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VPAP II ST-A - Sleep Medicine Network

1. 2 Access port Sensor tube Figure 17 Connecting the II ST A to a manometer for calibration CLEANING amp MAINTENANCE DAILY Test the mask alarm every day before use and each time any component of the breathing circuit is altered See Mask Alarm Test daily on page 77 Disconnect the air tubing and mask Wipe the inside and outside of the mask and cushion with a clean damp cloth Hang up to dry in the shade 90 WEEKLY MONTHLY Test the buzzer LED and power failure alarm every week as described in Buzzer LED Test Cweekly on page 77 and Power Failure Alarm Test Gweekly on page 77 Wash the mask and air tubing with pure soap Do not use moisturizing deodorizing fragranced or antibacterial soaps Refer to the mask user guide for further information Wash the headgear and straps with pure soap and drip dry Check the mask outlets for blockages Test the low pressure alarms once a month as described in Low Pressure Alarm Test on page 77 PERIODICALLY WARNINGS CAUTIONS The exterior of the II ST A should be cleaned with a damp cloth and mild detergent The mask and air tube are subject to normal wear and tear Inspect them regularly for any damage Always unplug the II ST A before cleaning and be sure that it is dry before plugging it back in The air tubing and some mask system
2. II ST A is equipped with an optional Mask Alarm When the alarm is enabled the II ST A will illuminate the low pressure alarm indicator light on the front panel sound an alarm and display the MASK OFF message on the LCD screen if it detects an excessive air leak for example if the patient s mask falls off during the night Pressing the Alarm Cancel button will silence the audible alarm and erase the message on the LCD but the indicator light will remain lit until you correct the cause of the alarm The audible alarm will not retrigger while the original alarm condition persists When the alarm condition is resolved the visual and audible alarms are reset If tbe Mask Alarm is enabled SmartStart Stop will not operate wben tbe mask is removed The factory default setting for the VPAP II ST A is alarm enabled If desired use the MASK ALARM menu option to disable the alarm To do this see II ST A Set up on page 18 Mask Alarm activation is a function of the II ST A s set pressure the air delivery system in use and whether the humidifier mode is set Certain set pressures and combinations of air delivery components may cause failure of the Mask Alarm to activate ResMed recommends that the Mask Alarm is tested before commencing treatment See Testing the Alarms on page 77 ALARMS AND WARNING LIGHTS 75 76 MASK ALARM ACTIVATION PRESSURES Mask Pressure at Activation Point cm H5O
3. O P amp y x Q PF High pressure alarm LED Fault alarm LED Alarm Cancel button Warning signal Low pressure light MASK OFF message on LCD screen and buzzer See Mask Alarm on page 75 for more information Light Emitting Diode If the VPAP II ST A detects an error it will illuminate one of the warning lights and sound the alarm It may also display a message on the LCD liquid crystal display screen If the alarm sounds or one of the warning lights illuminate silence the audible alarm by pressing the Alarm Cancel button and follow the actions outlined in the table below Cause Mask has become dislodged from your patient s face and a high leak is occurring Air tubing disconnected Action Reposition the mask on your patient s face Reconnect air tubing Low pressure light and buzzer Air tubing disconnected Hardware error Reconnect air tubing Return your VPAP II ST A for servicing DO NOT USE THE VPAP II ST A DEVICE High pressure light and buzzer Hardware error Return your VPAP II ST A for servicing DO NOT USE THE VPAP II ST A DEVICE ALARMS AND WARNING LIGHTS 75 Warning signal Fault light and buzzer Cause Accidental disconnection from mains power Mains power failure Action Check both ends of the power cord are firmly connected and the main power switch is on Remove the patient s mas
4. II ST A assures patient ventilator synchronization in the presence of changing leaks throughout sleep Automatic Trigger Trigger Threshold Threshold Adjustment L New Baseline Patient Flow Automatic Leak Compensation Figure 8 Vsync Automatic Leak management 1 Thomas J Meyer Mark R Pressma Joshua Benditt Francis D McCool Richard Mill man Ranjini Natarajan Nicholas S Hill Air Leaking Through the Mouth During Noc turnal Nasal Ventilation Effect on Sleep Quality Sleep1997 20 7 561 569 2 H Teschler J Stampa R Ragette N Konietzko M Berthon Jones Effect of mouth leak on effectiveness of nasal bilevel ventilatory assistance and sleep architecture European Respiratory Journal 1999 14 1251 1257 T CONTROL INSPIRATORY TIME CONTROL Also unique to the II series and complementing Vsync is the T CONTROL feature This plays a significant role in assuring good patient ventilator synchronization when there are leaks or changing disease conditions In the presence of large mouth and mask leaks no bi level system can accurately determine the patient s respiratory flow As a consequence during large mouth and mask leaks most bi level devices will continue to deliver their IPAP pressures while a patient is trying to exhale leading to poor synchronization increased work of breathing poor ventilation arousals from sleep patient discomfort and non compliance Unless inspiratory time
5. Vsync Automatic Leak management Trigger Cycle Threshold Adjustment on page 50 T jCONTROL INSPIRATORY TIME CONTROL The T CONTROL feature which is also unique to the II Series allows the clinician to set minimum and maximum limits on the time the ventilator spends in IPAP The minimum and maximum time limits are set at either side of the patient s ideal spontaneous inspiratory time providing a window of opportunity for the patient to spontaneously cycle to EPAP The minimum time limit is set via the IPAP Min Time parameter and the maximum time limit is set via the IPAP Max Time parameter T CUNTRUL IPAP IPAP Min Max Time Time Patient Flow Figure 2 T CONTROL IPAP Min and IPAP Max Time Parameters sets the Cycle Window T CONTROL s IPAP Max and IPAP Min Time parameters play a significant role in maximizing synchronization by effectively intervening to limit or prolong the inspiratory time when required This provides the clinician with the flexibility to manage different disease states as well as ensuring synchronization even in the presence of large mouth and or mask leak For further details see TiCONTROL Inspiratory Time Control on page 51 RISE TIME ADJUSTMENT NOTE Rise Time is the time taken for the pressure to increase from EPAP up to IPAP Rise Time can be set to MIN the fastest Rise Time and then in 50 unit increments from 150msec to 900msec This will control the rate of press
6. Press the Start Stop button to start the air flow The air will begin flowing slowly and build up to pressure in approximately 20 seconds OR STARTING TREATMENT 47 48 DELAY TIMER OOO SMARTSTART STOP NOTE e If the Delay Timer function has been enabled you can start the II ST A by pressing one of the Delay Timer buttons Note the settings menu must be locked to use the Delay Timer See Delay Timer on page 80 OR When SmartStart Stop simply referred to as SmartStart is enabled the II ST A will automatically start when the patient breathes into the mask and automatically stop when they remove it Set this by selecting the SMARTSTART STOP option in the Secondary menu see II ST A Set up on page 18 The Delay Timer option is still available If the Mask Alarm is enabled SmartStart Stop will not operate when tbe mask is removed 5 NOTE To stop treatment simply press the Start Stop button If SmartStart is enabled the flow will stop automatically when the patient removes their mask Remember that the patient must remove their mask whenever the II ST A is not operating Some air circuit components eg masks filters tubing may affect tbe operation of tbe SmartStart feature In tbe event tbat SmartStart does not trigger tbe operation of tbe VPAP II ST A start or stop tbe device by pressing the Start Stop bution For further details see Using SmartStart
7. This is a display of the patient s respiratory rate based on the last two breaths detected by the II ST A In Spontaneous Timed mode the displayed respiratory rate will consist of both patient initiated spontaneous and device initiated timed breaths Tidal Volume Secondary menu Monitored Parameter This is a display of the calculated tidal volume delivered to the patient by the VPAP II ST A It is calculated on a breath by breath basis by integrating an estimate of patient flow obtained by subtracting the leak flow and ResMed mask vent flow from the measured total flow rate This provides a useful indication of the trend and magnitude of change in the patient s tidal volume Tidal volume will normally increase as IPAP pressure is increased Since the VPAP II ST A assumes the vent flow to be that of a ResMed mask when performing calculations using masks other than ResMed masks will likely diminish accuracy in this display Unintentional leak has a similar effect on these calculations There will be some delay in the display of the Tidal Volume measurement after being selected 37 SYSTEM SET UP SPONTANEOUS TIMED MODE 38 ADJUSTABLE MONITORED DESCRIPTION USAGE PARAMETER Leak Monitored Parameter Ideally leak rates should be kept below 25 Secondary This is a display of leak as calculated by the L min to assure quality sleep menu VPAP STA It is a measure of additional No
8. J IPAP Delivered Pressure Figure 13 Restrictive device cycles within Cycle Window at IPAP Min Time OPTIMIZING SETTINGS FOR 53 EFFECTIVE VENTILATION 54 SET UP FOR DIFFERENT DISEASE STATES RESTRICTIVE LUNG DISORDERS eg chest wall deformity neuromuscular diseases As mentioned above some patients with restrictive respiratory disorders have problems with early or premature cycling to expiration This will cause inspiratory time to be too short and could affect the patient s ability to have an adequate tidal volume resulting in hypoventilation A safety system IPAP Min is included in the VPAP II ST A to prevent premature or early cycling Late cycling is not a common problem in this patient population however high leak conditions can interfere with cycling to expiration and eventually cause poor patient ventilator synchrony A safety system IPAP Max is included in the VPAP II ST A to prevent late cycling SETTING Tj CONTROL S IPAP MIN TIME 1 Measure the respiratory rate during ventilation and at rest see Measuring Respiratory Rate on page 59 2 Refer to the column entitled Restrictive IPAP Min in TiCONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 3 SetIPAP Min to the value that corresponds to the resting respiratory rate from step 1 4 Ifthe patient complains that inspiratory time is too long or too short verify the respiratory rate and IPAP Min setting
9. 25 26 VENTILATOR PARAMETER SETTINGS FOR SELECTED MODE OVERVIEW OF VPAP II ST A PRIMARY AND SECONDARY MENUS RESPIRATORY RATE TIDAL VOLUME 1 LEAK DELIVERED PRESSURE SET START PRESSURE SET IPAP Min SMARTSTART STOP HUMIDIFIER OVERHEAT DEFAULT DELAY TIME SET TIME HOURS SET TIME MINUTES COMPLIANCE RESET CALIBRATE PATIENT HOURS MACHINE HOURS PATIENT MODE Primary settings menu Secondary menu items and messages MODE IPAP EPAP IPAP Max 2 0 T MIN BPM 10 33 n8564w gt 10 0 J TIDAL VOLUME 0500ML S T 25 0 SULLIVAN gt r cmH20 cmH20 sec Symbol Panel ADJUSTABLE MONITORED PARAMETER MODE Primary menu SPONTANEOUS MODE This section discusses the key parameters that need to be adjusted and the monitored items that are displayed in Spontaneous mode The key adjustable parameters in this mode are PAP e EPAP e PAP Max e Rise Time e IPAP Min SYSTEM SET UP SPONTANEOUS MODE The monitored parameters displayed in this mode are Respiratory Rate e Tidal Volume e Leak e Pressure The key adjustable parameters and monitored parameters are discussed below in the order they appear in the II ST A primary and secondary menus For instructions on how to change settings see II ST A Set up on page 18 For othe
10. Erase saved compliance data 79 F Filters 64 Filter replacement 92 Flow pressure characteristics 100 Flow pressure characteristics masks 87 Full flow generator reset 80 H High mask leak 70 75 Home treatment set up 79 HumidAire 61 Humidification 61 Humidifier 15 70 Default setting 20 Mask Alarm 96 SmartStart 64 96 IEC 601 1 classifications 99 Insufficient air flow 97 Internal clock 100 Inverter 83 IPAP 24 25 Default setting 19 IPAP Max 12 Default setting 19 IPAP Min 12 default setting 20 IPAP Min and IPAP Max Calculation Guide 58 L Language 71 LCD screen 8 Choosing the display language 71 Pressure 69 M Machine hours 71 counter 79 Mask Alarm 48 70 75 96 Activation threshold 76 Antibacterial filter 64 Default setting 20 Humidifier 64 96 SmartStart 95 Mask Leaks 49 Measuring Respiratory Rate 59 Mode derni setting 19 Modes of Operation 26 Monitored Parameters 69 Mouth Leaks 49 101 102 Normal Pulmonary System 55 Obstructive Lung Diseases 53 Obstructive Lung diseases Obstructive Pulmonary Disease 55 Operating Modes 11 CPAP 11 Spontaneous 11 Spontaneous Timed 11 Timed 11 Overheating 92 Overheat default 70 Overheat default setting 20 Oxygen 59 Concentrations 59 Connector 60 Home use 60 79 Mask port 60 P Patient Compliance Downloading 80 Viewing 71 Patient Hours 71 Patient mode 19 71 Power Cord Clip 93 R Replacing the air filter 92 ResControl 65
11. SMARTSTART STOP settings IPAP 2 0 sec MASK ALARM menu Un MIN HUMIDIFIER BPM 10 a OVERHEAT DEFAULT 33 DELAY TIME a Symbol SET TIME HOURS PEES farel SET TIME MINUTES Secondary voLUME COMPLIANCE RESET 0500ML CALIBRATE PATIENT HOURS MACHINE HOURS PATIENT MODE MONITORED PARAMETERS DELIVERED PRESSURE ResMED Delivered pressure is measured internally by a pressure transducer The pressure transducer provides real time measurement of circuit pressure This transducer is used to provide a feedback loop to the microprocessor to assure accurate pressure delivery as well as pressure Rise Time control SULLIVAN ADDITIONAL FUNCTIONS ADJUSTABLE SETTINGS SET START PRESSURE This parameter represents the pressure delivered by the VPAP II ST A at the start of treatment during Delay Timer mode 69 70 SMARTSTART STOP NOTE When SmartStart Stop simply referred to as SmartSmart is enabled the II ST A will automatically start when the patient breathes into the mask and automatically stop when they remove it The Delay Timer option is still available Set this by selecting the SMARTSTART STOP option in the Secondary menu see II ST A Set up on page 18 If the Mask Alarm is enabled SmartStart Stop will not operate wben tbe mask is removed MASK ALARM HUMIDIFIER The II ST A is equipped with an optional Mask Ala
