S1 OpsMan Web

Operators manual

624302/04

Software version 2.3x

2013-06-07

0 1 9 7

HAMILTON-S1Operator's Manual

624302/04

624302/04

2013 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.

This mMEDICthe mocontacWhile not a s

NothinHAMILmodifywithoument tto furnownerherein

The eqfessionrespecWarra

Productradem

HAMILgramstions, traineddeemeiii

anual may be revised or replaced by HAMILTON AL at any time and without notice. Ensure that you have st current applicable version of this manual; if in doubt, t HAMILTON MEDICAL AG Marketing Department. the information set forth is believed to be accurate, it is ubstitute for the exercise of professional judgment.

g in this manual shall limit or restrict in any way TON MEDICALs right to revise or otherwise change or the equipment (including its software) described herein, t notice. In the absence of an express, written agree-o the contrary, HAMILTON MEDICAL has no obligation ish any such revisions, changes, or modifications to the or user of the equipment (including software) described .

uipment must be operated and serviced by trained pro-als only. HAMILTON MEDICALs sole responsibility with t to the equipment and its use is as stated in the Limited nty provided in this manual.

t and company names mentioned herein may be the arks of their respective owners.

TON MEDICAL will make available on request circuit dia-, component parts lists, descriptions, calibration instruc-or other information that will assist the users authorized personnel to repair those parts of the equipment d by HAMILTON MEDICAL to be repairable.

iv

Manufacturer Distributor in USA

HAMILTON MEDICAL AGVia Crusch 8CH-7402 BonadSwitzerlandPhone: (+41) 81Fax: (+41) 81 [email protected]

HAMILTON MEDICAL, Inc.624302/04

uz

660 60 1060 60 20medical.commedical.com

4990 Energy WayP.O. Box 30008Reno, NV 89520, USAPhone: (775) 858-3200Toll-free: (800) 426-6331Fax: (775) [email protected]

624302/04

Safety warnings, cautions, notes

The software version for the HAMILTON-S1 is visible in the System -> Info window. The software version for the VUP (ventilator unit processor) (that is, the digit to the left of the decimal point for VUP) should match the version on the title page of this manual. See section 4.3.1 for details.

WA

A Winjassalsan

CA

A Cpromidaertinceff

NOTEA Ntanv

RNING

ARNING alerts the user to the possibility of ury, death, or other serious adverse reactions ociated with the use or misuse of the device. It o describes potential serious adverse reactions d safety hazards.

UTION

AUTION alerts the user to the possibility of a blem with the device associated with its use or

suse, such as device malfunction, device failure, mage to the device, or damage to other prop-y. It also alerts against unsafe practices. This ludes the special care necessary for the safe and ective use of the device.

:OTE emphasizes information of particular impor-ce.

vi

Displayed only when the P/V Tool maneuver option is installed624302/04

Displayed only when the adaptive support venti-lation (ASV) option is installed.

Displayed when the heliox option is installed

Displayed only when the CO2 sensor option is installed

Displayed only when the SpO2 sensor option is installed

Displayed only when neonatal option is installed

624302/04

This moption

General war

CA

U.Son

NOTE

Intended usThe HAtilationand nehospitfessionintendsuperv

Displayed when the INTELLiVENT-ASV option is installedvii

anual shows screenshots and hardware with several s installed.

nings, cautions, and notes

UTION

. Federal law restricts this device to sale by or the order of a physician.

:

Not all options are available in all markets.

ASV and INTELLiVENT-ASV for adult and pediatric use only.

eMILTON-S1 ventilator is designed for intensive care ven- of adult and pediatric patients, and optionally infant onatal patients. The device is intended for use in the

al and institutional environment where health care pro-als provide patient care. The HAMILTON-S1 ventilator is ed for use by properly trained personnel under the direct ision of a licensed physician.

Displayed when the IntelliCuff option is installed

viii

The HAMILTON-S1 ventilator may be used for transport within a hospital or hospital type facility provided compressed gas is supplied. The device is not to be used in the presence of flam-mable anesthetic agents or other ignition sources. The ventila-tor is not to be used in an environment with magnetic resonance imaging (MRI) equipment. The device is not intended for transportation outside the hospital or for use in the home environment.

General not Op

befof ME

Thewhnoma

Monitoring The

vitaPatmomodoof meof

Anevetilathevenbagwhclinser624302/04

es for operatorserators must familiarize themselves with this manual ore using the ventilator on a patient. For training options the HAMILTON-S1, please contact the HAMILTON DICAL representatives.

displays shown in this manual may not exactly match at you see on your own ventilator. Your ventilator may t include all the modes and features described in this nual.

and alarms HAMILTON-S1 is not intended to be a comprehensive l sign monitor for patients on life-support equipment. ients on life-support equipment must be appropriately nitored by qualified medical personnel and suitable nitoring devices. The use of an alarm monitoring system es not give absolute assurance of warning for every form malfunction that may occur with the ventilator. Alarm ssages may not exactly pinpoint a problem; the exercise clinical judgment is necessary.

alternative means of ventilation must be available when-r the ventilator is in use. If a fault is detected in the ven-tor or its life-support functions are in doubt, disconnect HAMILTON-S1 from the patient and immediately start tilation with such a device (for example, a resuscitation ), using PEEP and/or increased oxygen concentration en appropriate. The ventilator must be removed from ical use and serviced by HAMILTON MEDICAL authorized vice personnel.

624302/04

It is recommended that additional independent monitoring devices be used during mechanical ventilation. The opera-tor of the ventilator must still maintain full responsibility for proper ventilation and patient safety in all situations.

Do not silence the audible alarm when leaving the patient unattended.

Do not use the exhaust port of the expiratory valve for spi-rometry. Due to the HAMILTON-S1s base flow, the exhaust gasum

He

ThehouconPul

Fire and oth To

HA(foigncon

To hosma

To inteuse

In cneeits

DoIf amaix

output is larger than the patients actual exhaled vol-e.

liox gas is not compatible with INTELLiVENT-ASV use. Masimo Rainbow SpHb sensor is valid for a total of 66 rs of operation. Once this time expires, you must nect a new SpHb sensor. For details, see Appendix F,

se oximetry.

er hazardsreduce the risk of fire or explosion, do not place the MILTON-S1 in a combustible or explosive environment r example, around flammable anesthetics or other ition sources). Do not use it with any equipment taminated with oil or grease.

minimize the risk of fire, do not use high-pressure gas es that are worn or contaminated with combustible terials like grease or oil.

reduce the risk of fire, use only breathing circuits nded for use in oxygen-enriched environments. Do not antistatic or electrically conductive tubing.

ase of fire, immediately secure the patients ventilatory ds, switch off the HAMILTON-S1, and disconnect it from

gas and electrical sources.

not put a vessel filled with a liquid on the ventilator. liquid enters the product, a fire and/or electric shock y occur.

xService and testing To ensure proper servicing and to prevent possible physical

injury, only qualified personnel should attempt to service the ventilator.

To reduce the risk of electrical shock, do not remove the ventilator housing. Refer the ventilator for servicing by qual-ified personnel.

To reduce the risk of electrical shock, disconnect electrical pobatnecstil

Dofied

Useon

AnwitME

Theser

To testioIf timmrep

ElectromagnFor fu

ElectromagnFor fu624302/04

wer from the ventilator before servicing. Be aware that tery power remains even after the mains is discon-ted. Be aware that if the power switch is off, some parts

l carry high voltage.

not attempt service procedures other than those speci- in the service manual.

replacement parts supplied by HAMILTON MEDICAL ly.

y attempt to modify the ventilator hardware or software hout the express written approval of HAMILTON DICAL automatically voids all warranties and liabilities.

preventive maintenance program requires a general vice every 5000 hours or yearly, whichever comes first.

ensure the ventilators safe operation, always run the ts and calibrations prescribed in Chapter 4, Tests, calibra-ns, and utilities, before using the ventilator on a patient. he ventilator fails any tests, remove it from clinical use

ediately. Do not use the ventilator until necessary airs are completed and all tests have passed.

etic susceptibilityrther information see Appendix A.

etic emissionsrther information see Appendix A.

624302/04

Units of measureAir and oxygen pressures are indicated on the HAMILTON-S1 in cmH2O or mbar. Hectopascals (hPa) are used by some institu-tions instead. Since 1 mbar equals 1 hPa, which equals 1.016 cmH2O, the units may be used interchangeably.

CO2 measurements are indicated in mmHg, Torr, and kPa. These units are user configurable.

SpO2 measurements are indicated in %.

