Ge R860 User Manual

CARESCAPE R860

Quick Reference Guide

Software Revision 10

User responsiblity

Refer to the User's Reference manual for step-by-step instructions. Read each component's User's Reference manual before using this system. All Warnings and Cautions are in the User's Reference Manual.

WARNING

Before using this system:

• Complete all of the preoperative tests.

• Test all other system components.

Introduction

Welcome

Thank you for choosing the GE Healthcare CARESCAPE® R860. Our goal is to provide you with the highest quality product and services available. This ventilator features a user interface specifically designed to streamline workflow while providing exceptional insight into patient needs.

Measured data definitions

Patient monitoring views show patient data measured by the ventilator and accessories.

Note

Some measured data can be viewed with different units. Set unit preferences on the Configuration > Units menu. See "Configuring units" in the "System configuration (Super User) and service" section.

Note

Some data is only available when an airway module with the required capabilities, such as spirometry and metabolics, is installed and warmed up.

Gases Data Definition Unit

FiO2 The percentage of oxygen that the

ventilator delivers to the patient.

EtO2 The percentage of oxygen exhaled,

measured at the end of expiration.

EtCO2 The percentage of carbon dioxide exhaled,

measured at the end of expiration.

FI-ET O2 The difference between inspiratory and

expiratory concentrations of oxygen.

Pulmonary Data Definition Unit

C The compliance of the patient’s respiratory

system measured during the breath cycle.

Cstat The static compliance of the patient’s

respiratory system measured during an inspiratory hold.

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%, kPa, or mmHg

ml/cmH2O, ml/ kPa, or ml/mbar

Pulmonary Data Definition Unit

Raw The average inspiratory and expiratory

airway resistance measured during the breath cycle.

PEEPe+i The sum of extrinsic and intrinsic positive

end expiratory pressures.

Time Constant The time needed for the lungs to deflate by

cmH2O/l/s, kPa/l/s, or mbar/l/s

cmH2O, kPa, or mbar

ms a certain amount or a percentage of volume.

• One Time Constant allows 63% of

volume to be exhaled.

• Two Time Constants allow for 86% of

volume to be exhaled.

• Three Time Constants allow for 95%

of volume to be exhaled.

• Four Time Contants allow for 98% of

volume to be exhaled.

Static PEEPi The pressure above PEEPe that remains

in the patient’s lungs, measured at the end

cmH2O, kPa, or

mbar of the expiratory phase during an expiratory hold.

Mechanical/

Definition Unit

Spontaneous Data

MVexp spont The volume of gas the patient exhales per

l/min minute with spontaneous breaths.

RR spont The number of spontaneous breath cycles

/min the patient completes per minute.

VTexp spont The volume of gas the patient exhales with

ml a spontaneous breath.

MVexp mech The volume of gas the patient exhales per

l/min minute with mechanical breaths.

RR mech The number of mechanical breath cycles

/min the patient completes per minute.

VTexp mech The volume of gas the patient exhales with

ml a mechanical breath.

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Mechanical/

Definition Unit Spontaneous Data

RSBI The rapid shallow breathing index is

/min/l calculated by dividing the spontaneous breath rate by the tidal volume, averaged over one minute. The RSBI reflects the frequency and depth of the patient’s breath cycles. A high RSBI value indicates that patient’s breath cycles are more frequent and shallow. RSBI is calculated in spontaneous breathing modes (CPAP/PS, VS, NIV, and SBT).

Per Weight Data Definition Unit

Weight The calculated ideal body weight for adult

kg patients. The entered weight of the patient for pediatric patients.

MVexp/kg The volume of gas the patient exhales per

l/min/kg minute per the patient’s ideal body weight.

VTexp/kg The volume of gas the patient exhales in a

ml/kg breath per the patient’s ideal body weight.

MVexp spont/kg The volume of gas the patient exhales per

l/min/kg minute with spontaneous breaths per the patient’s ideal body weight.

VTexp spont/kg The volume of gas the patient exhales in a

ml/kg spontaneous breath per the patient’s ideal body weight.

C/kg The dynamic compliance of the patient’s

lungs per the patient’s calculated ideal body weight.

VO2/kg The volume of oxygen a patient inhales

ml/kPa/kg, ml/

cmH2O/kg, or ml/

mbar/kg

ml/min/kg (consumes) per minute per the patient’s set weight.

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Per Weight Data Definition Unit

VCO2/kg The volume of carbon dioxide a patient

ml/min/kg exhales (produces) per minute per the patient’s set weight.

Metabolics Data Definition Unit

EE The amount of energy the patient expends

kcal/d or kJ/d per day in calories.

RQ The ratio between the amount of carbon

N/A dioxide the patient produces and oxygen the patient consumes.

VO2 The volume of oxygen a patient inhales

ml/min (consumes) per minute.

VCO2 The volume of carbon dioxide a patient

ml/min exhales (produces) per minute.

VO2/m2 The volume of oxygen a patient inhales

ml/min/m2 (consumes) per minute per square meter of body surface area.

VCO2/m2 The volume of carbon dioxide a patient

ml/min/m2 exhales per minute per square meter of body surface area.

Spirometry Data Definition Unit

Ppeak The highest pressure level measured

during the inspiratory phase.

Pplat The pressure level measured after the

inspiratory phase and before the expiratory

cmH2O, kPa, or

mbar

cmH2O, kPa, or

mbar phase (during an inspiratory pause).

Pmean The average pressure level measured

during the breath cycle.

PEEPe The pressure on the patient’s airway at the

end of the expiratory phase.

PEEPi The pressure that remains on the patient’s

airway at the end of the expiratory phase

cmH2O, kPa, or

mbar

cmH2O, kPa, or

mbar

cmH2O, kPa, or

mbar due to incomplete expiration. PEEPi is measured above PEEPe.

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Spirometry Data Definition Unit

VTinsp The volume of gas the patient inhales per

breath.

MVinsp The volume of gas the patient inhales per

l/min

minute.

VTexp The volume of gas the patient exhales per

breath.

MVexp The volume of gas the patient exhales per

l/min

minute.

Leak The percentage of volume leaked from the

patient circuit.

Timing Data Definition Unit

I:E The ratio of inspiratory time to expiratory

N/A

time.

Tinsp The duration of the inspiratory phase of the

breath cycle.

Texp The duration of the expiratory phase of the

breath cycle.

RR The number of breath cycles a patient

/min

completes per minute.

Cycle Time The sum of the duration of inspiratory and

expiratory phases.

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Navigation

Note

Shared information section for adult, pediatric, and neonatal patient types.

Ventilator display

The 15-inch touchscreen display provides audible and visual alarms, integrated key pad, and a Trim Knob control. The display unit uses the Panasonic CR2477/BN battery (1000 mAh and 3V). To select menu options or settings, touch only one touch point at a time to make sure the correct selection is made. Touch the setting or press the Trim Knob to confirm settings.

The touchscreen allows swipe gestures to move from one workspace to another workspace.

Do not use pencils, pens, or other objects to activate the touchscreen. The touchscreen will not function properly if tape or paper is stuck to the display surface.

WARNING

Liquids on the display may degrade the performance of the touchscreen. If liquids come in contact with the display, lock the touchscreen and clean the display. Unlock the touchscreen once the display has been cleaned to resume use of the touchscreen.

CAUTION

Do not apply excessive force to the touchscreen as damage may occur.

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Figure 1 • Display controls and indicators

1. Alarm light The integrated alarm light provides a visual alarm when an alarm condition occurs. The alarm light also provides a visual indicator when Audio Pause is active and alarm audio is silenced.

2. Trim knob control Turn the Trim Knob clockwise or counterclockwise to change a setting. Press the Trim Knob to confirm a setting.

3. Hard keys (key pad) Press the Audio Pause, Increase O2, Snapshot, Lock/ Unlock, or Home hard keys to access the associated features.

• Audio Pause: Press to silence alarms for 120

seconds.

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4. LED indicator The green LED illuminates when the ventilator is connected to the main power supply. The internal battery is charging when the LED is lit.

Display user interface

The user interface incorporates the Menu, Current Patient menu, alarm management, and Favorites procedures at the top of the display. The patient status (airway pressure bar) and workspace/monitoring area are located in the middle of the display. The navigation bar, message areas, battery status, standby, and quick keys are located at the bottom of the display.

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AB.100.010

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Figure 2 • Display user interface components

1. Favorites Provides short-cuts for up to four procedures (as selected by the user). Use to select specific procedures such as Increase O2, Inspiratory Hold, Expiratory Hold, and Manual Breath. See "Setting Favorites" in the "Operation" section.

2. Patient status The airway pressure bar shows a dynamic view of the patient airway pressure, Pmax, Ppeak, PEEP, FiO2, and VTexp. Use the tab on the pressure bar to collapse (hide) from view when available.

3. Navigation Select an icon to open the corresponding view. See "Navigating the user interface" for detailed information.

4. Additional Information Shows current time and additional setting information.

5. Main power Indicates whether the ventilator is connected to the main power supply or is running on battery. Also shows battery status when running on battery.

6. Standby Select the Standby quick key to go into Standby (pause/stop ventilation). See "Standby" in the "Operation" section.

7. Quick Keys Select to change the corresponding ventilator setting. Turn the Trim Knob to make a change. Select the quick key or press the Trim Knob to activate the change. When a quick key setting is selected, a Trim Knob visual cue indicates the change may be made by turning the Trim Knob and pressing to confirm the setting.

8. Current Mode and Mode

Settings

9. General Messages Shows notices, procedure status, and system

10.Monitoring This area is used to view waveforms, measured

Shows the active ventilation mode. Select to access ventilation modes, and change mode settings.

status information to the user. See "General messages" in the "Alarms and troubleshooting" section.

data, and settings.

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11.Menu Select to quickly access options such as: System menu, Procedures, Lung Mechanics, Suction, and Nebulizer. See "Main menu" in the "Navigation" section.

12.Current Patient menu Select to enter the Current Patient menu. This menu allows entry of the patient ID using an alphanumeric keyboard. Entered values for patient gender, height, and weight are used to calculate BSA (body surface area), and IBW (ideal body weight). This menu also allows the selection of tube type and diameter. See"New Patient" and "Current Patient" in the "Operation" section.

13.Alarm management Select to view alarms, alarm history, alarm setup, and alarm help. See "Alarms and troubleshooting" section.

Navigating active alarms

When an alarm occurs for measured data, the number and alarm limits are shown with a border around them. The color of the border and the alarm limit shows the priority of the alarm. Select within the border of the active alarm to open the Alarm Setup menu. Select the alarm limit that needs adjustment, then use the Trim Knob to adjust the setting and confirm changes. See "Alarm management" in the "Alarms and troubleshooting" section for additional information.

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Figure 3 • Select inside of the border to open the Alarm Setup menu.

Standby

Standby is displayed upon system startup or when the Standby quick key is selected. When the system is in Standby, the Standby quick key and the patient status (airway pressure) bar are colored tan. A “Standby”

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message is displayed in the navigation bar when in the Present/Patient

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Status workspace. Standby is used to stop ventilation to the patient, select a New or Previous patient, perform a System Check, and Park/ Unpark the patient circuit. The Setup button accesses the password protected Configuration (Super User) and Service menus.

Figure 4 • Standby menu

1. New Patient Select New Patient to enter patient information.

2. Circuit Setup Select Circuit Setup to select HME or Humidifier for adult and pediatric patient types.

3. Standby When Standby (hand icon) is selected the Standby menu displays. If the Patient detected alarm occurs, the Standby menu automatically displays.

4. Park/Unpark Circuit When the circuit is parked a message displays: Patient circuit is occluded and ventilator is in Standby.

