T Low Sync ������������������������������������������������������������������������������45 CPAP/PSV �������������������������������������������������������������������������������� 31 Avea ventilator modes ���������������������������������������������46–49 The Avea™ ventilator user guide is not intended to replace the operator manual. You must become completely familiar with the Avea ventilator operator manual before using the Avea ventilator.
Touch-Turn-Touch™/Touch-Turn-Accept™ techniques To change most controls on the Avea ventilator: 1. Touch the screen directly over the control to select it. The control highlights (changes color), indicating that it is active. 2. Turn the data dial clockwise to increase the selected value, and turn the dial counter-clockwise to decrease it.
Setting breath type and mode To access the MODE SELECT screen, press the MODE indicator on the touch screen or the MODE button on the membrane panel. MODE indicator MODE button...
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Setting breath type and mode (continued) The MODE SELECT screen appears. Select the touch-screen button for the desired mode. Selecting Volume A/C mode Primary controls for the proposed mode appear at the bottom of the touch screen. Use the techniques described on page 3 to set these controls. Press MODE ACCEPT to accept the new mode and primary control settings.
Setting advanced settings To set advanced settings, press the ADV SETTINGS button on the lower left of the user interface. Advanced settings refine the breath delivery beyond the primary breath control settings. Press the ADV SETTINGS button for the desired primary control. Not all primary controls have advanced settings.
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Setting advanced settings (continued) Advanced settings for volume Use the Touch-Turn-Touch or Touch-Turn-Accept technique to modify the advanced settings (see page 3).
Setting alarm limits Press the ALARM LIMITS membrane button (to the upper right of the UIM) to open or close the window. ALARM LIMITS button Alarm Limits window with Volume A/C mode selected on MODE SELECT window Use the Touch-Turn-Touch or Touch-Turn-Accept technique to modify the alarm limits settings (see page 3).
Section 2: Breath types and modes This section describes the breath types and ventilation mode combinations available for adult, pediatric and neonatal patients using the Avea ventilator. Breath types There are two basic breath types: • Mandatory breaths (delivered according to the set ventilator parameters) •...
Mandatory breaths Mandatory breaths can be triggered by the machine, patient or operator. The Avea ventilator can deliver five mandatory breath types: 1. Volume breaths 2. Pressure breaths 3. Time cycled pressure limited (TCPL) breaths (neonatal patients only) 4. Pressure regulated volume control (PRVC/Vsync ) breaths ®...
Demand breaths can be either pressure supported (PSV) or spontaneous. All demand breaths are accompanied by the yellow patient demand indicator, which flashes in the upper left of the touch screen. The Avea ventilator delivers two demand breath types: 1. PSV: Active when CPAP/PSV, synchronized intermittent mandatory ventilation (SIMV) and airway pressure release ventilation (APRV)/BiPhasic modes are selected.
The Avea ventilator measures the peak inspiratory pressure (Ppeak) every 2 ms throughout the breath cycle and sets a virtual pressure support target at the greater of PEEP + 2 cmH O or Ppeak–2 cmH...
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Volume breaths are controlled by inspiratory flow, limited by a pre-set volume or maximum inspiratory pressure and cycled by volume or time. During mandatory breaths, the demand system can provide additional flow if needed. The mode for this breath type is Volume Assist Control (A/C) mode.
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In a volume breath, airway pressure increases until the set tidal volume delivers. Flow delivers at the set flow rate for the duration of the inspiratory time (with a square waveform selected) or can decelerate to 50% of the set peak flow during the inspiratory phase of the breath (with a decelerating waveform selected).
Volume SIMV mode In synchronized intermittent mandatory ventilation (SIMV), mandatory and demand breath types can deliver. Mandatory breaths deliver when the SIMV Time window is open as a patient effort is detected, the breath interval elapses when no patient effort is detected or the MANUAL BREATH key is activated.
Pressure controlled ventilation Pressure breaths are controlled by pressure (inspiratory + PEEP), limited by pressure (inspiratory + PEEP) and cycled by time or flow. The mode for this breath type is Pressure Assist Control (A/C) mode. All breaths are mandatory breaths.
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In a pressure breath, a variable flow delivers to reach the set inspiratory pressure above baseline. Once the set pressure level is achieved, flow is regulated to maintain this pressure for the duration of the set inspiratory time. The monitored peak pressure is equal to the sum of the inspiratory pressure and PEEP settings.
