SYSTEM FOR SUPPLYING GASES FOR VENTILATION AND OXYGENATION WITH FEED OF INHALABLE SUBSTANCES

Abstract

A system (1000) feeds substances to a patient (30) with a ventilation of the patient and with an oxygenation of the patient. The system (1000) has at least one ventilation system (1), a sedation by inhalation system (17) with a dispensing system (7), an oxygenation system (2), a breathing gas dispensing path (3), a purge gas dispensing path (4), a breathing gas connection system (5), a connection element (25) located adjacent to the patient, an oxygenation connection system (6) and a switching unit (8). The switching unit (8) is configured to distribute and to split a quantity of an inhalable substance dispensed into a gas mixture by means of the dispensing system (7) between the connection element (25) located adjacent to the patient and the oxygenation system (2). At least one control unit (9, 10, 11, 12) is configured to control the switching unit (8) and/or the system (1000).

Claims

1. A ventilating and oxygenating system for ventilating and oxygenating a patient, the ventilating and oxygenating system comprising: a ventilation system configured with devices for supplying breathing gases to the patient with a breathing gas connection system connected to the ventilation system, wherein the breathing gas connection system is configured for a gas-carrying connection for a supply with feeding and removal of breathing gases to the patient; a patient connection system comprising a patient connection element located adjacent to the patient, the patient connection system being connected to the breathing gas connection system; an oxygenation system with an oxygenation connection system, wherein the oxygenation system comprises a membrane configured for a gas exchange with a blood circulation of the patient with a feed of a quantity of oxygen and of a quantity of inhalable and/or volatile substances into the blood circulation of the patient and for removing carbon dioxide from the blood circulation of the patient, and wherein the oxygenation system comprises devices for feeding and/or supplying a quantity of the purge gas to the membrane and wherein the oxygenation connection system is configured to supply the patient with quantities of blood enriched with the inhalable and/or volatile substances and with oxygen and remove quantities of blood enriched with carbon dioxide; a sedation by inhalation system comprising a dispensing system configured to dispense the inhalable and/or volatile substances, a gas removal port, a reflection unit and a gas return port; a breathing gas dispensing path; a purge gas dispensing path; a switching unit, wherein the switching unit is configured for splitting and/or distributing quantities of gas enriched with the inhalable and/or volatile substances into the breathing gas dispensing path and into the purge gas dispensing path, and is configured to feed and to supply a partial quantity of breathing gas enriched with the inhalable and/or volatile substances by means of the breathing gas dispensing path and by means of the connection element located adjacent to the patient to the airways of the patient and is configured to feed and to supply a partial quantity of breathing gas enriched with the inhalable and/or volatile substances to the oxygenation system by means of the purge gas dispensing path, wherein the breathing gas connection system is configured for feeding a partial quantity of breathing gas enriched with the inhalable and/or volatile substances from the switching unit via the connection element located adjacent to the patient to the patient and the breathing gas connection system is configured for feeding an additional partial quantity of breathing gas not enriched with inhalable and/or volatile substances from the ventilation system to the patient via the connection element located adjacent to the patient; and a controller, comprising at least one control unit, configured for controlling the switching unit.

2. A ventilating and oxygenating system in accordance with claim 1, wherein the dispensing system is configured to dispense inhalable and/or volatile substances or volatile anesthetics.

3. A ventilating and oxygenating system in accordance with claim 1, wherein the gas return port, the reflection unit and the patient connection element system located adjacent to the patient are configured as one assembly unit.

4. A ventilating and oxygenating system in accordance with claim 1, wherein a filter element is arranged at the reflection unit.

5. A ventilating and oxygenating system in accordance with claim 4, wherein: the filter element is configured as a heat and moisture exchanging (HME) filter for absorbing and releasing moisture; or the filter element is configured as a filter for retaining germs, viruses or bacteria present in the breathing gas.

6. A ventilating and oxygenating system in accordance with claim 4, wherein the gas removal port and the gas return port are configured in a common assembly unit with the reflection unit and/or with the breathing gas connection system and/or with the connection element located adjacent to the patient and/or with the filter element.

7. A ventilating and oxygenating system in accordance with claim 4, wherein the gas removal port and the gas return port are configured in a common assembly unit with the reflection unit and/or with an exhalation valve located adjacent to the patient and/or with the breathing gas connection system and/or with the connection element located adjacent to the patient and/or with the filter element.

8. A ventilating and oxygenating system in accordance with claim 1, wherein the control unit is configured to control the dispensing system to control the dispensing of the inhalable and/or volatile substances on the basis of concentrations of inhalable and/or volatile substances determined at the connection element located adjacent to the patient, at the breathing gas connection system or at the reflection unit.

9. A system in accordance with claim 8, wherein the control unit is configured to control the dispensing system to control the dispensing of the inhalable and/or volatile substances on the basis of an end-tidal concentration of at least one inhalable substance or of at least one anesthetic.

10. A ventilating and oxygenating system in accordance with claim 1, wherein the dispensing system is configured as a part of at least one of: the sedation by inhalation system; the ventilation system; and the breathing gas connection system.

