Engler ADS 2000 User manual

REV. F 10 / 21 / 2014

COMPANY PROFILE
Engler Engineering Corporation has been in business since 1964 and occupies an 8000
s uare foot facility in Hialeah, Florida (USA). We manufacture ultrasonic dental scalers,
polishers and combination units including electro surgery e uipment and ultrasonic
instruments for the veterinary market as well as a microprocessor controlled anesthesia
delivery system and a respiratory monitor for veterinary use only.
We also manufacture dental e uipment for the human market. Please visit our website
www.englerusa.com for more detailed information or call us at the numbers shown
below.
Engler Engineering Corp. ac uired the exclusive manufacturing and marketing rights of
Dynax products, including stretchers, animal restraint devices, comfort cots, heating
pads, and other products. We also ac uired the Alpha-Sonic, Ora-Sonic, and Pro-Sonic
line of piezo scalers.
Engler Engineering Corporation’s brand name veterinary products proudly include:
Excelsior, high speed dental air unit with vacuum / electro-surge / ultrasonic scaler / low
speed / high speed / air / water syringe,
Son - Mate II, ultrasonic scaler / polisher,
Sonus II, ultrasonic dental scaler,
Poli - X, micromotor variable speed polisher,
Drill Aire, high speed dental air unit, high speed, air / water syringe,
Drill Aire Plus, high speed dental air unit, high speed, low speed, air / water syringe,
Scale - Aire Mini, high speed dental air unit with ultrasonic scaler / high speed / low
speed / air / water syringe,
Scale - Aire, high speed dental air unit with ultrasonic scaler / high speed / low speed /
air / water syringe and compressor / tank,
Tri - Mate, ultrasonic scaler / micromotor polisher / electro-surge,
ADS 2000, microprocessor controlled anesthesia delivery system / ventilator,
Sentinel V.R.M., respiratory monitor.
Engler manufactures the Sonus V ultrasonic dental unit for the human market
We manufacture all of the inserts and tips used in the Engler products as well as many
others on the market today in the 18K, 25K, and 30K fre uency range.
Our repair department has the technical knowledge to repair and maintain most dental
devices manufactured by other companies including Shorline.
Engler Engineering Corporation's (EEC) foreign sales are handled through a large and
growing network of dental and veterinary distributors. At the present time we are
represented throughout Europe, South and Central America, Canada, Asia, New Zealand,
Australia, the Middle East, and most other countries.
If you have any uestions or comments, please contact:
Engler Engineering Corporation
1099 East 47th Street, Hialeah, Florida 33013
800-445-8581 – 305-688-8581 – FAX [phone]
Web site: www.englerusa.com Help site: www.engler411.com

TABLE OF CONTENTS
SECTION PAGE
_______________________________________________________________________
COMPANY PROFILE 2
PARTS LIST 4
SPECIAL INFORMATION – A must read preview. 5
INSTALLATION INSTRUCTIONS 6-7
GETTING FAMILIAR WITH THE ADS 2000 8-9
POUNDS TO KILOGRAMS CONVERSION CHART 10
TURNING ON THE ADS 2000 11-12
THE LCD DISPLAY in SET MODE 12-13
THE LCD DISPLAY in RUN MODE 14-15
UNDERSTANDING THE MINUTE VOLUME NUMBER 15-16
THE INSPIRATORY TIME 16-17
DISPLAYING TIDAL VOLUME 17
UNDERSTANDING FLOW RATE 17
UNDERSTANDING BREATHS PER MINUTE 18
HOW TO SET P.I.P. 18
UNDERSTANDING ASSIST 18
USING THE FILL / HOLD FEATURE 19
BUCKING THE ADS 19
UNDERSTANDING PEEP MODE 20
UNDERSTANDING THE FLUSH MODE 21
USING BREATHE FEATURE 22
USING THE MASK MODE 22
ENDOTRACHEAL TUBES and the ADS 2000 24
USING THE ADS 2000 in LAB MODE 25-26
USE OF EXTERNAL EQUIPMENT WITH THE ADS 2000 26
TROUBLESHOOTING THE ADS 2000 27-33
FREQUENTLY ASKED QUESTIONS 34-36
NOTICE OF CONFORMITY 37
ADS 2000 Engler Engineering Corporation 3

