Transcript Home Ventilation

HOME NON INVASIVE
POSITIVE PRESSURE
VENTILATION
BY
AHMAD YOUNES
PROFESSOR OF THORACIC MEDICINE
Mansoura Faculty of Medicine
Non-invasive ventilation
• Non invasive ventilation refers to techniques
that provide alveolar ventilation without an
invasive artificial airway in place i.e.
endotracheal or tracheostomy tube is not
needed.
• This can be accomplished by either negative or
positive pressure.
Home Ventilation
• Non Invasive Ventilaion
A) Negative pressure ventilation
B) Positive pressure ventilation (Pressure preset
ventilation or volume preset ventilation or dual
modes).
• Invasive Ventilaion (Pressure preset ventilation
or volume preset ventilation or dual modes)..
Modes of Ventilation
• Almost any ventilator mode that can be applied with an
endotracheal tube in place can be administered noninvasively.
• Pressure cycled ventilators have been applied utilizing :
- BIPAP.
- CPAP.
• Volume cycled ventilators have been used successfully
utilizing:
- control.
- Assist-control.
Non-invasive ventilation
• In the vast majority of cases therapy will be
delivered with positive pressure devices,
although a few individuals still use negative
pressure devices .
• Negative pressure devices present a number of
difficulties with regard to home ventilation
including bulkiness, fit and comfort , they can
induce significant upper airway obstruction ,
rendering therapy ineffective .
External Negative Pressure Ventilation
• ENPV is provided by a variety of devices applied
externally to the chest wall and abdomen.
• These devices generate intermittent subatmospheric pressure and thus inspiratory
airflow.
• Exhalation is usually passive, resulting from the
inward elastic recoil of the lung and chest wall.
Devices of External Negative
Pressure Ventilation
• Tank ventilator “iron lung”: the most effective
one.
• Cuirass.
• Jacket ventilator.
• Hayek oscillator: the most recent variation of
cuirass negative pressure ventilator
Iron-lung
Cuirrass
Non-invasive ventilation
• Prior to the introduction of NIV in the mid
1980’s, home ventilation was restricted to
a) negative pressure devices used primarily in
patients with poliomyelitis, and
b) tracheostomy ventilation used for patients with
severe respiratory muscle weakness or total
paralysis.
• Both forms of ventilatory support were
associated with significant practical difficulties,
which meant that home ventilation was
restricted to a small number of individuals
usually with complex chronic health care needs.
Non Invasive Positive Pressure Ventilation
• The simplicity, cost and acceptability of NIV has
led to this approach being widely adopted by
the respiratory community and accepted by
patients to the extent that NIPPV is now
considered first line therapy in the management
of chronic respiratory failure.
• Importantly, it is now recognized clinically that
ventilatory support during sleep is all that is
required to achieve sustained daytime
improvements for most patients.
Non Invasive Positive Pressure Ventilation
• European survey of home ventilation identified
almost 22,000 users in 16 countries, 87% of
whom used non-invasive ventilation .
• NIPPV is acceptable to patients on a long-term
basis and can alleviate symptoms related to
chronic hypoventilation , improving survival and
quality of life.
Non Invasive Positive Pressure Ventilation
• Volume preset ventilation delivers a stable tidal volume
irrespective of the patient’s pulmonary system
mechanics (compliance, resistance and active
inspiration) . In contrast, pressure preset ventilation
delivers a set pressure during inspiration and
expiration, and changes in the patient’s pulmonary
mechanics directly influence the flow and the delivered
tidal volume .
• Most studies evaluating these two modes in patients
with chronic respiratory failure have shown equivalent
effects with respect to maintaining nocturnal gas
exchange and improving daytime blood gases .
Non Invasive Positive Pressure Ventilation
• Due to lower cost and greater patient comfort , most
patients in the majority of centres are now prescribed
pressure preset devices, mostly commonly, bilevel
machines.
• volume ventilators are recommended for patients with the
most severe respiratory failure including those with
tracheostomy and when continuous or near continuous
ventilator support is needed.
• A switch from pressure to volume preset ventilation may
also be required in patients who are adherent to pressure
preset ventilation but who fail to respond to treatment .
• No difference in blood gas improvement, lung function or
compliance with therapy was seen between the two modes.