11. A ventilating and oxygenating system in accordance with claim 1, wherein the switching unit is configured as a part of at least one of: the sedation by inhalation system; the ventilation system; the breathing gas connection system; the oxygenation connection system; the purge gas dispensing path; the purge gas dispensing path; and the dispensing system.

12. A ventilating and oxygenating system in accordance with claim 1, further comprising a blood feed unit, for transporting quantities of blood to the patient and/or away from the patient, arranged in or at the oxygenation connection system and/or at the oxygenation system.

13. A gas splitting unit for a ventilating and oxygenating system for ventilating and oxygenating a patient, the gas splitting unit comprising: a switching unit; a breathing gas dispensing path; a connection element located adjacent to the patient; a gas removal port configured to remove partial quantities of breathing gas from inhalation gas; a gas return port for inhalation gas; and a purge gas dispensing path, wherein at least the switching unit, the breathing gas dispensing path, the connection element located adjacent to the patient, and the gas removal port, the gas return port form a common assembly unit.

14. A gas splitting unit in accordance with claim 13, wherein the gas splitting unit further comprises a reflection unit and/or a heat and moisture exchanging (HME) filter and/or an additional filter element in the common assembly unit.

15. A system in accordance with claim 1, wherein: the switching unit, the breathing gas dispensing path, the connection element located adjacent to the patient, the gas removal port, which is configured to remove partial quantities of breathing gas from inhalation gas, the gas return port for inhalation gas, and the purge gas dispensing path, comprise a gas splitting unit; at least the switching unit, the breathing gas dispensing path, the connection element located adjacent to the patient, and the gas removal port, the gas return port form a common assembly unit; and a gas feed unit, configured to transporting purge gas, is arranged in the gas splitting unit, in the purge gas dispensing path or in the oxygenation system.

16. A system in accordance with claim 15, wherein a purge gas absorber unit for removing carbon dioxide from the purge gas is arranged in the purge gas dispensing path or in the oxygenation system.

17. A system in accordance with claim 15, further comprising a waste gas line extending from the ventilation system to the gas splitting unit or to the switching unit and configured to feed exhaled gases from the ventilation system to a mixing chamber arranged in or at the switching unit or in or at the gas splitting unit and the removal of carbon dioxide from the breathing gas.

18. A system in accordance with claim 15, wherein the controller is configured as a central control system or as a central control unit.

19. A system in accordance with claim 15, wherein: the controller comprises the at least one control unit and further individual control units forming a non-central control system; and at least one of the at least one control unit and further individual control units is arranged in the oxygenation system and in the ventilation system.

20. A system in accordance with claim 19, wherein: at least one of the at least one control unit and further individual control units is arranged in the switching unit and/or is arranged in the dispensing system and/or an external control unit is arranged in the non-central control system; one of the individual control units and/or the external control unit is configured as the at least one control unit to control the switching unit and/or the dispensing system.

21. A system in accordance with claim 15, wherein the controller takes into consideration respective provided data of the ventilation system and/or of the oxygenation system when controlling the switching unit.

22. A system in accordance with claim 15, further comprising a process gas analysis unit arranged in or at the oxygenation connection system or associated with the oxygenation system, or arranged in or at the oxygenation connection system, wherein the process gas analysis unit is configured to provide gas analysis data determined based on an analysis for the system or for the controller.

23. A system in accordance with claim 15, further comprising a process gas analysis unit, for an gas analysis, arranged in or at the patient connection element located adjacent to the patient, or connected to the gas splitting unit or to the connection element located adjacent to the patient by means of a measured gas line, or arranged in or at the sedation by inhalation system or is associated with the sedation by inhalation system, wherein the process gas analysis unit is configured to provide gas analysis data determined on the basis of the analysis for the sedation by inhalation system, for the system and/or for the controller.

24. A system in accordance with claim 23, wherein: a central process gas analysis unit is arranged in the system or is associated with the system; the central process gas analysis unit is configured, together with a switching and distribution control unit, to carry out analyses of gas samples of the sedation by inhalation system, of the breathing gas connection system, of the connection element located adjacent to the patient, of the oxygenation system, of the oxygenation connection system, of the dispensing system or of the switching unit and/or to provide data determined on the basis of the analyses for the system and/or for the controller.

25. A system in accordance with claim 23, wherein: a blood gas analysis unit for a blood analysis is arranged in or at the oxygenation system or at the oxygenation connection system or is associated with the oxygenation system or with the oxygenation connection system; and the blood gas analysis unit is configured to provide data determined on the basis of the analysis for the oxygenation system, for the system and/or for the controller.

26. A system in accordance with claim 23, wherein: a process gas analysis unit for a gas analysis is arranged in or is associated with the switching unit or the dispensing system; and the process gas analysis unit is configured to provide gas analysis data determined on the basis of the analysis for the switching unit, for the dispensing system, for the system and/or for the controller.

27. A system in accordance with claim 15, wherein a humidifying/heating system for breathing gas is arranged for heating breathing gases in or at one or more of the gas splitting unit, the switching unit, the connection element located adjacent to the patient, and the breathing gas connection system.

