Content      ..     2      3      4      5     ..

HAMILTON-T1. Operator's Manual (2022) - page 4

7 Ventilation modes

Figure 7-4. PCV+ mode: Breathing pattern and

7.3 Pressure-controlled modes

controls

The following modes are pressure-control-

Insp

Exp

led:

• PCV+

• PSIMV+

• PSIMV+ with PSync

Time

• DuoPAP

• APRV

• SPONT

Time

7.3.1 PCV+ mode

PCV+ stands for pressure-controlled venti-

lation.

Breaths in PCV+ mode are pressure

Time

controlled and mandatory.

The ventilator delivers a constant level of

Ventilator controls

pressure, so the volume depends on the

pressure settings, the inspiration time, and

CO2 elimination

the resistance and compliance of the

1

ΔPcontrol

2

Rate

patient’s lungs.

Sigh (not shown)

In PCV+ mode, parameters are set only for

Oxygenation

mandatory breaths.

3

PEEP

4

I:E⁴⁶

• The pressure control (ΔPcontrol) setting

Oxygen (not shown)

defines the applied pressure above

Patient synchronization

PEEP.

5

Trigger

6

P-ramp

• Rate and I:E define the timing of the

breath cycle.

• The P-ramp setting controls the speed

with which the ventilator arrives at the

desired pressure.

This mode is available for use with a

speaking valve.

⁴⁶ Depending on the selected breath timing philosophy.

132

English | 10103179/02 USA

PSIMV+ mode

7

7.3.2 PSIMV+ mode

• ETS affects the inspiratory timing of the

supported breaths.

PSIMV+ stands for pressure-controlled

The inspiratory time can also be limited

synchronized intermittent mandatory

by TI max.⁴⁷

ventilation.

This mode is available for use with a

PSIMV+ mode has two options: with and

speaking valve.

without PSync. For a description of PSIMV+

with active PSync, see Section 7.3.3.

Figure 7-5. PSIMV+ mode: Breathing pattern

and controls

In PSIMV+ mode, the mandatory breaths

Insp

Exp

are PCV+ breaths. These can be alternated

with spontaneous breaths.

Each SIMV breath interval includes manda-

tory time (Tmand) and spontaneous time

(Tspont).

Time

• 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-

Time

neous, pressure-supported breath.

• If the patient does not trigger a breath

during Tspont, the ventilator automati-

cally delivers a mandatory breath at the

end of Tmand.

Time

Tmand

Tspont

Tmand

Tspont

Tmand

In PSIMV+ mode, parameters for both

mandatory and spontaneous breath types

Ventilator controls

are set.

CO2 elimination

• For mandatory breaths, the pressure

1

ΔPcontrol

2

Rate

control (ΔPcontrol) setting defines the

Sigh (not shown)

applied pressure above PEEP.

Oxygenation

Rate and I:E define the timing of the

3

PEEP

5

ΔPsupport

breath cycle.

4

I:E⁴⁸

Oxygen (not

• For spontaneous breaths, ΔPsupport

shown)

defines the pressure support above

Patient synchronization

PEEP.

6

P-ramp

8

ETS

7

Trigger

⁴⁷ 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.

⁴⁸ Depending on the selected breath timing philosophy.

Hamilton Medical | HAMILTON-T1 Operator's Manual

133

7 Ventilation modes

7.3.3 PSIMV+ mode with PSync

Figure 7-6. PSIMV+ with PSync mode: Breathing

pattern and controls

PSIMV+ stands for pressure-controlled

Insp

Exp

synchronized intermittent mandatory

ventilation.

PSIMV+ mode has two options: with and

without PSync. For a description of PSIMV+

without active PSync, see Section 7.3.2.

Time

If the patient triggers a breath, the ventila-

tor delivers a breath supported at the

ΔPinsp setting.

If the patient does not trigger a breath,

the ventilator automatically delivers a

Time

mandatory breath at the ΔPinsp setting.

In PSIMV+ mode, parameters for both

mandatory and spontaneous breath types

are set.

Time

• The ΔPinsp setting defines the applied

pressure above PEEP for mandatory and

Ventilator controls

spontaneous breaths.

CO2 elimination

• Rate and TI define the breath timing for

1

ΔPinsp

2

Rate

mandatory breaths.

Sigh (not shown)

• For spontaneous breaths, ETS affects

Oxygenation

the inspiratory timing of the supported

3

PEEP

4

I:E⁵⁰

breaths.

Oxygen (not shown)

The inspiratory time can also be limited

Patient synchronization

by TI max.⁴⁹

5

P-ramp

7

ETS

6

Trigger

⁴⁹ 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.

⁵⁰ Depending on the selected breath timing philosophy.

134

English | 10103179/02 USA

DuoPAP mode

7

7.3.4 DuoPAP mode

ΔPsupport is set relative to (above) PEEP/

CPAP, which means that spontaneous

DuoPAP stands for duo positive airway

breaths at the P high level are supported

pressure.

only when this target pressure is greater

than P high.

DuoPAP is a type of pressure ventilation

designed to support spontaneous breath-

Figure 7-7. DuoPAP mode: Breathing pattern

ing on two alternating levels of CPAP.

and controls

Insp

Exp

In this mode, the ventilator switches auto-

matically and regularly between two oper-

ator-selected levels of positive airway pres-

sure or CPAP.

Cycling between the levels is triggered by

DuoPAP timing settings or by patient

Time

effort.

In DuoPAP, the switch-over⁵¹ between the

two levels is defined by the pressure

settings, P high and PEEP/CPAP, and the

Time

time settings, T high and Rate.