DisposalDisposinstitutions wdisposoxygen

Year of manThe yeon thexi

e of all parts removed from the device according to your tions protocol. Follow all local, state, and federal regula-ith respect to environmental protection, especially when

ing an electronic device or parts of it (for example, cell, batteries).

ufacturear of manufacture is shown on the serial number label HAMILTON-S1 ventilation unit.

xii 624302/04

624302/04

Table of Contents

Safety warnings, cautions, notes . . . . . . . . . . . . . . .vGeneral warnings, cautions, and notes . . . . . . . . . . . . . . . viiIntended use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiGeneral notes for operators . . . . . . . . . . . . . . . . . . . . . . . viiiMonitoring and alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . viiiFire and other hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ixServicElectrElectrUnits DispoYear o

List of Fig

List of Ta

1 General in1.1 Introd1.2 Funct

1.2.11.2.21.2.3

1.3 Physic1.3.11.3.21.3.3

1.4 Symb

2 Preparing2.1 Introd2.2 Install

2.2.12.2.2

2.3 Install2.4 Installxiii

e and testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xomagnetic susceptibility . . . . . . . . . . . . . . . . . . . . . . . xomagnetic emissions . . . . . . . . . . . . . . . . . . . . . . . . . . xof measure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xisal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xif manufacture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

ures . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxv

bles . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxiii

formation. . . . . . . . . . . . . . . . . . . . . . . . 1-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2ional description . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

System overview . . . . . . . . . . . . . . . . . . . . . . . . . 1-9Gas supply and delivery . . . . . . . . . . . . . . . . . . . 1-11Gas monitoring with the flow sensor . . . . . . . . . 1-13

al description . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14Breathing circuits and accessories . . . . . . . . . . . 1-14Ventilation cockpit . . . . . . . . . . . . . . . . . . . . . . . 1-18Ventilation unit . . . . . . . . . . . . . . . . . . . . . . . . . 1-24

ols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-27

for ventilation . . . . . . . . . . . . . . . . . . . . 2-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2ing and positioning the Ventilation Cockpit . . . . . . . 2-4

Mounting the Ventilation Cockpit . . . . . . . . . . . . 2-4Adjusting the Ventilation Cockpit (tilt and swivel) 2-7

ing the patient tubing support arm . . . . . . . . . . . . . 2-9ing the humidifier . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9

xiv

Table of Contents

2.4.1 Connecting and attaching the humidifier . . . . . .2-102.5 Installing the modules (CO2, SpO2, Aeroneb) . . . . . . . . .2-132.6 Installing the pneumatic nebulizer . . . . . . . . . . . . . . . . . .2-152.7 Verifying the oxygen cell installation . . . . . . . . . . . . . . . .2-162.8 Connecting the patient breathing circuit . . . . . . . . . . . . .2-172.9 Using the auxiliary pressure (Paux) port . . . . . . . . . . . . . .2-252.10 Using an expiratory filter . . . . . . . . . . . . . . . . . . . . . . . . .2-262.11 Connecting to AC power . . . . . . . . . . . . . . . . . . . . . . . .2-272.12 Using2.13 Using

2.13.2.13.

2.14 Conn2.15 Conn

device2.16 Starti2.17 Shutt2.18 Venti

3 Hardware3.1 Set up

3.1.13.1.2

3.1.3

3.2 SpO23.3 Integr

3.3.13.3.23.3.3624302/04

the optional power strip . . . . . . . . . . . . . . . . . . . .2-28 the backup batteries . . . . . . . . . . . . . . . . . . . . . . .2-281 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-292 Replacing the optional extended battery pack . . .2-31ecting gas supplies . . . . . . . . . . . . . . . . . . . . . . . . .2-33ecting to an external patient monitor or other. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-37

ng up the ventilator . . . . . . . . . . . . . . . . . . . . . . . .2-37ing down the ventilator. . . . . . . . . . . . . . . . . . . . . .2-39lation cockpit navigation guidelines. . . . . . . . . . . . .2-39

options. . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 CO2 sensor monitoring. . . . . . . . . . . . . . . . . . . . . .3-3

Enabling CO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-5CO2 mainstream measurement . . . . . . . . . . . . . . .3-53.1.2.1 Introduction . . . . . . . . . . . . . . . . . . . .3-53.1.2.2 Connecting the CO2 mainstream

sensor . . . . . . . . . . . . . . . . . . . . . . . . .3-6CO2 sidestream measurement. . . . . . . . . . . . . . . .3-93.1.3.1 Using the LoFlo CO2 Module . . . . . .3-93.1.3.2 Module mounting . . . . . . . . . . . . . . . .3-93.1.3.3 Module exhaust . . . . . . . . . . . . . . . . .3-103.1.3.4 Connecting the CO2 sidestream

sensor . . . . . . . . . . . . . . . . . . . . . . . .3-113.1.3.5 Sidestream sample kit . . . . . . . . . . . .3-14

monitoring options . . . . . . . . . . . . . . . . . . . . . . . .3-15ated Aeroneb system . . . . . . . . . . . . . . . . . . . . . .3-16

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-16Indications for use. . . . . . . . . . . . . . . . . . . . . . . .3-17System description . . . . . . . . . . . . . . . . . . . . . . .3-17

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3.3.4 Enabling the Aeroneb option. . . . . . . . . . . . . . 3-193.3.5 Connecting the nebulizer. . . . . . . . . . . . . . . . . . 3-203.3.6 Performing the Aeroneb function test

(continuous nebulization). . . . . . . . . . . . . . . . . . 3-213.3.6.1 Setting the flow-rate for continuous

nebulization . . . . . . . . . . . . . . . . . . . 3-223.3.7 Connecting the nebulizer to the breathing

circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-233.3.8 Adding medication . . . . . . . . . . . . . . . . . . . . . . 3-253.3.9

3.3.103.3.11

3.4 IntelliC3.4.13.4.23.4.3

3.4.4

3.4.5

3.4.6

3.4.73.5 Work

humid3.5.13.5.23.5.3xv

Configuring nebulization . . . . . . . . . . . . . . . . . . 3-263.3.9.1 Configuring nebulization for

intermittent doses less thanor equal to 6 ml . . . . . . . . . . . . . . . . 3-26

3.3.9.2 Configuring nebulization forcontinuous doses . . . . . . . . . . . . . . . 3-27

Functional test . . . . . . . . . . . . . . . . . . . . . . . . . . 3-28Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29

uff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29Indications for use . . . . . . . . . . . . . . . . . . . . . . . 3-29System description. . . . . . . . . . . . . . . . . . . . . . . 3-293.4.3.1 About the cuff tubing . . . . . . . . . . . . 3-32Enabling the integrated cuff pressurecontroller option . . . . . . . . . . . . . . . . . . . . . . . . 3-32Operation of the automatic cuff pressurecontroller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-33Operating modes. . . . . . . . . . . . . . . . . . . . . . . . 3-343.4.6.1 Cuff pressure control OFF . . . . . . . . . 3-343.4.6.2 Setting constant cuff pressure

(MANUAL) . . . . . . . . . . . . . . . . . . . . 3-353.4.6.3 Setting cuff pressure relative to

airway pressure (AUTO) . . . . . . . . . . 3-363.4.6.4 Full deflation of the cuff . . . . . . . . . . 3-37Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-38

ing with the integrated HAMILTON-H900ifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-38

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-39Humidifier overview. . . . . . . . . . . . . . . . . . . . . . 3-39Setting up the humidifier . . . . . . . . . . . . . . . . . . 3-41

xvi

Table of Contents

3.5.4 Humidifier display on the ventilator. . . . . . . . . . .3-413.5.5 Controlling humidifier options . . . . . . . . . . . . . .3-433.5.6 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-44

4 Tests, calibrations and utilities . . . . . . . . . . . . . . . 4-14.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-24.2 Pre-operational checks . . . . . . . . . . . . . . . . . . . . . . . . . . .4-3

4.2.1 Pre-operational check with heliox . . . . . . . . . . . . .4-64.3 System functions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-8

4.3.1

4.3.2

4.3.3

4.3.44.3.5

4.4 Alarm4.4.14.4.24.4.34.4.44.4.54.4.64.4.7

5 Ventilato5.1 Introd5.2 Settin5.3 Patien

5.3.1

5.3.2624302/04

Info: Viewing ventilator operating hours,options, and versions . . . . . . . . . . . . . . . . . . . . . .4-8Tests & calib: Running sensor calibrationsand the tightness test . . . . . . . . . . . . . . . . . . . . . .4-94.3.2.1 Flow sensor calibration . . . . . . . . . . .4-104.3.2.2 Tightness test . . . . . . . . . . . . . . . . . .4-124.3.2.3 Oxygen cell calibration . . . . . . . . . . . .4-134.3.2.4 CO2 sensor/adapter zero calibration .4-144.3.2.5 SpO2 sensor/adapter test . . . . . . . . . .4-16Sensors on/off: Enabling/disabling SpO2, O2,and CO2 monitoring . . . . . . . . . . . . . . . . . . . . . .4-164.3.3.1 Gas source: Assigning air or heliox . . .4-17Setting day and night . . . . . . . . . . . . . . . . . . . . .4-19Setting date and time . . . . . . . . . . . . . . . . . . . . .4-20

tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-20High pressure . . . . . . . . . . . . . . . . . . . . . . . . . . .4-20Low minute volume . . . . . . . . . . . . . . . . . . . . . .4-20Oxygen supply failed and low oxygen alarms . . .4-21Disconnection . . . . . . . . . . . . . . . . . . . . . . . . . . .4-21Loss of mains power . . . . . . . . . . . . . . . . . . . . . .4-21Exhalation obstructed . . . . . . . . . . . . . . . . . . . . .4-22Apnea. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-22

r settings . . . . . . . . . . . . . . . . . . . . . . . . . 5-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2g up the patient . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-3t window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5

Patient window: Changing patient genderand height . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-5Patient window: Ventilation timer . . . . . . . . . . . . .5-7

