DE1566675B1 - Medical ventilator - Google Patents

Description

The invention relates to medical ventilation that is guaranteed if the patient does not make any unsatisfactory breathing attempts for anesthesia and treatment, or if one is already breathing, consisting of. suspends natural breathing initiated by an inhalation bladder,
for. the supply of anesthetic gas and / or other has controlled valve drives with which the inhaled gas and an exhalation control breathing valve and the exhalation valve from a valve for. the control of the exhalation periods, the inhalation period into an exhalation period and the operation of the valves can be reversed with the help of an io that a time control switch-inhalation and exhalation period-determining control is provided: the controllable control resistors device is adjustable and where the Device for setting the respiratory periods and a spontaneous attempt at breathing by the patient is connected to the switches in order to periodically control the one running respiratory period in the other possible valve drives so that a single respiratory period can be reversed. 15 lumen measuring device is provided, which is

Known medical ventilators this development of a set limit value for the patient Kind can either on - the. Gas or gas coming in or coming from the patient based on a time cycle Volume cycle or with. a pressure cycle responds in volume and thereby the timing control circuit work. When operating on the basis of the time cycle to initiate a new breathing period . corresponding. from the USA.r 20 controls that a gas pressure measuring device pre-patented 3101708 known embodiment will be seen when determining a specified pressure that Ventilator alone with the help of an electrical limit value of the patient received or niche control regulated, d. That is, the control system responds to gas coming from the patient and the device in predeterminable periods of doing the timing control circuit for initiation. one one inhalation period into an exhalation period 25 new ones. Breathing period reverses that the end of each and vice versa by analogous control of the inhalation and exhalation period in dependence. Valves around in order to artificially exclude the patient from the respective setting of the. Tax disgust. levels can be determined and that the volumetric

In other known devices with a device and the pressure measuring device with the

Pressure or volume cycle, 30 time control circuits are optionally available individually or in combination

the pressure or the volume of the patient's nation can be put into operation with the help of switches

incoming gas and coming from the patient.

The principle and the advantages of this ventilation period is reversed to the other, as soon as the device is based essentially on the fact that the time control circuit and the gas volume, which are constantly in operation during spontaneous attempts at breathing, reach a certain limit value - depending on whether the pressure or volume measurement has been sufficient. Other devices also offer the possibility of setting the device, or whether the set speed, either with a pressure cycle or a limit value for reversing the time control circuit, volume cycle or with both cycles simultaneously or not, always ensures that it is operated so that the fixed pressure 40 the patient at least one time-regulated pressure or volume limit value, which is offered, for example, in the case of a respiratory respiratory cycle, i.e. ventilation on which the patient is asked to be mentioned first, the Umten time cycle basis,
Control of the device in the other breathing period If the volume or pressure measuring device requires. works or is set, which is appropriate

It will be understood that doctors or anesthetists 45 would be the case with the patient breathing naturally

If one of these three above-mentioned is required, then the measuring devices or the

Will prefer working methods. In addition, the measuring device currently in operation is included

Doctors also often find different determinations of the volume or pressure limit value

view which working method of the device time control circuit to initiate a new at-

Under certain circumstances the most favorable one is to adjust and override the weather period so that

with it must still be taken into account that the respiratory period alone differs from the natural

during an operation it can be found that the patient's mood is being determined. But it should

For example, working with a print cycle is better if the patient does not breathe naturally, then it takes over

than with a volume cycle. the time control circuit alone controls the system

The ventilators known to date offer 55 advises. The same is true if the patient is after

However, the anesthetist does not have the option of producing natural breathing from any

with a single device optionally with time, reason suddenly stops breathing because in this

To work pressure or volume cycles, so that the At-

these devices are automatically relevant again with regard to their possible uses,

are limited and therefore for the doctor and pa- 60 so that the set with the control resistors

did not provide the best possible level of safety when breathing periods were never exceeded

Represent operation. can be.

Accordingly, the object of the invention consists in The invention is based on one in the drawing

the creation of a medical ventilator, the embodiment shown in more detail

that clarifies all three mentioned operational 65 to the anesthetist,

offers possibilities in one device and in which it shows _.

it is guaranteed that when working with pressure or F i g 1 a scheme of the gas cycle of the beat volume cycles even then a faultless ventilator according to the invention,

I 566 675

F i g. 2 a simplified representation of the electrical Control of the ventilator,

3 is a circuit diagram for a remote monitor unit for a device according to Fig. 1,

FIG. 4 shows a circuit diagram of part of FIG another switch arrangement.

According to FIG. 1, the ventilator consists essentially of a cubic frame made of metal profiles 1, 2, 3, 4, 5, 6 and 7. The surfaces

is controlled by operating a hand bellows 26 as a gas reservoir.

The gas circuit according to FIG. 1 has seven gas connections, a first closed 5 connection 27, a second closed connection 28, a connection 29 for the propellant gas, a Connection 30 for the gas for the patient, a connection 31 for the hand bellows 26, an inhalation connection 32 and an exhalation connection 33 for

of the frame are clad with panels of sheet metal to io the patients to form via pipes to the bellows with a device housing, and these boards have means of eight poppet valves Vl to V 8 (the Besse-openings and openings for receiving the ren Overview because shown in the open position) control devices, display devices and inlet and a distribution valve 34 for the gas and outlets for the gas. Two back that are upright. This valve 34 and the eight valves Vl parts 2 and 7 of the frame each carry bearings 8 15 to V 8 form a valve control and are with and 9, in which a rod 10 is freely rotatable. operated by a common control shaft, to which a control button is attached to the rod, two arms parallel to each other, with which the selection of 11 and 12 is rigidly attached, at the ends of which two bearings operating mode is carried out by hand, ie, the 13 and 14 are located, which carry a platform 15. A manual mode and the modes with offe coil spring 16 surrounds most of the 20 nem and closed circle. The valves Vl up to the length of the rod 10, with one end of the spring V 8 in the closed position against the arm 11 and the other end against a worm wheel 17, not shown, by an outer helical spring, through the center of which is held that which the Surrounds the valve rod and runs out of rod 10, which is mounted on the upright part 7. the valve housing protrudes, and the valves who-A shaft 18 is in engagement with the worm 25 according to the selected operating mode by eight wheel 17 and is also attached to part 7, and the cams on the control shaft open, which rotation of the shaft 18 if the worm wheel rotates 17 actuate swivel arms which rest against the valve rods on its mounting and act on the spring 16. The valves Vl to VS have Anmit a torsional force. A platform indicated by the broken keys, B, C, D, E, F, G, H, I, K, L and M, line 19 is supported within the frame and supports three cylindrical bellows, some of which are for two valves at the same time , are seen.

