| MONNAL T75

YL072800 - Revision 9A - 2021-06 - EN

User Manual YL072800

English
Software version V3.6.x

www.device.airliquidehealthcare.com
V3.6.xI9A
 Contents
Before use...............................................................................................7
Definitions of user warnings..............................................................................................................7
Intended use...................................................................................................................................... 7
Brief description of the device.......................................................................................................... 7
Requisite knowledge.......................................................................................................................... 8
Training..................................................................................................................................................8
Symbols and markings on the device............................................................................................. 10
General safety instructions..............................................................................................................11
Description of the device.......................................................................15
Terminology used............................................................................................................................ 15
Front panel....................................................................................................................................... 15
Right-hand side................................................................................................................................ 16
Left-hand side.................................................................................................................................. 16
Rear panel........................................................................................................................................ 17
Installation and commissioning............................................................. 19
Unpacking.........................................................................................................................................19
Connections and commissioning.................................................................................................... 19
Power supply...................................................................................................................................... 19
Oxygen supply.................................................................................................................................... 19
Assembly of patient circuit and accessories.................................................................................. 19
CO2 Measurement Probe.................................................................................................................. 20
Humidifier............................................................................................................................................20
Nebulization........................................................................................................................................ 21
Applying power...................................................................................................................................22
Automatic tests.................................................................................................................................. 22
Transport on the rolling stand.......................................................................................................... 23
Use........................................................................................................ 26
Screen description........................................................................................................................... 27
Stand-by mode................................................................................................................................... 27
Ventilation mode................................................................................................................................ 28
Start/stop ventilation....................................................................................................................... 28
Shutting down the unit.................................................................................................................... 29
New patient / Category selection.................................................................................................... 29
Ventilator configuration................................................................................................................... 30
Language.............................................................................................................................................30
Date and time..................................................................................................................................... 30
Transfer............................................................................................................................................... 31
Brightness........................................................................................................................................... 31
Audible alarm......................................................................................................................................31
 Ventilation modes............................................................................................................................ 32
Mode selection................................................................................................................................... 32
Ventilation set-points......................................................................................................................... 32
Description of ventilation modes.....................................................................................................33
VCV (Volume-Controlled Ventilation)................................................................................................33
PCV (Pressure-Controlled Ventilation)..............................................................................................33
PCV (Pressure-Controlled Ventilation)..............................................................................................34
SIMV (Synchronized Intermittent Mandatory Ventilation)...............................................................35
PSIMV (Synchronized Intermittent Mandatory Pressure Monitored Ventilation).......................... 36
PSV NIV (Non Invasive ventilation).................................................................................................. 37
CPAP (Continuous Positive Airway Pressure)................................................................................. 38
Duo levels (Alternation of two CPAP levels)....................................................................................38
APRV (Airway Presure Release Ventilation).....................................................................................39
PRVC (Pressure-Regulated Volume Controlled).............................................................................. 39
PS – PRO (interlocked barometric mode, intended for use in resuscitation)................................ 40
Oxygen therapy................................................................................................................................ 41
CO2 Option.......................................................................................................................................43
Introduction.........................................................................................................................................43
Installing the CO2 software option...................................................................................................43
Display of pressure and flow rate curves........................................................................................ 43
Setting up the CO2 measurement probe......................................................................................... 44
Adjusting the CO2 unit...................................................................................................................... 45
Monitored CO2 parameters...............................................................................................................45
Activation or deactivation of CO2 monitoring................................................................................. 47
Calibrating the CO2 probe................................................................................................................. 48
Recommendations for the use of the MASIMO IRMA™ CO2 measurement probe....................... 48
Display of pressure and flow rate curves........................................................................................49
Monitoring........................................................................................................................................ 51
Display of measurements..................................................................................................................51
Alarm settings.................................................................................................................................... 54
Automatic thresholds.........................................................................................................................56
Resetting............................................................................................................................................. 56
Alarm history...................................................................................................................................... 56
Measurements.......................................................................................58
Expiratory plateau............................................................................................................................ 58
Inspiratory plateau........................................................................................................................... 58
[R&C stat] key.................................................................................................................................. 58
P0.1 measurement key.................................................................................................................... 60
NIF (negative inspiratory force)....................................................................................................... 60
Manual Cycle....................................................................................................................................61
Work of Breathing (WOB)................................................................................................................ 62
Menu..................................................................................................... 63
Description....................................................................................................................................... 63
Menu structure.................................................................................................................................64
Apnea ventilation adjustment........................................................................................................... 64
TC (Tube Compensation).................................................................................................................. 65
 O2 low pressure................................................................................................................................. 66
Sensors............................................................................................................................................... 67
Other functions................................................................................................................................ 67
Oxygenation function-suction............................................................................................................68
Screen lock key (lock)....................................................................................................................... 69
Inhibiting the spirometry sensor....................................................................................................... 69
Nebulization........................................................................................................................................ 70
Loop curves........................................................................................................................................ 72
Trends..................................................................................................................................................73
Administrator configuration...................................................................75
Access..............................................................................................................................................75
Presentation..................................................................................................................................... 75
Setting inspiratory time in VCV mode (60)......................................................................................76
Setting inspiratory time in PCV mode (61)......................................................................................76
Inspiratory time monitoring (62)......................................................................................................76
Monitoring etCO2 (63)..................................................................................................................... 76
Disabling the RRmini set-point (64).................................................................................................76
Altered O2 network (65).................................................................................................................. 76
Volume setting (66)......................................................................................................................... 77
Enabling Options (67)...................................................................................................................... 77
Saving the ventilation set-points (68)............................................................................................. 77
Pressure Support Setting (69)......................................................................................................... 78
Setting the ventilation set-points (70)............................................................................................. 78
Selecting ventilation modes (71).....................................................................................................78
Alarms...................................................................................................80
Parameters....................................................................................................................................... 80
Acknowledgement of alarms........................................................................................................... 81
Inhibition of alarms..........................................................................................................................81
List of alarms...................................................................................................................................81
Maintenance..........................................................................................92
Definitions........................................................................................................................................ 92
Routine maintenance....................................................................................................................... 92
Expiratory assembly: flow sensor + expiratory valve Monnal EVA.................................................. 93
Monnal Clean’in filter (Type filtre HEPA: High- Efficiency Particulate Air)...................................... 94
Air intake filter................................................................................................................................. 95
Bacteriological filter.........................................................................................................................95
Accessories........................................................................................... 96
Items included in the package........................................................................................................ 96
List of consumables........................................................................................................................ 96
List of accessories.......................................................................................................................... 97
List of available documents............................................................................................................ 98
Maintenance..........................................................................................99
 By the user.......................................................................................................................................99
Battery life check............................................................................................................................... 99
By the technician........................................................................................................................... 100
O2 cell............................................................................................................................................ 100
Technical description.......................................................................... 102
Operation........................................................................................................................................102
Pneumatic system........................................................................................................................... 102
Ventilation operation........................................................................................................................103
Air/O2 mixture.................................................................................................................................. 104
Special characteristics of nebulization.......................................................................................... 105
CO2 monitoring................................................................................................................................ 105
Electrical power sources................................................................................................................105
Power supply management............................................................................................................ 106
Mains supply.................................................................................................................................... 106
Internal battery................................................................................................................................. 106
External battery................................................................................................................................ 107
Inputs and outputs.........................................................................................................................107
Alarm transfer...................................................................................................................................107
RS232 link.........................................................................................................................................108
Connectivity to hospital networks.................................................................................................. 108
Video output..................................................................................................................................... 110
Performances and characteristics.................................................................................................110
Regulatory requirements................................................................................................................. 110
Recovery of the components of the medical device.....................................................................110
Technical characteristics.................................................................................................................111
Settings tables..................................................................................................................................126
Testing the alarms......................................................................................................................... 133
Bibliography........................................................................................ 134
Appendix............................................................................................. 135
Checklist.........................................................................................................................................135
Expiratory assembly cleaning protocol..........................................................................................136
 1 Before use

1 Before use

1.1 Definitions of user warnings

CAUTION: Warns the user of the risks associated with the use or misuse of the device:
• occurrence of a technical problem or device malfunction,
• slight or serious injury to the patient.
Note: Highlights a particular item of information.

1.2 Intended use

Monnal T75 is a standalone turbine ventilator used to treat infants (weighing at least 3 kg), children
and adults. It is used for patient ventilation to compensate for or mitigate respiratory failure. Contact
with the patient is made via an adequate patient interface (e.g., mask or endotracheal tube), which al-
lows air to flow from the ventilator into the lungs.
It is for use by hospital personnel (doctors, nurses, etc.):
• In the intensive care unit,
• In the post-operative recovery room,
• When transporting patients in the hospital area.
Medical electrical system
Monnal T75 is part of the medical electrical system along with the CO2 measuring probe (IRMA™) (Ref.
KB033600).
It can also be operated with various accessories, such as:
• a Monnal Clean’in HEPA filter,
• a nebulizer,
• a humidifier,
• oxygen from a supply network, cylinder, or concentrator,
• an alarm transfer system.
Monnal T75 is used to monitor two respiratory gases – oxygen (O2) and carbon dioxide (CO2) (applies
to product reference KB033600).

1.3 Brief description of the device

Monnal T75 can supply tidal volumes from 20 to 2000 mL in volume-controlled mode, and insufflation
pressures from 0 to 99 cmH2O in pressure-controlled mode.
It can also supply FiO2 adjustable from 21 to 100% under continuous monitoring.
It has the following ventilation modes:

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Monnal T75 user manual

VCV (controlled ventilation or assisted volume-controlled ventilation)

PCV (controlled ventilation or assisted pressure-controlled ventilation)
PSV (spontaneous ventilation with inspiratory assistance and PEEP)
SIMV (intermittent assisted controlled ventilation)
PSIMV (intermittent assisted pressure-controlled ventilation)
PSV NIV (non-invasive ventilation).
CPAP (continuous positive airway pressure)
Duo Levels (alternation between two levels of CPAP).
PRVC (Pressure-regulated volume controlled ventilation)
PS-Pro: interlocked barometric mode, intended for use in resuscitation
APRV: Airway Pressure Release Ventilation
The device is equipped with a 10.4-inch color touch screen, an ergonomic control wheel and a func-
tional interface for easy adjustment of the various settings and ventilation parameters.
The ventilator may be used with a mobile stand, making it more convenient to move around, and can
be placed on a wall tablet.
CAUTION: The user is responsible for ensuring that the use of accessories does not affect
the safety and the expected performance of the device.

Patient environment
Under normal use, the patient is in a hospital bed and the Monnal T75 equipment is placed nearby. All
parts of the medical electrical system are suitable for use in the patient environment.
User’s position
The equipment is positioned with the display facing towards the user allowing them to make the nec-
essary adjustments with the coder wheel and read the information displayed on the screen. The rec-
ommended distance depends on the environment, the ambient light and the user’s visual acuity. The
rear of the equipment remains, however, within the user’s reach.
Options
Monnal T75– reference KB033600 - comes with the option of purchasing CO2 monitoring.

1.4 Requisite knowledge

Persons intending to operate this ventilator must be trained in its use.
Only persons who have fully read and understood this manual are authorised to handle and use this
ventilator. The present manual is intended to give all information necessary for the correct utilisation
of this ventilator, but is in no way intended to replace the medical prescription that is essential for ad-
justing the apparatus according to patient needs.

1.4.1 Training

There are two main types of training:

8
 1 Before use

• training in the use of the ventilator,

• training in the routine maintenance of the ventilator.
Training in the use of the ventilator
Training in the use of the ventilator takes around thirty minutes. It is carried out during installation in
the hospital department by Air Liquide Medical Systems staff or by an authorized Air Liquide Medical
Systems distributor. This training includes:
• validation of the intended use and description of the ventilator,
• installation and commissioning,
• comprehensive presentation of the operating functions of the ventilator,
• practice on a test lung, adapted to the type of hospital service.
This training can be repeated or covered in more depth at the request of the users, by contacting the
usual Air Liquide Medical Systems representative.
Training in routine maintenance
Training in the routine maintenance of the ventilator takes around thirty minutes. It is carried out dur-
ing delivery to the biomedical department, or during installation in the hospital department by Air Liq-
uide Medical Systems staff or by an authorized Air Liquide Medical Systems distributor. It is intended
for biomedical teams and equipment supervisors in the department.
The training includes:
• consumables management
• daily recommended maintenance practices
• monitoring minor alarms

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Monnal T75 user manual

1.5 Symbols and markings on the device

Weight and rated output of prod- ON button
uct

Weight of Monnal T75 device Weight of the system (Monnal T75,

mobile stand, articulated arm, sock-
et base, external battery pack and pa-
tient circuit)

Manufacturer O2 High pressure oxygen inlet fitting

280 - 600 kPa
105 - 130 L / min

Do not push Low pressure oxygen inlet fitting

O2
0 - 150 kPa
0 - 85 L / min

Complies with European Direc- Patient circuit inspiratory fitting

tive 93/42/CEE Notified Body No.
0459.

Device catalog number Patient circuit expiratory fitting

Serial Number of the device IRMA™ CO2 probe connector

Date of manufacture: Nebulizer fitting

YYYY-MM

Caution: refer to the user manual. O2 cell cover locked

Protective earth (ground) O2 cell cover unlocked

Type B applied part Expiratory valve eject button

Alternating current Video output VGA

10
 1 Before use

IP3X Protection Index according to the This logo means that the equipment
EN 60529 standard must not be disposed of via ordinary
(if serial num- waste channels. It must receive ap-
ber below 3: protection from the penetration propriate end-of-life handling, in ac-
MT75-05000) of solid bodies of diameter ≥ 2.5 cordance with European Directive
mm. 2012/19/UE (WEEE).
IP31 1: protection against vertically This device was manufactured after
(for serial falling water drops the 13th of August 2005.
numbers from X: no particular protection from
MT75-05000) the penetration of liquids, but
compliant with EN 60601-1.

Electrical protection fuse COM 1 RS232 connectors

COM 2

Alarm transfer outlet External power supply connector

AC power supply indicator light

Specific symbols for IRMA™ CO2 measurement probe (ref. KB033600)

IP44 Protection Index according to the Type BF device

EN 60529 standard
4: protection from the penetration
of solid bodies of diameter ≥ 1
mm.
4: protection from water splash-
ing from any direction

1.6 General safety instructions

Oxygen use
Precautions in case of oxygen leak:
• No smoking
• Avoid any flame or source of sparks
• Disconnect the oxygen source
• Fully air the room throughout the duration of the leak and for at least 20 minutes afterwards.
• Air one’s own clothing.
• The device must not be in operation near any incandescent source.
The device must not be used with inflammable anaesthetic agents or explosive products.
Do not use the equipment with helium or helium mixed with another gas.

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Monnal T75 user manual

The ventilator does not directly administer nitric oxide but can be used concomitantly with a Nitric Ox-
ide administration system, provided that the manufacturer of the nitric oxide delivery system has vali-
dated its use.
Do not use the device with components contaminated by inflammable substances (e.g. grease, oil,
etc.).
The internal components of the device were degreased before delivery and use a type of grease which
is compatible with oxygen. Do not grease or lubricate any part of the device.
Medical quality oxygen, which is dust-free and dry, must be used (H2O < 20 mg/m3).
The supply pressure on the high pressure oxygen inlet must be between 280 kPa (2.8 bar) and 600 kPa
(6 bar).
The supply pressure on the low pressure oxygen inlet must be less than 150 kPa (1.5 bar).
Power supply
CAUTION: To avoid the risk of electric shock, this equipment must only be connected to a
grounded power outlet.

Check that the voltage in the mains socket used matches the electrical characteristics of the ventilator
(indicated on the rear panel of the power supply adaptor).
Electrical isolation is accomplished by disconnecting the equipment from the power outlet. According-
ly, do not place the equipment in a position that would make it difficult to use this disconnect device.
The ventilator has an internal battery. It must be plugged into the mains on a regular basis in order to
keep the internal battery sufficiently charged.
In the event of any doubt about the condition of the mains power supply cable, use the device on its in-
ternal battery.
Do not use antistatic or electrically conductive tubing.
The user must not touch the patient and the equipment enclosures at the same time.
Modifications to the EM system require an assessment of their compliance with the requirements of
standard IEC60601-1.
IP Protection
To ensure the IP protection level of the device is maintained during normal use, it is essential that the
power cable is plugged in and all removable components (air filter, expiratory assembly, O2 sensor
cover and the rear plastic panel) are fitted in place.
Electromagnetic compatibility
Monnal T75 complies with the EN 60601-1-2 standard on the electromagnetic compatibility of medical
devices.
This device requires specific precautions as regards EMC. It must be installed and put into operation
in accordance with the EMC information provided in this user manual.
The ventilator functioning can be impaired by the use of appliances in its immediate proximity, such as
diathermic devices, high frequency electro-surgery units, defibrillators, cell phones or, more generally,
by electromagnetic interference that exceeds the levels specified in the EN 60601-1-2 standard.
Monnal T75 should not be placed next to or on top of this equipment. If it is not possible to do other-
wise, Monnal T75 should be monitored to make sure that it operates correctly where placed.
Do not use this ventilator in a specifically magnetic environment (MRI, etc.).

12
 1 Before use

Replacing a cable or internal component that is not provided by Air Liquide Medical Systems, may lead
to a rise in emissions or a decrease in the immunity of the device.
Connection to other electrical devices
Do not connect the device to other electrical appliances not mentioned in this user manual without
first consulting the manufacturers or technical support.
Devices connected to the inputs and signal outputs must comply with the 60601-1 Standard, Edition 2.
Commissioning
The device must not be put into service immediately after storage or transportation where the temper-
ature and humidity were different from the recommended operating conditions.
Before each use, check that the audible and visual alarms are working correctly and carry out the
checking process in the appendix (see Checklist on page 135).
Use
The manufacturer has provided solutions for most of the possible malfunctions of the ventilator, and
these are normally covered by the internal monitoring system. It is nevertheless recommended, in case
of complete patient dependence to provide an additional and fully autonomous system which can be
used to check the effectiveness of ventilation, as well as a back-up device, such as a suitable manual
insufflator. Lack of an alternative means of ventilation may result in patient death should the ventilator
fail.
If the accessories used are not compliant with the manufacturer’s recommendations, the manufactur-
er accepts no responsibility in the event of an incident.
Do not expose the device to direct sunlight.
Do not use the Monnal T75 in a hyperbaric chamber. It is not reccommended to push the pulmonary
ventilator by its top when fitted on its trolley. To move, push using the handle (at the base of the venti-
lator)
The device and its accessories (masks, circuits, etc.) are Latex Free in order to avoid the risk of allergic
reactions.
The air inlets behind and under the device must be completely unobstructed.
To operate the device from ambient air, a Monnal Clean’In (HEPA) filter must be used at the ventilator
inlet. This filter is recommended by Air Liquide Medical Systems.
Do not use the ventilator in an explosive or nicotine-laden atmosphere (cigarette smoke, fire, etc.).
Risk of cross-contamination
Reusing single-use accessories or consumables carries the risk of patient cross-contamination. This
risk also arises if reusable accessories or consumables are not sterilized between each use.
The endotracheal tube, mask, patient circuit, expiratory valve, humidification chamber, and the probe
or nebulizer adapters are part of the air pathway that may be contaminated under normal and sin-
gle-fault conditions by body fluids, secretions or gases exhaled by the patient.

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Monnal T75 user manual

Maintenance
• The ventilator must be checked regularly. To schedule and record maintenance operations, refer to
the maintenance form in the appendix.
In accordance with IEC 60601-1 (Annex A, Subclause 7.9.2.6):
“The instructions for use can contain a statement saying that the Manufacturer, assembler, in-
staller or importer considers himself responsible for the effect on basic safety, reliability and per-
formance of the ME equipment or ME system only if:
• appropriately trained personnel carry out assembly operations, extensions, readjustments, modifi-
cations or repairs;
• the electrical installation of the relevant room complies with the appropriate requirements;
• the ME equipment or ME system is used in accordance with the instructions for use.»”
The qualified technician must use only Air Liquide Medical Systems spare parts when carrying out
routine maintenance on the device.
Do not use abrasive powders, alcohol, acetone or other easily flammable solvents.
The device must be disconnected from the mains during any procedure such as maintenance or
cleaning
Recommendations for the use of the CO2 measurement probe MASIMO IRMA™ (REF. KB033600)
See CO2 Option on page 43.

14
 2 Description of the device

2 Description of the device

2.1 Terminology used

The expiratory assembly corresponds to the expiratory flow sensor and the Monnal EVA expiratory
valve.
The Monnal EVA expiratory valve corresponds to the valve body, the membrane, and the silicone disc.

2.2 Front panel

1. Alarm indicator light

It turns red to inform the user that an ultra or high alarm has been activated.
2. Color touch screen (10.4 inches)
This is the user interface and it enables to adjust all the ventilation parameters.
3. Control wheel
This is used to adjust and validate the parameters
4. AC power supply indicator light
It illuminates when the device is connected to the mains.
5. CO2 measurement probe connection (only for KB033600)

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Monnal T75 user manual

6. Expiratory assembly and expiratory limb connection

7. Expiratory assembly eject button
8. Ambiant air intake
9. Pneumatic nebulizer supply connection
10. Inspiratory limb connection

2.3 Right-hand side

Oxygen Cell
11. O2 sensor access cover
Oxygen access closed :

11

12. O2 sensor position

Oxygen access closed :

12

2.4 Left-hand side

Expiratory assembly

16
 2 Description of the device

13

14

13. Expiratory assembly built into the device

14. Electrical connection with the hot wire flow sensor (expiratory assembly withdrawn)

2.5 Rear panel

15 16

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Monnal T75 user manual

15 RS232 connections 16 Video output connection

17 Low pressure oxygen inlet 18 Cooling wings

19 High pressure oxygen inlet 20 Access to internal battery

21 AC power supply connector 22 AC power supply connector

23 Alarm transfer connector 24 On/Off button

25 Patient air intake filter 26 Monnal Clean’ in filter

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 3 Installation and commissioning

3 Installation and commissioning

3.1 Unpacking
Take the ventilator out of the packaging and place it on a table.
Unwrap the accessories supplied with the ventilator (see Items included in the package on page
96).
CAUTION: The ventilator weighs approximately 16 kg:
• Apply safe lifting procedures when installing it.
• For installation on a horizontal support, ensure that the horizontal support can bear the
weight of the unit. Check that the assembly is stable.

3.2 Connections and commissioning

3.2.1 Power supply

This ventilator may be used with various sources of electrical power (see Electrical power sources on
page 105):
• AC power supply;
• Power supply connected to an external DC source (external battery);
• Power supply connected to an internal DC source (internal battery).
To turn on the ventilator, plug it into a grounded AC power outlet.
CAUTION: Always check that the electrical network is compatible with the specifications in
this manual.

Check that the device preventing the mains plug from being pulled out is operative.

3.2.2 Oxygen supply

To supply FiO2 above 21%, connect the low or high pressure inlet of the ventilator oxygen to an avail-
able source, via an appropriate connection.
If this oxygen source is a cylinder, it must be equipped with a pressure reducer to suit the allowable
pressure range (2.8 to 6 bar).
CAUTION: Start by connecting the O2 connection hose to the ventilator before connecting it
to the oxygen network. Check the capacity of the oxygen cylinder before using the ventilator
for intra-hospital transport.
CAUTION: To prevent the low pressure O2 fitting becoming detached, ensure the input pres-
sure applied to the low pressure oxygen inlet is less than 150 kPa (1.5 bar).

3.2.3 Assembly of patient circuit and accessories

Connect the patient circuit to the ventilator and the humidifier (if used):

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Monnal T75 user manual

27 28

•
Connect the expiratory limb of the patient circuit to the expiratory valve of the ventilator: (27).
•
Connect the inspiratory limb of the patient circuit to the inspiratory outlet cone of the ventilator:
(28).
CAUTION: Make sure to limit dead space while installing patient circuit and accessories.

Air Liquide Medical Systems recommends the use of a bacteriological filter at the inspiratory outlet
of the ventilator or, preferably, at the Y-piece. It is also recommended to use patient circuits equipped
with water traps when using a humidifier.

1 Y-piece 2 Double-limb patient circuit

CAUTION: Empty the water traps regularly during ventilation.

When using the equipment on a patient for the first time, make sure that you follow the hospital’s hy-
giene protocol for new single-use equipment or adequately sterilized reusable equipment. The acces-
sories and consumables (patient circuit, masks, expiratory valves, adapters, nebulizer, etc.) are gener-
ally available in single-use and autoclavable versions.
CAUTION: Reusing single-use accessories or consumables carries the risk of patient cross-
contamination.

3.2.4 CO2 Measurement Probe

See CO2 Option on page 43 (for ref. KB033600).