28. A system in accordance with claim 15, wherein: a data network is arranged in or at the system or is associated with the system; the data network is configured to provide data to at least one of the system, the controller, the blood gas analysis unit, the process gas analysis units, the ventilation system, the oxygenation system, the switching unit, the dispensing system, and the sedation by inhalation system to enable the controller to control and/or to coordinate the switching unit and/or the dispensing unit.

29. A system in accordance with claim 15, further comprising a physiological patient monitoring system arranged in or connected to the system, wherein the physiological patient monitoring system is configured to provide physiological data for the system, for the ventilation system, for the oxygenation system, for the dispensing system, for the switching unit, for the controller and/or for a data network.

30. A system in accordance with claim 15, further comprising a heart and lung imaging and diagnostic system arranged in or connected to the system, wherein the heart and lung imaging and diagnostic system is configured to provide data for the system, for the ventilation system, for the oxygenation system, for the dispensing system, for the switching unit, for a physiological patient monitoring system, for the controller and/or for a data network.

31. A system in accordance with claim 15, wherein the system is configured to provide data with a data network in a data exchange.

32. A system in accordance with claim 15, wherein the controller is configured to control a quantity of inhalable and/or volatile substances as a function of data provided in a data network and/or as a function of a data provided by the controller.

33. A system in accordance with claim 15, wherein the controller is configured to control a distribution and/or a splitting of a quantity of inhalable and/or volatile substances into the purge dispensing path to the oxygenation system and into the breathing gas dispensing path to the connection element located adjacent to the patient or to the reflection unit as a function of the data provided in a data network and/or as a function of the data provided by the controller.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0119] In the drawings:

[0120] FIG. 1 is a schematic view of a first system for feeding inhalable substances;

[0121] FIG. 2 is a schematic view of a second system for feeding inhalable substances, and

[0122] FIG. 3 is a schematic view of a third system for feeding inhalable substances.

DESCRIPTION OF PREFERRED EMBODIMENTS

[0123] Referring to the drawings, FIG. 1 shows in a schematic view a patient 30 and a system 1000 for ventilation with oxygenation and decarboxylation with the essential principal components: Ventilator as a ventilation system 1, oxygenation system 2, breathing gas dispensing path 3, purge gas dispensing path 4, breathing gas connection system 5, oxygenation connection system 6, dispensing system 7, switching unit 8, gas removal port 16, gas return port 24, patient connection system comprising a connection element 25 located close to the patient, reflection unit 18, feed line 103 and a controller, comprising at least one control unit 9, provided and configured for controlling the dispensing system 7.

[0124] The patient 30 is connected fluidically to the ventilation system 1 for feeding and removing breathing gases by means of the breathing gas connection system 5 and of the connection element 25 located close to the patient, by means of an endotracheal tube 33 and of an airway access 32. A nasal mask or a tracheostoma may also be used as an alternative to the endotracheal tube 33. The sedation by inhalation system (SIS) 17 is formed essentially by the dispensing system 7, the gas removal port 16 for removing partial quantities of breathing gas from the inhaled gas, the reflection unit 18 and the gas return port 24 for returning the partial quantities of breathing gas from the switching unit 8 to the reflection unit 18. A partial quantity of breathing gas is made available and fed to the sedation by inhalation system (SIS) 17 from the ventilator 1 by means of the breathing gas connection system 5 and the gas removal port 16. An additional quantity of breathing gas, not enriched with inhalable substances, is fed directly to the airways 32 of the patient 30 via an endotracheal tube 33, the nasal mask or the tracheostoma by means of an additional component/additional path of the breathing gas connection system 5. The partial quantity of breathing gas, enriched with inhalable substances, reaches the switching unit 8 from the dispensing system 7 by means of the feed line 103. The partial quantity of breathing gas enriched with inhalable substances is fed from the switching unit 8 by means of the breathing gas dispensing path 3 to the airways 32 of the patient 30 via the gas return port 24 at the connection element 25 located close to the patient. The partial quantity enriched with inhalable substances is fed to the oxygenation system 2 from the switching unit 8 by means of the purge gas dispensing path 4. The switching unit 8 makes it possible to split and/or distribute partial quantities of gas enriched with inhalable substances into the breathing gas dispensing path 3 and into the purge gas dispensing path 4. Quantities of blood enriched with inhalable substances are fed into the blood circulation of the patient 30 from the oxygenation system 2 by means a purge gas flowing in the purge gas dispensing path 4 via the oxygenation connection system 6 and an invasive fluid access 31. A gas-to-blood exchange takes place in the oxygenation system 2 at a membrane 35 arranged in the oxygenation system 2. Quantities of gas enriched with oxygen O.sub.2 and with the inhalable substances from the oxygenation connection system 6 reach the blood circulation of the patient 30 from the oxygenation connection system 6 while flowing around the membrane 35, and quantities of carbon dioxide CO.sub.2 from the blood circulation of the patient 30 enter at the same time into the purge gas dispensing path 4. The ventilation system 1 is configured to supply breathing gases to the patient 30.

