WO2021189197A1 - Appareil et procédé de surveillance respiratoire - Google Patents

Appareil et procédé de surveillance respiratoire Download PDF

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Publication number
WO2021189197A1
WO2021189197A1 PCT/CN2020/080699 CN2020080699W WO2021189197A1 WO 2021189197 A1 WO2021189197 A1 WO 2021189197A1 CN 2020080699 W CN2020080699 W CN 2020080699W WO 2021189197 A1 WO2021189197 A1 WO 2021189197A1
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Prior art keywords
pressure
patient
energy
respiratory system
mechanical ventilation
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PCT/CN2020/080699
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English (en)
Chinese (zh)
Inventor
邹心茹
刘京雷
周小勇
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深圳迈瑞生物医疗电子股份有限公司
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Priority to CN202080098474.8A priority Critical patent/CN115297916A/zh
Priority to PCT/CN2020/080699 priority patent/WO2021189197A1/fr
Publication of WO2021189197A1 publication Critical patent/WO2021189197A1/fr

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    • 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
    • A61B5/087—Measuring breath flow
    • 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

Definitions

  • the invention relates to a breathing monitoring device and a breathing monitoring method.
  • Human respiration refers to the periodic inhalation and exhalation of gas, absorbing oxygen and expelling carbon dioxide, thereby realizing gas exchange.
  • mechanical ventilation can be used to help the patients complete their breathing; for example, for patients who do not breathe spontaneously, an external device such as a ventilator can usually be used to provide respiratory support to the patient.
  • an external device such as a ventilator can usually be used to provide respiratory support to the patient.
  • mechanical ventilation is a way of ventilation that uses mechanical devices to replace, control or change the patient's spontaneous breathing movement.
  • mechanical ventilation is also prone to cause lung injury (ventilator induced lung injury, VILI) when applied.
  • VILI lung injury
  • LPVS lung protective strategy
  • ARDS acute respiratory distress syndrome
  • ARDS patients have different types of lesions, etiology, and lesions involved, and the size and distribution of the collapsed alveolar area are different, resulting in inhomogeneity of the lungs. This inhomogeneity makes the lung compliance of different patients and the recruitment of alveoli The volume is also different, and the actual tidal volume required by different patients is also different, so only tidal volume as an evaluation index of lung injury is not enough.
  • the present invention mainly provides a breathing monitoring device and method.
  • an embodiment provides a breathing monitoring method, including:
  • the pressure at the different sites includes one or more of airway pressure, intrathoracic pressure, carina pressure, intrapulmonary pressure, esophageal pressure, intragastric pressure, transpulmonary pressure, and transdiaphragmatic pressure .
  • the breathing monitoring method further includes: correcting the transpulmonary pressure by airway pressure and esophageal pressure in a state where the positive end expiratory pressure is zero and non-zero.
  • the breathing monitoring method further includes: correcting the transpulmonary pressure through lung compliance and chest wall compliance.
  • the breathing monitoring method further includes: correcting the transdiaphragmatic pressure by the esophageal pressure and the intragastric pressure in a state where the positive end-expiratory pressure is zero and non-zero.
  • the gas flow rate includes at least an inhalation flow rate.
  • the calculation of the energy acting on the patient's respiratory system during mechanical ventilation based on the acquired pressure and gas flow rate includes:
  • the breathing monitoring method further includes: displaying the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the displaying the energy of the mechanical ventilation acting on the patient's respiratory system includes: displaying the real-time value of the energy of the mechanical ventilation acting on the patient's respiratory system and/or displaying the energy of the mechanical ventilation acting on the patient's respiratory system over time The change.
  • the breathing monitoring method further includes: alarming based on the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the alarming based on the energy of the mechanical ventilation acting on the patient's respiratory system includes:
  • the breathing monitoring method further includes: judging the patient's condition based on the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the judging the patient's condition based on the energy of the mechanical ventilation acting on the patient's respiratory system includes:
  • the patient's condition is judged according to the real-time value and/or change trend of the energy of the mechanical ventilation acting on the patient's respiratory system.
  • an embodiment provides a breathing monitoring device, including:
  • a pressure sensor that collects the pressure of the patient during the ventilation process, and the pressure reflects the pressure acting on different points of the patient's respiratory system during the ventilation process;
  • Flow sensor which collects the gas flow rate of the patient during the ventilation process
  • the processor is used to obtain the pressure of the patient during the ventilation process and the gas flow rate of the patient during the ventilation process, and calculate the energy acting on the respiratory system of the patient during the mechanical ventilation process according to the obtained pressure and gas flow rate.
  • the pressure at the different sites includes one or more of airway pressure, intrathoracic pressure, carina pressure, intrapulmonary pressure, esophageal pressure, intragastric pressure, transpulmonary pressure, and transdiaphragmatic pressure .
  • the processor corrects the transpulmonary pressure by airway pressure and esophageal pressure when the positive end expiratory pressure is zero and non-zero.
  • the processor corrects the transpulmonary pressure through lung compliance and chest wall compliance.
  • the processor corrects the transdiaphragmatic pressure through the esophageal pressure and the intragastric pressure in a state where the positive end-expiratory pressure is zero and non-zero.
  • the gas flow rate includes at least an inhalation flow rate.
  • the processor integrates the pressure and the gas flow rate to obtain the energy that acts on the patient's respiratory system during mechanical ventilation.
  • the processor integrates pressure and gas flow rate within a preset unit time; or, the processor integrates pressure and gas flow rate within one breathing cycle.
  • the breathing monitoring device further includes a display for displaying the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the display displays the real-time value of the energy of the mechanical ventilation on the respiratory system of the patient and/or displays the change over time of the energy of the mechanical ventilation on the respiratory system of the patient.
  • the processor also generates an alarm based on the energy acting on the patient's respiratory system based on mechanical ventilation.
  • the processor when it is determined that the energy of the mechanical ventilation acting on the patient's respiratory system exceeds the first threshold, the processor issues an alarm.
  • the processor when it is determined that the energy of the mechanical ventilation acting on the patient's respiratory system is lower than the second threshold, the processor issues an alarm.
  • the processor also judges the patient's condition based on the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the processor judges the patient's condition according to the real-time value and/or change trend of the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the breathing monitoring device includes a patient monitor, a patient monitoring module, or medical ventilation equipment.
  • an embodiment provides a computer-readable storage medium including a program that can be executed by a processor to implement the method as described in any of the embodiments herein.
  • Figure 1 is a schematic structural diagram of a breathing monitoring device according to an embodiment of the application.
  • Figure 2 is a schematic structural diagram of a breathing monitoring device according to another embodiment of the application.
  • FIG. 3 is a schematic structural diagram of a breathing monitoring device according to another embodiment of the application.
  • FIG. 4 is a schematic structural diagram of a breathing monitoring device according to another embodiment of this application.
  • FIG. 5 is a flowchart of a breathing monitoring method according to an embodiment of the application.
  • FIG. 6 is a flowchart of a breathing monitoring method according to another embodiment of the application.
  • FIG. 7 is a flowchart of a breathing monitoring method according to another embodiment of the application.
  • FIG. 8 is a flowchart of a breathing monitoring method according to still another embodiment of the application.
