Quick Reference Guide

fabian HFOi
Neonatal/Pediatric Ventilator
with Oscillatory Ventilation
for Software Version V 4.0

Important notice:
This quick reference guide does not replace in any way the original user manual but
represents a short description of the functionality of fabian HFO.
Detailed functionality description is provided in the user manual.

1
1. Mains, Air/Oxygen , Flow Sensor

1. Connect Air and Oxygen supply hoses with

appropriate gas source at wall outlet or gas
cylinders
2. Connect power supply cord with appropriate
electrical power source

3. Connect flow sensor cable with connector on

rear panel with corresponding socket

4. Connect grey plug of flow sensor cable with

socket of flow sensor

5. Make sure the sensor is fixed correctly by the click

sound when connected

2
2. Membrane holder and membrane insertion

The membrane holder is either made of autoclavable plastic or stainless steel. It is important to insert
the membrane correctly into its cavity for proper function of the device

1. Check membrane visually for mechanical damage

before insertion
2. Make sure the label «TOP» is visible

3. Check that membrane sits in its cavity and the

metal disc is properly centered

4. Rotate the membrane holder clockwise to fix

and counterclockwise to release it

3
3. Switch ventilator ON

B Push the green ON/OFF button (A) firmly to switch

ventilator on
A
To turn OFF keep button pressed for about 5s.
Confirm when alarm sounds by pressing alarm
silence button (B)

The start screen appears and an electronic and

pneumatic self test is performed automatically. Two
short beeps confirm the end of the test

Calibration screen appears >

!!Select patient range first before calibrating the flow

sensor!!

The flow sensor needs to be calibrated prior first use

Occlude one or both ends of the sensor with a

sterile glove

Touch «FLOW CAL» button to start calibration

procedure

The two lines in the flow sensor diagram move

towards the center and turn to green

A successful calibration procedure is confirmed with

a green tick symbol and the date and time stamp

Now, the ventilator is ready for use

!!Note!!
If a new flow sensor is connected to the ventilator, above procedure needs to be performed
prior use on a patient

4
4. Select ventilation mode

Select one of the following ventilation modes according your needs. A brief description:

IPPV Intermittent Positive Pressure Ventilation (same like CMV or IMV or TCPL)
SIPPV Synchronized Positive Pressure Ventilation (same like ASSIST or A/C or PTV)
SIMV Synchronized Intermittent Mandatory Ventilation
SIMV+PSV same as SIMV but the spontaneous breaths in between the SIMV
strokes are supported and are flow cycled instead of time cycled
PSV Pressure Support Ventilation (Flow cycled pressure limited)
CPAP Continuous Positive Airway Pressure (can be used as conventional NIV or for
intubated patients)
NCPAP nCPAP with variable flow generators like InfantFlow or Medijet
DUOPAP nCPAP on two different levels or if short inspiratory time is used, like a non invasive
ventilation with fix amount of breath per minute
HFO High Frequency Oscillatory Ventilation with active in- and expiration phase
(piston + membrane technology)
O2 Therapy High- or Low Flow Oxygen therapy with nasal cannula
(for instance RAM cannula or similar)

To select the mode, touch the related button once > button changes color from blue to yellow. Preset
of the parameters can be done and to confirm the mode, touch button again > changes to green color

Adjustment of SETTINGS

Adjustment of expiratory (base) flow, recommended is 6 LPM in Neonatal mode

Adjustment of maximal length of manual breath

Adjustment of Oxygen Flush Timer

5
6. SIPPV - Synchronized Intermittent Positive Pressure Ventilation

SIPPV ventilation allows the patient to trigger a time cycled, pressure limited breath. Each inspiratory
effort of the patient, reaching the preset trigger level will initiate a breath. The amount of breaths per
minute is determined by the patient. The following parameters should be set:

I-Flow set properly according patient needs (this flow controls the pressure rise time of the
inspiration. If set too low, the Pinsp is reached slower. For preemies, an I-Flow of about 6
LPM is sufficient, for bodyweight above 2 kg, we recommend the use of 8 LPM.

