CN103096981B - 使用lox来提供通气支持的方法、系统和装置 - Google Patents
使用lox来提供通气支持的方法、系统和装置 Download PDFInfo
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Abstract
一种便携式液氧系统,其使用快速气体转化模式提供大约6lpm-大约20lpm的氧气气体平均流速。液氧系统的重量可小于10磅。可设置热交换器,并且其中快速气体转化模式可利用热交换器上的加热器。快速气体转化模式可利用Stirling发动机,所述Stirling发动机使空气从热池穿过热交换器到达冷池。该系统具有多种操作模式。操作模式是连续的设定而不是离散的操作模式。当在操作模式之间切换时,流量可被改变。当在操作模式之间切换时,氧气气体压力可被改变。该系统可基于患者的情况自动地切换操作模式。
Description
相关申请的交叉引用
本申请要求享有2010年8月16日提交的美国临时专利申请No.61/374,777的优先权,该申请的内容在这里通过参考整体并入。
技术领域
本发明涉及一种通气治疗方案,用于遭受呼吸及通气失调症的人员,所述失调症例如是呼吸功能不足和睡眠呼吸暂停。更具体地,本发明涉及一种方法和设备,用于帮助通气工作,以及使用液氧(LOX)供应作为气体源来恢复通气、增强通气、或者将通气提供到肺部。
背景技术
有一系列临床综合症需要一些具有增高吸入氧气浓度的机械通气治疗形式。这些综合症包括:血氧不足、各种形式的呼吸功能不足、以及充血性心力衰竭。治疗这些情况的呼吸机对肺提供通气支持,并且通常输送增高浓度的氧气从而帮助器官充氧。用作这些呼吸机的输入的氧气供应通常是气罐中的压缩氧气气体或者医院用管道输送到治疗房间内的压缩氧气供应。近年来,已经试图将氧气从氧气机三通到呼吸机中,该氧气机通过室内空气而产生92%的氧气。通常地,即便是最便携的通气治疗系统也都由于呼吸机的尺寸和重量而具有受限的便携性。此外,如果患者需要增高的氧气浓度,也因为氧气罐的尺寸和重量,需要该氧气罐作为呼吸机的输入。由此,大量需要通气支持的患者不选择使用它,原因是他们不希望被连接到传统的呼吸机而被固定。为了解决这种远未满足的需要,近年来,已经设计出一种独特的新型通气系统(美国专利No.7,487,778,No.7,533,670,以及No.7,588,033),其使用非传统气体输送以及患者界面原理来工作,这样使得通气及氧气供应设备非常便携,并且在实际当中是可佩戴的。由此第一次,需要机械通气支持的患者能够获得这种支持,同时可以方便且容易地走动。
与机械通气治疗不同,还有需要氧气治疗但不必需要通气支持的临床综合症。这些氧气治疗系统包括气罐、氧气机、以及液氧(LOX)系统中的压缩氧气气体。这些液氧系统存储液体形式的氧气,并且液氧在作为气态氧气被输送到患者之前随着时间转化为气态氧气。LOX的有利之处在于它具有更高效的气体体积与存储体积比。一升LOX通常产生大约800升大气压力下的气态氧气,而气罐中的一升压缩氧气气体通常产生大约100升大气压力下的气态氧气。
在U.S.公开号为No.2008/0135044,2010/0252042,2010/0252041,2010/0252040,2010/0252039,2010/0252037中描述的非固定机械通气支持系统中,LOX的使用已经描述用于:(A)用于机械呼吸机的氧气供应,以及(B)使用由LOX系统产生的气体压力来为气动呼吸机提供动力。使用LOX作为机械呼吸机的输入的优点在于它能够帮助通气系统高度便携,这在许多临床应用中都是非常有用的,例如慢性阻塞性肺病(COPD)、间质性肺病(ILD)、部分神经肌肉性疾病、以及野外及流行病使用。然而,为了能在技术上使用LOX系统用于输入到这种呼吸机中成为可行,LOX系统、呼吸机或者两者都需要特别的独特特征。
总之,已有的机械通气治疗方案具有如下缺点:他们在容易被患者支撑和佩戴的非固定外形因素方面并不能提供呼吸支持。
发明内容
本发明通过独特的特征解决了现有系统的局限,所述独特的特征允许呼吸机与LOX共同使用。本发明的实施例包括一种便携式液氧系统,其使用快速气体转化模式提供大约6lpm-大约20lpm的氧气气体平均流速。液氧系统重量小于10磅。可设置热交换器,并且其中快速气体转化模式可利用热交换器上的加热器。快速气体转化模式可利用Stirling发动机,使空气从热池穿过热交换器到达冷池,其中热池是环境空气,并且其中冷池接近液氧存储部。可以设置液氧存储部,并且其中快速气体转化模式可利用至少部分围绕着液氧存储部的绝缘的下降。可以设置氧气气体存储部,并且其中相比平均流速而言较高的峰值流速可以利用氧气气体存储部中存储的氧气来实现。系统可具有多种操作模式。操作模式可以是连续的设定并且不是离散的操作模式。当在操作模式之间切换时,流量可被改变。当在操作模式之间切换时,氧气气体压力可被改变。系统可以基于患者的情况自动地切换操作模式。
本发明的实施例还可包括一种通气系统,其包括:便携式呼吸机;以及便携式液氧系统,该便携式液氧系统使用快速气体转化模式提供大约6lpm-大约20lpm的氧气气体流速。便携式呼吸机以及便携式液氧系统可被集成到单个便携式或者可佩戴单元中。液氧系统重量小于10磅。可设置热交换器,并且其中快速气体转化模式可利用热交换器上的加热器。快速气体转化模式可利用Stirling发动机,使空气从热池穿过热交换器到达冷池,其中热池是环境空气,并且其中冷池接近液氧存储装置。可以设置液氧存储装置,并且其中快速气体转化模式可利用至少部分围绕着液氧存储装置的绝缘的下降。可以设置氧气气体存储部,并且其中便携式呼吸机的峰值流量需求可以利用氧气气体存储部中存储的氧气来实现。可以设置患者界面,其中患者界面是鼻界面、面罩、气管内导管、气管造口管、或者经口管。呼吸机是可佩戴的。可设置混合器,用于滴定所需的氧气的量。
