Hamilton C2 User manual

Operator‘s Manual

PN 624131/06

Software version 2.x

October 2010

Preface

© 2010 HAMILTON MEDICAL AG. All rights reserved. Printed in
Switzerland. No part of this publication may be reproduced or
stored in a database or retrieval system, nor transmitted, in any
form or by any means, electronic, mechanical, by photocopy­ing, recording, or otherwise, without the prior written permis­sion of HAMILTON MEDICAL.

This manual may be revised or replaced by HAMILTON MEDI­CAL at any time and without notice. Ensure that you have the
most current applicable version of this manual; if in doubt,
contact HAMILTON MEDICAL AG Marketing Department.
While the information set forth is believed to be accurate, it is
not a substitute for the exercise of professional judgment.

Nothing in this manual shall limit or restrict in any way HAMIL­TON MEDICAL’s right to revise or otherwise change or modify
the equipment (including its software) described herein, with­out notice. In the absence of an express, written agreement to
the contrary, HAMILTON MEDICAL has no obligation to furnish
any such revisions, changes, or modifications to the owner or
user of the equipment (including software) described herein.

The equipment must be operated and serviced by trained pro­fessionals only. HAMILTON MEDICAL’s sole responsibility with
respect to the equipment and its use is as stated in the Limited
Warranty provided in this manual.

Product and company names mentioned herein may be the
trademarks of their respective owners.

HAMILTON MEDICAL will make available on request circuit dia­grams, component parts lists, descriptions, calibration instruc­tions, or other information that will assist the user’s authorized
trained personnel to repair those parts of the equipment
deemed by HAMILTON MEDICAL to be repairable.

624131/06 iii

Manufacturer Distributor in USA

HAMILTON MEDICAL AG
Via Crusch 8
CH-7402 Bonaduz
Switzerland
Phone: [phone]
Fax: [phone]
[e-mail]
www.hamilton-medical.com

HAMILTON MEDICAL, Inc.
4990 Energy Way
P.O. Box 30008
Reno, NV 89520
Phone: [phone]
Toll-free: [phone]
Fax: [phone]
[e-mail]

iv 624131/06

HAMILTON-C2 software information

The software version for the HAMILTON-C2 is visible in the

System -> Info

window. The software version for the VUP
(ventilator unit processor) (that is, the digit to the left of the
decimal point for VUP) should match the version on the title
page of this manual. See section 3.3.1 for details.

Definitions

WARNING

Indicates a potentially hazardous situation which,
if not avoided, could result in death or serious
injury.

CAUTION

Indicates a potentially hazardous situation which,
if not avoided, could result in minor or moderate
injury.

NOTE:

Emphasizes information of particular importance.

Applies only when the neonatal option is
installed.

624131/06 v

Applies only when the CO2 sensor option is
installed

Applies only when the TRC option is installed

vi 624131/06

General cautions and notes

Intended use

The HAMILTON-C2 ventilator is intended to provide positive
pressure ventilatory support to adults, pediatrics, infants and
neonates.

Intended areas of use:

• In the intensive care ward or in the recovery room

• During secondary transport from one hospital to another

• During transfer of ventilated patients within the hospital
The HAMILTON-C2 ventilator is a medical device intended for

use by qualified, trained personnel under the direction of a
physician and within the limits of its stated technical specifica­tions.

CAUTION

(USA only): Federal law restricts this device to sale
by or on the order of a physician.

NOTE:

Not all options are available in all countries.

General operation notes

• The displays shown in this manual may not exactly match

what you see on your own ventilator.

• Familiarize yourself with this operator’s manual before using

the ventilator on a patient.

• Displayed information that is ghosted is not active and may

not be selected.

• Dashes displayed in place of monitored data indicate that

valid values are not yet available or do not apply.

• If a ventilator control does not respond when selected by

touch or by the turn of a knob, the control is not active in
this particular instance or the function is not implemented.

624131/06 vii

Monitoring and alarms

• The HAMILTON-C2 is not intended to be a comprehensive
vital sign monitor for patients on life-support equipment.
Patients on life-support equipment should be appropriately
monitored by qualified medical personnel and suitable
monitoring devices. The use of an alarm monitoring system
does not give absolute assurance of warning for every form
of malfunction that may occur with the ventilator. Alarm
messages may not exactly pinpoint a problem; the exercise
of clinical judgment is necessary.

• An alternative means of ventilation shall be available when­ever the ventilator is in use. If a fault is detected in the ven­tilator or its life-support functions are in doubt, disconnect
the HAMILTON-C2 from the patient and immediately start
ventilation with such a device (for example, a resuscitation
bag), using PEEP and/or increased oxygen concentration
when appropriate. The ventilator must be removed from
clinical use and serviced by a HAMILTON MEDICAL autho­rized service engineer.

• It is recommended that additional independent monitoring
devices be used during mechanical ventilation. The opera­tor of the ventilator must still maintain full responsibility for
proper ventilation and patient safety in all situations.

• Do not silence the audible alarm when leaving the patient
unattended.

• Do not use the exhaust port of the expiratory valve for
spirometry. Due to the HAMILTON-C2’s base flow, the
exhaust gas output is larger than the patient’s actual
exhaled volume.

• Do not put a vessel filled with a liquid on the ventilator. If a
liquid enters the product, a fire and/or electric shock may
occur.