namely a first bellows as the exhalation bellows 20, the gas distribution valve 34 has the shape of a

a second bellows as central bellows 21 and a cylindrical bore 35 with a rotor 36 therein, third bellows as auxiliary bellows 22, the upper ends of which are coupled to the control shaft and are attached to one of the platform 15. The rotation 35 of a fixed cylinder of suitable diameter and suitable worm wheel 17 will consist of such a length. The two parallel holes ensure that the torsional stress 37 and 38 pass through two diameters of the rotor, the platform 15 can sink and the bellows are also removed or collapsed over its length. The amount of this rotation is therefore back-turned, by two diametrically opposed to control the force which the bellows collapse 40 form lying flat surfaces 39 and 40, which admit, while due to the length of the other and are parallel to the rotor axis. Four AnFeder this force can be precisely selected and the conclusions S, P, R and N enter the cylindrical essentially over the entire movement bore 35 and are in a position of the rotor area of the arms 11 and 12 is constant. so arranged and located that the connections S

The exhalation bladder 20 has an internal front 45 and P through the hole 37 and the ports R jumped in the manner of an inverted hat shape, which are connected to and N through the hole 38 so that their upper surface is suspended and down gas between the Connections S and P and R and N depends, as indicated by the broken line 23 can flow. A rotation of the rotor in the clock is so that in the collapsed state this moves in a clockwise direction or in the opposite direction, the bellows first, the remaining volume is very small. The 50 holes and connections out of alignment, then obscures the maximum stroke volume of the exhalation bellows 20, the connections and finally gives the information

carries 2000 ecm, while the other two bellows 21 and 22 each have a maximum stroke volume of 1400 ecm so that a negative (sub-atmospheric) pressure can build up.

The ventilator can be used for supplying a patient with gas on the basis of an open or closed gas circuit or a manually operated circuit with the exclusions free again, with a gas passage between ports S and R through part of the
Bore 35 and a surface 39 or 40 and a
55 different gas passage through another part of the
Bore 35 and the other surface 40 or 39 are created. Such gas passages will not
only formed when the surfaces 39, 40 directly den
Connections are opposite, but they are

Choice of application method only by a 60 also before if an edge is one of these faces

Control process is carried out on the device. In which a pair of connections releases, and the gas passages

only in both cases will the device either exist with one until the corresponding edge of the

Time, pressure or volume cycle or with a surface 39 or 40 covers the connections, d. h., it

Combination of these operated, with a considerable angular range for the rotation

With the help of two alternately operated, electrically 65 hung the rotor in front of which the gas connections

actuatable valves, namely an inhalation-effective. With the control button the three

valve 24 and an exhalation valve 25, are set during possible operating positions, where-

in the latter case, the ventilation circuit moves the wave between each position by 120 °

turns. This rotation of 120 ° between the positions gives an additional advantage: that the valves Fl to F 8 actuating cams can have a lower stroke than when one would use a 90 degree rotation between positions.

When the device is in operation, the patient connected to the device inhales and exhales via a connection 41 and is connected to the inhalation connection 32 and the exhalation connection 33 of the device via flexible hoses 42 and 43, the connection of these hoses being an overflow valve 44 having. This valve 44 is slightly biased towards the closed position by means of a spring 45 and enables the gas present in the hoses to escape to the atmosphere via a connection 44 a when the pressure in the circuit exceeds a fixed adjustable level. By means not shown, provisions have been made to ensure that the spill valve 44 can be locked in the closed position to prevent the discharge of gas to the atmosphere. The gas supply for the patient is connected to the connection 30, wherein a gas source with a flow control or control for a pressure of z. B. 0.2 to 0.7 kg / cm ^{2 is} provided if the ventilator works like a minute-volume divider.

During manual operation of the ventilator, the distributor valve 34 is in the position shown, while the valves Vl and F3, F6 and Vl are open and the hand bellows 26 is connected to the connection 31, the overflow valve 44 being operationally in the unlocked position. Opening the valves F 3 and Vl enables the gas in the bellows 21 and 22 to escape into the atmosphere as soon as the bellows are under the influence of the spring 16 when the inhalation valve 24 is either not operated or is not operated periodically and is open contract, causing the gas in bellows 20 to pass through port 28 to the atmosphere.

Gas flows from connection 30 to connection P via line 46, through the passage between P and N in distributor valve 34, out of connection N to connection G of open valve F 6 via line 47, from connection H of valve V 6 for the connection of the open valve F1 via the line 48 and from the connection B of the valve F1 to inflate the hand bellows 26 via the line 49 and the connection 31. Gas also flows from connection C of the open valve F1 via line 50 to a gas pressure test device 51 with zero center position and to connection 32 via line 52, from where it passes through hose 42 to overflow valve 44 and to connection 41 for the patient. The gas is not in the hose 43 and via the connection 33 in the line 53, through a stroke volume meter 54, the line 55, the exhalation valve 25 (which is either fully or periodically open and operated) and the line 56 to connection B of the Valve F 5 arrive because this valve is not open. The gas will also not pass from connection C via line 57, through control valve 58 for the flow rate, line 59, diaphragm valve 60 and line 61 to connection M , since neither valve F 4 nor valve F 8 is open . By compressing the inflated hand bellows 26 by pressure exerted by hand, gas will flow into the patient, some of the gas escaping into atmosphere via the valve 44 and the pressure used for the flow being displayed on the pressure testing device 51. The subsequent release of the pressure on the hand bellows 26 can be filled again, the gas in the patient's lungs being pushed out by the elastic resilience of the chest wall and a smaller part of the expelled gas returning via the flexible hose 42, whereby an unavoidable Amount of re-inhaled gas is given, but most of the gas is released through the overflow valve 44 to the atmosphere.

The electrical supply of the device does not need to be switched on during manual operation to be. However, if one of the other two previously mentioned modes is used is, however, electrical power must be available for an electronic control device, which alternately the electrically operated solenoid valves 24 and 25 operates, which the ventilation rhythm with control an inhalation period and a subsequent exhalation period. Should during the Manual operation electrical voltage can be applied to the electronic control device the valves 24 and 25 are operated alternately, but this has no adverse effect. If necessary an electrical lock could be placed to prevent the supply of electrical power, if the operation of the device was selected manually, but also without this simplification it is possible to switch from manual mode to another operating mode that is controlled by the control device controlled without interrupting the ventilation rhythm.

When the above-mentioned closed gas circuit is used, the rotor 36 of the valve 34 is rotated so that the hole 37 is aligned with the ports S and P and the hole 38 is aligned with the ports R and N , while the overflow valve 44 is blocked, so that no gas escapes into the atmosphere. The valves F2 and F3, F 5 and F8 are open, and the connections 27 and 28 are connected by a pipe or a hose 62, one branch 63 of which _{feeds a gas cleaner 64 (CO 2} absorber) to which a gas reservoir or Reservoir 65 is connected via a pipe 66. The container 65 has flexible walls and can expand when it absorbs gas, the gas pressure essentially not increasing due to the expansion of the container walls. A propellant such as B. compressed air is fed to port 29 and gas for the patient is brought to port 30 for manual operation. The flow of the driving gas is also controlled by external devices, not shown, and the gas for the patient initially fills the ventilator and then cancels any gas losses that occur due to absorption by the patient or through leaks.

