NL2002225C2

NL2002225C2 - Apparatus and system for monitoring breathing or ventilation, defibrillator device, apparatus and system for monitoring chest compressions, valve apparatus.

Info

Publication number: NL2002225C2
Application number: NL2002225A
Authority: NL
Inventors: Gerardus Wilhelmus Lugtigheid
Original assignee: Emergency Pulmonary Care B V
Priority date: 2008-11-19
Filing date: 2008-11-19
Publication date: 2010-05-21
Also published as: WO2010059049A3; WO2010059049A2

Description

P86849NL00

Title: Apparatus and system for monitoring breathing or ventilation, defibrillator device, apparatus and system for monitoring chest compressions, valve apparatus

The present invention relates to an apparatus for monitoring breathing or ventilation, particularly during resuscitation.

The invention also relates to a system comprising such an apparatus and a defibrillator.

5 Furthermore the invention relates to a system comprising such an apparatus and a chest fixation device.

Furthermore, the invention relates to a defibrillator device.

Devices for monitoring ventilation during resuscitation are e.g. known from US 6,155,257, describing a cardiopulmonary ventilator comprising 10 a chest compression sensor that is coupled to a controller, which actuates the ventilator after a certain number of compressions. The disadvantage of such a system is that it does not in any way monitor the effect of the cardiopulmonary resuscitation and it does not give any feedback to the user.

The apparatus of the present invention may be interfaced with 15 several different medical devices to monitor and control the effectiveness of mechanical or manual ventilation of the patient, particularly during resuscitation and/or signal the user in case of inadequate ventilation and/or intervene in the case of risk to the patient. The apparatus of the present invention may e.g. be interfaced with a manual ventilator or a mechanical 20 ventilator and/or a defibrillator such as an Automatic External Defibrillator (“AED”) and/or a cardiopulmonary resuscitation (“CPR”) device provided with a load distributing band for delivering mechanical chest compressions., also referred to as “Auto CPR”.

During a CPR procedure a defibrillator, in particular an AED, 25 provides unambiguous feedback and instructions. Existing ventilation 2 equipment however, particularly manual ventilation devices such as a resuscitator or a respirator lack such feedback and instructions, due to the fact that no relevant parameters are measured. As a result the skill and stress level of the operator determine the flow rate and pressure achieved during 5 manual ventilation and a much less controlled flow of gas is delivered into a patient’s airway than in the case of a mechanical ventilator. Thus there is a need for improved control during pulmonary resuscitation.

An object of the present invention is to provide an apparatus that improves the effectiveness of the breathing or ventilation, and/or intervenes in 10 the case of inadequate breathing or ventilation. Another object of the present invention is to synchronize mechanical ventilation and chest compressions during CPR. A further object of the present invention is to provide a control algorithm for breathing or ventilation.

To that effect the invention provides an apparatus for monitoring 15 breathing or ventilation of a patient during resuscitation, comprising ventilation detecting means for detecting values of ventilation parameters such as an airway pressure level, and/or an airway CO2 level and comprising processing means for processing detected values, wherein the apparatus is arranged to signal the detected values of the ventilation parameters.

20 By providing ventilation detection means, the apparatus monitors and compares different control parameters during breathing or ventilation particularly during resuscitation. By providing processing means the apparatus gives feedback to the operator with respect to the effectiveness of the breathing or ventilation, and/or intervenes in the case of inadequate 25 breathing or ventilation.

By providing drive means for automatically driving the apparatus, the processing means may give feedback to the drive means to automatically driving the apparatus to resuscitate the patient depending on a detected value of a ventilation parameter, and thus depending on the effectiveness of the 30 breathing or ventilation. By providing an automatic ventilation apparatus, the 3 operator may focus more on the overall condition of the patient, e.g. on medication and/or injuries. An automatic ventilation apparatus may be used as well as in hospital care as in emergency care situations.

