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Trilogy 200 Clinical Manual

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1. Removing the Air Inlet Path Air Inlet Path Foam Foam Chapter 7 Cleaning and Maintenance 124 Insert the new air inlet path foam in the slot lining the large circular cutout on the foam up with the circular connection at the top of the air inlet path compartment on the device Make sure the air inlet path foam is securely in place Replace the air inlet path cover using a screwdriver to secure each of the four screws Make sure all of the screws are firmly in place Cleaning the Patient Circuit Cleaning the reusable circuit is important in the hospital and in the home Circuits infected with bacteria may infect the user s lungs Clean the respiratory circuit on a regular basis If you are using a disposable circuit dispose of and replace it on a regular basis Follow your institution s protocol for cleaning the circuit Philips Respironics recommends that you perform the cleaning twice a week under normal conditions and more frequently as required If the patient uses the device on a 24 hour a day basis it may be convenient to have a second breathing circuit so you can switch CAUTION Exhalation devices patient circuits and water traps are shipped clean not sterile circuits while one is being cleaned Cleaning and disinfection of these parts should follow individual institution processes Cleaning Instructions Reusable Circuits and conform to guidelines Clean the patient circuit twice a week or f
2. Note Trilogy200 provides features to control access to the device prescription settings and to transfer new device settings onto the device using the SD Card These features are intended to be used as part of your clinical institutional procedures governing the use security and control of this medical device d WARNING To make sure the device is operating properly at start up always verify that the audible tone sounds and the alarm LEDs light red and then yellow momentarily Contact Philips Respironics or an authorized service center for service if these indications do not occur at start up Example of a Fully Connected Patient Breathing Circuit with Passive Exhalation Device Trilogy200 clinical manual 6 Ventilator Alarms This chapter describes the ventilator alarms and what you should do if an alarm occurs There are three types of alarms High Priority Require immediate response by the operator e Medium Priority Require prompt response by the operator Low Priority Require operator awareness These alarms alert you to a change in the ventilator status Additionally the ventilator also displays informational messages and confirmation alerts that notify you of conditions that need attention but do not qualify as alarm conditions Note If multiple alarms occur at the same time all alarms are processed and displayed but the alarms are ordered first by priority and then by occur
3. Table 5 Restore Ventilator Settings 3 Verify the Low Tidal Volume Alarm This procedure verifies that the Low Tidal Volume alarm is working properly For Passive and Active Flow circuits this will verify the Low Vte alarm For Active PAP circuits this will verify the Low Vti alarm It assumes that you have attached the test lung verified the ventilator settings and turned on ventilator power as described in the Initial Setup section A Change Alarm Ventilator Setting Modify the Low Tidal Volume alarm setting to match the one shown below in Table 6 Setting Value Low Vte Low Vti 500 ml o Table 6 Low Vte Low Vti B Verify the Alarm Alarm Setting Wait up to 40 seconds and verify the following alarm signals TheHigh Priority audible indicator sounds Ared light flashes on the Alarm Indicator Audio Pause button TheLow Tidal Volume alarm condition appears on the screen highlighted in red C Modify Ventilator Alarm Settings Modify the Low Tidal Volume alarm setting to match the one shown below in Table 7 Setting Value Table 7 Modify Low Vte Low Chapter 10 System Checkout Procedures 144 D Verify Reset E Wait 40 seconds and verify the following auto reset conditions TheHigh Priority audible indicator has stopped sounding The red light on the Alarm Indicator Audio Pause button has stopped flashing Restore Ventilator Settings Modify the ventilator settings and chang
4. High Expiratory Pressure message Red flashing button Low Expiratory Pressure message Device Action Operates Operates Operates 109 User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Check for occlusions in exhalation devices Make sure exhalation device is clean and functioning properly If alarm continues contact your health care professional Clinician Remove obstruction in leak device If alarm continues have the device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Make sure tubing is not kinked or pinched Check patient s breath rate If alarm continues contact your health care professional Clinician Check patient s tubing to make sure it is not kinked or pinched If alarm continues have device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Make sure tubing is not kinked or pinched If alarm continues contact your health care professional Clinician Check patient s tubing to make sure it is not kinked or pinched If alarm continues have device serviced Chapter 6 Ventilator Alarms Priority Audible Visual Alarm Device User Clinician Action Indicator Button Action and Display High Internal High Red flashing button Continues Us
5. eerte ttt ttennnnes 42 Circuit Disconnect Alarm eese ttes ttnnt tient tts nttttad 43 Apnea Alan inn ciii iem ct nec IRR DEED I free fette read 43 Pigh Vee E 43 LOW te AGAIN ciminna nna aa 43 Trilogy200 clinical manual High VALA essnee 44 LOW Vi ALIE M 44 High Respiratory Rate Alarm eterne retentus 44 Low Respiratory Rate Alarm eerte ntt nnt tttnnnnes 44 High Inspiratory Pressure Alarm ertet ntt nnne 44 Low Inspiratory Pressure Alarm seen teennttnntnennttnnnnnes 45 High Minute Ventilation Alarm eerte nnt tnnt 45 Low Minute Ventilation Alarm Low Battery Alarmas riti aco er pred High Temperature Alarm eee teen tte nnne ttn ttn tttnnnnis 46 Replace Detachable Battery Alarm entren 46 Ventilator Service Recommended Alarm ees 46 AC Power Disconnected Alarm eterne tenent tennnnntnnnnnened 47 Keypad Stuck Alarm imr mrt 47 Battery Discharging Stopped due to Temperature Info Message 47 Battery Not Charging due to Temperature Info Message 47 Battery Not Charging Info Message entente ttn 47 Check External Battery Info Message eerte 48 Battery Depleted Info Message eterne ttes 48 External Battery Disc
6. Note The patient has access to this setting if Flex is enabled Note C Flex is not available if CPAP is set to 4 cm HO Note C Flex Bi Flex and AVAPS are intended for use by adult patients C Flex in Comparison to Traditional CPAP Therapy 31 Bi Flex Note Bi Flex is only available In S mode the Bi Flex attribute adjusts therapy by inserting a small up to 25 cm H O in S mode amount of pressure relief during the latter stages of inspiration and during the beginning part of exhalation In the following diagram the bold lines represent Bi Flex in comparison to the dashed line representing normal BiPAP therapy Bi Flex levels of 1 2 or 3 progressively reflect increased pressure relief that will take place at the end of inspiration and at the beginning of expiration PRESSURE 4 BiPAP IPAP eo a a s D Traditional Bi Level Therapy gt TIME Ramp Note IPAP will not ramp below The device is equipped with a linear ramp function In CPAP S S T T HO and PC modes the Ramp feature will reduce the pressure and then gradually increase ramp the pressure to the prescription pressure setting so patients can fall asleep more comfortably The figure below illustrates how the ramp function works PRESSURE Ramp Time T IPAP EPAP o The Ramp Function Ramp Start gt A TIME Ramp Button Pressed Chapter 3 Modes Features and Alarms 32 Rise Time In S S T PC T PC SIMV a
7. RiseTime High Inspiratory Pressure Low Inspiratory Pressure Chapter 5 Viewing and Changing Settings 86 Viewing and Changing Options Menu Items From the Main Menu screen select the Options item The Options menu appears shown in the screen below Primary S T 06 11 2008 09 28 PM H20 0 5 10 15 20 25 30 RR 17BPM vte 837m Peak Flow 71 8 wi PIP22 9420 Leak 35min Minvent 11 7 imi Menu Access Detailed View Language English Pressure Units cmH20 o Alarm Volume Loud Navigate Options Menu The following settings are available on the Options menu Menu Access You can select Full or Limited menu access Full menu access allows operators to access all ventilator and prescription settings Limited menu access allows operators to access only certain settings and does not allow them to change prescription settings To prevent patients from changing prescription settings do not give them Full menu access Detailed View You can turn Detailed View on or off using this setting Detailed view displays additional settings and therapy information on the Monitor screen Language The next item on the Options menu allows you to select the Language that the software will appear in English French German etc The information on the screens will display in the language selected here e Pressure Units The next item allows you to select the pressure units that will display on the screens You c
8. 40 U 6096 dip in U for 5 cycles 70 U 30 dip in U for 25 cycles 596 U gt 95 dip in U for 5 sec Compliance Level 8 kV contact 15 kV air 2 kV for supply mains 1 kV for input output lines 1 kV differential mode 2 kV for common mode lt 5 U gt 95 dip in U for 0 5 cycle 4096 U 6096 dip in U for 5 cycles 70 U 30 dip in U for 25 cycles 596 U gt 95 dip in U for 5 sec NOTE U is the a c mains voltage prior to application of the test level Trilogy200 clinical manual Electromagnetic Environment Guidance Floors should be wood concrete or ceramic tile If floors are covered with synthetic material the relative humidity should be at least 30 Mains power quality should be that of a typical home or hospital environment Mains power quality should be that of a typical home or hospital environment Mains power quality should be that of a typical home or hospital environment If the user of the device requires continued operation during power mains interruptions it is recommended that the device be powered from an uninterruptible power supply or a battery Power frequency magnetic fields should be at levels characteristic of a typical home or hospital environment 163 Guidance and Manufacturer s Declaration Electromagnetic Immunity This device is intended for use in the electromagnetic environment specified below The
9. Chapter 3 to easily review all of the settings available in each therapy mode Note This chapter describes how to enable all of the device settings including device alarms For detailed information about each alarm please refer to Chapter 6 Note To change the circuit type you must be in the Setup screen with the airflow turned off See the Full Menu Access Mode section for more information Note When the Circuit Type setting is set to Passive Circuit all Ramp Start Pressure settings in all modes will maintain the minimum range Note When the Circuit Type setting is set to Active PAP or Active Flow the Flex and AVAPS features are unavailable 75 The Passive circuit provides leak compensation When using the Passive circuit in Volume Ventilation the set Vti is delivered to the patient above the calculated circuit and cuff or mask leak This is different from traditional active circuit ventilation where the cuff or mask leak reduces the tidal volume delivered to the patient Volume ventilation with the Passive circuit delivers an inspiratory tidal volume close to the device setting regardless of leak this should be considered when transitioning a patient from an active to a passive circuit With a Passive circuit Vte is estimated based on the calculated sum of circuit and cuff or mask leak The Active Flow circuit monitors proximal flow and proximal pressure When using the Active Flow circuit configuration
10. Continuous Positive Airway Pressure CPAP Mode In the Continuous Positive Airway Pressure CPAP mode the device delivers a continuous pressure to the patient at all times All breaths in this mode are Spontaneous breaths Spontaneous S Mode In Spontaneous S mode the device delivers bi level pressure support This mode provides only spontaneous breaths In this mode an Inspiratory Positive Airway Pressure IPAP is delivered during inhalation and a lower Expiratory Positive Airway Pressure EPAP is delivered during exhalation The following illustration describes these concepts IPAP 26 cm H O 1 Pressure Supported EPAP 6 cmH O Spontaneous Breath PS IPAP EPAP 20 cm H O PRESSURE 4 5seconds 4seconds 8 seconds 26 H t t 20 4 s 6 A Enter S mode S Mode T T T T T T T T T T T T T T T T T T T T T T T T gt 5 10 15 20 TIME Trilogy200 clinical manual 23 Spontaneous Timed S T Mode In Spontaneous Timed S T mode the device delivers bi level pressure support This mode provides Spontaneous and Mandatory breaths A Mandatory breath is delivered if the patient does not spontaneously breathe within the prescribed Breath Rate BPM setting This ensures that the patient receives a minimum number of breaths per minute In this mode an IPAP is delivered during inhalation and a lower EPAP is delivered during exhalation The duration of a Spontaneous breath is determined by the patient effort Th
11. Do not connect an unregulated or high pressure oxygen source to this connector on the device Chapter 4 Ventilator Setup 62 Connect the Remote Alarm Optional You can use a remote alarm as a nurse call system or in house remote alarm system It can generate an alarm at a distance of up to 91 meters 300 feet from the ventilator An audible tone sounds and a red light blinks to indicate that an alarm condition exists The remote alarm will sound when any of the following conditions exist The ventilator is off Any alarm occurs and is not silenced or reset Refer to the Accessories chapter of this manual for information on which remote alarm systems are compatible with the device Refer to the instructions included with the Remote Alarm Adapter Cable for information on how to connect a remote alarm to the ventilator Trilogy200 clinical manual AX WARNING When using a remote alarm make sure you fully test the remote alarm connector and cable by verifying that Annunciated alarms on the ventilator are also annunciated on the remote alarm Disconnecting the remote alarm cable from the ventilator or from the remote alarm results in an alarm notification at the remote alarm AX WARNING The remote alarm should be tested daily Trilogy200 clinical manual 5 Viewing and Changing Settings This chapter explains how to scroll through the ventilation screens and change ventilation settings It a
12. Verify the Detachable and Internal Lithium lon Batteries Function A Connect AC Power to the device and verify that the green AC LED on the front panel is lit B Verify that the detachable battery is properly installed C Turn the device on and verify that both the detachable and internal battery symbols appear on the display Verify that if either battery is less than fully charged the charge symbol will display on the respective battery D Disconnect the AC Power source from the device Verify that the AC Power Disconnected alarm message appears on the display and the green AC LED is not lit Press Reset Verify that the detachable battery symbol shows the level of charge noted in the previous step and that the device continues to operate Verify that the detachable battery symbol has a black box around it to indicate that it is in use Trilogy200 clinical manual 149 E Disconnect the detachable battery pack from the device Verify that the Detach Batt Disconnected alarm message appears on the display Press Reset Verify that the internal battery symbol shows the same level of charge as noted in Step C and the device continues to operate Verify that the internal battery symbol has a black box around it to indicate that it is in use F Reconnect the Detachable Battery and AC Power source N Verify the External Battery Function If Available A Connect AC Power to the device and verify that th
13. cord for damage or signs of wear Discontinue use and replace if damaged Note To remove AC power disconnect the power supply cord from the electrical outlet Connecting the AC Power Cord Chapter 4 Ventilator Setup 52 4 If desired secure the power cord using the cord retainer on the back of the device as shown below To secure the power cord use a screwdriver to remove the screw on the cord retainer Insert the cord as shown into the cord retainer and then re attach the cord retainer to the device by re attaching the screw P Lc Using DC Power You can operate the ventilator using an external battery detachable battery or the internal battery External Battery The ventilator can operate from a 12 VDC deep cycle marine type lead acid battery using the Philips Respironics Trilogy External Battery Cable This cable is pre wired and properly terminated to ensure safe connection of an external battery to the ventilator Battery operating time depends on the characteristics of the battery and usage of the device Due to a variety of factors including battery chemistry battery age and use profile the capacity of the external battery as shown on the device display is only an estimate of the actual remaining capacity Refer to the instructions supplied with the Philips Respironics Trilogy External Battery Cable for detailed information on how to operate the device using an external battery Trilogy200
14. during exhalation During the time window if patient effort continues to be detected after the first patient triggered breath Spontaneous breaths are delivered for the remainder of the window The figure below provides example breath patterns in PC SIMV mode Pressure 26 cm H O Spontaneous Breath Mandatory Window Pressure Support 10 cm H O Spontaneous Window PEEP 6 cm H O Mandatory Breath Rate 5 BPM Assist Breath PRESSURE 12 seconds 12 seconds 12 seconds 12 seconds t 1 26 1 x xe 20 4 o a Sample Breath Patterns in 1J OLJ PC SIMV Mode A Enter PC SIMV mode TMJTTTTIEITTATITTETTTTTLITFITATTTTITTTFFITITIITIT ITTTITTY i 5 10 15 20 25 30 35 40 45 TIME Trilogy200 clinical manual 27 Volume Control Ventilation Therapy Modes Volume Control ventilation modes deliver a prescribed inspired tidal volume according to a set Breath Rate and a set Inspiratory Time Control Ventilation CV Mode In Control Ventilation CV mode the device delivers volume control therapy This mode provides only Mandatory breaths A Mandatory breath is delivered according to the prescribed BPM setting for the prescribed Inspiratory Time This also means that the ventilator will not respond to patient effort In this mode the Tidal Volume is delivered during inhalation and PEEP is delivered during exhalation The following illustration describes these concepts Tidal Volume 5
15. is disconnected or has a large leak The device continues to single alarm to detect circuit operate The alarm will automatically terminate when the circuit is disconnect condition The Low reconnected or the leak is fixed Tidal Volume Low Minute Ventilation Low Respiratory Rate and Apnea alarms should Apnea Alarm be used in conjunction with This is a high priority alarm It occurs when the patient has not mg r AEcOnNea garm The Apnea alarm is only triggered a breath within the time specified in the apnea alarm intended for spontaneously setting The device continues to operate The alarm will automatically breathing patients terminate when two consecutive patient breaths are detected that meet the apnea alarm time setting High Vte Alarm This is a high priority alarm It occurs when the estimated exhaled tidal volume is greater than the High Vte alarm setting for three consecutive breaths The device continues to operate The alarm will automatically terminate when a breath occurs in which the exhaled tidal volume does not reach the High Vte alarm setting Low Vte Alarm This is a high priority alarm It occurs when the estimated exhaled tidal volume is lower than the Low Vte alarm setting for three consecutive breaths The device continues to operate The alarm will automatically terminate when a breath occurs in which the exhaled tidal volume exceeds the Low Vte alarm setting When AVAPS is on this alarm will occur when
16. status Chapter 6 Ventilator Alarms 114 Priority Escalates from Medium to High Low Battery High Temperature Escalates from Medium to High Trilogy200 clinical manual Medium when approx 20 minutes remains eee ee High when approx 10 minutes remains eee for Medium eee ee for High Device Action Visual Alarm Indicator Button and Display Medium Priority Yellow flashing button Low Detachable Battery Low External Battery or Low Internal Battery message appears in yellow On Status Panel box around battery is yellow Operates High Priority Red flashing button Low Detachable Battery Low External Battery or Low Internal Battery message appears in red On Status panel box around battery is red Yellow flashing button and yellow High Temperature message appears If condition worsens button flashes red and red High Temperature message appears Operates User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left button Reset to reset alarm Switch to an alternate battery Or switch to AC power source and recharge low battery Clinician Switch to alternate battery or AC power while you recharge low battery If low battery is recharged and alarm continues replace battery User Press Alarm Indicator Audio Pause button to silence alarm Or press
17. the ventilator will beep but no message will appear on the display Detachable Battery Disconnected Info Message This info message occurs when the detachable battery power source is lost and the device has switched to an alternate power source the internal battery if no other source is available If detachable battery power returns the ventilator will beep but no message will appear on the display Start On Battery Info Message This info message indicates that the ventilator has started on battery power and no AC power is available The device operator should verify that this is what is wanted Card Error Info Message This info message occurs when an unusable SD card is inserted into the ventilator The device continues to operate but data cannot be logged onto the SD card Trilogy200 clinical manual Trilogy200 clinical manual 4 Ventilator Setup This chapter provides instructions on how to assemble the ventilator It includes the following setup information Properly positioning the device Installing the air filter Supplying power to the device Connecting the breathing circuit Connecting a water trap optional Connecting a remote alarm optional WARNING Ventilator dependent patients should be continuously monitored by qualified personnel These personnel should be prepared to provide alternate therapy in the event of ventilator failure or inoperative equipment WARNING Do not
18. 87 Keypad Lock Feature 63 87 L Language Setting 86 LCD Brightness Setting 87 Low Respiratory Rate 78 Low Tidal Volume 76 M Main Menu Screen 94 Menu Access i 86 Full Menu i Limited Menu i Monitor Screen 64 Indicators 66 My Settings Menu 96 Flex 97 Ramp Start Pressure 96 Rise Time 96 O Operational Hours 89 Options Menu 86 Oxygen Valve Connector 18 P Passive Exhalation Device 57 Patient Circuit Cleaning 124 PC SIMV Mode 25 83 Positive End Expiratory Pressure PEEP 84 Pressure Control Mode 24 Pressure Control Ventilation 85 Pressure Setting 83 Pressure Support 83 Pressure Units 86 R Ramp Feature 31 Ramp Length 79 Ramp Start Pressure 80 96 Remote Alarm 62 104 Remote Alarm Connector 18 Rise Time 32 82 96 S Screen Saver 87 Secondary Prescription Setting 95 Secure Digital SD Card 17 133 Sensitivity 36 Digital Auto Trak Sensitivity Auto Trak Sensitivity 37 Leak Tolerance 36 Flow Trigger 40 Serial Connector Settings and Alarms Tests 138 Setup Screen i Sigh Feature 84 SIMV Mode 28 85 Specifications Control Accuracy 150 Electrical 150 167 Environmental 149 Pressure 150 Standards Compliance 149 T Tidal Volume 81 Timed Mode 82 Time Format 88 Trigger Type Auto Trak 78 Flow Trigger 78 Troubleshooting 129 V Volume Control Ventilation 19 WwW Warnings 3 Warranty 167 Water Trap 60 Index 168 Trilogy200 clinical manual Trilogy200 clinical manual
19. Chapter 6 for more information The yellow indicator is for the last available battery source Chapter 4 Ventilator Setup 56 DC Power Indicator Description Red Low Battery When the device detects that an in use battery s charge is nearly Indicator depleted has approximately 10 minutes of charge left the inside of the box surrounding the battery symbol turns red In addition to the battery indicator on the Monitoring screen a high priority alarm message will display indicating Low Battery See Chapter 6 for more information The red indicator is for the last available battery source Yellow Battery Whenever AC power is applied to the device the internal and Recharging Symbol ES detachable batteries will recharge as needed If the internal battery is being recharged the amp symbol displays If the detachable battery is being recharged the d symbol displays Battery Disposal Dispose of the batteries in accordance with local regulations First Time Use When setting up the device for the first time or after annual service apply AC power to the ventilator before turning on the blower Attempting to use the ventilator without first applying AC power such as installing a detachable battery pack and starting the blower will cause the internal battery to be displayed in red as an empty battery When in this state the internal battery will not be usable until AC power is applied Trilogy200 clinical manual Con
20. High Red flashing button Shuts down User Press Start Stop button Blank screen and then press Right button to silence alarm If using AC power try plugging device into alternate AC power source If loss of power continues switch to DC power by connecting a fully charged detachable or external battery to the device If there is still no power connect patient to alternate source of ventilation and contact your health care professional Clinician Restore AC power If alarm continues connect a fully charged detachable or external battery to device to restore power If alarm still continues have the device serviced Ventilator High Red flashing Shuts down if User Press Start Stop button Inoperative button Ventilator can t provide If display is operational Inoperative message therapy safely Power Off confirmation Or continues Screen appears Select to operate at a Right button to shut off Mili device and silence alarm limited level Immediately remove patient from ventilator and connect them to alternate source of ventilation Contact your health care professional for service Clinician Restore power If alarm continues have the device serviced Chapter 6 Ventilator Alarms 108 Ventilator Service Required Check Circuit Device Action Audible Visual Alarm Indicator Button and Display Priority High Red flashing button Ventilator Service Required message Operates Opera
21. Insert and securely latch the detachable battery into the device as shown below Insert Detachable Battery Properly Installed Detachable Battery 53 CAUTION The detachable and internal batteries wear out based on the amount of use hours or full charge discharge cycles The battery capacity and life are also reduced by operation at higher temperatures CAUTION Only use the Philips Respironics Trilogy Detachable Battery with the device Attaching the Detachable Battery CAUTION Prolonged operation or storage at elevated temperatures may reduce the service life of the detachable or internal battery and other internal components of the ventilator Chapter 4 Ventilator Setup 54 One side of the detachable battery has a set of LEDs that indicate the amount of charge left on the battery You can press the button below the LEDs to view how much charge remains LED Battery Capacity All 5 LEDs are lit 80 10096 capacity 4 LEDs are lit 60 79 capacity 3 LEDs are lit 40 5996 capacity Internal Battery The device contains an internal battery that can be used as a back up power source It is intended for use during short periods while switching between external power sources emergency situations or short durations when the user needs to be mobile The length of time the ventilator will operate on internal power depends on many factor
22. O in increments of 1 cm H O For pressure modes this alarm is not user settable Additional Settings Specific to Therapy Modes The Settings and Alarms menu also contains many additional settings specific to the various therapy modes The specific settings for each therapy mode are described below Continuous Positive Airway Pressure CPAP Mode In addition to the general settings described in the previous section of this manual you can also set the following settings in CPAP mode 1 CPAP Note If the CPAP pressure is set to 4 the minimum setting You can increase or decrease the CPAP pressure setting from 4 to the Ramp Length setting will be 20 cm HO in increments of 1 unavailable 2 TriggerType Note Trigger Type is not The device can be set to trigger breaths based on automatic flow available when an Active PAP thresholds or specific flow settings You can select Auto Trakor o Active Flow circuit is selected Flow Trigger as the Trigger Type When Auto Trak is selected the OW tigger is the triggering Je i method used for Active PAP and Auto Trak trigger initiates based on automatic flow thresholds Activ Flow circuits Trilogy200 clinical manual When Trigger Type is set to Flow Trigger Flow Trigger Sensitivity Leak Compensation and Flow Cycle Sensitivity become active and the trigger initiates based on the Flow Trigger Sensitivity setting Flow Trigger Sensitivity If you set the Trigger Type to Flow Trig
