HAMILTON-T1. Operator's Manual (2022)

5 Specifying ventilation settings

5.3 Entering patient data

5.4 Performing the preopera-

tional check, tests, and calibra-

CAUTION

tions

Entering the correct patient data ensures

The tests and calibrations described in this

safe ventilation settings for start up,

section help verify the safety and reliability

Apnea backup, and Safety ventilation/

of the ventilator.

Safety mode.

If a test fails, troubleshoot the ventilator as

Before proceeding, review the safety

indicated or have the ventilator serviced.

information in Chapter 1.

Make sure the tests pass before you return

the ventilator to clinical use.

Specifying the correct patient data is par-

ticularly important, as the ventilator uses

The test results are stored in memory,

this data as a basis for some calculations

including when the ventilator is turned

and initial mode control settings.

off. This allows the ventilator to be

checked and kept in storage, ready for

• For the Adult/Ped patient group, the

use.

ventilator uses sex and patient height

to calculate the ideal body weight

The time and date of the last test is

(IBW).

displayed in the System > Tests & calib.

window. Ensure the last performed preop-

The following control settings are

erational test is valid for your patient.

based on IBW: Vt, Rate, T low, T high,

and TI, and Apnea backup and safety

The audible alarm is paused during calib-

settings.

ration, and for 30 seconds thereafter.

• For Neonatal patients, the ventilator

Table 5-2. When to perform tests and calibra-

uses the patient body weight.

tions

The following parameters are set based

on Weight: Vt, Rate, T low, T high, TI,

Test or calib-

When to perform

and TI max, and Apnea backup and safe-

ration

ty settings.

Preopera-

Before connecting a new

tional check

patient to the ventilator.

To enter patient data

Flow sensor/

After connecting a new

4 In the Standby window:

circuit calibra-

breathing circuit or compo-

- Adult/Ped. Specify the patient sex

tion and Leak

nent (including a flow

and height. The device calculates the

test

sensor or pressure-monitor-

patient IBW.

ing line).

- Neonatal. Specify the patient

O2 sensor

After installing a new O2

weight.

calibration, if

sensor or when a related

needed

alarm occurs.

English | 10103179/02 USA

Performing the preoperational check

Test or calib-

When to perform

5.4.1 Performing the preoperational

ration

check

CO2 sensor/

Required after connecting a

Before proceeding, review the safety

adapter zero

CO2 sensor or when a rela-

information in Chapter 1.

calibration

ted alarm occurs.

(mainstream/

For details about performing the preoper-

Recommended after switch-

sidestream)

ational check with neonatal ventilation,

ing between different air-

see Section 6.2.

way adapter types.

Alarm tests

As desired

When to perform

Before connecting a new patient to the

To access tests and calibration functions

ventilator.

1. Do either of the following:

To perform the preoperational check

- Touch System > Tests & calib.

1. Use a setup as described in Table 5-3.

- In the Standby window, touch Preop

2. Perform all of the steps in Table 5-4.

check.

2. Touch the button for the desired oper-

To ensure that the ventilator functions

ation.

according to specifications on your

patient, perform the preoperational check

Figure 5-2. System > Tests & calib window

using the breathing circuit that will be

used on the patient.

Table 5-3. Test breathing circuit setup

Component

Specification

Breathing cir-

Adult/pediatric, ID10 to ID22

cuit

Flow sensor

Adult/pediatric, with calibra-

tion adapter

Test lung

Demonstration lung, 2 liter,

with adult ET tube between

flow sensor and lung

System

O2 sensor

Tests & calib

CO2 sensor

Leak test

Time and date of

(shown uncali-

last test/calibration

brated)

Circuit or Flow sensor, depending on

selected mode

Hamilton Medical | HAMILTON-T1 Operator's Manual

5 Specifying ventilation settings

Table 5-4. Preoperational check, overview

Corrective action

Do or observe…

Verify ...

indicates the component is calibrated

and ready. indicates the calibration was

Connect ventilator to primary power

and an oxygen supply.

unsuccessful.

Assemble the

The breathing cir-

If the ventilator does not pass the preoper-

patient breath-

cuit is assembled

ational check, have it serviced.

ing circuit.

correctly.

5.4.2 Performing the breathing circuit

Turn on the

During the self test,

ventilator.

the alarm lamp

Leak test

flashes yellow and

Before proceeding, review the safety

red in sequence.

information in Chapter 1.

With the ventila-

The System > Tests

To perform the Leak test

tor in Standby,

& calib window

touch Preop

opens.

Set up the ventilator for ventilation,

check in the

complete with breathing circuit and

Standby

flow sensor.

window.

Touch System > Tests & calib.

Perform the

The test passes. See

Touch Leak test.

Leak test.

Section 5.4.2.

The text Disconnect patient is now

Calibrate the

The calibration is

displayed.

flow sensor.

successful. See

Disconnect the breathing circuit at the

Section 5.4.3.

patient side of the flow sensor. Do not

block the open end of the flow

If necessary, run

The calibration is

the O2 sensor

successful. See

sensor.

calibration.

Section 5.4.4.

The text Block breathing circuit is now

displayed.

If necessary, run

The zero calibration

the CO2 sensor

is successful. See

Block the opening (wearing a glove is

zero calibration.

Section 5.4.5.

recommended). See Figure 5-3.

Ensure the opening is fully blocked.

Generate test

The corresponding

Failure to do so may result in test fail-

alarms.

alarm message is

ure.

displayed in the

message bar. See

The text Reconnect breathing circuit is

Section 5.4.6.

now displayed.

Note that patient

Connect the patient.

alarms are sup-

When the test is complete, verify that

pressed in Standby.

there is a checkmark in the Leak

test checkbox.

English | 10103179/02 USA

Calibrating the adult/pediatric flow sensor

Figure 5-3. Block the flow sensor opening when

5.4.3 Calibrating the adult/pediatric

prompted

flow sensor

This calibration checks and resets the

calibration points specific to the flow

sensor in use, and measures the circuit

resistance. The measured value determines

the required resistance compensation

during ventilation.

Ensure you are using the correct flow

sensor for the selected patient group. If

there is a mismatch, calibration fails.

For details about calibrating a neonatal

flow sensor, see Section 6.2.1.

When to perform

After connecting a breathing circuit or

component.

To cancel the test while it is in progress

Flow sensor calibration involves three

4 Touch Leak test again.

components:

In case of test failure

• Flow sensor

• Component in the breathing circuit

If the test fails,

is displayed in the Leak

directly following the flow sensor

test checkbox.

Ensure that you have performed all steps

• Calibration adapter

of the test correctly. If so, perform the

To calibrate an adult/pediatric flow sensor

following checks, repeating the Leak test

after each one, until the test is successful:

1. Calibrate the flow sensor in Standby,

with no patient connected.

• Check the breathing circuit for a dis-

connection between the ventilator and

2. Connect the flow sensor to the

the flow sensor, or for other large leaks

breathing circuit (Figure 5-4).

(for example, breathing circuit, humidi-

3. Connect the next component in the

fier).

circuit to the flow sensor (Figure 5-5).

• Check that the flow sensor and expira-

Depending on your setup, this could

tory valve set are properly seated.

be, for example, an HMEF, nebulizer,

CO2 sensor, or the flex tube.

• If the test still fails, replace the expira-

Do not connect any more components

tory valve set.

at this time. You will be prompted to

• If the test still fails, replace the breath-

connect the calibration adapter once

ing circuit.

the calibration process starts.

If the problem still persists, have the venti-

lator serviced.

