HAMILTON-T1. Operator's Manual (2022)

8 Monitoring ventilation

8.5 About the monitored para-

meters

The following table provides a list of the

ventilator’s monitored parameters.

You can review all parameter values in the

Monitoring window (Section 8.2.2). The

display of monitored parameters is

updated every breath or is time driven.

See Section 15.7 for parameter specifi-

cations.

For details about SpO2-related parameters,

see the Pulse Oximetry Instructions for

use.

For a comparison of Hamilton Medical

ventilation-related terminology with ISO

19223:2019, see Section 15.5.

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About the monitored parameters

Table 8-3. Monitored parameters

Parameter (unit)

Definition

Pressure

AutoPEEP

The difference between the set PEEP and the calculated total PEEP within

(cmH2O)

the lungs.

AutoPEEP is the abnormal pressure generated by air “trapped” in the alve-

oli due to inadequate lung emptying. Ideally, it should be zero. AutoPEEP is

calculated using the LSF method applied to the entire breath.

Actively breathing patients can create artifacts or noise, which can affect

the accuracy of these measurements.

When AutoPEEP is present, volutrauma or barotrauma might develop. In

active patients, AutoPEEP may present an extra workload to the patient.

AutoPEEP or air trapping may result from an expiratory phase that is too

short, which may be observed under the following conditions:

• Delivered tidal volume too large

• Expiratory time too short or respiratory rate too high

• Circuit impedance too high or expiratory airway obstruction

• Peak expiratory flow too low

AutoPEEP is also referred to as intrinsic PEEP.

Driving pressure,

A calculated value showing the ratio of tidal volume to static compliance,

ΔP

which reflects the difference between Pplateau and PEEP.

(cmH2O)

PEEP/CPAP

Monitored PEEP/CPAP. The airway pressure at the end of exhalation.

(cmH2O)

Measured PEEP/CPAP may differ slightly from the set PEEP/CPAP, especially

in spontaneously breathing patients.

ΔPinsp

Inspiratory pressure, the automatically calculated target pressure (additional

(cmH2O)

to PEEP) applied during the inspiratory phase.

Also displayed in the Vent Status panel.

Not all modes use the ΔPinsp parameter. Rather, this target pressure is set

using the following parameters, depending on the selected mode:

• APVcmv, APVsimv, ASV: Automatically calculated target pressure

• PCV+: ΔPcontrol setting

• PSIMV+, NIV-ST: ΔPinsp setting

• SPONT, NIV: ΔPsupport setting

• APRV, DuoPAP: P high setting

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8 Monitoring ventilation

Parameter (unit)

Definition

Pmean

Mean airway pressure. The absolute pressure, averaged over the breath

(cmH2O)

cycle.

Pmean is an important indicator of the possible impact of applied positive

pressure on hemodynamics and surrounding organs.

Ppeak

Peak airway pressure. The highest pressure during the previous breath

(cmH2O)

cycle.

It is influenced by airway resistance and compliance. Ppeak may differ

noticeably from alveolar pressure if airway resistance is high. This value is

always displayed.

Pplateau

Plateau or end-inspiratory pressure. The pressure measured at the end of

(cmH2O)

inspiration when flow is at or close to zero.

Used as a rough representation of alveolar pressure. Pplateau is displayed

for mandatory and time-cycled breaths.

Pprox

The airway pressure at the proximal patient interface.

(cmH2O)

Displayed only in HiFlowO2 when a flow sensor is connected.

Flow

Exp Flow

Peak expiratory flow.

(l/min)

Flow

The flow of gas to the patient in HiFlowO2.

(in HiFlowO2)

(l/min)

Flow (in nCPAP/

Only active in nCPAP and nCPAP-PC modes.

nCPAP-PC)

Displays the current flow as follows:

(l/min)

• In nCPAP mode, this value is the average flow, updated every second.

• In nCPAP-PC mode, this value is the average flow during expiration,

updated every breath.

Displayed in the Monitoring window.

Flow is affected by the setting of the Flow alarm. See Chapter 9.

Insp Flow

Peak inspiratory flow, spontaneous or mandatory. Measured every breath.

(l/min)

⁶⁴ Only displayed as an MMP; not displayed in the Monitoring window.

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About the monitored parameters

Parameter (unit)

Definition

Volume

ExpMinVol

Expiratory minute volume. The moving average of the monitored expiratory

MinVol NIV

volume per minute over the last 8 breaths. ExpMinVol changes to MinVol

(l/min)

NIV in noninvasive modes. MinVol NIV is an adjusted parameter taking leak-

age into account.

MVSpont

Spontaneous expiratory minute volume.

MVSpont NIV

The moving average of the monitored expiratory volume per minute for

(l/min)

spontaneous breaths, over the last 8 mandatory and spontaneous breaths.

In noninvasive ventilation modes, MVSpont is replaced by MVSpont NIV.

MVSpont NIV is an adjusted parameter taking leakage into account.

VLeak

Due to the leakage at the patient interface, displayed exhaled volumes in

(%)

the noninvasive modes can be substantially smaller than the delivered

MVLeak

volumes.

(l/min)

The flow sensor measures the delivered volume and the exhaled tidal

volume; the ventilator displays the difference as VLeak in % and as MVLeak

in l/min, averaged over the past 8 breaths.

VLeak/MVLeak can indicate leaks on the patient side of the flow sensor.

They do not include leakage between the ventilator and the flow sensor.

Use VLeak and MVLeak to assess the fit of the mask or other noninvasive

patient interface.

VTE

Expiratory tidal volume, the volume exhaled by the patient.

VTE NIV

It is determined from the flow sensor measurement, so it does not show

(ml)

any volume added due to compression or lost due to leaks in the breathing

circuit.

If there is a gas leak on the patient side, the displayed VTE may be less than

the tidal volume the patient actually receives.

In noninvasive ventilation modes, VTE is replaced by VTE NIV. VTE NIV is an

adjusted parameter taking leakage into account

VTESpont

Spontaneous expiratory tidal volume, the volume exhaled by the patient.

(ml)

If there is a gas leak on the patient side, the displayed VTESpont may be

less than the tidal volume the patient actually receives.

Only displayed for spontaneous breaths.

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8 Monitoring ventilation

Parameter (unit)

Definition

VTI

Inspiratory tidal volume, the volume delivered to the patient, determined

(ml)

from the flow sensor measurement.

If there is a gas leak on the patient side, the displayed VTI may be larger

than the displayed VTE.

Vt/IBW

Tidal volume is calculated according to ideal body weight (IBW) for adult/

Vt/Weight

pediatric patients and according to the actual body weight for neonatal

(kg)

patients.

Time

fControl

Mandatory breath frequency. The moving average of machine-delivered

(b/min)

breaths per minute over the last 8 total breaths.

fSpont

Spontaneous breath frequency.

(b/min)

The moving average of spontaneous breaths per minute over the last 8

total breaths.

fTotal

Total breathing frequency.

(b/min)

The moving average of the patient’s total breathing frequency over the last

8 breaths, including both mandatory and spontaneous breaths. When the

patient triggers a breath or the operator initiates a breath, fTotal may be

higher than the Rate setting.

I:E

Inspiratory:expiratory ratio.

Ratio of the patient’s inspiratory time to expiratory time for every breath

cycle. This includes both mandatory and spontaneous breaths. I:E may dif-

fer from the set I:E ratio if the patient breathes spontaneously.

Expiratory time.

(s)

In mandatory breaths, TE is measured from the start of exhalation until the

set time has elapsed for the switch to inspiration.

In spontaneous breaths, TE is measured from the start of exhalation, as dic-

tated by the ETS setting, until the patient triggers the next inspiration. TE

may differ from the set expiratory time if the patient breathes spontane-

ously.

