WO2002083221A2 - Procede pour commander la pression theorique d'un appareil permettant la mise en oeuvre d'un traitement de ventilation spontanee en pression positive continue et appareil permettant la mise en oeuvre d'un traitement de ventilation spontanee en pression positive continue - Google Patents

Procede pour commander la pression theorique d'un appareil permettant la mise en oeuvre d'un traitement de ventilation spontanee en pression positive continue et appareil permettant la mise en oeuvre d'un traitement de ventilation spontanee en pression positive continue Download PDF

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Publication number
WO2002083221A2
WO2002083221A2 PCT/DE2002/001425 DE0201425W WO02083221A2 WO 2002083221 A2 WO2002083221 A2 WO 2002083221A2 DE 0201425 W DE0201425 W DE 0201425W WO 02083221 A2 WO02083221 A2 WO 02083221A2
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WIPO (PCT)
Prior art keywords
pressure
breaths
event
target pressure
predetermined
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PCT/DE2002/001425
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German (de)
English (en)
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WO2002083221A3 (fr
Inventor
Siegfried Häußler
Mirko Wagner
Michael Lauk
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Seleon Gmbh
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Application filed by Seleon Gmbh filed Critical Seleon Gmbh
Priority to DE10291565T priority Critical patent/DE10291565D2/de
Publication of WO2002083221A2 publication Critical patent/WO2002083221A2/fr
Publication of WO2002083221A3 publication Critical patent/WO2002083221A3/fr

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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
    • A61M16/0057—Pumps therefor
    • A61M16/0066—Blowers or centrifugal pumps
    • A61M16/0069—Blowers or centrifugal pumps the speed thereof being controlled by respiratory parameters, e.g. by inhalation
    • 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
    • A61M16/026—Control means therefor including calculation means, e.g. using a processor specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
    • 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
    • A61M16/06—Respiratory or anaesthetic masks
    • 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
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
    • 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

