Mallinckrodt

Puritan Bennett 840 Ventilator

The PB 840 ventilator is designed for critical care
ventilation of adult and pediatric patients. Initial
setting of Ideal Body Weight (IBW - lowest setting
10 lbs) automatically sets ventilator controls for a
tidal volume of 6 ml/kg. The display features 2
screens. The top allows continuous viewing of
waveforms or a log of alarm history. The bottom
screen provides easy access of control settings,
apnea ventilation, and alarm settings.

Modes include volume controlled, pressure controlled, or volume-targeted-

pressure controlled (VC+) breaths in Assist/Control and for the mandatory
breaths in SIMV modes. Spontaneous ventilation includes pressure support,
volume support and CPAP. BiLevel ventilation is another option capable of
providing two level-CPAP. The rate (breaths/min) is set along with pressure levels
for the high and low PEEP and the time at high PEEP. The patient can breathe
spontaneously at the high and low levels of pressure and pressure support can be
added to all spontaneous breaths. BiLevel may be set as high as a 10:1 I:E ratio.

The trigger mechanism may be set as a pressure or flow trigger. Baseline flow is
automatically 1.5 LPM above the flow trigger setting which is adjustable from 1 -
20 LPM. The 840 also has automatic tube compensation (TC) to provide an
adjustable level of pressure support to overcome the resistance of breathing
through the endotracheal tube.
After connecting circuit and mains,
leave patient wye open
and power ON. If patient wye is
blocked during power ON,
ventilator will alarm and switch to
safety ventilation. After the 840 does
a power on self test, the bottom
screen will appear as seen on the
left. Same patient, new patient, or
short self-test (SST) may be selected
by touching screen and highlighting
item.

If SST is selected, operator has 4 seconds to press Test button on left side of
ventilation to activate SST. The 840 SST only requires the operator to 1) block
patient wye, 2) disconnect inspiratory limb of circuit and 3) disconnect
expiratory limb of circuit. During SST, the type of humidifier may be selected.

   
After touching New Patient, the screen goes to IBW. Touch IBW and adjust
body weight with knob, then press "Accept" located above knob and to the right
of CLEAR. IBW is given in pounds and kilograms. The 840 will automatically
set tidal volume to equal 7.25 ml/kg. All parameters can be adjusted.

After accepting body weight, touch

CONTINUE to go to ventilator
settings.

Touch MODE and adjust knob to

select A/C, SIMV, Spontaneous, or
BiLevel. Then touch Mandatory
Type to select VC, PC, or VC+
ventilator breaths. Touch Trigger
Type to select Pressure, Flow, or TC
Trigger. Press Accept, then touch
CONTINUE.
Note: if SIMV, Spontaneous, or
BiLevel mode is selected by
turning the knob, an icon for
selecting Pressure Support
appears. It is recommended that
pressure support be set, even if a
PS of 0 is desired, rather than
selecting 'none'.

Had SIMV-PC been selected, the

screen goes to default settings as
shown on left. Touch CONTINUE
to adjust ventilator settings. Note
that Vent Setup is active along the
bottom of the screen. All of the
ventilator settings can now be
adjusted by touching frequency
(for SIMV rate) and adjusting
knob. Accept is pressed after all
settings have been adjusted. A bar
displaying the effect of frequency
and inspiratory time settings (1
and 2) on I:E ratio would be
visible as shown below. 3 indicates
the Flow Acceleration % setting
on the default value of 50%.

Flow Acceleration % or rise time

% alters the initial flow allowed
during pressure control or
pressure supported breaths. 100%
provides the maximum or
unlimited initial flow and an
immediate increase in pressure.
Values less than 50% reduce the
initial blast effect of flow and may
increase patient comfort. The I:E
Ratio bar is also shown at left. The
orange arrow indicates which of
the three values may be locked or
fixed during pressure control
ventilation: inspiratory time
(locked), I:E ratio, or expiratory
time.
 After adjusting the ventilator
settings, touch Apnea Vent along
bottom of screen to set apnea
ventilation and apnea interval.
The Apnea Ventilation controls
are light blue indicating that these
settings are available for
adjustment.

Touch Alarms (next to Apnea

Vent) to set
 High inspiratory pressure
(P circ)
 High frequency (f tot)
 High and Low Minute
Ventilation (VE tot)
volume
 High and Low Mandatory
Tidal Volume

 High and Low

Spontaneous Tidal Volume

Alarm limits are set by touching alarm box and adjusting knob. After all alarms
are adjusted, press Accept. Actual patient values are indicated by flags on the
left of the bar.

This whole time the NPB 840 has

been waiting for you to set
everything and connect to the
patient. No alarms have been
going off. It hasn't even tried to
give a breath. "Vent Startup in
Progress" has been displayed
above the top screen. Ventilation
will start when you connect to the
patient.
 Touching the file icon next to
Alarms will bring up the view
shown here. Touch 'More
Settings' to adjust the Expiratory
Sensitivity % and Disconnect %
in spontaneous modes. The
Expiratory Sensitivity % adjusts
the flow cycle level of pressure
supported breaths. In the event of
a leak, the ES % can be adjusted
so that pressure supported
breaths will end. Maximum
setting is 45% which will be

effective for all but large leaks. There is also a Disconnect % which adjusts the
% loss of the returned flow signaling a disconnect alarm. A setting of 50% will
mean the expiratory tidal volume must fall to half of the inspiratory volume
before an alarm is activated.

The top screen allows continuous

viewing of waveforms. Waveforms
may be pressure/time, flow/time,
volume/time, and
pressure/volume. Up, lateral, and
down arrows on the right side of
the screen adjusts the scale. To
change waveforms, touch 'Plot'
and adjust knob. The waveforms
are color coded. Green indicates a
mandatory inspiration and red
indicates a spontaneous breath.
The patient's parameters are
displayed along the top of the
screen.

Touching the clipboard icon will

display a record of the last 86
alarm conditions and what
happened to them.