[0125] In the usual configuration, the ventilation system 1 is a part of a ventilator. Ventilation systems 1 for ventilators usually have means for supplying, feeding and removing breathing gases and substances to and from the patient, e.g., gas mixing devices 67 and gas feed devices 27, for example, a gas mixer and at least one gas feed unit (blower, piston drive, valve array), as well as gas feed devices, such as a gas port 60 for feeding gases, for example, air and oxygen, the breathing gas connection system 5, configured, for example, in the form of an inspiratory ventilation tube and often also of an expiratory ventilation tube and the connection element 25 located close to the patient, the so-called Y-piece, for connecting the ventilation tubes to the endotracheal tube 33, breathing mask or tracheostoma. Furthermore, a ventilation system 1 has an exhalation valve (exhalation valve) 20, through which exhaled gases returned via the expiratory ventilation tube of the breathing gas connection system 5 to the ventilator 1 can enter into the environment with the exhalation by the patient 30 via a waste gas outlet 300 or can be collected or removed by means of a system for collecting and removing quantities of used gas. In addition, alternative connection elements 25 located close to the patient are known as well, which also comprise an exhalation valve located close to the patient. In addition to the ventilation system 1, ventilators also have, in the usual configuration, elements, especially sensor systems, for detecting given and/or set pressures, flow rates and other operating parameters of a mechanical ventilation by measurement with a feed of gases and gas mixtures. At least the following parameters, such as inspiratory and expiratory ventilation pressures, ventilation rate, inhalation to exhalation ratio, upper and lower pressure limits, flow rate upper and lower limits, volume upper and lower limits and gas concentrations are set by a control unit 10 and/or monitored by means of the sensor system for a process of a mechanical ventilation. This sensor system is not shown in the view 1000 in this FIG. 1 for the sake of clarity. The dispensing system 7 is configured by means of a control unit 12 and a dispensing element 101 for an automated dispensing for dispensing a predefined quantity of substances and/or volatile anesthetic to a partial quantity of inhaled gas into the feed line 103 from a reservoir 100 containing inhalable substances and/or volatile anesthetic.

[0126] An anesthetic heater 102 may be activated by the control unit 12 in order to convert inhalable substances present in the liquid form in the reservoir 100 into a gas state of aggregation. An alternative embodiment variant for a manual dispensing or gas mixing would be an arrangement of so-called flow tubes, which can make possible the mixing of gases and/or the dispensing of inhalable substances or anesthetics by the interaction of needle valves and floating body flowmeters arranged in a rising tube. The switching unit 8 is configured by means of the control unit 9 to distribute or split the quantity of gases enriched with inhalable substances into the feed line 103 to the oxygenation system 2 or to the connection element 25 located close to the patient. The dispensing system 7 and the switching unit 8 are shown in this FIG. 1 as separate units, but the switching unit 8 may also be configured as an assembly unit of the dispensing system 7 in embodiments used in practice. The connection element 25 located close to the patient and the reflection unit 18 are shown in this FIG. 1 together with the gas return port 24 as a common unit. In embodiments used in practice, the connection element 25 located close to the patient, the reflection unit 18 and the gas return port 24 may also be configured as separate units. The connection element 25 located close to the patient, the reflection unit 18, and the gas return port 24 are shown in this FIG. 1 separately from the gas removal port 16. The connection element 25 located close to the patient, the reflection unit 18, the gas return port 24 and the gas removal port 16 may be configured in embodiments used in practice as a common assembly unit, for example, integrated into the connection element 25 located close to the patient. The control units 9, 10, 11, 12 may have a modular configuration or may be configured as a common control unit, and they may also form a central control unit 15 (FIG. 2) of the system 1000 or of the system 2000 (FIG. 2). Mixing of gases supplied by means of a gas port 60 takes place in the ventilation system 1 by means of the gas mixer 67. The gases oxygen and medical air are fed to the gas port 60, mostly by means of a central gas supply unit (GS). A quantity of breathing gas flows from the ventilation system 1 via the breathing gas connection system 5 to the patient 30. A partial quantity of breathing gas is removed from the breathing gas connection system 5 via the gas removal port 16 and is fed to the dispensing system 7.

[0127] Control of a gas feed unit 27 or of a piston drive, which can be used alternatively, is carried out in the ventilation system 1 by means of a control unit 10 in order to cause the breathing gas to flow to the patient 30 as well as to remove used breathing gases from the patient 30. The control unit 10 controls the course of the ventilation with inspiratory and expiratory ventilation pressures, tidal volumes, flow rates and other ventilation settings by means of an exhalation valve (exhalation valve) 20 and the gas feed unit 27. The breathing gas connection system 5 comprises an inhalation ventilation tube for feeding the breathing gas and an exhalation ventilation tube for removing the used exhaled gases of the patient 30, which are connected to one another by means of the connection element 25 located close to the patient, the so-called Y-piece, for connecting the patient 30. The setting and display elements, sensors for pressure and flow measurements, valves, nonreturn valves and other components, which are necessary for controlling the ventilation system 1 and for carrying out the ventilation, are not shown in this FIG. 1 for the sake of clarity. The patient 30 is connected to the oxygenation system 2 by means of the oxygenation connection system 6 for a supply with feeding and removing of quantities of blood into the blood circulation via an invasive fluid access 31. The patient 30 can be connected to the oxygenation system 2 via a fluid port 37, which is configured for a pumpless extracorporeal membrane oxygenation. The quantities of blood are transported to the patient 30 and away from the patient in such an embodiment by the pumping capacity of the heart of the patient himself. This configuration is called pumpless extracorporeal membrane oxygenation or pumpless extracorporeal lung assist (pECLA). However, the patient 30 is usually connected to the oxygenation system 2 by means of a blood feed unit 36, configured usually as a pump. The gas enriched with inhalable or volatile substances or anesthetic reaches a gas port 34 as a purge gas at the oxygenation system 2 by means of the purge gas dispensing path 4 from the switching unit 8. The oxygenation system 2 controls a quantity of flow and a flow velocity of the incoming flow of purge gas to the membrane 35 by means of a control unit 11. The membrane is configured to introduce oxygen from the purge gas into the blood and to remove carbon dioxide from the blood into the purge gas. A blood-to-gas exchange takes place in this manner outside the body (extracorporeally).