Inspiratory time.

(s)

In mandatory breaths, TI is measured from the start of breath delivery until

the set time has elapsed for the switch to exhalation.

In spontaneous breaths, TI is measured from the patient trigger until the

flow falls to the ETS setting for the switch to exhalation. TI may differ from

the set inspiratory time if the patient breathes spontaneously.

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About the monitored parameters

Parameter (unit)

Definition

Other calculated and displayed parameters

CPR Timer

Displayed as an MMP during CPR ventilation, shows how long CPR ventila-

tion has been on. For details, see Section 10.9.

Cstat

Static compliance of the respiratory system, including lung and chest wall

(ml/cmH2O)

compliances, calculated using the LSF method. Cstat can help diagnose

changes in elastic characteristics of the patient’s lungs.

Actively breathing patients can create artifact or noise, which can affect the

accuracy of these measurements.

Oxygen

Oxygen concentration of the delivered gas. It is measured by an O2 sensor

(%)

in the inspiratory pneumatics.

This parameter is not displayed if the O2 sensor is not installed, is defective,

is not a genuine Hamilton Medical part, or if oxygen monitoring is disabled.

P0.1

Airway occlusion pressure. The pressure drop during the first 100 ms when

(cmH2O)

a breath is triggered. P0.1 indicates the patient’s respiratory drive and

patient inspiration effort.

P0.1 applies only to patient-triggered breaths.

A P0.1 value of -3 cmH2O indicates a strong inspiratory effort, and a value

of -5 cmH2O indicates an excessive effort, possibly because the patient is

“air hungry” (peak inspiratory flow or total ventilatory support is inade-

quate) or has an excessive drive.

If P0.1 is below -3 cmH2O:

• Increase pressure or volume settings (depending on mode)

• Increase %MinVol (ASV mode only)

• Shorten P-ramp

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8 Monitoring ventilation

Parameter (unit)

Definition

PTP

Inspiratory pressure time product.

(cmH2O*s)

The measured pressure drop required to trigger the breath multiplied by

the time interval until the PEEP/CPAP level is reached at the beginning of

inspiration.

PTP is valid for patient-initiated breaths only, and indicates work by the

patient to trigger the breath. The work depends on:

• The intensity of the patient’s effort

• The trigger sensitivity

• The volume and resistance of the breathing circuit

PTP does not indicate total patient work but is a good indicator of how

well the ventilator is adjusted for the patient.

If PTP values increase, do the following:

• Increase trigger sensitivity

• Decrease P-ramp

RCexp

Expiratory time constant. The rate at which the lungs empty, as follows:

(s)

Actual TE, % emptying

1 x RCexp, 63%

2 x RCexp, 86.5%

3 x RCexp, 95%

4 x RCexp, 98%

RCexp is calculated as the ratio between VTE and flow at 75% of the VTE.

Normal values in intubated adult patients:

• Short, < 0.6 seconds: restrictive disease (ARDS, atelectasis, chest wall

stiffness)

• Normal, 0.6 to 0.9 seconds: normal compliance and resistance, or com-

bined decreased compliance and increased resistance

• Long, > 0.9 seconds: obstructive disease (COPD, asthma), broncho-

spasm, ET tube obstruction, or incorrect positioning

Use RCexp to set the optimum TE (Goal: TE ≥ 3 x RCexp):

• With passive patients: Adjust Rate and I:E

• With active patients: Increase ΔPsupport and/or ETS to achieve a longer

These actions may reduce the incidence of AutoPEEP.

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About the monitored parameters

Parameter (unit)

Definition

Rinsp

Resistance to inspiratory flow caused by the endotracheal tube and the

(cmH2O / (l/s))

patient’s airways during inspiration.

It is calculated using the LSF method applied to the inspiratory phase. Also

displayed in the Dynamic Lung panel.

Actively breathing patients can create artifact or noise, which can affect the

accuracy of these measurements.

RSB

Rapid shallow breathing index.

(1 / (l*min))

The total breathing frequency (fTotal) divided by the exhaled tidal volume

(VTE).

Because a patient with dyspnea typically takes faster and shallower breaths

than a non-dyspnoeic patient, RSB is high in the dyspnoeic patient and low

in the non-dyspnoeic patient.

RSB is often used clinically as an indicator of a ventilated patient’s readiness

for weaning.

RSB is only significant for spontaneously breathing patients weighing more

than 40 kg and is only shown if 80% of the last 25 breaths were spontane-

ous.

Ventilation time

Displayed in the Controls > Patient window, shows how long the patient

has been ventilated. For details, see Section 8.6.

Humidifier related

T Y-piece

For HAMILTON-H900 humidifier only. See Table 11-5.

(°C)

T humidifier

For HAMILTON-H900 humidifier only. See Table 11-5.

(°C)

CO2 related

FetCO2

Fractional end-tidal CO2 concentration.

(%)

Permits assessment of PaCO2 (arterial CO2). Note that it is inaccurate in

pulmonary embolism.

Available when a CO2 sensor is connected and enabled.

PetCO2

End-tidal CO2 pressure.

(mmHg)

The maximum partial pressure of CO2 exhaled during a tidal breath (just

before the start of inspiration). It represents the final portion of air that was

involved in the exchange of gases in the alveolar area, thus providing a reli-

able index of CO2 partial pressure in the arterial blood under certain cir-

cumstances.

PetCO2 does not reflect PaCO2 in the case of a pulmonary embolism.

Available when a CO2 sensor is connected and enabled.

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8 Monitoring ventilation

Parameter (unit)

Definition

slopeCO2

Slope of the alveolar plateau in the PetCO2 curve, indicating the volume/

(%CO2/l)

flow status of the lungs.

Available when a CO2 mainstream sensor is connected and enabled.

V’alv

Alveolar minute ventilation.

(ml/min)

Permits assessment of actual alveolar ventilation (as opposed to minute

ventilation).

Valv * f (normalized to 1 min)

Available when a CO2 mainstream sensor is connected and enabled.

V’CO2

CO2 elimination.

(ml/min)

Net exhaled volume of CO2 per minute. Permits assessment of metabolic

rate (for example, it is high with sepsis) and treatment progress.

Available when a CO2 mainstream sensor is connected and enabled.

VDaw

Airway dead space.

(ml)

Gives an effective, in-vivo measure of volume lost in the conducting air-

ways. A relative increase in dead space points to a rise in respiratory insuffi-

ciency and can be regarded as an indicator of the current patient situation.

Patients with high dead space values are at particular risk if the muscles

also show signs of fatigue.

Available when a CO2 mainstream sensor is connected and enabled.

VDaw/VTE

Airway dead space fraction at the airway opening.

(%)

Available when a CO2 mainstream sensor is connected and enabled.

VeCO2

Exhaled CO2 volume, updated breath by breath.

(ml)

Available when a CO2 mainstream sensor is connected and enabled.

ViCO2

Inspired CO2 volume, updated breath by breath.

(ml)

Available when a CO2 mainstream sensor is connected and enabled.

Vtalv

Alveolar tidal ventilation.

(ml)

VTE - VDaw

Available when a CO2 mainstream sensor is connected and enabled.

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Viewing patient ventilation time

8.6 Viewing patient ventilation

• When you select Last patient in the

Standby window, the timer continues

time

from the last total time recorded.

The Controls > Patient window displays a

• When you touch Reset, the timer resets

timer that shows how long the patient has

to 0.

been ventilated.

When the timer is reset, an entry is made

Figure 8-21. Ventilation time

to the Event log recording the time of the

reset, as well as how long the ventilator

had been running prior to the reset.

