CN117642200A - Ventilation equipment and pressure rise time adjusting method - Google Patents
Ventilation equipment and pressure rise time adjusting method Download PDFInfo
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- 238000009423 ventilation Methods 0.000 title claims abstract description 113
- 238000000034 method Methods 0.000 title claims abstract description 71
- 230000000241 respiratory effect Effects 0.000 claims abstract description 34
- 230000000630 rising effect Effects 0.000 claims description 63
- 230000008569 process Effects 0.000 claims description 42
- 230000008859 change Effects 0.000 claims description 24
- 230000036387 respiratory rate Effects 0.000 claims description 5
- 230000000877 morphologic effect Effects 0.000 claims description 4
- 210000002345 respiratory system Anatomy 0.000 claims description 3
- 230000036391 respiratory frequency Effects 0.000 claims 1
- 230000029058 respiratory gaseous exchange Effects 0.000 description 49
- 239000007789 gas Substances 0.000 description 22
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 description 14
- 229910002092 carbon dioxide Inorganic materials 0.000 description 7
- 239000001569 carbon dioxide Substances 0.000 description 7
- 230000003434 inspiratory effect Effects 0.000 description 7
- 210000004072 lung Anatomy 0.000 description 6
- 230000003247 decreasing effect Effects 0.000 description 5
- 238000010586 diagram Methods 0.000 description 5
- 239000006096 absorbing agent Substances 0.000 description 4
- 238000001914 filtration Methods 0.000 description 4
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 3
- 229910052760 oxygen Inorganic materials 0.000 description 3
- 239000001301 oxygen Substances 0.000 description 3
- 230000008878 coupling Effects 0.000 description 2
- 238000010168 coupling process Methods 0.000 description 2
- 238000005859 coupling reaction Methods 0.000 description 2
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- 244000144985 peep Species 0.000 description 2
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- 230000000007 visual effect Effects 0.000 description 2
- 239000002912 waste gas Substances 0.000 description 2
- 206010002091 Anaesthesia Diseases 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- 208000004852 Lung Injury Diseases 0.000 description 1
- 206010069363 Traumatic lung injury Diseases 0.000 description 1
- 238000009825 accumulation Methods 0.000 description 1
- 230000037005 anaesthesia Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
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- 230000007954 hypoxia Effects 0.000 description 1
- 230000006698 induction Effects 0.000 description 1
- 231100000515 lung injury Toxicity 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000005399 mechanical ventilation Methods 0.000 description 1
- 238000006213 oxygenation reaction Methods 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
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- 230000001105 regulatory effect Effects 0.000 description 1
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- 239000000126 substance Substances 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000002627 tracheal intubation Methods 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
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Abstract
A ventilation apparatus and pressure rise time adjustment method, the method comprising: acquiring at least one parameter characteristic (200) of the ventilation parameters, wherein the parameter characteristic is related to the pressure rise time, and the pressure rise time is the set time length of the rise of the airway pressure from the initial pressure value to the target pressure value in the same respiratory period; the pressure rise time (300) of the ventilation device is adjusted in accordance with at least one parameter characteristic relating to the pressure rise time. The pressure rise time may be adjusted in combination with one or more parameter characteristics so that the pressure rise time can be adapted better to the patient's situation.
Description
The invention relates to the technical field of medical equipment, in particular to ventilation equipment and a pressure rise time adjusting method.
Pressure rise time refers to the time during which the airway pressure of a patient is raised from an initial pressure value to a target pressure value set by the ventilator (e.g., ventilator or anesthesia ventilator) during ventilation. Taking a ventilator as an example, three typical ways of setting the pressure rise time of the ventilator are: the first is to set the pressure rise time to a certain time; the second is to set the pressure rise time to a certain percentage of the inspiration time, for example, the inspiration time of the patient is 1.5s, and the pressure rise time is set to 20%, then the actual pressure rise time is 0.3s; and thirdly, setting the pressure rise time by different gears, wherein each gear has a corresponding pressure rise time.
The reasonable setting of the pressure rise time directly affects the inspiratory flow rate of the patient, and flow rate synchronization is one of the important factors of man-machine synchronization in ventilation. In clinic, the condition of the patient varies, the setting of the pressure rise time should be individually adjusted according to the lung characteristics of the patient, because the same pressure rise time may be too short for a patient with small lung compliance, resulting in significant pressure overshoot, while it may be too long for a patient with large lung compliance, and the flow rate requirement at the beginning of inspiration may not be obviously satisfied, and the current setting of the pressure rise time has the following drawbacks: the use of a fixed pressure rise time setting may not meet ventilation requirements for different patients or for different phases of the same patient, resulting in an over-shoot of inspiratory pressure or an insufficient inspiratory primary flow rate. If the pressure rise time is unreasonable, a plurality of hazards can be caused: if the pressure rise time is too short, obvious pressure overshoot appears, the peak pressure of the lung of the patient is possibly too high, and lung injury and obvious overshoot feel are easily caused; if the pressure rise time is too long, the inspiration primary flow rate is insufficient, so that the inspiration of a patient is possibly insufficient, man-machine countermeasure is emphasized, and the breathing work of the patient is increased. In summary, the existing setting mode of the pressure rising time is fixed, which easily causes pressure overshoot or insufficient inspiration primary flow rate of the patient, so that man-machine countermeasure is caused, breathing work of the patient is increased, and the service time of the breathing machine is prolonged.
In order to adapt the pressure rising time to the condition change of a patient, it is required to accurately identify whether the pressure rising time is too long or too short in the ventilation process, which is one of the problems to be solved or improved in the current ventilation devices.
Disclosure of Invention
According to a first aspect, in one embodiment, a method for adjusting pressure rise time is disclosed, comprising:
acquiring ventilation parameters of a patient in a ventilation process, wherein the ventilation parameters comprise at least one of airway flow rate and airway pressure, and the pressure rise process is a process that the airway pressure finally changes from an initial pressure value to a target pressure value in the same respiratory cycle;
acquiring at least one parameter characteristic of the ventilation parameters about pressure rising time, wherein the pressure rising time is a set time length for rising the airway pressure from an initial pressure value to a target pressure value in the same respiratory cycle;
the pressure rise time of the ventilation device is adjusted in accordance with the at least one parameter characteristic relating to the pressure rise time.
