Drager Drager_Cicero_EM_-_User_manual Cicero EM Integrated Anaesthetic Workstation Instructions for Use

Cicero EM

Integrated Anaesthetic Workstation

Instructions for Use

Software-Versionen:

Ventilator: ................. 6.n/7.n

Monitor:.................... 4.n

23529278

Working with these Instructions for Use

Each page is organized according to the following
principles:

At the top – the subject ...

of the main chapter as listed in the Overall Contents
on page 3.

It is always contained in a headline and printed in
bold type at the beginning of the chapter.

Xxxxxxx Yxxxxxxxxx

Xxxxxxxxx

● Xxxxxxxxxxxxxxxxxxxxxxxxxxxx:

Xxxxxxxxxx: Vxxxxxxxxx?
Xxxxxxxxxxxxx: Hxxxxxxx ?, Fxxxxxxx ?, Dxxxxxx ?
Xxxxxxxxx: Sxxxxxxxxxxxxx ?

Xxxxxxxxxx Xxxxxxx xxxxxxxxxxxxxxx

1 Xxxxxxxxxxx Xxxxxxxxxx xxxxx -

● Xxxxxxxxxxxxx XXXXXXXXXX cccxxxxxxxxxxxxx xxxxx x

2 Xxxxxxxxxxxxxxxxxx xxxxxxxxx (X xxxxxxxxx).

1

2

Left-hand column – the text ...

contains explanations, prompts the user to do
something and describes the machine's response.

The dots and numbers refer to actions, while the
numbers also draw attention to details in the
illustrations supplementing the text.

The numbering starts anew on each page.

Xxxxxxxxxxxxxxxxxxx

● Xxxxxxxxxxxxxxx xxx Xxxxxxxxxxx xxxxxxxxx xxxxxxxx -

● Xxxxxxxxxx - xxxxxx xxxxxxxxxxxx ! - xxx xxx Xxxxxxxxxx

xxxxxxxxxxxx xxxxx !

● Xxxxxxxxxx xxxxxxxx xxxxxx xxx xxxxxxxxx Xxxxxxxxxx xxxxxx

xxx xxx Xxxxxxxxxxxxx:

– xxxx. –

(xxxxxxxx X xxxxxxxx Xxxxxxxxxxx)

● Xxxxxx xxxxxxxxx xxxx xxxxxx Xxxxxxx xxxx Xxxxxxxxx.

● Xxxxxx xxx Xxxxxxx xxx Xxxxxxxx xxxxxxxxxx.

O2-Xxxxxxx

● Xxxxxxxxxxxxx xxx Xxxxxx xxxxxx xxxxxcxxx !

Xxxxxxxx xxx xxx Xxxxxxxxxxxxxxx xxx Xxxxxxxx xxxxxxxx -

● xxxxxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxx

Xxxxxxxxx xxxxxxxxx

● Xxxxxxxxxxxx xxxxxxxx

3 Xxxx xx Xxxxx xxx xx Xxxxx xxxxxxxxxx xcxxxxxxxx - xxx xxx

Xxxxxxxcxx -

xxxxxx Xxxxxx Xxxxxxxxxxxxxxx xxxxx xxxxxxxxxxxxxx !

● Xxxxxxxxxxxxx xx Xxxxxxxx xxxxx xxx xxxxxxxxxxxxx
4 Xxxxxxxx xxx xxx Xxxxxxxxxxx xcxx xxxxxxx xxxxxxxxx

(xxxxxxxxxxxx) -

XYZ

Gasversorgung Flow O
Funktion Umschalter Air/N
ORC Flow N
O2-Flush Strömungsgeräusch, Beutel füllt sich

11:59

06.12.98
00:00

Pleth

Checkliste Cicero EM

Vor jeder Benutzung vom Anwender zu prüfen

Vapor Nullstellung
Füllung
Zeit seit letzter Inspektion 6<Monate
Sicherheitsfüllvorrichtung Verschlußschieber
eingeschoben und festgezogen
Stecksystem Adapter liegt gleichmäßig auf
Verriegelt

Narkosegasfortleitung Schauzeichen grün
Atemsystem Fester Sitz und vollständig
Atemkalk Kalk erneuert, kein Farbumschlag
Notbeatmungsbeutel Funktion gewährleistet

Zentralversorgung (ZV) Druck O

, Air, N2O > 2,7 bar

2

Reservegasflaschen Druck O

, Air > 50 bar

2

Sekretabsaugung Unterdruck vorhanden

, Air, N2O vorhanden

2

O gewährleistet

2

2O sinkt proportional mit Flow O2

Cicero nach Checkliste o.k ? Bitte bestätigen

3

4

Test-

Abbruch

Right-hand column - the illustrations ...

make it easier to locate the various parts of the
equipment.

Details mentioned in the text are highlighted in
bold type or coloured black.

Overall contents

For your safety and that of your patients 4

Intended use 5

Emergency Quick-Start 6

Operating concepts 9

Preparing for use 15

Anaesthesia ventilation 31

System screen functions 45

Parameter Box 85

Notes
Power failure
Gas failure

Master switch
Ventilator operating concept
Monitor operating concept

Power supply
Compressed gas supply
Connecting external equipment
Checking workstation with checklist

Spontaneous breathing/manual ventilation
IPPV mode
SIMV mode
PCV mode
Paediatric use
Changing patients
After use

Basic screen configuring
Monitoring functions in operation
Alarm concept

Function keys and indicators
Measurement functions

Messages - Cause - Remedy 99

Care 117

Checking readiness for operation 131

Location of valves and subsystems
Warning, caution and advisory messages

Stripping down machine
Disinfection, cleaning and sterilization
Disposing of throw-away articles
Re-assembling machine

Checking machine functions
Maintenance intervals

What's what 139

Technical data 151

Descriptions 163

Machine functions
Operation of the ceiling version

Abbreviations and symbols 189

Index 191

3

For your safety and that of your patients

For your safety and that of your
patients

Strictly follow the Instructions for Use

Any use of the apparatus requires full understanding and
strict observation of these instructions. The apparatus is
only to be used for purposes specified here.

Maintenance

The apparatus must be inspected and serviced regularly
by trained service personnel at six monthly intervals (and
a record kept).
Repair and general overhaul of the apparatus may only be
carried out by trained service personnel.
We recommend that a service contract be obtained with
DrägerService and that all repairs also be carried out by
them. Only authentic Dräger spare parts may be used for
maintenance.
Observe chapter "Maintenance Intervals".

Accessories

Do not use accessory parts other than those in the order
list.

Liability for proper function or damage

The liability for the proper function of the apparatus is
irrevocably transferred to the owner or operator to the
extent that the apparatus is serviced or repaired by
personnel not employed or authorized by DrägerService
or if the apparatus is used in a manner not conforming to
its intended use.

Dräger cannot be held responsible for damage caused by
non-compliance with the recommendations given above.
The warranty and liability provisions of the terms of sale
and delivery of Dräger are likewise not modified by the
recommendations given above.

Dräger Medizintechnik GmbH

Not for use in areas of explosion hazard

This apparatus is neither approved nor certified for use in
areas where combustible or explosive gas mixtures are
likely to occur.

Safe connection with other electrical equipment

Electrical connections to equipment which is not listed in
these Instructions for Use should only be made following
consultations with the respective manufacturers or an
expert.

4

Intended Use

Intended use

Integrated anaesthetic workstation
»Cicero EM« with system monitor

Universally applicable, integrated anaesthetic workstation
for

– Inhalation anaesthesia for adults, children and

neonates.

– Inhalation anaesthesia in semi-closed to virtually

closed systems with »low flow« and »minimal flow«
techniques (for minimum gas and anaesthetic

consumption).
– Automatic ventilation (IPPV).
– Synchronized intermittent mandatory ventilation

(SIMV).
– Pressure-controlled breathing (PCV) in the PCV

ventilator.
– Manual ventilation (MAN).
– Spontaneous breathing (SPONT).
– Automatic anaesthetic agent recognition.

The following information is displayed in colour on the
system monitor:
– Airway pressure and temperature
– Inspiratory O2 concentration
– Expiratory tidal volume
– Patient compliance
–CO2 and anaesthetic concentration at the Y-piece
– Fresh gas balance
together with the main haemodynamic parameters
monitored with the parameter box:
– ECG curve with heart rate and ST segment analysis.
– The real-time curve of the invasive blood pressure

(iBP) in two channels, with the systolic, diastolic and

mean pressure values.
– The values of the non-invasive blood pressure (NiBP)

with the systolic, diastolic and mean pressure values.
– The body temperature in two channels.
– The functional O2 saturation (SpO2) with the pulse

rate.
– The plethysmogram.

Other accessories (optional)

Vapor*)

Anaesthetic vaporizer for enflurane, isoflurane, halothane
and sevoflurane.

Connection for two Vapor vaporisers*)

Devapor*)

Anaesthetic vaporizer for desflurane.

Anaesthetic gas scavenging system*)

Uninterruptible power supply*)
Passive air conditioning*)

Heated breathing hoses.

pEEG*)

Notes on operation

Only non-flammable anaesthetic agents conforming to
EN 740 may be used. Risk of fire!

Since this apparatus is not approved for use with
inflammable anaesthetics (ether, cyclopropane, etc.),
it is not necessary to use antistatic (conductive) breathing
hoses or face masks.

Conductive breathing hoses and face masks may cause
burns during high-frequency surgery and are therefore
not recommended for this apparatus.

Any additional electrical equipment which is latched
onto the top of the workstation must also be con­nected to the base unit by means of an equipotential
bonding conductor!

Electromagnetic fields exceeding the limits specified
in EN 60601-1-2 may interfere with the operation of
the device and therefore put patients at risk.

Mobile radio telephones must not be used within
10 metres of the workstation!

Cicero EM must not be used with magnetic resonance
tomography (MRT, NMR, NMI).

The workstation should only be moved by the handles!

Always operate the device under the supervision of
qualified medical personnel in order to obtain prompt
assistance in the event of malfunction.

Retrofitting in different devices

The software described in these Instructions for Use, in
combination with the »Cicero EM«, has passed a conformity
evaluation procedure conforming to 93/42/EEC (medical
appliances); the corresponding conversion kits therefore

bear the C mark of conformity.

The conversion kit can also be installed in the »Cicero EM
color« even if the unit itself does not bear the C symbol,

because the conformity evaluation procedure has confirmed
the suitability of the product for this type of device.

*) Refer to the separate Instructions for Use for this equipment.

5

Emergency Quick-Start

Emergency Quick-Start

Press the master switch (1)

– The pressure gauges (2) are in the green zone.

– All lamps on the ventilator light up.

Press a function key on the ventilator

Recommendation: Press and hold down
longer than 1 second.

– The message »Test interrupted« is displayed.

For devices without PCV mode (software 6.n):

M

key for

D

I

O

MAN

SPONT

IPPV

SIMV

PCV VT

2

Gas/Power

ON / I
Press

1

001292780022927800329278

TEST

Pmax
PPCV

fIPPV TI:TE

TIP:TI

fIMV

PEEP

Flow

O

Deliver fresh gas

– With the delivery valve buttons (3) under the

measuring tubes

– If necessary fill the system rapidly with the O2

flush (4).

– The manual ventilation bag should fill.

Set the APL pressure limiting valve (5) to »MAN«

Set maximum pressure

– Turn the valve head (6) until the disc is at the

desired maximum pressure.

6

5

6

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

O2

4

3

fIPPV TI:TE

AIR

Lecktest ?

TIP:TI

Flow

PEEP

TEST

fIMV

Notes on Quick Start

The Quick Start procedure is permitted a maximum of
10 times in succession, and only if the previous (full) self­test was completed without error.

Emergency Quick-Start

Otherwise, the display on the ventilator and the system
screen instruct the user to run through the complete self­test.

Manual ventilation remains possible under all condi­tions!

● Quick Start can also be triggered by the »Cancel

Test« softkey.

● Quick Start can be triggered at any time, even during

a self-test.

If there is a power failure (manual ventilation is

possible)

Make sure that the master switch is pressed down

– The acoustic power failure warning is muted after

30 seconds.

Deliver fresh gas - set APL valve

– If required, press the O2 flush button (»O2 +«).

Note: If there is a power failure, the piston of the

ventilator is pushed to its end position by the
airway pressure. This increases the system volume
by a maximum of 1.4 litres.

06-12-98

16:47
00:00

Self-test

Self-test cancelled

cancel
test

00429278

If there is a gas failure

In case of AIR failure (medical air)

– The system automatically switches over to O2

supply.

In case of O2 failure

– The system automatically switches over to the

AIR supply. An acoustic alarm is sounded (O2
shortage signal). The supply of N2O is disabled.

If both O2 and air fail
The patient must immediately be ventilated with the
separate emergency ventilation bag!

7

8

Operating concepts

Page

Master switch.......................................................... 10

Ventilator operating concept .................................. 10

Monitor operating concept ..................................... 12

9

A

Operating concepts

Ventilator operating concept

Ventilator operating concept

Master switch for power and gas

1 Press to switch on. The switch clicks into position.

2 Turn clockwise to switch off.

Hardkeys –
for setting the operating modes

»MAN / SPONT« key

for manual ventilation or spontaneous breathing.

»IPPV« key

for IPPV mode.

»SIMV« key

for SIMV mode (see illustrations for the specific
ventilator versions)

»PCV« key

for PCV mode (for PCV ventilator).

»TEST« key

for leakage test and compliance measurement.

D

I

O

D

Gas/Power

ON / I
Press

1

2

005292780062927800729278

Standby key.

for setting ventilation parameters

Below the display window:

»Pmax / PPCV« key

for setting the maximum pressure for IPPV and
SIMV ventilation.

The same key is used in PCV mode to set the
plateau pressure.

»VT« key for setting the tidal volume.

»IPPV« key

for setting the ventilation frequency in IPPV
mode.

»TI : TE« key

for setting the time ratio between inspiration
and expiration.

»TIP : TI / Flow« key

for setting the relative inspiratory pause for
IPPV and SIMV ventilation.

Ventilator with PCV

MAN

SPONT

IPPV

P

max

SIMV PCV VT

PPCV

fIPPV TI:TE

TIP:TI

Flow

Ventilator without PCV

MAN

SPONT

IPPV

Pmax VT

fIPPV TI:TE

TIP:TI PEEP

TEST

fIMV

PEEP

fIMV

O

TEST

SIMV

O

00729278

The same key is used in PCV mode to set the
inspiratory flow.

»PEEP« key

for setting the PEEP pressure for IPPV mode.

»fIMV« key

for setting the ventilation frequency in SIMV
mode.

10

Display window with dialogue function

(in combination with the rotary control)

Example: adjusting the maximum pressure

In the black field, beside the rotary control:

Operating concepts

Operating concept of ventilator

1 The set value appears on the right and left-hand sides

of the field when a parameter key (Pmax, VT, fIPPV) is

pressed. Here: »23«.

2 The value on the right-hand side is changed by

turning the rotary control. Here: »28«.

The old and new values are consequently always

displayed together.

3 The value on the right (»28«) is confirmed as the

definitive value by pressing the control.

If the rotary control is not pressed and not turned again,
the machine is reset after 10 seconds without changing
the setting.

● This dialogue window also displays advisory

messages (see page 100) –

Example »Infant hoses«:

1

23 Pmax / mbar 28

2

3

MAN

SPONT

IPPV

PCV VT

SIMV

fIPPV TI:TE

Kinderschlaeuche

TIP:TI

PEEP

Flow

fIMV

Pmax
PPCV

TEST

O

Infant hoses

0082927800929278010292780112927801229278

Display window without dialogue function

Top left:

Continuous indication of the relative piston movement
(in % referred to the set stroke volume VT).

The set operating parameters correspond with the keys
below:

– Indication of the maximum pressure Pmax in mbar.
– Indication of the tidal volume VT in mL or L.
– Indication of the ventilation frequency fIPPV in

breaths per minute.

0% 100%

23

600

12

mbar ml/L 1/min

Pmax

PPCV

VT

fIPPV

11

Operating concepts

Monitor operating concept

Monitor operating concept

Hardkeys

The right-hand side is reserved for operating elements,
the left-hand side for displays.

E

This key switches the system screen from standby
to measuring mode and vice versa.

The system screen mode depends on the
ventilator mode:

Standby can only be selected on the system
screen if the ventilator is also in standby.

The system screen starts up when the ventilator is
started.

G

This key is used to deactivate the alarm tone for
two minutes. It is reactivated by pressing the key

again. The yellow LED in the key lights up while
alarms are suppressed (see page 79).

During this period, any new advisory and caution
messages will not be audibly signalled but will
appear as text in the alarm fields. Only new
warnings will be signalled once by the appropriate
tone sequence.

Inside the dark area, there are four keys acting directly on
the screen contents:

S

This key is used to call up a menu of the available
display options on the system screen. Selection is

made by turning and pressing the rotary control
(see page 68).

Q

This key always calls up the last standard screen
used (see page 68).

s

This key is used to »freeze« the curves on the
display so that they can be viewed in more detail.

0132927801429278

U

This key is used to generate a manual entry in the
list screen (see page 70).

Indicators

Above the G key are two bar-shaped indicators that
indicate the alarm status even when the acoustic alarm

has been switched off.

Red (upper) flashing lamp Warning !!!
Yellow (lower) flashing lamp Caution !!
Yellow lamp constantly lit Advisory !

12

Softkeys

Operating concepts

Monitor operating concept

1 Beside the screen, on the right-hand side, there is

an unmarked touch-sensitive keypad.

2 The function of these keys depends on the software

and is indicated on the screen itself.

Only those keys which can be activated are actually
shown.

Pressing some of the softkeys or the screen selector
key S will open a menu.

The area where selections can now be made is
turquoise, and the cursor is a yellow rectangle.

● To select: Turn rotary control.

The cursor moves within the turquoise
area.

● To confirm: Press rotary control.

The selected function appears.

All menu levels are displayed in staggered arrangement.
Inactivated menus are grey. The selected menu item is
highlighted in black and white.

Standby / Configuration

iBP 1 function OFF ON
location ART
sensitivity 42.5 50

iBP 2 function OFF ON
location CVP
sensitivity 42.5 50

ECG

NiBP

iBP locations

iBP channels

SpO

/ Pleth

2

CO

/ O

2

2

pEEG

12

3

015292780162927801729278

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

Configuring the colours

3 Press the »Config« softkey.

4 Under »Settings«, select the option »Colours«.

● Select the desired parameter in the colour menu and

confirm.

● Turn the rotary control until the desired colour is

displayed and then confirm

Select a menu position. Please confirm !

11:59

Change the settings. Please confirm again !

00:00

IPPV alarm limits

Anesth. Agent Alarms Calibration Settings

mode adult neon.

alarm sound 1 2 3 4 5 6 7 8 9

pulse tone 0 1 2 3 4 5 6 7 8 9

pulse tone
source ECG Pleth.

colours

curve speed 12,5 25 50
mm/s

call standard

06-12-98

ART
AORTA
A.Pulm
ZVD
ICP
iBP ?
NiBP
EKG
SpO

/Pleth

2

Temp.
pEEG
CO

2

Flow
Paw

Hintergrund hell dunkel

Module
farbig ja nein

Wählen Sie mit dem Drehknopf einen Parameter aus. Bestätigen !

11:59

Wählen Sie die gewünschte Farbe. Bestätigen !

00:00

4

13

14

Preparing for use

Page

Electrical power supply........................................... 16

Equipotential bonding............................................. 16

Uninterruptible Power Supply................................. 17

Compressed gas supply ......................................... 17

Anaesthetic gas scavenging system ...................... 18

Anaesthetic vaporizer ............................................. 19

Connecting external equipment ............................ 19

Parameter box ........................................................ 20

Checking workstation with checklist...................... 21

Manual tests............................................................. 21

Check Vapor....................................................... 22

Check anaesthetic gas scavenging...................... 22

Check breathing system...................................... 23

Check soda lime ................................................. 23

Check emergency ventilation bag ........................ 23

Check piped medical gas supply ......................... 24

Check reserve cylinders (optional)....................... 24

Checking the secretion aspiration system ............ 24

Check gas delivery.............................................. 25

Check Oxygen Ratio Control (ORC).................... 25

Check O

2 flush ................................................... 25

End of manual test according to checklist ................. 25

Self-test................................................................... 26

Semi-automatic part of the self-test........................... 26

Automatic self test.................................................... 27

Fresh gas outlet (option).......................................... 29

15

Preparing for use

Electrical power supply

Equipotential bonding

Preparing for use

The device must be correctly prepared and checked
before every use!

Connecting the electrical power supply

The mains voltage must be within the voltage range
specified on the nameplate on the back panel.

1 Plug the power plug into the wall socket.

Auxiliary mains sockets:

2 Sockets for additional devices that are switched on

and off with the master switch.
(3 sockets. Maximum current per socket: 2 A)

The sum of the derived current in the mains line must not
exceed 500 µA (IEC 601/1).

Equipotential bonding

(e.g. for intracardial or intracranial operations)

3 Connect one end of the earthing cable to the terminal

stud on the back panel.

● Connect the other end to the equipotential bonding

stud, e.g. on the operating table or ceiling lamps.

P

3

2

1

01829278

16

Uninterruptible Power Supply (optional, see

1

Instructions for Use of the UPS)

When the machine is powered by the UPS battery
during a mains power failure, no power is supplied to
the auxiliary sockets!