  • connection and “connection” mentioned in this application include direct and indirect connection (connection) unless otherwise specified.
  • Lung injury VILI is a combination of multiple types of injuries and is caused by excessive dynamic strain and energy load. Therefore, in this embodiment, by calculating the energy acting on the patient’s respiratory system during mechanical ventilation, it can be more accurate, true and accurate. Real-time assessment of lung injury.
  • the breathing monitoring device may include a pressure sensor 10, a flow sensor 30, and a processor 50.
  • the breathing monitoring device of the present invention can be applied to many occasions.
  • the breathing monitoring device of the present invention may be a patient monitor or a patient monitoring module in some embodiments, and may be a medical ventilation device, such as a ventilator, in some embodiments. And anesthesia machines, etc., are explained separately below.
  • the breathing monitoring device may be a patient monitor.
  • the breathing monitoring device may have an independent housing, and the housing panel may have a sensor interface area, where the sensor interface area may integrate multiple sensor interfaces for connecting with various external physiological parameter sensor attachments 111 , And can also be used to connect with the pressure sensor 10 and the flow sensor 30 in some embodiments.
  • the shell panel may also include one or more of a small LCD display area, a display 70, an input interface circuit 122, and an alarm circuit 120 (such as an LED alarm area).
  • the respiration monitoring device has an external communication interface 119 and a power interface 116 for communicating with the host of medical equipment such as patient monitors, ventilators, anesthesia machines, and taking power from the host of medical equipment.
  • the respiratory monitoring device can also support an external plug-in parameter module.
  • the plug-in monitor host can be formed by inserting the parameter module as a part of the monitor, or it can be connected to the host via a cable.
  • the external plug-in parameter module is used as an external accessory of the monitor.
  • the internal circuit of the breathing monitoring device is placed in the housing, and may include one or more signal acquisition circuits 112 corresponding to physiological parameters and a front-end signal processing circuit 113.
  • the signal acquisition circuits 112 may be selected from the group consisting of electrocardiogram circuits, breathing circuits, body temperature circuits, Blood oxygen circuit, non-invasive blood pressure circuit and invasive blood pressure circuit, etc., these signal acquisition circuits 112 are respectively electrically connected to the corresponding sensor interface for electrical connection to the sensor attachment 111 corresponding to different physiological parameters, and the output terminal is coupled to the front end
  • the signal processing circuit 113 and the communication port of the front-end signal processing circuit 113 are coupled to the processor 50, and the processor 50 is electrically connected to the external communication interface 119 and the power interface 116.
  • the sensor attachment 111 and the signal acquisition circuit 112 corresponding to various physiological parameters can adopt the general circuit in the prior art.
  • the front-end signal processing circuit 113 completes the sampling and analog-to-digital conversion of the output signal of the signal acquisition circuit 112, and outputs the control signal to control the physiological signal. During the measurement process, these parameters include but are not limited to: ECG, respiration, body temperature, blood oxygen, non-invasive blood pressure and invasive blood pressure parameters.
  • the front-end signal processing circuit 113 can be implemented by a single-chip microcomputer or other semiconductor devices. For example, a mixed-signal single-chip microcomputer such as LPC2136 of PHLIPS or ADuC7021 of ADI can be used, or an ASIC or FPGA can be used.
  • the front-end signal processing circuit 113 can be powered by an isolated power source.
  • the sampled data is simply processed and packaged, and then sent to the processor 50 through an isolated communication interface.
  • the front-end signal processing circuit 113 can be coupled to the processor through an isolated power interface 114 and a communication interface 115. 50 up.
  • the reason why the front-end signal processing circuit 113 is powered by the isolated power supply is that the DC/DC power supply isolated by the transformer plays a role in isolating the patient from the power supply equipment.
  • the main purposes are: 1. Isolate the patient, and float the application part through the isolation transformer. Make the patient's leakage current small enough; 2. Prevent the voltage or energy of defibrillation or electrosurgical application from affecting the boards and devices of the intermediate circuit such as the main control board (guaranteed by creepage distance and electrical clearance).
  • the front-end signal processing circuit 113 can also be directly connected to the processor 50 through a cable.
  • the processor 50 is used to complete the calculation of physiological parameters, and send the calculation results and waveforms of the parameters to the host (such as a host with a display, a PC, a central station, etc.) through the external communication interface 119; wherein the processor 50 can be connected through a cable It is directly connected to the external communication interface 119 for communication, and is directly connected to the power interface 116 through a cable to obtain power; the respiratory monitoring device may also include a power supply and battery management circuit 117, and the power supply and battery management circuit 117 is from the host through the power interface 116 The power is taken and supplied to the processor 50 after processing, such as rectification and filtering.
  • the power supply and battery management circuit 117 can also monitor, manage and protect the power obtained from the host through the power interface 116.
  • the external communication interface 119 can be one of Ethernet, Token Ring, Token Bus, and a local area network interface composed of the backbone fiber distributed data interface (FDDI) of these three networks. Or a combination thereof may also be one or a combination of wireless interfaces such as infrared, Bluetooth, wifi, and WMTS communication, or may also be one or a combination of wired data connection interfaces such as RS232 and USB.
  • the external communication interface 119 may also be one of a wireless data transmission interface and a wired data transmission interface or a combination of both.
  • the host can be any computer equipment such as the host of the monitor or a computer, and a monitoring device can be formed by installing the matching software.
  • the host may also be a communication device, such as a mobile phone.
  • the respiratory monitoring device sends data to a mobile phone that supports Bluetooth communication through a Bluetooth interface to realize remote data transmission.
  • the processor 50 After the processor 50 completes the calculation of the physiological parameter, it can also determine whether the physiological parameter is abnormal, and if it is abnormal, the alarm circuit 120 can be used to give an alarm.
  • the memory 118 can store intermediate and final data of the monitor, and store program instructions or codes for execution by the processor 50 and the like. If the monitor has a blood pressure measurement function, it may also include a pump valve drive circuit 121, which is used to perform inflation or deflation operations under the control of the processor 50.
  • the breathing monitoring device may also be a ventilator.
  • the ventilator is an artificial mechanical ventilation device used to assist or control the patient's autonomous breathing exercise to achieve the function of gas exchange in the lungs and reduce the consumption of the human body. Conducive to the recovery of respiratory function.
  • the breathing monitoring device may further include a breathing interface 211, an air source interface 212, a breathing circuit, a breathing assist device, and a display 70.
  • the breathing circuit selectively communicates the air source interface 212 with the patient's breathing system.
  • the breathing circuit includes an expiratory branch 213a and an inspiratory branch 213b.
  • the expiratory branch 213a is connected between the breathing interface 211 and the exhaust port 213c, and is used to export the patient's exhaled air to the exhaust port 213c.
  • the exhaust port 213c may be open to the external environment, or may be a channel dedicated to a gas recovery device.
  • the gas source interface 212 is used to connect with a gas source (not shown in the figure). The gas source is used to provide gas.
  • the gas can usually be oxygen, air, etc.; in some embodiments, the gas source can be a compressed gas cylinder or a center
  • the air supply source which supplies air to the ventilator through the air source interface 212.