According to a second aspect, in one embodiment there is disclosed a ventilation device comprising:
a patient interface for connecting to a respiratory system of a patient;
Breathing assistance apparatus for providing respiratory support power in ventilation for delivering respiratory support gas to a patient
A processor for performing the method as described in the first aspect.
According to a third aspect, in an embodiment a computer readable storage medium is disclosed, comprising a program executable by a processor to implement the method of the first aspect.
The above embodiment acquires at least one parameter feature related to the pressure rising time in the ventilation parameters, each parameter feature can at least independently determine whether the pressure rising time is suitable, and different parameter features can also jointly and jointly determine whether the pressure rising time is suitable, and when the pressure rising time is unsuitable, the ventilation pressure rising time can be correspondingly adjusted, so that the ventilation pressure rising time can be adapted to the changing illness state of a patient and the like.
FIG. 1 is a schematic illustration of the structure of a ventilator of an embodiment;
FIG. 2 is a waveform diagram of airway pressure during a breathing cycle in one embodiment;
FIG. 3 is a graph of airway pressure waveforms at different pressure rise times for one embodiment;
FIG. 4 is a graph of airway pressure waveforms with excessive pressure rise time for one embodiment;
FIG. 5 is a graph of airway pressure waveforms with too short a pressure rise time for one embodiment;
FIG. 6 is a graph of airway pressure waveforms with excessive pressure rise time for another embodiment;
FIG. 7 is a graph of airway pressure waveforms with excessive pressure rise time for yet another embodiment;
FIG. 8 is a waveform diagram of airway flow rate when pressure rise time is too long according to one embodiment;
FIG. 9 is a waveform diagram of airway flow rate with too short a pressure rise time for one embodiment;
FIG. 10 is a flow chart of a method of adjusting pressure rise time according to one embodiment;
FIG. 11 is a flow chart of adjusting pressure rise time according to an airway pressure waveform, according to one embodiment;
FIG. 12 is a flow chart of adjusting pressure rise time according to an airway flow rate waveform, according to one embodiment.
The invention will be described in further detail below with reference to the drawings by means of specific embodiments. Wherein like elements in different embodiments are numbered alike in association. In the following embodiments, numerous specific details are set forth in order to provide a better understanding of the present application. However, one skilled in the art will readily recognize that some of the features may be omitted, or replaced by other elements, materials, or methods in different situations. In some instances, some operations associated with the present application have not been shown or described in the specification to avoid obscuring the core portions of the present application, and may not be necessary for a person skilled in the art to describe in detail the relevant operations based on the description herein and the general knowledge of one skilled in the art.
Furthermore, the described features, operations, or characteristics of the description may be combined in any suitable manner in various embodiments. Also, various steps or acts in the method descriptions may be interchanged or modified in a manner apparent to those of ordinary skill in the art. Thus, the various orders in the description and drawings are for clarity of description of only certain embodiments, and are not meant to be required orders unless otherwise indicated.
The numbering of the components itself, e.g. "first", "second", etc., is used herein merely to distinguish between the described objects and does not have any sequential or technical meaning. The terms "coupled" and "connected," as used herein, are intended to encompass both direct and indirect coupling (coupling), unless otherwise indicated.
The most critical concept of the invention is that the parameter characteristics and the expression form thereof which can most reflect the pressure rise time are effectively selected from the airway pressure and the airway parameters, and the pressure rise time is regulated according to the parameter characteristics and the expression form.
Referring to fig. 1, an embodiment of a structure of a breathing apparatus is provided. The structure of the ventilator is described in this embodiment using a ventilator as an example. The ventilator includes a source of air interface 10, a breathing assistance device 20, a breathing circuit 30, a sensor interface 40, a memory 50, a processor 60, and a display 70. It should be understood that fig. 1 is merely an example of a ventilator and is not limiting of a ventilator, and that a ventilator may include more or fewer components than shown in fig. 1, or certain components may be combined, or different components.
The gas source interface 10 is adapted to be connected to a gas source (not shown) for providing a gas. The gas may be oxygen, air or the like. In some embodiments, the air source can adopt a compressed air bottle or a central air supply source, and the air source is used for supplying air to the breathing machine through an air source interface 10, and the air supply is of oxygen O 2 And air, etc. The gas source interface 10 may include conventional components such as pressure gauges, pressure regulators, flow meters, pressure reducing valves, and proportional control and protection devices for controlling the flow of various gases (e.g., oxygen and air), respectively. The gas input by the gas source interface 10 enters the breathing circuit 30 and forms mixed gas with the original gas in the breathing circuit 30. In other embodiments, the ventilator itself is provided with a source of air, and therefore the air source interface 10 is not provided.
The breathing assistance device 20 is used for providing power for the involuntary breathing of a patient, maintaining the airway unobstructed, i.e. driving the gas input by the gas source interface 10 and the mixed gas in the breathing circuit 30 to the respiratory system of the patient, and draining the gas exhaled by the patient into the breathing circuit 30, thereby improving ventilation and oxygenation and preventing hypoxia and carbon dioxide accumulation in the patient. In particular embodiments, breathing assistance apparatus 20 generally includes a mechanically controlled ventilation module having an airflow conduit in communication with breathing circuit 30. In a state that the patient does not recover spontaneous breathing in the operation process, a mechanical ventilation module is adopted to provide breathing power for the patient. In some embodiments, the breathing assistance apparatus 20 further includes a manual ventilation module, the airflow conduit of which communicates with the breathing circuit 30. During the induction phase prior to intubation of a patient during surgery, a manual ventilation module is typically required to assist the patient in breathing. When the breathing assistance apparatus 20 includes both a mechanically controlled ventilation module and a manual ventilation module, the mechanically controlled or manual ventilation mode may be switched by a mechanically controlled or manual switch (e.g., a three-way valve) to communicate the mechanically controlled ventilation module or manual ventilation module with the breathing circuit 30 to control the breathing of the patient. It will be appreciated by those skilled in the art that only a mechanically controlled ventilation module or a manual ventilation module may be included in the ventilator, depending on the particular needs.
