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510(k) Data Aggregation
(203 days)
INOMAX DS (DELIVERY SYSTEM), MODEL 10003
The INOmax DS delivery system delivers INOmax® (nitric oxide of inhalation) therapy gas into the inspiratory limb of the patient breathing circuit in a way that provides a constant concentration of nitric oxide (NO), as set by the user, to the patient throughout the inspired breath. It uses a specially designed injector module, which enables tracking of the ventilator waveforms and the delivery of a synchronized and proportional dose of NO. It may be used with most ventilators.
The INOmax DS provides continuous integrated monitoring of inspired O2, NO2, and NO, and a comprehensive alarm system.
The INOmax DS incorporates a battery that provides up to 6 hours of uninterrupted NO delivery in the absence of an external power source.
The INOmax DS includes a backup NO delivery capability that provides a fixed flow of 250 mL/min of NO which along with user supplied 10 L/min of oxygen provides 20 ppm in the gas flow to a patients breathing circuit. It may also use the INOblender for backup.
The target patient population is controlled by the drug labeling for INOmax and is currently neonates. The primary targeted clinical setting is the Neonatal Intensive Care Unit (NICU) and secondary targeted clinical setting is the transport of neonates.
The INO Therapeutics INOmax DS represents the continuing evolution of the Datex-Ohmeda (now GE Healthcare) INOvent Delivery System design. Its published performance specifications are not significantly different from the INOvent. The INOmax DS design incorporates a reconfiguration of hardware, electronic circuitry and software resulting in a more compact, stylish, modern, user-friendly and easier manufactured product.
The INOmax DS delivery system delivers INOmax® (nitric oxide of inhalation) therapy gas into the inspiratory limb of the patient breathing circuit in a way that provides a constant concentration of nitric oxide (NO), as set by the user, to the patient throughout the inspired breath. It uses a specially designed iniector module, which enables tracking of the ventilator waveforms and the delivery of a synchronized and proportional dose of NO. It may be used with most ventilators.
The INOmax DS provides continuous integrated monitoring of inspired O2, NO2, and NO, and a comprehensive alarm system. The INOmax DS incorporates a battery that provides up to 6 hours of uninterrupted NO delivery in the absence of an external power source.
The INOmax DS includes a backup NO delivery capability that provides a fixed flow of 250 mL/min of NO which along with user supplied 10 L/min of oxygen provides 20 ppm in the gas flow to a patients breathing circuit. It may also use the INOblender for backup.
The provided text describes the INOmax DS (Delivery System), a nitric oxide administration apparatus. However, it explicitly states that clinical studies were not required to support substantial equivalence for this device. Therefore, information regarding acceptance criteria derived from clinical studies, comparative effectiveness studies, or clinical ground truth establishment is not available within the provided document.
The document primarily focuses on non-clinical tests and the device's technological equivalence to a predicate device.
Here's an analysis based only on the provided text, addressing the requested points:
Acceptance Criteria and Device Performance
Since clinical studies were not required for this 510(k) submission, there are no specific performance acceptance criteria or reported device performance metrics from clinical trials mentioned. The manufacturer's conclusion is that the INOmax DS is "as safe, as effective, and performance is substantially equivalent to the predicate device."
Acceptance Criteria Category | Reported Device Performance |
---|---|
Clinical Performance | Not applicable; clinical studies were not required to support substantial equivalence. Device is considered "as safe, as effective, and performance is substantially equivalent to the predicate device." |
Non-Clinical Performance | The device complies with voluntary standards and underwent internal quality assurance measures: Risk Analysis, Requirements Reviews, Design Reviews, Unit-level Testing (Module verification), Integration Testing (System verification), Final Acceptance Testing (Validation), Performance Testing (Verification), Safety Testing (Verification). |
Other Information
Due to the lack of clinical studies, much of the requested information is not present in the provided document.
- Sample sizes used for the test set and the data provenance: Not applicable, as no clinical test set for performance evaluation is mentioned. Non-clinical testing details (e.g., number of units tested, specific data provenance) are not provided.
- Number of experts used to establish the ground truth for the test set and the qualifications of those experts: Not applicable, as no clinical test set requiring expert ground truth is mentioned.
- Adjudication method for the test set: Not applicable, as no clinical test set is mentioned.
- If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance: Not applicable. This device is a nitric oxide delivery system, not an AI-assisted diagnostic tool. No MRMC study was conducted or mentioned.
- If a standalone (i.e. algorithm only without human-in-the-loop performance) was done: Not applicable. This is a medical device for nitric oxide delivery, not an algorithm.
