ResMed Sleep Apnea Machine S9 VPAP Tx User Guide

S9 VPAPTx  
POSITIVE AIRWAY PRESSURE THERAPY DEVICE  
Clinical Guide  
English  
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S9 VPAPTx  
POSITIVE AIRWAY PRESSURE THERAPY DEVICE  
Clinical Guide  
English  
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Contents  
i
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General warnings and cautions  
WARNINGS  
Read the entire manual before using the device.  
Use the device only as directed by the physician or healthcare provider.  
Use the device only for the intended use as described in this manual. Advice contained in this  
manual should not supersede instructions given by the physician.  
If you notice any unexplained changes in the performance of the device, if it is making unusual  
or harsh sounds, if the device or the power supply are dropped or mishandled, if water is  
spilled into the enclosure, or if the enclosure is broken, discontinue use and contact your  
ResMed Service Center.  
The device should only be used with masks (and connectors) recommended by ResMed or by  
a physician or respiratory therapist. A mask should not be used unless the device is turned on.  
Once the mask is fitted, ensure that the device is blowing air.The vent hole or holes associated  
with the mask should never be blocked.  
Explanation:The device is intended to be used with special masks (or connectors) which have  
vent holes to allow continuous flow of air out of the mask. When the device is turned on and  
functioning properly, new air from the device flushes the exhaled air out through the mask  
vent holes. However, when the device is not operating, insufficient fresh air will be provided  
through the mask, and the exhaled air may be rebreathed. Rebreathing of exhaled air for  
longer than several minutes can, in some circumstances, lead to suffocation.This applies to  
most models of CPAP or bilevel devices  
Only ResMed air tubing and accessories should be used with the device. A different type of air  
tubing or accessory may alter the pressure you actually receive, reducing the effectiveness of  
the treatment.  
Only use the ResMed 90W or 30W power supply unit. Use the 90W power supply unit to power  
the system comprising the device, H5i, air tubing, DC/DC converter and battery pack.The 30W  
power supply unit is designed to power the device only and recommended for traveling.  
To maintain electrical safety and in accordance with IEC 60601, where a personal computer is  
used with the flow generator, the personal computer must be at least 5’ (1.5 m) away from, or  
at least 8’ (2.5 m) above the patient.The Personal Computer must comply to IEC 60950.  
CAUTIONS  
In the US, Federal law restricts the device to sale by or on order of a physician.  
Ensure that the device is protected against water. Enclose the device in the S9 travel bag for  
transport.  
Note: The above are general warnings and cautions. Specific warnings, cautions and notes appear with  
the relevant instructions in the manual.  
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Welcome  
The S9 VPAPTx provides continuous positive airway pressure (CPAP) and bilevel therapy.  
The S9 VPAPTx is a component of the S9 VPAPTx Lab System. The S9 VPAPTx Lab System provides  
remote PC control of a positive airway pressure therapy device (therapy device) capable of delivering  
multiple therapy modes. The system comprises:  
1. S9 VPAPTx or other compatible ResMed therapy device  
2. Tx Link connection module  
3. EasyCareTx titration software.  
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2
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This guide provides instructions for the S9 VPAPTx. Refer to theTx Link Quick Setup Guide and EasyCare  
Tx Online Help for instructions on their use.  
S9VPAPTx indications for use  
The S9 VPAPTx is indicated for the treatment and titration of patients with obstructive sleep apnea (OSA),  
respiratory insufficiency, central or mixed apneas, or periodic breathing. CPAP, S, ST, T and PAC modes  
are indicated for patients weighing more than 30 lb (13 kg); all other modes are indicated for patients  
weighing more than 66 lb (30 kg).  
The S9 VPAPTx is intended to be used in a clinical environment.  
S9VPAPTx contraindications  
Positive airway pressure therapy may be contraindicated in some patients with the following pre-existing  
conditions:  
severe bullous lung disease  
pneumothorax or pneumomediastinum  
pathologically low blood pressure, particularly if associated with intravascular volume depletion  
dehydration  
cerebrospinal fluid leak, recent cranial surgery or trauma.  
S9VPAPTx adverse effects  
Patients should report unusual chest pain, severe headache or increased breathlessness to the clinician.  
An acute upper respiratory tract infection may require temporary discontinuation of treatment. The  
following side-effects may arise during the course of therapy with the device:  
drying of the nose, mouth or throat  
nosebleed  
bloating  
ear or sinus discomfort  
eye irritation  
skin rashes.  
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S9VPAPTx at a glance  
Module/Adapter port  
Air filter  
DC power inlet  
Air outlet  
The S9 VPAPTx system comprises the following elements:  
S9 VPAPTx device  
H5i heated humidifier  
ClimateLine™ heated air tubing  
90W power supply unit  
S9 travel bag  
S9 USB Adapter.  
Optional components include:  
Standard air tubing  
SlimLineair tubing  
ClimateLineMAX ™ heated air tubing  
3 m air tubing  
Antibacterial filter.  
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Masks  
Mask systems recommended for use with the S9 VPAPTx can be found at www.resmed.com. For  
information on using a mask refer to the mask user guide.  
page under Service & Support. If you do not have internet access, please contact your ResMed  
representative.  
CAUTION  
Non-vented masks should not be used with the device.  
Supplemental oxygen  
Supplemental oxygen can be used with the S9 VPAPTx. For more information, see Adding supplemental  
oxygen” on page 22.  
Antibacterial filters  
Antibacterial filters increase resistance in the air circuit and may affect accuracy of displayed and  
delivered pressure, particularly at high flows. ResMed has tested and recommends using an antibacterial  
filter with a low impedance (eg, 2 cm H2O at 60 L/min).  
Humidifier  
The S9 VPAPTx is compatible with the H5i heated humidifier. For further information on using this  
humidifier refer to the H5i user guide.  
USB Adapter  
The S9 USB Adapter is designed for use with the S9 VPAPTx. The USB adapter connects the S9 VPAP Tx  
to a personal computer viaTx Link for remote monitoring and control. For further information on using  
this adapter refer to the S9 USB Adapter user guide.  
Climate Control  
The S9 VPAPTx, when used in conjunction with the H5i and ClimateLine or ClimateLineMAX heated air  
tubing, offers a feature called Climate Control.  
Climate Control enables the automatic delivery of a constant value of absolute humidity to the patients  
upper airway while protecting against rainout and allowing patients to select the air temperature that  
offers the most comfort for them.  
