Transcript SmartCare/PS

How to use SmartCare®/PS
For Software Revision 2.n
A short introduction
Table of contents
1. What is SmartCare/PS
2. Preparation
3. Operation
4. Monitoring SmartCare/PS
5. Ending SmartCare/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
This presentation is an introduction into the usage of SmartCare/PS SW 2.n
Before using it on a patient, make sure you have read and understood the
instructions for use.
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SmartCare/PS in a nutshell
Option for Evita V500/Evita V300 SW. 2.n
 The SmartCare/PS system is an automated clinical
protocol, designed to
– stabilize the patient's spontaneous breathing in a
comfortable zone of normal ventilation and
– to automatically reduce the inspiratory support
– to perform an automatic spontaneous breathing trial
 SmartCare/PS can be used for weaning intubated or tracheotomised patients with a
body weight above 15 kg.
 The patients should be ready for weaning, i.e., haemodynamically stable with
adequate oxygenation and spontaneous breathing.
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SmartCare/PS
Requirements
In addition to standard criteria [1] for starting to wean, the following conditions have to be met:
– The decision to wean was made.
– The decision to wean in SPN-CPAP/PS was made.
– The decision to wean automatically through SmartCare/PS was made.
– The treating physician and/or person responsible for the treatment has deemed the patient to be
hemodynamically stable.
– The patient's spontaneous respiratory rate is stable.
– The patient does not suffer from a severe chronic obstructive pulmonary disease (COPD).
– The patient does not suffer from any major neurologic disorders that influence the respiratory
center.
– The patient has a body weight between 15 kg and 200 kg.
References: [1] MacIntyre NR and the writing committee and Task force of the American College of
Chest Physicians. Evidence-Based Guidelines for weaning and discontinuing Ventilatory
support. Chest 2001;120:375S-395S.
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Table of contents
1. What is SmartCare/PS
2. Preparation
3. Operation
4. Monitoring SmartCare/PS
5. Ending SmartCare/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
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Before using SmartCare/PS
 Device is in the patient category adult or pediatric patients and
in ventilation mode SPN-CPAP/PS
 Patient is invasively ventilated (intubated or tracheotomized)
 The following settings are required for patients with an ideal
body weight of ≥36 kg:
Image
H 4 cm x W 6 cm
– Endotracheal or tracheotomy tube
– Active humidifier or HME filter.
 Patient's body weight between 15 kg and 200 kg.
 Leakage compensation on.
 CO2 sensor applied and CO2 monitoring on.
 Flow monitoring on
 Alarm limits appropriately set
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Before using SmartCare/PS:
Set ATC (Automatic Tube Compensation)
 For patients with a body weight
≤ 35 kg, deactivate ATC in the
»Ventilation settings« menu
 For patients with a body weight
> 35 kg, ATC can be used with
100 % compensation
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Before using SmartCare/PS:
Activate Apnea ventilation
 In the »Ventilation settings« menu
– Touch the keys »Additional
settings«  Apnea Ventilation...«
– Evita V500 displays the menu for
setting the apnea ventilation
– Touch the screen key »On«, and
press the rotary knob to confirm
– The status of apnea ventilation is
displayed by Evita V500 on the
main screen
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Table of contents
1. What is SmartCare/PS
2. Preparation
3. Operation
4. Monitoring SmartCare/PS
5. Ending SmartCare/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
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Set SmartCare/PS
Easy setup in just six steps
 In the »Ventilation settings« menu
select »SPN/CPAP/PS« and then
»SmartCare«
 The current settings are displayed
 Subsequently follow the 6 tabs and
enter the patient related values
 Step 6 will activate SmartCare/PS
 For body weight ≤ 35 kg, only the
menu options »Patient«, »Night
rest« and »Patient Session« are
displayed
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Set SmartCare/PS
Step 1: Set Patient Weight
 Touch the screen key »Patient«
and use the rotary knob to set the
patient‘s height
 IBW (Ideal body weight) of the
patient will be calculated.
 In the pediatric patient mode the
body weight is limited to 35 kg
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Set SmartCare/PS
Step 2: Set Airway access
 Touch the screen key »Airway
access«
 SmartCare/PS compensates for
the dead space and resistances
added by different humidification
and intubation types by adapting
the PS goal
 Set the intubation type either to
“ET” or “Trach.”
