ResMed Astral User manual

Quick guide to initiate
Invasive Ventilation
in (A)CV with Astral
23/03/2020
Covid19 epidemic period

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•(A)CV mode is commonly used in invasive ventilation
•The purpose of this guide is to describe the different steps to initiate (A)CV
ventilation mode with Astral
•You will find the procedure to ensure a correct Astral configuration
regarding circuit assembly, filters positioning, oxygen administration and
monitoring
•This guide is not conceived as a settings recommendation
•For additional information, please refer to the Astral user guide and the
instructions for any other devices that are included in the circuit
Introduction

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•Use the double limb circuit adapter
Double limb circuit assembly

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Example of Double limb circuit assembly
Antibacterial/Antiviral
filter/HEPA
Antibacterial/Antiviral
filter/HEPA
Heat Moisture
Exchange (HME)
HEPA: high-efficiency particulate air

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•From the patient home screen, press
and hold for 3 seconds, then
release
•Select:
•20 minutes—the device will return to
patient mode after 20 minutes of
inactivity, or
•Unlimited—the device will remain
unlocked until powered off or manually
locked.
Accessing Clinical Mode

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Using the Setup Assistant
•From the Main menu press Setup Menu
•Select Setup Assistant and press Start
•A warning message will display. Select Continue
NB: This procedure will reset ventilation and alarms settings

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Select the Patient type and Circuit type

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Perform the Learn Circuit
To connect a double limb circuit:
1. Ensure the device is fitted with the
double limb adapter (otherwise change
the adapter).
2. Start the test and follow the instructions
on the screen
3. Select the type of circuit
4. Connect all required circuit accessories
(e.g. humidifier or filters) and perform
perform a Learn Circuit
5. Select the interface type: Mask
* Oxygen flow must be turn off during the
Learn Circuit procedure

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Perform the Learn Circuit
It is required to perform:
•When starting a new patient
•When changing the circuit configuration
2 paths:
•Setup Assistant for a new patient
•Circuit for a patient already being ventilated

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Learn Circuit Results

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Select Interface Type
•Both for Tracheal or Endotracheal tube with inflated
cuff

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Select Ventilation Mode
Default Settings
•Adjust the setting according to the patients needs
Then
•Press to start ventilation
•To stop ventilation press and hold If oxygen is connected, turn off the oxygen

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•For double limb circuits, changing Trigger type can be done while the device is ventilating or in
Standby
•From the Setup menu, select Circuit from the Trigger type option, press Change
•2 types:
•Pressure trigger from Very High to Very Low sensitivity
•Flow trigger from 0.5 to 15 l/min
Selecting the Trigger Type

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•The Astral device supports four flow shape settings:
1. 100% (Constant)
2. 75%
3. 50%
4. 25%
Flow Shape settings

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Ti or Flow settings
•The user can set either Ti or Flow:
•Ti setting: the flow is adjusted automatically to deliver the Vt
in the set time
•Flow setting:
•Adult: from 10 to 120 l/min
•Pediatric: from 5 to 60 l/min

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•Display the Alarms menu to view/update the individual thresholds for each alarm to trigger
•Real-time values are displayed between the upper and lower thresholds
Accessing the Alarms Menu (Alarm 1 and 2)

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Accessing the Alarms Menu (Alarm 3, Apnoea response and
Disconnection alarm)

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•The volume level of the Astral device can be set from one to five (with five being the loudest and the default
being three)
•Alarm volume cannot be adjusted separately for individual alarms. Adjusting the alarm volume will change
the volume of all alarms, independent of alarm priority level
•When adjusting alarm volume, ensure that the alarm can be heard above the ambient noise levels that the
patient may experience in a variety of settings, including use in noisy environments
Setting the Alarm Volume

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•The Astral device is designed to be compatible with levels of supplemental oxygen up to 30 L/min
•At a fixed rate of supplemental oxygen flow, the inhaled oxygen concentration will vary depending on
the Ventilation mode and settings, patient breathing pattern, mask selection, and leak rate
Adding supplemental oxygen

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•To add supplemental oxygen:
1. Unlock the low flow oxygen inlet at the rear of the device by pushing up on the locking clip
2. Insert one end of the oxygen supply tubing into the oxygen port connector. The tubing will
automatically lock into place
3. Attach the other end of the oxygen supply tubing to the oxygen supply
4. Start ventilation
5. Turn on oxygen and adjust (at the oxygen supply) to the prescribed flow rate or FiO2 level
6. Turn off oxygen when you stop ventilation
Adding supplemental oxygen