  • the types of air supply include oxygen O2 and air.
  • the air source interface 212 can include pressure gauges, pressure regulators, flow meters, pressure reducing valves and air-oxygen ratios. Conventional components such as regulation and protection devices are used to control the flow of various gases (such as oxygen and air).
  • the inspiratory branch 213b is connected between the breathing interface 211 and the air source interface 212 to provide oxygen or air to the patient.
  • the gas input from the air source interface 212 enters the inspiratory branch 213b, and then enters through the breathing interface 211 The patient's lungs.
  • the breathing interface 211 is used to connect the patient to the breathing circuit.
  • the patient's exhaled gas can also be introduced to the exhaust port 213c through the expiratory branch 213a;
  • the breathing interface 211 may be a nasal cannula or a mask for wearing on the nose and mouth.
  • the breathing assist device is connected to the air source interface 212 and the breathing circuit, and controls the gas provided by the external air source to be delivered to the patient through the breathing circuit; in some embodiments, the breathing assist device may include an exhalation controller 214a and an inhalation controller 214b
  • the exhalation controller 214a is arranged on the exhalation branch 213a, and is used to switch on the exhalation branch 213a or close the exhalation branch 213a according to the control instruction, or to control the flow rate or pressure of the patient's exhaled air.
  • the exhalation controller 214a may include one or more of the exhalation valve, one-way valve, flow controller, PEEP valve and other devices capable of controlling flow or pressure.
  • the inhalation controller 214b is arranged on the inhalation branch 213b, and is used to switch on the inspiratory branch 213b or close the inspiratory branch 213b according to a control command, or to control the flow rate or pressure of the output gas.
  • the inhalation controller 214b may include one or more of devices capable of controlling flow or pressure, such as an exhalation valve, a one-way valve, or a flow controller.
  • the memory 215 may be used to store data or programs, for example, to store data collected by the sensor, data generated by the processor through calculation, or image frames generated by the processor.
  • the image frames may be 2D or 3D images, or the memory 215 A graphical user interface, one or more default image display settings, and programming instructions for the processor can be stored.
  • the memory 215 may be a tangible and non-transitory computer-readable medium, such as flash memory, RAM, ROM, EEPROM, and so on.
  • the processor 50 is used to execute instructions or programs to control various control valves in the breathing assist device, the air source interface 212 and/or the breathing circuit, or process the received data to generate the required calculations Or judge the result, or generate visualization data or graphics, and output the visualization data or graphics to the display 70 for display.
  • the breathing monitoring device as a ventilator. It should be noted that the above Figure 3 is just an example of the ventilator, which is not used to limit the ventilator to only this structure.
  • the breathing monitoring device may also be an anesthesia machine, which is mainly used to provide anesthetic gas and deliver the anesthetic gas to the patient's respiratory system through a respirator, and control the inhalation of anesthetic gas.
  • the breathing monitoring device of some embodiments may further include a breathing interface 311, a gas source interface 312, a breathing assist device 320, an anesthetic output device 330, a breathing circuit, a memory 350, and a display 70.
  • the gas source interface 312 is used to connect with a gas source (not shown in the figure), and the gas source is used to provide gas.
  • the gas can usually be oxygen, nitrous oxide (laughing gas), or air.
  • the gas source may be a compressed gas cylinder or a central gas supply source, and the anesthesia machine is supplied with gas through the gas source interface 312.
  • the gas supply types include oxygen O2, laughing gas N2O, and air.
  • the gas source interface 312 can include conventional components such as pressure gauges, pressure regulators, flow meters, pressure reducing valves, and N2O-O2 proportional control and protection devices, which are used to control the flow of various gases (such as oxygen, laughing gas, and air). .
  • the gas input from the gas source interface 312 enters the breathing circuit and forms a mixed gas with the original gas in the breathing circuit.
  • the breathing assist device 320 is used to provide power for the patient's involuntary breathing and maintain the airway patency.
  • the breathing assist device 320 is connected to the air source interface 312 and the breathing circuit, and controls the gas provided by the external air source to be delivered to the patient through the breathing circuit.
  • the breathing assist device 320 mixes the fresh gas input from the air source interface 312 with the gas exhaled by the patient in the breathing circuit and the anesthetic drug output from the anesthetic output device 330 and then outputs the mixture to the breathing interface 311 through the inhalation branch 340b. To drive the patient to inhale, and to receive the patient's exhaled air through the exhalation branch 340a.
  • the breathing assistance device 320 usually includes a machine-controlled ventilation module, and the airflow pipe of the machine-controlled ventilation module is in communication with the breathing circuit.
  • the machine-controlled ventilation module is used to provide the patient with breathing power.
  • the breathing assist device 320 further includes a manual ventilation module, and the airflow pipe of the manual ventilation module is in communication with the breathing circuit. In the induction phase before intubating the patient during the operation, it is usually necessary to use a manual ventilation module to assist the patient in breathing.
  • the breathing assist device 320 includes both a machine-controlled ventilation module and a manual ventilation module
  • the machine-controlled or manual ventilation mode can be switched through a machine-controlled or manual switch (such as a three-way valve), so that the machine-controlled ventilation module or manual ventilation mode can be switched
  • the module is connected with the breathing circuit to control the patient's breathing.
  • the anesthesia machine may only include a machine-controlled ventilation module or a manual ventilation module.
  • the anesthetic output device 330 is used to provide an anesthetic.
  • the anesthetic is mixed into the fresh air introduced by the air source interface 312 in the form of gas, and is delivered to the breathing circuit together.
  • the anesthetic output device 330 is realized by an anesthetic volatilization tank.
  • the anesthetic is usually liquid and stored in the anesthetic vaporization tank.
  • the anesthetic vaporization tank may include a heating device for heating the anesthetic to volatilize and generate anesthetic vapor.
  • the anesthetic output device 330 is connected to the pipeline of the gas source interface 312 , The anesthetic vapor is mixed with the fresh air introduced by the air source interface 312, and then is delivered to the breathing circuit together.
  • the breathing circuit may include an inspiratory branch 340b, an expiratory branch 340a, and a soda lime tank 340c.
  • the inspiratory branch 340b and the expiratory branch 340a are connected to form a closed circuit, and the soda lime tank 340c is set on the expiratory On the pipeline of branch 340a.
  • the mixed gas of fresh air introduced by the air source interface 312 is input from the inlet of the inspiratory branch 340b, and is provided to the patient through the breathing interface 311 provided at the outlet of the inspiratory branch 340b.
  • the breathing interface 311 may be a mask, a nasal cannula, or a tracheal cannula.
  • the inhalation branch 340b is provided with a one-way valve, which is opened during the inhalation phase and closed during the expiration phase.
  • the exhalation branch 340a is also provided with a one-way valve, which is closed during the inhalation phase and opened during the expiration phase.
  • the inlet of the expiratory branch 340a is connected to the breathing interface 311.
  • the exhaled gas enters the soda lime tank 340c through the expiratory branch 340a, and the carbon dioxide in the exhaled gas is filtered by the substance in the soda lime tank 340c.
  • the gas after the carbon dioxide is filtered out is recycled into the inhalation branch 340b.