3.2.5 Humidifier

If the ventilator is used with a humidifier ensure that it is always placed lower than the ventilator and
the patient.
Empty the water traps regularly in order to limit condensation in the pipes.

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 3 Installation and commissioning

CAUTION: Ensure that water does not enter the unit during handling of the patient circuit
or the humidifier (if used). If this occurs, immediately stop using the device, and contact the
Technical Department.
CAUTION: Humidification may increase the resistance of the filters used in the patient cir-
cuit. The filters should be tested frequently to check for an increase in resistance or block-
age.

3.2.6 Nebulization

The ventilator operates with pneumatic nebulization. It supplies a reduction pressure of 1.2 bar.

The nebulization outlet is located at the front of the unit and identified by the following symbol:
To set up a nebulizer:
1 2

5 4

1. Install a connector (5) upstream from the Y-piece, in the inspiratory limb of the patient circuit
(1).
2. Connect the body of the nebulizer (3) to this connector (5).
3. Connect the nebulizer pipe (4) to the nebulizer output of the ventilator.
CAUTION: The nebulization output (front panel) and the low-pressure inlet (rear panel) are
similar. Beware of not confusing them.

CAUTION: Nebulization with the ventilator includes certain constraints which must be taken
into consideration:
• Do not conduct treatment sessions with inflammable agents,
• Y-piece respiratory filters can prevent medication from being effective: their use is there-
fore not recommended,
• The precision of the expired volume can be impaired: a protective filter can then be used
at the expiration end.

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Monnal T75 user manual

CAUTION: Nebulization may increase the resistance of the filters placed in the patient cir-
cuit. The filters should be checked frequently for an increase in resistance or blockage.

Refer to Nebulization on page 70 Nebulization for a more detailed description of the nebulization
function and to Accessories on page 96 for different types of nebulizers available.

3.2.7 Applying power

Turn on the unit using the switch button (green) at the back of the unit.

The buzzers sound and the alarm lights light up.

After the initialization tests (duration: < 10 s), the ventilator goes into Stand-by Mode.
Select the appropriate language (see Ventilator configuration on page 30) and carry out the check-
ing phase (see Checklist on page 135).
Note: Monnal T75 is equipped with an absolute pressure sensor to compensate the effects
of altitude. In case of an installation in a high altitude area, an alarm tells the user to start the
automatic tests; the atmospheric pressure is therefore measured and the device compensat-
ed.
CAUTION: Do not obstruct the openings under and behind the ventilator, as this may com-
promise patient safety.

3.2.8 Automatic tests

The [Automatic tests] button checks the integrity and correct operation of the unit’s internal compo-
nents. In particular, it calibrates certain sensors, including the expiratory flow sensor and the oxygen
cell. Without the automatic test, the precision of ventilation parameters and measurements cannot be
guaranteed.
Note: Air Liquide Medical Systems recommends to run the automatic test before each use of
the device on a patient.

To run the automatic tests, press the [Automatic tests] button.

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 3 Installation and commissioning

1. To confirm, press [Validate];

Note: Remember to seal off the Y-piece of the patient circuit.
Otherwise, press [Cancel].
2. To interrupt the test, press [Stop] and then [Finish].
3. To start the test again, press the [Restart] button, and then [Validate]. At the point where tests
have been completed, a window opens, indicating that the plug should be removed from the
patient circuit Y-piece, accompanied by an audible reminder every 2 minutes.
Note: If the user does not unblock the patient circuit after 20 minutes, the test is stopped.
Press [Re-start] to resume the last step of the automatic tests.

If the automatic tests fail with the message «Circuit resistance not evaluated»:
• check the consistency between the patient category selected and the patient circuit used,
• check that the patient circuit is properly connected to the device,
• check that the filters and other accessories used do not cause too high a resistance.
CAUTION: Make sure that the patient category selected corresponds to the patient circuit
and the accessories used (see New patient / Category selection on page 29).

For a full description of the automatic test, see Technical description on page 102.

3.2.9 Transport on the rolling stand

When moving Monnal T75 Monnal T75 on its stand, place both hands on the handle to push it safely:

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Monnal T75 user manual

Once Monnal T75 is in place, activate the 2 brakes on the wheels:

CAUTION: When the floor is sloping, you must place both foot brakes on the same side: ei-
ther on the side sloping upwards or on the side sloping downwards. Placing one foot brake
on side sloping upwards and one brake on the side sloping downwards may imbalance Mon-
nal T75.

24
3 Installation and commissioning

25
Monnal T75 user manual

4 Use
The ventilator is controlled mainly via the touch screen and the control wheel.
CAUTION: Do not use any object that might scratch the screen.

The device starts up in Standby mode.

In the display zone, the message is “Unit on stand-by”.
The stand-by mode allows the user:
• to select the ventilation mode,
• to configure set-points and alarm thresholds for the selected mode,
• to start ventilation (green),
• to choose a patient category,
• to start automatic tests,
• to shut down the device (red).
In the stand-by mode screen, the following information is displayed:
• the current software version,
• the ventilation time counter,
• the power-on time counter,
• the current time and date,
• the time and date of the latest automatic tests and their result.

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 4 Use

4.1 Screen description

4.1.1 Stand-by mode

34 35 36 37 38

33 39
40
41
32
42

43

45
44

32 Stand-by screen zone: 33 Symbol status of external battery / indica-

tion of mains connection /status internal
• [New Patient] key to select a pa- battery
tient category
• [Start ventilation] key
• [Shutdown] key
• [Automatic tests] key
• [Oxygen therapy] function key

34 Ventilation mode and access to 35 Patient category

mode change

36 Software alarm indicator 37 Audible alarm silence button

38 Alarm display zone 39 Screen lock key

40 Alarm history access key 41 Menu access key

42 Nebulization access key 43 Curves access key

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Monnal T75 user manual

44 Ventilation start key or ventila- 45 Indications:

tion pause key • serial number;

• software version / counters / time and
today’s date.

4.1.2 Ventilation mode

49

51

46

47

48

50

46 Measurement access key 47 xx% O2 key

48 Access to other monitored parameters 49 Monitored respiratory parameters and ac-

cess to alarm settings

50 Ventilation set-points 51 Pressure and flow rate curves

52 Access key to the rest of the set-points a

ventilation mode in progress

4.2 Start/stop ventilation

Note: Adjust the parameters before starting ventilation.

To restore the standard settings, press the [New Patient] key.

To start ventilation, press the [Start ventilation] key.

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 4 Use

To stop ventilation in progress, press button [43]. A pop-up window appears telling the user whether
to cancel or validate by pressing the control wheel. In case of validation the unit then goes directly to
stand-by mode.
Note: If the unit was suddenly shut off during ventilation (e.g. battery exhausted), it automati-
cally resumes ventilation with the last parameters saved when restarted.

4.3 Shutting down the unit

The [Shutdown] key is accessible from the stand-by screen, and is used to switch the unit off.
To switch the unit off, press the [Shutdown] key. To confirm, press the control wheel. To cancel, press
the [Cancel] key.

4.4 New patient / Category selection

Press the [New patient] button to reinitialize all of the ventilation and alarm settings.

The choice of a patient category enables the prescriber to adapt each of the following elements to the
condition of the patient:
• Initial values of ventilation parameters and alarms,
• Ventilation parameter and alarm adjustment ranges.
Each of these values or ranges is given in the appendix of this manual.
CAUTION: For the safety of the patient and to optimize ventilation performance, the catego-
ry selected must be appropriate for the patient being ventilated. The diameter of the tubing in
the patient circuit must also be appropriate:

Patient category VT range (mL) Internal diameter of tubes in patient cir-

cuit (mm)

Adult 100-2000 22 mm

Child 50-500 VT > 100mL: 22 or 15 mm

VT < 100 mL: 12 mm

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Monnal T75 user manual

Patient category VT range (mL) Internal diameter of tubes in patient cir-

cuit (mm)

Infant 20-75 12 mm

≥ 3kg

Note: The patient category can only be changed in Stand-by Mode.

Note: Administrator Configuration (see Administrator configuration on page 75) can be

used to configure the set-points.

4.5 Ventilator configuration

Users may access the configurations at any time by pressing the [Menu] and [Ventilator Configura-
tion] keys.

The following parameters can be accessed:

4.5.1 Language

Monnal T75 offers several languages.

To change the language, press the [Language] keys.
Press the key for the desired language, then press [Back] twice, and [Exit].

4.5.2 Date and time

To change the date or time:

• Click on the display key: use the control wheel to increment or decrement a value.
• Press the control wheel to validate the number and go on to the next parameter.

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 4 Use

Note: If the date selected does not exist (e.g. 30 February), it will be displayed in red on the
screen and will not be taken into account. The previous date will be restored.

4.5.3 Transfer

This function can be reached from the stand-by screen. It allows the maintenance technician to trans-
fer data from the unit to a PC.

4.5.4 Brightness

To change the contrast of the screen:

• Press the [Brightness] button. A new window is displayed.
Turn the control wheel to increase or decrease the contrast until optimum visibility is obtained.

4.5.5 Audible alarm

Monnal T75 provides 2 different audible alarms to the user:

The first alarm is standard. It cannot be modified by the user. It is selected by default.
The second alarm (Custom) can be customized with another tone and its volume can be modified.
Note: This adjustment must be performed by a technician: contact your representative if you
want the alarm volume to be modified.

The alarm volume adjustment is for the convenience of the doctor. The maximum distance and the
volume of the alarm must therefore be determined by the user according to the surroundings.
Access to the alarm list can only be made when the unit is in stand-by mode.
To choose an alarm:
• Press the [Alarm: …] button and turn the control wheel to select [Standard] or [Custom];
• Validate to confirm.
An audible display of the alarm is then performed so that the user is aware of the new setting.
Note: Whatever the operation done on the device (shutdown, software update…), every se-
lected alarm remains.

Note: It is possible to select standard or custom alarm melody in the Administrator Configu-
ration.

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Monnal T75 user manual

4.6 Ventilation modes

4.6.1 Mode selection

The ventilation mode is selected from the ventilation mode display button in the upper left-hand part of
the screen (1).
To select or change the ventilation mode, press the display button, select the desired ventilation mode
(2), and press [Validate].

4.6.2 Ventilation set-points

There are several series of set-points for each ventilation mode.

These ventilation set-points can be adjusted either in Stand-by mode, or in ventilation mode. They are
displayed on one or two pages using the arrow according to the selected ventilation mode.

To adjust a set-point, touch it to select, set the desired value by turning the control wheel, and validate
by pressing the control wheel.

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4.7 Description of ventilation modes

4.7.1 VCV (Volume-Controlled Ventilation)

[VCV = Volume-controlled Ventilation]

Principle
VCV mode is used to control the tidal volume delivered to the patient on inspiration and the frequency
of the respiratory cycles. During expiration, the ventilator regulates the pressure in order to maintain
the set PEEP level.
The respiratory frequency can be increased as soon as the ventilator detects that the patient is making
a respiratory effort.
Ventilation set-points

FiO2 inspired oxygen fraction

VT tidal volume (mL)

RR minimum respiratory frequency (c/min)

PEEP positive end of expiration pressure (cmH2O)

TI/Ttot ratio of inspiration time to total cycle time (%)

Tplat adjustment of inspiratory plateau time (% du TI)

I. Trig inspiratory trigger (L/min)

Flow form of flow rate insufflated to the patient: constant, decelerated

Sigh sigh periodicity (1 sigh every x cycles)

VTsigh enabling the sigh function if ≠OFF

sigh amplitude (unit x VT; e.g.: VT sigh = 1.5 VT)

Sigh Period sigh period (1 sigh every “sigh period” cycles)

Note: If the patient tries to inhale at a greater flow rate than the flow rate set point, the venti-
lator will deliver the desired flow rate to the patient but will switch to expiration when the vol-
ume has been delivered (TI will not be observed in this case). The “Patient demand greater
than peak flow rate setting” alarm will then be triggered. In this case, it is advisable to in-
crease the peak flow rate (or reduce the inspiration time) and/or increase the VT setting.
Note: In VCV, there is no apnea ventilation (or “backup ventilation”).
Safety is guaranteed by the lower limit on the frequency and tidal volume according to each
patient category.

4.7.2 PCV (Pressure-Controlled Ventilation)

Principle
PCV mode is used to control the pressure delivered to the patient, the inspiration time, and the fre-
quency of the respiratory cycles. During expiration, the ventilator regulates the pressure in order to
maintain the set PEEP level.

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Monnal T75 user manual

The respiratory frequency can be increased as soon as the ventilator detects that the patient is making
a respiratory effort.

Table 1: Ventilation set-points

FiO2 inspired oxygen fraction

PI tidal volume (mL)

RR minimum respiratory frequency (c/min)

PEEP positive end of expiration pressure (cmH2O)

TI/Ttot ratio of inspiration time to total cycle time (%)

I.Trig inspiratory trigger (L/min or cmH2O)

Slope Pressure support pressure rise slope (cmH2O/s)

PIsigh enabling the sigh function if ≠OFF

pressure supplied during a sigh (unit x PI; e.g.: PI sigh = 1.4 PI)

Sigh sigh periodicity (1 sigh every x cycles)

Sigh Pe- sigh period (1 sigh every “sigh period” cycles)

riod

Note:
The value of PI corresponds to the pressure added to the current PEEP value.The PEEP value
is incorporated in the PI.
In PCV mode, unlike VCV, the pressure delivered to the patient is controlled but the tidal and minute
volumes are not.

4.7.3 PCV (Pressure-Controlled Ventilation)

Principle
A constant positive pressure is maintained above PEEP level in the patient circuit each time the patient
makes an inspiratory effort.
The switch to the expiratory phase can be triggered:
• If the flow rate falls below the set expiratory threshold (E. Trig),
• By an expiratory effort from the patient,
• If the maximum set insufflation time is reached (TImax).
If there is no inspiratory effort, the machine provides the minimum set frequency.
Ventilation set-points

FiO2 inspired oxygen fraction

PS pressure support ventilation (cmH2O)

RR mini Minimum respiratory frequency (c/min) (if the function is enabled)

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 4 Use

PEEP positive end of expiration pressure (cmH2O)

TImax Maximum inspiration time of cycles (s)

I.Trig Inspiratory trigger (L/min or cmH2O)

Slope pressure support pressure rise slope (cmH2O/s)

E.Trig Expiratory trigger (% of peak inspiratory flow)

Note: Apnea ventilation can be activated. The apnea parameters should be suited to the con-
dition and requirements of the patient.
• Use of the “RR mini” parameter. In the absence of inspiratory demand for a time longer
than “1/RR mini”, the ventilator initiates a pressure support cycle. The RR low alarm can
be associated with this safety feature by setting it to a value above “RR mini”.
• Use of the “TImax” parameter. In the event of a leak in the circuit, the flow rate expirato-
ry trigger might not be activated. In this case, the limitation on inspiration time allows the
patient to enter the expiratory phase.

4.7.4 SIMV (Synchronized Intermittent Mandatory Ventilation)

Principle
SIMV mode combines mandatory assisted controlled ventilation and pressure supports spontaneous
patient ventilation between the controlled cycles.
Ventilation set-points

FiO2 inspired oxygen fraction

VT tidal volume (mL)

RR determines the frequency of the mandatory cycles (c/min)

SIMV

PEEP positive end of expiration pressure (cmH2O)

Tins determines the inspiration time of the mandatory cycles (c/min)

Tplat inspiratory plateau time of the mandatory cycles (%TI)

I. Trig inspiratory trigger (L/min or cmH2O)

Flow form of flow rate insufflated to the patient: constant or decelerated.

PS pressure support ventilation delivered during the spontaneous cycles (s)

TImax maximum inspiration time of spontaneous cycles (s)

Slope pressure support pressure rise slope (cmH2O/s)

E.Trig expiratory trigger (% of peak inspiratory flow)

Operation
In this ventilation mode, the “controlled” cycle (VCV) delivers a fixed volume at the set frequency
RRSIMV. A SIMV period arises from this frequency.
E.g. for a SIMV frequency set to 10 cycles per minute, the SIMV period between two “controlled” (VCV)
cycles is 6 seconds.

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Monnal T75 user manual

In the event of absence of patient respiratory activity, this mode provides the guarantee of controlled
ventilation (VCV).
When the patient has regular and detectable respiratory activity, the unit responds by:
• supplying a “spontaneous” cycle (PSV) if the time elapsed since the last “controlled” cycle is less
than the SIMV period.
• supplying a “controlled” cycle (VCV) if the time elapsed since the last “controlled” cycle is greater
than the SIMV period. If patient respiratory activity declines again after a “spontaneous” cycle, the
unit waits for the SIMV period - set TiMax to expire before triggering a “controlled cycle” (VCV) it-
self.
Insufflation in a spontaneous cycle with pressure support ends:
• If the flow rate falls below the set expiratory threshold (E. Trig);
• If the patient makes an expiratory effort,
• or if the insufflation time reaches the maximum Ti setting (Timax).
Note: Apnea ventilation can be activated. The apnea parameters should be suited to the con-
dition and requirements of the patient.

4.7.5 PSIMV (Synchronized Intermittent Mandatory Pressure Monitored Ventilation)

Principle
PSIMV Mode combines mandatory assisted pressure-controlled ventilation and spontaneous patient
ventilation between the assisted controlled cycles.
Ventilation set-points

FiO2 inspired oxygen fraction

PI inspiratory pressure (cmH2O)

RR SIMV determines the frequency of the imposed cycles

(c/min)

PEEP positive end of expiration pressure (cmH2O)

Tins inspiration time of intermittent controlled assisted cycles (s)

I.Trig inspiratory trigger (L/min or cmH2O)

PS pressure support ventilation delivered during the spontaneous cycles (cmH2O)

TImax maximum inspiration time of spontaneous cycles (s)

Slope pressure support pressure rise slope (cmH2O/s)

E.Trig expiratory trigger (% of peak inspiratory flow).

Operation
In this ventilation mode, the “controlled” cycle (PCV) delivers a fixed pressure at the set frequency
RRSIMV. A SIMV period arises from this frequency.
E.g. for a SIMV frequency set to 10 cycles per minute, the SIMV period between two “controlled” (PCV)
cycles is 6 seconds.

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In the event of absence of patient respiratory activity, this mode provides the guarantee of controlled
ventilation (PCV).
When the patient has regular and detectable respiratory activity, the unit responds by:
• supplying a “spontaneous” cycle (PSV) if the time elapsed since the last “controlled” cycle is less
than the SIMV period,
• supplying a “controlled” cycle (PCV) if the time elapsed since the last “controlled” cycle is greater
than the SIMV period.
If patient respiratory activity declines again after a “spontaneous” cycle, the unit waits for the SIMV pe-
riod - set TiMax to expire before triggering a “controlled” cycle (PCV) itself.
Insufflation in a spontaneous cycle with pressure support ends:
• If the flow rate falls below the set expiratory threshold (E. Trig);
• If the patient makes an expiratory effort,
• or if the insufflation time reaches the maximum Ti setting (Timax).
Note: Apnea ventilation can be activated; the apnea parameters should be suited to the con-
dition and requirements of the patient.

4.7.6 PSV NIV (Non Invasive ventilation)

[NIV = Non Invasive ventilation]

Principle
NIV is started by pressing the PSV NIV key.
PSV NIV mode enables the prescriber to ventilate a patient via a non-airtight interface: facial or nasal
mask, NIV headset.
Likewise, the ventilation setting ranges and the alarm thresholds and ranges are suited to NIV.
• the PEEP setting is limited to 15 cmH2O,
• the PS setting is limited to 25 cmH2O,
• the E. Trig set-point is set at 50% by default,
• the high and low VTi alarms are disabled;
• the low MVe threshold is preset to 3 L/min (ADULT), 1.5 L/min (CHILD) and 1 L/min (INFANT).
Note: NIV generally involves more or less variable leakage, which the unit estimates. Esti-
mates are then input into the inspiratory demand detection algorithm to limit self-triggering. It
may be necessary, however, to increase the level of this inspiratory trigger slightly if self-trig-
gering occurs too often.
In the volume-controlled modes used in NIV, the insufflated volume does not take leaks into account.
The user must also take special care to monitor the NIV volumes. Especially the difference between
the VT insufflated by the ventilator (VTi) and the VT measured at the expiratory valve outlet (VTe) must
be monitored. The difference indicates the level of leakage.
CAUTION: Mask leaks are taken into account in the expiratory trigger mechanism.

Ventilation set-points

FiO2 inspired oxygen fraction

PS pressure support ventilation (cmH2O)

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Monnal T75 user manual

IP insufflation pressure (cmH2O)

RR mini minimum respiratory frequency (c/min)

PEEP positive end of expiration pressure (cmH2O)

I.Trig inspiratory trigger (L/min or cmH2O)

TImax maximum inspiration time of cycles (s)

Slope pressure support pressure rise slope (cmH2O/s)

E.Trig expiratory trigger (% of peak inspiratory flow)

4.7.7 CPAP (Continuous Positive Airway Pressure)

Principle
In CPAP mode, the ventilator regulates the pressure in the airways to the set CPAP value.
The patient breathes spontaneously through the device in this mode of operation.
Ventilation set-points

FiO2 Inspired oxygen fraction

CPAP Continuous positive airway pressure (cmH2O)

Note: Apnea ventilation can be activated; the apnea parameters should be suited to the con-
dition and requirements of the patient.

Note: Loops curves, inspiratory and expiratory plateau are deactivated in CPAP mode.

4.7.8 Duo levels (Alternation of two CPAP levels)

Principle
The Duo-Levels mode is characterized by controlled-pressure ventilation, combined with the patient
having the option of breathing spontaneously throughout the entire cycle.
Duo-Levels mode enables the prescriber to maintain a constant level of pressure (PI) for a period of
time T high, then a lower level of pressure (PEEP) for a period of time T low. The duration of the high-
pressure phase can be set, as can the minimum frequency. However, in order to enable the patient’s
spontaneous breathing to properly adapt with the ventilator, there are trigger windows for synchroniz-
ing the inspiratory and expiratory phases:
• from low pressure to high pressure, the trigger window is 60% of T low, 4 seconds maximum,
• from high pressure to low pressure, the trigger window is 30% of T high, 2 seconds maximum. If at
the end of T high, inspiration is underway, inspiration is extended for up to 1 second.
Note: The value of PI corresponds to the pressure added to the current PEEP value.The PEEP
value is incorporated in the PI.

Ventilation set-points

PI inspiratory pressure (cmH2O)

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PEEP positive end of expiration pressure (cmH2O)

RR mini minimum respiratory frequency (bpm)

T high high-level duration (s)

I. Trig. inspiratory trigger (L/min or cmH2O)

E. Trig. expiratory trigger (% of peak inspiratory flow)

Slope pressure support’s pressure rise slope (cmH2O/s)

4.7.9 APRV (Airway Presure Release Ventilation)

Principle
APRV mode is characterised by spontaneous ventilation, alternating between a constant high pressure
level and a short period at a lower pressure.
Ventilation set-points

FiO2 inspired oxygen fraction

P high high pressure (cmH2O)

P low low pressure (cmH2O)

T high duration at high level (s)

T low duration at low level (s)

Slope pressure support pressure rise slope (cmH2O/s)

Note: An absence of inspiratory demand during the apnea time (Tapnea) activates apnea
ventilation.

Note: The value of Phigh is absolute, meaning that the pressure on the high level will be
equal to Phigh, independent of the PEEP setting.

4.7.10 PRVC (Pressure-Regulated Volume Controlled)

[PRVC = Pressure-Regulated Volume Controlled]

Principle
PRVC mode is a pressure-regulated ventilation mode that guarantees the volume delivered to the pa-
tient. The ventilator automatically adapts the inspiratory pressure delivered so that the monitored Vti is
equal to the set Vt Target.
The adaptation interval of the PI is between 0.1 cmH2O and 3 cmH2O. It depends on the gap between
the Vt Target and the monitored Vti.
Note:
It is possible to activate or disable the set Vt Target:
• When the Vt Target is activated, the PI delivered to the patient is between the PEEP + 5
cmH2O and the PI max.
• The set PI then indicates Auto.

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Monnal T75 user manual

• When the Vt Target is OFF, the delivered PI is the set PI. The mode is then equivalent to
PCV mode.
• If the Vt Target is disabled during ventilation, the set pressure takes the current regulation
value.
The PI value corresponds to the pressure added to the current PEEP value. The pressure applied to the
patient is then equal to PI + PEEP.
Whatever the circumstances, the delivered PI should never exceed the PI Max.
CAUTION: The “Vt target and regulated pressure incompatibility!!!” alarm is activated when:
• Monitored volume < 90% of the Vt Target and delivered PI = PI Max;
• Monitored volume > 110% of the Vt Target and delivered PI = PEEP + 5 cmH2O.
Furthermore if the Ppeak, Vti Max or patient disconnection alarm is set off, the adaptation of
the PI is inhibited until the alarm stops.
Ventilation set-points

FiO2 inspired oxygen fraction (%)

Vt Target volume target (mL);

RR minimum respiratory frequency (c/min);

PEEP positive end of expiration pressure (cmH2O);

TI/Ttot ratio of inspiration time to total cycle time (%);

PI inspiratory pressure (cmH2O);

PI max maximum inspiratory pressure (cmH2O);

I.Trig inspiratory trigger (L/min or cmH2O);

Slope inspiratory pressure slope (cmH2O/s);

CAUTION: The Vt Target should not be used in NIV. If there is a leak, the tidal volume moni-
tored by the ventilator no longer represents the tidal volume inhaled by the patient. Any adap-
tation of the pressure is therefore inappropriate.