- The type of ground truth used (expert consensus, pathology, outcomes data, etc.): Not applicable, as no clinical ground truth establishment is mentioned. The primary basis for equivalence is technological similarity and compliance with voluntary standards and internal quality assurance measures, rather than a clinical ground truth.
- The sample size for the training set: Not applicable, as this is a medical device, not an AI algorithm requiring a training set.
- How the ground truth for the training set was established: Not applicable.
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(166 days)
INOMAX DS (DELIVERY SYSTEM), MODEL 10003
The INOmax DS delivery system delivers INOmax® (nitric oxide for inhalation) therapy gas into the inspiratory limb of the patient breathing circuit in a way that provides a constant concentration of nitric oxide (NO), as set by the user, to the patient throughout the inspired breath. It uses a specially designed injector module, which enables tracking of the ventilator waveforms and the delivery of a synchronized and proportional dose of NO. It may be used with most ventilators.
The INOmax DS provides continuous integrated monitoring of inspired O2, NO2, and NO, and a comprehensive alarm system.
The INOmax DS incorporates a battery that provides up to 6 hours of uninterrupted NO delivery in the absence of an external power source.
The INOmax DS includes a backup NO delivery capability that provides a fixed flow of 250 mL/min of NO which along with user supplied 10 L/min of oxygen provides 20 ppm in the gas flow to a patients breathing circuit. It may also use the INOblender for backup.
The target patient population is controlled by the drug labeling for INOmax and is currently neonates. The primary targeted clinical setting is the Neonatal Intensive Care Unit (NICU) and secondary targeted clinical setting is the transport of neonates.
The INOmax DS provides a constant dose of INOmax (nitric oxide) therapy gas into the inspiratory limb of the ventilator circuit. The INOmax DS uses a "dual-channel" design to ensure the safe delivery of INOmax.
The first channel has the delivery CPU, the flow controller and the injector module to ensure the accurate delivery of NO. The second channel is the monitoring system, which includes a separate monitor CPU, the gas cells (NO, NO2 and O2 cells) and the user interface including the display and alarms. The dual-channel approach to delivery and monitoring permits INOmax delivery independent of monitoring but also allows the monitoring system to shutdown INOmax delivery if it detects a fault in the delivery system such that the NO concentration could become greater than 100 ppm. INOmax drug is stored as a gas mixture of NO/N2 in an aluminum cylinder at a nominal pressure of 2200 psig.
The cylinder is attached to a high pressure regulator which incorporates a pressure gauge that indicates cylinder pressure when the cylinder valve is open. The cylinder regulator is attached via tubing to the INOmax DS using one of the two NO/NO2 quick connect inlets on the back of the machine.
The INOmax enters the back of the INOmax DS, passes through a filter, then a safety shutoff valve, which is open under normal operations.
An injector module is placed in the ventilator gas flow between the ventilator inspiratory outlet and the humidifier. Based on the ventilator flow, the INOmax cylinder concentration and set INOmax dose, the proportional solenoid delivers INOmax into the ventilator circuit via the injector module. This allows the INOmax DS to deliver a constant dose of INOmax regardless of the ventilator flow pattern or breath rate.
A flow sensor inside the INOmax DS also monitors the NO flow out of the machine. A check valve is included prior to the INOmax DS drug outlet to prevent pressure effects from the ventilator breathing circuit interfering with the NO flow sensor reading.
The INOmax DS gas monitoring system provides monitored values for inspired NO, NO2, and O2. The sample gas is withdrawn from the breathing circuit and goes through a water trap to remove excess water, a zero valve, a sample pump and finally a sample flow sensor to the gas monitoring cells. The zero valve allows the gas cells to be zeroed (during low calibration) without having to disconnect the sample line from the breathing circuit. The pump and sample flow sensor ensure a constant sample gas flow rate is maintained to the monitoring cells.
The gas monitoring cells are electrochemical; they are specific to each gas and provide an electronic signal, which is proportional to the concentration of gas present.
If the delivery system does go into shut down, the INOmax DS has an integrated backup function which provides a fixed flow of INOmax (0.25L/min) into the injector module using a pneumatic on/off switch and a restrictor built into the delivery side of the system. This fixed flow of INOmax will provide 20 ppm of NO when the continuous ventilator gas flow is 10 Limin. The backup is only for short term use until a replacement delivery system can be obtained. An alarm will warn the user if the backup system is turned on while the main delivery system is in use for INOmax delivery.
