Device for respiratory therapy

Abstract

The present invention relates to a respiratory therapy device (1) for the targeted assistance of a secretion removal from the airways of a patient and a method for operating such a respiratory therapy device (1). The respiratory therapy device (1) comprises a flow unit (2) for generating a respiratory airflow for an insufflation and a respiratory airflow for an exsufflation, which comprises a patient interface (3) for connecting the patient and a respiratory air interface and two fans (5, 6) fluidically connected in parallel each having an intake side (15, 16) and a delivery side (25, 26). A first fan (5) is fluidically coupled with its intake side (15) and a second fan (6) is fluidically coupled with its delivery side (26) to a switchable valve unit (7).

Claims

1. A respiratory therapy device for the targeted assistance of a secretion removal from the airways of a patient, wherein the device comprises a flow unit for generating at least one respiratory airflow for an insufflation into the patient and for generating at least one respiratory airflow for an exsufflation out of the patient, which flow unit comprises a patient interface for connecting the patient to the respiratory therapy device and a respiratory air interface for connecting the respiratory therapy device to respiratory air or ambient air, and wherein the flow unit comprises at least two flow paths extending in parallel, wherein each flow path comprises at least one gas source each having at least one intake side and at least one delivery side, a first gas source being fluidically coupled with its intake side and a second gas source being fluidically coupled with its delivery side to a switchable valve unit which is fluidically arranged between each of the first gas source and the second gas source and the respiratory air interface.

2. The respiratory therapy device of claim 1, wherein the first and second gas sources are designed as electronically operated fans.

3. The respiratory therapy device of claim 2, wherein the fans are arranged inversely in relation to one another in the flow paths.

4. The respiratory therapy device of claim 2, wherein the valve unit is configured for connecting the at least one intake side of a first fan to the respiratory air interface or to the patient interface and blocking the at least one delivery side of a second fan in at least one valve position.

5. The respiratory therapy device of claim 2, wherein the valve unit is configured for blocking the at least one intake side of a first fan and connecting the at least one delivery side of a second fan to the respiratory air interface or to the patient interface in at least one valve position.

6. The respiratory therapy device of claim 2, wherein the valve unit is configured for blocking the at least one intake side of a first fan and blocking the at least one delivery side of a second fan in at least one valve position.

7. The respiratory therapy device of claim 1, wherein the valve unit comprises at least one 3/3-directional valve.

8. The respiratory therapy device of claim 1, wherein the valve unit is designed as a proportional valve.

9. The respiratory therapy device of claim 1, wherein the valve unit comprises at least one rotary slide valve.

10. The respiratory therapy device of claim 2, wherein the flow unit is configured for operating at least one of the at least two fans even if the at least one intake side or the at least one delivery side of a fan is blocked by the valve unit and/or is configured for setting a requested speed of at least one of the at least two fans while the at least one intake side or the at least one delivery side of a fan to be set is blocked by the valve unit.

11. The respiratory therapy device of claim 1, wherein the device further comprises at least one oscillator unit for applying at least one defined oscillation to the respiratory airflow for the insufflation and/or exsufflation.

12. The respiratory therapy device of claim 11, wherein the oscillator unit is configured for generating the at least one defined oscillation by repeated switching over of the valve unit and/or is configured for switching over the valve unit between a fully open valve position and a partially open valve position during insufflation and/or exsufflation.

13. The respiratory therapy device of claim 11, wherein the oscillator unit is configured for switching over the valve unit between an at least partially open valve position for insufflation and an at least partially open valve position for exsufflation during insufflation and/or for switching over the valve unit between an at least partially open valve position for exsufflation and an at least partially open valve position for insufflation during the exsufflation.

14. The respiratory therapy device of claim 11, wherein the oscillator unit is configured for setting a different maximum and/or minimum degree of opening of the valve unit during insufflation than during exsufflation and/or is configured for switching over the valve unit at a frequency of 0.1 Hz to 100 Hz and/or is configured for setting a different frequency and/or amplitude for insufflation than for exsufflation.