The breathing circuit 30 includes an inhalation passage 30a, an exhalation passage 30b, and a carbon dioxide absorber 31, the inhalation passage 30a and the exhalation passage 30b being communicated to form a closed circuit, the carbon dioxide absorber 31 being provided on a pipe line of the exhalation passage 30 b. The mixed gas of fresh air introduced from the air source interface 10 is inputted from the inlet of the inhalation passage 30a and supplied to the patient through the patient interface 33 provided at the outlet of the inhalation passage 30 a. The patient interface 33 may be a mask, nasal cannula or tracheal cannula. In the preferred embodiment, the inhalation passage 30a is provided with a one-way valve 32, and the one-way valve 32 is opened during the inhalation phase and closed during the exhalation phase. The exhalation path 30b is also provided with a check valve 32, and the check valve 32 is closed during the inhalation phase and opened during the exhalation phase. The inlet of the exhalation path 30b communicates with the patient interface 33, and when the patient exhales, the exhaled gas enters the carbon dioxide absorber 31 through the exhalation path 30b, carbon dioxide in the exhaled gas is filtered out by the substances in the carbon dioxide absorber 31, and the carbon dioxide filtered gas is recirculated into the inhalation path 30 a. In some embodiments, a flow sensor and/or a pressure sensor is also provided in the breathing circuit 30 for detecting the flow of gas and/or the pressure in the tubing, respectively.
The sensor interface 40 is used to receive sensor-acquired ventilation parameters of the patient in ventilation. The ventilation parameters in this example include at least airway pressure (Paw) and/or airway Flow rate (Flow) of the patient. Specifically, the sensor may include a pressure sensor and a flow rate sensor, and the sensor interface 40 is connected to signal output terminals of the pressure sensor and the flow rate sensor, respectively.
In one embodiment, the sensor interface 40 may be just one connector that serves as a sensor output and subsequent circuitry (e.g., the processor 60) without processing the signals. The sensor interface 40 may also be integrated into the processor 60 as an interface to the processor 60 for accessing signals. In another embodiment, the sensor interface 40 may include an amplifying circuit, a filtering circuit, and an a/D converting circuit for amplifying, filtering, and analog-to-digital converting the input analog signal, respectively. Of course, it should be understood by the skilled person that the connection relation among the amplifying circuit, the filtering circuit and the a/D conversion circuit may be changed according to the specific design of the circuit, or one circuit may be reduced, for example, the amplifying circuit or the filtering circuit may be reduced, so that the corresponding functions thereof may be reduced.
The memory 50 may be used to store data or programs, such as data collected by the sensors, data computationally generated by the processor 60, or image frames generated by the processor 60, which may be 2D or 3D images, or the memory 50 may store a graphical user interface, one or more default image display settings, programming instructions for the processor 60. The memory 50 may be a tangible and non-transitory computer readable medium such as flash memory, RAM, ROM, EEPROM, or the like.
The processor 60 is configured to execute instructions or programs to control various control valves in the breathing assistance device 20, the air source interface 10, and/or the breathing circuit 30, or to process received data to generate desired calculations or determinations, or to generate visual data or graphics, and to output the visual data or graphics to the display 70 for display.
In this example, after the ventilation parameters of the patient during the pressure rise in ventilation are obtained, the processor 60 obtains at least one of the ventilation parameters with respect to the pressure rise time, and then adjusts the pressure rise time of the ventilation device based on the at least one of the ventilation parameters with respect to the pressure rise time.
The above-mentioned pressure rising process is a process that the airway pressure in the same respiratory cycle of the patient is finally changed from the initial pressure value to the target pressure value, and in order to better understand the pressure rising process, the pressure rising time is first described, where the pressure rising time is commonly found in the pressure target ventilation mode. In popular terms, the ventilator delivers air at a high pressure when the patient inhales, allowing the patient to inhale a sufficient amount of air through the pressure. When the inhalation of the patient is finished, the breathing machine actively reduces the pressure, and the patient exhales the waste gas in the patient through the pressure difference between the lung and the outside. For example, referring to fig. 2, a schematic diagram of an airway pressure waveform during a respiratory cycle is shown, wherein PEEP is positive end-expiratory pressure during the previous respiratory cycle. In the initial stage of the illustrated respiratory cycle, when the patient changes from the expiratory state in the previous respiratory cycle to the inspiratory state in the present respiratory cycle, the time when the airway pressure in the present respiratory cycle increases from the initial pressure value to the target pressure value (the airway pressure of the patient in the inspiratory state, expressed as Pset) is the pressure rise time, and the pressure rise time is used as the ventilation parameter of the ventilation device, so that the ventilation parameter can be set directly or indirectly.
However, in actual ventilation, the change in the airway pressure of the patient does not necessarily coincide with the set pressure rise time, for example, the pressure rise time is set to 0.5s on the ventilation apparatus, the airway pressure of the patient may reach the target pressure value after 0.4s, or the airway pressure of the patient may reach the target pressure value at 0.6 s. The process of actually and eventually changing the airway pressure to the target pressure value in a respiratory cycle is the pressure rising process defined in the application, in which the pressure value finally reached by the airway pressure is greater than the airway pressure at the beginning of the respiratory cycle, but this does not mean that the airway pressure is always rising. For example, referring to fig. 3, in the graph, the curve S1 is an airway pressure waveform with neither too long nor too short pressure rise time, the curve S2 is an airway pressure waveform with too short pressure rise time, and since the pressure rise speed is too fast, the ventilator will deliver a large flow of gas in a very short time, so that the curve S1 falls to the target pressure value after generating a peak, and the curve S3 is an airway pressure waveform with too long pressure rise time.
At least one of the above-mentioned parameter characteristics regarding the pressure rise time refers to a parameter characteristic that is derived from the ventilation parameter and that can reflect how fast or slow the pressure rise time is. The following examples are illustrative.
