EP1239911A2 - Dosage de gaz en fonction du volume inspire - Google Patents

Dosage de gaz en fonction du volume inspire

Info

Publication number
EP1239911A2
EP1239911A2 EP00993379A EP00993379A EP1239911A2 EP 1239911 A2 EP1239911 A2 EP 1239911A2 EP 00993379 A EP00993379 A EP 00993379A EP 00993379 A EP00993379 A EP 00993379A EP 1239911 A2 EP1239911 A2 EP 1239911A2
Authority
EP
European Patent Office
Prior art keywords
gas
oxygen
gas supply
supply system
sensor
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Withdrawn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
EP00993379A
Other languages
German (de)
English (en)
Inventor
Rainer Muellner
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.)
INO Therapeutics GmbH
Original Assignee
Messer Austria GmbH
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 Messer Austria GmbH filed Critical Messer Austria GmbH
Publication of EP1239911A2 publication Critical patent/EP1239911A2/fr
Withdrawn legal-status Critical Current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
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/12—Preparation of respiratory gases or vapours by mixing different gases
    • 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
    • A61M16/20—Valves specially adapted to medical respiratory devices
    • A61M16/201—Controlled valves
    • A61M16/202—Controlled valves electrically actuated
    • 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
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0015—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors
    • A61M2016/0018—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical
    • A61M2016/0021—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with a proportional output signal, e.g. from a thermistor
    • 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
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A61M2016/0033—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
    • A61M2016/0039—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the inspiratory circuit
    • 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
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/02—Gases
    • A61M2202/0266—Nitrogen (N)
    • A61M2202/0275—Nitric oxide [NO]

