Weinmann MEDUMAT Standard² Ventilator Operating instructions

Brand: Weinmann

Model: MEDUMAT Standard² Ventilator

Type: Operating instructions

• 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

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

Start up quickly and ventilate accurately

From now on, you no longer need to spend time considering which tidal volume (Vt)

and which respiratory rate (Freq.) are best suited to your patient. With MEDUMAT

Standard

, 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

. MEDUMAT Standard

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

Risk of injury resulting from incorrectly set restriction of maximum airway pressure!

An excessively high airway pressure might cause the patient serious or life-

threatening injury.

Always set the pressure limit pMax to match the current patient and the current

therapy.

Use presets and work according to guidelines

In the Start menu, you can set the patient's height under the “New patient” menu

item. This section explains how the ventilator automatically calculates the ideal tidal

volume using height and gender.

Ideal body weight (IBW) in kg is calculated from stated height in cm (x) as shown

below:

Example

IBW (female) = 45 kg + 2.3 kg • x

2.54 cm -60

• Child(1) (height < 154 cm):

IBW child = 2.05 kg • exp x

50 cm

IBW (male) = 50 kg + 2.3 kg • x

2.54 cm -60

• Adult(2) (height > 154 cm):

The tidal volume for the patient is calculated with the aid of ideal body weight and

the setting Vt per kg body weight (Vt/body weight) in the Operator menu:

• Patient, male, height 185 cm

Vt = IBW • Vt

Body weight

• Setting for Vt/body weight = 6 ml/kg

(1)

Source: TRAUB, S.L.; JOHNSON, C.E.: Comparison of methods of estimating creatinine

clearance in children. In: American journal of hospital pharmacy 37, 1980, No.2, pp. 195–201.

(2) Source: DEVINE, Ben J. Gentamicin therapy. The Annals of Pharmacotherapy, 1974, 8. year No.

11, pp. 650-655

IBW (male) = 50 kg + 2.3 kg • 185 cm

2.54 cm -60 = 79.52kg

Vt = 79.52 kg • 6 kg = 477 ml 480 ml

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.

Select the desired CPAP therapy using

the navigation knobs: PEEP, pMax,

ΔpASB. After adjusting the values,

begin the ventilation via “start”.

Now connect the patient to MEDUMAT

Standard². It is possible to adjust the

values using the navigation knobs while

the ventilation is running. The right-

hand navigation knob provides access

to additional ventilation parameters.

The ventilation mode can be changed

by pressing the menu button.

Select one of the following

ventilation modes: CPAP +

ASB (if available) or CPAP (CPAP is the

ventilation form

“CPAP + ASB” with a ΔpASB

of 0 mbar).

Modied in accordance with therapy recommendations for emergency medicine 2022

published by the Association of Emergency Physicians of Northern Germany

(Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte e.V. - AGNN).

Indications

• Hypoxemic ARI with respiratory rate > 25/min (count!) and

SpO2 < 90 % despite O2 administration; e.g. cardiogenic pulmonary edema.

• Hypercapnic ARI = clinical ventilatory insufciency with high respiratory rate/low

TV; e.g. acute exacerbated COPD (aeCOPD), bronchial asthma.

Contraindications

• Absolute: Absence of spontaneous respiration, gasping, airway obstruction,

gastrointestinal bleeding or ileus, non-hypercapnic coma

• Relative: Hypercapnic coma, high-grade hypoxemia agitation, pronounced

secretion, hemodynamic instability with shock, mask leakages.

Procedure

• Ensure logistical requirements: Check oxygen supply: at least a 2-l bottle; lled.

Check and adjust ventilator.

• Monitoring of respiratory rate (count!), SpO2, ECG and etCO2 as soon as NIV

initiated

• Commence NIV with patient semi-seated or seated.

• Slowly adjust the patient’s face mask; the patient can initially hold the mask in

place themselves where possible. The most important aim of the adaptation

phase is the synchronization of the ventilator and the patient.

• If the patient is highly agitated, careful sedation may be helpful and necessary.

A benzodiazepine, opiate or Propofol in a sub-anesthetic dose can be used here.

• In the case of continuing leakage or patient apnea, the device switches to Apnea

ventilation (if activated). This mode can also be selected before connection to

the patient.

SOP

Non-invasive ventilation (NIV)

in the case of acute respirators insufciency (ARI)

Adjusting the ventilation mode in the case of hypoxemic ARI

Mode: ................................................................... CPAP (without pressure support)

Initial PEEP: ..................................................................................................5 mbar

Initial FiO2: .................................................................................................... 100%

Target: ........................................................... SpO2 > 94 % (with COPD 88 – 92 %)

Reduce the FiO2 accordingly in the case of a more pronounced SpO2 increase

Increase PEEP in the case of insufcient SpO2 increase: .......................... 7 – 10 mbar

In the case of insufcient tidal volume:

Pressure support: .................................5 mbar (increase gradually where applicable)

Inspiratory trigger: .......................................................................As low as possible

Adjusting the ventilation mode in the case of hypercapnic ARI

Mode: ....................................................................... CPAP (with pressure support)

Initial PEEP: ................................................................................................. 5 mbar

Initial pressure support: ............................................................................... 5 mbar

Inspiratory trigger: ..................................................................... As low as possible

Expiratory trigger: ..................................................................... As high as possible

Initial FiO2: ...................................................................................... 40% or AirMix

Aim: .............................................................................................. SpO2 88 – 92 %

Reduce the FiO2 accordingly in the case of a more pronounced SpO2 increase

In the case of insufcient tidal volume:

Pressure support: ....................................... Increase gradually (up to max. 20 mbar)

In the case of pronounced ventilatory insufciency: ................... Change to BiLevel-

ventilation if necessary

Success criteria

Decrease in dyspnea, respiratory and heart rate, increase in SpO2, improved

vigilance, reduced etCO2 where applicable.

