ResMed VPAP ST User manual

Global leaders in sleep and respiratory medicine www.resmed.com
VPAP™ST / VPAP™S
POSITIVE AIRWAY PRESSURE DEVICE
H5i™
HEATED HUMIDIFIER
Clinical Guide
English

i
English
Contents
Welcome ..................................................................................................... 1
VPAP ST indications for use ................................................................. 1
VPAP S indications for use ................................................................... 1
VPAP ST and VPAP S adverse effects................................................... 1
H5i indications for use.......................................................................... 1
H5i contraindications............................................................................ 1
VPAP ST and VPAP S at a glance ................................................................. 2
Travelling with the VPAP ....................................................................... 2
H5i at a glance ............................................................................................. 3
Travelling with the H5i .......................................................................... 3
Operating information .................................................................................. 4
Bilevel pressures .................................................................................. 4
Modes of operation.............................................................................. 4
Triggering and cycling........................................................................... 5
Leak Management – Vsync ................................................................. 5
Rise time adjustment ........................................................................... 5
TiControl™ – Inspiratory Time Control.................................................. 5
VPAP ST and VPAP S features...................................................................... 7
Climate Control .................................................................................... 7
S9 Essentials........................................................................................ 8
Sleep quality......................................................................................... 8
Ramp.................................................................................................... 8
Setup............................................................................................................ 9
Mask and tubing setup....................................................................... 10
Filling the water tub ................................................................................... 11
VPAP basics ............................................................................................... 12
Navigating the menus ................................................................................ 13
About the menus ....................................................................................... 13
Home menu ....................................................................................... 13
Changing settings via the Home menu.................................... 14
S9 Essentials...................................................................................... 14
Viewing the treatment screens................................................ 15
Treatment screen parameters.................................................. 16
Setup menu........................................................................................ 17
Patient Setup menu ................................................................. 17
Clinical Setup menu ................................................................. 17
Clinical setup menu parameters............................................... 18
Info menu........................................................................................... 21
Standard Info menu ................................................................. 21
Advanced Info menu ................................................................ 22
Clinical Info menu..................................................................... 22
Info menu parameters.............................................................. 22
Managing Climate Control ......................................................................... 24

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Delivering therapy ...................................................................................... 25
Adding supplemental oxygen ............................................................. 25
Data management ..................................................................................... 26
SD card............................................................................................... 26
Removing the card ............................................................................. 26
Inserting the card ............................................................................... 26
Analysing the SD card data ................................................................ 27
Data storage....................................................................................... 27
Data transmission adapters................................................................ 27
Cleaning and maintenance......................................................................... 28
Disassembling the H5i ....................................................................... 28
Daily ................................................................................................... 28
Monthly .............................................................................................. 28
Reassembling the H5i ........................................................................ 29
Maintenance checklist........................................................................ 29
Reprocessing the H5i between patients............................................ 29
Replacing the air filter......................................................................... 29
Antibacterial filters ............................................................................ 30
Technical specifications.............................................................................. 31
General technical specifications ......................................................... 31
VPAP ST and VPAP S technical specifications .................................... 32
Air tubing technical specifications ...................................................... 33
Humidifier performance ..................................................................... 33
Pneumatic flow path .......................................................................... 33
Flow (maximum) at set pressures...................................................... 34
Displayed values................................................................................. 34
Pressure accuracy .............................................................................. 35
Warnings and Cautions .............................................................................. 36
WARNINGS ........................................................................................ 36
CAUTIONS.......................................................................................... 37

