CN107583153A - The cooperative control method and synthetical compositive evaluating of a kind of Breathing Suppotion - Google Patents
The cooperative control method and synthetical compositive evaluating of a kind of Breathing Suppotion Download PDFInfo
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- CN107583153A CN107583153A CN201710787636.9A CN201710787636A CN107583153A CN 107583153 A CN107583153 A CN 107583153A CN 201710787636 A CN201710787636 A CN 201710787636A CN 107583153 A CN107583153 A CN 107583153A
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Abstract
A kind of cooperative control method of Breathing Suppotion of the present invention, comprises the following steps：Step 1: control system starts lung ventilator module, Step 2: the physiological parameter of monitoring human body, the respiration information of monitoring lung ventilator module, Step 3: monitoring modular sends the respiration information of the physiological parameter of the human body monitored, lung ventilator module to control system, it is confirmed whether startup oxygen module, Step 4: when the physiological parameter of human body is less than predetermined threshold value, start oxygen module processed, control system starts oxygen module processed, by oxygen supply to lung ventilator module, empty oxygen mixing is realized, is transmitted to nearly patient end.The cooperative control method of the present invention, the respiration information of physiological parameter and lung ventilator module can be monitored, work is participated in by control system coordinate system oxygen module, the function of existing lung ventilator, also have the function of oxygen module processed concurrently, the operative configuration of oxygen module processed can be controlled simultaneously, extended use range, improved therapeutic quality.
Description
Technical field
The present invention relates to technical field of medical equipment, and in particular to a kind of cooperative control method of Breathing Suppotion and comprehensive collection
Into system.
Background technology
China's chronic respiratory disease patients（Chronic obstructive pulmonary disease, asthma, neuromuscular disease, pulmonary fibrosis, silicosis and various
Respiratory failure caused by reason）Number is numerous, turns into the serious public health problem for endangering public health, and prevention and control situation is very tight
It is high.Especially chronic obstructive pulmonary disease, 2012-2014 epidemiological investigation datas show, China 40 years old and above crowd chronic obstructive pulmonary disease are ill
Rate is 13.7%.World Health Organization's data show that China's chronic obstructive pulmonary disease death rate is occupied first of various countries, are only second to cardiovascular and cerebrovascular diseases sum
And cancer summation, turn into the 3rd underlying cause of death of resident.Disease Spectrum is weighed with disability adjusted life years to show, chronic obstructive pulmonary disease
Overall disease burden Yi Ju China Disease Spectrum second.
With the continuous progress of science and technology, and Clinical Experience enriches constantly, respiratory therapy constantly weeds out the old and bring forth the new,
Performance becomes better and approaching perfection day by day, using becoming increasingly popular.Lung ventilator, oxygen generating plant are wherein important respiratory therapies, and its application is
Community Health Station and family are covered from hospital ICU wards, public ward.During respirator treatment, generally require same
When row oxygen therapy, therefore, be equipped with and patient, treat scene matching oxygenerator be necessary.
ICU wards use lung ventilator row mechanical ventilation, and empty oxygen mixing is typically in lung ventilator inlet end.Its benefit is gaseous mixture
Body oxygen concentration is stable, gas flows through sensor（Pressure sensor and flow sensor etc.）Almost do not interfere with, accurate measurement, protect
It is stable to demonstrate,prove the breathing mechanics parameters such as accurate respiratory triggering, switching, measurement tidal volume；Shortcoming is：1. oxygen consumption is big, especially
It is high oxygen concentration mechanical ventilation, 2. such lung ventilators are expensive, generally in ten thousand/platforms of 20-40.The breathing that family and community use
Machine（Mechanical ventilation）Price is relatively cheap, and price is more to be accessed close to patient end in 1-5 ten thousand, oxygen.Its advantage is province's oxygen, shortcoming
That extra gas is added in mechanical ventilation, Ventilator Control System can not accurately judge user respiratory triggering,
Switching, breathing mechanics parameters calculate inaccuracy, influence patient's treatment, increase ICU specialties respirator treatment and family, community use
The gap of respirator treatment.Thus extend the time that patient treats in ICU, add the risk of ICU nosocomial infections, be unfavorable for steady
Regular patient arrives family or community application lung ventilator sequential therapy in time.