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Therapy modes  
The following table describes the therapy modes available on the S9 VPAPTx.  
Therapy mode  
Description  
CPAP (Continuous Positive Airway  
Pressure)  
Delivers a fixed pressure with optional Expiratory  
Pressure Relief (EPR). EPR can improve patient comfort.  
AutoSet  
Delivers CPAP therapy with optional Expiratory Pressure  
Relief (EPR). Automatically adjusts the CPAP pressure in  
response to snore, flow limited breaths and apneas.  
VAuto  
Automatically adjusts pressure in response to flow  
limitation, snore and apneas. Pressure Support (PS) is  
fixed throughout the night and can be set by the clinician.  
Min EPAP and Max IPAP restrict the delivered pressure  
range.  
Bilevel  
Provides for control over a number of related bilevel  
therapy modes—S, S/T andT. In all cases you may set  
two treatment pressures— one for inspiration (IPAP) and  
one for expiration (EPAP). The difference between IPAP  
and EPAP levels is the pressure support.  
S (Spontaneous)  
Senses when the patient is inhaling and exhaling  
and supplies the appropriate pressures accordingly.  
The difference between IPAP and EPAP levels helps  
determine the tidal volume.  
S/T (Spontaneous/Timed)  
T (Timed)  
Augments any breath initiated by the patient, but will also  
supply additional breaths should the patient breath rate  
fall below the clinician's set backup respiratory rate.  
The fixed respiratory rate and the fixed inspiration/  
expiration time set by the clinician is supplied regardless  
of patient effort.  
PAC (Pressure Assist Control)  
The inspiration time is preset in the PAC mode. There  
is no spontaneous/flow cycling. The inspiration can be  
triggered by the patient when respiratory rate is above a  
preset value, or time triggered breath will be delivered at  
the backup breath rate.  
ASV (Adaptive Servo-ventilation)  
Treats central sleep apnea and/or mixed apneas and  
periodic breathing. In ASV mode, the expiratory positive  
airway pressure (EPAP) is adjusted by the clinician to  
maintain upper airway patency, while Min PS and Max  
PS restricts the range of automatically adjusted pressure  
support.  
ASVAuto (Automatic Adaptive  
Servo-ventilation)  
Treats central sleep apnea and/or mixed apneas and  
periodic breathing. In ASVAuto mode, the expiratory  
airway pressure (EPAP) is automatically adjusted to  
maintain upper airway patency between the limits set  
by Min EPAP and Max EPAP, while Min PS and Max PS  
restrict the range of automatically adjusted pressure  
support.  
iVAPS (intelligent Volume-Assured  
Pressure Support)  
Maintains a preset target alveolar minute ventilation by  
monitoring delivered ventilation, adjusting the pressure  
support and providing an intelligent backup breath  
automatically.  
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S9VPAPTx basics  
Info menu button  
LCD screen  
Start/Stop  
button  
Alarm and  
therapy LEDs  
Setup menu button  
Alarm mute  
button  
Push dial  
Key  
Function  
Starts or stops treatment.  
Start/Stop button  
Power Save mode—hold for three seconds.  
Allows you to view the device service information or to exit from  
the menu.  
Info menu button  
Setup menu button  
Push dial  
Allows you to make changes to settings or to exit from the menu.  
Turning the dial allows you to scroll through the menu and change  
settings. Pushing the dial allows you to enter into a menu and  
confirm your choice.  
Press once to mute alarms. Press a second time to un-mute. If  
the problem is still present, the alarm will sound again after two  
minutes.  
Alarm mute button  
LCD screen  
Displays the menus, treatment screens and reminders.  
Backlight—when treatment is being delivered, the backlight  
(including the Start/Stop button) automatically turns off after  
30 seconds, otherwise it turns off after 3 minutes.  
Alarm LED  
Yellow LED—flashes during an alarm.  
Blue LED—always on during therapy (if enabled in the Options  
menu).  
Therapy LED  
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Setting up the S9VPAPTx  
Module/Adaptor Port  
4
To Tx Link  
5
6
8
1
3
7
2
WARNING  
Make sure the power cord and plug are in good condition and the equipment is not damaged.  
Keep the power cord away from hot surfaces.  
Do not leave long lengths of air tubing around the top of the patients bed. It could twist around  
the patients head or neck while they are sleeping.  
Do not use electrically conductive or antistatic air tubings.  
Do not use the air tubing if there are any visible signs of damage.  
Only ResMed products are designed to be connected to the module connector port. Connecting  
other devices could damage the device.  
CAUTION  
Incorrect system setup may result in incorrect mask pressure reading. Ensure the system is  
correctly set up.  
Be careful not to place the device where it can be bumped or where someone is likely to trip  
over the power cord.  
The H5i should only be connected or disconnected when the water tub is empty.  
Always place the H5i on a level surface below the level of the user to prevent the mask and  
tubing from filling with water.  
The S9 VPAPTx is compatible with the integrated H5i heated humidifier. For further information on using  
this humidifier refer to the H5i user guide.  
1. Align the H5i with the S9 VPAPTx and push them together until they click into place.  
2. Connect the DC plug of the power supply unit to the rear of the S9 VPAPTx.  
3. Connect the power cord to the power supply unit.  
4. Plug the USB Module into the Module/Adaptor port at the rear of the S9 VPAPTx.  
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5. Connect the S9 VPAPTx to theTx Link via USB serial cable.  
6. Plug the other end of the power cord into the power outlet.  
7. Connect one end of the air tubing firmly onto the air outlet.  
8. Connect the assembled mask system to the free end of air tubing.  
The S9 VPAPTx does not use the SD Card function to store data. All necessary data is transferred viaTx  
Link and available through the EasyCareTx software.  
Notes:  
Always ensure that the S9 VPAPTx is placed in an area where the alarm LED indicators are clearly  
visible.  
Place the power supply unit away from the H5i to allow for adequate ventilation.  
Filling the water tub  
WARNING  
Beware of electrocution. Do not immerse the device, humidifier, power supply or power cord in  
water. In the event of a spill, disconnect the device from the power supply and let the parts dry.  
Always unplug the device before cleaning and make sure that all parts are dry before plugging in  
the device.  
CAUTION  
Do not overfill the water tub as water may enter the device and air tubing.  
