GE Healthcare Non Invasive Ventilation (NIV) For the Engström Ventilator Relief, Relax, Recovery
COPD is currently the fourth leading cause of death in the world, and further increases in the prevalence and mortality of the disease can be predicted in the coming decades. 1 NIV has gained the dignity of first line intervention for acute exacerbation of chronic obstructive pulmonary disease (COPD), assuring reduction of the intubation rate, rate of infection and mortality. 2 One of the major conceptual advantages to NIV (both CPAP and BIPAP) is that the need for endotracheal intubation is avoided. This, in turn, should translate into better comfort (and, thus, less sedation) as well as a reduced risk of ventilatorassociated pneumonia (VAP) and tracheal injury. 4,3 Relief The implimentation of NIV plays an important role in the treatment of patients suffering from impending respiratory failure, supporting patients though a critical time. NIV might also facilitate endotracheal tube removal by supplying respiratory support in those who still need it (ie, failing the first weaning step), but who can protect their airways and clear secretions (ie, succeeding the second weaning step). 4,5 The possible benefits of NIV on respiratory function are improved oxygenation and alveolar ventilation and reduced work of breathing. 6 This offers clinicians time to stabilize a patient without the requirement of the placement of an artificial airway. Relax With the implementation of NIV, a patient s spontaneous ventilation is supported. As the patient initiates a breath, a level of support is delivered. This level of support may decrease the work of breathing of the patient, easing the patient s respiratory effort. The clinician can be guaranteed a minimal level of support through the use of a minimal rate requirement. Recovery Patients can be weaned from the support of NIV, and then monitored for signs of stabilization or future impending ventilatory failure. This can be achieved through the use of the Monitoring mode and CO 2 analysis offered with the Engström Carestation. In the event the patient is not able to wean, or requires intubation, the Engström can quickly be set up to deliver invasive ventilation.
Help increase patient comfort with an advanced NIV mode The newest innovations on the Engström Carestation include non invasive ventilation with a new and unique algorithm allowing for variable breathing patterns and periods of rest, prior to the initiation of backup ventilation. Ease of use Available in Adult or Pediatric modes, making the Engström an NIV specific ventilator Easy, on-screen visual identification utilizing an NIV icon (screen color/mask) Straightforward, adjustable user interface and centralized, logical display of data Synchronization Leak Management and triggering, utilizing Pressure and Flow as inspiratory triggering mechanisms to avoid auto triggering Introducing a new and unique algorithm allowing for variable respiratory rates and periods of rest, prior to the initiation of backup breaths Patient can remove breathing interface, for a clinician set period of time, with out the occurrence of alarms. This allows the patient the convenience of conversation and adjustment of the mask. Two needs, one universal machine In the event your patient s ventilation requirements rapidly change, the Engström can quickly provide invasive ventilation Incorporation of NIV allows hospitals to reduce costs by standardizing assets Simplified, intuitive interface allows for easy recognition of patient data
NIV Parameters and Settings Control and Ranges (Adult/Pediatric) FiO 2 : 21 to 100% O 2 PEEP: 2 to 20 cm H 2 O (increments of 1 cm H 2 O) P supp : Off to 30 cm H 2 O (increments of 1 cm H 2 O) Pressure Trigger: Flow Trigger: T supp : -10 to -.25 cm H 2 O -10 to -3 cm H 2 O (increments of 0.5 cm H 2 O) -3 to -0.25 cm H 2 O (increments of 0.25 cm H 2 O) 1 to 9 L/min 1 to 3 L/min (increments of 0.1 L/min) 3 to 9 L/min (increments of 0.5 L/min) 0.25 to 4 sec 0.25 to 1 sec (increments of 0.05 sec) 1 to 4 sec (increments of 0.1 sec) End Flow: 5 to 80% (increments of 5%) Rise Time: Bias Flow: Minimum Rate: 0 to 500 ms (increments of 50ms) 8 to 20 L/min (increments of 0.5 L/min) 0 to 40 breaths per minute (increments of 1 breath) Back up P insp : 1 to 30 cm H 2 O (increments of 1 cm H 2 O) Back up T insp : 0.25 to 5 sec 0.25 to 1 sec (increments of 0.05 sec) 1 to 4 sec (increments of 0.1 sec) 4 to 5 sec (increments of 0.25 sec) Trigger and End Flow Leak Compensation: Up to 50 L/min (Adult) Up to 30 L/min (Pediatric)
