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Vyaire Avea User Manual

Critical care ventilation
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Avea
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c r i ti c a l c a re ve nti l a ti o n
E N H A N C E D P U L M O N A R Y M O N I TO R I N G U S E R G U I D E

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  • Page 1 Avea ™ c r i ti c a l c a re ve nti l a ti o n E N H A N C E D P U L M O N A R Y M O N I TO R I N G U S E R G U I D E...

  • Page 2: Table Of Contents

    Table of contents Avea ventilator maneuvers �������������������������������������1 Tracheal catheter ��������������������������������������������� 17–18 Placement ������������������������������������������������������������������ 17–18 MIP/P Maneuver screen ����������������������������������2–3 Controls �������������������������������������������������������������������������� 2–3 Advanced pressure monitoring of the respiratory system ���������������������������������������19 Maximum inspiratory pressure (MIP) ��������������������� 4 Advanced mechanics ������������������������������������ 20–33 Respiratory drive (P ) ��������������������������������������������...

  • Page 3: Avea Ventilator Maneuvers �������������������������������������1 Tracheal Catheter

    Avea ventilator maneuvers...

  • Page 4: Mip/P 100 Maneuver Screen

    MIP/P Maneuver screen Maximum Inspiratory Pressure (MIP): The P maneuver measures the negative deflection in the pressure tracing during the patient’s active effort to demand a breath. During the maneuver, the inspiratory flow valve remains closed so no inspiratory flow is delivered. Controls Duration: This control determines the maximum time the maneuver will last.
  • Page 5 Controls (continued) Sensitivity: This control allows the clinician to set the maneuver sensitivity appropriate to patient ability. This setting establishes the level below PEEP that the airway pressure must drop before a determination of the onset of a patient effort is determined. Once patient effort is detected, the timer for the maneuver duration starts.

  • Page 6: Maximum Inspiratory Pressure (Mip)

    Maximum inspiratory pressure (MIP) MIP is the maximum negative airway pressure a patient achieves during an expiratory hold maneuver. It can be a good indicator of inspiratory muscle strength, useful in the weaning process and a means of determining the progression of neuromuscular disease. Range: -60 to 120 cmH Normal: -70 to -100 cmH...

  • Page 7: Respiratory Drive

    Respiratory drive (P The P is the negative pressure that occurs 100 ms after an inspiratory effort has been detected while the inspiratory valve is closed. Because it normally takes at least 300 ms for the patient to become aware of the occluded airway, P is a good test of the respiratory center output.

  • Page 8: Inflection Point (Pflex) Screen

    Inflection Point (Pflex) Maneuver screen The Pflex Maneuver is performed on patients during mandatory ventilation. Once the maneuver tidal volume is delivered, the ventilator cycles into exhalation and returns to normal ventilation at the current ventilator settings. The pressure/ volume (P /Vol) loop freezes with upper and lower inflection points that are automatically calculated and displayed on the inspiratory portion of the...

  • Page 9: Controls �������������������������������������������������������������������������� 7-9 Flow

    Inflection Point (Pflex) Maneuver screen (continued) The user can override the calculated Pflex values by moving the Pflex indicators to a new point along the PV loop and pressing the appropriate key. The corresponding Pflex values and delta Pflex volume change to represent values based on the current position of the indicators. The ventilator can store up to four PV loops and their respective inflection points simultaneously.
  • Page 10 Controls (continued) Peak flow: This control sets the peak flow. Range: 0.5 to 5 L/min Default: 1 L/min NOTE: A square wave flow pattern is used. Maneuver PEEP: This control determines the baseline pressure when the maneuver begins. Range: 0 to 50 cmH Default: 0 cmH NOTE: The maneuver PEEP can be set independently of the PEEP used during normal ventilation.
  • Page 11 Controls (continued) Start/Stop: This maneuver begins when Start is pressed and immediately terminates when Stop is pressed, a patient effort is detected or the maneuver tidal volume has been delivered. Once the maneuver terminates, normal ventilation resumes. Normal: < 5 cmH O (lower) 28 to 32 cmH O (upper-adults)

  • Page 12: Autopeepaw Maneuver Screen

    AutoPEEPaw Maneuver screen AutoPEEP occurs when insufficient expiratory time or dynamic flow limitation is present, which results in gas trapping. This is common in asthma or severe COPD. AutoPEEPaw: This function measures airway pressure at the end of exhalation before the beginning of the next mandatory inspiration.