Pressure SIMV In SIMV mode, the ventilator can deliver mandatory and demand breath types. Mandatory breaths deliver when the SIMV Time window is open as a patient effort is detected, the breath interval has elapsed when no patient effort is detected or the MANUAL BREATH key is activated.
Volume Guarantee breaths (neonatal patients only):* When Volume Guarantee is selected, the control Insp Pres becomes an advanced setting, the Volume setting displays as a primary control and the ventilator delivers a test breath at the set inspiratory pressure. The inspiratory pressure for subsequent breaths is adjusted breath-to-breath. The pressure adjusts separately for time triggered breaths, patient triggered breaths, apnea backup breaths and manual breaths to maintain monitored expired tidal volume close to the set target.
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The initiation of a breath resets the breath interval. Patients may initiate all breaths. Without patient effort, breaths deliver at the set breath rate. During mandatory breaths, the demand system can provide additional flow if needed. In a TCPL breath, the inspiratory flow is used to achieve a set inspiratory pressure. During the inspiratory phase of the breath, inspiratory pressure maintains while flow is allowed to decelerate.
TCPL SIMV mode* In SIMV mode, the ventilator can deliver mandatory and demand breath types. Mandatory breaths deliver when the SIMV Time window is open as a patient effort is detected, the breath interval has elapsed when no patient effort is detected or the MANUAL BREATH key is activated.
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The inspiratory pressure for subsequent breaths is adjusted breath-to-breath. The pressure adjusts separately for time triggered breaths, patient triggered breaths, apnea backup breaths and manual breaths to maintain monitored expired tidal volume. PRVC Mode In pressure regulated volume control (PRVC) breaths, the pressure level modulates up or down to achieve a pre-set tidal volume.
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• Reaching the Volume Limit setting • Reaching a delivered tidal volume > 1.5 times the set volume • Terminating the flow of the test breath • Activating the: - High Peak Pressure alarm - Low Peak Pressure alarm - Low PEEP alarm - Patient Circuit Disconnect alarm - I-Time Limit - I:E Limit...
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The mode for the PRVC breath type is PRVC Assist Control (A/C) mode.* All breaths are mandatory breaths. A breath can be triggered by the detection of a patient effort, the breath interval timing out or the MANUAL BREATH key being activated. The initiation of a breath resets the breath interval.
PRVC SIMV mode* In SIMV mode, the ventilator can deliver mandatory and demand breath types. Mandatory breaths deliver when the SIMV Time window is open as a patient effort is detected, the breath interval has elapsed when no patient effort is detected or the MANUAL BREATH key is activated.
APRV/BiPhasic mode* Airway pressure release ventilation (APRV)/BiPhasic is a time cycled pressure mode that cycles between two different baseline pressures based on time, which can be synchronized with patient effort. Controlled ventilation can be maintained by time cycling the transitions between baseline pressures.
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Note: Time High and Time Low are the maximum time settings for a time cycled transition. Actual times may vary depending on the patient’s spontaneous breathing pattern and Sync window setting. Setting the Sync to 0% cycles the transition between pressure levels on time only and does not synchronize with patient efforts. The MANUAL BREATH button is not active in APRV/BiPhasic.
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Apnea ventilation is available in APRV/BiPhasic mode. If the patient does not initiate a spontaneous effort or the ventilator does not time cycle between pressure levels before the apnea interval has elapsed, the ventilator alarms for apnea and begins apnea ventilation at the apnea ventilation settings.
CPAP/PSV* Continuous positive airway pressure with pressure support ventilation (CPAP/PSV) breaths are demand breaths with the pressure level during inspiration equal to the pre-set PSV level plus PEEP. This breath type is controlled by pressure (pre-set PSV level + PEEP), limited by pressure (pre-set PSV level + PEEP) and cycled by time (PSV Tmax) or flow (PSV cycle).
Apnea Backup ventilation Apnea Backup ventilation is available in Assist Control (A/C), SIMV, APRV/BiPhasic and CPAP/PSV modes. Apnea Backup in Assist Control or SIMV The set mandatory breath rate or the Apnea Interval setting (whichever provides the highest respiratory rate) determines the apnea backup rate. When the Apnea Interval setting (found in the Alarm Limits window) determines the backup rate, the ventilator continues to ventilate at this rate until the apnea has been resolved.
