1. Setting up the NICO monitor to measure pulmonary dead space fraction (V d /V t )

2. Power the NICO monitor on: –Hospital grade power cord to back of NICO –Set power switch to the On “|” position. The monitor’s fan is on. The front panel power indicator light is on. The internal battery begins to charge

3. Front Panel Attachments: Capnostat ® Sensor pushed in (Do not twist or turn). Capnostat ® Sensor is not disposable Fresh, CO 2 -Flow Sensor for each patient CO2-Flow Sensors slide and snap into the Capnostat ® CO2-Flow Sensor and Capnostat ® are “keyed”, match the arrow on the CO2-Flow sensor to the arrow on the Capnostat ® Note: CO2-Flow Sensors are single use and are supplied by Respironics.

4. Basics on NICO front attachments: Capnostat ® CO 2 sensors always go through a warm up phase and connect by push insertion. The software will prompt and guide you if a zero to the sensor (Capnostat) is required. Zeroing is always performed with a CO 2 -flow sensor in place (and not in the patient circuit) Adult CO 2 -flow sensor is single patient use

5. 1. Turn on NICO by pressing the standby (power) button (1). 2. Press MENU (2), which opens “SELECT A SCREEN”. 3. Rotate knob (3) to highlight and press to select. 1 2 3 Examples will follow to show how to ZERO the Capnostat (with CO 2 -Flow sensor), set the date and time and erase trends.

6. More basics… Whenever zero is required, the monitor will prompt you by displaying this message

7. Basics of navigating through NICO screens… 1.Large KNOB (1) navigates around the screens, highlighting items that can be changed or adjusted. 2.Pressing the large KNOB (1) selects the highlighted item. 3.The SETUP screen choices are selected to ZERO (2) the CO 2 sensor (if prompted by the monitor), and ERASE TRENDS (3) of previous subjects (before each patient) 4.The Time and Date (4) should be adjusted to match the clock used to document arterial blood gases. This only needs to be performed once, unless the monitor’s battery becomes depleted. 1 2 3 4 Standby (power) button

8. Select Press KNOB (1) to confirm Follow the on-screen instructions. Zeroing the Capnostat ®

9. After selecting, follow the on-screen instructions. Capnostat normally goes through a warm up phase with CO2-flow sensor in place. “CO 2 zero” is only required with initial use or change of Capnostat CO 2 sensor. Be sure to only zero the Capnostat with the CO2-flow sensor out of the patient circuit, and in room air (no CO 2 in the sensor). Press KNOB (1) to begin. Zeroing the Capnostat ®

10. If the Capnostat is not up to operating temperature, this message is displayed.“CO 2 zero” is only required with initial use or upon replacement of Capnostat CO 2 sensor. Zeroing the Capnostat ®

11. Once the Capnostat is up to operating temperature, zeroing begins, accompanied by this message. After zeroing is complete, this message is displayed. Zeroing the Capnostat ®

12. This message is displayed whenever the optical characteristics have changed since the last time the Capnostat was zeroed. Since the Capnostat is an optical device, zeroing “calibrates” the sensor for the optical characteristics of the airway adapter or CO 2 -flow sensor What does “zeroing” do? Things that may change the optical characteristics of the airway adapter include a change of adapter type, or secretions or condensation getting on the windows. In the event that this occurs, the CO 2 -flow sensor should be cleaned or replaced.

13. From the set up menu, rotate knob to select, then push to enter. Rotate knob to synchronize TIME/DATE screen to match care setting. Push to accept new time. Note: This synchronizes time for accurate Vd/Vt calculation. Monitor time will not change unless the battery becomes depleted. Monitor will prompt during start-up when Time/Date should be checked and re- entered. SET TIME / DATE

14. ERASING TRENDS Rotate knob and select YES, the monitor exits back to the SETUP screen. Enter screen, highlight and press the knob.

15. TABULAR DATA The Tabular data screen displays trended parameters in one minute intervals. For the purposes of this study, the Tabular Data Screen should be configured to display parameters appropriate to Vd/Vt measurement. Press the button, rotate knob to highlight TABULAR DATA and press the knob to select.

16. TABULAR DATA: Configure headings for Vd/Vt Rotate knob and highlight 2 nd column (CO-a is default) Press knob, then rotate to scroll through selections. Press knob to confirm when PeCO 2 selection appears. Rotate knob to highlight 3 rd column, and repeat process to change CI heading to ETCO 2

17. Adjust column headings as below Monitor minute to minute PeCO 2, VCO 2 data Refer to TABULAR DATA screen prior to drawing the ABG to assure that these values are stable.

18. Entering ABG Data Push DATA ENTRY button Rotate Knob and press for ABG DATA entry ABG DATA entry is essential to calculate Vd/Vt…

19. For Vd/Vt calculation, PaCO 2 is entered (1), then ABG draw time is entered (2) to synchronize time of PeCO 2 with PaCO 2 In data screen: 1.Knob highlights the previously chosen PaCO 2 (seen here as 40mmHg) 2.Note: As a result of 40mmHg PaCO 2, previous Vd/Vt was calculated as.20 1 2 Press knob to adjust PaCO 2 value (Vd/Vt = PaCO2-PeCO2/PaCO2 )

20. Highlighted PaCO 2 is pressed to enter a new value (change 40 to 44). Press to accept, and it exits to the Data Entry Screen to enter the ABG draw time.

21. …rotate knob to next and press. Then, enter ABG draw time to synchronize PaCO 2 with PeCO 2 ABG time is marked. Note: new Vd/Vt value is calculated

22. This data should be stable prior to ABG draw Refer to Tabular Data for 1 minute PeCO 2, ETCO 2, Vd AW, Vte-m, VCO 2 data

23. For technical support with the NICO monitor, contact: James Bement, Clinical Research Manager (203) 697-6407 Email: jim.bement@respironics.comjim.bement@respironics.com