a short introduction how to use smartcare ® /ps for software revision 2.n under construction

A short introduction

How to use SmartCare®/PSFor Software Revision 2.n under c

onstruction

2014 08 SmartCare/PS (SW 2.n) - How-to-use 2 | 46

Table of contents

1. What is SmartCare/PS

2. Preparation

3. Operation

4. Monitoring SmartCare/PS

5. Ending SmartCare/PS

6. Configuration

7. Alarms and messages

8. Frequently Asked Questions

This presentation is an introduction into the usage of SmartCare/PS SW 2.n

Before using it on a patient, make sure you have read and understood the instructions for use.

SmartCare/PS in a nutshellOption for Evita V500/Evita V300 SW. 2.n

The SmartCare/PS system is an automated clinical protocol, designed to

– stabilize the patient's spontaneous breathing in a comfortable zone of normal ventilation and

– to automatically reduce the inspiratory support

– to perform an automatic spontaneous breathing trial

SmartCare/PS can be used for weaning intubated or tracheotomised patients with a body weight above 15 kg.

The patients should be ready for weaning, i.e., haemodynamically stable with adequate oxygenation and spontaneous breathing.


SmartCare/PS Requirements

In addition to standard criteria [1] for starting to wean, the following conditions have to be met:

– The decision to wean was made.

– The decision to wean in SPN-CPAP/PS was made.

– The decision to wean automatically through SmartCare/PS was made.

– The treating physician and/or person responsible for the treatment has deemed the patient to be hemodynamically stable.

– The patient's spontaneous respiratory rate is stable.

– The patient does not suffer from a severe chronic obstructive pulmonary disease (COPD).

– The patient does not suffer from any major neurologic disorders that influence the respiratory center.

– The patient has a body weight between 15 kg and 200 kg.

References: [1] MacIntyre NR and the writing committee and Task force of the American College of Chest Physicians. Evidence-Based Guidelines for weaning and discontinuing Ventilatory support. Chest 2001;120:375S-395S.


Table of contents


2. Preparation

3. Operation



6. Configuration




Before using SmartCare/PS

ImageH 4 cm x W 6 cm

Device is in the patient category adult or pediatric patients and in ventilation mode SPN-CPAP/PS

Patient is invasively ventilated (intubated or tracheotomized)

The following settings are required for patients with an ideal body weight of ≥36 kg:

– Endotracheal or tracheotomy tube

– Active humidifier or HME filter.

Patient's body weight between 15 kg and 200 kg.

Leakage compensation on.

CO2 sensor applied and CO2 monitoring on.

Flow monitoring on

Alarm limits appropriately set


Before using SmartCare/PS: Set ATC (Automatic Tube Compensation)

For patients with a body weight ≤ 35 kg, deactivate ATC in the »Ventilation settings« menu

For patients with a body weight > 35 kg, ATC can be used with 100 % compensation


Before using SmartCare/PS: Activate Apnea ventilation

In the »Ventilation settings« menu

– Touch the keys »Additional settings« Apnea Ventilation...«

– Evita V500 displays the menu for setting the apnea ventilation

– Touch the screen key »On«, and press the rotary knob to confirm

– The status of apnea ventilation is displayed by Evita V500 on the main screen


Table of contents


2. Preparation

3. Operation



6. Configuration




Set SmartCare/PS Easy setup in just six steps

In the »Ventilation settings« menu select »SPN/CPAP/PS« and then »SmartCare«

The current settings are displayed

Subsequently follow the 6 tabs and enter the patient related values

Step 6 will activate SmartCare/PS

For body weight ≤ 35 kg, only the menu options »Patient«, »Night rest« and »Patient Session« are displayed

1 2 3 4 5 6


Set SmartCare/PS Step 1: Set Patient Weight

Touch the screen key »Patient« and use the rotary knob to set the patient‘s height

IBW (Ideal body weight) of the patient will be calculated.

In the pediatric patient mode the body weight is limited to 35 kg

1


Set SmartCare/PS Step 2: Set Airway access

Touch the screen key »Airway access«

SmartCare/PS compensates for the dead space and resistances added by different humidification and intubation types by adapting the PS goal

Set the intubation type either to “ET” or “Trach.”