The driving gas runs from the connection 29 via the line 67 to the connection R of the distributor valve 34, from the connection N via the line 47 to the connection of the open valve F 2, from the connection

209 513/44

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Connection F via line 68 to inlet 69 of bellows 21 and from outlet 70 of bellows 21 via line 71 to inhalation valve 24. During the exhalation period, inhalation valve 24 is in operation and closed, and bellows 21 is expanded by the propellant gas, whereby the platform 15 is raised and the other two bellows expand. During the following inhalation period, the inhalation valve 24 is inoperative in response to pressure changes. These switches and membranes work as a gas pressure measuring device which responds to the determination of a fixed pressure limit value for the gas coming to the patient or coming from the patient and thereby reverses a time control circuit to initiate a new breathing period in a manner explained later.
It was previously determined that the lifting

and open, whereby gas from the bellows 21 over the io volume of the exhalation bellows 20 is larger than the line 72 to the opening I and from there over the other two and that during the exclusion L of the open valve V 3 and the line 73 Breathing stroke a negative (sub-atmospheric) can get into the atmosphere. During this
Inhalation period, the spring 16 pushes the three
The bellows in the contracted position.

Patient gas from port 30 runs through line 46, port ?, hole 37, port S, lei pressure would be generated with the system described. In order that this process can be controlled from a negative maximum to zero (atmospheric pressure), a control valve 91 is used. The inlet of the valve 91 is via a lei

Lines 74 and 75 to the connection 27 and from there from device 92 to line 86 and the outlet of the hose 62, branch 63, gas cleaner 64 and valve 91 via a line 92 A with an on-line 66 further to fill the container 65. The 20 way valve 93 of a second inlet 94 of the bellows

remaining part of the gas system can be filled with gas by e.g. B. the hose 62 from the connector 28 is removed and the machine is thus enabled to operate a few cycles when it is removed To carry out the end of the hose 62, which is covered with the hand of the operator and is then reconnected to terminal 28. On the other hand, the flow rate for the Device must first be chosen large in order to quickly expel unwanted air from the gas circuit. For the following description it is assumed that such loading and filling of the System has already happened.

During the exhalation period, the expanding bellows 22 serving as an inhalation bellows draws gas from the container 65 through the connections described, i.e. also via the line 76 and a one-way valve 67 into an inlet 78 to the bellows 22. At the same time, that in the patient flows Gas into the expanding exhalation bellows 20 via line 43, connection 33, line 53, spirometer 54 (which shows the stroke volume of the exhaled gas), line 55, non-operated and open exhalation valve 25, line 56, connections D and E open valve V 5, line 79 and the unlimited inlet 80 of the bellows 20. During the inhalation stroke movement of the three bellows, during which the platform 15 descends, the gas in the bellows 22 is connected through a one-way valve 81 in a 20. The valve 91 works in the manner of a variable tap and includes a valve 91 ^ 4 , which is biased in the closed position, the valve 91 rotates in the bypass and is arranged so that an excessive negative pressure, which could be dangerous for the patient, the Valve 91A opens. During closed-loop operation, the additional gas required to relieve the negative pressure in excess of the desired negative pressure is therefore withdrawn from the container 65. If negative pressure is not required, the control valve 91 is fully open under these conditions, the one-way valve 93 is also open, which is necessary to supply gas to the bellows 20 so that the difference in the displacement of the bellows 20 and 22 can be canceled out.

The control valve 58 is constructed similarly to the control valve 91, but does not have a bypass valve like this.

When negative pressure is used, this is supplied to not only the patient but also the hose 42 and the connection to the terminal 32 in stationary Ver lines. The diaphragm valve 60 closes under these conditions so that the valve 81 does not open as soon as the bellows 22 expands, and thus the volume of gas which is directed in the direction of the bellows 20 is reduced

35

40

Outlet 82 of bellows 22 through which conduit 83, 50 can be drawn. The negative pressure applied during exhalation through ports K and M of the open valve V 8 is thus applied to the

Line 61, diaphragm valve 60, control valve 58, which regulates the speed or the volume of the gas flow to the patient, lines 57, 50 and 52, connector 32 and hose 42 fed into the patient, who is connected to connector 41 is. The gas does not run through the hose 43, since the exhalation valve 25 is not operated and is therefore closed during the inhalation period. At this time, the gas in the expiratory bladder 20 is released through a one-way valve 84 of an outlet 85 of the Bellows 20 led out via a line 86 in order to refill the container 65 via the connection 28. During this inhalation period, the positive (superatmospheric) pressure is applied to the Measuring device 51 is displayed and will also influence two switches 89 and 90 via lines 87 and 88, which are operated by the membrane, which test device 51 is displayed and the switches 89 and 90 forwarded. The reduction in the volume of the bellows 20 by the inner protrusion, the indicated by the broken line 23 is used to quickly reduce the required negative To build up work pressure.

The middle bellows 21 has an outlet valve 95 on its upper surface. The rod 96 of this valve extends through the platform 15 and through a spring 97 which cooperates with the rod 96 and plate 15 to keep the valve closed. A stop washer 98 is adjustably attached to the outer end of the valve rod 96 and is located such that expansion of the bellows beyond a desired limit causes the washer 98 to contact a portion of the frame, such as a portion of the frame. B. the parts 3 and 5 or a part attached thereto, and the valve 95 itself

can open, whereby drive gas can escape and prevents further expansion of the three bellows will.

A stop rail 100 is attached to the platform 15 via a link 99 and extends vertically in guides not shown can move. A pointer 101 is carried by the rail 100, and part of the pointer is visible in an opening 102 in a faceplate of the frame. A pole

period can change, as will be explained later.

