Hamilton Medical
1. The characteristic (Figure ; Outward appearance photograph of Galileo)
Galileo Gold which is the latest model in the Hamilton Inc. is the tech-tool which was manufactured, using the latest computer technology. The Hamilton Inc. is a company in Switzerland but this is opposite with the company in America where it became impoverished with the repeat of M/A. It studies a competing rival product well and to be incorporating a unique technology onto it is original. It is condensed by the new ventilation mode, the ASV to have made Hamilton-MMV develop into and AutoFlow similarity APV. Incidentally, East machine f was handling Amadeus and Veola but Nihon Kohden Corp. is treating Galileo. To the adult of the object patient from the newborn baby
2. The performance
1) The mode that it is possible to use
Apnea Backup
2) This proximal dater
The maximum intake gas flow rate
The active-ventilation .180 LPM
PSV. .180 LPM
The number of the maximum active-ventilations .120 BPM
The maximum SIMV number of times 60 BPM
3. The control circuit, the controlling mechanism
1) The outline of the controlling mechanism (Figure ; Block diagram of Galileo)
In the main CPU, it is intel486/DX2 66 MHz are used. The outline of the electrical system is as in the block diagram.
2) The characteristic of the mechanical mechanism
The basic structure is the same as Amadeus almost. The point of difference is the point which a graphical "NA" panel by the liquid crystal touchpanel is used for.
3) The gas flow rate measurement
a) The side of intake
Inside the main unit, an intake gas flow rate is measured from the position of the intake valve and the back and forth pressure of the valve. As for this information, the control of the intake valve and the end-of-suction end recognition condition of PSV, the control of the pressure in the ASV, "NADONI" are used.
b) Between the tracheal tube and the Y tube (Figure ; Fluothane Sir of Galileo : Fluothane Sir of the barrier Bull orifice type which is installed in the Y peace part)
It is doing a float rigger and an air quantity of ventilation monitor with 0.5-15-lpm sensitivity with the sensor of the delta-pressure type which measures a two-way flow rate between the Y peace and the patient. In the newborn baby mode, the sensitivity can be set in the range of 0.5LPM-5LPM using the special sensor. Because there is not a leak revision feature, if there is a leak, the trigger sensitivity must be corrected.
4) The intake valve (Figure ; Intake valve of Galileo)
The intake servo valve illustrated structure. It moves plunger "plunger" with the electromagnetic-force like the driving-unit of the speaker for the music and it controls an intake gas flow rate correctly in the range in 20-3,000 ml/the second. The position of this valve is continuously grasped with rank experimental use computer London integrated display sensor "positioner". The open condition of this servo valve is revised by the flow rate information. Incidentally, the servo loop time is 0.1 seconds and reacts within 0.1 seconds to any pattern. The valve itself response time is 40 ms.
5) The expiration valve (Figure ; Expiration valve of Galileo)
The exhalation-valve, too, is doing the structure which directly drives the silicon film which has a wide surface area with the electromagnetic-force like the intake valve. PEEP/CPAP pressure, too, is made with electromagnetic-force. Incidentally, respectively, there is not a servo control by the airway pressure.
4. The new Mattick circuit (Figure ; New Mattick schematic of Galileo)
The O2/ As for the dense fog which was entered than the Air plumbing, an oxygen concentration is controlled by the pure and electronic blender. This is O.2Then, it controls opening and shutting time by Solenoid-controlled valve which was provided for both sides of Air and in to command, it controls each flow rate. The thing to be highly precise, the thing that the that there are few age softenings machine work is simple, what there is little circuit resistance the pure and electronic blender have an advantage compared with the mechanicaeration cable type. Coal-water-gas is reserved by storage tank "reservoir tank". This is O.2/ It is doing the three top men of Air train-make-up-station's stabilization, and the stabilization of the driving-pressure, the securing of a peak rate of flow. Coal-water-gas becomes intake gas with the servo valve (the flow control valve). All intake gas is created from the intake servo valve type. In other words, it combines a demand flow system, too. Also, it calculates an intake flow rate, too, here. Intake gas is an outside flow transducer, and is monitored and of it is supplied by the patient. Expiration gas is an outside flow transducer and after measured, it is released from the exhalation-valve of the direct drive in the big worrying.
