U.S. patent number 3,581,742 [Application Number 04/736,173] was granted by the patent office on 1971-06-01 for intermittent positive pressure breathing device.
This patent grant is currently assigned to Medical Services, Incorporated. Invention is credited to Joseph G. Glenn.
United States Patent |
3,581,742 |
Glenn |
June 1, 1971 |
INTERMITTENT POSITIVE PRESSURE BREATHING DEVICE
Abstract
An intermittent positive pressure breathing (IPPB) device
permits variable adjustment of maximum flow rates, terminal flow
rates, and nebulization for patients having various lung
disorders.
Inventors: |
Glenn; Joseph G. (Tulsa,
OK) |
Assignee: |
Medical Services, Incorporated
(Tulsa, OK)
|
Family
ID: |
24958802 |
Appl.
No.: |
04/736,173 |
Filed: |
June 11, 1968 |
Current U.S.
Class: |
128/204.19;
128/204.25 |
Current CPC
Class: |
A61M
16/00 (20130101); A61M 16/127 (20140204); A61M
16/021 (20170801); A61M 16/12 (20130101); A61M
16/0063 (20140204) |
Current International
Class: |
A61M
16/10 (20060101); A61M 16/00 (20060101); A61M
16/12 (20060101); A62b 007/00 () |
Field of
Search: |
;128/28,145.5--145.8,194 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Rosenbaum; Charles F.
Claims
I claim:
1. Apparatus for lung ventilation comprising,
a breathing manifold assembly
a venturi chamber body connected to said assembly having:
an injector nozzle,
a venturi throat,
a venturi chamber behind said throat and around said nozzle, the
position of said nozzle outlet relative to said throat to permit
high initial flow rate, within the range of 25--90 liters/min. to
said assembly,
an intake check valve located in communication with said chamber to
permit flow unidirectionally into said chamber,
a variable size exhaust port to provide communication from the
chamber to the exterior,
means to supply fluid pressure to said nozzle inlet, and
a flow control bypass valve connected to said inlet which, when
closed, forces said fluid into said nozzle.
2. Apparatus according to claim 1 including a relief valve
downstream of said venturi chamber body adapted to open upon a
given pressure created within said lungs.
3. Apparatus of claim 2 wherein said valve provides an audible
signal on opening.
4. Apparatus of claim 3 wherein said valve includes
a valve seat,
a valve, having a magnet therein, seatable upon said seat,
a magnet adjustably situated opposite said valve magnet and
oriented to attract said valve magnet until a given pressure
overcomes said magnetic force to open said valve seat.
5. Apparatus of claim 1 wherein said intake check valve includes
adjustment means to vary the intake flow rate into said
chamber.
6. Apparatus of claim 1 wherein said breathing manifold assembly
includes
a mouthpiece,
a nebulizer separately supplied with a portion of fluid pressure
from said nozzle inlet.
7. Apparatus of claim 1 wherein said apparatus includes a separate
motor driven compressor to supply fluid pressure to said nozzle
inlet.
8. A patient's inhalation therapy method comprising the steps
of:
providing flow of lung acceptable fluid to an inhalation means,
and
phasing said flow to provide, at the output of said means, an
initial inhalation phase in which said flow rate is rapidly
reducing followed by a terminal inhalation phase in which said flow
rate is gradually reducing, said initial phase flow rates and said
terminal phase flow rates being adjustable to preselected values
independently of each other and independent of the desired ultimate
pressure, within said patient's lungs, at the end of said
inhalation.
9. Method of claim 8 wherein the flow rate of said initial phase is
within the range of about 20 to about 100 liters per minute
reducing to said lower value at a given pressure within the range
of 5 to 15 centimeters of water.
10. Method of claim 8 wherein flow rate (F.sub.i) for said initial
inhalation phase follows the approximate formula: F.sub.i
=80.7-3.05p-0.259p.sup.2 ; and said flow rate (F.sub.t) for said
terminal inhalation phase follows the approximate formula: F.sub.t
=46.3-2.621p+0.0417p.sup.2 where p = pressure in cm of water.