The apparatus according to the invention may be provided with 5 ventilation detecting means for detecting values of ventilation parameters, such as airway pressure level, airway CO2 level, oxygen saturation and/or respiratory flow. Also, the apparatus according to the invention may be provided with cardiac detecting means for detecting values of cardiac parameters, such as blood pressure, pulse or thoracic impedance. Other 10 ventilation and/or cardiac parameters may also be detected. The values of the ventilation parameters may be used to determine a relatively optimal ventilation for automatically resuscitating a patient, and/or may be given as information to e.g. an operator of the ventilation apparatus. The values of the cardiac parameters may be used as information for e.g. an operator for giving 15 for example chest compressions, either manually or automatically via an external device.

By providing display means the values of the detected ventilation and/or cardiac parameters may be displayed to a user and/or a medical assistant. Also, instructions may be provided on the display means to a user 20 and/or a medical assistant for the treatment of the patient.

In an aspect of the invention, a system is provided comprising such an apparatus and further comprising a defibrillator, thus enabling a simultaneous treatment of the patient of the breathing or ventilation function and the heart function. Advantageously, the defibrillator is an automatic 25 defibrillator which may be coupled to the apparatus and thus may be provided with the detected values for cardiac parameters for automatically defibrillating a patient.

In another aspect of the invention, a system is provided comprising such a ventilation apparatus and further comprising a chest fixation device, 30 wherein the processing means of the apparatus are arranged for processing 4 detected values of cardiac parameters and ventilation parameters for providing internal chest compression via automatic resuscitating of the patient.

Preferably, patient breathing or ventilation is synchronized with patient chest compression. By providing a chest fixation device, e.g. a chest 5 band arranged around the chest of a patient, the volume of the chest of the patient is approximately fixated. By providing automatic resuscitation of the patient, the lungs of the patient may be expanded and contracted regularly. Due to the chest fixation, the outer volume of the chest may not expand more and thus the expanding lungs are pressing against the heart, resulting in 10 internal chest compression, thereby providing a heart massage. The effect of such an internal chest compression may approximately be similar to an external chest compression, e.g. provided manually or via an automatically contracting chest belt. However, by providing an internal chest compression, an operator and/or a medical assistant can focus more on the condition of the 15 patient, such as medication or injuries. The ventilation apparatus may be coupled to the patient via a masque or via a tube in the airway.

Preferably the apparatus according to the present invention is provided with means for monitoring breathing or ventilation of a patient, having for example an airway pressure and/or an airway CO2 level monitor 20 that signals the occurrence of low CO2 levels during expiration. The apparatus of the invention is provided with various means for detecting and/or collecting data, in particular pressure data and CO2 data, and provided with microprocessors for storing and processing said data. The apparatus of the invention is further provided with means for displaying and/or signalling 25 information. Signalling may e.g. take place by giving an alarm to the user, by suggesting an action to be taken to the user, or by sending a control signal to a control device to take controlling action. Preferably the apparatus of the invention is interfaced with a defibrillator, such as an AED and/or a CPR device provided with a load distributing band for delivering mechanical chest 30 compressions (Auto CPR).

5

The apparatus may be provided with means for detecting and/or collecting data regarding the pressure and/or flow in the patient’s airway. A relatively high airway pressure at a relatively low flow during inspiration is a measure for the presence of obstructions in the airway, whereas a relatively 5 low pressure at a relatively high flow indicates the presence of leaks. In addition the apparatus may be provided with means for detecting and/or collecting data regarding the CO2 concentration level in the patient’s airway. A change in the maximum CO2 concentration level during expiration is a measure for the perfusion. In addition the apparatus may be provided with 10 means for detecting and/or collecting data regarding respiratory flow in the airway. Furthermore the apparatus may be provided with means for detecting and/or collecting data regarding oxygen saturation including the pulsation pattern thereof in the patient.

