Maquet Servo300, Servo s, Servo i

MAQUET

Servo i､Servo s

1. The characteristic (Figure ; Servo i outward appearance photograph, figure ; Servo s outward appearance photograph)

"The servo ventilator" of the Siemens Elema Inc. (Sweden) is the historic brand which established the status of the world standard machine of the resuscitator with spirit of innovation and advanced function evaluated. Of the resuscitator which established first the electronic servo control which is a standard control method however, it is in today. As the time when it is the mainstream that makes an intake valve and an expiration valve a mechanical control at the feedback servo control based on the pressure and the flow information electronic-ly, it was very epoch-making. In the catchphrase of "to the elephant from the mouse", as the ostentation, the patient object had the marvelous performance to make an adult a range more than a newborn baby.

Servo 900 pieces of development started in the 1960s and in 1971, a shipment was begun. In 1976, it developed into 900B and SIMV was added. In 1980, 900 C were sold and in today, PSV, PCV, an indispensable pressure ventilation mode was practicalized. In 1991, it sold Servo-300 and in addition to the pressure ventilation mode in the new generation of PRVC(Pressure Regulated Volume Control), VS(Volume Support), SIMV(Press.Contr.)+PSV "NADO", in the past, it established the demand performance not to depend on the trigger performance (PTV) to have been said to that it was impossible in the newborn baby mode and the continuous flow to have been said to that it was indispensable in the newborn baby mode of for. In 1995, -300 A of Servo were added and Control mode and Support mode proposed automatically switching feature (Automode). In 1997, the graphic function which was a defect, too, is Servo Screen It strengthened in 390 (the option). The history of the servo is development history itself of breathing mode.

Legendary servo of the furnishings 900 series, too, ended sale in 2003. The product-life cycle of Servo300 (1991-2003) which was a successor ended shortly unexpectedly, too, simultaneously with 900 C, selling. This is held in 2003 and however, Siemens Life Suport Systems is in GETINGE AB because it was bought. Way, MAQUET got to receive the company's name of MAQUET at the crown because it was a company in Germany originally, but GETINGE AB in Sweden bought MAQUET and unified a critical care department in MAQUET after buying Siemens Life Suport Systems. Since 2003, the rationalization of the production is done and only Servo i is sold. Servo s was sold in the purpose to invest an inexpensive model from 2005. This is the model which was born from the reason in case of sales to arrange for the model of the low-priced band simply, but actually, the innards is the same as Servo i approximately and these share hard and software.

In Servo i, until then, the flow transducer of the analog form on the side of the expiration which was called a defect was changed into the digital supersonic transit method and became high-precision and moreover a hi-reliability more. Of the infant 用, of the adult 用, three kinds of universal (both of the infant, the adult) models are prepared by Servo i. PCV, PRVC, VS, BiVent, NIV buy necessary one in the choice by the option handling. In fact, the software of the full-function is loaded into the main unit from the beginning. It becomes the mechanism which can use these features when buying an option and having cancel feature limitation. In software Ver4.0, option setting is done about NAVA, too. This became to have been able to take intake and expiration in the timing with moreover, the earliness of one step than in airway pressure's and flow's changing in the function of the respiratory muscle by taking the muscle-potential of the diaphragm with the sensor which was detained in the gullet.

2. The performance

1) The mode that it is possible to use

Servo i Servo s

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Volume Control(VC) VC

Pressure Control(PC)) The PC

PRVC

Vomume Support(VS)

Pressure Support(PS)/CPAP PS/CPAP

SIMV(VC)+PS SIMV(VC)+PS

SIMV(PC)+ PS SIMV(PC)+PS

SIMV(PRVC)+PS

Bi-Vent

NIV Pressure Support

NAVA

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Automode

+PEEP +PEEP

2) This proximal dater

Sampling time 0.5 The ms

The maximum intake gas flow rate

The active-ventilation .198 LPM

PSV. .198 LPM

The number of the maximum active-ventilations .150 BPM

The maximum SIMV number of times 60 BPM

3. The control circuit, the controlling mechanism

1) The outline of the controlling mechanism (Figure ; Controlling mechanism in Servo300)

Servo-300 became the special system which avoided a central-processing-system by MPU in the each other independent control board which loads each with MPU, cooperating with the analog-signal. This was the mechanism which was preventing system-wide's stopping by the crash of MPU by the design when considering in the peculiar danger which the digital implement has but makes version up difficult. Indeed, Servo i became a central control equipment by the general microprocessor.

