Elisee350中文操作培訓(xùn)ppt課件

1、Waking people up to sleepElise產(chǎn)品特點產(chǎn)品特點杰出性能源于科技杰出性能源于科技患者適用范圍患者適用范圍 簡約直觀操作的界面簡約直觀操作的界面 整體化氣路構(gòu)造整體化氣路構(gòu)造鞏固的整體、一體化的氣路構(gòu)造-鞏固耐用，缺點率低-緊湊的氣路機械死腔最小，反響最快，呼吸同步性更好-氣路系統(tǒng)的順應(yīng)性更小，呼吸機的壓力/流量/容量輸出更準確-一體化設(shè)計交融了當今工業(yè)設(shè)計、制造和工藝最新技術(shù)超強的供氣才干超強的供氣才干“人機協(xié)調(diào)性觸發(fā)技術(shù)人機協(xié)調(diào)性觸發(fā)技術(shù) 自動呼氣觸發(fā)功能：具備先進的呼氣觸發(fā)敏感度自動呼氣觸發(fā)功能：具備先進的呼氣觸發(fā)敏感度ETS自動調(diào)自動調(diào)理功能理功能自動能量轉(zhuǎn)移

2、觸發(fā)原理表示圖自動能量轉(zhuǎn)移觸發(fā)原理表示圖對患者波形的控制對患者波形的控制 方波或遞增波：具備氣道壓力上升斜率調(diào)理功方波或遞增波：具備氣道壓力上升斜率調(diào)理功能，順應(yīng)不同病人自主呼吸的吸氣用力的需求能，順應(yīng)不同病人自主呼吸的吸氣用力的需求，保證了病人溫馨性和同步性，保證了病人溫馨性和同步性 減速波形：減速波形：全面、完善、適用的呼吸方式和通氣方式全面、完善、適用的呼吸方式和通氣方式窒息后備保證功能窒息后備保證功能肺部復(fù)張工具肺部復(fù)張工具什么是肺復(fù)張戰(zhàn)略什么是肺復(fù)張戰(zhàn)略What is a recruitment maneuver?Periodic increase of insufflation p

3、ressure beyond the tele-inspiratory pressure released during the conventional ventilation cycles肺復(fù)張的目的肺復(fù)張的目的What is the aim of a maneuver recruitment ? To avoid atelectasy : sagging of air cells那些病人需求適用該項功能那些病人需求適用該項功能For which patients ?For neuromuscular patients which air cells could easily collap

4、seNot for COPD patients or all obstructive patients !同常規(guī)的嘆息功能比較有什么優(yōu)勢同常規(guī)的嘆息功能比較有什么優(yōu)勢?Pressure control. Indeed, in case of a sigh, a volume parameter is set up. Therefore the pressure is not controlled. In order to avoid barautroma, An HP alarm must be adjustedLong opening of air cellsElisee 呼吸報警設(shè)定、呼吸

5、監(jiān)測界面呼吸報警設(shè)定、呼吸監(jiān)測界面病人數(shù)據(jù)監(jiān)測、存儲、回想、分析病人數(shù)據(jù)監(jiān)測、存儲、回想、分析報警設(shè)定報警設(shè)定呼吸力學(xué)監(jiān)測呼吸力學(xué)監(jiān)測15英寸彩色觸摸屏幕英寸彩色觸摸屏幕 Its as easy as 實時數(shù)據(jù)監(jiān)測區(qū)域?qū)崟r數(shù)據(jù)監(jiān)測區(qū)域當前當前設(shè)置設(shè)置形狀形狀顯示顯示區(qū)域區(qū)域?qū)崟r波形實時波形、向量環(huán)、向量環(huán)監(jiān)測顯示監(jiān)測顯示區(qū)域區(qū)域分析分析工具工具區(qū)域區(qū)域技術(shù)維護菜單技術(shù)維護菜單技術(shù)維護菜單使得日常維護任務(wù)更為簡單容易技術(shù)維護菜單使得日常維護任務(wù)更為簡單容易 :調(diào)整呼吸機的傳感器調(diào)整呼吸機的傳感器調(diào)整供氣的傳感器調(diào)整供氣的傳感器不需求裝配設(shè)備不需求裝配設(shè)備 ! 同時按壓下按鈕同時按壓下按鈕 和和外

