SIMV/CPAP (PSV): PSV ends 30% peak insp flow or 5 sec

1
Bear 1000
Modes Controls Alarms
2
The Bear 1000 Ventilator
Graphics
Monitors
Alarms
PEEP
Controls
Flow Sensor
PA
NEB
Main Flow Filter
3
Monitors
PEEP
Alarms
Controls
Intermediate Model
4
Comprehensive Model
5
Bear 1000 Ventilator

• Flow controller
• Stepper motor to scissors valve controls flow
  (Flow Control Valve)
• Referenced to a pressure transducer
• Ventilator software compares the pressure signal
  and flow delivery to operator settings.
• Provides Pressure Augmentation
• Increased flow on demand (volume/flow
  augmentation)

6
Controls

• Modes
• Assist CMV
• SIMV-VC ( SIMV-PC on comprehensive model)
• CPAP PSV PSV ends 30 peak insp flow or 5 sec)
• Pressure Control
• Waveforms (peak flow set peak flow)
• Rectangular
• Descending (Flow ends at 50 Peak Flow)
• Sine

7
Control Panel
8
Controls
PS/PC
VT
RATE
FLOW
O2
SEN
P slope
MMV
IT
PAUSE
C COM
lock
SET
M. Breath Man Pause Exp Hold
100 Sighs P Aug
Modes
Waveforms
Neb
Assist CMV SIMV/CPAP Press Cont
9
Controls
RATE
O2
PS/PC
SEN
VT
FLOW
888
888
888
888
888
888
SET
lock
MMV
IT
PAUSE
C COM
P slope
888
888
888
888
888
M. Breath Man Pause Exp Hold
100 Sighs P Aug
Modes
Waveforms
Neb
10
Setting Controls
TIDAL VOLUME
SET
11
To Change Modes

• Current Mode pad indicator is lit
• Press new mode pad
• New mode pad will flash (still in old mode)
• All controls available in new mode will light
• The new values will be effective immediately upon
  changing the control, even if in use by current
  mode.
• Start with Pressure Slope of 0 and adjust by
  observing press waveform.

12
Changing Modes (Cont.)

• Set all alarms
• To activate new mode, press flashing mode key
• If flashing mode key is not pressed within one
  minute after changing the last setting, key will
  stop flashing and ventilator will remain in old
  mode.
• Use Alarm LOCK and Control LOCK keys - prevents
  controls and alarms from being inadvertently
  changed.

13
Controls
PS/PC
VT
RATE
FLOW
O2
SEN
P slope
MMV
IT
PAUSE
C COM
lock
SET
M. Breath Man Pause Exp Hold
100 Sighs P Aug
Modes
Waveforms
Neb
14
Flow Augmentation for Volume Breaths in CMV or
SIMV

• If patients inspiratory flow demand exceeds Peak
  Flow setting
• Proximal airway pressure will fall
• Patient will receive whatever flow needed
• Ventilator will continue to deliver flow until
  set tidal volume delivered

15
Flow Augmentation
Yes
NO
P
Flow
16
Volume Augmentation
Yes
NO
P
Flow
17
Controls
PS/PC
VT
RATE
FLOW
O2
SEN
P slope
MMV
IT
PAUSE
C COM
lock
SET
M. Breath Man Pause Exp Hold
100 Sighs P Aug
Modes
Waveforms
Neb
18
Pressure Augmentation

• Pressure Controlled ventilation with a guaranteed
  minimum tidal volume
• Does not limit tidal volume if patient demands
  more flow
• If target tidal volume not delivered by the time
  flow falls to the set peak flow level, switches
  to VC and remaining VT delivered at set peak flow
• For all machine breaths which may become volume
  guaranteed breaths

19
To Activate Pressure Augmentation

• Adjust Press Sup/Insp Pressure Level
• Select minimum Tidal Volume
• Press the Pres AUGMENT control to activate
• Adjust the High Pressure Alarm appropriately

20
Pressure Augmentation
Flow falls to set Peak Flow before target volume
delivered, switches to VC
Flow
Press
21
Pressure Waveform Variations
Set Insp Press
Set Peak Flow
Volume delivered or not at arrow
22
Pressure Slope

• Affects how fast the Flow Control Valve opens
• Determines how fast the inspiratory pressure
  level is reached

