Method of recovery of your own breathing of the patient and the device for its implementation

 

The invention relates to medicine. The method is performed by stimulating the strengthening of the respiratory efforts of the patient. In excess of a predetermined number of respiratory attempts, the amplitude of which exceeds the threshold of sensitivity of the ventilator (AIVL), the threshold increase. Raising the threshold is carried out in dependence on the flow rate of the breathing gas when you try to breathe. The device for implementing the method is equipped with a control channel of the flow rate of the breathing gas when you inhale, containing the circuit for measuring the flow rate of the breathing gas when you inhale, the entrance of which is connected to the circuit output And the input of which is connected to the output of the sensor respiratory attempts, the unit maximum flow rate of the breathing gas when you inhale, the inlet of which is connected to the output of another circuit And the input of which is connected to the output of the device to automatically change the threshold, and the comparison circuit flow rate in the breathing mixture with the installation of the specified setpoint speed, the output of which is connected to the control input of the device to automatically change the sensitivity threshold. The output of the circuit against Ista automatically change the threshold and the circuit of the relay time through the circuit OR connected to the switching circuit, AIVL on the breath. To the inputs of the alarm device connected to the signal outputs of the automatic change of the threshold control circuit of the frequency of respiratory cycles, measurement of the flow rate of the breathing gas when you try inhaling and circuit relay time. The invention allows to speed up the recovery of your own breathing of the patient. 2 s and 5 C. p. F.-ly, 2 Il.

The invention relates to medicine, in particular to methods and means for restoring proper breathing patients after artificial ventilation of the lungs.

There is a method to restore their breathing patients after artificial ventilation of the lungs by stimulating the strengthening of the respiratory efforts of the patient, implemented by the device according to ed. mon. No. 619183 and consists in the fact that in case of exceeding the number of respiratory attempts, the amplitude of which exceeds the threshold of sensitivity of the ventilator (AIVL), the threshold increases [1].

The threshold increases, the required number of times until it reaches a number of respiratory attempts, the amplitude of which exceeds the maximum avodat on spontaneous breathing.

In the absence of regular breathing attempts within a specified time AIVL switch on the breath and in the absence of attempts in the next respiratory cycle threshold lower.

When exceeding the maximum permissible frequency of respiratory cycles, the number of effective respiratory attempts is reduced by increasing the threshold.

The disadvantages of the described method of restoring your own breathing of the patient is the lack of measurement and evaluation of the intensity of some attempts of breath and because of this lack of control over the condition of the respiratory organs of the patient, as well as the difficulties associated with accelerated recovery of his own breathing of the patient.

The proposed method of recovery of your own breathing of the patient is free from the above disadvantages. In addition, this method is compared with the prototype has significant advantages. The intensity of the individual attempts breath is measured and evaluated directly and quickly, giving you the opportunity at any time to evaluate the condition of the respiratory system of the patient and his readiness to transition to spontaneous breathing.

Overcoming the shortcomings of the prototype and the above Doc patient (hereinafter attempts), exercise, depending on the flow rate of the breathing gas when you try to breathe. The speed of flow of the breathing gas is measured in the last of the respiratory cycle.

The doctor sets the low threshold of AIVL (the threshold), i.e., high sensitivity, and speed of flow of the breathing gas when you inhale (the flow rate). In addition, it sets the maximum allowable repetition frequency of respiratory cycles.

If the specified number of attempts, the amplitude of which is above a predetermined threshold, passes, then at the last attempt the measured flow rate and, if it is above the preset level, a signal is applied to the circuit changes the threshold and the threshold increases. This sequence is repeated until it reaches a maximum threshold.

If you reached the maximum threshold specified number of attempts again passes, you may receive the alarm about the possibility of the transfer of the patient to spontaneous breathing. The decision on the set of readings taken by the doctor.

In the absence of attempts within a specified time-triggered time relay, and signals the respiratory cycle threshold decreases, that is also accompanied by a corresponding alarm.

