DE102021114801A1 - Medical device for monitoring patient positioning - Google Patents

Abstract

The invention relates to a medical device (100) for monitoring a patient positioning (592), with a position data interface (110), a respiration data interface (120), a processing unit (130) and an output unit (140). The position data interface is designed to receive a patient position signal (112), the patient position signal indicating patient position information (114) on a patient within the patient position. The respiration data interface is designed to receive a patient respiration signal (122), the patient respiration signal indicating at least one measured value (125) of a respiration parameter (124) of a respiration of the patient. The processing unit is designed to determine a patient rotation angle (115) from the patient position information, the patient rotation angle describing a rotation of the patient about a patient axis (598) defined by the head and feet of the patient, and the processing unit is further designed to process the measured values of the patient respiration signal together with the determined patient rotation angle in a time-synchronized manner and to trigger a corresponding comparison output (132).

Description

The invention relates to a medical device for monitoring patient positioning. Furthermore, the invention relates to a system for monitoring patient positioning and a method for monitoring patient positioning.

It is known to change the patient's position while a patient is being ventilated, for example in order to relieve the load on the lungs during ventilation. For example, lying on one side can prevent the patient's abdomen from pressing on the lungs. The patient can be positioned manually by the nursing staff or automatically, for example using a rotating bed.

The document CA2561704A1 describes a method for logging the position and status of the lung in the case of a lung that can be automatically positioned, for example, via a rotating bed. It is also described here that the ventilation pressure can be adjusted depending on the controlled lung position.

The object of the present invention is to provide an improved medical device, in particular a medical device, which conveniently shows a dependency between patient positioning and measured values of a respiration parameter.

According to a first aspect of the invention, a medical device for monitoring a patient positioning is proposed for solving this problem, with a position data interface, a respiration data interface, a processing unit and an output unit.

The position data interface is designed to receive a patient position signal, in particular to receive it essentially continuously, the patient position signal indicating patient position information about a patient within the patient positioning.

The respiration data interface is designed to receive a patient respiration signal, in particular to receive it essentially continuously, the patient respiration signal indicating at least one measured value of a respiration parameter of a respiration of the patient.

The processing unit is designed to determine a patient rotation angle from the patient position information, the patient rotation angle describing a rotation of the patient about a patient axis defined by the patient's head and feet, and the processing unit being further designed to combine the measured values of the patient's respiration signal with synchronized with the determined patient rotation angle and trigger a corresponding comparison output.

The output unit is designed to provide an output signal which indicates the comparison output.

Within the scope of the invention, it was recognized that the patient's rotation angle is a particularly suitable parameter of the patient's positioning in order to classify the current patient's positioning, in particular for observing the effect of the patient's positioning on the measured values of the respiration parameter. Proceeding from this, it was recognized that a time-synchronized processing of the measured values and the patient's rotation angle advantageously allows a display of a state of the lungs that is useful for the further treatment of the patient.

Position-specific differences between measured values of a respiration parameter indicate inhomogeneities in the lungs. In particular, a function of the left lung can advantageously be compared to a function of the patient's right lung.

The medical device according to the invention preferably only represents a development of the measured values and the patient's rotation angle, so that medical specialists can draw conclusions about the condition of the patient, in particular the condition of the patient's lungs, in a known manner. The change in patient positioning does not have to take place at a specific point in time observed by a nurse, but can be continuously monitored by the medical device, for example based on a natural movement of the patient.

The comparison output preferably enables an overview of a previous predetermined period of time and the automatically recorded dependency between the patient's rotation angle and the measured values of the respiration parameter.

The medical device according to the invention can advantageously be combined with existing medical devices since their data can be obtained via the position data interface and the respiration data interface and further processed according to the invention without having to position new sensors or similar additional equipment in the patient's surroundings.

Respiration parameters of a patient's breathing are understood to be parameters relating to the patient's breathing, such as ventilation parameters and/or vital parameters related thereto. According to the invention, the respiration of the patient can include the ventilation of the patient for respiratory support, during anesthesia, during an operation and/or for spontaneously breathing patients.

The patient position information indicates the position of the patient as part of the patient positioning, for example on a hospital bed. According to the invention, the patient's rotation angle can be determined in the form of a detected angle and/or in the form of a detected angle range. For example, optical sensors, such as a camera system, allow a specific angle to be determined using evaluation routines of a patient positioning that are known to those skilled in the art. However, pressure sensors or the like on the lying surface can only make an angular range of the patient's rotation angle detectable.

According to the invention, the time-synchronized processing of the patient's rotation angle and measured values requires a determination of the measured values from the patient's respiration signal. The measured values can be read out via the processing unit and/or via an upstream unit of the medical device according to the invention.

The two interfaces can be formed by a common interface or alternatively be spatially separated from one another.

The various units of the medical device according to the invention can be arranged in a common housing or at least partially separately from one another. These units are separated from each other at least at the software level.