Do not use any additives (eg, scented oils and perfumes).These may reduce the humidification  
output of the H5i and/or cause deterioration of the water tub materials.  
Take care when handling the H5i as the water/water tub may be hot. Allow 10 minutes for the  
heater plate and any excess water to cool.  
If liquids are inadvertently spilled into or on the H5i, unplug the device from the power outlet.  
Disconnect the H5i from the device and allow it to drain and dry before re-using.  
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1. Slide the latch and lift open the flip lid.  
2. Remove the water tub.  
3. Fill the water tub (through the center hole) with distilled or deionized water up to the maximum water  
level mark (12.5 fl oz / 380 mL).  
4. Return the water tub to the H5i.  
5. Close the flip lid ensuring that it clicks into place.  
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Mask and air tubing settings  
Use the following settings below for each mask type:  
Mask type  
Full Face  
Pillows  
Settings  
Full Face  
Pillows  
Nasal  
Nasal (for Ultra Mirage mask, use ‘Nasal Ultra’)  
Pediatric  
Pediatric  
Notes:  
For more information on assembling the mask see the mask user guide.  
Products page under Service & Support. If you do not have internet access, please contact your  
ResMed representative.  
The S9 VPAPTx is compatible with the following air tubing:  
Air tubing  
Specifications  
Settings  
ClimateLine  
Heated  
Automatically detected  
Length: 6’6” (2 m)  
Inner diameter: 0.6” (15 mm)  
ClimateLineMAX  
Heated  
Automatically detected  
Length: 6’3” (1.9 m)  
Inner diameter: 0.75” (19 mm)  
SlimLine  
Standard  
Length: 6’ (1.8 m)  
If using the SlimLine, Standard or 3 m  
air tubing, adjust the tube setting via the  
Setup menu.  
Inner diameter: 0.6” (15 mm)  
Length: 6’6” (2 m)  
Inner diameter: 0.75” (19 mm)  
3 m  
Length: 9’10” (3 m)  
Inner diameter: 0.75” (19 mm)  
Notes:  
When using the SlimLine or ClimateLine above 20 cm H2O, the device optimum performance may  
not be reached if used with an antibacterial filter. The device performance must be checked prior to  
using the SlimLine for use with an antibacterial filter.  
The ClimateLine/ClimateLineMAX are designed only for use with the H5i.  
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Navigating the menus  
In general, to navigate the menus:  
1. Turn  
until the  
2. Press  
.
3. Turn  
until you  
4. Press  
to confirm  
parameter you  
The selection is  
highlighted in  
orange.  
see the setting that  
you require.  
your choice. The  
require is displayed  
in blue.  
screen returns to  
blue.  
About the menus  
There are three menus that are designed to help you choose your options. These are:  
1. Home menu—for day to day adjustments.  
2. Setup menu—where settings can be adjusted.  
3. Info menu—provides service information.  
Home menu  
The Home menu shows you what features are currently activated, and the accessories that are  
connected to the device.  
Humidity Level—displayed when the H5i is connected.  
Climate Control—displayed when both the H5i and the  
ClimateLine or ClimateLineMAX heated air tubing are connected and  
when Climate Control is set to Auto in the Setup menu.  
Humidity Level and HeatedTube—displayed when both the  
H5i and the ClimateLine or ClimateLineMAX heated air tubing are  
connected and when Climate Control is set to Manual in the Setup  
menu.  
11  
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Changing settings via the Home menu  
From the Home menu, you can adjust or check the following features:  
Humidity level  
Humidity levels can be adjusted at any time to find the setting that is most  
comfortable for the patient.  
Climate Control  
When the ClimateLine or ClimateLineMAX heated air tubing is connected and  
Climate Control is enabled, the air temperature can be adjusted to find the  
setting that is most comfortable for the patient.  
When set to Auto, Climate Control prevents rainout by maintaining 80%  
relative humidity in the delivered air. If Climate Control is set to Manual,  
Humidity Level and HeatedTube temperature can be set independently.  
Mask Fit  
Mask Fit is designed to help fit the mask properly to the patient.  
The Mask Fit feature delivers CPAP pressure for a three-minute period,  
prior to starting treatment. During this time, the mask can be adjusted to  
minimise leaks.  
To use Mask Fit:  
1. Fit the mask as described in the mask user guide.  
2. Press  
for at least three seconds.  
One of the MASK FIT screens is displayed (as shown on the left).  
3. If necessary, adjust the mask, mask cushion and headgear until there is  
a secure and comfortable fit. After three minutes, the pressure reverts  
to the set pressure and treatment will begin. You can end Mask Fit at  
any time by pressing  
.
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Viewing the treatment screens  
Depending on how the system has been configured and what mode has been selected, you will see one  
of the following example screens (shown in iVAPS mode below) when the device is running:  
9
H5i humidifier  
9
9
9
H5i humidifier  
ClimateLine/ClimateLineMAX 9 ClimateLine/ClimateLineMAX  
Climate Control – Auto Climate Control – Manual  
9
H5i humidifier  
9
9
Therapy data  
To toggle between the treatment screens, press  
from your HOME screen.  
9
Treatment with device  
trigger (Timed) and cycle  
(Timed, Ti Max orTi Min)  
breath indicators  
9
Treatment with spontaneous  
trigger and cycled breaths  
Pressure bar: In bilevel modes, the pressure bar is marked with fixed vertical lines indicating the  
expiratory and inspiratory pressures. In CPAP and AutoSet modes, only a set pressure is shown.  
13  
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Treatment screen parameters  
Parameter  
Modes  
Description  
Leak  
Estimate of the total rate of  
9 9 9 9 9 9 9 9 9 9  
air escaping due to mouth and  
unintentional mask leaks, expressed in  
L/min (5-breath moving average).  
Minute Ventilation (MV)  
Volume of air breathed in, or out within  
any 60-second period, expressed in  
L/min (5-breath moving average).  
9 9 9 9 9 9 9 9 9 9  
Target Minute  
Ventilation (TgMv)  
Minute ventilation the device is  
attempting to achieve. Pressure support  
increases if the minute ventilation falls  
below the target,and decreases if it  
goes above the target.  
9 9  
Respiratory rate (RR)  
Tidal volume (Vt)  
Frequency of breathing, expressed  
as the number of breaths per minute  
(5-breath moving average).  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
Volume of air inspired or expired in one  
respiratory cycle (breath), expressed in  
mL (5-breath moving average).  
