CN110038198B - Closed-loop expectoration method and system for automatically titrating expectoration pressure - Google Patents
Closed-loop expectoration method and system for automatically titrating expectoration pressure Download PDFInfo
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Abstract
The invention relates to a closed-loop expectoration method for automatically titrating expectoration pressure, which comprises S1, setting a reference value C2 of negative pressure phase flow-volume ring area F-V ring area of a user; s2, calculating the actual value R2 of the area of the F-V ring of the negative pressure phase of the user; s3, comparing the reference value C2 of the negative pressure phase F-V ring area with the actual value R2 of the negative pressure phase flow-volume ring area to adjust the negative phase pressure E-P and/or the positive phase pressure I-P. The invention also provides a closed-loop expectoration system for automatically titrating the expectoration pressure, which comprises: the reference value setting module is used for setting a reference value C2 of the negative pressure phase flow-volume ring area F-V ring area; the actual value calculating module is used for monitoring and calculating an actual value R2 of the area of the negative pressure phase F-V ring; a comparison module for comparing the reference value C2 with the actual value R2; an adjustment module that adjusts the negative phase pressure E-P and the positive phase pressure I-P based on a result of the comparison module. The expectoration method and the expectoration system ensure that the expectoration is safer and more effective.
Description
Technical Field
The invention relates to a expectoration machine, in particular to a mechanical charging and discharging method and system for automatically titrating expectoration pressure in a closed loop mode.
Background
Cough, a physiological mechanism by which normal persons clear secretions from the respiratory airways. However, for some patients suffering from cough dysfunction diseases, such as neuromuscular diseases with weakened cough force, and patients with mechanical ventilation intubation, it becomes necessary to remove airway secretions by some external force.
Mechanical ventilation (MI-E) devices, commonly known as expectoration machines, are well known devices used to assist patients with ineffective coughs in clearing their airways of noxious secretions. The device simulates the physiological mechanism of cough of a normal person, and controls the airway pressure of a pipeline (a mask connecting end, a mouthpiece connecting end or a trachea cannula connecting end) connected with a patient to be alternately switched between a set positive phase inflation pressure (positive pressure phase) and a set negative phase exhaust pressure (negative pressure phase). The positive phase inflation pressure slowly rises to gradually inflate the patient's lungs, and then rapidly switches to negative phase exhaust pressure to produce a high rate of cough flow, thereby carrying away secretions in the airway.
The most representative and most advanced commercially available MI-E device is CoughAsist T70/E70 from Philips Respironics.
Patent US6929007B2 discloses an improved MI-E system with percussive function which works by adding high frequency oscillations during positive inflation and negative exhaust pressure to loosen airway sputum. This patent is embodied in CoughAssist E70.
The invention patent US2005/0039749A1 also discloses an improved MI-E system which can judge the inspiratory effort of a patient in a pause phase after the negative pressure phase is combined, and realize the automatic synchronous triggering of the positive pressure phase switching, thereby improving the sputum feeling of the patient using the sputum machine. The specific application of this patent is embodied in the Cough-Trak function in CoughAssist T70/E70.
The invention patent EP1933912B1 provides an online MI-E expectoration system capable of working in cooperation with a respirator, the system judges the time of the respirator turning from an inspiratory phase to an expiratory phase through a sensor connected with a pipeline of the respirator, a normal ventilation channel between the respirator and a patient is cut off at the moment of judging that the time of the switching arrives, a negative pressure suction channel between the patient and the expectoration machine is opened, and then the system automatically restores the normal connection between the respirator and the airway of the patient once the time of finishing the negative pressure phase arrives. Briefly, the positive phase pressure of this MI-E is controlled by the ventilator and the negative phase pressure is controlled by the expectoration machine. The online MI-E expectoration system can greatly avoid a plurality of risks caused by sputum suction of the traditional sputum suction tube and achieve the effect of noninvasively clearing the sputum in the airway of a intubated patient. The specific application of this patent is the CoughSync expectoration machine developed by the applicant.
The current mechanical air charging and discharging (MI-E) device takes positive and negative phase expectoration pressure set by a user as a control target. Basically, there are two expectoration modes, namely a manual mode and an automatic mode, and in the manual mode, the switching of positive phase pressure and negative phase pressure is realized by the operation of a toggle or a remote controller by a user; and the automatic mode is a timing mode, and the machine controls the switching time of the positive and negative phase pressures according to the time set by a user. However, in any mode, the current MI-E devices are targeted to positive and negative phase expectoration pressures set by the user.