For operation of the device with an open gas circuit, the pipe or hose 62 is removed from the connection 5 28 and preferably also from the connection 27. The gas for the patient becomes the connection as before 30 out, and the connection 29 no drive gas is fed. The distribution valve 34 is located in the position shown, in which the

which are hinged to the spirometer 54, and further through the non-operated and open exhalation valve 25, ports D and E of the open

This circuit can be used to draw gas from or around the patient's lungs To support ejection of the gas therefrom. In

100 ^ 4, which is attached to the stop rail, protrudes io key and R as well as the connections P and N through the upper surface of the device housing and are connected to each other. The valves V2, V 4, VS allow an easily readable display of the expansion and Vl are open, and the rest of the valves are expansion and contraction of the bellows. By closed. Patient gas, which also acts as two control heads (not shown), flows via line 46, Ankaler direction in the frame, an upper cover plate 15, P and N, line 47, connections G and F 103 and a lower cover plate 104 - of the open valve V2 , line 68 and above that which lie in a plane behind the pointer 101, inlet 69 to the bellows 21. During exhalation and are of such a width that they are the sides of the period the inhalation valve 24 is in operation and Overlap opening 102, being closed by adjustment, and center bellows 21 expands due to the location of panels 103 and 104 by their control 20, raising platform 15, button a selected area of opening 102 and bellows 20 and 22 be stretched. While being uncovered. On the upper end of the upper of this expansion, air is drawn into the bellows 22 through the plate 103, two microswitches, an upper inlet 78 and the one-way valve 77 from the on-volume microswitch 105 and an upper overflow, 27 and 29, while gas is drawn from the monitoring switch 106 in such a way that as soon as the 25 patients coming to the bellows 20 via the hose stop rail 100 under the influence of the expanding bellows 43, the connection 33 and the pipes, a surface 107 is raised against the
Actuator of the volume microswitch 105 for
System arrives and closes it. Should the

Stop rail 100 reaches inlet 80 fractionally by a small valve V 5. It can rise a distance further, so a surface 108 of negative pressure will come to rest against the actuating element of the monitoring microswitch 106, as in operation for the closed rail
and open it. In the same way, two more are attached to the lower end of the lower cover plate 104, in this case the control valve 91 enables the air microswitch, namely a lower passage from the connection 28 to the bellows 20. During volume switch 109 and a lower monitoring the following inhalation period are located the switches 110, which are respectively closed and opened by the surfaces 111 and valves 24 and 25 in the open and closed 112, when the position, and the bellows are lowered by the spring 16 rod or rail 100 as soon as the 40 contracted, followed by the next period. Bellows from the expanded position together- The gas in the bellows 20 is pulled through a. The position of the plates 103 and 104 controls the one-way valve 84, the outlet 85, the line 86 and, in addition to the size of the opening, thus also the point at which the connection 28 is released to the atmosphere. The volume of air drawn by switches 105, 106, 109 and 110 into the bellows during the expansion or contraction of the bellows 45 during the exhalation period will again be actuated to atmosphere. The orders of magnitude are given, namely via a one-way valve 81, which means that when one of the microswitches 105 or outlet 82, the line 83, the connections K and L 109 is first actuated by the stop rail, the open valve V1 and the line 73. That is aligned with the indicator 107 with the end of the associated device operating mode in the cover plate 103 or 104 as an inhalation bellows, which gas located in the bellows 21 serving 50 runs from the outlet opening 102 is visible. The switches 106 and 110 70 via the line 71, valve 24, line 72, therefore work when the indicator 107 partially covers the closures / and M of the open valve V4 and further in the free end of the plates 103 and 104. via the line 61 and the path to the patient, the volume switches 105 and 109 are therefore already explained in the description of the operation for the circle closed by the stop rail 100 at an upper and 55,
The outlet valve 95 opens as before at lungs or the times of actuation of a specified expansion limit, and the pressure switches 105 and 109 result in a direct statement of the pressure to the patient or negative pressure, of the switch 89 volume actuated in each case to the pressure limit values 60 that are set for the gas pressure limit values that are reached or that come from the patient. Thus, the switches 105 and 109 and 90 of the pressure measuring device acts, while as well as the rail 100, the position of which from the eye diaphragm valve 60 allows gas to flow from the line 61 into the visual position of the three bellows or the flat line 59 and a withdrawal of form 15 depends, a volume measuring and volume gas through the line 59 is prevented. In order to be able to carry out this radio display device, the gas volume limit values established for the closed and also open guests by pressing the circle, the diaphragm valve has to respond to switch 105 or 109 and thus the time to a connection 60 ^ 4 (to which the Tube 59 is regulated to initiate a new breathing circuit) through the front surface of a

13 14

flexible membrane 60S is covered, with the device on the head, the spring together-line 61 lets gas into a compartment in which the presses, which is thus the valve in the closed position connection 60 ^ 4 and which holds through the walls. The gas located in the upper compartment of the valve and the membrane 605 is delimited. can be with its pressure below the pressure of the gas in this compartment from the line 61 a 5 lower compartment, the all-occurring and pressurized gas deflects the membrane common at or around atmospheric pressure, lays the connection 60A free and leaves, and when this pressure difference the spring pressure thus gas enter the line 59. If it exceeds the value, the valve will lift, but the negative pressure supplied to line 59 is used to reduce the pressure difference. The adjustment only for closing, ie for better and more secure io the position of the nut controls the pressure difference, closing the connection 60.4, because on the back at which the bypass valve works,
side of the diaphragm due to the opening 60 C in the actuated at a positive pressure limit value.

atmospheric pressure acts on the valve wall. Bar pressure switch 90 consists of a short cylindrical The control valve 58 consists of a body with a three-compartment with a flexible metal mem-cylindrical bore with an upper and lower flange 15 as a circular wall. The interior of the department is over. Inside the bore lies a hollow cylinder in communication with the conduit 88, and the drical rotor with a shaft which is rotatable through the outer center of the diaphragm is arranged so that the body protrudes, the interior of which makes a first electrical contact a cylindrical rotor is open to the bore and moves the spring leaf. A second to the first contact has the lower connection and a part 2 ° aligned electrical contact is on one of the cylinder wall of the rotor, the upper rigid blade, the position of which covers the conclusion by twisting, while seals prevent a control shaft with a button from being changed gas leaks can occur between the connections and around the distance between the contacts to varider surrounding atmosphere. In align. The contacts are arranged so that a device with the upper connection penetrates a 25 increase in pressure within the department group of radially arranged holes another above atmospheric pressure the contacts part of the rotor wall, which can close when twisted. The control button carries Eichmarkie rotor through the shaft successively more and more stanchions for the positive pressures at which the holes to the upper connection are exposed. The through-closing of the contacts takes place, so z. B. at 0 knife the holes in the rotor wall is 30 to 50 centimeters water column. The pressure switch flow rate, which can be actuated in accordance with the desired law of rotation / negative pressure limit value, varies, and on the shaft is a 89. The gas pressure measuring device is fitted with the off control button, with which the flow rate is constructed similarly to the pressure switch 90, amount by hand can be adjusted. This __ ^{that a} negative (subatmospheric) pressure structure enables a much easier production of the switch contacts within the department than the more common structure. The control button carries calibration markings that either have a specially shaped connection for the negative pressures at which the contacts or a rotor opening or a combination of close, so z. B. at 0 to 30 centimeters of water both used. pillar.

