IntelliVent ASV en

INTELLiVENT-ASV
Operators Manual
624470/00
Software version
2.2X
0 1 9 7
624470/00
624470/00 iii
2012 HAMILTON MEDICAL AG. All rights reserved. Printed in
Switzerland. No part of this publication may be reproduced or
stored in a database or retrieval system, nor transmitted, in any
form or by any means, electronic, mechanical, by photocopy-
ing, recording, or otherwise, without the prior written permis-
sion of HAMILTON MEDICAL.
Definitions
WARNING
Alerts the user to the possibility of injury, death, or
other serious adverse reactions associated with
the use or misuse of the device.
CAUTION
Alerts the user to the possibility of a problem with
the device associated with its use or misuse, such
as device malfunction, device failure, damage to
the device, or damage to other property.
NOTE:
Emphasizes information of particular importance.
Manufacturer Distributor in USA
HAMILTON MEDICAL AG
Via Crusch 8
CH-7402 Bonaduz
Switzerland
Phone: (+41) 81 660 60 10
Fax: (+41) 81 660 60 20
info@hamilton-medical.com
www.hamilton-medical.com
HAMILTON MEDICAL, Inc.
4990 Energy Way
P.O. Box 30008
Reno, NV 89520, USA
Phone: (775) 858-3200
Toll-free: (800) 426-6331
Fax: (775) 856-5621
marketing@hamilton-medical.net
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Table of Contents
1 INTELLiVENT-ASV . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
1.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
1.1.1 Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
1.1.2 Ventilation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4
1.1.3 Oxygenation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4
1.1.4 Quick Wean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
1.2 Indications for use and contraindications . . . . . . . . . . . . . 1-6
1.2.1 Indications for Use . . . . . . . . . . . . . . . . . . . . . . . . 1-6
1.2.2 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . 1-6
1.3 INTELLiVENT-ASV in clinical use . . . . . . . . . . . . . . . . . . . . 1-7
1.3.1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7
1.3.2 Step 1: Before connecting the patient to
INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . . . . . 1-8
1.3.3 Step 2: Preparing the ventilator for
INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . . . . . 1-9
1.3.4 Step 3: Determining patient profile for
INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . . . . . 1-9
1.3.5 Step 4: The INTELLiVENT window: Selecting
ventilation and oxygenation management . . . . . 1-10
1.3.5.1 Patient Conditions . . . . . . . . . . . . . . 1-12
1.3.5.2 Normal patient: No condition is
selected . . . . . . . . . . . . . . . . . . . . . . 1-14
1.3.5.3 ARDS patient . . . . . . . . . . . . . . . . . . 1-16
1.3.5.4 Chronic Hypercapnia patient . . . . . . 1-17
1.3.5.5 Patient with chronic hypercapnia and
ARDS (mixed condition) . . . . . . . . . . 1-19
1.3.5.6 Patients with brain injury . . . . . . . . . 1-20
1.3.5.7 Quick weaning . . . . . . . . . . . . . . . . . 1-23
1.3.5.8 Recruitment management . . . . . . . . 1-24
1.3.5.9 PEEP limit from HLI index . . . . . . . . . 1-25
1.3.6 Step 5: Alarm Settings . . . . . . . . . . . . . . . . . . . . 1-27
1.4 Monitoring INTELLiVENT-ASV. . . . . . . . . . . . . . . . . . . . . 1-36
1.4.1 INTELLiVENT-ASV symbols . . . . . . . . . . . . . . . . . 1-36
1.4.2 Horizon, Map, Guide . . . . . . . . . . . . . . . . . . . . . 1-43
1.4.3 INTELLiVENT-ASV trend . . . . . . . . . . . . . . . . . . . 1-49
1.4.4 Graphical INTELLiVENT-ASV indicators . . . . . . . . 1-51
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Table of Contents
1.5 Management of %MinVol . . . . . . . . . . . . . . . . . . . . . . . 1-52
1.5.1 Management of %MinVol (passive patient). . . . . 1-53
1.5.2 Management of %MinVol (active patient). . . . . . 1-56
1.6 Management of PEEP and Oxygen . . . . . . . . . . . . . . . . . 1-62
1.6.1 Management of PEEP/Oxygen for passive and
active patients. . . . . . . . . . . . . . . . . . . . . . . . . . . 1-65
1.6.2 Emergency increase of oxygen . . . . . . . . . . . . . . 1-72
1.6.3 Patient condition rules (during ventilation) . . . . . 1-72
1.7 Assessing results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-74
1.8 Open loop: Manual management of
ventilation and oxygenation1-75
1.9 Heart-Lung Interaction . . . . . . . . . . . . . . . . . . . . . . . . . . 1-77
1.10 Remarks: Sensor failure, standby, calibration. . . . . . . . . . 1-79
1.10.1 Ventilation management. . . . . . . . . . . . . . . . . . . 1-79
1.10.1.1 PetCO2 is not available . . . . . . . . . . . 1-80
1.10.1.2 Disconnection or flow sensor failure
resolved in 5 minutes or less . . . . . . . 1-80
1.10.1.3 Disconnection or flow sensor failure
resolved in more than 5 minutes . . . . 1-81
1.10.1.4 Standby . . . . . . . . . . . . . . . . . . . . . . . 1-81
1.10.2 Oxygenation management . . . . . . . . . . . . . . . . . 1-81
1.11 Technical data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-83
1.12 Data logging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-88
1.13 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-90
2 Quick Wean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3
2.1.1 Quick Wean modes. . . . . . . . . . . . . . . . . . . . . . . . 2-4
2.2 Quick Wean in clinical use. . . . . . . . . . . . . . . . . . . . . . . . . 2-7
2.2.1 Quick Wean workflow . . . . . . . . . . . . . . . . . . . . . 2-7
2.2.2 Key terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11
2.2.3 About the Quick Wean parameters . . . . . . . . . . . 2-12
2.2.4 Indications of use . . . . . . . . . . . . . . . . . . . . . . . . 2-14
2.3 Enabling/Disabling Quick Wean and automated SBTs . . . 2-14
2.3.1 Enabling/Disabling Quick Wean. . . . . . . . . . . . . . 2-14
2.3.2 Enabling/Disabling automated SBTs. . . . . . . . . . . 2-17
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2.4 Conditions for starting weaning activities . . . . . . . . . . . . 2-18
2.4.1 About %MinVol calculations . . . . . . . . . . . . . . . 2-19
2.4.2 Parameters monitored to determine weaning
readiness (To start group) . . . . . . . . . . . . . . . . . 2-20
2.4.3 User-modifiable parameters: SBT Controls
window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-23
2.4.3.1 Changing Quick Wean settings . . . . . 2-26
2.4.4 Quick Wean Vent Status window. . . . . . . . . . . . 2-26
2.4.5 Quick Wean window (view 4) . . . . . . . . . . . . . . 2-30
2.4.5.1 Displaying the Quick Wean window
(view 4) . . . . . . . . . . . . . . . . . . . . . . 2-31
2.5 Conducting an SBT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-32
2.5.1 Monitoring pulse and breath rate increases . . . . 2-34
2.5.2 Monitoring PetCO
2
increases . . . . . . . . . . . . . . . 2-36
2.6 Conditions for aborting an SBT . . . . . . . . . . . . . . . . . . . 2-36
2.7 Conditions for successfully completing an SBT . . . . . . . . 2-39
2.8 About Quick Wean alarms and messages . . . . . . . . . . . . 2-39
2.9 Configuring Quick Wean . . . . . . . . . . . . . . . . . . . . . . . . 2-41
2.9.1 Changing the SBT Controls window default
settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-44
2.9.2 Restoring factory default configuration settings 2-45
2.10 Quick Wean parameters. . . . . . . . . . . . . . . . . . . . . . . . . 2-46
2.11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-55
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary-1
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1
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Table of Contents
1
624470/00 1-1
INTELLiVENT-ASV
1.1 Introduction 1-3
1.1.1 Intended Use 1-3
1.1.2 Ventilation 1-4
1.1.3 Oxygenation 1-4
1.1.4 Quick Wean 1-5
1.2 Indications for use and contraindications 1-6
1.2.1 Indications for Use 1-6
1.2.2 Contraindications 1-6
1.3 INTELLiVENT-ASV in clinical use 1-7
1.3.1 Introduction 1-7
1.3.2 Step 1: Before connecting the patient
to INTELLiVENT-ASV 1-8
1.3.3 Step 2: Preparing the ventilator for
INTELLiVENT-ASV 1-9
1.3.4 Step 3: Determining patient profile
for INTELLiVENT-ASV 1-9
1.3.5 Step 4: The INTELLiVENT window:
Selecting ventilation and oxygenation
management 1-10
1.3.6 Step 5: Alarm Settings 1-27
1.4 Monitoring INTELLiVENT-ASV 1-36
1.4.1 INTELLiVENT-ASV symbols 1-36
1.4.2 Horizon, Map, Guide 1-43
1.4.3 INTELLiVENT-ASV trend 1-49
1.4.4 Graphical INTELLiVENT-ASV indicators 1-51
1.5 Management of %MinVol 1-52
1.5.1 Management of %MinVol (passive
patient) 1-53
1.5.2 Management of %MinVol (active
patient) 1-56
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1.6 Management of PEEP and Oxygen 1-62
1.6.1 Management of PEEP/Oxygen for passive
and active patients 1-65
1.6.2 Emergency increase of oxygen 1-72
1.6.3 Patient condition rules (during
ventilation) 1-72
1.7 Assessing results 1-74
ventilation and oxygenation 1-75
1.9 Heart-Lung Interaction 1-77
1.10 Remarks: Sensor failure, standby, calibration 1-79
1.10.1 Ventilation management 1-79
1.10.2 Oxygenation management 1-81
1.11 Technical data 1-83
1.12 Data logging 1-88
1.13 References 1-90
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1.1 Introduction
INTELLiVENT-ASV offers the operator fully automatic manage-
ment of ventilation and oxygenation based on physiologic
input from the patient. The following paragraphs give a short
overview of the automatic management of ventilation and oxy-
genation provided by INTELLiVENT-ASV.
Additional sections provide a detailed step-by-step description
how to start INTELLiVENT-ASV by selecting the patient profile
and various patient conditions to a description of how INTEL-
LiVENT-ASV works.
1.1.1 Intended Use
INTELLiVENT-ASV is intended for use with all current and future
mechanical ventilators from HAMILTON MEDICAL AG (except
MR-related equipment).
INTELLiVENT-ASV provides fully automated closed-loop ventila-
tion and oxygenation based on physiologic input from the
patient. It provides continuous dynamic monitoring and control
of the patient's ventilation needs based on specified clinician
targets and changing patient conditions. INTELLiVENT-ASV
continuously monitors patient conditions, and automatically
adjusts ventilation and oxygenation parameters to keep the
patient within target ranges, with minimal clinician interaction,
from intubation until extubation.
INTELLiVENT-ASV also provides tools to promote early weaning
as part of the closed-loop control.
The use of INTELLiVENT-ASV is designed for use with all adults,
and pediatric patients from 7 kg; it is not available for neonatal
applications. INTELLiVENT-ASV can be used in the hospital and
during primary and secondary transport. INTELLiVENT-ASV can-
not be used in an MRI environment, as the required sensors are
not currently available without metal components.
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1.1.2 Ventilation
%MinVol management operates in two modes, automatic
and manual. For manual %MinVol management, see Sec-
tion 1.8. The %MinVol management automatically sets the
minute volume (%MinVol) depending on either of the fol-
lowing:
The measured end-tidal CO
2
partial pressure (PetCO
2
), if
the patient is passive
The difference between targeted and actual respiratory
rate, if the patient is active and PetCO
2
is on or below
the target range
The target PetCO
2
that is set depends on:
The patients treatment level (Peak inspiratory pressure)
The pathology and treatment profile of the patient
entered by the operator the user has the possibility to
select ARDS, chronic hypercapnia and brain injury
The PetCO
2
target shift set by the user
Whether weaning is to be promoted (user setting)
The optimal rate is defined by the Otis equation as it is in
ASV. For details, see the ASV appendix in the device Opera-
tors Manual.
1.1.3 Oxygenation
The PEEP/Oxygen management operates in two modes,
automatic and manual. The automatic PEEP/Oxygen man-
agement sets the oxygen and PEEP values according to the
Measured O
2
saturation (SpO
2
)
Haemodynamic state of the patient
Various patient conditions
For details, see Section 1.3.5.1.
The patients conditions and the applied PEEP determine the
expected SpO
2
range for the patient.
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The optimal relationship between PEEP and oxygen used
during automatic PEEP/oxygen management is based on
the ARDSnet guidance when increasing the therapy, and
the OPEN lung concept when decreasing the treatment.
See Section 1.13.
In manual mode, the operator keeps the SpO
2
in the target
range by adjustments of the PEEP or the oxygen, or both,
based on the HLI and SpO
2
monitoring values and
on clinical practice.
NOTE:
If PEEP/CPAP control is automated, the PEEP high and
low limit control is activated. When activated, the Oxy-
genation maps show two red dotted lines, one showing
the upper PEEP limit and one showing the lower. If auto-
mated control is not active, only the upper PEEP limit
line is displayed.
Note that a mix of Oxygenation map images are used in
this manual, some showing both lines, some showing
only the upper limit. For details on PEEP limits, see Sec-
tion 1.3.5.9.
1.1.4 Quick Wean
Quick Wean is integrated into INTELLiVENT-ASV, and when
activated, provides closed-loop, continuous dynamic moni-
toring and control of patient conditions to initiate spontaneous
breathing trials (SBT). It is used to evaluate patients muscle
strength and breathing performance, thereby helping you
gauge the potential for extubation.
For details, refer to the Quick Wean chapter.
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1 INTELLiVENT-ASV
1.2 Indications for use and contraindications
1.2.1 Indications for Use
NOTE:
Use the INTELLiVENT-ASV (or fully closed-loop con-
trol) for adult and pediatric patients only.
Use INTELLiVENT-ASV for intubated patients.
Be sure you are familiar with the installation and con-
figuration of the CO2 and SPO2 sensors. Review the
associated information in the device Operators
Manual.
1.2.2 Contraindications
WARNING
Do not use INTELLiVENT-ASV if
The patient weight is under 7 kg
There is a high leakage
The INTELLiVENT-ASV target ranges for PetCO
2

and SpO
2
cannot be set according to the hospi-
tal protocol or to the patients condition
Heliox gas is not compatible with INTELLiVENT-
ASV.
Do not use the INTELLiVENT-ASV automatic
PEEP/oxygen adjustment if a high carboxyhae-
moglobin or methaemoglobin value is expected
or clearly evidenced, or if the difference bet-
ween SaO
2
and SpO
2
is greater than 5%.
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1.3 INTELLiVENT-ASV in clinical use
1.3.1 Introduction
WARNING
Additional ventilator-independent patient
monitoring (for example, bedside vital moni-
toring or a blood gas analyzer (BGA)) must be
used during INTELLiVENT-ASV ventilation.
Check PaCO
2
against displayed PetCO
2
, and
SaO
2
against SpO
2
.
The %MinVol and PEEP/Oxygenation adjust-
ment is a completely automatic application on
patients.
The physician is responsible for final decisions.
INTELLiVENT-ASV is a fully closed-loop solution for patients
oxygenation and ventilation. ASV serves as the basic ventilation
mode to complete a fully closed-loop solution. In combination,
INTELLiVENT-ASV addresses all applications from intubation
through extubation with simplicity for early weaning.
The figures shown below present the ASV concept and the
INTELLiVENT-ASV concept.
Figure 1-1. ASV Concept in clinical use
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Figure 1-2. INTELLiVENT-ASV concept in clinical use
Figures 1-1 and 1-2 show that INTELLiVENT-ASV is built on the
ASV concept, where the operator sets a %MinVol and the ASV
management implements it by adjusting the Vt, RR and the Ti.
For details, see the ASV appendix in the device Operators Man-
ual.
1.3.2 Step 1: Before connecting the patient
to INTELLiVENT-ASV
Prepare the device for clinical use.
Important: Familiarize yourself with the procedures con-
tained in the Preparing for ventilation chapter of the venti-
lator Operators Manual. This includes, but is not limited to,
performing the pre-operational procedures and testing
where required.
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1.3.3 Step 2: Preparing the ventilator for INTEL-
LiVENT-ASV
Prepare the device with a mainstream CO
2
sensor and one
or two SpO
2
sensors.
For details, refer to the chapters, Preparing the ventilator
and Pulse oximetry in the device Operators Manual.
1.3.4 Step 3: Determining patient profile
for INTELLiVENT-ASV
WARNING
To prevent possible hyper- or hypo-ventilation,
ensure the correct patient profile is selected.
Entering a substantially wrong height/IBW
input will lead to a deviation of rate setting and
%MinVol start values.
Important: In this step, the term patient profile is separate
from the term patient condition/s used in other parts of this
manual. In this use, patient profile refers only to gender, height
(IBW), adult or pediatric selections.
To specify the profile and patient settings:
1. Configure the patient profile.
2. Touch the appropriate adult, pediatric, gender and height
(IBW) buttons.
3. Touch the INTELLiVENT tab to open the INTELLiVENT win-
dow.
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1 INTELLiVENT-ASV
Figure 1-3. Startup screen initial patient profile
1.3.5 Step 4: The INTELLiVENT window: Selecting
ventilation and oxygenation management
NOTE:
During ventilation, INTELLiVENT-ASV is available from
every mode by touching the INTELLiVENT tab.
1. Select whether the management of %MinVol, PEEP/CPAP
and Oxygen should be automatic or manual.
2. Select the patient condition. See Section 1.3.5.1 for more
information on the patient conditions and their effects.
3. Select whether to enable Quick Wean, any auto recruit-
ment options and the PEEP limit control. For details, see the
Quick Wean chapter, as well as Sections 1.3.5.8 and
1.3.5.9.
4. Touch Continue. The Alarms window automatically opens.
For details, see Step 5: Alarm Settings.
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The Continue button and the Alarms window only appear
at start up, or after a mode change. Coming from the ASV
mode, the Controls window appears. See Figure 1-4.
Figure 1-4. INTELLiVENT window
1 Open/close for supporting Ventilation Map window
2 Touch INTELLiVENT tab to close
3 Selection of automatic/manual management of %MinVol,
PEEP/CPAP and oxygen
4 Patient conditions
5 Enable/disable Quick Wean
6 PEEP limit control (upper and lower limits)
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1 INTELLiVENT-ASV
7 Target shift
Use the Target Shift function to shift the CO
2
target range
for CO
2
elimination (in accordance with the PaCO
2
value
from the blood gas analysis) and shift the SpO
2
target
ranges (in accordance with the SaO
2
value from the blood
gas analysis) for oxygenation)
8 Open or close for Quick Wean control window
9 Automatic recruitment
1.3.5.1 Patient Conditions
The examples provided in this section are of a single patient
condition and include the consequences for ventilation and
oxygenation at the very start of ventilation.
The starting Pasv limit, maximal allowed inspiratory pressure
level = PEEP+Pinsp (Pressure high limit = P ASV limit +
10mmHg), is set depending on the patient conditions. The
PEEP/Oxygen automatic adjustment has boundaries during
ventilation, controlled by the patient conditions and HLI. Note
that you can set the PEEP high and low limits when it is auto-
matically controlled.
The following table gives you an overview of the rules and
settings for startup and during ventilation.
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1-14 624470/00
1 INTELLiVENT-ASV
The figures in the following sections display the rules and set-
tings for startup and during ventilation in detail.
The Pasv limit should be adjusted by the operator before the
start of ventilation. When a change in patient conditions
occurs, Plimit is changed to the new patient conditions and the
operator is notified by a text message.
1.3.5.2 Normal patient: No condition is selected
Ventilation:
The startup value for the %MinVol is 100%
For a spontaneously breathing patient, the acceptable
range of the spontaneous breathing rate is
d=%MinVol/10
The startup value for Pasv limit is 30 cmH
2
O (if previ-
ously ventilated with ASV, the settings are not be
changed)
Figure 1-5 shows the range of acceptable PetCO
2
values.
Figure 1-5. Acceptable PetCO
2
Range Normal Patient
Oxygenation:
The startup value for PEEP is 5 cmH
2
O
The startup value for oxygen is 60%
Figure 1-6 shows the range of acceptable values.
624470/00 1-15

