CN114099880A

CN114099880A - Ventilation mode automatic switching method and system

Info

Publication number: CN114099880A
Application number: CN202111403390.3A
Authority: CN
Inventors: 化静
Original assignee: Individual
Current assignee: Individual
Priority date: 2021-11-24
Filing date: 2021-11-24
Publication date: 2022-03-01
Anticipated expiration: 2041-11-24
Also published as: CN114099880B

Abstract

The invention discloses a method and a system for automatically switching a ventilation mode, which are suitable for a breathing machine, wherein the method comprises the following steps: under a PRVC (respiratory cycle ventilation) mode, judging whether spontaneous respiration with continuous preset times is detected, and if so, automatically switching to a VS (negative pressure ventilation) mode to work; if not, working according to a PRVC ventilation mode; in a VS (ventilation) mode, judging whether spontaneous respiration is detected within first preset time, if so, working according to the VS mode; if not, the PRVC ventilation mode is automatically switched to work. The invention can automatically switch between the PRVC ventilation mode and the VS ventilation mode according to the constantly changing spontaneous respiration capability of the patient, and encourage the patient to try spontaneous respiration, thereby realizing the purpose of going from the upper respirator to the evacuation of the respirator.

Description

Ventilation mode automatic switching method and system

Technical Field

The invention relates to the technical field of respirators, in particular to a method and a system for automatically switching a ventilation mode.

Background

The two-way mode switching type of the existing breathing machine is PS two-way switching PC, the PC is used as a backup mode when the PS mode is used, when the PS mode is applied, a patient does not breathe spontaneously or is not triggered to reach the set asphyxia time, the breathing machine can be automatically switched to the PC mode, and when the patient is continuously triggered for 2 times in the PC mode, the patient returns to the PS mode again. The switch has three obvious disadvantages, one is that PS and PC are pressure target ventilation, the effective tidal volume can not be ensured, and particularly, under-ventilation or over-ventilation can occur when the patient is unstable; secondly, when the PS is switched to the PC, the pressure is basically consistent, but the tidal volume under the PS is often smaller than that under the PC because the PC sets the inspiration time, and the switching result can cause the patient to adapt to the PC mode more easily, so that the dependence of a breathing machine occurs; thirdly, the switching mode is single, when the PC mode is switched, the ventilator strictly sets ventilation according to the parameters of the PC, the fixed ventilation frequency also easily enables the patient to be used to the PC ventilation mode, the patient is not favorable for spontaneous respiration, and the ventilator is easy to be dependent.

Therefore, the existing ventilation mode switching cannot well reduce the dependence of the patient on the respirator.

Disclosure of Invention

The present invention provides a method and a system for automatically switching a ventilation mode, aiming at least one defect existing in the prior art.

The technical scheme adopted by the invention for solving the technical problems is as follows: a ventilation mode automatic switching method is constructed and is suitable for a breathing machine, and the method comprises the following steps:

s10: under a PRVC (respiratory cycle ventilation) mode, judging whether spontaneous respiration with continuous preset times is detected, and if so, automatically switching to a VS (negative pressure ventilation) mode to work; if not, working according to the PRVC ventilation mode;

s20: in a VS (ventilation VS) mode, judging whether spontaneous respiration is detected within a first preset time, and if so, working according to the VS mode; if not, automatically switching to the PRVC ventilation mode to work.

Preferably, in the method for automatically switching between ventilation modes of the present invention, the first ventilation is performed in the PRVC ventilation mode, and whether spontaneous respiration meets trigger sensitivity is determined, if yes, an auxiliary PRVC ventilation is performed; and if not, performing the PRVC ventilation under control.

Preferably, in the method for automatically switching the ventilation mode, the range of the consecutive preset times is 2-5 times.

Preferably, in the method for automatically switching a ventilation mode according to the present invention, if not, the method automatically switches to the PRVC ventilation mode to operate in step S20, and further includes:

s21: judging whether spontaneous respiration is detected within second preset time, if so, carrying out primary auxiliary PRVC ventilation, and if not, carrying out controlled PRVC ventilation;

wherein the second preset time is a respiratory cycle time of the PRVC ventilation mode.

