Dräger Medical NeoFlow Operating instructions

NeoFlow
™
Neonatal Patient Mode
Operating Instructions NeoFlow for EvitaXL, 1. ed.
ME ICAL
D
Addendum to
Operating Instructions
Evita
XL
*
* These Operating Instructions apply also
to Evita 4 with the XL option

2
Operating Instructions NeoFlow for EvitaXL, 1. ed.
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PPrr rroo oopp pprr rriiii ee eettttaa aarr rryy yy IIII nn nnffffoo oorr rrmm mmaa aattttiiii oo oonn nn
This document contains information in which raeger Medical, Inc. claimed
proprietary rights. The information may not be reproduced in whole or in part
except as authorized in writing by räger. This information is the property of
raeger Medical, Inc., it is provided solely for the use intended.
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RRee eepp ppaa aaiiii rr rrss ss// //MM MMoo oodd ddiiii ffffiiii cc ccaa aattttiiii oo oonn nnss ss
Repairs on this device shall be performed only by raegerService or factory
authorized technical service personnel. Information about repairs can be
obtained from räger or Authorized ealers. raeger Medical, Inc. will not
be responsible for injury to persons or damage to property arising directly or
indirectly out of unauthorized repairs or modifications to this device.
Furthermore, any unauthorized repairs or modifications void any warranty
extended by räger.
This document is provided for your information only. It will not be
exchanged or updated without request.
TT
TTrr rraa aadd ddee eemm mmaa aarr rrkk kkss ss
The räger name and logo are registered trademarks of räger.
. AutoFlow® is a registered trademark of räger.
NeoFlow™ is a trademark of räger.
© räger Medical AG & Co. KGaA, 2002
All rights reserved, Subject to modifications