The Desflurane Vapor unit is powered by the side
connector for non-heating apparatus (No. 9 on page 140)
and will therefore continue to run as normal.

1 Plug the Cicero power plug into the socket of the

UPS.

2 Plug the UPS mains plug into the mains socket.

Preparing for use

UPS

Compressed gas supply

The UPS can supply the Cicero EM with electrical energy
for about 45 minutes. It is activated automatically in the
event of a power failure.

In the case of a ceiling unit, the auxiliary sockets are
not fitted.

Connecting the compressed gas supply

3 Screw hoses for O2, AIR and N2O into the rear of the

apparatus and plug connectors into the wall sockets.

Switch-on lock:

If the machine is switched on without pressure on the

O2 line, it is impossible to meter the other gases for

safety reasons!

S 3 S 4

F2 F2 F3 F4

g

S 5

S 6

USV - Ein / On

I

0

manuell

2

0192927802029278

3

4

»Pressure supply« appears on the ventilator.

● Connect O2 supply and confirm.

● Check that the supply pressure is adequate on the

pressure gauges on the front (pointers must be in the

green area).

4 Holder for anaesthetic gas scavenging. See next page

and separate Instructions for Use.

● If the machine is equipped with a vacuum bronchial

aspirator (option), a vacuum supply system must be

connected.

17

Preparing for use

AGS-system

Bronchial aspirator

Installing the anaesthetic gas scavenging
system:

● Hook the collecting system to the mount on the back

of the Cicero:
Place the slots of the receiving system over the
holders and slide the receiving system down.
See also "What's what" on page 146, No. 14.

Connecting the transfer hoses

1 Pass transfer hose from behind through the hole in

the Cicero EM and

2 connect the hose to the scavenging connector of the

breathing system (only on first installation - the hose
then remains on the connector).

3 Connect the transfer hose to the connector on the

receiving system.

● Make sure the connection is secure!

D

Detailed view
from below after
removing soda
lime container.

2

D

1

021292780222927802329278

4

4 Make sure that the connector for the second transfer

hose is sealed with a screw plug.

Do not plug the openings of the receiving system, other­wise the breathing system could be drained.

5 Connect the scavenging hose to the output connector

of the scavenging system.

6 Plug the connector of the scavenging hose into the

wall socket. The visual indicator shows »green«.

5

3

1

6

18

Preparing for use

Anaesthetic vaporizer

External equipment

Anaesthetic vaporizer:

– Only use the Vapors listed in the list of accessories!

– Note the separate Instructions for Use of the Vapor.

– Only use the Vapor intended for each anaesthetic

agent!

1 The fill plug must always be inserted and securely

tightened!

2 The thumbwheel must always be set to zero when

there is no fresh gas flow.

3 Vapor must always be secured by means of the

locking lever (set to the left-hand limit).

Connecting external equipment

Connection via the printer interface:

4 with a data cable for printers with serial interface,

such as:

3

2

0

Vol. %

1

0242927802529278

Deskjet (made by Hewlett-Packard)

This connector may also be used as an

RS 232 MEDIBUS interface.

● Equipment plugs must be secured with screws!

For interface configuration, see page 64.

Connection via the Dräger RS 232 MEDIBUS interface:

5 with data cable for standard PCs or other monitors.

● Equipment plugs must be secured with screws!

For interface configuration, see page 63.

After removing the outer back panel, the following
connections are accessible:

External screen

6 Any S-VGA-compatible screen can be connected.

External O2 sensor for inspiratory measurement:

7 Connect to the socket marked »O2«.

5

RS 232 C

RS 232 C

Vent.

4

Paw

CAN P-Box VGA extern VGA intern O2 Temp. / Spiro

6 7 8

P

m

*

Airway temperature sensor

8 Connect to the socket marked »Temp«.

19

Preparing for use

Parameter box

Fitting the parameter box

The parameter box can be operated either in the blue
holder or in the slot-in housing. The slot-in housing can
be mounted by Dräger Service on the left-hand side of
the Cicero EM.

The blue holder can be mounted by the user in any
position on a standard rail (10 x 25 mm).

In the blue holder, the parameter box can be tilted up and
down. In the slot-in housing its position is rigidly fixed.

In both cases, the synchronising output for an
external defibrillator is accessible from the rear.

Slot-in housing:

1 Push the parameter box straight into the slot-in

housing. The parameter box locks into position, and
the electrical connections are made.

To remove the parameter box, pull the blue handle on
the box to release the locking lever. The parameter
box can then be simply pulled out of the housing.

1

Cicero EM

D

0262927802729278025290940262909402729094

3

2

Blue holder:

2 Fix the blue holder in a suitable position.

3 Connect the cable of the mounting base to the

connector on the side of the Cicero EM.

4 Hang the parameter box onto the mount from above.

The plug connector must engage.

5 To remove, pull the blue handle on the parameter box.

The parameter box is released and can be taken out
of the blue holder.

6 Defibrillator connection.

Tilting the parameter box:

7 The parameter box can be swivelled up and down.

The parameter box is the central component of the
Dräger transport function. See the separate section in
these Instructions for Use, page 86.

6

4

5

7

20

Checking workstation with checklist

Manual tests:

After switching on, the apparatus runs through a self-test.

Preparing for use

Checking workstation with checklist

D

Prerequisites:

Machine is fully equipped -

Instructions for Use are familiar -

User has been instructed on using the machine -

Duration: approx. 5 minutes

Switching on:

1 Press the master switch.

(Combined master switch for gas and power)

The self-test starts

The user must first check:

On the ventilator:

– Indication of software version, all indicator lamps light

up for approx. 2 seconds. A single tone sounds.

– The message

»Self-test«

appears briefly in the display window.

The Ventilator display goes dark. No operations on the

ventilator are required during the self test.

On the screen:

– The internal program memories are tested. All LEDs

and display elements light up for approx. 2 seconds.

The LED in the standby key

E

remains lit.

I

O

D

Technology for Life

Cicero EM

Version 4.0

06-12-98

Self-Test

Gas/Power

ON / I
Press

1

00129278029292780302927803129278

– Two warning tones sound.

– A clock symbol uappears on the screen = duration

of self-test.

– The keys are still inactive.

Please wait!

Shortly afterwards:

– The checklist appears.

● Indication in user advisory field:

Is the Cicero EM o.k. according to checklist?

Please confirm!

● The user is consequently prompted to check the

points listed.

The equipment must be checked every time,
immediately before being used!

06-12-98

Self-test

In case of emergency: press any ventilator function key for quick startup

Check-list Cicero EM

To be verified by the user prior to each use

Vapor handwheel set to zero
fill - level ok
less than 6 months since last inspection
correctly seated and locked
Safety-fill plug secured in place

Gas scavenger operational
Breathing system complete, locked in place
Soda lime no colour change
Emergency breathing bag present, functional

Central gas supply all pressures greater than 2.7 bar
Backup cylinders all pressures greater than 50 bar
Suction functional

Gas delivery O
ORC N
O2-flush audible flow, breathing bag fills

11:59
00:00

2, Air, N2O present
2O flow changes proportionally to O2

Is the Cicero EM o.k. according to check-list ? Please confirm !

cancel

test

21

Preparing for use

Safety f

pug secu ed n p ace

Checking workstation with checklist

Check Vapor:

– Set the handwheel to »O«.

– Filling level OK?

– Last inspection less than six months ago?

Safety filler:

– The plug is inserted and secured.

Vaporiser mount:

– Vaporiser is correctly seated.

Locking mechanism:

– Plug-in system is locked (lever to the left as far as

possible).

Check-list Cicero EM

To be verified by the user prior to each use

Vapor handwheel set to zero
fill - level ok
less than 6 months since last inspection
correctly seated and locked
Safety-fill plug secured in place

0

Vol. %

0312927802429278031292780222927803229278

Check anaesthetic gas scavenging:

– Is indicator in wall socket green? (Only when using

Dräger systems; note sounds of gas flow in other
cases.)

– Hose connected to breathing system?

– Is the anaesthetic gas scavenging system correctly

installed?

– Are the two hoses fitted correctly?

– Are the vents open?

– Are all hoses free of kinks?

1 Is the transfer hose of the anaesthetic gas scavenging

system free of condensate? Drain if necessary.

Gas scavenger operational
Breathing system complete, locked in place
Soda lime no colour change
Emergency breathing bag present, functional

llll

D

1

22

Check breathing system:

Lift table top:

1 Lever set to the position shown in black.

Preparing for use

Checking workstation with checklist

Check completeness:

2 Valve discs inserted.

– Pressure limiting valve (APL) present.

– Inspiratory microbial filter (optional). Symbol:

– Expiratory microbial filter (optional). Symbol:

3 Pressure measuring hose with filter connected.

4 Measured gas return hose Symbol:

connected.

5 Hose with manual ventilation bag

present. (Connected from below;

not shown) Symbol:

– Correct breathing hoses connected.

(Adult or infant hoses)

6 Fresh gas hose connected.

(Connected from below; not shown)

Water trap (option)

7 Water traps are recommended in both the inspiratory

and the expiratory lines during prolonged anaesthesia,

low-flow anaesthesia and when using a humidifier.

1

03329278034292780352927803629278

3

2

4

APL

– Water traps must be fitted at the lowest point in the

hose and hang downwards.

– Check regularly and drain if necessary.

Observe hygiene regulations –

risk of infection !

The hose system remains sealed. The container must

be replaced securely!

Check soda lime:

8 Soda lime has not noticeably changed colour (purple).

– Filling level adequate (up to the mark).

– The absorber vessel must be screwed in (counter-

clockwise) as far as it will go.

Emergency ventilation bag:

(not shown)

– Bag is complete and hung from the side of the

Cicero EM.

– Bag functions correctly.

7

7

8

5

6

23

Preparing for use

2

Soda i

Checking workstation with checklist

Central medical gas supply

me no co our change

Emergency breathing bag present, functional

– The connectors have been pressed right into the wall

sockets for O2, AIR and N2O (not in holding
position!).

1 Pointers of all three pressure gauges are in the green

range.

Reserve cylinders (option)

2 Open cylinder valves.

Pressure indicator on O2 and AIR cylinders exceeds
50 bar?

Replace cylinders if not!

● Close cylinder valves (to prevent gas leaks).

Central gas supply all pressures greater than 2.7 bar
Backup cylinders all pressures greater than 50 bar
Suction functional

li

r

D

ir

r

1

0312927803729278

Checking the secretion aspirating system:

3 Negative pressure switch to »I«.

4 Set negative pressure to required intensity by means

of rotary control.

Seal the aspiration holes (or fold over the hose) and

5 Check negative pressure on pressure gauge.
3 Negative pressure switch to »O«.

If the negative pressure generated is insufficient,

● replace microbial filter in ejector system

(see »Maintenance intervals«, page 137 and
»What's what«, page 140, No. 11).

● Check adequate supply of compressed gas.

D

3 4

I

O

ON / I

Press

5

03829278

24

Check gas delivery

Preparing for use

Checking workstation with checklist

1 Switch over to »AIR«.

2 Open O2 and AIR delivery valves until the floats in the

measuring tubes indicate more than 9 L/min.

Open N2O delivery valve completely.
– Does N2O measuring tube indicate »O«?

1 Switch over to »N2O«.

– Does N2O measuring tube indicate more than

9 L/min?

Does AIR measuring tube indicate »O«?

Check Sensitive Oxygen Ratio Control (S-ORC)

2 Slowly close O2 delivery valve -

– check:

N2O indication decreases to »O« proportionally

with O2.

1 Switch over to »AIR«.

● Close N2O delivery valve.

Gas delivery O2, Air, N2O present
ORC N
O2-flush audible flow, breathing bag fills

2O flow changes proportionally to O2

31

O2

AIR N2O

031292780392927803129278

Check O2 flush

3 Press button »O2 +« –

– Is there a distinctly audible flow noise?

– Does the manual ventilation bag inflate?

End of manual test according to checklist:

– Confirm if all points are OK:

● Press rotary control on system screen.

Now the interactive part of the self-test begins (see
following page)

The following symbols are used:

? = Enquires whether an action has been performed

or a setting made.

06-12-98

Check-list Cicero EM

To be verified by the user prior to each use

Vapor handwheel set to zero
fill - level ok
less than 6 months since last inspection
correctly seated and locked
Safety-fill plug secured in place

Gas scavenger operational
Breathing system complete, locked in place
Soda lime no colour change
Emergency breathing bag present, functional

Central gas supply all pressures greater than 2.7 bar
Backup cylinders all pressures greater than 50 bar
Suction functional

Gas delivery O
ORC N
O2-flush audible flow, breathing bag fills

11:59
00:00

2, Air, N2O present

2O flow changes proportionally to O2

Is the Cicero EM o.k. according to check-list ? Please confirm !

2

cancel

test

u

= Waiting period. The selected test step is being

performed by the machine.

✔ = The action has been completed successfully.

25

Preparing for use

Self-test

As a basic rule, the general task to be performed is
specified in the centre field, and detailed operating
instructions to the user are given at the bottom of the
screen. The test begins with the question:

Fresh gas occluded?

● Close all delivery valves on the measuring block.

● Press rotary control to confirm.

Fresh gas occluded ?

Self-test

cancel

test

APL (Automatic Pressure Limitation) valve =
30 mbar?

● Flip the APL pressure limiting valve to »MAN«

and turn the valve head to set it to 30 mbar.

● Press rotary control to confirm.

Y-piece open?

● The Y-piece should be attached to the breathing

hoses and the patient connection should be open.
(For instance, it may be lying on the table.)

● Press rotary control to confirm.

● Wait a few seconds.

06-12-98

06-12-98

16:47

Occlude the fresh gas. Please confirm !

00:00

Self-test

automatic part

Hardware
Position of piston

16:47

Adjust pressure limitation valve (APL) to MAN position. Pressure setting 30 mbar.

00:00

Please confirm !

Self-test

automatic part

Fresh gas occluded ✓
APL (Automatic Pressure Limitation) valve = 30 mbar ✓
Y-piece open ?

040292780412927804229278

✓

cancel

test

26

06-12-98

16:47

Open the Y-piece. Please confirm !

00:00

cancel

test

Y-piece occluded?

1 Fit the patient connection of the Y-piece onto the

cone provided.

● Press rotary control to confirm.

– Additional internal tests requiring an occluded

Y-piece are then conducted by the ventilator.

The leakage test includes the measured gas sampling
and return lines. These lines must therefore be correctly
connected and not open-ended.

An open T-piece or open Luer lock will result in major
leakages!

Preparing for use

Self-test

1

0432927804429278 04529278

The automatic part of the self-test follows
immediately.

A list in the middle of the system screen shows, with
symbols, which points have already been completed,
with results if applicable, and which have still to be
carried out.

06-12-98

Self-test

automatic part

Hardware
Position of piston

16:47

Adjust pressure limitation valve (APL) to MAN position. Pressure setting 30 mbar.

00:00

Please confirm !

Self-test

automatic part

Fresh gas occluded ✓
APL (Automatic Pressure Limitation) valve = 30 mbar ✓
Y-piece open ✓
Y-piece occluded ?

✓

cancel

test

cancel

test

config.

06-12-98

16:47

Occlude the Y-piece. Please confirm !

00:00

27

Preparing for use

Self-test

Any faults found are immediately reported in the error
field and a brief note on action to remedy the fault
appears in the user advisory field.

The system stops until the user presses the rotary control
to confirm that the fault has been corrected.

DrägerService must be contacted in the case of faults
which cannot be remedied by the user (e.g. repeated
display of the same fault message or of a three-digit
service number).

Test result:

At the end of the test, all successfully tested items are

marked with a tick ( ✔ ). The measured values for IPPV

leakage and hose compliance are displayed.

Also, the entire sensor system is automatically self­calibrated. No user intervention is needed.

During the leakage test, the expiration valve is tested for
leaks. If a leak is found, the corresponding fault message
is generated after the leakage test.

The fault must be remedied. The self-test must then be
restarted by pressing the rotary control!

The system switches to »Standby« when the self-test
has been completed successfully.

It is now ready for operation and the illumination of the
flow measuring tubes go out.

Self-test

automatic part

Hardware ✓
Position of piston ✓
Operating pressure ✓
Valve and rolling diaphragm ✓
Leakage IPPV ?
Hose-compliance ?

Self-test

automatic part

Hardware
Position of piston
Operating pressure
Valve and rolling diaphragm
Leakage IPPV 12 ml/min
Hose-compliance 2.5 ml/mbar

✓
✓
✓
✓

Breathing system valves

Standby

Cicero EM

Ventilator

SW-Version 7.n

06-12-98

Leak found in expiratory valve.

Remedy the fault indicated and restart self-test by pressing the rotary control.

Data Manager

SW-Version 4.n

06-12-98

Parameterbox

SW-Version 2.n

06-12-98

cancel

test

04629278047292780482927804929278

✓

cancel

test

leakage

test

delete

trend

config.

»Standby« means that:

– The system can immediately be switched to any

operating mode.

– Gas consumption is zero.

– Power consumption is marginal.

– The piston pump is in withdrawal position.

Manual ventilation is not possible in standby mode!

Any attempt to undertake manual ventilation in standby
mode is immediately detected and causes the system
to start operation in MAN/SPONT mode.
(»Auto-WakeUp« function).

The system should be switched off completely and not
left in »Standby« if it is not required for several hours.

In »Standby«, the screen is switched to screen-saver
mode after one minute if there are no further user inputs.
It is reactivated automatically whenever a key is pressed
or the rotary control turned.

Standby

Cicero-EM

Ventilator

SW-Version 7.n

06-12-98

Select ventilation mode at the ventilator or switch on screen by

Data Manager

SW-Version 4.n

06-12-98

Parameterbox

SW-Version 2.n

15-12-98

1

leakage

test

delete

trend

config.

28

Fresh gas outlet (option)

Preparing

1 Fit the hose of the semi-open system (e.g. Mapleson

system) to the external fresh gas outlet, and connect

the anaesthetic gas scavenging hose.

● Perform self-test in conformity with the Cicero EM

Instructions for Use.
2 Set the desired O2 and N2O flows at the flowmeter

block.
3 Press »MAN SPONT« on ventilator for at least

1 second (or press the key and confirm with the rotary

control. Setting by Dräger Service).
4 The lamp in the »FRESH GAS OUTLET« key does not

light up.

● Check that pressure is building up in the circle system.

4 Switch on the fresh gas outlet –

Press »FRESH GAS OUTLET« key.

The lamp in the key lights up.

● Check that pressure builds up in the semi-open

system.

D

Preparing for use

Fresh gas outlet

2

fIPPV TI:TE

Cicero EM

TIP:TI

fIMV

PEEP

Flow

TEST

O

4

3

MAN

SPONT

IPPV

Pmax

SIMV

PCV VT

PPCV

1

0502927805129278

Operation

Only available in »MAN/SPONT« mode
3 Press »MAN SPONT« on ventilator for at least

1 second (or press the key and confirm with the rotary

control. Setting by Dräger Service).
4 Switch on the external fresh gas outlet –

Press »FRESH GAS OUTLET«

The lamp in the key lights up.

The circle system is switched off.

● Perform anaesthesia ventilation using the external

fresh gas outlet.

● When switching over to another mode, e.g. IPPV, the

circle system is automatically switched on again. The

external fresh gas outlet is then closed.
5 Monitoring the breathing gas (O2 and anaesthetic

gases) in semi-open mode with the sample

measurement at the mask manifold of the semi-open

system in HLM screen mode.

Pressure and flow are not monitored.

When switching on and in the event of a power
failure lasting longer than 2 minutes, Cicero EM
switches automatically to the circle system.

5

29

30

Anaesthesia ventilation

Page

Manual / Spontaneous ........................................... 32

Spontaneous breathing............................................. 32

Manual ventilation..................................................... 32

Selecting IPPV mode .............................................. 33

Adjusting ventilation parameters ............................... 33

Automatic compliance correction.............................. 34

Ventilation with pressure limitation ............................ 34

Limit settings............................................................ 34

Selecting SIMV mode ............................................. 35

Selecting PCV mode (PCV ventilator)...................... 36

Special features of mode changes............................ 37

Paediatric use ......................................................... 38

Anaesthesia ventilation with the Kuhn system............ 39

Checking water separators and water traps .......... 40

Checking soda lime ................................................ 41

Anaesthetic vaporizer ............................................. 41

Secretion aspirator ................................................. 42

Changing patients................................................... 43

After use ................................................................. 44

31

Anaesthesia ventilation

Manual / Spontaneous

Anaesthesia ventilation

Select Manual / Spontaneous mode

1 Press key »MAN SPONT« on ventilator for at least

one second (or press the key and confirm with the
rotary control. Setting by Dräger Service as from
software version 7.2).

2 Display in dialogue field:

MAN/SPONT

»Standard screen 1« appears with the alarm limits for

MAN/SPONT mode.

The

P

disabled.

If the manual ventilation bag is squeezed without pressing a key
while the machine is in »Standby« mode, the machine
automatically activates MAN/SPONT mode.

