WO2021262017A1

WO2021262017A1 - Modular system for multi-station patient ventilation

Info

Publication number: WO2021262017A1
Application number: PCT/PL2021/050041
Authority: WO
Inventors: Marek Darowski; Maciej KOZARSKI
Original assignee: Instytut Biocybernetyki I Inżynierii Biomedycznej Im.Macieja Nałęcza Polskiej Akademii Nauk
Priority date: 2020-06-23
Filing date: 2021-06-15
Publication date: 2021-12-30
Also published as: PL434417A1; EP4168080A1; PL244255B1

Abstract

The invention relates to a modular system for multi-station patient (P1, P2, P3, P4) ventilation, comprising a control ventilator (1), operating in pressure mode, having a pneumatic output (2) and an expiratory port (3), and comprising at least one gas volume divider (Dl, D2) with input ports (10,14) and output ports (11,12,15,9), and also a manifold exhaust line (4), and characterized in that between the ventilator (1) and the gas volume dividers (D1, D2) there is a valve block (5) interconnected, with an input (6) and outputs (7,8), where the gas volume dividers (D1,D2) are connected to the valve block (5) in parallel, wherein each of the gas volume dividers (D1, D2), has a pneumatic system (21) for transporting gases connected to each of its two output ports (11, 12, 15, 9), the pneumatic system (21) containing an inspiratory valve (22) for connecting, during inspiration phase, the gas volume divider (D1, D2) with the patient (PI, P2,P3, P4) airways, and an expiratory valve (24) for connecting the patient (PI, P2, P3, P4) with the manifold expiratory line (4), wherein the gas transport system (21) further comprises a valve (26) for setting a minimum end-expiratory pressure of the patient (PI, P2, P3, P4) lungs, wherein the valve (26) is connected to the manifold expiratory line (4) connected to the expiratory port (3) of the ventilator.

Description

Modular system for multi-station patient ventilation

The subject of the invention is a modular system for multi-station patient ventilation comprising a control ventilator, operating in pressure mode, having a pneumatic output and an expiratory port, and comprising at least one gas volume divider with input and output ports and a manifold expiratory line.

In emergency situations - natural disasters (e.g. gas explosions, typhoons, tsunamis, viral pandemics, terrorist attacks, poisonings), it may be necessary to administer respiratory therapies to so many victims that their number exceeds several times the number of necessary ventilators available in Poland or abroad. This is best illustrated by the situation caused by the COVID-19 virus pandemic in 2019-2020.

Examples of proposals to use a single ventilator to ventilate more than one patient are known in the literature (1. Neyman G., Irvin C.B. A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge. Academic Emergency Medicine 2006; 13(11): 1246—1249. doi: 10.1197/j.aem; 2. Paladino L., Silverberg M., Charchaflieh J.G., Eason J.K., Wright B.J., Palamidessi N., Arquilla B., Sinert R., Manoach S. Increasing ventilator surge capacity in disasters: ventilation of four adult-human- sized sheep on a single ventilator with a modified circuit. Resuscitation. 2008 Apr;77(l): 121-6. Epub 2007 Dec 31. PMID: 18164798. DOI: 10.1016/j.resuscitation.2007.10.016; 3. Sommer D.D., Fisher J.A., Ramcharan V., Marshall S., Vidic D.M. Improvised automatic lung ventilation for unanticipated emergencies. Crit Care Med. 1994 Apr;22(4):705-709). 2006.05.009). However, all these aforementioned solutions do not provide the metabolism-required appropriate ventilation of patient lungs connected to a single ventilator and stabilization of minute ventilation (the most important parameter of respiratory therapy), with unpredictable changes in respiratory mechanics during the respiratory therapy.

