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EP1284774A1 - Gas doser with a catheter - Google Patents

Gas doser with a catheter

Info

Publication number
EP1284774A1
EP1284774A1 EP01953149A EP01953149A EP1284774A1 EP 1284774 A1 EP1284774 A1 EP 1284774A1 EP 01953149 A EP01953149 A EP 01953149A EP 01953149 A EP01953149 A EP 01953149A EP 1284774 A1 EP1284774 A1 EP 1284774A1
Authority
EP
European Patent Office
Prior art keywords
gas
catheter
supply system
gas supply
breathing
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
EP01953149A
Other languages
German (de)
French (fr)
Inventor
Christian Krebs
Rainer Muellner
Stephan Haubenberger
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
INO Therapeutics LLC
Original Assignee
Messer Austria GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Messer Austria GmbH filed Critical Messer Austria GmbH
Publication of EP1284774A1 publication Critical patent/EP1284774A1/en
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/12—Preparation of respiratory gases or vapours by mixing different gases
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/01—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes specially adapted for anaesthetising
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/104—Preparation of respiratory gases or vapours specially adapted for anaesthetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A61M2016/0033—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
    • A61M2016/0039—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the inspiratory circuit
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/02—Gases
    • A61M2202/0266—Nitrogen (N)
    • A61M2202/0275—Nitric oxide [NO]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics
    • A61M2230/43—Composition of exhalation
    • A61M2230/437—Composition of exhalation the anaesthetic agent concentration