The provided document is a 510(k) summary for the INOmax DS (Delivery System), indicating its substantial equivalence to previously cleared predicate devices. It describes the device's technical specifications and intended use, but it does not contain information about a study that establishes acceptance criteria through performance metrics like sensitivity, specificity, or accuracy, nor does it detail a study involving human readers or expert consensus for ground truth.
Instead, the document focuses on demonstrating that the INOmax DS meets various engineering and safety standards, and that its performance is comparable to predicate devices. The "acceptance criteria" here are primarily framed as compliance with design specifications and relevant medical device standards.
Here's an attempt to extract the requested information based on the provided text, recognizing that much of it is not explicitly present for a typical AI/diagnostic device study.
1. Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria are generally implied by the design input and output specifications, and compliance with various standards. The "performance" is described in terms of the device's functional capabilities and its similarity to predicate devices.
Acceptance Criterion (Implied) | Reported Device Performance |
---|---|
Nitric Oxide (NO) Delivery Accuracy | NO set resolution: 0.1/1/5 ppm depending on range. Accuracy: +/- 20% indicated or 2 ppm, whichever is greater. NO inlet pressure: 1.7 to 2.3 Bar (25 to 33 psig). |
Backup NO Delivery Functionality | Provides a fixed flow of 0.25 L/min of NO. When delivered into 10 L/min of continuous ventilator gas flow (user-supplied 10 L/min O2), provides 20 ppm of NO. Integrated backup function with pneumatic on/off switch and restrictor. |
Gas Monitoring (NO) | Range resolution: 0 to 10 ppm +/- (20% of reading + 0.5 ppm). Accuracy: +/- 20% of reading + 0.5 ppm. Calibration: Daily zero with span at pre-use test if needed. |
Gas Monitoring (NO2) | Monitored values for inspired NO2 provided. (Specific accuracy/range not detailed beyond general "gas monitoring" similar to predicate). |
Gas Monitoring (O2) | Monitored values for inspired O2 provided. (Specific accuracy/range not detailed beyond general "gas monitoring" similar to predicate). |
Ventilator Compatibility | Compatible with most ventilators. Inspiratory flow range: 2-60 L/min for neonatal, 4-120 L/min for adult (differs from predicate). New ventilators "qualified" and "validated." |
Battery Backup Duration | Provides up to 6 hours of uninterrupted NO delivery in the absence of an external power source. |
Safety Shutoff (High NO Concentration) | Monitoring system can shut down INOmax delivery if it detects a fault where NO concentration could become greater than 100 ppm. |
Compliance with Medical Electrical Equipment Standards | Designed to comply with IEC 60601-1, IEC 60601-1-2 (EMC/EMI), IEC 60601-1-4 (Programmable Systems), IEC 60601-1-8 (Alarms). |
Compliance with Gas-Related Standards | Designed to comply with CGA V-1 (Medical Cylinder Connections), ASTM F-1462-93 (Oxygen Analyzers), ASTM F-1054-87 (Conical Fittings). |
Compliance with FDA Guidance for Nitric Oxide Delivery Devices | Designed to comply with FDA Guidance Document for Premarket Notification Submissions for Nitric Oxide Delivery Apparatus, Nitric Oxide Analyzer and Nitrogen Dioxide Analyzer (Special Controls). |
Physical Dimensions | Height 220mm, Width 350mm, Depth 160mm, Weight 5.5Kg (significantly smaller/lighter than predicate) |
Materials Selection | Materials based on INOmax DS Material(s) and Datex-Ohmeda INOvent Delivery System. |
Environmental Specifications | Ambient operation and storage pressure: 57 to 110 kPa (430 to 825 mmHg) (differs from predicate). Similar to INOmax DS for other environmental aspects. |
Calibration Gas Cylinders | Uses INOcal calibration gas (INO Therapeutics LLC). NO Cal gas 45 ppm +/- 4%. NO₂ Cal gas 10 ppm +/- 10%. |
2. Sample Size Used for the Test Set and Data Provenance
The document states "Testing indicated the INOmax DS met its design input specifications, design output specifications and risk analysis requirements. Testing completed included: Validation of ventilators." However, it does not specify:
- The exact sample size for the ventilator validation or other electrical/mechanical tests.
- The data provenance (e.g., country of origin, retrospective/prospective). This type of device's "testing" is typically bench testing and laboratory validation, not clinical data collection on patients in the way a diagnostic AI would be.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts
This information is not provided in the document. The device is an electro-mechanical gas delivery system, not a diagnostic tool requiring expert interpretation of images or other clinical data for "ground truth" establishment in the typical sense of AI/medical imaging studies. Ground truth here would be established by reference instruments and engineering standards.
