Zoll Z Vent® CPAP and Mechanical Ventilation

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Questions and Answers

Which of the following is a contraindication for Assist Control in ventilated patients?

Intubated patient

Pressure targeting

Assisted breaths

Tidal Volume (Vt < 200 mL) with pediatric/adult circuit (correct)

What does volume targeting in Assist Control ensure?

Improved respiratory rate variability

A consistent volume is delivered during inhalation (correct)

Reduction of mechanical failure risk

Constant airway pressure during expiration

Which potential complication is associated with Assist Control ventilation?

Increased oxygen saturation

Pneumothorax (correct)

Decreased respiratory effort

Enhanced lung compliance

In pressure targeting during Assist Control, which parameter is highlighted?

Vt parameter Signup and view all the answers

What is a primary indication for using Assist Control ventilation?

Intubated patient with a secured ET tube Signup and view all the answers

What is the purpose of the Zoll Z Vent® mechanical ventilator?

To manage both intubated and non-intubated patients of all ages Signup and view all the answers

Which ventilation mode allows for both volume and pressure targeting?

Assist Control (AC) Signup and view all the answers

What is the maximum airway pressure high limit for the Zoll Z Vent®?

100 cm H2O Signup and view all the answers

Which of the following is NOT a step in the procedure for setting up the Zoll Z Vent®?

Calibrate the tidal volume setting Signup and view all the answers

What is the purpose of the Fresh Gas/Emergency Air Intake filters during setup?

To ensure a clean air supply for the ventilator Signup and view all the answers

What is the correct action to take when disconnecting the power supply plug?

Pinch the plug at the base and slide up to release the safety latches. Signup and view all the answers

Which step is essential for ensuring a secure connection of the power supply plug?

Align both triangles on the plug and connection port. Signup and view all the answers

What should be done if the power switch fails during operation?

Disconnect the device from the mains power immediately. Signup and view all the answers

What should be avoided when connecting the power supply plug to prevent damage?

Twisting the power cable connection plug during connection. Signup and view all the answers

What action is advised to take in the event of a shutdown?

Turn the power switch to the OFF position. Signup and view all the answers

What is the primary purpose of Continuous Positive Airway Pressure (CPAP) ventilation?

To enhance gas exchange by distending airways and alveoli Signup and view all the answers

Which of the following conditions is NOT an indication for CPAP use?

Pneumothorax Signup and view all the answers

What should be monitored to ensure proper delivery of CPAP during treatment?

Pressure gauge to ensure it does not vary significantly Signup and view all the answers

What is a possible complication of CPAP treatment?

Fluid retention Signup and view all the answers

During the CPAP procedure, what is the significance of the 'No Leak Compensation' feature?

It adjusts the pressure for mask leaks Signup and view all the answers

What level of CPAP pressure is typically adjusted during treatment?

5-20 cm H₂O Signup and view all the answers

Which of the following is included in the contraindications for CPAP use?

Facial trauma or burns Signup and view all the answers

What preliminary step should be taken before using the Z-Vent CPAP?

Ensure the device passes a Self-Check Signup and view all the answers

What should be done immediately after confirming the ventilator is operating correctly?

Attach the patient airway to the patient circuit. Signup and view all the answers

Which of the following alarms indicate a potential issue during setup or initial use?

Disconnect Signup and view all the answers

What must always be available when connecting a patient to a ventilator?

An alternate means of providing mechanical ventilation Signup and view all the answers

What should not be connected to the USB port of the ventilator?

Any device since it does not provide signal input/output Signup and view all the answers

What is a critical step before connecting a patient to a ventilator?

Ensure the ventilator is functioning properly and set to correct parameters. Signup and view all the answers

What is the purpose of the Self-Check test that occurs after powering on the ventilator?

To check the operational integrity of the device Signup and view all the answers

How long are the ventilator's alarms muted during normal start-up?

120 seconds Signup and view all the answers

Which starting configuration should be selected for an infant when using the ventilator?

Pediatric Signup and view all the answers

What happens if there are no active medium priority alarms and no un-muted low priority alarms for a period of 15 seconds during start-up?

The mute self clears Signup and view all the answers

What should be done before connecting the patient to the ventilator?

Ensure the ventilator operates correctly Signup and view all the answers

What should be done if the high and low alarm limits are not suitable after changing parameter values?

Adjust the alarm limits to encompass the new value. Signup and view all the answers

What is the first step in performing an Operational Test before connecting the patient?

Press the Manual Breath button. Signup and view all the answers

If the HIGH AIRWAY PRESSURE LIMIT alarm does not activate during the Operational Test, what should be checked next?

The circuit connections and exhalation valve. Signup and view all the answers

During the Operational Test, what happens when the patient port is closed?