Non Invasive Positive Pressure Ventilation
• Volume preset ventilators are usually set in an assist /
control or control mode of support.
• Pressure preset devices may be set in an assist
(“spontaneous”) mode where each breath is patient
triggered; an assist / control (“spontaneous/ timed”)
mode where breaths may be patient or machine
triggered; and a control (“timed”) mode where all
breaths are machine triggered only .
• The pressure settings used in bilevel devices include
the inspiratory positive airway pressure (IPAP) and
expiratory positive airway pressure (EPAP), with the
difference between the two determining the level of
pressure support .
Non Invasive Positive Pressure Ventilation
• A recent innovation in this area is that of
autotitrating bilevel devices.
• The algorithms of these machines are designed
to automatically titrate pressure support levels,
and in some devices EPAP, based on minute
ventilation or flow targets.
• There is mounting evidence for the use of these
devices in managing sleep disordered breathing
in patients with central sleep apnoea/Cheyne–
Stokes respiration .
Goals of non-invasive ventilation
• For those with stable or slowly progressive disorders, the
purpose of providing ongoing therapy is to increase
survival while maintaining or improving the quality of life .
• In rapidly progressive disorders, the primary goal is to
palliate symptoms .
• In a small group of individuals, such as those with cystic
fibrosis, home NIPPV may provide a temporizing measure
until transplantation is possible .
• The non-invasive approach also permits earlier intervention
in the course of the disease than is possible with invasive
techniques , reduces acute care costs by decreasing
hospital length of stay and readmissions , and simplifies
the burden of care related to managing chronic respiratory
failure in the home .
Types of Home Ventilation
• Nocturnal Ventilatory Support ( sleep
disordered breathing) Usually Pressure preset
ventilators .
• Nearly Continuous (>18 hours) Ventilatory
Support (Nocturnal Ventilatory support + most
daytime ventilatory support ) Usually Volume
Preset Ventilators .
• Continuous ventilatory support (Ventilator
dependent individuals ) Life Support Ventilators
( BACK UP RATE , POWER FAILURE ALARMS
,MASK OFF ALARMS , LOW PREASSURE
ALARMS )
Patient Selection
• Criteria for selecting patients for NIPPV:
1. Alert & cooperative.
2. Hemodynamic stability.
3. No need for endotracheal intubation: to protect
airways or to remove excessive secretions.
4. No acute facial trauma.
5. Properly fitted mask.
6. No multiorgan dysfunction.
Exclusion criteria:
1. Respiratory arrest.
2. Cardiovascular instability (hypo tension,
arrhythmias, myocardial infarction).
3. Somnolence impaired mental status,
uncooperative patient.
4. High aspiration risk; Viscous or copious
secretions.
5. Recent facial or gastro-esophageal surgery.
6. Crainio-facial trauma, fixed naso-pharyngeal
abnormalities.
7. Burns.
8. Extreme obesity (>200% of ideal body wt).
Advantages of NIPPV
• Better tolerance.
• No need for sedation.
• Patient can talk, eat, …
Drawbacks of NIPPV
• Air leaks.
• Facial skin necrosis
• Gastric distension
• Eye irritation.
• Claustrophobia.
Treatment modalities for Positive Airway
Pressure Therapy
• Continuous positive airway pressure Provides a
constant pressure throughout the respiratory cycle
• Bi-level positive airway pressure Provides two pressure
levels during the respiratory cycle: a higher level during
inspiration and a lower pressure during expiration
• Autotitrating positive airway pressure Provides variable
pressures using device-specific diagnostic and
therapeutic algorithms
• Nocturnal noninvasive positive pressure ventilation
Provides two pressure levels at a set rate to assist
ventilation
Determining Optimal Continuous
Positive Airway Pressure
1. In-laboratory attended polysomnographically guided
CPAP titration
– Full-night studies.
– Split-night studies (consists of an initial
diagnostic portion and a subsequent CPAP
titration on the same night)
2. Unattended laboratory or home titration
3. Use of autotitrating devices
4. Formula-derived pressures from clinical, PSG, and/or
anthropometric variables
The current standard of practice
• The current standard of practice involves an attended
pressure titration during a laboratory PSG, during which
sleep stages and respiratory variables are monitored.