624302/04

5.4 Modes window: Setting the ventilation mode . . . . . . . . . 5-85.5 Controls window: Settings including apnea

backup ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-115.5.1 Adjusting and confirming control settings

without mode change . . . . . . . . . . . . . . . . . . . . 5-115.5.2 Adjusting and confirming control settings

after mode change . . . . . . . . . . . . . . . . . . . . . . 5-135.5.3 About apnea backup ventilation . . . . . . . . . . . . 5-15

5.6 Additions window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-165.6.15.6.25.6.3

5.7 Alarm5.7.15.7.25.7.35.7.4

6 Neonatal6.1 Introd6.2 Breath6.3 Flow s6.4 Test a6.5 Ventil6.6 Contr

6.6.16.6.26.6.3

6.7 Other

7 Monitori7.1 Introd7.2 Monit

7.2.1

7.2.27.3 Graph

7.3.17.3.2xvii

Sigh: Enabling/disabling the sigh function . . . . . 5-17TRC: Setting tube resistance compensation . . . . 5-18Table of control settings, additions, and ranges . 5-21

s window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-30Limits: Setting alarm limits . . . . . . . . . . . . . . . . . 5-31Loudness: Adjusting alarm loudness. . . . . . . . . . 5-33Buffer: Viewing active alarms. . . . . . . . . . . . . . . 5-34Table of alarm limit settings and ranges . . . . . . . 5-34

ventilation . . . . . . . . . . . . . . . . . . . . . . . 6-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2ing circuit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3ensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-3nd calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4ation modes and mode additions . . . . . . . . . . . . . . 6-4ols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5

Ti max . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5Flow trigger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5P-ramp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-6

ng. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2oring window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-4

Monitored parameter windows and sensordata window: Viewing numeric patient data . . . . 7-4About airway pressure (Paw and Paux). . . . . . . . . 7-5

ics window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7Setting up the graphics window . . . . . . . . . . . . . 7-8Setting up individual panels . . . . . . . . . . . . . . . . . 7-9

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7.3.3 Adjusting the scale of a graph. . . . . . . . . . . . . . .7-107.3.4 Waveforms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-127.3.5 Loops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-137.3.6 Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-157.3.7 Dynamic Lung. . . . . . . . . . . . . . . . . . . . . . . . . . .7-167.3.8 Vent status . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-167.3.9 INTELLiVENT-specific intelligent panels . . . . . . .7-177.3.10 ASV graphics window. . . . . . . . . . . . . . . . . . . . .7-177.3.11 ASV data window. . . . . . . . . . . . . . . . . . . . . . . .7-177.3.1

7.4 Tools7.4.1

7.4.27.5 Moni

8 Intelligen8.1 Introd8.2 Dynam

8.2.18.2.28.2.38.2.48.2.5

8.3 Heart8.4 Vent 8.5 ASV m8.6 ASV t8.7 INTEL8.8 Quick

9 P/V tool m9.1 Introd

9.1.19.1.29.1.39.1.49.1.5624302/04

2 Freeze and cursor measurement . . . . . . . . . . . . .7-17 window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-18

Hold: Performing inspiratory/expiratory holdmaneuvers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-18Performing a static P/V maneuver . . . . . . . . . . . .7-21

tored parameters . . . . . . . . . . . . . . . . . . . . . . . . . .7-21

t panels . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2ic Lung panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2Tidal volume (Vt). . . . . . . . . . . . . . . . . . . . . . . . . .8-3Compliance (Cstat) . . . . . . . . . . . . . . . . . . . . . . . .8-3Patient triggering: Muscle . . . . . . . . . . . . . . . . . . .8-4Resistance: Bronchial tree . . . . . . . . . . . . . . . . . . .8-4Heart circulation . . . . . . . . . . . . . . . . . . . . . . . . . .8-5

-Lung interaction . . . . . . . . . . . . . . . . . . . . . . . . . . .8-5status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-5

onitored data window . . . . . . . . . . . . . . . . . . . . . .8-8arget graphics window . . . . . . . . . . . . . . . . . . . . . . .8-8LiVENT-specific intelligent panels . . . . . . . . . . . . . .8-8 Wean-specific intelligent panels. . . . . . . . . . . . . . . .8-8

aneuver option . . . . . . . . . . . . . . . . . . . 9-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2Required conditions for use. . . . . . . . . . . . . . . . . .9-3Indication for use . . . . . . . . . . . . . . . . . . . . . . . . .9-3Contraindications for use . . . . . . . . . . . . . . . . . . .9-4How the P/V Tool works . . . . . . . . . . . . . . . . . . . .9-4

624302/04

9.2 Working with the P/V Tool . . . . . . . . . . . . . . . . . . . . . . . . 9-59.2.1 Performing the maneuver . . . . . . . . . . . . . . . . . . 9-69.2.2 Using the cursor feature to graphically analyze

the plot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-129.2.3 Analyzing the curve . . . . . . . . . . . . . . . . . . . . . . 9-149.2.4 Selecting plot type . . . . . . . . . . . . . . . . . . . . . . . 9-179.2.5 Using the Reference feature to review

stored curves . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-189.2.6 Flow sensor and breathing circuit check. . . . . . . 9-199.2.7

9.3 Refere

10 Respondi10.1 Introd10.2 How t10.3 Active10.4 Event10.5 Alarm

11 Maintena11.1 Introd11.2 Clean

11.2.111.2.211.2.3

11.3 Preven11.3.111.3.211.3.3

11.4 Calibr11.5 Storag11.6 Repac

12 Special fu12.1 Stand12.2 O2 en12.3 Suctio12.4 Manuxix

P/V Tool against P/V Tool Pro . . . . . . . . . . . . . . . 9-23nces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-23

ng to alarms . . . . . . . . . . . . . . . . . . . . . 10-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2o respond to an alarm . . . . . . . . . . . . . . . . . . . . . 10-5 alarm buffer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-6 logs: Reviewing events . . . . . . . . . . . . . . . . . . . . . 10-7 troubleshooting table. . . . . . . . . . . . . . . . . . . . . . 10-8

nce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-2ing, disinfection, and sterilization . . . . . . . . . . . . . 11-2

General guidelines for cleaning . . . . . . . . . . . . 11-10General guidelines for chemical disinfection. . . 11-10General guidelines for autoclave sterilization . . 11-11

tive maintenance . . . . . . . . . . . . . . . . . . . . . . . . 11-11Cleaning or replacing the fan filter. . . . . . . . . . 11-14Removing a gas supply filter housing . . . . . . . . 11-14Replacing the oxygen cell. . . . . . . . . . . . . . . . . 11-14

ation of the extended battery . . . . . . . . . . . . . . . 11-15e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-15king and shipping . . . . . . . . . . . . . . . . . . . . . . . . 11-15

nctions . . . . . . . . . . . . . . . . . . . . . . . . . 12-1by . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-2richment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-4ning tool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-5al breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-6

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12.5 Pneumatic and Aeroneb nebulizer. . . . . . . . . . . . . . . . .12-612.6 Print screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-712.7 Screen Lock/Unlock . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12-8

A Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1A.1 Physical characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . A-2A.2 Environmental requirements . . . . . . . . . . . . . . . . . . . . . . A-3A.3 Pneumatic specifications . . . . . . . . . . . . . . . . . . . . . . . . . A-3A.4 ElectrA.5 ContrA.6 MoniA.7 AlarmA.8 ConfiA.9 BreatA.10 OtherA.11 StandA.12 EMC A.13 WarraA.14 Misce

B Modes ofB.1 IntrodB.2 Mand

B.2.1

B.2.2B.3 SIMV

modeB.3.1B.3.2

B.4 PressuB.5 Advan

B.5.1

B.5.2624302/04

ical specifications . . . . . . . . . . . . . . . . . . . . . . . . . . A-4ol settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-6tored parameters . . . . . . . . . . . . . . . . . . . . . . . . . A-20s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-26guration specifications . . . . . . . . . . . . . . . . . . . . . A-33hing circuit specifications . . . . . . . . . . . . . . . . . . . A-37 technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . A-38ards and approvals . . . . . . . . . . . . . . . . . . . . . . . . A-41declarations (IEC 60601-1-2). . . . . . . . . . . . . . . . . A-42nty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-47llaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-48

ventilation . . . . . . . . . . . . . . . . . . . . . . .B-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-2atory modes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-6

Synchronized controlled mandatory ventilation ((S)CMV) modeB-6Pressure-controlled CMV (P-CMV) mode . . . . . . . .B-7

(synchronized intermittent mandatory ventilation)s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-8

SIMV mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-9P-SIMV mode . . . . . . . . . . . . . . . . . . . . . . . . . . .B-10

re support mode (SPONT) . . . . . . . . . . . . . . . . . . .B-11ced ventilation modes . . . . . . . . . . . . . . . . . . . . . .B-12

Adaptive pressure ventilation (APV) mode . . . . . .B-12B.5.1.1 Advantages of using the APV modes .B-14B.5.1.2 Principles of operation . . . . . . . . . . . .B-15Adaptive support ventilation (ASV) mode . . . . . .B-16

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B.5.3 DuoPAP (Duo positive airway pressure) andAPRV (Airway pressure release ventilation)modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-16B.5.3.1 Introduction . . . . . . . . . . . . . . . . . . . B-16B.5.3.2 Differences between DuoPAP and

