Systems for delivery of therapeutic gas to patients in need thereof using enhanced breathing circuit gas (bcg) flow measurement

The present invention generally relates to systems and methods of supplying therapeutic gas to a patient in need using flow measurement of accelerated respiratory circuit gas (BCG).

The therapeutic gas can be supplied to the patients who need it to provide medical benefits. One of the therapeutic gases is nitric oxide (NO) gas, which functions to dilate blood vessels in the lungs when infected by air, improving the oxygen supply of the blood and lowering pulmonary hypertension. At least for this reason, nitric oxide can be provided to patients with pulmonary hypertension as a therapeutic gas in respiratory gas.

Many of these patients who benefit from nitrogen monoxide are equipped with a ventilator (eg, constant-flow ventilator, variable-flow ventilator, high-frequency ventilator, biphasic positive pressure ventilator, or BiPAP). Receives breathing gas from the breathing circuit. To provide nitric oxide to the patient receiving the respiratory gas from the ventilator, nitric oxide can be injected into the respiratory gas flowing in the respiratory circuit. When using this technique, the prescribed dose of nitric oxide is based on the concentration of nitric oxide in the respiratory gas, for example, after injecting and / or mixing nitric oxide into the respiratory gas.

The above-mentioned and similar techniques of delivering nitric oxide into the respiratory gas flowing through the respiratory circuit can present a great challenge. For example, providing patients with accurate and / or precise nitric oxide doses is a major challenge, and respiratory gases can have unknown and / or indefinite flow profiles. This makes it very difficult to accurately and / or precisely deliver nitric oxide to a patient in a predetermined amount so that nitric oxide is delivered at a predetermined concentration (eg, a set dose). In addition, it is very important to deliver nitric oxide at a given dose, for example, administration can have a significant impact on safety and efficacy.

Therefore, it is necessary to at least provide the patient with an accurate and / or precise dose of nitric oxide, for example, the patient is receiving respiratory gas from a ventilator-equipped respiratory circuit.

