CN109107007B - Intelligent APRVplus breathing machine ventilation system and use method - Google Patents

Abstract

The invention relates to an intelligent APRVplus breathing machine ventilation system and a using method. An intelligent APRVplus ventilator ventilation system comprises an inspiration circuit, an expiration circuit, a microcomputer electronic controller and a gas circuit system for detecting and controlling the inspiration circuit and the expiration circuit; the gas circuit system comprises a flow sensor, a pressure release valve and a proportional electromagnetic valve; the inspiration circuit is provided with a flow sensor and a pressure sensor, and the expiration circuit is provided with a flow sensor, a pressure release valve and a proportional electromagnetic valve; the gas circuit system is connected with a microcomputer electronic controller, and the microcomputer electronic controller detects the information of the gas circuit system such as the respiratory rate, the airway pressure, the gas flow and the tidal volume of the gas circuit system through a flow sensor and a pressure sensor, and adjusts the gas circuit system through an expiration loop pressure release valve and a proportional electromagnetic valve. Through the technical scheme, intelligent accurate, safe and effective lung protective ventilation of ARDS is realized, and manpower and material resources are saved.

Description

Intelligent APRVplus breathing machine ventilation system and use method

Technical Field

The invention relates to the technical field of medical appliances, in particular to an intelligent APRVplus breathing machine ventilation system and a using method thereof.

Background

Mechanical ventilation is used for respiratory support treatment such as respiratory failure, general anesthesia, and major surgery due to various causes, and also for rehabilitation of various chronic nerve-muscle diseases, cardiac insufficiency, and various respiratory diseases. With the development of microelectronic technology, the performance and the function of modern respirators are gradually improved, ventilation control is more accurate, and safety is higher. With the updating of mechanical ventilation concepts and the popularization of mechanical ventilation technologies in more than ten years, the curative effect of modern respirators applied to critical severe respiratory failure patients is remarkably improved. However, the current mechanical ventilation technology is still not ideal for patients with severe respiratory failure, especially ARDS patients, and the prognosis of patients is not further improved. With the continuous deep understanding of respiratory pathophysiology, modern ventilator technology and functions still cannot meet the requirements of the respiratory support level of severe patients, and there are still more problems to be improved:

1. The function is limited, only ventilation support can be provided, and important physiological indexes (such as end-tidal CO₂ and oxygenation indexes) cannot be provided dynamically at the same time, so that ventilation adverse reaction can be caused.

2. The current breathing machine can not dynamically adjust breathing machine parameters in real time according to dynamic lung ventilation and ventilation indexes, and medical staff is required to additionally detect the indexes and then manually adjust the indexes. Not only is time and labor wasted and the medical cost increased, but also the medical cost is limited by various conditions of manpower and material resources, and adverse events are not found and correctly processed in time.

3. At present, the deep understanding of respiratory pathophysiology is that different pathophysiological phases of patients have different ventilation requirements and mechanical characteristics. Complex pathophysiological information needs to be integrated in the mechanical ventilation process of ARDS patients, and ventilation parameters are analyzed and adjusted in real time. This requires a skilled practitioner to have a skilled mechanical ventilation technique and a rich experience in respiratory support therapy. The application of the advantageous APRV ventilation mode is generally limited to a simple basic application, and cannot perform its intended function and function, because of the great limitation of professionals and the great time and effort involved. In particular, in recent years, research has demonstrated that pathophysiological oriented APRV ventilation scheme (APRVplus) can effectively improve patient prognosis, and for the above reasons, it is difficult to generally promote and benefit patients.

Disclosure of Invention

In order to solve the technical problems, the invention aims to provide an intelligent APRVplus breathing machine ventilation system.

An intelligent APRVplus ventilator ventilation system comprises an inspiration circuit, an expiration circuit, a microcomputer electronic controller and a gas circuit system for detecting and controlling the inspiration circuit and the expiration circuit; the gas circuit system comprises a flow sensor, a pressure release valve and a proportional electromagnetic valve; the inspiration circuit is provided with a flow sensor and a pressure sensor, and the expiration circuit is provided with a flow sensor, a pressure release valve and a proportional solenoid valve (CPAP valve); the gas circuit system is connected with the microcomputer electronic controller, the microcomputer electronic controller detects the gas circuit system information of the respiratory rate, the airway pressure, the gas flow and the tidal volume of the gas circuit system through the flow sensor and the pressure sensor, and the gas circuit system is adjusted through the exhalation circuit pressure release valve and the proportional electromagnetic valve. APRVplus the intelligent program module is in interactive communication connection with the microcomputer electronic controller, analyzes the information of the air path system according to a preset program, and adjusts the air path system through the exhalation loop pressure relief valve and the proportional electromagnetic valve.

