Siemens Servo i Talk about fewer bells and whistles, but much more straightforward to use, better designed, like a well-designed cell phone compared to my father in law’s. “Newer” isn’t necessarily better.

Servo i Mosby’s Respiratory Care Equipment Chapter 12 pages 531 - 549 Battery contains 2-6 modules of 12V 3 hour charge time 30 min running time EACH Bring in vent and talk about how it is an upgradeable platform; the shell should stay the same for a long time, and just upgrade the software, and add modules for new stuff. Will give you a readout as to actual battery length remaining.

Servo i Microprocessor-controlled Electrically and pneumatically driven Internal drive is the same as the Servo 300 Solenoid valve (rapid response) Flow measured by an ultrasonic transducer Pressure measured by pressure transducers Internal drive is not the same as the 300, take out for next year. Consider it a completely new ventilator, not an upgraded 300. Pressure measured by pressure transducers, as opposed to…? Solenoid valve? Take out as well. All new vents should be rapid response.

Modes Volume control Pressure control PRVC (Same as Servo 300) SIMV – With PC, VC, or PRVC breaths PS/CPAP Volume support Bi-Vent (APRV) NIV PRVC is not the same on this vent as on the 300! PRVC on the 300 did a step-up procedure to start the PRVC. The Servoi does a VC breath at set Vt and puts a pause on it. It measures compliance and resistance. It uses the plateau pressure as the pressure for the next breath. It also has an open/floating exp valve so that pressure can be relieved and adjusted throughout the breath.

Non-Invasive Ventilation Select at the start of the vent set-up Automatic compensation for leakage to maintain PEEP and pressure level set Modes available PC and PS (Controlled breath vs. spontaneous) Backup ventilation available in PS mode PS – Gives you the option of CPAP.

Servo i Adjuncts EtCO2 Open lung tool Y sensor monitoring Ultrasonic nebulizer NAVA Battery module

Servo i Standby is on the bottom left corner. Fixed knobs/keys allow instant adjustment of primary parameters.

Fixed Keys Start/stand-by Start breath O2 breaths – 100% O2 for one minute Expiratory hold – End expiratory pause pressure Inspiratory hold – Plateau pressure and static compliance calculated To get a static compliance value you must do both an insp and exp hold. Why? To account for autopeep.

Servo i Quick Access Key on right side of screen Access to Suction support Loops Waveform configuration Open lung tool

Servo i Trigger sensitivity 2L/min bias flow for flow triggering (Adult mode) Bar graph with green and red Closer to ‘0’ means less sensitive To the left of ‘0’ pressure-triggering begins, although 2L/min is still flowing This may increase WOB if there is no leak around the ETT Talk about colours on flow trigger. Doesn’t increase WOB! All new vents have bias flow, what is the leak around ETT stuff?

Servo i During the pre-use check, tubing compliance is calculated One has the option of turning tubing compensation on or off In what situations would it be beneficial to turn tubing compliance off? Can’t think when I’d want it off. Ask around.

Automode The patient starts on the control mode of ventilation, then when they trigger a breath they are switched to the support mode automatically If the patient becomes apneic, the vent switches back to the control mode Volume control – Volume support PRVC – Volume support Pressure control – Pressure support Very important to monitor the ‘Trend Screen’ closely to be aware how much time is spent in each mode before extubation Intended for quick wean patients, e.g. Post-op Another attempt at an automatic weaning mode. Successful? Maybe/maybe not. Not currently used clinically in Edmonton. How do you know on trend mode? Very hard, as it does differentiate between spont. breaths, RR, MV. Can only tell by maybe looking at change in Vt

Servo i Options Suction support Used for open suction technique Pre-oxygenates (2 minutes) and post-oxygenates (1 minute) Suspends alarms for 60 seconds during disconnect Flow is suspended until the patient is reconnected Nebulizer is paused during disconnect FiO2 can be set Different than 100% button, found under quick access. Nebulizer is an added ultrasonic module, can be also used on the Servo 300

Open Lung Tool Hess, Mechanical Ventilation; pages 141 - 144 An application of PEEP and alveolar recruitment as a lung protective strategy Accessed through the ’Quick Access’ key Balances compliance with optimal PEEP Uses end tidal CO2 measurement Patient must be hemo-dynamically stable Second line misleading; sounds like a press release. How exactly does it balance compliance with optimal peep? Can use ETCO2 if you have it available. Can use open lung tool on anyone. Using an open lung strategy (recruitment, finding optimal peep and ventilation pressures) should be done on hemo-dynamically stable patients. Talk about recruiting a patient 30 min post arrest who had sats in the low 70s on peep 12, FiO2 100%. What should we do? (CXR, Bronch, check for tube placement.)

Open Lung Tool Plots compliance over the pressure/volume curve Provides a breath-by-breath analysis of End insp. pressure PEEP Tidal volume Dynamic compliance Tidal CO2 elimination First line pretty confusing. Basically just a trending tool. Not sure if it provides breath-by-breath analysis. Bring vent into the class and demonstrate. What it does is chart/trend pressure, volume and dynamic compliance, and etCO2 if you have it.

Backup Ventilation Apnea settings are pre-set VS to VC, RR=15, I:E 1:2 PS to PC, RR=15 I:E 1:2 and pressures of PS level or 20cmH2O, whichever is greater (Backup is different for infants) Same Vt from Vs to VC. Can’t choose to go to PRVC – too bad (check on this).

Neurally Adjusted Ventilatory Assist NAVA was approved by the FDA in 2007 Relies on detection of the electrical activity of the diaphragm to control the timing and level of assistance Gives the opportunity to avoid over- or under-assisting the patient No delay between the signal for a breath and delivery Will give out my own notes and do my own lecture on this.

NAVA A special NG tube with sensors must be inserted (Edi catheter) and attached to the ventilator (can still be used an NG tube) Edi catheters are very expensive The operator can set the level of assistance (0-30cmH2O/uV)

NAVA Pt should have spontaneous efforts The vent begins inspiration as soon as the diaphragm begins to depolarize Level of sensitivity can be set (range, 0-2uV) Backup ventilation can be either PS or PC based on Edi trigger level Good for failure to wean patients, neuro, disynchronous with vent