When exceeding the maximum permissible frequency of respiratory cycles, the number of effective respiratory attempts is reduced by increasing the threshold.

A device for controlling AIVL on author. mon. No. 619183, which aims to accelerate the recovery of their own breathing patients after artificial ventilation of the lungs. The block diagram of this device is shown in Fig.1.

The device comprises: a sensor 1 respiratory efforts of the patient (MDC); scheme 2 automatically changes the threshold of AIVL (IPC); scheme 3 frequency control of breathing cycles (ICC); update scheme 4 (PS) containing the counter 5 with the specified conversion factor (LHCII) and reversible shift register 6 (PCP); time relay 7 (PB); the alarm device 8 (CA) and ventilator (AIVL) 9.

The device operates as follows. When respiratory efforts of the patient, the amplitude of which exceeds the lower threshold set by the doctor, the signal from the sensor 1 respiratory attempts through the circuit 2 automatically changes the threshold is supplied to the apparatus artificial wcislo respiratory efforts of the patient reaches a certain pre-defined value, determined by the conversion factor of the counter 5, the signal through the reversible shift register 6 is supplied to the circuit 2 automatically changes the threshold, the threshold is automatically increased.

With the passage of a specified number of respiratory attempts, the amplitude of which exceeds the newly established threshold, the signal conversion circuit 4 is fed back to the circuit 2 automatically changes the threshold, and the threshold again automatically increases. This is repeated until then, until the specified number of respiratory attempts, the amplitude of which exceeds a predetermined maximum threshold. When the appropriate signal is sent to the alarm device 8.

In the absence of regular breathing attempts the ventilator 9 is switched to the breath signal from circuit relay 7. If, in a subsequent respiratory cycle try again absent, the signal from circuit time relay 7 is supplied to the circuit 2 automatically changes the threshold and the threshold is automatically lowered.

If the frequency of respiratory cycles will exceed the maximum of izmeneniya threshold while there is an increase in the threshold that leads to an artificial reduction in the number of effective breathing attempts.

The described device on the bus. with a view. No. 619183 has drawbacks inherent in the above-described method of restoring your own breathing of the patient. The disadvantage of this device is the lack of measurement and evaluation of the intensity of some attempts of breath and because of this lack of control over the condition of the respiratory organs of the patient, as well as the difficulties associated with accelerated recovery of his own breathing of the patient.

The proposed device for the recovery of his own breathing of the patient is free from these disadvantages and, in addition, has a number of advantages of the method that is implemented. The intensity of the individual attempts breath is measured and evaluated directly and quickly, giving you the opportunity at any time to evaluate the condition of the respiratory system of the patient and his readiness to transition to spontaneous breathing. These advantages due to the fact that increasing the threshold, stimulating increased respiratory efforts of the patient, depending on the speed of the flow of breathing gas when the priests of the frame near opto-pairs.

The device according to the proposed method is free from the disadvantages of the prototype can be implemented in the variant shown in Fig.2, where:

1. The sensor of the respiratory efforts of the patient (MDC).

2. The automatic change of the threshold (IPC).

3. Time relay (PB).

4. Scheme “OR” (OR).

5. The ventilator (AIVL).

6. Count the number of respiratory attempts (ICP).

7. Diagram comparing the number of attempts (CSP).

8. Unit number of respiratory attempts (RCP).

9. Diagram of the frequency control of breathing cycles (ICC).

10. Comparison circuit frequency of respiratory cycles (SCC).

11. Unit maximum frequency of respiratory cycles (SCC).

12. Alarm (US).

13. The scheme of measurement of the flow rate of the breathing gas when you inhale (COI).

14. Comparison circuit flow rate of the breathing gas when you inhale (BSC).

15. Unit flow rate of the breathing gas when you inhale (RPS).

16. Sensor flow rate of the breathing gas when you inhale (DSP).

17. Scheme And (And).

18. Scheme And (And).

The device operates as follows. When respiratory efforts of the patient, the amplitude of which exceeds the lower threshold set by the doctor, the signal with Yes, the via scheme 4 OR served on the ventilator 5. At the same time this signal outputs 2 and 3 of the device 2 automatically changes the threshold is supplied respectively to count respiratory attempts 6 and chart 9 monitoring frequency of respiratory cycles.