Fire and other hazards

• To reduce the risk of fire or explosion, do not place the ven­tilator in a combustible or explosive environment (for exam­ple, around flammable anesthetics or other ignition

viii 624131/06

sources). Do not use it with any equipment contaminated
with oil or grease.

• To reduce the risk of fire, do not use high-pressure gas

hoses that are worn or contaminated with combustible
materials like grease or oil.

• To reduce the risk of fire, use only breathing circuits

intended for use in oxygen-enriched environments. Do not
use antistatic or electrically conductive tubing.

• In case of fire, immediately secure the patient’s ventilatory

needs, switch off the ventilator, and disconnect it from its
gas and electrical sources.

Service and testing

• To ensure proper servicing and to prevent possible physical

injury, only HAMILTON MEDICAL authorized service person­nel should attempt to service the ventilator.

• To reduce the risk of electrical shock, disconnect electrical

power from the ventilator before servicing.Be aware that
battery power remains even after the mains is discon­nected. Be aware that if the power switch is off, some parts
still carry high voltage.

• Do not attempt service procedures other than those speci-

fied in the service manual.

• Use replacement parts supplied by HAMILTON MEDICAL

only.

• Any attempt to modify the ventilator hardware or software

without the express written approval of HAMILTON MEDI­CAL automatically voids all warranties and liabilities.

• The preventive maintenance program requires a general

service every 5000 hours or yearly, whichever comes first.

• To ensure the ventilator’s safe operation, always run the

tests and calibrations prescribed in Section 3 before using
the ventilator on a patient.If the ventilator fails any tests,
remove it from clinical use immediately. Do not use the ven­tilator until necessary repairs are completed and all tests
have passed.

624131/06 ix

• The manufacturer can only be responsible for the safety,
reliability, and performance of the ventilator if:

– appropriately trained personnel carry out assembly

operations, extensions, readjustments, modifications or
repairs;

– the electrical installation of the relevant room complies

with the appropriate requirements; and

– the ventilator system is used in accordance with the

operator’s manual.

Electromagnetic susceptibility

The HAMILTON-C2 complies with the IEC 60601-1-2 EMC
(Electro Magnetic Compatibility) Collateral Standard. It is
intended for use in the electromagnetic environment described
in Table A-17 through Table A-19. Do not use the HAMILTON­C2 in an environment with magnetic resonance imaging (MRI)
equipment.

Units of measure

NOTE:

In this manual pressure is indicated in cmH2O, PCO2 in
mmHg and length in cm.

On the HAMILTON-C2 pressures are indicated in cmH2O, mbar
or hPa. Hectopascals (hPa) are used by some institutions
instead. Since 1 mbar equals 1 hPa, which equals

1.016 cmH

indicated in mmHg, Torr or kPa and length in cm or inch.

O, the units may be used interchangeably. CO2 is

2

Disposal

Dispose of all parts removed from the device according to your
institution’s protocol. Follow all local, state, and federal regula­tions with respect to environmental protection, especially when
disposing of the electronic device or parts of it (for example
oxygen cell, batteries).

x 624131/06

Year of manufacture

The year of manufacture is shown on the serial number label
on the HAMILTON-C2 ventilation unit.

