The present invention relates to an artificial ventilation system and a relative control method. In particular, the ventilation system is suitable for application to CPAP (Continuous Positive Airway Pressure) breathing helmets. By operating in this way, it is possible to provide artificial ventilation to a patient with respiratory difficulties destined for so-called “sub-intensive” therapies.
Background art Breathing helmets of the type with continuous positive pressure mechanical ventilation are known, which allow to provide artificial ventilation to a patient with breathing difficulties. There are numerous models produced by different companies and all have an appearance reminiscent of a diver’s helmet, in association with a plurality of tubes that carry oxygen and expel carbon dioxide. Known type helmets are completely transparent and fasten around the head with straps that can pass under the armpits. They are portable devices, sufficiently comfortable and light, which have a fairly low cost for a medical device. The internal volume is several liters (it allows the easy movement of the head) and the most comfortable models weigh a few hundred grams; they are all equipped with various safety systems, such as gauges to measure the internal pressure and anti suffocation valves. Several clinical studies have shown its effectiveness in treating various conditions that determine respiratory failure, therefore CPAP helmets are versatile and potentially very useful devices to cope with the COVID-19 emergency. These tools are used for patients who require respiratory assistance but are not so severe that ICU (intensive care unit) admission is required.
Artificial ventilation systems of the known type, however, require very frequent checks by nurses or doctors, for their supervision and monitoring. The regulation of the flows of the respirators of the known systems occurs mostly according to manual control processes, thus requiring the almost constant presence of an operator, that is to say of specialized health personnel. Fully automatic and at the same time extremely safe and efficient artificial ventilation systems are not known. Therefore, there is a need to define an artificial ventilation system and a related control method that are free from the aforementioned drawbacks.
An object of the present invention is to provide a fully automated artificial ventilation system which does not require frequent checks by specialized medical personnel.
Therefore, according to the present invention, an artificial ventilation system is provided with the characteristics set out in the attached product claim. According to another object, a control method of the artificial ventilation system is described. This method allows automatic control of the entire artificial ventilation system and implements innovative control strategies.
Therefore, according to the present invention, a control method of the artificial ventilation system is provided with the characteristics set out in the attached process claim.
Further preferred and / or particularly advantageous ways of implementing the invention are described according to the characteristics set forth in the attached dependent claims.
The invention will now be described with reference to the attached drawings, which illustrate some examples of non-limiting implementation of the housing element, in which:
With reference now to
The supply of the air / oxygen mixture is carried out in a gas supply system 50. In particular, the supply is achieved thanks to a suitable suction means which, in the example of
Advantageously, the plenum 6 can be provided with a light device 11 with ultraviolet radiation which guarantees the sterilization of the air / oxygen mixture, avoiding the spread of any contagion.
Preferably, the air-oxygen mixture could be integrated with the presence of a second medical gas, for example, ozone. In fact, as known, ozone is an excellent sanitizer to eliminate germs and bacteria. Its very high oxidizing power makes it an effective sanitizer and deodorant, certainly of interest in the current contingency of the fight against Covid 19. The supply of this secondary gas is very similar to that of the air / oxygen mixture. In fact, it will be sufficient to provide a tank 1A of this “Secondary Medical Gas” (SMG) under pressure and a circuit similar to that described for the air / oxygen mixture in which a first control valve 2A will be present to provide for the mixing of air and SMG, a calibrated orifice 3A to obtain the desired pressure drop and a second control valve 4A to regulate the flow rate of this second air / SMG mixture. The suction effect also for this second mixture will always be guaranteed by the ejector 5.
From the plenum 6, the air / oxygen mixture (possibly the air / oxygen / SMG mixture) reaches the respiratory helmet 13 by means of the supply duct 14, along which there is a first non-return valve 9 which prevents the backflow of the mixture. The mixture thus fed is then available for inspiration by the patient wearing the helmet 13.
Finally, the exhausted air, i.e. the air rich in carbon dioxide (C02) exhaled by the patient, is made to flow out by means of the exhaust duct 15 and the flow rate is regulated by a third control valve 8. A second non return valve return 10 prevents the backflow of carbon dioxide towards the respiratory helmet 13. The air / C02 mixture is then filtered into the filter element 7 and the air thus purified from C02 rejoins the main flow of the air / oxygen mixture directed to the plenum 6.