<p> Aspects of the invention relate to an infusion module (eg, from a nitric oxide supply system) that supplies nitric oxide into the exhaled portion of a respiratory circuit (with a ventilator). In one or more embodiments, the infusion module has and / or communicates with a bidirectional breathing circuit gas (BCG) flow sensor, and the bidirectional breathing circuit gas (BCG) flow sensor is a forward flowing breathing gas and Respiratory gas flowing in the opposite direction can be measured. Using the information communicated from this bidirectional BCG flow sensor and / or bidirectional BCG flow sensor to the nitric oxide supply system, the nitric oxide supply system can accurately supply NO through the injection module and the therapeutic gas. Can be avoided and / or reduced when and / or after supply into the respiratory gas.</p><p> In an exemplary embodiment, aspects of the invention can improve the ability of the respiratory circuit to detect flow profile, and / or the nitric oxide supply correction algorithm can be used in at least some aspects of the respiratory circuit gas flow profile. Control can be reduced and / or reduced. This can be time to improve patient safety, reduce the likelihood of user errors (eg, incorrect check values), and / or provide additional benefits.</p><p> The bidirectional BCG flow sensor can be used to address at least the reverse BCG flow phenomenon discovered herein.</p><p> Thus, one aspect of the invention relates to a method of administering a therapeutic gas to a patient; this method; the flow rate of the respiratory gas through and / or in the fluid connection with a ventilator-equipped respiratory circuit. The flow rate is forward when flowing from the ventilator to the ventilator and reverse when flowing from the ventilator to the ventilator; It has a step of defining the flow rate and supplying the therapeutic gas into the respiratory circuit gas; it has a step of defining a reverse respiratory gas circuit and stopping the supply of the therapeutic gas into the respiratory circuit gas; It has the step of defining the recovered breathing circuit gas in the forward direction and restoring the therapeutic gas to the supply in the breathing circuit gas, which recovers after compensating for at least some reverse flow rates.</p><p> In one or more embodiments, the step of compensating for at least a portion of the reverse flow rate is to bring the therapeutic gas into the respiratory circuit gas until the measured amount of forward flow rate is equal to the measured reverse flow rate. Has steps not to supply.</p><p> In one or more embodiments, the step of compensating for at least a portion of the reverse flow rate comprises comparing the volume of the reverse flow rate with the dead space volume and the measured amount of forward flow rate. It has a step of not supplying therapeutic gas into the respiratory circuit gas until (i) equals the measured reverse flow rate or (ii) the smaller dead space volume. In some embodiments, the dead space volume is entered by the user and / or communicated from the ventilator.</p><p> In one or more embodiments, the method optionally further directs the user to and from at least one bidirectional BCG flow sensor for measuring the flow of the patient and respiratory circuit gas. It has the step of adding a segment of the respiratory circuit.</p><p> In one or more embodiments, the method further comprises receiving and / or defining information indicating the type of ventilator. In one or more embodiments, the step of receiving and / or defining the type of ventilator is whether the ventilator is a BiPAP ventilator and / or a single-limb breathing circuit. Has a step of receiving and / or defining; the step of correcting at least a portion of the flow in the reverse direction is whether the ventilator is a BiPAP ventilator and / or of a single limb. Based on the steps of receiving and / or defining whether to attach a breathing circuit.</p><p> In one or more embodiments, when the ventilator is a BiPAP ventilator and / or attaches a single-limb breathing circuit, the step of compensating for at least a portion of the flow in the reverse direction is It has a step of not supplying therapeutic gas into the respiratory circuit gas until the measured forward flow rate is equal to at least a portion of the measured reverse flow rate. In one or more embodiments, the step of not supplying therapeutic gas into the respiratory circuit gas until the amount of measured forward flow is equal to at least a portion of the measured reverse flow is the measured forward flow. It has a step of not supplying therapeutic gas into the respiratory circuit gas until the amount of is (i) equal to the measured reverse flow rate or (ii) the smaller dead space volume.</p><p> In one or more embodiments, when the ventilator is a BiPAP ventilator and / or attaches a single-limb breathing circuit, the step of compensating for at least a portion of the flow in the reverse direction is The step of correcting at least a portion of the flow in the reverse direction includes a step of not supplying the therapeutic gas into the respiratory circuit gas until the measured amount of forward flow is equal to the measured reverse flow.</p><p> In some embodiments, flow measurements are performed from a ventilator.</p><p> In one or more embodiments, the method further comprises the step of measuring carbon dioxide in at least a portion of the measured reverse flow rate. In some embodiments, the steps of compensating for at least a portion of the reverse flow rate include carbon dioxide-containing step of supplying therapeutic gas into the respiratory circuit gas for the measured reverse flow rate and carbon dioxide-free. It has a step of not supplying therapeutic gas into the respiratory circuit gas for the measured reverse flow rate.</p><p> In one or more embodiments, the flow rate of the breathing circuit through and / or in the fluid connection with the breathing circuit equipped with an artificial respirator is measured by at least one bidirectional BCG flow sensor and also The bidirectional BCG flow sensor has (i) an operating range of forward flow that is greater than the operating range for reverse flow, and (ii) a separate calibration dataset and / or calibration routine for forward and reverse flow. Have one or more of them.</p><p> Another aspect of the invention relates to a nitric oxide supply system. In various embodiments, the nitric oxide supply system has an infusion module that supplies the physiotherapy gas into the respiratory gas in the respiratory circuit. This injection module; has an injector body with a first opening and a second opening, the first opening and the second opening are configured so that the injection module joins the patient's breathing circuit; therapeutic gas. It has an inlet, the therapeutic gas inlet is configured to receive the therapeutic gas and allow the therapeutic gas to be injected into the respiratory circuit gas flowing through the injection module; it also has at least one bidirectional BCG flow sensor, both. The forward BCG flow sensor can measure the respiratory circuit gas flow in the forward and reverse directions. The nitric oxide supply system also has a control module that provides the therapeutic gas at the therapeutic gas inlet, which communicates with at least one bidirectional BCG flow sensor. In one or more embodiments, when at least one bidirectional BCG flow sensor measures flow in the opposite direction, no therapeutic gas is supplied into the breathing circuit through the therapeutic gas inlet, and at least When one bidirectional BCG flow sensor measures the flow rate in the reverse direction and then measures the flow rate in the forward direction, the therapeutic gas is supplied into the breathing circuit after correcting at least a part of the flow rate in the reverse direction.</p><p> In one or more embodiments, the step of compensating for at least a portion of the reverse flow rate supplies therapeutic gas into the respiratory circuit until the measured forward flow rate is equal to the measured reverse flow rate. Have no steps.</p><p> In one or more embodiments, the steps of compensating for at least a portion of the reverse flow rate are the step of comparing the volume of the reverse flow rate to the volume of the dead space and the measured amount of forward flow rate. It has (i) a step of not supplying therapeutic gas into the breathing circuit until it is equal to (i) the measured reverse flow rate or (ii) the smaller dead space volume.</p><p> In one or more embodiments, information about bidirectional BCG flow is used by the nitric oxide supply system to ensure that a given dose of NO is delivered within the infusion module and then into the respiratory circuit. ..</p><p> In one or more embodiments, information about bidirectional BCG flow is used by the nitric oxide supply system and is not over-supplied, not over-supplied, and supplied with a given dose of NO. / Or to be administered.</p><p> In one or more embodiments, the at least one bidirectional BCG sensor is a thermomass flow meter.</p><p> In one or more embodiments, at least one bidirectional BCG flow sensor measures flow without interfering with flow in the patient's respiratory circuit.</p><p> In one or more embodiments, at least one bidirectional BCG flow sensor has a very fast response time of less than about 2 ms and provides low flow resistance in the patient's respiratory circuit, which is 1 minute. Approximately 150 pascals per 60 standard liters or 1.5 cmH at approximately 60 standard liters per minute₂Lower than O.</p><p> In one or more embodiments, the nitrogen monoxide supply system further comprises a carbon dioxide sensor, which is one or more of the following, (i) in fluid connection with the injection module. And / or exist in the connection between the breathing circuit and the sample line, (ii) exist in and / or there in the connection between the infusion module and / or the breathing circuit and the sample line. In one or more embodiments, the steps of compensating for at least a portion of the reverse flow rate include supplying the therapeutic gas into the respiratory circuit for the measured reverse flow rate, including carbon dioxide, and carbon dioxide. It has a step of not supplying therapeutic gas into the respiratory circuit gas for the measured reverse flow rate, which does not include.</p><p> In one or more embodiments, the bidirectional BCG flow sensor has one or more of the following, (i) a forward flow operating range greater than the reverse flow operating range and (ii) forward And have separate calibration datasets and / or calibration routines for reverse flow rates.</p><p> Another aspect of the invention relates to a nitric oxide supply system, which has at least one sensor capable of measuring at least one characteristic of the respiratory circuit gas. In one or more embodiments, at least one property is one or more of the following: (i) forward and reverse breathing circuit gas flow rate, (ii) breathing circuit gas humidity. , (Iii) the temperature of the breathing circuit gas, (iv) the type of gas in the breathing circuit gas. The nitrogen monoxide supply system can also have an infusion module that supplies the therapeutic gas into the respiratory gas in the respiratory circuit; the infusion module has an injector body with a first opening and a second opening; The first and second openings are configured so that the infusion module joins the patient's breathing circuit; has a therapeutic gas inlet, the therapeutic gas inlet receives the therapeutic gas, and the therapeutic gas flows through the infusion module. It is configured so that it can be injected into the respiratory circuit gas. The nitric oxide supply system can also have a control module for delivering the therapeutic gas to the therapeutic gas inlet, the control module communicating with at least the sensor, and the control module compensating for the therapeutic gas supply. And / or issue an alarm based on measurements from at least one sensor.</p><p> In one or more embodiments, at least one sensor is part of the infusion module, or is present in a fluid connection with the infusion module, and the infusion module is improperly installed in the breathing circuit and the control module. When is defined, the control module issues an alarm.</p><p> In one or more embodiments, at least one sensor can measure the flow rate of respiratory circuit gas in the forward and reverse directions, and the amount of reverse flow is greater than or greater than the amount of forward flow. If equal, the control module defines the infusion module to be improperly installed in the breathing circuit. In some embodiments, if the amount of reverse flow is greater than or equal to the amount of forward flow, the control module defines that the injection module is installed in the reverse direction, and the control module also defines reverse flow. And correct for this direction by switching measurements for forward flow.</p><p> In one or more embodiments, at least one sensor can measure the humidity of the respiratory circuit gas, and if the relative humidity of the respiratory circuit gas is 60% or greater, the control module will allow the injection module to breathe. Defined as improperly installed in the circuit. In some embodiments, the at least one sensor has a humidity sensor and / or a heat conductive sensor.</p><p> In one or more embodiments, at least one sensor can measure the temperature of the breathing circuit gas, and when the temperature of the breathing circuit gas is 25 ° C or higher or 30 ° C or higher, the control module , Define that the infusion module is improperly installed in the breathing circuit.</p><p> In one or more embodiments, at least one sensor can measure the type of gas in the breathing circuit gas and controls when the control module defines that the breathing circuit gas is not air or a mixture of air and oxygen. The module corrects the supply of therapeutic gas and / or issues an alarm.</p><p> In one or more embodiments, at least one sensor can measure the type of gas by measuring the density of the respiratory circuit gas and / or the thermal conductivity of the respiratory circuit gas.</p><p> In one or more embodiments, if the control module defines that the breathing circuit gas is not air or a mixture of air and oxygen, the control module selects a new flow calibration curve.</p><p> In one or more embodiments, if the control module defines that the breathing circuit gas is not air or a mixture of air and oxygen, the control module prompts the user to enter the type of gas.</p><p> In one or more embodiments, the control module tells the user that the control module defines that the respiratory circuit gas contains an anesthetic gas and / or that the user indicates that the respiratory circuit gas contains an anesthetic gas. An alarm is issued and the rate of fresh gas flow is increased to the patient's minute ventilation or higher.</p><p> In one or more embodiments, at least one sensor is part of the infusion module, or is present in a fluid connection with the infusion module, and the control module receives information indicating the type of ventilator. And / or define. In some embodiments, the control module defines the type of ventilator based on information related to respiratory gas.</p><p> In one or more embodiments, the control module defines the ventilator type as BiPAP ventilator, when the respiratory circuit gas has one or more of the following, and vice versa. It has (i) low frequencies and (ii) large volumes of directed flow, and the control module is one or more of the following, (i) encouraging the user to be convinced of the type of ventilator: , (Ii) urge the user to enter the volume of dead space, (iii) urge the user to add a carbon dioxide sensor to the breathing circuit, and (iv) urge the user to correct the dead space in the patient's airway. Prompt not to.</p><p> In one or more embodiments, the control module defines the ventilator type as an HFOV ventilator, when the respiratory circuit gas has one or more of the following: i) high frequency, (ii) small volume of reverse flow, (iii) high frequency forward flow pulse, and (iv) high common mode pressure, the control module is one or more of the following, (i) ) Encourage the user to be convinced of the type of ventilator, (ii) supply therapeutic gas to the average flow rate measured by the BCG flow sensor in proportion to the supply voltage.</p><p> In one or more embodiments, if the control module defines that the ventilator type is a conventional ventilator, then the control module is one or more of the following: (i) Ventilator to the user: Prompt to convince the type of vessel (ii) Supply therapeutic gas to the flow rate measured by the BCG flow sensor (eg, instantaneous flow rate) in proportion to the supply voltage.</p><p> In one or more embodiments, the control module defines the type of ventilator by circuit pressure detection using a gas infusion tube that communicates with the therapeutic gas inlet as an air pressure detection conduit.</p><p> In one or more embodiments, the at least one sensor has a carbon dioxide sensor and the control module corrects the observation of respiratory and / or therapeutic gas supply based on measurements from the carbon dioxide sensor.</p>

