VALVE ASSEMBLY, VENTILATOR, PROCESS FOR OPERATING A VALVE ASSEMBLY, AND COMPUTER PROGRAM
20220226599 · 2022-07-21
Inventors
- Hans-Ullrich HANSMANN (Lübeck, DE)
- Oliver GARBRECHT (Lübeck, DE)
- Hendrik FISCHER (Lübeck, DE)
- Georg MÄNNEL (Lübeck, DE)
Cpc classification
A61M16/208
HUMAN NECESSITIES
A61M16/024
HUMAN NECESSITIES
International classification
Abstract
A valve assembly, a ventilator, a process for operating a valve assembly and a computer program are provided. The valve assembly (10; 10a; 10b), for the ventilator (100), includes an inlet (12; 12a; 12b) configured for the inflow of a ventilation gas, an outlet (14; 14a; 14b) configured for the outflow of the ventilation gas and a volume flow control device (16; 16a; 16b) for the ventilation gas between the inlet and the outlet. The volume flow control device is configured to set the volume flow of the ventilation gas in a range between shut-off and a maximum volume flow and to provide an attenuation of a volume flow change during the opening, when the volume flow of the ventilation is increased, that differs from an attenuation occurring during the closing, when the volume flow of the ventilation gas is reduced.
Claims
1. A valve assembly for a ventilator, the valve assembly comprising: an inlet configured for an inflow of a ventilation gas; an outlet configured for an outflow of the ventilation gas; and a volume flow control device configured to control the ventilation gas between the inlet and the outlet and further configured: to set a volume flow of the ventilation gas in a range between shut-off and a maximum volume flow; and to provide an attenuation of a volume flow change which volume flow change occurs during an opening, providing an increase in volume flow of the ventilation gas, that differs from an attenuation occurring during a closing, providing a reduction of the volume flow of the ventilation gas.
2. A valve assembly in accordance with claim 1, wherein the volume flow control device provides a lower attenuation of the volume flow change during opening than the attenuation of the volume flow change during closing.
3. A valve assembly in accordance with claim 1, wherein the volume flow control device has a higher attenuation of the volume flow change during closing than the attenuation of the volume flow change during opening.
4. A valve assembly in accordance with claim 1, wherein the volume flow control device has a higher inertia during opening than during closing.
5. A valve assembly in accordance with claim 1, wherein: the volume flow control device comprises a pneumatic control element for controlling the volume flow by means of a control pressure volume; and a limitation of a control pressure volume change rate, which limitation occurs during the opening, is different from a limitation of the control pressure volume change rate, which limitation occurs during the closing.
6. A valve assembly in accordance with claim 5, wherein the pneumatic control element comprises a pilot valve configured to be adjusted by a control pressure volume or a pneumatic pump.
7. A valve assembly in accordance with claim 5, wherein: the volume flow control device comprises a diaphragm valve configured to be controlled by the pneumatic control element; the diaphragm valve is configured to be actuated by an admission connection and by a relief connection; and the admission connection and the relief connection each have limiting restrictions.
8. A valve assembly in accordance with claim 7, wherein the different restrictions are adjustable.
9. A valve assembly in accordance with claim 8, wherein the volume flow control device further comprises a control device for the dynamic control of the restrictions.
10. A valve assembly in accordance with claim 5, wherein: the volume flow control device comprises a diaphragm valve configured to be controlled by the pneumatic control element; the diaphragm valve is configured to be actuated by an admission connection and by a relief connection; the admission connection and the relief connection have a common limiting restriction.
11. A valve assembly in accordance with claim 5, wherein: the pneumatic control element comprises a pneumatic pump; the volume flow control device further comprises a diaphragm valve configured to be controlled by the pneumatic control element; the diaphragm valve is actuated via a control connection; and the volume flow control device further comprises an electrical control element for actuating the pneumatic pump.
12. A valve assembly in accordance with claim 11, wherein a restriction is arranged in the control connection.
13. A valve assembly in accordance with claim 12, wherein the restriction in the control connection is adjustable.
14. A ventilator comprising: a valve assembly comprising: an inlet configured for an inflow of a ventilation gas; an outlet configured for an outflow of the ventilation gas; and a volume flow control device configured to control the ventilation gas between the inlet and the outlet and further configured: to set a volume flow of the ventilation gas in a range between shut-off and a maximum volume flow; and to provide an attenuation of a volume flow change which volume flow change occurs during an opening, providing an increase in volume flow of the ventilation gas that differs from an attenuation occurring during a closing, providing a reduction of the volume flow of the ventilation gas.