Definitions

  • the invention relates to a gas supply system for the inhalative treatment of humans or mammals with a controlled gas dosage of at least one gas, a method for operating the gas supply system and its use.
  • Ventilation devices are used for mechanical ventilation, for anesthesia and for respiratory therapy by treatment with gases, e.g. B. Oxygen donation or treatment with nitrogen monoxide (NO).
  • gases e.g. B. Oxygen donation or treatment with nitrogen monoxide (NO).
  • a normally portable oxygen dispenser Such patients are referred to as spontaneously breathing patients, in contrast to patients who are intubated to a ventilator in the clinic.
  • LOT long-term oxygen therapy
  • CPAP continuous positive airways pressure
  • the gases are administered either through so-called nasal cannula or nasal tube (nasal application; in the simplest case, a gas supply hose, the opening of which is open below the patient's nostrils) or via a breathing mask (especially with CPAP).
  • WO 98/31282 (internal designation TMG 2028/67) describes a gas supply system for ventilated or spontaneously breathing patients, in which one or more gases (e.g. NO, oxygen) by means of a controller (program controller, sensor controller or combined program / Sensor control) are metered into the breathing gas unevenly (continuously or discontinuously).
  • a controller program controller, sensor controller or combined program / Sensor control
  • the tidal volume increases or decreases depending on the demands of the spontaneously breathing patient.
  • the breathing frequency and the characteristic of the breath curve (inspiration curve) change.
  • the invention has for its object to optimize the gas metering in inhalation therapy, especially in spontaneous breathing.
  • the gas supply system for the inhalative treatment of humans or mammals is a device for dosing gases or aerosols, in particular medical gases (e.g. oxygen, NO-containing gas) or aerosols (e.g. asthma agents).
  • the dosing dependent on the breathing curve can be used for all types of gases (also in combination), especially oxygen and a NO-containing gas or a NO-containing gas and hydrogen; Oxygen and hydrogen; Oxygen and helium; Oxygen, a NO-containing gas and hydrogen; Oxygen, a NO-containing gas and helium; Oxygen, carbon dioxide and helium; or oxygen, an NO-containing gas, carbon dioxide and hydrogen, and aerosols can be used.
  • the gas supply system with gas metering dependent on the tidal volume, ie metering of gases or aerosols, is used in ventilated or particularly preferably in spontaneously breathing patients.
  • the basic apparatus design of gas supply systems for ventilated or spontaneously breathing patients is described in WO 98/31282 (internal name TMG 2028/67), to which reference is hereby made.
  • the gas supply system for controlling the metering of gases or aerosols depending on the tidal volume preferably contains an additional gas line with a sensor which leads to the patient (human or mammal).
  • the additional gas line is connected to nasal cannula or breathing mask, for example.
  • the sensor preferably detects the pressure or gas flow (gas flow) in the nose or mouth area of the patient.
  • the pressure in the nose or mouth area is called breathing pressure
  • the gas flow (gas flow) in the nose or mouth area is called breathing gas flow.
  • a breath curve is the time course of respiratory pressure or respiratory gas flow.
  • the course of the breath curve is determined in particular by measuring the
  • the change in the tidal volume detected by the sensor is advantageously transmitted to a control unit which now controls the metered quantity of the gas or aerosol accordingly and z.
  • controllable metering valves respond so that the metering quantity is changed (e.g. by a longer opening time of the metering valves).
  • the amount of gas to be metered or the metered amount of gas V is calculated using the following formula:
  • V (ml) [desired concentration (%) * tidal volume (ml)] / 100.
  • the controlled adaptation of the gas quantity to the condition of the patient can ensure that the gas quantity or gas concentration required for the specific therapy is changed in accordance with the change in the tidal volume.
  • the gas concentration supplied can be kept constant in relation to the tidal volume or the gas quantity or gas concentration can be increased compared to the idle state due to the detected load condition of the patient. This means that the dosing device does not keep the concentration of the gas in the lungs constant but increases it in order to increase the effect under load.
  • Another criterion that can be determined for the patient's stress level is the number of breaths per minute.
  • the patient's stress level can be inferred and the therapy adapted accordingly.
  • the tidal volume is advantageously recorded through a second line to the patient (nasal cannula or mask) in which the applied pressure is measured during the entire time.
  • the metering of the gas takes place, for example, synchronized with inspiration, the duration of the metering and / or the amount of the metered gas being changed per unit of time in accordance with the detected load condition of the patient.
  • the breathing gas flow in particular the breathing gas flow during inspiration (inspiration flow), is e.g. B. recorded by detecting the pressure (negative pressure) during the entire inspiration phase, which is proportional to the gas flow or inspiration flow.
  • This negative pressure is advantageously recorded by means of a relative pressure sensor.
  • Another possibility is the direct measurement of the gas flow using a flow meter. Any errors resulting from the metering of the gas (excess pressure) are advantageously compensated for using algorithms in a control program, generally in the control unit.
  • the tidal volume can be determined particularly advantageously by interpolation of the recorded pressure or gas flow curve over time.
  • the amount of gas in one gas can be kept constant while the second amount of gas changes at the same time.
  • the time of dispensing can also be chosen arbitrarily, since it is precisely defined by the inclusion of the inspiration curve. In this way, one gas can be dosed at the start of triggering, a second gas only later.
  • the amount of gas is varied in such a way that the amount of gas supplied is adapted to the tidal volume (e.g. increasing amount of gas with increasing tidal volume).
  • the gas flow in the breathing gas line could also be changed by a control valve and adapted to the respective curve shape.
  • gas spike mistidal gas surge
  • Another possibility is dosing via a control valve, so that the dosing flow is adapted to the pressure curve and doses this pressure curve accordingly.
  • the gas curve-dependent gas metering of one or more gases and / or aerosols can generally be used for all types of metering control, in particular for program control, sensor control or a combined program / sensor control for inspiration-synchronized gas metering, which is pulse-modulated or in sequences ,
  • program control sensor control
  • a combined program / sensor control for inspiration-synchronized gas metering, which is pulse-modulated or in sequences
  • WO 98/31282 internal name TMG 2028/67
  • the tidal volume is recorded simultaneously (for the same breathing cycle) and the gas dosage is controlled, or the tidal volume of the previous breathing cycle is used to control the gas dosage for the subsequent breathing cycle.
  • FIG. 1 schematically shows a breath curve (respiratory pressure P in mbar versus time t in s) for the resting state a and for the stress state b of a patient.
  • a predetermined threshold value (trigger value) c is reached, the gas metering is triggered.
  • the volume flow V (in l / min.) Of the metered gas resulting from the breath curve-dependent control as a function of time t (in seconds s) is shown in FIG. 2 for the states a (rest) and b (load).
  • FIG. 3 shows schematically how the breath curve is interpolated from individual measured breath pressure values.
  • FIG. 4 schematically shows a gas supply system, in particular for spontaneously breathing patients (spontaneous breathers).
  • the gas is metered via controllable solenoid valves 3, 4, which are connected to the control unit 12 via the control lines 10, 11.
  • the triggering of the metering (triggering) is a defined signal of the pressure or flow sensor 8, which is passed on to the control unit 12 through the control line 9.
  • the gas supply system shown is used, for example, for metering two gases, such as oxygen (gas source 1) and NO-containing gas (gas source 2).
  • the pressure or flow in the nasal cavity is via the pressure measuring line 6
  • the trigger trigger signal can be chosen, e.g. B. at the beginning of inspiration (change from positive pressure to negative pressure, e.g. 0.1 mbar negative pressure) or to any pressure or flow during the inspiration.
  • the actual gas metering of the gases from gas sources 1 and 2 takes place via the separate gas line 5. As a result, the pressure increase for the determination of the breath curve is not or only slightly disturbed. This allows the
  • Breath or inspiration curve can also be recorded during gas metering.
  • FIG. 5 shows an example of how the metered amount of gas or the gas volume flow V is adjusted as a function of the breath curves in different states (a, b) of the patient (FIG. 5a) (FIG. 5b).
  • the gas flow of the metered gas is changed by a controllable valve, so that an increased gas surge occurs at a constant gas volume flow V (gas pike) in state b.
  • FIG. 6 shows an adaptation of a variable gas volume flow V of a metered gas (FIG. 6b) to the determined breath curve (FIG. 6a).
  • controllable valve e.g. solenoid valve