[0128] The setting and display elements, sensors for pressure and flow measurements, valves and other components, which are also necessary for controlling the oxygenation system 7 and for carrying out the extracorporeal enrichment with oxygen (oxygenation) and for the removal of carbon dioxide (decarboxylation), are not shown in this FIG. 1 for the sake of clarity. A process gas analysis unit 21 (PGA) associated with the oxygenation system 2 for the analysis of the gas composition of the purge gas is shown as another essential component of the system 1000. The process gas analysis unit 21 has, moreover, in addition to the measuring elements for determining gas concentrations, displaying and visualizing elements, as well as operating elements, not shown in this FIG. 1, which make reading and operation possible for a user. The process gas analysis unit 21 associated with the oxygenation system 2 is configured for an analysis of the gas composition of the purge gas. The purge gas is fed to the process gas analysis unit 21 and is analyzed in the process gas analysis unit 21 in order to monitor the ratios of carbon dioxide and oxygen at the membrane 35, and thus to determine the gas exchange and the transfer rate between blood circulation and purge gas and then to make possible an adequate control of oxygenation and decarboxylation for the patient by means of the control unit 11. Quantities of used gas are removed from the system 1000 from the oxygenation system 2 and from the ventilation system 1 via the waste gas outlet (waste) 300 via valve arrays, which are correspondingly provided for this purpose and are not shown in this FIG. 1. These quantities of used gas are usually introduced from the anesthesia device into the infrastructure of the hospital by means of an anesthetic gas removal system and are then properly disposed of there correspondingly. Depending on the splitting into the breathing circuit or into the blood circulation, the procedure is carried out with the system 1000 to feed substances related to oxygenation and decarboxylation by inhalation simultaneously with the performance of the ventilation with a gas-to blood exchange in the lungs of the patient 30 and/or extracorporeally with a gas-to-blood exchange at the membrane 35 of the oxygenation system 2. The ratio between the inhalable and extracorporeal administration of the inhalable substances can be set by the user by means of the switching unit 8. The measured values and status values of the process gas analysis unit (PGA) 21 of the oxygenation system 2 are available as a support for the user.

[0129] Data interfaces 211, which can make possible a unidirectional and/or bidirectional data exchange between the ventilation system 1, the oxygenation system 2, the dispensing system 7, the switching unit 8 and the sedation by inhalation system (SIS) 17, may be provided at the ventilation system 1, at the oxygenation system 2, at the dispensing system 7, and at the switching unit 8. Such a data exchange is preferably organized, initiated or coordinated in interaction and communication with the control units 9, 10, 11, 12 in the ventilation system 1, in the oxygenation system 2, in the sedation by inhalation system (SIS) 17, in the dispensing system 7, and in the switching unit 8. The data interfaces are connected to one another in a wired or wireless manner by means of data lines 210 (FIG. 2), which are not shown in the graphic representation in this FIG. 1 for the sake of clarity. An additional central control unit 15 (FIG. 2), not shown in this FIG. 1, may also be arranged in the system 1000, as well as in the systems 2000 (FIG. 2) and 3000 (FIG. 3), and it may be intended for coordinating the interaction in the system 1000 comprising the ventilation system 1, the oxygenation system 2, the sedation by inhalation system (SIS) 17, the dispensing system 7, the switching unit 8, optionally also with additional components 212, 213 (FIG. 2) (database, server, router, access point, hub) in a data network 212 (FIG. 2) (LAN, WLAN, Bluetooth, PAN, Ethernet) or network linking system.

[0130] FIG. 2 shows a system 2000 with possibilities of expanded configurations of the system 1000 for ventilation with oxygenation and decarboxylation according to FIG. 1.

[0131] Identical components in FIG. 1 and in FIG. 2 are designated with the same reference numbers in FIGS. 1 and 2.

[0132] In addition to the elements and components 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 16, 17, 18, 20, 21, 24, 25, 27, 30, 31, 32, 33, 34, 35, 36, 37, 60, 67, 100, 101, 102, 103, 211, and 300 shown in FIG. 1 and described for the system 1000 (FIG. 1), additional and features and components 15, 19, 22, 23, 26, 28, 38, 39, 70, 75, 210, 212, and 213 are present in the expanded system 2000 according to FIG. 2.