APRV . . . . . . . . . . . . . . . . . . . . . . . . B-19B.5.3.3 The many faces of DuoPAP and

APRV . . . . . . . . . . . . . . . . . . . . . . . . B-19B.5.3.4 Pressure support in DuoPAP/APRV

B.5.4B.5.5B.5.6

B.6 Leak c

C ASV (AdC.1 IntrodC.2 ASV uC.3 Detail

C.3.1C.3.2C.3.3C.3.4

C.3.5C.3.6

C.4 MinimC.5 ASV tC.6 ASV SC.7 Referexxi

breaths . . . . . . . . . . . . . . . . . . . . . . . B-20B.5.3.5 Synchronization . . . . . . . . . . . . . . . . B-21B.5.3.6 References . . . . . . . . . . . . . . . . . . . . B-21Volume Support (VS) mode . . . . . . . . . . . . . . . . B-21Noninvasive ventilation (NIV and NIV-ST) modes. B-23nCPAP-PS mode . . . . . . . . . . . . . . . . . . . . . . . . B-25B.5.6.1 Introduction . . . . . . . . . . . . . . . . . . . B-25B.5.6.2 Controls of nCPAP-PS . . . . . . . . . . . . B-26

ompensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-27

aptive Support Ventilation). . . . . . . . . . C-1uction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-2se in clinical practice . . . . . . . . . . . . . . . . . . . . . . . . C-3ed functional description of ASV . . . . . . . . . . . . . . C-15

Normal minute ventilation . . . . . . . . . . . . . . . . . C-15Targeted minute ventilation . . . . . . . . . . . . . . . . C-15Lung-protective rules strategy . . . . . . . . . . . . . . C-17Optimal breath pattern . . . . . . . . . . . . . . . . . . . C-20C.3.4.1 Initial breaths: How ASV starts . . . . . C-21C.3.4.2 Approaching the target . . . . . . . . . . C-22Dynamic adjustment of lung protection . . . . . . . C-24Dynamic adjustment of optimal breath pattern . C-25

um work of breathing (Otis equation) . . . . . . . . . C-26echnical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-28tart up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-31nces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-32

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D NIV (Noninvasive ventilation) . . . . . . . . . . . . . . . .D-1D.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-2D.2 Benefits of noninvasive ventilation, . . . . . . . . . . . . . . . . . D-3D.3 Required conditions for use. . . . . . . . . . . . . . . . . . . . . . . D-4D.4 Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-5D.5 Potential adverse reactions . . . . . . . . . . . . . . . . . . . . . . . D-5D.6 Selecting a patient interface . . . . . . . . . . . . . . . . . . . . . . D-5D.7 Control settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-7D.8 AlarmD.9 MoniD.10 AdditD.11 Refer

E CO2 sensoE.1 IntrodE.2 CO2 eE.3 End-tE.4 AirwaE.5 AlveoE.6 Capn

slopeE.7 FormuE.8 Refer

F Pulse oximF.1 IntrodF.2 SpO2

F.2.1

F.2.2F.3 Moni

F.3.1F.4 Viewi

F.4.1F.4.2

F.5 Work624302/04

s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-8tored parameters . . . . . . . . . . . . . . . . . . . . . . . . . . D-8ional notes about using noninvasive ventilation. . . . D-9ences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-11

r option: Volumetric Capnography . . . E-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-2limination (VCO2) . . . . . . . . . . . . . . . . . . . . . . . . . . E-3

idal CO2 (PetCO2 and FetCO2) . . . . . . . . . . . . . . . . . E-5y dead space (VDaw) . . . . . . . . . . . . . . . . . . . . . . . . E-5lar minute ventilation (Valv) . . . . . . . . . . . . . . . . . . . E-6ogram shape (slope of the alveolar plateau,CO2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-7las . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9

ences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-10

etry . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-3 monitoring options . . . . . . . . . . . . . . . . . . . . . . . . F-15

About Masimo SET and Masimo rainbow SET F-17F.2.1.1 Masimo SpHb sensor modes of

operation . . . . . . . . . . . . . . . . . . . . . F-18About Nihon-Kohden . . . . . . . . . . . . . . . . . . . . . F-19

tored parameters and settings. . . . . . . . . . . . . . . . . F-20About the SpO2 Raw parameter measurements . F-22

ng SpO2 data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-23SpO2 parameters in the Monitoring window . . . . F-23Quality index indicators. . . . . . . . . . . . . . . . . . . . F-25

ing in SpHb Spot Check mode (Masimo) . . . . . . . . . F-26

624302/04

F.5.1 Performing an SpHb spot check (Masimo) . . . . . F-28F.6 Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-29

F.6.1 SpO2 alarm delay . . . . . . . . . . . . . . . . . . . . . . . F-29F.6.2 SpO2 Alarm Limits window . . . . . . . . . . . . . . . . F-29F.6.3 Pulse oximeter-related alarm settings . . . . . . . . . F-30F.6.4 Viewing sensor information . . . . . . . . . . . . . . . . F-32

F.6.4.1 About the Masimo pulse oximeterinformation codes . . . . . . . . . . . . . . F-33

F.7 ConfiF.7.1

F.7.2

F.8 ConnF.8.1

F.8.2F.8.3F.8.4

F.9 TroubF.10 Cleanxxiii

guring the oximeters . . . . . . . . . . . . . . . . . . . . . . . F-35Configuring Masimo options . . . . . . . . . . . . . . . F-35F.7.1.1 Configuring the Masimo sensor

type and data acquisition options . . . F-36F.7.1.2 Table of Masimo data acquisition

settings . . . . . . . . . . . . . . . . . . . . . . F-37F.7.1.3 Enabling and configuring alarms . . . . F-38F.7.1.4 Selecting Masimo monitoring

settings . . . . . . . . . . . . . . . . . . . . . . F-39F.7.1.5 About the Masimo monitoring

options . . . . . . . . . . . . . . . . . . . . . . . F-40Configuring Nihon-Kohden options . . . . . . . . . . F-43F.7.2.1 Selecting the Nihon Kohden

sensor type . . . . . . . . . . . . . . . . . . . . F-43F.7.2.2 Enabling and configuring alarms . . . . F-44F.7.2.3 Selecting Nihon Kohden sensor

options . . . . . . . . . . . . . . . . . . . . . . . F-45ecting the equipment . . . . . . . . . . . . . . . . . . . . . . F-47

Connecting the Masimo oximeter . . . . . . . . . . . F-47F.8.1.1 Attaching the adapter to a rail . . . . . F-48F.8.1.2 Attaching the adapter cable . . . . . . . F-50F.8.1.3 Attaching the patient cable to

the SpO2 adapter . . . . . . . . . . . . . . . F-51F.8.1.4 Attaching the sensor to the

patient cable . . . . . . . . . . . . . . . . . . F-52Connecting the Nihon Kohden oximeter . . . . . . F-53Confirming measurements. . . . . . . . . . . . . . . . . F-54Disconnecting the SpO2 sensor . . . . . . . . . . . . . F-54

leshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-56ing and maintenance. . . . . . . . . . . . . . . . . . . . . . . F-60

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F.10.1 Cleaning the adapter . . . . . . . . . . . . . . . . . . . . . F-61F.10.2 Replacing the adapter . . . . . . . . . . . . . . . . . . . . . F-61F.10.3 Disposing of the adapter. . . . . . . . . . . . . . . . . . . F-61

F.11 Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-62F.11.1 Masimo Specifications. . . . . . . . . . . . . . . . . . . . . F-62F.11.2 Nihon Kohden specifications . . . . . . . . . . . . . . . . F-67

F.12 Basics of pulse oximetry . . . . . . . . . . . . . . . . . . . . . . . . . F-70F.13 SpO2/FiO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-73F.14 Refer

G Pneumati

H Parts and

I CommunI.1 IntrodI.2 RS-23I.3 PatienI.4 PDMSI.5 InspirI.6 RemoI.7 Conn

J ConfiguraJ.1 IntrodJ.2 BeginJ.3 LanguJ.4 Custo

and aJ.4.1

J.5 Quickcriteri

J.6 MMPparam

J.7 Vent panel

J.8 OptioJ.9 Interf624302/04

ences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-74

c diagram. . . . . . . . . . . . . . . . . . . . . . . . .G-1

accessories . . . . . . . . . . . . . . . . . . . . . . .H-1

ication interface. . . . . . . . . . . . . . . . . . . . I-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-22 interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-3t monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-4 or other computer system . . . . . . . . . . . . . . . . . . . . I-7atory:Expiratory (I:E) timing outlet . . . . . . . . . . . . . . I-10te alarm outlet . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-11ector pin assignments . . . . . . . . . . . . . . . . . . . . . . . I-12

tion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-1uction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2 configuration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2age: Choosing the default language . . . . . . . . . . . . J-3mize: Choosing the ventilation philosophylarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-4

Breath timing philosophies (adult patients) . . . . . . J-5 Wean: Choosing the default weaning activitya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-7 selection: Choosing the default main monitoringeter display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-10

Status: Configuring the Vent Status intelligent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-11ns: Activating software and hardware options . . . . J-13ace: Configuring the I:E timing outlet . . . . . . . . . . . J-14