23. The device continues to operate The battery is not used and the power source is switched to the next available power source Battery Not Charging due to Temperature Info Message This info message occurs when the detachable or internal battery becomes too hot while charging or the device was in too cold an environment before charging started The device continues to operate Battery charging stops until the battery cools or warms sufficiently Battery Not Charging Info Message This info message occurs when the device has detected an error condition with the battery that prevents it from accepting a charge The device continues to operate Battery charging stops Chapter 3 Modes Features and Alarms 48 Check External Battery Info Message This info message occurs when a bad connection exists to the external battery or the external battery failed The device continues to operate using power from the detachable battery if available or the internal battery Battery Depleted Info Message This info message occurs when the affected battery is fully depleted The device continues to operate using the next available power source External Battery Disconnected Info Message This info message occurs when the external battery power source is lost and the device has switched to an alternate power source either a detachable battery if connected or the internal battery if no other source is available If external battery power returns
24. The device uses two leak estimation algorithms A conservation of mass algorithm is used to compute the average leak for a given pressure support relationship This average leak is used when large leak variations are present in the system Average leak is a high estimate during EPAP pressure and a low estimate during IPAP pressure A better leak estimate enabled by the digital system is the parabolic leak algorithm Parabolic leak is proportional to the square of the patient pressure therefore the leak estimate is correlated to the changing patient pressure Both algorithms include unintentional circuit leak and are averaged over several breaths B Patient Flow The total circuit flow is comprised of the circuit leak and the patient flow The calculated patient flow is the total flow minus the circuit leak Patient flow is a primary input into the triggering and cycling mechanisms Trilogy200 clinical manual 37 Auto Trak Sensitivity Note Auto Trak is only available if you are using a passive circuit An essential feature of the device while operating in all modes is its ability to effectively sense spontaneous breathing efforts which causes the ventilator to trigger to inspiration and cycle to expiration Because no preset sensitivity threshold can assure patient and machine synchrony with changing breathing efforts and circuit leaks the device continuously tracks patient breathing patterns and automatically adjusts sensitiv
25. Verify patient status If problem continues have device serviced Low Inspiratory Pressure High Minute Ventilation Low Minute Ventilation Priority High Audible Visual Alarm Indicator Button and Display Red flashing button Low Inspiratory Pressure message Red flashing button High Minute Ventilation message Red flashing button Low Minute Ventilation message Device Action Operates Operates Operates 113 User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Check patient circuit for leaks or disconnects If using an Active PAP or Active Flow circuit check proximal lines to ensure they are not pinched or have water condensation refer to the Troubleshooting section tubing condensation If alarm continues contact your health care professional Clinician Verify patient status If problem continues have device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient
26. alarm Or press Left button Reset to reset alarm Switch to an alternate battery or AC power source while replacing current detachable battery Clinician Switch to an alternate battery or AC power source while replacing the current detachable battery User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Alarm goes away until next reminder appears Contact your health care professional to report alarm and have device serviced Clinician If alarm continues have device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm If you were using AC power check power cord and reconnect it if it has become disconnected Make sure device is not connected to an overloaded AC circuit If you were using an external detachable or internal battery recharge the battery Clinician Check batteries and recharge f necessary Restore AC power if available Chapter 6 Ventilator Alarms 116 Keypad Stuck Battery Discharging Stopped Due to Temperature Audible Device Action Visual Alarm Indicator Button and Display Priority Solid yellow button Keypad Stuck message Operates Operates Batt Discharge Stopped Temp message Trilogy200 clinical manual User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left R
27. containing the correct circuit type Remove the card and check that the small switch on the side of the SD Card is not in the Locked position If you continue to receive this message remove the card and have the prescription replaced with a valid prescription Remove the card and have the prescription replaced with the prescription with the correct serial number Remove the card and have the prescription replaced with a prescription in the correct version Chapter 5 Viewing and Changing Settings 94 Changing and Viewing Settings in Limited Menu Access Mode After you press the button and access the Monitor screen you can view and change settings using the Menu screens To enter the Menu screens from the Monitor screen press the Up button on the ventilator The Main Menu screen appears shown below Primary S T 06 24 2008 12 30 PM vte 837m Peak Flow 71 6umi Leak 31min Minvent 11 7 imi Switch to Secondary Settings My Settings Options Alarm Log Information Navigate You can choose from the following selections on the Main Menu screen Switch to Primary or Secondary Settings If your health care professional has set up a dual prescription for you this option will appear You can select it to change to either your Primary or Secondary prescription settings Safely Remove SD Card This option will appear if an SD card is inserted in the ventilator Select this option when you want to remov
28. delivered The device will deliver this breath once every 100 Mandatory or Assist breaths when the Sigh setting is enabled Sigh breaths are only available in volume modes of ventilation Trilogy200 clinical manual 21 Therapy Mode Table The following table summarizes all of the therapy modes and the settings available in each mode Some settings in the table are dependent upon other settings For instance if the circuit type is set to Active with Flow then the Flow Trigger Sensitivity Leak Compensation and Flow Cycle settings will display Note Pressure Support referred to in the table below and later in this manual is defined as IPAP EPAP or Pressure PEEP PC SIMV Therapy Modes S T T PC PC SIMV J v 7 uv L a 2 a p 7 E Low Respiratory Rate v v v v V High Inspiratory Pressure fJ o Low Inspiratory Pressure 1 d I y Trigger Type AVAPS and Flex settings are only available with the Passive circuit type High Vte and Low Vte settings are only available for Passive and Active Flow circuit types High Vti and Low Vti settings are only available with the Active PAP circuit type Leak compensation is only available with the Active Flow circuit type I Chapter 3 Modes Features and Alarms 22 Pressure Control Ventilation Therapy Modes Pressure Control ventilation modes deliver a prescribed pressure to the patient
29. flow trigger with leak compensation may be enabled The default setting when using the Active Flow Circuit is Leak Compensation On The clinician has the option to turn off leak compensation however unintentional leak will not be compensated Both options measure the flow at the proximal flow sensor Leak compensation is not available in the Active with PAP circuit configuration Circuit Disconnect You should not rely on any This setting enables or disables the circuit disconnect alarm If single alarm to detect a circuit bled dible al ill divi disconnect condition The Low enabled an audible alarm will sound when a large continuous air Tidal volume Low Minute leak such as mask removal has been detected in the circuit Ventilation Low Respiratory Rate and Apnea alarms should You can choose Off to disable the alarm Or you can increase or be used in conjunction with the decrease the setting from 5 to 60 seconds in 5 second increments Circuit Disconnect alarm For example a setting of 10 means that the alarm will sound after the circuit has been disconnected for 10 seconds Apnea This setting enables or disables the apnea alarm If enabled an audible alarm will sound when an apnea is detected You can choose Off to disable the alarm Or you can increase or decrease the setting from 10 to 60 seconds in 5 second increments For example a setting of 10 means that the alarm will sound if the time between spontaneous brea
30. from the date of shipment by Respironics to the original purchaser This warranty does not apply to batteries that are dropped misused altered or otherwise damaged after they are shipped This warranty is given in lieu of all other express warranties In addition any implied warranties including any warranty of merchantability or fitness for the particular purpose are limited to two years Some states do not allow limitations on how long an implied warranty lasts so the above limitation may not apply to you This warranty gives you specific legal rights and you may also have other rights which vary from state to state Limited Warranty 170 To exercise your rights under this warranty contact your local authorized Respironics Inc dealer or contact Respironics Inc at 1001 Murry Ridge Lane Murrysville Pennsylvania 15668 8550 1 724 387 4000 Trilogy200 clinical manual
31. inspiratory time IPAP 26 cm H O 2 Mandatory Breath EPAP 2 6 cm H O 3 Assist Breath Rate 10 BPM PS IPAP EPAP 20 cm H O PRESSURE 6 seconds 6 seconds 6 seconds PC Mode Pressure Control Synchronized Intermittent Mandatory Ventilation PC SIMV Mode The Pressure Control Synchronized Intermittent Mandatory Ventilation PC SIMV mode provides Spontaneous Assist and Mandatory breaths This mode uses a time window to decide what type of breaths should be delivered This time window is the maximum time between breaths according to the set Breath Rate When you enter PC SIMV mode the time window is started If the patient does not trigger a breath the ventilator will provide a Mandatory breath when the time expires and then begin the process again Mandatory breaths deliver the Pressure setting during inhalation and a lower Peak End Expiratory Pressure PEEP during exhalation Chapter 3 Modes Features and Alarms 26 During the time window if patient effort is detected either a Spontaneous or an Assist breath is delivered for the first effort If the last breath delivered was Mandatory then a Spontaneous breath is delivered for the first patient effort of the window If the last breath delivered was an Assist or Spontaneous breath then an Assist breath is delivered for the first patient effort of the window Assist breaths deliver the Pressure setting during inhalation and the PEEP setting
32. is enabled You can increase or decrease the setting from 4 to 50 cm H O in increments of 1 The IPAP Max Pressure must be equal to or greater than the IPAP Min value IPAP Min Pressure The IPAP Min Pressure setting displays if AVAPS is enabled You can increase or decrease the setting from 4 to 50 cm H O in increments of 1 The IPAP Min Pressure must be equal to or greater than the EPAP value and it must be less than or equal to the IPAP Max Pressure EPAP Note EPAP cannot be set to more than 30 cm H O below You can increase or decrease the Expiratory Positive Airway IPAP IPAP Max or IPAP Min Pressure EPAP from 4 to 25 cm H O in increments of 1 For active circuits EPAP can be set to zero When AVAPS is disabled the EPAP setting must be less than or equal to the IPAP setting When AVAPS is enabled the EPAP pressure must be less than or equal to the IPAP Min Pressure Tidal Volume Note In CV AC and SIMV f modes the tidal volume setting The Tidal Volume setting displays if AVAPS is enabled You can is limited by the Inspiratory increase or decrease the setting from 50 to 2000 ml in 5 ml Time to maintain the system s increments Use this setting to establish the target volume of minimum and maximum peak gas which the ventilator will produce and deliver during each flows Spontaneous breath Chapter 5 Viewing and Changing Settings 82 7 RiseTime You can adjust the rise time to find the most comforta
33. patient record usage and therapy information from the device on the SD card 17 Right Side Panel Left Side Panel Chapter 2 System Description 18 10 11 12 Serial Connector You can use this connector to connect the device to a computer running PC Direct or Sleepware software or to other Philips Respironics devices such as Alice 5 and AOM Use the Trilogy RS232 Serial Cable to connect the ventilator to the external device or computer Remote Alarm Nurse Call Connector If you are using an optional remote alarm or nurse call system with the ventilator you can connect the Philips Respironics remote alarm adapter cable or nurse call adapter cable to this connector Ethernet Connector when available You can connect a PC or router to this connector to upload therapy information to a secure web site so you can review therapy information remotely or remotely troubleshoot and service the device External Battery Connector DC Power Inlet You can connect an external stand alone lead acid battery here using the Trilogy External Battery cable Oxygen O Inlet Connector If using low flow supplemental oxygen connect the oxygen source to this connector using one of the O Inlet Quick Connects provided with the device Air Inlet and Filter Insert the filter supplied with the device into the air inlet Detachable Battery Pack Slot If you are using the Philips Respironics Lithium lon detachable bat
34. than this and varies with battery age environmental conditions and therapy Immediately seek an alternate power source when the Low Battery alarm appears Complete power failure and loss of therapy is imminent Operating Do not use this device if the ambient temperature is warmer than and Storage 40 C 104 F If the device is used at room temperatures warmer than Temperatures 40 C the temperature of the airflow may exceed 43 C This could cause system alarms thermal irritation or injury to the patient s airway Bacteria Filter Philips Respironics recommends that a main line outlet bacteria filter Part Number 342077 be used whenever the device is used for invasive therapy or if the ventilator may be used on multiple patients Patient Circuits The ventilator should only be used with patient interfaces e g masks General circuits and exhalation ports recommended by Philips Respironics Proper operation of the device including alarms with other circuits has not been verified by Philips Respironics and is the responsibility of the health care professional or respiratory therapist When adding any components to the breathing system the flow resistance and dead space of the added components such as humidifiers speaking valves Heat Moisture Exchangers HMEs and filters should be carefully considered in relation to the potential for adverse effects on the patient s ventilatory management and device alarms Passive Circ
35. that is not controlled by a switch This powers the system and charges the internal battery If the device still does not turn on contact an authorized service representative or Philips Respironics to have the device serviced Please have the model number and serial number ready when you call Chapter 8 Troubleshooting 130 The batteries are not charging The device is plugged in but the detachable if installed and internal batteries are not showing full capacity and are not charging Unexplained changes in the performance of the device The device is not working properly or is making unusual sounds Trilogy200 clinical manual Why It Happened The batteries may not charge if the device is too hot or too cold or is operating at an ambient temperature outside of the specified valid range The device cooling fan may not be working properly If this continues for more than 15 minutes an error will occur The device has been dropped or mishandled or is in an area of high EMI emissions What To Do Make sure the device is not close to a heat source Ensure the cooling air vents are not blocked Bring the ventilator to ambient room temperature If the problem continues contact an authorized service representative or Philips Respironics to have the device serviced Please have the model number and serial number ready when you call Press the Start Stop button and then select the Right button to shut of
36. the calculated tidal volume is less than 90 of the target tidal volume setting The alarm will automatically terminate when a breath occurs in which the exhaled tidal volume is equal or greater to 90 of the target tidal volume setting Chapter 3 Modes Features and Alarms 44 High Vti Alarm This is a high priority alarm It occurs when the delivered tidal volume is greater than the High Vti alarm setting for three consecutive breaths The device continues to operate The alarm will automatically terminate when a breath occurs in which the delivered tidal volume does not reach the High Vti alarm setting Low Vti Alarm This is a high priority alarm It occurs when the delivered tidal volume is less than the Low Vti alarm setting for three consecutive breaths The device continues to operate The alarm will automatically terminate when a breath occurs in which the delivered tidal volume exceeds the Low Vti alarm setting High Respiratory Rate Alarm This is a high priority alarm It occurs when the respiratory rate is greater than the High Respiratory Rate alarm setting The device continues to operate The alarm will automatically terminate when the measured respiratory rate is less than the High Respiratory Rate alarm setting Low Respiratory Rate Alarm This is a high priority alarm It occurs when the respiratory rate is less than the Low Respiratory Rate alarm setting The device continues to operate The alarm will automatica
37. the event log if it is multiple pages The number of pages appears in the upper right corner of the panel In the event log descriptions any description beginning with a 1 or 2 is a prescription change event The 1 represents a change to a primary setting and the 2 represents a change to a secondary setting This is followed by the setting that was changed The last two columns indicate setting and alarm changes If the entry is a setting change the first column shows the old setting value and the last column shows the new setting If the entry is an alarm the first column shows the value that triggered the alarm and the last column shows the number of seconds that the alarm was active Viewing Device Information From the Main Menu screen you can select Information to access the Information screen You can also view the Information screen by holding the Down key for 5 seconds This causes the detailed view of the Monitor Screen and the Information Menu to be displayed temporarily This key sequence is valid from the Monitor Screen while in Full or Limited Access The Information screen provides you with a summary of the current prescription settings device settings and system settings You can use the Up Down buttons to scroll through the information Trilogy200 clinical manual 91 Updating Prescriptions Using the SD Card ith th il d h When you change the device With the Trilogy200 you can update the patient s pre
38. user of this device should make sure it is used in such an environment IEC 60601 Test Level Compliance Level Immunity Test Conducted RF IEC 61000 4 6 3 Vrms 150 kHz to 80 MHz outside ISM bands 10Vrms 150 kHz to 80 MHz in ISM bands Radiated RF IEC 61000 4 3 10 V m 26 MHz to 2 5 GHz 10 V m 80 MHz to 2 5 GHz Electromagnetic Environment Guidance Portable and mobile RF communications equipment should be used no closer to any part of the device including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance d 1 2 P d 12 P 80MHz to 800 MHz d 23 JP 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in meters m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol 3y a NOTE 1 At 80 MHz and 800 MHz the higher frequency range applies NOTE 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stat
39. which the breath is patient triggered and the ventilator controls how the air is delivered based on defined settings An assisted breath is not cycled until the inspiratory time setting has been reached AVAPS Average Volume Assured Pressure Support feature available in S S T T and PC therapy modes Blower Hours The total number of hours that the blower has been on over the life of the device This value helps determine when the ventilator needs to be serviced You cannot reset this value It can only be reset by an authorized service center BPM Breaths Per Minute Chapter 12 Glossary 156 BTPS CPAP CV DC EPAP ESD Flex I E Ratio IPAP LED l min Term Acronym Definition Body Temperature and Pressure Saturated A standardization for lung volumes and flows to barometric pressure at sea level body temperature and saturated with water vapor reflecting the condition of air in the lung Continuous Positive Airway Pressure Control Ventilation therapy mode CV mode delivers Mandatory breaths with a user defined inspired tidal volume This is a Volume Control mode Direct Current Expiratory Positive Airway Pressure Electrostatic Discharge The device provides the Flex comfort feature The C Flex feature provides increased pressure relief during the expiratory phase of breathing The Bi Flex feature provides a level of pressure relief taking place at the end of inhalatio
40. 00 mL Mandatory Breath Rate 10 BPM Inspiratory Time 1 5 seconds Flow Pattern Square FLOW 6 seconds 6 seconds 6 seconds 6 seconds gt tt a o Enter CV mode Control Mode TIME Chapter 3 Modes Features and Alarms 28 Assist Control AC Mode In Assist Control AC mode the device delivers volume control therapy This mode provides Assist and Mandatory breaths An Assist breath is started when there is patient effort but it is ended when the Inspiratory Time setting has been met A Mandatory breath is delivered if the patient does not spontaneously breathe within the prescribed BPM setting This ensures that the patient receives aminimum number of breaths per minute In this mode the Tidal Volume is delivered during inhalation and PEEP is delivered during exhalation The following illustration describes these concepts Tidal Volume 500 mL Mandatory Breath Rate 10 BPM Assist Breath Inspiratory Time 2 0 seconds Flow Pattern Square FLOW 6 seconds 5 seconds 6 seconds 1 50 4 Enter A C mode v Assist Control Mode Synchronized Intermittent Mandatory Ventilation SIMV Mode In Synchronized Intermittent Mandatory Ventilation SIMV mode the device delivers both volume control and pressure control therapy This mode provides Spontaneous Assist and Mandatory breaths This mode uses a time window to decide what type of breaths should be delivered This tim
41. 152 Electrical AC Voltage Source Detachable Battery Internal Battery Type of Protection Against Electric Shock Degree of Protection Against Electric Shock Degree of Protection against Ingress of Water Mode of Operation Fuses Pressure Output SD Card and SD Card Reader 100 to 240 VAC 50 60 Hz 2 1 A Voltage 14 4 VDC Capacity 4176 mAh Chemistry type Lithium lon Voltage 14 4 VDC Capacity 4176 mAh Chemistry type Lithium lon Class Il Internally Powered Equipment Type BF Applied Part Device Drip Proof IPX1 Continuous There are no user replaceable fuses 4to 50 cm H O Use only SD cards and SD card readers available from Philips Respironics or the following SanDisk Standard SD Card 1 0 GB REF SDSDJ 1024 SanDisk Card Reader Writer SanDisk ImageMate REF SDDR 99 A15 Trilogy200 clinical manual 153 Control Accuracy Parameter Range Accuracy IPAP 4 to 50 cm H O Greater of 2 cm H O or 8 of setting EPAP 0 to 25 cm H O for Active Circuits Greater of 2 cm H O or 8 of setting 4 to 25 cm H O for Passive Circuits CPAP 4 to 20 cm H O Greater of 2 cm H O or 8 of setting PEEP 0 to 25 cm H O for Active Circuits Greater of 2 cm H O or 8 of setting 4 to 25 cm H O for Passive Circuits Pressure 4 to 50cm H O Greater of 2 cm H O or 8 of setting Pressure Support 0 to 30 cm H O Greater of 2 cm H O or 8 of setting Tidal Volume 50 to 2000 ml gt Greater of 15ml or 109
42. 6 of setting Active Circuits Greater of 15ml or 1596 of setting Passive Circuits Breath Rate 0 to 60 BPM for AC mode Greater of 1 BPM or 10 of the setting 1 to 60 BPM for all other modes Rise Time 1 to 6 2 cm H O the device will increase to a pressure of 67 IPAP EPAP 2 cm H O the set rise time multiplied by 100 ms for pressure supports less than or equal to 25 Ramp Start Pressure 0 to 25 cm H O for Active Circuits 8 of setting 2 Full Scale 4 to 25 cm H O for Passive Circuits 4 to 19 cm H O in CPAP mode Apnea Rate 4 to 60 BPM Greater of 1 BPM or 10 of setting Specifications listed are based on using a standard circuit consisting of 1 8 meter tubing REF 622038 one of the following exhalation devices Whisper Swivel Il REF 332113 Active PAP Exhalation Device REF 1053716 Active Flow Exhalation Device REF 1049503 or Active Exhalation Device REF 1065658 UPB Active PAP Exhalation Device REF 1073862 and Trilogy Proximal Flow Sensor REF 1050408 if required Limited to 25 cm H O when using the Bi Flex feature in S mode Pressure units may be cm H O hPa or mBar depending on device setup The difference between the Inspiratory Pressure and the Expiratory Pressure must never be more than 30 cm H O Pressure Support and PEEP not to exceed 50 cm H O 5All flows and volumes are measured at BTPS conditions 5The range of values correspond to tenths of seconds e g a setting of 4 indicates a Ri
43. Block Universal Porting Block White Striped Exhalation Valve Port on Trilogy Device Flow Line Flow Line Exhalation Valve Line Exhalation Valve Port on Porting Block Refer to the instructions included with the active exhalation device for more information Connect a Water Trap If you are using an optional water trap connect it to the patient circuit according to the manufacturer s instructions Trilogy200 clinical manual Note When using an active exhalation device with proximal flow ensure that any additional proximal ports are capped Note the pis symbol appears next to the Exhalation Valve port on the Universal Porting Block to indicate where the active exhalation valve line connects Connecting the Active Exhalation Device with Proximal Flow Sensor 61 Connect Supplemental Oxygen Optional To attach supplemental oxygen to the device 1 Connectthe oxygen tubing to the Oxygen Inlet Quick Connect Then connect the Quick Connect to the Oxygen Inlet on the back of the ventilator Oxygen Inlet Oxygen Inlet Quick Connect Oxygen Source Tubing Attaching the O Tubing 2 Make sure you press the Oxygen Inlet Quick Connect firmly into the inlet You should hear a click and the latch at the top of the inlet will pop up Press Tubing in and Latch a Pops Up This device is only compatible with a low flow oxygen source CAUTION providing up to 15 l min
44. C or DC power The ventilator accesses power from potential sources in the following order e AC Power External Battery e Detachable Battery Pack Internal Battery Trilogy200 clinical manual CAUTION The reusable foam inlet filter is required to protect the ventilator from dirt and dust Wash periodically and replace when damaged for proper operation Installing the Filter Note See Chapter 7 for information on how to clean and replace the air filter Using AC Power An AC power cord is provided with the device 1 Plug the socket end of the AC power cord into the AC power inlet on the side of the device To prevent accidental removal of the AC power cord from the device you may secure the AC power cord to the device using the AC power cord retainer located on the back of the device Plug the pronged end of the cord into a wall outlet not connected to a wall switch Ensure that all connections are secure If AC power is connected correctly and the device is operating properly the green AC Power LED should be on 51 Note This device is activated i e powered on when the AC power cord is connected or any of the three battery sources is available Pressing the Start Stop button turns the airflow on or off CAUTION The device may only be operated at temperatures between 5 C and 40 C 41 F and 104 F AX WARNING Periodically inspect the power