15. A ventilator in accordance with claim 14, wherein: the ventilator is configured to carry out an inhalation phase; or the ventilator is configured to carry out an exhalation phase; or the ventilator is configured to carry out an inhalation phase and the ventilator is configured to carry out an exhalation phase.
16. A ventilator in accordance with claim 15, wherein: the volume flow control device provides a lower attenuation for the inhalation; or the volume flow control device provides a lower attenuation for the exhalation during the opening than during the closing; or the volume flow control device provides a lower attenuation for the inhalation and the volume flow control device provides a lower attenuation for the exhalation during the opening than during the closing.
17. A ventilator in accordance with claim 16, wherein the volume flow control device is configured for the inhalation and for the exhalation to allow, relative to the same unit of time, volume flow changes during opening that exceed the volume flow changes occurring during closing at least by a factor of 2.
18. A ventilator in accordance with claim 16, wherein the volume flow control device is configured for inhalation and for the exhalation to allow, relative to the same unit of time, patient pressure changes occurring during opening that exceed patient pressure changes occurring during closing at least by a factor of 2.
19. A process for operating a valve assembly in a ventilator, wherein the valve assembly comprises an inlet for an inflow of a ventilation gas, an outlet for an outflow of the ventilation gas and a volume flow control device for control of the ventilation gas between the inlet and the outlet, the process comprising the steps of: setting a volume flow of the ventilation gas in a range between shut-off and a maximum flow; opening the valve assembly with a first attenuation, when the volume flow of the ventilation gas increases; and closing the valve assembly with a second attenuation, when the volume flow of the ventilation gas decreases, wherein the first attenuation differs from the second attenuation.
20. A process in accordance with claim 19, further comprising providing a computer program with a program code for carrying one for mores steps of the process, upon the program code being executed on a computer, on a processor or on a programmable hardware component.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0032] In the drawings:
[0033]
[0034]
[0035]
[0036]
[0037]
[0038]
[0039]
[0040]
[0041]
[0042]
[0043]
[0044]
[0045]
[0046]
DESCRIPTION OF PREFERRED EMBODIMENTS
[0047] Referring to the drawings, different examples will now be described in more detail with reference to the attached figures. The thicknesses of lines, layers and/or areas may be exaggerated for illustration in the figures.
[0048] Further examples may cover modifications, equivalents and alternatives, which fall within the scope of the disclosure. Identical or similar reference numbers pertain in the entire description of the figures to identical or similar elements, which may be implemented identically or in a modified form in a comparison with one another, while they provide the same function or a similar function.
[0049] It is apparent that if an element is described as being “connected” or “coupled” with another element, the elements may be connected or coupled directly or via one or more intermediate elements. If two elements A and B are combined with the use of an “or,” this shall be defined such that all possible combinations are disclosed, i.e., only A, only B as well as A and B, unless something else is explicitly or implicitly defined. An alternative wording for the same combinations is “at least one of A and B” or “A and/or B.” The same applies, mutatis mutandis, to combinations of more than two elements.
[0050]
[0051] The valve assembly 10 for a ventilator 100 (shown by broken lines, because it is optional from the viewpoint of the valve assembly) comprises an inlet 12, which is configured for the inflow of a ventilation gas. The valve assembly 10 further comprises an outlet 14, which is configured for the outflow of the ventilation gas. Moreover, the valve assembly 10 comprises a volume flow control device 16 for the ventilation gas between the inlet 12 and the outlet 14. The volume flow control device 16 is configured to set the volume flow of the ventilation gas in a range between shut-off and a maximum volume flow. The volume flow control device 16 is configured such that an attenuation of a volume flow change occurring during the opening, when the volume flow of the ventilation gas is increased, differs from an attenuation occurring during the closing, when the volume flow of the ventilation gas is reduced.
[0052] As is shown as an option (drawn in broken lines) in
[0053]
[0054] In some exemplary embodiments, an adaptation of a pneumatic control system can be carried out by an attenuator. This attenuator extracts energy from the system as soon as the output variable changes rapidly. Such an excited deflection of the output variable cannot thus lead so easily to a permanent or even rising oscillation amplitude any more. However, this attenuator comes into action mainly in case of the undesired excitations (disturbance variables) in order not to influence the actual ventilation performance in the sense of a rapid pressure increase or in order not to influence it too strongly.