624302/04

J.10 Nebulizer: Configuring the nebulizer type . . . . . . . . . . . .J-15J.11 SpO2: Configuring pulse oximeter settings . . . . . . . . . . . .J-16J.12 Defaults: configuring default settings . . . . . . . . . . . . . . . .J-18

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . .Glossary-1

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index-1xxv

xxvi

Table of Contents624302/04

624302/04

List of Figures

1-1 Closed-loop ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-31-2 Controller status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-41-3 HAMILTON-S1 system overview . . . . . . . . . . . . . . . . . . . . . . . 1-101-4 Gas delivery in the device . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-111-5 Flow sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-131-6 Ventilator with accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-151-7 Ventilation C1-8 Ventilation C1-9 Default scree1-10 Front of vent

circuit conne1-11 Rear of venti2-1 Ventilation C2-2 Disconnectin2-3 Mounting th2-4 Tilting the Ve2-5 Swiveling the2-6 Installing the2-7 Back of hum2-8 Power, comm2-9 HAMILTON-H

RS-232 port 2-10 CO2, SpO2, A2-11 Installing a p2-12 Check for th2-13 Patient breat

(pediatric/ad2-14 Patient breat

(neonatal). . 2-15 Patient breat2-16 Installing the2-17 Installing the2-18 Installing the2-19 Electrical pow2-20 To open the xxv

ockpit front view . . . . . . . . . . . . . . . . . . . . . . . . 1-18ockpit rear view . . . . . . . . . . . . . . . . . . . . . . . . . 1-20n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-22ilation unit (patient breathingctions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-24lation unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-26ockpit mounting positions . . . . . . . . . . . . . . . . . . 2-5g the Ventilation Cockpit . . . . . . . . . . . . . . . . . . . 2-6e Ventilation Cockpit. . . . . . . . . . . . . . . . . . . . . . . 2-6ntilation Cockpit. . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 Ventilation Cockpit . . . . . . . . . . . . . . . . . . . . . . . 2-8 patient tubing support arm . . . . . . . . . . . . . . . . . 2-9idifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11unication connections (bottom) . . . . . . . . . . . . . 2-12900 communications cable connected toon ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13eroneb modules . . . . . . . . . . . . . . . . . . . . . . . 2-14

neumatic nebulizer . . . . . . . . . . . . . . . . . . . . . . . 2-16e oxygen cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-17hing circuit for use with heater wireult) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-20hing circuit for use with heater wire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-21hing circuit for use with HME . . . . . . . . . . . . . . . 2-22 expiratory valve membrane . . . . . . . . . . . . . . . . 2-23 expiratory valve cover. . . . . . . . . . . . . . . . . . . . . 2-24 flow sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-25er symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-30

front cover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-32

xxvi

List of Figures

2-21 To remove the extended battery pack . . . . . . . . . . . . . . . . . . . 2-322-22 HAMILTON-S1 inlet fittings . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-362-23 Power switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-383-1 Selecting CO2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-53-2 Connecting the CO2 sensor cable . . . . . . . . . . . . . . . . . . . . . . . 3-73-3 Attaching the CO2 sensor to the airway adapter . . . . . . . . . . . . 3-73-4 Connecting the CO2 sensor/airway adapter to the

patient circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-83-5 Mounting br3-6 Connecting 3-7 Inserting the3-8 Attaching th3-9 System comp3-10 Selecting Ae3-11 Connecting 3-12 Connecting 3-13 Aeroneb solo3-14 Nebulizer for3-15 Nebulizer for3-16 Nebulizer for3-17 Add medicat3-18 Intermittent 3-19 Continuous 3-20 Connecting 3-21 Cuff tubing 3-22 Selecting the3-23 User Interfac

(manual or n3-24 User Interfac

kept constan3-25 User Interfac

automaticall3-26 Concept of a

airway press3-27 User Interfac

deflation of 3-28 HAMILTON-H3-29 Humidifier w624302/04

acket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-10the CO2 sensor cable . . . . . . . . . . . . . . . . . . . . . . 3-12 sample cell into the receptacle . . . . . . . . . . . . . . . 3-12e CO2 sensor to the airway adapter . . . . . . . . . . . 3-13onents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-18

roneb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19nebulizer to T-adapter. . . . . . . . . . . . . . . . . . . . . . 3-20HAMILTON-S1 Aeroneb module . . . . . . . . . . . . . . 3-21 nebulizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-22 adult breathing circuit . . . . . . . . . . . . . . . . . . . . . 3-23 pediatric breathing circuit . . . . . . . . . . . . . . . . . . 3-23 neonatal breathing circuit . . . . . . . . . . . . . . . . . . 3-24ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-26nebulization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-27nebulization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-27cuff tubing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-31connected to cuff inflating tube . . . . . . . . . . . . . . 3-31 cuff pressure controller . . . . . . . . . . . . . . . . . . . . 3-33e for automatic cuff pressure controlo automatic adjustment activated) . . . . . . . . . . . . 3-34e for cuff controller, showing cuff pressuret at manually set level . . . . . . . . . . . . . . . . . . . . . 3-35e for cuff controller, cuff pressurey adapted to actual airway pressure . . . . . . . . . . . 3-36utomatically set Pcuff based on patientsure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-37e for cuff controller, showing fullcuff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-38900 humidifier, front view . . . . . . . . . . . . . . . . . 3-40indow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-42

624302/04

4-1 Info window, screen 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-84-2 Info window, screen 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-94-3 Tests & calib window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-94-4 CO2 sensor/adapter calibration setup . . . . . . . . . . . . . . . . . . . 4-154-5 Sensors on/off window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-174-6 Gas Source window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-194-7 Day/Night window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-195-1 Patient setup window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-55-2 Patient wind5-3 Modes wind5-4 Controls win5-5 Controls win5-6 ASV mode w5-7 Sigh window5-8 TRC window5-9 Ptrach and P5-10 Alarm Limits5-11 Alarm Limits5-12 Alarm Loudn7-1 Basic display7-2 Monitored p7-3 Monitored w7-4 Paw/Paux wi7-5 Graphics win7-6 Panel setup w7-7 X-axis / Time7-8 Positive scalin7-9 Negative sca7-10 Pressure wav7-11 Dynamic pre7-12 Trend display7-13 Freeze and c7-14 Hold window8-1 Dynamic Hea8-2 Compliance 8-3 Rinsp shown8-4 Heart circulaxxvii

ow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6ow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9dow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-12dow after mode change . . . . . . . . . . . . . . . . . . . 5-14indow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-17

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-19aw waveforms (with TRC active) . . . . . . . . . . . . . 5-20 1 window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-32 2 window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-33ess window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-34 with monitoring windows. . . . . . . . . . . . . . . . . . . 7-3arameter window 1 . . . . . . . . . . . . . . . . . . . . . . . . 7-4indow 2, with sensor data . . . . . . . . . . . . . . . . . . 7-5ndow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-6dow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8indow (waveform window shown) . . . . . . . . . . 7-10

scale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11g values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12

ling values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-12eform display . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-13ssure/volume loop display . . . . . . . . . . . . . . . . . . 7-14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-16

ursor function . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-19rt/Lung panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-2shown by the dynamic lung. . . . . . . . . . . . . . . . . . 8-3 by the bronchial tree of the dynamic lung . . . . . . 8-4tion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-5

xxviii

List of Figures

8-5 Vent status panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-69-1 How the P/V Tool works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-59-2 P/V Tool information window . . . . . . . . . . . . . . . . . . . . . . . . . . 9-79-3 P/V Tool window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-89-4 P/V Tool Pro window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-109-5 Using the cursor function in the P/V Tool window:

Creating the linear compliance curve. . . . . . . . . . . . . . . . . . . . 9-139-6 Using the cursor function in the P/V Tool Pro window:

Creating the9-7 Interpreting 9-8 P/V Tool plot9-9 Paw/Flow plo9-10 Demonstrati9-11 Checking fo

the demons9-12 Checking flo10-1 Visual alarm 10-2 Active alarm10-3 Events windo12-1 Special funct12-2 Activate stan12-3 Standby actiA-1 HAMILTON-SB-1 (S)CMV contB-2 P-CMV contrB-3 Breath deliveB-4 SIMV controB-5 PSIMV+ contB-6 SPONT contrB-7 APVcmv conB-8 APVsimv conB-9 DuoPAP conB-10 APRV controB-11 DuoPAP presB-12 APRV pressuB-13 Pressure supB-14 VS control wB-15 NIV control w624302/04

linear compliance curve. . . . . . . . . . . . . . . . . . . . 9-14the P/V curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-15 window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-17t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-18

on lung assembly . . . . . . . . . . . . . . . . . . . . . . . . . 9-19r a gas leak between the Flow Sensor andtration lung. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-22w sensor performance . . . . . . . . . . . . . . . . . . . . . 9-22indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-4 buffer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-7w (all events shown) . . . . . . . . . . . . . . . . . . . . . . 10-8ion keys . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3dby window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-3vated window. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12-41 dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-2rol window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-7ol window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-8ry in SIMV modes. . . . . . . . . . . . . . . . . . . . . . . . . . B-9l window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-10rol window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-11ol window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-12trol window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-13trol window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-14trol window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-17l window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-17sure curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-18re curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-18port in DuoPAP/APRV . . . . . . . . . . . . . . . . . . . . . . B-20indow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-23indow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-24