If the number of effective respiratory efforts of the patient reaches a certain predetermined value determined by the setting device 8 number of attempts, then the signal from the comparison circuit 7 is fed through the scheme And 18 to the control input of circuit 13 measures the speed of the stream and then through the comparison circuit 14 on device 2 automatically changes the threshold, the threshold is automatically increased. Simultaneously with the output 4 of the device 2 automatically changes the threshold through the circuit 17 And the signal is fed to the scheme 15 unit flow rate and the threshold for a given flow rate of the breathing gas increases. And so repeats until then, until setting unit 8, the number of respiratory attempts, the amplitude of which exceeds a predetermined maximum threshold. When the appropriate signal is sent to the alarm device 12.

In case IF the ventilator 5 is switched to the breath. If in the next cycle try again absent, the signal from the second control circuit output relay time 3 is supplied to the circuit 2 automatically changes the threshold, the threshold is automatically lowered.

If the frequency of respiratory cycles exceeds the maximum allowable level, the signal from the circuit 9 controls the frequency of respiratory cycles through the comparison circuit 10 is supplied to the circuit 2 automatically changes the threshold with the increase of the threshold that leads to an artificial reduction in the number of effective breathing attempts.

Using the device automatically changes the threshold 2 is set to the initial minimum threshold. Using the knob 15 is set to the flow rate of the breathing gas when you try to breathe. With the help of unit 11 sets the maximum allowable repetition frequency of respiratory cycles. With the help of unit 8 sets the number of respiratory attempts in the passage of which the threshold increases.

Signals about the respiratory effort sensor respiratory efforts of the patient 1 is fed to the input device 2 automately mixture when you try to breathe.

In operation, the signal from the counter 6 number of respiratory attempts by the comparison circuit 7 is compared with the signal set on the setting device 8, the signal from circuit 13 measures the speed of the flow of breathing gas when you inhale through the comparison circuit 14 is compared with the signal set on the setting device 15, the signal from the circuit 9 controls the repetition frequency of respiratory cycles with the help of the comparison circuit 10 is compared with the signal set on the setting device 11.

The control signals generated at the outputs of circuits comparison with equality defined and measured values, served respectively: output of the comparison circuit 7 through the scheme And 18 to the control input of circuit 13 measures the speed of the flow of breathing gas when you inhale, with outputs of circuits comparing 10 and 14 at the respective control inputs of the device 2 automatically change the threshold.

The signals from the outputs of the circuit of the relay time 3, the counter 6 number of respiratory attempts circuit 9 controls the repetition frequency of respiratory cycles and circuits 13 measuring the flow rate of the breathing gas when you inhale served on the alarm device 12, which operates and includes the corresponding indicator in the absence of attempts in which astaty respiratory cycles, and so p.

Sensor 1 respiratory efforts of the patient is provided with a sensor 16 of the flow rate of the breathing gas when you inhale, which is made in the form of a rotameter, equipped with the necessary number of pinned on the case of photon-coupled pairs, the outputs of the photodetectors are connected to the device 2 automatically changes the threshold for respiratory try.

The proposed device for the recovery of his own breathing patient has compared to the prototype of the significant advantages due to the fact that stimulirovanie strengthen the respiratory efforts of the patient is carried out depending on the flow rate of the breathing gas when you try to breathe. The intensity of the individual attempts breath is measured and evaluated directly and quickly, giving you the opportunity at any time to assess the readiness of the patient to transition to spontaneous breathing.

Measurement and evaluation of the intensity of each attempted breath allow for more reliable monitoring of the respiratory system of the patient and to overcome the difficulties associated with accelerated recovery of his own breathing of the patient.

