Mainstream and Sidestream

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Mainstream and Sidestream
CAPNOSTAT 3 Mainstream CO2 Sensor
LoFloSidestream CO2 Module
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Capnography

• The standard-of-care
• Capnography
• Indicates a ventilatory event faster than any
  other type of monitoring
• Provides a means for continuous, real-time
  monitoring of ventilation
• Helps confirm ET tube placement
• Enables you to provide the same level of care
  during procedural sedation as is required in the
  O.R.

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Capnography

• Provides a time sensitive picture for the
  clinician as to the ongoing changes in a
  patients respiratory status during procedural
  sedation
• Immediate and sensitive data regarding a
  patients respiratory status for assessing the
  safety of a repeat bolus of medicine in an
  inadequately sedated patient

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Clinical Studies

• Study comparing the CAPNOSTAT mainstream with
  Microstream sidestream
• Study conducted in a neonatal NICU concluded
  that the CAPNOSTAT sensor is more accurate than
  Microstream at estimating PaCO2.

Kathleen Deakins RRT-NPS Comparison of
Microstream and Mainstream Capnography with
Arterial CO2 in Neonates University Hospitals of
Cleveland, OH FAARC 12-03
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Clinical Studies

• Procedural Sedation Study in the ED
• When the criteria of an ETCO2 gt50 mmHg, an
  absolute change gt10 mm Hg, or an absent waveform
  were applied, all respiratory distress was
  detected, not detected by pulse oximetry alone.
• The CO2 monitor represents an additional monitor
  that can add to the safety of procedural sedation
  by quickly detecting hypoventilation

Miner JR, Heegaard W, Plummer D. End-tidal
carbon dioxide monitoring during procedural
sedation. Academy Emergency Medicine.
20029(4)275-80.
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Clinical Studies

• Study comparing the CAPNOSTAT mainstream with
  Microstream sidestream in Emergency Medical
  Services
• Environmental conditions, specifically changes in
  ambient temperature
• Under the conditions of low and changing
  ambient temperature (-20 degrees C, 22 degrees
  C), only the Tidal Wave (Respironics mainstream)
  remained uninfluenced, whereas deviations of -12
  and 15 were found with the NPB-75 (Microstream
  sidestream).

Biedler A, Wilhelm W, Mertzlufft F. Portable
capnographs in emergency care a comparison of
equipment Anaesthesiol Reanim. 199924(3)71-8.
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CAPNOSTAT Mainstream Sensor

• Even under the harshest of airway conditions, the
  CAPNOSTAT sensors true single beam
• Successfully compensates for the presence of
  contaminates
• Continues to operate
• Provides accurate readings

Jaffe, MB. Mainstream or sidestream capnography?
Respironics-Novametrix White paper 1012102,
August 2002.
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CAPNOSTAT Mainstream Sensor

• Contaminate-free design
• Disposable patient sampling cuvette ensures
  analyzer is not exposed to, or contaminated with
  patient secretions, moisture, etc.
• Unaffected by patient secretions
• Microstream sidestream systems are affected by
  patient secretions
• Keeps defibrillator in service
• Reduces maintenance costs

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CAPNOSTAT Mainstream Sensor

• Family of Single Patient Use and Reusable Airway
  Adapters
• Adult, pediatric and infant
• CAPNO2mask
• For use on non-intubated patients

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CAPNOSTAT Mainstream Sensor

• No sample gas is diverted from the patient
• Typical sampling rates in sidestream systems run
  from 50cc to 250cc per minute
• Because there is no sampling, the CAPNOSTAT
  sensor is free from sample line occlusion and
  waveform distortions
• Heated sensor
• The CAPNOSTAT sensor heats the sample cell
  windows keeping them dry, minimizing effects from
  airway moisture

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Benefits of Using the CAPNOSTAT Sensor

• Superior solid state design for greater accuracy
  and robustness
• Instantaneous analysis due to no delay time and
  60ms rise time (other devices have greater than 2
  second delay time with a rise time of 200-240ms)
• Capnogram is displayed in 15 seconds, full
  specifications in 60 seconds
• Crisp waveform faithfully reflects airway
  ventilation
• Better performance at higher respiratory rates
• Relatively lightweight due to miniaturization and
  newer technologies

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Benefits of Using the CAPNOSTAT Sensor

• Low deadspace airway adapter is available for
  infants
• Airway adapter serves as the sample cell and is
  disposable
• Airway adapter is located in line with the
  patient
• No gas sampling takes place
• Analysis performed at the patient airway and
  under the same environmental conditions

