EP0273041A1 - Computer gated positive expiratory pressure system - Google Patents

Computer gated positive expiratory pressure system

Info

Publication number
EP0273041A1
EP0273041A1 EP87902943A EP87902943A EP0273041A1 EP 0273041 A1 EP0273041 A1 EP 0273041A1 EP 87902943 A EP87902943 A EP 87902943A EP 87902943 A EP87902943 A EP 87902943A EP 0273041 A1 EP0273041 A1 EP 0273041A1
Authority
EP
European Patent Office
Prior art keywords
valve
pressure
computing
sensing
generating
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP87902943A
Other languages
German (de)
French (fr)
Other versions
EP0273041A4 (en
Inventor
Charles C. Cummings
Robert I. Prince
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Puritan Bennett Corp
Original Assignee
Puritan Bennett Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Puritan Bennett Corp filed Critical Puritan Bennett Corp
Publication of EP0273041A1 publication Critical patent/EP0273041A1/en
Publication of EP0273041A4 publication Critical patent/EP0273041A4/en
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/04—Heartbeat characteristics, e.g. ECG, blood pressure modulation

Definitions

  • Such respirators drive a positive pressure breath into the lungs which are already at atmospheric pressure.
  • the pressure in the lungs is increased above atmospheric pressure, contrary to normal occurrence, which inhibits the heart's ability to pump blood.
  • negative thoracic pressure is developed upon inspiration of air, which aids in filling the heart with blood.
  • the resultant pressure gradient (the relatively positive pressure in the periphery and
  • PEEP Positive-End-Expiratory Pressure
  • a low level of positive pressure is maintained in the airway between positive pressure breaths.
  • PEEP uses a standard switch.
  • a pressure signal applied to the valve controls the high or low pressure states of the valve.
  • the low PEEP state is generated when the valve is fully open.
  • a partial closing of the valve creates high intrathoracic pressure between breaths, as some air from the tedal volume is not allowed to escape.
  • cardiac output drops significantly.
  • Intravenous fluids are used to increase intravascular volume in an effort to minimize this fall in cardiac output. The patient may already have compromised cardiac function, minimizing or negating the advantages of the intravascular volume increase. Additionally, patients
  • respirators typically lack adequate kidney function and cannot process the added fluids. If too much intravenous fluid is used, relative to the patient's ability (aided or not) to process the fluid, the fluid may enter the patient's lungs.
  • Positive inotropic agents are used to increase the squeeze of the heart to punp more blood. Obviously, the heart works harder than normal resulting in possible heart attacks or arrhythmias. Often, physicians will prescribe a combination of increased intravenous fluids and positive inotropic agents with PEEP.
  • the invention concerns a computer-gated.
  • the output of a cardiogram machine is amplified and squared, or an LED of a cardiogram machine is optically monitored, to determine an R- a e, or the beginning of electrical systole.
  • a signal is fed to a multiplier where the R-R wave signal (period) is multiplied representing the duration of the R-R wave with a variable interval set by a physician.
  • the resultant produce (R-R wave times variable interval) is used to trigger a solenoid operated 3-way valve.
  • the 3-way valve is normally closed to pass a positive pressure to a standard PEEP valve which functions normally. When triggered, the 3-way valve opens to allow a relatively low pressure to pass to the PEEP valve such that the PEEP valve creates a low pressure to the patient.
  • PEEP is removed for a variable time ratio immediately before a next heart beat.
  • the PEEP valve is controlled by computer gating a 3-way valve to create pressure drops, allowing the heart to fill. Once the heart fills, PEEP is resumed without any detrimental effects. Respiration of the patient is coordinated with the patient's heart beat to maximize cardiac output. Additionally pressure can be replaced immediately after drop out in an effort to improve emptying of the heart.
  • Figure 1 is a schematic of the present invention in its environment.
  • Figure 2 is a block diagram of the Figure 1 microcomputer contents, as connected to a 3-way valve.
  • Figure 3 reveals a second embodiment for detecting a heart beat interval.
