U.S. patent application number 15/128734 was filed with the patent office on 2018-11-08 for gas therapy system.
The applicant listed for this patent is Fisher & Paykel Healthcare Limited. Invention is credited to Alicia Jerram Hunter EVANS, Jonathan David HARWOOD, Quinton Michael SMITH, Callum James Thomas SPENCE, John Whitney STOREY.
Application Number | 20180318531 15/128734 |
Document ID | / |
Family ID | 54288151 |
Filed Date | 2018-11-08 |
United States Patent
Application |
20180318531 |
Kind Code |
A9 |
SPENCE; Callum James Thomas ;
et al. |
November 8, 2018 |
GAS THERAPY SYSTEM
Abstract
A respiratory therapy system configured to deliver gases to a
patient can have a non-sealed gas flow generating arrangement
configured to deliver a high flow of positive gas to an airway of a
patient and a negative flow of gas away from an airway of the
patient. The positive and negative flows of gas can be generated
simultaneously. The flow of positive and negative gases reduces
exhaled gases in anatomical dead spaces of the patient.
Inventors: |
SPENCE; Callum James Thomas;
(Auckland, NZ) ; STOREY; John Whitney; (Auckland,
NZ) ; HARWOOD; Jonathan David; (Auckland, NZ)
; SMITH; Quinton Michael; (Auckland, NZ) ; EVANS;
Alicia Jerram Hunter; (Auckland, NZ) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Fisher & Paykel Healthcare Limited |
Auckland |
|
NZ |
|
|
Prior
Publication: |
|
Document Identifier |
Publication Date |
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US 20180078719 A1 |
March 22, 2018 |
|
|
Family ID: |
54288151 |
Appl. No.: |
15/128734 |
Filed: |
April 10, 2015 |
PCT Filed: |
April 10, 2015 |
PCT NO: |
PCT/NZ2015/050044 PCKC 00 |
371 Date: |
September 23, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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61978662 |
Apr 11, 2014 |
|
|
|
62034061 |
Aug 6, 2014 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61M 2230/205 20130101;
A61M 16/161 20140204; A61M 2205/50 20130101; A61M 2206/20 20130101;
A61M 16/0672 20140204; A61M 2205/3368 20130101; A61M 2230/10
20130101; A61M 2016/0027 20130101; A61M 2230/50 20130101; A61M
2230/202 20130101; A61M 16/16 20130101; A61M 2016/1025 20130101;
A61M 2016/0033 20130101; A61M 2016/103 20130101; A61M 16/0009
20140204; A61M 2230/201 20130101; A61M 16/0069 20140204; A61M
16/0666 20130101; A61M 2230/06 20130101; A61M 16/0677 20140204;
A61M 2230/435 20130101; A61M 16/024 20170801; A61M 16/0057
20130101; A61M 16/08 20130101; A61M 2230/432 20130101; A61M 16/109
20140204 |
International
Class: |
A61M 16/00 20060101
A61M016/00; A61M 16/06 20060101 A61M016/06; A61M 16/08 20060101
A61M016/08; A61M 16/16 20060101 A61M016/16 |
Claims
1. A respiratory therapy system comprising: a positive gas flow
source; a negative gas flow source; at least one gas passageway
adapted to provide a non-sealed pneumatic link between an airway of
a patient and the positive and negative gas flow sources; and a
hardware controller which controls the positive gas flow source to
deliver a positive flow of gas to a subject via the at least one
gas passageway and control the negative gas flow source to provide
a negative flow of gas configured to draw gas from the airway of a
patient at a sufficient flow rate to reduce a concentration of an
exhaled gas in a physiological dead space of a subject.
2. The respiratory therapy system of claim 0, wherein the positive
gas flow source and the negative gas flow source are provided
simultaneously.
3. The respiratory therapy system of claim 0, wherein the positive
flow of gas comprises a rate of at least 10 liters per minute.
4. The respiratory therapy system of claim 2, wherein the positive
flow of gas comprises a rate of about 20 liters per minute to about
40 liters per minute.
5. The respiratory therapy system of claim 0, wherein the negative
flow of gas comprises a rate of at least 0.5 liters per minute.
6. The respiratory therapy system of claim 0, wherein the negative
flow of gas comprises a rate that is at least 25% of a rate of the
positive flow of gas.
7. The respiratory therapy system of claim 0, the system comprising
a first gas passageway adapted to provide a non-sealed pneumatic
link between an airway of a patient and the positive gas flow
source and a second gas passageway adapted to provide a non-sealed
pneumatic link between an airway of a patient and the negative gas
flow source, wherein the first gas passageway and the second gas
passageway interface with a patient interface that substantially
maintains pneumatic isolation of the positive and negative flows of
the first gas passageway and the second gas passageway.
8. The respiratory therapy system of claim 7, wherein the patient
interface is a nasal cannula comprising a first nasal prong and a
second nasal prong, the first and second nasal prongs adapted to be
fitted into the nares of the patient, and a manifold in pneumatic
communication with the nasal prongs, the first gas passageway, and
the second gas passageway.
9. The respiratory therapy system of claim 8, wherein the first gas
passageway extends into the first nasal prong and the second gas
passageway extends into the second nasal prong.
10. The respiratory therapy system of claim 7, further comprising a
transfer module configured to transfer moisture and/or heat from
the second gas passageway to the first gas passageway.
11. The respiratory therapy system of claim 0, wherein the
non-sealed pneumatic link comprises an occlusion of less than 95%
of the airway of the patient.
12. A method of delivering gas to the airway of a subject in need
thereof, improving the ventilation of a subject in need thereof,
reducing the volume of anatomical dead space within the volume of
the airway of a subject in need thereof, and/or treating a
respiratory condition or a sleep disorder in a subject in need
thereof, the method comprising: providing a positive gas flow
source; delivering, using the positive gas flow source, a
continuous flow of positive gas to the airway of a subject via at
least one gas passageway adapted to provide a non-sealed pneumatic
link between an airway of a patient and the positive gas flow
source; providing a negative gas flow source; drawing gas, using
the negative gas flow source, from the airway of the subject at a
flow rate sufficient to reduce a concentration of an exhaled gas in
a physiological dead space of a subject's airways.
13. The method of claim 12, wherein the delivering and the drawing
are performed simultaneously.
14. The method of claim 12, wherein drawing gas using the negative
flow source comprises drawing gas at a rate of at least 0.5 liters
per minute.
15. The method of claim 12, wherein drawing gas using the negative
flow source comprises drawing gas at a rate of at least 25% of a
rate of the positive glow of gas.
16. The method of claim 12, wherein gas is delivered to the airway
of the subject through a first gas passageway and gas is drawn from
the airway of the subject through a second gas passageway that is
substantially pneumatically isolated from the first gas
passageway.
17. The method of claim 16, wherein the first and second gas
passageways are pneumatically connected to one or more patient
interfaces that substantially maintain the pneumatic isolation of
the flow of gas in each passageway.
18. The method of claim 12, wherein gas is delivered to the airway
of the subject through a first patient interface and gas is drawn
from the airway of the subject through a second patient interface
or the same interface.
19. The method of claim 12, wherein the gas pressure in the
subject's airway is measured.
20. The method of claim 12, wherein the oxygen concentration of the
subject's airway is maintained at a substantially constant level or
increased.
21. The method of claim 12, wherein the carbon dioxide
concentration of the subject's airway is maintained at a
substantially constant level or reduced.
22. The method of claim 12, wherein the peripheral capillary oxygen
saturation of the subject is measured.
23. The method of claim 12, wherein the peripheral capillary oxygen
saturation of the subject is maintained at a substantially constant
level or increased.
24. The method of claim 12, wherein the peripheral capillary oxygen
saturation of the subject is increased compared to nasal high flow
therapy conducted at an equivalent flow rate.
25. The method of claim 12, wherein the non-sealed pneumatic link
provides less than 95% occlusion of the airway of the patient.
26. The respiratory therapy system of claim 8, wherein both the
first gas passageway and the second gas passageway extend into each
of the first nasal prong and the second nasal prong.
Description
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS
[0001] The present application is a national phase of PCT
Application No. PCT/NZ2015/050044, filed Apr. 10, 2015, titled "GAS
THERAPY SYSTEM," which claims priority benefit under 35 U.S.C.
.sctn.119(e) to U.S. Provisional Patent Application Ser. No.
61/978,662, filed Apr. 11, 2014 titled "GAS THERAPY SYSTEM,"; U.S.
Provisional Patent Application Ser. No. 62/034,061, filed Aug. 6,
2014, and any and all applications for which a foreign or domestic
priority claim is identified in the Application Data Sheet as filed
with the present application. Each of the foregoing are hereby
incorporated by reference under 37 CFR 1.57.