4. Adjudication Method (e.g., 2+1, 3+1, none) for the Test Set
This information is not provided and is not applicable for this type of device validation. Adjudication methods are typically used in clinical studies comparing human interpretations.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
No, an MRMC study was not done. This document describes a device for delivering therapeutic gas, not an AI-powered diagnostic tool that assists human readers.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) was done
Yes, implicitly. The device is a "standalone" system in that it performs its functions (gas delivery, monitoring) automatically based on user settings and its internal algorithms. Its performance is evaluated against engineering specifications and predicate devices, not typically in a human-in-the-loop context for a diagnostic output. The "testing" mentioned ("Validation of ventilators") would inherently be a standalone evaluation of the device's ability to interface and deliver gas with various ventilators.
7. The Type of Ground Truth Used (expert consensus, pathology, outcomes data, etc.)
For this type of device, the "ground truth" for performance evaluations would be:
- Reference measurements: From calibrated scientific instruments for gas concentrations (NO, NO2, O2), flow rates, pressure, etc.
- Engineering specifications: The device is designed to meet specific numerical parameters, and testing validates these parameters using metrology.
- Standard compliance: Adherence to national and international medical device standards (e.g., IEC 60601 series, ASTM, CGA).
- Predicate device performance: Functional equivalence to prior cleared devices serves as a benchmark.
8. The Sample Size for the Training Set
This information is not applicable and not provided. This is not an AI/machine learning device that requires a "training set." Its functionality is based on established physical principles and control algorithms, not learned patterns from data.
9. How the Ground Truth for the Training Set Was Established
This information is not applicable as there is no training set for this device.
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(29 days)
INOMAX DS (DELIVERY SYSTEM), MODEL 10003
The INOmax DS delivery system delivers INOmax® (nitric oxide of inhalation) therapy gas into the inspiratory limb of the patient breathing circuit in a way that provides a constant concentration of nitric oxide (NO), as set by the user, to the patient throughout the inspired breath. It uses a specially designed injector module, which enables tracking of the ventilator waveforms and the delivery of a synchronized and proportional dose of NO. It may be used with most ventilators.
The INOmax DS provides continuous integrated monitoring of inspired O2, NO2, and NO, and a comprehensive alarm system.
The INOmax DS incorporates a battery that provides up to 6 hours of uninterrupted NO delivery in the absence of an external power source.
The INOmax DS includes a backup NO delivery capability that provides a fixed flow of 250 mL/min of NO which along with user supplied 10 L/min of oxygen provides 20 ppm in the gas flow to a patients breathing circuit. It may also use the INOblender for backup.
The target patient population is controlled by the drug labeling for INOmax and is currently neonates. The primary targeted clinical setting is the Neonatal Intensive Care Unit (NICU) and secondary targeted clinical setting is the transport of neonates.
The INOmax DS provides a constant dose of INOmax (nitric oxide) therapy gas into the inspiratory limb of the ventilator circuit. The INOmax DS uses a "dual-channel" design to ensure the safe delivery of INOmax. The first channel has the delivery CPU, the flow controller and the injector module to ensure the accurate delivery of NO. The second channel is the monitoring system, which includes a separate monitor CPU, the gas cells (NO, NO2 and O2 cells) and the user interface including the display and alarms. The dual-channel approach to delivery and monitoring permits INOmax delivery independent of monitoring but also allows the monitoring system to shutdown INOmax delivery if it detects a fault in the delivery system such that the NO concentration could become greater than 100 ppm. INOmax drug is stored as a gas mixture of NO/N2 in an aluminum cylinder at a nominal pressure of 2200 psig. The cylinder is attached to a high pressure regulator which incorporates a pressure gauge that indicates cylinder pressure when the cylinder valve is open. The cylinder regulator is attached via tubing to the INOmax DS using one of the two NO/NO2 quick connect inlets on the back of the machine. The INOmax enters the back of the INOmax DS, passes through a filter, then a safety shutoff valve, which is open under normal operations. An injector module is placed in the ventilator gas flow between the ventilator inspiratory outlet and the humidifier. Based on the ventilator flow, the INOmax cylinder concentration and set INOmax dose, the proportional solenoid delivers INOmax into the ventilator circuit via the injector module. This allows the INOmax DS to deliver a constant dose of INOmax regardless of the ventilator flow pattern or breath rate. A flow sensor inside the INOmax DS also monitors the NO flow out of the machine. A check valve is included prior to the INOmax DS drug outlet to prevent pressure effects from the ventilator breathing circuit interfering with the NO flow sensor reading. The INOmax DS gas monitoring system provides monitored values for inspired NO, NO2, and O2 The sample gas is withdrawn from the breathing circuit and goes through a water trap to remove excess water, a zero valve, a sample pump and finally a sample flow sensor to the gas monitoring cells. The zero valve allows the gas cells to be zeroed (during low calibration) without having to disconnect the sample line from the breathing circuit. The pump and sample flow sensor ensure a constant sample gas flow rate is maintained to the monitoring cells. The gas monitoring cells are electrochemical; they are specific to each gas and provide an electronic signal, which is proportional to the concentration of the gas present. If the delivery system does go into shut down, the INOmax DS has an integrated backup function which provides a fixed flow of INOmax (0.25L/min) into the injector module using a pneumatic on/off switch and a restrictor built into the delivery side of the system. This fixed flow of INOmax will provide 20 ppm of NO when the continuous ventilator gas flow is 10 L/min. The backup is only for short term use until a replacement delivery system can be obtained. An alarm will warn the user if the backup system is turned on while the main delivery system is in use for INOmax delivery.