Definitions

  • the invention relates to a gas metering device with a catheter.
  • Ventilation devices are used for mechanical ventilation, for anesthesia and for respiratory therapy by treatment with gases, e.g. B. Oxygen donation or treatment with nitrogen monoxide (NO).
  • gases e.g. B. Oxygen donation or treatment with nitrogen monoxide (NO).
  • An inhalation anesthesia device is described for example in DE 37 12 598 A1. It is used to dose anesthetic gas into the breathing gas.
  • a device for supplying breathing gas or oxygen to a patient is described in DE 43 09 923 A1.
  • DE 43 25 319 C1 describes a device for the continuous dosing of NO to the breath of patients, containing a respirator, a NO dosing container, a dosing unit with control unit and an analyzer for determining the NO concentration in the breathing air.
  • the control unit takes over the dosing of the NO to be dosed by determining the volume flows of breathing gas and NO taking into account the NO analysis value.
  • the NO dosage is proportional to the volume or proportional to the volume flow, so that the NO concentration in the breathing gas is always kept constant.
  • the basic technical features of NO dosing in NO therapy are described in: "C. Krebs et al. ⁇ Technological basis for NO application and environmental security, Acta Anaesthesiologica Scandinavica Supplement 109, Vol. 40, 1996; Pp. 84-87 ".
  • WO 98/31282 (internal designation TG 2028/67) describes a gas supply system for ventilated or spontaneously breathing patients, in which one or more gases (for example NO, oxygen) are controlled by means of a controller (program control, sensor control or combined program) - / sensor control) be metered unevenly (continuously or discontinuously) into the breathing gas in a breathing tube.
  • gases for example NO, oxygen
  • controller program control, sensor control or combined program
  • the invention has for its object to provide a device for more effective care of patients with one or more gases.
  • Gas supply systems are arrangements or devices that deliver one or more gases to a patient or make them available for breathing.
  • the gases in particular medical gases, are preferably mixed with air, a breathing gas or oxygen, so that gas mixtures are obtained which maintain breathing.
  • a gas supply system is e.g. B. a ventilation system with respirator and Gasdo- sie ⁇ / orcardi for one or more gases.
  • a respiratory system consists, for example, of hose connections or gas lines, gas source, gas metering device
  • Ventilation systems with a ventilator are generally used for the inpatient treatment of patients.
  • Gas supply systems can be stationary or mobile, especially portable devices.
  • Gas supply systems according to the invention are preferably used for the treatment of humans or mammals with one or more gases, in particular for the inhalative treatment of the lungs.
  • the gas is generally not metered into the breathing gas, but is directed directly to the site of action, usually in the lungs, via a gas supply to which a catheter is connected.
  • the gas therefore does not have to keep breathing.
  • the gas supply system can therefore be used for administering both a breathable gas and a gas which does not maintain breathing. Clean gases, gas mixtures or aerosols are understood as gas.
  • a ventilation system that can be used with changes as a gas supply system is described, for example, in DE 43 25 319 C1, to which reference is made.
  • the gas metering ie gas or aerosol metering, takes place continuously or discontinuously, in particular sequentially (pulsed), via the catheter, during inspiration or expiration.
  • the gas supply system works advantageously controlled, according to the gas supply system for ventilated or spontaneously breathing patients described in WO 98/31282 (internal name TMG 2028/67), to which reference is made.
  • the gas supply systems are designed to direct the dosing gas directly into the catheter.
  • the time of dosing can be done by taking a negative pressure (spontaneous breathing) or taking a flow (artificial respiration).
  • the direct application of the gas in the lungs can lower the ventilation pressure, which relieves the patient.
  • the usual loss of gas when administering gases to the lungs is completely eliminated by using a catheter that is inserted into the trachea.
  • Medical gases or aerosols are supplied to the patient with one or more catheters.
  • the desired gas concentration can be applied directly to the catheter entrance, so that the gas reaches the desired lung areas with no loss.
  • several gases can be introduced into the body at the same time.
  • the gases can be directed through the catheter to any point in the airway, in particular from the tube to the alveolus area. This enables local and selective therapy.
  • NO administration a much smaller amount of NO can be directed directly into the lung areas without worsening the therapeutic effect.
  • the lower amount of NO increases the amount of 0 2 , which leads to an improvement in the amount of PaO 2 .
  • the risk of N ⁇ 2 formation is minimized, since NO and O 2 are only mixed in the lung areas.
  • the gas delivery catheter is used to advantage in both ventilated and spontaneously breathing patients.
  • the desired areas can be flowed to, so that possible side effects in healthy areas do not come into play.
  • the proportion of the metering gas increases, which in turn, depending on the gas, can lead to an undesirable reduction in Pa0. Therefore, the affected areas in the lungs should really only be subjected to selective flow in order to keep the proportion of dosing gas as low as possible.
  • the use of the gas supply system according to the invention is particularly advantageous.
  • gas supply system with catheter can be used for all types of lung diseases such as chronic bronchitis, asthma, fibrosis, emphysema and ARDS.
  • lung diseases such as chronic bronchitis, asthma, fibrosis, emphysema and ARDS.
  • gases containing NO, H 2 , He, 0, N 2 O, halothane, lloprost (llomedin), prostacyclin, H 2 O, saline solution, CO 2 or isoflurane are used as gases or aerosols. It is used both for breathers and for artificially ventilated patients.
  • the sensor is, for example, a gas sensor for determining the concentration of a metered gas or a metered gas component (eg NO, CO 2 or 0 2 ). This makes it possible to determine the local gas concentration at the site of action.
  • a pressure sensor is also advantageous.
  • Suitable microsensors are known, for example, from cardiac catheters (for example developed by the Fraunhofer Society for Microsystem Technology or US 4,815,472).
  • Fig. 1 shows schematically how a catheter for local gas metering is arranged in the lungs.
  • FIG. 2 shows the arrangement of two catheters for local gas metering (same or different gases) in different lung areas.
  • FIG. 3 shows a diagram of a system for local gas metering with a catheter in the case of a spontaneous breather (breathing donation).
  • FIG. 4 shows a schematic of a system for local gas metering with a catheter in a mechanically ventilated patient.
  • the gas or aerosol metering device 1 shown in FIG. 3 detects a breath via a negative pressure measurement 2, which is connected to the patient, and doses the preset amount of the gas or aerosol storage container 3 via the catheter 4 placed in the lungs respective gas or aerosol.
  • FIG. 4 shows schematically how a patient is connected to the respirator 6 via a ventilation hose 5.
  • the gas or aerosol metering device 1 recognizes the respective ventilation state via a flow measurement 7.
  • the gas or aerosol is dosed from the gas or aerosol storage container 3 via the catheter 4 placed in the lungs according to the setting on the dosing device 1.

Landscapes

  • Health & Medical Sciences (AREA)
  • Emergency Medicine (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Medicinal Preparation (AREA)

Abstract

The invention relates to a gas supply system comprising a gas dosing unit (1) and at least one catheter (4) for local administration of a gas or aerosol in an area of action, especially in the lungs. The gas supply system enables direct dosing of a therapy gas which does not sustain respiration in the respiratory tract.