624131/06 xi

xii 624131/06

Table of contents

1 General information. . . . . . . . . . . . . . . . . . . . . . . . 1-1

1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

1.2 Functional description . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

1.2.1 System overview . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

1.2.2 Gas supply and delivery . . . . . . . . . . . . . . . . . . . . . 1-5

1.2.3 Gas monitoring with the Flow Sensor. . . . . . . . . . . 1-7

1.3 Physical description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

1.3.1 Breathing circuits and accessories. . . . . . . . . . . . . . 1-9

1.3.2 Ventilator unit . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

1.3.3 Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-20

1.4 Symbols used on device labels and packaging . . . . . . . . 1-22

2 Preparing for ventilation . . . . . . . . . . . . . . . . . . . . 2-1

2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

2.2 Installing the patient tubing support arm . . . . . . . . . . . . . 2-4

2.3 Installing the humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5

2.4 Installing the option board . . . . . . . . . . . . . . . . . . . . . . . . 2-5

2.5 Installing the patient breathing circuit . . . . . . . . . . . . . . . 2-6

2.6 Installing the pneumatic nebulizer . . . . . . . . . . . . . . . . . 2-17

2.7 Setting up for monitoring by the optional CO2 sensor . . 2-19

2.7.1 CO2 mainstream measurement . . . . . . . . . . . . . . 2-20

2.7.2 CO2 sidestream measurement . . . . . . . . . . . . . . . 2-24

2.8 Installing the optional Aeroneb Pro nebulizer . . . . . . . . . 2-26

2.9 Using an expiratory filter . . . . . . . . . . . . . . . . . . . . . . . . 2-26

2.10 Connecting to primary power source . . . . . . . . . . . . . . . 2-27

2.10.1Connecting to AC power . . . . . . . . . . . . . . . . . . . 2-28

2.10.2Connecting to DC power . . . . . . . . . . . . . . . . . . . 2-28

2.11 About the batteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-30

2.12 Connecting the oxygen supply . . . . . . . . . . . . . . . . . . . . 2-32

2.13 Connecting to an external patient monitor or other device. . .
2-33

2.14 Starting up the ventilator . . . . . . . . . . . . . . . . . . . . . . . . 2-34

2.15 Shutting down the ventilator . . . . . . . . . . . . . . . . . . . . . 2-35

2.16 Display navigation guidelines . . . . . . . . . . . . . . . . . . . . . 2-35

3 Tests, calibrations and utilities . . . . . . . . . . . . . . . 3-1

3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2

3.2 Running the preoperational check . . . . . . . . . . . . . . . . . . 3-4

3.3 System functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

3.3.1 Info: Viewing device-specific information . . . . . . . . 3-6

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Table of contents

3.3.2 Tests & calib: Running sensor calibrations and the tight-

ness test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

3.3.3 Sensors on/off: Enabling/disabling

O2 and CO2 monitoring . . . . . . . . . . . . . . . . . . . . 3-15

3.3.4 Setting day and night . . . . . . . . . . . . . . . . . . . . . .3-16

3.3.5 Setting date and time . . . . . . . . . . . . . . . . . . . . . . 3-17

3.4 Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-18

3.4.1 Configuration: Configuring the ventilator . . . . . . .3-18

3.4.2 Data transfer:
Copying event log data to a USB memory device .3-19

3.5 Alarm tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-21

3.5.1 High pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-21

3.5.2 Low minute volume . . . . . . . . . . . . . . . . . . . . . . . 3-22

3.5.3 Low oxygen alarm. . . . . . . . . . . . . . . . . . . . . . . . .3-22

3.5.4 Disconnection on patient side . . . . . . . . . . . . . . . . 3-22

3.5.5 Loss of external power . . . . . . . . . . . . . . . . . . . . .3-23

3.5.6 Exhalation obstructed . . . . . . . . . . . . . . . . . . . . . .3-23

3.5.7 Apnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-23

4 Ventilator settings . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2

4.2 Patient grouping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-2

4.3 Quick start-up settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4

4.4 Patient setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-4

4.5 Modes window: Setting the ventilation mode . . . . . . . . . . 4-6

4.6 Controls windows: Setting controls including apnea backup

ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-8

4.6.1 Adjusting and confirming control settings without

mode change . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-8

4.6.2 Adjusting and confirming control settings after mode

change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10

4.6.3 About apnea backup ventilation . . . . . . . . . . . . . .4-12

4.6.4 Table of control settings, mode additions and ranges..

4-15

4.7 Alarms windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-22

4.7.1 Limits 1 and Limits 2: Setting alarm limits . . . . . . . 4-23

4.7.2 Loudness: Adjusting alarm loudness . . . . . . . . . . . 4-25

4.7.3 Buffer: Viewing alarm information . . . . . . . . . . . . 4-26

4.7.4 Table of alarm limit settings and ranges . . . . . . . .4-27

4.7.5 TRC: Setting tube resistance compensation . . . . . .4-29

xiv 624131/06

5 Neonatal ventilation . . . . . . . . . . . . . . . . . . . . . . . 5-1

5.1 Breathing circuit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2

5.2 Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2

5.3 Testing and calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

5.4 Ventilation modes and mode additions . . . . . . . . . . . . . . 5-3

5.5 Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3

5.5.1 Ti max . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

5.5.2 Flowtrigger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

5.5.3 P-ramp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

5.6 Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4

6 Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1

6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2

6.2 Values window: Viewing numeric patient data . . . . . . . . . 6-4

6.3 Graphics window: Selecting second screen graphic . . . . . 6-7

6.4 About graphic types. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

6.4.1 Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

6.4.2 Dynamic Lung . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9

6.4.3 Vent Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9

6.5 Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

6.6 Loops. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-12

6.7 Table of monitored parameters . . . . . . . . . . . . . . . . . . . 6-14

6.8 Freeze and cursor measurement. . . . . . . . . . . . . . . . . . . 6-23

7 Intelligent Panels . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

7.2 Dynamic Lung panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

7.2.1 Tidal volume (Vt) . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

7.2.2 Compliance (Cstat) . . . . . . . . . . . . . . . . . . . . . . . . 7-3

7.2.3 Patient triggering: Muscle . . . . . . . . . . . . . . . . . . . 7-3

