CHAPTER IV THEORY OF OPERATION ‘The Infant Star Mode! 500 has eight major functions that provide you and your patients with a level of safety and flexibility Full microprocessor control of gas delivery. Adjustable background flow ventilation to reduce work of breathing, Automatic correction of inadvertent PEEP... Built in patient monitoring. Five automatic alarms for tubing obstruction.. Data output to a personal computer. 20 minutes of internal battery power... and so‘tware updatability... for tomorrows infant ventilation requirements. ‘The Infant Star's gas delivery system is microprocessor controlled. A microprocessor and software program precisely shape the flow and amount of pressure delivered to the infant. ‘Gas from the blender enters a manifold with six individual solenoid valves. The solenoids are electronically controlled on/off switches, each having a specific output orifice size to control gas flow. One is sized to produce 2 liters per minute, one 4, one 8, one 16, anc the remaining two combine to produce 32 liters per minute. When you set the background flow control on the ventilator, a signal is sent to the microprocessor, activating one or more valves. For example, if you set a flow rete of 10 liters per minute, the microprocessor will open the 8 and 2 liter flow valves. ‘A mandatory breath is often examined by looking at the proximal airway pressure wave form. ‘Atypical pressure curve is produced by a combination of flow rate, peak Inspiratory pressure, and Inspiratory time. The flow rate that you set establishes the angle or the slope of the Inspiratory portion of the mandatory breath. A high flow rate will give you a square shaped wave, while a lower fluw rale will produce a sioped wave, The Model 00, Peak Inspiratory Pressure is establis ed by setting an electronic limit. If we set a flow rate of 410 liters per minute, the 8 and 2 liter solenoids are tuned on to produce a 10 liter flow. Gas flow will continue at 10 liters per minute for approximately 20% of inspiration. At the 20% point, the microprocessor predicts the ‘moment at which peak inspiratory pressure will be reached and gradually reduces the gas flow, preventing ‘overshoct. Looking at the pressure wave form, we will have 8, 6, 4 and 2 liters per minute and then zero flow. Since the ‘endotracheal tube is not cuted, the 2 liter per minute solenoid will tum on and off to hold the pressure at the PIP point during the inspiratory plateau, and gas flow stops. Following inspiration the exhalation valves opens, and expiration occurs quickly. In a gas delivery system of this type, the pressure wave form has been software ‘modeled to optimize ventilation, regardless of flow or rate. A ott rte on Sere am‘Adjustable Background Flow works like this. A low level flow of 2 liters per minute (adjustable to 30 LPM for 105 software and lower and 32 LPM for 107 Software anc higher both change in 2 LPM increments) is applied {as a background flow to eliminate the possibility of rebresthing. A sensitive pressure transducer monitors pressures at the baby's airway. When the baby produces a spontaneous inspiratory effort, the signal is {ransmitied back to the microprocessor, which then tums on one or more solenoids...providing additional gas to the airway within 30 mitiseconds. With the Mode! 500, 105 software and lower the additional gas flow is in direct proportion to the baby's effort. For example, if the baby produces 1 cm of water of negative effort at the airway. he will receive approximately 6 liters per minute, a combination of the 2 and 4 liter per minute solenoids. At 5 cm of water effort will produce up to 34 liters per minute. Model 500/950 107 software and higher Increased the responsiveness of the demand flow system. The demand flow system supplies extra flow to the circuit when the patients spontaneous breathing exceeds the background flow setting, You can establish flow rates that satisfies the requirements of the mandatory breath, while at the same time reducing the potential for increased expiratory work of breathing, When you adjust background flow, PEEP/CPAP, and vertilator rate the combination of these three settings is stored in the microprocessor, which predicts the amount of inadvertent PEEP these settings will produce. Based on this prediction, it increases or decreases the "on" cycle of a solenoid directing gas flow through a Jet Venturi system built into the exhalation valve block. This Venturi system produces a subambient pressure at the expiratory connection of the