PARTS LIST
Upon opening the carton the ADS 2000 was shipped in, you will find:
ADS 2000 Unit,
ADS instruction manual,
Instructional DVD,
Breathing Circuit with gas sampling elbow,
Green Oxygen Hose,
“To” Vaporizer Hose,
“From” Vaporizer Hose,
Blue Scavenger Tubing,
Power Adapter,
Mask Adapter,
Test Lung,
Gas sampling hose with Luer lock connectors.
PLEASE READ VERY CAREFULLY
Engler Engineering Corporation (EEC) makes every effort to verify that all parts
for this device including any optional accessories ordered with it are included in
this shipment. It is imperative that you inspect the package and if you find
any pieces damaged or missing, you must notify us immediately. Claims for
damaged or missing parts will only be accepted within five days of reciept.
EEC makes every effort to verify that our devices are built and tested to approved
standards. Any modification to the device, hoses or power supply initiated by
others nullifies all warranty statements. Engler Engineering Corporation will not
be held liable in any way, for any damage, injury or death due to non-authorized
service, improper installation, or improper use of this device.
Engler Engineering Corporation
1099 East 47th Street, Hialeah, Florida 33013
800-445-8581 305-688-8581 FAX [phone]
E-mail: [email protected]
4Engler Engineering Corporation ADS 2000

SPECIAL INFORMATION
There are a few special areas of information that must be read and understood prior to
operating the ADS 2000.
1. BATTERY BACKUP: The ADS 2000 has an internal battery backup system that
allows you to continue your procedures in the event of loss of electrical power. It
also protects the unit from electrical spikes that may occur during thunderstorms or
brownouts. In addition, it allows you to use it as an emergency ventilator in the field
if re uired. It is suggested that the power supply be plugged in, and connected to
the device at all times so you will have full power in the event of an emergency. The
battery backup should provide ten to twelve hours of use when fully charged.
2. The red LED on the face of the ADS 2000 will illuminate when the battery re uires
charging. It will also flash whenever the external gas sampling hose is
disconnected from the circuit.
3. The ADS 2000 can be damaged if any li uid or of anesthesia enters
it from the vaporizer. It is imperative that you do not overfill the vaporizer and
that you have it inspected and certified at least every year. Anesthesia
residue found in the ADS 2000 may void the warranty.
CAUTION: It is important when connecting the vaporizer to ensure that
The vaporizer is mounted lower than the ADS 2000. This will prevent
li uid anesthetic from possibly entering the ADS 2000.
4. This device must be flushed between procedures to ensure proper
operation. Failure to flush the device may allow unwanted foreign materials
to build up in the hoses and internal parts. This may cause incorrect
readings on the display, and / or interfere with the proper flow of gases
through the unit. Additionally, the unit may not be able to complete its self-
test causing a default which will show as an error on the display. Please
refer to page 21 of this manual for the flush procedure.
5. The breathing circuit hoses supplied with the ADS 2000 are “disposable”
type hoses and are easily replaceable. It is suggested that they be replaced
periodically.
6. The ADS 2000 will shut down the flow of oxygen, sound the alarm and
flash the LED, whenever the gas sampling circuit is disconnected. This is
an important safety feature for this device. Upon reconnecting the sampling
hose, the device will continue to operate with the settings as established.
ADS 2000 Engler Engineering Corporation 5

