WO2009011608A1

WO2009011608A1 - Method and device for artificial lung ventilation

Info

Publication number: WO2009011608A1
Application number: PCT/RU2007/000391
Authority: WO
Inventors: Igor Victorovich Isaev
Original assignee: Morozov, Vasiliy Jurievich
Priority date: 2007-07-19
Filing date: 2007-07-19
Publication date: 2009-01-22

Abstract

The invention relates to medical engineering, in particular to a method for artificial lung ventilation consisting in forming a positive end-expiratory pressure and in using assisted ventilation. The inventive method consists in carrying out an assisted lung ventilation based on a positive end-expiratory pressure stabilised in a breathing circuit, in waiting for a patient's spontaneous respiration attempt, in simultaneously comparing the current positive end-expiratory pressure value with the admissible threshold pressure fluctuation value for identifying the spontaneous respiration attempt, in carrying out assisted respiration, while identifying the spontaneous respiration attempt, or forced respiration when a respiratory delay attains the admissible threshold value. The positive end-expiratory pressure producing method consists in applying a setting force for forming a breathing mixture pressure in the respiratory line (3) of the breathing circuit (2) until a return respiratory valve (4), in autonomously supplying a part of said breathing mixture to the output of the breathing circuit (2) for closing an expiration line (10) and in additionally pumping the breathing mixture to the breathing circuit (2) from the respiratory line (3) if the pressure value downstream of the returnrespiratory valve (4) is less than the pressure upstream thereof. The breathing mixture is permanently present at the input of the return respiratory valve (4).

Description

Method and device for artificial lung ventilation

The field of technology.

The invention relates to the field of medical technology and relates to artificial ventilation of the lungs, and more specifically relates to a method and device for creating positive end-expiratory pressure (PEEP) and the implementation of assisted ventilation during mechanical ventilation.

The prior art.

A known method of artificial ventilation of the lungs, with the creation of positive pressure of the end of exhalation in which positive pressure is applied to the respiratory tract to expand the lungs of the patient, and negative pressure is applied around the chest and / or abdomen to reduce the burden on the lungs created by the chest, both pressures are synchronized (PCT / CA 2004/001851, WO2005 / 039679 Al, MKI A 61M 16/00).

A known method of artificial ventilation of the lungs with the creation of a positive pressure of the end of exhalation, which provides communication with the respiratory tract of the patient, use a source of respiratory mixture with adjustable pressure and providing expiration, a device for measuring respiratory air flow, automatic a tidal device for calculating the tidal volume of air to determine the degree of dynamic airway compression, determine the tidal air volume by measuring to provide artificial ventilation, determine the degree of dynamic airway compression for a specific tidal volume of air, and servo-regulating the effect on the degree of dynamic airway ways by automatically increasing expiratory pressure, if this degree is large, or reducing pressure on you Ohe, if the degree of small or equal to zero (Jfe U.S. Patent 6,854,462 B2, 15.02.2005, IPC A61M 16/00).

There is a method of creating positive end-expiratory pressure during mechanical ventilation, in which pressure is applied to the pressure of the membrane valve in the direction opposite to the pressure of the respiratory mixture at the outlet of the respiratory circuit to tightly close the expiratory line in the act of inspiration and to create positive pressure in the lungs at the end of the exhalation patient (RF patent 2 219 892 Cl, 10.24.2002, MKI A61H 31/02).

A device for artificial ventilation of the lungs is known (RF Patent 2185196, 05.29.2000, MKI A61M 16/00), which contains a respiratory mixture input unit, a compressor, an electric motor, a control and indication unit, a remote control, a sealing control unit, a switch, a respiratory humidifier mixtures, a nasal mask and a positive pressure regulator at the end of the exit.

Known artificial ventilation apparatus (patent of the Russian Federation 2219892, 10.24.2002, MKI A61H 31/02), which for operation in artificial ventilation mode with positive pressure The end of exhalation (PDKV) has a control unit that contains a program for controlling the inclusion of the pneumatic pulse generator when the lung reaches the set value of PDKV in the act of expiration. A device is known for providing artificial ventilation with positive end-expiratory pressure (CTTTA Patent 6,932,084,23.08.2005, MKI A61M 16/00) containing a computer for counting leaks of the respiratory mixture and compensating for positive airway pressure. The device increases the flow rate of the respiratory mixture during inhalation and / or exhalation, depending on the increase in its flow rate during sleep or heart failure.

