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

[cid:bc332115-41df-46b9-88d5-2d5ca8557b89]

www.bomimed.cahttp://www.bomimed.cam/

[cid:7a43a1c9-f9b2-4327-b429-475792410845]https://www.facebook.com/BOMImed[cid:700f53c0-252f-42f9-b662-974062c5da6f]https://twitter.com/BOMImed[cid:f2aa14fc-fd82-4b0b-aa1a-4cd3cbb7665d]https://www.linkedin.com/company/bomimed

[cid:a343ae0e-3d30-43fe-a51e-af52660291f3]https://bomimed.ca/

*PLEASE THINK OF THE ENVIRONMENT BEFORE PRINTING THIS EMAIL. This e-mail and any attachment transmitted with it are confidential and intended solely for the person or entity to whom it is addressed. If you receive this message in error please contact the sender immediately. Any unauthorized dissemination of this e-mail or its attachments and any use of any information contained in it is strictly prohibited. Any views expressed in this e-mail are those of the individual sender and do not necessarily reflect the views of BOMImed. Whilst we use reasonable endeavors to check and virus scan all e-mails leaving the Company, BOMImed accepts no responsibility for any computer virus or for any errors or omissions in this e-mail. Please undertake your own virus checking. Please note that BOMImed reserves the right to monitor e-mail communications through its networks at all times.

*VEUILLEZ PENSER À L’ENVIRONNEMENT AVANT D’IMPRIMER CE COURRIEL.

Ce courriel ainsi que tous fichiers inclus sont privés et confidentiels et à l’usage unique de la personne ou de l’entité ci-haut mentionné. Si ce courriel vous est transmis par erreur, veuillez contacter l’expéditeur de ce courriel immédiatement. La distribution de ce courriel incluant ses fichiers et l’information qu’il contient est considérée comme illégale. Les opinions exprimés dans ce courriel reflètent ceux de l’expéditeur et non nécessairement ceux de BOMImed. Bien que nous faisons tout notre possible afin d’éviter ces situations, BOMImed n’accepte aucunement la responsabilité pour la transmission d’un virus, des erreurs ou tout manque d’information possible dans ce courriel. Il est donc important que vous vous assuriez de votre propre protection contre les virus. Veuillez noter que BOMImed se réserve le droit de surveiller toute communications par courriel à travers ses réseaux et ce, en tout temps.

Disclaimer : This email (including any attachments or enclosed documents) is intended for the addressee(s) only and may contain privileged, proprietary or confidential information. Any unauthorized use, disclosure, distribution, copying or dissemination is strictly prohibited. If you receive this email in error, please notify the sender immediately, return the original (if applicable) and delete the email. Avis : Le présent courriel (y compris toute pièce jointe) est destiné à la personne ou aux personnes à qui il est adressé, et peut contenir des renseignements confidentiels, privés ou protégés par un privilège juridique. Toute utilisation, divulgation, distribution, copie ou diffusion non autorisée est strictement défendue. Si vous avez reçu le présent courriel par erreur, veuillez en informer immédiatement l’expéditeur, retourner l’original (le cas échéant) et supprimer ce courriel.