LTV 1200 Ventilator

SIMV pressure control mode

1.
2.
3.
4.

In this training module you will learn

The basics of SIMV mode
The difference between volume control and pressure control
mechanical ventilation
The settings for SIMV pressure control/pressure support mode
How to operate the front panel controls on the LTV 1200 ventilator

image credit: http://www.carefusion.com/our-products/respiratory-care/mechanical-ventilation/portableventilation-solutions/ltv-1200-series-ventilator

SIMV
There are several modes that a ventilator can be set to.

For the purposes of this training module the only mode that will
be discussed is Synchronized Intermittent Mandatory
Ventilation
SIMV mode is a common setting for neonatal and pediatric
patients.

SIMV - Synchronized Intermittent

Mandatory Ventilation
This is a ventilator mode where there are a minimum
number of required breaths being administered per
minute, but the patient is also able to have breaths
above the minimum requirement if their respiratory
drive triggers a spontaneous breath. It is
synchronized to deliver breaths with the patients own
breathing pattern, rather than forcibly administering
a breath when the patient is not ready to inhale.
SIMV can be either volume controlled or pressure
controlled.

SIMV

Image credit: LTV 1200 Operators Manual

Volume vs. Pressure

Ventilators can be set to administer a set amount of volume
of medical air and/or oxygen, or it can administer a set
amount of positive pressure of the medical air/oxygen being
given.
SIMV mode can be set to deliver either volume or pressure.

In the neonatal and pediatric population, patients

ventilators are set to administer specific pressures until the
child reaches adolescence to prevent over inflation and
damage to small and delicate lungs.

Rate

This refers to the patients minimum required respiratory

rate. This is number of breaths a patient is going to be
given by the ventilator in a minute.
The LTV 1200 can be set anywhere from 1-80 breaths per
minute.
On SIMV mode the patient is able to breath greater than the
rate if they have the inspriatory drive to do so.

PEEP Positive end expiratory

pressure

This is the amount of pressure that is required to keep the

lungs from adhering to each other. When a patient
completely exhales only the PEEP remains, so that their
lungs do not completely empty or this would lead to
atelectasis.
The PEEP is set internally within the LTV 1200 ventilator
some ventilators the PEEP is external.

PC - Pressure Control

This is the amount of pressure being given with each mandatory

breath being administered by the ventilator.
The LTV 1200 can deliver from 1-99cm H20 of pressure control.

PS Pressure Support

Pressure Support is the amount of pressure given to assist a

patient when they take their own breaths above the set
minimum breathing rate.
The LTV 1200 can deliver from 1-60cm H2O of pressure
support.
If the Physican orders a Pressure Support of 11, this includes
the PEEP (for example 6) so set the PS button to 5.
(PEEP 6 + PS 5 = Total Pressure Support 11)

PIP Peak Inspiratory Pressure

Peak Inspiratory Pressure is the total amount of pressure

that the lungs will be receiving. When a patient inhales and
lungs are at their fullest capacity, this is the PIP.
On SIMV Pressure Control mode this is the PEEP and the
PC combined. It will be shown on the display window.

FiO2 Fraction of inspired

oxygen

If a patient is breathing room air, their FiO2 is 21% as this is

the percentage of oxygen in the air we breath.
If a patient is breathing pure oxygen, their FiO2 is 100%
Mechanical Ventilators can be set to a percentage of additional
oxygen above 21% up to 100% depending on the patients
requirements.
The LTV 1200 has a high-flow oxygen tubing connection, lowflow can be used only with an adaptor.

O2 Flush & Manual Breath

If the patient needs one extra breath given, the Manual

Breath button can be pressed.
If the patient needs a temporary increase in FiO2 by
pressing the O2% button for 3 seconds, 100% oxygen will
be given for 1 minute.

Other Front Panel Controls

The Inspiratory time button sets the length of time for the
inspiratory period. The LTV 1200 can be set between 0.3-9.9
seconds.
The Sensitivity button determines the threshold at which
the patient can trigger a breath. The sensitivity can be set
on the LTV 1200 between 1-9 liters per minute.

Other Front Panel Controls Cont.

The Tidal Volume button is used when the ventilator is set

to volume control rather than pressure control.
The Control Lock button is used to lock the front control
panel from being adjusted.
The Inspiratory/Expratory Hold button will pause ventilator
functioning and is not routinely used by nursing staff.

