U.S. patent number 3,802,417 [Application Number 05/177,580] was granted by the patent office on 1974-04-09 for device for combined monitoring and stimulation of respiration.
Invention is credited to Volker Lang.
United States Patent |
3,802,417 |
Lang |
April 9, 1974 |
DEVICE FOR COMBINED MONITORING AND STIMULATION OF RESPIRATION
Abstract
A device for monitoring and automatically stimulating
respiration including means for directly monitoring respiratory
activity via the respiratory tract, a sensor for converting the
monitored respiratory activity into cyclical electrical signals
indicative of the respiration depth and frequency, and electronic
counter means for counting the electrical signals generated by the
sensor and for generating a signal when a predetermined number of
electrical signals have been counted. The device also includes an
alarm relay, integrating timing means for triggering the alarm
relay in the event that no signal is received from the counter
within a predetermined time period, and respiration stimulator
means activated by the alarm relay upon the triggering thereof for
automatically reestablishing respiration. Means are also provided
to clear mucus from the passage between the respiratory tract and
the sensor, and further to ensure that shallow breathing is not
mistaken for reestablished normal breathing.
Inventors: |
Lang; Volker (Munich,
DT) |
Family
ID: |
27510018 |
Appl.
No.: |
05/177,580 |
Filed: |
September 3, 1971 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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886429 |
Dec 18, 1969 |
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Foreign Application Priority Data
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Dec 21, 1968 [DT] |
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1816783 |
Feb 15, 1971 [DT] |
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2107099 |
Feb 15, 1971 [DT] |
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2107098 |
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Current U.S.
Class: |
600/529; 340/526;
601/44; 600/537; 340/573.1 |
Current CPC
Class: |
A61B
5/113 (20130101); A61M 16/024 (20170801); A61M
16/0051 (20130101); A61M 2016/0021 (20130101) |
Current International
Class: |
A61B
5/11 (20060101); A61B 5/113 (20060101); A61M
16/00 (20060101); A61b 005/08 () |
Field of
Search: |
;128/2.1R,30,30.2,25R,DIG.17,2.08,145.8 ;340/279 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Amer. Journ. of Med. Electronics, Apr.-June, 1964, pp.
105-109..
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Primary Examiner: Howell; Kyle L.
Attorney, Agent or Firm: Fleit, Gipple & Jacobson
Parent Case Text
RELATED APPLICATIONS
This application is a continuation-in-part of U.S. Pat. application
Ser. No. 886,429, filed Dec. 18, 1969, and now abandoned.
BACKGROUND OF THE INVENTION
In recent years, there has been decided progress in the care of
premature and newborn infants. In contrast to the previous
situation, it is now possible to keep even premature infants alive,
if only the still very immature organs can be relieved of load or
stimulated to the extent that the performance required of these
organs can be achieved. A problem that lies at the heart of the
matter is adequate spontaneous respiration.
Apparatus has been developed in this art that attempt, for the
monitoring, to detect the breathing activity through movements of
the thorax by means of respiratory belts, changes of electric
conductivity, and so forth. The electronic apparatus thus far
developed constitute an advance in the monitoring of endangered
children, and they also have led to a certain relief of the nursing
personnel. Unfortunately, however, they are easily subject to
disturbance from all movements of the children, that is, movements
are erroneously recorded as inhalations. In the case of usually
restless premature infants in the incubator, for whom these
monitoring devices are primarily developed, such a drawback must be
considered substantial. And if there is respiratory failure, the
oxygen deficiency is threatening in a relatively short time,
strongly increasing the restlessness of these children annd
manifesting the condition in increased motility.
Since these random movements are recorded in the prior art
monitoring apparatus as "inhalations," there is a delay in
triggering the alarm up to the point at which the child has become
devoid of tonus because of serious hypoxemia. From this instant of
alarm signalling until the monitoring personnel arrives and
artificial respiration is initiated, there is a substantial loss of
valuable time. And in animal experiments of recent years, it has
been shown that even respiratory cessation of short duration (above
60 seconds), especially when there is already a slight hypoxia, can
lead to brain damage which can cummulatively lead to observable
defects. Unfortunately, threatening pulmonary ventilation
disturbance through shallowness of respiration (e.g. in the
respiratory distress syndrome) cannot be detected in time by these
known instruments.