Figure 1-6. Acceptable SpO
2
Ranges Normal Patient
(the PEEP limit in the figures is an example and is the
default PEEP limit)
2
Ranges Normal Patient
(upper and lower PEEP limits enabled)
Recruitment maneuvers, weaning strategy, and HLI are deacti-
vated by default.
1-16 624470/00
1 INTELLiVENT-ASV
1.3.5.3 ARDS patient
WARNING
Set Chronic Hypercapnia and ARDS only if the
patient is suffering from one of these conditions.
If in doubt, leave unchecked.
Acute Respiratory Distress Syndrome (ARDS) presents as an
acute, severe injury to most segments of the lung.
Ventilation:
d=%MinVol/10
2
O
2
values.
2
Range ARDS Patient
Oxygenation:
2
O
624470/00 1-17

2
Ranges ARDS (the PEEP
limit in the figures is an example and is the default PEEP
limit)
Recruitment maneuvers, weaning strategy, and HLI are
deactivated by default.
1.3.5.4 Chronic Hypercapnia patient
The term chronic hypercapnia describes a patient with chroni-
cally high arterial CO
2
values, usually as a result of obstruction
in airways due to chronic bronchitis, emphysema, or both.
Ventilation:
The startup value for %MinVol is 90%
d=%MinVol/10
2
O
2
values.
1-18 624470/00
1 INTELLiVENT-ASV
2
Range Chronic
Hypercapnia Patient
Oxygenation:
No startup value for PEEP since PEEP must be set
manually
2
Ranges Chronic Hypercap-
nia (the PEEP limit in the figures is an example and corre-
sponds to the default PEEP limit)
624470/00 1-19

Recruitment maneuvers are inactive. Weaning strategy is dis-
abled by default. PEEP limitation by the HLI is not activated by
default as PEEP has to be set manually.
1.3.5.5 Patient with chronic hypercapnia and ARDS
(mixed condition)
Ventilation:
d=%MinVol/10
2
O
2
values.
2
Range Mixed Chronic
Hypercapnia/ARDS
Oxygenation:
2
O
1-20 624470/00
1 INTELLiVENT-ASV
2
Ranges Mixed Chronic
Hypercapnia/ARDS (the PEEP limit in the figure is an
example and corresponds to the default PEEP limit)
Recruitment maneuvers are inactive. Weaning strategy and
PEEP limitation by the HLI are disabled by default.
1.3.5.6 Patients with brain injury
WARNING
Always set brain injury if you are sure that the
patient has this condition. If the patient suffers
from a brain injury but brain injury is not set,
increased CO
2
levels and high cranial pressure
might result. Carefully monitor intracranial pres-
sure when available.
CAUTION
If brain injury is set but the patient should be nor-
mally ventilated, the patient will be slightly hyper-
ventilated and increased peak pressures might
occur.
624470/00 1-21

Ventilation:
The startup value for the %MinVol is 100%, or, if com-
bined with ARDS/Chronic Hypercapnia, the correspond-
ing ARDS/Chronic Hypercapnia value
d=%MinVol/15
The startup value for Pasv limit is:
28 cmH
2
O for brain injury only and for mixed
conditions (ARDS and Chronic Hypercapnia)
(see Figure 1-14).
30 cmH
2
O for brain injury combined with ARDS (see
Figure 1-15).
25 cmH
2
0 for brain injury combined with Chronic
Hypercapnia (see Figure 1-16).
2
Range Brain Injury
Patient only and mixed conditions
(Pasv limit = 28 cmH
2
O)
1-22 624470/00
1 INTELLiVENT-ASV
2
Range Brain Injury
Patient and ARDS (Pasv limit = 30 cmH
2
O)
2
Range Brain Injury
Patient and Chronic Hypercapnia (Pasv limit = 25 cmH2O)
624470/00 1-23

Oxygenation:
There is no startup value for PEEP as this is manually set
The range of acceptable values is the range for a normal
patient, a patient suffering from chronic hypercapnia or
ARDS, or a patient with a mixed condition, depending on
the setting.
Recruitment maneuvers are inactive. Weaning strategy is dis-
abled by default. PEEP limitation by the HLI is inactive as PEEP
has to be set manually.
1.3.5.7 Quick weaning
CAUTION
Check patient condition periodically to assess
whether the patient is able to be weaned.
NOTE:
If no CO
2
signal is available and the patient is breathing
actively, %MinVol is controlled via the spontaneous
breathing rate.
toring and control of patient conditions to evaluate the
patients potential readiness for extubation, including the pos-
sibility of conducting fully controlled spontaneous breathing
trials (SBTs).
For details, see the Quick Wean chapter of this guide.
1-24 624470/00
1 INTELLiVENT-ASV
1.3.5.8 Recruitment management
WARNING
Check for pneumothorax before ventilating the
patient. Automatic PEEP adjustment can lead to an
increase in ventilation pressure levels.
Recruitment is a strategy for re-expanding collapsed lung tis-
sue, and then maintaining higher PEEP to prevent subsequent
de-recruitment. To recruit collapsed lung tissue, sufficient
pressure must be imposed to exceed the critical opening pres-
sure of the affected lung.
The operator can select:
Passive Pt: Auto recruitment does not happen when
spontaneous breathing is detected
No Recruitment: No auto recruitment is conducted
The automatic recruitment maneuver in INTELLiVENT-ASV con-
sists of 20 sec CPAP with a pressure level of 40 cmH
2
O. The
trigger is set to 15 l/min and Pmax is set to 50 cmH
2
O.
Recruitment maneuvers occur after two consecutive automatic
increases of PEEP of 1 cmH
2
O. This means the recruitment
maneuver cycle occurs once every 12 minutes. The operator
receives an alarm notification as soon as a recruitment
maneuver is performed (see Table 1-2). See the next figure for
a graphic description of a recruitment cycle.
624470/00 1-25

Figure 1-17. Recruitment maneuver cycle
Important: During the recruitment maneuver, all patient
alarms are suppressed and the recruitment maneuver is can-
celled if a flow sensor failure or any pneumatic disconnection is
detected.
No recruitment maneuver takes place if:
HLI > 15% and HLI is used for PEEP limit
PEEP is manually changed
1.3.5.9 PEEP limit from HLI index
The device assesses the interaction between airway pressure
and haemodynamics by analyzing the Pulse Oximeter Plethys-
mogram. The Heart-Lung interaction (HLI) index is calculated
from the plethysmogram.
The PEEP limit control allows you to define an absolute high
limit that the PEEP controller cannot exceed. If enabled, you
can also specify an absolute low limit that it cannot fall below,
as shown in Table 1-1. The low limit can be set only when
CPAP/PEEP control is automated.
1-26 624470/00
1 INTELLiVENT-ASV
Figure 1-18. PEEP limit control
If HLI index is activated, it defines an upper limit for the PEEP
according to Figure 1-19:
Figure 1-19. PEEP Upper limit graph
Table 1-1. PEEP limit control settings
PEEP Limit Control
Range
Defaults Minimum difference
between High and
Low limit
5 to 25 cmH
2
O Low limit: 5 cmH
2
O
High limit: 25 cmH
2
O
No less than 2 cmH
2
O
624470/00 1-27

If the HLI value is not available for more than 6 minutes, the
PEEP limit set by the user in the INTELLiVENT window is taken
as the upper limit on PEEP.
In the case of chronic hypercapnia or brain injury, the operator
sets the PEEP manually.
If the operator manually limits the PEEP, the operator can
change the default value of 15 cmH
2
O to between 10 cmH
2
O
and 24 cmH
2
O.
If both the HLI-defined PEEP limit and operator-defined PEEP
limit are used, the PEEP is limited to the lower value.
1.3.6 Step 5: Alarm Settings
WARNING
Set all alarms to clinically acceptable values,
especially pressures, ExpMinVol, SpO
2
and CO
2
.
To prevent patient injury, review all alarm
settings periodically.
CAUTION
With the alarm silence button, the physiological
CO
2
and SpO
2
alarm can be suppressed for
< 120 seconds.
The alarm setting window appears automatically after confirm-
ing the INTELLiVENT-ASV settings on startup, when a new
patient is selected, or from a mode other than ASV. The pres-
sure limit is 30 cmH
2
O (alarm limit 40 cmH
2
O), if using a new
patient with INTELLiVENT-ASV. Depending on the selected
patient condition, the pressure limit has a specific default
value. This can be adjusted in the Alarms window.
1-28 624470/00
1 INTELLiVENT-ASV
Figure 1-20. Alarm Settings (on startup)
1. Make alarm selections according to patient conditions,
weaning strategy, recruitment strategy and PEEP limitation.
2. When selections are complete, touch the Confirm button
to set the alarm.
Touch Cancel and the Standby window appears again.
Note the following about special INTELLiVENT-ASV alarms:
PetCO
2
(low and high): Low and high monitored PetCO
2
. If
either limit is reached, a medium-priority alarm sounds.
Range:
Low: OFF, 0 to 99 mmHg/0 to 13.2 kPa
High: OFF, 1 to 100 mmHg/1 to 13.3 kPa
SpO
2
(low and high): Low and high monitored SpO
2
.
If either limit is reached, a medium-priority alarm is
sounded. If the SpO
2
falls below 85% of the set alarm limit,
a high-priority alarm is generated.
Range:
Low: OFF, 70 to 99%
624470/00 1-29

HLI (high): High HLI is monitored. If the specified high limit
is reached, a medium-priority alarm is generated.
Range:
High: OFF, 0 to 40%
Ensure the measurements for O
2
, SpO
2
, and CO
2
are acti-
vated and the corresponding alarms are set correctly.
Table 1-2. Alarm conditions
Alarm Definition
Complete these actions
Check
INTELLiVENT-
ASV PEEP
limit setting
HLI 10% and
VT/kg 6 ml or
(Ppeak exp pressure 10
cmH
2
O) and
PEEP 10 cmH
2
O
Verify if patient is haemody-
namic stable. Alarm is reset
when HLI limitation is deacti-
vated.
CO
2
sensor
faulty
Low priority.
CO
2
sensor signal indicates
a hardware error; or a
third-party sensor is
installed.
Disconnect the sensor from the
CO
2
module. Wait 10 seconds,
and reconnect. Then recalibrate
the sensor. Install a new CO
2

sensor, if error persists. Ensure
the sensor is a genuine HAMIL-
TON MEDICAL sensor.
FiO
2
oscilla-
tion
Medium priority.
Large up and down
changes of FiO
2
in a short
period of time.
Check patient.
Set PEEP and oxygen to manual
control.
FiO
2
set to
100% due to
low satura-
tion
Medium priority.
INTELLiVENT-ASV has
increased oxygen to 100%.
Observe the patient.
Silence the alarm; this also
resets the alarm.
High HLI Medium priority.
Measured HLI > alarm limit.
Verify the haemodynamic status
of the patient and adjust the
alarm limits if needed.
High PetCO
2
Medium priority.
PetCO
2
> the set alarm
limit.
Observe the patient. Verify and
adjust the ventilator settings,
including alarms.
1-30 624470/00
1 INTELLiVENT-ASV
Low PetCO
2
Medium priority.
PetCO
2
< the set alarm
limit.
Observe the patient. Verify ven-
tilator settings, including alarm
settings.
MV oscilla-
tion
Medium priority.
Large up and down
changes of %MinVol over
a short period of time.
Switch %MinVol to manual
control.
No haemo-
dynamic sta-
tus available
Medium priority.
HLI for > 6 minutes invalid,
SpO
2
measurement ON,
and HLI used by the con-
troller.
Inspect the pulse oximeter
attachment location on the
patient. Verify the pulse oxime-
ter plethysmogram.
No haemo-
dynamic sta-
tus available
Low priority.
HLI for > 6 minutes invalid,
SpO
2
measurement ON,
High HLI alarm limits on
and HLI not used by the
controller.
Inspect the pulse oximeter
attachment location on the
patient. Verify the pulse oxime-
ter plethysmogram.
Oxygenation
adjustment
OFF (no
SpO
2
)
Medium priority.
PEEP or Oxygen automatic,
SpO
2
invalid and needed
for at least the last 60 sec-
onds.
Set PEEP and Oxygen to manual
control.
Oxygenation
adjustment
OFF (no
SpO
2
)
Low priority.
PEEP or Oxygen automatic,
SpO
2
invalid and needed
for at least the last 30 sec-
onds.
Set PEEP and Oxygen to manual
control.
Oxygenation
Controller on
Limit
Low priority.
SpO
2
too low and PEEP
and/or Oxygen cannot be
further increased.
Observe patient.
Set Oxygen and/or PEEP to
manual control or resolve prob-
lem.
Alarm Definition
624470/00 1-31

%MinVol
automation
off
Operator Message.
Patient weight is set below
7 kg and %MinVol is in
automatic mode.
none
PEEP auto-
mation off
Operator Message.
Patient weight is set below
7 kg and PEEP is in auto-
matic mode.
none
PEEP manual Operator Message.
Chronic Hypercapnia only
(but no ARDS) and/or brain
injury selected.
none
PEEP oscilla-
tion
Medium priority.
Large up and down
changes in PEEP over a
short period of time.
Check patient.
PEEP set to manual control.
Recruitment
in progress
Low priority.
Recruitment maneuver in
progress.
Wait. Observe patient.
SpO
2
: sen-
sor error (left
slot)
Medium priority.
Hardware problem with
sensor adapter.
Replace left sensor adapter.
SpO
2
:
patient dis-
connected
(left slot)
Medium priority.
Probe is detached from
patient or not properly
attached to patient.
Probe malfunction.
Check whether left probe is
attached properly to patient.
Replace left probe.
Alarm Definition
1-32 624470/00
1 INTELLiVENT-ASV
SpO
2
: no
sensor (left
slot)
Medium priority.
Probe is disconnected from
adapter.
Adapter is disconnected
from ventilator.
Cable defective.
Connect left probe to adapter.
Connect left sensor adapter to
ventilator.
Replace left adapter and/or left
probe.
SpO
2
: light
interference
(left slot)
Medium priority.
Light interference in sensor
probe
Cover left probe with blanket or
change attachment site on
patient.
Replace left probe.
SpO
2
: poor
signal (left
slot)
Medium priority.
Pulse from left SpO
2
sensor
not found
Verify left probe attachment,
check if left probe site is prop-
erly perfused.
SpO
2
left
sensor
adapter
faulty
Operator Message.
left sensor adapter. Second
SpO
2
sensor still working
normally.
Replace left sensor adapter.
SpO
2
left
sensor dis-
connected
Operator Message.
Left probe is disconnected
from adapter. Adapter is
disconnected from ventila-
tor. Cable defective. Sec-
ond SpO
2
sensor still
working normally.
Connect left probe to adapter.
Connect left sensor adapter to
the ventilator. Replace left
adapter and/or probe.
SpO
2
left
sensor probe
faulty
Operator Message.
Left probe is detached
from patient or properly
attached to patient. Probe
malfunction. Second SpO
2

sensor still working nor-
mally.
Check left probe is attached
properly to patient. Replace left
probe.
Alarm Definition
624470/00 1-33