Description

Gasdosiergerät mit KatheterGas dosing device with catheter
Die Erfindung betrifft ein Gasdosiergerät mit Katheter.The invention relates to a gas metering device with a catheter.
Geräte zur Beatmung werden eingesetzt für die maschinelle Beatmung, für die A- naesthesie und für die Atemtherapie durch Behandlung mit Gasen, z. B. Sauerstoffspende oder Behandlung mit Stickstoffmonoxid (NO).Ventilation devices are used for mechanical ventilation, for anesthesia and for respiratory therapy by treatment with gases, e.g. B. Oxygen donation or treatment with nitrogen monoxide (NO).
Ein Inhalations-Anästhesiegerät wird beispielsweise beschrieben in DE 37 12 598 A1. Es dient zur Dosierung von Narkosegas in das Atemgas.An inhalation anesthesia device is described for example in DE 37 12 598 A1. It is used to dose anesthetic gas into the breathing gas.
Ein Gerät zur Zufuhr von Atemgas oder Sauerstoff zu einem Patienten wird in DE 43 09 923 A1 beschrieben.A device for supplying breathing gas or oxygen to a patient is described in DE 43 09 923 A1.
DE 43 25 319 C1 beschreibt ein Gerät zur kontinuierlichen Dosierung von NO zur A- temluft von Patienten, enthaltend einen Respirator, einen NO-Dosierbehälter, eine Dosiereinheit mit Steuergerät und einen Analysator zur Bestimmung der NO-Konzentration in der Atemluft. Das Steuergerät (Kontroll- und Regeleinheit) übernimmt die Dosierung des zu dosierenden NO durch Bestimmung der Volumenströme von Atemgas und NO unter Berücksichtigung des NO-Analysewertes. Die NO-Dosierung erfolgt volumenproportional oder volumenstromproportional, so daß die NO-Konzentration im Atemgas immer konstant gehalten wird. Die technischen Grundzüge der NO-Dosierung in der NO-Therapie werden beschrieben in: „C. Krebs et al.τ Technological basis for NO appli- cation and environmetal security, Acta Anaesthesiologica Scandinavica Supplement 109, Vol. 40, 1996; S. 84-87".DE 43 25 319 C1 describes a device for the continuous dosing of NO to the breath of patients, containing a respirator, a NO dosing container, a dosing unit with control unit and an analyzer for determining the NO concentration in the breathing air. The control unit (control and regulating unit) takes over the dosing of the NO to be dosed by determining the volume flows of breathing gas and NO taking into account the NO analysis value. The NO dosage is proportional to the volume or proportional to the volume flow, so that the NO concentration in the breathing gas is always kept constant. The basic technical features of NO dosing in NO therapy are described in: "C. Krebs et al. τ Technological basis for NO application and environmental security, Acta Anaesthesiologica Scandinavica Supplement 109, Vol. 40, 1996; Pp. 84-87 ".
In WO 98/31282 (interne Bezeichnung T G 2028/67) wird ein Gasversorgungssystem für beatmete oder spontanatmende Patienten beschrieben, bei dem ein oder mehrere Gase (z. B. NO, Sauerstoff) mittels einer Steuerung (Programmsteuerung, Sensorsteue- rung oder kombinierte Programm-/Sensorsteuerung) ungleichmäßig (kontinuierlich oder diskontinuierlich) in das Atemgas in einem Beatmungsschlauch dosiert werden. Bei medizinischen Anwendungen, bei denen Gase in der Lunge zur Wirkung kommen, besteht oft das Problem, die tatsächliche in der Lunge befindliche Gaskonzentration zu bestimmen. Es treten Gasverluste im Nasalbereich sowie Strömungs- und Homogensi- sierungsverluste im Rachenraum und der Trachea auf, die nicht quantifiziert werden können.WO 98/31282 (internal designation TG 2028/67) describes a gas supply system for ventilated or spontaneously breathing patients, in which one or more gases (for example NO, oxygen) are controlled by means of a controller (program control, sensor control or combined program) - / sensor control) be metered unevenly (continuously or discontinuously) into the breathing gas in a breathing tube. In medical applications where gases act on the lungs, there is often the problem of determining the actual gas concentration in the lungs. There are gas losses in the nasal area as well as flow and homogenization losses in the pharynx and the trachea, which cannot be quantified.
Der Erfindung liegt die Aufgabe zugrunde, ein Gerät für eine effektivere Versorgung von Patienten mit einem oder mehreren Gasen zu schaffen.The invention has for its object to provide a device for more effective care of patients with one or more gases.
Gelöst wurde die Aufgabe durch eine Vorrichtung mit den in Anspruch 1 beschriebenen Merkmalen.The object was achieved by a device with the features described in claim 1.