The ventilator ventilation system further comprises an operation panel and a display, wherein the operation panel and the display are respectively connected with the microcomputer electronic controller, the operation panel is used for resetting programs of the microcomputer electronic controller, and the display is used for displaying ventilation parameters and related physiological information of the inspiration and expiration loop.

The system also comprises a hemodynamic sensor, a blood oxygen sensor and an end-tidal carbon dioxide sensor which are connected with the microcomputer electronic controller; detecting data of a hemodynamic sensor, a blood oxygen sensor and an end-tidal carbon dioxide sensor by a microcomputer electronic controller; and the APRVplus intelligent program module is in interactive communication connection with the microcomputer electronic controller, and adjusts the gas circuit system according to the integrated analysis gas circuit system information through the exhalation circuit pressure release valve and the proportional solenoid valve.

The microcomputer electronic controller is connected with a cloud control module for remote control.

The application further provides a breathing machine with the ventilation system.

The application also provides a using method of the intelligent APRVplus breathing machine ventilation system.

A method of using a ventilator ventilation system, comprising the steps of:

(1) The microcomputer electronic controller intelligently adjusts ventilation parameters through a program scheme of APRVplus intelligent program modules, simulates ideal detection respiratory mechanics conditions, and automatically monitors and collects respiratory mechanics indexes of a patient through a flow sensor and a pressure sensor in the air path;

(2) The microcomputer electronic controller dynamically collects information parameters of hemodynamic, pulmonary ventilation and air exchange parameters of a patient through hemodynamic, end-tidal carbon dioxide and transesophageal or external Zhou Maiyang sensors;

(3) The microcomputer electronic controller can dynamically collect respiratory ventilation parameters and respiratory waveforms, can also dynamically collect lung imaging data in a case system, and can also collect physiological parameters manually input through a control panel;

(4) The microcomputer electronic controller integrates the pathophysiological parameters and the respiratory mechanics waveforms through a program scheme of the APRVplus intelligent program module, and analyzes and sets ventilation and hemodynamic targets; analyzing, calculating and setting APRV initial parameters which accord with the pathophysiological state of the patient, namely airway high pressure, airway low pressure, pressure release time and pressure release frequency;

(5) The microcomputer electronic controller dynamically collects the physiological parameter information in real time according to the program scheme of the APRVplus intelligent program module, and performs integration analysis to set ventilation targets and automatically adjust APRV parameters in real time. If the ventilation target is not reached, the microcomputer electronic controller automatically sends out an alarm and displays problem information through the display, and prompts an emergency treatment thought.

Wherein, the respiratory mechanics index in the step (1) comprises compliance, airway resistance and platform pressure.

Wherein the ventilation target of step (4) is oxygenation, carbon dioxide, allowed spontaneous respiratory levels, hemodynamics.

Wherein: the control program of the microcomputer electronic controller comprises:

1. Initial ventilation phase:

The first step:

1. analyzing the acquired physiological parameters to set a ventilation target, namely oxygenation\carbon dioxide\autonomous ventilation\hemodynamic target;

2. analyzing, calculating and setting APRV initial parameters: airway high pressure, airway low pressure, pressure release time, pressure release frequency;

3. Setting upper and lower alarm limits, namely respiratory frequency\airway pressure\minute ventilation\tidal volume\oxygenation\carbon dioxide\autonomous ventilation;

And a second step of:

1. Reading the flow velocity time waveform and the breathing parameter monitored by the breathing machine;

2. Further automatically adjusting the pressure release time according to whether the tidal volume meets the standard or not, and the ratio of the end-expiratory flow rate to the expiratory peak flow rate and the angle of the expiratory flow rate time curve;

And a third step of:

1. reading breathing parameters monitored by a breathing machine, autonomous ventilation and end-tidal CO₂ level;

2. judging whether the autonomous ventilation reaches the standard or not; if the information does not reach the standard, automatically analyzing the information, adjusting ventilation setting parameters, giving an alarm, and further prompting an analgesic and sedative management path;

3. after the analgesic sedation treatment is confirmed, and the autonomous ventilation reaches the standard, the alarm is terminated.