SpO
2
left
sensor light
interference
Operator Message.
Light interference in left
sensor probe. Second SpO
2

mally.
Cover left probe with blanket or
change attachment site on
patient. Replace left probe.
SpO
2
: poor
signal (left
slot)
Operator Message.
Pulse from left SpO
2
sensor
not found. Second SpO
2

mally.
Verify left probe attachment,
check if left probe site is prop-
erly perfused.
SpO
2
: sen-
sor error
(right slot)
Medium priority.
sensor adapter.
Replace right sensor adapter.
SpO
2
:
patient dis-
connected
(right slot)
Medium priority.
Probe malfunction. Probe is
detached from patient or
not properly attached to
patient.
Verify if right probe is attached
properly to patient.
Replace right probe.
SpO
2
: no
sensor (right
slot)
Medium priority.
Probe is disconnected from
adapter. Adapter is discon-
nected from ventilator.
Cable defective.
Connect right probe to adapter.
Connect right sensor adapter to
ventilator.
Replace right adapter and/or
probe.
SpO
2
: light
interference
(right slot)
Medium priority.
Light interference in sensor
probe
Cover right probe with blanket
or change attachment site on
patient.
SpO
2
: poor
signal (right
slot)
Medium priority.
Pulse from right SpO
2
sen-
sor not found.
Verify right probe attachment,
check if right probe site is prop-
erly perfused
Alarm Definition
1-34 624470/00
1 INTELLiVENT-ASV
SpO
2
right
sensor
adapter
faulty
Operator Message.
right sensor adapter. Sec-
ond SpO
2
sensor still work-
ing normally.
Replace right sensor adapter.
SpO
2
right
sensor dis-
connected
Operator Message.
Right probe is discon-
nected from adapter.
Adapter is disconnected
from ventilator. Cable
defective. Second SpO
2

mally.
Connect right probe to adapter.
Connect right sensor adapter to
the ventilator. Replace right
adapter and/or probe.
SpO
2
right
sensor probe
faulty
Operator Message.
Right probe is detached
from patient or properly
attached to patient. Probe
malfunction. Second SpO
2

mally.
Check whether right probe is
attached properly to patient.
SpO
2
right
sensor light
interference
Operator Message.
Light interference in right
sensor probe. Second SpO
2

mally.
Cover right probe with blanket
or change attachment site on
patient.
SpO
2
: poor
signal (right
slot)
Operator Message.
Pulse from right SpO
2
sen-
sor not found. Second
SpO
2
sensor still working
normally.
Verify right probe attachment,
check if right probe site is prop-
erly perfused.
SpO
2
too
high
Low priority.
Measured SpO
2
> alarm
limit
settings.
Alarm Definition
624470/00 1-35

SpO
2
too
low
High priority.
Monitored SpO
2
is below
88% and alarm limit.
settings.
SpO
2
too
low
Medium priority.
Monitored SpO
2
is below
alarm limit.
settings.
Ventilation
adjustment
OFF (no
PetCO
2
)
Low priority.
%MinVol automatic and 2.
highest value of PetCO
2

during last 8 breaths
invalid and PetCO
2
needed
by controller since > 30
seconds and < 60 seconds.
Set %MinVol to manual con-
trol, or resolve problem causing
CO
2
measurement error
Ventilation
adjustment
OFF (no
PetCO
2
)
Medium priority.
%MinVol automatic and 2.
highest value of PetCO
2

during last 8 breaths
invalid and PetCO
2
needed
by controller for at least
the last 60 seconds.
Set %MinVol to manual control
or resolve problem causing CO
2

measurement error.
Ventilation
Controller on
Limit
Low priority.
%MinVol cannot be fur-
ther increased.
Observe patient.
Set %MinVol to manual control
or resolve problem.
Alarm Definition
1-36 624470/00
1 INTELLiVENT-ASV
1.4 Monitoring INTELLiVENT-ASV
1.4.1 INTELLiVENT-ASV symbols
Table 1-3 lists information about single graphical elements and
their colors and meanings.
624470/00 1-37
T
a
b
l
e

1
-
3
.

S
i
n
g
l
e

g
r
a
p
h
i
c

e
l
e
m
e
n
t
s
I
N
T
E
L
L
i
V
E
N
T
-
A
S
V

S
y
m
b
o
l
C
o
l
o
r
A
/
M
D
e
s
c
r
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p
t
i
o
n
A
c
t
i
o
n
/
V
a
l
u
e
s
C
o
m
m
e
n
t
s
-
-
-
-
-
-
C
l
o
s
e

s
y
m
b
o
l
C
l
o
s
e
s

w
i
n
d
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w
s
U
s
e
d

w
h
e
n

c
h
a
n
g
i
n
g

I
N
T
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L
L
i
V
E
N
T
-
A
S
V
.

d
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r
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n
g

v
e
n
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624470/00 1-43

1.4.2 Horizon, Map, Guide
Monitor the %MinVol and PEEP/Oxygen management using
the Ventilation/Oxygenation Horizon, Ventilation/Oxygenation
Map and Ventilation/Oxygenation Guide windows, which pro-
vide detailed information on CO
2
elimination and oxygenation.
The Ventilation/Oxygenation Horizon panels display the physio-
logical input (PETCO
2
, SPO
2
). In addition, a capnogram and
pulse oximetry are displayed as waveforms in the Ventilation/
Oxygenation Horizon panel. The Ventilation Horizon displays
the patients spontaneous breathing rates in a second horizon-
tal panel.
The Ventilation/Oxygenation Guide describes all ventilation and
oxygenation management actions in automatic mode. Infor-
mation is displayed during manual ventilation control (that is,
how the automation would act as if it was active).
To access these panels, click the View navigation buttons in the
top right of the screen.
Figure 1-21. Ventilation Horizon (active patient)
1 Ventilation Horizon window
2 Floater
3 Ventilation Horizon
4 Spont target range
1-44 624470/00
1 INTELLiVENT-ASV
5 Capnogram
6 Spont value
7 PetCO
2
value
8 Quality indicator
Figure 1-22. Ventilation Horizon (passive patient)
1 Patient symbol
2 Ventilation Horizon window
3 Ventilation Horizon
4 Increase zone
5 Target zone
6 Decrease zone
7 Capnogram
8 PetCO
2
value
9 Quality indicator
624470/00 1-45

Figure 1-23. Oxygenation Horizon
1 Oxygenation Horizon window
2 Target zone
3 Increase zone
4 Patient symbol
5 Decrease zone
6 Plethysmogram
7 Perfusion index (PI) value (only with Masimo pulse
oximeter)
8 SpO
2
value
9 Quality indicator
1-46 624470/00
1 INTELLiVENT-ASV
Figure 1-24. Ventilation Map
1 Patient symbol
2 Ventilation Map
3 Ventilation Map window
4 Spont status
5 Indicator decrease
6 Target line
7 Increasing zone
8 Target zone
9 Decreasing zone
10 Pasv limit
11 Pressure high (alarm) limit
624470/00 1-47

Figure 1-25. Oxygenation map
1 Patient symbol
2 Oxygenation Map
3 Oxygenation Map window
4 Tabs
5 Indicator decrease
6 Increasing zone
7 Target zone
8 Decreasing zone
9 Indicator increase
10 Emergency zone
The maps display detailed information on the automatic
management of the ventilation and oxygenation. Oxygenation
management is represented by two different maps, PEEP/SpO
2
,
and PEEP/O
2
.
1-48 624470/00
1 INTELLiVENT-ASV
Figure 1-26. Oxygenation map (Open lung concept)
1 Patient symbol
2 Oxygenation Map
4 Decreasing target path
5 PEEP limit
6 Increasing target path
Figure 1-27. Oxygenation map (ARDSnet)
624470/00 1-49

1 Patient symbol
2 Oxygenation Map
4 Increasing target path
5 PEEP limit
6 Decreasing target path
1.4.3 INTELLiVENT-ASV trend
To display and review how the automatic management of
%MinVol and PEEP/Oxygen performed during the previous 1
hr, 3 hrs, 12 hrs, 24 hrs, or 96 hrs trend, touch the Trend but-
ton on the right side of the INTELLiVENT-ASV graphs.
The INTELLiVENT-ASV trend only works in the maps. The trend
is available in either automatic or manual management. See
a description of the trend in Figure 1-28 and Figure 1-29.
Figure 1-28. Trend CO
2
1 Patient symbol plus, small values (yellow) indication of
patients actual location and actual sensor values
2 %MinVol at a certain time
3 Trend button (accessible only in view 2/2)
4 fSpont at a certain time
1-50 624470/00
1 INTELLiVENT-ASV
5 Past PetCO
2
value
6 Past Ppeak value
Figure 1-29. Trend O
2
1 Oxygen at a certain time
2 History (patient history regarding SpO
2
and PEEP)
3 Patient symbol plus, small values (yellow) indication of
patients actual location and actual sensor values at a
certain time
4 Scrollable time bar (fine-tune/scroll to specific time
previous 24 h)
5 Actual SpO
2
value
6 Actual PEEP value
The case above shows a patient having a SpO
2
of 94% and
a PEEP of 5 cmH
2
O (indicated by the patient symbol and the
small yellow numbers inside the map) in the present. At 11:48,
the patient had a SpO
2
of 97% a PEEP of 5cmH
2
O (indicated
by the small orange cross and the large white numbers outside
the map).
624470/00 1-51

1.4.4 Graphical INTELLiVENT-ASV indicators
Figure 1-30 describes the graphical items that indicate if INTEL-
LiVENT-ASV is managing the patient automatically or manually.
Figure 1-30. Graphical INTELLiVENT-ASV Indicators
1 Color difference (light blue) in automatic management
2 Highlighted frame in automatic mode
3 Rotating circle in automatic management (blue)
4 Solid blue circle in manual mode
5 Color difference (dark blue) in manual management
1-52 624470/00
1 INTELLiVENT-ASV
1.5 Management of %MinVol
WARNING
Inspect CO
2
adapters/sensors regularly. Patient
secretions in airway adapters might lead to an
incorrect PetCO
2
reading.
DO NOT use the sidestream CO
2
sensor with the
automatic management of the %MinVol.
The minute volume adjustment operates based on the dif-
ferent concept depending on whether the patient is able to
trigger the breath (active), or not (passive).
All ASV safety limits are active:
Prevention of apnea
Prevention of baro- and volutrauma
Prevention of AutoPEEP
Prevention of dead-space ventilation
The limits for %MinVol for the automatic management are
shown in Table 1-4. As soon as a limit for the automatic
management of %MinVol is reached, an alarm message
is displayed (see Table 1-2).
Table 1-4. %MinVol Limits
Minimum MinVol [%] EtCO
2
available 70
EtCO
2
not available 100
Maximum MinVol [%] EtCO
2
available 200
EtCO
2
not available 200
624470/00 1-53

1.5.1 Management of %MinVol (passive patient)
End-tidal CO
2
partial pressure (PetCO
2
), available when the
CO
2
sensor is connected, is the maximum partial pressure of
CO
2
exhaled during a tidal breath (just before the start of inspi-
ration). This represents the final portion of air that was involved
in the exchange of gases in the alveolar area.
Under common clinical conditions, this represents a reliable
index of CO
2
partial pressure in the arterial blood. It has been
shown that under normal conditions, PaCO
2
is about 3-5
mmHg higher than PetCO
2
.
Under special clinical conditions (including massive ventilation/
perfusion problems, shunt) the difference between PetCO
2
and
PaCO
2
might increase. A change in the PaCO
2
-PetCO
2
differ-
ence can be taken into account by shifting the range of accept-
able PetCO
2
values in the INTELLiVENT window using the
Target Shift control. See Section 1.7 for details.
To get the most accurate approximation to PaCO
2
, the second
highest PetCO
2
value out of 8 breaths is used. The optimal
ranges of PetCO
2
depend on the operator-defined patient con-
ditions (Section 1.3.5.1), on the PetCO
2
Target Shift value set
be the user in INTELLiVENT window and on the actual level of
ventilator support. Within these ranges, and based on the
PetCO
2
response from the patient, the %MinVol is adjusted.
When PetCO
2
is above the zone of acceptable PetCO
2
ranges,
the minute ventilation is increased. If the PetCO
2
is below the
acceptable ranges, the %MinVol is decreased.
Only minor adjustments are made if PetCO
2
is in the accept-
able ranges to promote early weaning. For details on Quick
Wean, see the Quick Wean chapter of this guide.
The absolute limits for %MinVol are 70% (minimum) and
200% (maximum) of the physiological %MinVol value. The
minute volume management for passive patients adjusts CO
2

according to the following table.
1-54 624470/00
1 INTELLiVENT-ASV
PetCO
2
too high (Position on curve is above upper limit) -> %MinVol is increased.
PetCO
2
in range (Position on curve is between the limits) -> Automatically maintained
%MinVol is increased. Intention: Decreasing Pinsp
624470/00 1-55

PetCO
2
too low (Position on curve is below the lower PetCO
2
limit) -> Automatic
decrease of %MinVol
No PetCO
2
available Controller freezes and the alarm ventilation management off (no
PetCO
2
) appears
1-56 624470/00
1 INTELLiVENT-ASV
1.5.2 Management of %MinVol (active patient)
When a patient is spontaneously triggering the breaths, the
ventilator adjusts the target minute ventilation, based on the
spontaneous breathing rate of the patient. The spontaneous
breathing rate (fSpont) is compared with target rate as defined
by ASV rate (calculated using Otis's equation). If the patient
complies with RULE 1 and if the patients rate is above the zone
of acceptable spont rate (danger of patient fatigue), the
%MinVol increases. If the patient complies with RULE 1 and if
the patientss rate is below the zone, the %MinVol decreases.
RULE 1 Active Patient: The %MinVol management starts
to adjust the %MinVol based on the rate if five consecutive
spontaneous breaths occur and the PetCO
2
value is inside
or below the range.
As the ventilation management is running based on the
rate, it checks RULE 2 continuously. If the device does not
comply with RULE 2, it will continue to adjust the rate for
the %MinVol based on the spontaneous breathing rate of
the patient.
RULE 2 Passive Patient: Five consecutive mechanical
breaths or the PetCO
2
value exceeds the upper limit by at
least 3 mmHg.
In this case, the %MinVol is adjusted on the PetCO
2
input.
These rules are displayed in the following flow chart.
RULE 3 %MinVol is only changed when PetCO
2
is avai-
lable and the patient had 5 consecutive spontaneous
breaths.
When PetCO
2
is not available, the red controller freezes.
624470/00 1-57

Figure 1-31. Flowchart for rules of management of
%MinVol, active patient
1-58 624470/00
1 INTELLiVENT-ASV
While the patient is active, the patients spontaneous rate is
detected by the Flow Sensor, and the PetCO
2
value is only used
for additional safety on active patients in the background to
avoid excessive PetCO
2
values.
The lower limit of the range of acceptable spontaneous breath-
ing rate is equal to the ASV rate; the upper limit of the range is
equal to ASV rate + d.
d=%MinVol/k where k is 15 in brain injured patients, and
10 in all other patients.
If Quick Wean is activated, the range of acceptable PetCO
2
is
increased by 5 mmHg, and the value 2 is added to the ASV rate
to define the low spontaneous breathing rate for the rate con-
troller. For setting the high limit, d is multiplied by a factor of
1.5. In addition, the PetCO
2
limit is increased by 5 mmHg.
%MinVol management for active patients adjusts %MinVol as
shown in the following pages. The rate controller bar is dis-
played on the Ventilation Map or Ventilation Horizon window;
if no spontaneous breathing is detected, the bar is dimmed.
Rate too high (Position on bar is above upper limit) -> Automatically increases %MinVol
624470/00 1-59

Rate in range (Position on bar is between limits) -> %MinVol is maintained
Rate too low (Position on bar is below the lower limit) -> Automatic decrease of
%MinVol
1-60 624470/00
1 INTELLiVENT-ASV
PetCO
2
> (3mmHg+PetCO
2
limit) -> If PetCO
2
is > (+3mmHg than the PetCO
2
upper
limit), the ventilation management based on the PetCO
2
is started again even if the
patient breathes spontaneously
No spontaneous rate available -> Controller returns to managing ventilation according
to the PetCO
2
input. If CO
2
is not available, the controller stops management and gener-
ates an alarm.
624470/00 1-61

No PetCO
2
available -> Controller freezes.
1-62 624470/00
1 INTELLiVENT-ASV
1.6 Management of PEEP and Oxygen
WARNING
SpO
2
measurement can be incorrect if
the patients carboxyhaemglobin or methaemo-
globin increases abnormally
dye is injected into the blood
use of electrosurgical unit
measuring at a site with venous pulse
there is body movement
the pulse wave is small (insufficient peripheral
circulation)
In case of anemia and blood loss the SpO
2
sen-
sor is unable to detect tissue hypoxia.
Skin pigmentation can affect the SpO
2
value.
Verify SpO
2
by checking the plethysmographic
wave from and the quality index of the mea-
sured SpO
2
value.
Attach the pulse oximetry sensor carefully, and
check the position periodically. Do not diagnose
patients based solely on the data from the
pulse oximeter. Overall judgment must be made
by a physician who understands the limitations
and characteristics of the pulse oximeter, and
who can read the biomedical signals acquired
by other instruments.
Use disposable probes only once. They cannot
be sterilized and can cause cross infection.
If the attachment site is unclean, clean the
attachment site before attaching the probe. If
there is nail polish on the attachment site,
remove the polish. Otherwise, the amount of
transmitted light decreases, and measured
value can be incorrect or measurement unable
to be performed.
624470/00 1-63

Normal external light does not affect measure-
ment, but strong light such as a surgical light or
sunlight can affect measurement. If the measur-
ing site is affected, cover it with a blanket.
Make sure that there is no light interference
when attaching more than on probe.
Turn off the power of mobile phones, small
wireless devices and other devices which pro-
duce strong electromagnetic interference
around a patient (except for devices allowed by
the hospital administrator). Radio waves from
devices such as mobile phones or other small
wireless equipment.
Keep the patient away from the cable as much
as possible. If the cable coils around the patient
by their body movement, the patient can get
injured. If this happens, remove the cable
promptly.
To avoid poor circulation, do not wrap the tape
too tight. Check the blood circulation condition
by observing the skin color and congestion at
the skin peripheral to the probe attachment
site. Even for short-term monitoring, there can
be burn or pressure necrosis from poor blood
circulation, especially on neonates or low birth
weight infants whose skin is delicate. Accurate
measurement cannot be performed on a site
with poor peripheral circulation.
Never use the SpO
2
adapter in the presence of
any flammable anesthetic gas or high concen-
tration oxygen atmosphere. Failure to comply
with this warning can cause explosion or fire.
Never use the SpO
2
adapter in a hyperbaric oxy-
gen chamber. Failure to comply with this warn-
ing can cause explosion or fire.
1-64 624470/00
1 INTELLiVENT-ASV
When not measuring SpO
2
, disconnect the SpO
2

adapter from the device. Otherwise, noise from
the probe sensor can interfere and incorrect
from the probe sensor can interfere and incor-
rect data is displayed on the screen.
Before monitoring SpO
2
through the SpO
2

adapter, confirm that the operators manual of
the device to which the SpO
2
is connected
allows the use of the SpO
2
adapter. The safety
of the attachment section (including the SpO
2

adapter and the probe) depends on the specifi-
cations of the connected device. If the SpO
2

adapter is used with an instrument or SpO
2

probe other than the specified ones, the patient
and the operator can get an electrical shock and
the SpO
2
adapter can be become hot.
CAUTION
Detach SpO
2
sensor before defibrillation.
If the probe is attached to same limb that is
used for NIBP measurement or an IPB catheter,
the blood circulation at the attachment site is
affected and the measurement might not be
correct. Attach the probe to a limb where the
blood circulation is not affected.
Do not pull or bend the probe cable, and do not
let caster feet run over the probe cable. Failure
to follow these cautions may cause cable dis-
continuity, short circuit, skin burn on the
patient and incorrect measurement date.
Replace any broken probe with a new one.
Redness or skin irritation may appear on the
attachment site. Take extreme care of patients
with weak skin. In case of redness or skin irrita-
tion, change the attachment site or stop using
the probe.
624470/00 1-65

