Gas distribution unit for a ventilation and oxygenation system

Abstract

Gas distribution unit (3, 4, 8, 9, 16, 25) for a system for ventilation and oxygenation of a patient (30) comprises in a common unit: - a switching unit (8), - a breathing gas dosing path (3), - a patient-near connecting element (25), - a gas extraction connection (16) for extracting partial quantities of breathing gas from the inhalation gas, - a gas return connection (24) for inhalation gas and - a purge gas dosing path (4), - a control unit (9) on, wherein the gas distribution unit (3, 4, 8, 9, 16, 25) designed as a common structural unit has connections for connection to an oxygenation system (2), a dosing system (7), a ventilation system (1) and the patient (30), wherein the patient-near connecting element 25, the reflection unit 18, the gas return connection 24 and the gas extraction connection 16 are designed as a common structural unit integrated into the patient-near connecting element 25, wherein the switching unit (8) is designed to divide and / or distribute gas quantities enriched with inhalative substances (100) into the respiratory gas dosing path (3) and the purge gas dosing path (4), wherein the switching unit (8) is designed to supply and provide a partial quantity of respiratory gas enriched with the inhalative substances into the respiratory tract of the patient (30) by means of the respiratory gas dosing path (3) and by means of the patient-proximate connecting element (25), wherein the switching unit (8) is designed to supply and provide a partial amount of respiratory gas enriched with the inhalable substances to an oxygenation system (2) by means of the purge gas dosing path (4), wherein the control unit (9) is designed to control the switching unit (8), wherein the control unit (9) is designed to control a dosage of inhalative substances.

Description

The present invention relates to a gas distribution unit for a system for respiration and oxygenation. Such a system can make it possible with a device to provide breathing gases, gases or gas mixtures for respiration and oxygenation with gases or gas mixtures and with a device for extracorporeal membrane oxygenation to allow a patient with breathing gases and inhalation substances into the breathing circuit and into the blood circuit.The substances are, for example and preferably, gases dissolved in the gas phase or vapour phase, such as, for example, anesthetic agents, anesthetic gases, anesthetic agents or anesthetic agents, medicamentally active substances or medicaments dissolved in the gas phase or vapour phase, which are suitable for inhalation administration into the respiratory gas. The term "respiratory gas" is to be understood in the following as a generic term for gas quantities supplied to the patient or continued by the patient, so that inhalation gas, exhalation gas, respiratory gases, inhalation gases, exhalation gases as well as respiratory gas, respiratory gases are to be understood therewith. Application of conventional ventilation to intensive care units and also during the execution of an operation often leads to undesirable side effects, such as baro / volute trauma and aspiration, which can in part cause damage to the lung and can lead to complications such as pneumonia or sepsis. To avoid further damage and as therapy in the case of damaged heart or lung, there are approaches for oxygenation and circulation support, such as veno-venous extracorporeal membrane oxygenation (v.v. ECMO), pumpless extracorporeal lung support for carbon dioxide elimination (pECLA) and veno-arterial extracorporeal membrane oxygenation (v.a.ECMO).From the prior art, respiration and anesthesia apparatuses are known which can be used for respiration at an intensive care unit (ICU) or for performing surgical interventions in operating rooms (OR). US 2016 / 067 434 AA shows a ventilator for ventilating a patient for use on an intensive care unit. The ventilator shown is intended to avoid complications during the execution of the ventilation. US 4 148 312 A shows a combination of an anesthesia machine and a ventilator. For conducting ventilation during surgery, the loss of consciousness, pain insensitivity, and relaxation of muscles of the patient are essential.For this purpose, different volatile anesthetics (anesthetic agents) (halothane, isoflurane, desflurane, sevoflurane, ether) and nitrous oxide having different hypnotic, analgesic and muscle-relaxing properties are administered inhalatively to the patient in combination with air and oxygen with the aid of the anesthetic device, for example by means of an endotracheal tube. In addition, usually drugs are also given invasively into the blood circulation. The volatile anesthetics or anesthetic agents can be metered into the respiratory gas or into the respiratory gas mixture, for example, by evaporation using an anesthetic evaporator-also referred to as anesthetic evaporator or vapor (evaporator).US 2016 / 008 567 AA shows a system for dosing anesthetic or volatile anesthetic. WO 2009 / 033 462 A1 shows an anesthetic evaporator with a storage container and a conveying and metering device, wherein a vapor pressure of the anesthetic is generated by increased temperature, and saturated anesthetic vapor is generated.DE 10 2017 006 107 A1 shows a medical system with a device for processing and visualizing data obtained by means of an electro-impedance tomography device (EIT) with regard to a state of blood circulation of the heart and lung. The medical system comprises an EIT module, a ventilation module, a dosing module, a data input module and a control module. The control module coordinates a breath hold maneuver that is carried out on the ventilation module. The control module coordinates a perfusion measurement and a data acquisition of EIT data and determines a measure which indicates a state of blood circulation of the lung.WO 2018 / 026 671 A1 discloses a system for hypobaric oxygenation with a membrane oxygenator. The system enables the analysis of various parameters, such as flow rate, fluid composition, pressure, temperature, oxygen or carbon dioxide content, anesthetic concentration, anesthetic partial pressures in the oxygenation system.US 2020 / 038 564 A1 shows a blood pump which is suitable for extracorporeal transport of blood.U.S. Pat. No. 9,901,885 B1 shows a membrane which is designed and provided for a blood-to-gas and gas-to-blood exchange.US 2019 / 151 584 A1 shows a system for measuring inhalation anesthetics. A flow sensor is positioned in fluid communication with an anesthetic breathing circuit and is used to generate a measurement signal indicative of the concentration of a gaseous anesthetic in the breathing circuit. Optionally, a reflector arrangement may be provided to collect and return amounts of gaseous anesthetic escaping from the breathing circuit to the breathing circuit.DE 10 2014 107 980 A1 discloses a ventilation system with mechanical ventilation and extracorporeal blood gas exchange. The system comprises a ventilation device for machine ventilation of the lungs of a patient and an ECLS device for extracorporeal blood gas exchange. The ventilation system is designed to carry out a breathing assistance by the ventilation device on the one hand and an extracorporeal blood gas exchange by the ECLS device on the other hand in a coordinated manner in an automated manner. In this case, the ECLS device specifies a level of the extracorporeal blood gas exchange and the ventilation device adjusts itself automatically on the basis of the specified level.DE 10 201 2009 305 A1 discloses a device for metering oxygen for an anesthesia device, wherein a switching element bypasses the oxygen between a first gas path and a second gas path. The first gas path leads to a patient via a connecting and connecting element. The second gas path leads to a gas extraction connection which is configured for oxygen insufflation.In particular, when performing operations on the heart, so-called cardiopulmonary machines (HLM) are used. These heart-lung machines (HLM) assume the function of the heart and lung during the duration of the surgical intervention on the heart, i.e. the supply of oxygen into the blood circulation of the patient and the removal of carbon dioxide from the blood circulation of the patient and the blood flow in the blood vessels. For example, GB 2 568 813 A1 describes a heart-and-lung machine for extracorporeal gas exchange and oxygenation.WO 2009 / 033 462 A1 discloses a device for providing anesthetic gas. The apparatus enables, without the need for external fresh gas or transport gas, the provision of saturated anesthetic vapor and its delivery to a patient.U.S. Pat. No. 6,174,728 B1, U.S. Pat. No. 4,279,775 A and U.S. Pat. No. 2003 / 0 064 525 A1 show devices for determining constituents and blood gases in the blood of living beings.With the knowledge of the above-mentioned prior art, the present invention has addressed the object of providing a device for gas distribution which enables a distribution and / or distribution of portions of respiratory gas into the respiratory circuit and the blood circuit of a patient.The object is achieved with a gas division unit having the features of claim 1.Advantageous embodiments of the invention are evident from the dependent claims and are explained in more detail in the following description with partial reference to the figures.Ventilation systems are, in a conventional embodiment, part of a ventilator. Ventilation systems for ventilators have in the usual way suitable means for supplying, supplying and continuing breathing gases and substances to and from the patient, for example means for gas mixing and gas delivery, for example at least one gas delivery unit (blower, Blower, piston drive, valve arrangement), and also means for gas guidance, such as breathing gas connection system, for example in the form of breathing tubes and a connection element-the so-called Y-piece-for connecting the breathing tubes to an endotracheal tube, a breathing mask or a tracheostoma. In addition, connecting elements are also known which include an exhalation valve close to the patient. In addition to the ventilation system, ventilators also have elements-in particular sensors-for a measurement-technology detection of given and / or set pressures, flow quantities and further operating parameters of a mechanical ventilation with the supply of gases