DE202007003818U1 - Portable pneumotachograph for measuring components of the expiratory volume - Google Patents

Abstract

Portable pneumotachograph for determining components of the expiratory volume
a processor (3),
an exhalation PEEP valve (4) attached to the pneumotachograph (1),
a filter (5) mounted on the inhalation side of the pneumotachograph (1) for removing the proportion of component to be determined in the inspiratory air,
at least one sensor (7) mounted in or on the pneumotachograph tube (6), wherein the pneumotachograph tube (6) has an opening (8) on the sensor side in a sensor (7) arranged on the pneumotachograph tube (6) and / or at least one in the pneumotachograph tube (6) established means for sampling and further
an optical and / or acoustic control (9) of the expiratory flow.

Description

The The invention relates to a portable pneumotachograph for measurement of constituents, in particular NO, of the expiratory volume.

Nitrogen oxides and other gaseous Compounds in the exhaled air are used to assess the physical State of humans, because they are indicators of metabolic processes in the organism, disorders and human diseases. Stationary devices for diagnostic gas analysis The exhaled air is known and has been on the market for a long time available.

A portable gas analyzer with a NO sensor is in the EP 1 439 781 described in which the patient exhales at a prescribed flow rate: and a prescribed pressure. A disadvantage of the device described there is that no spirometric measurement data can be detected, which allow a correlation of the measured value recorded to the corresponding diseased lung area.

Also are devices for lung function analysis, spirometry for years in practice in use.

The Spirometry is a procedure for pulmonary function testing. there Lung and respiratory volumes are measured and graphically in the spirogram shown. To record lung volumes, a spirometer is used or even pneumotachograph needed.

Of the Patient is breathing over a mouthpiece in a breathing tube, with the nose closed with a nose clip becomes. The spirometer measures electronically via a flow sensor the air flow velocity, with the inhaled and exhaled, and from this is the amount of breathed air calculated per time. The amounts of air in these breaths to be moved forms the device graphically. So can also a direct comparison of the measured values various tests are done.

By measuring the rate of airflow or expiratory velocities and lung volumes, the physician is able to diagnose and control lung disease. The following values can be measured by spirometry:
Tidal volume (AZV): It corresponds to the volume inhaled or expired during normal breathing.

inspiratory Reserve Volume (IRV): This is the volume that is still after normal inhalation additionally can be inhaled.

expiratory Reserve Volume (ERV): It is the volume that after normal exhalation Additionally can be exhaled.

inspiratory capacity (IC): It is defined as the volume that is maximal after normal exhalation can be inhaled.

Vital capacity (VC) is the volume to be exhaled maximally after maximum inhalation can.

One second capacity (FEV1, Tiffeneau test) is the volume that is inhaled at maximum inhalation maximum one breath can be exhaled.

For example, these measures help distinguish between the two main groups of lung diseases:
Obstructive lung diseases: They are caused by a narrowing of the respiratory tract, eg by asthma or COPD.

restrictive Pulmonary diseases: Lung and / or thorax are reduced stretchable. Examples are pulmonary hardening (pulmonary fibrosis), fluid accumulation in the lung gap (pleural effusion) or a high-standing diaphragm (Diaphragm paresis).

at spirometry, the patient inhales via a mouthpiece or out. The mouthpiece is connected to a spirometer and in most cases with provided with a bacterial filter. To capture the different Measured variables must the patient the instructions of the examiner with respect to one and Follow exhalation exactly. Otherwise, wrong values are measured turn to wrong conclusions lead the treatment can. The Investigation hangs thus from a good cooperation of the patient.

One another device for measurement of NO in the exhalation volume is described in US Pat. No. 6,010 459 described. Here is a spirometry after the measured value acquisition. The patient breathes synthetic air that has been treated with NO and subsequently humidified one. When exhaling, the patient must generate a defined pressure in the meter, ostensibly, so that the palate-throat-sail closes when exhaling and no, the measurement falsifying air of the nasopharynx into the expiratory flow device in which the NO concentration up to 100 times compared to pulmonary exhaled air can. A disadvantage of this device is the locality, since for the measurement of the synthetic gas for Inhalation must be used.

