EP2563441A1 - Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire - Google Patents

Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire

Info

Publication number
EP2563441A1
EP2563441A1 EP10796308A EP10796308A EP2563441A1 EP 2563441 A1 EP2563441 A1 EP 2563441A1 EP 10796308 A EP10796308 A EP 10796308A EP 10796308 A EP10796308 A EP 10796308A EP 2563441 A1 EP2563441 A1 EP 2563441A1
Authority
EP
European Patent Office
Prior art keywords
gas
line
patient
regulating means
medical
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Withdrawn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
EP10796308A
Other languages
German (de)
English (en)
Inventor
Rainer KÖBRICH
Hermann ULRICHSKÖTTER
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.)
Getinge Deutschland GmbH
Original Assignee
Maquet Vertrieb und Service Deutschland 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 Maquet Vertrieb und Service Deutschland GmbH filed Critical Maquet Vertrieb und Service Deutschland GmbH
Publication of EP2563441A1 publication Critical patent/EP2563441A1/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Withdrawn legal-status Critical Current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
    • A61M16/104—Preparation of respiratory gases or vapours specially adapted for anaesthetics
    • 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
    • A61M16/01—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes specially adapted for anaesthetising
    • 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
    • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816—Joints or connectors
    • A61M16/0841—Joints or connectors for sampling
    • A61M16/085—Gas sampling
    • 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
    • A61M16/203—Proportional
    • 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
    • A61M16/22—Carbon dioxide-absorbing devices ; Other means for removing carbon dioxide
    • 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
    • A61M2016/0024—Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with an on-off output signal, e.g. from a switch
    • 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
    • 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
    • A61M16/1005—Preparation of respiratory gases or vapours with O2 features or with parameter measurement
    • A61M2016/102—Measuring a parameter of the content of the delivered gas
    • A61M2016/1035—Measuring a parameter of the content of the delivered gas the anaesthetic agent concentration
    • 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
    • A61M2202/0208—Oxygen
    • 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
    • A61M2202/025—Helium
    • 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)
    • 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]
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A61M2205/502—User interfaces, e.g. screens or keyboards
    • A61M2205/505—Touch-screens; Virtual keyboard or keypads; Virtual buttons; Soft keys; Mouse touches
    • 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
    • A61M2240/00—Specially adapted for neonatal use

