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. 


Using waveforms to identify asynchronies - Step 2

Author: Caroline Brown, Branka Cupic, Reviewer: Giorgio Iotti, Süha Demirakca

In the previous issue, our Bedside tip covered the starting point for identifying asynchronies using ventilator waveforms.

Using waveforms to identify asynchronies - Step 1

Author: Branka Cupic, Caroline Brown, Reviewer: Giorgio Iotti, Süha Demirakca

The first step to identifying asynchronies using standard ventilator waveforms is knowing what a synchronous breath looks like during pressure-support ventilation.

waveforms, respiratory activity, asynchrony, passive condition, active condition, pressure support, exponential decay, inspiratory effort, inspiratory flow, expiratory flow, Paw, flow, airway pressure, pes, esophageal pressure measurement

Journal Club: Flow Index - A new, noninvasive method to evaluate patient inspiratory effort during PSV 

Author: Marcela Rodriguez Jimenez , Reviewer: Munir Karjaghli

This presentation looks at an Italian study to investigate a novel, noninvasive method of evaluating the concavity of the inspiratory flow profile as an assessment of inspiratory effort during PSV.

Calculation of IBW in Hamilton Medical ventilators

Author: Kaouther Saihi, Thomas Laubscher, Reviewer: Bernhard Schmitt, Ralph Teuber

How is the ideal body weight (IBW) calculated in Hamilton Medical ventilators?

weight, ideal body weight, IBW, height, sex, patient group

Detecting complete airway closure in mechanically ventilated patients

Author: Jean-Michel Arnal, Intensivist, Hôpital Sainte Musse, Toulon, France, Reviewer: David Grooms, Süha Demirakca, Thomas Reimer

Repeated distal airway closure occurs during tidal ventilation in a significant proportion of mechanically ventilated ARDS patients due to a narrowing of the distal airways and surfactant depletion. It may cause damage to the distal airways and induce inflammation.

airway closure, ARDS, PEEP, recruitment, airway opening pressure, PV curve

Journal Club: Non-invasive assessment of respiratory muscle activity during PSV

Author: Marina Matos Rodriguez, Reviewer: Munir Karjahgli

While mechanical ventilation has been shown to result in a rapid loss of diaphragmatic strength in animals, there is less known about the time course of basis of ventilator-induced diaphragmatic weakness in humans.

respiratory muscles, Pmusc, least square fitting, lsf, occlusion method, esophageal pressure, respiratory activity

Use of AnaConDa with Hamilton Medical ventilators

Author: Thomas Reimer, Reviewer: Bernhard Schmitt, Matthias Himmelstoss, Kaouther Saihi, Munir Karjaghli

How do I use the AnaConDa§ (Anaesthetic Conserving Device from Sedana Medical) with Hamilton Medical ventilators?

AnaConDa, anaconda, anesthetic, delivery, filter, position, connection

Using the Trend function for PetCO2

Author: Joe Hylton, MA, BSRT, RRT-ACCS/NPS, NRP, FAARC, FCCM, Clinical Applications Specialist, Hamilton Medical Inc., Reviewer: Munir Karjahgli, Jean-Michel Arnal

It is well established that metabolism, perfusion, and efficient lung function are paramount to effective CO2 transport and elimination (1). Changes in a patient’s metabolic state, perfusion, or lung function can affect CO2 elimination, sometimes drastically.

Journal Club: Airway closure during surgical pneumoperitoneum in obese patients

Author: David Grooms, Reviewer: Munir Karjaghli

Airway closure is a frequent occurrence in obese patients during anesthesia and may be exacerbated by surgical pneumoperitoneum.