  • the computer-gated, positive expiratory pressure system is shown in Figure 1 in its environment, connected to a therapeutic device such as a PEEP system.
  • a patient 10 is shown using a respirator or ventilator 12 via a standard expiratory (PEEP) valve 14.
  • PEEP standard expiratory
  • the PEEP valve 14 opens and closes to allow low and high pressures to the patient 10.
  • the patient 10 is also connected to a cardiogram machine (EKG) 16. Successive heart beats are detected by the EKG 16 and a signal representing each beat is output to a microcomputer 18, the details of which are discussed regarding Figures 2 and 3.
  • EKG cardiogram machine
  • the microcom uter 18 combines the variable interval signal from 20 and a value representing the period between successive heart beats from EKG 16 and generates a controlling output to a solenoid 22 of a 3-way valve 24.
  • the 3-way valve 24 is connected by a first end to a positive pressure source 26.
  • a second valve end is pneumatically connected to a low relative pressure 28, while a third end is connected to the PEEP valve 14 via which the patient 10 received the positive pressure breaths.
  • the PEEP valve 14 Under normal operation of the ventilator 12, the PEEP valve 14 is operated to allow alternate low and high positive pressure breaths (approximately .4 psi) from the ventilator 12 to pass directly to the patient 10. However, in response to the output of microcomputer 18, the solenoid 22 is energized to yield at output 30, a negative pressure from the low relative pressure source 28. The negative pressure output at 30 opens the PEEP valve 14. Because the PEEP valve 14 is fully opened, a low pressure is received by the patient 10 from the ventilator 12. The resultant low pressure, in accordance with the present invention, occurs just prior to a predicted heart beat to insure the heart, when filling, does not work against high pressures. ? ⁇ ? systems per se too often generate high pressures -.- en the heart beats, inhibiting heart filling and deereasing cardiac output.
  • microcomputer 18 The output of EKG 16 is run through an operational amplifier 32 to a timer 34 which squares the amplified EKG signal to develop a series of electrical pulses corresponding to s-uccessive heart beats.
  • the electrical pulses of timer 34 are received by memor /calculator 36 which determines a period representing the interval between successive heart beats. This period is used to predict a next heart beat so a low pressure is delivered to the patient slightly before and during this next heart beat.
  • the variable interval generator 20 is set by the attending physician between 15 and 400 microseconds, for instance, by typical anolog controls.
  • the variable interval signal from 20 and the period signal from calculator 36 are used to generate a produce in multiplier 38.
  • the resultant product is used as a signal to energize the solenoid 32, to control 3-way ⁇ valve 24.
  • the 3-way valve 24 now opens output 30 to the vacuum 28. Accordingly, a resultant negative pressure fully opens the PEEP valve 14 and a low pressure reaches the patient. Should the heart rate vary, the difference between predicted and actual heart beats will be detected and pulse timing corrected. The time duration of the pulse to the solenoid is controlled by a second timer (not shown) .
  • FIG. 3 reveals a second embodiment for determining or sensing heart beats.
  • a photodetector 40 is used to detect the blinking LED 42 which is typically part of a cardiogram machine.
  • the photodetector 40 turning on and off with the flash of the LED 42, requires no timer or wave squarer, and thus is input directly to the amplifier 32 for subsequent processing in the manner of the Figure 2 embodiment.
  • a microprocessor e.g. C 64 Commadore Computer
  • a microprocessor may be adapted and software developed to monitor and determine beat period, with a programmable variable interval for use by the physician.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Pulmonology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Emergency Medicine (AREA)
  • Physiology (AREA)
  • Cardiology (AREA)
  • Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
  • Medical Informatics (AREA)
  • Biophysics (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Pathology (AREA)
  • Physics & Mathematics (AREA)
  • Percussion Or Vibration Massage (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)
  • External Artificial Organs (AREA)