In the control valve 58 are the connections in 40. The inhalation valve 24 and exhalation in direct connection with the associated lines valve 25 are similar, solenoid-operated valves 57 and 59, while in the control valve 91 each d each valve consists of two compartments, viz. Connection leads to a separate department, the üd ^{1 of} an upper department and a lower wall is common to both. The lines are divided with a common partition. Each 92 and 92 A communicate with the lower and 45 compartments has an outlet on which pipes are attached to the upper compartments which can be brought to the upper and upper compartments, respectively. The gas flow is lead from lower connections, and the common of the upper to the lower compartment. The partition wall of the compartments is broken through by an opening and an opposite wall in the upper one, which has an insert as a valve seat. A valve, the head of which is located in the upper section 50 valve seat or a valve rod, as is and can suitably close the opening, which is also the case with the bypass valve 91 ^ 4, runs with the valve rod through the compartment The lower wall, however, is the valve rod directly on the movable one of the lower compartment, with provided sealing fittings of the solenoid-actuated coil preventing the escape of gas. The closed and not loaded by a spring, since the wall of the compartment through which the valve rod 55 runs to reset the valve in the open position, is relatively thick, and the hole in it gravity is used. The valves are internally threaded to accommodate an external ventilator so that the valve rod threaded and flanged valve guide bearings are vertical, but they will accommodate conventional. The sealing means consist of one way of opening and closing, even then, flexible washer, e.g. B. made of neoprene, which at 6p when the device should be inclined thirty degrees from vertical the outer surface of the valve guide flange.

clamped and with its inner edge in one The wall of the upper compartment through which the

Groove of the valve rod is embedded. The outer valve rod runs, is relatively thick, and that End of valve rod is threaded and hole therein is threaded to carries a nut, between which and the departmental 65 an externally threaded and flange versehewandung, through which the rod runs to receive one of the guide bearings. The sealants The coil spring surrounding the rod is located. Due to the consist of a flexible washer like Movement of the nut on the valve rod in line with the bypass valve 91 ^ 4. The solenoid is on

15 16

concentric to the valve rod, and the valve guide collector circuits the solenoid actuating coils

serves as a bearing for the valve rod and the moving 24 ^ 4 and 25 ^ 4 as drives for the two valves 24

borrowed armature of the solenoid. When the valve is up and 25.

is closed, there is thus a possibility to send gas. This trapped gas prevents a symmetrical multidert-type circuit that the valve opens immediately as soon as vibrators are created, whereby a capacitor is no longer operated, the solenoid is no longer operated, and in order to achieve the emitter resistances of the two transistors, a helical groove is used in io binds. In such a circuit, the time controls the valve stem, which creates a constant of the capacitance and an emitter resistance through which gas can flow freely between the upper level for the length of a period, and the other compartment and the enclosed space, which can control the emitter resistance and capacitor , determined by the area of the valve guide and the duration of the subsequent period, the sum of which is limited by the washer. The closing of the two periods, the time of a cycle of the valve, is also tuned somewhat faster. In order to use very large condensers, since little force acts on the gas, if generators avoid upward bending of the seal in order to achieve the required length of the above-mentioned enclosed space by means of a time constant in the cross connections, directly coupled amplifiers are also used is enlarged. In the lower compartment ™ is installed each transverse branch, wherein each of the association provided from the outside adjustable stop, the stronger also applied the output of low Impegegen the valve head and the valve from danz manages which one anhindert directly for driving to open as far that the magnetic closed transistor is suitable and desirable. Circle is affected. The movable central As shown in Fig. 2, the battery iron armature supply the solenoid is shorter than the latter, 25 113 and / or the charger 114 the circuit over and when the valve is closed there is a two-pole on-off switch and double around the lower ends of the armature and the solenoid switch 115, shown in the on position, spool near the valve nearly in alignment. The remaining space inside the solenoid tube provides power to the charger 114 and the load 116 at the upper end is partially filled with a metal 30 to the battery to prevent excessive gassing of the piece, which is filled with a To prevent the adjustment screw of the battery due to overcharging, the outside of the tube can be moved around when the ventilator is not in operation. The size of an air gap in the magnetic circuit to pnp transistors Tl and Γ 2 are controlled by a control when the solenoid is operated. To the capacitor TC connected to their emitters. To reduce the losses and to create a fast working 35 emitter of the transistor Tl is to the positive Verdes valve, there is at least a partial supply through a control resistor REl angedes magnetic circuit, the central armature, from a closed, which consists of a series connection of a material with high permeability, for example from the resistor Rl, a set resistor R 2 known under the trademark "Radio Metal" and a potentiometer R 3, which is the material. 40 variable resistor is connected. The emitter of

The electrical and electronic parts of the device Γ 2 are similarly equipped with a control resistor.

rätes receive their supply in the form of low-level RE 2 wired, which consists of a resistor

voltage, e.g. B. from a 6.5 V battery 113 with R 4, a set resistor R 5 and a

Nickel-iron secondary cells, which is made up of a sufficient potentiometer R6 . A directly coupled one

Has capacity to supply the ventilator for longer than 45 transistor amplifiers 117 with npn transistors

Operate 24 hours. A charger 114 for this between the collector of Tl and the base of

Battery is also provided in the device, and the T2, where the resistor Rl the load of Tl

The output of the charger is automatically controlled and the resistor R 8 with low resistance

and designed in such a way that the battery 113 takes the greater part of the load on the charge

A fully charged state of 5 ° more 117 in about 3 hours. A similar amplifier 118

can be, whereby a slow automatically connects the output of T 2 with the input

Very low speed charging possible from Tl, and have resistors R9 and RIO

if this requires the same functions as the resistors Rl due to the battery condition

that should be. and R 8. Resistors R 11 and R 12 are both

Since the output of the charger is controlled, 55 amplifiers share emitter resistors,
this can be used to operate the ventilator at the output of the amplifier 117 is the on-non-existence of the battery. Both the battery 113 and the charger 114 pnp transistors Γ3 and Γ4, in whose collectors can be easily removed for maintenance purposes, the coil 24 A of ^{the inhalation valve} 24 is connected, since plug-in and socket connections have such a 6o Simplify the expansion connected according to a Darlington pair. Transistors Γ5 and T6, also from pnp polar

A simplified circuit diagram of the electronic tat, are driven in the same way by an amplifier control device for the valves 24 and 25, the 118 shows and have F i g in their collector circuit. 2. The control consists of a transistorized astable oscillating oscillator, the actuating coil 25 A of the exhalation valve, which is directly connected to ^e 5 25. The output stages of the amplifiers 117 and 118 driver and power transistors (as switches give off a maximum output voltage when turning ) is connected, which are like a Darlington- their inputs are at a minimum, and are switched together and reversed in their circuit, that is, if Tl does not conduct, conducts the output

