SOME TIPS ON MAKING THE BEST USE OF SLE 5000 NEONATAL VENTILATOR.

1. ARE YOU MAKING THE BEST
USE OF SLE 5000
VENTILATOR

2. AIM
•This presentation is not
a substitute for reading
the user manual
individually, and
discussing at bedside
what is not clear.
•A human life is hanging
at the other end of our
competence.
•Work-up your own
opinion, but follow the
consultant's preference
strictly in setting up the WILL YOU BUY A
ventilation of the baby. TICKET ON THIS
AIRLINE’S FLIGHT?

3. Which Readings to Record?

4.  Values displayed on the top right
corner (in small font) are the
parameters you planned for the
patient.
 Values under the eyebrow (large font)
are the actual delivered parameters to
the patient.

5. Modes of ventilation

6. CMV OR PTV
 CMV = IMV = [SIMV or PTV with trigger
disabled]
 PTV = A/C (baby controls the ventilator rate).
 PSV = A/C but with Flow cycling (Baby
controls the Ti also).
 SIMV + PSV = detailed in separate slide.
 HFO and HFO+CMV = presentation will
become too lengthy.

7. CMV & IMV: by definition…
 Continuous Mandatory Ventilation: Used most
often in the paralyzed or apneic patients. The
ventilator rate is set faster than the patient's own
breathing rate.
 Intermittent Mandatory Ventilation: The ventilator
rate is lower (less than 30 bpm), therefore the patient
gets chance to breathe spontaneously between two
controlled breaths.
 In both CMV and IMV, breaths are delivered
regardless of the patient's effort.
 Synchronization is not intended in either of these.

8. IMV-CMV FAN CLUB
Complications due to lack of synchronized ventilation are well known.

9. Adjusting Trigger Sensitivity
 Default trigger sensitivity to detect the patient's
breath effort is 2L/min, which will not detect
the breathing in any premature baby, and then
PTV, SIMV or PSV- all will work as CMV.
 Make the trigger (flow sensor) work by
decreasing the threshold to 0.4-0.6 in most
cases.
 Orange lines should be visible in the real time
graphs.

10. PTV becomes CMV when trigger is not adjusted
below the peak inspiratory flow

11. Orange lines: depict the neonate’s breathing
efforts in the first 0.2 seconds of the Ti
This dip
before
inspiration
assures
true
triggering
Ti

12. Trigger threshold correctly adjusted

13. Using SIMV with PS
 Once again the heart of PS is the flow cycling
of inspiration.
 Keep inspiration termination criteria at 5% of
the peak insp. flow for neonates.
 Pressure support for the non-SIMV breaths
should be set initially liberally (start with ~80%
of PIP values), and then bring it down to 4-5
mbars above PEEP in 1-2 days if possible.

14. On selecting SIMV, PS setup is offered in
the same window.

15. On selecting PS with
SIMV, these 2
parameter have to be
adjusted.
Only for the non-SIMV
breaths (free ones, over the
set rate), to counter the
imposed work of breathing,
reducing exhaustion, and
the energy expenditure.
0 – 100%
The mandatory cycles will
follow the set PIP.
Flow cycling applies only to
the non-SIMV breaths that
are now getting some extra
help during inspiration.
The mandatory cycles will
follow the set Ti (time
cycled).

16. I KNOW EVERY THING.
YOUR GIMMICKS DON’T IMPRESS ME.

17. PSV with Volume Targeted Ventilation
Its user
friendly
in SLE
This is the
only extra
dial on
screen.

18. Using TTV (Targeted Tidal Volume)
• This option is available in all modes, best used with
PTV for uniformity of delivered tidal volumes (c.f. with
SIMV).
• Press it ON,
• Set the desired tidal volume in ml.
• Set the automatic ET leak compensation to 20%
• Let the baby get benefit of auto-weaning of PIP
especially after Survanta administration, when
compliance increases.
• Contra-indication for TTV: ETT leaks > 20%.

19. A must read for connoisseurs

20. Your
pneumothorax
prevention button
Forget me if you
don’t like
synchronization.
ET leak
compensation,
Pressure
wave form
settings here.
Flow cycling of
inspiration in
PSV mode

21. It’s the tidal volume that causes
Pneumothorax not the pressure
 Set the desired tidal volume at 6 ml/kg, to get
best results.
 Range is 4-6 ml/kg.
 When choosing in this range, consider:
 Work of breathing,
 pCO2,
 Hyperinflation, BPD, MAS.
 Pre-existing barotrauma,
 Dead space compartment due to prematurity, flow
sensor (1 ml).