4.7.11 PS – PRO (interlocked barometric mode, intended for use in resuscitation)

Principle
The PS Pro mode is a PSV type pressure-regulated ventilation whose assistance frequency evolves au-
tomatically between two set frequencies: RR min and RR support (minimum frequency and maintained
frequency).
The aim of automatic adaptation of the frequency is to let the patient breathe autonomously when his
or her respiratory reflexes are active and allow the ventilator to take over when his or reflexes are inac-
tive.
Furthermore, the PS Pro mode can be combined with the Vt Target function. The inspiratory assis-
tance pressure is then adapted, cycle to cycle, so that the monitored Vt may converge towards the set
Vt Target.
If the patient spontaneously triggers above RR mini, each patient effort will be assisted. The set fre-
quency will then be the frequency of the patient.

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 4 Use

If the patient frequency reduces to the RR mini safety threshold, the ventilator will start the fixed cycles
to gradually reach the maintenance frequency, thus leaving the patient the opportunity of triggering a
new spontaneous cycle.
In the case of insufficient or no inspiratory effort (the patient’s respiratory frequency is lower than the
set minimum frequency), the ventilator guarantees an assistance frequency equal to the set mainte-
nance frequency.
A maintenance frequency equivalent to that set in VAC or PAC mode should therefore be set.
At the start of ventilation, the assistance frequency is equal to the maintenance frequency.
The maximum insufflation time (Ti max) is automatically set at 40% of the total time of a cycle with an
assistance frequency not exceeding 3.5 seconds.
Note: For operation of the Vt Target function, refer to PRVC mode.

CAUTION: The set minimum frequency is a safety threshold below which the ventilator pro-
vides controlled ventilation based on the set patient frequency.
If the patient is disconnected, the frequency is no longer adapted until the patient is recon-
nected.
Safety features of the Vt target function are applied when the function is activated.
Ventilation set-points

FiO2 inspired oxygen fraction (%)

PS inspiratory assistance (cmH2O);

RR support maintenance frequency at which the patient is ventilated when he or she no longer
breathes spontaneously (c/min);

PEEP positive end of expiration pressure (cmH2O);

Vt Target target volume (mL);

I. Trig. inspiratory trigger (L/min or cmH2O);

RR mini minimum respiratory frequency (c/min);

PI max maximum inspiratory pressure (cmH2O);

Slope inspiratory pressure slope (cmH2O/s);

E. Trig. expiratory trigger (% of inspiratory peak flow).

CAUTION: The Vt Target function should not be used in NIV. If there is a leak, the tidal vol-
ume monitored by the ventilator no longer represents the tidal volume inhalted by the patient.
Any adaptation of the pressure is therefore inappropriate.

4.8 Oxygen therapy

The oxygen therapy function delivers a mixture of air/O2 to the patient at a given rate and FiO2. This
function is used for non-ventilation dependent patients and may be used before NIV. It has adjustable
flow rates which are able to cover the patient’s peak inspiratory flow and consequently control the
FiO2 delivered.

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Monnal T75 user manual

The oxygen therapy function is available for all categories of patients treated with Monnal T75 (adults,
children and infants) where they are connected to the high pressure O2 network (the function is dis-
abled in low pressure O2). It requires the use of a humidifier and nasal cannula (or tracheotomy tube)
specific to high throughput oxygen therapy.
Note: Please refer to the patient/machine interface manual.

Set-up
1. Install the humidifier on the Monnal T75 stand;
Note: Place the humidifier lower than the patient to prevent water flowing into the cir-
cuit.

2. Perform an automatic test with a dual branch circuit (see Automatic tests on page 22).
3. Disconnect the double-limb circuit and set up the required patient circuit on the inspiratory limb
of the ventilator (52) and on the humidifier.

52

4. Connect the patient/machine interface between the humidifier and the patient.
5. Check that the humidifier is in working order before switching it on.
6. Enable the Oxygen therapy function and set the desired flow rate.

Note: Humidify the flow generated by the device.

CAUTION: Oxygen therapy is not a ventilation mode and must be used under supervision.
The patient breathes in a fully autonomous manner, this is why:
• Apnea ventilation is not ensured in the event of a patient’s respiratory arrest.
• No alarm is set off if the patient circuit is disconnected.
CAUTION: Monitored FiO2 is the FiO2 delivered by the ventilator. If the patient’s inspiratory
flow is greater than the flow set-point or if the nasal cannula are not properly positioned, then
monitored FiO2 is potentially higher than that inhaled by the patient.

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Note: Ppeak threshold can be adjusted. Its default setting is 45 cmH2O.

4.9 CO2 Option

4.9.1 Introduction

CO2 monitoring on the Monnal T75 (only for KB033600) is a fee-based software option.
After purchasing this option, Air Liquide Medical Systems provides:
• the activation code for the option,
• the CO2 probe for measuring the concentration of exhaled carbon dioxide (in accordance with ISO
80601-2-55),
• the necessary adapters.
The CO2 measurement probe is mounted on an airway adapter. This adapter is connected to patient
flow as close as possible to the intubation tube.
The IRMA™ CO2 measurement probe generates an infrared signal and transmits it to the receiver on
the opposite side, across the airway adapter. The measurement principle is based on the energy that
the CO2 absorbs. The probe sends the CO2 concentration measurement to the Monnal T75.
The Monnal T75 then displays the CO2 monitoring information that is received, in the form of a moni-
toring tile, time curve, trends curve and loop curve.
This information provides clinical support and can be used to assess the integrity of the patient’s air-
ways, as well as to check that accurate intubation has been successful.

4.9.2 Installing the CO2 software option

CO2 monitoring requires installation of the software option with a code. If you would like this option,
contact your Air Liquide Medical Systems representative.
1. Go to the [Administrator configuration] menu.
2. Press the [Activate options] key.
3. Enter the code that your Air Liquide Medical Systems representative has provided.
4. Quit the [Administrator configuration] menu. The CO2 option is enabled.

4.9.3 Display of pressure and flow rate curves

The pressure and flow rate curves are displayed in real time by default. The volume and CO2 curves
may also be displayed (if the software option is present).
Note: Spontaneous patient activity is represented by the curves displayed on-screen chang-
ing color. When the respiratory cycle comes from a patient demand, the curves are green, but
a controlled cycle is displayed in yellow.
Changing curves
To change curves:
1. Press the curve to be replaced. A menu appears in the bar on the right-hand side of the screen.
2. Select the desired curve in the menu. The curve is displayed automatically.

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Monnal T75 user manual

3. Press the [Back] key to quit the change curve menu.

Adjustment of scales
To adjust the time scale, press the [s] key.
To adjust the pressure scale, press the ordinate axis of the pressure curve or the [cmH2O] key.
To adjust the flow rate scale, press the ordinate axis of the flow rate curve or the [L/min] key.
To adjust the volume scale, press the y-axis of the volume curve or the [mL] key.
To adjust the CO2 scale, press the y-axis of the CO2 curve, the [mmHg] key, the [kPa] key or the [%] key.

4.9.4 Setting up the CO2 measurement probe

1. Connect the IRMA™ probe to the etCO2 connection socket (1).

2. Apply power to the ventilator.

3. Connect the probe to its patient adapter (a). The probe is correctly connected to its adapter
when you hear it click into position.

4. The LED flashes and then goes green. This means that the IRMA™ probe is ready for use (b).
5. Connect the IRMA™ probe, equipped with its adapter, to the Y-piece on the patient circuit (c).
6. Connect the IRMA™ probe to the patient’s endotracheal tube (d).
7. Position the IRMA™ probe (e) (see photo opposite).
Note: The probe sends information and alarms to Monnal T75. The probe has an LED indicat-
ing the following statuses:

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 4 Use

LED status Description

Continuous green OK

Flashing green Calibration in progress

Continuous red Probe error

Flashing red Checking the adapter

Note: For more information, please refer to the IRMA™ user manual from MASIMO.

4.9.5 Adjusting the CO2 unit

Several measurement units can be configured for CO2 measurement:

1. Go to the [Administrator configuration] menu.

2. Press the [EtCO2 Monitoring] key.

3. Choose between mmHg, kPa and%.
4. Validate with the control wheel.
This configuration will be saved when you press the [Exit Administrator config.] key.

4.9.6 Monitored CO2 parameters

The following CO2 parameters result from the interpretation of the temporal or volumetric capnogra-
phy curve. The volumetric capnography curve is the loop curve that gives the values of the exhaled
CO2 as a function of the exhaled volume.

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CO2 at the end of expiration (PetCO2 or FetCO2)

The maximum CO2 value measured during expiration is considered as being the CO2 value at the end
of expiration. This value can be expressed as partial pressure (PetCO2 in mmHg or kPa), or as a frac-
tion of the CO2 concentration of the gas (FetCO2 as a%).
As there is the risk that the intubation tube may not be properly sited or that it could move; evaluating
CO2 at the end of expiration is a way to confirm that the intubation has been performed correctly.
Note: EtCO2 measurement should not be used as a substitute for blood gas analysis.

CO2 Minute volume (VMCO2)

The CO2 minute volume is the volume of CO2 produced by the patient in 1 minute.
The volume of CO2 produced by the patient is expressed as the difference between the volume of CO2
exhaled
during expiration, and the volume of CO2 inhaled during inspiration.
Measuring VMCO2 enables medical staff to evaluate the level of gaseous exchange in the lung. It also
indicates how the patient is responding to treatment.
Dead space (VDaw)
The physiological dead space is the part of the air volume inhaled by the patient that is not part of the
gaseous exchanges in the lung.
The physiological dead space is the sum of the anatomical dead space (airways) and the alveolar
dead space (in the lung).
The value of the VDaw dead space that Monnal T75 monitors is an estimation of the volume lost in the
airways (anatomical dead space). This value is interpreted from the volumetric capnography curve.
Ratio of dead space to tidal volume (VDaw/Vt)
The anatomical dead space is usually compared to tidal volume, to define the ratio of anatomical dead
space volume to tidal volume (VDaw/VT).
This ratio is a way to show the fraction of tidal volume that is not part of the gaseous exchanges in the
lung.

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 4 Use

Alveolar ventilation per minute (VMalv)

Standard monitoring of the ventilation per minute not only includes lung ventilation, but also the venti-
lation of the parts that are not part of the gaseous exchanges airways, alveoli that are not perfused ).
Alveolar ventilation per minute (VMalv) is a way to refine the information provided by the ventila-
tion per minute calculation (MVe). The VMalv estimates the volume of air that is actually involved in
gaseous exchanges in one minute.
For example, a patient with an anatomic dead space of 100 mL could achieve a minute volume of 8L/
min, with the two settings below:
• tidal volume of 100 mL, and a frequency of 80 c/min, or….
• tidal volume of 500 mL, and a frequency of 16 c/min.
However, the alveolar ventilation would be completely different:
• For 100 mL of anatomic dead space, 100 mL of tidal volume, and a frequency of 80 c/min, the
VMalv is 0 L/min. Thus the air in the patient’s lungs is not being replaced,
• For 100 mL of anatomic dead space, 500 mL of tidal volume, and a frequency of 16 c/min, the
VMalv is 6.4 L/min. Thus the air in the patient’s lungs is being replaced.
The alveolar ventilation in one minute is calculated as:
VMalv = ƒ * ( Vt - VDaw )
Where f is the respiratory frequency, Vt is the tidal volume, and VDaw is the anatomical dead space.
Not all of the alveolar volume is involved in gaseous exchanges because some alveoli are only partial-
ly perfused. The volume not involved in gas exchange is called the alveolar dead space. To evaluate it,
the blood gas must be measured. This is used to calculate the CO2 arterial partial pressure (PaCO2).
Alveolar plateau slope (CO2 slope)
The alveolar plateau slope is the slope of the «plateau» of the CO2 loop curve after the initial rise. It de-
scribes the appearance of the volumetric capnography, and can provides an indication of the quality of
the ventilation-to-perfusion ratio.
A sharp slope can be observed in obstructive pulmonary diseases for example (asthma, COPD).

4.9.7 Activation or deactivation of CO2 monitoring

To activate or deactivate CO2 monitoring:

1. Go to the [Menu]
2. Press the [Sensors] key
3. Then press the [CO2 Monitoring] key.
Activating this option allows you to measure and display CO2 related monitoring. If this option is deac-
tivated, the CO2 monitoring values are replaced by “--”.
Note: When CO2 monitoring is activated, a CO2 probe must be connected. If there is no
probe, an alarm is triggered.

When a CO2 probe is connected to the device, CO2 monitoring is automatically activated, and the CO2
curve is displayed on the screen.
Note: If the CO2 probe is connected and the user does not require monitoring, the user may
deactivate it.

When the CO2 probe is connected or activated, the [Calibration] key can be used to calibrate the probe.

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4.9.8 Calibrating the CO2 probe

The IRMA™ probe must be calibrated when a significant shift in measurement is observed, or when the
[Calibrate the IRMA probe] alarm is triggered.
After the probe is connected to the device, you must wait approximately ten seconds before calibrat-
ing it.
If calibration is not an available option, the key is grayed out and unavailable.
To calibrate the CO2 probe:
1. Go to the [Menu].
2. Press the [Sensors] key.
3. Press the [Calibration] key.
The probe must be calibrated when using a new airway adapter on the sensor.
This must be disconnected from the Y-piece of the patient circuit and the patient. Then click on the
[Calibration] key to start calibrating the probe. The probe’s green indicator blinks for approximately
5 seconds during calibration. When the calibration is finished, the message [Calibration OK] is dis-
played.
Care must be taken to avoid breathing into the adapter when the probe is being calibrated. For the cali-
bration to succeed, it is extremely important for ambient air (21% O2 and 0% CO2) to be in the adapter/
probe combination.
Note: If the calibration is not done correctly, the measurement values will be skewed.

4.9.9 Recommendations for the use of the MASIMO IRMA™ CO2 measurement probe

• The IRMA™ probe may only be used by qualified, authorized medical personnel.
• The mainstream IRMA™ multi-gas probe is intended to be connected to a patient circuit to monitor
the gases inhaled/exhaled by adult or pediatric patients in emergency or intensive care situations.
• The probe must not be the sole patient monitoring device. It must always be used with other de-
vices to monitor vital signs and/or in addition to medical advice given by a qualified person. The
IRMA™ probe must be used by qualified, authorized medical personnel only.
• The probe must not be in direct contact with the patient.
• The IRMA™ probe must not be used with flammable anesthetic agents.
• IRMA™ airway adapters are single-use, and must not be re-used from one patient to another. Used
adapters must be disposed of via the appropriate hospital waste disposal channels. Reusing sin-
gle-use adapters can lead to patient cross-contamination.
• Used adapters must be disposed of via the appropriate hospital waste disposal channels.
• Do not use adapters intended for adult patients or children on infant patients, because such
adapters add 6 mL of dead volume to the patient circuit.
• Do not use adapters intended for infant patients on adult patients, because such adapters add 6
mL of dead volume to the patient circuit.
• The IRMA™ probe can give poor-quality measurements in the presence of devices that emit elec-
tromagnetic interference exceeding the levels mentioned in Standard 60601-1-2. Ensure that it is
used in a suitable environment.
• Only Air Liquide Medical Systems adapters may be used with the IRMA™ probe.
CAUTION: Use only IRMA™ probes sold by Air Liquide Medical Systems: Cat. No.:
KB020400.

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 4 Use

• Do not connect the IRMA™ at the outlet of an elbow connector, in order to avoid an accumulation
of patient secretions in the adapter and the obstruction of XTP™ windows.

• When using the IRMA™ probe, place the adapter so that its XTP™ windows are vertical, to avoid an
accumulation of patient secretions on these windows:

• When using the IRMA™ probe, position the adapter so that moisture and secretions do not accu-
mulate inside it due to the effect of gravity. Replace the adapter if it has been rained on or if it is
damp.
• Do not use any aerosol medication with the IRMA™ probe, to avoid a deterioration of IR transmis-
sion through the windows of the adapter.
• If the calibration is not done properly, the measurement values will be skewed.
• Never sterilize the IRMA™ probe or immerse it in liquid.
• Do not pull on the cable of the IRMA™ probe.
• Do not use the IRMA™ probe at a temperature below 0°C or above 40°C.
• During use, ensure that the IRMA™ probe is connected to the ventilator before you connect it to the
patient.
• The probe can be cleaned using a cloth dipped in alcohol (maximum 70% ethanol or 70% iso-
propanol).
• Remove the adapter before cleaning the probe.
• The adapters are not autoclavable.
• The gas measurements supplied by the probe must be checked regularly using a reference instru-
ment. We recommend that this check be performed annually.

4.10 Display of pressure and flow rate curves

The pressure and flow rate curves are displayed in real time by default. The volume and CO2 curves
may also be displayed (if the software option is present).

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Note: Spontaneous patient activity is represented by the curves displayed on-screen chang-
ing color. When the respiratory cycle comes from a patient demand, the curves are green, but
a controlled cycle is displayed in yellow.
Changing curves
To change curves:
1. Press the curve to be replaced. A menu appears in the bar on the right-hand side of the screen
(1).
2. Select the desired curve in the menu. The curve is displayed automatically.
3. Press the [Back] key to quit the change curve menu.
Adjustment of scales
To adjust the time scale, press the [s] key (5).
To adjust the pressure scale, press the ordinate axis of the pressure curve or the [cmH2O] key (3).
To adjust the flow rate scale, press the ordinate axis of the flow rate curve or the [L/min] key (2).
To adjust the volume scale, press the y-axis of the volume curve or the [mL] key.
To adjust the CO2 scale, press the y-axis of the CO2 curve, the [mmHg] key, the [kPa] key or the [%] key.
Freezing the curves
Pressing the [Freeze] key immediately freezes the curves (4).
Two cursors (vertical lines) are then available in order to measure and display the values of each
curve. The cursor currently selected appears in green.
Use the control wheel to select, modify or move the cursor.
The symbol Δ indicates the pressure, flow rate, volume, CO2, and time interval between the two cur-
sors.
To exit from frozen curve mode, press the [Back] key.
Note: The digital display of patient parameters continues to be refreshed on-screen whilst
the frozen are being displayed.

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4.11 Monitoring
Eight respiratory parameters (1) are continuously displayed on the screen.

Each measurement is displayed in a block containing:

53 Name 54 Unit of measurement

55 Current value 56 Upper alarm threshold

57 Lower alarm threshold

4.11.1 Display of measurements

The display of measurements varies according to the chosen ventilation mode.

The respiratory parameters are displayed over 2 or 3 pages. If the CO2 software option is present, an
additional page specifically for CO2 monitoring is displayed.

Press on the arrow to access the different pages.

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AVCV, APCV, SIMV, PSIMV, AVCV, APCV, SIMV, PSIMV, PSV NIV, CPAP and Duo-
PRVC Modes PRVC Modes Levels Modes

Page 1 Ppeak MVe Ppeak MVe Ppeak MVe

TI/Ttot* VTe TI/Ttot* VTe %leak VTe
Pplat RR RR spont RR RR spont RR
PEEP FiO2 or et- PEEP FiO2 or et- PEEP FiO2 or et-
CO2** CO2** CO2**

Page 2 %leak MVe spont %leak MVe spont RR/VTe MVe spont
Pmean VTi Pmean VTi Ti/Ttot* VTi
RR spont % spont Pplat %spont Pmean %spont
peakl
peakl peakE peakE leak maxE

Page 3 Rdyn Cdyn Rdyn Cdyn etCO2 VMCO2

WOB RR spont WOB RR spont VMalv MVe
P0.1 NIF P0.1 NIF Vdaw/Vt Vdaw
RR/VTe Auto-PEEP RR/VTe Auto-PEEP CO2 slope FiO2

Page 4 etCO2 VMCO2 etCO2 VMCO2

VMalv MVe VMalv MVe
Vdaw/Vt Vdaw Vdaw/Vt Vdaw
CO2 slope FiO2 CO2 slope FiO2

* TI/Ttot or I:E ratio according to monitoring configuration selected.

** If the CO2 monitoring option is present.
*** Static values displayed during an RC stat measurement. Dynamic values otherwise.

Measurements Definition IV NIV

Ppeak Inspiratory peak pressure of the cycle

Inspiratory peak pressure of the Volume insufflated during the cycle (invasive
cycle ventilation)

%leak Leak rate (non-invasive ventilation) (i-e)/i

PEEP Positive end-of-expiration pressure

Auto-PEEP Intrinsic PEEP

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Measurements Definition IV NIV

VTe Tidal volume exhaled

Pplat Pressure measured at the end of a plateau or in-

spiratory pause

MVe Expiratory volume per minute

Spont MVe Spontaneous expiratory volume per minute

RR Respiratory frequency

Spont RR Spontaneous respiratory frequency

Spont% Percentage of spontaneous respiratory cycles

FiO2 Insufflated oxygen fraction

TI/Ttot Ratio of inspiration time to total cycle time

I:E Ratio of inspiratory time to expiratory time

Peak insufflated flow

peak insp

Peak exhaled flow

peak exp

f/VTe Ratio of frequency to exhaled tidal volume

Pmean Average cycle pressure

P0.1 Obstruction pressure

Rstat Calculated static resistance

Cstat Calculated static compliance

Rdyn Calculated dynamic resistance

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Measurements Definition IV NIV

Cdyn Calculated dynamic compliance

WOB Respiratory effort (inspiratory)

NIF Negative inspiratory force

Leak rate during expiration

leak

CO2 monitoring if this option is present

etCO2 Fraction of CO2 at the end of expiration

VMCO2 CO2 minute volume

VMalv Alveolar minute volume

VDaw/VT Ratio of airway dead space to tidal volume

Vdaw Airway dead space

SlopeCO2 Slope of the volumetric capnogram on the alveo-

lar plateau

The value of Pplat is updated:

• After an inspiratory pause;
• In the event of an inspiratory plateau lasting longer than 0.3 s (in VCV and SIMV).

When the inspiratory plateau is not activated, the Pplat measurement is displayed as follows:
The static and dynamic resistance and compliance values are displayed in the same monitoring pan-
els and in the context of invasive ventilation only.
• When the RC stat function (see [R&C stat] key on page 58) is disabled, the dynamic resistance
and compliance values are displayed;
• When an RC stat measurement has been taken, the static values are displayed for a certain time
before the dynamic values reappear.

4.11.2 Alarm settings

The alarm thresholds can be adjusted directly via the screen.

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58

59

• To set a threshold:
• Select the value to be adjusted: it is highlighted.
Adjust the desired value by turning the control wheel, and press the control wheel to validate.
When an alarm threshold has been exceeded, the block and the associated alarm threshold turn red
(58). This display is maintained as long as the alarm is present.
When the alarm disappears, the block resumes its original appearance, but the threshold concerned re-
mains red (59): this indicates that the alarm took place.
CAUTION: After a new patient selection, the alarm thresholds are automatically reset to their
standard value.

These threshold settings must be systematically re-assessed in order to ensure that they suit the pa-
tient and his ventilation.
The upper pressure threshold is especially important to protect the patient from excessive airway
pressure.
The setting of alarm thresholds to the extreme values in the adjustment ranges can render the alarm
system ineffective.
The alarm thresholds can also be adjusted automatically according to the values measured. Refer to
the next section.

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Note: During a total power outage (AC power, external and internal batteries) the alarm
threshold settings are retained in memory and may be displayed after the electrical power is
restored. The settings are saved by a backup battery with a life of approx. 2 years. An alarm
is issued when the battery life becomes too short. The battery must be replaced. A power
outage of more than 2 years will cause the settings to be lost. At the next startup, the alarm
thresholds will be automatically restored to their default values.
MVe low threshold settings
In PSV NIV mode, the user has the option of setting the lower threshold of the expiratory minute vol-
ume (MVe) in the OFF position.
This setting is used to inhibit the alarms associated with the low expiratory minute volume (MVe) par-
ticularly in the event of non-invasive ventilation with major leaks.

4.11.3 Automatic thresholds

The [Auto set] button automatically configures the alarm thresholds according to the values measured
at the time when it is pressed.