45. Connector Secure Digital SD Card Slot IOIOI Serial Port Connector d Remote Alarm Connector oy Ethernet Connector Sao DC Power Connector O Oxygen Inlet L Ti Consult accompanying instructions for use Type BF Applied Part n Class II Double Insulated Trilogy200 clinical manual 13 IPX1 Drip Proof Equipment For Airline Use Complies with RTCA D0160F section 21 category M How to Contact Philips Respironics To have your device serviced contact Philips Respironics Customer Service department at 1 724 387 4000 or 1 800 345 6443 Respironics Inc 1001 Murry Ridge Lane Murrysville PA 15668 USA Chapter 1 Introduction 14 Trilogy200 clinical manual Trilogy200 clinical manual 2 System Description This chapter describes the front and rear panel device controls and features Front Panel Features The front panel contains the control buttons visual indicators and display screen Buttons The following buttons are included on the front panel of the device 1 Start Stop Button This button turns the airflow on or off starting or stopping therapy 2 Alarm Indicator and Audio Pause Button This button serves two purposes it temporarily silences the audible portion of an alarm and it also acts as an alarm indicator When silencing an alarm if the cause of the alarm is not corrected the alarm sounds again after one minute Each time the button is p
46. E of Vte Only the Active Flow circuit type directly measures exhaled tidal volume Vte The Active PAP circuit type DOES NOT measure Vte and only provides for an indication of the delivered tidal volume Vti If you notice any unexplained changes in the performance of the device if it is making unusual sounds if the device or detachable battery are dropped if water is spilled into the enclosure or if the enclosure is cracked or broken discontinue use and contact Philips Respironics or an authorized service center for service Chapter 1 Introduction Maintenance Follow the service recommendations provided in Chapter 7 of this manual Periodically inspect electrical cords cables and the detachable battery pack for damage or signs of wear Discontinue use and replace if damaged Repairs and adjustments must be performed by Philips Respironics authorized service personnel only Unauthorized service could cause death or injury invalidate the warranty or result in costly device damage Cleaning To avoid electrical shock always unplug the power cord from the wall Refer to Chapter 7 outlet before cleaning the ventilator B detalled cleaning Do not immerse the device in any fluids or spray the device with water MSE MEE Ne or cleaners Clean the device with a cloth dampened with an approved cleaner If the device has been exposed to rain or dampness dry the device including the area around the power cord connection with the po
47. Left Reset button to reset alarm Make sure device is not close to a heat source Make sure tubing is not under any bedding Check inlet filter and clean or replace it if needed Make sure cooling vents are not blocked If the ventilator is running off of the internal or detachable battery move to a cooler location and or power the device with AC power or a lead acid battery If alarm continues place patient on alternate source of ventilation and contact your health care professional Clinician If alarm continues after the measures above have been taken have device serviced Priority Audible Low or High depending on cause of alarm Replace Detachable Battery e for Low eee ee for High Ventilator Medium Service Recommended AC Power Medium Disconnected Device Action Visual Alarm Indicator Button and Display Replace Detachable Battery message appears If battery is nearing end of useful life message appears with yellow background and button is solid yellow If battery fails message appears with red background and button flashes red Operates Yellow flashing button Ventilator Service Recommended message Operates Switches to alternate power source Yellow flashing button AC Power Disconnected message and a box appears around battery in use 115 User Clinician Action User Press Alarm Indicator Audio Pause button to silence
48. Limited Warranty Respironics Inc warrants that the Trilogy200 system shall be free from defects of workmanship and materials and will perform in accordance with the product specifications for a period of two 2 years from the date of sale by Respironics Inc to the dealer If the product fails to perform in accordance with the product specifications Respironics Inc will repair or replace at its option the defective material or part Respironics Inc will pay customary freight charges from Respironics Inc to the dealer location only This warranty does not cover damage caused by accident misuse abuse alteration and other defects not related to material or workmanship Respironics Inc disclaims all liability for economic loss loss of profits overhead or consequential damages which may be claimed to arise from any sale or use of this product Some states do not allow the exclusion or limitation of incidental or consequential damages so the above limitation or exclusion may not apply to you Accessories and replacement parts including but not limited to circuits tubing leak devices exhaust valves filters and fuses are not covered under this warranty However Respironics warrants that the Product s internal and detachable battery where supplied will be free from defects in material and workmanship under normal and proper use and when correctly maintained in accordance with applicable instructions for a period of 90 days
49. Low Inspiratory Pressure alarm setting For pressure modes the alarm occurs when the delivered pressure is 5 cmH O or more below the target patient pressure during the inspiratory phase The alarm will automatically terminate when the delivered pressure comes within 5 cmH O of the target patient pressure during the expiratory phase High Minute Ventilation Alarm This alarm is a high priority alarm It occurs when the patient s minute ventilation is greater than the High Minute Ventilation alarm setting The device continues to operate The alarm will automatically terminate when the calculated minute ventilation is less than the High Minute Ventilation alarm setting Low Minute Ventilation Alarm This alarm is a high priority alarm It when the patient s minute ventilation is less than the Low Minute Ventilation alarm setting The device continues to operate The alarm will automatically terminate when the calculated minute ventilation is greater than the Low Minute Ventilation alarm setting Chapter 3 Modes Features and Alarms 46 Low Battery Alarm The Low Battery alarm occurs when the last battery available is low or nearly depleted This alarm occurs in two stages When approximately 20 minutes of battery run time remains a medium priority alarm is generated and the device continues to operate If no action is taken and the battery continues to deplete the alarm escalates to a high priority alarm when approximately 10 minut
50. Low Inspiratory Pressure 09 52 PM Low Vte 09 52 PM Low Respiratory Rate 09 52 PM Low Minute Ventilation 09 52 PM w Circuit Disconnect 09 52 PM o Alarm Log Screen The alarm log displays the alarms in chronological order with the most recent events displayed first It lists the 20 most recent alarms or messages that appeared on the device display When the device is Hp g PP p ay you can press the Right Clear in Limited Menu access mode the alarm log cannot be cleared Itcan button to clear the alarm log if be cleared when in Full Menu access mode Depending on how many desired alarms have occurred the alarm log may be several pages long The entries in the alarm log use the same names that displayed when the alarm initially occurred and was displayed in the Alarm View Note In Full Menu access mode Chapter 5 Viewing and Changing Settings 90 Viewing the Event Log Note In Full Menu access mode you can press the Right Clear From the Main Menu screen you can select Event Log to access the button to clear the event log if Event Log screen desired The event log displays a list of all events that have occurred such as ventilator setting changes ventilator inoperative conditions alarms etc in chronological order with the most recent events displayed first When the device is in Limited Menu access mode the event log is not available It can be viewed and cleared when in Full Menu access mode You can page through
51. PHILIPS PHILIPS RESPIRONICS 09 26 2008 02 16 PM 4 mn de EN OQ 0q Xi p SES Trilogy 200 LOO a E Zt x Respironics Inc REFl4054728 Es 1001 Murry Ridge Lane PHILIPS Murrysville PA 15668 USA 1552849 tes JH 6 7 10 Trilogy 200 CLINICAL MANUAL RESPIRONICS FOR CLINICIAN S USE ONLY Accessing Prescription Setting Screens The information on this page is ONLY for health care professionals Remove this page from the manual before giving the manual to the patient Full Menu Access Mode The ventilator has two levels of menu access Full and Limited Full Menu Access allows you to alter all available settings Limited Menu access permits the user to alter only those prescription parameters that affect patient comfort such as Rise Time Flex and Ramp Start Pressure if those parameters are available as part of the prescription The ventilator defaults to Full Menu Access mode After accessing the Main Menu if the device is in Limited Menu Access mode you can use the following Setup key sequence to enter Full Menu Access mode and be able to change prescription settings e Press the Down button and the Alarm Indicator Audio Pause button simultaneously for several seconds This will temporarily place the device in Full Menu Access mode When you perform this key sequence from the Monitor screen the Main Menu screen appears and an audible indicator sounds indicat
52. Patient Alarms High Exhaled Tidal Volume 44 High Minute Ventilation 45 High Peak Inspiratory Pressure 46 Low Exhaled Tidal Volume 44 Low Minute Ventilation 45 Low Peak Inspiratory Pressure 44 Low Respiratory Rate 44 Power Alarms 107 External Battery Disconnected 48 System Alarms Ventilator Service Recommended 46 Bacteria Filter Replacing 125 Battery Function Verification 146 Breathing Circuit Connection 57 Breathing Circuit Connection 84 Breath Rate 82 Breath Types Assist 20 C Cautions 8 15 133 Circuit Type Setting 74 Contraindications 11 Control Ventilation Mode 27 D Date Format 88 DC Power Detachable Battery Pack 52 External Battery 52 Detailed View 86 Index 166 DirectView Software 134 E EMC Information 159 EPAP 81 Ethernet Connector 18 Event Log 90 Exhalation Devices Cleaning 125 Exhalation Porting Block 18 F Flex 97 Flex Comfort Feature 30 80 Bi Flex 30 C Flex 30 Flow Cycle Sensitivity 79 Flow Pattern 84 Ramp 33 Square 33 Flow Trigger Sensitivity 79 Front Panel AC Power LED 15 Audio Pause Button 16 Keypad Backlight LEDs 16 Left Right Buttons 16 Red Alarm LED 15 Start Stop Button 15 Up Down Button 16 H High Minute Ventilation 77 High Respiratory Rate 77 High Tidal Volume Alarm 76 Humidifier 131 Trilogy200 clinical manual Inspiratory Time 82 In Use Bag 134 IP Address Mode Setting 88 IPAP 81 IPAP Max Pressure 81 IPAP Min Pressure 81 K Keypad Backlight
53. VAPS are intended for use by adult patients When you change the device prescription alarms and other settings using the SD card Trilogy200 requires that the caregiver review and verify the changes prior to the changes being used by the device The caregiver or health care professional is responsible to ensure that the prescription settings are correct and compatible with the patient after using this feature Installing the wrong prescription for a particular patient may result in improper therapy lack of appropriate safety monitoring and risk of death or injury to the patient This device is intended for use in the electromagnetic environment specified in Chapter 13 of this manual The user of this device should make sure it is used in a compatible environment Portable and mobile RF communications equipment should be used no closer to any part of the device including cables than the recommended separation distance calculated using the information provided in Chapter 13 of this manual The internal battery is NOT intended to serve as a primary power source It should only be used when other sources are not available or briefly when necessary for example when changing power sources The ventilator has a two stage low battery alarm The medium priority alarm indicates that approximately 20 minutes of operation remain and the high priority alarm indicates that less than 10 minutes of operation remain Actual run time may be more or less
54. ached to the device contact Philips Respironics or an authorized service Battery Symbol representative to have your Internal Battery wn device serviced Detachable Battery y There are several DC power indicators that will display on the Monitoring screen to indicate which battery is in use if applicable if the batteries are low charging or discharged etc The following table explains all of the DC power indicators DC Power Indicator Description Battery In Use Indicator A black box will appear around the battery that is in use For instance if the external battery is currently in use the symbol appears on the Monitoring screen Green Fully Charged When a battery is charged to greater than 9096 of its capacity all of the Battery Indicator bars in the battery symbol will appear in green Partially Charged When a battery is partially charged some of the bars in the battery Battery Indicator symbol will appear in green while others will be clear For instance if the external battery is 5096 charged the following symbol displays on Screen Yellow Low Battery When the device detects that an in use battery s charge is low has Indicator Medium approximately 20 minutes of charge left the inside of the box Priority surrounding the battery symbol turns yellow In addition to the battery indicator on the Monitoring screen a medium priority alarm message will display indicating Low Battery See
55. ain unlocked the entire time alarms are active Note Pressing the Left Cancel button will cancel the Keypad Unlock action Chapter 5 Viewing and Changing Settings 64 Accessing the Startup and Monitor Screens 1 After you press the button to begin therapy the Startup screen appears momentarily indicating the device name and the software version 2 The next screen that appears is the Monitor screen The appearance of this screen will vary depending on how you set up the device If Detailed View is turned off in the Options menu your screen will look like the screen shown below Note The symbols that appear on the Monitor screen are described in detail later in this Primary CPAP Monitor Panel chapter 03 20 2007 Date and Time 05 20 PM Panel E Status Panel Ext Detach Int Ramp o Menu A Monitor Screen Detailed View Off Thetop section of the screen called the Monitor panel shows the therapy mode and if you set up a dual prescription for the patient the Prescription indicator Note No Soft Buttons display appears indicating Primary or Secondary prescription The on the Monitor screen if Keypad patient breath symbol also displays during a patient triggered Lock is enabled breath and a bar graph displays the current pressure level The center section of the screen displays the current date and time The bottom section called the Status panel displays certain symbols that indicate features
56. al Specifications Environmental Operating Storage Temperature 41 F to 104 F 5 C to 40 C 4 F to 140 F 20 C to 60 C Relative Humidity 15 to 95 non condensing 15 to 95 non condensing Atmospheric Pressure 110 kPa to 60 kPa N A The operating range for the charging of the internal and detachable batteries is 10 C to 30 C The internal and detachable batteries will power the ventilator for the full operating range of 5 C to 40 C Accuracies stated in this manual are based on specific environmental conditions For stated accuracy the environmental conditions are Temperature 20 30 C Humidity 50 relative Altitude nominally 380 meters Physical Dimensions 6 6 Lx 11 2 W x 9 3 H 16 68 cm L x 28 45 cm W x 23 52 cm H Weight Approximately 11 Ibs 5 kg with the detachable battery installed Standards Compliance This device is designed to conform to the following standards IEC 60601 1 Medical electrical equipment Part 1 General requirements for safety e IEC 60601 1 2 General requirements for safety Collateral standard Electromagnetic compatibility Requirements and tests SO 10651 2 Lung ventilators for medical use Particular requirements for basic safety and essential performance Part 2 Home care ventilators for ventilator dependent patients e RTCA DO160F section 21 category M Emission of Radio Frequency Energy Chapter 11 Technical Specifications
57. al manual Note The Rise Time setting only displays if Flex is disabled If Flex is enabled the device will use a rise time of 3 Note In S T T PC PC SIMV SIMV CV and AC modes the Apnea Rate is greater than or equal to the Breath Rate and is limited by the current Inspiratory Time setting to maintain a minimum 1 1 E ratio Note In volume modes the Breath Rate range is limited by the current Inspiratory Time setting to maintain a minimum 1 1 IE ratio Note In pressure modes the inspiratory time range is limited by the current Breath Rate setting to maintain a minimum 1 1 IE ratio Note In volume modes the inspiratory time range is limited by the current Tidal Volume and Breath Rate settings to maintain a minimum 1 1 E ratio and the system s minimum and maximum peak flow 83 Pressure Control PC Mode All of the settings available in S T mode are available in PC mode except for the Flow Cycle Sensitivity setting when Flow Trigger is enabled Please refer to the descriptions in the S and S T Mode sections of this chapter for detailed information on the PC mode settings Pressure Control Synchronized Intermittent Mandatory Ventilation PC SIMV Mode The following settings described in the S and S T mode sections of this chapter also are available in PC SIMV mode Breath Rate Inspiratory Time Trigger Type FlowTrigger Sensitivity if Trigger Type is set to Flow Trigger Flow Cyc
58. an choose either cmH O hPa mBar Trilogy200 clinical manual 87 All pressure units on the screens will display in the unit of measure selected here Alarm Volume You can adjust the volume of the device alarms using this setting Select either Loud or Soft as the Make sure the alarm volume is alarm volume options set loud enough to be heard by the caregiver Consider the use of Keypad Lock You can enable or disable the Keypad aremote alai Lock feature which is described in detail earlier in this chapter Enabling the Keypad Lock feature can prevent someone from accidentally pressing a button and changing any of the settings Select On to enable the feature or Off to disable it Keypad Backlight The next item you can set is the Keypad Backlight You can turn the backlight On or Off using this setting Whenever you press the button to begin therapy the keypad backlight temporarily lights up Once therapy is being provided the keypad will be lit according to this Keypad Backlight setting If the setting is On the backlight remains on while therapy is provided If the setting is Off the backlight remains off while therapy is provided LCD Brightness The LCD display is lit by a backlight The backlight turns on when the initial Startup screen displays You can adjust the brightness of the LCD backlight from 1 10 with 1 being the dimmest setting and 10 being the brightest Screen Saver You can ch
59. ands d 1 2 P d 2 3 P d 1 2 P d 1 2 P For transmitters rated at a maximum output power not listed above the recommended separation distance d in meters m can be estimated using the equation applicable to the frequency of the transmitter where P is the maximum output power of the transmitter manufacturer Note 1 At 80 MHz and 800 MHz the higher frequency range applies Note 2 The ISM industrial scientific and medical bands between 150 kHz and 80 MHz are 6 765 MHz to 6 795 MHz 13 553 MHz to 13 567 MHz 26 957 MHz to 27 283 MHz and 40 66 MHz to 40 70 MHz Note 3 An additional factor of 10 3 is used in calculating the recommended separation distance for transmitters in the ISM frequency bands between 150 kHz and 80 MHz and in the frequency range of 80 MHz and 2 5 GHz to decrease the likelihood that mobile portable communications equipment could cause interference if it is inadvertently brought into patient areas Note 4 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Trilogy200 clinical manual Trilogy200 clinical manual A AC Power 51 AC Power Inlet 17 Air Filter Installation 50 Air Inlet Air Inlet Filter Cleaning 122 Replacing 123 Air Inlet Path Replacing 123 Alarm and Event Log Clean Up 148 Alarm Log 89 Alarms 102 Alarm Indicators 104 Alarm Messages 104 Alarm Reset 105 Alarm Volume Control 106
60. ange the screen saver to reduce power consumption or dim the screen in a dark Note Setting the screen saver to Black allows the device to run Off No screen saver displays and the LCD backlight remains fora longer period of time on lit at your brightness setting Davey power room You can choose the following settings Breath The display appears as a black screen with only the patient breath indicator and manometer visible Black The display s backlight is turned off and the display is black with no information visible Chapter 5 Viewing and Changing Settings 88 Dim The display s backlight is decreased so that the display is still visible but not as bright If enabled the screen saver will display after 5 minutes of no keypad activity Pressing any button on the device will exit the screen saver And any alarm or informational message will also exit the screen saver Date Format You can choose either mm dd yyyy or dd mm yyyy as the date format that will display on the device screens Time Format You can choose to display either an AM PM time format or 24 Hour time format for example 2 49 PM or 14 49 Month The month defaults to the current month The adjustable range is from 1 January 12 December Day The day defaults to the current day The adjustable range is from 1 31 The maximum value is based on the selected month Year The year defaults to the current year The adjustable
61. ate and change any of the therapy settings Detailed information about each setting follows 1 From the My Settings screen use the Up Down button to navigate to the setting you want to change and highlight it 2 To modify a setting once it is highlighted press the Right Modify button 3 Usethe Up Down Edit button to scroll through the available settings Press Down to decrease the setting or press Up to increase the setting 4 Onceyou have chosen the setting you want press the Right OK button to save the new setting Or if you decide not to change the setting press the Left Cancel button 5 Youcan now either navigate to the next setting you want to change using the Up Down Navigate button or exit the My Settings menu by pressing the Left Finish button to return to the Main Menu You can change the following settings in the My Settings menu if they are enabled by your health care professional RiseTime The Rise Time is the time it takes the ventilator to change from expiration to inspiration If this feature is enabled you can adjust the Rise Time from 1 to 6 to find the setting that provides you with the most comfort A setting of 1 is the fastest Rise Time while 6 is the slowest e Ramp Start Pressure The ventilator is equipped with an optional Ramp feature Ramp reduces the pressure and then gradually increases the pressure to your prescription setting so you can fall asleep more comfortably Tr
62. battery if available If alarm continues place patient on alternate source of ventilation and contact your health care professional Clinician If the alarm continues after the measures above have been taken place patient on alternate source of ventilation and have device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Replace depleted battery with another or switch to AC power if available Clinician Replace depleted battery with another or switch to AC power User Check connection of the external battery to ventilator Check the charge available on external battery and recharge battery if necessary Clinician Check external battery and recharge if necessary Restore AC power if available Alarm Priority Audible Detachable Battery Disconnected Start On Battery Card Error Device Action Visual Alarm Indicator Button and Display Switches to alternate power source Detachable Batt Disconnected message and a box appears around battery in use Start On Battery message appears Operates A Card Error message appears Operates 119 User Clinician Action User Check connection of the detachable battery to ventilator Check the charge available on detachable battery and recharge battery if necessary Clinician Check detachable battery and recharge if necessary Restore AC powe
63. being used such as Ramp as well as battery status Trilogy200 clinical manual 65 If Detailed View is turned on in the Options menu the Monitor screen will look like the screen shown below Primary S T 04 14 2008 05 32 PM Monitor Panel a 0 5 10 15 20 25 30 Pressure RR vte Leak 21 78 20sm 837 m 31w PIP23 3H20 LERatio1 3 2 Peak Flow 120 0 1min 11 7 imin Measured Settings Panel 4 Monitor Screen Detailed P View On BI Status Panel Ramp MAP11 0H20 Min Vent ES Bus Access Ext Detach Int This screen contains more detailed information about the therapy The top Monitor panel contains the Prescription indicator if a dual prescription exists the therapy mode a graph displaying the current pressure and the current date and time Additionally this panel also displays patient pressure respiratory rate RR exhaled tidal volume Vte and leak Thesecond panel in Detailed view is the Measured Settings panel It provides patient related data including Peak Inspiratory Pressure PIP Minute Ventilation Peak Inspiratory Flow Mean Airway Pressure MAP and I E Ratio The third panel is the Status panel and shows the same information displayed in the Detailed View Off screen including features in use such as Ramp and battery status Chapter 5 Viewing and Changing Settings 66 Monitor Screen Indicators Note Dashes on the display screen indicate that the
64. ble setting for the patient Increase or decrease the setting from 1 to 6 until you find the right setting The rise time levels from 1 to 6 progressively reflect slowed response of the pressure increase that will take place at the beginning of inspiration 8 Apnea Rate If the Apnea alarm is enabled you can set the Apnea Rate from 4 to 60 BPM in 1 BPM increments In S mode the Apnea Rate is greater than or equal to 1 2 E ratio Spontaneous Timed S T Mode All of the settings described in the S Mode section are also available in S T mode except for the Flex setting In addition to those settings the settings below are also available in S T mode 1 Breath Rate In AC mode you can increase or decrease the Breath Rate setting from 0 to 60 BPM while in all other modes you can increase or decrease the setting from 1 to 60 BPM in 1 BPM increments Use the Breath Rate setting to establish the minimum rate of mandatory breaths that the ventilator will deliver per minute 2 Inspiratory Time You can adjust the Inspiratory Time setting from 0 3 to 5 0 seconds in 0 1 second increments Inspiratory Time is the duration for the inspiratory phase of a mandatory breath Timed T Mode All of the settings available in S T mode are available in T mode except for the Trigger Type setting Please refer to the descriptions in the S and S T Mode sections of this chapter for detailed information on the T mode settings Trilogy200 clinic
65. boescsessacszess 71 Navigating the Menu Screens eterne ttt nente nennttnnnnttnnns 71 Changing and Viewing Settings in Full Menu Access Mode 72 Changing the Device Settings and Alarms ees 73 Device Settings Common to All Therapy Modes 73 Additional Settings Specific to Therapy Modes sss 78 Continuous Positive Airway Pressure CPAP Mode 78 Spontaneous S Mode esent tentent nnns tton ttn tons 80 Spontaneous Timed S T Mode sese eenttennttenntes 82 Timed T MODE sass icone i retro eo REC ROREM 82 Pressure Control PC Mode tentent tete tnnnentes 83 Pressure Control Synchronized Intermittent Mandatory Ventilation PC SIMV Modl eene tetnntnntnntntnnel 83 Control Ventilation CV Mode esee ttntnntonnns 84 Assist Control AC Modl eee ttn tentnntnnte tentes ttntats 85 Synchronized Intermittent Mandatory Ventilation ESTIMA IN CS isso E 85 Viewing and Changing Options Menu Items eene 86 Viewing the Alarm LO ei etie nter entis inrer Heuer ere ERE ee N 89 Trilogy200 clinical manual Viewirig the Event LOG cte erret p tied 90 Viewing Device Information eese tteennnttennnttennnnttnnnntennnt 90 Updating Prescriptions Using the SD Card eene 91 Changing and Viewing Settings
66. but the highlight for the active alarm is removed the LED is unlit and the audible alarm stops The screen below is an example of a possible alarm message Note An alarm message will Primary CPAP Alarms and Messages Low Inspiratory Pressure 10 33 PM Sample Alarms and Reset Messages Screen If a menu is displayed on the screen when an alarm occurs the description of the newly generated alarm is displayed in the menu banner area This is done so that the modification to the current parameter can be completed before addressing the alarm condition in case the modification affects the alarm condition The screen below is an example of an alarm message displayed in the menu banner Trilogy200 clinical manual 103 CPAP usur cr ae m Fm 30 Circuit Disconnect 02 09 PM Setlings And Alarme Options Alarm Log 5 Ewant Log Alarm in Menu Banner Information Screen GRD eue The Alarms and Messages Screen will automatically display in place of the Monitor screen when exiting from the menu system using the Exit soft key when an alarm is displayed in the menu banner If an alarm is manually reset by the user or self cancels the menu banner on screen before the alarm occurred will reappear If a Ventilator Inoperative alarm occurs the entire display screen turns red and the Ventilator Inoperative message appears on screen as shown below INOPERATIVE A VENTILATOR o Ven