and gas mixtures. For machine ventilation, at least the following parameters are set and / or monitored, such as inspiratory and expiratory ventilation pressures, ventilation frequency, inhalation to exhalation ratio, pressure upper and lower limits, flow rate upper and lower limits, volume upper and lower limits and gas concentrations. A ventilator and a ventilation system assist a system for supplying substances in the task and function of ensuring ventilation of the lungs, i.e. ensuring collapse of the lungs or individual areas of the lungs (alveolus). In addition, the ventilation system assists the patient in O 2 / CO 2- gas exchange in the lung. A system for supplying substances has suitable elements for the supply, supply and / or return of amounts of breathing gases. The breathing gas provided by the breathing system is supplied to the patient as fresh breathing gas with an inspiratory breathing tube by means of an inspiratory path of the breathing gas connection system. The respiratory gas or respiratory gas mixture exhaled by the patient is recirculated or continued by means of the respiratory gas connection system. The inspiratory path and the expiratory path of the respiratory gas connection system are usually brought together close to the patient at the location of the patient with the aid of a connection element close to the patient, a so-called Y-piece. The air exhaled by the patient passes from the patient via an exhalation path of the respiratory gas connection system with the aid of an exhalation valve, the so-called exhalation valve, often referred to as an EX valve, into the environment or into a suitable system for absorbing consumed amounts of gas. Depending on the design of the ventilator, the exhalation valve can be arranged in the ventilator itself, so that exhaled breathing gases can flow out to the environment by means of tracheostoma, endotracheal tube or nasal mask via the connecting element (Y-piece) and an exhalation breathing tube and the exhalation valve. In an alternative embodiment, the exhalation valve can be arranged outside the ventilator close to the patient, so that exhaled breathing gases can flow away to the environment by means of tracheostoma, endotracheal tube or nasal mask on a direct path via the exhalation valve. In such a configuration, no return of respiratory gases with an expiratory ventilation tube into the ventilator is provided via the respiratory gas connection system. Systems for supplying substances make possible a gaseous supply of substances into the breathing circuit and a gaseous supply of the substances outside the body into the blood circuit of a patient. This enables, for example for application in the clinical environment on an intensive care unit (ICU), simultaneous and / or parallel coordinated operation with the supply of substances to an inhalation sedative into the blood circulation as well as into the breathing circulation. The substances can be supplied to an inhalation sedative by means of the simultaneous and / or parallel coordinated operation via an airway access of the patient, and also via a gas / blood exchange system (membrane oxygenation, ECMO, oxygenator, oxygenation system). With a system for supplying substances, both an administration of substances for inhalation via the lung into the cardiovascular system of the patient can be made possible at the same time and an administration of these substances via the gas / blood exchange system into the blood circulation of the patient (extracorporeal circuit) can be effected. A system for supplying substances has the following components in a conventional embodiment:a ventilator having a ventilator system; anda respiratory gas connecting system,with a connecting element (Y-piece) close to the patientan oxygenation system having an oxygenation linkage system,a system for inhalation sedativeshaving a gas extraction connection for inhalation gas,having a reflection unit,having a metering system,having a gas recirculation connection for inhalation gas,a changeover unit,a respiratory gas dosing path,a purge gas dosing path; anda control unit.A ventilation system is designed to provide breathing gases to the patient. The respiratory gas connection system is designed for a gas-conducting connection for supplying and continuing amounts of respiratory gases to the patient. A system for inhalation sedative (SIS) is preferably formed by the dosing system, the gas extraction connection for extracting partial amounts of breathing gas from the inhalation gas, the reflection unit and the gas recirculation connection for recirculating the partial amounts of breathing gas from the dosing system to the switching unit. The inhalation sedative system (SIS) is configured with the dosing system for dosing inhalation substances. Portions of respiratory gas are provided and supplied to the inhalation sedative system (SIS) by the ventilator or ventilator system.The gas division unit can be designed as a stand-alone unit as well as as as a sub-component of a system for gaseous supply of substances.According to the invention, the gas division unit is formed by a common structural unit witha changeover unit,a respiratory gas dosing path,a connecting element close to the patient,a gas extraction connection for extracting partial amounts of respiratory gas from the inhalation gas,a gas recirculation connection for inhalation gas,a purge gas metering path,a control unit.This configuration results in a space-saving, compact arrangement with a small volume close to the airway access to the patient. The gas division unit forms a device for distributing and / or dividing portions of respiratory gas into the respiratory circuit and the blood circuit of a patient.The elements of the gas division unit with the changeover unit, the respiratory gas dosing path, the connection element close to the patient, the gas recirculation connection for inhalation gas and the gas extraction connection are designed and configured as described in the context of the system for gaseous supply of substances and are explained further below with respect to the respective function in the gas division unit.By means of the purge gas flowing in the purge gas dosing path, quantities of blood enriched with inhalation substances can be supplied to the patient via the oxygenation connection system, which can be provided, for example, by an oxygenation system.According to the invention, the gas division unit, which is designed as a common structural unit, has connections for connection to the oxygenation system and the dosing system, the ventilation system and to the patient.The respiratory gas dosing path and the gas recirculation connection can be preferably and for example embodied as internal lines in the gas division unit. The purge gas dosing path, the respiratory gas connection system, can be formed by the gas division unit preferably and for example as lines, e.g. in the form of ventilation tubes or hose lines to the oxygenation system, or to the patient and the ventilation system.Likewise, the feed line from the gas extraction connection to the metering system or the inhalation sedative (SIS) system is preferably designed, for example, as a hose line. The switching unit enables a division and / or distribution of gas quantities enriched with inhalation substances into the respiratory gas dosing path and into the purge gas dosing path. A partial quantity of respiratory gas enriched with inhalation substances is supplied and provided to the changeover unit by means of the gas extraction connection and the respiratory gas connection system. The changeover unit supplies and provides a partial quantity of respiratory gas enriched with inhalation substances to the airways of the patient by means of the respiratory gas dosing path and by means of the connection element close to the patient. The changeover unit supplies and provides a portion of respiratory gas enriched with inhalation substances to an oxygenation system by means of the purge gas dosing path.The connection between the changeover unit and the connecting element close to the patient with the supply of the partial quantity of respiratory gas enriched with the inhalation substances to the patient takes place with the aid of the respiratory gas dosing path. By means of the respiratory gas connection system, a partial quantity of respiratory gas enriched with inhalation substances is supplied and provided to the patient by the switching unit via the connection element close to the patient. By means of the respiratory gas connection system, the respiratory system can also supply and provide a further portion of respiratory gas, not enriched with inhalation substances, to the patient via the connection element close to the patient.The connection between the changeover unit and the oxygenation system with the supply of the portion of breathing gas enriched with the inhalation substances to the oxygenation system takes place with the aid of the flushing gas dosing path. Amounts of blood enriched with inhalation substances can be supplied from the oxygenation system to the patient via the oxygenation connection system by means of a purge gas flowing in the purge gas dosing path. For this purpose, a gas for blood exchange and a gas for blood exchange take place in the oxygenation system, wherein provided gas quantities enriched with oxygen O2and the inhalation substances pass from the oxygenation connection system via a flushing of a membrane into the blood circulation of the patient and at the same time quantities of carbon dioxide CO2produced in the metabolism of the patient pass from the blood circulation of the patient into the flushing gas dosing path. These processes of gas-to-blood and gas-to-blood exchange are referred to as oxygenation and decarboxylated. The oxygenation connection system is configured to fluidly connect to the blood circuit for delivering and delivering amounts of patient's blood. The oxygenated blood provided by the oxygenation system is introduced invasively to the patient by means of the oxygenation connection system as a fresh and oxygenated blood quantity with a feed line.Away from the patient, a carbon dioxide enriched blood is returned to the oxygenation system via the oxygenation connection system. The oxygenation connection system thus enables the patient to be supplied with blood quantities enriched with volatile substances and with oxygen (O 