Leoni Plus PräSent Hfo Eng

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Heinen + Löwenstein GmbHArzbacher Straße 80D-56130 Bad EmsTel. +49 (0) 2603 9600-0Fax +49 (0) 2603 960050

www.hul.de

Leoni Ventilators

Leoni mobil Leoni 2

Leoni plus

Mode of Operation

• The Leoni neonatal and pediatric ventilator functions according to the constant flow generator principle. • A constant gas flow of mixed Oxygen/Air is delivered to the patient via a hose system. • The desired concentration of the inhaled gas mixture is produced by a valve bank. • During the inspiration phase, the expiratory valve on the end of the hose system is closed, so that the flow must go towards the patient. • Exhalation is effected by opening the expiratory valve. The lung then deflates due to the pressure decrease.

Specifications

Leoni mobil Leoni 2 Leoni plus

O2 Monitor x x x

Electronic gas blender x x x

VIVE x x x

Integrated battery x x x

LCD Display x x  

TFT Colour screen     x

Touch screen, removeable     x

Volume trigger   x x

Curves: Pressure x    

Curves: Pressure / Volume / Flow   x x

Lopps: F/P, V/P, F/V   x x

Ventilation modes

Leoni mobil Leoni 2 Leoni plus

CPAP x x x

IPPV x x x

SIPPV   x x

SIMV   x x

SIPPV - PSV   x x

SIMV - PSV   x x

HFOV     x

Volume Limit   x x

Volume Guarantee     x

Manual Ventilatory Drive x x x

Leoni plus Ventilation modes

CPAP

IPPV / IMV

SIPPV

SIMV

PSV SIPPV

PSV SIMV

HFOV

CPAP Ventilation mode

Demand-CPAP

With support frequency

IMV/IPPV Ventilation mode

IMV

IPPV Ventilation mode

IPPV

SIPPV Ventilation mode

Leakage com- pensated volume trigge- ring Trigger sensi- tivity related to VTi (5 – 30 %)

SIMV Ventilation mode

Leakage com- pensated volume

triggering

PSV Ventilation mode

PSV SIPPV

PSV SIMV

HFOV Ventilation mode

HFOV on the membrane prin- ciple with recruit- ment breath function

Setting ranges

 IPPV/IMV

SIMV SIPPV CPAP

Breath rateFREQUENCY [BPM]

6 .. 200 2 .. 100 2 .. 100 -

Inspiration timeI-TIME [sec]

0.10 .. 2.00

0.10 .. 2.00

0.10 .. 2.00

-

Expiration timeE-time [sec]

0.20 .. 10.00

0.50 .. 30.00

0.20 .. 30.00

-

Inspiratory FlowINSP FLOW [l/min]

1 .. 32 1 .. 32 1 .. 32 -

Expiratory Flow E Flow [l/min]

2 .. 10 2 .. 10 2 .. 10 -

Setting ranges

 IPPV/IMV

SIMV SIPPV CPAP

Inspiratory PressureP INSP [cmH2O]

6 .. 60 6 .. 60 6 .. 60 -

Backup PressureP-BACK [cmH2O]

- - - 6 .. 60

Positive End Expiratory PressurePEEP [cmH2O]

0 .. 20 0 .. 20 0 .. 20 -

CPAP [cmH2O]- - - 1 .. 20

Setting ranges

 IPPV/IMV

SIMV SIPPV CPAP

O2 Concentration

OXYGEN [%]21 .. 100 21 .. 100 21 .. 100 21 .. 100

O2 Concentration Oxygen

flushO2-Flush [%]

23 .. 100 23 .. 100 23 .. 100 23 .. 100

Volume triggerTRIGGER [% VTi]

- 10 .. 30 10 .. 30 -

Setting ranges

 HFOV

Mean PressurePmean [cmH2O]

10 .. 30

High FrequencyHFFreq [Hz]

5 .. 20

High Frequency AmplitudeHFAmpl [cmH2O]

5 .. 80

Recruitment FrequencyFreqRec [1/min] 0 .. 10

Recruitment Inspiration TimeTI Rec [s]

