Drager Apollo

Asset Type

Anesthesia Machine

Manufacturer

Drager

Model

Apollo

What This Guide Helps With

This guide helps troubleshoot the PINSP NOT ACHIEVED alarm on a Drager Apollo anesthesia machine when the set inspiratory pressure in Pressure Mode is not being reached. Possible causes include ventilation settings, breathing circuit leaks, patient connection leaks, accessory problems, or fresh-gas shortage.

This alarm can affect delivered ventilation and should be handled with patient safety first, especially during active anesthesia use.

Step-by-Step Troubleshooting

Ensure Patient Safety First

• Confirm the patient is being ventilated adequately.
• Notify the anesthesia provider immediately if the alarm occurs during active patient use.
• If ventilation is not reliable, have clinical staff manually ventilate the patient or transfer ventilation to another safe method.
• Do not continue relying on the machine if inspiratory pressure cannot be achieved.

The goal is to keep the patient safely ventilated while the alarm condition is evaluated. PINSP NOT ACHIEVED can indicate that the machine is not reaching the pressure needed for the selected ventilation mode.

Verify the Reported Alarm and Behavior

• Confirm the displayed alarm is exactly PINSP NOT ACHIEVED.
• Verify the machine is operating in Pressure Mode or another pressure-controlled ventilation mode where inspiratory pressure is set.
• Observe whether the alarm occurs during every breath, only after circuit changes, only with certain fresh-gas settings, after changing ventilation parameters, or intermittently during patient movement.
• Check for low delivered tidal volume, low airway pressure waveform, audible leak, abnormal bellows or piston behavior, low fresh-gas flow, or inability to maintain set pressure.

This helps confirm a true ventilation pressure issue instead of a misunderstood setting, temporary disconnect, or setup problem.

Check the Set Ventilation Parameters

• Review the pressure control settings with the anesthesia provider.
• Check the set inspiratory pressure, PEEP, respiratory rate, inspiratory time, I:E ratio, fresh-gas flow, ventilation mode, patient size, and circuit type.
• Confirm the settings are appropriate for the patient and selected ventilation mode.

If the set pressure, timing, or mode is inappropriate, the machine may not achieve the expected inspiratory pressure even though the ventilator is functioning normally. If correcting the ventilation settings clears the alarm and ventilation is stable, stop troubleshooting and document the corrected setting issue.

Check for Breathing Circuit Leaks

• Inspect the breathing circuit from the machine to the patient connection.
• Check that the circuit tubing is fully seated.
• Check the Y-piece, patient elbow, filter or HME connection, sample line connection, and breathing bag connection.
• Check the APL valve position if relevant.
• Verify the absorber canister is seated correctly.
• Look for loose fittings, water trap issues, cracked tubing, stretched tubing, or damaged circuit components.

A leak is one of the most likely causes of PINSP NOT ACHIEVED because pressure cannot build if gas escapes from the breathing system. If a loose or damaged circuit component is corrected and the alarm clears, verify ventilation stability before returning the machine to use.

Check the Patient Connection and Airway Interface

• Have clinical staff verify the patient airway connection.
• Check for a loose endotracheal tube connection.
• Check for a leaking cuff.
• Check for a disconnected airway adapter.
• Check for poor mask seal.
• Check for a loose supraglottic airway connection.
• Check whether patient movement is affecting the seal.

The machine may be working properly, but a leak at the patient airway can prevent the set inspiratory pressure from being achieved.

Check Fresh-Gas Flow and Gas Supply

• Review the fresh-gas setting and gas supply condition.
• Confirm fresh-gas flow is set appropriately.
• Confirm oxygen and air pipeline supplies are connected.
• Check cylinder backup pressure if a cylinder is being used.
• Confirm no gas supply alarm is active.
• Verify flowmeters or electronic gas controls respond normally.
• Confirm low-flow settings are not too low for the current setup.

A fresh-gas shortage can prevent the system from maintaining the volume and pressure needed to achieve the set inspiratory pressure. If increasing or correcting fresh-gas flow clears the alarm, confirm stable ventilation and document the setting-related cause.

