U.S. patent application number 17/345994 was filed with the patent office on 2022-03-10 for ventilator system with multiple airflow control lumens.
The applicant listed for this patent is Lukasz R. Kiljanek. Invention is credited to Lukasz R. Kiljanek.
Application Number | 20220072250 17/345994 |
Document ID | / |
Family ID | 80470438 |
Filed Date | 2022-03-10 |
United States Patent
Application |
20220072250 |
Kind Code |
A1 |
Kiljanek; Lukasz R. |
March 10, 2022 |
VENTILATOR SYSTEM WITH MULTIPLE AIRFLOW CONTROL LUMENS
Abstract
Ventilator system with multiple inspiratory lumens is provided.
The inspiratory lumens are configured so that separate inspiratory
lumens provide inspiratory gas mixtures to separate portions of a
patient's airways, for instance to separate lungs and/or bronchi.
The ventilator system can include one or more expiratory lumens to
evacuate expiratory gases from airways. The use of separate
inspiratory lumen(s), with expiratory lumen(s), allows for
functional separation of structural portions of the lungs, and
maintenance of continuous or almost continuous flow through at
least part of respiratory cycle via inspiratory and expiratory
lumens. This can further reduce dead space and clear suspended
therein diseases causative agents with improvement in outcomes,
reduce risk of cross-contamination or cross-infection between
different parts of airways, for example such as cross-infection
from one lung lobe to another lobe or. The ventilator system allows
for independent titration of PEEP, pCO.sub.2 and pO.sub.2 with no
need for permissive hypercapnia.
Inventors: |
Kiljanek; Lukasz R.;
(Chesapeake Beach, MD) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Kiljanek; Lukasz R. |
Chesapeake Beach |
MD |
US |
|
|
Family ID: |
80470438 |
Appl. No.: |
17/345994 |
Filed: |
June 11, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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63075327 |
Sep 8, 2020 |
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63075555 |
Sep 8, 2020 |
|
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63077037 |
Sep 11, 2020 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61M 16/0486 20140204;
A61M 2202/0225 20130101; A61M 2205/7563 20130101; A61M 2205/583
20130101; A61M 2016/0042 20130101; A61M 2205/3331 20130101; A61M
2205/3592 20130101; A61M 16/0057 20130101; A61M 16/042 20140204;
A61M 2205/3375 20130101; A61M 2205/3553 20130101; A61M 16/161
20140204; A61M 2230/04 20130101; A61M 16/0816 20130101; A61M 16/14
20130101; A61M 2016/1025 20130101; A61M 16/1055 20130101; A61M
2016/103 20130101; A61M 16/0463 20130101; A61M 2202/0266 20130101;
A61M 16/1005 20140204; A61M 16/12 20130101; A61M 16/0051 20130101;
A61M 2016/0027 20130101; A61M 2205/3368 20130101; A61M 2230/205
20130101; A61M 16/0009 20140204; A61M 16/0404 20140204; A61M
2202/0208 20130101; A61M 2230/437 20130101; A61M 16/0434 20130101;
A61M 16/0808 20130101; A61M 16/208 20130101; A61M 2230/435
20130101; A61M 11/00 20130101; A61M 16/0093 20140204; A61M
2016/0039 20130101; A61M 16/106 20140204; A61M 2205/3344 20130101;
A61M 16/16 20130101; A61M 2230/432 20130101; A61M 16/1065 20140204;
A61M 16/107 20140204; A61M 16/0883 20140204; A61M 16/024 20170801;
A61M 16/1075 20130101; A61M 16/209 20140204; A61M 2016/1035
20130101; A61M 2230/30 20130101; A61M 2205/505 20130101; A61M
2205/581 20130101; A61M 2230/50 20130101 |
International
Class: |
A61M 16/04 20060101
A61M016/04; A61M 16/12 20060101 A61M016/12; A61M 16/20 20060101
A61M016/20 |
Claims
1. An apparatus for airflow control, the apparatus comprising: a
first inspiratory lumen that is configured to receive a first
inspiratory gaseous volume and to provide the first inspiratory
gaseous volume to a first portion of an airway of a patient while
the first inspiratory lumen is at least partially inserted into the
airway; a second inspiratory lumen that is configured to receive a
second inspiratory gaseous volume and to provide the second
inspiratory gaseous volume to a second portion of the airway while
the second inspiratory lumen is at least partially inserted into
the airway; and one or more expiratory lumens that are configured
to evacuate an expiratory gaseous volume from at least one of the
first portion of the airway and the second portion of the airway
while the one or more expiratory lumens are at least partially
inserted into the airway.
2. The apparatus of claim 1, wherein the first portion of the
airway includes a first lung, wherein the second portion of the
airway includes a second lung distinct from the first lung.
3. The apparatus of claim 2, wherein the first inspiratory lumen is
configured to provide the first inspiratory gaseous volume to a
first lobe of the first lung, wherein the one or more expiratory
lumens are configured to evacuate the expiratory gaseous volume
from a second lobe of the first lung, wherein the first lobe is
different than the second lobe.
4. The apparatus of claim 1, wherein the first portion of the
airway includes a first bronchus, wherein the second portion of the
airway includes a second bronchus distinct from the first
bronchus.
5. The apparatus of claim 1, wherein the first inspiratory lumen
receives the first inspiratory gaseous volume from a first gas
source, and wherein second inspiratory lumen receives the second
inspiratory gaseous volume from the first gas source.
6. The apparatus of claim 1, wherein the first inspiratory lumen
receives the first inspiratory gaseous volume from a first gas
source, and wherein second inspiratory lumen receives the second
inspiratory gaseous volume from a second gas source.
7. The apparatus of claim 1, wherein the first inspiratory gaseous
volume and the second inspiratory gaseous volume both include an
inspiratory mixture of a plurality of gases that are mixed
according to one or more predetermined ratios.
8. The apparatus of claim 7, wherein the inspiratory mixture
includes carbon dioxide (CO.sub.2).
9. The apparatus of claim 1, further comprising an endotracheal
tube, wherein the endotracheal tube includes at least the first
inspiratory lumen, the second inspiratory lumen, and the one or
more expiratory lumens.
10. The apparatus of claim 9, wherein the first inspiratory lumen
passes through the endotracheal tube and extends beyond a tip of
the endotracheal tube toward the first portion of the airway,
wherein the second inspiratory lumen passes through the
endotracheal tube and extends beyond the tip of the endotracheal
tube toward the second portion of the airway.
11. The apparatus of claim 10, wherein the tip of the endotracheal
tube includes the tip of the one or more expiratory lumens.
12. The apparatus of claim 1, wherein the one or more expiratory
lumens include a first expiratory lumen configured to evacuate a
first expiratory gaseous volume from the first portion of the
airway and a second expiratory lumen configured to evacuate a
second expiratory gaseous volume from the second portion of the
airway.
13. The apparatus of claim 12, wherein the first expiratory lumen
passes through an endotracheal tube and extends beyond a tip of the
endotracheal tube toward the first portion of the airway, wherein
the second expiratory lumen passes through the endotracheal tube
and extends beyond the tip of the endotracheal tube toward the
second portion of the airway.
14. The apparatus of claim 12, further comprising: a first
expiratory mixture pressurizer that provides suction to evacuate
the first expiratory gaseous volume from the first portion of the
airway through the first expiratory lumen and a second expiratory
mixture pressurizer that provides suction to evacuate the second
expiratory gaseous volume from the second portion of the airway
through the second expiratory lumen.
15. The apparatus of claim 12, wherein the one or more expiratory
lumens also include a third expiratory lumen configured to evacuate
a third expiratory gaseous volume from a third portion of the
airway.
16. The apparatus of claim 1, further comprising: one or more
inspiratory flow control mechanisms that control flow of the first
inspiratory gaseous volume to the first portion of the airway
through the first inspiratory lumen and that control flow of second
inspiratory gaseous volume to the second portion of the airway
through the second inspiratory lumen.
17. The apparatus of claim 1, further comprising: one or more
expiratory flow control mechanisms that provide pressurized suction
to control flow of the expiratory gaseous volume from at least one
of the first portion of the airway and the second portion of the
airway to an expiratory air output through the one or more
expiratory lumens.
18. The apparatus of claim 17, further comprising: one or more
inspiratory flow control mechanisms that provide the first
inspiratory gaseous volume to the first inspiratory lumen and that
provide the second inspiratory gaseous volume to the second
inspiratory lumen; a memory storing instructions; and a processor
that executes the instructions, wherein execution of the
instructions by the processor causes the processor to: maintain net
inspiratory flow at a first level during a first portion of each of
a plurality of respiratory cycles, wherein the net inspiratory flow
corresponds to provision of both the first inspiratory gaseous
volume and the second inspiratory gaseous volume, and maintain net
expiratory flow at a second level during the first portion of each
of the plurality of respiratory cycles, wherein the net expiratory
flow corresponds to provision of the pressurized suction to control
the flow of the expiratory gaseous volume.
19. The apparatus of claim 18, wherein the first portion of each of
the plurality of respiratory cycles is an inspiration, and wherein
an absolute value of the net inspiratory flow is greater than an
absolute value of the net expiratory flow.
20. The apparatus of claim 18, wherein the first portion of each of
the plurality of respiratory cycles is an expiration, and wherein
an absolute value of the net inspiratory flow is less than an
absolute value of the net expiratory flow.
21. The apparatus of claim 18, wherein the first portion of each of
the plurality of respiratory cycles is a hold, and wherein an
absolute value of the net inspiratory flow is equal to an absolute
value of the net expiratory flow.
22. The apparatus of claim 1, further comprising: an intratracheal
sensor that measures an intratracheal pressure in a trachea of the
patient; and one or more pressurizers, wherein the one or more
pressurizers are configured to provide airflow pressure based on
the intratracheal pressure, wherein the airflow pressure includes
at least one of a first inspiratory pressure to provide the first
inspiratory gaseous volume to the first portion of the airway via
the first inspiratory lumen, a second inspiratory pressure to
provide the second inspiratory gaseous volume to the second portion
of the airway via the second inspiratory lumen, and an expiratory
pressure to evacuate the expiratory gaseous volume from at least
one of the first portion of the airway and the second portion of
the airway via the one or more expiratory lumens.
23. The apparatus of claim 1, further comprising: one or more
markers along at least one of the first inspiratory lumen, the
second inspiratory lumen, and the one or more expiratory lumens,
wherein the one or more markers are at least one of radiopaque,
radioactive, emissive of a magnetic field, and emissive of one or
more electromagnetic signals.
24. The apparatus of claim 1, further comprising: a third
inspiratory lumen that is configured to receive a third inspiratory
gaseous volume and to provide the third inspiratory gaseous volume
to a third portion of the airway while the third inspiratory lumen
is at least partially inserted into the airway.
25. The apparatus of claim 1, further comprising: a microfilter
adapter that includes a microfilter medium and one or more one-way
airflow valves, wherein the microfilter adapter passes airflow
through the one or more one-way airflow valves and filters the
airflow through the microfilter medium, wherein the airflow
includes at least one of the first inspiratory gaseous volume, the
second inspiratory gaseous volume, and the expiratory gaseous
volume.
26. A method for airflow control, the method comprising: receiving
a first inspiratory gaseous volume into a first inspiratory lumen;
providing the first inspiratory gaseous volume to a first portion
of an airway of a patient using the first inspiratory lumen while
the first inspiratory lumen is at least partially inserted into the
airway; receiving a second inspiratory gaseous volume into a second
inspiratory lumen; providing the second inspiratory gaseous volume
to a second portion of the airway using the second inspiratory
lumen while the second inspiratory lumen is at least partially
inserted into the airway; and evacuating an expiratory gaseous
volume from the first portion of the airway and from the second
portion of the airway using one or more expiratory lumens while the
one or more expiratory lumens are at least partially inserted into
the airway.
27. The method of claim 26, wherein the first portion of the airway
includes a first lung, wherein the second portion of the airway
includes a second lung distinct from the first lung.
28. The method of claim 26, wherein an endotracheal tube includes
at least the first inspiratory lumen, the second inspiratory lumen,
and the one or more expiratory lumens.
29. The method of claim 28, wherein the first inspiratory lumen
passes through the endotracheal tube and extends beyond a tip of
the endotracheal tube toward the first portion of the airway,
wherein the second inspiratory lumen passes through the
endotracheal tube and extends beyond the tip of the endotracheal
tube toward the second portion of the airway.
30. The method of claim 26, wherein the one or more expiratory
lumens include a first expiratory lumen and a second expiratory
lumen, wherein evacuating the expiratory gaseous volume from the
first portion of the airway and from the second portion of the
airway using one or more expiratory lumens includes evacuating a
first portion of the expiratory gaseous volume from the first
portion of the airway using the first expiratory lumen and
evacuating a second portion of the expiratory gaseous volume from
the second portion of the airway using the second expiratory lumen.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] The present application claims the priority benefit of U.S.
provisional application No. 63/075,327 filed Sep. 8, 2020 and
entitled "Methods and Devices to Decrease Functional and Anatomical
Dead Space and Improve Outcomes in Severe, Infectious Process
Involving Lungs;" U.S. provisional application No. 63/075,555 filed
Sep. 8, 2020 and entitled "Methods and Devices to Decrease
Functional and Anatomical Dead Space and Improve Outcomes in
Severe, Infectious Process Involving Lungs;" and U.S. provisional
application No. 63/077,037 filed Sep. 11, 2020 and entitled
"Methods and Devices to Decrease Functional and Anatomical Dead
Space and Improve Outcomes in Severe, Infectious Process Involving
Lungs;" the disclosures of which are all hereby incorporated by
reference in their entireties.
BACKGROUND
1. Field
[0002] The present teachings are generally related to ventilator
systems. More specifically, the present teachings relate to
ventilator systems with multiple inspiratory lumens configured so
that separate inspiratory lumens provide gas to different portions
of a patient's airways, reducing dead space in the patient's
airways and reducing risk of cross-infection between the different
portions of the patient's airways.
2. Description of the Related Art
[0003] A ventilator is life support machine that can be used to
assist a patient with breathing. A ventilator generally includes a
tube that is inserted into the patient's mouth. A ventilator
mechanically provides air into the patient's airways. A ventilator
may be used, for example, when a patient is having trouble
breathing on their own due to an infection, an injury, a
disability, and/or another medical condition.
[0004] Dead space represents a volume of ventilated air in a
patient's airways that does not participate in gas exchange. For
instance, dead space can represent a volume of air that remains in
the patient's airways even after an exhalation, and that is thus
not replaced by fresh air from the patient's next inhalation. The
average dead space in a healthy individual's airways represent 26%
of tidal volume. Respiratory conditions, such as diseases,
injuries, or disabilities, can all increase dead space in the
airways of patients, for example by impairing a patient's ability
to inhale and/or exhale. Disease-causative agents (DCAs) can move
throughout dead space in a patient's airways, which can cause
infections or other diseases to spread throughout the patient's
airways. DCAs suspended in dead space are generally not accessible
to inhaled medications or to the human body's defense systems
(e.g., immune cells and antibodies).
SUMMARY
[0005] Techniques and systems are described herein for reducing
dead space and increasing clearance of dead space in a patient's
airways using a ventilator apparatus with multiple inspiratory
lumens. The inspiratory lumens are configured so that separate
inspiratory lumens provide air to separate lungs and/or bronchi.
The ventilator apparatus can also include one or more expiratory
lumens to receive and/or evacuate expiratory gases from the
patient's airways. The use of separate inspiratory lumens, together
with one or more expiratory lumens, can reduce dead space in the
patient's airways and increase the clearance of dead space. The use
of separate inspiratory lumens, together with one or more
expiratory lumens, can thus reduce risk of cross-infection and/or
cross-contamination between different parts of the patient's
airways, such as cross-infection from one lung to the other and/or
cross-infection between bronchi and reinfection of already
recovered portions of patient's lungs, with the DCAs suspended in
dead space.
[0006] In one example, an apparatus for airflow control is
provided. The apparatus includes a first inspiratory lumen that is
configured to receive a first inspiratory gaseous volume and to
provide the first inspiratory gaseous volume to a first portion of
an airway of a patient while the first inspiratory lumen is at
least partially inserted into the airway. The apparatus includes a
second inspiratory lumen that is configured to receive a second
inspiratory gaseous volume and to provide the second inspiratory
gaseous volume to a second portion of the airway while the second
inspiratory lumen is at least partially inserted into the airway.
The apparatus includes one or more expiratory lumens that are
configured to evacuate an expiratory gaseous volume from at least
one of the first portion of the airway and from the second portion
of the airway while the one or more expiratory lumens are at least
partially inserted into the airway.
[0007] In another example, a method for airflow control is
provided. The method includes receiving a first inspiratory gaseous
volume into a first inspiratory lumen. The method includes
providing the first inspiratory gaseous volume to a first portion
of an airway of a patient using the first inspiratory lumen while
the first inspiratory lumen is at least partially inserted into the
airway. The method includes receiving a second inspiratory gaseous
volume into a second inspiratory lumen. The method includes
providing the second inspiratory gaseous volume to a second portion
of the airway using the second inspiratory lumen while the second
inspiratory lumen is at least partially inserted into the airway.
The method includes evacuating an expiratory gaseous volume from
the first portion of the airway and from the second portion of the
airway using one or more expiratory lumens while the one or more
expiratory lumens are at least partially inserted into the
airway.
[0008] In another example, an apparatus for airflow control is
provided. The apparatus includes means for receiving a first
inspiratory gaseous volume into a first inspiratory lumen. The
apparatus includes means for providing the first inspiratory
gaseous volume to a first portion of an airway of a patient using
the first inspiratory lumen while the first inspiratory lumen is at
least partially inserted into the airway. The apparatus includes
means for receiving a second inspiratory gaseous volume into a
second inspiratory lumen. The apparatus includes means for
providing the second inspiratory gaseous volume to a second portion
of the airway using the second inspiratory lumen while the second
inspiratory lumen is at least partially inserted into the airway.
The apparatus includes means for evacuating an expiratory gaseous
volume from the first portion of the airway and from the second
portion of the airway using one or more expiratory lumens while the
one or more expiratory lumens are at least partially inserted into
the airway.
[0009] In another example, a non-transitory computer-readable
medium is provided having stored thereon instructions that, when
executed by one or more processors, cause the one or more
processors to: receive a first inspiratory gaseous volume into a
first inspiratory lumen; provide the first inspiratory gaseous
volume to a first portion of an airway of a patient using the first
inspiratory lumen while the first inspiratory lumen is at least
partially inserted into the airway; receive a second inspiratory
gaseous volume into a second inspiratory lumen; provide the second
inspiratory gaseous volume to a second portion of the airway use
the second inspiratory lumen while the second inspiratory lumen is
at least partially inserted into the airway; and evacuate an
expiratory gaseous volume from the first portion of the airway and
from the second portion of the airway using one or more expiratory
lumens while the one or more expiratory lumens are at least
partially inserted into the airway.
BRIEF DESCRIPTION OF THE FIGURES
[0010] FIG. 1 is a conceptual diagram illustrating a front view of
a ventilator system connected to a patient;
[0011] FIG. 2 is a conceptual diagram illustrating a side view of a
ventilator system connected to a patient;
[0012] FIG. 3 is a conceptual diagram illustrating a trachea
connected to a left lung and a right lung;
[0013] FIG. 4A is a conceptual diagram illustrating part of a
ventilator system with an endotracheal tube (ETT) in a trachea
providing inspiratory gas into a diseased right lung and a healthy
left lung.
[0014] FIG. 4B is a conceptual diagram illustrating part of the
ventilator system of FIG. 4A with the endotracheal tube (ETT)
evacuating expiratory gas that includes disease-causative agents
(DCAs) from the diseased right lung and the healthy left lung.
[0015] FIG. 4C is a conceptual diagram illustrating part of the
ventilator system of FIGS. 4A-4B with the endotracheal tube (ETT)
providing inspiratory gas that spreads disease-causative agents
(DCAs) to more of the diseased right lung and newly introduces the
DCAs into the newly-diseased left lung;
[0016] FIG. 4D is a conceptual diagram illustrating an example of
the ventilator systems of FIGS. 4A-4C with an adapter added on one
side of the balloon and another adapter added on the other side of
the balloon;
[0017] FIG. 4E is a conceptual diagram 400E illustrating a
cross-section of a micro-filter adapter;
[0018] FIG. 4F is a conceptual diagram 400F illustrating a
cross-section of an airflow rerouting adapter;
[0019] FIG. 5A is a conceptual diagram illustrating part of a
ventilator system with an endotracheal tube (ETT) that includes an
expiratory lumen that evacuates expiratory gas, a left inspiratory
lumen that provides inspiratory gas to the left primary bronchus
and left lung, and a right inspiratory lumen that provides
inspiratory gas to the right primary bronchus and right lung;
[0020] FIG. 5B is a conceptual diagram illustrating part of the
ventilator system of FIG. 5A where the right lung is diseased and
the left lung is healthy;
[0021] FIG. 5C is a conceptual diagram illustrating part of a
ventilator system with an endotracheal tube (ETT) that includes a
left expiratory lumen that evacuates expiratory gas from a left
primary bronchus and left lung, a right expiratory lumen that
evacuates expiratory gas from a right primary bronchus and right
lung, a left inspiratory lumen that provides inspiratory gas to the
left primary bronchus and left lung, and a right inspiratory lumen
that provides inspiratory gas to the right primary bronchus and
right lung;
[0022] FIG. 5D is a conceptual diagram illustrating part of a
ventilator system with an endotracheal tube (ETT) that includes an
inspiratory lumen that provides inspiratory gas, a left expiratory
lumen that evacuates expiratory gas from the left primary bronchus
and left lung, and a right expiratory lumen that evacuates
expiratory gas from the right primary bronchus and right lung;
[0023] FIG. 6 is a conceptual diagram illustrating part of a
ventilator system with an endotracheal tube (ETT) that includes an
expiratory lumen that evacuates expiratory gas, a left inspiratory
lumen that provides inspiratory gas, and a right inspiratory lumen
that provides inspiratory gas;
[0024] FIG. 7A is a conceptual diagram illustrating a cross-section
of an endotracheal tube (ETT) that includes an expiratory lumen
that evacuates expiratory gas, a left inspiratory lumen that
provides inspiratory gas, and a right inspiratory lumen that
provides inspiratory gas;
[0025] FIG. 7B is a conceptual diagram illustrating a cross-section
of a tube that includes a first lumen and a second lumen separated
by a membrane;
[0026] FIG. 8A is a graph diagram illustrating inspiratory flow,
expiratory flow, and pressure changes over time in a ventilator
system according to a first illustrative example;
[0027] FIG. 8B is a graph diagram illustrating inspiratory flow,
expiratory flow, and pressure changes over time in a ventilator
system according to a second illustrative example;
[0028] FIG. 8C is a graph diagram illustrating inspiratory flow,
expiratory flow, and pressure changes over time in a ventilator
system according to a third illustrative example;
[0029] FIG. 8D is a graph diagram illustrating inspiratory flow,
expiratory flow, and pressure changes over time in a ventilator
system according to a fourth illustrative example;
[0030] FIG. 8E is a graph diagram illustrating inspiratory flow,
expiratory flow, and pressure changes over time in a ventilator
system according to a fifth illustrative example;
[0031] FIG. 9A is a block diagram illustrating an architecture of
an exemplary ventilator system that includes an inspiratory control
system that provides inspiratory gas to a left lung and a right
lung through a left inspiratory lumen and a right inspiratory
lumen, and an expiratory control system that evacuates expiratory
gas from the left lung and the right lung through one or more
expiratory lumens;
[0032] FIG. 9B is a block diagram illustrating an architecture of
an exemplary ventilator system that includes a left inspiratory
control system that provides inspiratory gas to a left lung through
a left inspiratory lumen, a right inspiratory control system that
provides inspiratory gas to a right lung through a right
inspiratory lumen, a left expiratory control system that evacuates
expiratory gas from a left lung through a left expiratory lumen,
and a right expiratory control system that evacuates expiratory gas
from a right lung through a right expiratory lumen;
[0033] FIG. 10 is a flow diagram illustrating exemplary operations
for airflow control; and
[0034] FIG. 11 is a block diagram of an exemplary computing device
that may be used to implement some aspects of the technology.
DETAILED DESCRIPTION
[0035] A ventilator is a life support machine that can be used to
assist a patient with breathing. A ventilator generally includes an
endotracheal tube that is inserted via mouth into the patient's
trachea. A ventilator can mechanically provide an inspiratory gas
into the patient's airways. A ventilator can mechanically evacuate
an expiratory gas from the patient's airways. A ventilator may be
used, for example, when a patient is having trouble breathing on
their own due to an infection, an injury, a disease, a physical
handicap, a physical disability, weakness, sedation, use of
paralyzing anesthetics, another medical condition, another physical
condition, another anatomical condition, or a combination
thereof.
[0036] A patient's lungs and airways can become infected with
and/or otherwise affected by a disease-causative agent (DCA). DCAs
can include, for example, bacteria, fungi, viruses (e.g., virions,
viral agents), parasites, protozoa, helminths, prions, toxins,
synthetic toxicants, physical contaminants, chemical contaminants,
biological contaminants, radiological contaminants, portions of a
patient's immune system in patients that have an autoimmune
disease, other antigens or hazards, or combinations thereof.
Diseases can include infections, injuries, poisonings,
disabilities, disorders, syndromes, infections, isolated symptoms,
deviant behaviors, atypical, aberrant and pathologic variations of
structure and function, or combinations thereof. Certain types of
DCAs can be referred to as infection agents, toxins, antigens,
antibodies, cells, prions, infection vectors, disease agents,
disease vectors, microorganisms, microbes, pathogens, germs,
contaminants, chemicals, or combinations thereof.
[0037] Dead space represents a volume of ventilated air in a
patient's airways that does not participate in alveolar gas
exchange. For instance, dead space can represent a volume of air
that remains in the patient's airways even after an exhalation. The
average dead space in a healthy individual's airways represent 26%
of tidal volume. Tidal volume represents the volume of gas inspired
with breath. Average tidal volume is 450 milliliters (ml), so
average dead space is 117 milliliters (mL). Diseases, such as
respiratory diseases, and pathologic conditions, such as being
ventilated on mechanical ventilator with high respiratory rate, as
commonly required per treatment protocols, can cause a significant
increase in dead space in the airways of patients, for example
because a patient's ability to inhale and/or exhale may be
impaired. DCAs can freely move, or float, or move throughout dead
space in a patient's airways. This movement of DCAs within the dead
space can facilitate spreading of the diseases from contaminated to
uncontaminated yet portions of respiratory system, also to
uncontaminated portions of lungs. DCAs suspended in the dead space
are generally not accessible to other than inhaled medications,
circulating antibodies, immune cells, or other immune response
mechanisms of the patient.
[0038] The SARS-CoV-2 virus is an example of a disease-causative
agent (DCA). COVID-19 is an example of a disease that can be caused
by the SARS-CoV-2 virus. During the COVID-19 pandemic, ventilators
have been used to treat most severely sick patients with COVID-19
infections. According to some news reports during the COVID-19
pandemic, some patients' conditions appeared to worsen after the
patient was connected to a ventilator. In some examples, the
disease spread throughout a patient's airways after the patient was
connected to a ventilator. In some cases, patients can get
reinfected with COVID-19, sometimes weeks after their first
COVID-19 infection. In some patients, portions of the lungs can get
reinfected with COVID-19 while the patient is on a ventilator, even
during a first-in-lifetime COVID-19 infections. Furthermore, in at
least some patients, intravenous provision of antibodies can be
beneficial only before patient present significant lungs disease
and before patients end up on ventilator. Once such a patient is on
a ventilator, antibodies provide limited effect, for instance
because the dead space in the patient's lungs is already filled
with DCAs, the antibodies cannot reliably reach the DCAs suspended
in the dead space, and the effectiveness of such therapies is
lost.
[0039] Systems and techniques are described herein that minimize or
reduce the risk of infection and/or reinfection of patients' lungs
(and/or other portions of the patients' airways) while patients are
on a ventilator by clearing and reducing the dead space in the
patients' lungs. Once a patient ends up on a ventilator, the only
remaining treatments may have very limited effectiveness, so any
improvements to the functioning of the ventilator, such as improved
ability to clear DCAs from the patient's airways mechanically
and/or to reduce dead space, may significantly improve patient
outcomes and save lives. By preventing patients' conditions from
getting significantly worse, improvements to ventilators can also
expand the treatments that will be available and effective for
patients, for example allowing antibody treatments to be effective
for a longer period of time for COVID-19 patients. Such
improvements can also help patients with any lung disease or airway
issue caused by any DCA, even empirically caused by unknown
DCAs.
[0040] FIG. 1 is a conceptual diagram 100 illustrating a front view
of a ventilator system connected to a patient 105. The airway of
the patient 105 includes at least the patient 105's mouth 110,
larynx 112, trachea 115, bronchi (not pictured), left lung 130, and
right lung 135. The ventilator system includes an endotracheal tube
(ETT) 120 that is inserted into the mouth 110 of the patient 105
and into the patient 105's trachea 115, alongside the patient 105's
larynx 112. The ETT 120 ends in a tip 125 of the ETT 120 within the
trachea 115. Additional dashed tubes are illustrated extending
beyond the tip 125 of the ETT 120 partway into the left lung 130
and right lung 135, and may represent inspiratory lumens (e.g.,
left inspiratory lumen 220, right inspiratory lumen 225) and/or
expiratory lumens (e.g., left expiratory lumen 520, right
expiratory lumen 525) as discussed further herein. The ETT 120 is
kept in position through a patient interface 149, which can be
mechanically coupled to the patient 105 using one or more coupling
mechanisms of the patient interface 149, such as one or more rubber
bands, one or more clamps, one or more clips, one or more
fasteners, or a combination thereof. The ETT 120 provides
inspiratory gas (e.g., clean air) to the left lung 130 and right
lung 135 of the patient. The ET 120 receives and evacuates
expiratory gas (e.g., exhaled air) from the left lung 130 and right
lung 135 of the patient 105.
