Drager Evita 2 dura User manual [gb]

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Page 1

Evita 2 dura

Intensive Care Ventilator

Instructions for Use

MEDICAL

Software 4.n

1-251-96

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Working with these Instructions for Use

Header line – the title... of the main chapter

The title of the specific sub-section is printed underneath the main header – to help you find your way quickly from subject to subject.

Page body... the Instructions for Use

in combined text/illustrations. The information is expressed in the form of practical actions, giving the user direct hands-on experience in learning how to use the machine.

Left-hand column... the text

provides explanations and instructs the user step-by-step in the practical use of the product, with short, clear instructions in easy-to-follow sequence. Bullet points indicate separate actions. Where several actions are described, numbers are used both to refer to the relevant details in the illustrations and to specify the sequence of actions.

Right-hand column... the illustrations

provide the visual reference for the text and make it easier to locate the various parts of the equipment. Elements mentioned in the text are highlighted. Unnecessary details are avoided. Screen displays prompt the user to proceed and confirm correct actions.

Operation Starting up

Starting up

Switching on

Push in power switch on back panel until it clicks into place = ON. The flap comes down over the switch to prevent it being inadvertently switched off.

Evita 2 dura runs a self-test.

Wait until the 10-second test phase is complete.

Evita 2 dura always begins ventilation with the start-up values marked by an arrow on the on-screen knobs. To select these start-up values, please refer to pages 62 onwards. After power cuts and after standby mode, the settings valid immediately before the interruption of operation remain in use.

Patient mode

After switching on, Evita 2 dura displays a choice of patient modes:

–»Adults« = adult patients –»Paed.« = children –»Neo.« = neonates

(when using the "NeoFlow" option)

–»prev. patient« = previous patient

Example:

Adult ventilation

With this information, Evita 2 dura defines the adjustment ranges and the start-up values of the ventilation parameters.

The starting procedure, with selection of the patient mode, can be configured by the user, see Configuration on page 55 onwards.

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What's new in Evita 2 dura software 4.n

Specification of the humidifier used

– »Active humidifier«

or – »HME/Filter« (artificial nose) – for more accurate measurement of the volume

parameters

Apnoea ventilation On/Off

– can be selected as starting configuration

Extended range of settings for the alarm time TApnoea >>

– from 5 to 60 seconds

(formerly 15 to 60 seconds)

Ventilation mode BIPAPAssist

– for pressure-controlled assisted ventilation

Patient mode »prev. patient« can be selected

– to adopt the settings, including alarms, which were

effective before switching off the equipment

Evita Remote (Remote Pad) optionally available – Remote control pad for parallel remote operation of

function keys on Evita 2 dura 4.n

NIV

optionally available – Application mode to support non-invasive ventilation

therapies

Nurse call

optionally available – Socket for connecting alarm signals to a central alarm

station in the hospital

Simplified settings

under "other modes"

Leakage compensation On/Off

– for activation and deactivation of the automatic

leakage compensation function

Monitoring of tube blockages

– New alarm message »Tube blocked !!!«

Additional weaning parameters

available as software version 4.n plus upgrade in addition to the parameter occlusion pressure P 0.1 Evita 2 dura 4.n also determines the parameters

– RSB Rapid Shallow Breathing index

and – NIF Negative Inspiratory Force index

–fspn and MVspn as trend

External flow source available as software version 4.n plus upgrade – The amount of external flow is calculated by

Evita 2 dura 4.n (e.g. for additional tracheal gas

insufflation) and adjusts the volume monitoring

tolerances in order to avoid inadvertent alarms

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Page 5

Contents

For Your Safety and that of Your Patients.................................................9

Intended Medical Application.................................................................. 11

Operating Concept...................................................................................13

Ventilation Controls..................................................................................14

Setting ventilation parameters....................................................................14

Selecting the ventilation mode................................................................... 14

Screen Operating Controls...................................................................... 15

Keys for routine and additional functions....................................................15

Power switch............................................................................................ 16

Standby key »O «..................................................................................... 16

Screen Pages...........................................................................................17

Structure of the main page........................................................................ 17

Structure of the application-specific pages.................................................17

»Settings«..................................................................................................18

»Alarms«....................................................................................................18

»Measurements«........................................................................................18

»Calibration / Configuration«......................................................................19

Colour screen........................................................................................... 20

Operation................................................................................................. 21

Starting up............................................................................................... 22

Switching on............................................................................................. 22

Patient mode............................................................................................. 22

Selecting the patient mode........................................................................ 23

Starting ventilation..................................................................................... 24

Setting Ventilation Modes........................................................................25

IPPV..........................................................................................................27

SIMV, SIMV/ASB......................................................................................29

BIPAP, BIPAP/ASB.................................................................................. 31

BIPAPAssist................................................................................................32

CPAP, CPAP/ASB....................................................................................33

MMV, MMV/ASB...................................................................................... 34

Apnoea ventilation................................................................................... 36

Setting Alarm Limits.................................................................................37

In the Event of an Alarm.......................................................................... 38

Warning.................................................................................................... 38

Caution..................................................................................................... 38

Advisory.................................................................................................... 38

Suppressing the audible alarm...................................................................39

Information .......................................................................................... 39

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Contents

Displaying Curves and Measured Values................................................ 40

In the main page........................................................................................40

Display measured values........................................................................... 41

Curve freezing...........................................................................................42

Special Functions.....................................................................................43

Manual inspiration......................................................................................43

Manual expiration hold............................................................................... 43

Medicament nebulisation........................................................................... 44

Oxygen enrichment for bronchial suction................................................... 47

Switching to Standby/Terminating standby mode.................................. 49

Calibrating................................................................................................50

Calibrating the O2 sensor manually............................................................50

Calibrating the flow sensor manually..........................................................51

External flow source.................................................................................. 52

Switching off the monitor functions........................................................ 53

Configuration........................................................................................... 55

System Settings.......................................................................................56

Adjusting the volume of the audible alarm.................................................. 56

Setting the contrast................................................................................... 56

Country-specific settings......................................................................... 57

Selecting the language.............................................................................. 57

Setting the date and time...........................................................................57

Selecting measuring units..........................................................................57

Interface...................................................................................................58

Selecting the interface...............................................................................58

Screen......................................................................................................59

Selecting the displayed combination of measured values............................59

Selecting the displayed curves...................................................................61

Ventilation Defaults..................................................................................62

Patient-specific defaults.............................................................................62

Default ventilation parameter values........................................................... 63

Activating / deactivating pressure limit Pmax.............................................. 64

Apnoea ventilation on/off........................................................................... 65

Leakage compensation on/off....................................................................66

Default alarm limits.................................................................................... 67

Default ventilation mode.............................................................................69

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Contents

Fault – Cause – Remedy.......................................................................... 71

Care..........................................................................................................79

Dismantling..............................................................................................80

Removing parts......................................................................................... 80

Disinfecting/Cleaning/Sterilising............................................................ 83

Disinfecting / cleaning / sterilising schedule............................................... 85

Assembling.............................................................................................. 86

Mounting the expiration valve..................................................................... 86

Inserting the expiration valve...................................................................... 86

Fitting the flow sensor............................................................................... 87

Fitting the O2 sensor................................................................................. 87

Note on the use of heat and moisture exchangers...................................... 88

Note on the use of bacterial filters..............................................................88

For ventilating adults and children..............................................................89

For ventilating infants.................................................................................91

Supply and Connections..........................................................................92

Electrical power supply..............................................................................92

Gas supply................................................................................................93

Evita Remote (optional).............................................................................94

Connection................................................................................................94

Note automatic self-test............................................................................. 95

Nurse call (optional)..................................................................................96

Technical Data...........................................................................................96