Generally, it is considered that the higher the expectoration pressure is, the larger the generated expectoration amount is, and the higher the cough peak flow is, the more beneficial the discharge of airway secretion is; but the higher the expectoration pressure, the greater the risk of causing airway injury to the patient; and for some common respiratory airway diseases (such as Chronic Obstructive Pulmonary Disease (COPD) and medullary oblongata injury), the higher negative phase expectoration pressure can cause airway collapse to reduce expectoration effect.
In practice, the user (doctor or patient) will generally rely on experience to titrate the expectoration pressure for a particular patient based on the patient's different conditions (e.g. age, type of patient, patient airway impedance, patient's own cough intensity, etc.). The artificial titration of expectoration pressure has the following defects:
(1) titration of expectoration pressure is a trial and error process and is cumbersome to repeat once titration has occurred if the patient's condition changes.
(2) The expectoration pressure titrated by a trial and error method depending on experience is hardly said to be optimal, because a reliable index for evaluating the expectoration effect is not taken as a basis in the titration process. One of the most commonly used indexes for setting the expectoration pressure is that the cough peak flow is about to reach 160LPM (for general adults), but actually even though the cough peak flow can reach 160LPM, the sputum cannot be expectorated smoothly, and the two reasons are: 1. for some patients with easily trapped airways, most commonly COPD patients, their peak cough flow is not low, but the overall cough phase flow is low; 2. for some patients with poor lung compliance, even though peak expectoration flow is high, the volume of air that is coughed out with a cough is very small. Both of these situations suggest that it is not ideal to titrate expectoration pressure with a single index of expectoration, such as the commonly used peak expectoration flow.
Disclosure of Invention
Aiming at the defect that the expectoration pressure must be titrated by repeatedly trial and error depending on the experience of a user in the expectoration mode in the existing MIE device, the invention provides a closed-loop expectoration method for automatically titrating the expectoration pressure. The expectoration method automatically titrates positive phase expectoration pressure and negative phase expectoration pressure by taking the negative phase flow-volume ring area set by a user as a control target. Meanwhile, the sputum expectoration method automatically adjusts the rising slope of the positive phase sputum pressure by taking the ratio of the positive pressure phase flow-volume ring area to the negative pressure phase flow-volume ring set by a user as a control target.
The invention provides a closed-loop expectoration method for automatically titrating expectoration pressure, which comprises the following steps:
s1, setting the reference value C2 of the negative pressure phase flow-volume ring area F-V ring area of the user;
s2, calculating the actual value R2 of the area of the F-V ring of the negative pressure phase of the user;
s3, comparing the reference value C2 of the negative pressure phase F-V ring area with the actual value R2 of the negative pressure phase flow-volume ring area to adjust the negative phase pressure E-P and/or the positive phase pressure I-P.
The invention provides a closed-loop expectoration method for automatically titrating expectoration pressure, which comprises the following steps:
s1, the user sets the reference value C2 of negative pressure phase flow-volume ring area and sets the reference ratio C1/C2 of positive/negative pressure phase flow-volume ring area ratio;
s2, calculating an actual value R1 of the area of the positive pressure phase flow-volume ring, an actual value R2 of the area of the negative pressure phase flow-volume ring and an actual ratio R1/R2 of the two values;
s3, comparing the reference value C2 and the actual value R2 of the negative pressure phase flow-volume ring area, and automatically adjusting the negative pressure E-P and the positive pressure I-P;
s4, comparing the reference ratio C1/C2 and the actual ratio R1/R2 of the positive/negative pressure phase flow-volume ring area ratio, and automatically adjusting the positive pressure rising Slope P-Slope.
A closed-loop expectoration system for automatically titrating expectoration pressure, the expectoration system comprising:
a reference value setting module configured to set a reference value C2 for a negative pressure phase flow-volume annulus area F-V annulus area;
an actual value calculation module that monitors and calculates an actual value R2 of the negative pressure phase F-V loop area;
a comparison module that compares the reference value C2 with an actual value R2;
an adjustment module that adjusts the negative phase pressure E-P and the positive phase pressure I-P based on the result of the comparison module, and increases the negative phase pressure E-P and/or the positive phase pressure I-P for the next expectoration if the reference value C2 is smaller than the actual value R2; otherwise, it is decreased.
