the Trended Data pop-up window. Table 13-11: Summary of Trended Data Information REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-73 Chapter 13 Options and Accessories Using the Manual Rescale Function The Manual rescale buttons (Figure 13-36) allow you to adjust the vertical scale for most waveforms. Press the top half of the scale to change the upper limit, and the bottom half of the scale to change the lower limit. A pop-up window allows you to adjust the scale. Press the Cancel button to exit the popup window without making changes, or press Accept to select the new value and exit the pop-up window. Manual rescale button Pop-up window for adjusting scale Figure 13-36: Manually Rescaling a Vertical Axis on the Trending Screen Changing the Cursor Position The Cursor arrow buttons (Figure 13-36) allow you to adjust the position of the cursor for all three waveforms. You can also turn the knob to adjust the cursor position. The data display window for each waveform shows the value of the data at the time indicated by the cursor position. A window at the bottom of the screen shows the time reflective of the cursor position. Alarms are represented as active or inactive. To see which alarm was active at a given time, move the cursor to that time. Up to three alarms that were active appear in the data display window. They appear in order of priority. Maneuvers display the value obtained when the maneuver was performed. No data is displayed for times when the maneuver was not performed. 13-74 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Cursor Data display window Cursor arrow buttons Begin Trending Time Cursor Time End Trending Time Figure 13-37: Changing Cursor Position on the Trending Screen Selecting the Time Scale The selected time scale (Figure 13-38) applies to all three waveforms on the Trending screen. To choose a different scale, press the Time scale button: a Time Scale pop-up window allows you to select another scale. Press the Cancel button to exit the pop-up window without making changes, or press Accept to select the new value and exit the pop-up window. The new value will appear on the time scale button. NOTE: REF 1057983 A If there is not enough recorded data to display a time scale, then its respective button is grayed out. Respironics V200 Ventilator Operator’s Manual 13-75 Chapter 13 Options and Accessories Grayed-out button indicates that the time scale is not available Figure 13-38: Selecting the Time Scale for the Trending Screen Using the +2 Hrs/-2 Hrs buttons Using the Zoom Function The +2 Hrs and –2 Hrs buttons shift all three waveforms forward or backward by two hours without changing the time scale. If you press and hold the buttons, the time scale shifts every ½ second. If less than 2 hours of data exist, the waveform shifts by the amount of available data. The buttons are grayed if the waveform cannot shift any further. The Zoom button allows you to zoom in on trended data by switching the time scale to two hours, centered around the cursor position. If the current time scale is two hours, the zoom button is grayed. When the Zoom button shows a magnifying glass with a plus (+) sign, the “zoom in” function is available. Once zoomed in, the button changes to a magnifying glass with a minus (-) sign to indicate that the “zoom out” function is available, and the Time and View buttons are disabled. Zooming out returns the waveforms to their previous time scale and all buttons to their previous states. Using the Rescale Button 13-76 The Rescale button automatically adjusts the vertical axis for all three waveforms. The software determines a scale based on the minimum and maximum values of the data to display an optimal view. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Using the View 1/ View 2 buttons The View 1 and View 2 buttons make it possible for the user to store three trending waveforms and a time scale and recall them with a press of a button. A highlighted View button indicates that a preselected view is being displayed. If neither button is highlighted, the view (waveform(s) and/ or time scale) has been changed from the preselected view. Touch the View button to revert to the preselected view To store settings to one of the View buttons, select the desired waveforms and timescale then press and hold the View 1 or View 2 button for three (3) seconds. A pop-up window asks you to confirm that you want to change the preselected view. Press Yes to reconfigure the preselected view, or No to exit the pop-up window without making changes. Repeat the process to store settings to the other View button. Using the Clear button The Clear button allows you to clear all stored data for trending. Press Clear between patients or to erase all of a patient’s previously stored data. When you press Clear, a pop-up window asks you to confirm that you want to erase all stored data. Press Yes to clear the data, or No to exit the pop-up window without clearing data. Alarms during Trending If an alarm occurs while viewing the Trending screen, an Alerts window replaces the Settings window, and lists up to four currently active alarms. If the alarm conditions no longer exist, press Alarm Reset to close the Alerts window and restore the Settings window. PCMCIA Card The Trending option with the ventilator requires the use of a Respironics approved 16 MB flash memory card. The card must be used in conjunction with an adaptor for the PCMCIA slot at the back of the ventilator. The order number for the card and adaptor is P/N 1014293. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-77 Chapter 13 Options and Accessories Trending Not Available WARNING: The cover plate for the PCMCIA slot at the back of the ventilator must be replaced after the adaptor and card are installed. This is to protect the ventilator. CAUTION: The PCMCIA card should only be removed by trained service personnel once power to the ventilator is off. This Trending Not Available message indicates a problem with Trending option data storage. This message may appear if: • the PCMCIA card installed for the Trending option is removed, • the PCMCIA card includes unrecognizable or corrupted files, or • the PCMCIA card does not contain enough memory. • the internal clock setting was moved back by more than 1.25 hours and trending data was not erased. Contact Respironics Technical Support for more information. Specifications Data collection and display The system collects numeric data every 20 seconds. Alarms are considered active if they occurred at any time during the previous 20-second interval. If the selected time scale is 2 hours, each data point on a waveform represents 20 seconds. As the scale is increased, each data point represents a longer interval. Data is periodically refreshed if there is no user interaction. Display time-outs The Trending screen automatically reverts to the Monitor screen if 15 minutes elapse without user interaction. Pop-up windows are cleared from the display if 2 minutes elapse without user interaction, and any pending changes are cancelled. Table 13-12: Trending Data Specifications (Sheet 1 of 4) 13-78 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Trended data The Trending option simultaneously trends 32 parameters from four categories: patient data, settings, lung mechanics (Mech) and (NICO). Parameters that are not currently displayed are stored in memory for viewing. Trended data: Pt Data PIP (peak inspiratory pressure) MAP (mean airway pressure) Tidal Vol (exhaled tidal volume) Total VE (total minute volume) Spont VE (spontaneous minute volume) Tot & Spt VE (both spontaneous and total minute volume displayed on the same waveform) Total Rate (measured total respiratory rate) Spont Rate (measured spontaneous respiratory rate) Tot & Spt Rate (measured spontaneous and total rate displayed on the same waveform) Pe End (measured end expiratory pressure) I:E Ratio (inspiratory to expiratory ratio) Table 13-12: Trending Data Specifications (Sheet 2 of 4) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-79 Chapter 13 Options and Accessories Trended data: Alarm Pt Data (continued) (alarm occurrence) %O2 (percentage of oxygen delivered) F / Vt (rapid shallow breathing index) Ti/Ttot (the ratio of inspiratory time to total respiratory cycle time for spontaneous breaths) Peak L-Flow (peak flow of gas during the inspiratory phase) % Pt Trigger (percentage of patient triggered breaths) Pt Leak (patient leak) Trended data: Settings Set Tidal Vol (set tidal volume, only available in VCV mode) Set Pressure (set pressure, only available in PCV mode) Set PEEP (set PEEP level, only available in VCV or PCV mode) Set % O2 (set delivered O2%) Set PSV (set pressure support, only available in VCV mode) Set IPAP (set inspiratory positive airway pressure level, only available in NPPV mode) Set EPAP (set expiratory positive airway pressure level, only available in NPPV mode) Set I-Time (set inhalation time, only available in PCV or NPPV mode) Table 13-12: Trending Data Specifications (Sheet 3 of 4) 13-80 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Trended data: Mech Static C (static compliance maneuver, only available if Mechanics option is installed) Static R (static resistance maneuver, only available if Mechanics option is installed) VC (vital capacity maneuver, only available if Mechanics option is installed) MIP (maximum inspiratory pressure maneuver, only available if Mechanics option is installed) P0.1 (P0.1 maneuver, only available if Mechanics option is installed) Dynamic C (dynamic compliance, only available if Mechanics option is installed) Dynamic R (dynamic resistance, only available if Mechanics option is installed) Auto PEEP (expiratory hold) Trended data: NICO CO-a (Cardiac Output Average, only available if the respiratory profile monitor interface (NICO-Esprit) option is installed) SpO2 (O2 Saturation, only available if the respiratory profile monitor interface (NICO-Esprit) option is installed) ETCO2 (End Tidal CO2, only available if the respiratory profile monitor interface (NICO-Esprit) option is installed) VCO2 (CO2 Elimination, only available if the respiratory profile monitor interface (NICO-Esprit) option is installed) Vtalv (Alveolar Tidal Volume, only available if the respiratory profile monitor interface (NICO-Esprit) option is installed) Mvalv (Alveolar Minute Volume, only available if the respiratory profile monitor interface (NICO-Esprit) option is installed) Time scales Selected time scales apply to all displayed waveforms: 2, 4, 8, 16, 24, 48, or 72 hours. Table 13-12: Trending Data Specifications (Sheet 4 of 4) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-81 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-82 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Flow-Trak® Option Flow-Trak provides additional flow to Volume Control Ventilation (VCV) breaths. It allows the patient to draw additional flow or volume as desired. Ventilators with Flow-Trak installed are identified by the option label as seen in Figure 13-39. Figure 13-39: Flow-Trak option label Once the Flow-Trak option has been loaded on the ventilator it is active. Follow these steps to turn Flow-Trak Off and On: 1. While in VCV, press the Peak Flow settings button. 2. Press the Ftrak OFF button. 3. Press the Accept button. Use these same steps pressing Ftrak On to turn Flow-Trak on. Figure 13-40: Turning off the Flow-Trak Option Flow-Trak will stay resident on the ventilator when shut down and restarted. That is, if Flow-Trak is OFF when the ventilator is shut down then it will be OFF the next time the ventilator is started. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-83 Chapter 13 Options and Accessories NOTE: If the Ftrak On button is grayed out in the settings window (Figure 13-41) then the Flow-Trak Option has not been installed. Contact Respironics Customer Service Within the U.S.A. 1-800-345-6443 Outside the U.S.A. 724-387-4000 Figure 13-41: FTrak On Button Grayed Out, Flow-Trak is Not Loaded On the Screen When a patient initiates a Flow-Trak breath the ventilator screen shows the Breath Indicator bubble change from mandatory (Mand) or Assist to spontaneous (Spont). Figure 13-42: Breath Indicator During Flow-Trak Breath 13-84 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Breath Delivery The Flow-Trak option allows the ventilator to give additional flow to patients who are not receiving the flows or volumes they desire by monitoring the pressure during a mandatory or assist breath. If the patient draws more flow or volume than what has been set, the inhalation pressure drops and Flow-Trak is initiated. The target pressure during Flow-Trak is 2 cmH2O above PEEP. If the patient’s effort to draw flow or volume drops below the set flows or volumes the ventilator returns to VCV. The ventilator cycles to exhalation only if the set tidal volume plus compliance and BTPS compensation has been delivered (unless HIP has been met). If the patient effort ceases and set volume has not been met, the breath will continue to deliver flow until volume has been met. Flow-Trak Cycling Condition (following the delivery of set Vt) Response The delivered flow meets the exhalation flow threshold. The exhalation threshold is either the flow trajectory that would have been followed had there not been a Flow-Trak breath or 25% of measured peak flow (whichever is larger). The ventilator transitions to exhalation. Exhalation effort detected (pressure exceeds 4.5 cmH20 above PEEP). The ventilator transitions to exhalation. HIP condition has been met. The alarm sounds and ventilator transitions to exhalation. See “Alarms” on page 13-86. I-Time too long condition has been met. The alarm sounds and ventilator transitions to exhalation. See “Alarms” on page 13-86. Table 13-13: Breath Transitions If the actual I-Time is greater than the calculated I-Time, the next scheduled mandatory inspiration is postponed to ensure exhalation time. NOTE: In VCV, the calculated I-Time is based on the set tidal volume, peak flow, and waveform shape. Inspiratory Hold Inspiratory hold is only allowed if the actual I-Time is less than or equal to the calculated I-Time. Respiratory Mechanics The Flow-Trak option affects the following Respiratory Mechanics features. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-85 Chapter 13 Options and Accessories Respiratory Mechanics Maneuvers with Flow-Trak Maneuver Affect of Flow-Trak Static C & R The maneuver is cancelled if the patient initiates a Flow-Trak breath. A message appears when the maneuver is cancelled due to the change in breath type. Dynamic C & R Dynamic C & R are not calculated for Flow-Trak breaths. Ti/Ttot Ti/Ttot is not calculated for Flow-Trak breaths. Peak Lung Flow Peak Lung Flow is calculated for Flow-Trak breaths. Table 13-14: Respiratory Mechanics Maneuvers with Flow-Trak Alarms The Flow-Trak option does not change the ventilator alarms with the exception of those alarms found below in Table 13-15:. For a complete listing of ventilator alarms and descriptions see Chapter 9, “Alarms”, Table 9-1: “Alarm Alert Messages”. Flow-Trak Affected Alarms Alert Message Description I-Time too long The breath transitions from inhalation to exhalation when 3.5 seconds has passed for adults or 2.5 seconds for pediatrics from the start of the mandatory breath. If the operator’s settings result in a calculated I-Time > 3.5 seconds for adults or 2.5 seconds for pediatrics, then the calculated I-Time is the cycling criteria. Low Inspiratory Pressure Not available for the Flow-Trak triggered breath only. Table 13-15: Flow-Trak Affected Alarms NOTE: 13-86 The I-Time too long alarm and/or the Low Inspiratory Pressure alarm will sound if a circuit disconnect were to occur. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Respiratory Profile Monitor Interface (NICOEsprit) Option The respiratory profile monitor interface (NICO-Esprit) software allows the ventilator and the respiratory profile monitor to exchange information via a bidirectional RS-232 serial link. Through this link, the ventilator supplies the monitor with breath type and FIO2 information and in turn, the monitor provides the ventilator with data for trending parameters related to measuring CO2 elimination (VCO2). System Requirements The following hardware and software is required for the proper use of the respiratory profile monitor interface: Respiratory Profile Monitor Interface (NICO-Esprit) Requirements Monitor NICO Monitor, Model 7300 NICO2 Monitor, Model 7600 Part number varies by language Respironics V200 Ventilator Trending option loaded and enabled Respironics V200 ventilator with the respiratory profile monitor interface option enabled. NOTE: Ventilators with the respiratory profile monitor software installed are identified by an option label located near the power switch. Accessories RS-232 serial communications 3’ cable WARNING: 1018292 Use only Respironics approved cables when connecting to the communications port. Mounting kit, respiratory profile monitor 10060784 Table 13-16: respiratory profile monitor Interface Option Requirements REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-87 Chapter 13 Options and Accessories Communications When the respiratory profile monitor interface (NICO-Esprit) option is installed, the RS-232 communications port is configured for all communications functions in the following manner: Ventilator RS-232 Communications Port Settings Specification Setting Baud Rate 19200 Data Bits 8 Parity None Stop Bits 1 Table 13-17: Ventilator RS-232 Communications Port Settings NOTE: Hardware Setup The respiratory profile monitor interface (NICO-Esprit) option uses the communications port on the ventilator exclusively. The respiratory profile monitor interface (NICO-Esprit) option and the RS-232 Communications Option 2 cannot be installed on the same ventilator. Once the software is loaded on the ventilator, the necessary hardware can be attached. 1. Attach the respiratory profile monitor to the mounting bracket, and then attach the assembly to the ventilator. Assembly instructions are included with the bracket. Respiratory profile monitor Mounting bracket Ventilator Figure 13-43: Assembled Monitor, Bracket, and Ventilator 13-88 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories WARNING: Always turn the ventilator power OFF before connecting additional equipment. 2. Attach one end of the RS-232 serial communications cable to the RS232 port 1 or 2 on the back of the respiratory profile monitor. See Figure 13-44. 3. Attach the other end of the RS-232 serial communications cable to the serial communications port on the back of the ventilator. See Figure 13-44. Figure 13-44: RS-232 Communication Ports for the Monitor and the Ventilator 4. Connect the patient circuit to the ventilator. 5. Power up the ventilator if not already operating. NOTE: When powering on the ventilator for the first time after installing the respiratory profile monitor software, the Trending Memory Card must be reformatted. Press YES when asked the question: 6. Power up and connect the monitor according to the user’s manual for your Respironics respiratory profile monitor. REF 1057983 A • Inspect the monitor before powering up. • Press the Operate/Standby key to turn the monitor on. Respironics V200 Ventilator Operator’s Manual 13-89 Chapter 13 Options and Accessories • Connect the sensors to the monitor, ventilator circuit, and patient according to the Respiratory Monitoring section of the user’s manual for your Respironics respiratory profile monitor. 7. Select the NICO-Esprit interface on the respiratory profile monitor. • Press the MENU key to activate the SELECT A SCREEN menu. Figure 13-45: Select A Screen Menu screen • Turn the knob to highlight SETUP and then press the knob. The SETUP screen appears. • Turn the knob to highlight INPUT/OUTPUT and then press the knob. The INPUT/OUTPUT screen appears. Figure 13-46: Input/Output Setup Screen • Turn the knob to highlight RS232-2 and then press the knob. The RS232-2 screen appears • Turn the knob to highlight ESPRIT and then press the knob. The INPUT/OUTPUT screen appears. Figure 13-47: ESPRIT Choice for RS232-2 Port Screen 13-90 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories • Turn the knob to highlight EXIT and then press the knob. Turn the knob to highlight EXIT again and then press the knob.The monitor returns to the SETUP screen. The ventilator and the respiratory profile monitor will begin communication within 60 seconds. RS-232 Communications The bidirectional communication between the respiratory profile monitor and ventilator is initiated by the monitor. The ventilator recognizes the connect request message from the monitor and responds. Information Transferred from the Respiratory Profile Monitor to the Ventilator The respiratory profile monitor provides the ventilator with the data listed in the following table. The monitor sends the average value for each parameter for the previous 60 seconds. Information Transferred from the Respiratory Profile Monitor to the Ventilator Data Description CO-a Cardiac Output Average NOTE: Available only when the Cardiac Output option is installed. SpO2 O2 Saturation ETCO2 End Tidal CO2 VCO2 Volume CO2 Vtalv Alveolar Tidal Volume MValv Alveolar Minute Volume Table 13-18: Information Transferred from the Monitor to the Ventilator REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-91 Chapter 13 Options and Accessories Information Transferred from the Ventilator to the Respiratory Profile Monitor The ventilator provides the respiratory profile monitor with the following information. Information Transferred from the Ventilator to the Respiratory Profile Monitor Data Description Breath Type Mandatory, Assisted, Spontaneous, or Supported FIO2 The percentage of oxygen in the gas delivered to the patient. NOTE: If the optional oxygen sensor for the ventilator is used, this number will be the FIO2 measured by the sensor. If the optional oxygen sensor is not used, this will be the set FIO2. Table 13-19: Information Transferred from the Ventilator to the Monitor Trended NICO Data The ventilator captures the data sent from the respiratory profile monitor and stores it on the PCMCIA card (PC Card). The Trending screen makes it possible to display ventilator and monitor information for intervals from 2 to 72 hours. To access the respiratory profile monitor trended data: 1. Touch the Patient Data button at the top of any settings screen (VCV, PCV, or NPPV). NOTE: 13-92 If the Graphics option is not installed, the Graphics button is grayed out and Trending is only accessible from the Patient Data screen. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Patient Data button Figure 13-48: VCV Settings Screen 2. Touch the Trending button to display the Trending screen (Figure 1333). Trending button Figure 13-49: Patient Data Screen The Trending screen (Figure 13-34) displays three trending waveforms as well as a summary of ventilator settings and patient data. You can change the waveforms and time scale at any time. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-93 Chapter 13 Options and Accessories Parameter select button Manual rescale button Begin trending time Cursor time and date End trending time View 1, View 2 buttons Figure 13-50: Trending Screen The parameter select button above each waveform shows the name of the currently displayed parameter. To choose a different parameter for display, press the button above the waveform. The Trended Data pop-up window appears showing the available data choices. 3. Press the NICO button on the Trended Data pop-up window to view the available parameters. See Figure 13-51. 4. Select a parameter button then press Accept or Cancel to return to the Trending Data screen. 13-94 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Figure 13-51: Trended Data screen NOTE: REF 1057983 A For more information regarding the Trending Data screen or using the Trending Option, refer to “Trending Option” on page 13-69. Respironics V200 Ventilator Operator’s Manual 13-95 Chapter 13 Options and Accessories Troubleshooting Troubleshooting NICO button does not appear on the Trended Data screen NICO button on the Trended Data screen is grayed out Ventilator is not capturing data sent from the respiratory profile monitor Probable Cause: The ventilator may not have respiratory profile monitor interface software. What to Do: Contact Respironics Technical Service: 1-800-345-6443. Probable Cause: The respiratory profile monitor interface option is loaded but not enabled on the ventilator. What to Do: Contact Respironics Technical Service: 1-800-345-6443. Probable Cause: The bidirectional communication link is not functioning properly. What to Do: Check that the RS-232 serial communications cable (P/N 1018292) is being used. Check cable connections. Preform the steps listed on page 13-90 and page 13-91 for setting up the monitor with the RS-232 input/output for the ventilator. Cycle the power on the monitor. If there is no improvement, Contact Respironics Technical Service: 1-800-345-6443. The monitor displays the CHECK COMMUNICATION message Probable Cause: The bidirectional communication link is not functioning properly. What to Do: Check that the RS-232 serial communications cable (P/N 1018292) is being used. Check cable connections. If there is no improvement, Contact Respironics Technical Service: 1-800-345-6443. Probable Cause: What to Do: Any other condition 13-96 What to Do: Respironics V200 Ventilator Operator’s Manual The ventilator may not have respiratory profile monitor software. If the NICO button on Trended Data screen is grayed out, the respiratory profile monitor interface option is loaded but not enabled on the ventilator. Contact Respironics Technical Service: 1-800-345-6443. Contact Respironics Technical Service: 1-800-345-6443. REF 1057983 A Chapter 13 Options and Accessories Neonatal Option The Neonatal option allows the Respironics V200 Ventilator to ventilate intubated neonatal patients with an ideal body weight range of 0.5 - 6.5 kg (1.10 - 14.33 lb.) and an endotracheal tube I.D. range from 2.5 - 4.0 mm. The option provides pressure control in A/C, SIMV, and Apnea ventilation and also provides pressure support in SIMV and CPAP. The Neonatal Option is not available in VCV or NPPV modes. System Requirements The Neonatal option requires the following software and accessories for proper use: Neonatal option Requirements Respironics V200 Ventilator Neonatal option loaded and enabled. NOTE: Ventilators with the Neonatal option software installed are identified by the option label located near the power switch. Recommended Accessories Part Number Neonatal patient circuits (10 mm I.D.) Fisher & Paykel reusable circuit Hudson RCI disposable circuit Fisher & Paykel disposable circuit 900MR780 780-07 RT131 (RT125 is EU equivalent) 1002505 500-1000-43 22mm, Male x Male Connector (Refer to Figure 13-52.) coupling, Straight Silicone NOTE: We recommend using approved circuits or equivalent when connecting to the ventilator. Table 13-20: Neonatal Option Requirements Filter Silicone coupler Connector Circuit Figure 13-52: Circuit to Filter Connection REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-97 Chapter 13 Options and Accessories Changing Patient Types The Neonatal option is available once the software option is installed. The current patient is identified by the icon found on any active ventilation type screen. In Figure 13-53 the neonatal patient type has been selected, which is identified by the neonatal patient type icon. Neonatal patient type icon Figure 13-53: Identifying the Neonatal Patient Type Changing to or from the neonatal patient type requires that the Short Self-Test (SST) or Extended Self-Test (EST) must first be run. Attempts to change patient types to or from the neonatal patient type while in the active ventilation type screen causes a message box to appear explaining that you must run SST or EST in order to change patient type. Selecting Neonatal Patient Type To select the neonatal patient type, you must enter Diagnostic Mode. 1. Power off the ventilator. 