Contents
3
Operating Instructions EvitaXL, 1. US ed.
Contents
Important Safety Information . . . . . . . . . . . . . . . . . . . . . . . . . .4
Operator's Responsibility for Patient Safety . . . . . . . . . . . . . . 4
Limitation of Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Warranty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
efinitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Summary of WARNINGS and CAUTIONS . . . . . . . . . . . . . . . 7
Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Restrictions of Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Before Using for the First Time . . . . . . . . . . . . . . . . . . . . . . . . 11
Preparing for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
evice Check . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Calibrating the Neonatal Flow Sensor . . . . . . . . . . . . . . . . . . 14
Replacing the Neonatal Flow Sensor . . . . . . . . . . . . . . . . . . 15
peration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Selecting Neonatal Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Volume Controlled Ventilation in Neonatal Mode . . . . . . . . 17
Back-up Ventilation in Neonatal Mode . . . . . . . . . . . . . . . . . . 18
Pressure Support Ventilation (PSV) . . . . . . . . . . . . . . . . . . . . 18
Apnea Ventilation in Neonatal Mode . . . . . . . . . . . . . . . . . . . 19
NIV (Mask Ventilation) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Flow Monitoring uring Neonatal Ventilation . . . . . . . . . . . . 21
Flow Monitoring uring Pediatric Ventilation . . . . . . . . . . . . 22
Nebulizing Pharmaceutical Aerosols . . . . . . . . . . . . . . . . . . . 23
O 2 Concentration When Using Nebulizer . . . . . . . . . . . . . . 27
Oxygenation for Bronchial Suction . . . . . . . . . . . . . . . . . . . . 27
Configuration of Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Setting the Patient Range . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Start-up efaults for Ventilation Parameters and
Alarm Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
efining Start-up efaults for Tube Compensation (ATC) . 31
Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
ismantling the Neonatal Flow Sensor . . . . . . . . . . . . . . . . . 32
isinfecting/Cleaning/Sterilizing . . . . . . . . . . . . . . . . . . . . . . 32
Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Maintenance Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Technical Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Neonatal Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Performance ata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
isplay of Measured Values . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Materials Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Theory of peration
– Special Features of Neonatal Ventilation . . . . . . . . . . . . 39
Measuring Leakage Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Airway Pressure Measurement . . . . . . . . . . . . . . . . . . . . . . . . 41
Trigger Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
AutoFlow
®
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
rdering Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Important Safety Information
4
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Operator's Responsibility for Patient Safety
Limitation of Liability
Important Safety Information
perator's Responsibility for Patient Safety
The design of the equipment, the accompanying literature, and
the labeling on the equipment take into consideration that the
purchase and use of the equipment are restricted to trained
professionals, and that certain inherent characteristics of the
equipment are known to the trained operator. Instructions,
warnings, and caution statements are limited, therefore, largely
to the specifics of the raeger design.
This publication excludes references to various hazards which
are obvious to a medical professional and operator of this
equipment, to the consequences of product misuse, and to
potentially adverse effects in patients with abnormal
conditions. Product modification or misuse can be dangerous.
raeger Medical, Inc. disclaims all liability for the conse-
quences of product alterations or modifications, as well as for
the consequences which might result from the combination of
this product with other products whether supplied by raeger
or by other manufacturers if such a combination is not
endorsed by raeger Medical, Inc.
Patient monitoring
The operators of the ventilator system must recognize their
responsibility for choosing appropriate safety monitoring that
supplies adequate information on equipment performance and
patient condition. Patient safety may be achieved through a
wide variety of different means ranging from electronic
surveillance of equipment performance and patient condition
to simple, direct observation of clinical signs.
The responsibility for the selection of the best level of patient
monitoring lies solely with the equipment operator.
WARNING !
Strictly follow this perator's Instruction Manual
Any use of the product requires full understanding and
strict observation of all portions of these instructions.
The equipment is only to be used for the purpose
specified under "Intended Use" on page 10.
bserve all WARNINGS and CAUTI NS as rendered
throughout this manual and on labels on the equipment.
Limitation of Liability
raeger Medical, Inc.'s liability, whether arising out of or
related to manufacture and sale of the goods, their installation,
demonstration, sales representation, use, performance, or
otherwise, including any liability based upon raeger Medical,
Inc.'s Product Warranty, is subject to and limited to the
exclusive terms and conditions as set forth, whether based
upon breach of warranty or any other cause of action
whatsoever, regardless of any fault attributable to raeger
Medical, Inc. and regardless of the form of action (including,
without limitation, breach of warranty, negligence, strict
liability, or otherwise).
THE STATE EXPRESSE WARRANTlES ARE IN LlEU OF
ALL OTHER WARRANTIES, EXPRESSE OR IMPLIE ,
INCLU ING, WITHOUT LIMITATION, WARRANTlES OF
MERCHANTABILITY, FITNESS FOR ANY PARTICULAR
PURPOSE, OR NONINFRINGEMENT.
raeger Medical, Inc. shall not be liable for, nor shall buyer be
entitled to recover any special incidental, or consequential
damages or for any liability incurred by buyer to any third party
in any way arising out of or relating to the goods.

Important Safety Information
5
Operating Instructions NeoFlow for EvitaXL, 1. ed.
arranty
Warranty
All raeger products are guaranteed to be free of defects for a
period of one year from date of delivery.
The following are exceptions to this warranty:
1. The defect shall be a result of workmanship or material.
efects caused by misuse, mishandling, tampering, or by
modifications not authorized by raeger Medical, Inc. or its
representatives are not covered.
2. Rubber and plastic components and materials are
warranted to be free of defects at time of delivery.
Any product which proves to be defective in workmanship or
material will be replaced, credited, or repaired with raeger
Medical, Inc. holding the option. raeger Medical, Inc. is not
responsible for deterioration, wear, or abuse. In any case,
raeger Medical, Inc. will not be liable beyond the original
selling price.
Application of this warranty is subject to the following
conditions:
1. raeger Medical, Inc. or its authorized representative must
be promptly notified, in writing, upon detection of the defective
material or equipment.
2. efective material or equipment must be returned,
shipping prepaid, to raeger or its authorized representative.
3. Examination by raeger or its authorized representative
must confirm that the defect is covered by the terms of this
warranty.
4. Notification in writing, of defective material or equipment
must be received by raeger or its authorized representative
no later than two (2) weeks following expiration of this
warranty.
The above is the sole warranty provided by raeger Medical,
Inc. No other warranty expressed or implied is intended.
Representatives of raeger are not authorized to modify the
terms of this warranty.
raeger Medical, Inc., Telford, PA

