A respiratory monitoring method and a respiratory monitoring device

Abstract

A respiratory monitoring method and a respiratory monitoring device, for airway pressure data collected by a pressure sensor and gas flow rate data measured by a flow sensor in a breath cycle, calculate the inspiratory lung pressure and / or expiratory pressure value of a patient corresponding to the breath cycle; according to the inspiratory lung pressure and the expiratory pressure value, determine the driving pressure of the patient corresponding to the breath cycle. Thus, without the intervention of artificial factors such as inspiration and expiration holding, the driving pressure can be obtained and real-time detection of the driving pressure can be realized; since the ventilation is not disturbed, the method is also friendly to the patient.

Description

Technical Field

[0001] This invention relates to the medical field, specifically to a respiratory monitoring method and a respiratory monitoring device. Background Technology

[0002] During mechanical ventilation, improper settings of the ventilator can cause lung injury to patients. In 2000, the multicenter study of ARDSnet in the UK proposed a lung-protective ventilation strategy with low tidal volume (VT 6-8 ml / kg ideal body weight), low airway plateau pressure (Pplat < 30-35 cmH2O), high positive end-expiratory pressure (PEEP), and permissive hypercapnia (PHC) as its core. At present, the lung-protective ventilation strategy prioritizes maintaining low tidal volume, but clinical evidence shows that the mortality rate of ARDS has not been reduced by using low tidal volume ventilation [1]. This is because ARDS patients have different causes, different severity, different functional residual capacity, different re-expansion, and different sizes and distributions of collapsed alveolar areas, resulting in lung heterogeneity. This heterogeneity also makes lung compliance different, and the tidal volume that patients really need is also different. Therefore, it is not enough to use tidal volume as the lung-protective control. The commonly used protective lung ventilation strategy of small tidal volume combined with optimal positive end-expiratory pressure (PEEP) still suffers from alveolar overinflation in non-gravity-dependent areas and tidal collapse and re-expansion of alveoli in gravity-dependent areas, making ventilator-associated lung injury unavoidable. Furthermore, lung protection methods combining small tidal volume and plateau pressure limitation may still lead to lung injury and high pressure because patients with many collapsed alveoli have fewer normally ventilated alveoli, resulting in significantly increased overinflation. Different patients with the same tidal volume have different compliance levels, leading to varying pressures acting on the lungs. Therefore, monitoring the driving pressure—the force directly driving the expansion of the entire respiratory system—is crucial, combining Pplat (to prevent alveolar overinflation) with PEEP (to prevent alveolar collapse).

[0003] Existing methods for measuring driving pressure:

[0004] Airway pressure is the pressure acting on the respiratory system, including airway resistance, the lungs, and the chest wall. Intrapulmonary pressure is the pressure acting directly on the lungs and chest wall after removing airway resistance. Transpulmonary pressure is the pressure acting directly on the lungs after removing the portion of intrapulmonary pressure acting on the chest wall. Transpulmonary pressure is calculated by subtracting intrathoracic pressure from intrapulmonary pressure. Esophageal pressure is often used as an approximation of intrathoracic pressure: Transpulmonary pressure = Intrapulmonary pressure - Esophageal pressure.

[0005] Routine clinical measurement of driving pressure involves measuring plateau pressure during inspiratory hold and measuring PEEPtotal (PEEPi + PEEP) during expiratory hold. Driving pressure = Plateau pressure measured during inspiratory hold - PEEPtotal (PEEPi + PEEP) measured during expiratory hold. Inspiratory and expiratory holds are used to stabilize airflow in the airway, ensuring that airway pressure equals intrapulmonary pressure, eliminating interference from airway resistance, and obtaining the true intrapulmonary pressure. Driving pressure reflects the change in intrapulmonary pressure after removing the effects of airway resistance.

[0006] In clinical practice, some obese patients or those with high abdominal pressure have low chest wall compliance. The intrapulmonary pressure is mainly distributed on the chest wall, with very little pressure acting on the lungs. Therefore, in these patients, intrapulmonary pressure cannot reflect the true pressure acting on the lungs, and transpulmonary pressure (the pressure acting directly on the lungs after removing the portion acting on the chest wall) is needed for monitoring. Transpulmonary driving pressure = Transpulmonary pressure measured during inspiratory maintenance - Transpulmonary pressure measured during expiratory maintenance.

[0007] Current methods for measuring driving pressure, including inspiratory and expiratory hold, are quite complex, requiring data recording before calculation and potentially interfering with ventilation. Summary of the Invention

[0008] This invention mainly provides a respiratory monitoring method and a respiratory monitoring device that can obtain driving pressure without the need for inhalation and exhalation maintenance.

[0009] In one embodiment, a respiratory monitoring device is provided, comprising:

[0010] Pressure sensors are used to collect airway pressure, or airway pressure and esophageal pressure, from patients to obtain corresponding airway pressure data and esophageal pressure data.

[0011] A flow sensor is used to acquire data on the gas flow rate during ventilation.

[0012] Processor, for

[0013] For the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor within a respiratory cycle, calculate the intrapulmonary pressure and / or expiratory pressure values ​​corresponding to that respiratory cycle for the patient; determine the driving pressure for the patient corresponding to that respiratory cycle based on the intrapulmonary pressure and expiratory pressure values; or

[0014] For the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor within a respiratory cycle, the intrapulmonary pressure during the inspiratory phase and the intrapulmonary pressure during the expiratory phase of the patient corresponding to that respiratory cycle are calculated; based on the intrapulmonary pressure during the inspiratory phase and the intrapulmonary pressure during the expiratory phase, as well as the esophageal pressure measured by the pressure sensor within the respiratory cycle, the transpulmonary driving pressure of the patient corresponding to that respiratory cycle is determined.

[0015] In one embodiment of the respiratory monitoring device, the processor determines the transpulmonary driving pressure using one of the following methods:

[0016] The processor is configured to calculate the end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure of the patient corresponding to a respiratory cycle, based on the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor during a respiratory cycle; and to determine the transpulmonary driving pressure of the patient corresponding to the respiratory cycle based on the end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle.

[0017] The processor is configured to calculate the intrapulmonary pressure curve during the inspiratory phase and the intrapulmonary pressure curve during the expiratory phase for the patient within a respiratory cycle, based on the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor; to obtain the transpulmonary pressure curve corresponding to the respiratory cycle based on the intrapulmonary pressure curve during the inspiratory phase and the intrapulmonary pressure curve during the expiratory phase, as well as the esophageal pressure curve collected by the pressure sensor within the corresponding respiratory cycle; and to determine the end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure based on the transpulmonary pressure curve, thereby determining the transpulmonary driving pressure for the patient within the respiratory cycle.

[0018] In one embodiment of the respiratory monitoring device, a display device is also included, and the processor is further configured to:

[0019] The driving pressure or transpulmonary driving pressure is sent to the display device and displayed.

[0020] In one embodiment of the respiratory monitoring device, the driving pressure or transpulmonary driving pressure is displayed on the display device in a graphical form that changes over time.

[0021] In a respiratory monitoring device provided in one embodiment, the intrapulmonary pressure during the inspiratory phase includes the end-inspiratory intrapulmonary pressure, and the intrapulmonary pressure during the expiratory phase includes the end-expiratory intrapulmonary pressure; the steps of the processor calculating the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure include:

[0022] The gas flow rate data collected by the flow sensor and the airway pressure data collected by the pressure sensor during the ventilation process of a patient in one respiratory cycle are acquired in real time.

[0023] Based on the respiratory cycle, the gas flow rate data, and the airway pressure data, the intrapulmonary pressure data corresponding to the respiratory cycle is calculated; the intrapulmonary pressure data includes the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure.

[0024] In a respiratory monitoring device provided in one embodiment, the step of the processor calculating the transpulmonary driving pressure includes:

[0025] For a respiratory cycle, the intrapulmonary pressure data at the end of expiration and end of inspiration of the patient in that respiratory cycle are calculated based on the respiratory cycle and the gas flow rate data and airway pressure data corresponding to the respiratory cycle.

