DE102009025327A1 - Respiratory device for patient, has patient hose system supplying respiratory gas to patient during phases of inspiration and expiration, where respiratory gas provided from conveying device cools blower - Google Patents

Abstract

The device has an electronically controlled respiratory gas conveying device e.g. electrical blower, with a sensor device for determining respiratory gas parameters and/or parameters of the conveying device. A patient hose system is provided with a patient interface and a patient valve for releasing exhaled air in to ambient air, supplies respiratory gas to a patient during phases of inspiration and expiration, where the respiratory gas provided from the conveying device cools the conveying device. The blower and a display (3) are arranged in an interior space of the device. An independent claim is also included for a method for cooling a respiratory device for a patient.

Description

The The invention relates to a device for ventilation, consisting of an electronically controlled breathing gas delivery device with a sensor device, for determination of respiratory gas parameters and / or parameters of the respiratory gas delivery device, and a patient circuit with a patient interface and a patient valve, over the exhaled air is released into the ambient air, serving the Provision of breathing gas for the patient during the phases of inhalation and exhalation.

The Invention relates to this In addition, a method for cooling a device for ventilation.

In Respiratory machines often become electronic to produce compressed gas regulated breathing gas delivery device For example, so-called radial blower, where the air flow sucked in axially and ejected radially at the blower outlet is, or axial blower, in which the sucked gas is sucked in axially as well as ejected.

Of the Intake area, which is located in front of the breathing gas conveyor has in many cases Ambient pressure or has one in relation to the outflow area lower pressure.

to Discharge of the exhaled air from the patient is on the breathing mask or in the area of the breathing tube, an airflow over Patient valve or an outlet opening to the ambient air dissipated.

at Bilevel or home ventilation, the ventilators work with different Pressure levels for the inhalation or for the exhalation. While inhalation, the respiratory gas delivery device generates a higher volume of respiratory gas. The breathing gas flows past the breathing gas delivery device and cool these. While the exhalation produces a lesser respiratory gas delivery device Respiratory gas volume. Only a small amount of breathing gas flows around the respiratory gas delivery device, whereby the cooling effect is low and overheat the breathing gas conveyor can.

The Engines and in particular their bearings are often exposed to extreme loads. As a result, heat up the blower motors strong and need the cooling. One for the patient unpleasant side effect is the partially strong Noise.

In some devices will be additional fan used as a cooling fan, to power electronics, the breathing gas conveyor and others to cool temperature-sensitive components. This requires additional Space and a control electronics and is at an increased cost connected.

task It is the object of the present invention to provide an electronically controlled breathing gas delivery device to construct, which does not require a separate device for cooling.

These The object is achieved in terms of the device according to the invention in that that of the breathing gas conveyor Provided breathing gas at least temporarily also for cooling the Respiratory gas conveyor serves.

To is from the breathing gas conveyor a corresponding cooling minute volume generated. This is defined as the volume of respiratory gas, that per minute of cooling the breathing gas conveyor serves. The cooling minute volume can, dependent from the loading of the respiratory gas delivery device, be different from breath to breath. At higher ventilation frequency is the time to cool serves less. Accordingly, according to the invention, the cooling minute volume to the ventilation frequency customized.

In a preferred embodiment is the breathing gas delivery device as a fan, consisting of an electric motor with an attached to the shaft end impeller formed. In a another embodiment can also mounted several blower wheels be.

Advantageous is the breathing gas delivery device arranged in the airway of the ventilator that of the On the suction side constantly Fresh air flows in, which of the breathing gas conveyor is accelerated and compressed, the fresh air, the breathing gas conveyor at least partially flows around and thereby heat from the breathing gas conveyor dissipated becomes.

Prefers is the breathing gas delivery device arranged in the airway of the ventilator such that the fresh air at least 40% of the surface the breathing gas conveyor flows around.

Especially the breathing gas delivery device is preferred arranged in the airway of the ventilator such that the fresh air at least 60% of the surface the breathing gas conveyor flows around.