In some embodiments, processor 60 first generates an airway pressure waveform based on the airway pressure acquired during the pressure rise, then acquires the trend of the airway pressure waveform, and finally adjusts the pressure rise time of the ventilator based on the trend of the change. The trend includes, but is not limited to, a slope of a curve of the airway pressure waveform, a size of an area surrounded by the airway pressure waveform and a template curve, and a change of an area surrounded by the airway pressure waveform and a time axis in two adjacent time windows with the same length. Specifically:
during the pressure rise, processor 60 may obtain a curve slope of the airway pressure waveform, when the curve slope changes from positive to negative, processor 60 compares the airway pressure when the curve slope changes from positive to negative to a target pressure value, and if the airway pressure is less than the target pressure value, reduces the pressure rise time of the ventilation device. That is, if the airway pressure is still lower than the target pressure value during the pressure rise, the airway pressure waveform is reduced as shown in fig. 4, meaning that the pressure rise time is too long and the pressure rise speed is too slow, so that it is necessary to reduce the pressure rise time, in fig. 4, the arrow K points to a stage in which the slope is negative from positive, and Tslope represents the pressure rise time (in other figures Tslope also represents the pressure rise time).
The template curve is a curve fitted based on the set pressure rise time, and after the pressure rise time is set, the airway pressure of the patient changes according to the template curve in an ideal state. The template curve can be obtained from multiple experiments. The size of the area surrounded by the airway pressure waveform and the template curve has positive and negative characteristics. In this embodiment, when the template curve is located below the airway pressure waveform, the area enclosed by the airway pressure waveform and the template curve is positive, and when the template curve is located above the airway pressure waveform, the area enclosed by the airway pressure waveform and the template curve is negative. In this application, the actual curve of the airway pressure waveform is denoted by Sp, and the template curve is denoted by S1 (curve S1 is also the template curve in FIG. 2). When the enclosed area of the airway pressure waveform and the template curve is positive, processor 60 compares the absolute value of the enclosed area to a first threshold, and increases the pressure rise time of the ventilation device if the absolute value of the enclosed area is greater than the first threshold. For example, as shown in fig. 5, it can be seen that the airway pressure waveform exceeds the template curve too much during the rise, which means that the pressure rise time is too short and the pressure rise speed is too fast, thus requiring an increase in the pressure rise time.
And when the enclosed area of the airway pressure waveform and the template curve is negative, processor 60 compares the absolute value of the enclosed area to a second threshold, and if the absolute value of the enclosed area is greater than the second threshold, reduces the pressure rise time of the ventilation device. For example, fig. 6 shows a case where the area enclosed by the airway pressure waveform and the template curve is negative, and it can be seen from the figure that if the airway pressure waveform deviates too much from the template curve at the lower side during the pressure rising process, this means that the pressure rising time is too long, and the pressure rising speed is too slow, so that the pressure rising time needs to be reduced.
With reference to fig. 7, in fig. 7, two adjacent time windows with equal length are divided in the pressure rising time, wherein the latter time window is defined as a first time window T1, the former time window is defined as a second time window T2, and the processor 60 obtains a first area surrounded by the airway pressure waveform and the time axis in the first time window T1, and obtains a second area surrounded by the airway pressure waveform and the time axis in the second time window T2, and then compares the first area with the second area. It should be noted that the airway pressure waveform should be above the time axis during the pressure rising process, so the first area and the second area may not have positive and negative properties. When the first area is larger than the second area and the difference between the first area and the second area is larger than the preset area threshold, the change speed of the airway pressure waveform is too high, which is the result of too short pressure rise time, so that the pressure rise time of the ventilation device is increased, and when the first area is smaller than the second area and the difference between the first area and the second area is larger than the preset area threshold, the change speed of the airway pressure waveform is too low, which is the result of too long pressure rise time, so that the pressure rise time of the ventilation device is reduced.
The above modes can reflect the change trend of the airway pressure waveform, and the change trend can include the change speed and the change direction.
In some embodiments, after obtaining the airway pressure, the processor 60 does not generate an airway pressure waveform according to the airway pressure, but obtains an airway pressure peak value, which is the maximum value of the airway pressure in the pressure rising process, and then the processor 60 obtains a difference relation between the airway pressure peak value and the target pressure value, and adjusts the pressure rising time of the ventilation device according to the difference relation, where the difference relation can be used to represent the degree of phase difference between the airway pressure peak value and the target pressure value. If the peak airway pressure is greater than the target pressure value and the difference between the two is significant, it is believed that the patient's airway pressure rises too hard during the pressure rise, meaning that the pressure rise time is too short, thus increasing the pressure rise time of the ventilator.
The above-described difference relationship may be obtained simply by differencing the airway pressure peak value with the target pressure value, and in some embodiments, the difference relationship is further characterized by a pressure overshoot, which is calculated according to the following formula:
Wherein sigma is the pressure overshoot, P max Is the peak value of airway pressure, P, in the process of pressure rise set Is the target pressure value. After the pressure overshoot is obtained, the pressure overshoot can be compared with an overshoot threshold, and if the pressure overshoot is larger than the overshoot threshold, the pressure rise time of the ventilation device is increasedWherein the overshoot threshold is also a preset value. When the pressure overshoot is excessive, the airway pressure waveform may spike as shown in fig. 5.
In addition, whether the pressure rise time is appropriate may be determined based on the time of a certain set pressure value when the airway pressure rises, for example, whether the pressure rise time is appropriate may be determined based on the time when the airway pressure rises to half the target pressure value.
In some embodiments, processor 60 first generates an airway flow waveform based on the airway flow obtained during the pressure rise, then obtains a curvilinear morphology of the airway flow waveform, and adjusts the pressure rise time of the ventilation device based on the curvilinear morphology, wherein the curvilinear morphology of the airway flow waveform is used to characterize the shape of the airway flow waveform. That is, whether there is an excessively long pressure rise time or an excessively short pressure rise time is identified by the shape of the airway flow rate waveform. Specifically:
In some embodiments, the curve morphology of the airway flow waveform may be characterized by an initial airway flow value and an area between the airway flow waveform and the flow line between the peak airway flow value and the peak airway flow value, where the initial airway flow value is similar to the initial pressure value of the airway pressure, the initial airway flow value is the airway flow value at the beginning of the pressure rise time, the peak airway flow value is the maximum value of the airway flow value in the pressure rise process, the dashed line in fig. 8 is the flow line, and the L1 is the line between the initial airway flow value and the peak airway flow value, and the area between the airway flow waveform and the flow line is positive and negative. When the airway flow velocity waveform is located above the flow velocity connection line, the area between the airway flow velocity waveform and the flow velocity connection line is a positive value. If the area between the airway flow waveform and the flow line is positive and the absolute value is greater than a fifth threshold (e.g., as in the case of fig. 8), the pressure rise time of the ventilator is reduced, which is typically due to the fact that the airway flow waveform rises too much through the arc, and this is required to be reduced.