Note the following:

• At conventional settings and in the

absence of spontaneous breathing,

DuoPAP resembles PCV+.

Time

• As you decrease the rate, keeping

T high short relative to the time at the

Ventilator controls

lower pressure level, the mode looks

CO2 elimination

more like PSIMV+, with spontaneous

breaths following mandatory breaths.

1

P high

3

Rate

2

T high

• If T high is set to almost the breath

cycle time with just enough time at the

Oxygenation

low level to allow full or near-full exha-

4

PEEP/CPAP

5

ΔPsupport

lation, this mode looks like APRV

Oxygen (not shown)

(Section 7.3.5).

Patient synchronization

Pressure support can be set to assist spon-

6

P-ramp⁵²

8

ETS

taneous breaths in DuoPAP, whether they

7

Trigger

occur at the PEEP/CPAP or P high level.

⁵¹ The switch-over from PEEP/CPAP to P high is synchronized to the patient's efforts in the Synchronization window.

⁵² Pressure rise time to P high and ΔPsupport.

Hamilton Medical | HAMILTON-T1 Operator's Manual

135

7 Ventilation modes

7.3.5 APRV mode

Figure 7-8. APRV mode: Breathing pattern and

controls

APRV stands for airway pressure release

Insp

Exp

ventilation.

Set airway pressure P high is transiently

released to a lower level P low, after which

it is quickly restored to reinflate the lungs.

For a patient who has no spontaneous

Time

breathing efforts, APRV is similar to pres-

sure-controlled inverse ratio ventilation.

APRV allows spontaneous breathing at any

time during the respiratory cycle.

Time

APRV is an independent mode. When

changing modes, the pressure and timing

settings from any other mode are not

transferred to APRV, and vice versa.

When switching to APRV for the first time,

Time

the initial timing and pressure settings

proposed are based on IBW (Weight for

Ventilator controls

neonatal patients) as shown in the follow-

CO2 elimination

ing table.

1

P low

2

T low

Table 7-2. Default settings for APRV

Oxygenation

3

P high⁵³

4

T high

IBW /

P high / P

T high T low

5

ΔPsupport

Oxygen (not

Weight

low

(s)

(s)

(kg)

(cmH2O)

shown)

Patient synchronization

0.2 to

20 / 5

1.4

0.2

2.99

6

P-ramp (to P high)

7

Trigger⁵⁴

3 to 5.9

20 / 5

1.7

0.3

6 to 8.9

20 / 5

2.1

0.3

9 to 20.9

20 / 5

2.6

0.4

21 to 39

20 / 5

3.5

0.5

40 to 59

20 / 5

4.4

0.6

> 60

20 / 5

5.4

0.6

⁵³ With prolonged T high settings and short T low settings, the P high setting in effect becomes the PEEP level.

⁵⁴ Only used to count spontaneous breaths or to monitor patient activity.

136

English | 10103179/02 USA

SPONT mode

7

7.3.6 SPONT mode

Figure 7-9. SPONT mode: Breathing pattern and

controls

SPONT stands for spontaneous mode.

SPONT delivers spontaneous breaths and

operator-initiated manual, mandatory

breaths.

When pressure support is set to zero, the

ventilator functions like a conventional

Time

CPAP system.

• The pressure support (ΔPsupport)

setting defines the applied pressure

during inspiration.

Time

• The PEEP setting defines the PEEP

applied during expiration.

• ETS affects the inspiratory timing of the

supported breaths.

The inspiratory time can also be limited

Time

by TI max.⁵⁵

Ventilator controls

This mode is available for use with a

CO2 elimination

speaking valve.

1

ΔPsupport

Sigh (not shown)

Oxygenation

2

PEEP

Oxygen (not shown)

Patient synchronization

3

Trigger

5

ETS

4

P-ramp

⁵⁵ 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.

Hamilton Medical | HAMILTON-T1 Operator's Manual

137

7 Ventilation modes

Figure 7-10. ASV mode: Breathing pattern and

7.4 Intelligent Ventilation

controls

ASV^® is a volume-controlled Intelligent

Insp

Exp

Ventilation mode.

ASV is not available for neonatal patients.

7.4.1 ASV mode

Time

ASV stands for Adaptive Support Ventila-

tion^®.

ASV maintains an operator-preset, mini-

mum minute ventilation independent of

Time

the patient‘s breathing activity.

The target breathing pattern (tidal volume

and respiratory rate) is calculated by the

ventilator, based on the assumption that

the optimal breathing pattern results in

Time

the least work of breathing, and the mini-

mal force of breathing (driving pressure).

Ventilator controls

For initial settings, see Table 7-3.

CO2 elimination

ASV adjusts inspiratory pressure and

1

Plimit

Sigh (not shown)

mandatory rate on a breath-by-breath

%MinVol (not shown)

basis taking into account the changing

Oxygenation

patient lung mechanics (resistance, com-

pliance, RCexp) and applying lung-protec-

2

PEEP/CPAP

Oxygen (not shown)

tive strategies to meet the targets.

Patient synchronization

3

P-ramp

5

ETS

A decrease in pressure limitation (Plimit)

will follow with a decrease in tidal volume

4

Trigger

(Vt) and an increase in Rate.

138

English | 10103179/02 USA

ASV mode

7

ASV maintains a preset minimum minute

• Prevents AutoPEEP

ventilation:

• Prevents dead space ventilation

• Automatically adjusts for changing

• Does not exceed a ΔPinsp pressure of

patient conditions between active and

10 cmH2O below the upper pressure

passive states

limit

• Mandatory breaths are pressure

controlled

The operator sets the %MinVol, PEEP, and

Oxygen.