2) The characteristic of the mechanical mechanism

a) To have made newborn baby compatible without using the flow transducer of the mouth intake gas, expiration gas together is a marvelous technology. Moreover, that it is possible to do a stable gas control is an excelling technology to the object in the wide area. Moreover, as for the maximum sensitivity of the float rigger, 0.05LPM and this, too, are marvelous. Moreover, the Y sensor option which measures by the Y peace in the purpose to improve response, too, is prepared.

b) The gas circuit of the expiration type of the resuscitator is consequential with to be sterilized being possible but it is the tradition only of the Siemens Inc. that can sterilize even an induction system. The gas circuit is therefore very simple. However, it consumes a lot of bacterial filters as the consumables as the compensation.

3) The gas flow rate measurement (Figure ; Expiration Fluothane Sir)

It measures flow rate measurement by intake gas with the sensor of the delta-pressure type which made the inside of the intake gas module at the internal organs. The flow rate measurement by expiration gas is a supersonic transit type. As for this, the propagation time of the sound wave which propagates in fluid is the one to have used the nature that the speed of fluid changes and the propagation differential-time among two supersonic sending sources becomes a flow rate. In the module, a pressure sensor and an exhalation-valve are had.

4) The intake valve (Figure ; Structure of intake gas module)

It is the structure which is the same as Servo300. The intake valve drives piston "piston" with electromagnetic-force "electromagnetic motor", and pushes film type valve "membrane valve" and becomes the structure which controls the opening and shutting of a gas passageway. An intake valve and a drive circuit are modularized as the flow control unit.

5) The expiration valve (Figure ; Removability exhalation-valve unit)

The exhalation-valve unit of the removability was adopted and while the servo tradition sterilizes an exhalation-valve, the fault which can not operate was canceled. It is possible to do attachment and removal easily. As for being general, two exhalation-valve units follow one resuscitator. An exhalation-valve, expiration flow rate measuring apparatus ability and pressure measuring apparatus ability are had by the structure of the unit type to have united. It is the one and the similarity which was adopted when Evita of the Drager Inc. was the early stages. This isn't publishing the details of the? structure about whether or not it will be related to making Drager Inc. by the capital participation.

4. The new Mattick circuit (Figure ; New Mattick circuit of Servo i)

It is simple as it isn't possible to simplify any more. It omits even a purge style for the pollution prevention of the sensor and it supports pollution with the bacterial filter every sensor. However, these become the part which needs an exchange every patient. Generally, it is providing pressure and the mechanism which does flow rate sensor ー in the auto-calibration for the resuscitator even if it is operating but it doesn't have the auto-calibration mechanism which operates, that the patient is simple gas circuit therefore occupied to the servo series. Therefore, the proofreading process in case of start-up which is done before connecting with the patient is indispensable and must not save.

5. The control software

The explanation of the each function

1) The trigger formula

The pressure trigger formula or the flow trigger formula by the pressure change in the expiration valve eve can be chosen. It doesn't need a flow transducer in the Y peace even if it is a newborn baby. This is the beneficence of the accuracy improvement of the flow transducer on the side of the expiration. After Ver3.0, the Y sensor option which measures a flow with the pressure in the Y peace part in the purpose to improve response and a certainty more, too, is possible. Way, the bias flow is 2LPM in 0.5LPM, the adult mode in the infant mode and can to that very set float rigger sensitivity with 10% of steps. The float rigger sensitivity display is not an absolute value and becomes level 1-10. To do use per level 5 is recommended because the sensitivity is the highest but level 10 does an auto trigger. The display of the bargraph becomes red when raising a level. To be general doesn't use the area which is displayed, being red. Because there is not a leak revision feature, when using a cuff pear tube, the sensitivity control is important.

