Piston HFO/IMV Ventilator for Neonates and Infants

Precise and powerful

HFO piston technology
from Japan to the world
 HFO ventilation can reduce premature baby and neonate m
Child mortality is a major problem

Total death
15 million under 5 yea rs
pre mature babies/ of a g e
yea r in the world
There is more than Pre matu
1 premature birth in deaths a re ba bies
every 10 births for 40% ccount

Born too
the world ea rly,
ca use of ’s biggest Born too soon
newborn
deaths UN and
leading international
orga nizations* are
More tha n ths/yea r working
1 million dea ha nd in ha nd

)
velopment Goals (MDGs
UN M illennium De
hunger
e ex tr em e poverty and
1. To eradic at
ation
iv er sa l primary educ
2. To achi ev e un ering women
d er eq ua lit y and empow
gen
3. To promote tes
ra
c hild mortality
4. To reduce
th
maternal heal diseases
5. To improve ar ia, and other
ID S , m al
HIV/A
6. To combat ainability
en vi ro nmental sust
7. To en su re opment
b al p ar tn er ship for devel
ag lo
8. To develop

* The Millennium Development Goals (MDGs) are eight international development goals that were established following
the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium
Declaration. All 189 United Nations member states at the time (there are 193 currently) and at least 23 international
organizations committed to help achieve the Millennium Development Goals by 2015.
http://en.wikipedia.org/wiki/Millennium_Development_Goals
2
e mortality
HFO ventilation is recognized worldwide as an effective
treatment for neonates and premature babies
Perinatal mortality is affected by many things but ventilation plays a major factor in the hospital treatment. HFO (high
frequency ventilation) is a gentle ventilation method that is especially effective for neonates and premature babies.
Japan has one of the world's lowest perinatal mortality rates. One reason is adoption of the latest technology. Metran
HFO ventilators are used in nearly 90% of NICUs in Japan and we are glad to be able to contribute to the high level of
neonatal care in Japan.

Perinatal mortality of various countries

Source: Japanese Public Welfare Statistical Outline Table 1-24 [Perinatal Mortality (1,000s births) of other countries, by year]

Numbers of births and mortality rates

according to BW
Source: PEDIATRICS Volume 123, Number 2, February 2009: 446

Comparison of neonatal mortality rates according to BW.

a
P < .05, bP < .01, and cP < .001 for comparisons between 2005 and 2000
Source: PEDIATRICS Volume 123, Number 2, February 2009: 447

Numbers of births and mortality rates

according to gestational age
Source: PEDIATRICS Volume 123, Number 2, February 2009: 446

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 HFO ventilation is gentler to the lungs
HFO ventilation provides sufficient and sustained exchange of gas when the stroke volume is smaller than the anatomical
dead space.
HFO pressure waves are sinusoidal and symmetrical with respect to the mean airway pressure (MAP) axis. After passing
through the endotracheal tube, the amplitude of the HFO pressure wave falls drastically upon entering the trachea so
there is minimal pressure variation at the airway periphery near the pulmonary alveoli.
Compared with continuous mandatory ventilation (CMV), HFO ventilation has much less pressure swing at any MAP and
this greatly reduces physical injury to the pulmonary alveoli.

Usage of HFO ventilation by birthweight (2003–2012)

Source: Among infants with live birth, remained and mechanical ventilation
Satoshi Kusuda, M.D.
Maternal and Perinatal Center, Tokyo Women's Medical University
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Quest for perfection

Humming Vue superior piston technology

guarantees that the volume delivered in every stroke
is exactly according to the setting in any respiratory
conditions.
The following graphs show how Metran piston
technology has evolved over 30 years.

MAP10 stroke volume per amplitude (∆P)

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 A powerful and precise piston generating oscillation
Power
Humming Vue is a high value, full-featured, flexible pediatric HFO ventilator. Like previous Metran models, Humming Vue is
a volume generator ventilator. It produces the precise stroke volume (SV) to obtain a specified amplitude pressure (∆P). SV
is similar to tidal volume in conventional ventilation. A fixed SV is guaranteed no matter how the lung compliance changes.
The tidal volume which is delivered by the stroke volume of other ventilators becomes flat after the ventilator reaches a
certain power or doesn't have the power to provide higher tidal volume.