Hamilton Medical | HAMILTON-T1 Operator's Manual

5 Specifying ventilation settings

In the Standby window, touch Preop

Figure 5-6. Attach adapter, flip components

check.

The System > Tests & calib window is

displayed.

Touch Flow sensor.

A help guide is shown on the display,

providing an overview of the calibra-

tion process.

Figure 5-7. Flip components, remove adapter

Touch Start to begin calibration.

To close the guide without starting

calibration, touch Cancel.

When prompted on the display, attach

the calibration adapter to the compo-

nent connected to the flow sensor

and flip all three of them together

180° so the adapter is directly con-

To cancel an ongoing calibration

nected to the breathing circuit (Figure

5-6).

4 Touch Flow sensor again.

When prompted, flip the flow sensor/

In case of calibration failure

component/adapter 180° again, so

the flow sensor is directly connected

If the calibration fails,

is displayed in

to the breathing circuit, and remove

the Flow sensor checkbox.

the calibration adapter (Figure 5-7).

Ensure that you have performed all steps

When calibration is complete, verify

of the test correctly. If so, perform the

that there is a checkmark

in the

following checks, repeating the calibration

Flow sensor checkbox.

after each one, until calibration is success-

ful:

10. When successful, finish assembling

the breathing circuit, and continue

• Ensure that the flow sensor is appropri-

with other tests or ventilation.

ate for the selected patient group.

Figure 5-4. Connect the flow sensor

• Check the breathing circuit for a dis-

connection between the ventilator and

the flow sensor, or for other large leaks

(for example, breathing circuit, humidi-

fier).

Figure 5-5. Connect the next component

• Check that the flow sensor and expira-

tory valve set are properly seated.

English | 10103179/02 USA

Calibrating the O2 sensor

• If the calibration still fails, replace the

2. Touch System > Tests & calib.

flow sensor.

3. Touch O2 sensor.

• If the calibration still fails, replace the

4. When calibration is complete, verify

expiratory valve membrane.

that there is a checkmark

in the O2

• If the calibration still fails, replace the

sensor checkbox.

expiratory valve set.

Table 5-5. Oxygen concentration during O2

If the problem persists, have the ventilator

sensor calibration

serviced.

Standby or

Gas source

Set

active ventila-

connection

Oxygen

5.4.4 Calibrating the O2 sensor

tion

status

to ...

100% oxygen calibration³⁴

CAUTION

Standby

HPO

any

When using an oxygen supply < 99%

Connected

(HPO) or low pressure oxygen (LPO), cali-

Active

HPO

> 21%

brate the O2 cell at 21%. This informa-

ventilation³⁵

Connected

tion is displayed in the Calibration

window.

21% oxygen calibration

When the oxygen supply is less than 99%,

NOTICE

you must disconnect the oxygen supply

before calibration.

When using LPO, disconnect the oxygen

supply during calibration.

Standby

LPO

21%

Disconnected

Calibrate the O2 sensor if either of the

following occur:

Active ventila-

HPO

21%

tion

Connected

•

is displayed in the O2 sensor check-

Active

LPO

21%

box (Figure 5-2)

ventilation

Disconnected

• The O2 sensor calibration needed alarm

is generated.

To perform O2 sensor calibration

1. Using the information in Table 5-5, set

the Oxygen control as appropriate to

calibrate the sensor using either 21%

or 100% oxygen.

For example, to calibrate during active

ventilation with 100% oxygen, ensure

the Oxygen control is set to 22% or

higher.

³⁴ Calibrating at 100% improves the stability of measurements at higher oxygen concentrations during use.

³⁵ Only for adult/pediatric patients.

Hamilton Medical | HAMILTON-T1 Operator's Manual

5 Specifying ventilation settings

In case of calibration failure

Zero calibration requirements for main-

stream CO2 sensors

If the calibration fails, a red

is displayed

Perform a zero calibration in the following

in the O2 sensor checkbox.

cases:

Perform the following checks, repeating

• With the first use of the sensor

the calibration after each one, until calib-

ration is successful:

• When changing between airway

adapter types (for example, from single

• Ensure a Hamilton Medical O2 sensor is

use to reusable)

installed.

• When the CO2 calibration needed alarm

• If the second calibration attempt fails,

is generated

replace the O2 sensor.

Zero calibration requirements for side-

If the problem persists, have the ventilator

stream CO2 sensors

serviced.

You only need to perform a zero calibra-

tion with sidestream CO2 sensors when

5.4.5 Performing a zero calibration of

the CO2 calibration needed alarm is gene-

the CO2 sensor/adapter

rated.

Before proceeding, review the safety

To ensure all CO2 is dissipated, wait 2

information in Chapter 1.

minutes to perform the zero calibration

after removing the adapter from the

CAUTION

patient’s airway.

• Always perform zero calibration with

To perform the zero calibration of the CO2

the CO2 sensor (mainstream) or CO2

sensor/adapter (mainstream) and sensor/

module (sidestream) connected to the

module (sidestream)

airway adapter.

1. Connect the CO2 adapter (1 main-

• Be sure NOT to cover both ends of

stream) or the CO2 module (2 side-

the airway adapter with your fingers.

stream) to the CO2 port on the ventila-

tor (Figure 5-8), and ensure CO2

The CO2 adapter zero calibration compen-

monitoring is enabled.

sates for optical differences between air-

Wait at least 2 minutes for the device

way adapters and for sensor drift.

to warm up.

Note that the CO2 sensors are calibrated

2. Disconnect the CO2 sensor/adapter

at the factory; you only need to zero the

from the breathing circuit.

adapters as described next.

See Figures 4-4 and 4-6 for the sensor

location in the breathing circuit.

3. Attach the CO2 sensor to the adapter

(1 mainstream) or snap it into the CO2

module (2 sidestream) (Figure 5-9).

English | 10103179/02 USA

Testing the alarms

Keep these components away from all

In case of zero calibration failure

sources of CO2, including the patient's

and your own exhaled breath, as well

If the zero calibration fails,

is displayed

as the ventilator exhaust port.

in the CO2 sensor checkbox.

4. Touch System > Tests & calib.

Perform the following checks, repeating

the zero calibration after each one, until it

5. Touch CO2 sensor.

is successful:

Do not move the components during

• Check the airway adapter and clean if

calibration.

necessary.

6. When the zero calibration is complete,

• If the zero calibration still fails, ensure

verify that there is a checkmark

there is no source of CO2 near the air-

the CO2 sensor checkbox.

way adapter.

Figure 5-8. Connecting the components

• If the zero calibration still fails, connect

a new adapter.

• If the zero calibration still fails, connect

a new CO2 sensor (mainstream) or

CO2 module (sidestream).

If the problem persists, have the ventilator

serviced.

5.4.6 Testing the alarms

During ventilator startup, the HAMILTON-

T1 performs a self-check that also verifies

proper alarm function, including genera-

tion of an audible alarm sound. You are

not required to perform additional alarm

Figure 5-9. Sensor and adapter connected for

tests.

calibration

If desired, you can test any adjustable

alarm by manually changing the set limit

such that the ventilator exceeds or fails to

reach the set limit, thereby generating the

associated alarm. For details on setting

alarm limits, see Section 5.7.

For any tests, use a demonstration lung

assembly as described in Section 5.4.1.

Hamilton Medical | HAMILTON-T1 Operator's Manual

5 Specifying ventilation settings

Figure 5-10. Modes window, changing modes

5.5 Selecting the ventilation

mode

The active ventilation mode is displayed at

the top left corner of the display together

with the selected patient group.