  • the memory 350 may be used to store data or programs, for example, to store data collected by various sensors, data generated by the processor through calculation, or image frames generated by the processor.
  • the image frames may be 2D or 3D images, or memory 350 can store a graphical user interface, one or more default image display settings, programming instructions for the processor.
  • the memory 350 may be a tangible and non-transitory computer-readable medium, such as flash memory, RAM, ROM, EEPROM, and so on.
  • the processor 50 is used to execute instructions or programs to control the breathing assist device 320, the air source interface 310 and/or various control valves in the breathing circuit, or process the received data to generate the required calculation or judgment results , Or generate visualization data or graphics, and output the visualization data or graphics to the display 70 for display.
  • the following describes how the respiratory monitoring device calculates and uses the energy that acts on the patient's respiratory system during mechanical ventilation.
  • the flow sensor 30 is used to collect the gas flow rate of the patient during the ventilation process.
  • the gas flow rate of the patient during ventilation includes at least the patient's inspiratory flow rate.
  • the flow sensor 30 may be a flow sensor disposed at the patient end, such as a flow sensor disposed at the patient interface, and the gas flow rate is the gas flow rate collected by the flow sensor during inhalation.
  • the number of flow sensors 30 is multiple, including an inspiratory flow sensor and an expiratory flow sensor arranged at the mechanical ventilation end. For example, for a ventilator, it may be an inspiratory set in the inspiratory branch 213b.
  • the flow sensor and the expiratory flow sensor arranged in the expiratory branch 213a, for the anesthesia machine can be an inspiratory flow sensor arranged in the inspiratory branch 340b and an expiratory flow sensor arranged in the expiratory branch 340a Flow sensor; the gas flow rate is the difference between the flow rate collected by the inspiratory flow sensor and the expiratory flow sensor during inhalation.
  • the flow sensor 30 may also be a Ypiece flow sensor, which directly measures the flow rate of the gas flowing in and out of the patient end as the gas flow rate.
  • the energy that acts on the patient's respiratory system during mechanical ventilation can be calculated using the gas flow rate during the entire respiration period, including the gas flow rate during inhalation and expiration.
  • the number of pressure sensors 10 is one or more.
  • the pressure sensor 10 is used to collect the pressure of the patient during the ventilation process, and the pressure reflects the pressure acting on different points of the patient's respiratory system during the ventilation process-such as airway pressure, intrathoracic pressure, carina pressure, intrapulmonary pressure, One or more of esophageal pressure and intragastric pressure.
  • the pressure sensor 10 may be a catheter pressure sensor or an optical fiber pressure sensor.
  • the pressure at the corresponding point can be taken. For example, if the pressure sensor is inserted into the patient’s airway, the airway pressure can be collected, if the pressure sensor is inserted into the esophagus, the esophageal pressure can be collected, and if the pressure sensor is inserted into the stomach, the intragastric pressure can be collected.
  • the pressure sensor can be inserted into the carina inside the trachea to collect the carina pressure, the pressure sensor can be inserted into the stomach to collect the intragastric pressure, and the pressure sensor can be inserted into the chest cavity through a wound incision.
  • the intrathoracic pressure can be collected.
  • esophageal pressure can also be used to approximate the intrathoracic pressure.
  • the pressure at some points in the respiratory system can also be used to replace or calculate the pressure at some other points, which will be illustrated by a few examples below.
  • carina pressure may be used instead of intrapulmonary pressure.
  • esophageal pressure can be used instead of intrathoracic pressure.
  • intragastric pressure may be used instead of intraabdominal pressure.
  • the processor 50 may calculate intrapulmonary pressure based on airway pressure. For example, in some embodiments, the processor 50 calculates the intrapulmonary pressure based on airway pressure, respiratory system resistance, and the aforementioned gas flow rate. In a specific example, it can be calculated by the following formula:
  • Plung(t) refers to the function of the change of intrapulmonary pressure with time t, or real-time intrapulmonary pressure
  • Paw(t) refers to the function of the change of airway pressure with time t, or real-time airway pressure
  • Flow(t ) Is a function of the patient’s gas flow rate during ventilation with time t, or the patient’s real-time gas flow rate during ventilation
  • PEEP is the positive end-expiratory airway pressure, and the unit can be cmH 2 O
  • Raw is breathing System resistance.
  • the processor 50 may calculate the transpulmonary pressure by subtracting any one of the intrapulmonary pressure or the airway pressure from the esophageal pressure or the intrathoracic pressure.
  • the transpulmonary pressure can be obtained by subtracting the esophageal pressure from the airway pressure.
  • the processor 50 may also correct the transpulmonary pressure, which will be described in detail below.
  • the processor 50 also corrects the transpulmonary pressure through the airway pressure value and the esophageal pressure value in a state where the positive end expiratory pressure is zero and non-zero; specifically, the processor 50 obtains the expiratory pressure value.
  • the airway pressure Paw PEEP and the esophageal pressure Pes PEEP in the state where the positive end-expiratory pressure is non-zero , and the airway pressure Paw ZEEP and the esophageal pressure Pes ZEEP in the state where the positive end-expiratory pressure is zero are obtained; the processor 50 will Add (Paw PEEP- Paw ZEEP ) and subtract (Pes PEEP- Pes ZEEP ) to the transpulmonary pressure to obtain the corrected transpulmonary pressure.
  • the processor 50 also corrects the transpulmonary pressure value through lung compliance and chest wall compliance; specifically, the processor 50 obtains lung compliance Clung and chest wall compliance Ccw; it should be noted that There are multiple methods for the processor 50 to obtain the lung compliance Clung and the chest wall compliance Ccw. For example, the processor 50 can obtain the chest wall compliance Ccw through the following formula:
  • TV is the tidal volume
  • PesI is the end-inspiratory esophageal pressure
  • PEEP es is the end-expiratory esophageal pressure
  • the processor 50 may calculate the error compensation value by the following formula:
  • ⁇ Ptrans erro is the error compensation value
  • Ptrans is the transpulmonary pressure value
  • Plung is the intrapulmonary pressure value
  • the processor 50 subtracts the error compensation value from the transpulmonary pressure to obtain the corrected transpulmonary pressure.
  • the processor 50 may calculate the transdiaphragmatic pressure by subtracting any one of the intra-thoracic pressure or the esophageal pressure from the intra-abdominal pressure or the intragastric pressure.
  • the transdiaphragmatic pressure can be obtained by subtracting the intragastric pressure from the esophageal pressure.
  • the intra-abdominal pressure can be collected by extending the pressure sensor into the abdomen through a wound incision or the like.
  • the processor 50 may also correct the transdiaphragmatic pressure.
  • the processor 50 obtains the esophageal pressure Pes PEEP and the gastric pressure Psto PEEP when the positive end expiratory pressure is non-zero, and obtains the esophageal pressure Pes ZEEP and the gastric pressure when the positive end expiratory pressure is zero. Press Psto ZEEP ; the processor 50 adds (Pes PEEP- Pes ZEEP ) and subtracts (Psto PEEP- Psto ZEEP) to the transdiaphragmatic pressure to obtain the corrected transdiaphragmatic pressure.