[0133] Thus, the expanded system 2000 has an additional gas feed unit (blower) 38 and a purge gas absorber unit (carbon dioxide absorber) 39 in the oxygenation system 2. Such an additional gas feed unit 38 may be arranged in combination with the purge gas absorber unit 39 as a module, for example, as a kind of plug-in module in the oxygenation system 2.

[0134] The additional gas feed unit 38, as well as the purge gas absorber unit 39, may also be configured together or separately as independent units or modules, which may be connected, for example, as external modules to the oxygenation system 2. Thus, the expanded system 200 shows a measured gas line (sample line) 26, which can be joined to the connection system element 25 located close to the patient or can be connected to this, and through which samples of the breathing gas given at the patient 30 can be fed to an additional process gas analysis unit 23 or blood gas analysis unit 23, so that the process gas analysis unit 23 or the blood gas analysis unit 23 is capable, based on measurement, of determining concentrations of oxygen, carbon dioxide, or inhalable substances, for example, anesthetics and of determining measured values, which indicate these concentrations and of making them available for the control of the system 2000. For the further analysis, the expanded system 2000 may have, in addition, a blood gas analysis unit (BGA) 22 for the analysis of blood gases in the blood of the patient 30 in the oxygenation system 2. A blood gas analysis provides, for example, information concerning a gas distribution (partial pressure) of O.sub.2 (oxygen), CO.sub.2 (carbon dioxide) as well as the pH value and the acid-base balance in the blood of the patient 30. Such a blood gas analysis unit 22 (BGA) may be arranged in combination with the process gas analysis unit (PGA) 21 as a module, for example, as a kind of plug-in module in the oxygenation system 2. The blood gas analysis unit 22 (BGA) and the process gas analysis unit (PGA) 21 may also be configured together or separately as independent units or modules, which may be connected, for example, as external modules to the oxygenation system 2. The switching unit 8 and the dispensing unit 7 may also be configured in a common assembly unit, so that the process gas analysis unit 23 or the blood gas analysis unit 23 may then also be arranged within the common assembly unit both in or at the dispensing unit 7 or in or at the switching unit 8. The configuration of a common assembly unit with arrangement of the process gas analysis unit or blood gas analysis unit is not shown in this FIG. 2 for the sake of clarity. The expanded system 2000 shows as an additional component a humidifying and/or heating system 75 for controlling the temperature of breathing gases in the breathing gas connection system 5.

[0135] FIG. 3 shows a system 3000 with expansions of the configurations of the systems 1000, 2000 for ventilation with oxygenation and decarboxylation according to FIG. 1 or 2. Identical components in FIGS. 1, 2, and 3 are designated by the same reference numbers in FIGS. 1, 2 and 3.

[0136] In addition to the elements and components 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 60, 67, 70, 75, 100, 101 102, 103, 210, 211, 212, 213 and 300, which are shown and described in FIG. 2 in connection with system 2000 (FIG. 2), additional components 19, 29 are present in the expanded system 3000 according to FIG. 3. Thus, the switching unit 8 has a mixing chamber 19. This mixing chamber 19 is configured and intended to receive at least partial quantities of the exhaled gases of the patient 30 in this mixing chamber 19 of the switching unit 8 by means of the waste gas line 29, instead of allowing these—as is shown in the embodiments according to FIGS. 1 and 2—to flow from the waste gas outlet 300 into the environment. These partial quantities of exhaled gases can then be sent from the mixing chamber 19 of the switching unit 8, together with the quantities of breathing gas fed by the dispensing system 7 by means of the feed line 103 and enriched with inhalable substances, to the switching unit 8 and then be fed via the purge gas connection path 4 to the oxygenation system 2. The concentration of carbon dioxide in the gas mixture is reduced by the purge gas absorber unit 39 in the oxygenation system 2 and the quantity of inhalable substances remaining after exhalation by the patient can again be fed via the oxygenation system 2 by means of the oxygenation connection system 6. It is possible in this manner, depending on the selected splitting of the quantities of gas containing inhalable substances between the oxygenation system 2 and the ventilation system 1, by the switching unit 1, to reuse partial quantities of the inhalable substances still present in the exhaled gas of the patient 30 in the oxygenation system for the extracorporeal gas exchange, at least during defined time periods in the course of the ventilation by the ventilator 1, instead of allowing them to flow into the environment via the waste gas outlet or instead of having to dispose of them by means of a scavenging or collection system (AGS: Anesthesia Gas Scavenger, ORS: Open Reservoir Scavenger). It thus becomes possible at least partially due to the waste gas line 29 not to have to send quantities of inhalable substances in the exhaled gas continuously for disposal, but it is possible, instead, to reuse these quantities of inhalable substances. In particular, if the switching unit 8 is set such that the distribution of inhaled gas enriched with inhalable substances flows to the oxygenation system 2 essentially via the purge gas dispensing path, an appreciable percentage of the residual quantities of inhalable substances present in the exhaled gas returned in the exhaled gas to the ventilator can then be reused in the oxygenation system 2.