2) Volume Control (Figure ; Explanation of VCV)

It is the method which is more similar to the character as the quantity cycle than to the time cycle. Intake time is abridged when to be general is strong in the intake demand. To be adaptable to the patient with the diseased lung isn't recommended. This mode is equivalent to "sCMV" but the improvement of the synchronism to the spontaneous-respiration is an improvement. At the servo, this is called Volume Control Ventilation(VCV). It is described according to the number of the figure. ① A respiratory-cycle is composed of fixed organization "DOORI" TI, TP, TE if there is not an intake effort (=Time cycle). ④ It synchronizes with this if there is an intake trigger and an active-ventilation is sent. ② - 2cmH to be of strong intake's there being during intake time (TI) from the PEEP level₂PEEP level + 2cmH to be of the airway pressure OBJ DO and demand gas is supplied if becoming a negative pressure to the O₂It maintains to the O. As far as the intake demand exceeds a setting intake gas flow rate, it increases both intake quantity and intake time. Two choices can do when the intake demand flow rate declines on the way and becomes equal to the setting intake gas flow rate. When an air quantity of ventilation is achieved, an intake demand is more continued. The intake pose time can be elaborate, boils when intake ends and continues. ③ When the taking air quantity of ventilation can not be achieved when the intake demand flow rate becomes equal to the setting intake gas flow rate, it supplies the flow rate which was set until a taking air quantity of ventilation was achieved (=Volume cycle). Now, in the intake time, it is abridged. After that, the intake pose continues. ⑤ If reaching the upper limit pressure "upper pressure limit" in intake station on the way, it aborts intake. An intake pose isn't stored.

3)SIMV(Volume Control) (Figure ; Explanation of SIMV-VC)

It is a fixed time method. In the voluntary ventilation aspect, a demand flow and PSV are supplied. The length of the trigger window is 90% of the CMV cycle time. (Note : It is careful because this is called SIMV Breath cycle time but it differs from the concept which SIMV cycle time means in the other manufacturer in the servo). An active-ventilation is stored in Volume Control.

4)SIMV(Pressure Control) (Figure ; Explanation of SIMV-PC)

In this mode, an active-ventilation is stored in PCV. The explanation of ①-⑤ is the same as SIMV(Volume Control). Incidentally + 20cmH to be of Pressure Control Level above PEEP by the inspiratory-pressure for the safety of the patient₂Intake aborts when becoming above the O.

5)PSV

As for the end-of-suction end recognition condition, the (1) intake flow rate faces Cycle-off level( peak value. When passing after the value of the peak rate of flow becomes equal to or less than 25% in 50% of the time which becomes 25% of the peak rate of flow after the intake of (3)PSV begins in (2) airway pressure's reaching the airway pressure upper limit when becoming the following of % value ), it is. (4) However, in which case, in the maximum intake time of PSV, by the infant, in 1.5 seconds, it is limited and it is limited below 2.5 seconds by the adult. Specifically, condition (3)(4) is the measure to prevent PSV's not ending by the leak and so on.

6) Pressurre Control (Figure ; Explanation of PCV)

This mode is equivalent to PCV. Intake is begun in Patient trigger or Time trigger and in Time cycle, intake ends. A cycle is composed of TI, TP, TE which was set like the figure. The pressure which was set in Pressure Control above PEEP is inflicted on breathing circuit by the intake time. As for the figure, the ① intake flow rate pattern becomes an ordinary 暫減 corrugation. The ② intake flow rate sometimes approaches 0LPM, too, and it is in the end of intake in case of ③ 0LPM, too. ④ When about to boil in airway pressure upper limit "upper pressure limit", immediately, intake ends. ⑤ The intake effort of the patient can be synchronized with, too. + 20cmH to be of Pressure Control Level above PEEP by the inspiratory-pressure₂When exceeding above the O, as for intake, a winding-up by the court is done.

7)PRVC(Pressure Regulated Volume Control) (Figure ; Explanation of PRVC)

This is attempting to constant-ize an air quantity of ventilation, self-adjusting PCV pressure in the new mode to achieve the effect which is equal to the ventilation of the 従量 type as it utilized the advantage of PCV. It is the mutation of the 従量 type ventilation mode who puts on a peak airway pressure in the lower place. There are Pressure Limitation Ventilation of Drager Inc. Evita and an object likewise but this is adopted, improving in the development in AutoFlow in Evita4. This mode is the patient turning to be compulsory more than PCV and for the ventilation capacity to be scarcer about. If there is an intake trigger, it synchronizes with this and if not being, ventilation is begun in the constant interval. The decision of the PCV pressure is done by the following procedure. The normal condition calculates a new inspiratory-pressure by the following arithmetic expression every time intake ends.