Important Safety Information
6
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Definitions
Definitions
NN
NNOO OOTT TTEE EE::::
A NOTE provides additional information intended to
avoid inconveniences during operation.
Typing conventions in this manual
Controls are designated as » Control Name « , e.g:
»PEEP«
Screen pages are indicated as »Screen page«, e.g.
»Measured values«
Screen messages are printed in bold, e.g:
Flow Calibration
Screen messages rendered throughout the text are shown
including the exclamation marks indicating their alarm level,
e.g.
Standby activated !!!
Abbreviations and Symbols
Please refer to "Glossary" on page 45 for explanations.
WARNING !
A WARNING statement refers to conditions with a
possibility of personal injury if disregarded.
CAUTI N !
A CAUTION statement designates the possibility of damage
to equipment if disregarded.
Inspection examination of actual condition
Service measures to maintain specified condition
Repair measures to restore specified condition
Maintenance inspection, service, and repair, where
necessary
Preventive
Maintenance maintenance measures at regular intervals

Important Safety Information
7
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Summary of ARNINGS and CAUTIONS
Summary of WARNINGS and CAUTI NS
General Precautions
WARNING !
Strictly follow this perator's Instruction Manual
Any use of the product requires full understanding and
strict observation of all portions of these instructions.
The equipment is only to be used for the purpose
specified under "Intended Use" on page 10.
bserve all WARNINGS and CAUTI NS as rendered
throughout this manual and on labels on the equipment.
WARNING !
DANGER, risk of explosion if used in the presence of
flammable gases or anesthetics.
This device is neither approved nor certified for use in
areas where combustible or explosive gas mixtures are
likely.
WARNING !
Never use flammable medications (e.g. on the basis of
ethanol) or other substances based on flammable
solvents in the patient circuit. Fire hazard!
Always provide adequate ventilation when using
flammable substances for disinfection.
WARNING !
Electrical connections to equipment or components not
listed in these perating Instructions should only be
made after consultation with the respective manu-
facturers or a qualified expert.
CAUTI N !
Restriction of Distribution
Federal Law and Regulations in the United States and
Canada restrict this device to sale by or on the order of a
physician.
evice for use in health care facilities only and exclusively by
persons with specific training and experience in its use.
Precautions during preparation
Precautions during operation
CAUTI N !
Accessories
Use only accessories listed in the Ordering Information
(page 46).
WARNING !
Installation of the NeoFlow option into Evita XL ventilators
may only be performed by factory trained and authorized
service personnel. Follow installation instructions in the
respective documentation.
WARNING !
The operator of the ventilator must still assume full
responsibility for proper ventilation while flow monitoring
is not available during calibration.
WARNING!
The alarm limit »P AW
>
« must always be set so that a
warning is triggered if airway pressure increases with
reduced compliance or in the event of sudden changes in
the size of the leak.
WARNING!
Minute volume during neonatal ventilation cannot be
monitored without the neonatal flow sensor!
The operator of the ventilator must still assume full
responsibility for proper ventilation while flow monitoring
is not available during neonatal ventilation.

Important Safety Information
8
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Summary of ARNINGS and CAUTIONS
WARNING!
Effect of aerosols on sensors, filters,
and heat and moisture exchangers!
The measuring function of the flow sensor may be
impaired.
The flow resistance of filters is liable to increase and may
impair ventilation.
Do not put a bacteria filter on the nebulizer outlet when in
use!
WARNING!
Do not use a heat/moisture exchanger simultaneously
with a nebulizer or heated humidifier!
Risk of increased breathing resistance due to
condensation.
WARNING!
The nebulizer function integrated in Evita XL is designed
for nebulizers with a nebulizing flow of 6 L/min at 29 psi
(2 bar), for example nebulizer 84 12 935 (white central
body). ther nebulizers may cause deviations in tidal
volume and inspiratory 2 concentration!
WARNING!
The wires of the flow sensor are hot. If the neonatal flow
sensor is left in the patient circuit for some time during
nebulizing without being cleaned, deposits from the
medicated aerosols may build up and impair flow measu-
rement.
In the worst case, these deposits could catch fire.
Disconnecting the flow sensor cable is not sufficient to
prevent this.
It is therefore important to remove the complete flow
sensor before nebulizing medications.
WARNING!
While flow monitoring is not available during nebulizing,
the operator of the ventilator must still assume full
responsibility for proper ventilation.
Precautions during care procedures
CAUTI N !
o not ventilate larger pediatric patients with serious
infections and a severe cough using the neonatal flow
sensor. Instead, use the expiratory flow sensor for ventilation.
Otherwise, coughed up secretions may cause corrosion in
the neonatal flow sensor.
WARNING !
Always follow accepted hospital procedures for handling
equipment contaminated with body fluids.
WARNING !
Vent flow sensor after disinfection with ethanol for at
least 30 minutes or rinse with sterile water. therwise,
residual ethanol vapors might ignite and destroy the
sensor during calibration.
CAUTI N !
Certain components of the ventilator consist of materials that
are sensitive to certain organic solvents sometimes used for
cleaning and disinfecting (e.g., alkylamines, phenols,
halogen releasing compounds, oxygen releasing
compounds, strong organic acids, etc.). Exposure to such
substances may cause damage that is not always
immediately recognized. Sterilization with ethylene oxide
(EtO) is also not recommended.
CAUTI N !
o not allow any liquid into the connector of the flow sensor
cable.
CAUTI N !
Flow sensor is not compatible with parts washer equipment
and may not be autoclaved or steam-sterilized.
It cannot withstand high temperatures and would be
destroyed.
o not use compressed air, brushes or similar tools to clean
flow sensor element as this would possibly damage the thin
wires in the flow sensor.

