Hi everyone,

In follow-up to our recent discussion on A9 default settings, please see response below from BomiMed.

For pressure support triggering: On the surface, I think it makes more sense to have a less sensitive trigger (pressure) in the OR, but I don't feel strongly either way.

I also don't feel strongly about I:E vs Ti as the default variable. Sounds like both are used across the country. Either way, increasing the default respiratory rate from 8 to 12 will improve the I:E. If we do switch to I:E as the default variable, the preferred ratio was 1:2.5

I'll be putting up some sheets on the white board in our lounge for people to vote. I'll leave them up till mid January in order to allow people to return from holidays.

Marshall Tenenbein, MD, FRCPC

Site Specialty Lead - Anesthesia, Health Sciences Centre
Assistant Professor
Department of Anesthesiology, Perioperative, and Pain Medicine
Max Rady College of Medicine, University of Manitoba

From: Cynthia Boily [CBOILY@bomimed.com]
Sent: Tuesday, December 23, 2025 2:08 PM
To: Marshall Tenenbein, Dr.; Cory Olivier
Cc: Robert Hardy; Chrissy Ormiston; Renate Singh; Sonia Larouche; David Friesen; Vincent Wourms
Subject: Re: [EXTERNAL] RE: A9 Default Settings

Hi everyone,

I hope you are all doing well. I would like to take this opportunity to wish you all a wonderful holiday season.

As Cory mentioned, we will be happy to readjust the configuration of your A9s to suit your needs at the same time as we configure the machines at the other site (Women's) to match all the configurations together.

Here are the changes requested for now:

PCV-VG: initial settings to be changed for 12x500ml (instead of 10x425ml).

I:E vs Ti: Like Cory said, the choice between I:E vs Ti is up to the customer, according to preference. We see both around the provinces and the country, so it's really up to your needs. I just want to clarify, however, that you have the option of setting I:E or Ti as the default for all modes (VCV, PCV, PCV-VG, CPAP/PS) except SIMV modes, where it is automatically a Ti adjustment. We can, of course, change the default Ti adjustment to I:E adjustment.
CPAP/PS trigger:
- Indeed, in the default settings, we set the trigger in pediatrics to flow trigger, and for adult patients, we set the default trigger to pressure trigger -1 cmH20. Is that what you have?
- The reason behind this is that the A9 has a very high-performance, and therefore very sensitive ventilator, closer in performance to an ICU ventilator. In the OR, patients are often hyperdynamic or, depending on the surgery, the surgeon often presses on the patient's abdomen. When either of these situations occurs, the variation in flow caused by the heart pressing on the diaphragm (hyperdynamic patient) or by the abdomen pressing on the diaphragm (when the surgeon presses on the abdomen) can cause auto-triggering if the trigger is adjusted to flow trigger.
- However, with a pressure trigger, auto-triggering of this kind is avoided, which is why a pressure trigger of -1 cmH₂O (which is fairly easy to trigger) is set as the default for adult patients.
- Of course, this setting can always be modified in your configuration, but I invite you to try different trigger levels (flow and/or pressure) to see which adjustment you prefer.

I wish you a happy end to the year!

Cynthia Boily, inh/RT

Spécialiste Clinique/Clinical Specialist - Ventilation and anesthesia

c. 819-570-7355

www.bomimed.ca

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