Before Using for the First Time............................................................... 97

Device Check...........................................................................................97

Preparing the device check....................................................................... 97

Performing the device check......................................................................99

Device.....................................................................................................101

Leakproofing...........................................................................................103

Maintenance Intervals............................................................................107

Clean or replace cooling air filter............................................................. 107

Removing and reinserting ambient-air filter...............................................108

Correct disposal of batteries and O2 sensors.......................................... 108

Correct disposal of apparatus................................................................. 108

Description.............................................................................................109

Ventilation Modes.................................................................................. 110

Volume-controlled ventilation with PLV.....................................................110

Sigh (intermittent PEEP)..........................................................................111

SIMV.......................................................................................................112

ASB........................................................................................................113

BIPAP.....................................................................................................114

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Contents

BIPAPAssist............................................................................................. 115

MMV.......................................................................................................116

Flow measurement..................................................................................117

Automatic leakage compensation.............................................................119

Rapid Shallow Breathing RSB.................................................................121

Negative Inspiratory Force NIF................................................................ 121

Insp. O2 concentration during

medicament nebulisation...................................................................... 122

Bibliography...........................................................................................123

What's what........................................................................................... 125

Control unit............................................................................................. 126

Front connection block for ventilation.......................................................127

Back panel..............................................................................................128

Abbreviations......................................................................................... 129

Symbols................................................................................................. 132

Technical Data....................................................................................... 133

Environmental conditions.........................................................................134

Settings.................................................................................................. 134

Performance data....................................................................................135

Measured value displays..........................................................................136

Monitoring...............................................................................................137

Operating data........................................................................................ 138

Parts List / Order List.............................................................................141

Parts List................................................................................................ 142

For adult ventilation ................................................................................ 142

For paediatric ventilation .........................................................................143

Order List............................................................................................... 144

Index...................................................................................................... 146

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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. 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".

For Your Safety and that of Your Patients

Accessories

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

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.

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 authorised 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 Medical AG & Co. KGaA

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For Your Safety and that of Your Patients Safe use of the equipment

Safe use of the equipment

This equipment must only be used under the supervision of qualified medical staff, so that help is available immediately if any faults or malfunctions occur.

This equipment must not be used with flammable gases or anaesthetic agents. Danger of fire!

Do not use mobile telephones within 10 metres of ventilators!

Mobile telephones may impair the functioning of electromedical equipment and endanger the patient1).

Appropriate ventilation monitoring The built-in monitoring facilities of Evita 2 dura ensure

appropriate monitoring of ventilation therapy and therefore detect any undesirable changes in the following ventilation parameters:

– Airway pressure, Paw – Expiratory minute volume, MV – Inspiratory O2 concentration, FiO2 – Inspiratory breathing gas temperature, T – Expiratory CO2 concentration, etCO2 (optional) – Inspiratory breathing volume, VTI – Apnoea time – Tachypnoea monitoring

Back-up ventilation with an independent manual ventilation device

If a fault is detected in Evita 2 dura so that its life-support functions are no longer assured, ventilation using an independent ventilation device must be started without delay – if necessary with PEEP and/or increased inspiratory O2 concentration (e.g. with the Dräger Resutator 2000).

Changes in these parameters may be caused by: – Acute changes in the patient's condition

– Incorrect settings and faulty handling – Equipment malfunctions – Failure of power and gas supplies

If a fault occurs in this equipment, separate measuring instruments should be used.

1) Dräger medical equipment meets the requirements for immunity to interference in accordance with the specific product standards and EN 60601-1-2 (IEC 601-1-2). Depending on the type of mobile telephone used and on the application situation, however, field strengths exceeding the values specified in the applicable standards may develop in the immediate vicinity of the mobile telephone and therefore lead to faults and malfunctions.

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Intended Medical Application

Contents

Intended Medical Application

Contents

Intended Medical Application.................................................................. 12

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Intended Medical Application

Evita 2 dura

Long-term ventilator for intensive care. For adults, children and neonates.

With the following ventilation modes: IPPV Intermittent Positive Pressure Ventilation

controlled and assisted constant-volume ventilation. With the options: – CPPV (Continuous Positive Pressure Ventilation) – PLV (Pressure Limited Ventilation) – AutoFlow

for automatic regulation of inspiration flow

– IRV (Inversed Ratio Ventilation)

SIMV Synchronized Intermittent Mandatory Ventilation Procedure for weaning patients off the ventilator after they have started spontaneous breathing. With the options: – PLV (Pressure Limited Ventilation) – AutoFlow (optional)

for automatic regulation of inspiration flow

MMV Mandatory Minute Volume Ventilation Spontaneous breathing with automatic adjustment of mandatory ventilation to the patient's minute volume requirement. With the options: – PLV (Pressure Limited Ventilation) – AutoFlow (optional)

for automatic regulation of inspiration flow

*

(optional)

BIPAPAssist (Biphasic Positive Airway Pressure Assisted) Pressure-controlled assisted ventilation

APRV Airway Pressure Release Ventilation (optional) Spontaneous breathing on two pressure levels with long time ranges – independently adjustable.

Special modes:

Apnoea Ventilation

For switching over automatically to volume-controlled mandatory ventilation, if breathing stops. If apnoea occurs, Evita 2 dura emits an alarm after the preset alarm period (TApnoea > ) and starts volumecontrolled ventilation.

ILV (optional) Independent Lung Ventilation

Separate, differentiated, synchronised ventilation with two Evita units, one for each lung.

Diagnostics Intrinsic PEEP-measurement (optional)

for determining intrinsic PEEP and measuring trapped volume.

Occlusion pressure measurement (optional) for evaluating breathing drive during spontaneous breathing.

SB Spontaneous Breathing Spontaneous breathing at ambient pressure

CPAP Continuous Positive Airway Pressure Spontaneous breathing with positive airway pressure

ASB Assisted Spontaneous Breathing Pressure-assisted spontaneous breathing

BIPAP* Biphasic Positive Airway Pressure Pressure-controlled ventilation combined with free spontaneous breathing during the complete breathing cycle, and adjustable pressure increase to CPAP level.

–––––––––––

* Registered trade mark

With monitoring for

airway pressure, Paw expiratory minute volume, MV inspiratory O2 concentration, FiO2 inspiratory breathing gas temperature, T expiratory CO2 concentration, etCO2 (optional) functional O2 saturation and heart rate (optional) inspiratory breathing volume, VTI apnoea time tachypnoea monitoring to detect rapid, shallow spontaneous breathing

Automatic gas switch-over

In the event of a gas failure, the change-over to another gas is automatic.

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Operating Concept

Contents

Operating Concept

Contents

Ventilation Controls................................................................................ 14

Setting ventilation parameters...................................................................14

Selecting the ventilation mode.................................................................. 14

Screen Operating Controls.....................................................................15

Keys for routine and additional functions...................................................15

Power switch........................................................................................... 16

Standby key »O «.................................................................................... 16

Screen Pages..........................................................................................17

Structure of the main page....................................................................... 17

Structure of the application-specific pages................................................17

»Settings«.................................................................................................18

»Alarms«...................................................................................................18

»Measurements«.......................................................................................18

»Calibration / Configuration«.....................................................................19

Colour screen......................................................................................... 20

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Operating Concept Ventilation Controls

Ventilation Controls

1 Keys for selecting the ventilation modes:

– IPPV – SIMV – BIPAP and – other modes

2 Keys for selecting / setting ventilation parameters:

– Tidal volume VT – Inspiration time Tinsp – Frequency f – Inspiratory flow Flow – Inspiratory pressure Pinsp – Pressure-assisted spontaneous breathing ∆PASB – Positive end-expiratory pressure PEEP – Pressure rise time Ramp –O2 concentration O2 – Sensitivity Trigger

3 Central "turn-and-push" rotary knob for setting the

parameters: To set = turn the rotary knob To confirm setting = press the rotary knob.

