1. NEW 3.0 SOFTWARE FOR SERVO-i AND SERVO-s Servo-i Ventilator

2. SERVO-i VERSION 5.0 WEB CONFERENCE Overview of Servo-i
SERVO-i version 5.0 updates
SERVO-i VERSION 5.0 WEB CONFERENCE
Overview of Servo-i
WELCOME TO THE WEB CONFERENCE
SERVO-i version 5.0 updates 2

3. User Interface – display
12.1 inch, Touch screen
3~4 waveform display
2 Loops, Reference and Overlay function
Direct access knob
Screen save and capture function
Trends
Special function key
Auto brigtness

4. User Interface – display
3~4 waveform display.
Pressure(yellow), Flow(green), Volume(blue), (EtCO2,Edi/option)
2 Loops.
Volume/Pressure, Flow/Volume
Reference and Overlay function.
Compare patient’s status before and after Intervention
Trigger indicator
Pressure
Flow
Loop
Volume
Decrease the compliance

5. Touch pad – Ventilation mode
Ventilation mode window

6. Touch pad – Admit patient
Input the patient data

7. Touch pad – Nebulizer
Nebulizer
Setting the nebulizer

8. Touch pad – Status
Status
Information of the system

9. Touch pad – Additional settings
Adjust the parameters during
monitor the patient condition

10. Touch pad – Additional values
Additional settings
Measured & calculated values

11. Fixed keys – Alarm silence and Alarm profile
Alarm silence – 2min.
Alarm sound
Apnea time in only Support mode
Autoset in only CMV mode
Bell symbol when occur alrams
Alarm setting

12. Fixed keys – Save Cursor function Recorded waveform for 20 sec
compare the settings
Recorded waveform for 20 sec
Capture the display

13. Fixed keys – Trend Zoom in/out function
Display measured values and
waveforms at the same time
Event log display in green bar
Recorded patient’s data for 24 hours

14. Copy the patient’s data
Copy patient’s data by using memory card
Can edit and display the time-based values
and waveforms in MS excel

15. Fixed keys – Quick access
Stabilize O2 saturation
Comfortable patient : stop alarm & insp.flow
Suction support

16. Fixed keys – Quick access
Reference loop
Overlay fuction
Loop

17. Fixed keys – Quick access
Auto scales
Adjust channel : 2~4
Scales and Waveform configuration

18. Fixed keys – Menu
Alarm

19. Fixed keys – Menu
Review

20. Fixed keys – Menu
Compensate circuit compliance

21. Fixed keys – Menu
Copy data, Copy screen

22. Fixed keys – Menu O2 cell adatation : 장기간 사용중 O2 sensor가 소모되어
O2 alarm이 발생하는 경우 “Pre use check”
과정 없이 임시적으로 Calibration을 실행.

23. Fixed keys – Menu
Press Main screen for unlock

24. Function key & Direct access knobs
Start Ventilation
Direct access knobs
Special function key
: Start breath, O2 breaths, Exp.hold, Insp.hold

25. SERVO-i VERSION 5.0 WEB CONFERENCE Workflow of Servo-i
SERVO-i version 5.0 updates
SERVO-i VERSION 5.0 WEB CONFERENCE
Workflow of Servo-i
WELCOME TO THE WEB CONFERENCE
SERVO-i version 5.0 updates 25

26. Pre-use check & Patient circuit test
Yes No

27. Pre-use check & Patient circuit test
Do you wish to compensate for Compressible volume ?
Yes or NO

28. Compensate for Compressible Volume
Compensation “ON”
Compensation “OFF”

29. Compensate for Compressible Volume
Compensation “ON”
Compensation “OFF”

30. Ventilation Mode selection & setting
Ventilator setting 순서
호흡 모드 선택
해당 호흡 모드의 파라메터 셋팅

31. Set alams Alarm silence – 2min. Alarm sound
Apnea time in only Support mode
Autoset in only CMV mode
Bell symbol when occur alrams

32. Start ventilation
“ Start Ventilation”

33. Nebulizer patient unit
Servo ultra nebulizer
T-piece
Patient circuit 과 연결
Medication cup
Nebulizer patient unit
Ventilator 와 연결 그림

34. Servo ultra nebulizer

35. Servo ultra nebulizer - Cleaning

36. Servo ventilator Cleaning – Expratory cassette
넣을때 소리!!!

37. Servo ventilator Cleaning – Expratory cassette
기본적으로 preusecheck 권하나 응급실처럼 갑자기 환자가 들어오는경우에 대안 제시
기타 : EO gas 소독
(manual에는 없는 내용이나 다른 병원에서 가장 많이 사용중)

