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User Guide Addendum - iStan Lung
ADDENDUM TO ISTAN USER GUIDE
CONTENT
Please refer to the updated information in this addendum when utilizing these features on the iStan
simulator:
• iStan lung support for ventilation.
º
Includes asynchronous mechanical ventilation.
The current User Guide can be found on the CAE Healthcare website www.caehealthcare.com under
Support> User Guides.
Lung Compliance
The iStan lung allows support for ventilation, including asynchronous mechanical ventilation.
Lung compliance is adjusted independently on the mannequin and in the Muse software. They both
must be adjusted to equivalent levels to work effectively. Refer to the lung compliance settings table at
the end of these instructions for equivalency settings.
NOTE: The default configuration, no flanges attached on the lung, is considered normal lung
compliance in Muse. No hardware adjustments are needed.
IMPORTANT: To reduce the lung compliance, adjust the lung flange on the mannequin first, then
adjust the Muse software lung compliance.
To adjust the lung flange on the mannequin:
1. Unzip and fold back the iStan torso skin and shorts skin.
The Mannequin
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User Guide Addendum - iStan Lung
2. Use both hands to slightly bend and clip the top or bottom lung flange into
the flange slot. (Turning the mannequin feet outward allows more room to
reach inside the mannequin.)
The lung flange
The Mannequin Abdomen
NOTE: Clip the top lung flange for moderately reduced compliance. Clip
both the top and bottom lung flanges for severely reduced compliance.
The lung flange clipped
to top flange slot
The Lung
The lung flange
clipped to top and
bottom flange slot
The Lung
3. Replace and zip the torso skin and shorts skin.
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User Guide Addendum - iStan Lung
To adjust the lung compliance in the Muse software:
1. From the Run screen, click the lung on the homunculus figure.
The basic Respiratory parameters appear.
The Basic/Additional switch
The Respiratory View - Basic Parameters
2. Click the Basic/Additional switch to view additional parameters.
3. Click Lung Compliance Factor: [Left/Right] to adjust settings.
The Lung Compliance Factor settings appear.
The value
setting field
The Lung Compliance
Factor
The Lung Compliance Factor Parameter
4. Adjust compliance settings (click up/down arrows in the value setting field)
and click Accept when done. Ensure both left and right lung compliance
settings are adjusted accordingly.
See table on next page for lung compliance settings.
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User Guide Addendum - iStan Lung
iStan Lung Compliance Settings
Lung Flange Position
Muse Lung Compliance Factor: Left and Right
No Flanges Attached
Normal: 1.0
Top Flange Attached
Moderately Reduced: 0.5
Both Top and Bottom Flanges Attached
Severely Reduced: 0.3
NOTE: The lung flanges on the mannequin should be returned to normal compliance (no lung clipped
to the flange slot) after completion of use.
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User Guide Addendum - iStan Lung
Muse Lung Compliance Settings
Use the Lung Compliance Factor, Left and Right in Muse to increase/decrease lung compliance.
(In Muse, click the lung on the homunculus figure, then click the Basic/Additional switch to view
additional parameters.)
Increase in Peak Inspiratory Pressures (PIPs) and Plateau Pressures are evident with reduced lung
compliance.
Actual PIPs and Plateau Pressures observed will depend on the ventilator settings:
• Flow rate: lower inspiratory flows will reduce resultant PIPs.
• Inspiratory time: longer inspiratory times will reduce flow rates resulting in lower PIPs.
• Tidal volume: smaller tidal volumes will reduce flow rates resulting in lower PIPs.
• PEEP: Application of Positive End-Expiratory Pressure (PEEP) resulting in
higher PIPs and Plateau Pressures.
Example:
Ventilator Settings: VT: 450 mL, Rate: 12 breaths/min, I:E: 1:3, Inspiratory Flow: 27 L/min.