Description
BACKGROUND OF THE INVENTION
This invention relates to surgical inhalation apparatus and
processes. Bronchial asthma, chronic bronchitis and obstructive
emphysema are lung disorders caused by a reduction in the caliber
of the airways due to mucus, edema, inflammation, bronchial
collapse, spasm or combinations of these phenomena. The obstruction
to a patient's airflow results in subsequent impairment of
breathing or pulmonary function. Rate of flow within the lung and
associated airway system is primarily a function of the resistance.
As the obstruction becomes more severe a point is reached at which
further increases in pressure cause little increase in flow. The
patient's work to overcome this resistance and to create greater
pressure then begin to create other medical problems including
heart failure.
One category of intermittent positive pressure breathing devices
known do not permit sufficient initial and terminal flow rate
control independently of pressure settings and are therefore
ineffective in reducing the high flow resistances encountered in
severe obstructive lung diseases. These instruments however
increase turbulence resulting in increased pressure and actually
add to the resistance due to the disease itself. As a result in
many instances of use patients are literally short of breath.
A second category of instrument, in an attempt to reduce terminal
inhalation flow, must also reduce initial flow characteristics
causing excessive time to ventilate obstructed lungs.
A yet third category of apparatus is based on changing input
pressure to the device, thus changing initial flow, terminal flow
and nebulizer output.
SUMMARY
Accordingly, this invention has for its primary purpose and object
the overcoming of the problem associated with known prior art
devices and to provide an IPPB device which permits independent
adjustment and control of the inspiratory flow pressure and flow
rates to match the particular degree of an individual patient's
condition. It is believed that normal inhalation comprises a high
flow rate initial phase followed by a lower flow rate terminal
phase. As airway obstructions increase the terminal phase becomes
of greater importance in effective lung ventilation. The apparatus
and process of this invention permits adjustable initial high flow
rates to fill the unobstructed areas of the lung while permitting
adjustable lower flow rates of terminal flow to fill the congested
areas of the lungs. Particularly the invention provides a more
complete filling of the patient's lungs within a relatively short
period and without a great deal of patient work. Further, the
device and the methods of this invention permit adjustment of the
initial and terminal flow rates and rate of nebulization for adding
medicament to the patient's lungs.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an elevational assembly view of the apparatus comprising
this invention.
FIG. 2 is a sectional view taken along the line 2-2 of FIG. 1.
FIG. 3 is a sectional view taken along the line 3-3 of FIG. 1.
FIG. 4 is a sectional view of a modification form of this
invention.
FIG. 5 is a graphic display of the operating characteristics of the
apparatus of this invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring now to FIG. 1 the apparatus of this invention generally
includes a mouthpiece and valve assembly 10, motor-driven
compressor 22 and carrying case housing 20. The latter includes a
motor-driven compressor 22 and an outlet conduit 24. Electrical
power to the motor driven compressor 22 is supplied through
electrical conduit 26. The housing itself includes a lower base
portion 28 to which an upper portion 30 including a carrying handle
32 is attached by means of latches as at 34. The motor-driven
compressor is controlled by toggle switch 36. The mouthpiece and
valve assembly 10 includes a mouthpiece 40, a nebulizer 42 for the
introduction of medicament in a vaporous or a finely divided form,
a relief valve 44 and a main valve control body 46 all of which are
more fully hereinafter described. A bypass air supply conduit 48 is
connected between the air inlet and the nebulizer to drive the
latter by aspiration. All of the parts are assembled in
substantially the sequence shown in FIG. 1 except in those
instances where it is desired to omit the intermediate relief valve
body portion 44 which is hereinafter more fully described.