6、觀、分量、電源外觀、分量、電源尺寸尺寸 : 290 x 250 x 130 毫米毫米分量分量 :4,5 kg, ventilator only with internal battery0,4 kg, mains supply pack1,1 kg, external battery pack電源電源 :可外接直流電源可外接直流電源內(nèi)置電池內(nèi)置電池 : 不低于不低于4小時小時 外置電池外置電池 :不低于不低于4小時小時 (選配件選配件)Ventilation performances are preserved during the whole time of discharge擴展晉級功能擴

7、展晉級功能Optional 5個通氣預(yù)設(shè)程序規(guī)范2個 霧化吸入 2分鐘純氧吸入 P0.I 、阻力及順應(yīng)性丈量 吸氣堅持、呼氣堅持、手動通氣Waking people up to sleepElise操作培訓(xùn)操作培訓(xùn)產(chǎn)品引見目錄產(chǎn)品引見目錄呼吸的引見呼吸回路的銜接啟動/封鎖呼吸機通氣方式通氣參數(shù)報警管理FiO2通氣觀測技術(shù)維護菜單呼吸力學(xué)通氣方式的選擇霧化吸入成比例三項自動呼氣閥 (雙回路)送氣端口 觸摸屏幕呼吸機描畫呼吸機描畫主電源 / 外接電源形狀指示燈報警銷音按鈕藍牙信號指示燈內(nèi)置 / 外置電池形狀指示燈呼吸機描畫呼吸機描畫氧電池 開 / 關(guān) 按鈕遠程報警控制接口信號輸出端口低壓氧源空氣入

8、口空氣入口霧化端口高壓氧源12-28V外接直流電源基座呼吸回路銜接呼吸回路銜接銜接單/雙肢呼吸回路只需經(jīng)過卡扣，即可輕松銜接/裝配卡扣基準點在進展手動測試時，能自動探測到呼吸回路銜接的方式。不需任何工具不需任何工具 !呼吸回路銜接呼吸回路銜接2種呼氣閥可供選擇 : 單回路 呼氣閥上集合了外接呼氣閥控制端口及近端壓力傳感管端口外接呼氣閥控制端口近端壓力傳感線端口病人呼吸回路(直徑 22 mm)呼吸回路銜接呼吸回路銜接2種呼氣閥可供選擇 : 雙回路 成比例三項自動呼氣閥上集成了多項傳感及控制部分，允許銜接雙肢呼吸回路.患者呼氣口吸氣管路 (規(guī)范直徑 22 mm)呼氣管路(規(guī)范直徑 22 mm)呼吸

9、機的啟動呼吸機的啟動經(jīng)過按壓按右側(cè) 按鈕啟動設(shè)備隨即出現(xiàn)以下歡迎運用界面 :顯示最新的檢測結(jié)果選擇預(yù)先設(shè)定方式選擇設(shè)定新方式選擇先前運用的方式呼吸機的封鎖呼吸機的封鎖經(jīng)過按壓按右側(cè) 按鈕封鎖設(shè)備根據(jù)當前所處的不同形狀, 會出現(xiàn)以下兩種界面中的一個 :確認想要封鎖呼吸機正在通氣正在通氣未啟動通氣未啟動通氣手動測試手動測試測試前預(yù)備測試前預(yù)備 :銜接好通氣時所需一切附件銜接好通氣時所需一切附件將呼吸機同患者之延續(xù)開將呼吸機同患者之延續(xù)開如未經(jīng)過測試如未經(jīng)過測試, 請通知技術(shù)效力機構(gòu)請通知技術(shù)效力機構(gòu)手動測試手動測試通氣方式選擇通氣方式選擇n 5 個預(yù)設(shè)通氣程序n 存儲了通氣所需調(diào)整一切參數(shù) :n-

10、 通氣方式n- 患者類型n- 通氣參數(shù)n- 報警設(shè)置區(qū)別對待患者區(qū)別對待患者 白天白天/夜間夜間 的通氣的通氣需求需求 !減少對醫(yī)護人員的培訓(xùn)任務(wù)減少對醫(yī)護人員的培訓(xùn)任務(wù) !通氣方式選擇通氣方式選擇新方式設(shè)定新方式設(shè)定 按壓 “New patient按鈕，進入新通氣方式設(shè)定程序 隨即，出現(xiàn)如下患者類型選擇界面:Each element of the configuration is reminded on the screen thanks to an icon 新方式設(shè)定新方式設(shè)定一旦，確認了患者通氣類型后, 隨即會出現(xiàn)通氣方式選擇確認界面:壓力方式壓力方式容量方式容量方式雙控制方式雙控制方

