U.S. patent number 3,789,837 [Application Number 05/097,279] was granted by the patent office on 1974-02-05 for automatic therapeutic ventilator.
Invention is credited to Jack Anthony Liddall, Walter John Philips.
United States Patent |
3,789,837 |
Philips , et al. |
February 5, 1974 |
AUTOMATIC THERAPEUTIC VENTILATOR
Abstract
An automatic therapeutic ventilator having an oxygen bellows for
receiving and measuring a volume of oxygen and a breathing mixture
bellows for mixing the oxygen with air in a predetermined ratio.
Pneumatic and electrical control circuits are provided for
automatic, semi-automatic, and patient-triggered modes, and a sigh
circuit is incorporated in the control circuits. The bellows are
mounted on trays which can be replaced simply.
Inventors: |
Philips; Walter John (Don
Mills, Ontario, CA), Liddall; Jack Anthony (Port
Credit, Ontario, CA) |
Family
ID: |
22262597 |
Appl.
No.: |
05/097,279 |
Filed: |
December 11, 1970 |
Current U.S.
Class: |
128/202.22;
128/203.26; 128/205.15; 128/205.16; 137/565.33 |
Current CPC
Class: |
A61M
16/022 (20170801); A61M 16/16 (20130101); A61M
16/205 (20140204); A61M 16/0081 (20140204); A61M
16/206 (20140204); A61M 16/202 (20140204); A61M
16/204 (20140204); A61M 16/12 (20130101); A61M
16/00 (20130101); A61M 16/0051 (20130101); Y10T
137/86163 (20150401); A61M 16/186 (20130101); A61M
16/107 (20140204); A61M 16/0858 (20140204); A61M
16/0833 (20140204); A61M 16/0075 (20130101) |
Current International
Class: |
A61M
16/00 (20060101); A61M 16/16 (20060101); A61M
16/10 (20060101); A61M 16/12 (20060101); A61M
16/18 (20060101); A61m 016/00 () |
Field of
Search: |
;128/145.6,145.8,188,145.5 ;137/566,624.14,624.15 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Dunne; G. F.
Attorney, Agent or Firm: Rogers, Bereskin & Parr
Claims
1. A therapeutic ventilator adapted to be connected to a patient
adaptor means operable to convey a breathing mixture to a patient,
said ventilator comprising:
support means;
an oxygen bellows coupled to the support means for receiving a
predetermined volume of oxygen under pressure during an inhalation
period;
a breathing mixture bellows coupled to the support means and to the
oxygen bellows for receiving said volume of oxygen during an
exhalation period;
air valve means operable to permit air to enter the breathing
mixture bellows contemporaneously with the oxygen so that said air
and oxygen are mixed in a predetermined volumetric ratio thereby
creating a breathing mixture;
oxygen control valve means operably coupled to the oxygen bellows
to permit said pressurized oxygen to flow into the oxygen bellows
during an inhalation period until the oxygen bellows contains said
predetermined volume, and to permit said volume of oxygen to flow
from said oxygen bellows into said breathing mixture bellows during
said exhalation period; and
control means coupled to said oxygen control valve means and
operable to open said breathing mixture bellows during said
exhalation period whereby said predetermined volume of oxygen and
air are drawn into said breathing mixture bellows until a
predetermined volume of breathing mixture is contained in the
breathing mixture bellows such that the air and oxygen are in said
predetermined ratio and also operable to collapse said breathing
mixture bellows during said inhalation period whereby substantially
all of said predetermined volume of breathing mixture is
2. A therapeutic ventilator as claimed in claim 1 in which said
oxygen control valve means comprises: a flap valve operable
automatically to open under the force of the pressurized oxygen to
permit the oxygen to flow into the oxygen bellows during the
inhalation period, and to close upon removing the oxygen pressure
from the valve means thereby preventing
3. A therapeutic ventilator as claimed in claim 1 in which said
oxygen control valve means comprises a valve seat and a diaphragm,
said diaphragm having a flexible portion for engaging against said
valve seat under the influence of the pressurized oxygen to prevent
flow of oxygen from said oxygen bellows into said breathing mixture
bellows during the inhalation period, and said flexible portion
moving off said valve seat upon removing the oxygen pressure from
the valve means so that oxygen flows from the oxygen bellows into
the breathing mixture bellows during the exhalation
4. A therapeutic ventilator as claimed in claim 1 and further
comprising an adjustable flow valve operable to control the rate of
flow of pressurized oxygen into said oxygen bellows during said
inhalation period so that said predetermined volume of oxygen may
be varied according to the volume of oxygen required to prepare
said predetermined volume of breathing mixture.
