monsoon III Instructions for Use sw 2.07 Dec 2016.pdf
Page 1
Ventilation Beyond Limits
monsoon III
Instruction for Use
Warning
Carefully read the instructions of
use before using the ventilator to
familiarise yourself with the function
of the equipment
Ref: 215003.01EN / Date: 14.12.2016
SW 2.07
Page 2
Manufactured by:
ACUTRONIC Medical Systems AG
Fabrik im Schiffli
8816 Hirzel / Switzerland
Tel: +41 44 729 70 80
Fax: +41 44 729 70 81
e-mail: info@acutronic-medical.ch
www.acutronic-medical.ch
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TABELE OF CONTENT
Control Panel Variations ........................................................................................................................................................ 5
FOR YOUR SAFETY AND THAT OF YOUR PATIENTS ........................................................................................................... 6
Read Instructions for Use....................................................................................................................................................... 6
Notices and Warnings ............................................................................................................................................................. 6
Identification of the Device ................................................................................................................................................... 6
Safety Notices ........................................................................................................................................................................... 7
Maintenance ............................................................................................................................................................................. 9
Accessories .............................................................................................................................................................................. 10
Safe Use ................................................................................................................................................................................... 10
Liability for Proper Function and Damage ....................................................................................................................... 10
Medical Purpose .................................................................................................................................................................... 11
Qualification of Users ........................................................................................................................................................... 11
Contraindications .................................................................................................................................................................. 11
Indications for Use................................................................................................................................................................. 12
Ventilation Modes .................................................................................................................................................................. 13
Maintenance Intervals, Batteries ....................................................................................................................................... 14
Contents .................................................................................................................................................................................. 15
USER INTERFACE ......................................................................................................................................................... 16
Front View / Connectors ....................................................................................................................................................... 16
Control Panel Overview ........................................................................................................................................................ 17
Main Unit Overview ............................................................................................................................................................... 18
Display - Single Jet ................................................................................................................................................................ 19
Display - Double Jet .............................................................................................................................................................. 20
MONSOON III ............................................................................................................................................................... 21
PRESSURE LIMITS........................................................................................................................................................ 22
PIP Limit (Respiratory Tract Pressure) .............................................................................................................................. 22
PP Limit (Pause Pressure) .................................................................................................................................................... 22
Superimposed Pressure Limit (Superimposed Ventilation) ........................................................................................ 22
START-UP.................................................................................................................................................................... 23
Apparatus Preparation ......................................................................................................................................................... 23
Check P-Pressure and PIP Safety Limits........................................................................................................................... 24
Using the monsoon III with Single Lumen Catheter ...................................................................................................... 25
OPERATION ................................................................................................................................................................. 26
Parameter Settings ............................................................................................................................................................... 26
Menu ......................................................................................................................................................................................... 26
Superimposed Pressure Limit (SIPL) ................................................................................................................................. 27
Double Jet (Optional) ........................................................................................................................................................... 27
Bypass ...................................................................................................................................................................................... 28
Humidification / Climatisation ........................................................................................................................................... 28
Settings .................................................................................................................................................................................... 31
Language ................................................................................................................................................................................. 31
Maintenance ........................................................................................................................................................................... 31
Disconnection ........................................................................................................................................................................ 32
Laser Application ................................................................................................................................................................... 32
etCO2 – Measurement (Optional) ....................................................................................................................................... 33
Video Camera (Optional, not with new control panel) ................................................................................................. 34
Remote Control (Optional) .................................................................................................................................................. 35
Home Button (control panel with new hardware) ......................................................................................................... 35
Automatic – Manual Operating Mode ............................................................................................................................... 36
Terminating Operation......................................................................................................................................................... 37