To reset the timer to 0

1. Touch Controls.

2. In the Controls window, touch the

Patient tab.

3. Touch Reset.

The timer starts again at 00d 00h 00min.

8.7 Viewing device-specific

Controls

Ventilation time

information

(days, hours,

minutes)

The System > Info windows display device-

Patient

Reset

specific information including serial num-

ber, model, operating hours, hours since

startup, battery capacity, oxygen

The timer records time as follows:

consumption, software version, and

• The timer starts when you start ventila-

installed options.

tion.

The System > Info > About window pro-

• When you enter Standby, the timer

vides information about third-party open

pauses. It picks up again from the last

source libraries that were used to develop

value when you exit Standby and return

the ventilator software.

to active ventilation.

To view device-specific information

• When you set up a new patient in the

1. Touch System.

Standby window, and start ventilation,

the timer resets to 0.

2. If needed, touch the Info tab.

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9 Responding to alarms

9.1 Overview

In the event of certain technical failures,

the ventilator switches to Safety ventilation

Operator-adjustable and nonadjustable

(Section 7.6). This gives you time to

alarms together with a visual alarm indica-

arrange for corrective actions, including

tor notify you of conditions that require

organizing a replacement ventilator.

your attention.

When an alarm condition is serious

These alarms are categorized as high,

enough to possibly compromise safe venti-

medium, or low priority, as described in

lation, the device defaults to the Ambient

Table 9-1. The ventilator's visual alarm

state (Section 7.6). The ventilator immedi-

indications are described in Figure 9-1.

ately stops gas flow to the patient. The

release valve and expiratory valve are

Additional alarms conditions are associ-

opened, letting the patient breathe room

ated with technical fault and technical

air unassisted.

note alarms, as well as informational mes-

sages.

When reviewing alarms, you can access

on-screen alarm troubleshooting help in

You can view active alarms in the alarm

the Alarms > Buffer window. See Section

buffer (Figure 9-2). Information about the

9.2.1.

alarm is also stored in the Event log.

For details on setting alarm limits, see

Alarms are indicated in the color associ-

Section 5.7.

ated with the alarm priority as follows:

•

The alarm lamp on top of the ventilator

Table 9-1 describes the audio and visual

characteristics of these types of alarms

lights and flashes.

and provides guidance on how to

•

The message bar on the ventilator

respond.

display is shown in color and displays

the alarm text.

•

An MMP associated with an active

alarm is shown in color, together with a

colored bar to the right of the affected

parameter.

•

In the Monitoring window, a parameter

associated with an active alarm is

shown in the associated color.

•

Any affected parameter shown in the

Dynamic Lung is shown in color.

•

The Humidifier quick access icon is

shown in the associated color when a

related alarm is active.

•

The alarm text is displayed in the alarm

buffer.

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Overview

Table 9-1. Alarm indicators

Alarm

Message bar

Alarm lamp /

Audio

Action required

type

Alarm status

indicator

High

Red, with

Red, flashing

A sequence of

The patient’s safety is

priority

alarm mes-

5 beeps, repeated

compromised. The

sage

until the alarm is

problem needs immedi-

reset. If the audi-

ate attention.

ble alarm is not

silenced during

the first minute,

the continuous-

tone buzzer also

sounds.

Medium

Yellow, with

Yellow, flashing

A sequence of

The patient needs

priority

alarm mes-

3 beeps, repeated

prompt attention.

sage

periodically.

Low

Yellow, with

Yellow, solid

Two sequences of

Operator awareness is

priority

alarm mes-

beeps. This is not

required.

sage

repeated.

Technical

Red, with the

Red, flashing

Same as for high-

The ventilator enters

fault

text, Safety

priority alarm, if

Safety ventilation, or, if

ventilation,

technically possi-

it cannot safely venti-

Safety mode,

ble. At a mini-

late, the Ambient state.

or Technical

mum, a continu-

• Provide alternative

fault: xxxxxx

ous buzzer tone.

ventilation.

The buzzer

• Turn off the ventila-

cannot be

tor.

silenced.

• Have the ventilator

serviced.

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9 Responding to alarms

Alarm

Message bar Alarm lamp /

Audio

Action required

type

Alarm status

indicator

Technical Depends on

Same as the asso- Same as the asso- A technical alarm

event

severity of the

ciated alarm level ciated alarm level. cannot typically be cor-

event. Can be

rected by the operator.

low, medium,

Ventilation continues.

or high.

If needed, have the

ventilator serviced.

Technical Provides tech-

No action is required.

note

nical informa-

tion about a

hardware or

software

issue, display-

ed only in the

Event log.

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Alarm limit indicators

Figure 9-1. Visual alarm indications

9.1.2 Responding to an alarm

WARNING

When an Audio pause is active, the

following critical alarms still generate an

audible alarm:

• Apnea

• External power loss

• Oxygen supply failed

• Technical events: 231003, 243001,

243002, 283007, 284003, and

285003

• All technical faults

CAUTION

Carefully set alarm limits according to

Alarm lamp

Audio pause key

the patient's condition. Setting limits too

Message bar

Audio pause indi-

high or too low defeats the purpose of

cator and count-

the alarm system.

down

MMP and colored

NOTICE

bar associated

The factory default alarm limit settings

with alarm

are set in line with the selected patient

group, allowing for unattended monitor-

9.1.1 Alarm limit indicators

ing. These settings, however, can never

replace individual review of the patient

Alarm limits are shown in the Alarms >

and adjustment of alarm limits based on

Limits windows.

their condition.

When an alarm limit is disabled, that is, no

limit applies, the device shows the follow-

Alarms may result from either a clinical

ing Alarm Off symbol⁶⁵:

condition or an equipment issue. In addi-

tion, a single alarm condition can generate

multiple alarms.

Your search for the causes of the alarm

For details about setting alarm limits, see

condition should be assisted by, but not

Section 5.7.

limited to, the alarm messages displayed.

⁶⁵ Not available in all markets.

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9 Responding to alarms

To respond to an alarm

The display also indicates an Audio pause is

engaged as follows (Figure 9-1):

1. Approach the patient immediately.

2. Secure sufficient and effective ventila-

• The Audio pause indicator is displayed.

tion for the patient.

• A countdown timer on the main display

You can pause the audible alarm, if

shows the remaining time for the Audio

appropriate and available. See Section

pause.

9.1.3.

When the time expires and the issue has

3. Correct the alarm condition from the

not yet been resolved, an audible alarm

alarm messages. See Section 9.4.

sounds again.

For an informational message, wait

three (3) seconds for the message to

disappear, or follow the message

9.2 About the alarm buffer

instructions as appropriate.

The alarm buffer shows up to 5 active

For a technical fault, remove the venti-

alarm messages or up to 6 inactive alarm

lator from use, note the fault code,

messages:

and have the ventilator serviced.

•

The alarm buffer shows active alarms as

4. If appropriate, readjust the alarm limit.

they are generated (Figure 9-2). The

alarm messages also alternate in the

9.1.3 Temporarily silencing an alarm

message bar. Active alarms are shown

in wide color-coded boxes.

One component of an alarm is the audible

alarm sound. With most alarms, you can

•

If no alarms are active, the alarm buffer

pause (silence) the alarm sound for two

shows the most recent inactive alarms

minutes at a time.

(Figure 9-3). Inactive alarms are shown

in narrow color-coded boxes. In addi-

To temporarily silence an alarm

tion, the i-icon is visible on the display.

4 Press

(Audio pause) on the front

•

Touch an alarm entry to view trouble-

of the ventilator (Figure 10-2).

shooting help directly on the display.