PEEP 4 – 5 cmH2O depending on clinical protocol

Pinsp 16 – 18 cmH2O depending on clinical protocol. With this pressure the tidal volume is
controlled. Should be in between 4 – 6ml per kg bodyweight

I-Time Inspiratory time, set depending on flow waveform to achieve optimal tidal volume with
lowest Pinsp. Usually set between 0.25s and 0.5s for premature babies

Freq Set to achieve appropriate Minute Ventilation as per clinical guidelines

Trigger Set sensitivity level as per clinical guidelines. Usually between 1 – 3

VG Add VG if you want to maintain a stable tidal volume when lung compliance is
changing

6
7. SIMV Synchronized Intermittent Mandatory Ventilation

SIMV ventilation allows the patient to trigger a time cycled, pressure limited breath but only for a preset
amount per minute. In between the SIMV breaths, the patient can breath on PEEP level. The following
parameters should be set:

I-Flow set properly according patient needs (this flow controls the pressure rise time of the
inspiration. If set too low, the Pinsp is reached slower. For preemies, an I-Flow of about 6
LPM is sufficient, for bodyweight above 2 kg, we recommend the use of 8 LPM.

PEEP 4 – 5 cmH2O depending on clinical protocol

Pinsp 16 – 18 cmH2O depending on clinical protocol. With this pressure the tidal volume is
controlled. Should be in between 4 – 6ml per kg bodyweight

I-Time Inspiratory time, set depending on flow waveform to achieve optimal tidal volume with
lowest Pinsp. Usually set between 0.25s and 0.5s for premature babies

Freq Set to achieve appropriate Minute Ventilation as per clinical guidelines

Use frequencies below 40 BPM to avoid dis-synchrony between patient and ventilator!

Trigger Set sensitivity level as per clinical guidelines. Usually between 1 – 3

VG Add VG if you want to maintain a stable tidal volume when lung compliance is
changing

7
 8. SIMV+PSV Synchronized Intermittent Mandatory Ventilation with
Pressure Support
SIMV+PSV ventilation allows the patient to trigger a time cycled, pressure limited breath but only for a
preset amount per minute. In between the SIMV breaths, the patients spontaneous breath are
supported with a flow cycled breath and a preset pressure level. The following parameters should be
set:

I-Flow set properly according patient needs (this flow controls the pressure rise time of the
inspiration. If set too low, the Pinsp is reached slower. For preemies, an I-Flow of about 6
LPM is sufficient, for bodyweight above 2 kg, we recommend the use of 8 LPM.

PEEP 4 – 5 cmH2O depending on clinical protocol

Pinsp Pressure level for SIMV breath which are time cycled pressure limited and synchronized
with patients breathing pattern. 16 – 18 cmH2O depending on clinical protocol. With
this pressure the tidal volume is controlled. Should be between 4 – 6ml per kg
bodyweight.

PPSV Allows support of spontaneous breaths with a variable pressure to reduce work of
breathing. This support breaths are flow cycled so I-Time is controlled by the patient.

I-Time Inspiratory time, set depending on flow waveform to achieve optimal tidal volume with
lowest Pinsp. Usually set between 0.25s and 0.5s for premature babies.

Freq Set to achieve appropriate Minute Ventilation as per clinical guidelines

Use frequencies below 40 BPM to avoid dis-synchrony between patient and ventilator!
Trigger Set sensitivity level as per clinical guidelines. Usually between 1 – 3

VG Add VG if you want to maintain a stable tidal volume when lung compliance is
changing
The VG is only used for SIMV breath. PSV breath remains flow cycled.

8
SIMV+PSV functionality description

PSV Breath:
The spontaneous breath is supported by the ventilator, depending on the pressure level set with Ppsv.
The lowest possible PSV support is 2 cmH2O above the PEEP level and if set as low as this, may act like
an ET tube resistance compensation. It is flow cycled and detects the beginning of inspiration as well
as the end of inspiration. Therefore, I-Time is controlled by the patient and is variable breath by
breath.

Flow Termination Criteria:

The Flow Termination Criteria or also called expiratory trigger, is user adjustable. By opening the
SETTINGS WINDOW, the Termination Criteria PSV allows settings between 5 and 35%. Usually values
between 5 and 15% are clinically used in neonatal range. Higher values around 25% are typical in
pediatric range.

