Knowledge Base

This Knowledge Base is intended to provide answers to some frequently asked questions and give you some useful tips for using your Hamilton Medical ventilator. If you can't find the information you're looking for here, feel free to mail us with your query. 

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Test your IntelliVence (Vol 15 Issue 4)

08.08.2018
Author: Clinical Experts Group, Hamilton Medical Group, Reviewer: Bernhard Schmitt

Why is the current volumetric capnogram loop different from the reference loop?

pulmonary embolism, capnography, volumetric capnography, dead space, VDalv, PetCO2, capnogram

Bedside tip: Assessing lung recruitability

08.08.2018
Author: Munir Karjaghli, Reviewer: Paul Garbarini, David Grooms, Simon Franz

The percentage of potentially recruitable lung varies widely among ARDS patients, and zones of collapsed and consolidated alveoli in the most dependent lung frequently require airway opening pressures of more than 35–40 cmH2O to recruit (1).

recruitment, recruitability, hysteresis, assessing, assessment, p/v curve, pressure volume, recruitment maneuver, supine, prone, prone position, PEEP

Test your IntelliVence (Vol 15 Issue 3)

12.06.2018
Author: Simon Franz, Reviewer: Süha Demirakca, Paul Garbarini, David Grooms

A 6-month-old infant with combined tracheal stenosis and malacia both located in the subglottic trachea (therefore extrathoracically) is ventilated noninvasively with Heliox due to respiratory distress. In addition, abdominal distension is limited by a cast (reaching up to the abdomen). How would you explain the biphasic shape of the waveform for both the inspiratory and expiratory flow?

flow limitation, expiratory phase, inspiratory phase, biphasic shape, stenosis, malacia, trachea, extrathoracic, obstruction

Bedside tip: Using measured airway mechanics in pediatrics

12.06.2018
Author: Süha Demirakca, Reviewer: Paul Garbarini

The expiratory time constant (RCexp) is measured breath-by-breath on all Hamilton Medical ventilators. As RCexp is the product of compliance and resistance, this single variable gives us an overview of the overall respiratory mechanics.

Rcexp, respiratory mechanics, compliance, resistance, time constant, settings, flow interruption, restriction, obstructive condition, mixed disease, pediatric

HAMILTON-T1 for ventilator-assisted preoxygenation

06.06.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

The use of rapid sequence intubation (RSI) in the Emergency Department is often associated with complications, including serious oxygen desaturation.

rsi, rapid sequence oxygenation, preoxygenation, t1, hamilton-t1, niv, cpap, hypoxemia, vapox, pressure controlled, intubation

Test your IntelliVence (Vol 15 Issue 2)

25.04.2018
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini, David Grooms

This patient is passive and ventilated in pressure-control mode. Why is the flow curve shaped this way?

pressure control mode, flow limitation, COPD, expiratory flow, bicompartmental expiration, choke point, brochospasm

Bedside tip: How to use the expiratory time constant

25.04.2018
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini, David Grooms

The expiratory time constant (RCEXP) is a dynamic measurement of respiratory mechanics measured breath-by-breath on all Hamilton Medical ventilators.

rcexp, time constant, expiratory time constant, compliance, resistance, monitoring, respiratory mechanics

Test your IntelliVence (Vol 15 Issue 1)

20.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini

Why is the flow shape different for the second breath? The patient is ventilated in pressure-support mode with no backup respiratory rate (RR).

auto triggering, inspiratory effort, esophageal pressure, pressure, flow, slope, inspiratory flow, asynchrony, mechanical breath

Best-practice breathing circuit configuration for transport with HAMILTON-C1/T1/MR1

05.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

During transport, I am ventilating patients from premature infants through to pediatrics. Which breathing circuit, flow sensor or CO2 airway adapter should I use for each patient?

Breathing circuit, flow sensor, expiratory valve, airway adapter, transport, neonatal, premature, infants, pediatrics, HAMILTON-C1, C1, HAMILTON-T1, T1, HAMILTON-MR1, MR1

Translating competitors' ventilation modes into Hamilton Medical modes

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

Most ventilator manufacturers use their own specific abbreviations for the different ventilation modes on their ventilators. It is important for users to have a tool that enables them to compare the modes of one manufacturer with the modes of another.

ventilation modes, mode comparison, competitor modes, competitor, modes

Measurement of AutoPEEP and total PEEP

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

In the presence of dynamic pulmonary hyperinflation, the average end-expiratory pressure inside the alveoli (i.e., the actual, total PEEP (PEEPtot)) is higher than the PEEP applied by the ventilator (PEEPe). The difference between PEEPtot and PEEPe corresponds with the intrinsic PEEP (PEEPi), and is also known as AutoPEEP (1).

