Taking NIV further

Philips Respironics V60 ventilator pocket guide

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Introduction
Noninvasive ventilation (NIV) has been shown to significantly
reduce many of the complications associated with
conventional mechanical ventilation, including the incidence
of ventilator-acquired pneumonia, [1] while at the same time
reducing the overall cost of care by shortening lengths of stay.
[2, 3]

This pocket guide was designed to familiarize clinicians with

the V60 ventilator setup and application. It provides step-by-
step explanations of how to use the V60 ventilator from initial
setup to making mask and port settings to changing modes.
This guide also includes suggestions for increasing tank life
during transport.

The Philips Respironics V60 ventilator is a microprocessor-

controlled, bi-level positive airway pressure ventilatory assist
system that provides noninvasive and invasive ventilatory
support for adult and pediatric patients (> 20 kg).

References
1
Hill NS, Brennan J, Garpestad E, Nava S. Noninvasive ventilation in acute
respiratory failure. Crit Care Med. 2007 Oct;35(10):2402-7.

2
Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A. Noninvasive positive
pressure ventilation in the setting of severe, acute exacerbations of chronic
obstructive pulmonary disease: more effective and less expensive. Crit Care
Med. 2000 Jun;28(6):2094-102.

3
Hubble MW, Richards ME, Wilfong DA. Estimates of cost effectiveness of
prehospital continuous positive airway pressure in the management of acute
pulmonary edema. Prehosp Emerg Care. 2008 Jul-Sep;12(3):277-85.

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Contents
Introduction

Device overview
2 Front
2 Back
2 Side
3 Air inlet filter
3 Patient circuits

General operation
4 Mask and port settings
4 Setting changes
5 Mode changes
6 Batch changes
6 Alarm message navigation
7 Low rate
8 Menu tab
8 Screen lock
9 Patient data and waveforms
10 Standby
10 Help button
11 Mask leak symbols
12 Exhalation port settings
12 Exhalation port test

New modes and options

13 Ramp
13 C-Flex
14 Pressure control ventilation
14 AVAPS (average volume-assured pressure support)
16 Patient transport

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1
Device overview
Front

Back

Side

2
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Air inlet filter
To change the air inlet filter
1. Power down the V60 ventilator and disconnect it from AC
power.
2. Turn the D-ring fastener (bottom of side panel) counter-
clockwise one-quarter turn and release.
3. Remove the side panel.
4. Remove the air inlet filter by pinching it out of the recess in
the bracket.
5. Install the new air filter by tucking it in the recessed area.
6. Replace the side panel, and then push in the D-ring
fastener turn one-quarter rotation, or until it locks.

Patient circuits
Assemble the patient circuit, including bacterial filter, proximal
line and humidifier (if desired).

Standard patient circuit includes main flow filter, and proximal pressure
line. Not for use with a humidifier.

The standard humidifier patient circuit includes a main flow filter, a

short tube, water trap, pressure sensor, and elbow.
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General operation
Once the circuit and filter are attached, press the ON/
Shutdown button. An informational message is displayed on
the screen indicating which mask and leak port were last
used. If the current mask and port match the displayed data,
continue to Mode settings. Otherwise follow the instructional
steps to change the mask/port settings.

Mask and port settings

1. Press the Menu setting tab.
2. Press the Mask/Port button.
3. Press desired patient interface type (see Mask leak symbols
for more information) and press Accept to apply.
4. Press the desired exhalation port (see Exhalation port
settings for more information) and press Accept to apply.
5. Run the exhalation port test only if required.

Setting changes
1. In the settings window, touch the setting to be changed.
2. Adjust the setting by either using the arrow keys or the
navigation ring.
3. Once the correct value has been chosen, press Accept.

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Mode changes
The active ventilation mode is displayed in the upper left
corner of the screen. To set or change a mode, do the
following:

1. Select the Modes setting tab.

2. Select the desired mode (active mode will be displayed in
blue).
3. Adjust settings as desired. Newly adjusted setting values
will be displayed in yellow.
4. Select Activate Mode to apply.

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5
General operation
Batch changes
Batch changes are available in only the active mode. Batch
changes allow you to activate multiple ventilation setting
changes simultaneously. To make batch changes follow these
steps:
1. Press the Modes setting tab.
2. Press the active mode (it will state “Batch” and be
displayed in blue).

3. Adjust settings as desired so that newly adjusted values are

displayed in yellow.
4. Press Activate Batch Change to apply all changes at once.

Alarm message navigation

To hide alarms or informational messages in the Alarms or
Messages list, press the alarm button (flashing if high priority)
or the informational messages button when up arrows
are present. To display messages, touch the informational
messages button when the down arrows are present. For a
list of alarms, see the Respironics V60 Ventilator User Manual.

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Changing an alarm setting
1. Press the Alarm Settings tab.
2. Press and change the appropriate alarm value.
3. Press Accept.

