DE102017127455A1 - breathing device - Google Patents

Abstract

The present invention relates to a ventilation device for the respiration of a spontaneously breathing patient (1), in particular premature babies, comprising a respiratory gas generating device (7) and a tube system (2,3), wherein the tube system (2, 3) a breathing gas supply line (2), a generator (5), a plant part (4) for engagement with the mouth / nose part of the patient (1) and a breathing gas discharge (3), further comprising a control unit (6), which is characterized in that a flow meter (8) in the Breathing gas discharge (3) is arranged.

Description

The present invention relates to a ventilation device for the ventilation of spontaneously breathing patients, in particular for the ventilation of newborns.

In invasive forced ventilation, an intubated patient is supplied with a heated and humidified respiratory gas stream from a ventilator via an inspiratory line. This ends in a Y- or T-shaped piece, from which a lead leads to an endotracheal tube and thus into the patient. In this line there is a volumetric flow sensor which measures the gas flow coming to the patient or from the patient. The outflowing gas is then supplied to an exhalation valve on the respirator in an expiration line which is also attached to the Y or T piece and discharged from there into the environment.

Deratige known devices can perform in addition to an invasive forced ventilation usually triggered by a respiratory activity of the patient in various ways, invasive ventilation.

Gentler for the patient is non-invasive ventilation. In this device are used, the CPAP (Continuous Positive Airway Pressure) are performing, so a permanent, positive pressure to the atmosphere positive pressure (PEEP), generating, which prevents a collapse of the lungs and the Inhalation easier. In these devices, a high volume flow of a previously suitably mixed and also tempered and humidified breathing gas is passed through a supply air line in a so-called generator, which swirls the breathing gas.

For this generator, or this vortex chamber takes a spontaneous breathing patient via a in or before his nostrils ending nozzle (Prong) breathing air or exhales in this generator, such a Prong usually arranged in a preemie at a, the head covering cap and by means of this safely placed in front of the nostrils. From the generator leads an exhaust duct into the environment. Usually, a pressure sensor line with a pressure sensor is connected to the generator, so that the pressure prevailing in the generator pressure can be monitored by a corresponding ventilator. Due to the very high compared to the respiratory flow offered Atemgasstroms the pressure fluctuations in the generator are very low, so that such devices can detect leaks but not the breathing safely, especially not the depth of inspiration and no distinction of respiratory flow fluctuations and fluctuations due to leaks in the ventilation system can meet.

In the DE 10 2008 017 339 A1 In order to reduce the unused gas consumption, a ventilation system is proposed which has an inspiratory and an expiration branch, the former including a controllable gas inlet and the latter having an expiration valve whose threshold pressure can be predetermined. This pressure is approximated to the exhalation pressure of the patient. Behind the expiration valve is a flow sensor that measures qualitatively whether there is a gas flow. Via a control unit, the corresponding yes / no information is passed to the gas inlet, which accordingly increases the flow or lowers it to almost zero. The disadvantage here is that only a qualitative statement about the sum of respiratory flow and leakage losses is delivered. In addition, at the Expirationsventil, which must be bridged, additional leaks occur. An incorrectly set threshold pressure is another source of error. In addition, the length of time from the breath to the arrival of the corresponding signal at the gas inlet by the valve to be bridged increases, thereby adversely increasing the shift between respiratory rhythm and ventilation rhythm.

The object of the invention is therefore to provide a ventilation device which reduces the gas consumption in the operating case, the respiratory rhythm of the patient in phase supportive and at the same quantitative information about the spontaneous breathing of the patient supplying and utilizing.

To achieve this object, a ventilation device for the ventilation of a spontaneously breathing patient is proposed, in particular for premature babies, comprising a respiratory gas generating device and a hose system, the hose system having a respiratory gas supply line, a generator, a system component for engaging the patient's mouth / noseparty and a breathing gas discharge , further comprising a control unit, which is characterized in that a volumetric flow sensor is arranged in the breathing gas discharge.

With a very large and surprising advantage, the invention proposes the arrangement of a volume flow sensor in the breathing gas discharge before a device for non-invasive ventilation.

Under breathing gas, the invention means that gas which is offered to a patient for breathing and in particular is mixed by the respiratory gas generating device and is usually also tempered and moistened. This breathing gas can therefore have any required oxygen content and in addition to oxygen and nitrogen also have other gases. Of these, the invention distinguishes the inhaled or exhaled gas, which is the gas that comes in contact with the patient or came. The respiratory gas generating device - the actual respirator - preferably includes all the necessary gases and the usual mixing, temperature control and humidity control devices, as well as other common components such as gas and electrical connections also in terms of data storage and transmission and display. The hose system is one of commercially available hose materials and diameters. The generator is as described a device for generating respiratory gas vortices, wherein the respiratory gas supply line, the breathing gas discharge and the system part (the prong) are arranged or fastened thereto. The generator is the component of the device in which the required respiratory gas pressure is built up, whereby a stronger vortex formation for the breathing activity is advantageous. Because of this strong vortex formation, the pressure fluctuations in the generator are rather low, so that the respiratory activity of the patent imparted very little to the volumetric flow offered.