5. The control software
1) The trigger formula
When choosing a float rigger, the pressure trigger stops and a base flow is automatically added. The base flow becomes twice of values of the trigger sensitivity. It isn't adaptable to a base flow in the early stages of the expiration beginning and he is begun when the expiration gas flow rate becomes below the quadruple value of the trigger sensitivity. It doesn't begin in the case, too, at a breath and it rises to gradually the set value. When choosing a pressure trigger formula, a base flow isn't added.
2)A/C, sCMV
The active-ventilation can be chosen from VC, the PC, APV. When choosing VC, a mode name is written with CMV. When choosing a PC, it is written with P-CMV(P-A/C). In APV, it is written with APVcmv. 0.2 s immediately behind the active-ventilation don't react to the trigger. VC can choose an intake corrugation from four which are Sine, Square, 100%Dec., 50% of Dec.. But, in the newborn baby mode, VC can not be used.
3) SIMV (Figure ; SIMV logic of Galileo)
The active-ventilation of SIMV, too, can be chosen from VC, the PC, APV. In VC, it is written with SIMV. In the newborn baby mode, VC can not be used. At the PC, it is written with P-SIMV and in APV, it is written with APVsimv. The SIMV cycle time is a full time method until 4 seconds. In any more case, it becomes the partial time method that the trigger window time is 4 seconds.
PSV can be used by SPONT, SIMV, DuoPAP, APRV, the ASV mode. The end-of-suction end recognition condition can choose 10-40% of values of the intake peak rate of flow. This can be set in ETS(Expiratory Time Sensitivity). Maximum intake time is limited by 3 seconds.
5) The ASV( figure ; ASV : Breathing work volume WOB ) of this of being the total of resistive WOB and elastic WOB. controls an ASV, aiming at the air changes per hour f which becomes the least.
The ASV is the one of the desired-value in MMV (Volume Support and the similarity in the place to say in the Siemens Inc.) of the Hamilton method if expressing easily. By the AutoFlow (the Drager Inc.) method of SIMV with the number of times of the difference between the breathing rate and the breathing rate of the actual measurement It is the full-automatic ventilation mode of "the machine chooses automatically to the ideal ventilation condition that the intake work volume becomes the least personally" even if it gives and however the ventilation capacity changes surely from the condition where the spontaneous-respiration doesn't exist to the case to be doing a trigger. If interpreting like a wide sense, in 1 piece of the form of MMV which processes a high level, with the ventilating-pressure to be least, the goal expired volume per minute is the mode of which the patient can permit in the expired volume per minute above becoming above the constant value and also the set value. In the setting of an ASV, the important parameter is weight (Body Weight), % expired volume per minute (% Minute Volume) and maximum airway pressure (Pmax). It is possible to be adaptable to the equal to or more than 3-Kg weight but in the newborn baby mode, it isn't possible to use.
First, at the ASV, it fixes goal expired volume per minute (target rate) and goal air changes per hour (target volume). The goal expired volume per minute can be computed from weight (ideal body weight). The % value to this value becomes a % expired volume per minute. The goal air changes per hour is the type of Otis : A.B. Otis, W. O. Fenn, and H. Rahn, "Mechanics of breathing in man", J Appl Physiol, vol. 2, pp. It is computed based on 592-607, 1950. It is calculating the theoretical air changes per hour (target rate, f target) which makes WOB the least by this type as the target value.