Pressure support (PS)  
Difference between IPAP and EPAP.  
9 9 9 9 9 9 9 9  
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Alveolar minute  
ventilation (Va)  
Minute volume without dead space,  
expressed in L/min.  
Target alveloar  
Target alveolar minute ventilation that  
determines the amount of pressure  
support required, expressed in  
L/min.  
9
9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9  
ventilation (TgVa)  
Ti  
Duration of inspiration (ie, the  
respiratory flow into the lungs),  
expressed in seconds (5-breath moving  
average).  
I:E  
Inspiration to expiration ratio measured  
by the device (5-breath moving  
average).  
Ti Max  
Ti Min  
Maximum inspiration time in seconds  
Minimum inspiration time in seconds.  
9 9 9  
9 9 9  
9
9
% Spontaneous  
Triggering or Cycling  
(%SpontTrig or  
%Spont Cyc)  
Percentage of breaths that are  
spontaneously triggered or cycled  
(average of the last 20 breaths).  
9 9 9 9 9  
In PAC mode, there is no spontaneous  
cycling.  
Trigger/Cycle indicators  
(Timed, Ti Max or  
Ti Min)  
Indicates a patient or device  
triggered/cycled breath. In ST mode,  
Timed indicator is left blank if it is a  
spontaneous breath.  
9 9 9 9 9 9  
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Setup menu  
The Setup menu allows set up of all parameters pertaining to the patients therapy.  
Setup menu access  
To access Setup menu, press the Setup button. There are three screens available from the Setup menu  
as shown in iVAPS mode below:  
Settings  
Displays parameters directly affecting the patients therapy.  
Options  
Displays parameters affecting the patients comfort.  
Configuration  
Displays general device setting and resetting options.  
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Clinical setup menu parameters*  
Parameter  
Modes  
Range  
Description  
Settings  
Circuit  
Mask type  
Full Face / Nasal  
/ Pillows / Nasal  
Ultra / Pediatric  
Selects the type of mask used  
by the patient.  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
Default: Full Face  
Tube type  
AB filter  
SlimLine /  
Standard / 3 m  
Shows the type of air tubing  
used by the patient.  
Default: Standard Not displayed if ClimateLine or  
ClimateLineMAX is connected  
No /Yes  
Enables or disables antibacterial  
filter.  
Default: No  
Not displayed if H5i is  
connected.  
Ext.  
humidifier  
No /Yes  
Enables or disables an external  
humidifier.  
9 9 9 9 9 9 9 9 9 9  
Default: No  
Therapy  
Mode  
CPAP / S / ST /  
T / PAC / iVAPS /  
ASVAuto / ASV /  
AustoSet / VAuto  
Sets the therapy mode available  
on the device.  
9 9 9 9 9 9 9 9 9 9  
Default: CPAP  
Set pressure  
4–20 cm H2O  
Sets the fixed treatment  
pressure.  
9
Default:  
4 cm H2O  
EPR Level  
Height  
Off / 1 / 2 / 3  
Sets the EPR value.  
9 9  
Default: 3  
44-100 inches  
(110–250 cm)  
Body height needed for the  
dead space determination.  
9
Default: 70 inches  
(175 cm)  
Target Pt  
Rate  
8–30 BPM  
The rate input to the iVAPS  
algorithm. This should be set at  
the patients actual respiratory  
rate.  
9
Default: 15 BPM  
Target Va  
IPAP  
1–30 L/min  
Used to determine the amount  
of pressure support required by  
the iVAPS algorithm.  
9
Default: 5.2 L/min  
4–30 cm H2O  
Sets the pressure which will be  
delivered to the patient when  
the device is triggered into  
inspiration.  
9 9 9 9  
Default:  
10 cm H2O  
*Default settings may differ from country to country  
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Parameter  
Modes  
Range  
Description  
EPAP  
3–25 cm H2O**  
Sets the pressure which will  
be delivered to the patient  
when the device is cycled into  
expiration.  
9 9 9 9 9 9  
Default:  
4 cm H2O  
Dependent on IPAP.  
Min PS  
Max PS  
0–20 cm H2O  
Minimum pressure support in  
iVAPS mode.  
9 9 9  
Default:  
4 cm H2O  
Dependent on EPAP.  
0–28 cm H2O  
Maximum pressure support in  
iVAPS mode.  
9 9 9  
Default:  
20 cm H2O  
Dependent on EPAP and Min  
PS.  
Respiratory  
Rate  
5–50 BPM  
Sets the breaths per minute  
(BPM) or ‘backup’ rate.  
9 9 9  
Default: 10 BPM  
Ti Max  
Ti Min  
Ti  
0.3–4.0 sec  
Sets the maximum limit on the  
time the device spends in IPAP.  
9 9 9  
9
9
Default: 2 sec  
Dependent on Respiratory Rate.  
0.1–4.0 sec  
Sets the minimum limit on the  
time the device spends in IPAP.  
9 9 9  
Default: 0.3 sec  
Dependent onTi Max.  
0.1–4.0 sec  
Sets the duration of inspiration  
in timed breath.  
9 9  
Default: 2 sec  
Dependent on Respiratory Rate.  
RiseTime  
Trigger  
Min /  
Sets the time taken for the  
device to reach to IPAP.  
9 9 9 9 9  
100–900 ms  
Default: 150 ms  
Dependent onTi Max andTi.  
Very Low / Low /  
Med / High / Very  
High  
Sets the level of inspiratory flow  
above which the device changes  
from EPAP to IPAP.  
9 9 9 9 9  
Default: Med  
Cycle  
Very Low / Low /  
Med / High / Very  
High  
Sets the level of inspiratory flow  
below which the device changes  
from IPAP to EPAP.  
9 9 9  
9
Default: Med  
Max IPAP  
Min EPAP  
4–25 cm H2O  
Sets the maximum inspiratory  
pressure delivered by the  
device.  
9
9
Default:  
25 cm H2O  
4–[Max IPAP]  
cm H2O  
Sets the minimum expiratory  
pressure delivered by the  
device.  
Default:  
4 cm H2O  
Pressure  
Support  
0–10 cm H2O  
Difference between IPAP and  
EPAP. Adjust for patient comfort.  
