Automatic adjustment of assistance

Level of ΔPASB is automatically adjusted in steps of 2-4 mbar to keep parameters within following ranges:

Spontaneous breathing rate	>15 bpm <30 bpm (<34 bpm for patients with respiratory failure due to neurological disorders)
Expired tidal volume	>250 ml (ideal body weight <55 kg) >300 ml (ideal body weight >55 kg)
End tidal CO₂	<55 mmHg (<65 mmHg for patients with COPD

Automatic weaning & weaning trial

ventilator automatically attempts to reduce ΔPASB in steps of 2-4 mbar while keeping parameters within the ranges shown above
when the level of ΔPASB reaches a predefined level (ΔPASB goal) the ventilator starts an observation period. If the patient's parameters remain within the ranges shown above for the observation period the ventilator recommends that the patient can be separated from the ventilator

Preconditions

patient body weight 35-200 kg
ventilator in adult mode
CPAP/ASB mode
automatic tube compensation deactivated
invasive ventilation via ETT or tracheostomy
apnoea ventilation on and properly set
end tidal CO₂ monitoring through the ventilator
flow monitoring activated
ΔPASB should be set between ΔPASB goal+5 mbar and 35 mbar
PEEP 0-20

	ΔPASB goal
Tracheostomy and active humidification	5 mbar
Endotracheal tube and active humidification	7 mbar
Tracheostomy and HME/filter	9 mbar
Endotracheal tube and HME/filter	12 mbar

Setting

Set alarms appropriately
In CPAP/ASB mode select the SmartCare tab

Select patient weight, airway access, medical history and night rest in turn and make the appropriate settings
- if night rest is turned on no weaning will take place during the specific period
After making all the appropriate settings select patient session and turn SmartCare on

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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