Zoll Z Vent® CPAP and Mechanical Ventilation

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.

6. Select Start Menu Option

• 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

• 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.