DE2361728A1 - PROCEDURE FOR DRIVING A RESPIRATOR AND APPARATUS FOR CARRYING OUT THE PROCEDURE - Google Patents

Description

j ··. 1324 Bremen, December 11, 1973

AB M'.A.Uo MEDIGINSK AUDIOVISUELL UNDERVISNINGc LUND ₉ (SWEDEN)

PROCEDURE FOR DRIVING YOUR RESPIRATOR Uli © APPARATUS FOR CARRYING OUT THE PROCEDURE

Since the beginning of this Jatokwiderfcs I have m & m as

Type "Iron L * aimg ©% where d ± @

Patient

Already wälsresad- d © 3T dreissiig © r JaSas? © Pe Frenclmeff (Acta Oto ^ Laryisge 193 ^ s ⁿ Bx * osicliial and -traelieal catSseterissitioini ⁵¹¹ ) dx © Atnnangsnsascliine smsss Einbläsern - ^ osa Ga The apparatus was tob d @ r ^ © rkaiaft and ^m Spiro

as anesthesia machine ± n in connection with Braisthöklenope «rati © si © jni to © © TbraiuKslio IEi5iif®3.u © voss Phabenli@iSiy®2.itis« ^e E®i ^< = ^! demisn siacii u.om 2 _O world wars ^ rerlasosed m & n ataeSa ■

236172

Breathing machines. Constructions like "Lundia", "Gothia", Engström, Radcliff, Bird etc. appeared on the market. The number of types of machines has increased at a rapid pace with the advances in anesthesiology and the development of the postoperative breathing aid. In a monograph entitled "Automatic ventilation of the lungs", written by V «¥. Mushin _r L. Rendell-Baker and PW Thompson, edited by Blackwell Scientific Publications, Oxford 1959t , more than 250 different designs were discussed, including the one mentioned above - from outside the home country of the construction - only about twenty for greater application and distribution

Were © n most AtnmngsmasehiK ■ zam Zweck® adult use constructed "the medical development of infant nursing währer-.d the 50's and 60s, however, has caused for the youngest age group a great need for a, n Atwangs ·" machine . Initially, I would. various adult apparatuses tried out and changed »In the last few years a few constructions intended only for infants have been developed (Loosko and Bird breathing machines). The difficulty of treating all age groups with the same breathing machine is due to the dosage of breathing: back down = lead. Infants breath in breaths of 15-23 ml <, while the adult human breathes in breaths of 450-500 ml. In addition, breathing has to be adapted to the body size · This is why there are particular difficulties with infants because the body weight of a newborn child increases by around $ 300 in the first year of life ©

409825/0869

Atsmaragsiaechanik have _e pediatricians who have dealt in depth with these problems have come in recent years to consider _s that with the current respirators has no way to the demands of children and adult nursing with and comply with the same Respiratortyp to can. '.

The invention aims to overcome this drawback and "state Brin ceremony of a new method for driving a respirator to ventilate the lungs vosi patients, especially infants, then the respirator that with simple measures the various breathing needs to adapt can _o Second big the one to · unable brin supply The aim is to save breathing gas and to eliminate the intake gases, especially anesthetic gases, which are expelled by conventional respirators.

¥ ie with the known type of drive of a respirator In the case of the type according to the invention, gas under pressure must be injected into the lungs during an intake rating phase blow in, after which the gas supply is interrupted and the gas during an exhalation phase through an exhalation valve is discharged from or brought to the lungs. That for the invention process What is distinctive, however, is that one is based on the desired inspiratory volume for an individual Breath calculated gas mass in a closed compression room with rigid walls up to a pressure is compressed, which is higher than the existing pressure at the end of the inhalation phase in one with the The patient's lungs in open communication with the exhalation valve, which has a mainly constant volume,

