JP2020500634A - Co2除去のためのシステム - Google Patents
Co2除去のためのシステム Download PDFInfo
- Publication number
- JP2020500634A JP2020500634A JP2019530661A JP2019530661A JP2020500634A JP 2020500634 A JP2020500634 A JP 2020500634A JP 2019530661 A JP2019530661 A JP 2019530661A JP 2019530661 A JP2019530661 A JP 2019530661A JP 2020500634 A JP2020500634 A JP 2020500634A
- Authority
- JP
- Japan
- Prior art keywords
- patient
- ecla
- treatment
- removal
- medical device
- 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.)
- Granted
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- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 claims abstract description 226
- 229910002092 carbon dioxide Inorganic materials 0.000 claims abstract description 113
- 239000001569 carbon dioxide Substances 0.000 claims abstract description 113
- 230000000241 respiratory effect Effects 0.000 claims abstract description 66
- 239000008280 blood Substances 0.000 claims abstract description 54
- 210000004369 blood Anatomy 0.000 claims abstract description 54
- 210000004072 lung Anatomy 0.000 claims abstract description 24
- 238000011282 treatment Methods 0.000 claims description 85
- 238000009423 ventilation Methods 0.000 claims description 76
- 238000000034 method Methods 0.000 claims description 38
- 230000017531 blood circulation Effects 0.000 claims description 25
- 230000029058 respiratory gaseous exchange Effects 0.000 claims description 13
- 230000000694 effects Effects 0.000 claims description 10
- 238000006213 oxygenation reaction Methods 0.000 claims description 9
- 238000002644 respiratory therapy Methods 0.000 claims description 9
- 210000004556 brain Anatomy 0.000 claims description 5
- 239000000203 mixture Substances 0.000 claims description 4
- 210000001034 respiratory center Anatomy 0.000 claims description 3
- 230000004087 circulation Effects 0.000 claims description 2
- 210000003019 respiratory muscle Anatomy 0.000 claims 2
- 230000002708 enhancing effect Effects 0.000 claims 1
- 238000002560 therapeutic procedure Methods 0.000 abstract description 11
- 239000002671 adjuvant Substances 0.000 abstract 1
- 239000007789 gas Substances 0.000 description 49
- 238000005259 measurement Methods 0.000 description 11
- 238000004590 computer program Methods 0.000 description 10
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 9
- 229910052760 oxygen Inorganic materials 0.000 description 8
- 239000001301 oxygen Substances 0.000 description 8
- QVLMCRFQGHWOPM-ZKWNWVNESA-N N-arachidonoyl vanillylamine Chemical compound CCCCC\C=C/C\C=C/C\C=C/C\C=C/CCCC(=O)NCC1=CC=C(O)C(OC)=C1 QVLMCRFQGHWOPM-ZKWNWVNESA-N 0.000 description 7
- 238000004891 communication Methods 0.000 description 5
