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Air and oxygen supplies Connect air and oxygen supplies to the ventilator (seeFigure 3). The ventilator can use air and oxygen fromcylinder or wall supplies. Supply pressures must be 35 to100 psi (241 to 690 kPa).Air inletconnectorAir inletfilter bowlOxygen inletconncerAir hose(from airsupply)Oxygen hose(from oxygensupply)Figure 3.Connecting the air and oxygen suppliesWARNINGConnect only air to the air inlet, and only oxygen to theoxygen inlet. Do not attempt to switch air and oxygenor connect any other gas.6Puritan Bennett 840 Ventilator Pocket Guide

WARNINGTo ensure that a constant gas supply is available to thepatient, always connect at least two gas sources to theventilator. (There are three gas source connections: thecompressor, air inlet and oxygen inlet.)CAUTIONTo prevent damage to the ventilator, ensure thatthe connections to the air and oxygen supplies are cleanand unlubricated, and that there is no water in the air oroxygen supply gas. If you suspect water in the air supplygas, use an external wall air water trap to prevent waterdamage to the ventilator and its components.Puritan Bennett 840 Ventilator Pocket Guide7

Patient circuit Connect the patient circuit to the ventilator (see Figure 4).(From patient)(To patient)Expiratory filterInspiratory filterTubingCollector vialInspiratory limbof patient circuitHumidifierFigure 4.Connecting the patient circuit8Puritan Bennett 840 Ventilator Pocket Guide

Figure 5 shows you how to install the expiratory filterand collector vial to the ventilator. Attach the expiratorylimb of the patient circuit to the filter’s expiratory limbconnection.Pull latchup to installfilter, pulldown tohold filterand collectorvial in placeSlide filter rimonto these tracksFilterhousingareaExpiratorylimb connectionFigure 5.Installing the expiratory filter and collector vialPuritan Bennett 840 Ventilator Pocket Guide9

Cap the collector vial drain port if you are not using thedrain bag (see Figure 6). If you are using the drain bag, install clamp on tubing.Uncap collector vial drain port and install tubing tocollector vial drain port. Connect other end of tubingto drain bag. If the ventilator is mounted on the cart,place the drain bag in the cart drawer (see Figure 6).The drain bag is designed to lie flat, and is not designedto be suspended.Place drainbag in cartdrawerTubingFigure 6.Using the collector vial with or without drain bag10Puritan Bennett 840 Ventilator Pocket Guide

WARNINGCovidien recommends that you use one of the identifiedpatient circuits (see the Puritan Bennett 840 VentilatorOperator’s and Technical Reference Manual for patientcircuit testing specifications). Using a circuit with ahigher resistance does not prevent ventilation, but cancause an SST fault or compromise the patient’s ability tobreathe through the circuit.NOTE:To ensure optimum compliance compensation, Covidienrecommends that you use low-compliance patient circuits.(For pediatric patients, the compliance compensationvolume limit is four times the set tidal volume, in additionto the set tidal volume.)NOTE:To ensure optimum ventilation, use pediatric circuits forpatients whose ideal body weight (IBW) is 24 kg (53 lbs)or less, and adult circuits for patients whose IBW is morethan 24 kg.Puritan Bennett 840 Ventilator Pocket Guide11

Patient setupOnce you turn on the ventilator or run SST, the ventilatorruns POST, then displays the Ventilator Startup screen(see Figure 7) on the lower screen.NOTE:If TC was used on the previous patient setup, a noteemphasizing tube type and tube I.D. appears below theSAME PATIENT button explanation.Figure 7.Ventilator startup screen Touch SAME PATIENT, then press ACCEPT tocontinue ventilating with the most recent settings.Ventilation does not begin until a patient is connected. Touch NEW PATIENT to begin ventilating withnew settings.12Puritan Bennett 840 Ventilator Pocket Guide

NOTE:If you are unsure of the meaning of any symbol forventilator settings, alarms or monitored data, touch thesymbol on the screen; its definition will appear at the leftbottom corner of the lower screen. (Figure 8 shows wheresymbol definitions appear on the GUI.)New patient setup Touch the IBW button, then turn the knob to adjustthe IBW. (Many initial settings and setting limits areautomatically determined based on the IBW.) Theproposed value is shown in red.TouchCONTINUE (this button does not appear until you touch IBW), or touch RESTART to return to theVentilator Startup screen. At the New Patient Setup screen, settings for mode,mandatory type (for manual inspirations, if the selectedmode is SPONT), spontaneous type (if applicable)and trigger type appear. For any setting you want tochange, touch its button, then turn the knob to selectthe value. When you are finished changing settings,touch CONTINUE. At the New Patient Settings screen, more settings appear.Touch each setting you want to change, then turn theknob to select its value. (To cancel a highlighted change,press CLEAR.)PressACCEPT to put all settings into effect. Normal ventilation begins once a patient is connected. (Any timebefore you press ACCEPT, you can touch RESTART torestart setting changes.)Puritan Bennett 840 Ventilator Pocket Guide13