The proposed device provides faster recovery sobstvenniyh muscles of the patient.

sources of information

1. Technical description of the apparatus for artificial ventilation of the lungs “RO-5”. 1972.

2. Description of the invention to ed. mon. No. 619183.1978 year. Authors B. A. Berezin and C. L. Vanevski.

Claims

1. Method of recovery of your own breathing of the patient when performing artificial ventilation of the lungs by stimulating the strengthening of the respiratory efforts of the patient, namely, that in excess of a predetermined number of respiratory attempts, the amplitude of which exceeds the threshold of sensitivity of the ventilator (AIVL), the threshold increases, characterized in that the increase of the threshold is carried out in dependence on the flow rate of the breathing gas when you try to breathe.

2. The method according to p. 1, characterized in that the increase of the threshold is carried out in dependence on the flow rate of the breathing gas when you breath in the last of the respiratory cycle.

3. The method according to PP.1 and 2, characterized in that the threshold increases as necessary to achieve a given number of attempts breath, the amplitude reaches a preset maximum threshold Chu is and spontaneous breathing.

4. The method according to p. 3, characterized in that in the absence of regular breathing attempts within a specified time AIVL switch on the breath and in the absence of attempts in the next respiratory cycle threshold lower.

5. The method according to p. 4, characterized in that when the excess is allowable frequency of respiratory cycles, the number of effective respiratory attempts is reduced by increasing the threshold.

6. Device for the recovery of his own breathing of the patient containing the respiratory sensor attempts, connected through the automatic change of the threshold and the time relay with switching circuit of AIVL on the breath; the control channel number of respiratory attempts that contains a counter for the number of respiratory attempts, the input of which is connected to the output of the automatic change of the threshold unit maximum number of respiratory effort and a circuit for comparing the number of respiratory effort of installing the specified unit number, the output of which is connected with the control input of the automatic change of the threshold; the control channel frequency of respiratory cycles containing the control circuit frequent the activity, unit maximum frequency of respiratory cycles and the comparison circuit frequency of respiratory cycles with the specified installation of the frequency, the output of which is connected to the control input of the automatic change of the threshold and the alarm device, connected to the signal output count respiratory attempts, characterized in that it is provided with a control channel of the flow rate of the breathing gas when you inhale, containing the circuit for measuring the flow rate of the breathing gas when you inhale, the entrance of which is connected to the circuit output And the input of which is connected to the output of the sensor respiratory attempts, the unit maximum flow rate of the breathing gas when you inhale, the inlet of which is connected to the output of another circuit And the input of which is connected to the output of the device to automatically change the threshold, and the comparison circuit flow rate in the breathing mixture with the installation of the specified setpoint speed, the output of which is connected to the control input of the automatic change of the threshold; the output of the comparison circuit of the control channel number of attempts is connected to the other inputs of these circuits And the control o uceni to the switching circuit, AIVL on the breath; and to the inputs of the alarm device connected to the signal outputs of the automatic change of the threshold control circuit of the frequency of respiratory cycles, measurement of the flow rate of the breathing gas when you try inhaling and circuit relay time.

7. The device according to p. 6, characterized in that the sensor of the respiratory efforts of the patient is provided with a speed sensor of the flow of breathing gas when you inhale, which is made in the form of a flowmeter equipped with fixed casing opto-pairs in the amount of from 5 to 10, and the outputs of these photodetectors photon-coupled pairs are connected to the input device to automatically change the sensitivity of the respiratory try.

 

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FIELD: medical engineering.

SUBSTANCE: device has belt manufactured from inextensible flexible material having clamps mounted on one side along its length, with rollers enveloped by cords. Closed chambers built from flexible material, filled with liquid and having pressure gages, are attached to its other side in camp projections. Electromotor is mounted in the middle part of the belt on the same side with the clamps. The electromotor has control system. Drum enveloped with cords is rigidly fixed on the electromotor end part. The middle portion of each cord is rigidly connected to cylindrical drum surface. Free ends of the cords are connected to end clamps.

EFFECT: retained ability of unrestrained patient movements.

2 dwg

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