9
Default:  
4 cm H2O  
** 2-25 cm H2O for Europe and APAC  
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Parameter  
Modes  
Range  
Description  
Easy-  
Breathe  
(US Only)  
On / Off  
Enables Easy-Breathe comfort  
feature.  
9
Default: On  
Max  
Min–20 cm H2O,  
0.2 cm H2O  
Sets the upper limit of  
treatment pressure.  
9
9
Pressure  
increments  
Default:  
20 cm H2O  
Min  
Pressure  
4–Max cm H2O,  
0.2 cm H2O  
increments  
Sets the lower limit of treatment  
pressure.  
Default:  
4 cm H2O  
Min EPAP  
Max EPAP  
Options  
4–15 cm H2O  
Sets the minimum EPAP  
delivered by the device.  
9
9
Default:  
4 cm H2O  
4–15 cm H2O  
Sets the maximum EPAP  
delivered by the device.  
Dependent on Min EPAP.  
Default:  
15 cm H2O  
Climate  
Control  
Auto / Manual  
Sets the type of Climate  
Control.  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
Default: Auto  
Therapy LED  
On / Off  
Enables or disables the blue  
LED.  
Default: Off  
Date  
Time  
DD MmmYYYY  
00:00 (24 hr)  
Sets the current date or time.  
If you set a new date or time  
that occurs in the past then an  
‘Invalid date/time, data exists  
for this period’ message is  
displayed.  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
Configuration  
Language  
English / Français / Sets the display language.  
9 9 9 9 9 9 9 9 9 9  
Deutsch /  
Español /  
Português  
Default: English  
Restore  
factory  
defaults  
Yes / No  
Resets machine default settings  
(except for language, date and  
time).  
9 9 9 9 9 9 9 9 9 9  
Pressure  
units  
cm H2O / hPa  
Sets pressure unit.  
Sets temperature unit.  
Sets height unit.  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
9 9 9 9 9 9 9 9 9 9  
Default: cm H2O  
Temperature  
units  
°F / °C  
Default: °F  
Height units  
cm / inches  
Default: inches  
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Info menu  
Service  
Displays the device run hours, software version and other component  
versions.  
Parameter  
Description  
Run hours Displays the total number of hours the device has been used including warm-up and  
cool-down times for the humidifier.  
SW  
BID  
VID  
AID  
HID  
Displays the current software version.  
Displays the boot loader ID.  
Displays the variant ID.  
Displays the alarm software ID  
Displays the humidifier software ID.  
19  
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Managing Climate Control  
Designed to be ideal for most patients, Climate Control Auto enables the automatic delivery of a constant  
value of absolute humidity while protecting against rainout.  
To allow for increased flexibility, Climate Control can be turned to Manual in the Setup menu. Setting  
Climate Control to Manual disables the automatic control of humidity and allows humidity and  
temperature levels to be set independently. However, rainout protection is not provided when Climate  
Control is set to Manual.  
Humidity  
Setting range Default settings  
Climate Control  
Temperature  
Mode  
Setting range  
Default settings  
Climate Control – Auto  
Constant  
absolute humidity  
(depending on  
temperature  
setting)  
Off*, 60ºF–86ºF  
(16ºC–30ºC)  
80ºF (27ºC)  
Climate Control –  
Manual  
Humidity level  
Heated tube  
Off–6.0  
(0.5 increments)  
3
Off, 60ºF–86ºF  
(16ºC–30ºC)  
80ºF (27ºC)  
* When the temperature setting is set to Off the tube will not heat the air, nor will the humidifier heat the water to  
add humidity to the air.  
20  
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Delivering therapy  
WARNING  
Blocking the air tubing and/or air inlet of the device while in operation could lead to overheating of  
the device.  
CAUTION  
Make sure the area around the device is dry and clean and clear of bedding, clothes or other  
objects that could block the air inlet or cover the power supply unit.  
The following procedure describes the steps required to start therapy at the patients bedside using the  
S9 VPAPTx. Once these steps are completed, S9 VPAPTx can be remotely controlled from the EasyCare  
Tx software application on the PC.  
1. Make sure power is connected.  
2. Check the mask type is correct (see “Mask and air tubing settings” on  
page 10).  
3. Fit the mask to patient, and adjust the mask and headgear to achieve  
optimal fit.  
4. Perform mask fit (see “Mask Fit” on page 12).  
Once therapy has started a treatment screen is displayed.  
In order to assist the heater plate in cooling, the device will continue to blow air for up to an hour after  
treatment has stopped. However, you can unplug the device from the power outlet at any time and allow  
the heater plate to cool without air flow, or press  
to enable Power Save mode.  
Note: If power is interrupted during treatment, the device automatically restarts therapy when power is  
restored.  
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Adding supplemental oxygen  
WARNING  
Explosion hazard—do not use in the vicinity of flammable anesthetics.  
Oxygen supports combustion. Oxygen must not be used while smoking or in the presence of  
an open flame.  
Always ensure that the device is turned on and airflow generated before the oxygen supply is  
turned on. Always turn the oxygen supply off before the device is turned off, so that unused  
oxygen does not accumulate within the device enclosure and create a risk of fire.  
The S9 VPAPTx is designed to be compatible with the following levels of supplemental oxygen:  
up to 15 L/min for CPAP, S, T, ST, ASV and PAC modes  
up to 4 L/min for AutoSet, VAuto, iVAPS and ASVAuto modes.  
At a fixed rate of supplemental oxygen flow, the inhaled oxygen concentration will vary depending on:  
where the oxygen is introduced;  
the pressure settings;  
patient breathing pattern;  
mask selection; and  
leak rate.  
Adding oxygen may affect the trigger and cycle reliability, delivered pressure, and the accuracy of the  
displayed leak, tidal volume, minute ventilation and alveolar ventilation.  
To add supplemental oxygen:  
1.  
Fit the ResMed Oxygen Connector Port to the air outlet of the S9 VPAPTx and fit the air tubing to  
the oxygen connector.  
2. Fit the oxygen supply tubing to the port on the oxygen connector.  
3. Attach the other end of the oxygen supply tubing to an oxygen flowmeter.  
4. Optimize the therapy device settings first, and then add oxygen if baseline saturation remains low.  
5. Titrate oxygen according to institutional guidelines.  
6. Determine an initial oxygen flow rate during wakefulness. Only increase oxygen during sleep when  
titration of pressure is complete.  