Apnea settingsAlthough you aren’t required to change or confirm apneasettings, you should verify that they are appropriate forthe patient. Apnea settings are automatically determinedbased on IBW, but can be changed. If you selected NEW PATIENT, the Current ApneaSettings screen appears at the end of patient setup. If you selected SAME PATIENT, touch the APNEAbutton at the bottom of the lower screen to viewapnea settings.If you change any apnea settings, press ACCEPT to putnew settings into effect.Calibrating the oxygen sensorPress the 100% O2 /CAL 2 MIN key. This causes theventilator to deliver 100% oxygen (if available) for twominutes and calibrates the oxygen sensor.The ventilator’s oxygen monitoring feature is alwaysactive unless you disable the oxygen sensor (see the MoreSettings screen). The oxygen sensor is always enabled whenyou power up the ventilator.Once patient setup is completeOnce the settings are accepted, you can attach a patient tothe ventilator. Ventilation only begins when the ventilatorsenses that a patient is attached. (If you attach a patientbefore completing setup, the ventilator begins safetyventilation and declares a PROCEDURE ERROR alarmthat resets once patient setup is complete.)14Puritan Bennett 840 Ventilator Pocket Guide

Inspiratory pausePressing the INSP PAUSE key causes the ventilator to schedulean automatic pause maneuver as follows (see Table 1).   At the next scheduled inspiration, the inspiratory andexpiratory valves close to allow pressure to equilibratebetween the patient and the circuit.   The inspiratory pause continues until a stable pressure isreached or until two seconds elapse, whichever comes first.   The graphics screen will automatically be displayed (if itis not already active). The trace freezes and the values forcompliance and resistance are displayed.   You can extend the pause beyond two seconds to amaximum of seven seconds by holding down the INSPPAUSE key.Expiratory pausePressing the EXP PAUSE key causes the ventilator toschedule an automatic expiratory pause maneuver asfollows:   Press EXP PAUSE key to schedule automatic expiratorypause maneuver.   During the next exhalation, the inspiratory and expiratoryvalves close to allow pressure to equilibrate between thecircuit and the patient.   The expiratory pause continues until a stable pressure isreached or two seconds elapse, whichever comes first.   The graphics screen will automatically be displayed (if itis not already active). The trace freezes and the values forintrinsic (auto) PEEP and total PEEP are displayed.   You can extend the pause beyond two seconds to amaximum of 20 seconds by holding down the EXP PAUSEkey.Puritan Bennett 840 Ventilator Pocket Guide15

16R (******)R (******)R()Message asdictated by othertestsC (******)C(0)orC (500)Or Resistance (R)(if displayed):C (******)When you seeCompliance (C):Check the breathing waveforms andmonitored patient data for cluesabout these questionable inputs.Check the breathing waveforms andmonitored patient data for cluesabout these questionable inputs.Check the patient-ventilator interaction, the breathing waveforms, andthe patient circuit for underlyingcauses.The difference in pressure between end plateau and end exhalation 0.1 cm H2O. Thisis below the limits of reliable resolution. TheR and C values are therefore questionable.C 0 mL/cm H2O or C 500 mL/cm H2O.These measurements are outside ofphysiological limits.Do this:C 0.1 mL/cm H2O or patient flow 0.1 L/min. This points to questionable inputs tothe C equation, which would in turn renderR questionable. The low patient flow is belowthe threshold of reliable measurement.It means:Table 1. Inspiratory pause maneuver displaysPuritan Bennett 840 Ventilator Pocket Guide

