U.S. patent number 3,768,468 [Application Number 05/106,960] was granted by the patent office on 1973-10-30 for ventilators.
This patent grant is currently assigned to The British Oxygen Company Limited. Invention is credited to Lawrence Alfred Cox.
United States Patent |
3,768,468 |
Cox |
October 30, 1973 |
VENTILATORS
Abstract
A lung ventilator in which the volume of respirable gas passing
to the patient per unit time is continuously measured and the flow
stopped, to mark the end of the inspiratory phase and the start of
the expiratory phase, when a chosen volume has passed through the
meter.
Inventors: |
Cox; Lawrence Alfred (North
Weald, EN) |
Assignee: |
The British Oxygen Company
Limited (London, EN)
|
Family
ID: |
9748884 |
Appl.
No.: |
05/106,960 |
Filed: |
January 18, 1971 |
Foreign Application Priority Data
|
|
|
|
|
Jan 21, 1970 [UK] |
|
|
2938/70 |
|
Current U.S.
Class: |
128/204.21;
137/908 |
Current CPC
Class: |
A61B
5/091 (20130101); A61B 5/7242 (20130101); A61M
16/024 (20170801); A61M 16/0051 (20130101); A61B
2560/0276 (20130101); Y10S 137/908 (20130101) |
Current International
Class: |
A61B
5/091 (20060101); A61B 5/08 (20060101); A61M
16/00 (20060101); A61m 016/00 () |
Field of
Search: |
;128/145.8,142-142.3,142.4,145R,145.5,145.6,145.7,188,DIG.17
;137/68R |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Dunne; G. F.
Claims
I claim:
1. A lung ventilator adapted to control the volume of respirable
gas supplied to a patient irrespective of the duration of the
inspiratory phase of the patient's respiratory cycle, of the
patient's airway pressure, or of variations in the rate at which
gas flows to the patient, including an inhalation passageway
connected at one end to a supply of pressurized respirable gas, and
at the other end to the patient; an exhalation passageway connected
to the patient; a gas flow control valve in said inhalation
passageway; a gas flow sensitive transducer in said inhalation
passageway and said exhalation passageway adapted to generate
signals of which the frequency is proportional to the gas flow
rate; means integrating said flow rate signals to produce a signal
which is a measure of the volume of gas flowing therethrough; means
for closing the said valve when the said integrated signal from
said gas flow sensitive transducer in said inhalation passageway
reaches a chosen value, and means for reopening the valve and
rendering the transducer effective at the beginning of the next
inspiratory phase.
2. A lung ventilator as claimed in claim 1, including a
two-position, multiple-port valve movable between a `manual` and an
`automatic` position, the valve having two of its ports connected
to the inspiration and expiration passageways of the ventilator,
two ports adapted to be connected to a patient, and the remaining
port or ports adapted to be connected to a manual rebreathing
device.
3. A lung ventilator as claimed in claim 2, in which the said
multiple-port valve is connected to means for displacing it into
the manual position when the pressure of oxygen or other selected
gas supplied to the ventilator falls below a chosen minimum
value.
4. A lung ventilator as claimed in claim 1, in which the signals
corresponding to the inspiratory volume flow are fed to an
integrator of which the output is fed to a comparator for
comparison with like signals corresponding to the desired volume
flow, equalisation of the two signals being effective to cause the
comparator to generate a changeover signal stopping the inspiratory
flow and allowing the expiratory flow to start.
5. A lung ventilator as claimed in claim 4, in which the outlet of
the comparator is connected to a device controlling both a valve in
the inspiratory flow passageway and an auxiliary valve controlling
the position of a valve in the expiratory flow passageway.
6. A lung ventilator as claimed in claim 4, in which operation of
the control device is adapted to start a timer when the comparator
generates the said changeover signal and which, after a chosen time
has elapsed, causes the comparator to be reset and the inspiratory
valve to be opened.
7. A lung ventilator as claimed in claim 1, including a minute
volume indicator connected to said exhalation integrating
means.
8. A lung ventilator as claimed in claim 7, in which connected to
the minute volume indicator is an alarm device adapted to operate
when the minute volume goes beyond chosen minimum and maximum
values.
9. A lung ventilator as claimed in claim 4, including a tidal
volume indicator connected to the inspiratory flow integrator.
10. A lung ventilator as claimed in claim 1, in which couplied to
the inspiratory flow passageway is a meter for indicating the
oxygen content of the gas supplied to the outlet of the ventilator.
Description
This invention relates to ventilators, and particularly to lung
ventilators, which are devices intended to be connected to a
patient's airway and designed to augment or replace the patient's
ventilation automatically.
The present invention aims at providing a lung ventilator in which
the volume of gas supplied to the patient during each inspiratory
phase of the respiratory cycle can be chosen and adjusted,
irrespective of any variations in the rate of flow of gas to the
patient.
