Bunnell LifePulse 204 User manual

Bunnell Incorporated nwww.bunl.com n800-800-4358 (HFJV) n[email protected]
436 Lawndale Drive nSalt Lake City, Utah 84115 nintl 801-467-0800 nf 801-467-0867
Bunnell LifePulse HFV Quick Reference Guide # 03202-00.1
© 2017 Bunnell Incorporated

Initial Ventilator Setup
1. Provide Electrical Power: Plug the LifePulse into a hospital
grade electrical outlet in order to power it on.
2. Provide Gas Source: Connect the LifePulse to the air/
oxygen supply from a low flow blender (0-30 L/min.) or from
the low flow output (2-100 L/min.) of a standard blender.
3. Turn on LifePulse: Toggle the Ventilator Power switch on
the rear panel to the ON position. Press AUDIO PAUSED to
cancel the high priority “power on” audio and visual alarm.
MIXED GAS INPUT
30-60 PSI
(206.85 - 403.70 kPA)
+
+
00000 0
QUARTZ
+
+
+
+
+
+
+
+
+
+
+
ON
OFF
BATTERY ACCESS
REFER TO
USER MANUAL
OXYGEN SAMPLE
PORT
ON
ALARM VOLUME
OFF
ON
VENTILATOR
POWER
20A
DO NOT BLOCK
CIRCUIT
BREAKER
2A
100-240/ 2A
50-60 HZ
DO NOT BLOCK
HOURS 1/10
2
1
3
20. 420 .020 6.I
:
I
VENT INOP
CHECK VENT
LOW GAS PRESS
BATTERY DEPLETED
HIGH PIP
CANNOT MEET PIP
LOSS OF PIP
ALARMS
+
+
+
-
-
-
+
-
+
-
+
-
AUDIO
PAUSED
STANDBY
ENTER
HIGH FREQUENCY VENTILATOR
CONTROLS
HUMIDIFIER
MONITOR
PIP
PEEP
SERVO
P
Δ
MAP
UPPER
LIMIT
UPPER
LIMIT
LOWER
LIMIT
LOWER
LIMIT
PIP RATE I-TIME I:E RATIO
PAUSE TEMP GAS WATER
CHECK CIRCUIT
HIGH TEMP
LOW LEVEL
SYSTEM
TEST
cm H2O
cm H2O
cm H2O
cm H2O
cm H2O BPM SECONDS
00.0
00.0
00.0
00.0 00.0
LifePulse
bunnell
INSPIRED INFANT CARE
READY
o
C
ALARMS
3
1

Installing a Circuit
A Patient Circuit must be installed in order to use the
LifePulse. Follow these steps to install the Patient Circuit:
1. Open cartridge door and insert humidifier cartridge
into receptacle
2. Open water pump door by lifting up. Secure the water
inlet tube inside the water pump and snap the pump
door closed.
3. Attach the green gas inlet tube to the green-coded
Gas Out port on the LifePulse.
4. Attach the purge tube to the yellow-coded Purge port
on the LifePulse and to the yellow-coded port on the
Patient Box.
5. Press PUSH TO LOAD on top of the Patient Box and
gently stretch the pinch tube into the jaws of the pinch
valve.
6. Connect the clear pressure monitoring tube from a
LifePort adapter to its port on the Patient Box.
7. Insert the green delivery tube into the Jet port on the
LifePort adapter.
8. Attach the water transfer tube to the water inlet tube
and spike the water supply. The water supply should be
at or below the level of the humidifier cartridge.
9. Unclamp the water transfer tube.
Water Supply
8
9
7
5
4
46
+
-
HIGH FREQUENCY VENTILATOR
HUMIDIFIER
PAUSE TEMPERATURE GAS WATER
88.8
Life Pulse
bunnell
INSPIRED INFANT CARE
PURGE
PATIENT
BOX
BATTERY
_
+
GAS OUT
3
2
1
WARNING: Latch the water inlet tube on the humidifier
cartridge of the Patient Breathing Circuit into the water pump
housing prior to connecting to the water supply. Failure to do
so may result in cartridge overfill and delivery of water to the
patient by gravity feed.
WARNING: Clamp the water supply tube prior to opening the
water pump door to prevent cartridge overfill and delivery of
water to the patient by gravity feed. The water supply should
be positioned at or below the level of the humidifier cartridge
as an added precaution.
2