11、式通氣方式確認后, 隨后出現(xiàn)參數(shù)設(shè)定界面通氣方式通氣方式 : P(A)CVIn P(A)CV mode, the user can set recruitment cyclesMore about recruitment :通氣方式通氣方式 : P(A)CVOn P(A)CV mode, the parameters to set are :FiO2Inspiratory PressurePositive End Expiratory Pressure (PEEP)FrequencyInspiratory timeFlow or Pressure Inspiratory trigger in

12、Invasive ventilationInspiratory trigger in NIVInspiratory slope可設(shè)置運用可設(shè)置運用“肺復(fù)張參數(shù)肺復(fù)張參數(shù) :Recruitment periodRecruitment durationRecruitment pressure or通氣方式通氣方式 : P(A)CVThis mode is recommended at the beginning of weaning to facilitate the adaptation of the patient to the ventilator 通氣方式通氣方式 : (A)CVIn (A

13、)CV mode, the user can set recruitment cyclesMore about recruitment :通氣方式通氣方式 : (A)CVOn (A)CV mode, the parameters to set are :FiO2Tidal VolumePositive End Expiratory Pressure (PEEP)FrequencyInspiratory time or I/E ratio or Maxi flowFlow or Pressure Inspiratory trigger in Invasive ventilationInspira

14、tory trigger in NIVFlow shapePlateau timeorRecruitment parameters may be set up :Recruitment periodRecruitment durationRecruitment pressure 通氣方式通氣方式 : (A)CV(exaggerated patients demand) 通氣方式通氣方式 : PSIMVPSIMV = 同步間歇指令通氣壓力控制同步間歇指令通氣壓力控制This ventilation mode allows to alternate pressure assisted contro

15、lled ventilation and Pressure Support (PS) cycles initiated by the patientWhen the PSIMV mode is selected, an access to “Pressure Support adjustment is available from the first screen of parameters adjustmentSuited for weaning and in case of sedation decreasing !通氣方式通氣方式 : PSIMVOn PSIMV mode, the pa

16、rameters to set are :FiO2Inspiratory pressurePositive End Expiratory Pressure (PEEP)FrequencyInspiratory timeInspiratory slopeThe adjustable parameters of Pressure Support are :Pressure SupportInspiratory slopeFlow or Pressure Inspiratory trigger in Invasive ventilationInspiratory trigger in NIVExpi

17、ratory triggerMaximum inspiratory timeor通氣方式通氣方式 : PSIMV通氣方式通氣方式 : SIMVSIMV =同步間歇指令通氣容量控制同步間歇指令通氣容量控制This ventilation mode allows to alternate flow assisted controlled ventilation and Pressure Support (PS) cycles initiated by the patientWhen the SIMV mode is selected, an access to “Pressure Support

18、adjustment is available from the first screen of parameters adjustment通氣方式通氣方式 : SIMVOn SIMV mode, the parameters to set are :FiO2Tidal VolumePositive End Expiratory Pressure (PEEP)FrequencyInspiratory time or I/E ratio or Maxi flowFlow shapePlateau TimeThe adjustable parameters of Pressure Support

19、are :Pressure SupportInspiratory slopeFlow or Pressure Inspiratory trigger in Invasive ventilationInspiratory trigger in NIVExpiratory triggerMaximum inspiratory timeor通氣方式通氣方式 : SIMVIt is particularly recommended for treatment of chronic respiratory insufficiencies通氣方式通氣方式 : PSPrinciple :The beginn

20、ing and the end of the inspiratory cycle are initiated by the patient. However, Elise 350 is provided with a minimum frequency parameter : if the number of patient initiated breaths is lower than Fmini, the ventilator releases support breaths.通氣方式通氣方式 : PSApnea ventilation in pressureApnea ventilati

21、on in volumeApnea ventilation = Exclusive to Elise 350 !通氣方式通氣方式 : PS On PS mode, the parameters to set are : FiO2 Pressure Support Positive End Expiratory Pressure (PEEP) Inspiratory slope Leak Alarm threshold Flow or Pressure Inspiratory trigger in Invasive ventilation Inspiratory trigger in NIV E