17 18

output stage of the amplifier 117 strong, whereby Tl is influenced, which is set by the inhalation control wave and the pair of transistors Γ 3 and T 4 switched on by R 6 . The shown indication of the Bewird to operate the coil 14A and the degree of inhalation is only applicable when the ventilator valve 24 is operating on a time cycle based ventilator during the exhalation period,

close. If Tl does not conduct, then on ahn- 5 The resistors R 16 and R 18 with low

lent way the exhalation valve 25 is closed, resistance values are switched so that they are required

by switching its coil 25/1 during the inhalation event through switches parallel to RE1 and RE 2

period is operated. can be switched. Such a use

When Tl conducts, a voltage drops across REl , in a circuit through which the charging current of and a charging current for the capacitor TC flows io capacitor TC shortens the time available through REl, whereby a voltage of such constant and switches quickly, for example is built up in less than polarity that the emitter is biased by Tl a tenth of a second, from one phase of being beyond its blocking limit, breathing cycle to the other.
while the base of Tl is at a potential. The coils 24.4 and 25/1 are each located by which is determined by the current flow through the conventional potentiometer, not shown, which shunted from the resistor to the inductive effect when switching stand R13 and off RIO and off the set- to reduce these coils, while the resistance 2? 14 exists. Since the charging current was ex- R19 and decoupling capacitor 119 decreases ponential with time, the emitter is prevented Schalteinschwingvorgänge, also drop the voltage at time Tl to the Tl starts circle could affect to 20th These switching means can conduct, and it takes place due to the positive feedback so arranged or used that the coupling an increasing influence and opening of the valves 24 and 25 is slowed down in order to take effect that switches off Γ 2, while Tl for the required amount for the temporal overlap leads a further time period. The time it takes to reach the valve operation, that is, both valves so that the emitter voltage from Tl to the value ab- as are closed at the same time when this is required, which is required to initiate the switching action. The resistors RIO, R21, RIl and R13 is the time that is determined by the value of the control resistors are emitter resistances of the transistor pairs Γ 3, status REl, and this can be Γ-4 and Γ 5, Γ 6, with some These resistors can be changed with the help of a button that is assigned in 0.5 to more than one transistor. A one to five seconds is calibrated to set the potentiometer 30 pole single changeover switch and trigger selector switch tiometer R3 and the duration of the exhalation period 120 can be closed to control RY1 in parallel. In the same way, a similar RE1 controls to switch when the contacts 89.4 of the button, the potentiometer R6 and the inhalation pressure switch 89 are closed. Thus, during the period, during the resistance R 15, the patient should make a set resistance R16 during an exhalation period and the resistance R 8 should attempt to inhale and thus control a negative potential at the base of Tl . Nominally tive pressure should generate that is below the equal pressure resistances Rl and RA and set limit value , which is set by the calibrated control resistors R 2 and R 5 in connection with the button of the pressure switch 89, then set resistors i? 14 and R16 enable the exhalation period is ended immediately and a correct setting of the correct times in relation to an inhalation period is initiated,
, regardless of the comparison A two-pole single switch or pressure changes in the choice of parameters of the transistors Tl and switch 121 may whereby the T 2 and the capacity of TC to infer the Knopfeichung. Contacts 89 A or 9 (M of pressure switch 90

After all, it follows that the operation of the two resistors R 17 or R18 can switch in parallel to valves 24, 25 with a control device 45 REl or REl in order to extract the breathing and inhalation periods in the pressure cycle T from the transistors acting as switches 3 to Γ 6 controlled to end as coils 24.4, 25 ^ 4. Depending on the settings, it has valve drives with which both the time control potentiometers R 3 and R 6 are regulated from an inhalation period to an expression pressure that is reversed by the control process at the breathing period and vice versa 5 ° the pressure switches 89 and 90 are set are, and can. The duration of the breathing periods is determined as a function of the control valve 91, the Bevon of a time control circuit, which work from the breathing device with a time cycle or pressure cycle, transistors Tl, Tl, the control resistors REl, or a combination of both, REl and the capacitance TC . the inhalation and exhalation periods through the

Through an opening in the panel, which controls the time set, if the potentiometers R 3 and R 6 are not controlled, the positive and negative pressures set are first visible as an indication of the ventilation rate. Be enough here. If no negative pressure is used while the same basic principles were used in the pressure circuit, then the exhalation phase shown in British Patent 914 352 will thus be timed,
are, and one works with overlapping plates, 60 A two-pole single changeover switch or volume that lie in sliders or sliding guides and selector switch 122 can be closed, with one of the control shafts of the potentiometers R 3 and R 6 via the pole of the switch normally closing the Gear rack and pinion driven open contacts of microswitches 105 and 109 of the be. A lock is arranged so that the out volume measuring device enables the inhalation period is never less than the set 65 switch of the resistors R 17 and R 18 through inhalation period, although the preceding one through. The operation of the buttons that control the operation of the shaft, which controls the plates 103 and 104, changes the position of these R 3 controls, without changing the period of time microswitches relative to the stop rail 100, the

19 20

According to the expansion and contraction malfunction, the splint 100 becomes over a the bellows moves, and provided that the emergency volume switch can wander out and the maneuverable volume limits to close one or the other of the monitor switches 106 and 110 Operate the microswitch before the set times when using time and pressure cycles are enough, the machine works as a ventilation 5 works. Due to the relatively narrow operating device with volume cycles, whereby the closing of the lungs of the volume and monitor switch pairs (the Switch 105 the exhalation stroke and the closing by the relative positions of the actuating surfaces When the switch 109 ends the inhalation stroke. 107, 108, 101, 112 are controlled) and due to In a similar way to describing the fact that one is with some medical Pressure cycles can be any combination of 10 use cases, an inhalation bellows to completely empty the corresponding for a short period of time from the time and volume cycle Control periods of the ventilation circuit. a monitor switch during normal volume

Closing both switches 121 and 122 creates cycle open. To such an opening

a condition in which either the time to prevent what is an immediate display of a

Pressure or volume gives the inhalation and exhalation 15 delay, a capacitor SC, the

can end breathing periods. Below this loading is in series with a resistor R 24, through a

conditions, the set times will turn the device on the second pole of switch 122 in the circuit

control, if not either the set limit.

values for the volume or the pressures in shorter A two-pole double changeover switch 123 will be like

Time to be achieved. 20 in British Patent 970,626 used to denote the

If a control of the ventilator by monitor unit to turn on or off, and on

the electronic time control circuit takes place, a single-pole changeover switch is momentarily closed

a wrong function of the device and its pulls-124, which in the direction of the open switch position

dependent connections to the patient or a pre-stressed, is used to provide an acoustic

Turn off normal behavior during ventilation or monitoring, 25 indicators in the monitoring unit,

patient's respiratory system in expansion An indicator light 125 illuminates when the monitor

or contraction of the bellows over their normal gate unit is operating, and this lamp remains

Range of motion result, and this will burn when the audible indicator goes through the

used to switch a remote monitor unit switch 124 is turned off. A resistor R 25

operate, which a visible and / or audible 30 prevents the destruction and / or rapid