When first starting to ventilate a patient,

the mode associated with the selected

Quick setup is pre-selected. You can

change it, if needed.

For details about each of the modes, see

Chapter 7.

To select a mode

Do either of the following (see Figure

5-10):

Active mode,

New mode

patient group

- Touch the mode name (1) at the top

left of the display.

Modes

Cancel/Confirm

- Touch Modes (2) at the top right of

the display.

Figure 5-11. Controls window, changing modes

In the Modes window, touch the

desired mode, then touch Confirm.

The Confirm button is only displayed

after you select a different mode in

the window.

The Controls window opens.

Review and, if needed, adjust the

control settings (Figure 5-12), then

touch Confirm to enable the new

mode.

After you touch Confirm, the mode

changes at the end of the current

breath cycle.

Without confirmation, the window

Active mode,

Values depending

closes after a short time and the cur-

patient group

on mode

rently active mode remains in place.

Tabs: Basic, More,

Controls for new

Apnea, Patient,

mode

SpeakValve

New mode

Cancel/Confirm

English | 10103179/02 USA

Reviewing and adjusting ventilation settings

Figure 5-12. Controls window, settings for

5.6 Reviewing and adjusting

active mode

ventilation settings

You specify ventilation settings in the Con-

trols window tabs: Basic, More, Apnea.

The Patient tab provides access to patient

data during ventilation.

Which tabs are available depends on

which mode is selected, as well as

whether you are in Standby or active venti-

lation.

In addition, the window changes slightly

depending on whether you are changing

settings for the active mode or you are

changing modes.

Active mode,

Values depending

To change the control settings for the

patient group

on mode (I:E, TE,

active mode

TI)

1. Touch Controls, and select and adjust

Controls

Mode controls

settings as needed. See Figure 5-12.

Tabs: Basic, More, Apnea, Patient, Speak-

The change takes effect immediately.

Valve

2. Touch More to enable/disable Sigh, if

needed.

3. If applicable, touch Apnea and select

or deselect Backup as needed.

4. If you need to change basic patient

data, touch Patient and adjust settings

as needed. See Section 5.3.

Hamilton Medical | HAMILTON-T1 Operator's Manual

5 Specifying ventilation settings

5.6.1 About Plimit and related pres-

The following examples illustrate each of

sure-control settings

these cases.

The pressure limit setting (Plimit) defines

Example 1: Pressure control setting adjust-

ments exceed Plimit

the maximum allowed pressure to apply

during ventilation. This setting is available

Assume the control parameters are set as

in the Controls > Basic window (Figure

follows:

5-12).

Plimit = 32 cmH2O

Furthermore, the Plimit control setting is

ΔPcontrol = 25 cmH2O

directly related to the high Pressure alarm

PEEP/CPAP = 5 cmH2O

limit, in that changing one of these

Total inspiratory pressure = 30 cmH2O

settings automatically changes the other:

(ΔPcontrol + PEEP/CPAP in this example)

The high Pressure alarm limit is always

The total inspiratory pressure of

10 cmH2O greater than Plimit.

30 cmH2O is below Plimit. The ventilator

Depending on the selected mode, the

delivers the total inspiratory pressure as

following control parameters can be used

set.

to set pressure: ΔPcontrol, ΔPinsp, ΔPsup-

If you increase ΔPcontrol to 30 cmH2O,

port, or P high.

the total inspiratory pressure, which is

The total inspiratory pressure to be applied

now 35 cmH2O, exceeds Plimit and the

is defined as follows:

following occurs:

• ΔPcontrol + PEEP/CPAP

Plimit (1 in Figure 5-13) is highlighted

in yellow, indicating that total inspira-

• ΔPsupport + PEEP/CPAP

tory pressure exceeds Plimit

• ΔPinsp + PEEP/CPAP

Either decrease the pressure control

settings or increase Plimit to ensure

• P high³⁶

that Plimit is equal to or greater than

If the total inspiratory pressure exceeds

the total inspiratory pressure setting.

Plimit, the ventilator only delivers pressure

When Plimit (1 in Figure 5-17) meets

equal to Plimit. The ventilator cannot

this condition, it is no longer high-

deliver the set pressure and the Pressure

lighted in yellow.

limitation alarm is generated. When this

conflict occurs, the Plimit control is high-

lighted in yellow in the Controls window

and the Check Plimit alarm is generated.

During active adjustment, you may see the

pressure or Plimit controls turn yellow,

indicating that total inspiratory pressure

exceeds Plimit with the proposed settings.

Adjust pressure-related settings to resolve

the conflict.

³⁶ In DuoPAP and APRV modes, P high defines the total inspiratory pressure to be delivered. PEEP/CPAP does not need to be accounted

for.

100

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About Plimit and related pressure-control settings

Figure 5-13. Total inspiratory pressure exceeds

If you decrease Plimit to 25 cmH2O, the

Plimit

total inspiratory pressure of 30 cmH2O

exceeds Plimit and the following occurs:

1. The currently active Plimit control that

you are adjusting (1 in Figure 5-15) is

shown in orange.

The pressure controls are highlighted

in yellow (2) if the total inspiratory

pressure exceeds Plimit, indicating

there is a conflict.

2. Upon confirming the new Plimit

setting, Plimit (1 in Figure 5-16) is

highlighted in yellow, indicating there

is a conflict. The pressure controls

Figure 5-14. Total inspiratory pressure no longer

return to their default color.

exceeds Plimit

3. Either decrease the pressure control

settings or increase Plimit to ensure

that Plimit is equal to or greater than

the total inspiratory pressure setting.

When Plimit (1 in Figure 5-17) meets

this condition, it is no longer high-

lighted in yellow.

Figure 5-15. Plimit control is active, total

inspiratory pressure exceeds Plimit

Example 2: Plimit setting adjustment is

below total inspiratory pressure

Assume the control parameters are set as

follows:

Plimit = 32 cmH2O

ΔPcontrol = 25 cmH2O

PEEP/CPAP = 5 cmH2O

Total inspiratory pressure = 30 cmH2O

(ΔPcontrol + PEEP/CPAP in this example)

The total inspiratory pressure of

30 cmH2O is below Plimit. The ventilator

delivers the total inspiratory pressure as

set.

Hamilton Medical | HAMILTON-T1 Operator's Manual

101

5 Specifying ventilation settings

Figure 5-16. Total inspiratory pressure still

Apnea backup ventilation enabled

exceeds Plimit

Apnea backup provides ventilation after the

apnea time passes with no breath

attempts detected. The apnea time is set

in the Alarms window using the Apnea

time control.

When this occurs, the ventilator automati-

cally and immediately switches into Apnea

backup ventilation.

It generates a low-priority alarm, displays

the alarm Apnea ventilation, and provides

ventilation using the settings specified in

Section 7.1.2.

Figure 5-17. Total inspiratory pressure no longer

When set to Automatic, the control setting

exceeds Plimit

for the Apnea backup mode depends on

the IBW (or weight for neonates) of the

patient.

To change the Apnea backup control

settings

1. Touch Controls > Apnea.

2. Clear the Automatic checkbox.

The settings controls are enabled.

3. Change the values as desired.

The changes take effect immediately.

5.6.2 About Apnea backup ventilation

Before proceeding, review the safety

information in Chapter 1.

The HAMILTON-T1 provides Apnea backup

ventilation, a mechanism that minimizes

possible patient injury due to apnea or

cessation of respiration. Apnea backup is

available in the following modes: APVsimv,

SPONT, DuoPAP, APRV, and NIV.