Select the carrier gas for the anaesthetic agent:

3 Set the switch to »N2O« or »Air«.

and

p

keys on the ventilator are

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

O2 N2O ISO

Fi

29 70 0.8

Fet 26 68 0.6

06-12-98

11:59
00:00

1

MV L/min

6.0

freq 10 V

Warning: Caution:

SpO2 %

99

pulse 65

0.60

T

2

HR/Pulse (ECG)

ª

65

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

Advisory:

1/min

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

T1 36.8
T2 37.5

05229278

0532927805429278

Spontaneous breathing

4 Set pressure limiting valve APL to »SPONT«. It is

now open, regardless of the set pressure.

5 Set fresh gas –

detailed information on setting the fresh gas flow
can be found in the Annex on page 168.

Manual ventilation

with breathing bag

The airway pressure is limited via the pressure limiting
valve APL.

4 Set pressure limiting valve APL to »MAN« and set

required ventilation pressure:
turn valve head.

To fill system:

6 Press »O2 +«.

5 Set fresh gas with O2, N2O or AIR delivery valve –

● start manual ventilation.

6

O2

3

AIR

4

5

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

fIPPV TI:TE

Lecktest ?

TIP:TI

Flow

PEEP

fIMV

TEST

32

Selecting IPPV mode

After switching on, the ventilation parameters set prior to
delivery or subsequently programmed by DrägerService
are active in IPPV mode.

1 Set the values required for the patient.

Default settings upon delivery of new apparatus:
(may be altered by DrägerService if requested by
customer)

VT Tidal volume 0.6 L

fIPPV IPPV frequency 12 per min.

Pmax Maximum ventilation pressure 25 mbar

TI:TE Inspiration/expiration time ratio 1 : 1.7

TIP:TI Ratio of inspiratory pause

time/inspiration time 10 %

PEEP Positive end-expiratory pressure 0 mbar

MAN

SPONT

2

IPPV

SIMV PCV VT

23 600 12 IPPV Mode ?

max

P

PPCV

1

fIPPV TI:TE

TIP:TI

Flow

Anaesthesia ventilation

3

fIMV

PEEP

TEST

4

IPPV

2 Press

I

.

3 Display in dialogue field:

IPPV Mode ?

4 Press rotary control to confirm -

ventilation starts -

The parameters Pmax, VT, fIPPV, PEEP and piston

movement are displayed on the ventilator.

The system screen is also started and the IPPV alarm

limits are activated.

Adjusting ventilation parameters (Pmax for example):

5 Press »Pmax«.

6 The set value appears in the window above, while

3 the set value (left), the parameter and its unit of

measure (middle) and the value to be adjusted (right)

appear in the dialogue window -

4 turn rotary control:

MAN

SPONT

IPPV

32

5

Pmax

SIMV PCV V

PPCV

6

T

fIPPV TI:TE

23 Pmax / mbar 32

TIP:TI

PEEP

Flow

3

05529278

fIMV

4

05629278

3 the value on the right changes -

4 continue turning until the required maximum pressure

is reached. Press rotary control to confirm this value -

6 the new value is displayed -

if the new value is not confirmed, it will not be

adopted by the system and the display disappears

after approx. 10 seconds.

● fIPPV, VT, TI:TE, TIP:TI, PEEP and fIMV are adjusted

like Pmax after pressing the corresponding parameter

key.

33

Anaesthesia ventilation

IPPV

Automatic device compliance correction

Only set the desired patient tidal volume!

The compliance of the breathing system and of the hoses
used are established by the apparatus during the self-test
or during a manual leakage test. The reduction in tidal
volume due to system compliance is then corrected
automatically during ventilation so that the patient actually
receives the set tidal volume.

The leakage test should therefore be repeated whenever
changes have been made in the hoses –

The patient must always be disconnected and the
system set to »Standby« before starting the leakage
test ! (see page 44)

A detailed description of automatic compensation of
the system compliance can be found in the Annex on
page 167.

Ventilation with pressure limitation

When the set maximum ventilation pressure Pmax
is reached, inspiration is adjusted so that the pressure
remains constant up to the end of inspiration
(see page 37).

The set tidal volume is not fully applied in this case!

1 Display on ventilator:

Pressure limitation

2 The bar graph on the ventilator does not reach 100%.

If the pressure increases by more than 5 mbar above
the maximum ventilation pressure Pmax, e.g. because
the patient coughs, inspiration is immediately stopped
and expiration starts.

Limit settings

– Pmax, PEEP

The minimum difference between Pmax and PEEP is
10 mbar. As from software version 7.n, this minimum
difference is reduced to 5 mbar. Settings that result in
a smaller pressure difference are not permitted by the
system. The minimum Pmax setting remains 10 mbar,
as in previous versions.

MAN

SPONT

2

IPPV

SIMV

max

P

PCV V

P

PCV

SIMV-Mode ?

TIP:T

I

f

T

f

IPPVTI:TE

IMV

PEEP

Flow

1

TEST

05729278

– Max. inspiratory flow

The tidal volume, frequency, I:E ratio and inspiratory
pause time cannot be set to values resulting in an
inspiratory flow of more than 75 L/min.

– Max. minute volume

The tidal volume and frequency cannot be set to
values resulting in a minute volume of more than
25 L/min.

34

Selecting SIMV mode

In order to prevent the mechanical mandatory ventilation
stroke from being applied during the expiratory
spontaneous breathing phase, a special trigger ensures
that the mandatory ventilation stroke is controlled by the
patient and consequently synchronized with spontaneous
breathing (this is described in detail on page 180).

PEEP is not active in SIMV mode!

After switching on, the ventilation parameters program­med upon delivery are active in SIMV mode. They can be
changed by DrägerService on request.

The ventilation parameters of the preceding mode remain
active when changing from IPPV to SIMV mode and vice
versa!

Settings upon delivery of new apparatus:

VT Tidal volume 0.6 L

fIMV IMV frequency 12 per min.

Pmax Maximum ventilation pressure 25 mbar

TIP:TI Ratio of inspiratory pause

time/inspiration time 10 %

TI:TIE Inspiration/expiration time ratio 1:1.7

Anaesthesia ventilation

SIMV

If the ventilation frequency is equal to or greater than
6 breaths per minute in »SIMV mode«, the IPPV alarm
limits become active and the alarm mode »IPPV alarm
limits« is automatically displayed on the system screen.

If the ventilation frequency is less than 6 breaths per
minute in »SIMV mode«, special SIMV alarm limits
become active and the advisory message »SIMV alarm
limits« flashes in the status field of the system screen for
five seconds. This message does not require confirma­tion (see page 81).

When setting frequencies of more than 6 per minute,
the system automatically reverts to the IPPV alarm limits
and indicates this on the system screen.

The ventilation parameters are adjusted in the same way
as in IPPV mode:

1 Press the »SIMV« key.

2 Display in dialogue field:

SIMV Mode ?

3 Press rotary control to confirm -

ventilation starts -

the parameters Pmax, VT, fIMV, PEEP and piston

movement are displayed on the ventilator -

the system screen is also started and the alarm limits

for SIMV are activated.

To adapt the alarm limits automatically to the ventila-

tion mode, see »Alarm concept« on page 78.

IPPV alarm limits

standard screen 1- adults

1. ECG I

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

Fi O2 Vol %

06.12.98

11:59
00:00

1

Warning: Caution:

HR/Puls 72 50 120
Pulsdef.

122 80 160

NiBP sys
SpO

92 91 --

2

33 30 50

et CO

2

in CO

-- 5

2

AMV
Fi O

29 20 --

2

Fi SEV
PAW
iBP 1 sys
iBP 2 mit

-0.05 ± 0.10

ST

36.8 -- --

T1
T2

37.5 -- --

MV l/min

10.229

Freq 12 V

Select the required limits and confirm !

0.60∆ O2 --

T

99

Ventilator with PCV

MAN

SPONT

IPPV

max

P

PCV VT

SIMV

fIPPV TI:TE

PPCV

Ventilator without PCV

4 5

6.2 3.0 12.0

0.8 -- 3.4
9 8 40

125 80 167

31 0 8

SpO

%

2

SIMV-Mode ?

TIP:TI

PEEP

Flow

2

SIMV Mode ?

2

HR/Pulse (ECG)

72

pulse def. 4 ST + 0.05

et CO2 MV Peak

33 10.2 19

Freq. VT PEEP

12 0.81 1

etCO2 mmHg

33

Peak mbar PEEP

32 3

Plat 18 Mean 6

HR/Pulse SpO2 Art (1)

79 99 -- / --

1/min % mmHg

fIMV

3

3

Advisory:

1/min

TEST

SIMV

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

timer

start

36.8 °C

T1

37.5 °C

T2

1

0582927805929278

35

Anaesthesia ventilation

PCV

Selecting PCV mode (PCV ventilator)

After switching on in PCV mode the ventilation
parameters originally set by the factory or subsequently
reprogrammed by Dräger Service are applied.

Settings on delivery of a new machine:

(can be modified by Dräger Service at the customer’s
request).

fiPPV PCV frequency 12 per min.
Flow Inspiration flow 50 L per min.
TI:TE Ratio of inspiration time to

expiration time 1:1.7
PEEP Positive end-expiratory pressure 0 mbar
PPCV PCV operating pressure 10 mbar

The ventilation parameters are adjusted in the same way
as in IPPV mode:

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

fIPPV TI:TE

TEST

TIP:TI

fIMV

PEEP

Flow

O

00129078

1 Press the »PCV« key.

2 Display in dialogue field:

PCV mode ?

3 Press the rotary control to confirm –

ventilation in PCV mode starts.

In the absence of confirmation, the message
»PCV-Mode ?« disappears after 10 seconds without
any change in the ventilation function.

The parameters PCV, fIPPV, Flow, PEEP and piston
movement are displayed on the ventilator.
The system screen is also started, and the alarm limits for
IPPV are activated.

PCV characteristics and settings

1 The »Pmax« key is also labelled »PPCV«.

In »IPPV« mode the key has the »Pmax« function.
In »PCV« mode the key has the »PPCV« function.

● The »PPCV« value defines the level of the pressure

curve plateau that is attained during inspiration and
exactly maintained until the start of expiration.

2 The »TIP :TI« key is also labelled »Flow«.

PCV

1

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

fIPPV TI:TE

PCV-Mode ?

2

TIP:TI

PEEP

Flow

21

3

00229078

TEST

fIMV

O

00329078

In »IPPV« mode the key has the »TIP :TI« function.
In »PCV« mode the key has the »Flow« function.

● The »Flow« value defines the gradient of the

inspiratory curve. The permitted value range is
between 5 and 75 l per min.

36

Anaesthesia ventilation

PCV

Special features of mode changes

Changing from IPPV or SIMV to PCV

The PEEP setting is transferred to PCV mode from
IPPV/SIMV.

The PPCV value is the last set plateau pressure. Its
maximum value is Pmax. If the transferred PPCV value is
not at least 5 mbar more than PEEP, the PPCV value is
set to PEEP + 5 mbar.

If the Cicero EM is started up in PCV mode, the preset
standby value for PPCV is used. For the Flow, the
standby value is always set to 50 l/min. These default
settings can be modified by Dräger Service at the
customer's request.

Changing from PCV to IPPV or SIMV

The PEEP setting is transferred to the selected mode
from PCV.

Pmax is set to the last value applied in IPPV/SIMV
ventilation, provided that Pmax is at least 5 mbar more
than PEEP. If not, Pmax is set to PEEP+5 mbar.

Paw

PPCV

PEEP

Gradient (defined by the Flow setting)

Inspiration period [%]

1

T = ––––

f iPPV

t

00429078

Adjusting PPCV and Flow

As with all settings on the ventilator:

● Press the function key; the existing value and the

proposed new value are displayed in the dialogue
window.

● Turn the rotary control: the proposed new value

changes.

On reaching the desired setting:

● Press the rotary control: the new value is set.

Special alarm features

In PCV mode, the system screen is in »IPPV« monitoring
mode. There is no special monitoring mode for »PCV«.

If the selected ventilation pattern in PCV deviates
considerably from the last pattern selected in IPPV mode,
AMV or pressure alarms may be triggered in the usual
form:

– Yellow/red flashing light
– Tone sequence
– Message in the yellow/red field
– The limit value menu is automatically displayed
– The limit values can be adjusted

If the »auto set vent. al.« key is pressed, the system
calculates the new alarm limits from the limits applied in
the last IPPV ventilation mode. We therefore recommend
that you set the alarm limits manually in the limit value
menu.

37

Anaesthesia ventilation

Paediatric use

Paediatric use

Infant hose set

Infant hoses should be used for ventilation volumes of
less than 200 mL.

If a breathing gas humidifier is used, water traps should
be installed at the lowest points of the breathing hoses
(arrows) on both the inspiratory and the expiratory side.

Avoid pressure peaks

The fresh gas is stored in the breathing bag during inspi­ration. The pressure built up in the breathing bag when
working with high flow rates and long inspiration times
may be higher than the end-inspiratory pressure in the
patient, particularly when using a 0.5 L breathing bag.

Even at a fresh gas flow of 4 L/min, a pressure peak may
arise at the beginning of the expiration phase as fresh
gas streams out of the breathing bag. This is particularly
possible in combination with long inspiration times and
can be avoided by reducing the fresh gas flow or using
a 1.5 L breathing bag.

The setting increments and the metering precision for the
tidal volume VT depend on the selected adjustment
range.

06029278

(The adjustment range <20 mL is only selectable in
software version 7.2)

Range Interval Metering accuracy

< 20 1 mL ± 30 % or ± 6 mL
20 to 50 mL 2 mL ± 10 % or ± 10 mL
50 to 100 mL 5 mL ± 10 % or ± 10 mL

100 to 990 mL 10 mL ± 5 % or ± 15 mL

1 L to 1.4 L 0.01L ± 5 % or ± 15 mL

The system must calculate its new system compliance
following a change of hoses.

The patient must be disconnected for this purpose
and the leakage test started!

(see overleaf)

The ventilation parameters are adjusted in the same way
as in IPPV mode.

If a tidal volume of less than 200 mL is selected from a
higher setting, the system automatically generates the

1 display:

Infant hoses!

● Fit infant hoses –

MAN

SPONT

IPPV

PCV VT

SIMV

TEST

O

2

01029278

fIPPV TI:TE

Infant hoses

TIP:TI

PEEP

Flow

fIMV

Pmax
PPCV

1

2 press rotary control to confirm.

38

Then switch to »Standby« and call up the leakage test
(see page 46) so that the new compliance can be
calculated:

Invoking the leakage test

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

fIPPV TI:TE

IPPV Leakage test

TIP:TI

PEEP

Flow

2

Anaesthesia ventilation

Paediatric use

TEST

1

fIMV

O

1 Press

T

on the ventilator for at least three

seconds or press the softkey »Leakage test« on the
system screen -

2 Display in dialogue field on ventilator:

IPPV leakage test followed by: IPPV leak = xx mL

The menu for the leakage test appears on the system
screen followed by the current leakage and
compliance values a few seconds later.

The manual ventilation bag and its hose are not
included in the test!

The system switches back to »Standby« after the test.

The system screen should be switched over to »Neon«
mode (see page 49), in order to adapt the NIBP starting
pressure and the alarm limits to the patient.

Anaesthesia ventilation with the Kuhn system

● Prepare the Kuhn set in accordance with separate

Instructions for Use -

● Connect anaesthetic gas scavenging hose.

3 Press

M

4 Set pressure limiting valve APL to »MAN« -

● Connect inspiration hose via

on ventilator for at least one second -

4

3

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

O2

fIPPV TI:TE

AIR

Lecktest ?

TIP:TI

Flow

PEEP

061292780032927806229278

TEST

fIMV

5 connecting sleeve - Symbol:

6 Expiration connector remains open - Symbol:

7 Connect concertina hose and

breathing bag to manual ventilation
connector. Symbol:

The pressure indicated on the system screen is not
identical with the actual airway pressure. Reason: higher
flow resistance of the fresh gas hose in the Kuhn system.
The higher the fresh gas flow, the greater the difference.

In case the Cicero EM is equipped with an external fresh
gas outlet (see page 29) this should be used.

National regulations on the minimum monitoring
requirement must be observed!

The breathing gas can be monitored by

8 the measuring connection on the mask manifold or
5 at the inspiration output (switch the system screen to

HLM mode for this purpose)

D

5

6

7

8

39

Anaesthesia ventilation

Condensation

Check the water trap

– Regularly check the water trap on the left-hand side

of the Cicero EM. When the level comes close to the
»Full« mark, remove the jar by pulling it down and
empty it.

– Fit the jar firmly back in place!

If the permitted maximum level is exceeded, the
measured gas sampling system is switched off
automatically.

The advisory message »WATER TRAP? !« is displayed on
the system screen.

CO2, O2, breathing gas and N2O measurements will
then no longer be possible!

Remedy: Drain the water trap as described.

Check water separators

– Water separators must be fitted at the lowest point in

the hose and hang downwards.

– They must be checked regularly and drained if

necessary.

Note hygiene regulations ­risk of infection!

The hose system remains sealed.

– Container must be replaced securely.

06329278

D

Anaesthetic gas scavenging line (AGS)

– Check the transfer hose.

Condensate may have collected in the hose – drain if
necessary.

40

0352927802229278

D

Check soda lime

The soda lime turns purple from the bottom upwards
when saturated with CO2. To monitor the amount of CO2
absorption by the soda lime, the FiCO2 value can be
displayed on the system screen (see page 50).
FiCO2 is monitored during IPPV ventilation (default value:
adults 5 mmHg, neonates 8 mmHg; individually adjustable
from 0 to 10 mmHg). Change the soda lime after 2/3 of
the charge has changed colour. The colour may fade again
due to drying out after prolonged breaks.

Anaesthesia ventilation

Soda line

Anaesthetic

Changing soda lime during operation

(filling container, see page 128)

● Prepare a replacement soda lime container.

● Switch off the Vapor.

● Stop N2O delivery.

● Set ventilator to »MAN/SPONT« and the pressure

limiting valve to »SPONT«.

1 Briefly turn the soda lime container anticlockwise and

pull it downwards.

● Insert the replacement soda lime container from

below and turn clockwise as far as possible.

● Reset the machine to previon settings.

● Remove spent soda lime from the container.

Note hygiene regulations when dealing
with infectious patients - risk of infection!

Anaesthetic vaporizer

2 Handwheel with scale in % anaesthetic agent by

volume.

3 Zero button.

Locks in zero position (»O«) automatically when the
Handwheel is turned clockwise to the limit.

– MAX –

1

0642927806529278

4

2

0

Vol. %

3

4 Locking lever.

To the left: Vapor is locked onto the plug-in system.

To the front: Vapor is released and can be lifted off

the plug-in system. It must not be tilted
more than 45 degrees!

When using the connection for two Vapor units, the
Handwheel of the desired Vapor must first be released.
The second Vapor is then automatically locked.

3 Press zero button and turn handwheel

anticlockwise ­until required setting is reached.

41

Anaesthesia ventilation

Secretion aspirator

Secretion aspirator

Set negative pressure:

1 Set negative pressure switch to »I«.

2 Set required negative pressure with rotary control.

Seal the aspiration ports (or fold over the hose) and

3 check negative pressure on pressure gauge.
1 Set negative pressure switch to »O«.

Aspiration:

1 Set negative pressure switch to »I«.

4 Cover the »Fingertip« with your index finger.

● The aspiration capacity can be adjusted very

accurately with the aid of auxiliary air.

– Check filling level of aspiration vessel regularly and

drain if necessary.

Note hygiene regulations ­risk of infection!

D

12

I

O

4

D

ON / I

Press

3

2302927806629278

In order to avoid uncontrolled negative pressures in the
breathing system and patient's lung, we recommend that
you only carry out aspiration when the Y-piece is dis­connected from the patient tube.

42

Changing patients

Changing parts:

Refer to page 117 and 125 for a schematic overview and
description of methods for cleaning and disinfection.

Maintenance intervals: page 137.

● Machine in Standby mode -

● Vapor: thumbwheel set to »O« = Off.

After treating an infectious patient

the entire machine must be cleaned, disinfected and
sterilized.

Note hygiene regulations ­risk of infection!

Anaesthesia ventilation

Changing patients

06729278068292780692927807029278

1

2

After treating a non-infectious patient

the following parts must be replaced before continuing
with the next patient:

● Tube or mask

● Y-piece

● Both breathing hoses

● Temperature sensor and cable if applicable

1 T-piece of the measured gas hose and filter, if used

(disposable articles, household refuse) -

2 Draw the water trap container down and off to be

emptied -

The following must also be changed when working
without microbial filters:

3 O2 sensor with connecting lead, if used.
4 Flow sensor.

Disconnect lead from flow sensor - it remains on the
machine.

● Breathing bag with hose

● Breathing system:

Disconnect fresh gas hose - it remains on the machine.

● Pressure measuring hose and filter - must be

replaced. Hose connector remains on the machine.

● Soda lime container - turn anticlockwise and pull

down - must be replaced.

● Release the hose of the anaesthetic gas scavenging

system (lock in front of the connector - No. 5 on
page 118), and also disconnect from the wall socket
of the central scavenging system.

FULL

3

4

43

After use

After use

Set machine to »Standby«

In »Standby« mode,

– the system can immediately be switched to any

operating mode,

– gas consumption is zero,

– power consumption is marginal and

– the piston cylinder unit is in withdrawal position.