[0041] The ventilator system includes a pneumatic system 140 with a
pressurizer 145 (e.g., compressor and/or decompressor), an
inspiratory flow control system 150, and an expiratory flow control
system 155. The inspiratory flow control system 150 provides flow
of inspiratory gas(es) from one or more inspiratory gas sources
160, through an inspiratory tube 152, through a first fitting 147
(e.g., a wye-fitting), through a second fitting 148, through a
patient interface 149, through the ETT 120, and/or into the airway
of the patient 105. In some examples, the inspiratory flow control
system 150 can mix inspiratory gases from the one or more
inspiratory gas sources 160. For example, the one or more
inspiratory gas sources 160 can include an oxygen (O.sub.2) gas
source, a nitrogen (N) gas source, a carbon dioxide (CO.sub.2) gas
source, an argon (Ar) gas source, one or more gas sources for one
or more drugs (in gaseous and/or aerosolized form), one or more gas
sources for one or more other elemental gases, one or more gas
sources for one or more other molecular gases, an pre-mixed
atmospheric gas source, or a combination thereof. For example, the
inspiratory flow control system 150 can mix oxygen (O.sub.2),
nitrogen (N), carbon dioxide (CO.sub.2), argon (Ar), one or more
drugs (in gaseous and/or aerosolized form), one or more one or more
other elemental gases, one or more other molecular gases, a
pre-mixed atmospheric gas source, or a combination thereof.
[0042] Even though it may seem counter-intuitive to include carbon
dioxide (CO.sub.2) in the inspiratory gas mixture, it may be useful
to include carbon dioxide (CO.sub.2) in the inspiratory gas mixture
when carbon dioxide (CO.sub.2) is being evacuated in excess from
the patient 105's airways, as lack of carbon dioxide (CO.sub.2) can
increase alkalinity, pushing pH too high, and can cause negative
effects such as alkalosis. Some types of ventilator systems, such
as those illustrated in FIGS. 4A-4C, might not evacuate enough
carbon dioxide (CO.sub.2) to necessitate or benefit significantly
from inclusion of carbon dioxide (CO.sub.2) in the inspiratory gas
mixture. Other types of ventilator systems that regularly and
actively evacuate expiratory airflow, such as those illustrated in
or discussed with respect to FIGS. 2, 5A-5C, 6, 7A-7B, 8A-8E,
9A-9B, and 10, can evacuate enough carbon dioxide (CO.sub.2) that
inclusion of carbon dioxide (CO.sub.2) in the inspiratory gas
mixture may be necessary and/or significantly beneficial to reduce
alkalinity and prevent alkalosis or other negative effects.
[0043] In some examples, the inspiratory flow control system 150
can mix one or more liquids and/or one or more particulate solids
into the one or more gases, for example in aerosolized form. The
one or more liquids can include water (H.sub.2O), one or more drugs
in liquid form, one or more other liquids, or a combination
thereof. The one or more particulate solids can include one or more
drugs in particulate solid form, one or more other particulate
solids, or a combination thereof. The inspiratory flow control
system 150 can include an aerosolizer and/or particulatizer to
aerosolize and/or particulatize the one or more liquids and/or the
one or more solids. The inspiratory flow control system 150 can mix
the one or more aerosolized and/or particulate liquids and/or
solids into the one or more inspiratory gases.
[0044] The inspiratory flow control system 150 can mix gases and/or
liquids and/or particulate solids from the one or more inspiratory
gas sources 160 at one or more predetermined ratios and/or
proportions. The inspiratory flow control system 150 can mix
inspiratory gases and/or liquids and/or particulate solids from the
one or more inspiratory gas sources 160 at one or more
predetermined ratios and/or proportions to simulate the natural
ratios and/or proportions of these gases in Earth's atmosphere or
other ratios and/or proportions that may be selected or recommended
by an operator, by an artificial intelligence algorithm (e.g., one
or more trained machine learning models, one or more trained neural
networks, or a combination thereof), or a combination thereof. The
inspiratory flow control system 150 can mix inspiratory gases from
the one or more inspiratory gas sources 160 at one or more
predetermined ratios and/or proportions that increase or decrease a
relative quantity of one or more specific gases (e.g., increased
oxygen and/or decreased carbon monoxide) relative to the natural
ratios and/or proportions of these gases in Earth's atmosphere or
other ratios and/or proportions that may be selected or recommended
by an operator, by an artificial intelligence algorithm (e.g., one
or more trained machine learning models, one or more trained neural
networks, or a combination thereof), or a combination thereof. The
mixture mixed by the inspiratory flow control system 150 can be
referred to as the inspiratory mixture, the inspiratory gas, the
inspiratory substance, the inspiratory air, or some combination
thereof.
[0045] In some examples, some of the mixing and/or modifications to
gas properties described above with respect to the inspiratory flow
control system 150 can occur between the inspiratory tube 152 and
the ETT 120. In some examples, some of the mixing and/or
modifications to gas properties described above with respect to the
inspiratory flow control system 150 can occur at the first fitting
147, at the second fitting 148, and/or at the patient interface
149. For example, a drug tube 118 is illustrated in FIG. 1 going
into the second fitting 148. The drug tube 118 can provide one or
more drugs from one or more drug sources (e.g., one or more of the
one or more inspiratory gas sources 160) to the inspiratory gas
provided through the ETT 120 to the patient 105's airways. The one
or more drugs can include, for example, anesthetics, drugs for
treating an injury, drugs for treating a disability, a drugs for
treating a disease (e.g., a respiratory disease and/or any other
disease discussed herein), and/or drugs for treating symptoms of a
disease (e.g., a respiratory disease and/or any other disease
discussed herein), bronchodilators, or a combination thereof.
[0046] The inspiratory flow control system 150 can control various
properties of the inspiratory gas, such as temperature and/or
humidity. The inspiratory flow control system 150 can include a
warmer and/or a heat exchanger to control (e.g., increase or
decrease) the temperature of the inspiratory gas before the
inspiratory flow control system 150 provides the inspiratory gas to
the patient 105's airways through the inspiratory tube 152, through
the first fitting 147, through the second fitting 148, through the
patient interface 149, and/or through the ETT 120. The inspiratory
flow control system 150 can include a humidifier and/or a moisture
exchanger and/or a moisture trap to control (e.g., increase or
decrease) the humidity of the inspiratory gas before the
inspiratory flow control system 150 provides the inspiratory gas to
the patient 105's airways through the inspiratory tube 152, through
the first fitting 147, through the second fitting 148, through the
patient interface 149, and/or through the ETT 120. The inspiratory
flow control system 150 can control properties such as temperature
and/or humidity before mixing inspiratory gases/liquids/solids,
after mixing inspiratory gases/liquids/solids, or both.
[0047] The inspiratory flow control system 150 can include one or
more filters that filter out the contaminants from the inspiratory
gas before the inspiratory flow control system 150 provides the
inspiratory gas to the patient 105's airways through the
inspiratory tube 152, through the first fitting 147, through the
second fitting 148, through the patient interface 149, and/or
through the ET 120. The inspiratory flow control system 150 can
filter the inspiratory air before mixing inspiratory
gases/liquids/solids, after mixing inspiratory
gases/liquids/solids, or both.
[0048] In some examples, the inspiratory flow control system 150
can include one or multiple inspiratory lumens that provide
inspiratory gas to both lungs or separately provide inspiratory gas
to different portions of the patient 105's airways. For instance,
the inspiratory flow control system 150 can include a first
inspiratory lumen and a second inspiratory lumen. The multiple
inspiratory lumens can include a left inspiratory lumen 220 and a
right inspiratory lumen 225 as illustrated in, and/or described
with respect to, FIGS. 2, 5A, 5B, 6, 9A, and/or 9B. In some
examples with at least 2 inspiratory lumens, as illustrated on FIG.
9B, the inspiratory flow control system 150 can include a pressure
relief valve 906, a gas property control 908, inspiratory mixture
sensors 910, a buffer 912, an inspiratory mixture pressurizer 914,
a pressure relief valve 916, a gas property control 918,
inspiratory mixture sensors 920, a buffer 922, an inspiratory
mixture pressurizer 924, a capnometer 926, a gas property control
928, a gas mixer 930, or a combination thereof.
[0049] The expiratory flow control system 155 receives flow of
expiratory gas(es) from the patient 105's airways, through the ETT
120, through the patient interface 149, through the second fitting
148, through the first fitting 147, through an expiratory tube 157,
and/or transfers expiratory gas(es) into one or more expiratory gas
outputs 165. The one or more expiratory gas outputs 165 can include
a sink (e.g., a reservoir), an exhaust, or both. For example, if
the expiratory gas is from a patient whose airways include
disease-causative agents that might cause disease in others in the
area (e.g, doctors, nurses other patients), the one or more
expiratory gas outputs 165 can include a sink (e.g., a reservoir)
to trap the expiratory gas(es) within. If the disease-causative
agents can be reliably filtered out using one or more filters, the
one or more expiratory gas outputs 165 can include the one or more
filters and/or an exhaust.
[0050] In some examples, the expiratory flow control system 155
includes a suction device that provides suction from the patient
105's airway through the ETT 120 and expiratory tube 157. The
compressor(s) and/or pressurizer(s) 145 can provide gas compression
and/or pressure that can provide the suction for the suction device
of the expiratory flow control system 155. In some examples, the
expiratory flow control system 155 does not include or does not
activate its suction device, and instead receives expiratory flow
from the airways of the patient 105 based on the airflow provided
by patient 105's own exhalations. In some examples, the expiratory
flow control system 155 receives the expiratory partially using
suction from the suction device and partially using airflow
provided by patient 105's own exhalations, for example if patient
105 is passively exhaling during the expiration, but with not
enough flow rate to provide sufficient exhalation, or if the
patient 105 is breathing on their own but too weakly to provide
sufficient exhalation.
[0051] In some examples, the expiratory flow control system 155
filters out and/or traps one or more liquids (e.g., aerosolized
liquids), one or more solids (e.g., particulate solids), or a
combination thereof. The expiratory flow control system 155 can
filters out and/or traps the liquids and/or solids using one or
more filters, one or more moisture traps, or a combination thereof.
For example, a moisture tube 128 is illustrated coming from the
second fitting 148, which may output liquid collected by a moisture
trap within the second fitting 148. In some examples, the moisture
tube 128 can output to an expiratory gas output 165 (e.g., sink or
exhaust).
[0052] The expiratory flow control system 155 can control various
properties of the expiratory gas, such as temperature and/or
humidity. The expiratory flow control system 155 can include a
warmer and/or a heat exchanger to control (e.g., increase or
decrease) the temperature of the expiratory gas. The expiratory
flow control system 150 can include a humidifier and/or a moisture
exchanger and/or a moisture trap to control (e.g., increase or
decrease) the humidity of the expiratory gas. The expiratory flow
control system 155 can include one or more filters that filter out
the contaminants (such as disease-causative agents) from the
expiratory gas.
[0053] In some examples, the expiratory flow control system 155 can
include multiple expiratory lumens that separately receive
expiratory gas from different portions of the patient 105's
airways. For instance, the inspiratory flow control system 150 can
include a first expiratory lumen and a second expiratory lumen. The
multiple expiratory lumens can include a left expiratory lumen 520
and a right inspiratory lumen 525 as illustrated in, and/or
described with respect to, FIGS. 5C and 9B. In some examples, the
expiratory flow control system 155 can include a water trap 936, a
capnometer 938, expiratory mixture sensors 940, a buffer 942, an
expiratory mixture pressurizer 944, a water trap 946, a capnometer
948, expiratory mixture sensors 950, a buffer 952, an expiratory
mixture pressurizer 954, a filtration system 956, or a combination
thereof.
[0054] The pressurizer(s) 145 can be used to compress and/or
pressurize the inspiratory gas (e.g., the mixture of inspiratory
gases from the inspiratory gas sources 160) before providing the
inspiratory gas compressed and/or pressurized to the patient 105's
airways through the ETT 120. The pressurizer(s) 145 can compress
and/or pressurize the inspiratory gas within a buffer chamber. The
pressurizer(s) 145 can be used to compress, decompress, pressurize,
and/or depressurize expiratory gas, for example to provide suction
as part of a suction device.
[0055] The ventilation system can include one or more controllers
170. The one or more controllers 170 can each include one or more
computing systems 1100. For examples, the one or more controllers
170 can each include one or more processors 1110, one or more
memory units (e.g., ROM 1120, RAM 1125), one or more storage
devices 1130, one or more input devices 1145, one or more output
devices 1135, one or more communication interfaces 1140, or a
combination thereof. In some examples, the one or more controllers
170 can receive sensor data from one or more sensors of the
ventilator system, such as one or more capnometers 926/938/948, one
or more inspiratory mixture sensors 910/920, one or more expiratory
mixture sensors 940/950, or a combination thereof and/or other
sensors (not shown on pictures) used in clinical practice like
oxygen saturation of patient's blood, patient's blood pressure, ECG
curve, temperature, central line catheter transducer, video camera,
microphone, or a combination thereof. In some examples, the one or
more controllers 170 can analyze the sensor data from the one or
more sensors and one or more capnometers of the ventilator system,
for example to compare the sensor data to one or more predetermined
thresholds or ranges that the one or more controllers 170 can
trigger actions based on. In some examples, the one or more
controllers 170 can analyze the sensor data from the one or more
sensors of the ventilator system to identify one or more patterns
that the one or more controllers 170 can trigger actions based on.
Actions that can be triggered can include, for example, modifying
inspiratory airflow pressure, modifying inspiratory airflow
patterns (e.g., between inspiratory flows 830A-830E), modifying
expiratory airflow pressure (e.g., expiratory suction), modifying
expiratory airflow patterns (e.g., between expiratory flows
835A-835E), or a combination thereof.
[0056] The ventilation system can include one or more interfaces
175 for the one or more controllers 170. The one or more interfaces
175 can include one or more output devices 180, which can include
one or more display screens, one or more indicator lights (e.g.,
light emitting diodes (LEDs)), one or more speakers, one or more
headphones, one or more output devices 1135, or a combination
thereof. The one or more output devices 180 also include connectors
that can be used to connect the one or more controllers 170 to one
or the previously-listed types of output devices 180, such as
plugs, ports, jacks, wires, and/or wireless transceivers. The one
or more output devices 180 can output data to one or more users
190, such as sensor data from the one or more sensors of the
ventilator system, indicators that the sensor data has exceeded a
threshold, indicators that the sensor data has fallen below a
threshold, indicators that the sensor data has crossed into a
predetermined range, indicators that the sensor data has crossed
out of a predetermined range, indications of one or more patterns
recognized in the sensor data by the one or more controllers 170,
or a combination thereof.
[0057] The one or more interfaces 175 can include one or more input
devices 185, which can include one or more touchscreens, keyboards,
keypads, mouse pointers, trackpads, trackballs, microphones,
cameras, one or more input devices 1145, or a combination thereof.
The one or more input devices 185 also include connectors that can
be used to connect the one or more controllers 170 to one or the
previously-listed types of input devices 185, such as plugs, ports,
jacks, wires, and/or wireless transceivers. The one or more input
devices 185 can receive input data from one or more users 190, such
as input data identifying a threshold, a range, an inspiratory
airflow pattern to use (e.g., one of inspiratory flows 830A-830E),
an inspiratory airflow pattern to use (e.g., one of expiratory
flows 835A-835E), or a combination thereof.
[0058] In some examples, a ventilator system may include multiple
inspiratory flow control systems 150, multiple expiratory flow
control systems 152, multiple pressurizers 145, multiple
controllers 170, multiple inspiratory tubes 152, multiple
expiratory tubes 157, or a combination thereof. In an illustrative
example, the inspiratory flow control systems 150 of the ventilator
system may include a left inspiratory flow control system and a
right inspiratory flow control system. The left inspiratory flow
control system can mix an inspiratory mixture for, and/or provides
the inspiratory mixture to, the left lung 130 of the patient, in
some examples through a left inspiratory tube of the inspiratory
tubes 152 and/or through a left inspiratory lumen (e.g., left
inspiratory lumen 220). In some examples, a left pressurizer of the
multiple pressurizers 145 can provide pressure to provide the
inspiratory mixture from the left inspiratory flow control system
to the left lung 130 of the patient. In some examples, a left
controller of the multiple controllers 170 can control inspiratory
pressure, inspiratory mixture components, inspiratory mixture
component ratios, and/or other aspects of provision of the
inspiratory mixture from the left inspiratory flow control system
to the left lung 130. The right inspiratory flow control system can
mix an inspiratory mixture for, and/or provides the inspiratory
mixture to, the right lung 135 of the patient, in some examples
through a right inspiratory tube of the inspiratory tubes 152
and/or through a right inspiratory lumen (e.g., right inspiratory
lumen 225). In some examples, a right pressurizer of the multiple
pressurizers 145 can provide pressure to provide the inspiratory
mixture from the right inspiratory flow control system to the right
lung 135 of the patient. In some examples, a right controller of
the multiple controllers 170 can control inspiratory pressure,
inspiratory mixture components, inspiratory mixture component
ratios, and/or other aspects of provision of the inspiratory
mixture from the right inspiratory flow control system to the right
lung 135. The inspiratory tube(s) 152 are illustrated as a single
tube with a dashed line dividing the single tube into two tubes.
The single tube represents that the inspiratory tube(s) 152 can be
a single tube, while the dashed line division represents that the
inspiratory tube(s) 152 can include a left inspiratory tube and a
right inspiratory tube as discussed above.
[0059] In an illustrative example, the expiratory flow control
systems 155 of the ventilator system may include a left expiratory
flow control system and a right expiratory flow control system. The
left expiratory flow control system can receive an expiratory
mixture from, and/or suction the expiratory mixture from, the left
lung 130 of the patient, in some examples through a left expiratory
tube of the expiratory tubes 157 and/or through a left expiratory
lumen (e.g., left expiratory lumen 520). In some examples, a left
pressurizer of the multiple pressurizers 145 can provide negative
pressure to pull, extract, and/or suction the expiratory mixture
from the left expiratory flow control system from the left lung 130
of the patient 105 to the expiratory gas output(s) 165. In some
examples, a left controller of the multiple controllers 170 can
control expiratory negative pressure and/or other aspects of
receipt of the expiratory mixture from the left lung 130 to the
expiratory gas output(s) 165. The right expiratory flow control
system can receive an expiratory mixture from, and/or suction the
expiratory mixture from, the right lung 130 of the patient, in some
examples through a right expiratory tube of the expiratory tubes
157 and/or through a right expiratory lumen (e.g., right expiratory
lumen 525). In some examples, a right pressurizer of the multiple
pressurizers 145 can provide negative pressure to pull, extract,
and/or suction the expiratory mixture from the right expiratory
flow control system from the right lung 135 of the patient 105 to
the expiratory gas output(s) 165. In some examples, a right
controller of the multiple controllers 170 can control expiratory
negative pressure and/or other aspects of receipt of the expiratory
mixture from the right lung 135 to the expiratory gas output(s)
165. The expiratory tube(s) 157 are illustrated as a single tube
with a dashed line dividing the single tube into two tubes. The
single tube represents that the expiratory tube(s) 157 can be a
single tube, while the dashed line division represents that the
expiratory tube(s) 157 can include a left expiratory tube and a
right expiratory tube as discussed above.
[0060] FIG. 2 is a conceptual diagram 200 illustrating a side view
of a ventilator system connected to a patient 105. The side view
illustrates the ETT 120 entering the patient 105's mouth 110,
passing along the patient 105's larynx 112, and passing into and/or
through at least a portion of the patient 105's trachea 115. The
ventilator system includes a connector 230 to which a drug tube 118
can be connected.
[0061] The ventilator system includes a balloon 205 for the ETT
120. The balloon 205 inflates once the ETT 120 is in the trachea
115. The balloon 205, once inflated, secures the ETT 120 in
position in the trachea 115. The balloon 205, once inflated, can
protect the ETT 120 from scraping the walls of, colliding with the
walls of, or otherwise injuring the trachea 115. The balloon 205,
once inflated, can prevent airflow from passing through the trachea
115 other than through the ETT 120.
[0062] The ventilator system includes multiple inspiratory lumens
that provide inspiratory gas(es) to different portions of the
patient 105's airways. In particular, the ventilator system of FIG.
2 includes a left inspiratory lumen 220 and a right inspiratory
lumen 225. The left inspiratory lumen 220 and the right inspiratory
lumen 225 pass through the ETT 120 and extends beyond the tip 125
of the ETT 120, further into the patient 105's airways. The left
inspiratory lumen 220 extends toward and/or into the left primary
bronchus 210 and/or the left lung 130 of the patient 105. The right
inspiratory lumen 225 extends toward and/or into the right primary
bronchus 215 and/or the right lung 135 of the patient 105.
[0063] FIG. 3 is a conceptual diagram 300 illustrating a trachea
115 connected to a left lung 130 and a right lung 135. The trachea
115, as illustrated in FIG. 3, starts from a point below the larynx
112 (not pictured). The trachea 115, as it extends toward the left
lung 130 and the right lung 135, branches into the left primary
bronchus 210 and the right primary bronchus 215. The left primary
bronchus 210 conducts airflow between the trachea 115 and the left
lung 130. The right primary bronchus 215 conducts airflow between
the trachea 115 and the right lung 135. The primary bronchi can
branch into further, smaller bronchi. For example, the left primary
bronchus 210 branches into three left secondary bronchi 310. The
right primary bronchus 215 branches into three right secondary
bronchi 315. The secondary bronchi may be referred to as lobar
bronchi. Each secondary bronchus of the left secondary bronchi 310
and/or right secondary bronchi 315 can branch off further into
narrower tertiary bronchi or segmental bronchi. Further divisions
of the segmental bronchi are known as 4th order segmental bronchi,
5th order segmental bronchi, 6th order segmental bronchi, and so
forth, or may be referred to as subsegmental bronchi.
[0064] Bronchi may branch into smaller bronchioles 320, which
themselves may branch into further bronchioles 320. Some
bronchioles 320, referred to as respiratory bronchioles 320, end in
alveoli 325 that include alveolar ducts and alveolar sacs. The
alveoli may include surface epithelial cells referred to as
pneumocytes. If a patient 105 has a disease, alveoli 325 in the
left lung 130 and/or alveoli 325 in right lung 135 can become
infected with disease-causative agents (DCAs) such as viruses or
bacteria. In some examples, if a patient 105 has a disease,
pneumocytes of the alveoli 325 can become infected by certain DCAs
such as viruses or bacteria.
[0065] FIG. 4A is a conceptual diagram 400A illustrating part of a
ventilator system with an endotracheal tube (ETT) 120 in a trachea
115 providing inspiratory gas into a diseased right lung 135 and a
healthy left lung 130. The ventilator system includes a balloon 205
for the ETT 120. The balloon 205 is illustrated in its inflated
state, in which the balloon 205 secures the ETT 120 in position in
the trachea 115, protects the trachea 115 from being damaged by the
ETT 120, and/or prevent airflows from passing through the trachea
115 other than through the ETT 120.
[0066] A shaded area within part of the trachea 115 and some of the
bronchi represents the dead space 410 with limited gas exchange or
no gas exchange. The dead space 410 covers a significant portion of
the left primary bronchus 210 and the right primary bronchus 215,
for instance. The dead space 410 covers at least some of the left
secondary bronchi 310 and/or right secondary bronchi 315. In some
examples, the dead space 410 can also include certain segmental
bronchi, subsegmental bronchi, bronchioles 320, and/or alveoli
325.
[0067] The right lung 135 of FIG. 4A includes two infected alveoli
420 and a recovered alveolus 430. The two infected alveoli 420 are
each illustrated as white-colored 16-point starburst shape that are
shaded with a black crosshatch pattern and outlined in black. The
recovered alveolus 430 is illustrated as a white-colored 16-point
starburst shape that is outlined in black. The two infected alveoli
420 may be infected with a disease caused by DCAs 425. As noted
above, DCAs 425 can include, for example, bacteria, fungi, viruses
(e.g., virions), parasites, protozoa, helminths, prions, toxins,
synthetic toxicants, physical contaminants, chemical contaminants,
biological contaminants, radiological contaminants, portions of a
patient's immune system that have an autoimmune disease, or
combinations thereof. Diseases can include infections, injuries,
disabilities, disorders, syndromes, infections, isolated symptoms,
deviant behaviors, atypical, aberrant, or pathologic variations of
structure and function, or combinations thereof. The recovered
alveolus 430 may have previously been an infected alveolus that has
since recovered from the disease and/or no longer harbors DCAs 425.
Two example DCAs 425 are also illustrated in secondary and tertiary
bronchi of the right lung 135 near the infected alveoli 420. The
DCAs 425 are illustrated as white-colored 5-point star shapes that
are shaded with a black crosshatch pattern and outlined in
black.
[0068] The ETT 120, as illustrated in FIG. 4A, is providing an
inspiratory gas to the patient 105's airways. An exemplary flow of
the inspiratory gas down the ETT 120 and into and through the
bronchi of the left lung 130 and the right lung 135 is illustrated
using white arrows outlined in black. Because the DCAs 425 in the
bronchi are largely clustered dose to the infected alveoli 420 in
FIG. 4A, the flow of inspiratory gas in FIG. 4A might spread the
DCAs 425 to certain segmental bronchi, subsegmental bronchi,
bronchioles 320, and/or alveoli 325 that are close to the infected
alveoli 420. Because the DCAs 425 in the bronchi are largely
clustered close to the infected alveoli 420 in FIG. 4A, the flow of
inspiratory gas in FIG. 4A is unlikely to spread the DCAs 425 from
the right lung 135 to the left lung 130, or otherwise to portions
of the patient 105's airway (e.g., bronchi, bronchioles 320, and/or
alveoli 325) that are far away from the infected alveoli 420 in
FIG. 4A.
[0069] FIG. 4B is a conceptual diagram 400B illustrating part of
the ventilator system of FIG. 4A with the endotracheal tube (ETT)
120 evacuating expiratory gas that includes disease-causative
agents (DCAs) 425 from the diseased right lung 135 and the healthy
left lung 130 during the expiration. The right lung 135 of FIG. 4B
includes the two infected alveoli 420 of FIG. 4A and the recovered
alveolus 430 of FIG. 4A.
[0070] The ETT 120, as illustrated in FIG. 4B, is receiving and/or
evacuating an expiratory gas from the patient 105's airways. An
exemplary flow of the expiratory gas up the ETT 120 and from the
bronchi of the left lung 130 and the right lung 135 is illustrated
using white arrows shaded with black dots and outlined in black.
The flow of the expiratory gas from the patient 105's airways
toward and up the ETT 120 has pulled more DCAs 425 from the
infected alveoli 420 and spread the DCAs 425 through more of the
patient's airways. The expiratory gas from the infected alveoli
420's exit path can all become contaminated with DCSs 425,
including for instance the secondary right bronchus, the main right
bronchus, and the distal part of trachea 115 and ETT 120.
Additionally, because the dead space 410 is not briskly evacuated,
DCAs 425 released from pneumocytes of infected alveoli 420, or
otherwise present in the infected alveoli 420, can float into dead
space 410, and then from there spread to other proximal portions of
lungs 130-135. For example, the flow of the expiratory gas from the
patient 105's airways toward and up the ETT 120 has pulled some
DCAs 425 into other bronchi of the right lung 135 (e.g., the right
primary bronchus 215), adjacent to (or even into) bronchi of the
left lung 130 (e.g., the left primary bronchus 210), into the
trachea 115, and into the ETT 120. While some of these DCAs 425
will be successfully evacuated from the patient's airways by the
ETT 120, in some cases DCAs 425 may remain in the dead space 410
due to lack of timely evacuation of the dead space 410. The DCAs
425 that remain in the dead space 410 can then be spread further by
a inspiratory gas provided from the ETT 120 as illustrated in FIG.
4C with an subsequent inspiration after the expiration of FIG.
4B.
[0071] FIG. 4C is a conceptual diagram 400C illustrating part of
the ventilator system of FIGS. 4A-4B with the endotracheal tube
(ETT) 120 providing inspiratory gas that spreads disease-causative
agents (DCAs) 425 to more of the diseased right lung 135 and newly
introduces DCAs 425 into the newly-diseased left lung 130, for
instance as inspiratory gas passes through previously-contaminated
airways and ETT 120 (e.g., areas with DCAs 425 in FIG. 4B). This
spread causes the right lung 135 of FIG. 4C to include two newly
infected alveoli 440, and causes the recovered alveolus 430 of FIG.
4B to become reinfected, becoming a reinfected alveolus 435. The
right lung 135 of FIG. 4C also still includes the two infected
alveoli 420 of FIGS. 4A-4B.
[0072] The ETT 120, as illustrated in FIG. 4C, is providing an
inspiratory gas to the patient 105's airways. An exemplary flow of
the inspiratory gas down the ETT 120 and into and through the
bronchi of the left lung 130 and the right lung 135 is illustrated
using white arrows outlined in black. Because some DCAs 425 remain
in the dead space 410 after being pulled into the dead space 410 by
the flow of the expiratory gas of FIG. 4B, and because the ETT 120
and some airways became contaminated by the expiratory gas as
illustrated in FIG. 4B, the inspiratory gas provided from the ETT
120 into the patient 105's airways spreads the DCAs 425 from the
dead space 410 and other portions of the patient 105's airways that
were contaminated during the expiration of FIG. 4B (e.g., the ETT
120) throughout the patient 105's airways, even to parts of the
patient 105's airways that were previously healthy, non-diseased,
and/or free of DCAs 425. For example, the flow of the inspiratory
gas spreads the DCAs 425 to the recovered alveolus 430 of FIGS.