5. Start Ventilation Select to start patient ventilation.

6. System Check Select System Check to perform a ventilator system check.

7. Information Select to access information regarding the system check status and troubleshooting.

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8. Previous Patient/Current

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Patient

Select Previous Patient to use the previous patient’s ventilator settings and patient information. Select Current Patient to open the Current Patient menu and use the current patient’s ventilator settings and patient information.

9. Setup Select to access the Configuration (Super User) and Service menus. A password is required to enter these menus. Contact a training representative to obtain the password.

Main menu

Select Menu to quickly access ventilator features and options.

Figure 5 • The main Menu accesses the System menu, Procedures, Lung Mechanics, Nebulizer, and Suction options.

1. System Use the System menu to access data source, module type and version, calibrations (Paux Zero and Purge Flow), and display brightness. The System menu shows the software version, running hours, altitude, O2 supply pressure, air supply pressure, and battery status. See "System menu" located in this section.

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2. Procedures Use the Procedures menu to access the Assign Favorites menu and the following procedures: Manual Breath, Increase O2, Inspiratory Hold, Expiratory Hold, and Auto PEEP. See "Setting Favorites" in the "Operation" section.

3. Lung Mechanics Use the Lung Mechanics menu to access the Assign Favorites menu and the following procedures: P0.1, Negative Inspiratory Force (NIF), and Vital Capacity. See "Setting Favorites" in the "Operation" section.

4. Nebulizer Use the Nebulizer menu to access the Aerogen and Pneumatic Nebulizer procedures. See "Setting Favorites" section in the "Operation" section.

5. Suction Use the Suction menu to access the Assign Favorites menu and the Suction procedure. See "Setting Favorites" in the "Operation" section.

System menu

The System menu contains settings for data source selection, calibration options, display brightness, and system information.

1. Select Menu > System.

The Airway Module type and software version number are shown under data source.

2. Select Data Source (Ventilator or Airway Module).

• For Neonatal; select Ventilator or NFS. See "System menu" in the "Neonatal Operation" section.

3. Select Calibrations (Airway Module, Paux Zero, or Purge Flow).

• Select Airway Module to calibrate the airway module.

• Select Paux Zero. A green check mark indicates Paux Zeroing calibration was successful.

• Select Purge Flow. The Purge Flow check box may be checked or unchecked when performing a Paux Zero. Continuous purge flow will come from the Paux outlet when the Purge Flow check box is selected. A white check mark indicates Purge Flow is active.

Note

See "Purging the auxiliary pressure tubing" and "Zeroing auxiliary pressure" in the "Setup and connections" section.

4. Select Display Brightness to adjust the brightness level of the user interface.

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Select brightness level of 1 (low) to 5 (high).

5. View system information: software version, service packet version, running hours, altitude, O2 supply pressure, air supply pressure, and battery status.

Changing a setting

1. Touch the setting.

2. Change the value by turning the Trim Knob or selecting a menu item.

3. Touch the setting or push the Trim Knob to confirm the setting.

Figure 6 • The Trim Knob graphic is used to indicate that the use of the Trim Knob is necessary to change or confirm a setting

Note

To cancel or back out of a setting change, select X in the lower right corner of the menu, touch outside of the setting twice, select the Home hard key, or wait for the selection to time out. For example, ventilation and alarm setting changes can be cleared by selecting the Home hard key prior to confirming a setting.

Navigating the user interface

The ventilator user interface uses three different workspaces: Past/ Historical trends, Present/Patient status, and Future/Clinical decision support. Each workspace (rectangle icon) contains views (circle icons) that contain different configurations of data and functions.

When a workspace is selected, the correlating view icons are displayed.

• Use a swipe gesture or touch a workspace icon to go to a new workspace (swipe gesture: touch display and move finger tip left or right).

• When you navigate away from a workspace and then navigate back, the display will show the last view that was displayed from the workspace.

• If a view is not supported by the current patient type or software is not installed, it will not display.

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Figure 7 • Navigation example; select a workspace (rectangle) to see correlating views (circle).

Present/Patient Status workspace and views

The Present/Patient Status workspace shows the following views: Basic, Basic Waveform, Advanced Waveform, Splitscreen, and Charting. This workspace allows the user to choose the view in which they would like to see patient data displayed. See "Measured data definitions" in the "Patient monitoring" section for information on the numerics displayed in the Present views. See "Neonatal measured data definitions" in the "Neonatal patient monitoring" section for information on the numerics displayed in the Present views for a neonatal patient type.

• Touch the icon to display the corresponding view.

• Use a swipe gesture to view and move to Past (Historical trends) and

Future (Clinical decision support) workspaces.

Present/Patient Status Workspace

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Basic View

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Use the Basic view to see measured data in a large format that can be easily viewed from a distance. Note: The patient status (airway pressure) bar is permanently displayed to easily view patient airway pressure, tidal volume, and FiO2.

Basic Waveform View

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Use the Basic Waveform view to see patient waveforms and measured data. Note: the airway pressure bar may be collapsed to expand the monitoring area when the Paw and Flow waveforms are displayed.

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Advanced Waveform View

AB.100.120

AB.100.121

Use the Advanced Waveform view to see additional measured data associated with the patient waveforms. Note: The airway pressure bar may be collapsed to expand the monitoring area when the Paw and Flow waveforms are displayed.

Splitscreen View

Use the Splitscreen view to see spirometry, measured data, and waveforms. Select the upper right corner of the spirometry waveform to change settings. Note: The airway pressure bar may be collapsed to expand the monitoring area when the Paw and Flow waveforms are displayed.

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Charting View

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Use the Charting view to see a complete list of patient data.The airway pressure bar is permanently displayed to easily view patient airway and pressure settings, tidal volume and FiO2.

Past/Historical Trends workspace and views

The Past/Historical trends workspace shows information for the following views: Graphical trends, Numerical trends, Trends log, and Snapshot trends.

• Touch the icon to display the corresponding view.

• Use a swipe gesture to view and move to Present/Patient status or Future/Clinical Decision Support workspaces.

Past/Historical Trends Workspace

Graphical Trends View

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Graphical Trends View

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Use the Graphical trends view to review historical waveforms and patient trends. See "Graphical trends view" and "Graphical trends view - Neonatal" in the Patient Monitoring section.

Numerical Trends View

Use the Numerical trends view to review patient ventilation modes and settings, measured data, and alarm settings. See "Numerical trends view" and "Numerical trends - Neonatal" in the Patient Monitoring section.

Trends Log View

Use the Trends Log to review patient alarms and settings, and events that have occurred during ventilation. See "Trends log view" and "Trends log view - Neonatal" in the Patient Monitoring section.

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Snapshot Trends View

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Use Snapshot trends to view saved patient data. See "Snapshot trends view" and "Snapshot trends view - Neonatal" in the Patient Monitoring section for more information.

Future/Clinical Decision Support workspace and views

The Future/Clinical Decision Support workspace shows the following views (if software is installed): SBT, FRC, Spirometry, Metabolics, and Calculations.

• Touch the view icon to display the corresponding view.

• Use a swipe gesture to move to Present/Patient Status or Past/ HistoricalTrends workspaces and associated views.

Future/Clinical Decision Support

SBT View

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SBT View

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AB.100.130

Use the SBT view to evaluate spontaneous breathing trial data. See "SBT view" and "SBT view - Neonatal" in the Clinical Decision Support section.

FRC View

Use the FRC view to evaluate and review patient respiratory data. The FRC view includes three tabs: Evaluate, FRC INview (FRC procedure), and PEEP INview (PEEP INview procedure). See "FRC INview procedures" in the Clinical Decision Support section.

Spirometry View

Use the Spirometry view to evaluate and review graphs and data from spirometry and spirodynamic measurements. The Spirometry view includes the Spirometry tab and SpiroDynamics tab. See "Spirometry view" and "Spirometry view - Neonatal" in the Clinical Decision Support section.

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Metabolics View

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Use the Metabolics view to evaluate and review Metabolics measurements. See "Metabolics view" in the Clinical Decision Support section.

Calculations View

Use the Calculations view to calculate and review data based on the ventilator, measured data, and laboratory blood gas analysis data. See "Calculations view" in the Clinical decision support section.

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Setup and connections

EXP

AB.100.088

Adult

Current Mode

FiO2

Pinsp

cmH2O

Rate

/min

Tinsp

1.7

PEEP

cmH2O

Standby

Insp Hold

Exp Hold

Manual Breath

14:38

FiO2

No Alarms

Airway Pressure

cmH2O

-5

Pmax

Ppeak

PEEP

VTexp

508

PEEPe

cmH2O

Peak Pressure

cmH2O

Minute Volume

6.2

l/min

Tidal Volume

508

600

400

Respiratory Rat e

/min

1415

Setup and connections

Note

Shared information section for adult, pediatric, and neonatal patient types.

Ventilator overview front

Figure 8 • Ventilator front view

1. Display 10. Exhalation valve housing

2. Ventilator unit 11. Expiratory port

3. Inspiratory safety guard 12. Expiratory flow sensor

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4. Ventilator lock 13. Gas exhaust port

5. Cart 14. Park circuit port

6. Dovetail rails 15. Exhalation valve housing latch

7. Caster (wheel) 16. Water trap

8. Airway module bay (optional) 17. Auxiliary pressure port

9. Nebulizer connection 18. Inspiratory port

Ventilator overview back

AB.100.100

Figure 9 • Ventilator back view

Note

Not all connections may be available on all ventilator configurations.

1. Ethernet connection (not

14. Air high-pressure inlet filter

supported)

24 2065492-001

2. Ethernet connection (not supported)

3. USB connection (not supported) 16. Retaining channel

4. USB connection (Service connection)

5. Display Unit connection 18. Port 4 (Nurse call)

6. VGA (not for clinical use) 19. Patient circuit support arm

7. Module bay connection 20. Port 1 (neonatal flow sensor

8. Main power inlet and fuse holder 21. Port 2 (not supported)

9. Power switch 22. Port 3 (exhalation valve heater

10. Equipotential stud 23. Port 6 (RS232 Serial

11. Module bay mounting thumbscrews

12. Oxygen supply connection (pipeline)

13. O2 high-pressure inlet filter (optional)

15. Air supply connection (pipeline)

17. Ventilator unit fan filter

connection)

communication port)

24. Port 5 (RS232 Serial communication port)

25. Display unit fan filter

Connecting the breathing circuit

WARNING

Do not use antistatic or electrically conductive breathing tubes or masks.

Check all connections to the breathing circuit to make sure that there are no unintended connections made to other equipment, especially equipment that delivers fluids, as the patient could be harmed.

The inspiratory safety guard is required to connect the breathing circuits to the ventilator. The inspiratory safety guard must be used at all times during ventilation.

Note

See "Cleaning and maintenance" for information on the replacement of the inspiratory safety guard. See "Parts and accessories" for ordering information.

The exhalation valve heater should be used when an active humidifier with a heated expiratory limb is used.

Important

Consult your hospital guidelines for proper use of expiratory filters in conjunction with heated humidifiers.

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Connecting a HME (heat and moisture exchanger)

Note

To prevent excessive resistance in the breathing circuit, the HMEF500 should not be used for Adult patients.

Note

If using optional accessories see Figure in "Connecting the Pedi-lite(+) and D-lite(+) sensors".

1. Connect the inspiratory safety guard to the inspiratory port.

2. Attach the inspiratory limb of the patient circuit to the inspiratory safety guard.

3. Attach the expiratory limb of the patient circuit to the expiratory port or expiratory filter (if used).

4. Connect the Pedi-lite(+) or D-lite(+) sensor to the patient wye (if used). Use a 5 ml (minimum) spacer and elbow when using the Pedilite(+) or D-lite(+) sensor.

