Acutronic Medical Systems fabian HFO User manual

fabian HFO
Quick guide
TO THE OPERATOR AND PERSON IN CHARGE OF
MAINTENANCE AND CARE OF THE UNIT:
●● This Quick Guide is not a substitute for the Operation Manual. Read the
Operation Manual carefully before operating the unit.
●● This Quick Guide explains only some of the operations of the fabian HFO
ventilator. For details about content not included in this Quick Guide refer to
the Operation Manual.
1Quick guide for fabian +nCPAP evolution 01-04-2014

Quick guide for fabian HFO ventilator
Preparations of the ventilator:
Connections: (Power cord, gas supply)
•Connect power cord with respective power source
•Connect medical gas hoses to the respective connections
•Connect power cord of humidifier to respective power source
Patient breathing circuit, exhalation valve:
•Install the exhalation valve membrane holder. Check proper insertion of the membrane. The
marking TOP should be visible
•Connect inspiratory and expiratory hoses as shown in figure 1 with the respective
connections of the ventilator. Make sure that inspiratory and expiratory hose are not
connected the other way around
•Use partnumber 7209.e to connect HFO outlet with inspiratory limb of patient circuit
figure 1
Quick guide for fabian HFO 15-02-2013/Ho

Turn ventilator on:
•Once patient circuit is set up, turn ventilator on by pushing the green ON/OFF button
•After a 20s startup and selftest routine, the calibration screen comes up
Calibrate Flow Sensor now:
•Block both ends of Flow Sensor by hand using a sterile glove
•Touch Flow Cal button > sensor is tested and calibration starts
•After 5 seconds, the green tick indicates the success of calibration procedure
•If NCPAP or DUOPAP mode are in use, the flow sensor is automatically deactivated
Oxygen sensor calibration:
There is no need for a manual oxygen sensor calibration (done automatically in 24 hours
intervals)
There is no alteration of the gas going to patient during this procedure
Flowsensor calibration:

Ventilation Parameter setting:
•Select desired ventilation mode first
Important: By pushing the button, the parameters of the ventilation mode can be preset.
(button turns yellow), the new ventilation mode is only activated by re-tapping!
As long as mode is not confirmed, ventilator will continue ventilation in previous mode
•Select parameter you wish to change > button turns green > Adjust parameter by turning the
rotary knob and confirm setting either by tapping respective button or rotary knob >
parameter button turns blue again
•Only parameters necessary for selected mode, will appear on the screen
Trigger button for instance is only visible in modes were trigger is used

Use of Infant Flow mode: (Variable Flow Generators)
If single limb systems like the Infant Flow or MediJet are used, the connection between
ventilator outlet and humidifier inlet is a special one. If standard tubing is used, there is no
pressure build up!
Use Infant Flow
connecting tube
part number 7067!
Turn off of the ventilator:
•fabian HFO has an integrated safety system in case of accidentally turning off the ventilator
•To turn off the device press the green button for at least 5 seconds until all the blue
points in the status line are gone
•Press alarm mute button to confirm action
Fix keys:
Manual breath
Preoxygenation, flush
Nebulizer Aeroneb®(optional)
Home screen (parameter setting)
Calibration menu (flow sensor)
Alarm mute for 2 min. and reset of
visual alarm
ON / OFF
START / STOP ventilation, stand-by
Graphics, waves, loops, trends
Alarm limits, alarm history, loudness

Ventilation modes
Description of the ventilation modes on fabian HFO ventilator:
Available modes are:
IPPV (CMV) Intermittent Positive Pressure Ventilation
SIPPV (ASSIST) Synchronised Intermittent Positive Pressure Ventilation
(Assist Controlled Ventilation)
SIMV Synchronised Intermittent Mandatory Ventilation
SIMV+PSV Synchronised Intermittent Mandatory Ventilation
with Pressure Support
PSV Pressure Support Ventilation
CPAP Continuous Positive Airway Pressure Ventilation
nCPAP Nasal CPAP with Flow Generators
duoPAP Two Level Nasal CPAP with Flow Generators
HFO High Frequency Oscillatory Ventilation
O2Therapy High or Low Flow Oxygen Therapy (with nasal cannulas)
VG Volume Guaranteed Ventilation
VL Volume Limited Ventilation
IMPORTANT:
Volume Guarantee function is available in the following modes:
IPPV, SIPPV (ASSIST), SIMV, SIMV+PSV, PSV and HFO
In the SIMV modes, the Volume Guarantee function is only valid for the SIMV breath and not for
the PSV breath.
In PSV mode, the VG function is active for the PSV breath as well as for the back up breath in
case of APNEA.
The backup ventilation will start after the set apnea time. If apnea alarm is set to OFF, the
backup ventilation starts right after one period of expiratory time (Te).