4A-4B, which newly becomes reinfected to become a reinfected
alveolus 435 in FIG. 4C. The reinfected alveolus 435 is illustrated
as a black-colored 16-point starburst shape that is shaded with a
white crosshatch pattern and outlined in black. The flow of the
inspiratory gas spreads the DCAs 425 to other previously-health
alveoli 325, newly infecting them, including two newly infected
alveoli 440. The newly infected alveoli 440 are illustrated as
black-colored 16-point starburst shapes. The first of the newly
infected alveoli 440 is located in a part of the right lung 135 far
from the infected alveoli 420, branching from a different one of
the right secondary bronchi 315 than the infected alveoli 420. The
second of the newly infected alveoli 440 is located in the left
lung 130. Thus, FIGS. 4A-4C illustrate how a ventilator system that
both provides inspiratory gas to the patient 105's airways from the
tip 125 of the ETT 120 and evacuates an expiratory gas from the
patient 105's airways through the same tip 125 of the ETT 120 can
spread DCAs 425 throughout the patient 105's airways, for example
from a diseased lung (as in the right lung 135 of FIGS. 4A-4B) to a
formerly-healthy lung (as in the left lung 130). This cycle of
reinfecting the patient 105's airways, and spreading the DCAs 425
throughout the patient 105's airways, perpetuates and/or spreads
diseases and makes it harder for medications, therapeutics,
patients' native immune system cells, antibodies, or other
treatments to neutralize or eliminate the DCAs 425. This maintains
and/or spreads the diseased state in the patient 105's airways.
[0073] FIG. 4D is a conceptual diagram 400D illustrating an example
of the ventilator systems of FIGS. 4A-4C with an adapter 450 added
on one side of the balloon 205 and another adapter 455 added on the
other side of the balloon 205. The conceptual diagram 400D of FIG.
4D includes an exploded view of the ventilator system of FIG. 4D,
illustrating the ETT 120, the adapter 450, the adapter 455, and a
ventilator circuit tube 457. The adapter 450 is coupled to the ETT
120 on one end of the adapter 450, and to a ventilator circuit tube
457 on the other end of the adapter 450. The adapter 455 is coupled
to one portion of the ETT 120 (that includes the balloon 205 and
goes toward the patient 105's mouth) one end of the adapter 455,
and to another portion of the ETT 120 (that includes the tip 125 of
the ETT 120 and goes toward the patient 105's lungs 130-135) on the
other end of the adapter 455.
[0074] The ventilator circuit tube 457 may be, for example, a tube
between the ETT 120 and the patient interface 149, at least a part
of the patient interface 149, a tube between the patient interface
149 and the second fitting 148, a tube between the second fitting
148 and the first fitting 147, an inspiratory tube 152, an
expiratory tube 157, or a combination thereof.
[0075] Examples of the adapter 450 include the micro-filter adapter
460 of FIG. 4E, the airflow rerouting adapter 470 of FIG. 4F, and
the connector 610 of FIG. 6. Examples of the adapter 455 include
the micro-filter adapter 460 of FIG. 4E, the airflow rerouting
adapter 470 of FIG. 4F, and the connector 610 of FIG. 6. In some
examples, the ventilator system of FIG. 4D may include the adapter
450 but may omit the adapter 455. In some examples, the ventilator
system of FIG. 4D may include the adapter 455 but may omit the
adapter 450. In some examples, the ventilator system of FIG. 4D may
include both the adapter 450 and the adapter 455, which may both be
the same type of adapter or may be different types of adapters.
[0076] FIG. 4E is a conceptual diagram 400E illustrating a
cross-section of a micro-filter adapter 460. The micro-filter
adapter 460 includes an inner area 462 and an outer area 464. The
inner area 462 and the outer area 464 may be separated by a barrier
463. In some examples, the barrier 463 may be rigid. In some
examples, the barrier 463 may be pliable, as in a sleeve and/or a
membrane or the barrier maybe the microfiltration medium, on of a
kinds later listed. The inner area 462 includes a microfilter
medium 465. The microfilter medium 465 may include, for example,
N95 filter medium, N99 filter medium, HVAC filter medium, HEPA
filter medium, ULPA filter medium, MERV 16 filter medium, MERV 15
filter medium, MERV 14 filter medium, MERV 13 filter medium, MERV
12 filter medium, MERV 11 filter medium, MERV 10 filter medium,
MERV 9 filter medium, MERV 8 filter medium, MERV 7 filter medium,
MERV 6 filter medium, MERV 5 filter medium, MERV 4 filter medium,
paper filter medium, pleated filter medium, non-pleated filter
medium, or a combination thereof.
[0077] The micro-filter adapter 460 can be an example of the
adapter 250 and/or of the adapter 255 of FIG. 4D. Either way, the
micro-filter adapter 460 couples to the ETT 120 along a bottom side
of the micro-filter adapter 460 in a direction toward the patient
105's left lung 130, right lung 135, left primary bronchus 210,
right primary bronchus 215, left secondary bronchi 310, right
secondary bronchi 315, other bronchi, bronchioles 320, alveoli 325,
or combinations thereof. The micro-filter adapter 460 can couple to
the ETT 120 and/or to the ventilator circuit tube 457 along a top
side of the micro-filter adapter 460 in a direction away from the
patient 105's left lung 130, right lung 135, left primary bronchus
210, right primary bronchus 215, left secondary bronchi 310, right
secondary bronchi 315, other bronchi, bronchioles 320, alveoli 325,
or combinations thereof.
[0078] Examples of inspiratory airflow are illustrated in FIG. 4E
using white arrows outlined in black, which enter from the top side
of the micro-filter adapter 460 and move toward the bottom side of
the micro-filter adapter 460. Examples of expiratory airflow are
illustrated in FIG. 4E using white arrows shaded with black dots
and outlined in black, which enter from the bottom side of the
micro-filter adapter 460 and move toward the top side of the
micro-filter adapter 460. While both the inspiratory airflow and
expiratory airflow are illustrated flowing at the same time, in
some cases inspiratory and expiratory airflow happen sequentially
(i.e. inspiratory flow via microfilter medium 465 during
inspiration and expiratory flow via outer area bypassing the
microfilter medium 465 during expiration). In some cases,
inspiratory and expiratory airflow happen simultaneously (i.e.
continuous inspiratory flow via microfilter medium 465 and
continues expiratory flow via outer area bypassing the microfilter
medium). In some cases, inspiratory and expiratory airflow happen
independently and intermittently (i.e. intermittent independent
inspiratory flow via microfilter medium 465 and intermittent
independent intermittent expiratory flow via outer area bypassing
the microfilter medium 465 during at any other times). In some
cases either inspiratory airflow or expiratory airflow may be
flowing through the micro-filter adapter 460 without the other. For
instance, at some times, only the inspiratory airflow may be
flowing through the micro-filter adapter 460, while at other times,
only the expiratory airflow may be flowing through the micro-filter
adapter 460. In some examples, the microfilter medium can be placed
in outer area 464 as well, as addition to microfilter medium 465
placed in inner area 464, or without the microfilter medium 465 in
the inner area.
[0079] The micro-filter adapter 460 includes a first one-way
airflow valve 465A that permits inspiratory airflow to pass through
the first one-way airflow valve 465A into the inner area 462 (based
on movement direction moving toward the lungs 130-135) and prevents
expiratory airflow from passing through the first one-way airflow
valve 465A (based on movement direction moving away from the lungs
130-135). Once in the inner area 462, the inspiratory airflow
passes through the microfilter medium 465 and is filtered by the
microfilter medium 465. The micro-filter adapter 460 includes a
second one-way airflow valve 465B that permits inspiratory airflow
to pass through the second one-way airflow valve 465B out from
inside the inner area 462 (based on movement direction moving
toward the lungs 130-135) and prevents expiratory airflow from
passing through the second one-way airflow valve 465B to enter the
inner area 462 (based on movement direction moving away from the
lungs 130-135). Thus, inspiratory airflow is filtered by the
microfilter medium 465 before reaching the lungs 130-135 and
bronchi.
[0080] The micro-filter adapter 460 can include a one or more
one-way airflow valves 467A-467B that permit expiratory airflow to
pass through the one or more one-way airflow valves 467A-467B into
the outer area 464 (based on movement direction moving away from
the lungs 130-135) and prevents inspiratory airflow from passing
through the one or more one-way airflow valves 467A-467B (based on
movement direction moving toward the lungs 130-135). Once in the
outer area 464, the inspiratory airflow moves up without passing
through the microfilter medium 465, ensuring the microfilter medium
465 is kept free of DCAs 425 from the patient 105's airways. The
micro-filter adapter 460 includes one or more one-way airflow
valves 467C-467D that permit expiratory airflow to pass through the
one or more one-way airflow valves 467C-467D out from inside the
outer area 464 (based on movement direction moving away from the
lungs 130-135) and prevents inspiratory airflow from passing
through the one or more one-way airflow valves 467C-467D to enter
the outer area 464 (based on movement direction moving away from
the lungs 130-135). Thus, the inspiratory airflow and the
expiratory airflow are kept separate within the micro-filter
adapter 460 by the barrier 463 and the various one-way airflow
valves.
[0081] In some examples, the micro-filter adapter 460 can include,
and/or be coupled to, one or more mucus extraction tubes 469A-469B,
which may extract mucus from expiratory airflow and/or inspiratory
airflow to help prevent mucus from clogging any of the one-way
airflow valves 465A-465B, from clogging any of the one-way airflow
valves 467A-467F, from clogging the microfilter medium 465, from
clogging the inner area 462, from clogging the outer area 464, from
weakening the barrier 463, or a combination thereof. The one or
more mucus extraction tubes 469A-469B may use suction (e.g.,
negative pressure) to extract the mucus from the airflow. In some
examples, the micro-filter adapter 460 can include one or more
one-way airflow valves 467E-467F that permit expiratory airflow to
pass through the one or more one-way airflow valves 467E-467F into
the one or more mucus extraction tubes 469A-469B (based on movement
direction moving away from the lungs 130-135) and prevents
inspiratory airflow from passing through the one or more one-way
airflow valves 467E-467F to enter the one or more mucus extraction
tubes 469A-469B (based on movement direction moving toward the
lungs 130-135). In some examples, the one or more one-way airflow
valves 467E-467F instead permit inspiratory airflow to pass through
the one or more one-way airflow valves 467E-467F into the one or
more mucus extraction tubes 469A-469B (based on movement direction
moving toward the lungs 130-135) and prevents expiratory airflow
from passing through the one or more one-way airflow valves
467E-467F to enter the one or more mucus extraction tubes 469A-469B
(based on movement direction moving away from the lungs 130-135).
In some examples, the one or more one-way airflow valves 467E-467F
permit both inspiratory airflow and expiratory airflow to pass
through the one or more one-way airflow valves 467E-467F into the
one or more mucus extraction tubes 469A-469B. A first mucus
extraction tube 469A is illustrated above (away from the lungs
130-135) the microfilter medium 465 and above one-way airflow
valves 465A, 467C, and 467D. A second mucus extraction tube 469B is
illustrated below (toward from the lungs 130-135) the microfilter
medium 465 and below one-way airflow valves 465B, 467A, and 467B.
The mucus extraction tube(s) 469A-469B can connect to the outer
area 464, the inner area 462, or both. In some examples, the
barrier 463 may be cylindrical in shape as illustrated in FIG. 4E,
In some examples, the barrier 463 may be conical in shape, which
may increase filtration surface area, reducing the pressure
gradient across the microfilter medium 465 and maximizing the
lifetime of microfilter medium 465. In some examples, a microfilter
adapter 460 (and/or a microfilter medium 465 on its own) can be
placed distally from trachea 115, within inspiratory lumens 220-225
and/or expiratory lumens 520/525. In some examples, a microfilter
adapter 460 may be used upside-down, or backwards, relative to the
airflow and directionality illustrated in FIG. 4E, so that the
expiratory airflow is filtered through the microfilter medium 465
rather than the inspiratory airflow. In some examples, the outer
area 464 may also include a separate microfilter medium (of any of
the types discussed with respect to the microfilter medium 465)
that may filter the airflow passing through the outer area 464 of
the microfilter adapter 460.
[0082] A micro-filter adapter 460 may provide technical
improvements over the ventilator systems of FIGS. 4A-4C by
filtering inspiratory airflow before the inspiratory airflow
reaches the patient 105's lungs 130-135. A micro-filter adapter 460
may provide technical improvements over the ventilator systems of
FIGS. 4A-4C by separating the inspiratory airflows and expiratory
airflows to prevent DCAs 425 from the expiratory airflows from
mixing into the inspiratory airflows and spreading throughout the
patient 105's lungs 130-135 and airways in general.
[0083] FIG. 4F is a conceptual diagram 400F illustrating a
cross-section of an airflow rerouting adapter 470. The airflow
rerouting adapter 470 can be an example of the adapter 450 and/or
of the adapter 455 of FIG. 4D. Either way, the airflow rerouting
adapter 470 couples to the ETT 120 along a bottom side of the
airflow rerouting adapter 470 in a direction toward the patient
105's left lung 130, right lung 135, left primary bronchus 210,
right primary bronchus 215, left secondary bronchi 310, right
secondary bronchi 315, other bronchi, bronchioles 320, alveoli 325,
or combinations thereof. The airflow rerouting adapter 470 can
couple to the ETT 120 and/or to the ventilator circuit tube 457
along a top side of the airflow rerouting adapter 470 in a
direction away from the patient 105's left lung 130, right lung
135, left primary bronchus 210, right primary bronchus 215, left
secondary bronchi 310, right secondary bronchi 315, other bronchi,
bronchioles 320, alveoli 325, or combinations thereof.
[0084] Examples of inspiratory airflow are illustrated in FIG. 4F
using white arrows outlined in black. A primary inspiratory airflow
enters the airflow rerouting adapter 470 from the top side of the
airflow rerouting adapter 470 and moves toward the filter 485 and
the output 487. A secondary inspiratory airflow enters the airflow
rerouting adapter 470 from the inspiratory gas provision system 490
of the airflow rerouting adapter 470 moves toward the bottom of the
airflow rerouting adapter 470, toward the patient 105's lungs
130-135.
[0085] Examples of expiratory airflow are illustrated in FIG. 4E
using white arrows shaded with black dots and outlined in black. A
primary expiratory airflow enters the airflow rerouting adapter 470
from the bottom side of the airflow rerouting adapter 470 (from the
patient 105's lungs 130-135) and moves toward the filter 485 and
the output 487. A secondary expiratory airflow enters the airflow
rerouting adapter 470 from the inspiratory gas provision system 490
of the airflow rerouting adapter 470 moves toward the top of the
airflow rerouting adapter 470, away from the patient 105's lungs
130-135. While both the inspiratory airflow and expiratory airflow
are illustrated flowing at the same time, in some cases either
inspiratory airflow or expiratory airflow may be flowing through
the airflow rerouting adapter 470 without the other, and/or
sequentially, or continuously, For instance, at some times, only
the inspiratory airflow may be flowing through the airflow
rerouting adapter 470, while at other times, only the expiratory
airflow may be flowing through the airflow rerouting adapter
470.
[0086] A set of one-way airflow valves 465C-465D can route the
inspiratory airflow along the previously-described and illustrated
paths. A set of one-way airflow valves 467G-467H can route the
expiratory airflow along the previously-described and illustrated
paths.
[0087] The airflow rerouting adapter 470 includes a one-way airflow
valve 465C that permits the primary inspiratory airflow to pass
through the one-way airflow valve 465C toward the inspiratory
sensors 472A, the filter 485, and the output 487 (based on movement
direction moving toward the lungs 130-135) and prevents expiratory
airflow from passing through the one-way airflow valve 465C (based
on movement direction moving away from the lungs 130-135). The
airflow rerouting adapter 470 includes a one-way airflow valve 465D
that permits the secondary inspiratory airflow to pass through the
one-way airflow valve 465D toward the inspiratory sensors 472B, and
into the ETT 120 toward the tip 125 of the ETT 120 and toward the
patient 105's lungs 130-135 (based on movement direction moving
toward the lungs 130-135) and prevents expiratory airflow from
passing through the one-way airflow valve 465D (based on movement
direction moving away from the lungs 130-135).
[0088] The airflow rerouting adapter 470 includes a one-way airflow
valve 467G that permits the primary expiratory airflow to pass
through the one-way airflow valve 467G toward the expiratory
sensors 475A, the filter 485, and the output 487 (based on movement
direction moving away from the lungs 130-135) and prevents
inspiratory airflow from passing through the one-way airflow valve
467G (based on movement direction moving toward the lungs 130-135).
The airflow rerouting adapter 470 includes a one-way airflow valve
467H that permits the secondary expiratory airflow to pass through
the one-way airflow valve 467H toward the expiratory sensors 475B,
toward the top of the airflow rerouting adapter 470 and into the
ventilator circuit tube 457 and/or ETT 120 (based on movement
direction moving away from the lungs 130-135) and prevents
inspiratory airflow from passing through the one-way airflow valve
467H (based on movement direction moving toward the lungs
130-135).
[0089] The output 487 can be, for example, a sink or an exhaust.
Examples of the output 487 include the expiratory gas output(s) 165
and the output 958. Examples of the filter 485 include the
filtration 956. In some examples, the primary inspiratory airflow
may be output to the filter 485 and/or to the output 487. The
airflow rerouting adapter 470 can effectively replace the primary
inspiratory airflow with the secondary inspiratory airflow provided
by the inspiratory gas provision system 490, which can provide the
patient 105's lungs 130-135 and airways generally with more
fine-tuned inspiratory airflow than the ventilator system into
which the airflow rerouting adapter 470 is being added. This
fine-tuned inspiratory airflow can be clean of DCAs 425, as it is
not coming from an already-contaminated ETT 120, ventilator circuit
tubing 457, other tubing, or other portion(s) of the ventilator
system. In some examples, the primary expiratory airflow may be
output to the filter 485 and/or to the output 487. The airflow
rerouting adapter 470 can effectively replace the primary
expiratory airflow with the secondary expiratory airflow provided
by the expiratory gas provision system 490, which can provide the
ETT 120 and/or ventilator circuit tube 457 with expiratory airflow
that prevents warnings or alarms (e.g., regarding lack of
expiratory airflow or irregular expiratory airflow) from being
raised by the ventilator system into which the airflow rerouting
adapter 470 is being added.
[0090] In some examples, the airflow rerouting adapter 470 includes
one or more airflow sensors 466C beside the one-way airflow valve
465C that detect attributes of the primary inspiratory airflow. In
some examples, the one or more airflow sensors 466C are above the
one-way airflow valve 465C, and therefore the primary inspiratory
airflow encounters the one or more airflow sensors 466C before
passing through the one-way airflow valve 465C. In some examples,
the airflow rerouting adapter 470 includes one or more airflow
sensors 466D beside the one-way airflow valve 465D that detect
attributes of the secondary inspiratory airflow. In some examples,
the one or more airflow sensors 466D are below the one-way airflow
valve 465D, and therefore the secondary inspiratory airflow
encounters the one or more airflow sensors 466D after passing
through the one-way airflow valve 465D. In some examples, the
airflow rerouting adapter 470 includes one or more airflow sensors
468G beside the one-way airflow valve 467G that detect attributes
of the primary expiratory airflow. In some examples, the one or
more airflow sensors 468G are below the one-way airflow valve 467G,
and therefore the primary expiratory airflow encounters the one or
more airflow sensors 468G before passing through the one-way
airflow valve 467G. In some examples, the airflow rerouting adapter
470 includes one or more airflow sensors 468H beside the one-way
airflow valve 467H that detect attributes of the secondary
expiratory airflow. In some examples, the one or more airflow
sensors 468H are above the one-way airflow valve 467H, and
therefore the secondary expiratory airflow encounters the one or
more airflow sensors 468H after passing through the one-way airflow
valve 467H.
[0091] The various sensors of the airflow rerouting adapter
470--including the one or more airflow sensors 466C, the one or
more airflow sensors 466D, the one or more airflow sensors 468G,
the one or more airflow sensors 468H, the--can each measure one or
more airflow attributes of airflow. Each of these sensors can
include, for example, pressure sensors, pressure transducers, flow
sensors, capnometers, humidity sensors, oximeters (oxygen sensors),
thermometers (temperature sensors), other types of sensors
discussed herein, or a combination thereof. The one or more airflow
attributes can include, for example, airflow, pressure, speed,
velocity, volume, temperature, moisture, humidity, O.sub.2
concentration, CO.sub.2 concentration, N concentration, Ar
concentration, H.sub.2O concentration, other sensor measurement
data discussed herein, or a combination thereof. For instance,
examples of any of the sensors of the airflow rerouting adapter 470
can include the capnometer 926, the inspiratory mixture sensors
910, the inspiratory mixture sensors 920, the intratracheal sensors
934, the capnometer 938, the capnometer 948, the expiratory mixture
sensors 940, the expiratory mixture sensors 950, or a combination
thereof. Sensor data from the sensors of the airflow rerouting
adapter 470 can be passed to a controller 480. The controller 480
can control airflow provision (e.g., of the secondary inspiratory
airflow and/or of the secondary expiratory airflow) by the
inspiratory gas provision system 490. The controller 480 can be an
example of a controller 170.
[0092] In some examples, the inspiratory gas provision system 490
can include gas sources, gas mixer, gas property control,
humidifier, warmer, heat and moisture exchanger, capnometer,
inspiratory mixture pressurizer, buffer, inspiratory mixture
sensors (e.g., pressure and flow), gas property control
(humidifier, warmer, heat and moisture exchangers), pressure
relieve valve. In some examples, the inspiratory gas provision
system 490 can include, for example, the inspiratory flow control
system(s) 150, the inspiratory gas source(s) 160, the gas sources
932, the gas mixer(s) 930, the gas property control(s) 928, the
capnometer(s) 926, the inspiratory mixture pressurizer 914, the
buffer 912, the inspiratory mixture sensors 910, the gas property
control 908, the pressure release valve 906, the inspiratory
mixture pressurizer 924, the buffer 922, the inspiratory mixture
sensors 920, the gas property control 918, the pressure release
valve 916, or a combination thereof.
[0093] In some examples, the controller 480 may mix, pressurize,
heat, cool, humidify, dehumidify, or otherwise set one or more
attributes of the secondary inspiratory airflow based on one or
more one or more attributes of the primary inspiratory airflow as
measured by the airflow sensor(s) 466C and/or the inspiratory
sensors 472A. The controller 480 may verify that the attributes
match using the inspiratory sensors 472B and/or the airflow sensors
466D. In some examples, the controller 480 may mix, pressurize,
heat, cool, humidify, dehumidify, or otherwise set one or more
attributes of the secondary expiratory airflow based on one or more
one or more attributes of the primary expiratory airflow as
measured by the airflow sensor(s) 468G and/or the expiratory
sensors 475A. The controller 480 may verify that the attributes
match using the expiratory sensors 475B and/or the airflow sensors
468H.
[0094] An airflow rerouting adapter 470 may provide technical
improvements over the ventilator systems of FIGS. 4A-4C by allowing
to provide uncontaminated with DCAs inspiratory gas via
uncontaminated with DCAs inspiratory lumens, and customized control
of inspiratory airflow and/or expiratory airflow using the
inspiratory gas provision system 490, while still using the
framework of a ventilator system such as those of FIGS. 4A-4C, and
simulating expected inspiratory airflow and/or expiratory airflow
to the ventilator system using the inspiratory gas provision system
490. In some examples, use of an airflow rerouting adapter 470 can
provide some technical improvements similar to a ventilator system
illustrated in FIGS. 5A-5D.
[0095] FIG. 5A is a conceptual diagram 500A illustrating part of a
ventilator system with an endotracheal tube (ETT) 120 that includes
an expiratory lumen 510 that evacuates expiratory gas, a left
inspiratory lumen 220 that provides inspiratory gas to the left
primary bronchus 210 and left lung 130, and a right inspiratory
lumen 225 that provides inspiratory gas to the right primary
bronchus 215 and right lung 135. The left inspiratory lumen 220 and
right inspiratory lumen 225 both extend beyond the tip 125 of the
ETT 120 toward and/or into the patient 105's airways. The left
inspiratory lumen 220 and right inspiratory lumen 225 both extend
further into the patient 105's airways than the tip 125 of the ETT
120 does. In particular, the left inspiratory lumen 220 extends
beyond the tip 125 of the ETT 120 toward the patient 105's left
primary bronchus 210, left lung 130, and/or other left bronchi
within the left lung 130. The right inspiratory lumen 225 extends
beyond the tip 125 of the ETT 120 toward the patient 105's right
primary bronchus 215, right lung 135, and/or other right bronchi
within the right lung 135.
[0096] The left inspiratory lumen 220 and right inspiratory lumen
225 each provide a gaseous volume of inspiratory gas(es) to
different portions of the patient 105's airways. The left
inspiratory lumen 220 provides a first (left) gaseous volume of
inspiratory gas(es) to patient 105's left primary bronchus 210,
left lung 130, other left bronchi within the left lung 130,
bronchioles 320 within the left lung 130, alveoli 325 within the
left lung 130, or a combination thereof. An exemplary flow of the
first (left) gaseous volume of inspiratory gas(es) down the left
inspiratory lumen 220 and into the patient 105's airways is
illustrated using white arrows outlined in black. The right
inspiratory lumen 225 provides a second (right) gaseous volume of
inspiratory gas(es) to patient 105's right primary bronchus 215,
right lung 135, other right bronchi within the right lung 135,
bronchioles 325 within the right lung 135, alveoli 325 within the
right lung 135, or a combination thereof. An exemplary flow of the
second (right) gaseous volume of inspiratory gas(es) down the right
inspiratory lumen 225 and into the patient 105's airways is
illustrated using white arrows outlined in black.
[0097] The ETT 120 of FIG. 5A houses an expiratory lumen 510. For
instance, as illustrated in FIG. 6 and FIG. 7A, any space in the
ETT 120 not taken up by the left inspiratory lumen 220 or the right
inspiratory lumen 225 can be used as an expiratory lumen 510. Thus,
the tip 125 of the ETT 120 is also the tip of the expiratory lumen
510. Thus, in FIG. 5A, the left inspiratory lumen 220 and right
inspiratory lumen 225 both extend beyond the tip of the expiratory
lumen 510 toward the patient 105's airways. The left inspiratory
lumen 220 and right inspiratory lumen 225 both extend further into
the patient 105's airways than the tip of the expiratory lumen 510
does. The expiratory lumen 510, as illustrated in FIG. 4B, is
receiving and/or evacuating expiratory gas(es) from the patient
105's airways. An exemplary flow of the expiratory gas(es) up the
expiratory lumen 510 and from the trachea 115 and bronchi of the
left lung 130 and the right lung 135 is illustrated using white
arrows shaded with black dots and outlined in black.
[0098] The ventilator systems of FIGS. 5A-5C reduce dead space 410
compared to the ventilator systems of FIGS. 4A-4C by having
inspiratory gas delivered more directly and proximally to the
alveoli, and in most embodiment and most of ventilatory modes (as
illustrated on FIGS. 8A-8E) by continuous or all almost continuous
clearing of the dead space with continues gas flow between the
inspiratory lumen or lumens and expiratory lumen or lumens. The
dead space 410 in FIGS. 5A-5C is identified by shaded regions
similar to those that indicate dead space 410 in FIGS. 4A-4C. The
reduction in dead space 410 and continuous or close to continues
clearance of dead space 410 can reduce the ventilator's ability to
spread DCAs 425 from diseased portions of a patient 105's airways
to healthy portions of the patient 105's airways, as illustrated in
FIG. 5B. Additionally, inspiratory gas can be consistently and/or
continuously delivered to the lungs 130-135 by clean
(non-contaminated) inspiratory lumens 250/255, as all contaminated
expiratory gas leaves the lungs via separate expiratory lumen(s)
510/520/525.
[0099] FIG. 5B is a conceptual diagram 500B illustrating part of
the ventilator system of FIG. 5A where the right lung 135 is
diseased and the left lung 130 is healthy. Like FIG. 4A, the right
lung 135 of FIG. 5B includes two infected alveoli 420 and a
recovered alveolus 430. Several DCAs 425 are illustrated near the
two infected alveoli 420 in the diseased right lung 135. However,
the ventilator system(s) of FIGS. 5A-5C does not spread the DCAs
425 to different parts of the patient 105's airways as readily as
the ventilator system(s) of FIGS. 4A-4C. For instance, the
ventilator system(s) FIGS. 5A-5C include physical separation
between the tip of the expiratory lumen 510 (the tip 125 of the ETT
120) and tips of the inspiratory lumens (the left inspiratory lumen
220 and the right inspiratory lumen 225), preventing dead space
cross between the left lung 130 (and/or the left primary bronchus
210) and the right lung 135 (and/or the right primary bronchus 215)
through which DCAs 425 could otherwise cross between left
lungs/bronchi and right lungs/bronchi. The ventilator system(s)
FIGS. 5A-5C include physical separation between the tip of the left
inspiratory lumen 220 and the tip of the right inspiratory lumen
225, also preventing dead space between the left lung 130 (and/or
the left primary bronchus 210) and the right lung 135 (and/or the
right primary bronchus 215) through which DCAs 425 could otherwise
cross between lungs/bronchi.
[0100] FIG. 5C is a conceptual diagram 500C illustrating part of a
ventilator system with an endotracheal tube (ETT) 120 that includes
a left expiratory lumen 520 that evacuates expiratory gas from a
left primary bronchus 210 and left lung 130, a right expiratory
lumen 525 that evacuates expiratory gas from a right primary
bronchus 215 and right lung 135, a left inspiratory lumen 220 that
provides inspiratory gas to the left primary bronchus 210 and left
lung 130, and a right inspiratory lumen 225 that provides
inspiratory gas to the right primary bronchus 215 and right lung
135. The ventilator system of FIG. 5C is similar to the ventilator
system of FIGS. 5A and 5B, for instance because the ventilator
system of FIG. 5C also includes the left inspiratory lumen 220 and
the right inspiratory lumen 225. The left inspiratory lumen 220 and
the right inspiratory lumen 225 of the ventilator system of FIG. 5C
function similarly to the left inspiratory lumen 220 and the right
inspiratory lumen 225 of the ventilator system of FIGS. 5A and
5B.