• The goal is to determine a single fixed pressure that
eliminates apneas, hypopneas, snoring, and respiratory
effort–related arousals (RERAs); maintains adequate
oxygen saturation; and improves sleep architecture and
quality in all sleep positions and in all sleep stages.
• It is generally accepted that higher pressures are
required to reverse airway occlusion during REM sleep
and during sleep in a supine position.
• Split-night studies can potentially underestimate the
severity of OSA
Criteria for split-night (CPAP) titration
• At least 2 hours of recorded sleep time during
the initial diagnostic portion of the study
• Apnea-hypopnea indices during the diagnostic
portion of the study: AHI 40 OR
• AHI 20–40 (accompanied by significant oxygen
desaturation)
• At least 3 hours are available for CPAP titration
with the presence of REM sleep during a supine
sleep position
AASM recommendations for CPAP and
BPAP therapy for adult patients with sleep
related breathing disorders
• The presence of OSA based on an acceptable diagnostic
method should be established prior to CPAP therapy
(standard).
Indications for CPAP therapy include:
a. Moderate to severe OSA (standard)
b. Mild OSA (option)
c. Improvement of subjective sleepiness in patients with
OSA (standard)
d. Improvement of quality of life in patients with OSA
(option)
e. As an adjunctive therapy to lower blood pressure in
patients with OSA (option)
AASM recommendations for CPAP and BPAP
therapy for adult patients with sleep related
breathing disorders
3. The preferred CPAP titration method to determine
optimal positive airway pressure is an in-laboratory, fullnight, attended polysomnography, but split-night
studies are usually adequate (guideline).
4. Objective monitoring of CPAP use is recommended to
ensure optimal utilization (standard).
5. Close monitoring of CPAP utilization and any problems
that might develop, especially during the first few weeks
of use, is important, as is the correction of problems if
needed (standard).
6. Addition of heated humidification and a systematic
educational program enhance adherence to CPAP use
(standard).
AASM recommendations for CPAP and BPAP
therapy for adult patients with sleep related
breathing disorders
7. Patients with OSA treated with CPAP therapy should be
followed up yearly or more frequently as needed to
correct problems related to its use (option).
8. CPAP and bilevel positive airway pressure (BPAP)
therapy are generally safe with minor adverse effects
(standard).
9. BPAP can be considered as an optional therapy to
CPAP in selected patients who require high pressures,
who report difficulty exhaling against a fixed CPAP
pressure, or who have coexisting central
hypoventilation (guideline).
10. BPAP may also be beneficial in patients with some
forms of restrictive lung disease or hypoventilation
syndromes with daytime hypercapnia (option).
AASM recommendations for CPAP and
BPAP therapy for adult patients with sleep
related breathing disorders
• The extent to which asymptomatic patients with
mild OSA and no associated medical or
psychiatric disorders benefit from CPAP is less
certain.
• Intermittent use of CPAP should be avoided,
because virtually all of the gains in sleep quality
and daytime alertness derived from sleeping
with CPAP are rapidly reversed with CPAP
discontinuation.
Starting PAP treatment based
on a prediction equation
with subsequent adjustment based on symptoms,
machine readings, and nocturnal oximetry.
• Predicted CPAP =0.16XBMI +0.13 X NC + 0.04 XAHI – 5.12
where BMI = body mass index and NC = neck circumference
in centimeters AHI =apnea hypopnea index.
Auto-adjusting (auto-titrating) CPAP,
devices Auto-CPAP devices provide a useful
alternative for providing positive airway
pressure (PAP) treatment for patients with OSA .
• One can separate the uses of these devices into
two large categories These include:
(1) Auto-titration PAP to determine an effective
fixed level of CPAP)
2- Auto-adjusting CPAP for chronic treatment with
the advantage of delivering the lowest effective
pressure in any circumstance.
Chronic treatment with APAP would also eliminate
the requirement for a CPAP titration
Auto-CPAP devices
• When used in the auto-titration mode, the
devices are used by the patient for a period of
time (one night to several weeks). Information
stored in the device is transferred to a computer
and can be used to select an optimal fixed level
of CPAP for chronic treatment.