The invention provides a closed-loop expectoration system capable of automatically titrating expectoration pressure, which comprises:
a reference value setting module configured to allow a user to set a reference value C2 for negative pressure phase flow-volume annulus area and to set a reference value C1/C2 for positive/negative pressure phase flow-volume annulus area ratio;
an actual value calculation module that monitors and calculates an actual value of positive pressure phase flow-volume ring area, R1, and an actual value of negative pressure phase flow-volume ring area, R2, and a ratio of R1/R2;
a comparison module which compares a reference value C2 and an actual value R2 of the area of the negative pressure phase flow-volume ring and compares a reference value C1/C2 and an actual value R1/R2 of the ratio of the positive/negative pressure phase flow to the area of the volume ring;
an adjustment module that adjusts the negative phase pressure E-P, the positive phase pressure I-P, and the positive pressure rise ramp P-Slope based on a result of the comparison module.
The remote upgrading module can enable the closed-loop expectoration system to be connected to a cloud server of a manufacturer so as to realize online uploading of expectoration treatment data; the cloud server can continuously and remotely upgrade the control algorithm in the closed-loop expectoration controller by utilizing a large amount of treatment data uploaded by expectoration machines scattered in various places, so that the expectoration pressure titration level of the closed-loop expectoration controller gradually reaches or even exceeds the degree of experts in the industry.
Compared with the conventional MI-E expectoration mode, the closed-loop expectoration method for titrating the expectoration pressure provided by the invention has the following advantages:
(1) the setting of the closed-loop expectoration method is no longer a complicated process, so that the experience dependence on a user is reduced, the titration workload of expectoration parameters of the user is reduced, and once the expectoration parameters are determined for a specific patient, the expectoration parameters do not need to be titrated again even if the physiological condition of the patient is changed in the future;
(2) the index which is the F-V ring area (equivalent to airflow impulse) in expectoration and directly corresponds to the expectoration effectiveness is taken as a control target, so that the control of expectoration becomes intuitive and has evaluative property;
(3) the control rule in the controller of the closed-loop expectoration system can be continuously updated by utilizing big data obtained in actual use, so that the expectoration is more safe and effective.
Drawings
Fig. 1 is a working principle diagram of the expectoration method of the present invention.
Fig. 2 is a flowchart of the expectoration method of the present invention.
Fig. 3 is a block diagram of the expectoration system of the present invention.
Fig. 4 is a schematic diagram of a human-computer interaction interface of the expectoration system of the present invention.
Detailed Description
Embodiments of the present invention will now be described with reference to the drawings, wherein like parts are designated by like reference numerals. The embodiments described below and the technical features of the embodiments may be combined with each other without conflict.
Fig. 1 illustrates the control principle of the method and system of the present invention.
The starting point of the invention is based on the basic mechanical principle of secretion movement: in the process of expectoration, the average cough flow of the negative pressure phase and the expectoration air volume of the negative pressure phase both have to reach certain set values, so that the secretion in the air passage can be effectively expectorated. The movement of the secretions is generated by the thrust of the air flow acting on them, the greater the thrust, the faster the secretions accelerate; however, the duration of the thrust acting on the secretions is also critical, and the longer the thrust is acting, the longer the movement distance of the secretions is.
The average cough flow of the negative pressure phase determines the air flow thrust acting on the secretion, and the coughing air volume of the negative pressure phase determines the time of the air flow thrust acting on the secretion, so that the product of the two determines the air flow thrust acting on the secretion. The product of the average cough flow and the amount of expectoration (equivalent to the impulse of airflow) is the area of the negative pressure phase F-V ring shown in fig. 1. Therefore, the effectiveness of expectoration can be reflected very well by taking the area of the F-V ring of the negative pressure phase as a measurement index.
In the closed-loop expectoration mode with the flow-volume loop area as the target, the control target set by the user is not the expectoration pressure any more, but the F-V loop area target of the negative pressure phase. For example, it is generally considered that the average expectoration flow rate should reach 160LPM, and the expectoration air volume should reach at least 1L, so that the sputum can be effectively expectorated, and therefore a reasonable negative pressure phase F-V ring area target is 160 × 1-160L2/min。
In fact, not only the F-V ring area of the negative pressure phase but also the F-V ring area of the positive pressure phase are important, because the force of the positive pressure phase airflow acting on the secretion is opposite and is not beneficial to the movement of the secretion towards the mouth end of the patient, so if the F-V ring area of the positive pressure phase is too large, the secretion coughed out by the negative pressure phase is blown back to the deep part of the airway in the next positive pressure phase. Because of this, it is also important to control the F-V loop area ratio of the positive/negative pressure phase in the closed-loop expectoration mode. The area of the F-V ring of the positive pressure phase must be smaller than that of the negative pressure phase, so the ratio of the area of the F-V ring of the positive pressure phase to the area of the negative pressure phase is set to be smaller than 1 and can be between 0.3 and 0.8.
Because there are two control objectives, namely negative phase F-V loop area and positive/negative phase F-V loop area ratio, the control principle shown in FIG. 1 includes two parallel control loops.
In each control period, the expectoration system controls the output pressure of the MI-E device of the expectoration according to the control targets of positive phase expectoration pressure I-P, negative phase expectoration pressure E-P and positive phase expectoration pressure rising slope P-slope determined when the last expectoration is finished, and simultaneously monitors and records the flow-volume loop area change in the expectoration.
If the expectoration is judged to be finished in one control period, the actual negative pressure phase F-V ring area, the actual positive pressure phase F-V ring area and the ratio of the two, namely the actual positive/negative pressure phase F-V ring area ratio, of the expectoration can be calculated. Comparing the monitored actual value with the set value of the user, the positive phase expectoration pressure I-P, the negative phase expectoration pressure E-P and the positive phase expectoration pressure rising slope P-slope of the next expectoration can be adjusted according to a certain rule or control rate (namely a control algorithm operated in the expectoration controller), and the targets of the three parameters are obtained.
If the actual negative pressure phase F-V ring area at the end of the expectoration is smaller than the set negative pressure phase F-V ring area, the negative phase suction pressure E-P or the positive phase inflation pressure I-P of the next expectoration should be increased; otherwise, it should be decreased.
If the actual F-V ring area ratio of the positive pressure phase to the negative pressure phase at the end of the expectoration is smaller than the set F-V ring area ratio of the positive pressure phase to the negative pressure phase, the positive phase expectoration pressure rising slope P-slope of the next expectoration should be increased; otherwise, it should be decreased.
In practice a wide variety of expectoration controllers can be designed, such as simple rule-based controllers, PID controllers, or fuzzy logic controllers, neural network controllers, or controllers based on big data rule mining. However, no matter what the controller is, the risk that the increase of expectoration pressure will cause is considered while the expectoration is effective, for example, the positive phase pressure is too high, which may cause barotrauma to the lung, and the negative phase pressure is too high, which may cause premature collapse of the large airway.
And ending one control period and entering the next control period. The expectoration control process described above is repeated.
As shown in fig. 1, the closed-loop expectoration method for automatically titrating expectoration pressure of the present invention includes:
s1, setting the reference value C2 of the negative pressure phase flow-volume ring area of the user.
And S2, calculating the actual value R2 of the negative pressure phase flow-volume ring area of the user.
S3, comparing the reference value C2 of the negative pressure phase flow-volume ring area with the actual value R2 of the negative pressure phase flow-volume ring area to adjust the positive pressure rising Slope P-Slope. Specifically, if the reference value C2 of the negative pressure phase flow-volume ring area is smaller than the actual value R2 of the negative pressure phase flow-volume ring area, the negative phase pressure E-P and/or the positive phase pressure I-P of the next expectoration are/is increased; otherwise, it is decreased. In another embodiment, the closed-loop expectoration method for automatically titrating expectoration pressure of the present invention comprises:
s1, setting a reference value C1 of positive pressure phase flow-volume ring area and a reference value C2 of negative pressure phase flow-volume ring area of a user, and calculating a reference ratio C1/C2 of positive and negative pressure phase flow-volume ring area.
S2, calculating the actual value R1 of the positive pressure phase flow-volume ring area, the actual value R2 of the negative pressure phase flow-volume ring area and calculating the actual ratio R1/R2 of the positive and negative pressure phase flow-volume ring area of the user.
