K Number
K050990
Device Name
REMREST HEATED HUMIDIFIER
Date Cleared
2005-05-02

(13 days)

Product Code
Regulation Number
868.5450
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The Evo Heated Humidifier is intended to warm and add moisture to the breathing gases for administration to a patient. It is used for patients requiring Continuous Positive Airway Pressure (CPAP) therapy for the treatment of Obstructive Sleep Apnea. The addition of heated humidification to this therapy relieves the drying and irritating effects on the patient airways, which may arise from the use of a CPAP system. Use only with RemRest 900 series CPAP devices. It is portable and is intended to be used in the home, hospital, and institutional settings.
Device Description
The RemRest Heated Humidifier is a simple heated humidifier to be used with a CPAP device to provide heated and humidified air to the patient. It operates by a conductive heating surface warming a water reservoir and air passes over the water. The device has the following basic specifications: Size 13.1" L x 8.4" W x 4.7" H, Weight 2.5 lbs. dry, Water capacity 400 ml (1 2/3 cups), Power 100-240 VAC 50/60Hz or 1.0 A max., Heater setting 1-5 (85°F to 149°F / 29.4°C to 65°C), Humidity Range 30 mg H2O/l @ 25 lpm, Pressure drop 0.5 cm H2O @ 40 lpm.
More Information

Not Found

No
The description details a simple heated humidifier with basic specifications and a manual heater setting, with no mention of AI/ML terms or capabilities.

Yes.
The device warms and adds moisture to breathing gases for patients undergoing CPAP therapy for Obstructive Sleep Apnea, which directly addresses a medical condition.

No

The device is a heated humidifier intended to add moisture to breathing gases for patients undergoing CPAP therapy. Its function is therapeutic (to relieve drying and irritation), not diagnostic.

No

The device description clearly outlines physical dimensions, weight, water capacity, power requirements, and a heating element, indicating it is a hardware device with a heating function, not software only.

No, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to perform tests on samples taken from the human body (like blood, urine, tissue) to provide information about a person's health.
  • Device Function: The Evo Heated Humidifier's intended use is to warm and add moisture to breathing gases for patients receiving CPAP therapy. It directly interacts with the air being delivered to the patient's respiratory system, not with samples taken from the body.
  • Lack of Diagnostic Testing: The device description and intended use do not mention any form of diagnostic testing or analysis of biological samples.

Therefore, based on the provided information, the Evo Heated Humidifier is a therapeutic device used to improve the comfort and effectiveness of CPAP therapy, not an in vitro diagnostic device.

N/A

Intended Use / Indications for Use

The Evo Heated Humidifier is intended to warm and add moisture to the breathing gases for administration to a patient. It is used for patients requiring Continuous Positive Airway Pressure (CPAP) therapy for the treatment of Obstructive Sleep Apnea. The addition of heated humidification to this therapy relieves the drying and irritating effects on the patient airways, which may arise from the use of a CPAP system. Use only with RemRest 900 series CPAP devices. It is portable and is intended to be used in the home, hospital, and institutional settings.

Product codes (comma separated list FDA assigned to the subject device)

BTT

Device Description

The RemRest Heated Humidifier is a simple heated humidifier to be used with a CPAP device to provide heated and humidified air to the patient. It operates by a conductive heating surface warming a water reservoir and air passes over the water. The device has the following basic specifications: Size: 13.1" L x 8.4" W x 4.7" H, Weight: 2.5 lbs. dry, Water capacity: 400 ml (1 2/3 cups), Power: 100-240 VAC 50/60Hz or 1.0 A max., Heater setting: 1-5 (85°F to 149°F / 29.4°C to 65°C), Humidity Range: 30 mg H2O/l @ 25 lpm, Pressure drop: 0.5 cm H2O @ 40 lpm.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Patient airways

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Home, Hospital, and Institutional settings

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s): If the device was cleared using the 510(k) pathway, identify the Predicate Device(s) K/DEN number used to claim substantial equivalence and list them here in a comma separated list exactly as they appear in the text. List the primary predicate first in the list.

K010263, K003973

Reference Device(s): Identify the Reference Device(s) K/DEN number and list them here in a comma separated list exactly as they appear in the text.