Abstract

La mise en oeuvre de systèmes créant une pression positive en fin d'expiration (PEEP) se traduit par une diminution du débit cardiaque et du flux sanguin local, le coeur étant entouré d'une pression plus élevée que d'habitude (pression intrathoracique accrue). La présente invention permet de diminuer sélectivement la pression intrathoracique durant une faible partie du cycle cardiaque lorsqu'elle est le plus dommageable. Ladite invention permet de réduire la pression thoracique en fournissant une source de basse pression à la soupape PEEP (14). Sont décrits un moyen de détection (16) permettant de détecter les battements cardiaques séquentiels d'un patient, ainsi qu'un moyen de calcul (18), lequel est connecté au moyen de détection (16), pour calculer une période entre les battements cardiaques séquentiels. En outre, un organe à soupape (24) est connecté électriquement au moyen de calcul (18) et pneumatiquement au moyen de ventilation (12) afin de commander ce dernier, l'organe à soupape (24) étant positionné de manière à arrêter l'alimentation en pression positive en fonction de la période calculée.The implementation of systems creating positive pressure at the end of expiration (PEEP) results in a decrease in cardiac output and local blood flow, the heart being surrounded by a higher pressure than usual (increased intrathoracic pressure ). The present invention makes it possible to selectively decrease the intrathoracic pressure during a small part of the cardiac cycle when it is the most damaging. The invention reduces chest pressure by providing a source of low pressure to the PEEP valve (14). Described are a detection means (16) for detecting the sequential heartbeats of a patient, as well as a calculation means (18), which is connected to the detection means (16), for calculating a period between beats sequential heart. In addition, a valve member (24) is electrically connected to the calculating means (18) and pneumatically to the ventilation means (12) in order to control the latter, the valve member (24) being positioned so as to stop the 'positive pressure supply according to the calculated period.

