NL8402290A - Patient respiratory behaviour determining appts. - uses measuring sensor elements placed in contact amplitude of abdominal and costal respiration - Google Patents

Abstract

A frame consists of two brackets (1,2), placed parallel to each other, and connected by a rod (3) telescopically adjustable in length and which can be placed over a patient. A rod (5), fixed on each bracket, which projects downwards and on which a tube (6) can be adjusted vertically. Secured to each tube (6) is a measuring sensor (9,10) for determining the rhythm and aplitude of the abdominal respiration and the costal respiration respectively. A further measuring element (14), to be gripped by the patient, determines the evolution of the heart rate, and output signals may be simultaneously displayed and/or recorded from all measuring elements on the same time basis. The flow rate of blood from the legs, arms or head may also be determined.

Description

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Ν, Ο. 32635 X.

Device for determining the respiratory behavior of a patient.

The invention relates to a device for determining the respiratory behavior of a patient.

The natural breathing in the resting situation is the so-called abdominal breathing, also called full breathing at rest. Thereby the convex diaphragm contracts, making it flatter in the middle, while lifting the lower ribs on the sides. Due to the latter effect, the chest widens somewhat without any work of the outer intermediate rib muscles. If the abdominal muscles are somewhat relaxed at the beginning of breathing, the abdominal cavity will expand slightly due to the higher pressure in the abdominal cavity, which is visible as the "leading abdominal inhalation start".

This slight relaxation of the abdominal muscles at the beginning of the inspiration is necessary for the venous blood flow to continue in the femoral and pelvic veins, since this blood flow may stagnate in the abdominal cavity at a high pressure. Slightly lifting and turning the lower ribs to the side initiates the chest breathing through the outer intermediate rib muscles and assessors, which chest breathing is hardly necessary in the resting situation, however. By lifting the chest, a contraction of the abdominal muscles is reflexively evoked and the chest 20 is pulled down again with which the exhalation starts, whereby the diaphragm relaxes again and becomes convex.

In this breathing the diaphragm exerts a suction press pumping action on the venous blood, which is especially necessary in the resting situation because there is then little muscle action to let this blood flow back from the whole body to the heart.

Inhaling and exhaling is accompanied by a pressure change in the interpleural cavity and inherent in this by a pressure change in the intathoracic space and the right atrium. During inhalation, the blood is so to speak, because of the pressure drop then occurring, which increased venous supply is signaled by mechano receptors and leads to an acceleration of the heart rate. As soon as a pressure increase occurs again, which happens in any case during exhalation, the heart rate is decelerated in reverse. This phenomenon of varying heart rate is called the respiratory sinus arrhythmia, and this respiratory sinus arrhythmia must therefore be synchronized with the respiratory weightings under normal efficient respiratory behavior.

Aberrant inefficient breathing behavior can manifest itself in several ways. For example, if breathing continues for so long that the upper outer ribs and assessors still contract while the diaphragm may have already started expiration along with the abdominal muscles, drawing the lower ribs in and down, Despite the inhalation situation, an interpleural pressure increase nevertheless takes place. This negates the mechanism of the interpleural pressure drop and the inherent intrathoracic pressure drop and the atrium pressure drop. This does not benefit the venous return of the blood and is moreover a sign that the work of breathing itself is inefficient. The respiratory sinus arrhythmia curve loses its synchronization with the respiratory curves.

With efficient breathing, exhalation ends at the level of the functional residual capacity of the lungs. Forced exhalation is also inefficient. Thus, as indicated above, when inhaled too far, the respiratory sinus arrhythmia curve decreases rather than the respiration curves, whereas when exhaling too far, the reverse happens.

The invention is now based on the insight that it is possible to teach a patient an optimally efficient breathing behavior by simultaneously measuring the abdominal respiration, chest breathing and the respiratory sinus arrhythmia and making them directly observable so that the patient can check whether there is abdominal breathing (leading abdominal start), whether the respiratory sinus arrhythmia, which may have disappeared, appears and whether the breathing curves remain synchronized with it.