The most varied kinds of statistics show, unfortunately, and
especially in premature infants, that there is a shockingly high
incidence of brain damage, a substantial proportion being caused by
inadequate spontaneous respiration with hypoxia. Respiratory
failure in the premature is mostly caused by immaturity of the
respiratory center, and can be relieved immediately by the simplest
of measures, for example, manual slapping of the infant or repeated
short-duration rhythmic compression of the thorax.
The objective of the present invention is to develop an electronic
apparatus for combined automatic monitoring and stimulation of
respiration, ensuring a high degree of safety for the infant being
monitored, and at the same time relieving the nursing personnel of
work load.
SUMMARY OF THE INVENTION
According to the present invention, the problems of the prior art
are solved in that sensors consisting of thermistors or pressure
sensitive elements convert respiration to electric signals. The
electric signals are counted on electronic counters preset to count
a specific number of breaths. The output of the counter is fed to
integrating timing circuits that trigger an alarm relay if the
desired standard respiratory frequency is not attained. When
triggered, the alarm relay switches on a respiration stimulator
that consists of a rhythmically inflatable belt or cuff. The
inventive apparatus has a plurality of electronic counters for
counting exhalations and a corresponding number of timing circuits
so that respiration can be monitored and the desired standard
respiratory frequency can be established. By determination of the
respiration (e.g., by the expired air) by means of thermistors or
by a pressure sensitive sensor (Pitran, piezoelectric or
photoelectric measuring transducer), not only the respiratory
frequency but also the depth of respiration can be measured
semiquantitatively and utilized for monitoring the infant. A
special adapter that fits the nose of the child or a sound tube
with adapter that can be introduced into the nose or mouth, carries
the flow of respiratory air to the sensor. By means of the
apparatus of the invention the dangers of the prior art are
avoided. In the prior art, the magnitude of respiration is measured
indirectly by thoracic movements, by an expansion measuring strip
or by electric conductivity, and may result in mistaking the
child's movements for "inhalation" which can then lead to delayed
alarm after respiratory failure, just as it can result in
unreliably reported threatening shallowness of respiration.
With the inventive system, the first alarm relay (alarm I)
simultaneously switches on the respiration stimulator which
consists of a pulse generator that rhythmically initiates
respiratory activity via supplementary devices. For stimulation of
breathing, an inflatable belt can be positioned around the chest or
any other part of the child's body, the valve controlling the
inflation of such belt being rhythmically actuated by the pulse
generator. Spontaneous breathing on the part of the child can be
stimulated by the belt. Breathing can also be initiated by rhythmic
pain or heat stimuli, produced by electric stimulation of the skin,
nerves or muscles, or by thermal stimuli via skin or mucosa. The
desired respiratory depth can be adjusted by setting the threshold
value of an adjustable threshold value amplifier to the required
level.
In a further advantageous embodiment of the present invention,
there is provision for a second integrating timing circuit that
triggers a second alarm (nurses' alarm) if after the initiation of
the respiration stimulator by the first alarm circuit and the first
timing circuit, spontaneous respiration has not been reestablished
after a specific, predetermined time. The alarm triggering that is
controlled by the second timing circuit can be stopped only by
means of a manually actuated key.
It is further advantageous to selectively actuate acoustic or
optical indicator devices by the electric signals delivered from
the respiration snesor, to permit monitoring of individual
exhalations.
The device of the present invention reliably detects respiratory
failure and respiratory shallowness, and eliminates such
deficiencies by automatic stimulation, an alarm being triggered
upon unsuccessful stimulation of respiration. The apparatus of the
invention thus attains a reliability that is not afforded by the
known prior art devices. The combination of monitoring and
stimulation of respiration in the device of the invention by
eliminating travel time on the part of nursing personnel, makes
possible the early treatment of respiratory failure and the
resultant prevention of hypoxidosis in 90 to 95 percent of the
cases.