Important Safety Information
9
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Summary of ARNINGS and CAUTIONS
Precautions during maintenance
WARNING !
To avoid any risk of infection, clean and disinfect ventila-
tor and accessories before any maintenance according to
established hospital procedures - this applies also when
returning ventilators or parts for repair.
WARNING !
Preventive Maintenance work on the Evita XL ventilators
and their components may be performed by factory
trained and authorized personnel only.
WARNING !
Never operate the ventilator if it has suffered physical
damage or does not seem to operate properly.
We recommend that you contact DraegerService for
maintenance service for the Evita XL ventilator.
WARNING !
When servicing the ventilator, always use replacement
parts that are qualified to Draeger standards.
Draeger cannot warrant or endorse the safe performance
of third party replacement parts for use with Evita XL
ventilators.
CAUTI N !
Maintenance
This device must be inspected and serviced at regular
intervals. A record must be kept on this preventive
maintenance. We recommend obtaining a service contract
with raegerService through your vendor.
For repairs we recommend that you contact raegerService.

Intended Use
10
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Restrictions of Use
Intended Use
NeoFlow – neonatal mode with base flow.
Extends the patient range of the Evita
XL intensive care
ventilator to infants and premature babies with a minimum
body weight of 1.1 lbs (0.5 kg).
Extends the range of flow monitoring with Evita
XL during
pediatric and neonatal ventilation employing a proximal flow
sensor specifically designed for neonatal applications.
Restrictions of Use
WARNING !
DANGER, risk of explosion if used in the presence of
flammable gases or anesthetics.
This device is neither approved nor certified for use in
areas where combustible or explosive gas mixtures are
likely.
WARNING !
Never use flammable medications (e.g. on the basis of
ethanol) or other substances based on flammable
solvents in the patient circuit. Fire hazard!
Always provide adequate ventilation when using
flammable substances for disinfection.
WARNING !
Electrical connections to equipment or components not
listed in these perating Instructions should only be
made after consultation with the respective manu-
facturers or a qualified expert.
CAUTI N !
Restriction of Distribution
Federal Law and Regulations in the United States and
Canada restrict this device to sale by or on the order of a
physician.
evice for use in health care facilities only and exclusively by
persons with specific training and experience in its use.

Preparation
11
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Before Using for the First Time
Preparation
Before Using for the First Time
Installing the NeoFlow option
Configuring NeoFlow
Please refer to page 28 for instructions on configuring
NeoFlow.
WARNING !
Installation of the NeoFlow option into Evita XL ventilators
may only be performed by factory trained and authorized
service personnel. Follow installation instructions in the
respective documentation.