本发明的实施例可包括一种液氧系统,其包括液氧存储部;热交换器;风扇;热池;以及冷池,其中风扇使环境空气从热池穿过热交换器到冷池,从而产生快速气体转化模式。液氧系统可以是便携的。热池是通至环境的开口。冷池可以是液氧存储部或者蒸发盘管(evaporative coil)附近的区域。
本发明的实施例可包括一种便携式液氧系统,包括:液氧存储部;氧气气体存储部;液氧到气体转化单元,其中液氧到气体转化单元进一步包括液氧存储部与氧气气体存储部之间的热交换器;以及一个或多个控制器,用于确定热交换器的操作模式。操作模式可以自动地切换。热交换器的模式可以是用于通气治疗的快速气体转化模式,其提供了大约6lpm-大约20lpm的平均气体流量。热交换器的模式可以是用于氧气治疗的低气体转化模式,提供大约1lpm-大约6lpm的平均气体流量。一个或多个控制器可从一个或多个呼吸传感器接收信号,并且其中一个或多个控制器可使得热交换器在模式之间切换。一个或多个控制器可从一个或多个脉搏血氧计接收信号,并且其中一个或多个控制器可使得热交换器在模式之间切换。
本发明的实施例可包括一种治疗呼吸及通气失调的方法,该方法包括:提供便携式液氧系统,其中液氧系统包括液氧存储部、氧气气体存储部、液氧到气体转化单元、液氧存储部与氧气气体存储部之间的热交换器;以及使用快速气体转化模式提供大约6lpm-大约20lpm的氧气气体平均流速。该方法还包括在一个或多个控制器处接收来自于一个或多个呼吸传感器的关于患者通气需要的输入;基于来自于一个或多个呼吸传感器的信号自动地确定出热交换器的操作模式;以及将控制信号发送到一个或多个液氧存储部、氧气气体存储部、液氧到气体转化单元、以及热交换器,从而启动确定出的操作模式。液氧系统的重量可小于10磅。快速气体转化模式可利用热交换器上的加热器。快速气体转化模式可利用Stirling发动机,使空气从热池穿过热交换器到达冷池,其中热池是环境空气,并且其中冷池接近液氧存储装置。快速气体转化模式可利用至少部分地围绕着液氧存储部的绝缘的下降。相比平均流速而言较高的峰值流速可利用存储在氧气气体存储部中的氧气来实现。
通过理解接下来的详细描述、附图以及权利要求,本发明的附加特征、优点以及实施例将被陈述或者变得明显。此外,可以理解的是,本发明的前述概括以及接下来的详细描述都是示例性的,并且目的是提供进一步的解释,而非限制本发明要求保护的范围。
附图说明
附图包含在此用于提供本发明的进一步理解、并且并入说明书中并构成说明书的一部分,附图说明了本发明的优选实施例并且与详细描述一起用于解释本发明的原理。在附图中:
图1是根据示例性实施例的本发明的系统示意图。
图2显示了使用本发明示例性实施例来治疗呼吸功能不足的患者。
图3显示了现有技术中的可控机械通气。
图4显示了现有技术中的连续正压气道(CPAP)通气。
图5显示了现有技术中的鼻插管氧气治疗方案。
图6A是根据示例性实施例的LOX系统的示意图。
图6B是根据示例性实施例的两个压力设定LOX系统的示意图。
图7是根据示例性实施例的LOX模块的示意图。
图8是根据示例性实施例的LOX气体转化模块的示意图。
图9是根据示例性实施例的氧气气体存储模块的示意图。
图10是根据示例性实施例的Stirling发动机的示意图。
具体实施方式
本发明可包括LOX系统,该系统被用于:(A)输入到呼吸机,用于呼吸机将增高的氧气浓度输送给患者,以及(B)用于将加压气体输入提供给呼吸机,从而通过气动动力来驱动呼吸机。后者可允许呼吸机消耗相对较小量的电能,由此能够使用用于延长时间的电池动力来使呼吸机能够便携。
本发明利用通气系统向患者提供通气,该系统通常采用非侵入式鼻界面或者经气管界面。本发明还可被用于通过提供机械通气来支持患者的通气工作从而治疗呼吸功能不足。患者界面可包括喷射泵,该泵的几何构造能够使得系统的流体动力学达到最优,从而提高系统的效率和治疗的效果。加压气体(例如治疗性气体)以及更具体地富含氧气的气体可通过导管来输送。为了此处公开,术语管、导管、软管、气体输送回路等以可互换方式使用。此外,术语导管并不必须插入到患者气管中,并且不需要装置是长的以及挠性的。根据具体的用途,多种构造都是可行的。当加压的气体离开导管远端时,由于导管的设计,气体会夹带大约25-250%的环境空气,从而使得呼吸机输送的气体与夹带的气体的组合物被输送给患者。本发明的实施例例如可以在上气道产生大约2-40cmH2O的增加,以及在肺部中产生大约1-30cmH2O的增加。大约50ml的呼吸机输送气体体积能够夹带大约50ml,从而使得大约100ml被输送给患者,从而具有充足的驱动压力,使得大约100ml体积的大量(气体)到达气道或者肺部,从而增加这些区域的压力,由此机械地支持了呼吸。为了此处公开,当与本发明相关时,鼻插管、鼻导管、喷嘴、以及通气界面通常以互换方式使用。也可以使用其它通气界面,例如传统的非侵入通气面罩或者导气管等。