The audible ventilator alarm is muted

for two minutes. Pressing the key a

second time cancels the Audio pause.

The indicator light next to the Audio pause

key is continuously lit red while an Audio

pause is active.

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About the alarm buffer

To view alarms

Figure 9-3. Alarm buffer with inactive alarms

4 Open the Alarms > Buffer window by

doing one of the following:

- Touch an active alarm in the mes-

sage bar at the top of the display

(Figure 9-2).

- Touch the inactive alarm indicator

(the i-icon) (Figure 9-3).

- Touch the Audio pause indicator at

the bottom right of the display (Figure

9-1).

- Touch Alarms > Buffer.

The most recent alarm is at the top of the

list.

To clear the list of inactive alarms

Alarms

Inactive high-priority

alarm (red)

4 Touch the Reset button (Figure 9-3).

Buffer

Inactive low- or

Closing the alarm buffer does not

medium-priority

erase its contents.

alarm (yellow)

Figure 9-2. Alarm buffer with active alarms

i-icon

Reset

Alarms

High-priority alarm

(red)

Buffer

Low- or medium-

priority alarm

(yellow)

Alarm text in message bar

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9 Responding to alarms

9.2.1 Accessing on-screen

9.3 Adjusting alarm loudness

troubleshooting help

(volume)

Troubleshooting help is available for

alarms.

WARNING

To view the help for an alarm

Be sure to set the auditory alarm loud-

1. Touch the alarm message in the

ness above the ambient sound level. Fail-

buffer.

ure to do so can prevent you from hear-

ing and recognizing alarm conditions.

A Help window opens in the buffer,

providing troubleshooting information

You can set the loudness of the audible

for the selected alarm.

alarm. By default, the loudness is set to 5.

2. To view help for another alarm, touch

If you set the loudness below the default

the next alarm message.

value during a patient session, the value is

The contents of the Help window

reset to the default upon:

refresh with the new information.

• Setting up a new patient

The alarm is displayed as long as the

window is open even if the alarm is no

• Turning the ventilator off and on again

longer active.

You cannot set the loudness below the

3. Touch X to close the Help window.

minimum level configured for the device

(Chapter 13).

Figure 9-4. On-screen help window

To adjust the alarm loudness

1. Touch System > Settings.

2. Touch the Loudness button if the

Loudness window is not already

displayed.

3. Activate and adjust the Loudness

control, as needed.

4. Touch Test to check the loudness

level.

Ensure the loudness level is above the

ambient sound level.

5. Repeat the process as required, and

close the window.

Alarms

Selected alarm

Buffer

Alarm text and

troubleshooting

information

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Troubleshooting alarms

Figure 9-5. Alarm loudness control

System

Loudness

Settings

Loudness control

and Test button

9.4 Troubleshooting alarms

Table 9-2 is an alphabetical list of the

alarm messages displayed by the

HAMILTON-T1, along with their definitions

and suggested corrective actions.

These corrective actions are sequenced to

correct the most probable issue or to

present the most efficient corrective action

first. The proposed actions, however, may

not always correct the particular problem.

If your issue is not resolved after perform-

ing the recommended tasks, contact your

Hamilton Medical authorized service per-

sonnel.

For additional information, see the appro-

priate documentation as follows:

• For SpO2-related alarms, see the Pulse

Oximetry Instructions for Use.

• For HAMILTON-H900-related alarms,

see Section 11.1.6 and the HAMILTON-

H900 Instructions for Use.

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9 Responding to alarms

Table 9-2. Alarms and other messages

Alarm

Definition

Action needed

Ambient state

The inspiratory and expiratory

Provide alternative ventilation immedi-

channels are opened, letting the

ately.

patient breathe room air unas-

sisted. See Section 7.6.

Apnea ventilation

Low priority. Backup mode was

No action required.

ended

reset, and ventilator is again venti-

lating in its original support (pre-

apnea) mode.

Apnea ventilation

Low priority. Apnea backup ventila-

•

Check patient condition.

tion has started. No breath deliv-

•

Check trigger sensitivity.

ered for the operator-set apnea

•

Check the control settings for the

time. Apnea backup ventilation is

backup mode.

on.

•

Consider changing the mode.

Apnea

High priority. No patient trigger

•

Check patient condition.

within the operator-set apnea

•

Check trigger sensitivity.

time in APVsimv, SPONT, DuoPAP,

•

Consider changing the mode.

APRV, or NIV mode. Apnea backup

is off.

ASV: Cannot

Low priority. The operator-set

•

Check patient condition.

meet target

%MinVol cannot be delivered, pos-

•

Check the Plimit setting and adjust

sibly due to setting conflicts or

if appropriate.

lung-protective rules.

•

Consider a mode change. However,

be aware that other modes may not

enforce lung-protective rules.

Battery 1, 2: Cali-

Low priority. The battery requires

Replace the battery with a properly

bration required

calibration. You may continue to

calibrated battery to continue ventila-

use the battery.

tion.

Battery 1, 2:

High priority. Battery defective.

• Replace battery.

Defective

Ventilation continues if an alterna-

• Prepare alternative ventilation.

tive power source is connected.

• If the problem still persists, have the

ventilator serviced.

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Alarm

Definition

Action needed

Battery 1, 2:

Low priority. Battery capacity is

•

Connect the ventilator to primary

Replacement

insufficient for reliable operation

power (AC or DC).

required

and must be replaced immedi-

•

Replace the battery.

ately.

•

If a replacement is not available,

provide alternative ventilation until

the issue is resolved.

•

If the problem still persists, have the

ventilator serviced.

Battery 1, 2: Tem-

High priority. The battery tempera-

•

Remove the ventilator from the sun

perature high

ture is higher than expected.

or other heat source.

•

Replace the battery.

•

Provide alternative ventilation until

the issue is resolved.

•

If the problem still persists, have the

ventilator serviced.

Battery 1, 2:

Low priority. The battery in use is

•

Replace the battery.

Wrong battery

not the correct battery for this

•

Connect the ventilator to primary

ventilator.

power (AC or DC).

•

Provide alternative ventilation until

the issue is resolved.

Battery communi-

High priority. Battery data is not

•

Check the battery connectors and

cation error

available. Ventilation continues.

that the battery is installed correctly.

•

Make sure the battery lock is prop-

erly closed.

•

If the problem persists, replace the

battery.

•

If the problem still persists, have the

ventilator serviced.

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9 Responding to alarms

Alarm

Definition

Action needed

Battery low

The Battery low alarm has different

•

Connect the ventilator to a primary

levels of priority depending on

power source.

battery age and condition. The

•

Install charged battery.

alarm priority levels are defined as

•

If necessary, be prepared to provide

follows:

alternative ventilation.

High priority. The ventilator is run-

ning on battery power, and the

battery charge is critically low. You

have a minimum of 5 minutes

operating time left.

If the high-priority Battery low

alarm occurs when starting up the

ventilator, you may have less than

5 minutes of operating time

remaining.

Medium priority. The ventilator is

running on battery power and the

battery charge is low.

Low priority. The ventilator is run-

ning on primary power and the

battery charge is low.

Battery power

High priority. No battery is

•

Connect the ventilator to primary

loss

present.

power (AC or DC).

•

Insert a battery.

Battery totally dis-

High priority. The battery charge

•

Connect the ventilator to primary

charged

level is below 5%. The ventilator

power (AC or DC). Connecting to

switches to the Ambient state.

primary power also charges the bat-

tery.

•

Immediately provide alternative

ventilation until the issue is resolved.

•

If the problem still persists, have the

ventilator serviced.

Blower fault

High priority. A blower malfunc-

•

Immediately provide alternative

tion was detected. A technical

ventilation.

alarm cannot typically be cor-

•

Have the ventilator serviced.

rected by the operator. The venti-

lator switches to the Ambient

state.