7.2.4 Resistance: Bronchial tree. . . . . . . . . . . . . . . . . . . . 7-4

7.3 Vent Status panel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5

8 Responding to alarms . . . . . . . . . . . . . . . . . . . . . . 8-1

8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2

8.2 How to respond to an alarm . . . . . . . . . . . . . . . . . . . . . . 8-6

8.3 Alarm buffer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7

8.4 Events window: Reviewing the event log . . . . . . . . . . . . . 8-9

8.5 Alarm troubleshooting table. . . . . . . . . . . . . . . . . . . . . . 8-10

624131/06 xv

Table of contents

9 Special functions. . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

9.1 Standby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

9.2 O2 enrichment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-5

9.3 Suctioning tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

9.4 Manual breath/inspiratory hold . . . . . . . . . . . . . . . . . . . . . 9-7

9.5 Nebulizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-8

9.6 Print screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-9

10 Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-2

10.2 Cleaning, disinfection and sterilization . . . . . . . . . . . . . .10-2

10.2.1General guidelines for cleaning . . . . . . . . . . . . . . .10-7

10.2.2General guidelines for chemical disinfection . . . . . 10-7

10.2.3General guidelines for autoclave, ETO or plasma steril-

ization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-8

10.3 Preventive maintenance . . . . . . . . . . . . . . . . . . . . . . . . .10-9

10.3.1Servicing the air intake and fan filters . . . . . . . . . 10-10

10.3.2Replacing the batteries . . . . . . . . . . . . . . . . . . . .10-13

10.3.3Charging and calibrating the batteries . . . . . . . .10-14

10.3.4Replacing the oxygen cell . . . . . . . . . . . . . . . . . .10-14

10.4 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15

10.5 Repacking and shipping . . . . . . . . . . . . . . . . . . . . . . . . 10-15

A Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1

A.1 Physical characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

A.2 Environmental requirements . . . . . . . . . . . . . . . . . . . . . . A-3

A.3 Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . A-3

A.4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

A.5 Control settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5

A.6 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . A-13

A.7 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-27

A.8 Configuration specifications . . . . . . . . . . . . . . . . . . . . . A-31

A.9 Ventilator breathing system specifications . . . . . . . . . . . A-33

A.10 Other technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . A-34

A.11 Standards and approvals . . . . . . . . . . . . . . . . . . . . . . . . A-36

A.12 EMC declarations (IEC 60601-1-2). . . . . . . . . . . . . . . . . A-37

A.13 Warranty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-42

A.14 Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-43

xvi 624131/06

B Modes of ventilation . . . . . . . . . . . . . . . . . . . . . . . B-1

B.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-2

B.2 The biphasic concept . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-5

B.3 Mandatory modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-8

B.3.1 (S)CMV+ mode or APVcmv . . . . . . . . . . . . . . . . . . B-8

B.3.2 PCV+ mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-11

B.4 Spontaneous modes (SPONT and NIV) . . . . . . . . . . . . . . B-13

B.5 SIMV modes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-19

B.5.1 SIMV+ mode or APVsimv . . . . . . . . . . . . . . . . . . . B-20

B.5.2 PSIMV+ and NIV-ST modes . . . . . . . . . . . . . . . . . B-23

B.6 nCPAP-PS mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-28

B.6.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-28

B.6.2 Controls of nCPAP-PS . . . . . . . . . . . . . . . . . . . . . B-30

B.7 DuoPAP (Duo positive airway pressure). . . . . . . . . . . . . . B-31

B.7.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-31

B.7.2 The many faces of DuoPAP . . . . . . . . . . . . . . . . . B-32

B.7.3 Pressure support in DuoPAP breaths . . . . . . . . . . B-33

B.7.4 Synchronization . . . . . . . . . . . . . . . . . . . . . . . . . . B-34

B.7.5 Controls of DuoPAP . . . . . . . . . . . . . . . . . . . . . . . B-34

B.8 APRV (Airway pressure release ventilation) . . . . . . . . . . . B-36

B.8.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-36

B.8.2 Initialization of APRV . . . . . . . . . . . . . . . . . . . . . . B-37

B.8.3 Sustained high pressure recruitment manoeuvres. B-39

B.8.4 Controls of APRV . . . . . . . . . . . . . . . . . . . . . . . . . B-39

B.9 SAFETY mode and ambient state . . . . . . . . . . . . . . . . . . B-41

C ASV (adaptive support ventilation) . . . . . . . . . . . C-1

C.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-2

C.2 ASV use in clinical practice . . . . . . . . . . . . . . . . . . . . . . . . C-3

C.3 Detailed functional description of ASV . . . . . . . . . . . . . . C-15

C.3.1 Normal minute ventilation . . . . . . . . . . . . . . . . . . C-15

C.3.2 Targeted minute ventilation . . . . . . . . . . . . . . . . . C-16

C.3.3 Lung-protective rules strategy . . . . . . . . . . . . . . . C-17

C.3.4 Optimal breath pattern . . . . . . . . . . . . . . . . . . . . C-20

C.3.5 Dynamic adjustment of lung protection . . . . . . . . C-24

C.3.6 Dynamic adjustment of optimal breath pattern . . C-25

C.4 Minimum work of breathing (Otis’ equation) . . . . . . . . . C-26

C.5 ASV technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-28

C.6 ASV Start up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-31

C.7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-32

624131/06 xvii

Table of contents

D NIV (non invasive ventilation) . . . . . . . . . . . . . . . .D-1

D.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2

D.2 Benefits of noninvasive ventilation, . . . . . . . . . . . . . . . . . D-3

D.3 Required conditions for use . . . . . . . . . . . . . . . . . . . . . . . D-4

D.4 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-4

D.5 Potential adverse reactions . . . . . . . . . . . . . . . . . . . . . . . D-5

D.6 Selecting a patient interface . . . . . . . . . . . . . . . . . . . . . . D-5

D.7 Control settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-6

D.8 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7

D.9 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . D-8

D.10 Additional notes about using noninvasive ventilation. . . . D-9

D.11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11

E CO2 sensor option: Volumetric capnography . . . E-1

E.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-2

E.2 CO2 elimination (V’CO2). . . . . . . . . . . . . . . . . . . . . . . . . . E-3

E.3 End-tidal CO2 (PetCO2 and FetCO2) . . . . . . . . . . . . . . . . . E-5

E.4 Airway dead space (VDaw) . . . . . . . . . . . . . . . . . . . . . . . . E-5

E.5 Alveolar minute ventilation (V’alv) . . . . . . . . . . . . . . . . . . . E-6

E.6 Capnogram shape (slope of the alveolar plateau, slopeCO2) .