  • the processor 50 receives the signals of the pressure sensor 30 and the flow sensor 10, and calculates the energy acting on the patient's respiratory system during the mechanical ventilation process based on the collected pressure and gas flow rate. In some embodiments, the processor 50 integrates the collected pressure and gas flow rate to obtain the energy that acts on the patient's respiratory system during mechanical ventilation. In some embodiments, the processor 50 integrates the collected pressure and gas flow rate within a preset unit time, such as 1 minute, to obtain the energy that the mechanical ventilation acts on the patient's respiratory system. In some embodiments, the processor 50 may integrate the collected pressure and gas flow rate within one breathing cycle to obtain the energy that the mechanical ventilation acts on the patient's respiratory system.
  • the processor 50 may also integrate the collected pressure and gas flow rate within one breathing cycle and multiply it by the breathing rate to obtain the energy that the mechanical ventilation acts on the patient's respiratory system.
  • integrating the pressure and gas flow rate collected in a breathing cycle, and then multiplying it by the breathing rate to make a simple statistical cycle change also belongs to integrating the collected pressure and gas flow rate in a breathing cycle. The way. The following is a further explanation of how to calculate the energy of mechanical ventilation acting on the patient's respiratory system by combining the pressure at different points of the respiratory system.
  • the processor 50 calculates the energy of the mechanical ventilation acting on the patient's respiratory system based on the airway pressure and the gas flow rate. For example, the airway pressure and gas flow rate are integrated to obtain the energy of mechanical ventilation acting on the patient's respiratory system.
  • the formula is as follows:
  • Energy rs is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of airway pressure and gas flow rate in a single cycle
  • Tinsp is the inspiratory time of each breathing cycle
  • Paw is the airway pressure
  • Flow is the gas flow rate.
  • the energy calculated in a single cycle combined with the breathing rate can be converted into an amount per minute. The formula is as follows:
  • the unit of airway pressure Paw is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each breathing cycle is s; RR is the breathing rate, the unit is per minute; by airway pressure
  • the potential energy generated by the tidal volume formed by the positive end-expiratory pressure can also be considered.
  • This part of energy is generally a fixed The value of does not change with mechanical ventilation, and because it requires additional positive end-expiratory pressure release, it can often be omitted.
  • PEEP Volume is the tidal volume caused by the positive end-expiratory pressure, in L, specifically the volume that is exhaled when the positive end-expiratory pressure drop is 0; PEEP is the positive end-expiratory pressure.
  • Calculating the energy of mechanical ventilation acting on the patient's respiratory system based on airway pressure and gas flow rate can represent the energy of mechanical ventilation acting on the patient's entire respiratory system, such as the total energy acting on the patient's trachea, chest wall, and lungs.
  • the processor 50 calculates the energy of mechanical ventilation acting on the patient's respiratory system based on the values of intrapulmonary pressure and gas flow rate. It should be noted that the intrapulmonary pressure can be collected by the pressure sensor 10, or can be performed through the air pressure channel, etc. It is estimated that it has been described in detail above and will not be repeated here. In some examples, the pulmonary pressure and gas flow rate are integrated to obtain the energy that mechanical ventilation acts on the patient's respiratory system. The formula is as follows:
  • Energy lung is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of intrapulmonary pressure and gas flow rate in a single cycle
  • Tinsp is the inspiratory time of each respiratory cycle
  • Plung is the intrapulmonary pressure
  • Flow is the gas flow rate.
  • the energy calculated in a single cycle combined with the breathing rate can be converted into energy per minute. The formula is as follows:
  • the unit of intrapulmonary pressure Plung is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each breathing cycle is s; RR is the breathing rate, the unit is per minute; from the intrapulmonary pressure
  • the potential energy generated by the tidal volume formed by the end-expiratory pulmonary pressure can also be considered.
  • This part of energy is generally a The fixed value does not change with mechanical ventilation, so it can often be omitted.
  • PlungE Volume is the tidal volume caused by the end-expiratory pulmonary pressure, in L, specifically the volume that is exhaled when the end-expiratory pulmonary pressure drop is 0; PlungE is the end-expiratory pulmonary pressure.
  • Calculating the energy of mechanical ventilation acting on the patient's respiratory system based on the intrapulmonary pressure and gas flow rate can represent the energy of mechanical ventilation acting on the lungs and chest wall of the patient's respiratory system.
  • the processor 50 calculates the energy of the mechanical ventilation acting on the patient's respiratory system based on the values of transpulmonary pressure and gas flow rate. For example, integrating the transpulmonary pressure and gas flow rate to obtain the energy of mechanical ventilation acting on the patient's respiratory system, the formula is as follows:
  • Energy tr is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of transpulmonary pressure and gas flow rate in a single cycle; Tinsp is the inspiratory time of each respiratory cycle, Ptrans is the transpulmonary pressure, and Flow is the gas flow rate.
  • Tinsp is the inspiratory time of each respiratory cycle
  • Ptrans is the transpulmonary pressure
  • Flow is the gas flow rate.
  • the energy calculated in a single cycle can be combined with the respiration rate to convert into energy per minute, the formula is as follows
  • the unit of transpulmonary pressure Ptrans is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each breathing cycle is s; RR is the breathing rate, the unit is per minute; by transpulmonary pressure
  • the potential energy generated by the tidal volume formed by the end-expiratory transpulmonary pressure can also be considered.
  • This part of energy is generally a The fixed value does not change with mechanical ventilation, so it can often be omitted.
  • PtansE volume is the tidal volume caused by expiratory transpulmonary pressure, in L, specifically the volume of exhalation when the end-expiratory transpulmonary pressure drop is 0; PtransE is the end-expiratory transpulmonary pressure.
  • Calculating the energy of mechanical ventilation acting on the patient's respiratory system based on the transpulmonary pressure and gas flow rate can represent the energy of mechanical ventilation acting on the lungs of the patient's respiratory system.
  • the processor 50 calculates the energy of the mechanical ventilation acting on the patient's respiratory system based on the transdiaphragmatic pressure and the gas flow rate. For example, integrating the transdiaphragmatic pressure and gas flow rate to obtain the energy of mechanical ventilation acting on the patient's respiratory system, the formula is as follows:
  • Energy di is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of transdiaphragmatic pressure and gas flow rate in a single cycle; Tinsp is the inspiratory time of each respiratory cycle, Pdi is transdiaphragmatic pressure, and Flow is the gas flow rate.
  • Tinsp is the inspiratory time of each respiratory cycle
  • Pdi is transdiaphragmatic pressure
  • Flow is the gas flow rate.
  • the unit of transpulmonary pressure Pdi is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each respiratory cycle is s; RR is the breathing rate, the unit is per minute; from the transdiaphragmatic pressure
  • the potential energy generated by the tidal volume formed by the end expiratory transdiaphragmatic pressure can also be considered.
  • This part of energy is generally a The fixed value does not change with mechanical ventilation, so it can often be omitted.
  • PdiE volume is the tidal volume caused by the expiratory transdiaphragmatic pressure, in L, specifically the volume of exhalation when the end expiratory transdiaphragmatic pressure drop is 0; PdiE is the end expiratory transdiaphragmatic pressure.