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Cleaning and maintenance  
Regular cleaning should be carried out on the S9 VPAPTx.  
Clean the exterior of the device with a damp cloth and mild detergent.  
Reprocessing the H5i and air tubing between patients  
The H5i and air tubing should be reprocessed when used between patients. Cleaning and disinfection  
Support. If you do not have internet access, please contact your ResMed representative.  
Replacing the air filter  
Inspect the air filter for holes and check whether it is blocked by dirt or dust. With normal use of the  
S9 VPAPTx, the air filter needs to be replaced every six months (or more often in a dusty environment).  
1. Remove the air filter cover from the back of the device.  
2. Remove and discard the old filter.  
3. Insert a new ResMed air filter ensuring that it is sitting flat in the air filter cover.  
4. Replace the air filter cover.  
Notes:  
Ensure the air filter and air filter cover  
are fitted at all times.  
Do not wash the air filter.  
The air filter is not washable  
or reusable.  
Air filter cover  
Air filter  
The following filters are available for use with the S9 VPAPTx:  
Filter  
Efficiency  
Standard (ASMB 160)  
88% at 7 micron  
Hypo-allergenic (Air Safety Electret100 – electrostatic filter) 89.8% at 0.5 micron, bacterial  
efficiency of 99.54%.  
23  
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Working with alarms  
The S9 VPAPTx is fitted with an alarm module that continuously monitors both therapy and device  
conditions. Alarms are only activated when therapy is running. An alarm condition can be indicated by an  
audible sound, a flashing yellow LED or a message on the screen.  
Note:The alarms should be tested after final system setup to ensure the alarms work as required.  
Alarms menu  
The alarms pre-set for the device are:  
Power fail  
Blocked tube*  
System fault (system error).  
* Blocked tube alarm is only triggered reliably for pressures above 10 cm H2O.  
If the system has not been properly assembled, the device will trigger an alarm. Check that the air tubing  
has been properly attached to the device, mask and humidifier.  
Clearing the alarm message  
When an alarm activates, a corresponding alarm message is displayed.  
To clear an alarm message, press  
previously displayed screen.  
. This allows you to return to the  
Note: Alarms are cleared by pressing  
.
Testing the alarms  
When the device is turned on, the alarm LED will flash and the alarm will sound to confirm that the alarm  
is working.  
To test the alarm manually or to adjust the alarm volume using the menus, go to the Settings menu and  
select Alarm Vol/Test. When the setting is selected and confirmed, the alarm will sound and all LEDs will  
be active.  
The alarms should be tested weekly. To test some of the alarm conditions, follow the procedures  
described below. When completed, stop therapy and return all settings to their original settings  
appropriate to the patient before delivering therapy.  
Power fail  
1. Set up the device with the air tubing attached, but no mask.  
2. Press the Start/Stop key to start therapy.  
3. Unplug the DC plug of the power supply unit from the rear of the device. The alarm activates  
immediately.  
4. Plug the DC plug back in. The alarm stops.  
Blocked tube  
1. Set up the device with the air tubing attached, but no mask.  
2. Set pressure above 12 cm H2O in CPAP mode.  
Note: BlockedTube alarm only activates above 10 cm H2O.  
3. Press the Start/Stop key to start therapy.  
4. Block the air tubing with your hand. The alarm activates when tubing is blocked for 30–50 seconds.  
5. Unblock the air tubing. The alarm stops.  
System Fault  
No testing for system fault.  
24  
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Troubleshooting  
If there is a problem, try the following suggestions. If the problem cannot be solved, contact your  
equipment supplier or ResMed. Do not attempt to open the device.  
Problem/Possible cause  
No display  
Solution  
Power is not connected.  
Ensure the power cord is connected and the power outlet (if  
available) is on.  
The DC plug is partially inserted into Fully insert the DC plug.  
the back of the device or inserted  
too slowly.  
The S9 VPAPTx and H5i are not  
connected correctly.  
Ensure that the S9 VPAPTx and H5i are securely attached.  
Insufficient air delivered from the device  
Air filter is dirty.  
Replace air filter.  
Air tubing is not connected properly. Check air tubing.  
Air tubing is blocked, pinched or  
punctured.  
Unblock or free the air tubing. Check the air tubing for  
punctures.  
Mask and headgear are not  
positioned correctly.  
Adjust position of mask and headgear.  
Incorrect air tubing selected.  
If you are using the SlimLine, Standard or 3 m air tubing ensure  
that you have the correct air tubing selected via the menu.  
The H5i flip lid is not latched  
correctly.  
Close the flip lid ensuring that it clicks into place.  
The H5i flip lid seal is not fitted  
correctly.  
Make sure the flip lid seal is facing the right way up and fitted  
securely.  
Mask vents might be blocked.  
Check if you have sufficient venting. Unblock mask vents if  
necessary.  
EPAP may be set too low.  
There is excessive leak.  
Adjust EPAP settings.  
Adjust position of mask and headgear.  
Pressure rises inappropriately  
Talking, coughing or breathing in an  
unusual manner.  
Avoid talking with a nasal mask on, and breathe as normally as  
possible.  
Mask cushion is buzzing against the Adjust the headgear.  
skin.  
Cushion seated incorrectly causing  
excessive leak.  
Adjust headgear or re-fit cushion.  
Displays message: Heated tube fault, replace tube  
Device has been left in a hot  
environment.  
Allow to cool before re-use. Disconnect the power cord and  
then reconnect it to restart the device.  
There is a fault in your ClimateLine  
or ClimateLineMAX heated air tubing.  
Discontinue using your ClimateLine or ClimateLineMAX heated  
air tubing and contact your service provider. Use SlimLine,  
Standard or 3 m air tubing in the interim.  
Displays message: High temperature fault, refer to user manual  
Device has been left in a hot  
environment.  
Allow to cool before re-use. Disconnect the power cord and  
then reconnect it to restart the device.  
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Problem/Possible cause  
Solution  
Air filter is blocked.  
Replace your air filter. Disconnect the power cord and then  
reconnect it to restart the device.  
Air tubing is blocked.  
Check your air tubing and remove any blockages. Disconnect  
the power cord and then reconnect it to restart the device.  
Humidity level setting is too high,  
Turn the humidity level setting down and empty the water from  
resulting in accumulation of water in the air tubing.  
the air tubing.  