E-7

E.7 Formulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9

E.8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-10

F Low-pressure oxygen. . . . . . . . . . . . . . . . . . . . . . . F-1

G Pneumatic diagram. . . . . . . . . . . . . . . . . . . . . . . . .G-1

H Parts and accessories . . . . . . . . . . . . . . . . . . . . . . .H-1

I Communications interface . . . . . . . . . . . . . . . . . . . I-1

I.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-2

I.2 Patient monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-2

I.2.1 Patient data management system (PDMS) or other com-

puter system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-4

I.2.2 Connector pin assignments. . . . . . . . . . . . . . . . . . . I-6

I.3 Nurse call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-8

I.3.1 Inspiratory:expiratory (I:E) timing outlet . . . . . . . . . . I-8

I.3.2 Remote alarm outlet . . . . . . . . . . . . . . . . . . . . . . . . I-9

I.3.3 Connector pin assignments. . . . . . . . . . . . . . . . . . I-10

xviii 624131/06

J Configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-1

J.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J-2

J.2 Accessing configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2

J.3 General: Selecting the language, units of measure and oxygen

source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-3

J.3.1 Language: Selecting the default language . . . . . . . .J-3

J.3.2 Units: Selecting the default unit of measure for pressure

display, CO2 and length. . . . . . . . . . . . . . . . . . . . . .J-3

J.3.3 More: Selecting the oxygen source and enabling the

communications interface . . . . . . . . . . . . . . . . . . . . J-4

J.4 Graphics window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J-5

J.4.1 MMP: Selecting the default main monitoring parameter

display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-5

J.5 Setup window (quick start-up settings). . . . . . . . . . . . . . . . J-6

J.5.1 Use setups: Define the default quick start-up settings .

J-6

J.5.2 Use setups: Configure the quick start-up settings. . .J-7

J.6 Transfer window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J-12

J.7 Options windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J-13

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary-1

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1

User Notes. . . . . . . . . . . . . . . . . . . . . . . . User Notes-1

624131/06 xix

Table of contents

xx 624131/06

List of Figures

1-1 Gas delivery in the HAMILTON-C2 . . . . . . . . . . . . . . . . . . . . . . . 1-6

1-2 Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

1-3 HAMILTON-C2 with accessories . . . . . . . . . . . . . . . . . . . . . . . . 1-10

1-4 Front view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-13

1-5 Rear view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-16

1-6 Left side view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-17

1-7 Right side view. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-18

1-8 Default (basic) screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-20

2-1 Installing the patient tubing support arm and humidifier . . . . . . 2-4

2-2 Option board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6

2-3 Patient breathing circuit for use with inspiratory heater wire (Pediatric/

Adult) - (In place of the flex tube shown, a 15 x 22 adapter may be

used to attach the Flow Sensor to the ET tube.) . . . . . . . . . . . . . 2-9

2-4 Patient breathing circuit for use without heater wires (Pediatric/Adult)

- (In place of the flex tube shown, a 15 x 22 adapter may be used to

attach the Flow Sensor to the ET tube.) . . . . . . . . . . . . . . . . . . 2-10

2-5 Patient breathing circuit for use with HME (Pediatric/Adult) -

(In place of the flex tube shown, a 15 x 22 adapter may be used to

attach the Flow Sensor to the HME or ET tube.) . . . . . . . . . . . . 2-11

2-6 Patient breathing circuit with inspiratory heater wire for use with nC-

PAP-PS (non-invasive ventilation neonatal) - (Use a 15M x 15F adapter

to connect the infant flow sensor.) . . . . . . . . . . . . . . . . . . . . . 2-12

2-7 Patient breathing circuit with inspiratory heater wire (invasive ventila-

tion neonatal) - (Use a 15M x 15F adapter to connect the infant flow

sensor.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13

2-8 LiteCircuit (single-limb) patient breathing circuit (non-invasive ventila-

tion Pediatric/Adult) - (For use with NIV or NIV-ST) . . . . . . . . . . 2-14

2-9 Installing the expiratory valve . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15

2-10 Installing the Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16

2-11 Installing a pneumatic nebulizer . . . . . . . . . . . . . . . . . . . . . . . . 2-18

2-12 Connecting the CO2 sensor . . . . . . . . . . . . . . . . . . . . . . . . . . 2-22

2-13 Attaching the CO2 sensor to the airway adapter . . . . . . . . . . . 2-22

2-14 Connecting the CO2 sensor/airway adapter to the patient circuit . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-23

2-15 Inserting the sample cell into the receptacle . . . . . . . . . . . . . . . 2-25

2-16 Attaching the CO2 sensor to the airway adapter . . . . . . . . . . . 2-25

2-17 Installing the Aeroneb Pro nebulizer . . . . . . . . . . . . . . . . . . . . . 2-26

2-18 Car adapter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-29

624131/06 xxi

List of Figures

2-19 Power source symbols and battery charge indicator. . . . . . . . . 2-31

2-20 Oxygen inlet fittings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-33