exhalation leg of the breathing circuit. When the Jet flow is increased, more ‘subambient pressure is produced; when its decreased, tiere is less subambient pressure. Within § seconds of applying the correction, the microprocessor checks the pressure at the baby's airway and compares the amount of PEEP/CPAP that has been set to what is actually arriving at the airway. Based on this ‘comparison, further automatic compensation occurs until inadvertent PEEP/CPAP is eliminated. AAs you change the ventilator settings, the microprocessor, working with the pressure transducer and monitoring the baby's airway, makes corrections and holds the PEEP/CPAP level constant. While other systems require add-on equipment for patient monitoring, the Models 500/950 have a built-in ‘monitoring system. Digital displays simultaneously show pressure measurements of PEEP/CPAP, mean airway pressure (which is a lime weighted average) and PIP. ‘The pressure signal is taken from the infant's eirway through the proximal pressure tube to the pressure transducer, and then to the microprocessor which does the calculations, integrates them, and controls the display. ‘The integration of pressure monitoring within the ventilator reduces the duplication of components so common ‘when monitors are purchased separately. This approach also allows us to include two pressure trarsducers, one at the airway and one inside the ventilator. Other systems, using pressure gauges or stard alone monitors, are vulnerable to undetected high airway pressure caused by disconnection or blockage of :he proximal pressure tube. Using two transducers. allows a comparison of pressures, alerting the clinician, and preventing undetected high pressure. With this system, we can protect against proximal pressure tube blockage, disconnection, or even a single ‘transducer failure, The electronics also work to protect the baby's airway in 2ase of a circuit blockage. When you set peak inspiratory pressure, you program the microprocessor to limit pressure and to compare what is set and what is in fact occurring at the airway. Five different detection comparisons are checked, including 3 levels of pressure overshoot, the shape of the Expiratory Curve, actual CPAP versus the setting, ‘and high resistance in the inspiratory let of the breathing circuit. Ed isterentcs, Inc. 4.2 fan tr Woe S006 Serie MaralUnder all of these condi Wns, the Infant Star will sense an obstructed tube and provide a specific Error it will protect the baby's eliway from sustained pressure by shutting off the flow of For example, the AO1 message indicates HIP. The proximal pressure has reached the HIP setting pressure. If the HIP pressure setting is momentarily reached, gas ‘low will stop, the exhalation valve will open, and the baby's airway will be vented to PEEP/CPAP, ‘The obstructed tube indicator will activate both an audible alarm and visual signal. This situation will most frequently be caused by a baby fighting the ventilator, hiccuping or crying. If the exhalation valve opens but the pressure continues to rise due to a blockage in the expiratory leg of the breathing circuit, a second alarm will occur at HIP plus 5 cm of water. AO2 will appear on the display, and the system will activate both an audible and a visual signal. When this occurs, the circuit will vent through the inspiratory leg of the circuit, protecting the infant's airway from sustained pressure. {third alarm will occur if something partially blocks the expiratory leg of the breathing circuit and prevents exhalation from ocourring quickly, Under normal operation, the peak inspiratory pressure should drop more than 50% in the first 300 milliseconds. If something is impeding the baby's exhalation and pressure is not dropping quickly, the AO3 Message and an audible alarm will indicate elevated expiratory resistance. There is ‘a complete pneumatic shutdown for 1 second, which vents the patient to ambient ‘The ADs message indicates CPAP 6 cm of water greater than what has been set, for up to § seconds. This can ‘occur when water, tubing fatigue or some other factor is blocking gas flow in the expiratory leg of the breathing circuit, Complete pneumatic shutdown for 3 seconds and the patient is vented to ambient ‘The fifth detection point, AOS, indicates a blockage in the inspiratory leg of the circuit or in the proximal pressure line. The ventilator will alarm when the intemal pressure transducer is recording a pressure 10 cm of ‘water above the set HIP. Under the AO1 Alarm Condition