5. A therapeutic ventilator as claimed in claim 1 and further
comprising: an oxygen weight coupled to said oxygen bellows for
collapsing said bellows so that the oxygen bellows is normally in a
collapsed condition; and a breathing mixture weight coupled to the
breathing mixture bellows for opening the breathing mixture bellows
so that the breathing mixture
6. A therapeutic ventilator as claimed in claim 1 wherein said
control means comprises: a casing containing the breathing mixture
bellows; and valve means operable to permit compressed air and the
like to enter the casing about the breathing mixture bellows for
collapsing the bellows
7. A therapeutic ventilator as claimed in claim 6 in which the
control means further comprises: an adjustable flow valve operable
to permit compressed air to collapse the breathing mixture bellows
during the inhalation period until said predetermined volume of
breathing mixture has
8. A therapeutic ventilator as claimed in claim 7 and further
comprising an adjustable flow valve operable control the rate of
flow of pressurized oxygen into said oxygen bellows during said
inhalation period so that said volume of oxygen may be varied as
required to prepare said predetermined
9. A therapeutic ventilator as claimed in claim 8 and further
comprising an oxygen supply valve operable to cut off the supply of
pressurized oxygen during the exhalation period; and a compressed
air supply valve operable to cut off the supply of compressed air
during the exhalation period, the
10. A therapeutic ventilator as claimed in claim 9 and further
comprising electrical control means; and wherein the oxygen and
compressed air supply valves are solenoid operated, the supply
valves being electrically coupled to the electrical control means
for closing the supply valves during the
11. A therapeutic ventilator as claimed in claim 10 in which the
electrical control means comprises: an inhalation timer having a
first potentiometer variable for adjusting the inhalation period;
and an exhalation timer having second and third potentiometers in
series and variable for selectively adjusting the exhalation
period, the first and second potentiometers being ganged to operate
in unison and having substantially similar effects upon respective
inhalation and exhalation timers such that with the third
potentiometer set at zero resistance the inhalation and exhalation
periods are substantially equal for all positions of the first and
second potentiometers and such that introduction of the third
potentiometer resistance increases the exhalation period whereby
the
12. A therapeutic ventilator as claimed in claim 1 in which the
control means comprises a casing about the breathing mixture
bellows for receiving
13. A therapeutic ventilator as claimed in claim 12 and further
comprising: an electrical control circuit including a cycle timer
circuit; a solenoid operated oxygen supply valve operable to cut
off the supply of oxygen during the exhalation period; and a
solenoid operated compressed air supply valve operable to cut off
the supply of compressed air to the casing during the exhalation
period, the solenoid operated valves being coupled electrically to
the cycle timer circuit for contemporaneous
14. A therapeutic ventilator as claimed in claim 12 and further
comprising: an oxygen supply valve operable to cut off the supply
of oxygen during the exhalation period; a compressed air supply
valve operable to cut off the supply of compressed air during the
exhalation period; and control means operable to maintain the
supply valves open during the inhalation period and to maintain the
supply valves closed during the exhalation period.
15. A therapeutic ventilator as claimed in claim 12 and further
comprising: an adjustable flow valve operable to control the rate
of flow of pressurized oxygen into said oxygen bellows during said
inhalation period so that said volume of oxygen may be varied as
required to prepare said predetermined volume of breathing mixture
and in which the control means further comprises: an adjustable
flow valve operable to permit compressed air to collapse the
breathing mixture bellows during the inhalation period until said
predetermined volume of breathing mixture has been forced out
16. A therapeutic ventilator as claimed in claim 1 and further
comprising means providing a sigh periodically and including means
operable to adjust the period between sighs, said sigh means being
coupled to said control means to further collapse said breathing
mixture bellows without increasing said inhalation so that the
patient receives a greater volume
17. A therapeutic ventilator as claimed in claim 1 and further
comprising means providing a sigh periodically and including means
operable to adjust the period of the sigh, said sigh means being
coupled to the control means to lengthen an inhalation period so
that the patient receives a greater
18. A therapeutic ventilator as claimed in claim 13 in which the
electrical control circuit further comprises a sigh control circuit
and a sigh bypass pipe having a solenoid operated sigh supply
valve, the bypass pipe extending about said compressed air supply
valve so that with the sigh supply valve and the compressed air
supply valve open the flow of compressed air to the casing is
increased during the inhalation period, said sigh control circuit
including adjustable timer means for setting the period of the sigh
and for operating said sigh supply valve contemporaneously with
said compressed air supply valve once every sigh period, the sigh
period being substantially greater than the sum of the
19. A therapeutic ventilator as claimed in claim 13 in which the
electrical control circuit further comprises a sigh control circuit
coupled to the cycle timer circuit and adapted to periodically
increase the inhalation period, the sigh control circuit being
adjustable for varying the sigh period and for varying the time by
which the inhalation period is increased so that the patient
receives an increased volume of breathing mixture during a sigh
inhalation and the oxygen bellows receives a proportionately larger
volume of oxygen whereby the percentage volume of
20. A therapeutic ventilator as claimed in claim 18 and further
comprising: an oxygen flow valve operable to adjustably set the
rate of flow of oxygen through the oxygen supply valve; a
compressed air flow valve operable to adjustably set the rate of
flow of compressed air through the compressed air supply valve; and
a sigh flow valve operable to adjustably set the
21. A therapeutic ventilator as claimed in claim 19 and further
comprising flow valves operable to adjustably set the rate of flow
of oxygen through the oxygen supply valve, and operable to
adjustably set the rate of flow
22. A therapeutic ventilator as claimed in claim 1 and further
comprising: a humidifier coupled to the breathing mixture bellows
for receiving breathing mixture and adapted to add moisture to the
breathing mixture
23. A therapeutic ventilator as claimed in claim 1 and further
comprising a breathing control valve assembly operable to permit
breathing mixture to be forced to the patient during the inhalation