2. Titration adjustment parameter stage:

The following information is dynamically read and analyzed:

1. Automatically detecting respiratory mechanics indicators (e.g., compliance, airway resistance, plateau pressure);

2. reading ventilator settings and monitoring respiratory parameters

3. Reading information and physiological parameters (hemodynamics/blood oxygen/end-tidal CO₂/imaging, etc.)

Analyzing the above information, making the following adjustments:

1. Adjusting a ventilation target, namely oxygenation\carbon dioxide\autonomous ventilation\hemodynamic target;

2. Any one of the parameters does not reach the standard, and the APRV parameter is analyzed and adjusted: airway high pressure, airway low pressure, pressure release time, pressure release frequency;

3. if the autonomous ventilation still does not reach the target, alarming to prompt an analgesic sedation management path;

4. if the hemodynamics is still not reaching the target; alarming to prompt a hemodynamic management path;

5. If all the above objects are achieved: and analyzing the dynamically read parameters and information, and gradually decreasing the APRV parameter level according to a program until the SBT test and the machine withdrawal are guided.

The present invention is specifically described below:

An intelligent APRVplus breathing machine ventilation system comprises a circuit, a gas circuit, a microcomputer electronic control board (microcomputer electronic controller), an operation panel, a display, a hemodynamic sensor, an end-of-breathing carbon dioxide sensor and a transesophageal or external Zhou Maiyang sensor, wherein a flow sensor and a pressure sensor are arranged in the gas circuit, a power panel and the microcomputer electronic control board are arranged in the circuit, and the microcomputer electronic control board is respectively in communication connection with the power panel, the operation panel, the display, the gas circuit, the hemodynamics sensor, the end-of-breathing carbon dioxide sensor and the pulse oxygen sensor; and the APRVplus intelligent program module is in interactive communication connection with the microcomputer electronic controller.

The ventilation method using the intelligent APRVplus ventilator ventilation system comprises the following steps:

(1) The microcomputer electronic control board intelligently adjusts ventilation parameters through a program scheme of APRVplus intelligent program modules, simulates ideal detection respiratory mechanics conditions, and automatically monitors and collects respiratory mechanics indexes (such as compliance, airway resistance and platform pressure) of a patient through a flow sensor and a pressure sensor in the air path.

(2) The microcomputer electronic control board dynamically collects information parameters of patient hemodynamic, pulmonary ventilation and ventilation parameters through hemodynamic, end tidal carbon dioxide, transesophageal or exo Zhou Maiyang sensors.

(3) The microcomputer electronic control board dynamically collects respiratory ventilation parameters and respiratory waveforms, and simultaneously can dynamically collect lung imaging data in a case system through cloud information technology, and can also collect physiological parameters manually input through the control panel.

(4) The microcomputer electronic control board intelligently integrates the pathophysiological parameters and the respiratory mechanics waveforms through a program scheme of a APRVplus intelligent program module, and intelligently analyzes and sets ventilation targets (oxygenation, carbon dioxide, spontaneous respiratory level and hemodynamics); and (3) intelligently analyzing, calculating and setting APRV initial parameters which accord with the pathophysiological state of the patient, namely airway high pressure, airway low pressure, pressure release time and pressure release frequency.

(5) The microcomputer electronic control board dynamically collects the physiological parameter information in real time according to the program scheme of the APRVplus intelligent program module, and performs intelligent integration analysis to set ventilation targets and automatically adjust APRV parameters in real time. If the ventilation target is not reached, the microcomputer electronic control board automatically sends out an alarm and displays problem information through the display, and prompts an emergency treatment thought.

Through the technical scheme, the intelligent APRVplus breathing machine ventilation system is applied, through the interactive communication effect of the program scheme of the APRVplus intelligent program module and the microcomputer electronic controller, the breathing machine system intelligently collects and analyzes physiological parameter information of a patient, intelligently sets ventilation targets and adjusts ventilation parameters suitable for pathophysiological states of the patient in real time, so that intelligent accurate, safe and effective lung protective ventilation of ARDS is realized, manpower and material resources are saved, popularization and implementation are easy, respiratory support level of ARDS patients in all areas is improved evenly, and prognosis of the ARDS patients is improved integrally.