  • Page 13: Controls

    Controls Sensitivity: This control establishes the level that the airway pressure must drop below PEEP to terminate the AutoPEEPaw maneuver. Maneuver sensitivity has no effect on ventilator trigger sensitivity. Range: 0.1 to 5 cmH Default: 3 cmH Start/Stop: The maneuver begins when Start is pressed and the ventilator is in exhalation. The maneuver stops immediately when Stop is pressed, the maneuver completes or a patient effort is detected.

  • Page 14: Esophageal Maneuver Screen

    Esophageal maneuver screen Testing 1� A balloon test must be performed prior to placing the esophageal balloon. Connect the extension tubing and esophageal balloon to the ventilator, and select Esophageal Maneuver from the Maneuver Select menu. 2� Confirm the balloon is not yet placed in the patient.
  • Page 15 Testing (continued) 3� Press the Balloon Test soft key. The balloon fills and empties twice to confirm its integrity. Once this process completes, a Balloon Test Passed message appears in the message bar. 4� Insert the catheter.
  • Page 16 Placement Once the balloon leak test is passed, the balloon is ready for placement. Proper placement is imperative Airway Pressure (Paw) for accurate measurements. An approximate level of placement can be made by measuring the distance from the tip of the nose to the bottom of the earlobe Esophageal and from the earlobe to the distal tip of the Pressure (Pes)
  • Page 17 Placement (continued) After the catheter is inserted, touch Pes Off. The key changes color and reads Pes On. The ventilator fills the balloon to the appropriate level and begins monitoring data. Confirming proper placement: Once the balloon is placed, the appropriate balloon location can be confirmed by performing an occlusion technique.

  • Page 18: Additional Information

    Additional information The waveform produced can further confirm proper placement. Pes waveforms correlate to airway pressure in that they become positive during a positive pressure breath and negative during a spontaneous breath. Esophageal tracings may also show small cardiac oscillations reflective of cardiac activity.

  • Page 19: Placement

    Tracheal catheter Placement Some advanced mechanics measurements on the Avea ventilator require a tracheal catheter. To ensure the accuracy of measurements and minimize risk, place the tracheal catheter in the ET tube, and should not extend beyond the tip of the tube.
  • Page 20 Placement (continued) To ensure proper placement, measure the length of the ET tube and its associated adapters. Insert the tracheal catheter into the ET tube, and ensure the catheter does not extend beyond the tip of the tube. Next, assess the patient for signs of adverse response indicating the catheter may have been advanced beyond the tip of the ET tube.

  • Page 21: Of The Respiratory System

    Advanced pressure monitoring of the respiratory system The respiratory system behaves as four mechanical elements in series: endotracheal tube resistance (Ret), airway resistance (Raw), lung compliance (Cl) and chest wall compliance (Ccw). Pressure monitoring at various sites depends on these elements because they interact with delivered flow/volume and the source of the driving pressure.

  • Page 22: Advanced Mechanics

    Advanced mechanics Compliance Rapid shallow breathing index (f/ Vt): This index indicates the spontaneous breath rate per tidal volume, based on the formula: f/Vt = f f = spontaneous breath rate (BPM) Ve = spontaneous minute ventilation in L /min Range: 0 to 500 b /min/L...
  • Page 23 Compliance (continued) Ccw = dPes Range: 0 to 300 mL /cmH Normal: 175 to 200 mL/cmH O (adults) 50 to 190 mL/cmH O (pediatrics) NOTE: Requires placement of an esophageal balloon catheter. Dynamic lung compliance (Clung): The ratio of the tidal volume (exhaled) to the delta transpulmonary pressure.
  • Page 24 Compliance (continued) Where: dPplat tp = (Pplat aw – Pes) – (PEEPaw – PEEPes) Range: 0 to 300 mL /cmH Normal: 175 to 200 mL /cmH O (adults) 50 to 190 mL /cmH O (pediatrics) NOTE: This measurement requires an inspiratory hold maneuver esophageal balloon catheter.