Gasversorgungssysteme sind Anordnungen oder Vorrichtungen, die einem Patienten ein oder mehrere Gase zuführen oder für die Atmung bereitstellen. Die Gase, insbesondere medizinische Gase, werden vorzugsweise mit Luft, einem Atemgas oder Sauerstoff gemischt, so daß Gasgemische erhalten werden, die die Atmung unterhalten. Ein Gasversorgungssystem ist z. B. ein Beatmungssystem mit Beatmungsgerät und Gasdo- sieπ/orrichtung für ein oder mehrere Gase. Ein Beatmungssystem besteht beispielswei- se aus Schlauchverbindungen oder Gasleitungen, Gasquelle, GasdosieπtorrichtungGas supply systems are arrangements or devices that deliver one or more gases to a patient or make them available for breathing. The gases, in particular medical gases, are preferably mixed with air, a breathing gas or oxygen, so that gas mixtures are obtained which maintain breathing. A gas supply system is e.g. B. a ventilation system with respirator and Gasdo- sieπ / orrichtung for one or more gases. A respiratory system consists, for example, of hose connections or gas lines, gas source, gas metering device
(Gasdosiereinheit), Atemmaske, vorzugsweise einem Atemgasanfeuchter und gegebenenfalls einem oder mehreren Gasfiltern (z. B. NO2-Filter). Beatmungssysteme mit einem Beatmungsgerät werden im allgemeinen für die stationäre Behandlung von Patienten eingesetzt. Gasversorgungssysteme können stationäre oder mobile, insbesonde- re tragbare Geräte sein. Gasversorgungssysteme gemäß der Erfindung dienen bevorzugt zur Behandlung von Mensch oder Säugetier mit einem oder mehreren Gasen, insbesondere zur inhalativen Behandlung der Lunge.(Gas metering unit), breathing mask, preferably a respiratory gas humidifier and optionally one or more gas filters (e.g. NO 2 filter). Ventilation systems with a ventilator are generally used for the inpatient treatment of patients. Gas supply systems can be stationary or mobile, especially portable devices. Gas supply systems according to the invention are preferably used for the treatment of humans or mammals with one or more gases, in particular for the inhalative treatment of the lungs.
Bei dem Gasversorgungssystem gemäß der Erfindung erfolgt die Dosierung des Gases im allgemeinen nicht in das Atmungsgas, sondern wird über eine Gaszuführung, an die ein Katheter angeschlossen ist, direkt zum Wirkort, in der Regel in der Lunge, geleitet. Das Gas muß daher nicht die Atmung unterhalten. Es kann daher das Gasversorgungssystem zur Verabreichung sowohl eines atembaren Gases als auch eines die Atmung nicht unterhaltenden Gases eingesetzt werden. Als Gas werden Reingase, Gasgemische oder Aerosole verstanden.In the gas supply system according to the invention, the gas is generally not metered into the breathing gas, but is directed directly to the site of action, usually in the lungs, via a gas supply to which a catheter is connected. The gas therefore does not have to keep breathing. The gas supply system can therefore be used for administering both a breathable gas and a gas which does not maintain breathing. Clean gases, gas mixtures or aerosols are understood as gas.
Ein Beatmungssystem, das mit Änderungen als Gasversorgungssystem eingesetzt werden kann, ist beispielsweise in DE 43 25 319 C1 beschrieben, worauf Bezug genommen wird.A ventilation system that can be used with changes as a gas supply system is described, for example, in DE 43 25 319 C1, to which reference is made.
Die Gasdosierung, das heißt Gas- oder Aerosoldosierung, über den Katheter erfolgt kontinuierlich oder diskontinuierlich, insbesondere sequentiell (gepulst), während der Inspiration oder der Exspiration. Das Gasversorgungssystem arbeitet vorteilhaft gesteuert, entsprechend dem in WO 98/31282 (interne Bezeichnung TMG 2028/67) beschriebenen Gasversorgungssystem für beatmete oder spontanatmende Patienten, worauf Bezug genommen wird.The gas metering, ie gas or aerosol metering, takes place continuously or discontinuously, in particular sequentially (pulsed), via the catheter, during inspiration or expiration. The gas supply system works advantageously controlled, according to the gas supply system for ventilated or spontaneously breathing patients described in WO 98/31282 (internal name TMG 2028/67), to which reference is made.
Die Gasversorgungssysteme sind so aufgebaut, daß sie das Dosiergas direkt in den Katheter leiten.The gas supply systems are designed to direct the dosing gas directly into the catheter.
Der Zeitpunkt der Dosierung kann über Aufnahme eines Unterdrucks (Spontanatmer) oder Aufnahme eines Flows (künstliche Beatmung) erfolgen.The time of dosing can be done by taking a negative pressure (spontaneous breathing) or taking a flow (artificial respiration).