1 Press »Standby« on the ventilator for at least 1 second

(or hold down the key and confirm by pressing the
rotary control. Setting by Dräger Service as from
software version 7.2).

2 The following message is displayed:

»Standby«

The flow tubes are no longer lit up.

The system screen remains operational and should be
set to »Standby« by pressing E if not required.

The system screen can only be switched to
Standby if the ventilator is already in Standby!

● Set the Handwheel on the Vapor to »O «.

● Close the delivery valves for O2, N2O and AIR.

Continuing fresh gas flow while the device is in
standby mode can cause the soda lime to dry out!

In »Standby«, the screen is switched to screen-saver
mode after two minutes in the absence of any user input.
The screen is automatically reactivated when any key is
pressed or the rotary control is turned.

MAN

SPONT

IPPV

max

P

SIMV PCV VT

PPCV

fIPPV TI:TE

Standby

TIP:TI

Flow

2

PEEP

Standby

Ventilator

SW-Version 7.n

06-12-98

Select ventilation mode at the ventilator or switch on screen by

Cicero-EM

Data Manager

SW-Version 4.n

06-12-98

fIMV

Parameterbox

SW-Version 2.n

15-12-98

1

TEST

O

1

07129278

leakage

test

delete

trend

config.

04929278

If operation is interrupted for several hours, we recom­mend that you switch the system off instead of leaving it
in »Standby«:

● Turn master switch clockwise to »O «. After switching

off, the message »Power off« is displayed for about
10 seconds.

● Disconnect gas hoses from wall sockets -

● close reserve gas cylinders (if used)

● roll up hoses and hang them over the holder at the

back of the machine.

● Disconnect mains plug. This instruction does not

apply if using a UPS.

44

D

I

O

Gas/Power

ON / I

Press

02829278

System screen functions

Page

»Standby« screen .................................................... 46

Running the leakage test .......................................... 46

Delete trend ............................................................. 46

Basic screen configuration ..................................... 47

Access to Configuration ........................................... 47

Default values........................................................... 47

Operating Description .............................................. 48

Operating modes for adults and neonates................. 49

Alarm limits .............................................................. 49

Parameters

(ECG, NiBP, iBP, SpO2/Pleth, CO2/O2, pEEG) ......... 50

Configuring screen pages with modules ................... 53

Configuring the screen colours ................................ 60

Curve speed ............................................................ 60

General settings....................................................... 61

Acoustic................................................................... 61

List entry .................................................................. 61

Transport function .................................................... 62

External interfaces (MEDIBUS / printer).................... 63

Basic configuration................................................... 64

Calibration, O2, flow,................................................ 65

Testing (O2 linearity, gas sensor zero point).............. 66

Anaesthetic agent..................................................... 67

System screen functions during operation ............ 68

Switching on the system screen ............................... 68

Standard screens..................................................... 69

Data screen.............................................................. 69

List screen ............................................................... 70

Trend screen............................................................ 71

Softkeys .................................................................. 72

Alarm concept......................................................... 78

Priority of alarms ...................................................... 78

Show all alarms........................................................ 79

Suppress alarm tone ................................................ 79

Alarm modes............................................................ 80

CO2 alarm ............................................................... 80

Adjusting to the ventilation mode .............................. 80

Special features of alarm signalling........................... 82

45

System screen functions
»Standby« screen

System screen functions

»Standby« screen

In Standby mode, the Cicero EM is immediately ready for
operation. The »Standby« screen contains the following
softkeys:

– the leakage test,

– deleting the trend and list memory,

– system screen configuration.

If the device is left in Standby mode for longer than two
minutes, the screen is automatically switched off (dark).
It is automatically switched back on by any user input
(key, rotary control, etc.).

Running the leakage test:

The sample line and the sample gas return must be
connected correctly before starting the leakage test.
They are then included in the test as part of the overall
system. An open T-piece or open Luer lock can result in
major leakages!

1 Press either the softkey »leakage test« on the system

screen or the »TEST« key on the ventilator.

Ventilator

SW-Version 7.n

06-12-98

SIMV PCV VT

Standby

MAN

SPONT

IPPV

max

P

PPCV

Cicero-EM

Data Manager

SW-Version 4.n

06-12-98

Select ventilation mode at the ventilator or switch on screen by

Parameterbox

SW-Version 2.n

06-12-98

1

TEST

IPPV Leakage test

TIP:TI

fIPPV TI:TE

fIMV

PEEP

Flow

2

O

leakage

1

test

delete

trend

config.

1

072292780612927807329278

2 Display in dialogue field on ventilator:

IPPV leakage test

followed by:

IPPV leak = xx mL

The menu for the leakage test appears on the system
screen, followed after a few seconds by the current
leakage and compliance values.

The manual ventilation bag and its hose are not
included in the test!

The machine reverts to »Standby« after the test.

Delete trend; e.g. for a new patient:

Trend memory, list and Parameter Box memory (if used)
are deleted!

3 Press the softkey »delete trend« on the system

screen. Description on page 71.

The system enquires again whether the trend is really
to be deleted.

● Press softkey »delete« to confirm.

The original screen is restored if the softkey
»do not delete« is pressed.

Ventilator

SW-Version 7.n

06-12-98

Standby

Cicero-EM

Data Manager

SW-Version 4.n

06-12-98

Select ventilation mode at the ventilator or switch on screen by

Parameterbox

SW-Version 2.n

06-12-98

leakage

test

delete

3

trend

config.

1

46

Basic screen configuration

Access to Configuration

System screen functions

Basic screen configuration

Setting code

1 When you press the »Config« screen key, the screen

opposite is displayed:

Standby

Ventilator

SW-Version 7.n

06-12-98

Standby / Configuration

Anesth.Agent Default values

selection
man. auto

gas
Isoflurane

The anesthetic
agent is automati­cally selected by
agent detection

Cicero-EM

Data Manager

SW-Version 4.n

06-12-98

Select ventilation mode at the ventilator or switch on screen by

Calibration

more

Parameterbox

SW-Version 2.n

mode

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

06-12-98

adult neon.

leakage

test

delete

trend

config.

1

1

alarms inactive !

074292780752927807629278

Default values

The default settings are permanent. They are activated
after every modification and every time the device is
switched on.

By contrast the standard alarm limits are activated after
each standby.

The standard are protected by 4-digit code against
unauthorised modification.

Dräger Service can deactivate this protective function
or can program a different code freely selectable by the
user.

Enter code:

● Select the digits one by one by turning the rotary

control and press to confirm. After the fourth correct
digit has been entered, access is granted to the
selection range.

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

11:59
00:00

Check system configuration. Please confirm !

Default values

These default settings are password
protected.
The default settings are active
on start-up.

To change the default settings
enter the password:

0 1 2 3 4 5 6 7 8 9

* * * *

alarms inactive !

(The operating procedure for the basic screen
configuration is described on the next page).

47

System screen functions

Basic screen configuration

Operating Description

Operating Description

Part of screen: Representation:

Active menu level.................. Turquoise

Inactive menu level................ Grey

Cursor.................................. Yellow frame

Selected menu option ........... Inverse video

(white on black)

Current settings.................... Orange background

Operating function: Action:

Move cursor ......................... Turn rotary control

Confirm selection.................. Press rotary control

Go back one menu level ....... Select » z« and confirm

The following basic configurations are possible:

Mode Changeover between adult and

neonatal mode.

Standby / Configuration

time interval 2

active alarms sys dia

initial pres­sure adult 180 mmHg

punct. press.
adults 40 mmHg

units mmHg kPa

Interlock:
NiBP-SpO

NiBP-iBP on off

06-12-98

11:59
00:00

NiBP

on off

2

Select a menu position. Please confirm !
Change the settings. Please confirm again !

ECG

NiBP

iBP locations

iBP channels

SpO

CO

pEEG

2

/ O

2

/ Pleth

Settings

2

alarms inactive !

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

07729278

Alarm limits Selects the active alarm limits for

neonates or adults when switching
over to MAN/SPONT.

Parameters Standard settings of the patient

parameters.

Screen Configure screens.

Acoustics Select volume and type of tone

sequences.

List entry Define the criteria for an entry in the

list screen.

Transport Define the data exchange protocol

between the parameter box and the
system screen when transporting
the patient.

RS 232 (MEDIBUS) Set the interface parameters.

Log (printer) Configure the printer interface.

Basic setting Date, time and language setting.

48

System screen functions

Configuring the system screen in »Standby«

Mode

The Cicero EM has separate operating modes for adults
(adult) and neonates (neon). These modes differ in the
following way:

– Default alarm limits (see below)

– Volumeter measuring range (see page 58)

– NiBP functions (see page 91)

– ECG functions (see page 89).

Every time the Cicero EM is switched on, it automatically
operates in the mode selected in this menu.

Alarm limits

The standard alarm limits are defined

– separately for adults and neonates,

and, in order to activate/deactivate the MAN/SPONT
alarm limits, for

–et CO2,
– in CO2,
–O2 high and
– AMV.
The default alarm limits are automatically activated after

either:
– switching on the Cicero EM,
– leaving »Standby« mode,
– selecting »default« under »Alarms«,
– switching over between »Neon« and »adults« mode

Standby / Configuration

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

11:59
00:00

Default values

mode

adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

Select the required ventilation mode (adult or neonate). Please confirm !

Settings

mode

adult neo.

alarm limits

standard adult
standard neonates
Man/Spont-alarmlimits
et CO

2 on off

2 on off

in CO

2 high on off

O
MV on off

Standard alarm limits configuration menu. Please confirm !

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

078292780792927808029278

alarms inactive !

The limit values are allocated in groups to the following
measurement parameters:

– iBP
– ECG / SpO2 / NiBP / Temp
– Anaesth. Agent
– Pressure / Ventilation

Both the upper and lower limit is displayed at the limit
symbol:

22 Upper limit

_

11 Lower limit

Two dashes (– –) instead of a number indicate that this
alarm limit is deactivated and not monitored. This is set
by turning the rotary control respectively above or below
the maximum or minimum settable value and pressing to
confirm.

Not all the alarm limits can be deactivated!

Standby / Configuration

iBP

Aorta
sys

dia
A.Pulm
sys

mean

dia
CVP
mean
ICP
mean
mmHg
sys

mean

dia

06-12-98

160
80

100
50

24
8

24
8

20

-­ 8

0
16

0

160

80
24

8

100
50

11:59
00:00

ECG / SpO
NiBP / Temp

HR

Pulse

SpO

2

NIBP/ART
sys

dia

T

1

T

2

ST

Standard - Adult

1,5

2,3

-­ 3,4

--

--

12,0

--

Pressure /
Ventilation

12,0

MV

--

3,4

PAW

etCO

FiO

3,0
40
8
50

2

--

--

2

20

/

Anesth. Agent

2

120
50

Fi Hal

120

Fi Iso

50

-­Fi Enfl.

92

Fi Sevo

100
50

Fi Des

160
80

--

--

--

--

--

--

Standard alarm limits configuration menu. Please confirm !

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

49

System screen functions

Configuring the system screen in »Standby«

Parameters

The settings for the following parameters are defined with
this menu:

ECG Electrocardiogram.

NiBP Non-invasive blood pressure.

iBP location Determines where iBP is to be

measured.

iBP channels Preselecting the iBP channels.

SpO2/Pleth Pulse oximetry/plethysmogram.

CO2/O2 Capnography/oxygen measure-

ment.

pEEG Data-compressed electro-

encephelogram (processed EEG).

The settings defined here are activated:

– after switching on the unit

– after selecting »Standard« under »Settings« during

operation (see page 77).

Standby / Configuration

06-12-98

11:59
00:00

ECG

NiBP

iBP locations

iBP channels

/ Pleth

SpO

2

2/O2

CO

pEEG

Select the required parameter and confirm !

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

0812927808229278

ECG settings

measuring function Switching ECG measurement

on or off.

number of leads Choice of 3 or 5 leads.

lead Selects the displayed lead separa-

tely for the 1st, 2nd and 3rd ECG
curve.

With a 3-core cable, the choice is
limited to the 1st ECG.

amplitude Sensitivity of the measurement.

filter Switches the filter on or off

(see page 89).

pacemaker Switches pacemaker detection

on or off.

pulse deficit Switches the pulse deficit indica-
indication tion on or off.

ST segment Switches the ST segment analysis
analysis on or off.

If a 3-wire lead (3-core cable) is selected, only one ECG
can be displayed, and so the options for the 2nd and 3rd
ECG are cancelled.

Standby / Configuration

06-12-98

11:59
00:00

ECG

function on off

number 3 5
of leads

1.ECG 2.ECG 3.ECG

lead I II III

1

amplitude

filter on off

pacemaker on off

pulse def. on off
indication

ST-segment

on off

analysis

Select a menu position. Please confirm !
Change the settings. Please confirm again !

ECG

NiBP

iBP locations

iBP channels

SpO

2/O2

CO

pEEG

/ Pleth

2

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

50

System screen functions

Configuring the system screen in »Standby«

NiBP settings

(see also page 91)
time interval Sets the time between measure-

ments.

active alarms Determines which parameter is to

be monitored (systolic or diastolic
pressure).

initial pressure Sets the starting pressure.

punction pressure

Sets the punction pressure.

The initial and punction pressure can be set separately
for adults and neonates. To do so, switch from »adult« to

»neon« and vice-versa under »Mode«.
unit Selects the measuring units
interlock When set to »on«, peripheral pulse

alarms are suppressed while the
sphygmomanometer cuff is being
inflated.

iBP locations

(See also page 94) With this function, measuring sites
can be preselected independently of the channel. The
following locations are available:

ART Artery
AORTA Aorta
A.Pulm. Pulmonary artery
CVP Central venous pressure
ICP Intracranial pressure
? Other location

The following parameters can be selected:

monitoring Systolic, diastolic or mean pressure.
graph abs = fixed curve scale

morph = variable scale. For maximum

curve height.

amplitude Scale of the curve.

Can only be used with fixed scales
(»abs«).

pulse Switches pulse indication on/off.

iBP channels

defines input channels P1 and P2 of the parameter box:

measuring function

Switches the channel on/off.

location Determines the location for this channel.
sensitivity Selects the sensor sensitivity.

42.5 or 50 µV/V/mmHg

Standby / Configuration

06-12-98

Standby / Configuration

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

active alarms

ART

graph
amplitude
pulse
active alarms

AORTA

graph
amplitude
pulse
active alarms

A. Pulm

graph
amplitude
active alarms

CVP

graph
amplitude
active alarms

ICP

graph
amplitude
active alarms

?

graph
amplitude

11:59
00:00

iBP 1 function OFF ON
location ART
sensitivity 42.5 50

iBP 2 function OFF ON
location CVP
sensitivity 42.5 50

Select a menu position. Please confirm !

11:59

Change the settings. Please confirm again !

00:00

mean

mean

ECG

NiBP

iBP locations

iBP channels

SpO

CO

pEEG

ECG

NiBP

iBP locations

iBP channels

SpO

2/O2

CO

pEEG

ECG

NiBP

iBP locations

iBP channels

SpO

/ Pleth

2

CO

/ O

2

2

pEEG

2

2/O2

/ Pleth

2

/ Pleth

NiBP

time

3

interval

active alarms sys dia

initial pres­sure adult

180 mmHg

punct. press.
adults

units mmHg kPa

interlock:
NiBP-SpO

NiBP-iBP on off

Select a menu position. Please confirm !
Change the settings. Please confirm again !

Select a menu position. Please confirm !
Change the settings. Please confirm again !

sys
absol.
160
on
sys
absol.
160
on
sys
absol.
40
mean
absol.
20
mean
absol.
20
sys
absol.
160

40 mmHg

on off

2

dia
morph.

off
dia
morph.

off
dia
morph.

morph.

morph.

dia
morph.

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

083292780842927808529278

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

51

System screen functions

Configuring the system screen in »Standby«

SpO2/Pleth settings

(see also page 97):

measuring function

Switches SpO2 measurement on and off.

pulse Switches pulse rate display on and off.

C-Lock Switches ECG synchronization on and
(ECG synchr.) off.

mode Determines the speed of measurement.

Fast measurements are more susceptible
to antefoets.

CO2/O2 settings

sample rate Selects the flow rate of the sample gas

through the sample gas line at the Y­piece. Dräger recommends 200 mL/min
with connected sample gas return line.

CO2 amplitude The maximum amplitude of the CO2 real-

time curve can be set here.

CO2 unit The CO2 measuring unit can be selected

between mmHg and kPa.

insp. CO2 Switches the numerical display of the

inspiratory CO2 concentration on or off.
Inspiratory CO2 is monitored in IPPV
mode with an adjustable alarm limit of
0 to 10 mmHg.

Standby / Configuration

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

11:59
00:00

SpO2/Pleth

function on off

pulse on off

C-Lock
(ECG

on off

synchr.)

mode slow normal

fast

Select a menu position. Please confirm !
Change the settings. Please confirm again !

CO2 /O2

sample rate

60 200

ml/min

amplitude

2 0-75 0-110

mmHg CO

units CO2 mmHg kPa

Vol.%

insp. CO2 on off

sidestream on off
O2-measurem.

Select a menu position. Please confirm !
Change the settings. Please confirm again !

ECG

NiBP

iBP locations

iBP channels

SpO

2/O2

CO

pEEG

ECG

NiBP

iBP locations

iBP channels

SpO

2

2/O2

CO

pEEG

/ Pleth

2

/ Pleth

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

08629278

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

08729278

sidestream O2 measurement

»on«:O2 is measured by sampling the

sidestream.

»off«:O2 is measured by measuring

O2 at the inspiratory port
(requires inspiratory O2-sensor).

pEEG settings

This menu selects the pEEG Parameters displayed in the
pEEG module (see page 58).

Standby / Configuration

06-12-98

11:59
00:00

pEEG

SEF / SMF / EMG
SEF / δ.Ratio / EMG

L.SEF / R.SEF / EMG
SMF / δ.Ratio /EMG
SEF / δ.Ratio / δ/θ/α/β

L.SEF / R.SEF / SMF

Amplitude

Select a menu position. Please confirm !
Change the settings. Please confirm again !

ECG

NiBP

iBP locations

iBP channels

SpO

CO

pEEG

2

2/O2

/ Pleth

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

08829278

52

System screen functions

Configuring the system screen in »Standby«

Configuring screens

Three standard screens can be configured and stored
independently of one another. The colour configuration of
the screen can be defined. The following menu options
are available:

– Standard screen 1

– Standard screen 2

– Standard screen 3

– Colour

– Curve speed

– General settings

The screens are made up of »Graphs« and »Modules«
which can be selected via the menu with the aid of the
rotary control.

Configuring standard screen 1 (or 2 or 3)

Example:

The screen structure is shown schematically on the left­hand side of the screen. Alongside it, there is a table of
graphical and numerical modules for selection.

Modules which have already been selected are shown
against an orange background.

● Turn the rotary control to move the rectangular cursor

bar (yellow) to the desired module or graph in the
table.

Standby / Configuration

06-12-98

Standby / Configuration

Please observe your national
monitoring requirements.

06-12-98

standard - screen 1

delete

1. ECG

iBP1

CO

2

PAW

MV

O

2

11:59
00:00

SpO

11:59
00:00

2

Settings

mode

adult neon.

alarm limits

parameter

Ventilation

CO

2

CO2 short

double

CO

2

PAW
PAW short
PAW double
flow
flow short
AGas
O

2

N2O

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

CO

2

combi-vent
press. 1
press. 2

MV
volumeter
Gases
O

2

Econometer

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

standard - screen 1

standard - screen 2

standard - screen 3

colour

curve speed

general settings

Screen configuration menu. Please confirm !

Patient

Graph Module Graph Module

HR

combi-vent

CO

2

press. 1

combi-haem

Select a graph or a module by turning the rotary knob. Please confirm !

1. ECG

2. ECG

3. ECG
iBP1
iBP2
iBP1+iBP2
Pleth

HR
pEEG
temp
iBP1
iBP2
NiBP
SpO

2

combi-haem

alarms inactive !

0892927809029278

alarms inactive !

● Press the rotary control to confirm.

The selected item in the table is highlighted against a
white background and is displayed in the schematic
illustration on the left, framed by the rectangular
yellow cursor bar.

● It can be moved in the schematic with the aid of the

rotary control.

● When the rotary control is pressed to confirm, the

module is then locked in that position on the screen.

● The module is deleted by pressing »Delete«.

The standard screen selected by this method is activated

● every time the device is switched on

● on quitting the described standard screen

configuration.

● on calling up »Standard« in the operating

configuration.

Observe national regulations on the minimum
measurement parameters to be monitored!

53

System screen functions

Configuring the system screen in »Standby«

Examples of the other selectable graph modules:

ECG graph ECG real-time curve. The lead and

amplitude are selectable.

1. ECG I

iBP graphs:

iBP 1 Real-time curve of the channel 1

invasive blood pressure measurement.
The reference lines are added as
dashed lines.

iBP 2 As above, but for channel 2.

iBP 1 + iBP 2 Display of two iBP curves in a single

graph of double module size.

Plethysmogram

Real-time curve of the plethysmogram
measured by the SpO2 sensor.

1mV

160

iBP 1 ART

0

iBP 1

160

00

Pleth

iBP 2
160

09129278092292780932927809429278095292780962927809729278

CO2 graph Real-time curve of the CO2 concentration

of the breathing air in the Y-piece. The
alarm limits are shown as dashed lines.

