NASSER EL SHAAER1 بسم الله الرحمن الرحيم يأيها الناس اذكروا نعمت الله عليكم هل من خالق غير الله يرزقكم من السماء

NASSER EL SHAAER 1

الرحمن اللهبسم الرحيم

هل عليكم الله نعمت اذكروا الناس يأيهاو السماء من يرزقكم الله غير خالق من

تؤفكون فأنى هو اال اله ال االرض

NASSER EL SHAAER 2

VentilatorVentilator

NASSER EL SHAAER 3

Contents :Contents :• Introduction• Definition• Ventilator types• Classification of ventilators• Most common modes and parameters• New models of ventilators• Prices of some ventilators• Theory of operation

NASSER EL SHAAER 4

ContentsContents• Pneumatic component• Regular PPM• Trouble shooting• Required calibration• Most common spare parts• The safety

NASSER EL SHAAER 5

IntroductionIntroduction

• Mechanism of breathing :• In the inspiration the ribs are elevated,the diaphragm contracted and

flattened,and the chest cavity is enlarged.The resultant increase in volume of chest cavity and lungs causes the air pressure in the lunge to fall below atmospheric pressure ,air rushes in through the air passage ways to equalize the pressure

• In the expiration the muscles relax ,the ribs and diaphragm return to their original position,the elastic lunge then contract and force the air out

NASSER EL SHAAER 6

IntroductionIntroduction

• Gaseous exchange in lunge

• The pressure of oxygen in the lunge alveoli is greater than it is in lung capillaries oxygen then naturally diffuses into the capillaries

• In similar manner the carbon dioxide in the blood of the lung capillaries has a higher concentration than has this same gas in the lung alveoli

NASSER EL SHAAER 7

Definition Definition

• Mechanical ventilation is required when a patient's spontaneous efforts are unable to sustain adequate ventilation of the lungs

• Ventilators perform one of the most complex functions of the body-ventilation, a process in which the lungs take in and disperse oxygen the body needs and gather up and expel the carbon dioxide created as a result of body functions. In healthy people, this gas exchange takes place in the small air sacs of the lungs, called alveoli, and, in the course of one day, normally involves 8,000 to 9,000 liters of air breathed in through the nose or mouth and 8,000 to 10,000 liters of blood pumped through the lungs by the heart

NASSER EL SHAAER 8

DefinitionDefinition

• What patient want from the ventilator:• 1- pure gas:

• It happens by bacteria filter in the ventilator

• 2-gas with more oxygen:• Because the patient may have problem in the alveoli ,the ventilator

supply air and oxygen not air only

• 3-gas with suitable temperature :• It happens by humidifier

NASSER EL SHAAER 9

Definition Definition

• 4- moisture gas :• We can not give the patient dry gas,so the gas must pass through

humidifier

• 5-gas with controlled flow:

• It happens by proportional solenoid valve :

• 6-Patient may required medication

• It happens by nebulizer

• 7-GET RIDE OF THE EXPIRED GAS (infection ):• It happens by bacteria filter

• 8-safety:

NASSER EL SHAAER 10

Ventilator TypesVentilator Types

• Negative pressure :• Device that applied this "negative-pressure" principle was the iron lung, which

was widely used in the united states from the late 1920s into the 1950s, particularly for polio patients. However, these devices were large, and they greatly restricted patient movement

• Positive pressure :• In the late 1950s, "positive pressure" ventilators, which force air into the

lungs, were introduced

• Most ventilators today are computer-controlled, functioning in complex ways to produce positive-pressure ventilation that more closely matches patients' breathing needs

NASSER EL SHAAER 11

Ventilator TypesVentilator Types

• Invasive• Until about the early 1990s, modern ventilators required an artificial airway,

usually a tube placed through a hole surgically created into the patient's throat or a tube passed through the patient's nose or mouth

• None invasive• More recently, noninvasive positive-pressure ventilators that allow for gas

exchange through a face or nose mask have become popular

• High frequency

NASSER EL SHAAER 12

ClassificationClassification

• According to control :• Pressure control - volume control - flow control - time control

• According to place :• ICU - home care - anesthesia

• According to state :• Invasive - none invasive

• According to triggering :• Pressure - flow

• According to cycle :

• Pressure cycle-volume cycle-time cycle

NASSER EL SHAAER 13

Most Common Modes Most Common Modes And ParametersAnd Parameters

• CMV:controlled mandatory ventilation :• Breaths are delivered at preset intervals, regardless of patient effort