Secondly, family or community are typically both economical with oxygenerator offering oxygen way, and its oxygen flow scope is typically in 3-
10 liters/min, if oxygen flow demand exceedes afterwards, it is necessary to which the oxygen expense paid can steeply rise（Typically pass through steel cylinder
Oxygen supply, usage time is short, ventilation inconvenience）.In addition, patient's meeting of oximetry value in mechanical ventilation is fluctuated with the state of an illness, need
Or not need oxygen access, in theory can start and stop oxygenerator on demand, reduce power consumption（Oxygenerator power consumption is in 400-
Between 600 watts）, in fact, manual operation is extremely onerous, almost without feasibility.
For summary, during community or family's progress respirator treatment combination oxygen therapy, there is the problem of to be solved master
Want following points：
1st, oxygen output is measurable, can input control system, improve lung ventilator control performance；
2nd, oxygen output can supply on demand, it is necessary to when starting device, need not when arrestment；
3rd, oxygen output can save oxygen mode and extend oxygen delivery capacity：Supplied oxygen in inspiratory phase, expiratory phase oxygen feeding stop, with constant system
Oxygen amount reaches the effect of higher continuous supply flow rate；
4th, respiratory therapy pattern is expansible, and treatment, invasive respirator treatment, can pass through from high flow capacity oxygen therapy to noninvasive ventilator
One machine reaches the effect of two kinds of therapeutic equipments；
5th, lung ventilator module, oxygen machine module, state parameter can monitor, system control can cooperate with, and greatly reduce manual operation, suffer from
The workload of person's nursing.
The content of the invention
In view of this, it is a primary object of the present invention to provide one kind to have oxygen machine function and lung ventilator function, and energy concurrently
The cooperative control method and synthetical compositive evaluating of the Breathing Suppotion of synergy.
To reach above-mentioned purpose, the technical proposal of the invention is realized in this way：
The present invention provides a kind of cooperative control method of Breathing Suppotion, comprises the following steps：
Step 1: control system starts lung ventilator module,
Step 2: the physiological parameter of monitoring human body, the respiration information of monitoring lung ventilator module,
Step 3: monitoring modular sends the respiration information of the physiological parameter of the human body monitored, lung ventilator module to control system
System, is confirmed whether startup oxygen module,
Step 4: when the physiological parameter of human body is less than predetermined threshold value, startup oxygen module processed, control system starts oxygen module processed, will
Oxygen supply is realized empty oxygen mixing, transmitted to nearly patient end to lung ventilator module.
Wherein, the physiological parameter includes blood oxygen saturation SpO2, end-expiratory carbon dioxide numerical value and waveform, respiratory rate, tide
Tolerance, minute ventilation information；The respiration information of the lung ventilator module includes respirator treatment mode setting information, breathing is led to
The flow velocity in pressure, respiration channel, the pressure waveform in respiration channel, the flow velocity waveform in respiration channel and air-breathing in road
Triggering and switching identification information of exhaling.
Wherein, in the step 4, when blood oxygen saturation is more than or equal to preset value, the control system only starts lung ventilator
Module, oxygen module processed is not started.
Wherein, in the step 4, when blood oxygen saturation is less than preset value section, the control system starts oxygen mould processed
Block, output oxygen to nearly patient end, when blood oxygen saturation, which rises, reaches preset value, control system controls oxygen module processed by current
Oxygen flow exports oxygen.
Wherein, in the step 4, when blood oxygen saturation is less than preset value, the control system controls oxygen module processed,
Oxygen is exported to nearly patient end, when oxygen module processed reaches maximum rated output flow, the value of blood oxygen saturation is still unable to reach
During preset value, then start and save oxygen pattern；When province's oxygen pattern is that monitoring module recognizes inspiration trigger information, control system association
Oxygen is exported with initial instant of the oxygen module processed in each aspiratory action is controlled.
Wherein, in the step 4, when blood oxygen saturation is less than preset value, the control system control oxygen module processed by
According to flow velocity, sequential adjustment flow, output oxygen make blood oxygen saturation to nearly patient end with minimum regulation oxygen flow from low to high
Degree is stable in preset value section；It is described that according to flow velocity, sequential adjustment flow is from low to high with 0.5 liter/min is interval, from 0 to
The regulation flow of maximum output flow, or to save oxygen mode tuning.