Evita 2 dura

Setting ventilation parameters

2 To set a ventilation parameter = press the

corresponding parameter key. The yellow LED in the key lights up.

3 To set the value of the ventilation parameter =

turn the rotary knob. The value is displayed next to the parameter key.

3 To confirm the value = press the rotary knob.

The yellow LED goes out.

Selecting the ventilation mode

1 Hold down the appropriate key for about 3 seconds

or press the appropriate key briefly and confirm = press the rotary knob.

The selected ventilation mode will now be activated.

For detailed instructions on setting the ventilation modes, see page 25.

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Screen Operating Controls

1 Menu keys for selecting the menu on the screen. 2 Central "turn-and-push" rotary knob for selecting and

setting the options displayed on the screen. To select/set = turn the rotary knob

To confirm = press the rotary knob.

3 Screen operating keys:

»Print « key for manual printer logging, » « key for setting the screen brightness to

bright or dark, »Freeze « key for freezing the curves, »Curves « key for displaying a different pair of

curves, »Values « key for displaying a different

combination of measured values, one reserve key for future functions.

1 2

Operating Concept

Screen Operating Controls

Evita 2 dura

Keys for routine and additional functions

4 Frequently used keys for routine functions are

positioned on the right-hand side of the front panel: »g « key for suppressing the audible alarm tone,

»Alarm Reset« key for resetting or acknowledging alarm messages,

» « key for calling up information and help on the desired setting,

» « key for protecting against inadvertent or unauthorised modification of the settings of the ventilation parameters or ventilation modes.

5 Keys for additional functions are positioned on the

left-hand side of the front panel: » « key for switching the medicament nebuliser

on / off, »

O2 Suction«

bronchial suction. »Insp. hold« for manually activated inspiration, »Exp. hold« for extending the expiration time, one reserve key for future functions.

key for oxygen enrichment during

Evita 2 dura

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Operating Concept Power switch Standby key » O«

Power switch

To switch the apparatus on / off. Located on the back panel, with a covering flap to protect the switch from being switched off inadvertently.

Standby key »O «

Placed on its own, away from other keys. For keeping the apparatus on standby

or for switching on ventilation.

To switch to standby:

● Press and hold down the »O « key for at least

3 seconds.

To switch on ventilation:

● Briefly press and release the »O « key.

Evita 2 dura

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Screen Pages

The screen pages consist of two basic structures: – the main page, displaying all important ventilation

characteristics at a glance and

– the application-specific pages for functions and

settings.

Important functions are displayed in the same position in both structures:

– active ventilation mode and patient mode – alarm, warning and advisory messages – field for the menu selection keys – information and help.

Operating Concept

Screen Pages

➀ ➁

Structure of the main page

➀ Line for the active ventilation mode, patient mode

and trigger indicator.

➁ Bar for alarm, warning and advisory messages ➂ Field for menu selection keys ➃ Field for measured values ➄ Field for curves ➅ Bar for information and help

Structure of the application-specific pages

➀ Bar for the currently active ventilation mode and

patient mode (example: BIPAP)

➁ Field for displaying the selected menu ➂ Field for the menu bar ➃ Bar for the alarm, warning and advisory messages

➅ ➄ ➃ ➂

➀ ➅ ➆ ➁

➄ Field for menu selection keys ➅ Bar for information and help ➆ Screen field, selectable with the rotary knob ➇ Screen key, selectable with the rotary knob ➈ Field for continuous pressure display and monitoring

➄ ➇ ➈ ➂ ➃

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Operating Concept Screen Pages

The menu keys on the right-hand edge of the screen select the screen pages for the following specific application situations:

– Settings – Alarms – Measurements – Measurement manoeuvre (optional) – Calib./Config.

»Settings«

– For setting apnoea ventilation. – For setting intermittent PEEP. For detailed operating instructions, see "Setting

ventilation modes" on page 25 onwards.

Evita 2 dura

»Alarms«

– For displaying the measured values with their alarm

limits. – For setting the alarm limits. For detailed operating instructions, see "Setting alarm

limits" on page 37.

»Measurements«

– For displaying all the measured values in the current

ventilation mode. Press the »Table jj« screen key to display more option

measured values in »Table 2«.

001 37 253

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»Calibration / Configuration«

Sensors

– Calibrating the sensors for O2 and flow – Switching the monitoring system on and off

Device

– Setting the volume of the acoustic alarm – Setting the screen contrast – Setting the date and time – Selecting language and measurement units – Setting the external interfaces

Display

– Selecting 2 x 6 measured values from the main page – Selecting 2 x 2 curves from the main page

Operating Concept

Screen Pages

Ventilation

– Patient mode – Ventilation mode – Ventilation parameters – Alarm limits.

Page 20

Colour screen

For differentiating various items of information on the screen.

For messages:

Red = Alarm Yellow = Caution or advisory message Blue = Alarm is no longer active

Example: "!!! Apnoea" alarm

For menu buttons:

Green = Can be selected Black = Has been selected

Example: Menu button »Device ++«

For screen keys: Green "LED" in the screen key = function not active

002 37 253003 37 253004 37 253

Yellow "LED" in the screen key = function active Example: Screen key »Flow« – function active

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Operation

Contents

Operation

Contents

Starting up.............................................................................................. 22

Switching on............................................................................................ 22

Patient mode............................................................................................ 22

Selecting the patient mode....................................................................... 23

Starting ventilation.................................................................................... 24

Setting Ventilation Modes.......................................................................25

IPPV.........................................................................................................27

SIMV, SIMV/ASB.....................................................................................29

BIPAP, BIPAP/ASB................................................................................. 31

BIPAPAssist.............................................................................................. 32

CPAP, CPAP/ASB.................................................................................. 33

MMV, MMV/ASB..................................................................................... 34

Apnoea ventilation.................................................................................. 36

Setting Alarm Limits................................................................................37

In the Event of an Alarm......................................................................... 38

Warning................................................................................................... 38

Caution.................................................................................................... 38

Advisory................................................................................................... 38

Suppressing the audible alarm..................................................................39

Information .......................................................................................... 39

Displaying Curves and Measured Values............................................... 40

In the main page.......................................................................................40

Display measured values.......................................................................... 41

Curve freezing..........................................................................................42

Special Functions................................................................................... 43

Manual inspiration.....................................................................................43

Manual expiration hold..............................................................................43

Medicament nebulisation.......................................................................... 44

Oxygen enrichment for bronchial suction.................................................. 47

Switching to Standby/Terminating standby mode................................. 49

Calibrating...............................................................................................50

Calibrating the O2 sensor manually...........................................................50

Calibrating the flow sensor manually.........................................................51

External flow source................................................................................. 52

Switching off the monitor functions....................................................... 53

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Operation Starting up

Starting up

Switching on

● Push in power switch on back panel until it clicks into

place = ON.

The flap comes down over the switch to prevent it

being inadvertently switched off. Evita 2 dura runs a self-test.

● Wait until the 10-second test phase is complete.

Patient mode

After switching on, Evita 2 dura displays a choice of patient modes:

–»Adults« = adult patients –»Paed.« = children –»Neo.« = neonates

(when using the "NeoFlow" option) –»prev. patient« = previous patient

Example:

Adult ventilation

With this information, Evita 2 dura defines the adjustment ranges and the start-up values of the ventilation parameters.

The starting procedure, with selection of the patient mode, can be configured by the user, see Configuration on page 55 onwards.

005 37 253

Page 23

The screen key »prev. patient« can be used to restore the specific patient settings, including alarm limits and monitoring status, effective before switching off the device.