INSTALLATION INSTRUCTIONS
1. Connecting the Oxygen Hose - On the back panel of the unit there is a port marked
"OXYGEN IN", connect one end of the Green Oxygen Hose to this port and connect the
other end of this hose to your 50 PSI oxygen source. Since the oxygen fittings are
universally standard, you may use your own oxygen hose if desired.
CAUTION: IT IS EXTREMELY IMPORTANT THAT THE OXYGEN BE REGULATED TO A
PRESSURE OF 50 POUNDS PER SQUARE INCH (PSI), FOR THE MINUTE VOLUME PER
KILOGRAM DISPLAY TO READ ACCURATELY. PRESSURE OVER 50 PSI MAY DAMAGE
INTERNAL PARTS VOIDING THE WARRANTY.
2. Connecting the Vaporizer Hose - On the back panel of the unit there
is a port marked "TO VAPORIZER", connect one end of the non marked silicon hose to this
port and connect the other end to your vaporizer inlet port.
3. Connecting the Vaporizer Hose - On the back panel of the unit there is a port marked
"FROM VAPORIZER", connect one end of the blue striped silicon hose to this port and
connect the other end to your vaporizer outlet port.
NOTE: The ADS 2000 must be used with a precision vaporizer.
4. Connecting the Scavenger Tubing - Connect one end of the Blue Scavenger tubing
to the "SCAVENGER OUT” port on the back of the unit. Connect the other end to either a
"passive" or "active" scavenging system. This will help to eliminate all traces of anesthetic
gases used in the operating room that could pose a hazard to personnel. The use of a f/air
anesthesia gas filter unit or active anesthesia scavenger system is highly recommended.
Care must be taken to ensure that the scavenger port is not blocked by improper use of
these devices as the animal's ease of expiration depends on the resistance of the
scavenger line.
5. Connecting the Power Adapter - Connect the small male plug of the power
adapter into the back of the ADS 2000 at the 15 VDC @ 1.2 A outlet. Then plug the adapter
into an electrical outlet. The supplied power adapter continuously charges the internal
battery backup.
NOTE: On a full charge the ADS 2000 has 10 to 12 hours of battery backup for
uninterrupted operation during power failure. Complete battery recharging is
accomplished in approximately 8 hours.
6. Connecting the Breathing Circuit - Connect the two large ends of the breathing circuit to
the "BREATHING CIRCUIT" ports on the front panel of the ADS 2000. You may use your own
breathing circuit if you desire. The top port (inspiratory) of the ADS 2000 feeds oxygen / anesthesia
to the patient. The bottom port (expiratory) is the exhaust. After the lungs have been inflated
the internal exhale valve allows the natural elasticity of the animal's lungs to exhale oxygen /
anesthesia out through this port.
6Engler Engineering Corporation ADS 2000

7. Connecting the gas sampling system - To connect the external gas sampling system
perform the following steps:
1) Insert the Luer lock connector to the gas sampling input and rotate it clockwise one half turn.
2) Connect the two breathing circuits ends to the breathing circuit ports.
3) Now insert the gas-sampling elbow into the end of the breathing circuit as shown.
4) Insert the Luer lock connector to the gas-sampling elbow and rotate it clockwise one half
turn.
Note: You’re ADS 2000 unit is fitted with a hose disconnect safety system. In the event that the
external sampling hose becomes disconnected, the system will disconnect the gas input to the
patient, sound an alarm and flash the red LED on the front left corner of the unit.
Once the external sampling hose is reconnected, the unit will continue to work at its previous setting.
ADS 2000 Engler Engineering Corp 7

GETTING FAMILIAR WITH THE ADS 2000
In order to operate the ADS 2000 properly, you need know its controls.
Front View:
LCD DISPLAY - Displays Minute Volume, Inspiratory Time, Proximal Airway Pressure, Flow Rate,
Breaths Per Minute, Peak Inspiratory pressure, and Assist Pressure.
12
SET
POWER switch - This switch turns the power to the ADS 2000 ON and OFF.
MASK switch - This switch is used for enabling and disabling the Mask Mode
SET / RUN Switch - When in the SET, this switch allows the operator to enter in
the patients' weight. When switched to RUN the ADS 2000 begins ventilating the
patient.
VOLUME Knob - This knob controls the volume of the audible warning alarm. We suggest that you
start with it turned fully clockwise, i.e. full volume and adjust it as necessary.
FILL / HOLD Button - When this button is pressed, the ADS 2000 will fill the lungs of the patient to
the indicated peak inspiratory pressure and hold it until the button is released.
BREATHE Button - When this button is pressed, the ADS 2000 will initiate a breath to the
indicated peak inspiratory pressure to the patient.
WEIGHT UP / DOWN Buttons - When the ADS 2000 is in the SET MODE these buttons allow the
operator to enter the weight of the patient, from below 1.0 Kg. to 68 Kg.
FLOW RATE UP / DOWN Buttons - Depressing these buttons cause the FLOW RATE to increase
or decrease, from 0.2 LPM to 60 LPM.
BREATHS PER MINUTE UP / DOWN Buttons - These buttons control the minimum number
of times that the ADS 2000 will breathe per minute, from 1 to 95 B.P.M.
P.I.P. UP / DOWN Buttons - These buttons control the Peak Inspiratory Pressure in cm of
H2O, that the ADS 2000 will deliver to the patient, from 5.0 cm to 35 cm./ H2O
ASSIST UP / DOWN Buttons - These buttons set the sensitivity of inspiratory effort
necessary for the ADS 2000 to facilitate an assisted breath, from 0.3 to 6.0 cm. /
H2O They also allow the ASSIST feature to be turned off.
8 Engler Engineering Corporation ADS 2000