Wherein, monitoring module detects the flow information of the oxygen output of oxygen module processed, while monitoring module detection lung ventilator
Module is sent to the air velocity information of nearly patient end, and sends to control system, control system and calculate patient end oxygen accordingly
Concentration curve, and show.
Wherein, monitoring module detects the flow information of the oxygen output of oxygen module processed, sends it to lung ventilator module, will
Oxygen flow information is included as influence factor, accurately to calculate tidal volume, minute ventilation, expiration handover information and air-breathing
Trigger information.
A kind of synthetical compositive evaluating of Breathing Suppotion,
Including lung ventilator module, lung ventilator operation is performed；
Oxygen module processed, export oxygen；
Monitoring module, the physiological parameter of human body is monitored, monitor respiration information, the flow letter of monitoring oxygen module processed of lung ventilator module
Breath etc., control system, monitoring modular is by the physiological parameter of the human body monitored, the respiration information of lung ventilator module, oxygen module processed
Flow information etc. send to control system, control system Collaborative Control lung ventilator module and oxygen module processed, by air or empty oxygen
Gaseous mixture is transmitted to nearly patient end.
Wherein, the oxygen module processed exports oxygen to lung ventilator module, forms empty oxygen gas mixture, exports to nearly patient
End, the oxygen channel of the oxygen module processed are connected with the respiration channel of the lung ventilator module by magnetic valve.
The breathing module includes air blower and respiration channel, and the oxygen module processed includes oxygenerator and oxygen channel, also
Including breathing accessory, the breathing accessory is arranged at nearly patient end, the output end of the oxygen channel and the breathing accessory connection
Logical, the output end of the respiration channel exports with the breathing accessory UNICOM, the oxygenerator oxygen through the oxygen channel.
Wherein, in addition to humidifying device assembly, the humidifying device assembly connect with the output end of the respiration channel, for inciting somebody to action
Gas humidification in respiration channel.
Wherein, in addition to Neulized inhalation component, Neulized inhalation component are logical by the oxygen or breathing of decoction and oxygen module processed
The air-flow mixing in road is exported to patient according to the respiration information of patient in inspiratory phase, reduces drug waste.
Wherein, Neulized inhalation component includes compressor and atomising head, and driven compressor atomising head is by medical liquid atomizing.
Wherein, the Neulized inhalation component also can be that sieve plate is atomized.
Wherein, in addition to sputum aspirator tube, the control module control suction sputum pipeline are opened, there is provided negative pressure, suction out user's
Product phlegm.
Beneficial effect：
A kind of cooperative control method of Breathing Suppotion of the present invention, comprises the following steps：
Step 1: control system starts lung ventilator module,
Step 2: the physiological parameter of monitoring human body, the respiration information of monitoring lung ventilator module,
Step 3: monitoring modular sends the respiration information of the physiological parameter of the human body monitored, lung ventilator module to control system
System, is confirmed whether startup oxygen module,
Step 4: when the physiological parameter of human body is less than predetermined threshold value, startup oxygen module processed, control system starts oxygen module processed, will
Oxygen supply is realized empty oxygen mixing, transmitted to nearly patient end to lung ventilator module.
The cooperative control method of the present invention, the respiration information of physiological parameter and lung ventilator module can be monitored, be by controlling
Coordinate system oxygen module of uniting participates in work, improves the function of existing lung ventilator, also has the function of oxygen module processed concurrently, while can control
The operative configuration of system oxygen module processed, extends use range, improves therapeutic quality.
Brief description of the drawings
Fig. 1 is the structural representation of the synthetical compositive evaluating of the Breathing Suppotion of the present invention.
1 --- oxygen module processed, 2 --- lung ventilator module, 3 --- respiration channel, 4 --- oxygen channel,
5 --- control system, 6 --- monitoring modular, 7 --- air blower, 8 --- breathing accessory,
9 --- switch relay, 10 --- magnetic valve, 11 --- oxygen flow, flow sensor,
12 --- oximetry sensor, 13 --- expiration carbon dioxide sensors.
Embodiment
The present invention is described in detail with reference to the accompanying drawings and detailed description.