0.1 .. 3

Casing front

1) Control Panel

2) Touch Screen

3) Rotary Pulse Encoder

4) Inspiratory Connection

5) Expiratory Connection

6) Pressure Gauge

Connection

7) HFOV- Connection

2

1 3

5 7 6 4

Casing rear

1) Earth Connection

2) Serial Interface

3) Ethernet Connection

4) Flow Sensor Connection

5) Oxygen Connection

6) O2Sensor Access

7) Compressed Air Connection

8) Mains Connection

9) Nurse Call

3 2

1

9

56

7

8

4

Accessories

1) Proximal Pressure Line

2) Expiration Hose

3) Inspiration Hose

4) Y-Piece

5) Flow Sensor

6) Test Lung

7) Flow Sensor Cable

8) HFOV Hose with Filter

8

Control panel

Mode / Home

Loops

Curves

Alarm Limits

Power Failure LED

Battery Operation LED

Alarm LED

Alarm Mute Button

StandBy

Manual VentilatoryDrive

Rotary Encoder

ON/OFF

Start Ventilation

Numerical ValuesSwitch-Over

Start Screen

1) Flow Sensor

2) Flow Sensor Calibration

3) Oxygen Sensor Calibration

4) Main Menu Bar

5) Calibration Button

Main Sreen

1) Alarm Bar

2) Curves

3) Softkeys

4) Numerical Values

Curve Display

1) Flow Curve

2) Pressure Curve

3) Volume Curve

Curves freelyscalable

3 Curves at the same time

Loop Screen

1) Flow over Pressure

2) Flow over Volume

3) Volume over Pressure

Full-screen presentation possible

Loops freely scalable

Up to 3 loops at the same time

Alarm limits

1) Manual Adjustment

2) Autoset Adjustment

3) Alarm Logbook Function

Simultaneous Presentation

Simultaneous Presentation of:

Loops Curve Screen Alarm Limits Monitoring

HFO Leoni plus

High-frequency ventilation (HFV) as a ventilatory therapy hasreached increasing clinical application over the past ten years. Theterm comprises several methods. High-frequency jet ventilationmust be differentiated from high-frequency oscillatory ventilation(HFOV or HFO). In this booklet I concentrate on high-frequencyoscillatory ventilation. Therefore, the difference in meaning notwithstanding,I use both acronyms, HFV and HFO, interchangeably.

Indications for HFV

Since the early eighties results on oscillatory ventilation have beenpublished in numerous case reports and studies. Yet there areonly few controlled studies based on large numbers of patients.

In newborns HFV has first beenemployed as a rescue treatment. The goal of this type of ventilationis to improve gas exchange and at the same time reduce pulmonarybarotrauma.

Oscillatory ventilation can be tried when conventional ventilationfails, or when barotrauma has already occurred or is imminent. In the first place this applies to pulmonary diseases with reducedcompliance. The efficacy of HFV for these indications has beenproven in the majority of clinical studies. In severe lung failure,HFV was a feasible alternative to ECMO

When to switch from conventional ventilation to HFV must certainlybe decided by the clinician in charge, according to their experience.Some centres meanwhile apply HFV as a primary treatmentfor RDS in the scope of studies. Likewise, in cases of congenital hernia and during surgical correction, HFV has been successfully used as a primary treatment

Indications; HFV+IMV

Also in different kinds of surgery, especially in the region of the larynx and the trachea, HFV has proven its worth. Moreover, in primary pulmonary hypertension of the newborn HFV can improve oxygenation and Ventilation.

Always observing the contraindications in our NICU we follow this proven procedure: If conventionalventilation* fails, we will switch over to HFV. We will assumefailure of conventional ventilation, if maintaining adequate bloodgas tensions (pO2 > 50mmHg, SaO2 > 90%; pCO2 < 55 to65 mmHg) requires peak inspiratory pressures (PIP) in excess ofcertain limits. Those depend on gestational age and bodyweight:In small prematures we consider using HFV at PIP higher than22 mbar. With PIP going beyond 25 mbar we regard HFV evenas a necessity.

In more mature infants the pressure limits are somewhat higher

Combining HFV and IMV, and sustained inflation

Oscillatory ventilation on its own can be used in the CPAP mode,or with superimposed IMV strokes, usually at a rate of 3 to 5strokes per minute.

The benefit of the IMVbreaths is probably due to the opening of uninflated lung units toachieve further ‘volume recruitment’.Sometimes very long inspiratory times (15 to 30 s) are suggestedfor these sustained inflations (SI). By applying them about every20 minutes compliance and oxygenation have been improved andatelectases prevented.

Combining HFV and IMV, and sustained inflation

Especially after volume loss by deflation during suctioningthe lung soon can be reopened with a sustained inflation. However,whether these inflation manoeuvres should be employedroutinely is subject of controversial discussions.

In most of the clinical studies no sustained inflations were applied. In animal trials no increased incidence of barotrauma was found.Prevention of atelectases, which might occur under HFV withinsufficient MAP, is the primary benefit of combining HFV and IMV.

HFV superimposed to a normal IMV can markedly improve CO2 washout (‘flushing the deadspace’ by HFV) at lower peak pressures

Indications; HFV+IMV

Effect of a sigh manoeuvres through sustained inflation (SI):prior to the SI the intrapulmonary volume equals V1 at the MAP level (point a);

the SI manoeuvres temporarily increases pressure and lung volume according to the pressure-volume curve; when the pressure has returned to the previous MAP level, pulmonary volume remains on a higher level, V2(point b),

because the decrease in pressure occurred on the expiratorylimb of the PV loop.PressureVolume

Standard Accessories

Flow Sensor / Y-Piece / Connecting cable

Expiration valve / Expiration membrane

Oxygen cell

Hose system, heated and non-heated

HFOV Hose

Total System

Thank you very much for your open interest

Heinen + Löwenstein GmbHArzbacher Straße 80D-56130 Bad EmsTel. +49 (0) 2603 9600-0Fax +49 (0) 2603 960050

www.hul.de