In the aforementioned paper by Neyman & Irvin (Publication 1), four so-called artificial lungs representing the lungs of four patients were connected to the inspiratory port of a ventilator, using pneumatic Y-type tee junctions. The attached artificial lungs had the same compliance, and therefore their ventilation was identical. This system, having no elements for controlling the distribution of total ventilation delivered by the ventilator, cannot ensure the required ventilation of each lung, as in reality the patients' lungs have different mechanical properties (compliance and resistance of airways). Moreover, these properties can change significantly during respiratory therapy, and this varies from patient to patient, therefore the ventilation of all lungs cannot be kept constant.

In the aforementioned paper by Paladino et al. (Publication 2), the authors connected four healthy sheep with identical weight to a ventilator. They found that the animals received adequate lung ventilation, but did not show that this would also be the case if one of the sheep with healthy lungs would be replaced with a sheep having a lung pathology.

In the aforementioned paper by Sommer et al. (Publication 3), the authors suggested using a ventilator to ventilate more patients by simply adding mushroom (poppet) valves to each patient's expiratory circuit. However, they did not go beyond testing on pulmonary simulators. They recommended selecting patients with stable lung compliance in order to minimize the effect of dynamic changes in lung compliance and airway resistance on lung ventilation. In Publication 4. Branson R.D., Blakeman T.C., Robinson B.R., Johannigman J.A. Use of a Single Ventilator to Support 4 Patients - Laboratory Evaluation of a Limited Concept. Respir Care 2012;57(3):399-403, the authors questioned the relevance of solutions as simple as those presented in the aforementioned papers for ventilating four patients with a single ventilator. Using pulmonary simulators, they demonstrated that if just one patient's lung compliance changes, the entire previous distribution of ventilator ventilation between the lungs will change dramatically and the requirement for constant minute ventilation for each patient will not be met.

During late 2019 and into 2020, due to the sudden increase in the number of patients infected with COVID-19 coronavirus requiring artificial lung ventilation, and the concomitant dramatic ventilator shortage, many clinical facilities attempted to use a single ventilator to simultaneously ventilate more patients (ventilator splitting). All proposed solutions (described in publications: 5. O’Sullivan K. Irish researchers develop split ventilator for use on two Covid-19 patients at once., The Irish Times, April 10, 2020, https://www.irishtimes.com/news/health/irish-researchers-develop-split-ventilator- for-use-on-two-covid-19-patients-at-once-l.4225528; 6. Srinivasan S., Ramadi K.B., Vicario F., Gwynne D., Hayward A., Lagier D., Langer R., Frassica J.J., Baron R.M., Traverso G. A rapidly deployable individualized system for augmenting ventilator capacity Science Translational Medicine 18 May 2020:eabb9401, DOI: 10.1126 https://stm.sciencemag.org/content/early/2020/05/18/scitranslmed.abb9401.full; 7. Clarke A.L., Stephens A.F., Liao S., Byme T.J., Gregory S.D. Coping with COVID-19: ventilator splitting with differential driving pressure using standard hospital equipment. Anaesthesia, vol.75, issue 7, July 2020: 872-88) come down to manually adjusting, by trial and error, the distribution of the inspiratory gas volume delivered from the ventilator to each patient. Pneumatic stop valves located in the ventilator inspiratory lines are used for this purpose. Such a ventilation method would require permanent presence of medical personnel, which is impossible under conditions of usually prolonged respiratory therapy (days, weeks).

In Publication 8. Tonnetti T., Zanella A., Pizzilli G., Babcock C.I., Venturi S., Nava S., Pesenti A., Ranieri C.I. One ventilator for two patients: feasibility and considerations of a last resort solution in case of equipment shortage. Torax 2020;0.1-3. http://dx.doi.org/10.1136/thoraxjnl-2020-214895. Back then, the authors were conducting an objective study on the ventilator splitting concept, using two certified test lungs. They critically evaluated the existing solutions mentioned above, confirming the results of the paper by Branson et al. (Publication 4) They unequivocally stated that this concept, implemented in such a technically simple way as manually adjusting the ratio of inspiratory gas volume division from the ventilator, is risky for patients. This is because it does not guarantee stabilization of their ventilation with dynamic changes in lung mechanics occurring even during normal events, e.g. changes in patient's position, coughing or sudden partial obstruction of the endotracheal tube caused by sputum accumulation.