Embodiment 1
A kind of cooperative control method of Breathing Suppotion, comprises the following steps：
Step 1: control system starts lung ventilator module,
Step 2: the physiological parameter of monitoring human body, the respiration information of monitoring lung ventilator module,
Step 3: monitoring modular sends the respiration information of the physiological parameter of the human body monitored, lung ventilator module to control system
System, is confirmed whether startup oxygen module,
Step 4: when the physiological parameter of human body is less than predetermined threshold value, startup oxygen module processed, control system starts oxygen module processed, will
Oxygen supply is realized empty oxygen mixing, transmitted to nearly patient end to lung ventilator module.
The cooperative control method of the present invention, can monitor the respiration information of physiological parameter and lung ventilator module, pass through control
Systematic collaboration processed controls oxygen module processed to participate in work, and both function of the function with lung ventilator also with oxygen module processed, judgements are
It is no that oxygen module processed is added into work, while the operative configuration of oxygen module processed can be controlled, use range is expanded, improves treatment
Quality.
Wherein, the physiological parameter includes blood oxygen saturation SpO2, end-expiratory carbon dioxide numerical value and waveform, breathing frequency
Rate, tidal volume, minute ventilation information；The respiration information of the lung ventilator module include respirator treatment mode setting information,
The flow velocity in pressure, respiration channel in respiration channel, the pressure waveform in respiration channel, the flow velocity waveform in respiration channel with
And inspiration trigger and switching identification information of exhaling.
By the detection to blood oxygen saturation in the present invention, it can precisely judge whether oxygen module processed adds work, including
Following several modes：
1st, when blood oxygen saturation is more than or equal to preset value, the control system only starts lung ventilator module, does not start oxygen processed
Module.Now need not oxygen module processed participate in work, energy-conservation；
2nd, when blood oxygen saturation is less than preset value section, the control system starts oxygen module processed, output oxygen to nearly patient
End, when monitoring module monitors to blood oxygen saturation, which rise, reaches preset value, control system controls oxygen module processed by current oxygen
Flow exports oxygen.Reach preset value, oxygen is exported using present flow rate, the change of blood oxygen saturation can be effectively kept, carry
High therapeutic quality；
3rd, when blood oxygen saturation is less than preset value, control system control oxygen module processed, output oxygen to nearly patient end, when
When oxygen module processed reaches maximum rated output flow, when the value of blood oxygen saturation is still unable to reach preset value, then starts and save oxygen mould
Formula；When province's oxygen pattern is that monitoring module recognizes inspiration trigger information, control system Collaborative Control oxygen module is each
The initial instant output oxygen of aspiratory action.Specified oxygen-supplying amount can be effectively improved by the output for saving oxygen pattern, so that mustn't
Greater levels of oxygenerator is changed, has saved cost；
4th, when blood oxygen saturation is less than preset value, the control system controls oxygen module processed according to flow velocity order from low to high
Flow is adjusted, output oxygen to nearly patient end, makes blood oxygen saturation stable in preset value section with minimum regulation oxygen flow；
It is described that according to flow velocity, sequential adjustment flow is from low to high with 0.5 liter/min is interval, from 0 to maximum output flow regulation
Flow, or to save oxygen mode tuning.
Wherein, monitoring module detects the flow information of the oxygen output of oxygen module processed, while monitoring module detection lung ventilator
Module is sent to the air velocity information of nearly patient end, and sends to control system, control system and calculate patient end oxygen accordingly
Concentration curve, and show.The oxygen concentration curve of patient end is shown, effectively can record and show the oxygen supply feelings of patient end
Condition, the situation that carbon dioxide can not discharge is avoided the occurrence of, improve therapeutic effect.
Wherein, monitoring module detects the flow information of the oxygen output of oxygen module processed, sends it to lung ventilator module, will
Oxygen flow information is included as influence factor, accurately to calculate tidal volume, minute ventilation, expiration handover information and air-breathing
Trigger information.
The above method of the present invention can add oxygen in mask can also use nose conduit two paths control oxygen
User and air input user are inputted, oxygen channel can also be directly accessed on respiration channel, oxygen is directly supplied.