Blower service

Low priority. The blower has

Have the ventilator serviced.

required

reached the end of its lifespan.

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Troubleshooting alarms

Alarm

Definition

Action needed

Buzzer defective

High priority. A buzzer malfunc-

•

Restart device.

tion was detected. A technical

•

Provide alternative ventilation until

alarm cannot typically be cor-

the issue is resolved.

rected by the operator.

•

If the problem persists, have the

ventilator serviced.

Check CO2 air-

Low priority. Adapter disconnec-

•

Check patient condition.

way adapter

tion, optical block, or adapter type

•

Check the airway adapter for excess

changed.

moisture accumulation /contamina-

tion by secretions.

•

Replace / perform zero calibration

on airway adapter.

Check CO2

Low priority. The CO2 sidestream

•

Check patient condition.

sampling line

sensor sampling line is occluded

•

Replace sampling line.

by water.

Check flow

Neonatal only. Water is detected

•

Remove all water from the flow

sensor for water⁶⁶

inside the flow sensor, which is

sensor and flow sensor tubing.

affecting measurements.

•

You must position the flow sensor

Medium priority. You must

at a ≥ 45° angle to avoid water

acknowledge the alarm within 90

accumulation.

seconds by pressing the Audio

•

Adjust the FS alarm sensitivity

pause key. This gives you time to

control.

remove any accumulated water

from the flow sensor and tubing.

If the alarm is not acknowledged

within 90 seconds, the alarm

becomes high priority.

The alarm is active until flow

sensor measurements are again

within the expected range.

You can specify alarm sensitivity or

disable the alarm in Configuration.

See Section 13.3.5.

⁶⁶ Not available in all markets.

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9 Responding to alarms

Alarm

Definition

Action needed

Check flow

High priority. Flow sensor mea-

•

Make sure the flow sensor is the

sensor

surements are out of the expected

correct type for the patient (Adult/

range.

Ped or Neonatal).

If the alarm continues for 3 conse-

•

Check the flow sensor connection

cutive breath cycles, the External

to the ventilator.

flow sensor failed alarm is genera-

•

Connect and calibrate a new flow

ted and the ventilator switches to

sensor.

Sensor Failure mode (Section

7.6.1).

Check flow

High priority. The flow sensor

•

Check the flow sensor connection

sensor tubing

tubes are disconnected or

to the ventilator.

occluded.

•

Connect and calibrate a new flow

If the alarm continues for 3 conse-

sensor.

cutive breath cycles, the External

flow sensor failed alarm is genera-

ted and the ventilator switches to

Sensor Failure mode (Section

7.6.1).

Check for

Medium priority. Internal pressure

•

Observe the patient

blockage

is above 45 cmH2O in HiFlowO2.

•

Check patient interface for

If the pressure increases further

blockage.

and exceeds 50 cmH2O, the alarm

If no blockage is observed, consider

becomes high priority, flow stops,

reducing the flow to decrease pres-

and the pressure is released.

sure.

•

Check breathing circuit limbs and

tubing for kinks.

Check patient

High priority. Generated when

Check for:

interface

using a speaking valve and the Vt

• Disconnection

low or Low pressure alarm is

• Whether cuff is fully deflated

active.

• Upper airway occlusion

For additional alarm details when

• Speaking valve is operating properly

using a speaking valve, see Table

10-1.

Check Plimit

Low priority. Inspiratory pressure,

• Check the patient for adequate

including PEEP/CPAP, is above the

ventilation.

pressure limit (Plimit).

• Adjust Plimit and/or the pressure

Does not apply in APVcmv,

control settings, as appropriate.

APVsimv, or ASV modes.

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Troubleshooting alarms

Alarm

Definition

Action needed

Check settings

Low priority. A change to a

Check and confirm settings, including

control or alarm setting was not

alarms.

saved.

Circuit calibration

Medium priority, Low after silence.

Calibrate the neonatal breathing cir-

needed

The ventilator does not have cor-

cuit (Section 6.2.2).

rect calibration data.

Only active in nCPAP and nCPAP-PC

modes.

CO2 calibration

Low priority. A previous sensor

Perform the following checks, repeat-

needed

zero calibration failed.

ing the calibration after each one, until

calibration is successful:

•

Clean or replace airway adapter.

•

Perform a zero calibration of the

sensor, making sure there is no

source of CO2 near the airway

adapter.

•

Replace the airway adapter.

•

Replace the CO2 sensor.

•

If the problem persists, have the

ventilator serviced.

CO2 sensor

Low priority. The CO2 sensor sig-

•

Disconnect the sensor from the CO2

defect

nal indicates a hardware error or a

module. Wait a few seconds, and

third-party sensor is installed.

reconnect.

•

Perform a zero calibration of the

sensor. Ensure the sensor is

attached to the airway adapter

during zero calibration.

•

Replace the CO2 sensor. Make sure

the sensor is a genuine Hamilton

Medical part.

CO2 sensor

Low priority. The CO2 module is

•

Make sure a CO2 sensor is con-

disconnected

installed, but there is no signal

nected.

from the CO2 sensor. CO2

•

Check CO2 sensor connections

monitoring is enabled.

(CO2 sensor cable to module, CO2

module to ventilator).

•

If the problem persists, have the

ventilator serviced.

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9 Responding to alarms

Alarm

Definition

Action needed

CO2 sensor over

Low priority. The temperature at

• Check whether the sensor is

temperature

the CO2 sensor is too high.

affected by an external heating

source.

• Remove the sensor from the airway,

and disconnect the sensor from the

CO2 module. Reconnect.

• Verify that system is running within

the specified environmental condi-

tions. Check for excessive airway

temperature, which could be caused

by defective humidifier, heater wire,

or probe.

CO2 sensor

Low priority. The CO2 operating

Wait for the sensor to warm up.

warmup

temperature has not yet been

reached or is unstable.

CO2: Poor signal

Low priority. The CO2 sensor sig-

•

Check patient condition.

nal quality is poor.

•

Check CO2 sensor and adapter

connections.

•

Ensure that airway adapters are not

in a horizontal position relative to

the floor to reduce accumulation of

patient secretions.

If accumulation occurs, remove the

adapter, rinse with sterile water,

and reconnect.

CPR ON

Low priority. CPR ventilation is on.

•

Check and confirm settings, includ-

The alarm limits for ExpMinVol,

ing alarms.

fTotal, and Vt are set to their mini-

•

To stop CPR ventilation, press the

mum and maximum values.

Power/Standby key or change the

ventilation mode.

Device tempera-

High priority. The internal temper-

•

Remove the ventilator from the sun

ture high

ature of the ventilator is higher

or other heat source.

than expected.

•

Check the cooling fan filter and fan.

•

Prepare alternative ventilation.

•

Have the ventilator serviced.

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Troubleshooting alarms

Alarm

Definition

Action needed

Disconnection on

High priority. VTE is less than one-

•

Check patient condition.

patient side

eighth of the delivered VTI, and

•

Check the breathing circuit for a

delivered VTI exceeds 50 ml.

disconnection between the patient

Applicable in invasive modes.

and the flow sensor, or for other

large leaks (for example, ET tube).

For APRV and DuoPAP modes, only

applicable during the pressure

phase.

For alarm details when using a

speaking valve, see Table 10-1.

Disconnection on

High priority. Measured VTI at the

•

Check the expiratory valve:

ventilator side

flow sensor is less than one-half of

- Check the condition of the

the delivered VTI, and delivered

expiratory valve set. If anything

VTI exceeds 50 ml.

is defective, replace.