[0055] Digital controllers are, in principle, also able to amplify known frequencies of a control system selectively more weakly and hence to reduce or to suppress an oscillation. However, this requires a corresponding computing capacity.
[0056] Some exemplary embodiments use an attenuation set at a fixed value, which is integrated into a control system. As a result, the controller is relieved and more effort can correspondingly be expended for the reduction of specifically occurring resonance step-ups.
[0057] Thus, the volume flow control device 16 may have a lower attenuation during the opening than during closing or also vice versa, depending on the direction in which a higher dynamics (faster change) is desired. This dynamics may vary depending on the circuitry and the particular application; as will be explained in more detail below, a faster change is desired during ventilation at the beginning of a breathing phase. Such a fast change can be brought about in terms of the circuitry by a fast opening or also by a fast closing. The volume flow control device 16 can therefore also have a higher inertia during opening than during closing, depending on the particular variant of use and circuitry.
[0058] Some exemplary embodiments, in which the volume flow control device 16 has a pneumatic control element for controlling the volume flow on the basis of a control pressure volume, will be explained in more detail below. A limitation of a control pressure volume change rate during the opening differs from a limitation of the control pressure volume change rate occurring during closing.
[0059] This can be achieved by a correspondingly integrated attenuation. The attenuation is integrated in this case specifically so that the intended, fast responses of the system will not be limited or they will only be limited to a lesser extent and the greatest possible attenuation acts on the unintended, fast disturbance variables.
[0060] For example, the attenuation element shall extract energy from the system as soon as an oscillation generates an excessively steep slope of a signal.
[0061] It is useful for this to present the motion equation for a mechanical, oscillating model, which will be done below—as is also explained on the basis of Formula 1—based on the example of a diaphragm valve.
E=M*{umlaut over (s)}(t)+D*{dot over (s)}(t)+F*s(t) Formula 1
in which E is the total force,
M is the mass,
D is the attenuation or friction with a corresponding attenuation constant and F is a spring with a corresponding spring rate.
s(t) is the system in the time-related representation, i.e., e.g., the motion of a diaphragm;
{dot over (s)}(t) is the first derivative according to time, i.e., the velocity of the diaphragm, and
{umlaut over (s)}(t) is the second derivative according to the time, i.e., an acceleration of the diaphragm.
[0062] The mass is the mass of the diaphragm and of all moving parts in this example.
[0063] The attenuation is represented here, for example, by the viscosity of a diaphragm suspension or also by other forces, which are generated when the diaphragm shall change at a velocity. The attenuation can be used, in particular, to effectively suppress a resonance step-up by the combination of a plurality of components that are able to oscillate, as this will also be explained in more detail below on the basis of
[0064] The spring sets the path-dependent force. This is, as a rule, the actuating variable, with which the position of the diaphragm is set. The system itself also contains a spring characteristic, which is combined with the actuating variable.
[0065] Many components, which each generate a special behavior of their own in response to an excitation or also generate excitations themselves, are present in a pneumatic system, as it is given, for example, in a ventilation system.
[0066]
[0067] The excitations occurring during the normal operation are the changes in the desired variables due to the ventilation control, e.g., at the time of the change between the ventilation phases from inhalation to exhalation and vice versa. This excitation shall be transmitted to the system as rapidly as possible and in the asymptotic borderline case to the system. Other excitations of other effects or components of the system shall be attenuated to the extent possible. This means that the sum of the responses from all components must be lower than the amplification 1.
[0068] In the ideal case this means that, for example, an excitation caused by a mechanical bumping onto a ventilation tube does not generate a pressure oscillation. Through a poorly attenuated system, such an excitation (pressure velocity wave) can propagate to all components in the system with low losses. If the response of the other components is at a value of 1 (the impedance jump is correspondingly reverberant) or even higher, the excitation at the next oscillation amplitude is at least just as high as or even higher than the first excitation. The system then progresses to an oscillation.