CLINICAL APPLICATIONS .............................................................................................................................................. 37
Patient Data ............................................................................................................................................................................ 37
CPAP Ventilation Set for monsoon III ................................................................................................................................ 38
LEGEND: ...................................................................................................................................................................... 38
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SET-UP: ...................................................................................................................................................................... 38
APPARATUS SETTINGS: ................................................................................................................................................ 39
HUMIDIFICATION: ........................................................................................................................................................ 39
REMARKS:.................................................................................................................................................................... 39
DIAGRAM: .................................................................................................................................................................... 39
Infraglottic Catheter Jet Ventilation .................................................................................................................................. 40
Supraglottic (Catheterless) Jet Ventilation ...................................................................................................................... 41
Rigid Bronchoscopy .............................................................................................................................................................. 42
Infraglottic Jet Ventilation ................................................................................................................................................... 42
Transtracheal Jet Ventilation ............................................................................................................................................. 43
ALARMS AND ERROR CODES ........................................................................................................................................ 44
Patient Alarms ........................................................................................................................................................................ 45
System Alarms ........................................................................................................................................................................ 46
Notices ..................................................................................................................................................................................... 49
RECOMMENDED ACCESSORIES .................................................................................................................................... 51
TREATMENT, DISINFECTING / CLEANING ..................................................................................................................... 52
ABBREVIATIONS AND SYMBOLS.................................................................................................................................... 53
ABOUT ELECTROMAGNETIC COMPATIBILITY ................................................................................................................. 55
TECHNICAL SPECIFICATION ......................................................................................................................................... 59
Settings and Ranges ............................................................................................................................................................. 59
Dimensions ............................................................................................................................................................................. 59
Connections / Ports .............................................................................................................................................................. 59
Environmental Conditions .................................................................................................................................................. 60
Alarm Signal Sound Pressure Level ................................................................................................................................... 60
Disposal ................................................................................................................................................................................... 60
Rear View / Connections ...................................................................................................................................................... 61
Replacing Fuses ..................................................................................................................................................................... 62
TABLE OF FIGURES ...................................................................................................................................................... 63
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Control Panel Variations
The monsoon III control panel is equipped with a new hardware version. To identify the control panel
version you have, please compare the following pictures:
Old Control panel version with video function
New Control panel version Home Button
Figure 1. Control Panel Variations
The differences of the two versions:
Actual control panel
Naming:
Humidification
Scale Humidification:
0 – 8 (min=0, max = 8)
Video Button:
for camera use
w/o interfering adjusted and set values and alarms
New control panel
Naming:
Climatisation
Scale Climatisation:
0 – 10 (min = 3, max = 10)
Home Button:
fall back on start screen
w/o interfering adjusted an set values and alarms
Important!
The new hardware implements a change of the software to version 2.07. This software supports all
features of the new hardware version as well as all features of the former hardware versions covered
by the software version 2.03.
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FOR YOUR SAFETY AND THAT OF YOUR PATIENTS
Read Instructions for Use
Please read these Instructions for Use carefully before using the equipment; keep
them in a safe place for reference.
Any use of this apparatus requires full understanding and strict observation of these instructions for
use.
This apparatus is only to be used for purposes specified here.
Notices and Warnings
The three types of information NOTE, CAUTION and WARNING draw attention to the fact that the associated text should be read carefully in order to ensure safe use.
NOTICES are supplements to instructions
DANGER / CAUTION indicate a not directly imminent but latent hazard which may result in death or bodily injury unless prevented.
ATTENTION / WARNING indicate a risk which may result in equipment or property
damage when not avoided.
Identification of the Device
You can identify with the GTIn number which device type you have. See the list below:
GTIN
Ref. No. Description
7640140860527
212001
monsoon +
7640140861371
212101
monsoon + with EtCO2
7640140861395
212201
monsoon + with EtCO2 and double jet
7640140860534
211001
monsoon Basic
7640140861401
211101
monsoon Basic with EtCO2
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Safety Notices
Always observe
Any use of the ventilator requires full understanding and strict observation of these instructions. The apparatus is only to be used for purposes specified here.
Only operate the ventilator with accessories recommended by ACUTRONIC Medical
Systems AG.
The ventilator is only to be operated by qualified technical staff or under their supervision to immediately provide assistance in the event of malfunction.
If the new value is not confirmed by the operator by pressing the rotary pulse encoder
or the touch monitor the value will automatically be reset after a few seconds.
Always have an alternate ventilation system (e.g. resuscitation bag) when using the
ventilator.
If the life support function can no longer be ensured due to an obvious ventilator defect,
immediately provide artificial ventilation to the patient via a self-contained ventilator
(e.g. resuscitation bag).
The ventilator may not be used in combination with inflammable gases or narcotic
agents – there is otherwise an acute risk of fire and explosion!
An audible signal indicates a system or patient alarm and always requires action by a
medical professional.
An audible alarm will sound in the event of power failure. Resetting the alarm requires
the on/off switch to be pressed.
Never connect the ventilator to patients if an error or malfunction is detected during
equipment check!