[0026] Based on the difference between the intrapulmonary pressure data at the end of expiration and end of inspiration and the esophageal pressure data collected by the pressure sensor at the corresponding time, the transpulmonary pressure data corresponding to the end of expiration and end of inspiration of the respiratory cycle are obtained respectively; the transpulmonary pressure data includes the transpulmonary pressure at the end of inspiration and the transpulmonary pressure at the end of expiration.

[0027] The transpulmonary driving pressure corresponding to the respiratory cycle is obtained based on the end-inspiratory transpulmonary pressure and the end-expiratory transpulmonary pressure.

[0028] In one embodiment of the respiratory monitoring device,

[0029] The intrapulmonary pressure data includes intrapulmonary pressure waveforms, the esophageal pressure data includes esophageal pressure waveforms, and the transpulmonary pressure data includes transpulmonary pressure waveforms; or...

[0030] The intrapulmonary pressure data includes end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, and the esophageal pressure data includes end-inspiratory esophageal pressure and end-expiratory esophageal pressure.

[0031] The step of the processor calculating the difference between the intrapulmonary pressure data and the esophageal pressure data to obtain the transpulmonary pressure data corresponding to the respiratory cycle includes:

[0032] The corresponding end-inspiratory transpulmonary pressure is obtained by subtracting the end-inspiratory esophageal pressure from the end-inspiratory intrapulmonary pressure.

[0033] The end-expiratory intrapulmonary pressure is subtracted from the end-expiratory esophageal pressure to obtain the corresponding end-expiratory transpulmonary pressure.

[0034] In a respiratory monitoring device provided in one embodiment, the step of the processor calculating intrapulmonary pressure data based on the respiratory cycle, the gas flow rate data, and the airway pressure data includes:

[0035] The gas flow rate data includes the gas flow rate corresponding to the inhalation phase and the gas flow rate corresponding to the exhalation phase during the respiratory cycle. The airway pressure data includes the airway pressure corresponding to the inhalation phase and the airway pressure corresponding to the exhalation phase.

[0036] The gas volume corresponding to the inhalation phase is calculated based on the gas flow rate corresponding to the inhalation phase.

[0037] The intrapulmonary pressure during the inspiratory phase is calculated based on the airway pressure, gas volume, and gas flow rate during the inspiratory phase.

[0038] The intrapulmonary pressure during the expiratory phase is calculated based on the airway pressure and gas flow rate during the expiratory phase.

[0039] The intrapulmonary pressure waveform of the patient during the respiratory cycle is obtained based on the intrapulmonary pressure during the inspiratory and expiratory phases.

[0040] or,

[0041] The airway pressure data includes end-inspiratory airway pressure and end-expiratory airway pressure; the total gas volume during the inspiratory phase is calculated based on the gas flow rate data.

[0042] The end-inspiratory intrapulmonary pressure is calculated based on the end-inspiratory airway pressure, the total gas volume during the inspiratory phase, the end-inspiratory flow rate in the gas flow rate data, and the end-expiratory airway pressure.

[0043] The end-expiratory intrapulmonary pressure is calculated based on the end-expiratory airway pressure and the end-expiratory flow rate in the gas flow rate data, or the end-expiratory airway pressure is approximated as the end-expiratory intrapulmonary pressure.

[0044] In one embodiment of the respiratory monitoring device, the processor is further used for

[0045] The patient's tidal volume is acquired in real time using the flow sensor. The corresponding compliance is obtained based on the tidal volume and the driving pressure; or the corresponding lung compliance is obtained based on the tidal volume and the transpulmonary driving pressure. The patient's respiratory status is monitored based on the compliance or lung compliance.

[0046] In one embodiment of the respiratory monitoring device, the processor is further configured to:

[0047] The processor analyzes the driving pressure or the trans-lung driving pressure based on preset conditions. When the driving pressure or the trans-lung driving pressure does not meet the preset conditions, the processor issues a prompt signal.

[0048] In one embodiment, a respiratory monitoring method is provided, comprising:

[0049] Real-time acquisition of gas flow rate and airway pressure data, or gas flow rate data, esophageal pressure data, and airway pressure data of patients during ventilation;

[0050] For a respiratory cycle, the corresponding intrapulmonary pressure data is calculated based on the gas flow rate data and airway pressure data of that respiratory cycle. The intrapulmonary pressure data includes end-inspiratory intrapulmonary pressure (LIP) and end-expiratory intrapulmonary pressure (LIP). The LIP and LIP are used to characterize the pressures acting on the expected locations of the patient's respiratory system at the end of inspiration and expiration, respectively, during ventilation. The driving pressure corresponding to that respiratory cycle is obtained based on the LIP and LIP.

[0051] For the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor within a respiratory cycle, the intrapulmonary pressure during the inspiratory phase and the intrapulmonary pressure during the expiratory phase of the patient corresponding to that respiratory cycle are calculated; based on the intrapulmonary pressure during the inspiratory phase and the intrapulmonary pressure during the expiratory phase, as well as the esophageal pressure measured by the pressure sensor within the respiratory cycle, the transpulmonary driving pressure of the patient corresponding to that respiratory cycle is determined.

[0052] In one embodiment, a computer-readable storage medium is provided, on which a program is stored that can be executed by a processor to implement the respiratory monitoring method as described above.

[0053] According to the respiratory monitoring method and device of the above embodiments, for airway pressure data collected by a pressure sensor and gas flow rate data measured by a flow sensor within a respiratory cycle, the intrapulmonary pressure and / or expiratory pressure values ​​of the patient during the inspiratory phase corresponding to that respiratory cycle are calculated; based on the intrapulmonary pressure and expiratory pressure values ​​during the inspiratory phase, the driving pressure of the patient corresponding to that respiratory cycle is determined. Thus, the driving pressure can be obtained without manual intervention such as inspiratory and expiratory maintenance, and can be detected in real time; since it does not interfere with ventilation, it is also very patient-friendly. Attached Figure Description

[0054] Figure 1 This is a structural block diagram of an embodiment of the respiratory monitoring device provided by the present invention;

[0055] Figure 2 This is a structural block diagram of another embodiment of the respiratory monitoring device provided by the present invention;

[0056] Figure 3 A structural block diagram of one embodiment of the medical ventilation device in the respiratory monitoring device provided by the present invention;

[0057] Figure 4 A flowchart of an embodiment of the respiratory monitoring method provided by the present invention;

[0058] Figure 5 for Figure 4 The flowchart of step 1, an embodiment;

[0059] Figure 6 for Figure 4 In the flowchart of another embodiment of step 1;

[0060] Figure 7 This is a schematic diagram of the respiratory mechanics RC model.

[0061] Figure 8 Waveforms of airway pressure and intrapulmonary pressure in the respiratory monitoring device provided by the present invention;

[0062] Figure 9 A flowchart of another embodiment of the respiratory monitoring method provided by the present invention. Detailed Implementation

[0063] The present invention will now be described in further detail with reference to specific embodiments and accompanying drawings. Similar elements in different embodiments are referred to by associated similar element reference numerals. In the following embodiments, many details are described to facilitate a better understanding of this application. However, those skilled in the art will readily recognize that some features may be omitted in different situations, or may be replaced by other elements, materials, or methods. In some cases, certain operations related to this application are not shown or described in the specification. This is to avoid obscuring the core parts of this application with excessive description. For those skilled in the art, detailed description of these related operations is not necessary; they can fully understand the related operations based on the description in the specification and general technical knowledge in the art.

[0064] Furthermore, the features, operations, or characteristics described in the specification can be combined in any suitable manner to form various embodiments. At the same time, the steps or actions in the method description can be rearranged or adjusted in a manner obvious to those skilled in the art. Therefore, the various orders in the specification and drawings are only for the clear description of a particular embodiment and do not imply a necessary order, unless otherwise stated that a particular order must be followed.

[0065] The serial numbers assigned to components in this document, such as "first" and "second," are used only to distinguish the described objects and have no sequential or technical meaning. The terms "connection" and "linkage" used in this application, unless otherwise specified, include both direct and indirect connections (linkages).

[0066] Please refer to Figure 1 and Figure 2 Some embodiments of the present invention disclose a respiratory monitoring device, including a processor 40 and a display device 30.