1
English
Welcome
Thank you for choosing the VPAP ST or VPAP S or H5i.
Before operating these devices, please read the entire Clinical and Information Guides.
VPAP ST indications for use
The S9 VPAP ST is intended to provide non-invasive ventilation for patients weighing more than 13 kg
with respiratory insufficiency or obstructive sleep apnoea (OSA). The S9 VPAP ST is intended for home
and hospital use.
VPAP S indications for use
The S9 VPAP S is intended to provide non-invasive ventilation for patients weighing more than 13 kg with
respiratory insufficiency or obstructive sleep apnoea (OSA). The S9 VPAP S is intended for home and
hospital use.
VPAP ST and VPAP S contraindications
Positive airway pressure therapy may be contraindicated in some patients with the following pre-existing
conditions:
• severe bullous lung disease
• pneumothorax or pneumomediastinum
• pathologically low blood pressure, particularly if associated with intravascular volume depletion
• dehydration
• cerebrospinal fluid leak, recent cranial surgery, or trauma.
VPAP ST and VPAP S adverse effects
Patients should report unusual chest pain, severe headache, or increased breathlessness to their
prescribing physician. An acute upper respiratory tract infection may require temporary discontinuation of
treatment.
The following side effects may arise during the course of therapy with these devices:
• drying of the nose, mouth, or throat
• nosebleed
• bloating
• ear or sinus discomfort
• eye irritation
• skin rashes.
H5i indications for use
The H5i is indicated for the humidification of the air delivered from a CPAP or bilevel device. The H5i is
for use only as recommended by a physician. The H5i is intended for single patient re-use in the home
environment and re-use in a hospital/institutional environment.
H5i contraindications
The H5i is contraindicated for use with patients whose upper (supraglottic) airway has been bypassed.

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Air filter
DC power inlet
SD card slot
Module/Adapter port
Air outlet
VPAP ST and VPAP S at a glance
The VPAP system comprises the following elements:
• VPAP device
• Air tubing
• 90W power supply unit
• S9 travel bag
• SD card
• S9 SD card protective folder.
Optional components include:
• H5i heated humidifier
• Standard air tubing
• SlimLine™air tubing
• 3m air tubing
• ClimateLine™heated air tubing
• ClimateLineMAX ™heated air tubing
• 30W power supply unit (does not support H5i)
• Power Station II battery pack
• DC/DC Converter 24V/90W
• S9 Oximeter Adapter.
Travelling with the VPAP
When the patient travels with the VPAP only:
• Advise the patient to pack the SlimLine or Standard air tubing as the ClimateLine or ClimateLineMAX
heated air tubing is not designed to connect directly to the VPAP device.
• Advise the patient to purchase and travel with the approved power cord for the region where they will
be using the VPAP device.
• ResMed confirms that the VPAP ST and VPAP S meets the Federal Aviation Administration (FAA)
requirements (RTCA/DO-160, section 21, category M) for all phases of air travel.

3
English
Latch
Release
button
ClimateLine/
ClimateLineMAX
connection port
Air outlet
Flip lid
Flip lid seal
H5i
water tub
H5i at a glance
The H5i system comprises the following elements:
• H5i heated humidifier
• H5i cleanable water tub
• ClimateLine heated air tubing (if sold as a Climate Control Kit).
Optional components include:
• ClimateLineMAX heated air tubing
• H5i standard water tub.
Travelling with the H5i
When moving or travelling with your H5i:
• Ensure that the water tub is empty.
• Disconnect the H5i from the VPAP by pressing the release button.

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Operating information
The VPAP device uses internal pressure and flow sensors in the air path to respond reliably to patient
flow rates even in the presence of most normal leaks in the patient circuit.
Bilevel pressures
The VPAP device assists spontaneous breathing by cycling between two pressures in response to the
patient flow or a preset fixed time.
The inspiratory positive airway pressure (IPAP, or the sum of EPAP and the pressure support level) assists
inspiration.
The lower expiratory positive airway pressure (EPAP) eliminates exhaled air through the mask exhaust
vent. This facilitates exhalation comfort while providing a splint to maintain an open upper airway.
The difference of the two pressures—pressure support (PS) level—contributes to improved patient
ventilation.
Modes of operation
The following table describes the operating modes available on the VPAP ST or VPAP S.
Mode VPAP ST VPAP S
CPAP mode
A fixed pressure is delivered. ü ü
S (Spontaneous) mode
You may set two treatment pressures-–one for inspiration (IPAP) and
one for expiration (EPAP). The VPAP device senses when the patient
is inhaling and exhaling and supplies the appropriate pressures
accordingly. The difference between IPAP and EPAP levels helps
determine the tidal volume.
ü ü
ST (Spontaneous/Timed) mode
The VPAP device augments any breath initiated by the patient, but will
also supply additional breaths should the patient breath rate fall below
the clinician’s set “backup” breath rate.
ü
T (Timed) mode
The fixed breath rate and the fixed inspiration/expiration time set by
the clinician is supplied regardless of patient effort.
ü
Pressure
Support
Pressure
IPAP
0
EPAP
One breath cycle
Time
Rise time

