ResMed Astral Series Clinical Manual
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ResMed Astral Series Clinical Manual

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  • Page 1 Clinical guide English...

  • Page 2: Table Of Contents

    Patient circuit accessories ....................11 Power accessories......................11 Power supplies ....................... 12 Astral External Battery ....................12 ResMed Power Station II (RPSII) ..................12 Remote Alarm II ......................12 Pulse oximeter ....................... 12 Optional accessories ......................13 Astral Mobility bag ......................13 Astral SlimFit Mobility bag ....................
  • Page 3 Connecting to mains power .................... 60 Connecting the Astral External Battery ................61 Using the External Battery ........................ 61 Connecting to a ResMed Power Station (RPSII) .............. 62 Connecting to an external DC power source ..............62 Using the internal battery ....................63 Battery run time ..........................
  • Page 4 Using the Astral device for the first time ................66 Ventilation modes ......................67 (A)CV mode - Assisted volume-controlled ventilation............68 P(A)CV mode - Assisted pressure-controlled ventilation ..........69 P-SIMV - Pressure Synchronised Intermittent Mandatory Ventilation ......71 V-SIMV - Volume Synchronised Intermittent Mandatory Ventilation ....... 72 PS mode - Pressure support ...................
  • Page 5 Adjusting alarm settings ....................108 Setting the alarm volume ....................109 Testing the alarm sounders and indicators ..............109 Testing the Remote Alarm .................... 110 Testing the alarms ......................111 Testing the power alarms ..................... 111 Testing the pressure alarms ..................111 Testing the ventilation monitoring alarms ..............
  • Page 6 Deleting patient data ......................129 Cleaning and maintenance ....................130 Single patient use ......................130 Weekly ............................130 Monthly ............................130 Multi-patient use ......................131 Replacing components ....................132 Replacing the air filter ........................132 Replacing the expiratory flow sensor and antibacterial filter (Astral 150 only) ........132 Replacing the double limb adapter (expiratory valve) ..............134 Replacing the Oxygen sensor ......................134 Replacing the internal battery ......................135...
  • Page 7 Recommendations for suctioning ................... 164 Limited warranty ......................165 Appendix A: Definitions ....................166 Ventilation settings definitions ..................166 Measured and calculated parameter definitions ............168 Appendix B: Ventilation parameters................170 Ventilation Parameters summary table ................170 Ventilation displayed parameters................... 174 Supplementary Features ....................

  • Page 8: Introduction

    Introduction Introduction The Astral device provides mechanical ventilation to both ventilation dependent and non-dependent patients. It delivers pressure and volume ventilation through either a valve or leak circuit, and is compatible with a range of accessories to support specific use cases. The information in this guide applies to both the Astral 100 and the Astral 150 devices.

  • Page 9: General Warnings And Cautions

    Introduction General warnings and cautions The following are general warnings and cautions. Further specific warnings, cautions and notes appear next to the relevant instruction in the manual. A warning alerts you to possible injury. WARNING • If you notice any unexplained changes in the performance of the device, if it is making unusual or harsh sounds, if the device or the power supply are dropped or mishandled discontinue use and contact your healthcare provider.
  • Page 10 A caution explains special measures for the safe and effective use of the device. CAUTION • Repairs and servicing of the device should only be performed by an authorised ResMed service representative. • The temperature of the airflow for breathing produced by the device can be as much as 6ºC higher than the temperature of the room.

  • Page 11: The Astral System

    ResMed Connectivity Module Hospital (RCMH). Note: Some accessories may not be available in all regions. For a full list of accessories, see Ventilation accessories on www.resmed.com under the Products page. If you do not have internet access, please contact your ResMed representative.

  • Page 12: The Astral Device

    The Astral system The Astral device The following images describe the components of the Astral device. Description Adapter port Can be fitted with single limb adapter, single limb leak adapter or double limb adapter (Astral 150 only). Handle Inspiratory port (to patient) Provides an outlet for pressurised air to be delivered to the patient via the patient circuit.

  • Page 13: The Astral Device Interface

    The Astral system Description DC power inlet Device on/off push button Sensor connector Remote alarm five pin connector Low flow oxygen input (up to 30 L/min) Air inlet (complete with hypoallergenic filter) The Astral device interface The interface of the Astral device comprises several different features described in the following image. Description Touch screen Power source indicators...

  • Page 14: Touch Screen

    The Astral system Description Therapy on/off indicator Device ready Constant green display when the device is turned on but not ventilating. Device ventilating Flashes blue when the device is ventilating and the Ventilation LED setting is 'ON'. Otherwise is 'OFF'. Alarm mute/reset button Illuminates when an alarm is triggered and flashes when the sound is muted.

  • Page 15: Information Bar

    The Astral system Description Internal battery indicator Lock touch screen button Menu bar Bottom bar Start/Stop ventilation button Main screen Sub-menus Pressure bar Information bar The Information bar is displayed at the top of the touch screen. The Information bar displays the operating status of the device, including patient type, current circuit configuration, programs, information messages, ventilation status, alarms and power status.

  • Page 16: Menu Bar

    The Astral system Menu bar The Menu bar provides access to the four main menus in the Astral device. Monitors menu View real-time patient data in either waveform or monitoring formats including pressure, flow, leak, tidal volume, synchronisation and oximetry. Setup menu Configure and view ventilation therapy or device settings;...

  • Page 17: Pressure Bar

    The Astral system Pressure bar The Pressure bar displays real-time therapy data while the Astral device is ventilating. Patient pressure is shown as a bar graph. Peak inspiratory pressure is shown as a numerical value and watermark. Spontaneously triggering and cycling is indicated by The example below displays the pressure bar when a patient is spontaneously breathing.

  • Page 18: Circuits And Patient Interfaces

    Power accessories WARNING • The Astral device should only be used with accessories recommended by ResMed. Connection of other accessories could result in patient injury or damage to the device. • Connecting the Astral device to the battery of a battery-powered wheelchair may affect the device performance and may result in patient harm.

  • Page 19: Power Supplies

    Astral DC adapter. Astral External Battery The Astral External Battery has been designed specifically for use with the Astral series of ventilators. It is intended to provide Astral ventilators with eight hours of power when mains power is unavailable during typical use.

  • Page 20: Optional Accessories

    The stand holds both the Astral device and its external power supply. Aerogen ® nebuliser If required, a nebuliser can be used in conjunction with the Astral device. ResMed recommends Aerogen ® nebuliser products. For more information, refer to Attaching a nebuliser (see page 53).

  • Page 21: Using The Astral Device

    Connecting to mains power To connect to mains power: 1. Connect the DC plug of the supplied ResMed external power supply unit to the rear of the Astral device. 2. Connect the power cord to the ResMed power supply unit.

  • Page 22: Powering Off The Device

    Using the Astral device Powering off the device The Astral device can only be powered off when ventilation is stopped. Removing AC power does not power off the device. The device remains powered on internal battery. Turning off the device must be done manually and must be performed before leaving the device disconnected from AC power for any extended period of time.

  • Page 23: Using The Setup Assistant

    Using the Astral device To exit Clinical mode: 1. Press . The Exit Clinical Mode screen is displayed. 2. Press Confirm. The padlock is locked and the Patient Home screen is displayed. Note: If you do not make a selection within 7 seconds, the device returns to the previous screen. Using the Setup Assistant To quickly set up the Astral device and start ventilation, use the Setup Assistant.
  • Page 24 Using the Astral device 5. Select the Patient type. This will automatically configure default alarm and setting ranges. 6. The Select Circuit type screen is displayed. Select the circuit type to be connected to the device. 7. The Learn Circuit screen is displayed. Press Start. 8.
  • Page 25 Using the Astral device 9. Select the required Ventilation mode. The default settings for the mode are displayed. 10. Review and adjust the settings and alarms as required. For further information on adjusting setting parameters and alarm settings, refer to Adjusting patient settings (see page 28) and Adjusting alarm settings (see page 108).

