Weinmann MEDUMAT Standard2 User manual

• Start ventilation by height
• NIV therapy
• Resuscitation (CPR) with IPPV
• Resuscitation (CPR) with CCSV
• Anesthesia induction (RSI)
MEDUMAT Standard2
Step-by-step instructions
Important:
This document
does not replace the
instructions for use.
Complete information
can be found in
the instructions
for use.

Operating steps
21
Switch on ventilator Select “New patient”
3 4
Select patient height and gender Select “next”
5 6
Select the ventilation mode and check
the displayed ventilation parameters
Start ventilation

Use presets and work according to guidelines
By using the setting option of the Vt/kg body weight (BW) 4-10 ml/kg BW to be
applied, you will be working according to guidelines and determining the calculated
tidal volume for volume-controlled ventilation.
The ideal body weight and thus also the tidal volume to be applied are calculated
differently for male and female patients. The following formulas are used for this
purpose:
iGajic, O. et al. Ventilator-associated lung injury in patients without acute lung injury at the onset
of mechanical ventilation. Critical care medicine, 2004, no. 32, p. 1817-1824.
iiDeakin, C. D. et al. Advanced life support Section 4 of the European Resuscitation Council
Guidelines on Resuscitation 2010. Emergency + Rescue Medicine, 2010, No. 7, p. 578.
iiiDevine, Ben J. Gentamicin therapy. The Annals of Pharmacotherapy.
1974, 8. year, no. 11, p. 650-655
With a male patient 185 cm tall and a setting of 6 ml/kg BW, this results in the
following tidal volume:
The tidal volume results accordingly:
Vt = 80 kg x 6 ml/kg KG = 480 ml
= 79.51 kg ~ 80 kgIBW (in kg) = 50 + 2.3 x 185
2.54 - 60
IBW female (in kg) = 45 + 2.3 x Height in cm
2.54
iii
-60
IBW male (in kg) = 50 + 2.3 x Height in cm
2.54
iii
-60
Start faster and ventilate more precisely
From now on you don't have to think long about which tidal volume (Vt) is best for
your patient. With MEDUMAT Standard
2
, you can now initiate ventilation even more
precisely and quickly. By entering the patient’s height and gender, your ventilator
automatically calculates all ventilation parameters for the ideal body weight (IBW).
The IBW serves as an important indicator for setting the ventilation parameters
i
.
MEDUMAT Standard
2
enables you to start ventilation more quickly and far more
precisely – giving you more time for all the other important tasks.
Start ventilation by height

NIV therapy
Switch on ventilator.
1
Select “New patient” in the start
menu.
2
Set the patient’s height and gender or
select the appropriate patient group:
Adult, Child, Infant.
3

Select the desired CPAP therapy using
the navigation button: PEEP, pMax,
ΔpASB. After adjusting the values,
begin the ventilation via “start”.
5
Now connect the patient to MEDUMAT
Standard². It is possible to adjust the
values using the navigation button
while the ventilation is running. You
can nd other ventilation parameters in
the user menu on the right navigation
button. If it is necessary to switch the
ventilation mode, this is done using the
“user menu” function button on the
right side.
6
Select one of the following ventilation
modes: CPAP* or CPAP + ASB (if
available).
*pure CPAP is the ventilation form CPAP
+ ASB with a ΔpASB of 0mbar
4

Modied by Prof. Dr. med. Thoralf Kerner
Logistical requirements
Oxygen supply: at least a 2-l bottle, lled ....................................................... Check
Emergency medical team familiar with NIV..................................................... Check
Clinical requirements
Alert, cooperative (GCS >12) ........................................................................ Check
breathing spontaneously................................................................................ Check
If applicable, light sedation of agitated patients e.g. morphine (5-10 mg i.v. titrated)
or a short-acting benzodiazepine
Indications
Dyspnea......................................................................................................... Check
Respiratory rate > 25/min (count!) ................................................................. Check
SpO2< 90 % despite O2administration .......................................................... Check
Contraindications
Absolute contraindications:............................................................................ Check
Absence of spontaneous respiration, gasping, airway obstruction, gastrointestinal
bleeding or ileus
Relative contraindications:.............................................................................. Check
Coma, massive agitation, hemodynamic instability, severe hypoxemia
(SpO2< 75% despite O2), problems with airway access, status post gastrointestinal
surgery
Pulmonary edema
Primary device settings
Ventilation mode: ............................................................................................CPAP
PEEP (according to comfort and oxygenation): ..............................5 / 10 / (12) mbar
FiO2:............................................................. Initial 100 %, then AirMix if necessary
Target and success criteria
Target SpO2: > 90 %...................................................................................... Check
Decrease in dyspnea ...................................................................................... Check
Falling respiratory and heart rate.................................................................... Check
If applicable, improved vigilance..................................................................... Check
NIV sequence: Adjust device, place mask on patient's face (explain measure!),
connect mask to breathing circuit while device is running. Aim: Synchronization of
patient and device
SOP NIV
(Standard Operating Procedure)
Non-invasive ventilation (NIV) by the EMS