67. clinical manual Securing the Power Cord Using the Cord Retainer CAUTION Do not use the same external battery to operate both the ventilator and any other equipment such as power chairs CAUTION An external battery should only be connected to the ventilator using the Philips Respironics Trilogy External Battery Cable This cable is fused pre wired and properly terminated to ensure safe connection to a standard deep cycle lead acid battery Use of any other adapter or cable may cause improper operation of the ventilator Detachable Battery Pack Philips Respironics offers a detachable Lithium lon battery pack To use the detachable battery pack snap the battery into place on the back of the ventilator as shown in the following illustration When the device is not connected to an AC power source or an external battery the detachable battery will power the device if attached The length of time the ventilator will operate on battery power depends on many factors such as device settings battery charge level and condition or age of the battery When fully charged a new battery can power the ventilator for approximately three hours under typical patient conditions Whenever the ventilator is connected to AC power it will automatically recharge the detachable battery pack A completely discharged detachable battery will reach 8096 charge status within 8 hours when charging at approximately 23 C ambient temperature
68. creases AVAPS will reduce PS IPAP will not fall below IPAP Min even if the target tidal volume is exceeded If the Ramp function has been activated it will take precedence over the AVAPS feature Once ramp is complete AVAPS will resume Trilogy200 clinical manual 33 PRESSURE IPAP Max ui nn EPAP 15 30 45 60 TIME VOLUME Target Volume AVAPS Feature gt 15 30 45 60 TIME Flow Pattern Types Two flow patterns are available in Volume Control ventilation therapy modes Square Ramp Square With a square wave pattern airflow is generally constant throughout inspiration of the breath FLOW Square Flow Pattern TIME Chapter 3 Modes Features and Alarms 34 Ramp With a ramp flow pattern the airflow starts high and decreases throughout inspiration of the breath FLOW 5096 of aPeak Flow Ramp Waveform Pattern TIME For the active circuit in volume modes peak flow is required to be a minimum of 20 l min The wave form may be flattened when the combination of Inspiratory Time and Tidal Volume set points would result in a flow of less than 20 l min Therefore for some settings a Ramp flow pattern may provide a pattern that more closely resembles a Square flow pattern Trilogy200 clinical manual 35 Sigh Feature The sigh feature is available for Volume ventilation modes only When the sigh feature is enabled the ventilator delivers a sigh breath in p
69. device This section describes the following indicators was unable to compute the parameters For example when the device is first connected to a Measured Settings Panel Indicators patient the tidal volume minute e Status Panel Indicators ventilation and leak may be dashed until the device is able to accurately calculate these Monitor Panel Indicators patient parameters e Monitor Panel Indicators All of the indicators that may appear on the Monitor Panel are described in detail in the following table Indicator Description Prescription If you set up a dual prescription for the patient the words Primary or Secondary appear in the top left corner of the panel to indicate which prescription is active Therapy Mode The current therapy mode displays at the top of the panel for example CPAP S S T etc If a special feature such as Flex AVAPS or Sigh is active this feature will appear next to the therapy mode Date and Time If you are in Detailed view the current date and time appear in the top right corner of the panel In Detailed View Off they appear in the center panel Patient Breath e This symbol displays during a patient triggered breath Airway Pressure The manometer bar graph displays the airway pressure in the Manometer and patient circuit at all times The manometer bar moves to the Peak Pressure right as pressure increases during inhalation and moves to the Symbol left as pressure decreases d
70. ds whenever a power failure or a high medium or low priority alarm is detected Additionally an audible indicator sounds for informational messages and to confirm that certain actions have occurred for example when an SD card is inserted or removed from the device Ventilator Inoperative Audible Indicator When a Note For the alarmi indicators ventilator inoperative alarm occurs a continuous audible noted throughout this manual alarm sounds The alarm descriptions later in this chapter each dot represents an audible display this indicator as beep Power Failure Audible Indicator When a power failure occurs a series of beeps sounds in a 1 beep pattern repeating one second on then one second off The alarm descriptions later in this chapter display this indicator as High Priority Audible Indicator When a high priority alarm is detected a series of beeps sound in the following pattern which is repeated twice 3 beeps a pause and then 2 more beeps This indicator continues until the cause of the alarm is corrected or the audible alarm is paused The alarm descriptions later in this chapter display this indicator as Medium Priority Audible Indicator When a medium priority alarm is detected a series of beeps sound in a 3 beep pattern This pattern repeats until the cause of the alarm is corrected or the audible alarm is paused The alarm descriptions later in this chapter display this indicator as e Low Prior
71. e Mode CPAP Display Screen w Flex OFF Cancel Page SIT 06 24 2008 12 30 PM cm 0 5 10 15 20 25 30 Pressure RR Vte Leak 7 120 20sm 8374 31 Ventilator On Prescription Display Screen Prescription Audio Pause Primary Settings and Alarms Dual Prescription ON Mode CPAP Flex OFF w CPAP 0 0 cmH20 Pages Chapter 5 Viewing and Changing Settings 92 Select Cancel to cancel the prescription update process and return the screen to the initial state before the prescription update started Select Page to review the entire prescription The Menu Banner will reflect the prescription being updated Once the entire prescription has been reviewed a screen displays with the option to Cancel or OK the changes Select Cancel to cancel the prescription update process and return the screen to the initial state before the prescription update started Select OK to complete the prescription update and display the Prescription Change confirmation screen If the SD card is removed at any time during the prescription update the process aborts and the screen returns to the initial state before the prescription update started A confirmation screen will appear if errors occur during this process The following table summarizes the prescription errors their possible causes and the actions to take Trilogy200 clinical manual Note Make sure you closely review the prescription and confirm that all sett
72. e and Apnea alarms should be used in conjunction with the Circuit Disconnect and Low Peak Inspiratory Pressure alarms Test the operation of the circuit disconnect function daily and whenever a change is made to the patient circuit An increase in circuit resistance can prevent proper operation of some alarms Speaking valves Heat Moisture Exchangers HMEs and filters create additional circuit resistance and may affect the performance of alarms chosen for circuit disconnect protection Do not set the Low Peak Inspiratory Pressure alarm too low or the system may not detect large circuit leaks or a patient disconnect Chapter 1 Introduction Personnel Qualifications Modes of Ventilation SD Card Prescription Changes Electrical Interference Battery Back up Power Trilogy200 clinical manual Trilogy200 is a restricted medical device designed for use by Respiratory Therapists or other trained and qualified caregivers under the supervision of a physician The prescription and other device settings should only be changed on the order of the supervising physician The operator of the ventilator is responsible to read and understand this manual before use The device can provide therapies typically associated with both ventilator dependent and non dependent patients The mode of ventilation circuit type and alarm strategies should be chosen after a clinical evaluation of each patient s needs C Flex Bi Flex and A
73. e patient on alternate source of ventilation and contact your health care professional Clinician If alarm continues after the measures above have been taken place patient on alternate source of ventilation and have device serviced Detach Battery Not Operates User Press Alarm Indicator Charging or Internal Audio Pause button to Battery Not Charging silence alarm Or press Left Reset button to reset alarm If condition continues for internal battery place patient on alternate source of ventilation and contact your health care professional message Clinician If condition continues for internal battery place patient on alternate source of ventilation and have device serviced Battery Not Info Charging Chapter 6 Ventilator Alarms 118 Priority Check External Battery Battery Depleted External Battery Disconnected Trilogy200 clinical manual Visual Alarm Device Indicator Button Action and Display Check External Operates Battery message External Battery Operates Depleted or Detachable Battery Depleted message appears External Batt Switches to Disconnected alternate message and a box power source appears around battery in use User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Check connection to external battery Replace external battery with another external
74. e the following settings are also available in CV mode 1 FlowPattern You can choose either Ramp or Square for the Flow Pattern setting 2 Sigh You can enable or disable the Sigh setting by selecting On or Off A Sigh is a breath that is delivered every 100 breaths at 15096 of the normal volume Trilogy200 clinical manual Note The Flow Pattern setting might be limited to only Ramp or Square based on the Tidal Volume Inspiratory Time and Breath Rate settings to maintain the minimum and maximum peak flows 85 Assist Control AC Mode The AC mode contains the following settings described in the S S T PC SIMV and CV mode sections in this chapter Please refer to the descriptions in those sections for detailed information Tidal Volume Breath Rate Inspiratory Time e Flow Pattern Note The Low Inspiratory Pressure is limited to PEEP 2 in PEEP CV AG and SIMV modes Trigger Type Flow Trigger Sensitivity Note Flow Cycle Sensitivity is Sigh not available in AC mode High Inspiratory Pressure e Low Inspiratory Pressure Synchronized Intermittent Mandatory Ventilation SIMV Mode The SIMV mode contains the following settings described in the S S T PC SIMV and CV mode sections in this chapter Please refer to the descriptions in those sections for detailed information Tidal Volume Breath Rate Inspiratory Time Pressure Support e Flow Pattern e PEEP Trigger Type Sigh
75. e duration of a Mandatory breath is determined by the inspiratory time setting The following illustration describes these concepts IPAP 26 cm H O Pressure Supported EPAP 6 cm H O Spontaneous Breath Rate 10 BPM Mandatory Breath PS IPAP EPAP 20 cm H O note longer inspiratory time PRESSURE 6 seconds 6 seconds 4 6seconds t 1 26 4 20 S T Mode 10 4 6 A j Enter S T mode ST LL E Chapter 3 Modes Features and Alarms 24 Timed T Mode In Timed T mode the device delivers bi level pressure support This mode delivers Mandatory breaths only A Mandatory breath is delivered according to the prescribed BPM and inspiratory time settings This also means that the ventilator will not respond to patient effort In this mode an IPAP is delivered during inhalation and a lower EPAP is delivered during exhalation The following illustration describes these concepts IPAP 26 cm H O Mandatory Breath EPAP 6 cm H O Rate 10 BPM PS IPAP EPAP 20 cm H O PRESSURE 6 seconds 6 seconds 6 seconds 6 seconds i 1 1 Enter T mode T Mode DET ICIL I IILILM I ILUIL IILCIICXLIREETUIL 39 5 10 15 20 25 TIME Trilogy200 clinical manual 25 Pressure Control PC Mode In Pressure Control PC mode the device delivers bi level pressure support This mode delivers Assist and Mandatory breaths This mode is identical to S T mode except that all breaths have a fixed
76. e enn oon pat ase P PIRE 20 Therapy Mode Table ee eterne tteennntttnnnttnnnntttnnnitnnos 21 Pressure Control Ventilation Therapy Modes ee 22 Volume Control Ventilation Therapy Modes es 27 Therapy Mode Features isssccssssccossscssnssiconssserssssscsessesenisssesassssassiisnssit sande sneaidessnsstsasiienes 30 Flex Comfort Feature nscsssonssssonsesssnssivsonsesernsossennosvensosdsenoesvessstdeensederssstvesseeverseetvenses 30 RAMP sess e 31 RISC TMG AVAPS Feature Flow Pattern Types suscepti p an e te P E Re HORN 33 sp 35 Dual Prescription Feature eese nnttenn tentent tnnt tens ttttnn 35 Ir 36 BUPS GOmpPensationsscicsccssssnsscesatscceadssasessizcsesestcsnsstsisteccsatsedsarsadesscevesegsavcnsosersdetaiencd 41 ENSE 41 Loss of Power Alar cess setenta die dee i 41 Ventilator Inoperative Alarm eese teen tnnt nntonnis 41 Ventilator Service Required Alarm eese teen ttnnnttnnnes 41 Check Circuit Alarin oiii trt tec teli ctescesuad 42 Low Circuit Leak Alarm eese tienen ennt notte tton ttent toss ttto sid 42 High Expiratory Pressure Alarm eene nter tenentes 42 Low Expiratory Pressure Alarm eerte nnne 42 High Internal Oxygen Alarm
77. e green AC LED is lit B Connect the external battery cable to the external battery and to the ventilator C Verify that the external battery symbol is shown on the display and some level of charge is present D Disconnect the AC Power source from the device Verify that the AC Power Disconnected alarm message appears on the display and the green AC LED is not lit Press Reset Verify that the external battery symbol shows the level of charge as noted in the previous step and the device continues to operate Verify that the external battery symbol has a black box around it to indicate that itis in use E Reconnect the AC Power source Chapter 10 System Checkout Procedures 150 Alarm and Event Log Clean Up 1 Inthe Setup Menu select Alarm Log A Press Clear to clear the log file B Press Yes to confirm C Press Finish to complete 2 IntheSetup Menu select Event Log A Press Clear to clear the log file B Press Yes to confirm C Press Finish to complete Results All portions of this checkout procedure should be completed prior to connection to the patient If any of the tests fail to complete as indicated if possible correct the error clear the alarm and resume testing If correction of the failed portion is not possible return the device to Philips Respironics or an authorized service center for service and repair Trilogy200 clinical manual Trilogy200 clinical manual 11 Technic
78. e it is used in such an environment Emissions Test Compliance RF emissions CISPR 11 RF emissions Class B CISPR 11 Harmonic emissions Class A femmes m mm Voltage fluctuations Flicker Complies emissions IEC 61000 3 3 Electromagnetic Environment Guidance The device uses RF energy only for its internal function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment The device is suitable for use in all establishments including domestic establishments and those directly connected to the public low voltage power supply network that supplies building used for domestic purpose Chapter 13 EMC Information 162 Guidance and Manufacturer s Declaration Electromagnetic Immunity This device is intended for use in the electromagnetic environment specified below The user of this device should make sure it is used in such an environment Immunity Test Electrostatic Discharge ESD IEC 61000 4 2 Electrical fast Transient burst IEC 61000 4 4 Surge IEC 61000 4 5 Voltage dips short interruptions and voltage variations on power supply input lines IEC 61000 4 11 Power frequency 50 60 Hz magnetic field IEC 61000 4 8 IEC 60601 Test Level 6 kV contact 8 kV air 2 kV for power supply lines 1 kV for input output lines 1 kV differential mode 2 kV common mode lt 5 U gt 95 dip in U for 0 5 cycle
79. e remote alarm cable from the ventilator or from the remote alarm results in an alarm notification at the remote alarm The remote alarm should be tested daily When administering fixed flow supplemental oxygen the oxygen concentration may not be constant The inspired oxygen concentration will vary depending on the pressures patient flows and circuit leak Substantial leaks may reduce the inspired oxygen concentration to less than the expected value Appropriate patient monitoring should be used as medically indicated such as an alarming pulse oximeter This device DOES NOT alarm for loss of the low flow oxygen supply This device is intended to be connected to a low flow 0 15 l min oxygen source such as an oxygen concentrator or other oxygen source equipped with a pressure regulator set to 50 PSI or less and a flow regulator meter Do not connect the device to an unregulated or high pressure oxygen source The device may result in incorrect flow and tidal volume measurements and improper operation of related alarms if you add low flow oxygen directly into the patient circuit or mask instead of using the oxygen inlet on the back of the ventilator Oxygen supports combustion Oxygen should not be used while If oxygen is used with the device the oxygen flow must be turned off when the device is not in use Explanation of the Warning When the device is not in operation and the oxygen flow is left on oxygen delivered into the
80. e the SD card When the Remove SD Card confirmation message appears remove the card If you press the left cancel button or don t remove the card within 30 seconds the confirmation message will close and the ventilator will continue writing to the card Trilogy200 clinical manual Note If the Keypad Lock feature is enabled a message will appear that says Hold Right Key for 5 seconds to unlock Once you hold the key down for 5 seconds the keypad will unlock and you can enter the Main Menu screen The Keypad Lock feature is explained in detail later in this chapter Note In the example Main Menu screen shown the 1 5 that appears in the Menu banner indicates that item 1 is highlighted from a total of 5 items in the menu Main Menu Screen MySettings View and change certain prescription settings such as rise time or ramp starting pressure if these settings were enabled by your health care professional Options View and change certain device settings such as your alarm volume keypad lock or keypad backlighting Alarm Log View a list of the 20 most recent alarms that have occurred Information View detailed information about your device such as the device s software version and serial number Activating Your Primary or Secondary Prescription If your health care professional has set up a dual prescription for you follow the steps below to change your prescription selection Your health care prof
81. e the following value shown in Table 8 Setting Value Table 8 Restore Ventilator Low Vie Low V on 4 Verify Circuit Disconnect Alarm This procedure verifies that the Circuit Disconnect alarm is working properly It assumes that you have attached the test lung verified ventilator settings and turned on ventilator power as described in the Initial Setup section A C Change Circuit Disconnect Ventilator Setting Modify the Circuit Disconnect ventilator setting to match the value shown below in Table 9 Setting Value 4 Note The Low Inspiratory or Low Expiratory Pressure Alarm may also be detected Disconnect Test Lung Disconnect the test lung from the circuit Verify the Alarm Wait approximately 10 seconds and verify the following alarm signals TheHigh Priority Audible Indicator sounds Ared light flashes on the Alarm Indicator Audio Pause button Trilogy200 clinical manual 145 TheCircuit Disconnect alarm condition appears on the screen highlighted in red D Reconnect Test Lung Reconnect the test lung to the circuit E Verify Reset Wait at least 40 seconds and verify the following auto reset conditions TheHigh Priority audible indicator has stopped sounding The red light on the Alarm Indicator Audio Pause button has stopped flashing F Restore Ventilator Settings Modify the ventilator settings and change the following values shown below in Table 10 Setting Value
82. e window is the maximum time between breaths according to the set Breath Rate When you enter SIMV mode the time window is started If the patient does not provide any effort the ventilator will provide a Mandatory Volume breath when the time expires and then begin the process again Mandatory breaths deliver the Tidal Volume setting during inhalation and provide a lower Peak End Expiratory Pressure PEEP during exhalation Trilogy200 clinical manual 29 During the time window if patient effort is detected either a Spontaneous or an Assist breath is delivered for the first effort If the last breath delivered was Mandatory then a Spontaneous breath is delivered for the first patient effort of the window If the last breath delivered was an Assist or Spontaneous breath then an Assist breath is delivered for the first patient effort of the window Assist breaths deliver the prescribed Tidal Volume during inhalation and the PEEP setting during exhalation During the time window if patient effort continues to be detected after the first patient triggered breath Spontaneous breaths are delivered for the remainder of the window Spontaneous breaths deliver the prescribed Pressure Support setting above PEEP during inhalation and PEEP during exhalation The figure below provides example breath patterns in SIMV mode Tidal Volume 500 mL Pressure Supported Mandatory Window Breath Rate 5 BPM Breath Spontaneous Window Inspirato
83. ed humidifier the patient or the cleaning process condensed in the tubing or exhalation valve diaphragm Droplets of water affected the ability of the ventilator to measure proximal patient flow and pressure and trigger ona patient breath What To Do Increase the room humidity Consult with the patient s health care professional about using a humidifier with the device If using a humidifier refer to the instructions included with the humidifier to make sure it is working properly Tell the patient to stop using the device and contact their health care professional Use an appropriate method of water management such as a water trap when using a heated humidifier Remove tube s with condensation the exhalation valve line must be removed from both ends of the circuit the flow tube lines must be removed from the ventilator side The tubes are permanently attached to the flow element so the flow element must be removed from the patient circuit If there is water built up in the exhalation diaphragm disassemble the exhalation valve and clean dry the assembly Clear the flow tubes of water droplets using alow flow air source and re assemble the circuit Trilogy200 clinical manual 9 Accessories There are several accessories you can use with the ventilator Adding a Humidifier Use of a humidifier may reduce nasal dryness and irritation by adding moisture to the airflow If you are using a hu
84. ediately seek an alternate power source when the Low Battery message appears Complete power failure and loss of therapy is imminent The ventilator has a two stage low battery alarm The medium priority alarm indicates that approximately 20 minutes of operation remain and the high priority alarm indicates that less than 10 minutes of operation remain Actual run time may be more or less than this and varies with battery age environmental conditions and therapy 47 If the problem is not corrected the device will generate a reminder message once per day or whenever power is cycled until the issue is corrected Additionally if the device is powered off a reminder message will immediately appear when the device is turned on again AC Power Disconnected Alarm This is a medium priority alarm It occurs when the AC power source was lost and the device has switched to an alternate power source either a detachable or external battery if connected or the internal battery if no other source is available The device continues to operate If AC power returns the ventilator will beep but no message will appear on the display Keypad Stuck Alarm This is a low priority alarm It occurs when a key becomes lodged inside the case of the device Battery Discharging Stopped due to Temperature Info Message This info message occurs when the detachable or internal battery becomes overheated while providing power for the device
85. entilation therapy mode PC SIMV mode delivers Spontaneous Assisted and Mandatory breaths This is a Pressure Control mode Peak Flow Maximum flow rate in liters per minute reached during a breath Peak Inspiratory Highest pressure reached during inspiration Pressure PIP Chapter 12 Glossary 158 PEEP Pressure Control Ventilation PCV PS Ramp Rise Time RR SD Card Sigh SIMV Sleep State Spontaneous Breath Term Acronym Definition Positive End Expiratory Pressure Ventilation in which breaths are controlled by operator defined Pressure Inspiratory Time and Rise Time Pressure Support A feature that may increase patient comfort when therapy is started The ramp feature reduces pressure and then gradually increases the pressure to the prescription setting so patients can fall asleep more comfortably The Rise Time is the time it takes the ventilator to change from expiration to inspiration Respiratory Rate the number of breaths per minute Secure Digital card This card records usage and therapy data from the device A breath that is delivered every 100 mandatory or assisted breaths at 150 of the normal volume Synchronous Intermittent Mandatory Ventilation therapy mode SIMV mode delivers Spontaneous Assisted and Mandatory breaths with a user defined inspired tidal volume This is a Volume Control mode A low power state entered when the ventilator is runnin
86. equal to this setting You can choose Off to disable this alarm or you can increase or decrease the setting from 4 BPM to 80 BPM in 1 BPM increments It cannot be set higher than the High Respiratory Rate High Respiratory Rate This setting enables or disables the High Respiratory Rate alarm The alarm activates when the measured respiratory rate reaches or exceeds this setting You can choose Off to disable this alarm or you can increase or decrease the setting from 4 BPM to 80 BPM in 1 BPM increments It cannot be set lower than the Low Respiratory Rate except to be turned off Chapter 5 Viewing and Changing Settings 78 Low Inspiratory Pressure This setting configures the Low Inspiratory Pressure alarm It is only user settable in CV AC and SIMV modes It cannot be set lower than PEEP 2 cm HO or higher than the High Inspiratory Pressure For passive circuits you can increase or decrease the Low Inspiratory Pressure from 6 to 40 cm H O in increments of 1 cm H O For active circuits you can increase or decrease the setting from 2 to 40 cm H O in increments of 1 cm H O For pressure modes this alarm is not user settable High Inspiratory Pressure This setting enables or disables the High Inspiratory Pressure alarm It is only user settable in CV AC and SIMV modes The High Inspiratory Pressure cannot be set lower than the Low Inspiratory Pressure You can increase or decrease the High Inspiratory Pressure from 10 to 80 cm H
87. er Press Alarm Indicator Oxygen High Internal to operate Audio Pause button to Oxygen message when internal silence alarm Or press Left oxygen Reset button to reset alarm concentration Disconnect supplemental reaches oxygen supply from the 596 above ventilator and contact your ambient health care professional levels Clinician Disconnect supplemental oxygen from device Check external oxygen connection If problem continues have device serviced Circuit Red flashing button Operates User Press Alarm Indicator Disconnect Circuit Disconnect Audio Pause button to message silence alarm Or press Left Reset button to reset alarm Check breathing circuit and reconnect it if it has become disconnected or fix the leak If alarm continues to occur contact your health care professional If device will not exit circuit disconnect switch to an alternate source of ventilation Clinician Reconnect tubing or fix leak If alarm continues have device serviced Red flashing button Operates User Press Alarm Indicator Apnea message Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If using an Active PAP or Active Flow circuit check proximal pressure line to ensure it is not pinched or has water condensation refer to the Troubleshooting section tubing condensation If alarm continues contact your health care professional Clinician Verify patient
