in reference to fig2 , a first embodiment of the invention has been represented . in this figure , as in fig4 , the apparatus represented comprises the elements that have already been described in reference to fig1 . these elements will be represented with the same references . consequently in this figure , we find all of the elements which make up the apparatus of fig1 . in particular , we find the pressurized gas source 100 . within the scope of the invention , this source is a centrifugal fan type turbine ( which is to say that its output is on the side of the rotating element , for example via a tangential manifold pipe ) with an axial air intake ( which is to say that its air input is more or less aligned with the spindle of the rotating part of the turbine ). also , this gas source has a particularly low inertia , of around 150 gcm 2 . we also find an inhalation valve 113 that is capable of operating proportionally . more precisely , this valve preferably comprises a cock that can be controlled in rotation in a tubular body , so as to permit an “ all or nothing ” or a “ proportional ” operation . we will come back to this aspect . we can also remark on this figure that the end 120 of the duct 110 is shown in the form of a mask . in fact , the invention can be used with the end of its duct 110 corresponding to a mask ( non - invasive mode ) or an invasive mode ( for example insertion of ducts in patient ). in the case of this end 120 being in the form of a mask , the invention allows , as we will see , the leaks associated to such a mask to be controlled precisely . it can be seen on fig2 that the apparatus control means 50 have a specific structure . a comparator 151 , to define the operating reference value to be transmitted to the pressurized gas source via the connection 1510 . this comparator has two inputs : an input 1511 for one or more reference values . these reference values can be stored in a memory of the control means 50 . one or more reference values can therefore be stored in this way , in particular for : an input 1512 for a representative operating value of the apparatus . this value is a pressure or flow rate value . as we will see , this value is taken from : the pressure sensor 111 for a pressure value , the flow rate sensor 112 — or a flow rate measurement processing unit — for a flow rate value , a switch 152 capable of selectively connecting the input 1512 of the comparator 151 with the pressure sensor 111 , or the flow rate sensor 112 . this switch therefore corresponds to a means of selection . it is pointed out that means are associated to the comparator 151 to provide a reference value of the same nature ( pressure or flow rate ) to the input 1511 of this comparator as the value transmitted to the input 1512 of the comparator , according to the position of the switch . a control unit 51 capable of controlling the operation of the switch 152 , by means of a connection 510 . this control unit is also connected to : the sensors 111 and 112 , from which it receives the measurements in real time , the motor controlling the valve 113 , to control its operation . in fact , the opening of the valve cock must be directly proportional : to the desired flow rate , in the volumetric mode , to a desired pressure ramp , in the barometric mode . the switch control allows the operation of the pressure source to be regulated based on the pressure measurements ( barometric mode ) or the flow rate measurements ( volumetric mode ). also , according to the position of the switch 152 , which determines the operating mode of the apparatus ( barometric or volumetric ), an adapted reference value ( of pressure or flow rate ) is as stated provided to the reference value input 1511 . when the switch 152 connects the input 1512 to the output of the pressure sensor 111 , the apparatus is set to barometric mode . now when the switch 152 connects the input 1512 to the output of the flow rate sensor 112 , the apparatus is set to volumetric mode . the control means 50 thus comprise a direct closed regulation circuit between the sensors 111 and 112 , which characterize in real time and continuously the operation of the apparatus , and the pressurized gas source 100 . this direct closed regulation circuit permits the reference value transmitted to the source 100 to be adjusted in real time . it also permits the operating mode to be modified in real time : the selection of the sensor 111 using the switch corresponds to a 5 barometric mode , the selection of the sensor 112 using the switch corresponds to a volumetric mode . more precisely , this regulation circuit permits the nature ( pressure or flow rate ) of the parameter from which the operating reference value of the source 100 is defined to be modified within a phase ( inhalation or expiratory ). more precisely still , the specific combination according to the invention of the following elements : a low inertia centrifugal fan type turbine with axial intake , an inhalation valve capable of operating proportionally , a direct closed regulation loop using means to select the nature of the parameter ( flow rate or pressure ), controlled automatically and in real time by the control unit 51 , this combination permits in fact to control the operation of the apparatus with great precision in real time . this advantage extends to the control of wide ranges of flow rates , as mentioned in the introduction of this text . this combination also permits the source 100 to be controlled with great precision , in particular in the perspective of the purposes and objectives of the invention previously mentioned in this text . this configuration , which permits the operating mode to be changed in real time , based on monitoring of the operation of the apparatus and the parameters stored in a memory of the means 50 connected to the control unit , thus also offers very flexible use . in its different variants , the apparatus according to the invention can be operated in particular in a volumetric mode . in such case , the operation of the device is different from the operation of the device disclosed in fr 2 812 203 . indeed , in the case of the present invention the volumetric modes are operated on the basis of a control of the gas source . more precisely , the gas source is permanently controlled ( through connection 1510 ) as a function of the desired gas flow ( or volume ) to be delivered to the patient . more precisely even , in volumetric modes the flow is permanently measured by the flow sensor 112 , and exploited by the control means 50 to control the operation of the gas source 100 . it is specified that in the volumetric modes the rotating element of the inhalation valve 113 is controlled at the beginning of each inspiratory cycle so that it takes a certain position . then , during the inspiratory cycle , the position of this rotating element does not change anymore . the “ certain position ” mentioned above corresponds to an opening of the inhalation valve which allows a flow value through the valve substantially equal to the value desired for the patient . but in the case of the invention , the control of the apparatus is then not performed so as to keep a pressure difference between the upstream and downstream parts of the inhalation valve ( like it is the case in the apparatus of fr 2 812 203 ). instead , it is the operation of the gas source itself which is permanently controlled . it is specified that the control of the gas source is preferably the control of the rotation speed of the rotor of the compressor of the gas source in the case of a gas source which is a turbine — or compressors , these two terms being understood as equivalent in the present text ). and in the case of the invention the flow measured in the duct 110 is exploited for controlling the gas source . as mentioned above , the configuration presented above allows among others the operation according to different modes ( and a change of the respiratory mode in real time within a given respiratory cycle ). for example , it is possible to operate the apparatus in vaps ( volume assured pressure support ) mode in real time . such a mode uses the barometric mode and can transfer the mode to a volumetric mode in real time — including within a same inhalation or expiratory cycle . at the beginning , operation in barometric mode , an algorithm then monitors the volume of respiratory gas supplied to the patient on a constant basis , and extrapolates the volumes already supplied during the inhalation phase to determine if in a given pre - determined time , a pre - determined target volume will be indeed supplied to the patient during this phase . if the algorithm determines that this is not the case , the operation of the apparatus is forced into volumetric mode to supply the patient with a volume which permits this target to be met . it is clear that in such a mode , the switch 152 plays an important role ( in particular for the forced mode change mentioned ). also , the specific combination mentioned above is particularly advantageous for applying this mode . similarly , the invention significantly facilitates the application of other modes , for example the simv ( synchronous intermittent mandatory ventilation ) mode . it can be remarked in fig2 that the auxiliary pressure source 140 which controls the pressure line 1332 of the expiratory valve is directly connected to this valve , with no intermediate elements . this measure is made possible by the use of a micro - turbine for the auxiliary pressure source 140 . in fact , such a micro - turbine does not generate the unwanted side effects ( vibrations , operating anomalies , etc .) observed with traditional auxiliary pressure sources such as compressors , on flap of which is controlled by an alternating back and forth movement . it thus permits to dispense with the additional means ( filters , etc .) that are usually positioned between the auxiliary pressure source and the expiratory valve , to protect this valve from the unwanted side effects . the micro - turbine 140 can operate continuously , without its operation needing to be regulated . in this case , the expiratory valve is controlled by selective connection between the control line 1332 of the expiratory valve and the micro - turbine . this selective connection is provided by selection means ( not shown ) associated to the valve 135 . it is pointed out that the end 120 is fitted with a pressure sensor to monitor , during the expiratory phases , the pressure at the patient and to transmit , in real time , this pressure to the control unit 51 for control by the control unit by means