Journal Club: A non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during MV

Author: Màrcia Santos, Reviewer: Munir Karjaghli

Patient efforts during mechanical ventilation can have both beneficial and deleterious effects. Vigorous efforts generate pendelluft and amplify regional lung stress and strain, causing regional lung injury which may induce P-SILI.

high respiratory effort, inspiratory effort, assisted ventilation, dynamic pressure, dynamic lung stress, airway occlusion, spontaneous breathing, airway pressures

Journal Club: Change in plateau from peak pressure during inspiratory holds to identify effort and elastic workload

Author: Maritza Henriques, Reviewer: Munir Karjaghli

Applying the optimal level of assistance is one of the major challenges in mechanical ventilation.

Journal Club: Manual compression of abdomen to assess expiratory flow limitation

Author: Tim France, Reviewer: Munir Karjaghli

Our latest Journal Club presentation looks at expiratory flow limitation (EFL) and the use of abdominal compression as a means of assessment.

How to use high flow therapy in COVID-19 acute hypoxemic respiratory failure

Author: Aude Garnero, Intensivist, Hôpital Sainte Musse, Toulon, France, Reviewer: Jean-Michel Arnal, Süha Demirakca

High flow therapy (HFT) has been used widely during the COVID-19 pandemic. Published clinical experience is based mainly on retrospective studies and describes the main settings and the failure rate.

high flow, Hft, hfot, oxygen therapy, settings, adjustments, covid, pneumonia

Bedside tip: How to estimate mechanical power in volume- and pressure-control ventilation

Author: Justin Seemueller, Respiratory Clinical Specialist, Sentara Norfolk General Hospital, Reviewer: Jean-Michel Arnal, Süha Demirakca, David Grooms

As our understanding of VILI grows, there is a greater focus on mechanical power (MP) as a potential predictor of negative outcomes.

mechanical power, VILI, lung damage, pressure control, volume control, bedside, plateau pressure

Helmet NIV (NIPPV) ventilation on adult COVID-19 patients

Author: Bernhard Schmitt; Mirko Belliato, MD (Pavia, Italy), Reviewer: David Grooms, Munir Karjaghli, Thomas Reimer, Matthias Himmelstoss

All Hamilton Medical ventilators are able to deliver noninvasive ventilation through a helmet.

NIV, NIPPV, helmet, COVID, COVID 19, coronavirus

Safe use of Hamilton Medical ventilators on patients with highly infectious diseases

Author: Uwe Scherzer, Reviewer: Ralph Teuber, Ray Curtis, Kathrin Elsner

This article gives you an overview of possible measures that may be taken to ensure protection against internal contamination of the ventilators, as well as protection of patients and clinical staff.

infectious disease, corona virus, safety, infection prevention, contamination, epidemic, pandemic

Bedside tip

Author: N/A, Reviewer: N/A

This content is temporarily unavailable.

Calculation of V’alv, VDaw and VDaw/VTe

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

Influence of CO2 signal quality on INTELLiVENT-ASV automatic MinVol management

Author: Simon Franz, Reviewer: Matthias Himmelstoss, Thomas Reimer, Sebastian Hollenberg

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

Esophageal catheter placement

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, NutriVent, CooperSurgical

Measured values for Ppeak and Pplateau

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

Bedside tip: How to recognize increases in expiratory filter resistance

Author: Ken Hargett, Reviewer: Süha Demirakca, Matthias Himmelstoss, Simon Franz, Munir Karjaghli, David Grooms

It is well known that expiratory filters can become clogged with humidity and particles from nebulized medications trapped in the filter media (1).

RCexp, resistance, compliance, filter resistance, filter, occlusion, trending, expiratory flow, expiratory resistance, inspiratory resistance

Journal Club: Driving pressure and mechanical powers selected by INTELLiVENT-ASV

Author: Elmar Paetzold, Reviewer: Bernhard Schmitt, Munir Karjaghli, Simon Franz

Driving pressure and mechanical power are considered to be predictors of the risk of ventilation-induced lung injuries (VILI) in mechanically ventilated patients.

driving pressure, mechanical power, VILI, ventilator induced lung injury, lung injury, respiratory load, respiratory pressure

Bedside tip: Setting high flow oxygen therapy

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

High flow oxygen therapy combines several physiologic effects: Improved oxygenation, reduced inspiratory effort and work of breathing, improved lung mechanics, increased end-expiratory lung volumes (EELV), probably due to the positive end-expiratory pressure (PEEP) effect, increased carbon dioxide (CO2) clearance by washout of anatomic dead space, and improved comfort (1, 2).