本发明的实施例可使用如下所述的呼吸机向患者提供通气。呼吸机是可佩戴的,并且重量小于大约3磅,优选地大约1磅。呼吸机通常包括阀,该阀将呼吸机的输出调节到期望体积、压力或流量。呼吸机通常包括与患者活动相关的其它特征,例如体动记录仪或者计步器感测、基于患者活动水平的治疗水平的生物反馈控制、呼吸困难问卷调查、以及与远程医师的双向通讯能力。呼吸机还包括活塞或储液系统,用于放大输入压力或者在输送到患者期间存储氧气气体体积。
图1是本发明示例性总体系统的示意性图示。患者可使用通气气体输送回路113和非侵入开放式鼻通气界面129或者例如气管内导管、经口导管等的其它界面来进行通气。鼻界面129优选地没有密封患者的鼻子,而是使鼻子留有开口使得使用者能够从周围环境正常地以及自由地呼吸。通气气体可以以夹带环境空气的速度进行输送,从而使得通气气体与夹带的空气的组合物在动力下被输送到使用者的气管以及肺部。鼻界面129可使得物理学以及流动动力学达到最优,从而使其性能达到最大。
通气系统可包括多个主要部件:(1)LOX存储部,(2)LOX气体转化和存储部,(3)氧气气体存储部,(4)呼吸机部,(5)气体输送回路,以及(6)患者界面或面罩。LOX存储部、LOX气体转化和存储部、氧气气体存储部以及呼吸机可以是分开的单元或者可以集成为一个单元或者多个单元。自主通气呼吸传感器还可被用于探测、确定以及测量使用者的自主呼吸模式/阶段。这种信息可被用于根据患者需要同步和/或滴定治疗以及使气体输送能够舒适地与患者呼吸相匹配。
本发明的实施例可被用于支持患者的呼吸,包括通过增加肺部中的压力以及体积来支持呼吸工作。当使用本发明时,患者通过他们的上气道以及通过他们的鼻子正常地呼吸,同时通过界面接收机械支持。患者能够在使用期间保持嘴闭合,从而帮助将机械支持引导到下气道,或者如果需要的话能够使用牙垫或者护口器或者下巴带(chin band)。患者能够在静止时、在被运输时、在移动及活动时、或者在休息或睡眠时使用该治疗方案。该治疗方案具有家庭护理、医院、亚急性护理、急诊、战争、流行病以及运输应用。应当认识的是,除了将氧气输送到非固定、非侵入开放式气管通气系统之外,本发明的LOX存储部和LOX气体转化方面还能够被用于将通气气体供应到传统呼吸机或者用于传统的氧气治疗输送系统,以及其它医疗及非医疗应用。
图2显示了用于治疗呼吸功能不足时的示例性实施例。呼吸机201能够被患者203支撑或者佩戴,例如被独立地放置在使用者的身体上、头上或者面部上。由于通气系统可有助于对于人员呼吸所需要的某些机械工作,因此使用者可以是活动的,而不会遭受呼吸困难、血氧不足、血碳酸过多症、或者疲劳。使用者会受益于行走、活动以及参与日常生活的常规活动中,例如准备餐饮、洗浴、家庭杂务,以及离开房屋进行室外活动。此外,使用者能够交流、进食、饮水及吞咽,同时接收机械通气,而与其它通气界面截然不同,在所述其它通气界面中患者的气管被外部面罩封闭,或者从内部被带套囊导气管所密封。通气参数、通气计时算法、以及肺部上的作用在随后的描述中进行说明。患者203可通过界面205(例如鼻界面)进行呼吸。呼吸机201可经由导管209而联接到外部氧气供应部207。
图3显示了现有技术中用于机械通气的治疗方案。患者301被气管内(ET)导管303插入并且套囊(cuff)305在气管307内膨胀,由此使气管与环境空气隔绝。患者301镇静下来并且他们的肺部会通过ET导管203输送和移除的气体通气。气体可通过气体输送管309来输送。传感器311可测量气流。这种治疗方案在提供用于呼吸的机械支持中是非常有效的;但是在某些情况下例如野外紧急情况下,可能需要提供增高的氧气气体浓度。
图4显示了现有技术中的使用鼻罩401以及通常使用BiPAP通气模式的呼吸支持治疗、非侵入通气。非侵入通气(NIV)被用于使患者呼吸,或者可被用于帮助患者通气,在这种情况下患者的自主呼吸尝试能够触发呼吸机,从而输送基于压力或基于体积的机械通气。输送到肺部以及输送出肺部的全部体积从通气回路403以及鼻罩401输送及移除。类似的系统可被用于阻塞性睡眠呼吸暂停,在这种情况下,鼻罩内设置有排气孔405,从而使得呼出气体的一部分通过排气孔呼出。NIV、CPAP以及双水平正压通气(BiPAP)在临床上对于自主呼吸患者非常有效;但是这些模式和治疗不便于日常生活的活动,呼吸机不能由患者支撑,患者不能自然地以及自由地呼吸室内空气,并且患者的上气道不能正常地以及自然地起作用,原因是它被外部面罩密封件密封。
图5显示了传统的现有技术中的氧气输送插管501,用于实施氧气治疗。插管505的远端被构造成进入鼻孔503中。近端连接到氧气输送装置,该氧气输送装置能够以1-6lpm将连续流动氧气输送到患者鼻子,或者在探测到吸气尝试之后输送一团剂量的氧气。这个现有技术不会机械地支持患者的呼吸工作。
在附图6A中,LOX系统被描述为提供呼吸机所需的压力及流量。示例性实施例可包括:呼吸机100、LOX单元110、LOX112、LOX单元真空室114、LOX出口管116、热交换器124、加热器120、止回阀122、氧气气体存储器128、存储器压力调节器126、气体出口开/闭阀130、患者出口Pt以及进来的呼吸信号S。