Pcalc=Pin use*TVp/TVm

Pcalc : The computed pressure

Pin use : The used inspiratory-pressure

Pnext : The newly set inspiratory-pressure

TVp : The set taking air quantity of ventilation

TVm : The measured intake quantity

The Pcalc value can be hung on Low Pass Filter which has a time constant in 9 seconds and becomes the new standard pressure (Pnext) of the PCV ironhand order. In other words, the PCV pressure "Pressure Control Level" which is needed based on the measurement compliance every breath is fixed. The change of the pressure is a maximum of 3 cmH.₂It is limited to the O.

When final, the taking air quantity of ventilation settles by the constant value. Specifically, a control is done with the following protocol. It is described according to the figure.

① The first ventilation is 10cmH.₂It is done at the O pressure. The following PCV pressure (Pcalc) is calculated by this test ventilation but this value is used just as it is as Pnext. (Filter processing pear) ② 3 pieces of continuing breathing, too, are fixed without the filter processing but like the following type, 75% of values of the variation with pressure are used.

Pnext=Pin use+0.75*(Pcalc-Pin use)

=0.25*Pin use + 0.75*Pcalc

This place becomes a test ventilation procedure.

③ The filter processing is done from 5th breathing and readjusts the ventilating-pressure (Pnext) to need in usual procedure. The change range with pressure is 5cmH from the PEEP level.₂The O It is to below Upper Pressure Limit. It considers and it sets safety low as far as the airway pressure upper limit "Upper Pressure Limit" is possible. To be provided by ④, in breathing time, it is fixed on set TI and TE. This point is a difference with Volume Support. As for ⑤, the pressure is stable and shows that a set value is maintained about the air quantity of ventilation, too. In ⑥, the air quantity of ventilation shows the process of actual measurement's decreasing a increasing ventilating-pressure more than the set value. When a patient circuit is removed by the suction operation and so on, test ventilation procedure ① starts again.

8)VS(Volume Support) (Figure ; Explanation of VS)

As for this, too, the basics are PSV but to stabilize an expired volume per minute, they set a new PSV level(= Volume Support level) automatically by the procedure like PRVC. But, the filter which has a time constant in 18 seconds is used. The arithmetic expression of Pcalc switches over according to the measurement breathing rate because it is different from PRVC and the breathing rate depends on the patient. When more measurement breathing than the setting breathing rates occurs, it is the same as PRVC. When little, it becomes the following type.

Pcalc=Pin use*MVp/MVm

MVp : The set value of the expired volume per minute

MVm : The actual measurement of the intake expired volume per minute

① The first test ventilation is 10cmH.₂It is done at the O pressure. ② It ventilates 3 pieces of breathing which continues at 75% of pressure of the necessary variation. It doesn't process a filter to here. ③ After that, it sets by usual procedure. The range which the pressure changes into is Upper Pressure Limit from the PEEP level. - 5cmH₂It is to the O. The variation of the taking is 3cmH.₂It is the following of the O. Also, Pnext doesn't cross 1.5*Pin use. In ④, because the actual measurement increases than the set value, the air quantity of ventilation shows the process of decreasing the following ventilating-pressure.

⑤ Because this mode is basically the method which is the same as PSV, the ventilation doesn't start if there is not an intake trigger. As for the patient, free intake time, a breathing rate and expiration time are permitted.

⑥ It does the ⑧ automatic sounding of the alarm and it switches over in PRVC and it secures the expired volume per minute of the patient if a breathing rate decreases and is taken for the ⑦ anaerosis alarm. It returns to VS again when resetting an alarm manually.

The inspiratory-phase ends compulsorily if the intake quantity of the patient becomes 175% of the setting taking air quantity of ventilation. It begins in patient circuit's being removed by the suction operation and so on again from the test ventilation.