period and to permit exhaled breath to flow from the patient to an
outlet during the exhalation period, the breathing control valve
assembly comprising: a flap valve operable automatically to open
under the force of the breathing mixture to permit the breathing
mixture to flow to the patient, and to close after the inhalation
period thereby preventing return flow of exhaled breath from the
patient into the breathing mixture bellows; a valve seat; a
diaphragm having a flexible portion for engaging against the valve
seat to prevent flow of breathing mixture into said outlet; and a
control pipe coupling the breathing control valve to said supply of
compressed air for forcing said flexible portion onto said valve
seat during said inhalation
24. A therapeutic ventilator as claimed in claim 23 and further
comprising an orifice assembly coupled to said control pipe for
bleeding off compressed air from said control pipe after said
inhalation period so that the pressure in said control pipe drops
and said flexible portion moves off said valve seat to permit
exhaled breath to leave through said outlet during the exhalation
period, said orifice assembly being adjustable so that the rate of
bleeding can be varied to ensure that the flexible portion moves
away from the valve seat such that the patient's lungs are full of
breathing mixture for an adjustable fraction of the exhalation
25. A therapeutic ventilator as claimed in claim 1 and further
comprising: a spirometer adapted to receive exhaled breath during
the exhalation period and including a poppet valve operable to
permit the exhaled breath to be vented from the spirometer during
the inhalation period; and a control pipe coupling the poppet valve
to the compressed air supply for
26. A therapeutic ventilator as claimed in claim 12 and further
comprising an electrical control circuit adapted to shut off the
flow of oxygen and compressed air contemporaneously during the
exhalation period, the electrical control circuit including a
pressure control circuit adapted to respond to a low pressure
created by the patient's efforts to breathe whereby an inhalation
period begins and adapted to respond to a selected high pressure
when the patient's lungs are full of breathing mixture
27. A therapeutic ventilator as claimed in claim 12 and further
comprising an electrical control circuit adapted to shut off the
flow of oxygen and compressed air contemporaneously during the
exhalation period, the electrical control circuit including a
pressure control circuit and a cycle timer circuit, the cycle timer
circuit automatically controlling the timing of the inhalation and
exhalation periods unless the patient attempts to inhale before the
completion of an exhalation period, said pressure control circuit
being adapted to respond to a reduced pressure created by the
patient's attempt to inhale whereupon an inhalation period is
commenced and the cycle timer begins to time a new inhalation
and
28. A therapeutic ventilator as claimed in claim 27 and further
comprising a low pressure alarm adapted to operate should the
pressure in a tube feeding breathing mixture to the patient fall
below a minimum pressure for
29. A therapeutic ventilator for forcing a breathing mixture into a
patient's lungs during an inhalation period and for permitting the
patient to expel exhaled breath during an exhalation period, the
ventilator comprising: a pair of end members defining first and
second pairs of spaced-apart and parallel grooves, each pair of
grooves extending longitudinally of the ventilator; a breathing
mixture tray slidable in said first pair of grooves; a breathing
mixture bellows releasably coupled to said tray; a connecting
conduit coupled to said tray and adapted to receive breathing
mixture from the bellows and having a connecting end remote from
the bellows; a humidifier tray slidable in said second pair of
grooves; a humidifier coupled to said humidifier tray; a humidifier
conduit coupled to the humidifier tray and adapted to receive
breathing mixture from the connecting conduit and to direct said
breathing mixture into the humidifier; and a coupling means
attached to an end of said humidifier conduit remote from said
humidifier and adapted to slidably receive said connecting end of
the connecting conduit whereby the connecting conduit is
pneumatically sealed to the humidifier conduit, said conduits being
positioned on respective trays such that upon sliding the trays
toward one another in the respective pairs of grooves, said
30. A therapeutic ventilator for forcing a breathing mixture into a
patient's lungs during an inhalation period and for permitting the
patient to expel exhaled breath during an exhalation period, the
ventilator comprising: a pair of end members defining first and
second pairs of spaced-apart and parallel grooves, the second pair
of grooves being above the first pair and parallel therewith; a
breathing mixture tray slidable in said first pair of grooves; a
breathing mixture bellows releasably coupled to said tray; an
oxygen output conduit coupled to said tray and adapted to receive
oxygen from the bellows and having a connecting end remote from the
bellows: an oxygen tray slidable in said second pair of grooves; an
oxygen bellows releasably coupled to the oxygen tray; an
intermediate oxygen conduit coupled to the oxygen tray and adapted
to carry oxygen to and from the oxygen bellows, the intermediate
oxygen conduit having a connecting end remote from the oxygen
bellows; an oxygen control valve assembly coupled to the end
members and including means for sealably engaging said connecting
ends upon sliding said trays in respective pairs of grooves, the
valve assembly including valve means for permitting flow from an
oxygen supply into said intermediate oxygen conduit during the
inhalation period to expand said oxygen bellows, and further valve
means responsive to the pressure of the oxygen supply for opening
automatically after a predetermined reduction of said pressure to
direct oxygen from the intermediate oxygen conduit into the oxygen
output conduit and hence into the breathing mixture bellows during
the exhalation
31. A therapeutic ventilator as claimed in claim 30 in which the
end members define a third pair of spaced-apart parallel grooves,
said pairs of grooves extending longitudinally and said third pair
of grooves being spaced longitudinally from said first and second
pairs of grooves, the ventilator further comprising: a connecting
conduit coupled to said breathing mixture tray and adapted to
receive breathing mixture from the breathing mixture bellows and
having a connecting end remote from the bellows; a humidifier tray
slidable in said third pair of grooves; a humidifier coupled to
said humidifier tray; a humidifier conduit coupled to the
humidifier tray and adapted to receive breathing mixture from the
connecting conduit and to direct said breathing mixture into the
humidifier; and a coupling means attached to an end of said
humidifier conduit remote from said humidifier and adapted to
slidably receive said connecting end of the connecting conduit
whereby the connecting conduit is pneumatically sealed to the
