METHOD AND DEVICE FOR DETERMINING THE PEEP DURING THE RESPIRATION OF A PATIENT

• US 20090301492A1
• Filed: 11/14/2007
• Published: 12/10/2009
• Est. Priority Date: 11/16/2006
• Status: Active Grant

• Current Assignee: Hamilton Medical AG (Hamilton Company)
• Original Assignee: Hamilton Medical AG (Hamilton Company)
• Inventors: Durisch, Gion, Laubscher, Thomas, Wysocki, Marc, Brunner, Josef
• Granted Patent: US 8,528,553 B2
• Time in Patent Office: Days
• US Class Current: 128/204.230
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61M 16/00 Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes stimulating the respiratory movement by mechanical, pneumatic or electrical means, iron lungs combined with gas breathing means A61H31/00
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor

Abstract

The invention relates to a device for the automated determination of the PEEP of a patient. Said device comprises sensors and a suitable electronic system for determining a pressure-volume characteristic curve during a P/V manoeuvre. The electronic system is designed in such a way as to generate, specifically in terms of breathing pressure, the difference between “lung volume during exhalation (Vdef)” and “lung volume during inhalation (Vinf)”, and to determine the maximum value of said difference. The breathing pressure is then determined, for which the volume difference has a value defined in relation to the maximum value of the volume difference. The device calculates a PEEP value on the basis of said determined breathing pressure value.

Claims

1. A Device for automatically determining a positive end-expiratory pressure adjusted to a patient, comprising:

sensors and electronics for being able to determine a pressure/volume curve during a pressure-volume maneuver, said electronics designed to form a difference curve of the volumes during deflation and insufflation;

to search for a maximum of this difference curve,

to determine a value of the ventilation pressure at a volume of the difference curve defined in relation to the maximum, and

to determine a value for positive end-expiratory pressure on the basis of this determined value of the ventilation pressure.

2. The device according to claim 1, further comprising a display for displaying the values determined for positive end-expiratory pressure.

3. The device according to claim 1, further comprising an electronic connection to a ventilation device for transmitting the value determined for positive end-expiratory pressure and/or for triggering a pressure-volume maneuver.

4. The device according to claim 3, wherein the electronic connection is configured for controlling a ventilation device, in order to automatically use the value determined for the positive end-expiratory pressure as the basis for ventilation.

5. The device according to claim 1, wherein the determined value of the ventilation pressure is used as the positive end-expiratory pressure.

6. The device according to claim 1, further comprising means for selecting at least one numerical value corresponding to a disease profile and/or a body index of a patient from a table, or for calculating at least one numerical value, and the electronics are designed to process the determined value of the ventilation pressure with the at least one numerical value, in order to determine the positive end-expiratory pressure.

7. The device according to claim 1, wherein a limit value for the volume difference is established, and the electronics only determine an increased positive end-expiratory pressure if the maximum of a volume difference lies above this limit value.

8. The device according to claim 7, wherein the limit value is established as a function of at least one of a body index of a patient and a disease profile of the patient.

9. The device according to claim 8, wherein the ventilation pressure on which the positive end-expiratory pressure is based is the lowest of the pressures that prevail at locations at which the difference curve has a volume value that lies a defined amount below the maximum.

10. The device according to claim 9, wherein the defined amount is established by at least one of on the basis of the limit value, as a function of the body index of the patient and as a function of the disease profile of the patient.

11. The device according to claim 1, wherein a time measurement is present and the device is equipped to control the pressure ramp of the ventilation pressure and/or to repeatedly trigger a determination of a new positive end-expiratory pressure at certain time intervals.

12. The device according to claim 1, wherein the device is combined with a ventilation device, in such a manner that the ventilation device automatically takes over the value determined for positive end-expiratory pressure.

13. The device of claim 1, wherein the device comprises a ventilation device.

14. A method for automatic determination of a positive end-expiratory pressure adjusted to a patient, comprising:

determining a pressure/volume curve during implementation of a pressure-volume maneuver;

seeking a maximum of the volume difference (Vdef-Vinf)max for the pressure/volume curve;

determining the value of the ventilation pressure at a location of the difference curve that is defined in relation to the maximum (Vdef-Vinf)max; and

using the determined value of the ventilation pressure as a starting value for a determination of the positive end-expiratory pressure.

15. The method according to claim 14, further comprising using the value of the ventilation pressure as a positive end-expiratory pressure.

16. The method according to claim 14, further comprising processing the value with a numerical value, the numerical value selected or calculated in accordance with a disease profile and/or a body index.

17. The method according to claim 14, further comprising establishing a limit value for the volume difference, and if the maximum of the volume difference lies above the limit value, determining a new positive end-expiratory pressure, and if the determined volume difference lies below the limit value, not determining a new positive end-expiratory pressure or performing a positive end-expiratory pressure reduction.

18. The method according to claim 14, further comprising repeating the method at certain time intervals.

19. The method according to claim 14, further comprising starting the pressure-volume maneuver at a pressure below the set positive end-expiratory pressure.

20. The method according to claim 14, further comprising starting the pressure-volume maneuver at the positive end-expiratory pressure.

21. The method according to claim 14, further comprising employing a ventilation device, the value determined for positive end-expiratory pressure being automatically set on the ventilation device.

22. The method according to claim 14, further comprising, after determination of the positive end-expiratory pressure, performing a recruitment maneuver, and afterwards, performing ventilation with the positive end-expiratory pressure that has been determined.

23. The method according to claim 14, further comprising calculating the volume difference while the pressure-volume maneuver is performed, and stopping the pressure-volume maneuver during deflation, as soon as the volume value defined in relation to the volume difference maximum has been determined, and that subsequently, ventilation continues with the positive end-expiratory pressure that has been determined.

24. The method according to claim 14, further comprising using a pressure on which the positive end-expiratory pressure is based that is below the pressure prevailing at the maximum difference.

25. The method according to claim 24, further comprising determining this amount is determined by at least one of the limit value for the volume difference, as a function of a body index of the patient or as a function of the patient'"'"'s disease profile.