2. Power on the ventilator while holding down the ALARM RESET and 100% O2 keys for approximately 5 seconds. A message appears on the ventilator screen that prompts the user to ‘Verify that the patient is disconnected prior to proceeding.’ Press OK to enter Diagnostic Mode. 3. Once you’ve entered Diagnostic Mode, select either SST or EST. 4. Press Start SST (or if in EST, Start EST). 5. Select Neonatal patient type and then follow the remaining on-screen instructions. The next time the ventilator is powered on, it will be set for neonatal patients. For optimum performance use a Neonatal patient circuit (10 mm I.D.) with compliance compensation enabled. These same steps apply when changing to Adult or Pediatric patient type from Neonatal. 13-98 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Heated Filter Test The heated filter test in EST for adult and pediatric patient types automatically tests for pressure drop of the exhalation filter. This portion of EST is not possible with neonatal circuits. We recommend running this test according to the filter manufacturers recommendations. The following steps can be run in diagnostics mode: 1. Power off the ventilator. 2. Power on the ventilator while holding down the ALARM RESET and 100% O2 keys for approximately 5 seconds. A message appears on the ventilator screen prompting the user to ‘Verify that the patient is disconnected prior to proceeding.’ Press OK to enter Diagnostic Mode. 3. Once you’ve entered Diagnostic Mode, select the HARDWARE screen. 4. Press the SAFETY button so that it has a white background. 5. Attach a length of 22 mm I.D. tubing to the gas outlet port of the ventilator. 6. Set the air flow to 100 LPM. Record what the inhalation pressure sensor is reading. See Figure 13-54. 7. Attach the filter to the end of the length of 22 mm I.D. tubing and again record the inhalation pressure sensor reading. See Figure 1354. The difference between the first pressure reading and second pressure reading should not be greater than 4 cmH2O (or manufacturer’s recommendations). Inhalation Pressure Figure 13-54: Hardware Screen in Diagnostics Mode, Inhalation Pressure reading REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-99 Chapter 13 Options and Accessories Initial Neonatal Settings When the ventilator is first powered on and the neonatal patient type is selected, the initial startup settings found in Table 13-21: are applied. Each subsequent startup will display the settings from the last use of the ventilator of that patient type with the exception of O2. The last O2 setting used on the ventilator will remain regardless of patient type. Initial Patient Settings, Ranges Ventilation Settings Value Ranges Ventilation Mode PCV - SIMV AC, SIMV, CPAP Rate 20 BPM 1 - 150 BPM Pressure 10 cmH2O 5 - 100 cmH2O I-Time 0.3 Sec 0.1 - 2.0 Sec PEEP 3 cmH2O 0 - 35 cmH2O PSV 0 cmH2O 0 - 100 cmH2O I-Trigger 2.0 L/Min 0.3 - 10.0 L/Min E-Cycle 25% 10 - 80% Rise-TIme 0.2 Sec 0.1 - 0.5 Sec O2 % same as last O2 setting 21 - 100% Apnea Rate 20 BPM 1 - 80 BPM Alarm Settings Value Ranges High Press 30 cmH2O 10 - 105 cmH2O Low Insp Press 5 cmH2O 3 - 105 cmH2O Low Peep 0 cmH2O 0 - 35 cmH2O Low Vt Mand 10 mL 0 - 300 mL Low Vt Spont 3 mL 0 - 300 mL High Rate 150 BPM 0 - 150 BPM High VE 1.2 L 0.00 - 5.0 L Low VE 0.3 L 0.00 - 5.0 L Apnea 20 Sec 10 - 60 Sec I-Time Too Long sounds after 1.5 Sec of spont breath Table 13-21: Initial Neonatal Patient Settings 13-100 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Percent Leak NOTE: Patient data ranges and accuracies can be found in Chapter 12, “Technical Specifications” with the exception of the Exhaled Tidal Volume. The accuracy for exhaled Tidal Volume is ±(4ml ±10%) NOTE: Neither Respiratory Mechanics nor Expiratory Hold are active when the neonatal patient type is selected. Flow trigger is the only trigger type available. All other features apply. When the neonatal software option is loaded on the ventilator, a % Leak window appears on the Patient Data screen. The window displays the estimated leak of the delivered volume as a percentage. The % Leak value is updated at the beginning of each inhalation. The % Leak is available for all patient types when the neonatal software option is loaded. While the estimate for percent leak is not a precise measurement it can be used to trend relative changes in leak delivered volume. Percent Leak Figure 13-55: Patient Data Screen With % Leak REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-101 Chapter 13 Options and Accessories Patient Leak Values Patient Leak values (as seen in the Patient Data window, Figure 13-56) between 0 and 1 LPM are rounded values. Refer to Chapter 7, “Operating Theory”, for more information about Patient Leak Display. Patient Leak Figure 13-56: Patient Data Window 13-102 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Speaking Mode Option The Speaking Mode software option for the Respironics V200 Ventilator allows tracheostomized adult and pediatric patients who meet certain criteria to vocalize without the need of a speaking valve. The Speaking Mode software, when activated, closes the ventilator’s exhalation valve, keeping it closed during the expiratory phase. This action redirects airflow around the deflated balloon cuff on the tracheostomy tube, through the larynx and pharynx, and out through the mouth. As the air flow passes through the vocal cords, speech is returned. Speaking Mode provides pressure control and volume control in A/C, SIMV, CPAP, Pressure Support, and in the Flow-Trak ventilator option (if enabled). Speaking Mode is not available in NPPV mode, Respiratory Mechanics, and Neonatal options. Ventilators installed with Speaking Mode option software have the following identifying label located near the power switch: Figure 13-57: Speaking Mode Option Label Warnings, Cautions, and Notes REF 1057983 A Warnings A warning indicates a condition that could cause injury to a patient or operator if instructions are not followed. • Read and understand these Speaking Mode Option instructions before using Speaking Mode on a patient. • Wait at least 72 hours after a tracheostomy before initiating Speaking Mode. • Monitor patients with trained medical personnel when using Speaking Mode. • COMPLETELY DEFLATE the tracheostomy tube cuff before activating Speaking Mode. • Do not use while patient is sleeping, unresponsive, or comatose. • Do not use with patients with upper airway obstruction. • Do not use with foam cuff tracheostomy tubes. Respironics V200 Ventilator Operator’s Manual 13-103 Chapter 13 Options and Accessories • Do not use with neonatal tracheostomy tubes. • Do not use on neonates. • Do not inflate the tracheostomy tube cuff until Speaking Mode has been turned off. • Do not use on patients who are dependent on PEEP therapy. • Do not use with HME filters. • Discontinue using Speaking Mode promptly and institute appropriate ventilation if the patient experiences difficulty or their status deteriorates from baseline parameters. • Perform an airway patency test immediately after activating Speaking Mode. NOTE: Patient Preparation 13-104 Speaking Mode is available ONLY in invasive ventilation mode. Using Speaking Mode on a patient requires preparation before activating the mode. Refer to the Sequence for Use diagram in Figure 13-58 and follow the necessary steps before starting Speaking Mode and discontinuing Speaking Mode. The Speaking Mode Clinical Guide describes patient care steps in detail. WARNING: Read and understand these Speaking Mode Option instructions before using Speaking Mode on a patient. WARNING: Wait at least 72 hours after a tracheostomy before initiating Speaking Mode. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Tracheostomized patient ventilated in (PSV, PCV, VCV, SIMV, CPAP) mode Patient assessment Procedure halted FAIL PASS Baseline clinical parameters Observe patient settings Monitor with pulse oximeter Instruct patient Suction oral airway and tracheostomy tube Position patient Deflate cuff Activate Speaking Mode on the ventilator Confirm airway patency FAIL PASS Encourage speech PASS Monitor patient FAIL Discontinue Speaking Mode Inflate cuff Check ventilator settings and alarms Procedure complete Figure 13-58: Speaking Mode Sequence for Use REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-105 Chapter 13 Options and Accessories Settings Speaking Mode Ventilator Settings Available in Modes Pressure Control Ventilation (AC, SIMV, and CPAP) Volume Control Ventilation (AC, SIMV, and CPAP) Pressure Support Ventilation (SIMV and CPAP) Apnea Ventilation Starting Speaking Mode Patient Type: Adults & Pediatrics PEEP Automatically reset to zero and low PEEP alarm is reset to zero Trigger-type Automatically will switch from flow triggering, if previously selected, to a pressure triggering of 1 cm H2O Alarm Changes Exhaled volume alarms automatically change to delivered volume alarms Patient Data Trended and displayed values based on delivered volumes Mechanics Respiratory mechanics feature not available Prepare the patient and deflate the tracheostomy cuff. 1. Press the Speaking Mode button. Speaking Mode Button Figure 13-59: Speaking Mode Button The first message box appears, Turn Speaking Mode On? This message box explains the changes that will occur while the ventilator is operating in Speaking Mode. 13-106 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 2. Press Continue to continue or Cancel to exit Speaking Mode. Figure 13-60: Turn Speaking Mode On? First Message Box The second message box then appears with the same command, Turn Speaking Mode On?, reminding the user to: Please be sure there is NO Speaking Valve installed and the tracheostomy cuff is deflated. 3. Press Accept to continue or Cancel to exit Speaking Mode. Figure 13-61: Turn the Speaking Mode On? Reminder Second Message Box REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-107 Chapter 13 Options and Accessories Speaking Mode is ON when the Active Mode button in the upper left-hand corner of the screen is orange and the Speaking Mode button at the bottom of the screen has a white background. Active Mode button is orange Speaking Mode button Figure 13-62: How the Ventilator Screen Appears When Speaking Mode Is ON 4. We recommend reviewing alarm and ventilator settings at this time. Continue to monitor patient's respiratory effort and clinical status. If patient's respiratory efforts deteriorate, discontinue Speaking Mode. See “Discontinue Speaking Mode” on page 115. 13-108 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Alarms While in Speaking Mode, the ventilator switches all volumetric alarms from exhaled to delivered alarms. This means that all alarms that were triggered based on exhaled volumes will now be based on delivered volumes. These alarms include: • Low Exhaled Minute Volume • High Exhaled Minute Volume • Low Exhaled Mandatory Tidal Volume • Low Exhaled Spontaneous Tidal Volume Disabled Alarms The Low PEEP alarm is disabled while in Speaking Mode. This alarm will be appear “grayed out.” When the ventilator returns to PSV, PCV, VCV, SIMV, or CPAP operation, the current alarm settings will remain after Speaking Mode is discontinued. Disabled alarms are grayed out Figure 13-63: Alarm Settings Screen Changes can be made to these disabled alarms while in Speaking Mode, but they will not take affect until Speaking Mode is discontinued. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-109 Chapter 13 Options and Accessories Mode-Specific Alarms Disconnect Alarm If the tracheostomy tube becomes disconnected from the patient circuit, a high urgency Disconnect Alarm will sound. When the disconnect alarm is active, the ventilator continues ventilation. If the tracheostomy tube becomes re-connected, the alarm auto-resets. Airway Occlusion Alarm If the area surrounding the tracheostomy tube becomes obstructed during ventilation in Speaking Mode (e.g., the tracheostomy cuff is inflated) so the flow rate through the patient's airway during exhalation is less than 5 L/min for the entire exhalation, a high urgency airway occlusion alarm will sound. The ventilator continues to ventilate and the exhalation valve closes during inhalation only. The airway occlusion alarm will auto-reset when an exhalation occurs that does not meet the alarm condition. The airway occlusion alarm cannot be silenced by the alarm silence key. Figure 13-64: Speaking Mode Alerts: Disconnect and Airway Occlusion Alarms 13-110 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Displayed Data While in Speaking Mode, the ventilator switches all volumetric readings from exhaled to delivered readings. This means that all data displayed based on exhaled volumes will now be based on delivered volumes. Some data is not available in Speaking Mode, including data on Patient Leak (circled below in Figure 9). Patient Leak data is not available in Speaking Mode Figure 13-65: Active Mode: Displayed Data in the VCV Settings Screen The following data in the Patient Data screen displays in delivered volumes (not exhaled volumes): • Tidal Volume • Spontaneous Minute Volume • Total Minute Volume The following data is not available in Speaking Mode. Dashed lines appear in the data box instead of a numeric value: REF 1057983 A • Patient Leak • F/Vt (Ratio of respiratory rate to tidal volume) Respironics V200 Ventilator Operator’s Manual 13-111 Chapter 13 Options and Accessories Data not available in Speaking Mode Figure 13-66: Active Mode: Patient Data Screen Trended Data NOTE: NICO data is not available when the Speaking Mode is active NOTE: The time spent in Speaking Mode can be recorded as trended data. This requires the Trending Option be loaded and active on the ventilator. To access the Trending screen: 1. Press the Patient Data button at the top of the settings screen (see Figure 13-66). 2. Press the Trending button at the bottom of the settings screen (see Figure 13-67). 3. Choose a Parameter select button (light blue button above each displayed data option) that shows the name of the currently displayed data option (see Figure 13-67). 4. Once the Trended Data pop-up window has displayed, click on one of the Category Select buttons at the top of the menu to view and select parameters for each option. Speaking Mode Trended Data To display trended data in Speaking Mode, press the Speaking Mode Parameter select button over the displayed data option (if displayed). Or press any Parameter select button to activate the Trended Data pop-up window. (Figure 13-67). 13-112 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories 1. Press the Settings button. 2. Press the Speaking Mode button to show trended data options available in Speaking Mode (Figure 13-68). Parameter select button Trended Data pop-up window Category select buttons Parameter select buttons Figure 13-67: Selecting Speaking Mode on the Trended Data Screen REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-113 Chapter 13 Options and Accessories The trended data will appear as blocks of time shown as either ON or OFF. Speaking Mode trended data Figure 13-68: Speaking Mode Trended Data Screen For more information regarding Trending, see the Trending Option instructions or contact Respironics. Inc. Customer Service at the following numbers: • USA and Canada: 1-800-345-6443 or 724-387-4000 • Europe, Africa, and the Middle East: +33-1-47-52-30-00 • Asia Pacific: +852-3194-2280 In North America: Respironics California, Inc. 2271 Cosmos Court Carlsbad, California 92011 Made in USA 13-114 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Discontinue Speaking Mode Removing a patient from Speaking Mode is very similar to starting a patient on Speaking Mode. 1. Press the Speaking Mode button. 2. The message box appears, Turn Speaking Mode Off?, reminding the user to: Please be sure to inflate tracheostomy cuff AFTER switching SM OFF, Patent Data values and alarms will be based on exhaled volumes. WARNING: • Do not inflate the tracheostomy tube cuff until Speaking Mode has been turned off. Press Yes to turn Speaking Mode off. 3. Inflate the tracheostomy tube cuff (if Yes was pressed). • Press No to remain in Speaking Mode. Figure 13-69: Turn Speaking Mode Off? Message Box When discontinuing Speaking Mode, we recommend reviewing alarm and ventilator settings again. Continue to monitor patient's respiratory effort and clinical status. REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-115 Chapter 13 Options and Accessories (This page is intentionally blank.) 13-116 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Auto-Trak Sensitivity™ Introduction Auto-Trak Sensitivity is a feature designed to enhance patient comfort and ventilation effectiveness and reduce patient work of breathing. Auto-Trak automatically triggers and cycles breathing without the need for useradjustment of I-Trigger (sensitivity) and E-Trigger (cycling) thresholds. Auto-Trak is available in Volume Control Ventilation (VCV), Pressure Control Ventilation (PCV), and Noninvasive Positive Pressure Ventilation (NPPV). Compatible Patient Interfaces Respironics recommends the following patient interfaces for compatibility with the V200 Ventilator in NPPV. Refer to the usage instructions provided with each mask for detailed instructions. • Respironics Image3™ Full Face Mask • Respironics Spectrum™ Disposable Full Face Mask • Respironics Total™ Face Mask • Respironics Disposable Contour™ Deluxe Nasal Mask • Respironics Disposable Small Child Nasal Mask • Respironics Disposable Nasal Mask The V200 Ventilator’s built-in exhalation valve satisfies any Respironics mask requirement for an exhalation port in the patient circuit. Do not use an additional exhalation device (for example, Whisper Swivel®, Plateau™ Exhalation Valve, or equivalent). If the mask you are using has an air entrainment valve, be sure to titrate the EPAP level such that the entrainment valve remains closed to room air. This will ensure that the oxygen mix and breath triggering remain unaffected. WARNING: REF 1057983 A Titrate the EPAP level such that the masks air entrainment valve (if present) remains closed to room air. Always evaluate and monitor patient condition when adjusting EPAP or other settings. Respironics V200 Ventilator Operator’s Manual 13-117 Chapter 13 Options and Accessories How to Select AutoTrak 1. Touch either the I-Trigger or E-Trigger button in the Settings screen (Figure 13-70). Figure 13-70: Settings Screen 2. When the I-Trigger or E-Trigger window appears, touch the Auto button (Figure 13-71 and Figure 13-72). Figure 13-71: Sample Inspiratory Trigger Windowwith Auto-Trak Option Available (Pressure is not an available option for NPPV) 13-118 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Figure 13-72: Sample Expiratory Trigger Window with Auto-Trak Option Available. The Pressure or Flow values that previously appeared in the I-Trigger and E-Trigger windows are removed (Figure 13-73 and Figure 13-74). Figure 13-73: Sample Inspiratory Trigger Window with Auto-Trak Option Selected (Pressure is not an available option for NPPV) REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-119 Chapter 13 Options and Accessories Figure 13-74: Sample Expiratory Trigger Window with Auto-Trak Option Selected 3. Touch the Accept button. The ventilator does not begin using AutoTrak until you touch the Accept button. The Settings screen now displays Auto as the I-Trigger and E- Trigger settings (Figure 13-75). Figure 13-75: Settings Window with Auto-Trak Selected 13-120 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Chapter 13 Options and Accessories Turning Auto-Trak Off 1. Touch either the I-Trigger or E-Trigger button in the Settings screen (Figure 13-70). The I- Trigger or E-Trigger window will appear as shown in Figure 13-73 or Figure 13-74. 2. Change the I-Trigger setting to Pressure or Flow, or change the ETrigger setting to %Peak Flow. (When you change the I-Trigger setting to Pressure or Flow, the E- Trigger reverts to the most recently selected %Peak Flow value. Similarly, when you change the E-Trigger setting to %Peak Flow, the I-Trigger reverts to the most recently selected Pressure or Flow value.) 3. Touch the Accept button in the I-Trigger or E-Trigger window. The Settings screen will display the current I-Trigger and E-Trigger values as shown in Figure 13-70. Triggering and Cycling with AutoTrak In order to determine triggering and cycling sensitivity thresholds for each breath, Auto-Trak applies multiple algorithms derived from flow, volume and pressure measurements throughout the breathing cycle. Triggering Auto-Trak monitors changes in pressure and flow patterns throughout exhalation, applies compensation for circuit leaks, and triggers an inspiration when the criterion for one of the triggering algorithms has been met. As a backup, Auto-Trak uses pressure triggering at a fixed level of 3 cm H2O. Cycling Auto-Trak automatically cycles breathing based on the pressure and flow patterns at the end of inspiration and beginning of expiration. The threshold used to cycle each breath changes with the patients breathing pattern and lung dynamics. Leak Detection and Compensation Patient leaks at the mask interface are a critical factor and are significant in determining triggering and cycling thresholds. With noninvasive ventilation, failure to compensate for these leaks can impact the patients work of breathing. Patient leak is the average leak rate during a breath and is estimated as the delivered volume minus exhaled volume divided by the total breath time. This average estimated leak value is displayed in LPM as Pt Leak in the Patient Data section of the Settings screen. Pt Leak is updated with each breath. Bias flow through the patient circuit is adjusted according to the estimated leak and is quantified as follows: REF 1057983 A Respironics V200 Ventilator Operator’s Manual 13-121 Chapter 13 Options and Accessories • For adult patients: Bias flow = Pt Leak + 5 LPM. • For pediatric patients: Bias flow= Pt Leak + 3 LPM. Patient flow is estimated as the delivered flow (Bias flow during exhalation) minus the estimated Leak Flow, minus the measured expiratory flow (flow through the exhalation valve): • Patient flow = Delivered flow - Leak flow measured expiratory flow The estimated Leak Flow value in the above equation differs from the Patient Leak value defined earlier. Leak Flow is the estimated leak at a given moment in time and is dependent upon pressure (the higher the pressure, the higher the leak flow) and the physical characteristics of the leak itself. The Patient Leak value is the average Leak Flow over an entire breath. When Auto-Trak is selected in NPPV mode, the estimated exhaled tidal volume includes compensation for the estimated leak volume lost during exhalation. Therefore, all other parameters that depend on exhaled tidal volume also include this compensation (for example, minute ventilation and rapid-shallow breathing index, F/Vt). If the Graphics Option is enabled, waveforms and loops displayed in NPPV mode will show estimated flows and volumes that include compensation for the estimated leak. Exhaled tidal volume is leak-compensated only in NPPV. Leaks that may occur during invasive ventilation are intentionally not compensated for, allowing them to be more easily detected. 13-122 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A. RS-232 Communications Protocol The ventilator will allow for the transmission of data from the ventilator via the RS-232 communications interface. The ventilator receives commands from the remote device and responds with fixed format records. RS-232 Configuration The RS-232 communications port will be configured in the following manner for all communications functions: • Baud Rate 19,200 • Data Bits 8 • Parity None • Stop Bits 1 Commands Transmitted to the Ventilator Commands are transmitted as a series of four ASCII characters followed by a carriage return. Valid commands will be stored and response transmissions will be sent in the order the corresponding commands were received. Invalid commands will be returned in an error message (Table A-7: “Unrecognized Commands” on page A-24), in sequence with all other commands. Transmission of Data from the Ventilator Unless stated otherwise, all fields will be left justified and six (6) characters in length. A comma will separate each field. Each data transmission shall be terminated with a carriage return. In the following subparagraphs, a space is designated as “◆”. When data is unavailable, the output field shall contain “----◆◆” (i.e. four dash characters followed by two spaces). Ventilator Report Command and Response (VRPT) REF 1057983 A When the ventilator receives VRPT followed by a carriage return, it will respond by transmitting the information shown in Table A-1: “Ventilation Report”. The ventilator responds to the VRPT command by returning a string with a variable length. Fields 2 through 4 define the length of the message. The last character transmitted is a stop code indicating the end of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of fields between the start and stop codes. The fourth field is the start code, 0x02. The last field in the string is the stop code, 0x03. Respironics V200 Ventilator Operator’s Manual Appendix A-1 Appendix A RS-232 Communications Protocol Ventilation Report Description Example Resolution Range Units Comments Command Name VRPT N/A N/A N/A Number of characters between the start and stop codes 990 N/A N/A N/A 3 character field Number of fields between the start and stop codes 134 N/A N/A N/A 3 character field Start Code 0x02 N/A N/A N/A ASCII Start Transmission Character (STX) Time of request 13:45◆ N/A N/A N/A 24 hour clock, hh:mm◆ Date FEB◆23◆1997◆ N/A N/A N/A 12 character field, MMM◆DD◆YYYY◆ Current Ventilation Type VCV◆◆◆ N/A VCV◆◆◆ PCV◆◆◆ NPPV◆◆ N/A The ventilation type currently being used by the ventilator. VCV Mode Setting A/C◆◆◆ N/A A/C◆◆◆ SIMV◆◆ CPAP◆◆ N/A VCV Waveform Setting RAMP◆◆ N/A RAMP◆◆ SQUARE N/A VCV Patient Type ADULT◆ N/A ADULT◆ PED◆◆◆ NEO◆◆◆ VCV Respiratory Rate Setting 12◆◆◆◆ 1 1 - 80 BPM VCV Tidal Volume Setting 500◆◆◆ 1 50 - 2500 mL VCV Peak Flow Setting 30◆◆◆◆ 1 3 - 140 LPM VCV PEEP Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) VCV Pressure Support Setting 0◆◆◆◆◆ 1 0 - 100 cmH2O (hPa) VCV I-Trigger Type PRESS◆ N/A PRESS◆ FLOW◆◆ AUTO◆◆ N/A VCV Pressure I-Trigger Setting 2.0◆◆◆ 0.1 0.1 - 20.0 cmH2O (hPa) VCV Flow I-Trigger Setting 3.0◆◆◆ 0.1 0.5 - 20.0 LPM Table A-1: Ventilation Report (Sheet 1 of 10) Appendix A-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units VCV E-Cycle Type %Flow◆ N/A %FLOW◆ AUTO◆◆ N/A VCV %Flow Expiratory Cycle Setting 25◆◆◆◆ 1 10 - 80 % VCV Rise Time 0.1◆◆◆ 0.1 0.1 - 0.9 Sec VCV Oxygen Concentration Setting 21◆◆◆◆ 1 21 - 100 % VCV Plateau Setting 0.0◆◆◆ 0.1 0.0 - 2.0 Sec VCV Apnea Rate Setting 12◆◆◆◆ 1 1 - 80 BPM VCV High Inspiratory Pressure Alarm Limit Setting 35◆◆◆◆ 1 10 - 105 cmH2O (hPa) VCV Low Inspiratory Pressure Alarm Limit Setting 3◆◆◆◆◆ 1 3 - 105 cmH2O (hPa) VCV Low PEEP Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) VCV Low Mandatory Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL VCV Low Spontaneous Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL VCV High Respiratory Rate Alarm Limit Setting 150◆◆◆ 1 0 - 150 BPM VCV Low Minute Volume Alarm Limit Setting 1.