DE102006052572B3 - Pressure-supported spontaneous respiration facilitating method, involves implementing variable pressure support breathing by using variation sample of breathing way pressure in breathing device during spontaneous respiration - Google Patents

Abstract

The method involves implementing a variable pressure support breathing by using a variation sample of a breathing way pressure (Pvn), where n varies in between a range of 1 to m, in a breathing device during spontaneous respiration. The variation sample of the pressure is determined after a predetermined distribution. The pressure is controlled by a computer, where the values of the breathing way pressure p and n forms a time-dependent, predetermined mean value (8). An independent claim is also included for a breathing device for pressure-supported spontaneous breathing based on the basis of a pressure support respiration.

Description

The The invention relates to a method and a ventilation device for Pressure Support Spontaneous breathing based on pressure support ventilation, with ventilation by means of a respiratory connection and a connected one computer-integrated ventilation device takes place and wherein a depression assisting Gas transmission over the Respiratory connection at two different airway pressure levels with an upper level - accordingly a peak airway pressure - and a lower level - accordingly end-expiratory airway pressure.

The Spontaneous breathing assisting ventilation forms may be different Procedure performed and differ from controlled forms of ventilation, which do not support spontaneous breathing.

The most of the conventional ones Support procedure the spontaneous breathing of the patient connected to the ventilator by generating a constant airway pressure or respiratory gas flow. This results in a breathing pattern that behaves monotonously. Other Procedure for assistance spontaneous breathing in ventilated patients can be adapted to the needs of the patient Adapt patients or to defined target variables. This may include airway pressure or respiratory gas flow are continuously measured. About one integrated controller with appropriate programmatic means can the minute volume kept constant, components of lung mechanics optimized or gas exchange through extensive feedback systems be improved. Characteristic of the known forms of the Pressure Support Spontaneous breathing is the fact that after an adjustment period the breathing pattern remains constant.

There are ventilation methods in the document Putensen C., Hering R., Muders T., Wrigge H .: Assisted breathing is better in acute respiratory failure, Curr. Opin Crit Care Med. 2005; 11; 63-8, in which two different forms of ventilation, namely airway pressure release ventilation (APRV) and biphasic intermittent positive airway pressure (BIPAP), the latter being in the form of airway pressure (p). Time (t) curve in 1a is shown used. The two ventilation methods are characterized by two different, constantly spaced airway pressure (CPAP) levels: an upper level 1 airway pressure (CPAP level high) and a lower level 2 CPAP level low, between which spontaneous breathing can take place without restriction. The degree of pressure assistance results from the duration of the existence of the two airway pressure levels 1 . 2 and the tidal volume V _T during the two ventilation procedures. The tidal volume V _T in turn depends on respiratory physiological conditions and the constant difference between the two airway pressure levels.

In two-phase positive airway pressure ventilation, BIPAP, airway pressure is varied between two levels - the CPAP Level High and the CPAP Level Low. The changes in airway pressure also vary the tidal volume, with the two pressure levels 1 . 2 at their adjusted level fluctuations 3 exhibit. Tidal volume per se depends on the pressure variation and mechanical properties of the respiratory system. Spontaneous breathing can be unrestricted in this mode but is not systematically supported by the ventilator in a breath-synchronous manner.

In 1b For example, an airway pressure (p) time (t) curve for a constant pressure assist ventilation (PSV) with two prior art airway pressure levels is shown, with the two pressure levels 1 . 2 as level constant and mutually equal values 5 . 7 and the peak airway pressure values 5 are formed gleichabständig in time order. Spontaneous breathing can be unrestricted in this mode, but is systematically assisted breath-synchronously by the ventilator when a patient's inspiratory effort, known as triggers, occurs 4 , is detected by the ventilator.