Low rate
On the V60 ventilator, the low rate alarm may also serve as
an apnea alarm. The low rate alarm value should always be
programmed above the set (backup) rate. If the low rate alarm
value is lower than the set rate, the low rate alarm cannot be
triggered, and the alarm is essentially disabled. A text warning
will appear on the left side of the settings screen if the user
sets the low rate at or below the set (backup) rate.

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7
General operation
Menu tab
From the Menu window, user preferences can be adjusted.
There is a Brightness setting button for day or night view.
There is a Loudness setting button to adjust the volume of
alarms and audible feedback click. There is a Mask/Port menu
button to choose various mask leak values and to choose the
correct port (see Mask leak symbols). There is a Vent Info
menu button, which displays the software version and other
information specific to the ventilator, and the Screen Lock
button.

Screen lock
Screen lock deactivates all buttons and tabs on the
touchscreen except Alarm Silence, Alarm Reset, the alarm
message button, and help icon. The tabs will be grayed out.

To unlock the screen, press the accept button (√) in the

center of the navigation ring.

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Patient data and waveforms
The data screen displays alarms and patient data, which
include rate, estimated tidal volume, estimated minute
ventilation, peak inspiratory pressure, patient trigger %,
TI/T TOT %, and leak. There is also a breath phase/trigger
indicator that displays what triggered the breath (spontaneous
or timed) and when the expiratory phase has begun.

Pt. Trig – Patient-triggered breaths as a percentage of total

breaths over the last 15 minutes.
Rate – Total breath rate (Spont and Timed), a moving average
over the last 6 breaths or 15 seconds.
TI/T TOT – Inspiratory time divided by the total cycle time over
the last 8 breaths.
Pt. or Tot.Leak – Estimated unintentional leak (Pt. Leak) or
total of intentional plus unintentional leak (Tot.Leak).

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9
General operation
Standby
Standby suspends ventilation and retains current settings
when the clinician wants to temporarily disconnect the patient
from the ventilator. You can also change ventilator settings
and most menu functions during standby.

To activate Standby
1. Press the Standby tab. The Entering Standby window
appears.
2. Disconnect the patient from the ventilator.

The ventilator will not enter standby until the patient is

disconnected. It continues ventilation while waiting for the
patient to be disconnected. The standby mode gives the
clinician up to 60 seconds to disconnect the patient from the
ventilator. If after 60 seconds no disconnection is detected,
the standby mode cancels.

Help button
Press the help icon (?) to display additional information. Touch
the screen anywhere to return to normal operation.

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10
Mask leak symbols

Leak symbol Patient interface

(printed on mask)
Leak 1 PerfomaTrak oro-nasal mask
PerformaTrak nasal mask
Image3 oro-nasal mask
Viny nasal mask
Contour Deluxe nasal mask
AF811 oro-nasal mask

Leak 2 PerforMax full face mask

Leak 3 Respironics AP111 nasal cradle

Leak 4 Respironics Total face mask

The leak symbol represents

the intentional leak
characteristics of the mask,
and the proper V60 mask/
port settings will ensure
the greatest accuracy and
optimum performance. If
the leak symbol does not
appear on a Respironics
patient interface, use the
chart above to determine
the proper V60 setting. Leak 1 symbol on mask
When using an interface
other than a Respironics mask, choose the leak setting Other.
This selection causes Total Leak, not Patient Leak, to be
displayed on the patient data screen.

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11
General operation
Exhalation port settings
After pressing the appropriate mask setting, press the
correct exhalation port setting. The chart below references
the various exhalation port settings and when an exhalation
port test is recommended. An exhalation port test is only
recommended when using a PEV (plateau exhalation valve)
or non-Respironics exhalation ports with unknown leak
characteristics.

Port selections Onscreen Exhalation

pictorial port test
recommended
Respironics
Disposable
No
Exhalation port
(DEP)

Respironics
Whisper Swivel
No

Respironics Plateau
Exhalation Valve
Yes
(PEV)

Other exhalation
port
Yes

Exhalation port test

If a port test is required, follow the instructions provided on
the screen.

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12
New modes and options
Ramp
The ramp time allows your patient to adapt to ventilation
gradually by increasing inspiratory and expiratory pressures
(IPAP and EPAP/CPAP) from sub-therapeutic to user-set
pressures over a user-set interval (5-45 minutes).
How to set a ramp time
1. Press the Ramp Time button in the mode settings window.
2. As the ramp progresses, the Ramp Time button graphic
fills in.
3. To change the ramp interval or end the ramp, press
the Ramp Time button again, and the Ramp in Progress
window opens.
4. To end the ramp and apply the full IPAP and EPAP/CPAP
pressures immediately, press End Ramp.
5. To end the ramp and start a new one, press Start New
Ramp, and the Ramp Time setting window opens again so
you can set a new ramp time.

C-Flex
C-Flex improves the comfort of traditional CPAP by reducing
the pressure throughout active exhalation and returning it to
the set level before the end of exhalation. C-Flex may not be
appropriate for patients where even a transient drop in CPAP
is deemed undesirable.