Expecially in prematurely born children, irregular respiration is
frequently observed, and this condition may unpredictably lead to
respiratory failure. Before the onset of respiratory failure,
however, there is frequently an irregular gasping, and there is the
possibility that there will only be a respiration consisting of two
or three gasps after stimulation by the prior art devices. Such
defective respiration leads to no essential improvement, and on the
contrary usually ends in a deterioration of oxygen supply to the
patient being monitored. If a respiration monitoring device is
constructed as is known in the prior art, with alarm triggering
independent of the number and depth of the inhalations, there is
the great danger that in gasping breath there will be a delayed
alarm or that an existing alarm will be cut off. Such could well
result in increased oxygen deficiency for the infant, and, as a
consequence, brain damage.
With the present invention, the detection of respiration is by
means of expired air and hence such defective respiration can be
reliably reported. Accordingly, a further object of the invention
is to provide a respiration monitor which will detect gasping
respiration, and which is so arranged that gasping will not delay
triggering of the alarm.
This problem is solved by providing a respiration monitoring device
with an electronic counter for determination of respiration in
combination with an electric zero setter, timing member, pulse
generator and blocking circuits. A timing member that is connected
after the electronic counter triggers the four following functions
after the elapse of a predetermined time: blocking the input of the
timing member; electronic zeroing of the counter; actuation of a
time-delayed pulse generator that sends a pulse to the input of the
electronic counter; and lifting the block on the input of the
timing member. The four described functions have the effect that,
depending upon the preselected respiration frequency, at least 4,
8, 16 or 32 minus one exhalations are required to extinguish the
alarm that has been set off.
In the apparatus of the invention, it has been repeatedly observed
that false alarms are set off by penetration of mucus into the
sound tube or nose adapter introduced for the monitoring of
respiration. A further object of the invention is the elimination
of this defect, and such is eliminated with a blow-through device
for the respiration monitoring apparatus which consists of a
two-way valve connected to a breath sensor and an expander valve
associated with a gas tank or fan. The sound tube or adapter
serving to transmit pressure fluctuations and air flow that occur
in breathing can be connected either to the breath sensor or the
blow-through device by means of an intermediate two-way valve.
Penetration of mucus or fluid into the sound tube that serves for
transmission of the breathing to the sensor, after a short set
interval, leads to brief switching of the electromagnetic two-way
valve, by an electronic switch. This brief switching on of a
blow-through device leads to a cleaning of the sound tube. In
actuation of the two-way valve, an electronic blocking circuit at
the same time prevents disturbances that would occur in the
switching of the two-way valve caused by air movements from being
recorded in the breathing sensor and erroneously reported as
inhalation. Advantageously, both in start up of the monitoring
device and in manual cutoff of an alarm after respiratory failure,
there is an automatic cleaning of the sound tube by preliminary
blowing.
The foregoing objects and advantages of the present invention will
be more fully understood when reference is made to the following
description taken in conjunction with the accompanying drawings.
Claims
What is claimed is:
1. A device for automatically monitoring and stimulating
respiration, the device comprising: means for directly monitoring
respiratory activity via the respiratory tract; said means
including at least one sensor means for converting the monitored
respiratory activity into electrical signals indicative of the
respiration frequency; electronic counter means said at least one
sensor means for counting the electrical signals generated by said
sensor and for issuing a signal when a predetermined number of
electrical signals have been counted; an alarm relay; first
integrating timing means for receiving the signals issued by said
electronic counter means and for triggering said alarm relay in the
event that no signal is received from said counter means within a
predetermined time period; and respiration stimulator means
activated by said alarm relay upon the triggering thereof for
automatically reestablishing respiration.
2. The device recited in claim 1, in which said counting means
comprises a plurality of counters, and said first integrating
timing means comprises a corresponding number of timing circuits,
and further comprising means for delivering the electrical signals
generated by said sensor to one of said counters, and for
delivering the signal issued by said one counter to a corresponding
one of said timing circuits.
3. The device recited in claim 1, in which said respiration
stimulator means comprises a rhythmically inflatable belt, a
magnetic valve means controlling the inflation of said belt, and a
pulse generator means for actuating said magnetic valve.
4. The device recited in claim 1, in which said respiration
stimulator means comprises heating elements for establishing normal
respiration by way of thermal stimuli.
5. The device recited in claim 1, and further comprising a second
alarm relay and means for triggering said second alarm relay in the
event that respiration is not automatically reestablished by said
respiration stimulator means after a predetermined time period.