In addition, with the 2005 published Guidelines of the ATS / ERS (Exhaled breath condensate: methodological recommendations and unresolved questions) I. Horvath, J. Hunt and PJ Barnes, On behalf of the ATS / ERS Task Force on Exhaled Breath Condensates, Eur Respir J 2005; 26: 523- 548) for the first time presents an overall presentation of the methods for respiratory condensate diagnostics. Guidelines for NO measurement are included in the writings: "ATS Workshop Proceedings: Exhaled Nitric Oxide and Nitric Oxide Oxidative Metabolism in Exhaled Breath Condensates: Executive Summary." J Respir Crit Care Med. 2006 Apr 1; 173 (7): 811-813 "and" American Thoracic Society Documents: ATS Workshop Proceedings: Exhaled Nitric Oxide and Nitric Oxide Oxidative Metabolism in Exhaled Breath Condensates. "Proc Am Thorac Soc Vol 3 pp 131-145, 2006".

It It should be noted that the standardization of sampling, Sample storage and analysis is still to be improved. The standardization Sampling must be done in the future as well respectively. Especially in the analysis is therefore the method used and pay more attention to their validation.

Of the The invention is therefore based on the technical problem of a pneumotachograph for To indicate the measurement of components of the exhalation volume that is transportable and is a handy and a correlation of collected measurement data of one or more Components of the exhalation stream with a pulmonary function test allowed, the analytics taking into account standardizing guidelines can be done and allows localization of the disease.

Is solved the technical problem by the invention a transportable Pneumotachographs for the determination of components of the expiratory volume indicates the one processor, one exhaled on the pneumotachograph attached PEEP valve, one inhalation on the pneumotachograph attached filter for removing the portion of to be determined Component in the inspiratory air, at least one in or on Pneumotachograph tube attached sensor, wherein the pneumotachograph tube Sensor side has an opening and / or at least one set up in the pneumotachograph tube Sampling means and optical and / or acoustic control of the expiratory stream.

The core of the portable pneumotachograph for determining components of the expiratory volume is a pneumotachograph, preferably with an exchangeable mouthpiece, in which a bacterial filter is inserted. The patient breathes in and out through the pneumotachograph. On the inhalation side, a filter for filtering out the component to be measured from the ambient air is preset on the pneumotachograph. In the pneumotachograph, a sensor and / or a sampling, for example in the form of a cannula, preferably in the flow channel in the flow direction of the exhalation behind those in the pneumotachograph tube for generating a flow resistance lamellae or grid in the pipe, for example in the flow center, or in the pipe wall of the pneumotachograph tube protrudes, furnished. This means that, in the first embodiment, the sensor or the sensors or their sensitive layer are located directly in the mainstream and preferably the sensor is switched on and / or released at the desired measurement time. To protect against contamination by saliva or other substances, the sensor or the sampling opening must be aligned in the flow direction of the exhalation flow and shaped such that no saliva and no possible condensation water can get into the sampling opening. The exhalation takes place against an expiratory resistance, which is generated by the exhalation PEEP valves attached to the pneumotachograph tube. The expiratory resistance is preferably 5 to 20 cm H ₂ O and causes the mean airway pressure and functional residual capacity to increase.

through the PEEP valve is achieved that the ventilation of the lungs or alveoli also at an airway constriction, secretions in the airways or other types Ventilation disorders (distribution disorder) occurs more evenly. This measure is a requirement for a reproducible repetition of breathing maneuvers and a largely undisturbed emission the components of the exhaled air during the measuring process.

• • Tragen einer Nasenklammer bei der Inspiration
• • Ausatmung mit konstantem Flow bzw. Flow grösser Null, denn ein Stopp des Flow während des Ausatemmanövers bringt Luft aus der Nase in den Rachen.

In order to reduce the risk of erroneous measurement by admixing nasal air, the following measures may be provided:

• • Wearing a nose clip on inspiration
• • Exhalation with constant flow or flow greater than zero, because a stop of the flow during the exhalation maneuver brings air from the nose into the throat.