15. The respiratory therapy device of claim 1, wherein the respiratory air interface comprises at least one air inlet and at least one air outlet, the at least one air inlet and the at least one air outlet being provided by a common opening.

16. The respiratory therapy device of claim 1, wherein the patient interface comprises at least one coupling unit for connecting at least one hose unit, which hose unit is connectable to at least one breathing opening of the patient and which comprises at least one inhalation hose and at least one exhalation hose or which comprises only at least one inhalation hose.

17. A respiratory therapy device for assisting a secretion removal from the airways of a patient, wherein the device comprises a flow unit for generating at least one respiratory airflow for an insufflation into the patient and for generating at least one respiratory airflow for an exsufflation out of the patient, which flow unit comprises a patient interface for connecting the patient to the respiratory therapy device and a respiratory air interface for connecting the respiratory therapy device to the respiration air or breathing air and further comprises at least two flow paths, each flow path comprising at least one gas source having in each case at least one intake side and at least one delivery side, which gas sources are fluidically coupled to a switchable valve unit which is fluidically arranged between the flow unit and the respiratory air interface.

18. The respiratory therapy device of claim 1, wherein the flow unit is configured for setting at least one respiratory airflow for a respiration having at least one defined dynamic pressure for assisting the exhalation procedure for a defined time following a respiratory airflow for the exsufflation.

19. The respiratory therapy device of claim 1, wherein the device further comprises at least one respiration unit which is configured for generating a respiratory airflow for the respiration of the patient by the flow unit.

20. The respiratory therapy device of claim 1, wherein the device further comprises a sensor unit which monitors a volume flow rate or flow and/or a pressure of a respiratory gas flow for the insufflation and/or exsufflation, and a control unit which is configured for setting or controlling the switchable valve unit and the first and second gas sources as a function of signals from the sensor unit.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) Further advantages and features of the present invention result from the description of the exemplary embodiments, which are explained hereafter with reference to the appended figures.

(2) In the figures:

(3) FIG. 1 shows a very schematic illustration of a respiratory therapy device according to the invention;

(4) FIG. 2 shows a very schematic illustration of a further respiratory therapy device;

(5) FIG. 3 shows a very schematic illustration of another respiratory therapy device;

(6) FIG. 4 shows a schematic illustration of a valve unit in a perspective view;

(7) FIG. 5-9 show schematic illustrations of the valve unit in various settings in a sectional view;

(8) FIG. 10 shows a very schematic diagram of the functionality of the respiratory therapy device; and

(9) FIG. 11 shows a further very schematic diagram of the functionality of the respiratory therapy device.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

(10) The particulars shown herein are by way of example and for purposes of illustrative discussion of the embodiments of the present invention only and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the present invention. In this regard, no attempt is made to show details of the present invention in more detail than is necessary for the fundamental understanding of the present invention, the description in combination with the drawings making apparent to those of skill in the art how the several forms of the present invention may be embodied in practice.

(11) FIG. 1 shows a respiratory therapy device 1 according to the invention, which is designed as a coughing device 10. The respiratory therapy device 1 is operated here as per the method according to the invention and is used for the targeted assistance of a secretion removal from the airways of a patient.

(12) The respiratory therapy device 1 comprises a flow unit 2, using which a respiratory airflow for an insufflation and a respiratory airflow for an exsufflation are generated. The flow unit 2 comprises a first fan 5, a second fan 6, a valve unit 7, and a patient interface 3 and also a respiratory air interface 4. The fans 5, 6 are connected in parallel and can be controlled separately. To control the valve unit 7 and the fans 5, 6, the respiratory therapy device 1 comprises a control unit 11 here.

(13) The valve unit 7 comprises three fittings 97 here and offers three switchable valve positions 17, 27, 37. The valve unit 7 is designed as a 3/3-directional valve 47. Moreover, the valve unit 7 is designed here as a proportional valve 57, so that intermediate positions having various degrees of opening can be set in the valve positions 17, 27.