2) and to continue quantities of blood enriched with carbon dioxide (CO 2).Inhalation-sedative (SIS) systems make it possible to provide inhalation substances, for example substances having hypnotic (anesthetic), analgesic or muscle-relaxing properties or effects. Such inhalation-sedative (SIS) systems make it possible to dose or dose the inhalation substances via the switching unit to the ventilation system and / or to the oxygenation system and thus provide patients with gas quantities enriched with the inhalation substances in the breathing circuit and in the lungs of the patient and / or via the oxygenation system in the blood circuit.The control unit is designed to control the switching unit and / or the gas division unit. The control comprises a coordination of the division and / or distribution of gas quantities provided and / or supplied by the dosing system between the dosing paths, i.e. between the purge gas dosing path and the respiratory gas dosing path. The control unit performs, to a certain extent, gas or gas mixture management between the two dosing paths. The gas quantities provided and / or supplied, for example, by the inhalation sedative system (SIS) and / or the metering system, are enriched or saturated with quantities of substances, with quantities of volatile substances or with quantities of volatile anesthetics. With the control and / or coordination of the gas or gas mixture management, suitable specifications are made by the control unit, which quantities of breathing gas are then supplied to the breathing circuit and the lungs of the patient via the breathing gas connection system with the supplied quantities of breathing gas, or to the oxygenation system and thus from the oxygenation system via the oxygenation connection system with supplied or exchanged quantities of blood into the blood circuit of the patient. By controlling and coordinating the switching unit and / or the gas division unit by means of the control unit, it is possible to set a balance when feeding inhalative substances, for example between inhalation anaesthesia and extracorporeal anaesthesia, or also to cancel this balance during therapy from medical points of view. The control unit can thus put into practice specifications of a user with regard to the setting or changes of a therapeutic focus with respect to the balance between extracorporeal sedative by means of the oxygenation system or inhalation sedative by means of the inhalation sedative system (SIS) during operation of the system, which enables gaseous supply of substances into the breathing circuit and gaseous supply of the substances outside the body into the blood circuit of a patient. A system for inhalation sedative (SIS) has, for example, a gas extraction connection for inhalation gas for extracting a partial amount of inhalation gas from the inspiratory path of the respiratory gas connection system as a suitable element for supplying amounts of respiratory gases to the metering system. A system for inhalation sedative (SIS) has gas connections, for example a gas recirculation connection for inhalation gas for recirculating portions of inhalation gas from the switching unit or gas splitting unit back into the inspiratory path of the respiratory gas connection system and / or to the connection element (Y-piece) close to the patient, as a suitable element for supplying amounts of respiratory gases to the patient. A system for inhalation sedative (SIS) has suitable elements for storing and / or providing quantities of exhaled breathing gases or breathing gas mixture from the patient. For this purpose, an inhalation sedative (SIS) system has, for example, a reflection unit or an anesthetic gas reflector as a suitable element. During exhalation, the majority of anesthetic gas is stored or buffered in the reflection unit or in the reflector and reused in the subsequent inhalation. The reflector can be designed, for example, as a carbon reflector which is designed for storage or buffering of the inhalation substances for a period of several days. An exemplary design of a reflection unit has a chamber in the gas flow for the breathing gas with a reflection agent, for example a granulate of a suitably impregnated activated carbon. The activated carbon allows the inhalation, buffering and temporary binding of the inhalation substances from the exhalation gas of the patient during exhalation of the patient and release of the inhalation substances with the subsequent inhalation into the inhalation gas back into the respiratory gas connection system with supply to the patient. Such a reflection unit is arranged in or on the respiratory gas connection system, preferably on the connection element (Y-piece) or close to the connection element (Y-piece). Alternatively, the reflection unit can be formed as part of the connecting element (Y-piece) of the respiratory gas connecting system. Alternatively, the connecting element (Y-piece) can be formed as part of the reflection unit in the respiratory gas connecting system. The reflection unit has elements for filtering and / or buffering gas constituents and / or substances, in particular inhalation and / or volatile substances, in the respiratory gas. The reflection unit is sometimes also referred to as a reflector, gas reflector, or else an anesthetic gas reflector or anesthetic gas reflector. The inhalation sedative system (SIS) has a dosing system with correspondingly designed elements for dosing substances. The dosing system can be designed for dosing inhalational and / or volatile substances or volatile anesthetics. Suitably designed elements for dosing inhalation substances are, for example, valves or valve arrangements in the form of controlled, i.e. electrically or electronically controlled or regulated valves for dosing inhalation substances into a gas mixture. These include, for example, magnetic or electromagnetic control valves, as well as piezo valves or piezo actuators. Suitably designed elements for dosing inhalation substances are, for example, devices for evaporating or evaporating inhalation substances. Suitable devices for evaporating or evaporating inhalational, preferably volatile substances are formed, for example, by anesthetic evaporators. Such anesthetic gas evaporators, usually referred to as vapors, make it possible to enrich the gas stream with volatile substances suitable for inhalation or sedatives of a living being, for example an enrichment in an adjustable concentration of volatile anesthetic agents, e.g. desflurane, halothane, isoflurane, sevoflurane, ether. Vapors operate according to the metering principle of a change in ratios of flow quantities between a main stream and a secondary stream. The main stream and secondary stream are combined at the output of the vapors. Thus, in the side stream, the fed gas is saturated with the volatile substances; by adjusting or setting the flow rate ratio between the main stream and the side stream, the degree of metered addition-and thus also the concentration-of the substances at the outlet of the vapor can be adjusted. Thus, in the metering system, the supplied gas stream is enriched with substances suitable for inhalation or sedativeing of a living being. A suitable possibility for dosing inhalation substances by the dosing system in the inhalation sedative system (SIS) is provided, for example, by branching off a portion of inhalation gas from the total amount by means of the gas withdrawal connection on the respiratory gas connecting system, on the connecting element close to the patient, on the reflection unit or on the ventilation system and then dosing specific amounts of inhalation substances into this portion in the dosing system. Such metering can be effected, for example, by a metering valve which meters the inhalation substances into the branched portion of the inhalation gas in a time-pulsed manner. Subsequently, the partial amounts of the inhalation gas branched off and now enriched with inhalation substances are introduced again into the gas stream into the respiratory gas connection system via the gas recirculation connection, preferably or for example at the reflector or at the connection element (Y-piece), and are supplied to the patient. The volatile substances are introduced as an metered addition into the inhalation gas. From the ventilator or the ventilator system, via an inspiratory path of the respiratory gas connection system for carrying out a ventilator therapy with regard to pressure, temporal pressure variation, flow quantities, volumes of provided gas mixture of air and oxygen as respiratory gas, reaches the patient. Partial quantities of this inhalation gas are conducted by means of the gas extraction connection via a connecting element, usually designed as a hose line, to the metering system. In the dosing system, the inhalational or volatile substances are dosed for further use in the therapy of the patient via the lung and / or via the blood circulation. The inhalation substances are supplied by means of the dosing system to an inhalation sedative, for example in the form of volatile anesthetics or in the form of further substances to the respiratory gas or the respiratory gas and pass to the changeover unit via a connecting element, usually likewise designed as a hose line. In an alternative embodiment, the metered addition of the inhalation substances by the metering system can be effected by controlling a variable branched portion from the total amount of inhalation gas, preferably in a combination with a constant metered addition by the metering valve or a variable metered addition by a control valve, for example a proportional valve. If the inhalation substances are present in liquid form, a device for heating, for example a heater, is provided in the system for inhalation sedatives (SIS), which device enables the conversion of the inhalation substances from the liquid phase into a gaseous phase, so that the control valves or metering valves can feed inhalation substances into the inhalation gas in gaseous form.For determining concentrations of substances in the exhalation gas, a measurement system for process gas analysis (PGA) for determining a gas concentration, in particular a gas concentration of an inhalation substance or an anaesthesia gas concentration in the exhalation gas, can be used, for example. Such a measurement system (PGA) is designed to carry out an analysis of the respiratory