[0067] The processor 40 is used to acquire at least one of the patient's airway pressure data and esophageal pressure data; that is, it can acquire airway pressure data, esophageal pressure data, or both airway pressure data and esophageal pressure data. The processor 40 is also used to acquire the patient's gas flow rate data during ventilation. Based on the respiratory cycle, the processor 40 calculates the patient's inspiratory intrapulmonary pressure and / or expiratory pressure values ​​based on the airway pressure data and gas flow rate data; and determines and outputs the patient's driving pressure based on the inspiratory intrapulmonary pressure and expiratory pressure values, for example, by subtracting the expiratory pressure value from the inspiratory intrapulmonary pressure to obtain the patient's driving pressure. The expiratory pressure value can be the positive end-expiratory pressure directly measured by the ventilator through sensors, or it can be the expiratory intrapulmonary pressure calculated based on the airway pressure data and gas flow rate data.

[0068] The processor 40 also calculates the patient's intrapulmonary pressure during the inspiratory phase and intrapulmonary pressure during the expiratory phase based on the respiratory cycle, airway pressure data, and gas flow rate data; and determines and outputs the patient's transpulmonary driving pressure based on the intrapulmonary pressure during the inspiratory and expiratory phases, as well as esophageal pressure.

[0069] The processor 40 outputs driving pressure and / or transpulmonary driving pressure, which can be sent to external devices (such as printers, monitors, etc.) or to a display device 30 (such as a monitor) to display the patient's driving pressure. For example, the processor 40 outputs the patient's driving pressure and / or transpulmonary driving pressure to the display device 30, which receives and displays the driving pressure and / or transpulmonary driving pressure sent by the processor 40. The display device 30 can display the driving pressure and / or transpulmonary driving pressure in various ways, such as directly displaying the numerical values, or displaying them graphically or in charts (such as bar charts). Users can see the approximate range of the driving pressure and / or transpulmonary driving pressure values ​​through the graphs or charts; in short, it should reflect the level of the driving pressure and / or transpulmonary driving pressure to a certain extent. The display device 30 can output visual information and can be various types of displays.

[0070] It is evident that this invention can obtain driving pressure and / or trans-lung driving pressure without artificial intervention such as inspiratory and expiratory maintenance, and thus can detect driving pressure and / or trans-lung driving pressure in real time; since it does not interfere with ventilation, it is also very patient-friendly.

[0071] The respiratory monitoring device of the present invention can be applied to various occasions. For example, in some embodiments, the respiratory monitoring device of the present invention can be a patient monitor, a central station, a monitoring module, etc.; in some embodiments, it can be a medical ventilation device, such as a ventilator, anesthesia machine, portable handheld ventilation device, etc.; and in some embodiments, it can also be other medical devices with computing capabilities. The method by which the processor 40 acquires the above data may also differ depending on the type of respiratory monitoring device. For example… Figure 1As shown, the respiratory monitoring device also includes a pressure sensor and a flow sensor 70, etc.; the pressure sensor is used to collect the patient's airway pressure to obtain corresponding airway pressure data, or to collect airway pressure and esophageal pressure to obtain corresponding airway pressure data and esophageal pressure data. The flow sensor 70 is used to measure the gas flow rate data of the patient during ventilation. The processor 40 obtains airway pressure data and esophageal pressure data through the respiratory monitoring device's own pressure sensor, and obtains gas flow rate data through the flow sensor 70. For example, the respiratory monitoring device is a patient monitor, such as... Figure 2 As shown, it also includes a communication device 80, through which the processor 40 acquires airway pressure data, esophageal pressure data and gas flow rate data from other external devices.

[0072] To facilitate a more detailed explanation of the technical solution of this invention, this embodiment uses a respiratory monitoring device as an example of a medical ventilation device. Medical ventilation devices can provide mechanical ventilation to assist or control the patient's spontaneous breathing movements, thereby achieving gas exchange in the lungs, reducing the body's energy expenditure, and facilitating the recovery of respiratory function. For example... Figure 1 As shown, the medical ventilation equipment also includes a respiratory assist device 10 and a breathing circuit 20.

[0073] Medical ventilation equipment, taking ventilators as an example, such as Figure 3 As shown, it illustrates an invasive ventilator, which also includes a breathing interface 211, an air supply interface 212, and a memory 90.

[0074] The respiratory assist device 10 provides power to deliver a preset gas to the patient or to expel at least a portion of the patient's exhaled gas to the external environment. The preset gas is a gas that meets the patient's respiratory needs; for anesthesia machines, the preset gas may also contain anesthetic.

[0075] The breathing circuit 20 selectively connects the gas source interface 212 to the patient's respiratory system, including at least one branch (such as an expiratory branch 213a and an inspiratory branch 213b) and valves disposed on the branches, the valves being used to open or close the branches. The breathing circuit 20 is used to deliver the preset gas to the patient through the inspiratory branch 213b, and / or to exhaust at least a portion of the gas exhaled by the patient to the external environment through the expiratory branch 213a. In some embodiments, such as invasive ventilators, the breathing circuit 20 includes an expiratory branch 213a and an inspiratory branch 213b, with the expiratory branch 213a connected between the breathing interface 211 and the exhaust port 213c, for guiding the patient's exhaled gas to the exhaust port 213c. The exhaust port 213c can lead to the external environment or into a dedicated gas recovery device. In some embodiments, such as non-invasive ventilators, the breathing circuit 20 includes an inspiratory branch 213b but does not require an expiratory branch 213a, allowing the patient to exhale spontaneously. The gas source interface 212 is used to connect to a gas source (not shown in the figure) to provide gas, which can typically be oxygen or air. In some embodiments, the gas source can be a compressed gas cylinder or a central gas supply source, supplying gas to the ventilator through the gas source interface 212. The supplied gas types include oxygen (O2) and air. The gas source interface 212 can include conventional components such as a pressure gauge, pressure regulator, flow meter, pressure reducing valve, and air-oxygen ratio control and protection device, which are used to control the flow rate of various gases (e.g., oxygen and air). Of course, the gas source can also be a turbine, which outputs gas to the gas source interface 212, or a turbine can be used to directly replace the gas source interface 212. The inspiratory branch 213b is connected between the breathing interface 211 and the gas source interface 212 to provide the patient with a preset gas (such as oxygen or air). For example, the gas input from the gas source interface 212 enters the inspiratory branch 213b and then enters the patient's lungs through the breathing interface 211. The breathing interface 211 is used to connect the patient to the breathing circuit 20. In addition to introducing the gas transmitted from the inspiratory branch 213b into the patient, for invasive ventilators, it can also introduce the patient's exhaled gas into the exhaust port 213c through the expiratory branch 213a, while for non-invasive ventilators, it can also directly expel the patient's exhaled gas. Depending on the situation, the breathing interface 211 can be a nasal cannula or a mask worn over the mouth and nose.

[0076] The respiratory assist device 10 is connected to the gas source interface 212 and the breathing circuit 20, controlling the delivery of gas supplied by an external gas source to the patient through the breathing circuit 20. In embodiments of invasive ventilators, the respiratory assist device 10 may include an expiratory controller 214a and an inspiratory controller 214b; in embodiments of non-invasive ventilators, the respiratory assist device 10 may include an inspiratory controller 214b. The expiratory controller 214a is located on the expiratory branch 213a and is used to connect or close the expiratory branch 213a according to control commands, or to control the flow rate or pressure of the patient's exhaled gas. Specifically, the expiratory controller 214a may include one or more devices capable of controlling flow rate or pressure, such as an expiratory valve, a one-way valve, a flow controller, or a PEEP valve. The inspiratory controller 214b is located on the inspiratory branch 213b and is used to connect or close the inspiratory branch 213b according to control commands, or to control the flow rate or pressure of the output gas. In a specific implementation, the inhalation controller 214b may include one or more devices that can control flow rate or pressure, such as an exhalation valve, a one-way valve, or a flow controller.

[0077] The memory 90 can be used to store data or programs, such as data acquired by sensors, data generated by the processor, or image frames generated by the processor, which can be 2D or 3D images. Alternatively, the memory 90 can store a graphical user interface, one or more default image display settings, or programming instructions for the processor. The memory 90 can be a tangible and non-transitory computer-readable medium, such as flash memory, RAM, ROM, EEPROM, etc.