12. becomes insufficient In this mode one of two icons will briefly appear beneath the I E value on the LCD screen to indicate the event which triggered the EPAP to IPAP transition They are S patient initiated or spontaneous inspiration and T time initiated or backup machine breath The spontaneous timed mode is used when the security of a minimum backup rate is required the patient is not able to trigger the machine consistently or the basal respiratory rate is very low 33 34 ADJUSTABLE MONITORED PARAMETER IPAP Primary menu DESCRIPTION The IPAP Inspiratory Positive Airway Pressure setting ranges from 2 to 25 cm H5O This is the inspiratory pressure which will be delivered to the patient when the device is triggered into inspiration The difference between the IPAP and EPAP IPAP EPAP determines the pressure support level delivered to the patient Triggering to IPAP will occur as a result of either patient effort spontaneous trigger or the patient s respiratory rate falling below the backup breath rate time triggered such as in the event of apnea or hypopnea See Operating Modes on page 11 for details on cycling to EPAP USAGE The setting of the inspiratory pressure is made on the basis of patient tolerance and the effect of the pressure on ventilation and gas exchange As the IPAP pressure is increased and the difference between IPAP and EPAP wid
13. can limit the delay periods available to the patient For example you may choose to remove the 20 minute delay option Should the patient then press the 20 minute Delay Timer button the VPAP II ST A will start with the next available delay ie the 10 minute delay SET UP FOR HOME TREATMENT 81 82 USING BATTERY POWER FREQUENTLY ASKED QUESTIONS NOTE WARNING USING BATTERY POWER CAN I RUN A VPAP II ST A DEVICE FROM A BATTERY HOW Yes ResMed II ST A devices can be run from a battery for example a 12V or 24V battery To do this you will need a deep cycle battery and an inverter Note that typical automotive batteries may only be safely discharged to 8096 of their full charge and are therefore not suitable for use with the VPAP II ST A For further information about choosing a battery consult your inverter and or battery supplier WHAT CAPACITY BATTERY WILL NEED TO BUY TO RUN A VPAP II ST A DEVICE The capacity of the battery is given in amp hours You will need to determine the correct capacity which depends on the prescribed pressure setting and the number of hours the VPAP II ST A will be running on battery power Purchase a battery that will amply supply your needs Use the table Calculating battery capacity required on page 85 as a guide WHAT TYPE OF INVERTER IS SUITABLE FOR USE WITH A VPAP II ST A DEVICE Any CE for EU countries or UL for the USA marked inverter with both a minimum continu
14. device This will determine the capacity of the battery you require 1 Select an EPAP pressure Select the closest pressure in the table 2 Select an IPAP pressure Select the closest pressure in the table 25 cm H2O will give the worst case power consumption 3 The charge consumed by the II ST A the DC current x hours used In the table total charge is quoted for eight hours of use The values in the table are based on a respiratory rate of 15 BPM CALCULATING BATTERY CAPACITY REQUIRED EPAP IPAP Charge for Total charge Minimum cm H2O H20 1 hour required for 8 recommended amp hours hours battery capacity amp hours rating 4 8 1 51 12 1 29 4 16 1 86 14 9 36 8 16 2 03 16 3 40 12 16 2 09 16 7 42 4 25 2 22 18 5 45 8 25 2 37 19 0 46 12 25 2 40 19 2 47 Amp hour rating for 8 hours of use Sample calculation If EPAP pressure 12 cm H5O IPAP pressure 25 cm H5O and respiratory rate 15 BPM then the energy used in 8 hours 19 2 amp hours Minimum recommended battery capacity amp hour rating 47 NOTE The values above are based on a respiratory rate of 15 BPM Power consumption and recommended battery size will increase witb faster respiratory rates USING BATTERY POWER 85 86 CO REBREATHING DATA IMPORTANT INFORMATION ON CO REBREATHING The II ST A is intended to be used with special masks or connectors which have vent hole
15. fastest or shortest Rise Time It can also be set in 50 millisecond increments from 150 to 900 The higher the Rise Time setting the longer it takes for the pressure to increase from EPAP to IPAP NOTE The Rise Time scale approximates the time taken in milliseconds for the pressure to increase from 1096 to 9096 of the IPAP EPAP pressure difference under controlled conditions Range 90 msec nominal to 900 msec USAGE Generally Rise Time is adjusted to achieve maximum patient comfort The patient should feel that they are receiving adequate flow but not be startled by each transition to the IPAP level However if the patient has a high ventilatory demand eg patients with respiratory insufficiency then setting the Rise Time to MIN will help lower the patient s work of breathing For example a MIN Rise Time setting can help patients with respiratory insufficiency Consideration of the patient s actual inspiratory time will also help guide where to set the Rise Time Setting the Rise Time too long can limit the time spent at IPAP and could impair ventilation For example if a patient s inspiratory time is one second a Rise Time setting of less than 350 msec is recommended allowing sufficient time for ventilation at IPAP BPM Primary menu This parameter sets the Breaths Per Minute BPM or backup Rate The BPM rate ranges from 5 30 breaths per minute In the Spontaneous Timed mode the BPM rate
16. is set as a backup rate when the security of a minimum backup rate is required the patient is not able to trigger the machine consistently or the basal respiratory rate is very low The rate is usually set slightly lower than the patient s respiratory rate during quiet ventilation To check the patient s respiratory rate see Measuring Respiratory Rate on page 59 ADJUSTABLE MONITORED PARAMETER I E Display Primary menu DESCRIPTION Display Item only This display represents the set IPAP Max Setting as a percentage of the total cycle time as determined by the set BPM backup rate Thus the display indicates the maximum percentage inspiratory time should the patient breathe at the set BPM and have an inspiratory time equal to the set IPAP Max time It does not represent the patient s measured percent inspiratory time USAGE This display is useful in ensuring that the set IPAP Max time is appropriate with respect to the total cycle time as determined by the set BPM backup rate In the event that the IPAP Max time represents 50 or more of the total cycle time as determined by the set BPM rate the following message will appear on the screen CAUTION I E gt 5096 This indicates that an actual inverse inspiratory ratio ie inspiratory time gt expiratory time may be achieved with the set IPAP Max and BPM settings Respiratory Rate Secondary menu Monitored Parameter
17. not work return the VPAP II ST A to your supplier for servicing Do not attempt to service the unit yourself SET UP FOR HOME TREATMENT When you set up a VPAP II ST A for a patient to take home there are a number of things to be aware of 1 Always set pressures and oxygen levels with the equipment set up in exactly the same way as it will be used at the patient s home eg with the humidifier connected the oxygen line entrained at the same place same length air tubing and same mask system 2 Ensure that the patient has the relevant user s manual s and understands how to operate the equipment 3 When changing the settings consider whether the patient would like some of the options enabled if the prescribing physician permits it such as e SmartStart e Mask Alarm e Humidifier Gf using a humidifier and SmartStart or Mask Alarm see Using SmartStart or the Mask Alarm with a humidifier or antibacterial filter on page 64 Delay Timer limits e Lower Start Pressure 4 The LCD screen backlighting will automatically turn off when the setting menus are locked 5 Always remember to lock the setting menus using the PATIENT MODE menu See Step 3 on page 19 This is to prevent the patient from adjusting their prescribed settings Make sure that the patient has a contact phone number in case of emergency A good place to write this is in the front of the user s manual RESETTING THE II ST A RESETTING COMP
18. reduce the work of breathing Ensure IPAP Max is set appropriately see TICONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 FOLLOW UP Where patients are using ventilatory support on a long term basis regular follow up is important The purpose of follow up is to ensure that ventilation requirements have not altered over time to determine the need for ongoing oxygen therapy and to change to an alternative form of ventilatory support if this is required The frequency of follow up will depend upon the stability of the patient s condition and the problems which arise during therapy Some clinicians have recommended that initial follow up occur within the first three months of commencing nocturnal ventilatory assistance Subsequent follow up will be dictated by patient need and unit policy 1 Claman DM Piper A Sanders MH Stiller RA Votteri BA Nocturnal non invasive positive pressure ventilatory assistance Chest 1996 110 6 1581 88 67 EFFECTIVE VENTILATION 68 ADDITIONAL FUNCTIONS This section provides details on functions not previously covered in Ventilator parameter settings for selected mode on page 26 The functions described are those shaded in the diagram below OVERVIEW OF VPAP II ST A PRIMARY AND SECONDARY MENUS RESPIRATORY RATE TIDAL VOLUME LEAK DELIVERED PRESSURE MODE S T SET START PRESSURE IPAP 25 0 SET IPAP Min primary EPAP 10 0 cmo
19. see Additional Functions on page 69 DESCRIPTION USAGE In CPAP mode a single fixed pressure is The CPAP mode is often used in OSA IPAP Primary menu delivered patients who require no tidal volume augmentation The IPAP Inspiratory Positive Airway Use this parameter to set the CPAP Pressure setting ranges from 2 to pressure 25 cm H5O This is the CPAP pressure the patient will receive Respiratory Rate Secondary menu Monitored Parameter This is a display of the patient s respiratory rate based on the last two breaths detected by the VPAP II ST A ADJUSTABLE MONITORED DESCRIPTION USAGE PARAMETER Leak Monitored Parameter Ideally leak rates should be kept below 25 Secondary This is a display of leak as calculated by the L min to assure quality sleep menu VPAP II ST A It is a measure of additional Non ResMed masks may yield erroneous airflow required to compensate for leak calculations Even then the ResMed unintentional leak around the mask and or ypAP II ST A will yield a useful indication through the patient s mouth Since the of the trend and magnitude of change VPAP II knows the expected vent flow Th ill b delay in the displ of ResMed masks it calculates h us T i p ied x 4 MS additional flow as leak It is expressed in se ected liters per minute L min and updated NOTE The leak display provides an continuously estimate and is for
20. settings and displayed items available in this mode see Additional Functions on page 69 These include e SET START PRESSURE e SMARTSTART STOP MASK ALARM e HUMIDIFIER e OVERHEAT DEFAULT e DELAY TIME SYSTEM SET UP SPONTANEOUS MODE 31 32 SPONTANEOUS TIMED MODE This section discusses the key parameters that need to be adjusted and the monitored items that are displayed in Spontaneous Timed mode The key adjustable parameters in this mode are IPAP EPAP IPAP Max Rise Time BPM ratio this is a display only item but is dependent upon the IPAP Max and BPM settings IPAP Min The monitored parameters displayed in this mode are Respiratory Rate Tidal Volume Leak Pressure The key adjustable parameters and monitored parameters are discussed below in the order they appear in the II ST A primary and secondary menus For instructions on how to change settings see VPAP II ST A Set up on page 18 For other adjustable device settings and displayed items available in this mode see Additional Functions on page 69 MODE S T Primary menu In Spontaneous Timed mode the VPAP II ST A will follow the patient s spontaneous breathing as in Spontaneous mode However the clinician also specifies a breathing rate refer BPM setting below which they do not want the patient to fall below This is a backup rate which will be supplied if the patient s spontaneous breathing rate
21. the order of a physician INDICATIONS The VPAP II ST A is intended to assist the ventilation of spontaneously breathing adult patients 66 Ib or 30 kg with respiratory insufficiency and or obstructive sleep apnea The patient is expected to have no more than minor and transient adverse effects in the case of ventilation not being provided for extended periods eg overnight The system is intended for use in the hospital or home with patients who have adequate mental and physical capabilities to remove their mask quickly in case of system failure CONTRAINDICATIONS The II ST A should not be used in cases of severe respiratory failure where intubation is judged to be immediately necessary In addition VPAP therapy should be used with caution in the following cases Emphysematous bullae pneumothorax pneumomediastinum or past history of the above indicating risk of pneumothorax or further barotrauma e Decompensated cardiac failure or hypotension particularly if associated with intravascular volume depletion e Massive epistaxis or risk of recurrence if previous occurrence MEDICAL INFORMATION WARNINGS e Pneumoencephalus recent trauma or surgery that may have caused cranio nasopharyngeal fistula risk of entry of air into cranial cavity Acute sinusitis otitis media or perforated ear drum The clinician should assess on a case by case basis the relative risks and benefits of VPAP therapy in such a subje
22. 1 If pressure calibration becomes necessary see Pressure Calibration on page 89 PATIENT HOURS In patient mode the VPAP II ST A will display the total patient use hours if you press the Alarm Cancel OPTION button Patient Hours displays the accumulated number of hours when the patient was receiving therapeutic treatment It will only count hours when the device is operating and delivering pressure to the mask If the Delay Timer is activated the recording of patient hours will not start until the ramp period is completed Patient Hours is reset to zero when the Compliance Reset YES menu is selected MACHINE HOURS Machine Hours records the accumulated number of operating hours The user cannot reset it PATIENT MODE Locks the menus for patient use See Step 3 on page 19 CHANGING THE LCD SCREEN LANGUAGE The LCD screen will operate in six languages English French German Spanish Italian and Swedish The default setting is English 71 72 To change the language hold down both the MENU buttons and turn the II ST A on at the main power switch The current language will be displayed Use the 4 OPTION Y buttons to select the desired language and press the Start Stop button to lock it in ALARMS AND WARNING LIGHTS DEVICE ALARMS The VPAP II ST A device is equipped with an audible alarm and three warning lights to indicate when treatment is not being delivered correctly Low pressure alarm LED
23. 1 8 1 2 0 8 1 6 0 6 1 3 1 4 2 6 0 6 1 6 2 1 3 5 0 7 1 8 2 0 3 4 0 8 12 1 1 0 8 1 4 0 5 1 2 1 3 2 1 0 6 1 5 1 7 2 8 0 6 1 6 1 6 2 8 0 7 20 1 0 0 6 1 2 0 5 1 2 1 2 1 6 0 4 1 3 1 5 2 1 0 6 1 5 1 6 2 2 0 6 1 The flow rate of CO into the breathing simulator was adjusted to give a base line end tidal ie no rebreathing back into the simulator CO 39 mmHg As the tidal volume increased the base line end tidal decreased proportionally 2 The minimum working pressure of the II ST A is 2 cm HO These measurements were taken with the air tube detached from the mask TECHNICAL INFORMATION PRESSURE CALIBRATION NOTE e PROCEDURE II ST A does not require regular calibration However if you feel that it is necessary the following pressure calibration procedure can be conducted without returning the unit to an authorized service agent To calibrate the II ST A you will need The patient s device mask system and air tubing and any accessories if used eg humidifier filters etc A reference manometer with a range of 0 30 cm H5O in intervals of 0 1 cm H O or a RESCONTROL fitted with a sensor tube 3 or 2 5mm internal diameter and a standard Luer taper fitting If available a ResMed Modular mask and blind BUBBLE CUSHION For complete instructions on using the ResControl to calibrate tbe VPAP II ST A refer to tbe ResControl Clinician s Manual Assemble the VPAP II ST A as the patient wou