  • Page 26: Enhanced Access Feature

    Using the Astral device Enhanced access feature The Astral device offers an enhanced access feature ('Big buttons' mode) to provide easier usability and accessibility for starting and stopping ventilation as well as Alarm mute. The 'Big buttons' mode can be switched on and off as required in either Clinical or Patient mode. WARNING To prevent inadvertent alarm mute or reset, do not leave the patient in contact with the device screen.

  • Page 27: Starting And Stopping Ventilation

    Always ensure that the values in the ventilation therapy and alarm settings are appropriate before starting therapy. Note: If using the device for the first time, ResMed recommends performing a functional test before starting ventilation. Refer to Using the Astral device for the first time (see page 66).

  • Page 28: Locking And Unlocking The Touch Screen

    Using the Astral device To stop ventilation: Ventilation can be stopped at any time and from any screen. 1. If oxygen is connected, turn off the oxygen. 2. Press and hold 3. Release when prompted. 4. Press Confirm. Ventilation is stopped. Locking and unlocking the touch screen The touch screen can be unlocked at any time in both Patient and Clinical modes.

  • Page 29: Monitors Menu

    Using the Astral device Alarms 1 & 2 Tidal Volume (Vt) Minute Ventilation (Mv) Alarms Respiratory Rate Pressure Low PEEP Ventilation Stop Leak Non-vented Mask (NV Mask) / Rebreathing Alarm 3 Pulse Apnoea Response Apnoea Response Apnoea Detection Alarm Volume Alarm Level Alarm Minimum Volume Alarm Test...

  • Page 30: Setup Menu

    Using the Astral device Setup menu The Setup menu displays six different sub-menus: • Programs—to configure therapy programs • Setup Assistant—guides you through device setup • Circuit—to set up the circuit • Settings—to change the ventilation mode and related settings •...

  • Page 31: Information Menu

    Using the Astral device Information menu The Information menu is comprised of three sub-menus: • Events—all logged event activity that has taken place is displayed. A breakdown of specific alarms, settings or system events can also be viewed. • Device—information about the actual device is displayed, eg, Model and Serial numbers, Software version, and Next service due date.
  • Page 32 Using the Astral device To enable / disable additional programs: 1. Access Clinical mode. 2. From the Setup main menu, select Programs. 3. Enable additional programs by pressing the slider. Note: The current active program is highlighted in orange and cannot be disabled. In the screen below, P1: (A)CV is the current active program.

  • Page 33: Setting Up A New Program

    Using the Astral device To change programs: 1. Select P2: (A)CV. P2 becomes the active program. 2. Select and start the Setup assistant. Refer to Using the Setup Assistant (see page 16). Once the Setup assistant is complete, P2 will now be configured to the settings you have chosen and is ready to Start ventilation.
  • Page 34 Using the Astral device To adjust the Ventilation mode of the current active program: 1. Access Clinical mode, the Main Settings screen will be displayed automatically. 2. The current active Ventilation mode and settings are displayed. 3. Press the Ventilation mode button. The Select Ventilation Mode screen will display, the current active Ventilation mode will be highlighted orange.

  • Page 35: Adjusting Patient Settings

    Using the Astral device 6. To make changes to the patient settings within this mode, refer to Adjusting patient settings (see page 28). Note: If the mode change is cancelled you will be returned to the current active mode's primary settings page.

  • Page 36: Monitoring Ventilation

    Using the Astral device Notes: • The Apply button is disabled if one or more settings cannot be applied. Refer to Interdependence of controls (see page 88). A message is displayed indicating the reason. • If the mode change is cancelled you will be returned to the current active mode's primary settings page. All modifications will be disregarded.
  • Page 37 Using the Astral device Continuously displayed monitors During ventilation, the Bottom bar displays the current measures for VT, MV, Resp.rate, Ti, % Spont Trig, and Leak. For a detailed description of the Bottom bar refer to Getting to know the Astral device (see page 6).

  • Page 38: Device Settings

    Using the Astral device Device settings All device configuration settings are stored independently of patient programs. The configurable settings are described in the following table. Device setting Adjustable Description by patient Inspiratory Phase Determines how to set-up the inspiratory phase for volume controlled breaths. Duration Options Can be set to either Ti Option or PIF Option.

  • Page 39: Adjusting Device Settings

    Using the Astral device Adjusting device settings Access adjustable device settings from the Setup menu and select Device config. The current active selections are highlighted in orange. To change settings, simply select another of the available options. The revised setting is highlighted in orange.

  • Page 40: Exporting Device Settings Onto Usb Stick

    Using the Astral device Exporting device settings onto USB stick Exporting of device settings can be performed at any time. To export device settings: 1. Insert a USB stick into the USB connector at the rear of the device. Refer to Data Management process (see page 127).

  • Page 41: Service Reminders

    Using the Astral device Service reminders The Service reminders provide information that device servicing is required in the near future. There are two types of Service reminders: • Preventative maintenance reminder—the two year service interval is approaching. Note: This reminder is linked to the Next service due date as displayed on the Device information page. •...
  • Page 42 Using the Astral device To enable a Service reminder: The Service reminders can only be enabled or disabled in Clinical mode. 1. Access Clinical mode. 2. From the Main menu, press Setup . The Setup menu is displayed. 3. Select the Reminders tab from the Device Config. sub-menu. 4.

  • Page 43: Circuit Options

    Circuit options Circuit options The Astral device supports a range of circuits (the device and accessories assembled together) to suit individual patient needs. The device uses interchangeable circuit adapters. The following table may assist in selecting suitable circuits and settings for different patient types: Tidal volume range Recommended patient type setting Suitable circuit diameters 50 mL to 300 mL...
  • Page 44 Circuit options There are three circuit adapters: Adapter For use with Single limb leak Single limb circuit with intentional leak or mouthpiece circuit Single limb Single limb circuit with expiratory valve (expiratory valve integrated into the circuit) Double limb Double limb circuit (expiratory valve integrated into the adapter) OR single limb circuit with (Astral 150 only) intentional leak or mouthpiece circuit A Learn Circuit should be performed after any change of circuit.

  • Page 45: Fitting The Circuit Adapter

    Connecting a single limb circuit with intentional leak An intentional leak may be provided in-line using the ResMed Leak Valve or via an integrated mask vent. When using a circuit with intentional leak, estimation of the patient respiratory flow is enhanced by ResMed's automatic leak management feature Vsync.

  • Page 46: Connecting A Single Limb Circuit For Invasive Use

    Connecting a single limb circuit for invasive use CAUTION Always set up the ResMed Leak Valve in the breathing circuit with the arrows and the symbol pointing in the direction of air flow from the Astral device to the patient.

  • Page 47: Connecting A Single Limb Circuit With Expiratory Valve

    Circuit options Connecting a single limb circuit with expiratory valve In a single limb circuit with expiratory valve, air pressure at the patient is monitored using the proximal pressure sensor line. To enable fast and accurate connection, use an Astral Quick Connect Single Limb Circuit. This custom accessory with its integrated proximal pressure sensor and expiratory valve control line, is designed specifically for use with Astral ventilators.
  • Page 48 Circuit options To connect a standard single limb valved circuit to the Astral: 1. Connect the Proximal pressure line to the upper connector of the Astral device single limb adapter. 2. Connect the PEEP control line to the lower connector of the Astral device single limb adapter. 3.

  • Page 49: Connecting A Double Limb Circuit (Astral 150 Only)

    Circuit options Connecting a double limb circuit (Astral 150 only) A flow sensor within the Astral device measures exhaled air flowing through the expiratory valve integrated into the double limb circuit adapter. (This arrangement enables patient-exhaled tidal volume to be accurately measured and monitored). To connect a double limb circuit: 1.