624302/04

B-16 NIV-ST control window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-24B-17 Breath timing in nCPAP-PS . . . . . . . . . . . . . . . . . . . . . . . . . . . B-25B-18 nCPAP-PS basic controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-26C-1 Clinical use of ASV.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-4C-2 ASV control window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-5C-3 Hypothetical example of high %MinVol setting

incompatible with the lung-protective rules strategy. . . . . . . . C-10C-4 ASV target graphics window. . . . . . . . . . . . . . . . . . . . . . . . . . C-11C-5 ASV monitorC-6 Normal minu

ideal body wC-7 MinVol = 7 lC-8 Lung-protectC-9 Anatomy of C-10 Example of aC-11 Lung-protectC-12 Changes of tC-13 Three differe

plotted for aE-1 Typical capno

ventilation . E-2 Typical spirog

ventilation . E-3 CombinationE-4 InterpretatioF-1 Masimo SpF-2 Nihon KohdeF-3 Monitoring wF-4 Monitoring wF-5 Tools -> SpoF-6 SpO2 Alarm F-7 System Info 2

(Masimo) . . F-8 System Info 2

(Nihon KohdF-9 Masimo dataF-10 Enabling alarF-11 Selecting senxxix

ed data window . . . . . . . . . . . . . . . . . . . . . . . . . C-12te ventilation as a function ofeight (IBW) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-15

/min. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-16ive rules strategy . . . . . . . . . . . . . . . . . . . . . . . . C-17the ASV target graphics window. . . . . . . . . . . . . C-21 situation after the three initial breaths . . . . . . . . C-23ive limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C-24arget values in broncho-constriction . . . . . . . . . . C-26nt relationships between rate and WOB are hypothetical lung . . . . . . . . . . . . . . . . . . . . . . . . C-27gram of patient on pressure-controlled

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-3ram of a patient on pressure-controlled

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-4 of capnogram and spirogram. . . . . . . . . . . . . . . . E-4n of volumetric capnogram . . . . . . . . . . . . . . . . . . E-6O2 pulse oximeter components . . . . . . . . . . . . . . .F-14n SpO2 pulse oximeter components . . . . . . . . . . .F-15indow, SpO2raw . . . . . . . . . . . . . . . . . . . . . . . . .F-22indow, Window 2 tab . . . . . . . . . . . . . . . . . . . . .F-24

t Check window . . . . . . . . . . . . . . . . . . . . . . . . . .F-27Limits 2 window . . . . . . . . . . . . . . . . . . . . . . . . . .F-30 window, pulse oximeter information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-32 window, pulse oximeter informationen) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-33 acquisition parameters. . . . . . . . . . . . . . . . . . . . .F-37ms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-39sor options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-39

xxx

List of Figures

F-12 Configuring Masimo monitoring settings . . . . . . . . . . . . . . . . . F-40F-13 Nihon Kohden sensor selection . . . . . . . . . . . . . . . . . . . . . . . . F-44F-14 Enabling alarms (Nihon Kohden) . . . . . . . . . . . . . . . . . . . . . . . F-45F-15 Sensor selection in System window . . . . . . . . . . . . . . . . . . . . . F-45F-16 Configuring Nihon Kohden monitoring settings . . . . . . . . . . . . F-46F-17 Fully connected oximeter (Masimo) . . . . . . . . . . . . . . . . . . . . . F-48F-18 Adapter on rail, fully assembled (Masimo) . . . . . . . . . . . . . . . . F-48F-19 Adapter, open and closed views . . . . . . . . . . . . . . . . . . . . . . . F-49F-20 Fit adapter oF-21 Masimo ada

ports on adaF-22 Connecting

(Masimo). . F-23 Connecting F-24 Connecting F-25 Locking coveF-26 Connecting F-27 Connecting F-28 Pull back theF-29 Pull back theF-30 Remove the F-31 Response timF-32 Response timF-33 Response timF-34 Light absorp

deoxyhaemoF-35 Scheme of aF-36 Simultaneou

airway pressF-37 Oxygen-haemG-1 Pneumatic dH-1 Ventilator paI-1 HAMILTON-SI-2 HAMILTON-SI-3 HAMILTON-S

Special InterI-4 Remote alarmI-5 Interface con624302/04

ver rail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-49pter and patient cables, connectionpter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-50

the ventilator SpO2 cable to the ventilator. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-51the patient cable to the SpO2 adapter (Masimo) . . F-51the patient cable to the sensor (Masimo). . . . . . . . F-52r between patient cable and sensor (Masimo). . . . F-52

the patient cable to the ventilator . . . . . . . . . . . . . F-53sensor to the patient cable (Nihon Kohden). . . . . . F-53 sheath. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-54 sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-55sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-55e, SpO2 changes 0.6%/s . . . . . . . . . . . . . . . . . . . F-69e, SpO2 changes 0.6%/s . . . . . . . . . . . . . . . . . . . F-69e, pulse rate changes 10 bpm/s . . . . . . . . . . . . . . F-70

tion spectrum of oxy- (HbO2) andglobin (Hb) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-71

pulse oximeter . . . . . . . . . . . . . . . . . . . . . . . . . . . F-71s pulse oximeter plethysmogram andure recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-72

oglobin dissociation curve . . . . . . . . . . . . . . . . . F-73iagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-1rts and accessories . . . . . . . . . . . . . . . . . . . . . . . . .H-11 connected to a patient monitor . . . . . . . . . . . . . I-51 connected to a computer system . . . . . . . . . . . . I-71 connected to an external device through the

face connector . . . . . . . . . . . . . . . . . . . . . . . . . . . I-10 relay positions . . . . . . . . . . . . . . . . . . . . . . . . . . I-12

nectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-13

624302/04

J-1 Language window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-3J-2 Customize window. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-4J-3 Relationships between breath timing settings . . . . . . . . . . . . . . . J-6J-4 Quick Wean To start settings . . . . . . . . . . . . . . . . . . . . . . . . . . . J-8J-5 Quick Wean SBT settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-8J-6 Quick Wean To abort settings. . . . . . . . . . . . . . . . . . . . . . . . . . . J-9J-7 Main Monitoring Parameter selection drop-down list . . . . . . . . J-10J-8 Vent status window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-11J-9 Vent status iJ-10 Options windJ-11 Interface winJ-12 I:E outlet timJ-13 Nebulizer wiJ-14 SpO2 ParameJ-15 Masimo DataJ-16 Defaults winxxxi

ntelligent panel . . . . . . . . . . . . . . . . . . . . . . . . . . . J-12ow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-13dow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-14ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-15ndow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-16ter selection window . . . . . . . . . . . . . . . . . . . . . . J-17 Acquisition settings . . . . . . . . . . . . . . . . . . . . . . . J-18

dow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-19

xxxii

List of Figures624302/04

624302/04

List of Tables

1-1 Compatible parts and accessories . . . . . . . . . . . . . . . . . . . . . . 1-161-2 Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-272-1 Breathing circuit parts and patient types. . . . . . . . . . . . . . . . . 2-193-1 Airway adapter kit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-153-2 Controlling humidifier options on the ventilator . . . . . . . . . . . 3-433-3 Humidifier-related alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-444-1 When to per5-1 Ventilation m5-2 Control setti5-3 Alarm limit s7-1 Monitored p8-1 Dynamic lun8-2 Vent status p9-1 P/V Tool aga10-1 Alarm indica10-2 Alarms and o11-1 Decontamin11-2 Preventive mA-1 Physical charA-2 EnvironmentA-3 Pneumatic spA-4 Electrical speA-5 Control settiA-6 Control setti

ventilation mA-7 P/V Tool settA-8 Monitored pA-9 Real-time cuA-10 Adjustable aA-11 ConfiguratioA-12 Breathing cirA-13 Other techniA-14 Guidance an

electromagnxxxiii

form tests and calibrations . . . . . . . . . . . . . . . . . . 4-2odes and patient types. . . . . . . . . . . . . . . . . . . . . 5-9

ngs, mode additions, and ranges. . . . . . . . . . . . . 5-21ettings and ranges . . . . . . . . . . . . . . . . . . . . . . . 5-35arameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-22g normal values. . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4arameter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-7inst P/V Tool pro . . . . . . . . . . . . . . . . . . . . . . . . . 9-23tions in HAMILTON-S1 . . . . . . . . . . . . . . . . . . . . 10-3ther messages . . . . . . . . . . . . . . . . . . . . . . . . . . 10-9

ation methods for HAMILTON-S1 parts . . . . . . . . 11-4aintenance schedule . . . . . . . . . . . . . . . . . . . . . 11-12acteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2al requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . A-3ecifications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3cifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-4ng ranges and resolutions . . . . . . . . . . . . . . . . . . . A-6ngs applicable to HAMILTON-S1odes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-15ing ranges and resolutions . . . . . . . . . . . . . . . . . A-20arameter ranges and resolutions . . . . . . . . . . . . . A-21rves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-26larms with automatic and standard settings. . . . . A-26n specifications . . . . . . . . . . . . . . . . . . . . . . . . . . A-33cuit specifications . . . . . . . . . . . . . . . . . . . . . . . . A-37cal data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-38d manufacturer's declaration etic emissions . . . . . . . . . . . . . . . . . . . . . . . . . . . A-42

xxxiv

List of Tables

A-15 Guidance and manufacturer's declaration electromagnetic immunity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-43