One constant flow is a flow with a maximum deviation of +/- 10% from the mean.

to Control of the flow has the transportable pneumotachograph one optical or acoustic control on the basis of which the patient control and adjust his exhalation.

In a preferred embodiment, a valve or a flap is arranged between the inspiratory attached to the pneumotachograph filter, which is arranged exchangeably, and the pneumotachograph tube, which in the Expiration the entrance opening of the pneumotachograph closes. This ensures that the patient breathes only against the expiratory resistance through the PEEP valve. Preferably, the valve or the flap closes automatically. Such a valve may be a check valve, a check valve, or a simple flap that opens into the pneumotachograph tube. But there are no limitations of component technology.

The sensor can be selected from the group "electrochemical sensor, chemiluminescence sensor, NO sensor, O ₂ sensor, H ₂ O ₂ sensor, CO ₂ sensor, CO sensor" and / or a combination sensor from the named sensors The corresponding sensor can be used for the component (NO, O ₂ , ...) to be analyzed for the exhaled air, or several sensors can be set up for the simultaneous measurement of different constituents.

In the opening between sensor and pneumotachograph tube can be a controllable and / or controllable Valve, called in the following sensory valve, or a controllable or controllable pump, called in the further sensory pump, set up be. For this purpose, the sensor outside the Pneumotachograph tube and equipped with the pneumotachograph tube over a Be connected to a pipe and a sampling. The sensory valve or the sensory pump can after the proviso the inspiratory or expiratory or the pneumotachograph tube passing a partial inspiratory or partial expiratory volume or flow have the state "open" or "closed", preferably the sensory valve is controllable by the processor. Herewith is achieved that a sampling or measurement is carried out only if defined volume flows or partial volume flows of expiration pass the pneumotachograph tube. Point of time, When a measurement has to be made is about that of the pneumotachograph determined flux-volume correlation which is connected to a processor on which also the sensory valve connected and controlled by this is. Since the sampling processor-controlled directly from the pneumotachograph is done, every time delay or discordance between flow measurement and sampling is primarily excluded

The optical control of the expiratory stream may be obtained from the group "y-t graph, Bar graph, LED display with one or more LEDs "selected. The acoustic control can be a beep or a be in the volume or Frequency changing Be sound.

In a particular embodiment the PEEP valve is a double valve which controls the flow between limited to a minimum flow and a maximum flow. In other words: the Valve opens upon reaching a first correlation to the minimum flow Exhalation pressure, reducing the flow rate in the pneumotachograph tube jumped from the value "zero" to the flow velocity of the minimum flow increases. The patient can now exhale at a defined flow. When crossing a second opposite the first expiratory pressure greater second expiratory pressure, which correlates with the maximum flow closes the valve again and the Value of the flow velocity drops abruptly to the value "zero." The patient is now prevented from exhaling. An exhalation is only between the minimum flow and the maximum flow possible. Such a PEEP double valve has, for example, on the input side (pneumotachograph side) spring-loaded check valve and the output side (environment) on a pressure valve, wherein the spring-loaded check valve only when reaching or exceeding an input side generated first pressure opens and the pressure valve on the output side when crossing a higher generated on the input side Back pressure larger than the first pressure (opening pressure) is, closes. In other words: The PEEP valve opens its entrance opening only from overcoming a first defined pressure resistance. From this time is its exit opening open. at Increased flow increased at the same time the pressure on the check valve and the return spring will be compressed further and pushes at the same time in the direction of the exit opening. On the back between closure of the check valve and the spring is for example a cone attached to the press together the spring into the outlet opening and closes them gradually. With this type of PEEP valve can the expiratory flow and the expiratory resistance between a minimum value and a maximum value, each adjustable are limited.

Of the transportable pneumotachograph may include one or more gas-tight collection containers for Have collected samples and / or respiratory volumes of multiple breaths. With these can several breaths or samples are stored until analysis.