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

Calculating oxygen consumption for Hamilton Medical ventilators

Author: Simon Franz, Reviewer: Bernhard Schmitt, Thomas Reimer, Munir Karjaghli, Sebastian Hollenberg

As at June 2020, many hospitals are housing far more ICU beds than normal. Many may also be using new makes or models of ventilators they are unfamiliar with. In order to work out the total amount of oxygen required under these changed circumstances, it is necessary to know how to calculate the oxygen consumption for a particular ventilator.

oxygen consumption, transport, oxygen, oxygen requirement, base flow, leaks

Performing open and closed suctioning maneuvers with Hamilton Medical ventilators

Author: Elmar Pätzold, Reviewer: Matthias Himmelstoss, Thomas Sperling, Thomas Reimer, Joel Feindt

The Suctioning maneuver on Hamilton Medical ventilators is intended to support the withdrawal of excessive tracheal and/or bronchial secretions in the patient's airways, while protecting the user from possible contamination and also ensuring the patient's safety during the maneuver.

suctioning maneuver, suctioning tool, 02 enrichment, closed suctioning, open suctioning, pre-oxygenation

Liquid vs. air-filled cuff during air transport

Author: Simon Franz, Reviewer: Matthias Himmelstoss, Thomas Sperling, Thomas Reimer, Joel Feindt, Bernhard Schmitt

During fixed- or rotary-wing transport, my usual practice is to inject 10 ml of saline into the cuff of the patient’s endotracheal tube to prevent over-inflation. What would be the advantage of using an air-filled cuff in combination with an automatic cuff-pressure controller in these situations?

cuff pressure, altitude, airplane, liquid-filled, air-filled, pressure measurement, ETT, IntelliCuff

Journal Club: Pressure Muscle Index

Author: Munir Karjaghli, Reviewer: Bernhard Schmitt

One of the most challenging aspects of managing mechanical ventilation is balancing the positive effects of the patient’s breathing efforts with the risk of of lung injury that may accompany strong spontaneous efforts.

Pressure muscle indec; PMI; airway occlusion; spontaneous effort; respiratory drive; pressure output

Pressure target increase in P/V Tool vs. continuous low flow

Author: Simon Franz, Reviewer: Matthias Himmelstoss, Thomas Reimer, Elmar Pätzold, Bernhard Schmitt

Does the Hamilton Medical P/V Tool® provide a real low flow pressure/volume (P/V) loop?

Low flow, P/V Tool, lung recruitment, pressure volume, curve, recruitment maneuver

Journal Club: Atypical phenomena of COVID-19 induced ARDS

Author: Belal Mohammad Ahmad Al-Rajoub, Reviewer: Munir Karjaghli; Bernhard Schmitt

Many patients with COVID-19 induced ARDS are presenting with a combination of characteristics rarely seen in severe ARDS.

COVID-19, covid-19 induced ARDS, phenotypes, characteristics, respiratory treatment

Journal Club: Mechanical power and the reduction of VILI

Author: Marcia Correia Abreu dos Santos, Reviewer: Bernhard Schmitt

Mechanical power has become a hot topic in discussions about optimizing ventilator settings for critically ill patients.

mechanical power, VILI, respiratory load, ventilator settings, lung-protective

Journal Club: Effect of personalized MV on clinical outcomes in ARDS patients

Author: Belal Al-Rajoub, Reviewer: Bernhard Schmitt

Does a personalized ventilation strategy affect outcomes in ARDS patients?