humidifier conduit, said connecting conduit and said humidifier
conduit being positioned on respective trays such that upon sliding
the humidifier tray and the breathing mixture trays towards one
another in the respective pairs of grooves, said connecting end of
the
32. A therapeutic ventilator as claimed in claim 31 in which the
end members further define a fourth pair of spaced apart and
parallel grooves positioned above said third pair of grooves, said
ventilator further comprising: a spirometer tray slidable in said
fourth pair of grooves; and a spirometer coupled to the spirometer
tray and adapted to receive a
33. A therapeutic ventilator as claimed in claim 32 and further
comprising: a humidifier outlet conduit coupled to the humidifier
tray and adpated to receive humidified breathing mixture from the
humidifier, the outlet conduit having an outer end remote from the
humidifier; a connecting tube coupled to the spirometer tray and
adapted to lead exhaled breath into the spirometer, the connecting
tube having an outer end remote from the spirometer, said outer
ends extending in spaced-apart and parallel relation when the
spirometer tray and the humidifier tray are engaged in respective
pairs of grooves; and a breathing control valve adapted to
selectively provide passage for humidified breathing mixture from
the humidifier outlet conduit to the patient and to provide passage
for exhaled breath from the patient to the connecting tube, the
breathing control valve being a push fit over the said outer ends
and including
34. A therapeutic ventilator for forcing a breathing mixture into a
patient's lungs during inhalation period and for permitting the
patient to expel exhaled breath during an exhalation period, the
ventilator comprising: a pair of supporting end members; a
breathing mixture tray adapted to be movably mounted between the
end members for assembly between and removal from the end members;
a breathing mixture bellows releasably coupled to said tray; an
oxygen conduit coupled to said tray and adapted to feed oxygen into
the bellows, and having a connecting end; an oxygen tray adapted to
be movably mounted between the end members for assembly between and
removal from the end members; an oxygen bellows releasably coupled
to the oxygen tray; an intermediate oxygen conduit coupled to the
oxygen tray and adapted to carry oxygen from the oxygen bellows,
the intermediate oxygen conduit having a connecting end; an oxygen
control valve assembly fixedly coupled to the end members and
including means for sealably engaging said connecting ends upon
moving said trays into predetermined positions between the end
members, the valve assembly including valve means to direct oxygen
from the intermediate oxygen
35. A therapeutic ventilator as claimed in claim 34 and further
comprising: a connecting conduit coupled to said breathing mixture
tray and adapted to receive breathing mixture from the breathing
mixture bellows; a humidifier tray adapted to be movably mounted
between the end members for assembly between and removal from the
end members; a humidifier coupled to said humidifier tray; a
humidifier conduit coupled to the humidifier tray and adapted to
receive breathing mixture from the connecting conduit and to direct
said breathing mixture into the humidifier; and a coupling means
attached to at least one of the connecting conduit and the
humidifier conduit whereby the connecting conduit is pneumatically
sealed to the humidifier conduit upon moving the humidifier tray
and the breathing
36. A therapeutic ventilator as claimed in claim 35 and further
comprising: a spirometer tray adapted to be movably mounted between
the end members for assembly between and removal from the end
members; and a spirometer coupled to the spirometer tray and
adapted to receive a patient's exhaled
37. A therapeutic ventilator as claimed in claim 36 and which on
assembly in the end members, the oxygen tray is above the breathing
mixture tray, the spirometer tray is above the humidifier tray, and
the humidifier tray and spirometer trays are spaced horizontally
respectively from the breathing mixture tray and the oxygen tray.
Description
This invention relates to a therapeutic ventilator for
automatically forcing a humidified breathing mixture into a
patient's lungs during an inhalation period, and for then
permitting the lungs to exhale into a spirometer during an
exhalation period preparatory to the commencement of a new
inhalation period.
Various lung conditions and associated health problems cause
difficulty in breathing, and in extreme cases breathing can cease
unless the patient is ventilated artificially. Ventilators are
available for effectively taking over the breathing function of a
patient and forcing breathing mixture into his lungs to ensure an
adequate supply of oxygen. The ventilators should be capable of
three modes of operation, namely: fully automatic operation for
ventilating patients who have ceased breathing for themselves;
semi-automatic operation for assisting patients who are breathing
intermittently and weakly; and a patient triggered operation in
which mode the ventilator responds to attempts made by the patient
to breathe for himself. The breathing mixture is usually
oxygen-enriched air which is passed through a humidifier to pick up
moisture so that when the breathing mixture is forced into the
patient's lungs, the moisture ensures that mucus and tissue in the
patient's breathing system is not dried out. After each inhalation
period, the patient's lungs are allowed to collapse so that exhaled
breath passes back to a spirometer in the ventilator and the cycle
is then repeated.
There are many types of ventilators available. However, present
ventilators tend to be relatively large, unwieldy and expensive,
have many delicate parts for metering oxygen and air, and the
circuit carrying the breathing mixture is inaccessible and not
readily removed for autoclaving.
In one of its aspects, the present invention provides a relatively
small, simple and compact automatic therapeutic ventilator which is
readily dismantled and affords a visual inspection of its
operation. Oxygen is fed into a bellows which is expanded until a
predetermined volume of oxygen is collected. This oxygen is then
passed from the oxygen bellows into a further bellows which
collects the oxygen and contemporaneously inspires a predetermined
volume of air so that the air and oxygen mix thereby creating a
breathing mixture. A casing around the bellows is filled with
compressed air to collapse the bellows and force the breathing
mixture through a humidifier to the patient. The breathing mixture
bellows and oxygen bellows are visible to the operator so that he
has an immediate visible indication of the operation of the
ventilator as well as an indication of the relative volumes of
oxygen and air in the breathing mixture.
In a second of its aspects, the present invention provides a
ventilator having a breathing mixture bellows and humidifier
arranged so that trays carrying the bellows and the humidifier can
be slidably removed for autoclaving thereby removing completely the
circuit between the patient and the air intake.