Definitions

  • This invention relates to a method for controlling the target pressure of a device for performing the CPAP therapy according to the preambles of claims 1, 8 or 14 and a device for performing the CPAP therapy for performing these methods.
  • CPAP continuous positive airway pressure
  • the CPAP therapy is in Chest. Volume No. 110, pages 1077-1088, October 1996 and Sleep, Volume No. 19, pages 184-188.
  • a CPAP device uses a compressor, preferably a humidifier, a hose and a nasal mask, to apply a positive pressure of up to about 30 mbar in the patient's airways. This overpressure is intended to ensure that the upper respiratory tract remains fully open throughout the night and thus no obstructive breathing disorders (apneas) occur (DE 19849 571 A1).
  • the CPAP device 1 shows the CPAP device 1 and a patient 19.
  • the CPAP device in turn comprises a compressor 4, a ventilation hose 9, a ventilation mask 18, a pressure sensor 11 and a flow sensor 16.
  • the compressor contains a turbine 8 to generate excess pressure.
  • the pressure sensor 11, which is located in the compressor housing is connected to the respiratory mask 18 via a pressure measuring tube 10 in order to measure the actual pressure in the respiratory mask.
  • the pressure sensor can also be located in the respiratory mask and can be connected to the compressor housing via electrical lines.
  • One or more small holes 2 are made in or near the mask, so that an air flow from the compressor to the holes arises on average over time. This prevents the accumulation of CO 2 in the ventilation tube 19 and enables the patient to breathe.
  • the speed of the turbine 8 is regulated so that the actual pressure corresponds to a predetermined target pressure.
  • the setpoint pressure is conventionally preset under the supervision of a doctor and is referred to as the titration pressure.
  • the flow sensor can e.g. B. be a sensor with heating wire 17, which delivers its measurement signal via measurement line 15 to a controller in the compressor housing.
  • the CPAP- A device can be provided with a constriction in the breathing tube for the respiratory flow measurement, the differential pressure being measured via the constriction.
  • the pressure sensors can be arranged directly in the ventilation hose or connected to it via further pressure measurement hoses.
  • the controller can also take over pressure control.
  • Control procedures for CPAP devices have therefore been developed that lower the set pressure as much as possible.
  • Such a control is known from WO00 / 24446. This control is based on an algorithm in which at least three pressure values are set in succession during an “AutoSef” operation. If the tidal volume is independent of the set pressures, the pressures were too high. If the tidal volume increases with the set pressures, the pressures were too low.
  • the optimal pressure results from the point of intersection of the straight line through points in an area in which the tidal volume increases linearly with the pressure and a parallel to the pressure axis through points where the tidal volume is independent of the pressure.
  • BiPAP devices and multilevel devices were also developed. These devices have the property of helping the patient to breathe by lowering the pressure when exhaling and increasing the pressure when inhaling. So these devices work with at least two pressure levels.
  • WO 94/23780 describes a method for controlling the pressure of a CPAP device. If there are no breathing disorders during sleep, the pressure is gradually reduced. If sleep disorders such as apneas, hypopneas or snoring occur, the pressure is increased. Obstructive and central apneas are distinguished at a frequency of 5 Hz due to deliberately created pressure fluctuations.
  • US 5,335,654 describes a similar process. It determines the respiratory flow limitation that occurs in hypopneas based on the shape of the respiratory flow during inspiration. If the course of the respiratory flow shows a plateau or a flat area or if it deviates from a sinus shape, this is interpreted as hypopnea.
  • EP 0 934 723 A1 contains a similar disclosure.
  • DE 691 32 030 T2 also describes a control method for printing a pressure system for respiratory tracts.
  • the pressure is raised by a valve during inhalation and reduced during exhalation.
  • the valve is controlled so that the pressure is kept constant during inhalation and exhalation. If the valve position changes only slowly during an inhalation process, this is interpreted as the end of the inhalation process.
  • Inaudible vibrations or changes in pressure can be evaluated to determine whether the patient's breathing is regular, irregular, or apneic.
  • the duration of inhalation and exhalation as well as the flow velocities can be determined. This information can be stored in a memory.
  • admittance can be calculated from respiratory flow divided by pressure. The time course of the admittance can be compared with stored admittance schemes. The number of the most appropriate admittance scheme can be used as a "pointer" for a table that contains the action to be performed, such as a pressure increase.
  • EP 0 612 257 B1 also describes an auto-CPAP system that detects apneas, hypopneas and unstable breathing in order to adjust the pressure.
  • a large change in respiratory parameters is defined as a coefficient of variation value of 0.3 or more for 4 or more of the defined features such as: B. Inspiration time, total duration of a breath, mean inhalation flow, peak inhalation flow and roundness in 5 or 10 breaths.
  • Hypoventilation is defined as five consecutive breaths with an average inspiratory flow of less than 40% of the predicted supine mean inspiratory flow when awake.
  • Apnea is defined by the fact that there is no change in the breathing phase for 10 seconds.
  • Flatness is defined as the relative deviation of the observed airflow from the mean airflow. to
  • WO 99/24099 also describes a control method for an auto-CPAP device that takes into account apneas, hypopneas, reduced respiratory flow and snoring.
  • the snoring signal is obtained by bandpass filtering the respiratory flow signal with a lower cutoff frequency of 30 Hz and an upper cutoff frequency of 100 Hz.