Example:

Previous patient

The previous modes are displayed in the status line: – Previous ventilation mode (example: IPPV)

– Previous patient mode (A = Adult) – Previous application mode – tube or mask for

optional NIV (example: NIV)

The key »prev. patient« is not displayed by Evita 2 dura following a loss of data or removal of a previously used option (e.g. NeoFlow), thus preventing restoration of the previous setting.

Operation

Starting up

032 37 253

Selecting the patient mode

Either:

● Select the »Adults« key

or the »Paed.« key or the »Neo.« key (NeoFlow option) = turn rotary knob.

● Confirm = press rotary knob.

or:

● Select the key »prev. patient« = turn rotary knob.

● Confirm = press rotary knob.

Page 24

Operation Starting up

Starting ventilation

Evita 2 dura starts ventilation with the ventilation mode configured by the user and with the specific start settings for the patient or with the settings valid before the machine was last switched off. To select other start-up settings, see page 63. If no selection is made or if the rotary knob is not pressed to confirm the new settings, the apparatus automatically starts ventilation after 30 seconds with the last selected patient mode and ventilation mode and the associated ventilation parameters.

The main page is displayed on the Evita 2 dura screen. The user can check and correct the settings in the

display fields next to the parameter keys.

006 37 253

Page 25

Setting Ventilation Modes

To set the ventilation parameters: 1 Press the appropriate ventilation mode key. The

yellow LED in the key will light up.

2 Set the desired value = turn the rotary knob.

Confirm value = press the rotary knob. The yellow LED will go out.

Operation

Setting Ventilation Modes

Evita 2 dura

If the setting is at the upper or lower limit of the adjustment range for a parameter, the LED in the relevant key will start flashing

2 Acknowledge = press the rotary knob. If you fail to confirm/acknowledge the new settings within

30 seconds, the previous settings will remain operative.

Setting parameters for another ventilation mode 1 Press the relevant ventilation mode key briefly.

Its LED will flash. In the block of parameter keys, the keys for the

parameters relevant to the new ventilation mode will start flashing.

Set the new ventilation parameters: 1 Press the relevant key: its LED will stop flashing and

remain constantly lit.

2 Set the desired value = turn the rotary knob.

Confirm value = press the rotary knob. The yellow LED will go out.

To activate the ventilation mode: 3 Ventilation mode keys:

– IPPV – SIMV – BIPAP and – other modes.

4 »Other Modes« key for other ventilation modes that

are set on the screen. Factory-set default: CPAP/ASB.

● Hold down the relevant key for 3 seconds,

● Briefly press and release the relevant key and

press the rotary knob.

The selected ventilation mode will now be active.

Evita 2 dura

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Operation Setting Ventilation Modes

To prevent settings being changed inadvertently

1 Press the » « Its yellow LED will light up. The

parameter keys and ventilation mode keys will be

protected against inadvertent setting.

Before setting a new value: 1 Press the » « key. The yellow LED will go out.

Evita 2 dura

Page 27

IPPV

Intermittent Positive Pressure Ventilation

Volume-controlled ventilation with a fixed mandatory minute volume MV, set with the tidal volume VT and frequency f.

For patients unable to breathe spontaneously.

Paw

Operation

Setting Ventilation Modes

IPPV

Insp. pause

Pplat

● Set ventilation pattern for IPPV via the keys for the

ventilation parameters:

Tidal volume »VT« Insp.Flow »Flow«

Frequency »f« Inspiration time »Tinsp«

O2 concentration »O2« Positive end-expiratory pressure »PEEP«

IPPV can be supplemented by the following ventilation parameters:

Trigger (IPPV Assist) – for synchronising mandatory ventilation with attempted spontaneous breathing by the patient. By activating the trigger and setting the trigger sensitivity, the mandatory ventilator strokes are synchronised with the patient's spontaneous breathing attempts.

The trigger can be switched off if synchronisation with the patient's spontaneous breathing attempts is not required.

Flow

insp Te

Insp.Flow

To activate / set:

● Press ventilation parameter key »Trigger«.

● Set value = turn the rotary knob,

Confirm value = press the rotary knob.

To deactivate:

● Set a value less than 0.3 or above 15 L/min.

The display will show: – – –

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Operation Setting Ventilation Modes IPPV

Sigh – to prevent atelectasis.

Atelectasis can be prevented by activating the Sigh function and setting the sigh in the form of an intermittent PEEP. When the Sigh function is activated, the end-expiratory pressure is increased by the set intermittent PEEP for 2 ventilation strokes every 3 minutes.

Pmax

IPPV can be supplemented by the ventilation parameter Pmax.

● Activate »Pressure limit Pmax«, see page 64.

● Set value Pmax via the key for the ventilation

parameter »Pinsp«.

Pressure limited ventilation PLV* – for manually limiting

pressure peaks to the pressure limit Pmax. The tidal volume remains constant as long as the pressure curve continues to show a short pressure plateau and the flow curve shows a brief pause in the flow between inspiration and expiration. Volume monitoring is constantly active. If the set tidal volume VT can no longer be applied, the alarm "Volume not constant" is automatically generated.

When changing from IPPV to a pressure-controlled ventilation mode, the value of Pmax is adopted but is limited to 50 mbar (the display for the »Pinsp« ventilation parameter flashes).

● Confirm value = press the rotary knob

or set a higher value.

Paw

Flow

max

PEEP

–––––––––––––

* For a detailed description of PLV, see page 110.

Page 29

SIMV, SIMV / ASB

Synchronized Intermittent Mandatory Ventilation* Assisted Spontaneous Breathing**

Fixed mandatory minute volume MV, set with the tidal volume VT and frequency f. The patient can breathe spontaneously between the mandatory ventilation strokes, thereby contributing to the overall minute volume. Spontaneous breathing can be assisted by ASB.

For patients with insufficient spontaneous breathing or patients being weaned from artificial ventilation by progressive reduction of the mandatory proportion of the total minute volume.

The frequency can be reduced to 0 during the weaning process. The machine automatically changes to ventilation mode CPAP or CPAP/ASB. This ventilation mode is also displayed.

Set the ventilation pattern for SIMV via the keys for the ventilation parameters:

Paw

Flow

Operation

Setting Ventilation Modes

SIMV, SIMV / ASB

ASB pressure support

Pmax

PEEP

insp

Insp.Flow

fast rise time

Trigger window

slow rise time

Tidal volume »VT« Insp.Flow »Flow«

Frequency »f« At f = 0/min, the ventilator switches to CPAP mode.

Inspiration time »Tinsp« Sensitivity »Trigger« O2 concentration »O2«

Positive end-expiratory pressure »PEEP«

Additionally for SIMV / ASB: Pressure support »PASB«

Pressure rise time »Ramp«

SIMV, SIMV / ASB can be supplemented with the following ventilation parameters:

Apnoea ventilation – for automatic switchover to volumecontrolled mandatory ventilation if the patient stops breathing. If breathing stops, Evita 2 dura activates an alarm after the set alarm time (TApnoea > ) and starts volume- controlled ventilation with the set ventilation parameters: Frequency »fApnoea« Tidal volume »VTApnoea«

The patient can breathe spontaneously during apnoea ventilation. The apnoea ventilation frequency remains constant.

Set apnoea ventilation, see page 36.

Paw

Flow

Spontaneous breathing with ASB pressure support

fast rise time

slow rise time

Apnoea alarm time / T

Start of Apnoea Ventilation

PEEP

Apnoea >

* For a detailed description of SIMV, see page 112. ** For a detailed description of ASB, see page 113.

Page 30

Operation Setting Ventilation Modes SIMV, SIMV / ASB

Pmax

SIMV, SIMV / ASB can be supplemented with the ventilation parameter Pmax

● Activate »Pmax pressure limit«, see page 64.