  • Page 25: Resistance

    Resistance Respiratory system resistance (Rrs): Rrs is the airway pressure differential (peak minus plateau) to the inspiratory flow 12 ms prior to end inspiration. Rrs is a combination of artificial airway resistance (Rimp) and lung airway resistance (Rlung). Rrs increases with small artificial airways and asthma.
  • Page 26 Resistance (continued) Imposed resistance (Rimp): The measurement between the circuit wye and tracheal sensor during the inspiratory hold. Small artificial airways and high flow rates increase Rimp. Range: 0 to 100 cmH O/L /sec Normal: 4 to 12 cmH O/L /sec (adults) 6 to 15 cmH O/L /sec (pediatrics) NOTE: The measurement requires a tracheal catheter and an inspiratory hold maneuver.
  • Page 27 Flow Peak inspiratory flow rate (PIFR): This rate is the actual peak inspiratory flow rate for the inspiratory phase of a breath. Range: 0 to 300 L /min (all patients) Normal: 50 to 60 L /min (adults) 10 to 50 L /min (pediatrics) Peak expiratory flow rate (PEFR): This rate is the actual peak expiratory flow rate for the expiratory phase of a breath.

  • Page 28: Pressure

    Pressure Delta airway pressure (dPaw): This pressure reflects the difference between peak airway pressure (Ppeak aw) and baseline airway pressure (PEEPaw). dPaw = Ppeak aw – PEEPaw Range: -120 to 120 cmH Normal: 20 to 30 cmH O (adults) 12 to 24 cmH O (pediatrics) Delta esophageal pressure (dPes): This pressure reflects the difference between peak esophageal pressure (Ppeak es) and baseline esophageal pressure (PEEPes).
  • Page 29 Pressure (continued) Transpulmonary pressure plateau (PtpPlat): This pressure reflects the difference between airway plateau pressure (Pplat aw) and the corresponding Pes during an inspiratory hold. PtpPlat = Pplat aw – Pes Range: -60 to 120 cmH Normal: 13 to 18 cmH O (adults) 8 to 15 cmH O (pediatrics)

  • Page 30: Autopeep

    AutoPEEP AutoPEEPes: AutoPEEPes measures the difference between the Pes measured at the end of exhalation (PEEPes), minus the Pes measured at the start of a patient-initiated breath (Pes start) and the sensitivity of the ventilator’s demand system. The sensitivity of the ventilator’s demand system is the difference between baseline airway pressure (PEEPaw) and the airway pressure when the patient initiates a breath (Paw start).

  • Page 31: Placement

    AutoPEEP (continued) Transpulmonary pressure, AutoPEEP (PtpPEEP): The difference between the corresponding airway and Pes at the end of an expiratory hold during an AutoPEEP maneuver. PtpPEEP = Paw – Pes (at the end of an expiratory hold) Range: -60 to 120 cmH Normal: 0 NOTE: This measurement requires an expiratory hold and esophageal catheter placement.

  • Page 32: Work Of Breathing

    Work of breathing Ventilator work of breathing (WOBv): This equation calculates the summation of Paw minus baseline airway pressure (PEEPaw) multiplied by the change in tidal volume to patient (∆V) during inspiration and normalized to total inspiratory tidal volume (Vti). If Paw = PEEPaw, ∑(Paw –...
  • Page 33 Work of breathing (continued) Patient work of breathing (WOBp): This equation calculates the summation of two work components: work of the lung and work of the chest wall, normalized to the delivered tidal volume. WOBp = WOBlung + WOBcw Tiend ∑...
  • Page 34 Work of breathing (continued) Work of the lung (WOBlung): The calculation using Pes when PEEPes is greater than Pes, indicating patient effort. Work of the chest wall (WOBcw) for a spontaneously breathing patient is calculated using only the portion of the total tidal volume delivered due to patient effort (Vp) and Ccw.
  • Page 35 Work of breathing (continued) Imposed work of breathing (WOBi): WOBi reflects the work performed by the patient to breathe spontaneously through the breathing apparatus (e.g., the ET tube, breathing circuit, demand flow system). Imposed work is assessed by integrating the change in tracheal pressure and tidal volume, and normalizing the integrated value to the total inspiratory tidal volume (Vti) based on the following formula: WOBi = ∫...

  • Page 36: Avea Ventilator Screens

    Avea ventilator screens A mandatory, patient-triggered breath. Note a low WOBp and WOBi with high WOBv. A� Low WOBp B� WOBi C� WOBv A patient-triggered, pressure-supported breath. Note a higher WOBp and WOBi with lower WOBv and small amounts of AutoPEEP present.

  • Page 37: Notes

    Notes...
  • Page 38 Notes...
  • Page 39 Notes...
  • Page 40 26125 North Riverwoods Blvd 22745 Savi Ranch Parkway Mettawa, IL 60045, USA Yorba Linda, CA 92887, USA v ya i re�c o m ©2018 Vyaire. Vyaire, the Vyaire Logo and Avea are trademarks of Vyaire Medical, Inc. | 32114-001 Version A (0218)

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