Weinmann MEDUMAT Standard2 Step-by-step instructions

• Start ventilation by height

• NIV therapy

• Resuscitation (CPR)

• Anesthesia induction (RSI)

MEDUMAT Standard

2

Step-by-step instructions

Important:

This document

does not replace the

instructions for use.

Complete information

can be found in the
instructions for use.

Operating steps

21

Switch on ventilator Select "New patient"

3 4

Select patient height and gender Select "next"

5 6

Select the ventilation mode and check

the displayed ventilation parameters

Start ventilation

Use presets and work according to guidelines

By using the setting option of the Vt/kg body weight (BW) 4-10ml/kg BW to be

applied, you will be working according to guidelinesii and determining the calculated
tidal volume for volume-controlled ventilation.
The ideal body weight and thus the tidal volume to be applied are calculated
differently for male and female patients. The following formula is used for this:

For a 185-cm-tall male patient and a setting of 6ml/kg BW, the following tidal

volume results:

The Vt is obtained accordingly: Vt = 80kgx6ml/kg = 480ml

= 79.51kg ~ 80kgIBW (in kg) = 50 + 2.3 x

185

2.54

- 60

IBW female (in kg) = 45 + 2.3 x

Height in cm

2.54

iii

-60

IBW male (in kg) = 50 + 2.3 x

Height in cm

2.54

iii

-60

Start faster and ventilate more precisely

From now on, you will not need to spend a long time considering which tidal
volume (Vt) is the most appropriate for your patient. With MEDUMAT Standard

2

,
you can now initiate ventilation even more precisely and even faster. By entering the
patient’s height and gender, your ventilator automatically calculates all the ventilation
parameters for the ideal body weight (IBW). The IBW serves as an important indicator
when setting the ventilation parametersi. MEDUMAT Standard2 allows you to start

ventilation faster and far more precisely– giving you more time for all the other

important tasks.

Start ventilation by height

i

Gajic, O. et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of

mechanical ventilation. Critical care medicine, 2004, No. 32, P. 1817-1824.

ii

Deakin, C. D. et al. Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)
Sektion 4 der Leitlinien zur Reanimation 2010 des European Resuscitation Council. Notfall +
Rettungsmedizin, 2010, No. 7, P. 578.

iii

Devine, Ben J. Gentamicin therapy. The Annals of Pharmacotherapy. 1974, 8. Jg., No. 11, P. 650-655.

NIV therapy

Switch on ventilator

Select "New patient" in the start
menu.

Set the patient’s height and gender or
select the appropriate patient group:
Adult, Child, Infant

1

2

3

Select the desired CPAP therapy using
the navigation button: PEEP, pMax,

ΔpASB. After adjusting the values,

begin the ventilation via "start".

Select one of the following ventilation
modes: CPAP* or CPAP + ASB (if
available).
*pure CPAP is the ventilation form

CPAP+ ASB with a ΔpASB of 0mbar

Now connect the patient to MEDUMAT
Standard². It is possible to adjust the
values using the navigation button
while the ventilation is running. You

can nd other ventilation parameters in

the user menu on the right navigation
button. If it is necessary to change the
ventilation mode, this is done using the
"user menu" function button on the
right side.

5

6

4

Modied by Prof. Dr. med. Thoralf Kerner

Logistical requirements

Oxygen supply: at least a 2-l bottle, lled ....................................................... Check

Emergency medical team familiar with NIV ..................................................... Check

Clinical requirements

alert, cooperative (GCS >12) ......................................................................... Check

breathing spontaneously ................................................................................ Check

if applicable, light sedation of agitated patients e.g. morphine
(5-10 mg i.v. titrated) or a short-acting benzodiazepine.

Indications

Dyspnea ......................................................................................................... Check

Respiratory rate >25/min (count!) ................................................................. Check

SpO

2

<90% despite O2administration ........................................................... Check

Contraindications

Absolute contraindications: ............................................................................ Check

absence of spontaneous respiration, gasping, airway obstruction,
gastrointestinal bleeding or ileus

Relative contraindications: .............................................................................. Check

Coma, massive agitation, hemodynamic instability, severe hypoxemia
(SpO

2

<75% despite O2), problems with airway access, status post

gastrointestinal surgery

Pulmonary edema

Primary device settings

Ventilation mode: ............................................................................................CPAP

PEEP (according to comfort and oxygenation): ......................................5/7/10mbar

FiO

2

: ..............................................................................................Air Mix or 100%

Aim and success criteria

Target SpO

2

: >90% ....................................................................................... Check

Decrease in dyspnea ...................................................................................... Check

Falling respiratory and heart rate .................................................................... Check

If applicable, improved vigilance ..................................................................... Check

NIV sequence: Set the device, place the mask on the patient’s face (explain the

measure!), connect the mask to the hose system while the device is running. Aim:

Synchronization of patient and device

SOP

(Standard Operating Procedure)
Non-invasive ventilation (NIV) by the emergency medical
services

Exacerbated COPD

Escalation levels

In the event of imminent respiratory muscle fatigue, set pressure support (ASB).
Immediate intubation in the absence of clinical improvement or the occurrence of

contraindications!