Never connect to electrical devices not mentioned in this operator’s manual without
first consulting the manufacturer or an expert.
Never operate the ventilator while covered or set up in a way so as to negatively impact
the operation or function.
Always unplug before opening the housing!
Never use mobile phones within 10 metres of the ventilator. Mobile phones may interfere with the performance of electromedical equipment.
Never use anti-static or electrically conductive tubes.
Note: the safety and health of the users is guaranteed by the fact that the products for
example do not contain any allergenic or mutagenic materials such as phthalates.
The device can only be separated from the main power supply by removing the power
cord completely. Please ensure the power socket is freely accessible at all times for
disconnection. Do not remove the power cable unless for service purposes or transport.
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Warning: To avoid the risk of an electric shock the equipement must only be connected
to supply mains with protective earth.
Warning: Do not modify the equipment without authorization of the manufacturer.
Do not position the ventilator so that it is difficult to operate the disconnection device.
The power supply connector is isolating the ventilator from supply mains.
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Maintenance1
The monsoon III is a Universal Jet ventilator classified as device group IIb according to European directive.
1.) The apparatus must be safety inspected and serviced at regular 6 months intervals in compliance
with the manufacturer instructions as well as §6 MPBetreibV Medical Devices Operator Ordinance
dated 6/29/1998.
2.) Service must be performed by professionals trained by ACUTRONIC Medical Systems AG with the
suitable measuring and testing devices.
3.) ACUTRONIC Medical Systems AG recommends obtaining a service contract with an exclusive representative of ACUTRONIC Medical Systems AG.
4.) Only use genuine ACUTRONIC Medical Systems AG replacement parts.
Definition:
Inspection
Service
Repair
Maintenance
1
= Determine actual condition
= Measures to maintain desired condition
= Measures to restore desired condition
= Inspection, maintenance, repair
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Accessories
Use only accessories specified in the accessory list.
Safe Use
Do not use in explosion-risk areas.
This equipment is not approved for use in explosion-risk areas.
Safe connection with electrical devices
Do not connect to electrical devices not specified in this manual without consulting the manufacturers
or an expert professional.
Liability for Proper Function and Damage
Any and all liability for the proper function of the apparatus is irrevocably transferred to the owner or
operator if the apparatus has been serviced or repaired by personnel not associated with ACUTRONIC
Medical Systems AG Service or if the apparatus was used in a manner not conforming to its intended
use.
ACUTRONIC Medical Systems AG assumes no liability for damages caused by non-compliance with
preceding notices. The warranty and liability provisions of the terms of sale and delivery of
ACUTRONIC Medical Systems AG is likewise not modified by the recommendations mentioned above.
ACUTRONIC Medical Systems AG
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Medical Purpose
Universal Jet ventilator is designed for use in ICU (long term applications) and in the operating theatre
for laryngoscopy, rigid bronchoscopy, microsurgeries with or without laser. The apparatus is also suitable for use combined with imaging procedures to minimise organ motion due to artificial ventilation.
For ICU long-term applications we recommend performing routine blood gas analyses as the applied
minute volume cannot be accurately measured with Jet ventilation and could fluctuate greatly due to
modified pulmonary compliance.
Qualification of Users
The ventilator is only to be operated by qualified technical staff or under their supervision to immediately provide assistance in the event of malfunction. Required qualification is an adequate training in
the functionality and application of this jet ventilator as well as a medical education suitable to perform medical interventions like this.
Contraindications
With respect to contraindications please note Jet ventilation shall only be used by clinical specialists
with extensive knowledge of Jet ventilation.
There are no known contraindications in the area of laryngoscopy, bronchoscopy or laser surgery. In a
few cases CO2 exhalation in heavy weight patients was associated with problems during Single Jet
ventilation. In these cases Jet ventilation was temporarily suspended and conventional ventilation
used until the CO2 values returned to normal. With Double Jet CO2 exhalation is supported through the
low-frequency Jet, suspending Jet ventilation is therefore no longer required. Always monitor the CO2
values when using artificial ventilation. This may be done using a CO2 module for the monsoon III sold
separately, a capnograph or transcutaneous CO2 measurement.