  • the energy of mechanical ventilation acting on the patient's respiratory system can be calculated, which can represent the energy of mechanical ventilation acting on the diaphragm of the patient's respiratory system.
  • the processor 50 calculates the energy that the mechanical ventilation acts on the patient's respiratory system, there are many subsequent uses, which will be described in detail below.
  • the display 70 displays the calculated energy of the mechanical ventilation acting on the patient's respiratory system, for example, displaying the real-time value of the energy of the mechanical ventilation acting on the patient's respiratory system and/or displaying the energy of the mechanical ventilation acting on the patient's respiratory system.
  • Time changes for example, can display the change trend graph, trend table, etc. of the energy that mechanical ventilation acts on the patient's respiratory system.
  • Observers such as doctors can evaluate and judge the current degree and condition of lung injury based on the displayed energy of mechanical ventilation acting on the patient's respiratory system.
  • the processor 50 may give an alarm based on the energy exerted on the patient's respiratory system by mechanical ventilation. For example, when it is determined that the energy of the mechanical ventilation acting on the patient's respiratory system exceeds the first threshold, the processor 50 sends an alarm; and/or, when it is determined that the energy of the mechanical ventilation acting on the patient's respiratory system is lower than the second threshold, the processor 50 performs Call the police.
  • the processor 50 can control the display 70 to display alarm information.
  • the first threshold and the second threshold may be set by the user.
  • the processor 50 can determine the patient's condition based on the energy of the mechanical ventilation acting on the patient's respiratory system. In some specific embodiments, the processor 50 determines the patient's condition based on the real-time value and/or change trend of the energy of the mechanical ventilation acting on the patient's respiratory system.
  • the processor 50 determines that the patient's condition is improving, and generates corresponding prompt information; and/ Or, when the ventilation parameters remain unchanged, when it is determined that the change trend of the energy of the mechanical ventilation acting on the patient's respiratory system during the preset time period is increasing, the processor 50 determines that the patient's condition is deteriorating, and generates corresponding prompt information.
  • the ventilation parameters refer to the parameters of the respiratory monitoring device, especially when it is a ventilator or anesthesia machine, that the control device performs mechanical ventilation. Typical examples can be tidal volume, inspiratory flow rate, drive pressure, and end expiration. Parameters such as positive pressure and inhalation-expiration ratio.
  • Fig. 5 is a flowchart of a breathing monitoring method according to some embodiments of the present invention. The method includes the following steps:
  • Step 100 Obtain the gas flow rate of the patient during the ventilation process.
  • the gas flow rate includes at least the patient's inspiratory flow rate, and of course, may also include the patient's inhalation and expiration flow rates.
  • the above-mentioned gas flow rate can be collected by the flow sensor 30.
  • Step 200 Obtain the pressure of the patient during the ventilation process.
  • the pressure reflects the pressure acting on different points of the patient's respiratory system during ventilation, such as one or more of airway pressure, intrathoracic pressure, carina pressure, intrapulmonary pressure, esophageal pressure, and intragastric pressure.
  • airway pressure such as one or more of airway pressure, intrathoracic pressure, carina pressure, intrapulmonary pressure, esophageal pressure, and intragastric pressure.
  • intrathoracic pressure such as one or more of airway pressure, intrathoracic pressure, carina pressure, intrapulmonary pressure, esophageal pressure, and intragastric pressure.
  • the various pressures mentioned above can be acquired by the pressure sensor 10.
  • the pressure sensor 10 may be a catheter pressure sensor or an optical fiber pressure sensor.
  • the pressure at the corresponding point can be taken. For example, if the pressure sensor is inserted into the patient’s airway, the airway pressure can be collected, if the pressure sensor is inserted into the esophagus, the esophageal pressure can be collected, and if the pressure sensor is inserted into the stomach, the intragastric pressure can be collected.
  • the pressure sensor can be inserted into the carina inside the trachea to collect the carina pressure, the pressure sensor can be inserted into the stomach to collect the intragastric pressure, and the pressure sensor can be inserted into the chest cavity through a wound incision.
  • the intrathoracic pressure can be collected.
  • the pressure at some points in the respiratory system can also be used to replace or calculate the pressure at some other points, which will be illustrated by a few examples below.
  • carina pressure may be used instead of intrapulmonary pressure.
  • esophageal pressure can be used instead of intrathoracic pressure.
  • intragastric pressure may be used instead of intraabdominal pressure.
  • step 200 may calculate intrapulmonary pressure based on airway pressure. For example, in some embodiments, step 200 calculates the intrapulmonary pressure through airway pressure, respiratory system resistance, and the aforementioned gas flow rate. In a specific example, it can be calculated by the following formula:
  • Plung(t) refers to the function of the change of intrapulmonary pressure with time t, or real-time intrapulmonary pressure
  • Paw(t) refers to the function of the change of airway pressure with time t, or real-time airway pressure
  • Flow(t ) Is a function of the patient’s gas flow rate during ventilation with time t, or the patient’s real-time gas flow rate during ventilation
  • Raw is the resistance of the respiratory system.
  • step 200 can calculate the transpulmonary pressure by subtracting any one of the intrapulmonary pressure or the airway pressure from the esophageal pressure or the intrathoracic pressure.
  • the transpulmonary pressure can be obtained by subtracting the esophageal pressure from the airway pressure.
  • step 200 can calculate the transdiaphragmatic pressure by subtracting any one of the intra-thoracic pressure or the esophageal pressure from the intra-abdominal pressure or the intragastric pressure.
  • the transdiaphragmatic pressure can be obtained by subtracting the intragastric pressure from the esophageal pressure.
  • the intra-abdominal pressure can be collected by extending the pressure sensor into the abdomen through a wound incision or the like.
  • the pressure in order to make the subsequent calculation of the energy acting on the patient's respiratory system more accurate during the mechanical ventilation process, the pressure can be corrected before the obtained patient pressure is used in the calculation.
  • Figure 6 is an example. , By introducing step 210 to correct the pressure.
  • Step 210 Correct the acquired pressure of the patient.
  • Step 210 may be to correct the transpulmonary pressure or transdiaphragmatic pressure, etc., which will be described in detail below.
  • the transpulmonary pressure of the patient is obtained in step 200.
  • the transpulmonary pressure is corrected.
  • the transpulmonary pressure is corrected.
  • step 210 corrects the transpulmonary pressure by the airway pressure value and the esophageal pressure value when the positive end expiratory pressure is zero and non-zero; specifically, step 210 obtains the positive end expiratory pressure.
  • Step 210 adds the transpulmonary pressure Add (Paw PEEP- Paw ZEEP ) and subtract (Pes PEEP- Pes ZEEP ) to get the corrected transpulmonary pressure.
  • step 210 also corrects the transpulmonary pressure value through lung compliance and chest wall compliance; specifically, step 210 obtains lung compliance Clung and chest wall compliance Ccw; it should be noted that step 210 There are many ways to obtain lung compliance Clung and chest wall compliance Ccw.