24. A SET UP VENTILATOR SETTINGS STARTING OPTIMIZING SETTINGS FOR EFFECTIVE VENTILATION SYNCHRONIZATION SET UP FOR DIFFERENT DISEASE STATES ADDING SUPPLEMENTAL OXYGEN HUMIDIFICATION USING A RESCONTROL CLINICAL TROUBLESHOOTING ADDITIONAL 5 MONITORED PARAMETERS ADJUSTABLE SETTINGS ALARMS AND WARNING ee ee e 11 11 11 12 12 13 13 13 14 15 17 17 18 21 47 49 49 54 59 61 65 66 69 69 69 CONTENTS DEVICE ALARMS MASK ALARM TESTING THE ALARMS SET UP FOR HOME TREATMENT RESETTING THE II ST A DOWNLOADING COMPLIANCE DATA DELAY TIMER USING BATTERY POWER usc 32223339 2X5XXXX3c1 2x2 FREQUENTLY ASKED QUESTIONS POWER CONSUMPTION WITH THE VPAP II ST A SERIES COS REBREATHING DATA VV E ua IMPORTANT INFORMATION ON CO REBREATHING TECHNICAL INEORMUSTI ON PRESSURE CALIBRATION CLEANING amp MAINTENANCE REPLACING THE AIR FILTER STRIP OVERHEATING USING THE POWER CORD CLIP OPTIONAL ACCESSORY SERVICING SPECIFICATIONS e etus e ee bre 73 75 7 79 79 80 80 83 83 84 87 87 89 89 90 92 92 93 94 INTRODUCTION The VPAP II ST A provides a mode of non invasive positive pressure ventilation NPPV called Pressure Support with PEE
25. ASSEMBLY 15 16 Connect one end of the air tube to the outlet on the II ST A or humidifier if used Connect the other end to the mask system Turn the power switch on D The II ST A is now assembled Before use you will need to select the appropriate mode and set the operating parameters See Ventilator parameter settings for selected mode on page 26 SYSTEM SET UP CHOOSING A MASK NOTE e WARNING SKIN CARE For best results with mask ventilatory support an appropriate well fitted and comfortable mask is necessary to ensure ongoing tolerance to therapy and effectiveness of therapy If patients using a nasal mask are unable to maintain an effective lip seal and either the quality of ventilation or sleep is affected they should then try a nose mouth or full face mask such as the MIRAGE FULL FACE MASK The MIRAGE FULL FACE MASK comes in several sizes with shallow versions available For details on fitting your mask refer to your mask User s Guide For details on recommended masks contact your local ResMed office The II ST A should only be used with vented mask systems recommended by ResMed or by a physician or respiratory therapist See WARNINGS on page 4 Pressure area care is an important aspect of NPPV Damage to the skin especially across the nasal bridge is most likely to occur if NPPV is used on an almost continuous basis However it c
26. E HUMIDIFIER NOTE e Short 52cm air tubing is a necessary accessory for connecting the II ST A device to a HUMIDAIRE humidifier If a bumidifier is used tbe HUMIDIFIER menu option must be set to ON otberwise SmartStart and Mask Alarm operation may be affected See Using SmartStart or tbe Mask Alarm with a humidifier or antibacterial filter on page 64 Fill the humidifier with water according to the humidifier instruction manual 1 Richards GN Cistulli PA Ungar RG Berthon Jones M Sullivan CE Mouth leak with nasal continuous positive airway pressure increases nasal airway resistance Am J Respir Crit Care Med 1996 154 1 182 186 61 EFFECTIVE VENTILATION 62 Place the filled water chamber inside the HUMIDAIRE Connect the short air tubing 52cm to the left connector port and the long air tubing 2m or 3m to the right connector port on the humidifier Close the HUMIDAIRE lid Long air tubing 2m or 3m Short air tubing 52cm Place the II ST A on top of the HUMIDAIRE Do not place the II ST A underneath the humidifier This is to avoid water spilling into the II ST A device Connect the free end of the short air tubing to the air outlet of the II ST A OPTIMIZING SETTINGS FOR EFFECTIVE VENTILATION 63 64 Plug the HUMIDAIRE power cord into a power outlet and turn the power on 8 WARNING Insert the II
27. EU countries or UL for USA marked inverter with minimum continuous output power rating of 150W surge rating of 500W 50 milliseconds Storage Temperature 20 to 60 C 4 to 140 F Operating Temperature 5 to 40 C 41 to 104 F Operating Humidity 15 to 95 RH IEC 60601 1 CLASSIFICATION Class II Type CF GLOSSARY OF SYMBOLS Read Operating Manual before use Lire le manuel d utilisation avant emploi Class II double insulated Classe II double isolation v Type CF Applied Part Partie appliqu e du type CF CYCLING Breaths Per Minute BPM 5 to 30 Breathing Rate Accuracy 196 Inspiratory to Expiratory Ratio T E 1 9 to 1 0 1 10 to 90 of breath period 99 100 DYNAMIC PRESSURE AND FLOW CHARACTERISTICS COMPLIANCE DATA MASK ALARM DISPLAY NOTE AIR OUTLET Pressure Flow range IPAP 2 to 25 cm H2O EPAP 2 to 25 cm H5O Pressure Calibration Accuracy 1 cm H5O of the indicated control setting History 200 Days day by day measured at pressure Resolution 6 mins day Internal Clock accuracy 30 seconds per month Internal Clock Battery life 5 years Compliance data is viewed using the ResMed windows application SCAN or AutoScan v3 0 or greater Data is down loaded via modem or direct cable connect See Mask Alarm on page 75 Estimated Leak Range 0 to 150 L min Estimated Tidal Volume Range 0 to 3000 mL Leak and Tidal Volume displays are estimates Tbey are p
28. For further details see TiCONTROL Inspiratory Time Control on page 51 EMG Diaphragm All breaths are triggered Sigh spontaneously Patient Flow Mask Pressure Time Figure 4 Spontaneous mode 21 22 SPONTANEOUS TIMED MODE S T MODE In this mode the VPAP II ST A will follow the patient s spontaneous breathing as in Spontaneous mode However the clinician also specifies a breathing rate which they do not want the patient to fall below This is a backup rate which will be supplied if the patient s spontaneous breathing rate becomes insufficient This mode is used when a clinician wants to ensure a minimum backup rate is secured when the patient is not able to trigger the machine consistently or when the basal respiratory rate is very low When set in this mode the device will augment any breath initiated by the patient but will also deliver additional breaths should the respiratory rate fall below the clinician set backup breath rate T CONTROL s IPAP Min and IPAP Max Time parameters can be used to provide minimum and maximum limits on the inspiratory time however as in spontaneous mode the patient has primary breath control and cycling will usually occur spontaneously for both Spontaneous and backup Timed breaths For further details see TiCONTROL Inspiratory Time Control on page 51 EMG Diaphragm No effort Respiratory In m Ile Effort Machine generated breaths d
29. GS PROCEDURE Supplemental oxygen may desensitize the triggering of the VPAP II ST A more so at higher flow rates Oxygen flow rates exceeding the mask s EPAP vent flow may contribute to oxygen flow back into the VPAP II ST A If oxygen is used with this device the oxygen flow must be turned off when the device is not operating Explanation When the device is not in operation and the oxygen flow is left on oxygen delivered into the ventilator tubing may accumulate within the device enclosure and create a risk of fire Always begin II ST A therapy before the oxygen supply is turned on Always turn the oxygen supply off before stopping II ST A therapy Oxygen supports combustion Oxygen should not be used while smoking or in the presence of an open flame Fit the supplied oxygen connector to the air outlet of the VPAP II ST A and fit the air tubing to the oxygen connector Fit the oxygen supply tubing to the port on the oxygen connector OR Fit the oxygen supply tubing directly to the mask port A luer or nipple adapter may be required depending on the mask Attach the other end of the oxygen supply tubing to an oxygen flow meter Turn the II ST A on a In acute patients with hypoxemia first add oxygen to help reduce the work of breathing then optimize ventilator settings to improve ventilation b In chronic patients who do not have an important hypoxemic component optimize ventilator set
30. ILATION 56 4 Ifthe patient complains that the inspiratory time is too short verify the respiratory rate and IPAP Max setting SETTING IPAP MIN TIME Most patients with a normal pulmonary system do not have problems with premature cycling therefore the IPAP Min setting can remain at the default setting of 0 1 second SET UP FLOW CHART S AND S T MODE Choose S or S T Mode Adjust pressure settings IPAP 8 10 cm H2O EPAP 2 4 cm H5O Set TICONTROL Max and IPAP Min ST mode only set the respiratory frequency BPM to 4 6 below awake resting rate during ventilation Increase IPAP Increase EPAP Set Rise Time to patient comfort e Add O if patient is hypoxemic If SpO at rest 9096 after optimization of IPAP Y Add or increase O5 57 T jCONTROL IPAP MIN AND IPAP MAX TIME CALCULATION GUIDE To adjust IPAP Min and IPAP Max IPAP Min Ti Min IPAP Max Ti Max select the setting that corresponds to the patient s respiratory rate while using the ventilator at rest For COPD and Normal Patients IPAP Min setting can remain at the default setting of 0 1 second Respiratory Restrictive Frequency COPD BPM IPAP Max x EN E a EN NN EN I 7 s 7 z MEASURING RESPIRATORY RATE NOTE Respiratory rate sbould be calculated witb tbe patient ventilated and at rest e wben possible Measure the patient s resting respiratory rate durin
31. IN the fastest or shortest Rise Time It can also be set in 50 millisecond increments from 150 to 900 The higher the Rise Time setting the longer it takes for the pressure to increase from EPAP to IPAP NOTE The Rise Time scale approximates the time taken in milliseconds for the pressure to increase from 10 to 9096 of the IPAP EPAP pressure difference under controlled conditions Range 90 msec nominal to 900 msec USAGE Generally Rise Time is adjusted to achieve maximum patient comfort The patient should feel that they are receiving adequate flow but not be startled by each transition to the IPAP level Consideration of the IPAP Max time will also help guide where to set the Rise Time Setting the Rise Time too long can limit the time spent at IPAP and could impair ventilation SYSTEM SET UP BPM Primary menu This parameter sets the Breaths Per Minute BPM In Timed mode this represents the fixed respiratory rate at which the device will deliver therapy It determines the length of time between triggering events ie the respiratory cycle time The BPM rate ranges from 5 30 breaths per minute Timed mode is a controlled mode not dependent on the breathing effort of the patient should such effort exist The BPM rate should therefore be set at the rate the clinician wants the device to deliver therapy I E Display Primary menu Display Item only This display represents the
32. LIANCE To zero the patient hour counter and erase the saved compliance data select the COMPLIANCE RESET menu It will display ARE YOU SURE If you select YES then the compliance data will be erased and the counter reset The MACHINE HOURS counter cannot be reset SET UP FOR HOME TREATMENT 79 DOWNLOADING COMPLIANCE DATA COMPLIANCE ISSUES The II ST A measures the total hours the patient has been using the device so that usage can be determined and monitored This may be of particular importance in patients who fail to respond appropriately to therapy Patient Hours can be viewed when in Patient mode To view Patient Hours see Patient Hours on page 71 Patient Hours are reset cleared using the COMPLIANCE RESET item in the Clinical Mode menu The recording of patient hours will not commence unless the motor is on the mask is on and the ramp period if activated has completed More comprehensive compliance data and reports can be obtained by downloading information from the II ST A to a computer either directly or via modem using the AUTOSCAN compliance software The VPAP II ST A records compliance data every 6 minutes and will store up to 200 days of compliance data To download this data you will need a Clinical Interface Kit For more details please contact your supplier or refer to the AutoScan Clinician s Manual version 3 0 or later DELAY TIMER If the patient experiences difficulty fall
33. M 10 E 33 o RESMED VPAPIIST A ResMeED SULLIVAN cmH20 cmHoaO sec la Symbol panel SYMBOL PANEL DETAIL Humidifier option ON Menu lock enabled SmartStart enabled Mask Alarm enabled Spontaneous Timed breath by breath trigger indicator M NH El E BOO Pressure indicator DIAGRAMS 10 PRINCIPLES OF OPERATION OPERATING MODES The II ST A provides a higher pressure during inhalation PAP and a lower pressure during exhalation EPAP The II ST A has three operating modes which determine how the changes between IPAP and EPAP pressures are made Spontaneous Spontaneous Timed and Timed The II ST A also has a CPAP mode in which a fixed pressure is delivered e In Spontaneous mode the II ST A senses when the patient breathes in and when the patient breathes out The ventilator follows the patient s spontaneous breathing rate to supply the appropriate pressure In Spontaneous Timed mode the II ST A will follow the patient s spontaneous breathing as in Spontaneous mode However the clinician also specifies a breathing rate as in Timed mode which they do not want the patient to fall below This is a backup rate which will be supplied if the patient s spontaneous breathing rate becomes insufficient In Timed mode the clinician sets a breathing rate and an inspiratory time as set by the IPAP Max parame
34. P which delivers two treatment pressures This mode is sometimes called bi level ventilation A higher pressure is applied when the patient inhales and is called IPAP inspiratory positive airway pressure A lower pressure is applied when the patient exhales and is called EPAP Cexpiratory positive airway pressure sometimes referred to as PEEP positive end expiratory pressure The difference between the two treatment pressures represents the amount of pressure support provided to the patient The key to successful NPPV is synchronization how effectively the ventilator keeps in step with responds to and supports the patient s own breathing rhythm The ventilator needs to sense when the patient is inhaling and exhaling and supply IPAP and EPAP accordingly This manual includes information on how the VPAP II ST A operates as well as information on how to set up the II ST A to optimize ventilation Inhalation i Cycle j Exhalation Trigger Patient Flow Delivered Pressure EPAP Figure 1 Device in synchrony with patient INTRODUCTION MEDICAL INFORMATION WARNING CAUTION e CAUTION This icon draws your attention to possible personal injury This icon draws your attention to possible damage to equipment This icon draws your attention to an informative note Please read this manual carefully before use In the USA Federal law restricts this device to sale by or on