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Benefits of Using the CAPNOSTAT Sensor

• Immediate response for emergency situations
• No delay in measurement
• Variety of airway adapters allows use on
  intubated or nonintubated neonatal, pediatric,
  and adult patients
• Heated sensor keeps sample cell windows dry

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LoFlo Sidestream Module - Features

• Uses the same proven analyzer and electronic
  technology as the CAPNOSTAT 3 Mainstream CO2
  sensor
• Users can seamlessly switch between the LoFlo
  Sidestream CO2 Module or CAPNOSTAT 3 Mainstream
  CO2 Sensor, to allow selection of the technology
  most suited for the application

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LoFlo Sidestream Module - Features

• Innovative disposable patent pending sample cell
  and filter
• Eliminates the possibility of contamination of
  the analyzer, thereby protecting your investment
• Sampling rate of 50ml/minute

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LoFlo Sidestream Module - Features

• Complete family of
• Adult, pediatric, and infant nasal cannula kits
• Oral/nasal cannula kits
• Sampling kits with oxygen delivery
• Adult/pediatric and infant/neonatal on airway
  adapter kits for intubated patients
• Patents pending

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LoFlo Sidestream Module - Features

• Innovative, patents pending, low deadspace
  neonatal on-airway adapter with less than 1 ml
  deadspace

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LoFlo Sidestream Module - Features

• Sample pump rated for 24,000 hours of continuous
  use
• No routine changing of the sample pump
• Typical sidestream systems sample pump rated at
  7,000 hours or less
• Patent pending CAPflow, Respironics capillary
  based flow control system permits tight control
  of flow, independent of barometric pressure
• Pump is activated automatically when the
  disposable sample cell is connected and turns off
  automatically when sample cell is removed

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LoFlo Sidestream Module - Features

• Measurement of End Tidal Carbon Dioxide (ETCO2)
  and respiration rate
• Delivers a crisp, accurate capnogram at all
  respiratory rates up to 150 breaths per minute
• Waveforms and ETCO2 readings in 15 seconds, warm
  up in less than 80 seconds,
• Full accuracy in 3 minutes
• Routine gas calibration is not required

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LoFlo Sidestream Module - Features

• 50 ml/min flowrate
• Ideal for non-intubated and intubated patients
• Interchangeable with the CAPNOSTAT 3 Mainstream
  CO2 Sensor
• No calibration required

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Benefits of Using the LoFlo Sidestream Module

• LoFlo Module plugs into the M Series and is
  interchangeable (and backward compatible) with
  the CAPNOSTAT sensor
• Care giver has the choice of using the CAPNOSTAT
  sensor or the LoFlo module
• Superior solid state design for accuracy and
  robustness
• Immediate response for emergency situations
• Integrated filter keeps sample cell windows dry

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Benefits of Using the LoFlo Sidestream Module

• Analyzer CANNOT be contaminated due to our
  Removable Sample Cell
• Family of adult, pediatric and infant sampling
  cannulas and on-airway adapter kits allows LoFlo
  to be used on intubated or non-intubated patients
• 24,000 hour rated sample pump _at_ 50 ml/min sample
  rate
• No routine service is required

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Product Summary

• ZOLL offers you the choice of using mainstream or
  sidestream ETCO2 that best fits your applications
  -
• Plug and play
• Both technologies are robust, proven solid state
• Lifetime warranty
• Analyzer in both systems CANNOT be contaminated
  by patient secretions or water
• The CAPNOSTAT sensor and LoFlo module are for use
  in all clinical areas where ETCO2 monitoring is
  required
• No routine calibration

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Clinical Summary

• Of equal importance to the ETCO2 value is the
  waveform which faithfully reflects whats
  occurring.
• Subtle changes in waveforms can indicate actual
  or impending problems with setup, airway
  mechanics, respiratory drive, cardiovascular
  systems, and other important conditions.
• The shape and trends of the CO2 waveforms contain
  valuable information that is not available from
  any other source.

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Clinical Summary

• Capnography affords the clinician breath by
  breath trending of ETCO2 and thus a noninvasive
  look at ventilation
• Trending provides information on changes in
  ventilation and perfusion

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• Thank you for visiting the ZOLL web site. If you
• have any questions or need additional
  information,
• please call 1 [phone] or [phone]
• ZOLL Medical Corporation
• 269 Mill Road
• Chelmsford, MA 01824

This material is presented with the consent of
Respironics Inc. Wallingford CT. CAPNOSTAT is a
registered trademark and LoFlo is a trademark of
Respironics, Inc. Microstream is a registered
trademark of Oridion