[0101] However, the ventilator system of FIG. 5C includes the left
expiratory lumen 520 and the right expiratory lumen 525 in place of
a single expiratory lumen 510 of the ventilator system of FIGS. 5A
and 5B. The left expiratory lumen 520 and right expiratory lumen
525 both extend beyond the tip 125 of the ETT 120 toward and/or
into the patient 105's airways. The left expiratory lumen 520 and
right expiratory lumen 525 both extend further into the patient
105's airways than the tip 125 of the ETT 120 does. In particular,
the left expiratory lumen 520 extends beyond the tip 125 of the ETT
120 toward the patient 105's left primary bronchus 210, left lung
130, and/or other left bronchi within the left lung 130. The right
expiratory lumen 525 extends beyond the tip 125 of the ETT 120
toward the patient 105's right primary bronchus 215, right lung
135, and/or other right bronchi within the right lung 135.
[0102] In some examples (as illustrated in FIG. 4C), the left
inspiratory lumen 220 extends beyond the tip of the left expiratory
lumen 520 toward and/or into the patient 105's airways. In some
examples (as illustrated in FIG. 4C), the left inspiratory lumen
220 extends further into the patient 105's airways than the tip of
the left expiratory lumen 520. In some examples (as illustrated in
FIG. 4C), the right inspiratory lumen 225 extends beyond the tip of
the right expiratory lumen 525 toward and/or into the patient 105's
airways. In some examples (as illustrated in FIG. 4C), the right
inspiratory lumen 225 extends further into the patient 105's
airways than the tip of the right expiratory lumen 525.
[0103] In some examples (not illustrated), the left expiratory
lumen 520 extends beyond the tip of the left inspiratory lumen 220
toward and/or into the patient 105's airways. In some examples (not
illustrated), the left expiratory lumen 520 extends further into
the patient 105's airways than the tip of the left inspiratory
lumen 220. In some examples (not illustrated), the right expiratory
lumen 225 extends beyond the tip of the right inspiratory lumen 525
toward and/or into the patient 105's airways. In some examples (not
illustrated), the right expiratory lumen 225 extends further into
the patient 105's airways than the tip of the right inspiratory
lumen 525.
[0104] The left expiratory lumen 520 and the right expiratory lumen
525, as illustrated in FIG. 5C, are both receiving and/or
evacuating expiratory gas(es) from different parts of the patient
105's airways. An exemplary flow of the expiratory gas(es) up the
left expiratory lumen 520 from the bronchi of the left lung 130 is
illustrated using white arrows shaded with black dots and outlined
in black. An exemplary flow of the expiratory gas(es) up the right
expiratory lumen 525 from the bronchi of the right lung 135 is
illustrated using white arrows shaded with black dots and outlined
in black.
[0105] In some examples, the left inspiratory lumen 220 and the
left expiratory lumen 520 are coupled together. In some examples,
the right inspiratory lumen 225 and the right expiratory lumen 525
are coupled together. In some examples, the left inspiratory lumen
220 and the left expiratory lumen 520 are two distinct parts of a
single lumen, for example with a membrane in between (as in FIG.
7B). In some examples, the right inspiratory lumen 225 and the
right expiratory lumen 525 are two distinct parts of a single
lumen, for example with a membrane in between (as in FIG. 7B).
[0106] In some examples, a balloon 530 for the left lumens (the
left inspiratory lumen 220 and the left expiratory lumen 520) may,
in its inflated state (as illustrated in FIG. 5C), secure the left
lumens in position in the trachea 115 and/or left primary bronchus
210, protect the trachea 115 and/or left primary bronchus 210 from
being damaged by the left lumens, and/or prevent airflows from
passing through the trachea 115 and/or left primary bronchus 210
other than through the left lumens. In some examples, a balloon 535
for the right lumens (the right inspiratory lumen 225 and the right
expiratory lumen 525) may, in its inflated state (as illustrated in
FIG. 5C), secure the right lumens in position in the trachea 115
and/or right primary bronchus 215, protect the trachea 115 and/or
right primary bronchus 215 from being damaged by the right lumens,
and/or prevent airflows from passing through the trachea 115 and/or
right primary bronchus 215 other than through the right lumens. In
some examples, the balloon 530 and/or the balloon 535 may be
missing and/or may be intentionally left uninflated, for example to
prevent unintentionally producing one or more ulcers, because the
balloon 205 may be safer, an/or because the balloon 205 may provide
sufficient isolation of airflow on its own in some circumstances.
In some examples, a controller 170 of a pneumatic system 140 can
adjust pressures to help prevent airflow from crossing between the
left lung 130 and the right lung even without presence or inflation
of the balloon 530 and/or the balloon 535. In some examples, the
balloon 205 may be missing and/or may be intentionally left
uninflated, because the balloon 530 and/or the balloon 535 may
provide sufficient isolation of airflow without the balloon
205.
[0107] In some examples, the left expiratory lumen 520, the right
expiratory lumen 525, the left inspiratory lumen 220, and/or the
right inspiratory lumen 225 can include one or more valves for
uni-directional gas flow. Valves for uni-directional gas flow can
prevent expiratory gas from getting into the left inspiratory lumen
220 and/or the right inspiratory lumen 225. Valves for
uni-directional gas flow can prevent inspiratory gas from getting
into the left expiratory lumen 520 and/or the right expiratory
lumen 525. This can be particularly useful when an adapter such as
the connector 610 of FIG. 6 is used. Such valves can improve
isolation of inspiratory and expiratory lumens.
[0108] In some examples, the left expiratory lumen 520 and the
right expiratory lumen 525 can reach positions at or adjacent to
the carina of the left primary bronchus 310 and the carina of the
right primary bronchus 315, respectively. In some examples, the
left inspiratory lumen 220 and the right inspiratory lumen 225 can
reach positions past (and/or further deeper into the bronchial tree
than) the carina of the left primary bronchus 310 and the carina of
the right primary bronchus 315, respectively.
[0109] In some examples, the left expiratory lumen 520, the right
expiratory lumen 525, the left inspiratory lumen 220, and/or the
right inspiratory lumen 225 can extend deeper into a patient 105's
bronchial tree, which may further reduce dead space. For instance,
the left expiratory lumen 520, the right expiratory lumen 525, the
left inspiratory lumen 220, and/or the right inspiratory lumen 225
can extend into secondary bronchi, tertiary bronchi, 4.sup.th order
bronchi, 5.sup.th order bronchi, 6.sup.th order bronchi, and so
forth, or some combination thereof. The tips of the left
inspiratory lumen 220 and/or left expiratory lumen 520 can extend
into the superior lobe and/or the inferior lobe of the left lung
130. The tips of the right inspiratory lumen 225 and/or the right
expiratory lumen 525 can extend into the superior lobe, the middle
lobe, or the inferior lobe of the right lung 135. In an
illustrative example, the tips of the left expiratory lumen 520 and
the right expiratory lumen 525 extend into the superior lobes of
the left lung 130 and the right lung 135, while the tips of the
left inspiratory lumen 220 and the right inspiratory lumen 225
extend into inferior lobes of the left lung 130 and the right lung
135. The arrangement in this illustrative example can reduce dead
space 410 by a particularly significant amount. In some examples,
the left expiratory lumen 520, the right expiratory lumen 525, the
left inspiratory lumen 220, and/or the right inspiratory lumen 225
can themselves branch off into further sub-lumens, for example with
different sub-lumens going into different bronchi (e.g., different
secondary bronchi, tertiary bronchi, 4.sup.th order bronchi,
5.sup.th order bronchi, 6.sup.th order bronchi, and so forth).
[0110] In some examples, different lumens (e.g., the left
expiratory lumen 520, the right expiratory lumen 525, the left
inspiratory lumen 220, and/or the right inspiratory lumen 225) can
include markers (e.g., at the tips of the lumens and/or along the
lengths of the lumens) that allow the lumens to be located using a
scan of the patient 105 and/or using triangulation. The markers can
include materials that are visible in scans of the patient 105,
such as radiopaque markers, radiolucent markers, radioactive
tracers. Scans may include X-ray scans, magnetic resonance imagery
(MRI) scans, computerized tomography (CT) scans, computed axial
tomography (CAT) scans, C-arm scans, positron emission tomography
(PET) scans, fluoroscopy scans, angiography scans, or combinations
thereof. In some examples, the markers may include solenoids,
magnetic field emitters, electromagnetic field emitters, wireless
signal transmitters, or a combination thereof. Such markers may be
located within the patient 105 by detecting the fields or signals
transmitted by the markers and detecting distance between the
receiver(s) and the marker transmitting the signals based on signal
travel time, signal frequency shift, and/or another change in a
signal property between transmission of the signal and receipt of
the signal. Such markers may be located within the patient 105
using triangulation, by detecting the fields or signals transmitted
by the markers using multiple receivers or using a single receiver
at multiple points in time.
[0111] FIG. 5D is a conceptual diagram 500D illustrating part of a
ventilator system with an endotracheal tube (ETT) 120 that includes
an inspiratory lumen 540 that provides inspiratory gas, a left
expiratory lumen 520 that evacuates expiratory gas from the left
primary bronchus and left lung 130, and a right expiratory lumen
525 that evacuates expiratory gas from the right primary bronchus
and right lung 135.
[0112] As noted previously, it may be useful in the ventilator
systems of FIGS. 5A-5D to include carbon dioxide (CO.sub.2) in the
inspiratory gas mixture. For instance, depending on how inspiratory
flows are set (see e.g., inspiratory flows 830A-830E) and/or how
expiratory flows are set (see e.g., inspiratory flows 835A-835E),
carbon dioxide (CO.sub.2) may be being evacuated excessively and/or
from the patient 105's airways. Lack or decreased concentration of
carbon dioxide (CO.sub.2) can increase alkalinity, pushing pH too
high, and can cause negative effects such as alkalosis. Including
carbon dioxide (CO.sub.2) in the inspiratory gas mixture can offset
the evacuation of carbon dioxide (CO.sub.2), reducing alkalinity,
lowering pH, and preventing negative effects such as alkalosis.
[0113] In some examples, the ventilator systems of FIGS. 5A-5D may
be modified to include only inspiratory lumen into only one lung
and/or only one expiratory lumen into only one lung. For instance,
the ventilator systems of FIGS. 5A-5D may be modified to include
only the left inspiratory lumen 220 without the right inspiratory
lumen 225, or to include only the right inspiratory lumen 225
without the left inspiratory lumen 220. Similarly, the ventilator
systems of FIGS. 5A-5D may be modified to include only the left
expiratory lumen 520 without the right expiratory lumen 525, or to
include only the right expiratory lumen 525 without the left
expiratory lumen 520. Even in situations with only one inspiratory
lumen 220/225 into only one lung 130/135 and/or only one expiratory
lumen 520/525 into only one lung 130/135, dead space 410 is still
decreased relative to dead space 410 in ventilator systems of FIGS.
4A-4C, due to deeper division of inspiratory and expiratory
airflow. In some examples, this type of modification may be
desirable, for example to assist a patient that only has one
functional lung and/or to make a low-cost ventilator system (e.g.,
to assist patients in developing countries).
[0114] FIG. 6 is a conceptual diagram 600 illustrating part of a
ventilator system with an endotracheal tube (ETT) 120 that includes
an expiratory lumen 510 that evacuates expiratory gas, a left
inspiratory lumen 220 that provides inspiratory gas, and a right
inspiratory lumen 225 that provides inspiratory gas. The ventilator
system of FIG. 6 is similar to the ventilator system of FIGS. 5A
and 5B in that the ventilator system of FIG. 6 includes an ETT 120
with a left inspiratory lumen 220, a right inspiratory lumen 225,
an expiratory lumen 510, a tip 125, and a balloon 205. The left
inspiratory lumen 220 and the right inspiratory lumen 225 pass
through at least part of the ETT 120. The expiratory lumen 510 can
include at least a part of the ETT 120. A connector 610 can
mechanically and/or pneumatically connect the left inspiratory
lumen 220 and the right inspiratory lumen 225 to the ETT 120. In
some examples, the connector 610 can mechanically and/or
pneumatically introduce the left inspiratory lumen 220 and the
right inspiratory lumen 225 into the ETT 120. The connector 610 can
also mechanically and/or pneumatically couple the ETT 120 to the
ventilator tubing 605.
[0115] The ETT 120, the expiratory lumen 510, the left inspiratory
lumen 220, and/or the right inspiratory lumen 225, can each extend
downward in FIG. 6 toward the left lung 130, right lung 135, left
primary bronchus 210, right primary bronchus 215, left secondary
bronchi 310, right secondary bronchi 315, other bronchi,
bronchioles 320, alveoli 325, or combinations thereof. The left
inspiratory lumen 220, and/or the right inspiratory lumen 225 can
come from the left side of FIG. 6, from inspiratory tube(s) 152,
the inspiratory flow control system(s) 150, inspiratory gas
source(s) 160, or a combination thereof. In some examples, the left
inspiratory lumen 220 couples to its own inspiratory tube 152,
inspiratory flow control system 150, and/or inspiratory gas
source(s) 160. In some examples, the right inspiratory lumen 225
couples to its own inspiratory tube 152, inspiratory flow control
system 150, and/or inspiratory gas source(s)160. The ventilator
tubing 605 can couple to the expiratory tube(s) 157, the expiratory
flow control system(s) 155, the expiratory gas output(s) 165, or a
combination thereof. In another illustrative example the ventilator
tubing 605 can couple to the patient interface 149, 1.sup.st
fitting 147 or 2.sup.nd fitting 148, inspiratory tube(s) 152 and
expiratory tube(s) 157, the expiratory flow control system(s) 155,
the expiratory gas output(s) 165, or a combination thereof. In the
latter example, it would be the appropriate combination of
pressures (high-pressure flow in inspiratory lumens left 220 and
right 225) that would direct the inspiratory gas from inspiratory
lumens 220 and 225 into the expiratory tube(s) 157, the expiratory
flow control system(s) 155, the expiratory gas output(s) 165. Same
high-pressure flow in the inspiratory lumens 220 and 225 would
limit or stop the inflow of inspiratory gas via inspiratory tube(s)
152.
[0116] Exemplary flows of the inspiratory gas(s) into, along, and
out of each of the left inspiratory lumen 220 and the right
inspiratory lumen 225 are illustrated using white arrows that are
outlined in black. Exemplary flows of the expiratory gas(s) up the
expiratory lumen 510 of the ETT 120, up the ventilator tubing 605,
and out of the ventilator tubing are illustrated using white arrows
shaded with black dots and outlined in black. In some examples, the
connector 510 may also provide a left expiratory lumen 520 and a
right expiratory lumen 525 as in FIGS. 5C and 5D. In some examples,
the connector 610 may be used as an adapter 450 and/or as an
adapter 455. In some examples, use of the connector 610 as an
adapter 450 and/or as an adapter 455 can provide a left inspiratory
lumen 220, a right inspiratory lumen 225, a left expiratory lumen
520, and/or a right expiratory lumen 525 to a ventilator system
that might not otherwise include such lumens, such as the
ventilator system(s) of FIGS. 4A-4D. In some examples, use of the
connector 610 as an adapter 450 and/or as an adapter 455 can
provide inspiratory airflow through the left inspiratory lumen 220
and/or right inspiratory lumen 225 from a separate inspiratory
airflow source than the ventilator system to which the connector
610 is connected. The separate inspiratory airflow source can
include, for example, the inspiratory flow control system(s) 150,
the inspiratory gas source(s) 160, the inspiratory gas provision
system 490, the gas sources 932, the gas mixer(s) 930, the gas
property control(s) 928, the capnometer(s) 926, the inspiratory
mixture pressurizer 914, the buffer 912, the inspiratory mixture
sensors 910, the gas property control 908, the pressure release
valve 906, the inspiratory mixture pressurizer 924, the buffer 922,
the inspiratory mixture sensors 920, the gas property control 918,
the pressure release valve 916, or a combination thereof. In some
examples, use of the connector 610 as an adapter 450 and/or as an
adapter 455 can provide expiratory pressure and/or suction through
the left expiratory lumen 520, and/or a right expiratory lumen 525
from a separate expiratory pressure control, which can include, for
example, expiratory tube(s) 157, the expiratory flow control
system(s) 155, the expiratory gas output(s) 165, the water trap
936, the capnometer 938, the expiratory mixture sensors 940, the
buffer 942, the expiratory mixture pressurizer 944, the water trap
946, the capnometer 948, the expiratory mixture sensors 950, the
buffer 952, the expiratory mixture pressurizer 954, or a
combination thereof.
[0117] FIG. 7A is a conceptual diagram 700A illustrating a
cross-section of an endotracheal tube (ETT) 120 that includes an
expiratory lumen 705 that evacuates expiratory gas, a left
inspiratory lumen 220 that provides inspiratory gas, and a right
inspiratory lumen 225 that provides inspiratory gas. In some
examples, the left inspiratory lumen 220 and the right inspiratory
lumen 225 can pass freely through the ETT 120. In some examples,
the left inspiratory lumen 220 and the right inspiratory lumen 225
can be coupled to one another within at least a portion of the ETT
120. In some examples, the left inspiratory lumen 220 and the right
inspiratory lumen 225 can be two parts of a single lumen separated
by a membrane, similarly to the separation of the first lumen 710
and the second lumen 715 by the membrane 720 in the tube 750 of
FIG. 7B.
[0118] In some ventilator devices, the left inspiratory lumen 220
of FIG. 7A can instead be a left expiratory lumen 520, the right
inspiratory lumen 225 of FIG. 7A can instead be a right expiratory
lumen 525, and the expiratory lumen 705 can instead be an
inspiratory lumen 540. An example of such a ventilator device is
illustrated in FIG. 5D.
[0119] In some ventilator devices, the ETT 120 of FIG. 7A can also
include a left expiratory lumen 520 and/or a right expiratory lumen
525 in addition to the left inspiratory lumen 220 and the right
inspiratory lumen 225. In such ventilator devices, the ETT 120
itself can function as an expiratory lumen 705 as discussed above,
as an inspiratory lumen 540, as both, or as neither. An example of
such a ventilator device is illustrated in FIG. 5C.
[0120] FIG. 7B is a conceptual diagram 700B illustrating a
cross-section of a tube 750 that includes a first lumen 710 and a
second lumen 715 separated by a membrane 720. In some examples, the
membrane 720 can be stretch-compliant, allowing for the lumens
cross section area to accommodate current needs. If more flow is
required via first lumen 710, the pressure within the first lumen
710 can be higher than in second lumen 715, and the compliant
membrane 720 can allow for first lumen 710 to consume some of space
previously taken up by second lumen 715. If more flow is required
via second lumen 715, the pressure within the second lumen 715 can
be higher than in the first lumen 710, and the compliant membrane
720 can allow for second lumen 715 to consume some of space
previously taken up by first lumen 710.
[0121] In some examples, the tube 750 is an ETT 120. For instance,
the first lumen 710 may be an inspiratory lumen, which may in some
cases split into a left inspiratory lumen 220 and a right
inspiratory lumen 225. The second lumen 715 may be an expiratory
lumen 510, which may in some cases split into a left expiratory
lumen 520 and a right expiratory lumen 525. The balloon 740 for the
tube 750 may be an example of the balloon 205 for the ETT 120.
[0122] In some examples, the tube 750 includes the left inspiratory
lumen 220 and the right inspiratory lumen 225 within the ETT 120.
For instance, the first lumen 710 may be the left inspiratory lumen
220, and the second lumen 715 may be the right inspiratory lumen
225. The balloon 740 for the tube 750 need not be present, or may
be an example of the balloon 205 for the ETT 120.
[0123] In some examples, the tube 750 includes the left lumens (the
left inspiratory lumen 220 and the left expiratory lumen 520) of
FIG. 5C. For instance, the first lumen 710 may be the left
inspiratory lumen 220, and the second lumen 715 may be the left
expiratory lumen 520. The balloon 740 for the tube 750 may be an
example of the balloon 530 for the left lumens of FIG. 5C.
[0124] In some examples, the tube 750 includes the right lumens
(the right inspiratory lumen 225 and the right expiratory lumen
525) of FIG. 5C. For instance, the first lumen 710 may be the right
inspiratory lumen 225, and the second lumen 715 may be the right
expiratory lumen 525. The balloon 740 for the tube 750 may be an
example of the balloon 535 for the right lumens of FIG. 5C.
[0125] In some examples, the tube 750 includes an inspiratory tube
152 and an expiratory tube 157. For instance, the first lumen 710
may be the inspiratory tube 152, and the second lumen 715 may be
the expiratory tube 157.
[0126] In some examples, the tube 750 includes two inspiratory
tubes 152. For instance, the first lumen 710 may be a first
inspiratory tube 152 that provides inspiratory gas(es) to a left
inspiratory lumen 220 and/or from a first inspiratory flow control
system 150 and/or a first set of inspiratory gas source(s) 160. The
second lumen 715 may be a second inspiratory tube 152 that provides
inspiratory gas(es) to a right inspiratory lumen 225 and/or from a
second inspiratory flow control system 150 and/or a second set of
inspiratory gas source(s) 160.
[0127] In some examples, the tube 750 includes two expiratory tubes
157. For instance, the first lumen 710 may be a first expiratory
tube 157 that provides expiratory gas(es) from a left expiratory
lumen 520 and/or to a first expiratory flow control system 155
and/or a first set of expiratory gas output(s) 165. The second
lumen 715 may be a second expiratory tube 157 that provides
expiratory gas(es) from a right expiratory lumen 525 and/or to a
second expiratory flow control system 155 and/or a second set of
expiratory gas output(s) 165.
[0128] FIG. 8A is a graph diagram 800A illustrating inspiratory
flow 830A, expiratory flow 835A, and pressure changes 850 over time
815 in a ventilator system according to a first illustrative
example. A flow graph 805A and a pressure graph 810A are
illustrated in FIG. 8A. The flow graph 805A and the pressure graph
810A both include a shared horizontal time axis 815. The time axis
815 is the same for FIGS. 8A-8E, and includes times marked at time
zero (0), at time t.sub.A, at time t.sub.B after time t.sub.A, at
time t.sub.C after time t.sub.F, at time t.sub.H after time
t.sub.C, at time t.sub.E after time t.sub.E, at time t.sub.F after
time t.sub.E, at time t.sub.G after time t.sub.F, and at time h
after time t.sub.G. The timespan from time zero (0) to time t.sub.H
is an example of portion of a longer period of time with multiple
inspirations and multiple corresponding expirations.
[0129] The pressure graph 810 graphs pressure within a patient
105's lungs 130-135 (and/or another portion of the patient 105's
airways) over time 815. The pressure graph 810 includes a vertical
pressure axis 825. The vertical pressure axis 825 may measure
pressure in centimeters of water (cmH.sub.2O) or another pressure
unit. Graphed pressure changes 850 in pressure 825 are tracked over
time 815, and fluctuate from a value of zero (0) cmH.sub.2O to a
value of p cmH.sub.2O. The graphed pressure changes 850 of the
pressure graph 810A span two (2) cycles of inspiration and
expiration. The value of zero (0) cmH.sub.2O, within the context of
the graphed pressure changes 850, represent the pressure in the
patient 105's airways when the patient 105 has fully exhaled, or
been made to fully exhale by the pressurizer(s) of the ventilator
system. The value of p cmH.sub.2O, within the context of the
graphed pressure changes 850, represent the pressure in the patient
105's airways when the patient 105 has fully inhaled, or been made
to fully inhale by the pressurizer(s) of the ventilator system. In
some examples, the pressure graphed in the pressure 825 may be a
relative pressure rather than an absolute pressure. For instance,
the pressure changes curve 850 reaching a pressure zero (0) may not
mean that there is literally no pressure in the patient 105's lungs
130/135, but may refer to patient 105's lungs 130/135 having a
baseline pressure level (e.g., atmospheric pressure, or end
expiratory pressure (EEP) or positive end expiratory pressure
(PEEP)). Likewise, the pressure changes curve 850 reaching the
pressure p may not mean that p is the total pressure in the patient
105's lungs, but may simply refer to pressure p added to the
baseline pressure level.
[0130] In some examples, the inspiratory flows 830A-830E represent
sum of all inspiratory flows through all inspiratory lumens of a
ventilator system (e.g., inspiratory lumens 220, 225, and/or 540).
In some examples, the inspiratory flows 830A-830E represents
individual inspiratory flows through an individual inspiratory
lumen (e.g., inspiratory lumen 220, 225, or 540). In some examples,
the inspiratory flows 830A-830E represent sum of all inspiratory
flows through a subset of inspiratory lumens of a ventilator system
(e.g., inspiratory lumens 220, 225, and/or 540). In some examples,
the expiratory flows 835A-835E represent sum of all expiratory
flows through all expiratory lumens of a ventilator system (e.g.,
expiratory lumens 520, 525, 510, and/or 705). In some examples, the
expiratory flows 835A-835E represents individual expiratory flows
through an individual expiratory lumen (e.g., expiratory lumen 520,
525, 510, or 705). In some examples, the expiratory flows 835A-835E
represent sum of all expiratory flows through a subset of
expiratory lumens of a ventilator system (e.g., expiratory lumens
520, 525, 510, and/or 705).
[0131] From time zero (0) to time t.sub.A, the patient 105 is
inhaling (and/or is being made to inhale by the pressurizer(s) of
the ventilator system) and thus increasing pressure from an end
expiratory pressure (EEP) up to pressure p. The increase in
pressure from time zero (0) to time t.sub.A may be caused by an
absolute value of an inspiratory flow (of the inspiratory flows
830A-830E) being higher than an absolute value of a corresponding
expiratory flow (of the expiratory flows 835A-835E) from time zero
(0) to time t.sub.A. From time t.sub.A to time t.sub.B, the patient
105 is holding their breath (and/or is being made to hold their
breath by the pressurizer(s) of the ventilator system) and thus
maintaining pressure p. Maintenance of the pressure p to hold the
patient's breath, as in time t.sub.A to time t.sub.B, may be
referred to as inspiratory hold. The maintenance in pressure from
time t.sub.A to time to may be caused by an absolute value of an
inspiratory flow (of the inspiratory flows 830A-830E) matching, or
being substantially equal to, an absolute value of the
corresponding expiratory flow (of the expiratory flows 835A-835E)
from time t.sub.A to time t.sub.B. From time t.sub.B to time
t.sub.D, the patient 105 is exhaling (and/or is being made to
exhale by the pressurizer(s) of the ventilator system) thus
reducing pressure from pressure p back down to the end expiratory
pressure (EEP). The decrease in pressure from time is to time
t.sub.D may be caused by an absolute value of an inspiratory flow
(of the inspiratory flows 830A-830E) being lower than an absolute
value of the corresponding expiratory flow (of the expiratory flows
835A-835E) from time t.sub.B to time t.sub.D. Time zero (0) to time
t.sub.D represents a single inhale-exhale cycle. A second
inhale-exhale cycle occurs from time t.sub.D to time hi, and
generally matches the first inhale-exhale cycle from time zero (0)
to time t.sub.D.
[0132] The pressure in the patient 105's airways when the patient
105 has fully exhaled may be referred to as an end expiratory
pressure (EEP). In some cases, the EEP may be zero (0) cmH.sub.2O.
In some cases, the EEP may be higher than zero (0) cmH.sub.2O. In
some cases, the EEP may be less than zero (0) cmH.sub.2O (e.g., may
be a negative pressure). The value of the graphed pressure changes
850 at a given point in time may be a value relative to the
pressure in the patient 105's airways when the patient 105 has
fully exhaled (the EEP), rather than an absolute pressure value.
The graphed pressure changes 850 in the pressure graph 810 are the
same for FIGS. 8A-8E.
[0133] The flow graph 805A of FIG. 8A tracks an inspiratory flow
830A and an expiratory flow 835A over time 815. The inspiratory
flow 830A and the expiratory flow 835A are tracked along a vertical
flow axis 820. The vertical flow axis 820 may measure flow in cubic
centimeters per second (cc/s) or another flow unit. The vertical
flow axis 820 identifies zero (0) cc/s, three identified positive
values (f.sub.A, f.sub.B, and f.sub.C), and three identified
negative values (f.sub.D, f.sub.E, and f.sub.F). The positive
values (f.sub.A, f.sub.B, and f.sub.C) represent inspiratory flow
into the patient 105's airways. The negative values (f.sub.D,
f.sub.E, and f.sub.F) represent expiratory flow out of the patient
105's airways. These flow values are used in the inspiratory flows
830A-830E and in the expiratory flows 835A-835E of FIGS. 8A-8E. In
some examples, flow values f.sub.A and f.sub.D may share an
absolute value, for instance f.sub.D with f.sub.A being multiplied
by -1 and vice versa. In some examples, flow values f.sub.B and
f.sub.E may share an absolute value, for instance f.sub.B with
f.sub.E being multiplied by -1 and vice versa. In some examples,
flow values f.sub.C and f.sub.F may share an absolute value, for
instance f.sub.C with f.sub.F being multiplied by -1 and vice
versa.
[0134] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale by the pressurizer(s)
of the ventilator system) per the pressure changes 850, the
inspiratory flow 830A provides relatively low continuous flow of
inspiratory gas to the patient 105's airways at relatively low flow
rate f.sub.A to provide the patient 105 with inspiratory gas to
inhale during the inhalation from time zero (0) to time t.sub.A.