409825/0869

that the closed, the compressed gas mass containing Kompreseionsraun for pressure equalization between through the compression and patient connection rooms an inhalation valve with the patient connection area connected with the exhalation valve closed is held, and that after the pressure equalization between the compression and patient connection space the The inhalation valve is closed and the exhalation valve is opened »by means of which the pressure in the patient connection space is relieved to the atmosphere, whereby im Compression room a compression of a new gas mass for the next Eina timings phase in motion will. The special feature of this method is that the power source for the inhalation phase consists of compressed gas in a closed space with rigid walls and with a specific size: The desired inhalation volume is determined in a known manner, depending on the body weight, among other things, and based on this this desired inhalation volume can then be easily calculate the size of the gas mass that has to be compressed in the closed space so that one has blown exactly the desired amount of gas into the patient when the pressure is equalized between the latter and the patient's lungs. Pie size of the gas mass required to achieve the desired inhalation volume during a must be compressed with a single breath in the closed space, can be varied, namely either by varying the pressure to which the gas is compressed in the closed space, which in this case has constant size, or by varying the volume of the closed space in which the gas is compressed to a predetermined pressure.

The invention thus made it possible to considerably simplify the construction of the breathing machine. The invention also aims to bring about an apparatus according to the method of

409825/0869

Invention to drive a respirator, wherein the apparatus consists of an inhalation valve, an exhalation valve, a device to blow gas under pressure through the inhalation valve into the lungs, as well as control circuits and organs for controlling the function of the individual apparatus parts and is characterized in that The device to blow gas into the lungs under pressure ₉ - if the following exists ?! 1 »A compression room with stiff walls. _o . by an inlet valve asu © ine source of gas under pressure and passes through the Eijaatircrags ^"veisti: to di © Lung®n is connectable l, 2" j, a measuring unit, connected to the di © 'KompressionsrauiD 1st plus di®nt ₈ the pressure in'diesem au besti "n®B _s nud J ₀ ~ a patien & enanschltssseinheitp whose" heart 'toes Eiaatnrasgsventil ₈ exhalation. w & a. ® & m®m Tractesalassscfelmss abjreiaz · ?; is and the diarcSs. the Sinatümngsveatil ass <3 © mK © ia => press ions raura ρ through the TraekealassseSalmss © si the lungs usid through the AttsatmangsVeiafciI aa di @, ataosphere · -

is directed is that the volume - dupes-.SSoBtp.ressionsraissä@3-unter üffenhaltun-g des Eissstamsagsvemtils- -tssnviir changed and the pressure eat this © Eaum® amr from. Flows the eligibility investment

The invention will be shown to Kiaehst@fee.mt in the reference to the attached drawings' eiagehesides ³ described

1 shows a schematic diagram of one form of the apparatus ₈ according to the invention

2 shows a schematic diagram of another embodiment of the apparatus _{9 according to the invention}

3 shows a diagram of the thickness ratios in that shown in FIG

Usage, and

FIG. H schematically shows an automatic metering system for the apparatus according to the invention shown in FIG. 1.

The apparatus according to the invention shown in FIG. 1 tiat a compression _{space module KRM 8} which consists of a closed space with rigid walls and a specific size so that the volume of this closed space remains constant when the apparatus is functioning. On, the compression modules are a. Measuring module MM and a patient module PM connected · The inlet of the compression room, which can be connected to a pressurized gas source, is regulated by an ice valve KIV, while the outlet of the compression room and the connection with the patient module is regulated by a separation valve SV, which also acts as an inhalation valve The bar patient module has an outlet valve PUV, which serves as an exhalation valve, and also a connection T for connection to the patient's lungs. T must be connected to the patient module · The apparatus in Fig. 1 also includes an electronic pulse module EIM, in which control loops and the automatic system are used to control and scan the individual components of the apparatus. This electronic pulse module is connected to all three valves KIV, SV and PUV and also to the measuring module MM and determines the work cycle and cycle of the breathing machine

The apparatus shown in Fig. 1 functions as follows- wet. In the initial position, valves KIV and SV are closed and valve PUV is open. At start-up