[0078] In some embodiments, the processor 40 is used to execute instructions or programs to control various control valves in the breathing assist device 10, the air source interface 212 and / or the breathing circuit 20, or to process the received data to generate the required calculation or judgment results, or to generate visualization data or graphics and output the visualization data or graphics to the display 30 for display.

[0079] The above is a description of medical ventilation equipment, specifically ventilators. It should be noted that... Figure 3 This is just one example of a ventilator, and it is not meant to limit ventilators to having only this kind of structure.

[0080] The pressure sensor is used to collect at least one of the patient's airway pressure and esophageal pressure, obtaining at least one of the airway pressure data and esophageal pressure data. In this embodiment, the respiratory monitoring device includes a first pressure sensor 50 and a second pressure sensor 60. The first pressure sensor 50 is used to collect the patient's esophageal pressure; in this embodiment, the patient's esophageal pressure is detected in real time to obtain esophageal pressure data. The second pressure sensor 60 is used to collect the patient's airway pressure when the medical ventilation device ventilates the patient; in this embodiment, the patient's airway pressure is detected in real time to obtain airway pressure data.

[0081] The flow sensor 70 is used to collect the gas flow rate during patient ventilation. In this embodiment, the gas flow rate is detected in real time to obtain gas flow rate data. The flow sensor 70 can be installed in the airway between the breathing interface 211 and the gas source interface 212, or between the breathing interface 211 and the exhaust port 213c. The gas flow rate can be the flow rate of gas entering the patient's body. For invasive ventilation, in some embodiments, there are multiple flow sensors 70, including inspiratory flow sensors and expiratory flow sensors installed at the mechanical ventilation end. For example, for a ventilator, it can be an inspiratory flow sensor installed in the inspiratory branch 213b and an expiratory flow sensor installed in the expiratory branch 213a. In some embodiments, the flow sensor 70 can also be a Y-piece flow sensor directly connected to the patient end, and the gas flow rate is obtained by directly measuring the flow rate entering and leaving the patient end. For non-invasive ventilation, due to the characteristics of its ventilation method, gas leakage occurs. Therefore, the gas flow rate collected by the flow sensor 70 can be compensated to obtain the actual flow rate. Specifically, the processor 40 acquires the leakage amount during non-invasive ventilation, and then compensates the gas flow rate collected by the flow sensor 70 based on the leakage amount to obtain the actual gas flow rate.

[0082] This invention proposes a method for calculating driving pressure that does not require manual user operation, does not interfere with ventilation, and can do so. By calculating the intrapulmonary pressure, the calculated end-inspiratory intrapulmonary pressure is used as the plateau pressure, replacing the method of measuring with inspiratory pause or inspiratory hold; the calculated end-expiratory intrapulmonary pressure is used as the total positive end-expiratory pressure (PEEPtotal(PEEPi+PEEP)), replacing the method of expiratory hold; and then the driving pressure is obtained by subtracting the end-expiratory intrapulmonary pressure from the end-inspiratory intrapulmonary pressure. Since no inspiratory or expiratory hold is required, the driving pressure can be calculated in real time, thus achieving real-time monitoring of the driving pressure. The monitoring of the driving pressure can be real-time or non-real-time; this embodiment uses real-time monitoring as an example, and the method is as follows: Figure 4 As shown, it includes the following steps:

[0083] Step 1: For the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor within a respiratory cycle, calculate the intrapulmonary pressure during the inspiratory phase and the expiratory pressure corresponding to that respiratory cycle. In this embodiment, the intrapulmonary pressure at the end of inspiratory and expiratory phases is taken as the intrapulmonary pressure at the end of expiration. Specifically, taking real-time monitoring as an example, the processor 40 acquires the gas flow rate data of the patient during the ventilation process of a respiratory cycle in real time through the flow sensor 70, and acquires the airway pressure data of the patient during the ventilation process of that respiratory cycle in real time through the second pressure sensor 60. Then, the processor 40 calculates the intrapulmonary pressure data corresponding to that respiratory cycle based on the respiratory cycle, gas flow rate data, and airway pressure data; wherein the intrapulmonary pressure data includes at least the intrapulmonary pressure at the end of inspiratory and the intrapulmonary pressure at the end of expiration.

[0084] The processor 40 can calculate real-time intrapulmonary pressure data using methods such as... Figure 5 The method shown includes end-inspiratory airway pressure (Paw(t)) data. 吸末 ) and end-expiratory airway pressure Paw(t) 呼末 ). Below is about Figure 5 The method shown is explained in detail, including:

[0085] Step 11: The processor 40 calculates the total gas volume V(t) during the intake phase based on the gas flow rate data. 吸末 Total gas volume V(t) during the intake phase 吸末 This represents the total volume of gas entering the patient's lungs during the inspiratory phase of the respiratory cycle, which can be obtained by integrating gas flow rate data.

[0086] Step 12, Processor 40 calculates the end-inspiratory airway pressure Paw(t) 吸末 ), Total gas volume V(t) during the intake phase 吸末 ), the final intake velocity (Flow(t)) in the gas flow rate data 吸末 ) and end-expiratory airway pressure Paw(t 呼末 The end-inspiratory intrapulmonary pressure (Plung(t)) was calculated. 吸末 ).

[0087] Specifically, Figure 7 As shown, the respiratory mechanics RC model reveals the relationships between various parameters. In the figure, Flow represents gas flow velocity, equivalent to current; Paw represents airway pressure, equivalent to voltage; airway pressure resistance is equivalent to resistance R; respiratory system compliance is equivalent to capacitance C; and Plung represents intrapulmonary pressure. The respiratory mechanics equation can be constructed as follows:

[0088] Inhalation phase:

[0089] Expiratory phase: Plung(t) = Paw(t) - R*Flow(t).

[0090] Where R represents the resistance of the respiratory system, which is a known or preset quantity; t represents time; Paw(t) is the airway pressure as a function of time t, i.e., the airway pressure at any time t; Flow(t) is the gas flow rate as a function of time t, i.e., the gas flow rate at any time t; V(t) is the gas volume as a function of time t, i.e., the gas volume at any time t, which can be obtained by integrating the gas flow rate Flow(t). The gas volume at time t represents the total volume of gas entering the patient's body from the start of inspiration to the current time t. Plung(t) is the intrapulmonary pressure as a function of time t, i.e., the intrapulmonary pressure at any time t.

[0091] Intrapulmonary pressure, the pressure inside the lungs, is typically not directly measurable. In existing technologies, inspiratory and expiratory holding are performed to stabilize airway airflow, ensuring that airway pressure equals intrapulmonary pressure, thus eliminating interference from airway resistance and using airway pressure as the intrapulmonary pressure. This invention, however, does not employ inspiratory and expiratory holding; instead, it uses the following formula to calculate intrapulmonary pressure:

[0092] Inhalation phase:

[0093] Expiratory phase: Plung(t) = Paw(t) - R*Flow(t), formula (2).

[0094] Wherein, PEEP stands for Positive End-Expiratory Pressure, which is the end-expiratory airway pressure Paw(t). 呼末 The unit is usually cmH2O; τ is the time constant. The value of the time constant is affected by patient resistance and compliance, reflecting the speed of the patient's exhalation. Clinically, it is generally believed that the expiratory time required for a patient to complete exhalation is three times the time constant. There are several methods for calculating the time constant. One method is to use the ratio of tidal volume to flow rate at a certain moment during the expiratory phase as the time constant. Another method is to calculate it by fitting a real-time volume-time curve. Different calculation methods may result in different values. The time constant can be preset, and this invention does not limit it.

[0095] Processor 40 will increase the end-inspiratory airway pressure Paw(t) 吸末 ), Total gas volume V(t) during the intake phase 吸末 ), Inspiratory end flow rate (Flow(t)) 吸末 ) and end-expiratory airway pressure Paw(t 呼末 Substituting PEEP into formula (1) above, the end-inspiratory intrapulmonary pressure (Plung(t)) is calculated. 吸末 ). t 吸末 This refers to the moment at the end of inhalation.