35. Patient Flow Set Respiratory rate BPM Mask Pressure Time Figure 5 Spontaneous Timed mode TIMED MODE T MODE In this mode the clinician sets the breathing rate and an inspiratory time The timed mode is used when a fixed inspiratory time and respiratory rate is desired and the patient is not able to trigger the device consistently or the basal respiratory rate is very low It is important to note that the Timed mode is a controlled mode not dependent on the breathing effort of the patient should such effort exist EMG Diaphragm Respiratory m Efforts ignored Effort All breaths are Small increase in flow in machine generated response to breathing effort Patient Flow Set Respiratory rate BPM Inspiratory time IPAP Max UM Mask Pressure Time Figure 6 Timed mode SYSTEM SET UP 23 MODE In CPAP mode a fixed pressure is delivered The CPAP mode is often used in patients with obstructive sleep apnea OSA who require no tidal volume augmentation Brief Effort EMG Diaphragm ue dn Mask Flow Mask Pressure Time Figure 7 CPAP mode 24 CHOOSING MODE OF VENTILATORY SUPPORT WARNING If an individual is able to trigger the device into the IPAP pressure consistently without developing periods of apnea then the Spontaneous mode is appropriate It is important to know if a patient is able to trigger the device asleep as well as when awake A
36. RESMED II ST A CLINICIAN S MANUAL MANUFACTURED BY ResMed Ltd 97 Waterloo Road North Ryde NSW 2113 Australia Tel 61 2 9886 5000 or 1 800 658 189 toll free Fax 61 2 9878 0120 Email reception resmed com au DISTRIBUTED BY ResMed Corp 14040 Danielson Street Poway CA 92064 6857 USA Tel 1 858 746 2400 or 1 800 424 0737 toll free Fax 1 858 746 2900 Email usreception resmed com US DESIGNATED AGENT ResMed Corp EU AUTHORISED REPRESENTATIVE ResMed UK Ltd INTERNET www resmed com Protected by AU 697652 AU 699726 AU 713679 EP DE FR GB 0088761 EP 0661071B DE FR GB JP 1697822 US 4944310 US 5199424 US 5522382 US 6213119 US 6240921 Other patents pending Copyright subsists in ResMed products SULLIVAN AutoScan AutoSet Bubble Cushion HumidAire IPAP Min IPAP Max Mirage SmartStart T Control Ultra Mirage and Vsync are trademarks of ResMed Ltd 2002 ResMed Ltd All rights reserved CONTENTS INTRODUCTION S os med iV uAIttishrfIpe tt eS a0 MEDICAL INFORMATION INDICATIONS CONTRAINDICATIONS DIAGRAM S E PRINCIPLES OF OPERATION OPERATING MODES TRIGGERING AND CYCLING VSYNC AUTOMATIC LEAK MANAGEMENT TICONTROL INSPIRATORY TIME CONTROL RISE TIME ADJUSTMENT PRESSURE DELIVERY DEVICE ALARMS MASK ALARM ASSEMBLY AAA dida ud totes SYSTEM SEISUPo S ues V lee RR NN eed CHOOSING A MASK VPAP II ST
37. Resetting compliance 71 79 Resetting the flow generator 79 Restrictive Disorders 53 Restrictive respiratory disorders Restrictive Lung Disorders 54 Rise Time 19 S Servicing 94 Set start pressure 69 Set time minutes 71 Set up Flow Chart 57 Set up for home treatment 79 Set up menus 18 Skin Care 17 SmartStart 48 70 95 Antibacterial filter 64 Default setting 20 Humidifer 64 Mask Alarm 48 70 75 95 Specifications 99 Spontaneous mode 21 25 27 Spontaneous Timed mode 22 25 32 Start pressure Default setting 20 Start Stop button 47 Starting treatment 47 Stopping treatment 48 Symbol panel 9 Synchronization 1 11 49 T Testing the alarms 77 TiControl 51 Timed mode 23 39 Titration 59 Triggering and Cycling 11 Troubleshooting 95 U Ultra Mirage 17 Using Battery Power 83 Using oxygen in the home 60 V VPAP Control panel 8 LCD icons 8 Symbol Panel 9 Vsync 50 Ww Warning Lights 73 Fault 74 High pressure 73 7 Zero patient hour counter 79
38. ST A power cord into the socket at the rear of the device Plug the other end of the power cord into a power outlet and turn the power on Make sure that the power cord and plug are in good condition and the equipment is not damaged 9 Navigate the II ST A menu and set the HUMIDIFIER option to ON See VPAP II ST A Set up on page 18 The VPAP II ST A is now ready for use with the HUMIDAIRE USING SMARTSTART OR THE MASK ALARM WITH A HUMIDIFIER OR ANTIBACTERIAL FILTER You must activate the humidifier option in the HUMIDIFIER menu if the patient is using a humidifier This is especially important if SmartStart or the Mask Alarm is enabled Enabling the humidifier option adjusts the triggering threshold of these functions to ensure that II ST A allows for the increased resistance of the humidifier Similarly use of antibacterial filters may also require the humidifier option to be enabled to optimize the operation of SmartStart or the Mask Alarm To test the Mask Alarm see Mask Alarm Test daily on page 77 USING A RESCONTROL The RESCONTROL can be used to simultaneously monitor respiratory parameters while adjusting parameters and or remotely adjust the VPAP II ST A When a setting on the RESCONTROL is changed the display on the VPAP II ST A will automatically update Similarly when a setting on the VPAP II ST A is changed the RESCONTROL will automatically update its display For full details please refer
39. The mask alarm activates when flow exceeds a flow threshold contour Because the alarm is flow activated the corresponding mask pressure will depend on the impedance of the air circuit in use The example shown in the following graph approximates the mask pressure at which the alarm is activated for a relatively high impedance air circuit with the Humidifier option ON For lower impedance air circuits eg Humidifier option OFF ULTRA MIRAGE MASK 2m hose no humidifier the alarm will typically be activated at higher mask pressures The following graph is provided as a guide only Mask Alarm threshold characteristics 18 16 14 e Humidifier 12 option ON Mirage mask 10 3m hose HumidAire 8 6 4 2 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 Displayed II ST A Pressure IPAP or EPAP H20 TESTING THE ALARMS WARNING It is recommended that you test the Mask Alarm every day before use and each time any component of the breathing circuit is altered the buzzer LEDs Light Emitting Diodes and the power failure each week and low pressure alarms once a month The high pressure alarm is factory tested using specialized test equipment You can mute the alarm at any time by pressing the Alarm Cancel button MASK ALARM TEST DAILY 1 Configure the II ST A as it will be used by the patient see Assembly on page 15 and VPAP II ST A Set up on page 18 Block the opening of the mask
40. alculation Guide on page 58 3 SetIPAP Max to the value that corresponds to the resting respiratory rate from step 1 4 Ifthe patient complains that the inspiratory time is too short verify the respiratory rate and IPAP Max setting SETTING T CONTROL s IPAP MIN TIME Most patients with obstructive pulmonary disease do not have problems with premature cycling therefore the IPAP Min setting can remain at the default setting of 0 1 second NORMAL PULMONARY SYSTEM normal lungs using nasal mask Nasal mask therapy is often associated with mouth leaks that can lead to prolonged inspiratory time due to late cycling This can cause patient ventilator dysynchrony sleep disruption non compliance and other complications A safety system IPAP Max has been added to the VPAP II ST A to prevent late cycling Humidification can decrease patient airway resistance and help with small mouth leaks See Humidification on page 61 Large mouth leaks should be managed by using a Mirage Full Face Mask See ResMed masks on page 49 SETTING IPAP MAX TIME 1 Measure the respiratory rate during ventilation and at rest see Measuring Respiratory Rate on page 59 2 Refer to the column entitled Normal IPAP Max in TiCONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 3 Set IPAP Max to the value that corresponds to the resting respiratory rate from step 1 OPTIMIZING SETTINGS FOR 55 EFFECTIVE VENT
41. an also occur in patients who are unable to reposition the mask themselves because of upper limb weakness Patients who are on high dose oral steroids may also have an increased likelihood of skin problems and such patients need to be monitored for signs of skin breakdown Taking a preventative approach to avoid skin breakdown in the first place is important Masks need to be carefully fitted so that comfort and minimal leaks are achieved Frequently the use of an ULTRA MIRAGE or MIRAGE FULL FACE MASK can achieve both these goals The use of a protective dressing can also alleviate irritation to the skin If the skin does become reddened the area should be gently massaged and the mask fit reassessed Check that the head straps are not over tightened If a patient requires ventilatory support for prolonged periods the mask should be removed periodically to examine the skin for pressure area care and for placement of a protective dressing if required If patients require mask use on a continuous basis alternating between several styles of mask may also be of value SYSTEM SET UP 17 18 VPAP II ST A SET UP STEP 1 The VPAP II ST A can be set up using the display and buttons on the device itself or with the use of a separate control unit the RESCONTROL To set up the VPAP II ST A using the RESCONTROL see Using a ResControl on page 65 The II ST A is set using the menus on the LCD screen To access the set up menu
42. and flow conditions while maintaining a constant pressure DEVICE ALARMS The VPAP II ST A is equipped with an audible alarm and three warning lights to indicate a device malfunction that may affect treatment The alarms are for low pressure high pressure power failure or disconnection and overheating For further details see Alarms and Warning Lights on page 73 PRINCIPLES OF OPERATION 13 14 MASK ALARM The II ST A also has an optional mask off alarm which will activate in the presence of excessive leak A Mask off message will also appear on the LCD screen The mask off alarm can be enabled or disabled via the Mask Alarm menu For further details see Mask Alarm on page 75 ASSEMBLY 1 Check that you have the following items II ST A device e Air tubing Power cord e Carry bag Plug the power cord into the power socket at the back of the VPAP II ST A Plug the other end of the power cord into a mains power outlet WARNING Select an appropriate ResMed mask system see Choosing a Mask on page 17 and assemble it according to the user instructions supplied with the mask If you choose to use a humidifier refer to the user s manual supplied with the humidifier for connection instructions Also see Humidification on page 61 The VPAP II ST A should only be used with humidifiers recommended by ResMed or by a physician or respiratory therapist
43. and press the Start Stop button Allow the VPAP II ST A to run for 5 seconds or until the pressure stabilizes Then unblock the opening of the mask The Mask Alarm should activate within 5 to 10 seconds If the Mask Alarm fails to activate reconfigure the system or refer to the Mask Alarm reference in the Troubleshooting section on page 95 BUZZER LED TEST WEEKLY 1 Hold down the Alarm Cancel button and turn the VPAP II ST A on at the main power switch If the VPAP II ST A is already on you will need to turn it off first Keep the Alarm Cancel button pressed until the buzzer and LEDs activate The buzzer will sound and the LEDs will flash for approximately ten seconds POWER FAILURE ALARM TEST WEEKLY 1 With the air tubing and mask connected turn the VPAP II ST A on and press the Start Stop button Let it run for at least eight seconds to allow the backup capacitors to fully charge Turn the VPAP II ST A off using the main power switch The buzzer and fault LED will activate for approximately one minute LOW PRESSURE ALARM TEST MONTHLY 1 2 Disconnect the air tubing from the VPAP II ST A Turn the VPAP II ST A on and press the Start Stop button After a few seconds the buzzer will sound and the low pressure LED will light up ALARMS AND WARNING LIGHTS 77 78 WARNING If the buzzer LED power failure alarm or low pressure alarm tests do not work carefully repeat the steps above If they still do
44. anufactured to provide optimum performance using ResMed vented mask systems Other mask systems may be used however some of the device s features may be affected A qualified clinician should confirm the function of any feature s intended for use during therapy Features affected may include Breath trigger and cycling performance may become more or less sensitive or not function at all Thus the patient may not be adequately ventilated in some cases Therefore other masks should only be used if the physician has confirmed correct operation for the particular patient Other mask systems may or may not have adequate venting e Accuracy of Leak and Tidal Volume measurement may be affected SmartStart and Mask Alarm may not function reliably e Accuracy of Patient Hours measurement compliance meter may be affected as a result of unreliable SmartStart and Mask Alarm functions Some masks may add to circuit resistance and potentially increase the work of breathing The mask should be worn only when the machine is turned on and operating properly Explanation exhaled air is flushed out of the vents when the machine is operating If the unit is not operating exhaled air will be rebreathed The vent holes on the mask should never be blocked At low pressures especially at low EPAP pressures the flow through the exhalation ports may be inadequate to clear all exhaled gases Some rebreathing may occur The airflow for breathing may be
45. as much as 11 F 6 C higher than room temperature Caution should be exercised if the room temperature is higher than 95 F 35 C Do not drop or insert any objects into the air tubing or air outlet Do not open the flow generator case or attempt to adjust the unit MEDICAL INFORMATION DIAGRAMS FRONT VIEW Control panel Mask on II ST A Device Communications port LCD screen see LCD screen Detail on page 8 Carry handle Air outlet Humidifiers see Humidification on page 61 Air tube REAR VIEW Air filter cover see Replacing the air filter strip on page 92 Power cord see Using the Power Cord Clip optional accessory on page 93 Main power switch DIAGRAMS CONTROL PANEL DETAIL Patient Mo q Low General use buttons Start Stop ni Alarm pressure button Delay Timer Cancel alarm LED buttons button High pressure SULLIVAN alarm LED MODE p Jn j 1 cmh20 i A cmHaO po IPAP sec 2 li 24 p MENU Y f E 1 Menu Option 1 Fault a buttons buttons Set up buttons alarm SET MODE Clinical Mode LED LCD SCREEN DETAIL Cursor Set values S T 25 0 10 0 Primary settings menu Secondary menu and displays IPAP Max 2 0 d MIN BP
46. ce of cold air toward the device Remove blockage or replace clogged filter Remove blockage Insufficient air flow delivered from the VPAP II ST A continued over page Delay Timer is in use Air filter strips are dirty Airtubing is kinked or punctured Airtubing is not connected properly Plugs missing from the mask ports Wait for air pressure to build up gradually or press the Start Stop button to start immediately Replace air filter strips Straighten or replace air tubing Check and tighten both ends of the air tubing Replace plugs 97 98 Problem Air leaking around nose and eyes Possible cause Nasal cushion not fitted properly onto mask frame Mask and headgear straps not positioned correctly Plugs missing from mask ports Nasal cushion is torn or distorted Solution Fit cushion properly Adjust position of mask and headgear Note tighter is not always better Replace plugs Replace cushion Alarms not working when tested for problems with the Mask Alarm see the Mask Alarm reference on the previous page Malfunction Return to supplier for service SPECIFICATIONS RESMED II ST A DEVICE SPECIFICATIONS DIMENSIONS HxWxL 142 x 240 x 350mm 5 6 x 9 5 x 13 8in Weight 3 5kg 7 71b Power Supply Mains Input range 110 240V 50 60Hz 200VA voltage is self selecting External battery Via certified and CE