The provided document describes the INOmax DS (Delivery System), a device for delivering nitric oxide (NO) therapy, primarily to neonates. The document is a 510(k) summary for a premarket notification (K070867). It details the device's characteristics, its similarities to a predicate device, and the testing conducted to ensure its compliance with design specifications and applicable standards.
Here's an analysis of the acceptance criteria and study information:
1. Table of Acceptance Criteria and Reported Device Performance
The document doesn't explicitly present a table of acceptance criteria with corresponding performance metrics in a pass/fail format typical of many medical device studies for software algorithms. Instead, it describes compliance with various standards and design specifications. The performance is primarily characterized by comparing the INOmax DS to its predicate device (INOvent Delivery System) and outlining its features.
However, based on the narrative, we can infer some key performance aspects and their intended or reported capabilities:
Criterion (Inferred from Design/Standards) | Acceptance Criteria (Implied) | Reported Device Performance (INOmax DS) |
---|---|---|
NO Delivery Accuracy | Constant concentration of NO as set by user, synchronized and proportional to ventilator waveforms. | Achieves constant dose regardless of ventilator flow or breath rate. NO set resolution is 0.1/1/5 ppm depending on range, accuracy is +/-20% indicated or 2 ppm whichever greater. |
Integrated Gas Monitoring | Continuous monitoring of inspired O2, NO2, and NO. | Provides continuous integrated monitoring of inspired O2, NO2, and NO. NO range resolution 0-10ppm +/- (20% of reading +0.5ppm). |
NO Monitoring Accuracy | Sufficient accuracy for clinical use. | NO accuracy is +/-20% of reading +0.5ppm. |
Battery Backup Duration | Sufficient backup power in absence of external source. | Provides up to 6 hours of uninterrupted NO delivery. |
Backup NO Delivery Capability | Fixed flow of NO for emergency situations. | Fixed flow of 250 mL/min of NO, providing 20 ppm with 10 L/min oxygen. Also can use INOblender for backup. |
Safety - Fault Detection/Shutdown | System can detect faults and shut down NO delivery if concentration exceeds safe limits. | Monitoring system can shut down INOmax delivery if NO concentration could become greater than 100 ppm. |
Ventilator Compatibility | Compatibility with most ventilators. | May be used with most ventilators. New ventilators validated. |
Compliance with Standards | Device complies with applicable medical device standards. | Designed to comply with FDA Guidance, IEC 60601-1 (and amendments), IEC 60601-1-2, IEC 60601-1-4, IEC 60601-1-8, CGA V-1, ASTM F-1462-93, ASTM F-1054-87. |
Risk Analysis Requirements | Device meets risk analysis requirements. | Testing indicated the INOmax DS met its design input specifications, design output specifications and risk analysis requirements. |
2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)
The document refers to "Testing" that indicated the INOmax DS met its design input, output, and risk analysis requirements. It also states "Validation of ventilators" was performed, and "newly validated ventilators have been qualified with the INOmax DS."
- Sample Size for Test Set: Not explicitly stated for any specific test. The phrase "Validation of ventilators" implies a test set of ventilators, but the number is not given.
- Data Provenance: Not specified. Given the nature of a 510(k) submission in the US, the testing would generally be expected to be conducted under a US-based quality system, but the geographic origin of the specific test data is not detailed.