The surfaces of the sample-carrying lines or the air ducts of the pneumotachograph according to the invention can be modified and be such that applied to these membranes, liquid films or insert of porous layers or membranes are incorporated so that certain components of the sample gases are retained or chemically bonded in the layers , The list is exemplary and not limiting. For example, the water vapor content of the sample can be reduced by hygroscopic substances or water-binding layers or the analysis of interfering substances or chemicals from the exhalation or inhalation be physically or chemically bound to ensure trouble-free analysis can.

The Separation of water vapor on the or the sensors and / or in the supply lines to the sensor or sensors can also by tempering prevents one of the exhaled air corresponding temperature of 35 to 40 ° C. become.

on the other hand can free radicals by chemical reaction of in or on the modified surfaces disabled and so the sample can be stabilized. Furthermore, components can the exhalation stream, which is in an unanalyzable or by Superimposed cross-reactions Form can be converted into a selectively detectable form. The modification of the surfaces the sample-leading Lines or the air ducts can also a biological immobilizate, for example an immobilized Be enzyme that specifically converts organic compounds or Specifically binds components.

Of the transportable pneumotachograph may additionally with a rinsing device be equipped, which allows the sensor and / or sampling selected with a gas from the group "ingredient-free Air, synthetic air, prepared for the purpose of calibration Gases or a combination of these gases "flushed and thus from the exhaled air is cleaned to increase the accuracy of the measurements. For this purpose can a pump may be set up, for example, with the inhalation side attached to the pneumotachograph filter over a, preferably separate Line is connected and ambient air through the filter in the Sampling or sensor area pumps. The purge air can be sent to the environment via the PEEP valve or over disposed of a separate purge gas line become. But it can also be one or more connections to Connect be set up a pressurized or pressure-free purge gas bottle.

In a further embodiment is a calibration of the sensor with a gas selected from the group "ingredient-free Air, synthetic gases prepared for the purpose of calibration or a combination of said gases. "The calibration values of These gases are individually adjustable on the device.

In the practice then sees, for example in a NO analysis, as follows off: The patient is asked to take a deep breath. Right after the patient has to over a filter mouthpiece inhale deeply through the innovative pneumotachograph. These Inhalation occurs, for example, through an activated carbon air filter (Respiratory filter) through the pneumotachograph into the lungs.

This Breath is registered and expected expiratory volume of inspiratory volume. Thereafter, the patient must be without vom mouthpiece slowly exhale slowly.

This breath, as dictated by the analyzer, is designed to provide an expiratory resistance, preferably in the range of 5 to 20 cm H ₂ O, induced by the PEEP valve. respectively. With a control system (optical or acoustic control), the patient is shown the expiratory flow, preferably as a yt graph on a screen. Alternatively, a bar graph or different colored light emitting diodes can be used here. The acoustic control can be a beep or a sound that changes in volume or frequency.

Of the expiratory flow should preferably be 50 ml / sec. This but can also be varied. The flow of 50 ml / sec should be in a range of +/- 10% for 4 sec in children under 12 years or 6 seconds in children over 12 and Adults are kept. This corresponds to a flow of 50 ml / sec about 300 ml of air in total.

The Adaptation to the for the analysis of one or more constituents of the exhaled air required flow rates and pressures For example, due to required framework conditions by law or guidelines are made by selecting and using one of the required Flow and pressure authoritative PEEP valve or with a controllable PEEP valve by adjustment its to the required parameters.

During this Plateau, the NO reading should remain within a range of +/- 10%.

The Measurement is to be repeated. A measurement is subject to the RTS / ERS guidelines, if at least two breathing maneuvers meet the criteria.

One Partial and / or Gesamttexspirationsvolumen in a gas-impermeable collecting container, preferably a gas bag, to be caught.

The sampling and / or sensor may further be selected from one or more gases selected from the group consisting of ingredient-free air, synthetic gases prepared for the purpose of calibration, or a combination of said gases be rinsed after each measuring unit.

A Calibration of the sensor can be selected with one or more gases the group "ingredient-free Air, synthetic gases prepared for the purpose of calibration or a combination of said gases "after one or a number of measuring units respectively.

The Partial-free air can be generated by breathing room air on one side is pumped by the filter attached to the pneumotachograph. This cleaned air is then passed over the sensor.

