BiPAP A40
Set-up guide 1
Getting started
5
Humidification
2
Main screen
6
Connection to oximetry
3
Menus
7
Guidelines for ventilation set-up
4
Battery module
1
Getting started
Device navigation
How to start therapy
1 0
5
S/T AVAPS: 0.5
A
S/T AVAPS: 0.5
10
15
20
cm H2 O
25
12/30/2010
12/30/2010
06:12 PM
06:12 PM
5
1
Humidifier
Menu
A
Setup
30
Menu
Ramp
Therapy
6 2
3
4
1 Display screen 2 Perform action specified on-screen
(humidifier setting, cancel action or exit menu) 3 Navigate menus or change settings 4 Perform action specified on-screen
(activate ramp, select/modify/ confirm parameters) 5 Audio pause button 6 Start/stop button
• Connect the device to AC or DC power source, or use detachable battery module • Press device
to switch on the
• Select the treatment
to start
How to stop therapy
How to unlock S/T AVAPS: 5.0
S/T
cm H2O
cm H2O
0
5
10
Pressure
3.5
15
RR
20 ml
cm H2O
20
25
Vte
0
30
0 ml
5
10
Pressure
Leak
12.6
0.0 l/min
15
20
25
Vte
MinVent
0.0 l/min
30
Leak
0 ml
cm H2O
RR
0.0 l/min I:E Ratio
11 BPM
1:1.0
Standby Power Off
Cancel
Navigate
OK
Menu
• Press
To unlock the device
• To keep power on but stop therapy, select ‘Standby’
and • Press and hold for a few seconds to access Setup page
• Then select • To turn power off, select ‘Power Off’ • Then select
• Scroll down and select ‘Options’ • Modify ‘Menu access’ from ‘Limited’ to ‘Full’ • Press
to validate
and to come back to the main screen
• Press
When appears on the main screen, the device is unlocked
A
2
Main screen AVAPS activated with a speed rate of 0.5cmH2O/min.
Mode of ventilation
A
A
S/T AVAPS: 0.5
Breath indicator (patient or machine settable in Options)
0
5
10
15
Pressure
12.1 cm HO 2
Leak
30.0 l/min I:E Ratio
RR
1:3.0
12 BPM
1
Humidifier
Humidifier connected, setting FLEX1
AVAPS
AVAPS
A Symbols and icons
AVAPS: 1 AVAPS: 1 AVAPS 1 alarm enabled A Apnea AVAPS AVAPS: 1 A
A
A
A
Audio pause isAVAPS: active1 FLEX
Circuit disconnect FLEX: 1
FLEX alarm enabled
A
AVAPS AVAPS 1 AVAPS:
FLEX:11
Detachable AVAPS: AVAPS: 11battery is 20% capacity
FLEX: 1
Detachable battery is 1 1nearlyFLEX depleted FLEX
FLEX battery is Detachable 1 FLEX: 1 11 being FLEX: charged FLEX:
Detachable1 battery in use 11
Real-time monitored values when detailed view ON (Options settings)
Detachable battery connected and in use
AVAPS AVAPS AVAPS AVAPS: 1 AVAPS: AVAPS:11 AVAPS
AVAPS: 1 FLEX FLEX enabled FLEX FLEX FLEX: 1 FLEX: 1 FLEX: FLEX 1 FLEX enabled AVAPS (eg.AVAPS 1) FLEX: A 111 AVAPS: AVAPS: 1 1 1
FLEX
AVAPSFLEX battery is 80% capacity FLEX:Detachable 1
Pressure bar graph
Ramp
Menu
SD card inserted
FLEX: 1
A AA
cm H2 O 30
Vte
3.9 l/min
AVAPS
25
325 ml
MinVent
Device AVAPS: 1 unlocked
20
1
FLEX FLEX: 1
and FLEX setting
Humidifier connected and Humidifier setting (eg. 1) Bad FLEX humidifier state (flashing symbol displays) FLEX: 1
Ramp activated 1
1
SD Card error (bad memory card inserted)
3
Menus
Menu: Settings and alarms Mode Trigger type
CPAP, S, S/T, PC, T, AVAPS-AE Auto-Trak/Flow Trigger/ Auto-Trak (sensitive) Flex Lock (only in S mode) On (locked)/Off (unlocked) Flex (only in S mode) On/Off AVAPS AVAPS rate
On/Off 0.5 - 5 cmH2O/min, in 0.5 cmH2O/min increments
Tidal volume*
200 - 1500 ml, in 10 ml increments
IPAP max *
IPAPmin - 40 cmH2O, in 0.5 cmH2O increments
IPAP min* EPAP
4 - IPAPmax, in 0.5 cmH2O increments
4 - 25 cmH2O, in 0.5 cmH2O increments
Breath rate
0 - 40 BPM (4 - 40 BPM for T mode)
Inspiratory time