Displays message: Check ResMed 30/90W Power Supply Unit and fully insert the connector  
The DC plug is partially inserted into Fully insert the DC plug.  
the back of the device or inserted  
too slowly.  
A non-ResMed power supply unit is  
connected to the device.  
Remove the power supply unit and replace with a ResMed  
power supply unit.  
The power supply unit is being  
covered by bedding.  
Make sure that the power supply unit is free from bedding,  
clothes or other objects that could cover it.  
Water splashing on your face from the H5i  
The water tub is overfilled.  
Check that the water level is below the maximum water level  
mark.  
Condensation is forming in the air  
tubing and mask.  
Turn the humidity level setting down via the menu.  
Leaking water tub  
The water tub may be damaged or  
cracked.  
Contact your service provider for a replacement.  
The cleanable water tub is not  
assembled correctly.  
Check for damage and reassemble the cleanable water tub  
correctly.  
Air feels too warm/cold in the mask  
The temperature of the ClimateLine  
or ClimateLineMAX heated air tubing  
is set too high/low.  
Turn up/down the heated air tubing temperature via the menu.  
Alarm is activated and the LCD screen display disappears  
Power failure.  
Remove the patient’s mask until power is restored.  
Power cord is disconnected or mains Ensure the power cord is connected and the mains power  
power switch is turned off during  
therapy.  
outlet (if available) is on.  
Displays message: Tube blocked, please check your tube  
Air tubing is blocked. Check the air tubing and remove any blockages. Disconnect the  
power cord and then reconnect it to restart the device.  
Displays message: Alarm module fault, please contact service provider  
General failure of the device and/or  
the alarm module. Therapy cannot  
be started again.  
Contact your service provider immediately.  
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Technical specifications  
General technical specifications  
Power supply  
90W power supply unit  
Input range: 100–240V; 50–60Hz; 115V, 400Hz nominal for aircraft use  
Typical power consumption: 70W (80VA)  
Maximum power consumption: 110W (120VA)  
90W DC/DC converter  
Nominal inputs: 12V, 24V  
Typical power consumption: 70W  
Maximum power consumption: 110W  
Environmental  
conditions  
Operating temperature: +41ºF to +95ºF (+5ºC to +35ºC)  
Note: The air flow for breathing produced by this therapy device can be higher  
than the temperature of the room. Under extreme ambient temperature conditions  
(104°F/40°C) the device remains safe.  
Operating humidity:10 to 95% non-condensing  
Operating altitude: Sea level to 8,500’ (2,591 m); air pressure range 1013 hPa to  
738 hPa  
Storage and transport temperature: -4ºF to +140ºF (-20ºC to +60ºC)  
Storage and transport humidity: 10 to 95% non-condensing  
Electromagnetic Product complies with all applicable electromagnetic compatibility requirements  
compatibility  
(EMC) according to IEC60601-1-2, for residential, commercial, and light industry  
environments.  
It is recommended that mobile communication devices are kept at least one  
meter away from the device.  
Information regarding the electromagnetic emissions and immunity of these  
Service and Support. Click on the PDF file for your language.  
Aircraft use  
ResMed confirms that the S9 VPAPTx meets the Federal Aviation Administration  
(FAA) requirements (RTCA/DO-160, section 21, category M) for all phases of air  
travel.  
IEC 60601-1  
classification  
Class II (double insulation), Type BF, Ingress Protection IP21  
Measuring and  
display devices  
Pressure sensor: Internally located at device outlet, analog gauge pressure type,  
-5 to +45 cm H2O  
Flow sensor: Internally located at device inlet, digital mass flow type,  
-70 to +200 L/min  
S9VPAPTx technical specifications  
Mode pressure  
ranges  
CPAP, AutoSet mode  
Pressure: 4–20 cm H2O;  
S, ST, T and PAC mode  
IPAP: 4–30 cm H2O; EPAP: 2–25 cm H2O;  
iVAPS mode  
PS: 0–27 cm H2O; EPAP: 2–25 cm H2O;  
VAuto mode  
PS: 0-10 cm H2O; Min EPAP: 4 cm H2O; Max IPAP: 25 cm H2O;  
ASV and ASVAuto mode  
PS: 0–20 cm H2O; EPAP: 4–15 cm H2O;  
Maximum single Maximum single fault steady state pressure: 30 cm H2O—if pressure exceeded  
fault pressure  
for > 6 sec; 40 cm H2O—if pressure exceeded for >1 sec  
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Sound:  
Sound pressure level (CPAP mode)  
DECLARED  
DUAL-NUMBER  
NOISE  
with SlimLine air tubing: 26 dBA with uncertainty of 2 dBA as measured  
according to ISO 17510-1:2007  
EMISSION  
VALUES in  
accordance with  
ISO 4871:1996  
with Standard air tubing: 27 dBA with uncertainty of 2 dBA as measured  
according to ISO 17510-1:2007  
with either SlimLine or 28 dBA with uncertainty of 2 dBA as measured  
Standard air tubing and H5i: according to ISO 17510-1:2007  
Sound power level (CPAP mode)  
with SlimLine air tubing: 34 dBA with uncertainty of 2 dBA as measured  
according to ISO 17510-1:2007  
with Standard air tubing: 35 dBA with uncertainty of 2 dBA as measured  
according to ISO 17510-1:2007  
with either SlimLine or 36 dBA with uncertainty of 2 dBA as measured  
Standard air tubing and H5i: according to ISO 17510-1:2007  
Alarm volume  
settings  
Low (nominal 56 dBA), Medium (nominal 68 dBA), High (nominal 80 dBA)  
Physical  
Dimensions (L x W x H): 6.0” x 6.8” x 3.4” (153 mm x 172 mm x 86 mm)  
Weight: 2.30 lbs (1.045 kg)  
Housing construction: Flame retardant engineering thermoplastic  
Air outlet: 22 mm conical air outlet (complies with ISO 5356-1:2004)  
Air filter  
Standard: Polyester non-woven fiber  
Hypoallergenic: Acrylic and polypropylene fibers in a polypropylene carrier  
Supplemental  
oxygen  
Recommended maximum supplemental oxygen: 15 L/min (CPAP, S, T, ST, ASV and  
PAC modes), 4 L/min (AutoSet, VAuto, iVAPS and ASVAuto modes)  
Pneumatic flow path  
1
3
3
2
4
1. Flow sensor  
2. Blower  
3. Pressure sensor  
4. Mask  
5. Air tubing  
6. H5i  
7. Alarm module  
8. Device  
9. Inlet filter  
9
6
7
8
5
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Flow (maximum) at set pressures  
The following are measured at the end of the specified air tubing:  
Pressure  
cm H2O  
S9VPAPTx and  
standard air  
tubing,  
S9VPAPTx, H5i  
