K Number
K063404
Device Name
SERVO-I VENTILATOR SYSTEM, MODELS 64, 87 AND 800
Date Cleared
2007-02-15

(98 days)

Product Code
Regulation Number
868.5895
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The SERVO-i Ventilator System is intended for treatment and monitoring of patients in the range of neonates, infants and adults with respiratory failure or respiratory insufficiency. SERVO-i is a ventilator system to be used only by healthcare providers in hospitals or healthcare facilities and for in-hospital transport. The SERVO-i Ventilator with MR environment option is classified as MR Conditional for 1.T. 1.5T and 37 MR scanners. This means that it is safe to use in the MR environment if the conditions in the MR Environment Declaration for SERVO-i are met.
Device Description
The ventilator is a platform with several selectable ventilation modes, which monitor patients whom need respiratory assistance. The MR environment option makes it possible to qualify the Servo-i ventilator to be used in MR environment
More Information

Not Found

No
The document describes a ventilator system with an MR environment option and does not mention any AI or ML capabilities.

Yes
The device is intended for "treatment and monitoring of patients in the range of neonates, infants and adults with respiratory failure or respiratory insufficiency," indicating a therapeutic purpose.

No

The device is described as a ventilator system intended for treatment and monitoring of patients with respiratory failure or insufficiency, providing respiratory assistance. It does not perform diagnostic functions but rather therapeutic and monitoring ones.

No

The device description explicitly states it is a "ventilator system" and mentions hardware components like the "SERVO-i Ventilator with MR environment option" and testing in magnetic fields, indicating it is a physical device with software control.

Based on the provided information, the SERVO-i Ventilator System is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use clearly states that the device is for the "treatment and monitoring of patients in the range of neonates, infants and adults with respiratory failure or respiratory insufficiency." This describes a device used directly on a patient for life support and monitoring, not for testing samples taken from the body.
  • Device Description: The description reinforces this by stating it's a "ventilator system" that "monitor patients whom need respiratory assistance."
  • Lack of IVD Characteristics: The description does not mention any of the typical characteristics of an IVD, such as:
    • Analyzing biological samples (blood, urine, tissue, etc.)
    • Detecting or measuring substances in samples
    • Providing information for diagnosis, monitoring, or screening based on sample analysis

IVD devices are used to perform tests on samples taken from the body to provide information about a person's health status. The SERVO-i Ventilator is a therapeutic and monitoring device used on the body to support respiration.

N/A

Intended Use / Indications for Use

The SERVO-i Ventilator System is intended for treatment and monitoring of patients in the range of neonates, infants and adults with respiratory failure or respiratory insufficiency. SERVO-i is a ventilator system to be used only by healthcare providers in hospitals or healthcare facilities and for in-hospital transport.

The SERVO-i Ventilator with MR environment option is classified as MR Conditional for 1.T. 1.5T and 37 MR scanners. This means that it is safe to use in the MR environment if the conditions in the MR Environment Declaration for SERVO-i are met.

Product codes

CBK

Device Description

The ventilator is a platform with several selectable ventilation modes, which monitor patients whom need respiratory assistance. The MR environment option makes it possible to qualify the Servo-i ventilator to be used in MR environment

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

neonates, infants and adults

Intended User / Care Setting

healthcare providers in hospitals or healthcare facilities and for in-hospital transport.

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)

The SERVO-i ventilator with MR option have been tested with 1.0, 1.5, 3.0 T scanners without impairing its performance or the image quality of the scanner.

Vital parts of the ventilator have been tested for performance in excessive magnetic fields to evaluate the safety margins.

The emission from the SERVO-i has been further decreased with the MR option to reduce the probability for artifacts on the scanner images.

Each scanner and its environment forms an individual device. The MR Environment Declaration describes how a SERVO-i with MR option can be qualified to be used with an MR scanner forming a safe Medical System.

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

Not Found

Predicate Device(s)

K041223, K050055, K896380, K896391, K061627

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 868.5895 Continuous ventilator.

(a)
Identification. A continuous ventilator (respirator) is a device intended to mechanically control or assist patient breathing by delivering a predetermined percentage of oxygen in the breathing gas. Adult, pediatric, and neonatal ventilators are included in this generic type of device.(b)
Classification. Class II (performance standards).

0

K063404

Traditional 510(k)

130 (131) Doc-ID Issue no 01

Indications for Use

EVU-120150

510 (k) Summary

as required by section 807.92(c)

Subscribers Name & Address

Maquet Critical Care AB Röntgenvägen 2 SE-171 95 Solna, Sweden Tel: (011) 46 8 730 73 00 Fax: (011) 46 8 730 78 38

Contact Persons for this submission:

Ms. Veronica Ekström Tele. Direct; (011) 46 8 730 7300 extension 7367 Email: veronica.ekstrom@maquet.com

USA Contact :

Mr. Jamie Yieh Director, Regulatory Affairs/Quality Assurance Maquet Inc. 1140 Route 22 East, Suite 202 Bridgewater, NJ 08807 Phone: 908-947-2311 Fax: 908-947-2301 Email: jamie.yieh@maquet-inc.com

Trade Names

SERVO-i Ventilator System article no .; 64 87 800 MR Environment option: MR Environment kit (on-site) 66 71 712 and (factory installed) 66 72 289

Device Classification

| Common Name | Classification
Number | Class | Regulation Number |
|----------------------------------------------------------------|--------------------------|-------|-------------------|
| Ventilator, Continuous (Respirator) | 73 CBK | II | 868.5895 |
| Predicate Device Identification | | | |
| Legally marketed devices to which equivalence is being claimed | | | |
| SERVO-i Ventilatory System | | | K041223 |
| Aestiva/5 MRI GE, Datex-Ohmeda Inc. | | | K050055 |
| IC-2A Bio-med Devices Inc. | | | K896380 |
| MVP-10 Bio-med Devices Inc. | | | K896391 |
| iVent 201 VersaMed Medical Systems Inc. | | | K061627 |

FEB 1 5 2007

Doc-ID
EVU-120150

1

| MAQUET | Document Type
Traditional 510(k) | Section-Page
131 (131) |
|---------------------------------------|-------------------------------------|---------------------------|
| Object/Subject
Indications for Use | | Doc-ID
EVU-120150 - 01 |

Device Description

The ventilator is a platform with several selectable ventilation modes, which monitor patients whom need respiratory assistance. The MR environment option makes it possible to qualify the Servo-i ventilator to be used in MR environment

Indications for use:

The SERVO-i Ventilator System is intended for treatment and monitoring of patients in the range of neonates, infants and adults with respiratory failure or respiratory insufficiency. SERVO-i is a ventilator system to be used only by healthcare providers in hospitals or healthcare facilities and for in-hospital transport.

The SERVO-i Ventilator with MR environment option is classified as MR Conditional for 1.T. 1.5T and 37 MR scanners. This means that it is safe to use in the MR environment if the conditions in the MR Environment Declaration for SERVO-i are met.

Summary of technological characteristics of modified Device and Predicate Device: MR Environment option

The SERVO-i ventilator with MR option have been tested with 1.0, 1.5, 3.0 T scanners without impairing its performance or the image quality of the scanner.

Vital parts of the ventilator have been tested for performance in excessive magnetic fields to evaluate the safety margins.

The emission from the SERVO-i has been further decreased with the MR option to reduce the probability for artifacts on the scanner images.

Each scanner and its environment forms an individual device. The MR Environment Declaration describes how a SERVO-i with MR option can be qualified to be used with an MR scanner forming a safe Medical System.

2

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a circular border with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" arranged around the circumference. Inside the circle is a stylized symbol resembling an abstract human figure or a caduceus, with three curved lines representing the body and a ribbon-like element at the bottom.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Maquet Critical Care AB C/O Mr. Jamie Yieh Director, Regulatory Affairs/Quality Assurance Maquet, Incorporated 1140 Route 22 East. Suite 202 Bridgewater, New Jersey 08807

FEB 15 2007

Re: K063404

Trade/Device Name: SERVO-i Ventilator System Regulation Number: 868.5895 Regulation Name: Continuous Ventilator Regulatory Class: II Product Code: CBK Dated: January 24, 2007 Received: January 26, 2007

Dear Mr. Yieh:

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.

3

Page 2 - Mr. Yieh

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 (240) 276-0120. 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/industry/support/index.html.

Sincerely vours.

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

4

Indications for Use

510(k) Number (if known):

Device Name: SERVO-i Ventilator System

Indications For Use:

The SERVO-i Ventilator System is intended for treatment and monitoring of patients in the range of neonates, infants and adults with respiratory failure or respiratory insufficiency. SERVO-i is a ventilator system to be used only by healthcare providers in hospitals or healthcare facilities and for in-hospital transport.

The SERVO-i Ventilator is classified as MR Conditional for 1.T, 1.5T and 3T MR scanners. This means that it is safe to use in the MR environment if the conditions in the MR Environment Declaration for SERVO-i are met.

Prescription Use (Part 21 CFR 801 Subpart D)

AND/OR

Over-The-Counter Use (21 CFR 807 Subpart C)

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Page 1 of _

Mark Wahlund

Division Sign-Off) Division of Anesthesiology, General Hospital, Infection Cantrol, Dental D

$10(k) Number