Drawings

FIG. 1 is a schematic diagram of the intelligent APRVplus ventilator ventilation system of the present invention;

FIG. 2 is a flow chart of an embodiment of the present invention using a smart APRVplus ventilation system;

FIG. 3 is a program diagram of the present invention using the smart APRVplus ventilation system;

FIG. 4 is a programming scheme of the initial parameter setting of the present invention;

FIG. 5 is a programming scheme of the present invention for preserving partial spontaneous breathing and deep titration of sedation;

FIG. 6 is a programming scheme of intelligent titration adjustment of ventilation parameters according to the present invention;

FIG. 7 is a programming scheme of intelligent evacuation of ventilation parameters according to the present invention;

Fig. 4-7 are intelligent APRVplus intelligent preset program diagrams, wherein the APRV: airway pressure relief ventilation; phigh, airway high pressure; plow: airway depression; tlow: pressure release time, i.e., low pressure time; τ: an expiration time constant; RR, release frequency; RASS score: a sedation depth assessment tool; RR: the patient respiratory rate; SV: minute ventilation resulting from spontaneous breathing; MV: total minute ventilation; sedation sedation; ΔP (Phigh-Plow): driving the dynamic pressure; PH: acid-base pH value; paCO2: partial pressure of arterial blood carbon dioxide; PS: a pressure support level; fiO2: inhalation oxygen concentration; paO2: arterial blood oxygen partial pressure.

Detailed Description

As shown in FIG. 1, an intelligent APRVplus ventilator ventilation system comprises a circuit, an air circuit, a microcomputer electronic control board, an operation panel, a display, APRVplus intelligent program module, a hemodynamic sensor, an end-of-breathing carbon dioxide sensor and a transesophageal or external Zhou Maiyang sensor, wherein the air circuit is provided with a flow sensor and a pressure sensor, the circuit is provided with a power panel and the microcomputer electronic control board, the microcomputer electronic control board is in communication connection with the power panel, the operation panel, the display, the air circuit, the hemodynamics, the end-breathing carbon dioxide and the pulse oxygen sensor respectively, and the APRVplus intelligent program module is in interactive communication connection with a microcomputer electronic controller. The power strip of the circuit provides power to the components and the specific electrical connection can be achieved according to the prior art.

As shown in fig. 2-7, a ventilation method using the intelligent APRVplus ventilator ventilation system described above includes the steps of:

(1) The microcomputer electronic control board intelligently adjusts ventilation parameters through a program scheme of APRVplus intelligent program modules, simulates ideal detection respiratory mechanics conditions, and automatically monitors and collects respiratory mechanics indexes (such as compliance, airway resistance and platform pressure) of a patient through a flow sensor and a pressure sensor in the air path.

(2) The microcomputer electronic control board dynamically collects information parameters of patient hemodynamic, pulmonary ventilation and ventilation parameters through hemodynamic, end tidal carbon dioxide, transesophageal or exo Zhou Maiyang sensors.

(3) The microcomputer electronic control board dynamically collects respiratory ventilation parameters and respiratory waveforms, and simultaneously can dynamically collect lung imaging data in a case system through cloud information technology, and can also collect physiological parameters manually input through the control panel.

(4) The microcomputer electronic control board intelligently integrates the pathophysiological parameters and the respiratory mechanics waveforms through a program scheme (figures 3-7) of a APRVplus intelligent program module, and intelligently analyzes and sets ventilation targets (oxygenation, carbon dioxide, spontaneous respiratory level and hemodynamics); and (3) intelligently analyzing, calculating and setting APRV initial parameters which accord with the pathophysiological state of the patient, namely airway high pressure, airway low pressure, pressure release time and pressure release frequency.

(5) The microcomputer electronic control board dynamically collects the physiological parameter information in real time according to the preset program scheme, and performs intelligent integration analysis to set ventilation targets and automatically adjusts APRV parameters in real time. If the ventilation target is not reached, the microcomputer electronic control board automatically sends out an alarm and displays problem information through the display, and prompts an emergency treatment thought.