- Retrospective or Prospective: Not specified. Given the nature of device validation, these would typically be prospective tests conducted on the manufactured device.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)
This information is not applicable to this type of device submission. The INOmax DS is a physical medical device (gas delivery system), not an AI/software algorithm that requires expert interpretation for establishing ground truth in a diagnostic or image-based context. The "ground truth" for this device would be established by physical measurements against engineering specifications and validated standards.
4. Adjudication method (e.g. 2+1, 3+1, none) for the test set
This information is not applicable. Adjudication methods like '2+1' or '3+1' are typically used in clinical studies or for establishing ground truth from multiple expert readings in diagnostic imaging or similar fields. For a device like the INOmax DS, performance is verified through objective measurements and engineering standards, not through adjudication of expert opinions.
5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
This information is not applicable. An MRMC study is designed to evaluate the performance of diagnostic systems (often AI-assisted) by comparing multiple human readers' interpretations of multiple cases. The INOmax DS is a therapeutic gas delivery system, not a diagnostic imaging or AI-based diagnostic tool.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
This information is not applicable. The INOmax DS is a physical device with integrated hardware and software for gas delivery and monitoring. It is not an "algorithm only" device, nor is its performance typically evaluated in a standalone "algorithm only" context, as it functions as a complete system with human interaction (setting dose, monitoring, etc.).
7. The type of ground truth used (expert consensus, pathology, outcomes data, etc)
For this device, the "ground truth" is derived from:
- Engineering Specifications: The device's performance against its own design input and output specifications.
- Physical Measurements: Quantifiable measurements of gas concentration, flow rates, battery life, and alarm functions.
- Compliance with Standards: Verification against established industry and regulatory standards (e.g., IEC, ASTM, FDA guidance documents).
8. The sample size for the training set
This information is not applicable. The INOmax DS is not an AI/machine learning device that requires a "training set" in the conventional sense. The device's operation is based on predefined algorithms and control logic, not learned patterns from data.
9. How the ground truth for the training set was established
This information is not applicable for the same reasons as in point 8.
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(162 days)
INO THERAPEUTICS INOMAX DS (DELIVERY SYSTEM), MODEL 10003
The INOmax DS delivery system delivers INOmax® (nitric oxide of inhalation) therapy gas into the inspiratory limb of the patient breathing circuit in a way that provides a constant concentration of nitric oxide (NO), as set by the user, to the patient throughout the inspired breath. It uses a specially designed injector module, which enables tracking of the ventilator wayeforms and the delivery of a synchronized and proportional dose of NO. It may be used with most ventilators.
The INOmax DS provides continuous integrated monitoring of inspired O2, NO2, and NO, and a comprehensive alarm system.
The INOmax DS incorporates a battery that provides up to 6 hours of uninterrupted NO delivery in the absence of an external power source.
The INOmax DS includes a backup NO delivery capability that provides a fixed flow of 250 mL/min of NO which along with user supplied 10 L/min of oxygen provides 20 ppm in the gas flow to a patients breathing circuit. It may also use the INOblender for backup.
The target patient population is controlled by the drug labeling for INOmax and is currently neonates. The primary targeted clinical setting is the Neonatal Intensive Care Unit (NICU) and secondary targeted clinical setting is the transport of neonates.
The INOmax DS provides a constant dose of INOmax (nitric oxide) therapy gas into the inspiratory limb of the ventilator circuit. The INOmax DS uses a "dual-channel" design to ensure the safe delivery of INOmax.
The first channel has the delivery CPU, the flow controller and the injector module to ensure the accurate delivery of NO. The second channel is the monitoring system, which includes a separate monitor CPU, the gas cells (NO, NO2, and O2 cells) and the user interface including the display and alarms. The dual-channel approach to delivery and monitoring permits INOmax delivery independent of monitoring but also allows the monitoring system to shutdown INOmax delivery if it detects a fault in the delivery system such that the NO concentration could become greater than 100 ppm. INOmax drug is stored as a gas mixture of NO/N2 in an aluminum cylinder at a nominal pressure of 2200 psig.
The cylinder is attached to a high pressure regulator which incorporates a pressure gauge that indicates cylinder pressure when the cylinder valve is open. The cylinder regulator is attached via tubing to the INOmax DS using one of the two NO/N2 quick connect inlets on the back of the machine.
The INOmax enters the back of the INOmax DS, passes through a filter. then a safety shutoff valve, which is open under normal operation.