5. Connect the HME.

• Place the HME between the SpiroDynamics catheter (if used),

but after the Pedi-lite(+) and D-lite(+) sensor (if used).

• The HME should be removed when a nebulizer is active.

Replace the HME when the nebulizer is not in use.

6. Connect the circuit elbow to the HME (if used).

Note

To disconnect, follow instructions in reverse order.

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Adult

FiO2

Minute Volume

6.2

o t a

S p

o n

Current Mode

INSP

Figure 10 • Overview of setup and connections with a HME

1. Inspiratory safety guard

2. Inspiratory limb

3. Expiratory port/expiratory filter if used

4. Expiratory limb

5. Patient wye

6. HME

No Alarms

Insp

Exp

Manual

Hold

Breath

14:38

Airway

Pressure

PEEPe

Peak Pressure

cmH2O

l/min

FiO2

508

Tidal Volume

Pinsp

cmH2O

Pmax

Ppeak

Respiratory Rate

/min

PEEP

600

400

-5

VTexp

T o

t a l

S p o

508

n t

Rate

PEEP

Tinsp

Standby

1.7

/min

cmH2O

EXP

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Connecting the humidifier

The ventilator is designed to work with active humidification. GE Healthcare recommends the use of the Fisher & Paykel MR850 humidifier (refer to humidifier instructions for detailed information on humidifier connections and use).

WARNING

Never position any filter in the inspiratory limb downstream of a humidifier.

When adding attachments or other components to the ventilator, the pressure gradient across the breathing circuit may change.

1. Slide the humidifier heater onto the accessory rail (do not plug in).

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2. Press down on the light blue lever of the humidifier and slide the water chamber into the humidifier heater.

Release the light blue part of the humidifier heater.

3. Unwrap the water feed line from the humidifier water chamber and puncture the water reservoir. The water reservoir should be elevated above the humidifier at all times and water should flow down into the humidifier.

4. Use the short blue circuit tubing from the humidifier circuit pack and connect one end to the inspiratory safety guard and the other end to the appropriate port on the humidifier chamber.

5. Connect the longer piece of of blue circuit tubing to the remaining port on the humidifier. Connect the end of the white circuit tubing to the expiratory port or expiratory filter (if used).

6. Connect the heater wire to the humidifier heater, then connect the two leads to the ends of the patient circuit (the shorter lead to the blue tube).

7. Connect the temperature probe to the humidifier heater, connecting the keyed lead to the end of the blue tube of the patient circuit and the other to the patient wye for adult (near the patient wye on the blue tube for pediatric/neonatal).

Note

The thermal operating temperature of the humidifier is 18-26° C according to the manufacturer.

8. Turn on the ventilator and perform the System Check. See "System Check" in the Operation section for more information.

9. If the System Check passes, plug in the humidifier and attach the exhalation valve heater. See "Connecting the exhalation valve heater".

Note

To disconnect; follow the instructions in reverse order.

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Adult

No Alarms

FiO2

Tidal Volume

Minute Volume

l/min

6. 2

508

FiO2

Pinsp

Current Mode

cmH2O

INSP

Figure 11 • Overview of setup and connections with a humidifier

1. Humidifier (Fisher & Paykel)

2. Inspiratory safety guard

3. Inspiratory limb to and from humidifier to patient wye

4. Expiratory port/expiratory filter if used

5. Expiratory limb

6. Spacer (5 ml - minimum)

Insp

Exp

Manual

Hold

Breath

14:38

Airway Pressure

PEEPe

Peak Pressure

cmH2O

Pmax

Ppeak

Respiratory Ra te

/min

PEEP

600

400

-5

VTexp

508

Rate

PEEP

Tinsp

Standby

1.7

/min

cmH2O

EXP

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Connecting the nebulizer

The Aeroneb Professional Nebulizer System is a portable medical device for multiple patient use that is intended to aerosolize physician-prescribed solutions and suspensions for inhalation to patients on and off ventilation or other positive pressure breathing assistance.

The CARESCAPE R860 supports the Aeroneb Professional Nebulizer System (Aeroneb Pro and Aeroneb Solo) by Aerogen. Both nebulizer devices operate in-line using the ventilator nebulizer menu and nebulizer cable. The Aeroneb Pro and Aeroneb Solo are purchasable parts, see "Parts and accessories" section for ordering information.

The Aeroneb Pro and Aeroneb Solo (disposable) may be used with neonatal, pediatric, and adult patients in acute and subacute care environments. Both nebulizer models operate without changing the

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patient ventilator parameters and can be refilled without interrupting ventilation.

The nebulizers may be used with a neonatal, pediatric, or adult breathing circuit. The T-adapter for the nebulizer is specific to the breathing circuit type.

WARNING

Do not use a filter, heat-moisture exchanger or heat-moisture exchanger filter between the nebulizer and the patient airway.

Use of a heat-moisture exchanger or nebulizer in the breathing circuit can substantially increase flow resistance when a nebulizer is active. Monitor the breathing system filter frequently for increased resistance and blockage.

Use of an external pneumatic nebulizer may significantly impact volume delivery and monitoring, decrease trigger sensitivity, and cause alarms if external flow is introduced and Pneumatic Nebulizer Flow Compensation is not used.

CAUTION

It is strongly recommended to use an expiratory filter when a nebulizer is used to help protect the expiratory flow sensor.

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Ventilation modes

Ventilation mode features

Tube compensation

When a patient is intubated, the endotracheal or tracheostomy tube creates resistance in the airway. Tube compensation provides additional pressure to compensate for the difference between the lung pressure and breathing circuit pressure during the inspiratory phase of pressurecontrolled and pressure-supported breaths.

Tube compensation can be used to offset all or a percentage of the additional resistive pressure created by the endotracheal tube.

Note

To set Tube compensation, a Tube Type and Tube Diameter must be set in the New Patient or Current Patient menu.

WARNING

Tube compensation increases the pressure delivered to the patient. The pressure delivered with tube compensation is limited to Pmax - 5 cmH2O. Make sure that Pmax is set appropriately for the patient when using tube compensation.

To set Tube Compensation, select Current Mode > Mode Settings and select Tube Comp. A general message shows when tube compensation is on.

Note

The options for tube compensation are: Endotrach, Trach, or ---. When --is selected, the ventilator will not compensate for tube resistance.

Assist control

Assist control allows the ventilator to synchronize mechanical breaths to the patient's spontaneous efforts and the patient to trigger additional mechanical breaths to the set respiratory rate in the following ventilation modes:

• A/C VC

• A/C PC

• A/C PRVC When the patient initiates a breath with assist control enabled, the

ventilator delivers a breath based on the mode settings. After a patientinitiated mechanical breath, the ventilator may delay the delivery of the next mechanical breath to prevent two mechanical breaths from being delivered consecutively (breath stacking).

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Note

Under certain conditions, such as high spontaneous breathing rates or high leakage, the rate of mechanical breaths may not meet the set respiratory rate.

A general message shows when assist control is off. When assist control is off, the patient is able to draw spontaneous breaths at the set PEEP level between mechanical breaths.

To set Assist Control, select Current Mode > Mode Settings and select Assist Control (On or Off).

Leak compensation

WARNING

The exhaled volume of the patient can differ from the measured exhaled volume due to leaks.

To set Leak Compensation, select Current Mode > Mode Settings and select Leak Comp. A general message shows when leak compensation is on.

When the ventilator detects a leak in the breathing circuit, and leak compensation is active, the ventilator will respond in the following ways:

• Flow and volume waveforms and measured volume data are adjusted to account for leaks.

In the following volume-controlled modes, the ventilator adjusts the tidal volume delivered to compensate for leaks:

• A/C VC

• A/C PRVC

• SIMV VC

• SIMV PRVC

• BiLevel VG

• VS

The maximum tidal volume adjustment depends on the patient type:

• Adult - 25% of the set tidal volume

• Pediatric - 100% of the set tidal volume or 100 ml, whichever is less

• Neonatal - 100% of the set tidal volume

Trigger compensation

Leaks can cause the ventilator to initiate breaths automatically (autotriggering). Trigger compensation adjusts the flow trigger to compensate for leaks, reducing the need to manually adjust the Insp Trigger setting to prevent auto-triggering.

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Trigger compensation is available in all ventilation modes. To set trigger compensation, select Current Mode > Mode Settings, and select Trigger Comp.

Backup mode

Backup mode is available if the ventilator detects insufficient ventilation in modes that allow spontaneous breaths. When enabled, the ventilator automatically enters the set Backup mode if either of the following occur:

• The Apnea alarm is activated.

• The patient’s expired minute volume (MVexp) is below 50% of the

set low MVexp alarm.

The set Backup mode is shown under the Backup mode check box in Current Mode > Mode Settings . To enable Backup mode, select the check box.

Backup settings are a subset of available settings in each ventilation mode. Adjust Backup settings in Current Mode > Mode Settings > Backup Settings.

Note

Settings that are not designated as Backup settings remain at the current value when the ventilator transitions to the set Backup mode.

WARNING

Ensure that all users at the facility have been trained and notified of the facility default Backup mode settings. Before deactivating backup ventilation for a specific mode, ensure that all users at the facility have been trained and notified of these settings.

Backup mode is available in the following ventilation modes:

• SIMV VC

• SIMV PC

• SIMV PRVC

• BiLevel

• BiLevel VG

• CPAP/PS

• VS

• APRV The following ventilation modes may be set as the Backup mode:

• A/C VC

• A/C PC

• A/C PRVC

• SIMV VC

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• SIMV PC

• SIMV PRVC

• BiLevel

• BiLevel VG

Non-invasive ventilation (NIV)

Note

NIV mode is a purchasable option. NIV mode is intended to be used on spontaneously breathing patients.

During NIV mode, the patient draws spontaneous breaths as the ventilator maintains the set PEEP level and provides pressure support (PS).

Because flow triggers are affected by patient circuit leaks, flow and pressure triggers are applied simultaneously in NIV mode. When a flow trigger is set by the user, the ventilator uses a simultaneous pressure trigger to improve trigger detection.

The MVexp low, Apnea Time, and Leak Limit alarms may be disabled to prevent nuisance alarms when large patient circuit leaks are present. A medium priority alarm is active when any of these alarms is disabled. Select Audio Pause to acknowledge and de-escalate this alarm.

WARNING

If the Apnea Time, Leak Limit, or MVexp low alarms are disabled, additional monitoring, such as SpO2, ECG, and CO2, is recommended to prevent the patient from hypoventilating.

WARNING

If the patient does not meet the set Minimum Rate for spontaneous breaths, the ventilator delivers a backup breath based on the Backup Tinsp and Backup Pinsp settings. If the ventilator does not detect any spontaneous breaths within the set Patient Effort time, a high priority alarm indicates that the patient has stopped triggering breaths.

While in non-invasive ventilation, the ventilator is to be provided with CO2 monitoring equipment that complies with ISO 80601-2-55 or ISO 21647. If the Apnea Time, Leak Limit, or MVexp low alarms are set to Off, additional monitoring such as SpO2 or ECG is also recommended to protect the patient from hypoventilation.

Note

Leak Comp and Trigger Comp may be set if desired.