The curve can also be displayed in a
double-height module.

AGAS graph Real-time curve of the anaesthetic agent

concentration of the breathing gas at the
Y-piece.

CO

CO

ISO

40

2

40

0

2

0

3

0

54

System screen functions

Configuring the system screen in »Standby«

Flow graph Real-time curve of the expiratory

breathing gas flow.

PAW graph Real-time curve of the airway pressure.

The alarm limits are shown as dashed
lines (only the upper limit in Man/Spont).

The curve can also be displayed in a
double-height module.

Flow

PAW

PAW

20

20

0

09829278099292781002927810129278

20

0

0

O2 graph Real-time curve of the oxygen concentra-

tion at the Y-piece.

Short curves

The curves for CO2, Flow and PAW can also be
configured as short curves, so that they fit into the area
of a numerical module:

CO2 short (with indication of the CO2 value)

Flow short (with indication of the AMV value)

O

2

30

20

CO2 etCO2

40

0

Flow MV

20

31

102292781032927810429278

8.7

PAW short (with indication of the peak pressure)

PAW

20

0

Peak

22

0

55

System screen functions

Configuring the system screen in »Standby«

Examples of the selectable numerical modules:

HR/Pulse module

Shows the heart rate/pulse rate, which
can be obtained from the ECG, SpO2 or
iBP. The data source is shown in
descending order of priority.

Order of priority:

1. ECG

2. SpO2

3. iBP 1

4. iBP 2

This module also displays the pulse
deficit (calculated from the difference
between the heart rate and the pulse rate
obtained from SpO2 measurement) and
the ST segment height of the 1st ECG.

iBP 1/2 module Shows the systolic/diastolic and mean

values of the invasive blood pressure
measurement. The pulse rate can be
displayed at the same time.

For central venous and intracranial
pressure, the mean value is displayed in
large figures.

HR / Pulse (ECG)

1/min

H

pulse def 4 ST +0.05

iBP1 AORTA mmHg

65

122 / 89

pulse 65 (100)

iBP 2 CVP mmHg

4.5

mean

CO2 module The end-expiratory CO2 concentration

of the breathing gas (etCO2) is indica­ted. The inspiratory value (FiCO2) can
also be shown.

Gases module Shows the composition of the breathing

gas in relative concentrations of O2,
N2O and anaesthetic agent.

O2 module Shows the inspiratory O2 concentration

of the breathing gas (FiO2) and the
difference in relation to the expiratory
O2 concentration (∆ O2).

Comb. haem. module

Shows the combination of measured
values obtained from the measurements
of HR/Pulse, SpO2 and iBP (only ART
measuring site).

et CO2 Vol.%

33

Fi CO2 0

Vol.% O2 N2O ISO

Fi

29 70 0.8

Fet 25 68 0.6

Fi O2 Vol.%

29

∆ O2 4.3

HR/Pulse SpO2 ART

65 98 120/80

1/min % mmHg

56

System screen functions

Configuring the system screen in »Standby«

Comb. vent. module

Shows the combination of measured
values obtained from the measurements
of etCO2, AMV, Peak, Freq, VT and
PEEP.

AMV module Shows the expiratory tidal minute

volume, breathing frequency and VT.

Airway pressure module 1

Shows the maximum airway pressure
and the measured PEEP; also (small
print) the plateau pressure and mean
pressure value.

Airway pressure module 2

Shows the maximum airway pressure
and the measured PEEP.

etCO2 MV Peak

31 8.7 14

Freq VT PEEP

8 0.76 1

AMV L/min

6.0

Freq. 10 VT 0.60

Peak mbar PEEP

32 3

Plat 26 Mean 21

Peak PEEP mbar

SpO2 module Shows the functional O2 saturation of

the blood and the pulse rate.

Temperature (small)

This module displays the temperatures T1
and T2 in the bottom right-hand corner of
the screen (for the configuration see
»General settings« on page 61).
Alternatively, temperatures T1 and T2
could also be displayed in a normal
module.

NiBP module Shows the non-invasive blood pressure,

the mean pressure and the time
remaining until the next measurement.

During the measurement, the bar graph
shows the current sphygmomanometer
pressure.

32 3

SpO2 %

98

pulse 65

T1 36.8 °C

37.2 °C

T2

T1 T2 °C

36.8 37.2

NiBP mmHg
SYS Dia

123 / 88

15 min M (102)

57

System screen functions

Configuring the system screen in »Standby«

pEEG modules pEEG modules are available for

selection in the parameter menu
(see page 52).

Please observe the separate Instructions
for Use!

SEF90 Hz SMF

12.5 10.5

EMG

SEF / SMF / EMG SMF / d-Ratio / EMG

SEF90 Hz d-Ratio

12.5 0.5

EMG

SEF / d-Ratio / EMG SEF / d-Ratio / d / t / a / b

L.SEF90 Hz R.SEF90

12.5 10.5

EMG

L.SEF / R.SEF / EMG L.SEF / R.SEF / SMF

Total Ampl. delta

47 µV 34

BSR

Amplitude

SMF Hz d-Ratio

0.5 10.5

EMG

SEF90 Hz d-Ratio

12.5 0.5

d/q/a/b

L.SEF90 Hz R.SEF90

12.5 10.5

L.SMF9.5 R.SMF8.5

Volumeter module

This module comprises a breath volumeter (upper bar
graph) and a minute volumeter (lower bar graph). The
length of the bar represents the maximum measured
value in accordance with the mode selected:

Mode Breath VT MV

Neonates 0.25 L 2.5 L/min
Adults 1.25 L 12.5 L/min

Breath volumeter:

– The expiratory volume of each breath (VT) is shown

graphically by the upper bar and numerically in large
numerals abore.

Minute volumeter:

– The minute volumeter in the lower bar graph runs for

60 seconds, during which it adds up the tidal
volumes.

The time expired is shown in seconds together with the
value in large numerals. The individual breaths are shown
as segments in the bar graph. The volumeter stops
automatically after 60 seconds and beeps. The measured
values are displayed for 4 minutes and then deleted.

VT 0.60 L

Volumeter

4.3 L

1.25
30 s

12.5

To start the volumeter:

● Press the rotary control. If it is pressed again during

the 60 seconds, the values are deleted and the
volumeter restarted.

58

System screen functions

Configuring the system screen in »Standby«

Econometer module

In IPPV mode, shows the fresh gas balance in the
breathing system in the form of a bar graph (see des­cription on page 179)

Bar in the right-hand sector: The fresh gas flow is

unnecessarily high for
standard applications.

Bar in the left-hand sector: Risk of fresh gas shortage.

In this case, an advisory alarm draws attention to the
potential lack of fresh gas even before the »FRESH
GAS? !!« caution message is displayed on the system
screen.

A tendency indicator shows whether the system is filling
(arrow pointing to right), emptying (arrow pointing to left)

or whether the level is remaining constant (indicator »O«).

Immediate action need only be taken in the event of
the »FRESH GAS? !!« caution message.

The econometer is switched off when the ventilator
operates outside the frequency range of 6 to 40 strokes
per minute.

Fresh gas surplus:

none low high

Tendency: 0

Good setting

Fresh gas surplus:

none low high

Tendency: 0

Risk of fresh gas shortage High fresh gas surplus

Fresh gas surplus:

none low high

Tendency:

Good setting
but tendency dropping

Econometer temporarely disabled

The econometer is switched off.

Fresh gas surplus:

none low high

Tendency: 0

Fresh gas surplus:

none low high

Tendency:

Good setting
but tendency rising

59

System screen functions

Configuring the system screen in »Standby«

Configuring the screen colours

Colour settings always relate to all the settings
associated with a particular parameter. The curves and
their corresponding numerical modules are always in the
same colour if colour numerical modules are configured
by the user.

● Select the desired parameter and confirm.

● Change the colour by turning the rotary control.

Colours are displayed in the same order as the colour
scale at the top of the menu.

● Confirm the selected colour.

Configuring the background settings

dark Black background, bright curves and

numbers. Use preferably in a dark
environment.

bright White background, dark curves and

numbers. Use preferably in a bright
environment to avoid reflections on the
screen surface.

colour modules

yes The numerical modules are displayed

in the same colour as the associated
curve.

no The numerical modules are displayed

monochrome.

Standby / Configuration

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

11:59
00:00

ART
AORTA
A.Pulm
CVP
ICP
iBP ?
NiBP
ECG
SpO

/Pleth

2

temp.
pEEG
CO

2

flow
Paw

Background bright dark

Modules
fcoloured yes no

Select a menu position. Please confirm !
Change the settings. Please confirm again !

ART
AORTA
A.Pulm
CVP
ICP
iBP ?
NiBP
ECG
SpO

/Pleth

2

temp.
pEEG
CO

2

flow
Paw

Background bright dark

Modules
fcoloured yes no

Select a menu position. Please confirm !
Change the settings. Please confirm again !

standard - screen 1

standard - screen 2

standard - screen 3

colours

curve speed

general settings

standard - screen 1

standard - screen 2

standard - screen 3

colours

curve speed

general settings

Settings

alarms inactive !

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

111292781122927811329278

alarms inactive !

Settings

mode adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

Configuring the curve speed

The speed of the curves is determined in mm/s for the
following measured values:

haemodynamic Haemodynamic parameters in
adults adult mode.

haemodynamic Haemodynamic parameters in
neonates neonatal mode.

60

Standby / Configuration

haemodynamic 12,5 25 50
adults mm/s

haemodynamic 12,5 25 50
neonates mm/s

06-12-98

11:59
00:00

Settings

mode

alarm limits

parameter

standard - screen 1

standard - screen 2

standard - screen 3

colour

curve speed

general settings

Screen configuration menu. Please confirm !

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

adult neon.

System screen functions

Configuring the system screen in »Standby«

Configuring the general settings

The following can be switched on (»yes«) or off (»no«):

units Indication of the units.

Temperature
display Option to display the body temperatures in

the bottom right-hand corner of the screen
(below the softkeys).

This display configuration saves space for
a numerical module.

Acoustic

The volume and tones are defined here.

»0« equals »off«, while »1« is the lowest and »9« the
highest volume.

alarm sound Volume of the alarm

pulse tone Volume of the pulse tone

SpO2-modulated
ECG pulse tone The ECG pulse tone can optionally

be modulated with the SpO2 value.

Standby / Configuration

unit yes no

temperature­display yes no

06-12-98

Standby / Configuration

11:59
00:00

standard - screen 1

standard - screen 2

standard - screen 3

colour

curve speed

general settings

Screen configuration menu. Please confirm !

alarm sound 1 2 3 4 5 6 7 8 9

pulse tone 0 1 2 3 4 5 6 7 8 9

pulse tone
source

tone sequence DRÄGER Euro-Stand.

ECG Pleth.

Settings

mode

adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

Settings

adult neon.

mode

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

114292781152927811629278

alarms inactive !

tone sequence Specifies the tone sequence.

Either ISO or Dräger standard.

List entry

A menu is displayed to allow the user to select at
what times (fixed intervals) or events (warning, caution
message, NiBP measurement) list entries are to be
made.

In addition, this menu defines the source of the blood
pressure value and whether EEG entries are required.
If EEG entries are selected, they replace the temperature
entries.

06-12-98

Standby / Configuration

11:59
00:00

Alarm sound and pulse tone configuration menu. Please confirm !

Settings

mode

adult neon.

alarm limits

parameter

screen

time interval 1 2 5 10 off
trigg. by warning on off
trigg. by caution on off

with every

BP source iBP 1 iBP 2

NIBP

pEEG on off

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

06-12-98

11:59

List configuration menu. Please confirm !

00:00

61

System screen functions

Configuring the system screen in »Standby«

Transport function

The parameter box stores the following data, which can
be transferred to the system screen:

– Patient data from the list screen,

– Alarm limit settings and

– Measurement parameter settings.

The patient remains connected to the parameter box
while in transit. The patient's data remains constantly
available. There is no need to reconnect the patient and
set system screens.

The transport function can be preset in »Standby«
(operation in normal use is described on page 83 in the

»Parameter box« section).

Transport function on/off

When switched »off«, no data is exchanged between
the parameter box and the system screen (suitable for
stationary use of the parameter box).

When switched »on«, data is exchanged.

Transport menus yes/no

If switched to »no«, data is transferred between the
parameter box and the system screen in accordance
with the presetting in »Standby«.

If switched to »yes«, the user can modify the type and
scope of data transfer during operation (see also

»Parameter box« section on page 86).

The patient is connected for the first time to …

If a patient is connected for the first time, the parameter
box will not yet contain any stored data for the patient.
This will generally be the case in the admissions room.

If so, enter »yes« next to »parameter box«.

In response, any remaining data from the previous
patient will be deleted!

Standby / Configuration

06-12-98

11:59
00:00

Settings

transport
function on off

transport­menus yes no

The patient is new
to the:

monitor yes no

parameter
box yes no

Which data do you want
to transfer from the
parameter box?

settings yes no
alarm limits yes no
list yes no

Select a menu position. Please confirm !
Change the settings. Please confirm again !

mode

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

adult neon.

11829278

If the patient arrives with parameter box already
connected, i.e. with a "previous history" on the device,
enter »no« after »Parameter box«. Data will then be
transferred from the parameter box to the system screen.
Such cases will generally occur in the operating theatre
and in the recovery room.

62

System screen functions

Configuring the system screen in »Standby«

The following dialogue is then displayed on the system
screen:

»Do you want to transfer the following data from the
parameter box?«

Settings yes/no

If »yes«, the settings of the measurement parameters
are transferred from the box (e.g. iBP calibration,
NiBP interval, ECG amplitude, etc.).

If »no«, the current system screen settings remain
valid.

Alarm limits yes/no

If »yes«, the alarm limits are transferred.

If »no«, the current settings of the system screen will
remain valid.

List yes/no

If »yes«, the data stored in the parameter box is
transferred and inserted in the list.

If »no«, the data stored in the parameter box is not
transferred.

In normal operation (see section on the »Parameter box«
on pages 86), this dialogue is only displayed when the
»Transport menu« is set to »yes«. Otherwise, the
instructions programmed here are executed directly.

Standby / Configuration

06-12-98

11:59
00:00

Settings

transport
function on off

transport­menus yes no

The patient is new
to the:

monitor yes no

parameter
box yes no

Which data do you want
to transfer from the
parameter box?

settings yes no
alarm limits yes no
list yes no

Select a menu position. Please confirm !
Change the settings. Please confirm again !

mode

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

adult neon.

1182927811929278

External Dräger RS-232 interface (MEDIBUS)

The interface parameters for data transfer are pro­grammed here:

Settenigs for connecting the Dräger pEEG monitor:

baud rate: 1.2 or 9.6

parity: even (Information only, cannot be selected!)

data bits: 8 (Information only, cannot be selected!)

stop bits: 1 (Information only, cannot be selected!)

Standby / Configuration

06-12-98

11:59
00:00

Settings

mode

alarm limits

parameter

screen

baud rate (kBaud) 1.2 9.6
parity even
data bits 8
stop bits 1

Medibus interface configuration menu. Please confirm !

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

adult neon.

63

System screen functions

Configuring the system screen in »Standby«

Record (printer)

This menu is used to configure the interface for data
transfer to a logging printer (see Instructions for Use of
the device to be connected):

record output Determines whether the printer interface

is to be used for a printer or as an
additional MEDIBUS interface.

baud rate 1.2, 2.4, 4.8, 9.6 or 19.2
parity »even«, »odd« or »none«
data bits 7 or 8
stop bits 1 or 2

If the printer interface and Medibus interface are used
simultaneously, the Baud rate must be set to 1.2.

Basic configuration

The basic configuration comprises three items:

– time for the current time

– date for the current date

– language for the language version.

The same language version is also
used by the ventilator. The following
languages are available:

English GB
French F
German D
Dutch NL
Spanish E
Italian I
Danish DK
Swedish S
Norwegian N

– location The location of the device can be

entered. If so, it will then be
displayed in the list screen after the
data has been transported with the
parameter box.

Text input for the location:

● Select »monitor location«. A frame appears in the

input field.

Standby / Configuration

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

11:59
00:00

Settings

mode

adult neon.

alarm limits

parameter

record output printer Medibus

baud rate

1.2 2.4 4.8 9.6 19.2

(kBaud)

parity even odd none

data bits 7 8

stop bits 1 2

Printer/Medibus interface configuration menu. Please confirm !

time: 11 : 59
date: 01 - 04 - 96
language: GB F D NL I E

mon. location

Language, date and time configuration menu. Please confirm !

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

Settings

mode

adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

alarms inactive !

Language table

Language Ventilator SW Monitor SW

English All All
French All All
German All All
Dutch All All
Spanish All All
Italian All All
Danish as from 7.01 as from 4.0
Swedish as from 7.01 as from 4.0
Norwegian as from 7.20 as from 4.0

1202927812129278

● Letters are displayed inside this frame in alphabetical

order when you turn the rotary control.

● Confirm the desired letters. The frame jumps to the

next position where a letter can be entered.

Select the arrow symbol to exit this menu.

64

System screen functions

Configuring the system screen in »Standby«

Calibration

Since all sensors of the Cicero EM are calibrated fully
automatically, the use of this menu is not required in
normal operation. The following functions can be
calibrated in this menu:

–O2 sensor with 21% O2 by volume.

– Flow sensor.

–O2 sensor with 100% O2 by volume.

– Linearity check of the O2 sensor.

– Zero point of the gas sensor.

The significance of the symbols is as before:

? = Enquires whether an action has been performed

or a setting made.

u

= Waiting period. The selected test step is being

carried out by the system.

✔ = The action has been completed successfully.

O2-sensor 21% by volume

New sensors must be allowed to run in for 15 minutes.
(The zero point stability is increased)

For the inspiratory O2-sensor:

● Remove the sensor cell and expose to ambient air.

● Select the »O2 sensor« field and confirm.

The sidestream O2-sensor is calibrated automatically.
For manual calibration:

Standby / Configuration

06-12-98

Standby / Configuration

11:59
00:00

O2-sensor
21 Vol. % ✓

flow-sensor ✓

O

-sensor

2

100 Vol. %

linearity
check O

2

gassensor ✓

Calibration

more

Sensor manual calibration menu. Please confirm !

Calibration

more

For O2 concentration above 60 vol%.

Expose the sidestream hose to pure O

Please confirm !

alarms inactive !

alarms inactive !

.

2

122292781232927812429278

● Select the »O2 sensor 21 Vol.%« field and confirm.

Wait until the clock symbol (u,U, … ) is replaced by a
tick (✔).

● Reconnect the inspiratory sensor (if used).

Flow sensor

This procedure is only required if the flow sensor is not
calibrated automatically. Auto-calibration is only possible
if gas measurement is connected.

Manual calibration deactivates auto-calibration until the
equipment is restarted or for a maximum of 24 hours.

● Ensure that there is no movement of air inside the

sensor and that pure air is present in the sensor (seal
one side with your hand and hold horizontally to
prevent false calibration. See also page 177).

● Select the »flow-sensor« field with the rotary control

and press to confirm. The tick (✔) indicates that
calibration is complete.

06-12-98

Standby / Configuration

06-12-98

11:59
00:00

11:59
00:00

Sensor manual calibration menu. Please confirm !

Calibration

O2-sensor
21 Vol. % ✓

flow-sensor ✓

-sensor

O

2

100 Vol. %

linearity
check O

gassensor ✓

more

2

Sensor manual calibration menu. Please confirm !

alarms inactive !

65

System screen functions

Configuring the system screen in »Standby«

O2-sensor 100 Vol.% O2

For calibrating the sensor in pure oxygen:
Note the information on the screen; see also page 176.

For the inspiratory O2-sensor:

● Remove the sensor cell and expose it to pure oxygen.

For the sidestream O2-sensor:

● Expose the end of the sampling hose to pure oxygen.

● Select the field »O2-sensor 100 Vol.%« with the

rotary control and press to confirm. The tick (✔)
shows that calibration is complete.

Linearity check O2

Note the information on the screen; see also page 106!

For the inspiratory O2-sensor:

● Remove the sensor cell and expose it to pure oxygen.

Calibrate with 100% O2. Then expose the sensor cell
to ambient air.

For the sidestream O2-sensor:

Standby / Configuration

06-12-98

11:59
00:00

Standby / Configuration

Calibration

O2-sensor
21 Vol. % ✓

flow-sensor ✓

O

-sensor

2

100 Vol. %

linearity
check O

gassensor ✓

O2-sensor
21 Vol. % ✓

flow-sensor ✓

O

-sensor

2

100 Vol. %

linearity
check O

gassensor ✓

more

2

Sensor manual calibration menu. Please confirm !

Calibration

more

2

For O2 concentration above 60 vol%.

Expose the sidestream hose to pure O

Please confirm !

Calibrate with 100 Vol. % O2 .
After some seconds the display

21 Vol. %

O

2

appears. If the display is not within
the range from 18 to 24 Vol. % O
the sensor cell is defective.

alarms inactive !

.

2

alarms inactive !

2

123292781252927812629278

● Expose the end of the sampling hose to pure oxygen.

Calibrate with 100% O2. Then expose the end of the
hose to ambient air again.

● Select the field »linearity check O2« with the rotary

control and press to confirm.