A known artificial lung ventilation apparatus (patent of the Russian Federation 2146913,23.08.1999, MKI A6Sh31 / 02) containing a controlled exhalation valve installed on the patient's expiration line for hermetically closing the expiration line in the act of inspiration and creating positive pressure in the patient's lungs at the end of the exhalation act. The valve is implemented in the form of an adjustable spring-loaded diaphragm valve, the spring-loaded submembrane cavity of which is pneumatically connected to the outlet of the injector, which creates the necessary volumetric flow rate of the working gas with the atmosphere and the inlet of the pneumatic switch commuting the injector line and the inner space of the fur body, in which the respiratory mixture of a given volume for each a separate act of inspiration, and an inspiratory non-return valve in the breathing circuit for unidirectional delivery of the respiratory mixture into the lung e patient.

However, the spring force acting on the diaphragm valve overlaps the expiration line with a residual positive pressure in the patient's lungs, which immediately begins to fall due to due to leaks of the respiratory mixture from the respiratory circuit, due to its leaks, in particular at the places where the hoses enter the patient’s airways.

Known methods and devices for creating positive end-expiratory pressure and artificial ventilation of the lungs do not automatically compensate for leaks from the respiratory circuit and are not able to maintain a constant level of positive expiratory end pressure (PEEP) on the expiration in the respiratory circuit.

I would like to note that ((mechanical ventilation) usually involves the implementation of forced ventilation of the patient’s lungs.

By ((forced ventilation of the lungs) is usually understood ventilation with a forced uniform rhythm of supply and removal of the respiratory mixture from the patient’s lungs, and, therefore, with a forced uniform rhythm of the patient performing an act of inhalation. However (((artificial ventilation of the lungs ”may include forced and assisted ventilation of the patient’s lungs.

By ((assisted lung ventilation) is meant ventilation of the lungs with the supply of the respiratory mixture into the patient's lungs simultaneously with the occurrence of the patient's own breathing attempt, that is, with an uneven inhalation-exhalation rhythm.

The need for auxiliary lung ventilation appears when the patient has the ability to carry out independent breathing, manifested in the form of respiratory attempts, the occurrence of which has a random, chaotic nature, i.e. arrhythmic. In this case, it is still impossible to disconnect the patient from the artificial lung ventilation apparatus, and keeping him on forced ventilation without coordination with breathing attempts is already bad, since the patient's arrhythmic respiratory cycle begins to struggle with a certain respiratory rhythm of forced ventilation. The patient wastes his energy ineffectively and receives a failure of spontaneous breathing.

The occurrence of a patient’s respiratory attempt can only be judged by mild pressure drops that can be identified and identified as respiratory attempts (i.e., separated from the pressure drop associated, for example, with a gas leak from the respiratory circuit) when observing pressure fluctuations in the lungs the patient only against the background of stability of pressure in the respiratory circuit on the exhale. Known methods and devices for creating positive end-expiratory pressure and artificial lung ventilation, prevent dynamic compression of the airways, “constriction” of the alveoli of the lungs that occur when “pouring” into the area of negative pressure during the act of inspiration. However, the known methods and devices that create positive pressure of the end of exhalation and artificial ventilation of the lungs cannot automatically compensate for leaks from the respiratory circuit, which does not allow solving the problem of automatic stabilization of PDKV in the respiratory circuit on exhalation and the implementation of auxiliary lung ventilation.

SUMMARY OF THE INVENTION The basis of the present invention is the development of a method and device for creating positive end-expiratory pressure (PEEP) and mechanical ventilation, providing automatic stabilization of PEEP in the respiratory circuit on the exhale and the implementation of auxiliary lung ventilation.