Prinzipiell gibt es keine Einschränkungen bei der Wahl der Katheter. (Materialien entsprechend den Gaseigenschaften).In principle there are no restrictions in the choice of catheters. (Materials according to the gas properties).
Grundsätzlich ist es sinnvoll alle Arten von Gasen zu dosieren, wobei die Dosierung des Atemgases aufgrund der hohen Menge über die herkömmlichen Atemwege erfolgt.In principle, it makes sense to dose all types of gases, with the breathing gas being dosed via the conventional airways due to the large amount.
Durch die direkte Applikation des Gases in der Lunge kann der Beatmungsdruck ge- senkt werden, was den Patienten entlastet. Der übliche Gasverlust bei der Verabreichung von Gasen in die Lunge wird durch den Einsatz eines Katheters, der in die Trachea geführt wird, vollständig eliminiert.The direct application of the gas in the lungs can lower the ventilation pressure, which relieves the patient. The usual loss of gas when administering gases to the lungs is completely eliminated by using a catheter that is inserted into the trachea.
Mit einem oder mehreren Kathetern werden medizinische Gase oder Aerosole dem Pa- tienten zugeführt.Medical gases or aerosols are supplied to the patient with one or more catheters.
Die gewünschte Gaskonzentration kann direkt am Kathetereingang angelegt werden, so daß das Gas vollkommen verlustfrei die gewünschten Lungenareale erreicht. Dabei können je nach Anzahl der verlegten Katheter mehrere Gase gleichzeitig in den Körper geleitet werden. Durch die Katheter können die Gase an jede beliebige Stelle im Atemweg, insbesondere vom Tubus bis hin zum Alveolbereich, geleitet werden. Dadurch ist eine lokale und selektive Therapie möglich. Bei der NO-Verabreichung kann dadurch eine viel geringere NO-Menge direkt in die Lungenbezirke geleitet werden ohne den Therapieeffekt zu verschlechtern. Durch die geringere NO-Menge erhöht sich relativ betrachtet die 02-Menge, was zu einer Verbesserung des PaO2-Wen.es führt. Außerdem ist die Gefahr einer Nθ2-Bildung minimiert, da NO und O2 erst in den Lungenbezirken vermischt werden.The desired gas concentration can be applied directly to the catheter entrance, so that the gas reaches the desired lung areas with no loss. Depending on the number of catheters installed, several gases can be introduced into the body at the same time. The gases can be directed through the catheter to any point in the airway, in particular from the tube to the alveolus area. This enables local and selective therapy. In the case of NO administration, a much smaller amount of NO can be directed directly into the lung areas without worsening the therapeutic effect. Relatively speaking, the lower amount of NO increases the amount of 0 2 , which leads to an improvement in the amount of PaO 2 . In addition, the risk of Nθ 2 formation is minimized, since NO and O 2 are only mixed in the lung areas.
Der Katheter zur Gaszuführung wird sowohl bei beatmeten wie bei spontanatmenden Patienten mit Vorteil eingesetzt.The gas delivery catheter is used to advantage in both ventilated and spontaneously breathing patients.
Durch die genaue Verlegung des Katheters können genau die gewünschten Areale angeströmt werden, so daß eventuelle Nebenwirkungen bei gesunden Arealen nicht zum Tragen kommen.Due to the precise laying of the catheter, the desired areas can be flowed to, so that possible side effects in healthy areas do not come into play.
Strömt man alle Areale in der Lunge an (auch die gesunden) so steigt der Anteil des Dosiergases, was wiederum je nach Gas, zu einer unerwünschten Absenkung des Pa0 führen kann. Daher sollten wirklich nur selektiv die betroffenen Areale in der Lunge angeströmt werden, um den Dosiergasanteil möglichst gering zu halten. Bei Erkrankungen, bei denen es zu einer teilweisen Kollabierung der Alveolen kommt (Fibröse), ist der Einsatz des Gasversorgungssystem gemäß der Erfindung besonders vorteilhaft.If you flow to all areas in the lungs (including the healthy ones), the proportion of the metering gas increases, which in turn, depending on the gas, can lead to an undesirable reduction in Pa0. Therefore, the affected areas in the lungs should really only be subjected to selective flow in order to keep the proportion of dosing gas as low as possible. In the case of diseases in which the alveoli partially collapse (fibrosis), the use of the gas supply system according to the invention is particularly advantageous.