Escalation levels
In the event of imminent respiratory muscle fatigue, set pressure support (ASB).
Immediate intubation in the absence of clinical improvement or the occurrence of
contraindications!
Caution
• Continuous clinical observation and close patient contact
• No delay in pharmacological therapy or necessary intubation
• Prepared for intubation at any time
• Timely advance information to the receiving hospital
Exacerbated COPD
Primary device settings
Ventilation mode: ................................................................................. CPAP + ASB
PEEP: .........................................................................................................3/6mbar
∆pASB (according to comfort and oxygenation): increase slowly,
peak pressure max. 25 mbar
Inspiration trigger: as low as ........................................................................possible
Pressure ramp: .................................................................................................steep
FiO2:.......................................................................................................as required
Target and success criteria
Target SpO2: > 85 % ...................................................................................... Check
Decrease in dyspnea ...................................................................................... Check
Decrease respiratory and heart rate................................................................ Check
If applicable, improved vigilance..................................................................... Check
Escalation levels
In the event of imminent respiratory muscle fatigue, if available, set ventilation
mode BiLevel + ASB (e.g. PEEP: 5mbar, pInsp: 20mbar).
Immediate intubation in the absence of clinical improvement or the occurrence of
contraindications!
Caution
• Continuous clinical observation and close patient contact
• No delay in pharmacological therapy or necessary intubation
• Prepared for intubation at any time
• Timely advance information to the receiving hospital
This instruction might not
be valid in your country.
Please check
local guidelines.

Inspiratory trigger
The inspiratory trigger triggers a pressure support or a mechanical breath as soon
as inhalation effort is detected.
Trigger level Corresponding unit value
Level 1 (sensitive) Approx. 3l/min
Level 2 (medium) Approx. 6 l/min
Level 3 (insensitive) Approx. 10 l/min
Setting the levels of the inspiration trigger:
(If “3 levels” has been chosen as the trigger setting in the operator menu)
1 l/min
Very sensitive
5 l/min
sensitive
10 l/min
insensitive
15 l/min
Very insensitive
Trigger sensitivity:
1 l/min-15 l/min
Flow

Pressure
support and the
expiration trigger
Pressure support ΔpASB
The pressure support is always given as a value above PEEP. In addition to the set
PEEP, a patient receives this as soon as the inspiration trigger has been detected.
Example calculation:
PEEP = 5mbar, ΔpASB = 10mbar inspiration pressure in the inhalation phase = 15mbar
Trigger level Corresponding unit value
Level 1 (long) Approx. 10% Flow max
Level 2 (medium) Approx. 35 % Flow max
Level 3 (Short) Approx. 70 % Flow max
Expiratory trigger
Initiate expiration as soon as the ow to the patient is only the set value (in %) with
respect to the maximum ow. The length of the pressure support is set with the
expiratory trigger.
Trigger sensitivity: 5-80% of max. ow. In principle, the following applies: the smaller
the % value, the longer the pressure support lasts.
Pressure
PEEP
ΔpASB
Time
Time
Max. 4s
Flow
80% Flowmax
0%
100%
5%
5% Flowmax
Setting the levels of the expiration trigger:
(If “3 levels” has been chosen as the trigger setting in the operator menu)

Pressure ramp (pressure increase time)
A pressure ramp (or the pressure increase time) denes the time in which the pressure
increases from the PEEP to the inspiration pressure. This pressure increase time can
be set by the shape of the ramp: at, medium and steep.
<0.2seconds:
steep
Approx. 0.2seconds:
medium
Approx. 0.4seconds:
at
Pressure ramps using the example of a BiLevel + ASB curve
Pressure
Time
TI = Tinsp
∆pASB
1/Freq.
(spontaneous)
1/Freq. (set)
Pmax
Pinsp
Pressure
ramp dP
dT
PEEP
assisted spontaneous
respiration
mechanical
ventilation
dP
dT