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• 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
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
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
2
, 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
i
. MEDUMAT Standard
2
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 = 79.52kg
ml
Vt = 79.52 kg • 6 kg = 477 ml 480 ml
NIV therapy
Switch on ventilator.
1
Select “New patient” in the start
menu.
2
Set the patient’s height and gender or
select the appropriate patient group:
Adult, Child, Infant.
3
Select the desired CPAP therapy using
the navigation knobs: PEEP, pMax,
ΔpASB. After adjusting the values,
begin the ventilation via “start”.
5
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.
6
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).
4
Modied 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 insufciency 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 insufciency (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 insufcient SpO2 increase: .......................... 7 – 10 mbar
In the case of insufcient 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 insufcient tidal volume:
Pressure support: ....................................... Increase gradually (up to max. 20 mbar)
In the case of pronounced ventilatory insufciency: ................... 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. 3l/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 = 5mbar, ΔpASB = 10mbar inspiration pressure in the inhalation phase = 15mbar
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
Time
Max. 4s
Flow
80% Flowmax
0%
100%
5%
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) denes 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.
<0.2seconds:
steep
Approx. 0.2seconds:
medium
Approx. 0.4seconds:
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
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.
1
2
3
Following successful intubation, switch
to continuous ventilation “CPR IPPV”.
Check the ventilation parameters.
During the cardiac rhythm analysis or
debrillation, select “pause” to pause
the ventilation.
Following successful debrillation, if
applicable, press “pause” again to
restart the ventilation. The ventilation
will start automatically after at most
50seconds.
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.
4
5
6
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.
1
2
3
4
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.
5
6
If a chest compression device is being
used, this will need to be specied 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.
7
8
9
10
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
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