In order to better understand the properties and advantages of the present invention, the following detailed description will be referred to and the accompanying drawings will be added.<figref num="1">An exemplary nitric oxide supply system according to an exemplary embodiment of the present invention is shown as an example.</figref><figref num="2">An exemplary nitric oxide supply system and / or forward and reverse patient respiratory gas flow in a patient's respiratory circuit according to an exemplary embodiment of the invention is illustrated.</figref><figref num="3">An exemplary nitric oxide supply system, including check values and / or free breathing values, according to an exemplary embodiment of the invention is illustrated.</figref><figref num="4A">An exemplary nitric oxide comprising a bidirectional BCG flow sensor according to an exemplary embodiment of the present invention is shown as an example.</figref><figref num="4B">An exemplary nitric oxide comprising a bidirectional BCG flow sensor according to an exemplary embodiment of the present invention is shown as an example.</figref><figref num="5">An algorithm that corrects the reverse flow rate and / or avoids the supply of therapeutic gas according to an exemplary embodiment of the present invention is shown as an example.</figref><figref num="6A">An exemplary nitric oxide supply system according to an exemplary embodiment of the present invention is shown as an example.</figref><figref num="6B">An exemplary nitric oxide supply system according to an exemplary embodiment of the present invention is shown as an example.</figref><figref num="7">An algorithm that corrects the reverse flow rate and / or avoids the supply of therapeutic gas according to an exemplary embodiment of the present invention is shown as an example.</figref>

Detailed explanation

The present invention generally relates to systems and methods of delivering therapeutic gas to patients, using at least accelerated respiratory circuit gas (BCG) flow measurement, if necessary. At least some of these BCG flow measurements can sometimes be used to address some phenomena, with turbulent flows mixed with the therapeutic gas entering the therapeutic gas and allowing the patient to ventilate. Occurs when receiving from a breathing circuit. Utilizing at least some of these BCG flow measurements, the dose of the turbulent flow of therapeutic gas mixed in the respiratory gas that the patient receives from the ventilator can be at least more accurate and / or , A large supply of therapeutic gas into the respiratory gas can be avoided and / or reduced.

The systems and methods of the present invention can supply therapeutic gas to the patient from a supply system to the infusion module, and conversely, fluid with a respiratory circuit (with a ventilator) from which the patient receives respiratory gas. Can be present in the concatenation. The systems and methods of the present invention can have at least one BCG flow sensor, which can measure the flow of the patient's respiratory gas in the respiratory circuit. In addition, the systems and methods of the invention can supply therapeutic gas into the respiratory circuit so that the turbulent flow of therapeutic gas mixes with the patient's respiratory gas. Advantageously, the BCG flow sensor can measure flow in one or more directions (eg bidirectional BCG flow sensor) and / or sometimes breathing gas in a breathing circuit equipped with a frequency ventilator (eg high frequency ventilator). It can deal with some phenomena that occur when mixing therapeutic gases with a turbulent flow inside.

Referring to FIG. 1, an exemplary nitric oxide supply system 100 is illustrated, a nitric oxide supply system receiving therapeutic nitric oxide gas from a ventilator via an infusion module. Supply to. Any technique of the invention shall be used in any applicable system that supplies therapeutic gas to a patient receiving respiratory gas from a respiratory system (eg, ventilator, high frequency ventilator, respiratory mask, nasal cannula). Please understand that you can. For example, the systems and methods of the present invention can be modified and / or attached to other techniques of U.S. Pat. No. 5,580,83, entitled Supply System and / or "Nitromonide Supply System". It can be incorporated by referring to the contents.

Although the systems and methods of the invention describe applications with a ventilator, the systems and methods of the invention can be used with any applicable ventilator to which a ventilator can be attached. .. Therefore, the term ventilator is for simplicity only and is not limited. Therapeutic gas, the turbulent flow of therapeutic gas mixed in the respiratory circuit, the therapeutic gas supply system, and the like indicate nitric oxide gas (NO) used for treatment inhaling nitric oxide gas. It should be understood that other applicable therapeutic gases can also be used. Therefore, reference to nitric oxide, NO, and the like is merely a simple ball and is not limited.

In an exemplary embodiment, an exemplary nitrogen monoxide supply system, such as the Nitrogen monoxide supply system 100, delivers a therapeutic gas (eg, nitrogen monoxide, NO, etc.) in a respiratory circuit (with a ventilator). It can be used to mix with the turbulent flow as part of the patient's respiratory gas into the respiratory gas. To mix at least NO into the patient's respiratory gas in a turbulent flow, the nitric oxide supply system 100 provides and / or receives nitric oxide from a nitric oxide source 103 (eg, NO storage cylinder, NO generator, etc.). Can be, for example, via conduit 105. Further, the conduit 105 can also be present in the fluid connection with the infusion module 107, eg, via the therapeutic gas infusion section 110, and the infusion module 107 also inhales the breathing circuit with the ventilator 117. It can be present in the fluid connection with the limbs.

As shown, the artificial respirator 117 has an inspiratory outlet that supplies breathing gas (eg, forward flow 133) to the patient via the inspiratory limbs 121 and the "Y" portion 125 of the patient's respiratory circuit. It has an expiratory inlet and receives the patient's exhaled air through the expiratory limbs 127 and the "Y" portion of the patient's respiratory circuit. In general, this "Y" section connects the inspiratory limb 121 and the expiratory limb 127 to provide respiratory gas and / or the patient's exhaled breath can flow through this "Y" section. Sometimes, for simplicity, respiratory gas supply and exhalation are described without mentioning the "Y" part. This is just for simplicity and is not limited. When the infusion module 107 couples to the inspiratory limbs of the breathing circuit and / or fluidly connects to the breathing circuit, nitric oxide is transferred from the nitric oxide supply system 100 (eg NO forward flow 137) to the infusion module 107. It can be supplied via the same building 105 and / or the therapeutic gas inlet 110. This nitrogen monoxide is then supplied via the infusion module 107 into the inspiratory limb 121 of the patient's respiratory circuit with the ventilator 117, which supplies breathing gas to the patient 108. Used for. In at least some embodiments, the patient's respiratory circuit has only one limb for both inspiratory and expiratory flow. For example, as shown in FIGS. 6A-6B, the BiPAP ventilator has only one limb, which connects the inspiratory limb and the expiratory limb. For simplicity, sometimes the patient's respiratory circuit is shown to have separate inspiratory and expiratory limbs. This is for simplicity and is not limited.

Looking back at Figure 1, the nitric oxide supply system to control the flow of nitric oxide through the conduit 105 to the infusion module 107 and then to the patient 108 receiving respiratory gas from the patient's respiratory circuit. The 100 can have one or more control valves 109 (eg, proportional valves, bidirectional valves, etc.). For example, when the control valve 109 is open, nitric oxide is fed to patient 108, which is fed through conduit 105 to infusion module 107 and then to patient 108 by forward flow (eg NO forward flow 137). To do.

In at least some embodiments, the nitrogen monoxide supply system 100 has one or more NO flow sensors 105, which are the flow of therapeutic gas through the control valve 109 and / or the conduit 105. For example, the NO forward flow rate 137) can be measured, and then the flow rate of the therapeutic gas into the injection module 107 through the therapeutic gas inlet 110 and then to the patient 108 can be measured. Further, in at least some embodiments, the infusion module 107 has one or more breathing circuit gas (BCG) flow sensor 119, and the breathing circuit gas (BCG) flow sensor 119 passes through the infusion module 107. Then, at least the flow rate of the patient breathing gas supplied to patient 108 (eg, forward flow rate 133) can be measured. As shown in the infusion module 107, the BCG flow sensor 119 can be installed somewhere in the inspiratory limb 121, upstream of the infusion module 107 and / or in fluid coupling with the respiratory circuit or the like. Further, instead of receiving the flow rate information from the BCG flow rate sensor 119, the nitrogen monoxide supply system 100 can receive the flow rate information directly from the ventilator 117, which indicates the flow rate of the respiratory gas from the ventilator 117.

In an exemplary embodiment, the nitrogen monoxide gas flow rate is a turbulent flow that is mixed in proportion to the respiratory gas (also known as in proportion to the supply voltage) and is predetermined in the mixing of the respiratory gas and the therapeutic gas. Provides a concentration of NO. For example, the nitrogen monoxide supply system 100 can be made to a predetermined concentration of NO by using the known NO of the NO source 103 in the mixture of respiratory gas and therapeutic gas; the amount of respiratory gas flow rate in the patient circuit. Using the information from the BCG flow sensor 119 to determine the amount of therapeutic gas flow to the infusion module 107 (and then to the patient 108) in conduit 105, using the information from the NO flow sensor 115. Can be confirmed.