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of the apparatus, the inlet valve KIV to the compression: muta is opened, which is connected to the compressed gas source, the pressure isn! Compregsionsraum increases to a predetermined value P ₁ (see Fig. 3), which is sensed by the measuring module MM . When pressure P _{1 is reached} , the measuring module sends a signal to the electronic pulse module, which in this case the inlet valve KIV is asleep. Now the apparatus is to connect the patient & n ready. After the patient has been connected, the separation valve SV is opened, whereby the compression chamber comes into contact with the patient module PM, which is connected to the patient's lungs.Exhaust valve PUV of the patient module and also inlet valve KIV of the compression module are closed at this point in time.The result is pressure equalization between compression chamber KRM and the patient module as well as the patient's lungs, whereby the pressure drops to pressure P (Fig. 3). The opening of the exhaust valve PUV causes the pressure in the patient's lungs to be relieved to the atmosphere, ie the patient exhales. The opening of the inlet valve KIV of the compression chamber causes new gas. is supplied until the pressure P is reached again in the compression space KRM. The valves KIV and PUV are then closed and then the separation valve SV is opened so that a new breathing phase is started.

The individual valves can be pressurized and / or timed your t be. In the most advantageous embodiment, the inlet valve KIV has a time-controlled opening advance and a pressure-controlled as well as a time-controlled closing process, while the other two Valves SV and PUV are only time-controlled.

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The arrows in FIG. 1 indicate the directions of the gas flow in the individual parts of the apparatus.

The size of the individual breath is easy to determine, firstly "by knowing the pressure difference between pressure P ₁ and P" and secondly by knowing the combined size of the compression chamber and the patient module, the latter being designed in such a way that it is mainly used when the breathing machine is in operation , has a constant volume. It can consist of tubes which are bendable - at least at the very outermost part of the tracheal connection - but whose flow channel has a mainly constant cross-section. Pressure quotient automatically regulated and the desired size of the breath according to known methods, for example according to what is in LG Okmian, "Artificial Ventilation by Respirator for Newborn Infants during Anesthesia", Acta Anaesthesiologic Scandinavica, 19 ^ 3, Vol. 7, pp 31 -57 ("compression formula " and "two-pressure method", pp 3k, 35 and pp h6-5k) is specified.

As can be seen from FIG. H , a manometer can thus be used as the measuring module MM, a displaceable pulse generator IG being used to determine the pressure P ₁ . This pulse generator IG sends its pulses to a relay in the electronic pulse module EIM, which in turn closes the inlet valve KIV when the pressure P ₁ has been reached. A fixed pressure scale 10 and a displaceable scale unit 11, which partly has a scale 12 for the body weight in kg and partly a scale 13 for the size of the breath in milliliters, can be arranged on the manometer. These two scales 12, 13 must be retrograded, ie graded in the opposite direction to the pressure scale 10

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In the embodiment of the apparatus according to the invention shown in FIG. 6, the size of the individual breath is varied by varying the pressure with which the gas is introduced into the compression chamber KRM, which in this case has a constant volume. But you can also constantly use the same maximum pressure in the compression space and instead change the size of the compression space in order to
in this way the size of the individual breath
vary. Such a system is shown in Fig. 2,
which differs from Fig. 1 only in that
the compression space KRM ^{- has} a piston K, which can be adjusted in different positions by a motor M depending on how large the compression space is to be for a specific patient. In this embodiment of the apparatus according to the invention, the equalization pressure V is varied as a function of the volume of the compression space KRM,

It is a great advantage of the invention
The ventilation of the lungs, especially in the respiratory ventilation of infants,
can regulate much more effectively and precisely, and there is also the fact that one and the same respirator works
Exchange of the compression space module either for
Equalize infant or adult treatment. Another and immensely important advantage is
that everything was introduced into the respiratory apparatus
Breathing gas is fully utilized for the intended purpose in that the gas remaining in the compression chamber module at the end of the inhalation phase
is prevented from flowing out to the atmosphere during the exhalation phase, which is the case with the known respirators. With this advantage you can not only
considerable savings in terms of gas consumption

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_f but also reduce the risk of poisoning which exists for the operating personnel to a minimum, while the personnel is usually exposed to considerable amounts of anesthetic gas during the operation.