  • a flow limitation index is calculated as an RMS deviation over the middle range of the (normalized inhaled air flow-1).
  • the respiratory flow signal is fed to a band-limited differentiator. If the output signal of the differentiator exceeds an inhalation threshold or falls below an exhalation threshold, an exhalation detection signal or an inhalation detection signal is determined.
  • WO 00/27457 relates to error diagnosis in CPAP devices. If the pressure remains below 2 mbar for more than 0.3 seconds at an engine speed of more than 12,000 revolutions per minute, an error is detected.
  • the wearing of the face mask of a CPAP device is determined on the basis of the height of the air flow.
  • EP 0 934 723 A1 also relates to the control of a CPAP device based on the detection of apneas and partial occlusion of the upper respiratory tract.
  • fuzzy variables indicate membership in a set.
  • the quantity corresponds to a specific operating state of the device to be controlled.
  • fuzzy logic it is possible to design a controller taking into account a limited number of typical operating states. Fuzzy logic provides a formalism for interpolation between the states considered.
  • the object of the invention is to specify methods for controlling the target pressure of a CPAP device and a CPAP device for carrying out the methods, which allow a CPAP target pressure that is optimal for a patient to be set on the basis of the recorded respiratory flow profile of a patient.
  • 1 shows a device for performing CPAP therapy
  • the control method first calculates features from a measured respiratory flow curve and a measured actual pressure curve of a CPAP device, which are described under section 1 "Features”. Special combinations of the features are combined to form detectors, which are discussed in Section 2 "Detectors”. Flags are set in the detectors when they detect an event. The control process then changes the target pressure based on the event flags of the detectors, which is explained in section 3 "Control Process”.
  • the control method has three different states, namely a normal state, a sensitive state and a leak state, between which it is possible to switch back and forth.
  • Some detectors operate in a sensitive state with parameters that deviate from the normal state.
  • the control process changes to the sensitive state when the control process lowers pressure in the normal state. By selecting the parameters for the sensitive state, the control process reacts faster if the actual CPAP pressure is too low. If there is a leak, the system changes to the leak state.
  • FIG. 2 shows 50 seconds above the respiratory flow curve of a patient in the sleep stage NREM 2 (NREM: non rapid eye movement).
  • NREM non rapid eye movement
  • the various sleep stages are described in "A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects" by Rechtschaffen, A., Kales, A. (eds.), NIH publ NO. 204, U.S. Government Printing Office, Washington D. O, 1968.
  • a high flow above indicates inspiration and a low flow (below) expiration.
  • a distinct flank can be seen in the respiratory flow, which is used to detect individual breaths.
  • the first and second derivatives of the respiratory flow curve are estimated to detect the flanks.
  • the first derivative is shown in Fig. 2 below. Owing to
  • Noise in the respiratory flow curve is not just derived from the respiratory flow curve, but also low pass filtered.
  • the derivation and low-pass filtering takes place in one filter step by suitable selection of the coefficients of a digital filter.
  • the local maxima of the first derivative correspond to the maximum slope of the respiratory flow during the transition between inspiration and expiration. From the end of the inspiration, the beginning of the inspiration is sought by looking for the first local minimum in the estimated derivative.
  • the middle curve in FIG. 2 shows the automatically detected points in time, which are marked by vertical lines.
  • the expiration time results from the time difference between a minimum of the estimated derivative and the previous maximum of the estimated derivative. An expiration time is also entered with the reference symbol EL in FIG. 7.
  • FIG. 3 An example of a 50-second section of a respiratory flow curve of a patient in the sleep stage NREM 2 can be seen in FIG. 3 above.
  • the most recent selected breath is shown in the middle.
  • the cross-correlation function between the data series above and the individual breathing pattern is shown in the lower curve.
  • the correlation curve has values between one and minus one, the correlation becoming one if the two breaths match each other and equaling minus one if the curves are negatively correlated, i.e. when a peak in the breathing pattern exactly matches a valley in the data piece under consideration.
  • another dependency measure such as e.g. B. mutual information can be used.
  • the correlation curve shows whether breathing is regular and whether there are no breaths. If the successive breathing patterns are similar, then the correlation curve has a periodic course with local maxima close to one and local minima close to minus one.
  • the backward correlation is the mean value over a certain number of local maxima of the correlation curve before the current point in time. The backward correlation is a measure of how well the most recent breathing cycle matches the previous breathing cycles. The backward correlation is between 0 and 1.
  • the upper area of FIG. 4 shows the respiratory flow curve of a patient in stage NREM 2.
  • the lower area of FIG. 4 shows the difference between one and the local maxima of a correlation curve, which was calculated from the respiratory flow curve shown in FIG. 4 above. The higher the value of the lower curve in FIG. 4, the more the current breathing cycle deviates from the corresponding past breathing cycle.
  • FIG. 5 corresponds to FIG. 4, but the respiratory flow curve now comes from the REM sleep stage (REM: rapid eye movement).
  • REM rapid eye movement
  • the inspiration volume is hatched in FIG. 7 as area IV in a respiratory flow curve.
  • the short vertical lines in FIG. 7 mark the beginning of inspiration, the long vertical lines end of inspiration.
  • the inspiration volume can be standardized to the length of the inspiration.
  • the mean curvature of the respiratory flow during inspiration is calculated.
  • the first derivative of the respiratory flow during inspiration is estimated, i.e. additionally subjected to low-pass filtering.
  • a straight line is then fitted to the estimated first derivative. The slope of this fitted straight line gives the mean curvature of the inspiration.
  • Snoring is caused by vibration of the walls of the upper respiratory tract. It has been shown that the number of zero crossings in the alternating component of the actual CPAP pressure is a reliable characteristic for snoring.
  • a typical CPAP device 1 has a pressure control loop in which the turbine speed is controlled so that the pressure in the breathing mask 18 largely corresponds to a predetermined target pressure.
  • Some CPAP devices have faster pressure regulation, which is able to compensate for the pressure differences caused by the patient's breathing. With other CPAP devices, the actual pressure fluctuates with the patient's breathing.
  • the pressure control of a typical CPAP device is not so fast that it would be able to control snoring noises.
  • FIG. 6 A section of a respiratory flow signal is shown in FIG. 6 above, the associated CPAP actual pressure is shown below.
  • the curve below shows the variance of the actual CPAP pressure per breath.
  • the variance increases significantly when the actual CPAP pressure is changed by the patient snoring in the range of 30 to 40 seconds. In one embodiment, the variance is therefore used to detect snoring.
  • the actual pressure signal can be high-pass filtered before the variance is calculated in order to eliminate pressure fluctuations caused by breathing. In the preferred embodiment, however, the number of zero crossings in the alternating component of the actual CPAP pressure is used. It is the more robust feature when using CPAP devices with slower pressure control.
  • the zero crossings are only counted during the inspiration phase so that the control reacts to inspiratory snoring.
  • the snoring feature is used indirectly in the control, ie if snoring is present, the respiratory flow limitation and hypopneas are taken into account more by adding a snoring bonus to the respective features.
  • Flags are set in the detectors when they detect an event.
  • the control method then changes the pressure on the basis of the event flags of the detectors.
  • Table 2 Parameters for the respiratory arrest detector in the normal state and in the sensitive state (see section 3 control procedure)
  • the max_no_breath_time value corresponds to a time of 2 minutes at the sampling rate of 100 Hz used here.
  • the expiration time is used for apnea detection.
  • the apnea detector does the following: 1. Detection of respiratory arrests: there is a respiratory arrest if the expiration time is greater than exp_schwelle_in_sec.
  • the non-normalized mean inspiration volume, the backward correlation and the snoring feature are used for hypopnea detection.
  • n_insp_vol_breaths breaths the change in the inspiration volumes of the first half of the n_insp_vol_breaths breaths compared to the second half of the n_insp_vol_breaths breaths is calculated. 2. If snoring is additionally detected in the first half of the n_insp_vol_breaths breaths, then the snoring_volume_bonus is added to the change in the inspiration volume.
  • a hypopnea event occurs if minjumps hypopneas are found in the last n_breaths breaths.
  • hypopneas can change the start of stable breathing detection. After n_hypopnoen_reset_normal Hypopnoen, the detection of stable breathing begins again with the normal detector.
  • the snoring characteristic, the mean curvature and the backward correlation are used for the detection of respiratory flow limitation.
  • curvatureShort_schwelle breaths it is checked whether the snoring characteristic is above the schnarch_min_schwelle threshold. If this is the case, the curvatureShort_snoring_bonus is added to the curvature characteristic.
  • curvatureShort_schwelle breaths are counted how often both the curvature feature exceeds the curvatureShort_mean_schwelle threshold and the backward correlation exceeds the curvatureShort_correlation_schwelle threshold.
  • Table 7 Parameters for the detection of weak respiratory flow limitation with stable breathing in a sensitive state
  • curvatureLong_schwelle breaths it is checked whether the snoring characteristic is above the schnarch_min_schwelle threshold. If this is the case, the curvatureLong_snoring_bonus is added to the curvature characteristic.
  • curvatureLong_schwelle breaths are counted how often the curvature characteristic exceeds the threshold of curvatureLong_mean_schwelle.
  • the threshold can be set equal to curvatureLong_medium_mean_schwelle or equal to curvatureLong_high_mean_schwelle. This will be discussed later in the
  • Table 8 Parameters for the detection of respiratory flow limitation with stable and unstable breathing in the normal state
  • Table 9 Parameters for the detection of respiratory flow limitation with stable and unstable breathing in a sensitive state
  • the Wilcoxon rank sum test is used to detect the increase in the respiratory flow limitation feature.
  • the Curvature After Pressure Down Detector is only used in the sensitive state.
  • the Wilcoxon - Rank Sum Test is in the process of being hardened: Statistics, textbook and handbook of applied statistics, Oldenburg-Verlag, Kunststoff 1999 and in D.R. Cox, C.V. Hinkley: Theoretical Statistics, Chapman & Hall 1974.
  • the rank of the curvature features is determined for the last n_curv_breaths breaths.
  • the correlation feature is used to identify stable breathing.
  • the normal detector does the following:
  • a leak can already result from the mask sliding relative to the patient's face.
  • the mean value of the respiratory flow and the actual CPAP pressure is calculated in a data window of the width leakagejean low ime.
  • the data window for leak detection is advanced with a step size of step_size.
  • Table 12 Parameters for the detection of a leak state The parameters are independent of the state of the control.
  • the control method has three different states, namely a normal state, a sensitive state and a leak state, between which it is possible to switch back and forth.
  • Some detectors operate in a sensitive state with parameters that deviate from the normal state.
  • the sensitive state of the control there is a change if the control is in the normal state lowers the pressure.
  • the control reacts faster if the CPAP pressure is too low.
  • the control switches to the leak state.
  • the controller changes the pressure within the limits of lower_pressureJimit and upper_pressurejimit.
  • the printing recommendation is determined by titration_pressure.
  • the controller uses two different pressure steps for increasing the pressure: big_pressure_step and small_pressure_step. Pressure_down_step is used to lower the pressure.
  • Respiratory failure detector If no breath is detected for longer than max_no_breathJime, the pressure is increased by big_pressure_step.
  • Apnea event If an apnea event is determined, the pressure is increased by big_pressure_step if the current pressure is less than or equal to titration_pressure plus small_pressure_step.
  • hypopnea event If a hypopnea event is detected, the pressure is increased by small_pressure_step.
  • Respiratory flow limitation If the curvature long detector or the curvature short detector detects a respiratory flow limitation, the pressure is increased by small_pressure_step. The curvature after pressure down detector is not active in the normal state.
  • obstructive apneas are caused by occlusion of the upper respiratory tract. You can be treated with a higher CPAP pressure.
  • central apneas are based on an instruction from the brain to temporarily stop breathing. They cannot be remedied by CPAP therapy. For this reason, the parameter titration_pressure is chosen so high that experience has shown that obstructive apneas no longer occur.
  • the curvature long detector increases the pressure maxNumberOfCurvatureEvents in a row
  • curvatureLong_mean_schwelle curvatureLong_medium_mean_schwelle
  • the system switches from the normal state to the sensitive state when the pressure drops and to the leak state when a leak occurs.
  • the curvature after pressure down detector is active in the sensitive state.
  • the events of the detectors are used for the pressure change.
  • Respiratory failure event If no breath is detected for longer than max_no_breathJime, the pressure is increased by big_pressure_step.
  • Respiratory flow limitation If the curvature long detector, the curvature short detector or the curvature after pressure down detector detects a respiratory flow limitation, the pressure is increased by small_pressure_step.
  • the pressure is increased and if the pressure is less than the pressure before the last pressure drop and if the number of breaths since the last pressure drop is ⁇ n_breathsJor_restart_APDC_at_pressure_up.
  • the leak detector waits for leakage_restartJlowJime seconds until it starts again with the leak detection.
  • the events determined by the detectors are treated as fuzzy variables.
  • the advantage of this embodiment is that the control works more continuously.
  • the transition from "no event” to "event occurred” preferably takes place, that is to say the region in which the fuzzy variable increases from 0 to 1, so that the corresponding fuzzy variable reaches the value 0.5 at the limit value specified above.
  • a normal event is detected or recognized the more clearly the backward correlation exceeds a threshold value (see section 2.5).
  • the width of the selected transition area and the course of the transition function are of minor importance for the quality of the tax procedure.
  • the normal fuzzy variable can take the value zero if the backward correlation is less than 0.82, increase linearly from 0 to 1 if the backward correlation falls in the range between 0.82 and 0.9 and be 1 if the backward correlation exceeds 0.9.
  • other functions such as a suitably scaled arctan function or a probability integral ⁇ (x) can also be used to design the transition area:
  • the pressure change is determined from the sum of the fuzzy variables supplied by the individual detectors and preferably weighted with coefficients.
  • the coefficients take into account the fact that, for example, the pressure is increased rapidly when a breathing arrest is detected, while the target pressure of the CPAP device is increased more slowly when the breathing flow is limited. As a result, for example, the coefficient for the apnea fuzzy variable will be greater than that for the respiratory flow limitation fuzzy variable.
  • only some of the detectors can deliver fuzzy variables as results.
  • fuzzy variables is particularly advantageous in the case of the hypopnea detector, the curvature long detector, the curvature short detector and the curvature after pressure down detector.
  • fuzzy variables does not seem to make much sense in the leak state, since the leak state is not an orderly operation of the CPAP device, but an exceptional state.
  • intermediate results that occur in the detection of events in the detectors are also implemented as fuzzy variables. This applies in particular to the decision whether one of two breath stops lasts longer than long_apnoeJimeJn_sec, whether three breath stops are consecutive (section 2.2), whether the snoring feature is fulfilled, whether both the curvature feature and the correlation feature exceed a corresponding threshold (section 2.4.1 ) and whether the curvature characteristic exceeds CurvatureLong_mean_schwelle (section 2.4.2).
  • the target pressure control method according to the invention described above can also be used in BiPAP devices and in multilevel devices.
  • the setpoint pressure determined according to the control method can be used as the higher pressure in BiPAP devices or the highest pressure in multilevel devices.
  • the pressure determined according to a control method according to the invention specifies the time average of the pressures generated by a BiPAP or multilevel device.

Abstract

La présente invention concerne un procédé pour commander la pression théorique d'un appareil permettant la mise en oeuvre d'un traitement de ventilation spontanée en pression positive continue (CPAP), ainsi qu'un appareil permettant la mise en oeuvre d'un traitement de ventilation spontanée en pression positive continue. Ce procédé consiste à effectuer une mesure répétée d'un flux d'air respiratoire au cours du fonctionnement de l'appareil permettant la mise en oeuvre d'un traitement de ventilation spontanée en pression positive continue, au moins un critère tel qu'une corrélation en arrière de cycles respiratoires, le changement de volumes d'inspiration ou une caractéristique de courbe lors de l'inspiration étant calculé à partir de l'allure dans le temps du flux d'air respiratoire mesurée à pression théorique constante, puis la pression théorique est augmentée ou réduite en fonction de ce critère.
PCT/DE2002/001425 2001-04-18 2002-04-17 Procede pour commander la pression theorique d'un appareil permettant la mise en oeuvre d'un traitement de ventilation spontanee en pression positive continue et appareil permettant la mise en oeuvre d'un traitement de ventilation spontanee en pression positive continue WO2002083221A2 (fr)

Priority Applications (1)

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DE10291565T DE10291565D2 (de) 2001-04-18 2002-04-17 Verfahren zum Steuern des Solldrucks eines Geräts zum Durchführen der CPAP-Therapie sowie ein Gerät zur Durchführung der CPAP-Therapie

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE10118968.0 2001-04-18
DE10118968A DE10118968B4 (de) 2001-04-18 2001-04-18 Verfahren zum Steuern des Solldrucks eines Geräts zur Durchführung der CPAP-Therapie sowie ein Gerät zur Durchführung der CPAP-Therapie

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WO2004105846A2 (fr) 2003-05-21 2004-12-09 Seleon Gmbh Dispositif de commande d'un appareil anti-ronflement et appareil anti-ronflement par ex. destine a la therapie de bpco
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WO2013049552A3 (fr) * 2011-09-28 2013-08-01 General Electric Company Capteur d'écoulement comportant un dispositif de détection à système micro-électro-mécanique et procédé pour son utilisation
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WO2014150227A1 (fr) * 2013-03-15 2014-09-25 Fisher & Paykel Healthcare Limited Détermination de pression de titrage sur plusieurs nuits
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DE10118968B4 (de) 2007-03-01
WO2002083221A3 (fr) 2003-02-20
DE10291565D2 (de) 2004-04-15

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