47. ct When assessing the relative risks and benefits the clinician should understand that the II ST A flow generator can be set to deliver pressures to 25 cm H O Also in the unlikely event of certain fault conditions a maximum static pressure of 35 cm H5O is possible If it is believed that such a pressure could present a risk to a particular patient then this device must not be used For patients with limited respiratory capacity during sleep for example emphysema reduced central drive neuromuscular chest wall or lung parenchymal disease and similar conditions the use of the SmartStart feature may not be advisable if the unit is stopped inadvertently by this feature due to a leak for example the patient may have insufficient breathing to restart the unit Therefore a flow generator set in the Spontaneous mode should be used with caution in such subjects until it is established that the subject triggers the device satisfactorily during sleep This problem may be reduced by using the Spontaneous Timed mode This is NOT a life support ventilator II ST A is non continuous ventilator intended to augment patient breathing It is not intended to provide total ventilatory support or guaranteed volume delivery It may stop operating with power failure or if a fault occurs in the product Explosion hazard do not use in the vicinity of flammable anesthetics e ResMed II devices have been designed and m
48. d breathing rate and an inspiratory time The inspiratory time and respiratory rate is inspiratory time is determined by the IPAP desired and the patient is not able to Max setting trigger the device consistently or the basal respiratory rate is very low It is important to note that the Timed mode is a controlled mode not dependent on the breathing effort of the patient should such effort exist The IPAP Min time parameter does not operate in the timed mode In this mode a T icon will briefly appear beneath the I E value on the LCD screen to indicate the initiation of IPAP 39 TIMED MODE 40 ADJUSTABLE MONITORED PARAMETER IPAP Primary menu DESCRIPTION The IPAP Inspiratory Positive Airway Pressure setting ranges from 2 to 25 cm H5O This is the inspiratory pressure which will be delivered to the patient when the device is triggered into inspiration The difference between the IPAP and EPAP IPAP EPAP determines the pressure support level delivered to the patient USAGE The setting of the inspiratory pressure is made on the basis of patient tolerance and the effect of the pressure on ventilation and gas exchange As the IPAP pressure is increased and the difference between IPAP and EPAP widens the tidal volume will normally be increased The changes in IPAP and Tidal Volume can both be observed on the LCD screen It should be noted however that unnecessarily high inspiratory pressur
49. e VPAP Il ST A allows the Rise Time to be set to MIN the fastest or shortest Rise Time It can also be set in 50 millisecond increments from 150 to 900 The higher the Rise Time setting the longer it takes for the pressure to increase from EPAP to IPAP NOTE The Rise Time scale approximates the time taken in milliseconds for the pressure to increase from 1096 to 9096 of the IPAP EPAP pressure difference under controlled conditions Range 90 msec nominal to 900 msec USAGE Generally Rise Time is adjusted to achieve maximum patient comfort The patient should feel that they are receiving adequate flow but not be startled by each transition to the IPAP level However if the patient has a high ventilatory demand eg patients with respiratory insufficiency then setting the Rise Time to MIN will help lower the patient s work of breathing For example a MIN Rise Time setting can help patients with respiratory insufficiency Consideration of the patient s actual inspiratory time will also help guide where to set the Rise Time Setting the Rise Time too long can limit the time spent at IPAP and could impair ventilation For example if a patient s inspiratory time is one second a Rise Time setting of less than 350 msec is recommended allowing sufficient time for ventilation at IPAP Respiratory Rate Secondary menu Monitored Parameter This is a display of the respiratory rate based on the last two breaths d
50. e can produce worsening leak from the mask and mouth thereby reducing the effectiveness of ventilatory support These leaks will most likely occur in patients with very stiff lungs or chest walls or in patients with weak facial muscles EPAP Primary menu The EPAP Expiratory Positive Airway Pressure setting ranges from 2 cm H5O to the set IPAP level This is the amount of pressure in the circuit during the patient s expiratory phase EPAP is used to assist flushing of exhaled CO through the mask vents during exhalation maintain patency of the upper airway especially important during sleep overcome intrinsic PEEP in patients with obstructive lung disease and improve oxygenation and end expiratory lung volumes in patients with low lung volumes For guidelines on adjusting EPAP settings see Set up Flow Chart S and S T Mode on page 57 IPAP Max Primary menu In Timed mode the IPAP Max Time represents the inspiratory time That is the amount of time the device spends in IPAP will always equal the set IPAP Max time This setting determines the inspiratory time for each breath In Timed mode the patient cannot vary their inspiratory time nor regulate their own I E ratio ADJUSTABLE MONITORED PARAMETER Rise Time Primary menu DESCRIPTION Rise Time is the time taken for the pressure to increase from EPAP to IPAP The VPAP II ST A allows the Rise Time to be set to M
51. eathed at particular device settings The characteristics of masks other than those listed in the following table may be different and it is important to select a mask that provides comfort while delivering correct treatment The data provided is derived from bench testing and is for guidance only The amount of CO rebreathing in actual clinical use may vary It is recommended tbat patient monitoring be performed to assess tbe adequacy of patient CO level management particularly at low EPAP pressures TABLE 2 REBREATHING e Breath rate 15 BPM Tested under conditions of no leak Volume of rebreathed per breath ml see note 1 Tidal vol 200 mL Tidal vol 300 mL Tidal vol 500 mL Tidal vol 600 mL End tidal CO 240 mmHg End tidal CO 240 mmHg End tidal CO 240 mmHg End tidal CO 240 mmHg EPAP g l amp l amp l g mHO lo 8 la 2 Jo Js 2 la Js Je 5 3 i 5 3 5 D 3 E 5 8 5 3 7 POS S 2 POS 18 P gt gt E gt gt ES z gt gt 2 gt gt 2 gt 0 see note 2 5 5 4 8 2 5 2 3 10 3 10 2 12 7 47 21 4 20 4 25 2 8 6 26 0 25 1 30 9 10 7 2 1 6 1 0 2 4 0 6 2 0 2 1 4 3 0 9 3 0 3 3 6 4 1 1 4 2 3 5 7 5 2 5 3 1 4 1 0 2 2 0 6 1 7 1 8 3 9 0 7 2 7 3 0 5 5 0 9 3 1 2 9 5 7 1 6 4 1 3 0 9 2 1 0 6 1 5 1 6 3 5 0 7 2 2 2 6 48 0 8 26 24 4 8 1
52. enation and end expiratory lung volumes in patients with low lung volumes For guidelines on adjusting EPAP settings see Set up Flow Chart S and S T Mode on page 57 IPAP Max Primary menu IPAP Max Time is a TICONTROL parameter It allows adjustment of maximum inspiratory time parameter ranging from 0 1 to 3 seconds for Spontaneous Timed mode NOTE In Spontaneous Timed mode although it is possible to set an IPAP Max Time greater than 3 seconds the VPAP II ST A internally limits the IPAP Max Time to 3 seconds The IPAP Max Time parameter allows the clinician to limit the time the patient spends in IPAP The ability to limit the maximum inspiratory time is an important factor in optimizing patient ventilator synchronization Refer to Synchronization on page 49 for details on how to set the IPAP Max parameter to optimize synchronization in the presence of mask and or mouth leaks and in patients with different disease states exchange and reduced compliance For details on adjusting IPAP Max settings see TICONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 For details on synchronization see Synchronization on page 49 SYSTEM SET UP SPONTANEOUS TIMED MODE 35 36 ADJUSTABLE MONITORED PARAMETER Rise Time Primary menu DESCRIPTION Rise Time is the time taken for the pressure to increase from EPAP to IPAP The VPAP Il ST A allows the Rise Time to be set to MIN the
53. ens the tidal volume will normally be increased The changes in IPAP and Tidal Volume can both be observed on the LCD screen It should be noted however that unnecessarily high inspiratory pressure can produce worsening leak from the mask and mouth thereby reducing the effectiveness of ventilatory support These leaks will most likely occur in patients with very stiff lungs or chest walls or in patients with weak facial muscles If patients are unable to tolerate the desired IPAP level initially gradual increases in pressure may need to occur over time The Tidal Volume measurement which can be found in the secondary menu can be used as a guide to setting the IPAP level For guidelines on adjusting IPAP settings see Set up Flow Chart S and S T Mode on page 57 NOTE Before starting treatment make sure the Delay Timer setting is correct For further details see Delay Timer on page 80 ADJUSTABLE MONITORED PARAMETER EPAP Primary menu DESCRIPTION The EPAP Expiratory Positive Airway Pressure setting ranges from 2 cm H5O to the set IPAP level This is the amount of pressure in the circuit during the patient s expiratory phase USAGE EPAP is used to assist flushing of exhaled CO through the mask vents during exhalation maintain patency of the upper airway especially important during sleep overcome intrinsic PEEP in patients with obstructive lung disease and improve oxyg
54. ent you must lock the menu after set up before giving the II ST A to the patient To do this 1 Use the 4 MENU buttons to select the PATIENT MODE in the secondary menu 2 Press the 4 OPTION button to answer YES The display will ask ARE YOU SURE 3 Pressthe 4 OPTION button again to answer YES and the menus will be locked 4 To return to the clinical mode turn the II ST A off and refer to STEP 1 You do not need to lock the menu in tbe clinical mode It is more useful to have tbe menu readily accessible Tbe menu lock is to prevent patients from changing tbe settings at bome Table 1 VPAP II ST A menu maximum and minimum values adjustment increments and default values MENU Q OPTION DEFAULT MENU Y OPTION Y SET MODE CP S T SA S T SET IPAP 2 25 cm H O 0 2 increment 10 cm H5O SET EPAP 2 cm H5O IPAP 0 2 increment 8 cm SET IPAP Max 0 1 3 0 sec S amp S T modes 2 0 sec 0 1 10 8 sec T mode SET RISE TIME MIN 150 900 50 increment MIN SET BPM 5 30 BPM 1 sec increment 10 BPM EE DISPLAY ONLY 3396 RESPIRATORY RATE DISPLAY ONLY N A TIDAL VOLUME DISPLAY ONLY N A LEAK DISPLAY ONLY N A DELIVERED PRESSURE DISPLAY ONLY N A 19 20 MENU OPTION Q DEFAULT MENU Y OPTION Y SET START PRESSURE 2 cm H5O EPAP 0 2 increment 4 0 cm H2O SET IPAP Min 0 1 sec IPAP Max 0 1 increment 0 1
55. etected by the VPAP II ST A Tidal Volume Secondary menu Monitored Parameter This is a display of the calculated tidal volume delivered to the patient by the VPAP II ST A It is calculated on a breath by breath basis by integrating an estimate of patient flow obtained by subtracting the leak flow and ResMed mask vent flow from the measured total flow rate This provides a useful indication of the trend and magnitude of change in the patient s tidal volume Tidal volume will normally increase as IPAP pressure is increased Since the VPAP II ST A assumes the vent flow to be that of a ResMed mask when performing calculations using masks other than ResMed masks is likely to diminish accuracy in this display Unintentional leak has a similar effect on these calculations There will be some delay in the display of the Tidal Volume measurement after being selected ADJUSTABLE MONITORED DESCRIPTION USAGE PARAMETER Leak Monitored Parameter Ideally leak rates should be kept below 25 Secondary This is a display of leak as calculated by the L min to assure quality sleep menu VPAP II ST A It is a measure of additional Non ResMed masks may yield erroneous airflow required to compensate for leak calculations Even then the ResMed unintentional leak around the mask and or ypAP II ST A will yield a useful indication through the patient s mouth Since the of the trend and magnitude of change VPAP II ST A knows t
56. failure to trigger the device into IPAP may be due to upper airway obstruction or the presence of intrinsic PEEP The EPAP pressure should be titrated to abolish obstructive events and or overcome intrinsic PEEP However if the patient is not able to trigger the machine consistently or if the basal respiratory rate is very low then the Spontaneous Timed mode is more appropriate The mode used by the clinician can also be influenced by the therapeutic goals of treatment If the aim of therapy is to rest the respiratory muscles then the Spontaneous Timed mode may be applicable However if supporting and augmenting the patient s own respiratory efforts is required then the Spontaneous mode may be more appropriate The Timed mode is used when a fixed inspiratory time and respiratory rate is desired and the patient is not able to trigger the device consistently or the basal respiratory rate is very low The CPAP mode is often used in patients who have OSA and who require no tidal volume augmentation Some patients with uncomplicated OSA may fail to tolerate CPAP especially when prescribed high treatment pressures These patients may find the II ST A in S mode more comfortable as the pressure is lowered to EPAP during exhalation Care should be taken not to over ventilate patients using the Spontaneous Timed Spontaneous or Timed modes of ventilation as this may induce glottic closure resulting in airway obstruction SYSTEM SET UP
57. g assisted ventilation If you think the patient s respiratory rate will decrease during sleep and you are unable to measure it then estimate the nocturnal respiratory rate and use this figure to determine the IPAP Max and IPAP Min setting Refer to the section above that most appropriately matches the patient s condition In some instances recommended settings may need to be fine tuned based on patient feedback and or ongoing clinical assessment OPTIMIZING SETTINGS FOR ADDING SUPPLEMENTAL OXYGEN Up to 15 L min of oxygen can be added at the mask or at an oxygen connector between the VPAP II ST A and the air tubing Oxygen connector Oxygen connector Oxygen connector Mirage Full Face Ultra Mirage Oxygerf tubing Oxygen tubing Figure 14 Adding supplemental oxygen at the mask and near the device Adding oxygen at the air tubing near the II ST A maintains mask pressure accuracy whereas adding oxygen directly at the mask may increase mask pressure up to 2 cm H O above the prescribed level There is less likelihood of the oxygen line becoming kinked or the connector breaking off the mask port if oxygen is added at the connector near the device This method also improves the mixing of oxygen and air flow Actual oxygen concentrations will vary depending on the mask used where the oxygen is introduced pressure setting volume delivered leak and patient breathing pattern 59 EFFECTIVE VENTILATION 60 WARNIN