Display in the event of such an incorrect function of the battery. Discharge of the battery 113 if the remote

advises there. on the monitor unit or on the connecting wires

While the ventilator is running, a state should occur which, in the absence of the time and / or pressure cycles, the monitor input resistor R 25 will represent a low resistance for unit through the stop rail 100 in operation, the battery should represent. Lines that are used to connect one of the series-connected and normal monitor units to the ventilator have closed contacts on the monitor microphone ends in a plug or pin that opens into switches 106 and 110. In the circuit that matches terminals 128, 129, 130, 131 and 132. Monitor unit is a rectifier bridge switch- Two further lamps 126 and 127 indicate when Auftung in connection with a relay, which light up like 40, that the ventilator is supplied with electrical power according to the British patent shear power and that the battery 970 626 is usually in operation is held. The device is fully charged. Monitor switches 106 or 110 are shown either by FIG. 3, in which all relays in the deenergized state 108 or 112 of rail 100 are open, shows the circuit of the escape switch arm of the associated monitor switch 45 remote monitor units, with the to him leader 106 or 110 touches. Since the position of these scarfs broken lines are intended to represent the lines to the beater relative to the rail 100 by controlling the measurement device. The buttons described above which operate the panels 103 and 104, components of the monitor circuit are also changeable, the extent of the left area of the circuit can be shown. A two-pole connection and contraction of the bellows for the purpose of moving the on-off switch 133 to the off position separates the monitoring unit from being operated by the control device. Under battery 113 via terminal 132 and the protective conditions in which the monitor unit resistance R 29 and continues to disconnect is not operated, the indicator 101 will sweep the negative voltage from a bridge area of the opening 102 via a pole 135, the equal to or 55 rectifier 136 if the supply voltage is less than the voltage exposed by the cover plates feeds. When the switch 133 is closed on the cover plate, which is visible in the opening 102 and the voltage is connected to the fuse 138, is partially covered or beyond that connected to the primary winding, a relay Z / 2 should be operated. ben. The contact Zl moves from the illustrated

When the ventilator is operated in the rest position, the voltage disconnects the device battery volume cycles set by switch 122 rie from conductor 139 and replaces it with the equalized, controlling the expansion and applied voltage. If one now assumes that the contraction of the bellows with the aid of the micro 65, a monitor relay X / 2, which is inert, is carried out around a switch 105 and 109, the paths allowing slow fall, then the bellows and des Pointer 101 is closed by the plates 103 of the contact Xl , and the relays X / 2 and 104 are controlled. Any deviation or receives voltage from the negative terminal of the battery

21 22

terie on the closed microswitches 110 and 128 and 129 reversed, and the current flow through 106, a pole of the switch 123, resistor R 25, the relay, which goes in the same direction, terminal 129, a test pressure switch 140, which in as before has been described, runs through the closed position is biased, a contact Xl diodes D 3 and DS. Since the relay X / 2 is slow and a diode D1. The other circle to positive 5 drops, the interval when changing the PoIa terminal of the battery runs across the diode D 2, the rität, when the switch 123 is released, to terminal 128 and the second pole of the switch 123. short for the opening of the contact Xl, and the contact Z 2 is actuated and connects the subsequently re-established normal polarity, holds conductor 139 with conductor 141, to light up the lamp 142, the relay is attracted, as already described above via the closed contact Z 2 became io.

It can also be another form of monitor

voltage is applied and that the unit used normally in radio 148, as for example. B. tioned in the British. Patent application 46 661/65 is shown, and this

If the supply is interrupted, the monitor can either drop directly into the ventilation relay Z / 2, the battery voltage will be built into the device, as in Fig. 1 through the line 139 , and the lamp 142 is through with the broken line 141 indicated tube on the opening contact Z 2 deleted. Should that be shown, or negative voltage can be arranged between the terminal 32 to the relay X / 2 through the opening and the hose 42 , as one of the switches 110, 106 or 140 is indicated by the broken line 150. The are broken, the contact Xl will open 20 remote monitor unit and parts of the monitor and the subsequent closing of the open circuit according to FIG. 1 and 2 are then over the switch that operates the relay X / 2 , prevent fluid.

and the contact X2 is voltage to the line so that the devices to control the duration

tion 143 in order to let an indicator lamp 144 light up the inhalation and exhalation periods of only one and to be ready for operation at any time via the conductors 147.4 and 25 of the three possible device working cycles (time, total closed contact Yl of a non-excited men or pressure) are, relay YIl operate a buzzer 145 . While another switch arrangement can also be used for working with the volume cycle, FIG. 4 shows the associated parts of the delay capacitor SC via the relay X / 2 F i g. 2, which to achieve this goal appropriately unload, changed to this after opening the switch 106 30.

or 110 to keep it energized for a period of time, six switches 151, 152, 153, 154, 155 and 156

the resistance of the discharge path with four positions, those of a common is correct, in order to have an immediate display under- Control shaft can be operated with control button to press. used, whereby the following positions Off, Time,

The resistor R 24 allows both the resistor 35 to mean volume and pressure cycle. The switch of the discharge resistance increases as well as serves 151 and 152 take the place of the poles of the switch to protect the battery 113, if a short circuit ters 115 , the switch 151 the connection in the capacitor SC should occur. This capacitor to line 116 in the illustrated off position, the resistor R 24 and the second pole of the manufactures. In the other three positions, switch 122 can be omitted if 40 this switch voltage from the battery 113 and / the rake of the stop rail, which supplies the or from the charger 114 to the ventilator. Put the different microswitches into operation, the switch 153 has the correct and suitable distance from each other in the emitter circuit of the transistor Π and completes this circuit by having. The following can also be selected at the TT terminals: in the time cycle setting the additional warning devices would be connected to R 2 and the potentiometer R 3 in the volume. Voltage is also applied via a protective fuse cycle setting of the resistor .R 26, whereby a longer time constant than the maximum at lamp 125 in the device is supplied to the connection 146 and terminal 130 of a lighting. The time cycle position is put into operation, and the buzzer can be switched off and a potentiometer R 27. The remote monitor unit can be brought to rest, 5 ° switch 154 is in the emitter circuit of Γ2 and briefly the switch 147 is actuated, which is biased in tet either the resistor R 5 and the potentio direction to the position shown, meter R 6 for working with time cycles or the resulting voltage from the line 143 to the loading resistor!? 28 for working with volume drive of the relay Y / l is applied. The contact Yl cycle and print cycle on. The switch 155 then switches over to the voltage from the buzzer 55 to take the place of the second pole of the switch 122 and 145 and to apply it to the relay Y / 1 to apply the resistor R 24 and the capacitor SC , which is thus attracted remains if the switch 147 is released to take effect as before for the volume cycle. has been described. The switch 156 takes the

When switch 147 is not operated, both the second pole from switch 121 and a spring-loaded switch 124 on ventilator ⁶ insert both the first pole from switch 122 and the like . In the a similar function by being in operation off and time cycle position, the switch 156 does not establish an electrical circuit between conductors 143 , but enables the microswitch in the and the relay Y / 1 via the fuse 146 and volume cycle position that the microswitch 109 Terminals 130 and 131 close. and 105 the resistors R 18 and R17 in the