FIELD OF THE DISCLOSURE
[0002] The present disclosure generally relates to respiratory
therapy. More particularly, the present disclosure relates to gas
delivery systems for use in respiratory therapy.
BACKGROUND
[0003] A patient dealing with respiratory illness, for example
chronic obstructive pulmonary disease (COPD), can have difficulty
engaging in effective respiration. This difficulty may be the
result of a variety of physiological faults, including a breakdown
of lung tissue, dysfunctions of the small airways, excessive
accumulation of sputum, infection, genetic disorders, or cardiac
insufficiency. With such illnesses, it is useful to provide the
patient with a therapy that can improve the ventilation of the
patient. In some situations, the patient can be provided with a
respiratory therapy system that includes a gas source, an interface
that may be used to transmit gas to an airway of a patient, and a
conduit extending between the gas source and the interface. Gas
delivered to an airway of the patient from the gas source can help
to promote adequate ventilation of the patient. The gas source may,
for example, be a container of air and/or another gas suitable for
inspiration, for example, oxygen or nitric oxide, a mechanical
blower capable of propelling a gas through the conduit to the
interface, or some combination of both. The respiratory therapy
system may include structure used to heat and/or humidify gases
passing through the system to improve patient comfort and/or
improve the prognosis of the patient's respiratory illness.
[0004] A patient suffering from respiratory conditions may benefit
from reducing the volume of air that he inhales that does not take
part in the normal gas exchange of oxygen (02) and carbon dioxide
(CO2). This volume of air is contributed to by anatomical dead
space, which is gas that includes exhaled CO2 captured in the
patient's airways that is rebreathed upon inspiration. To reduce
dead space, the patient can be treated with high flow therapy,
which can involve the administration of gas to the airways of a
patient at a relatively high flow rate and at a relatively low
pressure. The high flow of gases reaching the patient's airways can
be beneficial for flushing out the patient's airways, which can
reduce the volume of anatomical dead space. High flow therapy is
often delivered with an unsealed patient interface such as, for
example, a nasal cannula.
[0005] It is an object of certain embodiments disclosed herein to
provide an improved or alternative system and method for
respiratory therapy that might overcome or ameliorate problems with
existing systems or methods, or at least provide the public with a
useful choice.
SUMMARY
[0006] Although high flow therapy may be useful for reducing the
level of anatomical dead space in the airways of a patient, the
level of dead space clearance may be limited by the flow rate of
gases supplied to the patient and/or by the path taken by gases
expelled from the patient's airways. For example, if the patient is
receiving high flow therapy and is using a nasal cannula, if the
patient's mouth is open, exhaled gases may travel up the airways
and leave the patient's body through the mouth or through the
nares. However, if the patient's mouth is closed, exhaled gases may
leave the patient's body substantially through the nares. The level
of anatomical dead space present if the patient's mouth is closed
may be greater than the level of anatomical dead space present if
the patient's mouth is open because the exhaled gases may be
required to travel further along the patient's airways to escape
the body. Additionally, for some patients, the respiratory effort
necessary for inhalation and/or exhalation is difficult to meet.
More respiratory effort may be required to force the exhaled gases
from the nares relative to the respiratory effort required to force
the exhaled gases from both the mouth and nares. This additional
respiratory effort may be difficult to achieve for a patient with
impaired respiratory function.
[0007] Thus, in accordance with certain features, aspects and
advantages at least some of the embodiments disclosed herein, a
respiratory therapy system is disclosed that provides additional
and/or alternative anatomical dead space respiratory clearance
assistance. The respiratory therapy system may comprise a
non-sealed gas flow generating arrangement. A first gas passageway
may be adapted to pneumatically link at least a part of the gas
flow generating arrangement to an airway of the patient. A second
gas passageway may be adapted to pneumatically link at least a part
of the gas flow generating arrangement to an airway of the patient.
The gas flow generating arrangement may be configured to
simultaneously deliver gases at a positive flow rate through the
first gas passageway and draw gases at a negative flow rate through
the second gas passageway. The first gas passageway may be
substantially pneumatically isolated from the second gas
passageway. The negative flow rate can provide additional and/or
alternative anatomical dead space clearance. In some embodiments,
the negative flow provides additional clearance. In some
embodiments, the negative flow allows for a reduction in positive
flow without compromising the anatomical dead space clearance. This
can provide greater physical comfort to a patient.
[0008] In some embodiments, a respiratory therapy system is
disclosed. The system has a positive gas flow source, a negative
gas flow source, at least one gas passageway adapted to provide a
non-sealed pneumatic link between an airway of a patient and the
positive and negative gas flow sources, and a hardware controller
which controls the positive gas flow source to deliver a positive
flow of gas to a subject via the at least one gas passageway and
control the negative gas flow source to provide a negative flow of
gas configured to draw gas from the airway of a patient at a
sufficient flow rate to reduce a concentration of an exhaled gas in
a physiological dead space of a subject. In some embodiments, the
positive gas flow source and the negative gas flow source are
provided simultaneously. In some embodiments, the positive flow of
gas comprises a rate of at least 10 liters per minute. In some
embodiments, the positive flow of gas comprises a rate of about 20
liters per minute to about 40 liters per minute. In some
embodiments, the negative flow of gas comprises a rate of at least
0.5 liters per minute. In some embodiments, the negative flow of
gas comprises a rate that is at least 25% of a rate of the positive
flow of gas. In some embodiments, the system comprises a first gas
passageway adapted to provide a non-sealed pneumatic link between
an airway of a patient and the positive gas flow source and a
second gas passageway adapted to provide a non-sealed pneumatic
link between an airway of a patient and the negative gas flow
source. In some embodiments, the first and second gas passageways
are both in a single conduit. In some embodiments, the first gas
passageway is in a first conduit and the second gas passageway is
in a second conduit. In some embodiments, the first gas passageway
interfaces with a first patient interface and the second gas
passageway interfaces with a second patient interface. In some
embodiments, the first patient interface is a nasal interface and
the second patient interface is an oral interface, or wherein the
first patient interface is an oral interface and the second patient
interface is a nasal interface. In some embodiments, the first gas
passageway and the second gas passageway interface with a patient
interface that substantially maintains pneumatic isolation of the
positive and negative flows of the first gas passageway and the
second gas passageway. In some embodiments, the patient interface
is a nasal cannula. In some embodiments, the nasal cannula
comprises a first nasal prong and a second nasal prong, the first
and second nasal prongs adapted to be fitted into the nares of the
patient, and a manifold in pneumatic communication with the nasal
prongs, the first gas passageway, and the second gas passageway. In
some embodiments, a first side of the manifold accepts the first
gas passageway, and wherein a second side of the manifold accepts
the second gas passageway. In some embodiments, the first gas
passageway extends into the first nasal prong and the second gas
passageway extends into the second nasal prong. In some
embodiments, both the first and second gas passageways extend into
each of the first nasal prong and the second nasal prong. In some
embodiments, both the first and second gas passageways enter the
manifold on a single side of the manifold. In some embodiments,
also includes a humidifier adapted to heat and/or humidify gases
passing through the first gas passageway. In some embodiments, the
system also has a transfer module configured to transfer moisture
and/or heat from the second gas passageway to the first gas
passageway. In some embodiments, the transfer module comprises a
wick or absorbent material. In some embodiments, non-sealed
pneumatic link comprises an occlusion of less than 95% of the
airway of the patient. In some embodiments, the non-sealed
pneumatic link comprises an occlusion of less than 90% of the
airway of the patient. In some embodiments, the non-sealed
pneumatic link comprises an occlusion of between 40% and 80% of the
airway of the patient. In some embodiments, the airway is one or
more of a nare or mouth. In some embodiments, the non-sealed
pneumatic link delivers 1 cm or less of pressure per 10 L/min of
flow. In some embodiments, the non-sealed pneumatic link delivers 1
cm or less of pressure per 15 L/min of flow.