WARNING: Patient connections must only be made
in the Standby mode. Do not connect the LifePulse
Patient Breathing Circuit to the LifePort adapter on
the patient’s ET tube while the LifePulse is running.
Failure to comply risks high pressures and volumes
being delivered to the patient, which may result in
volutrauma.
Testing and Preparation
1. Perform System Test: Attach a LifePort adapter and ET
tube to a test lung. Press SYSTEM TEST and verify the
LifePulse runs through the test sequence and returns to
Standby mode with an audible and visual alarm active. Press
AUDIO PAUSED to cancel the high priority “passed test”
alarm.
2. Perform Operational Test: Perform an Operational Test.
Press ENTER to activate the default settings (PIP: 20, Rate:
420, I-Time: 0.020) while attached to the test lung. Verify
that the READY indicator illuminates, the monitored PIP
reaches the set PIP, and PEEP is 0.0 ± 1.0 cm H2O when no
PEEP is supplied by the conventional ventilator.
3. Place LifePulse into Standby: Place the LifePulse into
Standby mode after the tests are completed and prior to
connecting to the patient.
4. Before Connecting to Patient, Remove and Save Test
Supplies: Remove the Test Supplies (LifePort, ET tube, and
test lung) from the LifePulse circuit and Patient Box. Save for
future use.
3

Beginning High Frequency Jet Ventilation
All infants treated with the LifePulse should be connected to a
conventional ventilator and appropriate physiologic monitors.
They must be intubated with a standard ET tube with a Bunnell
LifePort adapter attached.
1. Attach LifePort adapter to patient’s ET tube: Replace
standard ET tube adapter with appropriate size LifePort
adapter. Connect pressure monitoring tube to port on
Patient Box.
2. Connect LifePulse circuit to patient’s LifePort adapter:
Remove the cap on the jet port of the LifePort adapter and
connect the patient end of the LifePulse circuit to the jet
port.
3. Set HFJV PIP: Adjust the set HFJV PIP to equal the
monitored CV PIP (see Ventilation and Oxygenation flow
charts on pages 6 and 7).
4. Set HFJV Rate: Adjust the set HFJV Rate to the frequency
appropriate for the patient (420 bpm is recommended, or
slower for larger patients or to address hyperinflation).
5. Set HFJV I-Time: Starting I-time is usually left at the default
0.020 seconds.
6. Begin High Frequency Jet Ventilation: Press ENTER to
activate the Control settings. The PIP will quickly rise toward
the set PIP. The LifePulse may pause momentarily when a
conventional breath is delivered.
7. Eliminate LifePulse Interruptions: If the LifePulse is
pausing, reduce the CV PIP until the pauses go away (CV PIP
< Set HFJV PIP).
8. Lower CV Rate: Lower the CV rate to between 0 and
5 bpm. (Use 0 bpm if air leaks are the primary concern.
Use 1-5 bpm and/or increase PEEP if atelectasis and
oxygenation are the main concern.)
9. Assure Ready Indicator is On: Verify the Ready indicator
illuminates, which indicates the pressures are stable and the
LifePulse alarms are active.
10. Adjust PEEP: Adjust the CV PEEP setting to obtain the
desired MAP and oxygenation.
11. Reassess Blood Gases: Observe blood gas monitored
values and/or draw arterial blood gas samples after
30 minutes to determine if ventilator adjustments are
necessary.
WARNING: Do not leave the patient’s bedside while the
LifePulse water pump is running during initial start-up or
following a circuit change. A properly trained person must
observe the cartridge fill with sterile water for inhalation,
USP, to the second water level sensing pin and the water
pump stop pumping.
4
WARNING: There will be no LOSS OF PIP alarm for the first
15 seconds after the ENTER Button is pushed. A properly
trained person must observe the LifePulse reach the set PIP
and have the Ready indicator illuminate before leaving the
patient’s bedside.
2nd Pin