Based on this insight, the object of the invention is therefore to provide an effective device for determining the respiratory behavior of a patient, wherein the patient himself can easily check this behavior and correct it if necessary.

The device according to the invention is for this purpose characterized by a first and a second measuring device for determining the rhythm and the amplitude of the abdominal respiration and the chest breathing, respectively, a third measuring device for determining the course of the heart rate, and means for making and / or recording the output signals of these three measuring devices simultaneously and with the same time basis.

Because chest and abdominal breathing are thus made visible separately and simultaneously on, for example, a suitable screen, the patient can observe errors in his breathing behavior directly and learn to correct them by training, whereby the respiratory sinus arrhythmia, which is also shown simultaneously, is checked. for the efficiency of respiration, both in terms of muscle use and in terms of perfusion / ventilation, respectively, the gas exchange. With the aid of the device according to the invention it is thus possible to practice correct breathing behavior without forcing, the result being immediately visible. At the same time, the venous return of the blood can be influenced so that it can be optimally efficient. By means of the device according to the invention, it is possible to combat stress symptoms in the manner described and to help many cara patients and hyperventilation patients to get rid of their tendency to high breathing. Generally speaking, patients with breathing difficulties or an incorrect breathing habit can be enabled to find and learn the most efficient breathing behavior for them personally by using the device according to the invention.

As already noted, if inhalation is continued for too long, a premature interpleural pressure increase will occur, thereby reducing venous return of blood especially from the legs. In addition, if inhalation is continued for too long, the upper lung parts will increasingly be used and the increasing expansion of these higher lung parts can lead to the veins responsible for the return of blood from the arms and from the head more or less, which are pressed so that the recurring blood flow from these parts of the body is also reduced and in the worst case even completely blocked.

In order to gain insight into the strength of the venous return of blood both from the legs as well as from the arms and the head, according to a further development of the device, means have been provided for determining the flow velocity of the blood from the legs and / or from the arms and / or from the head, whereby the output signals of these further means can also be made detectable and / or recorded.

The device according to the invention can not only be used by a patient himself as an aid in regulating or correcting his breathing behavior, but can also be used in patients who are under anesthesia, in which case the observation is of course done by another person, for example the anesthetist.

If a patient is to be ventilated, the mechanism described above of a low interpleural pressure during inhalation and a high interpleural pressure during exhalation is turned upside down. During ventilation, air is pumped into the lungs under a predetermined overpressure during the inspiration phase, while the pump pressure is reduced during the exhalation phase so that the air can flow out of the lungs again. In this case, during the pumping in of air, there is no question of a relative decrease in interpleural pressure as is the case with natural inhalation (see above), but rather of an increased interpleural pressure. In addition, the pressure in the abdominal cavity 10 increases. As a result, the venous return of blood from the legs is obstructed. In addition, when air is pumped into the lungs, there will be a movement of the chest similar to the movement that occurs with chest breathing. As a result, the higher parts of the lungs are used to a much greater extent than with efficient natural respiration, as a result of which, as already indicated, the expanding upper lung parts cause the veins, which ensure that blood returns from the arms and from the head, more or pressed less tightly so that the return of blood from these parts of the body is also impeded. This overall reduction in venous recurrent blood flow also reduces the amount of blood pumped out by the heart. * The whole blood circulation is, as it were, inhibited, which in some circumstances can even have very damaging consequences, because this inhibited blood flow causes the exchange of gas. in the lungs and the perfusion / ventilation ratio is adversely affected or the supply of (oxygen-containing) blood to the brain can become too low.

Even during the exhalation phase, in which the air pump pressure is reduced, a slight overpressure (the so-called "PEEP") is (often) maintained to prevent the lungs from closing. The consequence of this is that also during this phase the interpleural pressure remains relatively high and the venous blood flow is therefore certainly not increased.