通常的LOX系统包括液相氧气隔间、以及被液氧的沸腾所连续填充的氧气气相隔间。相的改变通过热交换器单元来催化。这些系统通过使气体流出到大气来将气相隔间保持在大约23psi,从而避免增压超过23psi。通常的医用LOX系统被特别地设计以便保存氧气并且由此它们的输出相比呼吸机的需要而言相对较弱。被设计用于便携性的紧凑式LOX系统被构造成以极低流速(<3lpm)和低压(5psi以下)输送气体。更大的、更不便携的LOX单元被构造用于更大的流量输出;然而这些单元由于它们更大的尺寸而不能实际地适用于活动的非固定患者。通常的系统能够以4lpm以下的连续流速以及远低于23psi的压力来输送氧气气体,原因是当系统向患者打开时,气相隔间内的压力在几分之一秒内下降。气相隔间通常包含少于50ml的气体并且通过沸腾实现的气体产生率由于热交换器的设计和结构而被限制在4lpm以下,所述热交换器的表面面积通常小于20平方英寸。输出到患者的气流还受到出口阀中小孔尺寸的限制,这种小孔通常直径小于0.10”,由此限制了气流。
在本发明中,热交换器单元124被设计成具有更大的表面面积,通常大于30平方英寸,从而产生流速6-10lpm的气体,并且出口小孔也允许这种流速输出,所述小孔通常直径大于0.15”。可以增加加热器120来提高气态氧气的生产速率。气相隔间的气体容积通常在大约80ml以上并且可以是大约250ml,所述气相隔间通常包括压力调节器126、存储器128、止回阀122、开/闭阀130以及进来的呼吸信号S。这种构造能够连续地提供大约20psi以上、大约6lpm以上的氧气气体输出流速,由此满足部分呼吸机所需的参数。LOX系统可包括导管以及所有必需的感测部件以及在此所述的计时功能,从而以适当的压力以及在呼吸曲线的适当时刻输送所需体积的气体。
图6B中显示了附加的实施例,其中LOX系统包括两个压力设定。当患者需要不那么强的治疗或者需要保存LOX时,可以使用具有大约23psi设定的低压调节器126。当需要时或者不关注保存LOX时,具有大约30-50psi设定的较高压力调节器132可被用于提高该单元的输出。例如,当在飞机上旅行时,LOX系统能够被设定在较低的23psi设定,并且在飞行之后或者在到达有补充站点的目的地时,被重新设定为较高的设定。两个压力调节器可被构造在歧管136中,该歧管可通过开关134操作从而在设定之间切换。在飞行期间,患者仍然能够接收通气治疗,但是是以对应于23psi设定的较低的增升水平。在飞行之后以及当患者再次变得较为活跃时,增升水平能够被提高,原因是压力被设定到较高的输出设定。两个压力设定是示例性的并且它能够是任意数量的压力设定或者甚至是最小值与最大值之间连续调节的压力设定。在某些实施例中,LOX系统的操作模式可以是连续的设定以及不是离散的操作模式。
图7显示了根据本发明实施例的示意性整体LOX装置701。通常地,LOX装置701可包括但不限于以下部件:LOX存储部703、LOX液体到气体转化装置705、氧气气体存储装置707、以及一个或多个控制器707。LOX存储部703可以与LOX液体到气体转化装置705流体连通711。LOX液体到气体转化装置705可以与氧气气体存储装置707流体连通713。氧气气体存储装置707可与整体LOX装置701的外部以及其它装置(例如氧气输送系统、气体输送回路、呼吸机等等)流体连通715。一个或多个控制器707可以向LOX装置701内部或外部的各个部件提供控制信号717、719。氧气气体存储装置707的尺寸可被设置成适当地支持通气系统的自主氧气需求,然而LOX液体到气体转化装置705可仅仅能够支持通气系统的平均氧气需要。
LOX系统701可以是便携的和/或可佩戴的。在优选实施例中,LOX系统的重量可小于20磅,更优选地小于15磅,更优选地小于10磅,以及更优选地小于5磅。LOX系统小于10磅的重量允许患者在移动时舒服地携带和/或佩戴该装置。
图8显示了根据一个实施例的LOX液体到气体转化装置705。LOX液体到气体转化装置705通常可包括热交换器801,该热交换器通过它的输入711、经由LOX存储部703接收液氧,以及通过它的输出713将气态氧气输出到氧气气体存储装置707。热交换器801可具有多种模式,所述模式通过控制信号717进行控制,例如在低平均氧气气体输出流速(例如大约1lpm到大约6lpm,优选地大约3lpm)与高平均流速(例如高于大约6lpm,优选地在大约6lpm与大约20lpm)之间切换。选择性的较高平均流速可包括大于大约7lpm,大于大约8lm,大于大约9lpm,大于大约10lpm,大于大约11lpm,大于大约12lpm,大于大约13lpm,大于大约14lpm,大于大约15lpm,大于大约16lpm,大于大约17lpm,大于大约18lpm,大于大约19lpm,以及其中的范围例如大约7lpm-大约19lpm,大约8lpm-大约18lpm,等等。还可以使用更高或更低的流速。注意到这些是平均流速,这些平均流速在设定水平是连续的或者平均数达到这些范围。峰值流速可以高于平均流速。一种这样的模式是快速气体转化模式,这可以通过由加热器120向热交换器801增加热量而实现。另一种这样的模式可以绕过LOX存储装置703周围的绝缘部,从而对进入LOX液体到气体转化装置705中的氧气气体温度进行预热以及通过使LOX存储装置703的额外表面面积参与到热交换中来有效地增加热交换器801的表面面积。另一个这种模式是利用Stirling发动机,以便利用穿过热交换器的热量来为风扇提供动力,从而吹动环境空气穿过热交换器,从而增加其容积。Stirling发动机的另外细节在下面进行描述。
呼吸机流速在患者呼吸循环期间可能要求改变。在吸气期间通常需要较高的流速,而在呼气期间通常需要较低的流速或不需要流速。当LOX系统与呼吸机接界时,大于大约6-20lpm范围的峰值流速可以在吸气期间通过使用存储在氧气气体存储装置707中的氧气气体来实现。氧气气体存储装置707可以在呼气期间通过LOX液体到气体转化模块705而被再次填充。