2-21 Power switch. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-34

3-1 Info window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

3-2 Tests & calib window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8

3-3 Disconnection of the mainstream sensor for calibration . . . . . . 3-14

3-4 Disconnection of the sidestream sensor for calibration. . . . . . . 3-14

3-5 Sensor on/off window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16

3-6 Day/Night window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-17

3-7 Date&Time window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-18

3-8 Data transfer window 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-20

3-9 Data transfer window 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-21

4-1 Quick start-up settings (Example). . . . . . . . . . . . . . . . . . . . . . . . 4-4

4-2 Patient setup window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5

4-3 Patient setup window neonatal . . . . . . . . . . . . . . . . . . . . . . . . . 4-6

4-4 Modes window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

4-5 Basic (Controls) window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9

4-6 More window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-10

4-7 TRC window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-11

4-8 Basic window during mode change (ASV mode change) . . . . . 4-12

4-9 Automatic button . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-14

4-10 Limits 1 window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-24

4-11 Limits 2 window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-25

4-12 Loudness window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-26

4-13 TRC window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-30

4-14 Ptrach and Paw waveforms (with TRC active). . . . . . . . . . . . . . 4-31

6-1 HAMILTON-C2 screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3

6-2 Values window 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4

6-3 Values window 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

6-4 Values window 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

6-5 CO2 window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-7

6-6 Graphics window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8

6-7 Pressure waveform display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-9

6-8 Trends window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

6-9 Trend display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-11

6-10 Loop window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-12

6-11 Loop display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13

6-12 Freeze function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-24

7-1 Dynamic Lung panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

7-2 Compliance shown by the Dynamic Lung . . . . . . . . . . . . . . . . . 7-3

xxii 624131/06

7-3 Patient triggering shown by the Dynamic Lung muscle . . . . . . . . 7-4

7-4 Rinsp shown by the bronchial tree of the Dynamic Lung. . . . . . . 7-4

7-5 Vent Status panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6

8-1 Visual alarm indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4

8-2 Safety ventilation screen. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5

8-3 Ambient state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-6

8-4 Alarm buffer with active alarms . . . . . . . . . . . . . . . . . . . . . . . . . 8-8

8-5 Alarm buffer with inactive alarms . . . . . . . . . . . . . . . . . . . . . . . . 8-9

8-6 Events window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-10

9-1 Special function keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3

9-2 Activate Standby window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

9-3 Standby window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-5

10-1 Removing the filter cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-11

10-2 Removing the air intake filters . . . . . . . . . . . . . . . . . . . . . . . . 10-12

10-3 Removing battery 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13

10-4 Replacing the oxygen cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-15

A-1 HAMILTON-C2 dimensions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

B-1 Conventional pressure-controlled ventilation in a passive patient.

Flow to patient during inspiration (I); flow from patient during exha-

lation (E) only. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-6

B-2 Conventional pressure-controlled ventilation in an active patient

when the trigger is off. Pressure increases when the patient tries to
exhale (E) and pressure decreases when the patient tries to inspire (I),

as valves are closed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7

B-3 Biphasic PCV+ in an active patient when trigger is off. The patient can

freely inspire and exhale during any phase of ventilation (+). . . . B-8

B-4 (S)CMV+ basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-9

B-5 (S)CMV+ more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-10

B-6 Breath delivery by the adaptive volume controller. . . . . . . . . . . B-11

B-7 PCV+ basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-12

B-8 PCV+ more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-13

B-9 SPONT basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-14

B-10 SPONT more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-15

B-11 SPONT apnea controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-16

B-12 NIV basic controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-17

B-13 NIV more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-18

B-14 NIV apnea controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-19

B-15 Breath timing in SIMV+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-20

B-16 SIMV+ basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-21

B-17 SIMV+ more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-22

624131/06 xxiii

List of Figures

B-18 SIMV+ apnea controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-23

B-19 Breath timing in PSIMV+ and NIV-ST . . . . . . . . . . . . . . . . . . . . B-24

B-20 PSIMV+ basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-25

B-21 PSIMV+ more controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-26

B-22 NIV-ST basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-27

B-23 NIV-ST more controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-28

B-24 Breath timing in nCPAP-PS . . . . . . . . . . . . . . . . . . . . . . . . . . . B-29

B-25 nCPAP-PS basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-30

B-26 nCPAP-PS more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-31

B-27 DuoPAP pressure curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-32

B-28 Pressure support in DuoPAP . . . . . . . . . . . . . . . . . . . . . . . . . . B-33

B-29 DuoPAP basic controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-34

B-30 DuoPAP more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-35

B-31 DuoPAP apnea controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-36

B-32 APRV breath timing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-37

B-33 APRV basic controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-39

B-34 APRV more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-40

B-35 APRV apnea controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-41

B-36 Display SAFETY mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-42

C-1 Clinical use of ASV. The numbers in parentheses are step numbers,

which are explained in the next subsections. . . . . . . . . . . . . . . C-4

C-2 ASV basic controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-5

C-3 ASV more controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-6

C-4 Hypothetical example of high %MinVol setting incompatible with the

lung-protective rules strategy. The open circle denotes the actual tar-

get, the closed triangle (never shown on the ventilator) denotes the

(energetically) optimal target according to Otis’ equation. The HAMIL-

TON-C2 will alarm and inform the user that the ASV target cannot be

achieved. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-11

C-5 ASV target graphics window . . . . . . . . . . . . . . . . . . . . . . . . . . C-12

C-6 Normal minute ventilation as a function of ideal body weight (IBW).

