Weinmann MEDUMAT Standard2 User manual

• Start ventilation by height
• NIV therapy
• Resuscitation (CPR)
• 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
ii
and determining the calculated
tidal volume for volume-controlled ventilation.
The ideal body weight and thus the tidal volume to be applied are calculated
differently for male and female patients. The following formula is used for this:
For a 185-cm-tall male patient and a setting of 6ml/kg BW, the following tidal
volume results:
The Vt is obtained accordingly: Vt = 80kgx6ml/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 will not need to spend a long time considering which tidal
volume (Vt) is the most appropriate for your patient. With MEDUMAT Standard
2
,
you can now initiate ventilation even more precisely and even faster. By entering the
patient’s height and gender, your ventilator automatically calculates all the ventilation
parameters for the ideal body weight (IBW). The IBW serves as an important indicator
when setting the ventilation parameters
i
. MEDUMAT Standard
2
allows you to start
ventilation faster and far more precisely– giving you more time for all the other
important tasks.
Start ventilation by height
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. Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)
Sektion 4 der Leitlinien zur Reanimation 2010 des European Resuscitation Council. Notfall +
Rettungsmedizin, 2010, No. 7, P. 578.
iiiDevine, Ben J. Gentamicin therapy. The Annals of Pharmacotherapy. 1974, 8. Jg., No. 11, P. 650-655.

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

Select the desired CPAP therapy using
the navigation button: PEEP, pMax,
ΔpASB. After adjusting the values,
begin the ventilation via "start".
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
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 change the
ventilation mode, this is done using the
"user menu" function button on the
right side.
5
6
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): ......................................5/7/10mbar
FiO2:..............................................................................................Air Mix or 100%
Aim and success criteria
Target SpO2: >90%....................................................................................... Check
Decrease in dyspnea ...................................................................................... Check
Falling respiratory and heart rate.................................................................... Check
If applicable, improved vigilance..................................................................... Check
NIV sequence: Set the device, place the mask on the patient’s face (explain the
measure!), connect the mask to the hose system while the device is running. Aim:
Synchronization of patient and device
SOP
(Standard Operating Procedure)
Non-invasive ventilation (NIV) by the emergency medical
services

Exacerbated COPD
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
Primary device settings
Ventilation mode: ................................................................................. CPAP + ASB
PEEP: .........................................................................................................3/6mbar
∆pASB (according to comfort and oxygenation):.................................5/10/15mbar
Peak pressure (pMax): ........................................................................ max. 25mbar
Inspiration trigger: ........................................................................as low as possible
Pressure ramp: .................................................................................................steep
FiO2:..............................................................................................Air Mix or 100%
Aim and success criteria
Target SpO2: >85%....................................................................................... Check
Decrease in dyspnea ...................................................................................... Check
Falling respiratory and heart rate.................................................................... Check
If applicable, improved vigilance..................................................................... Check
Escalation levels
In the event of imminent respiratory 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

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