23. ET Leak
 Measured inspired vol minus measured expired vol.
 Automatic leak compensation means that ventilator
software will display the expiratory tidal volume (Vte)
inclusive of the amount that leaked out from the
sides of trachea during expiration.
 In SLE 5000, there is Automatic Leak Compensation
up to 20% if on TTV mode, and 50% in PTV, SIMV
and PSV mode. We have to enable it from the
“options” box after selecting the mode of ventilation.
 If ET leak is > 50% all the time, most authorities
recommend to change ET to a bigger size.

24. Selecting pressure wave form:
“RISE TIME”
In brief:
• Square wave: for stiff lungs.
• Sinus wave: for healthier lungs.
• We have to select the pressure wave pattern
from “options” menu.
• Default setting is towards the square wave in
SLE 5000.

25. Shifting from
HFO to
Conventional.
Do not press the
confirm button
without correcting
the PEEP to 4 or 5
cmH2O, otherwise
the PaW of HFO will
be delivered as
PEEP in convention
ventilation.
Consequences may
not be pleasant.

26. Measured values on right
hand column.
Ti
BPM tot:
Trigger
Vte (ml)
Vmin (Liters)
Leak%
Resistance (cmH2O/l/sec)
Compliance (ml/cmH2O)
C20/C ratio (ratio)
Mean (Airway) Pressure (mbar)
HFO VTe (Vol. of Oscillation in ml)
DCO2: Gas Transport Coefficient

27. MY LEARNING
CURVES OF OUR
VENTILATOR
MACHINES
bear cub 750

28. Measured values: Tidal Volume Vte (ml)
• Acceptable values:
• FT neonate is 4-8 ml/kg
• Preterm infant: 4 –6ml/kg.

29. Measured values: Minute volume Vmin (L)
• Acceptable Minute Volume:
• FT newborn is 200 - 400 ml/kg.
• Preterm: 200- 300 ml/kg
• Useful for guessing over or under ventilation
before BGA is done.

30. BPM tot: (tot = total), in 1 minute.
Trigger: No. of synchronized breaths in last 1 min.
• These values, may not be same as the (back-up) rate
you have set in PTV or SIMV.
• In PTV mode, for pCO2 manipulation, look at the
number of triggered breaths delivered before
changing the ventilator rate.
• If it is significantly less than the BPM tot, then
increasing the trigger sensitivity will increase the no.
of assisted breaths.

31. Using Standby mode or CPAP mode to evaluate
patients actual breathing effort without ET disconnection
when flow sensor is not used.
• Pressing Standby button for 3 second will
suspend ventilation for maximum of 90 sec,
although it can restarted any time before 90
sec, by repressing it.
• Ventilator maintains MAP during this period to
avoid derecruitment.
• Those on low settings, CPAP mode will be
safer to manually assess the spontaneous
breathing.

32. BPM measurement
• The ventilator measures BPM in 2 different ways, with
or without a flow sensor.
• With flow sensor: All breaths are counted:
Triggered, Spontaneous, and Mandatory.
• Without flow sensor: Only triggered and mandatory
breaths are counted by the pressure sensor
located inside the machine.

33. BPM tot
With
flow
sensor
No flow
sensor

34. Measured values: Resistance (cmH2O/L/sec)
• Acceptable:
• ET 2.5: 130 to150.
• ET 3 - 3.5: 50-80.
• Very high values (eg 300 or more) should never be neglected.
• Common reasons:
• Kinked or partially blocked ET,
• ET impinging on carina,
• Recent suvanta administration,
• Thick secretions in the airway,
• Severe BPD or MAS
• Very high PIP & rate together, in 2.5 size ET (high turbulence).

35. Changing the neck position will solve the problem

36. Compliance (ml/cmH2O)
Acceptable values:
Normal FT, not on ventilator: 2-2.5
Good for extubation: > 1

37. C20/C ratio for over-distension
Beaking also
denotes over-
distension
Ratio of compliance
Total lung compliance
during the last 20% of
breath cycle to the
total compliance.
If this calculated Compliance
value is less than of the last
20% of breath
0.8 (<1 according
to some experts),
the lungs are
overinflated,
therefore PIP
should be reduced.

38. Mean (Airway) Pressure (mbar)
• This parameter (along with the FiO2) is the
summary of what you are doing to the baby.
• Suggestion: MAP should be recorded in the
BGA chart. Currently its not.

39. HFO VTe (Vol. of Oscillation) in ml
• Volume of air moved in (and out) with each
oscillator piston movement.
• Delta P is an indirect representation of this
volume.
• Values of 2-2.5 ml/kg will give you normal
pCO2. (This is the anatomical dead space
volume in neonates).
• Useful as an adjuvant to chest vibration.

40. DCO2: Gas Transport Coefficient
• DCO2 = VT2 X F
• Values around 80 per kg will result in
normocarbia.
• Useful when chest is not visible due to
bandage; or when gross edema with tense
ascites causes poor vibrations.

41. THANKS