1. © 2002-2003, James H Philip, all rights reserved
New Anesthesia Delivery Systems at BWH Ohmeda Aestiva Draeger Fabius GS
Draft C
© , James H Philip, all rights reserved

2. Ready

3. James H Philip MD CCE Draft C
New Anesthesia Delivery Systems at BWH Ohmeda Aestiva Draeger Fabius GS
James H Philip MD CCE
Draft C

4. Short Clinical Conference first Surprise !!

5. Case 1 Ohmeda Aestiva 65 yo M for CABG on a Tuesday morning.
You induce anesthesia, intubate the trachea and confirm correct tube placement.
You turn on the ventilator on your Ohmeda Aestiva Anesthesia Machine
Ventilator alarms “Cannot Deliver Correct Volume”
Soon, it alarms “Cannot Ventilate”
If you know what is wrong and how to correct it Raise your hand now
If you do not know what is wrong and how to correct it Raise your hand now

6. Case 2 Draeger Fabius GS 45 yo M for Thoracotomy on a Saturday
You intubate trachea and confirm tube placement.
You turn on the ventilator on your Draeger Fabius GS Anesthesia Machine
Vent Monitor shows alarm “Vent Fail” There is no mechanical ventilation
If you know what is wrong and how to correct it Raise your hand now
If you do not know what is wrong and how to correct it Raise your hand now
Draeger Fabius GS

7. Ventilators do fail 1) Use reservoir bag and manually ventilate
2) If all else fails, use the Manual Resuscitator (Ambu Bag) on the back of the Anes Mach.
3) Determine ventilator problem and eliminate it Get help Repair your self

8. Ohmeda SmartVent Design
SmartVent is used in these Ohmeda ADSs SmartVent 7900 Aestiva
Compare expired volume to set volume
Adjust the next breath to correct this
by adjusting movement of the bellows
Flow sensors are the key element
They are required for ventilation
Measurement is more difficult than Control

9. Key Element = Flow Sensors

10. Differential Pressure Flow SensorsDP
Differential Pressure Flow Sensors DP

11. Differential Pressure Flow Sensor
Pressure Transducer
Variable Orifice
Flow

12. When Aestiva or any Ohmeda SmartVent fails
Usually a wet flow sensor
User Action
Ventilate by hand
Change or shake dry the flow sensors
Call for help if required

13. Fabius GS Introduction
We will soon have > 15 of these machines
We all must learn about them
We each must document that we have learned
Dept could not buy “old machines” They are no longer for sale
Dept did not buy more Ohmeda Aestivas Early failures led some clinicians to be wary

14. Gas flow interface Mechanical Needle Valves and Electronic Flow Measurement and Display
Pipeline pressures
Total flow
Mechanical
rotameter
Digital flow display
O2 supply low LED
Flow control valves
Wall
pressure
gauge

15. High-resolution display at BWH
Pipeline pressures
Total flow
Mechanical
rotameter
Finer needle
Valves
Are
coming
Digital flow display
O2 supply low LED
Flow control valves
Wall
pressure
gauge

16. User Control Many Keys, One Knob
Alarm Lamps
Warn
Caution
Advisory
Alarm limits
Ventilation mode
Alarm Silence
Volume
Setup menu
Pressure
Future 1
Future 2
AC power LED
Standby
Reading lamp
Home screen
Function
Rotary Control Knob
And, Press to Confirm

17. Ventilation Monitor Screen
Alarm Thresholds
Time
Alarm messages
Status
Inspired Oxygen
Fresh Gas Virtual flowmeters
Ventilation Volume
Ventilation Pressure
Pressure threshold
Pressure waveform
Function key descriptions

18. COSY COmpact SYstem for CO2 Absorption

19. COSY Breathing System – Top
Expiratory valve
Expiratory port
APL valve
Manual breathing bag connection
PEEP / Pmax valve
Inspiratory port
APL bypass valve
Inspiratory valve

20. COSY Breathing Circuit - Bottom
Flow sensor
Scavenging connection
Fresh gas hose connection
Pressure sensor connection
Ventilator hose connection
Absorber canister

21. Ventilator (eVent) Electrically driven = consumes no drive gas
Ventilation Modes Volume controlled Pressure controlled + future options
Easy access to ventilator by opening ventilator door but, can’t see much
Ventilator movement visible through window
Ventilation Monitor displays all information

22. Ventilator
Piston

23. Flow sensor

24. Hot wire is cooled by flow
Anemometer

25. Cause of Ventilation Failure
Piston and its membrane are mis-aligned because
Membrane has been drawn off piston surface
This occurs from negative pressure in circuit
Immediate Solution Cycle ventilator off and on times Vacuum draws membrane to piston. Problem is solved. Ventilator ventilates.
Long term Solution Draeger believes that this no longer occurs. Piston software prevents this.