The PIP High Limit activates an alarm. Signup and view all the answers

What must be confirmed regarding the external power before connecting the patient?

There is sufficient battery capacity. Signup and view all the answers

What should be done if the ventilator's alarms fail to activate during the Operational Test?

Manually ventilate the patient and check the circuit. Signup and view all the answers

What is the consequence of not confirming that the ventilator functions correctly before connecting the patient?

The patient might experience inadequate ventilation. Signup and view all the answers

What should you do to change parameter values if they are different from the defaults?

Use the parameter buttons and Dial. Signup and view all the answers

What is the primary function of the CPAP operating mode?

To assist patients with spontaneous breathing by providing constant pressure Signup and view all the answers

What should be performed before placing the patient on the ventilator?

Adjust the ventilator settings appropriately Signup and view all the answers

What happens to the mask icon when a low priority alarm occurs?

The icon disappears but reappears when alarms are muted Signup and view all the answers

Which parameter may require adjustment when transitioning to CPAP/BL mode?

Rise Time Signup and view all the answers

In AC mode, what does the patient receive during an assisted breath?

Either volume or pressure-based assistance Signup and view all the answers

What is the purpose of the Fresh Gas/Emergency Air Intake filters?

To protect the compressor and patient from particulate matter Signup and view all the answers

What is a critical adjustment to consider for infants when using CPAP/BL mode?

Ensure the rise time is set to a lower value Signup and view all the answers

How can default parameters be selected in the ventilator settings?

By highlighting the setting and pressing Accept Signup and view all the answers

What is a critical warning regarding the Fresh Gas/Emergency Air Intake?

It should never be blocked during operation Signup and view all the answers

What does BL mode provide to spontaneously breathing patients?

Two adjustable pressure settings for inhalation and exhalation Signup and view all the answers

What happens to the ventilator when an external power source fails?

It switches to internal battery power without interruption Signup and view all the answers

Which power source provides the longest operational time for the ventilator?

Internal 14.4 VDC Li-ion rechargeable battery Signup and view all the answers

What voltage range is acceptable for the ventilator's input connector?

11.8 to 30.0 VDC Signup and view all the answers

What is the role of the Fresh Gas/Emergency Air Intake during a ventilator failure?

It serves as an anti-asphyxia port Signup and view all the answers

What is the output of the External AC/DC Power Supply provided by ZOLL?

24 V at 4.2 A Signup and view all the answers

Which of the following power sources is used when available instead of the internal battery pack?

Both B and C Signup and view all the answers

What should be set during pressure-targeted ventilation to prevent alarms related to disconnection?

High tidal volume just above the patient's maximum tidal volume Signup and view all the answers

When adjusting the breath target from volume targeting to pressure targeting, which step should be taken first?

Press the 'Mode' parameter button twice Signup and view all the answers

What is a recommended tidal volume range for adult patients based on ideal body weight (IBW)?

6-8 mL/kg Signup and view all the answers

What range should PIP be set to during pressure-targeted ventilation?

15-20 cm H2O above PEEP Signup and view all the answers

Which parameter should be reset to ensure proper pressure alarm settings during ventilation?

Low pressure alarm to 10-15 cmH2O below PIP Signup and view all the answers

What is the maximum recommended PIP limit in a ventilator setup?

35 cm H2O Signup and view all the answers

How should FiO2 be adjusted according to patient's oxygen saturation needs?

From 21% up to 100% at the lowest setting to maintain SpO2 > 90% Signup and view all the answers

Which setting ranges are typically adjusted for PEEP?

3-5 cm H2O initially and then adjusted as needed Signup and view all the answers

Study Notes

Zoll Z Vent® CPAP (Setting)

CPAP is a spontaneous breathing mode of ventilation that provides continuous positive airway pressure.
It reduces the work of breathing and increases functional residual capacity (FRC) by distending airways and alveoli.
CPAP facilitates fluid movement from less compliant to more compliant interstitial spaces, improving oxygenation and lung compliance.
CPAP is indicated for conditions like congestive heart failure, pulmonary edema, submersion/drowning, COPD, and acute respiratory distress.
Contraindications include respiratory arrest, agonal respirations, unconsciousness, shock associated with cardiac insufficiency, pneumothorax, facial trauma or burns, and tracheotomy.
Possible complications include gastric distention, reduced cardiac output, hypoventilation, pulmonary barotrauma, and fluid retention.