And S3, comparing the reference ratio C1/C2 of the positive and negative pressure phase flow to the volume ring area with the actual ratio R1/R2 of the positive and negative pressure phase flow to the volume ring area to adjust the negative phase pressure E-P, the positive phase pressure I-P and the positive pressure rising Slope P-Slope. Specifically, if the actual negative pressure phase F-V ring area at the end of the expectoration is smaller than the set negative pressure phase F-V ring area, the negative phase suction pressure E-P or the positive phase inflation pressure I-P of the next expectoration should be increased; otherwise, it should be decreased. If the actual F-V ring area ratio of the positive pressure phase to the negative pressure phase at the end of the expectoration is smaller than the set F-V ring area ratio of the positive pressure phase to the negative pressure phase, the positive phase expectoration pressure rising slope P-slope of the next expectoration should be increased; otherwise, it should be decreased.
In another embodiment, as shown in fig. 2, the closed-loop expectoration method for automatically titrating expectoration pressure of the present invention comprises:
s1, setting a reference value C2 of negative pressure phase flow-volume ring area and setting a reference value C1/C2 of positive/negative pressure phase flow-volume ring area ratio;
s2, calculating the actual value R1 of the positive pressure phase flow-volume ring area, the actual value R2 of the negative pressure phase flow-volume ring area and the ratio R1/R2 when each expectoration is finished;
s3, comparing the reference value C2 and the actual value R2 of the negative pressure phase flow-volume ring area, and automatically adjusting the negative pressure E-P and the positive pressure I-P; specifically, if the actual value R2 of the negative pressure phase flow-volume ring area is smaller than the reference value C2 of the negative pressure phase flow-volume ring area, the negative phase pressure E-P or the positive phase pressure I-P of the next expectoration is increased; otherwise, it is decreased.
S4, comparing the reference value C1/C2 and the actual value R1/R2 of the ratio of the positive/negative pressure phase flow to the area of the volume ring, and automatically adjusting the positive pressure rising Slope P-Slope; specifically, if the actual F-V ring area ratio R1/R2 of the positive/negative pressure phase at the end of this expectoration is smaller than the set F-V ring area ratio C1/C2 of the positive/negative pressure phase, the positive phase expectoration pressure rising slope P-slope of the next expectoration should be increased; otherwise, it should be decreased.
According to another aspect of the present invention, as shown in fig. 3, there is provided a closed-loop expectoration system, including:
a reference value setting module configured to allow a user to set a reference value C2 for negative pressure phase flow-volume annulus area and to set a reference value C1/C2 for positive/negative pressure phase flow-volume annulus area ratio;
an actual value calculation module that monitors and calculates an actual value of positive pressure phase flow-volume ring area, R1, and an actual value of negative pressure phase flow-volume ring area, R2, and a ratio of R1/R2;
a comparison module which compares a reference value C2 and an actual value R2 of the area of the negative pressure phase flow-volume ring and compares a reference value C1/C2 and an actual value R1/R2 of the ratio of the positive/negative pressure phase flow to the area of the volume ring;
an adjustment module that adjusts the negative phase pressure E-P, the positive phase pressure I-P, and the positive pressure rise ramp P-Slope based on a result of the comparison module.
The remote upgrading module can enable the closed-loop expectoration system to be connected to a cloud server of a manufacturer so as to realize online uploading of expectoration treatment data; the cloud server can continuously and remotely upgrade the control algorithm in the closed-loop expectoration controller by utilizing a large amount of treatment data uploaded by expectoration machines scattered in various places, so that the expectoration pressure titration level of the closed-loop expectoration controller gradually reaches or even exceeds the degree of experts in the industry.
Alternatively, the closed loop expectoration system operates in an MI-E device. An MI-E device necessarily includes multiple modules for human-computer interaction, expectoration pressure and flow monitoring/control, power supply, gas path structure, expectoration machine housing, etc. An exemplary closed-loop expectoration mode human-machine interaction interface is shown in fig. 4.