• Spontaneous breaths are pressure sup-

ported

For details about working with ASV, see

Section 7.8.

• Prevents tachypnea

Table 7-3. ASV mode initial breath pattern settings

Patient group

IBW (kg)

ΔPinsp

TI (s)

Initial rate (b/

(cmH2O)

min)

Pediatric

3 to 5

15

0.4

30

6 to 8

15

0.6

25

9 to 11

15

0.6

25

12 to 14

15

0.7

20

15 to 20

15

0.8

20

21 to 23

15

0.9

20

24 to 29

15

1

20

> 30

15

1

20

Adult

10 to 29

15

1

20

30 to 39

15

1

18

40 to 59

15

1

15

60 to 89

15

1

15

90 to 99

18

1.5

15

> 100

20

1.5

15

Hamilton Medical | HAMILTON-T1 Operator's Manual

139

NIV mode

7

7.5.1 NIV mode

Figure 7-11. NIV mode: Breathing pattern and

controls

NIV stands for noninvasive ventilation.

NIV mode delivers spontaneous breaths.

NIV is designed for use with a mask or

other noninvasive patient interface.

When pressure support is set to zero, the

Time

ventilator functions like a conventional

CPAP system.

• The pressure support (ΔPsupport)

setting defines the applied pressure

during inspiration.

Time

• ETS affects the inspiratory timing of the

supported breaths.

The inspiratory time can also be limited

by TI max.

Time

• The PEEP setting defines the PEEP

applied during expiration.

Ventilator controls

CO2 elimination

For additional details about working with

1

ΔPsupport

Sigh (not shown)

noninvasive modes, see Section 7.7.

Oxygenation

2

PEEP

Oxygen (not shown)

Patient synchronization

3

Trigger

5

ETS

4

P-ramp

6

TI max

Hamilton Medical | HAMILTON-T1 Operator's Manual

141

7 Ventilation modes

7.5.2 NIV-ST mode

Figure 7-12. NIV-ST mode: Breathing pattern

and controls

NIV-ST stands for spontaneous/timed

noninvasive ventilation.

NIV-ST mode delivers time-cycled or flow-

cycled breaths. Every patient trigger results

in a flow-cycled, pressure-supported

breath.

Time

If the rate of patient-triggered breaths falls

below the set mandatory Rate, time-cycled

breaths are delivered at the set Rate and

timing.

Time

If the patient triggers a breath during the

breath interval, the ventilator immediately

delivers a spontaneous breath. If the

patient does not trigger an inspiration

during this time, the ventilator initiates a

mandatory breath according to the set

Time

Rate.

Ventilator controls

This mode requires that you set the para-

CO2 elimination

meters needed for both mandatory and

1

Rate

Sigh (not shown)

spontaneous breath types.

Oxygenation

• The inspiratory pressure setting, ΔPinsp,

2

PEEP

3

TI

defines the applied pressure for both

mandatory and spontaneous breaths.

Oxygen (not shown)

Patient synchronization

• The Rate and TI (inspiratory time)

4

ΔPinsp

7

ETS

control settings define the breath tim-

ing.

5

P-ramp

8

TI max

• For spontaneous breaths, the ETS

6

Trigger

setting affects the inspiratory timing of

the supported breaths.

The inspiratory time can also be limited

by TI max.

142

English | 10103179/02 USA

7 Ventilation modes

7.5.3.1 nCPAP mode

Figure 7-13. nCPAP mode: Breath pattern and

controls

nCPAP stands for nasal continuous positive

airway pressure.

This mode applies CPAP over a nasal inter-

face (mask or prongs). Leaks are compen-

Time

sated due to the set High Flow limit.

The nCPAP mode works with the following

parameters:

Time

• Control settings: PEEP/CPAP and

Oxygen

1

PEEP

3

Manual breath

key pressed

• Monitored parameters: Insp Flow and

2

Manual breath

4

Pressure limita-

Flow

tion

For details about the parameters and flow-

Oxygen (not

related alarms, see Sections 7.5.3, 5.10,

shown)

and 9.4.

When a manual breath is applied, the

pressure changes to PEEP + 5 cmH2O for a

period of 0.4 seconds, or so long as the

key is pressed, to a maximum of

15 seconds. When the manual breath is

completed, the pressure returns to the set

PEEP/CPAP level.

144

English | 10103179/02 USA

nCPAP-PC mode

7

7.5.3.2 nCPAP-PC mode

Figure 7-14. nCPAP-PC mode: Breathing pat-

tern and controls

nCPAP-PC stands for nasal continuous pos-

itive airway pressure - pressure control.

This mode delivers, in addition to the set

CPAP, intermittent, time-cycled, and pres-

sure-controlled breaths. This results in a

Time

biphasic breathing pattern.

The patient can also breathe freely at both

pressure levels. The inspiratory flow fol-

Time

lows the respiratory effort of the patient

on both pressure levels. Leaks are com-

pensated due to the set High Flow limit.

States

The following parameters are used in the

nCPAP-PC mode: Rate, ΔPcontrol, TI, P-

1

Rate

5

P-ramp

ramp, PEEP/CPAP, Oxygen

2

TI

6

Mandatory trigger

When a manual breath is applied, the

3

PEEP

7

Manual breath key

pressure changes to the ΔPcontrol setting

pressed

for the length of time set by the TI

4

ΔPcontrol

8

Pressure limitation

(inspiratory time) or so long as the key is

pressed, to a maximum of 15 seconds.

When the manual breath is completed,

the pressure returns to the set PEEP/CPAP

level.