  • Page 50: Connecting A Mouthpiece Circuit

    Circuit options Connecting a mouthpiece circuit The mouthpiece circuit is a single limb circuit with no expiratory valve or intentional leak. This circuit is not intended to support continuous exhalation into the circuit. For patients that may prefer continuous exhalation into the circuit, a circuit with expiratory valve or intentional leak should be considered. To connect a mouthpiece circuit: 1.

  • Page 51: Changing The Circuit Selection

    Circuit options Changing the circuit selection To change the circuit selection on the Astral device: 1. From the Setup main menu, select Circuit. 2. Select Circuit Type. (The current circuit type will be shown in orange). 3. Select the circuit you want to change to which will be highlighted orange. You will be taken to the Learn Circuit screen.
  • Page 52 Circuit options To perform a Learn Circuit: 1. From the Setup main menu, select the Circuit sub-menu. 2. Press Start and follow the on-screen prompts. Note: Trigger type sets whether a pressure-based or flow-based trigger threshold is used when a Double circuit is selected.
  • Page 53 Circuit options The following icons are used to report the Learn Circuit results: Learn Circuit Results Icon Description Learn Circuit completed Learn Circuit not tested. Default circuit characteristics will be applied. Accuracy of control and monitoring may not be met. Ensure that ventilation and alarms are effective before proceeding further. Learn Circuit completed.
  • Page 54 If possible, replace the oxygen sensor as described in Replacing the oxygen sensor (see page 134). Repeat Learn Circuit. If problem persists, return the device for servicing by an authorised ResMed Service Centre. If you choose to proceed with ventilation, FiO alarms will be disabled.

  • Page 55: Accessories

    Accessories Accessories For a full list of accessories, see Ventilation accessories on www.resmed.com under the Products page. If you do not have internet access, please contact your ResMed representative. Attaching patient circuit accessories WARNING • Adding or removing circuit components can adversely affect ventilation performance. ResMed recommends performing a Learn circuit every time an accessory or component is added to or removed from the patient circuit.
  • Page 56 Accessories To attach a humidifier to a patient circuit: 1. Connect a length of air tubing to the inspiratory port on the device. 2. Connect the other end of the air tubing to the inlet port on the humidifier. 3. Connect the patient circuit to the outlet port on the humidifier. The image below shows proper use of a humidifier in combination with a double limb circuit.

  • Page 57: Attaching A Heat Moisture Exchange (Hme)

    Accessories Attaching a Heat Moisture Exchange (HME) HME's are passive humidification systems that retain heat and moisture from the patient's exhaled gases via an internal membrane. An HME should not be used with active humidification. An HME can be used with the Astral device with a double limb circuit or single limb circuit with integrated valve. WARNING Only use HMEs that comply with the relevant safety standards, including ISO 9360-1 and ISO 9360-2.

  • Page 58: Adding Supplemental Oxygen

    Accessories To attach an antibacterial filter: 1. Fit the antibacterial filter to the inspiratory port of the device. 2. Connect the air tubing to the other side of the filter. 3. Perform the Learn Circuit function. 4. Attach the patient interface to the free end of the air tubing. WARNING •...
  • Page 59 Accessories WARNING • Use only medical grade oxygen sources. • Always ensure that the device is ventilating before the oxygen supply is turned on. • Oxygen flow must be turned off when the device is not ventilating so that oxygen does not accumulate within the device enclosure.

  • Page 60: Monitoring Delivered Oxygen

    Do not position the Astral device on its side as this may affect FiO monitoring accuracy. Attaching a nebuliser If required, a nebuliser can be used in conjunction with the Astral device. ResMed recommends Aerogen ® nebuliser products—designed to operate in-line with standard ventilator circuits and mechanical ventilators without changing ventilator parameters or interrupting ventilation.

  • Page 61: Attaching Other Accessories

    Accessories Connect the nebuliser unit with a T-piece into the inspiratory limb of the breathing circuit before the patient. If one of the Aerogen nebuliser models is being used (ie, Aeroneb Solo and Aeroneb Pro), it can be powered via the USB connector at the rear of the Astral device, or the Aerogen USB AC/DC adapter. Pictured above: Aeroneb ®...
  • Page 62 (pulse oximeter) connector at the rear of the device. *Please refer to the Ventilation accessories on www.resmed.com under the Products page for part numbers of oximeter accessories with confirmed compatibility. For information on how to use these accessories, refer to the user guide that comes with these accessories.

  • Page 63: Attaching A Remote Alarm

    Attaching a remote alarm The ResMed Remote Alarm II has been designed for use with Astral devices. The Remote Alarm II alerts you to an alarm that requires immediate attention. It triggers an audible and visual alarm when an alarm is triggered on the Astral device.

  • Page 64: Astral Carry Bag

    Accessories Astral Carry Bag The Astral device should always be packed in its Carry Bag when not in use to prevent damage to the device. WARNING The Astral should not be operated while in the Carry Bag. To ventilate while travelling, use the Astral Mobility bag or SlimFit mobility bag.

  • Page 65: Travelling With The Astral Device

    Astral carry bag to help security personnel understand the device and refer them to the following statement. • ResMed confirms that the Astral device meets the Federal Aviation Administration (FAA) requirements (RTCA/DO-160, section 21, category M) for all phases of air travel. •...

  • Page 66: Power Management

    Mains power • Astral External Battery • External DC power supply (eg, car 12V power outlet) • ResMed Power Station II • Internal battery For information on power supplies and sources, refer to the Technical Specifications (see page 138). English...

  • Page 67: Connecting To Mains Power

    Ensure that the power cord does not pose a tripping or choking hazard. To connect to mains power: 1. Connect the DC plug of the supplied ResMed external power supply unit to the rear of the Astral device. 2. Before connecting the power cord to the ResMed power supply unit, ensure the end of the connector of the power cord is correctly aligned with the input socket on the power supply unit.

  • Page 68: Connecting The Astral External Battery

    Power management Connecting the Astral External Battery The Astral External Battery has been designed specifically for use with the Astral Series of ventilators. It is intended to provide Astral ventilators with eight hours of power during typical use. For full details on using the Astral External Battery, refer to the External Battery user guide.

  • Page 69: Connecting To A Resmed Power Station (Rpsii)

    Power management Connecting to a ResMed Power Station (RPSII) The RPSII provides the Astral device with eight hours of power during typical use. To use, connect the power cord of the RPSII to the DC inlet port on the device.

  • Page 70: Using The Internal Battery

    Power management Using the internal battery An internal battery is included in the Astral device. It ensures a continuous power supply when mains power is disrupted and no external battery is connected to the device. When the Astral starts using the internal battery as its power source, you are notified by the Using internal battery alert and with the internal battery power source indicator.

  • Page 71: Storing And Recharging

    Power management Storing and recharging If the internal battery is not used, it must be recharged every six months. It takes approximately four hours to fully recharge the internal battery from depletion; however this can vary depending on environmental conditions and the device operating state. To prepare the internal battery for long-term storage: 1.
  • Page 72 Power management 2. Battery information The battery information can be accessed from the Battery sub-menu in the Information menu. This menu has two tabs: Charge—displays the current charge level (0-100%) for any batteries currently detected by the system, as well as the total system charge. Maintenance—displays the full charge capacity and the charge cycle count for any batteries currently detected by the system.

  • Page 73: Using The Astral Device For The First Time

    Using the Astral device for the first time When using the Astral device for the first time, ResMed recommends you first perform a functional test. A functional test will ensure the device is in proper working order before starting therapy. Information to assist you in resolving any issues is available in the Troubleshooting (see page 155) section.

  • Page 74: Ventilation Modes

    Ventilation modes Ventilation modes Astral supports a variety of ventilation modes. Available modes will vary depending on the circuit type chosen. Mode settings can be accessed from Main Settings tab from the Settings menu. Note: Some features may not be available on your device. Mode Circuit type Supplementary feature...

