1. MACS CPAP System Self Guided Tour

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

3. Features and Controls – Rear Panel Driving Gas Input zConnection for 55 psi (3.8 bar) oxygen source gas zAlways use a high flow gas source (pressure take-off) that can provide 55 + 15 psi pressure at a minimum of 40 L/min

4. 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

5. Features and Controls – Front Panel CPAP Control zAdjusts the CPAP from 0 to 20 cm H 2 O zAutomatic sensitivity zFlow adjusts automatically to meet patient demand up to 140 L/min zOxygen concentration is maintained at set % Oxygen control

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

7. Features and Controls – Front Panel Pressure Gauge zShows pressure in patient circuit at the output of MACS zCompare with control setting to insure proper operation zGives an indication of patient effort

8. Features and Controls – Front Panel Circuit Connection 1 zConnection for the large bore hose of the patient circuit

9. Features and Controls – Front Panel Circuit Connection 2 zPatient circuit small hose connection zConnects to the expiratory valve on the patient circuit

10. Patient Breathing Circuit Patient circuit is a single limb system zBoth hoses attach to the front of MACS zPatient end connects for clinical intervention y Directly to an endotracheal tube (invasive) y Face mask (noninvasive)

11. Patient Breathing Circuit Use only Airon Corporation patient circuits zCalibration of the CPAP control 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

12. Patient Breathing Circuit Accessories to optimize patient care zIn-line medication nebulizer y Fits between the mask and patient circuit y Nebulizer can be removed to add medication while maintaining pressure zCO2 monitoring y For In-line sampling place the Tee between the mask and circuit y Or use the nasal prongs under the mask zExpiratory bacteria / viral filter can be added using the 90 degree expiratory port elbow

13. Program Objectives MACS CPAP System self guided tour, objectives completed so far: þDescribe the main operating features of MACS þIdentify the controls and connections þDescribe the patient breathing circuit With an understanding of MACS’s capabilities, let’s look at patient application.

14. Patient Application Initial Set-up zAttach Airon patient circuit to MACS zAttach a high pressure oxygen hose to the rear of MACS zAttach the other end of the high pressure hose to the oxygen source

15. Patient Application Set % Oxygen Control zSet % Oxygen control to the desired oxygen level zAll breaths receive set oxygen level + 10% zOxygen tank time almost doubles with 65% setting zCaution - with rapid, large tidal volumes on 100% oxygen, the actual delivered percentage may be less than 100%

16. Patient Application Start CPAP zTurn on oxygen source zAttach patient breathing circuit to the patient using either a mask or endotracheal tube zAdjust the CPAP control to the level desired zIf the patient is not attached to the circuit, or there is a large leak, a high flow of gas will occur

17. Patient Application Monitor patient zAssess per your protocol y patient breathing rate y comfort y oxygenation y CO 2

18. Clinical Issues Let’s look at various clinical environments for CPAP application z Using CPAP z Pediatric support z Medication nebulization z CO 2 monitoring z Altitude operation

19. Clinical Issues Using CPAP zUsed on spontaneous breathing patients in respiratory failure including y Congestive Heart Failure (CHF) y COPD and Asthma y Near Drowning y CO poisoning zSet CPAP level as needed zCan be used with mask or ET-Tube

20. Clinical Issues Pediatric Support zMACS is safe for pediatric - adult patients zUse the lowest possible settings zMonitor closely for patient synchrony

21. Clinical Issues Providing nebulized medications zA medication nebulizer may be placed between the patient connection and the patient zPatient will inhale medication during every breath and exhale back out through patient circuit  Expiratory filter may be added for personnel safety

22. Clinical Issues CO 2 Monitoring zAny type of CO 2 analyzer may be used zWith in-line style analyzers place the sensor Tee between the patient circuit connection and the patient zWith sidestream analyzers place the nasal prong sampling tube under the face mask

23. Clinical Issues Altitude Operation zMACS can be used for air transports in unpressurized cabins up to 15,000 feet z Pressure settings will not change as altitude changes

24. Patient Safety Patient Safety Features zInternal Safety Pressure Release – limits circuit pressure to 40 cm H 2 O zAnti-Suffocation System – in the event of device malfunction, an internal valve will allow ambient air to enter the patient circuit

25. Cleaning and Maintenance zClean MACS between patients using a soft cloth and a mild detergent / disinfectant zDo not immerse MACS in water zDisposable patient circuit is for single use application and should not be cleaned, disinfected or reused zMACS should receive preventative maintenance every 2 years

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

27. Contact Information Thank you for you interest in the MACS CPAP System For more information visit www.AironUSA.comwww.AironUSA.com or call Airon Corporation at: 1-321-821-9433 1-888-448-1238 (toll free North America)