To adjust the automatic thresholds, press on a monitoring pad and the [Auto. threshold] button will ap-
pear on the right of the screen
Press the [Auto setting of alarm thresholds?] button, then confirm by pressing the dial: all the alarm
thresholds will update automatically.
CAUTION: After pressing the [Auto. Set] button, verify that the thresholds obtained in this
way are appropriate for the clinical condition of the patient.

Note: The [Auto set] key is deactivated when the screen is locked.

4.11.4 Resetting

As soon as an alarm threshold has been exceeded, it is highlighted in red, and remains highlighted
even when the alarm disappears.
To reset all the thresholds highlighted in red, press the [Reset] button.

4.11.5 Alarm history

The alarm history shows the latest alarm-related events recorded by the ventilator.

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The [History] key opens a window which displays a chronological list of the last 200 alarms.
For each alarm there is a date, priority (color), time, activation or deactivation (ON or OFF), name, and
for physiological alarms, the alarm threshold setting at the time of activation.
Use the control wheel to browse the list.
To exit the alarm history, press the control wheel.
Note: When a complete power cut occurs (mains, external and internal batteries), the histo-
ry is preserved and can be displayed after the power supply has been restored. These data
are preserved thanks to a back-up battery with a working life of approximately two years. An
alarm is triggered when this battery runs low. The battery should then be replaced.
Note: When the log reaches its maximum size, the oldest events will be overwritten by in-
coming events.

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5 Measurements

5.1 Expiratory plateau

The [Exp. Plat] key is used to create an expiratory pause (limited to 60 seconds). The pause continues
as long as the user holds down the button. As soon as the user stops pressing the button, the ventila-
tor resumes normal ventilation.

Note: A curve freeze can be applied in order to measure the autoPEEP value via the cursors
(See Display of pressure and flow rate curves on page 49).

5.2 Inspiratory plateau

The [Insp.Plat] button is used to create an inspiratory pause (limited to 40 seconds). The pause contin-
ues as long as the user holds down the button. As soon as the user stops pressing the button, the ven-
tilator resumes normal ventilation.
Note: A curve freeze can be applied in order to measure the Pplat pressure value via the cur-
sors (See CO2 Option on page 43).

5.3 [R&C stat] key

Calculated patient resistance and compliance values consist of selectively or periodically evaluating
resistance (in cmH2O/L/s) of the patient’s airways, along with their pulmonary compliance (in mL/
cmH2O). Changes in these measurements over time may provide information about the patient’s con-
dition (lessening of compliance, beneficial effect of a bronchodilator, etc.)
The result is shown on the monitoring pad and in the trends, and in a window which is displayed at the
end of the selective measurement.

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 5 Measurements

Note: This window also displays the Pplat and Auto-PEEP results.

To start the static resistance and static compliance measurement:

• Press the [Measures] key;
• A new window opens with the [R&C stat] and [P0.1] functions.
The static R&C measurement can be performed automatically when required (--) or according to the
following frequencies (min): 1, 2, 3, 4, 5, 10, 20, and 30.
1. Press on the ‘R&C stat’ set-point on the bottom row,
2. Select the required value with the control wheel and press on the control wheel to validate.
To enable the function, press on the [R&C stat] key. The indicator light comes on and the measurement
begins. The following is displayed in the alarm banner: ‘R and C stat measurement enabled’.
Note:
Pressing on the [R&C stat] button again disables the function.

Measurement principle
The ventilator generates:
• end-expiratory occlusion;
• inspiration (consistent with the current mode), delivering a Vt;
• end-inspiratory occlusion.
Note: Inspiration between the two occlusions can be shortened to ensure that the flow rate
at end of inspiration is not zero. The measurement is interrupted in the event of Ppeak.

The Rstat and Cstat values result from the following calculations:
• Cstat = VT / (Pplat – total PEEP);
• Rstat = (Ppeak – Pplat) / end of inspiration flow rate.
Measurement accuracy is ± 20%.
Note: This function is only available in VCV, PCV and PRVC. In these modes, the patient is
sufficiently passive for the end-inspiratory and end-expiratory occlusion pressures to be sta-
ble.

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Note: The set periodicity remains in the memory when the function is disabled.

5.4 P0.1 measurement key

P0.1 measurement can be useful to determine whether extubation will be successful. The procedure
begins with detection of an inspiratory demand by creating end-expiratory occlusion and by measuring
the drop in pressure after 0.1 seconds. The inspiratory cycle then continues normally.
The measurement result is shown on the monitoring pad and in the trends, and in a window which is
displayed at the end of the selective measurement.

To begin occlusion pressure measurement:

• Press the [Measures] button;
• A new window opens with the [R&C stat] and [P0.1]’ functions.
The occlusion pressure measurement can be performed automatically when required (--) or according
to the following frequencies (min): 1, 2, 3, 4, 5, 10, 20, and 30.
1. Press on the [P0.1] set-point on the bottom line;
2. Select the required value with the control wheel and press on the control wheel to validate.
To enable the function, press on the [P0.1] button. The indicator light comes on and the measurement
begins. The following is displayed in the alarm banner: ‘P0.1 measurement enabled’.
Note: Pressing on the [P0.1] button again disables the function.

Note: P0.1 measurement is accessible in all modes in invasive ventilation except CPAP and
Duo-Levels. It is not available in non-invasive ventilation, where the risk of leakage does not
guarantee a reliable measurement.
Note: The set periodicity remains in the memory when the function is disabled.

5.5 NIF (negative inspiratory force)

The NIF measurement can be useful in determining the possibility of a successful extubation.

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 5 Measurements

During the NIF operation, the patient circuit is blocked, and the low pressure generated by the patient
with respect to PEEP is measured. NIF is the patient’s maximum inspiratory effort. When the pressure
drop is less than -30 cmH2O, the probability of a successful extubation is higher.

The measurement result is written in the monitoring panel and in the trends, as well as a window
present during measurement.
The pressure curve is displayed on the upper part and the scale is changed so that it displays the neg-
ative pressures.
To activate the function, press the [Measurements] key and then press and hold the [NIF] key.
The LED lights up, and measurement begins, indicating the following message in the alarm panel: ‘NIF
measurement in progress’.
Note: As long as the key is pressed, the procedure takes place, the circuit is blocked, and the
pressure drop generated by the patient is measured.

When the key is released, ventilation is resumed.

Note: The maximum measurement duration is 30 s.

Note: NIF measurement is accessible in all ventilation modes except CPAP, Duo-Levels and
APRV. It is not available in non-invasive ventilation, where the risk of leaks does not guarantee
reliable measurement.
Note: The procedure may be interrupted by the raising of alarms such as Ppeak.

5.6 Manual Cycle

When the patient is in expiratory phase, an inspiratory cycle can be triggered manually (manual cycle).
To activate this function, press the [Measurements] key and then select [Cycle.M] when the patient is
in expiratory phase. The LED lights up and an inspiratory cycle is automatically launched, indicating the
following message in the alarm panel: ‘Manual cycle in progress’.
Note: If the [Cycle.M] key is still pressed at the end of the inspiratory cycle, an inspiratory
plateau is then automatically applied.

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Monnal T75 user manual

Note: The manual cycle is not available in CPAP or APRV.

5.7 Work of Breathing (WOB)

The WOB is the quantity of energy required to carry out ventilation.
Monnal T75 can calculate the work contributed by the patient to overcome the resistance of the circuit
and the intubation probe and obtain a sufficient flow rate generated by the machine after the trigger is
started. The value displayed on the monitoring unit equates to the Work Of Breathing Imposed (WOBi).
Note: Monitoring is not available for modes CPAP, Duo-Levels, APRV and PSV VNI.

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6 Menu

6.1 Description
The [Menu] key is on the right-hand side of the screen. It gives access to functions or commands via a
two-level structure.
The menu is accessible via the start-up, stand-by, and ventilation screens.

The menu items give access to:

• the oxygenation/aspiration function,
• apnea ventilation adjustment,
• tube Compensation settings,
• machine configuration
• sensor settings.
Press the [Exit] key to return to the previous screen.

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6.2 Menu structure

1st level 2nd level

O2 setting O2 boost: xx%

Oxygenation period: - before aspiration

- after aspiration

Apnea ventilation VT
settings

RR

T apnea

TC Compensation level

Tube type: - Endotracheal

- Tracheostomy

Ventilator config- Language

uration
Battery test

Date/hour

Transfer

Brightness

Alarm

Low pressure O2 Low pressure O2: ON/OFF

Sensors CO2 monitoring

Calibration

6.2.1 Apnea ventilation adjustment

Apnea ventilation uses an assisted volume-controlled mode with a frequency and tidal volume to be
adjusted. It keeps the PEEP and inspiratory trigger set in the current mode, Ti/Ttot of 33% and a de-
creasing flow rate form.

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Apnea ventilation is triggered when no inspiration has been triggered for a time greater than T apnea.
It stops when:
• The patient triggers more than three consecutive cycles,
• The user presses the apnea ventilation Off key,
• The user changes ventilation modes.
The ventilation of apnoea may be deactivated in CPAP mode by setting the apnoea T set-point to OFF.
In such a case, an alarm sounds to confirm deactivation and should be acknowledged.
CAUTION: For safety reasons, the ventilation of apnoea should only be deactivated where
the clinical situation allows. Air Liquide Medical Systems recommends that apnoea ventila-
tion is activated.
Note: Ideally, the apnea ventilation adjustment should be performed before starting ventila-
tion.

To access the apnea ventilation adjustments, press the [Menu] key and then [Apnea ventilation set-
tings].

6.2.2 TC (Tube Compensation)

[Patient circuit compensation]

In invasive ventilation, the tube compensation function is used to estimate tube end pressure (at the
tip of the tube) by making up for pressure loss in the intubation tube (tube resistance according to
flow rate). By therefore applying the pressure level, set not at the pressure measured in the Y piece but
at bottom pressure, the patient’s physiological needs will be met.
When the function is enabled, two pressure curves are displayed: Y piece pressure (unbroken line) and
bottom pressure (dotted line).
Note: The TC function is only available for the following pressure modes: PCV, PSV, SIMV,
and for spontaneous PSIMV, PRVC and PS-Pro cycles. Compensation only applies during the
inspiratory phase. The function remains enabled when users change modes during ventila-
tion, but becomes disabled when the device returns to Standby mode.
To enable the function, press the [Menu] button then the [TC] key.
Three parameters are available:
• Compensation level;
• Tube type;
• Tube diameter.

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Monnal T75 user manual

Compensation level
Compensation level varies from ‘none’ to 100%. If compensation level is 100%, loss of tube pressure
will be fully compensated. Inversely, ‘none’ means that no compensation takes place and that the
Compensation Tube function is not enabled.
As an example, 50% compensation means that only half of loss of tube pressure will be compensated.
CAUTION: If a compensation level is set, an information message indicating that the func-
tion is enabled is displayed in the alarm banner: «intubation tube compensation enabled».

Tube type
There are 2 types: endotracheal or tracheostomy.
Tube diameter
Internal tube diameter varies from 2.5 mm to 11 mm. According to the patient category selected
(adult, child, infant), suitable minimum and maximum setting limits are available.
CAUTION: Users must check that the type but also the internal diameter of the tube match
that attached to the patient.

CAUTION: Compensation is limited to 10 cmH2O.

CAUTION: For tubes of a diameter smaller than 3 mm, compensation is deliberately un-
der-estimated to avoid barotrauma. Bottom pressure is actually lower than the value dis-
played.
CAUTION: Ensure there are no leaks in order to prevent barotrauma.

6.2.3 O2 low pressure

This function allows the device to enrich the O2 mix from a low-pressure source (typically, a concen-
trator).
This is different from a high-pressure source connection since it works on a lower scale (pressure gen-
erally less than 1 bar, flow rate less than 10 L/min):
• Depending on the nature of the source and the ventilation settings, certain FiO2 values cannot be
guaranteed. A chart is provided for information purposes in Technical description on page 102).
• The mechanisms for monitoring the presence/absence of the source must be adapted.
To activate the “Low Pressure” function, press [Menu], then [Ventilator configuration], then [Low Pres-
sure O2] then set the position to “ON”. The “Low Pressure FiO2” descriptive label then appears on the
alarm panel.

66
 6 Menu

The enrichment of the O2 mix then takes place according to the FiO2 parameter, and the device then
delivers, as far as possible, the desired concentration. If the ventilation and low-pressure source set-
tings are incompatible, the FiO2 will not be reached and the “low FiO2” alarm will be generated. The
user will then be informed that these settings need to be modified.
CAUTION: To have efficient operation on a low O2 pressure source, the high pressure O2
connection hose must be disconnected from the device.

To prevent the low pressure O2 fitting becoming detached, ensure the pressure applied to the low
pressure oxygen inlet is less than 150 kPa (1.5 bar).

6.2.4 Sensors

CO2 monitoring
The [CO2Monitoring] key activates and deactivates CO2 monitoring.
See CO2 Option on page 43 for more information.
Calibration
The [CO2 sensor calibration] key calibrates the CO2 probe.
See CO2 Option on page 43 for more information.

6.3 Other functions

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Monnal T75 user manual

6.3.1 Oxygenation function-suction

The [xx% O2 ↗] key is used to ensure the patient has oxygenation, at a FiO2 greater than the current
FiO2. It also makes it possible to inhibit the alarms and ventilation in order to carry out pulmonary aspi-
ration.
Note: If the oxygenation FiO2 is lower than the current FiO2 (see Settings), the button is dis-
abled.

During suction, the PEEP level is maintained to the extent possible, depending on the size of the leak,
in order to limit alveolar derecruitment.
Note: Suction may be carried out according to different methods (fully unplugging the circuit,
opening a connection from the respiratory circuit, or “closed system”).

Low-leak methods will be preferred in order to limit alveolar derecruitment.

The Oxygenation-Suction function is organized into three steps:
1- Oxygenation
Once you press the [xx% O2↗] key, the FiO2 that is delivered increases to the value set for oxygena-
tion.
A countdown indicates the time remaining for oxygenation.
If the patient circuit is disconnected or opened to carry out pulmonary aspiration during this oxygena-
tion step (#1), the Suction step (#2) is activated.
Otherwise, the oxygenation turns off and the
[xx% O2 ↗] key turns off.
Note: It is possible to shut down the function at any time by pressing the [xx% O2 ↗] key.

2- Suction
During this step, the ventilator no longer generates ventilation-related alarms.
Additionally, ventilation is interrupted, thereby preventing the secretions contained in this circuit from
spreading. PEEP, however, is maintained, which is improved since the circuit’s leak is minimal.
Once aspiration is complete and the patient circuit has been reconnected, the ventilator automatically
detects the reconnection and activates the end-of-suction oxygenation phase.

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 6 Menu

Note: The suction time is limited to 40 seconds. Afterward, the end-of-aspiration oxygenation
phase (N°3) is automatically started.

Note: The user can also restart the ordinary ventilation by pressing the [Validate] button in
the dialogue box.

3- End-of-suction oxygenation
This step is used to re-oxygenate the patient after his or her disconnection during pulmonary suction.
A countdown indicates the time remaining for oxygenation.
At the end of this countdown, oxygenation shuts down and the [xx% O2 ↗] key turns off.
Note: It is possible to shut down the function at any time by pressing the [xx% O2 ↗] key.

Note: Throughout the entire oxygenation-aspiration function, nebulization is suspended. It

automatically resumes at the end of the function.

Settings
The different oxygenation settings can be adjusted via a window of the [O2 ↗ Settings] [Menu].
This menu is used to set:
• Target O2: FiO2 applied to the whole oxygenation-suction period.
• Duration of oxygenation before suction (step 1 “Oxygenation”)
• Duration of oxygenation after suction (step 3 “End-of-aspiration oxygenation”)
For more information, refer to Checklist on page 135.

6.3.2 Screen lock key (lock)

Press this button to lock the screen.

To unlock the screen, press this key again, and then validate using the control wheel.

6.3.3 Inhibiting the spirometry sensor

Whenever alarm #57 “Expiratory flow measurement inoperative” triggers, it appears as a high
priority (red color code).

The user has the ability to inhibit this alarm:

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Monnal T75 user manual

1. Touch the alarm banner. The “Choice of sensors” area appears on the right of the screen,
2. Disable the expiratory flow sensor by pressing the [Expi. Flow].
The active alarm disappears, then an informative message comes up: “Expiratory flow measure-
ment inactive, use an external monitor”.
This message stays displayed.
3. Press the [Back] button to return to the previous screen.

6.3.4 Nebulization

The ventilator can be used with a pneumatic nebulizer. It supplies a constant outlet pressure of 1.2 bar
(see Nebulization on page 21). The nebulization flow rate then depends on the choice of the nebulizer.
Because the only high-pressure source available in the ventilator is the high-pressure O2 inlet, nebu-
lization is possible only with the machine connected to the network (or a cylinder). The flow from the
nebulizer is then oxygen: FiO2 can therefore vary in the event of nebulization.
CAUTION: The accuracy of the Monnal T75 may be degraded by gases added during the use
of the nebulizer.

In order to limit these FiO2 variations and keep the ventilation parameters (such as tidal volume) con-
stant, the ventilator applies systematic compensation of the nebulization flow rate by reducing its own
outlet flow rate by an equivalent amount (and by prioritizing the reduction of its oxygen flow rate).
The FiO2 reading is displayed on screen; the value shown represents the concentration in the Y-piece
(i.e., it includes the nebulization flow).
Note: The display of the FiO2 value is an estimation of the gas concentration and cannot
substitute external monitor precision.

There are several mechanisms to alert the user to any changes in ventilation:
Oxygen concentration not observed
When the estimated FiO2 measurement in the Y-piece is more than 30% greater than the concentration
setting on the ventilator, an acknowledgeable HIGH alarm is triggered: “High FiO2!!! Nebuliza-
tion stopped”.
Nebulization is then shut off.
Nebulization flow greater than the machine output flow rate.
When the flow rate from the nebulizer is greater than the output flow rate of the machine, nebulization
is automatically shut off. This occurs, for example, in pressure-controlled cycles where the end-of-in-
spiration flow rate can be zero.
If nebulization is shut off for more than half the inspiratory cycle, an acknowledgeable MEDIUM alarm
is triggered: “Nebulization ineffective!!”.
Nebulization continues in spite of this.
CAUTION: Nebulization is deactivated for the pediatric use of the device.

To start a nebulization session:

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 6 Menu

• Press the [Nebulization] key displayed in the right-hand panel.

• The following settings should be adjusted in the nebulization screen:
• Activation or deactivation of nebulization (ON/OFF),
• Nebulization flow rate (L/min),
• Duration of the nebulization session (in minutes),
• Periodicity (frequency) of the sessions (in hours).
Activation/Deactivation
To activate nebulization, press the [Nebulization] key.
Turn the control wheel: the button says [ON].
Press the control wheel to validate.
To stop or disable nebulization, press the [Nebulization] key.
Turn the control wheel: the button says [OFF].
Press the control wheel to validate.
Flow rate
This parameter is used to define the nebulizer flow rate so that the ventilator can compensate for it.
There are various possible ways to define this flow rate: automatic adjustment or manual adjustment.
Automatic adjustment
This is the preferred mode.
When the automatic test is launched, the user is asked to integrate the nebulizer in the inspiratory limb
(see Nebulization on page 21) and to connect the device to the oxygen network (or cylinder).
The flow rate from the nebulizer can then be measured, and the flow rate parameter can be adjusted
automatically in the settings screen.
This flow rate will be taken into account for the next nebulization session so that it can be compensat-
ed.
Note: If the automatic test is running in the absence of a nebulizer (or if the device is not
connected to the oxygen network), a warning is triggered to inform the user. If a nebulization
session is subsequently requested, an acknowledgeable LOW alarm is triggered: “Did you
start the automatic tests with the Nebulizer?”.
If the user does not wish to interrupt ventilation, the nebulization flow rate can then be adjusted manu-
ally.

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Monnal T75 user manual

Manual adjustment
The device supplies a nebulization pressure of 1.2 bar. The user must refer to the nebulizer instruc-
tions to find out the correct nebulization flow rate for this pressure, and then adjust it accordingly on
screen.
Nebulization time
This defines the duration of the nebulization session.
Periodicity
This defines the frequency of the nebulization sessions.
Press the [Periodicity] button to set the frequency of nebulization (hours).
If necessary, you can activate just one nebulization session which will not be repeated periodically. To
do this, set the PERIODICITY parameter to “NONE”.
To go back to the previous screen, press [Back].

6.3.5 Loop curves

The following types of loop curves can be displayed:

• Volume / Pressure;
• Flow rate / Pressure;
• Volume / Flow rate;
• CO2 / Volume (if the CO software option is present).
To access the loop curves:
1. Press the [Curves] key in the right-hand bar
2. Press the [Loops] key.
To access these various types of loop curve, touch the curves zone until the desired curve is displayed.
To adjust the volume, pressure, flow rate, or CO2 scale, press the appropriate key (V mL, P cmH2O, D
L/min, CO2 mmHg, CO2% or CO2 kPa) until the desired scale is displayed.
To freeze the loop curve, press the [Freeze] key.

When the loop curve is frozen, two cursors appear and allow the value of the curve to be measured at
the point defined by the cursor.
To select the cursor, press the control wheel.

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 6 Menu

Turn the control wheel to move the cursor.

The values measured on each curve are displayed under the frozen curve.
The symbol Δ indicates the volume, pressure, flow rate, or CO2 interval between the two cursors.
To exit from frozen curve mode, press [Back].

6.3.6 Trends

This function allows the user to monitor the development of the following ventilation settings over a
maximum 80 hours:

RR VTi Vte MVe

Pplat Ppeak Pmean PEEP

Ti/Ttot %Leak Auto-PEEP spont. MVe

spont. RR spont.% peak ins peak exp

P0.1 Rstat Cstat Rdyn

Cdyn NIF WOB leak

I:E FiO2 etCO2

To access the trends:

• press the [Curves] key in the right-hand bar.
• press the [Trends] key.
This screen can display two trend curves.

2
To change the top trend and display another parameter, press the current parameter button (top-left of
the graph) and choose the desired parameter.
To change the top trend and display another parameter, press the current parameter button (top-left of
the graph) and choose the desired parameter.

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Monnal T75 user manual

The trend curves can be displayed every 2, 5, 10, 20 or 40 hours. To modify the time scales, use the
zoom + or - buttons (1).
To scroll the trends curves from left to right, use the arrows (2).
The user can display the precise values at a given moment (date and time) of the selected ventilation
parameters using the vertical line.
The user can thus move the line along the trends curve and read off the values of the two previously
defined parameters.

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 7 Administrator configuration

7 Administrator configuration

7.1 Access
The [Administrator config.] menu is accessible from the Stand-by mode. It is only accessible to autho-
rized persons.
After a special access procedure by authorized persons, press the [Administrator config.] button in the
right-hand bar to display the [Administrator config.] screen.

To close the [Administrator config.] menu, press the [Exit Administrator config.] button.

60 68
61
62

63

64 69
65

66 70
67

7.2 Presentation
The [Administrator config] menu enables the prescriber to customize the configuration of default ven-
tilation parameters (set-points, alarms, etc.)
The new parameters are applied whenever a new patient is selected.

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Monnal T75 user manual

Note: The defined parameters will be specific to each category (adult/child/infant).

7.3 Setting inspiratory time in VCV mode (60)

Several types of settings can be configured for inspiratory time.
• Setting the TI/Ttot ratio
• Setting the I:E ratio
• Setting the peak inspiratory flow
• Setting the Ti.
Configurations are saved when you press the [Exit Administrator config.] key.

7.4 Setting inspiratory time in PCV mode (61)

Several types of settings can be configured for inspiratory time:
• Setting the TI/Ttot
• Setting the I:E ratio
• Setting the Ti.
Configurations are saved when you press the [Exit Administrator config.] key.

7.5 Inspiratory time monitoring (62)

Several types of measures are available to measure inspiratory time:
• I:E ratio measurement;
• TI/Ttot ratio measurement.

7.6 Monitoring etCO2 (63)

See CO2 Option on page 43.

7.7 Disabling the RRmini set-point (64)

It is possible to deactivate the RRmini set-point for the following modes: PSV, PSV NIV and Duo-levels.
Press RRmini set-point key and modify and validate with the control wheel.
Configurations are saved when you press the [Exit Administrator config.] Key.

7.8 Altered O2 network (65)

Users may choose to use Monnal T75 on a so-called ‘altered’ O2 network, where O2 concentration is
lower than 100%. E.g., a network supplied by oxygen generators.

76
 7 Administrator configuration

In order to enable optimum operation in these conditions, it must be indicated that Monnal T75 is con-
nected to such a network. Select the O2 network to do this:
• Go to the ‘Administrator configuration’ menu;
• Press the [O2 supply altered] button and select [Enabled];
• Quit the [Administrator configuration] menu.
Note: An information message on green background ‘Operating on altered network’ is dis-
played in the alarm display area when the device is in Standby mode.