102

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Setting alarm limits

Figure 5-18. Controls > Apnea window

5.7 Setting alarm limits

Before proceeding, review the safety

information in Chapters 1 and 9.

You can access the Alarms window and

change alarm settings at any time, with-

out affecting ventilation.

Figure 5-19. Alarms > Limits 1 window

Controls

Automatic check

box

Apnea

Control settings cor-

responding to the

mode

Backup check box and mode

Alarms

Red or yellow bar

If the patient triggers two consecutive

(depending on alarm

breaths, the ventilator reverts to ventila-

priority) indicates the

tion in the original support mode and at

monitored value is

the original settings, and displays the mes-

out of range

sage, Apnea ventilation ended.

Limits 1, 2

Current monitored

value

Once Apnea backup ventilation is enabled

or disabled, it retains this status in all

Auto^37, ³⁸

Alarm Off symbol

applicable modes. Apnea backup ventila-

when an alarm limit

tion requires no clinician intervention,

is set to Off

although you can freely change the mode

during Apnea backup ventilation, either

switching to a new mode or accepting the

backup mode as the new mode.

Apnea backup ventilation disabled

When Apnea backup is disabled, the high-

priority Apnea alarm is generated when

apnea occurs and there is no patient trig-

ger within the operator-set interval.

³⁷ Not available during neonatal ventilation.

³⁸ Not available in all markets.

Hamilton Medical | HAMILTON-T1 Operator's Manual

103

5 Specifying ventilation settings

To review and adjust alarms

Either touch the Alarms button or

touch an MMP on the left of the

display.

The Alarms > Limits 1 window is

displayed (Figure 5-19).

To set an alarm limit individually,

touch the alarm control and adjust the

value.

Repeat for any other alarm.

Access additional alarm settings by

touching the Limits 2, and if used,

Limits 3 tabs.

The ventilator displays

(Alarm Off

symbol) when an alarm limit is set to

Off.

For details about the Oxygen alarm

limits, see Section 5.7.1.

To set alarm limits automatically,

touch Auto^38,39 in the Limits 1 window.

Selecting Auto automatically sets

alarm limits around the current

monitoring parameter values except

for the Vt and Apnea alarm limits⁴⁰.

These alarm limits remain unchanged,

and must be set manually to the

desired level.

Note that some automatic settings are

not appropriate under all clinical con-

ditions. Check the validity of the

settings as soon as possible.

Close the window.

The following table briefly describes each

of the adjustable ventilator alarms. Addi-

tional details are available in Table 15-13.

For SpO2-related alarms, see the Pulse

Oximetry Instructions for Use.

³⁹ Not available during neonatal ventilation.

⁴⁰ SpO2-related alarms are also not automatically set.

104

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Setting alarm limits

Table 5-6. Adjustable alarms

Alarm

Definition

Apnea time

The maximum time allowed from the beginning of one inspira-

tion to the beginning of the next inspiration.

If the patient does not trigger a breath during this time:

• A low-priority alarm sounds if Apnea backup is enabled.

Apnea ventilation begins.

• A high-priority alarm sounds if Apnea backup is disabled

Not applicable in nCPAP or nCPAP-PC modes, or during

HiFlowO2.

ExpMinVol (low and high)

Low and high expiratory minute volume. If either limit is

reached, a high-priority alarm is generated.

Not applicable in nCPAP or nCPAP-PC modes.

For alarm details when using a speaking valve, see Table 10-1.

During CPR ventilation, alarm limits are automatically set to

their minimum and maximum allowed limits. See Table 15-13.

Flow

Only active in nCPAP and nCPAP-PC modes.

The High Flow alarm is generated when the limit is reached.

fTotal (low and high)

Low and high monitored total breath rate (fTotal), including

both spontaneous and mandatory breaths. If either limit is

reached, a medium-priority alarm is generated.

Not applicable in nCPAP or nCPAP-PC modes.

During CPR ventilation, alarm limits are automatically set to

their minimum and maximum allowed limits. See Table 15-13.

Oxygen (low and high)

Low and high monitored oxygen concentration (Oxygen). If

either limit is reached, a high-priority alarm is generated.

Applies only when low-pressure oxygen is used or the Set

Oxygen alarm limits manually checkbox is selected with HPO.

PetCO2 (low and high)

Low and high monitored PetCO2. If either limit is reached, a

medium-priority alarm is generated.

During CPR ventilation, alarm limits are automatically set to

their minimum and maximum allowed limits. See Table 15-13.

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5 Specifying ventilation settings

Alarm

Definition

Pressure (low and high)

Low and high monitored pressure at the patient airway (Ppeak).

If the high Pressure limit is reached or the device fails to reach

the low Pressure limit, a high-priority alarm is generated.

When pressure reaches the Plimit setting (high Pressure limit

minus 10 cmH2O), inspiratory pressure is limited to this setting;

the pressure is not increased further.

If the delivered pressure is the same as the set high Pressure

alarm limit, the device aborts the breath and reduces the pres-

sure to PEEP level.

Sigh breaths are an exception to this rule. In this case, the

ventilator may apply inspiratory pressure up to 3 cmH2O below

the high Pressure alarm limit.

Vt (low and high)

Low and high expiratory tidal volume, for two consecutive

breaths. If either limit is reached, a medium-priority alarm is

generated.

When the delivered Vt is > 1.5 times the set upper Vt alarm

limit, the Inspiratory volume limitation alarm is generated. In this

case, the device aborts the breath and reduces the pressure to

PEEP level.

The APV controls reduce the pressure for the next breath by

3 cmH2O.

During CPR ventilation, alarm limits are automatically set to

their minimum and maximum allowed limits. See Table 15-13.

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About the Oxygen alarm limits

5.7.1 About the Oxygen alarm limits

To enable manual adjustment of Oxygen

alarm limits in HPO mode

How the device sets the Oxygen alarm

1. Touch Tools > Utilities.

limits depends on the gas source used

(LPO or HPO) and associated option

2. Select HPO mode as the gas source.

settings.

3. To set the Oxygen alarm limits your-

Oxygen alarm limits are set as follows:

self, touch the Set Oxygen alarm limits

manually checkbox.

Table 5-7. Setting Oxygen alarm limits in LPO

When selected, the Oxygen alarm limit

and HPO modes

controls are enabled in the Alarms

window. You can now set the limits as

Gas

Setting Oxygen alarm limits

desired.

source

4. To have the limits set automatically,

LPO

Always manually. The Oxygen

ensure the checkbox is clear.

alarm limit controls are enabled

in the Alarms window and are

Figure 5-20. Setting Oxygen alarm limits manu-

manually adjusted, as appropri-

ally with HPO

ate.

HPO

By default, automatically. The

Oxygen high/low alarms are, by

default, automatically set to the

current Oxygen setting ± 5 (abso-

lute value). The Oxygen alarm

limit controls are disabled in the

Alarms window.

To set them manually, select the

Set Oxygen alarm limits manually

option, as described next.

The minimum lower alarm limit is 18%.

Tools

Gas source: HPO mode

Setting the oxygen alarm limits manually

Utilities

Set Oxygen alarm limits

reduces the alarms, for example, when

manually checkbox

using an oxygen supply < 99%.

selected

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5 Specifying ventilation settings

To stop ventilation and place the ventilator

5.8 Starting ventilation

in Standby

Before starting ventilation, review the

1. Press and quickly release

(Power/

patient information in the Standby

Standby) while the ventilator is turned

window and ensure it is correct.

on (Figure 10-2).