For details about the parameters, see

Section 5.10.

Hamilton Medical | HAMILTON-T1 Operator's Manual

145

Clinical workflow with ASV

7

7.8.3 Clinical workflow with ASV

For technical specifications, see Section

15.10.

Figure 7-15 provides an overview of the

ASV clinical workflow.

Figure 7-15. Clinical use of ASV

Prepare ventilator for clinical use

Set controls as appropriate for patient

Set alarm limits appropriately

Ventilate patient for a period of time

NO

NO

Patient is stable*

NO

fSpont > fTarget +

fSpont = 0 AND

> 60 min

10b/min OR

PaCO2 < 45 mmHg?

(longer for hard-to-

PaCO2 > 45 mmHg?

wean patients)?

YES

YES

YES

Escalation

De-escalation

O2 < 40%

NO

%MinVol + 20%

%MinVol - 10%

AND

PEEP < 8 cmH2O

YES

Weaning

NO

ΔPinsp ≤ 10 cmH2O?

%MinVol - 10%

(limited to 25%)

* stable means fControl = 0 b/min AND

YES

PaCO2 ≤ 45 mmHg AND fSpont ~ fTarget

Consider extubation

Hamilton Medical | HAMILTON-T1 Operator's Manual

153

Monitoring ASV

7

Figure 7-16. Example of high %MinVol setting

Figure 7-17. ASV Graph panel

incompatible with the lung-protective rules

strategy

f (b/min)

7.8.6 Monitoring ASV

1

Patient symbol:

5

ΔPinsp: Inspira-

ASV interacts with the patient continu-

intersection of

tory pressure set

ously. Whenever the patient’s respiratory

current measured

by ventilator

mechanics change, ASV adjusts to this

tidal volume and

fControl: Machine

change. Whenever the patient’s breathing

rate

rate

activity changes, ASV adjusts the settings.

fSpont: Sponta-

The ASV graph, shown in Figure 7-17, pro-

neous breath rate

vides a real-time graphical view of the

2

Target point:

6

Minute volume

patient status relative to the set target. For

Intersection of

curve

details about the graph, see Section 8.4.3.

target tidal

For details on displaying the ASV graph and

volume and

ASV monitoring values, see Section 8.4.

target rate

3

Target minute

7

Current measured

To monitor progress over time, it is recom-

volume

point (in yellow)

mended that you plot trends for ΔPinsp,

and target value

fTotal, and fSpont. Review these trends,

(in green)

together with the %MinVol setting to gain

4

Safety frame

insight into the patient's ventilatory status.

Table 7-11 provides interpretations of typi-

cal ventilatory patterns.

Hamilton Medical | HAMILTON-T1 Operator's Manual

155

Functional overview

7

7.8.8 Functional overview

7.8.8.3 Targeted minute ventilation

The following sections provide a brief

Figure 7-19. MinVol = 7 l/min

overview of how ASV manages ventilation.

7.8.8.1 Normal minute ventilation

ASV defines normal minute ventilation

according to the graph in Figure 7-18.

Figure 7-18. Normal minute ventilation as a

function of ideal body weight (IBW)

f (b/min)

3 kg

5 kg

7.8.8.4 Lung-protective strategy

Not all combinations of Vt and f shown in

Figure 7-19 are safe for the patient. The

high tidal volumes will overdistend the

lungs, and the small tidal volumes cannot

IBW (kg)

produce alveolar ventilation at all.

Another risk lies in inadequate respiratory

7.8.8.2 Compensation for changes in

rates. High rates can lead to dynamic

apparatus dead space

hyperinflation or breath stacking, resulting

Dead space is calculated as 2.2 ml per kg.

in AutoPEEP. Low rates can lead to

This dead space is a nominal value that is

hypoventilation and apnea. Therefore, it is

valid, on average, for intubated patients

necessary to limit the number of possible

whose endotracheal tube is connected to

combinations of Vt and f.

the Y-piece of the ventilator by a standard

When limits are imposed on the possible

catheter mount.

combinations of Vt and f, ASV uses a dou-

ble strategy:

Changes in alveolar dead space due to

ventilation/perfusion mismatch must be

• The operator input for ASV determines

compensated using the %MinVol control.

the absolute boundaries.

If this dead space is altered by an artificial

• Internal calculations based on patient

airway configuration, such as the use of a

measurements further narrow the limits

heat and moisture exchanging filter

to counteract possible operator errors

(HMEF) or nonstandard tubing, modify the

and to follow changes of respiratory

%MinVol setting to take into account the

system mechanics.

added or removed dead space.

The effect of the strategy is shown in

Figure 7-20 and explained in the subse-

quent sections.

Hamilton Medical | HAMILTON-T1 Operator's Manual

157

7 Ventilation modes

Figure 7-20. Lung-protective rules strategy

7.8.8.5 Optimal breath pattern

Figure 7-21. Anatomy of the ASV target graph-

A

ics window

D

C

B

f (b/min)

A: High tidal volume limit

f (b/min)

The tidal volume applied by ASV is limited

(see A in Figure 7-20) by three operator

7.8.8.6 Initial breaths: How ASV starts

settings: high Pressure alarm limit, high Vt

alarm limit, and patient height.

How do you achieve the target values for

Note the following:

a given patient if you do not know

whether or not the patient can breathe

•

You must set the high Pressure limit

spontaneously? For this purpose, ASV uses

before connecting a patient to the

a predefined rate according to the calcu-

ventilator. The maximum pressure

lated IBW (Table 7-3).

applied in the ASV mode is 10 cmH2O

below the high Pressure alarm limit.