Getting familiar with the ADS 2000 cont.
BREATHING CIRCUIT PORTS - Connect the breathing circuit to these ports.
BATTERY LOW INDICATOR / SAFETY ALARM - The red led on the front panel of
the ADS 2000 is a warning indicator that the battery power is low, and that the unit
should be placed on charge immediately. When the unit is first powered up the led will
self test by flashing on and then should remain off.
The LED will also flash if the external sampling hose is disconnected.
GAS SAMPLING INPUT - To connect the Gas Sampling System, insert the Luer lock
connector to the Gas Sampling input and rotate it clockwise one half turn. The Luer
lock connector is located at the end of the 1/8” clear tube. Locate the other Luer lock
connector at the other end of the 1/8” clear tube. Connect it to the Gas Sampling elbow
on the Breathing Circuit.
Note: It is imperative that the Gas Sampling Hose stay connected during use.
Rear View:
SCAVENGER OUT - Connect one end of the blue "Scavenger" tubing to this port and
connect the other end to a scavenging filter canister or other scavenging device, either
active or passive.
FROM VAPORIZER - Connect one end of the "From Vaporizer" hose to this
port and connect the other end to the outlet port of your precision vaporizer.
TO VAPORIZER - Connect one end of the "To Vaporizer" hose to this port and
connect the other end to the inlet port or your precision vaporizer.
OXYGEN IN - Connect one end of the green "Oxygen" hose to this port and connect
the other end to an oxygen source that is set to a pressure of 50 PSI (pounds per
s uare inch).
POWER INLET - Connect your power cord to this port.
ALARM - This is the alarm speaker.
50 PSI / 5 PSI TOGGLE - This is the manual control to alternate between the 50 PSI
(normal) operating mode and the 5 PSI, (lab) mode.
ADS 2000 Engler Engineering Corporation 9

POUNDS TO KILOGRAMS CONVERSION CHART
In order for the ADS 2000 to operate properly, the correct patient weight must be entered. The ADS
2000 re uires that the patient's weight be entered in kilograms, therefore if the patients weight in
pounds is known then the following formula will help in determining the patients weight in kilograms.
Kg = P x 0.454
Where:
Kg = patient's weight in kilograms
P = patient's weight in pounds
Example: You have a 40 pound patient and need to find out it's weight in kilograms.
Kg = 40 x 0.454
Kg = 18.2 Kilograms or 18 Kilograms
Conversion from kilograms to pounds
Kilograms Pounds Kilograms Pounds
12.205 35 77.160
24.409 36 79.365
36.614 37 81.570
48.818 38 83.774
511.023 39 85.979
613.228 40 88.183
715.432 41 90.388
817.637 42 92.593
919.841 43 94.797
10 22.046 44 97.002
11 24.250 45 99.206
12 26.455 46 101.411
13 28.660 47 103.616
14 30.864 48 105.820
15 33.069 49 108.025
16 35.273 50 110.229
17 37.478 51 112.434
18 39.683 52 114.638
19 41.887 53 116.843
20 44.092 54 119.048
21 46.296 55 121.252
22 48.501 56 123.457
23 50.705 57 125.661
24 52.910 58 127.866
25 55.115 59 130.071
26 57.319 60 132.275
27 59.524 61 134.480
28 61.728 62 136.684
29 63.933 63 138.889
30 66.128 64 141.093
31 68.342 65 143.298
32 70.547 66 145.503
33 72.751 67 147.707
34 74.956 68 149.912
10 Engler Engineering Corporation ADS 2000

TURNING ON THE ADS 2000
1. Verify that the oxygen supply hose is connected properly. Open the O2 valve to begin
oxygen supply to the ADS 2000. The oxygen supply must be regulated to 50 PSI. Make sure
that the vaporizer (if in circuit) is "OFF" .
2. Place the "POWER" and "MASK" switches in the "O" position. Place the "SET /
RUN" switch into the "SET" position. Check that the Toggle Switch located at the rear
of the unit is set to “Normal” 50 PSI.
3. Place your thumb over the open end of the gas-sampling elbow that is connected to the end
of the breathing circuit.
Note: By placing your thumb over the gas-sampling elbow you are creating a closed circuit for
the ADS 2000 built in self-test feature.
Note: The gas sampling system hose must be properly connected before the ADS 2000 self-
test is initiated.
4. While still holding your thumb over the sampling elbow, place the Power switch to "I" or "On" .
The ADS 2000 will now perform a self-test. This will be indicated by the LCD display as shown in
Figure 1. Continue to hold your thumb over the end of the sampling elbow until this test is
complete.
Fig.1
5. As shown in Figure 2, at the end of the self-test you will be prompted by one of
the following messages in the LCD display.
Fig.2
A. B. C.
D. E. F.
G. H.
ADS 2000 Engler Engineering Corporation 11