AutoPEEP, auto peep, instrinsic peep, extrinsic peep, air trapping, g5, s1, c3, c6

Using APV mode on infants with an uncuffed ETT

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

During the expiratory phase of ventilation, the exhaled gas exits the ETT and is measured proximally at the flow sensor. Where a leak is present, the exhaled tidal volume (VTE) is significantly less than the inhaled tidal volume (VTI). In Adaptive Pressure Ventilation (APV) mode, the HAMILTON-G5 must therefore deliver a higher pressure and potentially a larger VTI to compensate for the leak in order to achieve a tidal volume close to the set exhaled volume target (VTarget).

Infants, APV, endotracheal tube, ETT, volume-targeted, pressure-controlled, leak

Measured values for Ppeak and Pplateau

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

A situation may occur where measured peak pressure (Ppeak) and plateau pressure (Pplateau) are the same, and the question arises as to whether this has to do with the patient or the ventilator.

hold maneuver, pplateau, driving pressure, plateau pressure, peak pressure, inspiratory hold, expiratory hold, g5, s1, c3, c6

Static compliance (Cstat) vs. dynamic compliance (Cdyn)

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

Why do Hamilton Medical ventilators monitor static compliance (Cstat) instead of dynamic compliance (Cdyn)?

measurement, respiratory mechanics, cstat, cdyn, resistance, compliance, static, dynamic

Adjusting the %MinVol in ASV mode

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

What are the recommendations for the initial %MinVol settings in Adaptive Support Ventilation (ASV®)?

ASV, MinVol, PaCO2, PetCO2, blood gas, acid base, adjustment, spontaneous, breathing rate, active, passive

Calculation of V’alv, VDaw and VDaw/VTe

02.03.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: N/A

How do Hamilton Medical ventilators calculate V`alv and VDaw/VTE, and what are these parameters used for?

volumetric capnography, dead space fraction, alveolar ventilation, capnography, capnogram

Bedside tip: Setting expiratory trigger sensitivity (ETS)

22.02.2018
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Jean-Michel Arnal

Optimal patient-ventilator synchrony is of prime importance, as asynchronies lead to increased work of breathing and patient discomfort, and are also associated with higher mortality and prolonged mechanical ventilation (1, 2, 3).

ets, expiratory trigger, inspiratory trigger, expiratory trigger sensitivity, asynchrony, delayed cycling, late cycling, trigger adjustment, double triggering, IntelliSync

Test your IntelliVence (Vol 14 Issue 5)

19.12.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

Why is the end-expiratory flow positive (above baseline)?

NIV, noninvasive ventilation, leak compensation, end-expiratory flow, leak rate

Bedside tip: Setting high flow oxygen therapy

19.12.2017
Author: Clinical Experts Group, Hamilton Medical , Reviewer: Paul Garbarini, David Grooms

High flow oxygen therapy combines several physiological effects: Oxygenation, PEEP, an increase in the end-expiratory lung volume (EELV), a lower respiratory rate (RR), a decrease in intrinsic PEEP and work of breathing, lower PaCO2, and improved humidification and comfort (1, 2). The optimal flow setting depends on the indications and the desired physiological effect.

high flow oxygen therapy, HFOT, settings, oxygenation, PEEP, flow

Neonatal ventilation with the HAMILTON-C1/T1/MR1

03.10.2017
Author: Hamilton Medical, Reviewer: NA

This video demonstrates how to use the neonatal function on the HAMILTON-C1/T1/MR1 ventilators.

hamilton-c1, hamilton-t1, hamilton-mr1, neonatal, setup, neonatal ventilation

Test your IntelliVence (Vol 14 Issue 4)

02.10.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

What causes this temporary stop in breathing?