In some embodiments, the curve morphology of the airway flow waveform may be represented by the ratio of the flow rate down time Tdown, which is the time for the airway flow to rise from a first flow value to the peak value of the airway flow during the pressure rise, and the flow rate up time Tup, which is the time for the peak value of the airway flow to fall to a second flow value during the pressure rise, wherein the first flow value and the second flow value are equal, that is, the ratio of the flow rate down time Tdown to the flow rate up time Tup, that is, the ratio of the time required for the airway flow to rise from a certain value to the peak value to the same value during the pressure rise, from which the shape of the airway flow can be represented as well. For example, as shown in fig. 9, where the ratio between the flow rate fall time Tdown and the flow rate rise time Tup is greater than the third threshold, the airway flow rate waveform as a whole appears to rise steeply, while the fall slope is gentle, featuring a pronounced "deceleration wave" that indicates a faster pressure rise rate, thus requiring an increase in the pressure rise time of the ventilation device. In fig. 8, however, the ratio between the flow rate decrease time Tdown and the flow rate rise time Tup is smaller than the fourth threshold, and the airway flow rate waveform as a whole appears to be a transitional smoothly circular arc shape indicating that the pressure rise rate is slower, so that it is necessary to reduce the pressure rise time of the ventilator.
The above parameter features can cooperate to determine whether the pressure rise time is too long or too short.
It should be noted that the above-mentioned various thresholds are not fixed, and each threshold may dynamically change according to at least one of parameters such as a target pressure value, a current pressure rise time, compliance and resistance monitored by the ventilator, a respiration time constant, a patient type, and an inhalation peak flow rate.
The pressure rise time can be increased or decreased automatically by the processor 60, and a prompt for adjusting the pressure rise time can be output, for example, a related prompt is displayed on the display 70 to prompt the medical staff to manually adjust the pressure rise time. After the pressure rise time is adjusted, the ventilator will raise the pressure in accordance with the adjusted pressure rise time in the next breathing cycle. The above-described pressure rise time adjustment may occur during each breathing cycle of the patient, for example, during a first breathing cycle in which the ventilator increases pressure in accordance with an initially set pressure rise time, during a first breathing cycle in which the ventilator adjusts the pressure rise time in accordance with the parameter characteristic of the ventilation parameter, during a second breathing cycle in which the ventilator increases pressure in accordance with the pressure rise time adjusted during the first breathing cycle, during this process in which the pressure rise time is again adjusted in accordance with the parameter characteristic of the ventilation parameter, during a third breathing cycle in which the ventilator increases pressure in accordance with the pressure rise time adjusted during the second breathing cycle, and so on. The adjustment of the pressure rise time may be increased or decreased according to a fixed time value or may be changed each time by a fixed percentage of the current pressure rise time, which fixed time value and fixed percentage may also be determined based on the parameter characteristics of the ventilation parameters described above.
In some embodiments, the processor 60 obtains at least one of a difference between the positive end expiratory pressure and the target pressure value, a respiratory rate, and a respiratory time constant of the patient, and determines an adjustment range for the pressure rise time based on at least one of the difference between the positive end expiratory pressure and the target pressure value, the respiratory rate, and the respiratory time constant, and during the automatically adjusting the pressure rise time, the physiological condition of the patient may be compromised, and the pressure rise time is set within an appropriate range.
The invention also provides a method for adjusting the rising time of pressure, referring to fig. 10, comprising the following steps:
step 100, acquiring ventilation parameters of a patient during pressure rise in ventilation. The ventilation parameter includes at least one of airway flow rate and airway pressure.
The above-mentioned pressure rising process is a process that the airway pressure in the same respiratory cycle of the patient is finally changed from the initial pressure value to the target pressure value, and in order to better understand the pressure rising process, the pressure rising time is first described, where the pressure rising time is commonly found in the pressure target ventilation mode. In popular terms, the ventilator delivers air at a high pressure when the patient inhales, allowing the patient to inhale a sufficient amount of air through the pressure. When the inhalation of the patient is finished, the breathing machine actively reduces the pressure, and the patient exhales the waste gas in the patient through the pressure difference between the lung and the outside. For example, referring to fig. 2, a schematic diagram of an airway pressure waveform during a respiratory cycle is shown, wherein PEEP is positive end expiratory pressure during the previous respiratory cycle. In the initial stage of the illustrated respiratory cycle, when the patient changes from the expiratory state in the previous respiratory cycle to the inspiratory state in the present respiratory cycle, the time when the airway pressure in the present respiratory cycle increases from the initial pressure value to the target pressure value (the airway pressure of the patient in the inspiratory state, expressed as Pset) is the pressure rise time, and the pressure rise time is used as the ventilation parameter of the ventilation device, so that the ventilation parameter can be set directly or indirectly.
However, in actual ventilation, the change in the airway pressure of the patient does not necessarily coincide with the set pressure rise time, for example, the pressure rise time is set to 0.5s on the ventilation apparatus, the airway pressure of the patient may reach the target pressure value after 0.4s, or the airway pressure of the patient may reach the target pressure value at 0.6 s. The process of actually and eventually changing the airway pressure to the target pressure value in a respiratory cycle is the pressure rising process defined in the application, in which the pressure value finally reached by the airway pressure is greater than the airway pressure at the beginning of the respiratory cycle, but this does not mean that the airway pressure is always rising. For example, referring to fig. 3, in the graph, the curve S1 is an airway pressure waveform with neither too long nor too short pressure rise time, the curve S2 is an airway pressure waveform with too short pressure rise time, and since the pressure rise speed is too fast, the ventilator will deliver a large flow of gas in a very short time, so that the curve S1 falls to the target pressure value after generating a peak, and the curve S3 is an airway pressure waveform with too long pressure rise time.
Step 200, acquiring at least one parameter characteristic of ventilation parameters related to pressure rise time.
The parameter characteristic refers to a parameter characteristic obtained from the ventilation parameter and capable of reflecting the degree of the rising time of the pressure.