Die Anwendung des Gasversorgungssystem mit Katheter kann bei allen Arten von Lungenkrankheiten zum Einsatz kommen wie z.B. chronische Bronchitis, Asthma, Fibröse, Emphysem und ARDS. Als Gase bzw. Aerosole werden z.B. Gase, enthaltend NO, H2, He, 0 , N2O, Halothan, lloprost(llomedin), Prostazyklin, H2O, Kochsalzlösung (saline solution), CO2 oder Isofluran, eingesetzt. Die Anwendung erfolgt sowohl bei Sponatat- mern als auch bei künstlich beatmeten Patienten.The use of the gas supply system with catheter can be used for all types of lung diseases such as chronic bronchitis, asthma, fibrosis, emphysema and ARDS. For example, gases containing NO, H 2 , He, 0, N 2 O, halothane, lloprost (llomedin), prostacyclin, H 2 O, saline solution, CO 2 or isoflurane are used as gases or aerosols. It is used both for breathers and for artificially ventilated patients.
Besonders vorteilhaft werden an dem Katheter ein oder mehrere Sensoren angeordnet. Der Sensor ist beispielsweise ein Gassensor zur Bestimmung der Konzentration eines dosierten Gases oder einer dosierten Gaskomponente (z.B. NO, CO2 oder 02). Damit ist die Bestimmung der lokalen Gaskonzentration am Wirkort möglich. Vorteilhaft ist auch die Verwendung eines Drucksensors. Geeignete Mikrosensoren sind beispielsweise von Herzkathetern bekannt (z.B. entwickelt von der Fraunhofer-Gesellschaft für Mik- rosystemtechnik oder US 4,815,472).One or more sensors are particularly advantageously arranged on the catheter. The sensor is, for example, a gas sensor for determining the concentration of a metered gas or a metered gas component (eg NO, CO 2 or 0 2 ). This makes it possible to determine the local gas concentration at the site of action. The use of a pressure sensor is also advantageous. Suitable microsensors are known, for example, from cardiac catheters (for example developed by the Fraunhofer Society for Microsystem Technology or US 4,815,472).
Die Erfindung wird anhand der Zeichnung erläutert.The invention is explained with reference to the drawing.
Fig. 1 zeigt schematisch, wie ein Katheter zur lokalen Gasdosierung in der Lunge angeordnet wird.Fig. 1 shows schematically how a catheter for local gas metering is arranged in the lungs.
Fig. 2 zeigt die Anordnung zweier Katheter zur lokalen Gasdosierung (gleiche oder ver- schiedene Gase) in verschiedenen Lungenbereichen.2 shows the arrangement of two catheters for local gas metering (same or different gases) in different lung areas.
Fig. 3 zeigt ein Schema eines Systems zur lokalen Gasdosierung mit einem Katheter bei einem Spontanatmer (Atemspende).FIG. 3 shows a diagram of a system for local gas metering with a catheter in the case of a spontaneous breather (breathing donation).
Fig. 4 zeigt ein Schema eines Systems zur lokalen Gasdosierung mit einem Katheter bei einem maschinell beatmeten Patienten. Das in Fig 3 gezeigte Gas- oder Aerosol-Dosiergerät 1 erkennt über eine Unterdruckmessung 2, die mit dem Patienten verbunden ist, einen Atemzug und dosiert aus dem Gas- oder Aerosol-Vorratsbehälter 3 über den in die Lunge gelegten Katheter 4 die voreingestellte Menge des jeweiligen Gases oder Aerosols.4 shows a schematic of a system for local gas metering with a catheter in a mechanically ventilated patient. The gas or aerosol metering device 1 shown in FIG. 3 detects a breath via a negative pressure measurement 2, which is connected to the patient, and doses the preset amount of the gas or aerosol storage container 3 via the catheter 4 placed in the lungs respective gas or aerosol.
Fig. 4 zeigt schematisch, wie ein Patient über einen Beatmungsschlauch 5 mit dem Re- spirator 6 verbunden ist. Über eine Flowmessung 7 erkennt das Gas- oder Aerosol- Dosiergerät 1 den jeweiligen Beatmungszustand. Das Gas oder Aerosol wird gemäß der Einstellung am Dosiergerät 1 aus dem Gas- oder Aerosol-Vorratsbehälter 3 über den in die Lunge gelegten Katheter 4 dosiert.4 shows schematically how a patient is connected to the respirator 6 via a ventilation hose 5. The gas or aerosol metering device 1 recognizes the respective ventilation state via a flow measurement 7. The gas or aerosol is dosed from the gas or aerosol storage container 3 via the catheter 4 placed in the lungs according to the setting on the dosing device 1.
BezugszeichenlisteLIST OF REFERENCE NUMBERS
1 Gas- oder Aerosol-Dosiergerät1 gas or aerosol dosing device
2 Unterdruckmessung 3 Gas- oder Aerosol-Vorratsbehälter2 Vacuum measurement 3 Gas or aerosol storage container
4 Katheter mit Gaszuleitung4 catheters with gas supply
5 Beatmungsschlauch5 ventilation hose
6 Respirator6 respirator
7 Flowmessung 8, 9 Katheter 7 flow measurement 8, 9 catheter

