K Number
K040862
Manufacturer
Date Cleared
2004-06-30

(89 days)

Product Code
Regulation Number
868.5905
Reference & Predicate Devices
Predicate For
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

Intended to provide CPAP for use in hospitals to treat newborns and infants less than 5kg body weight with RDS or which are recovering from RDS (Respiratory Distress Syndrome). May or may not include humidification capabilities.

Device Description

The Guardian Neonate CPAP / Humidification systems is non-invasive respiratory support device for neonatal patients

AI/ML Overview

The provided text describes the "Guardian Neonatal CPAP / Humidification System" and confirms its substantial equivalence to predicate devices, but it does not contain information about acceptance criteria or a study proving that the device meets those criteria, nor does it include details typically found in performance studies for medical devices like sample sizes, ground truth establishment, or expert involvement.

The document is a "Summary of Safety and Effectiveness" (510(k) summary) and an FDA clearance letter. These documents primarily focus on demonstrating substantial equivalence to a legally marketed predicate device rather than presenting raw performance data or detailed study results against specific acceptance criteria. The "Measured Data" section lists ranges for various parameters but doesn't present them as acceptance criteria or performance results from a study.

Therefore, I cannot fulfill the request as the necessary information is not present in the provided text. I can only report on what is explicitly stated.

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K040862

Summary of Safety and Effectiveness

Non-Confidential Summary of Safety and Effectiveness

Page 1 of 2 29 June 2004

Official Contact:John O'Dea, Ph.D. - General Manager
Proprietary or Trade Name:Guardian Neonatal CPAP / Humidification System
Common/Usual Name:CPAP system
Classification Name:Ventilator, non-continuous (Respirator)
Predicate Devices:EME - Infant Flow systems - K011516Vapotherm - 2000I - K000401

Device Description

The Guardian Neonate CPAP / Humidification systems is non-invasive respiratory support device for neonatal patients

Intended Use and Environments
Intended Use --Intended to provide CPAP for use in hospitals totreat newborns and infants less than 5kg body weight withRDS or which are recovering from RDS (RespiratoryDistress Syndrome). May or may not include humidificationcapabilities.
Environment of Use --Hospital

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Non-Confidential Summary of Safety and Effectiveness Page 2 of 2 29-Jun-04

General Technical Characteristics

AttributeGuardian CPAP System
Intended to provide CPAP for neonates and infants < 5kg body weight with RDS or recovering from RDS (Respiratory Distress Syndrome)Yes
Humidification of gasesYes
Environment of Use - HospitalYes
Single patient use circuits and accessories including patient interfacesYes
Design Features and Specifications
CPAP – Range of pressure2 to 10 cm H2O
Air / Oxygen mixtureYes
% O2 range21 – 100%
Range of Flow delivered1 to 15 Lpm (Flow Mode)1 to 20 L/min (CPAP Mode)
Humidification methodVapotherm microporous membrane
Range of temperature of gas delivered33 to 41 °C
Measured Data
Circuit Pressure (bar graph display) Range0-12 cm H2O
% O2 (window display) - Range21-100%
Gas temperature - Range10-50 °C
Flow (bar graph)Indicator
PowerAC and Battery
Pressure Relief Valve18 cmH2O
AlarmsHigh and Low PressureHigh and Low FIO2High and Low Temperature
Supply Gases FailureAir and Oxygen

Differences between Other Legally Marketed Predicate Devices

The data within the submission demonstrates that the proposed device when compared to the predicate device is safe and effective and is substantially equivalent.

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Image /page/2/Picture/1 description: The image shows the seal of the Department of Health & Human Services - USA. The seal is circular and contains the words "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" around the perimeter. In the center of the seal is an abstract symbol that resembles an eagle or bird-like figure. The symbol is composed of several curved lines and shapes.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

JUN 3 0 2004

Mr. John O'Dea General Manager Caradyne, Limited Parkmore Business Centre Parkmore West Galway. IRELAND

Re: K040862

Trade/Device Name: Guardian Neonate CPAP / Humidification System Regulation Number: 21 CFR 868.5895 Regulation Name: Continuous Ventilator Regulatory Class: II Product Code: CBK Dated: June 11, 2004 Received: June 14, 2004

Dear Mr. O'Dea:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Page 2 - Mr. O'Dea

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your Section 510(k) premarket notification. The FDA finding of substantial equivalence of your device to a legally marketed predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please contact the Office of Compliance at (301) 594-4646. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html

Sincerely vours.

Chi-Lien, Ph.D.

Chiu Lin, Ph.D. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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K040862 510(k) Number:

Guardian Neonate CPAP / Humidification system Device Name:

Indications for Use:

Intended to provide CPAP for use in hospitals to treat newborns and infants less than 5kg Intended to provide of provish are recovering from RDS. (Respiratory Distress Syndrome) May or may not include humidification capabilities

or Over-the-counter use __ Prescription Use XX (Per CFR 801.109)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Quu Suliom

(Division Sigh-Off) (Division Sigh-Off))
Division of Anesthesiology, General Hospital, Division of Anesthoolonsis.


510(k) Number: K040862

§ 868.5905 Noncontinuous ventilator (IPPB).

(a)
Identification. A noncontinuous ventilator (intermittent positive pressure breathing-IPPB) is a device intended to deliver intermittently an aerosol to a patient's lungs or to assist a patient's breathing.(b)
Classification. Class II (performance standards).