Caution

• Continuous clinical observation and close patient contact

• No delay in pharmacological therapy or necessary intubation

• Prepared for intubation at any time

• Timely advance information to the receiving hospital

Primary device settings

Ventilation mode: ................................................................................. CPAP + ASB

PEEP: .........................................................................................................3/6mbar

∆pASB (according to comfort and oxygenation): .................................5/10/15mbar

Peak pressure (pMax): ........................................................................ max. 25mbar

Inspiration trigger: ........................................................................as low as possible

Pressure ramp: .................................................................................................steep

FiO

2

: ..............................................................................................Air Mix or 100%

Aim and success criteria

Target SpO

2

: >85% ....................................................................................... Check

Decrease in dyspnea ...................................................................................... Check

Falling respiratory and heart rate .................................................................... Check

If applicable, improved vigilance ..................................................................... Check

Escalation levels

In the event of imminent respiratory fatigue, if available, set ventilation mode

BiLevel + ASB (e.g. PEEP: 5mbar, pInsp: 20mbar).

Immediate intubation in the absence of clinical improvement or the occurrence of

contraindications!

Caution

• Continuous clinical observation and close patient contact

• No delay in pharmacological therapy or necessary intubation

• Prepared for intubation at any time

• Timely advance information to the receiving hospital

Inspiratory trigger

The inspiratory trigger triggers a pressure support or a mechanical breath as soon as
inhalation effort is detected.

Trigger level Corresponding unit value

Level 1 (sensitive) Approx. 3l/min

Level 2 (medium) Approx. 6l/min

Level 3 (insensitive) Approx. 10l/min

Setting the levels of the inspiration trigger:

(If "3 levels" has been chosen as the trigger setting in the operator menu)

1l/min

Very sensitive

5l/min

sensitive

10l/min

insensitive

15l/min

Very insensitive

Trigger sensitivity: 1l/

min-15l/min

Flow

Pressure support and the

expiration trigger

Pressure support ΔpASB

The pressure support is always given as a value above PEEP. In addition to the set
PEEP, a patient receives this as soon as the inspiration trigger has been detected.
Example calculation:

PEEP = 5mbar, ΔpASB = 10mbar inspiration pressure in the inhalation phase = 15mbar

Trigger level Corresponding unit value

Level 1 (long) Approx. 10% Flow max

Level 2 (medium) Approx. 35% Flow max

Level 3 (Short) Approx. 70% Flow max

Expiratory trigger

Initiate expiration as soon as the ow to the patient is only the set value (in %) with
respect to the maximum ow. The length of the pressure support is set with the

expiratory trigger.

Trigger sensitivity: 5-80% of max. ow. In principle, the following applies: the smaller
the % value, the longer the pressure support lasts.

Pressure

PEEP

ΔpASB

Time

Time

Max. 4s

Flow

80% Flow

max

0%

100%

5%

5% Flow

max

Setting the levels of the expiration trigger:

(If "3 levels" has been chosen as the trigger setting in the operator menu)

Pressure ramp (pressure increase time)

A pressure ramp (or the pressure increase time) denes the time in which the pressure

increases from the PEEP to the inspiration pressure. This pressure increase time can

be set by the shape of the ramp: at, medium and steep.

<0.2seconds: steep Approx. 0.2seconds: medium Approx. 0.4seconds: at

Pressure ramps using the example of a BiLevel + ASB curve

Pressure

Time

TI = T

insp

∆pASB

1/Freq.

(spontaneous)

1/Freq. (set)

P

max

P

insp

Pressure

ramp

dP

dT

PEEP

assisted spontaneous

respiration

mechanical

ventilation

dP

dT

Resuscitation (CPR)

Switch on the device

Press the CPR button and select the
patient group

Check the ventilation parameters. In
the ventilation phase of 30:2 or 15:2
resuscitation, press the mask with the
"Double C grip" over the patient’s
mouth and nose.
Then hold down the MEDUtrigger key
until two mechanical breaths have been
administered.