Type of ( figure ; Otis
:RCe: respiratory time constant (= expiratory tidal volume / expiratory peak flow)
MV: minute ventilation
f: total respiratory rate
VD: dead space)
If dividing a goal expired volume per minute by goal air changes per hour (f target), it becomes a goal taking air quantity of ventilation. To measure the unsettled item of RCe "NADO" about the type of Otis, it repeats that P-SIMV ventilates a test five times. It measures RCe, Vt, f every time and it faces the following ventilation at these values. When these parameters deviate from the following condition, it enters an assumed value compulsorily and it does the following ventilation. For example, when RCe deviates from the default value, it does the processing to use 1(weights>10kg) or 0.5 (when the ȊO), and so on.
It computes VD from 2.2ml/kg body weight.
100%MV is 0.1L/min/kg(adult), 0.2L/min/kg(infants).
It fixes Vt by the within-the-limits of 2*VD-10*VD.
f adopts the value which fills with Te>3*RCexp by the within-the-limits of 5-60bpm.
It limits I:E ratio to the range of 1:1-1:4.
Te is 3*RCe.
Ti is 60/f target. - It becomes Te.
It limits RCe to the range of 0.1-2.
It limits V/P ratio to 5-120 ranges.
DuoPAP is the mode which corresponds to BIPAP, BiPhasic, Bi-Level to say in the other company. In Galileo Gold, DuoPAP and APRV do almost the same operation. DuoPAP defines a high-pressure aspect in P-high, Rate (the air changes per hour) and T high (the intake time) but APRV sets a ventilatory-pattern with T high and T low. Of the mode which is being "DURE" however, the PS can be added. Low pressure aspect however, high-pressure aspect however, but, the absolute pressure of the PS becomes the same. Therefore, the difference of DuoPAP and APRV is only the difference of the setting method. The method of each setting is to this because it is judged because it suits BIPAP and APRV. A low pressure aspect is provided from the high-pressure aspect and a trigger window is provided for the switchover to the high-pressure aspect from the low pressure aspect.
APV can be used for the active-ventilation of A/C, SIMV. APV is PRVC and a written mode name in AutoFlow, Servo in Evita. An active-ventilation is given with the PC (PC pressure is automatically controlled for the taking air quantity of ventilation to become a set value). An inspiratory-pressure is set in the range of high-pressure "RIMITUTO-" 10cmH2O from PEEP+5cmH2O. A variation is limited to a maximum of 2 cmH2O every time it ventilates. The PSV pressure is as the set value and doesn't change. At the equal to or less than 2-Kg weight, it isn't possible to use.
It is possible to use by the adult, the infant. It doesn't work neatly when there are many leaks. To set the setting of ETC and Ti max tight is essential.
9) Anaerosis back-up Apnea Backup
It switches over to the anaerosis back-up if admitting an anaerosis above the set-up time. Ventilation is done in the condition of the setting of A/C by the case. It returns to the original mode automatically when detecting a spontaneous-respiration. This can be avoided if pushing an alarm sound deadening key beforehand beforehand before suction operation if wanting not to need in for the anaerosis back-up by the respiratory tract suction operation and so on. As for 30 seconds in the back of the change-mode and after proofreading, the anaerosis back-up becomes invalid.
10) The nebulizer
It operates for 30 minutes when making on and it stops automatically. But, a nebulizer flow rate is added to the intake gas flow rate and is sent.
In case of the quantity ventilation mode, at 150% of volume of the setting air quantity of ventilation, in the pressure ventilation mode, an active-ventilation is done at the pressure of + 5cmH2O to 100 pieces of breathing (the active-ventilation or the spontaneous-respiration).
The SPONT mode is a spontaneous-respiration mode and can choose CPAP, or PSV, APRV.
13) PV tool (Figure ; PV tool screen of Galileo)
PV Low Flow PV Loop can be easily measured when using tool and the best PEEP value and the inspiratory-pressure can be fixed.
TRC is the function to offset the resistance of the tracheal tube by the tube resistance revision feature. It is TC of the Inc. of ATC, Bennett of the Drager Inc. and a similar feature. VC works in the expiration. The PC, APV work at both of intake and the expiration.