NOTE:
The emergency increase of Oxygen remains in place
for all cases while the Oxygen control is set to auto-
matic.
The PEEP/Oxygen controller can only adjust the
Oxygen between 30 and 100%.
The PEEP controller can only operate between 5 and
25 cmH
2
0.
With some models, a second SpO
2
sensor can be
used on the ventilator to increase the availability and
accuracy of SpO
2
measurement. For details, see the
ventilator Operators Manual chapter, Pulse oximetry.
The lung-protective rules for Oxygenation management use
the ARDSnet table when increasing the treatment, and the
Open-Lung concept when decreasing the treatment. The
Heart-Lung Interaction (HLI) is derived from the Plethysmo-
graphic curve. If HLI is above 15%, it is limiting the maximally
allowed PEEP, if activated. For details, see Section 1.13.
1.6.1 Management of PEEP/Oxygen for passive
and active patients
Using the SpO
2
signal, retrieved from the pulse oximeter, the
difference between the actual and the target SpO
2
value is cal-
culated. This calculation, together with the HLI value and the
operators input, is used to determine the treatment action.
The PEEP/Oxygen automatic management consists of two
steps. They are:
The operators input and the actual treatment (PEEP) define
the SpO
2
target range. The SpO
2
signal and the SpO
2

target range are used to define the treatment action
(increase, decrease, no change of treatment).
1-66 624470/00
1 INTELLiVENT-ASV
The system decides, depending on the actual combination
of PEEP and oxygen on the PEEP/Oxygen curve, if PEEP, oxy-
gen or both (when the currently used PEEP/Oxygen combi-
nation lies already on the PEEP/Oxygen curve) are increased.
The relationship between PEEP and oxygen is based on the
ARDSnet guidance for increasing therapy (Figure 1-32,
target path bold) and the open lung concept for decreasing
therapy (Figure 1-33, target path bold).
Figure 1-32. Increase of oxygenation support
(ARDSnet guidance)
Figure 1-33. Decrease of Oxygenation
(Open Lung concept)
624470/00 1-67

The device adjusts PEEP/Oxygen and, as a result, the oxygen-
ation of the patient is affected. The physiological input and the
controller action are shown on the following pages.
SpO
2
too high (Position of SpO
2
is above upper SpO
2
limit) -> Decrease oxygen
support
Position on OPEN LUNG curve:
1. Above curve: automatic decrease of Oxygen stepwise to the
PEEP/Oxygen curve.
2. On Curve: automatic decrease of PEEP and Oxygen to follow
the PEEP/Oxygen curve.
3. Below curve: automatic decrease of PEEP stepwise to the PEEP/
Oxygen curve.
1-68 624470/00
1 INTELLiVENT-ASV
SpO
2
in range Position of SpO
2
is between SpO
2
limits and oxygen setting is >
5% above PEEP/Oxygen curve -> Decrease oxygen support as long as SpO
2
is in
range and oxygen has been automatic for > 60 min (weaning).
624470/00 1-69

SpO
2
too low (Position SpO
2
is below lower SpO
2
limit) -> Increase oxygen
support.
Position on ARDSnet guidance curve:
1. Above curve: Change PEEP stepwise to get on the curve
2. On curve: increase of PEEP stepwise to PEEP limit and increase
of oxygen to follow the PEEP/Oxygen curve
3. Below curve: automatic increase of Oxygen, stepwise to a
value on the PEEP/Oxygen curve
1-70 624470/00
1 INTELLiVENT-ASV
SpO
2
critically low (Position represents a critical condition) -> Emergency
increase of oxygen (see next paragraph)
Indication on screen:
624470/00 1-71

No SpO
2
available -> Controller freezes and the alarm Oxygenation
Management off (no SpO
2
) appears.
Indication on screen:
1-72 624470/00
1 INTELLiVENT-ASV
1.6.2 Emergency increase of oxygen
This safety feature continuously monitors the patients SpO
2
to
avoid dangerous desaturation (as depicted in Figure 1-34) in
the background, and can react immediately to deliver the
patient 100% oxygen upon detection. The safety feature is
activated when the physiologic SpO
2
value of the patient falls
below the lowest acceptable value, triggering the 100% oxy-
gen response when oxygen control is set to automatic. In this
case, an alarm message is displayed indicating that the Oxygen
value was set to 100% (see Table 1-2).
Figure 1-34. Oxygenation Map where emergency
management of Oxygen occurs
1.6.3 Patient condition rules (during ventilation)
The device adjusts PEEP and oxygen as described in Table 1-5.
624470/00 1-73

Table 1-5. Patient condition rules during ventilation
Oxygenation
Management
Definition of action The case if ...
Decrease oxygen step-
wise
Decreases oxygen by
5% of current Oxygen
value every 60 sec-
onds.
Minimal step size
is 1%.
Oxygen automati-
cally managed
Decreasing oxygen
support
Increase oxygen step-
wise
Increases oxygen by
10% of current Oxy-
gen value every
30 seconds.
Minimal step size
is 1%.
Oxygen automati-
cally managed
Increasing oxygen
support
Increase PEEP stepwise Increases PEEP every 6
minutes by 1 cmH2O
PEEP automatically
managed
Increasing PEEP
support
PEEP is below the
upper PEEP limit
Decrease PEEP step-
wise
Decreases PEEP every 6
minutes by 1 cmH
2
O
PEEP automatically
managed
Decreasing PEEP
support
NOTE:
If a lower limit is speci-
fied, PEEP will not go
below the lower limit.
1-74 624470/00
1 INTELLiVENT-ASV
1.7 Assessing results
WARNING
The responsibility for the settings rests solely with
the physician.
NOTE:
Use the Target Shift control to correct the adjustment of
the measured PaCO2 value and a measured PetCO
2

value. The values can be shifted by 15 mmHg to the left
and by 10 mmHg to the right. After an adjustment of
5 mmHg, the target value can only be set to target val-
ues of -15/+10 mmHg by reconfirming using the cursor.
Use the Target Shift control in the oxygenation window
to change the target range for the SpO
2
measurement.
The target range can be shifted by 2% to the left and
by 5% to the right.
Note that the emergency range follows the target shift.
Decrease PEEP step-
wise
Exception: PEEP
decreases quickly every
30 seconds
PEEP automatically
managed
PEEP is above the
upper PEEP limit
(if PEEP was set
manually above
the limit or the
PEEP is above the
limit allowed by
HLI
Table 1-5. Patient condition rules during ventilation
Oxygenation
Management
Definition of action The case if ...
624470/00 1-75

Figure 1-35. Target shift
After the calculated targets are reached, the ventilation man-
agement results need to be assessed. Use the monitored
parameters for this purpose. However, to assess respiratory
acid-base status, it is recommended that arterial blood gases
be measured to monitor the minute volume adjustment.
ventilation and oxygenation
WARNING
If oxygen is manually controlled, the rapid
response PEEP/Oxygen adjustment is inactive.
The responsibility for the settings rests solely
with the physician (operator).
NOTE:
You can use INTELLiVENT-ASV in either automatic or
manual mode.
References in this section are to the display, Ventilation
Guide, shown in Figure 1-36.
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1 INTELLiVENT-ASV
In open-loop ventilation (manual mode), the operator sets
a value for %MinVol, PEEP and Oxygen supported by protocol
guidance from the ventilator. The guidance consists of text
notes based on the current results of the CO
2
and SpO
2
mea-
surement, and the patients respiratory rate. This guidance
informs the operator of what strategy the system would use in
the automatic mode to adjust %MinVol and PEEP/Oxygen. The
operators use their discretion to determine %MinVol and PEEP/
Oxygen on the basis of clinical judgment. Outside the safety
limits of the automatic system (70- 200% for %MinVol,
30-100% Oxygen and 5-24 cmH
2
O for PEEP), there is no guid-
ance available.
In Figure 1-36, the Horizon window contains recommenda-
tions for adjustment of %MinVol based on PetCO
2
and spon-
taneous rate (see arrow 1), and for adjustment of PEEP and
Oxygen based on SpO
2
and current PEEP setting (see arrow 2).
Figure 1-36. Ventilation guide
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1.9 Heart-Lung Interaction
WARNING
HLI cannot be used in patients with significant
cardiac arrhythmias (examples: atrial fibrilla-
tion, frequent premature beats, ventricular
fibrillation). Due to the irregular time between
heart beats in these patients, HLI does not
reflect the effect of mechanical ventilation on
the stroke volume of the heart.
HLI can be incorrect when:
tidal volume is < 6 ml/kg
patients breath activity is spontaneous
driving pressure is < 10 cmH2O
cardiac dysfunction is present
If there is low transthoracic pressure the sensi-
tivity of HLI is decreased.
In case of many changes in PEEP or too many
recruitment maneuvers occur, the HLI fluc-
tuates.
Low sensitivity of HLI when HR/RR < 3-4
Check plethysmographic curve (patient motion)
as well as SpO2 and HLI QI regularly.
To continuously assess the haemodynamic effect of mechanical
ventilation, the respiratory variation of the Pulse Oximeter
Plethysmogram (POP) is analyzed by the ventilator. From the
POP, an index called Heart-Lung Interactions (HLI) is calculated
according to the following formula:
HLI = 100*(POPmax POPmin) / ((POPmax + POPmin)/2)
POPmax is the maximal and POPmin is the minimal ampli-
tude of the pulse oximeter plethysmogram within the same
breath. The breath information is extracted from the airway
pressure signal delivered by the ventilator. Figure 1-37
illustrates this calculation in detail.
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1 INTELLiVENT-ASV
The HLI reflects how much airway pressure interacts with
haemodynamics: HLI >15% means high interaction. For
reference see Section 1.13.
In cases where HLI >15%, PEEP increase is limited and oxy-
gen increase is preferred.
Figure 1-37. Simultaneous pulse oximeter plethysmo-
gram and airway pressure recording with POPmax and
POPmin indicated on the plethysmogram
Patients with a high HLI show a higher variation of the POP
during the breath cycle (see left top curve in Figure 1-38), indi-
cating a higher variation of the arterial pressure during the
breath cycle. In contrast, the recordings of patients with low
HLI (right column of Figure 1-38) present a low variation of the
POP and of the arterial pressure, indicating stable haemody-
namics during mechanical ventilation.
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Figure 1-38. Tracking patients with high (left column)
and low (right column) heart-lung index
HLI is:
Reliable in passive patients, partly reliable in actively breath-
ing patients
Not reliable if cardiac arrhythmia is present
Signal dependent (artifacts, motion, autoscaling)
1.10 Remarks: Sensor failure, standby, calibration
1.10.1 Ventilation management
Certain situations invoke specific behaviors from INTELLiVENT-
ASV. These conditions include:
PetCO
2
is not available
Disconnection or flow sensor failure is resolved in 5 minutes
or less (<= 5 min)
Disconnection or flow sensor failure is resolved in more
than 5 minutes (> 5 min)
Standby
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1 INTELLiVENT-ASV
1.10.1.1 PetCO
2
is not available
When PetCO
2
is not available, the sensor value becomes
unavailable, or the sensor is switched off, the minute volume
adjustment works like ASV with a constant minute ventilation
(%MinVol) equal to the last valid automatic %MinVol (frozen
state).
The ventilation controller display changes from blue to red.
The alarm, Ventilation Adjustment OFF (no PetCO
2
), is
activated. INTELLiVENT-ASV works like ASV with constant
minute ventilation.
When PetCO
2
is available again the alarm is cleared and the
minute volume adjustment switches back to fully automatic
mode.
The controller changes from red into a blue rotating circle
again.
ASV optimizes automatic values and calculates the optimal
rate and tidal volume.
1.10.1.2 Disconnection or flow sensor failure resolved in 5
minutes or less
When a disconnection or flow sensor failure situation is
resolved in 5 minutes or less, the device:
The %MinVol management adjustment pauses for
10 breaths.
The ASV adjustment pauses Pinsp (Pressure support above
PEEP for all (mechanical and spontaneous) breaths) and
RRIMV (IMV rate calculated by the rate adjustment) remains
unchanged) for 4 breaths after reconnection.
If the adjustment is in its initialization phase, it remains
there for at least 3 more breaths.
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1.10.1.3 Disconnection or flow sensor failure resolved in
more than 5 minutes
When a disconnection or flow sensor failure is resolved in more
than 5 minutes:
The ventilation controller adjustment pauses for 2 minutes.
The ASV adjustment re-initializes. If the adjustment is in its
initialization phase, it remains there for at least 3 more
breaths.
1.10.1.4 Standby
When returning from Standby with a new patient selected and
INTELLiVENT-ASV activated, the %MinVol adjustment reinitial-
izes with the default settings. If last patient was selected, the
system assumes the %MinVol value from the last patient.
In the event the PetCO
2
quality index reads less than 50, the
device control display will change from a blue rotating circle to
a red non-pulsing circle. Ventilation management stops.
When the PetCO
2
quality index is greater than 50, the alarm
state will clear and the ventilation management returns to the
automatic mode. The device controller display reverts from the
red non-pulsing circle to the blue rotating circle.
1.10.2 Oxygenation management
The PEEP/Oxygen automatic management only operates when
a valid SpO
2
signal is available. Without an SpO
2
measure-
ment, the device leaves the settings unchanged and generates
a low-priority alarm after 30 seconds, and a medium-priority
alarm after 60 seconds. This alarm requires the operator to
check the SpO
2
signal. If information about the haemodynamic
state of the patient (estimated from the heart-lung interaction)
is no longer available, automatic control is NOT suspended.
When the HLI is activated but not available for longer than the
PEEP decrease interval (6 min), the ventilator management
takes the PEEP limits set by the user in the INTELLiVENT win-
dow as the upper and lower PEEP limits, and does not go
below the specified lower PEEP limit.
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1 INTELLiVENT-ASV
When the alarm condition Oxygenation Adjustment OFF (no
SpO
2
) occurs, this indicates to the operator that the SpO
2

