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510(k) Data Aggregation

    K Number
    K122063
    Date Cleared
    2013-08-02

    (385 days)

    Product Code
    Regulation Number
    868.5160
    Reference & Predicate Devices
    Predicate For
    N/A
    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Intellisave AX700 Anesthesia System is intended to provide general inhalational anesthesia and ventilation support to neonatal, pediatric and adult patients. The device is intended to provide volume or pressure controlled ventilation.

    Device Description

    The Intellisave AX700 suitable for most types of inhalation anesthesia. O2 and N2O or O2 and Air can be administered, and anesthesia vaporizer(s) can be connected to a back bar. The gasses can be supplied from a centralized supply or cylinders. The Intellisave AX 700 is a prescriptive device restricted to use by, or on the order of, a physician. The Intellisave AX700 includes the following: An Electronic Gas Mixer (EGM), an anesthesia ventilator with various ventilation modes, an Integrated Breathing System (IBS), and an optional multigas module.

    AI/ML Overview

    The Philips Intellisave AX700 Anesthesia System is an anesthesia breathing machine, which is a medical device and therefore its performance is compared to a similar predicate device already on the market rather than having explicit acceptance criteria set. The study conducted to demonstrate equivalence is a non-clinical performance assessment which shows how the AX700 is substantially equivalent to the GE Avance Anesthesia Breathing Machine (K112722).

    1. Table of Acceptance Criteria and Reported Device Performance

    Since this is a substantial equivalence submission for a medical device (anesthesia system), direct "acceptance criteria" are not explicitly defined as pass/fail thresholds for an AI algorithm's performance. Instead, the "acceptance criteria" can be interpreted as demonstrating that the Philips Intellisave AX700 Anesthesia System performs equivalently to the predicate device, the GE Avance Anesthesia Breathing Machine (K112722), across various technical and functional specifications. The table below summarizes the comparison presented in the 510(k) summary, effectively acting as the reported device performance against the predicate's established performance.

    CategoryPredicate Device (GE Avance) PerformanceProposed Device (AX700) PerformanceEquivalence Assessment (Comments)
    Ventilation ModesVolume Control, Pressure Control, SIMV, Pressure Support, PCV-VG, Cardiac Bypass ModeVolume Controlled Ventilation, Pressure Controlled Ventilation, SIMV, Pressure Supported Ventilation, Volume Supported Ventilation, PRVT, Heart-Lung ModeEquivalent
    Intended UseGeneral inhalation anesthesia and ventilatory support to neonatal, pediatric, adult patients; volume or pressure control ventilation.General inhalational anesthesia and ventilation support to neonatal, pediatric, and adult patients; volume or pressure controlled ventilation.Equivalent
    Ranges (Ventilation)
    Tidal volume20 to 1500 mL20 to 1500 mLEquivalent
    Minute volume0 to 99.9 L/min0.2 to 60.0 L/minEquivalent
    Pressure, inspired5 to 60 cmH2O4 to 67 cmH2OEquivalent
    Pressure limit12 to 100 cmH2O10 to 80 cmH2OEquivalent
    Pressure SupportOff, 2 to 40 cmH2O4 to 50 cmH2OEquivalent
    Respiration Rate4 - 100 BPM (VCV, PCV, PCV-VG), 2 to 60 BPM (SIMV, PSV)4 to 80 BPMBoth within range required for application.
    I:E Ratio2:1 to 1:83:1 to 1:9.9Equivalent
    Flow trigger1 to 10 L/min1 to 10 LPMEquivalent
    Inspiration termination5 to 50%10 to 80% (expiratory triggering)Both within range required for application.
    Inspiratory Pause0-60%0 to 70%Equivalent
    PEEPOFF, 4 to 30 cmH2OOFF, 4 to 20 cmH2OBoth within range required for application.
    Ventilator gas flowContinuous: Max. 80 L/min, Peak: 120 L/minContinuous: Max. 80 L/min, Peak: 120 L/minEquivalent
    (Fresh gas) Flow compensation200 mL/min to 15 L/min200 mL/min to 20 L/minEquivalent
    Accuracy (Ventilation)
    Tidal volume delivery> 210 mL: ±7%, 210 mL = ±9%, 60 cmH2O: 12 cm H2O for 15 seconds (+PEEP-2cmH2O with PEEP on)PEEP + 5 cmH2O for 15 secEquivalent
    Alarm silence120 seconds120 secondsEquivalent
    Fresh Gas
    Flow range (per gas)OFF, 100 mL/min-15 L/minOFF, 100 mL/min to 10 LPMBoth within range required for application.
    Total Flow rangeOFF, 150 mL/min-15 L/minOFF, 200 mL/min to 20 LPMBoth within range required for application.
    O2 flow accuracy± 5% or ± 20 mL/min± 10% or ± 50 mL/minBoth within range required for application.
    Balance gas flow accuracy± 5% or ± 20 mL/min (larger of) Air/N2O± 10% or ± 50 mL/minBoth within range required for application.
    Total flow accuracy± 10% or ± 40 mL/min± 10% or ± 50 mL/minEquivalent
    O2 concentration range (Air)21%, 25 to 100% (Air); 25 to 100% (N2O)21 to 100% (balance gas Air); 25 to 100% (balance gas N2O)Equivalent
    O2 concentration accuracy± 5% V/V for flows 1 LPM± 5% V/VEquivalent
    Compensationto 20℃ and 101.3 kPato 20℃ and 101.3 kPaEquivalent
    Alternate O2 flow500 mL/min – 10 L/min5 L/min - 15 L/minBoth within range required for application.
    Electrical Specs
    Power input100-120 Vac, 50/60 Hz100-120 Vac, 50/60 HzEquivalent
    Rating10A@220Vac/15A@120Vac10A@220Vac/15A@120 VacEquivalent
    Outlets3 outlets on back with 2A fuses, and one 3A fuse (120 V), breakers, isolation transformer3 outlets on back with 3.15A fuse (120 V) and one 1 outlet in front (vaporizer) with 3.15 A fuse. Isolation transformerEquivalent
    Pneumatic Specs
    Aux. Fresh gas OutletISO 22 mm OD / 15 mm IDISO 22 mm OD / 15 mm IDEquivalent
    Gas supply input35 to 100 psi58 to 87 psiBoth within range for Operating Room application.
    Adjustable Pressure Limiting valve0.8 to 70 cm H2OSpontaneous, 5 to 75 cmH2OEquivalent
    Environmental Specs
    Operation Temperature10° to 40°C10° to 40°CEquivalent
    Operation Humidity15 to 95% relative humidity10 to 90% relative humidityEquivalent
    Operation Altitude-440 to 3565 m-100 to 3000 mBoth within range required for application.
    Storage Temperature-25° to 60°C / -13° to 140°F-20° to 60°CEquivalent
    Storage Humidity10 to 95% RH10 to 90% relative humidityEquivalent