Fig.3
6. When the unit passes self test, the LCD Display will show (fig 2 A), its Automatic Default –
20 kilograms. The ADS 2000 has just passed the self-test.
7. If you get readout 2 B. “SWITCH TO SET", then place the SET / RUN switch to "SET". The
display will now give readout "A" or "C", if you get readout "A." then proceed to Step 6.
8. If you get readout 2 C. “SWITCH MASK OFF" then place the "MASK" switch to "O" or
"OFF". The display will now give readout "A", proceed to Step 6.
9. If you get any one of the error messages "D" through "H" please refer to
TROUBLESHOOTING THE ADS 2000, section of this manual, beginning on page 24.
10. If a message as in figure 3 is displayed, a hose from the Breathing Circuit or the Gas
Sampling Circuit is not connected properly. Re-connect hoses and try again.
The ADS 2000 is ready for operation!
Note: Do not connect TEST LUNG / patient until unit has passed self-test.
SET MODE
In this section you will learn and set up the parameters of the ADS 2000 in the "SET
MODE". The "SET MODE" is the resting or static mode for the ADS 2000. The "SET
MODE" is the mode in which you will enter the patients' weight in kilograms and from
that input the ADS 2000 will select all of the other parameters for you. Of course, the
ADS 2000 will only select values based on an average, if at any time you wish to
change any parameter, you may do so at any time.
THE LCD DISPLAY in SET MODE. Figure 2 A shows the default 20 kilograms display
once the self test process is completed.
1. Make sure that the SET / RUN switch is in the "SET MODE".
2. As shown on figure 2A we can see the following:
a. Patient default Weight is pre-selected at 20 Kilograms.
b. The default Flow Rate is pre-selected to a value of 24 liters per minute.
12 Engler Engineering Corporation ADS 2000

Set Mode cont.
c. The default number of Breaths Per Minute is 7.5
d. The default Peak Inspiratory Pressure is pre-selected to a value of
15 cm. of H2O.
e. The Assist feature is on and defaults at a pre-selected value of -3.0 cm. of
H2O.
Every time you turn the ADS 2000 on, the LCD display should show the default values as
shown on page 10, indicating a successful self-test.
3. To enter a different weight, simply press either the WEIGHT UP or WEIGHT DOWN
buttons on the front of the ADS 2000 while in Set Mode, until the upper line of the LCD
displays the desired weight.
NOTE: Weight values under 10 Kilograms are set to the nearest 0.5 Kilograms, while
weight over 10 Kilograms are set to the nearest 1 Kilogram.
NOTE: It is important to set the unit for the correct weight for each patient so that the
MINUTE VOLUME PER KILOGRAM value will be calculated correctly.
4. As you select different weight values the ADS 2000 automatically provides default
ventilation parameters. At any time before or during a procedure, you can change any of
following parameters:
a. LITERS PER MINUTE - To adjust the FLOW RATE to the patient, simply press the FLOW
RATE UP or FLOW RATE DOWN buttons on the front of the ADS 2000.
b. BREATHS PER MINUTE - To adjust the number of BREATHS PER MINUTE
delivered to the patient, simply press the BREATHS PER MINUTE UP or BREATHS
PER MINUTE DOWN buttons on the front of the ADS 2000.
c. PEAK INSPIRATORY PRESSURE - To adjust the Peak Inspiratory Pressure delivered to
the patient, press either the P.I.P. UP or P.I.P. DOWN buttons on the front of the ADS
2000.
d. ASSIST - To adjust the amount of inspiratory effort needed to initiate a breath by the
patient, press either the ASSIST UP or ASSIST DOWN buttons on the front of the ADS
2000.
NOTE: To turn the ASSIST feature off, press and hold the ASSIST DOWN button
until the LCD displays "OFF" where the ASSIST value was located.
ADS 2000 Engler Engineering Corporation 13