In an alternative embodiment becomes the cooling minute volume from the breathing gas conveyor generated and by means of a bypass line to the point to be cooled directed.

In a further embodiment serves the cooling minute volume also for cooling the electronic control and / or the sensor device.

A easy capture for the need of the needed Cooling minute volume based on the fact that a sensor device determines a parameter, the load on the breathing gas conveyor represents.

One suitable parameter, the load of the breathing gas conveyor represents and without the use of an additional Sensors can be determined, is the pressure of the breathing gas. Further suitable parameters are the average pressure or the flow of the breathing gas. Likewise, the power consumption of the breathing gas conveyor suitable to specify the load of Atemgasfördereinrichtung.

For a simple Implementation of the control of the cooling minute volume is the ratio in a store the parameter representing a load on the respiratory gas delivery device, for example, the pressure of the respiratory gas, the consequent warming the breathing gas conveyor deposited.

Further suitable parameters that load the respiratory gas delivery device represent quite accurately, are the temperature of the respiratory gas in the high pressure range or the engine temperature.

A easy detection of the temperature via a thermocouple.

A easy implementation of the control of the cooling minute volume is characterized realized that at least one determined parameter as a control variable for the control the breathing gas conveyor is used.

A energy-saving implementation of cooling takes place in that the cooling minute volume if necessary increased becomes.

A efficient implementation of cooling takes place in that the cooling minute volume is increased with increasing load of Atemgasfördereinrichtung.

A needs-based cooling the breathing gas conveyor is achieved by the cooling minute volume during the Exhalation increased becomes.

In an embodiment of the invention, the cooling minute volume by raising the engine speed increased.

In a pragmatic variant of the invention is the cooling minute volume gradually increased.

A Precise control of the cooling minute volume assumes that the cooling minute volume infinitely increased becomes.

The Limit temperatures for the breathing gas delivery device are respected when the cooling minute volume in the range 4 l / min to 40 l / min.

Regarding the method according to the invention the task is solved by that sensory a parameter that is a burden on the breathing gas conveyor represents is determined and this parameter at least as a control variable for the control the breathing gas conveyor is used, wherein the breathing gas delivery means the cooling minute volume generated.

Prefers becomes the cooling minute volume increased only during periods of exhalation.

To a sensory determination of the breathing position of the patient.

A Exact determination of the respiratory position is carried out by a sensory determination of pressure and / or flow of the breathing gas.

According to the invention Cooling minute volume dependent on the breathing position of the patient and / or controlled in response to the respiratory rate.

A for the Patient pleasant operation of the ventilator according to the invention is carried out by that the cooling minute volume load dependent is controlled. This results in a lower for the patient average noise level, as with devices according to the prior art or as at a constant high cooling minute volume.

embodiments

figure description

1 : general representation of a respirator,

2 : general representation of a ventilator with a hose system,

3 : pneumatic construction of a device for ventilation with leakage system,

4 : general representation of a ventilator with single-tube system with patient valve,

5 : pneumatic construction of a ventilation device with single-tube system with patient valve,

6 : general representation of a ventilator with double-tube system with patient valve,

7 : pneumatic construction of a device for breathing with double-tube system and patient valve,

8th : schematic representation of a blower,

9 : schematic representation of the respiratory tract in single tube ventilation and

10 : schematic representation of the respiratory gas passages in double tube ventilation.

1 shows the basic structure of a device for ventilation. In the area of a device housing with control panel ( 3 ) as well as display ( 3 ) is arranged in a device interior a breathing gas conveyor. The control panel and the displays ( 3 ) are used to control and monitor the therapy device and the connected accessories. The carrying handle ( 4 ) is used to transport the device. Via a coupling element at the device output ( 1 ), an unillustrated connection hose is connected.

From the device output ( 1 ), the breathing air flows through a hose system and ventilation access to the patient. The O2 coupling ( 2 ) serves as an adapter for connecting the oxygen source to the therapy device. The power cord ( 5 ) is used to connect the therapy device to the mains supply. The connection ( 6 ) is used to connect the optional mobile power supply that has batteries.

