Engler ADS 2000 - Using the Fill; Hold Feature; Managing Patient Bucking

USING THE FILL / HOLD FEATURE
1. FILL / HOLD fills the chest to the selected pressure and then maintains that
pressure, i.e., it does not allow exhalation until the button is released. FILL /
HOLD can be used to induce a patient as described below in the section
BUCKING THE ADS
2. FILL / HOLD can also help during closure of thoracotomy incisions. Simply press
the FILL / HOLD and hold it until the lungs are filled. The lungs will fill to the
preset parameter and will remain inflated AT THAT PRESSURE until the button
is released. There is some hysteresis, i.e. the pressure is allowed to fall 3 cm.
H
2
O before the chest is refilled.
Caution: Overzealous hyperinflation of previously collapsed areas of the lungs can
cause pulmonary damage.
For this reason it is best to inflate the lungs at the lowest possible P.I.P. value,
(around 10 cm. of H
2
O) and for the shortest time necessary (a few seconds) when
the chest is open.
RESISTING (BUCKING) THE ADS
1. If the patient is not in a deep enough plane of anesthesia it may attempt to buck
the ADS 2000. You will see very short inspiration times and violent attempts to
inhale and exhale. There are several practical solutions to this problem.
a. Patient may require additional medication, on doctors orders. (For example
intravenous drugs).
b. SET THE VAPORIZER TO 4 OR 5 PERCENT. Then press FILL / HOLD and
keep the button depressed for a second or two. Release, then repeat. Do this
until the patient relaxes, then RESET THE VAPORIZER and allow the ADS
2000 to take over.
c. Set the Assist value to a more sensitive value (i.e. a smaller negative number,
-2.0 is more sensitive than -4.0), turn the vaporizer to 3 or 4 percent. The patient
will usually ventilate himself down. The Minute Volume number may go up for a
few breaths.
3. Once the patient is stabilized, the settings can be adjusted (if necessary).
ADS 2000 Engler Engineering Corporation 19