To start ventilation

The Activate Standby window opens

(Figure 5-21).

4 Do one of the following:

- In Standby, press the Power/Standby

2. Touch Activate standby.

key.

The Standby window opens (Figure

- In Standby, touch Start ventilation.

5-22).

- Using the P&T knob, move the

While in Standby, the window shows the

cursor to the Start ventilation button,

elapsed time the ventilator has been in

and press the P&T knob.

Standby.

When using HiFlowO2, the button is

Note that, if another window is open on

labeled Start therapy.

the display, the elapsed time appears in a

When CPR ventilation is on, the

small yellow box on the left side of the

button is labeled Start CPR.

Standby window.

Ventilation starts.

Figure 5-21. Activate Standby window

5.9 Stopping ventilation

(Standby)

WARNING

Standby

No ventilation delivered to the patient.

When in Standby, the ventilator does not

Deactivate humidifier during Standby.

automatically resume ventilation when

Activate standby

the patient is reconnected. You must

manually restart ventilation.

NOTICE

• Patient alarms are suppressed in

Standby.

• Acoustic patient alarms are sup-

pressed for 1 minute after starting

ventilation from Standby.

Standby is a waiting mode that lets you

maintain ventilator settings while the

ventilator is not performing any ventilatory

functions.

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About the control parameters

Figure 5-22. Standby window

5.10 About the control para-

meters

Table 5-8 provides a brief description of

the ventilator’s control parameters, also

referred to as control settings. You can

review and adjust these settings in various

locations, depending on their function.

Table 15-9 in the Specifications chapter

provides the control parameter ranges and

default settings, including accuracy.

For a comparison of Hamilton Medical

ventilation-related terminology with ISO

19223:2019, see Section 15.5.

Elapsed time in

Start ventilation⁴¹

Standby

To end Standby and start ventilation

4 Do either of the following:

- Touch Start ventilation⁴¹.

- Press and quickly release

Ventilation resumes with the previous

settings.

To enter Standby and stop ventilation

1. Press the Power/Standby key.

2. In the confirmation window, touch

Activate standby.

The device enters Standby (Figure 5-1). The

yellow counter shows the time elapsed in

Standby.

⁴¹ When HiFlowO2 is selected: Start therapy; when CPR ventilation is on: Start CPR.

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5 Specifying ventilation settings

Table 5-8. Control parameters, defined

Parameter

Definition

%MinVol

Percentage of minute volume to be delivered in ASV mode. The ventila-

tor uses the %MinVol, Pat. height, and sex settings to calculate the

target minute ventilation.

Add 20% per degree of body temperature > 38.5°C (101.3°F).

Apnea backup

A function that provides ventilation after the adjustable apnea time

passes without breath attempts.

If Automatic is enabled, control parameters are calculated based on the

patient's IBW (Adult/Ped patient group) or Weight (Neonatal patient

group).

Applies in APVsimv, SPONT, DuoPAP, APRV, and NIV modes.

Be sure to review the safety information in Chapter 1.

ETS

ETS (expiratory trigger sensitivity) is the percent of peak inspiratory flow

at which the ventilator cycles from inspiration to exhalation.

Increasing the ETS setting results in a shorter inspiratory time. The ETS

setting lets you match the inspiratory time of pressure-supported

breaths to the patient’s neural timing.

Flow

In HiFlowO2, Flow is the continuous and constant flow of medical gas to

the patient in liters per minute.

Flow trigger

The patient’s inspiratory flow that triggers the ventilator to deliver a

breath.

Set to OFF when CPR ventilation is on. See Section 10.9.

HAMILTON-H900

Displayed when a HAMILTON-H900 humidifier is connected and the

related parameters

option is installed. See Section 11.1.7.

I:E

Ratio of inspiratory time to expiratory time.

Applies to mandatory breaths, and in APVsimv/APVcmv and PCV+

modes.

IBW

Ideal body weight. A calculated value using height and sex, used in cal-

(kg)

culations for ASV and startup ventilation settings for adult and pediatric

patients.

Oxygen

Oxygen concentration to be delivered.

Applies to all breaths and during HiFlowO2.

P high

The high pressure setting in APRV and DuoPAP modes. Absolute pres-

sure, including PEEP.

P low

The low pressure setting in APRV mode.

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About the control parameters

Parameter

Definition

Pat. height

Patient height. Used to compute ideal body weight (IBW) for adult and

pediatric patients.

PEEP/CPAP

Positive end expiratory pressure and continuous positive airway pres-

sure, baseline pressures applied during the expiratory phase.

Applies to all breaths, except in APRV mode and with HiFlowO2.

Plimit

The maximum allowed pressure to apply during ventilation. Does not

apply in nCPAP and nCPAP-PC modes, with Sigh breaths, or in HiFlowO2.

Changing Plimit or the high Pressure alarm limit automatically changes

the other: the high Pressure alarm limit is always 10 cmH2O greater

than Plimit.

When adjusting the pressure controls, the ventilator indicates when the

total inspiratory pressure (including PEEP/CPAP) exceeds Plimit. For

details, see Section 5.6.1.

In ASV mode, Plimit must be at least 15 cmH2O above PEEP/CPAP for

the ASV controller to function correctly.

P-ramp

Pressure ramp. The rate at which pressure rises to meet the set value.

The P-ramp setting lets you fine-tune the initial flow output during a

pressure-controlled or pressure-supported breath to match the ventila-

tor flow to the patient’s demand. Applies to all breaths.

Notes:

• Short P-ramp settings (0 to 50 ms) provide higher initial flow rates

and result in faster attainment of the target pressure. This may bene-

fit patients with elevated respiratory drive.

• Shorter P-ramp values have been correlated with reduced work of

breathing in certain patients.

• Setting the P-ramp too low, especially in combination with a small ET

tube (high resistance), may result in a noticeable pressure overshoot

during the early stage of inspiration and generation of a Pressure limi-

tation alarm.

• Setting the P-ramp too high may prevent the ventilator from attaining

the set inspiratory pressure. A square (rectangular) pressure profile is

the goal.

• P-ramp is not available during CPR ventilation.

Rate

Respiratory frequency or number of breaths per minute.

Sex

Sex of patient. Used to compute ideal body weight (IBW) for adult and

pediatric patients.

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5 Specifying ventilation settings

Parameter

Definition

Sigh

When Sigh is activated, every 50th breath is applied using one of the

following settings:

• In pressure-controlled modes, the pressure delivered is > 10 cmH2O

above the currently set Pcontrol or Pinsp.

• In volume-controlled modes, the tidal volume delivered is 150% of

the current tidal volume (Vt) setting.

During Sigh breaths, the Pressure and Vt alarm limits remain in effect to

help protect the patient from excessive pressures and volumes.

Not available for neonatal patients, in DuoPAP or APRV modes, or with

HiFlowO2.

T high

Length of time at the higher pressure level, P high, in DuoPAP and APRV

modes.

T low

Length of time at the lower pressure level, P low, in APRV mode.

Inspiratory time, the length of time to deliver gas for inspiration at the

Pcontrol or Vt setting. Used with Rate to set the breath cycle time.

Applies in PCV+, APVcmv, APVsimv, PSIMV+, NIV-ST, and nCPAP-PC

modes.

In PCV+ and APVcmv modes, TI can be controlled by Rate and TI or by

the I:E ratio (set in Configuration). All other modes are controlled by

Rate and TI.