The card reader ( 7 ) is a slot for a memory card. The memory card stores therapy data that the doctor can call up. The serial interfaces ( 8th ) are used to connect devices for displaying and evaluating therapy data. The filter compartment lid ( 9 ) above the air inlet serves to cover and secure positioning of the coarse and fine dust filter. The connection remote alarm ( 10 ) is used to connect the hospital nurse call system or the remote alarm box for out-of-hospital use.

The safety bar ( 11 ) prevents unintentional disconnection of the device from the mains supply. The mains connection ( 12 ) is the device-side contact for the power cord. The device shield ( 13 ) Gives information about the device, such as: Eg serial number and year of manufacture. The oxygen connection ( 14 ) is used to connect the oxygen supply when oxygen supply has been prescribed. The case fan ( 15 ) protects the device from overheating.

2 shows the basic structure of a device for ventilation with a hose system ( 16 ). The air flows through the hose system to the ventilation access. The hose system consists of corrugated hose, pressure measuring hose and adapter ( 17 ). The adapter ( 17 ) is used to connect the hose system to the device output. The pressure measuring hose ( 18 ) is used to measure the therapy pressure. The corrugated hose ( 19 ) conveys the breathing air to the patient. The sealing plug ( 20 ) is used to close the pressure measuring hose during cleaning (only with leakage system). The drying adapter ( 21 ) is needed to dry the tubing system with the aid of the therapy device and to check the function.

About the exhalation system ( 22 ) the carbon dioxide-containing exhaled air escapes during therapy. The port O2 sensor ( 23 ) is used to connect the oxygen sensor, which is available as an accessory (only for hose systems with patient valve). The connection humidifier ( 24 ) is used to connect the humidifier available as an accessory (only with leakage system). Not shown are a Druckmessein direction and a Flußmeßeinrichtung that are close to the patient in the area of the patient interface or positioned in the area of the ventilator or in the region of the connecting tube. A patient interface, such as a mask, for example, which is fixed by a head bandage on the patient's head, can also be connected via the breathing tube.

3 shows the pneumatic structure of a device for ventilation with leakage system. An electronically controlled fan draws in ambient air through a filter and conveys it to the device outlet. From here the air flows through the hose system and the ventilation access to the patient. Sensors detect the pressure at the ventilation access and in the tube system as well as the respiratory phase change. Accordingly, the blower provides the tidal volume and physician-set IPAP and EPAP pressures. When using a leakage system, the CO2-containing expiratory air is continuously flushed out via an exhalation system.

4 shows the basic structure of a device for ventilation with single-tube system ( 29 ). The connection pressure measuring hose ( 26 ) is marked in blue and is used to connect the pressure measuring hose to the device. The test adapter ( 27 ) is required in the functional check of the therapy device. The connection valve control hose ( 28 ) is used to connect the valve control hose ( 31 ) to the device. The single tube system ( 29 ) conveys the breathing air to the patient. The pressure measuring hose ( 18 ) is marked in blue and is used to measure the therapy pressure. The valve control hose ( 31 ) is used to control (open and close) the patient valve. The patient valve ( 32 ) serves to discharge the exhaled air of the patient from the hose system. To the connection patient ( 30 ), the ventilation access, the patient interface, is connected. Via the connection device output ( 25 ), the hose system is connected to the device output of the therapy device.

5 shows the pneumatic construction of a device for ventilation with single-tube system ( 29 ). Here the exhalation is controlled via the patient valve. When using the single tube system with patient valve, patient exhalation air escapes into the environment via the patient valve. The device controls the patient valve via the valve control hose. The single tube system consists of a breathing tube, a pressure measuring tube, a valve control tube and a patient valve. The ventilation access must be connected directly to the patient valve.

6 shows the basic structure of a device for ventilation with double-tube system ( 35 ). The device connection for the patient valve ( 33 ) is used to connect the patient valve to the device input of the therapy device. About the opening exhaled air ( 34 ) exhales the patient's exhaled air out of the device. The double hose system ( 35 ) conveys the breathing air to the patient and from the patient back to the device. The Y adapter ( 36 ), when using the double-tube system, brings the inhalation and expiratory tubing together and serves as an adapter for connection to the ventilator access. Via the connection device output ( 37 ), the hose system is connected to the device outlet ( 1 ) connected.