Preferably, in the automatic ventilation mode switching method according to the present invention, the step S21 includes:

s211: setting a third preset time within a range from a preset time interval to the second preset time; the fourth preset time is the second preset time and the third preset time;

s212: judging whether spontaneous respiration is detected within the first fourth preset time of the second preset time, if so, carrying out primary auxiliary PRVC ventilation; if not, executing step S213 or S214;

s213: whether spontaneous respiration is detected within a third preset time after the second preset time, if so, carrying out primary auxiliary PRVC ventilation; if not, working according to the PRVC ventilation mode;

s214: randomly giving one controlled PRVC ventilation at a preset time interval time point within a third preset time after the second preset time.

Preferably, in the ventilation mode automatic switching method of the present invention, the tidal volume of the PRVC ventilation mode is the same as that of the VS ventilation mode.

Preferably, in the automatic ventilation mode switching method of the present invention, the method further includes:

step S00: preconfiguring an automatic mode for automatic switching of the PRVC ventilation mode and the VS ventilation mode;

step S01: and operating in the PRVC ventilation mode according to the instruction of entering the automatic mode.

Preferably, in the method for automatically switching a ventilation mode according to the present invention, in step S20, if yes, the method operates in the VS ventilation mode, and further includes: control gives a preset pressure support value.

Preferably, in the ventilation mode automatic switching method according to the present invention, in the VS ventilation mode, the start of the apnea alarm and the stop of the pre-ventilation are controlled.

The invention also discloses a ventilation mode automatic switching system, which is suitable for a breathing machine and comprises:

the PRVC judging module is used for judging whether spontaneous respiration with continuous preset times is detected or not in a PRVC ventilation mode;

a VS judging module for judging whether spontaneous respiration is detected within a first preset time under the VS ventilation mode,

the control module is used for controlling automatic switching to the VS ventilation mode to work when the PRVC judgment module judges that the PRVC judgment module is yes; when the PRVC judging module judges that the PRVC is not the air vent mode, controlling the PRVC to work in the air vent mode; when the VS judging module judges that the ventilation mode is positive, the VS judging module controls the ventilation mode to work according to the VS ventilation mode; and when the VS judging module judges that the PRVC ventilation mode is not the preset ventilation mode, controlling the automatic switching to the PRVC ventilation mode to work.

By implementing the invention, the following beneficial effects are achieved:

according to the invention, whether spontaneous respiration is detected for a continuous preset number of times or not is judged in the PRVC ventilation mode, or whether spontaneous respiration is detected within a first preset time is judged in the VS ventilation mode, so that the automatic switching between the PRVC ventilation mode and the VS ventilation mode can be carried out according to the continuously changing spontaneous respiration capacity of a patient, the patient is encouraged to try spontaneous respiration, and the purposes of going from an upper respirator to a lower respirator are realized.

In addition, the second preset time is the respiratory cycle time of the PRVC ventilation mode, the third preset time is set in the range from the preset time interval to the second preset time, the fourth preset time is the second preset time-the third preset time, and the ventilation time is randomly determined at the preset time interval time point in the third preset time after the second preset time, so that the ventilation time provided for the patient each time is not fixed, and the dependence of the patient on controlling ventilation can be effectively reduced.

In addition, the tidal volume of the PRVC ventilation mode is the same as that of the VS ventilation mode, both the PRVC ventilation mode and the VS ventilation mode are volume target ventilation, the tidal volume can be effectively ensured, the tidal volume can also be ensured during switching, the transition from auxiliary ventilation and control ventilation to autonomous ventilation of a patient is realized on the premise of ensuring the tidal volume, and the ventilation efficiency and the ventilation safety of the patient are ensured. And the whole process is volume target ventilation, so that the ventilation safety and quality of the patient are ensured, and the workload of medical personnel can be reduced.

Drawings

The invention will be further described with reference to the accompanying drawings and examples, in which:

FIG. 1 is a schematic diagram of the method for automatically switching the ventilation mode according to the present invention;

FIG. 2 is a schematic interface diagram of the present invention;

fig. 3 is a block diagram of the automatic ventilation mode switching system of the present invention.