[0096] Step 13: Processor 40 calculates the end-expiratory airway pressure Paw(t) 呼末) and end-tidal flow rate (Flow(t)) in gas flow rate data 呼末 The end-expiratory intrapulmonary pressure (Plung(t)) was calculated. 呼末 Specifically, processor 40 will adjust the end-expiratory airway pressure Paw(t). 呼末 ) and end-expiratory flow rate Flow(t) 呼末 Substituting into formula (2) above, the end-expiratory intrapulmonary pressure Plung(t) is calculated. 呼末 ). t 呼末 This refers to the moment at the end of expiration. Of course, in some embodiments, Positive End-Expiratory Pressure (PEEP), i.e., end-expiratory airway pressure (Paw(t)), can also be used. 呼末 ) is used as the end-expiratory intrapulmonary pressure. Using PEEP as an approximation of the end-expiratory intrapulmonary pressure to calculate the driving pressure is less accurate than formula (2).

[0097] Intrapulmonary pressure data can also include intrapulmonary pressure at different times. Specifically, the processor 40 can calculate real-time intrapulmonary pressure data using methods such as... Figure 6 The method is shown below. Gas flow rate data includes: gas flow rate during the inspiratory phase (gas flow rate at different times during the inspiratory phase) and gas flow rate during the expiratory phase (gas flow rate at different times during the expiratory phase), i.e., Flow(t) is known. Airway pressure data includes end-expiratory airway pressure PEEP, airway pressure during the inspiratory phase (airway pressure at different times during the inspiratory phase), and airway pressure during the expiratory phase (airway pressure at different times during the expiratory phase), i.e., Paw(t) is known. The following section discusses... Figure 6 The method shown is explained in detail, including:

[0098] Step 11': Processor 40 calculates the gas flow rate Flow(t) corresponding to the inhalation phase. 吸 The gas volume V(t) corresponding to the intake phase is calculated. 吸 ). t 吸 This indicates different moments in the inhalation phase.

[0099] Step 12': Processor 40 calculates the airway pressure Paw(t) corresponding to the inhalation phase. 吸 ), gas volume V(t) 吸 ) and gas flow rate Flow(t) 吸 The intrapulmonary pressure Plung(t) during the inspiratory phase was calculated. 吸 Specifically, end-expiratory airway pressure (PEEP) can also be added to calculate Plung(t). 吸 For example, processor 40 will calculate the end-expiratory airway pressure PEEP and the airway pressure Paw(t) at different times during the inspiratory phase. 吸 ), gas volume V(t) 吸 ) and gas flow rate Flow(t) 吸Substituting into the above formula (1), the intrapulmonary pressure during the inspiratory phase (intrapulmonary pressure at different times during the inspiratory phase) Plung(t) is calculated. 吸 ).

[0100] Step 13', Processor 40 calculates the airway pressure Paw(t) corresponding to the expiratory phase. 呼 ) and gas flow rate Flow(t) 呼 The intrapulmonary pressure Plung(t) during the expiratory phase was calculated. 呼 Specifically, processor 40 will calculate the airway pressure Paw(t) corresponding to the expiratory phase. 呼 ) and the gas flow rate Flow(t) corresponding to the exhalation phase 呼 Substituting into formula (2) above, the intrapulmonary pressure during the expiratory phase (intrapulmonary pressure at different times during the expiratory phase) Plung(t) is calculated. 呼 ). t 呼 This indicates different moments in the exhalation phase.

[0101] Step 14', Processor 40, based on the intrapulmonary pressure Plung(t) during the inspiratory phase 吸 ) and expiratory intrapulmonary pressure Plung(t 呼 The intrapulmonary pressure Plung(t) at different times during the patient's respiratory cycle is obtained, thus generating an intrapulmonary pressure waveform, which is then displayed on a monitor, such as... Figure 8 The dotted waveform is shown in the image. This allows the user to see the trend of intrapulmonary pressure changes over time, facilitating monitoring of the patient's breathing. Of course, the processor 40 can also generate an airway pressure waveform based on the airway pressure data and display it on the screen, such as... Figure 8 The solid line waveform is shown in the graph. The intrapulmonary pressure waveform and the airway pressure waveform are in the same graph, sharing the same coordinate axis, for easy viewing by the user.

[0102] Step 2, the processor 40 will increase the end-inspiratory intrapulmonary pressure (Plung(t)). 吸末 Subtract the end-expiratory intrapulmonary pressure (Plung(t)) 呼末 ), thus obtaining the real-time drive pressure Pdrive; that is, Pdrive = Plung(t 吸末 )-Plung(t 呼末 The driving pressure (Pdrive) is the force that drives the expansion of the patient's entire respiratory system, that is, the driving pressure acting on the lungs and chest wall.

[0103] This invention creatively employs two different formulas to derive and calculate the end-inspiratory intrapulmonary pressure Plung(t) separately. 吸末 ) and end-expiratory intrapulmonary pressure (Plung(t)) 呼末 The difference between the two is used as the driving pressure, and no exhalation or inhalation is required to maintain it.

[0104] The processor 40 can further utilize the real-time drive pressure Pdrive obtained from the processor 40, or it can output the data. For example, the processor 40 analyzes the drive pressure based on a first preset condition. When the drive pressure does not meet the first preset condition, the processor 40 outputs a corresponding prompt signal, such as displaying a prompt message to the display device 30. The first preset condition can be a preset pressure range. If the drive pressure does not fall into this pressure range, it indicates that the drive pressure is too high or too low, and the processor 40 outputs a corresponding prompt signal to remind the doctor. The processor 40 can also output a corresponding prompt signal when it fails to calculate the drive pressure. For example, if the processor 40 cannot calculate the drive pressure, it outputs a corresponding prompt signal. If the processor 40 encounters an error during the calculation of the drive pressure or the obtained drive pressure exceeds an error threshold (such as an error threshold that the drive pressure cannot reach), it outputs a corresponding prompt signal. The prompt signal can be an alarm message, which can be emitted by the display device, speaker, or indicator light, etc.

[0105] The processor 40 can also adjust patient ventilation based on the driving pressure, for example, by adjusting the driving pressure through flow or pressure control. Alternatively, it can output the driving pressure to external devices (such as printers, monitors, etc.) or to the display device 30, where the real-time driving pressure Pdrive is displayed on the display interface, for example, as a real-time numerical value, or as a graph or chart showing the driving pressure changing over time. The processor 40 can also obtain the trend of driving pressure changing over time based on the driving pressure Pdrive at different times, for example, obtaining a waveform diagram of the driving pressure Pdrive; the processor 40 sends this trend of driving pressure changing over time to the display device 30. The display device 30 receives the trend of driving pressure changing over time sent by the processor 40 and displays it on its display interface, for example, displaying a waveform diagram of the driving pressure Pdrive, making it easier for medical staff to monitor changes in the patient's driving pressure. Because the driving pressure can be monitored in real time, the safety of patient ventilation is improved.

[0106] Furthermore, the processor 40 can also acquire the patient's tidal volume (TV) in real time. For example, the processor 40 acquires the patient's tidal volume in real time through a flow sensor, and obtains the corresponding compliance based on the tidal volume and driving pressure. For instance, it calculates the ratio of tidal volume to driving pressure to obtain real-time compliance, i.e., compliance = tidal volume / driving pressure. The processor 40 can also monitor the patient's respiratory status based on the compliance. Compliance refers to the ease with which an elastomer deforms under external force. The processor 40 displays this compliance through the display device 30, facilitating medical staff's understanding of the patient's lung physiology and enabling better ventilation.