It is published in Putensen C., Mutz N., Putensen-Himmer G., Zinserling J .: Spontaneous breathing during ventilation ventilatory ventilation in patients with acute respiratory distress syndrome, Am J. Respir. Crit. Care med 1999; 159; 1241-1248 a comparison between the ventilation methods: the respiratory pressure reduction ventilation APRV and the two-phase positive airway pressure ventilation BIPAP on the one hand and on the other hand the constant pressure support ventilation PSV described, the latter, as in 1b shown, only a lower airway pressure level is used and with each spontaneous inspiration, a higher airway pressure level is generated for a limited duration and each inspiratory inspiration measured by the ventilator, spontaneous breathing is supported, which requires a synchrony between the patient and the ventilator. It is described that to the egg The respiratory pressure reduction ventilation APRV or two-phase positive airway pressure ventilation BIPAP compared to the constant pressure support ventilation PSV with respect to the gas exchange lead to better results and on the other hand the constant pressure support ventilation PSV should bring no significant advantage compared to fully controlled ventilation. The decoupling of spontaneous breathing and machine-generated breaths for a better ventilation / perfusion ratio in the lungs is considered necessary. It is stated in the document that generation of a negative intrathoracic pressure is required to improve venous return and lung perfusion, which would not be possible with constant pressure assisted ventilation PSV, since with constant pressure assisted ventilation PSV, each breath is relatively high positive Printing is supported.

Despite this negative assessment, Patroniti N. et al.: Sigh Improved gas exchange and volume in patients with acute respiratory distress syndrome undergoing pressure support ventilation, Anesthesiology 2002; 393; 788-794 described that, as in 2 Shown is the constant pressure assisted breathing PSV in combination with tight sighs 6 ie with short-term increases in airway pressure above the upper pressure level 1 out and over a longer period of time, with the sigh 6 can be mechanically generated at fixed intervals, can certainly lead to an improvement in the gas exchange in the lungs in spontaneously breathing patients with acute respiratory failure. The mechanism of this improvement is most likely explained by the recruitment of collapsed lung areas, as an increase in venous return is not expected. It is also using sighs 6 in combination with the constant pressure support ventilation PSV a reduction of the respiratory frequency allows. Since the synchrony between the ventilator and the patient is improved with low respiratory drive, this circumstance could at least partially explain the positive effect of the combination.

This is in 2 an airway pressure (p) time (t) curve for the constant pressure assisted breathing PSV with a sigh involved 6 and two pressure constant airway pressure levels 1 . 2 In the constant pressure assisted breathing PSV, the level of support of each individual breath is adjusted to achieve the desired tidal volume. The sighs 6 can be generated by one above the upper pressure level 1 , lying, referred to as sigh respiratory peak pressure level 6 generated at regular intervals.

One Problem of the mentioned methods are that they have a ventilation pattern which is generated monotonically, which means that one Constancy of the flow or pressure profile from breath to breath results and so a monotone Breathing pattern can arise. However, this monotonous breathing pattern causes a loss of intrinsic variability of the respiratory system.

One Problem of the procedures, which at the same time through an extensive, over a design simple respiratory recognition outgoing feedback system, is the adaptation of the ventilator in the actual state on the basis of predefined time variables, which leads to a constancy in the desired state. After the adaptation of the Ventilator and the achievement of the desired state therefore finds a rigid support of Respiration instead, i. The result is a monotonous form of ventilation. Besides, they are used computer-aided Feedback algorithms complex, difficult to implement and associated with increased costs.

A Apparatus for assessing the applied air pressure in the automated Ventilation by positive airway pressure is in the document WO 00/24446 described, wherein by means of the device of the adjoining Airway pressure is varied so that at least three different pressure values be set. For These pressure values are used to measure the corresponding respiratory gas flow. Out the relation of the measured respiratory gas flow value to each other is assessed whether the adjacent airway pressure below or above an optimal Pressure levels is or whether the applied airway pressure the optimal Pressure level corresponds. The device may be in the setting of optimal airway pressure used in ventilators for CPAP therapy become.

One Problem is that the airway pressure caused by this System is generated, with constant patient needs constant remains.

Of the Invention is based on the object, a method and a ventilation device for pressure-assisted Specify spontaneous breathing, which are designed so suitable that an improved pressure support realized without extensive feedback between printing or flow changes and the ventilator. So should a rigid support to avoid breathing.

The The object is solved by the features of claims 1 and 10.

In the method of pressure-assisted spontaneous breathing based on pressure assist ventilation, wherein the ventilation is via a breathing port and a computer integrated ventilator connected thereto and wherein a pressure assisting gas transmission over the breathing port to two different airway pressure levels having an upper level - corresponding to a peak airway pressure - and a lower level - is performed according to end-expiratory airway pressure,
is according to the characterizing part of claim 1
during spontaneous breathing, performing a variable pressure _assist ventilation by means of a variation pattern of the airway pressure p _Vn with n = 1, 2, 3, ..., m from breath to breath in the ventilator, determining the variation pattern of the airway pressure p _Vn , according to a predetermined distribution, and is controlled by a computer and wherein the values of the airway pressure p _Vn , form a time-dependent, predetermined mean value.