The human-computer interaction interface comprises an information prompt bar at the top, and the current mode is an Intelli-Cough expectoration mode as shown in FIG. 4; the lower right corner is provided with an adjusting button or a manual expectoration button; the bottom is an operation menu and expectoration setting parameter display area, wherein expectoration parameters set by a user, such as a negative pressure phase F-V ring area set value and a positive/negative pressure phase F-V ring area ratio set value, are displayed; the left side can dynamically display airway pressure in expectoration; the middle part is a display area of a waveform or a ring; the right is the actual monitoring expectoration parameter in expectoration.
In specific implementation, the function of inputting basic height/weight and disease type information of a patient, such as neuromuscular diseases, obstructive pulmonary diseases, restrictive pulmonary diseases and the like, can be added in human-computer interaction, so that the input patient information can be utilized in the closed-loop expectoration mode controller to realize more personalized expectoration effectiveness control.
In a specific implementation, for any patient, a preset initial value option of expectoration pressure can be added: is a control target parameter for keeping the expectoration pressure when the last expectoration treatment is finished; or recording the preset initial value of the expectoration pressure of the expectoration treatment again. Such an option would make the closed-loop expectoration mode more satisfactory to the needs of different users.
The above-described embodiments are merely preferred embodiments of the present invention, and general changes and substitutions by those skilled in the art within the technical scope of the present invention are included in the protection scope of the present invention.
Claims (5)
1. A closed-loop expectoration system for automatically titrating expectoration pressure, the expectoration system comprising:
a reference value setting module configured to set a reference value C2 of a negative pressure phase F-V ring area;
an actual value calculation module that monitors and calculates an actual value R2 of the negative pressure phase F-V loop area;
a comparison module that compares the reference value C2 with an actual value R2;
an adjustment module that adjusts the negative phase pressure E-P and the positive phase pressure I-P based on the result of the comparison module, and increases the negative phase pressure E-P and/or the positive phase pressure I-P for the next expectoration if the actual value R2 is less than the reference value C2; otherwise, it is decreased.
2. Closed loop expectoration system according to claim 1,
the reference value setting module is configured to set a reference value C1 of the F-V ring area of the positive pressure phase of the user and set a reference ratio C1/C2 of the F-V ring area of the positive pressure phase and the negative pressure phase;
the actual value calculating module calculates the actual value R1 of the F-V ring area of the positive pressure phase of the user and calculates the actual ratio R1/R2 of the F-V ring area of the positive pressure phase and the negative pressure phase;
the comparison module compares the reference ratio C1/C2 with the actual ratio R1/R2;
the adjusting module adjusts a positive phase expectoration pressure rising slope P-slope based on the result of the comparing module, and if the actual ratio R1/R2 at the end of the expectoration is smaller than the reference ratio C1/C2, the positive phase expectoration pressure rising slope P-slope of the next expectoration is increased; otherwise, it is decreased.
3. A closed-loop expectoration system for automatically titrating expectoration pressure, the expectoration system comprising:
a reference value setting module configured to set a reference value C2 for negative pressure phase flow-volume annulus area and to set a reference value C1/C2 for positive/negative pressure phase flow-volume annulus area ratio;
an actual value calculation module that monitors and calculates an actual value R1 of the positive pressure phase F-V ring area, and an actual value R2 of the negative pressure phase flow-volume ring area, and a ratio R1/R2 of the two;
a comparison module which compares a reference value C2 and an actual value R2 of the F-V ring area of the negative pressure phase, and compares a reference ratio C1/C2 and an actual ratio R1/R2 of the F-V ring area ratio of the positive/negative pressure phase;
an adjustment module that adjusts the negative phase pressure E-P, the positive phase pressure I-P, and the positive pressure rise ramp P-Slope based on a result of the comparison module.
4. The closed loop expectoration system of claim 3, further comprising:
the remote upgrading module can be connected to the cloud server to achieve online uploading of expectoration treatment data and receive the algorithm updated by the cloud server.
5. The closed-loop expectoration system of claim 4, wherein the reference value setting module is configured to:
the entered height, weight and disease type information of the patient is received and respective reference values are set based on the information.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201910375567.XA CN110038198B (en) | 2019-05-07 | 2019-05-07 | Closed-loop expectoration method and system for automatically titrating expectoration pressure |
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| CN112274742A (en) * | 2020-09-15 | 2021-01-29 | 湖南明康中锦医疗科技发展有限公司 | Expectoration equipment based on positive and negative piezoelectric magnetic regulating valves and control method |
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