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INTERNATIONAL ISO
STANDARD 80601-2-90
First edition
2021-08
Medical electrical equipment —
Part 2-90:
Particular requirements for basic
safety and essential performance
of respiratory high-flow therapy
equipment
Appareils électromédicaux —
Partie 2-90: Exigences particulières pour la sécurité de base et les
performances essentielles des équipements de thérapie respiratoire à
haut débit
Reference number
©
ISO 2021
© ISO 2021
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ii © ISO 2021 – All rights reserved
Contents
Foreword . v
Introduction . vi
201. 1 Scope, object and related standards . 1
201. 2 Normative references . 4
201. 3 Terms and definitions . 5
201. 4 General requirements . 10
201. 5 General requirements for testing of ME equipment . 12
201. 6 Classification of ME equipment and ME systems . 13
201. 7 ME equipment identification, marking and documents . 13
201. 8 Protection against electrical hazards from ME equipment . 20
201. 9 Protection against mechanical hazards of ME equipment and ME systems . 20
201. 10 Protection against unwanted and excessive radiation hazards . 21
201. 11 Protection against excessive temperatures and other hazards . 22
201. 12 Accuracy of controls and instruments and protection against hazardous outputs . 26
201. 13 Hazardous situations and fault conditions for ME equipment . 33
201. 14 Programmable electrical medical systems (PEMS) . 34
201. 15 Construction of ME equipment . 34
201. 16 ME systems . 35
201. 17 Electromagnetic compatibility of ME equipment and ME systems . 36
201.101 Gas connections . 36
201.102 Requirements for the breathing system and accessories . 39
201.103 * Indication of duration of operation . 40
201.104 Functional connection . 41
201.105 Power supply cords . 41
201.106 Respiratory high-flow therapy equipment security . 42
202 Electromagnetic disturbances — Requirements and tests . 42
206 Usability . 43
208 General requirements, tests and guidance for alarm systems in medical electrical
equipment and medical electrical systems . 44
211 Requirements for medical electrical equipment and medical electrical systems used
in the home healthcare environment . 46
Annex C (informative) Guide to marking and labelling requirements for ME equipment and
ME systems . 48
Annex D (informative) Symbols on marking . 54
Annex AA (informative) Particular guidance and rationale . 55
AA.1 General guidance . 55
iii
AA.2 Rationale for particular clauses and subclauses . 55
Annex BB (informative) Data interface requirements . 69
BB.1 Background and purpose . 69
BB.2 Data definition. 70
Annex CC (informative) Reference to the IMDRF essential principles and labelling guidances. 73
Annex DD (informative) Reference to the essential principles . 76
Annex EE (informative) Reference to the general safety and performance requirements . 79
Annex FF (informative) Terminology — Alphabetized index of defined terms . 82
iv
Foreword
ISO (the International Organization for Standardization) and IEC (the International Electrotechnical
Commission) form the specialized system for worldwide standardization. National bodies that are
members of ISO or IEC participate in the development of International Standards through technical
committees established by the respective organization to deal with particular fields of technical activity.
ISO and IEC technical committees collaborate in fields of mutual interest. Other international
organizations, governmental and non-governmental, in liaison with ISO and IEC, also take part in the
work.
The procedures used to develop this document and those intended for its further maintenance are
described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the
different types of document should be noted. This document was drafted in accordance with the editorial
rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives or
/members_experts/refdocs).
Attention is drawn to the possibility that some of the elements of this document may be the subject of
patent rights. ISO and IEC shall not be held responsible for identifying any or all such patent rights. Details
of any patent rights identified during the development of the document will be in the Introduction and/or
on the ISO list of patent declarations received (see www.iso.org/patents) or the IEC list of patent
declarations received (see patents.iec.ch).
Any trade name used in this document is information given for the convenience of users and does not
constitute an endorsement.
For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and
expressions related to conformity assessment, as well as information about ISO's adherence to the World
Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT),
see www.iso.org/iso/foreword.html. In the IEC, see /understanding-standards.