The end-expiratory airway pressure p _{0 of} the variable pressure-assisted ventilation can be kept constant both at p ₀ and during ventilation with p ₀ ≠ const = p _0V can be varied.

through programmatic means in the computer can be used as a predetermined variation pattern a random order over a random pressure value generator can be used.

through programmatic means in the computer can the given variation pattern be formed fractally.

through programmatic means in the computer can the given variation pattern according to any distribution or order of absolute Values are formed.

During the implementation of a variable pressure _{assist ventilation} according to the invention, a different airway pressure p _Vn can be generated with each breath.

In a first associated variant of variable pressure assist ventilation with an internal computer alone, the airway pressure values p _Vn to be generated with n = 1, 2, 3,..., M can be queried from an internal memory or generated by the computer itself.

at variable pressure assist ventilation with an external or internal with respect to the ventilation device Control of the variation pattern can be internal sensors of the ventilation device the flow and monitor airway pressure, being based on trigger criteria within programmatic Means a detection performed becomes when an inspiration in the form of a pressure change and / or a flow exists whereupon the respirator with variable pressure assist ventilation responding.

• – Im ersten Überwachungsschritt erfolgt eine Druck-/Strömungsüberwachung durch die Beatmungseinrichtung,
• – im Triggerungsschritt wird über mindestens ein Druckänderungsignal und/oder Strömungssignal – eine Inspiration – der Druck- und/oder Strömungstrigger aktiviert, dessen/deren Signale dem internen oder externen Computer zugeführt werden, wobei bei Auslösungsstop die Überwachung von Druck- und Strömungsänderungen im Bereich des Beatmungsanschlusses latent weitergeführt wird,
• – im Abfrageschritt, der die Triggerung auslöst, erfolgen Abfragen über die nächste Druckunterstützung, aus deren Folge im Beatmungsmusterausgabeschritt das Beatmungsvariationsmuster aus einem zutreffenden Speicher freigegeben wird,
• – im Festlegungsschritt wird die Signalisierung der Druckunterstützung mit dem übernommenen Beatmungsvariationsmuster ausgegeben,
• – im Erzeugungsschritt wird die variable Druckunterstützung erzeugt und über den Beatmungsanschluss die variable Druckunterstützungsbeatmung durchgeführt,

wobei die letzten drei Schritte in einem Modul zur Lieferung der Druckunterstützungsniveaus, das entweder dem internen Computer oder dem externen Computer zugeordnet sein kann, abgearbeitet werden.The variable print support has the following steps:

• In the first monitoring step, a pressure / flow monitoring is performed by the ventilation device,
• - In the triggering step, at least one pressure change signal and / or flow signal - an inspiration - the pressure and / or flow trigger is activated, whose / their signals are supplied to the internal or external computer, wherein at trigger stop the monitoring of pressure and flow changes in the Ventilation connection is continued latently,
• In the interrogation step that triggers the triggering, queries are made about the next pressure assistance, from the sequence in the ventilation pattern output step the respiration variation pattern is released from an appropriate memory,
• In the setting step, the signaling of the pressure support is output with the adopted ventilation variation pattern,
• In the generating step, the variable pressure support is generated and the variable pressure support ventilation is carried out via the respiratory connection,

the last three steps being executed in a print support level delivery module, which may be associated with either the internal computer or the external computer.

In the respiratory device for pressure-assisted spontaneous breathing on the basis of a pressure assist ventilation with a respiratory connection, wherein the respiration takes place by means of the respiratory connection and the computer-integrated respiration device connected thereto and wherein a pressure-supporting gas transmission via the respiratory connection to two different airway pressure levels with an upper level - corresponding to a respiratory peak pressure - and a lower level - corresponding to end-tidal airway pressure - according to the method of claim 1, according to the characterizing part of claim 10, the respirator includes a pressure / flow generator, at least one pressure / flow sensor and a computer with at least one memory , wherein in the memory of the computer at least one variation pattern of the Support pressure is stored according to a predetermined distribution, and / or program-technical means are present in the computer, which generate during the operation of the ventilator, the variation pattern for a variable pressure assist ventilation, wherein the associated airway pressure _values p _Vn with n = 1, 2, 3, ... , m form a time-dependent, defined average and wherein the end-expiratory airway pressure p ₀ at a lower level with p ₀ ≠ const. = p _0V variable or with p ₀ = const. is constantly adjustable.