    2. Sample Size Used for the Test Set and Data Provenance

    This submission is for a traditional medical device (anesthesia system), not an AI/ML-driven device that relies on a test set of data samples for algorithmic performance evaluation.

    Therefore, there is no "test set" sample size in the context of data (e.g., images, patient records) or any mention of data provenance (e.g., country of origin, retrospective/prospective).

    The "testing" mentioned refers to engineering verification and validation testing of the physical and software components of the device.

    3. Number of Experts Used to Establish Ground Truth for the Test Set and their Qualifications

    As there is no "test set" of data samples in the sense of AI/ML, there were no experts used to establish ground truth for such a test set. This device is evaluated based on its functional specifications and compliance with established medical device standards.

    4. Adjudication Method for the Test Set

    Not applicable, as there is no "test set" in the context of data requiring adjudication. The evaluation is based on engineering tests and comparison to a predicate device.

    5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study was done, and its Effect Size with AI vs. without AI assistance

    No MRMC comparative effectiveness study was done as this is not an AI/ML-enabled diagnostic or assistive device. The submission describes a standalone anesthesia system.

    6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Study was done

    This question is not directly applicable in the context of this device. The device is an anesthesia system, a piece of medical equipment, not an algorithm being evaluated for its standalone performance. The "standalone" performance is the intrinsic technical and functional performance of the system as measured during bench testing and detailed in the comparison table. The device itself is designed for human-in-the-loop operation by a physician.

    7. The Type of Ground Truth Used

    The "ground truth" for this device's performance is established through engineering specifications, compliance with recognized industry standards (e.g., IEC, ISO), and direct measurement of physical and software outputs during verification and validation testing. The predicate device's established performance serves as the benchmark against which the proposed device's "truth" (its actual performance characteristics) is compared.

    8. The Sample Size for the Training Set

    Not applicable. This is not an AI/ML device that requires a "training set" of data.

    9. How the Ground Truth for the Training Set was Established

    Not applicable, as there is no "training set."

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