Of the constant flow of expiratory air may preferably be 10-500 ml / s, especially 45 to 55 ml / s.

Of the expiratory flow must be for a duration of 1 to 30 seconds, preferably from 2 to 10 seconds, in particular from 4 to 6 s, kept constant.

It can be determined by the value of the inspiratory volume and a corresponding mathematical correlation to expected expiratory volume Assignment of the measured values to temporally successively exhaled partial volume flows of a Exspirationsvolumens carried out, which determined this partial volume flows Regions and zones of the respiratory tract can be assigned. By the operation can Diseases and disorders of the respiratory tract.

Furthermore is provided that a measurement of components of the expiratory volume only then occurs when a defined Teilxspirationsvolumen the sensor happens. Through the spirometric measurement data acquisition can over the Process are calculated, at what time a partial flow x, which originates from a region Y of the lung, in which, for example a disease is suspected, the sensor happens. A measurement of Components of only this partial volume flow can then be started.

Under the terms of standards, such as the ATS / ERS guidelines, only measured values are evaluable and representative, which are defined under Measurement conditions were obtained. For this sees the inventive Procedure that a measurement of components of the expiratory volume only upon occurrence of the specified parameter (s) of the expiratory volume "Overcome of the expiratory resistance "and / or" constant expiratory Flow "and / or" duration of the expiratory flow ". If these parameters are not achieved or not kept long enough, If no measurement is taken, i. the sensor gets no signal from the processor to initiate a measurement. In this respect, no control the sensor takes place or a condition after initiation of the sensory Measurement was not adhered to, a reading taken under non-standard conditions has been determined to be identified and issued as such.

Preferably are the values of the parameter "Overcome of the expiratory resistance "and / or" constant expiratory Flow "and / or" duration of the expiratory flow "individually adjustable and / or these depending on the patient group and / or the condition of the patient's expiratory tract Storage medium, preferably the processor, retrievable.

In a particular embodiment The PEEP valve is detachable. This allows the transportable Pneumotachograph also used for the measurement of spirometric data without having to provide another spirometer. For the time The measurement sensor is preferably the recording of the spirometric measurement data except Operation set or switched off.

below the invention is explained in more detail with reference to an exemplary embodiment:

1 schematic representation of the portable pneumotachograph

The 1 shows a portable pneumotachograph for determining components of the expiratory volume with a pneumotachograph 1 with a means for pressure measurement 2 and a processor 3 , one exhaled on the pneumotachograph 1 attached PEEP valve 4 , one on the inhalation side of the pneumotachograph 1 attached filter 5 for removing the portion of component to be determined in the inspiratory air, one on the pneumotachograph tube 6 attached sensor 7 , wherein the pneumotachograph tube 6 an opening on the sensor side 8th in which a flowcontroller 10 is set up, and an optical control 9 the expiratory stream. The mouthpiece 11 is with a bacteria filter 12 fitted. For rinsing the sensor 7 pumps the pump 13 (with an additional connection 14 for connecting a purge gas container) the purge gas, here from the component to be determined purified ambient air through the filter 5 into the sensor chamber 15 , The pneumotachograph has an electrical manometer as standard 16 on which the pressure difference in front of and behind the slats 17 measures.

Between the inhalation side of the pneumotachograph 1 attached filter 5 and the pneumotachograph tube 6 is an inspirational valve 18 established, which in the expiration of the entrance opening of the pneumotachograph closes.

1

pneumotachograph

2

medium for pressure measurement

3

processor

4

PEEP valve

5

filter for removing the proportion of constituent to be determined in the inspiration air

6

pneumotachograph

7

sensor

8th

opening

9

optical control

10

flow controller

11

mouthpiece

12

bacterial filter

13

pump

14

Connection

15

sensor chamber

16

electrical manometer

17

slats

18

flap

Claims (15)