The patient support is formed by a combination of the patient and a corresponding support means, such as a patient bed, a deck chair or a patient bed. The positioning of the patient thus also includes the position of the patient on the corresponding positioning means.

Preferred embodiments of the medical device according to the invention are described below.

In a particularly preferred embodiment, the processing unit is further designed to determine a patient tilt angle from the patient position information, the patient tilt angle describing a tilt angle of a patient's upper body relative to a reference plane. The reference plane is preferably a plane formed by the lying surface and/or a plane formed by the arrangement of the patient's legs.

Furthermore, the processing unit in this embodiment is preferably designed to process the measured values of the patient's respiration signal together with the determined patient rotation angle and the determined patient tilt angle in a time-synchronized manner and to trigger a corresponding comparison output. This combined evaluation of the patient's rotation angle and patient's tilt angle provides a particularly large amount of information about the performance of the lungs in different spatial orientations. As a result, the state of the lungs can be inferred particularly reliably by medical specialists.

In an advantageous embodiment, the patient position information relates to a lying position of the patient, a body pose of the patient and/or a bed configuration of the patient positioning. The lying position, the body pose and/or the bed configuration are preferably divided into different classes. For example, the reclining position can include the classes supine position, prone position, right lateral position, left lateral position, half right lateral position and/or half left lateral position. Alternatively or additionally, the body pose can also include the classes sitting upright, sitting semi-upright and/or the like. The bed configuration may include, for example, an adjusted tilt angle of an upper deck and/or an adjusted tilt angle of a lower deck. Such components of the patient position information can be indicated by the patient position signal in addition to or as an alternative to an already determined patient rotation angle. Such information can therefore enable a check as to whether the patient rotation angle determined by the processing unit may actually have been present. For example, a received classification that a prone position is present indicates that certain patient rotation angles certainly cannot currently be present. The patient's angle of rotation is preferably specified using a predetermined reference axis, which can be aligned, for example, within the lying surface or perpendicular to the lying surface.

In a further advantageous embodiment, the respiration parameter of the patient's respiration relates to at least one of the following parameters: partial oxygen saturation in the patient's blood; partial pressure of oxygen in the patient's arterial blood; inspired oxygen fraction; end-tidal partial pressure of carbon dioxide in exhaled meten gas mixture of the patient; patient oxygenation index; patient ventilation index; patient breathing rate; patient's peak ventilation pressure; patient's tidal volume; carbon dioxide partial pressure in the patient's capillary blood; regionally resolved, impedance-based metric. These respiration parameters are particularly suitable for being able to obtain information about the current condition of the patient and in particular about the current condition of the patient's lungs. The impedance-based index can relate to a regional compliance and/or a so-called regional ventilation delay, for example. Such key figures can, for example, be obtained automatically using imaging methods, for example when using an electro-impedance device.

In a particularly preferred embodiment, the processing unit is further designed to determine a position type that is currently present, the position type being based at least on the determined patient rotation angle. The positioning type here represents a discrete classification of the position of the patient within the framework of the patient positioning. The positioning type can, for example, indicate an angular range for the specific patient rotation angle and thus enable a comparison between different positions of the patient with a similar patient rotation angle. Such comparability also advantageously enables a statistical evaluation of measured values for the respiration parameter when the patient is in similar positions, ie in particular when the patient is in the same position.

In a particularly preferred variant of the previous embodiment, the positioning type is also based on the patient's tipping angle. In this variant, the current position of the person can be identified particularly reliably using the patient's rotation angle and the patient's tilt angle. The patient tilt angle is particularly relevant when the patient is at least slightly upright, for example while sitting.

In a further preferred variant of the preceding embodiment or in an example of the preceding variant of the embodiment, the comparison output provided via the output signal indicates a time profile of the measured values of the respiration parameter, with the positioning type being assigned essentially to each measured value. This time profile of the measured values and the associated positioning types enables a correlation between the positioning type and the measured value to be recorded particularly quickly by medical specialists. Even if no correlation is recognizable, conclusions about the condition of the patient, in particular the condition of the patient's lungs, can be drawn by the medical specialist, such as the exclusion of certain diseases due to the non-occurrence of a usual correlation for this.

As an alternative or in addition to the display of the progression over time of the measured values and the associated bearing types, a measure for the correlation of measured values and bearing type can be determined. An example of such a measure is a correlation coefficient between measured values and the patient's rotation angle.

The processing unit is particularly preferably further designed to determine and provide a position-dependent average value for the measured values of the respiration parameter, the position-dependent average value relating to an average of measured values with the same and/or similar positioning type. The formation of such an average value ensures that no disruptive events, such as connection problems or the patient coughing, temporarily indicate a physiologically non-existent connection between the measured value and the type of positioning. This average value can therefore be used to identify particularly reliably which measured values for the respiration parameter are typically achieved when the corresponding type of positioning is present. The average value is preferably formed by an arithmetic mean of the measured values for the same type of bearing in each case.