Monnal T75 automatically measures the purity of the network, during the automatic test and adjusts
its algorithms accordingly.
Note: The automatic test must be launched before use on patients.

CAUTION: It must be ensured that the Monnal T75 mode of operation matches the actual
network oxygen concentration to prevent dysfunction (notably the appearance of technical
alarms)
Depending on oxygen concentration, the algorithms monitoring technical failures of the mixer may be
less sensitive.
Note: Depending on network concentration, certain set-points may not be available.

Note: The estimated FiO2 for nebulisation may be subject to error, up to the natural varia-
tions in network purity.

7.9 Volume setting (66)

It is possible to customize the alarm sound level.
Press the [Volume Setting] button, set the volume to between 0 and 100 using the control wheel, and
then validate.
Configurations are saved when you press the [Exit Administrator config.] button.
CAUTION: Adjusting the volume to a level below the ambient noise level may prevent med-
ical staff from hearing the alarms and render the alarm system ineffective.

7.10 Enabling Options (67)

See CO2 Option on page 43.

7.11 Saving the ventilation set-points (68)

The [Save current ventilation settings] key is used to save a ventilation mode with preferred settings
for each patient category. This ventilation mode with customized settings is applied by selecting [New
patient].

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Monnal T75 user manual

Note: The operation must be repeated for each patient category (adult/child/infant).

Note: The [Retrieve default settings] key is used to return to the factory configuration.

Note: See notes and procedure below.

7.12 Pressure Support Setting (69)

The function « Support Setting » allows the user to select the behavior of pressure setpoint depending
on how it is used. The default setting is PS.

7.13 Setting the ventilation set-points (70)

The [Save current ventilation settings] button is used to save a ventilation mode with preferred set-
tings for each patient category. This ventilation mode with customized settings is applied by selecting
[New patient].
CAUTION: Confusion may arise if different alarm settings are used on different devices with-
in the same zone, for example an intensive care unit or a heart surgery room.

Procedure for saving ventilation and alarm set point:

1. In standby mode, choose a category of patient (adult, child or infant);
2. Configure the chosen mode with the desired settings and alarm;
3. Go to the [Administrator Configuration] menu and press the save button(s);
4. Exit the [Administrator Configuration] menu;
5. Change the patient category and repeat the same operation.

7.14 Selecting ventilation modes (71)

The available ventilation modes are not always all used by all prescribers.
Therefore, the user has the option to define in advance, those modes that will be used most frequently.
To disable modes: press the desired mode, turn the control wheel and validate by pressing the control
wheel again.
Disabled and unused modes are no longer displayed.
Note: VCV mode is not accessible and cannot be disabled.

To reactivate the modes: press the desired mode, turn the control wheel and validate by pressing the
control wheel again.
The reactivated modes are then displayed on the screen.
Configurations are saved when you press the [Exit Modes selection] key.

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 7 Administrator configuration

To restore default configuration mode, press the [Retrieve default settings] key.

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Monnal T75 user manual

8 Alarms
Alarms are indicated by on-screen displays and the emission of audible sequences.
The header panel indicates the alarm status and level. Its color varies according to the importance:
red, yellow, cyan or green.
On the left of the alarm band is a software alarm indicator and an alarm silence button. The two but-
tons are displayed as follows:

Alarms Priority Software alarm indica- Inhibition key

tor

ULTRA High Red Red

HIGH High Red Red

MEDIUM Medium Yellow Yellow

LOW Low Cyan Cyan

INFO None Green None

Note: The software alarm signal flashes when an ULTRA, HIGH or MEDIUM alarm is raised.

The arrow means that there are several alarms at the same time.

8.1 Parameters
Alarms are ranked according to 3 priority levels, with different sounds and colors.

Alarms Background color Text color Sound

ULTRA Red White Intermittent

HIGH Red Black Intermittent

MEDIUM Yellow Black Intermittent

LOW Cyan Black Intermittent

INFO Green Black None

ULTRA alarms are high priority alarms referring to a device or power supply failure. HIGH alarms are
high priority alarms referring to a ventilation failure.
The INFO priority is displayed on a green background with the symbol .

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 8 Alarms

To indicated a technical error, the alarm also displays the symbol and a number so that the techni-
cal department can identify the exact source of the alarm.
If several alarms are triggered, a small arrow appears on the right-hand side of the panel, and only the
highest-priority alarm is visible. Press the panel to display the list of current alarms.
If multiple alarms are displayed in this list, the user can browse all alarms using the control wheel.
Note: The audible alarm is for a doctor working near the patient. The maximum distance
away and the volume of the alarm must therefore be determined by this person according to
the situation.

8.2 Acknowledgement of alarms

Certain alarms open a dialogue box. These are “acknowledgeable” alarms, which are specifically in-
tended to inform the user of a particular event.
A stand-by request or switching to internal battery are examples of acknowledgeable alarms. The user
must validate using the control wheel; the dialogue box then disappears.

8.3 Inhibition of alarms

Press to interrupt the audible signal for two minutes.

This greys out the inhibit button.

Press to cancel the alarm inhibition. The alarm message remains on the screen.
If this alarm is replaced by another audible alarm with a higher priority, the inhibit function is automati-
cally disabled and the new alarm begins to sound. The previous alarm is then automatically archived in
the history.

8.4 List of alarms

N° Alarm Priority Alarm activation Alarm onset delay Actions

0 Shut off ventilation? Placing on STAND- Immediate triggering Validate using the
HIGH
BY mode control wheel to stop
[acknowledgeable] ventilation

1 Ventilator shutdown? Unit Off request Immediate triggering Validate using con-
HIGH
trol wheel to switch
[acknowledgeable] off the unit

2 Expiratory limb might be obstructed!!! HIGH Electronic failure Triggered within 15

Check expiratory
or expiratory valve s (and 2 cycles with
limb membrane and
membrane is stuck high pressure)
accessories

Contact the techni-

cal department if the
problem persists

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Monnal T75 user manual

N° Alarm Priority Alarm activation Alarm onset delay Actions

3-7 Machine out of service!!! Use a back- Electronics failure Immediate triggering
HIGH Use a different unit
up ventilator
and contact the tech-
(ULTRA) nical department

Patient vented to at-

mosphere

8 HIGH Electronics failure Immediate triggering

Error detected!!! Use a different unit
and contact the tech-
Contact the tech. department nical department

Patient vented to at-

mosphere

9 Machine out of service!!! Use a back- Electronics failure Immediate triggering

HIGH Use a different unit
up ventilator
and contact the tech-
(ULTRA) nical department

Patient vented to at-

mosphere

10 Patient disconnection!!! HIGH The patient is dis- Triggered within 15 s Check the level of
connected leakage

11 High pressure!!! HIGH Pressure in pa- Triggered after 3

When the pressure
tient circuit > alarm consecutive ventila-
threshold is reached,
threshold tion cycles
the machine goes
into expiration mode.

Check the suitability

of alarm levels with
ventilation settings

12 Error detected!!! Contact the tech. HIGH Electronics failure Immediate triggering Use a different unit
department and contact the tech-
nical department

HIGH Electronics failure Immediate triggering Use a different unit

13 Screen fault!!! Ventilation
and contact the tech-
- Effective nical department

14

15 HIGH Electronics failure Immediate triggering Use a different unit

Incorrect
and contact the tech-
Settings!!! nical department

16 Incorrect alarms settings!!! HIGH Electronics failure Immediate triggering Use a different unit
and contact the tech-
nical department

17 Low minute volume!!! HIGH Expired ventilation Immediate triggering

Check for leaks in
per minute MVe is
the patient circuit.
below the set alarm
threshold Check the suitability
of alarm levels with
ventilation settings

18 Low frequency!! MEDIUM Measured frequen- Immediate triggering Check the suitability
cy below the alarm of alarm levels with
threshold ventilation settings

Ventilation downgraded! Replace the HIGH Electronics failure Immediate triggering Use a different unit
19
machine ASAP. and contact the tech-
- nical department

20

82
 8 Alarms

N° Alarm Priority Alarm activation Alarm onset delay Actions

21 O2 supply pressure too low!!! HIGH Immediate triggering

O2 supply pressure Check remaining
supply in cylinder or
< 1.5 bar pressure in wall net-
work.

In case of opera-
tion on low pressure
source, check that
the high pressure O2
connection hose is
disconnected from
the device.

22 O2 supply pressure too high!!! HIGH O2 supply pressure Immediate triggering Check pressure in
> 7 bar wall network.

Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
23
switching ventilator and contact the tech-
- nical department

24

25 HIGH Measured PEEP is Triggered within 15 s Ventilation contin-

PEEP greater
5 cmH2O above the ues, but extended
than set PEEP PEEP setting expiration will occur
if the high pressure
+ 5 cmH2O!!! alarm is activated

26 High respiratory rate!! MEDIUM The frequency mea- Check the suitability
Triggered
sured by the ventila- of alarm levels with
tor is above the set after 5 s ventilation settings
threshold

Self-triggering of in- Lower the inpiratory

Triggered
spiratory trigger trigger sensitivity
after 5 s

27 High minute volume!! MEDIUM Immediate triggering Check the suitability

MVe > set
of alarm levels with
threshold ventilation settings

28 High FiO2!!! HIGH Measured FiO2 > set

Immediate
threshold
triggering

Inhibition for 2 min

after change of set-
point

Error detected!!! Contact the tech. HIGH Electronics failure Immediate triggering Use a different unit
29
department and contact the tech-
- nical department

30

31 Error detected!!! Contact the tech. HIGH Immediate triggering

Pneumatic - Check the position
department
of the expiratory
problem valve and its mem-
brane.
Electronics failure
- Verify that the
membrane is not
punctured.

- Replace the lip seal

(Chapter XI, Mainte-
nance)

Contact the technical

department.

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Monnal T75 user manual

N° Alarm Priority Alarm activation Alarm onset delay Actions

Error detected!!! Contact the tech. HIGH Electronics failure Immediate triggering Use a different unit
32
department and contact the tech-
- nical department

33

34 Low FiO2!!! HIGH Measured FiO2 < set

Immediate
threshold
triggering

Inhibition for 2 min

after change of set-
point

35 Internal battery inoperative!!! Connect The battery is empty. Immediate triggering Immediately connect
HIGH
AC power to mains power sup-
(ULTRA) ply.

36 Internal battery discharged!!! Connect Internal battery al- Immediate triggering Connect the unit to
HIGH
AC power most empty mains (battery will
[acknowledgeable] charge

37 Electronics failure Immediate triggering Check battery

Internal battery unavailable!!! HIGH

Check battery [acknowledgeable]

Power Fault, connect to external HIGH Electronics failure Immediate triggering Use a different unit
38
source!!! Ventilation Effective and contact the tech-
- nical department

39

40 Apnea ventilation!!! HIGH No respiratory activ- Switch to back-up

T apnea
ity for a time > T ap- ventilation, associat-
nea Immediate ed alarm

triggering

41 Delivered gases too hot!!! HIGH Temperature of gas- Immediate triggering

Check that the unit
es supplied to pa-
is being used accord-
tient is approaching
ing to specifications
41°C
If problem persists,
use a different unit
and contact the tech-
nical department

Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
42
switching ventilator and contact the tech-
- nical department

45

46 Patient circuit leak detected during HIGH Patient circuit con- Triggering on exit Change the patient
automatic tests!!! nection problem from the automatic circuit, connect pa-
test tient circuit compo-
nents carefully, and
repeat the automatic
test

47 High FiO2 too!!! Nebulization stopped Incompatibility be- Immediate triggering Readjust the set-
HIGH
tween settings and points
[acknowledgeable] the nebulization
function

48 Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
switching ventilator and contact the tech-
nical department

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 8 Alarms

N° Alarm Priority Alarm activation Alarm onset delay Actions

49 Restart the automatic tests!!! HIGH The atmospher- Triggering when the Start the automatic
ic pressure has ventilator is started test in order to cali-
changed of more brate to the new at-
than 50 mB since the mospheric pressure
last automatic test

Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
50
switching ventilator and contact the tech-
- nical department

52

53 FiO2 sensor inoperative!!! HIGH Bad O2 sensor con- Immediate triggering

Replace the O2 sen-
nection, defective O2
sor (see O2 cell on
sensor
page 100)

Check O2 sensor
connection

54 Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
switching ventilator and contact the tech-
nical department

55 Sounder failure !!! Ventilation Effec- HIGH Electronics failure Immediate triggering Use a different unit
tive and contact the tech-
nical department

56 Expiratory flow measurement inoper- HIGH Hot Wire Sensor bro- Immediate triggering Replace the expira-
ative!!! ken tion flow rate sensor

57 Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
switching ventilator and contact the tech-
nical department

58 Safety Ventilation!!! recommend HIGH Electronics failure Immediate triggering Use a different unit
switching ventilator and contact the tech-
nical department

59 Low VTe!! MEDIUM Exsufflated volume < Triggered after 6 Check the suitability
set threshold consecutive ventila- of alarm levels with
tion cycles ventilation settings

60 High VTe!! MEDIUM Exsufflated volume > Triggered after 6 Check the suitability
set threshold consecutive ventila- of alarm levels with
tion cycles ventilation settings

61 Screen fault!!! Ventilation Effective HIGH Electronics failure Immediate triggering Use a different unit
and contact the tech-
nical department

62 High plateau pressure!! MEDIUM Lung pressure > Triggering at an in- Check the suitability
alarm threshold spiratory plateau of alarm levels with
ventilation settings

63 Low VTi!! MEDIUM Insufflated volume < Triggered after 3 Check the suitability
set threshold consecutive ventila- of alarm levels with
tion cycles ventilation settings

65 High VTi!! MEDIUM Actual insufflated Triggered after 3

The machine goes
volume > VT setting consecutive ventila-
into expiration mode
tion cycles
when the threshold
is reached.

Check the suitability

of alarm levels with
ventilation settings

In pressure-control
mode, check leakage
level

85
Monnal T75 user manual

N° Alarm Priority Alarm activation Alarm onset delay Actions

66 Nebulization ineffective MEDIUM Setting is incompati- Immediate triggering

Check the nebuliza-
ble with nebulization
tion flow setting

Change the settings

Safety Ventilation!! recommend MEDIUM Electronics failure Immediate triggering Use a different unit
67
switching ventilator and contact the tech-
- nical department

69

70 Screen fault!! Ventilation Effective MEDIUM Electronics failure Immediate triggering Use a different unit
and contact the tech-
nical department

71 Internal battery nearly discharged!! Battery low Immediate triggering Ventilation can con-
MEDIUM
tinue but the unit
[acknowledgeable] could stop at any
time. Immediately
connect the unit to
the mains power
supply

72 Error detected!! Contact the tech. de- MEDIUM Electronics failure Triggering when the Use a different unit
partment ventilator is started and contact the tech-
nical department

73 High pressure! LOW Ppeak > threshold Immediate triggering

When the high pres-
sure threshold is
reached, the ma-
chine goes into expi-
ration mode.

Check the suitability

of alarm levels with
ventilation settings

74 O2 supply pressure low! LOW O2 supply pressure Immediate triggering

Check remaining
is too low
supply in cylinder or
pressure in wall net-
work.

In case of opera-
tion on low pressure
source, check that
the high pressure O2
connection hose is
disconnected from
the device.

75 Low VTi! LOW Insufflated volume < Immediate triggering Check the suitability
set threshold of alarm levels with
ventilation settings

76 Low respiratory rate! LOW The measured fre- Immediate triggering Check the suitability
quency is below the of alarm levels with
set threshold ventilation settings

77 VT not reached! Check settings LOW The blower is on Immediate triggering Check the set-points
maximum and the
volume reached is
30% below the vol-
ume setting

78 Patient demand higher than set peak LOW Settings are below Triggered after 5 Adjust ventilation
flow! patient capacity consecutive ventila- settings to suit the
tion cycles patient

86
 8 Alarms

N° Alarm Priority Alarm activation Alarm onset delay Actions

79 High VTi! LOW Insufflated volume > Immediate triggering

The machine goes
set threshold
into expiration mode
when the threshold
is reached.

Check the suitability

of alarm levels with
ventilation settings

In pressure-control
mode, check leakage
level

80 High respiratory rate! LOW The measured fre- Immediate triggering Check the suitability
quency is above the of alarm levels with
threshold ventilation settings

Self-triggering of in- Immediate triggering Lower the inspiratory

spiratory trigger trigger sensitivity

Non Critical error! Ventilation Effec- LOW Electronics failure Immediate triggering Use a different unit
81
tive and contact the tech-
- nical department

86

87 Ventilator operates from internal bat- Loss of mains power Immediate triggering
LOW Battery life (see Bat-
tery! supply
tery life check on
[acknowledgeable] page 99)

Connect the unit to

the mains if internal
power is not neces-
sary

88 Ventilator operates from external bat- LOW [acknowledge- Loss of mains power Immediate triggering Monitor the remain-
tery! able] supply ing charge in the ex-
ternal battery and
connect the unit to
the mains if the bat-
tery is low

89 FiO2 sensor to be soon replaced! LOW Voltage below a Immediate triggering Replace the O2 sen-
threshold sor the next time you
put the unit in ser-
vice.

90 Perform a battery test! (Machine Every 6 months Conduct battery test

LOW
Configuration menu)
[acknowledgeable]

91 Did you start the automatic tests with Nebulization activat- Immediate triggering Run the automatic
LOW
the nebulizer? ed without having test
[acknowledgeable] run automatic test
with nebulizer con-
nected

92 End-inspiratory occlusion in progress INFO “Inspiratory pause” Triggering at the

respiratory function start of the expirato-
selected ry phase

93 End-expiratory occlusion in progress INFO “Expiratory pause” Triggering at the

respiratory function start of the inspirato-
selected ry phase

96 Low pressure O2 activated INFO Press the “O2 low Immediate triggering
presure” button

97 Nebulization in progress INFO Nebulization in Immediate triggering

progress

87
Monnal T75 user manual

N° Alarm Priority Alarm activation Alarm onset delay Actions

98 Nebulization due to start INFO Nebulization due to Triggering 15 min

start before the start of a
nebulization cycle

99 Screen locked INFO The user has locked Immediate triggering

the screen

100 INFO Unit in stand-by

Unit on Immediate

Stand-by triggering at ventila-

tion stop or at the
starting of the device

101 FiO2 sensor calibration: plan to Deviation from the Immediate triggering
LOW
restart the automatic tests! O2 sensor measure-
[acknowledgeable] ment

102 Suction; patient disconnection in MEDIUM Disconnecting the Triggering within 15

Validate to acknowl-
progress patient with the “Suc- s
edge the alarm
tion” function active
Conduct the auto-
matic test as soon
as possible

103 Oxygenation in progress – Suction INFO Press the “xx% Immediate triggering Reconnect the pa-
possible O2↗” button tient

104 End-of-suction oxygenation in INFO Reconnecting the cir- Triggering within 10

progress cuit after aspiration s

105 Expi. flow measurement disabled, INFO Disable the hot wire Immediate triggering Use an external mon-
use an external monitor sensor itor

106 Low minute volume alarm disabled LOW Immediate triggering Set a low MVe alarm
threshold different
from OFF

107 Press detected on \nthe touch LOW Electronic fault Immediate triggering Change the ventila-
screen! tion and contact the
tech. department

108 Vt target and set pressure incompat- MEDIUM Exhaled volume < Vt Immediate triggering Check that settings
ibility!! target and Delivered of Vt target and
pressure = Ppeak Ppeak are consistent

Exhaled volume > Vt Immediate triggering

Check that settings
target and delivered
of Vt targe (Pressure
pressure = PEEP + 5
delivered cannot be
cmH2O
lower than PEEP

+ 5 cmH2O)

109 Oxygen therapy enabled, Apnea venti- INFO Press the 'Oxygen Starts after pressing
lation disabled therapy' button the 'Start' button

110 Oxygen therapy branch may be ob- HIGH Pressure in pa- Starts after 4 s
Check the patient cir-
structed!!! tient circuit > alarm
cuit, the patient/ma-
threshold
chine interface and
the inspiratory limb
of the ventilator.

Check that the alarm

levels match the set-
tings.

111 R and C stat measurement enabled INFO Press the 'R&C stat' Immediate triggering
button

112 'P0.1 measurement enabled' INFO Press the 'P0.1' but- Immediate triggering
ton

88
 8 Alarms

N° Alarm Priority Alarm activation Alarm onset delay Actions

113 Intubation tube compensation en- INFO Press the 'TC' button Immediate triggering
abled

114 Operate on altered O2 supply INFO 'Enabled' setting of Immediate triggering

altered O2 network
in administrator con-
figuration

115 NIF measurement in progress INFO Press the NIF key Immediate triggering

116 Low pressure!!! HIGH Pressure in pa- Triggered after 3 Check the level of
tient circuit < alarm consecutive ventila- leakage
threshold tion cycles

117 Low pressure! LOW Pressure in pa- Immediate triggering Check the level of
tient circuit < alarm leakage
threshold

118 Manual cycle in progress INFO Immediate triggering

Press the

Cycle.M key

119 CO2 apnea!!! HIGH CO2 sensor: No pa- Immediate triggering A clinician must re-
tient breaths have evaluate the patient's
been detected for ventilation
more than 20 sec-
onds

120 Check IRMA probe (CO2) adapter! LOW CO2 sensor: UU Immediate triggering Check the UU
adapter is not prop- adapter
erly placed on the
probe

121 Replace IRMA probe (CO2) adapter! LOW CO2 sensor: UU Immediate triggering Change the adapter
adapter is obstruct-
ed or blocked

122 CO2 concentration is outside toler- LOW CO2 measured > Immediate triggering If CO2 is correctly
ance! 15% < 15%, calibrate the
probe

123 Calibrate the IRMA probe (CO2)! LOW CO2 sensor: Probe Immediate triggering Calibrate the probe
drift

124 IRMA probe error (CO2)! LOW CO2 sensor: probe Immediate triggering Disconnect and re-
hardware or soft- connect the probe. If
ware error the problem persists,
change probes.

125 CO2 measurement is inoperative! LOW CO2 sensor: Probe is Immediate triggering Connect the IRMA
not connected probe

126 IRMA probe (CO2): Internal tempera- LOW CO2 sensor: The in- Immediate triggering If the ambient tem-
ture outside tolerance! ternal probe temper- perature is normal,
ature exceeds the change probes
maximum measure-
ment threshold

127 IRMA probe (CO2 Ambient pressure LOW CO2 sensor: The at- Immediate triggering If the ambient pres-
is out of tolerance! mospheric pressure sure is normal,
measured by the change probes
probe exceeds the
maximum measure-
ment threshold

89
Monnal T75 user manual

N° Alarm Priority Alarm activation Alarm onset delay Actions

128 EtCO2 high!! MEDIUM EtCO2 measurement Immediate triggering

Check the suitability
greater than the set
of the alarm levels
threshold
with the ventilation
settings.

Check the patient’s

condition and the ab-
sence of secretions
in the adapter and
the patient circuit.

129 EtCO2 low!! MEDIUM EtCO2 measure- Immediate triggering

Check the suitability
ment is below the
of the alarm levels
set threshold
with the ventilation
settings.

Check the patient’s

condition and the
absence of leaks in
the patient circuit.

130 Re-breathing detected!! MEDIUM re-breathing > thresh- Immediate triggering Reduce the dead
old (4 mmHg) space

131 VMalv high!! MEDIUM VMalv value is above Immediate triggering Check the suitability
the set threshold of the alarm levels
with the ventilation
settings.

132 VMalv low!! MEDIUM VMalv value is below Immediate triggering Check the suitability
the set threshold of the alarm levels
with the ventilation
settings.

133 VMCO2 high!! MEDIUM VMCO2 value is Immediate triggering Check the suitability
above the set thresh- of the alarm levels
old with the ventilation
settings.

134 VMCO2 low!! MEDIUM VMCO2 value is be- Immediate triggering Check the suitability
low the set threshold of the alarm levels
with the ventilation
settings.

135 Perform Preventive Maintenance LOW Perform Preventive Immediate triggering

Contact the technical
Maintenance
department

The alarm can be

acknowledged.

136 Expiratory limb obstructed!!! Emer- HIGH Respiratory-tract Sounded after 5 s Check the condition
gency ventilation pressure during ex- in the event of low of the expiratory limb
halation > threshold frequency; otherwise and eliminate the
during exhalation after 2 cycles. cause of the obstruc-
tion. Backup ventila-
tion. Contact Techni-
cal Support.

137 Safety Ventilation!! recommend HIGH Electronic fault or Immediate triggering

Change the ventila-
switching ventilator mechanical jam
tion device and con-
tact the tech. depart-
ment

Patient respiratory
contact with room
air as backup ventila-
tion.

90
 8 Alarms

N° Alarm Priority Alarm activation Alarm onset delay Actions

138 Apnoea ventilation deactivated! LOW The Tapnea set-point Immediate triggering The Tapnea set-point
switches OFF during switches to a value
CPAP ventilator, or other than OFF dur-
the mode starts up ing CPAP Ventilator
with Tapnea set to or ventilation other
OFF than CPAP.