• When APAP devices are used for chronic
treatment they have the potential advantage of
delivering the lowest effective pressure in any
circumstance (body position, sleep stage). The
mean pressure for the night may be lower than a
single pressure that would be effective in all
circumstances (the prescription pressure). For
example, higher CPAP is usually needed in the
supine posture and during rapid eye movement
(REM) sleep.
Auto-titrating CPAP mode
• Attended auto-titration in CPAP naïve patient
(technologist extender)
• Unattended auto-titration in CPAP naïve patient
• Check prescription pressure after weight gain/loss
• Salvage a failed manual CPAP titration
Auto-adjusting mode
• Initial chronic treatment of OSA (no titration
needed)
• Chronic treatment in patients not tolerating CPAP
• Chronic treatment in patients with difficult
mask/mouth leak
BiPAP Pro Bi-Flex
• The BiPAP Pro Bi-Flex device delivers
the following therapies:
• Bi-level – Provides EPAP and IPAP.
• Bi-level with Bi-Flex – Bi-level therapy with
pressure relief upon exhalation to improve
patient comfort based on patient needs.
• CPAP.
• CPAP with C-Flex – Delivers CPAP therapy with
pressure relief upon exhalation to improve
patient comfort based on patient needs.
Pressure curve when BiPAP = 10/5 cm H2O; The pressure
is higher on inspiration than on expiration, but both
pressures are above ambient .In this example IPAP is set
as 10 cm H2O and EPAP is set as 5 cm H2O.
BiPAP S/T
SPECIFICATIONS:
• Modes : CPAP, S, ST
• Timed inspiration 0.5 to 3.0 seconds
• IPAP 4 to 25 cm H2O
• EPAP 4 to 25 cm H2O
• CPAP 4 to 20 cm H2O
• Breath rate 0 to 30 BPM
• Weight 1.36 kg Dimensions 18 cm x 14 cm x 10
cm
• Alarms Patient Disconnect, Apnea, Low Minute
Ventilation
BiPAP Auto
Autobilevel positive airway pressure with a minimum
EPAP of 6 cm H2O and a maximum IPAP of 25 cm H2O.
Automatic Positive Airway Pressure
• In the older generation of APAP devices, the
sensors were simplistic and measured only the
pressure inflections (vibrations) of a certain
frequency and amplitude that were caused by
snoring.
• The next generation of APAP devices became
more sophisticated and were able to sense flowbased changes such as apnea, hypopnea, or
inspiratory flow limitation based upon the
inspiratory flow contour (i.e., flattening of the
inspiratory flow waveform).
Advanced methods of Autotitration
• Newer generation devices can can increase the IPAP
alone in order to ameliorate obstructive events (Auto Bilevel PAP),correct hypoventilation (averaged volume
assured pressure support [AVAPS], Intelligent Volume
Assured Pressure Support (iVAPS ) or combat central
apneas in patients with complex sleep apnea (ServoVentilation).
• Devices may also introduce a back-up rate to prevent
central apneas and although in general they are not
referred to as APAP devices, they function using similar
principles and can be judged as the latest generation of
APAP devices .
BiPAP AVAPS
• Clinicians no longer need to choose between
pressure or volume ventilation in order to
deliver optimum therapy to NIV patients.
• Now, they can have both. The BiPAP AVAPS
(Average Volume Assured Pressure Support)
home ventilator enables clinicians to achieve
the prescribed target volume pressure
without compromising patient comfort.
• Automatically adapts to patient’s changing
needs
• Designed for clinical ease of use and patient
comfort
• Powered by advanced technologies
SPECIFICATIONS:
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Modes CPAP, S, ST, PC, T
AVAPS available on S, ST, PC, and T modes
Bi-Flex Available from S mode
Target Tidal Volume from 200 to 1500 ml
IPAPmin From EPAP to IPAPmax
IPAPmax From IPAPmin to 25 cm H2O
Timed inspiration 0.5 to 3.0 seconds
IPAP 4 to 25 cm H2O
EPAP 4 to 25 cm H2O
CPAP 4 to 20 cm H2O
Breath rate 0 to 30 BPM
Weight 1.36 kg Dimensions 18 cm x 14 cm x 10 cm
Alarms Patient Disconnect, Apnea, Low Minute Ventilation, Low
Tidal Volume (AVAPS modes only)
BiPAP AVAPS
Ideal body weight
• Estimated ideal body weight in (kg)
Males: IBW = 50 + 2.3 for each inch over 5 feet.