Embodiment 2, a kind of synthetical compositive evaluating of Breathing Suppotion, as shown in figure 1,
Including lung ventilator module 2, lung ventilator operation is performed；
Oxygen module 1 processed, export oxygen；
Monitoring module, monitor the physiological parameter of human body, respiration information, the flow of monitoring oxygen module 1 processed of monitoring lung ventilator module 2
Information, control system 5, monitoring modular 6 is by the physiological parameter of the human body monitored, the respiration information of lung ventilator module 2, oxygen mould processed
The flow information of block 1 is sent to control system 5, the Collaborative Control lung ventilator module 2 of control system 5 and oxygen module 1 processed, by air or
Empty oxygen gas mixture is transmitted to nearly patient end.
Wherein, the oxygen module 1 processed exports oxygen to lung ventilator module 2, forms empty oxygen gas mixture, exports to nearly patient
End, the oxygen channel 4 of the oxygen module 1 processed is with the breathing of the lung ventilator module 2 by being connected by magnetic valve 10.The control
System 5 processed is connected with switch relay 9, for controlling being turned on and off for oxygen module 1 processed, that is, controls oxygenerator to shut down or hinder
Only oxygenerator exports oxygen into oxygen channel 4, and oxygen channel 4 is turned off or opened by magnetic valve 10 with respiration channel 3
Control, control system 5 are connected with the electric signal of magnetic valve 10, control the shut-off of battery valve, and then control oxygen channel 4 logical with breathing
The UNICOM in road 3.Be provided with oxygen flow, flow sensor 11 in oxygen channel 4, monitor oxygen flow in oxygen channel 4 and
Oxygen gas flow rate.
It is mask or tracheae plug-in unit to breathe accessory 8, for connecting respiration channel 3 and patient end or respiration channel 3, oxygen
Passage 4 and patient end.I.e. oxygen can be exported to patient through respiration channel 3, can also be exported respectively to patient, according to patient's
Situation is different, using different types of breathing accessory 8.
Monitoring system monitors the blood oxygen saturation of user by oximetry sensor 12, also passes through expiration titanium dioxide
Carbon sensor 13 monitors end-expiratory carbon dioxide numerical value and waveform, respiratory rate, tidal volume, minute ventilation information；Wherein exhale
Frequency, tidal volume, minute ventilation information are inhaled to be calculated, and Sensor monitoring respiration channel 3 is additionally provided with respiration channel 3
Interior pressure, the flow velocity in respiration channel 3, the pressure waveform in respiration channel 3, the flow velocity waveform in respiration channel 3 and suction
Gas, which is triggered and exhaled, switches identification information.
The breathing module includes air blower 7 and respiration channel 3, and the oxygen module 1 processed includes oxygen machine and oxygen channel 4,
Also include breathing accessory 8, the breathing accessory 8 is arranged at nearly patient end, and the output end of the oxygen channel 4 is matched somebody with somebody with the breathing
The UNICOM of part 8, the output end of the respiration channel 3 and breathing accessory 8 UNICOM, the oxygenerator oxygen is through the oxygen channel
4 outputs.
Wherein, in addition to humidifying device assembly, the humidifying device assembly are connected with the output end of the respiration channel 3, are used for
By the gas humidification in respiration channel 3.
Wherein, in addition to atomizing component, atomizing component is by decoction and the oxygen of oxygen module 1 processed or the gas of respiration channel 3
Stream mixing is exported to patient according to the inspiration trigger and switching identification information of exhaling of patient.
Wherein, atomizing component includes compressor and atomising head, and driven compressor atomising head is by medical liquid atomizing.
Wherein, the atomizing component is sieve plate atomizing component.
Wherein, in addition to sputum aspirator tube, the control system 5 control suction sputum pipeline to open, there is provided negative pressure, suction out user's
Product phlegm.
The foregoing is only a preferred embodiment of the present invention, but protection scope of the present invention be not limited thereto,
Any one skilled in the art the invention discloses technical scope in, the change or replacement that can readily occur in,
It should all be included within the scope of the present invention.Therefore, protection scope of the present invention should be with scope of the claims
It is defined.