[0009] A method of delivering gas to the airway of a subject in
need thereof is also disclosed. The method improves the ventilation
of a subject in need thereof, reducing the volume of anatomical
dead space within the volume of the airway of a subject in need
thereof, and/or treating a respiratory condition or a sleep
disorder in a subject in need thereof. The method can include
providing a positive gas flow source, delivering, using the
positive gas flow source, a continuous flow of positive gas to the
airway of a subject via at least one gas passageway adapted to
provide a non-sealed pneumatic link between an airway of a patient
and the positive gas flow source, providing a negative gas flow
source, and drawing gas, using the negative gas flow source, from
the airway of the subject at a flow rate sufficient to reduce a
concentration of an exhaled gas in a physiological dead space of a
subject's airways. In some embodiments, the delivering and the
drawing are performed simultaneously. In some embodiments, the
delivering the continuous flow of gas comprises delivering a
positive flow of gas at a rate of at least 10 liters per minute. In
some embodiments, the delivering the continuous flow of gas
comprises delivering a positive flow of gas at a rate of at least
20 liters per minute. In some embodiments, drawing gas using the
negative flow source comprises drawing gas at a rate of at least
0.5 liters per minute. In some embodiments, drawing gas using the
negative flow source comprises drawing gas at a rate of at least
25% of a rate of the positive glow of gas. In some embodiments, gas
is delivered to the airway of the subject through a first gas
passageway and gas is drawn from the airway of the subject through
a second gas passageway that is substantially pneumatically
isolated from the first gas passageway. In some embodiments, the
first and second gas passageways are pneumatically connected to one
or more patient interfaces that substantially maintain the
pneumatic isolation of the flow of gas in each passageway. In some
embodiments, the first and second gas passageways are in separate
conduits or a single conduit. In some embodiments, gas is delivered
to the airway of the subject through a first patient interface and
gas is drawn from the airway of the subject through a second
patient interface. In some embodiments, gas is delivered to the
airway of the subject through a first patient interface and gas is
drawn from the airway of the subject through the same patient
interface. In some embodiments, the first patient interface is a
nasal interface and the second patient interface is an oral
interface, or the first patient interface is an oral interface and
the second patient interface is a nasal interface. In some
embodiments, the first patient interface is a nasal interface or an
oral interface. In some embodiments, the nasal interface is a nasal
cannula. In some embodiments, the nasal interface is a nasal
cannula. In some embodiments, the nasal cannula comprises a first
nasal prong that delivers a continuous flow of gas to the airway
and a second nasal prong that simultaneously draws gas from the
airway. In some embodiments, the nasal cannula comprises a first
nasal prong and a second nasal prong, each nasal prong delivering a
continuous flow of gas to the airway and simultaneously drawing gas
from the airway. In some embodiments, the subject's mouth is closed
or sealed. In some embodiments, the subject's mouth is open. In
some embodiments, the gas pressure in the subject's airway is
measured. In some embodiments, the gas pressure in the subject's
airway is maintained at a level of less than about 4 cm H2O,
preferably at a level of less than about 3.5, 3, 2.5, 5 or 1 cm
H2O, preferably with the subject's mouth open or closed, preferably
with the subject's mouth closed. In some embodiments, the oxygen
concentration of the subject's airway is measured. In some
embodiments, the oxygen concentration of the subject's airway is
maintained at a substantially constant level or increased. In some
embodiments, the carbon dioxide concentration of the subject's
airway is measured. In some embodiments, the carbon dioxide
concentration of the subject's airway is maintained at a
substantially constant level or reduced. In some embodiments, the
molar fraction of carbon dioxide in the upper airway of the subject
is reduced by at least about 10 molar % compared to the molar
fraction of carbon dioxide in the upper airway of the subject when
breathing without assistance. In some embodiments, wherein the
molar fraction of carbon dioxide in the upper airway of the subject
is reduced by at least about 1 molar % compared to nasal high flow
therapy conducted at an equivalent flow rate when the subject's
mouth is open. In some embodiments, wherein the molar fraction of
carbon dioxide in the upper airway of the subject is reduced by at
least about 10 molar % compared to nasal high flow therapy
conducted at an equivalent flow rate when the subject's mouth is
closed. In some embodiments, the peripheral capillary oxygen
saturation of the subject is measured. In some embodiments, the
peripheral capillary oxygen saturation of the subject is maintained
at a substantially constant level or increased. In some
embodiments, the peripheral capillary oxygen saturation of the
subject is increased compared to nasal high flow therapy conducted
at an equivalent flow rate. In some embodiments, the non-sealed
pneumatic link provides less than 95% occlusion of the airway of
the patient. In some embodiments, the non-sealed pneumatic link
provides less than 90% occlusion of the airway of the patient. In
some embodiments, the non-sealed pneumatic link provides between
40% and 80% occlusion of the airway of the patient. In some
embodiments, the airway is one or more of a nare or mouth. In some
embodiments, the delivering delivers gas at 1 cm or less of
pressure per 10L/min of flow. In some embodiments, the delivering
delivers gas at 1 cm or less of pressure per 15L/min of flow. In
some embodiments, the subject is hypoxic or hypoxemic or
hypercapnic before the method is carried out. In some embodiments,
the respiratory condition is chronic obstructive pulmonary disease,
asthma, pneumonia, bronchitis, or emphysema. In some embodiments,
the sleep disorder is obstructive sleep apnoea. In some
embodiments, the method is carried out using a system of any one of
claims 1 to 11.
[0010] In some configurations, a gas flow generating arrangement is
disclosed which may comprise a first flow generator adapted to
deliver gases at a positive flow rate, and may comprise a second
flow generator adapted to draw gases at a negative flow rate. In
some configurations, the gas flow generating arrangement may
comprise a single flow generator configured to simultaneously
deliver gases through the first gas passageway and draw gases
through the second gas passageway. The flow of gases can be
provided using a non-sealed or non-occluded interface. In some such
configurations, the flow generator may comprise a motor. The motor
may comprise a shaft. The shaft may be coupled to a first impeller
and a second impeller. The motor may cause the shaft to rotate, and
the first and second impellers may rotate concurrently with the
shaft. The first impeller may be substantially pneumatically
isolated from the second impeller. In some configurations, the
first impeller may have a first housing, and the second impeller
may have a second housing. In some configurations, the first and
second impellers may share a single housing having individual
compartments for each of the first and second impellers. The
compartments may be sealed or pneumatically isolated from one
another through the use of an internal partition. The respiratory
therapy system may be configured such that, in use, the motion of
the first impeller may deliver gases through the first gas
passageway, and such that, in use, the motion of the second
impeller may draw gases through the second gas passageway and may
guide the gases to a flow generator outlet.
[0011] In some configurations, the first gas passageway may be in a
first conduit and the second gas passageway may be in a second
conduit. In some configurations, the first and second gas
passageways may lie in a single conduit. The conduit may comprise a
first second and a second section. The first section may
accommodate the first gas passageway and the second section may
accommodate the second gas passageway. The first and second
sections may be pneumatically isolated from one another. The
conduit may comprise a barrier. The barrier may pneumatically
isolate the first and second gas passageways.
[0012] In some configurations, the first gas passageway may
interface with a first patient interface and the second gas
passageway may interface with a second patient interface. In some
such configurations, the first patient interface may comprise a
nasal interface and the second patient interface may comprise an
oral interface. In some such configurations, the first patient
interface may comprise an oral interface and the second patient
interface may comprise a nasal interface. One or both of the first
patient interface and the second patient interface may comprise a
non-sealing interface.
[0013] In some configurations, the first gas passageway and the
second gas passageway may interface with a patient interface that
may substantially maintain pneumatic isolation of the positive and
negative flows of the first gas passageway and the second gas
passageway. The patient interface may comprise a non-sealing
interface. The non-sealing interface may comprise a nasal cannula.
The nasal cannula may comprise a first nasal prong and may comprise
a second nasal prong. The first and second nasal prongs may be
adapted to be fitted into the nares of the patient. The nasal
cannula may comprise a manifold that may be in pneumatic
communication with the nasal prongs, the first gas passageway, and
the second gas passageway. In some configurations, a first side of
the manifold may accept the first gas passageway, and a second side
of the manifold may accept the second gas passageway. In some
configurations, both the first and second gas passageways may be
pneumatically linked to a single side of the manifold. In some
configurations, the first gas passageway may extend into the first
nasal prong, and the second gas passageway may extend into the
second nasal prong. In some configurations, both the first and
second gas passageways may extend into each of the first nasal
prong and the second nasal prong.
[0014] In some configurations, the respiratory therapy system may
comprise a humidifier. The humidifier may be adapted to heat and/or
humidify gases passing through the first gas passageway. The
humidifier may be positioned in-line between the gas flow
generating arrangement and an airway of the patient. In some
configurations, the respiratory therapy system may comprise a
transfer module. The transfer module may be used to remove moisture
and/or heat from the second gas passageway, and may transfer this
moisture and/or heat to the first gas passageway. In some such
configurations, the transfer module may comprise a wick or
absorbent material. The wick or absorbent material may extend
between the first gas passageway and the second gas passageway. In
some such configurations, the wick or absorbent material may be
present in a patient interface, e.g. a nasal cannula. In some
configurations, the wick or absorbent material may be a component
of the gas flow generating arrangement.
