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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.
Influence of CO2 signal quality on INTELLiVENT-ASV automatic MinVol management11.11.2019
Incorrect positioning of the CO2 mainstream sensor may affect the quality of the signal. When using INTELLiVENT®-ASV®, an unreliable signal may in turn affect the automated adjustments, as these are dependent on the quality index of the signal from the sensor.
Sensor Placement, Intellivent, Capnography, Ventilation Controller, Airway Adapter, Flow sensor
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Using INTELLiVENT-ASV in patients with severe V/Q mismatch07.11.2019
When using INTELLiVENT-ASV®, how can I increase %MinVol when PetCO2 is low and the CO2 target shift setting is already on the maximum of -20?
asv, intellivent, petco2, minute volume, target shift, shunt, vq, mismatch, paco2
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Test your IntelliVence (Vol 16 Issue 4)07.11.2019
Why is the volume curve not returning to zero?
leaks, cuff pressure, tracheal tube, positive flow, volume curve, flow curve
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Bedside tip - Managing cuff pressure in children intubated with cuffed tubes07.11.2019
The choice of tube size for uncuffed tubes is commonly made according to Cole`s formula (Age/4 + 4 mm); for cuffed tubes a size 0.5 mm smaller is recommended. The cuff pressure needs to be sufficient to avoid leakage during mechanical ventilation, and also to completely seal the airway and prevent micro-aspiration (thus preventing ventilator-associated pneumonia).
cuffed tubes, intubation, cuff size, cuff pressure, adjustment, leakage, pressure test, IntelliCuff
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Bedside tip: How to diagnose and avoid ineffective efforts08.07.2019
An ineffective effort is defined as a patient effort that is unable to trigger the delivery of a mechanical breath.
Ineffective effort, trigger threshold, waveforms, autoPEEP, pressure support, expiratory trigger sensitivity, ETS
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Test your IntelliVence (Vol 16 Issue 3)08.07.2019
Which patient/ventilator dyssynchrony is present here (blue arrow)?
ineffective effort, patient effort, airway pressure, expiratory flow, waveform, pleural pressure, PES
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Positioning and maintenance of breathing circuit sets04.05.2019
The application note available for download below provides valuable information about the positioning and maintenance of breathing circuits and their components.
breathing circuit, circuit set, position, maintenance, expiratory valve, secretion, occlusions, flow sensor, neubilizer, filter, expiratory port
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Test your IntelliVence (Vol 16 Issue 2)23.04.2019
The volumetric capnography loop displayed is from a passive patient ventilated in PC mode. What does its shape tell us?
volumetric capnography, airway deadspace, PEEP, ventilation perfusion ratio, airway resistance, ventilation perfusion mismatching
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Bedside tip: Using volumetric capnography to set PEEP23.04.2019
PEEP is used to keep the lung aerated and prevent lung collapse at the end of expiration. However, PEEP may over-distend the normally aerated lung and impair lung perfusion. Therefore, any change in PEEP may affect the overall ventilation/perfusion ratio in an unpredictable way.
volumetric capnography, setting PEEP, PEEP, ventilation perfusion ration, recruitment, VeCO2
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New videos for HAMILTON-C1/T1/MR104.03.2019
This series of four videos gives you a concise overview of important aspects related to operation of the HAMILTON-C1/T1/MR1, demonstrated on the HAMILTON-T1.
HAMILTON-T1, HAMILTON-C1, HAMILTON-MR1, videos, settings, Ventilation Cockpit, alarms, operation,
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Explaining the expiratory time constant04.03.2019
The expiratory time constant (RCexp) provides valuable information about the patient's lung mechanics. |
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Bedside tip: Achieving effective ventilation using volumetric capnography18.02.2019
Ventilation is effective when it removes CO2 at a rate that maintains a normal or a targeted pH.
effective ventilation, volumetric capnography, paco2, petco2, co2 production, co2 elimination, minute ventilation, tidal volume, dead space, alveolar ventilation, V'alv, V'CO2
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Test your IntelliVence (Vol 16 Issue 1)18.02.2019
The patient is being ventilated in volume assist control mode. What does the change of shape of the pressure curve represent?
flow starvation, inspiratory pressure, flow, pressure curve, inspiratory effort, decrease
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Heliox therapy with the HAMILTON-G5/S115.02.2019
Heliox, a mixture of helium and oxygen, may be indicated for patients in cases of acute and life-threatening upper airway obstruction.
g5, s1, heliox, obstruction
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Test your IntelliVence (Vol 15 Issue 6)07.01.2019
This intubated patient is being ventilated in PSIMV+ mode. What kind of asynchrony is visible in the breath marked by the cursor?