88. er 13 EMC Information c M Trilogy200 clinical manual Trilogy200 clinical manual 1 Introduction This chapter provides an overview of the Trilogy200 device Package Contents The Trilogy200 system may include the following components Some components are optional accessories that may not be packaged with the device Package Contents wma A SG Disposable Active Circuit No Water Trap m Y Disposable Passive Circuit No Water Trap gt G S ftn NN RS H Secure Digital e SD Card Q pre installed ZEEE uj Battery Flexible Tubing Flexible Trach Adapter Not Shown Universal Porting Block b d Exhalation Vah pre installed iy e O Inl ue Line pre assembled nlet Quick Connects N AC Power Cord ey to AED qo Proximal ty Pressure Line R x pre assembled Whisper Swivel II to AED Active Exhalation Device AED Chapter 1 Introduction Intended Use The Philips Respironics Trilogy200 system provides continuous or intermittent ventilatory support for the care of individuals who require mechanical ventilation Trilogy200 is intended for pediatric through adult patients weighing at least 5 kg 11 Ibs The device is intended to be used in home institution hospital and portable applications such as wheelchairs and gurneys a
89. es of battery run time remains High Temperature Alarm This alarm occurs when the estimated patient airstream temperature or the ventilator internal temperature is too high The alarm occurs in several stages The ventilator continues to operate Internal fans are started when the medium priority alarm is generated If the condition causing the high temperature is not corrected and the temperature continues to rise the alarm will escalate to the high priority alarm Replace Detachable Battery Alarm The Replace Detachable Battery alarm occurs when the detachable battery is nearing the end of its useful life or a failure in the detachable battery that prevents it from charging or discharging has been detected The alarm occurs in several stages from low to high priority The device continues to operate when the alarm is the low priority alarm If the alarm is reset without removing the battery the alarm will be regenerated once every hour until the detachable battery is removed The device continues to operate the detachable battery is not used and the power source is switched to the next available power source if the alarm is the high priority alarm Ventilator Service Recommended Alarm This is a medium priority alarm It occurs when the device has detected an error but the error will not affect device performance or safety The device continues to operate Therapy and safety are not compromised Trilogy200 clinical manual Imm
90. eset button to reset alarm Check the keys to determine if they are lodged in the case If alarm continues place patient on alternate source of ventilation and contact your health care professional Clinician Check keys to determine if they are lodged in the case If alarm continues place patient on alternate source of ventilation and have device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Move device to a cooler location Make sure device is not close to a heat source Make sure cooling vents are not blocked If alarm is detected for internal battery and continues place patient on alternate source of ventilation and contact your health care professional Clinician If alarm is detected on the internal battery and continues after the measures above have been taken place patient on alternate source of ventilation and have device serviced Priority Audible Visual Alarm Device User Clinician Action Battery Not Info Charging Due to Temperature Indicator Button Action and Display Batt Not Charging Operates User Press Alarm Indicator Temp message Audio Pause button to silence alarm Or press Left Reset button to reset alarm Make sure device is not close to a heat source Make sure cooling vents are not blocked Move device to a cooler location If device is too cold allow it to warm up If alarm continues plac
91. essional might use this feature if for instance you need one prescription for daytime use and a second different prescription for nighttime use 1 Usethe Up Down Navigate button to highlight the Switch to Primary or Secondary Settings option 2 Pressthe Right Select button A screen appears with a confirmation message saying Switch to Primary Settings or Switch to Secondary Settings depending on which prescription you are changing to 3 Pressthe Right Yes button to switch to the new prescription If you decide not to change the prescription press the Left No button The display returns to the Main Menu after you ve made your selection 95 Note The Options Alarm Log and Information items are discussed in detail earlier in this chapter in the Changing and Viewing Settings in Full Menu Access Mode section Note If you are currently using the primary prescription the menu option will say Switch to Secondary Settings If you are currently using the secondary prescription the option will say Switch to Primary Settings Chapter 5 Viewing and Changing Settings 96 Viewing and Changing My Settings Menu Items To view or change the therapy settings available on the My Settings screen use the Up Down Navigate button to highlight the My Settings option on the Main Menu and press the Right Select button The My Settings Menu screen appears Follow the general instructions below to navig
92. f Contents FOR CLINICIAN S USE ONLY Accessing Prescription Setting Screens sss i Chapter T Mtr AU Ctl OMe sssesctecsccsesaccvdsssssscsacncestseusennscssnstesnestnscadeacaedaadcazicavacteascsssstsandetosacsodstansdesasessvseseseatostseas 1 Package Contents snoren nunan aa 1 intended iUc 2 Warnings and Cautions eese titer notet tt i iaeiiai 3 Elis M 3 CALNE NDS ue setenta A E leri Ene DR POSER ERE ose oO EER EY 8 NOTES 10 Contraindicatioris cerent erint tette a sertis rore 11 Suc M 11 vanne Y 12 a xcidpt 12 Rear and Side Panels esterne nnne ntt nnt ttnnnnnts 12 How to Contact Philips Respironics eese tentent tnnt tnnntttsnts 13 Chapter 2 System Descriptio Msisi cette erre R RO RG RRs 15 Froint Panel Fat lc e neiaa Oa 15 bord N 15 Visual ItidiCators toto Ine nant PIRE tnpto a ne 16 Display SCKO GM aaisan ELS 16 Side and Rear Panel Features eerte nnt nnt ntt tttnnnnts 17 Table of Contents Chapter 3 Modes Features and Alarims cscsssssecssssssessessssesssssssessesssscssssssessesssscssssssessessseessessssesseesseeesees 19 Therapy MOGGS ein e 19 Breath Eyp6es s sion
93. f the device for a few seconds Restart the device by pressing the Start Stop button If the problem continues relocate the device to an area with lower EMI emissions e g away from electronic equipment such as cellular phones cordless phones computers TVs electronic games hair dryers etc Refer to Chapter 13 If the problem still occurs contact an authorized service representative or Philips Respironics to have the device serviced Please have the model number and serial number ready when you call Excessive Warm Air Out of Mask The air out of the mask is much warmer than usual Mask Discomfort The mask feels uncomfortable to wear there is significant air leakage around the mask or the patient experiences other mask related issues Runny Nose The patient has a runny nose Why It Happened The air filter may be dirty Or the device may be operating in direct sunlight or near a heater This could be due to improper headgear adjustment or improper mask fitting This may be caused by a nasal reaction to the airflow This only applies to non invasive therapy and will not occur during invasive therapy 131 What To Do Clean or replace the air filter as described in Chapter 7 The temperature of the air may vary based on the room temperature Make sure the device is properly ventilated Keep it away from bedding or curtains that could block the flow of air around the device Make sure
94. feature Opening the SD Card Door Chapter 9 Accessories 136 2 Pushthe SD card completely into the card slot until the card Note The SD card does not clicks into place need to be installed for the device to work properly Inserting the SD Card Note Use only SD cards available from Philips To remove the SD card select the Safely Remove SD Card option Respironics or the type listed in from the main menu After the Remove SD Card confirmation the v MT section ofthis manual message appears remove the card by pushing the card in until the card clicks to release The card will be slightly ejected from the device Using the Philips Respironics DirectView Software You can use the Philips Respironics DirectView software to download the prescription data from the SD card to a computer DirectView can be used by clinicians to receive and report stored data from the SD card DirectView does not perform any automatic scoring or diagnosing of a patient s therapy data Note Remote prescription changes are not permitted Using the Optional In Use Bag An optional in use bag is included for use with the ventilator The in use bag is required for portable use in order to properly secure the ventilator See the instructions included with the in use bag for details on how to use the bag with your device Trilogy200 clinical manual 137 Traveling with the System When traveling the carrying case is
95. flashing 6 Verify the Low Inspiratory Pressure Alarm This procedure verifies that the Low Inspiratory Pressure alarm is working properly It assumes that you have attached the test lung verified ventilator settings and turned on ventilator power as described in the Initial Setup section Trilogy200 clinical manual 147 A Change Ventilator Settings Modify the ventilator settings and change the following values shown below in Table 13 Setting Value Moe o Low Inspiratory Pressure 40 cm H O P High Inspiratory Pressure 60 cm H O 9 Table 13 Ventilator Settings Mm jet B Verify the Alarm Wait up to 40 seconds and verify the following alarm signals e The High Priority audible indicator sounds A red light flashes on the Alarm Indicator Audio Pause button e The Low Inspiratory Pressure alarm condition appears on the screen highlighted in red C Modify Ventilator Alarm Settings Modify the Low Inspiratory Pressure setting to match the one shown below in Table 14 Setting Value Table 14 Modify Low Setting Chapter 10 System Checkout Procedures 148 D Verify Reset Wait 40 seconds and verify the following auto reset conditions TheHigh Priority audible indicator has stopped sounding The red light on the Alarm Indicator Audio Pause button has stopped flashing Battery Function Verification Make sure the batteries are functioning properly and fully charged before patient use 1
96. for carry on luggage only The carrying case will not protect the system if it is put through checked baggage For your convenience at security stations there is a note on the bottom of the device stating that it is medical equipment and is suitable for airline use It may be helpful to bring this manual along with you to help security personnel understand the device If you are traveling to a country with a line voltage different than the one you are currently using a different power cord or an international plug adaptor may be required to make your power cord compatible with the power outlets of the country to which you are traveling Note The device is not Airline Travel suitable for airline use with any humidifiers or modems installed in the unit The device is suitable for use on airlines when the device is operating from an internal detachable or external battery power source It is not suitable for airline use when operating from AC power or from DC power sourced from the airplane Chapter 9 Accessories 138 Trilogy200 clinical manual Trilogy200 clinical manual 10 System Checkout Procedures This chapter details the test procedures that should be performed by the clinician prior to connecting the device to the patient Test the Active PAP Active Flow and Passive circuit types if you want to doa Note The actual circuit complete checkout on the device The tests should be performedas 2 iguration to be used
97. for invasive therapy or if the ventilator may be used on multiple patients Connecting the Breathing Circuit to the Device Note The device can be used with reusable or disposable circuits For detailed instructions on how to set up your device using a disposable circuit refer to the instructions included with the disposable circuit Connecting the Passive Exhalation Device Note The device does not provide circuit compliance compensation in volume modes Chapter 4 Ventilator Setup 58 b If your circuit type is Active PAP Active Exhalation Device with Proximal Pressure Note Passive circuit ventilation provides leak compensation in both volume and pressure modes Active PAP circuit ventilation does not provide leak compensation Particular care should be used at low tidal volumes to ensure adequate monitoring of exhaled tidal volume AX WARNING For ventilator dependent patients always have alternate 1 Connect the flexible tubing to an active exhalation device with proximal pressure A Connect the active exhalation device with proximal pressure to the flexible tubing that attaches to the ventilator and to the patient interface e g the tracheostomy tube 2 Connect the proximal pressure line and the exhalation valve line to the active exhalation device with proximal pressure and the Universal Porting Block on the device as described below A Attach the proximal pressure l
98. formation on alarms Loss of Power Alarm This is a high priority alarm It may occur when a complete power failure has occurred and power was lost while the device was providing therapy This may happen if the internal battery was the only power source in use and was completely depleted Ventilator Inoperative Alarm This is a high priority alarm It occurs when the ventilator detects an internal error or a condition that may affect therapy The device will shut down if the cause of the failure indicates that the device cannot deliver therapy safely If the device can deliver therapy at a limited level the device will continue to deliver limited therapy Ventilator Service Required Alarm This is a high priority alarm It occurs when the device cannot perform to specification a backup safety feature is compromised or the delivery of therapy is compromised The device continues to operate possibly in a reduced capacity mode If the problem is not corrected the device will generate a reminder message once per hour until the issue is corrected Additionally if therapy is stopped a reminder message will immediately appear when therapy is turned on again Chapter 3 Modes Features and Alarms 42 Check Circuit Alarm This is a high priority alarm It occurs when the device detects a problem with the patient circuit such as pinched or detached tubing water condensation in the proximal pressure lines or problems with the active e
99. g ae Hours You will need to record both the date and hours on the blank label to maximize your in service interval Record the service date as 24 months from the date first placed on a patient Record the hours as 10 000 hours for initial usage Use the device blower hours to determine when service is required The device blower hours are listed in the device software in the information menu Trilogy200 clinical manual Installing a New Bacteria Filter Preventive Maintenance Sticker 127 The following table provides information on recommended periodic maintenance for your device Time Hours of Service Recommended Maintenance Prior to initial use on a patient Charge Internal and Detachable Batteries to 10096 capacity by plugging ventilator into an AC power source for up to 8 hours Perform System Checkout Procedure in Chapter 10 Prior to long term storage after Charge both Internal and Detachable batteries to initial use 10096 capacity prior to storage While in storage after initial Recharge internal and detachable batteries to connection to AC Power every 3 10096 capacity by plugging ventilator into an AC months power source Batteries should recharge in 8 hours or less If in use every two weeks nspect and clean air inlet filter If in use every 6 months Replace air inlet filter Inspect enclosures and external connections for damage and contact Philips Respironics serv
100. g on the internal or detachable battery and the blower has been off for five minutes This state preserves battery power The device is restored by plugging the unit into AC power inserting an SD card or by pressing the Start Stop button Breath type in which the breath is patient triggered Trilogy200 clinical manual 159 Term Acronym Definition Spontaneous S Mode Spontaneous Timed S T Mode Tidal Volume Timed T Mode Volume Control Ventilation VCV Vte Vti Therapy mode in which all breaths are spontaneous The ventilator supports breathing with user defined Pressure Support PS and Rise Time values Therapy mode that is similar to S mode except that it can also deliver a mandatory breath if the patient does not spontaneously breathe within a set time The amount of air passing in and out of the lungs for each breath Timed pressure support therapy mode In Timed mode all breaths delivered are mandatory Ventilation in which breaths are controlled by an operator defined volume flow pattern breath rate and inspiratory time Exhaled Tidal Volume Inhaled Tidal Volume Chapter 12 Glossary 160 Trilogy200 clinical manual Trilogy200 clinical manual 13 EMC Information Guidance and Manufacturer s Declaration Electromagnetic Emissions This device is intended for use in the electromagnetic environment specified below The user of this device should make sur
101. ger the Flow Trigger Sensitivity setting displays You can increase or decrease the setting from 1 to 9 l min in 1 l min increments The flow trigger initiates when the patient s inspiratory effort creates a flow equal to or greater than the flow sensitivity setting Leak Compensation If you are using an Active Flow circuit you can turn Leak Compensation On or Off Flow Cycle Sensitivity If you set the Trigger Type to Flow Trigger the Flow Cycle Sensitivity setting displays You can increase or decrease the setting from 10 to 90 percent 96 in 196 increments As flow begins to decrease during inspiration if the patient flow is less than the flow cycle set point the device will cycle to expiration For example if the flow cycle is set to 7596 when the flow has decreased by 2596 of the peak flow the device will cycle to the EPAP PEEP level Ramp Length The Ramp Length allows you to set the ramp time You can disable Ramp by selecting Off or you can increase or decrease the Ramp Length setting from 5 to 45 minutes in 5 minute increments 79 Note Auto Trak is only available if the Passive Circuit is selected Note Flow Trigger with leak compensation is only available if the Active Flow circuit is selected Note Enabling Leak Compensation when using the Active Flow Circuit configuration only affects triggering and does not affect tidal volume delivery or Vte measurement Note A flow cycle sensitivi
102. gnal from the actual patient flow by 15 l min and delaying it for a 300 msec period This intentional delay causes the shape signal to be slightly behind the patient s flow rate Chapter 3 Modes Features and Alarms 38 A sudden change in patient flow will cross the shape signal causing the pressure level to change IPAP Pressure EPAP Cycle to EPAP Shape Signal Flow Estimated Patient Flow Trigger to IPAP Crossover Point Shape Signal Tracking the patient s flow pattern with the Shape Signal provides a sensitive mechanism to trigger to inspiration or cycle to expiration in response to changing breathing patterns and circuit leaks Trilogy200 clinical manual 39 Spontaneous Expiratory Threshold Inspiration to Expiration A second method used to cycle to expiration during spontaneous breathing in all modes except T CV AC and SIMV is called Spontaneous Expiratory Threshold SET The SET rises in proportion to the inspiratory flow rate on each breath When the SET and actual patient flow value are equal the unit cycles to expiration IPAP Pressure EPAP Spontaneous Expiratory 4 Threshold Flow Spontaneous Expiratory Threshold Flow Reversal Inspiration to Expiration As flow begins to decrease during inspiration a flow reversal can occur due to a large leak around the mask or because the patient s mouth is open When the device senses this flow reversal it aut
103. her cm H O hPa or mBar The default setting is cm H O so this manual uses cm H O throughout Main Menu Screen with Dual Prescription Enabled Chapter 5 Viewing and Changing Settings 74 Mode Setting You can change the Mode setting on the Settings and Alarms screen to one of the following therapy modes e CPAP e S e S T e T e PC e PC SIMV e CV e AC e SIMV Circuit Type There are three circuit types you can select e Passive Active PAP e Active Flow The Passive circuit type uses the Whisper Swivel II passive exhalation device The Active PAP circuit type uses an active exhalation device with a proximal air pressure sensing connection The Active Flow circuit type uses an active exhalation device with a proximal flow sensor When using the Passive circuit the ventilator displays estimated patient pressures based on the resistance of the standard patient circuit Whisper Swivel II with 1 8 meter tubing Adding accessories to the patient circuit humidifier water trap etc may cause an increase in circuit resistance and cause the device to display slightly higher pressures than what is actually delivered to the patient With the Active PAP or Active Flow circuit type selected patient pressure is measured directly and is not affected by any change in circuit resistance Trilogy200 clinical manual Note See Chapter 3 for detailed information about each therapy mode Note Refer to the chart in
104. hoose Off to disable this alarm or you can increase or decrease the setting from 40 ml to 2000 ml in 5 ml increments It cannot be set lower than the Low Vti setting except to be turned off Trilogy200 clinical manual Note The High and Low Vte alarms are available when the Passive or Active Flow Circuit is selected Note The High and Low Vti alarms are only available when the Active PAP Circuit is selected 77 Low Minute Ventilation Note You can increase or decrease the Low Minute Ventilation setting in equal to this setting You can choose Off to disable this alarm or you 0 1 l min increments from can increase or decrease the setting from 0 1 l min to 99 l min 0 1 to 0 99 l min and 1 l min increments from 1 to 99 l min This setting enables or disables the Low Minute Ventilation alarm The alarm activates when the calculated minute ventilation is less than or High Minute Ventilation This setting enables or disables the High Minute Ventilation alarm The alarm activates when the calculated minute ventilation reaches or exceeds this setting You can choose Off to disable this alarm or you can increase or decrease the setting from 1 l min to 99 l min in 1 l min increments It cannot be set lower than the Low Minute Ventilation setting except to be turned off Low Respiratory Rate This setting enables or disables the Low Respiratory Rate alarm The alarm activates when the measured respiratory rate is less than or
105. ice It is recommended that you clean 4 Wash the gray foam filter in warm water with a mild detergent the filter in the morning and Rinse thoroughly to remove all detergent residue Allow the filter SEINE Md me tworami Td filters provided with the system to air dry completely before reinstalling it If the foam filter is torn to ensure sufficient drying time or damaged replace it Only Philips Respironics supplied filters for the cleaned filter should be used as replacement filters 3 Examine the filter for cleanliness and integrity 5 Reinstall the filter as shown below Reinstalling the Filter Trilogy200 clinical manual 123 Replacing the Air Inlet Path Foam Follow your institution s protocol for how often you replace the air inlet path foam To replace the foam complete the steps below 1 Using a screwdriver remove the air inlet path cover by unscrewing the four screws as shown below Air Inlet Path Cover Remove 4 screws with Screwdriver a Removing the Air Inlet Path Cover 2 Remove the gray foam air inlet path by hand The removed air inlet path is shown below Air Inlet Path Compartment
106. ice if necessary Inspect power cord for damage and replace if necessary Every 10 000 hours or 2 Years Perform performance verification test per Trilogy whichever comes first Service Manual by Philips Respironics trained service technician Every 17 500 hours Replace the Motor Blower Assembly by Philips Respironics trained service technician Perform full calibration and verification by Philips Respironics trained service technician Refer to the Trilogy Service Manual for additional information Chapter 7 Cleaning and Maintenance 128 Trilogy200 clinical manual Trilogy200 clinical manual 8 Troubleshooting The ventilator is designed to respond to most issues with an appropriate alarm or information message These messages appear on the display screen Chapter 6 describes many of the alarms and what action you should take when the alarms occur This chapter provides additional troubleshooting information for other common issues you may have Why It Happened Device does not turn on The AC power cord is not Nothing happens when you plugged in and the internal press Start Stop to begin battery is not charged therapy The audible indicator Note The device requires AC does not sound and the power to charge the internal backlights on the buttons do battery when a new device is not light powered up for the first time What To Do Plug the AC power cord into the device and a wall outlet
107. ilogy200 clinical manual Note The options on the My Settings screen will vary depending on how your health care professional has set up your device Note For some therapy settings once you reach the highest or lowest setting available pressing the Up Down button again will cycle back through the settings For the parameters that do not wrap when you reach the highest or lowest setting possible a Limit Reached message appears in the Menu Banner on screen Note After you select OK to save the new setting the next setting in the list is automatically highlighted Note If some features or settings are not enabled on your ventilator they will not appear on your My Settings screen For instance if Ramp is not enabled the Ramp Start Pressure setting does not appear on the screen If your health care professional has enabled Ramp on your ventilator you can adjust the Ramp Start Pressure setting The setting can be adjusted from 4 0 to your prescription pressure setting in increments of 1 Flex The optional Flex feature allows you to adjust the level of air pressure you feel when you exhale during therapy If this feature is enabled by your health care professional you can adjust the setting from 1 to 3 97 Note If the Flex feature is enabled the Rise Time setting will not appear on your My Settings screen and cannot be adjusted When Flex is enabled the Rise Time is fixed at a setting of 3 Note Whe
108. in Limited Menu Access Mode 94 Activating Your Primary or Secondary Prescription sss 95 Viewing and Changing My Settings Menu Items es 96 Connecting the Ventilator to the Patient entente 98 Chapter 6 Ventilator Alakms iscsicsssssscsssiestssssesscsvssssctecassseceustsosssencencaiscinavlcovdctassedivanssavechestustuss arebadesanstdbussatenrt 99 Audible and Visual Alarm Indicators eerte 100 Audio Pause and Alarm Reset Features eene 105 What to Do When An Alarm Occurs eerte ttn nnnttnnnnttnnnns 106 Alarm Summary Table eese tenente rnnt nennen ttt nontttenntittnnns 107 Chapter 7 Cleaning and Maintenance csssccssscccsesccssseccnseeccsnssecsnsescessesessnseecessescesnseecsnsscenseescnnseeseaee 121 Cleaning the Ventilator ssssscccsessecsssseccneccsnseecsnsscesseecsnseecesseccsnseecsnsescenseecunseesens 121 Cleaning and Replacing the Air Inlet Filter en 122 Replacing the Air Inlet Path Foam eerte nnt ntt ttnnnnnes Cleaning the Patient Circuit eerte ttennnnttnnnnttnnnttnnnnttnnnns Cleaning Instructions Reusable Circuits Preventive MaiMteMAa Ne sissssssssscasssessussiecrsctsenssssssessesonssiussonsssevsnsssssasisesiverssedeesenstaaneess 126 Chapter 8 Troubleshooting a Chapter 9 Accessories ertet eetestec etel eines a a eec ee
109. ine 476 cm or 3 16 line to the proximal pressure port as shown in the next illustration If not attached connect the other end of the proximal pressure line to the Trilogy Universal Active PAP Tube Adapter as shown in the next illustration Connect the Trilogy Universal Active PAP Tube Adapter to the top striped port on the Universal Porting Block on the ventilator Connect the exhalation valve line 317 cm or 1 8 line to the exhalation valve port on the top of the active exhalation device with proximal pressure Connect the other end of the exhalation valve line to the exhalation valve port on the Universal Porting Block Trilogy200 clinical manual ventilation equipment such as a back up ventilator manual resuscitator or similar device available Note Make sure that components marked with an arrow are oriented properly When attaching an active exhalation device with proximal pressure to the patient make sure the proximal pressure port faces away from the patient Note The kie symbol appears next to the Exhalation Valve port on the Universal Porting Block to indicate where the active exhalation valve line connects Proximal Pressure Exhalation Valve Port Line Proximal Pressure Port Exhalation Valve Line Refer to the instructions included with the Active Exhalation Device for more information Universal Porting Block Trilogy Universal Active PAP Tube Adapter P Exhalat