• SIMV:synchronized intermitted mandatory ventilation :• Ventilator delivers preset breaths in coordination with the respiratory

effort of the patient,and spontaneous breathing is allowed between breaths

• CPAP:continuous positive airway pressure :• The patient breath spontaneously in this mode ,The patient must

trigger in this mode

NASSER EL SHAAER 14

Most Common Modes Most Common Modes And ParametersAnd Parameters

• Peep:positive end-expiratory pressure

• TV:tidal volume

• Minute volume

• Respiratory rate

• Sigh

• I/E ratio

NASSER EL SHAAER 15

New ModelsNew Models

• Bennetic• 7200 -7400

• Drager• Dura - evita - evita 2 -evita 4

• Gallilio

• Ohmeda

• Siemens

NASSER EL SHAAER 16

Prices Of Some ModelsPrices Of Some Models

• Siemens :• 299,000 LE

• Drager :• 220,000 LE

• Gallilio• 250,000 LE

• SLE - high frequency for(children)• 240,000 LE

• SLE- for (children)• 95,000 LE

NASSER EL SHAAER 17

Theory Of OperationTheory Of Operation

• Inspiration :• Expiratory valve is closed

so all the airflow delivered to the patient

patient

Expirationvalve

NASSER EL SHAAER 18


• Expiration

• Expiratory valve is open so all the air flow inside the lung will leave the lung

patient

Expirationvalve

NASSER EL SHAAER 19


• Ventilator :• It consist of two major systems

• 1- the pneumatic system 2- the electrical system

• The pneumatic system ,under control of the microprocessor in the electrical system

• The primary pneumatic system consist of two parallel circuits one for oxygen and one for air,solenoid valves

• An important element of the pneumatic system is two solenoid valves (psols) which control the flow delivered to the patient

• Air and oxygen flow sensors provide feed back , which is used by microprocessor to control the psols

NASSER EL SHAAER 20


• The electrical system

• It includes a card cage , housing for six printed board (pcbs)

• Initial instructions and data for microprocessor use are entered by the operator via the ventilator keyboard , the data is then stored in the ventilator memory , the microprocessor uses the stored data to control and monitor the desired flow of gas to the patient system

NASSER EL SHAAER 21


• Function of the ventilator relies on interaction of the following systems

• Two gas supply

• A pneumatic system

• A patient service system

• A keyboard display panel

• Microprocessor electronic

NASSER EL SHAAER 22


OperatorKeyboard

displaypanel

Microprocessorelectronic

Pneumaticsystem

Patient servicesystem

patient

Gas supplysystem

NASSER EL SHAAER 23


REGULATOR MIXER CONTROLLER

SAFTY&

INFECTION

PEEPCONTROL

EXHALATIONCONTROL

NASSER EL SHAAER 24

Theory Of OperationTheory Of Operation Major Components Of The Major Components Of The

Pneumatic SystemPneumatic System

O2 SupplyRegulation

Air SupplyRegulation

InternalCompressor

FlowSensor

ProportionalValve

NebulizerSolenoid

FlowSensor

ProportionalValve

NebulizerSolenoid

CheckValve

SafetyValve

PEEPRegulator

ExhalationSolenoid

ExhalationValve

FlowSensor

HeatedFilter

WallOxygenSupply

WallAir

Supply

From PatientSystem

To PatientSystem

To Nebulizer

NASSER EL SHAAER 25

Theory Of Operation Theory Of Operation Pneumatic Pneumatic

ComponentComponent

• Pneumatic system consist of :

• Wall gas supply system:• Delivers air and oxygen from external

supplies to the ventilator and regulates the gas pressure usable by the ventilator

• Water trap and filter (F1,F3)

• Inlet filter (F2,F4)

• Pressure switch (PS1,PS2)

• Check valve (CV1,CV2)

• Regulator (REG1,REG2)

• Cross-over solenoid valve (SOL3)

• Pilot pressure outlet filter (F7)

NASSER EL SHAAER 26


ComponentComponent

• Motor compressor system :• Supply air to the ventilator if source

pressure is below 35 PSIG

• Inlet filter (F5)

• Inlet silencer

• Compressor

• Outlet filter (F6)

• Heat exchanger

• Back pressure regulator (REG3)

• Unloading solenoid valve (SOL9)

• Pressure switch (PS3)

• Check valve (CV4)

• Pulsation damper . air silencer

NASSER EL SHAAER 27


ComponentComponent

• Flow control system :• Include component that filters,mix ,and

monitor gas parameters in ventilator• Screen filter (F10,F11) .Flow

and temperature sensors(q/t)• Proportional solenoid valves(psol)• Nebulizer solenoid valve (SOL1,SOL2)• Absolute pressure transducer (p2)• P2 inlet damping restrictor (R5)• Differential pressure transducer (DP)• DP autozero solenoid valve (SOL6)• BUV pressure switch (PS4) .Pressure

restrictors (R6,R7)• Exhalation pilot pressure check valve

(CV6)• Pilot pressure check valve (CV7)