Oxygen saturation is a measure for the effectiveness of breathing or 15 ventilation. The oxygen saturation level during a CPR procedure may be used as an additional control signal for the defibrillator. Following the administration of an electric shock by a defibrillator, the heart of a patient requires sufficient blood and oxygen to maintain or resume a normal rhythm. Therefore, a minimum oxygen saturation level may be defined, from which the 20 administration of an electric shock may be effective.

From the pulsation pattern, the cardiac output may be derived, which is a direct measure for the effectiveness of chest compressions. The apparatus may further be provided with a means for detecting and/or collecting data regarding the electric activity of the heart and thus the heart 25 function, such as a set of electrodes normally used by the defibrillator to measure an electrocardiogram (“ECG”).

Further means for detecting and/or collecting data and/or parameters other than previously mentioned may be provided as the operator may think fit.

6

The invention also provides for a defibrillator device, comprising cardiac detecting means for detecting values of cardiac parameters, further comprising ventilation detection means for detecting values of ventilation parameters, such as an airway pressure level and/or an airway CO2 level, 5 further comprising processing means for processing detected values of the detected cardiac and ventilation parameters, wherein the defibrillator device is arranged to signal the detected values of the cardiac parameters and ventilation parameters. By providing a defibrillator device that also may detect ventilation parameters, the defibrillator device may also give 10 information and/or instructions about the breathing or ventilation of the patient. In an advantageous embodiment, the defibrillator device may control an automatic ventilation apparatus. An automatic ventilation apparatus may also be combined with a CPR or with pacing of the heart for heart massage or heart frequency adjustment respectively, 15 In an embodiment, by signalling the occurrence of low CO2 levels during expiration, an AED can also be used to provide feedback and instructions on pulmonary resuscitation. Preferably, such an AED is arranged to monitor respiratory flow. This way, the respiratory minute volume of the patient can be monitored and compared with a target.

20 The invention also provides for a defibrillator device that is arranged to monitor oxygen saturation level and pulsation and to derive blood pressure information there from. This way, feedback may be provided on the ventilation effectiveness or the patient's respiratory movement.

According to an aspect of the invention a valve apparatus is provided 25 comprising a valve housing with an inspiration chamber and an evacuation chamber, wherein the valve housing comprises a combined fresh gas inlet with an gas evacuation outlet, wherein the fresh gas inlet comprises a valve which is open in a first position to allow fresh gas to flow to the inspiration chamber and to close off the evacuation chamber during inspiration and which is closed 30 in a second position to close off the fresh gas inlet for coupling the inspiration 7 chamber to the evacuation outlet during expiration for creating a negative pressure in the valve apparatus during expiration.

By providing a valve in the fresh gas inlet, the evacuation chamber may be closed off from the inspiration chamber during inspiration. Also, by 5 providing the valve in the fresh gas inlet, the inspiration chamber may be coupled to the evacuation chamber and thus to the evacuation outlet. By coupling the inspiration chamber to the evacuation outlet, the inspiration chamber empties and a negative pressure may be created in the valve housing during expiration. The patient is provided with a negative pressure during 10 expiration, which may help the expiration of the patient, thus providing an active expiration to the patient. The expiration of the patient may thus be faster and/or deeper. Also, during the expiration phase, more blood may flow to the heart due to a deep expiration, giving a beneficial effect for the heart function, 15 Preferably, during inspiration there is an excess pressure of approximately 20 hPa or more in the valve housing and thus on the patient. Preferably, during expiration, in particular at the beginning of the expiration, there is a negative pressure of approximately 10 hPa or less in the valve housing and thus on the patient, to facilitate expiration of the patient. At the 20 end of the expiration, the pressure is approximately zero. The pressure in the valve housing may be built up again during inspiration.

By providing a fresh gas inlet which is coaxially combined with the gas evacuation outlet, a compact connection may be provided for fresh gas and evacuation gas, thus reducing the number of connection cables.