Delayed cycling, cycling, flow curve, asynchrony, PSIMV
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Bedside tip: Initial settings for the most important NIV parameters in children19.12.2018
The success of NIV depends on the right choice of equipment and adjustment of the settings to suit each individual child. In this Bedside Tip, we show you the initial settings for the most important parameters when applying NIV therapy in children.
NIV, parameters, pediatric, peak pressure, ETS, pressure support, TI, PEEP, inspiratory trigger, ramp
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Pinsp setting in NIV-ST05.11.2018
My patient is being ventilated in NIV-ST mode and the clinician has ordered PEEP of 5 cmH2O and pressure support of 5 cmH2O. On my Hamilton Medical ventilator the control for adjusting pressure support in NIV-ST is labelled Pinsp (for HAMILTON-G5/S1: Psupport). So what value do I need to set?
Pinsp, Pcontrol, Psupport, NIV, NIV-ST, ncpap-ps, psimv+, asv
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HAMILTON-T1 for ventilator-assisted preoxygenation05.11.2018
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
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Bedside Tip: How to measure esophageal pressure correctly19.10.2018
A recent physiological study demonstrated that esophageal pressure estimates the pleural pressure at mid-thorax at all levels of PEEP. Therefore, an absolute measurement of esophageal pressure is useful for setting PEEP and monitoring transpulmonary pressure.
esophageal pressure measurement, how to measure, positioning, esophageal balloon, esophageal catheter, inflation, balloon filling, verification, occlusion test
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Test your IntelliVence (Vol 15 Issue 5)19.10.2018
This intubated patient is ventilated in pressure-support mode. What is the explanation for the sudden increase in esophageal pressure?
quiz, esophageal pressure, esophageal contraction, peristalsis, catheter placement, balloon inflation, pressure, esophageal pressure measurement
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How do Hamilton Medical ventilators monitor P0.104.09.2018
P0.1 is a parameter mainly known as a mechanical index of respiratory drive.
P0.1, respiratory drive, pressure drop, compensation, occlusion
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Test your IntelliVence (Vol 15 Issue 4)08.08.2018
Why is the current volumetric capnogram loop different from the reference loop?
pulmonary embolism, capnography, volumetric capnography, dead space, VDalv, PetCO2, capnogram
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Bedside tip: Assessing lung recruitability08.08.2018
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
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Bedside tip: Using measured airway mechanics in pediatrics12.06.2018
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
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Test your IntelliVence (Vol 15 Issue 2)25.04.2018
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
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Bedside tip: How to use the expiratory time constant25.04.2018
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
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Test your IntelliVence (Vol 15 Issue 1)20.03.2018
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
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Best-practice breathing circuit configuration for transport with HAMILTON-C1/T1/MR105.03.2018
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
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Calculation of V’alv, VDaw and VDaw/VTe02.03.2018
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
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PaCO2 - PetCO2 gradient and target shift02.03.2018
INTELLiVENT®-ASV® uses partial pressure of end tidal CO2 (PetCO2) measured by the CO2 sensor as monitoring input for the regulation of ventilation. The measured PetCO2 value is used to track partial CO2 pressure in the arteries (PaCO2).
Target shift, PetCO2, PaCO2, BGA, blood gas, target range, measured PetCO2
INTELLiVENT
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Adjusting the %MinVol in ASV mode02.03.2018
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
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Static compliance (Cstat) vs. dynamic compliance (Cdyn)02.03.2018
Why do Hamilton Medical ventilators monitor static compliance (Cstat) instead of dynamic compliance (Cdyn)?
measurement, respiratory mechanics, cstat, cdyn, resistance, compliance, static, dynamic
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Measured values for Ppeak and Pplateau02.03.2018
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
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Using APV mode on infants with an uncuffed ETT02.03.2018
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
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Measurement of AutoPEEP and total PEEP02.03.2018
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
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Translating competitors' ventilation modes into Hamilton Medical modes02.03.2018
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
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Bedside tip: How to set expiratory trigger sensitivity (ETS)22.02.2018
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
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APV vs. TCPL and PCV in neonates19.02.2018
Ventilators from Hamilton Medical offer the volume-targeted modes APVcmv/APVsimv (Adaptive Pressure Ventilation) as an alternative Time-Cycled Pressure Limited (TCPL) and Pressure-Controlled Ventilation (PCV) for neonates. There is strong evidence in the literature for the use of volume-targeted ventilation in neonates (see references below).
