Hamilton C2 User manual

Operator‘s Manual PN 624131/06 Software version 2.x October 2010

© 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.

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Manufacturer	Distributor in USA
HAMILTON MEDICAL AG	HAMILTON MEDICAL, Inc.
Via Crusch 8	4990 Energy Way
CH-7402 Bonaduz	P.O. Box 30008
Switzerland	Reno, NV 89520
Phone: [phone]	Phone: [phone]
Fax: [phone]	Toll-free: [phone]
[e-mail]	Fax: [phone]
www.hamilton-medical.com	[e-mail]

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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.

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Applies only when the CO2 sensor option is installed

Applies only when the TRC option is installed

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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.

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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

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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 specified 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.

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•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 cmH2O, the units may be used interchangeably. CO2 is indicated in mmHg, Torr or kPa and length in cm or inch.

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).

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Year of manufacture

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

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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

4.6Controls 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

4.6.4Table 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

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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

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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

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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

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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

ECO2 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 computer 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

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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

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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 ventilation 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 ventilation 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

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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

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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 exhalation (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

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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 target, 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 pressures (A), low alveolar ventilation (B), dynamic hyperinflation or breath stacking (C), and apnea (D) . . . . . . . . . . . . . . . . . . . . . . . . . . C-17

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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 symbol 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 safety 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, showing fractional concentration of CO2 plotted against time. . . . . E-3 E-2 Typical spirogram of a patient on pressure-controlled ventilation (same 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

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(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

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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 immunity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-38

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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

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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

1.4Symbols used on device labels and packaging 1-22

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1General information

1.1Introduction

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® (adaptive support ventilation) 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.

1-2

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