According to a further development, the device according to the invention is now coupled with means for promoting the venous return of blood, in particular from the legs, which means are activated when the blood flow rate determining means give a signal below a predetermined threshold level.

The invention will now be explained in more detail with reference to the accompanying figures.

Figure 1 is a schematic representation of a possible embodiment of the device according to the invention.

Figure 2 is a graph obtainable with the device of Figure 1.

Figure 3 schematically shows a second embodiment of the device according to the invention.

Figure 4 shows the bar charts obtained on the monitor screen.

Figure 5 schematically illustrates a third embodiment of the device according to the invention.

Figure 6 schematically shows an embodiment of the means by which the venous recurrent blood flow can be increased.

Figure 7 schematically shows an embodiment of the device according to the invention, connected to a respirator.

The device of figure 1 has a frame consisting of two semicircular brackets 1 and 2 placed parallel to each other, which are connected at their highest points by a telescoping connecting rod 3 adjustable in length and which over a bench 4 or the like lying patient. Attached to each bracket 1, 2 is a downwardly extending rod 5, on which a sleeve 6 is vertically adjustable and can be fixed by means of a clamping screw 7. The bush 6 carries at its lower end a resilient element in the form of a horizontal arm 8 of a resilient material, such as spring steel, at the free end of which a downwardly protruding knob-shaped sensor 9 and 10 is attached. A strain gauge 25 is attached to each of the arms 8 (not visible in the drawing), which are connected by connection lines 11 and 12 to two inputs of an electronic processing unit 13.

The device furthermore has two handle electrodes 14 to be gripped by the patient, which are connected by lines 15 to a heart rate monitor 30 or tachometer 16 * The device 13 is output lines 17 on a monitor with a screen 18 and, if desired, also on a writing recording device 24 (indicated by dotted lines in the figure). The heart rate meter 16 can be a meter known per se. The processing unit 13 is designed in such a way that the signals received from the strain gauges on the arms 8 and from the heart rate meter 16 are processed separately and are transmitted to the monitor with a common time base, on which these signals are displayed as three superimposed wavy curves on the screen 18 be made visible.

40 It will be clear that the measuring members with the sensors 9 and 10 8402290 ί * 6 for determining the results of the bulk * and breast damping can also be supported in another way and for instance by using a sitting patient one above the other. horizontal position Adjustable to be attached to a stand.

For measuring the heart rate, instead of the drawn handle electrodes 14, it is of course also possible to use adhesive electrodes to be applied to the wrists or other known means *

When using the device shown in Figure 1, the brackets 1 and 2 of the frame are placed over the patient lying on the bench 4 in a position in which the sensor 9 is positioned at a point about 4 cm below the navel on the abdomen of the abdomen. the patient rests and the feeler 10 rests against the breast at about a third of the length of the sternum from the bottom up. The patient receives both electrodes 14 in the 15 hands.

Figure 2 gives an example of the graphic image appearing on the screen 18 in which the upper curve 19 indicates the heart rate as a function of time, the curve 20 the amplitude of the abdominal respiration and the curve 21 the amplitude of the chest breathing 20 also as indicate the function of time. Flank breathing can also be registered and / or displayed if necessary.

The graph of Figure 2 depicts the situation with normal breathing behavior in the resting state, in which case about eight breaths per minute occur. As can be seen from the graph, the abdominal respiratory amplitude (curve 20) is approximately three times the thoracic amplitude (curve 21). It also appears that the onset of the abdominal inhalation (point 22) precedes the onset of the thoracic inhalation (point 23) by approximately 1 to 1 second. A comparison of the curve 19 with the curves 20 and 21 shows that the respiratory sinus arrhythmia is synchronized with the respiration, with the acceleration of the heart rate on inhalation (the ascending branch of the wavy line) and the deceleration of the heart rate on the exhalation (the descending branch of the wavy line) occurs. As explained above, this means that with proper abdominal breathing, the heart rate increases with lower chest pressure during inhalation and decreases with higher chest pressure during exhalation. This takes place under the influence of mechanoreceptors sensitive to volume change.