Caution

• Close clinical observation, stop if condition deteriorates

• Do not delay pharmacological/interventional therapy

• Be ready to intubate at all times when using NIV, above all in the case of relative

contraindications

• 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. 5 l/min

Level 3 (insensitive) Approx. 10 l/min

Setting the levels of the inspiratory 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 expiratory 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

The expiratory trigger initiates 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 the maximum ow . In principle, the following applies:

the smaller the % value, the longer the pressure support lasts.

Pressure

PEEP

ΔpASB

Time

Max. 4s

Flow

80% Flowmax

100%

5% Flowmax

Setting the levels of the expiratory 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

PEEP

assisted spontaneous

respiration

mechanical

ventilation

Resuscitation (CPR) with IPPV

Switch on the device.

Press the CPR button and select the pa-

tient group.

Check the ventilation parameters. In

the ventilation phase of 30:2 or 15:2

resuscitation, press the mask with the

“Double C grip” over the patient’s

mouth and nose.

Then hold down the MEDUtrigger

button until two mechanical breaths

have been administered.

Following successful intubation, switch

to continuous ventilation “CPR IPPV”.

Check the ventilation parameters.

During the cardiac rhythm analysis or

debrillation, select “pause” to pause

the ventilation.

Following successful debrillation, if

applicable, press “pause” again to

restart the ventilation. The ventilation

will start automatically after at most

50seconds.

Once ROSC is achieved, press the CPR

key again to exit the CPR mode. Then

check the ventilation parameters and

select, if applicable, the Air Mix key to

lower the FiO2 to < 1.0.

Resuscitation (CPR) with CCSV

Switch on the device.

Press the CPR button and select the pa-

tient group.

Check the ventilation parameters. In

the ventilation phase of 30:2 or 15:2

resuscitation, press the mask with the

“Double C grip” over the patient’s

mouth and nose.

Then hold down the MEDUtrigger

button until two mechanical breaths

have been administered.

Following successful intubation, switch

to continuous ventilation “CPR CCSV”.

Perform chest compressions

continuously. MEDUMAT Standard²

will deliver a mechanical breath

synchronously to each compression.

You can use the frequency tachometer

shown above to determine the

frequency of the compressions.

If a chest compression device is being

used, this will need to be specied using

the middle navigation knob.

With machine compressions the

compression frequency alarm

is deactivated and the frequency ta-

chometer turns gray.

The triggers are optimized by the device

and the trigger level is automatically set

to "3".

The hands-off time is shown for missing

chest compressions. Once the alarm lim-

it is reached, the device emits a hands-

off time alarm . If this is not answered

with compressions, the device automati-

cally switches to "CPR IPPV" ventilation.

If chest compressions are detected

again by MEDUMAT Standard² during

“CPR IPPV” apnea ventilation, the de-

vice automatically switches back to

“CPR CCSV”.

If these two measures do not lead to

success, CCSV is not applicable to this

patient. Please switch to “CPR IPPV” via

the right navigation knob.

If less or no compressions are detected

by MEDUMAT Standard² despite

correctly performed compressions,

please perform the following escalation

steps:

• Reduce the set trigger.

• Increase the set PEEP.

Interactive Simulation

Operate MEDUMAT Standard² live

on your computer with our free

simulation software.

You can nd more information at:

WEINMANN-Emergency.com

European Resuscitation Council Guidelines 2021

https://cprguidelines.eu/

Advanced Life Support

Give high-quality chest

compressions and

• Give oxygen

• Use waveform

capnography

• Continuous

compressions if

advanced airway

• Minimize interrup-

tions to compressions

• Intravenous or

intraosseous access

• Give adrenaline every

3-5 min

• Give amiodarone

after 3 shocks

• Identify and treat

reversible causes

Identify and treat

reversible causes

• Hypoxia

• Hypovolaemia

• Hypo-/hyperkalemia/

metabolic

• Hypo-/hyperthermia

• Thrombosis - coronary

or pulmonary

• Tension pneumotho-

rax

• Tamponade-cardiac

• Toxins

Consider ultrasound

imaging to identify

reversible causes

Consider

• Coronary angio-

graphy/percutaneous

coronary

• Mechanical chest

compressions to

facilitate transfer/

treatment

• Extracorporeal CPR

After ROSC

• Use an ABCDE

approach

• Aim for SpO2 of

94-98%

• 12-lead ECG

• Identify and treat

cause

• Targeted temperature

management

Page is loading ...

Weinmann MEDUMAT Standard² Ventilator Operating instructions

Brand: Weinmann

Model: MEDUMAT Standard² Ventilator

Type: Operating instructions

Download PDF

report

Weinmann MEDUMAT Standard² Ventilator Operating instructions

Weinmann MEDUMAT Standard² Ventilator Operating instructions

Related papers

Other documents