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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.
Bedside tip: How to estimate mechanical power in volume- and pressure-control ventilation24.02.2021
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
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PaCO2 - PetCO2 gradient and target shift29.01.2021
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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Helmet NIV (NIPPV) ventilation on adult COVID-19 patients05.01.2021
All Hamilton Medical ventilators are able to deliver noninvasive ventilation through a helmet.
NIV, NIPPV, helmet, COVID, COVID 19, coronavirus
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Safe use of Hamilton Medical ventilators on patients with highly infectious diseases05.01.2021
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
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Calculation of V’alv, VDaw and VDaw/VTe05.10.2020
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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Best-practice breathing circuit configuration for transport with HAMILTON-C1/T1/MR102.10.2020
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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Influence of CO2 signal quality on INTELLiVENT-ASV automatic MinVol management02.10.2020
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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Esophageal catheter placement09.09.2020
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
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Bedside tip: How to recognize increases in expiratory filter resistance07.09.2020
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
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Journal Club: Driving pressure and mechanical powers selected by INTELLiVENT-ASV17.07.2020
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
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Bedside tip: How to set high flow oxygen therapy16.07.2020
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
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Calculating oxygen consumption for Hamilton Medical ventilators30.06.2020
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
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Liquid vs. air-filled cuff during air transport11.06.2020
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
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Journal Club: Pressure Muscle Index10.06.2020
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
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Pressure target increase in P/V Tool vs. continuous low flow05.06.2020
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
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Journal Club: Atypical phenomena of COVID-19 induced ARDS03.06.2020
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
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Journal Club: Mechanical power and the reduction of VILI16.04.2020
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
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Journal Club: Effect of personalized MV on clinical outcomes in ARDS patients16.04.2020
Does a personalized ventilation strategy affect outcomes in ARDS patients?
PEEP, recruitment maneuvers, RMs, ARDS, LIVE study, personalized ventilation, personalized strategy
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Limitation on %MinVol in INTELLiVENT®-ASV®09.04.2020
Why can’t the %MinVol (percentage of minute ventilation) increase automatically to more than 200% in INTELLiVENT-ASV*?
INTELLiVENT-ASV, INTELLiVENT, increase MinVol, minute ventilation, automatic increase, manual
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Use of AnaConDa with Hamilton Medical ventilators09.04.2020
How do I use the AnaConDa§ (Anaesthetic Conserving Device from Sedana Medical) with Hamilton Medical ventilators?
AnaConDa, anaconda, anesthetic, delivery, filter, position, connection
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Can I measure work of breathing for patient and ventilator?09.04.2020
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
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Using one ventilator for multiple patients09.04.2020
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
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Use of muscle relaxants in ARDS patients09.04.2020
Should muscle relaxants be used in ARDS patients?
Muscle relaxants, NM, NMBA, blocking agent, sedation, ARDS, Rose trial, Acurasys, mortality, prone position, myorelaxants
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Lung recruitment in patients with mixed lung diseases09.04.2020
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
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Alarm "ASV: cannot meet target" during manual SBT with ASV09.04.2020
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
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How to set INTELLiVENT®-ASV® for a (COVID-19) ARDS patient07.04.2020
This article gives you step-by-step instructions on how to set the ventilator when using the ventilation mode INTELLiVENT-ASV* on ARDS patients.
INTELLiVENT, ASV, settings, ARDS, PEEP
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COVID-19: Respiratory treatment in critical care – current recommendations23.03.2020
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
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How to set ASV® correctly for a (COVID-19) ARDS patient23.03.2020
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
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Efficiency of HEPA filters18.03.2020
Does a High Efficiency Particulate Air (HEPA) filter offer full protection against viral cross-contamination?
HEPA, particulate, virus, filter, filter class, efficiency, particles, bacteria
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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Adjusting the %MinVol in ASV mode24.08.2017
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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Calculating Pplateau with HAMILTON-C1/T1/MR1 ventilators14.07.2017
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
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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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