  • Page 75: (A)Cv Mode - Assisted Volume-Controlled Ventilation

    300 mL, however Astral permits adjustment of ‘Vt’ setting parameter up to 500 mL for cases where ‘Vt’ is set such that it compensates for leak in the breathing circuit. WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination. Supplementary features: •...

  • Page 76: P(A)Cv Mode - Assisted Pressure-Controlled Ventilation

    Ventilation modes (A)CV breath pattern showing one patient triggered breath amongst time triggered breaths, with inspiratory duration defined by Ti. The patient-triggered breath re-schedules the next time-triggered breath. P(A)CV mode - Assisted pressure-controlled ventilation P(A)CV is a pressure target ventilation mode delivering pressure-controlled mandatory breaths: Inspiration can either be initiated by the ventilator at a set respiratory rate (time-triggered breath) or the patient (spontaneous-triggered breath).
  • Page 77 Ventilation modes Parameter Setting Trigger When Trigger Type is set to Flow: Adult: Off, 0.5 to 15 [1.0] (L/min) Paed: Off, 0.5 to 15 [0.5] (L/min) When Trigger Type is set to Pressure: Off, Very Low to Very High [Medium] Rise Time (msec) Min, 150 to 900 [200] Note: Some default settings are different for Mouthpiece circuit.

  • Page 78: P-Simv - Pressure Synchronised Intermittent Mandatory Ventilation

    Ventilation modes P-SIMV - Pressure Synchronised Intermittent Mandatory Ventilation P-SIMV is a mixed ventilation mode delivering pressure-controlled mandatory breaths and pressure-supported spontaneous breaths. Mandatory breaths are delivered at a set frequency and spontaneous breaths are permitted between mandatory breaths. For mandatory breaths The inspiratory pressure support is set using P control and is initiated by either: the ventilator at a set respiratory rate the patient - if the patient effort is close enough to the next scheduled mandatory breath.

  • Page 79: V-Simv - Volume Synchronised Intermittent Mandatory Ventilation

    Ventilation modes Supplementary features: • Apnoea response • Manual breath Spontaneous breaths are permitted between mandatory breaths as shown in the figure above. In order to promote synchrony with the patient's spontaneous efforts, mandatory breaths may be patient triggered. Such patient triggering will cause some variation in the mandatory ventilation respiratory rate. V-SIMV - Volume Synchronised Intermittent Mandatory Ventilation V-SIMV is a mixed ventilation mode delivering volume-controlled mandatory breaths and pressure-supported spontaneous breaths.
  • Page 80 300 mL, however Astral permits adjustment of ‘Vt’ setting parameter up to 500 mL for cases where ‘Vt’ is set such that it compensates for leak in the breathing circuit. WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination. English...

  • Page 81: Ps Mode - Pressure Support

    Ventilation modes Supplementary features: • Apnoea response • Manual breath (Astral 150 only) Spontaneous breaths are permitted between mandatory breaths as shown in the figure above. In order to promote synchrony with the patient's spontaneous efforts, mandatory breaths may be patient triggered.
  • Page 82 Ventilation modes Parameter Setting Trigger Double limb circuit: When Trigger Type is set to Flow: Adult: 0.5 to 15 [1.0] (L/min) Paed: 0.5 to 15 [0.5] (L/min) When Trigger Type is set to Pressure: Very Low to Very High [Medium] Single limb circuit: Very Low to Very High [Medium] Rise Time (msec)

  • Page 83: (S)T Mode - Spontaneous Ventilation With Backup Rate

    Ventilation modes (S)T mode - Spontaneous Ventilation with backup rate (S)T is a bilevel ventilation mode delivering pressure-supported spontaneous breaths: Inspiration is either initiated by the ventilator at a set rate (time-triggered breath) or the patient (spontaneous-triggered breath). Spontaneous-triggered breaths re-schedule the next time-triggered breath.

  • Page 84: P(A)C Mode

    Ventilation modes P(A)C mode P(A)C is a bilevel ventilation mode delivering pressure-controlled mandatory breaths: Inspiration is either initiated by the ventilator at a set rate (time-triggered breath) or the patient (spontaneous-triggered breath). Spontaneous-triggered breaths re-schedule the next time-triggered breath. Resp. rate and Trigger can be set to Off, but not at the same time. When Trigger is set to Off, the mode name will be shown on the Information bar as PC.

  • Page 85: Cpap Mode

    Ventilation modes CPAP mode CPAP mode delivers a constant level of pressure during inspiration and expiration. With CPAP administered via a valved breathing system, the inspiratory triggering level is settable to optimise the control of the exhalation valve and minimise the patient's work of breathing. Adjust trigger sensitivity to accurately report patient respiratory rate.

  • Page 86: Ivaps (Intelligent Volume Assured Pressure Support) Mode

    Ventilation modes iVAPS (intelligent Volume Assured Pressure Support) mode Note: This feature may not be available on your device. iVAPS is designed to maintain a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support automatically and providing intelligent backup breaths. The iVAPS therapy mode is indicated for patients weighing 30 kg and above.

  • Page 87: Target Alveolar Ventilation

    Ventilation modes Target alveolar ventilation iVAPS targets alveolar ventilation. Alveolar ventilation was chosen because gas exchange occurs at the alveoli level. Total ventilation includes the ventilation devoted to the conducting airways, whereas alveolar ventilation best represents the useful portion of ventilation that reaches the alveoli. Alveolar ventilation cannot be measured directly, so iVAPS estimates it using a height approximated value of anatomical deadspace as shown in the graph below.

  • Page 88: Intelligent Backup Rate (Ibr)

    Ventilation modes intelligent Backup Rate (iBR) Instead of mandating a fixed backup rate, the intelligent Backup Rate (iBR) will shift automatically between two limits. During sustained apnoea, the iBR will adopt a pre-configured Target Patient Rate. This Target Patient Rate defines the upper boundary for iBR. Set the Target Patient Rate to match the patient’s average spontaneous rate (unlike a traditional backup rate).

  • Page 89: Adopting Recently Learnt Targets

    Ventilation modes Adopting recently learnt targets To adopt recently learnt targets 1. From the Setup main menu, select Settings. 2. From the Settings menu, select the Main settings tab 3. From the on-screen selections, press Ventilation Mode, then select iVAPS. 4.
  • Page 90 Ventilation modes 5. Review the Learnt Targets and make adjustment to Pt Height if required. Select Confirm. 6. Select Apply. You have now successfully configured iVAPS. Note: With AutoEPAP switched on, the information window name is updated to iVAPS.AutoEPAP. English...

  • Page 91: Entering The Target Values Manually

    Ventilation modes Entering the target values manually The Target Va can also be determined to adopt a Target Patient Rate using a settable Target Va parameter and patient height. Target Pt Rate should match the patient's normal breathing rate. To enter the target values manually 1.
  • Page 92 Ventilation modes 5. From the iVAPS main settings screen select Apply. iVAPS has been successfully applied. English...

  • Page 93: Autoepap

    Ventilation modes AutoEPAP iVAPS mode only. Note: This feature may not be available on your device. The purpose of EPAP is to maintain upper airway patency. AutoEPAP automatically adjusts pressure in response to flow limitation or obstruction of the upper airway. EPAP is adjusted within Min EPAP and Max EPAP settings with the response depending on the degree of the upper airway obstruction.

  • Page 94: Flow Shape Settings

    Ventilation modes Flow shape settings The Astral device supports four flow shape settings: 1. 100% (Constant) 2. 75% 3. 50% 4. 25% The figure illustrates how Flow Shape affects breath delivery for a fixed volume. With volume breath option set to PIF (Peak Inspiratory Flow), adjusting the flow shape alters the inspiratory duration, whereas with volume breath option set to Ti (Inspiratory time), adjusting the flow shape alters the Peak Inspiratory Flow.