● Set the value of Pmax with the »Pinsp.«

Pressure limited ventilation PLV* – for manually limiting pressure peaks using the Pmax pressure limit. The tidal volume remains constant as long as the pressure curve continues to show a short plateau, and the flow curve shows a brief pause in the flow between inspiration and expiration. Volume monitoring is constantly active. If the set tidal volume VT can no longer be applied, the alarm "Volume not constant" is automatically generated.

––––––––––––

* For a detailed description of PLV, see page 110.

Page 31

BIPAP, BIPAP / ASB

Biphasic Positive Airway Pressure Assisted Spontaneous Breathing

Pressure-controlled ventilation combined with free spontaneous breathing during the complete breathing cycle, supported by adjustable additional pressure at CPAP level. The mandatory proportion of the total minute volume MV is set by means of the inspiration pressure Pinsp, PEEP and frequency f.

Adaptable to a wide range of patients, from those unable to breathe spontaneously at all to those breathing spontaneously before extubation. Suitable for weaning patients from artificial ventilation by progressively reducing the mandatory fraction of the minute volume MV and by reducing the additional artificial pressure support PASB.

The frequency can be reduced to 0 during the weaning process. The machine automatically changes to ventilation mode CPAP or CPAP/ASB. This ventilation mode is also displayed.

PEEP

Paw

fast rise time

Flow

spontaneous breathing

Tinsp

without

Pinsp

Setting Ventilation Modes

slow rise time

Trigger window for insp. and exp. synchronisation

spontaneous breathing

Operation

BIPAP, BIPAP / ASB

ASB

pressure assist

fast rise time

with

slow rise time

Set the ventilation pattern for BIPAP via the keys for the ventilation parameters:

Inspiration pressure »Pinsp« If Pinsp is set to the same value as PEEP, the machine changes over to CPAP mode.

Frequency »f« If f = 0/min, the apparatus switches over to CPAP mode.

Inspiration time »Tinsp« Sensitivity »Trigger« O2 concentration »O2«

Positive end-expiratory pressure »PEEP«

Additionally for BIPAP/ASB: Pressure support »PASB«

Pressure rise time »Ramp«

BIPAP, BIPAP/ASB can be supplemented with the following ventilation parameters:

Apnoea ventilation – for automatic switchover to volumecontrolled mandatory ventilation if the patient stops breathing. If the patient stops breathing, Evita 2 dura activates an alarm after the set alarm time (TApnoea > ) and starts volume-controlled ventilation with the set ventilation parameters: Frequency »fApnoea« Tidal volume »VTApnoea«

The patient can breathe spontaneously during apnoea ventilation. The apnoea ventilation frequency remains constant.

Set apnoea ventilation, see page 36.

Page 32

Operation Setting Ventilation Modes BIPAPAssist

BIPAPAssist

Biphasic Positive Airway Pressure Assisted

pressure-controlled, assisted ventilation The inspiratory strokes are the same as for BIPAP, but

the changeover from Pinsp to PEEP is not synchronised with expiration by the patient. The patient can breathe spontaneously at PEEP level through the entire ventilation process.

Every spontaneous breathing activity by the patient triggers a synchronised inspiratory stroke.

A non-synchronised inspiratory stroke is started by the device at the latest upon expiry of the time »f«.

For all patients, from those unable to breathe spontaneously to those breathing spontaneously before being weaned off the ventilator.

The set values for the relevant ventilation parameters are displayed alongside the keys for the ventilation parameters.

● Set the ventilation pattern for BIPAPAssist via the keys

for the ventilation parameters:

Inspiratory pressure »Pinsp«

Frequency »f«

Inspiration time »Tinsp«

O2 concentration »O2«

Positive end-expiratory pressure »PEEP«

Pressure rise time » «

Sensitivity »Trigger«

Absolute inspiratory pressure »Pinsp«

PEEP

Paw

fast rise time

Tinsp

Flow

spontaneous breathing

without

slow rise time

Pinsp

Trigger window

for synchronisation

with

spontaneous breathing

–––––––––––––––––––––––––––––––––––––––––––––––– To activate:

● Press menu button »other modes«.

When BIPAPAssist has been selected in the menu with the cursor:

● Hold the menu button »other modes« for approx.

3 seconds, or:

● Press the rotary knob.

Otherwise:

● Select BIPAPAssist = turn rotary knob,

activate = press rotary knob. The "LED" in the screen key »BIPAPAssist« changes from

green to yellow. Ventilation mode BIPAPAssist is now active and displayed in the status line. ––––––––––––––––––––––––––––––––––––––––––––––––

Page 33

CPAP, CPAP / ASB

Continuous Positive Airway Pressure Assisted Spontaneous Breathing

Spontaneous breathing at a raised pressure level, to increase the functional residual capacity FRC. Spontaneous breathing can be assisted with additional pressure by ASB.

For patients breathing spontaneously.

● Set the ventilation pattern for CPAP via the keys for

the ventilation parameters: O2 concentration »O2«

Positive end-expiratory pressure »PEEP« Additionally, for CPAP/ASB: Pressure support »PASB«

Pressure rise time »Ramp« Sensitivity »Trigger«

–––––––––––––––––––––––––––––––––––––––––––––––– To activate:

● Press menu button »other modes«.

Spontaneous breathing with ASB pressure support

Paw

fast rise time

Flow

Start of

slow rise time

Apnoea alarm time / T

Apnoea >

Apnoea Ventilation

Operation

Setting Ventilation Modes

CPAP, CPAP / ASB

PEEP

When CPAP/ASB has been selected in the menu with the cursor:

● Hold the menu button »other modes« for approx.

3 seconds,

or:

● Press the rotary knob.

Otherwise:

● Select CPAP/ASB = turn rotary knob,

activate = press rotary knob.

The "LED" in the screen key »CPAP/ASB« changes from green to yellow. Ventilation mode CPAP/ASB is now active and displayed in the status line. –––––––––––––––––––––––––––––––––––––––––––––––– CPAP/ASB can also be activated when frequency f = 0 in SIMV or BIPAP.

CPAP, CPAP/ASB can be expanded with the following ventilation parameters:

Trigger – for synchronising ventilation with attempted spontaneous breathing by the patient. By activating the trigger and setting the trigger sensitivity, the assisting ventilator strokes are synchronised with the patient's own spontaneous breathing attempts.

007 37 253

To set apnoea ventilation, see page 36.

Page 34

Operation Setting Ventilation Modes MMV, MMV / ASB

MMV, MMV / ASB

Mandatory Minute Volume Ventilation* Assisted Spontaneous Breathing

The overall minute volume is preset to a mandatory level, which can be adjusted by means of the tidal volume VT and frequency f. The patient can breathe spontaneously, thereby contributing a proportion of the total minute volume. The difference between the spontaneously breathed minute volume and the set minute volume is covered by the mandatory ventilation strokes. Spontaneous breathing can be assisted by the ASB pressure support.

This mode is intended for patients being weaned off the ventilator by progressively reducing the mandatory proportion of the total minute volume.

Paw

Flow

Tinsp

PEEP

Insp.Flow

ASB pressure support

Pmax

short rise time

Trigger phase

long rise time

● Set the pattern of ventilation for MMV with the

ventilation parameters: Tidal volume »VT«

Insp.Flow »Flow« Frequency »f«

Inspiration time »Tinsp« Sensitivity »Trigger« O2 concentration »O2«

Positive end-expiratory pressure »PEEP«

Additionally, for MMV / ASB: Pressure assist »PASB«

Pressure rise time »Ramp«

–––––––––––––––––––––––––––––––––––––––––––––––– To activate:

● Press menu button »other modes«.