As shown in FIG. 2, valve body 46 includes an annular flow chamber
50 which terminates at the forward end with a throat 52 into which
a nozzle 54 is placed for incoming air from the compressor inlet
manifold chamber 56. Interconnecting with manifold chamber 56 is
the nozzle flow passage 58 and bypass flow passage 60 and 62 which
are controlled by hand-operated valve 64, causing plunger 66 to go
downward sealing the bypass opening 60. Spring 70 is biased
normally retaining valve 64 upward in bypass condition until
depressed. Additionally, as best shown in FIGS. 1 and 3 the
nebulizer flow conduit 48 is connected to the manifold chamber 56
by passageway 72. An annular flow control check valve body 74
includes a resilient flapper-type valve 76, the dotted lines of
which show the inlet flow position. The check valve is adaptable to
either a fully opened position at the bottom thereof or further
controlled by a cap 78 as best shown in FIG. 3. Adjustment openings
80 and 82 cooperate respectively across slot opening 84 of the
check valve body and hence control the amount of airflow into the
flow chamber 50. Interconnecting with the flow chamber 50 is an
exhaust conduit 86, the opening of which is controllable by
threaded member 88. Forward of the valve body 46 is a relief valve
body portion 44 shown, in this embodiment, attached thereto. This
portion includes opposed upper and lower cylindrical members 90 and
92 respectively. The upper cylindrical member includes an opening
94 in the top thereof and has a valve seat 96 internally. A valve
98 is adapted to seat thereon and has included therewith a magnet
100 oriented as shown. The lower opposite cylinder 92 includes an
adjustable threaded member 102 which at its inner end includes a
magnet 104 aligned in such a way that the innermost pole is
opposite the innermost pole of magnet 100 hence tending to attract
each other and normally maintain the valve 98 seated. An additional
opening 106 may be provided to interconnect with the flow channel
108 of body 44 for the attachment of measuring or calibration
devices or for separate oxygen supply as desired. Otherwise, the
opening 106 is normally plugged or maintained closed.
Referring now to FIG. 4 a modified valve body 110 is adapted for
use with a pure oxygen source to be substituted for body 46. A
nozzle 54 is attached to chamber 112 which interconnects with
vertical passageway 114 and is divided at an inner chamber 116 to
form an upper valve seat 118 and a lower valve seat 120. A
hand-operated valve plunger 122 includes a valve body 124 which is
adapted to seat against either the upper or the lower valve seats
118 and 120. A spring 126 maintains the valve normally in an
exhaust position wherein oxygen, input at manifold 128, passes
through passageway 130 into chamber 116 and thence outward through
the lower part of vertical chamber 114. Upon depressing plunger 122
the oxygen input is directed into the upper portion of chamber 114
into manifold 112 and through nozzle 54.
OPERATION
In operation, a physician, knowing of a particular patient's
breathing needs, capabilities and general physical condition will
calibrate the breathing assembly of this invention. Normally to
accomplish this a test pressure gauge is connected into the port
106, for example, and replace the mouthpiece with a test lung. The
control valve is depressed and the pressure indicator will move up
to the setting of the valve 44 and will drop back to about 10 cm.
pressure. The highest point reached before the indicator starts to
fall is the prescribed pressure setting typically 12 to 20 cm. of
water. If pressure adjustment is required, to suit patient needs
and capabilities, setscrew 102 is turned to increase pressure and
vice versa. Other adjustments can be made as set forth
hereinafter.
Initial flow rate adjustments, with a constant input from the
compressor, occur using the check valve 74. Without the cap
adjustment device shown in FIG. 3 the highest flow rate, usually
about 85 to 90 liters/min., occurs into the patient's airflow
system. Using the cap and placing the ports 80 and 82 opposite the
opening 84 will provide a flow range of from approximately 25 to 70
liters/min. Terminal flow adjustment occurs by opening (reduce
flow) or closing (increase flow) of orifice 86 as setscrew (or
knurled knob) 88.
With the apparatus assembled and calibrated as shown in FIG. 1 the
patient places the mouthpiece 40 into his mouth and makes a tight
seal with the lips. In some instances a nose clip may be necessary
to prevent loss of air through the nose. Upon simultaneous
depression of the plunger 64 of the flow control valve the patient
gently inhales normally through the mouthpiece and allows the lungs
to be filled by slowly expanding his chest to a comfortable degree.
Pressure will begin to build up in the lungs as they are filling
taking about 3 to 5 seconds to reach a safe level prescribed by the
physician. When the prescribed pressure, capable of being accepted
by the patient in his particular condition, has been reached the
relief valve 98 of the valve body 44 will open to allow excess air
entering through the inlet tubing 24 manifold 56 and nozzle 54 to
escape. In many instances when the chest is expanded to a
comfortable degree by the patient and he stops, there is still a
noticeable degree of pressure building within the lungs without any
further work being done by the patient. At this point the patient
may release the flow control plunger or the excess air will be
exhausted through the relief valve body 44. Prior to the operation
the nebulizer may be filled with the exact amount and type of
medication prescribed which also enters the patient's lung cells to
clean, reduce infection and improve ventilation.