139 Reduced battery power for transfer!! Battery capacity 50% Immediate triggering See battery (see Bat-
MEDIUM
tery life check on
[acknowledgeable] page 99)

140 Insufficient battery power for transfer Battery capacity 25% Immediate triggering
HIGH The battery has
reached its operating
[acknowledgeable] limit.

Please replace it.

91
Monnal T75 user manual

9 Maintenance
Accessories can be re-usable (autoclavable) or single-use (disposable).
Re-usable elements must be regularly cleaned and sterilized to prevent infection.
This procedure, which is mandatory and extremely important, is the responsibility of the user.

9.1 Definitions
Cleaning
The act of removing all traces of soiling from a place, a surface, or an element.
Sterilization
Total destruction of all germ strains, viruses, and yeasts.
A sterilization or disinfection procedure is never possible on dirty or soiled elements.
A complete procedure includes:
1. Disassembly, pre-disinfection, rinsing and drying;
2. Cleaning, rinsing and drying;
3. Disinfection, rinsing and drying, or sterilization;
4. Reassembly and functional tests
CAUTION: Never use abrasive powders, acetone, or other powerful solvents.

Note: The following instructions have been approved by the manufacturer of the medical
equipment as ENABLING a medical device to be prepared for re-use.

It is always the responsibility of the department concerned to ensure that the sterilization procedure
actually implemented via the equipment, materials and personnel of the reprocessing facility achieves
the expected result.
This generally requires the validation and routine inspection of procedures.

9.2 Routine maintenance

The surface of the ventilator can be cleaned.
Air Liquide Medical Systems recommends the following cleaning products for this purpose: ANIOS
TSA or ANIOS SURFA’safe.
Obey the instructions of the product manufacturer, and do not allow any liquid to penetrate inside the
unit.
CAUTION: Maintenance must be carried out with the ventilator disconnected from the elec-
trical power supply.

92
 9 Maintenance

9.3 Expiratory assembly: flow sensor + expiratory valve Monnal EVA

There are two types of expiratory assembly: single-use assemblies and autoclavable assemblies (re-
usable).
The sensor and the single-use expiratory assembly valve are transparent. Both of these components
bear a Part Number, Batch Number, and the following logo: 2
The sensor and the autoclavable expiratory assembly valve are colored blue. Both of these compo-
nents bear a unit Serial Number, a Part Number, and the ‘autoclavable’ logo:
(Refer to the summary of markings below).
Single-use version
The expiratory assembly is delivered by Air Liquide Medical Systems clean and ready for clinical use.
The exchange interval depends on hospital infection-control protocols, the presence of secretions and
the nebulization of drugs.
Reusing single-use accessories or consumables carries the risk of patient cross-contamination.
Autoclavable version
The expiratory assembly is intended to undergo at least 50 sterilization cycles.
To help track the number of cycles, the sensor and valve are marked with a unit serial number (SN).
The expiratory flow sensor (67) requires special precautions during pre-disinfection, cleaning, and dis-
infection. It consists of a very fine, fragile platinum wire.
It is therefore important to:
• Avoid inserting any object into the flow sensor,
• Avoid exposing it to a jet of water or air,
• Avoid bumping or dropping it.
Summary of markings

Markings Autoclavable Single-use

Expiratory valve 134°

MAX 2
serial number part number

part number batch number

Expiratory 134°
flow sensor
MAX 2
serial number part number

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Monnal T75 user manual

Markings Autoclavable Single-use

part number batch number

After a cleaning / disinfection cycle (immersion, autoclave, etc.), the hot wire expiratory flow sensor
must be thoroughly dried before being reinstalled, connected to the expiratory valve Monnal EVA, and
connected to the ventilator.
Make a visual check to ensure that the various components are in good condition.
Sterilization of the reusable expiratory flow sensor and expiratory valve assembly before the first use
is recommended.
Preparation
Remove the expiratory assembly from its housing by pressing the eject pushbutton.
Separate the expiratory flow sensor (67) from the expiratory valve Monnal EVA, and then remove the
valve body (68) and the membrane (69).
Pre-disinfection / Cleaning
1. Immerse the expiratory assembly components (67,68,69) in a pre-disinfectant solution:
Air Liquide Medical Systems recommends the use of ANIOS products: ANIOSYME DD1,
SALVANIOS PH7, HEXANIOS G+R (obey product manufacturer instructions).
2. Shake the pre-disinfected components thoroughly in a cleaning solution*,
3. Rinse under running water*,
4. Dry the components fully.
*except the expiratory flow sensor
Sterilization
If necessary, sterilize the following parts of the expiratory assembly (compatible with sterilization for
18 min at 134°C and 1 bar above atmospheric pressure): expiratory flow sensor, valve body and mem-
brane.
Reassembly
Reassemble the expiratory assembly.
CAUTION: Incorrect reassembly of the expiratory assembly (incorrect positioning of the di-
aphragm in the valve body, omission of the silicone disc, placement of an additional silicone
disc, etc.) may result in degraded equipment performance.

9.4 Monnal Clean’in filter (Type filtre HEPA: High- Efficiency Particulate
Air)
The Monnal Clean’in filter is an air filter that is used to purify the air at the turbine’s intake.
It blocks 99.97% of all particles.
Air Liquide Medical Systems recommends checking this filter every three months.
A place on the filter’s label enables the user to indicate an installation date.
The Monnal Clean’in filter must be replaced at least once per year.

94
 9 Maintenance

CAUTION: The Monnal Clean’in filter may not be disinfected, cleaned, or sterilized.

Replacing the filter

Remove the filter assembly from its housing with the help of the drawer and replace it.

9.5 Air intake filter

The air intake filter must be managed and cleaned every three months.
To access to the filter, remove the rear panel.

Two cleaning methods are recommended:

• Remove the filter from its housing, and wash it using warm soapy water. Rinse under running wa-
ter. Make sure that the filter is fully dry before reinstalling it.
• Remove the filter from its housing and use an air jet to remove any particles trapped in it, and then
reinstall the filter.

9.6 Bacteriological filter

Apply manufacturer recommendations concerning the frequency of replacement of the bacteriological
filter. Refer to the user instructions supplied with the filter.

95
Monnal T75 user manual

10 Accessories
Air Liquide Medical Systems recommends using the following consumables and accessories with the
Monnal T75.
CAUTION: The use of non-recommended parts may result in degraded performance. It is the
user’s responsibility to verify the compatibility of the ventilator and all parts used to connect
the patient prior to using the ventilator.

10.1 Items included in the package

Package contents:
• 1 × Monnal T75 ventilator
• 1 Monnal Clean’In (HEPA) filter
• 1 user manual
• 1 Monnal EVA expiratory valve
• 1 expiratory flow sensor
• 1 power cable
• 1 specific gas connector

10.2 List of consumables

Consumables Reference

Expiratory assembly

Autoclavable expiratory flow sensor KY632200

Autoclavable expiratory valve Monnal EVA (per unit) KY694500

Group of 5 single-use expiratory valves Monnal EVA KY694800

Group of 20 single-use expiratory valves Monnal EVA KY694900

Group of 5 single-use expiratory flow sensors KY664500

Group of 20 single-use expiratory flow sensors KY664600

Membrane Monnal EVA x 5 KY665300

Batch of five lip seals YJ073300

O2 Cell

Oxygen cell (electrochemical O2 sensor) YR049700

Filters

Oxygen filtrabloc KB002800

Monnal Clean’In filter (HEPA filter, per-unit) KB030100

96
 10 Accessories

Consumables Reference

Group of 6 air intake filters KY650300

Group of 50 bacteria filters (inspiratory output) KV103300

Air intake filter mount KY652700

Patient circuits

Group of 20 single-use adult-patient circuits, 1.6 meter without any water-trap, KG020100
but with a smooth inside surface
Can be connected to a pneumatic nebulizer

Group of 20 single-use child-patient circuits, 1.6 meter without any water-trap, KG020200
but with a smooth inside surface
Can be connected to a pneumatic nebulizer

Group of 10 single-use adult-patient circuits, 1.6 meter KG019300

with inspiratory/expiratory water trap

Group of 12 single-use child-patient circuits, 1.6 meter with inspiratory/expirato- KG019400

ry water trap
Can be connected to a pneumatic nebulizer

Group of 15 single-use adult-patient circuits, 1.6 meter with a water-trap on the VD315100
inspiratory circuit and a corrugated surface expiratory circuit
Cannot be connected to a pneumatic nebulizer

Group of 10 single-use child-patient circuits 1.5 meter VD317600

With a water-trap on the inspiratory circuit and a corrugated surface expiratory

surface
Cannot be connected to a pneumatic nebulizer

10.3 List of accessories

Accessories of the EM system Reference

IRMA™ probe KB020400

Other accessories Reference

For other available accessories, please contact KY665000

Air Liquide Medical Systems for a catalogue

97
Monnal T75 user manual

Pneumatic nebulizers Reference

Group of 20 single-use pneumatic nebulizer KB025200

Ultrasonic nebulizer

Autoclavable Aerogen nebulizer, France KB028600

Single-use Aerogen nebulizer, FR/DE/NL/IT KB029300

Humidifiers Reference

Heating humidifier MR850 230V EU, FR / ES / EN VD324500

Heating humidifier MR850 115V US, PT / ES / EN VD324600

Heating humidifier MR850 230V EU, IT / ES / PT VD324700

CO2 monitoring option Reference

Monnal T75 IRMA™ CO2 probe KB020400

Monnal T75 CO2 monitoring software option KB034000

UU adult / pediatric adapters for the IRMA™ CO2 KB020300

probe (x25)

UU infant adapters for the IRMA™ CO2 probe KB032800

(x10)

10.4 List of available documents

User manuals Reference

Addition to Philips' communication protocol YL075500

98
 11 Maintenance

11 Maintenance
Certain maintenance operations are the responsibility of the user, whilst others must be performed by
a technician.
For any operation requiring the ventilator to be opened, call on a technician.
Air Liquide Medical Systems holds available to maintenance staff a maintenance manual containing
the circuit diagrams, component lists, descriptions, calibration instructions and all other information
relevant to maintenance staff.

11.1 By the user

The user must:
• Drain the patient circuit water traps as often as necessary,
• Clean, disinfect and sterilize the re-usable components after each patient: the patient circuit, the
expiratory flow sensor and the expiratory valve Monnal EVA (see Expiratory assembly: flow sensor
+ expiratory valve Monnal EVA on page 93);
• After each patient, change the items that are not re-usable (circuit, filters, expiratory valve, expira-
tion flow rate sensor, CO2 IRMA™ measurement probe airway adapter)
• Replace the bacteriological filter according to manufacturer recommendations,
• Replace the O2 sensor and expiratory flow sensor in the event of failure
• Replace the Monnal Clean’in filter (see Monnal Clean’in filter (Type filtre HEPA: High- Efficiency
Particulate Air) on page 94;
• Replace the air intake filter (see Air intake filter on page 95);
• Check the remaining battery capacity approximately every six months (start ventilation, and check
that battery capacity is adequate) (see below),
• The battery must be replaced after 500 charge/discharge cycles.
• Replace lip seal every three months.
• Go through a checklist before each use (see Checklist on page 135).

11.1.1 Battery life check

In order to assist users to check battery life, an acknowledgeable alarm ‘Perform battery test!’ is trig-
gered every 6 months, and prompts users to perform a battery test.
This test is accessible in Standby mode by pressing the [Menu] and [Machine Configuration] keys.
Note: To access the test, the device must be connected to the AC power supply, and the bat-
tery must be fully charged. The test may last for more than 3 hours.

Once the test selected, a window is displayed, and users may start or cancel the test.
Note: Do not connect to other devices (patient circuit). Do not disconnect the device from
the AC power supply.

When the test starts, the device will automatically switch to its internal battery. Discharge it completely
then automatically switch to the AC power supply. A window displays a figure indicating the remaining
battery life, compared to a new battery (3 hours’ battery life on standard ventilation as indicated in the
technical description in this manual).

99
Monnal T75 user manual

100% The battery is fully operational

75% 75% battery life remaining, does not need to be replaced.

50% 50% battery life remaining.

The conditions of use of the battery must be taken into consideration when deciding
whether to replace it or not:
If the battery is never used apart from in the test (permanently connected to the AC power
supply, back-up supply), the remaining battery life may be sufficient.
If the battery is used often, during intra-hospital transfer of variable duration, it may be nec-
essary to replace it.

25% The battery has reached its operating limit.

Please replace it.

In order to preserve a record of the test performed, the information is permanently displayed next to
the [Battery test] access key, and includes remaining battery life and test date.
Note: This test resizes the battery charge indicator displayed on-screen: for example, if the
battery is down to 50% of its initial charge, no more than three of the five pictogram cells can
be lit. This function keeps the user aware of the overall state of the battery.

11.2 By the technician

Servicing once a year and checking the operation and performance of the unit.
The ventilator counts two operational parameters: number of hours of ventilation, and number of
hours that the machine is powered up.
These times can be viewed at any time in the stand-by screen.
The internal battery must be replaced after 500 charge/discharge cycles or 3 years (whichever comes
first), and this replacement must be performed by a qualified technician. For more information, refer to
the maintenance manual.

11.3 O2 cell
Note: The working life of the O2 cell is approximately 5000 hours, but this can vary according
to the oxygen concentration used and the ambient temperature.

100
 11 Maintenance

1.
To open the compartment, press the cover down slightly and turn towards the symbol.

2. Disconnect the used sensor and then unscrew it to remove it from its housing.
3. Replace it with a new sensor, referring to the instructions on the packaging of the new sensor if
necessary.
4. Tighten the sensor properly in order to prevent leakage, and then connect it.
5.
To close the cover, press it down slightly (with the arrow pointing to ) and turn it until the
arrow points to .
6. Run the sensor calibration automatic test.
Note: It is recommended that you calibrate the O2 sensor frequently via the automatic test.

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Monnal T75 user manual

12 Technical description

12.1 Operation

12.1.1 Pneumatic system

AIR Ambient air intake PATIENT Patient

O2 LP Low-pressure oxygen inlet (concentrator) NEBULISEUR Nebulization outlet (calibrated coupler) to

which the nebulizer is connected

O2 HP High-pressure O2 inlet

(network, cylinder)

BF1 Bronze filter (laminar flow) PS1 O2 pressure sensor

C1 Non-return valve PS2 Differential pressure sensor

C2 Non-return valve PS3 Balloon pressure sensor

C3 Non-return valve

F1 Air intake filter (microfilter) PS4 Airway inspiratory pressure sensor

F2 O2 inlet filter (oxygen concentrator) PS5 Airway inspiratory pressure sensor (redun-
dancy

F3 O2 inlet filter (compressed gas) T Turbine

F4 Air intake filter TS1 Patient gas temperature sensor

FS1 O2 flow sensor V1 Oxygen regulating proportional solenoid

valve

FS2 Blower flow sensor V2 Nebulization on/off solenoid valve

FS3 Patient flow sensor V3 PEEP control proportional solenoid valve

FS4 Hot wire expiratory flow sensor V4 PEEP control on/off solenoid valve

102
 12 Technical description

M1 Membrane V5 Bleed on/off solenoid valve (redundancy)

M2 Membrane V6 Inspiratory phase control proportional sole-

noid valve

O2S Oxygen sensor V7 3/2 on/off patient venting solenoid valve

(MAP)

PR1 Pressure regulator (reducer): CO2S Carbon dioxide sensor

12.1.2 Ventilation operation

The blower (T) of the ventilator entrains ambient air via the microfilter (F1) and compresses it accord-
ing to the patient and the settings concerned. The compressed gas is then distributed via a pneumatic
network according to whether an inspiratory or expiratory phase is being delivered.
Inspiratory phase
The main component during the inspiratory phase is the solenoid valve (V6) which regulates the flow
rate via the flow sensor (FS3) when the selected mode is volume-controlled, or via the pressure sensor
(PS4) when the selected mode is pressure-controlled.
At the same time, the solenoid valves (V3), (V4) and (V5) are open, closed, and closed respectively
such that the blower pressure is applied to the membrane (M2) of the expiratory valve, thus forcing the
air sent via the solenoid valve (V6) to flow towards the patient only.
Expiratory phase
In this phase, the patient exhales the gases inhaled in the previous phase, and the unit is expected to
regulate to a pressure determined by the settings (PEEP).
With this in mind, the solenoid valve (V4) opens to depressurise the membrane (M2) and the PEEP
control proportional solenoid valve (V3) regulates the expiration pressure via the pressure sensor
(PS4).
At the same time, the inspiratory electromagnet regulates the flow via the flow sensor (FS3) for a rinse
flow of 3 L/min. This flow limits reinhalation and allows quick detection of an inspiratory demand.
Note: During ventilation with leakage, such as NIV, the solenoid valve (V6) is liable to in-
crease the rinse flow; it then enters an “on-demand valve” mode. The purpose of this function
is to compensate for leaks in order to maintain the PEEP in the circuit.
Obstruction management
Version A:
In normal operation, solenoid valve (V7) connects the turbine pressure to diaphragm (M1), which plugs
the safety ambient air intake. If the patient needs to be vented to atmosphere, solenoid valve (V7) con-
nects diaphragm (M1) to the patient. On each inspiratory effort by the patient, the safety ambient air
intake opens and the patient can breath freely through the device.
Version B:
In normal operation, solenoid valve (V7) connects the turbine pressure to diaphragm (M1), which plugs
the safety ambient air intake. If the patient needs to be vented to atmosphere, solenoid valve (V7) con-
nects diaphragm (M1) to the atmosphere, which opens the ambient air intake and depressurises the
patient’s airways. In the special case of an obstruction in the expiratory limb, once the pressure in the
airways reaches atmospheric pressure, ventilation continues in accordance with the mode selected by
the operator. This is the backup ventilation system: the patient exhales through the ambient air intake
valve. Patient exhalation periodically occurs through the expiratory valve, to check how it is functioning
and permit normal ventilation when there is no longer an obstruction.

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Note: Because it is possible to exhale through the ambient air intake valve in backup ventila-
tion mode, Air Liquide Medical Systems recommends that a bacteria filter always be insert-
ed at the point of connection with the inspiratory limb to avoid contamination of the ventila-
tor. Since exhalation occurs through the inspiratory limb in backup mode, part of the expired
gas is reinhaled. The inspiratory trigger is disabled and a minimum backup frequency is main-
tained. Oversight and monitoring linked to the exhaled flow are altered.
Version B of patient venting applies from Monnal T75 device no. MT75-05000.
• A lower serial number identifies the device as version A.
• A higher serial number identifies the device as version B.
Note: For more information, contact Air Liquide Medical Systems.

12.1.3 Air/O2 mixture

The O2 concentration of the gases administered to the patient depends on the source connected to
the unit. A distinction is made between O2 network operation and concentrator operation.
Operation on an O2 network
For proper operation, the pressure at the O2 inlet terminals (O2 HP) must be between 2.8 and 6 bar.
The O2 is then filtered via F3.
The proportional solenoid valve (V1) enriches the mixture in oxygen by regulating the flow via the flow
sensor (FS1), where the set-point is proportional to the upstream flow rate (FS2) and depends on the
FiO2 setting.
Note: Operation at a network pressure between 1.5 and 2.8 bar or between 6 and 7 bar is
possible, but the quality of enrichment might be affected. If the pressure falls below 1.5 bar
or goes above 7 bar, the oxygen supply is cut off by the proportional solenoid valve (V1) and
an oxygen supply error alarm is triggered.
Operation with a concentrator
The ventilator is equipped with a “low pressure” connector for working with a flow meter (intake via the
filter (F2)). The principle of precise control of the O2 concentration applied at high pressure is main-
tained when operating with a low-pressure source, with the device constantly delivering a mix at the
correct FiO2.

Minute volume (L/min)

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However, it may well be that the mix concentration cannot be achieved since it depends:
• on the type of concentrator and its settings (the O2 flow rate delivered by the concentrator is often
low and its O2 concentration variable [between 90 and 100%]);
• on the ventilation parameters.
The following graph shows the maximum concentrations that can be obtained with different concen-
trator flow rates (based on an O2 concentration of 100%) according to the minute volume of a patient
ventilated at the frequency of 15 bpm.
For example, for a concentrator delivering 5 L/min and a patient ventilated in volumetric mode with a
Vt of 0.5 L and a frequency of 15 bpm (i.e.: a minute volume of 0.5x15 = 7.5 L/min), the maximum con-
centration that may be obtained will be approximately 50%. The device will then be capable of deliver-
ing any required concentration below this value.
Note: Since the device only consumes the flow that it needs to ensure correct concentration
of the mixture, Air Liquide Medical Systems recommends that the low-pressure source be ad-
justed to its maximum flow rate. This will make it possible to obtain a wider range of possible
FiO2.
Whatever the function mode for the device, the oxygen sensor (O2S) ensures monitoring of the FiO2
concentration in the circuit.
This sensor is a chemical cell where an electrolytic reaction occurs. The current produced is propor-
tional to the partial pressure of oxygen.
However a compensation of this pressure is applied each time the automatic tests are lauched. Am-
bient humidity also affects the oxygen measurement at the rate of -0.03% per%Hr, at 25°C (see Mea-
sured parameters on page 122).

12.1.4 Special characteristics of nebulization

The O2 supply pressure (O2 HP) is reduced in the nebulization branch by the pressure reducer (PR1) at
a pressure of 1 bar.
The nebulization on/off solenoid valve (V2) provides nebulization via its open and closed positions.
The nebulization flow rate then depends on the nebulizer used.

12.1.5 CO2 monitoring

The CO2 (CO2S) sensor ensures monitoring of the CO2 concentration during the expiration of the pa-
tient.

12.2 Electrical power sources

he ventilator is compatible with various electrical power sources:
• Mains supply;
• Power supply on an external DC source (external battery);
• Power supply on an internal DC source (internal battery ).
The electrical characteristics of each of these sources are described in Electrical specifications on
page 112.
Note: If the unit suddenly shuts down during ventilation (e.g. battery empty), when the unit is
reconnected to the external or auxiliary power and restarted, it automatically resumes ventila-
tion with the last parameters saved.

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12.2.1 Power supply management

The supply board manages the energy source changeover automatically according to the hierarchy as
follows:
1. Mains supply;
2. In the event of failure, power supply from external battery;
3. In the event of failure, power supply from internal battery.

12.2.2 Mains supply

Two pictograms indicate whether or not the mains power supply is present.

Mains present

Mains absent

12.2.3 Internal battery

In the event of absence of the mains and the external source, the switch to internal battery is indicated
by a low-priority acknowledgeable alarm “Ventilator operates from internal battery!”.
The charge status of the internal battery is then indicated in the upper left-hand part of the screen (ex-
ample based on a new battery):

Full battery charge

Comfortable battery charge

Medium battery charge

Battery low - connect the unit to the mains power supply.

Associated with a medium-priority acknowledgeable alarm “Internal battery nearly dis-
charged!”

Battery dangerously low - imminent shutdown

Associated with high-priority acknowledgeable alarms “Internal battery discharged!!!
Connect AC power” and then “Internal battery inoperative!!! Connect AC power”
It is then urgent to connect the ventilator to the mains or to an external battery to prevent
it from shutting down due to a lack of power.

When the unit is connected to the mains or an external battery, the unit’s internal battery recharges. A
special pictogram appears on the screen to show the progress of light segments (example based on a
new battery):

Battery discharged

Battery half-charged

Battery fully charged

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 12 Technical description

In the event of operation at a high ambient temperature, a safety device might limit the battery charge.
This can have a significant effect on the charging time and operating duration of the battery.
Note: The battery takes about 10 hours to charge (at ambient 25°C).

When the unit is switched off but connected to the mains or an external battery, the internal battery au-
tomatically recharges.
If the unit cannot recharge the battery because the battery is absent or defective, the following pic-
togram appears on screen:

Battery unavailable
Associated with a high-priority alarm ‘Internal battery unavailable!!! Check
battery’

12.2.4 External battery

The Monnal T75 medical electrical equipment may be connected to a separate external power supply
to create a medical electrical system.
Two icons indicates the absence or presence of an external source.

Presence of an external battery

Presence of an external battery

In case of a power-supply disconnection, the changeover to the external battery is indicated with a low-
priority acknowledgeable alarm “Ventilator operates from external battery”.

12.3 Inputs and outputs

12.3.1 Alarm transfer

Description of the alarm transfer function

The alarm transfer function uses a dry contact to send an alarm from the ventilator to an external
module. The contact is either closed, allowing the flow of a current generated by the external module,
or open, preventing the current from flowing. This contact is accessible via the three-pin socket locat-
ed at the back of the unit.
Breaking capacity
The relay is used to switch from a maximum voltage of 24 V with a maximum current of 250 mA.
Pin configuration of the “alarm transfer” connector
Mechanical arrangement (view from rear of ventilator)

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3 2

Idle (without alarm)

• The contact located between the “NC” (3) output and “Common” (2) is closed.
• The contact located between the “NO” (3) output and “Common” (2) is open.