Applicable in invasive modes.

- Check whether the expiratory

For alarm details when using a

valve is affected by any nebuliz-

speaking valve, see Table 10-1.

ing agent.

- Make sure that the expiratory

valve is properly installed.

- Check whether there is a dis-

connection at the expiratory

valve.

•

Replace the expiratory valve.

•

Check the flow sensor. If needed,

replace the flow sensor.

Exhalation

High priority. Either the end-

•

Check patient condition.

obstructed

expiratory pressure is too high or

•

Check the expiratory limb for occlu-

the end-expiratory flow is too low.

sion.

Note that you must use an inspira-

•

Check the expiratory valve set.

tory filter to prevent contamina-

Replace if needed.

tion. The ventilator may be con-

•

Check the flow sensor tubes for

taminated if no inspiratory filter is

occlusion.

used.

•

Adjust breath timing controls to

Not active when using HiFlowO2.

increase the expiratory time.

•

Provide alternative ventilation until

the issue is resolved.

•

Have the ventilator serviced.

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9 Responding to alarms

Alarm

Definition

Action needed

External connec-

Medium priority. Low after silence.

•

If no patient is connected, restart

tions disabled

The Connectivity Module is turned

the ventilator.

off. Repeated connection attempts

•

If the problem persists, have the

have failed. Ventilation can con-

ventilator serviced.

tinue, but connection with other

devices is not possible.

External flow

High priority. The external flow

•

Check flow sensor for excessive

sensor failed

sensor does not work properly.

secretions and/or water accumula-

The alarm is generated when

tion.

either the Check flow sensor or

•

Provide alternative ventilation and

Check flow sensor tubing alarm is

clean the flow sensor with sterile

active for 3 consecutive breath

water.

cycles. The ventilator switches to

•

Connect and calibrate a new flow

Sensor Failure mode (Section

sensor.

7.6.1).

Fan failure

Medium priority. There is a prob-

•

Provide alternative ventilation until

lem with the cooling fan.

the issue is resolved.

•

Disconnect the ventilator from the

patient.

•

Have the ventilator serviced.

Flip the flow

Medium priority. Either the flow

•

Check the flow sensor. The end

sensor

sensor is connected to the breath-

marked PATIENT faces the patient.

ing circuit facing the wrong direc-

•

Reverse the flow sensor tube

tion or the flow sensor connec-

connections on the ventilator.

tions to the ventilator are

•

The blue tube attaches to the blue

reversed.

connector. The clear tube attaches

Ventilation continues, but the

to the white connector.

ventilator corrects for the reversed

signal.

Flow sensor calib-

High priority during ventilation,

•

Ensure the correct flow sensor for

ration needed

low in Standby. The ventilator

the selected patient group is

does not have correct calibration

attached to the breathing circuit.

data or flow sensor cannot be cali-

•

Calibrate the flow sensor as soon as

brated.

possible.

In Standby, may indicate that the

patient group has changed.

Note that flow, volume, and pres-

sure measurements are less accu-

rate with an uncalibrated flow

sensor.

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Troubleshooting alarms

Alarm

Definition

Action needed

Function key not

Medium priority. The function key

•

Turn off the ventilator using the

operational

is defective. Ventilation continues.

Power/Standby button on the back

of the device.

•

Have the ventilator serviced.

High Flow

Medium priority, Low after silence.

•

Check the patient interface and

Flow has reached the set limit.

breathing circuit for disconnection

or excessive leakage.

Only active in nCPAP and nCPAP-PC

modes.

•

Check ventilator settings and alarm

limits.

High frequency

Medium priority. The measured

•

Check the patient for adequate

fTotal exceeds the set alarm limit.

ventilation (VTE).

•

Check alarm limits.

•

Check the trigger sensitivity.

•

If the ventilator is in ASV mode, see

Section 7.8.

High minute

High priority. The measured

•

Check patient condition.

volume

ExpMinVol exceeds the set alarm

•

Check and confirm settings, includ-

limit.

ing alarms.

High oxygen

High priority.

•

Calibrate the O2 sensor.

One of the following has

•

Install a new O2 sensor.

occurred:

•

Check alarm limits (if set manually).

• If the Oxygen alarm limits are set

automatically, the measured

oxygen is more than 5% (abso-

lute) above the current Oxygen

control setting.

• If the Set Oxygen alarm limits

manually checkbox is selected,

the measured oxygen is above

the set upper limit.

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9 Responding to alarms

Alarm

Definition

Action needed

High PEEP

Medium priority. Monitored PEEP

•

Check patient condition.

exceeds (set PEEP + 5 cmH2O) for

•

Check and confirm settings, includ-

two consecutive breaths.

ing alarms.

For DuoPAP and APRV only: Alarm

•

Check the expiratory valve set for

applies to both P high and P low

possible obstructions.

settings. The alarm sounds when

•

Check for obstructions in the expira-

the monitored P high exceeds (set

tory limb.

P high + 5 cmH2O) or monitored

•

Check the flow sensor tubes for

P low exceeds (set P low +

occlusion.

5 cmH2O) for two consecutive

breaths.

If T low is set to < 3 seconds, the

High PEEP alarm is disabled for

P low settings. This reduces the

incidence of false positive alarms.

High pressure

High priority. A sigh cannot be

•

Check patient condition.

during sigh

fully delivered because excessive

•

Check the artificial airway of the

inspiratory pressure would be

patient for kinks and occlusions.

required. The sigh is partially deliv-

•

Check the breathing circuit limbs

ered.

and flow sensor tubes for kinks and

occlusions.

•

Consider disabling the Sigh function.

High pressure

High priority, Low after Audio

•

Check patient condition.

pause is activated. The measured

•

Adjust the Pressure alarm limit.

inspiratory pressure exceeds the

•

Check the artificial airway of the

set high Pressure alarm limit. The

patient for kinks and occlusions.

ventilator immediately stops gas

•

Check the breathing circuit limbs

flow to the patient and opens the

expiratory valve to reduce pressure

and flow sensor tubes for kinks and

to the PEEP/CPAP level.

occlusions.

•

Provide alternative ventilation once

If the pressure reaches 15 cmH2O

the ventilator enters the Ambient

above the high Pressure alarm

state.

limit for longer than 5 seconds,

the ventilator opens the release

valve.

If the pressure reaches 15 cmH2O

above the high Pressure alarm

limit for longer than 7 seconds,

the ventilator enters the Ambient

state.

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Troubleshooting alarms

Alarm

Definition

Action needed

Inspiratory

Medium priority. The delivered Vt

• Reduce the ΔPsupport setting.

volume limitation

is more than 1.5 times the set

• Adjust the high Vt alarm limit.

high Vt alarm limit. Pressure is

reduced to PEEP level.

The APV controls reduce the pres-

sure for the next breath by 3

cmH2O.

Disabled in noninvasive modes.

For alarm details when using a

speaking valve, see Table 10-1.

Invalid communi-

Low priority. The installed com-

• Contact your Hamilton Medical

cation board

munication board is invalid.

technical representative.

• Have the ventilator serviced.

IRV

Low priority. The set I:E ratio is

Check the timing control settings.

above 1:1, leading to inverse ratio

ventilation.

Does not apply in PSIMV+PSync,

SPONT, NIV, or NIV-ST modes, or in

HiFlowO2.

JTAG not working

Low priority. A hardware compo-

Remove the ventilator from use and

nent failed the self-test during

have it serviced.

startup.

Loss of external

Low priority. The ventilator is run-

• Silence the alarm.

power

ning on battery power due to loss

• Check integrity of connection to pri-

of a primary power source.

mary power source.

• Check battery status.

• Prepare for possible power loss.