Patient-triggered breaths are pressure sup-

ported and flow cycled.

•

Additionally, the target volume is lim-

ited to 150% of the high Vt alarm limit,

If the patient does not trigger the breath,

and pressure support is limited such

the delivery of the breath is time cycled,

that the inspired volume does not

with a preset pressure.

exceed the high Vt alarm limit in

The following controls are operator-set

mechanical breaths for more than a

(manual):

few breaths.

• PEEP/CPAP

•

If you set the Pressure alarm limit to a

very high pressure, say 60 cmH2O, the

• Oxygen

target volume is limited by the second

• P-ramp

criterion: 15 ml/kg.

• ETS

•

Check the Vt high setting to make sure

the target minute ventilation can be

• Trigger type and sensitivity

reached in passive patients.

158

English | 10103179/02 USA

Approaching the target

7

The following controls are adjusted auto-

The patient symbol marks the actual mea-

matically by ASV, and cannot be adjusted

sured value for Vt and Rate.

by the operator:

To achieve the target, ASV uses the follow-

• Mandatory breath rate: to change total

ing strategy:

respiratory rate

• If actual Vt < target Vt, the inspiratory

• Inspiratory pressure level: to change

pressure is increased.

inspiratory volume

• If actual Vt > target Vt, the inspiratory

• Inspiratory time: to allow gas flow into

pressure is decreased.

the lungs

• If actual Vt = target Vt, the inspiratory

• Startup breath pattern

pressure is left unchanged.

• If actual rate < target rate, the fControl

To safely start ASV, you set the patient

rate is increased.

height and sex, which are then used to

calculate the IBW.

• If actual rate > target rate, the fControl

rate is decreased.

Upon starting ventilation, after some initial

test breaths are delivered, the resulting

• If actual rate = target rate, the fControl

rate and tidal volume are measured and

rate is left unchanged.

compared with the target values. ASV then

responds to the differences between the

As a result, the patient symbol in Figure

current and target tidal volumes, as well

7-22 moves toward the circle. The current

as the current and target rates.

Vt is calculated as the average of inspira-

tory and expiratory volumes. This defini-

tion compensates in parts for leaks in the

7.8.8.7 Approaching the target

breathing circuit, including the endotra-

Figure 7-22 shows a possible scenario

cheal tube.

after the initial test breaths. The current

breath pattern, which is plotted as the

7.8.8.8 Dynamic adjustment of lung

patient symbol, shows clear deviation

protection

from the target. ASV's task is to move the

patient symbol as close to the circle as

The operator preset values are not

possible.

changed by ASV, and the corresponding

safety limits remain as defined in the pre-

Figure 7-22. Example after three initial breaths

vious sections. However, if the respiratory

system mechanics change, the safety limits

change accordingly, as defined in Section

7.8.8.4. The safety limits are updated on a

breath-by-breath basis.

For example, if the lungs stiffen, the high

Vt limit is lowered proportionally, and the

high rate limit is increased.

f (b/min)

Hamilton Medical | HAMILTON-T1 Operator's Manual

159

7 Ventilation modes

This dynamic adjustment ensures that ASV

applies a safe breathing pattern at all

times. In graphical terms, the dotted rec-

tangle changes as shown in Figure 7-23.

Figure 7-23. Lung-protective limits

f (b/min)

Lung-protective limits are changed dynam-

ically and according to the respiratory

system mechanics.

However, the limits set by the operator are

never violated.

7.8.8.9 Dynamic adjustment of optimal

breath pattern

After it is calculated, the optimal breath

pattern is revised with each breath accord-

ing to the RCexp measurements. A new

target breathing pattern is calculated

using ASV algorithms. The targets do not

change under steady-state conditions.

However, if the patient‘s respiratory

system mechanics change, the target

values also change.

160

English | 10103179/02 USA

8 Monitoring ventilation

8.1 Overview

8.2 Viewing numeric patient

data

You can configure how to view patient

data during ventilation, including viewing

Numeric patient data is readily available as

data numerically and graphically in a com-

follows:

bination of waveforms, loops, trends, and

• The main display prominently shows

Intelligent Panel graphics to suit your insti-

the configured main monitoring para-

tution’s needs (Figure 8-1).

meters (MMPs). See Section 8.2.1.

Data is also available in the Monitoring

• The Monitoring window provides access

window, which you can access at any time

to all of the parameter data. See

without affecting breath delivery.

Section 8.2.2.

For the list of monitored parameters, see

Section 8.5.

8.2.1 About the main monitoring

parameters (MMP)

Figure 8-1. Main display

The MMPs are the numerical monitoring

parameters shown on the left side of the

display. Every displayed parameter shows

the following elements: the current value,

name, and unit of the monitoring para-

meter.

The MMPs that are displayed, as well as

their sequence on the display, can be

changed in Configuration (Section 13.5).

Any of the monitored parameters can be

displayed as an MMP. As a result, MMPs

may differ between individual ventilators.

An MMP is normally displayed in white.

When directly related to an active alarm,

1

Current mode

3

Main monitoring

the MMP is shown in yellow or red, corre-

parameters

sponding to the alarm priority. In addition,

(MMP) (Section

a colored bar appears to the right of the

8.2.1)

affected MMP (Figure 8-2). After the

alarm resets, the affected MMP returns to

2

Pressure/time

4

Graphic display,

white and the bar is removed.

waveform, con-

configurable

figurable (Section

(Section 8.3)

8.3.2)

162

English | 10103179/02 USA

Viewing patient data in the Monitoring window

8

Figure 8-2. MMP components

Figure 8-3. Monitoring > General window

1

Monitoring

4

Parameter values

2

General

5

CO2 and SpO2

(if enabled)

3

1, 2, 3 tabs

1

MMP value

3

Parameter associ-

ated with an

8.3 Viewing graphical patient

active alarm

data

2

Parameter name/

4

Measured SpO2

units

value^*

The HAMILTON-T1 can show waveforms,

as well as graphic and Intelligent panels

* If SpO2 sensor is enabled and connected

on the lower portion of the display.