The aim of the invention is to provide a solution that does not have the foregoing disadvantages of solutions known in the state of the art and avoids the associated problems. This is a non-trivial task, as it has been shown beyond doubt in the publications cited (4,8) that ventilator gas splitting techniques based on the concept of "ventilator splitting" cannot be used in patients because of their high unreliability and the potential risk they pose to patient health and life.

The subject of the invention is a modular system for multi-station patient ventilation comprising a control ventilator, operating in pressure mode, having a pneumatic output and an expiratory port, and comprising at least one automatic gas volume divider with input and output ports and a manifold expiratory line. According to the invention, a valve block with inputs and outputs is interconnected between the ventilator and the gas volume dividers, the volume dividers being connected to the valve block in parallel, each of the volume dividers having a pneumatic gas transport system connected to each of its two output ports, comprising an inhalation valve for connecting, in the inhalation phase, the gas volume divider with the patient's airway, and a cut-off valve for connecting the patient with the manifold expiratory line. The gas transport system further includes a valve for determining a minimum end-expiratory pressure of the patient lungs, the valve being connected to a manifold expiratory line connected to an expiratory port of the ventilator.

Preferably, the pneumatic gas transport system further comprises an antibacterial/antiviral filter connected in serial mode.

Further preferably, the input of the valve block is connected to the pneumatic output of the ventilator, and the outputs of the valve block are connected to the input ports of the volume dividers.

It is also preferable to have each gas volume divider comprising a respiratory monitor having two independent pairs of maximum pressure and minute ventilation measurement paths for each output port.

More preferably, the at least one divider has an indicator for indicating the maximum pressure at the output port, and an indicator for indicating the minute ventilation delivered to the lungs of the patient.

It is also preferable to have a control system provided between the gas volume divider and the valve block, comprising sequentially: a tee junction for supplying the respiratory mixture, connected by a pneumatic line to an input port of the valve block, a cut-off valve, a manifold to which a pneumatic condenser is connected, as well as first and second cut-off valves, the control outputs of these valves also being connected to a pneumatic tee junction, which itself is connected to the tee junction, and furthermore the output of the first cut-off valve is connected to the output port of the valve block, and the output port of the second cut-off valve is connected to the output port of the valve block. The pneumatic condenser is preferably a bellow-type condenser.

It is also preferable when the cut-off valves are in the form of a multi- segmented body having an input chamber segment, an output chamber segment, an output chamber cover segment and a control chamber segment, wherein the input chamber has an input port supplying respiratory mixture flow, and the output chamber has an output port discharging the respiratory mixture flow, and further comprising, in the body of the output chamber, a centrally located opening closed by an aperture plate centrally mounted on the pusher, and having a diaphragm between the cover and the control chamber acting on the pusher, wherein the pusher is guided on one side in the opening of the cover and on the other side in the blind opening of the input chamber, and furthermore having a return spring arranged between the plate and the bottom of the input chamber, for pressing the plate against the edge of the opening of the output chamber, wherein the cover comprises peripherally arranged vent holes under the diaphragm, connecting the pneumatic region formed between the diaphragm and the cover to the atmosphere, and wherein the control chamber comprises a control port for supplying a pneumatic control signal to the control chamber.

The gas volume dividers are also preferably automatic dividers.

The object of the invention is illustrated in examples of implementation in the drawing, wherein Figure 1 shows a general schematic diagram of the system according to the invention, Figure 2 shows a schematic diagram of an automatic gas volume divider used in a preferable embodiment of the invention, Figure 3 shows a schematic diagram showing connections of the functional elements of the system according to the invention, Figure 4 shows an example of a valve block used in the invention, Figure 5 shows an example of a cut-off valve used in an embodiment of the invention.