For detailed studies and experienced data please contact:
ACUTRONIC Medical Systems AG
Fabrik im Schiffli
8816 Hirzel / Switzerland
Tel:
+41 44 72 9 70 80
Fax:
+41 44 729 70 81
e-mail: info@acutronic-medical.ch
www.acutronic-medical.ch
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Indications for Use
Always have a manual resuscitator ready when using a Jet ventilator in the event of insufficient CO2
elimination or insufficient oxygenation in the patient.
Oxygen saturation and CO2 should be routinely monitored via capnograph and pulse oximeter or
blood gas analysis.
With long-term use of the Jet apparatus routinely check the function of the mucous membranes of the
trachea for sufficient humidification to prevent desiccation. Since the monsoon III features an efficient
heating and humidification system no problems have occurred in the field.
A large number of surgical procedures of the ventilation system are performed through the use of laser. This poses a risk of flammable materials (e.g. catheter, swab, residual tissue) in the operating field
igniting, which could be further promoted by an increased concentration of oxygen.
Laser procedures may therefore only be performed together with the Jet catheter “Laserjet”.
The monsoon III features a function specifically for laser procedures allowing the user to set the oxygen concentration to be administered during a laser procedure. This feature is activated with the Laser
on/off switch, the blender as quickly as possible regulates at the set default oxygen concentration of
< 40 %Vol, the concentration cannot be increased with active laser function. Once the blender reaches
an oxygen concentration of < 40 %Vol the notification “Laser OK” is displayed.
Once the laser procedure is completed or the function is deactivated the blender automatically returns to the last O2 value setting.
The notification “Laser OK” merely refers to having reached the default oxygen concentration in
the blender. An increased oxygen concentration may still be present in the respiratory tracts of
the patient as the ventilation parameters or constricted respiratory tracts results in a decreased
depletion of the oxygen.
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Ventilation Modes
The Single Jet version features one port, the Double Jet features two ports for Jet ventilation. The frequency, inspiration time and emission pressure are adjustable.
The apparatus further features an outlet for a so-called AUX-Flow, which may be used for patient preoxygenation or emergency ventilation.
Only use this apparatus under the supervision of trained medical staff to provide immediate assistance
in the event of a malfunction.
Never use the apparatus with flammable gasses or anaesthetics, fire hazard!
Never use mobile phones within 10 metres of the apparatus!
Mobile phones may interfere with the function of electromedical apparatuses.
Also Note:
Availability of manual ventilation
If the life support function can no longer be ensured due to an obvious ventilator defect, immediately provide artificial ventilation to the patient via a self-contained ventilator (e.g. resuscitation bag).
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Maintenance Intervals, Batteries
Apparatus and/or parts must be cleaned and disinfected prior to any maintenance* - including returning the apparatus for repair.
Every 6 months
Maintenance and safety inspection according to IEC 60601 as amended
Perform:
- Check alarm and limit functions
- Check pressure connections
- Check electrical connections
- Check safety shut-offs
Every 12 months
Maintenance and safety inspection according to IEC 60601 as amended
- Check alarm and limit functions
- Check pressure connections
- Check electrical connections
- Check safety shut-offs
- Calibration
- Replace the following components:
- O2 sensor
- Qty. 2 gas supply input filter
- Water intake needle(s) qty. 2 on Double jet
- Water tube set:
Every 1000 operating hours
- Replace the following components:
- MATRIX Jet valve, qty. 2 on Double jet
- Heating cartridge
Every 3 years
- Replace all internal tubing
Every 10 years
Replace lithium battery for data backup (dispose of used battery)
Maintenance and safety inspection must be performed by professionals trained by
ACUTRONIC Medical Systems AG with the suitable measuring and testing devices.