(14) The first fan 5 is connected with an intake side 15 to a fitting 97 of the valve unit 7. The delivery side 25 or pressure side of the first fan 5 is connected here to the patient interface 3. The second fan 6 is connected with its delivery side 26 to a second fitting 97 of the valve unit 7. The intake side 16 of the second fan 6 is connected here to the patient interface 3. The valve unit 7 comprises a third fitting 97, which is connected here to the respiratory air interface 4.

(15) The respiratory air interface 4 is fluidically connected to the surroundings of the respiratory therapy device 1, so that ambient air can be drawn in and used for the insufflation. For this purpose, the respiratory air interface 4 has an air inlet 14. Alternatively or additionally, the respiratory air interface 4 can also be connected to a respiratory gas source and, for example, a pressure bottle.

(16) The respiratory air interface 4 is moreover equipped with an air outlet 24, via which the air drawn out during the exsufflation can be blown out into the surroundings of the device 1.

(17) Air inlet 14 and air outlet 24 are preferably provided by a common opening 34, via which the air can be both drawn in and also blown out. Separate openings can also be provided for air inlet 14 and air outlet 24.

(18) The patient interface 3 is equipped here with a coupling unit 13, to which a hose unit 200 can be coupled. The hose unit 200 is equipped with a patient interface 204. The patient interface 204 can be embodied, for example, as a full-face mask, a nasal mask, a nasal pillow, a mouthpiece, a tube, or as a larynx mask. Headgear can be provided for fixing the breathing mask 105.

(19) The hose unit 200 shown here is only equipped with one breathing hose, via which the respiratory air both for the insufflation and also for the exsufflation is conveyed. For example, a single-hose system is provided, which is suitable for coughing maneuvers. Then, for example, breathing back into the hose unit 200 is possible. It is possible that a CO2 washing in the region of the hose system is omitted. However, a two-hose system can also be coupled.

(20) In one embodiment, the hose unit 200 can be equipped with a patient valve 203. Exhaled air can be continuously exhaustible via this, for example. The patient valve 203 can be designed, for example, as a passive exhalation system for CO2 washing.

(21) However, a patient valve 203 controllable by the respiratory therapy device can also be provided, so that the exhaust of exhaled air can be intentionally adapted to breathing phases or coughing phases, respectively.

(22) The respiratory therapy device 1 preferably also comprises a sensor unit (not shown in greater detail here), which monitors the volume flow rate or flow and/or the pressure of the respiratory gas flow for the insufflation and/or exsufflation. For this purpose, the sensor unit can have corresponding pressure sensors and/or flow sensors. The control unit 11 can be suitable and designed for the purpose of setting and/or controlling the valve unit 7 and/or the fans 5, 6 as a function of the registered sensor signals. The patient valve 203 can also be controllable by the control unit 11.

(23) The flow paths shown here can be equipped with at least one filter unit, to be able to provide a purified respiratory airflow.

(24) In one advantageous embodiment, the respiratory therapy device 1 can also be equipped with a respiration unit 9. The respiration unit 9 is then operationally connected to the flow unit 2, to thus generate a respiratory airflow for the respiration of the patient. For this purpose, the respiration unit 9 can control at least one of the fans 5, 6 and/or the valve unit 7 accordingly. The respiration unit 9 is preferably also operationally connected to the control unit 11 and the sensor unit.

(25) In one embodiment of the respiration unit 9, at least one piece of software is stored for this purpose in the control unit 11, on the basis of which the flow unit 2 is controlled. This offers a particularly advantageous design expenditure. The respiration unit 9 can also have an independent or separate control unit.

(26) The respiratory therapy device 1 can also be equipped with an oscillator unit, in order to apply a defined oscillation to the respiratory airflow for the insufflation and exsufflation. For example, the oscillator unit 8 is provided by the valve unit 7. Such an embodiment is described in greater detail with reference to FIGS. 5 to 10.