In the general schematic diagram, Figure 1 shows an embodiment of a modular system for multi-station patient PI, P2, P3, P4 ventilation comprising a control ventilator 1 operating in pressure mode, having a pneumatic output 2 and an expiratory port 3. The system according to the embodiment comprises two gas volume dividers Dl, D2, with input ports 10 and 14 and output ports 11, 12 and 15, 9, respectively, and also a manifold expiratory line 4. A valve block 5 with input 6 and outputs 7, 8 is interconnected between the ventilator 1 and each of the gas volume dividers Dl, D2. The gas volume dividers Dl, D2 are connected to the valve block 5 in parallel. In the embodiment, the input 6 of the valve block 5 is connected to the pneumatic output 2 of the ventilator 1, while the outputs 7,8 of the valve block 5 are connected to the input ports 10, 14 of the gas volume dividers Dl, D2, respectively.

In Figure 3 it can be seen that each of the gas volume dividers Dl, D2 has a pneumatic gas transport system 21 connected to each of its two output ports 11, 12 and 15, 9, respectively, the pneumatic gas transport system 21 comprising an inspiratory valve 22 for connecting, during the inspiratory phase, the gas volume divider Dl, D2 to the patient PI, P2, P3, P4 airways, and a cut-off valve 24 for connecting the patient PI, P2, P3, P4 to the manifold expiratory line 4. The gas transport system 21 further includes a valve 26 for determining a minimum end-expiratory pressure of the patient PI, P2, P3, P4 lungs, the valve 26 being connected to the manifold expiratory line 4 connected to the expiratory port 3 of the ventilator. In one embodiment, the pneumatic gas transport system 21 further comprises an antibacterial/antiviral filter 25 connected in serial mode.

Figure 2 shows a gas volume divider applied to a preferable embodiment of the system, which is an automatic divider. This may be, for example, a divider such as disclosed in patent specification EP3154617. In the embodiment, each gas volume divider Dl, D2 includes a respiratory monitor having two independent pairs of maximum pressure and minute ventilation measurement paths for each of the output ports 11,12,15,9. Preferably, the at least one divider Dl, D2 has an indicator 17,18 for indicating the maximum pressure at the output port 11,12, and an indicator 16,19 for indicating the minute ventilation delivered to the lungs of the patient PI, P2, P3, P4. The respiratory gas from the ventilator 1 is supplied to the input port 10 of the gas volume divider Dl, D2, while it is further distributed to the patient PI through the output port 11 and to the patient P2 through the output port 12. The gas volume divider Dl, D2 also comprises a knob 20 for setting the percentage division of the gas volume delivered by the ventilator 1 to the input port 10, between the output ports 11 and 12 of the gas volume divider Dl, D2.

Figure 4 shows a detail of the system according to the embodiment, wherein there is a control system provided between the gas volume divider D1,D2 and the valve block 5, the control system comprising sequentially: a tee junction 27 for supplying the breathing mixture, connected by a pneumatic line to the input port 6 of the valve block 5, a cut-off valve 30, a manifold 31 with a pneumatic condenser 33 connected thereto, as well as the first 34 and the second 35 cut-off valves. The control outputs of the cut-off valves 34, 35 are also connected to the pneumatic tee junction 28, which is connected to the tee junction 27, and furthermore the output of the first cut-off valve 34 is connected to the output 8 of the valve block 5 and the output of the second cut-off valve 35 is connected to the output 7 of the valve block 5. In a preferable embodiment, the pneumatic condenser 33 is a bellow-type condenser.