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information for the subject device only (e.g. presence / absence, what scope was granted / cleared under the PCCP, any restrictions, etc).

Not Found

§ 868.5450 Respiratory gas humidifier.

(a)
Identification. A respiratory gas humidifier is a device that is intended to add moisture to, and sometimes to warm, the breathing gases for administration to a patient. Cascade, gas, heated, and prefilled humidifiers are included in this generic type of device.(b)
Classification. Class II (performance standards).

0

Summary of Safety and Effectiveness 3.1

Non-Confidential Summary of Safety and Effectiveness

Page 1 of 2 March 2, 2005

| Medical Industries America, Inc.

dba Evo Medical Solutions
2636 – 289th PlaceTel:    (515) 993-5001
Adel, IA 50003-8021Fax:    (515) 993-4172
Official Contact:Keith Theisen, Director of Engineering
Proprietary or Trade Name:RemRest heated humidifier
Common/Usual Name:Heated humidifier
Classification Name:Humidifier, Respiratory Gas (Direct Patient Interface)
Predicate Devices:Respironics - RemStar - K010263

Device Description:

The RemRest Heated Humidifier is a simple heated humidifier to be used with a CPAP device to provide heated and humidified air to the patient. It operates by a conductive heating surface warming a water reservoir and air passes over the water. The device has the following basic specifications:

Fisher & Paykel - HC 150 - K003973

Size13.1" L x 8.4" W x 4.7" H
Weight2.5 lbs. dry
Water capacity400 ml (1 2/3 cups)
Power100-240 VAC 50/60Hz or 1.0 A max.
Heater setting1-5 (85°F to 149°F / 29.4°C to 65°C)
Humidity Range30 mg H2O/l @ 25 lpm
Pressure drop0.5 cm H2O @ 40 lpm

Indications:

| Indications for Use -- | The evo Heated Humidifier is intended to warm and add
moisture to the breathing gases for administration to a patient. It
is used for patients requiring Continuous Positive Airway
Pressure (CPAP) therapy for the treatment of Obstructive Sleep
Apnea. The addition of heated humidification to this therapy
relieves the drying and irritating effects on the patient airways,
which may arise from the use of a CPAP system. Use only with
RemRest 900 series CPAP devices. |
|------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Patient Population -- | Patients utilizing CPAP devices for OSA and desire to have
heated humidification |
| Environment of Use -- | Home, Hospital, and Institutional settings |

1


Non-Confidential Summary of Safety and Effectiveness Page 2 of 2 March 2, 2005

Comparison to Predicate Devices:

RemRestPredicates
Heated Humidifier
Attributes
Indications for useTo warm and add moisture to the breathing
gases for administration to a patient. It is used
for patients requiring Continuous Positive
Airway Pressure (CPAP) therapy for the
treatment of Obstructive Sleep Apnea. The
addition of heated humidification to this
therapy relieves the drying and irritating effects
on the patient airways, which may arise from
the use of a CPAP system.F&P - HC 150 - K003973

Respironics - RemStar with
humidifier - K010263

Same |
| Environments of use | Home, Hospital, Institutional | Same |
| Patient Population | Patients utilizing CPAP devices for OSA and
desire to have heated humidification | Same |
| Contraindications | None | Same |
| Technology | | |
| Method of heating | Heated plate | Yes |
| Temperature
controlled | Yes | Yes |
| Connects between
CPAP and patient | Yes | Yes |
| Thermal cutoff | Yes | Yes |

Differences Between Other Legally Marketed Predicate Devices

There are no significant differences between the proposed device, RemRest Heated Humidifier, and the identified predicates.