[0015] In accordance with certain features, aspects and advantages
of at least one of the embodiments disclosed herein, a method of
delivering gas to the airway of a subject is also disclosed. In
various embodiments the method may comprise delivering gas to the
airway of a subject in need thereof, improving the ventilation of a
subject in need thereof, reducing the volume of anatomical dead
space within the volume of the airway of a subject in need thereof,
and/or treating a respiratory condition or a sleep disorder in a
subject in need thereof. In various embodiments, the method may
comprise delivering a continuous flow of gas to the airway of a
subject, preferably at a first flow rate of at least about 10
L/min, preferably about 10 to about 60 L/min, preferably about 20
to about 40 L/min, and simultaneously drawing gas from the airway
of the subject, preferably at a second flow rate that is the same
as or less than or greater than the first flow rate, preferably at
a second flow rate that is at least about 0.5 L/min, preferably at
a second flow rate that is at least about 25% of the first flow
rate, preferably at a second flow rate that is about 40 to about
60% of the first flow rate.
[0016] In various embodiments gas may be delivered to the airway of
the subject through a first gas passageway and gas may be drawn
from the airway of the subject through a second gas passageway that
is substantially pneumatically isolated from the first gas
passageway. In various embodiments the first and second gas
passageways may be pneumatically connected to one or more patient
interfaces that substantially maintain the pneumatic isolation of
the flow of gas in each passageway. In various embodiments the
first and second gas passageways may be in separate conduits or a
single conduit.
[0017] In various embodiments gas may be delivered to the airway of
the subject through a first patient interface and gas may be drawn
from the airway of the subject through a second patient interface.
In various embodiments gas may be delivered to the airway of the
subject through a first patient interface and gas may be drawn from
the airway of the subject through the same patient interface. In
various embodiments the first patient interface may be a nasal
interface and the second patient interface may be an oral
interface, or the first patient interface may be an oral interface
and the second patient interface may be a nasal interface. In
various embodiments the first patient interface may be a nasal
interface or an oral interface. In various embodiments the nasal
interface may be a nasal cannula. In various embodiments the nasal
cannula comprises a first nasal prong that delivers a continuous
flow of gas to the airway and a second nasal prong that
simultaneously draws gas from the airway, as described herein. In
various embodiments the nasal cannula comprises a first nasal prong
and a second nasal prong, each nasal prong delivering a continuous
flow of gas to the airway and simultaneously drawing gas from the
airway, as described herein. In various embodiments, a patient
interface may comprise a non-sealing interface where no seal is
formed at the nares and/or mouth of a subject.
[0018] In various embodiments the subject's mouth may be closed or
sealed. In various embodiments the subject's mouth may be open.
[0019] In various embodiments the gas pressure in the subject's
airway may be measured. In various embodiments the gas pressure in
the subject's airway may be maintained at a level of less than
about 4 cm H2O, preferably at a level of less than about 3.5, 3,
2.5, 5 or 1 cm H2O, preferably with the subject's mouth open or
closed, preferably with the subject's mouth closed.
[0020] In various embodiments the oxygen concentration of the
subject's airway may be measured. In various embodiments the oxygen
concentration of the subject's airway may be maintained at a
substantially constant level or increased.
[0021] In various embodiments the carbon dioxide concentration of
the subject's airway may be measured. In various embodiments the
carbon dioxide concentration of the subject's airway may be
maintained at a substantially constant level or reduced.
[0022] In various embodiments the molar fraction of carbon dioxide
in the upper airway of the subject may be reduced by at least about
10 molar % compared to the molar fraction of carbon dioxide in the
upper airway of the subject when breathing without assistance. In
various embodiments the molar fraction of carbon dioxide in the
upper airway of the subject may be reduced by at least about 1
molar % compared to nasal high flow therapy conducted at an
equivalent flow rate when the subject's mouth is open. In various
embodiments the molar fraction of carbon dioxide in the upper
airway of the subject may be reduced by at least about 10 molar %
compared to nasal high flow therapy conducted at an equivalent flow
rate when the subject's mouth is closed.
[0023] In various embodiments the peripheral capillary oxygen
saturation of the subject may be measured. In various embodiments
the peripheral capillary oxygen saturation of the subject may be
maintained at a substantially constant level or increased. In
various embodiments the peripheral capillary oxygen saturation of
the subject may be increased compared to nasal high flow therapy
conducted at an equivalent flow rate.
[0024] In various embodiments the method may be carried out using a
system for delivering and drawing gas that is not a closed system
and is vented to the surrounding atmosphere.
[0025] In various embodiments the subject may be hypoxic or
hypoxemic or hypercapnic before the method is carried out.
[0026] In various embodiments the respiratory condition may be
chronic obstructive pulmonary disease, asthma, pneumonia,
bronchitis, or emphysema.
[0027] In various embodiments the sleep disorder may be obstructive
sleep apnoea.
[0028] In various embodiments the method may be carried out using a
system described herein.
BRIEF DESCRIPTION OF THE DRAWINGS
[0029] Specific embodiments and modifications thereof will become
apparent to those skilled in the art from the detailed description
herein having reference to the figures that follow, of which:
[0030] FIG. 1A is a diagram of a respiratory therapy system
demonstrating certain features, aspects and advantages of some
configurations of the present disclosure.
[0031] FIG. 1B depicts a nasal cannula configuration.
[0032] FIG. 1C depicts a nasal cannula configuration.
[0033] FIG. 1D depicts a nasal cannula configuration.
[0034] FIG. 1E depicts a nasal cannula configuration.
[0035] FIG. 1F depicts a nasal cannula configuration.
[0036] FIG. 1G depicts a nasal cannula configuration.
[0037] FIG. 1H depicts a nasal cannula configuration.
[0038] FIG. 1I depicts a nasal cannula configuration.
[0039] FIG. 1J depicts a nasal cannula configuration.
[0040] FIG. 1K depicts a nasal cannula configuration.
[0041] FIG. 1L depicts a nasal cannula configuration.
[0042] FIG. 1M depicts a non-sealed nasal cannula
configuration.
[0043] FIG. 2A is a diagram of a respiratory therapy system
demonstrating certain features, aspects and advantages of some
configurations of the present disclosure.
[0044] FIG. 2B is a diagram of a respiratory therapy system
demonstrating certain features, aspects and advantages of some
configurations of the present disclosure.
[0045] FIG. 2C is a diagram of a respiratory therapy system
demonstrating certain features, aspects and advantages of some
configurations of the present disclosure.
[0046] FIG. 2D is a diagram of a respiratory therapy system
demonstrating certain features, aspects and advantages of some
configurations of the present disclosure.
[0047] FIG. 3 is a diagram of testing apparatus useful herein.
[0048] FIG. 4 is a graph of the airway CO2 level (Molar %) in (A)
an untreated control model subject, (B) a model subject treated
with nasal high flow therapy, (C) a model subject treated with
negative nasal high flow therapy drawing gas from the airway of the
model subject at 20 litres per minute, and (D) a model subject
treated with an exemplary embodiment of the presently disclosed
method, using negative nasal high flow therapy drawing gas from the
airway of the model subject at 16 litres per minute and positive
nasal high flow therapy delivering gas to the airway of the model
subject at 20 litres per minute.
[0049] FIG. 5 illustrates a flow chart of a process for providing
positive and negative high flow therapy to a patient.
DETAILED DESCRIPTION
[0050] Certain features, aspects and advantages of at least one of
the configurations disclosed herein include the realization that a
non-sealed respiratory therapy system may be configured such that a
positive gas flow may be delivered to an airway of a patient and a
negative gas flow may be drawn from an airway of a patient, wherein
the respiratory therapy system may be configured to simultaneously
generate both the positive and negative gas flows. `Positive flow,`
`positive gas flow,` `positive flow rate,` or other similar or
derivative phrases as referenced in this disclosure may be
interpreted to refer to gas flow that substantially progresses in a
direction towards an airway of the patient. `Negative flow,`
`negative gas flow,` `negative flow rate,` or other similar or
derivative phrases as referenced in this disclosure may be
interpreted to refer to gas flow that substantially progresses in a
direction away from an airway of the patient. `Non-sealed,`
`unsealed,` `non-occluded,` `unoccluded,` or other similar or
derivative phrases as referenced in this disclosure may be
interpreted to refer to a system that allows for gas exchange with
ambient air in order to provide high flow rates at relatively low
pressures. A further explanation of such a system is provided
below.
[0051] With reference to FIG. 1, a configuration for a respiratory
therapy system 100 is shown. In the illustrated configuration, the
respiratory therapy system 100 may comprise a gas flow generating
arrangement 101. The gas flow generating arrangement 101 may be
configured to generate a positive gas flow and a negative gas flow.
