1. pNeuton Transport Ventilator Model S Self Guided Tour

2. Program Objectives This program is a self guided tour of the pNeuton Model S Ventilator. At the end of this tour you will be able to: zDescribe the main operating features of the ventilator zIdentify the controls and connections zDescribe the patient circuit zSet-up the ventilator for patient operation zDefine various clinical environments for ventilator application zClean and maintain the ventilator

3. Features and Controls – Rear Panel Driving Gas Input zConnection for 50 psi oxygen source gas zAlways use a high flow gas source that can provide 55 + 15 psi pressure at a minimum of 40 L/min

4. Features and Controls – Rear Panel Alarm zAudible alarm sound generator zFactory preset low gas supply alarm yDo NOT put tape over the holes, push sharp objects into the alarm or, interfere, in any way, with the alarm. y The alarm is for patient protection and, if, for any reason, you suspect the alarm is not operating properly, have the unit serviced immediately.

5. Features and Controls – Rear Panel Air Entrainment zAmbient air is entrained for internal gas mixing zExternal housing contains air filter zAir filter replacement is part of the preventative maintenance

6. Features and Controls – Front Panel PEEP / CPAP Control zAdjusts the PEEP/CPAP from 0 to 20 cm H 2 O zAutomatic sensitivity zFlow adjusts automatically to meet patient demand up to 120 L/min zOxygen concentration is maintained at set % Oxygen control

7. Features and Controls – Front Panel Peak Pressure Control zLimits peak airway pressure from 10 to 75 cm H 2 O for mandatory breaths zAlert with “honking” noise when delivered pressure rapidly exceeds set pressure (e.g. cough) zUsed for Pressure Limit mode to set mandatory breath delivery

8. Features and Controls – Front Panel Tidal Volume Control zSets delivered Tidal Volume for mandatory breaths from 360 to 1,500 ml zCalibrated control for volume delivery zDelivered flow rate equals 600 ml/sec (36 L/min) for all mandatory breaths zOperating range sets inspiratory time of 0.6 to 2.5 seconds

9. Features and Controls – Front Panel Respiratory Rate Control zSets mandatory breath Respiratory Rate from 2 to 50 breaths/min zControl adjusts expiratory time with a range of 0.6 to 30 seconds zNon-calibrated control as Respiratory Rate may change as the Tidal Volume (inspiratory time) is changed zWide range rotation at lower Respiratory Rates to provide better control for slower IMV rates

10. Features and Controls – Front Panel % Oxygen Control zDelivered oxygen choice y 65% y 100% zSets both mandatory breath and spontaneous breath oxygen concentration

11. Features and Controls – Front Panel Mandatory Breath Control zActivates IMV mode zSwitch for mandatory breaths y On or Off zVentilator operates in CPAP mode with switch in “OFF” position

12. Features and Controls – Front Panel Pressure Gauge zRepresents pressure in patient circuit at the output of the ventilator

13. Features and Controls – Front Panel Patient Connection zConnection for the large bore hose of the patient circuit

14. Features and Controls – Front Panel Exp Valve zPatient circuit small hose connection zConnects to the expiratory valve on the patient circuit

15. Patient Circuit Patient circuit is a disposable, single limb system; zBoth hoses attach to the front of the ventilator zPatient end connects for clinical intervention y Directly to an endotracheal tube (invasive) y Any standard face mask (noninvasive)

16. Patient Circuit Use only Airon Corporation patient circuits; zCalibration of the PEEP/CPAP and Peak Pressure controls is based upon the Airon patient circuit zUsing other manufacturers circuits may cause y errors in pressure delivery y high expiratory flow resistance y interference with CPAP sensitivity y increased oxygen usage

17. Program Objectives pNeuton Model S Ventilator self guided tour, objectives completed so far: þDescribe the main operating features of the ventilator þIdentify the controls and connections þDescribe the patient circuit With an understanding of pNeuton’s capabilities, let’s look at patient application.