7 shows the pneumatic construction of a device for ventilation with double-tube system ( 35 ). When using the double-tube system with patient valve, an exhalation tube also exhausts the exhaled air through the device into the ambient air. In addition to the breathing tube that supplies air to the patient, the dual-tube system also includes an exhalation tube that delivers the exhaled air back to the unit and into the ambient air. The Patient valve is located on the exhalation tube for the double-tube system. When using the dual-tube system, the breathing tube on the device outlet of the device and the exhalation tube, at the end of which the patient valve is located, are placed on the exhalation air device inlet below the device outlet.

Of the Connecting piece of the pressure measuring hose is marked Connection to the device. The pressure measuring tube has the same length as the breathing tube and leads to the Y-connector, be brought together at the respiratory and exhalation tube. The valve control hose leads from Patient valve directly for connection to the device and is therefore shorter than the pressure measuring hose.

8th shows a schematic representation of an electric blower ( 38 ) consisting of an electric motor ( 39 ) and a propeller ( 40 ) mounted on a motor shaft. The jelly is surrounded by a housing. The blower ( 38 ) is surrounded by a sound-damping device ( 41 ), in an airway ( 42 ). This is defined by a suction area ( 20 ), in which an air pressure A prevails. The intake area guides the blower to the fan and from there to an outlet area ( 21 ), in which an air pressure B prevails - which is typically higher than air pressure A. The blower generates an airflow that passively passes ambient air into the intake area (FIG. 43 ) of the airway ( 42 ) sucks. The blower compresses the air and conveys it to the outlet area ( 44 ). This is followed by an unillustrated device output, to which a hose system can be connected. Since the air passage passes directly by the blower and the blower is embedded in the air path, the air drawn in by the blower continuously circumscribes the engine ( 39 ).

In an electric motor ( 39 ), different losses occur, which increase with the torque removed and lead to a warming of the engine. The power loss must be dissipated as heat, so that the engine does not overheat. The better the heat loss is dissipated, the more torque and thus power can be extracted from an engine. According to the invention, therefore, the electric motor is located substantially centrally in the air flow and is thus circumscribed by the cooling air on all sides. In addition, according to the invention cooling fins or the like are provided to selectively dissipate the heat of the engine.

Of the Electric motor is only part of the drive system, which at least still includes the electrical control of the engine. By a suitable control, the engine can be operated efficiently.

9 shows a schematic representation of the respiratory gas passages during single-tube ventilation during the various respiratory phases.

In the expiration ( 9a ) is the patient valve ( 32 ) opened by a control pulse. The exhaled air escapes via the patient valve ( 45 ) of the patient ( 48 ), as well as a blower ( 38 ) generated cooling minute volume ( 46 ), which serves to cool the electric motor.

This is necessary because in expiration according to the prior art no breathing gas delivered to the patient is no cooling minute volume is present and thus the engine heats up.

In 9b it can be seen that in inspiration the patient valve ( 32 ) closed is. The entire volume of respiratory gas delivered by the respiratory gas delivery device encompasses the respiratory gas delivery device and thus cools it, without having to generate an additional cooling minute volume from the respiratory gas delivery device.

10 shows a schematic representation of the respiratory gas passages in the double tube ventilation ( 35 ) during the various breathing phases. In the expiration, in 10b shown, the patient valve ( 32 ) opened by a control pulse. Via the patient valve ( 32 ) both the exhaled air ( 45 ) of the patient, as well as a blower ( 38 ) generated cooling minute volume ( 46 ), which serves to cool the electric motor / electronic components. This is necessary because in the expiration of the prior art no breathing gas is delivered to the patient thus no cooling minute volume is present and the engine heats up. In the inspiration, in 10a shown, the patient valve ( 32 ) closed. The entire volume of breathing gas delivered by the respiratory gas delivery device encompasses the respiratory gas delivery device ( 38 ) and thus cools them, without an additional cooling minute volume ( 46 ) must be generated by the breathing gas conveyor.