The first step:

1. analyzing the acquired physiological parameters to set a ventilation target, namely oxygenation\carbon dioxide\autonomous ventilation\hemodynamic target;

2. Analyzing, calculating and setting APRV initial parameters: airway high pressure, airway low pressure, pressure release time, release frequency;

3. Setting upper and lower alarm limits, namely respiratory frequency\airway pressure\minute ventilation\tidal volume\oxygenation\carbon dioxide\autonomous ventilation;

And a second step of:

1. Reading the flow velocity time waveform and the breathing parameter monitored by the breathing machine;

2. and further automatically adjusting the pressure release time according to whether the tidal volume meets the standard and whether the end-tidal flow rate accounts for the ratio of the expiratory peak flow rate and the angle of the expiratory flow rate time curve.

And a third step of:

1. reading breathing parameters monitored by a breathing machine, autonomous ventilation and end-tidal CO₂ level;

2. judging whether the autonomous ventilation reaches the standard or not; if the information does not reach the standard, automatically analyzing the information, adjusting ventilation setting parameters, giving an alarm, and further prompting an analgesic and sedative management path;

3. after the analgesic sedation treatment is confirmed, and the autonomous ventilation reaches the standard, the alarm is terminated.

4. Reading the carbon dioxide level, oxygenation index and hemodynamic index;

5. Judging whether the carbon dioxide level, oxygenation and hemodynamics reach the standards or not; if the physiological parameters are not up to standard, automatically analyzing the physiological parameters, adjusting ventilation setting parameters, and giving an alarm, wherein the alarm is terminated after the oxygenation and hemodynamics reach the standard or the treatment is confirmed.

In the present description and drawings, APRV: airway pressure relief ventilation; CPAP (continuous treatment): continuous positive airway pressure; phigh, airway high pressure; plow: airway depression; tlow: pressure release time, i.e., low pressure time; τ: an expiration time constant; f, the pressure release frequency; RASS score: a sedation depth assessment tool; RR: the patient respiratory rate; SV: minute ventilation resulting from spontaneous breathing; MV: total minute ventilation; sedation sedation; ΔP (Phigh-Plow): driving the dynamic pressure; PH: acid-base pH value; paCO₂: partial pressure of arterial blood carbon dioxide; PS: a pressure support level; fiO₂: inhalation oxygen concentration; paO₂: arterial blood oxygen partial pressure.

Claims (6)

1. An intelligent APRVplus ventilator ventilation system, includes inhalation circuit and expiration circuit, its characterized in that: the system also comprises a microcomputer electronic controller and an air path system for detecting and controlling the inhalation loop and the exhalation loop; the gas circuit system comprises a flow sensor, a pressure release valve and a proportional electromagnetic valve; the inspiration circuit is provided with a flow sensor and a pressure sensor, and the expiration circuit is provided with a flow sensor, a pressure release valve and a proportional electromagnetic valve; the gas circuit system is connected with the microcomputer electronic controller, the microcomputer electronic controller detects gas circuit system information of respiratory frequency, airway pressure, gas flow and tidal volume of the gas circuit system through the flow sensor and the pressure sensor, and the gas circuit system is adjusted through the exhalation circuit pressure release valve and the proportional electromagnetic valve;

The microcomputer electronic controller intelligently integrates pathophysiological parameters and respiratory mechanics waveforms through a program scheme of APRVplus intelligent program modules, and intelligently analyzes and sets ventilation targets; the initial parameters of the APRV which accord with the pathophysiological state of the patient are intelligently analyzed, calculated and set, namely, the airway pressure, the airway low pressure, the pressure release time and the pressure release frequency; dynamically collecting physiological parameter information in real time, and performing intelligent integration analysis to set ventilation targets and automatically adjust APRV parameters in real time; if the ventilation target is not reached, the microcomputer electronic controller automatically sends out an alarm and displays problem information through the display, and prompts an emergency treatment thought;

wherein,

The APRVplus parameters are initially set as:

① In the VCV state, the respiratory mechanics parameters are determined: platform pressure, airway resistance, respiratory system compliance;

② Airway high pressure Phigh: p high= Pplat, pplat is less than or equal to 30 cm H₂ O;

③ Airway low pressure Plow:5cm H₂ O;

④ Pressure release time Tlow:

The first step: initially setting to be 1.0-1.5 tau, wherein the expiration time constant tau is equal to the product of the respiratory system static compliance and the airway resistance, and the lung volume unit L;