Based on the measured value or the average value, the medical device according to the invention can be used to determine the position-dependent change in oxygenation, the position-dependent change in ventilation such as position-dependent exhalation of CO2, and/or the position-dependent change in mechanical lung properties, depending on the respiration parameter used according to the invention such as the resistance or the elastic properties of the lungs.

In a further embodiment, the processing unit is further designed to carry out a comparison between measured values and/or position-dependent average values of different positioning types and to trigger a ventilation alarm depending on this comparison, in particular depending on a specific difference and a comparison of this difference with a difference threshold value. The respiration alarm can be an acoustic and/or visual alarm, in particular this alarm can be used as an indication message about an output, such as a display. In this exemplary embodiment, the difference is preferably a difference between an average value for a first bearing type from the different bearing types and an average value for a second bearing type from the different bearing types. Such a difference above a difference threshold value predetermined via physiological data can indicate, for example, a severe impairment of a lung of the patient. In an alternative or supplementary variant of this embodiment, the difference is a difference between measured values of a common positioning type, so that the difference indicates a large change in the measured value with comparable patient positioning. Such a change above a variance of the measured values taken into account by the predetermined difference threshold value indicates an acute change in the condition of the patient, in particular the condition of the patient's lungs. It is therefore particularly advantageous to trigger a corresponding alarm in order to inform medical personnel as quickly as possible of a changed patient condition.

In an advantageous embodiment, the processing unit is also designed to detect a subsequent change over time in the measured values of the respiration parameter when there is a change in the patient's rotation angle, the patient's tilt angle and/or the current positioning type, and in particular to classify it according to a stored assignment rule. In this embodiment, the processing unit advantageously recognizes when there is a change in the patient's position, and this change is related to a corresponding change over time in the measured values of the respiration parameter. This makes it possible to recognize, for example, what influence turning back into the supine position has on the patient's breathing. Such a change in the state when there is a change in position can indicate the presence of certain clinical pictures, so that a corresponding classification is advantageous in order to enable a rapid diagnosis by medical specialists. Rapid changes in readings as position changes typically occur due to instantaneous gravitational effects. An average rate of change in readings occurs, for example, due to a shift of free fluid and/or mucus in the lungs. However, a slow change in the measured values with a change in position can indicate an effect in the lung tissue and thus give rise to further examinations of the patient.

According to a second aspect of the invention, a system for monitoring a patient positioning is proposed to solve the above-mentioned object, with a medical device according to at least one of the preceding embodiments according to the first aspect of the invention, and a sensor unit that is designed to detect a patient position of the patient inside to detect the patient position and to output the corresponding patient position signal.

The system according to the invention includes the medical device according to the invention and consequently all the advantages of this medical device. In particular, the system according to the second aspect of the invention enables a particularly reliable evaluation of the patient's position, since the sensor unit and the processing unit of the medical device can be coordinated with one another. In particular, the processing unit can be calibrated prior to use by a user with respect to the data of the sensor unit in order to determine the patient's rotation angle from the patient's position information in a particularly reliable manner.

In an advantageous embodiment of the system according to the invention, the sensor unit includes a number of optical sensor elements that are designed to provide image data that indicate a current condition of the patient within the patient support. If the monitored area includes more than one patient's bed and this is movable, as is common in intensive care units, the area that depicts the patient's bed is extracted from the optical data in the first step. Known methods of object recognition on the depth image can be used to determine the relevant partial area of the data. Details of such an optical evaluation of the positioning of the patient, for example for determining the patient's rotation angle using such image data, are known to the person skilled in the art and are therefore not explained in detail below. Consequently, this embodiment is particularly advantageous because existing sensor units and an existing algorithm for evaluating the data of such a sensor unit can be used for the implementation of the system according to the invention.

In an alternative or supplementary embodiment to the previous embodiment, the system according to the invention comprises a sensor unit with position sensors which, for example, detect where the patient's support points are in the patient's bed on the basis of pressure sensitivity. This allows at least a rough classification into different positions of the patient and consequently corresponding patient position information can be determined.

In a further embodiment, the system also has a ventilator and/or an electroimpedance device and/or a patient monitor for providing the patient respiration signal with the at least one measured value of the respiration parameter of the patient's respiration. In this embodiment, the processing unit of the medical device and the device providing the patient's respiration signal can be matched to one another in a particularly advantageous manner. The processing unit can thus be calibrated to the specific measured values that are provided by the ventilator and/or the electroimpedance device and/or the patient monitor, in particular calibrated with regard to the determination of the difference threshold value. In a particularly advantageous variant, the conversion of raw data into concrete measured values by the ventilator and/or the electroimpedance device and/or the patient monitor can be avoided in that the processing unit according to the invention can already use the raw data for the processing according to the invention.