  • Page 95: Interdependence Of Controls

    Ventilation modes Interdependence of controls Dynamic settings limits The adjustable range of one setting may be restricted by the value of another. When a dynamic limit of this kind is reached, a message describing the limitation (interdependence) is displayed on the Information bar and the Apply button is disabled.

  • Page 96: Triggering And Cycling

    Ventilation modes When making adjustments to the high pressure alarm limit, you are prompted to confirm the changes to any affected settings. If these setting changes are not accepted, the change to the high pressure alarm limit is not applied. Triggering and cycling •...

  • Page 97: Triggering With Intentional Leak Circuits

    Triggering with intentional leak circuits When using a circuit with intentional leak, estimation of the patient respiratory flow is enhanced by ResMed's automatic leak management feature—Vsync. Vsync technology allows the device to estimate the patient respiratory flow in the presence of unintentional leak.

  • Page 98: Triggering With Valve Circuits

    Ventilation modes Triggering with valve circuits When using single or double limb valve circuits, the Astral device uses ResMed's NIV+ trigger sensitivity technology. Unlike simple conventional triggering which only considers the magnitude of the pressure change, NIV+ also considers the shape of the pressure waveform to significantly improve trigger sensitivity.

  • Page 99: Changing The Trigger Type

    Ventilation modes Changing the Trigger Type For double limb circuits, changing Trigger type can be done while the device is ventilating or in Standby. To change between pressure and flow trigger types on double circuits: 1. From the Setup menu, select Circuit. 2.

  • Page 100: Cycling With Valve Circuits

    The higher the sensitivity selected, the smaller the patient effort required to trigger inspiration. The Touch trigger setting combines the standard trigger with ResMed’s Touch trigger technology to detect the patient engaging or blocking the mouthpiece to trigger inspiration.

  • Page 101: Supplementary Features

    Supplementary features Supplementary features Manual breath settings Manual breath feature allows the user to manually insert a breath within the currently delivered breathing pattern. The Manual breath feature is used to trigger manual breath(s) and can be pressed at any time. •...
  • Page 102 Supplementary features For pressure-assisted spontaneous breaths only the PS is magnified. For volume-controlled mandatory breaths, the volume is magnified by firstly flattening the flow shape, then by extending the Ti and finally by increasing the PIF. This applies to mandatory breaths in (A)CV and V-SIMV modes.

  • Page 103: Sigh Settings

    Supplementary features Sigh settings The Sigh breath feature allows the user to program the delivery of a 'sigh breath' at a regular interval (sigh interval) within the currently delivered breathing pattern. The sigh breath is a magnified version of the primary breath (Magnification factor set from 120 to 250%). For pressure-target breaths, the inspiratory duration and P control are magnified proportionally.

  • Page 104: Apnoea Settings

    Apnoea ventilation is displayed on the Information bar. The Apnoea response will deactivate when the patient triggers three consecutive breaths. ResMed recommends that Apnoea ventilation is enabled whenever the Resp. rate is set to Off. Control settings for Apnoea ventilation Parameter...

  • Page 105: (A)Cv Breath Pattern

    300 mL, however Astral permits adjustment of ‘Vt’ setting parameter up to 500 mL for cases where ‘Vt’ is set such that it compensates for leak in the breathing circuit. WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination.

  • Page 106: P(A)Cv Breath Pattern

    Supplementary features P(A)CV breath pattern Parameter Setting P control (cmH Adult: 2 to 50 [7] Paed: 2 to 50 [7] Ti (sec) Adult: 0.2 to 5.0 [1.0] Paed: 0.2 to 5.0 [0.6] Resp. rate (per min) Adult: 4 to 50 [15] Paed: 12 to 80 [15] English...

  • Page 107: Safety Volume Settings

    300 mL, however Astral permits adjustment of ‘Vt’ setting parameter up to 500 mL for cases where ‘Vt’ is set such that it compensates for leak in the breathing circuit. WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination.

  • Page 108: Non-Invasive Ventilation (Niv)

    Non-invasive ventilation (NIV) Non-invasive ventilation (NIV) Mask NIV Mask ventilation is supported by Astral on all circuit types and modes. NIV is commonly associated with leak, and minimising leak will promote optimal therapy. Astral’s vented (intentional leak) circuit therapies (CPAP, S, ST, iVAPS, and T modes) possess advanced leak management methods optimised for mask ventilation.

  • Page 109: Safety Considerations For Mouthpiece Ventilation

    Non-invasive ventilation (NIV) Safety considerations for mouthpiece ventilation The Disconnect Alarm allows detection of circuit disconnection (for example, when the mouthpiece has fallen out of reach of the patient), and whether the patient is able to reliably trigger ventilation or not. Regardless of whether the Disconnection Alarm is active or not, other mitigations may need to be put in place to ensure that patient safety is not compromised, such as the Apnoea alarm, external monitoring, an SpO...

  • Page 110: Alarms

    Alarms Alarms The Astral device activates alarms to alert you to conditions that require attention to ensure patient safety. When an alarm is activated, the Astral device provides both audible and visual alerts, and displays an alarm message in the Alarm display on the Information bar. As part of the alarm system (eg, the overpressure protection and system alarms), Astral may perform an automatic restart.

  • Page 111: Alarm Priority

    Alarms Indicator Description Alarm mute/reset button State: no light – no active alarms • steady light – active alarm/s • flashing light – alarm mute on. • This button also allows you to: mute the audible alert • reset the currently displayed alarm (if permitted). •...
  • Page 112 Alarms The following list of alarms is ordered by relative importance within priority. Adjustable alarms can be changed to suit therapy and care requirements. High priority alarms Medium priority alarms Low priority alarms Total power failure** High Pressure* Using internal battery High pressure protection Low PEEP* Battery 1 fault...

  • Page 113: Viewing The Active Alarms

    Alarms Viewing the active alarms in the Alarm display indicates that there are multiple active alarms. Although multiple alarms can be active simultaneously, the Alarm display only shows the highest priority alarm. The full set of active alarms is displayed in the Active alarms screen. When the highest priority alarm is cleared, the next highest priority alarm displays in the Alarm display.

  • Page 114: Resetting Alarms

    Alarms To silence alarms before they activate: 1. Press . Alarm mute is active for two minutes. During that period, is displayed on the Information bar and flashes. 2. To cancel Alarm mute, press the flashing again. Resetting alarms The following alarms cannot be manually reset. For these alarms you must correct the cause of the alarm.

  • Page 115: Adjusting Alarm Settings

    Alarms 2. Press Reset all to reset multiple alarms. Only those alarms that can be reset, will be reset. Any remaining alarms will require user intervention and correction. 3. Complete any required action to resolve the remaining alarms. 4. Press OK to close the Active alarms screen and return to the previous screen. Adjusting alarm settings CAUTION Adjusting alarm thresholds to maximum or minimum values may render the alarm ineffective.

  • Page 116: Setting The Alarm Volume

    Alarms Setting the alarm volume The volume level of the Astral device can be set from one to five (with five being the loudest and the default being three). It is also possible to set a minimum volume level, where any settings below the minimum are greyed out and disabled from use.

  • Page 117: Testing The Remote Alarm

    Alarms 3. Press Test to test the alarm. The alarm beeps twice and the LED flashes to indicate it is working correctly. Confirm the alarm beeps twice. Confirm the Alarm bar flashes red, then yellow. Confirm the mute button flashes. WARNING If no alarm sounds, do not use the ventilator.

  • Page 118: Testing The Alarms

    Testing the alarms Testing the alarms WARNING Do not perform alarm tests while the patient is connected to the ventilator. This section describes functional tests to confirm correct technical operation of Astral alarms. The efficacy of therapy alarm limits should be assessed clinically. It is recommended that alarms be tested individually.