R 0 cm H2O/L/s or R 500 cm H2O/L/s.These measurements are outside of physiological limits.Sub-threshold input value(s) C 1/3 of ventilator breathing system compliance (derivedfrom SST). Both C and R are questionable.Exhalation was not complete. This rendersend-expiratory pressure and total exhaledflow values questionable.R (yyy)R (yyy)IncompleteexhalationC (xxx)C (xxx)IncompleteexhalationIt means:R(0)orR (500)Or Resistance (R)(if displayed):C( )Message asdictated byother testsWhen you seeCompliance (C):Check for an insufficient expiratoryinterval. If possible, shorteninspiration time and reducerespiratory rate.If the patient’s IBW 24 kg, considerinstalling a pediatric patient circuit.Check the patient-ventilatorinteraction, the breathingwaveforms, and the patientcircuit for underlying causes.Do this:Table 1. Inspiratory pause maneuver displays (continued)Puritan Bennett 840 Ventilator Pocket Guide17

When you seeCompliance (C):18C 1.0 mL/cm H2O. This results fromquestionable input data. This out-of-rangevalue also renders R questionable.R 150 cm H2O/L/s. This results fromquestionable input data, possibly C.R (yyy)Out of rangePlateau is not “flat” (lung and circuitpressures did not equilibrate) or pausepressure was excessively noisy. Theseproblems render R and C questionable.It means:R (yyy)QuestionablemeasurementR (yyy)No plateauOr Resistance (R)(if displayed):Check the breathing waveforms andmonitored patient data for cluesabout these questionable inputs.Check the breathing waveforms andmonitored patient data for cluesabout these questionable inputs.If plateau continues to decline, checkfor a leak in the breathing circuit,possibly around the cuff. If plateauis unstable, check for moisturecondensing in a “lazy” loop or abreathing circuit being jiggled.Do this:Table 1. Inspiratory pause maneuver displays (continued)Puritan Bennett 840 Ventilator Pocket Guide

When you seeCompliance (C):The pressure rose slowly at the end of thesquare flow waveform. This suggests thatthe pressures, volumes and flows involvedare minimal and questionable. This is notexpected during normal ventilation.The difference between the circuit pressureat the end of the plateau and the pressureat the end of exhalation 0.5 cm H2O. Thisresults in a questionable R value.R (yyy)QuestionablemeasurementIt means:R (yyy)QuestionablemeasurementOr Resistance (R)(if displayed):Check for a highly compliant lunginflated slightly. If the tidal volumecan be safely increased, try that.Check the pressure-time waveformto see whether the patient delayedinspiration until the end of gasdelivery.Do this:Table 1. Inspiratory pause maneuver displays (continued)Puritan Bennett 840 Ventilator Pocket Guide19

The top of the upper screen shows monitored data (dataoutside the normal range flashes). Once normal ventilationis in progress, ventilator settings are displayed across thetop of the lower screen. (Figure 8 shows how information isdisplayed on the GUI.)Upper screen:monitoredinformation(alarms,patient data)Lowerscreen:ventilatorsettingsOff-screen keysKnobFigure 8.Puritan Bennett 840 Ventilator graphic user interface (GUI)20Puritan Bennett 840 Ventilator Pocket Guide

Alarm settingsMost alarm settings are initially set based on the patient’sIBW. You should review all alarm settings. Touch the ALARM SETUP button (lower screen) to viewthe current alarm setup (see Figure 9). Touch the alarm you want to change. Turn the knob to set the value you want. Proposed valuesare shown in red. You can change several alarm settingsin a batch change. To cancel a highlighted change,press CLEAR. Review all settings. Press ACCEPT to apply the new alarm settings.Press the ALARM SETUP button to cancel allalarm changes.You can touch the ALARM SETUP button at anytime during ventilation to show the current limits andmonitored value for each alarm. If an alarm annunciates,the alarm slider on the Alarm Setup screen will turn acolor indicating the urgency of the alarm state: red forhigh urgency, yellow for medium and low urgency.Figure 9.Alarm setupPuritan Bennett 840 Ventilator Pocket Guide21

NOTE:The upper limits for the spontaneous exhaled tidal volumeand mandatory exhaled tidal volume alarms are always thesame. Changing the upper limit of one alarm automaticallychanges the upper limit of the other.Main setting changesMain settings are the buttons displayed at the top of thelower screen, and you can only change them individually.Follow these steps to change main settings: Touch the setting you want to change Turn the knob to the set value Press ACCEPT to apply the new settingRemember: touch, turn, ACCEPT!22Puritan Bennett 840 Ventilator Pocket Guide