(27) The respiratory therapy device 1 can have further components (not shown in greater detail here). For example, a display unit or a display screen and an operating unit for carrying out inputs and settings can be provided. Moreover, the respiratory therapy device 1 can have at least one communication interface, via which it can communicate in a wireless and/or wired manner with external devices. Moreover, a remote control can also be provided for the respiratory therapy device 1. Such components are preferably operationally connected to the control unit 11.

(28) Specifications for the control of the valve unit 7 and/or the fans 5, 6 are preferably stored or saved in the control unit 11. These specifications can in particular be at least partially adapted by the user and/or a caregiver. The control unit 11 comprises, for example, at least one controller and/or other control components.

(29) The valve unit 7 is shown here in the first valve position 17. In this case, the first fan 5 is connected on its intake side 15 to the respiratory air interface 4. The first fan 5 can thus draw in air from the surroundings of the device 1 and provide it as the respiratory airflow for the insufflation at the patient interface 3. From there, the respiratory airflow can then be blown via the hose unit 200 and the patient interface 204 into the patient for insufflation.

(30) The second fan 6 can be activated or also deactivated in the first valve position 17. Since the second fan 6 is blocked in relation to the respiratory air interface 4 in the first valve position 17, no undesired exsufflation occurs during the provided insufflation even upon operation of the fan 6. The second fan 6 can thus already be ramped up to a particularly favorable speed for the imminent exsufflation during the insufflation.

(31) This advantage is also provided in the second valve position 27. The first fan 5 can then be brought to a desired speed without impairing the exsufflation carried out using the second fan 6.

(32) In the second valve position 27, the delivery side 26 of the second fan 6 is connected here to the respiratory air interface 4. The second fan 6 can draw air out of the patient via the patient interface 3 and the hose unit 200 coupled thereon and also the patient interface 204 during the exsufflation. The second fan 6 then blows out the drawn-out air via the respiratory air interface 4 in the surroundings of the device 1.

(33) In the third valve position 37, neither of the fans 5, 6 is connected here to the respiratory air interface 4 and/or both fans 5, 6 are blocked.

(34) The respiratory therapy device 1 is shown with an alternatively embodied patient interface 3 in FIG. 2. The patient interface 3 is equipped here with a coupling unit 13, to which a hose unit 200 having two hoses is connectable.

(35) For this purpose, the hose unit 200 is equipped here with an inhalation hose 201 and an exhalation hose 202, which are coupled to the patient interface 204. The inhalation hose 201 is coupled here to the first fan 5, so that the respiratory airflow for the insufflation can flow via this. The exhalation hose 202 is coupled here to the second fan 6, so that the respiratory airflow for the exsufflation can flow via this. For example, the patient interface 104 comprises a patient-proximal Y-piece. The two hoses 201, 202 can be connected there.

(36) Such a two-hose system can also be used particularly well for the respiration. This is particularly advantageous if the respiratory therapy device 1 is also equipped with a respiration unit 9. This is also particularly advantageous if the CO2-rich exhaled air is not to be inhaled again.

(37) Such an embodiment of the respiratory therapy device 1 having a two-hose system is particularly advantageous in this aspect: to conduct the respiratory air during an insufflation/inhalation toward the patient through the hose connection 201 and during an exsufflation/exhalation away from the patient through the hose connection 202, almost no CO2-rich respiratory air is inhaled again. The integrated valve unit alone controls the flow direction and through flow of the hose connections as a function of the breathing phases in this case, without an additional patient valve having to be used. This is a particular advantage of the invention, which results in particular due to the two fans connected in parallel and/or the switchable valve unit coupled thereon.

(38) FIG. 3 shows an alternative embodiment of the respiratory therapy device 1. The valve unit 7 is arranged here between the fans 5, 6 and the patient interface 3. In this case, the intake side 15 of the first fan 5 is connected to the valve unit 7. The delivery side 25 of the first fan 5 is connected here to an air outlet 24 of the respiratory air interface 4. Thus, either the first fan 5 or the second fan 6 can be connected to the patient interface 3 by means of the valve unit 7.