By `gas` in this specification is usually meant a mixture of gases,
although there might be occasions in practice in which a pure gas,
such as oxygen, might be used.
Accordingly the present invention provides a lung ventilator which
is as claimed in the appended claims.
The present invention will now be described by way of example with
reference to the accompanying drawing, which is a schema of one
form of lung ventilator of the present invention.
There are three main types of lung ventilators: volume-cycled,
time-cycled and pressure-cycled. Of these the volume-cycled
ventilator is the type preferred for long-term ventilation, as is
used in intensive care units. However, despite its popularity, the
volume-cycled ventilator has disadvantages.
The main advantage claimed for volume cycling is that the
ventilator will continue to deliver a chosen volume of gas
regardless of changes in compliance of the patient or resistance of
the airways. However this is only partly true, in that the actual
volume of gas may be less, sometimes considerably so, than the
volume which the ventilator indicates as having been supplied to
the patient. This discrepancy may be caused by leaks in the various
connections and by incorrectly set safety valves or other
components.
Conventional volume-cycled ventilators normally use a fixed-volume
device, such as bellows or a piston. With these ventilators, the
pattern of inspiratory flow is generally fixed, or is adjustable
only to a very limited extent. In other words, the limitations
imposed by bellows or a piston (with their associated driving
mechanisms) restricts the user's ability to alter the flow pattern
at will, even though the inspiration/expiration ratio can usually
be varied. It is well known that the inspiratory and expiratory
flow pattern in mechanical ventilation can affect the efficiency of
pulmonary gas exchange, even though the optimum ventilatory flow
pattern has yet to be defined. Thus the ability to be able to vary
the rate of flow throughout the inspiratory phase of the
respiratory cycle, and at the same time to choose the volume to be
cycled, would be a considerable advantage, which is offered by
apparatus of the present invention.
This includes a mixer 2 to which is connected separate pipe lines
for supplying oxygen and air or any other combination of respirable
gases. The desired gas mixture passes from the mixer 2 to a device
4 which determines the flow pattern. For example, it may be
desirable to maintain a constant flow rate throughout the
inspiratory phase. Alternatively it may be desirable for the flow
rate to be initially quite high, decreasing after a time to a
chosen rate which continues until the end of that inspiratory phase
of the respiratory cycle. Other flow patterns may also be required.
For convenience, the gas leaving the pattern generator 4 is shown
as passing to a separate device 6 for controlling the flow,
although in practice the devices 4 and 6 could be combined into a
single device determining both the flow rate and the flow pattern.
The gas then passes through a valve 8 which is biassed to be open
during the inspiratory phase, the valve 8 being controlled by a
device 10.
The gas next passes to a sensor 12, which is preferably of the type
which develops a signal, preferably electrical of which the
frequency is proportional to the gas flow rate, each time a unit
volume of gas has passed through the sensor. The signals pass to an
integrator or pulse counter 14.
On its way to a valve 16 samples of the gas may be passed into an
analyser 18 adapted to display the percentage of oxygen in the gas
flowing along the airway 20. This indicator acts as a check on the
correct operation of the mixer 2.
The valve 16 is preferably of the two-position, five-port type
although other multi-port valves could be used. Two of the ports go
to the patient (not shown); one of the ports is in communication
with the airway 20; another is in communication with an exhaust
line 22, and the fifth in communication with a manual rebreathing
device 24. Gas expired by the patient and passing up the line 22
flows through a second sensor 26 which, similarly to sensor 12,
passes to a second integrator or pulse counter 27 signals
indicative of the volumetric flow through it.
Gas leaving sensor 26 passes through an expiratory valve 28 which
is controlled by the pressure of gas in a control line 30, the
valve acting as a lightly loaded non-return valve when the pressure
in line 30 is below a chosen value, and being forcibly closed to
prevent further exhalation when the pressure is above this
value.
The pressure in control line 30 is derived from the main airway 20,
and an extension 32 of the control line also passes to the valve 16
to bias it to the position in which the valve is in its `automatic`
position. The valve 16 is movable manually or automatically from
this position to the `manual` position in which the device 24 is
able to supply gas to the patient, with airway 20 being blocked.
Although this is not shown in the drawing, or described in great
detail in the specification, the ventilator may be designed so that
upon failure of the oxygen supplied to the mixer 2, the valve 16 is
automatically switched over to its `manual` position and an alarm
signal generated to alert an operator of the ventilator to the fact
that it is operating in the manual mode. However the means by which
this can be effected do not form part of the subject-matter of this
application and so will not be described herein in greater
detail.
Inserted in the control line 30 is a valve 34 also controlled by
device 10. The change in pressure in line 30, as a result of
actuation of valve 34, is used to operate a pressure-sensitive
switch 39 connected to a timer 40.