HFO tidal volume per increase in amplitude

Vertical axis • This graph shows the change of HFO tidal volume (HFO Vte) for various models with MAP fixed at
HFO Vte: HFO tidal volume 10 cmH2O and amplitude (stroke volume) at maximum power according to each device.
Horizontal axis HFO Vte was measured during 100%, 75%, 50% and 25% of full power during HFO.
Amplitude (∆P): Stroke volume • Test lung compliance = 2.0 mL/cmH2O

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Precision
Our technology allows us to precisely control piston movement to within 13 microns. Humming Vue allows fine setting of
stroke volume with resolution as fine as 0.2 mL. This is critical when treating very small babies.
Due to constant feedback, our system can maintain the same HFO Vte even after changing the MAP setting.

Tidal volume per change in MAP

Vertical axis
• This graph shows HFO Vte when changing MAP setting with the ventilator at 50% of its maximum
HFO Vte: HFO tidal volume
amplitude.
Horizontal axis
• Test lung compliance = 2.0 mL/cmH2O
MAP: Mean airway pressure

MAP analysis of HFOV with model lung

Amplitude in relation to Stroke Volume

Source: Keiichi Kanno1, Masaki Shimizu1, Kouichi Takeda2
(1) Department of Neonatology, Saitama Children’s Medical Center, Saitama,
Japan
(2) Metran Co., Ltd., Saitama, Japan
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 Safety with a variety of settings
Appropriate amplitude and SV
If amplitude is set, the SV is automatically adjusted to maintain
that amplitude.
If SV is set, the amplitude changes according to the SV
setting. You can confirm the lung condition by changing the
amplitude or flow.
Even if ventilation is started or after changing the circuit, safe
ventilation is assured with appropriate amplitude and SV.

Auto SI
Lung recruitment can be performed periodically
from 0.5–10 s (1 to 120 times/hour).

Enhanced conventional modes

In addition to HFO, some of the Humming Vue models have enhanced conventional ventilation modes such as APRV and
NIV. All modes support treatment of any case.
A new feature VA (Volume Assured) can support respiration control by prioritizing ventilation volume.
Modes and breath types
SIMV: PC, VC, VA
A/C: PC, VC, VA
APRV

VA (Volume Assured)
In addition to VC or PC, Humming Vue also has
VA mode which is volume control ventilation with
pressure correction. VA supports respiration control
especially when CO2 control is prioritized.

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Sync+ (Sync Plus)
Sync+ is available for PC-SIMV. When the patient
has spontaneous breathing, Sync+ uses PS to
support those efforts.
When the patient experiences apnea, mandatory
ventilation automatically starts after the respiration
rate falls below the setting. Sync+ gives you flexible
respiration control, especially in neonatal patients
with sudden apnea.

Enhanced non-invasive modes

Humming Vue has improved non-invasive modes to support optimum ventilation, like CPAP, NIV and N-CPAP. Popular
high-flow therapy is available with cannulas. Humming Vue provides a variety of respiration control to support optimum
patient care.

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 Monitoring
Color touch screen High visibility alarms
The easy-to-see 15-inch color touchscreen and Humming vue has different colors and patterns to make
operation knob provide intuitive operation. it easy to check the alarm status. The alarm history and
operation history are also color coded according to
priority.

Alarm High priority

Medium priority
Low priority

Alarm canceled

Time-linked
Trend graphs and logs are time-linked. This enables you
Flexible setting to easily access any necessary information. When you
The monitoring parameters can be customized to match switch screens, the same event is clearly displayed in
the ventilation mode. both trend graphs.

360° alarm
PV, PF and FV loops indicator
You can select two
An alarm indicator on top of
loops from PV, PF and
the ventilator can be seen
FV.
from all directions.

Remote SI
Even if you are not near Humming Vue, manual breath/
HFO SI can be provided by a remote control.

