Medtronic Plc. · NYSE:MDT

Medtronic — Technical Presentation (June 2015)

102 slides from Medtronic's technical presentation, Jun 1, 2015

  1. Slide 1: The Puritan Bennett 980 Ventilator Clinical Applications Lesson Plan

    THE PURITAN BENNETT™ 980 VENTILATOR CLINICAL APPLICATIONS LESSON PLAN

  2. Slide 2: Overview

    OVERVIEW This guide is provided as a convenience companion document to the Operator’s Manual. It is not intended to replace the Operator’s Manual, which should always be available while using the ventilator. It is important to familiarize yourself with all information in the Operator’s Manual releva

  3. Slide 3: Contents

    CONTENTS  Puritan Bennett™ Leak Sync Software  Noninvasive Ventilation  Volume Control Plus  Pressure Control  Puritan Bennett™ BiLevel Software  Puritan Bennett™ PAV™ *+ Software  Tube Compensation Software  Volume Support  Puritan Bennett™ NeoMode 2.0 Software  Puritan Bennett™ Proximal

  4. Slide 4: Puritan Bennett Leak Sync Software

    PURITAN BENNETT ™ LEAK SYNC SOFTWARE

  5. Slide 5: Problem: Where Do Leaks Come From?

    PROBLEM: WHERE DO LEAKS COME FROM?  Patient interface  ETT (cuffed, deflated cuff or cuffless)  Trach tube (cuffed, deflated cuff or cuffless)  Mask or other external interface  Breathing circuit system 5 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  6. Slide 6: Problem: Common Leak Challenges

    PROBLEM: COMMON LEAK CHALLENGES  Auto-triggering  Late cycling-off of pressure support and volume support breaths  Overestimation of delivered tidal volume/flow  The possible need for frequent manual adjustments 6 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  7. Slide 7: Problem: Leaks

    PROBLEM: LEAKS Studies show that air leaks occur in up to 70% of children and can lead to significant clinical consequences, including1,2:  Inconsistent ventilatory delivery1  Unreliable lung function testing2  Inappropriate clinical assessment due to error in monitored volume1  Increased work o

  8. Slide 8: Solution: Puritan Bennett Leak Sync Software

    SOLUTION: PURITAN BENNETT™ LEAK SYNC SOFTWARE  Leak Sync software may reduce leak- related ventilation and monitoring problems* during both inspiration and exhalation.1 1. Oto J et al. A Comparison of Leak Compensation in Acute Care Ventilators During Noninvasive and Invasive Ventilation: A Lung Mo

  9. Slide 9: Solution: Puritan Bennett Leak Sync Software

    SOLUTION: PURITAN BENNETT™ LEAK SYNC SOFTWARE  Reduces auto-triggering and delayed cycling1  Leak compensates the data values for VTI (displayed as VTL) and VTE  Servo-controls breath delivery based on leak-compensated values  Works in VC+ and VS 1. Oto J et al. A Comparison of Leak Compensation

  10. Slide 10: Puritan Bennett Leak Sync Software Updates

    PURITAN BENNETT™ LEAK SYNC SOFTWARE UPDATES  Name: “Leak Compensation” changed to “Leak Sync”  VC+ and VS added  Defaults to ON with NIV and neonatal 10 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  11. Slide 11: Potential Benefits of Puritan Bennett Leak Sync Software

    POTENTIAL BENEFITS OF PURITAN BENNETT™ LEAK SYNC SOFTWARE  May reduce manual adjustments of sensitivity settings1  Improves triggering and cycling2  Leak compensates the data values for inspiratory and expiratory volumes to make them more relevant to the clinical situation1  Allows for VC+ and V

  12. Slide 12: Puritan Bennett Leak Sync Software Setup

    PURITAN BENNETT™ LEAK SYNC SOFTWARE SETUP  Menu tab/setup/more settings  Enabled or disabled  Enabled by default with neonatal patient type and also when NIV is selected  Set DSENS in L/min 12 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  13. Slide 13: Display Changes with Leak Sync Software Enabled

    DISPLAY CHANGES WITH LEAK SYNC SOFTWARE ENABLED  LS on vent setup button  DSENS = L/min (not %)  VTL and VTE = estimated patient values  Graphic displays estimated lung flows  Data displayed:  VLEAK  %LEAK  LEAK (leak rate@PEEP) 13 Puritan BennettTM 980 Ventilator Clinical Applications Lesso

  14. Slide 14: Performance

    PERFORMANCE The Puritan Bennett™ 840 ventilator with Leak Compensation software outperformed all other ventilators included in the studies.1 Invasive ventilation  The Puritan Bennett™ 840 ventilator outperformed all other ventilators in this study by requiring fewer breaths to achieve synchronizati

  15. Slide 15: How Puritan Bennett Leak Sync Software Works

    HOW PURITAN BENNETT™ LEAK SYNC SOFTWARE WORKS  Defaults on: NIV or Neonatal  Defaults off: INV/Pediatric or Adult  Adjusts within ~ 3 breaths  VTL and VTE compensated display  Flow/volume graphics leak compensated  Bias flow automatically adjusted 15 Puritan BennettTM 980 Ventilator Clinical A

  16. Slide 16: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities  Neonate, pediatric and adult invasive and non-invasively  Dynamic compensation of leaks during invasive and noninvasive ventilation Limitations Leak Sync software not active with:  Tube compensation (TC)  Proportional Assist™* Ventilation (PAV™ *+ softw

  17. Slide 17: Noninvasive Ventilation

    NONINVASIVE VENTILATION Medtronic Further, Together

  18. Slide 18: Problem: Invasive and Noninvasive Ventilation Present Challenges

    PROBLEM: INVASIVE AND NONINVASIVE VENTILATION PRESENT CHALLENGES  Mechanical ventilation may lead to significant asynchrony.1  Leaks may impact patient tolerance to NIV.2  Leaks may result in monitoring errors, breath management issues, and trigger and cycle asynchrony.2 1. Mahmoud RA, Proquitté

  19. Slide 19: Solution: NIV with Puritan Bennett Leak Sync Software

    SOLUTION: NON-INVASIVE VENTILATION (NIV) WITH PURITAN BENNETT LEAK SYNC SOFTWARE ™  NIV ventilation selection  Use with mask or other leak-prone patient interface  Works with various modes/breath types  Leak Sync software enabled 19 Puritan BennettTM 980 Ventilator Clinical Applications Lesson P

  20. Slide 20: Potential Benefits of NIV with Leak Sync Software

    POTENTIAL BENEFITS OF NIV WITH PURITAN BENNETT™ LEAK SYNC SOFTWARE  Help patients tolerate NIV so they can continue using NIV  Help avoid complications associated with intubation/artificial airways1 1. Epstein S. Should a Patient Be Extubated and Placed on Noninvasive Ventilation After Failing a S

  21. Slide 21: NIV Setup

    NIV SETUP  Setup button  Menu tab/vent  NIV  Shows applicable settings  CPAP mode is available  Flow trigger  ↑TI SPONT limit  DSENS defaults to OFF 21 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  22. Slide 22: How NIV Software Works

    HOW NIV SOFTWARE WORKS  NIV-compatible selection of mode and breath types (NEO CPAP added) is available  Volume alarms are disabled to reduce nuisance alarms  Leak Sync software automatically enabled 22 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  23. Slide 23: NIV Capabilities and Limitations

    NIV CAPABILITIES AND LIMITATIONS Only flow triggering is available. Capabilities Limitations  Stable respiratory drive Not available with:  Neonatal  Tube compensation (TC)  Pediatric  BiLevel  Adult  VC+ and VS  Proportional Assist™* Ventilation Plus (PAV™ *+ software) breath types 23 Purit

  24. Slide 24: Volume Control Plus

    VOLUME CONTROL PLUS Medtronic Further, Together

  25. Slide 25: Problem: Fixed Flow Patterns May Result in Discomfort and Asynchrony

    PROBLEM: FIXED FLOW PATTERNS MAY RESULT IN DISCOMFORT AND ASYNCHRONY 25 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  26. Slide 26: Solution: Volume Control Plus (VC+)

    SOLUTION: VOLUME CONTROL PLUS (VC+)  VC+ breaths deliver a variable flow.  The ventilator manages inspiratory pressure to achieve the desired tidal volume target. 26 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  27. Slide 27: Potential Benefits of VC+

    POTENTIAL BENEFITS OF VC+  Unlike standard VC, VC+:  Provides variable flow delivery and volume  Uses the lowest pressure necessary for volume delivery  Escalates pressure if volume delivery decreases  Active valve accommodates breathing variations. 27 Puritan BennettTM 980 Ventilator Clinical

  28. Slide 28: VC+ Setup

    VC+ SETUP  Select:  Gender and height or predicted body weight (PBW)  Invasive vent type  AC or SIMV mode  VC+ mandatory breath type  Adjust all available settings.  Set all appropriate alarms. 28 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  29. Slide 29: How VC+ Software Works and Alarm Strategy

    HOW VC+ SOFTWARE WORKS AND ALARM STRATEGY  Variable flow with active exhalation valve  Titration of pressure  1 – 3 cmH2O/breath  Alarm strategy  ↑PPEAK limit (determines max target pressure)  ↓PPEAK limit  Volume not delivered  ↑ VTI limit 29 Puritan BennettTM 980 Ventilator Clinical Applic

  30. Slide 30: Troubleshooting Inadequate VT Delivery

    TROUBLESHOOTING INADEQUATE VT DELIVERY  Check that TI is long enough.  Check that Rise Time is fast enough.  Check that the set tidal volume is not too high in comparison with the ↑PPEAK limit.  Check for auto-PEEP causing ↑PPEAK limit and resolve. 30 Puritan BennettTM 980 Ventilator Clinical Ap

  31. Slide 31: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities Limitations  Neonate, pediatric and adult  Invasive only  Leak Sync software compatible  High effort may result in regulating of pressure down to undesirable levels.  Leaks without Leak Sync software enabled may result in regulating of pressure down to

  32. Slide 32: Pressure Control

    PRESSURE CONTROL Medtronic Further, Together

  33. Slide 33: Two Problems

    TWO PROBLEMS  Fixed flow patterns in VC may result in discomfort and asynchrony.  VC+ may not always provide a consistent delivered pressure. 33 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  34. Slide 34: Solution: Pressure Control (PC)

    SOLUTION: PRESSURE CONTROL (PC)  PC breaths deliver variable flow and volume.  The inspiratory pressure target remains constant. 34 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  35. Slide 35: Potential Benefits of PC

    POTENTIAL BENEFITS OF PC Mean airway pressure more consistent while allowing more natural breathing. 35 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  36. Slide 36: PC Setup

    PC SETUP  Enter the patient’s gender and height or predicted body weight (PBW).  Select INV or NIV.  Touch AC or SIMV mode.  Touch the PC mandatory breath type.  Adjust all available settings.  Set all appropriate alarms. 36 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan |

  37. Slide 37: How to Use the Timing Padlocks

    HOW TO USE THE TIMING PADLOCKS  The user determines whether to set Inspiratory Time, I:E Ratio or Expiratory Time as the primary setting.  Changes in the preset rate will not alter the primary variable set in the timing padlocked area. 37 Puritan BennettTM 980 Ventilator Clinical Applications Less

  38. Slide 38: How PC Software Works

    HOW PC SOFTWARE WORKS  Mandatory, assisted/controlled pressure-based breath  INV or NIV  The user sets inspiratory time, inspiratory pressure/PEEP and pressure rise.  The ventilator manages flow to meet the patient’s needs and control pressure delivery. 38 Puritan BennettTM 980 Ventilator Clinic

  39. Slide 39: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities  May be used with neonate, pediatric and adult patients.  May be combined with Leak Sync. Limitations  Tidal volume is variable. 39 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  40. Slide 40: Puritan Bennett BiLevel Software

    PURITAN BENNETT™ BILEVEL SOFTWARE

  41. Slide 41: Two Problems

    TWO PROBLEMS  The limitations of volume control may lead to additional sedation.1  Inverse ratios and monitoring are limitations in traditional PCV. 1. Pohlman M. Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury. Crit Care Med. 2008;36:3019–3023.

  42. Slide 42: Solution: Puritan Bennett BiLevel Software

    SOLUTION: PURITAN BENNETT™ BILEVEL SOFTWARE  Mandatory-assisted and spontaneous-assisted pressure- based breath types  Active valve  Strategies for boosting mean airway pressure  Normal I:E or extended inverse available (>4:1) 42 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan

  43. Slide 43: Potential Clinical Benefits of BiLevel Software

    POTENTIAL CLINICAL BENEFITS OF PURITAN BENNETT™ BILEVEL SOFTWARE  Flow and volume variable  Active valve  Conventional or APRV style of breath timing  Potential for improved oxygenation1  Potential for reduction in sedation1 1. Putensen C. et al. Long-Term Effects of Spontaneous Breathing Durin

  44. Slide 44: BiLevel Software Setup

    PURITAN BENNETT™ BILEVEL SOFTWARE SETUP  Enter gender and height or predicted body weight (PBW).  Touch Invasive.  Touch BiLevel mode.  Adjust available settings. Note:  PH: Above ambient, not above PEEP; must be set at least 5 above PL  Spontaneous Type: TC or PS  Set all appropriate alarms.

  45. Slide 45: BiLevel Setup: Timing Padlock to Lock Release Time

    PURITAN BENNETT™ BILEVEL SOFTWARE SETUP: TIMING PADLOCK TO LOCK ‘RELEASE TIME’  User determines the primary setting. Options:  TH (Time High)  TH ratio to TL (Time High to Time Low ratio)  TL (Time Low)  Changes in set frequency will not alter the primary variable set in the timing padlocked ar

  46. Slide 46: BiLevel Software Setup

    PURITAN BENNETT™ BILEVEL SOFTWARE SETUP  PH: Pressure during the TH period  PL: Pressure during the TL period  When TH:TL > 4:1, with the TL period locked, changes in set f will change the TH, but the TL will remain constant regardless of patient effort period to accommodate the new f setting whi

  47. Slide 47: How BiLevel Software Works

    HOW PURITAN BENNETT™ BILEVEL SOFTWARE WORKS  Two pressure levels, breath availability and active valve  Conventional or APRV breath timing  Alarm strategy  PPEAK (peak pressure) may be 1 to 2 cmH2O higher than set pressure 47 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | J

  48. Slide 48: BiLevel Software: Spontaneous Support Options

    PURITAN BENNETT™ BILEVEL SOFTWARE: SPONTANEOUS SUPPORT OPTIONS  Pressure support  Works on PL and PH  PL + PS = target pressure  May be left at “0” cmH20  Tube Compensation 48 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  49. Slide 49: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities Limitations  Neonate, pediatric, adult  Only invasive  APRV inverse ratio settings  Limited respiratory mechanics  Support Spont breaths with PS, TC 49 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  50. Slide 50: Describe Changes That May Impact Oxygenation

    DESCRIBE CHANGES THAT MAY IMPACT OXYGENATION  PH – High Pressure  TH – High Pressure Time Habashi NM. Other approaches to open-lung ventilation: airway pressure release ventilation. Crit Care Med. 2005;33(3 Suppl):S228-40. 50 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | Jun

  51. Slide 51: Puritan Bennett PAV+ Software

    PURITAN BENNETT ™ PAV *+ SOFTWARE ™

  52. Slide 52: Problem: Diaphragm Fiber Atrophy Due to Disuse

    PROBLEM: WHEN THE VENTILATOR CONTROLS BREATHS INSTEAD OF THE PATIENT, ATROPHY OF DIAPHRAGM FIBERS HAPPENS RAPIDLY DUE TO DISUSE Levine et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. NEJM. 2008;358:1327-1335. 52 Puritan BennettTM 980 Ventilator Clinical Application

  53. Slide 53: Problem: Patient-Ventilator Asynchrony Is Prevalent

    PROBLEM: PATIENT-VENTILATOR ASYNCHRONY IS PREVALENT 24% of mechanically ventilated patients exhibit patient-ventilator asynchrony in >10% of their respiratory efforts. Thille A. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32:1512. 53 Puritan Bennett

  54. Slide 54: Problem: Asynchrony May Lead to the Use of Sedation

    PROBLEM: ASYNCHRONY MAY LEAD TO THE USE OF SEDATION Asynchrony Sedation Prolonged ventilation time1 Possible muscle atrophy2 and VAP3 Weaning is delayed 1. Kollef M et al. The use of continuous intravenous sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114:541–548. 2

  55. Slide 55: Problem: Associated Asynchrony Costs

    PROBLEM: ASSOCIATED ASYNCHRONY COSTS  24% of ICU patients exhibit asynchrony in greater than 10% of their breaths.1 [ 24% ]  Asynchrony is associated with 18 extra days on the ventilator: duration of mechanical ventilation 7 (3-20) days vs. 25 (9-42) days p=0.005 ventilation (days; IQR).1 [ 18 day

  56. Slide 56: Solution: Puritan Bennett PAV+ Software

    SOLUTION: PURITAN BENNETT™ PAV™*+ SOFTWARE  Monitors patient’s demand breath by breath  Monitors compliance and resistance  Allows variable volume, flow, inspiratory time and pressure  Promotes natural breathing* *Compared to VC, VC+ and PS 56 Puritan BennettTM 980 Ventilator Clinical Applicatio

  57. Slide 57: Potential Benefits of PAV+ Software

    POTENTIAL BENEFITS OF PURITAN BENNETT™ PAV™*+ SOFTWARE  Encourages use of the diaphragm1  Increases support as the patient’s demand increases  Improves patient-ventilator synchrony1,2  May help the clinician better manage a patient’s work of breathing3 1. Xirouchaki N. et al. Proportional assist

  58. Slide 58: PAV+ Software Setup

    PURITAN BENNETT™ PAV™*+ SOFTWARE SETUP  Enter gender and height or predicted body weight (≥25 kg).  Touch:  Invasive vent type  SPONT mode  PAV™*+  Select % Support, PEEP and FiO2.  Select tube type.  Adjust the tube ID (6-10 mm ID).  Adjust the alarms. 58 Puritan BennettTM 980 Ventilator C

  59. Slide 59: PAV+ Software Key Alarms

    PURITAN BENNETT™ PAV™*+ SOFTWARE KEY ALARMS  ↑PPEAK  ↑VTI limit  ↓VE or ↓VT 59 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  60. Slide 60: PAV+ Software Changes

    PURITAN BENNETT™ PAV™*+ SOFTWARE CHANGES  PA to PAV™*+ description  Default support starts at 70% Support  Two graphs and WOB bar  Enhanced calculation of compliance and resistance 60 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  61. Slide 61: How PAV+ Software Works: Measurements

    HOW PURITAN BENNETT™ PAV™*+ SOFTWARE WORKS: MEASUREMENTS Measures values that create work  Assesses compliance and resistance (4 - 10 breaths with an automatic plateau)  Measures flow and volume every 5 msec  Uses the “equation of motion” 61 Puritan BennettTM 980 Ventilator Clinical Applications

  62. Slide 62: How PAV+ Works: Settings and Monitored Parameters

    HOW PURITAN BENNETT™ PAV™*+ SOFTWARE WORKS: SETTINGS AND MONITORED PARAMETERS  % Support, PEEP and O2%  Tube size and type  Monitors:  Compliance, resistance and PEEPI  Work of breathing bar  WOBTOT and WOBPT  Elastic and resistance work  Estimated lung pressure shadow trace  Flow and volum

  63. Slide 63: PAV+ Software Alarm Strategy

    PURITAN BENNETT™ PAV™*+ SOFTWARE ALARM STRATEGY  High inspired tidal volume (↑VTI)  High circuit pressure (↑PPEAK)  PAV STARTUP TOO LONG  PAV R&C NOT ASSESSED  Set all other traditional alarms 63 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  64. Slide 64: Summary of How PAV+ Software Works

    SUMMARY OF HOW PURITAN BENNETT™ PAV™*+ SOFTWARE WORKS  PAV™*+ software measures work variables.  The primary settings are % Support, PEEP and O2%.  The software amplifies patient efforts to offset the total work of breathing.  The software adjusts delivered pressure within the same breath.  The

  65. Slide 65: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities Limitations  Intact respiratory drive  Apnea  25 kg (55 lb.) or greater  Oversedation  6.0 I.D. tube or greater  Abnormal respiratory drive  Leaks  <25 kg (55 lb.)  Severe air trapping  Pneumatic nebulizer  Not available with NIV 65 Puritan Bennet

  66. Slide 66: Tube Compensation

    TUBE COMPENSATION Medtronic Further, Together

  67. Slide 67: Problem: Imposed WOB from a Trach or an ET Tube

    PROBLEM: IMPOSED WOB FROM A TRACH OR AN ET TUBE  An endotracheal or tracheostomy tube can impose an increased work of breathing.1  Pressure Support limitations:  Fixed delivery pressure approach  T-Piece trials reduce the monitoring capabilities. 1. Maeda Y. Does the tube-compensation function o

  68. Slide 68: Solution: Tube Compensation (TC)

    SOLUTION: TUBE COMPENSATION (TC)  Tube Compensation (TC) assists the patient in overcoming the flow resistance of the artificial airway.  TC software supports spontaneous breaths.  Only to the point of overcoming the artificial airways  TC may reduce the work of breathing.1 1. Maeda Y. Does the

  69. Slide 69: Potential Benefits of Tube Compensation

    POTENTIAL BENEFITS OF TUBE COMPENSATION  Provide variable pressure with variable effort.  Reduce the imposed work associated with artificial airways.1  Allow for enhanced monitoring compared to the T-Piece approach. 1. Maeda Y. Does the tube-compensation function of two modern mechanical ventilat

  70. Slide 70: Tube Compensation Setup

    TUBE COMPENSATION SETUP  Select TC for spontaneous type.  In particular, mention:  % Support: 10% to 100%  Tube I.D.  Tube type  ↑PPEAK  ↑VTI 70 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  71. Slide 71: How Tube Compensation Software Works

    HOW TUBE COMPENSATION SOFTWARE WORKS  Supports spontaneous breathing in SPONT, BiLevel and SIMV.  TC checks the flow rate every 5 ms.  TC uses flow, the % Support setting and a look-up table to determine delivered pressure.  % Support settings are from 10% to 100% (in 5% increments). 71 Puritan

  72. Slide 72: TC-Specific Alarm Strategy

    TC-SPECIFIC ALARM STRATEGY  ↑PPEAK  ↑Inspired tidal volume  All of typical alarms 72 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  73. Slide 73: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities  Intact respiratory drive  7.0 kg (15.4 lb.) or greater  4.5 I.D. tube or bigger Limitations  Oversedation  NeoMode <7.0 kg (15.4 lb.)  <4.5 I.D. tube  Apnea 73 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  74. Slide 74: Volume Support

    VOLUME SUPPORT Medtronic Further, Together

  75. Slide 75: Problem: Limitations of Pressure Support

    PROBLEM: LIMITATIONS OF PRESSURE SUPPORT  Pressure support does not provide a target tidal volume.  Pressure support does not down- regulate pressure automatically. 75 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  76. Slide 76: Solution: Volume Support (VS)

    SOLUTION: VOLUME SUPPORT (VS)  Clinician can set a target tidal volume.  Automated pressure delivery is based on inspired volume.  VS provides variable flow. 76 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  77. Slide 77: Potential Benefits of Volume Support

    POTENTIAL BENEFITS OF VOLUME SUPPORT  Encourages the use of the diaphragm  Automatically decreases support pressure if target tidal volume is exceeded (1 – 3 cmH2O)  Increases pressure if the patient’s ability to take an adequate breath is compromised (1 – 3 cmH2O) 1. Sassoon C. Assist–Control Me

  78. Slide 78: Comparing Volume Support to Pressure Support

    COMPARING VOLUME SUPPORT TO PRESSURE SUPPORT Feature Volume Support Pressure Support Lowest pressure for the set volume Yes No Escalates if needed Yes No Adjusts for changes in Raw and C Yes No 78 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  79. Slide 79: Volume Support Setup

