HK1065699B - Prone positioning therapeutic bed - Google Patents

Description

Patient positioning has been used in hospital beds for some time to enhance patient comfort, prevent skin breakdown, improve drainage of bodily fluids, and facilitate breathing. One of the goals of patient positioning has been maximization of ventilation to improve systematic oxygenation. Various studied have demonstrated the beneficial effects of body positioning and mobilization on impaired oxygen transport. The support of patients in a prone position can be advantageous in enhancing extension and ventilation of the dorsal aspect of the lungs.

Proning has been recognized and studied as a method for treating acute respiratory distress syndrome ("ARDS") for more than twenty-five years. Some studies indicate that approximately three quarters of patients with ARDS will respond with improved arterial oxygenation when moved from the supine to the prone position.

There are several physiological bases for patient proning. When a person lies flat in the supine position, the heart and sternum lie on top of and compress the lung volume beneath it. Moreover, the abdominal contents push upward against the diaphragm and further compress and increase the pressures on the most dorsa lung units, where perfusion (i.e., blood flow volume reaching alveolocapillary membranes) is greatest. In an ARDS patient, ventilation in these dorsal regions is inhibited by fluid and cellular debris that settle into the most dependent lung segments. Lung edema may further increase the plural pressures in the most dependent regions. The combination of fluid accumulation with compression by the heart, sternum, and abdominal contents on the dorsal regions of the lung results in a significant ventilation-perfusion mismatch. Expressed more simple, the air entering the patient's lungs is not reaching those parts of the lungs (the dorsal regions where perfusion is greatest) that most need it.

Despite its promises, prone positioning has not been widely practiced on patients because, due to the inadequacies of prior art devices, it is a difficult and labor-intensive process. Logistically, moving a patient to the prone position using prior art technology requires careful planning coordination, and teamwork to prevent complications such as inadvertent extubation and loss of invasive lines and tubes.

Prone positioning using many prior art methods and devices has caused chest tubes, invasive lines, and infusions to become kinked. Worse, the rotation of a patient from the supine to the prone position on some beds has been reported to result in inadvertent extubation and decannulation, which can have catastrophic consequences. Accordingly, there is a need for a proning device with a patient line care management system that will minimize the risk of extubation, decannulation, or kinking of patient care lines.

In the therapeutic bed of WO 99/62454 , the central opening for receiving patient care lines at the head of the bed is provided by a continuous upright end ring, which also serves as a means for rotatably mounting the patient support platform on rollers. One drawback of such an arrangement is that the continuous end ring obstructs access to the head of the patient. Additionally, the initial placement of a patient on the bed requires disconnection of all patient care lines, and to remove a patient care line from the end ring requires that one end of the patient care line be unplugged from either the patient or the piece of equipment to which the line is attacked, which can be very inconvenient and may jeopardize the patient, depending on the particular condition of the patient.

DE 19942546 A1 shows a hospital bed having a stomach-rest and a back-rest, the stomach-rest and the back-rest being rotatable around an axis extending parallel to the longitudinal axes of the stomach-rest and the back-rest. The stomach-rest and the back-rest are connectable at the head end and/or at the foot end of the bed to at least part of a ring which extends at right angles to the stomach-rest surface and the back-rest surface. The centre of the ring lies on the axis of rotation.

The present invention seeks to provide an improved therapeutic bed.

According to this invention there is provided a therapeutic bed comprising a patient support platform having a longitudinal rotational axis, the patient support platform being mounted on at least one circular support member such that the patient support platform is operable to rotate about the longitudinal rotational axis, wherein the circular support member comprises a first section and a second section, the first and second sections, being operable to define a position, wherein the first section is movable with respect to the second section to facilitate manipulation of patient care lines and access to a patient lying on the patient support platform, wherein one or more vertical stabiliser tubes are mounted on or integral with the second section, and one or more shafts are mounted on or integral with the first section, wherein the one or more shafts of the first section are operate to be inserted into the vertical stabiliser tube of the second section to connect the first section to the second section.

Preferably the first section is operable to be pivoted about a vertical axis of one of the one or more shafts.

Conveniently the one or more shafts are operable to be inserted into the one or more vertical stabiliser tubes while the first section is in an open position with respect to the second section, so as to support the first section while it is in the open position.

Advantageously the circular support member comprises a ring and a first section and a second section forms sections of the ring.