9) AutoMode (Figure ; Explanation of AutoMode)

But three controlled-respiration (the active-ventilation) modes of PRVC, Volume Control, Pressure Control are prepared by Servo i When choosing these 3 modes, it switches over to support mode from control mode if doing a trigger continuously twice when making Automode switch on. It is automatically changed with control mode if there is not a constant time (Adult ; 12 sec., pediatric ; 8sec., neonate ; 5sec.) trigger in support mode.

(Table ; Measurement table of mode change in AutoMode)

In PRVC/Support, the ventilating-pressure of the last of PRVC becomes the original value of the ventilating-pressure of Volume Support just as it is. Volume Control/Support becomes the original value of the ventilating-pressure that the EIP pressure in last Volume Control is Volume Support. In Pressure Control/Support, each set-pressure becomes a ventilating-pressure.

10) Bi-Vent (Figure ; Explanation of Bi-Vent)

This is the mode to provide two PEEP levels to the spontaneous-respiration by BIPAP of the Drager Inc. and the mode of the ventilation of the similarity. It is near BIPAP of the wide sense and the mode concept to be specified at the this manual. It sides with the spontaneous-respiration as far as it is possible for the high-pressure aspect and the low pressure aspect to switch over. As for the trigger window, it is unclear but it is the situation that any % of ends of each aspect become a trigger window. It is different from BIPAP of the Drager Inc. and PSV with optional pressure can be added to each of the high-pressure aspects and the low pressure aspects.

11) NIV (Figure ; NIV setting screen)

It is the pressure ventilation mode to do under the mask. When becoming NIV mode, the screen-display becomes a yellow frame. Only PSV and the PCV mode can be chosen. There is a leak revision feature, but it chooses a best mask possibly and 及 for there to be few leaks and it sets it neatly. The maximum amount of leak which is permissible in NIV is Adult mode, is 50LPM, infant mode and is 15LPM. There is not setting of trigger sensitivity in NIV. (1) Boiling intake begins in 6-ml change's there being among 100 ms of (2) when the airway pressure declines in 1㎝H2O. Cycle off is when the (2) leak flow declines from setting cycle off value when the (1) airway pressure rises by + 1cmH2O from the set value.

12)Insp.Hold､Exp.Hold

Using these buttons, it is possible to do the measurement of End Inspiratory Pause pressure and Auto-PEEP.

13) The input/output

The copy and the ventilation information of the screen can be stored if inserting the memory card (pretending to do) Ventilation Record Card of the option. The information can be copied on to the PC through the memory card. Moreover, the signal can be realtime from the serial port of the RS232C terminal output.

14) The nebulizer

It doesn't need drive gas because it is a supersonic type. Therefore, the change of the air quantity of ventilation by drive gas and the change of the oxygen concentration don't happen.

15) The anaerosis back-up feature

There are a way of doing an anaerosis back-up using AutoMode and a way of using Back-up Ventilation. Back-up ventilation becomes PSV→PCV, VS→VC in the anaerosis. It is to be just as it is in the I:E ratio and the air changes per hour intake standing-up time. In the anaerosis time, by the adult mode, in the range in 15-45 seconds, in the infant mode, it is possible to set in the range in 5-15 seconds.

16) PEEP compensator (The PEEP revision)

Correct PEEP/CPAP is maintained regardless of the expiration gas flow rate by the servomechanism of the expiration valve.

17) The CO2 monitor

CO2 of the Y peace tip can be monitored with the option. It is an absorbance measurement method.

18) The battery

The NiMH battery of 12v can be attached to a maximum of 6 units. It is possible to use for approximately 30 minutes per unit.

19) The compressor

It is possible to be equipped with the special compressor. As the compressor, it is the quieter one more but it doesn't reach the silence of the turbine.

20) Rhys time

The time which reaches a set-pressure in case of pressure ventilation can be set. As for the graph, the start-up time draws in for the right than the left. (Figure ; Screen-display example when changing Rhys time)

6. The operation system (Figure ; Operating panel photograph)

1) The basics

One can be chosen from two operation systems (the intake adjusts-the-hours method and the I:E ratio setting method) in delivery. The technical expert of the manufacturer enters a release key and sets the mode and the operation system to provide. It is the same ability, being underlying because it has the software that the model which is Adult, Infant, Universal being "DURE" as the reality, too, is the same completely. According to the license purchase, the feature of PRVC and VS, AutoMode, Universal "NADO" is canceled and the performance of the model is fixed.