2

Third Party Review Quality Assessment

Section 1 – Submission Information
510(k) No.:K050990
Third Party Organization:Intertek / Artek
Third Party's Primary Reviewer(s):Mel Devine
ODE/OIVD Division:DAEID
Branch/Team:ARDB
Section 2 – 510(k) Decision
Third party recommendation:SE x NSE ______ Other (specify): ______
ODE/OIVD final decision:SE x NSE ______ Other (specify): ______
Section 3 – Assessment of Third Party Review
Review ElementRating (check one)
AdequateMinor Issue(s)Major Issue(s)
a. Determination of device eligibility for third party reviewx
b. Extent of pre-submission consultation with ODE/OIVD divisionx
c. Organization and format of review documentationx
d. Determination of 510(k) administrative completeness (screening review)x
e. Summary of device characteristics, intended use, and performance (including accessories, if applicable) and reason for 510(k) submissionx
f. Comparison to legally marketed devices—identification and analysis of key similarities and differencesx
g. Rationale for conclusions and recommendationx
h. Use of guidance documents and standardsx
i. Resolution of 510(k) deficiencies and FDA requests for additional informationn/a
j. Scope of reviewer expertise and use of consulting reviewersx
k. Other (specify):

Comments (explanation of ratings/issues): ___________________________________________________________________________________________________________________________________

Section 4 – ODE/OIVD Assessor Information

Assessed by: Oalom Date: 4/26/05 Tel. No.: 827 4479

Routing: Division--Clip completed assessment (this page only) to inside front cover of 510(k).
DMC--Forward this page only to Eric Rechen, POS/ODE, Rm. 120J, Corp. Blvd. (HFZ-402).





3

Image /page/3/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo consists of a stylized caduceus symbol, which features a staff with a snake winding around it, and three horizontal lines above it. The text "DEPARTMENT OF HEALTH AND HUMAN SERVICES - USA" is arranged in a circular pattern around the symbol. The logo is in black and white.

Public Health Service

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Medical Industries America, Incorporated C/O Mr. Ned E. Devine Responsible Third Party Official Intertek Testing Services NA, Incorporated 70 Codman Hill Road, Boxborough, Massachusetts 01719 ·

Re: K050990

Trade/Device Name: RemRest Heated Humidifier Regulation Number: 868.5450 Regulation Name: Respiratory Gas Humidifier Regulatory Class: II Product Code: BTT Dated: April 18, 2005 Received: April 19, 2005

Dear Mr. Devine:

We have reviewed your Section 510(k) premarket notification of intent to market the device we nave reviewed yoursed the device is substantially equivalent (for the icierciccu above and have acteriminosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Interstate conments of provises that have been reclassified in accordance with the provisions of Amendinents, or to de rouses 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 approval uppreation (The Act. The general controls provisions of the Act include controls provisions of the gistration, 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 If your device is classified (500 additional controls. Existing major regulations affecting (PMA), it may oc subject to sach adam f Federal Regulations, Title 21, Parts 800 to 898. In your device can oc round in the announcements concerning your device in the Federal Register.

4

Page 2 - Mr. Devine

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 moan mat I DA mas made statutes and regulations administered by other Federal agencies. of the Act of ally I oderal business requirements, including, but not limited to: registration 1 od indisting (21 CFR Part 807); labeling (21 CFR Part 801); good manufacturing practice allu listing (21 CFR Pat 001), labelity systems (QS) regulation (21 CFR Part 820); and if requirements as set form in the quadistion 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) This letter will anon you be objection.
premarket notification. The FDA finding of substantial equivalence of your device to a premarket notification. - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 - 11 your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), If you desire specific ach of Compliance at (240) 276-0115. 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 may obtain 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/industry/support/index.html.

Sincerely vours,

Synette Michie Davis

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

5

Indications for Use 3.3

Page 1 of 1

510(k) Number:K050990 (To be assigned)
Device Name:RemRest Heated Humidifier
Indications for Use:The Evo Heated Humidifier is intended to warm and add moisture to the breathing gases for administration to a patient. It is used for patients requiring Continuous Positive Airway Pressure (CPAP) therapy for the treatment of Obstructive Sleep Apnea. The addition of heated humidification to this therapy relieves the drying and irritating effects on the patient airways, which may arise from the use of a CPAP system. Use only with RemRest 900 series CPAP devices. It is portable and is intended to be used in the home, hospital, and institutional settings.

Prescription Use XX (Per CFR 801.109)

:

or

Over-the-counter use

Concurrence of CDRH, Office of Device Evaluation (ODE)

Ulus
(Division Sign

Division of ----------Infection Control. Duntal De Cests

510(k) Number...