(cm H2O)
Peak
Inspiratory
Pressure (PIP)
(cm H2O)
Plateau
Pressure
(cm H2O)
Static
Compliance
(mL/cm H2O)
Normal
0
9 – 13
7–9
65 – 70
1
Normal
5
55 – 65
50 – 60
10 – 15‡
0.5
Moderately
Reduced
0
18 – 24
14 – 20
25 – 35
0.5
Moderately
Reduced
5
23 – 28
18 – 24
25 – 35
0.5
Moderately
Reduced
10
30 – 36
26 – 32
20 – 25
0.5
Moderately
Reduced
15
45 – 50
40 – 45
15 – 20‡
0.3
Severely
Reduced
0
30 – 35
25 – 30
15 – 20
0.3
Severely
Reduced
5
30 – 35
27 – 33
15 – 20
0.3
Severely
Reduced
10
35 – 40
32 – 36
14 – 19
0.3
Severely
Reduced
15
40 – 45
38 – 42
14 – 19
0.3
Severely
Reduced
20
48 – 52
45 – 50
12 – 16
Lung
Compliance
Factor, L/R
Compliance
Configuration
(Mannequin
hardware)
Positive EndExpiratory
Pressure (PEEP)
1
‡ Over-distention
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User Guide Addendum - iStan Lung
Recommendations:
1. PEEP: If PEEP is set on the ventilator, the corresponding PEEP setting must
be applied in Muse for physiologic response to PEEP [Location: Respiratory
Parameters, Additional].
2. Normal Compliance Configuration: The application of PEEP on the ventilator
is not recommended.
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Set the PEEP in the Muse SW only, not on the ventilator.
3. Over-distention: Use the table above as a guide to the upper limit of
ventilator applied PEEP.
º
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Use the Muse SW alone to demonstrate the physiologic response to
higher PEEP settings.
iStan®
User Guide Addendum - iStan Lung
Muse Bronchial Resistance Settings
Use the Bronchial Resistance Factor, Left and Right in Muse to increase/decrease airway resistance.
(In Muse, click the lung on the homunculus figure, then click the Basic/Additional switch to view
additional parameters.)
Increase in Peak Inspiratory Pressures (PIPs) are evident with increased bronchial resistance.
Actual PIPs observed will depend on the ventilator settings:
• Flow rate: lower inspiratory flows will reduce resultant PIPs.
• Inspiratory time: longer inspiratory times will reduce flow rates resulting in lower PIPs.
• Tidal volume: smaller tidal volumes will reduce flow rates resulting in lower PIPs.
Example:
Ventilator Settings: VT: 450 mL, PEEP: 0 cm H2O. Hardware Lung Configuration: Normal Compliance.
I:E
Peak
Inspiratory
Pressure
(PIP)
(cm H2O)
Plateau
Pressure
(cm H2O)
Static
Compliance
(mL/cm H2O)
27
1:3
9 – 13
7–9
65 – 70
12
27
1:3
11 – 15
7–9
65 – 70
3
12
27
1:3
13 – 17
7–9
60 – 65
4
12
27
1:3
14 – 18
7–9
60 – 65
5
12
27
1:3
16 – 20
7–9
60 – 65
6
12
27
1:3
17 – 21
7–9
57 – 62
7
12
27
1:3
18 – 22
7–9
57 – 62
8
12
27
1:3
20 – 24
8 – 10
57 – 62
9
12
27
1:3
22 – 26
9 – 11
57 – 62
10
12
27
1:3
25 – 30
10 – 14
57 – 62
11
10
30
1:4
30 – 35
13 – 17
45 – 50
12
10
30
1:4
33 – 38
14 – 18
45 – 50
13
10
30
1:4
36 – 43
18 – 22
45 – 50
14
10
30
1:4
40 – 45
22 – 26
45 – 50
15
10
30
1:4
45 – 50
28 – 32
45 – 50
Bronchial
Resistance
Factor,
L/R
Rate
(breaths/
min)
Inspiratory
Flow
(L/min)
1
12
2
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User Guide Addendum - iStan Lung
iStan®
Recommendations:
1. Tidal volumes: The recommended maximum VT with mechanical ventilation is 450-500 mL.
Higher values are likely to cause over-distention of the hardware lung.
2. Onsets: The use of Onsets when making changes to the Bronchial Resistance Factor
settings is not recommended as this may yield inconsistent behavior, e.g., run-to-run
variation in PIPs.
3. PEEP: For the normal compliance lung configuration, the application of PEEP on the
ventilator is not recommended.
º
Set the PEEP in Muse only, not on the ventilator.
4. CO2: To adjust the modeled response to hardware settings (bronchial resistance / lung
compliance), consider using the following Muse parameters (Location: Respiratory
Parameters, Additional).
8
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O2 Consumption – Used to change rate of O2 consumption and production of CO2.
º
CO2 Production Factor – Allows for the manipulation of metabolic CO2 production.