Conveniently the first section of the circular support member is removable from the second section.

Preferably a second circular support member supports the patient support platform.

Conveniently one of the sections has one or more tubular openings, and another of the sections has one or more tabs adapted to mate with said one or more tubular openings wherein the tabs and tubular openings secure the first section to the second section.

Preferably at least one latch is mounted to a section, the latch being operable to secure the first section to the second section.

Conveniently a guide body is connected to the patient support platform, the guide body having a plurality of slots for receiving patient care lines,

A therapeutic bed is provided in the form of a prone positioning bed comprising a base frame, a patient support platform rotatably mounted on the base frame for rotational movement about a longitudinal rotational axis of the patient support platform, and a drive system for rotating the patient support platform on the base frame.

An upright end ring at the head end of the bed is split into an upper section and a lower section. The upper section is removable from the lower section to allow improved access to the head of the patient and to allow placement or removal of the patient from the bed by removal of patient care lines from the end ring without removing the patient care lines from the patient or the equipment to which the lines are attached.

Additionally, the bed is provided with pivotally mounted side rails that may be folded neatly out of the way underneath the patient support platform for improved access to the patient in the supine position. Straps are provided to secure the opposing side rails over the patient before rotation into the prone position. Preferably, a pressure-sensitive tape switch is mounted on the patient support platform adjacent teach side rail. When the side rail straps are properly tensioned, the side rails engage the tape switches, which allows the patient support platform to be rotated into the prone position. Alternatively, the straps that secure the opposing side rails over the patient may be connected to the patient support platform with tension-sensitive strap connectors that provide an indication of whether the straps are sufficiently tensioned before the patient is rotated into the prone position. The tension-sensitive strap connectors provide both a visual indication and an electrical signal that may be used by a controller to control the rotation of the patient support platform.

In order that the invention may be more readily understood, and so that further features thereof may be appreciated, the invention will now be described, by way of example, with reference to the accompanying drawings in which:

• Fig. 1 is a perspective view of a therapeutic bed in accordance with the present invention; and
• Fig. 2 is a perspective view of the head portion of the therapeutic bed of Fig. 1 looking toward the foot of the bed.

Referring to Figs. 1 and 2, a therapeutic bed 10 in accordance with the present invention preferably comprises a ground engaging chassis 12 mounted on wheels 14. A base frame 16 is mounted on chassis 12 with pivot linkages 18. Rams 15, 17 housed within base frame 16 co-operate with pivot linkages 18 to form a lift system to raise and lower base frame 16 on chassis 12. A patient support platform 20 having upright end rings 22, 24 is rotatably mounted on base frame 16 with rollers 26 such that patient support platform 20 may rotate about a longitudinal axis between a supine position and a prone position. Mattress or foam padding (not shown for clarity), such as the type described in co-pending and commonly assigned application for letters patent serial number 0-9/588513 filed June 6, 2000 entitled "MATTRESS WITH SEMI-INDEPENDENT PRESSURE RELIEVING PILLARS INCLUDING TOP AND BOTTOM PILLARS, overlays patient support platform 20.

Side support bars 28, 30 extend between end rings 22, 24. At the head of bed 10, a guide body 32 having a plurality of slots 34 for routing patient care lines (not shown) is slideably mounted on rails 36 with support rod 31. Similarly, at the foot of bed 10, a central opening 118 is provided for receiving a removable patient care line holder (not shown) having a plurality of circumferential slots for routing patient care lines.

Central opening 118 is preferably of sufficient size to allow passing of patient connected devices, such as foley bags (not shown), through the central opening 118 without disconnecting such devices from the patient. For such purposes, central opening 118 is preferably as large as possible, provided that strength and configuration requirements of the bed are maintained. More particularly, the inner diameter of central opening 118 is preferably at least eight inches, more preferably, at least about 12 inches, in diameter. The foregoing basic structure and function of bed 10 is disclosed in greater detail in international application number PCT/IE99/00049 filed June 3, 1999 .