Detailed Description

For a more clear understanding of the technical features, objects and effects of the present invention, embodiments of the present invention will now be described in detail with reference to the accompanying drawings.

It should be noted that the flow charts shown in the drawings are only exemplary and do not necessarily include all the contents and operations/steps, nor do they necessarily have to be executed in the order described. For example, some operations/steps may be decomposed, and some operations/steps may be combined or partially combined, so that the actual execution sequence may be changed according to the actual situation.

The block diagrams shown in the figures are functional entities only and do not necessarily correspond to physically separate entities. I.e. these functional entities may be implemented in the form of software, or in one or more hardware modules or integrated circuits, or in different networks and/or processor means and/or microcontroller means.

There are many breathing patterns of mechanical ventilation, Volume Control (VC), Pressure Control (PC), Volume Assist (VA), Pressure Assist (PA), pressure-regulated volume control (PRVC), synchronized intermittent commanded ventilation (SIMV), Pressure Support (PS), Volume Support (VS), etc. Different ventilation modes are selected according to the treatment purpose of a doctor or the requirements of the patient condition, such as volume-targeted ventilation modes VC, VS and PRVC, pressure-targeted ventilation modes PC and PS, a patient without spontaneous respiration usually selects a control ventilation mode (VC, PC and PRVC), a patient with certain spontaneous ability can select auxiliary or support ventilation-like modes (VA, PA and PS), and a patient with unstable condition can select an SIMV mode.

PRVC is an abbreviation for pressure regulated volume controlled ventilation. Pressure controlled ventilation PC ventilation varies with lung compliance and may result in hypoventilation. In the volume control VC mode, although the ventilation volume is ensured, barotrauma is easily caused. PRVC is a new controlled ventilation mode developed by combining the advantages of PCs and VCs. The unique point is that on the basis of ensuring the preset tidal volume parameter, the respirator can automatically and continuously monitor the chest-lung compliance and the volume/pressure relationship, and feed back and adjust the inspiratory pressure level of the next ventilation according to the chest-lung compliance and the volume/pressure relationship, so that the airway pressure is reduced as far as possible, and the barotrauma of the positive pressure ventilation is reduced. The PRVC is conducted with experimental volume control ventilation at the first time, the inspiratory pressure is low, the chest-lung compliance is measured and calculated by a microcomputer in the inspiratory process, the inspiratory pressure required by the next ventilation to reach the preset tidal volume is calculated, the actual tidal volume can be consistent with the preset tidal volume after the ventilation for several times, and the maximum inspiratory pressure is lower than the upper pressure alarm limit of 5cmH 20. The PRVC is a novel controlled ventilation mode with higher intelligent degree and is suitable for patients without spontaneous respiration.

VS is a novel spontaneous breathing mode, and after the breathing machine is started by the spontaneous breathing of a patient, the breathing machine can automatically measure the chest-lung compliance and the ventilation frequency in each ventilation process. And automatically adjusting the support level of next ventilation according to the spontaneous respiration capacity, so that the ventilation volume is stabilized above the ventilation volume in a preset minute during spontaneous respiration. The VS working principle is similar to that of RPVC, after the lowest tidal volume/minute is preset, the first ventilation is experimental ventilation, the actual tidal volume and compliance are measured, the next supporting pressure is calculated, then the value is measured and calculated, and after the ventilation is repeated for several times, the actual minute ventilation volume can be consistent with the preset value. The maximum inspiratory pressure is below the upper pressure alarm limit of 5cmH 20. VS can guarantee effective tidal volume and minute ventilation volume, is stable at an ideal level, can automatically maintain lower airway pressure, reduces the times of adjusting a breathing machine, and is suitable for patients who have spontaneous breathing but can not meet normal ventilation. In the process of withdrawing the ventilator, VS can ensure the ventilation demand of the patient, reduce the dosage of sedative, and support the automatic down-regulation of pressure level when the condition of illness is improved, thereby facilitating the evacuation of the ventilator.