According to the invention, the cooling minute volume ( 46 ) depending on the loading of the breathing gas conveyor facility increased. For this purpose, a parameter of the load is determined and used as a control parameter for the respiratory gas delivery device. Suitable parameters of the load are, for example, the engine temperature or the respiratory gas pressure. As the pressure increases, the cooling minute volume is increased according to the table below Medium pressure Cooling minute volume [L / min] up to 5 hPa 4 L / min up to 10 hPa 8 L / min up to 15 hPa 15 L / min up to 20 hPa 20 L / min up to 25 hPa 25 L / min up to 30 hPa 30 L / min > 30 hPa 40 L / min

• – mit Leckagesystem: CPAP, S, ST, T, SX, SXX, TA
• – mit Ventilsystem: PCV, PSV/aPCV, VCV

The device according to the invention can be operated in the following therapy modes:

• - with leakage system: CPAP, S, ST, T, SX, SXX, TA
• - with valve system: PCV, PSV / aPCV, VCV

Of the Doctor can with the pressure-controlled modes S, T, ST, SX, SXX, TA, PCV and PSV / aPCV enable volume compensation. This will be minimum volume and maximum pressure increase set. If the minimum volume is undercut, the device automatically increases the pressure continuously up to the set maximum pressure (therapy pressure plus max. Pressure increase).

In the controlled modes T, PCV and VCV and assisted-controlled Modes ST and PSV / aPCV allows the physician to control the respiratory rate in the range of 5 to 45 breaths per minute and the inspiratory time in the range of 20% to 67% of Set the breathing period. In S, SX, SXX and PSV modes, the Doctor for Inspiration and expiration choose one of 8 trigger levels each. In the modes ST and PSV can be deactivated by the expiratory trigger become. Switching to expiration is then time-controlled. In PSV mode, the mode indicator changes to aPCV. In the adaptive Mode TA adapts to the device automatically to the individual respiratory rhythm and the individual Respiratory pattern of the patient and sets the therapy pressure in exactly This rhythm and pressure curve available. Is not in the S-mode in the Breathing device, the therapy pressure is automatically adjusted with a minimum frequency of 5 breaths provided per minute. The CPAP mode does not provide breath assistance.

On the display will show the therapy pressure and, depending on from the mode, the current values for IPAP and EPAP and the respiratory rate (f) displayed. Depending on the used Tubing system will be the tidal volume (VT) or the inspiratory Tidal volume (VTi) displayed. Using the single tube system Only the inspiratory tidal volume can be measured while the Double tube system, the total tidal volume can be measured can. Furthermore, spontaneous or mechanical respiratory phase changes displayed and the pressure change graphed.

A Soft start function makes it easier to fall asleep or get used to higher Ventilation pressures. Of the Doctor poses for Inhalation and Exhalation Start pressures that occur during the Soft start phase continuously increase to the Therapiedrücke. this function must be activated by the doctor.

The Device has one Automatic switch. If this is activated, the device can through a breath in the breathing mask is turned on. This is switched off Device continues over the On / off button.

By a built-in battery, the device can be interrupted in the event of a power failure depending on load and temperature range at least one hour continue to be operated. The internal battery will be charged automatically or kept in a charged state, as long as the device is mains voltage is supplied.

In addition, can an external mobile power supply via the battery.