Females: IBW = 45.5 + 2.3 for each inch over 5 feet.
• Estimated adjusted body weight (kg)
If the actual body weight is greater than 30% of the
calculated IBW, calculate the adjusted body weight (ABW):
ABW = IBW + 0.4(actual weight - IBW)
• The IBW and ABW are used to calculate medication
dosages when the patient is obese.
• This formula only applies to persons 60 inches (152 cm) or
taller.
BiPAP AVAPS and VPAP™ ST with iVAPS
Anatomical Dead space
• Inspired/expired air remaining in conducting
airways
• Not involved in gas exchange
• Correlation between patient’s height and dead
space (Vd)
• Height is used to calculate anatomical dead
space (Vd) for each breath of air (Tidal Volume)
• Example dead space volume (Vd) : 120 ml for
height 175 cm or 70 inches
Anatomical dead space in relation to
height of the patient
As alveolar ventilation drops , iVAPS rapidly increase pressure
support until target Va is reached, and as alveolar ventilation
increase , iVAPS rapidly decrease pressure support .
Intelligent back up rate (iBR) stays out of the way at 2/3 spontaneous rate
whenever the patient spontaneously triggers above 2/3 of the target . once
the patient rate reach minimum back up rate (2/3 of the target ) iBR increase
towards patient spontaneous rate to maintain alveolar ventilation .Once
spontaneous trigering returns, iBR drops back to 2/3 of the target /
spontaneous rate.
Auto-TriLevel
• The auto-TriLevel principle by Weinmann combines two
proven types of therapy – auto-CPAP and BiLevel – into
a synthesis that offers the most therapy effectiveness.
Your benefits with these products:
• Therapeutically effective maximum and mean pressures
that are lower than BiLevel with the same tidal volume
for fewer side effects such as leakage.
• It‘s like a new titration every day – adjusts to patient‘s
high variability .
• Effortless titration and monitoring .
Auto-TriLevel
• IPAP: inspiratory pneumatic
splinting of the airways (ventilation)
• EPAP: easier exhalation at a low
expiratory pressure level for a
pleasant breathing sensation
• Additional end-expiratory pressure
(EEPAP): required minimum
pressure for adequate splinting of
airways during phase when risk of
collapse is highest
• PDIFF (Δ IPAP-EPAP): needoriented ventilation support by
means of changes between
inspiratory (IPAP) and expiratory
(EPAP) pressure levels
Auto-TriLevel
• Reduced mean and maximum therapy pressure
under TriLevel: Results of a bench test
comparison with BiLevel therapy.
• SOMNOvent auto-ST is the world‘s first automatic
BiLevel device that permits goal-oriented therapy
settings(SCOPES).
• With the combination of the autoTriLevel principle and
the automatic trigger WMtrak, this device delivers the
greatest effectiveness, reliability and breathing comfort
– simply the fastest therapy results.
• Particularly for cases of complicated SDB, SOMNOvent
auto-S, convinces with its intelligent combination of
automatic BiLevel S therapy and auto-CPAP.
Auto-TriLevel
• Auto-bilevel spontaneous (SOMNOvent auto-S ).
• Auto-bilevel spontaneous/timed (SOMNOvent
auto-ST ).
• Anti-cyclic modulated ventilation (SOMNOvent
auto-CR ).
ASV is a variant of BPAP that was developed to treat
Cheyne-Stokes central apnea. Both ASV and BPAP
devices with a backup rate are approved for use with
patients with central apnea and complex sleep apnea
SomnoVent CR
Respironics autoSV
ResMed VPAP Adapt SV
Advanced methods of titration
• Servo-ventilation made by different
manufacturers can successfully detect and treat
central apneas .
• During servo-ventilation, the expiratory positive
airway pressure is set at a level to treat
obstructive apneas and obstructive hypopneas.
• Combining APAP and servo-ventilation, with
APAP determining the EPAP level automatically,
whereas the servo-ventilation controlling
periodic breathing and central apneas has been
recently reported to be effective in ameliorating
SRBD .
BiPAP A30 Ventilator
• For 24 Hours Use
• BiPAP A30 ventilator has been designed to combine
ease of use with technology advancement to deliver
enhanced therapy that adapts to patient’s condition.