The following table shows the options for

8.2.2 Viewing patient data in the

each graphic type.

Monitoring window

The Monitoring window provides access to

monitored parameter data as follows:

• The General tab (Figure 8-3) provides

access to ventilation parameter values.

• When enabled, the CO2 and SpO2 tabs

provide access to CO2- and SpO2-rela-

ted data, respectively.

Hamilton Medical | HAMILTON-T1 Operator's Manual

163

8 Monitoring ventilation

Table 8-1. Graphical view options

2. Touch the desired option to select it,

or touch a tab (Trends, Loops, Graph-

Graphic type/Options

ics, Waveforms) to access additional

options.

Waveforms (data values plotted against time)

• Pressure

• PCO2⁵⁶

After making a selection, the window

closes automatically, and the display

• Flow

• FCO2⁵⁶

adjusts to the new selection.

• Volume

• Plethysmogram⁵⁷

Figure 8-4. Selected panel outlined in yellow

• Off

Graphics (Intelligent panels)

• Dynamic Lung⁵⁸

• ASV Graph⁵⁹

• Vent Status

Trends

1-, 6-, 12-, 24-, or 72-h⁶⁰ trend data for a

selected parameter or combination of para-

meters

Loops

• Pressure/Volume

• Volume/PCO2⁵⁶

Figure 8-5. Graphics selection window

• Pressure/Flow

• Volume/FCO2⁵⁶

• Volume/Flow

8.3.1 Selecting display options

You can change the graphics at any time.

To change the contents of a graphic panel

or waveform

1. Touch the area of the display to

change.

The selected panel is highlighted in

yellow (Figure 8-4).

The graphics selection window

1

Trends, Loops,

2

Available options

appears, displaying the current selec-

Graphics, Wave-

tion (Figure 8-5).

forms

⁵⁶ CO2 option required.

⁵⁷ SpO2 option required.

⁵⁸ Only for adult/pediatric patients.

⁵⁹ Only in ASV mode.

⁶⁰ 72-hour trend not available in all markets

164

English | 10103179/02 USA

Working with waveforms

8

8.3.2 Working with waveforms

8.3.2.3 Displaying waveforms

The ventilator can plot pressure, volume,

You select options in the Waveforms

and flow against time, in addition to other

window.

data as listed in Table 8-1.

Figure 8-7. Graphics selection > Waveforms

The waveforms provide an ongoing real-

window

time graphical view of the selected para-

meters over multiple breaths. As a result,

they also provide a way to assess the

numerical monitored parameter values.

8.3.2.1 Waveform views

You can show up to three waveforms on

the display. For details, see Section

8.3.2.3.

8.3.2.2 About the Pressure/time (Paw)

graph

1

Waveforms

3

Available options

The blue pressure limit line shows the

maximum pressure that the ventilator will

2

Time scale

apply, which you can set using the Plimit

control. The high Pressure alarm limit is

To select a waveform

shown as a red line. The high Pressure

alarm limit is always 10 cmH2O greater

1. Touch the area of the display where

than Plimit.

you wish to show a waveform or

touch the waveform to change

Figure 8-6. Pressure/time graph

(Section 8.3.1).

The graphics selection window

appears (Figure 8-5).

2. If needed, touch the Waveforms tab.

3. If needed, change the time scale to

apply to all waveforms.

4. Touch the waveform type to display.

To leave the area blank, touch Off.

You must display at least one wave-

1

High Pressure

3

Patient trigger

form in the top portion of the display.

alarm limit

indicator

Once the selection is made, the

2

Plimit

4

Airway pressure

window closes and the selected wave-

(Paw) waveform

form is displayed.

Hamilton Medical | HAMILTON-T1 Operator's Manual

165

8 Monitoring ventilation

Figure 8-8. Waveform display

8.3.2.5 Freezing and reviewing waveforms

and trends

You can temporarily freeze the display of

waveforms and trends. After 30 seconds

of inactivity, they are automatically

unfrozen.

When Freeze is enabled, any displayed

waveforms and trend graphs are frozen,

allowing you to scroll through them for a

detailed review. The Freeze function is

time-synced across the displayed graphs.

Note that when Freeze is enabled, all of

8.3.2.4 Changing the waveform time scale

the elements on the display are unavail-

able.

Scaling refers to the values of the x- and y-

axis of a waveform or a loop. In the wave-

Figure 8-9. Freezing waveforms

forms displayed on the ventilator, the x-

axis represents time, while the y-axis can

represent a variety of parameters, includ-

ing pressure, flow, or volume.

You can set the time scale (x-axis values)

of the waveforms; your selection applies

to all displayed waveforms.

A scale value refers to the length of the

x-axis. For example, a scale value of 24

means that the x-axis displays the wave-

form from 0 to 24 seconds.

The HAMILTON-T1 offers the following

time scale options, in seconds:

• Adult/Ped: 6, 12, 18, 24, 30

• Neonatal: 3, 6, 12, 18, 24

To change the time scale

1

Freeze button

3

Cursor

4 In the Waveforms window, touch the

2

Time at cursor

4

Value at cursor

Time scale arrow (Figure 8-7) and

(same color as the

select the time scale to use.

waveform)

Your selection applies to all displayed

waveforms.