When MMV has been selected in the menu with the cursor:

set

mandatory MV

no spontaneous breathing

beginning spontaneous breathing

spontaneously breathed MV

sufficient spontaneous breathing

● Hold the menu button »other modes« for approx.

3 seconds, or:

● Press the rotary knob.

Otherwise:

● Select MMV = turn rotary knob,

activate = press rotary knob. The "LED" in the screen key »MMV« changes from green

to yellow. Ventilation mode MMV is now active and displayed in the status line. ––––––––––––––––––––––––––––––––––––––––––––––––

____________ For a detailed description of MMV, see page 116.

007 37 253

Page 35

Pmax

MMV, MMV/ASB can be supplemented with the ventilation parameter Pmax.

● To activate »Pmax pressure limit«, see page 64.

Operation

Setting Ventilation Modes

MMV, MMV / ASB

––––––––-––––––

* For a detailed description of PLV, see page 110.

Page 36

Operation Apnoea ventilation

Apnoea ventilation

For automatic switch-over to volume-controlled mandatory ventilation if the patient stops breathing. It can be switched on in the ventilation modes SIMV, BIPAP, CPAP, APRV. Evita 2 dura emits an apnoea alarm if during the set alarm period »TApnoea« no expiration flow is measured or insufficient inspiratory gas is delivered. If breathing stops, Evita 2 dura emits an alarm after the set alarm time (TApnoea > ) and starts volume-controlled ventilation with the set ventilation parameters: Frequency »fApnoea« Tidal volume »VTApnoea«

The ventilation parameters »O2« and »PEEP« correspond to the settings effective at the time. The inspiration time for apnoea ventilation is determined from the set apnoea frequency »fApnoea« and a fixed I:E ratio of 1:2.

As in SIMV, the patient can breathe spontaneously during apnoea ventilation and the mandatory ventilation strokes will be synchronised with the patient's spontaneous breathing. The apnoea ventilation frequency remains constant.

Paw

Spontaneous breathing with ASB pressure support

apnoea alarm time

Apnoea >

Flow

Start of apnoea ventilation

PEEP

Apnoea

–––––––––––––––––––––––––––––––––––––––––––––––– To set apnoea ventilation:

● Press menu button »Settings«.

Display:

● Select screen key »Apnoea vent.« = turn rotary knob.

Switch on apnoea ventilation = press rotary knob.

The "LED" in the screen key changes from green to

yellow = apnoea ventilation is on.

● Select field »VTApnoea« = turn rotary knob,

activate = press rotary knob.

● Set values = turn rotary knob,

confirm = press rotary knob.

● Select, set and confirm »fApnoea« accordingly.

–––––––––––––––––––––––––––––––––––––––––––––––– To terminate apnoea ventilation:

● Press »Alarm Reset« key. The machine will continue

operating in its previous ventilation mode.

● Select another ventilation mode.

008 37 253

See page 65 for configuration of the apnoea ventilation status when starting the machine.

Page 37

Setting Alarm Limits

● Press the »Alarms« menu key.

Example display: »Limits« This page displays all the alarm limits that can be

set/adjusted. = lower alarm limit

= upper alarm limit

Example: Setting the upper alarm limit for fspont.

● Select the fspont screen field with the cursor = turn the

rotary knob. Confirm = press the rotary knob.

Operation

Setting Alarm Limits

● Set the desired value = turn the rotary knob.

Confirm = press the rotary knob.

The lower alarm limit does not have to be set for the airway pressure Paw, because it is automatically coupled with the PEEP setting.

The alarm limits do not have to be set for the O2 concentration. These limits are automatically coupled to the O2 concentration setting.

Lower alarm limit: for settings up to 60 Vol.% O2: setting –4 Vol.% O2 for settings from 60 to 100 Vol.% O2: setting –6 Vol.% O2

Upper alarm limit: for settings up to 60 Vol.% O2: setting +4 Vol.% O2 for settings from 60 to 100 Vol.% O2: setting +6 Vol.% O2

Adjustment ranges

Ventilation Parameter Adjustment Range Factory setting Hospital-specific setting*

MVtotal L/min

0.1 to 41

0.01 to 40

MVtotal +50 % MVtotal –20 %

....

009 37 253

Paw mbar

VTi L

TApnoea s

fspont 1/min 5 to 120

* The hospital-specific settings for your hospital can be entered in the table.

10 to 100 no lower alarm limit

0.021 to 4.0 no lower alarm limit

5 to 60 no lower alarm limit

no lower alarm limit

VTi + 100 %

....

Page 38

Operation In the Event of an Alarm

In the Event of an Alarm

1 the red or yellow LED flashes. 2 The alarm message is displayed in the right-hand

corner of the top line of the screen. Evita 2 dura assesses the alarm message according to

its priority, marks the text with exclamation marks and generates the various alarm tone sequences.

Warning = top priority message

1 The red LED flashes.

Warning messages are marked with three exclamation

marks.

Example: !!! Apnoea

Evita 2 dura generates a five-tone sequence that is

sounded twice and repeated every 7 seconds.

Caution = medium priority message

3 The yellow LED flashes.

Caution messages are marked with two exclamation

marks.

Example: !! Check settings

Evita 2 dura generates a 3-tone sequence that is

repeated every 20 seconds.

Advisory = low priority message

3 The yellow LED lights up and remains constantly lit.

Caution messages are marked with one exclamation

mark.

Example: ! Malfunction fan

Evita 2 dura generates a 2-tone sequence that sounds

only once.

If the loudspeaker for audible alarms fails on account of a defect, an auxiliary signal will sound continuously. This continuous tone also serves as power failure alarm, see page 92, if power is interrupted while the ventilator is in use.

To remedy the faults, please refer to the "Fault – Cause – Remedy" section starting on page 72.

Page 39

Operation

In the Event of an Alarm

Once the fault has been remedied, the audible alarm is switched off. Caution messages (!!) and advisory messages (!) disappear automatically.

Alarm messages (!!!) are then displayed in the colour of the status line and must be acknowledged:

1 Press the »Alarm Reset« key.

The message is erased from the screen.

Suppressing the audible alarm

for max. 2 minutes: 2 Press the »g « key. Its yellow indicator LED lights up,

and the alarm tone will be muted for 2 minutes. If the fault that triggered the alarm is still not remedied, the audible alarm starts up again after this period.

Evita 2 dura

2 3

If you wish to reactivate the audible alarm before the end of the 2-minute muting period:

2 Press the »g « key again. The yellow LED will now

go out. The message remains on the screen.

3 Alarms which can be acknowledged via Alarm Reset

must be acknowledged via the »Alarm Reset« key, see "Fault – Cause – Remedy", page 72.

Information

– For help with system operation. – For help with troubleshooting. 4 Press the » « key: the required information is

displayed in the bottom line of the screen.

To erase the message: 4 Press the » « key again.

Evita 2 dura

Page 40

Operation Displaying Curves and Measured Values

Displaying Curves and Measured Values

In the main page

A set of six selectable measured values is displayed in the right-hand field, and two selectable curves in the left-hand field.

To select a second group of 6 measured values: 1 Press the »Values « key.

To select another pair of curves: 2 Press the »Curves « key.

Measured values and curves can be selected, see "Combine displayed measured values", page 59 and "Combine displayed curves", page 61.

In the other screen pages, these curves and measured values are not displayed. The airway pressure is therefore continuously indicated by means of an analogue vertical bar display on the left-hand side of the screen.

1 2

006 37 253001 37 253

Evita 2 dura

Example: screen page "Measured values 1"

Page 41

Display measured values

● Press menu button »Measured values«.

Display example: »Table 1« Evita 2 dura displays the measured values and their units

of measure in the form of a table. The menu »Table 1« is displayed with all standard available measured values.