Figure 3 describes another embodiment of the device 40 according to the invention. In this device, to measure the 8402290% 7 r * breathing movements, two straps 25, 28 of elastic material are used which are fastened around the chest or around the abdomen of the patient, for example by means of Velcro fasteners, namely at positions corresponding to the positions of detectors 9 and 10 in figure 1. In each of the tapes 25 and 28, respectively, there is a mercury wire 26 and 29, respectively, and these mercury wires are connected via the connections 24 and 27 to the measuring device 33.

During the respiratory movements, the length of each of the mercury wires in the rhythm of the respiratory movements will become longer and longer and then shorter again. As a result, the resistance of the mercury wire will change in the same rhythm. This change in resistance can now be detected in the measuring circuit 33 and a signal can be derived therefrom which can be made visible on the monitor 30. It is noted that such mercury wire tapes are known per se in the medical art.

The device according to figure 3 is further provided with electrodes 34 or a finger or ear plethysmograph which can for instance be applied to the forearm and which supplies a signal to the heart rate meter 36 via a connection 35. Such probes are also known in medical technology. .

Furthermore, the Device is provided with one or two detectors with which the blood flow velocity can be measured, in many cases one detector suffices. These detectors 38 and 40 are connected to blood flow velocity meters 32a / 32b via respective connections 37 and 39. These blood flow rate meters can, for example, function according to the Doppler principle. Such blood flow rate meters and the associated detectors are known per se. Other types of blood flow rate meters, for instance provided with detector elements inserted into the bloodstream itself, can also be used within the scope of the invention.

The device according to Figure 3 is further provided with a screen 30 on which, in contrast to the embodiment of Figure 1, now no analog signals are made visible, but bar charts, the length of which is proportional to the amplitudes of the corresponding analog signal. Horizontal bar charts can also be used instead of vertical.

Furthermore, the inspiratory time in seconds, the exhalation time in seconds, the various amplitudes, the heart rate, the minimum and maximum of the heart-40 beat frequency, the time difference between the turning points of sinus arit- can be made visible in figures. it noodles and abdominal breathing (for inhalation and exhalation), time difference between the turning points of bulk and breast breathing (and possibly between bulk and flank breathing). The processor 33 may contain suitable calculation units for this purpose, which can also calculate averages, or the means present in the processor 33 can be appropriately programmed to display the above-mentioned parameters.

Figure 4 shows a schematic example of the image that can be seen on the monitor. All bar charts start at the same height. With the aid of the first three vertical bars 60, 61 and 62 on the screen, for example, the amplitudes of the breast respiration, the amplitude of the bulk respiration (possibly a further rod for the flank respiration) and the heart rate can be displayed in a similar manner. if in figure 2 the patient counts from the synchronization of the up and down movement of these bars, he can draw conclusions about the efficiency of his breathing. The two further bars 63 (and 64) can be used to display the outputs of the two blood flow rate meter (s) 32a / 32b. For example, the Doppler sensors 38 and 40 are used on the main veins 20 of the legs (or leg) and arms (or arm) of the patient, respectively. In that case, the output signals of the blood flow velocity meter 32 indicate the venous blood flow from the legs or from the arms / head of the patient, respectively. The patient can learn to influence the venous blood flow in such a way that it becomes optimally efficient for him / her.

Also in Figure 3, a separate recording device 31 can be connected for permanent recording of the analog or optionally digitized output signals of the measuring device 33.

When using the described device to teach patients correct breathing behavior, the curve 19 of the respiratory sinus arrhythmia on the screen 18 for the patient can serve as a check whether the breathing is as efficient as possible, i.e. whether the curves 19 and 20 maintain their synchronism. For example, when exhaled below the residual volume of the lungs, the exhalation 35 is inefficient with regard to the respiratory muscles and the perfusion / ventilation or gas exchange is not optimal, so that more oxygen is used by these muscles than would be necessary with more efficient breathing. On expiration, the pressure in the chest rises until it exhales below this residual volume. At that moment, the pressure in the chest decreases, so that the line of the res- 8402290 ψ 9 ê.