The following settings are available in NIV mode:

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Category Setting

Main Parameters FiO2

PEEP

Patient Synchrony Tsupp

Insp Trigger

Exp Trigger

Bias Flow

Rise Time

Safety PMax

Backup Pinsp

Minimum Rate

Backup Tinsp

WARNING

Before using NIV mode, the patient should demonstrate all of the following characteristics:

• Is responsive

• Breathes spontaneously

• Has a controlled airway

• Requires pressure support ventilation

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Figure 12 • NIV waveforms

1. Airway pressure (Paw) waveform

2. Pressure support (PS)

3. Inspiratory time (Backup Tinsp)

4. PEEP

5. Flow waveform

6. Backup Pinsp

7. Minimum rate backup breath

8. Tidal Volume (VT)

Spontaneous breathing trial (SBT mode)

AB.100.027

SBT mode is intended to be used to evaluate the patient’s ability to breathe spontaneously during a specified duration of time. See "SBT view" in the "Clinical decision support" section.

Prior to the SBT evaluation, the following setting limits must be entered:

• SBT Duration

• Apnea Time

• High and low MVexp alarm

• High and low RR alarm

During SBT mode, the patient initiates spontaneous breaths as the ventilator maintains the set PEEP level and provides pressure support (PS).

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Note

To set a pressure support level for spontaneous breaths, select Current Mode > Mode Settings and enter a PS value.

Note

To evaluate the Spontaneous Breathing Trial, select Clinical Decision Support > SBT.

Category Setting

Main Parameters FiO2

PEEP

Patient Synchrony Insp Trigger

Exp Trigger

Bias Flow

PS Rise Time

Safety Pmax

Stop Criteria RR

MVexp

Apnea Time

Figure 13 • SBT waveforms

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1. Airway pressure (Paw) waveform

2. Pressure support (PS)

3. PEEP

4. Flow waveform

5. Tidal Volume (VT)

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Operation

Power

Turning on power to the ventilator

1. Plug the power cord into an electrical outlet.

• The LED indicator illuminates (green) to indicate the main power is connected.

2. Press the power switch on the back of the ventilator to the On position.

• The start-up screen appears while the system runs a series of

automated self tests.

• When the self tests pass, the system goes into Standby and the

display shows the Standby menu.

• If the self tests fail, the display shows an alarm. See "List of

alarms" and "Troubleshooting" in the "Alarms and troubleshooting" section or "List of alarms – Neonatal" in the

"Neonatal alarms and troubleshooting".

3. Listen for two distinctly different audio tones to sound to make sure the primary speaker and backup buzzer are working properly.

4. Watch and verify the alarm light on the top of the display unit cycles through the following colors: blue, red, and yellow.

WARNING

If both the primary and backup audio tones do not sound or the alarm lights do not function correctly when the ventilator is powered on, take the ventilator out of service. Contact an authorized service representative to repair the system.

Turning off power to the ventilator

The ventilator may only be turned off when in Standby, Configuration (Super User), or Service. If the ventilator is turned off during ventilation, an alarm sounds and ventilation and monitoring continue. This ensures the ventilator cannot be accidentally shut off during ventilation.

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

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4. Press the power switch on the back of the ventilator to the Off position.

Patient Setup

New Patient

Use these instructions for preparing the ventilator for a New Patient. After powering on the ventilator the Standby menu displays.

1. Select NEW PATIENT.

2. Select Adult, Pediatric, or Neonatal patient type.

3. Select Patient ID (identification).

• Enter up to 10 characters and then select Confirm. (Only

English alpha-numeric characters may be entered).

WARNING

To protect patient privacy, do not use the patient’s name when entering the patient ID (identification). Consider the facility’s privacy policies when entering the patient ID.

4. Select Gender (male or female).

5. Select Height.

6. Select Weight.

• The ventilator calculates and displays the patient weight in

kilograms, the BSA (Body Surface Area), IBW (Ideal Body Weight), and a suggested VT (Tidal Volume). See the "Clinical theory" section for calculations.

• IBW is available for adult patients only.

7. Select (Endotrach, Trach, or ---).

When --- is selected, the ventilator will not compensate for tube resistance.

8. Select Tube Diameter.

9. Verify and confirm settings.

Previous Patient

The Previous Patient button shows upon power up of the ventilator when previous patient data exists. Previous Patient allows the clinician to use the patient settings and alarm limits that were previously used and view trends and historical data. For example, if a patient is extubated, but fails to progress and needs to be re-intubated, the clinician may use the previous patient settings.

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From the Standby menu, select PREVIOUS PATIENT.

Important

Previous Patient data is only saved when a normal shutdown sequence is performed. Abrupt or unexpected power loss will prevent this data from being saved.

Current Patient

Use this menu to update settings or change patient type from Pediatric to Adult or Adult to Pediatric. If Neonatal is installed, patient types may be changed from Neonatal to Pediatric or Pediatric to Neonatal.

1. Select Standby.

2. Select Current Patient.

The Current Patient menu shows.

3. Select the desired patient type and adjust settings.

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System Check

System Check overview

The ventilator should be fully cleaned and prepared for a patient before performing the System Check.

When started, the System Check runs automatically. Selecting the information icon will show the active progress in the System Check Details menu. The steps will show a green check mark (pass) or a red X (fail). When each check is completed, the next check begins.

A General Warning icon in the System Check indicates that a check has not been performed or completed for the current patient. Both the yellow warning icon and the yellow Start Ventilation button serves as a visual warning that a System Check needs to be performed.

WARNING

To help ensure the proper function of the system, it is highly recommended to complete the System Check between patients.

The patient must not be connected to the ventilator while completing the System Check.

Complete the System Check with the breathing circuit and accessories that will be used during ventilation.

If a System Check is not completed for the current patient, the system uses the compliance and resistance data from the last completed system check for the set patient type for all internal compensations. If the current breathing circuit differs significantly from the previous circuit, differences in ventilation parameters due to changes in the compensation process are possible.

Failure to complete a System Check may result in inaccurate delivery and monitoring. This may result in risk to the patient.

Additional System Check information

• The circuit leak is measured at 25 cmH2O. The resistance is the measured resistance of the inspiratory limb of the patient circuit. If the circuit leak is greater than 0.5 l/min or resistance or compliance measurements cannot be calculated, the Circuit Check will fail.

• If the circuit leak is greater than 0.5 l/min or if the exhalation flow sensor is changed after the System Check, the expiratory tidal volume may have decreased accuracy.

• If the relief valve failure alarm activates after the System Check then the ventilator will not allow ventilation until the relief valve portion of the System Check has passed.

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Circuit Setup

Use the Circuit Setup menu to select settings that must be compensated for in patient circuit measurements. The HME and Humidifier (must include a heated expiratory limb) settings are selected in the Circuit Setup. For adult and pediatric patient types the default selection is HME. For the neonatal patient type, the Circuit Setup menu is not available and the Humidifier selection will always be used.

WARNING

Changing the Circuit Setup will invalidate the current System Check results. Changing the patient circuit after completion of System Check will affect volume delivery and exhaled volume measurements. If any change is made to Circuit Setup or the patient circuit, repeat the System Check.

Circuit Setup should be checked when setting up a New Patient or a change has been made to the patient’s circuit setup.

A yellow warning icon will replace the previous System Check status icon (pass or fail) when a change has been made in the Circuit Setup menu. The yellow warning icon indicates that a System Check should be performed.

1. Select Circuit Setup.

The Circuit Setup menu displays.

2. Select the check box for the HME or Humidifier.

Settings are confirmed when the setting is changed.

3. Select X to close the menu.

Running a System Check

1. From Standby, select SYSTEM CHECK.

The Run System Check menu shows.

2. Attach the breathing circuit and all accessories that will be used to

ventilate the patient.

• Complete the System Check using the appropriate flow sensor per patient type. For example, use the neonatal flow sensor when completing a System Check for a neonatal patient.

3. Occlude the patient wye using the occlusion port.

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INSP

EXP

AB.100.209

1. Occlusion port

4. Select Start.

The System Check starts and shows the results of each check.

The system runs the following checks:

• Paw transducer check

• Barometric pressure check

• Relief valve check

• Exhalation valve check

• Expiratory flow sensor check

• Air flow sensor check

• Oxygen sensor check

• O2 flow sensor check

• Resistance check

• Circuit measurements check (circuit leak, compliance, and resistance)

Important

When performing the Resistance Check, the wye-piece and all breathing accessories such as: D-lite (+)/Pedi-lite(+) sensor and HME should remain on the occlusion port.

5. Select the information icon to see the System Check Details menu.

The System Check starts and shows the results of each check.

Note

Follow all on-screen system check instructions.

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As the System Check runs, the results of each check are displayed as a green check mark (pass) or red X (fail). If a check fails, a Help icon displays next to the failed check (red X). Select the Help icon to view possible causes and help for troubleshooting a failure.

When the System Check is complete, the Final Result line will display the patient type icon, a green check mark (pass) or red X (fail), and the date and time of the System Check.

Patient ventilation

Setting the ventilator data source

The data source is used to obtain patient monitoring parameters from either the ventilator or the airway module. See "Patient monitoring" for detailed information. See "Setting the ventilator data source"in the "Neonatal Operation" section.

1. Select Menu > System.

The System menu shows.

2. Select Data Source.

3. Select Ventilator or Airway Module to confirm settings.

If Ventilator is selected as the data source the Ventilator Data icon displays in the lower right corner of the display; the internal sensors of the ventilator will be the source for monitored data.

If Airway Module is selected as the data source and an airway module is installed and warmed up, the Airway Module (Patient) data icon displays in the lowerright corner of the display. The airway module will be the first source for monitored data. If data is not available through the airway module, monitored data will come from the internal ventilator sensors.

Ventilator Data Source Icons

Ventilator data Airway Module (Patient) data

Note

When Airway Module is selected as the data source, the data source icon will not be updated until the module is able to provide data. This may take 2 to 5 minutes when a module is first installed into the module bay. Only data available from the installed airway module will be displayed on the ventilator, all other data will be from the ventilator. For example, if a module capable of measuring CO2 and

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O2 only is installed, CO2 and O2 data displayed will be from the module, all other data will be from the ventilator.

System menu

The System menu contains settings for data source selection, calibration options, display brightness, and system information.

1. Select Menu > System.

The Airway Module type and software version number are shown under data source.

2. Select Data Source (Ventilator or Airway Module).

• For Neonatal; select Ventilator or NFS. See "System menu" in the "Neonatal Operation" section.

3. Select Calibrations (Airway Module, Paux Zero, or Purge Flow).

• Select Airway Module to calibrate the airway module.

• Select Paux Zero. A green check mark indicates Paux Zeroing calibration was successful.

Note

See "Purging the auxiliary pressure tubing" and "Zeroing auxiliary pressure" in the "Setup and connections" section.

4. Select Display Brightness to adjust the brightness level of the user interface.

Select brightness level of 1 (low) to 5 (high).

5. View system information: software version, service packet version, running hours, altitude, O2 supply pressure, air supply pressure, and battery status.

Setting a ventilation and backup mode

Ventilation modes are selected through the Current Mode button. The selected ventilation mode shows with the corresponding mode settings.

Ventilation modes may be changed in Standby or during ventilation.

Ventilation mode settings should be set prior to connecting a patient to the ventilator.

See "Backup mode" in the "Ventilation modes" section for additional information.

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1. Select Current Mode.

2. Select the desired ventilation mode.

The title of the vent mode shows in the Mode Settings menu along with the parameters for that mode. See "Ventilation modes" section for detailed information on types of modes and settings.

Depending upon the facility default setup for ventilation modes, the Mode Settings menu may contain two icons. The partial list icon represents the facility’s set ventilation modes and the full list icon represents the full set of ventilation modes available.

Select the appropriate icon to see available ventilation modes.

Partial list of ventilator modes Full list of ventilator modes

3. Select Assist Control, Leak Comp, or Trigger Comp if desired.

• Assist Control is only available in the following ventilation modes: A/C VC, A/C PC, and A/C PRVC.

