1. www.hamilton-medical.com See Ventilator-G5-Simulation
Hamilton G-5
See Ventilator-G5-Simulation

2. Modes S CMV SIMV P CMV P SIMV PS(Spont) APV ASV DuoPAP APRV NIV
Write on board SIMV and CMV 3 options each: Vol, Press, and Adaptive Press.
APRV and DuoPAP are the same thing.
So only thing new is ASV: Adaptive Support Ventilation.

3. G5 – Tests and Calibrations
Pre-operational check
Open Systems and Tests & Calib window
Select and run Flow Sensor calibration; follow prompts
Perform Tightness test; follow all prompts
Run O2 Cell and CO2 Sensor calibrations if necessary
Tightness is just a circuit leak test.

4. Start-Up
Select New Patient (default settings) or Last Patient (last parameters in use)
Adjust settings for patient type, gender, and height (IBW automatically calculated)
Select mode and confirm – All related parameters displayed
Adjust values and confirm
In settings, the I:E ratio doesn’t change with RR changes (What will change?)
If I:E stays the same, then Ti must change so watch this carefully. I:E is your fixed variable.

6. G5 – Ventilation Cockpit
Operated via main rotary dial, touch screen, and fixed keys
Data shown as waveforms or numerical
Alarm limits displayed adjacent to measured value
Power switch on back of screen
Stand-by key – Press to start ventilation
Press and confirm to stop ventilation

7. G5 Alarms High / Medium / and Low priority alarms
Visual and audible indicators depending on alarm
Alarm message window
Alarm event log

8. G5 – Proximal Flow Sensor
Measures flow, volume, pressure
Contains a diamond-shaped membrane in outer housing with pressure ports on each side
Must be installed correctly
Blue flow sensor tube proximal to the patient
Flow sensor tubings must be upright and secured with clamp and unkinked
Sensing tubes continuously flushed to prevent blockage
This is their big claim to fame, as they feel it is more sensitive then other vents and measures pressure difference across a resistance.
There is continuous gas flow through the lines to prevent occlusion.
Claims to be more accurate because the sensor is closer to the patient. The sensor isn’t actually closer though, because sensing actually still occurs back at the vent.

9. Hamilton G5 Flow Sensor
Ignore the Evita in the background.

10. Tube Resistance Compensation
Offsets the flow resistance imposed by the artificial airway
G-5 allows the choice of ETT and size, and also trach tubes compensation
Could potentially cause auto triggering and may need to be disabled or settings decreased
How could this cause auto cycling? Ask Leah.

11. TRC 100% compensated means that all ETT resistance is compensated
Do NOT forget about lung resistance and potential external resistance (E.g. tube kinking)
Again, make sure if you are using it, everyone is on the same page; it can’t be turned on and off.
Internal diameter of the tube isn’t constant. It will be narrowed by secretions, partial kinking, leaving the suction catheter down the ETT

12. G5 – Intelligent Panels Dynamic lung panel
View Vt, CL, r, and triggering in real time
Lungs expand and contract in synchrony with actual breaths based on proximal flow sensor signal
Vt – Lung size shown is relative to “normal” size for patient’s IBW
CSTAT – Breath to breath “normal” values for pt IBW. The shape of the lungs changes with compliance
Triggering – Displays muscle to indicate triggering
Resistance – Displays bronchial tree, breath to breath relative to “normal” values
Makes it sound more confusing than it is. Just a set of lungs that attempts to give you a picture view of what is happening in the lung.

13. G5 – Intelligent Panels Vent status panel
Visualizes parameters related to ventilator dependency
FiO2, PEEP, ExpMinVol, Pinsp, RSBI, P0.1, %fSpont
A floating indicator in each column displays values for each parameter
Indicator changes colour when each value in “weaning zone”
When all parameters are in the “weaning zone”, the frame around the panel changes to green, indicating patient may be ready for discontinuation of ventilation
Look into.