The gas flow generating arrangement 101 may be configured to
simultaneously generate a positive gas flow and a negative gas
flow. The gas flow generating arrangement 101 may comprise a first
flow generator 102 configured to generate a positive flow. The
first flow generator 102 may comprise a first gas inlet 104 and a
first gas outlet 106. The first flow generator 102 may comprise a
first blower 110. The first blower 110 may comprise a motor. The
motor may comprise a stator and a rotor. The rotor may comprise a
shaft. An impeller may be linked to the shaft. In use, the impeller
may rotate concurrently with the shaft to draw in gas from the
first gas inlet 104. The first flow generator 102 may comprise a
user interface 108, which may comprise one or more buttons, knobs,
dials, switches, levers, touch screens, speakers, displays, and/or
other input or output modules that a user might use to input
commands into the first flow generator 102 to view data and/or
control its operation and/or the operation of other aspects of the
respiratory therapy system 100. Operation of the first flow
generator 102 may result in the generation of a positive flow of
gas that may exit the first flow generator 102 through the first
gas outlet 106. The gas may move along a first gas passageway 126
that may extend from the first flow generator 102 to an airway of
the patient. The first gas passageway 126 may be in a first conduit
124. Optionally, a humidifier 133 may be located along the first
gas passageway 126. The humidifier 133 may comprise a humidifier
inlet 141 and a humidifier outlet 143. The humidifier 133 may
comprise water or another moisturizing agent (hereinafter referred
to as water). The humidifier 133 may comprise a heating element
(not shown). The heating element may be used to heat the water in
the humidifier 133 to encourage water vaporization and/or
entrainment in the gas flow and/or increase the temperature and/or
humidity of gases passing through the humidifier 133. The
humidifier 133 may comprise a user interface 145 which may comprise
one or more buttons, knobs, dials, switches, levers, touch screens,
speakers, displays and/or other input or output modules that a user
might use to input commands into the humidifier 133 to view data
and/or control its operation and/or the operation of other aspects
of the respiratory therapy system 100. The first conduit 124 may
comprise a heater. The heater may be used to add heat to gases
passing through the first conduit 124. The heat may prevent the
condensation of water entrained in the gas stream along a wall of
the first conduit 124. This heat may be useful if, for example, the
humidifier 133 is utilized. The heater may comprise one or more
resistive wires located in, on, around or near a wall of the first
conduit 124. Gas passing through the first gas passageway 126 may
be passed to a patient interface 132. The patient interface 132 may
comprise a non-sealing interface. As demonstrated in FIG. 1A, the
patient interface 132 may comprise a nasal cannula. However, the
patient interface 132 may comprise other interfaces, including but
not limited to nasal mask, an oral mask, an oro-nasal mask, a full
face mask, a nasal pillows mask, a nasal cannula, an endotracheal
tube, a nasogastric tube, a combination of the above or some other
gas conveying apparatus or system.
[0052] A sealed nasal interface is an interface which substantially
occludes a respiratory opening of a patient, such as one or more
nares and/or the mouth such that either or both of inhalation
and/or exhalation are forced through the cannula. The pressure of
gasses delivered to a patient in a sealed system is substantially
different than a non-sealed system, and thus the air flow dynamics
are substantially different between the two systems such that the
considerations applicable in a sealed system do not apply to a
non-sealed system. Moreover, sealed systems are used for different
types of patients suffering different types of respiratory problems
than a non-sealed system.
[0053] For example, U.S. Pat. No. 7,823,588 (the '588 patent)
describes a high pressure/high flow rate sealed interface system.
Col. 3, lines 39-52 of the '588 patent describes creating a peak
gas flow rate at the gas delivery device 222 (for example, a mask),
of 60 L/min by providing a pressure of about 35 cm H2O. This type
of high pressure/high flow system that includes gas pressures in
the realm of 40-60 cm, can be useful for ventilated patients when
delivered for short periods of time, for example during recruitment
manoeuvres, but can be dangerous when delivered for anything longer
than short periods of time. Moreover, sealed systems force can for
exhaled gas back into the patient's lungs as opposed to flushing
the exhaled air. Such systems, although useful for certain types of
clinical situations, are not useable for prolonged
administration.
[0054] High flow therapy, including nasal high flow therapy, is
generally provided using a non-sealed or non-occlusive system in
order to allow for a large flow of gases without an associated
significant increase in pressure. For example, for nasal high flow
therapy using an adult non-occlusive cannula delivering flows of
30, 40 and 50 L/min of humidified oxygen can generate
nasopharyngeal mean gas pressures of about 1.93 cm, 2.58 cm, and
3.31 cm respectively. This is roughly about 15 litres of flow per 1
cm pressure. In a sealed or occluded system, the gas pressure for a
given flow increases rapidly as the occlusion of the area of the
orifice, such as a nare, becomes quite high, for example, at around
95-100% occlusion of the oriface. A non-sealed interface, on the
other hand, would generate, for example, about 1 cm or less of
pressure per 10-15 L/min of flow.
[0055] A non-sealing nasal prong is generally designed to provide
less than 95% occlusion of the nares, and preferably less than 90%
occlusion of the nares. The actual size and shape of the nasal
prongs depends greatly on nare size of the patient. For example,
pediatric nasal cannula prongs will be significantly smaller in
size than adult nasal cannula prongs, despite providing an
equivalent amount of occlusion in the nares. In some embodiments,
the nasal prong is designed to provide only about 40-80% occlusion
to account for potential deformation of a prong against the inner
surface of the nare. This much smaller occlusion design is
particularly useful for neonate designs, but is still applicable to
pediatric and adult designs as well. In an embodiment, the nasal
prong in an adult non-occlusive nasal cannula is about 4mm in
diameter. In other embodiment, the diameter of nasal cannula can
range from about 3 mm in diameter to about 1 cm in diameter,
depending on the size and shape of the nasal passages of the
patient. Similar non-sealing considerations are also applicable to
masks that cover the mouth and masks that cover both the mouth and
nose as would be understood by a person of skill in the art from
the present disclosure.
[0056] With further reference to FIG. 1A, the respiratory therapy
system 100 may comprise a second flow generator 112. The second
flow generator 112 may comprise a second inlet 116 and a second
outlet 114. Likewise, the second flow generator 112 may comprise a
second blower 120 that may comprise a motor. The motor may comprise
a stator and a rotor. The rotor may comprise a shaft. An impeller
may be linked to the shaft. In use, the impeller may rotate
concurrently with the shaft to draw in gas from the second gas
inlet 116. The second flow generator 112 may comprise a user
interface 118 which may comprise one or more buttons, knobs, dials,
switches, levers, touch screens, speakers, displays and/or other
input or output modules that a user might use to input commands
into the second flow generator 112 to view data and/or control its
operation and/or the operation of other aspects of the respiratory
therapy system 100. Operation of the second flow generator 112 may
result in the generation of a negative flow of gas that may move
from an airway of a patient and through a second gas passageway
130. The first gas passageway 126 and the second gas passageway 130
may be substantially pneumatically isolated from one another. The
negative flow of gas may pass through the same interface 132 or a
different patient interface. The second gas passageway 130 may be
in a second conduit 128. The airway of the patient that is
pneumatically linked to the second gas passageway 130 may be the
same airway that is pneumatically linked to the first gas
passageway 126, or may be a different airway than the airway that
is pneumatically linked to the first gas passageway 126. For
example, if the airways are different, the first gas passageway 126
may be pneumatically linked to a nasal airway and the second gas
passageway 130 may be pneumatically linked to an oral airway, or
alternatively the first gas passageway 126 may be pneumatically
linked to an oral airway and the second gas passageway 130 may be
pneumatically linked to a nasal airway. Operation of the second
flow generator 112 may result in the generation of a negative flow
of gas that may pass from an airway of the patient, pass through
the second gas passageway 130, through the second gas inlet 116,
and out the second gas outlet 114.
[0057] In the illustrated configuration, and as implied above, the
respiratory therapy system 100 may operate as follows. Gas may be
drawn into the first flow generator 102 through the first gas inlet
104 due to the rotation of an impeller of the motor of the first
blower 110. Gas may then pass out of the first gas outlet 106 at a
positive flow rate and through the first gas passageway 126, which
may be in a first conduit 124. The gas may enter the humidifier 133
through the humidifier inlet 141. The humidifier 133 may be located
along the first gas passageway 126 between the first flow generator
102 and an airway of the patient. Once in the humidifier 133, the
gas may pick up moisture. Water in the humidifier 133 may be heated
by the heating element, which may aid in the humidification and/or
heating of the gas passing through the humidifier 133. The gas may
then leave the humidifier 133 through the humidifier outlet 143 and
progress further through the first gas passageway 126. Gas may then
be passed to an airway of the patient, where it may be taken into a
patient airway to aid in the treatment of a respiratory disorder.