Landscapes

  • Health & Medical Sciences (AREA)
  • Emergency Medicine (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Medicinal Preparation (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)

Abstract

L'invention concerne un système d'alimentation en gaz pour le traitement par inhalation d'un homme ou d'un mammifère, avec lequel au moins un gaz est dosé. Ce système se caractérise en ce que la commande du dosage de gaz se fait en fonction du volume inspiré.
EP00993379A 1999-12-18 2000-12-06 Dosage de gaz en fonction du volume inspire Withdrawn EP1239911A2 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE19961206A DE19961206A1 (de) 1999-12-18 1999-12-18 Atemzugsvolumenabhängige Gasdosierung
DE19961206 1999-12-18
PCT/EP2000/012246 WO2001043806A2 (fr) 1999-12-18 2000-12-06 Dosage de gaz en fonction du volume inspire

Publications (1)

Publication Number Publication Date
EP1239911A2 true EP1239911A2 (fr) 2002-09-18

Family

ID=7933241

Family Applications (1)

Application Number Title Priority Date Filing Date
EP00993379A Withdrawn EP1239911A2 (fr) 1999-12-18 2000-12-06 Dosage de gaz en fonction du volume inspire

Country Status (4)

Country Link
US (1) US20030172929A1 (fr)
EP (1) EP1239911A2 (fr)
DE (1) DE19961206A1 (fr)
WO (1) WO2001043806A2 (fr)

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CN112118884A (zh) 2018-05-14 2020-12-22 柯惠有限合伙公司 用于利用信号失真的呼吸努力检测的系统和方法
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Also Published As

Publication number Publication date
US20030172929A1 (en) 2003-09-18
WO2001043806A2 (fr) 2001-06-21
DE19961206A1 (de) 2001-07-05
WO2001043806A3 (fr) 2001-11-01

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