6. The operation system (Figure ; Operating panel of Galileo)
1) The general setting
It does all operation with two controls of the touchpanel, and C-knob, M-knob. It uses C-knob for the setting of a mode and a ventilation condition and it uses M-knob for the setting of a monitor display. Because the menu of the window form is displayed one after another by the operation of the touchpanel, it touches and it chooses a necessary item, it enters value if necessary, and it pushes CLOSE key last and it fixes it.
Three icons are prepared and can establish the menu of the monitor relation in operating these in the upper left of the screen. The icon is prepared in the upper right of the screen, too, and can set variously in operating these.
2) The setting of a mode (Figure ; Mode setting screen of Galileo)
Because a mode name is displayed when touching the item of the mode, it touches and it chooses a mode for the purpose, and it presses and it fixes "CLOSE". APV can be added using the "ADDITION" screen.
3) The setting of a parameter (Figure ; Parameter setting screen of Galileo)
Because an item is displayed in the direct screen right, the 4 main items of the oxygen concentration and PEEP "NADO" can be directly operated. A menu is displayed when the other item presses "CONTROLS".
4) The setting of an alarm (Figure ; Setting screen of Galileo)
Because an alarm menu is displayed when touching "ALARM" in the lower right of the screen, it sets in the same way.
7. The monitor, the alarm function
1) The patient condition
@ Breathing number of times (0-130 revolutions per minute)
A Maximum airway pressure (0-110cmH2O)
B The expired volume per minute (0-50LPM)
C The anaerosis (15-60 seconds)
2) The others
@ The setting confirmation
A The circuit shifts (2 pieces of breathing).
B Fluothane Sir
C The air, the oxygen plumbing
D The power
E It is impossible for the equipment to operate
F The oxygen concentration (18-103%)
G The PEEP pressure decline
8. The display feature
The airway pressure, the flow, the volume can be displayed at the same time with the 3 corrugation graphic. Moreover, the F-V curve, the P-V curve, breathing work volume, PTP, the airway resistance, the compliance, RSB, P01, AutoPEEP, "NADOWO" can be displayed.
9. The patient circuit composition, the humidifier
As for the humidifier, F&P is included as standard equipment.
10. The daily maintenance
1) Breathing circuit
It exchanges average breathing circuit and an exhalation-valve within 48 hours and it sterilizes them with EOG, the autoclave, the disinfectant. "DEISUPO" is desirable for the bacterial filter.
2) The outside flow transducer
It exchanges within 48 hours and it washes and it is sterilized. Specifically, the flow transducer is consumables. It is possible only for EOG and the disinfectant to sterilize this part and it must not do a heating to equal to or more than 62C. Tentatively, it is usable again until it is possible to proofread and it passes away.
3) The exhalation-valve
The lifetime is longer but the silicon film disposes of it than the outside flow transducer if doing sterilization with at least 10 times.
11. The regular inspection
1) Once a day, it is before use.
Of attaching to the patient to being the first time before and When exchanging O'2 senser [ and a flow transducer It does taking, sensor proofreading to at least 1 day to the thing except it. At this time, the resuscitator must be unbuckled from the patient.
2) 3-month "TO"
It checks a carbonated power filter, "RIA-PANERUHUAN". The test of the microleak of the electric system All the functional tests The pressure proofreading of the resuscitator
3) 12-month "TO"
It receives a check by the specification service engneer. For the details, refer to the manual.
12. The fault
1) The proofreading of Fluothane Sir can not not do that it is as it attached to the patient.
2) The minimum weight which can be adaptable in Galileo was 3 Kg but because the maximum sensitivity of the float rigger was 2LPM, to PTV to the newborn baby was insufficient in it for the sensitivity. It became Galileo Gold, maximum sensitivity became 0.5LPM and at this point, it was improved. However, because there is not a revision feature of the trigger sensitivity to the leak, it is difficult for it to choose sensitive setting realistically.