  • Page 119: Testing The Ventilation Monitoring Alarms

    Testing the alarms Alarm Test procedure Start ventilation. Low PEEP Set the PEEP setting to 10 cmH After 30 seconds disconnect the test lung. Start ventilation. Low Pressure Record the peak inspiratory pressure (PIP). Set the Low PIP alarm limit above PIP. Testing the ventilation monitoring alarms For Astral 150, all ventilation monitoring alarm tests are conducted using a test lung and double limb circuit in (A)CV mode.

  • Page 120: Testing The Oxygen Alarms

    Testing the alarms Testing the oxygen alarms To perform these tests an oxygen sensor must be fitted. Tests are performed without supplementary oxygen. Run a Learn Circuit prior to testing. Alarm Event Test procedure Low FiO Start ventilation. Set the alarm limit to 24%. High FiO Start ventilation.

  • Page 121: Alarm Settings And Conditions

    Alarm settings and conditions Alarm settings and conditions This section details the alarms and their activation conditions. If the alarm has adjustable settings these are described. Unless otherwise noted, alarms are applicable to all modes. Values provided within [square brackets] are the default settings. As soon as the activation condition is met, the Astral device provides both audible and visual alerts without delay.

  • Page 122: Respiratory Rate Alarms

    Alarm settings and conditions Respiratory rate alarms Respiratory rate alarms activate when the average respiratory rate (Resp. rate) exceeds the corresponding alarm setting (no delay). Respiratory rate alarms will not activate during the first 60 seconds of ventilation. Alarm message Activates when Alarm setting (per min) Respiratory rate is less than the Low Resp rate setting...

  • Page 123: Obstruction

    Alarm settings and conditions Obstruction WARNING When an obstruction is detected, ventilation is suspended. Ventilation can only resume when the monitored pressure reduces to below 3 cmH O and the monitored expiratory flow reduces below 1 L/min. Obstruction may be caused by a circuit obstruction. Obstruction can typically be caused by a pinched PEEP valve control tube or a blocked exhalation valve outlet.

  • Page 124: Breathing Circuit Alarms

    Alarm settings and conditions Alarm Activates when Alarm setting Low PEEP Monitored PEEP is less than or equal to 2 cmH O below the Low PEEP PEEP ventilation setting for 10 consecutive breaths. Off / On [On] High PEEP Monitored PEEP is greater than 2 cmH O above the PEEP setting for 10 consecutive breaths.

  • Page 125: Circuit Configuration Alarms

    Alarm settings and conditions Circuit configuration alarms Alarm Activates when Alarm setting Incorrect circuit The circuit connected to the ventilator differs from the attached circuit type setting. Incorrect circuit A single limb circuit with intentional leak or mouthpiece adapter circuit is attached to the ventilator but an incorrect adapter has been fitted.

  • Page 126: Oximetry Alarms

    Alarm settings and conditions Oximetry alarms The oximetry alarms are only available when the pulse oximeter is connected to the Astral device. The alarms are enabled even when the ventilator is in standby. The SpO and Pulse rate alarms are automatically disabled when the pulse oximeter is disconnected from the Astral device.

  • Page 127: Power Alarms

    Alarm settings and conditions Power alarms Power alarms are not adjustable. CAUTION Data cannot be saved while there is a Critically low battery or Battery inoperable alarm. Program selections made while these alarms are active may be lost if the device is restarted. Recording of ventilation data and alarms is suspended.

  • Page 128: Detecting Circuit Disconnection And De-Cannulation

    Detecting circuit disconnection and de-cannulation Detecting circuit disconnection and de-cannulation Inadvertent disconnection of a circuit component or accidental removal of a cannula poses a hazard to a dependent patient. Astral is equipped with a number of alarms that when used in conjunction with the Disconnection Alarm are able to reliably detect circuit disconnection (including de-cannulation).

  • Page 129: Astral Disconnection Alarm

    Astral Disconnection Alarm Astral Disconnection Alarm The Astral Disconnection Alarm constantly measures circuit resistance to calculate the degree of disconnection (displayed as a percentage). The high priority Disconnection Alarm will activate when the measured disconnection value is greater than the set tolerance for the alarm Activation Time. The alarm will only activate if the measured disconnection value is continuously above the Disconnection Tolerance for the alarm Activation Time.
  • Page 130 Astral Disconnection Alarm So if simulating disconnection, the measured disconnection should consistently exceed the disconnection tolerance (disconnected icon). By contrast, during ventilation of the patient, the measured disconnection percentage should be mostly below the configured disconnection tolerance. Some interface types (vented mask and mouthpiece) will allow for the alarm to be turned off. The default Disconnection Tolerance will change according to the Pediatric/Adult setting and the Interface type selected.

  • Page 131: Setting Activation Time

    Astral Disconnection Alarm 4. Connect patient to the ventilator and allow breathing to stabilise. 5. Check that the measured disconnection value is below the Disconnection Tolerance value. 6. Adjust the Disconnection Tolerance value based on patient dependency. 7. Press Apply to confirm settings. Note: Setting the Disconnection tolerance too low may result in annoyance alarms and may render the alarm ineffective.

  • Page 132: Disabling (Or Enabling) The Disconnection Alarm

    Astral Disconnection Alarm Disabling (or enabling) the Disconnection Alarm The Disconnection Alarm default setting is ON. To disable the Disconnection Alarm, the patient interface setting must be set to: • Mouthpiece (for valved circuits), or • Mask (for leak circuits). To disable or enable the Disconnection Alarm function: 1.
  • Page 133 Astral Disconnection Alarm To test the Disconnection Alarm: These steps should be performed prior to connecting patient to the ventilator. 1. Attach all components of the patient circuit, including interface (a test cannula should be used in the case of a tracheostomy). 2.

  • Page 134: Data Management Process

    Information bar alerts you to a failed transfer. WARNING Only connect devices specially designed and recommended by ResMed to the data communication ports. Connecting other devices could result in patient injury, or damage to the Astral device.

  • Page 135: Data Management Summary

    Data management process Data management summary The table below summarises the data available for use in ResScan. Detailed data Summary data Logged for the last 7 days , Median, 95 Logged for the last 365 days Pressure 25 Hz Flow 25 Hz Volume 25 Hz...

  • Page 136: Deleting Patient Data

    Deleting patient data Deleting patient data To delete patient data 1. Access Clinical mode. 2. From the main menu, select 3. From the Events sub menu, select the Delete tab. 4. Select delete. All patient data and event logs will be deleted and patient hours will reset to zero. English...

  • Page 137: Cleaning And Maintenance

    Do not immerse the device, pulse oximeter or power cord in water. The Astral device can be cleaned using an anti-bacterial solution on a clean, non-dyed disposable cloth. After replacing any accessory in the patient circuit, ResMed recommends you perform a Learn Circuit. CAUTION Clean only exterior surfaces of the Astral device.

  • Page 138: Multi-Patient Use

    Cleaning and maintenance Multi-patient use WARNING • To prevent the risk of cross-contamination, an antibacterial filter, placed on the inspiratory port is mandatory if the device is to be used on multiple patients as under some fault conditions, expired gas may be returned through the inspiratory port. •...

  • Page 139: Replacing Components

    Cleaning and maintenance Replacing components Replacing the air filter Inspect the condition of the air filter and check whether it is blocked by dirt or dust. With normal use, the air filter needs to be replaced every six months (or more often in a dusty environment). CAUTION Do not wash the air filter.
  • Page 140 Cleaning and maintenance To remove and replace the expiratory flow sensor and antibacterial filter: Before replacing the expiratory flow sensor, turn off the device and remove mains power and/or external battery. 1. Turn over the device and place on a soft surface (to protect the LCD screen). 2.