12.3.2 RS232 link

The RS232 link of this ventilator allows data input ((1), software updates) and output ((2), sending of
machine data).

2
Software updates
The ventilator software is updated via the RS232 link using standard IT tools.
Technical features:
• Speed: 115200 bps
• Parity: none
• Format: 8 bits; 1 start bit; 1 stop bit
• Flow check: No
Note: With regard to the RS232 link, the use of an accessory that is not compliant with the
safety requirements of this ventilator can bring about a reduction in the safety level of the re-
sulting system.
The following factors should be considered when choosing the accessory:
• Its use near the patient
• Certainty that its safety certification was carried out in compliance with the local standards in
force and/or the EN 60601-1 standard as well as IEC 60950-1
• Do not apply any abnormal voltage to the RS232 connector (15 V max.).

12.3.3 Connectivity to hospital networks

This ventilator incorporates a communication protocol for sending data to data-collection software or
external monitoring systems.

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 12 Technical description

Choice of protocol
From the “Admin Config” menu, select the protocol which corresponds to the external device, using the
encoder wheel:
• OTP,
• Monnal Link,
• VueLink/Intellibridge EC10.
Contact the information system manager to select the appropriate protocol.
Connecting the communication module
Connect the cable supplied by the manufacturer of the communication module to RS232 connector
no. 1 on the Monnal T75 and then connect the other end of the cable to the external device.
Do not leave the cable connected to the Monnal T75 without connecting it to an external device, in or-
der to prevent electromagnetic interference.
Air Liquide Medical Systems protocols
The Monnal T75 includes the following Air Liquide Medical Systems communication protocols:
• OTP,
• Monnal Link.
These protocols are available upon request.
For more information, contact [email protected].
Information transmitted
The information transmitted is as follows:
• ventilation set-points,
• alarms,
• alarm thresholds,
• all measurements apart from time curves.
Compatible communication modules
• Capsuletech Datacaptor (OTP protocol),
• Philips monitors (VueLink/Intellibridge Protocol EC10),
• Mindray (OTP protocol).
To obtain a full list of the communication modules compatible with the Monnal T75, contact the manu-
facturer.
A hospital network failure can result in no data being transmitted (alarms and monitoring) to the exter-
nal device.
Connection to a hospital network which includes other apparatus could give rise to previously unidenti-
fied risks to patients, operators or third parties.
The user should identify, analyze, evaluate and control such risks. Subsequent modifications made to
the hospital network could introduce new risks and require additional analysis. Modifications to the
hospital network include:
• modifications to the configuration of the external device;
• the connection of additional units to the external device;
• the disconnection of units from the external device;
• the updating of devices connected to the external device;

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Monnal T75 user manual

• the correction of devices connected to the external device.

[email protected]

12.3.4 Video output

The video output is located on the back panel of the unit: a remote screen can be connected via this
output in order to display an image of the ventilator screen.

12.4 Performances and characteristics

12.4.1 Regulatory requirements

Directives
European Council Directive 93/42/CEE concerning medical devices.
Directive 2012/19/EU of the European Parliament and Council concerning Waste Electrical and Elec-
tronic Equipment (WEEE).
Standards
The compliance of Monnal T75 with the essential requirements of Directive 93/42 is based on the fol-
lowing standards:
EN ISO 14971 | Application of risk management to medical devices
EN ISO 60601-1 | Medical electrical equipment – Part 1: General requirements for basic safety and es-
sential performance
EN ISO 80601-2-12 | Medical electrical equipment – Part 2-12: Particular requirements for basic safety
and essential performance of critical-care ventilators.
EN ISO 80601-2-55 | Medical electrical equipment – Part 2-55: Particular requirements for the basic
safety and essential performance of respiratory gas monitors.
Device class: IIb
Service life of Monnal T75: 7 years.
Year of Monnal T75 (Ref. KB022600) CE marking: 2008
Year of Monnal T75 with CO2 option (Ref. KB033600) CE marking: 2013

12.4.2 Recovery of the components of the medical device

Recovery of the components of the medical device

Characteristics of the packaging
Box for transportation (993 g) and wedge (650 g):

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 12 Technical description

• Recycled paper
• Recyclable
Protective foam (1580 g):
• Polyethylene
• Recyclable
Method of recovery for consumable items
All used consumable items from use of this ventilator (the patient circuit, the bacteriological filters,
etc.) must be collected in the hospital’s appropriate disposal channels. The packaging waste for the
device and for its accessories must be disposed of in the hospital’s appropriate disposal channels.
Shipping equipment
Air Liquide Medical Systems recommends that the user keep the original packaging.
If the medical device is returned, always use the original packaging. Otherwise, contact your Air Liq-
uide Medical Systems representative to obtain replacement packaging.
Equipment modifications
CAUTION: It is prohibited to alter the Monnal T75 equipment.

Accessories
The accessories used with this ventilator must comply with the general requirements of European di-
rective 93/42/CEE, as well as EN 60601-1 and collateral standards.
Accessories from the Air Liquide Medical Systems catalog or included in the accessories kit delivered
with the ventilator comply with these requirements. The use of accessories not recommended by Air
Liquide Medical Systems releases Air Liquide Medical Systems from all liability in the event of an inci-
dent.
The user is responsible for ensuring that the use of accessories does not affect the safety and the ex-
pected performance of the ventilator.
The inspiratory and expiratory resistance measurements of this respiratory were taken using a stan-
dard adult patient circuit and a bacteriological filter (KV103300).
CAUTION: The addition of intermediate parts or other components or assemblies to the res-
piration system of the ventilator may change the pressure gradient of the system which may
have a negative impact on the performance of the ventilator.
The prescriber must ensure that the assembly thus obtained complies with IEC 80601-2-12.Items in-
cluded in the package.

12.4.3 Technical characteristics

12.4.3.1 General specifications

Dimensions (Lxwxh) 40x30x35 cm

Mass 16 kg

Audible sound level 48 dB at 1 m

Operating conditions

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Monnal T75 user manual

Temperature +10°C to +40°C (+50°F to +104°F) (See warning under table)

Relative humidity 0 to 90% without condensation at 40°C max.

Atmospheric pressure 700 to 1060 hPa

Storage and transport conditions

Temperature -20°C to +70°C (-4°F to +158°F)

Relative humidity 0 à 90% without condensation at 40°C max

Atmospheric pressure 500 to 1060 hPa

Turbine and screen

Turbine warranty 40000h or 5 years (whichever comes first)

Control Resistive tactile pad

Screen Color 10.4", 640*480 pixels

Protection

Protection index IP3X (if the serial number is less than MT75-05000)
IP31(if the serial number is greater than MT75-05000)

Applied parts according to IEC 60601-1

Applied parts The respiratory system of the Monnal T75 ventilator is a type B ap-
plied part.
The CO2 probe of the Monnal T75 is a type BF applied part

CAUTION: Ambient temperature warning: the temperature of the Monnal T75 delivery flow
can exceed that of the room. Exercise extreme caution when using the Monnal T75 at ambi-
ent temperatures above 38 C (100.4°F).
At an ambient temperature of 38 C or higher, gas temperature can climb as high as 43 C, de-
pending on the settings. The 43°C limit can never be exceeded. In such conditions, humidifi-
cation or nebulization may not be effective. When ambient temperature exceeds 38°C, Air Liq-
uide Medical Systems recommends use of HME filters.

12.4.3.2 Electrical specifications

Main power supply

Input voltage 100 - 240 V AC +/- 5%

Frequency 50 to 60 Hz

Electrical power consumption 250 VA

250 VA T 16 A

External power supply fuse (x1) T 3,15 A, 250 V

T 16 A 0,25 A FST

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 12 Technical description

Main power supply

Main fuses (x2) T 3,15 A L, 250 V

Electrical class I

Type A

Leak current IEC 60601-1 compliant

Protection following a loss of power Continuous audible alarm and patient vented to
atmosphere

Internal battery (Air Liquide ref. KY633300)

Type NiMh
Rated voltage: 24 V
Rated capacity 2X4500 mAh

Battery capacity (new and charged battery) with 3 h typical

the standard ADULT configuration
Ambient temperature: 25°C

Charging time (h) 10 h typical (according to environmental condi-

tions)

Isolation

Separation from the power supply To electrically separate the Monnal T75 from the
power supply, disconnect the flexible power ca-
ble.

12.4.3.3 Electromagnetic Compatibility

All of the information set out below was obtained from the normative requirements to which the manu-
facturers of electro-medical devices are subject, within the meaning of standard IEC 60601-1-2 Ed4.
The medical device is compliant with the electromagnetic compatibility standards in force; neverthe-
less the user shall ensure that any electromagnetic interference does not create an additional risk,
such as radio-frequency transmitters or other electronic devices.
In this section you will find the information required to ensure that the installation and putting into op-
eration of your medical device is carried out under the best possible conditions in terms of electro-
magnetic compatibility. The various leads attached to the medical device must be separated from
each other.
Certain types of telecommunications mobile devices such as mobile phones may interfere with the
medical device. The recommended separation distances in this section must therefore be strictly ob-
served.
The medical device must not be used in close proximity to other equipment or placed on top of other
equipment. If this cannot be avoided, its operation under the conditions of use must be checked be-
forehand. The use of accessories other than those specified or sold by Air Liquide Medical Systems as
replacement parts may have the consequence of increasing the emissions or decreasing the immunity
of the medical device.

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Monnal T75 user manual

Note: The emission characteristics of this device allow it to be used in industrial areas and
in a hospital environment (class A as defined in CISPR 11). If used in a domestic environ-
ment (for which class B as defined in CISPR 11 is normally required), this equipment might
not offer adequate protection to radio-frequency communication services. The user may be
required to take mitigation measures, such as relocating or re-orienting the ventilator.
CAUTION: Exceptional electromagnetic disturbance may degrade ventilation performance.

CAUTION: RF hand-held communication devices should not be used (including peripherals

such as antenna cables and external cables) within a radius of 30 cm (12 inches) of any part
of the Monnal T75, including the cables specified by the manufacturer. Otherwise, the perfor-
mance of this equipment may be impaired.
Length of cables
CAUTION: These accessories and cables must be used with the Monnal T75. Their use with
other medical electrical equipment may increase the emissions of the equipment or decrease
its immunity.

Accessories and ca- Max- Test type in compliance with

bles used during test- imal
ing length

Monnal T75 equip- 3m RF Emission CISPR 11, Class B

ment:
Emission of harmonic currents IEC 61000-3-2
Power cable (3 m) -
Voltage fluctuation and voltage flickers IEC 61000-3-3
KY120500
Electrostatic discharge immunity IEC 61000-4-2

Radiated immunity – Electromagnetic IEC 61000-4-3

fields

Electrical fast transient/burst immunity IEC 61000-4-4

Surge immunity IEC 61000-4-5

Immunity to conducted disturbances, IEC 61000-4-6

induced by radio-frequency fields

Radiated immunity - Magnetic fields IEC 61000-4-8

Immunity to voltage dips, short inter- IEC 61000-4-11

ruptions and voltage variations

Recommended separation distances

The medical device is intended for use in an electromagnetic environment in which the disturbances
due to RF radiation are controlled.
The user or installer of the medical device can help prevent electromagnetic interference by maintain-
ing a minimum distance, according to the maximum output power of the radio-frequency transmis-
sion equipment. RF hand-held communication devices should not be used (including peripherals such
as antenna cables and external cables) within a radius of 30 cm (12 inches) of any part of the Monnal
T75, including the cables specified by the manufacturer. Otherwise, the performance of this equipment
may be impaired.

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 12 Technical description

Electromagnetic emissions
The medical device is intended for use in an electromagnetic environment described in the table be-
low. The user and installer must ensure that the medical device is used in the environment described
below.

Emission test Compliance Electromagnetic environment -

comments

Electromagnetic radiation dis- Group1 The medical device uses RF en-

turbance(Radiated emissions) ergy for its internal`operation.
(CISPR 11) Consequently, its radio frequen-
cy emissions are very low and
are not likely to create any inter-
ference with neighboring equip-
ment.

Power terminal disturbance Class B Home health care environment

voltage (Conducted emissions) and a professional health care
(CISPR 11) establishment environment.

Emission of harmonic currents Class A

(IEC 61000-3-2)

Voltage changes, voltage Compliant

fluctuations and flicker (IEC
61000-3-3)

Magnetic and electromagnetic immunity

The medical device is intended for use in a magnetic and electromagnetic environment described in
the table below. The user and installer must ensure compliance of the electromagnetic environment.

Immunity test Test level according to Compliance level Electromagnetic envi-

IEC 60601 ronment/comments

Electrostatic dis- ± 8 kV contact dis- ± 8 kV contact dis- Professional health

charges (ESD) (IEC charge charge care establishment en-
61000-4-2) vironment.
± 15 kV air discharge ± 15 kV air discharge

Electrical Fast Tran- ± 2 kV for electrical ± 2 kV for electrical

sient/Burst (IEC power lines power lines
61000-4-4)
± 1 kV for signal ports

Surges (IEC 61000-4-5) ± 1 kV in Differential ± 1 kV in Differential

mode mode

± 2 kV in common ± 2 kV in common
mode mode

Assigned industrial fre- 30 A/m 30 A/m

quency magnetic field
(IEC 61000-4-8)

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Monnal T75 user manual

Immunity test Test level according to Compliance level Electromagnetic envi-

IEC 60601 ronment/comments

Voltage dips, short in- 0% UT for 0.5 cycles 0% UT for 0.5 cycles Professional health
terruptions and volt- care establishment en-
age variations (IEC A 0°, 45°, 90°, 135°, A 0°, 45°, 90°, 135°, vironment.
61000-4-11) 180°, 180°,
If use of the system re-
225°, 270° and 315° 225°, 270° and 315° quires continued oper-
ation during power sup-
0% UT for 1 cycle 0% UT for 1 cycle ply cuts, the use of a
separate power source
70% UT 70% UT to power the medical
for 25 cycles at 50 Hz for 25 cycles at 50 Hz device is recommend-
ed (UPS, etc.).
For 30 cycles at 60 Hz For 30 cycles at 60 Hz
Single phase: at 0° Single phase: at 0°

Voltage interruptions 0 % UT; 0 % UT; Professional health

(IEC 61000-4-11) care establishment en-
for 250 cycles at 50 Hz for 250 cycles at 50Hz vironment.
for 300 cycles at 60 Hz
for 300 cycles at 60 Hz If use of the system re-
quires continued oper-
ation during power sup-
ply cuts, the use of a
separate power source
to power the medical
device is recommend-
ed (UPS, etc.).

Electromagnetic immunity, portable radio-frequency equipment

The medical device is intended for use in a magnetic and electromagnetic environment as described in
the table below. The user and installer must ensure compliance of the electromagnetic environment.

Immunity test Test level Compliance level Electromagnetic envi-

ronment/comments

WARNING: RF hand-held communication devices should not be used (including peripherals such as
antenna cables and external cables) within a radius of 30 cm (12 inches) of any part of the Monnal
T75, including the cables specified by the manufacturer. Otherwise, the performance of this equip-
ment may be impaired.

Radiated, radio-fre- 3 V/m 3 V/m Professional health

quency, electro- care establishment en-
magnetic fields (IEC 80 MHz to 2.7 GHz 80 MHz to 2.7 GHz vironment.
61000-4-3)
80 % MA to 1 kHz 80 % MA to 1 kHz
10 V/m 10 V/m
80 MHz to 2.7 GHz 80 MHz to 2.7 GHz
80 % MA to 1 kHz 80 % MA to 1 kHz

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 12 Technical description

Immunity test Test level Compliance level Electromagnetic envi-

ronment/comments

Proximity fields from 9 V/m 9 V/m

RF wireless commu-
nications equipment 710 MHz, 745 MHz, 710 MHz, 745 MHz,
(IEC 61000-4-3 interim
780 MHZ, 5240 MHz, 780 MHZ, 5240 MHz,
method)
5550 MHz, 5785 MHz 5550 MHz, 5785 MHz
27 V/m 27 V/m
385 MHz 385 MHz
28 V/m 28 V/m
450 MHz, 810 MHz, 450 MHz, 810 MHz,
870 MHz, 930 MHz, 870 MHz, 930 MHz,
1720 MHz, 1845 MHz, 1720 MHz, 1845 MHz,
1970 MHz, 2450 MHz 1970 MHz, 2450 MHz

Conducted distur- 3V 3V
bances, induced by ra-
dio-frequency fields 150KHz to 80MHz 150KHz to 80MHz
(IEC 610004-6)
6 V ISM bandwidth and 6 V ISM bandwidth and
bandwidths between bandwidths between
0.15 MHZ and 80 MHZ, 0.15 MHZ and 80 MHZ,
including amateur ra- including amateur ra-
dio bandwidths dio bandwidths
80% MA to 1 KHz 80% MA to 1 KHz

The electromagnetic field strengths of fixed radio-frequency transmitters, as determined by a sur-

vey of the electromagnetic environment (a), must be below the compliance level for each frequency
range. Interference may occur close to equipment identified by the following symbol:

Comment: These specifications may not apply in all situations. Electromagnetic propagation is affect-
ed by absorption and reflection from structures, objects and people.
(a) The electromagnetic field strengths of fixed radio-frequency transmitters, such as base stations for
mobile phones (cellular/wireless), mobile radios, amateur radio operators, AM/FM radio broadcasts
and TV broadcasts cannot be determined accurately through theory. To assess the electromagnetic
environment due to fixed RF transmitters, an electromagnetic site survey should be carried out. If the
intensity level of the radio-frequency field in the immediate environment in which the product is being

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used exceeds the radio-frequency compliance level specified above, the product performance must be
tested in order to check whether or not it is compliant with the specifications. In the case of any abnor-
mal performance of the device, additional measures may be necessary, such as reorienting or relocat-
ing the product.

12.4.3.4 Pneumatic specifications

High pressure (HP) and low pressure (LP) O2 inlets

Type of gas fitting NF, DISS, NIST (HP)

Connector (LP)

O2 pneumatic supply 2.8 - 6 bar / 280 - 600 kPa / 40 - 86 psi (HP)

0 – 1.5 bar / 0 – 150 kPa / 0 – 22 psi (LP)

Required maximum flow rate (at atmospheric 105 L/min at 2.8 bar / 130 L/min at 6 bar (HP)
pressure)
85 L/min at 1.5 bar (LP)

Standalone mode Cylinder (HP)

Concentrator (LP)

Mixer Electronic, electrochemical O2 sensor

Precision (% of set value) < 3%

Gas consumption(1) Patient ventilation + 4 L/min. (flow-by + internal

consumption)

Connectors

Inspiratory hose connector ISO 22 mm male

Expiratory hose connector ISO 22 mm male

Inspiratory and expiratory resistances(2)

Resistances at 60 L/min (cmH2O) Inspiratory: 3.9

(Unit + single-use adult patient circuit KG019300) Expiratory: 3.2

Resistances at 30 L/min (cmH2O) Inspiratory: 5.7

(Unit + single-use paediatric patient circuit Expiratory: 4.9
KG019400)

Pressure

Maximum limited pressure 100 cmH2O; blower performance limitation

(P lim max)

Maximum working pressure 0-100 cmH2O

(P w max)

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 12 Technical description

High pressure (HP) and low pressure (LP) O2 inlets

Minimum limited pressure Back-up ambient air intake preventing a pressure

drop in the patient circuit
(P lim min)

(1) Consumption example:

• For an adult, average consumption is 6 l/min of gas (air or oxygen;
• The flow-by + internal consumption of the unit is fixed at 4 l/min.
In the case of a B5 type cylinder being used, its volume is 5 litres. Because the gas is compressed
to 200 bar, in this case we have 1000 litres of gas. In our example, we will therefore have approxi-
mately 1 hour 40 minutes of operating time if the ventilation is carried out at 100% oxygen concen-
tration.
(2) The above-mentioned resistances take the ventilator and the circuit into account, but exclude
any other intermediate accessory. For accessories other than those mentioned in this manual,
please contact us. The test method is also available on request.

Compatibility of accessories (parts of the respiration system which can be removed and assem-
bled by the operator)

Inspiratory resistance Adult: max 5,5 cmH2O @ 30 L/min

Child: max 5,5 cmH2O @ 15 L/min
Infant: max 5,5 cmH2O @ 7,5 L/min

Expiratory resistance Adult: max 10 cmH2O @ 30 L/min

Child: max 6 cmH2O @ 15 L/min
Infant: max 6 cmH2O @ 7,5 L/min

Compliance 6 mL/cmH2O

12.4.3.5 Ventilation specifications

Ventilation modes

VCV (controlled ventilation or assisted vol- VCV

ume-controlled ventilation)

PCV (controlled ventilation or assisted pres- PCV

sure-controlled ventilation)

SIMV (Synchronised Intermittent Mandatory Ven- SIMV

tilation)

PSIMV (synchronised intermittent mandatory PSIMV

pressure-monitored ventilation)

PSV (spontaneous ventilation with inspiratory as- PSV

sistance and PEEP)

Non-invasive ventilation PSV NIV

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CPAP MODE (Continuous Positive Airway Pres- CPAP

sure)

Ventilation at two pressure levels Duo-Levels

Pressure-regulated volume controlled ventilation PRVC

Spontaneous ventilation with inspiratory assis- PS-Pro

tance, PEEP and servomechanism frequency

Airway Pressure Release Ventilation APRV

Inspiratory trigger system

Main inspiratory trigger in flow rate, secondary in pressure:

Turn the control wheel to set the inspiratory trigger to between 1 and 15 L/min or between 0.2 and 3
cmH2O. A pressure threshold
varying from 0.2 to 5 cmH2O is associated with it.
At the time of a patient demand, satisfying one of the conditions (flow rate or pressure) will trigger
an inspiratory cycle.

Expiratory trigger system

During any spontaneous cycle, the switch to expiration occurs as soon as one of the following crite-
ria is encountered:
- expiratory flow trigger (Trig. E); Expiration as soon as the inspiratory flow rate reaches x% of peak
inspiratory flow rate
- expiratory pressure trigger (not adjustable): expiration as soon as an overpressure of 3 cmH2O is
detected on the inspiratory
pressure signal
- expiratory time trigger (TI max.): expiration as soon as the insufflation time reaches the maximum
Ti setting (Timax).

Automatic Test

Tests initialization Checking the integrity of sensors to begin the

tests

Circuit rinsing Eliminating the oxygen present in the system

Pneumatic check Checking the integrity of the actuators of the in-

spiratory
and expiratory branches
Calibrating the oxygen and expiratory flow sen-
sors

Mixer check Checking the mixer

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 12 Technical description

End of tests Checking the safety mechanisms

Compliance measurement
Measurement of the resistance of the inspiratory
and
expiratory circuits and their accessories

12.4.3.6 Monitoring specifications

Curves

Flow rate (L/min) Adjustable on successive scales:

-10 to +10,
-20 to +20,
-40 to +40,
-80 to +80,
-160 to +160

Pressure (cmH2O) Adjustable on successive scales:

0 to +20,
0 to +40,
0 to +60,
0 to +100

Volume (mL) Adjustable on successive scales:

0 to +80,
0 to +100,
0 to +500,
0 to +1000

PCO2 (in mmHg or kPa) Adjustable on successive scales:

or In mmHg in kPa in%
FCO2 (in%) 0 to +50, 0 to +7, 0 to +7,
0 to +150, 0 to +15, 0 to +15

Time (s) Adjustable on successive scales:

0 to +3,
0 to +9,
0 to +24

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Curves

Loop curves Pressure / Volume

Volume / Flow rate
Flow rate / Pressure
CO2/Volume (only for KB033600)

Monitoring

Conditions for measurement of flows and vol- BTPS

umes

Data storage

Trends Simultaneous display of two parameters mea-

sured during a maximum period of 80 h.
All measured parameters are accessible.

Alarm log List of alarms triggered during the use of the unit
(4000 events recorded (1))

(1) The unit records 4000 events. An event is represented by a set-point or an alarm threshold when an
adjustment is made and an alarm if triggered. Because the alarm log reports only alarm-related events,
the maximum number of events recorded can be below 4000.