26. Let’s look at Fabius GS Breathing Circuit

27. Constant Volume FGF Decoupling COSY-1

28. Puff Leak from high flow through CO2 Absorber caused re-design

29. Constant Volume FGF Decoupling COSY-2
Prev
Bag
location
Moved

30. Constant Volume FGF Decoupling
Fresh Gas is
Stored until
the next breath

31. Virtual Anesthesia Machine
Operation
Simulation
Virtual Anesthesia Machine
Virtual Fabius GS
University of Florida
Sem Lampotang

32. VAS

33. Check Out and Use

34. Power Switch ON
Hidden on Back of Machine
OFF

35. Fabius GS Startup Standby when not in use No need to power off
Startup simple and straightforward
No automatic self test
Manual leak test
Manual calibration of sensors

36. Gases Connect pipeline gas supplies Connect reserve cylinders
Check that the supply pressures are in the specified range (green zone)
Connect reserve cylinders
Check cylinder pressure (open and re-close cylinder valve
Verify pressure (O2 > 725PSI, N2O > 435 PSI)

37. Electric Verify electrical connection Verify Power Switch is on
The green LED on the user interface illuminates whenever AC power is connected
Verify Power Switch is on
Power switch is located on the rear next to the AC power cord

38. Internal Diagnostics are automatic
Result FUNCTIONAL
CONDITIONALLY FUNCTIONAL - Use
Non-critical fault
Use machine now - Press Rotary Knob
Call for repair BB to continue operation.
NON-FUNCTIONAL - Don’t use
Serious fault was detected Can’t use it

39. 1 2 3 User Tests Defaults to Standby
User Tests components Simply follow directions
System Test (done)
Calibrate Flow Sensor
Calibrate O2 Sensor
Run Leak Test
Access alarm log
Restore site defaults
Done 1 2 3
Show all

40. Calibrate Flow Sensor
Hot-wire flow sensor (Spirolog®) Julian and Evita products.
Calibration time <15 seconds

41. Standby Mode Run Leak Test
The leak test function key opens the support page for the leak test
Leak test instructions
Airway pressure numeric
Oxygen flow numeric
For machines equipped with the auxiliary pressure gauge, the leak test can be performed by building up a pressure of 30 cmH2O and observing the pressure drop on the gauge.
The leak test includes the vaporizers. There is no need for a negative pressure test.

42. Calibrate Oxygen Sensor
Defaults to Standby
User Tests components
System Test (done)
Calibrate flow sensor
Calibrate O2 sensor
Run leak test
Access alarm log
Restore site defaults

43. Calibrate Oxygen Sensor
Calibration time is < 15 seconds
Room air 2 minutes first !

44. [Access Alarm Log] Access Alarm Log Alarm History up to 99 messages
The site defaults volume control settings, pressure control settings, alarm limits and alarm volume
can be restored by pressing the “Restore Site Defaults” function key.

45. Sleep Mode Do not power off, put to sleep
Happens after 5 minutes No Buttons pressed No Fresh Gas Flow
Pressing any button for Standby.
Emergency wakeup
Turn of FGF and awakens
Man/Spont mode
No confirmation required

46. Common Errors

47. Everything requires confirmation with Control Knob
Rotary Control
and
Push to Accept Knob

48. Flow Sensor can get wet Remove it, shake it dry, re-insert it
If replaced, calibrate before next case
Reported expired volume will be wrong
Delivered volume measured will be right

49. Compensate for Desflurane high conc
High concentration of desflurane
increases specific heat of the gas combo
cools hot wire anemometer more than right
Des Compensation On corrects this
Fabius GS does not measure agent so does not know when to correct

50. Leak and Functionality Check
You have done them, automatically
And, the ADS
knows it was checked
compensates for compliance

51. Further Fabius GS Education
Duty Room today Patrick Parisi, Draeger representative Mike Bradish Anes Engineering Elective Res
Support Info
ftp://jphilip.bwh.harvard.edu/technologyblock
Philip Grand Rounds Lecture Bradish Check Out Directions for Use PDF file BWH Check Out for older machines Anesthesia Written Board Exam Questions
Simulation at [University of Florida]

52. Thank you
End

53. Anesthesia Machines November 5, 2003
Study Guide Anesthesia Written Board Exam Questions ftp://jphilip.bwh.harvard.edu/technologyblock My answers available to all who answer the questions
Grand Rounds New Anesthesia Delivery Systems at BWH Ohmeda Aestiva Draeger Fabius GS
Clinical Conference Anesthesia Ventilator Failures
Support Info ftp://jphilip.bwh.harvard.edu/technologyblock
Simulation at [University of Florida]

55. Clinical Conference

56. Case 1 Ohmeda Aestiva 65 yo M for CABG on a Tuesday morning.
You induce anesthesia, intubate the trachea and confirm correct tube placement.
You turn on the ventilator on your Ohmeda Aestiva Anesthesia Machine
Ventilator alarms “Cannot Deliver Correct Volume”
Soon, it alarms “Cannot Ventilate”
If you know what is wrong and how to correct it Raise your hand now
If you do not know what is wrong and how to correct it Raise your hand now
Answer Dry the flow sensor tubes Use an HME to keep circuit dry

57. Case 2 Draeger Fabius GS 45 yo M for Thoracotomy on a Saturday
You intubate trachea and confirm tube placement.
You turn on the ventilator on your Draeger Fabius GS Anesthesia Machine
Vent Monitor shows alarm “Vent Fail” There is no mechanical ventilation
If you know what is wrong and how to correct it Raise your hand now
If you do not know what is wrong and how to correct it Raise your hand now
Answer Cycle between Vent and Bag/Man Ask why software not upgraded
Draeger Fabius GS