Pediatric mode only

To close SETTINGS menu, touch green area

Why is I-Time button orange when SIMV+PSV mode is selected?

In PSV mode, this button has a double function. It uses the I-Time for the SIMV breath and it also
represents the maximal I-Time for the PSV breath in case if the flow termination criteria is not met.
The PSV time is displayed and may vary breath by breath.

Spontaneous I-Time

I-Time for Apnea backup ventilation and max I-Time

for the PSV breath

9
9. PSV Pressure Support Ventilation

PSV mode allows the patient to trigger a flow cycled pressure limited breath each time his inspiratory
efforts meets the trigger criteria. The patient determines the amount of breath per minute as well as
the I-Time which may vary breath by breath in this mode. In case of an apnea, the ventilator will start
the backup ventilation, depending on the preset delay for the apnea alarm.
The following parameters should be set:

I-Flow set properly according patient needs (this flow controls the pressure rise time of the
inspiration. If set too low, the Pinsp is reached slower. For preemies, an I-Flow of about 6
LPM is sufficient, for bodyweight above 2 kg, we recommend the use of 8 LPM.

PEEP 4 – 5 cmH2O depending on clinical protocol

PPSV 16 – 18 cmH2O depending on clinical protocol. With this pressure the tidal volume is
controlled. Should be in between 4 – 6ml per kg bodyweight

I-Time Inspiratory time, set depending on flow waveform to achieve optimal tidal volume with
lowest Pinsp. Usually set between 0.25s and 0.5s with premature babies

Freq Set to achieve appropriate Minute Ventilation as per clinical guidelines

Trigger Set sensitivity level as per clinical guidelines. Usually between 1 – 3

VG Add VG if you want to maintain a stable tidal volume when lung compliance is
changing

10
PSV functionality description

PSV Breath:
The spontaneous breath is supported by the ventilator, depending on the pressure level set with Ppsv
The lowest possible PSV support is 2 cmH2O above the PEEP level and if set as low as this, acts like an
ET tube resistance compensation. It is flow cycled and detects the beginning of inspiration as well as
the end of inspiration. Therefore, I-Time is controlled by the patient.

Flow Termination Criteria:

The Flow Termination Criteria or also called expiratory trigger, is user adjustable. By opening the
settings window, the Termination Criteria PSV allows settings between 5 and 35%. Usually values
between 5 and 15% are clinically used for neonates. Higher values around 25% are typical in
pediatric range.

Why is I-Time button orange when SIMV+PSV mode is selected?

In PSV mode, this button has a double function. It uses the I-Time for the SIMV breath and it also
represents the max I-Time for the PSV breath in case if the flow termination criteria is not met. The
PSV time is displayed and may vary breath by breath.

Spontaneous I-Time

I-Time for Apnea backup breath and max. I-Time for

spontaneous breath

11
PSV functionality description (continued)

PSV Breath:
The spontaneous breath is supported by the ventilator, depending on the pressure level set with Ppsv
The lowest possible PSV support is 2 cmH2O above the PEEP level and if set as low as this, acts like an
ET tube resistance compensation. It is flow cycled and detects the beginning of inspiration as well as
the end of inspiration. Therefore, I-Time is controlled by the patient.

Flow Termination Criteria:

The Flow Termination Criteria or also called expiratory trigger, is user adjustable. By opening the
SETTINGS WINDOW, the Termination Criteria PSV allows settings between 5 and 35%. Usually, values
between 5 and 15% are clinically used for neonates. Higher values around 25% are typical in
pediatric range.

Apnea Backup Ventilation:

In case of APNEA, the ventilator starts its APNEA Backup ventilation mode. The delay for the onset of
the backup is set in the alarm screen with the Apnea time in seconds. Since babies generally have
several episodes of apnea, it is advisable to set this delay time based on the critical condition of the
baby.

Important:
If the Apnea alarm is set to OFF, the ventilator will start the Backup ventilation immediately after one
E-Time period!
In the status bar, the ventilator displays “apnea ventilation active”
Ventilation is done with PPSV, Freq, I-Time to provide minute ventilation. If inspiratory effort starts again,
the ventilation goes back to PSV.