  • the chest wall compliance Ccw can be obtained by the following formula:
  • TV is the tidal volume
  • PesI is the end-inspiratory esophageal pressure
  • PEEP es is the end-expiratory esophageal pressure
  • the processor 50 may calculate the error compensation value by the following formula:
  • ⁇ Ptrans erro is the error compensation value
  • Ptrans is the transpulmonary pressure value
  • Plung is the intrapulmonary pressure value
  • Step 210 subtracts the error compensation value from the transpulmonary pressure to obtain the corrected transpulmonary pressure.
  • the transdiaphragmatic pressure of the patient is obtained in step 200.
  • the transdiaphragmatic pressure is corrected.
  • the following examples illustrate the correction method of transdiaphragmatic pressure in detail.
  • Step 210 Obtain the esophageal pressure Pes PEEP and the intragastric pressure Psto PEEP in a state where the positive end expiratory pressure is non-zero , and obtain the esophageal pressure Pes ZEEP and the intragastric pressure Psto ZEEP in a state where the positive end expiratory pressure is zero; Step 210 adds (Pes PEEP- Pes ZEEP ) and subtracts (Psto PEEP- Psto ZEEP) to the transdiaphragmatic pressure to obtain the corrected transdiaphragmatic pressure.
  • step 210 may also be omitted, that is, the acquired pressure of the patient is not corrected.
  • Figure 5 above is an example that does not include step 210
  • Figure 6 above is an example that includes step 210.
  • Step 300 Calculate the energy acting on the patient's respiratory system during the mechanical ventilation process based on the obtained pressure and gas flow rate.
  • step 300 integrates the collected pressure and gas flow rate within a preset unit time, such as 1 minute, to obtain the energy of the mechanical ventilation acting on the patient's respiratory system. In some embodiments, step 300 integrates the collected pressure and gas flow rate within one breathing cycle and multiplies it by the breathing rate to obtain the energy that the mechanical ventilation acts on the patient's respiratory system. Of course, in step 300, the collected pressure and gas flow rate can also be integrated in a breathing cycle to obtain the energy of the mechanical ventilation acting on the patient's respiratory system. The following is a further explanation of how to calculate the energy of mechanical ventilation acting on the patient's respiratory system by combining the pressure at different points of the respiratory system.
  • step 300 calculates the energy of mechanical ventilation acting on the patient's respiratory system based on the airway pressure and gas flow rate. Specifically, step 300 integrates the airway pressure and gas flow rate to obtain the energy of mechanical ventilation acting on the patient's respiratory system.
  • the formula is as follows:
  • Energy rs is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of airway pressure and gas flow rate in a single cycle
  • Tinsp is the inspiratory time of each breathing cycle
  • Paw is the airway pressure
  • Flow is the gas flow rate.
  • the energy calculated in a single cycle combined with the breathing rate can be converted into an amount per minute. The formula is as follows:
  • the unit of airway pressure Paw is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each breathing cycle is s; RR is the breathing rate, the unit is per minute; by airway pressure
  • the potential energy generated by the tidal volume formed by the positive end-expiratory pressure can also be considered.
  • This part of energy is generally a fixed The value of does not change with mechanical ventilation, and because it requires additional positive end-expiratory pressure release, it can often be omitted.
  • PEEP Volume is the tidal volume caused by the positive end-expiratory pressure, in L, specifically the volume that is exhaled when the positive end-expiratory pressure drop is 0; PEEP is the positive end-expiratory pressure.
  • Calculating the energy of mechanical ventilation acting on the patient's respiratory system based on airway pressure and gas flow rate can represent the energy of mechanical ventilation acting on the patient's entire respiratory system, such as the total energy acting on the patient's trachea, chest wall, and lungs.
  • step 300 calculates the energy of mechanical ventilation acting on the patient's respiratory system based on the values of intrapulmonary pressure and gas flow rate.
  • intrapulmonary pressure can be collected by the pressure sensor 10, or can be estimated through the air pressure channel, etc. , which has been described in detail above and will not be repeated here.
  • the pulmonary pressure and gas flow rate are integrated to obtain the energy that mechanical ventilation acts on the patient's respiratory system. The formula is as follows:
  • Energy lung is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of intrapulmonary pressure and gas flow rate in a single cycle
  • Tinsp is the inspiratory time of each respiratory cycle
  • Plung is the intrapulmonary pressure
  • Flow is the gas flow rate.
  • the energy calculated in a single cycle combined with the breathing rate can be converted into energy per minute. The formula is as follows:
  • the unit of intrapulmonary pressure Plung is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each breathing cycle is s; RR is the breathing rate, the unit is per minute; from the intrapulmonary pressure
  • the potential energy generated by the tidal volume formed by the end-expiratory pulmonary pressure can also be considered.
  • This part of energy is generally a The fixed value does not change with mechanical ventilation, so it can often be omitted.
  • PlungE Volume is the tidal volume caused by the end-expiratory pulmonary pressure, in L, specifically the volume that is exhaled when the end-expiratory pulmonary pressure drop is 0; PlungE is the end-expiratory pulmonary pressure.
  • Calculating the energy of mechanical ventilation acting on the patient's respiratory system based on the intrapulmonary pressure and gas flow rate can represent the energy of mechanical ventilation acting on the lungs and chest wall of the patient's respiratory system.
  • step 300 calculates the energy of mechanical ventilation acting on the patient's respiratory system based on the values of transpulmonary pressure and gas flow rate. For example, integrating the transpulmonary pressure and gas flow rate to obtain the energy of mechanical ventilation acting on the patient's respiratory system, the formula is as follows:
  • Energy tr is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of transpulmonary pressure and gas flow rate in a single cycle; Tinsp is the inspiratory time of each respiratory cycle, Ptrans is the transpulmonary pressure, and Flow is the gas flow rate.
  • Tinsp is the inspiratory time of each respiratory cycle
  • Ptrans is the transpulmonary pressure
  • Flow is the gas flow rate.
  • the energy calculated in a single cycle can be combined with the respiration rate to convert into energy per minute, the formula is as follows
  • the unit of transpulmonary pressure Ptrans is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each breathing cycle is s; RR is the breathing rate, the unit is per minute; by transpulmonary pressure
  • the potential energy generated by the tidal volume formed by the end-expiratory transpulmonary pressure can also be considered.
  • This part of energy is generally a The fixed value does not change with mechanical ventilation, so it can often be omitted.
  • PtansE volume is the tidal volume caused by expiratory transpulmonary pressure, in L, specifically the volume of exhalation when the end-expiratory transpulmonary pressure drop is 0; PtransE is the end-expiratory transpulmonary pressure.
  • Calculating the energy of mechanical ventilation acting on the patient's respiratory system based on the transpulmonary pressure and gas flow rate can represent the energy of mechanical ventilation acting on the lungs of the patient's respiratory system.
  • step 300 calculates the energy of mechanical ventilation acting on the patient's respiratory system based on the values of transdiaphragmatic pressure and gas flow rate. For example, integrating the transdiaphragmatic pressure and gas flow rate to obtain the energy of mechanical ventilation acting on the patient's respiratory system, the formula is as follows:
  • Energy di is the energy exerted on the patient's respiratory system by mechanical ventilation obtained from the integration of transdiaphragmatic pressure and gas flow rate in a single cycle; Tinsp is the inspiratory time of each respiratory cycle, Pdi is transdiaphragmatic pressure, and Flow is the gas flow rate.