In those instances where greater oxygen enrichment or pure oxygen
is to be utilized in the treatment the unit such as that shown in
FIG. 4 is shown wherein the oxygen cylinder outlet or oxygen
pipeline outlet may be connected to passageway 128, the control of
the plunger valve 122 and the rest of the mechanism identical to
that shown in FIG. 2.
In some instances it is possible to utilize the apparatus of this
invention excluding the relief valve portion 44 which includes the
magnetic valve therewith, adding only the nebulizer and mouthpiece
unit directly downstream of the nozzle throat 52. The primary
difference being that such an assembly does not provide an obvious
or audible pressure break or sound from the relief valve to the
patient that the control pressure has been reached. The operation
is similar in that after the plunger 64 is depressed and normal
inhalation the lungs will fill with air (or oxygen). When the chest
is expanded to a comfortable degree there is a noticeable degree of
pressure buildup in the lungs without patient work when there is a
pause for a second or two then the flow control plunger is released
as also the seal with the lips about the mouthpiece then exhaling.
In this embodiment adjustment screw 88 is used to limit
pressure.
Additional modification includes the adaptability of having an
oxygen enrichment in an embodiment and assembly as shown in FIGS. 1
and 2 by directly attaching the input oxygen to port 106 which is
uncovered or unplugged.
The design and theoretical operation of this invention may be
considered with regard to the chart of FIG. 5. The venturi
air-entraining principle to accomplish lung ventilation has been
used heretofore in intermittent positive pressure breathing
apparatus. With such unit a higher rate of flow is permissible at
the start of the inhalation cycle yet will compensate to reduce the
flow rate after the pressure rises in the patient's lungs. The
maximum flow into a patient's lungs will vary over a wide range
generally with a high of 45 to 60 liters/min. This invention
considers the concept that there are two basic flow processes in
the inhalation cycle of a patient. This is the initial flow rate
(I) and the terminal flow rate (T). The use of a venturi nozzle and
a flow intake chamber 50 and check valve inlet 74 alone usually
provides the type of initial flow characteristic desired. However,
there is a loss of control over the terminal flow condition. This
invention permits adjustment of pressure, initial flow and terminal
flow and nebulization which can be varied without affecting each
other. As such the apparatus of this invention uses the venturi
principle to reduce flow initially closing the check or flutter
valve 76 as the pressure rises in the lungs of the patient to about
10 cm. of water pressure. The adjustable orifice exhaust port 86
reduces flow more gradually in the interest of effectively
ventilating the airways of the lungs and delivering medication to
the lung periphery. If in certain situations it is required to
reduce terminal flow still further this is accomplished by
increasing the opening of the exhaust port which is equipped with
either a setscrew 88 or some form of a knurled hand adjustment
knob. In reference to the chart of FIG. 5 that portion shaded and
identified as I is the initial flow rate characteristic which may
be adjusted according to the size of the flutter valve opening or
further adjusted by the relationship of cap 78, openings 80 and 82
relative to the opening 84 of the check valve 74. That is, if
opening 82 for example is the only opening of the check valve there
will be a lower initial flow rate. This flow rate for initial flow
may be designated by the formula: F.sub.i =80.7-3.05p-0.259p.sup.2
where F equals flow rate in liters per minute and p equals pressure
in centimeters of water.
The terminal flow area shaded and designated by the letter T is
further adjusted relative to the opening of the exhaust port 86 and
may be designated by the formula: F=46.3-2.621p+0.0417p.sup.2.
This invention has been described with reference to specific and
preferred embodiments. It will be apparent, however, that other
modifications can be made without departing from the spirit and
scope of the invention. Accordingly, this invention should be
construed not to be limited to the embodiment herein described but
should be limited by the scope of the appended claim with relation
to the existing prior art.
* * * * *