22、xpiratory trigger Maximum inspiratory timeor通氣方式通氣方式 : PSThe adjustable parameters of Pressure Support in pressure are :Apnea TimeInspiratory Pressure FrequencyInspiratory time The adjustable parameters of Pressure Support in volume are :Apnea TimeTidal Volume FrequencyInspiratory time or I/E ratio

23、or Maxi flow通氣方式通氣方式 : PS 臨床治療運用 :Because of its functioning, the PS mode allows to help and reduce the work of respiratory musclesTherefore, it is recommended for postoperative ventilation rehabilitation and in physiotherapyIt is also recommended for weaning通氣方式通氣方式 : PS.VTPS-VT = 壓力支持潮氣量保證雙方式通氣壓力支

24、持潮氣量保證雙方式通氣Pressure Support with guaranteed tidal volumeThis ventilation mode is described as a dual mode : it requires setting a pressure support and a target tidal volume that must be reached for each cyclePrinciple :The delivered cycle starts in PS ventilation. Every 10 minutes, Elise 350 calcula

25、tes if the tidal volume parameter can be delivered, according to the already supplied Vt and the remaining inspiratory timeIf the calculation foresees that Vt parameter can be reached, then Elise 350 stands in Pressure Support for the rest of the cycleOtherwise, if the calculation concludes that Vt

26、parameter will not be reached in PS, then Elise 350 insufflates the remaining volume while maintaining a constant flow until volume parameter is reached通氣方式通氣方式 : PS.VTPS.VT mode also allows to set an apnea time at the end of which the ventilator switches to apnea ventilation if the patient has not

27、breathedApnea ventilation setting is only available when Fmini = NOIf the patient initiates a breath afterwards, ventilation switches back to pressure supportApnea ventilation = Exclusive to Elise 350 !Apnea ventilation in pressureApnea ventilation in volume通氣方式通氣方式 : PS.VT On PS.VT mode, the parame

28、ters to set are : Pressure Support Positive End Expiratory Pressure (PEEP) Tidal Volume Leak Alarm threshold Flow or Pressure Inspiratory trigger in Invasive ventilation Inspiratory trigger in NIV Expiratory trigger Maximum inspiratory timeor通氣方式通氣方式 : PS.VTThe adjustable parameters of Pressure Supp

29、ort in pressure are :Apnea timeInspiratory pressure FrequencyInspiratory time The adjustable parameters of Pressure Support in volume are :Apnea timeTidal VolumeFrequencyInspiratory time or I/E ratio or Maxi flow通氣方式通氣方式 : PS.VTare likely to changeIt is recommended for patients who are in weaning te

30、st of a respiratory insufficiency通氣方式通氣方式 : CPAP CPAP = 繼續(xù)氣道正壓通氣The patient can breathe spontaneously thanks to a PEEP levelThe device counters the depression caused by the inspiration with a flow increase. During expiration, a back pressure on the exhalation valve maintains the expiratory pressure

31、at the pressure level set by the user通氣方式通氣方式 : CPAP 臨床治療 運用: 阻塞性睡眠呼吸暫停Obstructive Apnea Sleep syndrome 肺動脈瓣狹窄Pulmonary oedema通氣參數(shù)定義通氣參數(shù)定義Pressure Support (cmH2O) :在患者吸氣循環(huán)中呼吸機在在患者吸氣循環(huán)中呼吸機在PEEP壓力之上，額外給予的一個壓力程壓力之上，額外給予的一個壓力程度度Maxi flow (l/min) :呼吸機給患者供氣時所能提供的最大吸氣流速，在容量控制通氣中會直接呼吸機給患者供氣時所能提供的最大吸氣流速，在容量控

32、制通氣中會直接影響到所需吸氣時間的長短影響到所需吸氣時間的長短Flow shape :僅在容量控制方式中有效僅在容量控制方式中有效,可以患者吸氣項進展繼續(xù)遞增或遞減流速可以患者吸氣項進展繼續(xù)遞增或遞減流速Frequency (cycles/min) :一分鐘內(nèi)所呼吸總的次數(shù)一分鐘內(nèi)所呼吸總的次數(shù)Inspiratory slope :僅在壓力控制方式中有效僅在壓力控制方式中有效, 其意義為要到達設(shè)定的目的壓力值而所需求其意義為要到達設(shè)定的目的壓力值而所需求破費的時間破費的時間通氣參數(shù)定義通氣參數(shù)定義Positive End Expiratory Pressure (cmH2O) :由呼吸機維持的