PEEP, recruitment maneuvers, RMs, ARDS, LIVE study, personalized ventilation, personalized strategy

Can I measure work of breathing for patient and ventilator?

Author: Munir Karjaghli, Reviewer: Bernhard Schmitt, Thomas Reimer, Matthias Himmelstoss, Kaouther Saihi

Work of breathing (WOB) represents the integral of the product of volume and pressure. It represents the energy associated with a given VT at a given pressure (spontaneous, mechanical, or both).

WOB, work of breathing, load, airway pressure, pleural pressure, transpulmonary pressure, pressure time product, Paw, Pes, Paux

Using one ventilator for multiple patients

Author: Matthias Himmelstoss, Reviewer: Bernhard Schmitt, Munir Kargajhli, Thomas Reimer, Kaouther Saihi

In an emergency, is it possible to connect several people to one ventilator? Using a Y-connector if necessary?

Multiple patients, several patients, lung-protective, one ventilator, splitting, connect

Use of muscle relaxants in ARDS patients

Author: Jean-Michel Arnal, Munir Karjaghli, Reviewer: Bernhard Schmitt, Thomas Reimer, Kaouther Saihi, Matthias Himmelstoss

Should muscle relaxants be used in ARDS patients?

Muscle relaxants, NM, NMBA, blocking agent, sedation, ARDS, Rose trial, Acurasys, mortality, prone position, myorelaxants

Lung recruitment in patients with mixed lung diseases

Author: Jean-Michel Arnal, Reviewer: Bernhard Schmitt, Thomas Reimer, Matthias Himmelstoss, Munir Karjaghli, Kaouther Saihi

Is the potential for recruitment in patients with mixed lung diseases (e.g., ARDS and COPD) less than in patients with ARDS only?

ARDS, COPD, mixed lung disease, recruitment potential, recruitability, assess, lung recruitment

Alarm "ASV: cannot meet target" during manual SBT with ASV

Author: Sasha Starcevic, Kaouther Saihi, Reviewer: Matthias Himmelstoss, Thomas Reimer, Bernhard Schmitt, Munir Karjaghli

When conducting a manual Spontaneous Breathing Trial by setting the %MinVol to 25% in ASV mode, the alarm “ASV: cannot meet target” is generated.

ASV, alarm, SBT, wean, cannot meet target, reduce %MinVol

How to set ASV® correctly for a (COVID-19) ARDS patient

Author: Munir Karjaghli, Reviewer: Bernhard Schmitt

This article describes step-by-step how to set the ventilator when using the Adaptive Support Ventilation (ASV) mode on ARDS patients.

ASV, adaptive support ventilation, settings, ARDS, ARDS net, tidal volume, recruitability, recruitment, assessment

COVID-19: Respiratory treatment in critical care – current recommendations

Author: Munir Karjaghli, Reviewer: Bernhard Schmitt, Matthias Himmelstoss, Jean-Michel Arnal

In this article we outline the current recommendations for the respiratory treatment of COVID-19 patients drawn from recent literature and guidelines issued by various organizations worldwide. They reflect the status as at the date of last change shown here.

COVID-19, ventilation, recommendations, ARDS, coronavirus

Efficiency of HEPA filters

Author: Uwe Scherzer, Caroline Brown, Reviewer: Bernhard Schmitt, Ralph Teuber

Does a High Efficiency Particulate Air (HEPA) filter offer full protection against viral cross-contamination?

HEPA, particulate, virus, filter, filter class, efficiency, particles, bacteria

Bedside tip - How to manage cuff pressure in children intubated with cuffed tubes

Author: Süha Demirakca, Reviewer: David Grooms

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, as well as 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

Bedside tip - How to diagnose and avoid ineffective efforts

Author: David Grooms, Reviewer: Jean-Michel Arnal

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

Positioning and maintenance of breathing circuit sets

Author: N/A, Reviewer: N/A

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

Bedside tip: Using volumetric capnography for setting PEEP

Author: Jean-Michel Arnal, Senior Intensivist, Ste Musse Hospital, Toulon, France, Reviewer: David Grooms

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

New videos for HAMILTON-C1/T1/MR1

Author: N/A, Reviewer: N/A

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,

Explaining the expiratory time constant

Author: Clinical Expert Group, Hamilton Medical, Reviewer: n/a

The expiratory time constant (RCexp) provides valuable information about the patient's lung mechanics.