[0137] If an optional additional absorber unit 68 is introduced into the waste gas line 29, into the mixing chamber 19 of the switching unit 8 or into the switching unit 8, it thus becomes possible to remove carbon dioxide from the exhaled gas, so that there is a possibility for the continuous reuse of the residual quantities of inhalable substances returned to the ventilator with the exhaled gas even independently from phases of respiration or from the particular setting of the splitting into the breathing gas dispensing path 3 and into the purge gas dispensing path 4 after the CO.sub.2 removal, which setting is present during the operation.

[0138] Moreover, an additional process gas analysis unit (PGA) 23, arranged in the expanded systems 2000, 3000 according to FIGS. 2 and 3, for example, at the switching unit 8 or at the dispensing unit 7 is provided for the analysis of the gas 103 in the oxygenation dispensing path and/or in the breathing gas dispensing path 3, purge gas dispensing path 4 or in a path starting from the dispensing unit 7. Information concerning dispensing and the setting of the anesthetic dispensing 100, 101, 102 can thus be checked by measurement by means of concentration determination in the gas 103. Depending on the set splitting of the gas 103 into the breathing circuit or into the blood circulation to the switching unit 8, the gas in the breathing gas dispensing path 3 and the gas in the purge gas dispensing path 4 have different oxygen concentrations. The additional process gas analysis unit (PGA) 23 may be useful for monitoring this difference by measurement. In such a mode of operation, the anesthesia is carried out with the ventilation system 1 with the feed of volatile anesthetic as well as with the feed of additional substances, preferably volatile substances, by inhalation along with the performance of the ventilation with a gas-to-blood exchange directly in the lungs of the patient 30 or extracorporeally with a gas-to-blood exchange at the membrane 35 of the oxygenation system 2, depending on the desire of the user with different concentrations of oxygen in the breathing gas indirectly 5, 32, 33 to the lungs of the patient 3 and indirectly 6, 31 into the blood circulation of the patient 30.

[0139] The systems 1000, 2000, 3000 shown in FIGS. 1 through 3 may be connected for an interaction and for a common system operation by means of the data interfaces 211, data lines 210 in the data network 212 with the additional medical devices or systems, for example, with process gas analysis units (PGA) 20, 21, 23, blood gas analysis units (BGA) 22, the physiological patient monitoring (PPM) system 40 as well as with the heart and lung imaging and diagnostic system 50.

[0140] For example, the system 1000 and the expanded systems 2000, 3000 may thus have a physiological patient monitoring (PPM) system 40. Such a physiological patient monitoring system 40 has displays and visualizations of detected, determined, analyzed or calculated physiological measured data and/or parameters. These include, for example, measurement-based detections of ECG by means of ECG electrodes on the upper body of the patient and ECG cables, detection of an oxygen saturation (SPO.sub.2), for example, on the finger of the patient 30, detection of a non-invasive blood pressure measured value obtained by means of a blood pressure cuff on the upper arm of the patient 30, detection of an invasive blood pressure measured value obtained by means of an invasive access point on the hand of the patient 30, as well as of a body temperature, e.g., a skin temperature or a body core temperature of the patient 30. Gas samples can be sent via an optional port for gas suctioning at the Y-piece 25 and/or via another measured gas line (not shown in detail in FIG. 2 and in FIG. 3) to a physiological patient monitoring system 40 and gas analyses may be carried out in this system, for example, concentrations of carbon dioxide and methane can be determined, or analyses of other components, for example, alcohols (ethanol) in the exhaled gas can be determined. Thus, the control unit 12 in the dispensing system 7 may be configured to control the quantity of inhalable substances 100 as a function of the data provided in the data network 212 or in the network linking system and/or as a function of the data provided by one of the control units 9, 10, 11, 15. For example, the addition of the quantities of dispensed inhalable substances 100 by the dispensing system 7 can be carried out as a function of an oxygen or carbon dioxide partial pressure in the blood, of the acid-base balance or the pH value of the blood, concentrations of oxygen and carbon dioxide in the breathing gas or the blood pressure, heart rate, and ECG. The system 1000 and the expanded systems 2000, 3000 may also have—not shown in detail in FIG. 2 and in FIG. 3—a heart and lung imaging and diagnostic system 50. Heart and lung imaging and diagnostic systems 50 are configured, for example, as devices for computed tomography (CT diagnostics), magnetic resonance imaging (MRI diagnostics), X-ray devices (X-ray diagnostics), electrical impedance tomography devices (EIT diagnostics, EIT system) or ultrasound diagnostic devices (US diagnostics, sonography, Doppler sonography). The heat and lung imaging and diagnostic system 50 can provide the user with valuable information on the pathological state or the state of recovery of the lungs of the patient 30.