From time t.sub.A to time t.sub.B, during which the patient 105 is
holding his/her breath (and/or being made to hold his/her breath by
the pressurizer(s) of the ventilator system) per the pressure
changes 850, the inspiratory flow 830A provides zero (0) flow of
inspiratory gas to the patient 105's airways at flow value zero (0)
so as not to over pressurize the patient 105's airways. The period
from time t.sub.A to time t.sub.B may be referred to as an
"inspiratory hold," and may be when some of the gas exchange
between the blood and alveoli gas (e.g., blood oxygenation,
CO.sub.2 extraction) happens in the patient 105's respiratory and
circulatory systems, and/or where inspiratory flow may match
expiratory flow for net zero flow to exchange expiratory gases
(e.g., from the lungs 130/135 and including dead space 410 with
suspected DCAs 425) for clean inspiratory gases. From time zero (0)
to time t.sub.B, the expiratory flow 835A is zero (0) and thus is
not evacuating and/or receiving expiratory gas from the patient
105's airways, for instance so as not to interfere with inhalation.
Net flow from time zero (0) to time t.sub.A may be positive,
producing the inhalation. Net flow time t.sub.A to time t.sub.B may
be zero, producing the inspiratory hold. From time t.sub.B to time
t.sub.D, during which the patient 105 is exhaling (and/or being
made to exhale by the pressurizer(s) of the ventilator system) per
the pressure changes 850, the expiratory flow 835A evacuates and/or
receives a relatively high continuous flow of expiratory gas from
the patient 105's airways at relatively high (high absolute value)
flow rate f.sub.E. From time t.sub.B to time t.sub.D, the absolute
value of the expiratory flow f.sub.E may be higher than the
absolute value of the inspiratory flow f.sub.A, resulting in a net
effect of expiration, which can to help evacuate CO.sub.2-rich and
O.sub.2-deficient and potentially DCA 425-including expiratory gas
from the patient 105's airways. From time t.sub.B to time t.sub.D,
during which the patient 105 is exhaling (and/or being made to
exhale by the pressurizer(s) of the ventilator system) per the
pressure changes 850, the inspiratory flow 830A provides relatively
low continuous flow of inspiratory gas to the patient 105's airways
at relatively low flow rate f.sub.A to maintain continuous airflow
to perform gas exchange (exchanging contaminated expiratory air for
clean inspiratory air) and clear out dead space 410 (and any DCAs
425 suspended therein) from the patient 105's lungs 130/135 and
airways generally. Net flow from time t.sub.B to time t.sub.D may
be negative, producing the exhalation. The period of time from time
zero (0) to time to represents a single inhale-exhale cycle. A
second inhale-exhale cycle occurs from time t.sub.D to time
t.sub.H. The continuous inspiratory and expiratory flows can
provide continuous clearance and removal of dead space 410 with any
DCAs 425 suspended therein.
[0135] During the expiration phases (from time t.sub.B to time
t.sub.D and from time t.sub.F to time t.sub.H), even though
expiration happens, there is a continuous flow between inspiratory
and expiratory lumens, which allows the ventilator system to clear
out dead space 410 (along with any DCAs 425 included within the
dead space 410). Furthermore, because the inspiratory lumens are
separate from the expiratory lumens, inspiration lumens remain
noncontaminated or less contaminated with virions or other DCAs
425, so still-healthy alveoli 325 (and their pneumocytes) or
alveoli that already recovered have a chance to obtain
noncontaminated air.
[0136] In the pressure graph 810 and the flow graphs 805A-805E of
FIGS. 8A-8E, the length of expiration phases (from time t.sub.B to
time t.sub.D and from time t.sub.F to time t.sub.H) are longer than
the length of the inspiration phases (from time zero to time
t.sub.A and from time t.sub.D to time t.sub.E) so there is enough
time for expiration, and in some cases to prevent negative issues
such as intrinsic positive end expiratory pressure (PEEP).
Intrinsic PEEP can also be referred to as autoPEEP or PEEPi.
Intrinsic PEEP can occur when expiratory time is shorter than the
time needed to fully deflate the lungs, preventing the lung and
chest wall from reaching an elastic equilibrium point, also
referred to as "gas trapping."
[0137] FIG. 8B is a graph diagram 800B illustrating inspiratory
flow 830B, expiratory flow 835B, and pressure changes 850 over time
815 in a ventilator system according to a second illustrative
example. The pressure graph 810 of FIG. 8B matches the pressure
graph 810 of FIG. 8A.
[0138] The flow graph 805B of FIG. 8B tracks an inspiratory flow
830B and an expiratory flow 835B over time 815, and along the
vertical flow axis 820. In the flow graph 805B, the expiratory flow
835B evacuates and/or receives a relatively low continuous flow of
expiratory gas from the patient 105's airways at relatively low
(low absolute value) flow rate f.sub.D from time zero (0) to time
t.sub.A. In the flow graph 805B, the expiratory flow 835B evacuates
and/or receives a relatively high flow of expiratory gas from the
patient 105's airways at relatively high (relatively high absolute
value) flow rate f.sub.E from time t.sub.A to time t.sub.D. Under
the expiratory flow 835B of FIG. 8B, the expiratory flow 835B
continuously evacuates at least some of the CO.sub.2-rich and
O.sub.2-deficient and potentially DCAs 425-including expiratory gas
from the patient 105's airways, though the rate varies slightly by
time. This continuously maintained expiratory flow 835B can allow
the ventilator system to clear out dead space 410 (along with any
DCAs 425 included within the dead space 410).
[0139] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale by the pressurizer(s)
of the ventilator system) per the pressure changes 850, the
inspiratory flow 830B provides relatively high continuous flow of
inspiratory gas to the patient 105's airways at relatively high
flow rate f.sub.B to ensure that the patient 105 has inspiratory
gas to inhale during the inhalation from time zero (0) to time
t.sub.A. Net flow time zero (0) to time t.sub.A may be positive,
producing the inhalation. Net flow time t.sub.A to time B may be
zero, producing the inspiratory hold. From time t.sub.A to time
t.sub.B, during which the patient 105 is holding his/her breath
(and/or being made to hold his/her breath by the pressurizer(s) of
the ventilator system) per the pressure changes 850, the
inspiratory flow 830B still provides the relatively high continuous
flow of inspiratory gas to the patient 105's airways at relatively
high flow rate f.sub.B matching the relatively high flow of
expiratory gas (f.sub.E) from time t.sub.A to time t.sub.B to
ensure clearance of dead space 410 (and any DCAs 425 therein) and
help the patient's lungs 130-135 to perform gas exchange. From time
t.sub.B to time t.sub.D, during which the patient 105 is exhaling
(and/or being made to exhale by the pressurizer(s) of the
ventilator system) per the pressure changes 850, the inspiratory
flow 830B provides relatively low continuous flow of inspiratory
gas to the patient 105's airways at relatively low flow rate
f.sub.A to continue to perform gas exchange (exchanging
contaminated expiratory air for clean inspiratory air) and continue
to clear out dead space 410 (and any DCAs 425 suspended therein)
from the patient 105's lungs 130/135 and airways generally. Net
flow time t.sub.B to time t.sub.D may be negative, producing the
exhalation. With the relatively low flow rate f.sub.A of
inspiratory flow 830B from time t.sub.B to time t.sub.D, and the
relatively high absolute flow rate f.sub.E of expiratory flow 835B
from time t.sub.B to time t.sub.D, the net effect can be a decrease
in pressure in the lungs as illustrated in the pressure changes
850. Continuous inspiratory and expiratory flows can provide
continuous clearance and removal of dead space 410 with any DCAs
425 suspended therein.
[0140] The period of time from time zero (0) to time t.sub.D
represents a single inhale-exhale cycle. A second inhale-exhale
cycle occurs from time t.sub.D to time t.sub.H.
[0141] FIG. 8C is a graph diagram 800C illustrating inspiratory
flow 830C, expiratory flow 835C, and pressure changes 850 over time
815 in a ventilator system according to a third illustrative
example. The pressure graph 810 of FIG. 8C matches the pressure
graphs 810 of FIGS. 8A and 8B.
[0142] The flow graph 805C of FIG. 8C tracks an inspiratory flow
830C and an expiratory flow 835C over time 815, and along the
vertical flow axis 820.
[0143] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale his/her breath by the
pressurizer(s) of the ventilator system) per the pressure changes
850, the expiratory flow 835C is approximately zero (0) or very low
and the inspiratory flow 830C is not zero. From time t.sub.A to
time t.sub.B, during which the patient 105 is holding his/her
breath (and/or being made to hold his/her breath by the
pressurizer(s) of the ventilator system) per the pressure changes
850, the expiratory flow 835C evacuates and/or receives a
relatively high continuous flow of expiratory gas from the patient
105's airways at relatively high (high absolute value) flow rate
f.sub.E to help evacuate CO.sub.2-rich and O.sub.2-deficient and
potentially DCA 425-including expiratory gas from the patient 105's
airways. From time t.sub.B to time to, during which the patient 105
is exhaling (and/or being made to exhale by the pressurizer(s) of
the ventilator system) per the pressure changes 850, the expiratory
flow 835C evacuates and/or receives a relatively low continuous
flow of expiratory gas from the patient 105's airways at relatively
low (low absolute value) flow rate f.sub.D to help evacuate
CO.sub.2-rich and O.sub.2-deficient and potentially DCA
425-including expiratory gas from the patient 105's airways. The
high expiratory flow 835C in FIG. 8C maintained during the
inspiratory flow can allow the ventilator system to rapidly clear
out significant amounts dead space 410 (along with any DCAs 425
included within the dead space 410), and can be replaced with high
inspiratory flow as discussed below to perform gas exchange within
the patient 105's lungs 130/135 and airways generally.
[0144] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale by the pressurizer(s)
of the ventilator system) per the pressure changes 850, the
inspiratory flow 830C provides relatively low continuous flow of
inspiratory gas to the patient 105's airways at relatively low flow
rate f.sub.A to provide the patient 105 with inspiratory gas to
inhale during the inhalation from time zero (0) to time t.sub.A.
Net flow time zero (0) to time t.sub.A may be positive, producing
the inhalation. From time t.sub.A to time t.sub.B, during which the
patient 105 is holding his/her breath (and/or being made to hold
his/her breath by the pressurizer(s) of the ventilator system) per
the pressure changes 850, the inspiratory flow 830C provides a
relatively high continuous flow of inspiratory gas to the patient
105's airways at relatively high flow rate f.sub.B to perform gas
exchange (exchanging contaminated expiratory air for clean
inspiratory air) and continue to clear out dead space 410 (and any
DCAs 425 suspended therein) from the patient 105's lungs 130/135
and airways generally. Net flow from time t.sub.A to time to may be
zero, producing the inspiratory hold. The relatively high flow rate
f.sub.B for the inspiratory flow 830C from time t.sub.A to time
t.sub.B can be used to offset the relatively high flow rate f.sub.E
for the expiratory flow 835C from time t.sub.A to time t.sub.B.
From time t.sub.B to time to, during which the patient 105 is
exhaling (and/or being made to exhale by the pressurizer(s) of the
ventilator system) per the pressure changes 850, the inspiratory
flow 830C provides no flow, or very low continuous flow, of
inspiratory gas to the patient 105's airways. Net flow time t.sub.B
to time to may be negative, producing the exhalation. Because
expiratory flow 835C is still active from time t.sub.D to time
t.sub.E, the clearance of dead space 410 and DCAs 425 continues
from time t.sub.D to time t.sub.E. However, the clearance can be
lower and/or slower during the time h.sub.B to t.sub.D in graph
805C than as it was during the time t.sub.B to t.sub.D in
ventilatory system modes of operation presented on graphs
805A-805B, as there is no (or very low) inspiratory flow in
ventilatory system mode as shown on graph 805C during the time
t.sub.B to t.sub.D. Continuous inspiratory and expiratory flows can
provide continuous clearance and removal of dead space 410 with any
DCAs 425 suspended therein.
[0145] The period of time from time zero (0) to time to represents
a single inhale-exhale cycle. A second inhale-exhale cycle occurs
from time t.sub.D to time t.sub.H.
[0146] FIG. 8D is a graph diagram 800D illustrating inspiratory
flow 830D, expiratory flow 835D, and pressure changes 850 over time
815 in a ventilator system according to a fourth illustrative
example. The pressure graph 810 of FIG. 8D matches the pressure
graphs 810 of FIGS. 8A-8C.
[0147] The flow graph 805D of FIG. 8D tracks an inspiratory flow
830D and an expiratory flow 835D over time 815, and along the
vertical flow axis 820. In the flow graph 805D, the inspiratory
flow 830D provides relatively low continuous flow of inspiratory
gas to the patient 105's airways at relatively low flow rate
f.sub.A during the entire period of time 815 from time zero (0)
onward, to continuously provide the patient 105 with inspiratory
gas to inhale during inhalations and/or to perform gas exchange and
dead space clearance with suspended DCAc.
[0148] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale by the pressurizer(s)
of the ventilator system) per the pressure changes 850, the
expiratory flow 830D is approximately zero (0), or very low. Net
flow from time zero (0) to time t.sub.A may be positive, producing
the inhalation. From time t.sub.A to time t.sub.B, during which the
patient 105 is holding his/her breath (and/or being made to hold
his/her breath by the pressurizer(s) of the ventilator system) per
the pressure changes 850, the expiratory flow 835D the expiratory
flow 835D evacuates and/or receives a relatively low continuous
flow of expiratory gas from the patient 105's airways at relatively
low (low absolute value) flow rate f.sub.D to evacuate
CO.sub.2-rich and O.sub.2-deficient and potentially DCA
425-including expiratory gas from the patient 105's airways. Net
flow time t.sub.A to time t.sub.B may be zero, producing the
inspiratory hold. From time t.sub.B to time t.sub.D, during which
the patient 105 is exhaling (and/or being made to exhale by the
pressurizer(s) of the ventilator system) per the pressure changes
850, the expiratory flow 835D evacuates and/or receives a
relatively high continuous flow of expiratory gas from the patient
105's airways at relatively high (high absolute value) flow rate
f.sub.E producing exhalation and evacuating CO.sub.2-rich and
O-deficient and maintain high clearance of dead space with
suspended within DCA 425-s. Net flow time t.sub.B to time t.sub.D
may be negative, producing the exhalation. The high expiratory flow
835D in FIG. 8D can allow the ventilator system to rapidly clear
out significant amounts dead space 410 (along with any DCAs 425
included within the dead space 410). Continuous inspiratory and
expiratory flows can provide continuous clearance and removal of
dead space 410 with any DCAs 425 suspended therein.
[0149] The period of time from time zero (0) to time t.sub.D
represents a single inhale-exhale cycle. A second inhale-exhale
cycle occurs from time t.sub.D to time t.sub.H.
[0150] In some examples, the inspiratory flow 830D and/or the
expiratory flow 835D can be used with ventilator systems that are
similar to the ventilator systems of FIGS. 4A-4C but that are
modified (e.g., using one or more adapters and/or connecter, for
example connected 610 from FIG. 6.) to be more like the ventilator
systems of FIGS. 5A-5C (e.g., by adding left inspiratory lumens 220
and right inspiratory lumens 225 and one or more expiratory lumens
510/520/525 separate from the inspiratory lumens 220-225 and/or
separate from any expiratory lumens).
[0151] FIG. 8E is a graph diagram 800E illustrating inspiratory
flow 830E, expiratory flow 835E, and pressure changes 850 over time
815 in a ventilator system according to a fifth illustrative
example. The pressure graph 810 of FIG. 8E matches the pressure
graphs 810 of FIGS. 8A-8D.
[0152] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale by the pressurizer(s)
of the ventilator system) per the pressure changes 850, the
expiratory flow 835E evacuates and/or receives a relatively low
continuous flow of expiratory gas from the patient 105's airways at
relatively low (low absolute value) flow rate f.sub.D to help
evacuate CO.sub.2-rich and O.sub.2-deficient and potentially DCA
425-including expiratory gas from the patient 105's airways. From
time t.sub.A to time t.sub.B, during which the patient 105 is
holding his/her breath (and/or being made to hold his/her breath by
the pressurizer(s) of the ventilator system) per the pressure
changes 850, the expiratory flow 835E evacuates and/or receives a
relatively high continuous flow of expiratory gas from the patient
105's airways at relatively high (high absolute value) flow rate
f.sub.E to help evacuate CO-rich and O.sub.2-deficient and
potentially DCA 425-including expiratory gas from the patient 105's
airways. From time t.sub.B to time t.sub.D, during which the
patient 105 is exhaling (and/or being made to exhale by the
pressurizer(s) of the ventilator system) per the pressure changes
850, the expiratory flow 835C evacuates and/or receives a very high
continuous flow of expiratory gas from the patient 105's airways at
very high (very high absolute value) flow rate f.sub.F to help
evacuate CO.sub.2-rich and O.sub.2-deficient and potentially DCA
425-including expiratory gas from the patient 105's airways. The
high expiratory flow 835C in FIG. 8E can allow the ventilator
system to rapidly clear out significant amounts dead space 410
(along with any DCAs 425 included within the dead space 410).
[0153] From time zero (0) to time t.sub.A, during which the patient
105 is inhaling (and/or being made to inhale by the pressurizer(s)
of the ventilator system) per the pressure changes 850, the
inspiratory flow 830E provides very high continuous flow of
inspiratory gas to the patient 105's airways at very high flow rate
f.sub.C to provide the patient 105 with inspiratory gas to inhale
during the inhalation from time zero (0) to time t.sub.A and to
offset the expiratory flow 835E. Net flow from time zero (0) to
time t.sub.A may be positive, producing the inhalation. From time
t.sub.A to time t.sub.B, during which the patient 105 is holding
his/her breath (and/or being made to hold his/her breath by the
pressurizer(s) of the ventilator system) per the pressure changes
850, the inspiratory flow 830E provides a relatively high
continuous flow of inspiratory gas to the patient 105's airways at
relatively high flow rate f.sub.B to perform gas exchange
(exchanging contaminated expiratory air for clean inspiratory air)
and continue to clear out dead space 410 (and any DCAs 425
suspended therein) from the patient 105's lungs 130/135 and airways
generally. Net flow time t.sub.A to time t.sub.B may be zero,
producing the inspiratory hold. From time t.sub.B to time t.sub.D,
during which the patient 105 is exhaling (and/or being made to
exhale by the pressurizer(s) of the ventilator system) per the
pressure changes 850, the inspiratory flow 830E provides relatively
low continuous flow of inspiratory gas to the patient 105's airways
at relatively low flow rate f.sub.A to continue to perform gas
exchange. Net flow time t.sub.B to time t.sub.D may be negative,
producing the exhalation. Continuous inspiratory and expiratory
flows can provide continuous clearance and removal of dead space
410 with any DCAs 425 suspended therein through the entire
inhale-exhale cycle from time zero (0) to time t.sub.D.
[0154] The period of time from time zero (0) to time t.sub.D
represents a single inhale-exhale cycle. A second inhale-exhale
cycle occurs from time t.sub.D to time t.sub.H.
[0155] While the inspiratory flows 830A-830E and the expiratory
flows 835A-835E of FIGS. 8A-8E are illustrated as step functions
that instantaneously step between continuous flow rate values, it
should be understood that changes in flow rate in the inspiratory
flows 830A-830E and the expiratory flows 835A-835E may occur more
gradually. Furthermore, it should be understood that flow rates
illustrated as continuous in the inspiratory flows 830A-830E and
the expiratory flows 835A-835E of FIGS. 8A-8E may include
fluctuations and curves not illustrated in FIGS. 8A-8E.
[0156] In some examples, the inspiratory flow 830A may be paired
with any one of the expiratory flows 835A-835E, or a combination
thereof. In some examples, the inspiratory flow 830B may be paired
with any one of the expiratory flows 835A-835E, or a combination
thereof. In some examples, the inspiratory flow 830C may be paired
with any one of the expiratory flows 835A-835E, or a combination
thereof. In some examples, the inspiratory flow 830D may be paired
with any one of the expiratory flows 835A-835E, or a combination
thereof. In some examples, the inspiratory flow 830E may be paired
with any one of the expiratory flows 835A-835E, or a combination
thereof.
[0157] In some examples, the expiratory flow 835A may be paired
with any one of the inspiratory flows 830A-830E, or a combination
thereof. In some examples, the expiratory flow 835B may be paired
with any one of the inspiratory flows 830A-830E, or a combination
thereof. In some examples, the expiratory flow 835C may be paired
with any one of the inspiratory flows 830A-830E, or a combination
thereof. In some examples, the expiratory flow 835D may be paired
with any one of the inspiratory flows 830A-830E, or a combination
thereof. In some examples, the expiratory flow 835E may be paired
with any one of the inspiratory flows 830A-830E, or a combination
thereof.
[0158] FIG. 9A is a block diagram 900A illustrating an architecture
of an exemplary ventilator system that includes an inspiratory
control system that provides inspiratory gas to a left lung 130 and
a right lung 135 through a left inspiratory lumen 220 and a right
inspiratory lumen 225, and an expiratory control system that
evacuates expiratory gas from the left lung 130 and the right lung
135 through one or more expiratory lumens 510/520/525.
[0159] An inspiratory gas supply system of the ventilator system of
FIG. 9A, illustrated in the lower-left corner of FIG. 9A, includes
one or more gas sources 932. The one or more gas sources 932 may
correspond to the inspiratory gas sources 160 of FIG. 1. For
example, the one or more inspiratory gas sources 160 can include an
oxygen (O.sub.2) gas source, a nitrogen (N) gas source, a carbon
dioxide (CO.sub.2) gas source, an argon (Ar) gas source, one or
more gas sources for one or more drugs (in gaseous and/or
aerosolized form), one or more gas sources for one or more other
elemental gases, one or more gas sources for one or more other
molecular gases, an pre-mixed atmospheric gas source, or a
combination thereof.
[0160] The pre-mixed atmospheric gas source can include, for
example, filtered atmospheric air. In some examples, a pre-mixed
atmospheric gas can be sufficient to use as an inspiratory gas
mixture, or as a portion of the inspiratory gas mixture (e.g., with
some nitrogen (N) and/or oxygen (O.sub.2) added). In some examples,
a pre-mixed atmospheric gas may include approximately 21% oxygen
(O.sub.2), 78% nitrogen (N), and less than 1% of carbon dioxide
(CO.sub.2). Filters by the inspiratory gas supply system may
include n100, HEPA, or higher degree gas filtration filters, a UV
light for decontamination, and other filters and cleaners.
[0161] Gas sources for individual elements or molecules, such as
oxygen (O.sub.2), nitrogen (N), carbon dioxide (CO.sub.2), argon
(Ar), or other elements or molecules discussed herein, can be
stored in the gas source at a defined concentration. The
concentration can be 100/0, or can be a value less than 100% (in
which case the element or molecule may be mixed with atmospheric
air, for example).
[0162] The inspiratory gas supply system may include a gas mixer
930 for mixing gases from the gas sources 932 to produce an
inspiratory gas mixture, which may be known as an inspiratory gas,
an inspiratory mixture, an inspiratory aerosol, or some combination
thereof. The gas mixer 930 may include one or more gas equalizing
systems, one or more proportional valves, one or more calibrated
solenoid flow valves, or a combination thereof.
[0163] The gas mixer 930 may, for example, mix oxygen (O.sub.2),
nitrogen (N), carbon dioxide (CO.sub.2), argon (Ar), one or more
drugs (in gaseous and/or aerosolized form), one or more one or more
other elemental gases, one or more other molecular gases, a
pre-mixed atmospheric gas source, or a combination thereof. Even
though it may seem counter-intuitive, it may be useful to include
carbon dioxide (CO.sub.2) in the inspiratory gas mixture when
carbon dioxide (CO.sub.2) is being evacuated at a high rate (due to
continues or almost continues flow during the inhalation-exhalation
cycle through both inspiratory and expiratory lumens) from the
patient 105's airways, as lack of carbon dioxide (CO.sub.2) can
increase alkalinity, pushing pH too high, and can cause negative
effects such as alkalosis.
[0164] In some examples, the gas mixer 930 can mix one or more
liquids and/or one or more particulate solids into the one or more
gases, for example in aerosolized and/or particularized and/or
nebulized form. Sources for the liquids and/or solids can be stored
along with the gas sources 932. The one or more liquids can include
water (H2O), one or more drugs in liquid form, one or more other
liquids, or a combination thereof. The one or more particulate
solids can include one or more drugs in particulate solid form, one
or more other particulate solids, or a combination thereof. The gas
mixer 930 can include an aerosolizer and/or nebulizer and/or
particulatizer to aerosolize and/or nebulize and/or particulatize
the one or more liquids and/or the one or more solids. The gas
mixer 930 can mix the one or more aerosolized and/or particulate
liquids and/or solids into the one or more inspiratory gases.
[0165] The gas mixer 930 can mix gases and/or liquids and/or
particulate solids from the one or gas sources 932 at one or more
predetermined ratios and/or proportions. The gas mixer 930 can mix
inspiratory gases and/or liquids and/or particulate solids from the
one or more gas sources 930 at one or more predetermined ratios
and/or proportions to simulate the natural ratios and/or
proportions of these gases in Earth's atmosphere or other ratios
and/or proportions that may be selected or recommended by an
operator, by an artificial intelligence algorithm (e.g., one or
more trained machine learning models, one or more trained neural
networks, or a combination thereof), or a combination thereof. The
gas mixer 930 can mix inspiratory gases and/or liquids and/or
particulate solids from the gas sources 932 at one or more
predetermined ratios and/or proportions that increase or decrease a
relative quantity of one or more specific gases (e.g., increased
oxygen, decreased carbon monoxide) relative to the natural ratios
and/or proportions of these gases in Earth's atmosphere or other
ratios and/or proportions that may be selected or recommended by an
operator, by an artificial intelligence algorithm (e.g., one or
more trained machine learning models, one or more trained neural
networks, or a combination thereof), or a combination thereof. The
mixture mixed by the gas mixer 903 can be referred to as the
inspiratory mixture, the inspiratory gas, the inspiratory gas
mixture, the inspiratory fluid mixture, the inspiratory fluid, the
inspiratory substance, the inspiratory air, the inspiratory
aerosol, or some combination thereof. The ratios at which the
different gases are present in the inspiratory mixture may be set
by a user 190 through an interface 175.
[0166] In some examples, the gas sources 932 can include stable and
known pressures of each of the gases provided to the gas mixer 930.
The gas mixer 930 can adjust flows of each gas by adjusting flow
valves of for each of gases based on feedback loop based on sensor
data from the capnometer 926 and/or other sensors (e.g., the
inspiratory mixture sensors 910, the capnometer 938, the expiratory
mixture sensors 940, and/or the intratracheal sensors 934).
[0167] The inspiratory gas supply system may include a gas property
control 928. The gas property control 928 can include a humidifier
and/or a moisture exchanger and/or a moisture trap to control
(e.g., increase or decrease) the humidity of the inspiratory gas
before the inspiratory mixture is provided to the patient 105's
airways. The gas property control 928 can include warmer and/or a
heat exchanger to control (e.g., increase or decrease) the
temperature of the inspiratory gas before the inspiratory mixture
is provided to the patient 105's airways.
[0168] The inspiratory gas supply system may include a capnometer
926, which may measure a concentration of carbon dioxide in the
inspiratory mixture. Sensor data (e.g., readings/measurements) from
the capnometer 926 may be provided to the gas mixer 930 as
feedback. The gas mixer 930 may adjust the amount of carbon dioxide
and/or other gases in the inspiratory mixture based on the sensor
data from the capnometer 926.
[0169] An inspiratory gas delivery system of the ventilator system
of FIG. 9A, illustrated in the lower-middle of FIG. 9A, includes an
inspiratory mixture pressurizer 914. The inspiratory mixture
pressurizer 914 can be electronically controlled, for example using
the controller 170. The inspiratory mixture pressurizer 914
provides pressure to the inspiratory mixture. The amount of
pressure provided by the inspiratory mixture pressurizer 914 to the
inspiratory mixture can be programmable, for example based on
inputs from the user 190 to the interface 175, based on automated
pre-programmed reactions of the controller 170 to sensor data
reaching/crossing thresholds or reaching/crossing into or out of a
range, or a combination thereof. The amount of pressure provided by
the inspiratory mixture pressurizer 914 to the inspiratory mixture
can be based on sensor data from the capnometer 926, the
inspiratory mixture sensors 910, the intratracheal sensors 934, the
capnometer 938, and/or the expiratory mixture sensors 940. The
pressure programmed for the inspiratory mixture pressurizer 914 to
apply may be defined in terms of pressure/time (as in the pressure
graphs 810 of FIGS. 8A-8E) and/or flow/time (as in the flow graphs
805A-805E of FIGS. 8A-8E). The inspiratory mixture pressurizer 914
can react to program, manual control by operator, alarms,
thresholds, ranges, and safety settings including, but not limited
to one or more maximum inspiratory mixture pressure thresholds, one
or more minimum inspiratory mixture pressure thresholds, one or
more safe inspiratory mixture pressure ranges, one or more unsafe
inspiratory mixture pressure ranges, or a combination thereof.
Multiple pre-set thresholds and ranges may exist because certain
thresholds may differ based on whether a patient 105 has a healthy
respiratory system or not, and what types of diseases or conditions
a patient 105 may be suffering from. The thresholds may correspond
to positive end expiratory pressure (PEEP). In some examples, a
higher PEEP may be desirable. In some examples, a lower PEEP may be
desirable.
[0170] The inspiratory gas delivery system may include one or more
buffers 912. The buffers 912 may store the inspiratory mixture
while the inspiratory mixture pressurizer 914 pressurizes the
inspiratory mixture. The buffers 912 may store additional
inspiratory mixture in case the inspiratory gas delivery system
does not receive the inspiratory mixture or receives less than
needed of the inspiratory mixture for a short period from the
inspiratory gas supply system.
[0171] The inspiratory gas delivery system may include one or more
inspiratory mixture sensors 910. The inspiratory mixture sensors
910 may include pressure sensors, pressure transducers, flow
sensors, temperature sensors, humidity sensors, capnometers,
oximeters, or combinations thereof.