The problem is solved in that in the method of creating a positive pressure of the end of expiration (PEEP) during mechanical ventilation by applying a pressure generating force to the respiratory mixture to create a pressure, to block the exhalation line of the respiratory circuit and forming PEEP, according to the invention, the PEEP setting force is applied, creating pressure of the respiratory mixture, on the inspiratory line of the respiratory circuit to the inspiratory check valve, part of this respiratory mixture is autonomously fed to the outlet of the respiratory circuit to block the line and exhalation and automatically injected but additional respiratory mixture in the breathing circuit through the reverse inhalation valve when the pressure value for this valve to below the pressure valve, the inhalation valve on the return inlet breathing gas always present.

The problem is also solved by the fact that in the method of artificial ventilation of the lungs, which includes the sequential implementation of the act of inspiration and expiration during PEEP, a setting force is applied, creating pressure of the respiratory mixture, on the inspiratory line of the respiratory circuit to the inspiratory check valve, while breathing, the respiratory mixture is pumped in the respiratory circuit and block the exit by excess pressure at the inlet and outlet of the respiratory circuit, while exhaling, reduce the pressure at the inlet and outlet of the respiratory circuit to the MPC level In, while part of this respiratory mixture is independently supplied to the outlet of the respiratory circuit for overlapping the exhalation line and additionally automatically inject the respiratory mixture into the respiratory circuit through the inspiratory non-return valve, if the pressure behind the valve is lower than the pressure up to the valve, stabilizing the pressure in the respiratory circuit behind the inspiratory return valve, against the background of this stabilized pressure, the current PEEP value is compared with an acceptable value of pressure fluctuations and when a slight drop in pressure occurs, the patient's own respiratory attempt is identified, and a breath is taken at the moment of identification their own respiratory attempt as an auxiliary act of inspiration or when the time for holding an inspiration is reached, the maximum permissible value as a forced act of inspiration.

The task is solved in addition by the fact that the device for creating positive end-expiratory pressure (PEEP) in the respiratory circuit containing the inspiratory line connected through the inspiratory check valve to the patient's lungs, and the exhalation line including the PEEP control device containing a membrane pressure regulator , according to the invention, additionally contains an autonomous circuit in the form of a pipeline, one end of which is connected to the inspiratory line and connected to the inlet of the inspiratory check valve, and an exhalation membrane regulator, to the supmembrane olosti which is connected the other end of the conduit, and submembrane cavity is connected with the expiratory line, the pressure regulator membrane is mounted on the inspiratory line entering the breathing circuit. The membrane of the membrane expiratory regulator can be made flat or in the form of a bellows.

The membrane of the pressure regulator can also be made flat or in the form of a bellows. The problem is also solved in that the device for artificial ventilation of the lungs, containing the injection unit of the respiratory mixture, the respiratory circuit including the inspiratory line connected through the inspiratory check valve to the patient's lungs, and the expiratory line, the PDKV control device according to the invention, contains a membrane pressure regulator, regulating the pressure of the respiratory mixture at the entrance to the breathing circuit, a setter for setting the preset force, which creates excess pressure during inhalation and PEEP during exhalation, associated with the membranes a pressure regulator, a respiratory attempt sensor connected by the inlet to the inspiratory line, an autonomous circuit in the form of a pipeline, one end of which is connected to the inspiratory line and connected to the inlet of the inspiratory check valve, an exhalation diaphragm regulator, to the supmembrane cavity of which the other end of the pipeline is connected, and the submembrane cavity is connected to the exhalation line, while the discharge unit is made in the form of a continuous capacity blower and a circulation circuit connected to the blower and to the inlet inspiratory line breathing circuit submembrane cavity through the membrane of the pressure regulator. The membrane membrane regulator can be made flat or in the form of a bellows.

The membrane of the pressure regulator can also be made flat or in the form of a bellows.

Advantageously, the device would comprise a control circuit associated with a setpoint of a diaphragm pressure regulator. It is advisable that the respiratory attempt sensor be connected to the master of the membrane pressure regulator via a control circuit. It is also advisable that the respiratory attempt sensor would be implemented as a flow sensor or as a pressure sensor.

Brief List of Drawings

Further, the invention is illustrated by specific examples of its implementation and the accompanying drawings, in which: FIG. 1 illustrates the change in pressure P in the inspiratory line behind the inspiratory check valve during mechanical ventilation, according to the invention; in FIG. 2 is a schematic diagram of an artificial lung ventilation device with a device for generating positive end expiratory pressure (MPE) according to the invention.