[0107] Airway pressure is the pressure acting on the respiratory system (airway resistance, lungs, chest wall, etc.). Intrapulmonary pressure is the pressure acting directly on the lungs and chest wall after removing airway resistance. Transpulmonary pressure is the pressure acting directly on the lungs after removing the portion of intrapulmonary pressure acting on the chest wall. Transpulmonary pressure is calculated by subtracting intrathoracic pressure from intrapulmonary pressure. Esophageal pressure is often used as an approximation of intrathoracic pressure: Transpulmonary pressure = Intrapulmonary pressure - Esophageal pressure. After calculating real-time intrapulmonary pressure data based on respiratory cycle, gas flow rate data, and airway pressure data, processor 40 can also calculate the difference between intrapulmonary pressure and esophageal pressure data to obtain real-time transpulmonary pressure data. Transpulmonary pressure data includes end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure. Subtracting end-expiratory transpulmonary pressure from end-inspiratory transpulmonary pressure yields the real-time transpulmonary driving pressure. Specifically, intrapulmonary pressure data includes at least end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, and esophageal pressure data includes at least end-inspiratory esophageal pressure and end-expiratory esophageal pressure. Processor 40 subtracts end-inspiratory esophageal pressure from end-inspiratory intrapulmonary pressure to obtain real-time end-inspiratory transpulmonary pressure; it also subtracts end-expiratory esophageal pressure from end-expiratory intrapulmonary pressure to obtain real-time end-expiratory transpulmonary pressure. Of course, intrapulmonary pressure data can also include intrapulmonary pressure at different times, such as intrapulmonary pressure waveforms; esophageal pressure data can also include esophageal pressure at different times, such as esophageal pressure waveforms; and transpulmonary pressure data can also include transpulmonary pressure at different times, such as transpulmonary pressure waveforms. Processor 40 subtracts esophageal pressure waveforms from intrapulmonary pressure waveforms to obtain transpulmonary pressure waveforms. From these transpulmonary pressure waveforms, end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure can be obtained, and the difference between the two is the transpulmonary driving pressure.

[0108] In some embodiments, airway pressure data can be used to approximate esophageal pressure data in calculating transpulmonary pressure data. That is, the difference between intrapulmonary pressure data and airway pressure data is calculated to obtain real-time transpulmonary pressure data. For example, processor 40 subtracts end-inspiratory airway pressure from end-inspiratory intrapulmonary pressure to obtain real-time end-inspiratory transpulmonary pressure; subtracts end-expiratory airway pressure from end-expiratory intrapulmonary pressure to obtain real-time end-expiratory transpulmonary pressure; or, for example, subtracts airway pressure waveform from intrapulmonary pressure waveform to obtain transpulmonary pressure waveform, etc. The specific process of calculating transpulmonary pressure data using airway pressure data is the same as the process of calculating transpulmonary pressure data using esophageal pressure data described above, and will not be repeated here.

[0109] The processor 40 can also display real-time transpulmonary driving pressure on the display interface of the display device 30 to provide medical staff with a reference for the force acting on the lungs; it can also display the trend of transpulmonary driving pressure over time on the display interface of the display device 30 based on the transpulmonary driving pressure obtained at different times, such as displaying a waveform of transpulmonary driving pressure.

[0110] The processor 40 can determine the corresponding lung compliance based on tidal volume and transpulmonary driving pressure, such as by calculating the ratio of tidal volume to transpulmonary driving pressure to obtain real-time lung compliance, i.e., lung compliance = tidal volume / transpulmonary driving pressure. The processor 40 can also monitor the patient's respiratory status based on lung compliance. The processor 40 can also display this lung compliance on the display interface of the display device 30, facilitating medical staff's understanding of the patient's lung elasticity.

[0111] In some embodiments, the respiratory monitoring device may monitor transpulmonary driving pressure, and the respiratory monitoring process is as follows: Figure 9 As shown, it includes the following steps:

[0112] Step 1': The processor 40 acquires airway pressure data collected by the pressure sensor and gas flow rate data measured by the flow sensor within one respiratory cycle. This can be achieved by acquiring the patient's gas flow rate and airway pressure data in real time during ventilation. The specific process has been described in detail in the above embodiments and will not be repeated here.

[0113] Step 2': Processor 40 calculates the intrapulmonary pressure during the inspiratory phase and the intrapulmonary pressure during the expiratory phase for the patient corresponding to the airway pressure and gas flow rate data within a respiratory cycle; for example, by... Figure 5 or Figure 6 The method shown obtains real-time intrapulmonary pressure data, including intrapulmonary pressure during inhalation and exhalation. The specific process has been described in detail in the above embodiments and will not be repeated here.

[0114] Step 3': The processor 40 acquires the patient's esophageal pressure data in real time; for example, the processor 40 detects the patient's esophageal pressure in real time through the first pressure sensor 50 to obtain esophageal pressure data.

[0115] Step 4': The processor 40 determines the transpulmonary driving pressure corresponding to the respiratory cycle based on the intrapulmonary pressure during the inspiratory and expiratory phases, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle. There are several ways to determine the transpulmonary driving pressure, which will be described below:

[0116] One approach is that, in step 2', the processor 40 calculates the end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure corresponding to the patient's respiratory cycle based on the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor. The specific process has been described in detail in the above embodiments and will not be repeated here. Then, in step 4', the processor 40 determines the transpulmonary driving pressure corresponding to the patient's respiratory cycle based on the end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle.

[0117] Another approach is that, in step 2', the processor 40 calculates the intrapulmonary pressure curves during the inspiratory and expiratory phases of the patient corresponding to a respiratory cycle, based on the airway pressure data collected by the pressure sensor and the gas flow rate data measured by the flow sensor. The specific process has been described in detail in the above embodiments and will not be repeated here. Then, in step 4', the processor 40 obtains the transpulmonary pressure curve corresponding to the respiratory cycle based on the intrapulmonary pressure curves during the inspiratory and expiratory phases, and the esophageal pressure curve collected by the pressure sensor during the corresponding respiratory cycle; based on the transpulmonary pressure curves, the end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure are determined, thereby determining the transpulmonary driving pressure of the patient corresponding to that respiratory cycle.

[0118] In the two methods described above, the processor 40 can specifically calculate the transpulmonary driving pressure in the following way:

[0119] For a respiratory cycle, the processor 40 calculates the intrapulmonary pressure data at the end of expiration and end of inspiration of the patient in that respiratory cycle based on the respiratory cycle and the gas flow rate data and airway pressure data corresponding to the respiratory cycle; and obtains the transpulmonary pressure data corresponding to the end of expiration and end of inspiration of that respiratory cycle based on the difference between the intrapulmonary pressure data at the end of expiration and end of inspiration and the esophageal pressure data collected by the pressure sensor at the corresponding time.

[0120] The intrapulmonary pressure data can include intrapulmonary pressure waveforms, the esophageal pressure data can include esophageal pressure waveforms, and the transpulmonary pressure data can include transpulmonary pressure waveforms. The end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure can be obtained from the transpulmonary pressure waveforms.

[0121] Intrapulmonary pressure data may also include end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, and esophageal pressure data includes end-inspiratory esophageal pressure and end-expiratory esophageal pressure. The processor 40 calculates the difference between the intrapulmonary pressure data and the esophageal pressure data to obtain the transpulmonary pressure data corresponding to that respiratory cycle. This can be achieved by subtracting the end-inspiratory esophageal pressure from the end-inspiratory intrapulmonary pressure to obtain the corresponding end-inspiratory transpulmonary pressure; and by subtracting the end-expiratory esophageal pressure from the end-expiratory intrapulmonary pressure to obtain the corresponding end-expiratory transpulmonary pressure.

[0122] Furthermore, the processor 40 obtains the transpulmonary driving pressure corresponding to the respiratory cycle based on the end-inspiratory transpulmonary pressure and the end-expiratory transpulmonary pressure. For example, the transpulmonary driving pressure corresponding to the respiratory cycle is obtained by subtracting the end-expiratory transpulmonary pressure from the end-inspiratory transpulmonary pressure. The corresponding transpulmonary driving pressure can be calculated for each respiratory cycle, thereby enabling real-time detection of the transpulmonary driving pressure. The specific process has been described in detail in the above embodiments and will not be repeated here.

[0123] The processor 40 can obtain real-time transpulmonary driving pressure, which can be further utilized or output. For example, the processor 40 analyzes the transpulmonary driving pressure based on a second preset condition. When the transpulmonary driving pressure does not meet the second preset condition, the processor 40 outputs a corresponding prompt signal, such as displaying a prompt message to the display device 30. The second preset condition can be a preset pressure range. If the transpulmonary driving pressure does not fall within this pressure range, it indicates that the transpulmonary driving pressure is too high or too low, and the processor 40 outputs a corresponding prompt signal to remind the doctor. The processor 40 can also output a corresponding prompt signal when it fails to calculate the transpulmonary driving pressure. For example, if the processor 40 cannot calculate the transpulmonary driving pressure, it outputs a corresponding prompt signal. If the processor 40 reports an error during the calculation of the transpulmonary driving pressure or the obtained transpulmonary driving pressure exceeds an error threshold (such as an error threshold that the transpulmonary driving pressure cannot reach), it outputs a corresponding prompt signal. The prompt signal can be an alarm message, which is emitted by the display device, speaker, or indicator light, etc.