Cheyne stokes, CSR, apnea, stop breathing

Bedside tip: How to perform a recruitment maneuver

02.10.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

A recruitment maneuver (RM) is a transient increase in transpulmonary pressure applied to reaerate the collapsed lung.

recruitment, recruitment maneuver, ARDS, PEEP, sustained inflation, PV Tool

Using the IntelliCuff pressure controller

11.09.2017
Author: Hamilton Medical, Reviewer: NA

The IntelliCuff® pressure controller automatically maintains the desired cuff pressure to protect patients from ventilator-associated pneumonia and tracheal injuries.

cuff pressure, intellicuff, setup, handling

Preparing Hamilton Medical ventilators for use

11.09.2017
Author: Hamilton Medical, Reviewer: NA

Learn how to set up your HAMILTON-C1/C2/C3/T1/MR1 ventilator in just a few quick steps.

set up, check, preop, t1

How ASV works

11.09.2017
Author: Hamilton Medical, Reviewer: NA

The intelligent ventilation mode Adaptive Support Ventilation (ASV®) adjusts respiratory rate, tidal volume, and inspiratory time breath-by-breath, 24 hours a day, depending on the patient’s lung mechanics and effort.

asv, adaptive support ventilation, lung protective, volume-targeted, pressure-controlled, tidal volume

Setting PEEP using transpulmonary pressure measurement

11.09.2017
Author: Hamilton Medical, Reviewer: NA

One of the greatest challenges when mechanically ventilating patients is finding the correct setting for positive end-expiratory pressure (PEEP). This task can be made easier by using transpulmonary pressure measurement to distinguish between the pressure in the lungs and the chest wall components.

TPM, transpulmonary pressure, measurement, esophageal catheter, PEEP, setting PEEP

Volumetric capnography

11.09.2017
Author: Hamilton Medical, Reviewer: NA

By knowing how CO2 behaves on its way from the bloodstream through the alveoli to the ambient air, you can obtain useful information about ventilation and perfusion. Monitoring the CO2 level during respiration (capnography) is noninvasive, easy to do, and relatively inexpensive.

volumetric capnography, capnography, capnogram, CO2 measurement, CO2 sensor

Esophageal catheter placement

11.09.2017
Author: Hamilton Medical, Reviewer: NA

Correct placement of the esophageal catheter and balloon is critical for ensuring accurate transpulmonary pressure measurement (TPM).

esophageal pressure, measurment, Pes, Peso, esophageal catheter, esophageal balloon, s1, hamilton-s1

Bedside tip: How to select SpO2 targets

30.08.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

In mechanically ventilated patients, SpO2 targets are selected according to the previous lung condition and the actual severity of the disease.

spo2, spo2 targets, ARDS, normal lung, hypercapnia, brain injury, PEEP

Bedside tip: How to measure driving pressure

30.08.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

Airway driving pressure is associated with clinical outcomes in ARDS, post-surgical, and normal-lung patients, and is a measure of the strain applied to the respiratory system and the risk of ventilator-induced lung injuries. Evidence suggests we should keep driving pressure below 14 cmH2O. But how can we measure it?

driving pressure, hold maneuver, end-expiratory, end-inspiratory, plateau pressure, PEEP, ASV

Bedside tip: How to wean with ASV®

30.08.2017
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini

The American Thoracic Society and the American College of Chest Physicians recently provided recommendations to help optimize liberation from mechanical ventilation in adult ICU patients (1). They suggest using a ventilator liberation protocol and performing spontaneous breathing trials (SBTs) with modest inspiratory pressure support (5-8 cmH2O). So how do we implement these recommendations using the Adaptive Support Ventilation (ASV) mode?

weaning, wean, ASV, recommendations, liberation, protocol, criteria, readiness-to-wean

Test your IntelliVence (Vol 14 Issue 3)

29.08.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms, Simon Franz

What causes the distortions of pressure and flow during the second breath?

triggering, reverse triggering, muscle contractions, insufflation, double inspiration

Test your IntelliVence (Vol 14 Issue 2)

29.08.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

Why are there oscillations in the pressure and flow waveforms?

oscillations, pressure waveform, flow waveform, proximal airways, distal airways, secretions

Test your IntelliVence (Vol 14 Issue 1)

13.07.2017
Author: Dr. med. Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France, Reviewer: Paul Garbarini

What does this small bump at the beginning of expiration represent?

expiration, premature, cycling, cycles, inspiratory, effort, insufflation, trigger sensitivity