ncpap Software includes ncpap option (available with neonatal option) Expectations meet simplicity For sick babies, the early hours of life are usually characterized by the need for respiratory or circulatory support. Premature babies are especially likely to have respiratory problems because their lungs have not had enough time to develop before birth. Such respiratory problems can include decreased pulmonary compliance, decreased functional residual capacity (FRC) and airway closure 6. Customers utilizing the Neonatal capabilities of the Engström Carestation will be able to access a ncpap mode, with the institution of the NIV option. In this mode, nasal CPAP is delivered with out the use of the neonatal flow sensor. The use of ncpap will allow for a variation in patient interfaces to be used. Simple settings easy to read user interface The new ncpap menu parameters are basic and simple on the Engström. With the implementation of the simplified user interface and larger numeric display, you can easily assess your patients condition from across the NICU. ncpap Parameters and Settings Control and Ranges FiO 2 : 21 to 100% O 2 PEEP: Off, 2 to 15 cm H 2 O (increments of 1 cm H 2 O) Bias Flow: Pressure Trigger: Flow Trigger: 2 to 20 L/min (increments of 0.5 L/min) -10 to -.25 cm H 2 O -10 to -3 cm H 2 O (increments of 0.5 cm H 2 O) -3 to -0.25 cm H 2 O (increments of 0.25 cm H 2 O) 0.2 to 9 L/min 0.2 to 1 L/min (increments of 0.05 L/min) 1 to 3 L/min (increments of 0.1 L/min) 3 to 9 L/min (increments of 0.5 L/min) Leak Compensation: Up to 10 L/min
References: 1. Pauwels RA, Buist AS, Calverley PMA, Jenkins CR, Hurd SS, on behalf of the GOLD Scientific Committee. Global strategy for the diagnosis, management and prevention of chronic obstructive lung disease. NHLBI/WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001; 163: 1256-1276. 2. Antonelli M, Pennisi MA, Montini L. Clinical review: Noninvasive ventilation in the clinical setting - experience from the past 10 years. Crit Care. 2005; 9(1): 98-103. 3. Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med. 2001; 163: 540-577. 4. MacIntyre N. Mechanical Ventilation: Noninvasive Strategies in the Acute Care Setting. 32nd Critical Care Congress of the Society of Critical Care Medicine. 5. ACCP/SCCM/AARC Task Force. Evidence based guidelines for weaning and discontinuing mechanical ventilation. Chest. 2001; 120 (6 suppl): 375S-395S. 6. Duke G.J., et al. Non Invasive ventilation for adult acute respiratory failure. Part 1. Critical Care and Resuscitation 1999; 1: 187-198. Additional reading: 1. Schmidt GA. Mechanical ventilation: noninvasive strategies in the acute care setting. Indications for noninvasive ventilation acute care. Program and abstracts of the 32nd Congress of the Society of Critical Care Medicine; January 28-February 2, 2003; San Antonio, Texas. 2. Ferrer M, Valencia M, Nicolas JM, et al. Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial. Am J Respir Crit Care Med. 2006; 173: 164-170. 3. World Health Report. World Health Organization, Geneva. 2000. Available from URL: http://www.who.int/whr/2000/en/statistics.htm. 4. Plant PK, Owen JL, Elliott MW. One year period prevalence study of respiratory acidosis in acute exacerbations of COPD: implications for the provision of non invasive ventilation and oxygen administration. Thorax 2000; 55: 550-554. 5. Hammer J. Nasal CPAP in preterm infants does it work and how. GE Healthcare Intensive Care Med 2001; 27: 1689-1691. P.O. Box 7550 Madison, WI 53707-7550, USA Tel. 800-345-2700 www.gehealthcare.com/respiratorycare 2008 General Electric Company All rights reserved. GE and GE Monogram are trademarks of General Electric Company. Carestation is a registered trademark of Datex-Ohmeda, Inc. Datex-Ohmeda, Inc., a General Electric company, doing business as GE Healthcare. CC5073-A 6/08