Definitions

  • the invention relates to a method and a device for applying at least one medical gas to a ventilated patient.
  • a respirator generates a constant flow of breathing gas at least in a region of a breathing gas supply line. This constant flow of breathing gas is generated independently of the patient's breathing sequence.
  • the constant breathing gas flow is added to a predetermined amount of a medical gas to be administered.
  • the mixed gas of the respiratory gas flow provided by the respirator and the medical gas added to this flow is supplied to a connector, such as a so-called Y-piece, from which a patient supply line leads to the patient to be ventilated and another line.
  • a connector such as a so-called Y-piece
  • EP 0 937 479 B1, EP 0 937 479 B1, US Pat. No. 5,558,083, EP 0 786 264 B1, EP 1 516 639 B1, and EP 0 723 466 B1 also disclose devices and methods for administering nitric oxide continuous and pulsed time courses known to a ventilated patient.
  • control valves for adjusting the amount of nitrogen oxide are provided, which, however, each type of construction under specific given pressure conditions to pass a defined amount of gas per unit time.
  • the medical gas is provided in a suitable constellation for the device and the patient is provided in the open state of the regulatory means a suitable amount of gas for treatment available.
  • the object of the invention is to provide a method and a device for applying at least one medical gas to a patient ventilated by means of a ventilator, in which the amount of gas to be administered is easily adjustable.
  • the medical gas flows into the constant breathing gas flow in the first line generated by the respirator via the two parallel regulating means introduced and can be supplied to the patient.
  • the amount, in particular the volume of the medical gas introduced into the first line can be adjusted with a corresponding choice of pulse length and pulse train.
  • a constant pulse frequency is preset. This ensures that the breathing gas supplied to the patient has a constant proportion of the medical gas.
  • both the method and the device provide a variable adjustment of the amount of gas to be applied in large adjustment ranges and thus a wide concentration spectrum.
  • the pulse-shaped partial pressure caused by the gas pulses can be measured down to the respiratory tract of the ventilated patient.
  • the respiratory rate is the number of breaths of the patient within a certain time unit.
  • a pulse frequency indicates the number of gas pulses of the pulse train within the same time unit.
  • the regulating means are controlled by means of the control unit such that the pulse frequency is greater than the respiratory rate.
  • the pulse frequency of the gas pulses is 26, 52, 104 or 208 pulses per minute. With these pulse sequences, it could be observed that the periodic noise development of the device was tolerated particularly well by the patient and the patient reacted particularly well to the application of the medical gas. As already mentioned, the gas injection caused by the gas pulses very quickly leads to a homogeneous partial pressure situation.
  • the regulating means are controlled with the aid of a control unit or of the control unit in such a way that a gas quantity fixed to a gas pulse and / or a gas volume fixed to a gas pulse is introduced into the first line.
  • a gas quantity fixed to a gas pulse and / or a gas volume fixed to a gas pulse is introduced into the first line.
  • the medical gas contains NO (nitrogen monoxide).
  • the medical gas can in particular be provided as a gas mixture of NO (nitrogen monoxide) and N 2 (nitrogen).
  • a gas mixture of NO (nitrogen monoxide) and He (helium) has proven to be particularly advantageous, since particularly short reaction and reaction times are achieved, in particular by helium.
  • the parallel regulating means are preferably valves and are then also referred to as a valve bank.
  • the first valve has a flow rate of 0.16 liters per minute
  • the valve 2 a flow rate of 1.6 liters per minute
  • the valves 3 and 4 each have a flow rate of 8 liters per minute with permanent opening (measured with medical air).
  • regulating means which have a shortest possible opening time of ⁇ 7 milliseconds, preferably in the range of 4 milliseconds to 7 milliseconds.
  • the control unit can open the valves individually or in any combination, so that in the specific embodiments, a maximum flow of 17.76 liters per minute is possible.
  • a control unit optimizes the opening of the regulating means in such a way that the longest possible opening time is achieved within a cycle time of, for example, 104 gas pulses per minute.
  • a cycle time for example, 104 gas pulses per minute.
  • uniform and homogeneous mixing of the medical gas into the breathing air supplied to the patient is achieved.
  • this achieves a large, adjustable dosing range of the medical gas to be applied to the patient.
  • when only one valve is opened at a flow rate of 0.16 liters per minute, 7 milliseconds opening time per gas pulse and a pulse rate of 26 pulses per minute theoretically, 26 x 18.60 microliters of medical gas are applied per minute.
  • the invention will provide a larger therapeutic concentration spectrum clinically available.
  • the regulating means in the open state allow different volume flows to pass from the gas source to the first line.
  • the regulating means in the opened state have different volume flows from the gas let the source pass to the first line.
  • the regulating means each comprise at least one solenoid valve.
