1. Siemens Servo i
Talk about fewer bells and whistles, but much more straightforward to use, better designed, like a well-designed cell phone compared to my father in law’s. “Newer” isn’t necessarily better.

2. Servo i Mosby’s Respiratory Care Equipment Chapter 12 pages 531 - 549
Battery contains 2-6 modules of 12V
3 hour charge time
30 min running time EACH
Bring in vent and talk about how it is an upgradeable platform; the shell should stay the same for a long time, and just upgrade the software, and add modules for new stuff.
Will give you a readout as to actual battery length remaining.

3. Servo i Microprocessor-controlled
Electrically and pneumatically driven
Internal drive is the same as the Servo 300
Solenoid valve (rapid response)
Flow measured by an ultrasonic transducer
Pressure measured by pressure transducers
Internal drive is not the same as the 300, take out for next year. Consider it a completely new ventilator, not an upgraded 300.
Pressure measured by pressure transducers, as opposed to…?
Solenoid valve? Take out as well. All new vents should be rapid response.

5. Modes Volume control Pressure control PRVC (Same as Servo 300)
SIMV – With PC, VC, or PRVC breaths
PS/CPAP
Volume support
Bi-Vent (APRV)
NIV
PRVC is not the same on this vent as on the 300! PRVC on the 300 did a step-up procedure to start the PRVC. The Servoi does a VC breath at set Vt and puts a pause on it. It measures compliance and resistance. It uses the plateau pressure as the pressure for the next breath. It also has an open/floating exp valve so that pressure can be relieved and adjusted throughout the breath.

6. Non-Invasive Ventilation
Select at the start of the vent set-up
Automatic compensation for leakage to maintain PEEP and pressure level set
Modes available
PC and PS (Controlled breath vs. spontaneous)
Backup ventilation available in PS mode
PS – Gives you the option of CPAP.

7. Servo i Adjuncts EtCO2 Open lung tool Y sensor monitoring
Ultrasonic nebulizer
NAVA
Battery module

8. Servo i
Standby is on the bottom left corner. Fixed knobs/keys allow instant adjustment of primary parameters.

9. Fixed Keys Start/stand-by Start breath
O2 breaths – 100% O2 for one minute
Expiratory hold – End expiratory pause pressure
Inspiratory hold – Plateau pressure and static compliance calculated
To get a static compliance value you must do both an insp and exp hold. Why? To account for autopeep.

10. Servo i Quick Access Key on right side of screen Access to
Suction support
Loops
Waveform configuration
Open lung tool

11. Servo i Trigger sensitivity
2L/min bias flow for flow triggering (Adult mode)
Bar graph with green and red
Closer to ‘0’ means less sensitive
To the left of ‘0’ pressure-triggering begins, although 2L/min is still flowing
This may increase WOB if there is no leak around the ETT
Talk about colours on flow trigger.
Doesn’t increase WOB! All new vents have bias flow, what is the leak around ETT stuff?

12. Servo i
During the pre-use check, tubing compliance is calculated One has the option of turning tubing compensation on or off In what situations would it be beneficial to turn tubing compliance off?
Can’t think when I’d want it off. Ask around.

14. Automode
The patient starts on the control mode of ventilation, then when they trigger a breath they are switched to the support mode automatically
If the patient becomes apneic, the vent switches back to the control mode
Volume control – Volume support
PRVC – Volume support
Pressure control – Pressure support
Very important to monitor the ‘Trend Screen’ closely to be aware how much time is spent in each mode before extubation
Intended for quick wean patients, e.g. Post-op
Another attempt at an automatic weaning mode. Successful? Maybe/maybe not. Not currently used clinically in Edmonton.
How do you know on trend mode? Very hard, as it does differentiate between spont. breaths, RR, MV. Can only tell by maybe looking at change in Vt

15. Servo i Options Suction support Used for open suction technique
Pre-oxygenates (2 minutes) and post-oxygenates (1 minute)
Suspends alarms for 60 seconds during disconnect
Flow is suspended until the patient is reconnected
Nebulizer is paused during disconnect
FiO2 can be set
Different than 100% button, found under quick access.
Nebulizer is an added ultrasonic module, can be also used on the Servo 300

16. Open Lung Tool Hess, Mechanical Ventilation; pages 141 - 144
An application of PEEP and alveolar recruitment as a lung protective strategy
Accessed through the ’Quick Access’ key
Balances compliance with optimal PEEP
Uses end tidal CO2 measurement
Patient must be hemo-dynamically stable
Second line misleading; sounds like a press release.
How exactly does it balance compliance with optimal peep?
Can use ETCO2 if you have it available.
Can use open lung tool on anyone. Using an open lung strategy (recruitment, finding optimal peep and ventilation pressures) should be done on hemo-dynamically stable patients.
Talk about recruiting a patient 30 min post arrest who had sats in the low 70s on peep 12, FiO2 100%. What should we do? (CXR, Bronch, check for tube placement.)

17. Open Lung Tool Plots compliance over the pressure/volume curve
Provides a breath-by-breath analysis of
End insp. pressure
PEEP
Tidal volume
Dynamic compliance
Tidal CO2 elimination
First line pretty confusing. Basically just a trending tool.
Not sure if it provides breath-by-breath analysis. Bring vent into the class and demonstrate.
What it does is chart/trend pressure, volume and dynamic compliance, and etCO2 if you have it.

18. Backup Ventilation Apnea settings are pre-set VS to VC, RR=15, I:E 1:2
PS to PC, RR=15 I:E 1:2 and pressures of PS level or 20cmH2O, whichever is greater
(Backup is different for infants)
Same Vt from Vs to VC. Can’t choose to go to PRVC – too bad (check on this).

19. Neurally Adjusted Ventilatory Assist
NAVA was approved by the FDA in 2007
Relies on detection of the electrical activity of the diaphragm to control the timing and level of assistance
Gives the opportunity to avoid over- or under-assisting the patient
No delay between the signal for a breath and delivery
Will give out my own notes and do my own lecture on this.

20. NAVA
A special NG tube with sensors must be inserted (Edi catheter) and attached to the ventilator (can still be used an NG tube)
Edi catheters are very expensive
The operator can set the level of assistance (0-30cmH2O/uV)

21. NAVA Pt should have spontaneous efforts
The vent begins inspiration as soon as the diaphragm begins to depolarize
Level of sensitivity can be set (range, 0-2uV)
Backup ventilation can be either PS or PC based on Edi trigger level
Good for failure to wean patients, neuro, disynchronous with vent