Zoll Z Vent® Mechanical Ventilator

The Z Vent is a portable mechanical ventilator that can be powered by an internal battery or an external power source.
It offers multiple ventilation modes for infants to adults, including Assist Control (AC), CPAP, and Bi-Level (BL).
AC mode allows either volume or pressure targeting.
Specifications:
- Airway Pressure High Limit: 20 to 100 cm H2O
- Frequency: 0 to 80 BPM
- I-E Ratio: 1:99 to 4.0:1.0
- Inspiratory Time: 0.3 to 5.0 seconds
- PEEP: 0 to 30 cm H2O
- Oxygen Input Pressure: 55 psig
- Airway Pressure Low Limit: Off, 3 to 35 cm H2O
- Tidal Volume: 50 to 2000 mL (±10% of setting)
- Flow Rate: 0-100 LPM @ 40 H2O
- FiO2: 21% to 100%
- Peak Inspiratory Pressure (PIP): 10 to 80 cm H2O
- Dead Space: 22 mL (when using Zoll 6 or 12 ft circuit)

Setting Up the Ventilator

Follow these steps to set up the Z Vent:
- Attach the patient circuit.
- Attach the high-pressure oxygen supply (optional).
- Inspect Fresh Gas/Emergency Air Intake filters.
- Select the ventilator's power source.
- Power on the ventilator.
- Select start-up default configurations.
- Change the operating mode (optional).
- Change parameter values.
- Perform an operational test.
- Attach the patient.

ASSIST CONTROL (Volume targeting or Pressure targeting)

AC mode provides either controlled or assisted breaths.
When the patient triggers an assisted breath, they receive a breath based on either the volume or pressure target.
Volume targeting assures a constant volume delivered with a constant flow.
Pressure targeting provides constant airway pressure with a decelerating flow pattern.

Power Supply Connection and Disconnection

Connect the power supply firmly, aligning the triangles for secure connection.
Firmly insert the power supply plug into the connection port with aligned triangles.
Give a firm tug to ensure proper connection.
Pinch the plug at the base and slide up to release the safety latches to disconnect.
Do not twist the plug to avoid damage.

General Instructions

Turn the Power switch to the OFF ("0") position in case of a shutdown.
Disconnect the device from the mains power if the power switch fails or poses a risk.
Connect an AC/DC Power Supply plug to the device's External Power Input and a compatible electrical outlet for external power.
The ventilator automatically charges the internal battery while operating on external power.
The ventilator switches to its internal battery in case of external power failure and activates the EXTERNAL POWER FAILURE alarm.
Operation resumes on internal battery without interruption.
Operating power switches back to the external source when external power returns.

9. Attach Patient

Detach the test lung and attach the patient airway (endotracheal tube, supraglottic airway, tracheotomy tubes, or mask) to the patient circuit connection port.
Check all circuit connections and the exhalation valve for leaks if circuit-related alarms occur.
Never leave the patient unattended.
Ensure an alternate means of mechanical ventilation (bag-valve resuscitator and mask) is available.
Do not connect the patient until you determine that the ventilator is functioning properly and parameters are set correctly.
Do not connect anything to the USB connection.

3. Inspect Fresh Gas/Emergency Air Intake Filters

The Fresh Gas/Emergency Air Intake provides the gas path for the ventilator's internal compressor.
It has two filters: a removable foam filter and a Fresh Gas/Emergency Air Intake disk filter.
Inspect the filters and replace if dirty.
Never block the Fresh Gas/Emergency Air Intake, as free flow of air is required for compressor operation and spontaneous breathing in case of failure.

4. Select the Ventilator’s Power Source

The ventilator can use these power sources:
- Internal 14.4 VDC Li-ion rechargeable battery (10 hours of operation at factory default settings with pulse oximeter operating at 25°C).
- External AC/DC Power Supply (100 to 240 VAC 50/60 and 400 Hz).
- External DC power from a standard vehicle DC outlet using the 12 or 28 VDC Power Cable.

8. Change Parameter Values

Use the parameter buttons to highlight primary and secondary parameters or use the parameter button to access the context menu.
Use the Dial to adjust the highlighted parameter's value.
Press Accept to implement the change.
Alarm limits should be appropriate for the patient being ventilated.

9. Perform Operational Test

Before connecting the patient, perform an Operational Test to ensure proper circuit attachment and safety alarm functionality.
Procedure:
- Press the Manual Breath button: Gas should exit the patient connection with each press.
- Close the patient port: The HIGH AIRWAY PRESSURE LIMIT alarm should activate after two breaths reaching the PIP High Limit.
- Release the patient port: The PATIENT DISCONNECT alarm should activate.
- Partially close the patient port: Reset the PATIENT DISCONNECT alarm.
- Remove external power: The EXTERNAL POWER LOW/DISCONNECT alarms should activate.
- Reconnect external power: Reset the alarms.
If alarms fail to activate, manually ventilate the patient, check the circuit for leaks or a faulty exhalation valve, and repeat the test.
Confirm sufficient battery capacity if using the internal battery.