To energize relay X / 2 or not switch on 65 circuit. In the pressure cycle position rain, ie, in order to switch the monitor unit on or off, it enables the pressure switch contacts 90A to switch on, the switch 123 is actuated briefly. When the resistor R 18 is introduced into the circuit during operation, the polarity of the terminals will change. If while working with pressure

23 24

cycles no negative pressure is used, so will be gen to this department via connector and

the exhalation cycle performed with the potentiometer R 27 sleeves, and the entire department

timed, and the resistor in the circuit can easily be removed from the device for

is set with a calibrated control knob. Maintenance purposes or for replacement. The switching

If negative pressure is used, the 5 circles that are not in the closed compartment

Contact 8SM of the pressure switch are assigned by the trigger-contained switches, d. H. the

switch 120 can be taken into use, with switches 89 ^ 4, 90A, 105, 109, 106 and 110, are located

the corresponding settings of the control device at low voltage and have a relatively high

pressure switch 89 and potentiometer resistor to reduce the risk of explosions in the event of

jR27 determine when the exhalation period ends. io use of explosive gases to reduce ^ while for

If explosive anesthetic gases are used, the gas circuits, bellows, hoses and lines are anti-

all parts are used in the static rubber for safety reasons, whereby the assigned

Fig. 2 and 4 with the exception of parts 89 A, 90 ^ 4, belonging metal parts connected to the frame

105, 109, 106, 110, 113, 114, 24 A, 25 A and 128 which stands on metal.

up to 132 enclosed within a compartment, 15 in addition to valve 95 in the middle bellows 21,

one wall of which has a control and display panel through which the build-up of excessive pressure

forms, on which the associated control and display kes is prevented, are safety valves that

devices for operating the device - lift off at a specified adjustable pressure,

are brought. This panel forms part of the connections in connections 29 and 30 and in line 66

clothing of the frame. The electrical connections to the hand bellows 65 are arranged.

For this purpose 2 sheets of drawings

Claims (9)

Patent claims: 1. Medical ventilator for anesthesia and treatment of insufficient breathing, consisting of an inhalation bellows for the supply of anesthetic gas and / or other gas to a patient, an inhalation control valve for controlling the inhalation periods, an exhalation bellows for evacuating the gas exhaled by the patient and an exhalation control valve the control of the exhalation periods, wherein the operation of the valves can be regulated with the help of a control device determining the inhalation and exhalation periods and wherein the device can be switched from one breathing period to the other possible breathing period in the event of a spontaneous breathing attempt by the patient, characterized in that the control device ■ by switches (Γ3, Γ4; Γ5, Γ6) controlled valve drives (24 ^ 4, 25.4) with which the inhalation valve (24) and the exhalation valve (25) can be reversed from an inhalation period to an exhalation period and vice versa, that a time control circuit ( Tl, Tl, REl; REt, TC) is provided, which has adjustable control resistors (REl, RE 2) for setting the breathing periods and is connected to the switches (T 3, T4; TS, T6) to periodically close the valve drives (24 A, 25A) control that a volume measuring device (100,105,109) is provided that responds to the determination of a fixed limit value of the gas volume coming to the patient or coming from the patient and thereby reversing the time control circuit (Tl, T2, RE2, TC) to initiate a new breathing period that a gas pressure measuring device (89, 90) is provided which responds when a fixed pressure limit value of the gas coming to the patient or coming from the patient is determined, and the time control circuit (TI, Tl, RE2, TC). to initiate a new breathing period, that the end of each inhalation and exhalation period can be determined depending on the respective setting of the control resistors (REl, RE 2) and that the volume measuring device (100, 105, 109) and the pressure measuring device (89, 90) with the time control circuit (Γ1, Γ2, REl, RE2, TC) can be put into operation either individually or in combination with the help of switches (120, 121, 122). 2._ Device according to claim 1, characterized in that it has three mechanically interconnected bellows (20, 21, 22) which can be stretched and contracted simultaneously in a known manner, that a first bellows (20) as exhalation bellows and a second bellows ( 21) serves to take up a drive gas for the common expansion of all three bellows and that the gas is supplied to the bellows via a valve control (34, Vl to F 8) which, when the gas circuit is closed, the gas for the patient optionally to the second bellows (21 ), with the circuit open to the third bellows (22) or to enable a manually controlled gas circuit to a manually controllable gas reservoir (26). 3. Device according to claim 2, characterized in that the valves of the valve control (34, Vl to V 8) can be brought into three selection positions with the aid of a common control shaft, the gas supplied to the device in the first selection position to the second bellows (21 ), in the second selection position the two other bellows (20, 22) and in the third selection position the gas reservoir (26) designed as a compressible hand bellows and that in the first and second selection position the gas reservoir (26) is separated from the gas circuit in the device is. 4. Apparatus according to claim 3, characterized in that the gas for the patient or the drive gas in the first and second selection positions of the valves (34, Vl to VS) can be fed to the second bellows (21) as a drive bellows in order to allow the inhalation valve to be closed ( 24) to expand all bellows (20, 21, 22). 5. Apparatus according to claim 3 or 4, characterized in that that the three bellows (20, 21, 22) are connected to a platform (15) on which a spring (16) acts to urge the bellows in the contracted position seeks and with .opened inhalation valve (24) the bellows from the expanded to the contracted State. 6. Apparatus according to claims 4 and 5, characterized in that the gas for the patient in the first election of the. Valves - (34, - Vl to KS) from the second bellows (21) and in the second valve selection position from the third bellows (22) flows to a device such as a face mask, via which the patient is supplied with gas, and that in this case the gas exhaled by the patient can be discharged through the exhalation valve (25) and the first bellows (20). 7. Apparatus according to claim 6, characterized in that in the first and second selection position of the valves (34, Vl to VS) with the help of switches (120, 121, 122) contacts (105, 109, 89 ^ 4 , 90 A) can be switched on, each of which responds to the mentioned limit values of the volume and pressure of the gas flowing to and from the patient, with the closing of at least one of the contacts (105, 109, 89 A, 90 Λ) the effective resistance of one of two resistance chains (2M, R2, R3 and R4, R5, R 6; Rl ₁ R 26 and R4, R 28; R1, R 27 and R4, R 28) reduced to the timing control circuit (Tl, T2, REl; RE 2, TC ) to end the current breathing period and to initiate the other breathing period. 8. Apparatus according to one or more of claims 1 to 7, characterized in that the first bellows (20) for generating a negative, the extraction of gas from the lungs the patient-supporting pressure has a larger stroke volume than the other two bellows (21, 22), and that a variable opening (91) for adjusting the negative pressure in the desired Limits is provided. 9. Apparatus according to claim 8, characterized in that a safety valve (91.4) for limiting the negative gas pressure is provided.