The best embodiment of the invention

Hereinafter in the description: the term “breathing mixture” describes a suitable combination of gases for breathing, including atmospheric air; the term “respiratory contact” describes a set of lines of supply and removal of the respiratory mixture into the patient's lungs. The supply line includes the inspiratory line with the inspiratory non-return valve and the patient's inspiratory hose, the exhaust line includes the exhalation line and the patient's expiratory hose.

Atmospheric pressure of the respiratory mixture is taken as zero level of mechanical ventilation.

The proposed method of creating a positive end pressure expiration (PEEP) is as follows.

An inspiratory act is carried out, in which the respiratory mixture is injected into the respiratory circuit during the time of the solid-state reaction at an excess pressure Pu, which is applied at the inlet and outlet of the respiratory circuit to block the exit of the respiratory mixture. In this case, the pressure P in the inspiratory line behind the inspiratory check valve gradually increases during the time Tvd (Fig. 1) and reaches the level of excess pressure Pu at time Ti.

Then, an exhalation act is carried out, for which at a time point Ti reduce the pressure to the level of PEEP. In this case, the pressure P in the inspiratory line behind the inspiratory check valve gradually decreases during the time T outflow (Fig. 1) and reaches the PEEP level at the time Tg.

The achieved level of PEEP is stabilized (Fig. 1) and, against the background of a stable level of PEEP, on exhalation, an independent respiratory attempt of the patient is expected. The permissible biological time for holding the patient in inspiration is T add.

While waiting for a respiratory attempt, pressure fluctuations are continuously monitored and fluctuations of the current PEEP value are compared with an acceptable threshold value of pressure fluctuation in order to identify the patient's respiratory attempt, the occurrence of which is characterized by a slight pressure drop P (i.e., to separate it from the pressure drop associated with e.g. with natural gas leakage from the respiratory circuit).

Pressure fluctuations at the time T3 and T4 (Fig. 1) did not reach the threshold value of Pf and were not identified as the occurrence of a patient's respiratory attempt.

The pressure fluctuation at time point Ts reached the threshold value Рф and was identified as a respiratory attempt, as a result of where at the time point T _{5 the} subsequent act of inspiration is started and then, at time Tb the act of exhalation as described above.

However, in this act of exhalation, against the background of stabilized PEEP, an independent respiratory attempt of the patient did not occur, and with

5 when the patient has reached the inspiratory delay time IW, at the moment of time Tγ, the act of inspiration is forcibly started.

The dashed line in FIG. 1, for illustration, shows the line of decline in the level of PEEP due to natural leakage of the respiratory mixture. Как As can be seen from the graph, with non-compensation of leaks, the pressure in the respiratory circuit in the exhalation cycle due to the natural leakage of the respiratory mixture is continuously reduced.

At time T ₄ it reaches the threshold pressure fluctuation threshold level P _f .

15 A false breathing attempt is identified and inspiration begins if there is no patient breathing attempt.

Thus, assisted ventilation with unstable PEEP is not feasible due to the presence of a false identification of the patient's respiratory attempt. When carrying out auxiliary ventilation of the lungs, according to the invention, a positive pressure of the end of exhalation is created and stabilized as follows.

They create a constant presence of the respiratory mixture at the inlet of the check valve of the inspiration of the respiratory circuit, part of this respiratory

The 25th mixture is separated and autonomously directed towards the exit from the respiratory circuit towards the direction of the respiratory mixture leaving the respiratory circuit. At the same time, at the output of the respiratory circuit, the pressure of the respiratory mixture leaving the respiratory circuit and autonomously coming to the exit from the entrance of the respiratory circuit is directed towards each other.

5 Thus, the respiratory circuit is covered by external pneumatic feedback.

The PDKV master force is generated and the master force is applied to the respiratory mixture at the inlet of the respiratory circuit, in the inspiration line to the inlet of the non-return valve. The resulting pressure of the respiratory ιо mixture is pneumatically transmitted and is directly output to the respiratory circuit.

In addition, the output of the respiratory circuit, the pressure of the respiratory mixture, enters through the patient's respiratory system.