TI max

Maximum inspiratory time for flow-cycled breaths in the following

modes:

• NIV and NIV-ST: All patient groups

• APVsimv, PSIMV+, DuoPAP, and SPONT: Neonatal patient group

In Configuration, you can enable the TI max control setting for the

following modes:

• APVsimv, PSIMV+, DuoPAP, and SPONT: Adult/Ped patient group

For all patient groups, the switchover from inspiration to exhalation in

spontaneous breaths is normally controlled by the ETS setting. If gas

leakage is significant, however, the set cycle may never be reached. The

TI max setting provides a backup so inspiration can be terminated. The

ventilator switches over to exhalation when the set TI max is reached.

When speaking valve compatibility is activated (ON), the TI max control

setting is available in PSIMV+ and SPONT modes, in the Controls > More

window regardless of whether it is enabled in Configuration.

Vt/kg

Tidal volume per weight.

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About the control parameters

Parameter

Definition

Tidal volume delivered during inspiration in APVcmv and APVsimv

modes.

Weight

Actual body weight. Used only with neonates.

ΔPcontrol

The pressure (additional to PEEP/CPAP) to apply during the inspiratory

phase in PCV+ and PSIMV+ modes.

ΔPinsp

Pressure (additional to PEEP/CPAP) to apply during the inspiratory phase.

Applies in PSIMV+ PSync and NIV-ST modes.

ΔPsupport

Pressure support for spontaneous breaths in SPONT, NIV, APVsimv,

PSIMV+, and DuoPAP modes. It is the pressure (additional to PEEP/CPAP)

to apply during the inspiratory phase.

Pressure support helps the patient counteract the flow resistance of the

breathing circuit and endotracheal tube. It compensates for the

decreasing tidal volume and rising respiratory rate of a spontaneously

breathing patient.

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6 Specifying neonatal settings

6.1 Setting up for neonatal

6.1.1 Setting the patient group and

weight

ventilation

Before proceeding, review the safety

CAUTION

information in Chapter 1.

Entering the correct patient data ensures

Setting up for neonatal ventilation

safe ventilation settings for start up,

comprises the following steps:

Apnea backup, and safety ventilation.

To ...

See ...

You select the patient group and weight

On the ventilator, select

Section 6.1.1

in the Standby window when first setting

the patient group and

up the ventilator for the patient.

specify weight.

You can edit this information during venti-

Install the expiratory

Section 3.5.2

lation, if needed, in the Patient window.

valve.

Figure 6-1. Neonatal Standby window

Select and assemble the

Section 6.1.2

appropriate breathing

circuit and components.

Adjust the position of the

Section 6.1.2.6

breathing circuit.

Connect external devices.

Chapter 4

Perform the preopera-

Sections 6.2 and

tional check and any

5.4

required tests and calibra-

tions.

Select the ventilation

Sections 6.3 and

mode.

5.5

Patient group

Weight

tabs (Neonatal

selected)

Quick setup

Preop check

buttons

Selected mode

Start ventilation⁴²

and patient group

⁴² When HiFlowO2 is selected: Start therapy; when CPR ventilation is on: Start CPR.

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Setting up the patient breathing circuit

To select the patient group

6.1.2.1 Selecting the breathing circuit

components

1. In the Standby window, touch the

Neonatal tab. See Figure 6-1.

Select the correct breathing circuit and

2. Touch the appropriate Quick setup

components for your patient from Table

button.

6-2.

By default, they are labeled Neonatal

Table 6-2. Neonatal breathing circuit part

1, Neonatal 2, and Neonatal 3. The

specifications

Quick setup names and settings are

defined in Configuration. For details,

Patient group/Compo-

Specification

see Section 5.2.1.

nent

3. Touch the Weight control and set the

Patient group

Neonatal

patient’s body weight.

Weight (kg)

0.2 to 30

By default, the weight is set to 2 kg.

Breathing circuit tube ID

10 to 12

You can now select the ventilation mode,

(mm)

if the desired mode is not already selected.

Flow sensor

Neonatal

6.1.2 Setting up the patient breathing

Pressure line

Neonatal

circuit

CO2 airway adapter

Neonatal

Setting up a neonatal breathing circuit

comprises the following steps:

6.1.2.2 Connecting the neonatal breath-

Table 6-1. Assembling the breathing circuit

ing circuit

Figures 2-9 through 2-11 in Chapter 2

To ...

See ...

show typical neonatal breathing circuit

Select the components

Section 6.1.2.1

configurations.

Connect the breathing

Section 6.1.2.2

circuit

6.1.2.3 Working with the expiratory valve

Connect the flow sensor

Section 6.1.2.4

The process is the same as for adult and

pediatric patients. See Section 3.5.2.

Connect the pressure line Section 6.1.2.5

(nCPAP, nCPAP-PC modes)

Position the circuit

Section 6.1.2.6

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6 Specifying neonatal settings

6.1.2.4 Connecting the neonatal flow

6.1.2.5 Connecting the pressure-monitor-

sensor

ing line

Note the following:

Use the pressure line with the breathing

circuit when using the nCPAP or nCPAP-PC

• Use a Hamilton Medical neonatal flow

modes. Do not use a flow sensor.

sensor to ventilate your neonatal

patient.

The pressure is measured by a built-in T-

• Do not use an adult/pediatric flow

piece adapter in the inspiratory line, close

sensor.

to the patient, or (if available) over the

optional pressure measuring connection at

• The neonatal flow sensor adds 1.3 ml

the Y-piece of the breathing circuit.

of dead space.

Figure 6-3. Connecting the pressure line

To connect the neonatal flow sensor

For all modes except nCPAP and

nCPAP-PC, connect a flow sensor

between the Y-piece of the breathing

circuit and the patient connection. See

Figure 6-2.

When using the nCPAP and nCPAP-PC

modes, remove the flow sensor and

use the pressure-monitoring line with

the breathing circuit (Section 6.1.2.5).

Note that during calibration you place

the flow sensor proximal to the

patient.

HiFlowO2 does not require the use of

a flow sensor.

Connect the blue and clear tubes to

the flow sensor connection ports on

the ventilator.

The blue tube attaches to the blue

Pressure line

T-piece, Y-piece

connection port. The clear tube

connection port

attaches to the white connection port.

(blue)

Calibrate the flow sensor and perform

Pressure line

the Leak test. See Section 6.2.

Figure 6-2. Connect flow sensor between the

Y-piece and patient interface

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Positioning the breathing circuit

To connect the pressure-monitoring line

To perform the preoperational check

1. Using an adapter, connect the pres-

1. Use a setup as described in Table 6-3.

sure line to the small inlet at the top

2. Perform all of the steps in Table 6-4.

of the T- or Y-piece, whichever is

used. See Figure 6-3.

To ensure that the ventilator functions

according to specifications on your

2. Connect the pressure line to the blue

patient, perform the preoperational check

flow sensor connection port on the

using the breathing circuit that will be

ventilator.

used on the patient.

3. Calibrate the breathing circuit and

perform the Leak test.

Table 6-3. Test breathing circuit setup

Component

Specification

6.1.2.6 Positioning the breathing circuit

Breathing

Neonatal, ID10 to ID12

After assembly, position the breathing cir-

circuit

cuit so that the hoses will not be pushed,

pulled, or kinked as a result of a patient's

Flow sensor

Neonatal, with calibration

movement, transport, or other activities,

adapter

including scanner bed operation and

Pressure line

For use in nCPAP and nCPAP-

nebulization.