Description

TITLE OF THE INVENTION Computer Gated Positive Exporatory Pressure System
BACKGROUND
When breathing normally, one's diaphragm is dropped to increase one's thoracic cavity, thus creating a negative pressure in the thoracic cavity, relative to atmospheric pressure. Air is driven by the atmospheric pressure into the negative-pressure thoracic cavity. Many patients, such as victims of accidents suffering from shock, trauma or heart attack, may require a respirator or ventilator to aid breathing. Prior respirators used intermittent, positive pressure breaths to increase the pressure within a patient's lungs until filled. Air is expelled passively by the natural stiffness of the lungs.
Such respirators drive a positive pressure breath into the lungs which are already at atmospheric pressure. The pressure in the lungs is increased above atmospheric pressure, contrary to normal occurrence, which inhibits the heart's ability to pump blood. During normally respiration, negative thoracic pressure is developed upon inspiration of air, which aids in filling the heart with blood. The resultant pressure gradient (the relatively positive pressure in the periphery and
.; «J < ■• 1 -j **** negative pressure in the thorax) helps to fill the heart as it opens, subsequent to the heart's squeezing or pumping motion. If however, the pressure in the thoracic chamber is increased, as with respirators, the amount of blood returning or entering the heart is decreased. The heart also must squeeze against a higher pressure. A lower cardiac output results.
The common technique for improving arterial oxygen tension is the use of Positive-End-Expiratory Pressure (PEEP) , where a low level of positive pressure is maintained in the airway between positive pressure breaths. .PEEP uses a standard switch. A pressure signal applied to the valve controls the high or low pressure states of the valve. The low PEEP state is generated when the valve is fully open. A partial closing of the valve creates high intrathoracic pressure between breaths, as some air from the tedal volume is not allowed to escape. However, at 10 centimeters of water pressure of PEEP, cardiac output drops significantly. Intravenous fluids are used to increase intravascular volume in an effort to minimize this fall in cardiac output. The patient may already have compromised cardiac function, minimizing or negating the advantages of the intravascular volume increase. Additionally, patients
-<V..Ϊ_-".---τ requiring respirators typically lack adequate kidney function and cannot process the added fluids. If too much intravenous fluid is used, relative to the patient's ability (aided or not) to process the fluid, the fluid may enter the patient's lungs.
Positive inotropic agents are used to increase the squeeze of the heart to punp more blood. Obviously, the heart works harder than normal resulting in possible heart attacks or arrhythmias. Often, physicians will prescribe a combination of increased intravenous fluids and positive inotropic agents with PEEP.
Several investigators have evaluated the effect of cardiac cycle-specified, increases in thoracic pressure on cardiac output. They synchronized high frequency jet ventilation to various phases of the R-I. interval. Carlson and Pinsky found that the cardiac depressant effect of positive pressure ventilation is minimized if the positive pressure pulsations are synchronized with diastole. Otto and Tyson, however, found no significant changes in cardiac output while synchronizing positive pressure pulsations to various portions of the cardiac cycle.
Pinchak described the best frequency in high frequency jet ventilation. He also noticed rhythmic
r. εr£.""* oscillations in pulmonary artery pressure (PAP) and also rhythmic changes in systemic blood pressure. A possible e∑qolanation for these oscillations is that the jet pulsations move in and out of synchrony with the heart rate. In evaluating his data it appears that-when jet airway pressure peak occurred during early systole there was a high pulmonary artery pressure, and a low sys emic blood pressure. While Pinchak does not comment on this, his recorded data show that pulmonary artery pressure was waxing and waning precisely opposite to the blood pressure. A plausible explanation is an increase in pulmonary artery pressure is simply a reflection of an increase in pulmonary vascular resistance which causes a decrement in left ventricular filling and thus decrease in systemic blood pressure secondary to a decrease in cardiac output. If the slight oscillations in the systemic blood pressure reflect oscillations in cardiac output, then Pinchak's study would support Pinsky and Carlson's work, suggesting that positive airway pressure is least detrimental during diastole.
SUMMARY OF THE INVENTION The invention concerns a computer-gated.
positive expiratory pressure system for supplementing positive end-expiratory pressure (PEEP) systems. The output of a cardiogram machine is amplified and squared, or an LED of a cardiogram machine is optically monitored, to determine an R- a e, or the beginning of electrical systole. A signal is fed to a multiplier where the R-R wave signal (period) is multiplied representing the duration of the R-R wave with a variable interval set by a physician. The resultant produce (R-R wave times variable interval) is used to trigger a solenoid operated 3-way valve. The 3-way valve is normally closed to pass a positive pressure to a standard PEEP valve which functions normally. When triggered, the 3-way valve opens to allow a relatively low pressure to pass to the PEEP valve such that the PEEP valve creates a low pressure to the patient.