• Being at home can work wonders so It delivers a
smooth transition from hospital to home for chronic
respiratory patients.
• Compatible with PSG Systems
• Optional Oximetry Module
• Intuitive, User Friendly & Colored Interface
• Integrated Heated Humidifier
• Graphical & Statistical Data Management on Encore Pro
& Direct View Soft wares
SPECIFICATIONS:
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Modes CPAP, S, ST, PC, T , AVAPS
AVAPS available on S, ST, PC, and T modes
AVAPS Rate 0.5 to 5 cmH2O/min
Target Tidal Volume from 200 to 1500 ml
IPAP 4 – 30 cmH2O
EPAP 4 – 25 cmH2O
Breath Rate 0 – 40 BPM
Inspiratory Time 0.5 – 3 sec
Rise Time 1 (100 ms) – 6 (600 ms)
Monitoring Pressure, Tidal Volume, Minute Ventilation, Respiratory
Rate, I/E Ratio
• Weight 2.1 kg (with Power Supply) Noise Level < 30 dBA at 10 cmH2O
• Humidification System one Humidification & Dry Box technology
• Alarms Patient Disconnect, Apnea, Low Minute Ventilation, Low Tidal
Volume, High Respiratory Rate
BiPAP A40 Ventilator
• BiPAP A40 comes with well-known and
clinically proven Philips Respironics
technology such as Auto-Trak, AVAPS and
a Dry Box humidifier design.
• The device is capable of non invasive and
invasive pressure ventilation, up to 40
cmH2O, providing treatment for your
chronic respiratory insufficiency patients.
• The device features AVAPS-AE, the first
fully automatic ventilation mode, designed
to help clinicians during titration process,
while maintaining comfort and therapy
optimization at the lowest pressures.
BiPAP A40 Ventilator
• This new innovative ventilation mode helps in providing
long term therapy compliance regardless of changes to
the body position, sleep stages and respiratory
mechanics.
• Detachable Battery with up to 5 Hours Backup
• AVAPS-AE Automatically Adjust Ventilation to the
Patients Need
• Compatible with PSG Systems
• Optional Oximetry Module
• Intuitive, User Friendly & Colored Interface
• Integrated Heated Humidifier
• Graphical & Statistical Data Management on Encore Pro
& Direct View Soft wares
SPECIFICATIONS
• Ventilation modes : CPAP, S, S/T, PC, T, AVAPS-AE
• Hybrid ventilation AVAPS (Average Volume Assured
Pressure Support) AVAPS-AE
• IPAP 4 – 40 cm H2O
• EPAP 4 – 25 cm H2O
• Target tidal volume (when AVAPS enabled) 200 – 1500 ml
• Breath rate 0 – 40 bpm (4 – 40 bpm in T mode)
• Inspiratory time 0.5 – 3 sec.
• Triggering and cycling Auto-Trak ,Sensitive Auto-Trak,
Flow triggering.
• Rise time 1 (100 ms) – 6 (600 ms)
• Size 21.6 cm W x 19 cm L x 11.5 cm H
• Weight 2.1 Kgs (with power supply)
SPECIFICATIONS:
• Humidification System One humidity control and ‘Dry Box’
technology
• Alarms Patient disconnection Apnea ,Low minute ventilation
,Low tidal volume (with AVAPS/AVAPS-AE only) ,High RR
• Monitoring Pressure, tidal volume, minute ventilation,
respiratory rate, leak, I/E ratio
• Battery back up Detachable battery module: 5 hours
• DC power source 12 VDC, 5.0 A (external battery),
24 VDC, 4.2 A (power supply)
• Data management Encore Pro 2 and Direct View software
• Compatible with oximetry module
• Advanced detection of residual respiratory events(Obstructed
Airway Apnea, Clear Airway Apnea, Hypopnea, Periodic
Breathing, RERA, Large Leak and Snore)
Finger tip pulse oximeter with adapter
Detachable Battery ,Detachable
Battery Module and roll stand
Carrying Case. The bag is designed
to attach the ventilator to a wheelchair
VENTImotion 2
Oxygen supply with VENTI-O2 / VENTI-O2 plus
• For safety reasons (risk of fire), it is not
permitted to supply oxygen directly to the tube
system or to the breathing mask without a
special safety device.