Bedside tip: How to achieve effective ventilation using volumetric capnography

Author: Munir Karjaghali, Reviewer: David Grooms, Jean-Michel Arnal

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

Heliox therapy with the HAMILTON-G5/S1

Author: Clinical Experts Group, Hamilton Medical, Reviewer: NA

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

Bedside tip: Initial settings for the most important NIV parameters in children

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

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

Pinsp setting in NIV-ST

Author: Hamilton Medical, Reviewer: N/A

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

HAMILTON-T1 for ventilator-assisted preoxygenation

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

Bedside Tip: How to measure esophageal pressure correctly

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

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

How do Hamilton Medical ventilators monitor P0.1

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

P0.1 is a parameter mainly known as a mechanical index of respiratory drive.

P0.1, respiratory drive, pressure drop, compensation, occlusion

Bedside tip: Assessing lung recruitability

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

Bedside tip: Using measured airway mechanics in pediatrics

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

Bedside tip: How to use the expiratory time constant

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

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

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

Using APV mode on infants with an uncuffed ETT

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

Measurement of AutoPEEP and total PEEP

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

Bedside tip: Setting expiratory trigger sensitivity (ETS)

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

APV vs. TCPL and PCV in neonates

Author: Martin Henschke, Simon Franz, Reviewer: Bernhard Schmitt, Matthias Himmelstoss, Matthias Näf

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

Spontaneous breathing trial (SBT) in ASV mode

Author: Jean-Michel Arnal, Simon Franz, Reviewer: Matthias Himmelstoss, Sebastian Hollenberg, Thomas Reimer, Bernhard Schmitt

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

Use of two sensors in close proximity

Author: Sasha Starcevic, Reviewer: Matthias Himmelstoss, Thomas Reimer, Sebastian Hollenberg, Simon Franz

Is there anything to consider when using two SpO2 sensors in one patient?

Sensors, next, fingers, close, interference, measurements

FAQs - Speaking valve option

Author: Simon Franz, Reviewer: Matthias Himmelstoss, Thomas Reimer, Sebastian Hollenberg

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

Neonatal ventilation with the HAMILTON-C1/T1/MR1

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

Bedside tip: How to perform a recruitment maneuver

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

Setting PEEP using transpulmonary pressure measurement

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

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

How ASV works

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

Preparing Hamilton Medical ventilators for use

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

Using the IntelliCuff pressure controller

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

Bedside tip: How to select SpO2 targets

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

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®

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

Adjusting the %MinVol in ASV mode

Author: Aleh Satsishur, Simon Franz, Reviewer: Ralph Teuber, Matthias Näf, Thomas Sperling, Kaouther Saihi, Bernhard Schmitt

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

Calculating Pplateau with HAMILTON-C1/T1/MR1 ventilators

Author: Simon Franz, Reviewer: Matthias Näf, Thomas Sperling, Kaouther Saihi, Ralph Teuber

Even if the idea of a “safe” plateau pressure is already being questioned, it is still standard of care to use it for tailoring lung-protective ventilation in acute respiratory distress (ARDS) patients1. This gives rise to a common question asked by users of HAMILTON-C1/T1/MR1 ventilators: How can I measure/calculate Pplateau with my device?

Driving pressure, pplateau, plateau pressure, inspiratory hold, hamilton-c1, c1, t1, mr1

Recommended sizes for nCPAP interfaces

Author: Alexandra Gerlach, Reviewer: Ralph Teuber; Elmar Pätzold; Bernhard Schmitt

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