An injector module is placed in the ventilator gas flow between the ventilator inspiratory outlet and the humidifier. Based on the ventilator flow, the INOmax cylinder concentration and set INOmax dose, the proportional solenoid delivers INOmax into the ventilator circuit via the injector module. This allows the INOmax DS to deliver a constant dose of INOmax regardless of the ventilator flow pattern or breath rate.
A flow sensor inside the INOmax DS also monitors the NO flow out of the machine. A check valve is included prior to the INOmax DS drug outlet to prevent pressure effects from the ventilator breathing circuit interfering with the NO flow sensor reading.
The INOmax DS gas monitoring system provides monitored values for inspired NO, NO2, and O2. The sample gas is withdrawn form the breathing circuit and goes through a water trap to remove excess water, a zero valve, a sample pump and finally a sample flow sensor to the gas monitoring cells. The zero valve allows the gas cells to be zeroed (during low calibration) without having to disconnect the sample line from the breathing circuit. The pump and sample flow sensor ensure a constant sample gas flow rate is maintained to the monitoring cells.
The gas monitoring cells are electrochemical; they are specific to each gas and provide an electronic signal, which is proportional to the concentration of the gas present.
If the delivery system does go into shut down, the INOmax DS has an integrated backup function which provides a fixed flow of INOmax (0.25L/min) into the injector module using a pneumatic on/off switch and a restrictor built into the delivery side of the system. This fixed flow of INOmax will provide 20 ppm of NO when the continuous ventilator gas flow is 10 L/min. The backup is only for short term use until a replacement delivery system can be obtained. An alarm will warn the user if the backup system is turned on while the main delivery system is in use for INOmax delivery.
The INOmax DS is a Nitric Oxide Administration Apparatus designed to deliver INOmax (nitric oxide for inhalation) therapy gas to neonates in clinical settings such as the Neonatal Intensive Care Unit (NICU) and during transport. The device ensures a constant concentration of nitric oxide (NO) as set by the user, throughout the inspired breath, utilizing a dual-channel design for delivery and monitoring. It also includes integrated monitoring of O2, NO2, and NO, and a comprehensive alarm system. A key safety feature is a 6-hour battery backup and a fixed-flow backup NO delivery capability.
Here's an analysis of its acceptance criteria and the study proving it:
1. Table of Acceptance Criteria and Reported Device Performance
Feature/Specification | Acceptance Criteria (Predicate: Ohmeda INOvent Delivery System) | INOmax DS Reported Performance |
---|---|---|
Indications for Use | Similar to INOmax DS | Except battery backup is 6 hours and provides an integrated backup system for delivering a fixed flow of NO into a constant flow of breathing circuit gas to produce a constant concentration of NO. (Also includes continuous integrated monitoring of inspired O2, NO2, and NO, and a comprehensive alarm system. Backup NO delivery is 250 mL/min of NO which, with 10 L/min of oxygen, provides 20 ppm; can also use INOblender for backup.) Target population: neonates; Clinical setting: NICU and transport. |
Physical Dimensions | Height 215 mm, Width 350 mm, Depth 430 mm, Weight 21 Kg | Height 220 mm, Width 350 mm, Depth 160 mm, Weight 5.5 Kg |
Ventilator Compatibility | Similar to INOmax DS | Except 2-60 L/min for inspiratory flow for neonatal and 4-120 L/min for adult. |
NO Delivery Control | Similar to INOmax DS (implicitly, the INOvent delivers a constant concentration as set by the user via an injector module) | NO set resolution is 0.1 / 1 / 5 ppm depending on range, accuracy is +/- 20% indicated or 2 ppm whichever is greater, and NO inlet pressure is 1.7 to 2.3 Bar (25 to 33 psig). (Delivers a constant concentration of NO as set by the user, throughout the inspired breath, tracking ventilator waveforms). |
NO Cylinder | Same as INOmax DS | Same (INOmax ™) |
Gas Monitoring | Similar to INOmax DS (implicitly, includes O2, NO2, and NO monitoring) | NO range resolution is 0 to 10ppm +/- (20% of reading +0.5 ppm) 10 to 100ppm +/- (10% of reading +0.5 ppm), calibration span is daily zero with span at pre-use test if needed, and NO accuracy is +/- 20% of reading +0.5 ppm. (Continuously monitors inspired O2, NO2, and NO). |
Injector Module | Same as INOmax DS | Same (Enables tracking of ventilator waveforms and synchronized/proportional dose of NO). |
NO Delivery Shut Off | Same as INOmax DS | Same (dual-channel design with monitoring system able to shutdown INOmax delivery if fault detects NO concentration > 100 ppm). |
Calibration Gas Cylinders | NO Cal gas 40 - 80 ppm +/- 4%, NO₂ Cal gas 10 -15 ppm +/- 10% | INOcal calibration gas, INO Therapeutics LLC; NO Cal Gas 45 ppm +/- 4%, NO₂ Cal Gas 10 ppm +/- 10% |