In a third of its aspects, the invention provides an automatic
therapeutic ventilator in which the flow of oxygen into and out of
the oxygen bellows is controlled by the pressure of the oxygen; the
flow of compressed air for compressing the breathing mixture
bellows, the flow of exhaled breath out of a spirometer, the flow
of breathing mixture from the humidifier to the patient, and the
return flow of exhaled breath from the patient to the spirometer
are controlled automatically by compressed aIr pressure.
In a fourth of its aspects, the present invention provides an
automatic therapeutic ventilator having adjustable electrical
timers for controlling inhalation and exhalation periods such that
the exhalation period is substantially equal to or greater than the
inhalation period.
According to one further aspect of the invention a sigh circuit is
provided for automatically and periodically increasing the volume
of breathing mixture fed to the patient during a breathing cycle,
the sigh circuit being arranged to increase the inhalation period
so that the oxygen to air ratio in the breathing mixture remains
substantially constant before, during and after the sigh cycle.
These, and other aspects of the invention will be better understood
with reference to the following description and drawings
wherein:
FIG. 1 is a diagrammatic representation of a pneumatic circuit for
mixing oxygen and air into a breathing mixture and applying
compressed air to force the breathing mixture into a patient's
lungs;
FIG. 2 is a diagrammatic representation of an alternative
embodiment of the pneumatic circuit;
FIG. 3 (on two sheets identified as Parts I and II) is a
diagrammatic representation of an electrical circuit which controls
the flow of compressed air and oxygen according to timing
characteristics built into the electrical circuit;
FIG. 4 is a diagrammatic representation of an alternative
embodiment of a part of the electrical circuit;
FIG. 5 is an exploded perspective view of an automatic therapeutic
ventilator built according to the invention;
FIG. 6 is a front sectional view of the ventilator shown in FIG.
5;
FIG. 7 is a sectional view of a breathing control valve assembly
taken on lines 7--7 of FIG. 6;
FIG. 8 is a sectional view of part of the valve assembly taken on
lines 8--8 of FIG. 7;
FIG. 9 is a sectional view of a part of the valve assembly taken on
lines 9--9 of FIG. 6;
FIG. 10 is an exploded perspective view of a flap valve assembly;
and
FIG. 11 is a perspective view of a further flap valve assembly.
For the purposes of description, the invention falls into three
parts. A first part is a pneumatic circuit which receives air and
oxygen, mixes the air and oxygen to form a breathing mixture and
then forces the mixture through a humidifying device to the
patient. Exhaled breath from the patient is collected in a
spirometer. A second part is a control circuit for timing and
sequentially operating the pneumatic circuit, and a third part is a
structural embodiment of the pneumatic circuit. The three parts
will be described in the order in which they were introduced.
Reference is first made to FIG. 1 which illustrates a first
embodiment of the pneumatic circuit. A pressurized oxygen supply 29
is connected to an inlet 30 at the end of an oxygen input conduit
32 and air enters through an air filter 34 to mix with the oxygen
thereby creating a breathing mixture. A compressed air supply 35 is
connected to an inlet 36 on the end of a feed pipe 38 for forcing
the breathing mixture through the circuit and out by way of a tube
40 to the patient. The breathing mixture is driven with sufficient
pressure to inflate the patient's lungs. Upon removing the
compressed air pressure from the breathing mixture, the patient's
lungs collapse driving exhaled breath back through the tube 40 and
eventually out through an outlet tube 42.
For convenience, the pneumatic circuit will be described firstly
with reference to the formation of a breathing mixture and its
passage to the patient; secondly with reference to the exhaled
breath; and then finally with reference to the compressed air and
associated valving for controlling the flow of breathing mixture
and exhaled breath. In general, ducts carrying air, oxygen or
breathing mixture will be referred to as conduits, ducts carrying
exhaled breath as tubes, and ducts carrying compressed air as
pipes.
On entering the inlet 30, oxygen first passes through a pressure
regulator 44 which reduces the pressure from the oxygen supply 29
and holds it within close limits, and then through a solenoid valve
46 which can be actuated to shut off the flow of oxygen through the
conduit 32 as will be described. Next, the oxygen passes through a
flow valve 48 which determines the rate of flow of oxygen through
the conduit 32 and then on to an oxygen control valve assembly 50.
A single diaphragm 52 incorporates a flap valve 54 which opens in
response to pressure when oxygen is passing through the conduit 32
and a flexible portion 56 which is free to move against a valve
seat 58 under the influence of the oxygen pressure to thereby
prevent oxygen escaping down an oxygen output conduit 60. At the
instant depicted by the drawing, oxygen is passing through conduit
32, past flap valve 54, and on through intermediate oxygen conduit
62 into an oxygen bellows 64. A transparent casing 66 protects the
bellows 64 and defines an opening 68 for guiding a rod 70 attached
to a metal disc 72 coupled to the top of the bellows 64. As oxygen
flows through the conduits 32, and 62, the bellows 64 is expanded
from a collapsed position, through the position shown in FIG. 1 and
on to the position shown in broken outline. At this point the
solenoid valve 46 closes and oxygen bleeds through an orifice 74 in
the oxygen control valve assembly 50 thereby reducing the pressure
in the valve assembly 50 and conduit 32. The resulting pressure
differential across the diaphragm 52 causes the flap valve 54 to
close and the flexible portion 56 to lift off the seat 58.