 Set the tube diameter
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2
Set SmartCare/PS
Step 3: Set Medical history
 Touch the screen key »Medical
history«
 SmartCare/PS’s weaning protocol
can adapt to the medical history of
the patient
 Set neurological disorder to “Yes”
when treating patients with slightly
increased breathing frequency up
to 34 bpm due to neurological
disorders
 Set COPD to „Yes“ when treating
patients with increased levels of
etCO2 due to COPD
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3
Set SmartCare/PS
Step 4: Night rest
 Touch the screen key »Night rest«
 When »Night rest« is activated,
SmartCare/PS will not actively
reduce the PS for weaning
purposes during the set period of
time
 Nevertheless, even during night rest
the SmartCare/PS protocol will
keep the patient stable, i.e. react
accordingly to any of the 8
diagnoses
 The time period can be modified at
any time, including during night rest
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Set SmartCare/PS
Step 5: Change guideline
 Touch the screen key »Change
guideline«
 Change »RRspon«, »VT/kg«, and
»etCO2« when necessary
 Changes will be active by
confirming with »Yes«
 Note: these changes will “overwrite”
all settings, done before
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5
Set SmartCare/PS
Step 6: Activate SmartCare/PS
 Touch »Patient Session« screen key
 SmartCare/PS is now ready for
weaning
 To start a patient weaning session
with SmartCare/PS press »On«
and confirm with the rotary knob
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6
SmartCare/PS is now active
 »SmartCare« and the symbol
» « appears in the upper part of
the screen.
 The following settings cannot be
changed when SmartCare/PS is
active:
– Airway access
– Medical history
– ATC on/off
– Apnea ventilation on/off
– Date/time
– »Tube« mode
 PS can be changed by the user
at any time.
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Typical sequence of a patient session
 SmartCare/PS
first attempts to stabilize the patient's spontaneous breathing by
adjusting the pressure support
 “Adapt”: Pressure support is regularly adapted to the patient's respiratory profile
 “Observe”: When pressure support reaches a minimum value SmartCare/PS starts a
spontaneous breathing trial (SBT)
 “Maintain”: When the SBT concluded successfully, the system displays a
recommendation to disconnect the patient from Evita V500 and continues to keep
the patient stable
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Table of contents
1. What is SmartCare/PS
2. Preparation
3. Operation
4. Monitoring SmartCare/PS
5. Ending SmartCare/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
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SmartCare/PS Monitoring
Full transparency
 Evita V500 / Evita V300 displays the actions taken by the SmartCare/PS protocol
fully transparent to the user
 Separate views can be used and configured, like: Values, Logbook, Trend pages
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SmartCare®/PS Monitoring
Displaying 1-hr trend
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3
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 Display 1 hr trend
 Touch »Main« 
 »Trends« screen key
 EvitaXL displays the menu for selecting parameters for trend display
 If SmartCare®/PS is available, EvitaXL will additionally offer the parameters
»Diagnosis« and »SC-PSupp.«
 Touch the parameter key »Diagnosis«
 Evita V500 displays the trend profile for the last hour
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SmartCare®/PS Monitoring
Displaying 1-hr trend
 Inspiratory support is
maintained or increased.
 The patient is being weaned.
 The patient is hyperventilated,
inspiratory support is being
reduced.
der Screen fehlt mir
To display the diagnosis for a particular moment in time:
 Turn the rotary knob to position the cross-hair cursor over the required point.
 EvitaXL displays the diagnosis at the top of the trend display.
 The cross-hair cursor cannot be moved if the trend has been frozen via
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SmartCare/PS Monitoring
Displaying Measured Values and Settings
 Touch »Data...«
»SmartCare« key
 The status of the current
patient session and the set
patient data are displayed
1
 The values for SC-RRspon,
SC-VT and SC-etCO2 are
mean values between the
individual ventilation
classes
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der Screen fehlt mir
SmartCare/PS Monitoring
Displaying Logbook
 Touch the keys »Logbook«
»SmartCare«.
 Changes, events and alarms in the
patient session are listed in a table
with the date and time of occurrence.
 If PS was modified by the user,
Evita V500 displays the new value
with the symbol » * «
 When changing to the trend or basic
page, the same point in time is
displayed with the corresponding
data.
 Logbook data are retained until the
next patient session starts.
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SmartCare/PS Monitoring
Displaying Trends
 Select »Trends« »SmartCare«
 Evita V500 displays the trends for
»Diagnosis« and »SC-ΔPS«
 The possible diagnoses are listed
beside the scale on the right. The
current ventilation diagnosis is
highlighted in color
 Select time scale in increments of
30 minutes, 1, 2, 4, 8, 12 hours, 1
day, 7 days
 Displaying trend values at a specific
point in time, turn the rotary knob to
position the cursor on the point in
time or touch the point in time.
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Table of contents
1. What is SmartCare/PS
2. Preparation
3. Operation
4. Monitoring SmartCare/PS
5. Ending SmartCare/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
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Ending SmartCare/PS
 SmartCare/PS indicates successful weaning with
» SC: SBT successful « and the symbol »
«
 Following the decision made by the treating physician and/or person responsible for
the treatment, disconnection of the patient from the device may be considered.
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Ending SmartCare/PS
 Ending a patient session in the
»Ventilation settings« menu
– Touch keys »SmartCare« 
»Patient Session« »Off«
– Press rotary knob to confirm
2
– The patient session is ended
– After a patient session has been
manually ended, Evita V500
continues ventilation with the
last ΔPsupp setting
– After a patient session has been
terminated, the course data (e.g.