A-16 Recommended separation distances between portableand mobile RF communications equipment andthe HAMILTON-S1 ventilator . . . . . . . . . . . . . . . . . . . . . . . . . .A-46

B-1 Ventilation mode summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-3B-2 Controls active in HAMILTON-S1 ventilation modes . . . . . . . . . . B-5C-1 Blood gas and patient conditions and possible

adjustments for ASV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-8C-2 InterpretatioC-3 Interpretatio

100% MinVC-4 Interpretatio

than 100%C-5 ASV technicC-6 Initial breathC-7 Initial breathD-1 Patient interE-1 Examples of

mechanicallyF-1 SpO2 pulse F-2 Masimo SpHF-3 SpO2 paramF-4 SpO2 paramF-5 SpO2 paramF-6 Spot Check F-7 Adjustable aF-8 Masimo senF-9 Masimo optF-10 Masimo datF-11 Masimo moF-12 Nihon KohdF-13 Connecting F-14 TroubleshooF-15 Masimo pulsF-16 Nihon KohdH-1 Ventilator paI-1 Interfacing h624302/04

n of breathing pattern at 100% MinVol setting . .C-12n of breathing pattern at much higher than ol setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-13n of breathing pattern at much lowerMinVol setting . . . . . . . . . . . . . . . . . . . . . . . . . . .C-13al data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-28 pattern for Adult settings . . . . . . . . . . . . . . . . . .C-31 pattern for Pediatric settings . . . . . . . . . . . . . . . .C-31faces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .D-6 normal or expected values in ventilated patients . . . . . . . . . . . . . . . . . . . . . . . . E-8

oximeter options. . . . . . . . . . . . . . . . . . . . . . . . . . F-16b sensor modes . . . . . . . . . . . . . . . . . . . . . . . . . . F-18eters and settings. . . . . . . . . . . . . . . . . . . . . . . . . F-21eters in the Monitoring window . . . . . . . . . . . . . . F-24eter quality index indicators . . . . . . . . . . . . . . . . . F-25window Status area options . . . . . . . . . . . . . . . . . F-28larms with automatic and standard settings . . . . . F-30sor information . . . . . . . . . . . . . . . . . . . . . . . . . . . F-34ion settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-35a acquisition settings. . . . . . . . . . . . . . . . . . . . . . . F-37nitoring parameters. . . . . . . . . . . . . . . . . . . . . . . . F-41en option settings . . . . . . . . . . . . . . . . . . . . . . . . . F-43the Masimo oximeter . . . . . . . . . . . . . . . . . . . . . . F-47ting issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-56e oximeter specifications . . . . . . . . . . . . . . . . . . . F-62en pulse oximeter specifications . . . . . . . . . . . . . . F-67rts and accessories. . . . . . . . . . . . . . . . . . . . . . . . .H-2ardware for patient monitors . . . . . . . . . . . . . . . . . I-6

624302/04

I-2 Requirements for interfacing PDMSs. . . . . . . . . . . . . . . . . . . . . . I-8I-3 Monitoring overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I-8I-4 PDMS overview

(Patient Data Management System) . . . . . . . . . . . . . . . . . . . . . . I-9I-5 Interface connector pin assignments. . . . . . . . . . . . . . . . . . . . . I-13J-1 Timing controls applicable to breath timing

control philosophies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-7xxxv

xxxvi

List of Tables624302/04

1624302/04

General information

1.1 Introduction 1-2

1.2 Functional description 1-9

1.2.1 System overview 1-9

1.2.2 Gas supply and delivery 1-11

1.2.3 Gas monitoring with the flow sensor 1-13

1.3

1.41-1

Physical description 1-14

1.3.1 Breathing circuits and accessories 1-14

1.3.2 Ventilation cockpit 1-18

1.3.3 Ventilation unit 1-24

Symbols 1-27

1-2

1 General information

1.1 Introduction

The HAMILTON-S1 (hereafter referred to as the device) pro-vides for intensive care ventilation of adult, pediatric and neo-natal patients. This device must be operated only by trained personnel under the supervision of a licensed physician.

Fully closed-loop control. Optional. On the HAMILTON-S1, you can install the worlds first and unique fully closed-loop control option. The device is intended only for adult and pedi-atric pas INT

The phestablpatienautomadjustthe taeach in

This fethat ntory vepatienthe dasuitab

In closlectedadjust(see Fi624302/04

atients. With the HAMILTON-S1 this feature is referred to ELLiVENT-ASV.ysiological inputs come from the patient. The physician

ishes targets and a strategy that are matched with the t inputs, or what the INTELLiVENT-ASV feature has atically established. Then the ventilator automatically s the ventilator settings (output) to get the patient within rget ranges. This automatic input and output continues, fluencing the other, resulting in a closed-loop system.

ature is an improvement on older conventional devices eeded frequent manual intervention to maintain satisfac-ntilation. With this device, when you enter specific t conditions (with INTELLiVENT-ASV), the device uses ta received from sensors (CO2, flow, and SpO2) to make le automatic adjustments.

ed-loop ventilation, information from the patient is col- and analyzed by the device in a continuous manner, ing the ventilator without frequent human intervention gure 1-1).

624302/04

The de

Au

PEE

Au

As theally or adjustmand vethe seneters d1-3

Figure 1-1. Closed-loop ventilation

vice incorporates three main closed-loop control inputs:

tomatic minute volume

P

tomatic oxygen adjustment

situation requires, the operator can control them manu-automatically. This means the operator can let the ent controllers in the device determine oxygenation

ntilation for the patient solely on the basis of input from sors, or can intervene and determine treatment param-erived from a clinical judgment.

1-4

1 General information

Ventilsive casure-cmodes

(S)Ctrovol

P-Cmo

SPO

The ad

ASrecpatmiz624302/04

Figure 1-2. Controller status

ation modes. This device offers a fully featured inten-re ventilator and uses conventional volume- and pres-ontrolled and spontaneous modes, plus other advanced . The three conventional modes include:

MV+ and SIMV+, delivered by an adaptive volume con-ller, combine the attributes of pressure-controlled with ume-targeted ventilation.

MV and P-SIMV are conventional pressure-controlled des.

NT is a conventional pressure-controlled mode.

vanced modes include:

V(adaptive support ventilation) ensures the patient eives selected minute ventilation with the optimal breath tern (lowest pressure and volume, optimal rate to mini-e work of breathing and intrinsic PEEP).

624302/04

Volume Support provides designated volume to spontane-ously breathing patients as per body weight. Predominantly intended for neonates, but applicable to all patient groups.

Optional, INTELLiVENT-ASV is a complete fully closed-loop ventilation solution for oxygenation and ventilation. It relies on ASV to perform the first step to a fully closed-loop solution. It covers all applications from intubation until extubation with simplicity for an early weaning.

Quacttorpatposbre

Dumopatsimposa ceithout

NIVtimven

APvenand

nCnas

Patientriggerthis defeaturetrache1-5

ick Wean is integrated into INTELLiVENT-ASV, and when ivated, provides closed-loop, continuous dynamic moni-ing and control of patient conditions to evaluate the ients potential readiness for extubation, including the sibility of conducting fully controlled spontaneous athing trials (SBTs).

oPAP and APRV are two related pressure-controlled des where the operator sets two pressure levels and the ient can breathe spontaneously at either level. This is ilar to having an upper and lower level of continuous itive airway pressure (CPAP). Both modes provide

ombination of controlled and spontaneous breaths at er level, while letting the patient breathe freely through- the entire breath cycle.

(noninvasive ventilation) and NIV-ST (spontaneous/ed noninvasive ventilation) provide pressure support tilation through a mask or other noninvasive interface.

Vcmv and APVsimv are dual-control adaptive pressure tilation modes that combine the attributes of pressure- volume-controlled ventilation.

PAP-PS provides pressure support ventilation through al interface for infants and neonates.

t triggered breaths may be flow triggered or pressure ed. To reduce the patients work of breathing while on vice, the ventilators tube resistance compensation (TRC) offsets the resistance imposed by the tracheal (ET) or

ostomy tube.

1-6

1 General information

Monitor window. The Monitoring window on the Cockpit offers the operator a clear view of the various displays showing the patients status during ventilation. The device offers a vari-ety of monitoring capabilities. This window displays monitored parameters as numbers. To display individual data elements the Monitoring window displays data in various forms. These include:

Real-time waveforms showing pressure, volume, and flow against time

Dy

Tre

Int

The Ineleme

TheovevenmaToomevolandcru

Thememapat

Opauxpre624302/04

namic loops

nd graphs

elligent Panels

telligent Panels allow the operator to select various nts for display, to include:

Ventilation Map provides additional trending to get an rview in time of changes of physiological input and tilator actions (modifications of setting) while in auto-tic ventilation. Additionally you can use the optional P/V l Pro. The P/V Tool Pro is an automated function to asure and display the inflation and deflation pressure-ume curves of the lungs for determination of the lower upper inflection points and the deflation limb dere-

itment point.

devices monitored data is based on pressure and flow asurements collected by the HAMILTON MEDICAL proxi-l flow sensor, placed between the Y-piece and the ient and shows:

Oxygen measurements by integrated oxygen monitor

Proximal CO2 measurement by the mainstream and sidestream CO2 sensor

Measurement of O2 saturation (SpO2) by one or two pulse oximeters

tionally the pressure measurements can come from an iliary pressure sensing site (Paux) or from an esophageal ssure measurement.