LOX系统701的多种模式可提供用于基于流量和/或输出气体压力而进行切换。操作模式可被手动地切换、自动地切换和/或基于来自一个或多个传感器的输入(例如呼吸传感器)而进行切换。
图9显示了根据一个实施例的氧气气体存储装置707。氧气气体存储装置707可包括多模式压力调节器模块901,例如用于在当处于保存/飞行模式时的大约23psi与当处于使患者通气最大化时的大约50psi之间改变输出压力。多模式压力调节器模块901通常可从LOX液体到气体转化装置705接收氧气气体并且与氧气气体存储部903流体连通,由此调节氧气气体存储部903的气体压力。多模式压力调节器模块901可包含多个压力调节器,所述压力调节器被开通或关闭,从而控制压力设定。选择性地,多模式压力调节器模块901还可包括单个压力调节器,该压力调节器例如通过改变调节器内调节隔膜上的弹簧作用力而在多个压力设定之间切换。
LOX装置701可具有由一个或多个控制器709所控制的双模式操作。一个或多个控制器709可以与LOX液体到气体转化装置705、氧气气体存储装置707、和/或LOX装置701的其它部件、呼吸机等连通。作为可行的示例,控制器可以影响热交换器801上的加热器120、可以影响LOX存储装置703周围的绝缘水平、可以在多模式压力调节器模块901内的多个压力调节器之间切换、或者可以影响多模式压力调节器模块901内的压力调节器设定。一个或多个控制器709可包括一个或多个处理器以及一个或多个内存。
LOX装置701的第一操作模式可被用于氧气治疗,而LOX装置701的第二操作模式可被用于向呼吸机提供动力。当处于氧气治疗模式下时,液体到气体的转化速率可以是大约1-6lpm的平均气体流速。当处于呼吸机模式时,液体到气体的转化速率可以是大约4-10lpm的平均气体流速。在一个装置中具有两种模式可允许患者拥有仅仅一个LOX系统,而不是需要两个LOX系统,一个用于氧气治疗,而分开的一个用于机械通气。当患者仅仅需要氧气治疗时,LOX装置可仅仅产生大约1-6lpm的平均气体流速,并且装置不会浪费任何过多的氧气。当患者需要机械通气时,LOX装置可产生大约4-10lpm的平均气体流速,这对于获得足够的机械支持而言是必须的。LOX装置可具有自动地确定出是否用于氧气治疗或者通气治疗的能力并且能够自动地在这些模式之间切换。例如,附接到LOX装置的患者回路的类型能够用信号通知LOX装置是氧气治疗管还是通气治疗管,并且LOX装置能够相应地切换操作模式。可选择地,呼吸机能够将呼吸机正用于通气治疗的信号发送到LOX装置,而LOX装置相应地改变。可选择地,LOX装置可直接地从患者传感器接收有关患者是否需要氧气治疗还是机械通气的输入。根据特定的情况,也可以使用其它信号系统。
为了从低转化速率模式改变到高转化速率模式,LOX装置热交换器801可以从第一状态切换到第二状态。例如,液氧可通过打开阀805而被引导穿过附加的热交换器803,或者热交换器801可例如通过向热交换器801的外部施加热量(例如应用加热器120)来改进。加热器可被电力地或者通过其它方式控制。
尽管前面描述了LOX装置701从一个输出改变到第二个输出,或者具有第一和第二状态的热交换器801,但是输出和状态可以超过两个或者可以是连续的。例如,LOX装置701可基于治疗的需要而在一定范围内自动地调节转化速率。由此,如果患者轻快地行走同时使用通气治疗的话,那么可以通过传感器和/或控制系统向LOX装置701发送信号,从而提高气体转化速率继而处理患者的需求。相反地,如果LOX装置701被用于氧气治疗以及患者在休息或者睡觉,那么可以通过传感器和/或控制系统向LOX装置701发送信号,从而降低转化速率以保存液氧供应并且防止转化的气体排出到大气造成浪费。
在选择性实施例中,LOX装置701可具有由液氧产生且没有排出到大气、而是收集在另一个存储器或者气罐中的气体。因此,不会存在液氧浪费或者仅有少量的液氧浪费。
LOX装置701可包括附加特征。LOX装置701可包括一个或多个接头,用于高压快连接从而附接到呼吸机输入软管。输出气体可被加温,从而当通气气体进入患者体内时患者更加舒适。附加地,湿气或者水可被加入到LOX装置701的气相中。由LOX装置701产生的冷凝物可被收集、循环和/或用于湿润被输送给患者的氧气气体。LOX存储部703能够是高压气囊,从而使得形状系数能够令人满意以及更便于被患者佩戴。LOX装置701和呼吸机能够成为一体或者能够以模块方式附接。热交换器801可以是黑色或者其它颜色,从而改进热传递特性。热交换器801可包括翼片和/或由多个小管制成,以增加表面面积。热交换器801还可是管子内部的管子,从而在内部管之内具有加热的环形空间和液体。
如图10中所示,LOX装置701还能够产生类似于Stirling发动机的效果。LOX Stirling发动机可以通过使用两个温度池来提供动力,一个相对较热1001而另一个相对较冷1005。LOX Stirling发动机可驱动风扇1003,从而吹动空气穿过LOX系统的蒸发盘管,以便增加蒸发速率。Stirling发动机的热池可以是环境温度,而冷池可以由最靠近LOX存储部703的蒸发管道和/或靠近LOX存储部703的区域提供。一旦蒸发过程开始,即氧气开始流动,那么盘管会降低温度,从而启动Stirling发动机风扇。一旦风扇启动,蒸发可变得更加有效,即穿过管道的更大对流可导致更多热量蒸发。不需要任何电能来运行这个系统。