The gas may pass through a patient interface 132 on its way to the
airway, which may be a nasal cannula. Preferably simultaneously,
the second flow generator 112 may draw gases at a negative flow
rate out of an airway of the patient and through the second gas
passageway 130, which may be in a second conduit 128. The gases may
be drawn through the second inlet 116 of the second flow generator
112 and out the second outlet 114. The airway in pneumatic
communication with the second gas passageway 130 may be the same
airway as the airway in pneumatic communication with the first gas
passageway 126, and gases moving between the patient airway and the
second flow generator 112 may pass through a patient interface,
which may be the same patient interface 132 in pneumatic
communication with the first gas passageway 130.
[0058] The negative flow provides for additional or alternative
anatomical dead space clearance. Positive high flow therapy
significantly reduces CO2 build up in anatomical dead spaces of the
patient. Negative flow can also provide additional anatomical dead
space clearance. When used together, a combination of positive and
negative flow in a high flow therapy system provides for a greater
reduction in CO2 in the anatomical dead spaces of a patient then
just using positive flow. In addition, negative flow can be used to
reduce the positive flow rate required to achieve a desired level
of anatomical dead space clearance. For example, a certain positive
flow rate used to provide a certain level of anatomical dead space
clearance can be reduced by using a combination of positive and
negative flow in order to achieve the same level of clearance. A
lower positive flow rate, in some situations, can reduce patient
discomfort that can occur from higher flow rates in a high flow
therapy system.
[0059] Referring again to FIG. 1A, it should be understood that the
illustrated configuration should not be taken to be limiting, and
that many other configurations for the respiratory therapy system
100 are possible. In some configurations, the first flow generator
102 may, for example, comprise a source or container of compressed
gas (for example, air). The container may comprise a valve that may
be adjusted to control the flow of gas leaving the container. In
some configurations, the first flow generator 102 may use such a
source of compressed gas and/or another gas source in lieu of the
first blower 110. In some configurations, the first blower 110 may
be used in conjunction with another gas source. In some
configurations, the first flow generator 102 may draw in
atmospheric gases through the first gas inlet 106. In some
configurations, the first flow generator 102 may be adapted to both
draw in atmospheric gases through the first gas inlet 106 and
accept other gases (for example, oxygen, nitric oxide, carbon
dioxide, etc.) through the same first gas inlet 106 or a different
gas inlet. In some configurations, the first flow generator 102 and
the second flow generator 112 may have individual housings or may
share a single housing 122. In some configurations, the first flow
generator 102 and the humidifier 133, if present, may share a
single housing 137. In some configurations, the first flow
generator 102, the second flow generator 112, and the humidifier
133 may all share a single housing. In some configurations, the
respiratory therapy system 100 may comprise a single user interface
located on the first flow generator 102, the second flow generator
112, the humidifier 133, the patient interface 132, or another
component of the respiratory therapy system 100. In some
configurations, the operation of components of the respiratory
therapy system 100 may be actuated wirelessly using a user
interface located on a remote computing device, which may be a
tablet, a mobile phone, a personal digital assistant, or another
computing device. In some configurations, the operation of the
first flow generator 102, of the second flow generator 112, of the
humidifier 133, or of other components or aspects of the
respiratory therapy system 100 may be controlled by a controller.
The controller may comprise a microprocessor. The controller may be
located in or on the first flow generator 102, the second flow
generator 112, the humidifier 112, or other components of the
respiratory therapy system 100 or on a remote computing device. In
some configurations, multiple controllers may be used. In some
configurations, the respiratory therapy system 100 may comprise one
or more sensors for detecting various characteristics of gases in
the respiratory therapy system 100, including pressure, flow rate,
temperature, absolute humidity, relative humidity, enthalpy, oxygen
concentration, breath composition and/or carbon dioxide
concentration, or one or more sensors for detecting various
characteristics of the patient or of the health of the patient,
including heart rate, EEG signal, EKG/ECG signal, blood oxygen
concentration, blood CO2 concentration, and blood glucose. One or
more of the sensors may be used to aid in the control of components
of the respiratory therapy system 100 through the use of a closed
or open loop control system. In some configurations, there may be
no user interface or a minimal user interface for components of the
respiratory therapy system 100. In some such configurations, the
respiratory therapy system 100 may utilize a sensor to determine if
the patient is attempting to use the respiratory therapy system 100
and automatically operate (e.g., the first flow generator 102 may
generate a positive flow, the second flow generator 112 may
generate a negative flow, the humidifier 133 may humidify gases,
etc.) according to one or more predetermined parameters if data
obtained from the sensor indicates that the patient is attempting
to use the respiratory therapy system 100. In some configurations,
preferably, the first flow generator 102 may generate a positive
flow of gas and the second flow generator 112 may simultaneously
generate a negative flow of gas. In some configurations, the first
flow generator 102 and the second flow generator 112 may be
actuated at different times. For example, in some configurations,
the first flow generator 102 may be configured to generate a
positive flow of gas while the patient is inhaling, and the second
flow generator 112 may be configured to generate a negative flow of
gas while the patient is exhaling. The first flow generator 102
and/or the second flow generator 112 may be configured to generate
pulsed positive and/or negative flows at frequencies that may be
equal to, higher or lower than the patient's rate of
respiration.
[0060] In some configurations, the first flow generator 102 and/or
the second flow generator 112 may be configured to alternatively
generate positive and negative flows. For example, the first flow
generator 102 may be switchable between a positive flow mode and a
negative flow mode, and likewise the second flow generator 112 may
be switchable between a positive flow mode and a negative flow
mode. Thus, in some such configurations, two separate positive
flows or two separate negative flows may be administered to one or
more airways of a patient. Furthermore, it should be understood
that in some configurations the flows for the first flow generator
102 and/or the second flow generator 112 may be adjustable. For
example, in some configurations, the first flow generator 102 may
generate a positive gas flow at rates of about 0 to about 100
L/minute, or about 10 to about 30 L/minute. Similarly, the second
flow generator 112 may generate a negative gas flow at rates of
about 0 to about 100 L/minute, or about 10 to about 30 L/minute. In
some configurations, the ranges of deliverable gas flow rate for
each flow generator may encompass both positive and negative flow
rates. For example, one or both of the flow generators may generate
gas flows at rates of about -100 L to +100 L/minute (where -100
L/minute implies generation of a negative flow of 100 L/minute and
+100 L/minute implies generation of a positive flow of 100
L/minute). In some configurations, the gas flow generation
arrangement 101 may be configured in such a way that the positive
flow rate is set to a function of the negative flow rate, e.g., the
positive flow rate may be set to a value that is 2 times greater
than the negative flow rate. In some configurations, if desired,
one of the flow generators may be temporarily deactivated and gas
therapy may proceed with only one of the flow generators active. In
some configurations, the on/off state of one or more of the flow
generators or the flow rates generated by one or more of the flow
generators may be adjusted according to a function of one or more
characteristics of the gases in the respiratory therapy system 100,
of the patient, or of the health of the patient. The
characteristics may include some or all of the characteristics
listed above. In some such configurations, the adjustment may occur
automatically. In some such configurations, the respiratory therapy
system 100 may instead suggest adjustments (for example, through a
user interface) that may be selected or confirmed by a user of the
respiratory therapy system. In some configurations, more than one
flow generator may be utilized to generate a positive flow or to
generate a negative flow. In some configurations, a flow generator
may be used together with a single gas passageway, where the flow
generator may be configured to alternatively generate positive and
negative flows. The delivery of positive and negative flows may be
synchronized with the patient's respiratory cycle. For example, the
flow generator may generate a positive flow during at least a
portion of an inspiratory period and may generate a negative flow
during at least a portion of an expiratory period.
[0061] Attention is given towards various configurations of the
respiratory therapy system 100 where a patient interface 132 in
pneumatic communication with a nasal airway of the patient is used.
The patient interface 132 may be a nasal cannula 132. FIGS. 1B-1M
demonstrate various configurations in which a nasal cannula 132 is
used with the respiratory therapy system 100. It should be
understood that the nasal cannula illustrated should not be taken
to be limiting, and that other cannula configurations may be
utilized. For example, in some configurations, a nasal cannula with
two left prongs and one right prong may be used, and/or the prongs
used may have different lengths, and/or the prongs may have
different orientations (for example, one prong may at least
partially extend up along an internal surface of a nare and another
prong may not substantially extend along an internal surface of a
nare). FIG. 1B illustrates a nasal cannula 132 comprising a pronged
section 134 and a manifold 136. The pronged section 134 may
comprise a first nasal prong 134A and a second nasal prong 134B. A
barrier 138 may be used to substantially pneumatically isolate
sections of the nasal cannula 132. Gases passing through the first
gas passageway 126 may enter the nasal cannula 132 through a side
of the manifold 136 and enter the nasal airway of the patient
through the first nasal prong 134A. Gases may also be drawn out of
the nasal airway of the patient through the second nasal prong 134B
and leave another side of the manifold 136 through the second gas
passageway 130. The barrier 138 may aid in substantially
pneumatically isolating the positive gas flow moving through the
first nasal prong 134A and the negative gas flow moving through the
second nasal prong 134B.