And a second step of: t_low is adjusted according to the expiratory flow-time curve, so that the end expiratory flow is more than 50% of the expiratory peak flow PEFR; or an expiratory flow rate-time curve angle of 45 °;

⑤ Pressure release frequency f: 10-14 times/min;

The APRVplus parameter titration adjustment method comprises the following steps:

For hypercarbonated blood:

⑴ Ensuring whether hemodynamics reaches target

⑵ Ensuring proper sedation depth and minute ventilation SV resulting from spontaneous breathing is targeted

⑶ Increasing tidal volume:

a. Increase driving pressure ΔP (Phigh-Plow):

P high 2cmH₂ O/times is increased, and the upper limit is 30cmH₂ O;

If necessary, moderately reducing P low 1-2 cmH₂ O;

b. Moderately prolong Tlow0.05-0.1 s to >50% PEFR

⑷ Minute ventilation was increased: for severe hypercarbonated blood, the PH is less than or equal to 7.2, the PaCO₂ is more than 60mmHg,

A. synchronous increase of DeltaP (Phigh-Plow) and extension of Tlow

B. Increasing the release frequency by 2 times/min, and 25 times/min at maximum

C. moderately increasing the pressure support level PS 2-4 cm H₂ O

For hypoxia:

⑴ Ensuring whether hemodynamics reaches target

⑵ Increasing Phigh 2cmH₂ O/time to a maximum of 30cmH₂ O;

⑶ If no CO₂ is retained, the Thigh is prolonged,

A. Moderately shortening Tlow0.05-0.1 s, tlow1.0τ, and increasing Plow 2-4 cm H₂ O if necessary;

b. reducing the release frequency by 2 times/min;

⑷ In combination with the lung in the recumbent or prone position;

⑸ If CO₂ retention is accompanied, alveolar ventilation is improved: increasing ΔP (Phigh-P low), increasing the release frequency;

⑹ If accompanying respiratory distress, moderately increasing sedation depth while adjusting parameters: increasing release frequency, increasing DeltaP (Phigh-Plow), and guaranteeing ventilation; after the respiratory symptoms and oxygenation are improved, the original parameters and the sedation level are recovered in time;

⑺ Adding FiO₂;

APRVplus the evacuation conditions were:

If the respiratory failure cause is improved, if the pH value is more than or equal to 7.3, the arterial blood oxygen partial pressure PaO₂ is more than 70 mmHg, the arterial blood oxygen partial pressure SaO₂ is more than 92%, and the oxygen absorption concentration FiO₂ is less than or equal to 50%; or to a ventilation oxygenation target;

a. Gradually reducing Phigh 2cmH₂ O; if the reduction degree of the oxygenation index of Phigh is reduced by more than 20%, the original Phigh level is restored;

b. The release frequency is reduced by 1-2 times per minute, and the Thigh is prolonged; moderately increasing PS 2cmH₂ O/times, wherein PS does not exceed 12cmH₂ O;

c. if Phigh is less than or equal to 20cmH₂ O; and (3) performing SBT test every day, and entering a withdrawal tube drawing process.

2. The ventilator ventilation system of claim 1, wherein: the microcomputer electronic controller presets a program for analyzing the information of the gas circuit system, and adjusts the gas circuit system through the expiratory circuit pressure relief valve and the proportional solenoid valve according to the program.

3. The ventilator ventilation system of claim 1, wherein: the ventilator ventilation system further comprises an operation panel and a display, wherein the operation panel and the display are respectively connected with the microcomputer electronic controller, the operation panel is used for resetting programs of the microcomputer electronic controller, and the display is used for displaying ventilation parameters and related physiological information of the inspiration and expiration loop.

4. The ventilator ventilation system of claim 1, wherein: the gas circuit system also comprises a hemodynamic sensor, a blood oxygen sensor and an end-tidal carbon dioxide sensor which are connected with the microcomputer electronic controller; the microcomputer electronic controller detects hemodynamic sensor, blood oxygen sensor, and end-tidal carbon dioxide sensor data.

5. The ventilator ventilation system of claim 1, wherein: the microcomputer electronic controller is connected with a cloud control module for remote control.

6. A ventilator with the intelligent APRVplus ventilator ventilation system of any of claims 1-5.