For adult patients, minute ventilation is calculated as 0.1 l/kg * IBW

(solid line). For pediatric patients, the value indicated by the dotted

line is used. Minute ventilation for a 15 kg patient thus is calculated as

0.2 l/kg * 15 kg = 3 l/min. . . . . . . . . . . . . . . . . . . . . . . . . . . . C-15

C-7 MinVol = 7 l/min. All possible combinations of Vt and f which result

in a minute ventilation of 7 l/min lie on the bold line. . . . . . . . C-16

C-8 Lung-protective rules strategy to avoid high tidal volumes and pressu-

res (A), low alveolar ventilation (B), dynamic hyperinflation or breath

stacking (C), and apnea (D) . . . . . . . . . . . . . . . . . . . . . . . . . . C-17

xxiv 624131/06

C-9 Anatomy of the ASV target graphics window. The rectangle shows

the safety limits; the circle shows the target breath pattern. . . C-21

C-10 Example of a situation after the three initial breaths. The patient sym-

bol marks the actual measured values for Vt and rate. . . . . . . . C-23

C-11 Lung-protective limits are changed dynamically and according to the

respiratory system mechanics. However, the limits derived from the

operator input are never violated. . . . . . . . . . . . . . . . . . . . . . . C-24

C-12 Changes of target values in broncho-constriction. For clarity, the sa-

fety limits are omitted. For clinical examples, see Belliato 2000. C-26

C-13 Three different relationships between rate and WOB are plotted for a

hypothetical lung: (+) purely resistive load causes WOB to rise with ra­te, (x) purely elastic load creates highest load at low rates, (o) the total
lung shows a clear minimum which can be calculated according to

the equation below. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-27

E-1 Typical capnogram of patient on pressure-controlled ventilation, sho-

wing fractional concentration of CO2 plotted against time. . . . . E-3

E-2 Typical spirogram of a patient on pressure-controlled ventilation (sa-

me breath as shown in Figure E-1). . . . . . . . . . . . . . . . . . . . . . . E-4

E-3 Combination of capnogram and spirogram (that is, fractional end-ti-

dal CO2 concentration plotted against volume). . . . . . . . . . . . . E-4

E-4 Interpretation of volumetric capnogram. . . . . . . . . . . . . . . . . . . E-6

G-1 Pneumatic diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-1

H-1 Ventilator parts and accessoires - standard trolley. . . . . . . . . . . . H-1

H-2 Ventilator parts and accessoires - standard trolley. . . . . . . . . . . . H-2

I-1 HAMILTON-C2 connected to a patient monitor . . . . . . . . . . . . . I-3

I-2 HAMILTON-C2 connected to a computer system . . . . . . . . . . . . I-5

I-3 RS-232 connector pinout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-6

I-4 RS-232 cable (PN 157354) wiring diagram . . . . . . . . . . . . . . . . . I-7

I-5 HAMILTON-C2 connected to an external device through the Special

connector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-8

I-6 Remote alarm relay positions . . . . . . . . . . . . . . . . . . . . . . . . . . I-10

I-7 Interface connectors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-11

J-1 Language configuration window . . . . . . . . . . . . . . . . . . . . . . . . J-3

J-2 Units configuration window . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-4

J-3 More configuration window. . . . . . . . . . . . . . . . . . . . . . . . . . . . J-5

J-4 MMP configuration window. . . . . . . . . . . . . . . . . . . . . . . . . . . . J-6

J-5 Default setups configuration window . . . . . . . . . . . . . . . . . . . . . J-7

J-6 Setup > patient configuration window . . . . . . . . . . . . . . . . . . . . J-8

J-7 Mode controls configuration window. . . . . . . . . . . . . . . . . . . . . J-9

J-8 Mode controls configuration window

624131/06 xxv

List of Figures

(Vt/IBW) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-9

J-9 Alarms configuration window . . . . . . . . . . . . . . . . . . . . . . . . . . J-10

J-10 Vent Status configuration window . . . . . . . . . . . . . . . . . . . . . . J-10

J-11 Vent Status intelligent panel . . . . . . . . . . . . . . . . . . . . . . . . . . . J-11

J-12 Transfer window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-12

J-13 Software options window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-13

J-14 Hardware options window . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-14

xxvi 624131/06

List of Tables

1-1 Compatible parts and accessories . . . . . . . . . . . . . . . . . . . . . . . 1-11

1-2 Symbols used on device labels and packaging . . . . . . . . . . . . . 1-22

2-1 Breathing circuit parts according to patient height or IBW . . . . . 2-8

2-2 Tracheal tubes and CO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8

3-1 When to perform tests and calibrations . . . . . . . . . . . . . . . . . . . 3-2

4-1 Patient grouping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

4-2 Control settings, mode additions and ranges . . . . . . . . . . . . . . 4-15

4-3 Alarm limit settings and ranges . . . . . . . . . . . . . . . . . . . . . . . . 4-27

