MEDUMAT Transport - NEANN · NIV therapy Start MEDUMAT Transport using the on/off key 1 2 Select...

• Ventilation initiation by height• NIV therapy• Ventilation modes at a glance

MEDUMAT TransportStep-by-step instructions

Important: This document

does not replace the instructions for use.

Complete information can be found in the instructions for use.

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Ventilation from the scene of an emergency to the hospital

Take advantage of the versatility of the MEDUMAT TransportThe ventilator allows for unprecedented usability: from the emergency medical team in a pre-hospital setting to the secondary transport of emergency and intensive care patients.For fast readiness for use and correct handling of the MEDUMAT Transport, you will receive a brief overview of the NIV therapy, the ventilation initiation by height and the ventilation modes.

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Use presets and work according to guidelinesBy using the setting option of the Vt/kg body weight (BW) 4-10 ml/kg BW to be applied, you will be working according to guidelinesii and determining the calculated tidal volume for volume-controlled ventilation.The ideal body weight and thus the tidal volume to be applied are calculated differently for male and female patients. The following formula is used for this:

For a 1.85-m-tall male patient and a setting of 6 ml/kg BW the following tidal volume results:

The Vt is obtained accordingly: Vt = 80 kg x 6 ml/kg = 480 ml

= 79.51 kg ~ 80kgIBW = 50 + 2.3 x185

2.54- 60

IBW female = 45 + 2.3 xheight

2.54

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IBW male = 50 + 2.3 xheight

2.54

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Start faster and ventilate more preciselyFrom now on you will not need to spend a long time considering which tidal volume (Vt) to set for your patient. With MEDUMAT Transport, you can now initiate ventilation even more precisely and even faster. By entering the patient’s height and gender, your ventilator automatically calculates the ventilation parameters for the ideal body weight (IBW). The IBW serves as an important indicator when setting the ventilation parametersi. MEDUMAT Transport allows you to start ventilation faster and far more precisely – giving you more time for all the other important tasks.

Start ventilation by height

iGajic, O. et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Critical care medicine, 2004, No. 32, P. 1817-1824.

iiDeakin, C. D. et al. Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“) Sektion 4 der Leitlinien zur Reanimation 2010 des European Resuscitation Council. Notfall + Rettungsmedizin, 2010, No. 7, P. 578.

iiiDevine, Ben J. Gentamicin therapy. The Annals of Pharmacotherapy. 1974, 8. Jg., No. 11, P. 650-655.

Operating steps

3 4

Select "height" Select gender and patient height

1 2

Switch on ventilator Select "New patient"

5 6

Select ventilation mode Start ventilation

NIV therapy

Start MEDUMAT Transport using the on/off key

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Select "New patient" in the start menu.

3

Select the appropriate patient group: Adult, Child or Infant. Alternatively, select "height" in the activated function. Then set the patient’s height in the device.

Subsequently activate non-invasive ventilation ("NIV"). For the ventilation mode decide between: BiLevel + ASB, CPAP + ASB and CPAP (pure CPAP is the ventilation form "CPAP + ASB" with an ∆pASB of 0 mbar).

4

Then set the values using the rotating switch: PEEP (CPAP, CPAP + ASB and BiLevel + ASB), pInsp (only BiLevel + ASB), pMax (CPAP, CPAP + ASB and BiLevel + ASB), frequency (only BiLevel + ASB) or I:E (only BiLevel + ASB). After adjusting the corresponding values, begin the ventilation via "Start ventilation".

5

Now connect the patient to MEDUMAT Transport. It is possible to adjust the values using the rotating switch while the ventilation is running. You can control the inspiratory trigger and the pressure support (ASB) using the function keys on the right side. If it is necessary to change the ventilation mode, this is done using the "Mode" function key on the right side.

6

Modified by Prof. Dr. med. Thoralf Kerner

Logistical requirementsOxygen supply: at least a 2-l bottle, filled ....................................................... CheckEmergency medical team familiar with NIV ..................................................... Check

Clinical requirementsalert, cooperative (GCS > 12) ......................................................................... Checkbreathing spontaneously ................................................................................ Checkif applicable, light sedation of agitated patients e.g. morphine (5-10 mg i.v. titrated) or a short-acting benzodiazepine.