THE LCD DISPLAY in RUN MODE
NOTE: We suggest that you practice with the provided TEST LUNG, until you feel
confident that you fully understand the proper operation of the ADS 2000. Throughout
the manual whenever the word "patient(s)" is used, you will also see the words, “TEST
LUNG”, this means that you should first familiarize yourself with this function by using
the TEST LUNG first.
NOTE: When using the TEST LUNG you should always keep the vaporizer OFF.
1. Now that you have entered in the patients' weight (the TEST LUNG simulates a 20
Kilogram patient), you are ready to begin delivering anesthesia or ventilating your
patient (TEST LUNG).
2. If you haven't done so already, connect the end of the Breathing Circuit to your
patient (TEST LUNG).
3. Place the SET / RUN switch to "RUN". The patient's (TEST LUNG) chest
should begin to fill up to the preset P.I.P. (Peak Inspiratory Pressure)
4. After the patient (TEST LUNG) has reached the preset P.I.P. the exhale valve will
open and the patients' (TEST LUNG) chest will exhale (deflate). The LCD display
should look similar to the display below.
NOTE: Numbers used in section 5 and 6 of pages 11 and 12 are examples only.
5. The upper line of the LCD readout is now displaying, from left to right, the
following information:
a. Minute Volume Per Kilogram, (100 in this case). This number will be
updated with each breath.
b. Peak Inspiratory Pressure Graph, (A s uare black cursor moving
across a white background).
NOTE: The cursor starts at 0 cm. of H2O and moves up to the selected Peak
Inspiratory Pressure (15 cm. of H2O in this case).
14 Engler Engineering Corporation ADS 2000

NOTE: A s uare BLACK cursor moving across a WHITE background indicates that the breath
was initiated by the ADS 2000. Whereas a s uare WHITE cursor moving across a BLACK
background indicates that the patient initiated the breath.
c. Inspiratory Time, (.73 seconds in this case)
6. The bottom line of the LCD readout shows the following parameters:
a. Flow Rate, (24 Liters Per Minute in this case).
b. Breaths Per Minute, (7 Breaths per minute in this case).
c. Peak Inspiratory Pressure, (15 cm. of H2O in this case).
d. Assist (Inspiratory Effort), (-3.0 cm. of H2O in this case).
7. The ADS 2000 will now wait until either the patient initiates a breath, either by
giving an inspiratory effort of e ual or greater than the ASSIST value
(-3.0 in this case), or until it is time for the A.D.S 2000 to give the next breath
(computed by the microprocessor), it will then repeat the cycle.
NOTE: If pressure in the system increases between breaths, a built in safety feature will
cause the ADS 2000 to allow an "exhale" (pop-off) , i.e. the exhale valve opens to allow
pressure to escape. This would happen, for instance, if the surgeon leaned on the
patient's chest. It can also happen if the patient tries to exhale after he has already
exhaled a tidal volume. You will hear the exhale valve open and close rapidly. This is
normal.
To temporarily stop the ADS during a procedure, place the SET / RUN switch to
"SET". Doing so will hold the current parameters, the current breath will be completed
and the machine will stop. To continue ventilation, switch back to "RUN".
UNDERSTANDING THE MINUTE VOLUME NUMBER
1. Since blood gas analysis is not always available, we provide a Minute Volume
Number as a guide, to know if you are properly ventilating the patient. A properly
ventilated patient should re uire from 150 to 250 ml. / minute / Kg. The 150 ml. /
minute / Kg. number is appropriate for larger patients and the 250 ml. / minute/ Kg.
number for smaller patients. In general, it is better to over ventilate rather than
under ventilate a patient.
NOTE: The Minute Volume per Kilogram number becomes useful after the patient has
stabilized. It will re uire a few breaths for this stabilization to take place, and then you will
see the Minute Volume per Kilogram number fluctuate slightly between breaths.
ADS 2000 Engler Engineering Corporation 15