Mode, breath type and batch(multiple) changes Touch the SETUP button on the lower screen.The Current Vent Setup screen appears. To change ventilation setup (mode, mandatory breathtype, spontaneous type or trigger type), touch its button,then turn the knob to set the value. Proposed changes areshown in red. (Press CLEAR to cancel a change you’vejust made.) Once you’ve made all the changes you want (you don’thave to make any changes at all), touch CONTINUE.Appropriate settings for the ventilation setup you’veselected appear on the lower screen. For each of the current ventilator settings you want tochange, touch its button, then turn the knob to set itsvalue. (Press CLEAR to cancel a change you’ve just made.)Onceyou’ve made any changes you want, review the settings, then press ACCEPT to apply all the new settingsat the same time. (Touch SETUP to cancel all changes.)Previous setupOnce ventilator settings are in effect, the PREVIOUSSETUP button appears at the bottom of the lower screenwhen you press SETUP, and allows you to restore theentire previous setup (including alarm and apnea settings)that was in effect immediately before you made settingchanges using the Ventilator Setup screen. To restore the previous setup, touch PREVIOUS SETUP,then press ACCEPT.Puritan Bennett 840 Ventilator Pocket Guide23

Humidification type, humidifier volume, O2 sensorenable/disable and disconnect sensitivity (Dsens)To view or change: Touch the OTHER SCREENS button, then touch theMore Settings button. Touch each setting you want to change (you can changemultiple settings), then turn the knob to set its value. Toleave settings unchanged, touch the OTHER SCREENSbutton again. Press ACCEPT to apply the new settings.24Puritan Bennett 840 Ventilator Pocket Guide

Constant during rate changeIf you selected pressure control (PC), you can select oneof three timing variables (inspiratory time, I:E ratio, orexpiratory time) to be held constant when the respiratoryrate setting changes. Touch SETUP. Touch CONTINUE. The breath timing bar appears in thelower screen (see Figure 10). Touch one of the lock icons to select TI, I:E, or TE asthe setting that remains constant when the rate settingchanges. Review settings and change if necessary, then pressACCEPT. The value displayed is the one held constantduring rate changes, and becomes the only setting you canadjust directly.Figure 10.Constant during rate change (inspiratory time selected)NOTE:You can change the value of the constant setting at anytime, but the value does not change as a result of changingthe rate setting.Puritan Bennett 840 Ventilator Pocket Guide25

Alarm handlingThe SmartAlert Alarm System offers prioritized alarmannunciation that distinguishes primary alarms fromsecondary, dependent alarms (that is, alarms that arise dueto the initial alarm condition) and indicates the urgencylevel of each alarm. An alarm log keeps a time-and-datestamped record of alarms, alarm silences, and resets inorder of occurrence.Alarms on the Puritan Bennett 840 Ventilator are classifiedas high-, medium- or low-urgency (see Figure 11).High-urgency alarm indicator(red): Immediate attentionrequired to ensure patient safety.Medium-urgencyalarm indicator(yellow): Promptattention required.Low-urgency alarmindicator (yellow):Indicates a change in thepatient-ventilator system.Figure 11.Alarm indicatorsNOTE:You can always change an alarm setting even when alarmsare active. You do not need to press ALARM RESET or waitfor the alarm to autoreset.26Puritan Bennett 840 Ventilator Pocket Guide

Alarm silencePressing ALARM SILENCE mutes the alarm sound for twominutes. The key’s LED lights during the silence period, andturns off if the alarm is reset. Every time you press ALARMSILENCE, the two-minute silence period restarts. An on-screenalarm silence notification appears on the display when alarmsilence is active.WARNINGNever leave patient unattended when ALARM SILENCEis activated. ALARM RESET will cancel silence.Alarm resetPressing the off-screen ALARM RESET key resets thedetection algorithms of all active alarms, except for these:AC POWER LOSSCOMPRESSOR INOPERATIVEDEVICE ALERTO2 SENSORINOPERATIVE BATTERYLOW AC POWERLOW BATTERYNO AIR SUPPLYNO O2 SUPPLYPROCEDURE ERRORPressing ALARM RESET has no effect on patient data.If an alarm condition persists, the alarm becomes activeagain, according to the detection algorithm for that alarm.For example, if the APNEA alarm is active, ALARM RESETresets the apnea detection algorithm to its initial state andreturns the venti

Power Plug the ventilator power cord to AC power (see Figure 2). The power cord retainer protects against accidental disconnection, and must always be in place during operation. To avoid electrical shock hazard, connect the ventilator power cord into a grounded AC power outlet. Power cord retainer Power cord To AC power WarninG fiGUre 2.