PC modes

Test lung

Neonatal, with neonatal ET

6.2 Performing the preopera-

tube between flow sensor

tional check, tests, and calibra-

and lung model (an IngMar

tions

neonatal lung model is rec-

ommended)

Before proceeding, review the safety

information in Chapter 1.

Table 6-4. Preoperational check, overview

The following sections in this chapter pro-

vide information that is specific to neona-

To ...

See ...

tal ventilation, and is intended as a supple-

Perform the preoperational

Section 5.4 in

ment to the information provided in

check

Chapter 5

Chapter 5.

Perform the Leak test

Section 5.4.2

For details about when to perform the

in Chapter 5

tests, and about the full preoperational

check process, see Section 5.4.

Calibrate the neonatal flow Section 6.2.1

sensor

When to perform

In nCPAP modes, calibrate

Section 6.2.2

Before connecting a new patient to the

the breathing circuit

ventilator.

Perform other calibrations,

Section 5.4 in

as needed

Chapter 5

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6 Specifying neonatal settings

6.2.1 Calibrating the neonatal flow

7. When prompted, flip the flow sensor

sensor

and calibration adapter together 180°

so the adapter is directly connected to

Calibrate the flow sensor after connecting

the Y-piece (Figure 6-5).

a new flow sensor or whenever the Flow

8. When prompted, flip the flow sensor/

sensor calibration needed alarm is genera-

adapter 180° again, so the flow

ted.

sensor is directly connected to the Y-

A flow sensor is required for all modes

piece, and remove the calibration

except nCPAP or nCPAP-PC modes or when

adapter (Figure 6-6).

using HiFlowO2. Before proceeding,

9. When calibration is complete, verify

ensure you have the calibration adapter

that there is a checkmark in the Flow

available.

sensor checkbox.

To calibrate a neonatal/pediatric flow

10. When successful, continue with other

sensor

tests or ventilation.

1. Calibrate the flow sensor in Standby,

Figure 6-4. Attach adapter

with no patient connected.

2. Make sure that the Neonatal patient

group is selected, a neonatal flow

sensor is connected, and the calibra-

tion adapter is available.

3. Set up the ventilator for ventilation,

connecting the flow sensor to the Y-

Figure 6-5. Flip components

piece.

4. In the Standby window, touch Preop

check.

The System > Tests & calib window is

displayed.

5. Touch Flow sensor.

6. When prompted on the display, attach

Figure 6-6. Flip components, remove adapter

the calibration adapter to the patient

end of the flow sensor (Figure 6-4).

To cancel an ongoing calibration

4 Touch Flow sensor again.

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Calibrating the neonatal breathing circuit (nCPAP and nCPAP-PC modes)

In case of calibration failure

To calibrate the circuit with the pressure

line

If the calibration fails, a red X is displayed

1. Touch System > Tests & calib.

in the Flow sensor checkbox.

2. Touch Circuit.

Perform the following checks, repeating

the calibration after each one, until calib-

If you have not already disconnected

ration is successful:

the patient, the text Disconnect patient

is displayed.

• Ensure that the flow sensor is appropri-

3. Disconnect patient as follows:

ate for the selected patient group.

- If using a Y-piece, disconnect the

• Check the breathing circuit for a dis-

breathing circuit from the patient.

connection between the ventilator and

the flow sensor, or for other large leaks

- If using a T-piece, disconnect the

interface from the patient.

(for example, breathing circuit, humidi-

fier).

4. Follow the instructions displayed in

the message line.

• Check that the correct flow sensor is

connected, and that the flow sensor

5. When calibration is complete, verify

and expiratory valve/membrane are

that there is a checkmark in the Circuit

properly seated.

checkbox.

• If the calibration still fails, replace the

6. When successful, continue with other

flow sensor.

tests or ventilation.

• If the calibration still fails, replace the

To cancel an ongoing calibration

expiratory valve membrane.

4 Touch Circuit again.

• If the calibration still fails, replace the

expiratory valve set.

If the problem persists, have the ventilator

serviced.

6.2.2 Calibrating the neonatal breath-

ing circuit (nCPAP and nCPAP-PC

modes)

The nCPAP and nCPAP-PC modes use a

pressure line in the breathing circuit to

measure the inspiratory pressure. Do not

use a flow sensor.

This calibration ensures that the breathing

circuit resistance compensation is accu-

rate.

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6 Specifying neonatal settings

In case of calibration failure

6.4 Setting the patient weight

If the calibration fails, a red X is displayed

for ventilation

in the Circuit checkbox.

For neonates, the ventilator uses actual

Perform the following checks, repeating

body weight (instead of a calculated IBW),

the calibration after each one, until calib-

set in the Weight control.

ration is successful:

Specifying the correct weight is particu-

• Check the breathing circuit for a dis-

larly important as the ventilator uses this

connection between the ventilator and

data as the basis for some calculations and

the pressure line, or for other large

mode control settings. By default, neona-

leaks (for example, breathing circuit,

tal weight is set to 2 kg.

humidifier).

To set up the patient, see Section 6.1.1.

• Check that the pressure line and expira-

tory valve set is properly seated.

6.5 Alarms for neonatal ventila-

• If the calibration fails, replace the pres-

sure line.

tion

• If the calibration still fails, replace the

Note that the following adjustable alarms

breathing circuit and expiratory valve

use patient Weight to set the initial alarm

set.

limits:

If the problem persists, have the ventilator

• Tidal volume, high and low (Vt)

serviced.

• Minute volume, high and low

(ExpMinVol)

6.3 Selecting the ventilation

Be sure to set the correct patient Weight in

mode

the Standby window before starting venti-

lation. See Section 6.1.1.

The neonatal modes available on the

ventilator are either pressure controlled or

adaptive (pressure regulated and volume

6.6 O2 enrichment for

targeted).

neonates

Note that the ventilator generates a con-

The applied oxygen concentration during

tinuous and constant base flow from the

the enrichment maneuver is increased to

inspiratory outlet to the expiratory outlet

125% of the current Oxygen setting.

during the later part of exhalation.

For additional details on performing O2

The base flow is set to a fixed 4 l/min for

enrichment, see Chapter 10.

neonatal patients.

For the list of supported modes and details

about each one, see Chapter 7.

To select the ventilation mode

4 See Section 5.5.

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7 Ventilation modes

7.1 Overview

To select the breath timing to use, see

Section 13.4.1.

The HAMILTON-T1 offers a full range of

Figure 7-1. Breath timing parameters

ventilation modes that provide full and

partial ventilatory support.

The primary aims of mechanical ventilation

are:

• Elimination of CO2

• Oxygenation

• Decreased work of breathing

• Patient synchronization

Time

The detailed mode descriptions provided

in this chapter illustrate how the controls

work to achieve these goals.

For a comparison of Hamilton Medical

ventilation-related terminology with ISO

19223:2019, see Section 15.5.

Time

7.1.1 Breath types and timing options

Rate

Hamilton Medical ventilators support two

2, 3

I:E ratio

main breathing methods: mandatory

breaths and spontaneous breaths.

Note that in the breath patterns shown in

Mandatory breaths. The start of inspiration

this chapter, we show I:E. What is actually

(triggering) is determined by the ventilator

displayed on your device depends on the

or the patient. The end of inspiration

breath timing selection on the ventilator.

(cycling) is determined by the ventilator.

Spontaneous breaths. The start of inspira-

tion (triggering) and end of inspiration

(cycling) is determined by the patient. The

patient breathes independently or receives

support from the ventilator.

