Drager Apollo

Asset Type

Anesthesia Machine

Manufacturer

Drager

Model

Apollo

What This Guide Helps With

This guide helps troubleshoot a PEEP HIGH alarm on a Drager Apollo anesthesia machine. The alarm indicates that expiratory pressure is elevated above the expected PEEP level, which may be caused by ventilation settings, patient or airway resistance, a restricted breathing circuit, filter blockage, scavenging restriction, or device-related pressure control issues.

The reported condition is that expiratory pressure is 5 cmH2O above PEEP for 2 breaths, or 5 cmH2O above PEEP in Pressure Support mode for more than 30 seconds.

Step-by-Step Troubleshooting

Ensure Patient Safety First

• Confirm the patient is being adequately ventilated and monitored.
• Have anesthesia staff assess airway patency, chest movement, oxygenation, ventilation, and circuit pressure behavior.
• If pressure remains elevated or ventilation is questionable, switch to manual ventilation or another anesthesia machine as clinically appropriate.
• Do not continue case support on a machine with unresolved high expiratory pressure alarms.
• Protect the patient from inadequate exhalation, air trapping, barotrauma risk, or unstable ventilation.

Verify the Reported Alarm and Behavior

• Confirm the displayed alarm is exactly PEEP HIGH.
• Observe whether the alarm occurs during automatic ventilation, Pressure Support mode, or intermittently during the case.
• Check whether expiratory pressure remains approximately 5 cmH2O above the set PEEP.
• Note whether the alarm appears after two breaths or after prolonged elevated expiratory pressure.
• Confirm the alarm is a real pressure-related event and not a misunderstood ventilator setting or transient patient/circuit event.

Check Ventilation Parameters

• Review the current ventilation mode and settings with anesthesia staff.
• Check the set PEEP, pressure limit, inspiratory pressure, pressure support level, respiratory rate, inspiratory time, I:E ratio, tidal volume settings, and fresh gas flow.
• Verify the settings are appropriate for the patient and are not causing incomplete exhalation or elevated baseline pressure.
• If settings are corrected and the alarm clears, monitor the machine through several breaths before returning it to service.

Check for Patient or Airway Causes

• Have clinical staff evaluate for airway obstruction, bronchospasm, secretions, coughing, patient-ventilator fighting, reduced lung compliance, or a kinked/obstructed endotracheal tube.
• Remember that the anesthesia machine may be alarming correctly because the patient cannot exhale normally.
• If the cause is patient-related and the alarm resolves after clinical correction, document the finding and no device repair may be needed.

Inspect the Breathing Circuit

• Check the breathing circuit for kinked tubing, an occluded expiratory limb, water accumulation, blocked filters, incorrectly installed HME or bacterial filter, obstructed Y-piece, or misconnected circuit tubing.
• Verify gas can flow freely through both the inspiratory and expiratory limbs.
• If a circuit issue is found, replace or correct the affected component and verify the alarm clears.

Check the Expiratory Valve Area and Manual/Automatic Ventilation Setup

• Verify the breathing system is assembled correctly.
• Check that manual/automatic ventilation selection is correct.
• Confirm the APL valve is not affecting ventilation when the machine is expected to be in automatic ventilation.
• Inspect accessible expiratory valve areas for visible contamination, sticking, moisture, or obstruction.
• Do not perform internal disassembly during clinical troubleshooting.

Check the Anesthetic Gas Scavenging Line

• Inspect the scavenging line connected to the Apollo.
• Check for kinks, pinched tubing, blocked tubing, improper connection, excessive back pressure, a full or restricted waste gas interface, or incorrect scavenging setup.
• Correct or replace restricted scavenging tubing according to facility policy and safe gas management practices.
• Verify waste anesthetic gas can leave the system without creating back pressure.
• If correcting the scavenging line clears the alarm, confirm stable ventilation and proper scavenging function before returning the machine to service.

Check External Accessories and Filters

• Replace questionable external accessories one at a time.
• Check the breathing circuit, expiratory filter, HME/filter, sampling line if it affects the circuit setup, scavenging hose, and reservoir bag if relevant to the setup.
• Confirm whether the alarm clears after replacing an accessory or continues with known-good accessories installed.
• Rule out accessory restrictions before suspecting internal machine failure.

Run a Pre-Use or System Check

• Remove the machine from patient use before performing extended testing.
• Run the Apollo pre-use or system check according to facility procedure.
• Verify the machine passes leak, compliance, valve, ventilation, and breathing system checks as applicable.
• A failed system check after external causes are corrected may indicate a device-related ventilation or pressure regulation problem.

Isolate Whether the Issue Is External or Device-Related

• After the patient is no longer connected, test with a known-good breathing circuit, known-good filters, correct ventilation settings, clear scavenging pathway, and proper breathing system assembly.
• Observe whether the PEEP HIGH alarm returns during automatic ventilation testing.
• If the alarm does not return, the likely cause was external, clinical, or setup-related.
• If the alarm continues with a known-good external setup, the issue is more likely internal to the anesthesia machine.

Stop When Resolved

• If the alarm clears after correcting settings, circuit restriction, patient airway issue, or scavenging restriction, confirm stable ventilation through multiple breaths.
• Confirm no repeat PEEP HIGH alarm.
• Complete the required machine check.
• Return the Apollo to service only when safe operation is verified.
• Document the corrective action clearly in the work order.

If the Problem Persists

If the PEEP HIGH alarm continues after ventilation settings, patient causes, breathing circuit, filters, scavenging line, and external accessories have been ruled out, remove the anesthesia machine from service.

Persistent PEEP HIGH alarms may indicate an internal expiratory valve, pressure sensing, ventilation control, breathing system, or scavenging interface problem.

• Remove the device from service.
• Label it Out of Service.
• Send it for bench evaluation or qualified repair.
• Do not keep troubleshooting during active patient care.

Clinical Use Tip

Never troubleshoot repeated PEEP HIGH alarms on an active patient unless anesthesia staff confirm it is safe. Elevated expiratory pressure can affect ventilation and patient safety. Move the patient to a backup device or alternate ventilation support before extended troubleshooting.

Work Order Documentation (CCR Method)

CCR = Complaint, Cause, Resolution

Complaint

What was reported by the clinical staff.

Example:
"Drager Apollo anesthesia machine displayed PEEP HIGH alarm during automatic ventilation. Expiratory pressure remained above the set PEEP level during use."

Cause

What was observed during troubleshooting.

Example:
"Ventilation parameters and breathing circuit were checked. Scavenging line was inspected and found restricted, creating excess pressure during exhalation."

Resolution

What action was taken.

Example:
"Corrected scavenging line routing and verified proper connection. Replaced questionable external tubing as needed. Ran machine check and confirmed PEEP HIGH alarm did not return. Device returned to service."

Helpful Details to Include (If Known)

• Alarm behavior
• Accessories swapped
• Power behavior
• Environmental factors
• Indicator lights
• Final device status

Final Thought

A PEEP HIGH alarm should be treated as a real ventilation concern until proven otherwise. Start with patient safety, confirm the alarm behavior, check ventilation settings, inspect the breathing circuit, and verify the scavenging line before suspecting internal failure. Clear documentation helps show whether the cause was external, clinical, or device-related.

That is successful troubleshooting.