• Provide alternative ventilation until

the issue is resolved.

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9 Responding to alarms

Alarm

Definition

Action needed

Loss of PEEP

Medium priority. One of the

•

Check patient condition.

following conditions is in effect:

•

Check the breathing circuit for

• Pressure during exhalation is

leaks. Replace the breathing circuit,

below (set PEEP/CPAP - 3

if necessary.

cmH2O) for more than 10

•

Check the condition of the expira-

seconds

tory valve set. If anything is defec-

• Measured end-expiratory pres-

tive, replace.

sure is below (set PEEP/CPAP - 3

cmH2O) for two consecutive

breaths

Loudspeaker

High priority. A loudspeaker mal-

•

Check patient condition.

defective

function was detected. A technical

•

Provide alternative ventilation until

alarm cannot typically be cor-

the issue is resolved.

rected by the operator. Ventilation

•

Have the ventilator serviced.

continues.

Low frequency

Medium priority. Measured fTotal

•

Check patient condition.

is below the set alarm limit.

•

Adjust the low fTotal alarm limit.

Low minute

High priority. Measured ExpMinVol

•

Check patient condition.

volume

is below the set alarm limit.

•

Check the breathing circuit and arti-

ficial airway of the patient for leaks

and/or disconnection.

•

Check and confirm settings, includ-

ing alarms.

Low oxygen

High priority.

•

Check patient condition.

One of the following has

•

Check the oxygen supply. Provide

occurred:

an alternative source of oxygen, if

necessary.

• If the Oxygen alarm limits are set

automatically, the measured

•

Calibrate the O2 sensor.

oxygen is more than 5% (abso-

•

Provide alternative ventilation and

lute) below the current Oxygen

install a new O2 sensor.

control setting.

• If the Set Oxygen alarm limits

manually checkbox is selected,

the measured oxygen is below

the set lower limit.

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Troubleshooting alarms

Alarm

Definition

Action needed

Low pressure

High priority. The set pressure

• Check patient condition.

during inspiration was not

• Check the breathing circuit for a

reached.

disconnection between the patient

and the flow sensor, or for other

large leaks.

Maximum leak

Low priority. The set Vt cannot be

• Check patient condition.

compensation

reached due to a leak.

• Inspect the system for leaks.

In APVsimv and APVcmv modes

• Suction the patient, if needed.

only.

• Ensure the high Pressure limit is

appropriate.

• Switch to a different ventilation

mode.

O2 sensor calibra-

Low priority. O2 sensor calibration

• Calibrate the O2 sensor.

tion needed

data is not within the expected

• Verify temperature settings are

range, or the sensor is new and

within environmental specifications.

requires calibration.

• Replace O2 sensor if required.

• Have the ventilator serviced.

O2 sensor defec-

Low priority. The O2 sensor is

Install a new O2 sensor.

tive

depleted.

O2 sensor missing

Low priority. There is no signal

Install an O2 sensor or use an external

from the O2 sensor.

monitor, according to ISO

80601-2-55.

O2 sensor not

Low priority. The incorrect type of

Ensure a Hamilton Medical O2 sensor

system compa-

O2 sensor is installed.

is used and it is properly installed.

tible

Obstruction

High priority. End-expiratory pres-

• Check the patient.

sure > set PEEP/CPAP + 5, or Flow

• Check the expiratory limb for occlu-

< 1 l/min.

sion.

Only active in nCPAP and nCPAP-PC

• Check the expiratory valve set.

modes.

• Check the pressure line for occlu-

sion.

• Adjust breath timing controls to

increase the expiratory time.

• Have the ventilator serviced.

Options not

High priority. Options were not

• Restart device.

found

found during startup.

• If the problem persists, have the

ventilator serviced.

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9 Responding to alarms

Alarm

Definition

Action needed

Oxygen supply

High priority. Oxygen source flow

•

Check patient condition.

failed

is lower than expected.

•

Check the oxygen supply. Provide

an alternative source of oxygen, if

necessary.

•

Check the oxygen source/supply for

potential leakage.

•

Provide alternative ventilation until

the issue is resolved.

Performance lim-

Medium priority, Low after silence.

•

Check patient condition.

ited by high alti-

The airway pressure cannot be

•

If at all possible, consider lowering

tude

reached at the current altitude.

altitude to reach the target perfor-

As long as the device remains

mance.

above the altitude limit, the pres-

•

Provide alternative ventilation until

sure cannot be reached, and the

the issue is resolved.

alarm is active.

PetCO2 high

Medium priority. PetCO2 exceeds

•

Check patient condition.

the set alarm limit.

•

Check and confirm settings, includ-

ing alarms.

PetCO2 low

Medium priority. PetCO2 is below

•

Check patient condition.

the set alarm limit.

•

Check the breathing circuit and

flow sensor/artificial airway of the

patient for leaks.

•

Check and confirm settings, includ-

ing alarms.

Pressure limit has

Low priority. The pressure limit

Make sure the pressure limit is high

changed

setting (Plimit) has changed.

enough so that sufficient pressure can

be applied for adequate breath deli-

Either the Plimit setting or the

very.

high Pressure alarm limit setting

has been adjusted by the opera-

If sufficient pressure cannot be

tor.

applied, the Pressure limitation alarm is

generated.

Changing Plimit or the high Pres-

sure alarm limit automatically

changes the other: The high Pres-

sure alarm limit is always

10 cmH2O greater than Plimit.

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Troubleshooting alarms

Alarm

Definition

Action needed

Pressure limitation

Medium priority, Low after silence.

• Check the patient for adequate

Inspiratory pressure, including

ventilation.

PEEP/CPAP, is above the pressure

• Check and confirm settings, includ-

limit (Plimit). The ventilator limits

ing alarms.

applied pressure, so the target

pressure or volume may not be

achieved.

Pressure not

High priority. Airway pressure has

• Check expiratory valve and breath-

released

exceeded the Pressure limit, and

ing circuit for kinks and occlusions.

the pressure was not released via

• Provide alternative ventilation until

the expiratory valve after

the issue is resolved.

5 seconds. The ventilator enters

• Have the ventilator serviced.

the Ambient state.

Preventive main-

Low priority. The device was last

Have the ventilator serviced as soon as

tenance required

serviced more than 1 year ago.

possible.

The ventilator requires preventive

maintenance.

Real-time clock

Medium priority. The date and

Set the date and time (System >

failure

time are not set.

Settings window).

Release valve

Low priority. During the routine

If the problem still persists, have the

defective

check of the ambient valve during

ventilator serviced as soon as possible.

the Leak test, the valve was found

to be defective.

The alarm is reset when a Leak test

is successfully passed.

Ventilation is not necessarily

affected.

Replace HEPA

Low priority. The air inlet HEPA

Replace the HEPA filter as soon as pos-

filter

filter shows increased resistance.

sible.

Replace O2

High priority. Communication

• Replace O2 sensor.

sensor

error, O2 sensor is defective.

• If you cannot replace the O2 sensor,

Ventilation is not necessarily

consider disabling it.

affected. Oxygen concentration

should not be affected by this

issue. Ventilation can continue.

Safety mode

Technical fault. A hardware or

• Provide alternative ventilation until

software issue was detected. The

the issue is resolved.

ventilator switches to Safety

• Have the ventilator serviced.

mode.

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9 Responding to alarms

Alarm

Definition

Action needed

Safety ventilation

Technical fault. A hardware or

• Provide alternative ventilation until

software issue was detected. The

the issue is resolved.

ventilator switches to Safety venti-

• Have the ventilator serviced.

lation.

Self test failed

High priority. The self test failed

• Restart device.

during startup. The Start ventila-

• If the problem persists, have the

tion button is unavailable.

ventilator serviced.