gas with regard to concentrations of inhalation substances, in particular anesthetic concentrations or nitrous oxide (N 2 O), as well as carbon dioxide CO 2 or oxygen (O 2) on the basis of an amount of respiratory gas from the respiratory gas connection system or from the connection element provided with a suction-extraction pump and by means of a measurement gas line.The switching unit enables switching, division or distribution of gas quantities and / or inhalation substances for sedatives, such as volatile anesthetic agents or medicaments. By means of the switching unit, a switching, division or distribution of gas quantities of the gas between the respiratory gas connection system and the connection element (Y-piece) with reflection unit on the one hand and the oxygenation system on the other hand can take place. With the switching, division or distribution of gas quantities, there is also indirectly a supply with division or distribution of the inhalational or volatile substances, anesthetics or further substances from the dosing system into the respiratory gas connection system with the connection element close to the patient and / or to the oxygenation system. Suitable means of the changeover unit for changeover and distribution are, for example, valves or arrangements of valves, 3 / 2-way valves or a combination of two 2 / 2-way valves arranged in parallel in the gas flow with corresponding state control for distribution and division into partial amounts from the metering system by means of the respiratory gas metering path to the breathing system or by means of the purge gas metering path to the oxygenation system.The switching unit is designed for switching between the two dosing paths and, in cooperation with the two dosing paths, for distributing and distributing the enriched gas quantities of respiratory gas to the oxygenation system and to the connecting element close to the patient. The inhalational or volatile substances are supplied to the respiratory gas by means of the metering system and the inhalational sedative system (SIS) of the changeover unit and pass from the changeover unit either by means of the gas recirculation connection and via the respiratory gas metering path and the respiratory gas connecting system, usually still via the connecting element (Y-piece) close to the patient into the respiratory gas and by means of endotracheal tube, tracheostoma, or nasal mask into the bronchial tract and the lung of the patient, or from the changeover unit via the flushing gas metering path to the oxygenation system and from the oxygenation system by means of the oxygenation connecting system then into the blood circulation of the patient.In embodiments of the system for supplying substances in the area of intensive care or emergency care, the switching unit in the gas flow is connected downstream of the dosing system. The switching unit can also be formed as a component of the inhalation sedative (SIS) system.The oxygenation system is configured to provide oxygen and eliminate carbon dioxide into a blood stream to the patient. The oxygenation system comprises a membrane for gas / blood exchange. With the aid of this membrane, an amount of oxygen is supplied into the blood volume of the patient's blood circulation by means of a flushing gas and an amount of carbon dioxide is removed from the patient's blood circulation. The purge gas is provided to the oxygenation system by means of the purge gas connection path from the switching unit. The transport of the quantity of blood to and from the patient can be effected by means for delivering blood, for example by a blood delivery unit (pump). Such a blood delivery unit (pump) is preferably arranged in or on the oxygenation connection system or in or on the oxygenation system and serves for transporting blood quantity to and from the patient.The control of the gas division unit can nevertheless be configured with a control unit or by means of a plurality of control units (slave) in cooperation with a central control unit (master) as a so-called "master-slave" arrangement. Coordination and cooperation can be made possible by coordinated protocols in the data exchange, for example in a data network (LAN, WLAN). The control unit provides a wide variety of functions for operating the gas division unit. The control unit usually comprises a data memory (RAM, ROM) which is designed for storing a program code. The sequence of the program code is coordinated by a microcontroller arranged as an essential element in the control unit or by another configuration of computing elements (FPGA, ASIC, μP, μC, GAL). The control unit is designed, prepared and provided to coordinate the operation of the gas division unit and to carry out the comparison operations, arithmetic operations, memory and data organization of the data sets required in the course of operation, activations of actuators and sensors, measurement value acquisition of measurement sensors and sensors, data and information processing, and information and data provision on components inside the system and to the outside of the system.According to the invention, a switching, division or distribution of gas quantities between the respiratory gas connection system, in particular the connection element (Y-piece) close to the patient and the oxygenation system takes place by means of the gas division unit. Suitable means for switching and distributing, as described above for the switching unit, such as, for example, valves or arrangements of valves, 3 / 2-way valves or a combination of two 2 / 2-way valves arranged in parallel in the gas flow and having corresponding state control, can also be used for functions such as switching, distributing or distributing gas quantities in the gas distributing unit. With the switching, division or distribution of gas quantities, the switching unit enables substances provided to be conveyed to the patient's lung as well as to enter the patient's blood circulation via the oxygenation system for inhalation with the breathing gas. This offers advantages, for example, when an inhalation therapy of amounts of volatile, inhalation medicaments or substances by means of the ventilator or by means of the ventilator system in combination with the system for inhalation sedatives and, if required, simultaneously or instead also by means of the oxygenation system is desired.This results in an overall important advantage of the present invention in that a distribution of a administration of inhalational substances via the patient's lung, as well as extracorporeally into the patient's blood circulation, can be carried out.In a further preferred embodiment, the gas division unit can have a further absorber unit which is provided for removing carbon dioxide from the exhalation gas of the patient. This further absorber unit enables carbon dioxide to be removed from the exhalation gas, so that even independently of breathing phases or the respective setting of the changeover unit during operation for division into breathing gas dosing path and flushing gas dosing path, continuous reutilization of recycled residual amounts of inhalation substances in the exhalation gas can be enabled.In a further preferred embodiment of the gas division unit, an arrangement with a purge gas absorber unit and / or a further gas delivery unit, for example designed as a blower (Blower) for transporting purge gas in the oxygenation system or the purge gas dosing path, can be arranged and provided.The further gas delivery unit enables circulation of the purging gas in a circulation flow. This makes it possible to avoid the need to carry away purge gas enriched with inhalation substances or volatile anesthetic (anesthetic agent) as used gas and thus to prevent valuable substances from being reused for the further therapy. The purge gas absorber unit is thus advantageously designed to remove a proportion of carbon dioxide from the purge gas, so that amounts of inhalation substances or volatile anesthetic (anesthetic agent) not introduced into the circulation at the membrane can be used again in the operation of the oxygenation system in the circulation after removal of carbon dioxide. Embodiments with an open anesthetic gas discharge line (ORS: open reservoir scavenger) are also possible, in which case the used exhalation gas is filtered or retained by means of an activated carbon collector and the filtered exhalation gas is subsequently fed to the room air.The flushing gas absorber unit removes the proportion of carbon dioxide from the exhaled breathing gas, so that amounts of inhalation substances or volatile anesthetic (anesthetic agent) not absorbed by the patient can be used again for the therapy after removal of carbon dioxide in the circuit. The flushing gas absorber unit contains a special type of lime granulate (soda lime), known as hydrated lime, usually consisting of calcium hydroxide [Ca(OH) 2] and / or sodium hydroxide [Na OH]. By means of a chemical reaction, the proportion of carbon dioxide is removed from the exhalation gas with the release of heat and water.In a further preferred embodiment, a moistening / heating system for breathing gas, which is provided for heating breathing gases, can be arranged in or on the gas division unit, in or on the changeover unit, in or on the connection element close to the patient, in / or on the breathing gas connection system.In a further preferred embodiment, a mixing chamber, which is provided for supplying exhalation gases from the patient by means of an exhaust gas line for exhalation gases, can be arranged in or on the gas division unit. The exhaust gas line makes it possible not to have to continuously supply amounts of inhalation substances in the exhalation gas to disposal at least partially, but instead makes it possible to reutilize these amounts of inhalation substances again. This results in savings possibilities for the inhalation substances, which brings with it cost advantages and a reduction in the supply of gases harmful to the climate into the environment.In a preferred embodiment, the gas division unit and / or the connecting element close to the patient can have a connection for a measurement gas line, which is provided for connection to a process gas analysis unit.Data and / or information can be provided between the process gas analysis unit and the control unit / control units with the aid of data lines or data