the gas delivery stops and both the visual and audible obstructed tube alarms ‘occur. The exhalation valve opens to vent the airway to PEEP. Under the AO2, A03 and A04 Alarm Conditions, the gas delivery stops and both the visual and audible obstructed tube alarm occur. The exhalation valve and the internal vent system both open to vent the airway to ambient. This automatic response protects the baby's airway, while the error messages identify the most likely problem. ‘You may output patient data directly to an IBM compatible personal computer and then to a printer. A Standard S232 cable, compatible with all PCs, connects to the output on the back panel of the ventilator. Hard copy iS produced by connecting the PC to a printer. It's convenient and cost effective for you to capture both ventilator ‘and patient data directly, without having to produce handwritten copies. You can automatically record control settings, airway pressures and respiratory trending. ‘Most ventilators have no battery backup. In a power failure, patients can be placed at risk. The Models 500/950 have a built in battery backup, and operates on the battery at all times. When connected to an electrical outlet, a self-contained charger keeps the battery at full power. Should electricity to the hospital fal, the Model 500 will continue operating for up to 30 minutes on battery power alone. By designing with microprocessor control of display calculations and pneumatics, major changes can be made by simply rewriting the software. Small components, called EPROM's, can be exchanged on the circuit boards to change its operations characteristics. ‘The upper module contains the microprocessor electronics and the controls to establish the ventilator parameters, Two upper module contains the microprocessor electronics and the controls to establish the ventilator parameters. SF tntrasonics, inc. Save 43 Infant Star Model 500/950 Service Manual‘Two modes of ventilation are available: CPAP and IMV for ISV 500 and four modes of ventilation are available for ISV 950: CPAP, IMV, HFV ONLY and HFV IMV Dedicated displays identify the control settings: Flow Rete, from 4-40 liters per minute... Background Flow 2-30 LPM (2-32 LPM 107 software and higher). Ventilator Rat2, from 1-150 Breaths Per Minute... Peak Inspiratory Pressure, from 5-90 cm of water... Inspiratory Time, from 1 to 3 seconds, and Low Inspiratory Pressure, from 3-60 om of water, HIP Alarm 5-105 CM HO, and PEEP 0-24 CM H20, with ISV 950 additional HFV Rate 2-22 Hz and Ampiitude. ‘A push button control allows a single display to be used for observing the IE ratio, expiration time, or duration of positive pressure. The three proximal pressure displays provide information about the actual pressure being applied at the baby's airway, The displays include PEEP/CPAP, Mean Airway Pressure, and PIP. ‘You can adjust the audible intensity from soft to loud, and check the visual displays for specific atarm violations. The alarm silence button provides a 60 second silence for all violations with the exception of continuous power loss and ventilator inoperative. When an alarm situation self corrects, the audible alarm will ‘automatically silence while the visual indicator provides you with information on what caused the problem. The Visual Reset Button will lear the indicator. Alarms are provided for Low Inspiratory Pressure, Low FEEP/CPAP, Airway Leak, Obstructed Tube, Insufficient Expiratory Time, Low Oxygen Pressure, High Pressure, Low Air Pressure, External Power Loss, Low Battery fallure and Ventilator inoperative, ‘The lower chamber of the ventilator contains the pneumatic systems, including a mechanical popoff valve exhalation valve, block assembly and an oxygen blender control. (On the back panel, the pneumatics chamber has both air and oxygen inlets, each protected with water traps and filters. A third outlet provides blended gas at the concentration set on the oxygen control. The blended gas may be connected to an accessory flowmeter mourned on a rail system for hand resuscitation or aerosol delivery. The ISV 950 has a HFV on otf key switch. ‘The rear of the electronics module includes the On/Off switch for system power, and a Hour meter, RS232 serial output port for PC connection, Star Sync and Remote Alarm Connector, Analog pressure outputs for ‘connecting to a strip chart recorder, External battery connection, Circuit breakers and an adjustable baffle for ‘changing the audible alarm intensity. Ei ieteszonies, nc. 4-4 fan stro S085 San an