The common advantages of PRVC and VS are: 1. can monitor the compliance of the chest and the lung in real time, keep lower airway pressure, reduce the mechanical lung injury of the atmospheric pressure, and has high reliability. Reducing the dosage of sedative and muscle relaxant, and improving the adverse effects of mechanical ventilation on the circulatory system. The patient is more comfortable, the evacuation time of the breathing machine is shortened, and the time for living in an intensive care unit is shortened; 2. when PRVC and VS are used, particular attention should be paid to the setting of the upper airway pressure limit, since the inspiratory pressure level of PRVS and VS can be automatically adjusted within the range from the positive end expiratory pressure PEEP to 5cmH20 below the upper airway pressure limit, and if the upper airway pressure limit is adjusted too low, the actual tidal volume is less than the preset tidal volume, and hypoventilation occurs. If the spontaneous respiration of the patient is not well coordinated with the breathing machine, monitoring deviation can be caused, the patient feels uncomfortable when the inspiratory pressure is high and low, and the trigger sensitivity needs to be adjusted to coordinate mechanical ventilation with the spontaneous respiration.

As shown in fig. 1, the present invention discloses a ventilation mode automatic switching method, which is suitable for a ventilator having a PRVC ventilation mode (assisted & controlled ventilation) and a VS ventilation mode (spontaneous ventilation), and comprises the following steps:

step S10: under a PRVC (respiratory cycle ventilation) mode, judging whether spontaneous respiration with continuous preset times is detected, and if so, automatically switching to a VS (negative pressure ventilation) mode to work; if not, working according to the PRVC ventilation mode.

In some embodiments, the predetermined number of consecutive times ranges between 2 and 5 times. Preferably, the continuous preset times are 2 times, and when spontaneous respiration is not detected or only 1 spontaneous respiration is detected between 2 times of forced ventilation, the operation is carried out according to a PRVC ventilation mode; when 2 continuous spontaneous breaths are detected, the operation is automatically switched to the VS ventilation mode, the expiration end is taken as a mark, and the VS ventilation mode is displayed in the mode display area. In other embodiments, the preset number of consecutive times may be 3 times, or 4 times, or 5 times.

Step S20: in a VS (ventilation) mode, judging whether spontaneous respiration is detected within first preset time, if so, working according to the VS mode; if not, the PRVC ventilation mode is automatically switched to work. The first preset time is self-priming time set by each respirator independently.

Under the VS ventilation mode, when the patient does not breathe spontaneously within the first preset time, the patient is switched to the PRVC ventilation mode to work, ventilation is carried out immediately, the PRVC ventilation mode is displayed in the mode display area, and VS pre-ventilation is not carried out after the mode switching; when the patient has spontaneous breathing for a first predetermined period of time, then the VS ventilation mode is operated and the control is to deliver a predetermined pressure support value, for example a pressure support value of 10cmH 2O. In other embodiments, the third predetermined time may be other values within a predetermined range, and the pressure support value is not limited to 10cmH 2O.

In some embodiments, in step S20, if not, automatically switching to the PRVC ventilation mode, further comprising:

step S21: and judging whether spontaneous respiration is detected within second preset time, if so, carrying out primary auxiliary PRVC ventilation, and if not, carrying out controlled PRVC ventilation. Wherein the second preset time is the respiratory cycle time of the PRVC ventilation mode.

Specifically, step S21 includes:

step S211: setting a third preset time within a range from the preset time interval to the second preset time; the fourth preset time is the second preset time and the third preset time;

step S212: judging whether spontaneous respiration is detected within the first fourth preset time of the second preset time, if so, carrying out primary auxiliary PRVC ventilation; if not, executing step S213 or S214;

step S213: whether spontaneous respiration is detected within third preset time after the second preset time, if so, carrying out primary auxiliary PRVC ventilation; if not, working according to a PRVC ventilation mode;

step S214: randomly giving one controlled PRVC ventilation at a preset time interval time point in a third preset time after the second preset time.

