EP-Lab setup

Jet Ventilator:

Basic Monsoon Setup

1. Hook up the oxygen and air hoses first (these gases are needed during bootup).

2. Turn on the machine (button on the back - bootup will take a full two minutes).

3. Make sure you have the correct hose to attach to the port (you need a hose with

    blue tips; connects to the jet outlet port). The hose must be connected prior to

    operating the machine.

4. If the warning “Maintenance Required” comes on, clear it by hitting the alarm

    reset button twice.

5. Using the Alpha Dial, review the default settings on the machine:

f (breaths per minute) – should be in the 80-120 range:

%IT (percent inspiratory time) – 40% is a good place to start

Limits – look at PP (pause pressure) limit: 20 cm H2O is reasonable

humidity – ?

bypass flow – part of the humidifier, not used

6. Set desired FIO2 on the FIO2 dial.

7. The P (pressure) dial on the far right adjusts the delivered air pressure. You

    will want at least 20 PSI and likely higher than that. The delivered pressure is

    displayed on the LCD screen once the Monsoon begins operation. With the

   blue tip hose connected to the jet outlet port, begin operation and adjust the

   displayed DP (driving pressure, in PSI) to desired value (increase by turning the

   P dial clockwise)

8. Note: A red tip hose can be used with some but not all bronchoscopes to

   connect the airway pressure port on the Monsoon to the tip of the scope (this

  permits the Monsoon to monitor airway pressure). If in use, then actual airway

  pressures will be displayed. In addition, you can use the Alpha Dial to enter the

  Limits section, where you can set limits to how high peak inspiratory pressure

  is allowed to go and how high PEEP is allowed to go.

To Operate in Automatic Mode:

1. Place the Auto/Manual button in Auto

2. Push the start button

3. In Auto mode, the pressure in the jet ventilation line (blue tip hose) is measured

just before the onset of the next inspiration. This measurement is called PP or

pause pressure. Especially when ventilating at high frequencies, and therefore

with a low Vt, PP will reflect mean airway pressure and serve as a protection

against barotrauma. You can adjust the PP setting via the Limits section of the

Alpha Dial. Ventilation will cease temporarily whenever the PP setting is

exceeded. If you frequently exceed the PP limit, consider changing the limit or

the ventilation settings.

4. The main screen will display the settings for f, FIO2, %IT, DP (driving

pressure) and PP limit (not the actual pause pressure, but the limit setting).

Also displayed are tidal volume (TV) and minute ventilation (MV). If the red

monitoring hose is used, additional measured values are displayed.

To Operate in Manual Mode:

1. Place the Auto/Manual button in Manual

2. Push start and hold the button down for as long an inspiration as desired.

Release the button to permit exhalation. You must push the start button for

each breath separately.

Troubleshooting:

1. Hypoxemia – likely due to atelectasis if the FIO2 is high. Achieve higher

ventilation by increasing the driving pressure (turn “P” dial clockwise) and/or

increase the percent inspiratory time (%IT).

2. Suspected/documented hypercapnia – need greater gas exchange, so try

increasing the frequency of ventilation (may need to decrease %IT to avoid air

trapping, and may need to increase driving pressure to get more delivered gas in

a shorter time).

3. If all else fails, switch to Manual mode with a high driving pressure.

4. It is also essential to have the standard hand held jet ventilator in the room and

ready to hook up in case the Monsoon fails in both Auto and Manual mode.