(39) The second fan 6 is connected with its delivery side 26 to the valve unit 7. The intake side 16 of the second fan 6 is connected here to an air inlet 14 of the respiratory air interface 4. While two of the fittings 97 are thus coupled to the fans 5, 6, the third fitting 97 is connected here to the patient interface 3.

(40) The valve unit 7 is located here in the second valve position 27. In this case, the second fan 6 is connected to the patient interface 3. The fan 6 can thus draw in the air via the air inlet 14 and blow it via the patient interface 3 and the hose unit connected thereto and/or the patient interface 204 into the patient for the insufflation. The first fan 5 is blocked off in relation to the patient interface 3 in this valve position 27.

(41) In the second valve position 27, the first fan 5 can be operated further, without undesired exsufflation occurring. The first fan 5 can thus already be ramped up to an optimum speed, which is required for the next exsufflation, during the insufflation, for example.

(42) In the first valve position 17, the first fan 5 is connected here to the patient interface 3. The second fan 6 is then blocked off from the patient interface 3. The first fan 5 then generates a respiratory airflow for the exsufflation and draws air via the patient interface 3 and/or the hose unit 200 and the patient interface 204 out of the patient for this purpose. The first fan 5 blows out the air via the air outlet 24 from the device 1 into the surroundings. The first valve position 17 enables an adaptation of the speed of the second fan 6, without unfavorably impairing the exsufflation.

(43) FIG. 4 shows an embodiment of the valve unit 7 as a rotary slide valve 67. The rotary slide valve 67 is a 3/3-directional valve 47 here and can be used as a proportional valve 57.

(44) The rotary slide valve 67 comprises three fittings 97 here and can be moved into three valve positions. The valve positions correspond, for example, to the valve positions 17, 27, 37 shown in FIG. 1 or FIG. 3. Thus, either the first fan 5 or the second fan 6 can be connected to the respiratory air interface 4 and/or the patient interface 3 using the valve unit 7.

(45) A rotatable valve piston 117 is provided here for switching the valve positions, which is moved by means of a drive unit 107 into the respective position. For better illustration of the rotating piston 117, the valve unit 7 is shown partially transparent here.

(46) The rotary slide valve 67 shown here can be used, for example, in the flow unit 2 described with reference to FIG. 1.

(47) The intake side 15 of the first fan 5 is then connected to a first fitting 701. The delivery side 26 of the second fan 6 is connected to a second fitting 702. The respiratory air interface 4 is connected with the air inlet 14 or the air outlet 24 to a third fitting 703. Thus, either the first fan 5 or the second fan 6 can be connected to the respiratory air interface 4 by rotating the valve piston 117.

(48) In the position of the valve piston 117 shown here, the first fan 5 is switched in, so that an insufflation can occur. If the valve piston 117 is rotated accordingly, the second fan 6 can blow out the air via the respiratory air interface 4, so that an exsufflation is possible. The respiratory airflow for the insufflation is indicated here by two arrows having solid lines. The respiratory airflow for the exsufflation is indicated here by dashed arrows.

(49) If the rotary slide valve 67 shown here is used in the flow unit 2 according to FIG. 3, the assignment of the fittings 97 changes accordingly. The delivery side 25 of the first fan 5 is then connected to the first fitting 701. In the setting shown here of the valve piston 117, an exsufflation is then provided. The intake side 16 of the second fan 6 is then connected to the second fitting 702. The patient interface 3 is connected to the third fitting 703.

(50) The functioning of the valve unit 7 shown in FIG. 4 is explained by way of detail hereafter. For this purpose, various valve positions are shown in FIGS. 5 to 9. The valve unit 7 is shown in a sectional front view looking toward the valve piston 117.

(51) The rotary slide valve 67 shown here can assume various intermediate positions 77, 87 having different degrees of opening by pivoting the valve piston 117 in the first and second valve positions 17, 27. In this case, arbitrary and/or discrete intermediate positions are possible. Continuous and/or fixedly specified intermediate positions can also be provided. The valve unit 7 can thus assume intermediate positions for the insufflation and exsufflation, in which the flow is reduced accordingly by a cross-sectional reduction of the flow path.