Minute Volume cont.
There are two ways to change the Minute Volume per Kilogram number:
a. Since the Minute Volume number is directly proportional to Breaths Per
Minute, the most direct way to change the Minute Volume number is to change
the number of Breaths Per Minute.
b. Changing the Peak Inspiratory Pressure (P.I.P.) will change the Tidal Volume
and therefore change Minute Volume number as well. Obese patients with low
thoracic compliance and patients with restrictive lung conditions will often need
a higher Peak Inspiratory Pressure. The best method is to observe the “rise
and fall” of the chest and adjust the Peak Inspiratory Pressure for a
"reasonable" amount of filling.
THE PEAK INSPIRATORY PRESSURE GRAPH
1. The Peak Inspiratory Pressure of the patient is indicated by a cursor moving
across the middle of the LCD display.
2. The cursor starts at 0 cm. of H2O and moves up to the selected Peak
Inspiratory Pressure.
3. A s uare BLACK cursor moving across a WHITE background indicates that the
breath was initiated by the ADS 2000. Whereas a s uare WHITE cursor moving
across a BLACK background indicates that the patient initiated the breath, (ASSIST
MODE).
THE INSPIRATORY TIME
1. The information in the upper right hand corner of the display shows the
Inspiratory Time in seconds, e.g., 1.20 and is updated with each breath. The exact
length of inspiration is not critical, but it should allow an INSPIRATORY:
EXPIRATORY RATIO of at least 1:2. This means at 10 Breaths Per Minute, the
inspiratory time should be no longer than two seconds. Generally, intervals of 0.75 to
2 seconds are suggested, the shorter time intervals being best for smaller patients.
2. The easiest way to adjust the Inspiratory Time is to adjust the Flow Rate, i.e. the
higher the Flow Rate the uicker the lungs will be brought up to the preset Peak
Inspiratory Pressure, thus a uicker Inspiratory Time. Generally set the Flow Rate so
that the patient's chest rises in a reasonable time.
IMPORTANT: Very short Inspiratory Times may indicate a very high Flow Rate into
a very small patient. Under these circumstances, the narrowness of the tube and the
resistance of the trachea and other air passageways will cause the pressure to build
up without inflating the lungs. It is usually very obvious when this occurs because the
pressure will rise extremely rapidly, but the chest will not fill. DO NOT LET THIS
CONDITION GO UNCORRECTED. Lower the FLOW RATE to 2 or 4 LPM and let the
chest fill more slowly.
16 Engler Engineering Corporation ADS2000

Inspiratory Time cont.
Once the chest is filling normally, raise the FLOW RATE up to a reasonable
Inspiratory Time.
3. If the Inspiratory Time exceeds 3 seconds, the ALARM will sound. This may be
due to the Flow Rate being too low, but is usually caused by a leak in the system.
Most of the time the problem will be a leaking endotracheal tube cuff. This can
almost always be detected by carefully listening for a leak during inhalation.
DISPLAYING TIDAL VOLUME
Tidal Volume can be displayed instead of Minute Volume Per Kilogram when in
Normal and LAB MODE. This option is always available by pressing WEIGHT UP
while the SET / RUN switch is on RUN. This option can also be initiated upon start-up .
In order to have the ADS 2000 display the Tidal Volume, press the Flow Rate up
button while turning the ADS 2000, ON.
To exit this mode, press WEIGHT DOWN while the SET / RUN switch is on RUN or
turn the ADS 2000 OFF and restart the unit.
UNDERSTANDING FLOW RATE
The Flow Rate displayed on the ADS 2000 is an instantaneous value, i.e. if the ADS
2000 was set to 24 LPM and if the unit were to have an inspiratory time of 1 minute,
then 24 liters of gas would have been used. In reality, the ADS 2000 only allows gas to
flow when a breath is being delivered. In order to determine the "Actual FLOW RATE" a
simple calculation can be performed.
This calculation is as follows:
Fave. = (Fins xTon xB) / 60
Where:
Fave.= Actual Flow Rate
Fins.= Flow Rate on LCD Display
Ton= Inspiratory Time
B= Actual Breaths Per Minute
ADS 2000 Engler Engineering Corporation 17