Perform a Leak Test or System Check

• When safe and not connected to a patient, run the appropriate anesthesia machine checkout, leak test, or system test.
• Check whether the machine passes the breathing system leak test.
• If the machine fails leak testing, keep it out of patient use until the leak source is corrected.

A system leak test helps separate external circuit or setup problems from a machine-side leak or internal ventilator issue.

Isolate Accessory-Related Causes

• Swap or remove external accessories one at a time if safe to do so.
• Check the breathing circuit, HME/filter, water trap, CO2 sample line, breathing bag, absorber canister, and patient airway adapter.
• If a specific accessory causes the issue, replace it and document the finding.

Many pressure alarms are caused by disposable accessories or setup issues rather than internal machine failure.

Check for Physical Damage, Contamination, or Misassembly

• Inspect the machine and breathing system for obvious external issues.
• Look for cracked plastic fittings, damaged seals, absorber not latched, damaged or missing canister gasket, foreign material on sealing surfaces, liquid contamination, loose external panels, or loose ports.

Damaged seals or improperly seated parts can create leaks large enough to prevent inspiratory pressure from being achieved.

Determine Whether the Issue Is External or Device-Related

• Likely external or setup-related causes include incorrect ventilation settings, leaking circuit or filter, improperly seated absorber or breathing system parts, fresh-gas shortage, or an accessory leak.
• Likely device-related causes include alarm persistence with known-good circuit and accessories, adequate fresh-gas supply, appropriate settings, failed leak test with no external leak found, repeated inability to build pressure, or alarm return after checkout.
• Rule out simple and external causes before escalating the anesthesia machine for repair.

The issue should be narrowed to settings, accessory, gas supply, leak, or machine failure before deciding the next action.

Stop When Resolved

• If the alarm clears after correcting settings, repairing a leak, replacing an accessory, or correcting fresh-gas flow, confirm the alarm does not return.
• Verify stable ventilation behavior.
• Confirm the machine passes required checkout if it was removed from service.
• Return the anesthesia machine to service only after it is safe and functional.
• Document the corrected cause clearly in the work order.

If the Problem Persists

If PINSP NOT ACHIEVED continues after ventilation settings, patient circuit, accessories, fresh-gas flow, external leaks, and system checkout have been ruled out, the issue may indicate an internal ventilator, breathing system, flow delivery, pressure sensing, or control problem.

Remove the anesthesia machine from service. Label it Out of Service. Send it for repair, service evaluation, or qualified bench testing.

Do not leave the machine available for patient use if it cannot reliably achieve set inspiratory pressure.

Clinical Use Tip

Never troubleshoot on an active patient. Move patient to backup device first.

Do not troubleshoot an unresolved ventilation pressure alarm on an active patient unless clinical staff are maintaining safe ventilation. If inspiratory pressure is not being achieved, patient ventilation must be stabilized first using manual ventilation or another anesthesia machine if needed.

Work Order Documentation (CCR Method)

CCR = Complaint, Cause, Resolution

Complaint

What was reported by the clinical staff.

Example:
"Drager Apollo displayed PINSP NOT ACHIEVED alarm during Pressure Mode ventilation. Set inspiratory pressure was not being reached."

Cause

What was observed during troubleshooting.

Example:
"Breathing circuit leak found at loose patient filter connection. Fresh-gas supply and ventilation settings were checked and no gas supply issue was found."

Resolution

What action was taken.

Example:
"Reseated filter and circuit connection. Verified alarm cleared, ventilation pressure stabilized, and machine passed checkout. Returned to service."

Helpful Details to Include (If Known)

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

Final Thought

PINSP NOT ACHIEVED should be treated as a ventilation performance alarm, not just a nuisance message. Start with patient safety, confirm the alarm, check settings, leaks, accessories, and fresh-gas supply first, then escalate when the machine still cannot achieve pressure. Clear documentation helps show what was ruled out and why the device was returned to service or removed for repair.

That is successful troubleshooting.