Optional can in an integratable into the ventilator external computer also Variation pattern of support pressure be contained in one of its external memories, with which a second externally prepared variant of the variable pressure support ventilation is feasible.

In the second variant with the external computer this can be used as a so-called main computer, which constantly polls the internal computer of the ventilator after the start of a breath - a flow or a pressure difference - and provides the heights of the airway pressure levels to be generated p _Vn .

The pressure or flow generator is responsible for generating the predetermined airway pressure p _Vn , and the pressure or flow sensors constantly monitor the variable pressure assist ventilation.

Of Further, at least one module for providing pressure support levels for the variable pressure assist ventilation available to either the internal or the external computer assigned.

The Invention allows it, without extensive feedback system, i.e. without adaptation of the ventilation pattern to the measured respiration a patient or to a specific measurement variable or to a Measurement parameters, the variation of pressure support in the ventilation device to control, with the variation before the start of the ventilation process and the mean of the pressure support values be chosen freely can.

there becomes spontaneous breathing with different airway pressure levels support but not by means of an extensive feedback mechanism, which the restoration and maintenance of the variability of the breathing pattern in every situation possible. The spontaneous breathing as described with the change the support pressure both without pressure support take place as well as maximum supported.

The Invention opened the possibility, that by restoring and maintaining the variation of the breathing pattern in variable pressure assist ventilation is not just one Improvement of lung function, but also a faster weaning of the Patients can be reached by mechanical ventilation, so that shorter Ventilation times result. Uneven spontaneous breathing by means of variable support pressure values can improve the venous return and cardiac output to lead. disproportionately Pressure Support breaths can after all to the opening contribute to collapsed lung areas.

The Invention is based on an embodiment explained in more detail by means of several drawings.

It demonstrate:

1a an airway pressure (p) time (t) curve with two fixed airway pressure levels for two-phase positive airway pressure ventilation and spontaneous breathing according to the prior art,

1b an airway pressure (p) time (t) curve for a constant pressure assisted ventilation PSV and with two fixed airway pressure levels according to the prior art,

2 an airway pressure (p) time (t) curve for a constant pressure assisted breathing PSV and sighs involved with two fixed airway pressure levels of the prior art;

3 an airway pressure (p) time (t) curve for the inventive method with variable pressure assist ventilation having a plurality of peak airway pressure levels, a fixed end-expiratory airway pressure value, and time-variable adjustable assist pressure values;

4 an airway pressure (p) time (t) curve during constant pressure assist ventilation PSV and pulmonary function parameters in respiratory insufficiency 2 .

5 an airway pressure (p) time (t) curve during ventilation with variable pressure assist ventilation and pulmonary function parameters in respiratory insufficiency 3 .

6 a schematic representation of the ventilation device according to the invention and

7 a flowchart about the method in the ventilator.

The following are the 3 and 6 considered together.

In the method according to the invention for pressure-assisted spontaneous breathing on the basis of pressure-assisted ventilation, respiration takes place in accordance with FIG 6 by means of a respiratory connection 21 and a computer integrated ventilator connected thereto 20 , wherein a pressure-assisting gas transmission via the breathing port 21 at two different airway pressure levels with an upper level 1 - According to a peak airway pressure - and a lower level 2 - According to a end-expiratory airway pressure - is performed.

According to the invention according to 3 during spontaneous breathing, variable pressure _assist ventilation using a variation pattern of airway pressure p _Vn with n = 1, 2, 3, ..., m from breath to breath in the ventilator 20 performed, wherein the variation pattern of the airway pressure p _{Vn determined} according to a predetermined distribution and by means of a computer 24 . 26 according to 6 and wherein the values of the airway pressure p _{Vn are} a time-dependent, predetermined mean value 8th form.

The end-expiratory airway pressure p ₀ 2 can with both p ₀ = const. const kept constant as well during ventilation with p ≠ _0. = p _{0V be} varied.

By means of programmatic means in one of the computers 24 . 26 For example, a random order can be used as a given variation pattern via a random pressure value generator.