Alarm screen, alarm limit setting
To access the alarm limits screen, push the alarm limits button
To adjust alarm limits, move cursor to the parameter, push rotary knob and adjust value
according your clinical guidelines
Note!
In PSV mode, the apnea delay time determines after which delay the backup ventilation will start.
To allow the baby breathing with short periods of apnea, the apnea time should be set
somewhere in between 3 seconds and 6 seconds.
Autoset Sets the alarm limit automatically based on measured value
MV upper limit 80% above measured value, lower limit 50% below measured value
Frequency, 50% above measured value
Apnea, 10 seconds
Ppeak 3 cmH2O above measured value
PEEP 3 cmH2O below measured value
Alarm loudness can be set in 3 different levels.
Show Log opens the alarm history logfile.

IPPV (CMV)
In IPPV, there is no synchronisation with patients breathing pattern. This mode should only be
used for patients without spontaneous breathing efforts. Sedated patients for instance.
Settings to start with:
I-Flow between 8 LPM
E-Flow same as I-Flow
Rate between 55 and 60 bpm
Inspiratory time Ti between 0.3 sec and 0.4 sec
Pinsp between 15 –18 cmH2O
PEEP 4 - 6 cmH2O
To adjust wave form, use I-Flow. For square waveform increase, for decelerating or sine
wave decrease I-Flow.
Recommended alarm settings:
•Low minute volume
•Low PEEP
•Ppeak

SIPPV (ASSIST)
Every inspiratory effort triggers a breath with a fixed inspiratory time and inspiratory pressure.
The minimum rate per minute is the preset one. A patient triggered breath is coloured green, a
none triggered is grey.
Note: It is important that the Ti is watched carefully in this mode –too long a set Ti in an infant
with tachypnoea will result in a short expiratory time (Te) and leads to air trapping, with the risk
of air leak.
Settings to start with:
I-Flow 8 LPM
E-Flow same as I-Flow
Rate 40 bpm
Inspiratory time between 0.3 sec and 0.4 sec
Pinsp between 16 –18 cmH2O
PEEP 4 - 6 cmH2O
Recommended alarms:
Same as IPPV but in addition Respiratory Rate to alert in case of Hyperventilation
Try to achieve an exhaled tidal volume of about 5 –6 ml/kg bodyweight. To increase Tidal
Volume, increase Pinsp and eventually rise PEEP

SIPPV (ASSIST) with VG (Volume Guarantee)
If VG is added to the SIPPV (ASSIST) ventilation, each breath is maintained at same exhaled
tidal volume. In case of an improvement of lung compliance, the Pinsp is automatically reduced.
Every single inspiratory effort of the patient is supported with a mechanical breath with fixed
inspiratory time and fixed Inspiratory Pressure. If the breath was triggered by patient, it is
coloured green, if none triggered, grey. The baby controls the rate of ventilation.
Settings to start with:
I-Flow 8 LPM
E-Flow same as I-Flow
Rate between 35 and 40 bpm
Inspiratory time between 0.3 sec and 0.4 sec
Pinsp between 16 –18cmH2O
PEEP 4 - 6 cmH2O
How to start VG function:
Step 1
Setup ventilator in SIPPV (ASSIST) and start ventilation
Step 2
Once the Exhaled Tidal Volume VTe reading is constant, press Vguarant button > turns green

Step 3
Turn rotary knob clockwise > current Tidal Volume VTe is taken from readings. Pinsp button
changes to orange colour and P insp is automatically increased by 5 cmH2O to allow ventilator
to compensate for a changing lung compliance. Confirm setting by pushing rotary knob. Setting
is accepted if button turns to blue colour again.
Triggered and none triggered breath are independently supported based on lung compliance.
Step 4
If Volume Guarantee function is deactivated, the Pinsp pressure which was necessary to deliver
preset target volume, will be used. In case of a flow sensor failure, the ventilator automatically
memorizes the last correct Ppeak value and continues ventilation at this level, until flow sensor
problem is solved.
Meaning of the orange Pinsp button:
Maximum pressure to achieve target volume, allowed by the
user, but ventilator will always use lowest possible Ppeak to deliver the target
volume.

The following graphic shows different support of triggered and none triggered breath. To
maintain the preset exhaled tidal volume, the ventilator changes the Ppeak breath to breath by
maximum change of 3 cmH2O.
Note:
If the preset target volume is not achievable within the set Pinsp, a warning message „Tidal
Volume not reached“ is displayed in the status line underlined by an acoustic beep every 10s.
An arrow in the Pinsp button pointing upward indicating use of a higher Pinsp is necessary to
achieve target volume

SIMV+PSV
The ventilator synchronizes patient’s inspiratory efforts and delivers a fixed amount of
synchronised mechanical breath with preset inspiratory time. Spontaneous inspiratory efforts in
between mechanical breath are supported with pressure support level PPSV . Patient determines
begin and end of PSV breath depending on the preset flow termination criteria.
The I-Time button has changed to orange, indicating that the set I-Time is only valid for SIMV
breath and represents maximal I-Time in case flow termination criteria isn‘t met. (i.e. in case of
high ET tube leakage)
Settings to start with:
I-Flow 8 LPM
E-Flow same as I-Flow
Rate between 20 to 30 bpm
Inspiratory time between 0.3 sec and 0.4 sec
Pinsp between 16 –18 cmH2O
P psv 16 –18 cmH2O
PEEP 4 - 6 cmH2O
The minimum pressure difference between PEEP and PPSV is always 2 cmH2O and PPSV is max
same level as Pinsp.
If Volume Guarantee is added, the VG criteria is only valid for the SIMV breath. Not for the PSV
breath.