相比标准的LOX装置,LOX装置输出可以是较高的压力以及较高的流速以满足危重护理喷射呼吸机的需要。输出压力在通气模式期间可通常为大约15-80psi,并且优选地大约25-40psi。流速在通气模式期间可通常为大约4-20lpm,并且优选地大约8-10lpm。
尽管前面的描述介绍了LOX装置被用于非固定通气治疗,但是本发明的相同原理可被用于静态通气。例如,静态LOX系统能够通过本发明的实施例进行改进,用于向机械呼吸机提供动力。
可选地,高频低体积通气能够通过呼吸机以及患者界面来输送,其中非常低的气体体积以非常快的频率输送,例如每分钟大约12-120循环、大约5-50ml,或者优选地每分钟大约30-60循环、大约10-20ml。以此方式,相当细微的体积被输送到肺部,同时将气管和肺部中获得的压力控制成更接近于期望水平,即便是在开放的气管系统中。这种输送波形能够是连续的或者能够与呼吸的吸气阶段相同步。而且,所述的不同波形能够整体地或者部分地组合,例如体积能够被同步并且在吸气期间能够以一次输送,并且随后在呼气期间能够输送高频低体积通气。应当注意的是,通气气体输送在激活时能够逐渐地升高,从而使得它的幅度不会突然增加,而突然增加会将患者唤醒。
尽管前面描述了本发明的治疗方案采用鼻界面,但是其它界面也可包含在本发明中,例如经口界面。导管的尖端能够靠近嘴的入口、与嘴的入口共面、或者在嘴唇与下颌线之间凹陷到嘴的内部。导管可被成形为使其路线沿着牙齿,或者在牙齿的面颊一侧或者舌头一侧,或者穿过嘴的中心。导管可被定位成使得导管的一部分搁置在舌头的上表面上,或者被定位成使得导管的一部分靠着硬腭的下表面搁置,在这种情况下导管的远端可远离腭并朝着口咽气管地形成角度或者向下弯曲。导管能够被分岔,从而使得在嘴的左右两侧上定位有左导管和右导管。导管可被集成到牙垫或者护口器。导管优选地容易插入患者的嘴中以及从患者的嘴中移除。前面所述的所有与鼻界面相联系的适当细节都可以应用于本发明实施例中使用的口导管。
本发明还可与气管内导管(ET)界面共同使用。在侵入式机械通气的断绝期间,这种界面版本对步行患者的习惯而言是有帮助的。处于ICU呼吸机上的步行患者通常非常费力,原因是患者必须在很多医护人员的帮助下移动患者身旁的大型且复杂的ICU呼吸机。本发明可被用于帮助患者行走,同时从本发明描述的通气系统和界面接收充足的通气支持。在这个实施例中,ET管连接器可包括用于本发明通气界面的附接件。患者可以通过ET管的靠近连接器(该连接器是打开的)的近端自主地呼吸环境空气,同时患者的自主呼吸通过本发明的通气系统以及导管界面而有效地增高。可选择地,如果期望供应呼吸末正压(PEEP),则设置专门的PEEP阀,用于附接到ET管的端部。专门的PEEP阀可包括单向阀,从而使得环境空气可以通过本发明的喷射喷嘴而容易地夹带到ET管中并且朝着患者的肺部,而且还允许通过PEEP阀进行呼气,同时保持期望的PEEP水平。优选地,患者仍然可以通过PEEP阀、通过集成到PEEP阀或者与PEEP阀平行的吸气阀而自主地呼吸室内空气。在患者呼气阶段期间,本发明中使用的呼吸机能够通过输送具有适当波形的气体而提供如前所述的PEEP。导管尖端能够轻微地靠近ET管的靠近连接器的近端开口,或者能够与近端开口共面,或者可以插入到ET管中至适当深度、通常在中点附近,但是适当的深度可能依赖于系统的其它变量。根据临床需要或者患者的忍受程度,深度能够是可调节的,从而对于个别情况而言,夹带以及性能或功能够达到最优。本发明这个实施例中使用的ET管连接器可提供必要的喷射泵几何形状,如前面结合鼻插管外部同心管所述。ET管连接器可包括喷射进口、喷射喉以及扩散区段。或者可选择地,ET管可以是特殊构造,该构造将对喷射泵性能有利的尺寸和几何形状结合到一起。前面根据鼻界面所述的全部适当细节都可应用于本发明这个版中中使用的ET管导管界面。此外,通过针对每种不同的患者界面设置类似的专门PEEP阀,PEEP能够被包含在本发明所述的其它患者界面中。
如前面所指出,图1是描述了本发明实施例的框图,其具备扩展的特征和能力。呼吸机模块包括多个其它附件或者功能模块,或者与多个其它附件或者功能模块相连通。
可以设置发射器和/或接收器103,用于将有关患者、患者治疗、以及呼吸机性能的信息发射到远程位置和/或从远程位置接收这些信息,用于检查、分析和归档。例如,患者对于治疗的顺从性或者治疗的利用率能够被监测和评定。重要信息的走势能够被获得,例如患者的呼吸频率、I:E率或者呼吸深度。同时,信息能够被发送到呼吸机,从而例如对设定编程,以便滴定呼吸机的输出以满足患者需要。
可以设置内部或外部加湿器105,用于治疗的扩展使用,或者如果在干燥气候中使用的话。湿气可以通过集成到呼吸机或者与呼吸机联接在一起的湿气发生器或者使用独立的加湿器(stand alone humidifier)来输送。加湿后的空气或者氧气能够通过气体输送回路的气体输送通道、或者通过如前所述的气体输送回路中的另一腔体、或者通过分开的插管或者管道来输送。为了扩展使用,当患者可能固定时,加湿系统可以是固定的系统并且能够输送相对较高数量的湿气;并且对于移动时期,由于尺寸和能量消耗的限制,患者能够要么不接收加湿,要么使用能够输送相对较低数量湿气的便携式加湿系统。