Step 300, adjusting the pressure rise time of the ventilation device according to at least one parameter characteristic related to the pressure rise time. The following specifically exemplifies how the pressure rise time is adjusted.
In some embodiments, adjusting the pressure rise time, as shown in FIG. 11, includes the steps of:
step 310a, generating an airway pressure waveform according to the airway pressure acquired in the pressure rising process.
Step 320a, obtaining the variation trend of the airway pressure waveform.
The trend of the change in this step includes, but is not limited to, the slope of the curve of the airway pressure waveform, the size of the area surrounded by the airway pressure waveform and the template curve, and the change of the area surrounded by the airway pressure waveform and the time axis in two adjacent time windows with the same length.
The template curve is a curve fitted based on the set pressure rise time, and after the pressure rise time is set, the airway pressure of the patient changes according to the template curve in an ideal state. The template curve can be obtained from multiple experiments. The size of the area surrounded by the airway pressure waveform and the template curve has positive and negative characteristics. In this embodiment, when the template curve is located below the airway pressure waveform, the area enclosed by the airway pressure waveform and the template curve is positive, and when the template curve is located above the airway pressure waveform, the area enclosed by the airway pressure waveform and the template curve is negative.
The airway pressure waveform should be above the time axis in the pressure rising process, so the area enclosed by the airway pressure waveform and the time axis can be considered to be not positive or negative all the time.
Step 330a, adjusting the pressure rise time of the ventilation device according to the variation trend of the airway pressure waveform.
In some embodiments, when the slope of the curve changes from positive to negative, the airway pressure at which the slope of the curve changes from positive to negative may be compared to a target pressure value, and if the airway pressure is less than the target pressure value, the pressure rise time of the ventilator may be reduced. That is, if the airway pressure is still lower than the target pressure value during the pressure rise, the airway pressure waveform is reduced as shown in fig. 4, meaning that the pressure rise time is too long and the pressure rise speed is too slow, so that it is necessary to reduce the pressure rise time, in fig. 4, the arrow K points to a stage in which the slope is negative from positive, and Tslope represents the pressure rise time (in other figures, tslope also represents the pressure rise time).
In some embodiments, when the enclosed area of the airway pressure waveform and the template curve is a positive value, the absolute value of the enclosed area may be compared to a first threshold, and if the absolute value of the enclosed area is greater than the first threshold, the pressure rise time of the ventilation device is increased. For example, as shown in fig. 5, it can be seen that the airway pressure waveform exceeds the template curve too much during the rise, which means that the pressure rise time is too short and the pressure rise speed is too fast, thus requiring an increase in the pressure rise time. And when the area enclosed by the airway pressure waveform and the template curve is a negative value, the absolute value of the enclosed area can be compared with a second threshold value, and if the absolute value of the enclosed area is larger than the second threshold value, the pressure rise time of the ventilation device is reduced. For example, fig. 6 shows a case where the area enclosed by the airway pressure waveform and the template curve is negative, and it can be seen from the figure that if the airway pressure waveform deviates too much from the template curve at the lower side during the pressure rising process, this means that the pressure rising time is too long, and the pressure rising speed is too slow, so that the pressure rising time needs to be reduced.
In some embodiments, referring to fig. 7, two adjacent time windows with equal length are divided in the pressure rising time in fig. 7, wherein the latter time window is defined as a first time window T1, the former time window is defined as a second time window T2, a first area surrounded by the airway pressure waveform and the time axis in the first time window T1 is obtained, a second area surrounded by the airway pressure waveform and the time axis in the second time window T2 is obtained, and then the first area and the second area are compared. When the first area is larger than the second area and the difference between the first area and the second area is larger than the preset area threshold, the change speed of the airway pressure waveform is too high, which is the result of too short pressure rise time, so that the pressure rise time of the ventilation device is increased, and when the first area is smaller than the second area and the difference between the first area and the second area is larger than the preset area threshold, the change speed of the airway pressure waveform is too low, which is the result of too long pressure rise time, so that the pressure rise time of the ventilation device is reduced.
The above modes can reflect the change trend of the airway pressure waveform, and the change trend can include the change speed and the change direction.
In some embodiments, after the airway pressure is obtained, the airway pressure waveform may not be generated according to the airway pressure, but an airway pressure peak value is obtained, where the airway pressure peak value is the maximum value of the airway pressure in the pressure rising process, then a difference relationship between the airway pressure peak value and the target pressure value is obtained, and then the pressure rising time of the ventilation device is adjusted according to the difference relationship, where the difference relationship may be used to represent the degree of phase difference between the airway pressure peak value and the target pressure value. If the peak airway pressure is greater than the target pressure value and the difference between the two is significant, it is believed that the patient's airway pressure rises too hard during the pressure rise, meaning that the pressure rise time is too short, thus increasing the pressure rise time of the ventilator.
The above-described difference relationship may be obtained simply by differencing the airway pressure peak value with the target pressure value, and in some embodiments, the difference relationship is further characterized by a pressure overshoot, which is calculated according to the following formula:
wherein sigma is the pressure overshoot, P max Is the peak value of airway pressure, P, in the process of pressure rise set Is the target pressure value. After the pressure overshoot is obtained, the pressure overshoot can be measured The pressure overshoot is compared with an overshoot threshold, and if the pressure overshoot is greater than the overshoot threshold, the pressure rise time of the ventilation device is increased, wherein the overshoot threshold is also a preset value.
In some embodiments, adjusting the pressure rise time, as shown in FIG. 12, includes the steps of:
step 310b, generating an airway flow velocity waveform according to the airway flow velocity obtained in the pressure rising process.
Step 320b, obtaining a curve morphology feature of the airway flow velocity waveform, wherein the curve morphology feature is used for representing the shape of the airway flow velocity waveform.
In some embodiments, the curve morphology of the airway flow waveform may be characterized by an initial airway flow value and an area between the airway flow waveform and the flow link between the peak airway flow value and the peak airway flow value, where the initial airway flow value is the airway flow value at the beginning of the pressure rise time, the peak airway flow value is the maximum value of the airway flow value in the pressure rise process, the dotted line in fig. 8 is the flow link between the initial airway flow value and the peak airway flow value, and the area between the airway flow waveform and the flow link is positive and negative. When the airway flow velocity waveform is located above the flow velocity connection line, the area between the airway flow velocity waveform and the flow velocity connection line is a positive value.