25 In an embodiment, the valve apparatus may be provided with various sensors for detecting and/or measuring ventilation parameters. The values of these parameters may further be processed by processing means and may be signalled to the operator to give information and/or feedback to the operator. Also, the values may be provided to a control unit for controlling 30 drive means for automatically driving the ventilation apparatus.

8

In an embodiment the valve apparatus may be a Pmax valve apparatus, i.e. a valve apparatus with a maximum pressure level. In an other embodiment, the valve apparatus may be an adjustable valve apparatus, i.e. a valve apparatus of which the pressure level may be varied. Also, different 5 embodiments of a valve apparatus that is arranged to provide a negative expiration pressure at the beginning of an expiration may be possible.

Further advantageous embodiments are given in the dependent claims.

The invention will be further explained using graphs and examples 10 of preferred embodiments.

Fig. 1 shows a control apparatus according to the present invention in a typical manual CPR setup.

Fig. 2 shows a apparatus according to the present invention in a typical mechanical CPR setup.

15 Fig. 3 shows a typical set of curves for sensed pressure, C02, impedance and pulsation.

Fig. 4 shows an algorithm for controlled manual CPR to be used in the control apparatus according to the present invention.

Fig. 5 shows an algorithm for controlled mechanical CPR to be used 20 in the control apparatus according to the present invention.

Fig. 6 shows a valve apparatus according to the invention during inspiration (Fig. 6a) and expiration (Fig. 6b).

Referring to Fig. 1, a typical manual CPR setup comprises a face mask 1, which is provided with a pressure transducer 11 that is connected to 25 the control apparatus 2, which in turn is connected to an Automatic External Defibrillator AED 3. The face mask may be used with a resuscitation bag 4 as shown in Fig. 1. Alternatively a resuscitation bellows may be used, which provides a constant volume of air when fully squeezed. Preferably the face mask is provided with straps that may be fitted around the head of the 30 patient, such that the face mask may be secured airtight over the nose and 9 mouth of the patient. The pressure transducer measures the pressure in the airway passage from the resuscitator to the patient. It provides a measure of the actual pressure achieved in the airway of the patient during breathing or pulmonary resuscitation. The face mask is further provided with a CO2 sensor 5 12, which may comprise, for example, an infrared source and a detector. Other forms of CO2 detection may be substituted as well. This sensor may be provided in the passage from the resuscitator to the airway of the patient, in which case the CO2 level is measured and displayed without delay.

Alternatively the sensor may be provided in a separate sensor unit 10 connected to the passage through a relatively long sampling line that samples a small stream of gas to the sensor unit, in which case the CO2 level is measured and displayed with a known delay, which is related to the length and diameter of the sampling line. The control apparatus 2 is further provided with a pulsation sensor 13, which may be attached to the forehead of a patient 15 using a headband. Alternatively the pulsation sensor 13 may be clamped to the earlobe or nose of the patient.

The setup of fig.l may be used by a lay person with training skills in Basic Life Support (BLS). The single adaptation to the BLS procedure is to place the face mask over nose and mouth of the patient, to fit the straps 20 around the head of the patient and to attach the pulsation sensor.

The AED gives instructions and/or information to the user concerning the CPR. The AED may also give information and/or instructions to the user concerning the ventilation of the patient depending on the detected values of the pressure sensor 11 and/or the CO2 sensor 12.

25 Referring to Fig. 2, a typical mechanical CPR setup comprises a face mask 1 provided with pressure sensor 11 and CO2 sensor 12 that is connected to the control apparatus 2 in a similar way as explained in fig.l. The face mask 1 may be used with a flow generator 5, which is also connected to the control apparatus 2. Furthermore a load distributing band 6 is connected to the 30 control apparatus 2 for providing mechanical chest compressions. The setup of 10 fig. 2 may be used for example by paramedics of the emergency medical services. The two adaptations to the Advanced Life Support procedure are: 1) to place the face mask over nose and mouth of the patient, to fit the straps and attach the pulsation sensor, and 2) to attach the load distributing band to the 5 patient. The control apparatus 2 then synchronizes inspiration and chest compression in a ratio of 1:1.