Still referring to Fig. 1, bed 10 preferably comprises one or more folding side rails 62 pivotally mounted to patient support platform 20 to assist in securing a patient to support platform 20 before rotation into the prone position. As further described below in connection with Fig. 15, side rails 62 fold underneath platform 20 for easy access to a patient lying atop cushions 21 a, 21b, 21c in the supine position. Bed 10 also preferably has a head rest 50 and a pair of head restraints 48, which are described in more detail below in connection with Fig. 3. Although not shown for the sake of clarity, a fan may be mounted on the patient support platform 20 near the end ring 24 at the foot of bed 10 to ventilate a patient's legs.

As shown in Fig. 2, end ring 22 at the head of bed 10 is split into two sections for improved access to a patient lying on bed 10. Upper section 22a is removable from lower section 22b. Upper section 22a has a pair of shafts 40 that are inserted into vertical stabilizer tubes 38 in the closed position. Likewise, tabs 46 on upper section 22a mate with tubular openings on lower section 22b. Latches 44 secure upper section 22a to lower section 22b in the closed position. When latches 44 are unlatched, upper section 22a may be raised, pivoted about the vertical axis of one of the shafts 40, and left in an open position supported by one of the shafts 40 in corresponding stabilizer tube 38. Alternatively, upper section 22a may be removed entirely. In either case, upper section 22a may be moved out of the way for unobstructed access to the patient and manipulation of patient care lines.

Although the foregoing specific details describe a preferred embodiment of this invention, persons reasonably skilled in the art will recognize that various changes may be made in the details of the method and apparatus of this invention without departing from the scope of the invention as defined in the appended claims. Therefore, it should be understood that this invention is not to be limited to the specific details shown and described herein. When used in this specification and claims, the terms "comprises" and "comprising" and variations thereof mean that the specified features, steps or integers are included. The terms are not to be interpreted to exclude the presence of other features, steps or components. The features disclosed in the foregoing description, or the following claims, or the accompanying drawings, expressed in their specific forms or in terms of a means for performing the disclosed function, or a method or process for attaining the disclosed result, as appropriate, may; separately, or in any combination of such features, be utilised for realising the invention in diverse forms thereof.

Claims (9)

1. A therapeutic bed (10) comprising a patient support platform (20) having a longitudinal rotational axis, the patient support platform (20) being mounted on at least one circular support member (22) such that the patient support platform (20) is operable to rotate about the longitudinal rotational axis, wherein the circular support member (22) comprises a first section (22a) and a second section (22b), the first and second sections (22a, 22b) being operable to define a position, wherein the first section (22a) is movable with respect to the second section (22b) to facilitate manipulation of patient care lines and access to a patient lying on the patient support platform (20), characterised in that one or more vertical stabiliser tubes (38) are mounted on or integral with the second section (22b), and one or more shafts (40) are mounted on or integral with the first section (22a), wherein the one or more shafts (40) of the first section (22a) are operable to be inserted into the vertical stabiliser tube (38) of the second section (22b) to connect the first section (22a) to the second section (22b).
2. A therapeutic bed (10) according to Claim 1 wherein the first section (22a) is operable to be pivoted about a vertical axis of one of the one or more shafts (40).
3. A therapeutic bed (10) according to Claim 1 or Claim 2 wherein the one or more shafts (40) are operable to be inserted into the one or more vertical stabiliser tubes (38) while the first section (22a) is in an open position with respect to the second section (22b); so as to support the first section (22a) while it is in the open position.
4. A therapeutic bed (10) according to any one of the preceding Claims wherein the circular support member (22) comprises a ring and a first section (22a) and a second section (22b) forms sections of the ring.
5. A therapeutic bed (10) according to any one of the preceding Claims wherein the first section (22a) of the circular support member (22) is removable from the second section (22b).
6. A therapeutic bed (10) according to any one of the preceding Claims wherein a second circular support member (24) supports the patient support platform (20).
7. A therapeutic bed (10) according to any one of the preceding Claims wherein one of the sections (22a, 22b) has one or more tubular openings, and another of the sections (22a, 22b) has one or more tabs (46) adapted to mate with said one or more tubular openings wherein the tabs (46) and tubular openings secure the first section (22a) to the second section (22b).
8. A therapeutic bed (10) according to any one of the preceding Claims wherein at least one latch (44) is mounted to a section (22a, 22b), the latch (44) being operable to secure the first section (22a) to the second section (22b).
9. A therapeutic bed (10) according to any one of the preceding Claims wherein a guide body (32) is connected to the patient support platform (20), the guide body having a plurality of slots (34) for receiving patient care lines.