Also can by means of programmatic means in the computer 24 . 26 the predetermined variation pattern can be fractally formed.

It can also by means of programmatic means in the computer 24 . 26 the predetermined variation pattern may be formed according to any distribution or order of absolute values.

The Pattern of the Respiratory Assist Variation of the Invention can therefore also be set arbitrarily, so that three or more Support pressure levels be generated.

In 3 For example, the airway pressure values p _{Vn are varied} at three or more pressure- _assisting levels p _V1 , p _V2 , p _V3 , p _Vm in the pressure altitude, and their respective pressure- _assisting level structure is not equally spaced in chronological order but from the trigger 4 dependent, triggered and trained. Both sigh p _Vm 6 with a maximum support, eg with a pressure increase of eg 35 cm H ₂ O column as well as a free spontaneous breathing at the airway pressure value p _V3 with largely avoided support at different time intervals to the previous pressure support level are generated, the airway pressure 2 represents the end-expiratory pressure level p ₀ .

The 4 Figure 4 shows the airway pressure (p) time (t) curve during PSV of the prior art and the pulmonary function parameters in respiratory insufficiency, with each breath supporting spontaneous breathing at the same pressure p _K for comparison to the following 5 ,

In 5 For example, an airway pressure (p) time (t) curve during ventilation is shown with variable pressure assist ventilation of the present invention and pulmonary function parameters in respiratory failure. With each breath, a different airway pressure p _{Vn is} generated, the mean 8th the assist pressure values p _Vn can be compared with the peak airway pressure values of conventional ventilation techniques.

In order to clarify the difference between the method according to the invention for variable pressure assist ventilation and the conventional ventilation methods, in the 4 the course of the nearly constant airway pressure p _K recorded over about 35 seconds is shown. It differs from the course of the airway pressure p _Vn during the variable pressure support ventilation according to the invention on the same model 5 ,

The mean 8th of support pressure in 5 and the mean support pressure 8th' in 4 are almost identical in the two ventilation methods, but the variable pressure support ventilation in 5 to a better gas exchange and to better lung mechanics, which shows a comparison between the parameters elasticity in mbar / l and resistance in mbar / l / s in the lung. At the same middle support pressures set 8th' in 4 and mean 8th in 5 are in 5 in variable pressure assist ventilation according to the invention significantly higher tidal volume V _T (250 ml), considerably lower parameters of pulmonary compliance (elastance = 75 mbar / l) and airway resistance (Resistance = 9mbar / l / s) possible.

In the 6 illustrated ventilation device 20 for pressure-assisted spontaneous breathing on the basis of a pressure support ventilation contains a ventilation port 21 , wherein the ventilation by means of the ventilation port 21 and a computer integrated ventilator connected thereto 20 takes place and wherein a pressure-assisting gas transmission via the breathing port 21 at two different airway pressure levels with an upper level 1 - According to the peak airway pressure - and a lower level 2 - According to the end-expiratory airway pressure - is performed at a support pressure.

According to the invention, the ventilation device contains 20 a pressure / flow generator 22 , a pressure / flow sensor 23 as well as a computer 24 with at least one memory 25 , wherein in the memory 25 of the computer 24 at least one variation pattern of the support pressure is stored according to a predetermined distribution, and / or program-technical means in the computer 24 present during operation of the ventilator 20 generate the Va riationsmuster for a variable pressure support ventilation, wherein the associated airway pressure values p _Vn with n = 1, 2, 3, ..., m form a time-dependent, defined mean and wherein the end-expiratory airway pressure p ₀ at a lower level with p ₀ = const. const kept constant as well during ventilation with p ≠ _0. = p _{0V is} variably adjustable.

In an associated variant - the variant 1 - with the internal computer 24 alone, for example, the support pressure values to be generated according to the invention become from the internal memory 25 queried or through the computer 24 self generated.

Likewise, in a second in the ventilation device 20 integrable external computer 26 also the variation patterns of support pressure in one of its external memories 27 be contained, with which the second variant of the variable pressure support ventilation can be performed.

In the variant with the external computer 26 - Variant 2 - this can be called the main computer, which is the internal computer 24 the ventilation device 20 constantly after the start of a breath queries and provides the amount of support pressure, be trained.