I-Time of the SIMV breath and max. I-Time of PSV breath

I-Time of the PSV

breath, patients
spontaneous I-Time 12
10. CPAP Continuous Positive Airway Pressure

CPAP. This mode can be used as invasive or non invasive ventilation mode.
In case of use non invasive, the flow sensor must be switched OFF in the calibration screen.
The following parameters should be set:

FLOWmin Set Flow to about 8LPM. There is an automatic increase of flow in case of a higher
demand from patient or due to leaks. This Demand Flow feature will increase to
maximum the double of the preset value.
CPAP Set CPAP pressure value depending on clinical guidelines
Pmanual Allows a stimulation of the patient in case of an apnea. However, in case of non
invasive ventilation, there is no apnea detection active! It can be used for
Sustained Lung Inflation procedure

This mode can be used invasive or none invasive with various CPAP systems from F&P like
FlexiTrunk, Stephan Easy Flow, Dräger Babyflow or the Hudson Inka system.

With above systems, the flow

sensor needs to be deactivated
manually in the calibration screen

13
11. nCPAP non invasive CPAP

NCPAP. This mode is used for the variable flow generators from CareFusion, Inspiration, Medical
Innovations or similar. Those are single limb systems and don’t need an exhalation valve to generate
the CPAP level. The CPAP level is depending upon the amount of flow. The fabian HFO has an
automatic leak compensation in this mode, which increases flow to a level of maximal 40% than the
initial flow used for the preset pressure level. The following parameters need to be set:

CPAP Set to 4 or 5 cmH2O depending on clinical guidelines. The ventilator will adjust
necessary flow automatically and display the used amount of flow.

Pmanual Allows a stimulation of the patient in case of an apnea. However, in case of non
invasive ventilation, there is no apnea detection active!

Make sure using the correct connection between ventilator outlet and humidifier chamber as per
below pictures!!

14
 12. DUOPAP Nasal Continuous Positive Airway Pressure on two
pressure levels
DUOPAP. In addition to the NCPAP mode, this modality offers the ventilation on two different
pressure levels and thus may be beneficial to increase the etCO2 washout or act as a mode with a
fixed amount of breaths to stimulate babies with an increased amount of apneas.
The following parameters need to be set:

CPAP Set to 4 or 5 cmH2O depending on clinical guidelines. The ventilator will adjust
necessary flow automatically and display the used amount of flow.
PDUO Allows a stimulation of the patient in case of frequent apnea periods with a fixed
amount of breaths per minute and I-Time around 0.6s. Other possibility is bilevel CPAP
on two pressure levels in case of etCO2retention problems. If used in bilevel mode,
small pressure differences of about 2 – 3 cmH2O is recommended
FREQ Breaths per minute

Make sure using the correct connection between ventilator outlet and humidifier chamber as per
below pictures!!

15
13. HFO High Frequency Oscillatory Ventilation

HFO Ventilation is using small tidal volumes with frequencies usually between 5 and 15 Hz. In- and
expiration are active and a base flow is controlling the fresh gas delivery to the patient. MAP is used to
control oxygenation together with FiO2 and the amplitude serves to wash out the etCO2. The
following parameters are usually set:

Frequency For babies below 1 kg, start with 12-15 Hz

For babies above 1 kg, start with 10 to 12 Hz

MAP The mean airway pressure usually is taken from conventional ventilation and set
either same or 2 – 3 cmH2O above.

Amplitude Start with about double of MAP value

FiO2 Same as used during conventional ventilation

Base Flow Usually set at 8 LPM to start with (position default is 8 LPM)

VG Add VG if you want to maintain a stable stroke volume when lung compliance is
changing

16
14. Use of Volume Guarantee Function VG

The VG function is available on fabian HFO in the following ventilation modalities:

IPPV Each breath tidal volume is controlled and maintained with lowest possible Pinsp
SIPPV same as above. The spontaneous breath is supported with a lower pressure level
to avoid over distension. However, minimal support is 2 cmH2O above PEEP level.
SIMV Each SIMV breath is a volume guaranteed breath
SIMV+PSV Each SIMV breath is volume guaranteed, the PSV breath is flow cycled and NOT
volume guaranteed in this mode.
PSV Each breath is volume guaranteed also the backup ventilation is volume
guaranteed
HFO Each cycle is volume guaranteed

In conventional ventilation, the Pinsp varies to compensate for a lung compliance change. The
ventilator increases maximal 3 cmH2O from one breath to the next to avoid lung overdistension.
In HFO ventilation, the amplitude is automatically adjusted to maintain expiratory tidal volume for VG.
In case of ET-tube leakage, the amplitude is increased.