• - Empfangen eines Patientenlagesignals, wobei das Patientenlagesignal eine Patientenlageinformation zu einem Patienten innerhalb der Patientenlagerung indiziert;
• - Empfangen eines Patientenrespirationssignals, wobei das Patientenrespirationssignal mindestens einen Messwert eines Respirationsparameters einer Atmung des Patienten indiziert;
• - Bestimmen eines Patienten-Rotationswinkels aus der Patientenlageinformation, wobei der Patienten-Rotationswinkel eine Drehung des Patienten um eine durch Kopf und Füße des Patienten definierte Patientenachse beschreibt;
• - zeitlich synchronisiertes Verarbeiten der Messwerte des Patientenrespirationssignals zusammen mit dem bestimmten Patienten-Rotationswinkel und Auslösen einer entsprechenden Vergleichsausgabe; und
• - Bereitstellen eines Ausgabesignals, welches die Vergleichsausgabe indiziert.

According to a third aspect of the invention, a method for monitoring a patient positioning is proposed to solve the above-mentioned problem, having the steps:

• - receiving a patient position signal, the patient position signal indicating patient position information about a patient within the patient support;
• - receiving a patient respiration signal, wherein the patient respiration signal indicates at least one measurement of a respiration parameter of a respiration of the patient;
• - determining a patient rotation angle from the patient position information, the patient rotation angle describing a rotation of the patient about a patient axis defined by the head and feet of the patient;
• - time-synchronized processing of the measured values of the patient respiration signal together with the determined patient rotation angle and triggering a corresponding comparison output; and
• - Providing an output signal which indicates the comparison output.

The method according to the invention is carried out by the medical device according to the invention and therefore has all the advantages of this medical device. In particular, the method according to the invention advantageously allows a connection to be recognized between the measured values of the respiration parameter and the present patient rotation angle and/or the currently present positioning type. Furthermore, a dynamic change in the position of the patient can advantageously be evaluated in order to recognize whether this change in position has also led to a change in the measured value of the respiration parameter.

The method according to the invention particularly advantageously avoids the patient having to be repositioned manually, since positioning changes that have already taken place naturally are evaluated automatically and thus allow conclusions to be drawn about the patient's condition based on the temporal synchronization with the measured values.

The method steps according to the invention are preferably carried out in the order described. According to the invention, the first two steps, ie receiving the patient position signal and the patient respiration signal, can be carried out in reverse order. However, the patient rotation angle is always determined after the patient position signal has been received. The time synchronized processing can only occur after the patient rotation angle is determined and the patient respiration signal is received. The output particularly preferably takes place essentially in real time. Preferably, the method is performed within less than a minute, more preferably within less than 30 seconds, especially within less than 10 seconds.

• 1 eine schematische Darstellung eines ersten Ausführungsbeispiels eines Medizingerätes gemäß einem ersten Aspekt der Erfindung;
• 2 eine schematische Darstellung eines zweiten Ausführungsbeispiels des Medizingerätes gemäß dem ersten Aspekt der Erfindung;
• 3, 4 eine jeweilige beispielhafte Ausgabe durch eine Ausgabeeinheit des Medizingerätes gemäß dem ersten Aspekt der Erfindung;
• 5 eine schematische Darstellung eines Ausführungsbeispiels eines Systems gemäß einem zweiten Aspekt der Erfindung;
• 6 ein Flussdiagramm eines Ausführungsbeispiels eines Verfahrens gemäß einem dritten Aspekt der Erfindung.

The invention will now be explained in more detail with reference to advantageous exemplary embodiments that are shown schematically in the figures. Of these show in detail:

• 1 a schematic representation of a first embodiment of a medical device according to a first aspect of the invention;
• 2 a schematic representation of a second embodiment of the medical device according to the first aspect of the invention;
• 3 , 4 a respective exemplary output by an output unit of the medical device according to the first aspect of the invention;
• 5 a schematic representation of an embodiment of a system according to a second aspect of the invention;
• 6 a flow chart of an embodiment of a method according to a third aspect of the invention.

1 shows a schematic representation of a first embodiment of a medical device 100 according to a first aspect of the invention.

The medical device 100 is designed to monitor patient positioning. For this purpose it has a position data interface 110 , a respiration data interface 120 , a processing unit 130 and an output unit 140 . The medical device 100 is surrounded by a common housing 102

The two interfaces 110 and 120 are spatially separated from one another in a common receiving unit 105 of the medical device 100 . The position data interface 110 is designed to receive a patient position signal 112, the patient position signal 112 indicating patient position information 114 on a patient within the patient position. The respiration data interface 120 is designed to receive a patient respiration signal 122, the patient respiration signal 122 indicating at least one measured value 125 of a respiration parameter 124 of a respiration of the patient. Patient position information 114 and respiration parameters 124 are shown as part of the respective signal 112, 122 for reasons of clarity. The two signals 112, 122 are transmitted wirelessly in the illustrated embodiment. In an alternative exemplary embodiment, the transmission is cable-based. The structure of such interfaces for the wireless or cable-based transmission of signals is known in principle to the person skilled in the art, so that it is not discussed in detail below.