connections. The data lines or data connections are preferably designed as a wired or wireless data network (Ethernet, LAN, WLAN, Bluetooth, PAN) or bus system (CAN, LON), which has data nodes for data coordination (switch, hub, router) on the one hand, and also components (database, server, router, access point) for data storage, data distribution.In a preferred embodiment of the gas division unit, a system for physiological patient monitoring (PPM) can be arranged or assigned to the system. This further preferred embodiment offers the advantage that the effect of the administration of volatile substances and / or medicaments and / or anesthetic agents on the condition of the patient is monitored by measurement using physiological measurement variables, such as oxygen saturation in the blood (SPO 2), carbon dioxide concentration during and at the end of the exhalation phase (endtidal carbon dioxide concentration, etCO 2), heart rate, blood pressure, body temperature. From these measured variables, the user can draw conclusions about the current therapy situation of both the blood gas exchange in the lung and the extracorporeal blood gas exchange with regard to the removal of carbon dioxide and the supply of oxygen. In addition, it is possible to use the oxygen saturation in the blood (SPO 2) as a controlled variable for the metering of oxygen in the metering system; furthermore, the division of gas quantities into the ventilation system, or the inhalation sedative system (SIS) and the oxygenation system can also be controlled in the changeover unit. The carbon dioxide concentration can serve as a basis for controlling the extracorporeal blood gas exchange by the oxygenation system, which can be carried out, for example, by means of adaptations of delivery quantities at the blood delivery unit and / or flow quantities of the purge gas.In a preferred embodiment of the gas division unit, a system for imaging and diagnosing heart and lung can be assigned to the gas division unit. This further preferred embodiment offers the advantage that during therapy the condition of the lung, in particular also changes (improvement, recovery, exacerbation) of the situation of the lung can be tracked during therapy. Suitable imaging systems are, for example, ultrasonic diagnostics, electro-impedance tomography (EIT), computer tomography (CT), X-ray (X-ray), magnetic resonance tomography (MRI). In this context, electro-impedance tomography (EIT) is to be emphasized in particular, since-in contrast to the other four systems mentioned-it offers the possibility of continuous imaging of the lung, thorax and heart. Thus, global and / or regional changes in the state of the lung, the type of ventilation of the lung with possibly regional overstretching and collapse can be made visible. Changes in the type of ventilation by the ventilation system and in the manner of combined use with the oxygenation system for extracorporeal blood gas exchange are thus effectively visible and able to be checked promptly for the user.In further preferred embodiments of the gas division unit, the control unit can be designed to control the distribution and / or the division of the amount of inhalation substances into the flushing gas dosing path towards the oxygenation system and the breathing gas dosing path towards the connection element close to the patient or towards the reflection unit as a function of the data provided in the data network or network system.In particular, the control unit can coordinate or control the distribution and division of the portions of respiratory gas enriched with inhalation substances into the patient's lung or via the oxygenation system into the patient's blood circulation on the basis of data which indicate a current lung state of the patient and are provided, for example, by a system for imaging and diagnosing heart and lung in the data network or network system. Thus, with systems of EIT diagnostics (EIT system), possible changes in the lung condition can be made visible continuously and promptly during therapy. Thus, effects of ventilation and the manner of combined use with the oxygenation system are timely visible and verified to the user. If, for example, data are provided by an EIT system in the network, which indicate a current state of a ventilation situation of the lung or changes, or a trend of the ventilation situation of the lung of the patient, then the control unit of the switching unit can control the distribution of the amounts of inhalation substances and / or amounts of oxygen into the blood circulation or the breathing circulation of the patient on the basis thereof.Thus, for example, in the case of a deteriorating aeration situation, i.e. with the EIT system, it can be determined that lung regions are either no longer adequately aerated (ventilation) or no longer adequately perfused (perfusion) or are neither adequately aerated nor adequately perfused, the control unit can cause the switching unit to carry out the distribution of the respiratory gas enriched with inhalation substances and optionally oxygen between respiratory gas dosing path and scavenging gas dosing path with an increase of the partial quantity of respiratory gas into the scavenging gas dosing path. In the case of an improvement in the situation of the patient's lung determined by means of the EIT system, for example as a result of a healthy condition or recovery of the patient's lung during the course of therapy, the control unit can cause the changeover unit to carry out the distribution of the respiratory gas enriched with inhalation substances and optionally oxygen between the respiratory gas dosing path and the purge gas dosing path with an increase in the partial quantity of respiratory gas into the respiratory gas dosing path.The present invention will now be explained in more detail with the aid of the following figures and the associated descriptions of figures without restrictions of the general inventive idea. The following are shown:FIG. 1 shows a first schematic illustration of a system for supplying inhalation substances,FIG. 2 shows a second schematic illustration of a system for supplying inhalation substances,FIG. 3 shows a third schematic illustration of a system for supplying inhalation substances.FIG. 1 shows a schematic representation of a patient 30 and a system 1000 for ventilation with oxygenation and decarboxylated with essential main components: ventilator as ventilation system 1, oxygenation system 2, respiratory gas dosing path 3, flushing gas dosing path 4, respiratory gas connection system 5, oxygenation connection system 6, dosing system 7, switching unit 8, gas extraction port 16, gas recirculation port 24, connection element 25 close to the patient, reflection unit 18, supply line 103 and at least one control unit 9 provided and designed for controlling the dosing system 7. The patient 30 is connected to the ventilation system 1 by means of the respiratory gas connection system 5 and the connection element 25 close to the patient fluidically by means of an endotracheal tube 33 and a airway access 32 for supplying and continuing respiratory gases. Alternatively to endotracheal tube 33, a nasal mask or a tracheostoma can also be used. The inhalation sedative system (SIS) 17 is substantially formed by the dosing system 7, the gas extraction connection 16 for extracting partial amounts of respiratory gas from the inhalation gas, the reflection unit 18 and the gas recirculation connection 24 for recirculating the partial amounts of respiratory gas from the switching unit 8 to the reflection unit 18. By means of a further component / further path of the respiratory gas connection system 5, a further quantity of respiratory gas not enriched with inhalation substances is directly supplied from the respiratory system 1 via the connection element 25 close to the patient to the airways 32 of the patient 30 via an endotracheal tube 33, nasal mask or tracheostoma. From the dosing system 7, the portion of respiratory gas enriched with inhalation substances reaches the changeover unit 8 by means of the supply line 103, From the changeover unit 8, the portion of respiratory gas enriched with inhalation substances is supplied to the airways 32 of the patient 30 by means of the respiratory gas dosing path 3 via the gas recirculation connection 24 on the connection element 25 close to the patient. From the changeover unit 8, the partial amount enriched with inhalation substances is fed to the oxygenation system 2 by means of the purge gas dosing path 4. The switching unit 8 enables the division and / or distribution of gas quantities enriched with inhalation substances into the respiratory gas dosing path 3 and the scavenging gas dosing path 4. quantities of blood enriched with inhalation substances are supplied from the oxygenation system 2 to the blood circulation of the patient 30 by means of a scavenging gas flowing in the scavenging gas dosing path 4 via the oxygenation connection system 6 and an invasive fluid access 31. A gas for blood exchange and a gas for blood exchange take place in the oxygenation system 2 on a membrane 35 arranged in the oxygenation system 2. Gas quantities enriched with oxygen O 2 and the inhalation substances from the oxygenation connection system 6 pass via a circulation of the membrane 35 into the blood circulation of the patient 30, and at the same time quantities of carbon dioxide CO 2 pass from the blood circulation of the patient 30 into the circulation gas dosing path 4.The ventilation system 1 is, in a conventional embodiment, part of a ventilator. Ventilation systems 1 for ventilators usually have means for supplying, supplying and continuing breathing gases and substances to and from the patient, for example means for gas mixture 67 and gas delivery 27, for example a gas mixer and at least one gas delivery unit (blower, blood, piston drive, valve arrangement), as well as means for supplying gas, such as a gas connection 60 for supplying gases, such as air and oxygen, for example, the breathing gas connection system 5, for example designed in the form of an inspiratory breathing tube and often also an expiratory breathing tube and the connection element 25-the patient-close connection element 25-the so-called Y-piece-for connecting the breathing tubes to endotracheal tube 33, breathing mask or tracheostoma. Furthermore, a ventilation system 1 has an exhalation