The function of the apparatus according to the invention is explained below in connection with FIGS. 1, 3 and k . First of all, it is ensured that the compression space module KRM has the appropriate size for the current patient so that it is not necessary to use an inexpediently high pressure in the compression space module in order to be able to compress the necessary gas mass for blowing into the patient's lungs. The inhalation volume can vary between 15-25 ml in infants and ^ 50-500 ml in adults. It is also ensured that the correct scale unit 11 is mounted, since the graduation of the scale unit 11 varies depending on the volume of the compression space module in the embodiment according to FIGS. 1, 3 and k . The distance between the graduation marks on the volume scale 13 is dependent on the volume of the compression room and patient modules of the apparatus, while the distances between the individual graduation marks on the scale 12 are determined empirically. In the embodiment shown, the compression module and scale unit 11 are designed for the respiratory ventilation of children with a body weight of up to kO kg.

When the apparatus is started, one begins to adjust the displaceable scale unit 11 in such a way that the current body weight (scale 12) is set to a scale line 20 cm H "0 of the pressure scale 10. It has been empirically proven that this pressure of 20 cm H ₂ O corresponds approximately to a normal expansion of the healthy lungs of normal children and also normal adults. Then the pulse generator IG will open

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the O-mark on scales 12 and 13. If the patient has then been connected with the aid of a tracheal tube coupled to the patient module, the pressure in the compression space module drops to P "when the valves KIV and PUV have been closed and the separation or inhalation valves SV have been opened, which can be read on the manometer MM . After a few inhalation and exhalation cycles a "normal state" of the respirator ventilation is reached, and at this point in time the pressure P "at the end of the exhalation phase can be read off for control purposes, and consequently also the volume of the individual breath achieved in the current case on scale 13. Should the pressure P "read off at the end of the exhalation phase deviate significantly from the presumed final pressure 20 cm H_0, for example> · 5 cm H_0, and should the volume of the individual breath deviate significantly from that which the patient should strive for, an adjustment of the pulse generator IG and the setting of the scale unit 11, so that the most appropriate ventilation of the lungs is achieved. An increase in ventilation is achieved by moving the pulse generator and the scale unit 11 upwards and a reduction by moving them downwards along the pressure scale 10. In the construction shown, the size of the individual breaths can thus be regulated with great accuracy and by reading the pressure P. ₂ also read off on volume scale 13 of scale unit 11.

The above course of setting and regulating the breathing machine corresponds to the aforementioned "two-pressure method ¹¹ , although the volume of the patient module, which is known, has been included in the grading of the scales 12 and 13. If the volume of the patient module is not included in these calculations has been recorded, you have to

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OBlGINAL INSPECTED

¹² 236 ί'728

Using the "two-pressure method" while the separation valve SV is closed, first pressurize the compression chamber module KRM, the pulse generator IG closing the inlet valve KIV of the compression chamber when pressure P ₁ has been reached. Tracheal connection T is blocked on the tracheal tube, after which the inhalation or separation valve SV is opened while both valves KIV and PUV are kept closed. Here, the pressure in the system drops slightly to a pressure of P "(not shown), and the movable, combined scale 11 (FIG. H) is set so that the O-bars for calibrating the apparatus exactly opposite the pressure P_ stand. Since the compression space module KRM has a very large volume in relation to the patient module PM, the pressure drop between pressure P ^ and P "is only a few millimeters H ~ 0 - a pressure drop that can actually be disregarded in this context. If you want to avoid having to read two pressures and block the tracheal connection during the initial phase, the necessary correction of the system can be done very simply by shifting the marking value of the pulse generator in relation to the sensing level of the pulse generator so that the marking value Pressure P corresponds and the sensing level corresponds to _{pressure P 1.}