GENERAL RULES
• HFJV ΔP (PIP - PEEP) is the primary determinant of PaCO2. HFJV I-time and Rate are secondary.
• Resting lung volume (FRC supported by set PEEP) and mean airway pressure (MAP) are crucial determinants of PaO2.
• Avoid hypercarbia and hypoxemia by using optimal PEEP (see “When to Raise” PEEP below).
• Minimize IMV at all times, using very low rates (typically 0 – 5 bpm), unless IMV is being used to recruit lung volume or
stabilize FRC. In general, keep CV PIP at a level necessary to achieve a moderate chest rise.
• To overcome atelectasis, IMV rates up to 5 bpm can be used for 10 – 30 minutes. Thereafter, IMV rate should be dropped
back to as close to 0 as possible.
• If lowering CV rate worsens oxygenation, PEEP may be too low. Higher PEEPs and lower CV rates reduce risk of lung injury.
• Lower FiO2before PEEP when weaning until FiO2is less than 0.4.
Patient Management During HFJV
SETTING INITIAL WHEN TO RAISE WHEN TO LOWER
HFJV PIP Whatever produces
desired PaCO2
To decrease PaCO2
To increase PaCO2 (Raise PEEP if nec-
essary to keep SpO2constant)
HFJV Rate 420 bpm (neonates)
300 bpm (peds)
To decrease PaCO2in smaller pa-
tients with low compliance
To eliminate inadvertent PEEP or
hyperinflation by lengthening exhala-
tion time or to increase PaCO2when
weaning
HFJV I-TIme 0.020 seconds To increase delivered tidal volume
and lower PaCO2
0.020 is the minimum
CV Rate 0 - 5 bpm To reverse atelectasis as a temporary
recruitment maneuver (3 – 5 bpm)
To minimize volutrauma, especially
when air leaks are present, or to de-
crease hemodynamic compromise
CV PIP
PIP necessary to
achieve moderate
chest rise
To reverse atelectasis or stabilize lung
volume; PIP typically < HFJV PIP
To minimize volutrauma, especially
when air leaks are present, or to de-
crease hemodynamic compromise
CV I-Time 0.4 seconds To reverse atelectasis or stabilize lung
volume
To minimize volutrauma, especially
when air leaks are present, or to de-
crease hemodynamic compromise
PEEP
7 – 12 cm H2O
(Neonates)
10 – 15 cm H2O
(Peds)
To improve oxygenation and de-
crease hyper-ventilation
To find optimal PEEP:
Raise PEEP until SpO2stays constant
when switching from IMV to CPAP
Lower PEEP only
• when it appears that cardiac out-
put is being compromised; or
• when oxygenation is adequate
• FiO2< 0.4, and
• when lowering PEEP doesn’t de-
crease PaO2
FiO2As needed Raise as needed after optimizing
PEEP
Lower FiO2in preference to PEEP when
weaning until FiO2< 0.4
Special Air Leak Considerations:
1. Minimize IMV by using HFJV and adequate CPAP.
2. If oxygenation is compromised AND expiratory time has been optimized, raise PEEP, even if the lungs appear to be over-
expanded on x-ray.
5

Yes
Yes
Yes
Yes
Yes
Yes
To raise PaCO
2
try the
following in order:
1. decrease HFJV PIP
2. decrease HFJV Rate
3. decrease HFJV I-time
4. increase CV PEEP
PaCO2
Hypocarbia
PaCO
2
too
Low?
Hypercarbia
PaCO
2
too
High?
To lower PaCO
2
try the
following in order:
1. increase HFJV PIP
2. increase HFJV I-time
3. increase HFJV Rate*
4. decrease CV PEEP **
PaCO
2
too High?
PaCO
2
too Low?
PaO
2
too
Low?
PaO
2
too
Low?
PaO
2
too
High?
PaO
2
too
High?
Go to Oxygenation Flow Chart
Decrease FiO
2
until < 0.40
then decrease CV PEEP
Maintain Current Settings
Yes
Yes
No
No
No
No
No
No
* Increasing HFJV Rate increases minute ventilation. However, if lungs are hyperinflated, decreasing
HFJV Rate can lower PaCO
2
by increasing exhalation time.
** Decreasing CV PEEP increases Δ pressure (amplitude) and lowers PaCO
2
, but it will also lower MAP, which
may lower PaO
2
.
Ventilation Control Flow Chart
6