sensor values are unavailable or are invalid. The management
outputs are frozen (no change), pending operator interven-
tion.
In the event the SpO
2
quality index reads less than 60, the
device control display changes from a blue pulsing circle to a
red non-pulsing circle. Oxygenation management stops.
When the SpO
2
quality index is greater than 60, the alarm
state will clear and oxygen management returns to automatic
mode. The device controller display reverts from the red non-
pulsing circle to the blue pulsing circle.
The emergency increase of oxygen management is inactive
when oxygen is controlled manually.
The oxygen management pauses during
Disconnection (controllers are reactivated with their last set-
tings)
O
2
flush (controllers are reactivated with their last settings)
Flow sensor calibration (controllers are starting with the set-
tings before the calibration)
Tightness test (controllers are starting with the settings
before the test)
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1.11 Technical data
Table 1-6 presents pertinent technical data for use by the
operator.
Table 1-6. Technical data Ventilation management
Ventilation management related operator setting
%MinVol 25 to 350% (manual)
70 to 200% (automatic)
Patient height 130 to 250 cm (adult), 30 to 150 cm
(pediatric)
Internal calculations
Ideal body weight
NOTE:
INTELLiVENT-ASV can only be
used for patients weighing
greater than 7 kg.
In kilograms, calculation based on
patient height and gender. For details,
see the chapter on Ventilator settings in
the ventilator Operators Manual.
MinVol (target) In l/min, target Minute Volume is calcu-
lated as: IBW (in kg) x NormMinVent (in l/
kg/min) x %MinVol/100 where
NormMinVent is the normal Minute Ven-
tilation (not valid for pediatric < 30kg).
Respiratory Rate In b/min, calculated on the basis of Otis
equation.
Vdaw 2.2 ml/kg
Vt (target) MinVol/f (target)
Monitoring
Values (numerical) PetCO
2
target range, depending on dis-
ease input and treatment (Ppeak)
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When managing a passive patient, when the PetCO
2
value
exceeds or undercuts the acceptable PetCO
2
range
(10 to 150mmHg) an alarm condition occurs and the
automatic management freezes.
Current ventilation
setting values (numer-
ical)
MinVol, Vt, fTotal, fControl, Ppeak
(Pinsp+PEEP)
Pinsp Status of patient
(numerical)
fSpont, PetCO
2
Graphics display
(curve)
F versus Vt, target value, actual value,
safety boundaries, PetCO
2
versus target
value
Alarms
All device alarms are
functional
See the Alarms chapter in the ventilator
Operators Manual.
Special %MinVol adjustment OFF (no PetCO
2
)
Performance specifications
Settling time < 5 minutes
Response time (90%
of steady state)
< 5 minutes (typical)
(rel./command) Over-
shoot/undershoot
< 20%
Steady state deviation 5%
Maximum change of
%MinVol per breath
1%
Lung-protective ventilation
Minimum %MinVol 70% (100% if no CO
2
is available)
Maximum %MinVol 200%
Table 1-6. Technical data Ventilation management
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When managing an active patient, the %MinVol has the same
limits as with a passive patient. If the rate is too high and the
automatic management cannot adapt the %MinVol any lon-
ger, the operator is informed.
Table 1-7 presents pertinent technical data for use by the
operator.
Table 1-7. Technical data Oxygenation management
Ventilation management-related operator settings
%Oxygen 21 to 100% (manual)
30 to 100% (automatic)
PEEP 0 to 50 mbar (manual)
5 to 24 mbar (automatic)
Patient height 130 to 250 cm (adult), 30 to 150 cm (pediatric)
Internal calculations
Ideal body weight
NOTE:
INTELLiVENT-ASV can only be used for patients
weighing greater than 7 kg.
In kilograms, calculation based on patient height and
gender. For details, see the device settings chapter in
the ventilator Operators Manual.
Monitoring
Target values
(numerical)
SpO
2
Current achieved
values (numerical)
Oxygen, PEEP
Status of patient
(numerical)
SpO
2
Graphics display
(curve)
PEEP-Oxygen curve/PEEP-SpO
2
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1 INTELLiVENT-ASV
Alarms
All device alarms are
functional except
apnea alarms
See the Alarms chapter in the ventilator Operators
Manual.
SpO
2
related, HLI related
Special Oxygen adjustment OFF (no SpO
2
)
Performance
specifications
SpO
2
(Oxygen) SpO
2
(PEEP)
Setting time 6 minutes N/A (only target range for
SpO
2
specified)
Response time (90%
of steady state)
6 minutes N/A (only target range for
SpO
2
specified)
Rel/Command over-
shoot
none N/A (SpO
2
of some patients
does not respond at all to
PEEP changes, in this case
Oxygen is changed too if it is
set to automatic)
Command overshoot none N/A (SpO
2
of some patients
does not respond at all to
PEEP changes). Upper PEEP
limit 24 cmH
2
O, user can set
lower limit
Steady state deviation N/A (only target
range for SpO
2
speci-
fied)
N/A (only target range for
SpO
2
specified)
Tracking error N/A N/A (only target range for
SpO
2
specified)
Maximum change Decrease: 5% of cur-
rent Oxygen (mini-
mal step size 1%)
Increase: 10% of cur-
rent Oxygen (mini-
mal step size 1%)
1 cmH
2
O
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Lung-protective ventilation
Minimum %Oxygen 30%
Maximum %Oxygen 100%
Minimum PEEP 5 cmH
2
O
Maximum PEEP default = 15 cmH
2
O, 8cmH
2
O if HLI activated and no
HLI value, or limited by HLI5 cmH
2
O (patient defined as
haemodynamically unstable)
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1 INTELLiVENT-ASV
1.12 Data logging
NOTE:
Only authorized service personnel can analyze the data.
Breath-by-breath data representing the actual values of these
listed monitoring values and settings are saved by the ventila-
tion unit of the processor.
Table 1-8. Data log inputs
Saved parameters Unit
Date
Time
ARDS
Chronic Hypercapnia
Brain injury
Quick wean
Controller ventilation
Controller oxygenation
Controller PEEP
HLI activated
Recruitment passive
Recruitment running
AZ spont
PEEP limit cmH
2
O
%MinVol %
ExpMinVol l/min
RRIMV breaths per min
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The memory reserved for breath-by-breath data allows storage
of at least 10 days of recording. The data is saved breath-by-
breath, but at most one time per second.
The data can be exported to a CF via the test software window
#22: Event log technical status. Then press the button
Export black box. The breath-by-breath data are retained in
the event of a power failure or shut down.
RRtot breaths per min
RRtarget breaths per min
fSpont breaths per min
Ti sec
Pinsp cmH
2
O
SpO
2
%
PetCO
2
mmHg
Oxygen %
PEEP/CPAP cmH
2
O
HLI %
Pulse bpm (beats per min)
QI-SpO
2
%
VtTarget mL
Rcexp sec
Table 1-8. Data log inputs
Saved parameters Unit
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1.13 References
Feissel M, Teboul JL, Merlani P, Badie J, Faller JP, Bend-
jelid K. Plethysmographic dynamic indices predict fluid
responsiveness in septic ventilated patients. Intensive Care
Med. (2007) 33(6): 993-999.
Laubscher TP, Frutiger A, Fanconi S, Brunner JX. The
automatic selection of ventilation parameters during the
initial phase of mechanical ventilation. Intensive Care Med.
(1996) 22:199-207.
Laubscher TP, Heinrichs W, Weiler N, Hartmann G,
Brunner JX. An Adaptive Lung minute volume controller.
IEEE Transactions on Biomedical Engineering 41:51-59,
1994.
Michard F. Volume management using dynamic parame-
ters. The good, the bad, the ugly. Chest 2005, 128: 1902-
1904.
Michard F. Changes in arterial pressure during mechanical
ventilation. Anesthesiology 2005, 103(2):419-428
Niemer, Nemes. Datenbuch Intensivmedizin. Gustav Fis-
cher Verlag: Stuttgart, New York 1979, p.5
Novotni D, Arnal JM, Demory D, Lopez R, Wysocki M,
Laubscher T, Durisch G. Continuous and automatic mea-
surement of respiratory variations of the pulse oxymeter
plethysmogram (HLI) is correlated with PEEP changes during
fully closed loop ventilation. Intensive Care Med. (2010)
36:350
Yamada Y, Du H. Analysis of the mechanics of expiratory
asynchrony in pressure support ventilation : a mathematical
approach. J Appl Physiol 88:2143-2150, 2000.
2
624470/00 2-1
Quick Wean
2.1 Introduction 2-3
2.1.1 Quick Wean modes 2-4
2.2 Quick Wean in clinical use 2-7
2.2.1 Quick Wean workflow 2-7
2.2.2 Key terms 2-11
2.2.3 About the Quick Wean parameters 2-12
2.2.4 Indications of use 2-14
2.3 Enabling/Disabling Quick Wean and
automated SBTs 2-14
2.3.1 Enabling/Disabling Quick Wean 2-14
2.3.2 Enabling/Disabling automated SBTs 2-17
2.4 Conditions for starting weaning activities 2-18
2.4.1 About %MinVol calculations 2-19
2.4.2 Parameters monitored to determine
weaning readiness (To start group) 2-20
2.4.3 User-modifiable parameters:
SBT Controls window 2-23
2.4.4 Quick Wean Vent Status window 2-26
2.4.5 Quick Wean window (view 4) 2-30
2.5 Conducting an SBT 2-32
2.5.1 Monitoring pulse and breath rate
increases 2-34
2
increases 2-36
2.6 Conditions for aborting an SBT 2-36
2.7 Conditions for successfully completing an
SBT 2-39
2.8 About Quick Wean alarms and messages 2-39
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2 Quick Wean
2.9 Configuring Quick Wean 2-41
2.9.1 Changing the SBT Controls window
default settings 2-44
2.9.2 Restoring factory default
configuration settings 2-45
2.10 Quick Wean parameters 2-46
2.11 References 2-55
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2.1 Introduction
WARNING
The decision to terminate ventilatory support
for the patient is under the sole responsibility
of the physician or caregiver. Additional criteria
not provided by the ventilator have to be taken
into account.
Additional ventilator-independent patient
monitoring (for example, bedside vital moni-
toring or a blood gas analyzer (BGA)) must be
used during INTELLiVENT-ASV ventilation.
Check PaCO
2
against displayed PetCO
2
, and
SaO
2
against SpO
2
.
The physician is responsible for final decisions
regarding weaning and extubations.
NOTE:
The RSB parameter is only used for adult patients; it
is not used for pediatric patients.
Refer to the ventilator Operators Manual for details
on general ventilator use, alarms, customizing the
layout, and so on.
toring and control of patient conditions to evaluate the
patients potential readiness for extubation, including the pos-
sibility of conducting fully controlled spontaneous breathing
trials (SBTs).
Weaning from a ventilator is a difficult process that comprises
training, evaluation, and testing. A widely accepted and com-
monly used method is to decrease ventilatory support and, if
possible, perform SBTs to evaluate the patients muscle activity
and endurance.
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2 Quick Wean
An SBT is a diagnostic test that can help determine whether
the patient is ready to be removed from ventilator support and
can breathe on their own.
Together with the clinician and the patient, Quick Wean is part
of a complex care cycle that has as its goal a respiratorily
healthy, spontaneously breathing patient.
When Quick Wean is activated, the device decreases ventila-
tory support, and performs an SBT when criteria are met and
SBTs are enabled. It is known that the use of a protocolized
standard process is beneficial in regard to patient safety and
outcomes
1
.
2.1.1 Quick Wean modes
Quick Wean offers two modes of use: with and without auto-
mated SBTs. For details on enabling or disabling these options,
see Section 2.3.
1. See references, listed in Section 2.11.
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Table 2-1. Quick Wean modes of use
Quick Wean mode Description
Quick Wean disabled No continuous monitoring against
defined weaning criteria occurs.
This is the default setting.
Quick Wean enabled The device does the following:
Shifts the PetCO
2
range by
+5 mmHg (+0.8 kPa) to support
spontaneous breathing. See Figure
2-2.
When the patient is active and the
patients rate is below the upper
limit of the target range (Section
1.5.2), the device gradually
reduces %MinVol to 70%. As long
as these conditions are met, the
%MinVol is decreased to and/or
maintained at 70%.
The system continuously monitors
the patient against weaning crite-
ria. See Section 2.4.
Two SBT-related options are then avai-
lable: automated SBTs enabled or dis-
abled.
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2 Quick Wean
Automated SBTs
enabled
This option offers all the benefits of
providing standardized, protocolized
care.
ria.
When defined criteria are met,
automatically initiates an SBT.
All of the related parameters are
configurable, and some can be fine
tuned during ventilation.
See Section 2.3.2.
Monitoring (auto-
mated SBTs disabled)
This is the default setting.
ria. See Section 2.4.
As long as the patient is active and
the patients rate is below the
upper limit of the target range, the
%MinVol is decreased to and/or
maintained at 70%.
All of the related parameters are
configurable, and some can be fine
tuned during ventilation.
Table 2-1. Quick Wean modes of use
Quick Wean mode Description
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2.2 Quick Wean in clinical use
This section describes the Quick Wean workflow, key terms,
and the parameters used.
2.2.1 Quick Wean workflow
A workflow diagram is provided in Figure 2-1. Quick Wean
offers two workflow options:
Automated SBTs enabled
No automated SBTs
For an overview of the process, see Table 2-2. The numbers in
the table correspond to those in Figure 2-1.
Table 2-2. Quick Wean workflow
Quick Wean workflow For details,
see...
1 Enable Quick Wean monitoring. The fol-
lowing occurs:
The device shifts the PetCO
2
range by
+5 mmHg (+0.8 kPa) to support
spontaneous breathing. See Figure
2-2.
As long as the patient is active and
the patients rate is below the upper
limit of the target range (Section
1.5.2), the device gradually reduces
%MinVol to 70%.
Section 2.3.1
2 Monitor weaning conditions.
The device monitors key parameters,
whose values must remain within set
ranges for a set period of time for the
patient to be eligible for weaning activi-
ties.
Section 2.4
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2 Quick Wean
3 Enable automated SBTs (optional).
When SBTs are enabled, the device
initiates an automated SBT when the
conditions related to the start of an
SBT are fulfilled for a preset period of
time.
When SBTs are disabled, the device
still gradually reduces %MinVol to
70% as long as the patient is active
and the patients rate is below the
upper limit of the target range (Sec-
tion 1.5.2), but no SBT is initiated.
Section 2.3.2
4 All conditions are met.
If automated SBTs are disabled, the
device maintains the %MinVol at
70% as long as the patient condi-
tions are met (Section 1.5.2), but
does not take any other actions.
If automated SBTs are enabled, the
device starts an SBT when the condi-
tions for the start of an SBT are ful-
filled for a preset period of time.
Section 2.5
5 During an ongoing SBT, the device moni-
tors conditions to determine whether to
abort the trial.
Section 2.6
6 End the SBT. Section 2.7
7 Return to step 2, evaluating conditions to
conduct another SBT.
Section 2.4
Table 2-2. Quick Wean workflow
Quick Wean workflow For details,
see...
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Figure 2-1. Quick Wean workflow
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2 Quick Wean
Figure 2-2. PetCO
2
range shift when Quick Wean enabled
1 Quick Wean disabled
2 Standard PetCO
2
curve (here, between 35 & 41 mmHg)
3 Quick Wean enabled
4 Shifted PetCO
2
curve (here, between 40 & 46 mmHg)
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2.2.2 Key terms
The following table defines some basic, important Quick Wean
terms and parameters.
Table 2-3. Key terms for Quick Wean
Parameter Description
SBT Spontaneous breathing trial. Diagnostic test to
help determine whether patients are ready to be
removed from ventilator support and can breathe
on their own.
To start group of
parameters
A list of parameters that must all be within a pre-
defined range for a specific amount of time for the
patient to be considered ready for an SBT.
These parameters are: PEEP, Rate, Oxygen, SpO
2
,
VT/IBW, RSB (adults only), Psupport, %fspont
This set of parameters and values is referred to as
the To start criteria.
To abort group of
parameters
A list of parameters that are monitored during an
SBT, to determine whether to abort the SBT. If any
of the values is outside the predefined range for a
specified period of time, an ongoing SBT is
aborted.
These parameters are: PEEP, Rate, Oxygen, SpO
2
,
VT/IBW, RSB (adults only), PetCO
2
inc,
Psupport, %fspont
This set of parameters and values is referred to as
the To abort criteria.
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2 Quick Wean
2.2.3 About the Quick Wean parameters
Quick Wean monitors a large set of parameters to support
weaning.
Default settings for these parameters are consensus based
1
,
and, if modified, are generally set once and then used as the
defaults. Some of these settings cannot be changed during
ventilation.
The parameters are grouped in three basic categories,
described in Table 2-4.
Table 2-4. Quick Wean parameter types
Parameter group
Description
Default configuration set-
tings
Set during ventilator configuration in the Con-
figuration -> Quick Wean screen, in
Standby.
These include:
To start parameters
PEEP and %MinVol settings to use in an SBT
To abort parameters
See Table 2-3 for the full list in each group.
These settings cannot be modified during ventila-
tion. For details, see Section 2.9.
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The full list of parameters, listing where each one is set and
monitored, and value ranges, is available in Section 2.10.
User-modifiable controls in
SBT Controls window
These settings can be controlled by the clinician
during ventilation in the SBT Controls window.
These include:
Time before starting SBT
Time between 2 SBTs
Rate high limit
Psupport high
Psupport low
Time range for SBTs
Manually start or stop an SBT
For details, see Section 2.4.3.
Calculated These parameters are calculated values and can-
not be changed. They are displayed in a variety of
locations, including the Monitoring window.
These include:
Rate Inc%
Pulse Inc%
PetCO
2
inc (not displayed)
For details, see Section 2.5.1 and 2.5.2.
Table 2-4. Quick Wean parameter types
Parameter group
Description
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2 Quick Wean
2.2.4 Indications of use
Quick Wean can be enabled at any time during ventilation.
Conducting an SBT, however, is only possible when:
The patient is actively breathing
The patients SpO
2
values are in the normal range
See Section 1.5.2 for detailed requirements.
The required Quick Wean parameters meet configured cri-
teria
NOTE:
Quick Wean is not available if the patient condition
selected in INTELLiVENT-ASV is Brain injury.
2.3 Enabling/Disabling Quick Wean and auto-
mated SBTs
You can enable or disable Quick Wean. When Quick Wean is
enabled, you can enable or disable the use of automated SBTs.
See Table 2-1 for an overview of each mode.
2.3.1 Enabling/Disabling Quick Wean
NOTE:
Quick Wean is not available if the patient condition
selected in INTELLiVENT-ASV is Brain injury.
For details on configuring Quick Wean default settings,
see Section 2.9.1.
624470/00 2-15