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English
Triggering and cycling
(S and ST modes) Under normal conditions, the VPAP device triggers (initiates IPAP) and cycles
(terminates IPAP and changes to EPAP) as it senses the change in patient flow. Patient breath detection
is enhanced by the VPAP device’s automatic leak management feature—Vsync.
In addition, the VPAP device has adjustable trigger/cycle sensitivity to optimise the sensing level
according to patient conditions.
Leak Management – Vsync
Vsync monitors and compensates for leak by continuously and automatically adjusting the baseline flow.
This enables reliable triggering and cycling while maintaining the set pressures.
Rise time adjustment
(S, ST andT modes) Rise time sets the time taken for the VPAP device to reach IPAP. The greater the
rise time value, the longer it takes for pressure to increase from EPAP to IPAP.
Patients with a high ventilatory demand may prefer a shorter rise time, while patients who are slow
breathers may prefer a longer rise time.
Note: A prolonged rise time inhibits fast pressurisation, therefore, rise time should not be set longer than
Ti Max or the patient’s normal inspiratory time.
TiControl™ – Inspiratory Time Control
(S and ST modes) Unique to ResMed CPAP and bilevel devices, TiControl allows the clinician to set
minimum and maximum limits on the time the device spends in IPAP. The minimum and maximum time
limits are set at either side of the patient’s ideal spontaneous inspiratory time, providing a ’window of
opportunity’ for the patient to spontaneously cycle to EPAP.
The minimum time limit is set via the Ti Min parameter and the maximum time limit is set via the Ti Max
parameter.
TiControl’s Ti Max and Ti Min parameters play a significant role in maximising synchronisation by
effectively intervening to limit or prolong the inspiratory time when required. This ensures synchronisation
even in the presence of significant mouth and/or mask leak.
Very low
Medium
Very high
Patient flow
Very low
Medium
Very high
Patient flow
Adjustable trigger sensitivity Adjustable cycle sensitivity

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Patient flow
Pressure
Ti Max
Ti Min Cycle
Window
The following table is a guide to selecting the Ti Max and Ti Min values that best correspond to the
patient’s respiratory rate and inspiration and expiration ratio, depending on the respiratory conditions.
Notes:
•I:E = 1:1 – Ti Min prevents the premature cycling to EPAP for patients whose inspiratory effort is
extremely weak.
•I:E = 1:3 – Ti Max limits the inspiration time for patients who require a longer expiration time.
Patient breath
(BPM)
Ttot = 60/BPM
(sec)
I:E = 1:2
(Reference)
Sufficient inhalation time
I:E = 1:1
Secure
exhalation
time
I:E = 1:3
Ti Min Ti Max Ti Max
10 6 2 1. 0 2.0 1. 5
15 41. 3 1. 0 2.0 1. 3
20 3 1. 0 0.8 1. 5 1. 0
25 2.4 0.8 0.7 1. 2 0.8
30 2 0.7 0.6 1. 0 0.7
35 1. 7 0.6 0.5 0.8 0.7
40 1. 5 0.5 0.5 0.7 0.7