IndicationsDyspnea ......................................................................................................... CheckRespiratory rate > 25/min (count!) ................................................................. CheckSpO2 < 90% despite O2administration ........................................................... Check

ContraindicationsAbsolute contraindications: ............................................................................ Checkabsence of spontaneous respiration, gasping, airway obstruction, gastrointestinal bleeding or ileus

Relative contraindications: .............................................................................. Check Coma, massive agitation, hemodynamic instability, severe hypoxemia (SpO2 < 75% despite O2), problems with airway access, status post gastrointestinal surgery

Pulmonary edema

Primary device settingsVentilation mode: ............................................................................................CPAPPEEP (according to comfort and oxygenation): ......................................5/7/10 mbarFiO2: .............................................................................................................0.4-1.0

Aim and success criteriaTarget SpO2: > 90% ....................................................................................... CheckDecrease in dyspnea ...................................................................................... CheckFalling respiratory and heart rate .................................................................... CheckIf applicable, improved vigilance ..................................................................... Check

NIV sequence: Set the device, place the mask on the patient’s face (explain the measure!), connect the mask to the hose system while the device is running. Aim: Synchronization of patient and device

SOPNon-invasive ventilation (NIV) by the emergency medical services

Escalation levelsIn the event of imminent respiratory muscle fatigue, set pressure support (ASB). Immediate intubation in the absence of clinical improvement or the occurrence of contraindications!

Caution• Continuous clinical observation and close patient contact• No delay in pharmacological therapy or necessary intubation• Prepared for intubation at any time• Timely advance information to the receiving hospital

Exacerbated COPD

Primary device settingsVentilation mode: ................................................................................. CPAP + ASBPEEP: .........................................................................................................3/6 mbar∆pASB (according to comfort and oxygenation): .................................5/10/15 mbarPeak pressure (pMax): ........................................................................ max. 25 mbarInspiration trigger: ........................................................................as low as possiblePressure ramp: .................................................................................................steepFiO2: .............................................................................................................0.4-1.0 Aim and success criteriaTarget SpO2: > 85% ....................................................................................... CheckDecrease in dyspnea ...................................................................................... CheckFalling respiratory and heart rate .................................................................... CheckIf applicable, improved vigilance ..................................................................... Check

Escalation levelsIn the event of imminent respiratory fatigue, set ventilation mode BiLevel + ASB (e.g. PEEP: 5 mbar, pInsp: 20 mbar).Immediate intubation in the absence of clinical improvement or the occurrence of contraindications!

Caution• Continuous clinical observation and close patient contact• No delay in pharmacological therapy or necessary intubation• Prepared for intubation at any time• Timely advance information to the receiving hospital

Many different names, many different ventilation modes. Almost every ventilator manufacturer today chooses its own names for the ventilation modes available on the respective device. This can lead to particular challenges, for example, during the transport and transfer of a patient receiving home ventilation. In order to facilitate the transfer of settings from one ventilator to another in the future, we have compiled the following overview of the current home ventilators as well as the transport ventilator MEDUMAT Transport. Here the approximate equivalents of the ventilation modes and ventilation parameters are listed in tabular form.

Ventilation modes at a glance

Similarity of various ventilation modes and setting parameters

WEINMANN Emergency MEDUMAT Transport

Weinmann VENTIlogic LS (1)

Covidien Legendair (1)

ResMed VS III (1),Elisée 150 (1)

Philips Respironics Trilogy 100 (5) / 200 (4)

GE Vivo 40 (2) / 50 (3)

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PCV PCV, T PCV PCV, PC PC, T PCV Pressure-controlled, mandatory ventilation

aPCV aPCV assPCV (A)PCV, (A)PC – PCV (A) Assisted, pressure-controlled ventilation

BiLevel + ASB (invasive)

SIMV, ST – ST PC-SIMV, S/T – Assisted, pressure-controlled ventilation with free spontaneous respiration at 2 pressure levels with optional pressure support at the lower pressure level (invasive ventilation)

BiLevel + ASB (non-invasive)

SIMV, ST – ST, PSIMV PC-SIMV, S/T – Assisted, pressure-controlled ventilation with free spontaneous respiration at 2 pressure levels with optional pressure support at the lower pressure level (non-invasive ventilation)

– – – – – – Pressure-controlled ventilation with long inspiration phase and short expiration phase

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IPPV VCV CV VC CV VCV Volume-controlled, mandatory ventilation

S-IPPV aVCV assCV V(A)C AC VCV (A) Assisted, volume-controlled ventilation

– – assPCV with target Vt

– – PCV (A + TgV) Assisted, volume-controlled ventilation with inspiration pressure regulation

SIMV + ASB – SIMV SIMV SIMV – Assisted, volume-controlled ventilation with optional pressure support at the lower pressure level

PRVC + ASB SIMV with volume compensation

– ~ PS.Tv S/T + AVAPS – Assisted, volume-controlled ventilation with optional pressure support at the lower pressure level and inspiration pressure regulation

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es CPAP with ∆pASB=0 CPAP – CPAP CPAP CPAP Continuous positive airway pressure without pressure support

CPAP + ASB (invasive)