[0069] Furthermore, each component of the system is provided with a frequency response of its own. This can be represented as a Bode diagram. Since the oscillation is an energy and mass exchange, there also are strongly nonlinear frequency curves. Resonance ranges develop as a function of the frequency. The frequencies of resonance, qualities (width of the resonance range) and amplitudes are only partially constant. Some components are, e.g., strongly temperature-dependent (diaphragms made of elastomers) or even individual and variable (patient compliance and resistance are variable over time).
[0070] The exceeding of the frequency of resonance likewise ensures a phase change, as a result of which the response of the system will be shifted by, for example, 180°, and an imaginary negative feedback of a controller becomes a positive feedback for disturbance variables.
[0071] This could be counteracted by the attempt at integrating in the system so many components with a low-pass function that a rapid response will be rapidly suppressed. This unfortunately leads to slow overall behavior of the system, as a result of which the pressure rise time would not be sufficient for a ventilation.
[0072] At least some exemplary embodiments generate a high attenuation by a restriction, i.e., by a resistance or by a narrowing in a pneumatic system. The carrying through of a volume flow through this restriction generates a high pressure loss, which also leads as a result to a loss of energy.
[0073] On a closer scrutiny of the components, the beginning of the breathing phases is always the time range in which high pressure gradients are required and desirable. For the inhalation valve 42, this is the beginning of the inhalation. An attenuated characteristic is rather desired for the rest of the course of the ventilation. As a result, even though disturbance variables can be compensated more slowly, no excessive system response amplitudes will develop any longer.
[0074] A control system for a pneumatic pressure/volume flow control can be configured in the ventilation technology in exemplary embodiments such that an operation in a broad frequency range is made possible at a reasonable effort for the controller. Suppression of oscillation excitations can in this case be suppressed with passive elements. This leads to a lower load on the computing capacity, for example, a software controller. A fundamental attenuation can thus be achieved in exemplary embodiments by pneumatic elements, and tuning can be carried out by parameterization of the controller.
[0075] The pneumatic control element is in some exemplary embodiments, for example, a pilot valve, which can be set by means of a control pressure volume, or a pneumatic pump.
[0076]
[0077]
[0078] As can be seen in
[0079]
[0080] Accordingly, a restriction R1, R2, R3, R4 is integrated in some exemplary embodiments into the actuation of a valve with the pilot valves, separately for inhalation and for exhalation on the sides 18a, 18b, which are not necessary for the rapid pressure change. The attenuation shall in this case especially prevent the transmission of a disturbance variable as a positive feedback to the control system. An attenuation in the ventilation system itself is unaffected thereby. This has the advantage that no additional active elements are present in the system.
[0081] As was already stated, an attenuation is integrated in this case for disturbance variables. The intended fast changes at the beginning of a breathing phase 46, 56 shall not be attenuated if possible or they should be attenuated to a lesser extent only.
[0082] In the case of the inhalation valve 42, the valve is configured as an NC (NORMALLY CLOSED) type valve. This embodiment was already shown schematically in
[0083] As was explained farther above, it holds true for disturbance variables and oscillation excitations that energy shall be extracted from the system, and the distribution of the attenuation between opening/closing is irrelevant for the overall attenuation. Similar requirements arise for the exhalation valve 52. The exhalation valve 52 has the NO (NORMALLY OPEN) type configuration here, so that the pilot valve 17a has the NC (NORMALLY CLOSED) type configuration. The venting of the exhalation valve 52 must take place rapidly during the initiation of the exhalation 56, whereas the closing can take place in an attenuated manner. The restriction R4 for the relief is small and the restriction R3 for the admission is higher here as well.
[0084] The above-mentioned NC and NO valve types differ according to the usual technical teaching as follows: [0085] An NO valve is in the “OPEN” state without external activation, i.e., a gas can flow through the valve. [0086] An NC valve is in the “CLOSED” state without external activation, i.e., no gas can flow through the valve.
[0087] For example, the following values are selected as values for the restriction in case of a control pressure volume of 5 mL:
[0088] Inhalation: [0089] Admission R1=40 mbar/(L/minute) Relief R2=5 mbar/(L/minute)
[0090] Exhalation: [0091] Admission R3=40 mbar/L/minute) Relief R4=5 mbar/(L/minute).
[0092]
[0093]
[0094] This exemplary embodiment pertains to the introduction of additional energy extraction systems, which can or must each be set. The embodiment is shown for this with restrictions and with a volume located behind the restriction. The two valves 42, 52 to be controlled have control pressure volumes 48, 58, which are located each behind the diaphragms.