Claims (10)
- A kind of 1. cooperative control method of Breathing Suppotion, it is characterised in that：Comprise the following steps：Step 1: control system starts lung ventilator module,Step 2: the physiological parameter of monitoring human body, the respiration information of monitoring lung ventilator module,Step 3: monitoring modular sends the respiration information of the physiological parameter of the human body monitored, lung ventilator module to control system System, is confirmed whether startup oxygen module,Step 4: when the physiological parameter of human body is less than predetermined threshold value, startup oxygen module processed, control system starts oxygen module processed, will Oxygen supply is realized empty oxygen mixing, transmitted to nearly patient end to lung ventilator module.
- A kind of 2. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：The physiological parameter bag Include blood oxygen saturation SpO2, end-expiratory carbon dioxide EtCO2 numerical value and waveform, respiratory rate, tidal volume, minute ventilation letter Breath；The respiration information of the lung ventilator module includes respirator treatment mode setting information, the pressure in respiration channel, breathes and lead to The pressure waveform in flow velocity, respiration channel, the flow velocity waveform in respiration channel and inspiration trigger and switching of exhaling in road are known Other information.
- A kind of 3. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：In the step 4, When blood oxygen saturation is more than or equal to preset value, the control system only starts lung ventilator module, does not start oxygen module processed.
- A kind of 4. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：In the step 4, When blood oxygen saturation is less than preset value section, the control system starts oxygen module processed, and output oxygen works as blood to nearly patient end When oxygen saturation rising reaches preset value, control system controls oxygen module processed to export oxygen by current oxygen flow.
- A kind of 5. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：In the step 4, When blood oxygen saturation is less than preset value, the control system controls oxygen module processed, and output oxygen is to nearly patient end, when oxygen mould processed When block reaches maximum rated output flow, when the value of blood oxygen saturation is still unable to reach preset value, then starts and save oxygen pattern；It is described When province's oxygen pattern is that monitoring module recognizes inspiration trigger information, control system Collaborative Control oxygen module is in each aspiratory action Initial instant output oxygen.
- A kind of 6. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：In the step 4, When blood oxygen saturation is less than preset value, the control system controls oxygen module processed according to flow velocity sequential adjustment stream from low to high Amount, output oxygen to nearly patient end, make blood oxygen saturation stable in preset value section with minimum regulation oxygen flow；It is described to press It with 0.5 liter/min is interval that according to flow velocity, sequential adjustment flow, which is, from low to high, from 0 to maximum output flow regulation flow, or To save oxygen mode tuning.
- A kind of 7. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：Monitoring module detection system The flow information of the oxygen output of oxygen module, while monitoring module detection lung ventilator module is sent to the air velocity letter of nearly patient end Breath, and send to control system, control system calculates patient end oxygen concentration curve accordingly, and shows.
- A kind of 8. cooperative control method of Breathing Suppotion according to claim 1, it is characterised in that：Monitoring module detection system The flow information of the oxygen output of oxygen module, sends it to lung ventilator module, accurately calculates tidal volume, minute ventilation, exhales Gas handover information and inspiration trigger information.
- 9. the synthetical compositive evaluating of the cooperative control method of the Breathing Suppotion according to any one of claim 1 to 8, it is special Sign is：Including lung ventilator module, lung ventilator operation is performed；Oxygen module processed, export oxygen；Monitoring module, the physiological parameter of human body is monitored, monitor respiration information, the flow letter of monitoring oxygen module processed of lung ventilator module Breath etc.,Control system, monitoring modular is by the physiological parameter of the human body monitored, the respiration information of lung ventilator module, oxygen module processed Flow information etc. is sent to control system, control system Collaborative Control lung ventilator module and oxygen module processed, and air or empty oxygen are mixed Gas is closed to transmit to nearly patient end.
- A kind of 10. synthetical compositive evaluating of Breathing Suppotion according to claim 9, it is characterised in that：The oxygen module processed Oxygen is exported to lung ventilator module, forms empty oxygen gas mixture, is exported to nearly patient end, the oxygen channel of the oxygen module processed with The respiration channel of the lung ventilator module is connected by magnetic valve.
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| CN109091735A (en) * | 2018-07-05 | 2018-12-28 | 柴小青 | A kind of Anesthesia machine, ventilator intelligence ventilatory control system |
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| CN110496282B (en) * | 2019-06-17 | 2023-09-15 | 广州和普乐健康科技有限公司 | Method and device for intelligently starting and stopping breathing machine and breathing machine |
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