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English
VPAP ST and VPAP S features
Climate Control
VPAP devices, when used in conjunction with the H5i and ClimateLine or ClimateLineMAX heated air
tubing, offer a feature called Climate Control.
Climate Control enables the automatic delivery of a constant value of absolute humidity to the patient’s
upper airway while protecting against rainout and allowing patients to select the air temperature that
offers the most comfort for them.
Rainout protection
Rainout refers to the water or condensation that collects in the patient’s tubing or mask. Rainout is a
common side effect of using a humidifier due to the humidified air cooling as it travels down the tubing
and into the mask. Rainout occurs when relative humidity, which is a measure of the air’s capacity to hold
water vapour, exceeds 100%.
Climate Control protects the patient from rainout by maintaining a target relative humidity of 80% as well
as maintaining the temperature of the air delivered to the patient without compromising the amount of
absolute humidity delivered.
Automatic constant humidity delivery
For each temperature setting, the Climate Control system delivers a constant amount of water vapour, or
absolute humidity, to the patient’s upper airway. The following table shows the target absolute humidity
value that will be delivered to the mask for a selection of temperature settings.
Temperature delivered to the mask Target absolute humidity at the mask,
Body Temperature Pressure Saturated (BTPS)
16ºC 10 mg/L
20ºC 12 mg/L
24ºC 16 mg/L
27ºC 19 mg/L
30ºC 22 mg/L
Automatic constant temperature delivery
The temperature sensor located at the mask end of the ClimateLine or ClimateLineMAX heated air
tube enables the system to automatically control the temperature of the air delivered to the patient.
This ensures the temperature of the air delivered to the patient does not fall below the set minimum
temperature, therefore maximising breathing comfort for the patient.
Automatic adjustment
The H5i and ClimateLine or ClimateLineMAX heated tubing are controlled by the Climate Control algorithm
to deliver constant humidity and temperature outputs. The system adjusts automatically to changes in:
• ambient room temperature and humidity values
• flow due to pressure changes
• flow due to mask or mouth leak.

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S9 Essentials
S9 Essentials is designed to make device interaction and menu navigation easier for patients. If enabled,
S9 Essentials disables the Info and Setup functionality so that patients can simply start and stop therapy
and adjust ramp, humidification and Climate Control. S9 Essentials can be enabled via Clinical Setup >
Options > Access.
Sleep quality
Designed to promote compliance, the Sleep Quality indicator allows the patient to actively engage in
their own therapy by identifying leak, usage and AHI information. This information can be set to:
• Usage—where only usage hours are displayed
• On—where usage, mask fit and AHI information are displayed.
Ramp
Ramp is designed to make the beginning of treatment more comfortable.
In CPAP mode during ramp time, the pressure increases from a low pressure to the prescribed
treatment pressure.
In S, ST and T modes, ramp time defines the period during which the pressure gradually increases from a
low start pressure (referred to as Start EPAP) to the prescribed treatment pressure (EPAP).
IPAP
EPAP
0
Ramp time
Time
Start EPAP

9
English
Setup
1. Align your H5i with your VPAP device and push them together until they click into place.
2. Connect the DC plug of the power supply unit to the rear of the VPAP device.
3. Connect the power cord to the power supply unit.
4. Plug the other end of the power cord into the power outlet.
5. Connect one end of the air tubing firmly onto the air outlet.
6. Connect the assembled mask system to the free end of air tubing.
Notes:
•Always ensure that your VPAP device and H5i are placed on a stable, level surface for proper
operation.
•Place the power supply unit away from the H5i to allow for adequate ventilation.

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Mask and tubing setup
• For more information on assembling the mask see the mask user guide.
• If your patient is using a full face mask ensure that the “Full Face” setting is selected. If your patient
is using a nasal pillows mask ensure that the “Pillows” setting is selected. If your patient is using a
nasal mask ensure that the “Nasal” setting is selected with the exception of the Ultra Mirage mask
which should use the “Nasal Ultra” setting. If your patient is using a paediatric mask ensure that the
“Pediatric” setting is selected.
• For a complete list of recommended masks and their settings go to www.resmed.com on the
Products page under Service & Support. If you do not have internet access, please contact your
ResMed representative.
• The VPAP device is compatible with the following tubing:
Tube Specifications Settings
ClimateLine
Length:
Inner diameter:
Heated
2 m
15 mm
Automatically detected
ClimateLineMAX
Length:
Inner diameter:
Heated
1.9 m
19 mm
Automatically detected
SlimLine
Length:
Inner diameter:
1.8 m
15 mm
If using the SlimLine, Standard or 3 m
tubing, adjust the tube setting in the
Patient Setup or Clinical Setup menus.
Standard
Length:
Inner diameter:
2 m
19 mm
3 m
Length:
Inner diameter:
3 m
19 mm
Notes:
•When using the SlimLine or ClimateLine above 20 cm H2O, the device optimum performance
may not be reached if used with an antibacterial filter. The device performance must be checked
prior to prescribing the SlimLine for use with an antibacterial filter.
•The ClimateLine/ClimateLineMAX are designed only for use with the H5i.