[0095] The limit frequency can be set in this case according to Formula 2 with the value of the volume (C for volume capacity) and with the restriction R5, R6:
ω=1/(2π*R*C) Formula 2.
[0096] For example, the restrictions R5, R6=10 mbar/(L/minute) are selected. The reduction of the limit frequency is also helpful in suppressing the transmission of higher frequency components. The maintenance of the volume may be especially advantageous in this case in adapting the restriction, because especially the energy extraction can be modulated here. The volume of the inhalation valve 48 and of the exhalation valve 58 for the control pressure can be used here for the volume (see
[0097] In another exemplary embodiment, one or more restrictions can be set permanently, variably or dynamically, for example, also by a control device. As a result, these elements can be set dynamically in order nevertheless to make possible a sufficiently fast system response in the case of an intended pressure change in case of sufficient disturbance variable suppression.
[0098]
[0099] In other exemplary embodiments, the pneumatic control element may comprise a pneumatic pump 49, 59.
[0100]
[0101] Analogously to the above-described exemplary embodiments, adjustable attenuations can also be used in exemplary embodiment with micropumps 49, 59.
[0102] The volume flow control devices for the inhalation and for the exhalation are configured in the exemplary embodiments being explained here such that there is a lower attenuation during opening than during closing. Other exemplary embodiments or implementations are generally conceivable as well.
[0103] For example, at least one of the volume flow control devices is configured for the inhalation and for the exhalation in order to allow, relative to the same unit, volume flow changes during opening that exceed the volume flow changes occurring during closing at least by a factor of 2, 4 or 8. In a concrete implementation, the volume flow change can be limited to 100 L/minute in 30 msec during the increase and to 100 L/minute in 240 msec during lowering.
[0104] At least one of the volume flow control devices for the inhalation and for the exhalation may be configured to allow, relative to the same unit of time, patient pressure changes during opening that exceed the patient pressure changes occurring during closing at least by a factor of 2, 4 or 8. The patient pressure change can thus be limited in one implementation to 40 mbar in 30 msec during the increase and to 40 mbar in 240 msec during the lowering.
[0105] The aspects and features that are described together with one or more of the examples and figures described in detail above may also be combined with one or more of the other examples in order to replace an identical feature of the other example or in order to additionally introduce the feature into the other example.
[0106] Examples may be or pertain to, furthermore, a computer program with a program code for executing one or more of the above processes when the computer program is executed on a computer or processor. Steps, operations or processes of different processes described above may be executed by programmed computers or processors. Examples may also cover program storage devices that are tangible and non-transient, e.g., digital storage media, which are machine-readable, processor-readable or computer-readable and machine-executable, processor-executable or computer-executable programs of instructions. The instructions execute some or all of the steps of the above-described processes or cause them to be executed. The program storage devices may comprise or be, e.g., digital memories, magnetic storage media, for example, magnetic disks and magnetic tapes, hard drives or optically readable digital storage media. Further examples may also cover computers, processors or control units, which are programmed for executing the steps of the above-described processes, or (field)-programmable logic arrays ((F)PLAs=(Field) Programmable Logic Arrays) or (field)-programmable gate arrays ((F)PGA=(Field) Programmable Gate Arrays), which are programmed for executing the steps of the above-described processes.
[0107] Only the basic principles of the disclosure are shown by the description and the drawings. Furthermore, all the examples listed here shall be used, in principle, expressly for illustrative purposes only in order to support the reader in understanding the basic principles of the disclosure and of the concepts contributed by the inventor(s) to the further development of the technique. All the statements made here about basic principles, aspects and examples of the disclosure as well as concrete examples thereof comprise the equivalents thereof.
[0108] A function block designated as a “means for . . . ” carrying out a defined function may pertain to a circuit, which is configured for carrying out a defined function. A “means for something” can thus be implemented as a “means configured for or suitable for something,” e.g., configured as a component or a circuit for or suitable for the respective task.