Stabilization of the positive pressure of the end of exhalation is carried out as follows.

If the pressure of the breathing mixture in the breathing circuit behind the inspiratory check valve is lower than the level of PEEP present at the check valve inlet, the inspiratory check valve opens and the breathing mixture is automatically additionally injected into the breathing circuit through the inspiratory check valve until the pressure on the check valve is equalized and pressure in the respiratory circuit of the specified PEEP.

In FIG. 2 is a schematic diagram of an artificial lung ventilation device with a device for generating a positive 25th end expiratory pressure (MPD) according to the invention.

Actually the device for creating a positive pressure of the end of exhalation (PDKV), according to the invention, contains a membrane pressure regulator mounted on line 3 of the inspiration at the entrance to the idiomatic circuit, an autonomous circuit in the form of a pipe 14 and a membrane regulator 15 exhalation. The membrane pressure regulator may be a membrane regulator 8.

The pipeline 14 is connected at one end to the inspiratory line 3 and connected to the inlet of the inspiratory non-return valve 4, and at the other end is connected to the supramembrane cavity 16. The submembrane cavity 17 of the exhalation diaphragm regulator 15 is connected to the exhalation line 10, and the nozzle 18 is connected to the atmosphere. The membrane of the membrane regulator 15 can be made flat or in the form of a bellows of any flexible material (rubber, plastics, including silicone, metal, etc.). In a schematic diagram (FIG. 2), a device for generating positive end-expiratory pressure (PEEP) is included in an artificial lung ventilation device according to the invention, as described. The artificial lung ventilation device includes a pressure unit 1, the input of which is a breathing mixture, a breathing circuit 2 containing an inhalation line 3 with a check valve 4, an inhalation hose 5 and an exhalation hose 6 connected to the patient's lungs 7, and an exhalation line 10, a membrane pressure regulator 8 with switch 9 and nozzle for communication with the inlet of the pressure unit (not numbered). The membrane of the membrane regulator 8 can be made flat or in the form of a bellows of any flexible material (rubber, plastics, including silicone, metal, etc.).

The blower unit 1 contains a continuous-flow breathing air blower, which is made in the form of a blower 11, and a circulation loop 12, which is connected to the blower 11 and to the inhalation line 3 at the inlet of the respiratory circuit through the submembrane cavity 13 of the pressure regulator 8. The device contains an autonomous circuit in the form of a pipe 14 and a membrane expiratory regulator 15.

The pipe 14 is connected at one end to the inspiratory line 3 and connected to the inlet of the inspiratory non-return valve 4, and at the other end is connected to the supramembrane cavity 16. The submembrane cavity 17 of the exhalation diaphragm regulator 15 is connected to the exhalation line 10, and the nozzle 18 is connected to the atmosphere. The membrane of the membrane regulator 15 can be made flat or in the form of a bellows of any flexible material (rubber, plastics, including silicone, metal, etc.). The device also contains a respiratory attempt sensor 19, connected by an input to the inspiratory line 3, and by an output - with a setter 9 through the control circuit 20.

The sensor 19 can be performed as a flow sensor (flow rate or mass or volumetric flow rate). The sensor 19 can also be implemented as a pressure sensor.

In the proposed device, the circuit 20 with the function of controlling artificial ventilation of the lungs and respiratory attempt can be constructed according to the known principles of trigger systems responding to an inspiratory attempt by a patient, or various systems of response to an inspiratory attempt by a patient can be implemented - by pressure, flow rate, volume, etc. d.

An artificial lung ventilation device with a device for creating positive end-expiratory pressure works as follows. When you turn on the blower 11, the breathing mixture enters the submembrane cavity 13 of the membrane pressure regulator 8.

Under the pressure created by the pressure of the setter 9, the respiratory mixture enters through the line of inspiration 3 to the inlet of the check valve 4 and the pipeline 14 into the supramembrane cavity 16 of the membrane regulator 15 exhalation.

During the act of inspiration, the respiratory mixture enters the inlet of the non-return valve 4 of the inspiration and into the supramembrane cavity 16 with an excess pressure Ри.

Under the influence of excess pressure, the inspiratory check valve 4 opens and the respiratory mixture enters the patient’s lungs 7 and then, from the patient’s lungs, through the exhalation line 10, into the submembrane cavity 17 of the exhalation diaphragm valve 15. In this case, the outlet of the respiratory mixture from the respiratory circuit is blocked by the same excess pressure created by the respiratory mixture in the supramembrane cavity 16, the nozzle 18 is closed. The pressure in line 3 of the inspiration gradually rises to the level of overpressure. Then carry out the act of exhalation. To this end, a positive pressure of the end expiratory pressure (PEEP) is applied to the respiratory mixture in the submembrane cavity 13 by the adjuster 9 and the respiratory mixture is withdrawn through the nozzle (not numbered) in the submembrane cavity 13 to lower the pressure of the respiratory mixture to the PEEP level. In the breathing circuit at the inlet of the check valve 4 there is a breathing mixture with a pressure at the level of PEEP.

While the pressure in the breathing circuit behind the inspiratory check valve 4 is higher than the pressure to the check valve 4, the check valve 4 is closed and the breathing mixture through the nozzle 18 in the exhalation diaphragm valve 15 is released into the atmosphere. The pressure in the respiratory circuit behind the check valve 4 of the breath is gradually reduced to the level of PEEP. When the PEEP level is reached, nozzle 18 also closes in the respiratory the circuit behind the check valve 4 of the inspiration on the exhalation sets the pressure of PEEP.

When the breathing mixture leaks from the breathing circuit, for example, when there is a natural leak at the joints of the hoses and lines of the breathing circuit, the pressure in the breathing circuit behind the check valve 4 of the inspiration drops and becomes lower than the pressure at the inlet to the check valve 4, where the breathing is constantly present mixture at the level of PDKV.

Under the influence of increased pressure at the inlet, the non-return valve 4 opens and the respiratory mixture is automatically pumped in from the inhalation line 3 through the non-return valve 4 until the pressure at the non-return valve 4 is equalized and the pressure in the respiratory circuit reaches the PEEP level.

Thus, in the respiratory circuit behind the inspiratory check valve 4, a constant level of positive pressure of the end of expiration is automatically maintained, i.e. PDKV pressure is stabilized.

The respiratory attempt sensor 19 compares, against the background of stabilized PDKV pressure, the current PDKV value with an acceptable threshold value of pressure fluctuation. If the threshold value is exceeded, the sensor 19 and / or circuit 20 identifies the patient's respiratory attempt and gives a signal to the controller 9 to perform an auxiliary inspiration act.

If the inhalation delay time has reached the maximum permissible value, and the respiratory attempt has not been identified, then, when this value is reached, the act of inspiration is forcibly performed similarly to the above.

The setter 9 of the membrane pressure regulator 8 can regulate for example, by means of a sensor 19 and / or circuit 20. Manual control of the task is also possible.

Industrial applicability.

The invention can be used for ventilation of the patient’s lungs with a partial and / or complete absence of respiratory activity of the patient.

Claims

CLAIM.

1. A method of creating a positive end-expiratory pressure (PEEP) during mechanical ventilation by applying to

5 of the respiratory mixture of the pressure-generating force setting the PDKV to block the exhalation line of the respiratory circuit and the formation of the PDKV, characterized in that they apply the force-setting PDKV, creating the pressure of the respiratory mixture, on the inspiratory line of the respiratory circuit to the inspiratory check valve, part of this breathing valve mixtures are independently supplied to the outlet of the respiratory circuit to block the expiration line and additionally automatically inject the respiratory mixture into the respiratory circuit through the inspiratory non-return valve, if the pressure value behind this Pan lower than the pressure upstream of the valve, the inspiratory valve to reverse the respiratory inlet

15 mixture is always present.