»O2 : 21 Vol.%« appears after 20 seconds.
The sensor cell is defective if the value displayed
does not lie between 18 and 24 Vol.% O2.

Gas sensor zero check

Zero alignment of the gas sensor for N2O, anaesthetic
agent and O2 is generally automatic. If manual calibration
is desired:

● Select the field »gas sensor« with the rotary control

and press to confirm.

06-12-98

Standby / Configuration

11:59
00:00

Sensor manual calibration menu. Please confirm !

Calibration

O2-sensor
21 Vol. % ✓

flow-sensor ✓

-sensor

O

2

100 Vol. %

linearity
check O

gassensor ✓

more

2

alarms inactive !

Only necessary if the automatic calibration
fails (INOP instead of values).

66

06-12-98

11:59
00:00

Sensor manual calibration menu. Please confirm !

System screen functions

Configuring the system screen in »Standby«

Anaesthetic agent

The Cicero EM has an automatic anaesthetic agent
identification system and can therefore recognise the
anaesthetic agent actually used. If automatic recognition
is not required by the user, the anaesthetic agent can
also be selected manually.

● Select »selection« and confirm -

● Position the cursor frame over »man« with the rotary

control and confirm -

● Select the »gas« option and confirm -

● Turn the rotary control until the desired anaesthetic

agent is displayed in the window.

Automatic anaesthetic recognition can be reactivated at
any time by selecting and confirming »auto«. This
selection overwrites the manual settings.

The responsibility for the choice of anaesthetic agent
and correct filling of the Vapor remains with the user.

When the anaesthetic agent is changed, the trend
memory for the anaesthetic agent concentration is
automatically deleted.

Standby / Configuration

Anesth. Agent

selection

man. auto

gas
Isoflurane

The anesthetic
agent is automati­cally selected by
agent detection

06-12-98

11:59
00:00

Calibration

more

Default values

mode

adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

alarms inactive !

12729278

When using for the first time, the anaesthetic agent is set
to »auto« by default.

Notes on automatic anaesthetic agent recognition:

– The measuring accuracy required by the ISO

standard is attained at the latest 4 minutes after
switching on the unit.

– The threshold value for automatic recognition is

0.15 Vol.%.

– Gas mixtures are recognised as from a concentration

of 0.4% by volume for the second gas.

In the event of a gas mixture, the main gas is identified
and measured. When changing gas the measured
value display informs the user of the gas status:

Phase Insp. value Exsp. value Display

1 dithered bright »AGAS mix«
2 dithered dithered »AGAS mix«
3 bright dithered »AGAS mix«
4 bright bright

1: Mixture during inspiratory phase, while expiratory

phase still has pure gas.

2: Mixtures during both inspiratory and expiratory

phases.

3: Pure gas (again) during inspiration, while expiratory

phase (still) has gas mixture.

4: Pure gas (again) in both breathing phases.

67

System screen functions

System screen functions during operation

Switching on the system screen

The system screen starts up automatically whenever a
ventilation mode is invoked on the ventilator. »standard
screen 1« is displayed with the monitoring mode corres­ponding to the selected ventilation mode.

To start up the system screen alone:

2

1 Press

E

or Q on the screen.

2 To call up a selection menu:

Press S.

A selection menu appears for the following screens:

Standard-screens 1, 2 and 3,
Data-screen,
List screen and
Trend screen.

– Standard screens 1, 2 and 3

contain the graphical and numerical modules
configured by the user.

– The data-screen

contains a tabular overview of all measured values.
The top curve and top module of the last selected
standard screen are displayed above these values.

– The list screen

contains all the measured values and alarms which
have been saved and makes it easier to complete the
anaesthetic record (See page 70). The top curve and
top module of the last selected standard screen are
displayed above these values.

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40

30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

MV L/min

6.0

freq 10 V

Warning: Caution:

SpO2 %

99

pulse 65

0.60

T

1

Advisory:

HR/Pulse (ECG)

ª

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

1/min

65

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

T1 36.8
T2 37.5

128292780532923812829278

– The trend screen

shows the measured values over time. The top curve
and top module of the last selected standard screen
are displayed above these values.

3 Press Q to return directly to the last selected

»standard screen«.

3

68

Standard screens

The three standard screens are preconfigured by the
manufacturer.

The configuration of these screen pages is described
from page 47 ff. onwards.

The softkeys are described on page 13.

Example of a standard screen:

Data screen

All the current measured values are presented on this
screen in tabular form.

The results of the last leakage/compliance test are
shown with date and time in the column headed
»Other«.

The curve shown at the top is the uppermost curve of the
last selected standard screen.

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

iBP1

CO

PAW

O2 N2O ISO

Fi
Fet 26 68 0.6

11:59
00:00

IPPV alarm limits

data screen - adults

2. ECG
II

1mV

Patient

160

SpO2 99

0

2

40

HR/Puls 134

30

ST +0.05

0

Sys (M) Dia mmHg

NiBP 123 (102) 88

20

iBP 1
ART 122
iBP 2
CVP

T 1 36.8 °C
T 2 37.2

06-12-98

(100) 89

12

0

°C

29 70 0.8

11:59
00:00

System screen functions during operation

MV L/min

6.0

freq 10 V

CO2 1 33

O
ISO 0.8 0.6
N

2

Taw 35.0

freq 10 V

0.60

T

Gases

Fi Fet

29 25

2

O 70 68

MV

6.0

0.60

T

System screen functions

Warning: Caution:

SpO2 %

99

pulse 65

Warning: Caution:

Ventilation

MV 6.0
VT 0.60
freq 10

Peak 32
plat. 26
mean 21
PEEP 3

Insp. flow [30]
Pmax

[25]

SpO

2

Ti : Te [1:1.7]
Tip : Ti [10]
pat. - compl. [67]

99

pulse 65

Standard screens

Data screen

Advisory:

HR/Pulse (ECG)

65

etCO2 mmHg

33

Advisory:

HR/Pulse (ECG)

65

ART

Other

etCO2

33

1/min

1/min

23

auto set

pat. alarm.

auto set
vent. al.

screen
config.

T1 36.8
T2 37.5

pat. alarm.

ª

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

ª

pulse def. 4 ST + 0.05

122/ 89

7 : 18
pulse 65 (100)

leakage
hose compliance 2

Peak PEEP

32 3

plat 26 mean 21

T1 °C T2 °C

36.8 37.2

limits

alarm

info

para­meter

timer
start

config.

limits

auto set

auto set
vent. al.

alarm

info

para-

meter

timer
start

config.

0532927812929278

69

System screen functions

y

a

a

System screen functions during operation

List screen

List screen

Certain measured values which have been automatically
or manually saved are displayed here for documentation
(to facilitate compilation of the anaesthetic record).

A time interval, delimited by the connection and
disconnection of the parameter box, is indicated in the list
by the label »interval x start« and »interval x end«. The
user programmed location of the device is also displayed
after the data has been transferred (see page 64).

The measured values and the warning or caution
messages triggering them are recorded line by line,
together with the time, either at specified intervals and/or
as a function of warning or caution messages or of an
NiBP measurement.

A list entry can be generated manually at any time by
pressing U indpendently of the screen in use.

Additionally a number of predefined labels can be
inserted into the record using the Softkeys.

For example: »Start of surgery«

»position change«

»Intubation«

HR/Pulse ECG

ª

65

Cpat
ml/mbar

60
60

60
60

60

Advisory:

temp
°C
T

36.8/37.2

36.9/37.3

36.7/37.1

36.8/37.1

36.9/37.3

1/min

1/T2

IPPV alarm limits

list screen - adults

II

I

1mV

time

Warning

start of anaesthesia

11:00

SpO

2

11:05

11:10

SpO

2

11:13

11:15
12:30 Interval 1- start

12:45 63 120/100/90 90 1/35 6.4 30/26 1.4/1.1 32/26/3 60 36.8/37.2
12:50 62 122/102/89 97 1/37 6.3 31/25 1.4/1.2 31/25/3 60 36.9/37.3

13:00 Interval 1- end

06-12-98

!!!

!!!

11:59
00:00

HR/Pulse
1/min

64
67

63
62

63

NIBP
mmHg
Sys/M/Dia

iBP1/ART
120/100/90
123/103/88
iB P2/CVP

- - / 8/ - -

- - / 9/ - ­ NiBP
128/107/93

Warning: Caution:

pulse def 4 ST + 0.05

list entry next page preceding page

CO

MV

O2

SpO
%

90
97

96
90

97

2

2

mmHg

L/min

i/et

1/35

6.4

1/37

6.3

1/31

6.2

1/34

6.1

1/33

6.0

Vol. %
i/et

30/26
31/25

32/24
31/25

33/23

anesth
agent
Fi/Fet

ISO

1.4/1.1

1.4/1.2
Enfl

1.2/1.1

1.2/1.1

1.1/1.0

PAW
mbar
Peak/Plat/PEEP

32/26/3
31/25/3

33/27/3
31/28/3

30/26/3

start of

anaesthesi

intuba-

tion

start of

surger

position

change

end of

surgery

extuba-

tion

event

1

event

2

print

13029278

The list can run into several pages - so that you may have
to "leaf through" for a specific entry.

Return to previous page:

● Select »previous page« with the rotary control and

press to confirm.

Continue to next page:

● Select »next page« with the rotary control and press

to confirm.

Define list entry:

● Select and confirm »list entry«. A menu is displayed

for the user to define the times (fixed intervals) or
events (warning, caution message, NiBP measure­ment) at which list entries should be made.

● In addition, this menu defines the source of the

displayed blood pressure measurement and whether
EEG entries are required. If EEG entries are selected,
they replace the temperature entries.

Print list entry:

IPPV alarm limits

list screen - adults

II

I

1mV

06-12-98

time interval 1 2 5 10 off
trigg. by warning on off
trigg. by caution on off

BP source iBP 1 iBP 2

pEEG on off

11:59
00:00

Warning: Caution:

ª

pulse def 4 ST + 0.05

list entry next page preceding page

with every

NIBP

Advisory:

HR/Pulse ECG

1/min

65

start of

anaesthesi

intuba-

tion

start of

surgery

position

change

end of

surgery

extuba-

tion

event

1

event

2

print

13129278

● Press the »print« softkey to print out the complete list

on a connected external printer.

70

System screen functions

System screen functions during operation

Trend screen

Trend screen with zoom function

The measured values are shown as a function of time
since measurement began.

The values can be stored for a maximum of 8 hours.

The zoom function can be called up when the system has
been in operation for more than 30 minutes. A segment
of the time range can be enlarged (possibly several
times) with this function. The segment is identified by a
dashed border.

Example:

● Turn rotary control - move segment.

● Press rotary control - the dashed area is extended to

cover the full display width.
If the system screen has been in operation for a

sufficiently long period of time, a new dashed area
appears which can then be extended as described
above.

The maximum has been reached when no additional
dashed frame appears.

Full trend:

● Press »full trend« in order to redisplay the complete

trend.

● By activating the softkeys

–»NiBP«,
–»iBP 1« and
–»iBP 2«
the relevant blood pressure trends can be selected,
with the display of diastolic, systolic and mean
pressure.

IPPV alarm limits

trend screen - adults

1. ECG I

1mV

CO

2

50

25

0

100

O

2

0

11:00 12:00 13:00

Comp

100

50

ISO

3

1,5

0

Select a trend sector and magnify by confirming !

06.12.98

11:59
00:00

Warning: Caution:

MV

10

5

0

NiBP

120
100

Sys
M

80

Dia

0

11:00 12:00 13:00

SpO

100

2

80

HR

150
100

50

0

Advisory:

HR/Pulse (ECG)

65

1/min

ª

pulse def. 4 ST + 0.05

NiBP

iBP 1

iBP 2

full

trend

config.

132292781282927807329278

Clearing the list and trend memory:

In principle, the trend memory and list of the system
monitor are erased by switching off the Cicero EM.

The trend memory and list can also be cleared in standby
mode.

If a parameter box is connected, its list memory will also
be cleared.

1 Press

to switch over to »Standby« mode.

E

This is only possible if the ventilator is already in
»Standby« mode.

● Press the softkey »delete trend«.

The system enquires again whether the trend is really
to be deleted.

● Press the softkey »delete« to confirm.

The original screen is restored by pressing the softkey
»do not delete«.

The stored trend of the anaesthetic agent concen­tration is deleted every time the anaesthetic agent is
changed.

Ventilator

SW-Version 7.n

06-12-98

Standby

Cicero-EM

Data Manager

SW-Version 4.n

06-12-98

Select ventilation mode at the ventilator or switch on screen by

Parameterbox

SW-Version 2.n

06-12-98

1

leakage

test

delete

trend

config.

1

71

System screen functions

Softkeys

Limits

Softkeys

1 On the right-hand side, beside the screen, there is

an unmarked touch-sensitive keypad.

2 The function of these keys changes and is indicated

on the screen.

Only those keys which can be activated are indicated on
the screen.

Limits

The display comprises the designation of the measured
value, the value actually measured on the patient (large
numerals) and the set upper and lower alarm limits (small
numerals) under the symbol for the relevant alarm limit
(lower: <, upper:

A deactivated alarm limit is indicated by dashes in the
numbers field, and an alarm limit that cannot be activated
is indicated by a blank field.

The limit value settings only apply temporarily! They are
overwritten by the standard alarm limits when

– the Cicero EM is switched on.

– the system screen is switched to »Standby«.

– the setting »Default« is selected and confirmed for

»Alarms«.

– the mode is switched over between »neon.«/»adult«.

To change alarm limits:

● Move the cursor frame to the required alarm limit with

the rotary control and press to confirm.

● The value can then be altered by turning the rotary

control until the required value has been obtained.

>

).

<>

Pulse 72 50 120

IPPV alarm limits

standard screen 1- adults

1. ECG I

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

Fi O2 Vol %

06.12.98

11:59
00:00

MV l/min

10.229

Freq 12 V

Select the required limits and confirm !

Warning: Caution:

HR/Puls 72 50 120
Pulsdef.
NiBP sys

122 80 160

92 91 --

SpO

2

33 30 50

et CO

2

in CO

-- 5

2

6.2 3.0 12.0

AMV
Fi O

29 20 --

2

Fi SEV
PAW

125 80 167

iBP 1 sys
iBP 2 mit

-0.05 ± 0.10

ST
T1

36.8 -- --

37.5 -- --

T2

SpO

0.60∆ O2 --

T

99

4 5

0.8 -- 3.4
9 8 40

31 0 8

%

2

12

Advisory:

HR/Pulse (ECG)

1/min

72

pulse def. 4 ST + 0.05

et CO2 MV Peak

33 10.2 19

Freq. VT PEEP

12 0.81 1

etCO2 mmHg

33

Peak mbar PEEP

32 3

Plat 18 Mean 6

HR/Pulse SpO2 Art (1)

79 99 -- / --

1/min % mmHg

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

timer
start

T1

36.8 °C

37.5 °C

T2

237292780582927809529278

● The value is confirmed by pressing the rotary control -

this value now represents the active limit.

Each active alarm limit is shown as a dashed line in the
dynamic gas curve displayed on the screen. In this
example: CO2 curve.

Refer to the section describing the »Alarm concept«
from page 78 onwards for information on the links
between certain alarms.

The limit value menu is automatically displayed whenever
an alarm limit has been violated.
(see »Alarm concept«, page 78)

72

CO

2

40

0

System screen functions

Softkeys

Patient alarm AutoSet

Patient alarm AutoSet

Alarm limits can also be set automatically once the
patient is stable.

The user can set a new limit range with new upper and
lower alarm limits by pressing the softkey »auto set pat.
al.«.

The alarm limits set in the »limits« menu are deleted and
cannot be automatically reactivated. The default alarm
limits remain unaffected by the Autoset and can be
reactivated at any time via the functions »config.«,
»alarms« and »default«.

The alarm limits for SpO2 and FiO2 also remain
unaffected.

AutoSet cannot set the lower alarm limits for the heart
rate below 40 beats per minute and below 90 mmHg for
systolic pressure values (50 mmHg for neonates).

Deactivated alarm limits (– –) are not activated by
auto set!

IPPV alarm limits

standard screen 1- adults

06-12-98

11:59
00:00

Warning: Caution:

The alarm limits of haemodynamic parameters have been automatically adapted
to the actual measurement values !

Advisory:

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para­meter

timer
start

config.

13329278

Parameter new measured value Unit Remarks

tolerance …
upper lower

ECG/Pulse HR/Pulse +20.0 –20.0 beats per

minute but not less than 40 beats per minute

ST +0.05 –0.05 mV

NiBP/ART SYS +20.0 –20.0 mmHg but not less than 90 mmHg (50 mmHg for neonates)

DIA +20.0 –20.0 mmHg

AORTA SYS +20.0 –20.0 mmHg

DIA +20.0 –20.0 mmHg

ART pul. SYS +15.0 –15.0 mmHg

DIA +5.0 –5.0 mmHg

MIT +10.0 –10.0 mmHg
CVP MIT +5.0 –5.0 mmHg
ICP MIT +5.0 –5.0 mmHg
mmHg SYS +20.0 –20.0 mmHg

DIA +20.0 –20.0 mmHg

MIT +20.0 –20.0 mmHg
TEMP +1.0 –1.0 °C

2 +5.0 –5.0 mmHg

etCO
Fi AGAS HAL +0.5 –0.5 Vol. %

ENF +0.5 –0.5 Vol. %

ISO +0.5 –0.5 Vol. %

DES +0.5 –0.5 Vol. %

SEV +0.5 –0.5 Vol. %

73

System screen functions

Softkeys

Ventilation alarm AutoSet

Alarm Info

Ventilation alarm AutoSet

Prerequisite:
The ventilator must be in »IPPV«, »SIMV« or »PCV« mode.

The ventilation alarms can be automatically adjusted to
the current settings of the ventilator by pressing the
»auto set vent. al.« softkey.

The alarm limits previously set in the »limits« menu are
overwritten and cannot be reactivated!

The default alarm limits are not affected by Autoset and
can be reactivated at any time via the functions »config.«,
»alarms« and »default«.

Deactivated alarm limits (– –) are not activated by auto
set!

Parameter new measured value tolerance Unit

upper lower

P

aw PEEP + (Pmax- PEEP) / 4 Pmax + 10 mbar

T

AMV V

f * 0.6 VT * f * 1.4 L/min

*

but always: over 0.5

IPPV alarm limits

standard screen 1- adults

06-12-98

11:59
00:00

Warning: Caution:

The alarm limits of ventilation parameters have been automatically adapted
to the actual ventilator settings !

Advisory:

limits

auto set

pat. alarm.

auto set

vent. al.

alarm

info

screen
config.

para-

meter

timer

start

config.

1342927813529278

Alarm Info

The warning and caution fields each have space for
displaying three entries. The advisory message field has
space for four entries.

If further messages are present, a complete list of all
entries in order of priority can be displayed on the
system screen by pressing the softkey »alarm info«.

The list can be read as long as the key is pressed.

IPPV alarm limits

standard screen 1- adults

06-12-98

11:59
00:00

Warning:

xxxx
xxxy
xxxz

Caution:

xxxx
xxxy
xxxz

xxxx
xxxy
xxxz

xxxx
xxxy
xxxz

zzzz
zzzx
zzzy
zzzj
zzzq

Advisory:

xxxw
xxxx
xxxy
xxxz

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

74

System screen functions

Softkeys

Screen structure

Parameter

Configuring the screen structure

A selection menu is displayed when the softkey
»screen config.« is pressed.

The graphical and numerical modules are selected as
described from page 53 onwards.

IPPV alarm limits

standard screen 1- adults

1. ECG 1

1mV

standard - screen 1

delete

1. ECG

iBP1

CO

PAW

O

2

Please observe your national
monitoring requirements.

06-12-98

combi-vent

2

press. 1

MV

SpO

combi-haem

2

11:59
00:00

Warning: Caution:

Pulsedef 4 ST + 0.05

CO

2

combi-vent
press. 1
press. 2

MV
volumeter
Gases
O

2

Econometer

iBP 1

122/ 89

Pulse 65 (100)

Peak PEEP

32 3

Plat 26 Mean 21

V

0.60

T

Volumeter 4.3 27s

HR

CO

2

Select a graph or a module by turning the rotary knob. Please confirm !

1. ECG

2. ECG

3. ECG
iBP1
iBP2
iBP1+iBP2
Pleth

HR
pEEG
temp
iBP1
iBP2
NiBP
SpO

2

combi-haem

Patient

Graph Module Graph Module

Ventilation

CO

2

CO2 short

double

CO

2

PAW
PAW short
PAW double
flow
flow short
AGas
O

2

N2O

Advisory:
TEMP2 CALIB !TEMP1 !!APNOEA CO2 !!!

HR/Pulse (ECG)

65

ART

etCO

2

33

1.0

12

auto set

pat.alarm.

auto set
vent. al.

screen
config.

timer
start

1362927813729278

Parameter

A selection menu with the functions »ECG«, »NiBP«,
»iBP1«, »iBP2«, »SpO2/Pleth«, »CO2 /O2« and »pEEG«

is displayed when the softkey »parameter« is pressed.

See the section on the »Parameter Box« on pages 89
for a detailed description of how to set the parameters for
»ECG«, »NiBP«, »iBP« and »SpO2«.

The »CO2 /O2« and »pEEG« menu is identical with the
Standby menu described on page 52.