The receiving unit 105 is designed to output correspondingly preprocessed signals 117, 118 to the processing unit 130. In this case, the pre-processing includes such an adaptation of the patient position signal 112 and the patient respiration signal 122 that the corresponding signals 117 , 118 can be processed by the processing unit 130 . The communication between receiving unit 105 and processing unit 130 is cable-based.

The processing unit 130 is designed to determine a patient rotation angle 115 from the patient position information 114, the patient rotation angle 115 describing a rotation of the patient about a patient axis defined by the patient's head and feet. The patient axis is a straight line that describes a longitudinal alignment of the patient. Thus, when the patient is in a lying position, the patient's axis is preferably an axis which intersects the head and a center of gravity of the patient and runs in the area of the two feet. A time course of patient rotation angles 115 and measured values 125 is shown, in which a current value is always added to the values already stored. In the illustrated embodiment, patient rotation angles and readings are cleared after a predetermined storage time interval. The processing unit 130 is further designed to process the measured values 125 of the patient's respiration signal 122 together with the determined patient rotation angle 115 in a synchronization module 134 in a time-synchronized manner and to trigger a corresponding comparison output 132 . In this case, the comparison output 132 is triggered by the synchronization signal 136 which is received by the output unit 140 of the medical device 100 .

The output unit 140 is designed to provide an output signal 142 which indicates the comparison output 132 . It has an output interface 144 for this purpose. The output unit 140 communicates via the output interface 144 with an external output device 150 which has a display 152 for the graphic output of the comparison output 132 . In the exemplary embodiment shown, the comparison output 132 is a graph over a time axis, with areas of different patient rotation angles being optically distinguished from one another. Such a visual distinction can be made by using differently colored areas and/or by using lines to visualize a change in position. This type of display is used in the context of 3 explained.

In the exemplary embodiment shown, the respiration parameter is the partial oxygen saturation in the patient's blood. In principle, various parameters of the patient's respiration are suitable for the respiration parameter according to the invention. Preferably, the respiratory parameter relates to at least one of the following parameters: partial oxygen saturation in the patient's blood; partial pressure of oxygen in the patient's arterial blood; inspired oxygen fraction; end-tidal partial pressure of carbon dioxide in the patient's expired gas mixture; patient oxygenation index; patient ventilation index; patient respiratory rate; patient's peak ventilation pressure; patient's tidal volume; carbon dioxide partial pressure in the patient's capillary blood; regionally resolved, impedance-based metric.

As is known, various properties of the patient can be examined via parameters of this type and their change due to the position of the patient. That can vary dependent change in patient oxygenation. Alternatively or in addition, the exhalation of CO2 and/or the change in mechanical lung properties can be monitored. Such lung properties are, for example, the dynamic resistance of the lungs and/or elastic properties of the lungs, such as the so-called compliance, ie elasticity, of the lungs.

The temporal synchronization of the received data can take place, for example, based on the point in time at which the data was received by the medical device 100 according to the invention. Alternatively or additionally, the time synchronization can be based on the received data, for example based on a time stamp that has already been supplied by an external device. According to the invention, it is only important that there is a temporal connection between the measured values of the respiration parameter and the patient rotation angles assigned on the basis of the temporal synchronization. A time difference between a point in time at which the patient rotation angles were determined and a point in time at which the corresponding measured values of the respiration parameter were received is preferably less than 60 seconds, preferably less than 30 seconds, particularly preferably less than 10 seconds.

In the exemplary embodiment shown, the measured values 125 are determined from the pre-processed signal 118 by the processing unit 130 . Alternatively or additionally, the measured values can already be determined by the receiving unit 105 or an additional unit of the medical device according to the invention.

The components of the medical device according to the invention can be arranged in a common housing, as in the illustrated exemplary embodiments, or alternatively can be arranged at least partially spatially separate from one another. The communication between components of the medical device can be cable-based or wireless.

2 shows a schematic representation of a second exemplary embodiment of the medical device 200 according to the first aspect of the invention.

The medical device 200 differs from that in 1 Medical device 100 illustrated in that the position data interface and the respiration data interface are arranged within a common data interface 228. The data interface 228 has individual components that separate the two interfaces from one another at least at the software level.

Furthermore, the medical device 200 differs in that the processing unit 230 is designed to determine not only the patient rotation angle 115 but also a patient tilt angle 216 from the patient position information 114 . The patient tilt angle 216 and the patient rotation angle 115 are further processed in order to determine a positioning type 260 therefrom. The positioning type 260 allows the current position of the patient to be classified depending on the parameters of this position that can be read from the patient position information 114 .

This is followed by a time-synchronized processing of the corresponding measured values 125 with the storage type 260 present during the determination and/or reception of this measured value. The comparison output 232 also shows an assignment of the measured values to the corresponding storage type 232, which is not shown here for reasons of clarity is shown.