The artificial ventilation system 100, as will be seen below, can be controlled automatically and for this purpose also includes a control unit 12 which can manage input data and control the appropriate actuators. The input data may be, according to a non-exhaustive list, the flow rate and pressure of the air / oxygen mixture (possibly of the air / oxygen / SMG mixture), the concentration of oxygen and C02 in the respiratory helmet 13, as well as pressure and temperature always inside the helmet. In addition, the Sp02 oxygen saturation data is also fundamental, to which additional biomedical parameters, such as heart rate and respiratory rate, can be added. The control unit 12, according to strategies that will be illustrated below, will operate the first control valve 2 and the second control valve 4 to regulate the oxygen concentration and the flow rate of the air / oxygen mixture in the supply duct 14 (as well as, similarly the first control valve 2A and the second control valve 4A to regulate the concentration of SMG and the flow rate of the air / SMG mixture, if a second medical gas is present). The control unit 12 will also operate the third control valve 8 to adjust the exhaust air flow in the exhaust duct 15.
The artificial ventilation system 100, 200 can advantageously be provided with a particular layout involving the supply duct 14, the exhaust duct 15 and the respiratory helmet 13, as illustrated in
In these Figures it can be seen that the supply duct 14 and the exhaust duct 15 are integrated in the first casing 16 which connects to a second casing 17 inside the respiratory helmet 13. The first casing 16 is in turn integrated in a coupling 18 which can be attached to the breathing helmet 13 by means of a bayonet connection or by means of threaded connections. Advantageously, the coupling 18 can be provided with sensors 19 in communication with the control unit 12 for the transmission of the parameters involved in the control strategies, as described hereafter.
The first casing 16, as mentioned above, groups together the supply duct 14 of the air / oxygen mixture (possibly air / oxygen / SMG) and the exhaust duct 15 of the exhausted air, rich in C02. Inside the first casing 16 the two flows are evidently separated by means of a separation septum 20, as visible in
Furthermore, this layout has further advantages:
In particular, with reference to
As anticipated, the artificial ventilation system 100, 200 according to any of the embodiments described above can be managed and controlled automatically by means of the control unit 12.
A first control method 300 of the artificial ventilation system has two priority levels and is based on a closed loop control.
According to a first and most important priority level, the control unit maintains the patient’s oxygen saturation Sp02 at the desired level, i.e. above a first threshold value and, at the same time, limits the C02 concentration to helmet interior below a second threshold value.
With a second priority level, the control method optimizes the consumption of the externally supplied oxygen as well as patient comfort by keeping the air / oxygen mixture entering the helmet and the helmet pressure and temperature in corresponding predetermined intervals.
The first control method 300 is illustrated in
Control line 310 includes a closed-loop controller 320, such as a proportional-integrative-derivative (PID) controller, which adjusts the patient’s oxygen saturation by comparing the input SP02 saturation (the current value) with the desired level, above a first threshold value; the regulator 330 which manages the sequence of the implementation of the control valves; the actuators 340 and 350 enslaved to the regulator 330 which receive the logic command from the regulator 330 and give an electric command, respectively, to the third control valve 8 which regulates the flow rate of the outgoing flow from the helmet 13 (and therefore the C02 flow rate) and to the second control valve 4 which regulates the flow of the air / oxygen mixture; the C02 controller 360 that manages and monitors the amount of C02 inside the helmet; a logic switch 370 which alternately connects the actuator 350 with the regulator 330 or with the C02 controller 360.
Once the PID controller 320 has calculated the desired SP02 value, the PID controller 320 communicates such a value to the regulator 330 which sets the sequence of the control valve actuation, which can be in the following order: first regulation of the exhaust air flow (containing C02) by means of the actuator 340 which activates the third control valve 8 and subsequently, if the room for maneuver on the exhaust air flow control is ended (in other words, if the third control valve 8 is in an extreme position and is not further adjustable), regulation of the flow of the air / oxygen mixture by means of the actuator 350 which operates the second control valve 4.
This strategy is active, as described, when the C02 concentration value remains below a second threshold value, monitoring chaired by the C02 controller 360. Should the C02 concentration exceed the second threshold value, the C02 controller 360 has the authority to reverse the control valve actuation logic. In particular, the regulator 330, “ordered” by the C02 controller 360, will use the logic switch 370 to enslave the actuator 350 to control the C02 concentration. The actuator 350 will then actuate the second control valve 4 to regulate (in this case increase) the flow of the air / oxygen mixture inside the respiratory helmet 13. The closed-loop control of the patient’s oxygen saturation remains active by means of the PID controller 320, but in this case the regulator 330 will only manage the actuator 340 which operates the third control valve 8 to regulate the exhaust air flow.
As mentioned, a second control line 380 with lower priority can be dedicated to the patient’s comfort and contains suitable algorithms for monitoring some of his biomedical parameters. The second control line 380 proceeds in parallel with respect to the first control line 310, of higher priority, obviously subordinated to the correct operation of the parameters controlled by the first control line 310.