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L VCV Apnea Interval Alarm Limit Setting 20◆◆◆◆ 1 10 - 60 sec PCV Mode Setting A/C◆◆◆ N/A A/C◆◆◆ SIMV◆◆ CPAP◆◆ N/A PCV Patient Type ADULT◆ N/A ADULT◆ PED◆◆◆ NEO◆◆◆ PCV Respiratory Rate Setting 12◆◆◆◆ 1 1 - 150 BPM PCV Pressure Setting 20◆◆◆◆ 1 5 - 100 cmH2O (hPa) Comments Table A-1: Ventilation Report (Sheet 2 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-3 Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units PCV Inspiratory Time Setting 1.00◆◆ 0.01 0.1 - 9.9 sec PCV PEEP Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) PCV Pressure Support Setting 0◆◆◆◆◆ 1 0 - 100 cmH2O (hPa) PCV I-Trigger Type PRESS◆ N/A PRESS◆ FLOW◆◆ AUTO◆◆ N/A PCV Pressure I-Trigger Setting 2.0◆◆◆ 0.1 0.1 - 20.0 cmH2O (hPa) PCV Flow I-Trigger Setting 3.0◆◆◆ 0.1 0.3 - 20.0 LPM PCV E-Cycle Type %FLOW◆ N/A %FLOW◆ AUTO◆◆ N/A PCV %Flow Expiratory Cycle Setting 25◆◆◆◆ 1 10 - 80 % PCV Rise Time 0.1◆◆◆ 0.1 0.1 - 0.9 sec PCV Oxygen Concentration Setting 21◆◆◆◆ 1 21 - 100 % PCV Apnea Rate Setting 12◆◆◆◆ 1 1 - 80 BPM PCV Apnea Interval Alarm Limit Setting 20◆◆◆◆ 1 10 - 60 sec PCV High Inspiratory Pressure Alarm Limit Setting 35◆◆◆◆ 1 10 - 105 cmH2O (hPa) PCV Low Inspiratory Pressure Alarm Limit Setting 3◆◆◆◆◆ 1 3 - 105 cmH2O (hPa) PCV Low PEEP Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) PCV Low Mandatory Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL PCV Low Spontaneous Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL PCV High Respiratory Rate Alarm Limit Setting 150◆◆◆ 1 0 - 150 BPM Comments Table A-1: Ventilation Report (Sheet 3 of 10) Appendix A-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units PCV Low Minute Volume Alarm Limit Setting 1.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L PCV High Minute Volume Alarm Limit Setting 60.0◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L NPPV Mode Setting SPONT/T N/A SPONT/T SPONT◆◆ NPPV Patient Type ADULT◆ N/A ADULT◆ PED◆◆◆ NEO◆◆◆ NPPV Respiratory Rate Setting 12◆◆◆◆ 1 1 - 80 BPM NPPV EPAP Setting 5◆◆◆◆◆ 1 2 - 25 cmH2O (hPa) NPPV IPAP Setting 5◆◆◆◆◆ 1 2 - 35 cmH2O (hPa) NPPV Inspiratory Time Setting 1.0◆◆◆ 0.1 0.1 - 9.9 sec NPPV Rise Time 0.1◆◆◆ 0.1 0.1 - 0.9 sec NPPV I-Trigger Type AUTO◆ N/A FLOW◆◆ AUTO◆◆ N/A NPPV Flow I-Trigger Setting 3.0◆◆◆ 0.1 0.5 - 20.0 LPM NPPV E-Cycle Type AUTO◆◆ N/A FLOW◆◆ AUTO◆◆ N/A NPPV %Flow Expiratory Cycle Setting 25◆◆◆◆ 1 10 - 80 % NPPV Oxygen Concentration Setting 21◆◆◆◆ 1 21 - 100 % NPPV Apnea Rate Setting 12◆◆◆◆ 1 1 - 80 BPM NPPV Low Inspiratory Pressure Alarm Limit Setting 3◆◆◆◆◆ 1 3 - 105 cmH2O (hPa) NPPV Low EPAP Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 25 cmH2O (hPa) NPPV Low Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL Comments Table A-1: Ventilation Report (Sheet 4 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-5 Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units Comments NPPV High Respiratory Rate Alarm Limit Setting 150◆◆◆ 1 0 - 150 NPPV Low Minute Volume Alarm Limit Setting 1.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L NPPV Apnea Interval Alarm Limit Setting 20◆◆◆◆ 1 10 - 60 sec NPPV High Leak Alarm Limit Setting 60◆◆◆◆ 1 10 - 60 sec Measured Peak Inspiratory Pressure 24.1◆◆ 0.1 for -20.0 to 99.9 1 for 100 to 130 -20.0 - 130 cmH2O The PIP value from (hPa) the Patient Data screen. Measured Mean Airway Pressure 5.6◆◆◆ 0.1 for -20.0 to 99.9 1 for 100 to 120 -20.0 -120 cmH2O The MAP value (hPa) from the Patient Data screen. Measured End Expiratory Pressure 2.0◆◆◆ 0.1 -20.0-99.9 cmH2O The End Exp. value (hPa) from the Patient Data screen. Measured End Inhalation Pressure 24.0◆◆ 0.1 for -20.0 to 99.9 1 for 100 to 130 -20.0 - 130 cmH2O The Plateau value (hPa) from the Patient Data screen. Measured Tidal Volume 468◆◆◆ 1 0 - 2500 Measured Spontaneous Minute Volume 0.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L The Spont VE value from the Patient Data screen. Measured Minute Volume 5.83◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L The Total VE value from the Patient Data screen. Measured Spontaneous Breath Rate 0.0◆◆◆ 0.1 for 0.0 to 9.9 1 for 10 to 150 0.0 - 150 BPM The Spont Rate value from the Patient Data screen. Measured Total Breath Rate 12.0◆◆ 0.1 for 0.0 to 9.9 1 for 10 to 150 0 - 150 BPM The Total Rate value from the Patient Data screen. Measured Rapid Shallow Breathing Index 5◆◆◆◆◆ 1 0 - 500 BPM/L The F/Vt value from the Patient Data screen. BPM mL The Tidal Volume value from the Patient Data screen. Table A-1: Ventilation Report (Sheet 5 of 10) Appendix A-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units Comments Measured I:E Ratio 1:4.1◆ 0.1 for 9.9:1 to 1:9.9 1 for 1:10 to 1:99 4.1:1-1:99 N/A The I:E Ratio display from the Patient Data screen. Measured Patient Leak 0.0◆◆◆ 0.1 for 0.0 to 99.9 1 for 100 to 140 0.0 - 140 LPM The Pt Leak display. Measured Percent of Breaths Triggered by the Patient (NPPV Spont/T mode only; otherwise ◆◆◆◆◆◆) 56.2 0.1 for 0.0 to 99.9 1 for 100 0.0 - 100 % The Pt Trigger display on the NPPV Monitor screen. Monitored Oxygen Concentration 55.1◆◆ 0,1 for 0.0 to 99.9 1 for 100 0.0 - 100 % The % O2 display from the Patient Data Screen. Ti/Ttot 0.23◆◆ 0.01 0.00 - 1.00 N/A Dynamic Resistance 5.43◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 99.9 1 for 100 to 400 0.00 - 400 cmH20 The Dynamic /L/Sec Resistance display from the Mechanics Patient Status Screen Dynamic Compliance 19.2◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 99.9 1 for 100 to 350 0.00 - 350 mL/ The Dynamic cmH20 Compliance display from the Mechanics Patient Status Screen Peak Lung Flow 35.1◆◆ 0.1 for 99.9 to 99.9 1 for -100 to -300 1 for 100 to 300 -300 - 300 LPM The Peak L-Flow display from the Mechanics Patient Status Screen Vital Capacity 450◆◆ 1 0 - 9999 mL Vital Capacity display from Vital Capacity Screen The Ti/Ttot display from the Mechanics Patient Status Screen Table A-1: Ventilation Report (Sheet 6 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-7 Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units Comments Vital Capacity Time of Last Maneuver 11-1401◆◆13:11 1 minute 01-01-70 0:00 to 01-19-38 3:14 N/A Time of Last Maneuver display from the Vital Capacity Screen.15 character field, 24 hour clock: MMDD-YYuuHH:MM MIP -54.1◆ 0.1 for -99.9 to 99.9 1 for -100 and 100 to 200 -100 - 200 cmH20 MIP display from MIP/P0.1 display Screen MIP Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-7 0 0:00 to 01-19-38 3:14 N/A P0.1 -2.3◆◆ 0.1for -99.9 to 99.9 1 for -100 and 100 to 200 -100 - 200 cmH20 P0.1 display from MIP/P0.1 display screen P0.1 Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-1-/38 3:14 N/A Static Resistance 5.43◆◆ 0,01 for 0.00 to 9.99 0.1 for 10.0 to 99.9 1 for 100 to 400 0.00 - 400 cmH20 Static Resistance /L/Sec display from the Static C & R screen Static Compliance 19.2◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 99.9 1 for 100 to 350 0.00 - 350 mL/ Static Compliance cmH2O display from the Static C & R Screen Static C & R Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-19-38 3:14 N/A MIP Time of Last Maneuver display from MIP/P0.1 Screen15 character field, 24 hour clock: MMDD-YYuuHH:MM P0.1 Time of Last Maneuver display from MIP/P0.1 Screen.15 character field, 24 hour clock: MMDD-YYwwHH:MM Static C & R Time of Last Maneuver display from Static C & R Screen.15 character field, 24 hour clock: MMDD-YYwwHH:MM Table A-1: Ventilation Report (Sheet 7 of 10) Appendix A-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units Comments AutoPeep 1.2◆◆ 0.1 for -9.9 to 9.9 1 for -10 to 20 1 for 10 to 120 -20 - 120 cmH2O AutoPeep display from the Mechanics Patient Status Screen AutoPeep Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-19-38 3:14 N/A Occlusion Alarm Status or SM Occlusion Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Safety Valve Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low Internal Battery Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Nonvolatile Memory Failure—Using Default Settings NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Primary Alarm Failure NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High Inspiratory Pressure Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Apnea Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low Inspiratory Pressure Alarm Status or Disconnect Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Air Source Fault Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A O2 Valve Stuck Closed Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A AutoPeep Time of Last Maneuver display from Mechanics Patient Status Screen.15 character field, 24 hour clock: MMDD-YYwwHH:MM Table A-1: Ventilation Report (Sheet 8 of 10) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-9 Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units Comments Exhalation Valve Stuck Open Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low O2 Supply Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low supply pressure Low O2 Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low O2 concentration Low Minute Volume Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low Mandatory Tidal Volume Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High Minute Volume Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low Tidal Volume Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low Spontaneous Tidal Volume Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A I-Time Too Long Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High Respiratory Rate Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High O2 Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High Enclosure Temperature Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High Internal Oxygen Concentration Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Low PEEP Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A Table A-1: Ventilation Report (Sheet 9 of 10) Appendix A-10 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Ventilation Report (Continued) Description Example Resolution Range Units Low EPAP Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A High Leak Alarm Status NORMAL N/A NORMAL ALARM◆ RESET◆ N/A 100% O2 Function Status OFF◆◆◆ N/A ON◆◆◆◆ OFF◆◆◆ N/A Status of the 100% O2 LED on the front panel Alarm Silence Status OFF◆◆◆ N/A ON◆◆◆◆ OFF◆◆◆ N/A Status of the Alarm Silence LED on the front panel Screen Lock Status OFF◆◆◆ N/A ON◆◆◆◆ OFF◆◆◆ N/A Status of the Screen Lock LED on the front panel Tube Type ET◆◆◆◆ N/A ET◆◆◆◆ TT◆◆◆◆ NONE◆◆ N/A Tube type as selected in Respiratory Mechanics Screens (Not used) Tube Size 7.0◆◆◆ 0.1 for 3.5 to 9.9 1 for 10 3.5 - 10 mm Tube size as selected in Respiratory Mechanics Screens (Not used) VCV High Minute Volume Alarm Limit Setting 60.0◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L Static C & R Plateau End Pressure 8.2◆◆◆ 0.1 for -20 to 99.9 1 for 100 to 130 -20.0 - 130 cmH2O Pplat display from Static C & R Screen Stop Code 0x03 N/A N/A N/A Comments ASCII End Transmission Character (ETX) Table A-1: Ventilation Report (Sheet 10 of 10) Volume Control Ventilation Settings Report (VCVS) REF 1057983 A When the ventilator receives VCVS followed by a carriage return, it will respond by transmitting the information shown in Table A-2: “Volume Control Ventilation Settings Report”. The ventilator responds to the VCVS command by returning a string with a variable length. Fields 2 through 4 define the length of the message. The last character transmitted is a stop code indicating the end of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of Respironics V200 Ventilator Operator’s Manual Appendix A-11 Appendix A RS-232 Communications Protocol fields between the start and stop codes. The fourth field is the start code, 0x02. The last field in the string is the stop code, 0x03. Volume Control Ventilation Settings Report Description Example Resolution Range Units Comments Command Name VCVS N/A N/A N/A Number of characters between the start and stop codes 209 N/A N/A N/A 3 character field Number of fields between the start and stop codes 29 N/A N/A N/A 2 character field Start Code 0x02 N/A N/A N/A ASCII Start Transmission Character (STX) Time of request 13:45◆ N/A N/A N/A 24 hour clock, hh:mm◆ Date FEB◆23◆1997◆ N/A N/A N/A 12 character field, MMM◆DD◆YYYY◆ Current Ventilation Type VCV◆◆◆ N/A VCV◆◆◆ PCV◆◆◆ NPPV◆◆ N/A The ventilation type currently being used by the ventilation. VCV Mode Setting A/C◆◆◆ N/A A/C◆◆◆ SIMV◆◆ CPAP◆◆ N/A VCV Waveform Setting RAMP◆◆ N/A RAMP◆◆ SQUARE N/A VCV Patient Type ADULT◆ N/A ADULT◆ PED◆◆◆ NEO◆◆◆ VCV Respiratory Rate Setting 12◆◆◆◆ 1 1 - 80 BPM VCV Tidal Volume Setting 500◆◆◆ 1 50 - 2500 mL VCV Peak Flow Setting 30◆◆◆◆ 1 3 - 140 LPM VCV PEEP Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) VCV Pressure Support Setting 0◆◆◆◆◆ 1 0 - 100 cmH2O (hPa) VCV I-Trigger Type PRESS◆ N/A PRESS◆ FLOW◆◆ AUTO◆◆ N/A VCV Pressure ITrigger Setting 2.0◆◆◆ 0.1 0.1 - 20.0 cmH2O (hPa) Table A-2: Volume Control Ventilation Settings Report (Sheet 1 of 2) Appendix A-12 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Volume Control Ventilation Settings Report (Continued) Description Example Resolution Range Units VCV Flow I-Trigger Setting 3.0◆◆◆ 0.1 0.5 - 20.0 LPM VCV E-Cycle Type %Flow◆ N/A %FLOW◆ AUTO◆◆ N/A VCV %Flow Expiratory Cycle Setting 25◆◆◆◆ 1 10 - 80 % VCV Rise Time 0.1◆◆◆ 0.1 0.1 - 0.9 Sec VCV Oxygen 21◆◆◆◆ Concentration Setting 1 21 - 100 % VCV Plateau Setting 0.0◆◆◆ 0.1 0.0 - 2.0 Sec VCV Apnea Rate Setting 12◆◆◆◆ 1 1 - 80 BPM VCV High Inspiratory Pressure Alarm Limit Setting 35◆◆◆◆ 1 10 - 105 cmH2O (hPa) VCV Low Inspiratory Pressure Alarm Limit Setting 3◆◆◆◆◆ 1 3 - 105 cmH2O (hPa) VCV Low PEEP Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) VCV Low Mandatory Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL VCV Low Spontaneous Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL VCV High Respiratory Rate Alarm Limit Setting 150◆◆◆ 1 0 - 150 BPM VCV Low Minute Volume Alarm Limit Setting 1.00◆◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L VCV Apnea Interval Alarm Limit Setting 20◆◆◆◆ 1 10 - 60 VCV High Minute Volume Alarm Limit Setting 60.0◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L Stop Code 0x03 N/A N/A Comments sec N/A ASCII End Transmission Character (ETX) Table A-2: Volume Control Ventilation Settings Report (Sheet 2 of 2) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-13 Appendix A RS-232 Communications Protocol Pressure Control Ventilation Settings Report (PCVS) When the ventilator receives PCVS followed by a carriage return, it will respond by transmitting the information shown in Table A-3: “Pressure Control Ventilation Settings Report”. The ventilator responds to the PCVS command by returning a string with a variable length. Fields 2 through 4 define the length of the message. The last character transmitted is a stop code indicating the end of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of fields between the start and stop codes. The fourth field is the start code, 0x02. The last field in the string is the stop code, 0x03. Pressure Control Ventilation Settings Report Description Example Resolution Range Units Comments Command Name PCVS N/A N/A N/A Number of characters between the start and stop codes 195 N/A N/A N/A 3 character field Number of fields between the start and stop codes 27 N/A N/A N/A 2 character field Start Code 0x02 N/A N/A N/A ASCII Start Transmission Character (STX) Time of request 13:45◆ N/A N/A N/A 24 hour clock, hh:mm◆ Date FEB◆23◆1997◆ N/A N/A N/A 12 character field, MMM◆DD◆YYYY◆ Current Ventilation Type VCV◆◆◆ N/A VCV◆◆◆ PCV◆◆◆ NPPV◆◆ N/A The ventilation type currently being used by the ventilator. PCV Mode Setting A/C◆◆◆ N/A A/C◆◆◆ SIMV◆◆ CPAP◆◆ N/A PCV Patient Type ADULT◆ N/A ADULT◆ PED◆◆◆ NEO◆◆◆ PCV Respiratory Rate Setting 12◆◆◆◆ 1 1 - 150 BPM PCV Pressure Setting 20◆◆◆◆ 1 5 - 100 cmH2O (hPa) PCV Inspiratory Time Setting 1.00◆◆ 0.01 0.1 - 9.9 sec PCV PEEP Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) PCV Pressure Support Setting 0◆◆◆◆◆ 1 0 - 100 cmH2O (hPa) Table A-3: Pressure Control Ventilation Settings Report (Sheet 1 of 3) Appendix A-14 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Pressure Control Ventilation Settings Report (Continued) Description Example Resolution Range Units PCV I-Trigger Type PRESS◆ N/A PRESS◆ FLOW◆◆ AUTO◆◆ N/A PCV Pressure I-Trigger Setting 2.0◆◆◆ 0.1 0.1 - 20.0 cmH2O (hPa) PCV Flow I-Trigger Setting 3.0◆◆◆ 0.1 0.3 - 20.0 LPM PCV E-Cycle Type %FLOW◆ N/A %FLOW◆ AUTO◆◆ N/A PCV %Flow Expiratory Cycle Setting 25◆◆◆◆ 1 10 - 80 % PCV Rise Time 0.1◆◆◆ 0.1 0.1 - 0.9 sec PCV Oxygen Concentration Setting 21◆◆◆◆ 1 21 - 100 % PCV Apnea Rate Setting 12◆◆◆◆ 1 1 - 80 BPM PCV Apnea Interval Alarm Limit Setting 20◆◆◆◆ 1 10 - 60 sec PCV High Inspiratory Pressure Alarm Limit Setting 35◆◆◆◆ 1 10 - 105 cmH2O (hPa) PCV Low Inspiratory Pressure Alarm Limit Setting 3◆◆◆◆◆ 1 3 - 105 cmH2O (hPa) PCV Low PEEP Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 35 cmH2O (hPa) PCV Low Mandatory Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL PCV Low Spontaneous Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL PCV High Respiratory Rate Alarm Limit Setting 150◆◆◆ 1 0 - 150 BPM PCV Low Minute Volume Alarm Limit Setting 1.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L Comments Table A-3: Pressure Control Ventilation Settings Report (Sheet 2 of 3) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-15 Appendix A RS-232 Communications Protocol Pressure Control Ventilation Settings Report (Continued) Description Example Resolution Range Units PCV High Minute Volume Alarm Limit Setting 60.0◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L Stop Code 0x03 N/A N/A N/A Comments ASCII End Transmission Character (ETX) Table A-3: Pressure Control Ventilation Settings Report (Sheet 3 of 3) Non-Invasive Positive Pressure Ventilation Settings Report (NPVS) When the ventilator receives NPVS followed by a carriage return, it will respond by transmitting the information shown in Table A-4: “Non-Invasive Positive Pressure Ventilation Settings Report”. The ventilator responds to the NPVS command by returning a string with a variable length. Fields 2 through 4 define the length of the message. The last character transmitted is a stop code indicating the end of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of fields between the start and stop codes. The fourth field is the start code, 0x02. The last field in the string is the stop code, 0x03. Non-Invasive Positive Pressure Ventilation Settings Report Description Example Resolution Range Units Command Name NPVS N/A N/A N/A Number of characters between the start and stop codes 168 N/A N/A N/A 3 character field Number of fields between the start and stop codes 23 N/A N/A N/A 2 character field Start Code 0x02 N/A N/A N/A ASCII Start Transmission Character (STX) Time of request 13:45◆ N/A N/A N/A 24 hour clock, hh:mm◆ Date FEB◆23◆1997◆ N/A N/A N/A 12 character field, MMM◆DD◆YYYY◆ Current Ventilation Type VCV◆◆◆ VCV◆◆◆ PCV◆◆◆ NPPV◆◆ N/A The ventilation type currently being used by the ventilator. N/A Comments Table A-4: Non-Invasive Positive Pressure Ventilation Settings Report (Sheet 1 of 3) Appendix A-16 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Non-Invasive Positive Pressure Ventilation Settings Report (Continued) Description Example Resolution Range Units NPPV Mode Setting SPONT/T N/A SPONT/T SPONT◆◆ NPPV Patient Type ADULT◆ N/A ADULT◆ PED◆◆◆ NEO◆◆◆ NPPV Respiratory Rate Setting 12◆◆◆◆ 1 1 - 80 BPM NPPV EPAP Setting 5◆◆◆◆◆ 1 2 - 25 cmH2O (hPa) NPPV IPAP Setting 5◆◆◆◆◆ 1 2 - 35 cmH2O (hPa) NPPV Inspiratory Time Setting 1.0◆◆◆ 0.1 0.1 - 9.9 sec NPPV Rise Time 0.1◆◆◆ 0.1 0.1 - 0.9 sec NPPV I-Trigger Type FLOW◆◆ N/A FLOW◆◆ AUTO◆◆ N/A NPPV Flow I-Trigger Setting 3.0◆◆◆ 0.1 0.5 - 20.0 LPM NPPV E-Cycle Type %FLOW◆ N/A %FLOW◆ AUTO◆◆ N/A NPPV %Flow Expiratory Cycle Setting 25◆◆◆◆ 1 10 - 80 % NPPV Oxygen Concentration Setting 21◆◆◆◆ 1 21 - 100 % NPPV Apnea Rate Setting 12◆◆◆◆ 1 1 - 80 BPM NPPV Low Inspiratory Pressure Alarm Limit Setting 3◆◆◆◆◆ 1 3 - 105 cmH2O (hPa) NPPV Low EPAP Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 25 cmH2O (hPa) NPPV Low Tidal Volume Alarm Limit Setting 0◆◆◆◆◆ 1 0 - 2500 mL NPPV High Respiratory Rate Alarm Limit Setting 150◆◆◆ 1 0 - 150 BPM NPPV Low Minute Volume Alarm Limit Setting 1.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L NPPV Apnea Interval Alarm Limit Setting 20◆◆◆◆ 1 10 - 60 Comments sec Table A-4: Non-Invasive Positive Pressure Ventilation Settings Report (Sheet 2 of 3) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-17 Appendix A RS-232 Communications Protocol Non-Invasive Positive Pressure Ventilation Settings Report (Continued) Description Example Resolution Range Units NPPV High Leak Alarm Limit 60◆◆◆◆ 1 1 - 60 LPM Stop Code 0x03 N/A N/A N/A Comments ASCII End Transmission Character (ETX) Table A-4: Non-Invasive Positive Pressure Ventilation Settings Report (Sheet 3 of 3) Patient Data Report (PTDT) When the ventilator receives PTDT followed by a carriage return, it will respond by transmitting the information shown in Table A-5: “Patient Data Report”. The ventilator responds to the PTDT command by returning a string with a variable length. Fields 2 through 4 define the length of the message. The last character transmitted is a stop code indicating the end of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of fields between the start and stop codes. The fourth field is the start code, 0x02. The last field in the string is the stop code, 0x03. Patient Data Report Description Example Resolution Range Units Comments Command Name PTDT N/A N/A N/A Number of characters between the start and stop codes 275 N/A N/A N/A 3 character field Number of fields between the start and stop codes 32 N/A N/A N/A 2 character field Start Code 0x02 N/A N/A N/A ASCII Start Transmission Character (STX) Time of request 13:45◆ N/A N/A N/A 24 hour clock, hh:mm◆ Date FEB◆23◆1997◆ N/A N/A N/A 12 character field, MMM◆DD◆YYYY◆ Measured Peak Inspiratory Pressure 24.1◆◆ 0.1 for -20.0 to 99.9 -20.0 - 130 cmH2O The PIP value from (hPa) the Patient Data 1 for 100 to 130 screen. Measured Mean Airway Pressure 5.6◆◆◆ 0.1 for -20.0 to 99.9 -20.0 -120 1 for 100 to 120 cmH2O The MAP value (hPa) from the Patient Data screen. Table A-5: Patient Data Report (Sheet 1 of 4) Appendix A-18 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Patient Data Report (Continued) Description Example Resolution Range Units Comments Measured End Expiratory Pressure Data 2.0◆◆◆ 0.1 -20.0-99.9 cmH2O The End Exp. value (hPa) from the Patient Data screen. Measured End 24.0◆◆ Inhalation Pressure 0.1 for -20.0 to 99.9 -20.0 - 130 cmH2O The Plateau value (hPa) from the Patient 1 for 100 to 130 Data screen. Measured Tidal Volume 468◆◆◆ 1 0 - 2500 Measured Spontaneous Minute Volume 0.00◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L The Spont VE value from the Patient Data screen. Measured Minute Volume 5.83◆◆ 0.01 for 0.00 to 9.99 0.1 for 10.0 to 60.0 0.00 - 60.0 L The Total VE value from the Patient Data screen. Measured Spontaneous Breath Rate 0.0◆◆◆ 0.1 for 0.0 to 9.9 1 for 10 to 150 0.0 - 150 BPM The Spont Rate value from the Patient Data screen. Measured Total Breath Rate 12.0◆◆ 0.1 for 0.0 to 9.9 1 for 10 to 150 0 - 150 BPM The Total Rate value from the Patient Data screen. Measured Rapid Shallow Breathing Index 5◆◆◆◆◆ 1 0 - 500 BPM/L The F/Vt value from the Patient Data screen. Measured I:E Ratio 1:4.1◆ 0.1 for 9.9:1 to 1:9.9 1 for 1:10 to 1:99 4.1:1-1:99 N/A The I:E Ratio display from the Patient Data screen. Measured Patient Leak 0.0◆◆◆ 0.1 for 0.0 to 99.9 1 for 100 to 140 0.0 - 140 LPM The Pt Leak display. Measured Percent of Breaths Triggered by the Patient (NPPV Spont/T mode only; otherwise ◆◆◆◆◆◆) 56.2◆◆ 0.1 for 0.0 to 99.9 1 for 100 0.0 - 100 % The Pt Trigger display on the NPPV Monitor screen. Monitored Oxygen Concentration 55.1◆◆ 0,1 for 0.0 to 99.91 for 100 0.0 - 100 % The % O2 display from the Patient Data Screen. Ti/Ttot 0.23◆◆ 0.01 0.00 - 1.00 N/A mL The Tidal Volume value from the Patient Data screen. The Ti/Ttot display from the Mechanics Patient Status Screen Table A-5: Patient Data Report (Sheet 2 of 4) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-19 Appendix A RS-232 Communications Protocol Patient Data Report (Continued) Description Example Resolution Range Units Comments Dynamic Resistance 5.43◆◆ 0.01 for 0.00 to 9.990.1 for 10.0 to 99.91 for 100 to 400 0.00 - 400 cmH2 0/L/ Sec The Dynamic Resistance display from the Mechanics Patient Status Screen Dynamic Compliance 19.2◆◆ 0.01 for 0.00 to 9.990.1 for 10.0 to 99.91 for 100 to 350 0.00 - 350 mL/cm H20 The Dynamic Compliance display from the Mechanics Patient Status Screen Peak Lung Flow 35.1◆◆ 0.1 for -99.9 to 99.91 for -100 to -3001 for 100 to 300 -300 - 300 LPM The Peak L-Flow display from the Mechanics Patient Status Screen Vital Capacity 468◆◆ 1 0 - 9999 mL Vital Capacity display from Vital Capacity Screen Vital Capacity Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-19-38 3:14 N/A Time of Last Maneuver display from the Vital Capacity Screen.15 character field, 24 hour clock: MMDD-YYuuHH:MM MIP -54.1◆ 0.1 for -99.9 to 99.91 for -100 and 100 to 200 -100 - 200 cm H20 MIP display from MIP/P0.1 display Screen MIP Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-7 0 0:00 to 01-19-38 3:14 N/A MIP Time of Last Maneuver display from MIP/P0.1 Screen15 character field, 24 hour clock: MMDD-YYuuHH:MM P0.1 -2.3◆◆ 0.1for -99.9 to 99.91 for -100 and 100 to 200 -100 - 200 cm H20 P0.1 display from MIP/P0.1 display screen P0.1 Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-1-/38 3:14 N/A P0.1 Time of Last Maneuver display from MIP/P0.1 Screen.15 character field, 24 hour clock: MMDD-YYwwHH:MM Static Resistance 5.43◆◆ 0,01 for 0.00 to 9.990.1 for 10.0 to 99.91 for 100 to 400 0.00 - 400 cmH2 0/L/ Sec Static Resistance display from the Static C & R screen Table A-5: Patient Data Report (Sheet 3 of 4) Appendix A-20 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Patient Data Report (Continued) Description Example Resolution Range Units Comments Static Compliance 19.2◆◆ 0.01 for 0.00 to 9.990.1 for 10.0 to 99.91 for 100 to 350 0.00 - 350 mL/ cmH2 O Static Compliance display from the Static C & R Screen Static C & R Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-19-38 3:14 N/A Static C & R Time of Last Maneuver display from Static C & R Screen.15 character field, 24 hour clock: MMDD-YYwwHH:MM AutoPeep 1.2◆◆ 0.1 for -9.9 to 9.91 for -10 to -201 for 10 to 120 -20 - 120 cmH2 O AutoPeep display from the Mechanics Patient Status Screen AutoPeep Time of Last Maneuver 11-14-01◆◆13:11 1 minute 01-01-70 0:00 to 01-19-38 3:14 N/A AutoPeep Time of Last Maneuver display from Mechanics Patient Status Screen.15 character field, 24 hour clock: MMDD-YYwwHH:MM Static C & R Plateau End Pressure 8.2◆◆◆ 0.2 for -20 to 99.9 1 for 100 to 130 -20.0 - 130 cmH2O Pplat display from Static C & R Screen Stop Code 0x03 N/A N/A N/A ASCII End Transmission Character (ETX) Table A-5: Patient Data Report (Sheet 4 of 4) Alarm Status Report (ALRM) REF 1057983 A When the ventilator receives ALRM followed by a carriage return, it will respond by transmitting the information shown in Table A-6: “Alarm Status Report”. The ventilator responds to the ALRM command by returning a string with a variable length. Fields 2 through 4 define the length of the message. The last character transmitted is a stop code indicating the end of the message. The second field indicates the number of characters between the start and stop codes. The third field indicates the number of fields between the start and stop codes. The fourth field is the start code, 0x02. The last field in the string is the stop code, 0x03. Respironics V200 Ventilator Operator’s Manual Appendix A-21 Appendix A RS-232 Communications Protocol Alarm Status Report Description Example Range Comments Command Name ALRM N/A Number of characters between the start and stop codes 202 N/A 3 character field Number of fields between the start and stop codes 28 N/A 2 character field Start Code 0x02 N/A ASCII Start Transmission Character (STX) Time of request 13:45◆ N/A 24 hour clock, hh:mm◆ Date FEB◆23◆1997◆ N/A 12 character field, MMM◆DD◆YYYY◆ Occlusion Alarm Status or SM Occlusion Status NORMAL NORMAL ALARM◆ RESET◆ Safety Valve Status NORMAL NORMAL ALARM◆ RESET◆ Low Internal Battery Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Nonvolatile Memory Failure—Using Default Settings NORMAL NORMAL ALARM◆ RESET◆ Primary Alarm Failure NORMAL NORMAL ALARM◆ RESET◆ High Inspiratory Pressure Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Apnea Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low Inspiratory Pressure Alarm Status or Disconnect Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Air Source Fault Alarm Status NORMAL NORMAL ALARM◆ RESET◆ O2 Valve Stuck Closed Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Table A-6: Alarm Status Report (Sheet 1 of 3) Appendix A-22 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix A RS-232 Communications Protocol Alarm Status Report (Continued) Description Example Range Comments Exhalation Valve Stuck Open Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low O2 Supply Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low supply pressure Low O2 Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low O2 concentration Low Minute Volume Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low Mandatory Tidal Volume Alarm Status NORMAL NORMAL ALARM◆ RESET◆ High Minute Volume Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low Tidal Volume Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low Spontaneous Tidal Volume Alarm Status NORMAL NORMAL ALARM◆ RESET◆ I-Time Too Long Alarm Status NORMAL NORMAL ALARM◆ RESET◆ High Respiratory Rate Alarm Status NORMAL NORMAL ALARM◆ RESET◆ High O2 Alarm Status NORMAL NORMAL ALARM◆ RESET◆ High Enclosure Temperature Alarm Status NORMAL NORMAL ALARM◆ RESET◆ High Internal Oxygen Concentration Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Low PEEP Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Table A-6: Alarm Status Report (Sheet 2 of 3) REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix A-23 Appendix A RS-232 Communications Protocol Alarm Status Report (Continued) Description Example Range Low EPAP Alarm Status NORMAL NORMAL ALARM◆ RESET◆ High Leak Alarm Status NORMAL NORMAL ALARM◆ RESET◆ Stop Code 0x03 N/A Comments ASCII End Transmission Character (ETX) Table A-6: Alarm Status Report (Sheet 3 of 3) Unrecognized Commands If an unrecognized command is received, the ventilator will respond by transmitting the information shown in Table A-7: “Unrecognized Commands”. Unrecognized Commands Description Example Comments The unrecognized command response: ?ERROR ?ERROR Time of request 13:45◆ 24 hour clock, hh:mm◆ Up to the first five characters received set off in brackets [VRPY] Example for VRPT being sent as VRPY. Nonprintable characters are returned as ^. Table A-7: Unrecognized Commands Appendix A-24 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix B. Customer Service & Warranty Customer Service For further information or assistance in operating the Respironics V200, contact Respironics Customer Service: Within the United States: 800-345-6443 Outside the United States: 724-387-4000 Fax: 724-387-5012 email: service@respironics.com Warranty Two Year Warranty Respironics warrants the Respironics V200 to be free from defects in material and workmanship for a period of two years from the date of purchase, provided that the unit is operated under conditions of normal use as described in this Operator’s Manual. At its discretion, Respironics will make replacements, repairs, or issue credits for equipment or parts that are found to be defective. Exclusions This warranty does not apply to any unit or individual parts which have been repaired or altered in any way that, in Respironics’ judgement, affect its ability or reliability, or which has been subjected to misuse, negligence, abuse, or accident. Unauthorized service and/or failure to perform periodic maintenance may void this warranty. This warranty does not cover damage that may occur in shipment. Warranty Limits This warranty takes precedence over all other warranties, expressed or implied. This warranty also takes precedence over all other obligations or liabilities on the part of Respironics including, but not limited to, contingent or consequential damages, such as costs of repairing or replacing other property which may be damaged as a direct result of Respironics V200 operation. This warranty, and the rights and obligations described herein, is construed under and governed by the laws of the State of California, U.S.A. REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix B-1 Appendix B Customer Service & Warranty Options and Accessories Appendix B-2 Warranties are available for various options and accessories. See the specific option or accessory in Chapter 13 for complete warranty information. Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix C. Alarm Testing Procedure The following procedure is available if the operator wants to test the operation of the following alarms. We recommend following “Preoperational Procedure” on page 8-32 before performing the Alarm Testing procedure. It is assumed that the preoperational procedure has been run before the Alarm Testing Procedure is followed. Setup 1. Connect O2 supply to the Respironics V200 Ventilator. 2. Connect optional O2 sensor. 3. Run EST. 4. Attach the test lung to the patient wye. (Use the test lung provided with your system.) 5. Use the following settings: REF 1057983 A • Mode VCV-A/C • Tidal Vol: 400ml • High Pressure (HIP): 50cmH20 (hPa) (or higher if required by the test lung) • Rate: 10 Bpm • Low Insp Press: 3 cmH20 (hPa) • Peak Flow 40 Lpm • • PEEP: 4 cmH20 (hPa) Low PEEP: 2 cmH20 (hPa) • Low Vt Mand: 0 mL • • PSV: 0 cmH20 (hPa) Low Vt Spont: 0 Lpm • I-Trigger: 2 cmH20 (hPa) • High Rate: 150 Bpm • O2: 21% • Low VE: 1 L • Insp. Hold: 0 sec. • Apnea: 15 sec. • Apnea Rate: 20 Bpm Respironics V200 Ventilator Operator’s Manual Appendix C-1 Appendix C Alarm Testing Procedure High Inspiratory Pressure Alarm Test 1. During inhalation squeeze the test lung for at least two breaths until the High Pressure alarm sounds. 2. Wait for one normal breath, the alarm auto resets. 3. RESET the alarm. Low Volume Alarm Test 1. Set the Low Vt Mand alarm limit to 500 ml. 2. Wait for one breath and alarm should sound. 3. Set the Low Vt Mand to 0 ml. 4. Wait for one breath and RESET the alarm. Low O2 Alarm Test (If optional O2 sensor is installed.) 1. Turn the ventilator OFF. 2. Disconnect the O2 sensor and its Tee from the inhalation limb of the patient circuit. (Leave the electrical connection.) 3. Connect the inspiratory bacteria filter directly to the gas outlet port and connect the inhalation limb to the filter. 4. Turn the ventilator ON. 5. Set the O2 setting to 40%. 6. Wait at least 3-5 breaths, the alarm should sound. 7. Set the O2 setting to 21%. 8. Wait for 3 - 5 breaths, the alarm should reset. 9. Press the RESET key to clear the alarm. 10. Turn the ventilator OFF and re-insert the O2 sensor and Tee. 11. Turn the ventilator ON. Power Fail Alarm Test 1. While the system is ventilating normally, pull the AC plug from the wall. 2. If the backup battery is attached, the ventilator should continue ventilating, and an alarm should sound every 60 seconds. If no backup battery is attached, the ventilator will stop operating and sound a continuous audible alarm. 3. Plug the power cord back in. Appendix C-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Appendix C Alarm Testing Procedure 4. Alarm should reset. (If the backup battery is attached, the ventilator should return to AC power. If no battery is attached, the ventilator will resume operating.) Apnea Alarm Test 1. Set the rate to 1 breath per minute. 2. Wait for 20 seconds. 3. The Respironics V200 should begin ventilating at a rate of 20 BPM while activating the Apnea alarm. 4. Reset the rate to 10 BPM. 5. RESET the alarm. 6. The Respironics V200 should begin ventilating normally. REF 1057983 A Respironics V200 Ventilator Operator’s Manual Appendix C-3 Appendix C Alarm Testing Procedure (This page is intentionally blank.) Appendix C-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Glossary Abbreviations 24 Hrs used to describe format for time-of-day when AM or PM does not appear AC alternating current (power) A/C assist/control ventilation AM/PM used to describe format for time-of-day when AM or PM occurs ASCII commonly accepted 8-bit binary code for characters Assist assist/control ventilation ATPS ambient temperature, ambient pressure, saturated (with water vapor) Auto-PEEP end-expiratory alveolar pressure above set PEEP level Aux auxiliary BTPS Body temperature (98°F, ambient pressure) 100% saturated (with water vapor) C compliance, ratio of change in volume divided by change in pressure CL lung compliance cmH2O unit of pressure measurement centimeters of water CMV controlled mechanical ventilation (same as A/C) CPAP continuous positive airway pressure Crs compliance of respiratory system Cw chest wall compliance DISS Diameter Index Safety System E-Cycle Expiratory Cycle End Exp end expiratory pressure EPAP expiratory positive airway pressure ETO ethylene oxide. Gas used for sterilization. REF 1057983 A Respironics V200 Ventilator Operator’s Manual Glossary-1 Glossary f respiratory frequency FIO2 fractional inspired oxygen FRC functional residual capacity f/VT rate versus tidal volume ratio; rapid shallow breathing index HIP high inspiratory pressure HME heat and moisture exchanger hPa unit of pressure measurement hecto Pascals I:E ratio inspiration:exhalation ratio ICU intensive care unit ISO International Standards Organization IMV intermittent mandatory ventilation Inop inoperational IPAP inspiratory positive airway pressure I-Time inspiratory time L Liter MAP mean airway pressure mL milliliter, or 1/1000 L mm millimeters msec millisecond M a notation for screw threads: metric NPPV noninvasive positive pressure ventilation NO nitric oxide O2 molecular oxygen OIM operator initiated mandatory Paw airway pressure PCV pressure-controlled ventilation Pe End airway pressure at end exhalation Glossary-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Glossary PEEP positive end-expiratory pressure Pi End airway pressure at the end of inhalation PIP peak inspiratory pressure Plateau inspiratory plateau pressure, pressure at end exhalation and no flow from or out of the ventilator Pplat end-inspiratory plateau pressure psi pounds per square inch; Unit of pressure measurement psig pounds per square inch gauge (above atmospheric pressure) PSV pressure-support ventilation SIMV synchronous intermittent mandatory ventilation Spont Rate spontaneous respiratory rate Spont T spontaneous timed Spont VE spontaneous volume exhaled STPD standard temperature, standard pressure dry SVO safety valve open Tidal Vol tidal volume Total RR total respiratory rate Total VE total volume exhaled/minute V volume • V flow VAC volts of alternating current (power) • V E expired minute ventilation Vent ventilator VT tidal volume REF 1057983 A Respironics V200 Ventilator Operator’s Manual Glossary-3 Glossary Definitions Airway Pressure the pressure in the patient circuit, measured at the distal end of the