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English
Filling the water tub
1. Slide the latch and lift open the flip lid.
2. Remove the water tub.
3. Fill the water tub (through the centre hole) with water up to the maximum water level mark (380 mL).
4. Return the water tub to the H5i.
5. Close the flip lid ensuring that it clicks into place.

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Info menu button**
Allows you to view
your sleep statistics
or exit from the
menu.
LCD screen*
Displays the menus,
treatment screens and
reminders.
Setup menu button**
Allows you to make
changes to settings
or exit from the
menu.
Push dial
Turning the dial
allows you to
scroll through the
menu and change settings.
Pushing the
dial allows you to
enter into a menu and confirm
your choice.
Start/Stop button
Starts or stops
treatment.
VPAP basics
Key:
Home
Humidity level
Ramp
Heated tube
Climate Control
Start/Stop
Power Save mode (hold for 3 sec)
Push Dial
Setup menu
Info menu
Advanced Info menu (hold for 3 sec)
Clinical Setup menu (hold for 3 sec)
* Backlight—When treatment is being delivered, the
backlight (including the Start/Stop button) automatically
turns off after 30 seconds, otherwise it turns off after 3
minutes.
** The Info and Setup menus are disabled if S9 Essentials
is enabled.

13
English
Navigating the menus
In general, to navigate the menus:
1. Turn until the
parameter you
require is displayed
in blue.
2. Press .
The selection is
highlighted in
orange.
3. Turn until you
see the setting that
you require.
4. Press to confirm
your choice. The
screen returns to
blue.
About the menus
There are three menus that are designed to help you choose your options. These are:
1. Home menu—for day to day adjustments.
2. Info menu—provides sleep quality information.
3. Setup menu—where settings can be adjusted.
Home menu
The Home menu shows you and your patient what features are currently activated, and the accessories
that are connected to the device.
Ramp—displayed when the Max Ramp function is activated in the
Clinical Setup menu.
Humidity Level—displayed when the H5i is connected.
Climate Control—displayed when both the H5i and the
ClimateLine/ClimateLineMAX heated air tube are connected and
when Climate Control is activated in the Clinical Setup menu.
Humidity Level and Heated Tube—displayed when both the H5i
and the ClimateLine/ClimateLineMAX heated air tube are connected
and when Climate Control is set to Manual in the Clinical Setup
menu.

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Changing settings via the Home menu
From the Home menu, you can adjust or check the following features:
Ramp
Designed to make the beginning of treatment more comfortable for the
patient, ramp time is the period during which the pressure increases from an
initial pressure to the prescribed treatment pressure or minimum treatment
pressure.
Humidity level
The patient can adjust their humidity level at any time to find the setting that
is most comfortable for them.
Climate Control
When the ClimateLine/ClimateLineMAX heated air tubing is connected and
Climate Control is enabled, the patient can adjust the air temperature to find
the setting that is most comfortable for them.
When set to Auto, Climate Control prevents rainout by maintaining 80%
relative humidity in the delivered air. If Climate Control is set to Manual,
Humidity Level and Heated Tube temperature can be set independently.
Mask-fit
Mask-fit is designed to help patients fit the mask properly.
The mask-fit feature delivers treatment pressure for a three-minute period,
prior to starting treatment. During this time, the mask can be adjusted to
minimise leaks.
To use mask-fit:
1. Fit the mask as described in the mask user guide.
2. Press for at least three seconds.
One of the MASK FIT screens shown is displayed (as shown on the left).
3. If necessary, adjust the mask, mask cushion and headgear until there is
a secure and comfortable fit. After three minutes, the pressure reverts
to the set pressure and treatment will begin. You can end mask-fit at any
time by pressing .
S9 Essentials
When S9 Essentials is enabled, the patient can simply start and stop therapy, access mask fit and adjust
ramp, humidification and Climate Control.

15
English
Viewing the treatment screens
Depending on how the system has been configured, you will see one of the following example screens
(shown in ST mode below) when the device is running:
üH5i humidifier üH5i humidifier
üClimateLine/ClimateLineMAX
heated air tube
üClimate Control – Auto
üH5i humidifier
üClimateLine/ClimateLineMAX
heated air tube
üClimate Control – Manual
üStandard VPAP without
optional accessories
üOximetry data via the
oximeter adapter
In S and ST modes, the fixed lines on the pressure bar indicate the expiratory and inspiratory pressures.
In CPAP mode, only a set pressure is shown. While the treatment is ramping (indicated by an orange
ramp icon below the pressure bar), the pressure values appear in orange. When a set pressure is reached
these values are displayed in white.
To toggle between treatment screens 1 and 2, press from your HOME screen.
üTreatment with device
trigger (Timed) and cycle
(Timed, Ti Max or Ti Min)
breath indicators
üTreatment with spontaneous
trigger and cycled breaths

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Treatment screen parameters
Parameter Modes Description
CPAP S ST T
CPAP üFixed treatment pressure.
S / ST / T ü ü ü Set (EPAP and IPAP) pressures.
Ramp ü ü ü ü Orange icon shows that device is ramping up.
Oxygen saturation
(SpO2)*
ü ü ü ü Measure of the saturation of blood haemoglobin with
oxygen, expressed as a percentage (sampled every
second).
Leak ü ü ü ü Estimate of the total rate of air escaping due to mouth
and unintentional mask leaks, expressed in L/min
(5-breath moving average).
Minute Ventilation (MV) ü ü ü ü Volume of air breathed in, or out within any 60-second
period, expressed in L/min (5-breath moving average).
Pulse* ü ü ü ü Number of heart beats in a 60-second time frame
(sampled every second).
Respiratory rate (RR) ü ü ü ü Frequency of breathing, expressed as the number of
breaths per minute (5-breath moving average).
Tidal volume (Vt) ü ü ü ü Volume of air inspired or expired in one respiratory cycle
(breath), expressed in mL (5-breath moving average).
Pressure support (PS) ü ü ü Difference between IPAP and EPAP.
Ti ü ü ü ü Duration of inspiration (ie, the respiratory flow into the
lungs), expressed in seconds (5-breath moving average).
I:E ü ü ü ü Inspiration to expiration ratio measured by the device
(5-breath moving average).
Ti Max ü ü ü Maximum inspiration time in seconds
Ti Min ü ü ü Minimum inspiration time in seconds.
% Spontaneous
Triggering or Cycling
(%Spont Trig or %Spont
Cyc)
ü ü Percentage of breaths that are spontaneously triggered
or cycled (average of the last 20 breaths).
Trigger/Cycle indicators
(Timed, Ti Max or Ti
Min)
ü ü Indicates a patient or device triggered/cycled breath.
In ST mode, Timed is left blank if it is a spontaneous
breath.
* Only available via the oximeter adapter.

17
English
Setup menu
The Setup menu consists of:
• Patient Setup menu—allows the patient to optimise comfort settings as well as make changes to
the mask or tube type.
• Clinical Setup menu—allows you to set all parameters pertaining to the patient’s therapy.
Patient Setup menu
Only settings relevant to the patient are displayed in the Patient Setup menu. Depending on how the
device has been customised via the Clinical Setup menu, the following screens can be viewed:
Tube—only displayed if ClimateLine/ClimateLineMAX is not connected. If
ClimateLine/ClimateLineMAX is attached, no setting is required.
Climate Ctrl—only displayed if ClimateLine/ClimateLineMAX is connected and
also set to PATIENT in the Clinical Setup menu.
Mask—always available.
Mask Fit—always available.
Leak Alert—only displayed if set to PATIENT in the Clinical Setup menu.
SmartStart—only displayed if set to PATIENT in the Clinical Setup menu.
+ Clinical Setup menu
To access the Clinical Setup menu, press and hold the Setup button and push dial for three seconds.
There are four screens available from the Clinical Setup menu as shown in ST mode below:
Settings
Displays parameters directly affecting the patient’s therapy.
Note: Clinical menus are identified by the yellow open lock shown in the
top right corner. Where further options exist on a screen, the blue scroll bar
down the right of the screen indicates your position within these options.
Options
Displays parameters affecting the patient’s comfort, therapy feedback and
compliance reporting.
Reminders
Displays parameters for accessories requiring replacement.
Configuration
Displays general device setting and resetting options.