[0062] Although the configuration illustrated in FIG. 1B shows that
the first gas passageway 126 and the second gas passageway 130 may
be pneumatically linked to different sides of the manifold 136, the
sides being roughly perpendicular to the nasal prongs 134A, 134B of
the pronged section 134, other configurations are possible. FIG. 1C
demonstrates that the first gas passageway 126 and the second gas
passageway 130 may interface with the nasal cannula 132 on a single
side of the manifold 136. For example, the first and second gas
passageways 126, 130 may interface with the manifold 136 on a side
that is roughly coaxial with the nasal prongs 134A, 134B of the
pronged section 134 of the nasal cannula 132. Additionally, FIG. 1C
may demonstrate that the first and second gas passageways 126, 130
may be in a single conduit. The conduit may comprise the same
barrier 138 or another partition that may substantially
pneumatically isolate the first and second gas passageways 126,
130. FIG. 1D may demonstrate that the first and second gas
passageways 126, 130 may be in different conduits that may
interface with the same side of the manifold 136. It is to be
understood that the cannula examples disclosed in the present
disclosure describe non-sealing interfaces as explained above.
Thus, for example, the prongs 134A and/or 134B are designed such
that they provide less than 95% occlusion of the nares, less than
90% occlusion or about 40%-80% occlusion of the nares as explained
above in greater detail.
[0063] Advantageously, in some configurations, the respiratory
therapy system 100 in combination with the nasal cannula 132 may be
configured such that both positive and negative flows may be
delivered/drawn with each prong 134A, 134B of the pronged section
134 of the nasal cannula 132. Similarly, preferably but not
necessarily, the positive and negative flows may be administered
simultaneously. The administration of both positive and negative
flows in each prong 134A, 134B of the nasal cannula 132 may be more
comfortable and/or more effective relative to administering a
positive flow in the first prong 134A and a negative flow in the
second prong 134B. As seen in FIG. 1E, the first and second gas
passageways 126, 130 may be received in a single conduit
interfacing with the manifold 136 that may split the positive and
negative flows using a pair of barriers 138A, 138B that may extend
into the prongs 134A, 134B. The flows may be split in such a way
that both prongs 134A, 134B are pneumatically linked with both the
positive and negative flows. FIGS. 1E and 1F demonstrate that the
positive and negative flows may move in/out of the nasal cannula
132 from a single side of the manifold 136. While FIG. 1E
demonstrates that a pair of barriers 138A, 138B may be used to
split the flows, FIG. 1F illustrates that the first gas passageway
126 (and barrier 138) may be split at or near the manifold 136 into
two compartments such that positive flow moving through the first
gas passageway 126 may move into both nasal prongs 134A, 134B of
the nasal cannula 132. Negative flow may be drawn out of the
patient airway and through the second gas passageway 130 through
the sections of the prongs 134A, 134B that are not being utilized
to deliver positive flow to the patient airway. For example, the
second gas passageway 130 and the nasal cannula 132 may be
configured such that the negative flow of gas passes under or
around the compartments that carry the positive flow of gas.
Similarly, FIG. 1G demonstrates that the first and second gas
passageways 126, 130 may interface with the manifold 136 of the
nasal cannula 132 on different sides of the manifold 136 (e.g. on
opposing sides of the manifold 136 roughly perpendicular to the
prongs 134A, 134B). FIG. 1H demonstrates that each of the first gas
passageway 126 and the second gas passageway 130 may be divided
into compartments using, for example, the barriers 138A, 138B to
deliver/draw the positive and negative flows through the nasal
prongs 134A, 134B. FIG. 1I demonstrates that the first and second
gas passageways 126, 130 may enter the manifold 136 of the nasal
cannula 132 through a single side of the manifold 136, where the
single side may be roughly perpendicular to the nasal prongs 134A,
134B of the nasal cannula 132. It should be understood that more
than one of each of the positive and negative gas flows may be
delivered to one or more airways of the patient (e.g. fed into each
prong of the nasal cannula 132). For example, in some
configurations, two negative gas flows and one positive gas flow
may be used in a prong of the nasal cannula 132, or two negative
gas flows and two positive gas flows may be used in a prong of the
nasal cannula 132. Additionally, it should be understood that, in
some configurations, the pronged section 134 may comprise only one
prong adapted to be fitted into a single nare of the patient. In
some configurations, the pronged section 134 may comprise more than
two prongs. In some such configurations, more than one prong may be
fitted into a single nare of the patient. In some configurations,
one prong is larger and/or taller than the other prong. In any of
the above nasal cannula 132 configurations, the positive and
negative flows may be fixed or variable as implied above. Moreover,
in some configurations, if more than one positive or more than one
negative flow is utilized, the flow rate of each positive or
negative flow may be adjusted (e.g., through a valve arrangement or
some other means).
[0064] In some configurations, moisture and/or heat may be removed
from the negative flow of the second gas passageway 130 and added
to the positive flow of the first gas passageway 126. In some such
configurations, the nasal cannula 132 may comprise a transfer
module 139. The transfer module 139 may be configured to aid in
transferring heat and/or moisture from the negative flow (e.g. from
the second gas passageway 130) to the positive flow (e.g. to the
first gas passageway 126). The transfer module 139 may comprise a
wick or absorbent material (hereinafter referred to as a wick). The
wick may comprise, for example, natural or artificial sponge,
melamine foam, metal (e.g. sodium) polyacrylates, calcium chloride,
or other materials exhibiting a relatively high capacity for
retaining and/or transferring heat and/or moisture. The wick may
comprise anti-pathogenic materials or additives such as silver or
zinc-based substances. The transfer module 139 may be positioned
such that it extends between the first gas passageway 126 and the
second gas passageway 130. Preferably, the transfer module 139 may
act as a seal between the first gas passageway 126 and the second
gas passageway 130, or may substantially prevent pneumatic
communication between the first gas passageway 126 and the second
gas passageway 130. FIG. 1J illustrates a nasal cannula 132
configuration in which a transfer module 139 is placed. The
transfer module 139 be used to remove heat and/or moisture from
exhaled/drawn gases passing through the second nasal prong 134B and
through the second gas passageway 130. The heat and/or moisture may
then be transferred across the transfer module 139 such that the
heat and/or moisture may be entrained in the flow of gases passing
through the first gas passageway 126 and into the first nasal prong
134A. FIG. 1K illustrates a nasal cannula 132 configuration in
which nasal prong 134A is longer than nasal prong 134B. FIG. 1L
illustrates a nasal cannula 132 in which the nasal prong 134B is
removed, providing only an opening centered about the opening of
the nare with negative flow. FIG. 1M illustrates a nose 171 with
nares 175. The prongs 134A and 134B of cannula 132 are designed, as
described above, to be non-sealing such that an exchange of air can
occur at the point where the prongs 134A and 134B interact with the
nares 175. This allows for a release of pressure such that a
pressure build-up, either from positive or negative flow does not
occur.
[0065] Other configurations for respiratory therapy systems capable
of simultaneously delivering positive and negative flows are
possible. FIG. 2A demonstrates a respiratory therapy system 200
comprising a gas flow generating arrangement 201 comprising a
single flow generator 202 that may be configured to simultaneously
deliver gases through a first gas outlet 216 and through a first
gas passageway 230 (which may be in a first conduit 228) and draw
gases through a second gas passageway 226 and through the second
gas inlet 206. However, and as illustrated in FIG. 2B, it should be
understood that the first and second gas passageways 230, 226 may
be in a single conduit 225 that may extend between the flow
generator 202 and a patient airway. The first and second gas
passageways 230, 226 in the conduit 225 may be substantially
pneumatically separated by a partition 227 that may lie between the
first and second gas passageways 230, 226. In some configurations,
the first and second gas passageways 230, 226 may be arranged such
that they are in parallel (e.g. side-by-side) or arranged such that
they are coaxial (e.g. one above another) with respect to one
another. Similarly to the respiratory therapy system presented in
paragraphs the respiratory therapy system 200 may comprise a user
interface 208, a first gas inlet 204, a blower 210, a gas exhaust
214 and a patient interface 233 which may comprise a non-sealing
interface and which may comprise a nasal cannula. Likewise, many of
the alternative configurations suggested above or elsewhere in the
specification may be adapted to be used with the respiratory
therapy system 200. It should be understood that in this
embodiment, while they share a common gas flow generating
arrangement 201, the first and second gas passageways 230, 226 are
substantially pneumatically isolated from each other to the extent
that the flow of gas through the first gas passageway 230 is
substantially unaffected by flow of gas through the second gas
passageway 226.