Piratory sinus arrhythmia starts to rise again, which is a signal for the patient to start breathing again. Efficient breathing is also limited. Normally, the pressure in the chest decreases when you breathe in. As described above, however, if breathing is too long (and too high), an increase in chest pressure occurs, causing the line of the respiratory sinus arrhythmia to drop again.

There is a certain individual breathing behavior that is most efficient. With the aid of the described device, the patient 10 can observe whether his breathing behavior is correct and the patient can also check whether abdominal breathing by comparing the amplitudes of the two breathing curves 20 and 21 and from the location of the starting points 22 and 23. is. If necessary, it may lower the frequency with an inherent increase in the amplitudes, in particular the abdominal amplitude, such that the intended synchronization of curves 19 and 20 occurs or is maintained.

Teaching efficient abdominal breathing at rest is important for cara and cardiac patients because, as described above, the efficiency of venous blood flow can be optimally adjusted individually. In particular, this can prevent the heart muscle from being forced to use excessive oxygen and squeezing its own coronary artery branches during contraction due to a forced contraction of the heart muscle.

The device according to the invention is also important for cara patients and patients with hyperventilation. Such patients can learn to decrease their respiratory rate using the device, and also learn to properly lead the starting point 22 of the abodminal inhalation to the starting point 23 of the torahal inhalation.

Other patients, such as hypertension patients, asthma patients, cara patients and patients with psychosomatic disorders, can also learn to break the vicious circle caused by a hyperactivity of the thoracic respiration with the aid of the device and thereby to a more adjusted and a more efficient breathing behavior to come and a better matching of perfusion and ventilation.

Both the devices of Figure 1 and that of Figure 3 can be used to assist patients with malfunctioning midrib muscles, which patients rely on abdominal breathing as efficiently as possible, to train the diaphragm. This can be done by applying pretension to the diaphragm in these patients, for example by tensioning an elastic band around the patient's body in the correct position or a band of non-yielding material, the ends of which are of an adjustable spring mechanism. In that case, the patient must overcome this extra external tension while performing the breathing movements, while still maintaining the correct breathing behavior, whereby the diaphragm is trained in order to continue to function optimally under load.

Figure 5 shows a further development of the device according to the invention. In this embodiment, the components 24 '... * 41' correspond to the components 24 ... 41 of Figure 3 and also have the same function as the corresponding components in Figure 3. Further discussion thereof is therefore unnecessary.

In Figure 5, a unit 43 has been added which receives a signal from the multi-core connecting cable 41 'via a connection 42, which signal is an indication of the strength of the venous blood flow. This may be the signal which is recorded via one of the sensors 20 38 'or 40' and which indicates the venous blood flow from the legs or from the arms / head respectively, but it may also be a possible combined signal. . However, for further discussion it is believed to be the signal indicative of venous blood flow from the legs. This sig-25 sewing is fed to the unit 43 in which a threshold detector is present, which transmits only the peaks in the signal corresponding to the blood flow shoots, in particular at the beginning of the inspiration and expiration phase, and therefore blocks noise signals. Depending on the strength of these peaks, a signal can now (possibly after evaluation by an operator) be supplied via a connection 44 to a unit 45, which will be discussed in more detail below.

Figure 6 shows an exemplary embodiment of the unit generally designated 45 in Figure 5. The unit 45 is provided with a number of inflatable cuffs 53, 54, 55 which are attached in a row with (little or no) spacing around, for example, a patient's calves. These cuffs are of a known type that is also used, for example, with blood pressure monitors. Although three cuffs are shown in the figure, other numbers can also be used. It is further noted that such a unit 45 can be arranged around each 40 of the calves, in which case both units must be operated synchronously.