PSV, S PSV ST PSV, S S PSV Continuous positive airway pressure with pressure support (invasive ventilation)

CPAP + ASB (non-invasive)

PSV, S PSV ST PSV, S S PSV Continuous positive airway pressure with pressure support (non-invasive ventilation)

Overview 1/2

List of sources:1. „Einstellung Beatmungsgeräte“, VitalAire GmbH, Version: June 20102. „Vivo 40 with Target Volume“, Breas Medical AB, Version: August 2014 http://www.breas.com/products/vivo-40/ 3. „Vivo 50“, Breas Medical AB, Version: August 2014 http://www.breas.com/products/vivo-50/






GE Vivo 40 (2) / 50 (3)

General description

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Spo

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4. http://www.healthcare.philips.com/de_de/homehealth/respiratory_care/trilogy200/default.wpd#&&/wEXAQUOY3VycmVudFRhYlBhdGgFFkRldGFpbHM6U3BlY2lmaWNhdGlvbnOKh+5fzpW/Rh82+nJNs/BzMC6HpA==, Version: February 2014






GE Vivo 40 (2) / 50 (3)

General description

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5. http://www.healthcare.philips.com/de_de/homehealth/respiratory_care/trilogy100/default.wpd#&&/wEXAQUOY3VycmVudFRhYlBhdGgFFkRldGFpbHM6U3BlY2lmaWNhdGlvbnOKh+5fzpW/Rh82+nJNs/BzMC6HpA==, Version: February 2014


Weinmann VENTIlogic LS

Covidien Legendair ResMed VS III Elisée 150

Philips Respironics Trilogy 100/200

GE Vivo 40/50

General description

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Pmax - P maxi - IPAP max pressure Max. pressure Pressure limit

Freq. F AF F/F min Respiratory rate (rr) Respiratory rate Frequency

Vt Vti Vt Vt Tidal volume (Vt) Tidal volume Tidal volume

Pinsp IPAP IPAP Pin IPAP Inspiration pressure Inspiration pressure

PEEP PEEP / EPAP EPAP PEEP PEEP / EPAP PEEP / CPAP Positive end-expiratory pressure

ASB - IPAP - PS IPAP Pressure support

I:E Ti:T I:E/ I:T I:E Inspiration time (s) Inspiration time (s) I:E ratio

Trigger inspiration (l/min) Trigger sensitivity insp. (8 levels)8 = very sensitive

Trigg I (5 levels)5 = very insensitive

TgI (P) (6 levels)TgI (V) (3-8l)

Flow trigger sensitivity Inspiratory trigger (9 levels)

Inspiration trigger

Trigger expiration (% from max. insp. flow)

Trigger sensitivity exp. (8 levels)8 = 95% of max. insp. flow

Trigg E (% of max. insp. flow)

TgE (% of max insp. flow)

- Expiratory trigger (9 levels)

Expiration trigger

Trigger window (time in which the next breath can be triggered)

Trigger lockout time (time in which no breath can be triggered)

– – - - Period in which the patient can trigger the next breath

only in PRVC+ASB Vti Target Vt: Vt min only with AVAPS Target volume (TgV) Minimum tidal volume

constant, decreasing constant, accelerating, decelerating

R, S, D Curve (3 levels) Square, ramp Square, rectangle, decelerating

Flow progress

Pressure/flow ramp(3 levels)

Pressure increase time (6 levels)

Ramp (4 levels) Curve (3 levels) Increase time (6 levels) Increase time (9 levels) Pressure increase time

Similarity of various ventilation modes and setting parameters

Overview 2/2





GE Vivo 40/50

General description

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Inspiration trigger






Expiration trigger







Flow progress








GE Vivo 40/50

General description

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Inspiration trigger






Expiration trigger







Flow progress




We take no responsibility for the accuracy of the information. The information in the above table does not represent a 1:1 translation, but merely an indication of the approximate equivalents.

Headquarter WEINMANN Emergency Medical Technology GmbH + Co. KG Frohbösestraße 12 22525 Hamburg Germany

T: +49 40 88 18 96-0 F: +49 40 88 18 96-480 T: +49 40 88 18 96-120 Customer Service T: +49 40 88 18 96-122 After-Sales Service E: [email protected]

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U.A.E. WEINMANN Emergency Medical Technology GmbH + Co.KG (Branch) T: +971 432 100 31 • [email protected]

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Singapore Weinmann Singapur PTE, Ltd. T: +65 65 09 44 30 • [email protected]

Spain WEINMANN Emergency Medical Technology GmbH + Co. KG T: +34 91 79 01 137 • [email protected]

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MEDUMAT Transport - NEANN · NIV therapy Start MEDUMAT Transport using the on/off key 1 2 Select...

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