1

2

3

Following successful intubation, change
to continuous ventilation and check the
ventilation parameters

During the cardiac rhythm analysis or

debrillation, select "pause" to pause

the ventilation.

• No movement artifacts

• Reduction of thoracic impedance

• No oxygen enrichment of ambient
air

Following successful debrillation, if

applicable, press "pause" again to
restart the ventilation. The ventilation
will start automatically after at most

50seconds.

Once ROSC is achieved, press the CPR
key again to exit the CPR mode. Then
check the ventilation parameters and
select, if applicable, the Air Mix key to
lower the FiO2 to <1.0.

4

5

6

Advanced Life Support

https://cprguidelines.eu/
European Resuscitation Council Guidelines for Resuscitation 2015

Monsieurs, Koenraad G.Khalifa, Gamal Eldin Abbas et al. Resuscitation , Volume 95 , 1 - 80

© 2015 European Resuscitation Council. Published by Elsevier Ireland Ltd. All rights reserved.

Anesthesia induction (RSI)

Switch on the device

Select "New patient" on the home
screen and set the patient’s height
and gender. Or select the appropriate
patient group: Adult, Child, Infant.

Select "RSI" in the "mode" submenu

MEDUMAT Standard² begins the
therapy in demand mode. In this mode,
the spontaneously breathing patient is
pre-oxygenated. The total RSI time and
the time since the last spontaneous
breath are shown on the display.

2

1

3

4

To check the tube position following
successful intubation or as a fallback

position for a difcult airway, change to

the manual mode.

Check the ventilation parameters.
Connect the patient hose system
to the tube or press the mask
with the "Double C grip" over the
patient’s mouth and nose and trigger
the mechanical breath with the

Following successful intubation, change
to continuous ventilation to ventilate
the patient in a controlled manner.

The device changes to controlled IPPV
or BiLevel + ASB ventilation depending
on availability and setting. Please check
the ventilation parameters and adjust
them if necessary.

5

6

7

8

Excerpt from the S1 guideline

"Pre-hospital emergency anesthesia in adults" of the German
Association for Anesthesiology and Intensive Care Medicine (DGAI)

Indications for pre-hospital emergency anesthesia

• Acute respiratory insufciency (hypoxia and/or respiratory rate* <6 or >29/min)

and contraindications for or failure of non-invasive ventilation (NIV)

• Loss of consciousness/neurological decit with risk of aspiration

• Multiple trauma/severe trauma with

i) hemodynamic instability, systolic BP <90mmHg or

ii) hypoxia with SpO

2

<90% despite = 2l/min O2administration or

iii) traumatic brain injury with GCS <9

* in the presence of not rapidly reversible causes

if required

Management of complications

Indication: patient, application and user-related factors, experience of the

emergency medical team, situation at the scene, transport times, air and ground
rescue

Communication in the team: Site of anesthesia induction, clear allocation of
tasks, selection of medicines, other important notes and agreements

Optimal positioning: "Light, space, warmth" concept, ideal for upper
body elevation in the ambulance (caution: not with spinal immobilization or

hemodynamically unstable patients), head in "snifng" position.

Pre-oxygenation:

For a spontaneously breathing

patient, at least 3-4 min O

2

insufation with 12-15l/min via a

face mask with reservoir or demand
valve, if applicable, NIV or mask
ventilation

parallel

Standardized preparation:

Anesthetic and emergency medicine,
alternative airways, suction, capnography.

Monitoring: Pulse oximetry, ECG, blood
pressure, capnography

Two peripheral venous accesses: In case

of difcult puncture conditions, consider in

-

traosseous puncture in a time-critical manner.

Rapid Sequence Induction (RSI)

Continuous monitoring: Anesthesia management and monitoring

Rapid Sequence Induction (RSI)

• If applicable, remove the cervical spine immobilization and begin manual in-line
stabilization

• Announcement of the anesthetic medicine with active substance and dosage,
step-by-step application

• Wait for loss of consciousness and relaxation effect

• Airway management without intermediate ventilation in normoxic patients*

• Tube position check (capnography, auscultation, insertion depth)

• If applicable, stop manual in-line stabilization and close the cervical spine
immobilization brace again

* In individual cases, despite the increased risk of aspiration, intermediate ventilation may be necessary in
order to maintain oxygenation.

Please note that these are excerpts from the S1guideline "Pre-hospital emergency anesthesia in adults".

Source: Anästh Intensivmed 2015;56:317-335 Aktiv Druck & Verlag GmbH

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