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510(k) Data Aggregation

    K Number
    K182862
    Device Name
    Servo Guard
    Date Cleared
    2019-10-21

    (375 days)

    Product Code
    Regulation Number
    868.5260
    Reference & Predicate Devices
    Predicate For
    N/A
    AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
    Intended Use

    The Servo Guard is a bacterial/viral filter for applications in respiratory care.The filter is intended to be used in patient circuits to reduce the spread of viruses and bacteria from patient/persomel and to protect the patient circuits and ventilators from contamination. The filter shall only be used with the ventilators Servo-i and Servo-s.

    Device Description

    A Breathing Circuit Bacteria Filter is intended to protect from contamination as well as to reduce particles such as dust and microbiological matters from gases used in the patient circuit of a respiratory device. The bacterial/viral filter is a disposable accessory normally used on the expiratory limb of the ventilator breathing system to reduce possible cross contamination between patient and equipment and between patient. It can also be used on the inspiratory pipe, in order to reduce dust particles to the patient.

    AI/ML Overview

    This document is a 510(k) summary for the Servo Guard bacterial/viral filter. It describes non-clinical testing performed to demonstrate substantial equivalence to a predicate device.

    Here's the information requested based on the provided text, focusing on the study that proves the device meets the acceptance criteria:

    1. Table of Acceptance Criteria and Reported Device Performance

    Test Method (Type of Study)Acceptance CriteriaReported Device Performance
    ISO 23328-1 Filter efficiency> 99.3 % measured in both flow directions99.329 % - 99.93%
    ASTM F2101-14 Standard Test Method for Evaluating the Bacterial Filtration EfficiencyBFE/VFE filter efficiency shall be > 99.999 %BFE: 99.99951% - 99.999984 % VFE: 99.99960% - 99.999980 %
    ISO 18562-2: 2017 Biocompatibility evaluation of breathing gas pathways in healthcare applications -- Part 2: Tests for emissions of particulate matter< 12 [µg/m3]1.4 [µg/m3]
    ISO 18562-3 Biocompatibility evaluation of breathing gas pathways in healthcare applications - Part 3: Tests for emissions of volatile organic compounds (VOCs)The MOS (Margin Of Safety) value shall be higher than 1 for identified substances.Cyclohexane: 35.0 (Neonate), 83.3 (Pediatric/Adult)Ethylbenzene: 7.8 (Neonate), 32.5 (Pediatric/Adult)m+p-Xylene: 4.2 (Neonate), 10.0 (Pediatric/Adult)o-Xylene: 15.0 (Neonate), 35.7 (Pediatric/Adult)Tetrachloroethylene: 4.7 (Neonate), 11.1 (Pediatric/Adult)Trichlorofluoromethane: 27.6 (Neonate), 65.6 (Pediatric/Adult)

    2. Sample Size for the Test Set and Data Provenance

    The document describes non-clinical testing (laboratory studies), not a clinical trial with human subjects. Therefore, the concept of "test set" in the context of data provenance and sample size of human data is not directly applicable here. The tests were performed on the device itself.

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

    Not applicable. The ground truth for these non-clinical tests is established by standardized test methods (e.g., ISO, ASTM) and physical/chemical measurements, not by expert human interpretation.

    4. Adjudication Method for the Test Set

    Not applicable, as this refers to human expert review processes in clinical studies.

    5. If a multi-reader multi-case (MRMC) comparative effectiveness study was done

    No. This document describes non-clinical performance testing of a medical device (a filter), not a study involving human readers or comparative effectiveness of AI vs human performance.

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

    Not applicable. This is not an AI device or an algorithm. It's a physical filter.

    7. The type of ground truth used

    The ground truth used for these tests is based on standardized physical and chemical measurements according to established international and national standards (ISO 23328-1, ASTM F2101-14, ISO 18562-2, ISO 18562-3). For example:

    • Filter efficiency is measured precisely through laboratory methods.
    • Bacterial and viral filtration efficiency is measured with specific microbial challenge tests.
    • Particulate matter and VOC emissions are measured using analytical chemistry techniques.

    8. The Sample Size for the Training Set

    Not applicable. This is a physical medical device, not an AI/machine learning algorithm that requires a training set.

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

    Not applicable, for the same reason as above.

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