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Contents
The monsoon III is available in the following configurations:
-
monsoon III Basic
o 1-channel Jet
o Pause pressure monitor
o Respiratory tract pressure monitor
o AUX-Flow 15 lpm
o Air/oxygen blender
o 9” touch screen colour display
o Optional:
Video camera (old control panel)
etCO2 module
-
monsoon III +
o 1-channel Jet
o Pause pressure monitor
o Respiratory tract pressure monitor
o Flow monitor
o Built-in heater and humidification
o AUX-Flow 0 -70 lpm
o Air/oxygen blender
o 9” touch screen colour display
o Optional:
Video camera (old control panel)
2nd Jet channel
etCO2 module
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USER INTERFACE
Front View / Connectors
2
3
4
1
5
6
Figure 2. monsoon III – front view
Legend:
Element 1:
Element 2:
Element 3:
Element 4:
Element 5:
Element 6:
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Control panel (MMI = ManMachineInterface) with rotary pulse encoder
Main unit
Control panel connection
Controls for main unit
Ports for patient tubes, water supply, etCO2 measuring tube
Connection cable control panel to main unit
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Control Panel Overview
1
2
3
4
5
6
7
8
9
10
00
Figure 3. Control panel overview
Legend:
Element 1:
Element 2:
Element 3:
Element 4:
Element 5:
Element 6:
Element 7:
Element 8:
Element 9:
Element 10:
Patient alarm LED
System alarm LED
Display
Jet on/off switch (with LED); hold key in manual mode
Manual/automatic mode switch (with LEDs)
Old control panel: Video channel activation for camera
New control panel: Home Button
Laser function on/off switch (with LED)
Reset alarms and notifications
Mute alarm (with LED) (2 minutes)
Rotary pulse encoder
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Main Unit Overview
1
In the event of an control panel defect ventilation will continue with
the previously set parameters, the defective piece can meanwhile be
replaced with a new control panel during operation.
For safety reasons the Jet may only be switched off from the main
unit.
2
3
4
Legend:
Element 1:
Element 2:
Element 3:
Element 4:
Element 5:
Patient alarm LED
System alarm LED
Connected power LED
Mute alarm (with LED) (2 minutes)
Jet on/off switch (with LED)
5
Figure 4. Main unit overview
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Display - Single Jet
3
5
4
2
1
6
7
Figure 5. Single Jet display
Legend:
Element 1:
Element 2:
Element 3:
Element 4:
Element 5:
Element 6:
Element 7:
Parameter Jet channel 1
Graphics respiratory tract pressure and etCO2
Alarm and notification field
Measurements
Help, menu and patient data keys
Oxygen, Aux and humidification parameters
Respiratory tract- and pause pressure limits
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Display - Double Jet
3
5
4
2
1
7
6
8
Figure 6. Double Jet display
Legend:
Element 1:
Element 2:
Element 3:
Element 4:
Element 5:
Element 6:
Element 7:
Element 8:
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Parameter Jet channel 1
Graphics respiratory tract pressure and etCO2
Alarm and notification field
Measurements
Help, menu and patient data keys
Parameter Jet channel 2
Oxygen parameter
Respiratory tract- and pause pressure limits
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monsoon III
Depending on the model the monsoon III features a built-in O2-air supply blender, a separate mixed
gas outlet as well as a built-in heater coupled with ventilatory gas humidification.
Brief summary of built-in features:
Adjustable frequency
Adjustable inspiration time
Adjustable operating pressure
Adjustable oxygen concentration
Respiratory tract pressure measurement and monitoring including graphics
Pause pressure measurement
Continuous gas mixture volume via separate connection
Jet air flow heating and humidification/climatisation (optional)
Pause pressure limit monitoring with automatic shut-off
Ventilatory volume measurement
etCO2 measurement (optional)
Built-in clock with date
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PRESSURE LIMITS
PIP Limit (Respiratory Tract Pressure)
This limit can only be used with a separate measuring lead (proximal lead). The control panel displays
the current patient respiratory tract pressure in graphics and numbers. This allows ventilation patterns
to easily be recognised.
The display is automatically gauged based on the PIP alarm settings. If the pressure exceeds the defined limit the main valve shuts off and an alarm notification appears on the display. The valve will
only be reactivated once the pressure has fallen to 40% of the limit. The audible alarm is automatically
reset once the main valve is cleared.
In graphics the PIP limit is displayed as a broken line!
PP Limit (Pause Pressure)
The PP alarm is activated as soon as the monsoon III is in automatic mode and the “Start / stop” key
has been pressed.
The pause pressure corresponds to the pressure inside the Jet lead and is measured a few milliseconds prior to engaging the main valve. The current patient respiratory tract pressure is indicated numerically on the control panel. This method allows the residual pressure inside the lead to be measured. If the value exceeds the limit the valve can only be activated once the pressure inside the lead
falls to 20% of the limit. The audible alarm is automatically reset once the main valve is cleared.
Superimposed Pressure Limit (Superimposed Ventilation)
The SIPL limit works similar to the PIP limit, but will only disable the Jet valve 1 while the value exceeds the limit, without triggering an alarm. This method allows the use of superimposed Jet ventilation.