0.5 - 3 sec, in 0.1 sec increments
Rise time lock
On (locked)/Off (unlocked)
Rise time
1 (fastest) to 6 (slowest)
Ramp length
0 - 45 minutes, in 5 minute increments
Ramp start pressure
4 cmH2O - prescribed EPAP, in 0.5 cmH2O increments
System One humidification On (System One Humidity Control)/ Off (classic mode) Humidifier
1 (coolest) to 5 (hottest)
*only when AVAPS is enabled
Menu: Settings and alarms (cont.) Tubing type lock
On (locked)/Off (unlocked)
Tubing type
15 mm/22 mm
System One resistance lock
On (locked)/Off (unlocked)
System One resistance (interface type) 0, X1, X2, X3, X4, X5 or Invasive Circuit disconnect alarm
Off; 15 or 60 sec
Apnea alarm
Off; 10, 20 or 30 sec
Low tidal volume alarm (only when AVAPS is enabled)
On/Off
Low minute ventilation alarm
Off; 1 - 99 LPM
High respiratory rate alarm
Off; 4 - 60 BPM
Menu: Settings and alarms: AVAPS-AE Settings
Range
AVAPS rate Tidal volume
0.5 - 5 cmH2O/min, in 0.5 cmH2O/min increments 200 ml - 1500 ml
Maximum pressure
6 - 40 cmH2O
Pressure support Max 2 - 36 cmH2O
Pressure support Min EPAP Max pressure EPAP Min pressure Breath rate
2 - 36 cmH2O
4 - 25 cmH2O 4 - 25 cmH2O
Auto/0 - 40 BPM
Menu: Options S/T AVAPS: 0.6
To navigate through the Options menu:
A
Setup Menu
1/18
Options
Menu access Detailed view Language Pressure units Breath Indicator
Finish
Full ON English cmH20 Patient
Navigate
Modify
to scroll • Use through the menu. • Use the left and right buttons to perform the actions specified on the on-screen buttons and set according to your preference.
Under ‘Options’, you have access to the following parameters: Menu access Detailed view
Full (device unlocked)/Limited (device locked) On (monitored data on the screen)/Off (no monitored data on the screen, only time and date) Language You have the choice between 22 different languages Pressure units cmH2O/hPa Breath indicator Patient (spontaneous breath)/machine (controlled breath) Keypad lock On (buttons inactive)/Off (buttons active) Keypad backlight On/Off LCD brightness 1 (darkest) to 10 (lightest) Screen saver Dim (backlight is decreased)/Breath (black screen, but manometer and breath indicator are visible)/ Off (no screen saver) Date and Date and time settings time format Blower hours Number of hours the blower has been active (resettable) Therapy hours Number of hours the patient receives therapy (resettable) SpO2 Date of the last complete SpO2 session (at least 4 hours)
4
Battery module
To connect the battery module to the BiPAP A40 device and install the detachable battery, complete the following steps: 1. Remove the side cover on the therapy device 2. Line up the detachable battery module and the therapy device side by side 3. Press the two units together until they snap into place 4. Insert the detachable battery into the battery module, and close the lid
2
3
4
Humidification Humidification Humidification Humidification
With device turned off, remove and fill chamber with water. With device turned off, remove and fill chamber with water. 1. (a) Lift humidifier door until it locks in place. Do not force 1. (a) Lift humidifier door until it locks in place. Do not door higher thanforce the locked position. (b) Grasp front of door higher than the locked position.chamber (b) Graspand front of toward you. slide With device turned off, remove and fill chamber with water. chamber and slide toward you. With device turned off, remove and fill chamber with water.