[0172] The inspiratory gas delivery system may include a gas
property control 908. The gas property control 908 can include a
humidifier and/or a moisture exchanger and/or a moisture trap to
control (e.g., increase or decrease) the humidity of the
inspiratory gas before the inspiratory mixture is provided to the
patient 105's airways. The gas property control 908 can include
warmer and/or a heat exchanger to control (e.g., increase or
decrease) the temperature of the inspiratory gas before the
inspiratory mixture is provided to the patient 105's airways.
[0173] The inspiratory gas delivery system may include a pressure
release valve 906. The pressure release valve 906 may release the
inspiratory mixture into one or more inspiratory lumens. In the
ventilator system of FIG. 9A, a single inspiratory tube or
inspiratory lumen branches into a left inspiratory lumen 220, which
provides the inspiratory mixture to the left lung 130, and a right
inspiratory lumen 225, which provides the inspiratory mixture to
the right lung 135. The inspiratory tube and/or inspiratory lumens
are illustrated using thick dashed lines in FIGS. 9A-9B. The thick
dashed lines include arrowheads pointing in the direction of
inspiratory flow toward the lungs 130-135.
[0174] The ventilator system of FIGS. 9A-9B includes one or more
intratracheal sensors 934 that monitor pressure, flow, CO.sub.2
level, oxygen level, humidity, temperature, and/or other properties
at the carina of the trachea 115 and/or one or more other portions
of the trachea 115. The one or more intratracheal sensors 934 may
be used to maintain desired positive end expiratory pressure (PEEP)
where it is needed the most, still allowing the ventilator system
of FIGS. 9A-9B to apply negative or reduced pressure. Another way
to measure PEEP is to measure it by expiratory mixture sensors
940/950. Negative pressures may need to be applied to expiratory
lumen(s) (e.g., expiratory lumen 510 of FIG. 9A and/or expiratory
lumens 520 and 525 of FIG. 9B) by the expiratory mixture
pressurizers 994/954 to overcome the flow resistance in expiratory
lumen(s) 520-525 as the expiratory mixture(s) is/are leaving the
lungs 130-135 via airways and via expiratory lumen(s) 520-525. Such
negative, or lower than PEEP pressure, applied to expiratory lumens
will allow for more efficient expiratory mixture(s) evacuation from
lungs 130-135 via expiratory lumen(s) 520-525. This sometimes may
be necessary to maintain required shorter length of the expiratory
phase, to maintain pre-determined and/or recommended and/or preset
by operator higher respiratory rate. The intratracheal sensors 934
can include pressure sensors and/or one or more tips of one or more
pressure transducers. The intratracheal sensors 934 can include
pressure sensors as well as other sensors (e.g., flow, temperature,
humidity, capnometer, oxygen sensor, and/or other gas
properties).
[0175] The ventilator system of FIGS. 9A-9B includes one or more
expiratory lumens that evacuate and/or receive expiratory gas(es)
from the left lung 130 and/or the right lung 135. The one or more
expiratory lumens can include a single expiratory lumen 510 as in
FIGS. 5A-5B. The a left expiratory lumen 520 and a right expiratory
lumen 525 as in FIG. 5C. The one or more expiratory lumens are
illustrated using thick solid lines in FIGS. 9A-9B. The thick solid
lines include arrowheads pointing in the direction of expiratory
flow away from the lungs 130-135.
[0176] An expiratory gas receipt system of the ventilator system of
FIG. 9A, illustrated in the upper-middle of FIG. 9A, can include a
water trap 936 or moisture trap that traps water, moisture, and/or
other liquids (e.g., mucous) that the expiratory gas receipt system
can separate from the expiratory gas. The expiratory gas receipt
system can include a capnometer 938, which may measure carbon
dioxide concentration in the expiratory gas(es). The sensor data
from the capnometer 938 can be used for a feedback loop, for
example to the expiratory mixture pressurizer 944.
[0177] The expiratory gas receipt system can include one or more
expiratory mixture sensors 940 that can measure properties of the
expiratory gas(es). The one or more expiratory mixture sensors 940
may include pressure sensors, pressure transducers, flow sensors,
temperature sensors, humidity sensors, capnometers, oximeters, or
combinations thereof.
[0178] The expiratory gas receipt system can include an expiratory
mixture pressurizer 944. The expiratory mixture pressurizer 944 can
provide pressure, for instance negative pressure (e.g., providing
suction), to the one or more expiratory lumens 510/520/525.
Negative pressure can allow for receipt and/or evacuation of more
expiratory gas(es) from the left lung 130 and/or the right lung
135, and DCAs 425 included within. For example, negative pressure
can allow for receipt and/or evacuation of more expiratory gas(es)
from the dead spaces 410, and DCAs 425 included within. Negative
pressure can allow for flow of expiratory gas(es) from the lungs
130-135 to occur at a faster rate. The expiratory mixture
pressurizer 944 can be electronically controlled, for example via a
controller 170. The expiratory mixture pressurizer 944 can include,
for example, a rotary compressor, a turbine, a suction device, or a
combination thereof. The expiratory gas receipt system can include
a buffer 942, which may for example be used by the expiratory
mixture pressurizer 944 for providing negative pressure on the one
or more expiratory lumens.
[0179] The amount of expiratory pressure provided by the expiratory
mixture pressurizer 944 can be programmable, for example based on
inputs from the user 190 to the interface 175, based on automated
pre-programmed reactions of the controller 170 to sensor data
reaching/crossing thresholds or reaching/crossing into or out of a
range, or a combination thereof. In some examples, the controller
170 that controls the expiratory mixture pressurizer 944 can adjust
expiratory pressure based on sensor data from the capnometer 926,
the inspiratory mixture sensors 910, the intratracheal sensors 934,
the capnometer 938, the expiratory mixture sensors 940, or a
combination thereof. The amount of expiratory pressure provided by
the expiratory mixture pressurizer 944 can be programmable
pressure/time (as in the pressure graphs 810 of FIGS. 8A-8E) and/or
flow/time (as in the flow graphs 805A-805E of FIGS. 8A-8E). The
expiratory mixture pressurizer 944 can react to alarms, thresholds,
ranges, and safety settings including, but not limited to one or
more maximum expiratory mixture pressure thresholds, one or more
minimum expiratory mixture pressure thresholds, one or more safe
expiratory mixture pressure ranges, one or more unsafe expiratory
mixture pressure ranges, or a combination thereof. Multiple pre-set
thresholds and ranges may exist because certain thresholds may
differ based on whether a patient 105 has a healthy respiratory
system or not, and what types of diseases or conditions a patient
105 may be suffering from. Expiratory pressure may be set to
maintain a PEEP pressure above a threshold (e.g., a positive PEEP
pressure) as measured at the intratracheal pressure sensors 934 or
in any other way (for example as measured by expiratory mixture
sensors 940/950). An example minimum expiratory pressure may be 5
cmH.sub.2O, as less than that may be detrimental to pulmonary
function or insufficient to maintain proper oxygenation in certain
clinical scenarios. Specific expiratory pressures may be desirable
to treat certain diseases. For example, to treat diseases such as
ARDS, expiratory pressure of 12 cmH.sub.2O may be useful.
[0180] An expiratory gas removal system of the ventilator system of
FIG. 9A, illustrated in the upper-left corner of FIG. 9A, can
includes a filtration system 956 that filters the expiratory gases,
for example to remove DCAs 425 and/or harmful contaminants. The
expiratory gas removal system can include an output 958, which may
include a gas sink/reservoir and/or an exhaust (e.g., to the
atmosphere). In some examples, certain filtered and/or safe
portions of the expiratory gases can be output using an exhaust,
while dangerous portions of the expiratory gases (e.g., including
DCAs 425 corresponding to highly infectious/contagious/deadly
diseases) can be output to a sink or reservoir to prevent infecting
or contaminating other individuals.
[0181] In some examples, the one or more expiratory lumens and/or
one or more inspiratory lumens may include stiff walls to withstand
positive pressure supplied by the inspiratory mixture pressurizer
914 and/or to withstand negative pressure supplied by the
expiratory mixture pressurizer 944. In some examples, the one or
more expiratory lumens and/or one or more inspiratory lumens may,
at least in some areas, be surrounded by a tube, such as the ETT
120. The tube may include stiff walls to withstand positive
pressure supplied by the inspiratory mixture pressurizer 914 and/or
to withstand negative pressure supplied by the expiratory mixture
pressurizer 944.
[0182] In some examples, the inspiratory flow control system 150 of
FIG. 1 may include at least a subset of the inspiratory gas supply
system and/or at least a subset of the inspiratory gas delivery
system of FIG. 9A. In some examples, the inspiratory gas source(s)
160 of FIG. 1 may include at least a subset of the inspiratory gas
supply system and/or at least a subset of the inspiratory gas
delivery system of FIG. 9A. In some examples, the expiratory flow
control system 155 of FIG. 1 may include at least a subset of the
expiratory gas receipt system and/or at least a subset of the
expiratory gas removal system of FIG. 9A. In some examples, the
expiratory output(s) 165 of FIG. 1 may include at least a subset of
the expiratory gas receipt system and/or at least a subset of the
expiratory gas removal system of FIG. 9A.
[0183] FIG. 9B is a block diagram 900B illustrating an architecture
of an exemplary ventilator system that includes a left inspiratory
control system that provides inspiratory gas to a left lung 130
through a left inspiratory lumen 220, a right inspiratory control
system that provides inspiratory gas to a right lung 135 through a
right inspiratory lumen 225, a left expiratory control system that
evacuates expiratory gas from a left lung 130 through a left
expiratory lumen 520, and a right expiratory control system that
evacuates expiratory gas from a right lung 135 through a right
expiratory lumen 525. The ventilator system of FIG. 9B shares many
components and traits with the ventilator system of FIG. 9A.
[0184] However, the ventilator system of FIG. 9B includes a left
inspiratory lumen 220 with its own left inspiratory gas delivery
system (with elements 916-924) and a right inspiratory lumen 225
with its own right inspiratory gas delivery system (with elements
906-914). The left inspiratory gas delivery system can include an
inspiratory mixture pressurizer 924, buffer 922, inspiratory
mixture sensors 920, gas property control 918, and pressure release
valve 916. These elements can function similarly to corresponding
elements in the right inspiratory gas delivery system (and of FIG.
9A), such as the inspiratory mixture pressurizer 914, the buffer
912, the inspiratory mixture sensors 910, gas property control 908,
and pressure release valve 906.
[0185] While the ventilator system of FIG. 9B is illustrated with
the left inspiratory gas delivery system and right inspiratory gas
delivery system both supplied with inspiratory mixture by a shared
inspiratory gas supply system (with elements 926-932), this need
not be the case. In some examples, the left inspiratory gas
delivery system may include its own left inspiratory gas supply
system, and the right inspiratory gas delivery system may include
its own right inspiratory gas supply system.
[0186] The ventilator system of FIG. 9B also includes a left
expiratory lumen 520 with its own left expiratory gas receipt
system (with elements 936-944) and a right inspiratory lumen 525
with its own inspiratory gas delivery system (with elements
946-954). The right inspiratory gas delivery system can include a
water trap 946, capnometer 948, expiratory mixture sensors 950,
buffer 952, and/or expiratory mixture pressurizer 954. These
elements can function similarly to corresponding elements in the
left expiratory gas delivery system (and of FIG. 9A), such as the
water trap 936, capnometer 938, expiratory mixture sensors 940,
buffer 942, and/or expiratory mixture pressurizer 944.
[0187] While the ventilator system of FIG. 9B is illustrated with
the left expiratory gas receipt system and right expiratory gas
receipt system both outputting expiratory mixture to a shared
expiratory gas removal system (with elements 956-958), this need
not be the case. In some examples, the left expiratory gas receipt
system may include its own left expiratory gas removal system, and
the right expiratory gas receipt system may include its own right
expiratory gas removal system.
[0188] The expiratory Mixture collectively from all or some
Expiratory Lumens, or separately from all or some Expiratory
lumens, in all examples, can be analyzed, per clinical needs, for
white cell count, epithelial cells count, red cell count, with
culture, stains, microscopic examination, polymerase chain
reaction, any other test, all quantitative and qualitative, in
appropriate clinical scenarios, to diagnose, to follow up and
compare disease activity and/or response to treatment in all, or
some portions of the lungs.
[0189] The separate left inspiratory gas delivery system and right
inspiratory gas delivery system separately supply pressurized
inspiratory mixture to the left lung 130 and right lung 135,
respectively, through the left inspiratory lumen 220 and the right
inspiratory lumen 225, respectively. Because of the separate left
inspiratory gas delivery system and right inspiratory gas delivery
system, the left inspiratory mixture pressurizer 924 and the right
inspiratory mixture pressurizer 914 can be set to provide different
pressures for inspiratory gases to the left lung 130 and right lung
135, respectively, through the left inspiratory lumen 220 and the
right inspiratory lumen 225, respectively. This may be helpful if
one lung is in a different state than the other lung--for example,
if one lung is more diseased or injured than the other lung, if one
lung is smaller or larger than the other lung, if one lung is or
more or less compliant or more or less capable than the other lung,
or some combination thereof. Similarly, the left gas property
control 918 and the right gas property control 908 can set higher
or lower humidities, temperatures, or other gas properties for
inspiratory mixture supplied to one lung than the other lung. In
ventilator systems with a separate left inspiratory gas supply
system and a separate right inspiratory gas supply system, the left
lung 130 and the right lung 135 may even be provided with slightly
different inspiratory mixtures (e.g., more oxygen to one lung than
the other, more carbon dioxide to one lung than the other), based
on different needs of the two lungs 130-135.
[0190] For example, it may be beneficial to deliver more oxygen to
a lung involved in pneumothorax, or to lung involved directly in
the pneumonia process, while maintaining lower oxygen concentration
in a healthier lung, to not stimulate creation of free radicals and
high oxygen concentration injury and optimize shunting. In another
clinical example of the unilateral left or lung pulmonary emboli or
lung hemorrhage it may be useful, desired by the operator, or
indicated, to provide oxygen to one lung but not the other
lung.
[0191] Similarly, the separate left expiratory gas receipt system
and right expiratory gas receipt system separately receive
expiratory mixture from the left lung 130 and right lung 135,
respectively, through the left expiratory lumen 520 and the right
expiratory lumen 525, respectively. Because of the separate left
expiratory gas receipt system and right expiratory gas receipt
system, the left expiratory mixture pressurizer 944 and the right
expiratory mixture pressurizer 954 can be set to provide different
expiratory pressures to apply to the expiratory gases through the
left expiratory lumen 520 and the right expiratory lumen 525,
respectively. This may be helpful if one lung is in a different
state than the other lung--for example, if one lung is more
diseased or injured than the other lung, if one lung is smaller or
larger than the other lung, if one lung is or more or less
compliant or more or less capable than the other lung, or some
combination thereof. In ventilator systems with a separate left
expiratory gas output system and a separate right expiratory gas
output system, the expiratory gases received from the left lung 130
and the expiratory gases received from the right lung 135 may even
be filtered differently and/or output to different types of outputs
(e.g., exhaust, sink) based on the properties of the expiratory
gases and/or lungs 130-135 (e.g., based on which of the lungs
130-135 is diseased and which of the lungs 130-135 is healthy).
Different clinical testing can be applied to expiratory gas
evacuated from different functional or structural portions of the
lung, entire lung, or both lungs to allow for localization and
identification of the problem, diseases, or clinical context.
Different treatments can be applied to inspiratory gas inhaled into
different portions of the lung to allow for directing the treatment
to a given structural or functional portion of the lung, or the
entire lung.
[0192] The amount of inspiratory pressure applied by the
inspiratory mixture pressurizer 914 may be set based on sensor data
from the capnometer 926, the inspiratory mixture sensors 910, the
inspiratory mixture sensors 920, the intratracheal sensors 934, the
capnometer 938, the capnometer 948, the expiratory mixture sensors
940, the expiratory mixture sensors 950, any other sensor or a
combination thereof. The amount of inspiratory pressure applied by
the inspiratory mixture pressurizer 924 may be set based on sensor
data from the capnometer 926, the inspiratory mixture sensors 910,
the inspiratory mixture sensors 920, the intratracheal sensors 934,
the capnometer 938, the capnometer 948, the expiratory mixture
sensors 940, the expiratory mixture sensors 950, any other sensor
or a combination thereof. The amount of expiratory pressure applied
by the expiratory mixture pressurizer 944 may be set based on
sensor data from the capnometer 926, the inspiratory mixture
sensors 910, the inspiratory mixture sensors 920, the intratracheal
sensors 934, the capnometer 938, the capnometer 948, the expiratory
mixture sensors 940, the expiratory mixture sensors 950, any other
sensors or a combination thereof. The amount of expiratory pressure
applied by the expiratory mixture pressurizer 954 may be set based
on sensor data from the capnometer 926, the inspiratory mixture
sensors 910, the inspiratory mixture sensors 920, the intratracheal
sensors 934, the capnometer 938, the capnometer 948, the expiratory
mixture sensors 940, the expiratory mixture sensors 950, any other
sensors, or a combination thereof.
[0193] In some examples, the inspiratory pressures applied by the
inspiratory mixture pressurizers 914 and 924, and the expiratory
pressures applied by the expiratory mixture pressurizers 944 and
954, can be set based on certain criteria. These criteria can
include, for example, to match as closely as possible, breath by
breath, the amount of the expiratory mixture exiting the right lung
135 through the right expiratory lumen 525 with the amount of the
inspiratory mixture entering the right lung 135 through the right
inspiratory lumen 225. These may be determined by matching areas of
inspiratory flow and expiratory flow curves (graphed as flow/time).
These criteria can include, for example, to match as closely as
possible, breath by breath, the amount of the expiratory mixture
exiting the left lung 130 through the left expiratory lumen 520
with the amount of the inspiratory mixture entering the left lung
130 through the left inspiratory lumen 220. These may be determined
by matching areas of inspiratory flow and expiratory flow curves
(graphed as flow/time). These criteria can include maintaining
positive expiratory pressure at the position of intratracheal
pressure sensors 934. This would functionally separate the left
lung 130 from the right lung 135, by minimizing the left-to-right
and right-to-left flow between the lungs.
[0194] In some examples, the ventilator system may output a warning
(e.g., through interface 175), or may automatically adjust
inspiratory pressures and/or expiratory pressures, when certain
thresholds are reached and/or crossed. One threshold may be if
(Expiratory Mixture volume from right lung 135/Inspiratory Mixture
volume to right lung 135) approaches, reaches, or crosses a certain
threshold T.sub.1. Another threshold may be if (Expiratory Mixture
volume from left lung 130/Inspiratory Mixture volume to left lung
130) approaches, reaches, or crosses the threshold T.sub.1. Another
threshold may be if (Expiratory Mixture volume from right lung
135/Inspiratory Mixture volume to right lung 135) approaches,
reaches, or crosses the threshold 1/T.sub.1. Another threshold may
be if (Expiratory Mixture volume from left lung 130/Inspiratory
Mixture volume to left lung 130) approaches, reaches, or crosses
the threshold 1/T.sub.1. The value of T.sub.1 may be set
automatically by the controller 170 and/or by the user 190 through
the interface 175. These thresholds, warnings and automatic
adjustments, or any combination of thereof, may warn operator of
undesired poor functional separation between the left vs. right
lung, may warn operator about presence of significant leak of
left-to-right or right-to-left of inspiratory gasses, and may
alleviate this leak.
[0195] Another threshold may be if (Expiratory Mixture volume from
right lung 135--Inspiratory Mixture volume to right lung 135)
approaches, reaches, or crosses a certain threshold T.sub.2.
Another threshold may be if (Expiratory Mixture volume from left
lung 130--Inspiratory Mixture volume to left lung 130) approaches,
reaches, or crosses the threshold T.sub.2. Another threshold may be
if (Expiratory Mixture volume from right lung 135--Inspiratory
Mixture volume to right lung 135) approaches, reaches, or crosses
the threshold 1/T.sub.2. Another threshold may be if (Expiratory
Mixture volume from left lung 130--Inspiratory Mixture volume to
left lung 130) approaches, reaches, or crosses the threshold
1/T.sub.2. The value of T.sub.2 may be set automatically by the
controller 170 and/or by the user 190 through the interface 175.
These thresholds, and based on them warnings and automatic
adjustments, or any combination of thereof, may warn operator of
undesired poor functional separation between the left vs. right
lung, may warn operator about presence of significant leak of
left-to-right or right-to-left of inspiratory gasses, and may
alleviate this leak.
[0196] Another threshold may be if (Expiratory Mixture volume from
right lung 135) approaches, reaches, or crosses a certain threshold
T.sub.3. Another threshold may be if (Expiratory Mixture volume
from right lung 135) approaches, reaches, or crosses the threshold
T.sub.3. Another threshold may be if (Expiratory Mixture volume
from right lung 135) approaches, reaches, or crosses the threshold
1/T.sub.3. Another threshold may be if (Expiratory Mixture volume
from left lung 130) approaches, reaches, or crosses the threshold
1/T.sub.3. Another threshold may be if (Inspiratory Mixture volume
to right lung 135) approaches, reaches, or crosses the threshold
T.sub.3. Another threshold may be if (Inspiratory Mixture volume to
right lung 135) approaches, reaches, or crosses the threshold
T.sub.3. Another threshold may be if (Inspiratory Mixture volume to
right lung 135) approaches, reaches, or crosses the threshold
1/T.sub.3. Another threshold may be if (Inspiratory Mixture volume
to left lung 130) approaches, reaches, or crosses the threshold
1/T.sub.3. The value of T.sub.3 may be set automatically by the
controller 170 and/or by the user 190 through the interface 175.
These thresholds, and based on them warnings and automatic
adjustments, or any combination of thereof, may warn operator of
undesired poor functional separation between the left vs. right
lung, may warn operator about presence of significant leak of
left-to-right or right-to-left of inspiratory gasses, and may
alleviate this leak.
[0197] Detection that any of the thresholds above are approached,
reached, or crossed may automatically cause, or may cause users 190
to perform, change to a different mode of ventilation, PEEP
adjustments, use of different size(s) of endotracheal tube, use of
different size(s) of inspiratory lumen(s), use of different size(s)
of expiratory lumen(s), changes to the positioning of patient, or a
combination thereof.
[0198] In an illustrative example, a patient 105's left lung 130
may be more diseased and have lower compliance than the patient
105's right lung 135. If inspiratory pressures and/or expiratory
pressures are set identically for the left lung 130 and right lung
135, the controller 170 may detect that there is more Gas "Expired"
by the "more compliant side" (in this case the right side) even
though the same amount of Gas was "inspired" by both sides due to
same applied pressure. The controller 170 can determine this
mismatch as a sign of poor functional separation between the lungs
and can first attempt to neutralize it by applying higher end
expiratory pressure to the right expiratory lumen 525 and lower end
expiratory pressure to the left expiratory lumen 520. This should
decrease or eliminate the mismatch and improve functional
separation between the left and right lung. The controller 170 can
monitor the pressure at intratracheal pressure sensors 934 to make
sure this matches an expected value (for example preset PEEP
pressure) or range (e.g., at a preset programmed by the user 190).
If the intratracheal pressure sensors 934 is lower than the
expected value or range, the controller 170 can increase both
pressures provided by right expiratory mixture pressurizer 954 for
right lung 135 and left expiratory mixture pressurizer 944 for left
lung 135, maintaining the earlier established pressure difference
between pressures provided by right expiratory mixture pressurizer
954 (end expiratory pressure for the right expiratory mixture
pressurizer 954) for right lung 135 and left expiratory mixture
pressurizer 944 (end expiratory pressure for the right expiratory
mixture pressurizer 944) for left lung to functionally separate
left and right lung.
[0199] If the pressure detected the intratracheal sensors 934 is
above the expected pressure (for example preset PEEP), the
controller 170 can decrease both (for example end expiratory
pressures) provided by right expiratory mixture pressurizer 954 for
right lung 135 and left expiratory mixture pressurizer 944 for left
lung 135, maintaining the earlier established pressure difference
between pressures provided by right expiratory mixture pressurizer
954 for right lung 135 and left expiratory mixture pressurizer 944
for left lung to functionally separate left and right lung.
[0200] If the controller 170 cannot eliminate the mismatch as
discussed above, and the criteria for an alarm or warning triggers,
and the user 190 (e.g., a health care provider), may decide to
change a position of the patient 105, for example by putting the
patient 105 on his/her right side, to decrease compliance of the
right lung 135.
[0201] In some examples, negative or lower than PEEP pressures may
need to be applied to expiratory lumen(s) (e.g., expiratory lumen
510 of FIG. 9A, and/or expiratory lumens 520 and 525 of FIG. 9B) by
the expiratory mixture pressurizer (994 and/or 954) to overcome the
flow resistance in expiratory lumen(s) as the expiratory mixture(s)
is/are leaving the lungs via airways and via expiratory lumen(s).
Such negative or lower than PEEP pressure will allow for efficient
expiratory mixture(s) evacuation from lungs 130-135 via the
expiratory lumen(s). It may be useful to maintain required shorter
length of the expiratory phase, as it may be useful to maintain
higher respiratory rates that are pre-determined, recommended,
and/or preset by an operator, and/or to prevent a phenomena
referred to as "auto-PEEPing."
[0202] Pressure data from pressure sensors and/or transducer(s)
(e.g., of the inspiratory mixture sensors 910, the inspiratory
mixture sensors 920, the intratracheal sensors 934, the expiratory
mixture sensors 940, and/or the expiratory mixture sensors 950) can
be used to maintain a desired (e.g., selected by operator) level of
PEEP. Similarly, pressure data can also be used to trigger alarms
in case of high pressures (e.g., exceeding a threshold) or low
pressures (e.g., less than a threshold). The readings from various
sensors (e.g., capnometer 926, the inspiratory mixture sensors 910,
the inspiratory mixture sensors 920, the intratracheal sensors 934,
the capnometer 938, the capnometer 948, the expiratory mixture
sensors 940, the expiratory mixture sensors 950, or a combination
thereof), which may include pressure sensor(s), pressure
transducer(s), temperature sensor(s), and/or capnometer(s), can be
used to calculate the inspiratory mixture(s) flow rate(s) (which
depend on pressures applied by inspiratory mixture pressurizer(s)
914/924) and expiratory mixture(s) flow rate(s) (which depend on
pressures applied by expiratory mixture Pressurizer(s) 944/954) to
maintain functional separation of the portions of the lungs.
[0203] Functional separation of the left lung 130 from the right
lung 135 may be beneficial, in many clinical scenarios to prevent
DCAs 425 from freely crossing between the left lung 130 from the
right lung 135. For example, if patient has COVID-19 caused
pneumonia in the left lung 130, it may be desired to functionally
separate the left lung 130 from the right lung 135 to prevent DCAs
435 (e.g., COVID-19 virions) from moving from left lung 130 from
the right lung 135.
[0204] The ventilator system pictured on FIG. 9B allows one or more
operators (e.g., users 190) to functionally separate the left lung
130 from the right lung 135, by assuring that all (most) of the
inspiratory mixture entering the left lung 130 via left inspiratory
lumen 220 exits from the left lung 130 by the left expiratory lumen
520, and as little as possible of this inspiratory mixture exits
through the right expiratory lumen 525 or enters right main
bronchus 215 or right lung 135. Likewise, the ventilator system can
assure that all (most) of the inspiratory mixture entering the
right lung 135 via right inspiratory lumen 225 exits from the right
lung 135 by the right expiratory lumen 525, and as little as
possible of this inspiratory mixture exits through the left
expiratory lumen 520 or enters the left main bronchus 210 or left
lung 130. In many clinical scenarios, the compliance of left lung
130 and right lung 135 differ. Thus, it can be useful to provide
different pressures for the left inspiratory mixture pressurizer
924 and the right inspiratory mixture pressurizer 914, it can be
useful to provide different pressures for the left expiratory
mixture pressurizer 944 and the right inspiratory mixture
pressurizer 954, to strengthen and maintain the functional
separation between the left lung 130 and the right lung 135.
[0205] In order to preserve functional separation between the left
lung 130 and right lung 135, if indicated, the controller 170 can
perform a real-time analysis of sensor data from various sensors
(e.g., capnometer 926, the inspiratory mixture sensors 910, the
inspiratory mixture sensors 920, the intratracheal sensors 934, the
capnometer 938, the capnometer 948, the expiratory mixture sensors
940, the expiratory mixture sensors 950, or a combination thereof).
The controller 170 can test the compliance of the left lung 130 and
right lung 135 by applying various inspiratory pressures,
expiratory pressures, CO.sub.2 concentrations, temperatures,
inspiratory mixture flow rates, and/or expiratory mixture flow
rates.
[0206] In some examples, the controller 170 may detects that, even
though same pressure is provided by the inspiratory pressurizers
914 and 924, different expiratory pressures may be used or
detected. In an illustrative example, during each breath, 500 cc of
inspiratory mixture is provided via right inspiratory lumen 225,
430 cc is received via right expiratory lumen 525, 530 cc of
inspiratory mixture is provided via left inspiratory lumen 220, and
600 cc is received via left expiratory lumen 520. In this example,
the controller 170 may determine that there is insufficient
functional separation between the right lung 135 and the left lung
130, and will attempt to correct this in at least one of several
ways. The controller 170 can increase the negative pressure (e.g.,
increase absolute value of the negative pressure) applied to the
right expiratory lumen 525 to increase expiratory flow rate through
it the right expiratory lumen 525, decrease the pressure applied to
right inspiratory lumen 225 to increase inspiratory flow rate
through the right inspiratory lumen 225, or a combination
thereof.