valve (exhalation valve) 20, by means of which the exhalation gases returned to the ventilator 1 via the exhalation ventilation tube of the respiratory gas connection system 5 can then pass with the exhalation by the patient 30 via an exhaust gas outlet 300 into the environment or can be collected or carried away by means of a system for collecting and carrying away consumed gas quantities. In addition, alternative connecting elements 25 close to the patient are also known, which include an exhalation valve close to the patient. In addition to the ventilation system 1, conventionally designed ventilators also have elements-in particular a sensor system-for a measurement-technology detection of given and / or set pressures, flow quantities and further operating parameters of a mechanical ventilation with the supply of gases and gas mixtures. For a sequence of mechanical ventilation, at least the following parameters, such as inspiratory as expiratory ventilation pressures, ventilation frequency, inhalation to exhalation ratio, pressure upper and lower limits, flow rate upper and lower limits, volume upper and lower limits and gas concentrations, are set by a control unit 10 and / or monitored with the aid of the sensor system.For reasons of clarity, this sensor system is not also shown in the illustration 1000 in this FIG. 1. The dosing system 7 is designed for automated dosing by means of a control unit 12 and a dosing element 101 to dose a predetermined amount of the substances and / or volatile anesthetic from a reservoir 100 with inhalation substances and / or volatile anesthetic agent to the partial amount of inhalation gas into the feed line 103.An anesthetic heater 102 can be activated by the control unit 12 in order to convert inhalation substances present in liquid form in the reservoir 100 into a gaseous aggregate state. An alternative embodiment variant for manual metering or gas mixing would be an arrangement of so-called flow tubes, which in the interaction of needle valves and float flow meters arranged in a riser tube can enable gas mixing and / or metering of inhalation substances or anesthetic agents.The switching unit 8 is configured by means of the control unit 9 to distribute or divide the quantity of the gas enriched with inhalation substances into the supply line 103 to the oxygenation system 2 or to the connection element 25 close to the patient.The connecting element 25 close to the patient and the reflection unit 18 are shown in this FIG. 1 together with the gas recirculation connection 24 as a common unit. In practical embodiments, the connecting element 25 close to the patient, the reflection unit 18, the gas recirculation connection 24 and the gas extraction connection 16 can be configured as a common structural unit, for example integrated into the connecting element 25 close to the patient.The control units 9, 10, 11, 12 can be modular or can be designed as a common control unit, as can also form a central control unit 15 (FIG. 2 ) of the system 1000 or system 2000 (FIG. 2 ). In the ventilation system 1, a mixing of gases provided by means of a gas connection 60 takes place by means of the gas mixer 67. The gases oxygen and medical air are supplied to the gas connection 60, usually by means of a central gas supply unit (ZV). A total quantity of respiratory gas reaches the patient 30 from the respiratory system 1 via the respiratory gas connection system 5.In the ventilation system 1, a control of a gas delivery unit 27 or an alternatively usable piston drive takes place by means of a control unit 10, in order to carry the respiratory gas to the patient 30, and the continuation of used respiratory gases from the patient 30. The control unit 10 controls the sequence of the ventilation with inspiratory and expiratory ventilation pressures, tidal volumes, flow rates and further ventilation settings by means of an exhalation valve (exhalation valve) 20 and the gas delivery unit 27. The respiratory gas connection system 5 consists of an inspiration ventilation tube for supplying the respiratory gas and an expiration ventilation tube for continuing the used exhalation gases of the patient 30, which are connected to one another for connecting the patient 30 by means of the connection element 25 close to the patient, the so-called Y-piece. The setting and display elements, sensors for pressure and flow measurements, valves, check valves and further components required for monitoring the ventilation system 1 and carrying out the ventilation are not shown as well in this FIG. 1 for reasons of clarity. The patient 30 is connected to the oxygenation system 2 by means of the oxygenation connection system 6 for delivery and delivery of blood quantities into the blood circulation via an invasive fluid access 31. The connection of the patient 30 to the oxygenation system 2 can be effected via a fluid connection 37, which is configured for pumpless extracorporeal membrane oxygenation. In this case, the transport of the blood quantities to the patient 30 and away from the patient 30 takes place in such an embodiment by the pumping capacity of the heart of the patient himself. This embodiment is referred to as pumpless extracorporeal membrane oxygenation (pECLA). The connection of the patient 30 to the oxygenation system 2 is usually effected, however, by means of a blood delivery unit 36, usually designed as a pump. From the changeover unit 8, the gas enriched with inhalation or volatile substances or anesthetic agents reaches, as purge gas, by means of the purge gas metering path 4, a gas connection 34 on the oxygenation system 2. the oxygenation system 2 monitors, by means of a control unit 11, a flow rate and flow rate of the inflow of purge gas to the membrane 35. In this way, a blood-to-gas exchange takes place outside the body (extracorporeal). The setting and display elements, sensors for pressure and flow measurements, valves and further components which are furthermore required for monitoring the oxygenation system 7 and carrying out the extracorporeal enrichment with oxygen (oxygenation) and removal of carbon dioxide (decarboxylated) are not also shown in this FIG. 1 for reasons of clarity. As further components of the system 1000, an optional process gas analysis unit 21 (PGA) assigned to the oxygenation system 2 for an analysis of the gas composition of the purge gas is shown. In addition to the metrological elements for determining gas concentrations, the process gas analysis unit 21 also has elements for display and display-not shown in FIG. 1-as well as operating elements which enable a user to read and operate. The process gas analysis unit 21 assigned to the oxygenation system 2 is designed for an analysis of the gas composition of the purge gas. The purge gas is supplied to the process gas analysis unit 21 and is analyzed in the process gas analysis unit 21 in order to monitor the ratios of carbon dioxide and oxygen at the membrane 35, in this way to determine the gas exchange and the transfer rate between the blood circulation and the purge gas and then to provide an adequate control of oxygenation and decarboxylatement for the patient by means of the control unit 11. Consumed gas quantities are continued from the oxygenation system 2 and from the ventilation system 1 via valve arrangements provided accordingly thereto and not shown in this FIG. 1 via the exhaust gas outlet (waste) 300 from the system 1000. Usually, these consumed gas quantities are introduced by means of an anesthetic gas transfer system from the anesthetic device into the infrastructure of the hospital and are then disposed of therein in a correspondingly expert manner. Depending on the division into the breathing circuit or into the blood circuit, the execution with the system 1000 for supplying substances of oxygenation and decarboxylated takes place inhalatively simultaneously with the execution of the ventilation with a gas-to-blood exchange in the lung of the patient 30 and / or extracorporeally with a gas-to-blood exchange on the membrane 35 of the oxygenation system 2. the ratio between inhalation and extracorporeal administration of the inhalation substances can be adjusted for the user via the changeover unit 8. As support, the measured values and status values of the process gas analysis unit (PGA) 21 of the oxygenation system 2 are available to the user.Data interfaces 211 can be provided on ventilation system 1, oxygenation system 2, dosing system 7, switching unit 8, which can allow a uni-directional and / or bi-directional data exchange between ventilation system 1, oxygenation system 2, dosing system 7, switching unit 8, and inhalation sedative system (SIS) 17. Such a data exchange is preferably organized, initiated or coordinated in the interaction and communication of the control units 9, 10, 11, 12 in the ventilation system 1, oxygenation system 2, inhalation sedative system (SIS) 17, dosing system 7, switching unit 8. The data interfaces are connected to one another by means of data lines 210 (FIG. 2 ) which are not shown in this FIG. 1 for reasons of clarity of the drawing. A further central control unit 15 (FIG. 2 )-not shown in this FIG. 1-can also be arranged in the system 1000 as well as in the systems 2000 (FIG. 2 ) and 3000 (FIG. 3 ) and be provided to coordinate the interaction in the system 1000 of the ventilation system 1, oxygenation system 2, inhalation sedative system (SIS) 17, dosing system 7, switching unit 8, optionally also with further components 212, 213 (FIG. 2 ) database, server, router, access point, hub) in a data network 212 (FIG. 2 ) (LAN, WLAN, Bluetooth, PAN, Ethernet) or network system via data lines 210 (FIG. 2 ).FIG. 2 shows a system 2000 with possibilities for extended embodiments of the system 1000 for ventilation with oxygenation and decarboxylated according to FIG. 1. Like components in Fig. 1 and Fig. 2 are denoted by like reference numerals in Figs. 1 and 2.In addition to the elements and components 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 16, 17, 18, 20, 21, 24, 25, 27, 30, 31, 32, 33, 34, 35, 36, 37, 60, 67, 100, 101, 102, 103, 211, 300 shown and described in FIG. 1, further features and components 15, 19, 22, 23, 26, 28, 38, 39, 70, 75, 210, 212, 213 are present in the extended system 2000 according to FIG. 2.In further embodiments of the systems 1000 (FIG. 1 ), 2000, 3000 (FIG. 3 ), the changeover unit 8, the respiratory gas