The combined weight of the rod 70 and disc 72 acts on the bellows
64 and forces oxygen back through the intermediate oxygen conduit
62 where it meets the closed flap valve 54 and is diverted past the
valve seat 58 and on through the oxygen output conduit 60 where it
meets an oxygen input valve 76. A light spring is associated with
valve 76 to maintain it in the closed position against gravity
until the pressure of the oxygen opens the valve 76 so that oxygen
enters a bellows 78 where the oxygen will be mixed with air drawn
in through air filter 34 by the gravitational action of a metal
disc 79 on the bottom of bellows 78. A similar valve 80 is provided
adjacent valve 76 at an end of an air inlet conduit 82 which
connects the filter 34 to the inside of the bellows 78. In the
position shown, the valves 78 and 80 are closed because no oxygen
or air is passing through respective conduits 60 and 82. However,
the bellows 78 already contains a quantity of breathing mixture
from a previous oxygen and air input and is being collapsed by
compressed air fed from inlet 36. As a result the breathing mixture
is forced from bellows 76, through a connecting conduit 83, and
into a humidifier 86. An electrical heating element 88 is suspended
within a humidifier chamber 90 which opens downwardly into water 92
contained in an outer casing 94. The element 88 slowly vapourizes
the water 92 to humidify the breathing mixture as it leaves the
connecting conduit 84 and passes through the chamber 90 before
leaving by a humidifier outlet conduit 96.
A breathing control valve assembly 98 has a diaphragm 100 defining
a flap valve 102 and a flexible portion 104 adapted to be moved
against a valve seat 106. The portion 104 is held against seat 106
by compressed air fed from the inlet 36 until such time as the
compressed air flow is interrupted as will be described. As shown
in the figure, breathing mixture is being forced past the flap
valve 102 into a breathing mixture outlet conduit 108 which
incorporates an adjustable blow-off valve 110 to ensure that the
breathing mixture is not pressurized excessively. Tube 40 then
receives the breathing mixture from the conduit 108 and delivers it
into a tracheal tube 111 to inflate the patient's lungs. The
breathing mixture will continue to flow through the tube 40 only as
long as the compressed air is allowed to collapse the bellows 78.
As a result, once the rate of flow through valve 142 is set, the
volume of breathing mixture being fed to the patient from the
bellows 78 can be controlled by varying the time period that the
compressed air is used to collapse bellows 78. Further, by
occasionally permitting more compressed air to be fed for the same
time period, a sigh can be developed to further inflate the
patient's lungs and ensure that his lung cells are opened. This
will be described later.
The next part of the pneumatic circuit to be described is the part
concerned with the exhaled breath. After the patient has received
sufficient breathing mixture for a single inhalation the solenoid
valve 140 cuts off the supply of compressed air. The patient's
lungs are then at a higher pressure than the pressure inside the
humidifier outlet conduit 96 because the compressed air pressure is
reduced as will be described. Consequently, the flap valve 102
closes. Compressed air is also applied to the underside of flexible
portion 104 of diaphragm 100, so that when the solenoid valve
closes, the flexible portion 104 moves away from valve seat 106 as
will be described with reference to the part of the circuit
associated with the compressed air supply. The patient's exhaled
breath then passes back down tube 40 and enters an exhalation input
tube 112 which feeds exhaled breath into the valve assembly 98. The
flexible portion 104 is remote from valve seat 106 so that the
exhaled breath continues on past valve seat 106 and out through a
connecting tube 114.
An optional spirometer 116 includes a bellows 118 surrounded by a
casing 120 defining an opening 122 for guiding a rod 124. The rod
is attached to a metal disc 126 coupled to the top of bellows 118
and has a removable attachment 128 which is one of a series of
different attachments for adding to the rod 124 to change the total
weight of rod 124, disc 126 and attachment 128 as required in
special circumstances where complete lung collapse is undesirable.
A minimum total weight excluding attachment 128 is needed for
collapsing bellows 118 to expel exhaled breath from the spirometer.
Sufficient weight must be provided to ensure that all of the
exhaled breath leaves the spirometer before the next breath begins
to enter the spirometer. The base of the spirometer includes a flap
valve 130 associated with the end of connecting tube 114 for
opening automatically when exhaled breath is being forced by the
collapsing patient's lungs through tube 114 and into bellows 118 to
expand the bellows. In the position shown, the bellows 118 contains
exhaled breath and is in the process of collapsing thereby forcing
exhaled breath out past a poppet valve 132 attached to a diaphragm
134. Compressed air is fed to the under surface of the diaphragm
134 while exhaled breath is leaving the bellows 118 to hold the
poppet valve 132 open.
There are several design considerations to be satisfied by the
third part of the pneumatic circuit, namely that part containing
compressed air. Firstly, the patient must alternatively receive
breathing mixture and exhale his breath. Secondly, the bellows 78
must be collapsed by the compressed air once every cycle. Thirdly,
the compressed air must be applied to poppet valve 132 and valve
assembly 98 to control these valves.
At an instant when the bellows 64 is expanding, the bellows 78 is
collapsing to feed a breathing mixture to the patient, and the
bellows 118 is also collapsing to expel the previous exhaled breath
from the patient. As the cycle of operation continues, an instant
will occur when the oxygen bellows 64 is collapsing at which time
the breathing mixture bellows 78 will be expanding to receive
oxygen from bellows 64, and the bellows 118 will be receiving the
exhaled breath from the patient. The compressed air supplies the
energy to the pneumatic circuit necessary in meeting these
requirements and the timing of the supply of compressed air is
controlled by the electrical circuit which will be described with
reference to FIG. 3.
Dealing first with the physical connections from the compressed air
supply 35, the inlet pipe 38 receives compressed air from inlet 36
and guides the air through a pressure regulator 138, through a
solenoid valve 140 and then through an adjustable flow valve 142.