For example, if the PRVC breathing rate is set to 10/min, the second predetermined time is 6 s. If the preset time interval is 0.5 second, setting a third preset time within the range of 0.5 second to 6 seconds, for example, setting the third preset time to 4 seconds, ventilating the ventilator in the first 2S of 6S according to a conventional mode, and when the patient has spontaneous respiration trigger within the first 2S, giving the patient auxiliary PRVC ventilation once, and ventilating the patient in the last 4S according to the conventional mode of PRVC; when the current 2S is not triggered, the ventilator enters the back 4S, and the two situations are divided into two situations, namely when the patient has spontaneous respiration triggering in the back 4S, one auxiliary PRVC ventilation is given; one is to administer a controlled PRVC ventilation randomly at preset time interval points (2.5s, 3s, 3.5s, 4s, 4.5s, 5s, 5.5s, 6 s).

The inspiration time and the breathing frequency of the PRVC ventilation mode need to be set in advance, and the breathing cycle time is calculated according to the breathing frequency. Since the second preset time is the breathing cycle time of the PRVC ventilation mode, the third preset time is set within the range from the preset time interval to the second preset time, the fourth preset time is the second preset time-the third preset time, and the ventilation time is randomly determined at the preset time interval time point within the third preset time after the second preset time, the ventilation time provided to the patient each time is not fixed, and the dependence of the patient on controlling ventilation can be effectively reduced.

In this embodiment, the first ventilation is performed in a PRVC ventilation mode, and whether spontaneous breathing meets the trigger sensitivity is determined, if yes, an auxiliary PRVC ventilation is performed; and if not, performing the PRVC ventilation under control.

Specifically, during the first ventilation, ventilation is performed in a PRVC ventilation mode, if spontaneous respiration of the patient still exists and the spontaneous respiration frequency is higher than a preset frequency, ventilation is performed on one auxiliary PRVC, the gas is delivered to the patient according to a preset tidal volume, ventilation frequency and airway pressure, normal ventilation is completed, and at the moment, the ventilator works according to the spontaneous respiration frequency of the patient. If the patient does not breathe spontaneously or the breathing rate is lower than a preset rate although the patient breathes spontaneously, the controlled PRVC is ventilated, and the breathing rate of the patient is controlled by the ventilator.

In this embodiment, the tidal volume of the PRVC ventilation mode is the same as that of the VS ventilation mode, and both the PRVC ventilation mode and the VS ventilation mode are volume target ventilation, which can effectively ensure the tidal volume, and can also ensure the tidal volume during switching, and the transition from control ventilation to spontaneous breathing support ventilation of the patient is realized on the premise of ensuring the tidal volume. The tidal volume refers to the volume of air inhaled or exhaled each time during quiet breathing.

In some embodiments, in VS ventilation mode, control ceases to activate the apnea alarm and ceases to pre-ventilate.

In this embodiment, the method further includes:

step S00: an automatic mode is pre-constructed and used for automatically switching between a PRVC ventilation mode and a VS ventilation mode;

step S01: and operating in the PRVC ventilation mode according to an instruction of entering the automatic mode. Wherein, the first ventilation is conducted in the PRVC ventilation mode, whether spontaneous respiration accords with trigger sensitivity is judged, if yes, one auxiliary PRVC ventilation is conducted; and if not, performing the PRVC ventilation under control.

Specifically, an "AUTO mode" control, that is, AUTO-VG shown in fig. 2, is added to the mode interface, and when the user clicks the control, the mode enters the AUTO mode and the PRVC ventilation mode is operated by default.

The current PRVC ventilation mode may be a PRVC entering an automatic mode, or a PRVC when another mode is switched to the automatic mode.

The current VS ventilation mode may be other mode switching to VS or switching to VS in an automatic mode.

As shown in fig. 3, the present invention also discloses a ventilation mode automatic switching system, which is suitable for a ventilator having a PRVC ventilation mode (assisted & controlled ventilation) and a VS ventilation mode (spontaneous ventilation), and comprises:

the VS judging module is used for judging whether spontaneous respiration is detected within first preset time or not in the VS ventilation mode; the first preset time is self-priming time set by each breathing machine independently;

the control module is used for controlling the automatic switching to the VS ventilation mode to work when the PRVC judgment module judges that the PRVC judgment module is yes; when the PRVC judging module judges that the PRVC is not the air inlet, the PRVC ventilation mode is controlled to work; when the VS judging module judges that the ventilation mode is positive, the VS module is controlled to work in a VS ventilation mode; and when the VS judging module judges that the PRVC ventilation mode is not the preset ventilation mode, controlling the automatic switching to the PRVC ventilation mode.