The positioning type 260 can be, for example, a classification of the patient's position into a supine position, a right lateral position, a left lateral position and a prone position. In addition, a finer subdivision can be made, for example into a half-right side position and a half-left side position. Alternatively or additionally, the positioning type can describe an angular range of the patient's rotation angle and/or the patient's tilting angle.

By classifying the position of the patient, different measured values that were obtained with a comparable position of the patient can advantageously be related to one another. In the exemplary embodiment shown, an averaging module 270 is used in the processing unit 230 in order to determine and provide a position-dependent average value for the measured values 125 of the respiration parameter 124 . The position-dependent average value relates to an average of measured values 125 with the same and/or similar storage type 260.

As an alternative or in addition to determining a position-dependent average value for the measured values, the processing unit can also be designed to record a subsequent change over time in the measured values of the respiration parameter in the event of a change in the patient's rotation angle, the patient's tilt angle and/or the current positioning type to be classified according to a stored assignment rule. The dynamics of such a change can be a specific indicate clinical picture. Thus, a rapid change can be caused by instantaneous gravitational effects, while a moderate dynamic arises from the displacement of free fluid or mucus in the lungs. On the other hand, there can be a slow change in effects in the lung tissue. Based on the existing dynamics of the change in the measured value when there is a change in position, medical specialists can thus obtain further auxiliary variables in order to assess the condition of the lungs for further treatment.

In an embodiment that is not shown, the determination of the average value is made possible by a comparison between the current measured values and this average value for a specific positioning type, so that a ventilation alarm can be triggered depending on the resulting difference. In this case, the difference is preferably compared with a difference threshold value, which advantageously takes into account an expected variance of the measured values received. Only when a measured value deviates significantly more from the average value than the expected variance can it be assumed that an acute change in the patient's condition is occurring, to which the medical nursing staff should be made aware. Such measured values are preferably taken into account in the comparison to the average value which were received clearly after a detected change in the patient's position and therefore do not deviate from the average value due to a change in position.

Finally, the medical device 200 differs from the medical device 100 in that no external output device 150 is provided, but the output unit 240 is connected directly to a display unit 255 of the medical device 200 .

In a further exemplary embodiment, which is not shown, the patient position information includes, in addition to sensor data, as is the case, for example, in the context of 5 are explained, data relating to a classification of the patient's position, for example a classification of the lying position of the patient, a body pose of the patient and/or a bed configuration of the patient positioning. For example, a parameter set that indicates the current setting of the patient's bed can be received via the patient's position information.

the 3 and 4 show a respective exemplary comparison output 332, 432 by an output unit of the medical device according to the first aspect of the invention.

The comparison edition 332 in 3 FIG. 3 shows a diagram which represents time via the X-axis 380 and the partial oxygen saturation in the blood of the patient via the Y-axis 385. A measured value curve 386 is plotted here, which shows the measured values received continuously over time. A proportion of oxygen in the inhaled gas mixture that is kept constant in the present ventilation mode, that is to say the inspiratory oxygen fraction 387, is also shown as a comparison variable.

It can be clearly seen that after a change in position 388, as represented by vertical lines, there is a change in the measured values. The measured value curve 386 essentially corresponds to a stepped curve, with a change only taking place in the area of the change in position 388 .

The comparison output 332 shown makes it clear that the medical device according to the invention automatically supplies the medical specialist with different parameters for the position-dependent respiration parameter. A characteristic value of the corresponding measured values can thus be determined for each positioning type and/or each angular range of the patient's rotation angle. In addition, with each change in position 388, a dynamic of the respiration parameter for the respective change in position can be recognized. As explained above, this allows conclusions to be drawn about the current condition of the patient, in particular the current condition of the patient's lungs.

The comparison edition 432 in 4 shows a table structure 490, with each bearing type 260 being shown an average value 465 of the corresponding measurement values associated with this bearing type 260. This table structure 490 can alternatively or additionally correspond to a diagram 3 be issued.

As explained above, the respective output can take place via a display of the medical device according to the invention or via an external output device that is objected to by the medical device.

5 shows a schematic representation of an embodiment of a system 500 according to a second aspect of the invention.

The system 500 is designed to monitor a patient support 592 . The system has the medical device 200 according to the invention and a sensor unit 595 for this purpose. For reasons of clarity, the structure of the medical device 200 is not shown in detail. In the exemplary embodiment shown, however, it is the same medical device 200 that was already used in 2 is shown. The display unit is different than in 2 a table structure 490 as output, along with other measurements of vital signs of the treatment.

The sensor unit 595 is designed to detect a patient's position within the patient support 592 and to output the corresponding patient position signal 112 .

