R100 (Figure ; Outward appearance photograph of R100)
1. The characteristic
R100 deals with the infant-the adult with the resuscitator of the adult version of Calliope alpha. Because it was telling HFO energy to the patient circuit through the cartridge of the disposable product, the labor of the maintenance of the HFO mechanism like humming V is done and Calliope alpha was reduced. The HFO amplitude of vibration is the large-volume type which reaches 350 ml, too, and R100 is the valuable HFO machine which can ventilate an adult in earnest.
2. The performance
1) The mode that it is possible to use
The anaerosis back-up
2) This proximal dater
The maximum intake gas flow rate .140LPM
The maximum air changes per hour .80 BPM
The HFO number of times .5-15 Hz
The maximum HFO amplitude of vibration .2ml(15Hz)-350ml(5Hz)
+ SIGH (The manual)
3. The explanation of the control circuit, the controlling mechanism
1) The outline of the controlling mechanism
A mechanism was simplified because it was doing a flow control mechanically in that humming V is done and the part, the mechanism were complicated but R100 was controlling a ventilating-pressure by microprocessor -, doing the aperture of the intake valve and the expiration valve in the servo control.
2) The characteristic of the mechanical mechanism
The mechanism which is different from the piston method of being hummed to get the stroke volume of the HFO developmental-mechanics, too, large-volume was adopted.
3) The gas flow rate measurement
Of the side of intake and the expiration together A heat ray type is used. The sensor of call feeling is protected by the heating filter. Because the sensor makes NO degrade, it isn't possible to do the use of NO.
4) The intake valve
It is doing an intake gas control with the servo valve. By the demand method, the base flow is the value which added the flow rate of the float rigger sensitivity to 3LPM but in the HFO mode, to be general supplies the continuous flow of 10-40LPM.
5) The expiration valve
The exhalation-valve is controlling PEEP/CPAP pressure with the servo control. In the HFO mode, it is adjusting an average airway pressure by the exhalation-valve.
6) The HFO wrapping experimental use computer London integrated display (Figure ; Photograph of cartridge of R100 : The maintenance became easy with the adoption of the large-sized cartridge of the disposal) (Figure ; Photograph of rotary-valve)
HFO generates positive pressure and a negative pressure in Blois, and it blocks this off with the rotary-valve and is generating vibration. This vibration is communicated to the patient circuit through the cartridge.
4. The new Mattick circuit (Figure ; New Mattick schematic of R100)
Each dense fog of oxygen, air enters Fluothane Sir of air and oxygen via the decompression-valve, the flow valve. The ratio of oxygen and air is fixed to become the inhalation oxygen concentration which was set with the panel and this ratio is kept regardless of the flow rate.
1) The general ventilation, the CPAP ventilation mode
Airway pressure control during intake is done by the control of the intake flow. In the expiration, the base flow of float rigger + 3LPM which was set with the panel flows. PEEP/CPAP pressure control is done by the exhalation-valve aperture. At the time of the pressure trigger, the base flow becomes zero. It is converted into the expiratory-phase when the patient circuit internal pressure becomes higher than the "the inspiratory-pressure upper limit" caution set value. Gas is sent to the lung through the patient circuit. PEEP/CPAP pressure is adjusted to the gas which was summoned from the lung by the exhalation-valve through the expiration line and is opened to it in the atmosphere.
2) The HFO ventilation mode
The oscillation energy which was made with HFO developmental-mechanics is told to the patient circuit through the cartridge ("DEISUPO"). A bulkhead (the diaphragm) is made with the film by which there are 2 pieces of Muro of the side of the machine and the patients' side in the cartridge and it at the center has flexibility. The labor of the wash of the HFO mechanism and the sterilization was saved by the adoption of the cartridge and the labor of the maintenance was reduced.
The vibration generating procedure of R100 adopts a blower motor, and a rotary-valve, a diaphragm. The structure changes to the vibration to become the stroke volume and the frequency which was set by the rotary-valve by making positive pressure/a negative pressure occur with the blower motor and adds vibration into breathing circuit from the side of intake through the diaphragm. The inner mechanism can be roughly divided into this vibration occurrence control unit and the new Mattick control unit which manages ventilator ability. As for the side of intake, each gas which plumbing was inputted to passes a decompression-valve, and a flow valve, Fluothane Sir. According to the set oxygen concentration, in the flow rate, it is controlled (it is possible to set in the range of 10-40LPM) and it is sent to breathing circuit as the continuous flow by the flow valve. It changes the intake gas passage of the time of HFO and the conventional ventilation into the side of intake with the impedance valve of the diaphragm tip. At the time of HFO, the side of the diaphragm opens, the vibration gets to spread into breathing circuit and the side of the main unit induction port becomes becoming resistance to the half-open condition. This floats down a continuous flow but is minimizing that the vibration spreads through this interior of the body and to attenuate in the vibration. In conventional ventilation, the side of the diaphragm prevents in all , the becoming diaphragm chamber prevents becoming in the debt space and as for the side of the main unit induction port, it becomes possible to pour a becoming max-flow into the opening-all the way. On the side of the expiration, it is equipped with an expiration filter and it is used for the germ capture in the expiration and the protection of expiration Fluothane Sir.
5. The control software
HFO and IMV can not be used.
1) The trigger formula
It is a flow trigger formula. The maximum sensitivity is 0.5LPM. The pressure trigger, too, can be chosen. In this case, the base flow becomes zero.