[0066] FIG. 2C demonstrates a configuration for a respiratory
therapy system 200 involving a flow generating arrangement 201
comprising a flow generator 202 comprising a blower 210 capable of
generating simultaneous positive and negative flows in further
detail. The blower 210 may comprise a motor 243 that may comprise a
stator 240 and a rotor 242. The rotor 242 may be, for example, a
motor shaft. A first impeller 248 and a second impeller 250 may be
coupled to the rotor 242. The first and second impellers 248, 250
may comprise a housing 244 that may pneumatically isolate the first
and second impellers 248, 250. The housing 244 may comprise an
internal partition 246 that may help to substantially seal or
substantially pneumatically isolate the space around the first and
second impellers 248, 250. In some configurations, each of the
first and second impellers 248, 250 may have separate housings. In
use, the concurrent rotation of the first impeller 248 with the
rotor 242 due to the action of the motor 243 may cause gas to enter
the blower 210 through the first gas inlet 204. Gas may be
propelled out the first outlet 216 and through the first gas
passageway 230 (which may pass through a humidifier 232 and which
may be in a single conduit 228 as described above). The gas may be
introduced into an airway of the patient using one of the interface
systems demonstrated in FIGS. 1B-1H and in the above paragraphs, or
using another interface or combination of interfaces. Likewise, the
concurrent rotation of the second impeller 250 with the rotor 242
due to the action of the motor 243 may draw gases out of a patient
airway, through the second gas passageway 226, through the second
gas inlet 206 and out the gas exhaust 214. Valve arrangements may
be used to further control the flows administered to the patient
(e.g., the flow rates of gases passing through sections of the
first gas passageway 230 and/or gases passing through sections of
the second gas passageway 226). Advantageously, the use of a single
blower 210 in the flow generating arrangement 201 as demonstrated
in FIG. 2C may be more efficient and more cost effective than using
multiple blowers. In some configurations, and as seen in FIG. 2D,
the respiratory therapy system 200 may comprise a first transfer
module 239 (e.g., in a patient interface) and/or a second transfer
module 241 (e.g., in the blower 210, extending between the sections
of the housing 244). The first transfer module 239 and/or second
transfer module may be configured to aid in transferring heat
and/or moisture from the negative flow (e.g., from the second gas
passageway 226) to the positive flow (e.g., to the first gas
passageway 230). The configurations suggested above may be equally
applicable to some such transfer modules 239, 241. It should be
understood that in the embodiments of FIGS. 2C and 2D, while they
share a common gas flow generating arrangement 201, the first and
second gas passageways 230, 226 are substantially pneumatically
isolated from each other to the extent that the flow of gas through
the first gas passageway 230 is substantially unaffected by flow of
gas through the second gas passageway 226.
[0067] As discussed above, also disclosed herein is a method of
delivering gas to the airway of a subject. In various embodiments
the method may comprise delivering gas to the airway of a subject
in need thereof, improving the ventilation of a subject in need
thereof, reducing the volume of anatomical dead space within the
volume of the airway of a subject in need thereof, and/or treating
a respiratory condition or a sleep disorder in a subject in need
thereof.
[0068] For example, FIG. 5 illustrates a method of providing
positive and negative flow of gases in a high flow therapy system.
The method includes the step 501 of providing a positive high flow
rate of respiratory gases to the airway of a patient. The method
also includes the step 503 of providing negative pressure to the
airway of the patient. The high flow therapy system of FIG. 5 is a
non-sealed system such that pressure does not build up in the
system.
[0069] In various embodiments, the method may comprise delivering a
continuous flow of gas to the airway of a subject. For example, the
flow of gas may be delivered at a first flow rate of at least about
10, 12, 15, 17, 20, 22, 25, 27, 30, 32, 35, 37, 40, 42, 45, 47, 50,
52, 55, 57, or 60 L/min, and useful ranges may be selected between
any of these values (for example, about 10 to about 60, about 10 to
about 40, or about 20 to about 40 L/min).
[0070] In various embodiments, the method may comprise
simultaneously drawing gas from the airway of the subject. In some
embodiments gas may be drawn from the airway of the subject at a
second flow rate that is the same as or less than or greater than
the first flow rate. In some embodiments the second flow rate may
be at least about 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60,
65, 70, 75 or 80%, or more, of the first flow rate, and useful
ranges may be selected between any of these values (for example,
about 0.5 to about 80, about 35 to about 65, about 40 to about
60%). In some embodiments the second flow rate may be at least
about 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 17, 20, 22, 25,
27, 30, 32, 35, 37, 40, 42, 45, 47, 50, 52, 55, 57, or 60 L/min,
and useful ranges may be selected between any of these values (for
example, about 0.5 to about 60, about 15 to about 45, about 20 to
about 40 L/min). In some embodiments the second flow rate may be
about 5 to about 80% of the first flow rate, provided that the
second flow rate is at least about 0.5, 1, 2, 3, 4, or 5 L/min
[0071] In various embodiments the method may be carried out using a
system as described herein or an equivalent system that is adapted
to carry out the described method.
[0072] With reference to FIG. 3, testing apparatus comprises lung
pump 1, computer 2 to control pump 1 to simulate breathing,
computer 3 to record sensor output, airway model 4, connecting tube
5, aluminum base block 6, CO2 bleed valve 7, CO2 rotameter 8, CO2
sensor 9, nasal high flow (NHF) rotameter 10, and NHF cannula
11.
[0073] A method and system described herein was assessed using the
testing apparatus. The airway CO2 levels were assessed of (A) an
untreated control model subject, (B) a model subject treated with
standard NHF therapy at a flow rate of 20 L/min, (C) a model
subject treated with negative NHF therapy drawing gas from the
airway of the model subject using a standard two-prong nasal canula
at 20 L/min, and (D) a model subject treated with an exemplary
embodiment of the presently disclosed method, using negative NHF
therapy drawing gas from the airway of the model subject at a flow
rate of 16 L/min and positive NHF therapy simultaneously delivering
gas to the airway of the model subject at a flow rate of 20 L/min,
using a cannula of FIG. 1B described above. All scenarios were run
with the mouth of the airway model 4 in the open position and in
the closed position.
[0074] The results are shown in Table 1 and FIG. 4 and indicate
that standard NHF therapy (B) reduced the CO2 levels in the upper
airway by 32% and 14% for mouth open and mouth closed,
respectively, compared to the untreated control (A). Use of
negative NHF therapy (C) reduced the CO2 levels by 11% and 6% for
mouth open and mouth closed, respectively, compared to the
untreated control (A). Used of both negative and positive pressure
(D) reduced the CO2 levels by 34% and 31% for mouth open and mouth
closed, respectively, compared to the untreated control (A).
TABLE-US-00001 TABLE 1 results of testing Average CO.sub.2 level
(molar %) Mouth Open Mouth Closed A 2.83 2.71 B 1.91 2.33 C 2.52
2.54 D 1.85 1.87
[0075] Testing is carried out with combinations of positive and
negative flow rates, including positive flow rates of from about 5
to about 60 L/min, and negative flow rates of about 5 to about 60
L/min, including specific flow rate combinations of +20/-20,
+20/-40, +20/-60, +40/-20, +40/-40, +40/-60, +60/-20, +60/-40, and
+60/-60 L/min.
[0076] Unless the context clearly requires otherwise, throughout
the description and the claims, the words "comprise", "comprising",
and the like, are to be construed in an inclusive sense as opposed
to an exclusive or exhaustive sense, that is to say, in the sense
of "including, but not limited to."
[0077] Where, in the foregoing description reference has been made
to integers or components having known equivalents thereof, those
integers or components are herein incorporated as if individually
set forth.
[0078] The disclosed methods, apparatus and systems may also be
said broadly to comprise the parts, elements and features referred
to or indicated in the specification of the application,
individually or collectively, in any or all combinations of two or
more of said parts, elements or features.
[0079] Reference to any prior art in this specification is not, and
should not be taken as, an acknowledgement or any form of
suggestion that that prior art forms part of the common general
knowledge in the field of endeavour in any country in the
world.
[0080] Although the present disclosure has been described in terms
of certain embodiments, other embodiments apparent to those of
ordinary skill in the art also are within the scope of this
disclosure. Thus, various changes and modifications may be made
without departing from the spirit and scope of the disclosure. For
instance, various components may be repositioned as desired.
Moreover, not all of the features, aspects and advantages are
necessarily required to practice the present disclosure.
Accordingly, the scope of the present disclosure is intended to be
defined only by the claims that follow.
* * * * *