The sensor unit 595 is an optical sensor unit which determines the patient position signal 112 via a plurality of optical sensor elements 596 and subsequent processing. The functioning of such a sensor unit 595 is known to the person skilled in the art. The algorithm for detecting patient rotation angle typically consists of a sequence of steps: detecting a patient bed; detecting a patient location; Weighting of pixels of the detected patient position. Details on this are given, for example, in Grimm et al. (“Sleep Position Classification from a Depth Camera using Bed Aligned Maps”, 2016 23rd International Conference on Pattern Recognition (ICPR), 2016, pp. 319-324, doi: 10.1109/ICPR.2016.7899653).

In an alternative exemplary embodiment, the sensor unit at least partially includes pressure sensors that are arranged on a lying surface of the patient's bed. Based on the dynamics of the correspondingly detected pressure signals, a rotation in a certain direction can also be inferred.

In the exemplary embodiment shown, the system 500 additionally includes a ventilator 597 which is currently being used to ventilate the patient and which is designed to provide the patient respiration signal 122 with the at least one measured value of the respiration parameter of the patient's respiration.

The provision of a system 500 of ventilator 597, medical device 200 and sensor unit 595 according to 5 . advantageously enables the medical device to be calibrated using the data from the other devices in the system 500. This can, for example, improve the accuracy of the time synchronization of measured values and patient rotation angles and/or positioning types to be carried out, since a systematic time offset can be taken into account, for example.

In the exemplary embodiment shown, the various devices of the system according to the invention are spatially separated from one another. In an exemplary embodiment that is not shown, these devices are at least partially combined with one another. Alternatively or additionally, communication between devices can also take place via a network, such as a hospital network, and/or via an additional device, such as a patient monitor. Alternatively or additionally, the system according to the invention can comprise an electrical impedance device.

According to the teaching presented, the system according to the invention can have additional devices. For example, the patient's bed can have a type of automatic control, which also emits a signal to the medical device according to the invention in order to determine the position of the patient, such as a patient's tipping angle. In this sense, the patient position signal can include a combination of signals from different devices, such as a combination of signals from an optical sensor and a patient value, in order to calculate the patient rotation angle, the positioning type and/or the patient tilt angle or the like from this combination according to the invention determine.

Additionally is in 5 the patient axis 598 is shown, which is automatically determined from the information from the sensor unit 595.

6 FIG. 6 shows a flowchart of an embodiment of a method 600 according to a third aspect of the invention.

The method 600 is designed to monitor patient positioning. To do this, it has the steps described below.

A first step 610 includes receiving a patient position signal, the patient position signal indicating patient position information about a patient within the patient support.

A further step 620 includes receiving a patient respiration signal, the patient respiration signal indicating at least one measured value of a respiration parameter of a respiration of the patient.

A next step 630 includes determining a patient rotation angle from the patient position information, the patient rotation angle describing a rotation of the patient about a patient axis defined by the patient's head and feet.

A subsequent step 640 includes a time-synchronized processing of the measured values of the patient respiration signal together with the determined patient rotation angle and triggering a corresponding comparison output.

A final step 650 includes providing an output signal that indicates the comparison output.

The first three steps 610, 620, 630 can also be carried out in a different order. However, the patient rotation angle can only be determined after the patient position signal has been received. The further steps 640 and 650 always take place only after the execution of the first three steps 610, 620, 630.

The signals according to the first two method steps can continue to be received while the concluding method steps 640, 650 for the preceding method sequence have not yet been completed. The method 600 according to the invention is particularly preferably carried out essentially in real time. In particular, less than 60 seconds, in particular less than 30 seconds, particularly preferably less than 10 seconds elapse between the receipt of the two signals and the provision of the output signal.

In a variant of this exemplary embodiment, measured values of a respective bearing type are averaged over a previous, predetermined period of time to form an average value. In this case, stored previous measured values are preferably used, which are stored in an internal memory at least for the predetermined period of time. The preceding predetermined period of time comprises at least 10 minutes, in particular at least 30 minutes, particularly preferably at least 60 minutes.

In a variant of this exemplary embodiment, the method steps are carried out at a common location. Alternatively, at least individual method steps can be carried out at a distance from one another.

reference list

100,200

medical device

102

Housing

105

receiving unit

110

location data interface

112

patient position signal

114

Patient Position Information

115

Patient rotation angle

117, 118

preprocessed signal

120

Respiratory Data Interface

122

patient respiration signal

124

respiratory parameters

125

reading

130, 230

processing unit

132, 232, 332, 432

comparison output

134

synchronization module

136

synchronization signal

140, 240

output unit

142

output signal

144

output interface

150

external output device

152

screen

216

patient tilt angle

228

data interface

255

display unit

260

storage type

270

averaging unit

380

X axis

385

Y axis

386

measured value curve

387

inspiratory oxygen fraction

388

change of position

465

average value

490

table structure

500

system

592

patient positioning

595

sensor unit

596

optical sensor element

597

ventilator

598

patient axis

600

procedure

610, 620, 630, 640, 650

process steps

QUOTES INCLUDED IN DESCRIPTION

This list of documents cited by the applicant was 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.