In Servo-i, it is this "DENO" of the ( U.S. and the day gradually with the strong request at the American market and in the Japanese market. There are few differences in the numbers of sales and they can choose ) which is the time where there are many numberses of sales in Japan, too, the intake adjusts-the-hours method which is used with the general resuscitator, i.e. the method to set from the taking air quantity of ventilation, the intake time, the air changes per hour. In this case, I:E ratio is processed inside the inside as 1:2 and the trigger window time of SIMV is fixed.

On the other hand, the I:E ratio setting method which was used for former servo, too, can be chosen. This puts on the operation system of the conventional servo hereditarily by the method to set from the expired volume per minute, the breathing rate, the % intake time, the % intake pose time which is peculiar to the servo. However, the inevitability which uses this method is question.

2) The operation

A standby screen is displayed in case of start-up (Figure ; Screen in case of start). To be general chooses a beginning check menu and checks in the beginning. It skips to the emergency and it is possible to start, too. It sets using the touchpanel (Figure ; Screen where a setting menu was displayed ; Being NIV mode in this figure). It chooses a mode, a taking air quantity of ventilation, an air changes per hour, alarm setting and so on in the touchpanel, it makes display a menu and it chooses value with the knob, and it pushes and it fixes a knob. The items such as PEEP and the oxygen concentration which access 頻回 can do a setting change quickly because the control to have supported an item like the function key of the PC is prepared by the lower part of the liquid crystal screen (It is protected with the transparent cover so as not to be carelessly changed).

7. The monitor, the alarm function (Figure ; Alarm screen-display example : In this figure, it is alarm setting by the NIV mode).

① The expiration expired volume per minute ; The upper limit, the minimum, the standing-next un-set alarm

② The airway pressure upper limit ; Simultaneously with the caution, it aborts intake.

③ The anaerosis ; When a trigger isn't recognized for 15 seconds

④ The oxygen concentration ; The upper limit, the minimum

⑤ The others ; When the power, the gas supply have a malfunction

8. The display feature (Figure ; Screen-display example)

It is possible to display a various graphic presentation (the flow, the volume, the pressure, "HURO-BORIYU-MUKA-BU" and so on), various monitor value and so on.

9. The patient circuit composition, the humidifier

F&P and so on can be chosen.

10. The daily maintenance

It is necessary to wash breathing circuit and the part of the expiration type, for them to be sterilized, to dry up. It disinfects an expiration unit with alcohol and so on after washing with equal to or more than 85°C hot water, after that, it rinses it with the purified water and it makes it dry up in the sterilization in the auto clay part. If preparing more than one expiration unit beforehand, the equipment can be done by the continuous running duty in exchanging an expiration unit in order. There is a hand which installs the bacterial filter of "DEISUPO" in the exhalation-valve eve to avoid the sterilization of the expiration type, too.

11. The regular inspection

1) The induction system

It never makes a year and it washes the part of the induction system, too, "KUHA" 5,000 hour by hour and it sterilizes it. Specifically, it is a filter for the gas module, a bacterial filter for the inspiratory-pressure transducer, a bacterial filter for the O2 cell, a nozzle unit for the gas module.

2) O'2 senser ー

The fuel battery for the oxygen concentration measurement needs an exchange regularly because it is consumables. After exchange, the calibration is necessary. The supersonic type sensor which can be used in the extended period, too, is prepared with the option.

3) The others

It never makes a year and it checks the check of the battery module, a gas supply pressure transducer in the "KUHA" 5,000 hour by hour (For the details, it refers to the manual).

4) The expiration cassette membrane

The membrane of the exhalation-valve can do operation (the veto) with 10,000,000 times as the standard. The function to display a status of use to each cassette is prepared (For the details of the way of accessing, it refers to the manual).

12. The fault

1) It succeeds to the operation system which is peculiar to the servo which is called I:E ratio setting method, too, at this point, it is possible to seemingly see it in the kindness to the servo user but originally, such an operation system is empty realistically because it was a fault.