6. The device recited in claim 5, and further comprising a second
timing means connected after said first timing means for energizing
said second alarm relay after the elapse of said predetermined time
period.
7. The device recited in claim 1, and further comprising a gasping
respiration safety including an electronic zeroing means connected
to said counter means; a pulse generator means for putting a
predetermined count on said counter means; and a blocking circuit
means for blocking the input to said first timing means.
8. The device recited in claim 7, wherein said first timing means
is connected after said electronic counter means and initiates, in
succession, the blocking of the input of said first timing means,
the electronic zero setting of said counter means by said
electronic zeroing means, the energizing of said pulse generator to
deliver a pulse to the input of said electronic counter, and the
removal of the blocking of the input of said first timing
means.
9. The device recited in claim 1, and further comprising a
blow-through device including a two-way valve in combination with
said sensor means and a source of pressurized gas.
10. The device recited in claim 9, and further comprising a sound
tube serving for transmission of respiratory activity, said tube
being selectively connected by said two-way valve either to said
means sensor or to said blow-through device.
11. The device recited in claim 9 and further including an
electronic circuit means for switching said valve in the event of
penetration of mucus or fluid into said sound tube.
12. The device recited in claim 9, and further including a second
blocking circuit, means actuated simultaneously with the actuation
of said two-way valve, for blocking signals developed in the
operation of said two-way valve from being erroneously detected as
respiration.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a block diagram of the circuitry of the apparatus of the
present invention;
FIG. 2 is a schematic diagram illustrating the function of the
invention according to FIG. 1; and
FIG. 3 is a block diagram of the circuitry of the device of the
present invention with gasping respiration safety and blow-through
device.
DETAILED DESCRIPTION OF THE DRAWINGS
Into the nose or mouth of the child to be monitored, there is
introduced a suitable, optimally fitted nose adapter 20 or mouth
adapter 19. The respective adapter elements lead the flow of
respiratory air directly or via a sound tube to a breath sensor
1,2. The breath sensor receives the respiratory air flow and
converts the same to electric signals. As suitable sensors there
may be used thermistors 1 or pressure sensitive measuring
transducers 2 (according to principles of piezoelectricity or
photoelectricity), or pressure sensitive transistors (Pitrans).
Both possibilities are indicated in FIG. 1. The sensitivity of
thermistor 1 can be enhanced by preconnection of a preheated
thermistor, which at the same time makes selective detection of the
expired air possible.
Between amplifier 4 and the pressure sensitive sensor 2, there is
an active filter 3. This filter has a feedback amplifier and
selectively separates out all interfering frequencies. Only
frequencies produced by the breathing are introduced into amplifier
4 for amplification. For example, interfering pulses caused by
noise are filtered out. The analog signal of sensor 1,2 is
amplified in amplifier 4 and is converted by the threshold value
amplifier 5 (Schmidt trigger) into a digital signal. The threshold
value amplifier is adjustable, to adapt the threshold value to a
predetermined minimum depth of respiration so that no signal is
transmitted in the event of shallow breathing. If the depth of
respiration is above the threshold level, a signal from the
threshold value amplifier 5 is simultaneously transmitted to the
respiratory frequency control unit 18 and to an optical and
acoustic indicator unit 6,7,8,21. In this way, the signal can be
brought selectively by switch 6 to lamp 7 or the sine generator 8
which generates an acoustic frequency and results in an audible
signal via speaker 21.
The signal derived from the threshold value amplifier 5 is applied
to respiratory frequency control unit 18 including an electronic
counter 9 comprised of a plurality of electronic counting units in
the form of flip-flop circuits. Beyond the electronic counter 9
there is a timing circuit (Miller integrator) 10 connected to the
counter output. The desired breathing frequency (exhalations per
minute) can be set by a preselector switch 23 which at the same
time sets the counter 9 and timing circuit 10 associated therewith
by means of switches 24 and 25. Depending upon the setting for
respiratory frequency, a specific number of exhalations (4-32 per
minute) is counted by the electronic counter 9, and after counting,
a signal is developed which is sent to timing circuit 10 associated
with the counting device 9. The respiratory frequency control thus
consists in determining whether the predetermined number of
exhalations occur within the predetermined time given by timing
circuit 10. The timing circuit is so tuned to electronic counter 9
that a signal is sent to alarm relay 11 and to the second timing
(e.g., 10 to 20 seconds) circuit 15 if the predetermined standard
time has elapsed without any exhalations count by the electronic
counter 9 corresponding to the setting.