of a regulation circuit ( not shown ) of the compressor 140 . it has already been stated that the inhalation valve 113 was capable of operating proportionally . more precisely , in one embodiment of the invention , this valve comprises : a valve body comprising an orifice connected to the inhalation duct , and , a moving ( rotating ) element , such as a cock , capable of blocking the said orifice in a closed position , and at least partially free this orifice in the open position . the said moving element features a recess that can be aligned with the said orifice of the valve body to allow the gas from the gas source to pass through to the inhalation duct , the said recess comprising : a first part , whose geometry corresponds to a proportional operation of the inhalation valve when the said first part is aligned with the said orifice , a second part , whose geometry corresponds to an all or nothing operation of the inhalation valve when the said second part is aligned with the said orifice . the recess of the cock may be shaped so that when the said cock 5 moves to move the inhalation valve from its closed position to its open position , the said first part is first of all aligned with the recess , then the said second part is then aligned with the said recess , if this movement continues . in this way , the command to open the inhalation valve causes firstly a progressive opening ( corresponding to a proportional operation of the valve ), then an extension of the opening of the valve to an all or nothing mode . fig3 shows diagrammatically in a developed view an orifice 1130 in the body of the valve and a recess 1131 of a cock . the recess 1131 has a contour formed by a first part 11311 that is more or less triangular , and a second part 11312 that is more or less rectangular . a base of the triangle of the first part of the recess is parallel with one side of the rectangle of the second part of the recess . this configuration permits both rapid opening of the valve 113 and very good control . in particular , in volumetric modes fine control can be achieved for small desired values of flow , and quick operation can be achieved for higher desired values of flow . indeed , when a small volume is desired for the patient in a volumetric mode , the cock of the valve is controlled so as to make a small angular move between the closed position of the valve and a target angular position . this target angular position shall typically define a passageway for the flow of gas with the “ proportional ” part 11311 of opening 1131 . this allows a fine definition of the volume which will flow through the passageway of the valve . this allows control of flow values as small as 4 liters / minute in volumetric modes , while the prior art apparatuses generally only allowed control of flow values larger than about 20 liters / minute . for larger desired values of the flow , the angular position can possibly define a passageway for the flow of gas with the contribution of the part 11312 of opening 1131 . in this part of the aperture , the rotation of the cock allows to reach faster an angular position corresponding to the large desired value for the flow . however , in a preferred embodiment of the invention the aperture 1311 of the cock shall be designed so that the volumetric modes shall use only the first part 13111 of this aperture . in this preferred embodiment , the other part 13112 of the aperture shall correspond to angular positions of the cock used for barometric modes . in these barometric modes indeed , the cock can typically be controlled so as to be wide open at the beginning of an inspiratory cycle , and a large passageway through the valve is desired to control the operation of the apparatus on the basis of a pressure parameter . this is obtained by the fact that the first part 11311 of the recess 1131 has two edges 113111 and 113112 angled with respect to the direction x that the cock moves in with respect to the valve body . fig4 represents a variant of an embodiment of the invention . in the embodiment , another flow sensor 132 is positioned on the exhalation duct 130 . the control means 50 comprise among others comparison and processing means 52 which are connected to the flow sensors 112 ( by a connection 1120 ) and 132 ( by a connection 1320 ). these means 52 are capable of monitoring and comparing the respective flow rates in the inhalation 110 and expiratory 130 ducts in real time . these means are also associated to processing means capable of filtering the difference between the said respective flow rates in real time . these means 52 therefore monitor in real time the difference in flow rate between the inhalation and expiratory ducts . the said processing means are connected to the control unit 51 . they include among others a memory and a processor programmed to trigger a new inhalation phase via the control unit 51 when the said filtered difference is higher than a determined threshold . more precisely , during the expiratory phases , if the volumetric mode is selected , these means 52 constantly monitor the change in the difference between the respective flow rates between the inhalation and expiratory ducts ( difference corresponding to the difference in flow rate ). these means 52 are also connected to a memory , and together they can