In some embodiments, if not, the control module automatically switches to the PRVC ventilation mode, further comprising:

and judging whether spontaneous respiration is detected within second preset time, if so, carrying out primary auxiliary PRVC ventilation, and if not, carrying out controlled PRVC ventilation. Wherein the second preset time is the respiratory cycle time of the PRVC ventilation mode. The method specifically comprises the following steps:

setting a third preset time within a range from the preset time interval to the second preset time; the fourth preset time is the second preset time and the third preset time;

judging whether spontaneous respiration is detected within the first fourth preset time of the second preset time, if so, carrying out primary auxiliary PRVC ventilation; if not, executing whether spontaneous respiration is detected within a third preset time after the second preset time, and if so, performing primary auxiliary PRVC ventilation; if not, working according to a PRVC ventilation mode;

or, judging whether spontaneous respiration is detected within the first fourth preset time of the second preset time, if so, carrying out primary auxiliary PRVC ventilation; if not, randomly giving the controlled PRVC ventilation for one time at a preset time interval time point in a third preset time after the second preset time.

It should be noted that the switching condition, i.e. the continuous preset number and the preset time, may be actively set by the user, or the continuous preset number may be specified, and then the respiratory frequency of the PRVC ventilation mode is adjusted, so as to adjust the respiratory cycle time.

In some embodiments, the control module is further configured to, in the VS ventilation mode, control ceasing to activate the apnea alarm and ceasing to pre-ventilate.

In this embodiment, the system further includes:

and the automatic mode module is used for working in a PRVC ventilation mode according to an instruction of entering the automatic mode. Wherein, the first ventilation is conducted in the PRVC ventilation mode, whether spontaneous respiration accords with trigger sensitivity is judged, if yes, one auxiliary PRVC ventilation is conducted; and if not, performing the PRVC ventilation under control.

Specifically, a control of an "automatic mode module", that is, AUTO-VG shown in fig. 2, is added to the mode interface, and when a user clicks the control, the automatic mode is entered and the PRVC ventilation mode is operated by default.

By implementing the invention, the following beneficial effects are achieved:

It is to be understood that the foregoing examples, while indicating the preferred embodiments of the invention, are given by way of illustration and description, and are not to be construed as limiting the scope of the invention; it should be noted that, for those skilled in the art, the above technical features can be freely combined, and several changes and modifications can be made without departing from the concept of the present invention, which all belong to the protection scope of the present invention; therefore, all equivalent changes and modifications made within the scope of the claims of the present invention should be covered by the claims of the present invention.

Claims

1. A ventilation mode automatic switching method is suitable for a breathing machine and is characterized by comprising the following steps:

2. The method for automatic switching of ventilation modes according to claim 1, wherein a first ventilation is performed in the PRVC ventilation mode, whether spontaneous breathing meets trigger sensitivity is determined, and if yes, an auxiliary PRVC ventilation is performed; and if not, performing the PRVC ventilation under control.

3. The automatic switching method of ventilation mode according to claim 1, characterized in that said preset number of consecutive times ranges between 2 and 5 times.

4. The method according to claim 1, wherein in step S20, if no, automatically switching to the PRVC ventilation mode, further comprising:

5. The automatic ventilation mode switching method according to claim 4, wherein the step S21 includes:

6. The method of automatic switching of ventilation modes of claim 1, wherein the tidal volume of the PRVC ventilation mode is the same as the VS ventilation mode.

7. The automatic ventilation mode switching method according to claim 1, further comprising:

8. The method for automatically switching between ventilation modes according to claim 1, wherein if yes, in step S20, operating in the VS ventilation mode further comprises: control gives a preset pressure support value.

9. The automatic ventilation mode switching method according to claim 1, wherein in the VS ventilation mode, the control is performed to stop the activation of the apnea alarm and stop the pre-ventilation.

10. An automatic ventilation mode switching system suitable for a ventilator, comprising: