K Number
K080256
Device Name
PULMODYNE CHF FLOW GENERATOR SYSTEM
Manufacturer
Date Cleared
2008-05-09

(99 days)

Product Code
Regulation Number
868.5965
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
To provide CPAP to spontaneously breathing adult patients in the hospital and pre-hospital (EMS) environment.
Device Description
The Pulmodyne CHF Flow Generator is a venturi type oxygen / air mixture delivery device which provides CPAP pressure at high flows to a spontaneously breathing patient. It can deliver up to 150 Lpm flow at a FiO2 between 28- 100%. It utilizes standard in-line PEEP valves to set the prescribed pressure and interfaces with the patient via a face mask or ET tube. The Pulmodyne CHF Flow Generator incorporates several components: Flow generator (two styles - fixed flow and variable flow) . Patient interface mask . PEEP valve . Circuit / tubing and connectors . Air entrainment filter . The Pulmodyne CHF Flow Generator is multi-patient, reusable and can be cleaned while the other components: circuit, mask, entrainment filter, and PEEP valve are disposable, single patient use.
More Information

Not Found

No
The device description details a mechanical, venturi-type flow generator and associated components, with no mention of software, algorithms, or data processing that would indicate AI/ML. The "Mentions AI, DNN, or ML" section is explicitly marked as "Not Found".

Yes
The device is described as providing CPAP (Continuous Positive Airway Pressure) to patients, which is a medical therapy used to treat respiratory conditions.

No

The device is described as a "venturi type oxygen / air mixture delivery device which provides CPAP pressure at high flows to a spontaneously breathing patient." Its intended use is "To provide CPAP," which is a treatment, not a diagnostic act. There is no mention of it collecting, analyzing, or interpreting biological data to identify a disease or condition.

No

The device description explicitly lists multiple hardware components (flow generator, patient interface mask, PEEP valve, circuit/tubing, air entrainment filter) and describes a physical, venturi-type oxygen/air delivery system.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended use is to provide CPAP to spontaneously breathing adult patients. This is a therapeutic intervention, not a diagnostic test performed on samples taken from the body.
  • Device Description: The device description details a system for delivering oxygen/air mixture and pressure to a patient's respiratory system. It does not describe any components or processes for analyzing biological samples (like blood, urine, tissue, etc.).
  • Lack of IVD Characteristics: There is no mention of analyzing samples, detecting biomarkers, or providing diagnostic information based on in vitro testing.

IVD devices are used to examine specimens derived from the human body to provide information for diagnostic, monitoring, or compatibility purposes. This device directly interacts with the patient's respiratory system for therapeutic support.

N/A

Intended Use / Indications for Use

To provide CPAP to spontaneously breathing adult patients in the hospital and prehospital (EMS) environment.

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

BYE - 868.5965, BYE

Device Description

The Pulmodyne CHF Flow Generator is a venturi type oxygen / air mixture delivery device which provides CPAP pressure at high flows to a spontaneously breathing patient. It can deliver up to 150 Lpm flow at a FiO2 between 28- 100%. It utilizes standard in-line PEEP valves to set the prescribed pressure and interfaces with the patient via a face mask or ET tube. The Pulmodyne CHF Flow Generator incorporates several components:
Flow generator (two styles - fixed flow and variable flow) .
Patient interface mask .
PEEP valve .
Circuit / tubing and connectors .
Air entrainment filter .
The Pulmodyne CHF Flow Generator is multi-patient, reusable and can be cleaned while the other components: circuit, mask, entrainment filter, and PEEP valve are disposable, single patient use.

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

Adults

Intended User / Care Setting

Hospital, sub-acute institution, or pre-hospital (EMS)

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.

K982283

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

§ 868.5965 Positive end expiratory pressure breathing attachment.

(a)
Identification. A positive end expiratory pressure (PEEP) breathing attachment is a device attached to a ventilator that is used to elevate pressure in a patient's lungs above atmospheric pressure at the end of exhalation.(b)
Classification. Class II (performance standards).

0

K080256

MAY - 9 2008

Non-Confidential Summary of Safety and Effectiveness

Page 1 of 4 6-May-08

| Pulmodyne
2055 Executive Dr.

Indianapolis, IN 46241Tel - (317) 246-5505
Official Contact:Tami Lefevers, Quality Manager
Proprietary or Trade Name:Pulmodyne CHF Flow Generator
Common/Usual Name:CPAP flow generator
Classification Name:Breathing Attachment Positive End Expiratory Pressure
BYE - 868.5965
Predicate Devices:Caradyne - Whisperflow - K982283

Device Description:

The Pulmodyne CHF Flow Generator is a venturi type oxygen / air mixture delivery device which provides CPAP pressure at high flows to a spontaneously breathing patient. It can deliver up to 150 Lpm flow at a FiO2 between 28- 100%. It utilizes standard in-line PEEP valves to set the prescribed pressure and interfaces with the patient via a face mask or ET tube. The Pulmodyne CHF Flow Generator incorporates several components:

Flow generator (two styles - fixed flow and variable flow) .

  • Patient interface mask .
  • PEEP valve .
  • Circuit / tubing and connectors .
  • Air entrainment filter .

The Pulmodyne CHF Flow Generator is multi-patient, reusable and can be cleaned while the other components: circuit, mask, entrainment filter, and PEEP valve are disposable, single patient use.

| Indications for Use: | To provide CPAP to spontaneously breathing adult patients in the
hospital and pre-hospital (EMS) environment. |
|----------------------|------------------------------------------------------------------------------------------------------------------|
| Patient Population: | Adults |
| Environment of Use: | Hospital, sub-acute institution, or pre-hospital (EMS) |

1

Non-Confidential Summary of Safety and Effectiveness

Page 2 of 4 6-May-08 ·

There are several conditions were therapeutic CPAP is Contraindications: contraindicated:

Patients who have:

.

  • Facial lacerations .
  • Laryngeal trauma .
  • Recent tracheal or esophageal anastomosis .
  • Gastrointestinal bleeding or ileus .
    • Recent gastric surgery
  • Basilar skull fracture .
  • ◆ Patients at high risk of vomiting
  • Emphysematous Bulla when an area of the lung may be brittle and present a risk . of bursting
  • Hypovolaemia low blood volume .
AttributeVariable / Adjustable
Whisper flow
WF 8500
K982283Proposed
Pulmodyne CHF
Flow Generator
Use
Intended for delivery of CPAPYesYes
Used with PEEP valves, CPAP mask and
circuit tubingYesYes
Environment - Hospital, sub-acute and
pre-hospital (EMS)YesYes
Design
Works by a venturi method to create a
vacuum to provide high flowsYesYes
Has oxygen inlet fitting which attach to wall
oxygen source standard CGA or DISS fittingYesYes
Has an On / Off valveYesYes
Can adjust oxygen flow through the
venturi portYesYes
Has an air entrainment port with
22 mm ID inletYesYes
AttributeVariable / Adjustable
Whisper flow
WF 8500
K982283Proposed
Pulmodyne CHF
Flow Generator
Air entrainment port with particulate filterYesYes
Has a valve which adjusts the flow to the
venturi nozzleYesYes
Outlet port (22 mm)YesYes
Option for an in-line oxygen analyzerYesYes
Circuit is standard 22 mm tubingYesYes
Can have a humidifier placed in-lineYesYes
Connects to patient interface - mask
or ET tubeYesYes
Utilizes a standard PEEP valve to
establish the circuit pressureYesYes
Patient can entrain room air should
oxygen flow failYesYes
One-way valve to prevent
rebreathing, if no gas flowYes in maskYes in elbow
Flow generator can be cleaned and is reusableYesYes
Other components -- circuit, mask
PEEP valve, entrainment filter are
Disposable, single patient useYesYes
Accessories required -
CPAP maskYesYes
Particulate filter at air entrainment portYesYes
22 mm tubingYesYes
Head strap for maskYesYes
Various connectorsYesYes
PEEP valvesYesYes
AttributeVariable / Adjustable
Whisper flow
WF 8500
K982283Proposed
Pulmodyne CHF
Flow Generator
Performance Standards / Specifications
Oxygen input pressure 60 psiYesYes
Output flow range up to 140 LpmYesYes
Fittings - 22 and 30 mmYesYes
Range of Oxygen (FiO₂)28-100%28-100%
Materials
Generator -
Stainless steel and PVCYesYes
CPAP mask - PVC and siliconeYesYes
Circuit tubing and connectors - PEYesYes

2

Non-Confidential Summary of Safety and Effectiveness

Page 3 of 4
6-May-08

:

·

3

Non-Confidential Summary of Safety and Effectiveness Page 4 of 4 6-May-08

Conclusion:

There are no significant differences that affect the safety or effectiveness of the intended device as compared to the predicate devices.

4

Image /page/4/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle with three tails, and the text "DEPARTMENT OF HEALTH & HUMAN SERVICES. USA" arranged in a circle around the eagle. The eagle is black, and the text is also black. The logo is simple and recognizable.

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

MAY - 9 2008

Pulmodyne C/O Mr. Paul E. Dryden President ProMedic, Incorporated 24301 Woodsage Drive Bonita Springs, Florida 34134-2958

Re: K080256

Trade/Device Name: Pulmodyne CHF Flow Generator Regulation Number: 21 CFR 868.5965 Regulation Name: Positive End Expiratory Pressure Breathing Atachment Regulatory Class: II Product Code: BYE Dated: May 6, 2008 Received: May 7, 2008

Dear Mr. Dryden:

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.

5

Page 2 - Mr. Dryden

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 yours,

Sutte Y. Michael Omd.

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

6

Indications for Use Statement

Page 1 of 1

510(k) Number: K080256 (To be assigned)

Pulmodyne CHF Flow Generator Device Name:

Indications for Use:

To provide CPAP to spontaneously breathing adult patients in the hospital and prehospital (EMS) environment.

Prescription Use XX (Part 21 CFR 801 Subpart D) 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)

(Division Sign-Off

(Division of Anesthesiology, General Hospital Infection Control, Dental Devices

510(k) Number. K080256