(52) FIG. 5 and FIG. 6 show the valve unit 7 in the first valve position 17. In this case, the valve unit 7 of FIG. 5 is shown in a completely open valve position 77 and in FIG. 6 it is shown in a partially closed valve position 87.

(53) FIG. 7 shows the valve unit 7 in the third valve position 37. The fittings 97 are blocked here.

(54) In FIG. 8 and FIG. 9, the valve unit 7 is shown in the second valve position 27. In this case, FIG. 8 shows a partially open valve position 87 and FIG. 9 shows a completely open valve position 77.

(55) If the valve unit 7 shown here is used in the flow unit 2 described with reference to FIG. 1, the intake side 15 of the first fan 5 is connected to the first fitting 701. The delivery side 96 of the second fan is connected to the second fitting 702. The respiratory air interface 4 is connected to the third fitting 703.

(56) A maximum flow for the insufflation can then be achieved with the completely open valve position 77 of FIG. 5. The flow path between the first fan 5 and the respiratory air interface 4 is maximally enabled here.

(57) The only partially open valve position 87 of FIG. 6 enables a correspondingly reduced flow for the insufflation. The flow path between the first fan 5 and the respiratory air interface 4 is intentionally restricted here.

(58) In the third valve position 37 shown in FIG. 7, neither an insufflation nor an exsufflation takes place. Both fans 5, 6 are separated from the respiratory air interface 4.

(59) The partially open valve position 87 in the second valve position 27 shown in FIG. 8 enables a restricted or reduced exsufflation. The flow path between second fan 6 and the respiratory air interface 4 is only partially enabled here.

(60) The connection between second fan 6 and respiratory air interface 4 is maximally enabled in FIG. 9, so that a maximum respiratory airflow can be set for the exsufflation.

(61) In the event of an integration of the rotary slide valve 67 into the flow unit 2 described in FIG. 3, the connection of the fittings 701, 702, 703 is modified accordingly as per the interconnection shown in FIG. 3.

(62) The rotary slide valve 67 presented here can also be used for the targeted generation of an oscillation of pressure and/or flow of the respiratory airflow. For this purpose, the valve piston 117 is pivoted between various settings at a predefined or settable frequency.

(63) The valve positions shown in FIG. 5 to FIG. 8 can be assumed, for example, to generate an oscillation during the insufflation.

(64) For example, firstly the completely open valve position 77 shown in FIG. 5 is provided. Thus, initially a maximum possible positive pressure or maximum possible flow is provided during the insufflation. Subsequently, the valve piston 117 is pivoted into the partially open valve position 87 shown in FIG. 6. A targeted reduction of the pressure or flow thus occurs during the insufflation.

(65) Subsequently, the valve piston 117 is moved into the closed valve position 37 shown in FIG. 7. A respiratory airflow having a flow of essentially zero thus results during the insufflation. The pressure applied to the patient interface 204 can sink to a level in this case, for example, which is essentially determined by the degree of lung filling.

(66) Subsequently, the valve piston 117 is pivoted into the partially open valve position 87 of the second valve position 27 shown in FIG. 8. The delivery side 26 of the second fan 6 provided for the exsufflation is thus switched in. A desired short-term reduction of the pressure with a flow reversal during the oscillation thus occurs in this setting.

(67) A directional reversal of the rotational movement of the valve piston 117 preferably now follows. In this case, the valve piston 117 is rotated back into the above-described settings in reverse sequence, until the completely open valve position 77 of the first valve position 17 is reached in FIG. 5.

(68) The above-described valve movement then takes place again. The repetition rate can be, for example, between 1 Hz and 30 Hz in this case.

(69) The generation of an oscillation during the exsufflation can be achieved, for example, by the valve positions shown in FIG. 6 to FIG. 9.