Depending on the collected data of the ventilation parameters, the control unit 2 controls the flow generator 5 for providing the patient with fresh air via the mask 11. The flow generator 5 may be the drive means that drive 10 the ventilation apparatus for resuscitating the patient controlled automatically by the control unit 2.

The control unit 2 may also control the defibrillator device for automatically providing compressions to the patient’s chest. Thereto, the patient may be provided with a chest band 6 that may contract, whereby the 15 contractions are controlled by the control unit, depending on values detected of cardiac parameters, such as pulse determined by the pulsation sensor 13.

Alternatively, a fixed chest band may be provided avoiding the volume of the chest to be expanded. Due to e.g. automatic ventilation, the lungs of the patient may be expanded and contracted. Expansion of the chest 20 may not be possible because of the fixed chest band thereby giving an internal chest compression and a pressing of the lungs against the heart, resulting in a heart massage that is synchronous with the ventilation of the patient. When an automatic ventilation apparatus is used in combination with a fixed chest band, an operator may focus more on other aspects of the condition of the 25 patients, e.g. medication or injuries. Heart massage and ventilation of the patient are thus provided simultaneously.

The control apparatus 2 may have a wireless connection (not shown) with an emergency department of a hospital, for transmitting data thereto and for receiving feedback from emergency medicine physicians based there.

11

Also, the ventilation apparatus of Fig. 1 may be driven automatically be a flow generator and controlled automatically by the control unit, similar to the embodiment of Fig. 2.

Referring to Fig. 3, a typical output of the various sensors during 5 pulmonary resuscitation using a CPR setup as displayed in Fig. 1 comprises an airway pressure curve 1, a ventilation flow curve 2, a CO2 curve 3 and a pulsation-saturation curve 4. Inspiration and expiration are clearly distinguished phases in the airway pressure curve 1, also showing the maximum pressure exerted on the airway during inspiration and the residual 10 pressure that is retained in the airway and lungs of the patient after expiration. This situation, where a residual pressure keeps the alveoli open and prolongs the exchange of gases, helps to improve oxygen saturation and is referred to as positive end expiration pressure or PEEP. Maximum pressure and PEEP are important control parameters during pulmonary resuscitation, 15 particularly in the case of near-drowning.

Referring to Fig. 4, a typical control algorithm for manual CPR comprises the steps of: - sensing an airway pressure and a ventilation flow and plotting a pressure and flow curve; 20 - a control loop for recognising and treating leaks; - a control loop for recognising and treating airway obstructions; - sensing an airway CO2 level and plotting a CO2 curve; - a control loop for recognising and treating low perfusion; - sensing oxygen saturation and pulsation and plotting a saturation and 25 pulsation curve; - a control loop for recognising and treating ineffective compression

The pressure curve plotted from recorded pressure data displays the inspiration pressure and PEEP level achieved during ventilation and by comparing the achieved levels with standard settings, the control apparatus 30 determines deviations e.g. too low or too high pressure levels, which may be 12 due to obstructions, such as vomit or blood clots, or leakage, and signals these deviations to the operator. Subsequently, the control apparatus instructs the operator to take specific actions to treat the probable causes of these deviations and restore normal ventilation.

5 The CO2 curve plotted from recorded CO2 data displays the CO2 level achieved during inspiration and expiration and by comparing the achieved levels with standard settings, the control apparatus may signal the operator in case the achieved values deviate from the standard, in particular too low concentration levels, which may be due to inadequate lung perfusion or 10 insufflations of the stomach. Subsequently the control apparatus instructs the operator to take specific actions such as the instruction to insert a tube into the patient’s throat to treat the probable causes of these deviations and restore normal perfusion.