Each of the sleeves 53, 54, 55 is connected via a respective pipe line 52, 51, 50 to a pump unit 49, 48, 47. These pump units are in turn activated by signals from the control unit 46. These control unit 46 receives an input signal via the connecting line 44 already mentioned in figure 5 from unit 43.

The input signal from line 44 is used to start a clock pulse generator 56 which delivers clock pulses to a counter 57. The counter 57 steps from one state to the next under the control of these clock pulses, thereby supplying control signals depending on the achieved state. to the pump units 47, 48, 49 in such a way that these pump units are switched on sequentially such that first of all the cuff 55 is brought under a predetermined pressure, a short time later the cuff 54 and again a short time later the cuff 53.

Instead of separate pumps, different valves can of course also be connected to a single pump to inflate or bleed the various cuffs. After a next 2Q cuff is pressurized, the previous cuff may deflate again. However, it is also possible to bleed all cuffs at the end of a sequence at the same time.

As a result, there is a driving effect on the blood located in the veins within the femur 59 25 in the direction of arrow 58. Arrow 58 indicates the return direction of venous blood flow and the propelling effect induced by this series of cuffs thus results in a forced increase in the venous recurrent blood flow to the heart.

It will be clear that the control can be such that shoots are fitted each time at the correct times (to reinforce too weak naturally occurring shoots). On the other hand, however, a continuous succession of light shoots can also be produced (venous massage) if this is desirable from a medical point of view.

It is further noted that such a venous massage device can also be applied around the arms of a patient, albeit with less effect, since the legs form, as it were, a much larger reservoir from which blood can be pumped through the massage device. toward the heart.

It is further noted that, preferably if possible, the normal venous blood flow should be measured beforehand, so that the measured values obtained then can be used to control the strength of the mass effect. It has been indicated above that the cuffs are placed under a predetermined pressure. Depending on this pressure and depending on the speed at which this pressure is reached or depending on the speed at which the successive cuffs are activated, the strength of the shoots generated in the blood stream can be varied as required.

To this end, for example, a detector circuit 10 66 may be present in the unit 45, which determines the strength of the incoming signals and which ensures, via a signal over the line 67, that the pump pressure decreases as the signal strength increases.

The device of Figures 5 and 6 can be used in particular in cases where a patient has to be ventilated. As already indicated in the introduction, it is certainly not imaginary that under ventilation conditions the venous recurrent blood flow decreases sharply because of the totally changed pressure conditions within the body. Now if the strength of the recurring blood flow falls below a certain value, the device of figure 6 is activated to increase the venous blood flow in a forced manner.

Figure 7 shows a further embodiment of the invention, which differs only in some respects from the embodiment of figure 5. The parts corresponding to figure 5 are indicated with the same references.

25 is a unit 69 which forms a monitoring unit for venous blood flow from the arms, which blood flow in turn indicates the venous blood flow from the head. During ventilation, it can happen that during the inspiration phase the venous blood flow from the arms stops, which is an indication that the venous blood flow from the head also stops. This is then caused by an excessive expansion of the upper lung parts, as a result of which the relevant main veins are pressed shut. In such a case, the unit 69 can issue a warning which can be responded to by switching the ventilator to exhale immediately or possibly after an acceptable very short period. The unit 69 can optionally give a signal for this purpose directly to the ventilator via the line 70. In the ventilator, after the warning signal has been received via the line 70, the remaining period for pumping air is adjusted between 0 and a possible very short 40 period.

8402290 9 * 13

It is noted that the embodiments of the device have only been described schematically and that it has been assumed that various parts of the device are normally available as standard components or can be realized without any difficulty by an expert known in the field, for which various possibilities then exist. . A detailed description of the various parts from the various figures is therefore considered superfluous.