110. ing the Active Flow Circuit configuration flow trigger with leak compensation may be enabled The default setting when using Note EnablingLeak the Active Flow Circuit is Leak Compensation On The clinician has Compensation wanen dang me i Active Flow Circuit configuration the option to turn off leak compensation however unintentional only affects triggering and does leak will not be compensated Both options measure the flowatthe not affect tidal volume delivery proximal flow sensor or Vte measurement Flow Cycle Sensitivity Inspiration to Expiration This cycling method is only active if the Flow Trigger has been selected for the Trigger Type As flow begins to decrease during inspiration if the patient flow is less than the flow cycle sensitivity setting the device will cycle to expiration For example if the flow cycle sensitivity setting is set to 75 when the flow has decreased by 25 of the peak flow the device will cycle to the EPAP PEEP level Trilogy200 clinical manual 41 BTPS Compensation All flows and volumes used in Trilogy are expressed in BTPS Body Temperature atmospheric Pressure Saturated with H O All pressures are expressed relative to atmospheric pressure Ventilator Alarms This section describes all of the ventilator alarms and informational messages in order of priority from high priority alarms to low priority alarms and finally informational messages Refer to Chapter 6 for more in
111. ing you are now in Full Menu Access mode When you perform this key sequence when the airflow is off the Setup screen appears and an audible indicator sounds You can go into the Options menu and permanently change the Menu Access setting to Full Menu Access Otherwise the device will return to the Menu Access mode stored in the setting once you exit the menu screens or if one minute passes without pressing any device buttons If you are in the Setup mode and an SD card is in the device Write Event Log to SD Card will appear in the menu Note The Full Menu Access key sequence can be performed either from the Power Off screen or from the Monitor screen Note When the airflow is off and AC power is removed from the device for more than 5 minutes the device will enter a low power mode to save battery life When the device is in low power mode the Setup key sequence will be ignored Press the Start Stop button or connect AC power or insert an SD card to exit the low power mode Note Philips Respironics recommends that after you are finished changing prescription settings and you give the device to the patient you set the device back to Limited Menu Access mode so patients cannot change their prescription settings Respironics Inc 1054728 1001 Murry Ridge Lane Murrysville PA 15668 USA 1072919 JH 6 7 10 2010 Koninklijke Philips Electronics N V All rights reserved Trilogy200 clinical manual Table o
112. ings are correct Note If both prescriptions of a dudl prescription are being updated you must accept the primary prescription using the OK button before being able to review the secondary prescription Both prescriptions have to be accepted before any changes are made Message Prescription Change Failed Prescription Failed Circuit Type Prescription Failed Card is Read Only Prescription Failed Serial Number Prescription Failed Version Displayed when an error occurs during the prescription update This is caused by an attempt to set a value for a prescription parameter that is not valid for the therapy mode or an attempt to set a prescription parameter to an invalid value Displayed when the circuit type in the new prescription doesn t match the circuit type set for the ventilator Displayed when the prescription is write protected Displayed when the device serial number on the new prescription does not match the serial number for the device Displayed when the version of the prescription does not match the version accepted by the device 93 Remove the card and have the prescription replaced with a valid prescription If the circuit type in the prescription is correct remove the card change the circuit type on the ventilator and re insert the card If the circuit type on the ventilator is correct remove the card and replace the prescription on the card with a prescription
113. ion Valve Port on Universal Porting Block If your circuit type is Active Flow 1 Connect the Flow Sensor to an active exhalation device as shown below Flow Sensor 2 Connect the other end of the flexible tubing to the active exhalation device A Connectthe active exhalation device to the flexible tubing that attaches to the ventilator B Connect the flow sensor to the patient interface e g the tracheostomy tube 59 Connecting an Active Device with Proximal Pressure Connecting the Flow Sensor Note If the active exhalation device has the proximal pressure line connected when you are setting up an active flow circuit type remove the proximal pressure line and cap the proximal pressure port before attaching to the flexible tubing Note Make sure that components marked with an arrow are oriented properly Chapter 4 Ventilator Setup 60 C Connectthe flow lines and the exhalation valve line to the Universal Porting Block on the ventilator as shown below Connect the White Striped Flow Line to the top striped port on the Universal Porting Block on the device e Connect the other Flow Line to the middle port on the Universal porting Block Connectthe Exhalation Valve Line to the Exhalation Valve port on the top of the active exhalation device and connect the other end of the line to the Exhalation Valve port on the Universal Porting
114. ions for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the device is used exceeds the applicable RF compliance level above the device should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as re orienting or relocating the device Over the frequency range 150 kHz to 80 MHz the field strengths should be less than 3 V m Chapter 13 EMC Information 164 Recommended Separation Distances between Portable and Mobile RF Communications Equipment and This Device The device is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled The customer or the user of this device can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and this device as recommended below according to the maximum output power of the communications equipment Rated Maximum Separation Distance According to Frequency of Transmitter Power Output of MAGRI Transmitter 150 kHz to 80 MHz 150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2 5 GHz Watts outside ISM Bands in ISM B
115. is option will appear if an SD card is inserted in the ventilator Select this option when you want to remove the SD card When the Remove SD Card confirmation message appears remove the card If you press the left cancel button or don t remove the card within 30 seconds the confirmation message will close and the ventilator will continue writing to the card Settings and Alarms View and change prescription settings and alarms Options View and change device settings such as Full or Limited Access mode Detailed View Language etc Alarm Log View a list of the 20 most recent alarms that have occurred e Event Log View a list of all events that have occurred such as ventilator setting changes ventilator inoperative conditions alarms etc Information View detailed information about the device such as the device s software version and serial number Trilogy200 clinical manual Note For some therapy settings once you reach the highest or lowest setting available pressing the Up Down button again will cycle back through the settings For the parameters that do not wrap when you reach the highest or lowest setting possible a Limit Reached message appears in the Menu Banner on screen Main Menu Screen Example Note In the example Main Menu screen shown the 2 6 that appears in the Menu banner indicates that item 2 is highlighted from a total of 6 items in the menu Note Ifyou change a setti
116. it is away from direct sunlight and heating equipment Ensure the cooling air vents are not blocked If the problem continues contact an authorized service representative or Philips Respironics to have the device serviced Please have the model number and serial number ready when you call Make sure the patient is properly fitted with the correct size mask If the problem continues try fitting the patient with a different mask Call the patient s health care professional Chapter 8 Troubleshooting 132 Dryness The patient has throat or nose dryness Sinus or Ear Pain The patient experiences nasal sinus or ear pain Patient Tubing Condensation There is condensation in the circuit tubing or exhalation valve lines Exhalation Valve or Flow Tube Condensation Active Flow Circuit only There is condensation in the proximal flow or exhalation valve lines and the condensation is causing the system to alarm or not properly trigger on patient effort Trilogy200 clinical manual Why It Happened The air is too dry This only applies to non invasive therapy and will not occur during invasive therapy The patient may have a sinus or middle ear infection This only applies to non invasive therapy and will not occur during invasive therapy Moisture added to the circuit from a heated humidifier may condense This condensation is typically referred to as rain out Excessive humidity from the heat
117. ity Audible Indicator When a low priority alarm is detected a series of beeps sound in a 2 beep pattern This pattern repeats until the cause of the alarm is corrected or the audible alarm is paused The alarm descriptions later in this chapter display this indicator as Chapter 6 Ventilator Alarms 102 Informational Messages and Confirmation Audible Indicators When an informational message appears on screen a brief 1 beep audible indicator sounds Additionally when the device detects that a certain action has been completed for example when the Start Stop button is pressed to start therapy or when an SD card is inserted or removed from the device a brief 1 beep audible indicator sounds The alarm descriptions later in this chapter display this indicator as Alarm Messages When the ventilator detects an alarm the Alarms and Messages Screen is displayed showing a description of the alarm condition When an alarm message appears it will be highlighted in red if it ae EM lx also display in the Menu Banner is a high priority alarm or in yellow if it is a medium or low priority Famenuisacivewhenan alarm The highlight color matches the alarm LED color on the Alarm alarm occurs Indicator Audio Pause button If an alarm is manually reset by the user the Alarms and Messages screen is removed and the Monitoring Screen is re displayed If the alarm self cancels the Alarms and Messages screen remains displayed
118. ity thresholds to ensure optimum sensitivity as breathing patterns change or as circuit leaks change The algorithms used to ensure optimum sensitivity are the Volume Trigger Shape Signal Spontaneous Expiratory Threshold SET Flow Reversal Maximum IPAP Time and Volume Control Cycle Volume Trigger Expiration to Inspiration The volume trigger is one method used to trigger inspiration during spontaneous breathing in all modes except T and CV The volume trigger threshold is 6 ml of accumulated patient inspiratory volume When patient effort generates inspiratory flow causing 6 ml of volume inspiration is triggered Shape Trigger Shape Cycle Expiration to Inspiration Inspiration to Expiration The shape trigger cycle is another method used to trigger inspiration and or cycle from inspiration to expiration during spontaneous breathing in all modes except T and CV This method continuously tracks patient inspiratory and expiratory flow and adjusts the spontaneous trigger and cycle thresholds for optimum sensitivity The Shape Signal appears as a shadow image of the patient s actual flow The shape signal functions as a sensitivity threshold at either inspiration or expiration When the patient s flow rate crosses the shape signal the unit changes pressure levels The following figure illustrates how the shape signal is super imposed onto the actual waveform to trigger and cycle off IPAP The shape signal is created by offsetting the si
119. l Ee eaae Adding a Humidifier essen teen tenent ttennnntts nnns nottttsnntttnnns 133 Adding Supplemental Oxygen to the Device ee 133 Using a Remote Alarm Unit inei e iieri iiis 134 Using a Nurse Call System eerte ttenottttnnnnte Using a Secure Digital SD Card eese eene tnnt ttnntttnns Using the Philips Respironics DirectView Software Using the Optional In Use Bag eene tte ttnnnnnts Traveling with the System esten teen tenente notte ntes notte nonni 137 Airline Travel zoo ttn tci nat inm ede Raa 137 Table of Contents vi Chapter 10 System Checkout Procedures ssssssssssssccssssecessscsssssecsssscesnseessnseecesssceesnseessnssceesuseessnseeseess 139 IrrlEdenm E 139 Visual ISETer Tap sesscscsssasscscdcaseiadeadasdevenisinssshczscssceancsstenesscas aR RAR 139 MD he STUN AE AREE AA 140 Settings and Alarms TeSts csssecssessccsseecsssesccnssccsnseecsnsnscessseecsnseecensnccesnseessnseeeensesees 140 Battery Function Verification eee esten eee ntes tte notet nnnm 148 Alarm and Event Log Clean Up e eene teennn tenen tttnnnntttnnns 150 irre 150 Chapter 11 Technical Specifications eene teen tentent tton ttts ttt natia tt socis 151 Chapter T2 Glossy CL Chapt
120. lace of every 100th mandatory or assisted breath delivered regardless of the mode of operation i e AC CV and SIMV The Sigh breath is delivered using a volume equal to 15096 of the set volume that was in effect when the breath was initiated FLOW Example of Sigh Feature TIME Dual Prescription Feature The device provides a dual prescription feature that allows you to enter a primary prescription and a secondary prescription for the patient if needed For example you can set a primary daytime prescription and secondary nighttime prescription See Chapter 5 for more information on the dual prescription feature Note Both prescriptions must use the same circuit type Chapter 3 Modes Features and Alarms 36 Triggering The device can be set to trigger breaths using the Auto Trak or Flow Trigger sensitivity features Digital Auto Trak Sensitivity An important characteristic of the device is its ability to recognize and compensate for unintentional leaks in the system and to automatically adjust its trigger and cycle algorithms to maintain optimum performance in the presence of leaks This feature is known as Digital Auto Trak Sensitivity The following sections examine this function in detail by describing the leak tolerance function and sensitivity Leak Tolerance A microprocessor monitors the total flow of the patient circuit and calculates patient flow values A Leak Estimation Average and Parabolic
121. le Sensitivity if Trigger Type is set to Flow Trigger RiseTime In addition to these the following settings are also available in PC SIMV mode Note In PC SIMV mode you cannot set up Pressure Support You can increase or decrease the Pressure setting from 4 to 50 for Mandatory and Assist breaths Pressure PEEP greater cm H O in increments of 1 This is the pressure the ventilator will 4 5 30cm HO deliver during the inspiratory phase of a mandatory or assist breath 1 Pressure Note The Pressure Support and PEEP settings together cannot 2 Pressure Support exceed 50 cm H O You can increase or decrease the Pressure Support setting from 0 to 30 cm HO in increments of 1 This is the pressure support the ventilator will deliver during the inspiratory phase of a Spontaneous breath Chapter 5 Viewing and Changing Settings 84 3 PEEP The Positive End Expiratory Pressure PEEP setting can be increased from 0 to 25 cm H O in active circuits and 4 to 25 cm HO in passive circuits in increments of 1 PEEP is the positive pressure maintained in the patient circuit during exhalation The PEEP must be less than or equal to the pressure setting Control Ventilation CV Mode The following settings described in the previous sections of this chapter are also available in CV mode e Tidal Volume Breath Rate Inspiratory Time e PEEP High Inspiratory Pressure Low Inspiratory Pressure In addition to thes
122. lly terminate when the measured respiratory rate is greater than the Low Respiratory Rate alarm setting High Inspiratory Pressure Alarm This alarm occurs in several stages and escalates from an audible beep for the first two occurrences to a high priority alarm if the problem continues It is detected differently for volume and pressure therapy modes For volume modes the alarm will sound if the measured patient pressure exceeds the High Inspiratory Pressure setting specified by the clinician The alarm will automatically terminate when the peak inspiratory pressure is less than or equal to the High Inspiratory Pressure alarm setting Trilogy200 clinical manual 45 For pressure modes the alarm occurs when the delivered pressure exceeds the target patient pressure by 5 cmH O or more during the inspiratory phase The device will automatically cycle to the expiratory phase and continue to operate The alarm will automatically terminate when the delivered pressure falls within 5 cmH O of the target patient pressure during the inspiratory phase Low Inspiratory Pressure Alarm This is a high priority alarm It is detected differently for volume and pressure therapy modes For volume modes the alarm will sound if the measured patient pressure is less than the Low Inspiratory Pressure setting specified by the clinician The alarm will automatically terminate when the peak pressure at the end of the breath is greater than or equal to the
123. lso describes how to connect the ventilator to the patient once the settings are complete Keypad Lock Feature There is a Keypad Lock feature that users can enable from the Options menu It is intended to prevent accidental changes to device settings This feature will lock the navigation keys Up Down Stop Left and Right keys If the Keypad Lock is enabled a Keypad Unlock message will display on the bottom of the screen any time you press one of the navigation keys If the keypad is locked you must unlock it before you can enter the Menu To unlock the keypad and enter the menu you must first hold the Right button for 5 seconds to unlock the keypad An audible indicator sounds when the keypad is successfully unlocked Once the display is unlocked you can enter the Menu as you normally would by pressing the Up button Note There is a keypad lock inactivity time out period After you have unlocked the keypad as indicated the keypad will re lock after five minutes of inactivity to prevent someone from accidentally pressing a button and changing any of the settings Note When Keypad Lock is enabled the Left Right and Up Down buttons are locked while the ventilator is turned on The Alarm Indicator Audio Pause continues to function normally The Start Stop button is locked only when this button is used to stop therapy Note The keypad will automatically unlock if an alarm or informational message occurs and will rem
124. mal tubing if using the Active PAP or Active Flow Exhalation Device can remain connected to the ventilator Remove the used bacteria filter from the ventilator by gently pulling straight out from the connector Follow the manufacturer s labeling and your institution s infection control guidelines for disposal of the bacteria filter Attach a new bacteria filter The openings on either end of the bacteria filter are different sizes Fit the larger opening onto the gas outlet port on the side of the ventilator as shown 125 AX WARNING Philips Respironics recommends that a main line outlet bacteria filter Part Number 342077 be used whenever the device is used for invasive therapy or if the ventilator may be used on multiple patients Chapter 7 Cleaning and Maintenance 126 4 Connectthe patient circuit Fit the ventilator end of the flexible tubing onto the bacteria filter Breathing Circuit Connection Bacteria Filter Preventive Maintenance Your new Philips Respironics Trilogy ventilator includes a blank PM Service Due label affixed to the bottom of your device The label is blank which allows you to document when service is due Service is due every 10 000 hours or 24 months whichever comes first depending on the usage of the device de Service Date V
125. midifier with the ventilator refer to the instructions provided with the humidifier for complete setup information Adding Supplemental Oxygen to the Device The delivered oxygen concentration varies with changes in flow in the circuit The following may have an impact on oxygen concentration e Pressure settings Patient Tidal Volume e Peak Inspiratory Flow e ERatio Respiratory rate Circuit leak rate Oxygen flow rate To add oxygen to the circuit the oxygen supply must comply with the local regulations for medical oxygen The oxygen flow into the oxygen valve cannot exceed 15 l min and the pressure cannot exceed 50 psi Chapter 9 Accessories 134 Supplemental Oxygen Warnings When administering fixed flow supplemental oxygen the oxygen concentration may not be constant The inspired oxygen concentration will vary depending on the pressures patient flows and circuit leak Substantial leaks may reduce the inspired oxygen concentration to less than the expected value Appropriate patient monitoring should be used as medically indicated such as an alarming pulse oximeter This device DOES NOT alarm for loss of the low flow oxygen supply Oxygen supports combustion Oxygen should not be used while smoking or in the presence of an open flame Do not connect the device to an unregulated or high pressure oxygen source The device may result in incorrect flow and tidal volume measurements and improper ope
126. n AC Assist Control Ventilation e CV Control Ventilation SIMV Synchronized Intermittent Mandatory Ventilation Chapter 3 Modes Features and Alarms 20 Breath Types There are four breath types that apply to the Volume Control and Pressure Control ventilation therapy modes Spontaneous Mandatory Assisted Sigh Spontaneous Breath A Spontaneous breath is triggered by the patient Breaths are initiated by the patient s inhalation effort and air delivery is controlled based on the current pressure or volume setting Breaths are terminated by either the ventilator settings or by the patient s exhalation effort depending on the mode selected Mandatory Breath A Mandatory breath or machine breath is completely controlled by the ventilator The ventilator controls both the beginning triggering and end cycling of the inspiratory phase Assisted Breath An Assisted breath is controlled by both the patient and the ventilator Breaths are initiated by the patient s effort and air delivery is controlled by the current pressure or volume settings Volume Assisted breaths will deliver the prescribed Tidal Volume within the prescribed Inspiratory Time Pressure Assisted breaths will deliver the prescribed Inspiratory Pressure for the prescribed Inspiratory Time Breaths are terminated when the Inspiratory Time setting has been reached Sigh A Sigh breath is a breath where 15096 of the prescribed volume is
127. n adjusting the Flex setting it is recommended that you start with the minimum setting of 1 which provides the least relief Levels 2 and 3 progressively increase the pressure relief Note If you are using an Active PAP circuit the Flex feature is unavailable Note Flex is only available if Auto Trak is enabled Chapter 5 Viewing and Changing Settings 98 Connecting the Ventilator to the Patient After you have finished adjusting your ventilator settings perform the following steps to connect the ventilator to the patient 1 Perform System Checkout Do not connect the ventilator to the patient until you perform the system checkout procedures defined in Chapter 10 2 Start Therapy Press the button to begin therapy When you start therapy the display backlight and the backlights on the buttons turn on the red and yellow alarm LEDs turn on momentarily and an audible indicator sounds to indicate that therapy has started The Startup screen appears on the display 3 Connect the Breathing Circuit to the Patient Interface After you have assembled the system started therapy and adjusted your ventilator settings as needed you can connect the breathing circuit to the patient The illustration below shows the breathing circuit connected to a mask You can also connect the breathing circuit to a tracheostomy tube Trilogy200 clinical manual
128. n and at the start of exhalation The ratio of inspiratory time to expiratory time Inspiratory Positive Airway Pressure Light Emitting Diode Liters Per Minute Trilogy200 clinical manual 157 Term Acronym Definition Mandatory Breath A Mandatory Breath is completely controlled by the ventilator Breaths are initiated by the ventilator according to the breath Rate BPM setting Breaths are cycled according to the Inspiratory time setting MAP Mean Airway Pressure This is the average airway pressure over a full breath cycle The MAP value displayed on the screen represents the average MAP value over six breaths and is updated at the end of each exhalation Minute Ventilation The volume of gas that moves in and out of the lungs in one minute It is calculated by multiplying the tidal volume by the respiratory rate The Minute Ventilation value displayed on the screen represents the average Minute Ventilation over six breaths and is updated at the end of each exhalation Operational Hours This is the total number of hours that the blower has been on since this value was last reset You can reset this value each time you give the device to a new patient to help track their device usage OSA Obstructive Sleep Apnea PC Pressure Control therapy mode PC mode delivers Assisted and Mandatory breaths with a user defined pressure This is a Pressure Control mode PC SIMV Pressure Control Synchronous Intermittent Mandatory V
129. n or accuracy of the device If the device has been exposed to either very hot or very cold temperatures during storage allow it to adjust to ambient temperature before starting therapy The reusable foam inlet filter is required to protect the ventilator from dirt and dust Wash periodically and replace when damaged for proper operation Cooling Air Vents Do not block the cooling air vents located on the base and the rear of the device This may cause the device to overheat in high ambient temperatures or at high therapy settings Battery Life The internal and detachable batteries wear out based on the amount of use hours or full charge discharge cycles The battery capacity and life are also reduced by operation at higher temperatures Detachable Battery Only use the Philips Respironics Trilogy Detachable Battery with the ventilator Cleaning Do not steam autoclave the ventilator Doing so will destroy the ventilator Do not immerse the device in liquid or allow any liquid to enter the enclosure or inlet filter Do not use harsh detergents abrasive cleaners or brushes to clean the ventilator system Use only cleaning agents and methods listed in this manual Chapter 1 Introduction 10 Patient Circuit Exhalation valves patient circuits and water traps are shipped clean not sterile Cleaning and disinfection of these parts should follow individual institution processes and conform to guidelines provided by Philips Respir
130. nd SIMV modes rise time is the amount of time it takes the device to change from the expiratory pressure setting to the inspiratory pressure setting Rise time levels of 1 2 3 4 5 or 6 progressively reflect slowed response of the pressure increase that will take place at the beginning of inspiration Adjust the rise time to find the most comfortable setting for the patient PRESSURE Rise Time T m aE quini penses EPAP Rise Time gt TIME AVAPS Feature Note AVAPS is only available if Average Volume Assured Pressure Support AVAPS is a feature you are using a passive circuit available in the S S T PC and T modes It helps patients maintain a tidal volume V equal to or greater than the target tidal volume PEN Note C Flex Bi Flex and AVAPS Volume setting in the ventilator by automatically controlling the are intended for use by adult pressure support PS provided to the patient The AVAPS feature patients adjusts PS by varying the IPAP level between the minimum IPAP Min and maximum IPAP Max settings AVAPS averages V and changes the PS value gradually This occurs over several minutes The rate of change is slow so that the patient is not aware of breath to breath pressure changes As patient effort decreases AVAPS automatically increases PS to maintain the target tidal volume The IPAP level will not rise above IPAP Max even if the target tidal volume is not reached Conversely as patient effort in
131. nd may be used for both invasive and non invasive ventilation It is not intended to be used as a transport ventilator The system is recommended to be used only with various combinations of Philips Respironics approved patient circuit accessories such as patient interface devices humidifiers water traps and circuit tubing Trilogy200 clinical manual Warnings and Cautions Caution U S federal law restricts this device to sale by or on the order of a physician Warnings A warning indicates the possibility of injury to the user or operator Patient Monitoring Alternative Ventilation Patient Disconnect Protection Prior to placing a patient on the ventilator a clinical assessment should be performed to determine The device alarm settings Needed alternative ventilation equipment If an alternative monitor i e an alarming Pulse Oximeter or Respiratory Monitor should be used For ventilator dependent patients always have alternate ventilation equipment such as a back up ventilator manual resuscitator or similar device available Ventilator dependent patients should be continuously monitored by qualified personnel These personnel should be prepared to provide alternate therapy in the event of ventilator failure or inoperative equipment For ventilator dependent patients do not rely on any single alarm to detect a circuit disconnect condition The Low Tidal Volume Low Minute Ventilation Low Respiratory Rat
132. nect the Breathing Circuit to the Ventilator Complete the following steps to set up your patient circuit 1 If you are using a bacteria filter connect one end of the flexible tubing to the outlet of the bacteria filter and connect the bacteria filter inlet to the breathing circuit connection located on the side of the ventilator If you are not using a bacteria filter connect the tubing directly to the device s breathing circuit connection Trilogy Breathing Circuit Connection Flexible Tubing Bacteria Filter 2 Connectthe other end of the flexible tubing to a separate exhalation device a If your circuit type is Passive and you are using a Philips Respironics Passive Exhalation Device 1 Connect the flexible tubing to the rotating end of the Passive Exhalation Device 2 Connect the other end of the Passive Exhalation Device to the patient interface e g the mask Passive Exhalatiori Device Flexible Tubing Flexible 7 Jj Tubing Whisper Bacteria Filter Swivel II Bacteria Filter Refer to the instructions included with the Passive Exhalation Device for more detailed setup information 57 AX WARNING Philips Respironics recommends that a main line outlet bacteria filter Part Number 342077 be used whenever the device is used
133. ng but decide you do not want to save it you can press the Left button to cancel the change Changing the Device Settings and Alarms From the Main Menu screen use the Up Down button to highlight the Settings and Alarms menu and press the Right button to select the menu Device Settings Common to All Therapy Modes Some of the settings on this menu will vary depending on the therapy mode you select The section below describes all of the settings that are common to all therapy modes Dual Prescription Setting You can turn the dual prescription setting on or off Enable the setting if you want to create two separate prescriptions for the patient For instance you may want to set up a daytime prescription and then a separate nighttime prescription If you enable this setting then the menu options on the Main Menu will change to include three new options Switch to Primary Secondary Settings Primary Settings and Alarms Secondary Settings and Alarms The Main Menu screen will look like the screen below Primary S T 06 11 2008 09 04 PM a 0 5 10 15 20 25 30 RR 20BPM vte 837m Peak Flow 71 6 mi 35 min Minvent 11 7 wi PIP21 0H20 Leak Switch to Secondary Settings Safely Remove SD Card Primary Settings and Alarms Secondary Settings and Alarms w Options Navigate 73 Note In the Options menu described later in this chapter you can specify the Pressure Units displayed by the device choosing eit
134. o b Circuit Disconnect Table 10 Restore Ventilator Settings 5 Verify the High Inspiratory Pressure Alarm This procedure verifies that the High Inspiratory Pressure alarm is working properly It assumes that you have attached the test lung verified ventilator settings and turned on ventilator power as described in the Initial Setup section A Change Ventilator Settings Modify the ventilator settings and change the following values shown below in Table 11 Setting Value ol Table 11 Ventilator Settings Dr Note If this alarm is not reset within 3 occurrences the alarm the High Priority Indicators Chapter 10 System Checkout Procedures 146 Setting Value B Verify the Alarm Wait up to 40 seconds and verify the following alarm signals e The Medium Priority audible indicator sounds Ayellow light flashes on the Alarm Indicator Audio Pause button e The High Inspiratory Pressure alarm condition appears on the screen highlighted in yellow C Modify Ventilator Alarm Settings Modify the High Inspiratory Pressure setting to match the one shown below in Table 12 Setting Value o High Inspiratory Pressure 60 cm H O Table 12 Modify High Inspiratory Pressure Alarm D Verify Reset Setting Wait 40 seconds and verify the following auto reset conditions The Medium Priority audible indicator has stopped sounding Theyellow light on the Alarm Indicator Audio Pause button has stopped
135. ollow the instructions in Chapter 5 to access the Setup Screen Settings and Alarms Tests Complete the following steps to set up the settings and alarms tests 1 Setup A Settings And Alarms Menu Modify the settings in the Settings and Alarms menu to match those shown below in Table 1 If necessary refer to Chapter 5 for instructions on modifying ventilator settings Setting Value Circuit Type Active PAP Active Flow or Passive AVAPS passive circuit oniy IPAP 20cm H O Table 1 Ventilator Settings 12 BPM in the Settings and Alarms Trilogy200 clinical manual 141 Setting Trigger Type passive circuit Auto Trak type Flow Trigger Sensitivity 6 0 l min Active PAP or Active Flow circuit type Leak Compensation Active On Flow circuit type Flow Cycle Sensitivity Active PAP or Active Flow circuit type B Options Menu Modify the settings in the Options menu to match those shown below in Table 2 Setting Value p o Detailed View Neira edi in the Options Menu C Turn Device Power On Press the Start Stop button on the front of the ventilator The system will begin operating using the defined ventilation settings Chapter 10 System Checkout Procedures 142 2 Verify the High Tidal Volume Alarm This procedure verifies that the High Tidal Volume alarm is working properly For Passive and Active Flow circuits this will verify the High Vte alarm For Active PAP circuits thi
136. ollow your institution s provided by Philips Respironics with each accessory protocol 1 Disconnect the circuit from the device and disassemble the circuit for cleaning Thoroughly wash your hands 2 Using a mild detergent such as liquid dishwashing soap clean all accessible surfaces of the circuit Do not clean using alcohol 3 Rinse the circuit with tap water removing all remaining detergent 4 Prepare a solution of one part white vinegar to three parts distilled water An average beginning quantity is 16 ounces vinegar to 48 ounces distilled water The actual amount will vary according to individual needs Regardless of the quantity the ratio must remain 1 part 3 parts Soak the circuit in this solution for one hour Rinse the circuit completely with tap water Trilogy200 clinical manual Place the circuit on a clean towel to dry Do not wipe dry The circuit must be completely dry before storing Reassemble the circuit when dry Store in a plastic bag or dust free area Inspect components for deterioration prior to use Cleaning the Exhalation Devices Disassemble the exhalation device from the patient circuit Follow the detailed cleaning instructions included with your exhalation device Replacing the Bacteria Filter Optional To remove a bacteria filter and replace it with a new one 1 Disconnect the flexible tubing from the bacteria filter by gently pulling straight out from the filter The proxi
137. omatically cycles to expiration Maximum IPAP Time Inspiration to Expiration The maximum inspiratory time is determined by the adjustment of the Inspiratory time setting A maximum IPAP time of 3 0 seconds acts as a safety mechanism to limit the time spent in inspiration during spontaneous breathing For mandatory or assisted breaths the maximum inspiratory time will equal the Inspiratory time setting up to 5 0 seconds Chapter 3 Modes Features and Alarms 40 Volume Control Cycle Inspiration to Expiration Only available during Volume Control Therapy An Inspiratory Time setpoint limits the time spent in inspiration during breathing in all modes Once the time limit is reached the unit automatically cycles to expiration Flow Trigger Flow trigger provides a manual setting that allows for breath initiation and termination based on a set flow trigger sensitivity and flow cycle sensitivity Flow Trigger Sensitivity Expiration to Inspiration The flow trigger initiates when the patient s inspiratory effort creates a flow equal to or greater than the flow trigger sensitivity setting The method of the flow trigger is dependent upon the circuit type that is chosen Leak Compensation When using the Passive Circuit configuration compensation for both the intentional and unintentional leak is included in the triggering method When using the Active PAP Circuit configuration leak compensation is not available When us
138. on d ibed i d if fthe device S f the patient should be used to escribed in order to verify proper operation of the device Some o perform the system checkout the procedures in this chapter require you to change settings on the pyocedure device If you are not familiar with the procedures for accomplishing this please refer to Chapter 4 Ventilator Setup and Chapter 5 Viewing and Changing Settings Tools Required Universal Porting Block Active PAP Exhalation Device with Tube Adapter connected Active Flow Exhalation Device with Flow Sensor AX WARNING Passive Exhalation Device e Test Lung If you notice any unexplained changes in the performance Small Flat Head Screwdriver ofthe device if it is making unusual sounds if the device or detachable battery are Visual Inspection dropped if water is spilled into the enclosure or if the enclosure 1 Verify that the enclosure is not broken and that all applicable ae screws are in place Respironics or an authorized service center for service Chapter 10 System Checkout Procedures 140 2 Verify that the device handle SD Card door and detachable battery are secure and in good working order 3 Verify that the rubber feet are on the bottom of the device Initial Setup 1 Connect the power cord to the device and then to an AC outlet 2 Attach the test lung to the patient connection end of the desired circuit Active PAP Active Flow or Passive 3 F
139. onics with each accessory External DC Power Do not use the same external battery to operate both the ventilator and any other equipment such as power chairs An external battery should only be connected to the ventilator using the Philips Respironics Trilogy External Battery Cable This cable is fused pre wired and properly terminated to ensure safe connection to a standard deep cycle lead acid battery Use of any other adapter or cable may cause improper operation of the ventilator The ventilator should only be connected to an automotive electrical system using the Philips Respironics Trilogy Automotive Adapter when available This adapter is fused filtered and designed for safe connection to a standard automotive electrical system Use of any other adapter or cable may cause improper operation of the ventilator Do not operate the ventilator from a car electrical system when starting the vehicle or jump starting the vehicle Electrical transients during starting may cause improper operation of the ventilator Electrostatic Do not use antistatic or conductive hoses or conductive patient tubing Discharge ESD with the device Notes This product does not contain natural latex rubber or dry natural rubber in patient or operator accessible areas or in the air path or breathing circuit Trilogy200 clinical manual 11 Contraindications If the patient has any of the following conditions consult their health care profe
140. onnected Info Message s 48 Detachable Battery Disconnected Info Message ss 48 Start On Battery Info Message ener ttes 48 Card Error Info Message eese ennt tenente tnenn tenen nnenenn tne 48 Chapter 4 Ventilator Setup seco eci ete t Ee ER RD Ue ED ER p iR n dec pd 49 Position the Device oii rH atender rn Betas tne TEER 50 install the Air Filter cuori dbi n bre in 50 Supply Power to the Device eese testet nnt tnntttnn ttn tttnt ttt nsttas 50 Ugutio e M 51 Using DE go 52 Device Power Source Indicators eee tnnt tttnnnnes 54 Table of Contents Battery Disposali uicete trt et NR RR UR eR NER 56 First Time USE pa anr a i 56 Connect the Breathing Circuit to the Ventilator e 57 Connect a Water Trap o eesseccsscssscsseesnecnseesseceseesuccesecsnecsseesueceseesuccssessucceseesnccnsessnecnseesneeses 60 Connect Supplemental Oxygen Optional esent 61 Connect the Remote Alarm Optional eerte tnnttnnntnnns 62 Chapter 5 Viewing and Changing Settings eterne nnt a Keypad Lock Feature Accessing the Startup and Monitor Screens Monitor Screen Indicators eese teet ntes ennt ttn ntttonts On Screen Button PaMell ssisssscssssccssessassscacessessscssestzscssadsvesaccedsazesssavssscheaces
141. play if the Ramp Length is set to Off or if the CPAP pressure is set to 4 cm HO Note Ramp Start Pressure is less than or equal to CPAP 1 cm H O in CPAP mode Note In CPAP mode Flex is only available when CPAP is greater than 4 cm HO Note In S mode Flex is only available when EPAP is greater than or equal to 4 cm H O and IPAP is less than or equal to 25 cm HO Note Flex is only available when Auto Trak is enabled Note Ramp is not available in the Passive Circuit when IPAP EPAP 4 cm H O or when IPAP Min EPAP 4 cm HO Note Ramp Start Pressure is less than or equal to EPAP 1 cm H O in S S T T and PC modes Note Ramp Start Pressure is greater than or equal to 0 cm H O when the circuit type is Active PAP or Active Flow in S S T T and PC modes Note Ramp Start Pressure is greater than or equal to 4 cm H O when the circuit type is Passive in S S T T and PC modes Note AVAPS is only available if the Passive Circuit is selected 81 IPAP The IPAP setting displays if AVAPS is Off You can increase or decrease the Inspiratory Positive Airway Pressure IPAP from 4 Note IPAP IPAP Max or IPAP to 50 cm HLO in increments of 1 IPAP is limited to a maximum of cannot be set to more than 30 cm H O above EPAP 25 cm H O when Flex is enabled You cannot set the IPAP setting lower than the EPAP setting IPAP Max Pressure The IPAP Max Pressure setting displays if AVAPS
142. r if available User Check battery status and determine how long device can operate on battery power Find AC power source as soon as possible Clinician Restore AC power when available If alarm continues replace AC power cord to determine if there is a problem with the cord User Press Alarm Indicator Audio Pause button to silence alarm Or press Left button Reset to reset alarm Remove SD Card and use another card if available Check the write protect switch on the card If condition persists contact your health care professional Clinician Remove SD Card and use another card if available Ensure card meets specifications Check write protect switch on card If condition persists contact an authorized representative of Philips Respironics Chapter 6 Ventilator Alarms 120 Trilogy200 clinical manual Trilogy200 clinical manual 7 Cleaning and Maintenance Cleaning the Ventilator WARNING To avoid electrical shock always unplug the power cord from the The ventilator s exterior surface and the exterior of the detachable battery pack if using should be cleaned before and after each patient use and more often if needed wall outlet before cleaning the 1 Unplug the device and clean the front panel and exterior ofthe 6 U ator enclosure as needed using a clean cloth dampened with any of the following cleaning agents CAUTION Water Do not immerse the device or allow any liquid
143. range is from 2000 2099 Hour The hour defaults to the current hour The adjustable range is from 12 AM 12 PM or 0 23 depending on the selected Time Format Minute The minute defaults to the current minute The adjustable range is from 0 59 IP Address Mode You can change the IP address mode to either DHCP or Static depending on the type of network you are using if applicable Trilogy200 clinical manual 89 Operational Hours The operational hours displays the total number of hours that the device blower has been on since the last time this value was reset You can reset this value to zero 0 if desired e g each time you give the device to a new patient This value helps you determine how often the patient is using the device The Operational Hours shown here differs from the Blower Hours shown on the Information screens The Blower Hours displayed in the Information screen is the total number of hours that the blower has been working over the life of the device You cannot reset this value Viewing the Alarm Log From the Main Menu screen you can select Alarm Log to access the Alarm Log screen An example is shown below 9 P Note In the Alarm Log screen Primary S T 06 11 2008 09 52 PM the 1 2 shown in the Menu EGO banner indicates that page 1 0 5 10 15 20 25 30 of 2 alarm log pages is being RR 20sBPM vte 837m Peak Flow 71 6 imi viewed at this time PIP23 2420 Leak 35umin Minvent 11 7 wi
144. ration of related alarms if you add low flow oxygen directly into the patient circuit or mask instead of directly adding it into the oxygen inlet on the back of the ventilator e If oxygen is used with the device the oxygen flow must be turned off when the device is not in use Explanation of the Warning When the device is not in operation and the oxygen flow is left on oxygen delivered into the tubing may accumulate within the device s enclosure e The ventilator should not be operated in the presence of flammable gasses This could cause a fire or explosion Using a Remote Alarm Unit You can use a Philips Respironics Remote Alarm unit with your device There is a dedicated adapter cable assembly for connecting the device to the Remote Alarm unit REF 1045291 Refer to the instructions included with your Remote Alarm unit and adapter cable assembly if you have questions on how to use it with device Trilogy200 clinical manual AX WARNING The remote alarm should be tested daily When using a remote alarm make sure you fully test the remote alarm connector and cable by verifying that Annunciated alarms on the ventilator are also annunciated on the remote alarm Disconnecting the remote alarm cable from the ventilator or from the remote alarm results in an alarm notification at the remote alarm Using a Nurse Call System You can use an institutional Nurse Call system with your device There are several Philips Re
145. rence with the newest highest priority alarms at the top of the list The alarm precedence is in the following order high priority medium priority low priority and informational messages Note Not all alarms are available in every therapy mode some alarms are mode dependent Chapter 6 Ventilator Alarms 100 Audible and Visual Alarm Indicators When an alarm condition occurs Thealarm LED indicator on the Alarm Indicator Audio Pause button lights e The audible alarm sounds Amessage appears on the screen describing the type of alarm e The remote alarm if applicable is activated Each of these is described in detail below Alarm LED Indicators The Alarm Indicator Audio Pause button on the front of the ventilator lights up as follows whenever an alarm is detected Red Flashing Indicator When the device detects a high priority alarm the Alarm Indicator Audio Pause button flashes red Yellow Flashing Indicator When the device detects a medium priority alarm the Alarm Indicator Audio Pause button flashes yellow e Yellow Solid Indicator When the device detects a low priority alarm a solid yellow light appears on the Alarm Indicator Audio Pause button The Alarm Indicator Audio Pause button does not light up when informational messages or confirmation alerts display Trilogy200 clinical manual e Alarm Indicator Audio Pause Button 101 Audible Indicators An audible indicator soun
146. ressed the alarm silence period resets to one minute See Chapter 6 for more information 3 Up Down Button This button allows you to navigate the display menu and edit device settings Front Panel Controls and Display Screen Note When you start therapy the display backlight and the backlights on the buttons turn on the red and yellow alarm LEDs turn on momentarily and an audible indicator sounds to indicate that therapy has started The Startup screen appears on the display WARNING To make sure the device is operating properly at start up always verify that the audible tone sounds and the alarm LEDs light red and then yellow momentarily Contact Philips Respironics or an authorized service center for service if these indications do not occur at start up Chapter 2 System Description 16 4 C Left and Right Buttons These buttons allow you to select display options or perform certain actions specified on screen Visual Indicators Several power and alarm indicators appear on the front panel 5 AC Power LED In the lower right corner of the front panel a green LED indicates that AC power is applied to the device This light remains on as long as adequate AC power is available Keypad Backlight LEDs The Start Stop Up Down and Left Right buttons all have a white LED that lights up if the keypad backlight is turned on in the device Options menu See Chapter 5 for more informa
147. ry Time 3 0 seconds Mandatory Breath Pressure Support 10 cm H O Assist Breath PEEP 6 cm H O PRESSURE 12 seconds 12 seconds 12 seconds 12 seconds H t t t 1 m z RA zl m 26 20 4 10 4 Jol folo o A nter SIMV mode SIMV Mode PIIGIUUDTOOTEUTITOITUETLOTIUDETPETSTDEDILTUSTd IIDPDUOTULLITIETEITFACTT i 5 10 15 20 25 30 35 40 45 TIME Chapter 3 Modes Features and Alarms 30 Therapy Mode Features The device has several additional features that enhance patient comfort Flex Comfort Feature The device consists of a special comfort feature called Flex The device provides the Flex feature in CPAP mode and S mode This feature is only available when Auto Trak is enabled C Flex When in CPAP mode if C Flex is enabled it enhances patient comfort by providing pressure relief during the expiratory phase of breathing In the following diagram the dashed lines represent normal CPAP therapy in comparison to the bold line representing C Flex C Flex levels of 1 2 or 3 progressively reflect increased pressure relief PRESSURE Exhalation Inhalation CPAP TIME C Flex pressure relief is determined by the C Flex setting and the amount of patient flow C Flex returns to the set pressure by the end of exhalation when the airway is most vulnerable to closure Trilogy200 clinical manual Note Flex is not available if AVAPS is enabled or if an active circuit is used
148. s such as device settings battery charge level and condition or age of the battery When fully charged a new battery can power the ventilator for approximately three hours under typical patient conditions Whenever the ventilator is connected to AC power it will automatically recharge the internal battery A completely discharged internal battery will reach 8096 charge status within 8 hours when charging at approximately 23 C ambient temperature Device Power Source Indicators There are many power source indicators on the device and the display screen These indicators are described in detail below AC Power Indicator When AC power is applied to the device the green AC LED indicator on the front of the device lights Trilogy200 clinical manual o Detachable Battery LEDs AX WARNING The internal battery is NOT intended to serve as a primary power source It should only be used when other sources are not available or briefly when necessary for example when changing power sources 55 DC Power Indicators Note Under normal operating conditions the internal battery The internal detachable and external battery symbols that will symbol will always display on display on the Monitoring screen are shown below The detachable the Monitoring screen If the and external battery symbols will only appear on screen if a Symeordppedrsds d empty red battery on your screen detachable or external battery is att
149. s will verify the High Vti alarm It assumes that you have attached the test lung verified the ventilator settings and turned on ventilator power as described in the Initial Setup section A Change Alarm Ventilator Setting Modify the High Tidal Volume alarm setting to match the one shown below in Table 3 Setting Value o High Vte High Vti Table 3 High Vte Vti Alarm Setting B Verify the Alarm Wait up to 40 seconds and verify the following alarm signals TheHigh Priority audible indicator sounds Note Do not use the Reset button to manually reset the alarm Instead use the Modify Pause button button to change ventilator TheHigh Tidal Volume alarm condition appears on settings This applies to all tests the screen highlighted in red Ared light flashes on the Alarm Indicator Audio C Modify Ventilator Alarm Settings Modify the High Tidal Volume alarm setting to match the one shown below in Table 4 4 Setting Value d Table 4 Modify Vte High Vti High Vte High Vti 500 ml Alarm Setting D Verify Reset Wait 40 seconds and verify the following auto reset conditions TheHigh Priority audible indicator has stopped sounding The red light on the Alarm Indicator Audio Pause button has stopped flashing Trilogy200 clinical manual 143 E Restore Ventilator Settings Modify the ventilator settings and change the following value shown in Table 5 Setting Value j High Vte High Vti ff
150. scription using prescription alarms and other the SD Card This feature lets you update a single prescription or settings using the SD card both prescriptions if the dual prescription feature is enabled The Trilogy200 requires that the prescription update can occur either when the ventilatorisofforon e9iver review and verify the changes prior to the changes 1 Insert an SD Card with a valid prescription into the device A being used by the device a The caregiver or health care Change Prescription m rs on the display change scriptio essage appears on the display professional is responsible to 2 Select No to cancel the prescription update process and return ensure that the prescription to the previous display the black screen if the airflow was off or AE i ana compatible with the patient the Monitor Standby screen if the airflow was on Select Yesto after using this feature Installing start the prescription update process Once the prescription is the wrong prescription for a read in and validated one of the following screens appears on particular patient may result tha display to all t th iptiohi t in improper therapy lack of e aisplay to allow you to ensure the prescription IS correct appropriate safety monitoring and risk of death or injury to the patient 07 02 2008 12 31 PM Primary Settings and Alarms Dual Prescription ON xs Ventilator Off Prescription Circuit Type Passiv
151. se Time of 0 4 seconds 7Flex is not available when AVAPS is active Flex is not available with Active Circuits Chapter 11 Technical Specifications 154 Measured Patient Parameters Parameter Range Accuracy Vte Vti 0 to 2000 ml Greater of 15ml or 15 of reading and Respiratory Rate Patient Triggered Breaths I E Ratio 9 9 1 1 9 9 Calculation based on Inspiratory Time and Expiratory Time All flows and volumes are measured at BTPS conditions Spontaneous Breathing During Power Failure Conditions Flow Set Inspiratory Resistance cm ae Expiratory Resistance cm ae KIWA Active Active Circuit with Passive Active Active Circuit with Passive Circuit Proximal Flow Circuit Circuit Proximal Flow Circuit Sensor Sensor 30 lt 3 0 lt 3 5 lt 2 0 lt 2 0 lt 2 0 lt 1 5 60 lt 9 0 lt 10 5 lt 5 0 lt 3 0 4 5 4 0 Disposal Dispose of this device and batteries in accordance with local regulations Trilogy200 clinical manual Trilogy200 clinical manual 12 Glossary The following terms and acronyms appear throughout this manual Term Acronym Definition AC Power Alternating Current power AC Assist Control therapy mode AC mode delivers Assisted and Mandatory breaths with a user defined inspired tidal volume This is a Volume Control mode Apnea A condition marked by the temporary cessation of spontaneous breathing Assisted Breath Breath type in
152. spironics cables available to connect a nurse call system to the device Refer to the instructions included with your cable assembly if you have questions on how to connect it to the device Using a Secure Digital SD Card An SD card is provided with the device to record device usage information You can insert the SD card into the SD Data Card slot on the left side of the device Make sure the label on the SD card faces the back of the ventilator To insert the SD card 1 Open the SD card door by sliding the door forward and then pulling it out as shown below TIL y 2 T Lu w 135 WARNING Ensure that the Nurse Call systems used do not exceed SELV Safety Extra Low Voltage levels as described in IEC 60601 1 SELV levels do not exceed a nominal value of 25VAC or 60VDC at rated supply voltage on the transformer or converter between conductors in an earth free circuit which is isolated from the supply mains by a safety extra low voltage transformer or by a device with equivalent separation WARNING The Trilogy s Nurse Call feature is for use only in a medically supervised environment WARNING Do not rely on the audible indicator provided by the Nurse Call system as the primary indicator of the operating state of the device or of patient events WARNING The Nurse Call feature should be considered a back up to the Trilogy device s primary alarm system Do not rely solely on the Nurse Call