12.4.3.7 Measured parameters

Measured para- Measurement Resolution Precision Filtering

meters range

Peak airway pres- 0 - 100 1 +/- (2 cmH2O + 15 ms

sure (Ppeak, 4%)
cmH2O)

Positive end of ex- 0 - 99 1 +/- (2 cmH2O + 15 ms

piratory pressure 4%)
(PEEP, cmH2O)

Plateau pressure 2 - 99 1 +/- (2 cmH2O + 15 ms

(Pplat, cmH2O) 4%)

Frequency (RR, 0 - 120 1 +/-1 bpm 4 cycles

bpm)

Insufflated tidal 0 - 3000 1 +/- (4 mL + 15%) -

volume (VTi, mL)

Leak (%) 0 - 100 1 +/- 20% -

Expired tidal vol- 0 - 5000 1 +/- (20 mL + 15%) -

ume (VTe, mL)

Expired volume 0 - 40 0.1 +/- (0.5 L/min + 30 s

per minute (MVe, 15%)
L/min)

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 12 Technical description

Measured para- Measurement Resolution Precision Filtering

meters range

FiO2 (Vol.%) 18 - 100 1 < +/- 3 abs 5s

Intrinsic PEEP(1) 0 - 99 1 +/- (2 cmH2O +

(Auto-PEEP, 4%)
cmH20)

Spontaneous ex- 0.5 - 40 0.1 +/- (0.5 L/min + 30 s

haled volume per 15%)
minute (Spont
MVe, L/min)

Ratio of inspira- 0 – 100 1 +/- 5% -

tion time to total
time (TI/Tot)

Spontaneous fre- 0 – 120 1 +/-1 bpm 4 cycles spon-

quency (spont. tanés
RR, bpm)

Percentage of 0 - 100 1 +/- 5 % -

spontaneous cy-
cles (spont%)

Peak insufflated 0 – 120 0,1 +/- (1 L/min + 125 ms

flow rate ( max 10%)
ins, L/min)

Peak exhaled flow 0 - 150 0,1 +/- (2 L/min + 125 ms

rate ( max exp, L/ 15%)
min)

Ratio of frequen- 0 - 5000 1 +/- 20% -

cy to exhaled tidal
volume (RR/VTe,
bpm/L)

Mean cycle pres- 0-99 1 +/- (2 cmH2O + -

sure (Pmean, 4%)
cmH2O)

Occlusion pres- 0-20 1 +/- (2 cmH2O + -

sure(1) (P0.1, 4%)
cmH2O)

Estimated pa- 5 - 200 0,1 +/- (5 cmH2O/(L/ -

tient resistance(1) s) + 20%)
(Rstat, cmH2O/(L/
s))

Estimated pa- 10 - 150 0,1 +/- (5 mL/cmH2O -

tient compli- + 20%)
ance(1) (Cstat,
mL/cmH2O)

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Measured para- Measurement Resolution Precision Filtering

meters range

Estimated patient 5 - 200 0,1 +/- (5 cmH2O/(L/ -

resistance (Rdyn, s) + 30%)
cmH2O/(L/s))

Estimated patient 10 - 150 0,1 +/- (5 mL/cmH2O -

compliance (Cdyn, + 30%)
mL/cmH2O)

WOB (Joule/L) 0-2 0,001 +/- 0,7 -

NIF (cmH2O) 0 – 30 1 +/- (2 cmH2O + -

4%)

Ratio of inspira- 1/20 - 1/0.3 1/0.1 +/- (1/0.3) -

tion time to expi-
ration time (I:E)

Leak rate ( leak, L/ 0 -120 1 +/- (2 L/min + -

min)) 15%)

Measured parameters related to the IRMA™ CO2 measurement probe

Fraction of CO2 at 0 – 15 0,1 +/- (0,43% abs. + -

the end of expira- 8 % rel.)
tion
(etCO2,%)

CO2 pressure at 0-100 1 +/- (3 mmHg abs. -

the end of expira- + 8 % rel.)
tion
(etCO2, mmHg)

CO2 minute vol- 0 - 9999 1 - 30s

ume (VMCO2,
mL/min))

Alveolar minute 0 – 99 0,1 - 30s

volume (Vmalv, L/
min)

Ratio of airway 0 – 100 1 - -

dead space to
tidal volume
(Vdaw/Vt,%)

Airway dead 0 – 5000 1 - -

space volume
(Vdaw, mL)

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 12 Technical description

Measured para- Measurement Resolution Precision Filtering

meters range

Slope of the vol- 0 – 99 0,1 - -

umetric capno-
gram on the
alveolar plateau
(SlopeCO2,%CO2/
L)

1) Filtering is performed with a rolling average of n samples.

Oxygen sensor specifications

Service life Approximately 5000 h (variable duration as a

function of concentration and temperature)

Conditions of use and storage Same as those of the device

Power supply Provided by the device, including during battery

operation

Calibration Calibration is automatically conducted during in-

teractive testing.
Precision is guaranteed only when there is fre-
quent calibration
(at least weekly).

Minimum flow rate to guarantee precision. 5 L/min

Drift of measurement accuracy over 6 hours < +/-3 Vol.%

Response time at 90% (extreme conditions) 45s

Response time at 90% according to the EN ISO < 10 s

80601-2-55 standard

Start time Immediate

Sampling rate of the O2 cell data 5 ms

Influence of humidity on the oxygen measure- - 0.03 (% per%RH at 25°C)

ment

Effect of pressure Compensation of the measurement as a function

of atmospheric pressure.
Compensation of the measurement at average
pressure of the respiratory cycle.

12.4.3.8 Specifications of accessories

Single-use adult patient circuit

Part No. KG019300

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Monnal T75 user manual

Single-use adult patient circuit

Resistance at 60 L/min 1.2 cmH2O

Compliance 1.2 mL/ cmH2O

Volume 1050 cm3

Single use pediatric patient circuit

Part No. KG019400

Resistance at 30 L/min 5 cmH2O

Compliance 0.6 mL/cmH2O

Volume 760 cm3

Ventilator outlet bacteriological filter

Part No. KV103300

Resistance at 30 L/min 1.7 cmH2O

Compliance 0.1 mL/cmH2O

Volume 120 cm3

12.4.3.9 IRMA™ Probe

For more information, please refer to the IRMA™ user manual from MASIMO.

12.4.4 Settings tables

Invasive ventilation

Set- Unit Adult Child Infant

points
Min. Max. Incr. Default Min. Max. Incr. Default Min. Max. Incr. Default

VT mL 100 2000 10 450 50 500 5 200 20 75 1 35

RR bpm 4 80 1 15 5 120 1 25 10 120 1 40

TI/Ttot % 5 80 1 33 5 60 1 33 5 60 1 33

I/E - 1/19 1/0.3 1/0.1 1/2t 1/19 1/0.7 1/0.1 1/2 1/19 1/0.7 1/0.1 1/2

Flow L/min 2 150 1 20 2 150 1 15 2 150 1 4

Tplat % 0 60 5 20 0 60 5 0 0 40 5 0

RR bpm 1 80 1 10 1 120 1 15 1 120 1 30

SIMV

I. Trig L/min OFF, 1* 15 1 3 OFF, 1* 15 1 3 OFF, 1* 15 1 3

cmH2O OFF, 3 0,2 0,6 OFF, 3 0,2 0,6 OFF, 3 0,2 0,6
0,2* 0,2* 0,2*

PEEP cmH2O 0 50 1 4 0 50 1 4 0 50 1 4

Tins s 0.2 10.0 0.1 1.3 0.2 8.0 0.1 0.8 0.2 3.0 0.1 0.5

PS cmH2O 2 40 1 10 2 40 1 10 2 40 1 10

PI cmH2O 2 99 1 10 2 99 1 10 2 99 1 10

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 12 Technical description

Set- Unit Adult Child Infant

points
Min. Max. Incr. Default Min. Max. Incr. Default Min. Max. Incr. Default

FiO2 % 21 100 1 60 21 100 1 50 21 100 1 35

Timax s 0.3 5 0.1 1.5 0.3 5.0 0.1 1.5 0.2 2.5 0.1 1

E. Trig % 5 90 5 30 0 90 5 30 0 90 5 30

Slope cmH2O/ 20 200 10 150 20 200 10 150 20 200 10 150

s

RR mi- bpm 1 80 1 6 1 100 1 10 1 100 1 15

ni

Sighs OFF ON -- OFF OFF ON -- OFF OFF ON -- OFF

Vtsigh x VT 1 2 0.1 1,2 1 2 0.1 1,2 1 2 0.1 1,2

PiSigh x PI 1 2 0.1 1,2 1 2 0.1 1,2 1 2 0.1 1,2

Sighs Period 9 200 1 20 9 200 1 20 9 200 1 20

T high s 0,3 30 0,1 1,5 0,2 30 0,1 1,5 0,2 30 0,1 0,5

T low s 0,1 30 0,1 0,6 0,1 30 0,1 0,5 0,1 30 0,1 0,3

P high cmH2O 2 99 1 15 2 99 1 15 2 99 1 15

P low cmH2O 0 50 1 0 0 50 1 0 0 50 1 0

according to ventilation mode

Alarms Unit Adult Child Infant

Min. Max. Incr. Default Min. Max. Incr. Default Min. Max. Incr. Default

Ppeak cmH2O 10 100 1 45 10 100 1 45 10 100 1 45

high

Pplat cmH2O OFF, 1 50 1 OFF OFF, 1 50 1 OFF OFF, 1 50 1 OFF

high

Pplat cmH2O OFF, 1 50 1 30 OFF, 1 50 1 OFF OFF, 1 50 1 OFF

high

RR low bpm 1 70 1 6 1 110 1 10 1 110 1 20

RR bpm 11 80 1 45 11 120 1 50 11 120 1 70

high

Low mL OFF 2900 10 OFF OFF 1900 10 OFF OFF 500 10 OFF
VTi

High mL 100 3000 10 3000 100 2000 10 1000 100 800 10 100
VTi

Low mL OFF, 10 2000 10 OFF OFF, 10 2000 10 10 OFF, 10 500 10 10

VTe

High mL 10 3000 10 3000 10 3000 10 1000 10 800 10 100

VTe

Low L/min 0.5 39.0 0.5 3.0 0.5 39.0 0.5 1.5 0.1 39.0 0.1 1
MVe

High L/min 1.5 30.0 0.5 25.0 1.5 40.0 0.5 10.0 1.0 40.0 0.1 5.0
MVe

FiO2 % 1,8 95 1 55 18 95 1 45 18 95 1 30
low

FiO2 % 23 100 1 65 23 100 1 55 23 100 1 40

high

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Alarms Unit Adult Child Infant

Min. Max. Incr. Default Min. Max. Incr. Default Min. Max. Incr. Default

T ap- s 15 60 1 20 4 60 1 20 2 30 1 10
nea

CO2 alarms (if the CO2 monitoring software option is enabled)

etCO2 mmHg OFF, 1 98 1 27 OFF, 1 98 1 30 OFF, 1 98 1 30

low low
% OFF, 1 14 1 4 OFF, 1 14 1 4 OFF, 1 14 1 4

etCO2 mmHg 1 99 1 49 1 99 1 49 1 99 1 49
haut
% 1 15 1 6 1 15 1 6 1 15 1 6

VM- mL/ OFF 990 10 OFF OFF 990 10 OFF OFF 990 10 OFF
CO2 min
high

VM- mL/ 10 1000 10 1000 10 1000 10 1000 10 1000 10 1000

CO2 min
high

VMalv L/min OFF 39 0,5 OFF OFF 39 0,5 OFF OFF 39 0,5 OFF
low

VMalv L/min 1 40 0,5 40 1 40 0,5 40 1 40 0,5 40

high

Settings: PRVC and PS-PRO (Invasive ventilation)

De- Min. Max. Incr. Adult Child Infant

scrip-
tion De- Min. Max. Incr. De- Min. Max. Incr. De- Maxi Pas Incr.
fault fault fault

Expi- PRVC PEP cmH2O 0 50 1 0 0 50 1 0 0 50 1 0

ratory PS
pres- PRO
sure

FIO2 PRVC FiO2 % 21 100 1 50 21 100 1 50 21 100 1 35

PS
PRO

Fre- PRVC f c/min 4 80 1 15 5 120 1 25 5 120 1 40

quen-
cy

VCRP PI cmH2O 1 1 1
Insuf- AUTO AUTO AUTO AUTO AUTO AUTO AUTO AUTO AUTO
fla-
tion 2 99 15 2 99 15 2 99 15

pres-
PS AI
sure AUTO AUTO AUTO AUTO AUTO AUTO
PRO
2 40 2 40 2 40

Pres- Pente cmH2O/ AUTO AUTO 10 150 20 200 10 150 20 200 10 150
PRVC
sure s
In- PS
crease PRO
slope

I:E VCRP Ti/ % 2 40 1 33 5 60 1 33 5 60 1 33

ratio Ttot

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 12 Technical description

De- Min. Max. Incr. Adult Child Infant

scrip-
tion De- Min. Max. Incr. De- Min. Max. Incr. De- Maxi Pas Incr.
fault fault fault

Inspi- VCRP Trig.I L/min OFF 15 1 5 OFF 15 1 5 OFF 15 1 5

ratory
trig- cmH2O 3 0.2 1 3 0.2 1 3 0.2 1
ger
PS L/min 1 15 1 5 1 15 1 5 1 15 1 5
PRO
cmH2O 0.2 3 0.2 1 0.2 3 0.2 1 0.2 3 0.2 1

Expi- PS Trig. E % 5 90 5 30 5 90 5 30 0 90 5 30
ratory PRO
trig-
ger

PS f min c/min 1 80 1 8 1 100 1 15 1 100 1 20

Mini
PRO
fre-
quen-
cy

Main- PS f ent. c/min 4 99 1 15 5 120 1 25 5 120 1 40

te- PRO
nance
fre-
quen-
cy

Vt Vt mL 2000 10 500 500 5 200 75 1 35

PRVC OFF OFF OFF
Tar- Cible
get PS 100 50 20
PRO

PI PRVC PI cmH2O 2 99 1 20 2 99 1 20 2 99 1 20
max max
PS 2 99 2 99 2 99
PRO

Non-invasive ventilation

Set- Unit Adult Child Infant

points
Min Max Incr. Default Min Max Incr. Default Min Max Incr. Default

PS cmH2O 2 25 1 15 2 25 1 15 2 25 1 15

PEP cmH2O 0 15 1 5 0 15 1 5 0 15 1 5

RR mi- c/min 1 80 1 8 1 100 1 15 1 100 1 20

ni

Timax s 0.3 5.0 0.1 1,3 0.3 5.0 0.1 1.2 0.2 2.5 0.1 0.5

I. Trig L/min 1 15 1 5 1 15 1 5 1 15 1 5

cmH2O 0,2 3 0,2 1 0,2 3 0,2 1 0,2 3 0,2 1

E. Trig % 10 90 5 50 10 90 5 50 5 90 5 50

Slope cmH2O / 20 200 10 150 20 200 10 150 20 200 10 150

s

CPAP cmH2O 2 50 1 5 2 25 1 5 2 25 1 5

Pi cmH2O 2 99 1 15 2 99 1 15 2 99 1 15

T high s 0.3 30 0.1 1.5 0.2 30 0.1 1.5 0.2 30 0.1 0.5

T low s 0,1 30 0,1 0,6 0,1 30 0,1 0,5 0,1 30 0,1 0,3

P high cmH2O 2 99 1 15 2 99 1 15 2 99 1 15

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Set- Unit Adult Child Infant

points
Min Max Incr. Default Min Max Incr. Default Min Max Incr. Default

P low cmH2O 0 50 1 0 0 50 1 0 0 50 1 0

Alarms Unit Adult Child Infant

Min Max Incr. Default Min Max Incr. Default Min Max Incr. Default

Ppeak cmH2O 10 100 1 45 10 100 1 45 10 100 1 45

high

RR low c/min 1 70 1 6 1 110 1 10 1 110 1 20

RR c/min 11 80 1 35 11 120 1 40 11 120 1 70

high

Low mL Non-adjustable alarm Non-adjustable alarm Non-adjustable alarm

VTi

High mL Non-adjustable alarm Non-adjustable alarm Non-adjustable alarm

VTi

Low mL OFF, 10 2900 10 10 OFF, 10 2900 10 10 OFF, 10 500 10 10

VTe

High mL 100 3000 10 3000 100 3000 10 1000 10 800 10 100

VTe

Low L/min OFF, 59.0 0.1 2.0 OFF, 59.0 0.1 1.5 OFF, 39 0.1 1
MVe 0.5 0.1 0.1

High L/min 1.0 60.0 0.1 30.0 1.0 60.0 0.1 10.0 0,9 40 0.1 5
MVe

FiO2 % 18 95 1 55 18 95 1 45 18 95 1 30*
low

FiO2 % 23 100 1 65 23 100 1 55 23 100 1 40*

high

T ap- s 15 60 1 20 4 60 1 20 2 30 1 10
nea

*If FiO2 set-point =35%

CO2 ALARMS (IF THE CO2 MONITORING SOFTWARE OPTION IS ENABLED)

etCO2 mmHg OFF, 1 98 1 30 OFF, 1 98 1 30 OFF, 1 98 1 30

low
% OFF, 1 14 1 4 OFF, 1 14 1 4 OFF, 1 14 1 4

etCO2 mmHg 1 99 1 49 1 99 1 49 1 99 1 49
high
% 1 15 1 6 1 15 1 6 1 15 1 6

VM- mL/ OFF 990 10 OFF OFF 990 10 OFF OFF 990 10 OFF
CO2 min
low

VM- mL/ 10 1000 10 1000 10 1000 10 1000 10 1000 10 1000

CO2 min
high

VMalv L/min OFF 39 0,5 OFF OFF 39 0,5 OFF OFF 39 0,5 OFF
low

VMalv L/min 1 40 0,5 40 1 40 0,5 40 1 40 0,5 40

high

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 12 Technical description

Suction settings

Suc- Unit Adult Child Infant

tion
Min Max Incr. Default Min Max Incr. Default Min Max Incr. Default

O2 Tar- 21 100 1 100 21 100 1 100 21 100 1 60

%
get
(Vol
O2)"

Oxy- s 30 900 10 120 30 900 10 120 30 900 10 120

gena-
tion
time

Post- s 30 300 5 120 30 300 5 120 30 300 5 120

oxy-
gena-
tion
time

Nebulization settings

Nebu- Unit Adult Child Infant

lization
Min Max Incr. Default

Flow L/min 1.0 20.0 0.5 6.0 Inactive function Inactive function

min 1 60 1 10
Nebu-
lization

dura-
tion

Fre- h 1 24 / 1 none
quency none

Oxygen therapy settings

Oxygen Unit Adult Child Infant

Min Max Incr. Default Min Max Incr. Default Min Max Incr. Default

FiO2 % 21 100 1 50 21 100 1 50 21 100 1 50

Flow L/min 2 80 1 60 2 60 1 25 2 60 1 15
rate

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Automatic alarm thresholds

VCV VPC SIMV PSIMV PSV PSV CPAP Duo PRVC PS PRO
NIV APRV Levels

P peak cmH2O P peak P peak -- P peak -- P peak

(cmH2O)
mea- mea- measured +max. (20%, +5) measured +max.
sured + sured (20%, +5)
33% +max.
(20%,
+5)

Pmin cmH2O P peak P peak -- P peak measured - max (20%, -- P peak

(cmH2O) 5)
mea- mea- measured - max
sured - sured -
33% max (20%, 5)

(20%, 5)

P plat cmH2O P plat OFF -- OFF OFF

(cmH2O) mea-
sured
+5

VTi low mL VTi OFF VTi -- -- -- VTi

(mL)
measured - 75% measured - 75% measured - 75%

VTi high mL VTi 2000 VTi -- -- -- VTi

(mL) mL
measured + 50% measured + 50% measured + 50%

MVe L/min MVe measured - 50%

low (L/
min)

MVe L/min MVe measured + MVe measured + 75% MVe MVe

high (L/ 50% mea- mea-
min) sured + sured +
50% 75%

RR low c/min RR measured - 50%

(c/min)

RR high c/min RR measured + 50%

(c/min)

VMCO2 mL/min VMCO2 measured – max(- 50%, 10)

low

VMCO2 mL/min VMCO2 measured – max(+ 50%, 30)

high

VMalv L/min VMCO2 measured – max(- 50%, 10)

low

high L/min VMalv measured – max(+ 50%, 5)

VMalv

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 12 Technical description

12.5 Testing the alarms

Alarm testing methods

Power supply failure alarm Disconnect the AC power cord.

High FiO2 alarm Temporarily change the threshold to activate the

corresponding alarm.

Low exhaled volume alarm Temporarily change the threshold to activate the
corresponding alarm.

High pressure alarm Temporarily change the threshold to activate the

corresponding alarm.

High PEEP alarm Temporarily change the threshold to activate the

corresponding alarm.

Obstruction alarm Use a suitable device to simulate obstruction of

the expiratory branch during ventilation (e.g. by
clamping the expiratory branch).

O2 supply failure alarm Disconnect the oxygen supply.

Means of testing an alarm in each category

LOW ALARM Adjust a min VTe threshold to below the mea-

sured value.

MEDIUM ALARM Adjust a min VTe threshold to below the mea-

sured value and wait three cycles. This same
alarm switches to MEDIUM.

HIGH ALARM Disconnect the hot-wire sensor in standby or ven-

tilation mode.

ULTRA ALARM Cannot be simulated without opening the equip-

ment.

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Sep;130(3):815-21.
• Brochard L., Isabey D. La ventilation non invasive. In: L. Brochard and J. Mancebo, Editors, Ventila-
tion artificielle principes et applications, Arnette Ed, Paris (1994), pp. 241–259.

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14 Appendix

14.1 Checklist
The following actions must be applied when commissioning a unit after every maintenance operation:

Done

Connect the unit to the O2 wall outlet

Check that the supply pressure is correct (between 2.8 and 6 bar).

Install the patient circuit on the device and connect a test lung.

Connect the unit to the mains power supply and check that the indicator light on the
front panel lights up.

Apply power to the unit pressing the On/Off button at the back of the device.
You should hear a BEEP and the ventilator screen should light up.

Select [New Patient], “Adult” type, in the stand-by screen, and start ventilation.
Check there is no technical alarm after 1 minute of ventilation.

Power supply
During ventilation on a test lung, disconnect the electrical connection
Check that the ventilator ventilates on its internal battery and announces this fact on
screen.
Check the battery is charged enough (3 squares at least) if an intra-hospital trans-
port is programmed. Reconnect the AC power supply. (See also Testing the alarms on
page 133)

Alarm level tone

Press the [Stand-by] key, a dialog box is displayed asking for confirmation of venti-
lation stop. Check that the alarm level tone associated to the demand of ventilation
stop is sufficient. If it’s not, see Audible alarm on page 31. Confirm the ventilation
stop.

Seal off the Y-piece and run the automatic test sequence; the message “test success-
fully completed” appears, with a compliance value.

Check that alarm transfer is operative (if used).

Select [New Patient] and the appropriate type of patient (ADULT or CHILD or INFANT)
from the stand-by screen.

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14.2 Expiratory assembly cleaning protocol

Complete operation:
1. Disassembly
2. Pre-disinfection
3. Sterilisation
4. Reassembly
Disassembly

• Disassemble the patient circuit by removing its components: pipes, fittings, water traps, and Y-
piece.
• Disassemble the expiratory assembly according to the diagram below.
• Remove the expiratory assembly from its housing by pressing the eject pushbutton.
• Remove the expiratory flow hot wire sensor (1), the valve body (2), the membrane (3), and the sili-
cone disc (4). Do not remove the two seals from the valve body (2).
CAUTION: The flow sensor requires special precautions:
• Avoid inserting any object into the flow sensor,
• Avoid exposing it to a jet of water or air,
• Avoid impacts or dropping it.
Pre-disinfection / cleaning
Immerse the expiratory assembly components in a pre-disinfectant solution: Air Liquide Medical Sys-
tems recommends the use of ANIOS products: ANIOSYME DD1, SALVANIOS PH7, HEXANIOS G+R
(obey the instructions of the product manufacturer).
Rinse the parts under running water, except for the expiratory flow sensor (1), which should only be
dipped in water.
Leave the components to dry on absorbent paper.
Sterilisation: prion cycle 134°/18 min/ 1 bar above atmospheric pressure
CAUTION: Sterilisation must be performed with care by certified personnel.

Condition the components removed from the expiratory assembly before the procedure.
The expiratory assembly can tolerate 50 sterilisation cycles. A unique serial number on the expiratory
flow sensor (1) and the valve body (2) gives the date of manufacture of the components and can be
used to track the number of cycles they have undergone.

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 14 Appendix

Reassembly
Reassemble the expiratory assembly (wear sterile gloves to do this):
- install the silicone disc in the membrane,
- reposition the membrane in the valve body.
CAUTION: Before any further use of the expiratory assembly, check that it was correctly re-
assembled by connecting it to the ventilator and performing the automatic tests.

Monnal EVA autoclavable expiratory assembly

Monnal EVA single-use expiratory assembly

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UM000103

Air Liquide Medical Systems S.A.

YL072800 - Revision 9A - 2021-06 - EN

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