[0207] If the controller 170 can't find a solution to resolve
inadequate functional separation of the left lung 130 and the right
lung 135 (or portions thereof) based on pressure, or if capnometer
sensor data is more reliable or readily available, then the
controller 170 can base its actions on capnometer data from
capnometers (e.g., capnometers 926, 934, 938, and/or 948). The
controller 170 can, increase, for a brief period, the CO.sub.2
concentration of the inspiratory mixture to the right lung 135 and
measure a time elapsed until a peak CO.sub.2 concentration is
detected corresponding to the CO.sub.2 concentration increase. The
intratracheal sensors 934 may include a capnometer, which may be
useful for this purpose. If the time to detected CO.sub.2 partial
pressure peak is long (e.g., longer than a threshold) and peak is
low (e.g., lower than a threshold), the controller 170 may
determine that there is little (e.g., less than a threshold)
inspiratory mixture crossing from the right lung 135 to the left
lung 130. If the time to detected CO.sub.2 partial pressure peak is
short (e.g., shorter than a threshold), and peak is high (e.g.,
higher than a threshold), the controller 170 may determine that
there is a lot of (e.g., more than a threshold) inspiratory mixture
crossing from the right lung 135 to the left lung 130.
[0208] The controller 170 can then repeat by the attempt by
increasing, for a brief period, the CO concentration of the
inspiratory mixture to the left lung 130 and measure the time
elapsed until peak CO.sub.2 is detected by the capnometers. If the
time to detected CO.sub.2 partial pressure peak is long (e.g.,
longer than a threshold), and peak is low (e.g., lower than a
threshold), the controller 170 may determine that there is little
(e.g., less than a threshold) inspiratory mixture crossing from the
left lung 130 to the right lung 135. If the time to detected
CO.sub.2 partial pressure peak is short (e.g., shorter than a
threshold), and peak is high (e.g., higher than a threshold), the
controller 170 may determine that there is a lot of (e.g., more
than a threshold) inspiratory mixture crossing from the left lung
130 to the right lung 135.
[0209] The controller 170 can further try to adjust the pressures
of inspiratory pressurizers 914/924 and the expiratory pressurizers
944/954 to maintain minimal peak and longest possible time to
peak.
[0210] Instead of increasing CO.sub.2 in the inspiratory mixture(s)
and detecting the peak in CO.sub.2 at the capnometer(s)
corresponding to the increase in CO.sub.2, the controller 170 may
instead decrease CO.sub.2 in the inspiratory mixture(s) and detect
a corresponding dip in the peak in CO.sub.2 at the
capnometer(s).
[0211] Instead of increasing CO.sub.2 in the inspiratory mixture(s)
and detecting the peak in CO.sub.2 at the capnometer(s)
corresponding to the increase in CO.sub.2, the controller 170 may
instead increase or decrease temperature of the inspiratory
mixture(s) and detect a corresponding peak or dip in temperature at
one or more thermometers, such as a thermometer of the
intratracheal sensors 934.
[0212] The intratracheal pressure sensor 934, may be used to warn
the operator of flow issues, within the inspiratory and expiratory
lumen, for example due to mucus plugging. In such scenarios, the
gradient of the pressure between the inspiratory or expiratory
pressurizers vs. intratracheal sensors would be out of proportion
higher than baseline gradient, recorded earlier during normal
operation. This can be sensed by sensor and software and can
trigger warning similarly to warning described earlier.
[0213] The intratracheal pressure sensor 934 can allow to accurate
titration of PEEP exactly in position, where it really should be
measured. This would provide most accurately PEEP, regardless of
biases caused by example of flow and resistance via inspiratory or
expiratory lumens.
[0214] In some examples, the inspiratory flow control system 150 of
FIG. 1 may include at least a subset of the inspiratory gas supply
system and/or at least a subset of the inspiratory gas delivery
systems of FIG. 9A. In some examples, the inspiratory gas source(s)
160 of FIG. 1 may include at least a subset of the inspiratory gas
supply system and/or at least a subset of the inspiratory gas
delivery systems of FIG. 9A. In some examples, the expiratory flow
control system 155 of FIG. 1 may include at least a subset of the
expiratory gas receipt systems and/or at least a subset of the
expiratory gas removal system of FIG. 9A. In some examples, the
expiratory output(s) 165 of FIG. 1 may include at least a subset of
the expiratory gas receipt systems and/or at least a subset of the
expiratory gas removal system of FIG. 9A.
[0215] FIG. 10 is a flow diagram illustrating exemplary operations
1000 for airflow control. The operations 1000 may be performed by a
ventilator system. The ventilator system that performs the
operations 1000 may include the ventilator systems of FIG. 1, the
ventilator system of FIG. 2, the ventilator system of FIG. 4A, the
ventilator system of FIG. 4B, the ventilator system of FIG. 4C, the
ventilator system of FIG. 5A, the ventilator system of FIG. 5B, the
ventilator system of FIG. 5C, the ventilator system of FIG. 6, the
ETT 120 of FIG. 7A, a ventilator system providing pressure changes
850, a ventilator system providing inspiratory flow 830A, a
ventilator system providing inspiratory flow 830B, a ventilator
system providing inspiratory flow 830C, a ventilator system
providing inspiratory flow 830D, a ventilator system providing
inspiratory flow 830E, a ventilator system providing expiratory
flow 835A, a ventilator system providing expiratory flow 835B, a
ventilator system providing expiratory flow 835C, a ventilator
system providing expiratory flow 835D, a ventilator system
providing expiratory flow 835E, the ventilator system of FIG. 9A,
the a ventilator system of FIG. 9B, one or more components of any
of the previously-listed ventilator systems or elements, or a
combination thereof.
[0216] At operation 1005, the ventilator system receives a first
inspiratory gaseous volume into a first inspiratory lumen. At
operation 1010, the ventilator system provides the first
inspiratory gaseous volume to a first portion of an airway (e.g.,
of a patient 105) using the first inspiratory lumen while the first
inspiratory lumen is at least partially inserted into the
airway.
[0217] At operation 1015, the ventilator system receives a second
inspiratory gaseous volume into a second inspiratory lumen. At
operation 1020, the ventilator system provides the second
inspiratory gaseous volume to a second portion of the airway using
the second inspiratory lumen while the second inspiratory lumen is
at least partially inserted into the airway. In some examples, the
ventilator system can provide the first inspiratory gaseous volume
to the first portion of the airway using the first inspiratory
lumen (as in operation 1010) contemporaneously with providing the
second inspiratory gaseous volume to the second portion of the
airway using the second inspiratory lumen (as in operation
1020).
[0218] According to a first illustrative embodiment of operations
1005-1020, examples of the first inspiratory lumen of operations
1005 and 1010 may include the left inspiratory lumen 220 of FIGS.
5A-5C, 6, 7A, 9A, and 9B. According to the first illustrative
embodiment of operations 1005-1020, examples of the first portion
of the airway of operations 1005 and 1010 include the left lung
130, the left primary bronchus 210, one or more left secondary
bronchi 310, one or more tertiary bronchi in the left lung 130, one
or more 4th order bronchi in the left lung 130, one or more 5th
order bronchi in the left lung 130, one or more 6th order bronchi
in the left lung 130, one or more bronchioles 320 in the left lung
130, one or more alveoli 325 in the left lung 130, a left portion
of the trachea 115, or a combination thereof.
[0219] According to the first illustrative embodiment of operations
1005-1020, examples of the second inspiratory lumen of operations
1015 and 1020 may include the right inspiratory lumen 225 of FIGS.
5A-5C, 6, 7A, 9A, and 9B. According to the first illustrative
embodiment of operations 1005-1020, examples of the second portion
of the airway of operations 1015 and 1020 include the right lung
135, the right primary bronchus 215, one or more right secondary
bronchi 315, one or more tertiary bronchi in the right lung 135,
one or more 4th order bronchi in the right lung 135, one or more
5th order bronchi in the right lung 135, one or more 6th order
bronchi in the right lung 135, one or more bronchioles 320 in the
right lung 135, one or more alveoli 325 in the right lung 135, a
right portion of the trachea 115, or a combination thereof.
[0220] According to a second illustrative embodiment of operations
1005-1020, examples of the first inspiratory lumen of operations
1005 and 1010 may include the right inspiratory lumen 225 of FIGS.
5A-5C, 6, 7A, 9A, and 9B. According to the second illustrative
embodiment of operations 1005-1020, examples of the second portion
of the airway of operations 1005 and 1010 include the right lung
135, the right primary bronchus 215, one or more right secondary
bronchi 315, one or more tertiary bronchi in the right lung 135,
one or more 4th order bronchi in the right lung 135, one or more
5th order bronchi in the right lung 135, one or more 6th order
bronchi in the right lung 135, one or more bronchioles 320 in the
right lung 135, one or more alveoli 325 in the right lung 135, a
right portion of the trachea 115, or a combination thereof.
[0221] According to the second illustrative embodiment of
operations 1005-1020, examples of the second inspiratory lumen of
operations 1015 and 1020 may include the left inspiratory lumen 220
of FIGS. 5A-5C, 6, 7A, 9A, and 9B. According to the second
illustrative embodiment of operations 1005-1020, examples of the
second portion of the airway of operations 1015 and 1020 include
the left lung 130, the left primary bronchus 210, one or more left
secondary bronchi 310, one or more tertiary bronchi in the left
lung 130, one or more 4th order bronchi in the left lung 130, one
or more 5th order bronchi in the left lung 130, one or more 6th
order bronchi in the left lung 130, one or more bronchioles 320 in
the left lung 130, one or more alveoli 325 in the left lung 130, a
left portion of the trachea 115, or a combination thereof.
[0222] At operation 1025, the ventilator system evacuates an
expiratory gaseous volume from the first portion of the airway and
from the second portion of the airway using one or more expiratory
lumens while the one or more expiratory lumens are at least
partially inserted into the airway. In some examples, the
ventilator system can evacuate the expiratory gaseous volume from
the first portion of the airway and from the second portion of the
airway using the one or more expiratory lumens (as in operation
1025) contemporaneously with providing the first inspiratory
gaseous volume to the first portion of the airway using the first
inspiratory lumen (as in operation 1010) and/or with providing the
second inspiratory gaseous volume to the second portion of the
airway using the second inspiratory lumen (as in operation
1020).
[0223] Examples of the one or more expiratory lumens of operation
1025 can include the expiratory lumen 510 of FIGS. 5A-5B, the
expiratory lumen 510 of FIG. 6, the expiratory lumen 510 of FIG.
7A, the expiratory lumen 510 of FIG. 9A, the left expiratory lumen
520 of FIG. 5C, the left expiratory lumen 520 of FIG. 9A, the left
expiratory lumen 520 of FIG. 9B, the right expiratory lumen 525 of
FIG. 5C, the right expiratory lumen 525 of FIG. 9A, the right
expiratory lumen 525 of FIG. 9B, or a combination thereof.
[0224] In some examples, the first portion of the airway includes a
first lung, and the second portion of the airway includes a second
lung distinct from the first lung. For instance, according to the
first illustrative embodiment of operations 1005-1020, the first
lung may be the left lung 130, and the second lung may be the right
lung 135. According to the second illustrative embodiment of
operations 1005-1020, the first lung may be the right lung 135, and
the second lung may be the left lung 130.
[0225] In some examples, the first inspiratory lumen is configured
to provide the first inspiratory gaseous volume to a first lobe of
the first lung, and the one or more expiratory lumens are
configured to evacuate the expiratory gaseous volume from a second
lobe of the first lung. In some cases, the ventilator systems of
FIGS. 5A-5D may be used to provide this difference in lobe for
inspiratory air provision versus expiratory air evacuation. The
first lobe is different than the second lobe. For instance, if the
first lobe is a superior lobe, then the second lobe can be a middle
lobe or an inferior lobe, and vice versa. If the first lobe is a
middle lobe, then the second lobe can be a superior lobe or an
inferior lobe, or vice versa. If the first lobe is an inferior
lobe, then the second lobe can be a superior lobe or a middle lobe,
or vice versa.
[0226] In some examples, the second inspiratory lumen is configured
to provide the second inspiratory gaseous volume to a first lobe of
the second lung, and the one or more expiratory lumens are
configured to evacuate the expiratory gaseous volume from a second
lobe of the second lung. In some cases, the ventilator systems of
FIGS. 5A-5D may be used to provide this difference in lobe for
inspiratory air provision versus expiratory air evacuation. The
first lobe is different than the second lobe. For instance, if the
first lobe is a superior lobe, then the second lobe can be a middle
lobe or an inferior lobe, and vice versa. If the first lobe is a
middle lobe, then the second lobe can be a superior lobe or an
inferior lobe, or vice versa. If the first lobe is an inferior
lobe, then the second lobe can be a superior lobe or a middle lobe,
or vice versa.
[0227] In some examples, the first portion of the airway includes a
first lobe of the first lung, and the second portion of the airway
includes a second lobe of the second lung. The first lobe can be
different than the second lobe. For instance, if the first lobe is
a superior lobe, then the second lobe can be a middle lobe or an
inferior lobe, and vice versa. If the first lobe is a middle lobe,
then the second lobe can be a superior lobe or an inferior lobe, or
vice versa. If the first lobe is an inferior lobe, then the second
lobe can be a superior lobe or a middle lobe, or vice versa. In
some cases, the ventilator systems of FIGS. 5A-5D may be used to
provide this difference in lobe based on lung.
[0228] In some examples, the first portion of the airway includes a
first bronchus, and the second portion of the airway includes a
second bronchus distinct from the first bronchus. The first and
second bronchi may each (or both) be primary, secondary, tertiary,
4.sup.th order, 5.sup.th order, or 6.sup.th order bronchi. For
instance, according to the first illustrative embodiment of
operations 1005-1020, the first bronchus may be a bronchus in the
left lung 130, and the second bronchus may be a bronchus in the
right lung 135. According to the second illustrative embodiment of
operations 1005-1020, the first bronchus may be a bronchus in the
right lung 135, and the second bronchus may be a bronchus in the
left lung 130.
[0229] In some examples, the first inspiratory lumen receives the
first inspiratory gaseous volume from a first gas source, and
second inspiratory lumen receives the second inspiratory gaseous
volume from the first gas source. In some examples, the first
inspiratory lumen receives the first inspiratory gaseous volume
from a first gas source, and wherein second inspiratory lumen
receives the second inspiratory gaseous volume from a second gas
source. The first gas source can include, for example, the
inspiratory gas source(s) 160 of FIG. 1, the inspiratory flow
control system(s) 150 of FIG. 1, the inspiratory tube(s) 152 of
FIG. 1, the inspiratory gas supply system of FIG. 9A, the
inspiratory gas supply system(s) of FIG. 9B, the inspiratory gas
delivery system of FIG. 9A, the inspiratory gas delivery system(s)
of FIG. 9B, one or more components of one of the previously listed
elements, or a combination thereof. The second gas source can
include, for example, the inspiratory gas source(s) 160 of FIG. 1,
the inspiratory flow control system(s)150 of FIG. 1, the
inspiratory tube(s) 152 of FIG. 1, the inspiratory gas supply
system of FIG. 9A, the inspiratory gas supply system(s) of FIG. 9B,
the inspiratory gas delivery system of FIG. 9A, the inspiratory gas
delivery system(s) of FIG. 9B, one or more components of one of the
previously listed elements, or a combination thereof.
[0230] In some examples, the first inspiratory gaseous volume and
the second inspiratory gaseous volume both include an inspiratory
mixture of a plurality of gases that are mixed according to one or
more predetermined ratios. The plurality of gases may be stored and
provided for mixing by the inspiratory gas source(s) 160 and/or the
gas sources 932. The plurality of gases may be mixed to form the
inspiratory mixture by the inspiratory flow control system(s) 150
and/or the gas mixer 930. In some examples, the inspiratory mixture
may include at least one of oxygen (O.sub.2), carbon dioxide
(CO.sub.2), nitrogen (N), argon (Ar), one or more drugs (in gaseous
and/or aerosolized form), one or more one or more other elemental
gases, one or more other molecular gases, a pre-mixed atmospheric
gas source, or a combination thereof
[0231] In some examples, the ventilator system can include an
endotracheal tube 120. The endotracheal tube can include at least
the first inspiratory lumen, the second inspiratory lumen, and the
expiratory lumen. Examples of arrangements of the first inspiratory
lumen, the second inspiratory lumen, and the expiratory lumen in
the ETT 120 are illustrated in FIGS. 5A, 5B, 5C, 6, 7A, and 7B.
[0232] In some examples, the first inspiratory lumen passes through
the endotracheal tube and extends beyond a tip of the endotracheal
tube toward the first portion of the airway, wherein the second
inspiratory lumen passes through the endotracheal tube and extends
beyond the tip of the endotracheal tube toward the second portion
of the airway.
[0233] In some examples, the tip 125 of the endotracheal tube 120
includes the tip of the expiratory lumen of operation 1025. For
example, the expiratory lumen 510 of FIGS. 5A, 5B, and/or 6 may be
examples of the expiratory lumen of operation 1025 where the tip of
the expiratory lumen is the tip 125 of the endotracheal tube
120.
[0234] In some examples, the ventilator system includes one or more
inspiratory flow control mechanisms that control flow of the first
inspiratory gaseous volume to the first portion of the airway
through the first inspiratory lumen and that control flow of second
inspiratory gaseous volume to the second portion of the airway
through the second inspiratory lumen. Examples of the one or more
inspiratory flow control mechanisms can include, for instance, the
inspiratory gas source(s) 160 of FIG. 1, the inspiratory flow
control system(s) 150 of FIG. 1, the inspiratory tube(s) 152 of
FIG. 1, the inspiratory gas supply system of FIG. 9A, the
inspiratory gas supply system(s) of FIG. 9B, the inspiratory gas
delivery system of FIG. 9A, the inspiratory gas delivery system(s)
of FIG. 9B, the pressurizer(s) 145, the controllers 170, one or
more components of one of the previously listed elements, or a
combination thereof.
[0235] In some examples, the one or more expiratory lumens include
a first expiratory lumen configured to evacuate a first expiratory
gaseous volume from the first portion of the airway and a second
expiratory lumen configured to evacuate a second expiratory gaseous
volume from the second portion of the airway. In some examples, the
first expiratory lumen passes through the endotracheal tube and
extends beyond a tip of the endotracheal tube toward the first
portion of the airway. In some examples, the second expiratory
lumen passes through the endotracheal tube and extends beyond the
tip of the endotracheal tube toward the second portion of the
airway. Examples of the first expiratory lumen include the left
expiratory lumen 520 and the right expiratory lumen 525. Examples
of the second expiratory lumen include the left expiratory lumen
520 and the right expiratory lumen 525.
[0236] In some examples, a first expiratory mixture pressurizer
provides suction to evacuate the first expiratory gaseous volume
from the first portion of the airway through the first expiratory
lumen. In some examples, a second expiratory mixture pressurizer
that provides suction to evacuate the second expiratory gaseous
volume from the second portion of the airway through the second
expiratory lumen. Examples of the first expiratory mixture
pressurizer include the expiratory mixture pressurizer 944 and the
expiratory mixture pressurizer 954. Examples of the second
expiratory mixture pressurizer include the expiratory mixture
pressurizer 944 and the expiratory mixture pressurizer 954.
[0237] In some examples, the one or more expiratory lumens of the
ventilator system also include a third expiratory lumen configured
to evacuate a third expiratory gaseous volume from a third portion
of the airway. In some examples, the third expiratory lumen may
branch off of the first expiratory lumen or the second expiratory
lumen. In some examples, the third portion of the airway may
include, for example, one or more bronchi that the third expiratory
lumen evacuates more expiratory gas from than the first expiratory
lumen and/or the second expiratory lumen do.
[0238] In some examples, the ventilator system includes one or more
expiratory flow control mechanisms that control flow of the
expiratory gaseous volume from the first portion of the airway and
from the second portion of the airway to an expiratory air output
through the one or more expiratory lumens. Examples of the one or
more expiratory flow control mechanisms can include, for instance,
the expiratory gas output(s) 165 of FIG. 1, the expiratory flow
control system(s) 155 of FIG. 1, the expiratory tube(s) 157 of FIG.
1, the expiratory gas receipt system of FIG. 9A, the expiratory gas
receipt system(s) of FIG. 9B, the expiratory gas removal system of
FIG. 9A, the expiratory gas removal system(s) of FIG. 9B, the
pressurizer(s) 145, the controllers 170, one or more components of
one of the previously listed elements, or a combination
thereof.
[0239] In some examples, the ventilator system includes one or more
inspiratory flow control mechanisms that provide the first
inspiratory gaseous volume to the first inspiratory lumen and that
provide the second inspiratory gaseous volume to the second
inspiratory lumen. Examples of the one or more inspiratory flow
control mechanisms can include, for instance, the inspiratory flow
control system(s) 150, the inspiratory gas source(s) 160, the
inspiratory gas provision system 490, the gas sources 932, the gas
mixer(s) 930, the gas property control(s) 928, the capnometer(s)
926, the inspiratory mixture pressurizer 914, the buffer 912, the
inspiratory mixture sensors 910, the gas property control 908, the
pressure release valve 906, the inspiratory mixture pressurizer
924, the buffer 922, the inspiratory mixture sensors 920, the gas
property control 918, the pressure release valve 916, or a
combination thereof.
[0240] In some examples, the ventilator system includes a
controller. The controller can include, for example, a memory
storing instructions, and a processor that executes the
instructions. Examples of the controller include the controller 170
and/or the controller 480. Execution of the instructions can cause
the processor to maintain net inspiratory flow at a first level
during a first portion of each of a plurality of respiratory
cycles. Net inspiratory flow corresponds to provision of both the
first inspiratory gaseous volume and the second inspiratory gaseous
volume.
[0241] Examples of net inspiratory flow include inspiratory flows
830A-830E. Execution of the instructions can cause the processor to
maintain net expiratory flow at a second level during the first
portion of each of the plurality of respiratory cycles, wherein net
expiratory flow corresponds to provision of pressurized suction to
control flow of the expiratory gaseous volume. Examples of net
expiratory flow include expiratory flows 835A-835E.
[0242] In some examples, the first portion of each of the plurality
of respiratory cycles is an inspiration (e.g., time zero (0) to
time t.sub.A or time to t.sub.D time t.sub.E), and an absolute
value of the net inspiratory flow is greater than an absolute value
of the net expiratory flow. In some examples, the first portion of
each of the plurality of respiratory cycles is an expiration (e.g.,
time t.sub.B to time t.sub.D or time t.sub.F to time t.sub.H), and
an absolute value of the net inspiratory flow is less than an
absolute value of the net expiratory flow. In some examples, the
first portion of each of the plurality of respiratory cycles is an
hold (e.g., inspiratory hold, expiratory hold, or pause) (e.g.,
time t.sub.A to time t.sub.B or time t.sub.E to time t.sub.F), and
wherein an absolute value of the net inspiratory flow is equal to
an absolute value of the net expiratory flow.
[0243] In some examples, the ventilator system includes an
intratracheal sensor that measures an intratracheal pressure in a
trachea of the patient. An example of the intratracheal sensor
includes the intratracheal sensors 934. In some examples, the
ventilator system includes one or more pressurizers. The one or
more pressurizers are configured to provide airflow pressure based
on the intratracheal pressure measured by the intratracheal sensor.
The airflow pressure includes at least one of a first inspiratory
pressure to provide the first inspiratory gaseous volume to the
first portion of the airway via the first inspiratory lumen, a
second inspiratory pressure to provide the second inspiratory
gaseous volume to the second portion of the airway via the second
inspiratory lumen, an expiratory pressure to evacuate the
expiratory gaseous volume from at least one of the first portion of
the airway and the second portion of the airway via the one or more
expiratory lumens, or a combination thereof. The one or more
pressurizers may include, for example, the pressurizers 145, the
inspiratory mixture pressurizer 914, the inspiratory mixture
pressurizer 924, the expiratory mixture pressurizer 944, the
expiratory mixture pressurizer 954, or a combination thereof.
[0244] In some examples, the ventilator system includes one or more
markers along at least one of the first inspiratory lumen, the
second inspiratory lumen, the one or more expiratory lumens, or a
combination thereof. The one or more markers can be radiopaque,
radioactive, emissive of a magnetic field, emissive of one or more
electromagnetic signals, or some combination thereof. The one or
more markers can thus be used to locate the first inspiratory
lumen, the second inspiratory lumen, and/or the one or more
expiratory lumens within the patient 105's body, for example via a
scan and/or via triangulation, to determine whether the lumens are
positioned correctly in the patient 105's body (e.g., in the first
portion of the airway, in the second portion of the airway,
etc.).
[0245] In some examples, the ventilator system includes a third
inspiratory lumen that is configured to receive a third inspiratory
gaseous volume and to provide the third inspiratory gaseous volume
to a third portion of the airway while the third inspiratory lumen
is at least partially inserted into the airway. In some examples,
the third inspiratory lumen may branch off of the first inspiratory
lumen or the second inspiratory lumen. In some examples, the third
portion of the airway may include, for example, one or more bronchi
that the third inspiratory lumen provides more inspiratory gas to
than the first inspiratory lumen and/or the second inspiratory
lumen do.
[0246] In some examples, the ventilator system includes a
microfilter adapter that includes a microfilter medium and one or
more one-way airflow valves. The microfilter adapter passes airflow
through the one or more one-way airflow valves and filters the
airflow through the microfilter medium. The airflow includes at
least one of the first inspiratory gaseous volume, the second
inspiratory gaseous volume, and the expiratory gaseous volume.
Examples of the microfilter adapter include the microfilter adapter
460. Examples of the microfilter medium include the microfilter
medium 465. The microfilter adapter can be positioned in the
ventilator system similarly to the adapter 450 and/or the adapter
455. In some examples, the ventilator system includes another type
of adapter in addition to or instead of the microfilter adapter,
such as the connector 610, which may provide the first inspiratory
lumen and the second inspiratory lumen. In some examples, the
ventilator system includes another type of adapter in addition to
or instead of the microfilter adapter, such as the airflow
rerouting adapter 470.
[0247] FIG. 11 illustrates an exemplary computing system 1100 that
may be used to implement some aspects of the technology. For
example, any of the computing devices, computing systems, network
devices, network systems, servers, and/or arrangements of circuitry
described herein may include at least one computing system 1100, or
may include at least one component of the computer system 1100
identified in FIG. 11. The computing system 1100 of FIG. 11
includes one or more processors 1110 and memory units 1120. Each of
the processor(s) 1110 may refer to one or more processors,
controllers, microcontrollers, central processing units (CPUs),
graphics processing units (GPUs), arithmetic logic units (ALUs),
accelerated processing units (APUs), digital signal processors
(DSPs), application specific integrated circuits (ASICs),
field-programmable gate arrays (FPGAs), or combinations thereof.
Each of the processor(s) 1110 may include one or more cores, either
integrated onto a single chip or spread across multiple chips
connected or coupled together. Memory 1120 stores, in part,
instructions and data for execution by processor 1110. Memory 1120
can store the executable code when in operation. The system 1100 of
FIG. 11 further includes a mass storage device 1130, portable
storage medium drive(s) 1140, output devices 1150, user input
devices 1160, a graphics display 1170, and peripheral devices
1180.
[0248] The components shown in FIG. 11 are depicted as being
connected via a single bus 1190. However, the components may be
connected through one or more data transport means. For example,
processor unit 1110 and memory 1120 may be connected via a local
microprocessor bus, and the mass storage device 1130, peripheral
device(s) 1180, portable storage device 1140, and display system
1170 may be connected via one or more input/output (I/O) buses.
[0249] Mass storage device 1130, which may be implemented with a
magnetic disk drive or an optical disk drive, is a non-volatile
storage device for storing data and instructions for use by
processor unit 1110. Mass storage device 1130 can store the system
software for implementing some aspects of the subject technology
for purposes of loading that software into memory 1120.
[0250] Portable storage device 1140 operates in conjunction with a
portable non-volatile storage medium, such as a floppy disk,
compact disk or Digital video disc, to input and output data and
code to and from the computer system 1100 of FIG. 11. The system
software for implementing aspects of the subject technology may be
stored on such a portable medium and input to the computer system
1100 via the portable storage device 1140.
[0251] The memory 1120, mass storage device 1130, or portable
storage 1140 may in some cases store sensitive information, such as
transaction information, health information, or cryptographic keys,
and may in some cases encrypt or decrypt such information with the
aid of the processor 1110. The memory 1120, mass storage device
1130, or portable storage 1140 may in some cases store, at least in
part, instructions, executable code, or other data for execution or
processing by the processor 1110.
[0252] Output devices 1150 may include, for example, communication
circuitry for outputting data through wired or wireless means,
display circuitry for displaying data via a display screen, audio
circuitry for outputting audio via headphones or a speaker, printer
circuitry for printing data via a printer, or some combination
thereof. The display screen may be any type of display discussed
with respect to the display system 1170. The printer may be inkjet,
laserjet, thermal, or some combination thereof. In some cases, the
output device circuitry 1150 may allow for transmission of data
over an audio jack/plug, a microphone jack/plug, a universal serial
bus (USB) port/plug, an Apple.RTM. Lightning.RTM. port/plug, an
Ethernet port/plug, a fiber optic port/plug, a proprietary wired
port/plug, a BLUETOOTH.RTM. wireless signal transfer, a
BLUETOOTH.RTM. low energy (BLE) wireless signal transfer, an
IBEACON.RTM. wireless signal transfer, a radio-frequency
identification (RFID) wireless signal transfer, near-field
communications (NFC) wireless signal transfer, dedicated short
range communication (DSRC) wireless signal transfer, 802.11 Wi-Fi
wireless signal transfer, wireless local area network (WLAN) signal
transfer, Visible Light Communication (VLC), Worldwide
Interoperability for Microwave Access (WiMAX), Infrared (IR)
communication wireless signal transfer, Public Switched Telephone
Network (PSTN) signal transfer, Integrated Services Digital Network
(ISDN) signal transfer, 3G/4G/5G/LTE cellular data network wireless
signal transfer, ad-hoc network signal transfer, radio wave signal
transfer, microwave signal transfer, infrared signal transfer,
visible light signal transfer, ultraviolet light signal transfer,
wireless signal transfer along the electromagnetic spectrum, or
some combination thereof. Output devices 1150 may include any
ports, plugs, antennae, wired or wireless transmitters, wired or
wireless transceivers, or any other components necessary for or
usable to implement the communication types listed above, such as
cellular Subscriber Identity Module (SIM) cards.