2. A method of artificial ventilation of the lungs, including the sequential implementation of the act of inhaling and exhaling during PEEP, characterized in that a setting force is applied, creating pressure of the respiratory mixture, on the inspiratory line of the respiratory circuit to the inspiratory non-return valve, while breathing, the respiratory mixture is injected into the respiratory circuit and block the exit by excess pressure at the inlet and outlet of the respiratory circuit, while exhaling, reduce the pressure at the inlet and outlet of the respiratory circuit to the level of PEEP, while part of this respiratory mixture

25 tonefully fed to the outlet of the respiratory circuit to block the exhalation line and additionally automatically inject the respiratory mixture into the respiratory circuit through the inspiratory non-return valve, if the pressure behind the valve is lower than the pressure before the valve stabilizes

SUBSTITUTE SHEET (RULE 26) By adjusting the pressure in the respiratory circuit behind the inspiratory check valve on the exhale, against the background of this stabilized pressure, the current PEEP value is compared with the permissible pressure fluctuation value and, if a slight pressure drop occurs,

5 of the patient’s own breathing attempt, and breathing in at the moment of identifying their own breathing attempt as an auxiliary act of inspiration or when the inspiration delay time reaches the maximum permissible value as a forced inspiration act. io 3. Device for creating positive end-expiratory pressure (PEEP) in the respiratory circuit, containing the inspiratory line connected through the inspiratory check valve to the patient's lungs, and the exhalation line, including the PEEP control device, containing a membrane pressure regulator, DIFFERENT in that

15 completely contains an autonomous circuit in the form of a pipeline (14) one end of which is connected to the inspiratory line (3) and connected to the inlet of the inspiratory non-return valve (4), the expiratory membrane regulator (15), to which the other membrane is connected (16) the end of the pipeline (14), and the submembrane cavity (17) is connected to the line (10)

20 exhalation, while the membrane pressure regulator (8) is installed on the line (3) of the inspiration at the entrance to the respiratory circuit.

4. The device according to claim 3, characterized in that the membrane of the regulator (15) of inhalation is made flat.

5. The device according to claim 3, characterized in that the membrane of the regulator 25 (15) of the exhalation is made in the form of a bellows.

6. The device according to claim 3, characterized in that the membrane of the pressure regulator (8) is made flat.

SUBSTITUTE SHEET (RULE 26)

7. The device according to claim 3, characterized in that the membrane of the pressure regulator (8) is made in the form of a bellows.

8. A device for artificial ventilation of the lungs containing the pressure unit of the respiratory mixture, the respiratory circuit, including

5 the inspiratory line connected through the non-return valve of the inspiration to the patient's lungs, and the exhalation line, PDKV control device, characterized in that it contains a membrane pressure regulator (8) that regulates the pressure of the respiratory mixture at the inlet to the respiratory circuit, a regulator (9) for installation a setting force that creates excess pressure during inspiration and PEEP during exhalation associated with the regulator membrane (8), a respiratory attempt sensor (19) connected by the input to the inspiration line (3), an autonomous circuit in the form of a pipeline (14), one the end of which is connected to l Nia (3) inspiratory and is connected to the inlet of the check valve (4) inhalation diaphragm

15, an exhalation regulator (15), to the supmembrane cavity (16) of which the other end of the pipeline (14) is connected, and the submembrane cavity (17) is connected to the exhalation line (10), while the discharge unit is made in the form of a continuous blower (11) and a circulation loop (12) connected to the blower (11) and

20 with a line (3) of inspiration at the entrance to the respiratory circuit through the submembrane cavity (13) of the membrane pressure regulator (8).

9. The device according to claim 8, characterized in that the membrane of the exhalation regulator (15) is made flat.

10. The device according to claim 8, characterized in that the membrane of the regulator 25 (15) is made in the form of a bellows.

11. The device according to claim 8, characterized in that the membrane of the pressure regulator (8) is made flat.

SUBSTITUTE SHEET (RULE 26)

12. The device according to claim 8, characterized in that the membrane of the pressure regulator (8) is made in the form of a bellows.

13 The device according to claim 8, characterized in that it contains a control circuit (20) associated with a setter (9) of the membrane pressure regulator 5.

14. The device according to claim 8, characterized in that the sensor (19) of the respiratory attempt is connected to the setter (9) of the membrane pressure regulator through the control circuit (20).

15. The device according to claim 8, characterized in that the respiratory attempt sensor (19) is designed as a flow sensor.

16. The device according to claim 8, characterized in that the sensor (19) of the respiratory attempt is made as a pressure sensor.

fifteen

twenty

SUBSTITUTE SHEET (RULE 26)