exhalation filter. Baseline as in baseline pressure. The pressure at end exhalation. Baud serial transmission speed usually bits/second. Bias flow a continuous flow of gas used during expiratory phase when flow triggering is active. Bit binary digit. Compliance a measure of stiffness for containers that hold gas (i.e. lungs, patient tubing). The volume required to increase the pressure in the container by a unit of pressure (i.e., L/cmH2O (hPa)). Continuous positive airway pressure (CPAP) a mode of ventilator operation that allows the patient to breath spontaneously from a continuous-flow or demand valve at an elevated airway pressure. (same as CAP) E-Cycle The E-Cycle setting on the ventilator determines when the ventilator will transition from inspiration to expiration in PSV and NPPV modes. E-Cycle defines the percent of peak inspiratory flow that end inspiratory flow needs to drop to in order for inspiration to end. End Expiratory Pressure (End Exp) the airway pressure measured at the end of exhalation. The display is updated at the end of each exhalation. Expiratory phase (exhalation) the part of the ventilatory cycle from the beginning of expiratory flow to the beginning of inspiratory flow. Flow Trigger initiation of inspiration when the patients inspiratory effort exceeds the flow sensitivity setting (threshold). Indicator a light, usually light emitting diode (LED). Inspiration:Exhalation Ratio (I:E ratio) a standard I:E ratio. It is displayed as XX:1 when exhalation period is larger than the inhalation period. It is displayed as 1:XX when inhalation period is larger than the exhalation period. Inspiratory phase (inspiration) the part of the ventilatory cycle from the beginning of inspiratory flow to the beginning of expiratory flow. Any inspiratory pause (plateau) is included in the inspiratory phase. Inspiratory time inspiratory time (expressed in seconds) is the duration of inspiration during mechanical ventilation. As inspiratory time increases, mean airway pressure increases and the I:E ratio becomes lower. Glossary-4 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Glossary Inspiratory pause inspiratory pause is a brief pause (0.1 to 2 seconds) at endinspiration during which pressure is held constant and flow is zero. The purpose of the pause is to improve gas distribution throughout the lungs. Same as Plateau pressure. Intermittent Mandatory Ventilation (IMV) a mode of ventilatory support that allows spontaneous breathing in between mandatory breaths from the ventilator. Mandatory Breath a breath whose inspiratory flow and or pressure is under the control of the ventilator. Manual Breath a breath initiated by the operator. Mean Airway Pressure (MAP) the average over one inspiration/exhalation cycle. The value displayed is the average of this calculation over one minute. The display is updated at the end of each exhalation. Medical gas a gas that has been refined and purified according to specifications in the United States Pharmacopoeia (USP) intended for human use in the diagnosis or treatment of disease. Millisecond (msec) one thousandth of a second. • Minute Ventilation ( V E) the total amount of gas moving out of the lungs during 1 minute. Noninvasive pertaining to a diagnostic or therapeutic technique that does not require the skin to be broken or a cavity or organ of the body to be entered. Mechanical ventilation via mask, nasal prongs, or mouthpiece. Peak Inhalation Pressure (PIP) the greatest airway pressure during an inspiratory cycle no matter what the breath type. The pressure is measured at the exhalation valve and the new data is displayed at the beginning of exhalation. Plateau Pressure (Plateau) the pressure measured at the end of exhalation on every breath. The display is updated at the beginning of each exhalation. PCMCIA Card (PC Card) Acronym for Personal Computer Memory Card International Association, more commonly referred to as a PC Card. This is a data storage device with an approximate physical size of a credit card, used in conjunction with the Trending Option. Positive End-Expiratory Pressure (PEEP) the application and maintenance of pressure above atmospheric at the airway throughout the expiratory phase of positive-pressure mechanical ventilation. Pressure Support Ventilation (PSV) pressure-limited assisted ventilation designed to augment a spontaneously generated breath; the patient has primary control over the frequency of breathing, the inspiratory time, and the inspiratory flow. REF 1057983 A Respironics V200 Ventilator Operator’s Manual Glossary-5 Glossary Pressure Sensitivity a measure of the amount of negative pressure that must be generated by a patient to trigger a mechanical ventilator into the inspiratory phase; alternatively, the mechanism used to set or control this level. Pressure Trigger initiation of inspiration when the patients inspiratory effort exceeds the sensitivity threshold. PVC O2 Sensor Tee An external oxygen sensor adapter made of polyvinyl chloride (PVC). This O2 Sensor Tee is gray in color and cannot be autoclaved or chemically disinfected. Rapid Shallow Breathing Index (F/VT) used to evaluate the adequacy of the patients spontaneous ventilation. It is calculated by as shown below • f/Vt = (Spont Rate)/(Spont VE) Resistance The pressure drop across a pneumatic device (i.e. bacteria filter, patient circuit tubing) for a unit of flow when the volume of the device remains constant, i.e., (cmH2O (hPa))/mL/sec. Risetime the time required for a pressure support or pressure controlled breath to reach its target pressure. RS-232 ANSI standard for communication. Spontaneous Respiratory Rate (Spont Rate) the average rate of the spontaneous breaths in the last eight breaths delivered by the ventilator. • Spontaneous Volume Exhaled (Spont V E) the exhaled volume that would come from spontaneous breaths, projected over one minute. The calculation is done by averaging the spontaneous exhaled tidal volume from the last eight breaths and projecting what that volume would be if it continued for one minute. Tidal Volume (Tidal Vol) the volume of patient gas as measured at the exhalation flow transducer. The display shows an average unless the current breath differs substantially from the average. When there is a substantial change, the current breath is displayed. The average for tidal volume is restarted when the operator changes the tidal volume setting and the machine is delivering mandatory breaths. Time Trigger initiation of inspiration by the ventilator according to the respiratory frequency (Rate) setting. Total Respiratory Rate (Total RR) the total breaths taken, spontaneous breath rate + mandatory breath rate, from the last eight breaths and projecting what that rate would be if it continued for one minute. • Total Volume Exhaled (Total V E) the total exhaled volume that would come from all the patient’s breaths, projected over one minute. The calculation is done by averaging the total exhaled tidal volume from the last eight breaths and projecting what that volume would be if it continued for one minute. This value is updated at the end of each exhalation. Glossary-6 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Glossary Trigger normally a patient effort to begin inhalation. Volume space occupied by matter measured in milliliters or liters. Window either a period of time or a portion of a screen depending on the context. REF 1057983 A Respironics V200 Ventilator Operator’s Manual Glossary-7 Glossary (This page is intentionally blank.) Glossary-8 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Index Symbols 100% O2 Key, 8-9 A A/C, Assist Control, 7-3 AC Inlet, 5-2 ACCEPT key, 5-8, 8-2 Accept Key, 8-8 Accessories, 4-2, 13-1 Adjust Control Knob, 8-11, 12-7 Adult Disposable Patient Circuit, 13-2 Patient Circuit Kit, 13-2 Adult/Pediatric Keys, 8-20 Air Inlet Filter, 5-1 Air Source Fault Alarm, 9-5 Airway Pressure, 7-4 Alarm Reset Key, 8-9 Alarm Silence, 12-9 Alarm Silence Key, 8-9 Alarm Status Indicators, 8-5 Alarms, 9-1 Audible, 9-2 Auto-Reset of, 9-3 Descriptions, 9-5, 9-8 High Urgency, 9-1, 9-2 Low Urgency, 9-1, 9-2 Medium Urgency, 9-1, 9-2 Operator-Initiated Reset of, 9-3 Remote, 6-2 Reset, 9-3 Silence, 9-2 Visual, 9-1 Alert Messages, 9-4 Altitude, Setting, 5-5, 5-9 Analog Port, 5-2, 6-7 REF 1057983 A Apnea Alarm, 9-5 Apnea Ventilation, 7-7, 8-27 Operation During, 7-7 Respiratory Rate, 8-22 Apply Date, 5-8 Apply Time, 5-8 Assist Control Ventilation, 7-3 Assist Control Ventilation (A/C), 7-3 Audible Alarm Failed Alarm, 9-5 Auto-PEEP, 8-31 Calculation, 8-31 B Backup Battery, 4-4 Power Status Indicators, 8-6 Bad ADC Wrap Sensor Alarm, 9-5 Bad Bat Volt Sensor Alarm, 9-5 Bad Int O2 Sensor Alarm, 9-5 Bad Int Temp Sensor Alarm, 9-5 Battery Backup On Alarm, 9-5 Baud Rate, RS-232, 6-2, A-1 Breath Indicator, 8-13 Breath Type, 12-1 Selecting, 8-23 BTPS, G-1 Built-In Test, 11-11 Bus Activity Monitor, 11-10 C Cautions, 2-5 Circuit Breaker Humidifier AC, 5-2 Mains, 5-2 Cleaning, Ventilator Parts, Clock, 5-7 Respironics V200 Ventilator Operator’s Manual 10-1 Index-1 Index Compliance, G-1, G-4 Circuit, 5-5, 11-5 Compensation, 8-33, 11-1 Tubing, 5-10 Compliance and Approvals, 12-11 Continuous Positive Airway Pressure, CPAP, 7-4 F 7-4 D Date of Manufacture, 3-3 Date Setting, 5-7 Delivered O2, %O2, 8-29 Diagnostic Codes, 11-5 Descriptions, 11-6, 11-8 Mode, 5-5, 11-2 Diagnostics, 11-1 Display Front Touch Panel, 8-11 Patient Leak, 7-6 F/Vt, 8-29 Filters Removal/Installation Bacteria, 10-4 Cooling, 10-8 Heated Bacteria, 4-18 Inspiratory Bacteria, 4-16 Internal Air Source Inlet, 10-10 O2 Input Filter, 10-9 Flex Arm, 4-22 Front Panel, 8-3 Controls, 8-10 Keys, 8-8 Text Version, 8-3 Touch Display, 8-11 G Gas Supplies Lost - SVO Alarm, Glossary, G-1 9-5 E H End Exhalation Pressure, 8-31 EPAP, 7-6, 8-23, 12-3, G-1 EST, 11-4 Exhalation Bacteria Filter, 13-2 Exp Valve Stuck Open Alarm, 9-5 Expiratory Bacteria Filter, 4-18 Expiratory Hold Calculated Values, 12-7 Expiratory Hold Key, 8-10 Expiratory Positive Airway Pressure, G-1 Extended Self Test (EST), 5-12, 11-4 High Indicator, 8-5 High Inspiratory Pressure, 9-5, 12-9 Alarm Test, C-2 High Inspiratory Pressure Alarm, 9-5 High Internal O2 Alarm, 9-5 High Leak Rate Alarm, 9-5 High Minute Volume Alarm, 9-6 High O2 Alarm, 9-6 High Respiratory Rate, 9-6, 12-9 High Respiratory Rate Alarm, 9-6 High Temperature Alarm, 9-6 High Urgency Alarm, 12-9 high urgency alarm, 9-1, 9-5 Humidifier AC Circuit Breaker, 5-2 AC Outlet, 6-1 Connecting, 6-3 Index-2 Respironics V200 Ventilator Operator’s Manual REF 1057983 A Index I N I:E Ratio, 8-29 Inspiratory Bacteria Filter, 4-17, 13-2, Installation, 4-16 Removing and Replacing, 10-5 Inspiratory Trigger (I-Trigger), 8-21 IPAP, 7-6, 8-23, 12-3 I-TIME, 7-2 I-Time Too Long Alarm, 9-6 Non-Invasive Positive Pressure Ventilation (NPPV), 7-6 Non-Invasive Ventilation, 7-1, 7-6, 8-1 Normal Indicator, 8-5, 12-9 Notes, 2-8 NPPV, 7-6, 8-23 L Labels, 12-18 Lock Screen, 8-8 Low Backup Battery Alarm, 9-6 Low EPAP Alarm, 9-6 Low Insp Pressure Alarm, 9-7 Low Minute Volume Alarm, 9-7 Low O2 Alarm, 9-7 Low O2 Supply Alarm, 9-7 Low PEEP Alarm, 9-7 Low Tidal Volume Alarm, 9-7 Low Vt Mandatory Alarm, 9-8 Low Vt Spontaneous Alarm, 9-8 M Mandatory Breaths, 7-3, 8-26 Manometer, 8-13 Manual Breath Key, 8-10 Med/Low Indicator, 8-5 Medium/Low Urgency Alarm, 12-9 Modes, 8-1, 12-1 Common to NPPV, 7-6 Common to VCV & PCV, 7-3 Emergency, 7-7 Mount Wall, 5-4 REF 1057983 A 13-4 Symbols Nurse Call Label, 12-18 Remote Alarm, 5-1 O O2 Cylinder Bracket, 13-1 High Pressure Hose, 13-1 Manifold, 13-1 Sensor, 4-16, 13-3 Sensor Kit, 13-1 O2 Sensor Tee Autoclaving, 10-2 Chemical Disenfecting, 10-2 See also PVC O2 Sensor Tee O2 Valve Stuck Closed Alarm, 9-8 Occlusion - SVO Alarm, 9-8 On/Off Power, 5-4 On/Off Switch, 5-2 Open, 7-7 Safety Valve, 7-7, 7-8, 9-9, 9-10 Operating Conditions, 9-1 Instructions, 8-1 Theory, 7-1 Options Communications, 13-1 Flow-Trak, 13-1 Graphics, 13-1 Neonatal, 13-1 Respironics V200 Ventilator Operator’s Manual Index-3 Index Respiratory Mechanics, 13-1 RS-232 Communications 2, 13-1 Trending, 13-1 Output Analog label, 3-1 Analog port, 6-7 Field, A-1 Port, 6-1 Serial label, 3-2 Oxygen Source Connection, 4-21 Oxygen Sensor, 13-3 P Panel, Back Connections and Controls, 5-1 Panel, Front Dispay, 8-11 Patient Initiated Breath Triggering, 7-5 Patient Leak Display, 7-6 Pediatric Patient Circuit Kit, 13-2 Positive End Expiratory Pressure (PEEP), 7-5 POST, 11-10 Power Cord, 5-3 Power On Self Test (POST), 11-10 Power Status Indicators, 8-6 Pressure Support Ventilation (PSV), 7-4 PVC O2 Sensor Tee Cannot be autoclaved, 10-2 Cannot be chemically disinfected, 10-2 Index-4 Table Top Mounting, 4-4 Tidal Volume, G-6 Time Format, 5-7 Time Setting, 5-7 Total Rate, 8-29 Total VE, 8-29 Touch Display, 8-11 U Using Default Altitude Alarm, 9-8 Using Default Compliance Alarm, 9-8 Using Default Settings Alarm, 9-8 Ventilator Inoperative, 12-9 Ventilator Inoperative Indicator, 7-5 8-5 W Warnings, Warranty, S Safety Valve Open, T V R Restart, 11-11 Alarm, 9-8 Rise Time Setting, Safety Valve Ventilator Inoperative, 8-5 Schedule for Periodic Maintenance, 10-7 Screen Lock Key, 8-8 Screen Locked, 12-9 Self-Test Hardware, 11-10 Serial Port, 5-1 SIMV, 7-3 Software Options, 13-1 Spont Rate, 8-29 Spontaneous Respiratory Rate (Spont Rate), G-6 Spontaneous Volume Exhaled (Spont VE), G-6 SST, 11-3 Symbols, 3-1 Synchronized Intermittent Mandatory Ventilation (SIMV), 7-3 2-1 13-5, B-1 12-9 Respironics V200 Ventilator Operator’s Manual REF 1057983 A
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