Preparation
12
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Preparing for Use
Preparing for Use
Installing the neonatal flow sensor
Prepare patient circuit – see chapter "Ventilating Infants" in the
EvitaXL Operating Instructions.
●Only the neonatal flow sensor (84 11 130) may be used.
1Plug the Y-piece to ventilator circuit.
2Insert neonatal flow sensor into the Y-piece.
3Plug the flow sensor cable into the socket.
●Route sensor cable to the ventilator along the patient
circuit.
4Plug the flow sensor connector into the socket on the back
panel of the ventilator and tighten thumbscrews.
●Connect test lung complete with tracheal tube CH 12 and
ET-tube connector to the patient end of the neonatal flow
sensor.
WARNING !
Do not use the Y-piece with integral flow sensor
(part no. 84 10 185). This flow sensor features a different
flow characteristic curve and would give inaccurate flow
measurements.
00137566
2
3
1
00237566
4
00337566

Preparation
13
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Device Check
Device Check
The NeoFlow option expands the EvitaXL
pre-use check procedure by the
following function:
— Calibration neo. flow sensor
10237683

Preparation
14
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Calibrating the Neonatal Flow Sensor
Calibrating the Neonatal Flow
Sensor
— Before use, as part of the ventilator
check.
— After replacing the neonatal flow
sensor.
— At least once every 24 hours.
N TE: The last calibration value
obtained is saved until the next
calibration, even when the ventilator
is switched off.
Before each calibration, the neonatal
flow sensor is automatically cleaned.
N TE: Recalibration is not necessary if
the plug of the neonatal flow sensor
has been temporarily unplugged.
Starting calibration for EvitaXL
●Press » Sensor Parameter« key.
The »Sensor Parameter«, menu is
displayed. Select »NeoFlow« menu,
flow monitoring is activated.
Start calibration:
●Touch »Start« screen key.
The screen key turns green, the
ventilator now calibrates the flow
sensor.
The »Start« screen key turns pale-green
when calibration is complete.
13837683

Preparation
15
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Replacing the Neonatal Flow Sensor
Calibration procedure
●Remove ET-tube connector,
●Remove neonatal flow sensor from Y-piece,
●Insert patient ET-tube connector directly into the Y-piece for
the duration of the calibration.
●Wearing a sterile glove, hold neonatal flow sensor so that
both sides are sealed and flow is zero, as required for
calibration.
●Start calibration = press dial knob.
Calibration is completed after approx. 1 second.
If the message Calibration ok is displayed:
●Remove ET-tube connector from Y-piece. Re-install
neonatal flow sensor into the Y-piece. Reconnect tube
connector.
If calibration is unsuccessful:
●Repeat calibration. If necessary, replace neonatal flow
sensor. Check sensor cable.
Replacing the Neonatal Flow Sensor
If the following error message is displayed:
Neo flow measurement inop.
1isconnect flow sensor cable from the neonatal flow
sensor.
2Press buttons on both sides while pulling the flow sensor
element out of its housing.
Insert new sensor until it engages.
3The two oval markings on flow sensor element and sensor
housing must line up.
1Reconnect flow sensor cable.
●Calibrate neonatal flow sensor, see page 14.
WARNING !
The operator of the ventilator must still assume full
responsibility for proper ventilation while flow monitoring
is not available during calibration.
0083756600937566
1
2
33

Operation
16
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Selecting Neonatal Mode
peration
Selecting Neonatal Mode
The required patient mode can be
selected from the EvitaXL menu
immediately after switching on or while
in standby mode:
The menu ranges can be configured,
see "Configuring Ventilation, Setting the
patient range", on page 28.
●Touch » Neo.« screen key.
isplay (example for neonatal mode):
In the top line of the screen, after the
ventilation mode identifier,
Neo. = Neonatal mode is displayed.
»mAdult« = Adult
»Ped.« = Pediatric
» Neo.« = Neonatal
10437682

Operation
17
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Volume Controlled Ventilation in Neonatal Mode
Volume Controlled Ventilation
in Neonatal Mode
The AutoFlow® ventilation mode
supplement is always active when using
volume controlled ventilation (CMV,
SIMV, MMV) in neonatal mode.
AutoFlow® – for automatic regulation of
"Insp. Flow" and "Pinsp".
EvitaXL uses AutoFlow* to decelerate
and regulate inspiratory flow and
providing a constant pressure
throughout the inspiratory phase. The
ventilator determines the lowest
possible peak pressure for providing the
selected VT at a given patient
compliance, thereby avoiding pressure
peaks.
EvitaXL delivers an additional inspiratory
flow if the patient breathes in. This flow
is limited by the alarm limit VTi >.
The patient can also breathe out during
the inspiratory plateau phase.
Inspiratory pressure is limited by the
alarm limit PAW >.
* Refer to page 43 for a detailed
description of AutoFlow.
WARNING!
The alarm limit »PAW >« must always
be set so that a warning is triggered
if airway pressure increases with
reduced compliance or in the event
of sudden changes in the size of the
leak.
19337683