33、，患者在呼氣循環(huán)期間繼續(xù)堅持的一個正壓力由呼吸機維持的，患者在呼氣循環(huán)期間繼續(xù)堅持的一個正壓力Inspiratory Pressure (cmH2O) :患者在輔助患者在輔助/控制呼吸循環(huán)中的吸氣項時，呼吸機提供的一個高于控制呼吸循環(huán)中的吸氣項時，呼吸機提供的一個高于PEEP的壓力的壓力值值I/E ratio (1/x) :在在1次呼吸中，吸氣所用時間和呼氣所用時間之間的比值次呼吸中，吸氣所用時間和呼氣所用時間之間的比值A(chǔ)pnea Time (s) :僅在自主呼吸方式下有效僅在自主呼吸方式下有效, 其表示為一段時間區(qū)間之后，如呼吸機未探其表示為一段時間區(qū)間之后，如呼吸機未探測到患者的呼吸循環(huán)，

34、患者能夠出了現(xiàn)窒息的情況。測到患者的呼吸循環(huán)，患者能夠出了現(xiàn)窒息的情況。通氣參數(shù)定義通氣參數(shù)定義Inspiratory Time (s) :從吸氣流速而時間區(qū)間Time space between the beginning of inspiratory flow and the beginning of expiratory flowMaximum Inspiratory Time (s) :呼吸機向患者輸入氣體所需最長時間區(qū)間，設(shè)定潮氣量到達與否呼吸機向患者輸入氣體所需最長時間區(qū)間，設(shè)定潮氣量到達與否Expiratory Trigger :到達一個規(guī)定的界定值時，引起的呼氣循環(huán)到達一個規(guī)定

35、的界定值時，引起的呼氣循環(huán). 定義為最大峰值流速的定義為最大峰值流速的% 或自動觸發(fā)規(guī)范或自動觸發(fā)規(guī)范Inspiratory Trigger :到達一個規(guī)定的界定值時，引起的吸氣循環(huán)到達一個規(guī)定的界定值時，引起的吸氣循環(huán). 觸發(fā)的方式觸發(fā)的方式有有 :流速觸發(fā)流速觸發(fā)Flow trigger壓力觸發(fā)壓力觸發(fā)Pressure trigger在無創(chuàng)通氣中的觸發(fā)在無創(chuàng)通氣中的觸發(fā)Non invasive trigger通氣參數(shù)定義通氣參數(shù)定義Tidal Volume (ml) :吸氣或呼氣時間內(nèi)患者所吸入或呼出的氣體容量吸氣或呼氣時間內(nèi)患者所吸入或呼出的氣體容量FiO2 (%) :患者吸入氣體內(nèi)氧氣

36、所占的百分比患者吸入氣體內(nèi)氧氣所占的百分比Plateau time (s) :Time during which insufflation is maintained nil at the patient level參數(shù)設(shè)置參數(shù)設(shè)置要設(shè)置某項參數(shù)時, 只需按壓下相對應(yīng)的圖標隨即彈出增減調(diào)理按鈕 和 調(diào)整至需求運用的數(shù)值后, 按壓 按鈕進展確認修正提示但前通氣方式提示但前患者形狀前往至方式設(shè)定界面 確認后進入報警設(shè)置界面按壓“start ventilation開場通氣其它參數(shù)設(shè)定界面擴展特點擴展特點進入擴展特點設(shè)置界面 :擴展特點擴展特點BTPS 校正校正 : 氣體溫度和壓力校正氣體溫度和壓力校

37、正當呼吸機啟用該功能后進展自動的校正當呼吸機啟用該功能后進展自動的校正僅限于丈量呼出潮氣量僅限于丈量呼出潮氣量 (Vte)If BTPS = NO ATPD (Ambient Temperature Pressure & Dryness)RC 自動丈量自動丈量患者肺部力學(xué)情況患者肺部力學(xué)情況 :每隔每隔 15 分鐘自動丈量阻力和順應(yīng)性分鐘自動丈量阻力和順應(yīng)性僅有限于在有創(chuàng)通氣的僅有限于在有創(chuàng)通氣的ACV 方式方式擴展特點擴展特點多種氧源多種氧源 高壓高壓 / 低壓氧源低壓氧源更好的適宜各種供氧條件更好的適宜各種供氧條件可在可在Ti, maximum flow 或或 I/E 中選擇運用查