establish during the expiratory phases if the difference in flow rate corresponds : if the value of the difference in flow rate remains below a memorized threshold , simply to a leak at the end 120 of the inhalation duct , or if the value of the difference in flow rate exceeds this memorized threshold , to a greater difference in flow rate , associated to the start of a demand from the patient for a new inhalation phase — in this case , the means 52 transmit a specific signal to the control unit 51 in order that it adapts the reference values sent to the comparator 151 to trigger a new inhalation phase . it therefore appears after reading the above description that an apparatus of the invention is advantageous . in fact , such an apparatus permits the barometric and the volumetric modes to be combined . it permits control with great precision for wide flow rate ranges . furthermore , as we saw above , in volumetric mode , during the expiratory phases it is possible to monitor the difference in flow rate between the inhalation an expiratory circuits and to trigger new inhalation phases automatically , according to the monitoring data . it may also be remarked that in the case of the invention , the control of the leak rate on the one hand , and the pep on the other hand , are carried out independently . it is pointed out that the “ leak rate ” corresponds to a flow rate that is to be established in the inhalation duct , even during the expiratory phases . such a leak rate is particularly used and known as part of non - invasive ventilation ( which is to say that the end 120 of the inhalation duct is in the form of a mask ). the leak rate in the case of the invention is carried out by the inhalation valve 113 . the selective control of the proportional opening of this valve allows the value of the said leak rate to be controlled precisely . in the apparatus where the inhalation valve is not a specific valve as used in the invention ( for example in apparatus where this inhalation valve is a bladder valve similar to the expiratory valve 133 ), then a leak connection needs to be fitted in parallel to the inhalation valve , to establish a certain pressure in the inhalation circuit 110 even when the inhalation valve is closed . the use of an inhalation valve capable of proportional operation allows this connection to be dispensed with . the leak rate is thus controlled by the controlled opening of the inhalation valve , while the pep is controlled by the micro - turbine 140 and the expiratory valve . this disposition is advantageous with respect to apparatus of the existing technique with an inhalation valve of the same type as the expiratory valve 133 of the examples described above . in the case of these known apparatus when a new inhalation phase is started , the pressure source controls the opening of the inhalation valve pneumatically , which then changes suddenly from a closed position to an open position . this pneumatic control is provided by a pneumatic connection established directly between the pressure source and the expiratory valve ( a similar connection to the 1331 connection shown in these figures that controls the expiratory valve ). the inhalation valve consequently acts like an “ all or nothing ” valve . temporary excess pressure may result in the inhalation duct , which is a source of discomfort for the patient . this can be especially the case if the pressure source is a turbine , and if a pep is to be used during the expiratory phases . in fact this case , given that the value of the pep depends on the speed of rotation of the turbine , then a suitable reference value must be provided for the speed of rotation ( the reference value provided by the connection of the control unit to the pressurized gas source is then typically a speed of rotation reference value ). the speed of rotation of the turbine is then adapted to maintain a pep of the desired value , by means of a leak connection . however , when a new inhalation phase is started , this speed of rotation may cause excess pressure in the inhalation duct that is freed by the open inhalation valve . although the invention herein has been described with reference to particular embodiments , it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention . it is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims .
a breathing assistance apparatus operates in alternating inhalation and expiratory phases wherein a ) the control means of the apparatus comprise selection means capable of selecting a pressure parameter or a flow rate parameter to define ; b ) the reference value for the gas source , the selection means are controlled by an automatic control unit being : i ) connected to pressure and flow rate sensors situated on the inhalation duct to form a direct closed regulation loop for selecting a reference value parameter , ii ) associated to a program allowing the selection to be made in real time from a pressure or flow rate signal , so that the association of a direct closed regulation circuit for the selection of a reference value parameter with a valve permitting proportional operation , allows real time control of barometric and volumetric operating modes , between and during the inhalation and expiratory phases . the invention also concerns associated operating processes .