It is the variable trigger window method which is the same as that humming V is done.
3) The CPAP mode
It is a demand method. The PSV pressure is operating as zero by CPAP. Of course, PSV, too, can be used.
As for the end-of-suction end condition (expressed in R100 with the expiration recognition), the intake flow rate makes the time to have fallen to 10-45% of the peak value the ending of PS intake to the measurement maximum intake flow rate in case of the PS. 10-45% of values can be chosen. The others don't have an use condition.
5) The HFO mode
In the HFO mode, the intake valve works as the mechanism which supplies a continuous flow simply. An average airway pressure controls an exhalation-valve and is controlled. The panel can set continuous flow quantity in the range of 10-40LPM.
6) Manual SIGH
The SIGH pressure which was set when pushing the SIGH button manually in the HFO mode can be added. It controls the time which applies SIGH pressure in controlling the time which is pushing the SIGH button.
7) The anaerosis back-up
"The "APUNEA" ventilation" is automatically started up when it becomes an anaerosis. An automatic-removal is done when recognizing a spontaneous-respiration. The ventilation condition is the same as the setting of general ventilation. Only the "APUNEA" air changes per hour can be set, being different. But, the "APUNEA" number of times isn't made, to be less than the setting air changes per hour.
6. The operation system (Figure ; Front panel of R100 : Setting the main item with the control but setting small setting using the liquid crystal panel)
1) First
First, it chooses "an operation mode". There are HFO, CPAP and general ventilation. The approximate setting is possible at the direct control in HFO and CPAP but in the general ventilation, A/C, or SIMV, PC VC must be set. Because a message is displayed to push "confirmation" or the "cancel" button to the liquid crystal panel when the PC or VC pushes "PCV""VCV" and the written button, it follows to that, and it pushes and they fixes either button.
2) The setting of a mode (Figure ; Setting method of mode to have used a liquid crystal panel)
It uses a liquid crystal panel to choose A/C or SIMV. "Choice" When turning a control, the option of the menu bar (there is item of the IMV setting, the IMV caution, the IMV data, the corrugation, the loop) which is under the screen can be scrolled. The chosen item changes into the blue. A/C, SIMV, the float rigger, the pressure trigger, the intake corrugation, the infant and the growing up, Rhys time, the expiration recognition, the "APUNEA" air changes per hour, the plateau time, "NADOWO" (in PSV) can be set when choosing "the IMV setting" and pressing "a choice" newly.
3) The headline (Figure ; Main item can be directly set with control)
It sets with the control while seeing the numeral display of the taking air quantity of ventilation, the intake flow rate, the inspiratory-pressure, the intake time, the air changes per hour, the PEEP/CPAP pressure, the trigger sensitivity, the oxygen concentration, the "NADOHA" LED. As for the setting of HFO, too, in the same way, it sets an average airway pressure, a frequency, a stroke volume with the control.
4) The setting of HFO (Figure ; Setting screen of HFO)
The frequency, the average airway pressure, the stroke volume can be set with the direct control. It sets using the HFO base flow, the SI pressure setting, the MAP upper limit -1, the MAP upper limit -2, the amply upper limit, the amply minimum, the "NADOHA" liquid crystal panel.
5) The setting of an alarm (Figure ; Alarm setting screen, figure ; Screen which sets expired volume per minute minimum of alarm Settei screen)
When pressing the IMV caution of the liquid crystal panel, it becomes an alarm Settei screen. It sets the inspiratory-pressure upper limit, an inspiratory-pressure minimum, PEEP minimum, an active-ventilation quantity minimum, a voluntary air quantity of ventilation minimum, the air changes per hour upper limit, the expired volume per minute upper limit, an expired volume per minute minimum, "APUNEA" monitoring time, "WO".
7. The monitor, the alarm function, the display feature (Figure ; 3 corrugation display example by graphic-screen)
The value and the corrugation can be displayed in the liquid crystal display. In "the IMV dater", in the measurement value, at "the corrugation", 3 corrugations of the flow, the pressure, the volume can be displayed. In "the loop", the P/V curve and the F/V curve can be displayed. The atmospherically limen, the inspiratory-pressure minimum, the PEEP minimum, the active-ventilation quantity minimum, the voluntary air quantity of ventilation minimum, the air changes per hour upper limit, the expired volume per minute upper limit, the expired volume per minute minimum, the "APUNEA" monitoring time, "WO" can be set.
8. The patient circuit composition
A patient circuit was shown in the figure. (Figure ; Patient schematic of R100)
9. The daily maintenance
It exchanges a patient circuit and a diaphragm chamber every a maximum of week of patients. It exchanges an expiration filter every a maximum of 2 weeks of patients.
10. The regular inspection
It checks in the beginning before use. A patient circuit, and HFO cartridge, a bacterial filter are sterilized in the exchange, the wash in the patient and also the constant period.
1) 3-month "TO"
It receives a check.
2) It is every "TO" in 5,000 hours or in 1.
It does spare maintenance.
11. The fault
1) There are an item which can be directly set with the control of the panel and an item to set with the liquid crystal panel and there is not system.
2) The liquid crystal panel is small.
3) To set SIMV and A/C, the background information is necessary because it is different from the way of the other company. The rule is different in the same way about the selection method of the PC and VC, too.