- 208000028399 Critical Illness Diseases 0.000 description 4
- 230000006870 function Effects 0.000 description 4
- 238000004458 analytical method Methods 0.000 description 3
- 239000012528 membrane Substances 0.000 description 3
- 238000012544 monitoring process Methods 0.000 description 3
- 210000003205 muscle Anatomy 0.000 description 3
- 244000144985 peep Species 0.000 description 3
- 230000004044 response Effects 0.000 description 3
- 238000011144 upstream manufacturing Methods 0.000 description 3
- 210000001367 artery Anatomy 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 230000037396 body weight Effects 0.000 description 2
- 238000004364 calculation method Methods 0.000 description 2
- 230000008878 coupling Effects 0.000 description 2
- 238000010168 coupling process Methods 0.000 description 2
- 238000005859 coupling reaction Methods 0.000 description 2
- 238000001514 detection method Methods 0.000 description 2
- 230000003434 inspiratory effect Effects 0.000 description 2
- 238000001990 intravenous administration Methods 0.000 description 2
- 238000004519 manufacturing process Methods 0.000 description 2
- 230000002685 pulmonary effect Effects 0.000 description 2
- 230000036387 respiratory rate Effects 0.000 description 2
- 230000000630 rising effect Effects 0.000 description 2
- 210000003462 vein Anatomy 0.000 description 2
- 241001631457 Cannula Species 0.000 description 1
- MYMOFIZGZYHOMD-UHFFFAOYSA-N Dioxygen Chemical group O=O MYMOFIZGZYHOMD-UHFFFAOYSA-N 0.000 description 1
- 208000019693 Lung disease Diseases 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 210000000709 aorta Anatomy 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 238000009530 blood pressure measurement Methods 0.000 description 1
- 210000004204 blood vessel Anatomy 0.000 description 1
- 229940026085 carbon dioxide / oxygen Drugs 0.000 description 1
- 230000002612 cardiopulmonary effect Effects 0.000 description 1
- 210000000038 chest Anatomy 0.000 description 1
- 230000003750 conditioning effect Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000000502 dialysis Methods 0.000 description 1
- 229910001882 dioxygen Inorganic materials 0.000 description 1
- 238000002618 extracorporeal membrane oxygenation Methods 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 230000004217 heart function Effects 0.000 description 1
- 230000001771 impaired effect Effects 0.000 description 1
- 230000004199 lung function Effects 0.000 description 1
- 238000005399 mechanical ventilation Methods 0.000 description 1
- 230000003278 mimic effect Effects 0.000 description 1
- 230000003227 neuromodulating effect Effects 0.000 description 1
- 230000003287 optical effect Effects 0.000 description 1
- 230000035790 physiological processes and functions Effects 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 230000009325 pulmonary function Effects 0.000 description 1
- 230000009467 reduction Effects 0.000 description 1
- 210000002345 respiratory system Anatomy 0.000 description 1
- 210000004761 scalp Anatomy 0.000 description 1
- 230000002000 scavenging effect Effects 0.000 description 1
- 239000000126 substance Substances 0.000 description 1
- 230000001360 synchronised effect Effects 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- 210000001631 vena cava inferior Anatomy 0.000 description 1
- 210000002620 vena cava superior Anatomy 0.000 description 1
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- General Health & Medical Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
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- Biomedical Technology (AREA)
- Biophysics (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Surgery (AREA)
- Physics & Mathematics (AREA)
- Pathology (AREA)
- Emergency Medicine (AREA)
- Hematology (AREA)
- Anesthesiology (AREA)
- Vascular Medicine (AREA)
- Pulmonology (AREA)
- Urology & Nephrology (AREA)
- Physiology (AREA)
- Psychiatry (AREA)
- Cardiology (AREA)
- Artificial Intelligence (AREA)
- Computer Vision & Pattern Recognition (AREA)
- Signal Processing (AREA)
- Psychology (AREA)
- External Artificial Organs (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
Abstract
Description
3 患者
5 ECLAデバイス、医用デバイス
7 生体電気センサ
9 流れ発生器、流れ発生手段
11 血液流路、ガス流路
13 人工肺
15 入口
17 センサ、第1の流量および/または圧力センサ
19 センサ、血液ガス分析器
21 センサ、第2の流量および/または圧力センサ
22A 制御ユニット
22B 制御ユニット
22C 制御ユニット
23A ユーザ入力デバイス
23B ユーザ入力デバイス
25 オペレータ
26A ガス入口
26B ガス入口
27A ディスプレイデバイス
27B ディスプレイデバイス
29 生体信号入力ポート
30 人工呼吸器
31 吸気ライン
32 ガス出口
33 呼気ライン
35 共通ライン
39 空気圧ユニット
37 Yピース
38A 第1の圧力および流量センサ配列
38B 第2の圧力および流量センサ配列
41 有線接続部
43A 通信ポート
43B 通信ポート
45 生体信号入力ポート
47 独立型モニタユニット
49A 信号リンク
49B 信号リンク
49C 信号リンク
51A 制御リンク
51B 制御リンク
53 食道カテーテル
55 電極
Claims (20)
- 患者(3)の循環系からの二酸化炭素(CO2)除去のためのシステム(1)であって、
前記患者の血液からのCO2の体外除去を通じて前記患者(3)に対して体外式肺補助(ECLA)治療を提供するための医用デバイス(5)と、
前記ECLA治療により得られるCO2除去の度合いを制御するように前記医用デバイス(5)の動作を制御するための少なくとも1つの制御ユニット(22A〜22C)と
を備え、前記システム(1)は、
呼吸するための前記患者の努力を示す生体電気信号を検出するための生体電気センサ(7)であって、前記少なくとも1つの制御ユニット(22A〜22C)は、前記検出された生体電気信号に基づき前記医用デバイス(5)の前記動作を制御するように構成された、生体電気センサ(7)をさらに備えることを特徴とする、システム(1)。 - 前記少なくとも1つの制御ユニット(22A〜22C)は、現在のCO2除去の度合いが不十分であることを前記生体電気信号が示すときに、前記医用デバイス(5)の前記動作を強化するように構成された、請求項1に記載のシステム(1)。
- 前記患者の肺に対する呼吸ガスの供給を通じて前記患者(3)に対して呼吸治療を提供するための人工呼吸器(30)をさらに備え、前記少なくとも1つの制御ユニット(22A〜22C)は、前記生体電気信号、および前記人工呼吸器(30)により提供される前記患者(3)の現在の換気レベルに基づき前記医用デバイス(5)の前記動作を制御するように構成された、請求項1または2に記載のシステム(1)。
- 前記少なくとも1つの制御ユニット(22A〜22C)は、前記人工呼吸器(30)により前記患者(3)に対して現在送達されている一回換気量および/またはピーク圧力、および/または前記患者(3)の体重から、前記患者(3)の前記現在の換気レベルを判定するように構成された、請求項3に記載のシステム(1)。
- 前記少なくとも1つの制御ユニット(22A〜22C)は、前記ECLA治療および前記呼吸治療により得られるCO2除去の全体的度合いが不十分であることと、前記現在の換気レベルが前記患者(3)の最大換気レベルのような前記患者(3)の所定のしきい値換気レベルに実質的に相当するまたはそれを超過することとを前記生体電気信号が示すときに、前記ECLA治療により得られるCO2除去の前記度合いを上昇させるように前記医用デバイス(5)を制御するように構成された、請求項3または4に記載のシステム(1)。
- 前記少なくとも1つの制御ユニット(22A〜22C)は、前記生体電気信号に基づき、前記呼吸治療により得られるCO2除去の度合いを制御するように前記人工呼吸器(30)の動作を制御するようにさらに構成された、請求項3から5のいずれか一項に記載のシステム(1)。
- 前記少なくとも1つの制御ユニット(22A〜22C)は、前記ECLA治療および前記呼吸治療により得られるCO2除去の全体的度合いが不十分であることと、前記現在の換気レベルが前記患者(3)の最大換気レベルのような前記患者(3)の所定のしきい値換気レベル未満であることとを前記生体電気信号が示すときに、前記呼吸治療により得られるCO2除去の前記度合いを上昇させるように前記人工呼吸器(30)を制御するように構成された、請求項6に記載のシステム(1)。
- 前記生体電気信号は、前記患者の横隔膜もしくは上気道筋の電気的活動を表す筋電図(EMG)信号、または呼吸中枢に関連する前記患者の脳の一部の電気的活動を表す脳波(EEG)信号である、請求項1から7のいずれか一項に記載のシステム(1)。
- 前記生体電気センサ(7)は、前記患者(3)の横隔膜および/または上気道からEMG信号を捕捉するための複数の電極(55)を有する食道カテーテル(53)を備える、請求項1から8のいずれか一項に記載のシステム(1)。
- 前記少なくとも1つの制御ユニット(22A〜22C)は、前記医用デバイス(5)により生成される体外血流、体外血液酸素添加のためのフレッシュガス流、および体外血液酸素添加のためのフレッシュガスの組成のうちのいずれかまたは任意の組合せを前記生体電気信号に基づき制御することによって、前記医用デバイス(5)の前記動作を制御するように構成された、請求項1から9のいずれか一項に記載のシステム(1)。
- 患者の血液からのCO2の体外除去を通じて前記患者(3)に対して体外式肺補助(ECLA)治療を提供するための医用デバイス(5)であって、前記ECLA治療により得られるCO2除去の度合いを制御するように前記医用デバイス(5)の動作を制御するための制御ユニット(22A)を備え、
前記制御ユニット(22A)は、呼吸するための前記患者の努力を示す生体電気信号に基づき前記医用デバイス(5)の動作を制御するように構成されたことを特徴とする、医用デバイス(5)。 - 患者(3)の循環系からのCO2除去のための方法であって、
ECLA治療により得られるCO2除去の度合いを制御するように、前記患者の血液からのCO2の体外除去を通じて前記患者(3)に対して前記ECLA治療を提供する医用デバイス(5)の動作を制御するステップと、
呼吸するための前記患者の努力を示す生体電気信号を記録するステップ(S1)と、
前記記録された生体電気信号に基づき前記医用デバイス(5)の前記動作を自動的に制御するステップ(S2)と、
を含むことを特徴とする方法。 - 現在のCO2除去の度合いが不十分であることを前記生体電気信号が示すときに、前記医用デバイス(5)の前記動作を強化するステップをさらに含む、請求項12に記載の方法。
- 前記生体電気信号、および前記患者の肺に対する呼吸ガスの供給を通じて前記患者(3)に対して呼吸治療を提供する人工呼吸器(30)により提供される前記患者(3)の現在の換気レベルに基づき、前記医用デバイス(5)の前記動作を自動的に制御するステップをさらに含む、請求項12または13に記載の方法。
- 前記現在の換気レベルは、前記人工呼吸器(30)により前記患者(3)に対して現在送達されている一回換気量および/またはピーク圧力、および/または前記患者(3)の体重から判定される、請求項14に記載の方法。
- 前記ECLA治療および前記呼吸治療により得られるCO2除去の全体的度合いが不十分であることと、前記現在の換気レベルが前記患者(3)の最大換気レベルのような前記患者(3)の所定のしきい値換気レベルに実質的に相当するまたはそれを超過することとを前記生体電気信号が示すときに、前記ECLA治療により得られるCO2除去の前記度合いを上昇させるように前記医用デバイス(5)を自動的に制御するステップ(S6A)をさらに含む、請求項14または15に記載の方法。
- 前記呼吸治療により得られるCO2除去の度合いを制御するように前記人工呼吸器(30)の動作を前記生体電気信号に基づき自動的に制御するステップをさらに含む、請求項14から16のいずれか一項に記載の方法。
- 前記ECLA治療および前記呼吸治療により得られるCO2除去の全体的度合いが不十分であることと、前記現在の換気レベルが前記患者(3)の最大換気レベルのような前記患者(3)の所定のしきい値換気レベル未満であることとを前記生体電気信号が示すときに、前記呼吸治療により得られるCO2除去の度合いを上昇させるように前記人工呼吸器(30)を自動的に制御するステップ(S6B)を含む、請求項17に記載の方法。
- 前記生体電気信号は、前記患者の横隔膜もしくは上気道筋の電気的活動を表すEMG信号、または呼吸中枢に関係する前記患者の脳の一部の電気的活動を表すEEG信号である、請求項12から18のいずれか一項に記載の方法。
- 前記医用デバイス(5)の前記動作は、前記医用デバイス(5)により生成される体外血流、体外血液酸素添加のためのフレッシュガス流、および体外血液酸素添加のためのフレッシュガスの組成のうちのいずれかまたは任意の組合せを前記生体電気信号に基づき制御することによって制御される、請求項12から19のいずれか一項に記載の方法。
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