166

English | 10103179/02 USA

Working with Trend graphs

8

To freeze waveforms and trends

For details on freezing a trend, see the

previous section.

1. Touch the Freeze button (1 in Figure

8-9).

Most monitoring parameters can be

Any displayed waveforms and Trend

trended. The following parameters are

graphs are frozen, and cursor bars are

trended in combination: Ppeak/PEEP,

displayed.

ExpMinVol/MVSpont, fTotal/fControl,

VDaw/VTE, VTE/Vtalv, and SpO2/Oxygen

2. To scroll through the graphics for

analysis, turn the P&T knob clockwise

and SpO2/FiO2 (if supported on your

or counter-clockwise.

device).

The cursor bars move to the right and

Figure 8-10. Trend panel

to the left.

3. To unfreeze the display, touch the

Freeze button again or press the P&T

knob.

The display returns to displaying real-time

data and all of the elements on the display

are available.

8.3.3 Working with Trend graphs

Trend data includes all data since the

ventilator was turned on for a selected

parameter for the past 1, 6, 12, 24, or

72 hours.

1

Trend graph

3

Elapsed time rela-

From the time the ventilator is turned on,

tive to present

it continuously stores up to 72 hours of

2

Current time

monitored parameter data in its memory,

including when in Standby. This data is

deleted upon setting up a new patient.

You can also freeze trend graphs and

examine them more closely. When trends

are frozen, the panel shows the time and

the corresponding value of the monitored

parameter. For details on using

(Freeze) to freeze trends, see Section

8.3.2.5.

Hamilton Medical | HAMILTON-T1 Operator's Manual

167

8 Monitoring ventilation

8.3.3.1 Displaying trends

8.3.4 Working with loops

Figure 8-11. Graphics selection > Trends

The HAMILTON-T1 can display a dynamic

window

loop based on the parameter combina-

tions listed in Table 8-1.

Figure 8-12. Loops panel, Pressure/Volume loop

displayed

1

Trends

3

Trend time, in

hours

2

Parameter list

4

Confirm

To display trends

1. Touch the graphics area at the bottom

1

Stored reference

4

Plimit (high Pres-

half of the display (Section 8.3.1).

loop

sure alarm limit -

2. In the graphics selection window,

10 cmH2O)^*

touch the Trends tab (Figure 8-11).

2

Current loop

5

High Pressure

3. Select the parameter(s) to trend.

alarm limit^*

3

Loop reference

6

Key parameters

4. Touch the desired trend time.

button

5. Touch Confirm.

^* Displayed if applicable

The selected trend information is displayed

(Figure 8-10).

168

English | 10103179/02 USA

Displaying loops

8

8.3.4.1 Displaying loops

The previous and current characteristics

are shown. Any previously stored loop is

Figure 8-13. Graphics selection > Loops window

discarded.

8.4 Working with Intelligent

panels

You can show any of the following Intelli-

gent panels on the ventilator display:

• Dynamic Lung

• Vent Status

• ASV Graph

The Intelligent panels are all displayed

using the graphics selection window

1

Loops

2

Parameter

Graphics tab.

options

8.4.1 Dynamic Lung panel: real-time

To display loops

ventilation status

1. Touch the graphics area at the bottom

The Dynamic Lung⁶¹ shows an up-to-date

half of the display (Section 8.3.1).

visual representation of key ventilation

2. In the graphics selection window,

data (Figure 8-14). It visualizes tidal

touch the Loops tab.

volume, lung compliance, patient trigger-

3. Touch the parameter combination to

ing, and resistance in real-time.

display.

In addition to the graphic representation,

The selected combination is displayed

the panel shows numeric data for key

(Figure 8-12).

parameters. If all values are in a normal

range, the panel is framed in green.

8.3.4.2 Storing loops

The Dynamic Lung comprises the following

components:

You can store a loop to use as a reference,

for comparison purposes.

• Mechanical breath

• Respiratory compliance

To store a new loop

• Airway resistance

4 In the Loop display (Figure 8-12),

touch

(Loop reference) to store

• Patient triggering

the loop curve with the current date

• SpO2 data (if installed and enabled)

and time.

⁶¹ Only for adult/pediatric patients.

Hamilton Medical | HAMILTON-T1 Operator's Manual

169

8 Monitoring ventilation

Figure 8-14. Dynamic Lung panel

Respiratory compliance

Respiratory compliance is a measure of the

lung's ability to stretch and expand. Com-

Male

pliance is illustrated by the contour lines of

174 cm

IBW: 70 kg

the lung, as shown in Figure 8-15. The

static measurement is provided with the

Cstat parameter.

PVI

---

Figure 8-15. Examples of lung compliance

%

(Cstat) illustrated in Dynamic Lung

Rinsp

Cstat

PetCO2

SpO2

Pulse

10

36.2

43

93

80

cmH2O/l/s

ml/cmH2O

mmHg

%

1/min

1

Sex, height, IBW

5

Representation of

breaths and tidal

volume

2

Representation of

6

Patient trigger

lung compliance

(diaphragm)

3

Representation of

7

Heart and pulse

airway resistance

display^*

4

Monitored parameter values

^* If SpO2 sensor enabled and connected.

Mechanical breaths, with tidal volume

The mechanical breath is shown as a set

of lungs that expand and contract in syn-

1

Very low compli-

3

Normal compli-

chrony with ventilator breath delivery,

ance

ance

showing the delivered tidal volume (Vt) in

real-time. The lung size displayed is rela-

2

Low compliance

4

High compliance

tive to the “normal” size for the patient’s

height.