58. he expected vent flow Th llb delay in the displ of ResMed masks it calculates any h us i p ied x 4 ay additional flow at the end of exhalation as value alter being selected leak It is expressed in liters per minute L NOTE The leak display provides an min and updated continuously estimate and is for trending purposes only Pressure Monitored Parameter Secondary This is a display of pressure delivered from menu the VPAP II ST A Delivered pressure is measured internally by a pressure transducer IPAP Min IPAP Min Time is a ICONTROL The IPAP Min Time parameter allows the Secondary parameter It allows adjustment of the clinician to set a minimum time the patient menu minimum inspiratory time parameter spends in IPAP ranging from 0 1secs to IPAP Max for Spontaneous mode IPAP Min Time is the minimum duration of time that the device will remain at the IPAP level The ability to set the minimum IPAP time is an important factor in optimizing patient ventilator synchronization for patients with restrictive diseases For details on adjusting IPAP Min settings see TICONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 a Thomas J Meyer Mark R Pressma Joshua Benditt Francis D McCool Richard P Millman Ranjini Natarajan Nicholas S Hill Air Leaking Through the Mouth During Nocturnal Nasal Ventilation Effect on Sleep Quality Sleep1997 20 7 561 569 For other adjustable device
59. imizing patient ventilator synchronization with a three layered approach 1 ResMed Masks minimizing leak 2 Vsync automatic leak management 3 T CONTROL inspiratory time control RESMED MASKS The selection of a good fitting easy to use comfortable mask is the first step in ensuring good synchrony and effective ventilation ResMed s MIRAGE and ULTRA MIRAGE masks provide comfort while minimizing leaks 49 EFFECTIVE VENTILATION 50 Studies show that almost all patients on bi level therapy experience mouth leaks during sleep 2 The MIRAGE FULL FACE MASK solves mouth leaks by providing a comfortable seal around both the nose and mouth Vsync AUTOMATIC LEAK MANAGEMENT TRIGGER CYCLE THRESHOLD ADJUSTMENT Vsync is the automatic leak management algorithm unique to the II series Vsync continuously monitors changing leaks and estimates the patient respiratory flow It continuously measures a patient s respiratory flow to enable it to make triggering and cycling decisions A breath is triggered if this flow signal exceeds a flow threshold value above baseline see Figure 8 A breath is cycled if this flow signal falls below a flow threshold value The VPAP II ST A continuously measures flow caused by leak It automatically compensates for intentional and unintentional leak by adjusting the baseline flow As the baseline is adjusted the trigger and cycle thresholds see Figure 8 are maintained In this way the
60. ing asleep with full pressure they may wish to use the Delay Timer The airflow starts very gently while they fall asleep and slowly increases to full operating pressure over a selected time period The timer can be set to 5 10 or 20 minute delay periods The clinical mode must be locked to use the Delay Timer It is important to note that the Delay Timer may not be suitable for some patients This is due to fact that when the Delay Timer is chosen the pressure starts in CPAP and gradually ramps up to deliver the prescribed pressure support This means that the patient is not receiving the full pressure support level during the ramping period see Figure 16 Pressure A Prescribed IPAP ae ee Prescribed EPAP 4 re AT N EPAP pressure envelope Start pressure 4 gt Time STANDBY t 5 minutes 5 MIN elapsed Delay Timer key pressed Figure 16 Pressure increase with Delay Timer To start the Delay Timer choose a delay time and press the corresponding button must be in Patient Mode The air will start to flow automatically There is no need to push the Start Stop button If the patient has not yet fallen asleep when the flow reaches full pressure they may press one of the Delay Timer buttons again You may disable the Delay Timer entirely by removing all the delay options until only 0 is remaining The VPAP II ST A Delay Time default is zero See II ST A Set up on page 18 Alternatively you
61. is controlled patient ventilator synchrony cannot be maintained OPTIMIZING SETTINGS FOR The T CONTROL feature provides such control enabling flexibility and synchronization even under large leak conditions T CONTROL allows the clinician to set minimum and maximum limits on the time that the device spends in IPAP Called IPAP Min and IPAP Max time these time limits are set at either side of the patient s ideal spontaneous inspiratory time These provide a window of opportunity for the patient to spontaneously cycle to EPAP Thus the IPAP Min and IPAP Max times determine the Cycle Window T CONTROL IPAP IPAP Min Max Time Time Patient Flow Figure 9 T CONTROL sets the Cycle Window In the presence of large leaks T CONTROL via the IPAP Max time parameter effectively intervene to limit the IPAP duration This ensures that the device remains in synchrony with the patient Vsync with T CONTROL enable synchronization despite the presence of leaks even large ones Thus the VPAP II ST A provides security for both patient and clinician 51 EFFECTIVE VENTILATION 52 T CONTROL Patient Flow Cycle time without IPAP Max Time 3 seconds IPAP Max Time Delivered Pressure Figure 10 IPAP Max Time Ensures cycling the presence of leaks T CONTROL MANAGING DIFFERENT DISEASE STATES T CONTROL also allows the clinician to set limits on the spontaneous inspiratory time for patients with particu
62. itored Parameter Secondary This is a display of pressure delivered from menu the VPAP II ST A Delivered pressure is measured internally by a pressure transducer a Thomas J Meyer Mark R Pressma Joshua Benditt Francis D McCool Richard P Millman Ranjini Natarajan Nicholas S Hill Air Leaking Through the Mouth During Nocturnal Nasal Ventilation Effect on Sleep Quality Sleep1997 20 7 561 569 For other adjustable device settings and displayed items available in this mode see Additional Functions on page 69 These include SET START PRESSURE e SMARTSTART STOP e MASK ALARM HUMIDIFIER OVERHEAT DEFAULT e DELAY TIME SYSTEM SET UP 43 TIMED MODE 44 ADJUSTABLE MONITORED PARAMETER MODE Primary menu CPAP MODE This section discusses the key parameters that need to be adjusted and the monitored items that are displayed in CPAP mode The key adjustable parameter that needs to be adjusted in this mode is IPAP which represents the single fixed pressure that the device will deliver The monitored parameters displayed in this mode are Respiratory Rate e Leak Pressure The CPAP parameter and monitored parameters are discussed below in the order they appear in the II ST A primary and secondary menus For instructions on how to change settings see VPAP II ST A Set up on page 18 For other adjustable device settings and displayed items available in this mode
63. k but leave the VPAP II ST A on operation will resume when power is restored O HEAT ALARM message on LCD screen and buzzer See Overheating on page 92 for more information Rapid breathing and high ambient room temperature have caused the motor to overheat If the patient is comfortable with the constant pressure let it run the motor will cool down after about 15 minutes and resume normal operation If the single pressure is uncomfortable stop the unit by pressing the Start Stop button and allow it to cool you may resume normal operation when cool Cool the room if possible but do not direct the source of cold dry air toward the II ST A Air inlet filters clogged Replace inlet filters see Replacing the air filter strip on page 92 ALARM CANCEL BUTTON The alarm will sound for a minimum of one minute in the event of a power fault and as long as the alarm condition exists for other alarms You can press the Alarm Cancel button to silence the alarm at any time If the alarm was caused by a high mask leak correcting the cause of the leak will also silence the alarm If the alarm was caused by a high pressure condition the high pressure light will continue to flash until the II ST A is turned off If you only press the Alarm Cancel button and do not remove or fix the cause of the alarm the alarm will trigger again after two minutes MASK ALARM NOTE e WARNING The
64. l the paper backing off the cable clip 3 Wait 2 minutes after placing the cable clip TECHNICAL INFORMATION 95 94 Push the power cord firmly into the cable clip to secure it SERVICING CAUTION The VPAP II ST A is designed to give years of trouble free operation It will not require regular servicing provided that it is cleaned and maintained according to instructions If you feel that the unit is not performing properly check the troubleshooting table on page 95 If it is still not working properly contact ResMed or an authorized service agent Inspection and repair should only be performed by an authorized service agent Under no circumstances should you attempt to service or repair the unit yourself TROUBLESHOOTING Problem VPAP II ST A does not start when you press the Start Stop or Delay Timer button and the LCD screen is blank Possible cause Power cord is not connected properly VPAP II ST A is not switched on Power outlet may be faulty Solution Check both ends of the power cord TECHNICAL INFORMATION Switch on main switch at rear of unit Try another power outlet SmartStart is enabled but flow does not start when you begin breathing in the mask Breath is not deep enough to trigger SmartStart Excessive leak SmartStart not enabled 4i does not appear on the LCD screen Mask or mask valve combination affecting SmartStart Take a deep breath in and ou
65. lar disease states such as obstructive lung diseases and restrictive respiratory disorders Cycle Window Patient Flow Delivered Pressure Figure 11 Normal device cycles spontaneously within Cycle Window MANAGING OBSTRUCTIVE LUNG DISEASES Some patients with obstructive lung diseases may have a very slow decrease in inspiratory flow due to high airway resistance This can lead to late cycling with an associated prolonged inspiratory time and a shortened expiratory time This in turn increases the risk of Intrinsic PEEP caused by further air trapped in the lungs For these patients the IPAP Max feature allows you to set a maximum time that the device will spend in IPAP assuring sufficient expiratory times Cycle Window 7 Cycle time without IPAP Max Patient Flow IPAP Max Time Delivered Pressure Figure 12 Obstructive High Airway Resistance device cycles within Cycle Window at IPAP Max Time MANAGING RESTRICTIVE DISORDERS Some patients with restrictive disorders may cycle to expiration too early especially during certain stages of sleep This can lead to under supported breaths diminished tidal volumes and poor ventilation For these patients T CONTROL s IPAP Min feature allows you to set a minimum time that the machine will spend in IPAP before spontaneous cycling is allowed thus increasing inspiratory time Cycle Window Cycle time without IPAP Min Patient Flow Min Time gt
66. ld normally use it and connect all accessories eg humidifier filters etc that are normally used If you have a Modular mask connect this instead of the patient s normal mask and fit the blind Bubble Cushion If you do not have a Modular mask or a blind BUBBLE CUSHION you can use the patient s normal mask and block the opening with the palm of your hand If you are using a MIRAGE mask be careful not to block the mask exhaust vents Turn the VPAP II ST A on to allow the pressure transducer to warm up The motor does not need to be running if it does start running press the Start Stop button to stop the flow Let the device warm up for 15 minutes Remove the plug from one of the access ports on the mask and insert the Luer taper end of the sensor tube The other end of the sensor tube should be fitted to the manometer or the RESCONTROL Access the setting menus Clinical Mode and select the CALIBRATE from the secondary menu You may need to turn the II ST A off and then on again with the buttons held down see VPAP II ST A Set up on page 18 The flow will start automatically TECHNICAL INFORMATION 89 5 Read the pressure on the manometer or RESCONTROL and adjust the gain value using the 4 OPTION Y buttons on the II ST A until the pressure reading is 16 0 2 cm H O 6 To store the new calibration setting press the Start Stop button or change the menu with the 4 MENU buttons Manometer
67. n Use of topical nasal decongestants Skin breakdown Wound dressing on nasal bridge Change to Mirage or Bubble mask available from ResMed Contact your supplier for more details Ensure head straps are not overtightened Use of nasal pillows this type of mask has a higher resistance so ventilator settings should be checked Gastric distension continued over page Reduce peak inspiratory pressures Modify Rise Time Check ventilation mode Spontaneous or S T would be least likely to cause this Problem continued from previous page Possible Solution Try gastrointestinal antispasmodics Change sleeping position lying on left side Add humidification to reduce nasal resistance Continued daytime sleepiness sleep fragmentation Attend to mouth leaks OPTIMIZING SETTINGS FOR Refit mask to minimize mask leaks Eliminate upper airway obstruction Reduce peak inspiratory pressure Add humidification to reduce nasal resistance Upper airway obstruction Increase EPAP Check if the problem is positional Ensure the patient is not over ventilated causing glottic closure Inability to trigger Check for mouth breathing and if so change to Mirage Full Face Mask Check for upper airway obstruction or intrinsic PEEP and increase EPAP accordingly see TICONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 Intrinsic PEEP Slowly increase EPAP to
68. n ResMed masks may yield erroneous airflow required to compensate for leak calculations Even then the ResMed unintentional leak around the mask and or vpAp ST A will yield a useful indication through the patient s mouth Since the of the trend and magnitude of change II ST A knows the expected vent flow Th ill b delav in the displ of ResMed masks it calculates any h T S pY ael X a ayo additional flow as leak It is expressed in Pe ean Na Ue ANEN oeng se CUN liters per minute L min and updated NOTE The leak display provides an continuously estimate and is for trending purposes only Pressure Monitored Parameter Secondary This is a display of pressure delivered from menu the VPAP II ST A Delivered pressure is measured internally by a pressure transducer IPAP Min IPAP Min Time is a CONTROL The IPAP Min Time parameter allows the Secondary parameter It allows adjustment of the clinician to set a minimum time the patient menu minimum inspiratory time parameter spends in IPAP ranging from 0 1secs to IPAP Max IPAP Min Time is the minimum duration of time that the device will remain at the IPAP level The ability to set the minimum IPAP time is an important factor in optimizing patient ventilator synchronization for patients with restrictive diseases For details on adjusting IPAP Min settings see TICONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 a Thomas J Meyer Ma
69. nge As the IPAP pressure is increased and the difference between IPAP and EPAP widens the tidal volume will normally be increased The changes in IPAP and tidal volume can both be observed on the LCD screen It should be noted however that unnecessarily high inspiratory pressure can worsen leak from the mask and mouth thereby reducing the effectiveness of ventilatory support These leaks will most likely occur in patients with very stiff lungs or chest walls or in patients with weak facial muscles If patients are unable to tolerate the desired IPAP level initially gradual increases in pressure may need to occur over time The Tidal Volume measurement which can be found in the secondary menu can be used as a guide to setting the IPAP level For guidelines on adjusting IPAP settings see Set up Flow Chart S and S T Mode on page 57 NOTE Before starting treatment make sure the Delay Timer setting is correct For further details see Delay Timer on page 80 ADJUSTABLE MONITORED PARAMETER EPAP Primary menu DESCRIPTION The EPAP Expiratory Positive Airway Pressure also known as EEP or PEEP setting ranges from 2 cm to the set IPAP level This is the amount of pressure in the circuit during the patient s expiratory phase USAGE EPAP is used to assist flushing of exhaled CO through the mask vents during exhalation maintain patency of the upper airway especially impor
70. or adjust the IPAP Min setting until the patient feels the inspiratory time is slightly too long 5 Reduce the IPAP Min setting by 0 2 to 0 3 second from the setting in the previous step SETTING T CONTROL s IPAP MAX TIME 1 Measure the respiratory rate during ventilation and at rest see Measuring Respiratory Rate on page 59 2 Refer to the column entitled Restrictive IPAP Max in TiCONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 3 SetIPAP Max to the value that corresponds to the resting respiratory rate from step 1 4 Ifthe patient complains that inspiratory time is too short verify the respiratory rate and IPAP Max setting OBSTRUCTIVE PULMONARY DISEASE eg COPD asthma acute exacerbation Patients with chronic obstructive pulmonary disease typically require a longer expiratory time to avoid or minimize air trapping Failure to cycle to expiration can occur due to high airway resistance and or a high leak condition This could increase inspiratory time and cause further air trapping interfere with cycling and eventually cause poor patient ventilator synchrony A safety system IPAP Max is included in the VPAP II ST A to prevent late cycling SETTING T CONTROL s IPAP MAX TIME 1 Measure the respiratory rate during ventilation and at rest see Measuring Respiratory Rate on page 59 2 Refer to the column entitled COPD IPAP Max in TiCONTROL IPAP Min IPAP Max time C
71. or the Mask Alarm with a humidifier or antibacterial filter on page 64 OPTIMIZING SETTINGS FOR EFFECTIVE VENTILATION SYNCHRONIZATION OPTIMIZING SETTINGS FOR The key to effective NPPV is synchronization how effectively the ventilator keeps in step with responds to and supports the patient s own breathing rhythm Synchronization is achieved by the ventilator quickly and reliably detecting when the patient inhales and when the patient exhales and changing the pressure accordingly In so doing the ventilator is matching both the frequency and pattern of the patient s spontaneous breathing effort Synchronization is most often affected by mask and mouth leaks e the patient s disease state MASK AND OR MOUTH LEAKS Most bi level devices measure the patient s flow rate to detect when to trigger to IPAP and when to cycle to EPAP Mask and or mouth leaks can interfere with this triggering and cycling The magnitude of mask and or mouth leaks will change especially during the night as the patient sleeps Poor synchronization between the patient and device will result if these leaks are not solved or compensated for This poor synchronization forces patients to exhale against the higher IPAP level which increases work of breathing and can cause fragmented sleep muscle fatigue and reduced compliance COUNTERACTING THE EFFECTS OF MASK AND MOUTH LEAKS The ResMed II ST A system counteracts the effects of leak thereby max
72. ous output power rating of 150W and a surge rating 50 milliseconds of 500W when the II ST A is switched on will be suitable If the inverter manufacturer lists only a peak power rating contact the manufacturer to obtain the surge power rating It is also recommended that the inverter is certified by an accredited testing and certification organization such as TUV or BSI in addition to CE markings for EU countries Please contact your local ResMed office for further information CAN USE A HUMIDIFIER WITH AN INVERTER No Humidifiers are not suitable for use with inverters The use of an inverter with a humidifier may result in serious damage to the humidifier and serious injury to the user 83 84 HOW DO SET UP MY BATTERY AND INVERTER TO POWER VPAP II ST A DEVICE Connect your inverter to your battery then connect your II ST A to the inverter Refer to the inverter manufacturer s instructions when connecting the inverter to the battery Be careful to observe the correct polarity match positive and negative cable to battery posts Alternately connect your deep cycle battery to the inverter via the cigarette lighter socket For advice on how to maintain your deep cycle battery in good condition consult your battery supplier POWER CONSUMPTION WITH THE VPAP II ST A SERIES Use the table to estimate the power consumption for typical running conditions of your VPAP II ST A
73. r adjustable device settings and displayed items available in this mode see Additional Functions on page 69 DESCRIPTION In the Spontaneous mode the VPAP II ST A senses when the patient breathes in and when the patient breathes out The device follows the patient s spontaneous breathing rate to supply the appropriate pressure In this mode an S icon will briefly appear beneath the I E value on the LCD screen to indicate the initiation of IPAP for each breath detected by the VPAP II ST A USAGE The Spontaneous mode is used when the patient is able to trigger the device to IPAP consistently both awake and asleep without developing periods of apnea The Spontaneous mode is used to support and augment the patient s own respiratory efforts 27 28 ADJUSTABLE MONITORED PARAMETER IPAP Primary menu DESCRIPTION The IPAP Inspiratory Positive Airway Pressure setting ranges from 2 to 25 cm H5O This is the amount of pressure in the circuit during the patient s inspiratory phase The difference between the IPAP and EPAP IPAP EPAP determines the pressure support level delivered to the patient Triggering to IPAP will occur as the result of patient effort in the Spontaneous mode See Operating Modes on page 11 for details on cycling to EPAP USAGE The setting of the inspiratory pressure is made on the basis of patient tolerance and the effect of the pressure on ventilation and gas excha
74. rk R Pressma Joshua Benditt Francis D McCool Richard P Millman Ranjini Natarajan Nicholas S Hill Air Leaking Through the Mouth During Nocturnal Nasal Ventilation Effect on Sleep Quality Sleep1997 20 7 561 569 For other adjustable device settings and displayed items available in this mode see Additional Functions on page 69 These include SET START PRESSURE e SMARTSTART STOP MASK ALARM HUMIDIFIER OVERHEAT DEFAULT DELAY TIME ADJUSTABLE MONITORED PARAMETER MODE Primary menu TIMED MODE This section discusses the key parameters that need to be adjusted and the monitored items that are displayed in Timed mode SYSTEM SET UP The key adjustable parameters in this mode are PAP e EPAP e PAP Max Rise Time BPM e ratio this is a display only item but is dependent upon the IPAP Max and BPM settings The monitored parameters displayed in this mode are e Respiratory Rate e Tidal Volume e Leak e Pressure The key adjustable parameters and monitored parameters are discussed below in the order they appear in the II ST A primary and secondary menus For instructions on how to change settings see II ST A Set up on page 18 For other adjustable device settings and displayed items available in this mode see Additional Functions on page 69 DESCRIPTION USAGE In the Timed mode the clinician sets the The Timed mode is used when a fixe
75. rm When the alarm is enabled the VPAP II ST A will illuminate an indicator light on the front panel sound an alarm and display the MASK OFF message on the LCD screen if it detects an excessive air leak for example if the patient s mask falls off during the night For full details see Mask Alarm on page 75 If a humidifier is being used select ON in the Humidifier menu In order for the SmartStart Stop and Mask Alarm features to function correctly the II ST A must make adjustments for the added resistance of a humidifier When Humidifier is selected the icon will appear in the lower LCD area This feature may also be used to adjust for added resistance of an antibacterial filter OVERHEAT DEFAULT See Overheating on page 92 DELAY TIMER OOO See Delay Timer on page 80 SET TIME HOURS Allows you to set the internal clock hours for compliance measurement purposes A 24 hour display format is used ie 6 pm is 18 00 SET TIME MINUTES COMPLIANCE RESET CALIBRATE Allows you to set the internal clock minutes for compliance measurement purposes ADDITIONAL FUNCTIONS To zero the patient hour counter and erase the saved compliance data select the COMPLIANCE RESET menu It will ask ARE YOU SURE If you select YES then the compliance data will be erased and the counter reset See Downloading Compliance Data on page 80 To display total hours of patient use see Patient Hours on page 7
76. rovided for trending purposes only Measured Respiratory Rate Range 0 60 BPM x 1096 Measured Delivered Pressure Range 0 to 35 cm H5O 1 cm H5O To fit standard 22mm tapered connection PRESSURE MEASUREMENT Internally mounted pressure transducer FLOW MEASUREMENT NOTE Internally mounted flow transducer The manufacturer reserves the right to change these specifications without notice INDEX A Adding supplemental oxygen 59 Adjustable Settings 69 Adjusting settings remotely 65 Adjusting the internal clock 70 Air filter strips 92 97 Air leak 98 Alarms 73 Cancel Button 74 92 Testing 77 Antibacterial filters 64 Assembling the flow generator 15 Automatic backlight 79 AutoScan 80 B Basic Operations Spontaneous mode 27 Spontaneous Timed mode 32 Timed mode 39 Battery Power 83 Calculating battery capacity 85 capacity 83 Power consumption 84 BPM 99 Default setting 19 Calibration 71 89 Changing display language 71 Cleaning 90 Clinical mode Default settings 19 CO2 rebreathing data 87 Common problems 99 Compliance Data Downloading 80 Specifications 100 Constant pressure 92 Control panel 8 CPAP mode 44 Cycling specifications 99 D Default setting 19 Delay Timer 70 80 Default setting 20 Insufficient air flow 97 Limiting 81 Device Alarms 73 Device calibration 89 Difficulty falling asleep 80 Downloading patient data 80 Dynamic pressure characteristics 100 INDEX E EPAP Default setting 19
77. s turn the II ST A on while holding down the two right hand side buttons on the control panel until CLINICAL MODE appears on the bottom of the LCD STEP 2 Select the menu items using the 4 MENU Y buttons The settings menu items are shown in Table 1 on page 19 The X o first seven items are in the Primary Settings menu shown MENU Y on the main screen of the LCD with a movable cursor while the rest appear in the secondary menu as text at the bottom of the screen in the message panel RESPIRATORY TIDAL VOLUME LEAK SULLIVA DELIVERED PRESSURE MODE S T SET START PRESSURE IPAP 25 0 fomno SET IPAP Min Primary EPAP 10 0 ficmH20 SMARTSTART STOP settings IPAP Max 2 0 MASK ALARM menu T MIN HUMIDIFIER 10 4 OVERHEAT DEFAULT LE 33 DELAY TIME 46 Symbol SET TIME HOURS ids SET TIME MINUTES ___ Secondary TIDAL VOLUME COMPLIANCE RESET 0500ML CALIBRATE L J PATIENT HOURS MACHINE HOURS M PATIENT MODE Figure 3 Overview of VPAP II ST A Primary and Secondary menus To change a setting press the 4 OPTION VY buttons to select the desired value or status The settable range and default values for each menu are also shown in Table 1 on page 19 uw MC OPTION Y SYSTEM SET UP STEP 3 NOTE If you are setting the II ST A for home treatm
78. s are single patient use only to avoid the risk of cross infection between patients Refer to the user instructions supplied with your mask system for further information Do not use bleach chlorine alcohol or aromatic based solutions scented oils moisturizing deodorizing fragranced or antibacterial soaps to clean the II ST A or the mask system as these may damage or otherwise reduce the life of the product For full details on cleaning or sterilizing your mask refer to your mask User s Guide TECHNICAL INFORMATION 91 92 REPLACING THE AIR FILTER STRIP CAUTION The air filter strip should be replaced approximately every 1500 operating hours ie 6 months with 8 hours a day usage or when visibly dirty To remove the air filter slide out the air filter cover Instructions on replacing the air filter strip are supplied with new filters The air filter strips are not washable or reusable OVERHEATING NOTE WARNING In rare circumstances when high ambient room temperature is combined with rapid breathing and large pressure changes the air pump may overheat A clogged air inlet filter may also contribute to this occurrence The VPAP II ST A alarm will activate and display O HEAT ALARM in the message panel of the LCD screen Pressing the Alarm Cancel button will silence the audible alarm and erase the message on the LCD but the indicator light will remain lit until you correct the cau
79. s not been selected does not appear on the LCD screen IPAP and or EPAP settings are too low for the air delivery components being used Use only equipment as recommended and supplied by ResMed Enable the Humidifier option see Using SmartStart or the Mask Alarm with a humidifier or antibacterial filter on page 64 Enable the Humidifier option Use a lower impedance bacterial filter Enable the Humidifier option Increase IPAP and or EPAP pressure if appropriate Use different air delivery components 96 Problem continued from previous page VPAP II ST A mode set to S S T or T and delivers a single pressure instead of alternating between the two set pressures and pressure indicator displays a constant level Possible cause Rapid breathing and a room temperature above 35 C 95 F have caused the motor to overheat O HEAT appears on LCD screen and the alarm is activated Blocked air filter has caused overheating Blocked air inlet Solution Cancel the alarm by pressing the Alarm Cancel button and or if the patient is comfortable with the constant pressure let it run The motor will cool down after about 15 minutes and resume normal operation TECHNICAL INFORMATION if the single pressure is uncomfortable stop the unit by pressing the Start Stop button and allow it to cool You may resume normal operation when cool cool the room if possible but do not direct the sour
80. s to allow a continuous flow of air out of the mask When the II ST A is turned on and functioning properly new air from the device flushes exhaled air out through the mask vents However when the machine is not operating fresh air will not be provided through the mask and exhaled air may be rebreathed Rebreathing of exhaled air for longer than several minutes can in some circumstances lead to suffocation This warning applies to all bi level pressure devices The amount of rebreathing is dependent upon respiratory rate tidal volume I E ratio leak characteristics of the patient interface eg dead space and EPAP pressure To a lesser extent IPAP pressure will also affect rebreathing Lower pressures higher tidal volumes and higher percentage IPAP will increase the amount of retained and thus increase rebreathing The pressure flow characteristics graph below provides the exhaust flow characteristics of the ResMed masks available for use with II ST A devices MASK FLOW PRESSURE CHARACTERISTICS Mirage Modular Standard Disposable Nasal 4549 Mirage Disp Full Face Mirage Full Face Vent Flow L min Ultra Mirage 0 5 10 15 20 25 Pressure cm H20 CO2 REBREATHING DATA 87 88 NOTE The CO rebreathing table below provides information on rebreathing at different EPAP levels and tidal volumes This information may assist in assessing the CO rebr