Claims

Patentansprüche claims
1. Gasversorgungssystem mit mindestens einem Katheter (4).1. Gas supply system with at least one catheter (4).
2. Gasversorgungssystem nach Anspruch 1 , dadurch gekennzeichnet, daß der Katheter (4) zur Einführung in den Atemweg und/oder in die Lunge von Mensch oder Säugetier geeignet ist.2. Gas supply system according to claim 1, characterized in that the catheter (4) is suitable for introduction into the airway and / or into the lungs of humans or mammals.
3. Gasversorgungssystem nach Anspruch 2 oder 3, dadurch gekennzeichnet, daß das Gasversorgungssystem eine Gasdosiereinheit (1) enthält, die ein Gas oder Aerosol über den Katheter (4) an einem Wirkort dosiert.3. Gas supply system according to claim 2 or 3, characterized in that the gas supply system contains a gas metering unit (1) which doses a gas or aerosol via the catheter (4) at a site of action.
4. Verfahren zum Betrieb eines Gasversorgungssystems nach einem der Ansprüche 1 bis 3, dadurch gekennzeichnet, daß ein atembares oder die Atmung nicht unterhaltendes Gas oder Aerosol über ein Katheter (4) dosiert wird.4. A method for operating a gas supply system according to one of claims 1 to 3, characterized in that a breathable or non-breathing gas or aerosol is metered through a catheter (4).
5. Verwendung eines oder mehrerer Katheter (4) bei der Dosierung eines Gases oder Aerosols.5. Use of one or more catheters (4) in the metering of a gas or aerosol.
6. Verwendung nach Anspruch 5, dadurch gekennzeichnet, daß am Katheter (4) ein Sensor angeordnet ist.6. Use according to claim 5, characterized in that a sensor is arranged on the catheter (4).
7. Verwendung nach Anspruch 5, dadurch gekennzeichnet, daß das dosierte Gas NO, H2, He, O2, N2O, CO2 , Halothan, lloprost, Prostazyklin, H2O, Kochsalzlösung oder I- sofluran enthält.7. Use according to claim 5, characterized in that the metered gas contains NO, H 2 , He, O 2 , N 2 O, CO 2 , halothane, lloprost, prostacyclin, H 2 O, saline or I-soflurane.
8. Katheter (4), an dem ein Sensor angeordnet ist. 8. Catheter (4) on which a sensor is arranged.
EP01953149A 2000-05-20 2001-05-18 Gas doser with a catheter Ceased EP1284774A1 (en)

Applications Claiming Priority (3)

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DE10025202 2000-05-20
DE2000125202 DE10025202A1 (en) 2000-05-20 2000-05-20 Gas dosing device with catheter
PCT/EP2001/005684 WO2001089617A1 (en) 2000-05-20 2001-05-18 Gas doser with a catheter

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