The embodiment of the cut-off valve 34,35 in the form of a multi-segment body having an input chamber segment 37, an output chamber segment 38, a cover segment 39 of the output chamber 38, and a control chamber segment 41. The input chamber 37 has an input port IN supplying a respiratory mixture volume and the output chamber 38 has an output port OUT discharging a respiratory mixture volume. The body of the output chamber 38 comprises a centrally located opening closed by an aperture plate 43 centrally mounted on a pusher 42. Between the cover 39 and the control chamber 41, there is a diaphragm 40 acting on the pusher 42. The pusher 42 is guided on one side in the cover opening 39 and on the other side in the blind opening of the input chamber 37. A return spring 44 is provided between the plate 43 and the bottom of the input chamber 37 for pressing the plate 43 against the edge of the output chamber opening 38. The cover 39 includes peripherally spaced vent holes under the diaphragm 40, connecting the pneumatic region formed between the diaphragm 40 and the cover 39 to the atmosphere. The control chamber 41 comprises a control port CONT for supplying a pneumatic control signal to the control chamber 41. The cut-off valve 34, 35 is normally closed, but under the influx of control pressure supplied by the control port CONT to the chamber above the diaphragm 40, the pusher 42 is moved and the connection between the chambers 37 and 38 of the valve is opened, allowing air to flow between the IN and OUT pneumatic ports. Return to normally closed state is enabled by the return spring 44.

The modular system for multi-station automatic patient ventilation according to the invention has very preferable performance features.

For example, using a single gas volume division controller for two patients reduces the required number of components, which are the most expensive parts of the system, by a factor of two compared to a solution that would use separate gas volume controllers for each patient. In a preferable embodiment, thanks to the use of the automatic controller, the simplicity of selecting parameter settings for the entire system is ensured: for each pair of patients, as well as within the entire system. Constant pressure operation of the ventilator ensures no interaction between controllers.

An important feature of the system includes larger number of simultaneously ventilated patients, potentially facilitating their pairing, so that each of the gas volume division controllers would ventilate a pair with similar mechanical parameters of the respiratory system, i.e. similar airway resistance and pulmonary compliance.

The mode of ventilator operation is essential in a system for multi-station patient ventilation with a single ventilator. Apart from special means of individualized ventilation, the vast majority of ventilators have two modes: the pressure mode, where the pressure generated by the ventilator is constant and independent of the gas volume delivered to the patient, and the volume mode, where the volume of gas delivered by the ventilator is constant and independent of the pressure at the ventilator's output port.

Simultaneous ventilation of several patients connected in parallel to the ventilator differs dramatically in the two modes of operation described. The pressure mode means that the ventilator acts like a pressure source with very low natural resistance, maintaining pressure in a network of patients connected in parallel, independent of the amount of air they are taking in. This also means that changing the breathing resistance or lung compliance of any patient has no effect on the ventilation conditions of the others. In volumetric mode of operation, a fixed volume of gas delivered cyclically by the ventilator must be divided among the patients. The ventilator behaves as a gas volume source with very high intrinsic resistance. A change in the air intake of one of the connected patients, whether introduced by the physician or arising from a different cause, immediately changes the network pressure and thus the ventilation conditions of all patients. While controlling these changes with only two connected patients is relatively easy, it can be a virtually impossible task in case of more patients. Because of that, the pressure mode is the only appropriate ventilation mode for the multi-station ventilation.

The operation of the modular system for multi-station patient ventilation according to the invention can best be illustrated by analyzing the schematic diagram shown in Figure 3. The ventilator 1 preferably operating in constant pressure mode generates a cyclic positive pressure in its pneumatic output port 2 during the inspiratory phase. It is fed to input 6 of valve block 5, with the gas volume dividers D1 and D2 connected in parallel to its outputs 7 and 8, respectively. Their maximum number depends on one hand on the total minute ventilation required by patients P, P2, P3, P4, and on the second hand on the maximum minute ventilation available in ventilators, which is about 200 L/min in currently manufactured ventilators. It is very important to have the ventilator 1 providing the possibility of using the constant pressure mode, because then the operation of the individual gas volume dividers is independent, i.e. a change in the respiratory gas volume flow taken by one of the gas volume dividers Dl, D2 has no effect on the operation of the others, i.e. there is no interaction between them.