Patent Literature Cited

• CA 2561704 A1 [0003]

Claims (14)

Medical device (100) for monitoring a patient positioning (592), with - a position data interface (110), which is designed to receive a patient position signal (112), the patient position signal (112) indicating patient position information (114) on a patient within the patient positioning (592), - a respiration data interface (120), which is designed to receive a patient respiration signal (122), the patient respiration signal (122) indicating at least one measured value (125) of a respiration parameter (124) of a respiration of the patient, - a processing unit (130) which is designed to determine a patient rotation angle (115) from the patient position information (114), the patient rotation angle (115) being a rotation of the patient about a patient axis ( defined by the head and feet of the patient) 598) describes, and wherein the processing unit (130) is further designed to process the measured values (125) of the patient respiration signal (122) together with the determined patient rotation angle (115) in a time-synchronized manner and to trigger a corresponding comparison output (132), - An output unit (140) which is designed to provide an output signal (142) which indicates the comparison output (132). Medical device (200) according to claim 1 , wherein the processing unit (230) is further designed to determine a patient tilt angle (216) from the patient position information (114), the patient tilt angle (216) describing a tilt angle of a patient's upper body relative to a reference plane, and the processing unit (230) is further designed to process the measured values (125) of the patient respiration signal (122) together with the determined patient rotation angle (115) and the determined patient tilt angle (216) in a time-synchronized manner and to trigger a corresponding comparison output (232). Medical device (100) according to claim 1 or 2 , wherein the patient position information (114) relates to a lying position of the patient, a body pose of the patient and/or a bed configuration of the patient support (592). Medical device (100) according to at least one of the preceding claims, wherein the respiration parameter (124) of the patient's respiration relates to at least one of the following parameters: partial oxygen saturation in the patient's blood; partial pressure of oxygen in the patient's arterial blood; inspired oxygen fraction (387); end-tidal partial pressure of carbon dioxide in the patient's expired gas mixture; patient oxygenation index; patient ventilation index; patient breathing rate; patient's peak ventilation pressure; patient's tidal volume; carbon dioxide partial pressure in the patient's capillary blood; regionally resolved, impedance-based metric. Medical device (200) according to at least one of the preceding claims, wherein the processing unit (230) is further designed to determine a currently available positioning type (260), the positioning type (260) being based at least on the determined patient rotation angle (115). Medical device (200) according to claim 2 and 5 , wherein the positioning type (260) is further based on the patient tilt angle (216). Medical device (200) according to claim 5 or 6 , wherein the comparison output (232) provided via the output signal (142) indicates a time course of the measured values (125) of the respiration parameter (124), with essentially each measured value (125) being assigned the positioning type (260). Medical device (200) according to at least one of Claims 5 until 7 , wherein the processing unit (230) is further designed to determine and provide a position-dependent average value (465) for the measured values (125) of the respiration parameter (124), the position-dependent average value (465) being an average of measured values (125) with the same and / or similar storage type (260). Medical device (200) according to at least one of Claims 5 until 8th , wherein the processing unit (230) is designed to carry out a comparison between measured values (125) and/or position-dependent average values (465) of different storage types (260) and depending on this comparison, in particular depending on a specific difference and a comparison of this difference with a Difference threshold to trigger a ventilation alarm. Medical device (200) according to at least one of the preceding claims, wherein the processing unit (230) is further designed to to record subsequent changes over time in the measured values (125) of the respiration parameter (124), in particular correspondingly to classify a stored assignment rule. System (500) for monitoring a patient positioning (592), with - a medical device (100) according to at least one of the preceding claims, and - A sensor unit (595) which is designed to detect a patient position of the patient within the patient support (592) and to output the corresponding patient position signal (112). System (500) according to claim 11 , wherein the sensor unit (595) comprises a number of optical sensor elements (596) which are designed to provide image data which indicate a current condition of the patient within the patient support (592). System (500) according to claim 11 or 12 , further comprising a ventilator (597) and/or an electroimpedance device and/or a patient monitor for providing the patient respiration signal (122) with the at least one measured value (125) of the respiration parameter (124) of the patient's respiration. A method (600) for monitoring a patient support (592), comprising the steps of - receiving a patient position signal (112), the patient position signal (112) indicating patient position information (114) about a patient within the patient support (592); - receiving a patient respiration signal (122), the patient respiration signal (122) indicating at least one measurement (125) of a respiration parameter (124) of a respiration of the patient; - determining a patient rotation angle (115) from the patient position information (114), wherein the patient rotation angle (115) describes a rotation of the patient about a patient axis (598) defined by the head and feet of the patient; - Time-synchronized processing of the measured values (125) of the patient respiration signal (122) together with the determined patient rotation angle (115) and triggering a corresponding comparison output (132); and - providing an output signal (142) which indicates the comparison output (132).

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