How to start VG function?

Set desired target volume with the Vguarant button. With Pmax button set the maximal pressure limit
accepted for the patients lung. Now VG can be started by pushing the central button. The Pmax
button turn orange to indicate that this becomes a limit. The central button turn green to indicate an
active VG function.

Step 1: Set desired target volume for the VG

Setting for
VG Volume

Step 2: Set Pressure limit for VG

Setting for
Pressure limit for
VG

17
Step 3: Start VG function by pressing centre button

ON/OFF button for

VG function
Green = ON
Blue = OFF

Important:
To avoid any risk of a lung overdistension in case of a flow sensor problem or a loss of the
flow signal, the pressure level set in the Pinsp field becomes active and the VG function is
deactivated automatically. As soon as flow signal return, the VG automatically starts function
again. Despite of the dimmed field, the value can be adjusted manually at any time.

Pressure level being active in

case of a flow sensor problem
or if VG is deactivated

Pressure limit tolerated to

deliver a volume guaranteed
breath

18
Important notice:
To guarantee a proper functionality of the VG, it is absolutely mandatory to set a correct I-Time, which
allows having a short plateau at the end of inspiration. The expiratory tidal volume is targeted by the
ventilator by adjusting the inspiratory pressure level. If the inspiratory time is insufficient to deliver the
target volume, the ventilator won’t be able to deliver the targeted volume and an alarm is given.
An arrow pointing upwards in the Pmax button indicates, that the pressure limit is not sufficient to
deliver the set tidal volume.

Important notice:
Volume guaranteed ventilation of fabian HFO can be used even in presence of massive
leakages; anyway expert users on VG consider ET tube leakage above 40% to be
alarmed properly. Leaks above this level may lead to difficulties in achieving the desired
accuracy.
If VG is used in PSV mode, the patient can be weaned from the ventilator because the
ventilator is using the lowest possible pressure level to maintain set tidal volume.

19
Important:
For VG to function correctly, a pressure plateau is needed. Check for correct I-Time and I-Flow
setting. The waveform of the inspiratory flow should return back to baseline and a short pause for the
pressure equalisation should be present before exhalation starts

Below graphic shows inspiratory time being too short

If I-Time or I-Flow are set too low, target volume might not be achieved and the ventilator will alarm
“Tidal volume not reached”
The correct adjustment of the lower alarm limit of minute volume is mandatory to avoid
hypoventilation in case of insufficient tidal volume delivery.
In case of a loss of the flow sensor signal, the ventilator automatically will return to the initial pressure
level Pinsp, set by the user to achieve target volume.

Guide:
If your device has a measurement of time constant (tau), you should set I-Time to about 2-3 times tau.
Expiratory time shall be about 4 to 5 times tau to allow lung to empty to avoid breath stacking and
inadvertent PEEP.

20
The following graph shows an expiratory time being almost too short

If the target volume is not delivered for 5 consecutive breaths, the ventilator will alarm. The status line
shows the message VTe not reached, check settings.

• In case of loss of the flow signal from the flow sensor, the ventilator automatically is using the
pressure level set in Pinsp
• Adjust Pinsp manually when lung compliance improves, to avoid lung over distension in case VG is
switched off.

21
15. Alarm limits

Once all the parameters are set and the ventilator is connected to the patient, adjust the alarm limits
accordingly.

The limits are to be set according the clinical condition of the patient and should be readjusted from
time to time based on the measured values.

High Minute Volume Alarm

Low Minute Volume Alarm. Very important to set slightly

below measured MV
High Inspiratory Pressure Alarm. Must be set above Pmax if
VG is in use!

