1.1.

1 Intended use
-INTELLiVENT-ASV provides fully automated closed-loop
ventilation and oxygenation based on physiologic input from the
patient.
-It provides continuous dynamic monitoring and control of the
patient's ventilation needs based on specified clinician targets and
changing patient conditions.
-INTELLiVENT-ASV continuously monitors patient conditions, and
automatically adjusts ventilation and oxygenation
parameters to keep the patient within target ranges, with minimal
clinician interaction, from intubation until extubation.
-INTELLiVENT-ASV also provides tools to promote early weaning
as part of the closed-loop control.
-The use of INTELLiVENT-ASV is designed for use with all adults, and
pediatric patients from 7 kg; it is not available for neonatal
applications.
-INTELLiVENT-ASV can be used in the hospital and during primary
and secondary transport. INTELLiVENT-ASV can-not be used in
an MRI environment, as the required sensors are not currently
available without metal components.
1.1.2 Ventilation
-%MinVol management operates in two modes, automatic and
manual. For manual %MinVol management, see Sec-tion 1.8. The
%MinVol management automatically sets the minute volume
(%MinVol) depending on either of the following:
The measured end-tidal CO2 partial pressure (PetCO2), if the
patient is passive
The difference between targeted and actual respiratory
rate, if the patient is active and PetCO2 is on or below the
target range.
-The target PetCO2 that is set depends on:
The patients treatment level (Peak inspiratory pressure)
The pathology and treatment profile of the patient entered by
the operator
the user has the possibility to select ARDS, chronic hypercapnia
and brain injury
The PetCO2 target shift set by the userWhether weaning is to
be promoted
(user setting)
-The optimal rate is defined by the Otis equation as it is in ASV.

1.1.3 Oxygenation
1.1.4 Quick wean
-active > provides closed-loop, continuous dynamic monitoring
and control of patient conditions to initiate spontaneous breathing
trials(SBT).
-It is used to evaluate patients muscle strength and breathing
performance, thereby helping you gauge the potential for
extubation.
1.2 Indications for use and contraindications
-indication
adult and pediatric patients
intubation patient
be sure you are familiar with the installation and configuration of
the CO2 and
SpO2 sensors.
-contraindications
pt weight< 7kg
There is a high leakage
target range for PetCO2 and SpO2 cannot be set according to
the hospital
protocol or to the patients condition.
Heliox gas cannot be used in this mode
if high carboxyhaemoglobin or methaemoglobin value is
expected or clearly
evidenced, or if the difference between SaO2 and SpO2 is
greater than 5%do
not use the INTELLiVENT-ASV automatic PEEP/Oxygen
adjustment.
1.3 INTELLiVENT-ASV in clinical use
1.3.1 introduction
-Figure 1-1. ASV concept in clinical use
-Figure 1-2 INTELLiVENT-ASV concept in clinical use
1.3.2 step 1: before connecting the patient to INTELLiVENT-ASV
1.3.3 Step 2 :preparing the ventilator for INTELLiVENT-ASV
-device: mainstream CO2 sensor and one or two SpO2 sensors.
1.3.4 Step 3:determining patient profile for INTELLiVENT-ASV
-patient profile patient condition/s
-patient profile refers only: gender, height(IBW), adult or pediatric

selections.
1.3.5 Step 4: The INTELLiVENT-ASV window: selecting ventilation and
oxygenation management
-%MinVol, PEEP/CPAP and Oxygen automatic or manual
-select patient condition
-select whether to enable Quick Wean, any auto recruitment
options and the PEEP limit control.
1.3.5.1 Patient conditions
-The starting Pasv limit, maximal allowed inspiratory pressure
level= PEEP+Pinsp (Pressure high limit= P ASV
limit+10mmHg), is set depending on patient conditions.
1.3.5.6 Pt with brain injury
-if pt suffers from a brain injury but brain injury is not set,
increased CO2 levels and
high cranial pressure might result.
-if brain injury is set but the patient should be normally ventilated,
the patient will be slightly hyperventilated and increased
peak pressure might occur.
1.3.5.8. Recruitment management
-Check for pneumothorax before ventilating the patient.
-Recruitment is a strategy for re-expanding collapsed lung tissue,
and then maintaining higher PEEP to prevent subsequent derecruitment.
-The operator can select:
passive pt: auto recruitment does not happen when spont.
breathing is detected
no recruitment: no auto recruitment is conducted.
-The auto recruitment maneuver in INTELLiVENT-ASV consist of
20sec CPAP with a pressure level of 40cmH2O. The trigger
is set to 15L/min and Pmax is set to 50cmH2O.
-1-24?????
1.3.5.9 PEEP limit from HLI index
1.3.6 Step5: Alarm Settings
1.5 Management of %MinVol
-Warnings
inspect CO2 adapters/sensors regularly. Patient secretions
in airway adapters might lead to an incorrect PetCO2 reading.
do not use the sidestream CO2 sensor with the automatic
management of the %MinVol.
-All ASV safety limits are active. [1-52]

1.5.1 Management of %MinVol (passive patient)

-PetCO2(end-tidal CO2 partial pressure)
available when the CO2 sensor is connected
is the maximum partial pressure of CO2 exhaled during a
tidal breath (just before the start of inspiration)
This represents the final portion of air that was involved in the
exchange of gases in the alveolar area.
common clinical conditions:
under common clinical conditions, this represents a reliable
index of CO2 partial pressure in the arterial blood.
It has been shown that under normal conditions, PaCO2 is
about 3-5mmHg higher than PetCO2.
special clinical conditions: (massive ventilation, perfusion
problems, shunt)
the different between PetCO2 and PaCO2 might increase.
change in the PaCO2-PetCO2 can be taken into account by
shifting the range of acceptable PetCO2 values in the
INTELLiVENT-ASV window.
-to get the most accurate approximation to PaCO2, the second
highest PetCO2 value
out of 8 breaths is used.
-the optimal ranges of PetCO2 depend on the operator-defined
patient conditions.
-when PetCO2 is above/below the zone of acceptable PetCO2
ranges, the minute ventilation is increased/decreased.
-only minor adjustment are made if PetCO2 is in the acceptable
ranges of to promote early weaning.
-The absolute limits for %MinVol are 70% (min) and 200% (max) of
the physiological %MinVol value.
1.5.2 Management of %MinVol (active patient)
-when a patient is spontaneously triggering the breaths, the
ventilator adjusts the target minute volume, based on the
spontaneous breathing rate of the patient.
-if the pt complies with the RULE 1 [1-56] and if pt rate is
above/below the zone of acceptable spont rate(danger of patient
fatigue), the %MinVol increase/decrease.
RULE 1: The %MinVol starts to adjust the %MinVol based on the
rate if five consecutive spont. breaths occur and the
PetCO2 value is inside or below the range.

Management of PEEP and Oxygen