UNDERSTANDING BREATHS PER MINUTE
1. The Breaths Per Minute displayed is the exact Breaths Per Minute only when the
Assist is in the OFF setting. If the Assist is ON, the displayed value is the minimum
Breaths Per Minute, i.e. the ADS will initiate a breath only if the patient does not do so
in the allotted time. The ADS 2000 correctly updates and displays the Minute Volume
per Kilogram after each breath, whether the patient or the machine initiated the breath.
Example 1 If the Assist is OFF and the Breaths Per Minute is set at 6.0, then the
patient (TEST LUNG) will only have six inspiratory / expiratory cycles each minute.
Example 2 If in the above case, the Assist was in the -2.0 setting and the Breaths
Per Minute remained at 6.0, and the patient gave a single inspiratory effort of -2.0 cm.
of H2O, then the patient will have seven inspiratory / expiratory cycles for that minute.
HOW TO SET P.I.P.
1. To adjust the Peak Inspiratory Pressure, simply depress either the P.I.P.
UP or P.I.P. DOWN buttons on the front of the ADS 2000.
NOTE: To see how the P.I.P. setting works using the Test Lung, press the P.I.P.
DOWN button until it displays 5.0, place the SET / RUN switch to "RUN". The Test
Lung will begin to fill up to 5.0 cm. H2O shown on the display. Notice that the Test Lung
does not inflate as much as it did when the P.I.P. was set at 15 cm. H2O.
UNDERSTANDING ASSIST
1. The default setting for Assist, (assisted respiration) is set at -3.0 cm. of H2O. This
setting allows for a breath to be initiated by the patient. If you wish to allow the patient to
initiate its own breath, use the Assist buttons (far right on the display) to set the amount
of NEGATIVE PRESSURE, (vacuum) the patient has to produce in order to initiate a
breath.
2. You would usually select the lowest possible number that does not cause false
breaths. When in Assist MODE the ADS 2000 will wait for the patient to initiate a
breath. If the patient does not SPONTANEOUSLY INITIATE a breath, the ADS 2000
will automatically begin the breathing cycle for the patient at the set parameters.
3. If you prefer not to allow the patient to initiate it's own breath, you may do so by
pressing the ASSIST DOWN button until the display reads "OFF".
This is not recommended.
18 Engler Engineering Corporation ADS 2000

USING THE FILL / HOLD FEATURE
1. FILL / HOLD fills the chest to the selected pressure and then maintains that
pressure, i.e., it does not allow exhalation until the button is released. FILL /
HOLD can be used to induce a patient as described below in the section
BUCKING THE ADS
2. FILL / HOLD can also help during closure of thoracotomy incisions. Simply press
the FILL / HOLD and hold it until the lungs are filled. The lungs will fill to the
preset parameter and will remain inflated AT THAT PRESSURE until the button
is released. There is some hysteresis, i.e. the pressure is allowed to fall 3 cm.
H2O before the chest is refilled.
Caution: Overzealous hyperinflation of previously collapsed areas of the lungs can
cause pulmonary damage.
For this reason it is best to inflate the lungs at the lowest possible P.I.P. value,
(around 10 cm. of H2O) and for the shortest time necessary (a few seconds) when
the chest is open.
RESISTING (BUCKING) THE ADS
1. If the patient is not in a deep enough plane of anesthesia it may attempt to buck
the ADS 2000. You will see very short inspiration times and violent attempts to
inhale and exhale. There are several practical solutions to this problem.
a. Patient may re uire additional medication, on doctors orders. (For example
intravenous drugs).
b. SET THE VAPORIZER TO 4 OR 5 PERCENT. Then press FILL / HOLD and
keep the button depressed for a second or two. Release, then repeat. Do this
until the patient relaxes, then RESET THE VAPORIZER and allow the ADS
2000 to take over.
c. Set the Assist value to a more sensitive value (i.e. a smaller negative number,
-2.0 is more sensitive than -4.0), turn the vaporizer to 3 or 4 percent. The patient
will usually ventilate himself down. The Minute Volume number may go up for a
few breaths.
3. Once the patient is stabilized, the settings can be adjusted (if necessary).
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UNDERSTANDING PEEP MODE
1. The ADS 2000 has a built in PEEP (Positive End Expiratory
Pressure) mode. To activate the PEEP MODE perform the following:
a. Press the Assist UP button until the unit displays “Entering the PEEP MODE”
and the alarm beeps.
b. As shown below, the LCD display will now show a PEEP value instead of an
Assist number
NOTE: An " * " (asterisk) is displayed as an indication that the ADS 2000 is in the
PEEP MODE.
NOTE: The Assist MODE will not function when the ADS 2000 is in PEEP MODE.
NOTE: PEEP pressures range from 0 to 9 cm. of H2O. Adjust the PEEP
pressure by using the ASSIST UP and ASSIST DOWN buttons.
c. To exit the PEEP MODE Press the ASSIST DOWN button until the
unit displays “Entering the ASSIST MODE” and the alarm beeps.
20 Engler Engineering Corporation ADS 2000