Oxygenation Flow Chart
No
No
Yes
Yes
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
To raise MAP & PaO
2
try the
following in order:
1. increase CV PEEP
2. increase CV Rate (3-5 bpm)
3. increase CV PIP
4. increase CV I-time
5. increase FiO2
too Low
Underinflation
or Atelectasis?
Overinflation
or P.I.E./Air leak?
To decrease gas trapping & raise
PaO2 try the following in order:
1. decrease CV Rate
2. decrease HFJV Rate *
(60 bpm at a time)
3. decrease HFJV PIP **
4. decrease CV PEEP ***
5. increase FiO2
PaC O2
too High?
PaCO2
too High?
Pa CO
2
too Low?
Pa CO2
too Low?
PaO
2
too
High?
PaO
2
too
High?
Go to Ventilation Flow Chart
Decrease FiO
2
until < 0.40
then decrease CV PEEP
Maintain Current Settings
No
* Decreasing HFJV Rate decreases minute ventilation. It may also lower PaCO 2 by increasing exhalation time.
** Decreasing HFJV PIP decreases pressure (amplitude) and minute ventilation ; PaCO2may increase. .
*** Decreasing CV PEEP increases pressure (amplitude) and decreases MAP ; PaCO2 and PaO2 may decrease.
PaO
2
is
Hypoxemia
7

MAP may be too low if FiO2> 0.5 or SpO2< 85%
Increase MAP by raising
PEEP 1-2 cm H20
Maintain MAP and work on
lowering FiO2
Turn CMV to CPAP
Uniform overinflation or
compromised BP despite lower
HFJV rates (240-300) and CV is
set to CPAP?
SaO2drops?
Titrating MAP up or down may improve oxygenation. Use your understanding of the
interactions of the cardiopulmonary system to achieve optimal results.
SpO2improves in 1-15
minutes?
SpO2or BP improves
in 5-15 minutes?
YES
YES
YES
YES
NO
SpO2drops in 1-5
minutes?
NO
In rare situations in which PEEP
may be excessive:
Decrease MAP by lowering
PEEP 1-2 cm H20
Underinflation or
Atelectasis?
Make sure to provide 3-5
CMV breaths
Increase MAP by raising
PEEP 1-2 cm H20
PIE/AIrleak or
normal inflation?
Optimizing MAP During HFJV
8

The Importance of Servo
• Servo = driving pressure that automatically regulates flow.
• Servo changes with each change in HFJV or CV settings.
• Servo changes as lung volume or mechanics change.
Servo changes are early indications of changes in the patient’s
condition or the LifePulse’s performance (assuming HFJV and CV
settings have not changed).
Servo Increases with:
• Improving compliance or resistance
• Loose tubing connections
• Moisture interference in LifePort
• Mechanical issues with LifePulse
Servo Decreases with:
• Worsening compliance or resistance
• Patient needs suctioning
• Obstructed ET tube
• Tension pneumothorax
• Right mainstem intubation
Charting and trending Servo can help inform patient
management decisions.
9

Weaning Patient from LifePulse
1. Lower HFJV PIP Slowly
• Avoid lowering PEEP/MAP until FiO2is < 0.40.
• Maintain HFJV Rate.
• Reduce the HFJV PIP (1-2 cm H2O) as needed per PCO2.
2. Lower HFJV and CV PIP to Teens
• Continue to reduce the HFJV PIP while keeping the Rate
constant.
• Reduce the CV PIP as needed to avoid interrupting the
LifePulse PIP.
• Maintain appropriate MAP (may need to increase PEEP).
• If you are weaning to CV rather than NIV, increase the CV
Rate in response to PCO2once the HFJV PIP is < 18 cm
H2O. Interrupting the LifePulse breaths with the CV breaths
may now be appropriate.
3. Evaluate Patient During CV or NIV Trial
• Observe the patient and monitored parameters to ensure
patient is tolerating the weaning process.
• Increase the CV Rate or NIV support, if necessary, after the
LifePulse is in Standby mode. If CV PIP has to be increased
to > 18 cm H2O, the trial is a failure and the patient should
be returned to the LifePulse.
4. Consider NIV Trial
• Consider NIV trial if HFJV PIP < 18 cm H2O, MAP ≤ 8 cm
H2O, and FiO2is ≤ 0.40.
• Restart the LifePulse if the trial is unsuccessful. Try again in
12-24 hours.
10
NOTE: During storage, plug the LifePulse into an
electrical wall outlet in a properly ventilated room in
order to maintain battery charge.
See the LifePulse User Manual for more information
on cleaning and storage.