SC trend and SC logbook) is
retained until a new patient is
entered
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Table of contents
1. What is SmartCare®/PS
2. Preparation
3. Operation
4. Monitoring SmartCare®/PS
5. Ending SmartCare®/PS
6. Configuration
7. Alarms and Messages
8. Frequently Asked Questions
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Configuration
Configure displayed values
 The display of measured values
can be configured to show
SmartCare®/PS related values
– Press the keys »System Setup«
»Screen« »Values...«
– Select the desired group of
values
– Evita V500 displays the menu
for selecting the parameter
3
– Specific parameters can be
selected for SmartCare/PS
1
– These parameters can only be
displayed as individual values
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der Screen fehlt mir
Table of contents
1. What is SmartCare®/PS
2. Preparation
3. Operation
4. Monitoring SmartCare®/PS
5. Ending SmartCare®/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
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Alarms and messages
Priority of alarms
 Different background colors indicate the priority levels of the alarms.
The priority of the alarm messages is also indicated in the tables for Current alarms
and Alarm history by exclamation points.
!!!
Warning
High-priority alarm message
!!
Caution
Medium-priority alarm message
!
Note
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Immediate action is required to avert acute danger
Prompt action is required to avert danger
Low-priority alarm message
Attention is required, delayed response is sufficient
Messages and Related Actions
Suspension of a Patient Session
 "Running patient session suspended. SmartCare/PS waiting for the end of the
condition that caused the suspension."
»
SmartCare« is displayed in
the header bar of the screen
 SmartCare/PS waits for the end of the condition that causes the suspension and
does not change the pressure support level during this time. When the condition
ends, SmartCare/PS starts to collect data again and resumes classification and
control of the pressure support level
 "Deactivates the patient session and Evita V500 continues ventilation“
 Cannot be influenced by the user
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Messages and related actions
Suspending conditions
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Troubleshooting I
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Troubleshooting II
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Table of contents
1. What is SmartCare®/PS
2. Preparation
3. Operation
4. Monitoring SmartCare®/PS
5. Ending SmartCare®/PS
6. Configuration
7. Alarms and messages
8. Frequently Asked Questions
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FAQ
 Is SmartCare/PS failsafe, because it
alters the pressure on its own?
– SmartCare/PS is an independent
add-on to Evita V500/V300 and
does not alter the safety
mechanisms built into the
ventilator. All alarm limits reactions
based on the severity of alarms
remain untouched.
– Therefore, we recommend setting
the following alarm limits before
starting a patient session:
Parameter
Alarm limit
MV low
–25 % of current MV
MV high
25 % of current MV
RRspon high
40/min with body weight ≥ 36 kg
60/min with body weight ≤ 35 kg
VT low
4 mL/kg body weight
VT high
12 mL/kg body weight
Paw
42 mbar with body weight ≥ 36 kg
etCO2 low
29 mbar with body weight ≤ 35 kg
etCO2 high
18 mmHg
etCO2 high
57 mmHg (without COPD)
67 mmHg (with COPD)
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FAQ
 What if my patient goes apneic?
– The Evita V500 ventilator’s apnea
ventilation will kick in as backup ventilation
in case of an apnea episode with the tidal
volume and frequency you have set.
– In this case the caregiver is notified and the
patient session is ended.
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FAQ
 Can I use any humidifier?
– For patients with body weights >35 kg, any
active humidifier or passive heat-moistureexchanger (HME) can be used
– For patients with body weights <= 35 kg,
only active humidification can be used
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FAQ
 Can I use SmartCare/PS at night to keep the
patient stable, but not to wean?
– SmartCare/PS comes with the function
“Night rest”
– You can set a time period during which the
patient will be kept stable by the system in
the comfortable zone of normal ventilation,
but with no weaning off the ventilatory
support
– If necessary, the system will increase the
Pressure Support during night rest
– Weaning will automatically commence after
the night rest period has ended
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FAQ
 What if SmartCare/PS recommends
“SC: SBT successful”, but no decision maker
is available?
– SmartCare/PS will enter the „Maintain”
phase and keep the patient ventilated on
the lowest level of Pressure Support
– Should the patient develop instabilities or
require higher levels of support pressure
SmartCare/PS will stabilize the patient
according to the protocol
– Should instabilities persist, SmartCare/PS
will switch back to the “Adapt” phase
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FAQ
 Is SmartCare/PS affected by the usage of
nebulized drugs?
– As long as the etCO2 and flow sensors are
not rendered inoperable by excessive
amounts of nebulized drugs, SmartCare/PS
is not affected.
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FAQ
 What happens during bronchial suctioning?
– Endotracheal suctioning can be performed
as often as necessary without having to
activate any special procedure.
– However, it is highly recommended that the
suction function of Evita V500 will be used
with pre- and post-oxygenation.
– This allows SmartCare/PS to detect
reactions to suctioning, so that respiratory
changes are not considered as instabilities
with subsequent actions based on the
protocol.
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FAQ
 Can I change the Pressure Support level
during a SmartCare/PS patient session?
– Yes
– The Pressure Support level can be altered
manually at any time
– SmartCare/PS will continue with the current
phase with the new Pressure Support level
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Thank you for
your attention.