Electrical Specifications | Similar toINOMax DS | Except no nurse call and battery back-up is 6 hours. |
Environmental Specs | Similar to INOmax DS | Except ambient operation and storage pressure are 57 to 110 kPa (430 to 825 mmHg). |
NO Back-up Delivery | 20 ppm @ 15 L/min | 0.25 L/min when delivered into 10 L/min provides 20 ppm, plus INOblender may also be used. |
Safety and Effectiveness | Implied to be safe and effective for its intended uses by the predicate device (Ohmeda INOvent Delivery System), which was legally marketed prior to May 28, 1976, or reclassified. | The INOmax DS met its design input specifications, design output specifications, and risk analysis requirements, as demonstrated by performance bench testing, integrity testing, environmental and mechanical testing, validation against ventilators, and product standards certification testing. Deemed safe and effective, and "as safe and effective as the predicate INOvent Delivery System, while performing as well or better than this predicate device." |
2. Sample size used for the test set and the data provenance (e.g. country of origin of the data, retrospective or prospective)
The document does not specify a "test set" in the context of clinical or patient data. The testing described includes:
- Performance bench testing
- Integrity testing
- Environmental and mechanical testing
- Validation against ventilators testing
- Product standards certification testing
These are technical engineering and laboratory tests, not tests with a human patient cohort. Therefore, concepts like sample size, country of origin, retrospective/prospective data provenance (for patient data) are not applicable here. The data provenance would be from internal lab testing by INC Therapeutics.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts (e.g. radiologist with 10 years of experience)
This is not applicable as the device is a piece of medical equipment (Nitric Oxide Administration Apparatus). The "ground truth" for its performance is established through objective engineering specifications, performance standards (e.g., IEC 60601-1), and comparisons to a predicate device's measured performance. Validation is against these technical specifications, not against expert medical diagnoses or interpretations.
4. Adjudication method (e.g. 2+1, 3+1, none) for the test set
This is not applicable for the type of technical performance testing described. Adjudication methods are typically used in clinical studies for ambiguous cases, often involving multiple experts to reach a consensus on diagnostic interpretations. The performance of the INOmax DS is measured against defined technical parameters and standards.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
This is not applicable. The INOmax DS is a medical device for delivering therapy gas and monitoring physiological parameters, not an AI-powered diagnostic tool requiring human reader interpretation of images or other data. Therefore, an MRMC study and analysis of human reader improvement with AI assistance are irrelevant to this device.
6. If a standalone (i.e. algorithm only without human-in-the loop performance) was done
This is not applicable as the device is not an algorithm or AI system. It is a standalone medical device that performs its intended function independently, delivering nitric oxide and monitoring gases. While a human operator sets parameters and monitors the device, the core function (gas delivery, monitoring, alarms) is performed by the device itself (algorithm only without human-in-the-loop performance is a concept for AI driven diagnostics).
7. The type of ground truth used (expert consensus, pathology, outcomes data, etc.)
The "ground truth" for the INOmax DS's performance is based on:
- Design input specifications: Pre-defined technical requirements for the device.
- Design output specifications: The technical characteristics and performance generated by the design process.
- Risk analysis requirements: Ensuring safety and mitigating identified risks.
- Applicable product standards: Compliance with industry standards like FDA Guidance, IEC 60601-1, IEC 60601-1-2, IEC 60601-1-4, IEC 60601-1-8, CGA V-1, ASTM F-1462-93, ASTM F-1054-87.
- Predicate device performance: Comparison to the established performance of the Ohmeda INOvent Delivery System.
These are primarily objective, quantitative engineering and regulatory criteria, rather than clinical 'ground truth' derived from patient outcomes or pathology.
8. The sample size for the training set
This is not applicable. The INOmax DS is a hardware-based medical device with integrated software/firmware for control and monitoring, not a machine learning or AI model. Therefore, there is no "training set" in the context of data used to train an algorithm.
9. How the ground truth for the training set was established
This is not applicable for the reasons outlined in point 8. The device's functionality is designed, engineered, and then verified against its specifications and relevant standards through testing.
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