How to use the LTV 1200 Ventilator

The LTV 1200 Ventilator is designed for inpatient hospital

settings.
Other ventilators such as the LTV 1150 are designed for at
home use.
The ON button is located in the bottom left hand corner
of the control panel.

Press Turn Press

In order to change
any of the settings
on the front control
panel, the operator
needs to press the
button they wish to
change, turn the Set
Value wheel to the
desired setting, then
press the button
again to confirm the
new setting.

Minimum Weight Requirement

The LTV 1200 can be
used for patients
greater than 5
kilograms/11 pounds
Infants < 5kg 10kg
Pediatric 10kg 40kg
Adults > 40kg

Image credit: https://www.welchallyn.com/content/welchallyn/americas/en/products/categories/physicalexam/scales/pediatric/scale-tronix-pediatric-scales.html

Display Window

The red lit display window will provide the following monitored
data information;
The PIP
The mean airway pressure (MAP)
The PEEP
The actual respiratory rate (f)
The minute ventilation (VE)
The inspiratory/expratory ratio (I:E)
(More monitored data is available depending on ventilator mode)
Patient alarms also display in this area.
This window automatically scrolls through the data, but pressing
the select button can allow the user to choose what information
they wish to see.

Airway Pressure Monitor

This display will show in real time the inhalation and
exhalation pressures. Each light represents 2cm H2O.
The single green light (shown below at 16cm H2O) is the
peak inspiratory pressure (PIP) from the previous breath.
In this example the pressure is displaying 6cm H2O,
which is what the patients PEEP is set to this means the
patient is in between breaths currently.

High Pressure Alarm

The high pressure limit can be set 5-100cm H2O on the LTV
1200 Ventilator
If this alarm is sounding then check for the following;
Does the patient have increased secretions or a mucus plug?
Is the patient crying or coughing?
Is any wheezing audible?
Is the ventilator circuit (tubing) bent or kinked?
Is there excess water condensation present in the tubing?

Low Pressure Alarm

The low pressure limit can be set 1-60cm H2O on the LTV 1200
Ventilator
If this alarm is sounding then check for the following;
Is the tubing disconnected from the patient?
Is the tubing disconnected from the ventilator?
Is the tracheostomy tube too small (the patient has outgrown
it)?
If the tracheostomy tube has a cuff, is the cuff underinflated?

Silence Reset

If at any time you are unsure of why the patient is alarming,

and the patient is not adequately mechanically ventilating,
begin administering manual ventilations using a bag valve
attached directly to the tracheostomy tube or endotracheal
tube.
Pressing this button will silence alarms for 60 seconds, of if pressed
before an alarm might sound (for example when purposefully
disconnecting tubing) it will preemptively silence the alarm for 60
seconds.
This button will also reset the display screen after the audible alarm
has ceased.

Vent Inop & Low Min. Vol.

If the Vent Inop light is lit, and a constant alarm is

sounding, this indicates that the ventilator is not currently
in operation and is in standby mode. This occurs when the
ventilator detects a problem that deems the ventilator
operation to be unsafe.
The low minute volume (Low Min. Vol.) can be set between
0.1-99.0 liters, or can be turned off as seen above. This
setting is more appropriate for volume control modes of
operation.

Indicator Lights
The Patient Effort light will light up
when the patient is triggering their
own spontaneous breaths
The External Power light is lit
when the LTV 1200 ventilator is
connected to an AC power source.
The charge status will indicate the
charge status of the internal
battery for the LTV 1200 ventilator.
A green light indicates the battery
is fully charged
The battery level light will only be
lit when the LTV 1200 ventilator is
operating on battery power alone.
The LTV ventilator can operate for
approximately one hour without an
external power source.

References
Lawson, S.J. (2001).Introduction of Mechanical Ventilation of the
Neonate(3rd ed.). Riverside, CA: RC Educational Consulting Services,
Inc. Retrieved from
http://www.rcecs.com/MyCE/PDFDocs/course/V7042.pdf
LTV 1200, 1150 Ventilator, and MR Conditional LTV 1200 System
Operator's Manual(7th ed.). (2013). Yorba Linda, CA: CareFusion.
Ventilator management self-study module (n.d.). Baltimore, MD: Mt.
Washington Pediatric Hospital.