In other embodiments, the ratio of the flow rate down time Tdown and the flow rate up time Tup may be used to characterize the curve morphology of the airway flow waveform, where the flow rate up time Tup is the time for the airway flow rate to rise from a first flow rate value to a peak value of the airway flow rate during the pressure rise, and the flow rate down time Tdown is the time for the peak value of the airway flow rate to fall to a second flow rate value during the pressure rise, where the first flow rate value and the second flow rate value are equal, that is, the ratio of the flow rate down time Tdown and the flow rate up time Tup is the ratio of the time required for the airway flow rate to rise from a certain value to the peak value to the same value during the pressure rise, and the shape of the airway flow rate can be similarly represented from the ratio.
Step 330b, adjusting the pressure rise time of the ventilation device according to the curve morphological characteristics of the airway flow velocity waveform.
If the area between the airway flow waveform and the flow line is positive and the absolute value is greater than the fifth threshold, the pressure rise time of the ventilator is reduced, and when this occurs, the airway flow waveform generally rises over a slightly larger arc, which is due to the excessively long pressure rise time, so that the pressure rise time needs to be reduced.
And if the ratio between the flow rate falling time Tdown and the flow rate rising time Tup is greater than the third threshold value, the pressure rising time is increased. For example, as shown in fig. 9, where the ratio between the flow rate down time Tdown and the flow rate up time Tup is greater than the third threshold, the airway flow rate waveform as a whole appears to rise steeply, while the falling slope is gentle, featuring a pronounced "deceleration wave" that indicates a faster pressure rise rate, thus requiring an increase in the pressure rise time of the ventilation device. If the ratio between the flow rate falling time Tdown and the flow rate rising time Tup is smaller than the fourth threshold value, the pressure rising time is decreased. For example, in fig. 8, the ratio between the flow rate decrease time Tdown and the flow rate rise time Tup is smaller than the fourth threshold, and the airway flow rate waveform as a whole looks like a transitional smooth circular arc shape indicating that the pressure rise rate is slower, so that it is necessary to reduce the pressure rise time of the ventilator.
The above parameter features can cooperate to determine whether the pressure rise time is too long or too short.
It should be noted that the above-mentioned various thresholds are not fixed, and each threshold may dynamically change according to at least one of parameters such as a target pressure value, a current pressure rise time, compliance and resistance monitored by the ventilator, a respiration time constant, a patient type, and an inhalation peak flow rate.
The pressure rise time can be automatically increased or decreased by the ventilation device, and the prompting information for adjusting the pressure rise time can be output, for example, related prompting information is displayed on the display 70 of the ventilation device, so as to prompt the medical staff to manually adjust the pressure rise time. After the pressure rise time is adjusted, the ventilator will raise the pressure in accordance with the adjusted pressure rise time in the next breathing cycle. The above-described pressure rise time adjustment process may occur in each breathing cycle of the patient, e.g. in a first breathing cycle the ventilator increases the pressure according to an initially set pressure rise time, in the first breathing cycle the pressure rise time is adjusted according to the parameter characteristic of the ventilation parameter, in a second breathing cycle the ventilator increases the pressure according to the adjusted pressure rise time in the first breathing cycle, in the process the pressure rise time is adjusted according to the parameter characteristic of the ventilation parameter, in a third breathing cycle the ventilator increases the pressure according to the adjusted pressure rise time in the second breathing cycle, and so on. The adjustment of the pressure rise time may be increased or decreased according to a fixed time value or may be changed each time by a fixed percentage of the current pressure rise time, which fixed time value and fixed percentage may also be determined based on the parameter characteristics of the ventilation parameters described above.
In some embodiments, at least one of a difference between the positive end expiratory pressure and the target pressure value, a respiratory rate and a respiratory time constant of the patient may be obtained, and an adjustment range of the pressure rise time may be determined according to at least one of the difference between the positive end expiratory pressure and the target pressure value, the respiratory rate and the respiratory time constant, and in the process of automatically adjusting the pressure rise time, the physiological condition of the patient may be considered, and the pressure rise time may be set within a suitable range.
The above-described manner effectively adjusts the pressure rise time based on different parameter characteristics in the airway pressure and the airway flow rate so that the pressure rise time can be adapted to the patient's condition to better ventilate the patient.
The foregoing description of the invention has been presented for purposes of illustration and description, and is not intended to be limiting. Variations of the above embodiments may be made by those of ordinary skill in the art in light of the present teachings.
Claims (16)
- A method for adjusting pressure rise time, applied to a ventilation device, characterized in that it comprises:acquiring ventilation parameters of a patient in a ventilation process, wherein the ventilation parameters comprise at least one of airway flow rate and airway pressure, and the pressure rise process is a process that the airway pressure finally changes from an initial pressure value to a target pressure value in the same respiratory cycle;Acquiring at least one parameter characteristic of the ventilation parameters about pressure rising time, wherein the pressure rising time is a set time length for rising the airway pressure from an initial pressure value to a target pressure value in the same respiratory cycle;the pressure rise time of the ventilation device is adjusted in accordance with the at least one parameter characteristic relating to the pressure rise time.
- The method of adjusting of claim 1, wherein adjusting the pressure rise time of the ventilation device based on the at least one parameter characteristic relating to pressure rise time comprises:generating an airway pressure waveform according to the airway pressure acquired in the pressure rising process;acquiring the variation trend of the airway pressure waveform;and adjusting the pressure rise time of the ventilation equipment according to the change trend of the airway pressure waveform.
- The adjustment method according to claim 2, characterized in that the trend of the airway pressure waveform is characterized by at least one of the following parameter characteristics:a curve slope of the airway pressure waveform; andthe size of the area enclosed by the airway pressure waveform and the template curve; andthe air passage pressure waveform and the time axis in two adjacent time windows with the same length form the area change.
- The method of adjusting of claim 3, wherein adjusting the pressure rise time of the ventilation device based on the curve slope of the airway pressure waveform comprises:when the slope of the curve changes from a positive value to a negative value, comparing the airway pressure with a target pressure value;if the airway pressure is less than a target pressure value, the pressure rise time of the ventilation device is reduced.