Humidification 5Humidification
1. (a) Lift humidifier door until it locks in place. Do not force (a)place. GentlyDopush tab located inside round opening on top 1. (a) Lift humidifier door until it locks2. in not door higher thanforce the locked position. (b) Grasp front of 2. (a) Gently push tab located inside round opening(b) onSeparate top of(b) chamber. top and bottom of chamber. door higher than the locked position.chamber Graspand front of toward slide you. of chamber. (b) Separate top and bottom of chamber. chamber and slide toward you. With device turned off, remove and fill chamber with water.
Undocking the battery module or humidifier
(a)place. GentlyDopush located inside round opening on top 1. (a) Lift humidifier door until it locks2. in not tab force 2. (a) Gently push tab located inside 3. round opening onSeparate top bottom chamber distilled water. of chamber. of(b) chamber. (b) and bottom door higher than the locked position.Fill Grasp front of withtop 3. Fill bottom chamber withtop distilled water. of chamber. of chamber. (b) Separate and bottom chamber and slide toward you.
2. (a) Gently push tab located inside 3. round opening on top with distilled water. Fill bottom chamber 3. Fill bottom chamber withtop distilled water. of chamber. (b) Separate and bottom of chamber. 4. Observe maximum fill lines located on sides of chamber. 4. Observe maximum fill lines located on sides of chamber.
Release latch
3. Fill bottom chamber with distilled 4. water. Observe maximum fill lines located on sides of chamber. 5. Do not overfill. 4. maximum fill lines located on sides of chamber. 5. Observe Do not overfill.
(bottom Reassemble the chamber by lacing p the hinges on lid over the Reassemble the chamber by lacing p the onback lid over the twohinges tabs on of chamber. Closeview) lid until it locks in place two tabs on back of chamber. Close lid until locks in place with an itaudible click. Insert filled chamber into humidifier. 5. Do not overfill. with an audible click. Insert filled chamber intoof humidifier. 4. Do Observe maximum fill lines located on sides chamber. 5. not overfill. Reassemble the chamber by lacing p the hinges on lid over the Reassemble the chamber by lacing p the onback lid over the twohinges tabs on of chamber. Close lid until it locks in place two tabs on back of chamber. Close lid until it locks in place with an audible click. Insert filled chamber into humidifier. with an audible click. Insert filled chamber into humidifier. 5. Do not overfill.
6
Connection to oximetry
Back of device
1 Nurse call connector 2
1
2 Accessory slot
3
(cover shown) 3 SD card slot 4 DC power inlet
4
6
A
B
C
5 AC power inlet 6 Filter area
5
To connect the oximetry module: A Remove the cover from the accessory slot on the back of the BiPAP A40 B Remove the cover from the oximetry accessory C Plug the oximetry accessory into the accessory slot D Plug the oximetry sensor of your choice into the oximetry module When the oximetry module is connected, and detailed view ON, the SpO2 and heart rate values are monitored on the main screen (see below). A
S/T AVAPS: 0.5
0
5
10
Pressure
20
Vte
12.1 cm HO 2
MinVent
D
15
3.9 l/min SpO2
95
325 ml RR
12 BPM Heart Rate
79
2
Humidifier
Menu
25
cm H2O 30
Leak
0.0 l/min I:E Ratio
1:1.0
7
Guidelines for ventilation se
Initial settings
IPAP = 8 - 10 cmH2O, EPAP = 4 cmH2O and RR = 10 - 12 BPM
IPAP
Increase IPAP if the patient wants more air, targeting patient tidal volume at 8 ml/kg of ideal weight
EPAP
• without OSAS (Obstructive Sleep Apnea Syndrome): 4 - 5 cmH2O • with OSAS: increase EPAP to remove obstructive apnea events • with intrinsic PEP (stable chronic COPD): 5 - 6 cmH2O
BPM
Set to 2 - 3 BPM under patient’s spontaneous frequency
Rise time
Obstructive patients prefer short rise time: from 1 - 4 (100 ms - 400 ms) Restrictive patients prefer long rise time: from 3 - 6 (300 ms - 600 ms)
Ti
Set Ti between 25% and 33% for obstructive patients Set Ti between 33% and 50% for restrictive patients (refer to table opposite) OHS
COPD
Other restrictive diseases (NMD, etc.)
AVAPS
Vt target 8 - 10 ml/kg of ideal body weight (refer to table opposite) Allow a more restrictive pressure window to combine comfort and efficacy. • IPAPmin = comfortable IPAP • IPAPmax = IPAPmin + 5 cmH2O
Allow a more restrictive pressure window to combine comfort and safety. • IPAPmin = efficient IPAP • IPAPmax = IPAPmin + 5 cmH2O
IPAP window (IPAPmin and IPAPmax)
Allow a wide range of pressure variation to ensure the right pressure at the right time. • IPAPmin = EPAP • IPAPmax = 25 - 30 cmH2O
AVAPS rate
AVAPS rate setting depends on patient needs and clinical condition: 0.5 - 3 cmH2O/min so target tidal volume is reached smoothly 3 - 5 cmH2O/min so target tidal volume is reached more rapidly
Check patient arterial blood gases (PaCO2 and PaO2) and oxygen saturation (SpO2). Important: Guidelines are intended to serve only as a reference. They shall be used only in conjunction with the instructions and/or protocol set forth by the physician and institution in which the assist device is being used. The guidelines are not intended to supersede established medical protocols.
n set-up Conversion table to set the inspiratory time for controlled breaths Set back up breath rate (BPM) 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
I/E 1/3, Ti/Ttot 25% 1.5 s 1.4 s 1.3 s 1.2 s 1.1 s 1.0 s 0.9 s 0.9 s 0.8 s 0.8 s 0.8 s 0.7 s 0.7 s 0.7 s 0.6 s 0.6 s
I/E 1/2, Ti/Ttot 33% 2.0 s 1.8 s 1.7 s 1.5 s 1.4 s 1.3 s 1.3 s 1.2 s 1.1 s 1.1 s 1.0 s 1.0 s 0.9 s 0.9 s 0.8 s 0.8 s
I/E 1/1, Ti/Ttot 50% 3.0 s 2.7 s 2.5 s 2.3 s 2.1 s 2.0 s 1.8 s 1.7 s 1.6 s 1.5 s 1.5 s 1.4 s 1.3 s 1.3 s 1.2 s 1.2 s
Set the inspiratory time in seconds: Ti (second) = 60/Respiratory rate x % Ti Conversion table to set the target tidal volume in relation to the ideal weight Height 1.50 m 1.55 m 1.60 m 1.65 m 1.70 m 1.75 m 1.80 m 1.85 m 1.90 m
Calculated ideal weight (if BMI = 23) 52.0 kg 55.0 kg 59.0 kg 62.5 kg 66.5 kg 70.5 kg 74.5 kg 78.5 kg 83.0 kg
Target Vte if 8 ml/kg 410 ml 440 ml 470 ml 500 ml 530 ml 560 ml 600 ml 630 ml 660 ml
Target Vte if 10 ml/kg 520 ml 550 ml 590 ml 620 ml 660 ml 700 ml 740 ml 780 ml 830 ml
Calculated with an ideal Body Mass Index of 23 kg/m2 (BMI = weight/height 2)
Philips Healthcare is part of Royal Philips Electronics How to reach us www.philips.com/healthcare
[email protected]
Philips Respironics 1010 Murry Ridge Lane Murrysville, PA 15668 Customer Sevice +1 724 387 4000 800 345 6443 (toll free, US only)
Asia +49 7031 463 2254
Philips Respironics International Headquarters +33 1 47 28 30 82
Europe, Middle East, Africa +49 7031 463 2254
Philips Respironics Asia Pacific +65 6882 5282 Philips Respironics Australia +61 (2) 9947 0440 1300 766 488 (toll free, Australia only)
Latin America +55 11 2125 0744 North America +1 425 487 7000 800 285 5585 (toll free, US only)
Philips Respironics France +33 2 51 89 36 00 Philips Respironics Italy +39 039 203 1 Philips Respironics Sweden +46 8 120 45 900 Philips Respironics Switzerland +41 6 27 45 17 50
Philips Respironics United Kingdom +44 800 1300 845 www.philips.com/respironics
Philips Respironics China +86 400 828 6665 +86 800 828 6665 Philips Respironics Deutschland +49 8152 93 06 0
This guide contains abstracted information from the User Manual; please refer to the latest version for complete information regarding the BiPAP A40 device.
© 2012 Koninklijke Philips Electronics N.V. All rights are reserved. BiPAP A40 is registered trademark of Philips. Philips Healthcare reserves the right to make changes in specifications and/or to discontinue any product at any time without notice or obligation and will not be liable for any consequences resulting from the use of this publication. Broudy AE 9/5/12 MCI 4104688 PN 1098001