  • at least one regulating means can be preceded and / or followed by an orifice plate or another throttling means for restricting the volume flow flowing through the regulating means.
  • Solenoid valves are on the one hand inexpensive and on the other hand solenoid valves have relatively short response times. The solenoid valves are driven in particular binary, so that they are fully closed in a first operating state and fully open in a second operating state.
  • Regulating means of the same type can be used by the throttling means for restricting the volumetric flow passing through the regulating means, in particular solenoid valves of the same type, wherein the volume flow flowing through the regulating means in the opened state is different by the provision of different flow resistances. As a result, different volume flows can be generated through the regulating means in a simple manner.
  • the patient supply gas is removed. At least the proportion of the medical gas and / or the proportion of a reaction product of the medical gas in the withdrawn gas is determined.
  • the gas can be taken from the patient supply line via a measuring line and fed to an analysis unit for detecting at least the proportion of the medical gas and / or the proportion of a reaction product of the medical gas.
  • the removal and detection may be once or more once during an inhalation process, preferably repeatedly with each inhalation.
  • the inner diameter of the measuring line is preferably smaller than the diameter of the first line, the second line and the patient supply line.
  • the proportion of the medical gas in the inhaled gas is regulated to the preset desired value.
  • the amount of medical gas to be administered to the patient can be monitored and / or kept constant in a simple manner. If, in addition to or as an alternative to the proportion of the medical gas, the proportion of a reaction product of the medical gas is analyzed, it is advantageous to determine the proportion of an oxidation product of the medical gas.
  • nitric oxide (NO) is used as medical gas
  • the proportion of the oxidation product nitrogen dioxide (NO 2 ) can be determined.
  • the proportion of nitrogen dioxide detected can then be compared with a permissible target value.
  • the introduction of the medical gas into the first line can then be stopped or the volume of the introduced medical gas can be reduced. If the concentration of nitrogen dioxide in the respiratory gas is too high, the patient may be harmed and this should be avoided.
  • the ventilator determines information about a flow profile of the respiration of the ventilated patient.
  • a control unit can then control the regulation means depending on the determined flow profile such that they introduce a larger amount of the medical gas into the first line during the inhalation phases of the patient with each generated gas pulse and / or introduce the gas pulses with a higher pulse frequency into the first line during the exhalation of the patient.
  • the same pulse frequency is used during the inhalation phase and during the respiratory phase.
  • the pulse frequency is preset to 104 gas pulses per minute.
  • the pulse frequency may be higher during the inspiratory phase than during the exhalation phase.
  • the volume introduced with each gas pulse may be equal to or greater than the gas volume of the gas pulses during the exhalation phase.
  • solenoid valves preferably reversible valves are used between a fully closed and a fully open position, which are controlled binary.
  • the invention can be used in particular in neonatology for the treatment of pulmonary hypertension of a premature baby with nitric oxide. Nitric oxide is also applied to treat patients after organ transplants. However, the invention can also be used for the application of other gaseous drugs. Depending on the clinical application, up to 10% of the inspired volume may come from a gas source for delivery of gaseous drugs. Such a gas source is also referred to as additive gas source since it is provided in addition to a respiratory gas source or source of oxygen.
  • Figure 1 is a schematic representation of a device for applying at least one medical gas to a with Help of a ventilator ventilated patients according to a first embodiment
  • FIG. 2 a schematic representation of components of an applicator for application of the medical gas
  • FIG. 3 shows a schematic representation of a device for applying at least one medical gas to a patient ventilated by means of a ventilator according to a second exemplary embodiment of the invention
  • FIG. 4 shows an illustration of the time course of the respiration of the ventilated patient and the application of the medical gas according to the first and second exemplary embodiments of the invention
  • FIG. 5 a schematic representation of a device for the application of at least one medical gas to a patient ventilated by means of a ventilator according to a third exemplary embodiment of the invention.
  • FIG. 6 is an illustration of the temporal course of the respiration of a ventilated patient and the application of the medical gas according to the third exemplary embodiment of the invention.
  • FIG. 1 shows a schematic representation of a device 10 for applying at least one medical gas to a patient 14 ventilated by means of a respirator 12 according to a first exemplary embodiment of the invention.
  • Medical gas NO nitric oxide
  • This gas is provided in a gas cylinder 16 as a gas mixture (NO / N 2 ) comprising N 2 nitrogen and NO nitrogen monoxide.
  • NO / N 2 a gas mixture
  • a pressure regulator 18 the gas mixture NO / N 2
  • a first line 24 designed as a breathing air hose leads to a connecting element 26 designed as a Y-piece.
  • a second line 28 designed as an exhaust air hose and a patient supply line 30 are connected to the connecting element 26.
  • the patient supply line 30 is connected to a test lung simulating the patient 14 in the form of an inflatable balloon 32.
  • the end of the patient supply line 30 leading to the patient 14 is connected to a breathing mask or a tube inserted into the respiratory tract of the patient 14.
  • the exhaust hose 28 is guided back to the respirator 12, wherein the flowing back through the exhaust hose 28 gas mixture is either dissipated or reprocessed in the ventilator 12.
  • the respirator 12 is connected in the present embodiment via a connecting hose 34 with a formed as a gas cylinder 36 gas source.
  • the gas cylinder 36 contains an oxygen (O 2 ) and nitrogen (N 2 ) comprising gas mixture (O 2 / N 2 ).
  • the gas mixture O 2 / N 2 is limited by means of a pressure regulator 38 to a preset desired value and fed via the connecting tube 34 to the ventilator 12.
  • oxygen and nitrogen may also be provided by separate gas sources 36, particularly via a central gas supply to a hospital.
  • the ventilator 12 generates a constant flow of respiratory gas in the breathing air tube 24.
  • the medical gas mixture NO / N 2 intended for the treatment of the patient is supplied to this constant breathing gas flow via the connecting line 40.
  • the metering device 20 continuously generates gas pulses having a pulse frequency which is at least independent of the respiratory rate of the patient.
  • a measuring line 41 is connected to the patient supply line 30 and at least part of the gas mixture in the patient supply line 30 leads to the connection piece A of the metering device 20.
  • the gas mixture supplied to the metering device 20 via the connecting piece A is measured by a measuring / evaluation unit 44 of the metering device 20 analyzed.
  • FIG. 2 shows a schematic representation with components of the metering device 20 according to FIG.
  • the metering device 20 is also referred to as NO application device due to the nitrogen monoxide used in the exemplary embodiment as a medical gas.
  • the metering device 20 has a first module 42 with a measuring / evaluation unit 44, which analyzes the proportion of NO in the gas mixture (O 2 / N 2 / NO) supplied via the connecting piece A and sends a corresponding measured value to a control unit 48 arranged in the second module 46 transfers.
  • the control unit 48 is connected to a control unit 50 designed as a human-machine interface.
  • the operating unit 50 is preferably designed as a touch screen. Parameters of the metering device 20, in particular setpoint values, can be set via the operating unit 50.
  • setting values, measured values and operating values can be output via a display unit of the operating unit 50.
  • the tax- Unit 48 is preferably connected via a data line, not shown, with a control unit of the ventilator 12. Via this data line, relevant parameters measured values and further information between the control unit 48 and the control unit of the ventilator 12 can preferably be transmitted bidirectionally.
  • the metering device 20 has a third module 52, which in the present exemplary embodiment comprises four magnetic valves 54 to 60, to which the respective medical gas mixture NO / NO 2 is supplied via the connecting piece C.
  • the solenoid valves 54, 56 are each preceded by a metering orifice 62, 64 for restricting the flow through the respective solenoid valve 54, 56.
  • the output sides of the solenoid valves 54 to 60 are connected to the port B, so that the solenoid valves 54 to 60 are connected in parallel.
  • the control unit 48 of the metering device 20, the solenoid valves 54 to 60 individually control, ie open individually or in combination.
  • valve bank 52 it is possible to achieve a gas flow between the connecting piece C and the connecting piece B by opening a valve 54 to 60 and thus to introduce medical gas NO via the connecting line 40 into the breathing gas line 24.
  • the flow rate between the connecting piece C and the connecting piece B can be increased by the simultaneous opening of several valves 54 to 60.
  • the applied amount, ie the amount of medical gas NO introduced into the breathing gas line 24 can be adjusted by a suitable choice of the pulse duration and / or by a suitable choice of the pulse frequency.
  • the gas pulses generated by the individual valves 54 to 60 may have a different pulse duration at preferably the same pulse frequency.
  • the third module with the parallel arrangement of a plurality of valves 54 to 60 is also referred to as valve bank 52.
  • the valve bank 52 with the four solenoid valves 54 to 60 allows a large adjustable dosing range and a flexible adaptation of the amount of gas to be applied when using gas sources 16 with different starting concentrations of the medical gas.
  • the initial concentration is preferably preset as a parameter via the operating unit 50 and taken into account in the calculation of the pulse duration and pulse frequency for generating the quantity to be applied.
  • the solenoid valve 54 has a flow rate of 0.16 liters per minute
  • the solenoid valve 56 has a flow rate of 1.6 liters per minute
  • the solenoid valves 58 and 60 each have a flow rate of 8 liters per minute measured with medical air.
  • the pulse frequency, d. H. the clock rate is 104 gas pulses per minute, d. H. 104 bolups per minute. If smaller amounts of the medical gas NO are to be applied or if, for other reasons, a lower clock rate or a lower pulse frequency are selected, this is preferably reduced to 52 gas pulses per minute or 26 gas pulses per minute. If a higher pulse frequency is to be selected, this can also be increased to 208 gas pulses per minute.
  • initial maximum dosages of 40 ppm are applied in adult patients and initial maximum dosages of 20 ppm in children. In neonates or preterm infants, the initial maximum dosage may be lower.
  • the dosage is gradually or continuously reduced to 0.5 ppm in preterm infants to 0, 1 ppm for weaning the patient.
  • the initial concentration of the medical gas in the gas source 26 is preferably 1,000 ppm. All dosage information refers on the Y-piece 26 supplied breathing air with the introduced medical gas.
  • valve bank 52 having a plurality of valves 54 to 60 arranged in parallel, it is possible to use gas sources 16 with higher starting concentrations of the medicinal gas, in particular of up to 2,000 ppm or up to 4,000 ppm, with currently customary amounts of application. Compared with gas sources with 1,000 ppm of the same amount of gas, the service lives are doubled when the initial concentration is doubled.
  • the use of the valve bank 52 provides a larger therapeutic concentration spectrum.
  • the minimum opening duration of the solenoid valves 54 to 60 in the present embodiment is 7 milliseconds.
  • FIG. 3 shows a schematic representation of a device 100 for applying at least one medical gas to a patient ventilated by means of a ventilator 12 in accordance with a second exemplary embodiment of the invention.
  • the device 100 is structurally and functionally consistent with the device 10 of FIG.
  • the medical gas nitrogen monoxide (NO) is provided as a gas mixture comprising nitrogen monoxide (NO) and helium (He).
  • the gas mixture (NO / He) preferably consists of nitrogen monoxide (NO) and helium (He), with the exception of customary impurities.
  • This gas mixture (NO / He) is provided via a gas source 102 designed as a gas cylinder and via the pressure regulator 18 and the connecting line 22 in the connecting piece C of the metering device 20 fed.
  • a gas source 102 designed as a gas cylinder and via the pressure regulator 18 and the connecting line 22 in the connecting piece C of the metering device 20 fed.
  • NO nitrogen monoxide
  • He helium
  • FIG. 1 Representations of the temporal courses of the respiration of the ventilated patient 14 as well as the application of the medical gas in the form of gas pulses are shown in FIG.
  • the time course of the patient's breathing 14 is shown as the volume flow Q.
  • a first inhalation phase of the patient 14 takes place.
  • a respiratory arrest of the patient 14 takes place.
  • a first exhalation phase of the patient 14 takes place and between the times t3 and t4 second inhalation phase, which is shorter than the first inhalation phase is.
  • a second exhalation phase takes place.
  • the gas pulses introduced into the breathing air supply line 24 with the aid of the metering device 20 are represented as the volume flow of the relevant portion of the medical gas NO.
  • the delivery of the medical gas takes place in this embodiment by gas pulses having a constant pulse frequency and thus independent of the respiratory rate of the patient 14.
  • solenoid valves preferably reversible valves are used between a fully closed and a fully open position, which are controlled binary.
  • the invention can be used in particular in neonatology for the treatment of pulmonary hypertension of a premature baby with nitric oxide. Nitric oxide is also applied to treat patients after organ transplants. However, the devices 10, 100 described in the exemplary embodiments can also be used for the application of other gaseous medicaments.
  • FIG. 5 shows a schematic illustration of a further device 200 for applying at least one medical gas to a patient 14 ventilated by means of a ventilator 12 in accordance with a third embodiment.
  • th embodiment of the invention shown.
  • the metering of the medical gas NO into the patient circuit part of the respirator 12, ie into the respiratory air hose 24, is proportional to the respiratory course of the patient 14.
  • the exemplary embodiments according to FIGS. 1 and 3 in the third embodiment generates gas pulses with different gas volume depending on the respiratory phase and / or the course of the respiratory phase.
  • a data and / or signal line 202 is provided between the respirator 12 and the metering device 20, via which the control unit 48 of the metering device 20 transmits information about a real-time flow profile of the respiration of the ventilated patient 14 with the aid of signals and / or data.
  • a real-time-capable bus system such as a CAN-BUS or a serial interface, such as a USB interface or RS232 interface
  • a real-time data transmission protocol can be used for data transmission.
  • the introduction of the medical gas into the breathing air supply line 24 then takes place in such a way that during the breathing phases of the patient a higher concentration of the medical gas is contained in the supplied ventilation air.
  • the gas pulses are delivered at a constant pulse frequency, wherein the amount of gas delivered per gas pulse is greater during the inhalation phases than during respiratory arrest phases and during the exhalation phases of the patient 14.
  • the pulse frequency during the inhalation phases may be higher than during the exhalation phases and during respiratory arrest.
  • the delivery of the medical gas through the metering device 20 may be interrupted.
  • the pulse frequency is preferably 104 gas pulses per minute. Only when the gas flow of the medical gas required by the valve bank 52 is greater than or equal to the maximum flow through a valve 54-60, so that the flow through this valve 54-60 would not be sufficient to apply the required amount of medical gas or the valve 54-60 would no longer close and thus would no longer generate gas pulses, an additional additional valve 54-60 or, instead of the first valve 54-60, a second larger-flow valve 54-60 is opened by the control unit 48 controlled.
  • the medical gas NO is not provided as a gas mixture of nitrogen monoxide and nitrogen (NO / N 2 ), but as a gas mixture of nitrogen monoxide (NO) and helium (He).
  • NO nitrogen monoxide
  • He nitrogen monoxide
  • the advantages associated with this gas mixture (NO, He) have already been explained in connection with FIG.
  • the gas pulses are generated in this fourth exemplary embodiment as described for the third exemplary embodiment in conjunction with FIG.
  • FIG. 6 shows a representation of the time course of the respiration of the ventilated patient 14 and the time profile of the application of the medical gas (NO / N 2 ) / (NO / He).
  • the respiratory air flow of the ventilated patient 14 is shown in the upper diagram, similar to FIG.
  • the lower diagram shows the time course of the gas pulses through which the medical gas NO or the gas mixture (NO / N 2 ), (NO / He) is fed into the breathing gas supply line 24. It can be seen that in the exemplary embodiment shown during the inhalation phases of the patient, the gas flow through the valves 54 to 60 or through the valve bank 52 is varied at a constant pulse width by a specific selection and / or combination of different valves 54 to 60.
  • the amount of gas applied in a gas pulse can be further varied by the fact that the individual pulse widths, with which the valves 54 to 60 are driven to generate a gas pulse, are different, so that at least two valves 54 to 60 deliver gas pulses of different pulse width. As a result, a total gas pulse is generated, which has been generated from two partial pulses of different pulse width. The Ges amt impulse has then a gradual course of the respiratory gas supply 24 is initiated.
  • the pulse frequencies during the inhalation phases are twice as high as in the exhalation phase.
  • the pulse frequency during the inhalation phase may be 208 gas pulses per minute and during the exhalation phase 104 gas pulses per minute.
  • the pulse frequency may be 104 gas pulses per minute during the inspiratory phase and 52 gas pulses per minute during the exhalation phase.
  • the length of a patient's inhalation 14 and / or the course of inspiration of the patient 14 can be determined empirically and according to the estimated course for each gas pulse during an inhalation, a gas quantity of the medical gas to be introduced through this gas pulse into the respiratory gas supply line 24 is determined. The fixed amount of gas is then introduced by a suitable control of the solenoid valves 54 to 60 in the breathing gas supply line 24.
  • a closed loop system is formed so that the gas mixture exhaled by the patient 14 remains in the closed loop system.
  • the medical gas not absorbed by the patient also remains in the circulatory system.
  • Such closed circuits are used in particular during anesthesia of the patient 14.
  • the patient 14 is connected to an anesthesia machine.
  • the control unit 48 is connected via an interface with the anesthetic machine.
  • the anesthesia machine comprises at least one sensor for determining the beginning of a breath of the patient 14 and a sensor for determining the volume of gas mixture inhaled in this breath.
  • the anesthesia machine communicates via the interface with information about the beginning of the breath and the inspired volume of gas mixture to the control unit 48, which determines in dependence of this data, the amount of the valves 54 to 60 injecting medical gas such that so much medical gas is injected so that it is completely or at least almost completely absorbed by the patient 14 in the breath, so that it no accumulation of the medical gas in the gas mixture of the closed-loop system comes.
  • the control unit 48 controls the solenoid valves 54 to 60 in particular such that the amount of medical gas to be injected is injected within a short time at the beginning of the breath. Thus, an accumulation of the medical gas in the gas mixture is avoided, thereby avoiding, for example, reactions with other substances in the closed-loop system.
  • the medical gas is taken up in a carrier gas, in particular helium.
  • a carrier gas in particular helium.
  • the ventilator 12 comprises a sensor for calculating the gas volume of a breath of the patient 14 and a sensor for determining the time of beginning of a breath.
  • the respirator 12 is connected via a data interface to the metering device 20, wherein via the interface data with information about the volume of the last breath of the patient 14 and data with information about the times of at least the last two breaths of the patient 14 are transmitted.
  • the control unit 48 determines in response to this data in real time the beginning of the next breath of the patient 14 and controls depending on the calculated start of the breath and at least the gas volume of the last breath, the solenoid valves 54 to 60 such that the injecting amount of medical gas to Beginning of the next breath is injected jerkily. Under jerky injection is understood in particular that the medical gas is injected within the shortest possible time.
  • the control unit 48 opens the solenoid valves 54 to 60 as far as possible at the beginning of the breath.

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  • Health & Medical Sciences (AREA)
  • Anesthesiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Emergency Medicine (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)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

L'invention concerne un dispositif et un procédé pour administrer au moins un gaz médical (NO) à un patient (14) sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire (12). Ledit appareil d'assistance respiratoire (12) produit un flux de gaz respiratoire (O2/N2) constant dans un tuyau d'alimentation (24). Des impulsions de gaz médical (NO) sont acheminées dans ledit flux de gaz respiratoire. Ces impulsions de gaz sont produites et introduites dans le tuyau d'alimentation (24) à l'aide d'au moins deux moyens de régulation (54 à 60) disposés en parallèle. Selon l'invention, une unité de commande (48) commande les moyens de régulation (54 à 60) de sorte que les impulsions de gaz introduites dans le tuyau d'alimentation (24) présentent un train d'impulsions à fréquence d'impulsions constante.
EP10796308A 2010-04-29 2010-11-30 Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire Withdrawn EP2563441A1 (fr)

Applications Claiming Priority (2)

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DE102010016699A DE102010016699A1 (de) 2010-04-29 2010-04-29 Verfahren und Vorrichtung zur Applikation mindestens eines medizinischen Gases an einen mit Hilfe eines Beatmungsgeräts beatmeten Patienten
PCT/EP2010/068556 WO2011134545A1 (fr) 2010-04-29 2010-11-30 Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire

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EP2563441A1 true EP2563441A1 (fr) 2013-03-06

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EP10796310A Withdrawn EP2563443A1 (fr) 2010-04-29 2010-11-30 Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire
EP10800899.6A Active EP2563444B1 (fr) 2010-04-29 2010-11-30 Dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'anesthésie
EP10796309A Withdrawn EP2563442A1 (fr) 2010-04-29 2010-11-30 Procédé et dispositif pour l'application d'au moins un gaz à usage médical à un patient sous assistance respiratoire à l'aide d'un respirateur
EP10796308A Withdrawn EP2563441A1 (fr) 2010-04-29 2010-11-30 Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire

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EP10796310A Withdrawn EP2563443A1 (fr) 2010-04-29 2010-11-30 Procédé et dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'assistance respiratoire
EP10800899.6A Active EP2563444B1 (fr) 2010-04-29 2010-11-30 Dispositif pour administrer au moins un gaz médical à un patient sous assistance respiratoire au moyen d'un appareil d'anesthésie
EP10796309A Withdrawn EP2563442A1 (fr) 2010-04-29 2010-11-30 Procédé et dispositif pour l'application d'au moins un gaz à usage médical à un patient sous assistance respiratoire à l'aide d'un respirateur

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US (4) US20130104885A1 (fr)
EP (4) EP2563443A1 (fr)
CN (4) CN102933248A (fr)
DE (1) DE102010016699A1 (fr)
ES (1) ES2759804T3 (fr)
WO (4) WO2011134547A1 (fr)

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Publication number Publication date
CN102946934A (zh) 2013-02-27
CN102933250A (zh) 2013-02-13
EP2563444A1 (fr) 2013-03-06
US20130092159A1 (en) 2013-04-18
ES2759804T3 (es) 2020-05-12
DE102010016699A1 (de) 2011-11-03
WO2011134546A1 (fr) 2011-11-03
CN102933248A (zh) 2013-02-13
US20130104885A1 (en) 2013-05-02
US20130087145A1 (en) 2013-04-11
WO2011134545A1 (fr) 2011-11-03
EP2563443A1 (fr) 2013-03-06
US20130098361A1 (en) 2013-04-25
EP2563442A1 (fr) 2013-03-06
WO2011134547A1 (fr) 2011-11-03
CN102933249A (zh) 2013-02-13
EP2563444B1 (fr) 2019-09-04
WO2011134548A1 (fr) 2011-11-03

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