PSV
The ventilator synchronizes the patients inspiratory effort and delivers a breath at fixed pressure
levels but variable I-Time is controlled by patient based on preset flow termination criteria. The
rate is controlled by the patient.
Settings to start with:
I-Flow 8 LPM
E-Flow same as I-Flow
Rate between 30 to 40 bpm
Inspiratory time between 0.3 sec and 0.4 sec
Pinsp between 16 –18 cmH2O
P psv 16 –18 cmH2O
PEEP 4 - 6 cmH2O
Important:
In PSV mode, the apnea backup ventilation will start after the preset apnea delay set in the
alarm menu. Make sure to set this apnea delay to about 4 –6 seconds, because babies tend to
have short periods of apnea and you don‘t want the ventilator to kick in to early. If apnea is set
to OFF, the ventilator starts backup after E-Time.
The minimum pressure difference between PEEP and PPSV is always 2 cmH2O and PPSV is max
same level as Pinsp.

PSV+VG
If Volume Guarantee is added to PSV, the ventilator automatically is adjusting the PPSV level
necessary to maintain preset target volume. In case of an apnea, the ventilator will start cycling
at preset rate and PBackup. As soon as spontaneous activity restarts, the backup stops.
Settings to start with:
I-Flow 8 LPM
E-Flow same as I-Flow
Rate between 30 to 40 bpm Safety backup rate in case of apnea
Inspiratory time between 0.3 sec and 0.4 sec Used for backup and as max I-Time
Pbackup = Pinsp between 16 –18 cmH2O PBackup is the Pinsp used during
apnea backup ventilation
PPSV 16 –18 cmH2O
PEEP 4 - 6 cmH2O
The minimum pressure difference between PEEP and PPSV is always 2 cmH2O and PPSV is max
same level as Pinsp.
Note:
PSV breath as well as apnea backup breath are volume targeted breath in this mode.
The delay to start backup ventilation is set with the apnea time in alarm limit screen.
If apnea is set to OFF > backup starts after E-Time

HFO Ventilation
High Frequency Oscillatory ventilation uses the following settings:
Settings to start with:
Flow 8 LPM
MAP about 2 cmH2O above MAP used for conventional ventilation
Amplitude start at about 22 cmH2O
Frequency 12 to 15 Hz for babies below 1kg and 8 –12 Hz for babies above
1kg I:E Ratio 1:2
Pmanual If used in your clinical guidelines for lung recruitment, otherwise
deactivate in ventilation menu
Vguarant Set at 2 ml per kg bodyweight depending your clinical guidelines

CPAP
The CPAP mode can be used for intubated patient as well as for nasal CPAP. If used with
nasal CPAP systems like F&P bubble CPAP, Hudson or similar, the Flow Sensor must be
deactivated manually in the calibration screen.
The ventilator automatically compensates leaks by increasing flow to max Flowmin plus100% to
avoid CPAP pressure drop.
Settings to start with:
FLOWmin 8 LPM
CPAP 5 cmH2O
Pmanual 12 cmH2O
Backup OFF
Important:
Make sure the flow sensor is deactivated, otherwise the apnea alarm is triggered all times. Use
alternative system for apnea detection.
For Variable Flow systems like Infant Flow®, Inspire™ or MediJet®, please use the option
NCPAP and DUOPAP if available in your unit.

O2Therapy
O2Therapy is an option which allows use of a continuous flow of blended gas, from 1 –15 LPM.
Nasal cannulas of various makes like F&P, Atom or similar can be used. There are no alarm
functions active in this mode, except for the set FiO2
For weaning purposes, this mode can also be used in conjunction with variable flow systems
like Infant Flow®, Inspire™ or MediJet®, however there won‘t be any alarm settings on pressure
monitoring.
Note:
This mode can also be used to put the ventilator in standby mode. By setting a flow of 4 LPM,
the humidifier dual servo temperature controls remain active, so no need to switch it off in case
of short term standby mode.

Features
Graphics:
Waves: Displays 3 waveforms, Pressure, Flow and Volume simultaneously
Freeze: Freezes the waves or Loops
Loops: Pressure-Volume and Flow-Volume Loops
Trends: up to 5 days trending of measured values
Save Loop: The save Loop function stores one Loop and keep it as reference until a new
Loop is saved
Waves:
Loops:
Manual scaling mode.
Use up and down
keys for scaling
graphics

Sub Menu:
The submenu allows access to fine-tune some of the ventilation modes, i.e.:
•Manual breath
•Flow termination criteria for PSV ventilation
•Flush time
•………….
Trends: