WO2019080955A1 - Système pour soutenir l'échange gazeux chez des patients - Google Patents

Système pour soutenir l'échange gazeux chez des patients

Info

Publication number
WO2019080955A1
WO2019080955A1 PCT/DE2018/000306 DE2018000306W WO2019080955A1 WO 2019080955 A1 WO2019080955 A1 WO 2019080955A1 DE 2018000306 W DE2018000306 W DE 2018000306W WO 2019080955 A1 WO2019080955 A1 WO 2019080955A1
Authority
WO
WIPO (PCT)
Prior art keywords
gas
patient
unit
controller
adjustable
Prior art date
Application number
PCT/DE2018/000306
Other languages
German (de)
English (en)
Inventor
Markus GRÜNDLER
Christoph Gründler
Bernd RESLO
Thilo Joost
Rainer KÖBRICH
Original Assignee
GRÜNDLER 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 GRÜNDLER GmbH filed Critical GRÜNDLER GmbH
Publication of WO2019080955A1 publication Critical patent/WO2019080955A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/082—Evaluation by breath analysis, e.g. determination of the chemical composition of exhaled breath
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4836—Diagnosis combined with treatment in closed-loop systems or methods
    • A—HUMAN NECESSITIES
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    • 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
    • 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
    • A61M16/0087—Environmental safety or protection means, e.g. preventing explosion
    • A61M16/009—Removing used or expired gases or anaesthetic vapours
    • 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
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/083—Measuring rate of metabolism by using breath test, e.g. measuring rate of oxygen consumption
    • A61B5/0836—Measuring rate of CO2 production
    • A—HUMAN NECESSITIES
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    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
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    • A61M16/0072—Tidal volume piston pumps
    • A—HUMAN NECESSITIES
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    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0465—Tracheostomy tubes; Devices for performing a tracheostomy; Accessories therefor, e.g. masks, filters
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    • 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
    • A61M16/105—Filters
    • A61M16/106—Filters in a path
    • A61M16/1065—Filters in a path in the expiratory path
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    • 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
    • A61M16/1075—Preparation of respiratory gases or vapours by influencing the temperature
    • A—HUMAN NECESSITIES
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    • 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
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    • A61M16/1075—Preparation of respiratory gases or vapours by influencing the temperature
    • A61M16/1095—Preparation of respiratory gases or vapours by influencing the temperature in the connecting tubes
    • A—HUMAN NECESSITIES
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    • 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
    • A61M2016/0027—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
    • A61M16/10—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
    • A61M2016/103—Measuring a parameter of the content of the delivered gas the CO2 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
    • 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
    • A61M2202/0225—Carbon oxides, e.g. Carbon dioxide
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/02—Gases
    • A61M2202/0225—Carbon oxides, e.g. Carbon dioxide
    • A61M2202/0233—Carbon monoxide
    • 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
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A—HUMAN NECESSITIES
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    • A61M2205/00—General characteristics of the apparatus
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    • A61M2205/00—General characteristics of the apparatus
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    • A—HUMAN NECESSITIES
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    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/36—General characteristics of the apparatus related to heating or cooling
    • A61M2205/3673—General characteristics of the apparatus related to heating or cooling thermo-electric, e.g. Peltier effect, thermocouples, semi-conductors
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    • A61M2205/00—General characteristics of the apparatus
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    • A61M2230/00—Measuring parameters of the user
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    • A61M2230/00—Measuring parameters of the user
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    • A61M2230/43—Composition of exhalation
    • A61M2230/437—Composition of exhalation the anaesthetic agent concentration

Definitions

  • the invention relates to a system for assisting the gas exchange in patients having the features of the preamble of claim 1.
  • the breathing gas is usually applied cyclically by means of overpressure via a tube inserted into the trachea or by means of a face mask in the respiratory tract, while the exhalation takes place automatically by the passive restoring forces of the respiratory system when the external pressure is reduced.
  • the tidal volume and the respiratory pressures under ventilation are always the so-called "pendulum volume” or “dead space volume”, which is bidirectionally moved in the air-conducting system of the patient and the respiratory system.
  • the system according to the invention serves to support the gas exchange in patients instead of or in addition to a ventilator.
  • the system has a gas delivery unit, a gas analysis sensor and a controller.
  • the delivery unit is used in particular to promote a respiratory gas or breathing gas.
  • a breathing gas may be, for example, oxygen or even air from the environment or mixtures thereof, optionally including additional therapeutic gases.
  • Breathing gas is gas that comes from a patient's airways. By promoting respiratory gas or breathing gas, such a system can be used in particular to support pulmonary gas exchange.
  • the delivery unit is a pump and may also include a reservoir unit.
  • the delivery unit is the pump that is used for suctioning and returning the breathing gas.
  • a gas analysis sensor which can be designed as a measuring unit for gas-in-gas or gas-in-liquid and in particular measures the volume flow and / or the concentration of a gas.
  • the system may also be, for example, a device that continuously or intermittently routes portions of the breathing gas via a CGV absorber or oxygenator and then back into the circuit.
  • the delivery unit may be a pump that operates unidirectionally or bidirectionally.
  • the system has a memory for electrical energy, in particular a battery.
  • a memory in particular, a capacitor in question.
  • the memory allows the system to operate for at least a short time without a foreign power source, such as when a patient is being transferred within a hospital, or when no power source is available outside a hospital.
  • the system according to the invention is characterized in that it has a control with which an automatic control of the delivery unit takes place as a function of measured values of the gas analysis sensor and optionally user inputs.
  • the regulation takes place in such a way that an adjustable elimination rate for gaseous constituents of the exhaled gas, in particular for CO2, is kept constant, by which is meant that the set elimination rate is continuously sought and, as far as possible, achieved.
  • This allows the measured values to not be monitored by an operator and the delivery unit's delivery rate not always to be manually adjusted.
  • laminate rate is meant the volume per unit time of the particular gaseous constituent of exhaled gas withdrawn from the body by the system
  • the system also includes a gas metering unit controlled by the automatic control.
  • Gas metering unit is understood to mean a unit with which specific amounts of a therapeutic gas, in particular oxygen, can be added in a targeted manner. The gas metering unit allows targeted influence on the elimination rate.
  • the system has an automatic control of the gas metering unit and / or the delivery unit such that a target concentration for gaseous constituents of the exhaled gas, in particular CO2, or the respiratory rate of a patient, and the desired adaptation speed to the respective target value can be set as the target value and by the system is tracked automatically.
  • a target concentration for gaseous constituents of the exhaled gas in particular CO2, or the respiratory rate of a patient
  • the desired adaptation speed to the respective target value can be set as the target value and by the system is tracked automatically.
  • the gas analysis sensor is used in this case, in particular the measurement of the concentration of the gaseous components the exhaled gas.
  • the target value, the adaptation speed and / or the relevant current value are preferably visualized.
  • the invention proposes that the alveolar ventilation of a patient can be increased by the system. While the patient is brought to the largest possible tidal volume and / or the largest possible respiratory rate, either by immediate request and / or increase of the respiratory drive by CO2 supply in spontaneously breathing patients or by a ventilator in controlled ventilated patients, the delivery unit is on regulated a maximum possible flow rate. In the case of a piston pump, this means, for example, that the piston pump is operated with a maximum compatible stroke and speed.
  • the invention proposes that the control has an adjustable shutdown sequence in which an automatic stepwise reduction of the activity of the conveyor unit and / or the gas metering unit takes place a tolerable maximum value for the respiratory rate and / or COrGehalt in the exhalation gas is adjustable, which is not exceeded during the Abstellsequenz planned.
  • activity of the delivery unit is meant the volume flow delivered by the delivery unit.
  • activity of the gas metering unit means the volume flow added by the gas metering unit.
  • the system preferably has a control with a user interface, especially a screen, on.
  • the user interface has an indication of the pulmonary blood flow of the patient or the course of which, this blood flow or its course is calculated and in particular as a function of data of the gas analysis sensor and preferably determined by means of a Feinbuchsensors tidal volume.
  • missing data can also be imported via a data interface from other medical devices (for example, from the ventilator or calorimetry module).
  • other medical devices for example, from the ventilator or calorimetry module.
  • FIG. 1 shows a schematic overview of the system 1 according to the invention in use in a non-ventilated patient 2.
  • a flexible tube 5 of the system 1 is introduced from outside through a small opening 3 in the region of the neck 4 of the patient 2 the flexible tube 5 consists of a first tube section 8 in the form of a catheter 9 for insertion into the trachea 6 and a second tube section 10 in the form of a connecting tube 1 1 for connecting the first hose section 8 to a reservoir unit 12 of the system 1.
  • the connecting tube 11 has a larger outer cross section than the catheter 9.
  • the catheter 9 is surrounded by a grommet 13 and is held by this clamping against displacement along the catheter 9.
  • the reservoir unit 12 is designed as a piston pump 14 and is thus simultaneously conveying unit 15.
  • the piston pump 14 is driven by a linear motor 16 as drive unit 17.
  • the drive unit 17 is shown only symbolically in FIG. 1, since this does not matter further in the context of the invention.
  • the connecting tube 1 1 is interrupted by a measuring cuvette 18 for a gas analysis sensor 19, here a C02 sensor 20, which is attached to the cuvette 18 is. Between the measuring cuvette 18 and the piston pump 14, the connecting hose 1 1 is also interrupted by a first branch 21. This first branch 21 is formed as well as the subsequent branches each by a tee or Y-piece.
  • the first branch 21 leads via a first filter 22, which forms a hygienic barrier as well as the filter described below, to a second branch 23, at one output of a high pressure sensor 24 and the other output a ventilation valve 25 with an outlet to the environment connected.
  • the connecting tube 1 1 is interrupted successively by a third branch 26 and a fourth branch 27.
  • the third branch 26 leads via a second filter 28 to a pressure vessel 29 which can be fluidically connected or disconnected via a metering valve forming a gas metering unit 30.
  • the pressure vessel 29 contains a therapeutic gas, in particular oxygen.
  • the fourth branch 27 leads via a third filter 31 to a fine pressure sensor 32 with a sensor protection valve 33.
  • the high pressure sensor 24 is designed for measuring pressures in the range from -750 mbar to +750 mbar and thus the control of the suction and pumping pressures the piston pump 14 is used
  • the Feinchristsensor 32 is designed for measuring pressures in the range of -5mbar to + 5mbar and thus serves to control the breathing of the patient 2 when the piston pump 14 is not working.
  • the piston pump 14 can be heated by a thermoelectric heating element 34 as a temperature control unit 35.
  • the flexible tube 5 is wrapped with a thermal insulation 36.
  • the sensors ie the gas analysis sensor 19, the high pressure sensor 24 and the fine pressure sensor 32, and the actuators, ie the linear motor 16, the heating element 34, the ventilation valve 25, the gas metering unit 30 and the sensor protection valve 33 are each via electrical lines , which are not shown for the sake of clarity, connected to a controller 37.
  • the controller 37 comprises in particular an input and output unit in the form of a touch-sensitive display 38, a so-called "touch screen", for operation by a user ..
  • the controller 37 has a battery as a power storage (not shown) to the system 1, at least temporarily, independently of an external power source, while the controller 37, which also supplies the power to the other system components, has a 230 V connection for network operation.
  • the flexible hose 5 and the piston pump 14 are together with the first, third and fourth branch 21, 26, 27 and the three filters 22, 28, 31 and the measuring cuvette 18th a patient set 39.
  • the interfaces to the remaining components of the system 1 are each symbolized by dashed lines, wherein in the area of the filters 22, 28, 31 as interfaces usual hose connections in the form of plug or screw (not shown in detail) are used.
  • the patient set 39 is designed as a disposable product, which does not rule out that individual components prepared for repeated use, so in particular cleaned and sterilized, can be.
  • An open end 40 of the catheter 9 establishes a fluidic connection to the lung-proximal portion of the trachea 6.
  • the breathing activity of the patient 2 can be determined via the fine pressure sensor 32.
  • gas is sucked out by means of the piston pump 14 and pumped back to the end of the next inhalation phase or at the beginning of the next exhalation phase.
  • This gas is rich in CO2 and can therefore be referred to as "spent air.” Sucking and pumping back causes fresh air to be drawn through the free upper airways (nose and mouth) into the trachea 6 of the patient 2 as soon as it is aspirated flows and takes place in the subsequent inhalation not only used air in the lungs, but immediately oxygen-rich and CG poor, so "fresh air”. This significantly improves the CC> 2 clearance in the lungs as well as the G uptake.
  • the recirculation of the used air has the advantage that the balance of the energy and moisture balance of the respiratory tract is not affected, since no moisture and no energy is taken or supplied.
  • the pumped gas is kept warm during the intermediate storage in the piston pump 14 by means of the heating element 34 and beyond a temperature exchange with the environment through the thermal Insulation 36 or active heating of the flexible tube 5 kept low.
  • the pumping speed is regulated in particular by means of the data of the high-pressure sensor 24. If, for example from the pressure curves during suction and pumping, it emerges for the controller that the catheter 9 is clogged, the system can blow it open automatically.
  • the ventilation valve 25 can be opened during suction, whereby predominantly gas is sucked from the environment.
  • the first filter 22 ensures that there is no contamination with pathogens from the environment.
  • the ventilation valve 25 After suction, the ventilation valve 25 is closed and the gas in the piston pump 14 is pumped out of this. In particular, by a discontinuous, Pulse-like pumping can be achieved, that the catheter 9 is released again.
  • the ventilation valve 25 thus forms a switchable opening 41 to the environment and the first branch 21 together with the second branch 23 a branch 42 for the switchable opening 41.
  • the ventilation valve 25 can also be used to the extracted gas completely or partially blown out into the environment. Instead of or in addition to the extracted gas can then be passed via an opening of the gas metering unit 30 from the pressure vessel 29, a therapeutic gas via the flexible tube 5 to the patient 2, wherein the pumping process can also be temporally shifted, in particular in the phase of inhalation Patient 2.
  • the third branch 26 forms, together with the gas metering unit 30, a switchable supply line 43, by which, instead of or in addition to the recirculated gas, a volume flow of a further gas can be conducted to the flexible tube 5.
  • the functions mentioned are automatically controlled by the controller 37 as a function of inputs of the operator on the one hand and the data of the sensors, that is to say of the gas analysis sensor 19, the high-pressure sensor 24 and the fine-pressure sensor 32.
  • the touch-sensitive display 38 serves as a user interface 44.
  • control and output are effected with at least one of the following output variables: time of pumping and / or aspiration, velocity profile of the pumping and / or aspiration, volume of pumping and / or aspiration.
  • the goal here is always a non-existent or minimized disturbance of respiration / ventilation of the patient.
  • "regulation” means that a control loop is formed, while “output” means that pure control takes place without the formation of a control loop.
  • the determination of the beginning of the suction takes place in particular as a function of the measured beginning of the expiration and the expected end of the expiration.
  • the beginning of the expiration of a non-ventilated patient can be determined by measuring a significant increase in the pressure in the area of the flexible tube 5 between pumps and suction by means of the fine pressure sensor 32.
  • the determination of the beginning of the suction by analysis of the time course of the pressure, so the pressure change, in the region of the flexible tube 5 done.
  • the intrathoracic pressure initially increases slightly, that is, the pressure change is an increase in pressure, the pressure increase per unit time is always lower, that is, the first derivative of the pressure after the time is positive and second derivative negative.
  • the beginning of the suction can be done by orientation on the waveform of the subsequent pressure drop after this described initial pressure increase.
  • the aspiration may be started after a defined delay.
  • the controller 37 has a program for optimizing the suction time, which means the start of the suction. At the same time, the aim is to have the most expiration possible within the exhalation, since in this phase the C02 concentration is maximal and the method of the dead space exhaustion most effective.
  • the suction must be stopped prematurely if the patient inhales earlier than expected by the system, ie while still in the aspiration
  • the optimization program notes an accumulation of such abortions and If necessary, it adjusts the suction time, in which it is advanced, which can also be done step by step.
  • the accumulation of crashes means a poor synchronization.
  • the program can cause a delay of the suction time to move backwards, if there are no crashes, to a still to reach later suction.
  • the system 1 has a program for optimizing the extraction speed.
  • the extraction speed can be increased and reduced with particularly good synchronization.
  • the synchronization process ie the number of aborts per unit of time due to premature inhalation of the patient, is visualized by the user interface 44.
  • system 1 comprises a program with user-selectable modes in which one of the following values or combinations of values are predetermined and aimed by the program by automatically adjusting the suction and pumping:
  • Target is an operator-specified volume of CO2 to be eliminated per unit of time, which is the elimination rate.
  • the elimination rate can be determined automatically, for example by determining the C0 2 content in the
  • Gas flow so the breathing gas of the patient 2, in the flexible tube by means of Gas analysis sensor 19 can be determined.
  • the target is aimed at by changing the sucked and pumped back gas volume, ie by automatic control of the delivery unit 15, especially by changing the Kolbenhubvolumens the piston pump 14.
  • the goal can be achieved by adding therapeutic gases such as oxygen, ie by automatic regulation of the gas metering unit 30.
  • the operator additionally specifies at what speed or within which time period the stated target value is to be achieved.
  • the goal is aimed at as described under (a), but the system 1 adjusts the change in the aspirated gas volume per breath as a function of the predetermined adaptation rate and the respectively measured elimination rate, ie, for example, slowly increases the extracted gas volume per breath.
  • the CO 2 value can either be determined from the gas analysis sensor 19 or read continuously or intermittently via an interface from another system, ie from a separate gas analysis sensor, for example from a transcutaneous one
  • Target is an adjustable respiratory rate of the patient, especially a lower respiratory rate. This is sought by the program by changing the aspirated and pumped back gas volume per breath by the gas volume is increased to reduce the respiratory rate or to stimulate the respiratory rate, the gas volume is reduced.
  • the aim can be achieved by adding oxygen.
  • the target tracking thus takes place by automatic regulation of the delivery unit 15 and / or the gas metering unit 30.
  • the program can provide additional modes. For each mode a Abstellsequenz is also provided, in which preferably an automatic stepwise reduction of the sucked and pumped back gas volume, ie reduction of the activity of the conveyor unit 15, down to zero, taking into account a maximum tolerated, adjustable increase or absolute value of the respiratory rate and / or the C02 content, in order to support a weaning of the patient.
  • a Abstellsequenz is also provided, in which preferably an automatic stepwise reduction of the sucked and pumped back gas volume, ie reduction of the activity of the conveyor unit 15, down to zero, taking into account a maximum tolerated, adjustable increase or absolute value of the respiratory rate and / or the C02 content, in order to support a weaning of the patient.
  • the controller 37 also provides a CO detoxification mode for a patient 2.
  • the piston pump 14 is operated with a maximum compatible stroke and speed (so that the synchronization with the patient is still present and no disturbance of the respiration occurs) and specifically added via the gas metering unit 30 CO2.
  • the patient 2 is prompted for deep and / or frequent breaths, the C0 2 addition triggering a natural urge in this direction on the patient 2.
  • a regulated CÜ2 addition in Depending on the values of the gas analysis sensor 19, in the case of the patient 2 there is no too low CO 2 content in the blood despite the strong supply of fresh gas.
  • the controller 37 of the system 1 calculates the pulmonary blood flow of the patient 2. This blood flow and its course is visualized by means of a display of the user interface 44, so that the person receiving the treatment receives an image of the patient Metabolic and circulatory activity of the patient 2 receives.

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  • Health & Medical Sciences (AREA)
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  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Anesthesiology (AREA)
  • Pulmonology (AREA)
  • Emergency Medicine (AREA)
  • Hematology (AREA)
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  • Environmental & Geological Engineering (AREA)
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  • Biodiversity & Conservation Biology (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

L'invention concerne un système pour soutenir l'échange gazeux chez des patients (2) en complément ou à la place d'un appareil respiratoire. Le système (1) présente une unité de transport (15) pour le gaz respiratoire, un capteur (19) analyse de gaz et un dispositif de commande (37). Pour diminuer la charge d'utilisation et de contrôle pour les thérapeutes, selon l'invention, un taux d'élimination réglable du système (1) pour le CO2 dans le gaz expiré est maintenu constant par la régulation automatique de l'unité de transport (15) au moyen du dispositif de commande (37) en fonction de valeurs de mesure du capteur (19) d'analyse de gaz.
PCT/DE2018/000306 2017-10-26 2018-10-23 Système pour soutenir l'échange gazeux chez des patients WO2019080955A1 (fr)

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WO2022194724A1 (fr) 2021-03-16 2022-09-22 Koninklijke Philips N.V. Tire-lait ou ensemble de collecte de lait

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DE602004003409T2 (de) 2003-03-18 2007-10-04 Maquet Critical Care Ab Gerät zur Bestimmung von Absaugdurchfluss und Absaugzeit und zur Absaugung von Totraum
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WO2022194724A1 (fr) 2021-03-16 2022-09-22 Koninklijke Philips N.V. Tire-lait ou ensemble de collecte de lait

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