If the chosen values for breathing frequency and/or depth of
respiration are not attained, alarm relay 11 (alarm stage I) is
energized by the first timing circuit 10 and at the same time the
pulse generator 12 (multivibrator) is switched on to control
magnetic valve 13 for the respiration stimulator 36. The
respiratory failures are counted by the electromechanically
functioning counter 14, and are recorded. The respiratory failures
recorded by counter 14, and successfully treated failures, can be
evaluated in terms of therapy, prognosis and diagnosis.
Along with the alarm relay 11, the first timing circuit 10
energizes the second timing circuit 15 (Miller integrator) which,
when its preestablished time interval has elapsed, energizes the
second alarm relay 16 (alarm stage II). The alarm set off by the
second alarm relay 16 can only be interrupted by means of a cutoff
key 17. The use of key 17 also results in the reset of the
respiratory frequency control unit 18 and the second timing circuit
15 to zero. The second timing circuit 15 is adjustable to a time of
10-20 seconds. If during this time there is no adequate spontaneous
respiration as a result of stimulation, the second alarm relay 16
is set off. This alarm relay 16, as already noted, can only be
restored to its initial setting by by manual depression of key 17.
If adequate spontaneous respiration develops before the termination
of the stimulation time the timing circuits 10 and 15 and the
electronic counter 9 are reset to zero, along with alarm relay 11,
and hence pulse generator 12 for the respiration stimulator 36 is
disconnected along with its appurtenant magnetic valve 13.
The circuit is so arranged that if there is current failure, alarm
relays 11 and 16 are always energized. The respiratory frequency
control unit is designed in such a way that the frequency can be
set at 15 to 140 exhalations per minute.
The operation of the device of the present invention will now be
explained with reference to FIG. 2. The individual exhalations of
the child are detected by breath sensor 1 or 2 which delivers
electric signals to the respiration frequency control 18 of the
apparatus as indicated by the arrows in the schematic diagram. Four
or more exhalations serve for the determination of respiratory
frequency. As shown by the schematic diagram, reaching the standard
breath frequency leads to cutoff of the respiration stimulator and
of alarm relay 11 (alarm stage I).
If it happens that the standard respiratory frequency is no longer
reached, e.g., in extreme respiratory shallowness, slowing or
cessation, the respiration stimulation and alarm stage I are
switched on, with simultaneous recording of respiratory failure by
an incorporated counter 14. Breathing frequency higher than the
established standard leads only to triggering of the alarm if at
the same time a significant shallowness of respiration occurs and
inadequate ventilation results. In most cases, indicated by the
arrow in the schematic, respiration stimulation results in the
reestablishment of spontaneous respiration of the premature infant
or patient. The individual exhalations are detected then by the
breath sensor, signals are delivered to the respiration frequency
control 18, and when the standard frequency is attained, the
respiration stimulator and alarm stage I are cut off. If, in rare
instances, e.e., with long-lasting hypoxia, a period of 10 seconds
(adjustable to 20 seconds) elapses without the reestablishment of
spontaneous respiration during stimulation, alarm stage II is
tripped (activating the central alarm facility and lighting up of
alarm cutoff key 17). This alarm can then only be cut off manually
by the depression of the light key 17 by an attendant. Alarm stage
I, after a brief interval, is triggered during shallow respiration
or during respiratory failure and serves primarily for monitoring
the respiration of small children, school age children and adults,
and may be used even if the stimulator is not used.