[0109] Functions of different elements shown in the figures including each function block designated as “means,” “means for providing a signal,” “means for generating a signal,” etc., may be implemented in the form of dedicated hardware, e.g., “a signal provider,” “a signal processing unit,” “a processor,” “a control,” etc., as well as as hardware capable of executing software in connection with corresponding software. In case of provision by a processor, the function may be provided by an individual, jointly used processor or by a plurality of individual processors, some of which or all of which can be used jointly. However, the term “processor” or “control” is far from being limited to hardware capable exclusively of executing software, but it may comprise digital processor hardware (DSP hardware, DSP=Digital Signal Processor), network processor, application-specific integrated circuit (ASIC=Application Specific Integrated Circuit), field-programmable logic array (FPGA=Field Programmable Gate Array), read-only memory (ROM=Read Only Memory) for storing software, random-access memory (RAM=Random Access Memory) and non-volatile storage device (storage). Other hardware, conventional and/or customer-specific, may also be included.
[0110] A block diagram may represent, for example, a schematic circuit diagram, which implements the basic principles of the disclosure. Similarly, a flow chart, a flow diagram, a state transition diagram, a pseudocode and the like may represent different processes, operations or steps, which are represented, for example, essentially in computer-readable medium and are thus executed by a computer or by a processor, regardless of whether such a computer or processor is explicitly shown. Processes disclosed in the description or in the patent claims may be implemented by a component that has means for carrying out each of the respective steps of this process.
[0111] It is apparent that the disclosure of a plurality of steps, processes, operations or functions disclosed in the description shall not be interpreted as being in the defined order, unless this is explicitly or implicitly stated otherwise, e.g., for technical reasons. Therefore, these are not limited to a defined order by the disclosure of a plurality of steps or functions, unless these steps or functions are not replaceable for technical reasons. Further, an individual step, function, process or operation may include in some examples a plurality of partial steps, partial functions, partial processes or partial operations and/or may be broken up into same. Such partial steps may be included and be part of the disclosure of these individual steps, unless they are explicitly ruled out.
[0112] Furthermore, the following claims are herewith included in the detailed description, where each claim may stand as a separate example in itself. While each claim may stand in itself as a separate example, it should be borne in mind that—even though a dependent claim may relate in the claims to a defined combination with one or more other claims, other examples may also comprise a combination of the dependent claim with the subject of every other dependent or independent claim with the subject of every other dependent or independent claim. Such combinations are explicitly proposed here, unless it is stated otherwise that a defined combination is not intended. Further, features of a claim may also be included for every other independent claim, even if this claim is not made directly dependent on the independent claim.
[0113] While specific embodiments of the invention have been shown and described in detail to illustrate the application of the principles of the invention, it will be understood that the invention may be embodied otherwise without departing from such principles.
LIST OF REFERENCE CHARACTERS
[0114] 10, 10a, 10b Valve assembly [0115] 12, 12a, 12b Inlet [0116] 14, 14a, 14b Outlet [0117] 16, 16a, 16b Volume regulating device [0118] 17a, 17b Pilot valves [0119] 18a, 18b Admission connection [0120] 19a, 19b Relief connection [0121] 20 Process for operating a valve assembly [0122] 22 Adjustment of the volume flow of the ventilation gas in a range between shut-off and a maximum flow [0123] 24 Opening of the valve assembly with a first attenuation, wherein the volume flow of the ventilation gas increases [0124] 26 Closing of the valve assembly with a second attenuation, wherein the volume flow of the ventilation gas decreases, wherein the first attenuation is different from the second attenuation [0125] 30 Patient/lung [0126] 40 Exhalation path [0127] 42 Exhalation valve [0128] 44 Nonreturn valve [0129] 46 Exhalation phase [0130] 48 Control volume [0131] 49 Pump, micropump, pneumatic pump [0132] 50 Inhalation path [0133] 52 Inhalation valve [0134] 54 Nonreturn valve [0135] 56 Inhalation phase [0136] 58 Control volume [0137] 59 Pump, micropump, pneumatic pump [0138] 60 Sensors [0139] 62 Sensors [0140] 70 Gas source [0141] 100 Ventilator [0142] 501 closed [0143] 502 open [0144] 503 fast opening [0145] 504 dynamic control [0146] 701 Low-pass curve [0147] 702 Curve with resonance [0148] 703 Curve with a resonance and with adapted attenuation [0149] 704 greatly attenuated curve [0150] 705 slightly attenuated curve [0151] 901 greatly attenuated curve [0152] 902 moderately attenuated curve [0153] 903 weakly attenuated curve [0154] 1101 greatly attenuated curve [0155] 1102 weakly attenuated curve [0156] R1-R14 Restrictions [0157] R11r-R14r Nonreturn valves