The integrator 14 supplies a signal, indicative of the volume
passing through the sensor 12, to a comparator 36, which receives a
similar signal from a preset volume signal generator 38 which the
operator can adjust. The comparator 36 supplies an output signal to
the control device 10, and is arranged to supply this signal when
the measured volume of gas passing through the sensor 12 is equal
to the volume preset by device 38.
Operation of control device 10 is arranged to cause switch 39 to
supply a signal to an expiratory timer 40 which then supplies a
signal resetting the comparator 36 and the valve 8 when a chosen
time interval has elapsed since operation of the control device
10.
The integrator 14 is also connected to a voltmeter 46 operating as
a tidal volume indicator. During the inspiratory phase of the
breathing cycle the integrator 14 increments the reading of
voltmeter 46, which reading remains static during the ensuing
expiratory phase. At the changeover to the next inspiratory phase
the integrator 14 and the meter 46 are reset to zero (by means
which is not shown).
The integrator 27 is similarly connected to a second voltmeter 42
acting as a minute volume indicator, which is connected in turn to
an alarm device 44. The charge sensed at the appropriate terminal
of meter 42 is continually discharged through a leak resistor (not
shown). The meter 42 thus settles at a reading determined by the
constant leak being balanced (somewhat inexactly) by the pulsiform
additions from integrator 27, the meter being damped appropriately.
This reading is a measure of the minute volume. Too low a reading,
caused as by the patient ceasing to breathe, or the supply of gas
falling excessively or ceasing, causes the alarm 44 to be
triggered. This happens also when the reading becomes excessive,
indicating over-ventilation of the patient.
For convenience, all the components of the ventilator are
preferably enclosed in a common housing from which project the ends
of the various conduits and airways, and also the control knobs for
the adjustable components. The faces of the minute volume indicator
and tidal volume indicator are also visible to the operator, so
that he has all the necessary indications of the working of the
ventilator without being concerned about its internal
arrangements.
The ventilator operates as follows:
The mixer 2 supplies to the pattern generator 4 gas having a chosen
amount of oxygen. This may range in steps from about 20 percent
oxygen to 100 percent oxygen. The pattern generator may provide for
continuous adjustment of the flow rate pattern or it may similarly
be able to provide any one of a discrete number of patterns.
Similarly the flow rate device may provide for any one of, say, six
different flow rates to be provided, spanning the range, say, from
10 to 70 litres per minute, although conceivably this could be
adjustable continuously over the same range or any other range
considered desirable.
During the inspiratory phase the valve 8 is biassed open, as by a
solenoid in device 10 operating both valves 8 and 34, as indicated
by the broken line 48. When in the `automatic` mode, the gas
passing through the valve 8 flows directly through the sensor 12
and the respective passages in the valve 16.
During this phase, the valve 28 is biassed closed by the pressure
in control line 30, so that no flow passes from the patient through
the sensor 26.
When the signals from the integrator 14 indicate that the volume of
gas which has passed through the sensor 12 is equal to the desired
volume, then the comparator 36 generates a signal to vary the
position of the control device 10. This device 10 is then effective
to close the valve 8 and simultaneously open the valve 34, so that
the pressure of the gas in line 30 decreases and allows the
expiratory valve 28 to open to permit the patient to expire. This
pressure rise operates switch 39 and starts the expiratory timer 40
to set the length of the expiratory phase of the respiratory cycle.
When this preset time has lapsed, the timer 40 supplies a signal to
the comparator to reset it. The control device 10 is also reset,
causing the expiratory valve to be closed and the inspiratory valve
8 to be opened, so that the next respiratory cycle is started.
It will be appreciated that the essential components of the
ventilator which give it the desired and novel degree of
flexibility are the sensor 12; the integrator 14 for measuring the
volume of gas supplied to the patient; the comparator 36; the
volume control 38, and the control device 10 and its associated
valve 8 in the airway to the patient.
As has been mentioned briefly above, in the event of failure of
electrical supplies or pressure of the gas supplied to the
ventilator, the valve 16 is arranged to be switched automatically
to its `manual ` mode. The device 24 may be a rebreathing bag, or
self-filling bellows or equivalent device, by means of which the
patient may be inflated manually and allowed to expire naturally,
as is well-known.
It is usual in lung ventilators to incorporate a safety valve to
control the pressure of gas in the system to ensure that the
patient is not over-inflated should part of the ventilator
malfunction. The safety valve is not shown in the drawing, for
clarity, but it would normally be positioned upstream of the sensor
12 so that any gas passing to the atmosphere through the safety
valve would not be registered falsely as gas supplied to the
patient.
It will thus be seen that the present invention provides a lung
ventilator in which the flow of gas to the patient may be adjusted
to have a desired pattern during each inspiratory phase, while the
tidal volume can be preset to a chosen amount irrespective of any
variations in the flow rate or pattern.
The manner in which many components of the illustrated system are
actuated has been shown only by way of example. Thus some of the
pneumatically operated or biassed components could be actuated
mechanically or electromechanically while still being in accordance
with the invention.
* * * * *