With very great advantage, the invention now proposes to arrange a volume flow sensor in the hitherto freely in the space ending breathing gas discharge. Although this increases in principle the flow resistance, but advantageously allows the determination of the respiratory activity, in which he determines the sum of the normal breathing gas flow without respiratory activity and with inhalation and exhalation of a patient. The provision of such a flow direction sensing volume flow sensor at this point of the ventilator thus for the first time enables the measurement of a patient's respiratory effort without having to flow the respiratory gas through a sensor which would be located directly or very close to the patient between it and the ventilator at Prongs just for premature is difficult to achieve. He also overcomes the disadvantages of the previously known attempts to Atemtätigkeitsbestimmung, such as pressure sensors or sensors, which are arranged between the back of the patient lying and the bed or as a strain gauge around the chest, so as to draw conclusions about the breathing activity of the patient. Especially with small preemies such external motion sensors are difficult and error prone.

The determinability of these values is due to the fact that the control unit is calculating in the operating state from the data of the volume flow sensor, the tidal volume and the volume flow of breathing air, in particular from these apnea phases is also recognizing, for which they have appropriately programmed software. This is possible by differentiating between inhalation and exhalation phases, as a result of which the basic flow of the respiratory gas can also be determined. In addition, leaks could be detected in the case of suddenly occurring, larger changes in the volume flow.

In an embodiment of the invention, it is provided that the volumetric flow sensor each has two arranged in the flow direction one behind the other, and brought in the operating state to increased and kept constant operating temperatures, electrical conductor tracks. By thus constructed, very fast and very precise reacting sensors is achieved with advantage that even small volume flow fluctuations of the high breathing gas background current due to the breathing activity of the patient can be detected. Such flowmeters have a very high accuracy of measurement, which is essential for the operation of the device according to the invention - only by this very high accuracy of measurement is the measurement of the very small amplitudes of the breathing cycle on the much higher injected Atemgasgrundfluss possible. Thus, the invention of the prior art, in which a quantitative Atemflussmessung due to the achievable there, comparatively low accuracy does not take place, stands out clearly.

If different characteristic curves for different generators are stored in the controller, the device according to the invention can also be operated with such different generators without the need for further structural or technical adaptations.

Finally, the invention still provides that a pressure measuring line between the generator and breathing gas generating device is arranged. As a result, in addition to the breathing activities of a patent, further operating parameters can be detected, which are helpful for securing the functionality of the device.

In an advantageous embodiment of the invention, the gas composition of a breathing gas fed in the operating state, in particular the oxygen content, can be regulated by the control unit. As a result, the composition of the supplied gas is adaptable to the needs of the patient without additional control modules.

According to the invention, it is further provided that the ventilation device is designed and set up to be able to carry out normal invasive ventilation in addition to the described ventilation method nCPAP, for which it knows the appropriate connections, exhalation valves and a correspondingly configured and arranged at the gas supply device programmed control. In particular, it is also adapted to perform high frequency oscillatory ventilation (HFOV), as it is important for premature babies.

• 1: ein Schema einer Ausführungsform der Erfindung im Betriebszustand und
• 2: Zusammenhang von Atemgasgrundstrom und Atemtätigkeit.

In the following the invention will be described in greater detail by means of an example drawing, in which:

• 1 a schematic of an embodiment of the invention in the operating state and
• 2 : Connection of respiratory gas background current and respiratory activity.

In 1 the invention is shown schematically in an embodiment in the operating state. At a gas supply device 7 is one, in a generator 5 ending breathing gas supply 2 arranged. Through this, in the case of use, a breathing gas with a certain basic volume flow into the generator 5 introduced and there so swirled that a lung of, in the case of use of the device connected to this, patients 1 is biased and so his breathing is facilitated. The in the breathing gas supply 2 prevailing pressure can be up to 400 mm of water and is significantly reduced at the generator outlet, for example, 10 mm or 5 mm water column or less, depending on the selected and applied volume flow.

The usually existing humidifier (Humidifier) is not shown as well as a tempering. At the patient 1 is an investment part 4 (Prong) arranged, which is either directly in front of his nostrils or by means of a short neck in this ending and usually arranged and aligned by means of cap or mask on the head of the patient. The vast majority of the breathing gas base flow is unused by a breathing gas discharge 3 stepping outside. Advantageously, an exhalation valve is superfluous.

Between generator 5 and gas supply device 7 is a pressure measuring line 9 arranged, wherein the pressure sensor, not shown, usually in the gas supply device 7 is arranged.

A control unit 6 is with the gas supply device 7 and a volumetric flow sensor 8th in the breathing gas discharge 3 via data and / or control lines 10 controlled connected formed.