81. se of the alarm The audible alarm will not retrigger while the original alarm condition persists When the alarm condition is resolved the visual and audible alarms are reset In the event of an overheat condition the VPAP II ST A will automatically revert from bi level treatment to a constant pressure for about 15 minutes to allow the pump to cool When cool the pump will automatically return to normal operation If constant pressure treatment is inappropriate for the patient you can also press the Start Stop button allow the II ST A to cool then resume normal treatment The factory default setting is for tbe EPAP exbalation pressure to be delivered in tbe event of an overbeat condition Tbis setting can be changed to tbe bigber IPAP inbalation pressure if appropriate using tbe OVERHEAT DEFAULT menu See VPAP II ST A Set up on page 18 If using the ResAlarm II in conjunction with the VPAP II ST A note that the ResAlarm II is configured to alarm if the pressure falls above or below IPAP However if the pressure stays at IPAP the alarm will not activate Therefore the factory overheat default setting should not be changed to IPAP under any circumstance UsING THE POWER CORD CLIP OPTIONAL ACCESSORY The power cord clip can be used to minimize the chance of the power cord becoming dislodged from the power inlet The power cord clip is available through your ResMed supplier 1 Make sure the surface is clean and dry Pee
82. sec SMARTSTART STOP ON OFF OFF MASK ALARM ON OFF ON HUMIDIFIER ON OFF OFF OVERHEAT DEFAULT IPAP OR EPAP EPAP DELAY TIME add remove 0 5 10 20 0 SET TIME HOURS 1 hour user set SET TIME MINUTES 1 minute user set COMPLIANCE RESET YES Are You Sure N A CALIBRATE YES Are You Sure N A PATIENT HOURS DISPLAY ONLY 00000 MACHINE HOURS DISPLAY ONLY 00000 PATIENT MODE YES to lock menu menu locked If using the ResAlarm II see Overheating on page 92 VENTILATOR SETTINGS DESCRIPTION OF MODES SYSTEM SET UP The following four diagrams illustrate the four modes of operation available on the VPAP II ST A Each diagram depicts three measurements on the vertical axis Respiratory Effort using Electromyogram EMG Diaphragm Patient Flow L min and Mask Pressure cm H5O The horizontal axis depicts units of time in seconds SPONTANEOUS MODE S MODE In this mode the VPAP II ST A senses when the patient breathes in and when the patient breathes out The device follows the patient s spontaneous breathing rate to supply the appropriate pressure The spontaneous mode is used when the patient is able to trigger the device to IPAP consistently both awake and asleep without developing periods of apnea Although the patient has primary breath control and cycling to EPAP will usually occur spontaneously T CONTROL s IPAP Min and IPAP Max Time parameters can be used to provide minimum and maximum limits on the inspiratory time
83. set inspiratory time as determined by the IPAP Max setting as a percentage of the total cycle time as determined by the set BPM rate In Timed mode the displayed value represents the actual percentage of time the device will spend in IPAP for each respiratory cycle It is useful in ensuring that the set inspiratory time as determined by the IPAP Max setting is appropriate with respect to the total cycle time as determined by the set BPM rate In the event that the IPAP Max time represents 5096 or more of the total cycle time as determined by the set BPM rate the following message will appear on the screen CAUTION I E gt 5096 This indicates that an actual inverse inspiratory ratio ie inspiratory time gt expiratory time may be achieved with the set IPAP Max and BPM settings 41 TIMED MODE 42 ADJUSTABLE MONITORED PARAMETER Respiratory Rate Secondary menu DESCRIPTION Monitored Parameter This is a display of the respiratory rate based on the last two breaths detected by the II ST A In Timed mode the displayed respiratory rate will consist of device initiated timed breaths only as dictated by the set BPM rate USAGE Tidal Volume Monitored Parameter This provides a useful indication of the Secondary This is a display of the calculated tidal trend and Magnitude of change in the menu volume delivered to the patient by the patient s tidal volume Tidal
84. t through the mask Adjust position of mask and headgear Replace any plugs that may be missing from ports on mask Ensure air tube is connected firmly at both ends Straighten kinked air tube or replace punctured air tube Enable the SmartStart option or use Start Stop button to start the device Use the Start Stop button to start the device SmartStart is enabled but the VPAP II ST A does not stop automatically when you remove your mask continued over page SmartStart not enabled 4B does not appear on the LCD screen Mask Alarm enabled M appears on the LCD screen Enable the SmartStart option or use the Start Stop button to start the device Use the Start Stop button to stop the device the Mask Alarm overrides SmartStart 95 Problem continued from previous page Possible cause Humidifier or bacterial filter used but Humidifier option has not been selected amp does not appear on the LCD screen Incompatible humidifier or mask system being used Device incorrectly calibrated Solution Enable Humidifier option Use a lower impedance bacterial filter Use only equipment as recommended and supplied by ResMed Return to supplier for calibration Mask Alarm is enabled but alarm does not activate when the mask is removed during treatment continued over page Incompatible air delivery system being used Humidifier or bacterial filter used but Humidifier option ha
85. tant during sleep overcome intrinsic PEEP in patients with obstructive lung disease and improve oxygenation and end expiratory lung volumes in patients with low lung volumes For guidelines on adjusting EPAP settings see Set up Flow Chart S and S T Mode on page 57 IPAP Max Primary menu IPAP Max Time is a TICONTROL parameter It allows adjustment of maximum inspiratory time parameter ranging from 0 1 to 3 seconds for Spontaneous mode NOTE In Spontaneous mode although it is possible to set an IPAP Max Time greater than 3 seconds the VPAP II ST A internally limits the IPAP Max Time to 3 seconds The IPAP Max Time parameter allows the clinician to limit the time the patient spends in IPAP The ability to limit the maximum inspiratory time is an important factor in optimizing patient ventilator synchronization Refer to Synchronization on page 49 for details on how to set the IPAP Max parameter to optimize synchronization in the presence of mask and or mouth leaks and in patients with different disease states For details on adjusting IPAP Max settings see TICONTROL IPAP Min and IPAP Max time Calculation Guide on page 58 For details on synchronization see Synchronization on page 49 SYSTEM SET UP SPONTANEOUS MODE 29 30 ADJUSTABLE MONITORED PARAMETER Rise Time Primary menu DESCRIPTION Rise Time is the time taken for the pressure to increase from EPAP to IPAP Th
86. ter This fixed rate is supplied to the patient at the fixed inspiratory time e In CPAP mode a fixed pressure is delivered For further information on these modes see Ventilator Settings on page 21 TRIGGERING AND CYCLING To provide effective ventilation it is important to maximize the synchronization between the breathing rhythm of the patient and the pressure pattern supplied by the ventilator Synchronization is achieved by the ventilator quickly and reliably detecting when the patient inhales and when the patient exhales The II ST A uses pressure and flow transducers to accurately sense the patient s inhalation and exhalation efforts The VPAP II ST A detects the beginning of the patient s inspiratory effort by measuring the increase in flow When inspiratory flow increases above a certain level the device changes from EPAP to IPAP This change from EPAP to IPAP is called triggering Similarly the VPAP II ST A changes from IPAP to EPAP when the inspiratory flow decreases below a certain level The change from IPAP to EPAP is called cycling For further details see Synchronization on page 49 PRINCIPLES OF OPERATION Vsync AUTOMATIC LEAK MANAGEMENT Vsync is the automatic leak management algorithm unique to the VPAP II Series Vsync monitors and compensates for leak by continuously and automatically adjusting the baseline flow thereby maintaining reliable triggering and cycling For further details see
87. tings to improve ventilation before adding oxygen so as not to mask poor ventilation with good SpO levels Titrate oxygen according to your institutional guidelines or the physician s prescription If the patient is using oxygen at home complete titration with the oxygen entrained into the circuit at the same place that the patient will be using at home HUMIDIFICATION Humidification may be required for patients who experience nasal and upper airway drying as a consequence of the high flow dry air being directed through the nasal and oral passages It may also be required for those individuals who have tenacious secretions OPTIMIZING SETTINGS FOR INDICATIONS FOR HUMIDIFICATION nasal stuffiness congestion e rhinnorhea following the use of mask ventilation mouth dryness e ventilation through a tracheostomy e patients with thick secretions eg cystic fibrosis bronchiectasis Richards and colleagues demonstrated that leaks occurring during the use of non invasive positive pressure ventilation could significantly increase nasal resistance This increase in nasal resistance associated with leaks during positive pressure use can be largely prevented by fully humidifying the inspired air The II ST A is fully compatible with ResMed humidifiers ResMed produces passive and heated humidifiers that will humidify the air flow to relieve these symptoms Contact your supplier for details SET UP FOR USE WITH HUMIDAIR
88. to the ResControl Clinician s Manual L ResControl II ST A Figure 15 Connecting ResControl to the II ST A OPTIMIZING SETTINGS FOR 65 EFFECTIVE VENTILATION 66 CLINICAL TROUBLESHOOTING COMMON PROBLEMS ASSOCIATED WITH NON INVASIVE POSITIVE PRESSURE SUPPORT VENTILATION NPPV Problem Patient acceptance of therapy Possible Solution Patient and family education Gradual acclimatization Many patients using NPPV have mouth leaks during sleep This can cause poor synchronization and sleep fragmentation Asking questions about mouth nose dryness adding humidification and exploring the need for a Mirage Full Face Mask can improve the effectiveness of ventilation and improve patient acceptance Check ventilator settings Rise Time IPAP Min and Max Mask intolerance Intensive coaching and practice with the mask Ensure patient has patent nasal passages Review mask cushion size and fit Assure patient is not over tightening headgear Mask leaks eye irritation Adjust mask forehead adjustment or change mask cushion size Mouth leaks persistent hypoventilation Add humidification to reduce nasal resistance and change to a full face mask Mirage Full Face Mask available from ResMed Contact your supplier for more details Nasal blockage mucosal dryness Minimize mouth leaks Add humidificatio
89. trending purposes only Pressure Monitored Parameter Secondary This is a display of pressure delivered from menu the VPAP II ST A Delivered pressure is measured internally by a pressure transducer a Thomas J Meyer Mark R Pressma Joshua Benditt Francis D McCool Richard P Millman Ranjini Natarajan Nicholas S Hill Air Leaking Through the Mouth During Nocturnal Nasal Ventilation Effect on Sleep Quality Sleep1997 20 7 561 569 For other adjustable device settings and displayed items available in this mode see Additional Functions on page 69 These include e SET START PRESSURE e SMARTSTART STOP e MASK ALARM e HUMIDIFIER e DELAY TIME SYSTEM SET UP 45 CPAP MODE 46 STARTING TREATMENT 1 Assemble the II ST A and connect the air tubing See Assembly on page 15 Assemble the mask system as described in the mask system user instructions and fit it to the patient CAUTIONS Arrange the air tube so that it allows the patient to move freely while asleep this configuration not possible with Mirage mask Do not leave long lengths of air tubing around the top of the bed which could twist around the patient s head or neck while sleeping Make sure the area around the II ST A is clean dust free and clear of bedding clothes and any other potential air intake blockages 4 START STOP Start the VPAP II ST A in one of the following ways
90. ure increase when the II ST A switches from EPAP to IPAP The higher the Rise Time setting the longer it takes for the pressure to increase from EPAP to IPAP Generally this feature is adjusted to achieve maximum patient comfort The patient should feel they are receiving adequate flow without being startled by each transition to the IPAP level However if the patient has a high ventilatory demand then setting the Rise Time to MIN will help lower the patient s work of breathing as this is the fastest Rise Time setting The Rise Time sbould be set less than tbe patient s inspiratory time otberwise tbe patient will not spend any time at tbe IPAP pressure and ventilation could be affected A safety feature of the VPAP II ST A does not allow Rise Time to exceed tbe IPAP Max time setting The Rise Time scale approximates tbe time taken in msec for tbe pressure to increase from 1096 to 9096 of tbe IPAP EPAP pressure difference under controlled conditions Range 90 msec nominal to 900 msec For further details see Ventilator parameter settings for selected mode on page 20 PRESSURE DELIVERY The VPAP II ST A dynamically adjusts for pressure fluctuations by constantly measuring the delivered pressure and comparing this to the set pressure The delivered pressure is measured internally using pressure transducers Adjustments are made approximately 80 times a second allowing the II ST A to rapidly accommodate changing leak
91. volume will II ST A It is calculated a breath Normally increase as IPAP pressure is by breath basis by integrating an estimate increased of patient flow obtained by subtracting the Since the II ST A assumes the vent leak flow and ResMed mask vent flow from flow to be that of a ResMed mask when the measured total flow rate erforming calculations using masks other 8 8 than ResMed masks will likely diminish accuracy in this display Unintentional leak has a similar effect on these calculations There will be some delay in the display of the Tidal Volume measurement after it is selected Leak Monitored Parameter Ideally leak rates should be kept below 25 y p Secondary This is a display of leak as calculated by the L min to assure quality sleep menu II 5 It is a measure of additional Non ResMed masks may yield erroneous airflow required to compensate for leak calculations Even then the ResMed unintentional leak around the mask and or II ST A will yield a useful indication through the patients mouth Since the of the trend and magnitude of change VPAP II ST A knows the expected vent flow of ResMed masks it calculates any There will be some delay in the display of additional flow as leak It is expressed in the palevalue ater pang selected liters per minute L min and updated NOTE The leak display provides an continuously estimate and is for trending purposes only Pressure Mon

VPAP II ST-A - Sleep Medicine Network

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