The pulsation and oxygen saturation curve plotted from recorded 15 pulsation and saturation data displays the venous pressure level achieved and the oxygen saturation level achieved, and by comparing the achieved levels with standard settings, the control apparatus may signal the operator in case the achieved values deviate from the standard, which may be due to ineffective compression of the patient’s chest. Subsequently the control apparatus 20 instructs the operator to take specific actions to treat the probable causes of these deviations.

The thoracic impedance curve plotted from recorded thoracic impedance data, displays the variation in the thoracic cavity and thus the volume of the lungs and by comparing the achieved levels with standard 25 settings, the control apparatus may signal the operator in case the achieved values deviate from the standard, which may be due to ineffective ventilation. Subsequently the control apparatus instructs the operator to take specific actions to treat the probable causes of these deviations.

Referring to Fig. 5, a typical control algorithm for mechanical CPR 30 comprises similar steps as referred to in Fig. 4, with an additional step in that 13 the thoracic impedance is compared with the pulsation curve. The control loop for recognising and treating ineffective ventilation is replaced by a control loop for synchronizing ventilation with chest compressions.

By providing the control apparatus with such extended control 5 algorithms containing the recognized and approved best practices of emergency medicine physicians and professional respiratory therapists, the situation is achieved that these best practices are embedded in the hardware and are thus available to all users of that hardware.

Fig. 6 shows a valve apparatus 100 according to the invention. The 10 valve apparatus 100 comprises a valve housing 110 with an inspiration chamber 101 and an evacuation chamber 102. A fresh gas flow inlet (FGF) 103 is connected to the inspiration chamber 101. An evacuation outlet 104 is connected to the evacuation chamber 102. In this embodiment, the fresh gas flow inlet 103 and the evacuation outlet 104 are combined coaxially, to provide 15 an efficient and elegant connection of the valve apparatus 100 to an evacuation line (not shown) and a fresh gas line (not shown).

The fresh gas flow inlet 103 is provided with a valve 105, which is in this embodiment provided as a duckbill valve. However, other types of valves may also be provided. During inspiration, as shown in Fig. 6a, the valve 105 is 20 open and provides for an open connection between the fresh gas flow inlet 103 and the inspiration chamber 102 to a patient connection 106. The evacuation chamber 102 is cut off from the inspiration ‘route’ via the valve 105. During inspiration, fresh gas is supplied under pressure to the patient. Preferably the pressure during inspiration is approximately 20 hPa or more in the valve 25 housing to enable a good inspiration by the patient.

During expiration, the valve 105 is closed and the fresh gas flow inlet 103 is closed off from the valve apparatus 100. Due to the closed valve 105, the inspiration chamber 101 is in fluid communication with the evacuation chamber 102 and the evacuation outlet 104. Air in the inspiration 30 chamber 101 will flow to the evacuation outlet 104. During expiration a 14 negative pressure may be in the valve housing 110, thereby facilitating expiration of the patient.

The valve apparatus may also be combined with a maximum pressure valve and/or with an adjustable pressure valve, and/or in other valve 5 apparatus applications. Also, in the valve housing, sensors may be provided to measure and/or detect values of ventilation parameters, such as airway pressure and/or CO2 content and/or oxygen saturation. The detected values of the ventilation parameters may be provided as information to an operator or as input to an automatic ventilation apparatus.

10 The invention is not limited to the preferred embodiments described herein. Within the context of the invention many variations are possible.

Claims

An apparatus for monitoring a patient's respiration during resuscitation comprising respiratory detection means for detecting values of respiratory parameters, such as an airway pressure level and / or an airway CO2 level, and comprising processing means for processing detected values, wherein the device is arranged to signal detected values of respiratory parameters.

2. Device as claimed in claim 1, further comprising driving means for automatically driving the device to resuscitate the patient depending on a detected value of a respiratory parameter.

Device according to claim 1 or 2, wherein the device signals the occurrence of a low CO2 level during patient exhalation.