The amount of pressure relief is determined by the C-Flex

setting and the expiratory flow of the patient. Pressure relief
is increased with a higher setting number (1, 2, or 3) and
greater patient expiratory flow. This applies during only the
active part of exhalation.

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13
New modes and options
Pressure control ventilation
In pressure-controlled ventilation (PCV), breaths with a user-
set IPAP and I-Time are delivered to the patient. The patient
can trigger an inspiration and, therefore, control the rate.
However, the patient does not control the inspiratory time.
Also be aware that any changes in EPAP without an equal
change in IPAP will change the pressure support.

AVAPS (average volume-assured pressure support)

AVAPS is a volume-targeted mode and is intended for use
with stable chronic patients who do not require rapid
pressure support changes to maintain a target V T. The V60
ventilator will automatically adjust IPAP (up to 2.5 cmH2O
per minute), to maintain a tidal volume target. AVAPS is not
intended for patients with high resistance and low compliance.

IPAP Min
EPAP

Target VT

AVAPS automatically adapts pressure support (< 2.5 cmH2O per

minute) to guarantee an average tidal volume

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Starting AVAPS
1. When switching from S/T mode to AVAPS, set the Min P at
the current IPAP pressure.
2. During AVAPS startup, there may be a period of time
before the target tidal volume is achieved. If the target V T
is not achieved at the current Min P setting, increase the
Min P until the target V T is reached. Remember, the V T
displayed on the V60 is a 6-breath average, so the effect
of a settings change may not be fully reflected for several
breaths.
3. Once the target V T is reached, reduce Min P slightly to
allow the AVAPS algorithm to adjust.
4. If target V T is not achieved due to a low Max P setting,
an informational message will appear. Adjust Max P
accordingly unless the maximum pressure for the patient
has been reached.
5. If target V T is exceeded because Min P is set too high, an
informational message will appear. Adjust Min P accordingly
unless the minimum pressure for the patient has been
reached.
6. Set the high and Low V T alarms appropriately.
7. In AVAPS, the EPAP setting must be at least 1 cmH2O
below the Min P setting. In some cases, an increase in
the Min P setting is required before increasing the EPAP
setting.

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15
New modes and options
Patient transport
Tips to maximize E-cylinder oxygen tank duration
• Make sure all cylinders are full (2000 psig or more).
• We recommend that you do not use any oxygen delivery
devices that will limit flow such as Grab ‘N Go ® cylinder/
regulators (flow is limited to 100 l/min). The pressure will be
maintained, but the oxygen concentration will be reduced
and low oxygen pressure alarm will annunciate.
• Make sure the cylinder regulators are turned off while the
V60 is connected to wall oxygen.
• Never turn the cylinder regulator on until you are ready to
transport the patient.
• Turn on only one cylinder regulator at a time. If you turn on
both cylinders, they may become depleted simultaneously,
leaving you with no backup oxygen.
• Whenever possible, reduce FIO2 prior to transport. The
higher the FIO2 setting, the greater the oxygen consumption.
This is particularly important during transport in high leak
situations such as NIV.
• Minimize all inadvertent leaks. Tighten masks prior to
transport, and loosen up when patient is back on wall
oxygen.
• Avoid using masks that have an exhalation port built into the
mask when there is already an exhalation port in the circuit.

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16
 Below are graphs representing oxygen tank duration at
various leak values. These are estimates only based on 2000
psig. Time may vary depending on the V60 settings and the
patient’s changing ventilatory demand.

VT 500; RR 40; IPAP 18; EPAP 6

90
80
Duration in (minutes)

70
60
50
40
30
20
10

0
30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
FI02 (%)
Leak 10 Leak 20 Leak 30 Leak 40 Leak 50

VT 500; RR 20; IPAP 18; EPAP 6

140
Duration in (minutes)

120
100
80
60
40
20
0 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
FI02 (%)
Leak 10 Leak 20 Leak 30 Leak 40 Leak 50

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17
Philips Healthcare is part of
Royal Philips Electronics

How to reach us
www.philips.com/healthcare
healthcare@philips.com
fax: +31 40 27 64 887

Asia
+852 2821 5888

Europe, Middle East, Africa

+49 7031 463 2254

Latin America
+55 11 2125 0744

North America
+1 425 487 7000
800 285 5585 (toll free, US only)

Grab ‘N Go is a registered trademark of Praxair

Technology, Inc. AVAPS, C-Flex, Contour Deluxe,
Image3, PerformaTrak, PerforMax, Respironics, and
Respironics Total are trademarks of Respironics, Inc.
and its affiliates.

© 2010 Koninklijke Philips Electronics N.V.

All rights are reserved.
Philips Healthcare reserves the right to make changes in
specifications and/or to discontinue any product at any time
without notice or obligation and will not be liable for any
consequences resulting from the use of this publication.

Printed in the U.S.A. 4522 962 64441 * JULY 2010

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