• See "Assist control", "Leak compensation", or "Trigger compensation" in the "Ventilation modes" section for detailed information.

4. Set the desired settings for the ventilation mode and confirm.

When ventilator settings are confirmed, the Mode Settings menu closes and the selected ventilation mode shows in Current Mode.

5. To set a Backup Mode, select Current Mode.

6. Select Backup Settings.

• Set the desired settings for the backup mode and confirm.

7. Confirm all ventilation mode settings.

Setting limit indicators

When adjusting ventilation mode settings, yellow and red visual indicators show when parameters are approaching their setting limits. Green visual indicators show the parameters are appropriate for the setting limits.

Starting patient ventilation

WARNING

Ventilation will not start until 'Start Ventilation' is selected.

Ensure that the ventilator battery is fully charged before starting patient ventilation. See "Battery status" for additional information.

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1. From Standby, select START VENTILATION.

If the Start Ventilation button is green, a System Check has been completed for the current patient and when selected, will start ventilation.

If the Start Ventilation button is yellow, the Complete System Check warning alert will display the following:

Select Continue to bypass System Checkout and start ventilation. Select Cancel to remain in Standby.

Note

It is recommended that System Check is completed prior to starting ventilation.

2. After ventilation has started, connect the breathing circuit to the patient.

Standby

Pausing ventilation

WARNING

The patient will not be ventilated when in Standby.

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

Park Circuit

Park Circuit allows the patient circuit to be occluded without the ventilator alarming while in Standby. When the patient circuit is positioned on the occlusion port the display activates the PARK CIRCUIT selection.

WARNING

The patient will not be ventilated while the circuit is parked and in Standby.

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventialtion to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

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3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

4. Occlude the patient circuit using the occlusion port.

INSP

EXP

1. Occlusion port

5. Select PARK CIRCUIT.

• The display will show: Patient circuit is occluded and the ventilator is in Standby.

Ventilation adjustments

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Ventilaltion modes and setting adjustments may be changed while in Standby or while ventilating.

Changing ventilation modes

1. Select the Current Mode.

The Mode Settings menu shows.

2. Select the desired mode from the list.

• Use the scroll bar to view additional modes.

3. Confirm setting.

Setting Favorites

Up to four Favorite procedures may be selected to show on the upperright corner of the user interface.

1. Select Menu.

2. Select Procedures, Lung Mechanics, or Suction menus.

3. Select Assign Favorites.

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The Assign Favorites menu shows with a list of the following procedures: Increase O2, Suction, Auto PEEP, Inspiratory Hold Expiratory Hold, P 0.1, NIF, Vital Capacity, and Manual Breath.

4. Select up to four Favorites.

Favorites show in the upper right corner of the display.

Note

The following Favorite procedures begin automatically after they are selected: Manual Breath, Suction, and Increase O2.

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Alarms and troubleshooting

Alarm priority

Audible and visual indicators tell the priority of the alarm.

Priority Color Light Tone

High Red Flashes red Series of five tones,

twice

Medium Yellow Flashes yellow Series of three tones

Low Blue Solid blue Single tone

Note

For medium and high priority alarms, the alarm tone is repeated until audio pause is selected or the alarm condition is resolved. When high priority alarms are not resolved within the set high alert audio time limit, the pitch and volume of the tone increases to the maximum audio level. See "Alarm setup" for information on how to set High Alert Audio.

When more than one alarm occurs at the same time, the alarm bar, alarm light, and audible alarm tone indicates the highest priority alarm.

The color on the right side of the alarm light shows the priority of the alarm. The left side of the alarm light is blue when audio pause is active.

Some medium priority and high priority alarms are de-escalated and change to low priority alarm when audio pause is selected. To see which alarms can be de-escalated, see "List of alarms - adult and pediatric" or "List of alarms – Neonatal". Until the de-escalated alarm condition is resolved, the low priority alarm stays active.

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Troubleshooting

The table lists possible problems that could occur when using the ventilator. If a problem occurs that is not listed, see "Repair policy" in the "Cleaning and maintenance" section for more information.

Symptom Problem Solution

The main power indicator is not on.

Ventilator cannot be turned off.

Backup audio alarm turns on.

The electrical power cord is not connected correctly.

• Connect the power cord.

• Loosen the power cord retaining clamp and make sure plug is fully seated. Then tighten the retaining clamp.

The inlet circuit breaker

Turn the circuit breaker on.

(switch) is off.

The power cord is

Replace the power cord.

damaged.

The electrical outlet that the power cord is

Use a different electrical

outlet. connected to has no power.

An internal fuse is open. Contact an authorized service

representative to repair the

ventilator.

The display unit cable is loose.

Turn the ventilator switch off,

and then disconnect from the

main power. Check and

tighten the display unit

connectors.

The ventilator is not in Standby.

A system failure has occurred.

Set the ventilator to Standby,

and then turn the system off.

Contact an authorized service

representative to repair the

ventilator.

The display unit cable is loose.

Turn the ventilator switch off,

and then disconnect from the

main power. Check and

tighten the display unit

connectors.

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Symptom Problem Solution

An alarm shows although the data is within range.

The alarm is from the ventilator but the value shown is from the airway module. (Not applicable for neonatal.)

The Ppeak high alarm conditions are checked before the display view is updated.

• Calibrate the airway module.

• Go to Menu > System and change the selection for Data Source.

No action required. In some situations the ventilator will react to a transient high pressure before the data can be sampled and shown on the display.

Ventilator does not deliver set VT in A/C VC or SIMV VC modes.

The Plimit setting prevents the full VT from being delivered in

• Change the VT setting.

• Change the Plimit setting.

the inspiratory period.

Ventilator does not deliver set VT in A/C PRVC, SIMV PRVC, or BiLevel VG modes.

Ventilator transitions to Backup mode.

Pmax alarm limit is limiting delivered inspiratory pressure.

The ventilator is at minimum allowed delivery.

MVexp low, Apnea alarm, RR alarm, and

• Change the VT setting.

• Change the Pmax setting.

• Change the VT setting.

• Change the Pmin setting.

Change ventilation settings.

insufficient patient ventilation.

Short delay in the breath cycle at the PEEP pressure level.

Automatic pressure transducer zeroing interference.

No action required. The situation will be corrected when zeroing is complete.

Automatic flow sensor zeroing interference.

Ventilator is automatically triggering a breath.

The breathing circuit leak rate is higher than the flow trigger level.

• Enable Trigger Compensation.

• Check the breathing circuit for leaks.

• Turn Leak Comp On.

• Increase the Flow triggering level or change from Flow triggering to Pressure triggering.

• Make sure the correct patient type is selected.

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Symptom Problem Solution

VT, compliance and resistance values are not accurate.

System Check was not done with the current patient circuit.

Flow sensors are dirty • Clean expiratory flow

Complete System Check with the same breathing circuit that will be used on the patient.

sensor.

• Clean neonatal flow sensor.

• Replace D-lite flow

sensor.

• Replace D-lite

spirometry sensing lines.

• Calibrate gas module.

System Check fails. Water trap on the

exhalation valve is not on tightly.

Patient circuit not connected to the ventilator.

Patient wye is not occluded correctly.

Expiratory flow sensor has failed.

Exhalation valve and seals are not seated correctly.

A connection port on the patient circuit is open.

Leak in patient circuit is very large.

System Check was stopped before it completed.

Touchscreen does not respond.

The touchscreen is locked.

The touchscreen requires calibration or repair.

Make sure the water trap is tightly secured.

Attach the patient circuit to the inspiratory and expiratory ports.

Make sure the patient wye is occluded completely with the leak test plug.

Clean or replace the flow sensor. Make sure flow sensor is connected correctly.

Remove and replace the exhalation valve.

Make sure all connection ports are occluded.

Check the breathing circuit for leaks.

Do a System Check and let it complete.

Press the Lock hard key at the bottom of the display unit.

Contact an authorized service representative to repair the ventilator.

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Cleaning and maintenance

Note

Shared information section for adult, pediatric, and neonatal patient types.

Part replacement schedule

The table shows recommended part replacement intervals. Replace the part at the interval or number of cleaning cycles, whichever occurs first.

*Visually inspect parts to determine if cleaning or replacement is needed. Look for deformation, cracks, or discoloration.

Interval Cleaning Cycles

Exhalation Valve Assembly 12 months 50

Exhalation Valve Diaphragm 12 months 50

Expiratory flow sensor 6 months 50

Neonatal flow sensor 6 months 25

Aerogen Aeroneb Pro Nebulizer and T-adapters

Cart-mounted water trap *As needed 50

Water trap connector tubing (hytrel tubing)

Display and ventilator fan filters *As needed *As needed

Compressor air inlet filter *As needed *As needed

D-lite sensor *As needed 50

Pedi-lite sensor *As needed 50

Inlet filter bowl *As needed *As needed

12 months 26

*As needed 50

Exhalation valve assembly

Obey infection control and safety procedures when handling water traps. Infectious hazard might be present.

To remove the exhalation valve assembly:

1. Make sure the expiratory flow sensor has been removed, if not remove the expiratory flow sensor from the exhalation valve assembly.

2. Push down on the latch, as shown below, and then pull the exhalation valve assembly away from the ventilator.

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Important

Do not try to remove the exhalation valve assembly without first pushing down on the release latch. Damage might occur to the housing.

AB.100.001

Figure 14 • Exhalation valve assembly

3. Remove the water trap and empty it. Make sure to save the o-ring from the water trap.

AB.100.002

Figure 15 • Exhalation valve disassembly

1. Diaphragm

2. Seal

3. Exhalation valve housing (side view)

4. O-ring

5. Water trap

4. Lift the edge of the diaphragm to remove it from the exhalation valve housing. Make sure to save the seal.

5. Before re-assembling or using the exhalation valve assembly, do the following:

• Check for visible cracks, discoloration, or other degradation

• Replace any worn components

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• Perform System Check

Note

Re-assemble the exhalation flow sensor in reverse order.

User maintenance

Calibrate the system when any one of these occurs:

• Performance is questionable, such as a System Check failure.

• Internal components are serviced or replaced.

• Every six months. For best performance of the system, calibrate more frequently.

Do the scheduled maintenance as shown in the table. Processing and disassembly instructions are available later in this section.

Interval Maintenance

During cleaning and setup • Inspect the parts for damage and replace or

repair, as necessary.

As necessary • Empty the water trap on the exhalation

valve housing.

• Empty the water trap on the air pipeline inlet fitting and replace the filter.

• Clean and replace the expiratory flow sensor.

• Clean or replace the neonatal flow

sensor.

Monthly • Remove and clean fan filters for the display

unit, vent housing, airway module, and compressor.

Every two months • Calibrate the airway module, if one is

installed.

Every six months • Calibrate the O2 Flow Control Valve*

• Calibrate the Air Flow Control Valve*

• Calibrate the Exhalation Valve*

• Check performance of internal battery. **

Annually • Schedule an annual service and

maintenance check for the ventilator, airway module, and compressor.

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Important

*If the ventilator is moved from the facility, calibrate the O2 Flow Control Valve, Air Flow Control Valve, and Exhalation Valve.

Important

**If the ventilator is used more than once a month on battery power, such as to transport a patient within the facility, it is recommended that the battery performance test be completed every six months.

58 2065492-001

Neonatal Introduction

Overview of neonatal ventilation

The neonatal option on the CARESCAPE R860 provides ventilation for neonatal patients weighing down to 0.25 kg. Using an optional neonatal flow sensor at the patient wye, which connects to the ventilator with a cable, allows for more accurate flow and volume monitoring in the neonatal patient type.