(70) For example, the valve piston 117 is firstly arranged in the completely open valve position 77 of the second valve position shown in FIG. 9. This enables an exsufflation with a maximum possible negative pressure and/or a maximum flow for the exsufflation.

(71) The valve body 117 is subsequently pivoted into the only partially open valve position 87 of FIG. 8. The flow is thus intentionally reduced during the exsufflation.

(72) The valve piston 117 is then moved into the third valve position 37 of FIG. 7. The flow paths for exsufflation and insufflation are then completely closed. The flow is substantially zero. The pressure applied to the patient interface 204 can rise to a level, for example, which is essentially determined by the degree of lung filling.

(73) The valve piston 117 is subsequently pivoted into the partially open valve position 87 of the first valve position 17, as shown in FIG. 6. The intake side 15 of the first fan 5 is thus intentionally switched in during the exsufflation. A desired short-term increase of the pressure with a corresponding flow reversal thus occurs during the oscillation.

(74) The valve piston 117 is subsequently pivoted back again via the above-described positions in reverse sequence.

(75) If the valve piston 117 reaches the position shown in FIG. 9, the rotational movement begins from the beginning during the exsufflation. The reversal of the rotational movement preferably also takes place at a frequency of 1 Hz to 30 Hz.

(76) The rotational movement during the oscillation preferably takes place between an end position fully open and at least partially closed. The rotational movement during the oscillation can also occur between the two end positions each fully open, however. The rotational movement during the oscillation preferably occurs between the end positions fully open for one flow direction and partially open in the other flow direction. A greater dissipation of the pressure can thus be ensured during the insufflation, for example. The specifications of the rotational direction relate in this case in particular to one flow direction. Moreover, an end position is understood in particular as an effective end position. The effective end position can correspond to a stop. The effective end position can be independent of an end stop, for example, in a valve without stop or a 360° valve.

(77) Valve positions other than those shown here can also be provided for the oscillation during the insufflation and/or exsufflation.

(78) FIG. 10 shows an example of a pressure curve as can be provided during a usage of the respiratory therapy device 1. For this purpose, the pressure 301 was plotted against the time 302.

(79) During the insufflation 304, a correspondingly high pressure 301 is provided for a defined time. For a particularly effective stimulation of the coughing reflex and/or for particularly effective detaching of the secretion, it then switches over very briefly to the exsufflation 305. For this purpose, the pressure 301 is lowered within a defined time span to a correspondingly negative level and kept there for a specific duration.

(80) A renewed increase of the pressure to the desired level for the insufflation can then be performed, for example. A very rapid reduction of the pressure 301 is subsequently performed again for the exsufflation. This alternation between insufflation and exsufflation can be repeated for a desired time span. For example, the number of the repetitions and/or the frequency of the repetitions can be specified by a user and/or caregiver.

(81) In the curve shown here, a pause 306 is provided after the exsufflation 305. This offers a great relief to the patient, since the coughing processes require a substantial physical exertion. The pressure curve shown here has a slight overpressure or a positive therapy pressure during the pause 306. The exhalation against such a slight, intentional overpressure is particularly reasonable for respiratory therapy. The overpressure can be formed, for example, as a constant positive pressure (CPAP).

(82) The pressure is between 4 and 30 mbar, for example. In contrast, a pressure in the range of approximately +/−70 mbar or even higher can be set for the exsufflation and/or insufflation. In the pause, substantially smaller flows typically result in the scope of inhalation and exhalation in comparison to the insufflation or exsufflation.

(83) A respiration can also be provided in the pause. The respiration unit 9 is then active in particular. For example, a pressure up to approximately 50 mbar and in particular between 10-35 mbar is then provided for the respiration or inspiration.

(84) The drop of the pressure 301 at the transition from insufflation to exsufflation preferably occurs here by way of correspondingly rapid switching over of the valve unit 7. The speed of the fan 6 for the exsufflation is preferably adapted accordingly even before the switching procedure of the valve unit 7. However, this is not necessary according to the invention.