    VOLUME SUPPORT SETUP  Select SPONT mode  Select VS for spontaneous type  Select:  VT SUPP  Trigger setting  Oxygen %  Rise %  ESENS  PEEP  ↑VTI  ↑PPEAK 79 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  80. Slide 80: How Volume Support Software Works

    HOW VOLUME SUPPORT SOFTWARE WORKS  VS varies the inspiratory pressure to deliver the operator-set target tidal volume.  During VS, the inspiratory pressure target cannot be lower than PEEP + 1.5 cmH2O and cannot exceed the ↑PPEAK limit - 3 cmH2O.  Pressure adjust a max of +/- 3 cmH2O/breath if ne

  81. Slide 81: VS-Specific Alarm Strategy

    VS-SPECIFIC ALARM STRATEGY  ↑PPEAK limit (determines max target pressure)  Volume not delivered  ↑VTI limit 81 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  82. Slide 82: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities Limitations  Neonatal to adult  Oversedation  Spontaneously breathing patients  Apnea  Invasive ventilation only  High effort may result in regulating  SPONT mode only of pressure down to undesirable levels.  Leaks without Leak Sync software enabled

  83. Slide 83: Puritan Bennett NeoMode 2.0 Software

    PURITAN BENNETT ™ NEOMODE 2.0 SOFTWARE

  84. Slide 84: General Problem

    GENERAL PROBLEM  Small tidal volume requirements  Ability to use AC and SIMV to ventilate with NIV  Auto-triggering and delayed cycling1  Management of nuisance alarms with CPAP  Reducing excessive oxygen exposure  Excessive tidal volume delivery 1. Oto J et al. A Comparison of Leak Compensati

  85. Slide 85: Potential Solution: NeoMode 2.0 Software

    POTENTIAL SOLUTION: PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE  Puritan Bennett™ Leak Sync software  A wide spectrum of modes both INV and NIV  Volume targeted availability down to 2.0 mL  Assist Control (VC, PC)  SIMV (VC, PC)  Spontaneous  Assist Control (VC, VC+ (PS) and PC)  CPAP  SIMV (VC,

  86. Slide 86: Potential Solution: NeoMode 2.0 Software

    POTENTIAL SOLUTION: PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE  A NIV CPAP-specific mode with nuisance alarm management  A configurable temporary elevate oxygen feature  Enhanced monitoring of C20/C and mL/kg 86 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  87. Slide 87: Potential Solution/Benefits of NeoMode 2.0 Software

    POTENTIAL SOLUTION/BENEFITS OF PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE  One machine for all patient sizes  Possible reduced use of invasive ventilation  Automatic management of leaks  Reduced alarms in the NICU with NCPAP  Better management of oxygen exposure  Intended delivered volume managed b

  88. Slide 88: NeoMode 2.0 Software Setup

    PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE SETUP  Install the neonatal adapter door and the single patient use neonatal expiratory filter.  Connect a neonatal breathing circuit to the ventilator.  Select the neonatal breathing circuit type in Short Self-Test (SST).  Neonatal-specific settings and saf

  89. Slide 89: NeoMode 2.0 Software Setup

    PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE SETUP  Select actual patient weight  Range for neonates is 0.3 kg to 7.0 kg (0.66 lb. to 15 lb.)  Select INV or NIV and modes  Includes A/C, SIMV, Spont, BiLevel and CPAP  Breath type VC, VC+ or PC  All other specific settings  Configurable elevated FiO2

  90. Slide 90: How NeoMode 2.0 Works: Alarm Strategies in CPAP

    HOW NEOMODE 2.0 SOFTWARE WORKS: ALARM STRATEGIES IN CPAP  When in NeoMode 2.0 mode, if NIV CPAP is used:  VE TOT, VTE SPONT and ↑VTI alarms are not available.  VE and VTE displays are not available.  TA can be adjusted but defaults to off to avoid inadvertent alarms.  Adjust the DSENS alarm. 90

  91. Slide 91: Capabilities and Limitations of NeoMode 2.0 Software

    CAPABILITIES AND LIMITATIONS OF PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE Indications: Limitations:  0.3 kg (0.66 lb.) and above  Pediatric or adult breathing circuit  VT 2 mL and above  >7.0 kg (15 lb.) PBW  Neonatal breathing circuit  Neonatal adapter door and neonatal expiratory filter 91 Purit