Fig. 1 shows the details of the divider Dl connection, assuming that the next divider D2 and possible other dividers connected in parallel are identical. It will be obvious for the expert in art that a larger number of dividers Dl, D2 and a larger number of patients PI, P2, P3, P4 - respectively - can be connected by doing so. The flow of respiratory gas volume supplied under constant pressure from ventilator 1 to the input port 10 of the divider Dl is divided between patients PI and P2 at a ratio set by the physician. To ensure control of this division process, monitoring of both pressure and minute ventilation delivered to the lungs of ventilated patients PI, P2, P3, P4 was applied in each of the two output channels 11,12 and 15,9 of the dividers Dl, D2, respectively. It is very important to have respiratory gas volume flow in the inspiratory phase administered to one patient PI through the inspiratory valve 22, preventing a backflow of air into the ventilator 1 in the expiratory phase. The air exhaled by the patient PI is routed through the expiratory valve 24 through the antibacterial/antiviral filter 25, and the valve 26 establishing the minimum pressure in the exhalation phase directed to the manifold expiratory line 4 connected to the expiratory port 3 of the ventilator 1. This closes the airway from the ventilator 1 to the patient PI, and from the patient PI to the ventilator 1 identically for each of the connected patients PI, P2, P3, P4.

In Figure 3, connecting successive pairs of patients PI, P2, P3, P4 consists of expanding the connections of the system components in an identical manner for each attached patient PI, P2, P3, P4, and the number of patients, as determined by the physician, is limited by the capacity of the ventilator 1 and their required individual minute ventilation. In order to allow objective control of the ventilation conditions, the gas volume divider Dl, D2 was provided with a respiratory monitor of the peak output pressure and minute ventilation delivered to each patient PI, P2, P3, P4. The number of connected patients PI, P2, P3, P4 does not have to be even. In this case, the unused output of the Dl, D2 divider should be blocked.

Figure 1 of the drawing shows an example configuration of the ventilator 1 connections of the controlling modular system for ventilation in case of simultaneous ventilation of four patients PI, P2, P3, P4. The directions of the respiratory gas volume flows delivered by the ventilator 1 from the pneumatic output port 2 and received by the ventilator 1 at the expiratory port 3 are illustrated by the arrows.

The valve block 5 shown in Figure 4 is the system component intermediating between the ventilator and the dividers Dl and D2. The controllable cut-off valves 34 and 35 used therein connect the pneumatic condenser chamber 33 to the input ports of the dividers Dl and D2 in the inspiratory phase, while in the expiratory phase, they cut off the pneumatic connection of the dividers to the condenser chamber 33. Since a cut-off valve 30 is engaged between the condenser chamber 33 and the output port of the ventilator 1, a charge of compressed air will remain in this condenser chamber 33 at the pressure prevailing at the pneumatic output 2 of the ventilator 1 when the cut-off valves 30 are engaged. The output pressure of the ventilator 1 is also a control signal supplied to the control ports CONT of the cut-off valves 34 and 35. During the expiration phase, the output pressure drops to atmospheric pressure, causing the flow to be cut off between the input port IN and the output port OUT of each of the valves 34 and 35.

The input 6 of the valve block 5 is connected to a pneumatic manifold made of a system of pipes connected by tee junctions 27 and 28, supplying the respiratory mixture to the control ports CONT of the cut-off valves 34 and 35, and then through the outputs 8 and 7 to the dividers Dl and D2. The system may be expanded as needed to include another controlled valve 36 by extending the connections as additional lines 29 and 32, indicated by the dashed line. The valve block 5 plays an important role in the distribution system of the gas administered from the ventilator 1 to the lungs of the patients PI, P2, P3, P4. During the initial phase of inspiration, when the gas flow is the greatest, it provides an additional portion of air previously stored in the condenser 33. Furthermore, the presence of the condenser 33 reduces the interaction of the attached dividers Dl, D2 during the inhalation phase.

Of course, the invention is not limited to the shown embodiments, and various modifications are possible within the scope of patent claims, without departing from the essence of the invention.