Setting the SIPL limit below 10mbar will disable this limit.
The SIPL limit must be set to below the PP limit or ventilation will be interrupted due to
responding to the PP limit.
The SIPL is further automatically limited by the PIP.
The following formula applies: SIPLmax = PIP Ist - 5mbar
In graphics the PIP limit is displayed as a broken line!
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START-UP
Apparatus Preparation
The following must be performed prior to initial use of the apparatus.
CAUTION: Do not connect patients to this apparatus until these eight steps have been
completed.
Do not position the ventilator so that it is difficult to operate the disconnection device.
1. Connect apparatus to mains and equipotential bonding terminal ( ) and switch on
for 1 minute, then shut off. Unplug apparatus from mains and switch on again. An audible alarm must sound.
2. Connect air and oxygen supply tubes to the respective ports at the back of the apparatus and wall ports. The inputs are marked and coded to prevent reversing the two
gas connections.
The maximum available operating pressure is 3.5 Bar.
The following applies to supply pressures below 4 Bar:
Maximum operating pressure = lower supply pressure – 0.5 Bar.
3. Connect the apparatus to a suitable outlet using the power cable. The apparatus may
be operated at 220 VAC to 240 VAC and automatically adjusts to the respective voltage
without manual intervention. However, be sure the fuse used conforms to the value
indicated on the label for the respective voltage. Fuses may only be exchanged by a
trained technician. When exchanging fuses always use the same value fuse.
4. Connect patient tube to the port at the front of the apparatus labelled JET.
5. Connect pressure sensing line to the port labelled accordingly. Acutronic recommends using the separate pressure sensing line, if possible. This eliminates the risk of
pneumothorax.
6. Finally, connect the AUX-Flow tube to the port labelled accordingly. The AUX-Flow is
primarily intended to pre-oxygenate the patient via mask, as well as for emergency
patient ventilation via resuscitation bag. (e.g. AMBU or Laerdal)
7. Switch on apparatus. The power switch is located at the back of the apparatus to prevent accidental apparatus switch-off.
8. After being switched on the internal oxygen sensor will automatically be calibrated.
The apparatus is automatically calibrated every 24 hours. If calibration fails due to
disconnected gas supply, calibration can be started manually from the “Settings”
menu.
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Check P-Pressure and PIP Safety Limits
CAUTION: Limits of the pressure switch-off must be tested using the included test lung
prior to using the Jet ventilator.
1. Connect Jet patient tube to one of the two LUER-LOCK connections on the test lung.
2. Connect pressure sensing line to the second LUER-LOCK connection on the test lung.
3. Set PIP pressure limit to 15 mbar
4. Set PP pressure limit to 20 mbar
5. Use the operating pressure control to set the operating pressure to 1.5 bar.
6. Switch apparatus to automatic mode. To do so press the key labelled auto/manual. The LED must
light on auto. LED = green
7. Set frequency to 150 CPM. Select inspiration time of 40%.
8. Start Jet ventilation by pressing the start/stop key.
9. Use your thumb to close the opening at the side of the test lung. Pressure will build and the apparatus will suspend ventilation once the set pressure limit is reached. The alarm notification "PIP
too high" will appear and an audible signal will sound; release test lunch. The apparatus will continue ventilation and the audible alarm will mute.
10. Disconnect the pressure sensing line from the test lung and repeat test. The apparatus will suspend ventilation. The alarm notification "PP too high" will appear and an audible signal will
sound. Once the test lung is released ventilation will continue and the audible alarm will mute.
If using a Double Jet the second Jet must be tested by repeating steps 1 through 10.
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Using the monsoon III with Single Lumen Catheter
CAUTION: Limited space may not always allow the use of a Jet catheter with second
lumen for continuous pressure monitoring or capnography. For this reason the monsoon III features a built-in pause pressure monitor.
CAUTION: It monitors the pressure still present in the respiratory tracts after applying
the Jet pulse. This determines whether the respiratory tract pressure has decreased
during expiration.
CAUTION: This safety feature provides reliable protection from patient barotrauma. To
ensure this safety feature is effective the Jet frequency must be higher than 80 CPM. At a
Jet frequency below 80 CPM the volume of a single Jet pulse may be big enough to
cause barotrauma.
The following graphic illustrates the PP (Pause Pressure) measurement:
Pause pressure measurement
Figure 7. Pause Pressure measurement
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