Set the tube diameter

2


Set SmartCare/PS Step 3: Set Medical history

Touch the screen key »Medical history«

SmartCare/PS’s weaning protocol can adapt to the medical history of the patient

Set neurological disorder to “Yes” when treating patients with slightly increased breathing frequency up to 34 bpm due to neurological disorders

Set COPD to „Yes“ when treating patients with increased levels of etCO2 due to COPD

3


Set SmartCare/PS Step 4: Night rest

Touch the screen key »Night rest«

When »Night rest« is activated, SmartCare/PS will not actively reduce the PS for weaning purposes during the set period of time

Nevertheless, even during night rest the SmartCare/PS protocol will keep the patient stable, i.e. react accordingly to any of the 8 diagnoses

The time period can be modified at any time, including during night rest

4


Set SmartCare/PS Step 5: Change guideline

Touch the screen key »Change guideline«

Change »RRspon«, »VT/kg«, and »etCO2« when necessary

Changes will be active by confirming with »Yes«

Note: these changes will “overwrite” all settings, done before

5


Set SmartCare/PS Step 6: Activate SmartCare/PS

Touch »Patient Session« screen key SmartCare/PS is now ready for

weaning To start a patient weaning session

with SmartCare/PS press »On« and confirm with the rotary knob

6


SmartCare/PS is now active

»SmartCare« and the symbol » « appears in the upper part of the screen.

The following settings cannot bechanged when SmartCare/PS is active:– Airway access– Medical history– ATC on/off– Apnea ventilation on/off– Date/time– »Tube« mode

PS can be changed by the user at any time.


Typical sequence of a patient session

SmartCare/PS first attempts to stabilize the patient's spontaneous breathing by adjusting the pressure support

“Adapt”: Pressure support is regularly adapted to the patient's respiratory profile

“Observe”: When pressure support reaches a minimum value SmartCare/PS starts a spontaneous breathing trial (SBT)

“Maintain”: When the SBT concluded successfully, the system displays a recommendation to disconnect the patient from Evita V500 and continues to keep the patient stable


Table of contents


2. Preparation

3. Operation



6. Configuration




SmartCare/PS Monitoring Full transparency

Evita V500 / Evita V300 displays the actions taken by the SmartCare/PS protocol fully transparent to the user

Separate views can be used and configured, like: Values, Logbook, Trend pages


SmartCare®/PS Monitoring Displaying 1-hr trend

Display 1 hr trend

Touch »Main« »Trends« screen key

EvitaXL displays the menu for selecting parameters for trend display

If SmartCare®/PS is available, EvitaXL will additionally offer the parameters »Diagnosis« and »SC-PSupp.«

Touch the parameter key »Diagnosis«

Evita V500 displays the trend profile for the last hour

1

12

3


der Screen fehlt mir

SmartCare®/PS Monitoring Displaying 1-hr trend

To display the diagnosis for a particular moment in time:

Turn the rotary knob to position the cross-hair cursor over the required point.

EvitaXL displays the diagnosis at the top of the trend display.

The cross-hair cursor cannot be moved if the trend has been frozen via

Inspiratory support is maintained or increased.

The patient is being weaned.

The patient is hyperventilated, inspiratory support is being reduced.


der Screen fehlt mir

SmartCare/PS Monitoring Displaying Measured Values and Settings

Touch »Data...« »SmartCare« key

The status of the current patient session and the set patient data are displayed

The values for SC-RRspon, SC-VT and SC-etCO2 are mean values between the individual ventilation classes

1

2

2014 08 SmartCare/PS (SW 2.n) - How-to-use 23 | 46 der Screen fehlt mir

SmartCare/PS Monitoring Displaying Logbook

Touch the keys »Logbook« »SmartCare«.

Changes, events and alarms in the patient session are listed in a table with the date and time of occurrence.

If PS was modified by the user, Evita V500 displays the new value with the symbol » * «

When changing to the trend or basic page, the same point in time is displayed with the corresponding data.

Logbook data are retained until the next patient session starts.


SmartCare/PS Monitoring Displaying Trends

Select »Trends« »SmartCare«

Evita V500 displays the trends for »Diagnosis« and »SC-ΔPS«

The possible diagnoses are listed beside the scale on the right. The current ventilation diagnosis is highlighted in color

Select time scale in increments of 30 minutes, 1, 2, 4, 8, 12 hours, 1 day, 7 days

Displaying trend values at a specific point in time, turn the rotary knob to position the cursor on the point in time or touch the point in time.


Table of contents


2. Preparation

3. Operation



6. Configuration




SmartCare/PS indicates successful weaning with

» SC: SBT successful « and the symbol » «

Following the decision made by the treating physician and/or person responsible for the treatment, disconnection of the patient from the device may be considered.