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40

30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

Warning: Caution:

ECG

NiBP

iBP 1

iBP 2

SpO

2

/ O

CO

2

pEEG

pulse 65

SpO

99

MV L/min

6.0

freq 10 V

Select the required parameter and confirm !

0.60

T

/ Pleth

2

%

2

Advisory:

HR/Pulse (ECG)

65

etCO2 mmHg

33

2 0

1/min

ª

pulse def. 4 ST + 0.05
iBP1 ART mmHg

122/ 89

pulse 65 (100)

Fi CO

Peak mbar PEEP

32 3

plat 26 mean 21

T1 T2 °C

36.8 37.2

limits

auto set

pat. alarm.

auto set

vent. al.

alarm

info

screen
config.

para­meter

timer
start

config.

75

System screen functions

Softkeys

Timer

Timer

● The timer is started by pressing the softkey

»timer start«.

The time is shown below the actual time on the
screen. The softkey changes automatically to
»timer stop«.

● The timer is stopped when the softkey is pressed

again.

IPPV alarm limits

standard screen 1- adults

06-12-98

11:59
00:00

Warning: Caution:

Advisory:

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer

start

config.

13829278

76

System screen functions

Softkeys

Configuring during operation

Configuring during operation

This softkey calls up the configuration menu. Refer to the
corresponding section from page 47 onwards.

The menu for configuring the settings is displayed:

Settings

– mode Change over between adult and

neonate modes.
– alarm sound For setting the volume.
– pulse tone For setting the volume.
– SpO2-modulated

ECG pulse tone Activates/deactivates ECG pulse

tone modulation by the SpO2 value.

– Curve speed Sets the speed of the haemo-

dynamic curves.
– colours For setting the colours.
– call standard Activates the screen configuration

and all parameter settings

configured in »Standby«.

Calibration

– iBP 1/2 To zero invasive blood pressure

sensor in channel 1 or 2.
– Flow sensor Calibrates the flow sensor.
– more Calibrate O2 sensor with 21 or

100% O2, linearity check of the

O2 sensor, volume, flow, zero

point of the gas sensor, NiBP test.

IPPV alarm limits

standard screen 1- adults

06-12-98

IPPV alarm limits

Anesth.Agent

selection
man. auto

gas
Isoflurane

The anesthetic
agent is automati­cally selected by
agent detection.

06-12-98

11:59
00:00

11:59
00:00

Warning: Caution:

Alarms

default

CO

on off

2

SpO2 on off

parameter­box

HLM on off

Pmax on off

AGas Mix on off

Check system configuration. Please confirm !

on off

Calibration

iBP 1

iBP 2

more

Advisory:

Settings

adult neon.

mode

?

?

alarm sound 1 2 3 4 5 6 7 8 9

ECG pulse tone 0 1 2 3 4 5 6 7 8 9

ECG pulse tone

2 modulated on off

SpO

curve speed 12,5 25 50
mm/s

colours

call standard

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para­meter

timer

start

config.

1392927814029278

Alarms

– default Activates the standard alarm

limits.
– CO2 Activates/deactivates all CO2

alarms (including »Apnea«).
– SpO2 Activates/deactivates all SpO2

alarms.
– Parameter box Activates/deactivates all

parameter box alarms.
– HLM mode Activates/deactivates the

heart/lung machine monitoring

mode.
– Pmax »on« Ventilator pressure limitation

generates a caution message.

»off« Ventilator pressure limitation

generates an advisory message.

The »off« setting is recommended

for ventilation with intentional

pressure limitation.

AGas mix When switched »on«, a signal

tone is generated in addition to

the advisory message on

recognising a mixture.

77

System screen functions

Alarm concept

Alarm concept

Priority of alarms

The alarms are arranged in order of priority and assigned
to specific tones or tone sequences.

The information appropriate to the situation is clearly
presented in the separate fields for:

Warning marked »!!!« Text in a red field
Caution marked »!!« Text in a yellow field
Advisory marked »!« Text in a white field

Warnings are accompanied by a continuous tone, caution
messages by a tone at 30 second intervals and advisory
messages by a single tone. Low-priority technical
messages are displayed without audible alarm tone.
Tones conforming to the EURO standard or Dräger
standard are available as alternatives.

For warnings, the tones conforming to the Euro standard
are separated by pauses of about 15 sec.

4 Whenever a warning or caution message occurs,

the corresponding LED lights up above the
key:

Warning red, flashing
Caution yellow, flashing
Advisory yellow, constant

A summary of all alarm limit settings appears on the
screen, and the parameter which has been exceeded is
highlighted.

G

IPPV Alarmgrenzen

Standardbildschirm 1 - Erwachsene

16:47

01.12.98
00:00

1 2 3

Alarm: Achtung:

Hinweis:

Grenzen

P. Alarme
anpassen

V. Alarme
anpassen

Alarm
Info

Bildsch.
Aufbau

Para­meter

Stopuhr
Start

Konfig.

4

1412927805829278

Example:

The SpO2 concentration has fallen below the lower
alarm limit for SpO2, which is set to 91%.

The measured value is 90%.

– In the alarm field, the symbol for the lower alarm limit

and the parameter name »SpO2« are displayed.
The field changes colour from blue to red.

– The red LED flashes.

– The alarm tone is sounded.

– The alarm limits menu is automatically opened. The

upper or lower alarm limit that has been exceeded or
not attained is highlighted.

This value can be altered by turning the rotary control
and confirmed by pressing the control.

The alarm limit can be confirmed directly if it is to
remain unchanged.

The limit value menu is always closed whenever a
value is confirmed. If the alarm condition is no longer
present, the limit value menu closes automatically.

<

IPPV alarm limits

standard screen 1- adults

1. ECG I

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

Fi O2 Vol %

06.12.98

11:59
00:00

Warning: Caution:

HR/Puls 72 50 120
Pulsdef.
NiBP sys
SpO

2

et CO
in CO
AMV
Fi O

2

Fi SEV
PAW
iBP 1 sys
iBP 2 mit
ST
T1
T2

MV l/min

10.229

Freq 12 V

Select the required limits and confirm !

0.60∆ O2 --

T

4 5

122 80 160

92 91 --

33 30 50

2

-- 5

2

6.2 3.0 12.0

29 20 --

0.8 -- 3.4
9 8 40

125 80 167

31 0 8

-0.05 ± 0.10

36.8 -- --

37.5 -- --

SpO

%

2

99

Advisory:

HR/Pulse (ECG)

1/min

72

pulse def. 4 ST + 0.05

et CO2 MV Peak

33 10.2 19

Freq. VT PEEP

12 0.81 1

etCO2 mmHg

33

Peak mbar PEEP

32 3

Plat 18 Mean 6

HR/Pulse SpO2 Art (1)

79 99 -- / --

1/min % mmHg

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

timer
start

T1

36.8 °C

37.5 °C

T2

78

If several alarms occur simultaneously (in this example:
pulse rate), the alarm limits which have been exceeded
are shown against a dithered yellow background. When
the first alarm has been confirmed (by pressing the rotary
control on the system screen), the alarm limit of the alarm
with the next lower priority is activated and displayed.

System screen functions

Alarm concept

Show all alarms

1 Press the softkey »alarm info«.

The alarm texts of all warning, caution and advisory
messages are displayed in order of priority.

Suppress alarm tone:

2 Press the G key on the screen or parameter box.

The yellow LED will light up.

The alarm tone will be muted for 2 minutes for
Caution and Advisory messages. During this period,
any new Caution and Advisory messages that occur
will not be acoustically signalled.

New Warning messages will be signalled during this
period by a once-only alarm tone.

Exception:
NiBP alarms are suppressed until the next
measurement is made.

3 The red (upper) or yellow (lower) LED continues to

light up and the text remains on the display.

IPPV alarm limits

standard screen 1- adults

06-12-98

: Achtung:

11:59
00:00

Hinweis:

Message display fields

Warning:

xxxx
xxxy
xxxz

Grenzen

P. Alarme
anpassen

V. Alarme
anpassen

Alarm
Info

Bildsch.
Aufbau

Para­meter

Stopuhr
Start

Caution:

xxxx
xxxy
xxxz

xxxx
xxxy
xxxz

xxxx
xxxy
xxxz

zzzz
zzzx
zzzy
zzzj
zzzq

3

2

Advisory:

xxxw
xxxx
xxxy
xxxz

1

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para­meter

timer
start

config.

13529278141292781332927813429278

To reactivate the alarm tone during the 2 minutes:

2 Press G again.

The yellow LED goes out.

AutoSet patient alarms:

Refer to page 73.

AutoSet ventilation alarms:

Refer to page 74.

IPPV alarm limits

standard screen 1- adults

IPPV alarm limits

standard screen 1- adults

Warning: Caution:

Warning: Caution:

Advisory:

Advisory:

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

79

System screen functions

Alarm concept

Alarm modes

For adults / neonates:

The device stores two different sets of alarm limits, one
for adults and one for neonates.

The standard alarm limits for neonates and adults can
be configured in the Standby configuration menu.

The required mode (»adult« or »neon.«) is activated
under »mode« (see page 49).

The current mode is indicated in the status field at the top
left of the screen.

Activating default alarm settings

The alarm limits are reset to the preconfigured standard
alarm limits via the function »default« in the configuration
menu. The standard alarm limits are automatically active
after starting from »Standby« mode. The standard alarm
limits are automatically active after starting the screen
from »Standby« mode and after changing mode between
»adult« / »neon.«.

IPPV alarm limits

Anesth.Agent

selection
man. auto

gas
Isoflurane

The anesthetic
agent is automati­cally selected by
agent detection.

06-12-98

Alarms

default

CO

on off

2

SpO2 on off

parameter-

on off

box

HLM on off

Pmax on off

AGas Mix on off

11:59

Check system configuration. Please confirm !

00:00

Calibration

iBP 1

iBP 2

more

Settings

adult neon.

mode

?

?

alarm sound 1 2 3 4 5 6 7 8 9

ECG pulse tone 0 1 2 3 4 5 6 7 8 9

ECG pulse tone

2 modulated on off

SpO

curve speed 12,5 25 50
mm/s

colours

call standard

1402927814229278

CO2 alarm on/off

In »MAN/SPONT« monitoring mode, the alarm limits for
inspiratory and expiratory CO2 can also be deactivated
by the »CO2 alarm on/off« key.

In this case there will be no CO2 monitoring!

Press the key again to reactivate the CO2 alarms.

When changing over to »IPPV« monitoring mode or
»SIMV« with a frequency of more than 6 ventilation
strokes per minute, the CO2 alarms are automatically
reactivated.

Changing to »HLM« mode or »SIMV« with a frequency up
to 6 strokes/min. does not affect the deactivation.

When the CO2 alarm is on and the ventilator is in IPPV
mode, the inspiratory CO2 concentration in the breathing
gas is monitored with a fixed maximum limit of 5 mmHg!

The inspiratory CO2 concentration can be set by the user
in the range from 0 to 10 mmHg.

Adaption to the ventilation mode

The alarm limits are switched over automatically with the
ventilator.

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40

30

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

MV L/min

6.0

freq 10 V

Warning: Caution:

NiBP mmHg

Sys Dia

123/ 88

0.60

T

15 min (102)

Advisory:

HR/Pulse ECG

ª

pulse def 4 ST + 0.05

pulse 65

1/min

65

SpO2 %

99

etCO2 mmHg

33

IBP1 ART mmHg

122 / 89

V

0.60

T

volumeter 4.3 27s

1.0

12

limits

auto set

pat.alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

The alarm mode »IPPV alarm limits« is automatically
activated on the system screen if the ventilation
frequency for »IPPV« and »SIMV« is greater than
6 breaths per minute.und blinkt in den ersten fünf
Sekunden.

80

The MAN/SPONT alarm limits are automatically activated
in »MAN/SPONT« mode and the SIMV alarm limits for
»SIMV« mode with a ventilation frequency of less than
6 breaths per minute. The currently active alarm limits are
indicated in the status field and flash for the first five
seconds.

A special alarm mode can be activated via the function
»alarms« in the »config.« menu for operation with a
heart/lung machine (»HLM« mode). In this case, all apnea
alarms are deactivated and the gas values are indicated
continuously, regardless of the respiratory phase.

All other alarm monitoring continues as in the ventilation
mode from which »HLM« was activated.

The message »HLM« is also displayed on screen after the
ventilation mode.

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

MV L/min

6.0

freq 10 V

Warning: Caution:

SpO2 %

99

pulse 65

0.60

T

System screen functions

Alarm concept

Advisory:

HR/Pulse (ECG)

ª

65

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

1/min

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

T1 36.8
T2 37.5

05329278

Alarm limits in ventilation mode »MAN/SPONT«»SIMV« with fIMV < 6 »SIMV« with fIMV ≥ 6

for »IPPV« and »PCV«

Minute volume AMV

Inspiratory anaesthetic agent

Airway pressure Paw

Inspiratory O2 concentration FiO2

off/on off/on off/on

>

off/on off/on off/on

<

on on on

>

off/on off/on off/on

<

on on on

>

off on on

<

off/on off/on off/on

>

on on on

<

Apnea pressure off set to 30 seconds set to 15 seconds
Apnea flow off set to 30 seconds set to 15 seconds
Apnea CO2 set to 1 minute set to 30 seconds set to 15 seconds
All other alarm limits remain unaffected by this function.

81

System screen functions

Alarm concept

Special alarm features

Related parameters are combined so that the
user is not disturbed by unnecessary cascade
alarms.

Combination of Apnea alarms from pressure,
flow and CO2 measurement:

Measurement Result Message Special features

CO2 No breathing APNEA CO2 !!! With indication of the time elapsed
Flow Breathing detected in seconds
Pressure Breathing detected

CO2 No breathing APNEA !!! With indication of the time elapsed
Flow No breathing in seconds
Pressure Breathing detected

CO2 No breathing APNEA !!! With indication of the time elapsed
Flow Breathing detected in seconds
Pressure No breathing

CO2 Breathing detected APNEA !!!
Flow No breathing
Pressure No breathing

CO2 Breathing detected CHECK PRESSURE !
Flow Breathing detected
Pressure No breathing

CO2 Breathing detected FLOW SENSOR !
Flow No breathing
Pressure Breathing detected

If a parameter fails for obvious reasons, the combination
is broken up and a separate alarm is signalled for each
parameter. Only the CO2 Apnea alarm is signalled in
»MAN/SPONT« mode.

82

Combined alarms for no pulse or heart rate:

The heart/pulse rate is determined from the ECG, SpO2
and iBP1 and 2.

Measurement Result Message Special features

ECG No heart beat ASYSTOLE !!!
SpO2 Any
iBP 1 Any
iBP 2 Any

ECG Heart beat iBP 1 PULSE? !!!
SpO2 Pulse
iBP 1 No Pulse
iBP 2 No Pulse

ECG Heart beat CHECK iBP 2 !
SpO2 Pulse
iBP 1 Pulse
iBP 2 No Pulse

System screen functions

Alarm concept

ECG Heart beat CHECK iBP 1 !
SpO2 Pulse
iBP 1 No Pulse
iBP 2 Pulse

ECG Heart beat SPO2 SENSOR? !
SpO2 No Pulse
iBP 1 Pulse
iBP 2 Pulse

ECG Heart beat SPO2 PULSE? !!!
SpO2 No Pulse
iBP 1 No Pulse
iBP 2 No Pulse

The logic of the remaining three parameters is applied if
any of the four is deactivated. If a further parameter fails,
the combination is broken up and a separate alarm
signalled for each parameter.

Monitoring the alarm limits for heart/pulse rates from
different sources:

The heart rate is always determined from the 1st ECG.

Two of the three parameters (SpO2, iBP1 and iBP2) are
chosen for monitoring the pulse rate. If two of these
parameters output a measured value between the alarm
limits, the advisory message »CHECK xyz!« is generated
instead of a pulse alarm.

A heart/pulse alarm is only generated if at least two
parameters indicate a violation of the alarm limits.
If another para-meter fails, the combination is broken up
and a separate alarm is signalled for each parameter.

Monitoring the alarm limits of the blood
pressure values from different sources:

The NiBP alarm is deactivated when measuring an
arterial pressure.

The standard alarm limits for NiBP and ART are
coupled.

NiBP alarms are suppressed by pressing G until
the next NiBP measurement is performed.

83

84

Parameter box

Page

Function keys and displays..................................... 86

Transport function................................................... 87

Measurement functions .......................................... 89

ECG / heart rate ...................................................... 89

ECG display........................................................ 89

Adjusting settings................................................ 89

Electrosurgery and ECG ..................................... 90

Non-invasive blood pressure (NiBP) ......................... 91

Start monitoring................................................... 91

Interrupt measurement ........................................ 91

Adjusting settings................................................ 92

Measuring the blood pressure of neonates .......... 93

Invasive blood pressure (iBP) ................................... 94

Start monitoring................................................... 94

Calibrating transducers ....................................... 94

Adjusting settings................................................ 95

Setting functions ................................................. 95

iBP display .......................................................... 96

Functional O2 saturation (SpO2)............................... 97

SpO2 display....................................................... 97

Adjusting settings................................................ 97

Setting functions ................................................. 97

Coupling with non-invasive pressure

measurement ...................................................... 97

Temperature measurement....................................... 98

Start measurement .............................................. 98

Display................................................................ 98

85

Parameter box

Function keys and displays

Parameter box

Function keys

The parameter box is controlled by the Cicero EM.
A number of functions can be accessed quickly and
directly via the function keys.

G

On pressing this key on the screen or parameter
box, the yellow LED lights up.

The acoustic alarm is then muted for 2 minutes for
Caution and Advisory messages.

Please see the explanations on page 79.

¡

Starts automatic NiBP measurement.

The yellow LED in the key lights up as long as
»Auto« mode remains active.

g

AUTO

ECG NIBP SpO2 T1 T2 P1 P2

Start
Stop

Punct.

Act.

1

→ 0 ←→ 0 ←

d

14329278

‚

NiBP measurement can be started and ended
manually with this key.

This key can also be operated between two
measurements in »auto« mode. The time intervals of
automatic measurement are not affected. If the key
is pressed while a measurement is in progress, this
measurement will be interrupted and the cuff
deflated.

t

A static pressure is built up in the NiBP cuff when
this key is pressed in order to stop the venous blood

flow. The yellow LED in the key lights up during this
time.

The blood flow is released when the key is pressed
again. It is released automatically after two minutes.
The pressure is set by the user in the NiBP menu.

≠

Zero alignment key for invasive blood pressure
measurement. The infusion system must be exposed

to atmospheric pressure and the key pressed twice.

If the message »CAL« appears on the screen:

– Check the position of the shutoff valves.

– Does the pressure transducer still detect an arterial

pulse?

– Check pressure transducer.

Displays

1 Act.

Power indicator.
Lights up when the parameter box is active. Shortly
after inserting the parameter box into the holder, the
yellow LED begins to flash until communication with
the system screen has been established.
If the system screen is in Standby the LED does
not light.

86

Transport function

The parameter box stores:
– the patient data from the list screen

– alarm limit settings and
– measurement parameter settings.

The patient remains connected to the parameter box in
transit. The patient's data remains constantly accessible.
There is no need to reconnect the patient and configure
the monitors.

Plugging in/unplugging the parameter box

White housing:

To connect:

● Hold the parameter box by the blue handle.

Parameter box

Transport function

Fixing the parameter box to the unit

● Slide the parameter box into the white housing.

It clicks audibly into place, and all LEDs on the front
panel light up briefly.

To disconnect:

● Pull out the blue handle. After overcoming a tangible

resistance, the box is electrically disconnected and
freely transportable.

Blue holder:

The parameter box can be tilted in the blue holder. On
overcoming a set resistance, it can be adjusted to an
ergonomic position.

To connect:

● Hold the parameter box by the blue handle.

● Place the parameter box on the crossbar of the holder

and allow it to swivel down.

It clicks audibly into place, and all LEDs on the front
panel light up briefly.

144292781452927814629278

To disconnect:

● Pull out the blue handle. Swivel upwards to discon-

nect electrically, and lift off the crossbar. The box is
now freely transportable.

87

Parameter box

Transport function

Data transfer

Data transfer

After the parameter box has been clipped into place, it
exchanges data with the system screen. It will perform as
programmed in »Standby« (see page 62).

A complete list of the transported data is given in the

»Technical Data« on page 160.

Fully automatic procedure

The message

»Data will be transferred as wanted« is displayed.

After about 12 seconds, all parameter box functions
are active. No user intervention is required.

Semi-automatic procedure

The transport menu is displayed, as preconfigured by
the user in »Standby«.

If the monitoring requirements have changed in the
meantime, the user can intervene in the data transfer
and modify settings in the same way as for the
configuration in »Standby«.

Data transfer can of course also be confirmed
unchanged after checking the display.

● These settings are confirmed and then transferred by

pressing the rotary control. After about 12 seconds,
all parameter box functions are active.

The patient is new
to the:

Parameter­box yes no

Which data do you want
to transfer from the
parameter box?

Settings yes no
Alarm limits yes no
List yes no

List intervals

If the user has opted to transfer list data in the semi­automatic procedure, the intervals can now be selected.

An interval (monitoring interval) is considered to be the
time between connection and disconnection of the
parameter box.