2) That a feature is limited like software at the hardware, the amount of money which the user paid in spite of being equal software together about all production models is unpleasant. Only SIMV, and PSV, VC are had by what and BASIC model. It doesn't reach and, to say and even PCV is option handling about PRVC and VC, AutoMode, Bi-Vent. In Servo i which is never inexpensive, even as for PCV, that there is not standard built-in suffers from the understanding. The situation with Servo s which Servo i (to have made leaving all to others and) to have bought nothing by considering it haggled over with the lowering the price and it bought inexpensively and the same performance which can not laugh to laugh is happening. If comparing to the car, it is a power window and a rear wiper, the one as the air con isn't on at expensive Benz. As the feelings of the general Japanese user, it goes to the price corresponding to the production cost in the consent, but it 感"ZIRU" expensive pricing of all of the matters which are soft and it 感"ZIRU" a uncomfortable feeling of being doing. The price soars corresponding to it if the feature rises if going in this railway. If saying by the feeling of the PC and the home electric appliance, the improvement and the improvement of the technology are consequential and it is the idea having to do with a government official which ignored improvement that to that very requires an expensive option fee. The possibility that the present PC becomes the pricing which exceeds one set of 10,000,000,000 if such pricing is approved Way, the cost doesn't seem to be so taken for soft itself because VELA which is made in the U.S. of the rival is average, plentiful the various mode and it becomes the price range of the inexpensive machine. e360 of Newport Inc. is to be fully loaded with the software approximately at the half price. In Japan-domestic, the great servo, too, is the pattern to serve an option function to in delivery, making an estimation in the less specification on the actual sales scene in case of sales. However, such an sales form is extraordinary.

3) In spite of the display of the pulmonary mechanics, too, it isn't possible to understand that the expensive option is necessary.

4) It is special status but PRVC and Bi-Vent mode however, the airway pressure has risen to the alarm level when there is rapid expiration in inspiratory-phase station on the way. In other words, the pressure relieving by the exhalation-valve is slow. If saying only on the catalog, the response of the ironhand type on the side of intake is good overwhelmingly compared with Evita but extreme under the conditions, the phenomenon of the pressure spike by the overshoot on the graphic-screen and the pressure spike because the pressure relieving is slow and so on can be observed. This cause will be the problem of the ironhand software of the exhalation-valve. Behind in the release of the exhalation-valve in and causing a rapid pressure spike by it when there is beginning of the rapid expiration because the distinction of the inspiratory-phase and the expiratory-phase closes an exhalation-valve at the poor total pressure in the wryneck vapor-phase inside the machine even if it is Bi-Vent Way, because an intake valve and an exhalation-valve are controlled in the form which the CPAP pressure changes into with the passage of time in Evita, gas above the set-pressure is relieved from the exhalation-valve. Therefore, at the pressure corrugation, the spike is 1cmH2O degree even if it supposes that it was, admitting hardly. In the substitute, relieving, the "GIYU-TUTO" bray sometimes occurs from the exhalation-valve, too.

5) The exhaust sound of the car resembles, for there to be a peculiar sound every manufacturer and that there is the same sound for the structure to be different about the servo in the past and the latest servo is interesting about the sound which intake gas flows through, the sound where expiration gas is discharged. But, because the sound of the servo is the sound to make feel to choke as it is doing breathing through the thin pipes such as the snorkel if saying in the personal taste, the impression isn't good.

6) As for the performance of the hard ware, the world will be the best. However, control software isn't broken in the utilization in this. It isn't possible to say that it is decided in case of general evaluation to Evita with bad hardware performance and that it wins. There is a difference to have made obvious in the ironhand technology, the gas flow rate control technique which included the maturation of the operation system and the control software of the exhalation-valve, the foul "TE" know-how. Newborn baby mode however, because the trigger doesn't have a leak revision feature, it isn't utilizing the trigger sensitivity of the precious world summit level.

7) To require a test sequence in case of start beginning is troublesome. This is the problem of the specification by the design philosophy to make as simple in the new Mattick circuit as as much as possible. However, is it possible to get understanding of the user how much or it is question.

8) It becomes very expensive when equipped with the necessary option.