2/26/2018 DOCA3667B Pro Series Operating Manual.doc 14 of 22
GETTING STARTED
A TYPICAL USAGE SCENARIO
The Model 2002
PRO
/2002IE
PRO
is a time cycled volume ventilator with an adjustable pressure
limit. The more you understand of the ventilator, how it works, and what it does in response to
your settings, the more comfortable you will be with it. It will feel "right" to change a setting and
get what you want from the ventilator.
Making the initial settings:
What are you going to do first? If this is your first ventilator, you've probably spent many an
hour bagging patients that required IPPV. You are, by now, comfortable doing that. Let's setup
the ventilator to "bag" a patient as you would bag one yourself. If you are convinced the
ventilator is bagging the patient, as you would be, you can feel comfortable with what the
machine is doing.
When you bag a patient, you're careful not to over inflate the lungs. You have a feeling as to how
hard to squeeze the bag. Your feelings have grown out of experience: checking the chest wall
excursion and correlating that with a reading from the airway pressure manometer on the
anesthesia machine. In general, for a healthy patient, the peek inspiratory pressure (PIP) should
be kept in the range of 15-20 cm H
2
O. Patients with more compliant lungs may even require less
pressure for adequate ventilation and visa versa.
After induction and intubations, when it is time to start IPPV, set the VOLUME controls fully
clockwise to the minimum setting. These controls are needle valves regulating inspiratory flow,
with no or very little flow you will deliver no or a very small tidal volume (TV). Set the
maximum working pressure limit (MWPL) control to about 20 cm H
2
O. The airway pressure will
not exceed this setting regardless of what you do with the other controls. Connect the ventilator
to the breathing system (BS) as discussed in the Set-up Procedure, fill the bellows by turning up
the fresh gas flow until the bellows reaches the top of the bellows housing. Turn the ventilator
on. Set the RATE control to an appropriate rate for the patient.
There will be a pause before the first inspiration. Watch the chest wall excursion and the airway
manometer as you would when you bag. Since we have started with the inspiratory flow very
low, the first TV delivered will be too small to generate sufficient airway pressure.
Consequently, the Low Breathing System (LO BSP) alarm will sound -- don't be alarmed. Now,
increase the VOLUME controls breath by breath, a little at a time, until the chest wall excursions
and PIP reach levels that you would seek to achieve while bagging. At this point you can be
comfortable that the ventilator "is squeezing the bag" as you would be.
Trimming the settings as the case proceeds:
At this point the ventilator is delivering an inspiratory flow, determined by your setting of the
VOLUME controls, for a time as calculated from your setting of the RATE control. This flow for
a time results in a volume delivered to the bellows assembly that "squeezes the bag", I mean
bellows, displacing the mixed gas within to the patient.
This delivery to the patient, these TVs at the set rate, results in the overall minute ventilation
(MV). It is the proper MV that must be delivered to the patient in order to maintain proper blood
gas and pH levels.
This MV can be delivered in many ways from a few large TVs to a lot of small TVs. The most
optimum combination is up to you to determine just as you would while bagging.
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