• On this device, the supply of oxygen is
permitted only using the VENTI-O2 and VENTIO2 plus oxygen supply valves.
• It is possible to supply up to 4 l/min or 15 l/min
of oxygen using VENTI-O2 or VENTI-O2 plus. In
the event of a fault, the VENTI-O2 gives the
oxygen off into the atmosphere, thus preventing
it from accumulating in the device.
VENTIpower
• You can use VENTIpower to operate
the device independently of the
electricity supply.
• You can connect VENTIpower to the
device in parallel to the regular
electricity supply (top socket).
• If the regular electricity supply fails,
VENTIpower undertakes the supply of
power to the device after a delay of
approx. 4 seconds.
• VENTIpower must be switched on for
this.
VENTIlogic LS
Intended use
• VENTIlogic LS is used for invasive and noninvasive life-support ventilation.
• The device can be used in both static or mobile
operation, both at home and in appropriate
hospital departments.
Note :VENTIlogic LS is not a ventilator for
intensive care purposes. The device can be
used for weaning off invasive ventilation and
converting to mask ventilation. It is used on
patients with medium to severe acute and
chronic global respiratory insufficiency with a
tidal volume of at least 50 ml and a body weight
of at least 5 kg.
Intended use
• VENTIlogic plus is used for invasive and noninvasive life-support ventilation. The device can
be used in both static or mobile operation, both
at home and in appropriate hospital
departments.
Note :VENTIlogic plus is not a ventilator for
intensive care purposes . The device can be
used for weaning off invasive ventilation and
converting to mask ventilation. It is used on
patients with medium to severe acute and
chronic global respiratory insufficiency with a
tidal volume of at least 50 ml and a body weight
of at least 5 kg.
Intended use
• Obstructive respiratory disorders, such as
COPD •
• Restrictive respiratory disorders such as
scolioses, deformities of the thorax ,
• Neurological, muscular and neuromuscular
disorders, such as muscular dystrophies,
pareses of the diaphragm etc.
• Central respiratory regulation disorders
• Hypoventilation syndrome associated with
obesity
Pathologic defaults
offer a choice of disease-specific preset
setting values to facilitate a quick and
sensible starting point to therapy.
Stellar 150
• The Stellar 150 is intended to provide ventilation
for non-dependent, spontaneously breathing
adult and pediatric patients (30 lb/13 kg and
above) with respiratory insufficiency, or
respiratory failure, with or without obstructive
sleep apnea.
• The device is for noninvasive use, or invasive
use (with the use of the ResMed Leak Valve).
• Operation of the device includes both stationary
, such as in hospital or home, or mobile, such
as wheelchair usage.
Stellar provides the following modes
• CPAP mode—a fixed pressure is delivered.
• S (Spontaneous) mode—the device senses the patient
breath and triggers IPAP in response to an increase in
flow, and cycles into EPAP at the end of inspiration. The
breath rate and the respiratory pattern will be
determined by the patient.
• ST (Spontaneous/Timed) or PS (Pressure Support)
mode—the device augments any breath initiated by the
patient, but will also supply additional breaths should
the patient breath rate fall below the clinician's set
’backup’ breath rate.
• T (Timed) mode—the fixed breath rate and the fixed
inspiration time set by the clinician are supplied
regardless of patient effort.
Stellar provides the following modes
• PAC (Pressure Assist Control)—the inspiration time is
preset in the PAC mode. There is no spontaneous/flow
cycling. The inspiration can be triggered by the patient
when respiratory rate is above a preset value, or time
triggered breaths will be delivered at the backup breath
rate.
• iVAPS (intelligent Volume Assured Pressure Support)—
designed to maintain a preset target alveolar ventilation
by monitoring delivered ventilation, adjusting the
pressure support and providing an intelligent backup
breath automatically. The iVAPS therapy mode is
indicated for patients 66 lb (30 kg) and above.
Pathology Defaults
• The Pathology Defaults offer a choice of
disease-specific preset setting values to
facilitate efficient commencement of therapy.
• You can select from four sets of respiratory
system mechanics.
• Before use you will need to review the set
parameters on the Clinical Settings screen.