The Insufflation Maneuver function allows the patient to administer a higher volume by pressing the appropriate button to help with coughing. The maneuver can be triggered manually by pressing a button during ventilation. The device goes into the insufflation maneuver mode and the insufflation is started synchronously with the next inhalation. this function must be unlocked by the attending physician.

insufflation is a process in which the pressure in the thorax of the patient is increased. Through this maneuver Coughing can be facilitated or sigh respiration can be performed. The function must be enabled by the doctor. The insufflation maneuver can only during the respiration be triggered. It contains at least one single procedure consisting of insufflation and subsequent exhalation. The doctor can set the insufflation maneuver that the single process is repeated up to 250 times. Likewise a distance of max. Set 250 inhalations and exhalations between two individual procedures become. Several individual operations together with the defined distances then form a complete process. The chosen one Ventilation mode will be after the completion of the whole operation as well between the individual maneuvers continued. The maneuver ends automatically after the end of all individual maneuvers or by manual termination.

to support in the surveillance of patient and device, Especially with life-support ventilation, the device has a remote alarm connection. All high and medium priority alarms are connected to this port the alarm "None Mains voltage "forwarded. All other alarms are displayed on the device. In the hospital can the device be connected directly to the hospital's internal alarm system.

in the Device the therapy data is stored on a removable MMC or SD card. It has one Memory card reader for MMC or SD cards, with the help of therapy data on a memory card can be stored. In consultation with the attending physician, the therapy data can be obtained in this way independent of the patient from the location of the device be read as the data is transported with the memory card can be. Whether there is a memory card in the device and recorded therapy data can be recognized by the symbol in the status bar. appear the symbol is not, the memory card is defective or does not exist.

Claims (19)

Device for ventilation, consisting of an electronically controlled breathing gas conveyor with a sensor device for determining Atemgasparametern and / or parameters of Atemgasfördereinrichtung, and a patient tube system with a patient interface and a patient valve, is discharged through the exhalation air to the ambient air, serving the provision of breathing gas for the patient during the phases of inhalation and exhalation, characterized in that the breathing gas provided by the breathing gas conveyor at least temporarily also serves to cool the breathing gas conveyor. Apparatus according to claim 1, characterized in that the breathing gas delivery device as a blower ( 38 ) consisting of an electric motor ( 39 ) with an impeller attached to the shaft end ( 40 ) is trained. Device according to Claim 1 or 2, characterized that the breathing gas conveyor in the airway of the ventilator is arranged such that from the suction side constantly fresh air flows after which from the breathing gas conveyor is accelerated and compressed, the fresh air, the breathing gas conveyor at least partially flows around and thereby heat from the breathing gas conveyor dissipated becomes. Device according to one of the preceding claims, characterized characterized in that the cooling minute volume also for cooling the electronic control and / or the sensor device is used. Device according to one of the preceding claims, characterized in that a sensor device has at least one parameter determines which represents a burden of Atemgasfördereinrichtung Device according to claim 5, characterized in that that the pressure of the breathing gas is used as parameter. Device according to claim 5, characterized in that that as a parameter the temperature of the respiratory gas in the high pressure area or the fan temperature is used. Device according to one of the preceding claims, characterized in that at least one determined parameter is used as a control variable for the control of the breathing gas conveyor. Device according to one of the preceding claims, characterized characterized in that the cooling minute volume if necessary increased becomes. Device according to one of the preceding claims, characterized characterized in that cooling minute volume is increased with increasing load of Atemgasfördereinrichtung. Device according to one of the preceding claims, characterized characterized in that the cooling minute volume while the exhalation increases becomes. Device according to one of the preceding claims, characterized characterized in that the cooling minute volume is increased by raising the engine speed. Device according to one of the preceding claims, characterized characterized in that the cooling minute volume gradually increased becomes. Device according to one of the preceding claims, characterized characterized in that the cooling minute volume infinitely increased becomes. Device according to one of the preceding claims, characterized characterized in that the cooling volume in the range 4 l / min to 40 l / min. Method of cooling a ventilation device in which a parameter is sensory, the load on the breathing gas conveyor represents is determined and this parameter at least as a control variable for the control the breathing gas conveyor is used and wherein the breathing gas conveyor the cooling minute volume generated. Method according to Claim 16, characterized that the cooling minute volume controlled load-dependent becomes. Method according to claim 16, characterized in that that the cooling minute volume in dependency of Respiratory system of the patient is controlled. Method according to claim 16, characterized in that that the cooling minute volume in dependency of Respiratory rate is controlled.