dosing path 3, the connecting element 25 close to the patient, the gas extraction connection 16, the gas recirculation connection 24, the flushing gas dosing path 4 and the control unit 9 can form a common structural unit to form a gas division unit. Thus, the extended system 2000 has a further gas conveying unit (blower, Blower) 38 and a flushing gas absorber unit (carbon dioxide absorber) 39 in the oxygenation system 2. The further gas delivery unit 38, as well as the purge gas absorber unit 39, can also be embodied jointly or separately as independent units or modules, so that the gas division unit can be extended by the gas delivery unit 38 and / or the purge gas absorber unit 39. The extended system 2000 shows a measurement gas line (sample line) 26, which can be connected to or connected to the connecting element 25 close to the patient and through which samples of the breathing gas given to the patient 30 can be fed to a further process gas analysis unit 23 or blood gas analysis unit 23, so that the process gas analysis unit 23 or blood gas analysis unit 23 is capable of determining concentrations of oxygen, carbon dioxide or inhalation substances, for example anaesthetics (anaesthetic agents), by measurement technology, and of determining measured values which indicate these concentrations and providing them for the control of the system 2000. For further analysis, the extended system 2000 can also have a blood gas analysis unit (BGA) 22 for analyzing blood gases in the blood of the patient 30 in the oxygenation system 2. Blood gas analysis provides information regarding a gas distribution (partial pressure) of O 2( oxygen), CO 2( carbon dioxide), as well as the pH and acid-base balance in the blood of the patient 30, for example. Such a blood gas analysis unit 22 (BGA) can be arranged in combination with the process gas analysis unit (PGA) 21 as a module, for example as a type of plug-in module in the oxygenation system 2. The blood gas analysis unit 22 (BGA) and the process gas analysis unit (PGA) 21 can also be configured jointly or separately as independent units or modules, which can be connected to the oxygenation system 2 as external modules, for example. The switching unit 8 and the dosing unit 7 can also be embodied in a common structural unit, so that the process gas analysis unit 23 or the blood gas analysis unit 23 can then also be arranged within the common structural unit both in or on the dosing unit 7 and the switching unit 8. The configuration of a common structural unit with an arrangement of process gas analysis unit or blood gas analysis unit is not shown in this FIG. 2 for reasons of clarity. The extended system 2000 shows as a further component a moistening and / or heating system 75 for the temperature control of respiratory gases in the respiratory gas connection system 5.FIG. 3 shows a system 3000 with extensions of the configurations of the systems 1000, 2000 for respiration with oxygenation and decarboxylated according to FIG. 1 or 2. Like components in FIGS. 1, 2, 3 are denoted by like reference numerals in FIGS. 1, 2 and 3. In addition to the elements and components 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 60, 67, 70, 75, 100, 101, 102, 103, 210, 211, 212, 213, 300 shown and described with respect to the system 2000 (FIG. 2 ) in FIG. 2, further components 19, 29 are present in the extended system 3000 according to FIG. 3. Thus, the changeover unit 8 has a mixing chamber 19. This mixing chamber 19 is designed and provided for the purpose of receiving at least partial amounts of the exhalation gases of the patient 30, instead of having these flow-as shown in the embodiments according to FIGS. 1 and 2-from the exhaust gas outlet 300 into the environment, by means of an exhaust line 29 in this mixing chamber 19 of the changeover unit 8. From the mixing chamber 19 of the changeover unit 8, these partial amounts of exhalation gases can then be conducted to the changeover unit 8 together with the amounts of breathing gas, which are supplied by the metering system 7 by means of the supply line 103 and enriched with inhalation substances, and then are supplied to the oxygenation system 2 via the flushing gas connecting path 4. In the oxygenation system 2, the concentration of carbon dioxide in the gas mixture is reduced by the purge gas absorber unit 39, and the amount of inhalation substances remaining after exhalation by the patient can be supplied via the oxygenation system 2 again by means of the oxygenation connection system 6. In this way, depending on the selected division of the gas quantities with inhalation substances between oxygenation system 2 and ventilation system 1 by switching unit 8, it is possible to use again partial quantities of the inhalation substances still present in the exhalation gas of patient 30 in the oxygenation system for extracorporeal gas exchange, at least during defined time segments during the course of the ventilation by ventilator 1, instead of having to flow into the environment via the exhaust gas outlet or to have to dispose of them by means of a continuation or collection system (AGS: Anesthesia Gas Scavenger, ORS: Open Reservoir Scavenger). Thus, the exhaust gas line 29 at least partially gives rise to the possibility of not having to continuously supply quantities of inhalation substances in the exhalation gas for disposal, but instead to the possibility of reutilizing these quantities of inhalation substances. In particular, if the switching unit 8 is set such that the distribution of inhalation gas enriched with inhalation substances flows essentially via the flushing gas dosing path to the oxygenation system 2, a considerable proportion of the residual amounts of inhalation substances in the exhalation gas returned to the ventilator in the exhalation gas can then be recycled in the oxygenation system 2. If an optional further absorber unit is introduced into the exhaust gas line 29, into the mixing chamber 19 of the changeover unit 8 or in the changeover unit 8, this allows carbon dioxide to be removed from the exhalation gas, so that even independently of breathing phases or the respective setting of the division into breathing gas metering path 3 and flushing gas metering path 4 during operation after the CO 2- removal, there is a possibility of continuous renewed utilization of the remaining amounts of inhalation substances returned to the ventilator with the exhalation gas in the oxygenation system 2.In the extended systems 2000, 3000 according to FIGS. 2 and 3, a further process gas gas analysis unit (PGA) 23 can additionally have, for example arranged on the changeover unit 8 or on the metering unit 7 for analyzing the gas 103 in the oxygenation metering path and / or in the respiratory gas metering path 3, purge gas metering path 4 or from the metering unit 7. Information regarding the dosage and setting of anesthetic dosage 100, 101, 102 can thus be tested by measurement technology in gas 103 by means of concentration determination. Depending on the adjusted division of the gas 103 into the breathing circuit or into the blood circuit to the switching unit 8, the gas in the breathing gas dosing path 3 and in the flushing gas dosing path 4 has different concentrations of oxygen. The further process gas gas analysis unit (PGA) 23 can be useful for monitoring this difference by measurement technology. In such a mode of operation, the performance with the respiratory system 1 of anaesthesia takes place with the supply of volatile anaesthetics (anaesthetic agents) and also with the supply of further substances, preferably volatile substances, inhalationally simultaneously with the performance of ventilation with a gas-to-blood exchange directly in the lung of the patient 30 or extracorporeally with a gas-to-blood exchange at the membrane 35 of the oxygenation system 2, indirectly 5, 32, 33 to the lung of the patient 30 and indirectly 6, 31 into the blood circulation of the patient 30, depending on the desire of the user with different concentrations of oxygen in the respiratory gas.The systems 1000, 2000, 3000 shown in FIGS. 1 to 3 can be connected to the further medical devices or systems, for example to process gas gas analysis units (PGA) 20, 21, 23, blood gas analysis units (BGA) 22, the physiological patient monitoring system (PPM) 40 and the system 50 for imaging and diagnosing heart and lung 50, for interaction and for joint system operation by means of the data interfaces 211, data lines 210 in the data network 212. For example, system 1000 and augmented systems 2000, 3000 may include physiological patient monitoring (PPM) system 40. Such a physiological patient monitoring system 40 has displays and representations of acquired, determined, analyzed or calculated physiological measurement data and / or parameters. These include, for example, measurement-technology acquisitions of ECG by means of ECG electrodes on the upper body of the patient and ECG cables, acquisition of oxygen saturation (SPO 2), for example on a finger of the patient 30, acquisition of a non-invasive blood pressure measurement value by means of a blood pressure cuff on the upper arm of the patient 30, acquisition of an invasive blood pressure measurement value by means of an invasive access point on the hand of the patient 30, and also a body temperature, for example a skin temperature or a body core temperature of the patient 30. Via an optional connection for gas extraction at the Y-piece 25 and / or a further measurement gas line, gas samples can be conducted to a system 40, not shown in detail in FIGS. 2 and 3, for physiological patient monitoring and gas analyses can be carried out therein, For example, concentrations of carbon dioxide, methane or analyses with respect to further constituents, such as, for example, alcohols (ethanol) of the exhalation gas. Thus, the control unit 12 in the dosing system 7 can be configured to control the amount of inhalation substances 100 as a function of the data provided in the data network 212 or network network system and / or as a function of the data provided by one of the control units 9, 10, 11, 15. Thus, for example, the metered addition of the amounts of metered inhalation substance 1000 by the metering system 7 can be effected as a function of an oxygen or carbon dioxide partial pressure in the blood, the acid-base household or pH value of the blood, concentrations of oxygen and