To enable Quick Wean:
1. In the INTELLiVENT window Quick Wean section, select
Automatic.
Figure 2-3. Quick Wean activation
The PetCO
2
range is shifted to the right by +5 mmHg
(+0.8 kPa). See Figure 2-2.
The SBT Controls window appears on the left
(Figure 2-4).
Figure 2-4. SBT Controls window
2-16 624470/00
2 Quick Wean
1 Quick Wean enable/disable buttons
2 SBT Controls window (Section 2.4.3) with user-
modifiable controls
3 Click arrow to display or hide the SBT Controls
window (Section 2.4.3)
4 The setting of the Time before starting SBT
parameter is also used to enable or disable automated
SBTs
5 Manual Start SBT and Stop SBT buttons (ghosted)
when patient is not spontaneously breathing)
2. Make changes to the settings, as desired. See Section 2.4.3.
If you are enabling Quick Wean for the first time, the
Continue button is displayed. If this is not the first time,
skip to step 5.
3. Select Continue, if applicable. The Alarms -> Limits 1
window appears.
4. Review the settings, make any changes as desired, then
click Confirm to save changes and exit the window.
5. If Continue is not present, close the window.
The Vent Status and Quick Wean (view 4) windows appear.
These windows are always visible, unless you change the
layout. See Sections 2.4.4 and 2.4.5.
If the patient is active and the patients rate is below the upper
limit of the target range (Section 1.5.2), the device immediately
starts monitoring the To start parameters (Section 2.4.2)
and starts gradually reducing %MinVol to 70%.
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2.3.2 Enabling/Disabling automated SBTs
By default, automated SBTs are disabled.
To enable automated SBTs:
1. Ensure Quick Wean is enabled. See Section 2.3.1.
2. Display the SBT Controls window by clicking on the
white arrow next to the Quick Wean label. See Figure 2-4.
3. Select the Time before starting SBT control and set it
to the length of time that patient conditions must meet the
To start criteria before an SBT can begin.
By setting this parameter to a value, you are enabling auto-
mated SBTs. The default setting, --, indicates that the
parameter has no value and no automated SBTs can take
place.
For example, if this parameter is set to 30 min, the To
start criteria must be fulfilled for 30 min before an SBT
can be started. Note that regardless of whether SBTs are
enabled, %MinVol is gradually reduced to 70%.
The basic prerequisite for these actions is that the patient is
active and the patients rate is below the upper limit of the
target range (Section 1.5.2).
4. You can define other settings in this window now, if
desired. See Section 2.4.3.
To disable automated SBTs:
In the SBT Controls window, select the Time before start-
ing SBTs control and change the value to OFF (--). The set-
ting, --, indicates that the parameter has no value and no SBTs
can take place.
2-18 624470/00
2 Quick Wean
2.4 Conditions for starting weaning activities
Quick Wean continuously monitors the patients condition
against a set of criteria that must be met for weaning activities
to be possible. They are referred to as the To start parame-
ters or criteria.
First, the patient must be active and the patients rate must be
below the upper limit of the target range (Section 1.5.2). Once
the patients condition meets these requirements, the To
start parameters are monitored.
When patient conditions meet all the criteria, one of the fol-
lowing occurs, depending on whether automated SBTs are
enabled:
Table 2-5. What happens when To start criteria are met
When To start criteria
are met ...
The device ...
Automated SBTs enabled Shows the status Conditions fulfilled.
Starts a countdown. Patient conditions for the
To start parameters must remain within the
predefined ranges for the period of time speci-
fied in the Time before starting SBT
parameter.
Note that any of the To start parameters can
be out of range for up to the time specified in
the Delay Time parameter without affecting
the countdown. For example, with a Delay
Time of 30 s, any parameter can be out of
range for up to 30 s with no effect. If a parame-
ter value remains out of range for 31 or more
seconds, the countdown timer is reset to the
time period specified in Time before start-
ing SBT.
If patient conditions remain within the criteria
ranges for the required period of time, the
device starts an SBT. See Section 2.5.
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You can also start a manual SBT at any time that the patient is
breathing spontaneously.
To manually start an SBT:
1. Open the SBT Controls window (Figure 2-4).
2. Touch the Start SBT button.
Note that the button is enabled only when the patient is
breathing spontaneously.
The system immediately starts an SBT by reducing %MinVol
to 25% (default setting). The Quick Wean window (view 4)
is automatically displayed, and the display of the Vent
Status window changes to show To abort criteria (Section
2.4.4).
2.4.1 About %MinVol calculations
When Quick Wean is enabled, once the patient is active and
the patients rate is below the upper limit of the target range as
described in Section 1.5.2, the device starts gradually decreas-
ing %MinVol to 70%.
The device adjusts %MinVol as follows:
If %MinVol is already at 70%, the device does nothing.
If %MinVol is above 70%, the device decreases %MinVol
by subtracting 10% of the difference between the current
value and 70% every 5 minutes.
Automated SBTs disabled
(default)
Shows the status Conditions fulfilled.
Note that any of the To start parameters can be
out of range for up to the time specified in the
Delay Time parameter without affecting this sta-
tus. If a parameter value is out of range for longer
than Delay Time, the device removes the Condi-
tions Fulfilled status, and continues to monitor the
patients condition.
Table 2-5. What happens when To start criteria are met
When To start criteria
are met ...
The device ...
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2 Quick Wean
2.4.2 Parameters monitored to determine weaning
readiness (To start group)
The following parameters are monitored to determine the
patients readiness for weaning activities. They are monitored
regardless of whether automated SBTs are enabled or disabled.
Table 2-6. Quick Wean To start parameters and values
Parameter Description Default values
For parameter ranges and details, see Section 2.10.
Oxygen% % of inspired oxygen. 40
Rate
(b/min)
Respiratory rate in number of
breaths per minute.
35
VT/IBW (ml/kg) Tidal volume per kilogram of
ideal body weight (kg/IBW).
5
PEEP (cmH
2
O) Positive end-expiratory pressure.
The airway pressure at the end of
exhalation.
Adults: 8
Pediatrics: 6
Psupport high
(cmH
2
O)
The upper threshold of applied
inspiratory pressure required dur-
ing the inspiratory phase.
12
%fspont To qualify for an SBT, the patient
must be fully spontaneously
breathing for a minimum of 1
minute.
= 100%for a mini-
mum of 60 s
RSB (l*min) Rapid shallow breathing index.
The total breathing frequency
(fTotal) divided by the exhaled
tidal volume (VTE).
The RSB parameter is only used
for adult patients; it is not used
for pediatric patients.
105
SpO
2
% Indirect measurement of oxygen
saturation in the blood.
In INTELLiVENT-ASV
normal/high range
624470/00 2-21

1 INTELLiVENT-ASV
high (above 97% in
example)
2 INTELLiVENT-ASV
normal (93 to 97% in
example)
3 INTELLiVENT-ASV
below normal (below
93% in example)
Time before
starting SBT
(min)
Defines the length of time that
patient conditions must stay
within the To start limits
before an SBT can start.
This parameter is also used to
enable or disable automated
SBTs. See Section 2.3.2.
-- undefined (OFF),
automated SBTs are
disabled (Section
2.3.2)
Time between 2
SBTs (min)
The minimum length of time that
must pass between two SBTs.
30
2-22 624470/00
2 Quick Wean
Delay Time (s) The length of time a parameter
value can be out of range with-
out affecting the countdown to
an SBT (the time period defined
in the Time before starting
SBT parameter).
If any one parameter is out of
range for longer than this time
period, the countdown timer is
reset.
These include:
PEEP
Rate
Oxygen
SpO
2
VT/IBW
RSB (adults only)
Psupport
%fspont
30
SBT Time range
(hh:mm)
Defines the hours between
which an SBT can be started.
Even if patient conditions match
the To start criteria for the
required amount of time, if the
start time for the SBT is outside
of the range specified here, the
SBT will not take place until the
current time of day is inside the
specified range, if criteria are still
met.
Between 8:00 and
20:00
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2.4.3 User-modifiable parameters: SBT Controls
window
The SBT Controls window provides access to all the param-
eters you can modify, if needed, during ventilation. You do not
have to put the ventilator into Standby to modify them.
Most of the time-related parameters (Time before start-
ing SBT, Time between 2 SBTs, SBT time range, Max
Duration) are only effective when automated SBTs are
enabled (Section 2.3.2). You can adjust the other parameters at
any time.
When SBTs are enabled, the system monitors these parameters
to help determine whether to start an SBT, and once an SBT is
taking place, whether to abort the SBT. These values are used
in addition to the To start parameters specified during con-
figuration (Section 2.9). The default threshold values for these
settings are shown in Table 2-6.
The SBT Controls window opens automatically when you
enable Quick Wean.
To display or hide the SBT Control window, select the white
arrow to the left of the Quick Wean label, which toggles the
display of the window. See Figure 2-4.
Table 2-7. SBT Controls window parameters available during
ventilation
Time before start-
ing SBT (min)
See Table 2-6.
Time between 2
SBTs (min)
See Table 2-6.
2-24 624470/00
2 Quick Wean
Rate
(b/min)
Respiratory rate. Number
of breaths per minute.
When used as To start
criteria, the patient must
require less than the limit
specified.
To start:
35
Psupport high
(cmH
2
O)
The upper threshold of
applied inspiratory pres-
sure required during the
inspiratory phase.
When used as To start
criteria, the patient must
require less than the limit
specified.
Shown as the upper
Pinsp limit in the Vent
Status window.
To start:
12
Psupport low
(cmH
2
O)
The bottom limit of the
pressure support applied
during an SBT; that is,
the pressure support will
not fall below this value.
Shown as the lower
Pinsp limit in the Vent
Status window.
5
SBT Time range
(HH:MM)
See Table 2-6.
ventilation
624470/00 2-25

Start SBT button Select to immediately
start an SBT.
The system immediately
reduces %MinVol to
25%, displays the Quick
Wean window (view 4),
and changes the display
of the Vent
Status window (Section
2.4.4).
This button is only avai-
lable when the patient is
active and meets the
conditions specified in
Section 1.5.2.
--
Stop SBT button Select to immediately
abort an SBT.
The system returns to
normal INTELLiVENT-ASV
settings and starts moni-
toring patient conditions
for the next possible SBT.
This button is only avai-
lable when the patient is
active and meets the
conditions specified in
Section 1.5.2.
--
ventilation
2-26 624470/00
2 Quick Wean
2.4.3.1 Changing Quick Wean settings
To change a Quick Wean setting, select the desired control in
the SBT Controls window, and make changes. See Table 2-7
for modifiable options.
The changes are implemented immediately, and the system
starts making adjustments, if needed.
2.4.4 Quick Wean Vent Status window
As in other modes, the Vent Status window uses floating indi-
cators moving up and down within the columns to show the
value for a specific parameter. When Quick Wean is enabled,
this window shows the status for SBT- and weaning-related
parameters. The data is updated every breath.
The Vent Status window is displayed by default when Quick
Wean is activated.
The content of the window changes depending on which
phase the device is in, as described in Table 2-8.
Table 2-8. Vent Status window display
When ... Vent Status window displays ...
Quick Wean is enabled Displays the To start criteria and
status, and the text Verifying condi-
tions. See Figure 2-5.
To start conditions are met The window displays the text, Con-
ditions fulfilled, and shows one of
two screens:
Time before start-
ing SBT is set to --
(undefined, auto-
mated SBTs are dis-
abled)
The text SBT will not start.
A timer showing how long
(HH:MM:SS) the patient condi-
tions have been within the target
ranges.
624470/00 2-27

Time before start-
ing SBT is set to > 0
min (automated
SBTs are enabled)
A countdown from the length of
time specified in the Time
before starting SBT param-
eter, shown in the text Starting
SBT in X min. For example, if the
parameter value is 30 min, the
timer counts down from 30.
If the next possible start time is
outside of the allowed time
period set in SBT time range,
shows the next possible start
time, with the text, Next SBT at
YYYY-MM-DD HH:MM.
A timer showing how long
(HH:MM:SS) the patient condi-
tions have been within the target
ranges.
SBT in progress The window displays the text, SBT
running, a timer showing how long
the SBT has been running, and puls-
ing green bars above and below the
floats for parameters that are within
the defined thresholds. See Figure
2-9.
Note that parameters that are out of
range do not have the green bar
above and below the value.
Table 2-8. Vent Status window display
When ... Vent Status window displays ...
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2 Quick Wean
Figure 2-5. Quick Wean Vent Status window,
verifying conditions
Figure 2-6. Time to starting SBT set to --,
no SBT will start
624470/00 2-29

Figure 2-7. Time to starting SBT set to > 0, out of time
range, shows next possible SBT start time
Figure 2-8. Time to starting SBT set to > 0, count-
down started
2-30 624470/00
2 Quick Wean
Figure 2-9. Quick Wean Vent Status window,
SBT is running
2.4.5 Quick Wean window (view 4)
The Quick Wean window, available in View 4 of the scrollable
views (Figure 2-11), displays a status overview of all the key
ventilation parameters. This window is always available, and is
displayed in the main window by default when Quick Wean is
activated.
The window shows green check marks next to parameters that
are within the target ranges, that is, below the To abort lim-
its. The data is updated every breath. If a parameter goes out
of range, the check mark is replaced by text indicating whether
the value is too high or too low. See the two examples pro-
vided in Figure 2-10.
During an active SBT, the window displays a timer showing
how long the SBT has been running. When an SBT is ended,
the window displays information about how the previous SBT
ended (fulfilled or aborted).
The History (arrow) buttons at the bottom of the window allow
you to scroll through previous SBT data.
624470/00 2-31

Figure 2-10. Quick Wean window, view 4
1 Check marks indicating value within limits
2 Current status message
3 Number of history pages available
4 History buttons
5 Parameter value out of range
6 SBT status (active or previous)
2.4.5.1 Displaying the Quick Wean window (view 4)
If the Quick Wean window is not visible, you can access it using
the View arrows.
To display the window, click the View arrows until View 4
appears.
2-32 624470/00
2 Quick Wean
Figure 2-11. View arrows and Quick Wean window,
view 4
1 View arrows and name of displayed view (view 4, Quick
Wean status displayed)
2.5 Conducting an SBT
To start an SBT, all of the following conditions must be met:
The patient must be active and the patients rate must be
below the upper limit of the target range (Section 1.5.2)
Automated SBTs must be enabled (Section 2.3.2)
Patient conditions must be within target ranges for all the
To start criteria, for the specified time (Time before
starting SBT setting)
Enough time has passed since the last SBT (Time between
2 SBTs setting), if applicable
The current time is within the allowed range (SBT Time
Range setting)
624470/00 2-33

If all conditions are met, the system starts an SBT. The following
changes occur:
The Vent Status window displays pulsing green bars above
and below parameters with values within threshold values,
and starts a timer. See Section 2.4.4.
Note that parameters that are out of range do not have the
green bar above and below the value.
The Quick Wean (view 4) window is automatically dis-
played.
An SBT timer starts running in the Quick Wean window.
See Section 2.4.5.
Additional parameters are also monitored during an SBT:
Rate inc% (breathing rate increase), Pulse inc% (heart
rate increase, %), and PetCO
2
inc (absolute increase in
PetCO
2
). See Sections 2.5.1 and 2.5.2.
Note that Pulse inc% is not used in determining abort cri-
teria.
The system changes the settings for PEEP, %MinVol, and
Pinsp, as shown in Table 2-9.
Table 2-9. Quick Wean active SBT settings (defaults)
Parameter Default
Setting
Set in ...
%MinVol 25% Configuration ->
Quick Wean -> SBT
Settings
PEEP 5 cmH
2
O Configuration ->
Quick Wean -> SBT
Settings
Pinsp (minimum) 5 cmH
2
O SBT Controls, in
Psupport low set-
ting
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2 Quick Wean
2.5.1 Monitoring pulse and breath rate increases
NOTE:
Rate inc%, Pulse inc%, PetCO
2
inc are only
monitored during an SBT.
Pulse inc% is not used as part of To abort crite-
ria; it is only provided for informational purposes.
During an SBT, some additional parameters are also monitored,
Breathing Rate Increase% (Rate Inc%) and Pulse Rate
Increase% (Pulse inc%). The increase in PetCO
2
is also mon-
itored; see Section 2.5.2.
The changes in these values can give an indication of whether
the patient is experiencing increased work of breathing (WOB)
during an SBT
1
.
The rate increases are measured every minute by taking the
current value and calculating the % change from an average
rate or pulse established just prior to the start of the SBT.
The parameter values are displayed in:
Monitoring 2 window (Figure 2-12)
Secondary monitoring parameters (SMP) (configurable)
Main monitoring parameters (MMP) (configurable)
Trend graph
Rate inc% is also shown in the Quick Wean window
(view 4)
We recommend displaying these parameters in the SMP list
when the patient is undergoing an SBT.
624470/00 2-35

Figure 2-12. Pulse inc% and Rate inc% in Monitoring
window
1 Rate Inc% and Pulse Inc% parameters
Figure 2-13. Pulse inc% and Rate inc% in SMP
2-36 624470/00
2 Quick Wean
2
increases
NOTE:
PetCO
2
inc is:
Used as part of To abort criteria.
Only monitored during an SBT.
During an SBT, the system monitors increases in PetCO
2
. The
changes in this value can, like Rate inc% and Pulse inc%,
give an indication of whether the patient is experiencing
increased work of breathing (WOB).
It is also used as a To abort criterion. You define a maximum
allowed increase in Configuration -> Quick Wean ->
To abort. See Section 2.9.
The rate increase is measured every minute by taking the cur-
rent value and calculating the change from an average PetCO
2

established just prior to the start of the SBT.
This value is not displayed.
2.6 Conditions for aborting an SBT
NOTE:
The maximum length of time a disconnection is allowed
is 1 minute, regardless of the Tolerance Time set-
ting. If an SBT is aborted due to disconnection (whether
inadvertent or for suctioning), simply start a manual SBT
when the patient is reconnected (Section 2.4).
During an SBT, the device monitors parameters against the To
abort threshold values.
If a parameter is out of range for longer than the time inter-
val specified in the Tolerance Time parameter, the SBT is
aborted, and an alarm is generated.
If a parameter is out of range for less than the allowed time
in Tolerance Time, the SBT continues uninterrupted.
624470/00 2-37

When an SBT is aborted, the device returns to normal Quick
Wean settings, returns the %MinVol to the value prior to the
start of the SBT (at least 70%), and starts monitoring patient
conditions against the To start thresholds (Section 2.4.2).
Table 2-10 lists the To abort parameters and the default
threshold values.
Table 2-10. Quick Wean To abort parameters
PEEP (cmH
2
0) Positive end-expiratory pressure.
The airway pressure at the end of
exhalation.
You can configure the maximum
pressure allowed to start an SBT
(Section 2.4), and an absolute
low limit that it cannot fall below
during an SBT (Section 2.5).
> 8
Rate (b/min) Respiratory rate. Number of
breaths per minute.
> 35
Oxygen (%) Inspired oxygen (%). > 50
SpO
2
(%) Indirect measurement of oxygen
saturation in the blood.
Below INTEL-
LiVENT-ASV nor-
mal range - 2%
See Table 2-6 for
an illustration.
VT/IBW (ml/kg) Tidal volume per kilogram of
ideal body weight
5
RSB
(1/(l*min))
Rapid shallow breathing index.
The total breathing frequency
(fTotal) divided by the exhaled
tidal volume (VTE).
The RSB parameter is only used
for adult patients; it is not used
for pediatric patients.
> 105
2-38 624470/00
2 Quick Wean
PetCO
2

increase
(mmHg or kPa)
End-tidal CO
2
pressure increase.
Only applies during an SBT.
> 1.1 kPa
(8 mmHg)
Psupport high
(cmH
2
O)
The upper threshold of applied
inspiratory pressure required dur-
ing the inspiratory phase.
> 12
%fspont When patient is fully spontane-
ously breathing, this value is
100%.
< 100%for 60 s
Tolerance Time
(s)
Defines the length of time a
parameter can be out of range
during an SBT before the SBT is
aborted.
Adults: 180
Pediatrics: 30
Max Duration
(min)
Defines the length of time the
SBT can run. If the patient condi-
tions continue to stay within
defined thresholds, the SBT ends
after the time interval specified
by this parameter.
-- (OFF), there is
no limit to how
long the SBT can
run
Table 2-10. Quick Wean To abort parameters
624470/00 2-39