To supply a predetermined set dose of therapeutic gas to the patient and / or to supply a sample therapeutic gas to the patient, the therapeutic gas supply system 100 has a system control device 111, the system control device 111 being 1 It has one or more processors or memory, and this system control is, for example, a computer system, a single board computer, one or more application-specific integrated circuits (ASICs), or a combination thereof. A processor can be connected to memory and is one or more readily available memory, such as random access memory (RAM), read-only memory (ROM), flash memory. There are memory, compact / optical stale, hard disk, or local or remote digital stale. Support circuits can be connected to processors to support processors, sensors, valves, sampling systems, supply systems, user inlets, displays, injection modules, respiratory equipment, etc. in the traditional way. These circuits include cache memory, power supplies, clock circuits, input / output electrical circuits, analog-to-digital and / or digital-to-analog converters, subsystems, power controllers, signal conditioners, and the like. .. The processor and / or memory can communicate with sensors, valves, sampling systems, supply systems, user inputs, displays, infusion modules, breathing equipment, etc., and the communication path can be wired or wireless, as appropriate. Configure hardware, firmware, and / or software to interconnect components and / or provide telecommunications across communication paths.

The clock circuit can be inside the system controller and / or measure the time relative to the start time, eg the time to start. The system has a real-time clock (RTC) that provides real time and can be synchronized with a time management source such as a network. The memory can be configured to receive and store values for calculations and / or comparisons with other values such as sensors, pumps, valves and the like.

In an exemplary embodiment, memory can store a set of mechanically executable instructions (or algorithms) that can trigger a sampling system when executed by a processor, and / or system. It can be fed to perform various methods and operations. For example, the supply system can perform, for example, a method of supplying a given set dose of therapeutic gas (eg, NO concentration, NO PPM, etc.) to the patient in need of them, at a given concentration to be delivered to the patient. The steps of receiving and / or defining the therapeutic gas, for example, can be entered by the user; have the step of measuring the flow rate in the inspiratory limbs of the patient's respiratory circuit; during the inspiratory flow, the therapeutic gas containing NO to the patient. It has a step of supplying; a step of monitoring a change in inspiratory flow or inspiratory flow; and a step of changing the amount (eg volume or mass) of the supplied therapeutic gas in a later inspiratory flow.

For other embodiments, the sampling system performs, for example, a method of determining the concentration of target gas (eg NO) supplied to the patient; operates a sampling pump and / or a gas sampling valve (eg, 3 directions). It has the step of opening a valve (such as a valve) to obtain a gas sample from the inspiratory limb of the patient's breathing circuit, which is a mixture of air and the therapeutic gas supplied to the patient (eg NO); the gas sample. Has a step of exposing to a gas sensor (eg, a catalytic electrochemical gas sensor); has a step of obtaining information from a sensor that indicates the concentration of the target gas (eg, NO, nitrogen dioxide, oxygen) to be supplied to the patient. It has a step of communicating the concentration of the target gas to the user. Mechanically executable instructions can also include instructions for any of the other methods described herein.

Further, at least to make the dosage of therapeutic gas accurate, the nitric oxide supply system 100 can have a user input / display 113, which has a display and a keyboard and / or buttons. Or, it is a touch screen device. The user input / display 113 receives a predetermined setting from the user and receives the patient's prescription (mg / kg standard body weight, mg / kg / hour, mg / kg / respiration, mL / respiration, cylindrical concentration, supply concentration, duration, etc. ), Patient's age, height, gender, weight, etc. The user input / display 113 is used to define the patient's dose and / or gas measurement in at least some embodiments, eg, using the gas sampling system 129, where the gas sampling system 129 is the patient. A sample of gas supplied to 108 via sample line 131 can be received. The gas sampling system 129 has a number of sensors, such as, but not limited to, nitric oxide gas sensors, nitrogen dioxide gas sensors, and / or oxygen gas sensors, which are user-input. / Can be used to display relevant information (eg, gas concentration, etc.) on the display 113.

The above can be used in the melt to supply the therapeutic gas to the patient, the patient receives the breathing gas from the patient's breathing gas with a ventilator, but NO in the patient's breathing gas. Mixing as a proportion of gas cannot explain at least some surprising phenomena discovered by the present invention. Without knowledge of at least some of these phenomena, the exact NO concentration (eg NO as patient respiratory gas concentration, parts per million (PPM) NO, etc.) would differ from the prescribed percentage of NO. right. For example, these amazing phenomena sometimes occur and / or attach with an accurate percentage of NO that is higher than a given percentage of NO. This proportion of NO is particularly important as a supply of administration to the patient and affects efficacy rather than a given therapeutic dose. Therefore, more accurate NO administration is possible by explaining at least some of these surprising phenomena.

Further research has discovered a surprising phenomenon (reverse respiratory circuit gas (BCG) flow phenomenon), and surprisingly, sometimes gas in the respiratory circuit (eg, patient's respiratory gas, therapeutic gas, patient's respiratory gas and (For example, a mixture of therapeutic gases) is in the other direction than in the forward direction. For example, referring to FIG. 2, the gas flow rate in the breathing circuit is in the forward direction (eg, forward BCG flow rate 133) from the ventilator 117 to the patient, and sometimes, surprisingly, the gas flow rate in the breathing circuit is. Reverse direction from the patient to ventilator 117 (eg, reverse BCG flow rate 200). This reverse flow (eg, reverse BCG flow 200) is caused by many sources, eg, but not limited to, valves in a rapidly operating ventilator 117 (to name a few). Reverse flow caused by (not shown); flow driven by the patient (eg patient spontaneous breathing); reverse flow during the first part of the patient's expiratory phase, eg, using a BiPAP ventilator When using a single limb circuit, such as a patient who has had; and / or there is obstruction of the expiratory limb. As a result of this bidirectional flow rate in the respiratory circuit described above, many phenomena occur, for example, overdose of therapeutic gas into the patient's respiratory circuit.

The reverse flow is problematic for the nitrogen monoxide supply system 100, which is generally the therapeutic gas delivered into the respiratory gas through the infusion module 107 and one-way of the respiratory gas flowing from the ventilator. This is because it is based on the flow sensor 119 that measures the flow rate of the gas. Since the flow sensor 119 cannot define the flow direction, the flow in the reverse direction is reported as the forward direction (ie, in the forward BCG flow from the ventilator 117 to the patient 108), and the nitrogen monoxide supply system 100 is determined. An undesired dose greater than the dose (eg, a given set dose) can be delivered into the respiratory gas, which can occur when this reverse flow phenomenon occurs. Failure to detect and / or correct at least this phenomenon described above sometimes provides the patient with a non-predetermined therapeutic dose, which also affects efficacy and / or its Issue a result alarm (for example, supply failure alarm status).

According to an embodiment, when the forward respiration gas flow rate is measured by the flow sensor 119, the system 100 can supply the therapeutic gas into the forward flow respiration gas via the injection module 107, but the flow sensor 119 is forward. Since the flow rate cannot be detected in a direction other than that, there is no difference between the absence of flow rate and the flow rate in the opposite direction. According to the above embodiment, after flowing in the forward direction, the mixture of therapeutic gas and respiratory gas then flows in the reverse direction, and the flow sensor 119 sets this as a zero flow rate that terminates the supply of the therapeutic gas into the respiratory gas. Can be shown (in fact, breathing gas with therapeutic gas). This mixture of respiratory gas and therapeutic gas then returns to flow in the forward direction, the flow sensor 119 measures it, and the system 100 then injects the therapeutic gas into the mixture of respiratory gas and therapeutic gas in a forward flow module. Oversupply via 107. This results in a double dose of therapeutic gas in the respiratory gas, and when the first detection of a forward-flowing object, the respiratory gas receives the first infusion of the therapeutic gas and then the mixed therapeutic gas (first infusion). ) And the respiratory gas again receive an infusion of another therapeutic gas as it flows in the forward direction. Therefore, the patient then receives respiratory gas with twice the prescribed dose of therapeutic gas.