carbon dioxide in the respiratory gas or blood pressure, heart rate, ECG. The system 1000 and the extended systems 2000, 3000 can also have a system 50, not shown in detail in FIGS. 2 and 3, for imaging and diagnosing heart and lung. Systems 50 for imaging and diagnosing heart and lung are configured, for example, as devices for computed tomography (CT diagnostics), magnetic resonance tomography (MRT diagnostics), X-ray devices (X-ray diagnostics), devices for electrical impedance tomography (EIT diagnostics, EIT system) or devices for ultrasonic diagnostics (US diagnostics, sonography, Doppler sonography). The heart and lung imaging and diagnostic system 50 can provide the user with valuable information as to which disease or recovery state the patient's 30 lung is in.Based thereon, the user may configure the systems 1000, 2000, 3000 to inhalatively locate the center of gravity of delivering oxygen to the patient 30 via the path across the lung or by extracorporeal membrane oxygenation (ECMO) invasively via the path across the blood circuit. In particular, devices for electro-impedance tomography (EIT diagnostics) make possible, in contrast to CT diagnostics, X-ray diagnostics, MRT diagnostics, US diagnostics, continuous imaging of the lung, thorax and heart. Thus, with systems 50 of EIT diagnostics (EIT system), possible changes in the lung condition can be made visible continuously and promptly during therapy. Thus, effects of ventilation and the manner of combined use with the oxygenation system are timely visible and verified to the user. If, for example, data are provided by an EIT system 50 in the network 212 which indicate a current state of a ventilation situation of the lung or changes, or a trend of the ventilation situation of the lung of the patient 30, then the control unit 9 of the switching unit 8 can control the distribution of the amounts of inhalation substances 100 and / or amounts of oxygen into the blood circulation or the breathing circulation of the patient 30 on the basis thereof. Thus, for example, in the case of a deteriorating aeration situation, i.e. with the EIT system 50, it can be determined that lung regions are either no longer adequately aerated (ventilation) or no longer adequately perfused (perfusion) or are neither adequately aerated nor adequately perfused, the control unit 9 can cause the switching unit 8 to perform the distribution of the breathing gas enriched with inhalation substances 100 between breathing gas dosing path 3 and flushing gas dosing path 4 with an increase of the partial amount of breathing gas into the flushing gas dosing path 4. In the event of an improvement in the situation of the lung of the patient 30 determined by means of the EIT system 50, for example as a result of a healthy condition or recovery of the lung of the patient 30 during the course of the therapy, the control unit 9 can cause the changeover unit 8 to carry out the distribution of the respiratory gas enriched with inhalation substances 100 between the respiratory gas dosing path 3 and the flushing gas dosing path 4 with an increase in the partial quantity of respiratory gas into the respiratory gas dosing path 3.List of Reference Numbers1 Ventilation system (BS), ventilator 2 oxygenation system (OS) (oxygenator) 3 respiratory gas dosing path 4 flushing gas dosing path 5 respiratory gas connection system 6 oxygenation connection system 7 dosing system (DS) 8 switching unit 9 control unit, control module (μC 1) of the switching unit 10 control unit, control module (μC 2) of the ventilator / ventilation system 11 control unit, control module (μC 3) of the oxygenation system (OS) 12 control unit, control module (μC 4) of the dosing system (DS) 15 external control unit, external control module (μC M) 16 gas withdrawal connection for respiratory gas, inhalation gas 17 system for inhalation sedative (SIS) 18 reflection unit (CR), element for anesthetic gas recovery, anesthetic gas reflector 19 mixing chamber at switching unit 20 exhalation valve of ventilator 21 process gas analysis (PGA, PGA-OS) of oxygenation system 22 blood gas analysis (BGA) of oxygenation system 23 process gas analysis (PGA, PGA-DS, PGA-SIS) of dosing system 24 gas recirculation connection for respiratory gas, inhalation gas, 25 connecting element (Y-piece) 26 close to the patient, measurement gas line 27 gas delivery unit (blower, blood, piston drive) in the ventilation system 28, filter element for moisture recovery (HME filter) 29 exhaust gas line for exhalation gas 30 patient, living beings 31 invasive fluid access to the blood circuit of the patient 32 airway access, access to the airways of the patient 33 endotracheal tube, alternatively nasal mask or tracheostoma 34 gas connection to the oxygenation system 35 membrane, blood<->gas exchange membrane, oxygenator membrane 36 fluid connection to blood delivery unit (pump) 37 fluid connection in pumpless extracorporeal membrane oxygenation 38 further gas delivery unit (blower, Blood) in or on the oxygenation system 39 purge gas absorber unit, carbon dioxide absorber (CO 2- Remove) in the oxygenation system 40 physiological patient monitoring system (PPM) 50 heart and lung imaging and diagnostic system 60 gas connection for supplying gases (oxygen, air) to the ventilator 67 gas mixer for mixing gases (oxygen, oxygen, oxygen, and the like, Air) in ventilator 70 Heating system for blood quantities at oxygenation connection system 75 Moistening / heating system for breathing gas at breathing gas connection system 100 Reservoir (anesthetic tank) for inhalation substances or anesthetic 101 Dosing element 102 Anesthetic heating 103 Supply line for providing the gas mixture to switching unit 8 210 Data lines, data connections, data nodes 211 Data interfaces, data nodes, data coordination (switch, hub, router) 212 Network network system, data network (LAN, WLAN, Bluetooth, PAN, Ethernet), 213 Components in the data network (database, server, router, access point, Lift) 300 exhaust outlet (waste) 1000 system (FIG. 1 ) 2000 extended system (FIG. 2 ) 3000 extended system (FIG. 3 )

Claims

A gas division unit (3, 4, 8, 9, 16, 25) for a system for breathing and oxygenation of a patient (30) has, in a common structural unit: - a changeover unit (8), - a breathing gas dosing path (3), - a connecting element (25) close to the patient, - a gas extraction connection (16) for extracting partial amounts of breathing gas from the inhalation gas, - a gas recirculation connection (24) for inhalation gas and - a flushing gas dosing path (4), - a control unit (9), wherein the gas division unit (3, 4, 8, 9, 16, 25) designed as a common structural unit has connections for connection to an oxygenation system (2), a dosing system (7), a ventilation system (1) and the patient (30), wherein the connecting element 25 close to the patient, the reflection unit 18, the gas recirculation connection 24 and the gas extraction connection 16 are designed as a common structural unit integrated into the connecting element 25 close to the patient, wherein the switching unit (8) is designed to divide and / or distribute amounts of gas enriched with inhalation substances (100) into the respiratory gas dosing path (3) and the scavenging gas dosing path (4), wherein the switching unit (8) is designed to supply and provide a partial amount of respiratory gas enriched with the inhalation substances in airways of the patient (30) by means of the respiratory gas dosing path (3) and by means of the connecting element (25) close to the patient, wherein the switching unit (8) is designed to supply and provide an partial amount of respiratory gas enriched with the inhalation substances to an oxygenation system (2) by means of the scavenging gas dosing path (4), wherein the control unit (9) is designed to control the switching unit (8), wherein the control unit (9) is designed to control the dosage of inhalational substances.The gas separation unit (3, 4, 8, 9, 16, 25) according to claim 1, wherein a further absorber unit for removing carbon dioxide from the purge gas is arranged in the purge gas dosing path (4).The gas separation unit (3, 4, 8, 9, 16, 25) according to claim 1 or claim 2, wherein a gas delivery unit (38) for transporting purge gas is arranged in the gas separation unit (3, 7, 8, 9, 18, 24, 25) or in the purge gas dosing path (4).Gas division unit (3, 4, 8, 9, 16, 25) according to one of Claims 1 to 3, wherein a moistening / heating system (75) is arranged in or on the gas division unit, in or on the changeover unit (8), in or on the connecting element (25) close to the patient.Gas division unit (3, 4, 8, 9, 16, 25) according to one of Claims 1 to 4, wherein a mixing chamber (19) for supplying exhalation gases from the patient (30) by means of an exhaust line (29) is arranged in or on the gas division unit (3, 4, 8, 9, 16, 25).Gas division unit (3, 4, 8, 9, 16, 25) according to one of the preceding claims, wherein the gas division unit (3, 4, 8, 9, 16, 25) has a connection for a measurement gas line (26) which is provided for connection to a process gas analysis unit (21).Gas division unit (3, 4, 8, 9, 16, 25) according to one of the preceding claims, wherein a process gas analysis unit (21) is assigned to the gas division unit (3, 4, 8, 9, 16, 25).The gas division unit (3, 4, 8, 9, 16, 25) according to one of the preceding claims, wherein a system (40) for physiological patient monitoring is assigned to the gas division unit (3, 4, 8, 9, 16, 25).Gas division unit (3, 4, 8, 9, 16, 25) according to one of the preceding claims, wherein a system (50) for imaging and diagnosing heart and lung is assigned to the gas division unit (3, 4, 8, 9, 16, 25).Gas division unit (3, 4, 8, 9, 16, 25) according to one of the preceding claims, wherein the control unit (9) is designed to control the distribution and / or the division of the amount of inhalation substances into the flushing gas dosing path (4) towards the oxygenation system (2) and the breathing gas dosing path (3) towards the connection element (25) close to the patient or towards a reflection unit (18) as a function of provided data (210, 211, 212).The gas division unit according to claim 10, wherein the control unit (9) is configured to perform the control of the distribution and / or division depending on data (210, 211, 212) indicating a current lung condition of the patient (30).

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