Each of these intervals are displayed on a separate line in
the list screen, with the identifier »interval« and the date
and time. In addition, the user-programmed device
location is also displayed (see page 64).

1472927814829278

List from interval:

Date Time

every session
1 18/08 8.00/9.00

2 18/08 13.15/14.00

88

Parameter box

ECG / Heart rate

ECG / Heart rate

ECG display

● Insert the electrode cable in the ECG input of the

parameter box, and attach the electrodes to the
patient (for instructions, see »Descriptions« from
page 163 onwards).

1 The ECG of the preprogrammed lead appears on the

system screen as specified in the configuration menu.

2 The heart rate is displayed.

Adjusting settings

● Press the softkey »Parameter«. The menu

for setting the parameters is displayed.

● Move the cursor frame to »ECG« with the

rotary control and press to confirm.

measuring
function on / off

Activates and deactivates the ECG
measuring function.

number
of leads 3 / 5

Selects the type of cable used. If you are
using a 3-lead ECG cable, leads 1, 2 and 3
are available. If only 3 electrodes of a 4 or
5-lead cable are connected, the system
displays the following error message:
»Elektrode«.

lead I / II / III / AVR / AVL / AVF / V

Selects the lead separately for the 1st, 2nd
and 3rd ECG. With a 3-core cable, the
choice is restricted to lead 1, 2 and 3.

amplitude mV / 4 / 2 / 1 / 0.5 / 0.25

Sets the ECG amplitude in mV on the
screen in relation to the reference bar to the
left of the ECG graph. Changes to settings
are immediately visible on the curve.

filter on / off

»on« yields an extremely stable ECG

without interference.

»off« yields an ECG with higher band

width, but less stable.

pacemaker on / off

Activates and deactivates pacemaker
pulse detection. Pacemaker pulses are
enlarged disproportionately when this
function is activated (not taken into account
when calculating the heart rate).

g

Man./Spont. alarm limits

standard screen 1- adults

II

1

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

1mV

iBP1

CO

PAW

O2 N2O ISO

Fi
Fet 26 68 0.6

06-12-98

1mV

iBP1

CO

PAW

O2 N2O ISO

Fi
Fet 26 68 0.6

11:59
00:00

IPPV alarm limits

standard screen 1- adults

2. ECG
II

160

0

2

40
30

0

20

0

29 70 0.8

11:59
00:00

IPPV alarm limits

standard screen 1- adults

2. ECG
II

160

0

2

40
30

0

20

0

29 70 0.8

06-12-98

11:59
00:00

AUTO

Start
Stop

MV L/min

6.0

freq 10 V

MV L/min

6.0

freq 10 V

Select the required parameter and confirm !

MV L/min

6.0

freq 10 V

Select a menu position. Please confirm !
Change the settings. Please confirm again !

Punct.

Warning: Caution:

pulse 65

0.60

T

Warning: Caution:

ECG

NiBP

iBP 1

iBP 2

SpO

CO

pEEG

pulse 65

0.60

T

Warning: Caution:

function on off

number 3 5
of leads

lead I II III

amplitude

filter on off

pacemaker on off

pulse def. on off
indication

ST-segment
analysis

pulse 65

0.60

T

Act.

d

SpO2 %

99

/ Pleth

2

/ O

2

2

SpO2 %

99

ECG

1.ECG 2.ECG 3.ECG

1

on off

SpO2 %

99

→ 0 ←→ 0 ←

Advisory:

HR/Pulse ECG

2

ª

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

1/min

65

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

Advisory:

HR/Pulse ECG

ª

pulse def. 4 ST + 0.05

IBP1 ART mmHg

122 / 89

pulse 65 (100)

1/min

65

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

Advisory:

HR/Pulse ECG

ª

pulse def. 4 ST + 0.05

IBP1 ART mmHg

122 / 89

pulse 65 (100)

1/min

65

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para­meter

timer
start

config.

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para­meter

timer
start

config.

auto set

pat. alarm.

auto set
vent. al.

alarm

info

para­meter

timer
start

14929278150292781512927815229278

89

Parameter box

ECG / Heart rate

pulse deficit indication on / off

Activates and deactivates the pulse deficit
indication derived from the heart rate and
SpO2 pulse.

ST-segment analysis on / off

Activates and deactivates ST-segment
analysis. Alarms only active in adult mode.

Monitoring of limit values is deactivated
when »off«.

The analysis is based on the derivation from
the 1st ECG.

ST-segment analysis may be impaired
by simultaneous high-frequency electro­surgery!

Electrosurgery during an ECG

ECG measurements are susceptible to interference
from electrosurgery (high frequency surgery). To avoid
unnecessary false alarms, whilst still guaranteeing safe
monitoring, the system responds as follows to detected
high frequency interference:

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40
30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

Warning: Caution:

function on off

number 3 5
of leads

1.ECG 2.ECG 3.ECG

lead I II III

amplitude

filter on off

pacemaker on off

pulse def. on off
indication

ST-segment
analysis

MV L/min

6.0

freq 10 V

Select a menu position. Please confirm !
Change the settings. Please confirm again !

0.60

T

SpO2 %

99

pulse 65

ECG

1

on off

Advisory:

HR/Pulse ECG

ª

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

1/min

65

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

auto set

pat. alarm.

auto set

vent. al.

alarm

info

para-

meter

timer

start

15229278

– the ECG curve is always displayed,

– an »ECG noise« error message is displayed,

– the heart rate display is frozen and

– ECG alarms are suppressed.

After the high frequency interference has ceased, the
complete monitoring function is again active. If high
frequency interference lasts longer than 15 seconds
without interruption, the heart rate and S-T segment
values are replaced by dashes (» – – «).

90

Non-invasive blood pressure (NiBP)

Parameter box

Non-invasive blood pressure (NiBP)

Start monitoring

The main steps can be undertaken at the parameter box.

1 Plug the hose connectors into the parameter box.

The rubber rings on the connectors can be moistened
slightly so that they can be inserted more easily.

● Apply the appropriate cuff to the patient and connect

it to the hose. Ensure that all connections are tight.
Even slight leaks make measurement impossible.

Manual measurement

2 Press ‚.

The cuff is inflated and the cuff pressure indicated
constantly in the bar graph within the module.

3 The systolic, diastolic and

4 mean pressure are displayed when the measurement

is complete.

Incorrect measurements are repeated 5 seconds after
releasing the air. A third and last attempt is made after
30 seconds if the second measurement also proves
incorrect.

g

7

AUTO

2

Start
Stop

1

3

NiBP mmHg
Sys Dia

123 / 88

15 min M (102)

5

Punct.

Act.

d

→ 0 ←→ 0 ←

15329278

4

6

Automatic measurement

5 Time bar indicating the relative time elapsed between

two automatic measurements. The actual cuff
pressure is indicated here during the measurement.

6 Time interval for automatic measurement.

7 Press ¡.

The LED in the key lights up and automatic measure­ment starts. NiBP measurements are performed by
the parameter box at the set time intervals.

To interrupt measurement

2 Press ‚.

to interrupt measurement. The air is immediately
expelled from the cuff.

91

Parameter box

Non-invasive blood pressure (NiBP)

Changing settings

● Press the softkey »parameter«.

● Move the cursor frame to »NiBP« with the rotary

control and press to confirm.

The menu for setting the parameter is displayed.

auto on / off

Activates automatic measurements at
the specified time intervals.

punction Start / Stop

Starts or stops venous congestion.
Inflation ends automatically after
2 minutes.

measurement Start / Stop / Turbo

»Start« Triggers manual measure-

ment outside the automatic
time interval.

»Stop« Stops a measurement.

Or press the ‚ key on
the parameter box.

»Turbo« Five simplified measure-

ments in five minutes.
This mode can also be
stopped with »Stop«.

time interval 2 / 3 / 5 / 10 / 15

Selects the time interval for automatic
measurement in minutes. The starting
time for the next automatic measure­ment is not affected by a measure­ment triggered manually between two
automatic measurements.

active alarms sys / dia

Determines whether the systolic or
diastolic pressure is to be monitored.

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40

30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

MV L/min

6.0

freq 10 V

Select a menu position. Please confirm !
Change the settings. Please confirm again !

T

NiBP

auto on off

punction Start Stop

measure Start Stop Turbo

time interval 5

active alarms sys dia

initial pressure 180 mmHg

punction pressure 40 mmHg

units mmHg kPa

interlock:
NiBP-SpO

on off

2

NiBP-iBP on off

Warning: Caution:

NiBP

auto on off

punction Start Stop

measure Start Stop Turbo

time interval 5

active alarms sys dia

initial pressure 180 mmHg

punction pressure 40 mmHg

units mmHg kPa

interlock:

on off

NiBP-SpO

2

NiBP-iBP on off

SpO

99

pulse 65

0.60

15529278

%

2

Advisory:

HR/Pulse (ECG)

65

etCO2 mmHg

33

2 0

1/min

ª

pulse def. 4 ST + 0.05
iBP1 ART mmHg

122/ 89

pulse 65 (100)

Fi CO

Peak mbar PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

15429278

punction pressure numerical

(separate for adults and neonates)
Sets the punction inflation pressure
of the sphygmomanometer cuff.

The cuff is inflated to the preset
starting pressure for the first
measurement; after reading off the
systolic pressure, the cuff is inflated
to 20 mmHg above the last
measured systolic value for the next
measurement. If the inflation
pressure is too low for correct
measurement of the systolic
pressure, air is automatically released
from the cuff and the measurement is

92

repeated 5 seconds later with a
higher cuff pressure. If it is still too
low, the air is released again and the
measurement repeated 30 seconds
later with an elevated cuff pressure.

Punction pressure numerical display

(Separate for adults and neonates).
Sets the punction inflation pressure
in the sphygmomanometer cuff.

Turn the rotary knob to change the
value, and press to confirm.

Unit mmHg / kPa Switching over between the

measuring units »mmHg« and »kPa«.

Interlock
NiBP–SpO2 on / off

Activates and deactivates the inter­lock function between »NiBP« and
»SpO2«.

When the NiBP sphygmomanometer
cuff is inflated with the Interlock on,
the »SpO2 PULSE ? !!!« alarm is
deactivated in order to prevent false
alarms if both measurements are
taken on the same arm. Generally,
»Interlock on« is recommendated.

NiBP

auto on off

punction Start Stop

measure Start Stop Turbo

time interval 5

active alarms sys dia

initial pressure 180 mmHg

punction pressure 40 mmHg

units mmHg kPa

interlock:
NiBP-SpO

NiBP-iBP on off

on off

2

Parameter box

Non-invasive blood pressure (NiBP)

15529278

Interlock

NiBP–iBP
auto / off

Activates and deactivates the
interlock function

between »NiBP« and »iBP«.

The »iBP 1/2 PULSE ? !!!«
measurement is suppressed while the
cuff is inflated.

NiBP alarms:

NiBP alarms are suppressed during invasive blood
pressure measurement in an artery.

If an NiBP alarm is triggered, the alarm sound is
suppressed until the next NiBP measurement by

pressing G.

Measuring the blood pressure of neonates

The parameter box includes special algorithms in
neonatal mode for monitoring neonates. Changing over
to neonatal mode is described on page 49.

Standby / Configuration

06-12-98

11:59
00:00

Default values

mode

adult neon.

alarm limits

parameter

screen

acoustic

list entry

transport

RS 232 (Medibus)

record (printer)

basic config.

Select the required ventilation mode (adult or neonate). Please confirm !

alarms inactive !

07829278

93

Parameter box

Invasive blood pressure (iBP)

Invasive blood pressure (iBP)

Start monitoring the invasive blood pressure

The invasive blood pressure can be measured on two
channels simultaneously. The settings and functions of
the channels are identical and are described only once
below.

● Connect pressure transducer to the parameter box

(colour-coded grey).

● Connect infusion system and catheter/canula to the

transducer. Eliminate any air bubbles in the catheter/
transducer system, as they can impair measurement.

● Apply the pressure transducer level with the heart.

● If necessary, wait until the pressure transducer has

warmed up.

● Connect the transducer dome to the catheter/infusion

system and open it to atmospheric pressure.

Calibrating the sensors

On the system screen

● Press the »parameter« softkey.

● Select »iBP 1« or »iBP 2« with the rotary control and

press to confirm.

● Position the cursor frame over »Calibration« with the

rotary knob and press to confirm. The system
enquires whether the infusion system has been
exposed to atmospheric pressure.

● Open the sensor dome and press to confirm.

g

IPPV alarm limits

standard screen 1- adults

2. ECG
II

1mV

iBP1

160

0

CO

2

40

30

0

PAW

20

0

O2 N2O ISO

29 70 0.8

Fi
Fet 26 68 0.6

06-12-98

11:59
00:00

AUTO

Start
Stop

MV L/min

6.0

freq 10 V

Select a menu position. Please confirm !
Change the settings. Please confirm again !

Punct.

Warning: Caution:

function on off

location AORTA

active
alarms

graph

amplitude 160

pulse on off

calibrate

pulse 65

0.60

T

iBP 1

sys dia

%

SpO

2

99

Act.

d

absol. morph.

u

→ 0 ←→ 0 ←

Advisory:

HR/Pulse (ECG)

65

etCO2 mmHg

33

2 0

1/min

ª

pulse def. 4 ST + 0.05
iBP1 ART mmHg

122/ 89

pulse 65 (100)

Fi CO

Peak mbar PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

156292781572923815829278

The clock symbol uappears during the calibration

process. A tick (✔) then appears behind the function.

● Close the transducer dome and reopen the connec-

tion to the catheter/infusion system; the pressure
trace and pressure values are displayed.

Or on the parameter box:

● Press the zero alignment key

≠

of the corres-

ponding sensor twice; a tick (✔) appears behind the

menu item on the system screen.

A question mark (?) appears after the menu item if
a fault occurs during zero alignment. »CAL ?« is
displayed instead of the measured values and the

LED in the ≠ key flashes.

g

AUTO

Start
Stop

Punct.

Act.

d

→ 0 ←→ 0 ←

94

Setting functions

Parameter box

Invasive blood pressure (iBP)

function on / off

Activates and deactivates the iBP
measuring function.

location The names of the following catheter site

labels are programmed:

ART Artery

AORTA Aorta

A.Pulm Pulmonary artery

CVP Central venous pressure

ICP Intracranial pressure

? Any other site

The following parameters are automatically preselected
on selecting a location name:

– curve amplitude

– monitoring type (diastolic, mean pressure, systolic)

– alarm limits

– colour code of catheter site (label).

iBP 1

function on off

location AORTA

active
alarms

graph

amplitude 160

pulse on off

calibrate

sys dia

absol. morph.

u

15929278

95

Parameter box

Invasive blood pressure (iBP)

active alarms sys / dia

Determines whether the systole »sys« or
diastole »dia« is to be used for monitoring.

graph absol / morph

Absolute: Bottom line equals absolute
zero. Manual amplitude selection
possible.
Morphological: Automatic amplitude
selection. Optimum curve size. Bottom
line does not equal absolute zero.

amplitude Determines the magnitude of the absolute

pressure graph on the screen. The selec­ted amplitudes depend on the location.
They have been pre-configured in
standby-mode under »Default values«,
»Parameters«, »iBP locations«.

iBP 1

function on off

location AORTA

active
alarms

sys dia

graph

absol. morph.

amplitude 160

pulse on off

calibrate

u

15929278

pulse on / off

Activates and deactivates pulse indication
in the iBP module.

calibrate Sensor zero calibration.

The clock symbol ( u) is displayed
during calibration.

iBP Graph

A pressure graph appears on the screen (example):

1 Absolute graph, referred to the zero pressure

(= values in the bottom reference line).

The scale of the upper reference line can be varied.

or

– Morphological graph.

The graph is automatically adjusted to the full height
of the trace. Manual adjustment of the height is not
possible in this case.

2 Numerical representation of systole/diastole and mean

pressure (in brackets). (In CVP and ICP, the mean
pressure is displayed in large figures).

SIMV alarm limits

standard screen 1- adults

II

1mV

iBP1

160

1

0

CO

2

40

30

0

PAW

20

0

O2 N2O ISO

Fi

29 70 0.8

Fet 26 68 0.6

06-12-98

11:59
00:00

MV L/min

6.0

freq 5 V

Warning: Caution:

SpO2 %

99

pulse 65

0.60

T

Advisory:

HR/Pulse ECG

ª

pulse def. 4 ST + 0.05
IBP1 ART mmHg

122 / 89

pulse 65 (100)

1/min

65

2

etCO2 mmHg

33

Peak PEEP

32 3

plat 26 mean 21

T2 °C

T

1

36.8 37.2

limits

auto set

pat. alarm.

auto set
vent. al.

alarm

info

screen
config.

para-

meter

timer
start

config.

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96

Parameter box

Functional oxygen saturation (SpO2)

Functional oxygen saturation (SpO2)

Graph

1 Presentation of the plethysmogram as a curve.

2 Numerical presentation of the saturation value and

pulse rate.

Changing settings

● Press the softkey »parameter« on the system screen.

● Move the cursor frame to »SpO2 / Pleth.« with the

rotary control and press to confirm.

The menu for setting the parameters is displayed.

Setting functions

measuring
function on / off

Activates and deactivates the measuring
function.

pulse on / off

Activates and deactivates indication of the
pulse rate.

C-Lock on / off

Activates and deactivates automatic C-Lock
synchronization.
C-Lock synchronizes measurement of the
saturation with the ECG. Leads to better
results if the patient moves or perfusion is
poor.
C-Lock »on« automatically suppresses the
pulse deficit alarm.

mode slow / normal / fast

changes the speed of measurement.

Man./Spont. alarm limits

standard screen 3 - adults

II

1mV

iBP1

160

0

Pleth

1

06-12-98

11:59
00:00

SpO2 %

98

Pulse 65

SpO2

function on off

pulse on off

C-Lock
(ECG
synchr.)

mode slow normal

fast

on off

Warning: Caution:

NiBP mmHg

Sys Dia

123/ 88

15 min (102)

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Advisory:

HR/Pulse ECG

ª

pulse def 4

IBP1 ART mmHg

122 / 89

pulse 65 (100)

pulse 65

1/min

65

SpO2 %

99

2

T1 T2 °C

36.8 37.2

limits

auto set

pat.alarm

auto set
vent. al.

alarm

info

screen
config.

para­meter

timer

start

config.

16129278

slow mode: The measured value responds
slowly to changes in oxygen saturation.
Patient movement has little or no effect.

normal mode: The mode for normal
conditions with relatively quiet patients.

fast mode: This mode should be used
whenever rapid reactions are required and
patient movement is negligable.

Coupling with non-invasive pressure measurement

The interlock function should be activated for simulta­neous measurement of SpO2 and non-invasive blood
pressure on one arm. This prevents unnecessary alarms
due to failure to detect a pulse during NiBP measurement
(see page 171).

97

Parameter box

Temperature measurement

Temperature measurement

Start measurement

– Use a protective sheath for rectal sensors.

– Apply the sensor(s) to the patient and connect with

the parameter box (colour-coded green).

Correct temperature values are displayed after approx.
three minutes.

Display:

If programmed, the small temperature module is
displayed under the softkeys. To set this display mode,
see page 61.

T1 36.8 °C

37.2 °C

T2

Alternative:

Select numerical module display with
»Screen configuration«.

T1 T2 °C

36.8 37.2

98

Message, cause and remedy

Page

Where messages are displayed.............................. 100

Location of valves and subsystems ........................101

Messages on the system screen ............................ 102

Warning messages...................................................102

Caution messages....................................................104

Advisory messages ..................................................106

Messages on the ventilator..................................... 109

Message in the ventilation system..........................110

Message during the self-test..................................... 111

Message during operation ........................................ 114

99

Message, cause and remedy

Where messages are displayed

Where messages are displayed:

Warning, caution and advisory messages

These are the three types of message output by the
system. They are classified in order of priority and listed
alphabetically in the following tables.

Warnings ................................................: from page 102

Caution...................................................: from page 104

Advisory..................................................: from page 106

Messages on the Ventilator .....................: from page 109

Messages in normal operation.................: from page 109

User prompts

appear at the bottom of the screen.

Fault messages (only during self-test)

appear in the middle of the lower third of the screen.

Warning Caution Advisory

1632927816429278

Messages on the ventilator

These are always output during operation. Refer to the
chapter entitled »Anaesthesia ventilation«.

In exceptional cases, messages may also appear in the
dialogue field during operation and the self-test. Refer to
the table on page 109.

In the event of a problem with the ventilator, signalled by
a message in the dialogue field of the ventilator and/or
the message »VENT INOP« on the system screen,
manual ventilation with the breathing bag is always
possible with the Cicero EM.

The Ventilator then switches over automatically to
»MAN/SPONT« mode. The volume of the breathing
system increases rapidly to 1.4 litres, because the pump
piston is forced back to its starting position by the gas
pressure.

Remedy: Immediately increase the gas flow and/or press
»O2 flush« on the flowmeter block.

In the event of particularly serious problems, e.g.
»Control pressure low«, it is possible that when manual
ventilation is attempted no pressure will be generated in
the breathing system. Simultaneous failure of the
compressed air and compressed oxygen supply would
be such a serious fault.

Fault messages

User prompts

TEST

dialogue field

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In these cases, immediately ventilate the patient with
the separate emergency breathing bag.

100