According to another embodiment, the flow sensor 119 can distinguish the direction of the flow and read the flow in the forward and reverse directions as the same, after which the patient receives three times the dose of the therapeutic gas. For example, when measuring a forward flow rate (eg, respiratory gas flow rate) with a flow rate sensor 119, the system 100 supplies a first dose of therapeutic gas into the forward flow rate respiratory gas via an infusion module 107. When this mixture of respiratory gas and therapeutic gas then flows in the reverse direction, when measured by the flow sensor 119, System 100 will then flow the second dose of therapeutic gas in the reverse direction of the respiratory gas and therapeutic gas. It can be supplied into the mixture, resulting in a respiratory gas with twice the therapeutic gas at a given dose. In addition, the mixture of respiratory gas and double dose therapeutic gas then flows forward, and when measured by the flow sensor 119, System 100 will positively flow the triple dose therapeutic gas. And then re-supplied into the mixture of the therapeutic gas at a double dose, resulting in a respiratory gas with a therapeutic gas at a dose of 3 times the prescribed dose. Therefore, the patient then receives respiratory gas with a therapeutic gas that is three times the prescribed dose.

With reference to FIG. 3, in an exemplary embodiment, the check valve 302 (eg, pneumatic check valve) is fluidly connected to the intake limb 121 when corresponding to the reverse BCG flow rate. For example, the check valve 302 can be installed in the intake limb 121 upstream of the injection module 107. When in use, the check valve 302 can be opened to supply reverse BCG flow rate (eg, reverse flow rate 200) vibrations, etc. before being measured by the BCG flow rate sensor 119. The use of check valves addresses the problem of having at least some reverse BCG flow rates, but these check valves also introduce many problems, including but not limited to 2 ~ 3 examples include delayed response flow from forward flow cracking pressure, contamination where the surface seal and material affect the seal performance due to the physical attraction of static electricity, repetition between units due to component tolerance or material selection, seal performance. It is characterized as an undamped spring mass system that has a surface finish that affects the flow and is vulnerable to the generation of audible noise or vibration "noise" induced by forward flow, and / or flow control accuracy, repeatability, and It can be compromised from the control response time.

In addition, the reverse valve 302 can interfere with the ventilator, which has a free breath valve 304. Opening the free valve 304 (sometimes called a suffocation-preventing valve), air causes ventilator failure, disturbance occurs in the breathing circuit, and / or the patient using the ventilator unknowingly exhales. .. The free breathing valve 304 requires a ventilator to allow the patient attempting to breathe unconsciously to have the ability to inhale air. By embodiment, when the ventilator does not have this free valve 304, it can be considered as a closed system with a ventilator that controls the amount of time the respiratory air is supplied to the patient. Without this free-breathing valve, if the patient attempts to breathe unconsciously, the user cannot breathe in and breathe, and there is no air inlet into the patient's breathing circuit. With this free-breathing valve, if the patient unknowingly attempts to breathe, the free-breathing valve can then act to allow the user to breathe air from the surrounding environment. For ventilators equipped with a free breathing valve, the check valve provided in the patient's breathing circuit allows interference from the free breathing valve, and the check valve does not achieve the purpose of this safety feature, this ventilator. Do not use with.

Similar to the free breathing valve, a mechanically high pressure safety valve is connected to the intake limb of the breathing circuit, either alone or in combination with the free breathing valve, and at least the mechanically high pressure safety valve is used as a redundant and safe measuring instrument. It can release the air pressure in the event of ventilator exhalation valve failure, obstruction, and / or exhalation limb circuit obstruction. A check valve used to block the reverse flow in series with the intake limb can prevent the high pressure reverse flow gas from escaping during standby.

There are other problems with using check valves. For example, check valves sometimes have training and / or usability issues (eg, check valves are used when not needed, and there is no check valve when needed). Also, it is difficult to disconnect and / or disassemble the breathing circuit, insert it into the check valve, and / or many adapters require the check valve to be connected to the breathing circuit.

In an exemplary embodiment, a check valve 302 and / or an additional check valve is injected into the injection module 107, therapeutic gas inlet 110, and / or conduit 105 to at least reduce and / or prevent interference with the free breath valve 304. Can be installed in.

Referring to FIGS. 4A-4B, an exemplary injection module (eg, injection module 400) may have at least one bidirectional flow sensor (eg, bidirectional BCG flow sensor 402) and / or be fluid connected. It can, and exemplify, at least address some of the above mentioned phenomena (eg, reverse BCG flow rate, etc.) and / or provide additional benefits. The infusion module 400 has a first end 404 and a second end 406, which can be coupled to the inspiratory limb of the patient's respiratory circuit and / or fluidly connected to the patient's respiratory circuit. it can. At the first end 404 and the second end 406, there is a first opening and a second opening, respectively, which allow liquid to flow through the injection module in the body of the injection module 400 (eg, respiratory gas). The injection module 400 also has a communication port 408, which is capable of communicating information between the injection module (and any additional components) and the nitric oxide supply system. In at least some embodiments, the communication port 408 and / or other communication port is a nitrogen monoxide supply system and / or a pressure sensor (eg, a differential pressure sensor, a differential pressure sensor that measures fluid flow, a common mode in a breathing circuit. Can be fluid connected with a pressure sensor, etc. to define the pressure in the. Further, the infusion module 400 has a therapeutic gas inlet 410, which can receive the therapeutic gas from the nitric oxide supply system and / or treat in respiratory gas through the infusion module. Gas can be injected. In at least some embodiments, the gas inlet 410 can be fluid connected to a pressure sensor or other related sensor with a supply device and / or a pneumatic conduit for reporting the air pressure in the breathing circuit. , A bidirectional flow rate can be provided to define the ventilator. In at least some embodiments, the bidirectional flow information is via communication from the ventilator (eg, direct communication, indirect communication, etc.).

In an exemplary embodiment, when dealing with at least the reverse flow rate, the injection module 400 may have at least a bidirectional BCG flow sensor 402 and / or be fluid connected, the bidirectional BCG flow sensor 402 of the patient. The bidirectional flow rate of the therapeutic gas in the respiratory circuit can be measured. With the infusion module 400 fluidly connected to the inspiratory limb of the patient's respiratory circuit, the bidirectional BCG flow sensor 402 can measure the bidirectional flow rate within the inspiratory limb of the respiratory circuit, and the bidirectional sensor 402 When measuring the flow rate in the forward direction 133, the therapeutic gas (eg, from the nitrogen monoxide supply system) can be supplied into the respiratory gas and when the bidirectional sensor 402 measures the flow rate in the reverse direction 200. , The therapeutic gas cannot be supplied into the respiratory gas. When using the infusion module 400, the bidirectional sensor 402 and at least the nitric oxide supply system in this method can reduce the overdose of the therapeutic gas in the scenarios described above, and the therapeutic gas is ventilator and / or Feed the patient using a ventilator device that causes a time of reverse flow. This allows the patient to receive a respiratory gas mixed with a given therapeutic gas.

In an exemplary embodiment, the bidirectional flow sensor 402 is any sensor capable of measuring flow in both forward and reverse directions, measuring flow and / or pressure in the patient's breathing circuit with little interference. It can (eg, because the flow rate and / or pressure in the breathing circuit is fairly accurate and important in treating the patient) and can provide a very fast response time (eg, the flow rate information is nitrogen monoxide). Can communicate very quickly to the supply system). For example, the bidirectional flow sensor 402 can be a thermal flow meter (sometimes called a heat dispersion flow meter); a pressure-based flow meter; an optical flow meter; an electromagnetic, ultrasonic, and / or corioli flow meter; a laser Doppler flow meter, And / or provide a response time of less than about 2 milliseconds, less than about 150 pascals at about 60 standard liters per minute (SLPM) or about 1.5 cmH at about 60 standard liters per minute.₂It can be any flow meter that provides a low flow resistance of less than O.

Furthermore, in response to the above difficulties, it is very difficult to measure both forward and reverse flow rates, for example, for the following reasons, for example, the accuracy of the flow rate measurement is that of the therapeutic gas supplied to the patient. Forward flow (eg, peak flow) is higher than reverse unhappiness because at least reverse flow measurement does not compromise the measurement range and accuracy of forward flow because it affects dosage. And / or because the flow calibration curves and / or outputs are different with respect to forward and reverse flow rates. In an exemplary embodiment, the bidirectional flow sensor can measure from? 50SLPM (eg, 50SLPM flow in the reverse direction) to about +180SLPM (eg, 180SLPM flow in the forward direction). At least some of these drawbacks are exacerbated by a flow sensor that has a NO injection portion and / or, for example, at least affects the accuracy of flow measurement of BCG flow when flowing in the opposite direction. This is because there are other downstream characteristics.