  • Tinsp is the inspiratory time of each respiratory cycle
  • Pdi is transdiaphragmatic pressure
  • Flow is the gas flow rate.
  • the unit of transpulmonary pressure Pdi is cmH 2 O; the unit of gas flow rate Flow is L/min; the unit of inspiration time Tinsp of each respiratory cycle is s; RR is the breathing rate, the unit is per minute; from the transdiaphragmatic pressure
  • the potential energy generated by the tidal volume formed by the end expiratory transdiaphragmatic pressure can also be considered.
  • This part of energy is generally a The fixed value does not change with mechanical ventilation, so it can often be omitted.
  • PdiE volume is the tidal volume caused by expiratory transdiaphragmatic pressure, in L, specifically the volume of exhalation when the end expiratory transdiaphragmatic pressure drop is 0; PdiE is the end expiratory transdiaphragmatic pressure.
  • the energy of mechanical ventilation acting on the patient's respiratory system can be calculated, which can represent the energy of mechanical ventilation acting on the diaphragm of the patient's respiratory system.
  • the breathing monitoring method may further include step 310, using mechanical ventilation to act on the patient The energy of the respiratory system.
  • Step 310 uses the energy of the mechanical ventilation to act on the patient's respiratory system, which may be to display the energy, use the energy to give an alarm and indicate the patient's condition, and so on. Therefore, referring to FIG. 8, in some embodiments, step 310 may include one or more of steps 311 to 313, which will be described in detail below.
  • Step 311 displaying the energy of the mechanical ventilation acting on the patient's respiratory system.
  • step 311 displays the calculated energy of mechanical ventilation acting on the patient's respiratory system, for example, displaying the real-time value of the energy of mechanical ventilation acting on the patient's respiratory system and/or displaying the energy of mechanical ventilation acting on the patient's respiratory system over time For example, it can display the trend graph and trend table of the energy of mechanical ventilation acting on the patient's respiratory system over time. Observers such as doctors can evaluate and judge the current degree and condition of lung injury based on the displayed energy of mechanical ventilation acting on the patient's respiratory system.
  • step 312 an alarm is issued according to the energy exerted on the patient's respiratory system by the mechanical ventilation.
  • step 312 may generate an alarm based on the energy exerted on the patient's respiratory system by mechanical ventilation. For example, when it is determined that the energy of mechanical ventilation acting on the patient's respiratory system exceeds the first threshold, step 312 generates an alarm; and/or when it is determined that the energy of mechanical ventilation acting on the patient's respiratory system is lower than the second threshold, step 312 generates an alarm.
  • step 312 can control the display of alarm information.
  • the first threshold and the second threshold may be set by the user.
  • Step 313 Judging the patient's condition based on the energy of the mechanical ventilation acting on the patient's respiratory system.
  • step 313 can determine the patient's condition based on the energy of the mechanical ventilation acting on the patient's respiratory system. In some specific embodiments, step 313 determines the patient's condition based on the real-time value and/or change trend of the energy of the mechanical ventilation acting on the patient's respiratory system.
  • step 313 determines that the patient's condition is improving, and generates corresponding prompt information; and/or Under the condition that the ventilation parameters remain unchanged, when it is determined that the change trend of the energy of the mechanical ventilation acting on the patient's respiratory system during the preset time period is increasing, step 313 determines that the patient's condition is deteriorating, and generates corresponding prompt information.
  • the ventilation parameters refer to the parameters of the respiratory monitoring device, especially when it is a ventilator or anesthesia machine, that the control device performs mechanical ventilation. Typical examples can be tidal volume, inspiratory flow rate, drive pressure, and end expiration. Parameters such as positive pressure and inhalation-expiration ratio.
  • the above steps 311 to 313 can be selectively executed by the user according to the actual situation of the patient or several of them.
  • the patient's pressure and gas flow rate can be monitored during ventilation.
  • the energy of mechanical ventilation acting on different parts of the patient's respiratory system can be obtained, so as to compare Accurate, true and real-time evaluation of lung injury, and further, can analyze the value of the energy and other information, and perform follow-up work such as alarm and disease judgment.
  • any tangible, non-transitory computer-readable storage medium can be used, including magnetic storage devices (hard disks, floppy disks, etc.), optical storage devices (CD to ROM, DVD, Blu Ray disks, etc.), flash memory and/or the like .
  • These computer program instructions can be loaded on a general-purpose computer, a special-purpose computer, or other programmable data processing equipment to form a machine, so that these instructions executed on the computer or other programmable data processing device can generate a device that realizes the specified function.
  • These computer program instructions can also be stored in a computer-readable memory, which can instruct a computer or other programmable data processing equipment to operate in a specific manner, so that the instructions stored in the computer-readable memory can form a piece of Manufactured products, including realizing devices that realize designated functions.
  • Computer program instructions can also be loaded on a computer or other programmable data processing equipment, thereby executing a series of operation steps on the computer or other programmable equipment to produce a computer-implemented process, so that the execution of the computer or other programmable equipment Instructions can provide steps for implementing specified functions.
  • Coupled refers to physical connection, electrical connection, magnetic connection, optical connection, communication connection, functional connection and/or any other connection.

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Abstract

Appareil et procédé de surveillance respiratoire. Le procédé consiste : à acquérir la pression d'un patient pendant un processus de ventilation (200), la pression reflétant la quantité de pression agissant sur différents points de position du système respiratoire du patient pendant le processus de ventilation ; à acquérir un débit de gaz concernant le patient pendant le processus de ventilation (100) ; à calculer, en fonction de la pression et du débit de gaz acquis, la quantité d'énergie agissant sur le système respiratoire du patient pendant un processus de ventilation mécanique (300). Au moyen de l'appareil de surveillance respiratoire, la pression et un débit de gaz concernant un patient peuvent être surveillés pendant un processus de ventilation, et l'énergie agissant sur le système respiratoire du patient pendant une ventilation mécanique peut être obtenue en fonction de la pression et du débit de gaz concernant le patient, ce qui permet d'évaluer plus précisément et réellement les lésions pulmonaires en temps réel. En outre, des informations telles que la valeur numérique de l'énergie peuvent être analysées, et des opérations ultérieures telles qu'un déclenchement d'alarme et une détermination d'état pathologique peuvent être effectuées.
PCT/CN2020/080699 2020-03-23 2020-03-23 Appareil et procédé de surveillance respiratoire WO2021189197A1 (fr)

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CN114099880A (zh) * 2021-11-24 2022-03-01 黄燕华 通气模式自动切换方法及系统
CN114366086A (zh) * 2022-01-13 2022-04-19 湖南比扬医疗科技有限公司 一种呼吸门控监控装置、方法及计算机可读存储介质
WO2023097553A1 (fr) * 2021-12-01 2023-06-08 深圳迈瑞生物医疗电子股份有限公司 Dispositif de ventilation et module d'extension de celui-ci, et procédé de surveillance de pression
WO2023115531A1 (fr) * 2021-12-24 2023-06-29 深圳迈瑞生物医疗电子股份有限公司 Procédé de surveillance de respiration et appareil de surveillance de respiration

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