The pressure or flow generator 22 is responsible for generating the predetermined airway pressure p _V , and the pressure or flow sensor (s) 23 monitor / monitor the breathing pattern constantly.

This in 7 The illustrated flow chart with step sequence shows the sequence of events in the context of the variable pressure assist ventilation according to the invention with respect to the respiration device 20 external or internal control of the variation pattern.

The internal sensors 23 the ventilation device 20 monitor the flow and airway pressure. Based on trigger criteria, it is recognized when the patient begins to inhale, ie when there are already or still pressure change and / or flow signals, whereupon the ventilation device 20 responds with a computer-supplied variable pressure support. The level of variable pressure support may vary according to variant 2 with the external computer 26 the internal computer 24 the ventilation device 20 transferred and according to variant 1 by its own internal computer 24 generated or from the memory 25 be retrieved.

The sequence of steps consists of the following:
In the monitoring step 30 there is a pressure / flow monitoring by the ventilation device 20 , In the triggering step 31 is detected via the pressure or flow sensor, the breathing effort in the form of pressure change and / or flow signals and after exceeding the trigger threshold, a signal to the internal or external computer 24 . 26 fed. If the trigger threshold is not exceeded, the monitoring is continued latently. In the query step 32 triggered by the triggering, queries are made about the next print support, the result of which in the ventilation pattern output step 33 the ventilation pattern from an appropriate memory 25 . 27 is released. In the fixing step 34 the signaling of the variable pressure assistance is output with the adopted ventilation pattern, so that in the generating step 35 the variable pressure assistance is generated and via the ventilation port 21 the variable pressure assist ventilation is performed. The three steps 33 . 34 . 35 be in a module 36 to provide the print support levels that are part of either the internal computer 24 or the external computer 26 is.

With of the invention as a result, a reduction in mortality through an improvement in mortality respiratory function, a faster weaning of patients from the mechanical ventilation as well as shorter ones Time spent by patients in the intensive care unit become.

Further advantages of the invention are that the lung function with respect to the gas exchange, ie the arterial oxygenation or CO ₂ -Elimination of the mechanical properties of the lungs, for example, the resistance and the elasticity and the reduction of the work of breathing can be improved.

1

upper pressure level

2

lower pressure level

3

pressure fluctuations through spontaneous breathing

4

trigger

5

constant upper pressure value

6

sigh

7

constant lower pressure value

8th

Average

8th'

middle Support pressure value

20

ventilator

21

respiration connection

22

Print- or flow generator

23

Print- or flow sensor (s)

24

internal computer

25

internal Storage

26

external computer

27

external Storage

30

monitoring step

31

Triggerungsschritt

32

inquiry step

33

Ventilation pattern output step

34

setting step

35

generating step

36

module for the delivery of pressure support levels

p _V

airway pressure

p ₀

expiratory airway pressure

p _0V

variable end-expiratory airway pressure

V _T

tidal volume

Claims (14)

A method of pressure-assisted spontaneous breathing based on pressure assist ventilation, wherein ventilation is by means of a breathing port and an integrated computer-integrated ventilator, and wherein pressure-assisting gas transfer across the breathing port to two different airway pressure levels having an upper level corresponding to a peak airway pressure and a lower level, respectively an end-expiratory airway pressure, characterized in that during spontaneous breathing, a variable pressure _assist ventilation by means of a variation pattern of the airway pressure p _Vn with n = 1, 2, 3, ..., m from breath to breath in the ventilation device ( 20 ), wherein the variation pattern of the airway pressure p _{Vn is determined} according to a predetermined distribution and by means of a computer ( 24 . 26 ) and wherein the values of the airway pressure p _{Vn have} a time-dependent, predetermined average value ( 8th ) form. Method according to claim 1, characterized in that the end-expiratory airway pressure p ₀ ( 2 ) of variable pressure assist ventilation with both p ₀ = const. const kept constant as well during ventilation with p ≠ _0. = p _{0V is} varied. Method according to claim 1 or 2, characterized in that by means of program technology in the computer ( 24 . 26 ) as a predetermined variation pattern a random order over a random pressure value generator is used. Method according to Claim 1, characterized in that by means of program technology in the computer ( 24 . 26 ) the predetermined variation pattern is fractally formed. Method according to Claim 1, characterized in that by means of program technology in the computer ( 24 . 26 ) the predetermined variation pattern is formed according to any distribution or order of absolute values. Method according to one of the preceding claims, characterized characterized in that during the execution a variable pressure assist ventilation with each breath a different airway pressure is generated. Method according to one of the preceding claims, characterized in that in a first associated variant of the variable pressure assisted ventilation with an internal computer ( 24 ) alone the airway pressure values p _Vn to be generated with n = 1, 2, 3,..., m from an internal memory ( 25 ) or by the computer ( 24 ) are self-generated. Method according to claims 1 to 7, characterized in that in the case of variable pressure assisted ventilation with respect to the respiratory means ( 20 ) external or internal control of the variation pattern internal sensors ( 23 ) of the ventilation device ( 20 ) monitor the airway flow and / or the airway pressure, wherein based on trigger criteria within programmable means a recognition is performed by when an inspiration in the form of at least one pressure change and / or flow signal is present, after which the ventilation device ( 20 ) reacts with computer-supplied variable pressure assist ventilation. Method according to claims 1 to 8, characterized in that the variable pressure assistance comprises the following steps: - in the first monitoring step ( 30 ) there is a pressure / flow monitoring by the ventilation device ( 20 ), - in the triggering step ( 31 ) is activated by means of at least one pressure change and / or flow signal of the pressure or flow trigger whose signals the internal or external computer ( 24 . 26 ), in the absence of triggers triggers the monitoring of pressure and flow changes in the area of the ventilation port ( 21 ) is continued latently, - in the query step ( 32 ), which triggers the triggering, queries are made about the next pressure support, the result of which in the ventilation pattern output step (FIG. 33 ) the ventilation variation pattern from an appropriate memory ( 25 . 27 ) is released, - in the setting step ( 34 ) the signaling of the pressure support is output with the adopted ventilation variation pattern, - in the generation step ( 35 ), the variable pressure support is generated and sent via the ventilation port ( 21 ) the variable pressure assist ventilation, the last three steps ( 33 . 34 . 35 ) in a module ( 36 ) for the delivery of the print support levels either to the internal computer ( 24 ) or the external computer ( 26 ) is processed. Ventilation device for pressure-assisted spontaneous breathing on the basis of a pressure assist ventilation with a breathing port, wherein the ventilation by means of the breathing port and the connected computer-integrated ventilation device and wherein a pressure-assisting gas transmission via the breathing port at two different airway pressure levels with an upper level - corresponding to a peak airway pressure - and a lower Level - according to a end-expiratory airway pressure - is performed, according to the method of claim 1, characterized in that the ventilation device ( 20 ) a pressure / flow generator ( 22 ), at least one pressure / flow sensor ( 23 ) and at least one computer ( 24 . 26 ) with at least one memory ( 25 . 27 ), wherein in the memory ( 25 . 27 ) of the computer ( 24 . 26 ) at least one variation pattern of the support pressure is stored according to a predetermined distribution, and / or program-technical means in the computer ( 24 . 26 ) that are present during the operation of the ventilation device ( 20 ) generate the variation pattern for variable pressure assist ventilation, wherein the associated airway pressure _values p _Vn with n = 1, 2, 3, ..., m form a time-dependent, defined mean, and wherein the end-expiratory airway pressure p _{0 is} at a lower level with p ₀ ≠ const. = p _0V variable or with p ₀ = const. is constantly adjustable. Ventilation device according to claim 10, characterized in that optionally in one in the ventilation device ( 20 ) integrable external computer ( 26 ) also variation patterns of the support pressure in one of its external memories ( 27 ), with which a second externally prepared variant of the variable pressure support ventilation is feasible. Ventilation device according to claim 11, characterized in that in the second variant with the external computer ( 26 ) is used as a so-called main computer, the internal computer ( 24 ) of the ventilation device ( 20 ) constantly polls for the beginning of a breath and provides the heights of the airway pressure levels to be generated p _{Vn of} the support pressure. Ventilation device according to claim 10 to 12, characterized in that it comprises a pressure or flow generator ( 22 ), which is responsible for the generation of the predetermined airway pressure p _Vn , and pressure or flow sensors ( 23 ) which constantly monitor variable pressure assist ventilation. Ventilation device according to claim 10 to 13, characterized in that a module ( 36 ) is provided for the delivery of pressure support levels for variable pressure assistive breathing either to the internal computer ( 24 ) or the external computer ( 26 ) assigned.