2.7 Conditions for successfully completing an SBT
During an SBT, the device monitors parameters against the To
abort threshold values. If parameters remain in range for the
duration set for the SBT (specified by the Max Duration
parameter), the SBT is ended and marked as SBT successfully
fulfilled. An SBT Fulfilled alarm is generated.
When an SBT is fulfilled, the device returns to normal INTEL-
LiVENT settings, returns the %MinVol to the value prior to the
start of the SBT (at least 70%), and starts monitoring patient
conditions against the To start thresholds (Section 2.4.2),
and the Time between 2 SBTs time (Section 2.4.3).
2.8 About Quick Wean alarms and messages
Quick Wean provides a set of alarms and messages related to
weaning activities, including SBTs. Messages are written to the
Event log. Alarms and messages are displayed in the following
locations:
Alarm message bar
Event log
Quick Wean window (view 4)
To review and dismiss an alarm, do any of the following:
Touch the message. The Alarms -> Buffer opens. Review
the message, then close the window.
Touch the red I-icon and view the alarm log.
Open Alarms -> Buffer and review the alarm message,
then close the window.
Table 2-11 provides an overview of all of the alarms and
messages. For detailed information about system alarms, see
your ventilator Operators Manual.
2-40 624470/00
2 Quick Wean
Table 2-11. Quick Wean alarms and messages
Alarm or
Message
Description Where displayed
SBT aborted
Medium-priority
alarm (yellow)
The SBT was aborted because one
or more parameters were out of
range for longer than Tolerance
Time or the test was manually
stopped.
Alarm bar
SBT successfully
fulfilled
Medium-priority
alarm (yellow)
The SBT was ended because Max
Duration was reached
Alarm bar
SBT abort after
MM minutes
How long the SBT ran before being
aborted.
Event log
Quick Wean View
4 window
SBT start at YYYY-
MM-DD HH:MM
When an SBT starts automatically,
this message records the time.
Event log
Quick Wean View
4 window
SBT fulfilled after
MM minutes
When SBT ends successfully, this
message records the time. The time
is equal to the Max Duration
value.
Quick Wean View
4 window
SBT manually start
at YYYY-MM-DD
HH:MM
When an SBT is manually started by
selecting the Start SBT button in
the SBT Controls window, this
message records the time.
Quick Wean View
4 window
SBT manually
abort after MM
minutes
When an SBT is manually ended by
selecting the Stop SBT button in
message records for how long the
SBT ran.
Quick Wean View
4 window
SBT manually
stopped at YYYY-
MM-DD HH:MM
When an SBT is manually ended by
selecting the Stop SBT button in
message records the time.
Event log
624470/00 2-41

2.9 Configuring Quick Wean
You configure Quick Wean using the Configuration
screens, in Standby mode. These settings cannot be modified
while ventilating a patient.
While the default parameter values are all based on the cur-
rently available literature
1
, you can change the settings if you
prefer to use a different protocol.
The system monitors patient conditions against these parame-
ter thresholds to determine whether the patient is ready for
weaning activities, what adjustments to make when an SBT
begins, and whether to abort the weaning activities.
For details on putting the ventilator into Standby and accessing
the Configuration screens, refer to the ventilator Operators
Manual.
The settings are separated into Adult and Pediatric categories.
For the list of default values, see Table 2-12.
Too High messages When a parameters value goes
above the allowed range, the mes-
sage Too High is recorded on the
Quick Wean (view 4) screen. A
message is also recorded in the
Event log. For example, Oxygen
Too High
Quick Wean View
4 window
Too Low messages When a parameters value goes
below the allowed range, the mes-
sage Too Low is recorded on the
Quick Wean (view 4) screen. A
message is also recorded in the
Event log. For example, VT/IBW
Too Low.
Quick Wean View
4 window
Table 2-11. Quick Wean alarms and messages
Alarm or
Message
Description Where displayed
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2 Quick Wean
To change the default configuration settings:
1. Without a patient connected, put the ventilator in Standby.
2. Access the Configuration screens, and on the left side,
select Quick Wean.
The Quick Wean tabs appear, with the To start parame-
ters displayed by default.
Figure 2-14. Quick Wean configuration: To start
1 Access Quick Wean configuration options
2 Tabs for each Quick Wean phase
3 Adult parameter settings
4 Pediatric parameter settings
5 Restore factory default settings
3. On the To start tab, make changes as desired to the
parameter thresholds. See Figure 2-14.
624470/00 2-43

Patient conditions are monitored against these values to
determine when they are ready for an SBT. For details about
these parameters, see Section 2.4.2.
4. Select the SBT settings tab, and make changes as
desired to PEEP or %MinVol. See Figure 2-15.
When an SBT begins, the device adjusts PEEP and %MinVol
to these values. For details about these parameters, see
Section 2.5.
Figure 2-15. Quick Wean configuration: SBT Settings
5. Select the To abort tab, and make changes as desired.
See Figure 2-16.
During weaning activities, patient conditions are monitored
against these values to determine whether to abort the
weaning settings. For details about these parameters,
see Section 2.6.
2-44 624470/00
2 Quick Wean
Figure 2-16. Quick Wean configuration: To abort
6. When finished, click Close, then Close/Save to save
your changes.
The settings you specified are now used as the system defaults
during normal operation. You can later reset them to the fac-
tory default settings, if desired. See Section 2.9.2.
2.9.1 Changing the SBT Controls window default
settings
The SBT Controls window settings are not available within the
Configuration screen; however, you can change the default
settings if desired. You can set separate values for adults and
pediatric patients, as well.
To change SBT Controls window default settings:
1. Open the SBT Controls window (Section 2.4.3).
2. Set all the parameters to the desired settings (Section 2.4.3)
for the target patient type (adult or pediatric).
3. Enter Standby mode, and access the Configuration ->
Defaults window.
624470/00 2-45

4. Select whether the settings are for Adults or Pediatric
patients.
5. Select Set factory defaults, and when prompted,
select Yes.
6. When finished, click Close, then Close/Save to save
your changes.
7. If needed, repeat steps 2 through 6 for another patient
type.
The default settings for the SBT Controls window are now
set as you defined them. For more details on default values on
the device, refer to the ventilator Operators Manual.
You can later reset these values, and all the other parameter
values, to the factory default settings, if desired. See Section
2.9.2.
2.9.2 Restoring factory default configuration
settings
To return to the factory settings, select the Set Factory
Defaults button in the Quick Wean configuration screen. All
parameters are restored to the factory-defined values.
2-46 624470/00
2 Quick Wean
2.10 Quick Wean parameters
The following table is a comprehensive list of all of the Quick
Wean-related parameters.
NOTE:
Adult and pediatric settings are the same unless other-
wise noted.
The RSB parameter is only used for adult patients; it is
not used for pediatric patients.
Table 2-12. Quick Wean parameters
Parameter Definition /
Default values
Where displayed /
Where set
Range
Oxygen (%) Inspired oxygen.
To start: 40%
To abort: > 50%
Displayed on:
Vent Status
panel
Quick Wean
window view 4
INTELLiVENT-
ASV main win-
dow
Monitoring 1
window
Set on Configura-
tion screens:
To start
To abort
To start:
3050
To abort:
4060
624470/00 2-47

%fspont Percentage of spontane-
ous breaths to total
breaths taken. When
patient is fully spontane-
ously breathing, this value
is 100.
To abort: < 100% for 60
seconds
Displayed on:
Quick Wean
window view 4
Vent Status
panel
Monitoring 1
window
Set on:
N/A (calculated
value)
--
%MinVol Minute volume.
When Quick Wean is
enabled, as long as the
patient is active and the
patients rate is below the
upper limit of the target
range (Section 1.5.2), the
device gradually reduces
%MinVol to 70%.
When SBTs are enabled
and an SBT starts, %Min-
Vol is reduced to a default
value of 25%.
Quick Wean enabled:
70%
During SBT: 25%
Displayed on:
INTELLiVENT-
ASV main win-
dow in the
%MinVol con-
trol
Set on Configura-
tion screen:
SBT Settings
(sets the %Min-
Vol to be main-
tained during an
SBT)
%MinVol
during SBT:
2570
Default values
Where displayed /
Where set
Range
2-48 624470/00
2 Quick Wean
PEEP
(cmH
2
O)
Positive end-expiratory
pressure. Airway pressure
at the end of exhalation.
To start:
Adult: 8 cmH
2
0
Pediatric: 6 cmH
2
0
To abort:
Adult: > 8 cmH
2
0
Pediatric: > 6 cmH
2
0
Displayed on:
Vent Status
panel
Quick Wean
window (view 4)
INTELLiVENT-
ASV main win-
dow
Monitoring 1
window
Set on Configura-
tion screens:
To start
SBT settings
(minimum dur-
ing SBT)
To start:
510
PEEP
during SBT:
05
PetCO
2

(mmHg)
End-tidal CO
2
pressure. Displayed on:
Quick Wean
window (view 4)
Pediatric
patients: EtCO
2

on Vent Status
panel
Note that this is an
indirect abort crite-
rion. See Section
1.5.2.
--
Default values
Where displayed /
Where set
Range
624470/00 2-49

PetCO
2

increase
(mmHg or
kPa)
The absolute increase in
PetCO
2
(relative to an
average calculated prior to
the start of the SBT) that is
permitted during an SBT.
See Section 2.5.2.
To abort: > 8 mmHg
(1.1 kPa) increase
Not displayed.
Set on Configura-
tion screen:
To abort
420 mmHg
1.12.7 kPa
Psupport
high
(cmH
2
O)
The upper threshold of
applied inspiratory pres-
sure required during the
inspiratory phase.
To start: 12 cmH
2
O
To abort: > 12 cmH
2
O
Displayed and set
on:
SBT Controls
window
625
Psupport
low
(cmH
2
O)
The bottom limit of the
pressure support applied
during an SBT; that is, the
pressure support will not
fall below this value.
Default: 5 cmH
2
O
Displayed and set
on:
SBT Controls
window
010
Pulse Inc% Pulse rate increase. The
system monitors the
change in rate from base-
line and updates the value
every minute.
Note that this parameter is
not used as an abort crite-
rion.
Displayed on:
Monitoring 2
window
SMP
Set on:
N/A (calculated
value)
--
Default values
Where displayed /
Where set
Range
2-50 624470/00
2 Quick Wean
RSB
(1 /(l*min))
Rapid shallow breathing
index. The total breathing
frequency (fTotal) divided
by the exhaled tidal vol-
ume (VTE).
The RSB parameter is only
used for adult patients; it is
not used for pediatric
patients.
To start:
105/(l*min)
To abort:
> 105/(l*min)
Displayed on:
Vent Status
panel
Quick Wean
window (view 4)
Set on Configura-
tion screen:
To start
010
Rate
(b/min)
Respiratory rate. Number
of breaths per minute.
To start: 35 b/min
To abort: > 35 b/min
Displayed on:
Vent Status
panel
Quick Wean
window (view 4)
Set on Configura-
tion screen:
To abort
2565
Rate inc% % increase in the respira-
tory rate, as a result of the
SBT.
To abort: > 50% increase
over the average rate
established just prior to the
start of the SBT
Displayed on:
Quick Wean
window (view 4)
Monitoring 2
window
Set on Configura-
tion screen:
To abort
20100
Default values
Where displayed /
Where set
Range
624470/00 2-51

SpO
2
Indirect measurement of
oxygen saturation in the
blood.
To start: in INTELLiVENT-
ASV normal or high range
To abort: below INTEL-
LiVENT-ASV normal range
- 2%
For an illustration, see
Table 2-6.
INTELLiVENT-ASV
Oxygenation panel
Not set
directly.
Used
together
with PEEP
and O
2
set-
tings.
VT/IBW (ml/
kg)
Tidal volume per kilogram
of ideal body weight.
To start: 5 ml/kg
To abort: < 5 ml/kg
Displayed on:
Quick Wean
window (view 4)
Vent Status
panel
Set on Configura-
tion screen:
To start
36
Default values
Where displayed /
Where set
Range
2-52 624470/00
2 Quick Wean
Time Related
Delay Time
(s)
The length of time a
parameter value can be
out of range without
affecting the countdown
to an SBT (the time period
defined in the Time
before starting SBT
parameter).
If any one parameter is out
of range for longer than
this time period, the
countdown timer is reset.
The parameters that must
meet this time limit are:
PEEP, Rate, Oxygen,
SpO
2
, VT/IBW, RSB (adults
only), Psupport,
%fspont
To start: By default, 30 s
Displayed and con-
figured on Config-
uration screen:
To start
0300
Max Dura-
tion
(min)
Defines the length of time
the SBT can run. If the
patient conditions con-
tinue to stay within
defined thresholds, the
SBT ends after the time
specified by this parame-
ter.
By default, -- (undefined),
there is no limit to how
long the SBT can run.
Displayed and con-
figured on Config-
uration screen:
To abort
-- (undef.),
30240
Default values
Where displayed /
Where set
Range
624470/00 2-53

SBT time
range
Defines the hours between
which an SBT can be
started.
Even if patient conditions
match the To start crite-
ria for the required
amount of time, if the start
time for the SBT is outside
the range specified here,
the SBT will not take place
until the current time of
day is inside the specified
range, if criteria are still
met.
If an SBT is in progress
when the time exceeds the
upper limit of this range,
the SBT continues until it is
completed. For example, if
the SBT length is set to 30
min, a SBT began at 19:45
and the time allowed
range ends at 20:00, the
SBT continues until 20:15,
unless it aborts.
The default is from 8:00 to
20:00.
Displayed and
configured on:
SBT Controls
window
HH:MM
Default values
Where displayed /
Where set
Range
2-54 624470/00
2 Quick Wean
Time before
starting SBT
(min)
that patient conditions
must stay within the To
start limits before an SBT
can start.
This parameter is also used
to enable or disable auto-
mated SBTs. See Section
2.3.2.
To start: -- (undefined; by
default, automated SBTs
are disabled)
Displayed and
configured on:
SBT Controls
window
-- (undef.)
120
When unde-
fined, auto-
mated SBTs
are disabled.
Time
between 2
SBTs
(min)
Defines the minimum
length of time that must
pass between two SBTs.
Only applies when auto-
mated SBTs are enabled.
To start next SBT: By
default, 30 min
Displayed and
configured on:
SBT Controls
window
-- (undef.)
240
When unde-
fined, a
second SBT
will not start.
Tolerance
Time (s)
a parameter can be out of
range during an SBT
before the SBT is aborted.
To abort: By default:
Adults: 3 min (180 s)
Pediatrics: 30 s
Displayed and
configured on:
To abort
Adults:
10600
Pediatrics:
10300
Default values
Where displayed /
Where set
Range
624470/00 2-55

2.11 References
Boles JM, et al. Considerations for assessing readiness to
wean. Eur Resp Journal 2007, 29:1033-1056.
Esteban A, et al. Extubation Outcome after Spontaneous
Breathing Trials with T-Tube or Pressure Support Ventilation.
Spanish Lung Failure Collaborative Group. Am J Resp Crit
Care Med 1997, 156:459-465.
Esteban A, et al. Effect of spontaneous breathing trial
duration on outcome of attempts to discontinue mechani-
cal ventilation. Spanish Lung Failure Collaborative Group.
Am J Resp Crit Care Med 1999, 159:512-518.
Ely EW, Baker AM, Dunagan DP, et al. Effect on the
duration of mechanical ventilation of identifying patients
capable of breathing spontaneously. NE Journal of Med
1996, 335:1864-1869.
Esteban A, Frutos F, Tobin MJ, et al. A comparison of
four methods of weaning patients from mechanical ventila-
tion. Spanish Lung Failure Collaborative Group. NE Journal
of Med 1995, 332:345-350.
Coplin WM, Pierson DJ, Cooley KD, Newell DW,
Rubenfeld GD. Implications of extubation delay in brain-
injured patients meeting standard weaning criteria. Am J
Resp Crit Care Med 2000, 161:1530-1536.
Kollef MH, Shapiro SD, Silver P, et al. A randomized,
controlled trial of protocol-directed versus physician-
directed weaning from mechanical ventilation. Crit Care
Med 1997, 25:567-574.
Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Man-
cebo J. Clinical characteristics, respiratory functional
parameters, and outcome of a two-hour T-piece trial in
patients weaning from mechanical ventilation. Am J Resp
Crit Care Med 1998, 158:1855-1862.
Brochard L, Rauss A, Benito S, et al. Comparison of three
methods of gradual withdrawal from ventilatory support
during weaning from mechanical ventilation. Am J Resp Crit
Care Med 1994, 150:896-903.
2-56 624470/00
2 Quick Wean
MacIntyre NR, et al. Evidence-based guidelines for
weaning and discontinuing ventilatory support: a collective
task force facilitated by the American College of Chest Phy-
sicians; the American Association for Respiratory Care; and
the American College of Critical Care Medicine. Chest
2001, 120 (6 Suppl):375S-395S.
Papanikolaou J, et al. New insights into weaning from
mechanical ventilation: left ventricular diastolic dysfunction
is a key player. Intensive Care Med 2011, 37:1976-1985.
624470/00 Glossary-1
Glossary
A Ampere, a unit of current.
AC Alternating current.
alarm lamp Lamp atop the HAMILTON-S1 that lights in a color corre-
sponding to the active alarm.
ALI Acute lung injury<.
ambient state An emergency state, in which the ventilator opens the
ambient and exhalation valves and closes the inspiratory
valves. This lets the patient breathe room air unassisted
by the ventilator.
apnea Cessation of breathing.
Apnea time The maximum time allowed without a breath trigger,
an alarm setting.
APRV Airway pressure release ventilation mode.
APVcmv Adaptive pressure ventilation CMV mode.
APVsimv Adaptive pressure ventilation SIMV mode.
ARDS Adult respiratory distress syndrome.
ASV Adaptive support ventilation, a positive pressure ventila-
tion mode intended to adapt with the patient as he/she
progresses from full mechanical ventilation to sponta-
neous breathing.
ASV target
graphics window
ASV graphical data representation, an Intelligent Panel.
ASV monitored
data window
ASV numeric patient data, an Intelligent Panel.
AutoPEEP Unintended positive end-expiratory pressure, a monitored
parameter.
b/min Breaths per minute.
backup Apnea backup ventilation.
Glossary-2 624470/00
Glossary
breathing circuit Includes the inspiratory-expiratory tubing, humidifier,
filters, and water traps.
breathing pattern A specific sequence of breaths (CMV, IMV, or CSV) with
a designated control variable (volume, pressure, or dual
control) for the mandatory breaths (or the spontaneous
breaths for CSV).
bronchial tree A part of the dynamic lung that shows resistance.
BTPS Body temperature, barometric pressure, saturated with
water vapor.
C Compliance.
CE A certification mark that indicates compliance with the
Medical Device Directive, 93/42/EEC.
cm Centimeter, a unit of length.
cmH
2
O Centimeters of water, a unit of pressure. 1 cmH
2
O is
approximately equal to 1 mbar, which equals 1 hPa.
CMV Controlled mandatory ventilation.
COPD Chronic obstructive pulmonary disease.
CPAP Continuous positive airway pressure.
CSA Canadian Standards Association.
Cstat Static compliance, a monitored parameter.
dB(A) Decibel, a unit of acoustic power.
DuoPAP Duo positive airway pressure ventilation mode.
Dynamic Lung An Intelligent Panel that visualizes tidal volume, lung
compliance, patient triggering, and resistance in real-
time.
E Exhalation.
emergency buzzer The buzzer designed to sound for at least 2 min as
a backup to the alarm speaker.
ET Endotracheal.
ETS Expiratory trigger sensitivity, a control setting.

event log A record of clinically relevant ventilator occurrences,
including alarms, setting changes, calibrations, maneu-
vers, and special functions since the ventilator was
powered on. The HAMILTON-S1 has three event logs:
a Settings log, an Alarms log, and an All events log.
Exp Flow Peak expiratory flow, a monitored parameter.
ExpMinVol Expiratory minute volume, a monitored parameter and
alarm setting. In the Vent Status panel, ExpMinVol is the
percentage of normal minute ventilation, based on IBW.
f Respiratory rate.
FCO
2
Fractional concentration of CO
2.
fcombi A parameter trend setting including both fControl and
fSpont.
fControl Mandatory breathing frequency, a monitored parameter
in ASV mode.
FetCO
2
Fractional end-tidal CO
2
concentration, a monitored
parameter.
FiO
2
Fraction of inspired oxygen.
FlowPattern Flow pattern, a control setting.
Flowtrigger Flow trigger sensitivity, a control setting.
FRC Functional residual capacity, the volume in the lungs at
the end-expiratory position.
%fSpont Spontaneous breath percentage, a monitored parameter
in the Vent Status panel only.
fSpont Spontaneous breathing frequency, a monitored parame-
ter.
fTotal Total breathing frequency, a monitored parameter. The
moving average of the patients total breathing frequency
over the past 8 breaths.
ft Foot, a unit of length.
Gender Sex of patient, a control setting.
Glossary
HME Heat and moisture exchanger (artificial nose).
hPa Hectopascal, a unit of pressure. 1 hPa is equal to 1 mbar,
which is approximately equal to 1 cmH
2
O.
Hz Hertz, or cycles per second, a unit of frequency.
I Inspiration.
IBW Ideal body weight.
I:E Inspiratory:expiratory ratio, a setting, timing parameter,
and monitored parameter. Ratio of inspiratory time to
expiratory time.
IMV Intermittent mandatory ventilation.
in. Inch, a unit of length.
Insp Flow Peak inspiratory flow, a monitored parameter.
Insp time Inspiratory time, in ASV.
inspiratory hold A respiratory maneuver in which gas is retained in the
patients airways, often for X-raying purposes.
Intelligent Panel A type of graphic display on the HAMILTON-S1. The Intel-
ligent Panels include the Dynamic Lung, Vent Status, ASV
target graphics window, and ASV monitored data win-
dow panels.
IntelliTrig Intelligent trigger, a feature that ensures that the set
trigger sensitivity can trigger a breath independent from
leakage and breath pattern.
INTELLiVENT-ASV Fully closed loop ventilation solution, automatic MinVol,
PEEP and oxygen adjustment, based on physiological
patient conditions.
IPP Interaction panel processor.
IRV Inverse ratio ventilation.
J Joule, a unit of work.
kg Kilogram, a unit of mass.
kPa Kilopascal, a unit of pressure.

l Liter, a unit of volume.
l/min Liters per minute, a unit of flow.
lb Pound, a unit of weight.
Leak Percent leakage volume, an alarm setting.
Loudness Alarm loudness, a control setting.
LSF Least squares fitting, a mathematical procedure for find-
ing the best fitting curve to a given set of points by mini-
mizing the sum of the squares of the offsets of the points
from the curve.
m Meter, a unit of length.
mandatory breath A breath for which either the timing or size is controlled
by the ventilator. That is, the machine triggers and/or
cycles the breath.
manual breath A user-triggered mandatory breath started by pressing
the Manual breath key.
mbar Millibar, a unit of pressure. 1 mbar equals 1 hPa, which is
approximately equal to 1 cmH
2
O.
%MinVol Percentage of minute ventilation, a control setting in ASV
mode.
MinVol Minute volume, a calculated and monitored parameter
used in ASV mode. Based on the operator-set %MinVol,
the ventilator calculates the target MinVol in l/min, then
measures and displays it in the ASV target window.
ml Milliliter, a unit of volume.
MMP Main monitoring parameters.
ms Millisecond, a unit of time.
nCPAP-PS Ventilation mode which applies nCPAP by nasal interfaces
with reduced dead space on neonates.
NIV Noninvasive ventilation.
NIV-ST Spontaneous/timed noninvasive ventilation, a ventilation
mode.
Glossary
O
2
Oxygen.
Oxygen Oxygen concentration of the delivered gas, a setting and
monitored parameter.
P0.1 Airway occlusion pressure, a monitored parameter.
Patient Patient type, a control setting.
Patient height A control setting used to compute the patients ideal
body weight (IBW).
Pause Inspiratory pause, a control setting and timing parameter.
Paux Auxiliary pressure.
Paw Airway pressure.
PCO
2
Partial pressure of CO
2.
Pcontrol Pressure control, a control setting in P-CMV and P-SIMV
modes. Pressure (additional to PEEP/CPAP) to be applied
during the inspiratory phase.
Peak flow Maximum flow during the breath cycle, a control setting.
PEEP/CPAP PEEP (positive end-expiratory pressure) and CPAP (conti-
nuous positive airway pressure), a control setting and
monitored parameter. PEEP and CPAP are constant pres-
sures applied during both the inspiratory and expiratory
phases.
PetCO
2
End-tidal CO
2
pressure, a monitored parameter.
P high High positive airway pressure level, a control setting.
Pinsp Inspiratory pressure, the target pressure (additional to
PEEP/CPAP) to be applied during the inspiratory phase,
in ASV mode.
PIP Positive inspiratory pressure.
P low Low positive airway pressure level, a control setting.
Pmean Mean airway pressure, a monitored parameter.
Pminimum Minimum airway pressure, a monitored parameter
PN Part number.

Ppeak Peak airway pressure, a monitored parameter. The Pres-
sure alarm uses Ppeak as its reference pressure.
Pplateau Plateau airway pressure, a monitored parameter.
P-ramp Pressure ramp, a control setting. It is the rise time for
pressure in pressure-controlled and pressure-supported
breaths.
Pressure An alarm setting.
pressure control Maintenance of a consistent transrespiratory pressure
waveform despite changing respiratory system mechan-
ics.
P-SIMV Pressure-controlled synchronized intermittent mandatory
ventilation mode.
Psupport Inspiratory pressure support, a control setting valid during
SPONT breaths. Psupport is pressure (additional to PEEP/
CPAP) to be applied during the inspiratory phase.
PTP Pressure time product, a monitored parameter.
P-trigger Pressure trigger sensitivity, a control setting.
Rate Number of breaths per minute, a control setting, alarm
setting, and timing parameter.
RCexp Expiratory time constant, a monitored parameter.
RCinsp Inspiratory time constant, a monitored parameter.
RDS Respiratory distress syndrome.
Rexp Expiratory flow resistance, a monitored parameter.
Rinsp Inspiratory flow resistance, a monitored parameter.
RSB Rapid shallow breathing index, a monitored parameter.
SBT Spontaneous breathing trial.
sec Second, a unit of time.
(S)CMV Synchronized controlled mandatory ventilation mode.
sigh Breaths delivered to deliberately increase tidal volume at
a regular interval.
Glossary
SIMV Synchronized intermittent mandatory ventilation mode.
slopeCO
2
Volume/flow status of the lungs, a monitored parameter.
SMP Secondary monitoring parameters.
SPONT Spontaneous pressure support mode of ventilation.
spontaneous
breath
A breath for which both the timing and size are con-
trolled by the patient. That is, the patient both triggers
and cycles the breath.
SpO
2
/FiO
2
Ratio which is an approximation of the PaO
2
/FiO
2
ratio
standby The ventilator is in a waiting state, during which time
there is no breath delivery.
STPD Standard temperature and pressure, dry. Defined as gas
at 0 C (273 K), barometric pressure at sea level, and dry.
Suctioning tool The ventilator is in a waiting state that lets you maintain
ventilator settings for a very short time while the
HAMILTON-S1 is not performing any ventilatory func-
tions. This mode is useful when preparing the ventilator
before attaching it to a patient, during tracheal suction-
ing, or when changing a patient breathing circuit.
TE Expiratory time, a monitored parameter.
technical fault A type of alarm, resulting because HAMILTON-S1s ability
to ventilate safely is questionable.
Texp Duration of expiratory phase, a timing parameter.
TF Technical fault.
T high Duration of high airway pressure level, a control setting.
%TI Inspiratory time, as a percentage of total cycle time,
a control setting.
TI Inspiratory time, in s, a control setting and monitored
parameter.
Ti max Maximum inspiratory time in s, a control setting.
Tinsp Duration of inspiratory phase, including any pause, a tim-
ing parameter.

Tip Inspiratory pause time in s, a setting.
T low Duration of low airway pressure level, a control setting.
Trach tube Tracheostomy tube.
TRC Tube resistance compensation.
trend The patients data stored in the HAMILTON-S1 for the last
1, 12, or 24 hours.
trigger The patients inspiratory effort, either flow or pressure,
that causes the ventilator to deliver a breath.
Tspont Time period for spontaneous breaths in the SIMV/P-SIMV
breath interval.
Ttotal Total breath cycle time, a timing parameter; or total
maneuver time, a calculated parameter displayed by the
P/V Tool maneuver.
V Volt, a unit of electric potential or volume.
VA Volt-ampere, a unit of electric power.
Valv Alveolar minute ventilation, a monitored parameter.
VariIndex Variability index (variability of volume and timing), a mon-
itored parameter available in the Vent Status panel only.
VC Vital capacity.
VCO
2
CO
2
elimination, a monitored parameter.
Vcursor Delivered volume at selected point, a displayed value
when the P/V Tools cursor measurement function is
active.
VDaw Airway dead space, a monitored parameter.
VDaw/VTE Airway dead space fraction at the airway opening,
a monitored parameter.
VeCO
2
Exhaled CO
2
volume, a monitored parameter.
Glossary-10 624470/00
Glossary
Vent Status panel An Intelligent Panel that visualizes six parameters related
to the patients ventilator dependency, including oxygen-
ation, CO
2
elimination, and patient activity.
When weaning activities are in process, the Vent Status
panel monitors To abort criteria.
ventilator breath-
ing system (VBS)
A breathing system bounded by the low-pressure gas
input port(s), the gas intake port(s), and the patient
connection port, together with the fresh-gas inlet and
exhaust port(s), if fresh-gas inlet or exhaust ports are
provided, as described in EN 794-1.
Ventilation Cockpit The graphical user interface or interaction panel of the
HAMILTON-S1.
ventilation unit The HAMILTON-S1 that contains the pneumatics (without
the Ventilation Cockpit).
ViCO
2
Inspired CO
2
volume, a monitored parameter.
VIP Ventilator interface processor.
VLeak Leakage volume, a monitored parameter.
volume control Maintenance of a consistent inspiratory volume wave-
form despite changing respiratory system mechanics,
using feedback control with the volume signal.
VRC Ventilator real-time controller.
Vt Tidal volume, a control setting and an alarm setting.
Vtalv Alveolar tidal ventilation, a monitored parameter.
Vtarget Target volume, a control setting in the APV modes.
VTE Expiratory tidal volume, a monitored parameter. It is
the integral of all negative flow measurements during
exhalation.
VTI Inspiratory tidal volume.
VUP Ventilator unit processor.
WOBimp Work of breathing, a monitored parameter. The work
performed by the patient to breathe through the ventila-
tors demand flow system, the breathing circuit, and the
endotracheal tube.
624470/00 Index-1
Index
A
abort SBT
conditions for 2-36
defining defaults 2-44
parameters monitored 2-37
alarms
about 2-39
dismissing 2-39
INTELLiVENT-ASV 1-27
SBT aborted 2-40
SBT successfully fulfilled 2-39,
2-40
viewing 2-39
ARDS patient, settings 1-16
assessing treatment 1-74
auto recruitment 1-24
B
brain injury, settings 1-20
C
chronic hyperapnia patient, settings
1-17
CO
2
sensor faulty alarm 1-29
completing SBT, conditions for 2-39
configuring Quick Wean 2-41
D
Delay Time
parameter settings 2-52
start SBT setting 2-22
disconnection resolved in > 5 min,
ventilation management 1-81
disconnection resolved in 5 min,
ventilation management 1-80
F
fulfilling SBT, conditions for 2-39
H
High PetCO
2
alarm 1-29
history of SBTs, in View 4 2-30
HLI
about 1-77
index, use of 1-24
I
INTELLiVENT-ASV
alarms 1-27
assessing treatment 1-74
data logging 1-88
graphical, color indicators 1-51
overview 1-7
symbols used 1-36
INTELLiVENT-ASV window, overview
1-11
L
Low PetCO
2
alarm 1-30
M
Max Duration
abort SBT setting 2-38
messages, Quick Wean, about 2-39
%MinVol management 1-52
active patient 1-56
automatic or manual 1-10
passive patient 1-53
Monitoring window
Pulse inc% parameter 2-35
Rate inc% parameter 2-35
O
Oxygen
management 1-62
oxygenation horizon 1-45
Index-2 624470/00
Index
oxygenation management 1-62, 1-81
manual 1-75
selecting options 1-10
oxygenation map 1-47
ARDSnet 1-48
Open Lung concept 1-48
P
parameters
abort SBT 2-37
during SBT 2-43
list of 2-46
start SBT 2-18, 2-20
patient conditions 1-20
ARDS 1-16
chronic hypercapnia 1-17
mixed, settings 1-19
normal 1-14
settings 1-12
patient profile, selecting 1-9
PEEP
controlling high and low limits 1-26
management 1-62
managing 1-24
PetCO
2
increase, abort SBT setting 2-38
not available, ventilation
management 1-80
parameter settings 2-48, 2-49
Psupport high
start an SBT setting 2-20
Psupport low, parameter settings 2-49
Pulse inc%
monitoring during SBT 2-34, 2-36
viewing 2-35
Q
Quick Wean
alarms, about 2-39
configuration. See Quick Wean
configuration
history of SBTs, viewing 2-30
messages, about 2-39
parameters. See Quick Wean
parameters
SBT. See SBT
timer, viewing 2-30
Quick Wean configuration
abort SBT settings 2-44
SBT settings 2-43
start SBT settings 2-42
Quick Wean parameters
abort SBT 2-37
changing settings 2-26
Delay Time 2-22, 2-52
list of 2-46
Max Duration 2-38, 2-52
monitoring Pulse inc% and Rate
inc% 2-34, 2-36
Oxygen 2-37, 2-46
PEEP 2-37, 2-48
PetCO
2
2-48, 2-49
PetCO
2
increase 2-38
Psupport high 2-20, 2-38, 2-49
Psupport low 2-49
Pulse inc% 2-49
Rate 2-37, 2-50
Rate inc% 2-50
RSB 2-20, 2-37, 2-50
SBT time range 2-22, 2-53
SpO
2
2-20, 2-37, 2-51
start SBT 2-18, 2-20
status overview, View 4 2-30, 2-31
Time before starting SBT 2-21,
2-54
Time between 2 SBTs 2-21, 2-54
Tolerance Time 2-38, 2-54
VT/IBW 2-37, 2-51
624470/00 Index-3

Quick Wean window (View 4)
about 2-30
displaying 2-31
R
Rate
Rate inc%
monitoring during SBT 2-34, 2-36
viewing 2-35
recruitment management 1-24
RSB
S
SBT
aborting 2-36
conducting 2-32
configuration. See Quick Wean
configuration
current conditions. See Vent Status
window
default settings for 2-33
disabling automated 2-17
enabling automated 2-17
fulfilling 2-39
parameter status overview, View 4
2-31
parameters, abort SBT 2-37
parameters, start SBT 2-18, 2-20
Pulse inc%, monitoring during
2-34, 2-36
Rate inc%, monitoring during
2-34, 2-36
starting automatically 2-18
starting manually 2-19
successfully completing 2-39
timer, viewing 2-30
SBT abort after message 2-40
SBT aborted alarm 2-40
SBT fulfilled after message 2-40
SBT manually abort after message 2-40
SBT manually start at message 2-40
SBT manually stopped message 2-40
SBT settings window, defining defaults
2-43
SBT start at message 2-40
SBT successfully fulfilled alarm 2-39,
2-40
SBT time range
SpO
2
Standby, ventilation management 1-81
Start SBT, defining defaults 2-42
T
Target shift, about 1-75
Time before starting SBT
Time between 2 SBTs
Tolerance Time
Too High messages 2-41
Too Low messages 2-41
trend graphs 1-49
CO
2
1-49
O
2
1-50
V
Vent Status window
Quick Wean 2-26
ventilation guide 1-76
ventilation horizon 1-43, 1-44
Index-4 624470/00
Index
ventilation management
disconnection resolved in > 5 min
1-81
disconnection resolved in 5 min
1-80
manual 1-75
PetCO
2
not available, INTELLiVENT-
ASV 1-80
returning from Standby 1-81
selecting options 1-10
ventilation map 1-46
View 4 window, Quick Wean
displaying 2-31
parameter status overview 2-30
VT/IBW

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