  • Page 141: Replacing The Double Limb Adapter (Expiratory Valve)

    Cleaning and maintenance Replacing the double limb adapter (expiratory valve) Regularly check the double limb adapter for moisture and contaminants. Replace as necessary using the procedure as described in Connecting circuits. Replacing the Oxygen sensor To remove and replace the oxygen sensor (O cell): Before replacing the O sensor, turn off the device and remove from mains power and/or external...

  • Page 142: Replacing The Internal Battery

    As the battery ages, the available capacity decreases. When the remaining battery capacity is low, do not rely on the internal battery as the primary power supply. • Only recharge the internal battery inside the device or by using a ResMed approved charger. Avoid hard, physical impact on the device. •...

  • Page 143: Servicing

    Failure to do so could void your Astral device warranty, damage the Astral device or result in possible injury or death. Note: Retain the original packaging of the Astral device for use when shipping to/from an authorised ResMed Service Centre.

  • Page 144: Device Information

    Replace every six months (or more if necessary). Mask Masks should be reprocessed or replaced between patients. Cleaning, disinfection and sterilisation instructions are available from the ResMed website, www.resmed.com/downloads/masks. If you do not have internet access, please contact your ResMed representative. Patient circuits Follow the protocol of the hospital/healthcare facility and the recommendations of the manufacturer.

  • Page 145: Technical Specifications

    Technical specifications Technical specifications Operating pressure range Single limb with valve or double limb with valve: 3 to 50 hPa Single limb with intentional leak: 2 to 50 hPa CPAP: 3 to 20 hPa Maximum working pressure limit: 10 to 80* hPa *Not applicable on all device variants Forced cycling occurs if the Pressure alarm limit is exceeded.
  • Page 146 Technical specifications Dimensions (L x W x H) 285 mm x 215 mm x 93 mm Display screen size: 150 mm x 90 mm Weight 3.2 kg Inspiratory port / double limb adapter 22 mm taper, compatible with ISO 5356-1:2004 Anaesthetic &...
  • Page 147 IP21 (Protected against finger sized objects and against vertically dripping water.) when placed on a table stand, when used with the ResMed Homecare Stand, or when attached to the RCM or RCMH.
  • Page 148 WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination. ** To achieve specified accuracies, a successful Learn Circuit must be performed.
  • Page 149 Technical specifications Pneumatic flow path WARNING Under normal or single fault conditions the entire pneumatic flow path can become contaminated with body fluids or expired gases if antibacterial filters are not installed on the ventilator outlet and double limb adapter exhalation port.

  • Page 150: Monitoring

    Monitoring Monitoring This section specifies the monitored parameters of the Astral device. Monitored therapy parameters are only displayed during ventilation. Other parameters (eg, battery charge level and oximetry data) are monitored even when not ventilating. The Astral device monitors the following parameters: Time parameters Parameter Updates...

  • Page 151: Pressure Parameters

    Monitoring Parameter Updates Units Range Resolution Accuracy Measured Unintentional End of breath 0 to 100 Leak (for double limb circuit with expiratory valve) * When Resp. rate ≥ 8/min, and Pressure ≤ 30 hPa for circuits with intentional leak, and with non-compliant interface. Pressure parameters Parameter Updates...

  • Page 152: Accuracy Of Controls

    Accuracy of controls Notes: • All flows and volumes are measured at BTPS conditions. • To achieve specified accuracies, a successful Learn Circuit must be performed prior to measurement testing. Specified accuracies exclude mask compliance. • Pressure may be displayed in cmH O, hPa or mbar.
  • Page 153 Accuracy of controls Parameter Range Resolution Accuracy Trigger (inspiratory trigger) (A)CV, P(A)CV: 0.5 L/min Off, 0.5 to 15 L/min V-SIMV, PSIMV, PS, CPAP: 0.5 to 15 L/min Inspiratory Pressure Trigger (A)CV, P(A)CV: Off, Very Low to Very High PS, P-SIMV, V-SIMV, CPAP: Very Low to Very High Trigger sensitivity –...
  • Page 154 300 mL, however Astral permits adjustment of ‘Vt’ setting parameter up to 500 mL for cases where ‘Vt’ is set such that it compensates for leak in the breathing circuit. WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination. Notes: •...

  • Page 155: Measurement System And Accuracy

    Measurement System and Accuracy Measurement System and Accuracy The Technical Specifications published above are provided in accordance with ISO 80601-2-72 2015. Due to the introduction of a new home care standard, manufacturers are required to declare measurement uncertainty. In accordance with ISO 80601-2-72 2015 the measurement uncertainty of the manufacturer's test equipment is: For measures of flow ±...

  • Page 156: Guidance And Manufacturer's Declaration Electromagnetic Emissions & Immunity

    Emissions & Immunity Medical electrical equipment needs special precautions regarding EMC and needs to be installed and put into service according to EMC information provided in this document. This declaration currently applies for the following ResMed devices: • Astral Series of Ventilators.

  • Page 157: Guidance And Manufacturer's Declaration - Electromagnetic Immunity

    Guidance and Manufacturer’s Declaration Electromagnetic Emissions & Immunity Guidance and manufacturer’s declaration – electromagnetic immunity These devices are intended for use in the electromagnetic environment specified below. The customer or the user of the device should assure that the device is used in such an environment. Immunity test IEC60601-1-2 test Compliance level Electromagnetic environment—guidance...
  • Page 158 Guidance and Manufacturer’s Declaration Electromagnetic Emissions & Immunity Immunity test IEC60601-1-2 test Compliance level Electromagnetic environment—guidance level, Ed. 4 Radiated RF 10 V/m 10 V/m Recommended separation distance for life IEC 61000-4-3 80 MHz to 2.5 GHz 80 MHz to 2.5 GHz support equipment for Home d = 1.2 √P 80 MHz to 800 MHz...

  • Page 159: Recommended Separation Distances Between Portable And Mobile Rf Communications Equipment And The Life Support Device

    Guidance and Manufacturer’s Declaration Electromagnetic Emissions & Immunity Recommended separation distances between portable and mobile RF communications equipment and the life support device These devices are intended for use in an environment in which radiated RF disturbances are controlled. The customer or the user of the device can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the device as recommended below, according to the maximum output power of the communications equipment.

  • Page 160: Symbols

    If you need information on these disposal systems, please contact your local waste administration. The crossed-bin symbol invites you to use these disposal systems. If you require information on collection and disposal of your ResMed device please contact your ResMed office, local distributor or go to ResMed.com/environment.

  • Page 161: Standards Compliance

    • ISO 80601-2-72 Medical electrical equipment - Part 2-72: Particular requirements for basic safety and essential performance of home healthcare environment ventilators for ventilator-dependent patients Training and support For training and support materials, please contact your ResMed representative.

  • Page 162: Troubleshooting

    Troubleshooting If there is a problem, try the following suggestions. If the problem cannot be solved, contact your care provider or ResMed. Alarm troubleshooting The most common reason for an alarm to sound is because the system has not been properly assembled or a Learn Circuit has not been correctly performed for each program.
  • Page 163 Troubleshooting Alarm message Action Flow sensor fault Replace expiratory flow sensor. Flow sensor not calibrated Perform a Learn Circuit. Check the patient's status. High FiO Check and adjust the oxygen supply. Verify that therapy and alarm settings are appropriate. Perform a Learn Circuit to recalibrate the oxygen sensor. Check the patient's status.
  • Page 164 Troubleshooting Alarm message Action Check the patient's status. High Vte Check double limb circuit adapter for contaminants or water. Inspect the double limb circuit adapter. If necessary, replace the circuit adapter. Verify that therapy and alarm settings are appropriate. Perform a Learn Circuit. Check the patient's status.
  • Page 165 Power fault / no charging Check connection to mains power (if present). This can be caused by the battery temperature being out of range. If problem persists, contact your ResMed Service Centre. Check the connection of the proximal sense line. Pressure Line disconnected Check the circuit for water.
  • Page 166 Troubleshooting Alarm message Action Check the patient's status. Safety system fault Transfer the patient to an alternate means of ventilation. Return the device for servicing. Check the patient's status. System fault Perform a Learn circuit. If problem persists, or the device fails self-test, return the device for service. Check the patient's status and airway.