and standard air  
tubing,  
S9VPAPTx and  
SlimLine,  
L/min  
S9VPAPTx, H5i  
and ClimateLine,  
L/min  
L/min  
L/min  
4
8
12  
16  
20  
25  
200  
200  
200  
200  
190  
180  
170  
170  
170  
170  
170  
161  
195  
190  
184  
175  
168  
144  
170  
170  
170  
170  
161  
125  
Displayed values  
Value  
Range  
Display resolution  
Pressure sensor at air outlet  
Mask pressure  
Flow derived values  
Leak  
3–30 cm H2O  
0.1 cm H2O  
0–200 L/min  
0–4000 mL  
0–50 BPM  
0–30 L/min  
0.1–4.0 sec  
1:50–2:1  
1 L/min  
1 mL  
Tidal volume  
Respiratory rate  
Minute ventilation  
Ti  
1 BPM  
0.1 L/min  
0.1 sec  
0.1  
I:E ratio  
Value  
Accuracy1  
Pressure measurement1  
Mask pressure  
Flow measurements1  
Leak2  
0.5 cm H2O (+ 4% of measured value)  
12 L/min or 20% of reading, whichever is greater, at 0 to 60 L/min  
Tidal volume2  
Respiratory rate2  
Minute ventilation2  
20%  
1.0 BPM  
20%  
1 Results are expressed at ATPD (AmbientTemperature and Pressure, Dry)  
2 Accuracy may be reduced by the presence of leaks, supplemental oxygen, tidal volumes <100 mL or minute ventilation  
<3 L/min.  
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Symbols  
The following symbols may appear on your product or packaging.  
Caution;  
vertically dripping water;  
European Authorised Representative;  
number; Serial number; Direct current;  
pollution control logo 2; Not drip proof; Keep dry;  
Read instructions before use;  
Protection against insertion of fingers and against  
Type BF equipment;  
Class II equipment;  
European RoHS; Batch code;  
China pollution control logo 1;  
Start/Stop;  
Manufacturer;  
Catalogue  
China  
Prescription only (In the US, Federal  
law restricts these devices to sale by or on the order of a physician.).  
Environmental information  
WEEE 2002/96/EC is a European Directive that requires the proper disposal of electrical and electronic  
equipment. This device should be disposed of separately, not as unsorted municipal waste. To dispose of  
your device, you should use appropriate collection, reuse and recycling systems available in your region.  
The use of these collection, reuse and recycling systems is designed to reduce pressure on natural  
resources and prevent hazardous substances from damaging the environment.  
If you need information on these disposal systems, please contact your local waste administration. The  
crossed-bin symbol invites you to use these disposal systems. If you require information on collection  
and disposal of your ResMed device please contact your ResMed office, local distributor or go to  
Servicing  
The S9 VPAPTx is intended to provide safe and reliable operation when operated in accordance with the  
instructions provided by ResMed. ResMed recommends that the S9 VPAPTx be inspected and serviced  
by an authorized ResMed Service Center if there is any sign of wear or concern with device function.  
Otherwise, service and inspection of the devices generally should not be required during the five year  
design life of the device.  
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Limited warranty  
ResMed Ltd (hereafter ‘ResMed’) warrants that your ResMed product shall be free from defects in  
material and workmanship from the date of purchase for the period specified below.  
Product  
Warranty period  
Mask systems (including mask frame, cushion, headgear and tubing)—excluding  
single-use devices  
90 days  
Accessories—excluding single-use devices  
Humidifier water tubs  
Batteries for use in ResMed internal and external battery systems  
CPAP and bilevel device data modules  
Humidifiers and humidifier cleanable water tubs  
Titration control devices  
6 months  
1 year  
CPAP, bilevel and ventilation devices (including external power supply units)  
Battery accessories  
2 years  
Portable diagnostic/screening devices  
This warranty is only available to the initial consumer. It is not transferable.  
If the product fails under conditions of normal use, ResMed will repair or replace, at its option, the  
defective product or any of its components.  
This Limited Warranty does not cover: a) any damage caused as a result of improper use, abuse,  
modification or alteration of the product; b) repairs carried out by any service organization that has not  
been expressly authorized by ResMed to perform such repairs; and c) any damage or contamination due  
to cigarette, pipe, cigar or other smoke; and d) any damage cause by water being spilled on or into an  
electronic device.  
Warranty is void on product sold, or resold, outside the region of original purchase.  
Warranty claims on defective product must be made by the initial consumer at the point of purchase.  
This warranty replaces all other expressed or implied warranties, including any implied warranty of  
merchantability or fitness for a particular purpose. Some regions or states do not allow limitations on how  
long an implied warranty lasts, so the above limitation may not apply to you.  
ResMed shall not be responsible for any incidental or consequential damages claimed to have resulted  
from the sale, installation or use of any ResMed product. Some regions or states do not allow the  
exclusion or limitation of incidental or consequential damages, so the above limitation may not apply to  
you.  
This warranty gives you specific legal rights, and you may also have other rights which vary from region  
to region. For further information on your warranty rights, contact your local ResMed dealer or ResMed  
office.  
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258189/2 2013-02  
S9 VPAPTx  
CLINICAL  
GLO MULTI  
Manufacturer: ResMed Ltd 1 Elizabeth Macarthur Drive Bella Vista NSW 2153 Australia. Distributed by: ResMed Corp 9001  
Spectrum Center Boulevard San Diego CA 92123 USA.  
ResMed (UK) Ltd 96 Milton Park Abingdon Oxfordshire OX14 4RY UK.  
S9, H5i, ClimateLine, SlimLine, SmartStart, TiControl and VPAP are trademarks of ResMed Ltd. S9, ClimateLine, SlimLine,  
SmartStart and VPAP are registered in U.S. Patent and Trademark Office.  
© 2013 ResMed Ltd.  
Download from Www.Somanuals.com. All Manuals Search And Download.  
Global leaders in sleep and respiratory medicine www.resmed.com  

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