Drager Zeus Manual
Drager Zeus Manual >>> https://urlgoal.com/2tgVCq
Dräger Zeus Official User Manual: The official instruction manual for Dräger Zeus Infinity provides information for installing, calibrating, and maintaining the device. It is from the official website of the manufacturer of the device so this source can be trusted.
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This is a mono-center, randomized, simple-blind trial based on a non-inferiority hypothesis for the consumption of Desflurane between Perseus (manual mode guided by Vaporview ventilators) and Aisys (automated Etcontrol mode ventilators). Two Aisys systems and two Perseus systems were dedicated to the study. The investigator responsible for the protocol included anonymized participants. For the allocation of participants, a randomization was performed manually by an agent of the URC Robert Debré (Research Clinic Unit). The patient and the URC agent were blinded. The e-crf was implemented by the URC agent, copying the data collected by the investigator.
Before the procedure, the soda lime tank of the ventilator was systematically changed and the circuit purged. Standard monitoring was placed before the induction of general anaesthesia, associated to a bispectral index BIS monitor. After pre-oxygenation, the induction of general anaesthesia was achieved using propofol 2 to 3 mg.kg-1, sufentanil Target Control Infusion 0.2 ng.ml-1 and atracurium 0.5 mg.kg-1. After orotracheal intubation, mechanical ventilation was initiated (Vt 7 ml.kg-1, PEEP 6 cm H2O) and set to maintain PetCO2 between 35 and 40 mmHg. An association of TCI sufentanil and the continuous infusion of atracrium were used to maintain anaesthesia and Desflurane in a mixture of O2/air 50/50% was started and set to deliver a constant age-adjusted concentration corresponding to MAC [1 - 1.2] [10]. Patients were randomly allocated to receive Desflurane, delivered either by the Etcontrol TCIA mode in the Aisys group (reference group) or by the Vapor View manually assisted mode in the Perseus group. The desired Fe was achieved automatically in the Aisys group with the EtControl mode and manually in the Perseus group with the VaporView mode (Figure 1).
In this prospective randomized study, based on daily clinical practice conditions, Desflurane consumption does not statistically differ if administered by either the Perseus A500 in VaporView mode or the automated EtControl mode of the Aisys Cs2. Moreover the kinetic profiles to reach the targeted Fe (MAC 1-1.2) at the beginning of the administration; the elimination rates at the end of anaesthesia and the number of intraoperative Fd (Perseus group) or Fet (Aisys group) adjustments showed no significant differences between the two groups. The choice of Desflurane was made because this agent is particularly suitable for low-flow anaesthesia [11]. Furthermore, it is the least degradable of the currently available inhaled anesthetics [12]. It is also the most expensive halogenated anesthetic [11] and could be accountable for 20 to 25% of overall anesthetic drug costs [13] and has a potential environmental impact [14]. This makes all endeavors to reduce its consumption highly justified. Vaporview is software associated with the Perseus machine. It may be used to help anesthesiologists manually maintain optimal FGF and Fd to predict upcoming Fe according to an algorithm that gives the evolution of inspired (Fi) and end-tidal (Fe) fractions of halogenated agents according to FGF and Fd. The current study is the first one to measure the exact halogenated agent consumption using Vaporview mode in a controlled clinical situation. It is also the first to compare Desflurane kinetic profiles between Vaporview and a TCIA mode. Additionally, this study could be helpful for practitioners in providing a clinical protocol to be followed using Vaporview.
The EtControl TCIA mode was chosen because Aisys is actually a workstation commonly used for performing TCIA. The EtControl mode is easy to handle, adjusting automatically the FGF to 0.5l.min-1 during the longest period of inhaled anaesthesia. The Aladin halogenated tank of the Aisys is a vaporizer that needs a minimum FGF passing through it to deliver halogenated agent in the system. That is why FGF with the Aisys is limited to 0.5 l.min-1. A median Desflurane consumption, under 14 ml.hr-1 (i.e. under 0.23 ml.min-1) in both groups was observed. For Aisys in EtControl mode, it is less than previously described by Singaravelu and Barclay [15], probably because the period at low FGF was much longer in our study with a 330 min median anaesthesia. Indeed, it has been shown that 50% of the consumption happens during the first 10 minutes of administration [16]. The current study is the first measuring the exact halogenated agent consumption administered using Perseus in Vaporview mode. In previous publications, a few studies have compared manual versus automated modalities of halogenated agent delivery. Struys and colleagues [6] compared the Zeus (Dräger) in auto-control mode (FGF 0.5l.min-1) and the Primus (Dräger) in manual mode with a stable FGF (1l.min-1). But this study was an in-vitro comparison, with a very short period of anaesthesia (30 minutes) and the lowest FGF in the Primus group was only 1l.min-1. To our knowledge, De Cooman and colleagues [17] are the first ones finding a consumption difference in favor of a manual mode. In this study, the Zeus in auto-control mode was compared with the ADU (GE), but the groups were not comparable (n=26 versus n=10) and not randomized. Moreover, unlike us, Desflurane consumption was calculated and not directly measured.
Another crucial part of our results is that the manually-assisted Vaporview and automated protocol Aisys displayed similar Fe kinetic profiles at the initiation of inhaled anaesthesia (Table 3). This is consistent with previous arguments showing that it is more efficient to saturate the breathing system with an overshoot of high Fd than with a high FGF [16,18] Accordingly, a recent study comparing Sevoflurane and Desflurane kinetics between four groups using Aisys showed that the initiation of inhaled anaesthesia using only very low FGF was clinically possible [19]. In this study, the wash-in was made by an overshoot of Fd (18% Desflurane) keeping the same low FGF (0.5 or 1 l.min-1). But the time to reach MAC 1 at 0.5 l.min-1 FGF was 8.5 +/- 0.7 min, about 6 minutes longer than in our study. In clinical practice this wash-in duration is too long with the risk of the patient awakening during this period. This explains why in auto-control mode of the Aisys ventilator, a short period of high but not excessive FGF (6l.min-1) is automatically provided to obtain a faster target Fe. This is also why in the current study a short period of high FGF (3l.min-1) was maintained in manual mode to rapidly obtain MAC 1. This reduced 3 l.min-1 FGF regimen in the Perseus group was chosen because it was noticed in the pilot study that the velocity for reaching high Fe was too high at 6l.min-1 (less than 1 min). An explanation could be that the breathing system, including the absorbent canister is two times larger for the Aisys than for the Perseus.
In conclusion, in daily clinical practice conditions, Desflurane consumption is not inferior between the manually-assisted administration in the Dräger Perseus Vaporview mode and the automated-controlled administration using the General Electrics Aisys EtControl. Fe kinetic profiles and ventilator adjustment requirements did not differ between these two administration methods. 153554b96e
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