- A method of adjusting as defined in claim 3, wherein adjusting the pressure rise time of the ventilation device based on the size of the area bounded by the airway pressure waveform and the template curve comprises:when the area enclosed by the airway pressure waveform and the template curve is a positive value, comparing the absolute value of the enclosed area with a first threshold value, and if the absolute value of the enclosed area is larger than the first threshold value, increasing the pressure rise time of the ventilation equipment;and comparing the absolute value of the enclosed area with a second threshold value when the area enclosed by the airway pressure waveform and the template curve is a negative value, and reducing the pressure rise time of the ventilation equipment if the absolute value of the enclosed area is larger than the second threshold value, wherein the area enclosed by the airway pressure waveform and the template curve is a positive value when the template curve is positioned below the airway pressure waveform, and the area enclosed by the airway pressure waveform and the template curve is a negative value when the template curve is positioned above the airway pressure waveform.
- A method of adjusting as defined in claim 3, wherein adjusting the pressure rise time of the ventilator based on the change in the area enclosed by the airway pressure waveform and the time axis within two adjacent time windows of equal length comprises:acquiring a first area surrounded by an airway pressure waveform and a time axis in a later time window;acquiring a second area surrounded by the airway pressure waveform and the time axis in the previous time window;when the first area is larger than the second area and the difference value between the first area and the second area is larger than a preset area threshold value, increasing the pressure rising time of the ventilation equipment;and when the first area is smaller than the second area and the difference value between the first area and the second area is larger than a preset area threshold value, reducing the pressure rising time of the ventilation equipment.
- The method of adjusting of claim 1, wherein adjusting the pressure rise time of the ventilation device based on the at least one parameter characteristic relating to pressure rise time comprises:generating an airway flow velocity waveform according to the airway flow velocity obtained in the pressure rising process;acquiring curve morphological characteristics of the airway flow velocity waveform, wherein the curve morphological characteristics are used for representing the shape of the airway flow velocity waveform;And adjusting the pressure rise time of the ventilation equipment according to the curve morphological characteristics of the airway flow velocity waveform.
- The adjustment method of claim 7, wherein the curvilinear morphology feature of the airway flow velocity waveform is characterized by at least one of the following parametric features:the area between the waveform of the air passage flow velocity and the flow velocity connecting line between the initial value of the air passage flow velocity and the peak value of the air passage flow velocity, wherein the initial value of the air passage flow velocity is the air passage flow velocity at the beginning of the pressure rising time, the peak value of the air passage flow velocity is the maximum value of the air passage flow velocity in the pressure rising process, and the flow velocity connecting line is the connecting line between the initial value of the air passage flow velocity and the peak value of the air passage flow velocity; andthe ratio between the flow rate falling time and the flow rate rising time is that the flow rate of the air channel rises from a first flow rate value to an air channel flow rate peak value in the pressure rising process, and the flow rate falling time is that the flow rate peak value of the air channel falls to a second flow rate value in the pressure rising process, wherein the first flow rate value and the second flow rate value are equal.
- The method of adjusting of claim 8, wherein adjusting the pressure rise time of the ventilator based on the curvilinear morphology feature of the airway flow rate waveform comprises:Increasing the pressure rise time of the ventilator if the ratio between the flow rate fall time and the flow rate rise time is greater than a third threshold;and if the ratio between the flow rate falling time and the flow rate rising time is smaller than a fourth threshold value, or the area between the airway flow rate waveform and the flow rate connecting line is positive and the absolute value is larger than a fifth threshold value, reducing the pressure rising time of the ventilation equipment, wherein when the airway flow rate waveform is positioned above the flow rate connecting line, the area between the airway flow rate waveform and the flow rate connecting line is positive.
- The method of adjusting of claim 1, wherein adjusting the pressure rise time of the ventilation device based on the at least one parameter characteristic relating to pressure rise time comprises:acquiring an airway pressure peak value, wherein the airway pressure peak value is the maximum value of the airway pressure in the pressure rising process;acquiring a difference relation between the airway pressure peak value and the target pressure value;and adjusting the pressure rise time of the ventilation equipment according to the difference relation between the airway pressure peak value and the target pressure value.
- The method of adjusting according to claim 10, wherein adjusting the pressure rise time of the ventilation device according to the difference relationship between the airway pressure peak value and the target pressure value comprises:Calculating to obtain pressure overshoot according to the airway pressure peak value and the target pressure value;the pressure overshoot is calculated according to the following formula:wherein sigma is the pressure overshoot, P max Is the peak value of airway pressure, P, in the process of pressure rise set Is the target pressure value;and adjusting the pressure rise time of the ventilation device according to the pressure overshoot.
- The method of adjusting as defined in claim 11, wherein the adjusting the pressure rise time of the ventilation device based on the pressure overshoot comprises:and comparing the pressure overshoot with an overshoot threshold, and if the pressure overshoot is greater than the overshoot threshold, increasing the pressure rise time of the ventilation device.
- The adjustment method according to claim 1, characterized in that the method further comprises:acquiring at least one of a difference between the positive end-expiratory pressure of the patient and the target pressure value, a respiratory rate, and a respiratory time constant;determining an adjustment range of the pressure rise time according to at least one of a difference between the positive end-expiratory pressure and the target pressure value, a respiratory frequency and a respiratory time constant;and adjusting the pressure rise time of the ventilation equipment within the adjustment range of the pressure rise time.
- The method of adjusting of claim 1, wherein adjusting the pressure rise time of the ventilation device based on the at least one parameter characteristic relating to pressure rise time comprises:identifying whether the pressure rise time is too long or too short according to the at least one parameter characteristic related to the pressure rise time;if the pressure rise time is too long or too short, the pressure rise time is prompted to be adjusted or automatically adjusted.
- A ventilation apparatus, comprising:a patient interface for connecting to a respiratory system of a patient;a respiratory assistance device for providing respiratory support power in ventilation to output respiratory support gas to a patient;a processor for performing the method of any of claims 1-14.
- A computer readable storage medium comprising a program executable by a processor to implement the method of any one of claims 1-14.
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