Claims

1. A modular system for multi-station patient (PI, P2, P3, P4) ventilation, containing a control ventilator (1) operating in pressure mode, having a pneumatic output (2) and an expiratory port (3), and comprising at least one gas volume divider (Dl, D2) with input (10,14) and output (11,12,15,9) ports, and also a manifold expiratory line (4), characterized in that between the ventilator (1) and the gas volume dividers (Dl, D2), there is a valve block (5) interconnected, with an input (6) and outputs (7,8), where the gas volume dividers (Dl, D2) are connected to the valve block (5) in parallel, wherein each of the gas volume dividers (Dl, D2), has a pneumatic system (21) for transporting gases connected to each of its two output ports (11,12,15,9), the pneumatic system (21) containing an inspiratory valve (22) for connecting, during inspiration phase, the gas volume divider (Dl, D2) with the patient (PI, P2 ,P3, P4) airways, and an expiratory valve (24) for connecting the patient (PI, P2, P3, P4) with a manifold expiratory line (4), wherein the gas transport system (21) further comprises a valve (26) for setting a minimum end-expiratory pressure of the patient (PI, P2 ,P3, P4) lungs, wherein the valve (26) is connected to the manifold expiratory line (4) which is in turn connected to the expiratory port (3) of the ventilator.

2. The system according to claim 1, characterized in that the pneumatic system (21) for transporting gases further comprises an antibacterial/antiviral filter (25) connected in serial mode.

3. The system according to claim 1, characterized in that the input (6) of the valve block (5) is connected to the pneumatic output (2) of the ventilator (1), while the outputs (7,8) of the valve block (5) are connected to the input ports (10, 14) of the gas volume dividers (Dl, D2).

4. The system according to claim 1, characterized in that each gas volume divider (Dl, D2) comprises a respiratory monitor having two independent pairs of maximum pressure and minute ventilation measurement paths for each of the output ports (11, 12, 15, 9).

5. The system according to claim 4, characterized in that at least one divider (Dl, D2) has an indicator (17,18) for indicating the maximum pressure at the output port (11, 12), and an indicator (16, 19) for indicating the minute ventilation delivered to the patient (PI, P2, P3, P4) lungs.

6. The system according to claim 1, characterized in that between the gas volume divider (Dl, D2) and the valve block (5), there is a control system comprising sequentially: a tee junction (27) for supplying the breathing mixture, connected by a pneumatic line to the input port (6) of the valve block (5), a cut-off valve (30), a manifold (31) with a pneumatic condenser (33) connected thereto, and the first and the second cut-off valves (34, 35), wherein the control outputs of the cut-off valves (34, 35) are also connected to the pneumatic tee junction (28), which is in turn connected to the tee junction (27), and furthermore the output of the first cut off valve (34) is connected to the output (8) of the valve block (5), and the output of the second cut-off valve (35) is connected to the output (7) of the valve block

(5).

7. The system according to claim 6, characterized in that the pneumatic condenser (33) is a bellow-type condenser.

8. The system according to claim 6, characterized in that the cut-off valves (34, 35) are in the form of a multi- segmented body having an input chamber segment (37), an output chamber segment (38), an output chamber (38) cover segment (39) and a control chamber segment (41), wherein the input chamber (37) has an input port supplying a flow of the respiratory mixture, and the output chamber (38) has an output port discharging a flow of the respiratory mixture, and further in the body of the output chamber (38), there is a centrally located opening closed by an aperture plate (43) that is centrally mounted on the pusher (42), and there is a diaphragm (40) located between the cover (39) and the control chamber (41) acting on the pusher (42), wherein the pusher (42) is guided on one side in the opening of the cover (39), and on the other side in the blind opening of the input chamber (37), and furthermore there is a return spring (44) arranged between the plate (43) and the bottom of the input chamber (37) for pressing the plate (43) against the edge of the opening of the output chamber (38), wherein the cover (39) comprises peripherally arranged vent holes under the diaphragm (40), connecting the pneumatic region formed between the diaphragm (40) and the cover (39) to the atmosphere, and wherein the control chamber (41) comprises a control port for supplying a pneumatic control signal to the control chamber (41).

9. The system according to claim 1, characterized in that the gas volume dividers (Dl, D2) are automatic dividers.