TCPL, PCV, APV, volume targeted, pressure controlled, adaptive pressure ventilation, neonates, neonatal ventilation, volutrauma
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Spontaneous breathing trial (SBT) in ASV mode16.02.2018
How can I perform a spontaneous breathing trial when my patient is being ventilated with ASV®?
ASV, SBT, weaning, pressure support, MInVol, breathing rate, spontaneous
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Use of two sensors in close proximity16.02.2018
Is there anything to consider when using two SpO2 sensors in one patient?
Sensors, next, fingers, close, interference, measurements
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FAQs - Speaking valve option16.02.2018
Hamilton Medical offers an optional speaking valve function for the HAMILTON-C1/T1/MR1 ventilators. This function can be activated in the pressure-controlled modes Spont, PCV+ and P-SIMV+.
Speaking valve, pressure control, PEEP, pressure support, airtrapping
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Test your IntelliVence (Vol 14 Issue 5)19.12.2017
Why is the end-expiratory flow positive (above baseline)?
NIV, noninvasive ventilation, leak compensation, end-expiratory flow, leak rate
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Bedside tip: How to set high flow oxygen therapy15.12.2017
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
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Neonatal ventilation with the HAMILTON-C1/T1/MR103.10.2017
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
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Test your IntelliVence (Vol 14 Issue 4)02.10.2017
What causes this temporary stop in breathing?
Cheyne stokes, CSR, apnea, stop breathing
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Bedside tip: How to perform a recruitment maneuver02.10.2017
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
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Esophageal catheter placement11.09.2017
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
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Volumetric capnography11.09.2017
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
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Setting PEEP using transpulmonary pressure measurement11.09.2017
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
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How ASV works11.09.2017
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
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What is INTELLiVENT-ASV11.09.2017
In conventional ventilation modes, the clinician sets ventilator controls such as tidal volume, respiratory rate, and expiratory and inspiratory time to achieve clinical targets, including a certain level of oxygenation and alveolar ventilation for the patient.
intellivent, ASV, targets, oxygenation
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Preparing Hamilton Medical ventilators for use11.09.2017
Learn how to set up your HAMILTON-C1/C2/C3/T1/MR1 ventilator in just a few quick steps.
set up, check, preop, t1
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Using the IntelliCuff pressure controller11.09.2017
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
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Bedside tip: How to select SpO2 targets30.08.2017
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
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Bedside tip: How to measure driving pressure30.08.2017
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
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Bedside tip: How to wean with ASV®30.08.2017
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
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Test your IntelliVence (Vol 14 Issue 3)29.08.2017
What causes the distortions of pressure and flow during the second breath?
triggering, reverse triggering, muscle contractions, insufflation, double inspiration
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Test your IntelliVence (Vol 14 Issue 2)29.08.2017
Why are there oscillations in the pressure and flow waveforms?
oscillations, pressure waveform, flow waveform, proximal airways, distal airways, secretions
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Assessing lung recruitability and setting PEEP using the P/V Tool Pro®28.08.2017
In acute respiratory distress syndrome (ARDS) patients, a recruitment strategy combines recruitment maneuvers (RMs) and positive end-expiratory pressure (PEEP) to prevent atelectrauma.
Lung recruitment, recruitment maneuver, PV Tool , ARDS, VILI, PEEP
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Test your IntelliVence (Vol 14 Issue 1)13.07.2017
What does this small bump at the beginning of expiration represent?
expiration, premature, cycling, cycles, inspiratory, effort, insufflation, trigger sensitivity
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Recommended sizes for nCPAP interfaces25.09.2016
The table displayed here, which is included with all the relevant consumables sold, shows the various sizes of bonnets, prongs and masks, and the corresponding recommended head circumferences and weights.
nCPAP interface, size, mask, prongs, bonnets, weight, height
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