The solenoid valve 140 is selectively coupled electrically to
oxygen valve 46 so that both valves may be opened contemporaneously
for a predetermined time interval. The quantity of compressed air
passing through pipe 38 can be varied by adjusting flow valve 142.
The pipe 38 feeds the compressed air to compressed air valve
assembly 144 which is similar in construction to the oxygen control
valve assembly 50 and incorporates a diaphragm 146 defining a flap
valve 148 and a flexible portion 150. Pressure from the compressed
air supply moves the flexible portion 150 against a valve seat 152
and opens the flap valve 148 permitting compressed air to enter
casing 154 about bellows 78 to collapse the bellows and force
breathing mixture to the patient. After a time set by the
electrical control circuit, the solenoid valve 140 is closed and
the compressed air trapped in the feed pipe 38 adjacent the valve
assembly 144 bleeds off through orifice 156. As a result there is a
differential created across the flap valve 148 and flexible portion
150 resulting in the flap valve closing and the flexible portion
moving off the valve seat 152. Compressed air then exhausts from
casing 154 to atmosphere and the bellows 78 opens under the
influence of the weight of disc 79 to refill the bellows with
breathing mixture.
A bypass pipe 160 having a solenoid valve 162 and flow valve 164 is
provided to supplement the flow of compressed air through solenoid
valve 140 and valve 142 to provide a sigh, when the valves 162, 164
are opened, more compressed air passes into casing 154 during the
time interval set for inhalation. As a result the patient receives
a larger volume of breathing mixture.
A control pipe 166 carries compressed air from a point in the feed
pipe intermediate solenoid valve 140 and flow valve 142 for
controlling the breathing control valve assembly 98 and the poppet
valve 132. A pressure regulator 168 in the pipe 166 further reduces
the pressure of the compressed air which passes on to the junction
of a breathing control pipe 170 and a spirometer control pipe 172.
Pressure is applied directly from pipe 172 to the underside of
diaphragm 134 in a poppet valve assembly 174 which also has an
orifice 176 for bleeding compressed air.
Compressed air entering the pressure control pipe 170 must first
pass through a one-way valve 178 which prevents flow in a direction
from pipe 170 into pipes 172 and 166. An orifice assembly 180 is
coupled to pipe 170 for bleeding compressed air from pipe 170. The
assembly 180 includes a main branch pipe 182 feeding an adjustable
orifice 184 and a fixed orifice 186. A secondary branch pipe 188
feeds a further fixed orifice 190. The arrangement of the orifices
184, 186 and 190 is such that if the adjustable orifice 184 is
closed, then the rate of pressure bleeding from pipe 170 is fixed
by the orifice 190. If the orifice 184 is fully open, the rate is
fixed by the combined effect of orifices 186 and 190. At any
position between fully open and fully closed, the orifice 184 has
the effect of providing an adjustable rate of pressure bleed from
pipe 170.
The control pipes 166, 170 and 172 provide pressure control of the
poppet valve 132 and flexible portion 104 of diaphragm 100 in
breathing control valve assembly 98. When the solenoid valve 140 is
open, the poppet valve is open to permit exhaled breath to escape
from bellows 118 and the valve seat 106 is sealed by flexible
portion 104 to prevent breathing mixture from finding its way into
the spirometer 116. While the valve 140 is open, compressed air is
bleeding through orifice 176 and through orifice assembly 180. As
soon as the valve 140 is closed, the pressure in pipes 166 and 172
begins to drop due to air bleeding through orifice 176, and the
orifice assembly 180 permits controlled bleeding so that the
pressure in pipe 170 begins to drop. The sizes of orifices 190, 184
and 186 are chosen so that the flexible portion 104 moves more or
less slowly off valve seat 106 as required so that the breathing
mixture may be held in the lungs for a short finite period. This is
desirable in cases where the lungs may be inflated differentially
because of internal restrictions associated with the lungs.
Turning now to the sequence of operation of the valves in the
circuit, the order of events will be described with reference to a
patient inhaling and exhaling. The breathing mixture is first
prepared as previously described by feeding oxygen to the bellows
64 to collect a predetermined volume of oxygen in the bellows. This
oxygen is then fed into the bellows 78 where it is mixed with air.
At this point, the bellows 64 has collapsed and the bellows 78 is
fully extended with the bottom of bellows 78 resting on the bottom
of casing 154. Solenoid valves 46, 140 and 162 are all closed and
the patient has just finished exhaling into the spirometer 166.
Next the valves 46 and 140 are opened so that oxygen begins to flow
into the bellows 64 to supply a fresh charge of oxygen for the next
breath. Simultaneously, compressed air enters the casing 154 and
collapses the bellows 78 thereby forcing a breathing mixture
through the connecting conduit 84, humidifier 86, breathing control
valve assembly 98, exhalation input tube 112, and finally through
tube 40 to the patient. The quantity of breathing mixture fed to
the patient depends upon the setting of the flow control valve 142
and the time that the solenoid valve 140 is open. Solenoid valve 46
and flow valve 48 similarly control the quantity of oxygen supplied
to the bellows 64. Valves 46 and 140 are electrically operated in
parallel so that oxygen is fed through conduit 32 and compressed
air is fed through feed pipe 38 for a predetermined length of time.