38. Management– Servo duoguard
1 .HEPA Filter – 환자의 호기 가스가 통과되며,바이러스 및 박테리아를 걸러냄
2. Electrostatic Filter -네불라이저 약물을 집진 하여 HEPA Filter에 약물이 흡착되지 않음
네불라이저 사용중에도 호기저항 증가 거의 없음
(Test 6차례)
물이차는 경우 털어줄것 권장
Must Be Use in Nebulizing
2 ~3 days Use 권장 (nebulizer 자주 사용시)
Reduce cleaning time for Exp. cassette
Reduce Patient’s Expiratory Resistance ( Auto PEEP, WOB )

39. Management– Servo duoguard
** 저가 필터를 장시간 사용하는 경우 장비의 고장을 유발할 수 있습니다 .
** 교차감염 방지 및 Exp. Cassette 고장을 방지하기 위하여 제조사에서 공급하는
ServoDuoGuard를 사용 할 것을 권장함.

40. Management– Preventive Maintenance

41. Management– Preventive Maintenance

42. SERVO-i VERSION 5.0 WEB CONFERENCE Ventilation Mode and Parameters
SERVO-i version 5.0 updates
SERVO-i VERSION 5.0 WEB CONFERENCE
Ventilation Mode and Parameters
WELCOME TO THE WEB CONFERENCE
SERVO-i version 5.0 updates 42

43. Controlled Mandatory Ventilation (CMV / ACMV)
Ventilator setting 순서
호흡 모드 선택
해당 호흡 모드의 파라메터 셋팅

44. Volume Controlled Ventilation (VCV)

45. Volume Controlled Ventilation (VCV)X Y Z
I : E ratio & T pause
X : Inspiration time EX) Resp. rate : 20 b/min, I:E ration가 1:2
Y : Pause time (% of respiratory cycle) T pause : 10 % 인 경우
Z : Expiration time I : E = 1 sec : 2 sec = (0.7 sec sec) : 2 sec
I : E = (X+Y) : Z I E

46. Volume Controlled Ventilation (VCV)
T insp. rise (Inspiratory rise time)
Time to peak inspiratory flow or pressure at the
start of each breath as a percentage of
respiratory cycle time or in second
Support mode에서 의미 있슴
Shorter Insp. Rise time
→ Reduce WOB insp

47. Volume Controlled Ventilation (VCV)
T Insp. rise time
The change of the rise time in Volume Control
Increase the airway peak pressure and peak flow

48. Volume Controlled Ventilation (VCV)
Flow Adaptation
Flow Adaptation :
It is possible for the patient, by their own inspiratory efforts, to receive a higher inspiratory flow and Tidal Volume during an inspiration than pre-set.
Without Flow Adaptation :
Normal volume controlled ventilation. ARDSnet lung protective protocol with 6 ml/kg tidal volume
전통적인 VC는 정해진 insp. Time & exp. Time에 맞춰 설정한 tidal volume을 constant flow로 환자에게 넣어준다.

49. Volume Controlled Ventilation (VCV)
Flow Adaptation
Air starvation
Adequate flow
Inadequate flow
Inadequate flow
* Extra flow
in servo
전통적인 VC는 정해진 insp. Time & exp. Time에 맞춰 설정한 tidal volume을 constant flow로 환자에게 넣어준다.
Extra effort 후 flow가 계산된 flow rate으로 떨어질경우 flow는 set tidal을 맞추기위해 flow를 유지한다.

50. Volume Controlled Ventilation (VCV)
Flow pattern
The end inspiratory flow as % of Vpeak
Decelerating Flow
- lower the peak airway pressure
Poor lung compliance can cause excessive airway pressure leading to barotrauma, volutrauma, and adverse hemodynamic effects.
If the patient continues to inspire vigorously, added, unnecessary work is done. This can lead to fatigue.