In FIG. 3, the pressure variation curve in the compression space module is indicated by a solid line and the pressure variation curve of the patient module by a dashed line. The pressure is shown along the ordinate and the time along the abscissa. One can clearly see how the pressure falls during the inhalation phase in the compression space module KRM and the pressure in the patient module and consequently in the patient's lungs rises until an equalization is achieved at pressure P 1. At the end of the inhalation phase, ie when pressure P _{2 is} reached, the separation valve is activated

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ORIGINAL SMSPECTED

SV is closed and, after a short interval, the exhalation valve PUV and also the inlet valve KIV are opened, with exhalation beginning and the compression module being recharged at the same time. As is known, the exhalation phase is much longer than the inhalation phase, although most of the pressure is released very quickly during a period of 1-2 seconds, depending on, among other things, whether the lungs are healthy or not. The breathing rate is time-controlled and regulated by an electronic pulse module EIM. One advantage of the apparatus is that the equalization _{pressure P 2} can be determined very easily and precisely, since this pressure in the compression space module is kept constant during the interval between the closure of the separation valve SV and the opening of the inlet valve KIV.

From the above it can be seen that the drive apparatus of the respirator consists of a pressure chamber, which are fed directly from the usual gas source, depending on the desired volume of the individual Breath, is charged up to a certain, specific pressure. This has the complex structure the well-known jlespirators can be avoided, so that the apparatus is much cheaper and much easier to manufacture.

A09825 / 0869

Claims (1)

Claims 2 3 · "'/ '28 1. Procedure for driving a respirator to release gas under pressure during the inhalation phase Pump lungs! after which the gas supply is interrupted and the gas through during an exhalation phase an exhalation valve is discharged from or brought to the lungs, characterized in that that one calculated based on the desired inspiratory volume for a single breath Gas mass compressed to a pressure in a closed compression space with rigid walls which is higher than the pressure present at the end of the inhalation phase in one of the lungs of the Patient connection area in open communication with the exhalation valve, which has a mainly constant volume that the closed one containing the compressed gas mass Compression space for pressure equalization between the compression and patient connection spaces through a Inhalation valve connected to the patient connection area with the exhalation valve kept closed, and that after pressure equalization between the compression and patient connection space Inhalation valve is closed and the exhalation valve is opened, through which the pressure in the patient connection chamber is relieved to the atmosphere, with a compression of a new one in the compression space Gas mass started for the next inhalation phase will. 2. The method according to claim 1, characterized in that the pressure to which the gas is compressed in the closed space is varied as a function of the desired inhalation volume during a single breath. 3 · Method according to claim 1, thereby marked that the volume of the 409825/0869 closed compression space in which the gas is compressed is varied depending on the desired inhalation volume during a single breath. H. Apparatus for driving a respirator by the method according to one of claims 1-3, which has an inhalation valve, an exhalation valve, a device to blow gas under pressure through the inhalation valve into the lungs, and control circuits and organs for regulating the function of the individual apparatus parts, characterized in that the device for injecting gas under pressure into the lungs consists of the following: 1.) a compression chamber (KR! ¹ !) with rigid walls, which is connected to a source through an inlet valve (Kiv) for gas under pressure can be connected and can be connected to the lungs through the inhalation valve (SV), 2.) a measuring device (MM) which is connected to the "compression chamber" and serves to determine the pressure in it, and 3 ·) A patient connection unit (PM), the interior of which is separated from the inhalation valve (SV), exhalation valve (PUV) and a tracheal connection (τ) and which is connected to the compression r aum (KRM), through the tracheal connection to the lungs and through the exhalation valve (PUV) to the atmosphere, whereby the apparatus is set up so that the volume of the compression chamber (KRM) while keeping the inhalation valve (SV) open is unchanged and the pressure in the same is influenced by the flow through the inhalation valve (SV ₁ ). 5. Apparatus according to claim 4, d a d u r c h characterized in that the compression space (KRM.) has a variable volume for adapting it in relation to the desired size of the individual breath 409825 / 0869- 6. Apparatus according to claim 5 »thereby marked that the volume of the Compression room (KRM) by an im Kompressionsraura displaceable piston (κ) is variable. ORIGINAL INSPECTED 40982 5/0 8 69