[0124] The processor 40 can also adjust patient ventilation based on the transpulmonary driving pressure, for example, by adjusting the transpulmonary driving pressure through flow or pressure control. Alternatively, it can output the transpulmonary driving pressure to external devices (such as printers, monitors, etc.) or to the display device 30, where the real-time transpulmonary driving pressure is displayed on the display interface, for example, as a real-time numerical value, or as a graph or chart showing the transpulmonary driving pressure changing over time. The processor 40 can also obtain the trend of the transpulmonary driving pressure over time based on the transpulmonary driving pressure at different times, for example, by obtaining a waveform diagram of the transpulmonary driving pressure; the processor 40 sends this trend of the transpulmonary driving pressure over time to the display device 30 for display, for example, by displaying a waveform diagram of the transpulmonary driving pressure, making it easier for medical staff to monitor changes in the patient's transpulmonary driving pressure.

[0125] In summary, the respiratory monitoring method and device provided by this invention can calculate and monitor the driving pressure in real time using intrapulmonary pressure without requiring inspiratory pause or manual operation by the user; the plateau pressure and PEEPtotal during the driving pressure calculation process can be calculated and monitored in real time without requiring inspiratory pause or manual operation by the user; the trans-lung driving pressure can be calculated and monitored in real time without requiring inspiratory pause or manual operation by the user; and the compliance and lung compliance based on the driving pressure calculation can be calculated and monitored in real time without requiring inspiratory pause or manual operation by the user.

[0126] Those skilled in the art will understand that all or part of the functions of the various methods in the above embodiments can be implemented by hardware or by computer programs. When all or part of the functions in the above embodiments are implemented by computer programs, the program can be stored in a computer-readable storage medium, which may include: read-only memory, random access memory, disk, optical disk, hard disk, etc., and the program is executed by a computer to achieve the above functions. For example, the program can be stored in the memory of a device, and when the program in the memory is executed by the processor, all or part of the above functions can be achieved. In addition, when all or part of the functions in the above embodiments are implemented by computer programs, the program can also be stored in a server, another computer, disk, optical disk, flash drive, or external hard drive, etc., and can be downloaded or copied to the memory of a local device, or the system of the local device can be updated. When the program in the memory is executed by the processor, all or part of the functions in the above embodiments can be achieved.

[0127] This document describes various exemplary embodiments with reference to them. However, those skilled in the art will recognize that changes and modifications can be made to the exemplary embodiments without departing from the scope of this document. For example, various operational steps and components for performing operational steps can be implemented in different ways depending on the specific application or considering any number of cost functions associated with the operation of the system (e.g., one or more steps can be deleted, modified, or combined with other steps).

[0128] Furthermore, as those skilled in the art will understand, the principles herein can be reflected in a computer program product on a computer-readable storage medium pre-loaded with computer-readable program code. Any tangible, non-transitory computer-readable storage medium may be used, including magnetic storage devices (hard disks, floppy disks, etc.), optical storage devices (CD-ROMs, DVDs, Blu-ray discs, etc.), flash memory, and / or the like. These computer program instructions may be loaded onto a general-purpose computer, a special-purpose computer, or other programmable data processing apparatus to form a machine, such that instructions, which execute on the computer or other programmable data processing apparatus, can generate means for performing a specified function. These computer program instructions may also be stored in a computer-readable storage medium that can instruct the computer or other programmable data processing apparatus to operate in a particular manner, such that instructions stored in the computer-readable storage medium can form an article of manufacture, including means for implementing the specified function. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to perform a series of operational steps on the computer or other programmable apparatus to produce a computer-implemented process, such that instructions, which execute on the computer or other programmable apparatus, can provide steps for implementing the specified function.

[0129] While the principles herein have been illustrated in various embodiments, numerous modifications to the structure, arrangement, proportions, elements, materials, and components, particularly suited to specific environmental and operational requirements, may be used without departing from the principles and scope of this disclosure. These modifications and other alterations or alterations will be included within the scope of this document.

[0130] The foregoing specific descriptions have been described with reference to various embodiments. However, those skilled in the art will recognize that various modifications and changes can be made without departing from the scope of this disclosure. Therefore, considerations for this disclosure are to be illustrative rather than restrictive, and all such modifications are to be included within its scope. Similarly, advantages, other advantages, and solutions to problems with respect to various embodiments have been described above. However, benefits, advantages, solutions to problems, and any elements that produce these, or make them more explicit, should not be construed as critical, essential, or necessary. The term “comprising” and any other variations thereof as used herein are non-exclusive inclusion, meaning that a process, method, article, or apparatus that includes a list of elements includes not only those elements but also other elements not expressly listed or not part of the process, method, system, article, or apparatus. Furthermore, the term “coupled” and any other variations thereof as used herein refer to physical connections, electrical connections, magnetic connections, optical connections, communication connections, functional connections, and / or any other connections.

[0131] Those skilled in the art will recognize that many changes can be made to the details of the above embodiments without departing from the basic principles of the invention. Therefore, the scope of the invention should be determined according to the following claims.

Claims

1. A respiratory monitoring device, characterized in that, include A pressure sensor is used to collect the patient's airway pressure to obtain corresponding airway pressure data; or, to collect the patient's airway pressure and esophageal pressure to obtain corresponding airway pressure data and esophageal pressure data. A flow sensor is used to acquire data on the gas flow rate during patient ventilation. Processor, used for: The gas flow rate data collected by the flow sensor and the airway pressure data collected by the pressure sensor during the ventilation process of a patient in one respiratory cycle are acquired in real time. The gas flow rate data includes the gas flow rate during the inspiratory phase and the gas flow rate during the expiratory phase within the respiratory cycle. The airway pressure data includes the airway pressure during the inspiratory phase and the airway pressure during the expiratory phase. The gas volume during the inspiratory phase is calculated based on the gas flow rate during the inspiratory phase. The intrapulmonary pressure during the inspiratory phase is calculated based on the airway pressure, gas volume, and gas flow rate during the inspiratory phase, and the intrapulmonary pressure during the inspiratory phase includes the end-inspiratory intrapulmonary pressure. The intrapulmonary pressure during the expiratory phase is calculated based on the airway pressure and gas flow rate during the expiratory phase, and the intrapulmonary pressure during the expiratory phase includes the end-expiratory intrapulmonary pressure. The driving pressure for the patient corresponding to the respiratory cycle is determined based on the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure; or, the transpulmonary driving pressure for the patient corresponding to the respiratory cycle is determined based on the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle. or, Processor, used for: The gas flow rate data collected by the flow sensor and the airway pressure data collected by the pressure sensor during the ventilation process of a patient in one respiratory cycle are acquired in real time. The airway pressure data includes end-inspiratory airway pressure and end-expiratory airway pressure; the total gas volume during the inspiratory phase is calculated based on the gas flow rate data; the end-inspiratory intrapulmonary pressure is calculated based on the end-inspiratory airway pressure, the total gas volume during the inspiratory phase, the end-inspiratory flow rate in the gas flow rate data, and the end-expiratory airway pressure; the end-expiratory intrapulmonary pressure is calculated based on the end-expiratory airway pressure and the end-expiratory flow rate in the gas flow rate data, or the end-expiratory airway pressure is approximated as the end-expiratory intrapulmonary pressure; The driving pressure for the patient corresponding to the respiratory cycle is determined based on the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure; or, the transpulmonary driving pressure for the patient corresponding to the respiratory cycle is determined based on the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle.