In an exemplary embodiment, the bidirectional flow sensor 402 can be fluid connected to the nitric oxide supply system via communication port 408. This allows flow information to be passed to the nitric oxide supply system and can be used by the nitric oxide supply system for NO supply and / or monitoring. At the expense of this bidirectional flow information, the nitric oxide supply system can more accurately supply and / or monitor NO.

Referring to FIG. 5, in an exemplary embodiment, with an infusion module having a bidirectional flow sensor and / or fluid connection, a nitrogen monoxide supply system (eg, using CPU 111) is provided with a therapeutic gas supply algorithm. This algorithm provides therapeutic gas when, for example, the forward flow rate is measured after correcting the measurement of the reverse flow rate before. According to the embodiment, in step 502, when the bidirectional flow sensor measures the forward flow rate, then in step 504, the nitrogen monoxide supply system (eg, using CPU111) injects therapeutic gas into the infusion module and then in the patient. It can be supplied into the respiratory circuit (eg, in a proportional amount to achieve a constant therapeutic gas concentration). This process can later be repeated to measure the forward flow rate. However, in step 506, the bidirectional rainfall sensor measures the reverse flow rate, and then in step 508, the nitric oxide supply system does not supply and / or shuts off the therapeutic gas (using, for example, CPU 111).

Then, in step 510, the volume volume of the reverse flow rate is defined, for example, by a nitric oxide supply system (eg, with CPU 111) using the flow information from the bidirectional flow sensor. In step 512, the above embodiment is continued, and then in step 514, the bidirectional flow sensor can measure the forward flow again (eg, after measuring the bidirectional flow), and then the nitrogen monoxide supply. The system (eg, using CPU 111) can deliver therapeutic gas within the forward flow rate after measuring that the amount of forward flow rate is equal to the total volume of the measured reverse flow rates.

According to the above embodiment, in an exemplary embodiment, the therapeutic gas is not doubled by not supplying the therapeutic gas until all the reverse flow rates that have passed through the infusion module have passed through the infusion module again and flowed forward. .. For example, when the bidirectional flow sensor measures the forward flow rate in step 512, the nitrogen monoxide supply system (eg, using CPU111) immediately begins to supply the therapeutic gas into the forward flow rate (eg, the reverse flow rate passing through). The reverse flow rate, which begins to flow forward (without waiting for), is doubled.

In an exemplary embodiment, the nitrogen monoxide supply system can be used with a BiPAP ventilator, which breathes with a single limb rather than an inspiratory limb and a separate expiratory limb. Attach to the circuit. This arrangement allows for unique challenges and considerations, as detailed below.

Referring to FIG. 6A, in an exemplary embodiment, the patient receives respiratory gas from the BiPAP ventilator 117. Figure 6A depicts a BiPAP ventilator, but the systems and methods described utilize a single limb for inspiratory and expiratory flow and / or exhalation valves with the habit of one or more BCG flow sensors. Can be used with any breathing device that utilizes (also known as a pressure control valve). In at least some embodiments, the respiratory device can have a breathing mask 602 and / or an exhaust port 604. In addition, in some embodiments, the BiPAP ventilator 117 can have a bias flow rate, which is very fast (eg, 10 liters per minute or more, 10-20 liters per minute, etc.). , Used to release expiratory flow outside the exhaust port 604, and / or leak from the mask (eg, during exhalation, during inspiration, etc.).

Due to the presence of at least a single limb in the respiratory circuit, one or more BCG flow sensors 402 obtain forward and reverse flow to and from the patient. When the BCG flow sensor measures the forward flow rate 133 of the respiratory gas, the therapeutic gas is supplied to the respiratory gas, and the therapeutic gas inlet 110 and the like are purchased. The respiratory gas, including the therapeutic gas, then moves a single limb towards the patient. In this way, the respiratory gas between the therapeutic gas inlet 110 and the patient receives the therapeutic gas supply, and the volume of this respiratory gas is V in FIG. 6A._delDesign as. The therapeutic gas inlet 110 can be installed adjacent to the BCG flow sensor 402 (ie, the distance from the BCG flow sensor 402 to the therapeutic gas inlet 110 is greater than the distance between the physiotherapy gas inlet 110 and the patient. Is much shorter), so V_delCan also be approached between the BCG flow sensor and the patient as the volume of respiratory gas in the respiratory circuit. V_delIs a known parameter entered by the user or is defined by the nitric oxide supply device 100.

The breathing circuit in FIG. 6A also has an expiratory valve, allowing the expiratory flow to be expelled from the patient, because the breathing circuit does not have a separate expiratory limb. The volume of the breathing circuit between the BCG flow sensor 402 and the exhalation valve is the dead space volume V_deadDesign as. V_deadIs a parameter entered by the user or is defined by the nitric oxide supply device 100. For example, the user selects and / or inputs information with a special ventilator and / or ventilator type (eg, using a user interface with a therapeutic gas supply system) and the appropriate V._deadCan be applied, for example, various Vs where the gas supply system is associated with a special ventilator_deadTo hold and / or connect values. V_deadAppropriate values for can then be applied. In at least some embodiments, the therapeutic gas supply system detects a significant amount of reverse flow volume (eg, 100 ml or greater), at relatively low frequencies (eg, less than 0.5 Hz), and forward flow volume. Gains much less reverse flow (eg, forward-to-reverse flow ratio of at least 2: 1) and gives the user a V_deadHave them enter values and / or select and / or enter information with a special ventilator and / or ventilator type. In at least some examples, information (eg V_deadEtc.) can be communicated and / or recovered from the ventilator.

Next, looking at FIG. 6B, during the patient's expiratory phase, the patient has an expiratory volume V._{exp exp}Is introduced into the breathing circuit. V_{exp exp}Then V_delReplace at least part of, then V_deadReplace at least part of. This replaced V_deadSome or all of these can be expelled to the surroundings through the exhalation valve. The replacement of respiratory gas in the reverse direction 200 can be measured as a reverse flow rate, when the BCG flow rate sensor 402 is a bidirectional flow rate sensor. This reverse flow rate can be corrected according to the method described above (eg V)._{exp exp}Is V_delLess, etc.). In at least some examples, V_deadIs very small (eg less than 25 ml) and very small, with a correction of 0 ml. For example, the NO supply system does not supply during the reverse flow example and / or supplies during the forward flow. But V_del, V_dead, And V_{exp exp}Part of the respiratory gas (V), including the therapeutic gas, depending on the relative volume of_del) Is discharged through the exhalation valve. Therefore, in an exemplary embodiment, some or all of the reverse flow rates are V._del, V_dead, And V_{exp exp}The correction depends on the relative volume of.

With reference to FIG. 7, in an exemplary embodiment, when the infusion module has a bidirectional BCG flow sensor and / or is fluid connected, the nitrogen monoxide supply system (eg, using CPU111) has a therapeutic gas supply algorithm. The therapeutic gas supply algorithm provides, for example, the therapeutic gas when measuring the forward flow rate after correcting at least a portion of the previously measured reverse flow rate. Depending on the embodiment, in step 702, the type of ventilator (eg, BiPAP, high frequency ventilator, constant flow ventilator, variable flow ventilator, etc.) can be entered by the user or from a bidirectional flow sensor. Defined by a nitrogen monoxide supply system based on flow rate information (eg using CPU111). For example, a small volume of reverse flow detected at high frequencies indicates a high frequency ventilator device. Detection of high common mode pressure in the breathing circuit establishes a high frequency ventilator device. As another embodiment, a large volume of reverse flow (eg, the same digit as the volume of forward flow) indicates a BiPAP ventilator. Depending on the embodiment, at low frequencies (eg, less than 1 Hz, less than 1 breath per minute, etc.), small, temporary zero flow, reverse flow, and / or continuous forward bias flow volume (eg, less than 100 ml). ) Indicates a conventional ventilator.