NASSER EL SHAAER 28


ComponentComponent

• Exhalation system :• Filter and monitors the flow of the patient s

exhaled gas • Bacteria filter heater• Exhalation bacteria filter• Peep/cpap system :• Regulator (REG5) .Solenoid

valve (SOL7)• Adjustable restrictor (R3)• Jet venturi (JV) .Damping

restrictor (R4)• Filter (F8) .Air

capacitor• Pressure transducer (P1) .Solenoid

valve (SOL8)• Exhalation pilot control solenoid valve (SOL4)

NASSER EL SHAAER 29


ComponentComponent

• Safety valve system :• Vents excessive ventilator pressure

• Back pressure regulator (REG4)

• Pilot restrictors (R1,R2)

• Solenoid valve (SOL5)

• Safety valve /check valve (SV/CV3)

• Patient system:• Include external component that deliver

gas from the ventilator to the patient

NASSER EL SHAAER 30

NASSER EL SHAAER 31

PPMPPM

• 1-inspect exterior of equipment for damage or missing hardware

• 2-inspect the power cord,strain relief and plugs for any signs of damage

• 3-turn unit off,open user accessible covers and inspect unit for damage

• 4-clean unit interior components and exterior with vacuum or compressed air

• 5-clean compressor ,fan and filters

• 6-inspect interior for signs of corrosion or missing hardware.Repair as required

• 7-inspect electrical components for signs of excessive heat or deterioration

NASSER EL SHAAER 32

PPMPPM

• 8-inspect all tubing and hoses for crimping or cracking

• 9-verify operation of high and low alarms for correct trigger and response time

• 10-cycles alarms and verify correct operation of audio and visual indicators

• 11-perform manufacturers recommended operational verification procedure

• 12-verify correct operation of all buttons,controls,displays

• 13- verify correct operation of unit in all functional modalities

• 14-clean exterior of unit including all accessories,cables,controls and displays

NASSER EL SHAAER 33

PPMPPM

• Daily :• Main flow and exhalation bacteria filter

• Gas supply water traps and filter

• Nebulizer or patient pressure bacteria filter

• Exhalation gas collector vial

• Every 250 hours• Cooling fan filter

• Every 2.500 and 10.000 hours• Ventilator ,all voltage and frequencies

• Annually :• Nebulizer bacteria filter,main flow bacteria filter replaced

NASSER EL SHAAER 34

Trouble ShootingTrouble Shooting

• 1-ventilator fails to cycle

• 2-high total breath rate

• 3-low total breath rate

• 4-nebulizer will not deliver flow

• 5-patient cant trigger an assist breath

• 6-ventilator will not power up

• 7-ventilator is turned on, all led illuminate,but no gas flow

• 8-loss of air supply pressure

NASSER EL SHAAER 35

Trouble ShootingTrouble Shooting

• 9-loss of oxygen supply pressure

• 10-high peak inspiratory pressure

• 11-low peak inspiratory pressure

• 12-low total minute volume

• 13-temperature high

• 14-loss of data

NASSER EL SHAAER 36

Required CalibrationRequired Calibration

• Calibration of BUV volumes

• Calibration of battery charger voltage

• Calibration of pressure

• Calibration of flow

• Calibration of volume

• Calibration of voltage

NASSER EL SHAAER 37

Calibration Calibration Recommended Tool And Test EquipmentRecommended Tool And Test Equipment

NASSER EL SHAAER 38

Most Common Spare PartsMost Common Spare Parts

• Filters• Patient pressure

• Main flow

• Nebulizer

• Exhalation

• Safety valve(sv/cv3)• Reg5

• Sol4 ,sol6 , sol8

• Cv6 ,cv7 , psol

NASSER EL SHAAER 39

The SafetyThe Safety

• 1-Back up ventilation (BUV)• Mandatory breaths with tidal volume of 0.5 liter , respiratory rate of

12 bpm, peak flow of 45 IPM

• 2-SAFTY VALVE open,ventilator is in operative• Permit the patient to breathe room air unassisted by ventilator

• Safety open in the following state:

• 1-air and oxygen supplies have been lost

• 2-A fault have been detected

• 3-power to the ventilator has been disrupted

• 4-POST is in progress

NASSER EL SHAAER 40

The SafetyThe Safety

• 3-Alarms

• 4-Self-diagnostics• (POST) power on self test

• (QUEST) quick extended self test

• (TEST) total extended self test

• Lamp test

• I:E ratio check

• Nebulizer flow check

• Ongoing checks

Documents

NASSER EL SHAAER1 بسم الله الرحمن الرحيم يأيها الناس اذكروا نعمت الله عليكم هل من خالق غير الله يرزقكم من السماء