51. Volume Controlled Ventilation (VCV)
Trigger sensitivity (Pressure & Flow)
Pressure triggering
보통 -1 ~ -2 cmH2O 정도로 설정. 환자의 흡기 노력에 의해 미리 정한 압력 수준까지 음압이 발생하는 경우 이를 감지하여 흡기가 시작됨
Flow triggering
호기시 2 l/min (소아, 0.5 l/min)의 bais flow가 환자의 흡기 노력에 의해 그 유량이 감소 될 때 호흡기가 이를 감지하여 흡기가 시작됨

52. Volume Controlled Ventilation (VCV)
Trigger sensitivity (Pressure & Flow)

53. Volume Controlled Ventilation (VCV)
Trigger sensitivity
* Indicator
Missed Effort
More
Sensitivity
Decreased
WOBp
little trigger effort
less trigger effort

54. Pressure Controlled Ventilation (PCV)
그림 좌우 같은그림으로

55. Pressure Controlled Ventilation (PCV)
그림 좌우 같은 그림
PC above PEEP
Ppeak = PEEP + PC above PEEP

56. Pressure Controlled Ventilation (PCV)
Active expiratory valve
inspiration 동안 환자의 호기 노력으로 압력이 3cmH2O 상승하면 호기 밸브를 열어 설정한 압력을 유지 시킴

57. Pressure Controlled Ventilation (PCV)
Collapsed airways and alveoli will fill like avalanches during insufflation of air. The filling is pressure and time dependant. Due to the tissue pressure this is more obviously expressed in the dependant parts of the lung. When a collapsed airway or alveoli starts to open this will result in a small pressure drop. If the continued filling of the alveoli is not immediately sensed and gas replenished, the alveoli will collapse again or depend on redistribution of air from other parts of the lung. If the response is exaggerated it will hyperinflate the area giving rise to barotrauma. The tight and exact regulation of the Servo-i will immediately sense even minute deviations in pressure and respond immediately.
Late Inspiratory flow
: 흡기말 alveoli open시 떨어지는 압력을 셋팅한 level로 유지하여 alveoli recuritment 효과
Ultrsonic flow sensor
refresh rate 2,000 times/sec

58. Pressure Controlled Ventilation (PCV)
Late Inspiratory flow
: 흡기말 alveoli open시 떨어지는 압력을 셋팅한 level로 유지하여 alveoli recuritment 효과
Ultrsonic flow sensor
refresh rate 2,000 times/sec

59. Pressure Controlled Ventilation (PCV)
T Insp. rise time
The change of the rise time in Pressure Control
Avoid overshoot
Affect MAP and tidal volume

60. Pressure Regulated Volume Control (PRVC)
Prvc는 volume control mode 처럼 환자에게 설정한 볼륨을 전달하되
낮은 압력으로 공급하기위해 pc 와같은 decelerating flow로 환직를제공하는 모드
Tidal volume setting
→ Volume guarantee (VCV)
Auto adjust Pressure level
→ Decelerating flow (PCV)

61. Upper pressure limit in PRVC & VC mode
Pressure Regulated Volume Control (PRVC)
Upper pressure limit in PRVC & VC mode VC PC
PRVC
Target
Tidal volume
Insp. pressure
Flow pattern
Constant
Decelerating
Assist Ventilation
Yes

62. Supported Ventilation / Spontaneous Ventilation
Ventilator setting 순서
호흡 모드 선택
해당 호흡 모드의 파라메터 셋팅

63. Pressure Supported Ventilation (PSV)
Inspiratory cycle off(Insp. cycle off)
Adjust the inspiration time
PS above PEEP
Ppeak = PEEP + PS above PEEP
T insp. rise (set by second)
Reduce WOBinsp
Increase patient comfort

64. Pressure Supported Ventilation (PSV)
Decreased insp. cycle off
Longer inspiration time
Reduce respiratory rate
Increase tidal volume
70% 1%

65. Pressure Supported Ventilation (PSV)
Increased insp. cycle off
Fighting between patient and ventilator due to long inspiration time
Shorter inspiration time
Fighting 1%
50%
서로 셋팅이다름 그림교체

66. Pressure Supported Ventilation (PSV)
Increased insp. cycle off
Too long inspiration time due to leakage Ti
40%
30% Ti
50%

67. Continuous Positive Airway Pressure (CPAP)
PS above PEEP = set to 0

68. Backup/Apnea Ventilation
‘Patient’s trigger’

69. Synchronized Intermittent Mandatory Ventilation(SIMV)
Ventilator setting 순서
호흡 모드 선택
해당 호흡 모드의 파라메터 셋팅

70. Synchronized Intermittent Mandatory Ventilation
PSV
CMV

71. Synchronized Intermittent Mandatory Ventilation(SIMV)
Example:
SIMV rate ~ 6 b/min
Breath cycle time ~ 3 sec
Mandatory breath time을 결정

72. SERVO-i VERSION 5.0 WEB CONFERENCE Thank you for listening !!!
SERVO-i version 5.0 updates
SERVO-i VERSION 5.0 WEB CONFERENCE
Thank you for listening !!!
WELCOME TO THE WEB CONFERENCE
SERVO-i version 5.0 updates 72