If the ventilator type is a BiPAP ventilator or a similar ventilator, this algorithm can proceed with the steps shown in Figure 7. If the ventilator type is not a BiPAP ventilator or a similar ventilator, the algorithm has the steps in Figure 5 above. However, it is possible to perform the steps in Figure 7 on ventilator types other than BiPAP ventilators, provided that the volume of dead space is infinitely large (ie, V)._dead>> V_{exp exp})。

When the bidirectional flow sensor measures the forward flow rate in step 704, then in step 706, the nitrogen monoxide supply system supplies the therapeutic gas (using, for example, CPU 111) into the infusion module and then into the patient's respiratory circuit. Can be (eg, the proportional amount required to achieve a constant therapeutic gas concentration). This process can be repeated later to measure the forward flow rate. However, in step 708, when the bidirectional flow sensor measures the reverse flow rate, then in step 710, the nitric oxide supply system does not supply and / or shuts off the therapeutic gas (using, for example, CPU 111). To do.

The volume volume of the reverse flow rate is then defined, for example, by a nitric oxide supply system (eg, using CPU111), which is defined using flow rate information from a bidirectional flow sensor. But V_del, V_dead, And V_{exp exp}Only part of the reverse flow rate is corrected, depending on the relative volume of.

As an example, V as described in step 714._{exp exp}<V_delAt that time, V_deadActs as an upper bound on the amount of reverse flow to compensate. That is, V as described in step 718._{exp exp} V_delAt the time of, all reverse flow rate (V_{exp exp}) Is corrected as described in step 722, for example, a nitric oxide supply system can supply therapeutic gas within a forward flow rate (eg using CPU111), which measures the amount of forward flow rate measured. It can be supplied after it becomes equal to the total volume of the reverse flow rate. V as described in step 720_{exp exp}> V_delAt that time, V_delPart of is gone through the exhalation valve and therefore V_deadIs the upper limit of the correction as described in step 724, so the nitric oxide supply system can supply the therapeutic gas within the forward flow rate (using, for example, CPU 111), which is the measured forward flow rate amount. Is a known or defined V_deadCan be supplied after it becomes equal to the amount of.

According to the first scenario, as another embodiment, V as described in step 716._{exp exp} V_delAt this time, there are some possibilities that a part of the reverse flow rate is corrected. V as described in step 726_dead> V_{exp exp}At that time, V_{exp exp}Can be part of the reverse flow rate corrected as described in step 732. V as described in step 728_{exp exp}= V_delAt that time, V_deadCan be part of the reverse flow rate corrected as described in step 734. V as described in step 730_dead<V_{exp exp}At that time, V_deadCan be part of the reverse flow rate corrected as described in step 736.

In at least some examples, at least the above values for steps 732, 732, and 736 are used to exceed the correction of iNO supply but remain within a particular predetermined dose range. This slightly higher supply, for example, means that the first part of the exhaled breath (eg, the dead space of the patient's air) is outside the patient's breathing circuit through an exhaust port (eg, the exhaust port 604 shown in FIGS. 6A-6B). Generated by discharging, thereby V_{exp exp}Some of them do not contain iNO, for example, the gas supply slightly exceeds the supply. The slightly higher supply is not entirely due to the dead space in the patient's airways, but through the outlet and / or less than about 98% of the iNO.

According to the above embodiment, the NO gas monitor probably reports less than it really is, for example, because it is a sampling portion of the gas flow rate that does not contain iNO. In an exemplary embodiment, carbon dioxide (CO), as described in more detail below.₂) Sensors are used to detect the above scenarios and / or at least to correct iNO gas monitor readings during this scenario.

According to the second scenario, V as described in step 716_{exp exp} V_delAt, there are several possibilities to correct part of the reverse flow rate. V as described in step 726_{exp exp}> V_deadAt that time, V_{exp exp}Is not used and / or required for compensation as part of the reverse flow rate as described in step 732. V as described in step 728_{exp exp}= V_delAt that time, V_deadIs not used and / or required for compensation as part of the reverse flow rate as described in step 734. V as described in step 730_{exp exp}<V_deadAt this time, part of the reverse flow rate is not used and / or required for correction as described in step 736.

In at least some embodiments, at least the above values for steps 732, 732, and 736 are used to fall below the iNO supply correction but remain within certain accuracy with respect to the iNO supply system. This slightly lower supply occurs, for example, for at least some of the reasons mentioned above (eg, the first part of the exhaled air is not exhausted outside the vent, is less absorbed, etc.). According to the above embodiment, the NO gas monitor probably reports less than it really is, for example, because it is a sampling portion of the gas flow rate without iNO. In an exemplary embodiment, CO₂The sensor is used to detect the scenario described above and / or at least to correct the reading of the iNO gas monitor during this scenario.

In an exemplary embodiment, the therapeutic gas supply system can be automatically defined to follow either the first or second scenario. The demarcation of which scenario to follow is based on user input, ventilator selection and / or user input, and / or communication between the ventilator and the therapeutic gas supply system, to name a few. ..

In an exemplary embodiment, CO₂Sensors (eg mainstream infrared CO₂Sensors) can be used to detect scenarios, for example V_{exp exp} V_delAt the time, the iNO supply can be corrected and / or the iNO monitoring can be corrected and / or various other uses. CO₂The sensor can be placed in close proximity to the flow sensor 402 and / or sample line 131 (eg, as shown in FIGS. 6A-6B), or in either the injection module and / or sample line. be able to. For example, V_{exp exp} V_delAt that time, CO regarding iNO supply₂A sensor can be used to detect reverse flow volume correction, which is CO at reverse flow₂When can be detected (eg, detect the lowest amount of iNO and / or CO₂The latter half of the exhalation occurs in the lungs when detecting as gas exhaust), CO₂The volume of this gas, including_CO2Designed as, but V_deadCan be used in connection with, for example, V_CO2 V_deadAnd / or V_CO2&lt;V_deadIt is a factor in any of.

By example, according to the above example, V_CO2 V_deadWhen, the reverse flow rate is not used and / or not required to correct the iNO supply. By another embodiment, according to the above embodiment, V_CO2&lt;V_deadAt that time, when the flow rate moves, the positive iNO is CO₂Can be supplied for the detected reverse flow volume (eg CO₂Including V_CO2Shows the expiratory flow rate that supplies iNO during inspiration and gas exchange that occurs in the lungs), iNO supply is CO₂Can be stopped for reverse flow volumes that did not detect (eg CO₂Does not include V_CO2However, it indicates the expiratory flow rate that supplies iNO during inspiration but while gas exchange does not occur in the lungs) and / or iNO supply resumes.

In an exemplary embodiment, NO monitoring is CO₂The sensor can be flown and corrected. CO to compensate for NO monitoring according to the above embodiment by yet another embodiment₂The sampling system and / or its elements (eg, sample pump, NO sensor, etc.) can be deactivated and / or not activated when detecting at a reverse flow rate, and / or the flow rate is positive. Upon returning in direction, the sampling system and / or its elements (eg, sample pump, NO sensor, etc.) can be reactivated and / or activated.

Further, in an exemplary embodiment, CO₂The sensor is used in BiPAP ventilators or other breathing circuit configurations that do not include a single limb. For example, CO₂The sensors and related guarantees described above are used in respiratory circuits with separate inspiratory and expiratory limb circuits.

In an exemplary embodiment, NO is not supplied until the forward flow rate is measured above the minimum threshold and / or the flow rate is stopped for a period of time when the user issues an alarm. For example, the NO supply system does not supply NO until the forward flow rate is measured in the injection module and is at least above the minimum flow rate value (eg, above the forward flow rate of 0.25 ml / min). For other embodiments, the BCG flow sensor measures the flow rate for a period of time (eg, 0 ml / min for 10-30 seconds, 0 ml / min for 15 seconds) and / or a very small flow rate for a period of time (eg, 0 ml / min). , 10-30 seconds +/- 0.25ml / min, 15 seconds +/- 0.25ml / min, etc.), the NO supply system does not supply NO and alerts the clinician in that case. This indicates that, as mentioned above, the ventilator is spare-installed and / or does not have an infusion module connection. This property can sometimes be used to prevent wasting NO gas into the atmosphere.