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Specifications
Ventilation modes SIMV, A/C, APRV*, CPAP, N-CPAP*, NIV*, HFO, Standby
Breath types PC, VC*, VA*, HFO
*Options of Humming Vue Plus and Humming Vue Advanced. APRV, VC and VA are available for Humming Vue Advanced only.

Settings and Range

Inspiration pressure 5–80 cmH2O IMV base flow 3–20 Lpm
Inspiration time 0.1–3.0 s Sync+ On, Off
Tidal volume 2–300 mL Tube diameter 2.0–8.0 mm
Inspiration flow 3–30 Lpm Tube length 30–300 mm
Flow pattern Square, Decelerating Tube compensation Off, 0–100%
Plateau time 0–2.0 s N-CPAP flow 3–30 Lpm
PEEP/CPAP 0–30 cmH2O Amplitude 0–200 cmH2O
Breath rate 1–150 bpm Stroke volume 0–160 mL
Breath rate (NIV) 0–150 bpm Maximum stroke Freq (Hz): <9 10 11 12 13 14 15 16 17
volume according to
Backup rate 1–150 bpm frequency Max SV (mL): 160 154 148 130 120 112 106 99 89
PSV (above PEEP) 0–50 cmH2O
MAP 3–40 cmH2O
PSV (above P-high) 0–15 cmH2O
Frequency 5–17 Hz
Exhalation trigger 10–90%
SI pressure 3–50 cmH2O
Trigger type Pressure, Flow
SI time Off, 0.5–10 s
Trigger sensitivity Press: Off, -0.1 to -10.0 cmH2O
SI cycles 1–120 cph
Flow: Off, 0.2–10.0 Lpm
HFO base flow 10–30 Lpm
P-high 1–80 cmH2O
Amplitude control On, Off
P-low 0–30 cmH2O
Auto SI On, Off
T-high 0.1–30 s
Oxygen saturation 21–100%
T-low 0.1–2.0 s
Flush iO2 21–100%
Rise tme 0.1–0.9 s

Alarms
Types High priority 5 consecutive beeps Lamp: red Message: red Blinks two times per second
Medium priority 3 consecutive beeps Lamp: yellow Message: yellow Blinks once every 2 seconds
Low priority 2 consecutive beeps Lamp: yellow Message: green Lit continuously in yellow
Power failure Continuous buzzer sound Lamp: red Blinks two times per second
Alarm suspend Audio alarm can be silenced for 30, 60, 90 or 120 seconds by pressing the alarm suspend button

Monitoring Data and Waveforms

Data Peak inspiratory pressure, Mean airway pressure, PEEP/CPAP, Plateau, IE ratio, Overall breath rate, Spontaneous breath rate,
Tidal volume, Minute volume, Proximal leak, Dynamic compliance, FiO2, P-high*, P-low*, N-CPAP**, Amplitude***, MAP***,
SI pressure***, HFO base flow***, Vhfo***, SI time***
Waveforms Pressure, Flow, Volume (excluding HFO), Pressure-volume loop, Pressure-flow loop, Flow-volume loop
*APRV mode, **N-CPAP mode, ***HFO mode

Operating Conditions
Gas supply input Pressure: 0.3–0.5 MPa, Minimum flow: 100 Lpm
Protection level against electric shock Class 1 equipment
Degree of protection against electric shock Type B applied part
Water resistance IPX0
Dimensions (W) × (D) × (H) 517 × 691 × 1,350 mm including stand
517 × 489 × 568 mm main unit only
Weight Main unit: 38 kg, Main unit and stand: 55 kg
Power AC 100–240 V 50/60 Hz, 200 VA
Environmental operating temperature 10–40 °C
Humidity 10–95% RH (non condensing)
Altitude -300–3,000 m

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 This brochure may be revised or replaced by Nihon Kohden at any time without notice.

Metran Co., Ltd.

2-12-18 Kawaguchi, Kawaguchi-shi, Saitama 332-0015, Japan
Phone +81 (48) 242-0333 Fax +81 (48) 242-0550
www.metran.co.jp/en support_en@metran.co.jp

7403 CAT.No.62-030A ’15.08. CLB. C