14. Intelligence Panels

15. APV Essentially PRVC Available in SIMV as well
Measures the patient dynamic compliance in order to obtain the appropriate pressure
Pressure is then adjusted to maintain the Vt target
Adaptive pressure ventilation, which is actually a good description.

16. DuoPAP and APRV DuoPAP – Set Rate and Thigh APRV – Thigh and Tlow
Biggest difference is the time at Tlow
Setting of PS must be considered, as PS pressure must exceed Phigh in order to support breaths at the Thigh
They have Thigh and Phigh backwards.
They are the same mode, despite what the manual tells you. It tells you that you use them in different ways, but really it just gives you different base controls for the same mode.

17. Adaptive Support Ventilation
ASV – An updated version of MMV
“Automatic” mode for full or partial ventilatory support, and as a weaning mode
Minimum Minute Volume Target is calculated by
IBW X Normal MV X %MVset/100
ASV also calculates optimal RR
Takes into consideration deadspace (Calculated at 2.2ml/kg)
Where does it get normal MV from? I think it is based on pt wt.

18. ASV
Once initiated, 5 pressure-limited test breaths are delivered at 15cmH20 > baseline
Ventilator measures Cdyn, Rce, Vt, RR to determine initial targets for Vt and RR
Found in Intelligence Panels
ASV lung protective rules determine minimum and maximum values for each parameter
Targets for Vt and RR recalculated for breath to breath, taking into account changes in lung mechanics or user settings
Ti / I:E controlled during mandatory ventilation according to the rules base
Rce?

19. ASV
Weaning initiated automatically and continuously as patient breathing effort and lung mechanics improve
During spontaneous breathing, the only parameter controlled by ASV is Vt
ASV Algorithm – Minimal settings are mandatory breath rate ‘0’ and inspiratory pressure <8cmH20

20. ASV Advantages Disadvantages
Improved selection of parameters when little is known about the patient
Ability to adapt to changing lung mechanics and patient effort
Disadvantages
Severe COPD may require longer TE than provided by ASV algorithm
ASV may be prone to pressure in response to patient effort when  may be more appropriate
Not so sure about first advantage.

21. ASV Screen

22. Extras Paux – Allows for measurement of pressures at a different site
Requires another set of tubing connected to the Paux connector
Generates a flow of 9L/min to keep the lumen clear (Rinse flow)
Cannot be used if an esophageal balloon is in use (May cause overinflation)
Cannot be sued for an esophageal balloon. This is used for more advanced assessment like measuring tracheal/carinal pressures.

23. G-5 Ports

24. P/V Tool Three main purposes to it
Finding optimal PEEP/critical opening pressure
Finding the top pressure where the most gas exchange happens
As a recruitment tool
Low-flow inflation and deflation tool
Pt cannot be spontaneously breathing
No leak in system (incl. chest tubes)
Pt should be hemodynamically and neurologically stable
Can set all pressures, ramp, and pause time
Flow sensor must be calibrated and functioning
Can have chest tubes, just no leak from lung into chest tube.
Find the top pressure where the most exchange happens? Don’t believe that, but can find where overdistension occurs.

25. P/V Tool
Records a quasi-static P/V curve and records the inflation and deflation limbs
Settings
Pstart – PEEP at start of manoeuvre
Ptop – Maximum pressure applied
End PEEP – PEEP applied at end of deflation limb
Ramp speed – Rate of change of pressure
Tpause – Length of pause between inflation and deflation limbs
Because the flow is very los, pressure from resistance is miniscule, so can be accepted as a true representation.

26. Extras ETS – Expiratory Trigger Sensitivity
Percentage of peak inspiratory flow at which the vent cycles from inspiration to exhalation
5 - 70% (Increased = more sensitive)
Spontaneous breaths only

27. Extras Pramp – Time constant for inspiratory rise to set pressurems
Shorter settings = Higher initial flow rates
Watch the pressure waveform

28. Extras ETCO2 sensor Heliox attachment Sigh breath
Sigh every 50 breaths
VC - Vt delivered is 50% higher
PC – 10 cmH2O higher