  • Page 167: Learn Circuit Troubleshooting

    Troubleshooting Learn Circuit troubleshooting Error code Action Hardware fault detected. Contact an authorised Service Centre. 104, 105 During the first step of the Learn Circuit, check that the inspiratory port and air inlet filter of the Astral device are clear of obstructions; and the circuit is not connected to the inspiratory port.
  • Page 168 Troubleshooting Error code Action Unable to learn the circuit. Ensure that the circuit is not moved until completion of the test. Check the circuit and attached accessories for blockages. Ensure that there are no sharp bends or kinks in the circuit and the patient end is not blocked.
  • Page 169 Troubleshooting Error code Action Unable to learn the circuit. Ensure that the circuit is not moved until completion of the test. Check the circuit and attached accessories for blockages. Ensure that there are no sharp bends or kinks in the circuit and the patient end is not blocked.

  • Page 170: General Troubleshooting

    Troubleshooting General troubleshooting Issue Action Condensation forming in circuit Condensation may form due to high humidity settings and low ambient temperatures. Adjust humidifier settings in accordance with manufacturer's instructions. Touch screen damaged or If you are unable to power off the Astral device normally, use the following forced non-responsive shutdown procedure: Disconnect any external power source (eg, AC mains or external battery).

  • Page 171: Recommendations For Suctioning

    Recommendations for suctioning Recommendations for suctioning Suctioning involves application of negative pressure (vacuum) to the airway through a catheter tube to remove airway secretions causing airway obstruction. Astral supports two methods of suctioning based on the selection of catheter  open and closed. The need for suctioning can be detected by the ventilator through: •...

  • Page 172: Limited Warranty

    • This warranty is only available to the initial consumer. It is not transferable. If the product fails under conditions of normal use, ResMed will repair or replace, at its option, the defective product or any of its components. This Limited Warranty does not cover: a) any damage caused as a result of improper use, abuse, modification or alteration of the product;...

  • Page 173: Appendix A: Definitions

    Appendix A: Definitions Appendix A: Definitions Ventilation settings definitions The available settings will vary with the selection of the ventilation mode. Each mode details the settings available. Setting Definition Apnoea Definition Apnoea Definition sets the type of breath which must be delayed for an apnoea to be detected.
  • Page 174 Appendix A: Definitions Setting Definition P control max Maximum allowed pressure control (P control max) sets the maximum pressure control above PEEP allowed to achieve the target safety volume. Patient type Select from Adult or Paediatric. This setting configures the default values and ranges available for ventilation settings and determines circuit resistance acceptance criteria applied in the Learn Circuit.

  • Page 175: Measured And Calculated Parameter Definitions

    Appendix A: Definitions Measured and calculated parameter definitions The following measured and calculated parameters are displayed during configuration or during ventilation. Each Ventilation mode details the parameters displayed. Parameter Definition Average of percentage of Oxygen delivered to circuit. I:E is the ratio of the inspiratory period to the expiratory period. The measured I:E ratio is displayed as a monitored parameter during ventilation.
  • Page 176 Appendix A: Definitions Parameter Definition Resp. rate Respiratory rate (Resp. rate) is the number of breaths per minute averaged over the last eight breaths. The measured Resp. rate is displayed as a monitored parameter during ventilation. RSBI Rapid Shallow Breathing Index (RSBI) is calculated by dividing the breath rate by Tidal Volume.

  • Page 177: Appendix B: Ventilation Parameters

    Appendix B: Ventilation parameters Appendix B: Ventilation parameters The following table provides a summary of the Astral device parameter ranges and the [default settings]. Ventilation Parameters summary table Valve Ventilation and Mouthpiece Parameter Leak Ventilation Setting Circuit Respiratory rate  ...
  • Page 178 Appendix B: Ventilation parameters Valve Ventilation and Mouthpiece Parameter Leak Ventilation Setting Circuit    (cmH Adult: 2 to 50 [7] • Paed: 2 to 50 [7] • Spontaneous breaths: V-SIMV, P-SIMV Adult: 2 to 50 [7] • Paed: 2 to 50 [7] •...
  • Page 179 Appendix B: Ventilation parameters Valve Ventilation and Mouthpiece Parameter Leak Ventilation Setting Circuit Cycle (%)      P-SIMV, V-SIMV (spontaneous breaths), PS 5 to 90 [25%] (leak) 5 to 90 [Auto] (valve) Cycle is fixed at 15% for valve, 10% for leak.
  • Page 180 300 mL, however Astral permits adjustment of ‘Vt’ setting parameter up to 500 mL for cases where ‘Vt’ is set such that it compensates for leak in the breathing circuit. WARNING ResMed does not recommend 500 mL as the upper limit for the pediatric tidal volume use; however, clinicians may choose this upper limit based on their clinical determination. English...

  • Page 181: Ventilation Displayed Parameters

    Appendix B: Ventilation parameters Ventilation displayed parameters The following therapy parameters are displayed on the device but cannot be changed directly. They are determined by the adjustable parameters and internal algorithms. Valve Ventilation and Mouthpiece Parameters Leak Ventilation Setting Circuit I:E Ratio ...
  • Page 182 Appendix B: Ventilation parameters Valve Ventilation and Mouthpiece Features Leak Ventilation Setting Circuit Sigh Breath   Off / On [Off] Sigh Alert   Off / On [Off] Sigh Interval   3 to 60 [10] (min) Sigh Magnitude ...
  • Page 183 Appendix B: Ventilation parameters Valve Ventilation and Mouthpiece Features Leak Ventilation Setting Circuit Apnoea Vt       If Apnoea Response is (A)CV + Alarm: (mL) Adult: 100 to 2500 [500] Paed: 50 to 500 [100] Apnoea Flow Shape ...

  • Page 184: Supplementary Features Displayed Parameters

    Appendix B: Ventilation parameters Supplementary Features displayed parameters The following therapy parameters are displayed on the device but cannot be changed directly. They are determined by the adjustable parameters and internal algorithms. Parameter Valve Ventilation and Mouthpiece Circuit Leak Ventilation Manual Breath Ti ...
  • Page 185 Appendix B: Ventilation parameters Parameter Valve Ventilation and Mouthpiece Circuit Leak Ventilation Apnoea PIF Display       (L/min) Apnoea Ti Display (Inspiration Time)       Apnoea Rise Time     ...

  • Page 186: Appendix C: Alarm Parameters

    Appendix C: Alarm parameters Appendix C: Alarm parameters The following table provides a summary of the Astral device alarm settings and the default settings. Valve Ventilation and Mouthpiece Alarm Leak Ventilation Setting Circuit Vti - Low     ...
  • Page 187 Appendix C: Alarm parameters Valve Ventilation and Mouthpiece Alarm Leak Ventilation Setting Circuit Pressure - Low   Off, 2 to 79 [5] (Peak Inspiratory Pressure) (cmH Pressure - Low         Off / On [On] (Peak Inspiratory Pressure) (cmH Disconnection...
  • Page 188 Appendix C: Alarm parameters Valve Ventilation and Mouthpiece Alarm Leak Ventilation Setting Circuit - Low (%)           Off, 18 to 99 [Off] - High (%)       ...
  • Page 189 See ResMed.com for other ResMed locations worldwide. Astral, AirView and ResScan are trademarks and/or registered trademarks of the ResMed family of companies. For patent and other intellectual property information, see ResMed.com/ip. Actichlor is a trademark of Ecolab US. Inc. Aerogen and Aeroneb are registered trademarks of Aerogen, Inc.

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