除了LOX系统107之外,还可以设置压缩空气源109,该压缩空气源通常从外部附接到呼吸机,但是如果治疗用于固定使用的话(例如在家中使用),还可选择地从内部连接到呼吸机。压缩空气源109的示例可包括压缩空气源和/或发生器。可以设置混合器111来控制气体输送回路113中的微量输送的氧气。混合器111可以从压缩空气源109和/或LOX系统107接收输入并输出到呼吸机115。混合器111可被用于滴定所需的氧气的量,或者基于临床滴定、或者通过脉搏血氧计或者其它生物反馈信号滴定。对于所需的低于100%的氧气浓度,该系统可以使用来自于压缩机、气罐或者壁挂气源的压缩空气,或者空气能够从例如患者界面处、或者系统中其它地方(例如气体输送回路或者呼吸机)处的压缩氧气气体夹带到系统中。如果空气被夹带的话,那么它能够从室内空气被夹带。为了治疗其它疾病和应用,其它呼吸气体同样能够通过混合到输送气体中来输送,例如氦氧混合物,氧化氮,或者空气、氧气、氦气及氧化氮的组合。脉搏血氧计117能够被用于确定出适当的混合器设定,从而实现适当的氧气饱和度。脉搏血氧计117还能够被用于滴定呼吸机系统的其它设定,从而满足患者生理学需要,或者控制与鼻插管而不是与呼吸机共同使用的LOX系统的快速气体转化模式。控制器可使用来自于一个或多个脉搏血氧计的信号来切换LOX系统的模式。除了氧气和空气气体的压缩供应部之外,呼吸机还可包括内部或外部的空气及氧气发生装置,例如用以产生加压空气的泵或者吹风机,以及用以产生加压的氧气气体的氧气发生器和/或泵。氧气源还可以是液氧,或者液氧发生系统。
由于治疗频繁地用于帮助日常生活的活动以及用于提高活动性,所以可以在呼吸机系统的内部或外部设置计步器119和/或体动记录传感器121。还可以设置二氧化碳监测器131。
能够设置外部呼吸传感器123,例如呼吸肌尝试传感器、胸部阻抗传感器、或者其它呼吸类型,例如导管麦克风或者振动传感器。外部传感器123可被用作鼻气流或者鼻压力传感器125的冗余传感器、或者用于补充从鼻气流传感器获得的信息、或者代替鼻气流传感器。鼻气流或鼻压力传感器125可测量自主呼吸。鼻气流或者鼻压力传感器可被定位在非侵入、开放式鼻通气界面129处或者定位在其它适当位置处。
药物输送模块127能够从内部或者外部结合到通气系统。由于目前雾化药物输送吸入器的挑战,本发明可被用于将药物颗粒推进以及使药物颗粒沉积在呼吸系统深处,而不需要载物推进器。由于使用治疗的患者通常还需要处方药物,因此这是一种便利且有效的处理药物的方式。
当治疗用于呼吸支持时,使用者可具有两个选择:(1)佩戴或者手提呼吸机,从而使得使用者能够走动或者享受日常生活的活动;或者(2)静态使用,在患者打算静止或者没有能力走动的情况下。输送回路可选地设置成25-100英尺长,从而使得气体源和呼吸机能够在患者家里静止,而患者能够在他们家里四处移动同时佩戴界面并接收治疗。或者,气体源可以是静止的,并且连接到具有25-100英尺软管的呼吸机,从而使得患者能够佩戴或者手提呼吸机并且在软管范围内移动。在特定实施例中,气体输送回路可连接到混合器,该混合器例如从医院加压气体供应部处接收加压氧气以及加压空气。在其中移动性并不重要的这些应用中,该系统可以附接到房屋气体供应部,并且可以输送更高水平的治疗以及呼气期间的PEEP治疗。所有这些静态使用以及移动使用的不同选择应用到前面所述的各种不同的界面技术。
呼吸机能够自包含有电池以及气体供应部,以便使得它能够被患者支撑,使得患者能够走动以及参与到日常生活的活动中,这通过他们从呼吸机接收、但是在容易支撑的包装中接收到的呼吸支持来实现。
为了使本发明描述的治疗方案能够针对患者的需要更有效地滴定,呼吸机系统要能够完成确定出所需呼吸支持水平的决定。为了实现这个,呼吸机能够针对患者的需要滴定输出,例如在走动或者活动期间,输出可以增加。可选择地,在自主呼吸传感器测量到更高呼吸速率期间,输出能够增加。或者在呼吸传感器测量到较高呼吸尝试期间,输出可以增加。可以使用其它生物反馈信号。除了输出增加或者改变以满足患者的呼吸需要之外,呼吸机输出相对于患者自主吸气阶段的时机、以及输出波形能够改变,从而满足患者的舒适度和生理学需要。例如,在练习期间,输出能够从早期以75ml输送的上升波形改变到在吸气开始之后延迟开启100毫秒触发的下降波形。
为了便于将这种新式治疗方案集成到已有的治疗样式中,可以设置转化系统。具体地,患者界面可以是模块化的,从而使得患者能够通过具有常规的或者稍稍改进的氧气鼻插管的传统氧气治疗方案来管理。于是,当期望将患者切换到新式治疗方案时,附加部件(例如外部同心管)可以添加到鼻插管,从而形成喷射泵设计并将插管的远端适当地定位从而实现本发明的功能。可选择地,例如通过提供附加的呼吸感测功能、定时功能、波形功能、以及切换到必要的输出幅度,气体输送设备上的开关能够被切换,从而使设备的输出从氧气治疗改变到这种治疗。系统的LOX部同样能够是模块化的,它们能够被氧气气体罐、壁挂氧气、压缩气体、以及氧气-空气混合器所替代。