WARNING

While ventilating in the neonatal patient type, additional patient monitoring methods, such as SpO2, ECG, and CO2 are recommended.

Several features are available with the neonatal option:

• The calculated tidal volume per unit of weight is displayed while adjusting the tidal volume setting.

• The volume delivered per unit of weight can be displayed during ventilation for continuous monitoring.

• Safety-related limits have been imposed on ventilation settings and alarm limits for the intended patient population.

Information presented in other sections of this manual applies to all patient types, including neonatal. Exceptions are detailed in this section.

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Neonatal setup and connections

AB.100.175

Neonatal setup and connections

Note

See "Setup and connections" (shared information section for adult, pediatric, and neonatal patient types) for additional information.

Connecting the Neonatal Flow Sensor (NFS)

WARNING

Calibrate the Neonatal Flow Sensor after every day of continuous use and after replacement.

CAUTION

Port 1 must only be used to connect the neonatal flow sensor.

1. Connect the neonatal flow sensor cable connector to to port 1 on the back of the ventilator.

2. Connect the neonatal flow sensor to the cable.

3. Connect the neonatal flow sensor to the patient breathing circuit.

4. Connect the neonatal flow sensor to the patient airway connection.

Note

To disconnect, follow the steps in reverse order.

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Neonatal ventilation modes

Ventilation mode basics

Invasive and non-invasive ventilation

The ventilator provides several standard modes for invasive ventilation and non-invasive modes (nCPAP for neonates).

• Invasive ventilation modes provide a range of patient support, from

fully controlled mechanical breaths to pressure supported breaths for spontaneously breathing patients.

• Non-invasive modes are intended to be used for spontaneously

breathing patients only.

Note

See ventilation mode descriptions for details about the settings and features each mode provides.

The primary difference between setting up a patient for invasive and noninvasive ventilation is the accessories used.

• Invasive ventilation is delivered through an artificial airway (e.g.,

endotracheal tube), which is inserted into the patient's trachea.

• Non-invasive ventilation is delivered using positive-pressure

ventilation through an accessory such as a nasal mask or mouthpiece. These accessories are often attached to the patient’s head to increase the quality of the airway seal to minimize airway leaks.

Non-invasive ventilation masks should be non-vented and must not include an entrainment (inspiratory) valve. Patient circuits for use with non-invasive ventilation must be dual-limb with connections for both the inspiratory and expiratory ports of the ventilator.

Mechanical and spontaneous breaths

The ventilator offers multiple ventilation modes, which support mechanical and spontaneous breaths.

Mechanical breaths are controlled by the ventilator. The ventilator uses the selected mode settings to determine the characteristics of the breath such as timing, volume, and pressure. Depending on which mode is set, mechanical breaths are initiated by the ventilator or the patient.

• Ventilator-initiated: the ventilator uses the set respiratory rate to

initiate a breath.

• Patient-initiated: the patient activates the set inspiratory trigger (flow

or pressure) to initiate a breath.

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Spontaneous breaths are initiated and controlled by the patient.

AB.100.034

Note

In ventilation modes with a PS setting, spontaneous breaths are pressure-supported at the PS level.

Figure 16 • Breath Types

1. Patient-initiated, mechanical breath

2. Spontaneous pressure supported breath

3. Ventilator-initiated, mechanical breath

Note

The segment colored orange in the waveform represents the breath trigger.

Ventilation mode settings

Ventilation mode settings are separated into four categories:

• Main Parameters

• Breath Timing

• Patient Synchrony

• Safety

Each ventilation mode has a unique set of settings. See each ventilation mode description for a list of applicable settings.

Quick Keys on the lower portion of the display provide access to ventilation mode settings that are likely to be adjusted frequently. The remaining settings can be adjusted in the Current Mode > Mode Settings menu.

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Note

When changing ventilation modes, some settings may change if the two modes do not share the same limits or increments.

• When the setting is greater than the maximum value allowed in the

new mode, the maximum value is set.

• When the setting is less than the minimum value of the new numeric

range, the minimum value is set.

• When the setting is between increments, the value is rounded to the

increment above or below it.

Main

Definition

Parameter

FiO2 Fraction of

inspired oxygen

PEEP Positive End

Expiratory

The percentage of oxygen that the ventilator delivers to the patient.

The pressure that the ventilator holds in the patient’s lungs during the expiratory phase.

Pressure

VT Tidal Volume The volume of gas that the ventilator delivers

with each volume-regulated or controlled breath.

Pinsp Inspiratory

Pressure

The pressure above PEEP that is maintained during the inspiratory phase of a pressureregulated breath. In BiLevel mode, Pinsp is the pressure above PEEP at which the patient can spontaneously breathe.

PS Pressure

Support

The pressure above PEEP that is maintained during a pressure-supported breath.

Plow Low Pressure The low pressure level at which the patient can

spontaneously breathe in APRV mode. This setting is equivalent to PEEP in other modes.

Phigh High Pressure The high pressure level at which the patient can

spontaneously breathe in APRV mode.

Breath

Definition

Timing

Rate Respiratory rate The number of breaths delivered to the patient

in one minute.

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Breath

Definition

Timing

Flow Inspiratory flow The rate at which the gas is delivered to the

patient during the inspiratory phase of a volume-controlled breath.

I:E Inspiratory

The ratio of inspiratory time to expiratory time. time:Expiratory time

Tinsp Inspiratory Time The time in seconds that the ventilator uses to

deliver the inspiratory phase of the breath cycle.

Insp Pause Inspiratory

Pause

The percentage of the inspiratory phase during

which the breath is held and no additional flow

is delivered by the ventilator during volume

controlled breaths.

Tpause Pause Time The period in seconds at the end of the

inspiratory phase during which the breath is

held and no additional flow is delivered by the

ventilator during volume controlled breaths.

Thigh High Time The time in seconds that the ventilator holds the

high pressure level in APRV mode.

Tlow Low Time The time in seconds that the ventilator holds the

low pressure level in APRV mode.

Patient

Definition

Synchrony

Insp Trigger Inspiratory

Trigger

The patient effort required to initiate the

inspiratory phase of a breath. The trigger can be

set as either a positive flow value (Flow Trigger)

or a negative pressure deflection below PEEP

(Pressure Trigger).

Exp Trigger Expiratory

Trigger

The percentage of peak flow at which the

pressure supported breath inspiratory phase

ends and the expiratory phase begins.

Rise Time Rise Time The time in milliseconds for pressure to reach

90% of the set inspiratory pressure.

PS Rise Time Pressure

Support Rise

The time in milliseconds for pressure to reach

90% of the set pressure support level. Time

64 2065492-001

Patient

Definition

Synchrony

Bias Flow Bias Flow The continuous flow that is circulated through

the patient circuit during the expiratory phase of the breath cycle. The bias flow may be increased above this setting by the ventilator for some FiO2 settings.

Tsupp Pressure

Support Time

The maximum inspiratory time for a pressuresupported breath.

Safety Definition

Pmax Maximum

Pressure

The maximum pressure allowed in the patient breathing circuit. Once reached, the inspiratory phase ends, and the ventilator immediately begins the expiratory phase.

Plimit Pressure Limit The pressure at which the breath is limited and

held for the remaining inspiratory time in a volume-controlled breath.

Pmin Minimum

Pressure

The minimum target pressure offset from PEEP allowed in PRVC, VS, SIMV PRVC, and BiLevel VG modes.

Minimum Rate Minimum

respiratory rate

The minimum number of breaths per minute a patient must draw before the ventilator delivers a backup breath.

Backup Pinsp Backup

Inspiratory Pressure

Backup Tinsp Backup

Inspiratory Time

The pressure above PEEP that the ventilator maintains as it delivers a mechanical breath in CPAP/PS and NIV modes.

The time in seconds that the ventilator uses to deliver the inspiratory phase for a mechanical breath in VS, CPAP/PS and NIV modes.

Positive end expiratory pressure (PEEP)

PEEP is the low pressure maintained in the patient’s airway during the expiratory phase. PEEP prevents the patient’s lungs from collapsing at the end of expiration. Maintaining a PEEP level improves the possibility of increasing oxygenation. PEEP (or the equivalent setting of Plow) is available in all ventilation modes.

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Pressure support

Pressure support provides additional pressure during the inspiratory phase of spontaneous breaths in spontaneous breathing modes. The PS setting is available in the following ventilation modes:

• CPAP/PS

• SIMV VC

• SIMV PC

• SIMV PRVC

• BiLevel

• BiLevel VG

• NIV

• SBT The maximum duration of the inspiratory phase for pressure-supported

breaths is Tsupp or 4 seconds for adults, 1.5 seconds for pediatrics, and

0.8 seconds for neonates. The inspiratory phase of pressure-supported breaths ends when one of the following occurs:

• Set Exp Trigger is detected.

• Set VT is delivered (VS mode only).

• Pressure exceeds PEEP + PS + 2.5 cmH2O.

• Set Tsupp is reached.

Flow and pressure triggering

The ventilator detects a patient’s spontaneous breathing effort based on changes in flow or pressure.

• Flow trigger: A breath is delivered when the patient’s inspiratory effort reaches the Insp Trigger setting.

• Pressure trigger: A breath is delivered when the patient’s negative airway pressure (below PEEP) reaches the Insp Trigger setting.

To set a flow or pressure trigger, adjust the Insp Trigger setting.

• To set a flow trigger, select Current Mode, select the trigger setting, set a positive value using the Trim Knob and confirm.

• To set a pressure trigger, select Current Mode, select the trigger setting, set a negative value using the Trim Knob and confirm.

The ventilator synchronizes mechanical breaths with patient triggers when in the following modes:

• SIMV VC

• SIMV PC

• SIMV PRVC

• BiLevel

• BiLevel VG

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And when assist control is active in the following modes:

• A/C VC

• A/C PC

• A/C PRVC

Breath timing preferences

The parameters used to represent the timing of a delivered breath or inspiratory phase of a delivered breath may be selected by the facility.

Note

Timing and Flow default settings may be changed by a Super User. See the "Configuration menu (Super User)" section for more information.

The following table shows which settings are available based on the ventilation mode and Timing and Flow selections.

Timing I:E I:E Tinsp Tinsp Tpause

Flow On Off On Off On

A/C VC I:E

Flow

A/C PC I:E I:E Tinsp Tinsp Tinsp

A/C PRVC I:E I:E Tinsp Tinsp Tinsp

SIMV VC Tinsp

Flow

SIMV PC Tinsp Tinsp Tinsp Tinsp Tinsp

SIMV PRVC Tinsp Tinsp Tinsp Tinsp Tinsp

BiLevel Tinsp Tinsp Tinsp Tinsp Tinsp

BiLevel VG Tinsp Tinsp Tinsp Tinsp Tinsp

APRV Thigh

Tlow

CPAP/PS Backup

Tinsp

VS Backup

Tinsp

NIV Backup

Tinsp

nCPAP Tinsp Tinsp Tinsp Tinsp Tinsp

I:E Insp Pause

Tinsp Insp Pause

Thigh Tlow

Backup Tinsp

Tinsp Flow

Thigh Tlow

Backup Tinsp

Tinsp Insp Pause

Thigh Tlow

Backup Tinsp

Tpause Flow

Thigh Tlow

Backup Tinsp

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Note

Selecting a breath timing for the modes listed in the table will not affect other ventilation modes.

Ventilation mode features

Tube compensation

Tube compensation can be used to offset all or a percentage of the additional resistive pressure created by the endotracheal tube.

Note

To set Tube compensation, a Tube Type and Tube Diameter must be set in the New Patient or Current Patient menu.