38、看方式中選擇運用查看方式:僅限于在僅限于在 ACV 方式方式 !報警管理報警管理 Two independent systems to trigger audible alarms 1 voice synthesis Adjustable volume Controlled by the main microprocessor 1 buzzer controlled by : The main microprocessor The alarm microprocessor An hardware independent system supplied by an extra battery通氣

39、報警通氣報警需求設(shè)置報警參數(shù)時，可經(jīng)過按壓 按鈕直接進入呼吸機報警設(shè)置界面隨即出現(xiàn)如圖參數(shù) : 報警參數(shù)的調(diào)理方式和通氣參數(shù)調(diào)理方式是一樣的！報警參數(shù)的調(diào)理方式和通氣參數(shù)調(diào)理方式是一樣的！FiO2 Elise 350 automatically manages FiO2 value according to FiO2 parameterFiO2 Elise 350 automatically manages FiO2 value according to FiO2 parameterFiO22分鐘純氧功能分鐘純氧功能O2 100 %- 按壓按壓 圖標按鈕后可獲得兩分鐘的純氧通氣圖標按鈕后可獲得

40、兩分鐘的純氧通氣 - 在運用高壓供氧方式時，該功能有效在運用高壓供氧方式時，該功能有效低壓供氧低壓供氧高壓供氧高壓供氧FiO2O2Flow-by with oxygen+/- Inspiratory flow+/- Flow trigger +/- Flow-byFiO2圖形圖形 :Inspi.Expi.流速曲線O2 concentration at level patientSAIME systemOther systemAn important oxygen peak can be delivered at the very beginning of the inspiration pha

41、se where the flow is the most important減少對氧氣的耗費減少對氧氣的耗費通氣察看通氣察看When the ventilation begins, a screen that allows to control on ventilation curves automatically appears From that screen, the user can have a look at the ventilation thanks to the following elements :Bargraph of instantaneous pressurePr

42、essure curve Flow curve Ventilation measuresTrigger通氣察看通氣察看By pressing on one of the 4 displayed measures at the bottom of the screen, you have direct access to the measures screen Choice between 11 measuresReal time display of the values 通氣察看通氣察看From curves screen, the evolution of measures can be

43、frozen by pressing one of the curvesPress on any point of the curves to display the corresponding valuePossibility to determine value between two points治療控制治療控制 : 事件回放事件回放 The journal of events registers : The whole of alarms release / stop Every act made on the ventilator : Start / Stop of the vent

44、ilation Start / Stop of the ventilator Change of the ventilation parameters value Start / Stop of the alarms Change of the alarms threshold呼吸力學(xué)丈量選項呼吸力學(xué)丈量選項通氣時可選擇運用多種呼吸力學(xué)丈量工具運用的有效性要根據(jù)所處在的通氣方式或通氣方式用戶可以經(jīng)過在曲線監(jiān)測屏幕下，經(jīng)過翻頁找到相關(guān)需求的丈量工具P0.1胸腔閉合壓力胸腔閉合壓力 霧化功能霧化功能吸氣堅持吸氣堅持呼氣堅持呼氣堅持手動通氣手動通氣阻力阻力 / 順應(yīng)性順應(yīng)性呼吸力學(xué)丈量選項呼吸力學(xué)丈

45、量選項吸氣堅持功能吸氣堅持功能- It is carried out at the end of the inspiratory cycle when the tidal volume is delivered.- A nil flow is manually maintained.- The pause cannot exceed 5 seconds. After this time, an exhalation cycle is automatically released.- This option is available only in invasive ACV modeMaximu

46、m pressure valuePlateau pressure value Resistance value呼吸力學(xué)丈量選項呼吸力學(xué)丈量選項呼氣堅持功能呼氣堅持功能- It is carried out at the end of the exhalation cycle.- During the pause, the circuit is obstructed.- The pause cannot exceed 12 seconds. After this time, an inspiratory cycle is automatically released.- This option is available only in invasive ACV modeP