This document was prepared by Technical Committee ISO/TC 121, Anaesthetic and respiratory
equipment, Subcommittee SC 3, Lung ventilators and related equipment, and Technical Committee
IEC/TC 62, Electrical equipment in medical practice, Subcommittee SC D, Electromedical equipment, in
collaboration with the European Committee for Standardization (CEN) Technical Committee CEN/TC
215, Respiratory and anaesthetic equipment, in accordance with the Agreement on technical cooperation
between ISO and CEN (Vienna Agreement).
A list of all parts in the ISO 80601 series and the IEC 80601 series can be found on the ISO and IEC
websites.
Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html and /national-
committees.
v
Introduction
Respiratory high-flow therapy equipment has been used successfully for years with neonatal patients. In
recent years there is more information about treating adults with respiratory high-flow therapy
equipment when it is used as an intermediate therapy to improve oxygenation in adult critical care
patients, respiratory care units and for palliative care. High-flow therapy equipment is also used in the
treatment of chronic respiratory disease to reduce exacerbation, improve physiological outcomes and
[30][43][44][47] 1
quality of life . The use of respiratory high-flow therapy equipment continues to increase as it
is easily set up and is well tolerated by patients.
Since the outbreak of COVID-19 in January of 2020, its spread has been rapid and fierce. In hospitals
across the world, all kinds of respiratory high-flow therapy equipment have been widely used. In general,
there is a trend to use more non-invasive respiratory therapy. More and more new manufacturers of
respiratory high-flow therapy equipment have rapidly emerged. Neither international nor national
standards are available for respiratory high-flow therapy equipment. With the spread of the epidemic
globally, the demand for this document is clear and very urgent.
The first respiratory high-flow therapy equipment was constructed by the connection of a humidifier,
air/oxygen mixer/blender, flowmeter, breathing tube and cannula. Based on the improvement in
technical integration in recent years, there are several technical routes for respiratory high-flow therapy
equipment on the market. Respiratory high-flow therapy equipment is not fully covered by the existing
standards for humidifiers, gas mixers for medical use, flowmeters or ventilators.
This document addresses the basic safety and essential performance requirements of respiratory high-
flow therapy equipment, including risks related to oxygen (e.g., fires, incorrect oxygen concentration,
incorrect flow delivery, etc.).
Specifically, the following risks and related requirements were considered in the development of this
document.
— Contaminated air entering the gas intake port of the respiratory high-flow therapy equipment.
— Instability of gas supply from a high-pressure inlet.
— Insufficient pressure from a high-pressure inlet, and subsequent effects on oxygen delivered to the
patient.
— Insufficient oxygen being delivered to the patient, and related alarm condition.
— Usability by operators wearing personal protective equipment (such as gloves and blurred visors),
when setting up equipment, or viewing or changing settings.
— Instability of output delivered to patients, necessitating frequent operator adjustment.
— Processing of equipment, including the surface of the enclosure and internal gas pathways,
particularly after use on infectious patients.
— Infectious exhaled gas.
— Overheating of respiratory high-flow therapy equipment.
In this document, the following print types are used:
— requirements and definitions: roman type;
— test specifications and terms defined in Clause 3 of the general standard, in this document or as noted:
italic type;
Numbers in square brackets refer to the Bibliography.
vi
— informative material appearing outside of tables, such as notes, examples and references: in smaller type.
Normative text of tables is also in a smaller type.
In referring to the structure of this document, the term:
— “clause” means one of the five numbered divisions within the table of contents, inclusive of all
subdivisions (e.g. Clause 201 includes subclauses 201.7, 201.8, etc.);
— “subclause” means a numbered subdivision of a clause (e.g. 201.7, 201.8 and 201.9 are all subclauses
of Clause 201).
References to clauses within this document are preceded by the term “Clause” followed by the clause
number. References to subclauses within this particular document are by number only.
In this document, the conjunctive “or” is used as an “inclusive or” so a statement is true if any combination
of the conditions is true.
For the purposes of this document, the auxiliary verb:
— “shall” means that conformance with a requirement or a test is mandatory for conformance with this
document;
— “should” means that conformance with a requirement or a test is recommended but is not mandat
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