(85) The rise of the pressure 301 from the exsufflation to the next insufflation or after a pause toward the following insufflation preferably occurs less rapidly or over a longer time span. The pressure rise can be performed by a correspondingly cautious ramping up of the corresponding fan 5, 6, in addition to the change of the valve position.

(86) The increase of the pressure 301 in preparation for the pause 306 is also performed here by a correspondingly slow speed increase of the fan 5.

(87) FIG. 11 shows an example of a coughing maneuver having a subsequent pause 306. For this purpose, the pressure 301 was plotted against the time 302 in the upper graphic. In the middle graphic, a speed 307 of the first fan 5 was plotted by way of example and in very idealized form against the time 302. In the lower graphic, a speed 307 of the second fan 6 was plotted by way of example and in very idealized form against the time 302. The vertically extending, dashed lines very schematically indicate switching over of the valve position in this case.

(88) At the beginning of the maneuver, the valve unit 7 is moved into the valve position for the insufflation. According to the embodiment shown in FIG. 1, the first valve position 17 is assumed for this purpose, so that the first fan 5 is switched in.

(89) The speed 307 of the first fan 5 is then increased slowly over a defined time. The pressure 301 increases accordingly. After reaching the pressure 301 required for the insufflation, the speed 307 is maintained.

(90) After a specific time, the change takes place from the insufflation 304 to exsufflation 305. The change occurs particularly rapidly here for an effective triggering of the coughing reflex and/or for a particularly effective assistance of the secretion removal. For this purpose, the valve unit 7 is switched into the second valve position 27. The pressure 301 drops accordingly over a very short time span. The negative pressure 101 necessary for the exsufflation 305 is reached.

(91) To be able to enable the pressure transition particularly rapidly, the speed 307 of the second fan 6 was increased to the required amount already before the switching in. The pressure 301 and the speed 107 for the exsufflation 305 are now maintained for a predetermined time 102. The second fan 6 thus reaches its target operating range before the switchover into the exsufflation phase.

(92) A switchover of the valve unit 7 into the first valve position subsequently takes place again. The first fan 5 is thus switched in again. After the switching in, the speed 307 of the first fan 5 is increased enough that a correspondingly lighter overpressure suitable for the respiration during the pause 306 is provided. The first fan 5 thus accelerates during the pressure buildup or to generate the pressure curve. The second fan 6 is now no longer switched in, so that its speed 107 can be reduced accordingly.

(93) After the end of the pause 306, an increase of the speed 107 of the first fan 5 can again take place, to reach the pressure 301 required for the insufflation 304. The coughing maneuver can now begin from the beginning.

(94) Overall, the invention presented here offers the advantage that a particularly patient-friendly and also effective coughing machine is provided. Moreover, the invention offers the advantage that substantially improved respiration is also possible. A particularly gentle assistance during the secretion removal can thus take place during the respiration, for example, by the patient being assisted in an exhalation phase using a negative therapy pressure. The invention can particularly advantageously be used in this case with a two-hose system.

(95) A further advantage is that the respiration can take place alone or also in combination with a coughing and/or secretion therapy. For example, a pause takes place during a coughing and/or secretion therapy, in which a positive therapy pressure is used to relieve the patient. A respiration of the patient can also take place in the pause.

(96) TABLE-US-00001 List of reference numerals: 1 respiratory therapy device 2 flow unit 3 patient interface 4 respiratory air interface 5 fan 6 fan 7 valve unit 8 oscillator unit 9 respiration unit 10 coughing device 11 control unit 13 coupling unit 14 air inlet 15 intake side 16 intake side 17 valve position 24 air outlet 25 delivery side 26 delivery side 27 valve position 34 opening 37 valve position 47 directional valve 57 proportional valve 67 rotary slide valve 77 valve position 87 valve position 97 fitting 107 drive 117 valve piston 200 hose unit 201 inhalation hose 202 exhalation hose 203 patient valve 204 patient interface 301 pressure 302 time 303 oscillation 304 insufflation 305 exsufflation 306 pause 307 speed 701 fitting 702 fitting 703 fitting