4. Device as claimed in any of the foregoing claims, wherein the respiratory detection means comprise a pressure sensor for detecting an airway pressure level and / or a CO2 sensor for detecting a CO2 level.

5. Device as claimed in any of the foregoing claims, wherein the respiration detection means further comprise a heartbeat and / or oxygen saturation sensor.

Apparatus as claimed in any of the foregoing claims, wherein the respiration detection means are adapted to monitor the respiratory flow.

7. Device as claimed in any of the foregoing claims, further comprising a respiratory flow monitor.

Apparatus according to any one of the preceding claims, further comprising display means for displaying detected values of respiratory parameters.

9. Device as claimed in any of the foregoing claims, further comprising heart detection means for detecting heart parameters, such as heartbeat or blood pressure, wherein the processing means are further adapted to process detected values of heart parameters.

CO2 level, further comprising processing means for processing detected values of the detected cardiac and respiratory parameters, wherein the defibrillation device is adapted to signal detected values of a cardiac and / or respiratory parameter.

Apparatus as claimed in claim 9, wherein the display means are further adapted to signal low blood pressure.

Apparatus as claimed in claim 9 or 10, wherein the heart detection means are further adapted to monitor the heart output of an ECG signal and wherein the display means are further adapted to signal the occurrence of a low heart output.

12. Device as claimed in any of the claims 9-11, wherein the heart detection means are further adapted to detect heartbeat and / or breast impedance.

Apparatus according to any one of claims 9 to 12, wherein the display means are further adapted to display detected values of heart parameters.

A system comprising the device of any one of claims 1-13 and further comprising a defibrillator.

The system of claim 14, wherein the defibrillator is an automatic external defibrillator.

16. System comprising the automatic ventilation device as claimed in any of the claims 9-13, further comprising a breast-fixing device and wherein the processing means of the device are adapted to process detected values of heart parameters and breathing parameters for providing breast compression via automatic resuscitation of the patient.

The system of claim 16, wherein the processing means of the device are further adapted to synchronize patient respiration with patient chest compression.

A system according to claim 16 or 17, wherein the breast securing means 5 comprises a chest strap.

A defibrillation device, comprising heart detection means for detecting values of heart parameters, further comprising respiration detection means for detecting values of respiration parameters, such as an airway pressure level and / or an airway

The defibrillation device according to claim 19, wherein the defibrillation device is adapted to control an apparatus for monitoring respiration according to any of claims 1-7.

21. A defibrillation device as claimed in claim 19 or 20, adapted to monitor an oxygen saturation level and to determine a blood pressure therefrom.

A defibrillation device according to any of claims 19-21, adapted to monitor a breast impedance,

The defibrillation device of any one of claims 19 to 22, wherein the defibrillation device is an automatic external defibrillator.

A valve device comprising a valve housing with an inspiration chamber and an evacuation chamber, wherein the valve housing comprises a combined fresh gas inlet with a gas evacuation outlet, wherein the fresh gas inlet comprises a valve that is open in a first position to bring fresh gas to the inspiration chamber and to close the evacuation chamber during inspiration 30 and closed in a second position to close the fresh gas inlet for coupling the inspiration chamber to the evacuation outlet during expiration to create a negative pressure in the valve device during expiration.

25. Valve device according to claim 24, wherein the fresh gas inlet and the gas evacuation outlet are arranged coaxially.

The valve device of claim 24 or 25, wherein the valve device further comprises a patient connection.

The valve device of any one of claims 24 to 26, wherein the valve device comprises a pressure gauge.

Valve device according to any of claims 24 27, wherein the valve device comprises a Pmax valve device and / or a valve device with an adjustable pressure.

The valve device of any one of claims 24 to 28, wherein the valve is a duck bill valve.

The valve device of any one of claims 24 to 29, wherein the valve device is integrated into the head of a respiratory balloon.

31. Method for providing a negative pressure in a valve device during expiration, wherein an expiration chamber and an evacuation chamber are coupled to a gas evacuation outlet during expiration.