The ventilator controls mandatory breath

timing using a combination of inspiratory

time (TI) and Rate.

For some modes, you can set the ventila-

tor to use any of the following combina-

tions to control breath timing: I:E or TI.

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Ventilation modes

7.1.2 Ventilation modes

A ventilation mode combines breath type,

breath sequence, and control variables.

The choice of mode is a medical decision

that depends on the patient’s CO2 elimi-

The following tables provide an overview

nation, oxygenation, activity, and breath-

of the available ventilation modes.

ing effort.

Table 7-1. HAMILTON-T1 ventilation modes, description and applicable patient group

Mode name

Patient

Mode

group

Volume-targeted modes, adaptive pressure controlled

APVcmv /

All

Breaths are volume targeted and mandatory.

(S)CMV+

APVsimv /

All

Volume-targeted mandatory breaths can be alternated with

SIMV+

pressure-supported spontaneous breaths.

Pressure-controlled modes

PCV+

All

All breaths, whether triggered by the patient or the ventilator,

are pressure-controlled and mandatory.

PSIMV+

All

Mandatory breaths are pressure controlled. Mandatory breaths

can be alternated with pressure-supported spontaneous

breaths.

DuoPAP

All

Mandatory breaths are pressure controlled. Spontaneous

breaths can be triggered at both pressure levels.

APRV

All

Spontaneous breaths can be continuously triggered. The pres-

sure release between the levels contributes to ventilation.

SPONT

All

Every breath is spontaneous, with or without pressure-sup-

ported spontaneous breaths.

Intelligent ventilation

ASV

Adult/Ped

Operator sets %MinVol, PEEP, and Oxygen. Frequency, tidal

volume, pressure, and I:E ratio are based on physiological input

from the patient.

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125

Mode type

Intelligent

Vol targeted, adaptive

Pressure controlled

Noninvasive

Ventilation

press. control

Mode

ASV

APVcmv

APVsimv

PCV+

PSIMV

PSIMV+

DuoPAP

APRV

SPONT

NIV

NIV-ST

nCPAP**

nCPAP-PC

***

+PSync

Timing

Rate

T low

Rate

T high

Mandatory

ΔPcontrol

ΔPinsp

ΔPcontrol

P high

ΔPinsp

ΔPcontrol

breaths

Spontaneous

ΔPsupport

ΔPinsp

ΔPsupport

ΔPinsp

breaths

ETS

TI max

Baseline press.

PEEP/CPAP

P low

Trigger

P-ramp

Plimit

Oxygen

Sex

Pat. height

Mode specific

%MinVol

Sigh***

Apnea

backup

APVsimv

PCV+

* I:E, TI

** Neonatal only

*** Adult/Ped only-

- N/A

X applies to this mode

7 Ventilation modes

7.2 Volume-targeted modes,

adaptive pressure control

The following modes are volume targeted,

with adaptive pressure control:

• APVcmv / (S)CMV+

• APVsimv / SIMV+

• VS

In this manual, we refer to the APV modes

using the APVcmv / APVsimv nomencla-

ture. You can select the format to use in

Configuration (Section 13.4.2).

NOTICE

•

The minimum inspiratory pressure

(Ppeak - PEEP) in APVcmv and

APVsimv modes is 5 cmH2O. Be aware

that a small set tidal volume with high

lung compliance may lead to higher-

than-expected tidal volumes.

•

Ensure Plimit is set appropriately for

adaptive modes. This setting provides

a safety pressure limit for the device

to appropriately adjust the inspiratory

pressure necessary to achieve the

target tidal volume.

The maximum available inspiratory

pressure (Plimit), is indicated by a blue

line on the pressure waveform

display.

If Plimit is set too low, there may not

be enough margin for the device to

adjust its inspiratory pressure to

deliver the target tidal volume.

128

English | 10103179/02 USA

APVcmv / (S)CMV+ mode

7.2.1 APVcmv / (S)CMV+ mode

Figure 7-2. APVcmv / (S)CMV+: Breathing pat-

tern and controls

APVcmv stands for adaptive pressure venti-

Insp

Exp

lation with controlled mandatory ventila-

tion. This mode is also called (S)CMV+,

which stands for synchronized controlled

mandatory ventilation.

APVcmv is a volume-targeted pressure-

controlled ventilation mode. It functions

Time

similarly to the conventional volume-

controlled mode of ventilation, (S)CMV,

except that pressure is the control variable

rather than flow. Pressure is adjusted

between breaths to achieve the target

Time

tidal volume.

The breath can be triggered by the ventila-

tor or by the patient. If the breath is trig-

gered by the patient, the inspiratory rate

may increase.

Time

The ventilator uses the Plimit setting (high

Ventilator controls

Pressure alarm limit minus 10 cmH2O) as a

CO2 elimination

safety boundary for its inspiratory pressure

adjustment, and does not exceed this

Rate

value. An exception is Sigh breaths, when

Sigh (not shown)

the ventilator may apply inspiratory pres-

Oxygenation

sures 3 cmH2O below the high Pressure

PEEP

I:E⁴³

alarm limit.

Oxygen (not shown)

Breaths in APVcmv mode are volume-tar-

Patient synchronization

geted and mandatory, delivered at the

Trigger

P-ramp

lowest possible pressure depending on

lung conditions.

The operator sets the target tidal volume

(Vt).

The ventilator delivers the set target

volume (Vt) at a preset rate. The patient

can trigger mandatory breaths between

preset rate breaths.

⁴³ Depending on the selected breath timing philosophy.

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129

7 Ventilation modes

7.2.2 APVsimv / SIMV+ mode

If the patient does not trigger a breath

during Tspont, the ventilator automatically

APVsimv stands for adaptive pressure

delivers a mandatory breath at the end of

ventilation with synchronized intermittent

Tmand.

mandatory ventilation. This mode is also

called SIMV+, synchronized intermittent

In this mode, parameters for both manda-

mandatory ventilation plus.

tory and spontaneous breath types are set.

•

The tidal volume (Vt) setting defines the

The APVsimv mode combines attributes of

delivered volume of mandatory breaths.

the APVcmv and SPONT modes, delivering

volume-targeted mandatory breaths or

•

Rate and I:E define the timing of the

pressure-supported spontaneous (patient-

breath cycle for mandatory breaths.

triggered) breaths.

•

For spontaneous breaths, ΔPsupport

APVsimv mode ensures that the set target

defines the pressure support above

volume is delivered during the mandatory

PEEP.

breaths.

•

ETS affects the inspiratory timing of the

After the mandatory breath is delivered,

supported breaths.

the patient is free to take any number of

The inspiratory time can also be limited

spontaneous breaths for the remainder of

by TI max.⁴⁴

the APV breath interval.

The ventilator uses the Plimit setting (high

Pressure alarm limit minus 10 cmH2O) as a

safety boundary for its inspiratory pressure

adjustment, and does not exceed this

value. An exception is Sigh breaths, when

the ventilator may apply inspiratory pres-

sures 3 cmH2O below the high Pressure

alarm limit.

Each breath interval includes mandatory

time (Tmand) and spontaneous time

(Tspont).

• If the patient triggers a breath during

Tmand, the ventilator immediately

delivers a mandatory breath.

• If the patient triggers a breath during

Tspont, the ventilator delivers a sponta-

neous pressure-supported breath.

⁴⁴ TI max is only available for adult/pediatric patients if it is enabled in Configuration (Section 13.4.4). It is always available for

neonates.

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HAMILTON-T1. Operator's Manual (2022) - page 3