Thus, PEEP is removed for a variable time ratio immediately before a next heart beat. The PEEP valve is controlled by computer gating a 3-way valve to create pressure drops, allowing the heart to fill. Once the heart fills, PEEP is resumed without any detrimental effects. Respiration of the patient is coordinated with the patient's heart beat to maximize cardiac output. Additionally pressure can be replaced immediately after drop out in an effort to improve emptying of the heart.
BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a schematic of the present invention in its environment.
Figure 2 is a block diagram of the Figure 1 microcomputer contents, as connected to a 3-way valve. Figure 3 reveals a second embodiment for detecting a heart beat interval.
DETAILED DESCRIPTION-~OF THE INVENTION The computer-gated, positive expiratory pressure system is shown in Figure 1 in its environment, connected to a therapeutic device such as a PEEP system. A patient 10 is shown using a respirator or ventilator 12 via a standard expiratory (PEEP) valve 14. The PEEP valve 14 opens and closes to allow low and high pressures to the patient 10. In accordance with the present invention, the patient 10 is also connected to a cardiogram machine (EKG) 16. Successive heart beats are detected by the EKG 16 and a signal representing each beat is output to a microcomputer 18, the details of which are discussed regarding Figures 2 and 3. A
variable interval is generated by generator 20 as a
EET second input to the microcomputer 18, the value of the interval being set by the attending physician. The microcom uter 18 combines the variable interval signal from 20 and a value representing the period between successive heart beats from EKG 16 and generates a controlling output to a solenoid 22 of a 3-way valve 24. The 3-way valve 24 is connected by a first end to a positive pressure source 26. A second valve end is pneumatically connected to a low relative pressure 28, while a third end is connected to the PEEP valve 14 via which the patient 10 received the positive pressure breaths.
Under normal operation of the ventilator 12, the PEEP valve 14 is operated to allow alternate low and high positive pressure breaths (approximately .4 psi) from the ventilator 12 to pass directly to the patient 10. However, in response to the output of microcomputer 18, the solenoid 22 is energized to yield at output 30, a negative pressure from the low relative pressure source 28. The negative pressure output at 30 opens the PEEP valve 14. Because the PEEP valve 14 is fully opened, a low pressure is received by the patient 10 from the ventilator 12. The resultant low pressure, in accordance with the present invention, occurs just prior to a predicted heart beat to insure the heart, when filling, does not work against high pressures. ?ΞΞ? systems per se too often generate high pressures -.- en the heart beats, inhibiting heart filling and deereasing cardiac output.
In Figure 2, the details of microcomputer 18 are evident. The output of EKG 16 is run through an operational amplifier 32 to a timer 34 which squares the amplified EKG signal to develop a series of electrical pulses corresponding to s-uccessive heart beats. The electrical pulses of timer 34 are received by memor /calculator 36 which determines a period representing the interval between successive heart beats. This period is used to predict a next heart beat so a low pressure is delivered to the patient slightly before and during this next heart beat. The variable interval generator 20 is set by the attending physician between 15 and 400 microseconds, for instance, by typical anolog controls. The variable interval signal from 20 and the period signal from calculator 36 are used to generate a produce in multiplier 38. The resultant product is used as a signal to energize the solenoid 32, to control 3-way ■valve 24.
B5T1 ST3 ϊ'.T In a normal state, 3-way valve 24 connects the positive pressure 26 to the output 30, putting PEEP valve 14 in a partially closed position. Thus, the ventilator 12 can generate a high, positive pressure breath to the patient 10. However, assume the EKG 16 detects a heart beat each second. The EKG signal is amplified at 32, squared by timer 34, and the period of one second calculated in memory 36. If the variable interval generator is set by the physician for 0.8 second, multiplier 38 forms a product of the period and variable interval- (1.0 x 0.8) equal to 0.8 seconds. Thus, 0.2 second before the next predicted, heart beat (0.8 second from the last heart beat) solenoid 22 is energized. The 3-way valve 24 now opens output 30 to the vacuum 28. Accordingly, a resultant negative pressure fully opens the PEEP valve 14 and a low pressure reaches the patient. Should the heart rate vary, the difference between predicted and actual heart beats will be detected and pulse timing corrected. The time duration of the pulse to the solenoid is controlled by a second timer (not shown) .
Figure 3 reveals a second embodiment for determining or sensing heart beats. A photodetector 40 is used to detect the blinking LED 42 which is typically part of a cardiogram machine. The photodetector 40, turning on and off with the flash of the LED 42, requires no timer or wave squarer, and thus is input directly to the amplifier 32 for subsequent processing in the manner of the Figure 2 embodiment.
Other modifications are apparent to those skilled in the art which do not depart from the spirit of the present invention, the scope being defined by the appended claims. For instance, rather than use a microcomputer, a microprocessor (e.g. C 64 Commadore Computer) may be adapted and software developed to monitor and determine beat period, with a programmable variable interval for use by the physician.