P
-9
9
23
Pediatric Setting for Pressure Slope

• PO zero
• P - 9 to P 9
• To be used with ETT lt 5 or 6 mmID and pediatric
  circuit

24
Pressure Slope Available in Breaths that are

• Pressure Supported
• Pressure Controlled
• Flow and volume augmented breaths with reference
  to baseline pressure
• Pressure augmented breaths with reference to PS
  or PC level
• Spontaneous breaths with reference to baseline
  pressure

25
Minimum Minute Volume (MMV)

• Use in SIMV or CPAP modes
• MMV must be gt SIMV minute volume
• In CPAP, MMV lowest acceptable VEspon
• Patient will receive SIMV breaths (or spontaneous
  breaths) as long as Total Minute Volume exceeds
  MMV level
• MMV Backup Rate MMV Level/ Tidal Vol
• MMV Active indicator will light
• MMV displays time of MMV during last 30 minutes

26
MMV Ends When
Total Min Vol gt MMV by 10 or 1LPM
MMV level
MMV
SIMV
SIMV
27
MMV Ends When
Total Min Vol gt MMV by 10 or 1LPM
MMV level
MMV
CPAP
CPAP
28
(No Transcript)
29
Monitors

• Exhaled Volume
• Rates/Ratio
• Pressures
• Indicator lights
• Controlled Breath
• Sigh Breath
• Patient Effort
• MMV Active

30
(No Transcript)
31
Controlled Sigh Pt Effort MMV Active
Total Spont IE Ratio MMV
Tidal Total MV Spont MV
Peak Mean Plateau
Pressures
Exh Vol
Rates/Ratio
MONITORS
32
Breath Type Indicators

• Controlled breath lights if machine breath
  delivered.
• Does not light for spontaneous or PS breaths
• Will light for sigh breath (so will Sigh
  breath) or for manual breath delivery
• If patient effort exerted when machine breath
  triggered, Patient Effort will also light.

33
MMV Active

• Lights continuously whenever the MMV backup rate
  is active.
• Used in SIMV or CPAP modes

34
Exhaled Volume

• Tidal Volume
• Total MV
• Spontaneous MV

Measured by exhaled flow sensor. Corrected for
patient humidity. VT reflects the most recent
breath. MV reflects averaged breaths.
35
Rates/Ratio

• Total
• Spont
• IE Ratio
• MMV

MMV displays the of time during the last half
hour that MMV backup rate was active. Provides 30
min averages.
36
Pressures

• Peak
• Mean
• Plateau

All pressures are proximal airway, including the
analog manometer. Mean displays the average
proximal airway pressure over the last 30
seconds.
37
(No Transcript)
38
Alarms

• Indicators (Factory Set)
• Time/IE Limit - Built-in alarm when IT 5 s
  Pause time. IE exceeds 11, ends insp
• Run Diagnostics - means a system error was
  detected. Error code displayed in Total MV when
  Test key pressed
• Gas Supply Failure
• lt 27.5 psig
• Failed to Cycle
• No ventilator or demand breath was delivered
• Cannot be alarm silenced
• Error code appears in Total Minute Volume display

39
Set Alarms for

• IE Override (ON or OFF)
• Total Minute Volume
• Total Breath Rate
• Peak Inspiratory Pressure
• Baseline Pressure

40
Time/IE Limit Run Diagnostics Gas
Supply/Failure Failed to Cycle
ALARMS
Alarm Silence
Visual Reset
Total Rate
Test
Total MV
Base- line P
PIP
IE Over
888
888
888
888
Dimmer
41
Setting Alarms
TOTAL MINUTE VOLUME
42
When Setting Alarms

• You have 15 seconds after pressing indicator key
  and indicator starts to flash.
• When alarm Set knob is turned, the adjustment
  period is extended.
• The new alarm setting takes effect immediately,
  even while the indicator flashes.

43
Leak Makeup

• Any leak in patient circuit detected by pressure
  transducer
• Delivers flow to maintain baseline pressure
  measured at proximal airway
• Maximum flow delivery is over 200 LPM

44
Summary

• In addition to the traditional modes, the Bear
  1000 has pressure augmentation and flow
  augmentation capabilities.
• Pressure slope allows shaping of the pressure
  waveform which can reduce the initial flowrate in
  PC and PS for patient comfort.