[0253] Input devices 1160 may include circuitry providing a portion
of a user interface. Input devices 1160 may include an
alpha-numeric keypad, such as a keyboard, for inputting
alpha-numeric and other information, or a pointing device, such as
a mouse, a trackball, stylus, or cursor direction keys. Input
devices 1160 may include touch-sensitive surfaces as well, either
integrated with a display as in a touchscreen, or separate from a
display as in a trackpad. Touch-sensitive surfaces may in some
cases detect localized variable pressure or force detection. In
some cases, the input device circuitry may allow for receipt of
data over an audio jack, a microphone jack, a universal serial bus
(USB) port/plug, an Apple.RTM. Lightning.RTM. port/plug, an
Ethernet port/plug, a fiber optic port/plug, a proprietary wired
port/plug, a wired local area network (LAN) port/plug, a
BLUETOOTH.RTM. wireless signal transfer, a BLUETOOTH.RTM. low
energy (BLE) wireless signal transfer, an IBEACON.RTM. wireless
signal transfer, a radio-frequency identification (RFID) wireless
signal transfer, near-field communications (NFC) wireless signal
transfer, dedicated short range communication (DSRC) wireless
signal transfer, 802.11 Wi-Fi wireless signal transfer, wireless
local area network (WLAN) signal transfer, Visible Light
Communication (VLC), Worldwide Interoperability for Microwave
Access (WiMAX), Infrared (IR) communication wireless signal
transfer, Public Switched Telephone Network (PSTN) signal transfer,
Integrated Services Digital Network (ISDN) signal transfer,
3G/4G/5G/LTE cellular data network wireless signal transfer,
personal area network (PAN) signal transfer, wide area network
(WAN) signal transfer, ad-hoc network signal transfer, radio wave
signal transfer, microwave signal transfer, infrared signal
transfer, visible light signal transfer, ultraviolet light signal
transfer, wireless signal transfer along the electromagnetic
spectrum, or some combination thereof. Input devices 1160 may
include any ports, plugs, antennae, wired or wireless receivers,
wired or wireless transceivers, or any other components necessary
for or usable to implement the communication types listed above,
such as cellular SIM cards.
[0254] Input devices 1160 may include receivers or transceivers
used for positioning of the computing system 1100 as well. These
may include any of the wired or wireless signal receivers or
transceivers. For example, a location of the computing system 1100
can be determined based on signal strength of signals as received
at the computing system 1100 from three cellular network towers, a
process known as cellular triangulation. Fewer than three cellular
network towers can also be used--even one can be used--though the
location determined from such data will be less precise (e.g.,
somewhere within a particular circle for one tower, somewhere along
a line or within a relatively small area for two towers) than via
triangulation. More than three cellular network towers can also be
used, further enhancing the location's accuracy. Similar
positioning operations can be performed using proximity beacons,
which might use short-range wireless signals such as BLUETOOTH.RTM.
wireless signals, BLUETOOTH.RTM. low energy (BLE) wireless signals,
IBEACON.RTM. wireless signals, personal area network (PAN) signals,
microwave signals, radio wave signals, or other signals discussed
above. Similar positioning operations can be performed using wired
local area networks (LAN) or wireless local area networks (WLAN)
where locations are known of one or more network devices in
communication with the computing system 1100 such as a router,
modem, switch, hub, bridge, gateway, or repeater. These may also
include Global Navigation Satellite System (GNSS) receivers or
transceivers that are used to determine a location of the computing
system 1100 based on receipt of one or more signals from one or
more satellites associated with one or more GNSS systems. GNSS
systems include, but are not limited to, the US-based Global
Positioning System (GPS), the Russia-based Global Navigation
Satellite System (GLONASS), the China-based BeiDou Navigation
Satellite System (BDS), and the Europe-based Galileo GNSS. Input
devices 1160 may include receivers or transceivers corresponding to
one or more of these GNSS systems.
[0255] Display system 1170 may include a liquid crystal display
(LCD), a plasma display, an organic light-emitting diode (OLED)
display, a low-temperature poly-silicon (LTPO) display, an
electronic ink or "e-paper" display, a projector-based display, a
holographic display, or another suitable display device. Display
system 1170 receives textual and graphical information, and
processes the information for output to the display device. The
display system 1170 may include multiple-touch touchscreen input
capabilities, such as capacitive touch detection, resistive touch
detection, surface acoustic wave touch detection, or infrared touch
detection. Such touchscreen input capabilities may or may not allow
for variable pressure or force detection.
[0256] Peripherals 1180 may include any type of computer support
device to add additional functionality to the computer system. For
example, peripheral device(s) 1180 may include one or more
additional output devices of any of the types discussed with
respect to output device 1150, one or more additional input devices
of any of the types discussed with respect to input device 1160,
one or more additional display systems of any of the types
discussed with respect to display system 1170, one or more memories
or mass storage devices or portable storage devices of any of the
types discussed with respect to memory 1120 or mass storage 1130 or
portable storage 1140, a modem, a router, an antenna, a wired or
wireless transceiver, a printer, a bar code scanner, a
quick-response ("QR") code scanner, a magnetic stripe card reader,
a integrated circuit chip (ICC) card reader such as a smartcard
reader or a EUROPAY.RTM.-MASTERCARD.RTM.-VISA.RTM. (EMV) chip card
reader, a near field communication (NFC) reader, a document/image
scanner, a visible light camera, a thermal/infrared camera, an
ultraviolet-sensitive camera, a night vision camera, a light
sensor, a phototransistor, a photoresistor, a thermometer, a
thermistor, a battery, a power source, a proximity sensor, a laser
rangefinder, a sonar transceiver, a radar transceiver, a lidar
transceiver, a network device, a motor, an actuator, a pump, a
conveyer belt, a robotic arm, a rotor, a drill, a chemical assay
device, or some combination thereof.
[0257] The components contained in the computer system 1100 of FIG.
11 can include those typically found in computer systems that may
be suitable for use with some aspects of the subject technology and
represent a broad category of such computer components that are
well known in the art. That said, the computer system 1100 of FIG.
11 can be customized and specialized for the purposes discussed
herein and to carry out the various operations discussed herein,
with specialized hardware components, specialized arrangements of
hardware components, and/or specialized software. Thus, the
computer system 1100 of FIG. 11 can be a personal computer, a hand
held computing device, a telephone ("smartphone" or otherwise), a
mobile computing device, a workstation, a server (on a server rack
or otherwise), a minicomputer, a mainframe computer, a tablet
computing device, a wearable device (such as a watch, a ring, a
pair of glasses, or another type of jewelry or clothing or
accessory), a video game console (portable or otherwise), an e-book
reader, a media player device (portable or otherwise), a
vehicle-based computer, another type of computing device, or some
combination thereof. The computer system 1100 may in some cases be
a virtual computer system executed by another computer system. The
computer can also include different bus configurations, networked
platforms, multi-processor platforms, etc. Various operating
systems can be used including Unix.RTM., Linux.RTM., FreeBSD.RTM.,
FreeNAS.RTM., pfSense.RTM., Windows.RTM., Apple.RTM. Macintosh
OS.RTM. ("MacOS.RTM."), Palm OS.RTM., Google.RTM. Android.RTM.,
Google.RTM. Chrome OS.RTM., Chromium.RTM. OS.RTM., OPENSTEP.RTM.,
XNU.RTM., Darwin.RTM., Apple.RTM. iOS.RTM., Apple.RTM. tvOS.RTM.,
Apple.RTM. watchOS.RTM., Apple.RTM. audioOS.RTM., Amazon.RTM. Fire
OS.RTM., Amazon.RTM. Kindle OS.RTM., variants of any of these,
other suitable operating systems, or combinations thereof. The
computer system 1100 may also use a Basic Input/Output System
(BIOS) or Unified Extensible Firmware Interface (UEFI) as a layer
upon which the operating system(s) are run.
[0258] In some cases, the computer system 1100 may be part of a
multi-computer system that uses multiple computer systems 1100,
each for one or more specific tasks or purposes. For example, the
multi-computer system may include multiple computer systems 1100
communicatively coupled together via at least one of a personal
area network (PAN), a local area network (LAN), a wireless local
area network (WLAN), a municipal area network (MAN), a wide area
network (WAN), or some combination thereof. The multi-computer
system may further include multiple computer systems 1100 from
different networks communicatively coupled together via the
internet (also known as a "distributed" system).
[0259] Some aspects of the subject technology may be implemented in
an application that may be operable using a variety of devices.
Non-transitory computer-readable storage media refer to any medium
or media that participate in providing instructions to a central
processing unit (CPU) for execution and that may be used in the
memory 1120, the mass storage 1130, the portable storage 1140, or
some combination thereof. Such media can take many forms,
including, but not limited to, non-volatile and volatile media such
as optical or magnetic disks and dynamic memory, respectively. Some
forms of non-transitory computer-readable media include, for
example, a floppy disk, a flexible disk, a hard disk, magnetic
tape, a magnetic strip/stripe, any other magnetic storage medium,
flash memory, memristor memory, any other solid-state memory, a
compact disc read only memory (CD-ROM) optical disc, a rewritable
compact disc (CD) optical disc, digital video disk (DVD) optical
disc, a blu-ray disc (BDD) optical disc, a holographic optical
disk, another optical medium, a secure digital (SD) card, a micro
secure digital (microSD) card, a Memory Stick.RTM. card, a
smartcard chip, a EMV chip, a subscriber identity module (SIM)
card, a mini/micro/nano/pico SIM card, another integrated circuit
(IC) chip/card, random access memory (RAM), static RAM (SRAM),
dynamic RAM (DRAM), read-only memory (ROM), programmable read-only
memory (PROM), erasable programmable read-only memory (EPROM),
electrically erasable programmable read-only memory (EEPROM), flash
EPROM (FLASHEPROM), cache memory (L1/L2/L3/L4/L5/L15), resistive
random-access memory (RRAM/ReRAM), phase change memory (PCM), spin
transfer torque RAM (STT-RAM), another memory chip or cartridge, or
a combination thereof.
[0260] Various forms of transmission media may be involved in
carrying one or more sequences of one or more instructions to a
processor 1110 for execution. A bus 1190 carries the data to system
RAM or another memory 1120, from which a processor 1110 retrieves
and executes the instructions. The instructions received by system
RAM or another memory 1120 can optionally be stored on a fixed disk
(mass storage device 1130/portable storage 1140) either before or
after execution by processor 1110. Various forms of storage may
likewise be implemented as well as the necessary network interfaces
and network topologies to implement the same.
[0261] While various flow diagrams provided and described above may
show a particular order of operations performed by some embodiments
of the subject technology, it should be understood that such order
is exemplary. Alternative embodiments may perform the operations in
a different order, combine certain operations, overlap certain
operations, or some combination thereof. It should be understood
that unless disclosed otherwise, any process illustrated in any
flow diagram herein or otherwise illustrated or described herein
may be performed by a machine, mechanism, and/or computing system
1100 discussed herein, and may be performed automatically (e.g., in
response to one or more triggers/conditions described herein),
autonomously, semi-autonomously (e.g., based on received
instructions), or a combination thereof. Furthermore, any action
described herein as occurring in response to one or more particular
triggers/conditions should be understood to optionally occur
automatically response to the one or more particular
triggers/conditions.
[0262] The foregoing detailed description of the technology has
been presented for purposes of illustration and description. It is
not intended to be exhaustive or to limit the technology to the
precise form disclosed. Many modifications and variations are
possible in light of the above teaching. The described embodiments
were chosen in order to best explain the principles of the
technology, its practical application, and to enable others skilled
in the art to utilize the technology in various embodiments and
with various modifications as are suited to the particular use
contemplated. It is intended that the scope of the technology be
defined by the claims.
[0263] Illustrative aspects of the disclosure include:
[0264] Aspect 1. An apparatus for airflow control, the apparatus
comprising: a first inspiratory lumen that is configured to receive
a first inspiratory gaseous volume and to provide the first
inspiratory gaseous volume to a first portion of an airway of a
patient while the first inspiratory lumen is at least partially
inserted into the airway; a second inspiratory lumen that is
configured to receive a second inspiratory gaseous volume and to
provide the second inspiratory gaseous volume to a second portion
of the airway while the second inspiratory lumen is at least
partially inserted into the airway; and one or more expiratory
lumens that are configured to evacuate an expiratory gaseous volume
from at least one of the first portion of the airway and the second
portion of the airway while the one or more expiratory lumens are
at least partially inserted into the airway.
[0265] Aspect 2. The apparatus of Aspect 1, wherein the first
portion of the airway includes a first lung, wherein the second
portion of the airway includes a second lung distinct from the
first lung.
[0266] Aspect 3. The apparatus of Aspect 2, wherein the first
inspiratory lumen is configured to provide the first inspiratory
gaseous volume to a first lobe of the first lung, wherein the one
or more expiratory lumens are configured to evacuate the expiratory
gaseous volume from a second lobe of the first lung, wherein the
first lobe is different than the second lobe.
[0267] Aspect 4. The apparatus of any of Aspects 1 to 3, wherein
the first portion of the airway includes a first bronchus, wherein
the second portion of the airway includes a second bronchus
distinct from the first bronchus.
[0268] Aspect 5. The apparatus of any of Aspects 1 to 4, wherein
the first inspiratory lumen receives the first inspiratory gaseous
volume from a first gas source, and wherein second inspiratory
lumen receives the second inspiratory gaseous volume from the first
gas source.
[0269] Aspect 6. The apparatus of any of Aspects 1 to 5, wherein
the first inspiratory lumen receives the first inspiratory gaseous
volume from a first gas source, and wherein second inspiratory
lumen receives the second inspiratory gaseous volume from a second
gas source.
[0270] Aspect 7. The apparatus of any of Aspects 1 to 6, wherein
the first inspiratory gaseous volume and the second inspiratory
gaseous volume both include an inspiratory mixture of a plurality
of gases that are mixed according to one or more predetermined
ratios.
[0271] Aspect 8. The apparatus of Aspect 7, wherein the inspiratory
mixture includes carbon dioxide.
[0272] Aspect 9. The apparatus of any of Aspects 1 to 8, further
comprising an endotracheal tube, wherein the endotracheal tube
includes at least the first inspiratory lumen, the second
inspiratory lumen, and the one or more expiratory lumens.
[0273] Aspect 10. The apparatus of Aspect 9, wherein the first
inspiratory lumen passes through the endotracheal tube and extends
beyond a tip of the endotracheal tube toward the first portion of
the airway, wherein the second inspiratory lumen passes through the
endotracheal tube and extends beyond the tip of the endotracheal
tube toward the second portion of the airway.
[0274] Aspect 11. The apparatus of Aspect 10, wherein the tip of
the endotracheal tube includes the tip of the one or more
expiratory lumens.
[0275] Aspect 12. The apparatus of any of Aspects 1 to 11, wherein
the one or more expiratory lumens include a first expiratory lumen
configured to evacuate a first expiratory gaseous volume from the
first portion of the airway and a second expiratory lumen
configured to evacuate a second expiratory gaseous volume from the
second portion of the airway.
[0276] Aspect 13. The apparatus of Aspect 12, wherein the first
expiratory lumen passes through an endotracheal tube and extends
beyond a tip of the endotracheal tube toward the first portion of
the airway, wherein the second expiratory lumen passes through the
endotracheal tube and extends beyond the tip of the endotracheal
tube toward the second portion of the airway.
[0277] Aspect 14. The apparatus of any of Aspects 12 to 13, further
comprising: a first expiratory mixture pressurizer that provides
suction to evacuate the first expiratory gaseous volume from the
first portion of the airway through the first expiratory lumen and
a second expiratory mixture pressurizer that provides suction to
evacuate the second expiratory gaseous volume from the second
portion of the airway through the second expiratory lumen.
[0278] Aspect 15. The apparatus of any of Aspects 12 to 14, wherein
the one or more expiratory lumens also include a third expiratory
lumen configured to evacuate a third expiratory gaseous volume from
a third portion of the airway.
[0279] Aspect 16. The apparatus of any of Aspects 1 to 15, further
comprising: one or more inspiratory flow control mechanisms that
control flow of the first inspiratory gaseous volume to the first
portion of the airway through the first inspiratory lumen and that
control flow of second inspiratory gaseous volume to the second
portion of the airway through the second inspiratory lumen.
[0280] Aspect 17. The apparatus of any of Aspects 1 to 16, further
comprising: one or more expiratory flow control mechanisms that
provide pressurized suction to control flow of the expiratory
gaseous volume from at least one of the first portion of the airway
and the second portion of the airway to an expiratory air output
through the one or more expiratory lumens.
[0281] Aspect 18. The apparatus of Aspect 17, further comprising:
one or more inspiratory flow control mechanisms that provide the
first inspiratory gaseous volume to the first inspiratory lumen and
that provide the second inspiratory gaseous volume to the second
inspiratory lumen; a memory storing instructions; and a processor
that executes the instructions, wherein execution of the
instructions by the processor causes the processor to: maintain net
inspiratory flow at a first level during a first portion of each of
a plurality of respiratory cycles, wherein the net inspiratory flow
corresponds to provision of both the first inspiratory gaseous
volume and the second inspiratory gaseous volume, and maintain net
expiratory flow at a second level during the first portion of each
of the plurality of respiratory cycles, wherein the net expiratory
flow corresponds to provision of pressurized suction to control
flow of the expiratory gaseous volume.
[0282] Aspect 19. The apparatus of Aspect 18, wherein the first
portion of each of the plurality of respiratory cycles is an
inspiration, and wherein an absolute value of the net inspiratory
flow is greater than an absolute value of the net expiratory
flow.
[0283] Aspect 20. The apparatus of Aspect 18, wherein the first
portion of each of the plurality of respiratory cycles is an
expiration, and wherein an absolute value of the net inspiratory
flow is less than an absolute value of the net expiratory flow.
[0284] Aspect 21. The apparatus of Aspect 18, wherein the first
portion of each of the plurality of respiratory cycles is a hold,
and wherein an absolute value of the net inspiratory flow is equal
to an absolute value of the net expiratory flow.
[0285] Aspect 22. The apparatus of any of Aspects 1 to 21, further
comprising: an intratracheal sensor that measures an intratracheal
pressure in a trachea of the patient; and one or more pressurizers,
wherein the one or more pressurizers are configured to provide
airflow pressure based on the intratracheal pressure, wherein the
airflow pressure includes at least one of a first inspiratory
pressure to provide the first inspiratory gaseous volume to the
first portion of the airway via the first inspiratory lumen, a
second inspiratory pressure to provide the second inspiratory
gaseous volume to the second portion of the airway via the second
inspiratory lumen, and an expiratory pressure to evacuate the
expiratory gaseous volume from at least one of the first portion of
the airway and the second portion of the airway via the one or more
expiratory lumens.
[0286] Aspect 23. The apparatus of any of Aspects 1 to 22, further
comprising: one or more markers along at least one of the first
inspiratory lumen, the second inspiratory lumen, and the one or
more expiratory lumens, wherein the one or more markers are at
least one of radiopaque, radioactive, emissive of a magnetic field,
and emissive of one or more electromagnetic signals.
[0287] Aspect 24. The apparatus of any of Aspects 1 to 23, further
comprising: a third inspiratory lumen that is configured to receive
a third inspiratory gaseous volume and to provide the third
inspiratory gaseous volume to a third portion of the airway while
the third inspiratory lumen is at least partially inserted into the
airway.
[0288] Aspect 25. The apparatus of any of Aspects 1 to 24, further
comprising: a microfilter adapter that includes a microfilter
medium and one or more one-way airflow valves, wherein the
microfilter adapter passes airflow through the one or more one-way
airflow valves and filters the airflow through the microfilter
medium, wherein the airflow includes at least one of the first
inspiratory gaseous volume, the second inspiratory gaseous volume,
and the expiratory gaseous volume.
[0289] Aspect 26. A method for airflow control, the method
comprising: receiving a first inspiratory gaseous volume into a
first inspiratory lumen; providing the first inspiratory gaseous
volume to a first portion of an airway using the first inspiratory
lumen while the first inspiratory lumen is at least partially
inserted into the airway of a patient; receiving a second
inspiratory gaseous volume into a second inspiratory lumen;
providing the second inspiratory gaseous volume to a second portion
of the airway using the second inspiratory lumen while the second
inspiratory lumen is at least partially inserted into the airway;
and evacuating an expiratory gaseous volume from the first portion
of the airway and from the second portion of the airway using one
or more expiratory lumens while the one or more expiratory lumens
are at least partially inserted into the airway.
[0290] Aspect 27. The method of Aspect 26, wherein the first
portion of the airway includes a first lung, wherein the second
portion of the airway includes a second lung distinct from the
first lung.
[0291] Aspect 28. The method of Aspect 27, wherein providing the
first inspiratory gaseous volume using the first inspiratory lumen
includes providing the first inspiratory gaseous volume to the a
first lobe of the first lung using the first inspiratory lumen,
wherein evacuating the expiratory gaseous volume using one or more
expiratory lumens includes evacuating the expiratory gaseous volume
from a second lobe of the first lung using one or more expiratory
lumens, wherein the first lobe is different than the second
lobe.
[0292] Aspect 29. The method of any of Aspects 26 to 28, wherein
the first portion of the airway includes a first bronchus, wherein
the second portion of the airway includes a second bronchus
distinct or from the first bronchus.
[0293] Aspect 30. The method of any of Aspects 26 to 29, wherein
receiving the first inspiratory gaseous volume into the first
inspiratory lumen includes receiving the first inspiratory gaseous
volume into the first inspiratory lumen from a first gas source,
wherein receiving the second inspiratory gaseous volume into the
second inspiratory lumen includes receiving the second inspiratory
gaseous volume into the second inspiratory lumen from the first gas
source.
[0294] Aspect 31. The method of any of Aspects 26 to 30, wherein
receiving the first inspiratory gaseous volume into the first
inspiratory lumen includes receiving the first inspiratory gaseous
volume into the first inspiratory lumen from a first gas source,
wherein receiving the second inspiratory gaseous volume into the
second inspiratory lumen includes receiving the second inspiratory
gaseous volume into the second inspiratory lumen from a second gas
source.
[0295] Aspect 32. The method of any of Aspects 26 to 31, further
comprising: mixing a plurality of gases into an inspiratory mixture
according to one or more predetermined ratios, wherein the first
inspiratory gaseous volume and the second inspiratory gaseous
volume both include the inspiratory mixture.
[0296] Aspect 33. The method of Aspect 32, wherein the inspiratory
mixture includes carbon dioxide.
[0297] Aspect 34. The method of any of Aspects 26 to 33, wherein an
endotracheal tube includes at least the first inspiratory lumen,
the second inspiratory lumen, and the one or more expiratory
lumens.
[0298] Aspect 35. The method of Aspect 34, wherein the first
inspiratory lumen passes through the endotracheal tube and extends
beyond a tip of the endotracheal tube toward the first portion of
the airway, wherein the second inspiratory lumen passes through the
endotracheal tube and extends beyond the tip of the endotracheal
tube toward the second portion of the airway.
[0299] Aspect 36. The method of Aspect 35, wherein the tip of the
endotracheal tube includes the tip of the one or more expiratory
lumens.
[0300] Aspect 37. The method of any of Aspects 26 to 36, wherein
the one or more expiratory lumens include a first expiratory lumen
and a second expiratory lumen, wherein evacuating the expiratory
gaseous volume from the first portion of the airway and from the
second portion of the airway using one or more expiratory lumens
includes evacuating a first portion of the expiratory gaseous
volume from the first portion of the airway using the first
expiratory lumen and evacuating a second portion of the expiratory
gaseous volume from the second portion of the airway using the
second expiratory lumen.
[0301] Aspect 38. The method of Aspect 37, wherein the first
expiratory lumen passes through an endotracheal tube and extends
beyond a tip of the endotracheal tube toward the first portion of
the airway, wherein the second expiratory lumen passes through the
endotracheal tube and extends beyond the tip of the endotracheal
tube toward the second portion of the airway.
[0302] Aspect 39. The method of any of Aspects 37 to 38, further
comprising: providing primary suction, using a first expiratory
mixture pressurizer, to evacuate the first expiratory gaseous
volume from the first portion of the airway through the first
expiratory lumen; and providing secondary suction, using a second
expiratory mixture pressurizer, to evacuate the second expiratory
gaseous volume from the second portion of the airway through the
second expiratory lumen.
[0303] Aspect 40. The method of any of Aspects 37 to 39, further
comprising: evacuating a third expiratory gaseous volume from a
third portion of the airway using a third expiratory lumens while
the third expiratory lumen is at least partially inserted into the
airway, wherein the one or more expiratory lumens also include the
third expiratory lumen.
[0304] Aspect 41. The method of any of Aspects 26 to 40, further
comprising: controlling flow, of the first inspiratory gaseous
volume to the first portion of the airway through the first
inspiratory lumen and of the second inspiratory gaseous volume to
the second portion of the airway through the second inspiratory
lumen.
[0305] Aspect 42. The method of any of Aspects 26 to 41, further
comprising: providing pressurized suction, using one or more
expiratory flow control mechanisms, to control flow of the
expiratory gaseous volume from at least one of the first portion of
the airway and the second portion of the airway to an expiratory
air output through the one or more expiratory lumens.
[0306] Aspect 43. The method of Aspect 42, further comprising:
maintaining net inspiratory flow at a first level during a first
portion of each of a plurality of respiratory cycles, wherein the
net inspiratory flow corresponds to provision of both the first
inspiratory gaseous volume and the second inspiratory gaseous
volume using one or more inspiratory flow control mechanisms, and
maintaining net expiratory flow at a second level during the first
portion of each of the plurality of respiratory cycles, wherein the
net expiratory flow corresponds to provision of the pressurized
suction to control the flow of the expiratory gaseous volume using
the one or more expiratory flow control mechanisms.
[0307] Aspect 44. The method of Aspect 43, wherein the first
portion of each of the plurality of respiratory cycles is an
inspiration, and wherein an absolute value of the net inspiratory
flow is greater than an absolute value of the net expiratory
flow.
[0308] Aspect 45. The method of Aspect 43, wherein the first
portion of each of the plurality of respiratory cycles is an
expiration, and wherein an absolute value of the net inspiratory
flow is less than an absolute value of the net expiratory flow.
[0309] Aspect 46. The method of Aspect 43, wherein the first
portion of each of the plurality of respiratory cycles is a hold,
and wherein an absolute value of the net inspiratory flow is equal
to an absolute value of the net expiratory flow.
[0310] Aspect 47. The method of any of Aspects 26 to 46, further
comprising: measuring an intratracheal pressure in a trachea of the
patient using an intratracheal sensor; and provide airflow pressure
using one or more pressurizers based on the intratracheal pressure,
wherein the airflow pressure includes at least one of a first
inspiratory pressure to provide the first inspiratory gaseous
volume to the first portion of the airway via the first inspiratory
lumen, a second inspiratory pressure to provide the second
inspiratory gaseous volume to the second portion of the airway via
the second inspiratory lumen, and an expiratory pressure to
evacuate the expiratory gaseous volume from at least one of the
first portion of the airway and the second portion of the airway
via the one or more expiratory lumens.
[0311] Aspect 48. The method of any of Aspects 26 to 47, wherein
one or more markers are included along at least one of the first
inspiratory lumen, the second inspiratory lumen, and the one or
more expiratory lumens, wherein the one or more markers are at
least one of radiopaque, radioactive, emissive of a magnetic field,
and emissive of one or more electromagnetic signals.
[0312] Aspect 49. The method of any of Aspects 26 to 48, further
comprising: receiving a third inspiratory gaseous volume into a
third inspiratory lumen; providing the third inspiratory gaseous
volume to a third portion of an airway using the third inspiratory
lumen while the third inspiratory lumen is at least partially
inserted into the airway.
[0313] Aspect 50. The method of any of Aspects 26 to 49, further
comprising: filtering airflow at least in part by passing airflow
through one or more one-way airflow valves of a microfilter adapter
and through a microfilter medium of the microfilter adapter,
wherein the airflow includes at least one of the first inspiratory
gaseous volume, the second inspiratory gaseous volume, and the
expiratory gaseous volume.
[0314] Aspect 51: A non-transitory computer-readable medium having
stored thereon instructions that, when executed by one or more
processors, cause the one or more processors to: receive a first
inspiratory gaseous volume into a first inspiratory lumen; provide
the first inspiratory gaseous volume to a first portion of an
airway of a patient using the first inspiratory lumen while the
first inspiratory lumen is at least partially inserted into the
airway; receive a second inspiratory gaseous volume into a second
inspiratory lumen; provide the second inspiratory gaseous volume to
a second portion of the airway use the second inspiratory lumen
while the second inspiratory lumen is at least partially inserted
into the airway; and evacuate an expiratory gaseous volume from the
first portion of the airway and from the second portion of the
airway using one or more expiratory lumens while the one or more
expiratory lumens are at least partially inserted into the
airway.
[0315] Aspect 52: The non-transitory computer-readable medium of
Aspect 51, further comprising any of Aspects 26 to 50.
[0316] Aspect 53: An apparatus for airflow control, the apparatus
comprising: means for receiving a first inspiratory gaseous volume
into a first inspiratory lumen; means for providing the first
inspiratory gaseous volume to a first portion of an airway using
the first inspiratory lumen while the first inspiratory lumen is at
least partially inserted into the airway of a patient; means for
receiving a second inspiratory gaseous volume into a second
inspiratory lumen; means for providing the second inspiratory
gaseous volume to a second portion of the airway using the second
inspiratory lumen while the second inspiratory lumen is at least
partially inserted into the airway; and means for evacuating an
expiratory gaseous volume from the first portion of the airway and
from the second portion of the airway using one or more expiratory
lumens while the one or more expiratory lumens are at least
partially inserted into the airway.
[0317] Aspect 54: The apparatus of Aspect 54, further comprising
means for performing any of the operations of any of Aspects 26 to
50.
* * * * *