Airway resistance

A Disconnection alarm is indicated by a

Airway resistance refers to the total resis-

deflated lung. An Exhalation obstructed

tance imposed by the patient’s airway as

alarm is indicated by an over-inflated lung.

well as the artificial airway, such as an

endotracheal tube or tracheostomy tube.

The movement and shape of the lungs

Airway resistance is illustrated by the size

allow you to quickly verify that the ventila-

and color of the tracheobronchial tree, as

tor is ventilating the patient.

shown in Figure 8-16. The resistance mea-

surement is provided with the Rinsp para-

meter.

170

English | 10103179/02 USA

Displaying the Dynamic Lung

8

Figure 8-16. Examples of resistance shown by

SpO2 data

the bronchial tree of the Dynamic Lung

If the SpO2 option is enabled and a sensor

is connected, the Dynamic Lung panel

shows a heart and big vessel illustration

superimposed on the lungs. The heart

beats in synchrony with the patient's pulse

rate.

For details about SpO2 measurement, see

the Pulse Oximetry Instructions for Use.

8.4.1.1 Displaying the Dynamic Lung

To display the Dynamic Lung

1

Resistance

3

Moderate

1. Touch the graphics area at the bottom

information is

resistance

half of the display (Section 8.3.1).

unavailable

2. In the graphics selection window,

2

Normal resistance

4

High resistance

touch the Graphics tab (Figure 8-5).

3. Touch Dynamic Lung.

Patient trigger

The Dynamic Lung panel is displayed

If a patient trigger is detected, an illustra-

(Figure 8-18).

tion of the diaphragmatic muscle appears

Figure 8-18. Dynamic Lung in display

briefly at the beginning of inspiration, as

shown in Figure 8-17. This allows you to

quickly see whether the breath is patient

triggered.

Figure 8-17. Patient triggering (1) in Dynamic

Lung

Male

174 cm

IBW: 70 kg

PVI

---

%

Rinsp

Cstat

PetCO2

SpO2

Pulse

10

36.2

43

93

80

cmH2O/l/s ml/cmH2O

mmHg

%

1/min

Hamilton Medical | HAMILTON-T1 Operator's Manual

171

8 Monitoring ventilation

8.4.2 Vent Status panel: real-time

Figure 8-19. Vent Status panel

ventilator dependence status

The Vent Status panel (Figure 8-19)

displays six parameters related to the

patient’s ventilator dependence, in the

areas of oxygenation, CO2 elimination,

and patient activity.

A floating indicator moving up and down

within the column shows the value for a

given parameter.

When the indicator is in the white (wean-

ing) zone, a timer starts, showing how

long that value has been in the weaning

zone. When all values are in the weaning

zone, the Vent Status panel is framed in

green, indicating that weaning should be

considered. A timer appears, recording the

length of time all values have been in the

1

Group title

5

Monitored value,

weaning zone (Figure 8-19).

numeric

2

Monitored value,

6

Green outline

The panel is updated breath by breath.

graphic (floater)

indicating all

Table 8-2 describes the parameters shown

values are in the

in the Vent Status panel.

weaning zone

3

Elapsed time

7

Elapsed time all

You can configure the weaning zone

value has been in

values have been

ranges for these parameters in Configura-

weaning zone

in weaning zone

tion. To set the values, see Section 13.6.1.

4

Weaning zone

with user-config-

urable limits

172

English | 10103179/02 USA

Displaying the Vent Status panel

8

Table 8-2. Vent Status parameters

8.4.3 ASV Graph panel: real-time

patient condition and targets

Parameter

Definition

(unit)

Available in ASV⁶³ mode, the ASV Graph

shows how the adaptive lung controller

For additional details, including ranges and

moves toward its targets. The graph

accuracy, see Table 15-9.

shows both the target and real-time

Oxygen (%)

Oxygen setting.

patient data for tidal volume, frequency,

pressure, and minute ventilation.

PEEP (cmH2O)

PEEP/CPAP setting.

Figure 7-17 in Chapter 7 describes the

MinVol (l/min)

Normal minute ventilation

graph in detail.

(see Section 7.8).

ΔPinsp (cmH2O)

Inspiratory pressure, the

8.4.3.1 Displaying the ASV Graph

target pressure (additional

to PEEP/CPAP) applied

To display the ASV Graph

during the inspiratory

1. Touch the graphics area at the bottom

phase.

half of the display (Section 8.3.1).

RSB

Rapid shallow breathing

2. In the graphics selection window,

(1 / (l*min))⁶²

index. The total breathing

touch the Graphics tab (Figure 8-5).

frequency (fTotal) divided

3. Touch ASV Graph.

by the exhaled tidal

volume (VTE).

The ASV Graph is displayed (Figure 8-20).

%fSpont (%)

Spontaneous breath per-

Figure 8-20. ASV Graph panel (1)

centage. The moving

average of the percentage

of spontaneous breaths

over the last 10 total

breaths.

8.4.2.1 Displaying the Vent Status panel

To display the Vent Status panel

1. Touch the graphics area at the bottom

half of the display (Section 8.3.1).

2. In the graphics selection window,

touch the Graphics tab (Figure 8-5).

3. Touch Vent Status.

The Vent Status panel is displayed (Figure

8-19).

⁶² Weaning zone defaults are based on normal values < 100/(l*min) for adult patients. Default values can be changed in Configuration.

⁶³ Only for adult/pediatric patients.

Hamilton Medical | HAMILTON-T1 Operator's Manual

173

Content      ..     2      3      4      5     ..