应当注意的是,上面所述不同实施例能够以多种方式组合,从而将特殊的治疗输送给患者,并且尽管本发明已经参考其优选实施例进行了详细描述,但是对于本领域技术人员而言明显的是可以做出各种改变和组合而不会脱离本发明。同时,尽管本发明已经描述为一种用于患者移动呼吸支持的方案,但是可以理解的是,在本发明范围内,实施例可以适当地缩放,从而使得治疗能够提供更高的支持水平用于更严重的受损的以及可能无法走动的患者,或者能够提供完全或者几乎完全的通气支持用于无法呼吸的或者极度重症的患者,或者能够在紧急、野外或者交通场所提供支持。同时,尽管本发明主要描述为通过鼻界面来管理,但是应当注意的是,通气参数可以通过多种其它气管界面装置(例如ET管、气管造口管、喉切除管、环甲软骨切开术管、支气管导管、喉罩气管、口咽气管、鼻罩、经口插管、鼻-胃管、全面罩等等)来管理。并且尽管实施例中公开的通气参数已经大部分具体化从而与成人呼吸增升相兼容,但是应当注意的是,适当地缩放的治疗方案能够应用到小儿及新生儿患者。此外,尽管目标疾病状态被大多数描述为呼吸功能不足和睡眠呼吸暂停,但是其它呼吸、肺部以及气管失调能够通过通气参数进行必要调节的治疗而被医治,例如ALS、神经肌肉疾病、脊髓损伤、流行性感冒、CF、ARDS、肺部移植桥接、以及能够通过这种疗法治疗的其它疾病,以及集体事故、流行病、军事、桥梁及运输应用。最后,尽管本发明已经描述为独立的治疗方案,但是该治疗方案可以是模块化的,例如通气系统能够适合于在侵入式或者非侵入式或者其它封闭系统通气模式与在此所述的非侵入开放式通气模式之间切换。或者,该治疗方案可以与其它通气模式相结合而同时使用,例如在清醒镇静医药处理期间,其中患者用作为呼吸的后备方式的传统呼吸机通气同时患者通过在此所述的模式接收通气。
尽管前面的描述针对本发明的优选实施例,但是注意到,其它变形和改进对于本领域技术人员而言是显而易见的,并且不会脱离本发明的精神或范围。此外,结合本发明一个实施例描述的特征可以与其它实施例结合使用,即使上面没有明确地提出。本发明可以实施成其它专用模式,而不会脱离它的精神或者本质特征。所述实施例在各个方面都被理解为示意性的而非限制性的。
Claims (16)
1.一种便携式液氧系统,所述液氧系统使用快速气体转化模式提供6lpm至20lpm的氧气气体平均流速,
所述便携式液氧系统包括:
热交换器,以及
风扇,
其中,所述快速气体转化模式利用Stirling发动机,所述Stirling发动机驱动所述风扇,从而吹动环境空气从热池穿过所述热交换器到达冷池,所述热池是通至环境的开口,所述冷池靠近液氧存储部。
2.如权利要求1所述的便携式液氧系统,其特征在于,所述便携式液氧系统的重量小于10磅。
3.如权利要求1所述的便携式液氧系统,其特征在于,所述快速气体转化模式利用至少部分围绕着所述液氧存储部的绝缘的下降。
4.如权利要求1所述的便携式液氧系统,其特征在于,所述液氧系统进一步包括氧气气体存储部,并且其中利用在所述氧气气体存储部中存储的氧气来实现比所述平均流速高的峰值流速。
5.如权利要求1所述的便携式液氧系统,其特征在于,所述液氧系统具有多种操作模式。
6.如权利要求5所述的便携式液氧系统,其特征在于,所述操作模式是连续的设定而不是离散的操作模式。
7.如权利要求5所述的便携式液氧系统,其特征在于,当在所述操作模式之间切换时,流量被改变。
8.如权利要求5所述的便携式液氧系统,其特征在于,当在所述操作模式之间切换时,氧气气体压力被改变。
9.如权利要求5所述的便携式液氧系统,其特征在于,所述液氧系统基于患者的情况而自动地切换所述操作模式。
10.一种通气系统,包括:
便携式呼吸机;以及
便携式液氧系统,所述便携式液氧系统使用快速气体转化模式提供6lpm至20lpm的氧气气体流速,所述便携式液氧系统包括:
热交换器,以及
风扇,
其中,所述快速气体转化模式利用Stirling发动机,所述Stirling发动机驱动所述风扇,从而吹动环境空气从热池穿过所述热交换器到达冷池,所述热池是通至环境的开口,所述冷池靠近液氧存储部。
11.如权利要求10所述的通气系统,其特征在于,所述便携式呼吸机和所述便携式液氧系统被集成为单个便携式单元或可佩戴单元。
12.如权利要求10所述的通气系统,其特征在于,所述便携式液氧系统的重量小于10磅。
13.如权利要求10所述的通气系统,其特征在于,所述快速气体转化模式利用至少部分围绕着所述液氧存储装置的绝缘的下降。
14.如权利要求10所述的通气系统,其特征在于,所述通气系统进一步包括患者界面,其中所述患者界面是鼻界面、面罩、气管内导管、气管造口管、或者经口管。
15.如权利要求10所述的通气系统,其特征在于,所述便携式呼吸机是可佩戴的。
16.如权利要求10所述的通气系统,其特征在于,所述通气系统进一步包括混合器,以用于对所需氧气的量进行滴定。
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CN103096981A (zh) | 2013-05-08 |
EP2605836A4 (en) | 2016-06-01 |
CA2807416A1 (en) | 2012-02-23 |
CA2807416C (en) | 2019-02-19 |
WO2012024342A1 (en) | 2012-02-23 |
BR112013003621A2 (pt) | 2016-08-23 |
EP2605836A1 (en) | 2013-06-26 |
US20120118285A1 (en) | 2012-05-17 |
AU2011292111B2 (en) | 2015-03-26 |
JP5891226B2 (ja) | 2016-03-22 |
US10099028B2 (en) | 2018-10-16 |
JP2013534172A (ja) | 2013-09-02 |
AU2011292111A1 (en) | 2013-02-07 |
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