Apnea Backup in APRV/BiPhasic and CPAP/PSV When these modes are selected, you must: 1. Set the primary and advanced settings for CPAP/PSV or APRV/BiPhasic. 2. Select the breath type for Apnea Backup mode (Volume or Pressure in adult and pediatric patients or Volume, Pressure or TCPL in neonatal patients) by pressing the Apnea Settings button.
nCPAP/IMV Nasal CPAP (nCPAP) is a spontaneous ventilation. In this mode, no mechanical positive pressure breaths deliver. Nasal IMV is a time triggered, time cycled mode of pressure control ventilation provided via nasal prongs as an enhancement to the nCPAP mode. When a rate is set greater than zero, time triggered, time cycled mandatory breaths deliver.
Standby When activated, Standby retains the primary controls, advanced settings and alarm limits when the patient is away from the ventilator. To initiate Standby, press the screen’s membrane button. The Standby Check message appears, asking you to confirm your intent to stop ventilation. The patient should be disconnected from the ventilator prior to the user initiating Standby.
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Standby (continued) Note: The patient wye must be blocked for this flow to be directed through the full length of the patient circuit. The STANDBY NOT VENTILATING message displays. Press Resume to restart ventilation at the current settings.
Volume Limit The Volume Limit (Vol Limit) setting sets the volume limit for a pressure limited breath. When the volume delivered to the patient meets or exceeds the pre-set volume limit, the inspiratory phase of the breath terminates. The volume limit is active for Pressure, PRVC/Vsync, TCPL and PSV breaths only. In neonatal applications, the volume limit requires a wye flow sensor.
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Machine Volume The Machine Volume (Mach Vol) control sets the minimum tidal volume delivered as the control is activated in a pressure control breath. This control is always used with the time cycling criterion in pressure control ventilation. The machine volume is circuit compliance compensated in adult and pediatric applications.
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During this transition in flow, the inspiratory time remains constant and the Ppeak increases to reach the set machine volume. The maximum Ppeak is determined by the High Peak Pressure alarm setting. Note: Pmax disables when the machine volume is set. If flow cycling is active in pressure control, the ventilator does not cycle the flow until meeting the machine volume.
Inspiratory Rise The Inspiratory Rise (Insp Rise) setting controls the slope of the pressure rise during a mandatory breath. This control is a relative control with fast at a setting of 1 and slow at a setting of 9. The Insp Rise control is not active for TCPL breaths. Flow Cycle The Flow Cycle setting sets the percentage of the peak flow that terminates the inspiratory phase of a pressure control or TCPL breath.
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Waveform During the delivery of a volume breath, flow can be delivered in one of two user- selectable waveforms: Square Wave or Decelerating Wave. The default waveform is Decelerating Wave. Square Wave (Square) With this waveform selected, the ventilator delivers gas at the set peak flow for the duration of the inspiration.
Bias Flow The Bias Flow control sets the background flow available between breaths. Additionally, this control establishes the base flow for flow triggering. Note: To ensure adequate bias flow for inspiratory triggering, the Bias Flow setting should be at least 0.5 L per minute greater than the flow trigger threshold. Consult the ventilator circuit manufacturer to ensure the Bias Flow setting can sufficiently prevent overheating the ventilator circuit.
Vsync* When Vsync is selected, a decelerating flow, volume test breath to the set tidal volume with a 40 msec pause delivers to the patient. The ventilator sets the target pressure at the end inspiratory pressure for the first pressure control breath. The next breath and all subsequent breaths deliver as pressure control breaths.
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Vsync* (continued) • Terminating the flow the test breath • Activating the: - High Peak Pressure alarm - Low Peak alarm - Low PEEP alarm - Patient Circuit Disconnect alarm - I-Time Limit - I:E Limit *Vsync is only available for adult and pediatric patients Note: The Peak Flow control sets the flow rate, which is used for the test breath only.
PSV Rise The PSV Rise setting sets the slope of the pressure rise during a pressure-supported breath. It is a relative control with a range from fast at a setting of 1 to slow at a setting of 9. PSV Cycle The PSV Cycle setting sets the percentage of peak inspiratory flow that terminates the inspiratory phase of a PSV breath.
T High PSV The T High PSV setting sets the volume limit for a pressure limited breath. When the volume delivered to the patient meets or exceeds the pre-set volume limit, the inspiratory phase of the breath terminates. T High Sync The T High Sync setting sets the length of the Time High trigger (Sync) window.
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