The measured value MVleak represents the leakage in L/min and is determined by Evita 2 dura by comparing the applied inspiratory minute volume with the measured expiratory minute volume. The measured value MVleak is used by Evita 2 dura for automatic correction of the applied tidal volume VTi and the flow and volume curves. This presupposes that leakage compensation has been activated, see page 66. For safety reasons, the measured values for the minute volume are not corrected.

To display the measured values of add-on features (e.g. "Evita 2 dura CapnoPlus"):

Operation

Display measured values

001 37 253

● Select the »Table 2« menu with the »Table jj« menu

key. Functional extensions of measured values, e.g. CapnoPlus CO2 monitoring, are displayed in further measured value tables.

The following are optionally displayed (upgrade SW4.n plus):

VTASB Inspiratory tidal volume during an ASB stroke RSB Rapid Shallow Breathing NIF Negative Inspiratory Force

010 37 253

1) For a detailed description of RSB, see page 121.

2) For a detailed description of NIF, see page 121. Use of NIF, see "Manual expiration", page 43.

Page 42

Operation Curve freezing

Curve freezing

To study the curve(s) in detail: 1 Press the »Freeze « key.

Evita 2 dura

To return to displaying new curve(s):

1 Press the »Freeze « key again.

006 37 253

Page 43

Special Functions

Manual inspiration

This function may be used in all modes except CPAP spontaneous breathing without ASB pressure support. An automatic ventilation stroke can be triggered independently of the starting time and extended up to a maximum of 15 seconds. Or: Between two automatic ventilation strokes, a ventilation stroke can be manually started and held for a maximum 15 seconds.

The pattern of the manually started ventilation stroke depends on the ventilation mode used.

For IPPV, SIMV and MMV: volume-controlled ventilation stroke, defined by the VT and Tinsp settings.

Operation

Special Functions

Manual inspiration

For BIPAP: pressure-controlled ventilation stroke, defined by the Pinsp and Tinsp settings.

For CPAP/ASB: pressure-controlled ventilation stroke, defined by the PASB setting.

1 Press and hold down the »Insp. hold« key for as long

as inspiration is required.

Either an automatic ventilation stroke that has just begun will be prolonged for as long as the key is held down, or a new ventilation stroke will be started and prolonged for as long as the key is held down – in each case for a maximum of 15 seconds.

Manual expiration hold

Active in all ventilation modes. For determining the weaning value NIF

Evita 2 dura

1 2

2 Hold down the »Exp. hold« key.

The expiration phase remains effective and Evita 2 dura determines the measured NIF value as long as the key is pressed. After 15 seconds, the system automatically interrupts the expiration phase.

1) For a detailed description of NIF, see page 121.

Page 44

Operation Special Functions Medicament nebulisation

Medicament nebulisation

During adult ventilation

Applicable in every ventilation mode. Evita 2 dura applies the medicament aerosol in synchronisation with the inspiratory flow phase and maintains the minute volume constant.

Depending on the set O2 concentration, the ventilator supplies the medicament nebuliser with medical air, pure oxygen or a mixture of medical air and oxygen. Deviations in O2 concentration are therefore kept to a minimum.

In extreme cases (with a minimum inspiration flow of 15 L/min), the deviations can be up to ±4 % by volume*. To avoid greater deviations, medicament nebulisation is automatically switched off with inspiration flows of less than 15 L/min.

During paediatric ventilation

Medicament nebulisation is possible in the pressurecontrolled paediatric ventilation modes.

In volume-controlled ventilation modes, medicament nebulisation is only possible with AutoFlow (optional extra).

Unlike in adult ventilation, the medicament nebuliser nebulises continuously in paediatric ventilation, but the aerosol generated during expiration does not reach the lungs.

Depending on the set O2 concentration, the medicament nebuliser is supplied by the ventilator with medical air, oxygen or a mixture of medical air and oxygen. Deviations in O2 concentration are therefore kept to a minimum.

We recommend that you do not use the medicament nebuliser at breathing rates of less than 12 bpm.

For breathing rates above 12 bpm, please refer to the graph on page 122 of these Instructions for Use.

The maximum possible deviations in O2 concentration are ±4 % by volume.

For breathing rates of less than 12 bpm, the deviations in O2 concentration may be much greater.

These deviations cannot be detected by the device's internal O2 concentration monitor.

_____________ * For a detailed description of the inspiratory O2 concentration during

medicament nebulisation, please refer to the Appendix, page 122.

Page 45

The medicament nebuliser is automatically switched off after 30 minutes. After administration of the aerosol, the flow sensor is automatically cleaned and calibrated in order to prevent malfunctions in flow measurement.

Use only medicament nebuliser 84 12 935 (white middle section).

Prepare the medicament nebuliser as specified in the specific Instructions for Use.

If other pneumatic medicament nebulisers are used, major deviations in tidal volume and inspiratory O2 concentration may be caused.

Operation

Special Functions

Medicament nebulisation

For use during adult ventilation 1 Connect the nebuliser to the inspiratory side

(temperature sensor side) of the Y-piece.

2 Connect the inspiration hose to the medicament

nebuliser.

● Place the medicament nebuliser in the vertical

position.

● Using hose clips, route the nebuliser hose back to

the ventilator along the expiratory hose.

For use during paediatric ventilation 3 Insert the catheter connector (ISO cone Ø 15 / Ø 11)

into the inlet of the medicament nebuliser.

4 Insert the adapter (ISO cone Ø 22 / Ø 11) into the

outlet.

5 Fit the corrugated hose (0.13 m long) on to the outlet

adapter.

6 Remove the corrugated hose of the hose set from

the inspiratory adapter of the Y-piece and connect it to the inlet adapter of the medicament nebuliser.

7 Connect the free end of the corrugated hose on

the nebuliser outlet to the inspiratory adapter of the Y-piece.

Page 46

Operation Special Functions Medicament nebulisation

1 Connect the nebuliser hose to the port on the front

panel of the Evita 2 dura.

● Fill the medicament nebuliser in accordance with its

specific Instructions for Use.

Warning: the effect of aerosols on sensors, filters and heat and moisture exchangers (HME) must be taken into account.

The measuring function of the flow sensor may be impaired. The flow resistance of filters is liable to increase and may impair ventilation.

Do not place a microbial filter on the nebuliser outlet during nebulisation!

During medicament nebulisation, do not use a heat and moisture exchanger (HME) at the Y-piece. Risk of increased breathing resistance!

2 Hold down key » « until the yellow LED lights up.

● Advisory message on the screen:

Nebuliser on!

Evita 2 dura

The nebuliser remains in operation for 30 minutes.

If you wish to interrupt medicament nebulisation before it is complete:

2 Press » « again. The yellow LED goes out,

the nebuliser will be switched off.

The flow sensor is then automatically cleaned and calibrated.

● Remove residual medicament. Strictly follow the

Instructions for Use of the medicament nebuliser.

Page 47

Oxygen enrichment for bronchial suction

To avoid any risk of hypoxia during bronchial suction, Evita 2 dura offers a programme for oxygen enrichment during the removal of secretions.

After the programme is started, Evita 2 dura ventilates the patient in the selected ventilation mode for an initial oxygen enrichment phase of 180 seconds. In adult mode, the ventilator supplies 100 % oxygen by volume, and in paediatric mode it delivers the set O2 concentration* plus 25 % (for example: setting = 60 % by vol.; administered = 75 % by vol.)

When the ventilator is disconnected for suction, Evita 2 dura interrupts the ventilation. During the suction time, the audible alarms are suppressed, so that the suction routine is not disturbed.

Operation

Special Function

Oxygen enrichment for bronchial suction

After suction and automatically recognised reconnection, Evita 2 dura delivers an increased O2 concentration for the final oxygen enrichment phase of 120 seconds. In adult mode, the O2 concentration is 100 % by volume. In paediatric mode, the enriched concentration is 25 % higher than the set concentration. During suction and for 2 minutes afterwards, the lower alarm limit for the minute volume is switched off.

Before suction 1 Hold down the »O2 Suction« key until the yellow

LED comes on. Evita 2 dura ventilates the patient in the set ventilation mode with increased O2 concentration: 100 % O2 by volume in adult mode, and a 25 % higher O2 concentration than the set value in paediatric mode. If no PEEP greater than 4 mbar is set, a PEEP of 4 mbar will be automatically activated. This PEEP enables the Evita 2 dura to detect subsequent disconnection. The other ventilation parameters remain unchanged.

● Display in the help line at the bottom edge of the

screen:

Evita 2 dura

O2 enrichment 180 s

The remaining time is counted down continuously. This initial oxygen enrichment lasts for a maximum of 180 seconds. During this time, Evita 2 dura waits for a disconnection for suction. If there is no disconnection after expiry of the 180 seconds, the oxygen enrichment programme is automatically terminated.

_____________ * For a detailed description of the inspiratory O2 concentration during

medicament nebulisation, please refer to the Appendix, page 122.

Page 48

Operation Special Function Oxygen enrichment for bronchial suction

After disconnection for suction

Evita 2 dura delivers a minimal flow for the duration of disconnection in order to detect the end of the disconnection phase automatically. In the help line at the bottom of the screen, the amount of time available for suction is continuously counted down (example):

Execute suction and reconnect 120 s

If suction is ended and ventilation reconnected within the displayed time, Evita 2 dura starts the final O2 enrichment phase.

Automatic interruption of oxygen enrichment

If there is still no reconnection after 120 seconds, the oxygen enrichment programme is reeminated. All alarms are immediately reactivated. Evita 2 dura immediately continues ventilating in the set ventilation mode.

After reconnection

Evita 2 dura continues ventilating in the set ventilation mode, except that for final oxygen enrichment the increased oxygen concentration of 100 % by volume for adults and 25 % above the set concentration for paediatric ventilation will continue to be delivered for 120 seconds.

● Message in the help line at the bottom of the screen:

Final O2 enrichment 120 s

The time remaining is counted down continuously.

To interrupt oxygen enrichment 1 Press the »O2 Suction« key again.

Evita 2 dura

Page 49

Selecting Standby Mode

No ventilation takes place in standby mode!

– to select the patient mode – to perform the device check – to maintain Evita 2 dura ready for operation – to preset ventilation parameters and alarm limits.

Switching to Standby

1 Hold down the » O « key for about 3 seconds.

The Standby alarm tone is sounded.

2 The »Alarm Reset« key can be used to switch off the

Standby alarm tone.

Operation

Selecting Standby Mode

Evita 2 dura

The standby alarm tone can no longer be muted with the »

« key.

Terminating standby mode

– to continue ventilation. 1 Press » O « key.

The LED goes out, and ventilation commences.

If the patient mode is changed while on standby, Evita 2 dura will determine new starting values for ventilation, see page 64.

Display (example):

011 37 253

Page 50

Operation Calibrating

Calibrating

The saved calibration / zeroing values remain stored even when the machine is switched off.

The pressure sensors for measuring the airway pressure are calibrated automatically.

The O2 sensor and flow sensor are calibrated automatically every day.

The flow sensor and O2 sensor can be calibrated manually at any time, even during ventilation.

Calibrating the O2 sensor manually

– Before operation, during the device check – After replacing the O2 sensor

(wait for the 15-minute warm-up time of the O2 sensor).

– If the measured value and set value deviate from each

other by more than 2 Vol.%.

The O2 sensor can be calibrated at any time, even during ventilation. The applied O2 concentration is not affected by the calibration process.

Make sure that the O2 supply of the device is on. Start calibration:

● Press the »Calib./Config.« menu key.

● Select the »O2« menu key = turn the rotary knob.

● Start »O2« calibration = press the rotary knob.

Display (example): Message in the help line at the bottom of the screen:

O2 calibration

After calibration is complete, the following message appears in the help line:

Calibration ok

012 37 253

Page 51

Calibrating the flow sensor manually

– Before operation, during the device check. – After replacing the flow sensor.

The flow sensor is cleaned and calibrated automatically after every use of the medicament nebuliser.

To start calibration:

● Avoid flammable gases (e.g. alcohol vapours after

disinfection).

● Press the »Calib./Config.« key.

● Select the »Flow« screen key = turn the rotary knob.

● Start calibration = press the rotary knob.

Operation

Calibrating

Display (example):

Evita 2 dura uses the next inspiration phase for the calibration. Short inspiration times are prolonged to about 1 second.

Message in the help line at the bottom of the screen:

Flow calibration

After calibration is complete, the following message appears in the help line:

Calibration ok

013 37 253

Page 52

Operation External flow source

External flow source

When a constant external flow of up to 12 L/min is applied (e.g. during medicament nebulisation with separate gas supply and not from Evita 2 dura or during separate tracheal gas insufflation), this flow can be determined by Evita 2 dura and the tolerance for the flow sensor monitoring parameters increased in order to prevent generation of the alarms "Flow measurement fault" and "Neo. flow measurement fault" (NeoFlow option) during these applications. The original measurement of the expiratory volume is continued: During an expiratory flow, Evita 2 dura measures a correspondingly higher value for VTe and MV.

To avoid alarms:

● Adjust the upper alarm limit for MV.

To determine the external flow:

● Press menu button »Calib./Config.«.

● Select the menu »Ext. Flow« via the menu button

»Sensor jj«.

● Select screen key »Measure« = turn rotary knob,

confirm = press rotary knob.

● Yellow LED lights up in the »Measure« key.

The external flow is calculated by Evita 2 dura. Display during calculation:

Determining external flow

Once the external flow has been determined, it is displayed by Evita 2 dura together with the time and date. The following message is simultaneously displayed by Evita 2 dura:

Confirm value via

● Confirm = press rotary knob.

Determination of the external flow is aborted by Evita 2 dura if it exceeds 12 L/min or if flow measurement by Evita 2 dura is faulty.

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When the external flow has been determined successfully, it is taken into account in the monitoring of the flow sensor: the yellow LED in the key »Extern. flow« lights up.

The advisory message

External flow !

is displayed as long as the external flow is taken into account by Evita 2 dura.

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When an external flow is not applied:

● Switch off: select key »Extern. flow« =

turn rotary knob, confirm = press rotary knob.

Once the external flow has been measured by Evita 2 dura, its inclusion can be reactivated at any time:

● Select screen key »Extern. flow« =

turn rotary knob, confirm = press rotary knob.

If the external flow changes:

● Press key »Measure« so that the external flow can be

redetermined by Evita 2 dura.

Operation

External flow source

Switching off the monitor functions

E.g. if a spent sensor cannot be immediately replaced.

● An adequate external monitoring function must

immediately be ensured!

Example: Switching off Flow Monitoring.

● Press the »Calib./Config.« menu key.

● Select »Sensor on/off« with the »Sensor jj«

menu key.

Example display:

● Select the »Flow on« screen line =

turn the rotary knob. Confirm = press the rotary knob.

● In the selection menu, select »off« =

turn the rotary knob. Confirm = press the rotary knob.

The corresponding measured values disappear. The alarm function is deactivated.

To switch the monitor function back on after replacing the sensor:

● Select »Flow off« screen line =

turn the rotary knob. Confirm = press the rotary knob.

● In the selection menu, select »on« =

turn the rotary knob. Confirm = press the rotary knob.

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Configuration