[0141] Based on this, the user can configure the systems 1000, 2000, 3000 such as to place the main focus of feeding oxygen to the patient 30 by inhalation on the path via the lungs or by means of the extracorporeal membrane oxygenation (ECMO) invasively on the path via the blood circulation. Contrary to CT diagnostics, X-ray diagnostics, MRI diagnostics, US diagnostics, especially electrical impedance tomography devices (EIT diagnostics) make possible a continuous imaging of the lungs, thorax and heart. Thus, possible changes in the state of the lungs can be visualized continuously and in a timely manner during the treatment with systems 50 for EIT diagnostics (EIT system). Effects of the ventilation and of the manner in which the combined use with the oxygenation system is employed are thus visible to the user in a timely manner and they can be checked. If, for example, data of an EIT system 50 are provided in the network 212, which data indicate a trend in the ventilation situation of the lungs of the patient 30, the control unit 9 of the switching unit 8 can control the distribution of the quantities of inhalable substances 100 and/or of the quantities of oxygen into the blood circulation or into the breathing circuit of the patient 30 on the basis of these data. For example, in case of an exacerbation of the ventilation situation, i.e., when the EIT system 50 determines that lung regions are no longer ventilated sufficiently (ventilation) or are not perfused sufficiently (perfusion) any longer or that they are neither ventilated sufficiently nor are they perfused sufficiently any longer, the control unit 9 can prompt the switching unit 8 to carry out the distribution of the breathing gas enriched with inhalable substances 100 between the breathing gas dispensing path 3 and the purge gas dispensing path 4 such that it increases the partial quantity of breathing gas into the purge gas dispensing path 4. In case of an improvement of the situation of the lungs of the patient 30, which is determined by means of the EIT system 50, for example, as a consequence of a recuperation or recovery of the lungs of the patient 30 in the course of the treatment, the control unit 9 can prompt the switching unit 8 to carry out the distribution of the breathing gas enriched with inhalable substances 100 between the breathing gas dispensing path 3 and the purge gas dispensing path 4 by increasing the partial quantity of breathing gas into the breathing gas dispensing path 3.

[0142] 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 NUMBERS

[0143] 1 Ventilation system (VS), ventilator [0144] 2 Oxygenation system (OS) (oxygenator) [0145] 3 Breathing gas dispensing path [0146] 4 Purge gas dispensing path [0147] 5 Breathing gas connection system [0148] 6 Oxygenation connection system [0149] 7 Dispensing system (DS) [0150] 8 Switching unit [0151] 9 Control unit, control module (μC1) of the switching unit [0152] 10 Control unit, control module (μC2) of the ventilator/ventilation system [0153] 11 Control unit, control module (μC3) of the oxygenation system (OS) [0154] 12 Control unit, control module (μC4) of the dispensing system (DS) [0155] 15 External control unit, external control module (μLCM) [0156] 16 Gas removal port for inspiratory breathing gas, inhaled gas [0157] 17 Sedation by inhalation system (SIS) [0158] 18 Reflection unit (CR), element for anesthetic gas recovery, anesthetic gas reflector [0159] 19 Mixing chamber at switching unit [0160] 20 Exhalation valve of the ventilator [0161] 21 Process gas analysis (PGA, PGA-OS) of the oxygenation system [0162] 22 Blood gas analysis (BGA) of the oxygenation system [0163] 23 Process gas analysis (PGA, PGA-DS, PGA-SIS) of the dispensing system [0164] 24 Gas return port for inspiratory breathing gas, inhaled gas [0165] 25 Patient connection system with connection element located close to the patient (Y-piece) [0166] 26 Measured gas line [0167] 27 Gas feed unit (blower, piston drive) in the ventilation system [0168] 28 Filter element for moisture recovery (HME filter) [0169] 29 Waste gas line for exhaled gas [0170] 30 Patient, living being [0171] 31 Invasive fluid access to the blood circulation of the patient [0172] 32 Airway access, access to the airways of the patient [0173] 33 Endotracheal tube, alternatively nasal mask or tracheostoma [0174] 34 Gas port at the oxygenation system [0175] 35 Membrane, blood<->gas exchange membrane, oxygenator membrane [0176] 36 Fluid port with blood feed unit (pump) [0177] 37 Fluid port for pumpless extracorporeal membrane oxygenation [0178] 38 Additional gas feed unit (blower) in or at the oxygenation system [0179] 39 Purge gas absorber unit, carbon dioxide absorber (CO.sub.2 remove) in the oxygenation system [0180] 40 Physiological Patient Monitoring (PPM) system [0181] 50 Heart and lung imaging and diagnostic system [0182] 60 Gas port for feeding gases (oxygen, air) to the ventilator [0183] 67 Gas mixer for mixing gases (oxygen, air) in the ventilator [0184] 68 Additional absorber unit [0185] 70 Heating system for quantities of blood at the oxygenation connection system [0186] 71 Humidifying/heating system for breathing gas at the breathing gas connection system [0187] 100 Reservoir (anesthetic tank) for inhalable substances or anesthetics [0188] 101 Dispensing element [0189] 102 Anesthetic heater [0190] 103 Feed line for supplying the gas mixture to the switching unit 8 [0191] 210 Data lines, data links, data nodes [0192] 211 Data interfaces, data nodes, data coordination (switch, hub, router) [0193] 212 Network linking system, data network (LAN, WLAN, Bluetooth, PAN, Ethernet) [0194] 213 Components in the data network (database, server, router, access point, hub) [0195] 300 Waste gas outlet (waste) [0196] 1000 System (FIG. 1) [0197] 2000 Expanded system (FIG. 2) [0198] 3000 Expanded system (FIG. 3)