18. Patient Application Set Main Controls zDetermine Peak Pressure maximum zChoose % Oxygen zSet Tidal Volume zSet Resp Rate zPEEP/CPAP can be set to minimum

19. Patient Application Initial Set-up zAttach Airon patient circuit to ventilator zAttach a test lung to the patient connection on the circuit zAttach a high pressure oxygen hose to the rear of the ventilator zAttach this hose to the oxygen source

20. Patient Application Begin Ventilation zTurn ON oxygen supply zFor IMV, turn Mandatory Breaths control “ON”  Ventilator will start to provide breaths at the settings on the controls

21. Patient Application Set PEEP / CPAP zAdjust the PEEP/CPAP control to the level desired zIf a test lung or patient is not attached to the circuit, a high flow of gas will occur zWith Mandatory Breaths control “OFF”, set at least 4 cm H 2 O to optimize performance in CPAP mode

22. Ventilator Operation Tidal Volume and Respiratory Rate Interchange zTidal Volume control is calibrated, Respiratory Rate control is not zSet desired Tidal Volume first, then adjust the rate as desired zTidal Volume control effectively sets inspiratory time y Uses a fixed inspiratory flow zAlways recount the Respiratory Rate after Tidal Volume adjustments

23. Ventilator Operation Peak Pressure Limit zOperates to limit the peak airway pressure during mandatory breaths zFor volume ventilation, set the Peak Pressure 10 cm H 2 O above the pressure needed to deliver the set Tidal Volume zPeak Pressure control is not an alarm y During rapid patient exhalation, as seen during coughs, the expiratory valve will make a “honking” noise to alert you that the patient is reaching the peak pressure setting

24. Ventilator Operation % Oxygen Control zSet % Oxygen control to the desired oxygen level zBoth mandatory breaths and spontaneous breaths receive set oxygen level zOxygen tank time doubles with 65% zCaution - with rapid, large tidal volumes on 100% oxygen, the actual delivered percentage for spontaneous breaths might be slightly less than 100%

25. Clinical Issues Pediatric Ventilation zTidal Volume setting 360 to 1,500 ml zVolumes range often used on patients from 23 kg (50 pounds) and higher zMonitor closely for patient synchrony zpNeuton is not approved for neonatal or small children due to mandatory breath flow of 36 L/min zPressure Limit Ventilation may be a useful mode for some pediatric patients

26. Clinical Issues Pressure Limit Ventilation zSet the Peak Pressure to the desired pressure level zAdjust Tidal Volume control to increase or decrease inspiratory time zResp Rate functions in same fashion, controlling the expiratory time y Recheck delivered respiratory rate with Tidal Volume changes zAdjust PEEP/CPAP to established baseline pressure

27. Clinical Issues MRI Operation zpNeuton is compatible with MRI scanners up to 1.5 Tesla in strength zWhile tests show that pNeuton functions at the bore of the MRI unit, a minimum proximity of 12 inches (0.3 meter) from the bore is recommended zSafe MRI practice calls for all devices used in the proximity of a MRI scanner, including pNeuton, be anchored to prevent inadvertent movement

28. Clinical Issues Altitude Operation zVentilator can be used for air transports in unpressurized cabins up to 15,000 feet z Delivered Tidal Volume will increase and Respiratory Rate will decrease as altitude increases z Pressure settings will not change as altitude changes z Always use an external spirometer to check the delivered tidal volume zDo not use the ventilator in hyperbaric chambers – the delivered Tidal Volume will drop rapidly as pressure increases

29. Patient Safety pNeuton - Patient Safety Features zAudible alarm for low supply gas pressure zHigh Pressure Release – pressure is relieved at the Peak Pressure control setting zInternal Safety Pressure Release – limits circuit pressure to 80 cm H 2 O, regardless of the setting of the Peak Pressure control zAnti-Suffocation System – in the event of ventilator malfunction, an internal valve will allow ambient air to enter the patient circuit

30. Cleaning and Maintenance zClean ventilator between patient use applications using a soft cloth and a mild detergent/disinfectant zDo not immerse the ventilator in water zPatient circuit is disposable, single use application and should not be cleaned, disinfected or reused zVentilator should receive preventative maintenance every 2 years

31. Program Objectives pNeuton Model S Ventilator self guided tour completed; you should now be able to: þDescribe the main operating features of the ventilator þIdentify the controls and connections þDescribe the patient circuit þSet-up the ventilator for patient operation þDefine various clinical environments for ventilator application þClean and maintain the ventilator Next Step – consider reviewing the pNeuton Case Study and completing the competency evaluation

32. Contact Information Thank you for you interest in the pNeuton Transport Ventilator For more information visit www.pneuton.comwww.pneuton.com or call Airon Corporation at 888-448-1238