As shown in the block diagram of FIG. 3, the electric signals from
the sensor 1 or 2 pass via the amplifier 4 to the threshold value
amplifier 5 and respiration frequency control unit 18. The signal
is delivered to an electronic counter 9 that contains electronic
counting units consisting of flip-flop circuits. A timing circuit
10 (Miller integrator) is connected after elelctronic counter 9,
and is adapted to receive the counter input. By this timing circuit
10, it can be determined whether the predetermined number of
exhalations have occurred within a preestablished time given by the
circuit. The desired respiration frequency (exhalations per minute)
is set through a preselector switch 23 which simultaneously, by
means of the switching levers 24, 25, set the counter 9 and the
timing circuit 10 associated therewith. Depending upon the
respiration frequency setting, a specific number of exhalations
(4-32) is counted by electronic counter 9, and after the counting,
a signal is applied to the associated timing circuit 10, setting it
to zero. The respiration frequency control involves determining
whether the predetermined number of exhalations occur within the
predetermined time given by timing circuit 10. The timing circuit
is so tuned to the electronic counter 9 that a signal to relay 11
is transmitted if the predetermined standard time has elapsed
without the electronic counter 9 counting the number of exhalations
for which it is set. If the standard value for respiration
frequency is not reached, alarm relay 11 is triggered by timing
circuit 10.
The gasping respiration safety operates at the same time that alarm
relay 11 is triggered. Four processes are initiated in succession
by the respiration safety, and simultaneously with the triggering
of alarm relay 11. First, the input of timing circuit 10 is
electronically blocked by blocking circuit 28; second the
electronic zero-setting device 29 for the counting circuit 9 is
energized; third, a pulse is applied to the input of the electronic
counter 9 by a time delayed pulse generator 30; and fourth, the
blocking of the input of the timing circuit 10 is removed.
After the completion of these processes, 4, 8, 16 or 32 exhalations
minus one are necessary for the renewed setting of timing circuit
10 to zero i.e., for extinguishing the alarm. This means for the
child being monitored, that depending upon the preestablished
respiration frequency, there must be at least 3, 7, 15 or 31 normal
exhalations to deactivate the triggered alarm. In this way, a very
high monitoring safety is attained for the patient.
The automatic blow-through device operates as follows. The
automatically controlled blow-through device (pertubator) for the
respiration monitoring apparatus is shown in the block circuit
diagram of FIG. 3. The respiratory air of the patient passes via
sound tube 20 to two-way valve 34 and breath sensor 1. If the sound
tube is clear, air movements occurring in expiration will be
converted by the sensor to electric signals and carried via
amplifier 4 and Schmidt trigger 5 to the counting circuit 18, there
determining whether the respiratory frequency is adequate by means
of the associated timing circuit. A timing member 31 (e.g., Miller
integrator) is connected with Schmidt trigger 5, controlling a
monostable flip-flop 32. The "on" time of this flip-flop determines
the switching time of the electromagnetic two-way valve 34. At the
same time, the monostable flip-flop 32 controls an electronic
blocking circuit 33 connected to the Schmidt trigger 5.
If the child breathes regularly and if the sound tube is free of
mucus, the air displacement or pressure fluctuation occurring in
expiration exceeds a threshold and causes a response by the
respiration sensor. The signals of the sensor are electrically
amplified and delivered via Schmidt trigger 5 to the electronic
device of the respiration monitoring apparatus. With adequate
respiration, timing member 31 is always reset to zero by Schmidt
trigger 5.
If, however, the sound tube to the nose or throat is filled with
mucus or fluid, the threshold is not reached, and there is no
electric signal from respiration sensor 1 strong enough to activate
Schmidt trigger 5. Hence, timing member 31 is not reset to zero by
the Schmidt trigger 5. After a few seconds (adjustable) the timing
member 31 sends a pulse through flip-flop 32. This flip-flop then
briefly energizes the two-way gas valve 34 and thereby connects the
sound tube with the expander valve associated with a gas tank or
fan 35. Valve 34 can take the form of any conventional electrically
operated valve which, in one position, communicates the tube 20
with the sensor 1, and which, in the other position, communicates
tube 20 with the tank or fan 35. A blow-through (cleaning) of the
sound tube 20 is thereby effected. At the same time, Schmidt
trigger 5 is electrically blocked by monostable flip-flop 32 via
blocking circuit 33 until valve 34 has been de-energized for a
time, and thereby no electric signal of disturbance from sensor 1,
caused by switching of valve 34, can reach Schmidt trigger 5.
Above, a specific embodiment of the present invention has been
described. It should be appreciated, however, that this embodiment
is described for purposes of illustration only and that numerous
alterations and modifications may be practiced by those skilled in
the art without departing from the spirit and scope of the
invention. Accordingly, it is the intent that the present invention
not be limited by the above but be limited only as defined in the
appended claims.
* * * * *