624302/04

Vent status

The Vent Status displays the patients level of ventilator dependency. The Ventilation Horizon, Map and Guide allow the operators to view and keep track of the patients situa-tion and the controllers actions. The data window provides this information in a numeric form. The devices trending function lets you view up to 96 hours of previously collected data. You can freeze trend waveforms, real-time wave-forms, or loops and use the cursor measurement function to

GlolunASthedyn

Alarmbe set shownto alarconsidThis re

User i(38 cmdial anwhen elemenand of

Configdefaulpatienlayoutin the 1-7

determine a value at a selected point.

bal Dynamic Lung/Hemodynamics with hemodynamics-g interactions (see section 8.2 and the INTELLiVENT-V manual) and show the current status of the lung and activity and interaction of the patient's lungs and hemo-amics

s. The operator can adjust the device alarms; they can individually or automatically using the Auto button in the Alarms window (refer to Chapter 10, Responding ms). You can switch OFF some alarms. Other alarms are ered critical and you cannot switch these alarms OFF. striction helps ensures the patients safety.

nterface. The device uses a combination of a 15 inch ) touch screen display with a separate press-and-turn d key buttons. The key buttons (referred to as keys), activated are a momentary backlit push buttons. Each t of the user interface is designed for ease of operation

fers ergonomic benefits.

uration. The language, ventilation philosophy, alarms, t patient group, default mode and settings (for each t group individually) and options and default graphics (for each patient group individually) can be preselected configuration mode.

1-8

1 General information

Power. The device is normally powered from AC mains, offer-ing a voltage range of 100 to 240 Volt AC, 50/60 Hz. In the event of an AC power failure, the ventilator power source automatically switches to backup battery. A single optional, hot-swappable extended battery pack can power the device for a minimum of 1 hour, so multiple packs permit operation for a longer period. If the extended battery pack is not installed or is depleted, the internal battery provides power for a mini-mum of 1 hour.

Moun

Trome

Ver

The Vethe tobe ins

Nebumicropnebulinebulimatic

The P/you mvolumpoints

The Mcontro

The PEPEEP (

The Oof Oxy

The COcontinEtCO2poses.

The Spcontin624302/04

ting. Variations for mounting the device include:

lley-mount version with space for a VENTILAIR II dical air compressor

sion suitable for shelf or pendant

ntilation Cockpit is detachable and can be attached to p, front, or side of the ventilation unit, or the device can talled on a hospital rail system.

lization function. The ventilator offers pneumatic and ump nebulization (using Aerogen technology). The

zation function allows the device to power an Aeroneb zer or a pneumatic nebulizer connected to the pneu-nebulizer outlet.

V Tool Pro feature is an automated process that lets easure and display the inflation and deflation pressure-e curves of the lungs for determination of inflection . This option is preinstalled on the device.

inute Volume Adjustment feature enables automatic l of %MinVol (Ventilation adjustment).

EP Adjustment feature enables automatic control of as part of the Oxygenation Adjustment).

xygen Adjustment feature enables automatic control gen.

2 sensor with an associated MinVol controller feature uously monitors airway carbon dioxide and reports and inhaled/exhaled CO2 for display and alarm pur-

O2 sensor is a sensor attached to the patient which uously monitors the oxygen saturation of the blood.

624302/04

The neonatal feature lets you ventilate neonates.

Added features. These additional features are available for the device:

The communications interface lets you monitor the patient from a remote workstation, transmits alarms through a nurse call relay system, and transmits I:E timing signals. This feature is preinstalled on the device.

The power strip (multiple-socket outlet, MSO) provides ACa h

IntH9setH9heaIn aconout

nCairwnat

Theme

1.2 Functio

The fohardw

1.2.1 SysteIn Figudevicepatiena parti1-9

power to the VENTILAIR II medical air compressor, and umidifier.

egrated humidifier. With the use of the HAMILTON-00 humidifier, you can monitor and control humidifier tings directly from the ventilator screen. The HAMILTON-00 also provides a breathing circuit with integrated ter wires and temperature probe, improving ease of use. ddition, all humidifier data can be transmitted to any nected PDMS. You can still use other humidifiers, with- full system integration.

PAP-PS. This feature applies nasal continuous positive ay pressure with additional pressure support to neo-

es.

heliox feature provides for heliox delivery, with adjust-nts of inspired and exhaled volumes.

nal description

llowing paragraphs describe the operation of the device are.

m overviewre 1-3 the conceptual overview of the HAMILTON-S1 is shown. The principle functions are to ventilate the t and implement the physicians ventilation strategy for cular patient.

1-10

1 General information

The imexchanand thboth tthe syexecutin gen

Whmicscrinpdeldevas mograscr

Thecaldis

Theandfuncro624302/04

Figure 1-3. HAMILTON-S1 system overview

portant element in the system operations is the ge of information between the device and the patient e operator and the device. This interaction provides for he patients needs and permits the operator to control stem. As the device works, the operator has the tools to e the orders of the physician. The following list describes eral terms the basic elements and features of the device.

en you input instructions or settings you use the devices roprocessor system accessing features by way of a touch

een, push button keys, and a press-and-turn dial. Your uts become instructions for the devices pneumatics to iver precisely controlled gas mixtures to a patient. The ice receives inputs originating from several sources such

sensors within the ventilator. As the device receives this nitored data, it adjusts gas delivery to the patient. The phic user interface (GUI) displays this data via the touch een display using various windows.

devices pneumatic system delivers gas, while its electri- systems control the pneumatics, monitor alarms, and tribute power.

devices microprocessor system controls gas delivery monitors the patient. The gas delivery and monitoring ctions are cross-checked by an alarm controller. This ss-check feature helps prevent simultaneous failure of

624302/04

these two main functions and minimizes the possible hazards of software failure.

The device acts as an electronically controlled pneumatic ventilation system. Power comes from an AC source with internal battery backup. There is an optional extended bat-tery backup available to order which protects against power failure or unstable power and aids in intra-hospital trans-port.

1.2.2 Gas sThe desupplie(Figuregrated

Withinsystemaccordervoir,As thedrops,1-11

upply and deliveryvice uses high-pressure oxygen, air and heliox from wall s, cylinders, or the VENTILAIR II medical air compressor 1-4). These gases enter though water traps with inte- high-efficiency particle filters at the gas inlets.

Figure 1-4. Gas delivery in the device

the ventilator, the gas enters the devices pneumatic . An electronic mixer combines oxygen and air/heliox ing to the user-set concentration. This mixture fills a res- which is maintained within a prescribed pressure range. gas mixture is delivered to the patient, the pressure and the reservoir is refilled.

1-12

1 General information

Gas in the reservoir supplies the inspiratory valve. The micro-processor controls the size of the inspiratory valve opening and the length of time it is open to meet the user settings. The opening of the valve is then adjusted based on feedback in the form of monitored data.

The device delivers gas to the patient through the inspiratory limb breathing circuit parts, including possibly the inspiratory filter, flex tubes, the humidification system, a water trap, the Y-piece, the CO sensor and the flow sensor. An internal high pressu

Gas exbreaththe Y-pand mcover internflow ssurem

An oxthe gareservpropogas. Naffectsmonitbelow

The mcarbon

The Spthe saplethyinteracinform

The opcoordi624302/04

2re valve supplies the nebulizer flow (oxygen).

haled by the patient passes through the expiratory limb ing circuit parts, including flex tubes, the flow sensor, iece, a humidifier or HME, and an expiratory valve cover

embrane. Gas is vented through the expiratory valve such that no exhaled gas comes into contact with any al components of the device. Measurements taken at the ensor are used in the pressure, flow, and volume mea-ents.

ygen cell (sensor) monitors the oxygen concentration of s to be delivered to the patient, which is the same as the oir concentration. This galvanic cell generates a voltage rtional to the partial pressure of oxygen in the delivered either the pressure nor the humidity of the inspired gas the oxygen measurement. The ventilator alarms if the

ored oxygen concentration is more than 5% above or the oxygen setting, less than 18%, or more than 105%.

ainstream/ sidestream CO2 sensor continuously monitors dioxide and reports EtCO2 and inhaled/exhaled CO2.

O2 sensor attached to the patient continuously monitors turation of hemoglobin with oxygen in the blood and a smographic curve which is used to assess heart-lung tion. A second sensor may be used to secure the SpO2 ation.

erations of the inspiratory and expiratory valves are nated to maintain system pressure levels.

624302/04

1.2.3 Gas monitoring with the flow sensorThe device accurately measures flow, volume, and pressure in the patients airway with the HAMILTON MEDICAL flow sensor. This proximal flow sensor lets the device sense even weak patient breathing efforts. Between its highly sensitive flow trig-ger and fast response time, the device helps minimize the patients work of breathing.

The flow sensor contains a thin, diamond-shaped membrane withinside. Table o

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the outer housing and has a pressure port on either he membrane allows bidirectional flow through its vari-rifice (Figure 1-5).

Figure 1-5. Flow sensor

ea of the orifice changes depending on the flow rate. s progressively as the flow increases, creating a pressure cross the orifice. The pressure difference is measured by -precision differential pressure s