Ending SmartCare/PS


Ending SmartCare/PS

2

3

Ending a patient session in the »Ventilation settings« menu

– Touch keys »SmartCare« »Patient Session« »Off«

– Press rotary knob to confirm

– The patient session is ended

– After a patient session has been manually ended, Evita V500 continues ventilation with the last ΔPsupp setting

– After a patient session has been terminated, the course data (e.g. SC trend and SC logbook) is retained until a new patient is entered


1

Table of contents

1. What is SmartCare®/PS

2. Preparation

3. Operation

4. Monitoring SmartCare®/PS

5. Ending SmartCare®/PS

6. Configuration

7. Alarms and Messages



ConfigurationConfigure displayed values

The display of measured values can be configured to show SmartCare®/PS related values

– Press the keys »System Setup« »Screen« »Values...«

– Select the desired group of values

– Evita V500 displays the menu for selecting the parameter

– Specific parameters can be selected for SmartCare/PS

– These parameters can only be displayed as individual values

1

32

2014 08 SmartCare/PS (SW 2.n) - How-to-use 30 | 46 der Screen fehlt mir

Table of contents


2. Preparation

3. Operation



6. Configuration




!Note

!!Caution

!!!Warning

Alarms and messagesPriority of alarms

High-priority alarm message

Immediate action is required to avert acute danger


Different background colors indicate the priority levels of the alarms. The priority of the alarm messages is also indicated in the tables for Current alarms and Alarm history by exclamation points.

Medium-priority alarm message

Prompt action is required to avert danger

Low-priority alarm message

Attention is required, delayed response is sufficient

Messages and Related ActionsSuspension of a Patient Session

"Running patient session suspended. SmartCare/PS waiting for the end of the condition that caused the suspension."

» SmartCare« is displayed in the header bar of the screen

SmartCare/PS waits for the end of the condition that causes the suspension and does not change the pressure support level during this time. When the condition ends, SmartCare/PS starts to collect data again and resumes classification and control of the pressure support level

"Deactivates the patient session and Evita V500 continues ventilation“

Cannot be influenced by the user


Messages and related actionsSuspending conditions


Troubleshooting I


Troubleshooting II


Table of contents


2. Preparation

3. Operation



6. Configuration




FAQ

Is SmartCare/PS failsafe, because it alters the pressure on its own?

– SmartCare/PS is an independent add-on to Evita V500/V300 and does not alter the safety mechanisms built into the ventilator. All alarm limits reactions based on the severity of alarms remain untouched.

– Therefore, we recommend setting the following alarm limits before starting a patient session:


Parameter Alarm limit

MV low –25 % of current MV

MV high 25 % of current MV

RRspon high 40/min with body weight ≥ 36 kg

60/min with body weight ≤ 35 kg

VT low 4 mL/kg body weight

VT high 12 mL/kg body weight

Paw 42 mbar with body weight ≥ 36 kg

etCO2 low 29 mbar with body weight ≤ 35 kg

etCO2 high 18 mmHg

etCO2 high 57 mmHg (without COPD)

67 mmHg (with COPD)

FAQ

What if my patient goes apneic?

– The Evita V500 ventilator’s apnea ventilation will kick in as backup ventilation in case of an apnea episode with the tidal volume and frequency you have set.

– In this case the caregiver is notified and the patient session is ended.


FAQ

Can I use any humidifier?

– For patients with body weights >35 kg, any active humidifier or passive heat-moisture-exchanger (HME) can be used

– For patients with body weights <= 35 kg, only active humidification can be used


FAQ

Can I use SmartCare/PS at night to keep the patient stable, but not to wean?

– SmartCare/PS comes with the function “Night rest”

– You can set a time period during which the patient will be kept stable by the system in the comfortable zone of normal ventilation, but with no weaning off the ventilatory support

– If necessary, the system will increase the Pressure Support during night rest

– Weaning will automatically commence after the night rest period has ended


FAQ

What if SmartCare/PS recommends “SC: SBT successful”, but no decision maker is available?

– SmartCare/PS will enter the „Maintain” phase and keep the patient ventilated on the lowest level of Pressure Support

– Should the patient develop instabilities or require higher levels of support pressure SmartCare/PS will stabilize the patient according to the protocol

– Should instabilities persist, SmartCare/PS will switch back to the “Adapt” phase


FAQ

Is SmartCare/PS affected by the usage of nebulized drugs?

– As long as the etCO2 and flow sensors are not rendered inoperable by excessive amounts of nebulized drugs, SmartCare/PS is not affected.


FAQ

What happens during bronchial suctioning?

– Endotracheal suctioning can be performed as often as necessary without having to activate any special procedure.

– However, it is highly recommended that the suction function of Evita V500 will be used with pre- and post-oxygenation.

– This allows SmartCare/PS to detect reactions to suctioning, so that respiratory changes are not considered as instabilities with subsequent actions based on the protocol.


FAQ

Can I change the Pressure Support level during a SmartCare/PS patient session?

– Yes

– The Pressure Support level can be altered manually at any time

– SmartCare/PS will continue with the current phase with the new Pressure Support level


Thank you foryour attention.

a short introduction how to use smartcare ® /ps for software revision 2.n under construction

Documents

monitoring smartcareps

smartcareps requirements

smartcareps system

usage of smartcareps

smartcareps image h

patients body weight

patients spontaneous

pediatric patients