WARNING

To set Tube Compensation, select Current Mode > Mode Settings and select Tube Comp. A general message shows when tube compensation is on.

Note

The options for tube compensation are: Endotrach, Trach, or ---. When --is selected, the ventilator will not compensate for tube resistance.

Assist control

• A/C VC

• A/C PC

• A/C PRVC

When the patient initiates a breath with assist control enabled, the ventilator delivers a breath based on the mode settings. After a patientinitiated mechanical breath, the ventilator may delay the delivery of the

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next mechanical breath to prevent two mechanical breaths from being delivered consecutively (breath stacking).

Note

Under certain conditions, such as high spontaneous breathing rates or high leakage, the rate of mechanical breaths may not meet the set respiratory rate.

A general message shows when assist control is off. When assist control is off, the patient is able to draw spontaneous breaths at the set PEEP level between mechanical breaths.

To set Assist Control, select Current Mode > Mode Settings and select Assist Control (On or Off).

Leak compensation

WARNING

The exhaled volume of the patient can differ from the measured exhaled volume due to leaks.

When the ventilator detects breathing circuit leaks, leak compensation does two or three functions depending on the selected ventilation mode. In all modes:

• Flow and volume waveforms and measured volume data are

adjusted to account for leaks.

In the following volume-controlled modes, the ventilator adjusts the tidal volume delivered to compensate for leaks:

• A/C VC

• A/C PRVC

• SIMV VC

• SIMV PRVC

• BiLevel VG

• VS The maximum tidal volume adjustment is limited to 100% of the set tidal

volume for the neonatal patient type.

• Neonatal - 100% of the set tidal volume To set leak compensation, select Current Mode > Mode Settings and

select Leak Comp. A general message shows when leak compensation is on.

Trigger compensation

Leaks can cause the ventilator to initiate breaths automatically (autotriggering). Trigger compensation adjusts the flow trigger to compensate

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for leaks, reducing the need to manually adjust the Insp Trigger setting to prevent auto-triggering.

Trigger compensation is available in all ventilation modes. To set trigger compensation, select Current Mode > Mode Settings, and select Trigger Comp.

Backup mode

• The Apnea alarm is activated.

• The patient’s expired minute volume (MVexp) is below 50% of the set low MVexp alarm.

The set Backup mode is shown under the Backup mode check box in Current Mode > Mode Settings . To enable Backup mode, select the check box.

Backup settings are a subset of available settings in each ventilation mode. Adjust Backup settings in Current Mode > Mode Settings > Backup Settings.

Note

Settings that are not designated as Backup settings remain at the current value when the ventilator transitions to the set Backup mode.

WARNING

Backup mode is available in the following ventilation modes:

• SIMV VC

• SIMV PC

• SIMV PRVC

• BiLevel

• BiLevel VG

• CPAP/PS

• VS

• APRV

The following ventilation modes may be set as the Backup mode:

• A/C VC

• A/C PC

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• A/C PRVC

• SIMV VC

• SIMV PC

• SIMV PRVC

• BiLevel

• BiLevel VG

Nasal continuous positive airway pressure (nCPAP)

The nCPAP mode is a purchasable option. The nCPAP mode is intended for non-invasive ventilation of neonatal patients only.

WARNING

Before using nCPAP mode, the patient should demonstrate all of the following characteristics:

• Is responsive

• Breathes spontaneously

• Has a controlled airway

• Requires pressure support ventilation

• Patient needs oxygen therapy

While in nCPAP ventilation, the ventilator is to be provided with CO2 monitoring equipment that complies with ISO 80601-2-55 or ISO 21647.

If the Apnea Time, Leak Limit, or MVexp low alarms are disabled, additional monitoring, such as SpO2, ECG, and CO2, is recommended to prevent the patient from hypoventilating while ventilating in the neonatal patient type without the neonatal flow sensor.

The Patient Disconnected alarm is not enabled during nCPAP mode. The Apnea, Circuit Leak, MVexp low, and PEEPe low alarms are the primary disconnection notifications. To make sure that the ventilator detects a patient disconnect, set the PEEPe Low limit correctly for the patient’s condition.

Note

The neonatal flow sensor is not used during nCPAP.

The nCPAP mode allows a clinician to set a FiO2 and Bias Flow rate for gas through the patient circuit. The clinician can also set a level of PEEP

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to be maintained in the patient circuit and a respiratory rate for mechanical breaths. The mechanical breaths delivered are time cycled, but are synchronised with a patient trigger where necessary. The clinician will set the inspiratory pressure inspiratory time for the time cycled breaths.

The Bias Flow rate, set by the clinician will be used to maintain PEEP and for the inspiratory phase of the time cycled mechanical breaths. Insufficient setting of the Bias Flow rate may cause an inability to reach or maintain the set PEEP and or inspiratory pressure during the mechanical breaths.

During nCPAP, the patient draws spontaneous breaths through a nasal interface as the ventilator maintains the set inspiratory pressure.

If large patient circuit leaks are present, the user may disable the MVexp low, Apnea Time, and Leak Limit alarms.

Important

Backup ventilation is not available while using nCPAP mode.

The following settings are available in nCPAP mode:

Category Setting

Main Parameters FiO2

PEEP

Pinsp

Breath Timing Rate

Tinsp

Patient Synchrony Bias Flow

Insp Trigger

Safety Pmax

72 2065492-001

AB.100.205

Figure 17 • nCPAP waveform

1. Airway pressure (Paw) waveform

2. Tinsp

3. Pinsp

4. PEEP

5. Expiratory time

6. Flow waveform

Invasive neonatal ventilation modes

The following invasive ventilation modes are availble for neonatal patients. See "Ventilation modes" for detailed information.

• A/C VC

• A/C PC

• A/C PRVC

• SIMV VC

• SIMV PC

• CPAP/PS

• BiLevel

• SIMV PRVC

• BiLevel VG

• APRV

• VS

• SBT

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Note

BiLevel, SIMV PRVC, BiLevel VG, APRV, and VS are purchasable options.

74 2065492-001

Neonatal Operation

Power

Turning on power to the ventilator

1. Plug the power cord into an electrical outlet.

• The LED indicator illuminates (green) to indicate the main power is connected.

2. Press the power switch on the back of the ventilator to the On position.

• The start-up screen appears while the system runs a series of

automated self tests.

• When the self tests pass, the system goes into Standby and the

display shows the Standby menu.

• If the self tests fail, the display shows an alarm. See "List of

alarms" and "Troubleshooting" in the "Alarms and troubleshooting" section or "List of alarms – Neonatal" in the

"Neonatal alarms and troubleshooting".

3. Listen for two distinctly different audio tones to sound to make sure the primary speaker and backup buzzer are working properly.

4. Watch and verify the alarm light on the top of the display unit cycles through the following colors: blue, red, and yellow.

WARNING

Turning off power to the ventilator

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

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4. Press the power switch on the back of the ventilator to the Off position.

Patient Setup

New Patient

Use these instructions for preparing the ventilator for a New Patient. After powering on the ventilator the Standby menu displays.

1. Select NEW PATIENT.

2. Select Adult, Pediatric, or Neonatal patient type.

3. Select Patient ID (identification).

• Enter up to 10 characters and then select Confirm. (Only

English alpha-numeric characters may be entered).

WARNING

To protect patient privacy, do not use the patient’s name when entering the patient ID (identification). Consider the facility’s privacy policies when entering the patient ID.

4. Select Gender (male or female).

5. Select Height.

6. Select Weight.

• The ventilator calculates and displays the patient weight in

kilograms, the BSA (Body Surface Area), IBW (Ideal Body Weight), and a suggested VT (Tidal Volume). See the "Clinical theory" section for calculations.

• IBW is available for adult patients only.

7. Select (Endotrach, Trach, or ---).

When --- is selected, the ventilator will not compensate for tube resistance.

8. Select Tube Diameter.

9. Verify and confirm settings.

Previous Patient

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From the Standby menu, select PREVIOUS PATIENT.

Important

Previous Patient data is only saved when a normal shutdown sequence is performed. Abrupt or unexpected power loss will prevent this data from being saved.

Current Patient

1. Select Standby.

2. Select Current Patient.

The Current Patient menu shows.

3. Select the desired patient type and adjust settings.

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System Check

System Check overview - neonatal

The ventilator should be fully cleaned and prepared for a patient before performing the System Check.

WARNING

To help ensure the proper function of the system, it is highly recommended to complete the System Check between patients.

The patient must not be connected to the ventilator while completing the System Check.

Changing the patient circuit after completion of System Check will affect volume delivery and exhaled volume measurements. If any change is made to the patient circuit, repeat the System Check.

Complete the System Check with the breathing circuit and accessories that will be used during ventilation.

Failure to complete a System Check may result in inaccurate delivery and monitoring. This may result in risk to the patient.

Running a neonatal system check

1. From Standby, select SYSTEM CHECK.

The Run System Check menu shows.

2. Attach the neonatal flow sensor to the breathing circuit and all accessories that will be used to ventilate the patient.

3. Occlude the patient wye using the occlusion port.

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INSP

EXP

AB.100.208

1. Occlusion port

4. Select Start.

The System Check starts and shows the results of each check.

The system runs the following checks:

• Paw transducer check

• Barometric pressure check

• Relief valve check

• Exhalation valve check

• Expiratory flow sensor check

• Air flow sensor check

• Oxygen sensor check

• O2 flow sensor check

• Neonatal flow sensor check

• Resistance check

• Circuit measurements check (circuit leak, compliance, and resistance)

Important

When performing the Neonatal Flow Sensor Check, remove the occlusion from the neonatal flow sensor, keeping the flow sensor attached to the patient circuit.

5. Select the information icon to see the System Check Details menu.

The System Check starts and shows the results of each check.

Note

Follow all on-screen system check instructions.

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When the System Check is complete, the Final Result line will display the patient type icon, a green check mark (pass) or red X (fail), and the date and time of the System Check.

Patient ventilation

System menu (neonatal)

The System menu contains settings for data source selection, NFS calibration options, display brightness and system information.

WARNING

Calibrate the Neonatal Flow Sensor after every day of continuous use.

1. Select Menu > System.

2. Select Data Source (Ventilator or NFS).

3. Select Calibrations (NFS, Paux Zero, or Purge Flow) .

• Select NFS to calibrate the Neonatal Flow Sensor. A green check mark indicates the NFS calibration was successful.

• Select Paux Zero. A green check mark indicates Paux Zeroing calibration was successful.

Note

See "Purging the auxiliary pressure tubing" and "Zeroing auxiliary pressure" in the "Setup and connections" section.

4. Select Display Brightness to adjust the brightness level of the user interface.

Select brightness level of 1 (low) to 5 (high).

5. View system information: Software version, Service Pack version, Running hours, Altitude, O2 pressure, Air pressure, and Battery status.

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Setting the ventilator data source

The data source is used to obtain patient monitoring parameters from either the ventilator or the Neonatal Flow Sensor (NFS). See "Neonatal patient monitoring" for detailed information.

WARNING

Calibrate the Neonatal Flow Sensor after every day of continuous use.

While ventilating in the neonatal patient type without the neonatal flow sensor, additional patient monitoring such as SpO2, ECG, and CO2 are recommended.

Flow and volume accuracy are decreased when not using the neonatal flow sensor for the neonatal patient type.

1. Select Menu >System.

The System menu shows.

2. Select Ventilator or NFS and confirm settings.

If the ventilator is selected as the data source the Ventilator Data icon displays, the internal flow sensors of the ventilator will be used for flow and volume monitoring.

If the NFS is selected as the data source the Patient Data icon displays, the neonatal flow sensor will be used for flow and volume monitoring.