6-1 Monitored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-15

7-1 Dynamic Lung normal values . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5

7-2 Vent Status parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6

8-1 Alarm indications in HAMILTON-C2 . . . . . . . . . . . . . . . . . . . . . . 8-3

8-2 Alarms and other messages . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-11

10-1 Decontamination methods for

HAMILTON-C2 parts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4

10-2 Preventive maintenance schedule . . . . . . . . . . . . . . . . . . . . . . . 10-9

A-1 Physical characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

A-2 Environmental requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

A-3 Pneumatic specifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3

A-4 Electrical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4

A-5 Control setting ranges and resolutions (adult). . . . . . . . . . . . . . . A-5

A-6 Control setting ranges and resolutions (neonatal) . . . . . . . . . . . . A-8

A-7 Controls active in HAMILTON-C2 ventilation modes . . . . . . . . . A-12

A-8 Monitored parameter ranges, resolutions

and accuracies (adult). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-13

A-9 Monitored parameter ranges, resolutions

and accuracies (neonatal) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-19

A-10 Real-time curves and loops (adult) . . . . . . . . . . . . . . . . . . . . . . A-25

A-11 Real-time curves and loops (neonatal). . . . . . . . . . . . . . . . . . . . A-26

A-12 Adjustable alarm ranges and resolutions (adult) . . . . . . . . . . . . A-27

A-13 Adjustable alarm ranges and resolutions (neonatal) . . . . . . . . . A-29

A-14 Configuration specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . A-31

A-15 Ventilator breathing system specifications . . . . . . . . . . . . . . . . A-33

A-16 Other technical data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-34

A-17 Guidance and manufacturer's declaration – electromagnetic emis-

sions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-37

A-18 Guidance and manufacturer's declaration – electromagnetic immuni-

ty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-38

624131/06 xxvii

List of Tables

A-19 Recommended separation distances between portable and mobile RF

communications equipment and the HAMILTON-C2 ventilatorA-41

B-1 Classification of HAMILTON-C2 ventilation

modesB-3
B-2 Control parameters for initialization of APRVB-38
B-3 Safety mode settingsB-43
C-1 Blood gas and patient conditions and possible adjustments for ASV

C-10
C-2 Interpretation of breathing pattern at 100 % MinVol settingC-13
C-3 Interpretation of breathing pattern at much higher than 100% Min-

Vol settingC-13
C-4 Interpretation of breathing pattern at much lower than 100% MinVol

settingC-14
C-5 ASV technical dataC-28
C-6 Initial breath pattern for Adult settingsC-31
C-7 Initial breath pattern for Pediatric settingsC-31
E-1 Examples of "normal" or expected values in mechanically ventilated

patientsE-7
H-1 Ventilator parts and accessoriesH-3
I-1 Interfacing hardware for patient monitorsI-4
I-2 Requirements for interfacing PDMSsI-5
I-3 Interface connector pin assignmentsI-11

xxviii 624131/06

1

General information

1.1 Introduction 1-2

1.2 Functional description 1-4

1.2.1 System overview 1-4

1.2.2 Gas supply and delivery 1-5

1.2.3 Gas monitoring with the Flow Sensor 1-7

1.3 Physical description 1-9

1.3.1 Breathing circuits and accessories 1-9

1.3.2 Ventilator unit 1-13

1.3.3 Screen 1-20

1.4 Symbols used on device labels and packaging 1-22

624131/06 1-1

1 General information

1.1 Introduction

NOTE:

The infant and neonatal module as well as tube resis­tance compensation (TRC) may not be installed in older
devices (sold before August 2010).

The HAMILTON-C2 is designed for intensive care ventilation of
adult, pediatric, infant and neonatal patients.

Ventilation modes. This full-functioned intensive care ventila­tor offers a complete range of modes. PCV+, PSIMV+, and
SPONT are conventional pressure-controlled modes. (S)CMV+
and SIMV+, delivered by an adaptive volume controller, com­bine the attributes of pressure-controlled with volume-targeted
ventilation. DuoPAP and APRV are two related forms of pres­sure ventilation designed to support spontaneous breathing on
two alternating levels of CPAP. ASV
tion) guarantees that the patient receives the selected minute
ventilation with the optimal breath pattern (lowest pressure
and volume, optimal rate to minimize work of breathing and
intrinsic PEEP). NIV (noninvasive ventilation) and NIV-ST (spon­taneous/timed noninvasive ventilation) provide pressure sup­port ventilation through a mask or other noninvasive interface.
nCPAP-PS provides pressure support ventilation through nasal
interface for infants and neonates.

Patient-triggered breaths are flow triggered.
Monitoring. The HAMILTON-C2 offers a variety of monitoring

capabilities. It displays monitored parameters as numbers. You
can also see this data graphically, as a combination of real-time
waveforms (curves), Loops, Trends and special Intelligent Pan­els. These Intelligent Panels include the Dynamic Lung, which
shows the lung’s activity, and the Vent Status, which indicates
the patient’s level of ventilator dependency. The HAMILTON­C2’s monitored data is based on pressure and flow measure­ments collected by the HAMILTON MEDICAL proximal Flow
Sensor, between the Y-piece and the patient, and on FiO2
measurements by the integral oxygen monitor.

®

(adaptive support ventila-

1-2 624131/06