Operation
18
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Back-up Ventilation in Neonatal Mode
Pressure Support Ventilation (PSV)
Back-up Ventilation in Neonatal Mode
during volume-controlled neonatal ventilation
Volume-controlled ventilation during neonatal ventilation is
only possible with intact flow monitoring. If neonatal flow
monitoring fails or has been switched off during volume-
controlled ventilation, EvitaXL automatically switches over to
pressure-controlled back-up ventilation.
N TE: Apnea monitoring continues during back-up ventilation
and apnea ventilation is started if necessary.
uring back-up ventilation, inspiratory pressure will corre-
spond to the mean value of the last mandatory inspiratory
pressures applied while flow monitoring was still active during
volume-controlled neonatal ventilation. The ''Tinsp'', '' f '', ''O2''
and ''PEEP'' ventilation parameters retain the same settings as
before back-up ventilation.
Pressure Support Ventilation (PSV)
As in adult and pediatric modes, spontaneous breathing in
neonatal mode can be assisted with Pressure Support during
PCV+, SIMV, CPAP, and MMV ventilation. Pressure Support
Ventilation may be used for patients with adequate
spontaneous breathing.
N TE: Pressure supported spontaneous breathing during
neonatal ventilation is only possible if flow monitoring is
active!
●Set the ventilation pattern for PSV ventilation with the
parameters:
— Support pressure »PSupp.«
— Pressure rise time »Slope«
— Maximum inspiratory time »Tinsp«
A pressure supported breath during neonatal ventilation is
ended at the latest after the set maximum inspiratory time Tinsp.

Operation
19
Operating Instructions NeoFlow for EvitaXL, 1. ed.
Apnea Ventilation in Neonatal Mode
Apnea Ventilation in Neonatal
Mode
Unlike in adult or pediatric ventilation,
pressure controlled apnea ventilation is
started after the set alarm time
(TApnea >) if an apnea occurs in
ventilation modes with activated apnea
ventilation. Apnea ventilation is
controlled by adjusting the following
settings:
Frequency »f«
Pinsp »PApnea«
uring apnea ventilation, the ratio of
inspiration to expiration is 1:2.
Ventilation parameters "O2" and "PEEP"
remain at their respective settings in use
at the time apnea ventilation is started.
Setting apnea ventilation parameters:
●Touch »Add. settings« screen key in
the desired ventilation mode. EvitaXL
displays the possible additional
settings.
●Touch »Apnoea ventilation...«
screen key. EvitaXL displays the menu
for setting apnea ventilation
parameters.
●Touch »PApnea« and »f« screen
knobs.
Turn dial knob to set value,
press dial knob to confirm.
To switch on/off
●Touch » n« or » ff« screen key,
press dial knob to confirm.
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Operation
20
Operating Instructions NeoFlow for EvitaXL, 1. ed.
NIV (Mask Ventilation)
NIV (Mask Ventilation)*
See EvitaXL Operating Instructions for
details on Non Invasive Ventilation (NIV).
Set ventilation parameters
●As described for »Tube« application
mode.
An additional screen knob »Tinsp« is
displayed for CPAP/PSupp.
In patient modes »Pediatric« or
»Neonate«, EvitaXL limits the maximum
duration of a pressure support breath to
1.5 seconds .
●The maximum duration of a pressure
support breath may be further limited
with the »Tinsp« screen knob.
»Tinsp« also limits the duration of
pressure supported breaths in the other
ventilation modes which can be
combined with PSV.
Leakage compensation in »Mask«
mode
epending on the selected patient
mode, EvitaXL compensates for leaks up
to the following values in order to detect
a patient trigger:
EvitaXL compensates for calculated
leaks up to 200 % of the set tidal volume,
but not more than max. 2 L (regardless
of the patient mode).
*Available Option
Pediatric mode: 15 L/min
Neonatal mode: 7 L/min
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