Ventilator Data Source Icons

Ventilator Data NFS (Patient) Data

Setting a ventilation and backup mode

Ventilation modes are selected through the Current Mode button. The selected ventilation mode shows with the corresponding mode settings.

Ventilation modes may be changed in Standby or during ventilation.

Ventilation mode settings should be set prior to connecting a patient to the ventilator.

See "Backup mode" in the "Ventilation modes" section for additional information.

1. Select Current Mode.

2. Select the desired ventilation mode.

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The title of the vent mode shows in the Mode Settings menu along with the parameters for that mode. See "Ventilation modes" section for detailed information on types of modes and settings.

Select the appropriate icon to see available ventilation modes.

Partial list of ventilator modes Full list of ventilator modes

3. Select Assist Control, Leak Comp, or Trigger Comp if desired.

• Assist Control is only available in the following ventilation

modes: A/C VC, A/C PC, and A/C PRVC.

• See "Assist control", "Leak compensation", or "Trigger

compensation" in the "Ventilation modes" section for detailed information.

4. Set the desired settings for the ventilation mode and confirm.

When ventilator settings are confirmed, the Mode Settings menu closes and the selected ventilation mode shows in Current Mode.

5. To set a Backup Mode, select Current Mode.

6. Select Backup Settings.

• Set the desired settings for the backup mode and confirm.

7. Confirm all ventilation mode settings.

Setting limit indicators

Starting patient ventilation

WARNING

Ventilation will not start until 'Start Ventilation' is selected.

Ensure that the ventilator battery is fully charged before starting patient ventilation. See "Battery status" for additional information.

1. From Standby, select START VENTILATION.

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If the Start Ventilation button is green, a System Check has been completed for the current patient and when selected, will start ventilation.

If the Start Ventilation button is yellow, the Complete System Check warning alert will display the following:

Select Continue to bypass System Checkout and start ventilation. Select Cancel to remain in Standby.

Note

It is recommended that System Check is completed prior to starting ventilation.

2. After ventilation has started, connect the breathing circuit to the

patient.

Standby

Pausing ventilation

WARNING

The patient will not be ventilated when in Standby.

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventilation to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

Park Circuit

WARNING

The patient will not be ventilated while the circuit is parked and in Standby.

1. Disconnect the patient from the breathing circuit.

2. Select Standby.

Select Pause Ventialtion to go to Standby. No ventilation will be delivered. Select Cancel to continue ventilation if a warning message is displayed.

3. Select Pause Ventilation.

• Monitoring and ventilation will stop.

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4. Occlude the patient circuit using the occlusion port.

INSP

EXP

AB.100.209

1. Occlusion port

5. Select PARK CIRCUIT.

• The display will show: Patient circuit is occluded and the

ventilator is in Standby.

Ventilation adjustments

Ventilaltion modes and setting adjustments may be changed while in Standby or while ventilating.

Changing ventilation modes

1. Select the Current Mode.

The Mode Settings menu shows.

2. Select the desired mode from the list.

• Use the scroll bar to view additional modes.

3. Confirm setting.

Setting Favorites

Up to four Favorite procedures may be selected to show on the upperright corner of the user interface.

1. Select Menu.

2. Select Procedures, Lung Mechanics, or Suction menus.

3. Select Assign Favorites.

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The Assign Favorites menu shows with a list of the following procedures: Increase O2, Suction, Auto PEEP, Inspiratory Hold Expiratory Hold, P 0.1, NIF, Vital Capacity, and Manual Breath.

4. Select up to four Favorites.

Favorites show in the upper right corner of the display.

Note

The following Favorite procedures begin automatically after they are selected: Manual Breath, Suction, and Increase O2.

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Neonatal alarms and troubleshooting

Alarm priority

Audible and visual indicators tell the priority of the alarm.

Priority Color Light Tone

High Red Flashes red Series of five tones,

twice

Medium Yellow Flashes yellow Series of three tones

Low Blue Solid blue Single tone

Note

When more than one alarm occurs at the same time, the alarm bar, alarm light, and audible alarm tone indicates the highest priority alarm.

The color on the right side of the alarm light shows the priority of the alarm. The left side of the alarm light is blue when audio pause is active.

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Troubleshooting

Symptom Problem Solution

The main power indicator is not on.

Ventilator cannot be turned off.

Backup audio alarm turns on.

The electrical power cord is not connected correctly.

• Connect the power cord.

• Loosen the power cord retaining clamp and make sure plug is fully seated. Then tighten the retaining clamp.

The inlet circuit breaker

Turn the circuit breaker on.

(switch) is off.

The power cord is

Replace the power cord.

damaged.

The electrical outlet that the power cord is

Use a different electrical

outlet. connected to has no power.

An internal fuse is open. Contact an authorized service

representative to repair the

ventilator.

The display unit cable is loose.

Turn the ventilator switch off,

and then disconnect from the

main power. Check and

tighten the display unit

connectors.

The ventilator is not in Standby.

A system failure has occurred.

Set the ventilator to Standby,

and then turn the system off.

Contact an authorized service

representative to repair the

ventilator.

The display unit cable is loose.

Turn the ventilator switch off,

and then disconnect from the

main power. Check and

tighten the display unit

connectors.

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Symptom Problem Solution

An alarm shows although the data is within range.

The alarm is from the ventilator but the value shown is from the airway module. (Not applicable for neonatal.)

The Ppeak high alarm conditions are checked before the display view is updated.

• Calibrate the airway module.

• Go to Menu > System and change the selection for Data Source.

No action required. In some situations the ventilator will react to a transient high pressure before the data can be sampled and shown on the display.

Ventilator does not deliver set VT in A/C VC or SIMV VC modes.

The Plimit setting prevents the full VT from being delivered in

• Change the VT setting.

• Change the Plimit setting.

the inspiratory period.

Ventilator does not deliver set VT in A/C PRVC, SIMV PRVC, or BiLevel VG modes.

Ventilator transitions to Backup mode.

Pmax alarm limit is limiting delivered inspiratory pressure.

The ventilator is at minimum allowed delivery.

MVexp low, Apnea alarm, RR alarm, and

• Change the VT setting.

• Change the Pmax setting.

• Change the VT setting.

• Change the Pmin setting.

Change ventilation settings.

insufficient patient ventilation.

Short delay in the breath cycle at the PEEP pressure level.

Automatic pressure transducer zeroing interference.

No action required. The situation will be corrected when zeroing is complete.

Automatic flow sensor zeroing interference.

Ventilator is automatically triggering a breath.

The breathing circuit leak rate is higher than the flow trigger level.

• Enable Trigger Compensation.

• Check the breathing circuit for leaks.

• Turn Leak Comp On.

• Increase the Flow triggering level or change from Flow triggering to Pressure triggering.

• Make sure the correct patient type is selected.

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Symptom Problem Solution

VT, compliance and resistance values are not accurate.

System Check was not done with the current patient circuit.

Flow sensors are dirty • Clean expiratory flow

Complete System Check with the same breathing circuit that will be used on the patient.

sensor.

• Clean neonatal flow

sensor.

• Replace D-lite flow

sensor.

• Replace D-lite

spirometry sensing lines.

• Calibrate gas module.

System Check fails. Water trap on the

exhalation valve is not on tightly.

Patient circuit not connected to the ventilator.

Patient wye is not occluded correctly.

Expiratory flow sensor has failed.

Exhalation valve and seals are not seated correctly.

A connection port on the patient circuit is open.

Leak in patient circuit is very large.

System Check was stopped before it completed.

Touchscreen does not respond.

The touchscreen is locked.

The touchscreen requires calibration or repair.

Make sure the water trap is tightly secured.

Attach the patient circuit to the inspiratory and expiratory ports.

Make sure the patient wye is occluded completely with the leak test plug.

Clean or replace the flow sensor. Make sure flow sensor is connected correctly.

Remove and replace the exhalation valve.

Make sure all connection ports are occluded.

Check the breathing circuit for leaks.

Do a System Check and let it complete.

Press the Lock hard key at the bottom of the display unit.

Contact an authorized service representative to repair the ventilator.

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nCPAP Troubleshooting

Symptom Problem Solution

Auto-triggering. Trigger setting is too

sensitive.

No triggering or missed triggers.

Trigger setting is not sensitive enough.

• Increase the Insp Trigger setting.

• Set a pressure Insp Trigger.

• Enable trigger compensation.

• Check the patient interface.

• Check the expiratory flow sensor.

• Decrease the flow Insp Trigger setting.

• Increase the pressure Insp Trigger setting.

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Neonatal cleaning and maintenance

Note

See "Cleaning and maintenance" (shared information section for adult, pediatric, and neonatal patient types) for additional information.

Processing the neonatal flow sensor

WARNING

Calibrate the Neonatal Flow Sensor after every day of continuous use.

CAUTION

Do not use compressed air or a water jet to clean the neonatal flow sensor.

Do not use an automated washer to clean or disinfect flow sensors.

Do not insert anything into the flow sensor to clean internal surfaces. Damage may occur to the flow sensor.

Note

See the shared "Cleaning and maintenance" section for detailed cleaning instructions.

Calibrating the neonatal flow sensor

The neonatal flow sensor can be calibrated automatically through the System Check or manually through the System menu.

WARNING

Calibrate the Neonatal Flow Sensor (NFS) after every day of continuous use.

Note

The neonatal flow sensor can only be manually calibrated when the neonatal flow sensor is not set as the data source.

1. Select Menu > System.

2. Under Data Source, select Ventilator.

3. Hold the flow sensor between thumb and index finger to occlude both ports at the same time.

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AB.100.183

4. Under Calibration, select NFS.

When the calibration is complete, a green check mark (pass) or red X (fail) will appear next to NFS.

5. Under Data Source, select NFS.

6. Connect the flow sensor to the patient circuit.

92 2065492-001

CARESCAPE R860 Quick Reference Guide English 2065492-001 03 15 D

Ge R860 User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

Introduction

Welcome

Measured data definitions

Navigation

Ventilator display

Display user interface

Navigating active alarms

Standby

Main menu

System menu

Changing a setting

Navigating the user interface

Present/Patient Status workspace and views

Past/Historical Trends workspace and views

Future/Clinical Decision Support workspace and views

Setup and connections

Ventilator overview front

Ventilator overview back

Connecting the breathing circuit

Connecting a HME (heat and moisture exchanger)

Connecting the humidifier

Connecting the nebulizer

Ventilation modes

Ventilation mode features

Tube compensation

Assist control

Leak compensation

Trigger compensation

Backup mode

Non-invasive ventilation (NIV)

Spontaneous breathing trial (SBT mode)

Operation

Power

Turning on power to the ventilator

Turning off power to the ventilator

Patient Setup

New Patient

Previous Patient

Current Patient

System Check

System Check overview

Additional System Check information

Circuit Setup

Running a System Check

Patient ventilation

Setting the ventilator data source

System menu

Setting a ventilation and backup mode

Setting limit indicators

Starting patient ventilation

Standby

Pausing ventilation

Park Circuit

Ventilation adjustments

Changing ventilation modes

Setting Favorites

Alarms and troubleshooting

Alarm priority

Troubleshooting

Cleaning and maintenance

Part replacement schedule

Exhalation valve assembly

User maintenance

Neonatal Introduction

Overview of neonatal ventilation

Neonatal setup and connections

Connecting the Neonatal Flow Sensor (NFS)

Neonatal ventilation modes

Ventilation mode basics

Invasive and non-invasive ventilation

Mechanical and spontaneous breaths

Ventilation mode settings

Positive end expiratory pressure (PEEP)

Pressure support

Flow and pressure triggering

Breath timing preferences