Ventilator Operating Modes

Always adjust the ventilator before connecting the patient.
Use predefined configurations (Adult, Pediatric, Mask CPAP) for default settings.
Do not use CPAP or BL mode on a patient not spontaneously breathing or who may stop breathing spontaneously.
CPAP and BL are for ventilatory support, not ventilation.
When using non-invasive CPAP and BL with LC (Leak Compensation):
- The head with a mask icon appears where the speaker/mute icons are.
- Low and Medium priority alarms cause the mask icon to disappear.
- The icon reappears when low priority alarms are muted.
- The muted speaker icon appears when Medium priority alarms are muted.

7. Change Operating Mode

The ventilator offers these operating modes:
- AC (Assist/Control): Controlled or assisted breaths based on volume or pressure.
- CPAP (Continuous Positive Airway Pressure): Constant positive airway pressure for spontaneous breathing.
- BL (Bilevel): Two pressure settings (IPAP and EPAP) to assist spontaneous breathing.
To select a mode:
- Press the Mode parameter button.
- Turn the Dial to highlight the desired mode.
- Press the Accept button.

Transitioning Modes

Transitioning between modes may require adjustment of these parameter/alarm limits:
- Low BPM Alarm
- High BPM Alarm
- Low Airway Pressure Alarm
- PEEP
- VT High Limit
- VT Low Limit
- Rise Time
- Pressure Support
Transition to CPAP/BL mode automatically sets the rise time to 3, which may be too fast for infants and small children.

5. Power On the Ventilator

Turn the Power switch to "I" to power on the ventilator.
The device performs a Self-Check test to check alarms and system operation.
It waits for user input to select a start-up configuration.
Alarms are muted for 2 minutes during start-up, allowing you to connect the patient circuit, adjust settings, and perform an operational test.
The start-up mute automatically clears after 15 seconds with no active medium priority alarms and no un-muted low priority alarms.
Always start the ventilator, select patient settings, ensure operation, and then connect the patient.
Always manually ventilate the patient while they are not connected to the ventilator.

When powered on, the Start Menu appears, allowing you to choose a starting configuration.
Options:
- Adult
- Pediatric
- Mask CPAP – Continuous Positive Airway Pressure (CPAP)
- Custom – Values saved in a previous session
- Last Settings – Values set for the last patient treated
Gas flow at start-up detects the patient in case of improper procedures.
Default settings are intended to speed up configuration.
Exercise particular care when adjusting the ventilator for infants.

Instrument Settings

This section likely describes settings for a specific type of medical instrument (e.g., a ventilator).

Setting Breath Target

To adjust the breath target:
- Press the Mode parameter button twice to highlight the Breath Target parameter.
- Use the dial to switch between V (Volume Targeting) and P (Pressure Targeting).
- Press the Accept button.
You cannot adjust tidal volume in pressure-targeted ventilation.
You may need to adjust PIP to maintain desired tidal volume.

Setting PIP Target (Pressure-Targeted Ventilation)

To adjust the PIP target in pressure-targeted ventilation:
- Press the PIP parameter button.
- Use the Dial to set the desired PIP target value.
- Press the Accept button.

Important Considerations

Pressure Target Ventilation: Setting high and low tidal volume limits helps prevent leaks and ensures minimum tidal volume delivery.
Warning: During pressure-targeted ventilation, always set the high tidal volume limit just above the patient's maximum tidal volume. A disconnection or decannulation will trigger an alarm if there is an increase in volume.

Adult Default Parameter Settings

Parameter	Default Setting Value	Options/Range
Mode	AC (V)	AC (V) or AC (P)
BPM	12	Custom setting 1:2 for typical Pts
I:E	1:3	50-2000 mL
VT	450	0-30
PEEP	5	10-80
PIP Limit	35	21% (0.21) - 100% (1.0)
FIO2	21

Tidal Volume (Vt): 6-8 mL/kg of IBW; Use Vt of 10-12 mL/kg with lower RR (6-8/min) for hypotensive patients with SBP < 80 mmHg.
Other settings:
- FiO2: Adjust from 21% up to 100% at the lowest setting required to maintain SpO2 >93%.
- PEEP: 3-5 cm H2O, adjust as needed.
- PIP: 15-20 cm H2O above PEEP (ideal < 35).
- Rate (FiO2): Adult 12 - 14 bpm; Child 16-20 bpm; Infant 30 - 40 bpm.
- High/Low Pressure Alarm: Reset high pressure alarm to 10-15 cmH2O above the PIP. Reset low inspiratory pressure alarm to 10-15 cmH20 below the PIP.

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Description

Explore the settings and indications for Zoll Z Vent® CPAP. This quiz covers its benefits, contraindications, potential complications, and general mechanical ventilation principles. Perfect for students and professionals in respiratory care and critical care medicine.