2. The respiratory monitoring device as described in claim 1, characterized in that, The processor determines the transpulmonary driving pressure corresponding to the respiratory cycle based on the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle, including: Based on the values ​​of the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure, and the esophageal pressure measured by the pressure sensor during the respiratory cycle, the transpulmonary driving pressure for the patient corresponding to that respiratory cycle is determined; or, Based on the intrapulmonary pressure curves during the inspiratory and expiratory phases, and the esophageal pressure curves collected by the pressure sensor during the respiratory cycle, a transpulmonary pressure curve corresponding to the respiratory cycle is obtained; based on the transpulmonary pressure curves, the end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure are determined, thereby determining the transpulmonary driving pressure of the patient corresponding to the respiratory cycle.

3. The respiratory monitoring device as described in claim 1 or 2, characterized in that, It also includes a display device, and the processor is further configured to: The driving pressure or transpulmonary driving pressure is sent to the display device and displayed.

4. The respiratory monitoring device as described in claim 3, characterized in that, The driving pressure or transpulmonary driving pressure is displayed on the display device in a graphical form that changes over time.

5. The respiratory monitoring device as described in claim 1, characterized in that, The processor determines the transpulmonary driving pressure corresponding to the respiratory cycle based on the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle, including: Based on the difference between the end-expiratory intrapulmonary pressure and the end-inspiratory intrapulmonary pressure and the esophageal pressure data collected by the pressure sensor at the corresponding time, the transpulmonary pressure data corresponding to the end of expiration and end of inspiration of the respiratory cycle are obtained respectively; the transpulmonary pressure data includes the end-inspiratory transpulmonary pressure and the end-expiratory transpulmonary pressure. The transpulmonary driving pressure corresponding to the respiratory cycle is obtained based on the end-inspiratory transpulmonary pressure and the end-expiratory transpulmonary pressure.

6. The respiratory monitoring device as described in claim 5, characterized in that, The esophageal pressure data collected by the pressure sensor at the corresponding time includes the end-inspiratory esophageal pressure and the end-expiratory esophageal pressure. The processor obtains transpulmonary pressure data corresponding to the end of expiration and end of inspiration of the respiratory cycle based on the differences between the end-expiratory intrapulmonary pressure and the end-inspiratory intrapulmonary pressure and the esophageal pressure data collected by the pressure sensor at the corresponding time, including: The corresponding end-inspiratory transpulmonary pressure is obtained by subtracting the end-inspiratory esophageal pressure from the end-inspiratory intrapulmonary pressure. The end-expiratory intrapulmonary pressure is subtracted from the end-expiratory esophageal pressure to obtain the corresponding end-expiratory transpulmonary pressure.

7. The respiratory monitoring device as described in claim 1, characterized in that, The processor is also used for: The intrapulmonary pressure waveform of the patient during the respiratory cycle is obtained based on the intrapulmonary pressure during the inspiratory and expiratory phases.

8. The respiratory monitoring device as described in claim 1 or 2, characterized in that, The processor is also used for: The patient's tidal volume is acquired in real time using the flow sensor. The corresponding compliance is obtained based on the tidal volume and the driving pressure; or the corresponding lung compliance is obtained based on the tidal volume and the transpulmonary driving pressure. The patient's respiratory status is monitored based on the compliance or lung compliance.

9. The respiratory monitoring device as described in claim 1 or 2, characterized in that, The processor is also used for: The processor analyzes the driving pressure or the trans-lung driving pressure based on preset conditions. When the driving pressure or the trans-lung driving pressure does not meet the preset conditions, the processor issues a prompt signal.

10. A respiratory monitoring method, characterized in that, include: Real-time acquisition of gas flow rate and airway pressure data, or gas flow rate data, esophageal pressure data, and airway pressure data of patients during ventilation; The gas flow rate data includes the gas flow rate corresponding to the inspiratory phase and the gas flow rate corresponding to the expiratory phase. The airway pressure data includes the end-expiratory airway pressure, the airway pressure corresponding to the inspiratory phase, and the airway pressure corresponding to the expiratory phase. The gas volume corresponding to the inspiratory phase is calculated based on the gas flow rate corresponding to the inspiratory phase. The intrapulmonary pressure at different times during the inspiratory phase is calculated based on the end-expiratory airway pressure and the airway pressure, gas volume, and gas flow rate at different times during the inspiratory phase. The intrapulmonary pressure at different times during the expiratory phase is calculated based on the airway pressure and gas flow rate at different times during the expiratory phase. or, The airway pressure data includes end-inspiratory airway pressure and end-expiratory airway pressure; the total gas volume during the inspiratory phase is calculated based on the gas flow rate data; the end-inspiratory intrapulmonary pressure is calculated based on the end-inspiratory airway pressure, the total gas volume during the inspiratory phase, the end-inspiratory flow rate in the gas flow rate data, and the end-expiratory airway pressure; the end-expiratory intrapulmonary pressure is calculated based on the end-expiratory airway pressure and the end-expiratory flow rate in the gas flow rate data, or the end-expiratory airway pressure can be used as the end-expiratory intrapulmonary pressure; For a respiratory cycle, the driving pressure corresponding to that respiratory cycle is obtained based on the intrapulmonary pressure at the end of inspiration and the intrapulmonary pressure at the end of expiration. Alternatively, for a respiratory cycle, the transpulmonary driving pressure for the patient corresponding to that respiratory cycle is determined based on the end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by a pressure sensor during the respiratory cycle.

11. The method as described in claim 10, characterized in that, The determination of the transpulmonary driving pressure corresponding to the respiratory cycle based on the end-inspiratory intrapulmonary pressure and end-expiratory intrapulmonary pressure, as well as the esophageal pressure measured by the pressure sensor during the respiratory cycle, includes: Based on the values ​​of the end-inspiratory intrapulmonary pressure and the end-expiratory intrapulmonary pressure, as well as the esophageal pressure values ​​collected by the pressure sensor during the respiratory cycle, the transpulmonary driving pressure for the patient corresponding to that respiratory cycle is determined; or, Based on the intrapulmonary pressure curves during the inspiratory and expiratory phases, and the corresponding esophageal pressure curves, a transpulmonary pressure curve corresponding to the respiratory cycle is obtained; the end-inspiratory transpulmonary pressure and end-expiratory transpulmonary pressure are determined based on the transpulmonary pressure curves; and the transpulmonary driving pressure corresponding to the respiratory cycle is obtained based on the end-inspiratory transpulmonary pressure and the end-expiratory transpulmonary pressure.

12. The method as described in claim 10, characterized in that, The esophageal pressure data includes end-inspiratory esophageal pressure and end-expiratory esophageal pressure; the determination of the transpulmonary driving pressure corresponding to the respiratory cycle based on end-inspiratory intrapulmonary pressure, end-expiratory intrapulmonary pressure, and the esophageal pressure measured by the pressure sensor during the respiratory cycle includes: The corresponding end-inspiratory transpulmonary pressure is obtained by subtracting the end-inspiratory esophageal pressure from the end-inspiratory intrapulmonary pressure. The end-expiratory transpulmonary pressure is obtained by subtracting the end-expiratory esophageal pressure from the end-expiratory intrapulmonary pressure. The transpulmonary driving pressure corresponding to the respiratory cycle is obtained based on the end-inspiratory transpulmonary pressure and the end-expiratory transpulmonary pressure.

13. The method as described in claim 10, characterized in that, The method further includes: The intrapulmonary pressure waveform is obtained by measuring the intrapulmonary pressure at different times during the inhalation and exhalation phases.

14. The method as described in claim 10, characterized in that, Also includes: Real-time acquisition of the patient's tidal volume; The corresponding compliance is obtained based on the tidal volume and the driving pressure; or the corresponding lung compliance is obtained based on the tidal volume and the transpulmonary driving pressure. The patient's respiratory status is monitored based on the compliance or lung compliance described above.

15. The method as described in claim 10, characterized in that, It also includes at least one of the following: The driving pressure is displayed on the display interface of the display device; For the driving pressure at different times, the trend of the driving pressure changing over time is displayed on the display interface of the display device; The real-time transpulmonary driving pressure is displayed on the display interface of the display device; Based on the transpulmonary driving pressure obtained at different times, the trend of the transpulmonary driving pressure changing over time is displayed on the display interface of the display device.

16. A computer-readable storage medium, characterized in that, The medium stores a program that can be executed by a processor to implement the method as described in any one of claims 10-15.

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