Low PEEP Pressure Alarm

High Breath Rate Alarm

High ET-Tube Leakage Alarm

Apnea Alarm (only visible in modes where used. Not in

IPPV or SIPPV)
In PSV mode, this alarm delay is used as delay for onset of
backup ventilation. If set to OFF, onset of backup is
immediately after E-Time

If etCO2 module or SpO2 module are activated, those

alarms settings are accessed by pressing this button

22
16. Oxygen Therapy HFNC (High Flow Nasal Cannula)

Settings:
This mode is used for HFNC to supply heated and humidified gas by nasal cannula. Flow setting and
oxygen FiO2 settings are available. There are no patient alarms active in this particular modality

The over pressure relief valve is set to 500 cmH2O to avoid backup pressure in supply tubing is vented
to ambient so set flow is delivered through nasal cannula

To avoid inadvertent excessive flows, a first limit is set at 5 LPM; to override, by pushing the rotary
knob allows to set and confirm flows up to 15 LPM.

23
17. Guide

Settings:
To improve ventilation, one needs to understand the flow versus time waveform, which allows a
simple way of analysis if ventilation is performed correctly.
The fabian ventilators are equipped with accurate flow measurement and graphic capabilities to
facilitate the wave form analysis.

I-Time too short

If the inspiratory time is set too short, Pinsp levels needed are higher

E-Time too short

If the expiratory time E-Time is set too short, the lung can not empty completely before the next
breath is delivered. Leading to inadvertent PEEP

There is no such thing like a standard settings for a neonatal ventilator, each patient has its own lung
mechanics (i.e. compliance and resistance) and therefore need to be treated individually.
If ventilation is optimized, the two targets like sufficient oxygenation and etCO2 removal can be
achieved more efficiently and ventilation can be reduced in time.

24
18. LOOPS

Features:
The LOOP SCREEN allows to visualize ventilation with P/V loops and F/V loops. The FREEZE function
offers the possibility to safe a reference loop and to compare it for instance pre- and post application
of surfactant or Bronchodilators.

1 2 3 4 5 6 7 8

1. Waves display: displays 3 waveforms Pressure, Flow and Volume

2. LOOPS display: displays 1 waveform and 2 LOOPS
3. etCO2 Optional: displays the etCO2 values and wave
4. SpO2 Optional: displays the SpO2 value and pleth wave
5. Freeze: freezes the current waves and loops
6. Save reference loop: if waves or loops are frozen, button for save reference loop appears
7. Trend data: displays the trend data, up to 5 days trending
8. Measured values: displays the different numeric blocks of measured values

25
19. Trends

Features:
The trend feature allows trending of all the parameters up to five days back. In daily practice, this
feature is used to see if changes happened during night shift for instance. Trend data can also be
downloaded on a USB stick for further use.

Important notice:
This quick reference guide does not replace the instructions for use.
For details, please always refer to the fabian HFO instructions for use.

26
20. Patient circuit assembly for NO application in HFO mode

NO application with devices having a flow sensor to measure inspiratory flow:

If your NO device uses a dedicated flow sensor to measure the bias inspiratory flow to calculate the
amount of NO to be delivered, the port FG / nCPAP (4) must be used to supply the bias flow in HFO.
Those flow sensors could not tolerate the HFO swings on the Insp port.

4 3 2 1

Legenda:
1. Connection for inspiratory hose
2. Proximal pressure tube connection
3. Exspiratory hose connection and membrane holder
4. Fresh gas outlet for HFO and InfantFlow nCPAP generators

HFO without use of NO or with NO delivery systems without flow sensor:

If your NO delivery system has no flow sensor in place but uses continuous flow, outlet (1) is used
The switch over from internal to external Bias flow is done as follows in the SETTINGS MENU:

27
21. Switch over from internal- to external Bias Flow

1. Touch button Bias Flow external

2. Confirm by touching «confirm»

3. Touch Bias Flow extern again to accept change

If you change from HFO mode to conventional mode, there is no need to remove the flow
sensor from the NO device if no NO is used. In the conventional mode, the freshgas flow is
directed to Insp automatically.
IMPORTANT NOTICE: When ventilator is switched OFF , the Bias Flow will return to intern
automatically and must manually be set by operator after switch ON of the device
28
22. Patient circuit with NO flow sensor (Bedfont NoxBox i)

4 3 2 1

to humidity chamber

Flow sensor NOxBOX

29
23. Patient circuit with NO flow sensor (InoVent System)

4 3 2 1

30