Claims

What is claimed is:
1. A gating system for controlling a ventilator means which generates a positive pressure breath, the systems including: a sensing means for sensing sequential aa_-_ beats of a patient; a computing means, connected to the sensing means, for computing a period between the sequential heart beats; a valve means connected electrically to the computing means and pneumatically to the ventilator means for controlling the ventilator means, the valve means positioned to cease positive pressure breaths in response to the computed period.
2. A system as in claim 1, including: a vacuum means, pneumatically connected to the valve means, for generating a low pressure to the ventilating means via the valve means.
3. A system as in claim 2 , including a positive pressure means, the valve means comprising a 3-way valve having first, second and third ends, the first end connected pneumatically to the ventilator means, the second end connected to the vacuum means,
BAD ORIGIN 3 . 2 . -J • - «'* "" and the third end connected to the positive pressure means.
4. A system as in claim 3, the 3-way valve having a solenoid electrically connected to the computing means, which positions the 3-way valve.
5. A system as in claim 4, including a variable means, connected to the computing means, for generating a variable interval signal to the computing means.
6. A system as in claim 5, the computing means having a multiplier means, connected to the sensing means and the variable means, for generating a product signal based on the computed period times the variable interval signal.
7. A system as in claim 6, the ventilator means having a gated valve pneumatically connected to the valve means first end, the gated valve opened by the valve means pneumatic connection of the relative low pressure source means to the ventilator means, and the gated valve closed by the valve mea__s pneumatic connection of the positive pressure means to the ventilator means.
- J _ -T- SHEET
8. A pneumatic control system for a patient's therapeutic device including: a pneumatic valve through which a fluid may flow; a sensing means for sensing a patient's sequential heart beats and generating beat signals; a computing means, connected to receive the sensed beat signals, for computing a period between sequential beat signals, and for generating a period signal; a variable means for generating a variable interval signal; a combining means, connected to receive and combine the period signal and the variable interval signal, and connected to the valve means, for controlling the valve means in response to the combined period signal and variable interval signal.
9. A system as in claim 8 including a low pressure source means, pneumatically connected to the valve means, for creating a relative negative pressure when the valve means is opened.
- IT"
10. A system as in claim 9, including a positive pressure means, the valve means comprising a 3-way valve having three end means; a first end means for connection to the therapeutic device, a second end means for connection to the vacuum means, and a third end means for connection to the positive pressure means.
11. A system as in claim 10, the 3-way valve having a solenoid electrically connected to the computing means, which positions the 3-way valve.
12. A system as in claim 11, the computing means comprising a multiplying means, connected to the sensing means and the variable means, for generating a product signal based on the computed period times the variable interval signal.
13. A system as in claim 12, the sensing means having an amplifying means connected to the sensing means, for amplifying the beat signal.
14. A system as in claim 13, the computing means including a timing means, connected to the amplifying means, for squaring the beat signal, and for generating pulses to the multiplying means.
'
15. A system as in claim 12, the sensing means including a photodetector means for detecting light signals in response to a patient's heart beat, the photodetector means generating an output to the amplifying means.
SUBSTITUTE SHEET
EP19870902943 1986-03-31 1987-03-27 Computer gated positive expiratory pressure system. Withdrawn EP0273041A4 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US84594286A 1986-03-31 1986-03-31
US845942 1986-03-31

Publications (2)

Publication Number Publication Date
EP0273041A1 true EP0273041A1 (en) 1988-07-06
EP0273041A4 EP0273041A4 (en) 1990-01-11

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EP19870902943 Withdrawn EP0273041A4 (en) 1986-03-31 1987-03-27 Computer gated positive expiratory pressure system.

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EP (1) EP0273041A4 (en)
JP (2) JPS63503207A (en)
AU (1) AU598255B2 (en)
CA (1) CA1302505C (en)
CH (1) CH672991A5 (en)
DE (1) DE3790137T1 (en)
DK (1) DK162257C (en)
GB (1) GB2194892B (en)
NL (1) NL8720165A (en)
SE (1) SE459214B (en)
WO (1) WO1987006040A1 (en)

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DE3790137T1 (en) 1988-03-31
JPS63503207A (en) 1988-11-24
DK504687A (en) 1987-09-25
EP0273041A4 (en) 1990-01-11
GB2194892B (en) 1990-05-09
GB2194892A (en) 1988-03-23
DK504687D0 (en) 1987-09-25
CA1302505C (en) 1992-06-02
AU7231687A (en) 1987-10-20
AU598255B2 (en) 1990-06-21
GB8722069D0 (en) 1987-10-28
SE459214B (en) 1989-06-12
WO1987006040A1 (en) 1987-10-08
DK162257B (en) 1991-10-07
NL8720165A (en) 1988-01-04
DK162257C (en) 1992-03-02
JPH06125Y2 (en) 1994-01-05
SE8703727L (en) 1987-10-01
JPH0488952U (en) 1992-08-03
SE8703727D0 (en) 1987-09-28
CH672991A5 (en) 1990-01-31

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