153. ssional before using the device in a non invasive mode Inability to maintain a patent airway or adequately clear secretions At risk for aspiration of gastric contents Diagnosed with acute sinusitis or otitis media Epistaxis causing pulmonary aspiration of blood Hypotension System Overview This ventilator provides both pressure control and volume modes of therapy The device can provide non invasive or invasive ventilation It can be used to provide total therapy to patients as they progress from non invasive to invasive ventilation When prescribed the device provides numerous special features to help make patient therapy more comfortable For example the ramp function allows you to lower the pressure when trying to fall asleep The air pressure will gradually increase until the prescription pressure is reached Additionally the Flex comfort feature provides increased pressure relief during the expiratory phase of breathing The ventilator can be operated using several different power sources including an internal Lithium lon battery This battery is automatically used when the detachable Lithium lon battery pack external Lead Acid battery or AC power are not available Chapter 1 Introduction 12 Symbols The following symbols appear on the device Front Panel b Therapy Start Stop EX Alarm Indicator Audio Pause AC Power Indicator Rear and Side Panels Symbol Description AC Power
154. status Trilogy200 clinical manual Priority Audible Visual Alarm Indicator Button and Display Red flashing button High Vte message Red flashing button Low Vte message Red flashing button High Vti message Red flashing button Low Vti message Device Action 111 User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status Chapter 6 Ventilator Alarms 112 Priority High Respiratory Rate High Low Respiratory High Escalates from Audible indicator to Medium priority and then High priorit
155. t and the patient averaged over the previous breath This only appears in detailed view when the Passive Circuit is selected Chapter 5 Viewing and Changing Settings 68 Measured Settings Panel All of the indicators that may appear on the Measured Settings panel available only in Detailed view are described in the following table Indicator Description PIP Peak Inspiratory Pressure displays the maximum pressure delivered to the patient during the previous breath I E Ratio Displays a comparison of the time spent in inspiration to the time spent in expiration during the previous breath Peak Flow Displays the maximum inspiratory flow delivered to the patient during the previous breath in l min BTPS MAP Displays the Mean Airway Pressure which is the weighted average of pressure in the patient s airway over 6 breaths MinVent Minute ventilation displays the amount of air delivered to the patient over the last minute in l min BTPS Trilogy200 clinical manual Status Panel Indicators 69 All of the indicators that may appear on the Status Panel are described in the following table Indicator Description Ss Indicates that the device is in Full Menu Access mode which means you can adjust all prescription settings Philips Respironics recommends that you change the device to Limited Menu Access mode before giving the device to the patient so patients cannot adjust their prescription settings Only
156. tery pack to power the device attach it here Cord Retainer Secure the power cord using the cord retainer to prevent someone from accidentally disconnecting the power cord See Chapter 4 for more information Trilogy200 clinical manual Jt e 00000 Rear Panel Trilogy200 clinical manual 3 Modes Features and Alarms Therapy Modes The device provides Pressure Control Ventilation PCV and Volume Control Ventilation VCV for non invasive and invasive patients Pressure Control ventilation delivers a prescribed pressure to the patient according to set breath rate and set inspiration time parameters This means that each breath is controlled so that a prescribed amount of pressure is delivered to the patient The device offers six different Pressure Control modes of operation e CPAP Continuous Positive Airway Pressure S Spontaneous Ventilation S T Spontaneous Timed Ventilation T Timed Ventilation PC Pressure Control Ventilation PC SIMV Pressure Controlled Synchronized Intermittent Mandatory Ventilation Volume Control ventilation delivers a prescribed inspired tidal volume to the patient according to set breath rate and set inspiratory time parameters This means that each breath is controlled so that a prescribed tidal volume is delivered to the patient The device offers three different Volume Control modes of operatio
157. tes Red flashing button Check Circuit message Trilogy200 clinical manual User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm The alarm goes away until next reminder appears Connect patient to alternate source of ventilation and contact your health care professional as soon as possible Clinician If alarm continues have the device serviced User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Check patient circuit to make sure it is set up as your health care professional specified Make sure there is no kinked or pinched tubing Make sure tubing is properly attached Make sure all tubing and exhalation devices are clean and free of condensation refer to the Troubleshooting section tubing condensation If using Active PAP or Active Flow Exhalation Device make sure diaphragm is inserted correctly and is not wrinkled or kinked If alarm continues contact your health care professional Clinician Verify patient status Verify that breathing circuit setup is correct Correct any errors If alarm continues have device serviced Low Circuit Leak High Expiratory Pressure Low Expiratory Pressure Priority High Audible Visual Alarm Indicator Button and Display Red flashing button Low Circuit Leak message Red flashing button
158. the on screen button panel This panel corresponds with the control buttons on the ventilator Theleft on screen button specifies the action for the Left button on the device Thecenter on screen button specifies the action for the Up Down buttons on the device Theright on screen button specifies the action for the right button on the device Navigating the Menu Screens To navigate through all of the menu screens and settings Usethe Up Down button to scroll through the menu options and settings Usethe Left and Right buttons to perform the actions specified on the screens left and right on screen buttons 71 Example On Screen Button Panel Note The on screen buttons will vary depending on which screen is displayed and what settings are enabled on your device Chapter 5 Viewing and Changing Settings 72 Changing and Viewing Settings in Full Menu Access Mode Clinicians can view and change settings using the Menu screens when the device is in Full Menu Access mode To enter the Menu screens from the Monitor screen press the Up button on the ventilator The Main Menu screen shown below appears 06 11 2008 09 13 PM cm H20 10 15 20 25 30 vte 837m Peak Flow 71 6 imi Leak 35min Minvent 11 7 vmi Safely Remove SD Card Settings And Alarms Options Alarm Log w Event Log Navigate Choose from the following selections on the Main Menu screen Safely Remove SD Card Th
159. ths exceeds 10 seconds Chapter 5 Viewing and Changing Settings 76 Low Vte This setting enables or disables the Low Vte alarm The alarm activates when the estimated exhaled tidal volume is less than or equal to this setting You can choose Off to disable this alarm or you can increase or decrease the setting from 40 ml to 2000 ml in 5 ml increments It cannot be set higher than the High Vte setting When AVAPS is On the alarm activates when the calculated tidal volume is less than 9096 of the target tidal volume setting This alarm can be set to on or off High Vte This setting enables or disables the High Vte alarm The alarm activates when the estimated exhaled tidal volume is greater than or equal to this setting You can choose Off to disable this alarm or you can increase or decrease the setting from 50 ml to 2000 ml in 5 ml increments It cannot be set lower than the Low Tidal Volume setting except to be turned off Low Vti This setting enables or disables the Low Vti alarm The alarm activates when the measured inhaled tidal volume is less than or equal to this setting You can choose Off to disable this alarm or you can increase or decrease the setting from 40 ml to 2000 ml in 5 ml increments It cannot be set higher than the High Vti setting High Vti This setting enables or disables the High Vti alarm The alarm activates when the measured inhaled tidal volume is greater than or equal to this setting You can c
160. tilator Inoperative Alarm Screen Chapter 6 Ventilator Alarms 104 To turn the ventilator off from a Ventilator Inoperative condition use the normal power off sequence When the Start Stop button is selected the following screen will display Ventilator Inoperative Power Off Ventilator Inoperative Power Off Screen ene Select the Right button Yes to turn the ventilator off and stop the audible alarm Selecting the Left button No will return the screen to the Ventilator Inoperative Alarm Screen without silencing the audible alarm Remote Alarm When the ventilator detects an alarm condition if you are using a remote alarm system a signal is sent from the ventilator to activate the remote alarm The Remote Alarm is discussed in Chapter 4 Trilogy200 clinical manual 105 Audio Pause and Alarm Reset Features This section describes the Audio Pause and Alarm Reset features Audio Pause When an alarm occurs you can temporarily silence the audible indicator by pressing the Alarm Indicator Audio Pause button The alarm is silenced for 60 seconds and then will sound again if the cause of the alarm has not been corrected Each time the Alarm Indicator Audio Pause button is pressed the alarm silence period resets to one minute When Audio Pause is active the Alarm Indicator Audio Pause symbol EX appears if you are on the Monitor screen Additionally an Audio Pause message displays in the men
161. tion Red Alarm LED On the Alarm Indicator Audio Pause button a red light flashes to indicate a high priority alarm Yellow Alarm LED On the Alarm Indicator Audio Pause button a yellow light Note See Chapter 6 for more er au information about high flashes to indicate a medium priority alarm A solid yellow light medium and jaw priority indicates a low priority alarm alarms Display Screen The display screen allows you to view settings system status information real time patient data alarms and logs You can also modify certain settings on the display screen See Chapter 5 for more information on viewing and modifying device settings Trilogy200 clinical manual Side and Rear Panel Features The ventilator s side and rear panels contain the following connectors and features shown at right 1 AC Power Inlet You can plug the AC power cord into this connector located on the right side of the ventilator Breathing Circuit Connection The breathing circuit connector is located on the right side of the device You can connect your circuit tubing system here See Chapter 4 for details Exhalation Porting Block The porting block used here depends on the type of exhalation device you are using The Universal Exhalation Porting Block is shown here See Chapter 4 for more information Secure Digital SD Card Slot On the left side of the device is a slot for the optional SD Card You can have the
162. to enter the Soapy water or a mild detergent enclosure or the inlet filter Hydrogen Peroxide 396 CAUTION Do not use harsh detergents 1096 bleach solution 10 bleach 90 water abrasive cleaners or brushes to 2 D T liquid to drip i h il clean the ventilator system Use Do not allow any liquid to drip into the ventilator case or only the cleaning agents and detachable battery pack After cleaning use a soft dry cloth to methods described in this manual remove any residual cleaner Use extra care when cleaning the display Abrasive cleaners can scratch the display Isopropyl Alcohol 91 3 Allow the device to dry completely before plugging in the power cord Chapter 7 Cleaning and Maintenance 122 Cleaning and Replacing the Air Inlet Filter Under normal usage you should clean the gray foam filter at least once every two weeks and replace it with a new filter every six months or sooner if needed CAUTION 1 Ifthe device is operating stop the airflow by pressing the The reusable foam inlet filter is button Disconnect the device from the power source required to protect the ventilator from dirt and dust Wash 2 Remove the filter from the enclosure by gently squeezing the periodically and replace when filter in the center and pulling it away from the device as shown aged for proper operation below Removing the Air Inlet Filter Note Never install a wet filter into the dev
163. trained health care professionals and clinicians should adjust prescription settings Displays when a Secure Digital SD memory card is inserted in the ventilator Displays when the ventilator detects an error with the SD card Displays at all times when an external battery is attached to the ventilator The level of green shading shown in the symbol indicates the battery capacity and will go down as the battery charge level decreases When the entire symbol is green the battery is fully charged Displays at all times when a detachable battery is attached to the ventilator The level of green shading shown in the symbol indicates the battery capacity and will go down as the battery charge level decreases When the entire symbol is green the battery is fully charged Displays at all times indicating the status of the internal battery The level of green shading shown in the symbol indicates the battery capacity and will go down as the battery charge level decreases When the entire symbol is green the battery is fully charged Chapter 5 Viewing and Changing Settings 70 Indicator Description A black box displays around the battery that is currently supplying power to the ventilator when AC power is not available In the status panel shown above the external battery is in use so the E symbol displays ig A yellow lightning bolt symbol displays with the Detachable or Internal battery symbol to indicate when the ba
164. ttery is charging In the status panel shown on the previous page the detachable battery is being charged so the M8 symbol displays rx Displays when the Alarm Indicator Audio Pause button has been pressed and Audio Pause is active The alarm is silenced for one minute when the Alarm Indicator Audio Pause button is pressed Pp Displays when the Ramp feature is active Note Ifa battery in use is very low less than 20 minutes remaining the inside of the box surrounding the battery symbol will change to yellow and all of the bar indicators in the battery will be empty If a battery in use is near depletion less than 10 minutes remaining the inside of the box surrounding the battery symbol will change to red and all of the bar indicators in the battery will be empty These color changes only occur for the last available battery source Trilogy200 clinical manual On Screen Button Panel The illustration below shows the on screen button panel on the Main Menu screen in relation to the buttons on the front of the device a gt Primary SIT 06 11 2008 09 04 PM fzo o 5 10 15 20 25 30 RR 20BPm vte 837m Peak Flow 71 6 win PiP21 0f20 Leak 35umin Minvent 11 7 umi Menu 18 Switch to Secondary Settings Safely Remove SD Card On Screen Primary Settings and Alarms Button Secondary Settings and Alarms w Options Panel navigates Cc Atthe very bottom of the display screen is
165. tubing may accumulate within the device s enclosure Fire or Explosion The ventilator should not be operated in the presence of flammable gasses This could cause a fire or explosion Trilogy200 clinical manual Improperly Functioning Ventilator Respond immediately to any alarm It may indicate a potentially life threatening condition Refer to the Alarms and Troubleshooting chapters for more information Visually monitor the patient and ventilator at all times during an Alarm Silence period Allowing alarms to continue without intervention may result in harm to the patient If the high priority Low Internal Battery message appears immediately connect the ventilator to an alternate power source If no alternate power source is available immediately place the patient on an alternate source of ventilation If the Ventilator Inoperable alarm occurs immediately place the patient on an alternate source of ventilation You should not rely on any single alarm to detect a circuit disconnect condition The Low Tidal Volume Low Minute Ventilation Low Respiratory Rate and Apnea alarms should be used in conjunction with the Circuit Disconnect alarm Make sure the alarm volume is set loud enough to be heard by the caregiver Consider the use of a remote alarm Trilogy200 offers the following circuit type selections Passive Active Flow e Active PAP Proximal Airway Pressure The Passive circuit type provides an ESTIMAT
166. ty set at 9096 will result in the most sensitivity If the flow cycle sensitivity is set at 1096 this will result in the least sensitivity 90 Flow Cycle Sensitivity 10 Flow Cycle Sensitivity o Flow Cycle Sensitivity Chapter 5 Viewing and Changing Settings 80 Ramp Start Pressure You can increase or decrease the ramp start pressure in increments of 1 from 4 cm H O to the CPAP pressure setting The patient also has access to this setting unless the ramp length is set to Off Flex You can enable or disable the Flex setting Off disables the setting and prevents the patient from using Flex To enable the setting set Flex to 1 2 or 3 The patient also has access to this setting if Flex is enabled The Flex feature is not available when using an active circuit type Spontaneous S Mode The following settings described in the CPAP mode section of this chapter also are available in S mode Flex Trigger Type Flow Trigger Sensitivity Flow Cycle Sensitivity Ramp Length Ramp Start Pressure In addition to those settings the settings below are also available in S mode 1 AVAPS AVAPS is only available if Flex is not enabled You can disable AVAPS by selecting Off or you can enable AVAPS by selecting On If you select Off the IPAP setting displays If you select On the IPAP Max Pressure and IPAP Min Pressure display Trilogy200 clinical manual Note The Ramp Start Pressure setting will not dis
167. u banner on the Alarm Display screen You can pre silence alarms that have not yet occurred by pressing the Alarm Indicator Audio Pause button while no alarms are active Then if an alarm occurs the audible indicator does not sound until the Audio Pause time limit has expired This can be useful during patient setup so caregivers can prevent alarms from sounding that they know will occur during the setup process The LED and display will still show the alarm but the audible alarm will not sound Alarm Reset The Reset button is used to clear the currently active alarm s from the display and stop the LED and audible alarm indicator This button should be selected after the situation causing the alarm s has been corrected All active alarms are cancelled and alarm detection is restarted when this button is selected The ventilator self cancels certain alarms if the cause of the alarm is corrected shutting off the alarm LED the audible alarm and the alarm background color However the alarm text remains on the screen You can manually reset an alarm by pressing the Left button Reset The Audio Pause function is cancelled if the alarm is manually reset Chapter 6 Ventilator Alarms 106 Alarm Volume Control As explained in Chapter 5 you can adjust the Alarm Volume from the Options menu You can select Loud or Soft depending on your preference What to Do When An Alarm Occurs Complete the following steps when an alarm occ
168. uits An exhalation port is required when using a passive circuit For the passive circuit at low expiratory pressures the flow through the exhalation port may be inadequate to clear all exhaled gas from the tubing some rebreathing may occur Rebreathing of exhaled air for longer than several minutes can in some circumstances lead to suffocation Active Circuits Only use the active exhalation devices designed for Trilogy200 Philips Respironics has not verified proper operation of other active exhalation devices and their use may result in improper or unsafe device operation With active exhalation circuits the exhalation device must be operating properly for the ventilator to deliver therapy The exhalation device should be inspected on a daily basis and replaced whenever necessary System Checkout Do not use the ventilator on a patient until a system checkout has been performed See Chapter 10 of this manual To make sure the device is operating properly at start up always verify that the audible tone sounds and the alarm LEDs light red and then yellow momentarily Contact Philips Respironics or an authorized service center for service if these indications do not occur at start up Chapter 1 Introduction Remote Alarms When using a remote alarm make sure you fully test the remote alarm connector and cable by verifying that Annunciated alarms on the ventilator are also annunciated on the remote alarm Disconnecting th
169. uring exhalation The peak pressure is also indicated on this bar It is positioned according to the maximum patient pressure reached during each breath The Peak Pressure symbol appears as a blue bar on the manometer If a High Inspiratory Pressure alarm occurs the Peak Pressure symbol changes from blue to red Trilogy200 clinical manual 67 Indicator Description Low Pressure Indicator High Pressure Indicator AN Pressure Respiratory Rate RR Exhaled Tidal Volume Vte Inhaled Tidal Volume Vti Leak If you enable a volume therapy mode this indicator appears below the manometer bar indicating the low pressure alarm setting If you enable a volume therapy mode this indicator appears below the manometer bar indicating the high pressure alarm setting This indicator displays the current patient pressure This only appears in detailed view This indicator displays the measured respiratory rate in Breaths Per Minute BPM This only appears in detailed view This indicator displays the estimated exhaled tidal volume in milliliters and reflects compensation for BTPS This only appears in detailed view when Passive Circuit is selected This indicator displays delivered tidal volume in milliliters and reflects compensation for BTPS This only appears in detailed view when the Active with PAP Circuit is selected This indicator displays the total leak non returned flow between the unit outle
170. urs 1 Whenever an alarm occurs first always observe the patient and ensure that adequate ventilation and oxygenation if appropriate are available 2 Lookatthe alarm indicators and listen to the audible alarm sound Note the color of the Alarm Indicator Audio Pause button red or yellow and whether the LED is solid or flashing 3 Lookatthe display to check the alarm message that appears on screen and whether it is highlighted in red or yellow 4 Pressthe Alarm Indicator Audio Pause button to temporarily silence the audible alarm A visual indicator displays if you are on the Monitor screen ZX or an Audio Pause message appears in the menu banner on the Alarm Display screen 5 Lookupthe alarm in the alarm descriptions later in this chapter to determine the source of the alarm and the appropriate action Trilogy200 clinical manual Make sure the alarm volume is set loud enough to be heard by the caregiver Consider the use of a remote alarm You should not rely on any single alarm to detect a circuit disconnect condition The Low Tidal Volume Low Minute Ventilation Low Respiratory Rate and Apnea alarms should be used in conjunction with the Circuit Disconnect alarm 107 Alarm Summary Table The following table summarizes all of the high medium and low priority alarms and informational messages Priority Audible WTEC VET Device User Clinician Action Indicator Button Action and Display Loss of Power
171. use the ventilator on a patient until a system checkout has been performed See Chapter 10 of this manual WARNING For ventilator dependent patients always have alternate ventilation equipment such as a back up ventilator manual resuscitator or similar device available CAUTION Do not operate the ventilator at temperatures below 5 C 41 F or above 40 C 104 F Chapter 4 Ventilator Setup 50 Position the Device Place the ventilator on a flat level surface Or as an alternative you can place the device in the optional in use bag The in use bag is required for portable use in order to properly secure the ventilator Do not operate the ventilator while on its side upside down or in any other orientation Make sure that the air inlet on the back of the device is not blocked If you block the air flow around the device the ventilator may not work properly Install the Air Filter The device uses a gray foam filter that is washable and reusable The reusable filter screens out normal household dust and pollens The filter must be in place at all times when the device is operating Two reusable gray foam filters are supplied with the device If the filter is not already installed when you receive the device you must install the filter before using the ventilator To install the filter insert the gray foam filter into the filter area as shown Supply Power to the Device The device can operate on A
172. wer cord disconnected from the device before applying AC power A Cautions A caution indicates the possibility of damage to the device Storage The internal and detachable batteries will self discharge in storage If it is desired to keep the batteries fully charged for example as a back up ventilator plug the device into AC power for about eight hours every 16 days Alternatively the ventilator may be left continuously connected to AC power without battery degradation Allowing the batteries to fully discharge will not harm the batteries or lose device settings but may require a longer battery charge time prior to use Trilogy200 clinical manual Operating The device may only be operated at temperatures between 5 C and and Storage 40 C 41 F and 104 F Temperatures Do not operate the device in direct sunlight or near a heating appliance because these conditions can increase the temperature of the airflow delivered to the patient Prolonged operation or storage at elevated temperatures may reduce the service life of the battery and other internal components of the ventilator The ventilator has an internal and detachable Lithium lon Battery Do not expose the device or detachable battery to temperatures above 40 C 104 F during use or above 60 C 140 F during storage This will reduce battery life and may increase the risk of fire or damage the battery Condensation Condensation may affect operatio
173. xhalation device Low Circuit Leak Alarm This is a high priority alarm that only occurs with the passive circuit It occurs when the system detects a problem with the leak device in the passive circuit High Expiratory Pressure Alarm This is a high priority alarm It occurs when the delivered pressure exceeds the target patient pressure during the expiratory phase by 5 cmH O This may be due to pinched tubing or the patient having afast breath rate The device continues to operate The alarm will automatically terminate when the delivered pressure comes within 5 cmH O of the target patient pressure during the expiratory phase Low Expiratory Pressure Alarm This is a high priority alarm It occurs when the delivered pressure is 5 cmH O or more below the target patient pressure during the expiratory phase The device continues to operate The alarm will automatically terminate when the delivered pressure comes within 5 cmH O of the target patient pressure during the expiratory phase High Internal Oxygen Alarm This is a high priority alarm It occurs when there is a leak in the internal air delivery system that allows oxygen to build up inside the device The alarm is generated when the internal oxygen concentration reaches 596 above ambient levels Trilogy200 clinical manual 43 Circuit Disconnect Alarm This is a high priority alarm It occurs when the breathing circuit is di dorh leak The devi You should not rely on any
174. y High Inspiratory Pressure Trilogy200 clinical manual for first two consecutive occurrences for 3rd consecutive occurrence eee ee for 10th consecutive occurrence Device Action Visual Alarm Indicator Button and Display Red flashing button High Respiratory Rate message Operates Red flashing button Low Respiratory Rate message Operates Peak Pressure symbol turns red When condition first occurs a beep will sound When condition occurs for third time button flashes yellow and yellow High Inspiratory Pressure message appears When condition occurs for 10th time button flashes red and red High Inspiratory Pressure message appears Operates User Clinician Action User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Continue using device If alarm continues contact your health care professional Clinician Verify patient status User Press Alarm Indicator Audio Pause button to silence alarm Or press Left Reset button to reset alarm Make sure tubing is not pinched or blocked If alarm continues contact your health care professional Clinician

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