In an exemplary embodiment, the iNO supply returns to a supply algorithm proportional to the supply voltage that supplies the average injection module flow rate, eg, supplying a relatively constant amount of NO individually through high frequency pulses for the entire time. be able to. In at least some embodiments, the iNO supply system detects short-term zero flow rates (eg, 50 ms and above) at high frequencies (eg, 2 Hz and above) and / or a small amount of reverse flow volume (eg, 5 Hz and above). When detecting 0 such as less than 5 milliliters at high frequency (eg 2Hz or higher) and / or detecting high pressure in common mode (eg 1PSI or higher), use a high frequency ventilator and issue an alarm in the reaction. Attempts and / or indicates that the user is to confirm that they are using a high frequency ventilator. The confirmed and / or defined supply system returns to a constant volume supply algorithm and nets. It provides a constant NO flow rate proportional to the average forward flow rate (eg, reverse flow rate and zero flow rate are described) and compensates for, for example, a high frequency ventilator.

In an exemplary embodiment, using a bidirectional flow sensor and / or the present invention, the infusion module is fluid connected to the respiratory circuit regardless of the muki where the end of the infusion module is a forward end or a reverse end. Install. That is, the bidirectional flow sensor and / or the present invention allows the infusion module to be easily connected to the breathing circuit. This is very important as an infusion module, and respiratory circuits, ventilators, and / or supply systems are assembled during critical care, high stress, and / or when time is important.

In an exemplary embodiment, when the infusion module is used regardless of the orientation of the infusion module associated with the flow rate of the respiratory circuit, the measurement range of the bidirectional flow sensor is equal in the forward and reverse directions (eg, -120 to +120 SLPM). ).

In an exemplary embodiment, the systems and methods of the invention can utilize techniques (eg, algorithms) that can monitor the amount of flow in each direction for the entire time, defining that direction and breathing the infusion module. Install in relation to the flow rate of circuit gas. For example, the algorithm is used to orient the infusion module (in relation to the respiratory circuit gas flow rate) so that the volume of the forward flow rate is greater than the volume of the reverse flow rate. After defining the direction of the infusion module in relation to the respiratory circuit gas flow rate, start NO gas supply. If the injection module is defined to be in the opposite direction (eg, at the NO inlet upstream of the respiratory gas sensor), the algorithm subtracts the supplied NO flow rate from the flow rate measured by the respiratory gas sensor. This technique is effective in many cases (eg, NO can be supplied by the injection module in either direction). For other embodiments, indicating that the infusion module operates preferentially in one direction, the systems and methods of the invention can alert the clinician that the BCG sensor has been inserted in the opposite direction. ..

In exemplary embodiments, the systems and methods of the invention can utilize techniques (eg, algorithms) that secure the infusion module in place in the patient's respiratory circuit. For example, if the patient's breathing circuit has a humidifier, the systems and methods of the invention can detect the position of the infusion module with respect to the humidifier and / or secure the position of the infusion module upstream of the humidifier. it can. To detect and / or secure the location of the humidifier, the systems and / or methods of the present invention can measure humidity and / or temperature, for example, with an infusion module. If the humidity is too high (eg, about 80% relative humidity) and / or the temperature is too high (eg, about 30 degrees Celsius or more, about 85 degrees Fahrenheit or more, from the heated priority circuit used to prevent solidification. (For example, body temperature close to 37 ° C), which indicates an improper position in the respiratory circuit of the infusion module, eg, position in the inspiratory limb downstream of the humidifier, expiratory limb, and / or "Y" It is a part etc. Illustrative temperatures that indicate improper installation include temperatures below or above; approximately 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37. , 38, 39, 40 ° C. Humidity examples that indicate improper installation include the following humidity or higher; approximately 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 96. , 97, 98, 99, 100% Relative Humidity (RH). Relative humidity is measured directly (eg by a humidity sensor) and / or indirectly (eg by a thermal conductivity sensor). In at least some embodiments, the location of the infusion module, eg, the "Y" portion, can be detected when measuring approximately equal flow rates in both directions (eg, indicating inspiration and expiration). Indicating a misplacement (eg, installing the injection module downstream of the humidifier, installing the injection module in the Y-section) can provide alarms and / or other instructions.

In exemplary embodiments, the systems and methods of the invention include techniques for detecting gases having densities and / or thermal conductivity significantly different from nitric oxide, oxygen, nitrogen and / or air, to name a few. Available (eg algorithms, sensors, etc.). For example, a breathing circuit gas containing only nitrogen and / or oxygen (eg, air, a mixture of oxygen and air, pure nitrogen gas, pure oxygen gas, etc.) has a density of 1.25 to 1.42 g / L in STP. Therefore, at a density of about 1.2 g / L or less (eg, 1.1, 1.0, 0.9 g / L or less) or a density of about 1.5 g / L or more (eg, 1.6, 1.7, 1.8 g / L or more). Gas indicates the presence of other gases in the respiratory circuit gas. Using this technique, the systems and methods of the present invention detect the supply of nitric oxide when used, for example, with anesthesia, a helium mixture and / or with other gases and / or mixtures. And / or prevent oversupply. By embodiment, with respect to anesthesia, when an oversupply is detected, a message and / or alarm is issued to indicate an increase in the amount of fresh gas flow (eg, dilute the remaining anesthesia). According to other embodiments, calibration information can be added to the flow sensor and used to associate the sensor output with the flow of respiratory circuit gas. This sensor output sometimes varies for gases with different densities and / or thermal conductivity. When detecting and / or inputting this gas by the user, the calibration information can be modified and / or replaced to measure the flow rate. For example, the system controller calibrates when it detects and / or receives information indicating that it is using and / or using a gas of different density and / or thermal conductivity (eg, anesthesia, helium mixture, etc.). Correct and / or replace the information to enable flow measurement.

In an exemplary embodiment, when inputting / detecting using an anesthesia machine, at least based on algorithms associated with the user's input and / or supply system, the systems and methods of the invention provide a minimum of fresh gas flow. It can be guaranteed to provide the average to IM. According to the embodiment, when the user confirms that the supply system uses the anesthesia machine and / or the detection of the use of the anesthesia machine, the NO supply system has the lowest average fresh gas flow rate in the inflow module and / or the anesthesia machine. You can let the user see that it is flowing through (eg, corresponding to communication from the supply system, corresponding to communication from the injection module). The lowest average fresh gas flow rate can pass through the injection module. As mentioned above, NO and / or NO in the anesthetized respiratory circuit₂Prevents them from gathering.

Many indications and modifications have been found to be easy to those of skill in the art, and the indications and modifications can form a therapeutic gas supply system that supplies the dispensing gas of the present invention, resulting in a predetermined base. Methods and systems for introducing the amount of drug gas into the patient can be improved, all of which are within the scope of the invention as defined in the following claims. Therefore, the present invention is limited only by the following claims and their equivalents.

Throughout the specification, "one embodiment," "one embodiment," "one or more embodiments," "exemplary embodiments," "plural exemplary embodiments," and / or "plural embodiments." "Means a particular property, structure, material, or feature described in connection with an embodiment having at least one embodiment of the invention. Accordingly, clauses such as "in one or more embodiments", "in a particular embodiment" and / or "in one embodiment" in various places throughout the specification are the same embodiments of the invention. It does not necessarily show the morphology. In addition, specific properties, structures, materials, or features can be combined in the appropriate manner in one or more embodiments.

It should be understood that any of the steps described can be reorganized, separated, and / or combined without departing from the scope of the invention. For simplicity, the steps sometimes exist in succession. This is just for simplicity and is not limited.

Further, it should be understood that any element and / or embodiment of the invention described may be reorganized, separated, and / or combined without departing from the scope of the invention. For simplicity, the elements are sometimes described separately. This is just for simplicity and is not limited.

Although the present invention has been described in the context of specific embodiments, it should be understood that these embodiments merely represent the principles and applications of the present invention. It will be apparent to those skilled in the art that various modifications and modifications can be made to the methods and devices of the invention without departing from the scope of the invention. Accordingly, the present invention is shown to include modifications and modifications to the extent of the appended claims and their equivalents.