The gas supply device 7 is a breathing gas in the breathing gas supply 2 feeding in, taking the relevant parameters as a function of the control unit 6 is changing. These include gas composition, gas flow, gas temperature, gas humidity and others more.

The invention in the Atemgasableitung 3 provided volume flow sensor 8th is with the controller 6 formed indirectly or directly connected. This is in the case of use, the gas flow in the Expirationszweig 3 measuring, which results from fed gas flow as a basic variable, superimposed with the inhalation and exhalation flow of the patient 1 , as well as leakage losses. The fluctuations in the volume flow are therefore correspondingly low in comparison to the basic volume flow 13 , so only highly accurate flow sensors in the flow sensor 8th can be used. Typically, for example, with a base flow rate of 8,000 ml / min, fluctuations of +/- 2.5 ml / min are to be precisely measured to the controller 6 to provide appropriate information for controlling the basic volume flow. Such a precision of the flow measurement is achievable according to the invention only with flow sensors containing temperature sensors, which are in the operating state increased and kept constant operating temperatures, and in which measured value recording of the required energy supply to maintain the temperature is constant. In addition, these sensors according to the invention also have a flow direction measurement, in particular by two temperature sensors spaced apart from one another in the flow direction, in which the temperature sensor located in the lee has a lower energy input than that in the windward position.

The control unit 6 In the operating state, the exhaled volume flow, the inhaled volume flow and the basic volume flow are calculated from the data collected and provided with appropriate software for this purpose. By integration over the inhalation and exhalation, it is also the inhalation and expiratory volume of the patient 1 Detecting. It contains further stored flux-pressure curves of different generators 5 , so that the device according to the invention with all commercially available generators 5 operable and their respective characteristic relationship between the adjusted volume flow and the pressure applied to the Prongausgang know and using.

This connection is in 2 shown.

Evident is an idealized volume flow, which is shown here approximately as a sinusoid. The time [t] is plotted on the x-axis, the y-axis contains the volume flow dV / dt. The interruptions of the y-axis should symbolize that the changes in the volume flow are small in comparison to the basic volume flow 13 , In particular, there are changes in the order of a few milliliters per minute, for example, of 2.5 ml / min at a basic volume flow 13 of about 8,000 ml / min. The above the Basic volume flow 13 lying part of the curve symbolizes the expiratory volume flow 11 , wherein an exhalation volume as an integral between the two associated intersections with the basic volume flow 13 results. Accordingly, the inspiratory volume flow 12 the part of the curve that is below the basic volume flow 13 lying and the inspiratory volume that area, which is due to integration between the two associated intersections with the basic volume flow 13 results.

In the case of an apnea, the device according to the invention is able to recognize these safely, since in such a case just no fluctuation in the basic volume flow 13 occurring. In this case, the device according to the invention is designed to give a warning signal, for example in optical or acoustic or a combined warning signal.

With great advantage, the inventive arrangement allows a flow sensor with flow direction detection in the breathing gas discharge 3 Surprisingly, a completely new mode of operation of the device according to the invention, which is the next possible for self-contained breathing activity of a patient and thus minimally invasive. In particular, the ventilation of preemies is so gently enabled. The device is

LIST OF REFERENCE NUMBERS

1

patient

2

Breathing gas supply line

3

Respiratory gas discharge

4

plant part

5

generator

6

control unit

7

Gas supply device

8th

Flow Sensor

9

Pressure gauge line

10

Data / control line

11

Ausatemvolumenstrom

12

Einatemvolumenstrom

13

Basic Flow

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• DE 102008017339 A1 [0006]

Claims (7)

Respiratory device for the respiration of a spontaneously breathing patient (1), in particular premature babies, comprising a respiratory gas generating device (7) and a tube system (2,3), wherein the tube system (2, 3) a breathing gas supply line (2), a generator (5), a Plant part (4) for contact with the mouth / nasal part of the patient (1) and a Atemgasableitung (3), further comprising a control unit (6), characterized in that a volume flow sensor (8) in the breathing gas discharge (3) is arranged. Ventilation device after Claim 1 , characterized in that the control unit (6) in the operating state, the composition of the gas supply device (7) fed gas, in particular its oxygen content, is regulating. Ventilation device after Claim 1 or 2 , characterized in that the control unit (6) in the operating state from the data of the volume flow sensor (8), the tidal volume and the flow rate of the breathing air is calculating, in particular from these also apnea phases is discerning. Ventilation device after Claim 1 . 2 or 3 , characterized in that the volumetric flow sensor (8) in each case two in the flow direction arranged one behind the other, and brought in the operating state to increased and kept constant working temperatures, electrical conductor tracks. Ventilation device according to one of the preceding claims, characterized in that in the controller (6) different characteristic curves for different generators are stored. Ventilation device according to one of the preceding claims, characterized in that a pressure measuring line (9) between the generator (5) and breathing gas generating device (7) is arranged. Respiratory device according to one of the preceding claims, characterized in that it is additionally designed carrying out a normal invasive ventilation.

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