  92. Slide 92: Puritan Bennett Proximal Flow Sensor

    PURITAN BENNETT ™ PROXIMAL FLOW SENSOR

  93. Slide 93: Problems: Accurate Graphics and Proximal Flow Sensor Issues

    PROBLEMS: ACCURATE GRAPHICS AND PROXIMAL FLOW SENSOR ISSUES  Circuit volume affecting graphs  Calibrations during ventilation  Water contamination of Proximal Flow Sensor 93 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  94. Slide 94: Solution: Proximal Flow Sensor and Monitoring Software

    SOLUTION: PURITAN BENNETT™ PROXIMAL FLOW SENSOR AND MONITORING SOFTWARE  Measures flow and volume reflected at the patient wye  Displays both proximal flow and proximal pressure  Uses proximal flow values in the display of graphics.  Requires no manual calibration  Weight 6.6 g; dead space <1 m

  95. Slide 95: Potential Benefits of the Proximal Flow Sensor

    POTENTIAL BENEFITS OF THE PURITAN BENNETT™ PROXIMAL FLOW SENSOR  Improved graphics for patient management  Improved patient data 95 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  96. Slide 96: Proximal Flow Option Components

    PURITAN BENNETT™ PROXIMAL FLOW OPTION COMPONENTS  Proximal Flow Hardware  Proximal Flow Sensor 96 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  97. Slide 97: Proximal Flow Sensor Setup: Enabling/Disabling the Sensor

    PURITAN BENNETT™ PROXIMAL FLOW SENSOR SETUP: ENABLING/DISABLING THE SENSOR  To disable or enable the Proximal Flow Option: 1. Touch the Configure wrench icon 2. Touch the Options tab 3. Touch the Prox tab 4. Touch the Enabled or Disabled button 5. Touch Accept  Periodic expiratory phase purging oc

  98. Slide 98: Proximal Flow Sensor Setup with NeoMode 2.0 Software

    PROXIMAL FLOW SENSOR SETUP WITH PURITAN BENNETT™ NEOMODE 2.0 SOFTWARE  Installed during the SST (prompts are given)  Two connections:  Install monitoring end at the patient circuit wye  Install connector end on the ventilator’s front panel behind a clear door  Neonatal invasive ventilation only

  99. Slide 99: Proximal Flow Sensor Setup: Alarm Strategy

    PURITAN BENNETT™ PROXIMAL FLOW SENSOR SETUP: ALARM STRATEGY  Alarms respond to values monitored with the flow sensor  Breaths are controlled from the internal flow sensors (prox flow values are for monitoring only)  Prox inoperative 99 Puritan BennettTM 980 Ventilator Clinical Applications Lesson

  100. Slide 100: How the Neonatal Proximal Flow Sensor Works

    HOW THE PURITAN BENNETT™ NEONATAL PROXIMAL FLOW SENSOR WORKS  Measures flows, pressures and tidal volumes  Requires NeoMode 2.0 software option  Purge and auto-zero  Waveform Monitoring:  PCIRCY  VY  VTY  Monitored data:  VTIY  VTLY  VTEY  VTE SPONTY  VTE MANDY  VETOTY  LEAKY 100 Puri

  101. Slide 101: Comparing the Values for Leak and Leak Y

    COMPARING THE VALUES FOR LEAK AND LEAKY Patient + Circuit Patient 101 Puritan BennettTM 980 Ventilator Clinical Applications Lesson Plan | June 1, 2015

  102. Slide 102: Capabilities and Limitations

    CAPABILITIES AND LIMITATIONS Capabilities Limitations  Measuring flows, pressures and  Non-invasive (NIV) tidal volumes of invasively  Pediatric and adult ventilated neonatal patients  ET >4.0 mm  PBW of 0.3 kg (0.66 lb) to 7.0 kg (15.4 lb) using ET tube sizes from  PBW >7.0 kg (15.4 lb) 2.5 m

Medtronic — Technical Presentation (June 2015) on 6ix