With reference to
The second control method 400 uses a dynamic model of the process to predict its future evolution and choose the best control action.
Also in this second case, the control method of the artificial ventilation system has two priority levels:
The block diagram of
More specifically, the state observer 410 receives as input data (see
A: parameters selected from an existing database. For example, Sp02 oxygen saturation, respiratory rate, heart rate, etc. The pre-existing database is a collection of human physiological parameters, grouped and clustered, the selection of which will be made on the basis of similarity between a patient and a specific cluster.
B: parameters measured in the respiratory helmet 13 thanks to the presence of suitable sensors. For example, pressure, temperature, oxygen concentration, air / oxygen mixture flow, C02 concentration, etc.
The estimation model implemented in the state observer 410 allows instead to have as output data, by way of example, the models of the following physiological parameters of lung functions:
C: flows of oxygen and C02 in the pulmonary alveoli and blood compartments, instantaneous volume of the lungs, pressure in the alveoli, etc.
The parameters indicated with A, B and C constitute input data for the controller 420. In addition, the controller 420 can manage:
D: parameters defined by the operator of the ventilation system. For example, the weights of the variables that realize the objective function to be optimized;
E: manipulate parameters. For example, the position, at a given instant of time, of the second control valve 4 and of the third control valve 8.
Based on all parameters A, B, C, D and E, the controller 420 is able to calculate the optimal values of oxygen saturation and C02 concentration and to predict the evolution of the model results over a time interval defined by a number N of time steps, using a predetermined sequence of manipulable parameters E within the same time interval.
The algorithm is based on the optimization of an objective function, which evaluates the distance of the control system from the objectives and optimal control constraints, minimizing this distance. The control objectives are assessed in the predetermined time interval in which appropriate penalties are defined on the ability of the control system to follow its objectives and on the effort to implement the control valves. An example of an objective function structured in this way is the following: ål o WI (100 - Sp02ky +w2 ( Max C02 - C02k)2 + w3 ( valve 4 command)k + w4 ( valve 8 command)k where:
According to a lower priority level, the optimization process of the objective function will have to take into account further control constraints related to:
At each predetermined time instant t, the controller 420 will find the optimal sequence of manipulate parameters E (position of the second 4 and third control valve 8) which minimize the objective function in the time interval N. Obviously, only the first optimum activation will be used, then the controller 420 will act on the regulation of the exhaust air flow by means of the actuator 340 which activates the third control valve 8 and on the regulation of the air / oxygen mixture flow by means of the actuator 350 which activates the second control valve 4.
The procedure will be repeated at the next time instant t + 1.
As seen, the first control method 300 and the second control method 400 both derive from a single methodology which presents a strategy based on at least two priority levels. They are declined according to different approaches and can be used alternatively depending on the applications.
The first control method 300 is certainly easier to be implemented, does not require specific modeling (for example, mathematical models of lung functions) and does not require high computational skills.
The second control method 400 is more complex, requiring sophisticated modeling of lung functions and higher computational capacity. On the contrary, however, it allows in a single framework to monitor and assist patients with severe respiratory problems. Furthermore, due to its predictive approach and estimating the internal states of respiratory functions, the second control method is faster in reacting to any worsening of the patient’s situation. Finally, it is more adaptable to a wider class of pathologies.
The control method 300, 400 for the artificial ventilation system 100, 200 may undergo further variations, without thereby departing from the scope of the present invention. For example, it may also be able to control a mixture consisting of air / oxygen / SMG, in this case also acting on the control valve 4A of the air / SMG mixture.
Ultimately, the artificial ventilation system object of the present invention has undoubted advantages: it does not require any fixed infrastructure, since only needs the respiratory helmet, at least one cylinder for compressed oxygen, the electro-hydraulic circuitry, the ultraviolet light device and the control electronics. The artificial ventilation system is therefore completely portable and has ample flexibility for any application. Furthermore, the system is fully automatically controllable, with control strategies also based on sophisticated predictive algorithms, and does not require the presence on site of a health worker.
In addition to the ways of implementing the invention, as described above, it should be understood that there are numerous further variants. It must also be understood that these methods of implementation are only examples and do not limit the object of the invention, nor its applications, nor its possible configurations. On the contrary, although the above description makes it possible for the skilled person to implement the present invention at least according to an exemplary configuration thereof, it must be understood that numerous variations of the components described are conceivable, without thereby departing from the object of the invention, as defined in the appended claims, interpreted literally and / or according to their legal equivalents.
Number | Date | Country | Kind |
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102020000013012 | Jun 2020 | IT | national |
Filing Document | Filing Date | Country | Kind |
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PCT/IB2021/054704 | 5/28/2021 | WO |