Note that if this error occurs when

• If the device enters the Ambient

the device is restarting from a

state, provide alternative ventilation

complete power loss, the device

and have the ventilator serviced.

enters the Ambient state.

SpeakValve OFF

Low priority. Speaking valve

Press the Audio pause key to confirm

compatibility is deactivated.

and resolve the alarm.

SpeakValve ON

Low priority. Speaking valve

• If a speaking valve is in use, no

compatibility is activated.

action required.

• If a speaking valve is not in use, turn

off compatibility in the Controls >

SpeakValve window.

Suctioning

Low priority. Ventilation suppres-

Resume ventilation when desired by

maneuver

sion is active, and ventilator

first reconnecting the patient.

settings are being maintained,

although the ventilator is not

delivering breaths.

Technical event:

Low, medium, or high priority. A

Have the ventilator serviced.

xxxxxx

hardware or software issue was

detected. A technical alarm

cannot typically be corrected by

the operator. Ventilation contin-

ues.

Technical fault:

Technical fault. A hardware or

• Provide alternative ventilation until

xxxxxx

software issue was detected. The

the issue is resolved.

ventilator switches to the Ambient

• Have the ventilator serviced.

state or to Safety ventilation.

Technical state

Technical fault. There is a problem

Have the ventilator serviced.

failed

with the hardware configuration.

Ventilation is not possible.

Touch not func-

Low priority. The touch screen is

• Turn the ventilator off and on again.

tional

defective.

• If the problem persists, have the

ventilator serviced.

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Troubleshooting alarms

Alarm

Definition

Action needed

Unknown part

Technical fault. A hardware or

•

Provide alternative ventilation until

number

software issue was detected. The

the issue is resolved.

ventilator switches to the Ambient

•

Have the ventilator serviced.

state.

Vent outlet tem-

High priority. Inspiratory tempera-

•

Check whether the room tempera-

perature high

ture is too high.

ture exceeds the ventilator’s operat-

ing temperature limit.

Ventilation continues, but if tem-

perature stays high, the ventilator

•

Check that the air intake on the

may enter the Ambient state.

device is not obstructed.

•

Provide alternative ventilation until

the issue is resolved.

•

Have the ventilator serviced if tem-

perature cannot be reduced.

Ventilation can-

Technical fault. A hardware or

•

Provide alternative ventilation until

celed

software issue was detected. The

the issue is resolved.

ventilator switches to the Ambient

•

Contact your Hamilton Medical rep-

state.

resentative.

•

Have the ventilator serviced.

Vt high

Medium priority. Measured VTE

•

Check the pressure and volume

exceeds the set limit for 2 conse-

settings for potential leaks and/or

cutive breaths.

disconnections.

In invasive modes, if the delivered

•

Check and confirm settings, includ-

tidal volume exceeds 150% of set

ing alarms.

high Vt alarm limit (Vt > 1.5 * high

Vt alarm limit), the Inspiratory

volume limitation alarm is genera-

ted.

Vt low

Medium priority. Measured VTE is

•

If a speaking valve is in use, ensure

below the set limit for 2 consecu-

the cuff is deflated.

tive breaths.

•

Check patient condition.

High priority. When speaking valve

•

Check and confirm settings, includ-

compatibility is activated. This

ing alarms.

alarm can indicate the cuff is still

•

Check the breathing circuit and arti-

inflated. See Table 10-1.

ficial airway of the patient for leaks,

kinked limbs or tubing, or discon-

nection.

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9 Responding to alarms

Alarm

Definition

Action needed

Wrong expiratory

Medium priority, Low after silence.

Install the appropriate expiratory valve.

valve⁶⁷

The type of expiratory valve

To start ventilating the patient, you

installed does not match the

must confirm that you are aware of

selected patient group, or no

the issue by selecting either Accept or

expiratory valve is installed.

Decline in the dialog box.

In addition to the alarm message,

• By selecting Accept, you accept the

after attempting to start ventila-

risks associated with using the

tion, the device displays a dialog

wrong valve for selected patient.

box describing the risks of pro-

Ventilation starts after touching

ceeding with the wrong valve.

Accept.

The alarm is recorded in the

This option is only to be used in

Events log and remains in the

emergency cases, where the appro-

alarm buffer.

priate expiratory valve for the

patient group is not available and

mechanical ventilation must be

delivered.

• By selecting Decline, the dialog box

closes and you remain in standby.

The selection you make (Accept or

Decline) is recorded with the alarm in

the Events log.

⁶⁷ Applies only to devices with serial number > 3000.

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Ventilation settings and functions

10.1

Overview

214

10.2

Accessing settings during ventilation

214

10.3

Entering/exiting Standby

216

10.4

Oxygen enrichment

217

10.5

High flow oxygen therapy

219

10.6

Manual breath

220

10.7

Working with a nebulizer

220

10.8

Working with a speaking valve

221

10.9

CPR ventilation

223

10.10

Locking and unlocking the touch screen

226

10.11

Capturing a screenshot

226

10.12

Setting display options

227

10.13

About the Event log

228

213

10 Ventilation settings and functions

To change patient data during ventilation

10.1 Overview

4 Open the Controls > Patient window

Before proceeding, review the safety

by doing either of the following (see

information in Chapter 1.

Figure 10-1):

- Touch the Patient icon at the top left

10.2 Accessing settings during

of the display, next to the mode

ventilation

name.

- Touch Controls, then touch the

You can change patient data and ventila-

Patient button, and adjust settings as

tion control settings during ventilation, as

needed.

Figure 10-1. Controls > Patient window (Adult/

Ped shown)

10.2.1 Accessing patient data during

ventilation

NOTICE

Changing the patient height (Adult/Ped.)

or weight (Neonatal) automatically

adjusts the following settings based on

the recalculated IBW or updated Weight:

• Apnea backup setting (when set to

Automatic)

• Safety ventilation/Safety mode startup

values

Other settings and alarm limits are not

adjusted.

Controls

Adult/Ped: Sex and

During ventilation, the Controls > Patient

height, calculated IBW

window displays the basic patient profile,

Neonatal: Weight

including sex, height, and ventilation time

Patient

(Section 5.2).

When the ventilator is in Standby, the

patient controls are accessible in the

Standby window.

Note that if you are ventilating using the

Last patient setup, these controls are

greyed out and unavailable.

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Accessing settings during ventilation

10.2.2 Accessing settings during

Figure 10-2. Function keys

ventilation

At any time during ventilation, you can

adjust settings, as needed. Changes are

applied immediately.

•

Touch any MMP, the SpO2 parameter

under the MMPs, or Alarms to access

the alarm limit controls.

•

Touch Controls to access the mode

controls. Some controls are also avail-

able on the right side of the main

display.

•

Touch the mode name at the top left of

the display (Figure 5-1) or the Modes

button to change the selected ventila-

tion mode.

The mode changes at the end of the

current breath cycle.

Note that you can only select the nCPAP

and nCPAP-PC modes when in Standby.

•

Touch the Patient icon or touch Con-

trols > Patient to access patient

settings.

Power/Standby

O2 enrichment

Day/Night⁶⁸

Nebulizer

•

Touch the Humidifier icon to access the

Humidifier window.

Screen lock/

Print screen

unlock

•

Touch the Connectivity icon to access

the Connectivity window.

Manual breath

Audio pause

The ventilator also provides access to key

functions.

Keys on the front of the ventilator provide

access to important functions, including

entering Standby mode and pausing the

audible alarm.

When a selected function is active, the

indicator light next to the key is lit.

⁶⁸ Applies only to devices with serial number > 3000.

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