Portable pneumotachograph for determining components of the expiratory volume comprising a processor ( 3 ), one exhaled on the pneumotachograph ( 1 ) attached PEEP valve ( 4 ), one on the inhalation side of the pneumotachograph ( 1 ) attached filters ( 5 ) for removing the proportion of component to be determined in the inspiratory air, at least one in or on the pneumotachograph tube ( 6 ) mounted sensor ( 7 ), whereby at one of the pneumotachograph tubes ( 6 ) arranged sensor ( 7 ) the pneumotachograph tube ( 6 ) an opening on the sensor side ( 8th ) and / or at least one in the pneumotachograph tube ( 6 ) and a visual and / or acoustic control ( 9 ) of the expiratory flow. Transportable pneumotachograph according to claim 1, characterized in that between the inhalation side of the pneumotachograph ( 1 ) attached filters ( 5 ) and the pneumotachograph tube ( 6 ) a valve ( 18 ) is arranged, which in the expiration of the entrance opening of the pneumotachograph ( 1 ) closes. Transportable pneumotachograph 1 or 2 , characterized in that the sensor ( 7 ) is selected from the group "electrochemical sensor, chemiluminescence sensor, NO sensor, O ₂ sensor, H ₂ O ₂ sensor, CO ₂ sensor, CO sensor, biomarker sensor (eg, immunological, molecular biology, etc.) "and / or a combination sensor of said sensors is. Transportable pneumotachograph according to one of claims 1 to 3, characterized in that in the opening ( 8th ) between sensor ( 7 ) and pneumotachograph tube ( 6 ) a controllable and / or controllable valve ( 15 ) is set up. Transportable pneumotachograph according to claim 4, characterized in that the valve ( 15 ) according to the requirements of the pneumotachograph tube ( 6 ) has the state "open" or "closed", whereby preferably the valve ( 15 ) by the processor ( 3 ) is controllable. Transportable pneumotachograph according to one of claims 1 to 5, characterized in that the optical control ( 9 ) of the expiratory flow is selected from the group "yt graph, bar graph, light emitting diode display with one or more light emitting diodes". Transportable pneumotachograph according to one of claims 1 to 6, characterized in that by the PEEP valve ( 4 ) an expiratory resistance, preferably from 5 to 20 cm H ₂ O, is adjustable and can be generated. Transportable pneumotachograph according to one of claims 1 to 7, characterized in that the PEEP valve ( 4 ) on the input side (pneumotachograph side) has a spring-loaded check valve and the output side (environment) a pressure valve, wherein the spring-loaded check valve opens when exceeding a first input pressure generated on the input side and the pressure valve on exceeding an input side generated second pressure, wherein the second pressure is greater than the first pressure is, closes and wherein the expiratory flow is kept substantially constant by means of a control device established on the output side. Transportable pneumotachograph according to one of claims 1 to 8, characterized in that one or more collecting container for Collecting samples and / or respiratory volumes of multiple breaths is. Transportable pneumotachograph according to one of claims 1 to 9, characterized in that the sensor ( 7 ) and / or the sampling with a gas selected from the group "constituent-free air, synthetic, prepared for the purpose of calibration gases or a combination of said gases" are flushable. Transportable pneumotachograph after egg nem of claims 1 to 10, characterized in that the sensor ( 7 ) can be calibrated with a gas selected from the group consisting of "ingredient-free air, synthetic gases prepared for calibration or a combination of said gases". Transportable pneumotachograph according to one of claims 1 to 11, characterized in that the PEEP valve is removable. Transportable pneumotachograph according to one of claims 1 to 12, characterized in that the surfaces of the sample-carrying Lines or air ducts of the pneumotachograph in such for the implementation and / or binding of components of the exhaled air are modified, that the surface itself physically and / or is chemically active or on and / or in the surfaces individually or in combination physically and / or chemically active membranes, liquid films, porous Layers, applied and / or incorporated biological immobilizates are. Transportable pneumotachograph according to one of claims 1 to 13, characterized in that the sensor ( 7 ) or the sensitive layer of the sensor ( 7 ) directly in the pneumotachograph tube ( 6 ), in the main stream, is arranged. Transportable pneumotachograph according to claim 14, characterized in that the sensor ( 7 ) has a control which, at the desired measuring time, switches off and / or releases the sensor ( 7 ).