8402290

Claims (19)

2. Device according to claim 1, characterized in that further means are provided for determining the flow velocity of the blood from the legs and / or from the arms and / or from the head of the patient. 3. Device as claimed in claim 2, characterized in that the device is coupled with means by which the strength of the venous recurrent blood flow, in particular from the legs, is increased, which means are activated if the blood flow rate determining means output signal below a predetermined threshold level. 4. Device as claimed in claims 1-3, characterized in that the first and the second measuring member each consist of a sensor which can be placed against the abdomen or chest of a patient, which is movably suspended on a support frame and with a sensor on the support frame. displacements of the sensor responsive electrical member is connected. Device according to claim 4, characterized in that each food Irish is carried by a resilient element to which a strain gauge is attached. 6. Device according to claim 4 or 5, characterized in that the carrying frame is provided with two parallel brackets which can be placed over the patient and are connected by a connecting rod of adjustable length and to which the sensors are attached. Device as claimed in any of the claims 1-3, characterized in that the first and second measuring member each consist of an elastic band in which a mercury wire is arranged around the body of the patient at the level of the abdomen or the chest, respectively, which mercury wire is coupled to a circuit which outputs an output signal varying depending on its change in resistance caused by length change of the mercury wire » 8. Device as claimed in claims 1-3, characterized in that the first and the second measuring member each consist of a flexible band or wire which can be placed around the body under light spring tension, the ends of which have 8402290. connected to an electrical signal transmitter which responds to the relative movements of these ends occurring during breathing. Device according to any one of the preceding claims, characterized in that the heart rate measuring device comprises two hand electrodes to be held by the patient, which are connected to a heart rate meter. 10. Device as claimed in any of the claims 1-8, characterized in that the heart rate measuring device comprises electrodes or a finger or ear plethysmograph arranged at a suitable location on the patient's body and connected to a circuit for delivering output signals corresponding to the heart rate. 11. Device as claimed in any of the claims 2-10, characterized in that the means for determining the blood flow rate consist of at least one probe to be used at a suitable location on the patient's body, which is coupled to a Doppler on the Doppler principle-based measuring circuit. 12. Device according to any one of the preceding claims, characterized in that the output signals of the measuring members are passed on to a monitor via an electronic processing unit and are displayed in suitable form on the screen of the monitor. 13. Device as claimed in claim 12, characterized in that the signals are displayed on the screen of the monitor as a number of superimposed wavy curves, the common time base being indicated along the basis of the graph and along the ordinate of the graph plots the amplitude of abdominal and chest breathing, the frequency of the heartbeat, and, if applicable, the strength of the blood flow rate. 14. Device as claimed in claim 12, characterized in that the output signals are displayed on the screen of the minitor in the form of so-called bar charts, the length of the respective bar corresponding to the amplitude of the abdominal and chest breathing. , the frequency of the heartbeat and, if applicable, the rate of venous recurrent blood flow. Device as claimed in any one of claims 3-14, characterized in that the means by which the venous recurrent blood flow is promoted consist of a series of swellable cuffs arranged one behind the other, preferably around a leg or the legs of the patient, the swellable cuffs of which part is connected via hoses to a pumping mechanism, which pumping mechanism functions in such a way that the swellable 8402290% cuffs can be successively brought under chosen pressure after a predetermined interval interval and at a predetermined speed. 16. Device as claimed in claim 15, characterized in that the hoses of the various swellable cuffs are coupled to a series of valves which are controlled by means of a processor. 17. Device according to claim 15 or 16, characterized in that the pump mechanism or the valves are controlled by a counter mechanism to which counting pulses are supplied by a clock ** 10 pulse unit, which clock pulse unit is started depending on an externally generated signal. 18. Device as claimed in claim 17, characterized by a comparator circuit in which the strength of the peaks in the signal corresponding to the shoots in the venous blood flow is assessed and which can output an output signal, depending on the strength mentioned to the means or not. for promoting venous blood flow. 19. Device as claimed in any of the claims 2-18, characterized in that the device is used in combination with a ventilator and in that the means for determining the blood flow rate, in particular the venous blood flow from the arms, a signal delivering to a monitoring unit, which issues a signal when said blood flow (substantially) stops, which signal may be applied, after a very short delay period, to the ventilator 25 to stop pumping air. ********* 8402290