As a result, the flow control valves 48 and 142 must be set to
ensure that the required relative volumes of oxygen and compressed
air are fed to the respective bellows 64 and casing 154. While the
breathing mixture is being fed to the patient, the control pipe 166
and associated pipes 170, 172 are supplied with compressed air. As
a result the spirometer 116 is permitted to pass previously exhaled
breath out through outlet tube 42 while the breathing mixture is
being fed to the patient. The compressed air is permitted to
collapse bellows 78 until a point is reached where the volume to be
supplied to the patient has left the bellows 78. Normally the
bellows will not be fully collapsed at this point. Both solenoid
valves 46 and 140 are then de-energized so that oxygen begins to
flow from the bellows 64 into the bellows 78 and is followed by air
which enters the bellows 78 from the filter 34. Simultaneously, the
patient begins to exhale and the pressure in the pipe 170 is
reduced as compressed air bleeds through the orifice assembly 180.
The patient's exhaled breath then passes into the spirometer and
because the pressure in pipe 172 has bled through the orifice 176
in the poppet valve assembly 174, the valve 132 closes, trapping
the patient's exhaled breath in the bellows 118. After a
predetermined time which is at least as long as the time taken to
force breathing mixture into the patient, the bellows 78 is again
full of breathing mixture, the bellows 118 is full of exhaled
breath and the bellows 64 contains a fresh charge of oxygen. The
patient is then ready to receive a new charge of breathing mixture
and the breathing cycle is repeated.
For physiological reasons (believed to be to eliminate errors in
the volume of air inhaled to oxygenate the blood) it is necessary
to occasionally prepare a sigh for the patient. The electrical
timing circuit which will be described later, incorporates a
circuit for connection to the solenoid valve 162 in the bypass pipe
160. At intervals selected by the operator and timed electrically,
solenoid valve 162 will open with the solenoid valves 46 and 140 to
thereby permit an extra charge of compressed air to pass around the
bypass pipe 160. This results in collapsing the bellows 78 further
than it is collapsed for a normal breath so that the patient
receives an extra charge of breathing mixture. At the next breath,
the patient will receive a breathing mixture in which the oxygen
content is slightly reduced because a fixed volume of oxygen is fed
into the bellows 78 on every cycle and the bellows 78 was collapsed
further for the sigh. However, the mixture will be restored to
substantially the desired proportions within several cycles.
The oxygen supply can be increased or completely stopped. Flow
valve 48 can be operated manually to increase the volume of oxygen,
and if desired, a switch 190 in the line to the solenoid of the
solenoid valve 46 can be opened so that valve 46 remains in a
closed position. As a result, no oxygen will be fed to the bellows
64. The flap valve 76 inside bellows 78 then prevents flow of
breathing mixture back through oxygen output conduit 60.
A pressure sensing device 192 is coupled by a branch pipe 194 to
the junction of tube 40, conduit 108 and tube 112. The device 192
is coupled electrically to the electrical control circuit which
will be described.
In situations where the supply of compressed air is limited, it
would be preferable not to waste compressed air. In the pneumatic
circuit just described, air is bled through orifice assembly 180
and orifice 176 while maintaining the diaphragm 100 against the
valve seat 106 and holding the poppet valve 132 open. Further, in
some instances it may be desirable to ensure that the ratio of
oxygen to air is maintained substantially constant after a sigh and
that a minimum of oxygen is vented. A pneumatic circuit which will
satisfy these requirements is illustrated in FIG. 2.
Reference is now made to FIGS. 1 and 2 with particular reference to
FIG. 2. Parts appearing in FIG. 1 which are identical with those
already described with reference to FIG. 1 are given the same
numerals, and parts which are similar to corresponding parts in
FIG. 1 are given primed numerals. The main difference between the
FIG. 1 and FIG. 2 embodiments lies in the arrangement for
permitting the pressures in pipes 170, 172, conduit 32 and feed
pipes 38 to become atmospheric. Dealing first with the oxygen
supply through conduit 32, a control valve assembly 50' is similar
to valve 50 with the exception that the orifice 74 in valve 50 is
removed. Oxygen is vented through a solenoid valve 46' positioned
to replace solenoid valve 46 and including an outlet 196. Solenoid
valve 46' has a first position in which oxygen is free to pass
through the valve from the inlet 30 and into the valve 50' and
there is no flow through the outlet 196. Upon de-energizing the
valve 46', the valve takes up a second position in which oxygen is
prevented from passing from the inlet 30 through to the conduit 32.
However, in the second position oxygen from conduit 32 is free to
pass through the valve 46' and out to atmosphere by way of outlet
196. This arrangement minimizes the loss of oxygen because unlike
the previous embodiment shown in FIG. 1, the oxygen vents to
atmosphere only after valve 46' shuts off the oxygen supply. In the
FIG. 1 embodiment the oxygen vents continuously through orifice 74
when valve 46 is open.
A compressed air valve assembly 144' is similar to valve assembly
50' with the exception that the underside of diaphragm 146' is
connected by a branch pipe 198 coupled to control pipe 166. A
solenoid valve 200 is provided in control pipe 166 and operates in
a similar manner to valve 46' to selectively either permit
compressed air to pass from pressure regulator 168 to control pipe
166 or, when de-energized, to permit compressed air to exhaust
through outlet 202 from the underside of diaphragm 146' and branch
pipe 198. Valve 200 also permits the pressure in pipe 172 and in
the underside of poppet valve diaphragm 134' to bleed to
atmosphere. As a result there is no orifice in the poppet valve
assembly 174'.
Because the control pipe 166 now has a control valve 200, pressure
regulator 168 can be fed from inlet 36 directly by a feed pipe
204.
Valve 200 can not be used to permit the pressure on the underside
of diaphragm 100 to be relieved by permitting compressed air from
pipe 170 to pass through outlet 202. This is because as previously
mentioned the pressure in pipe 170 and the underside of diaphragm
100 is relieved relatively slowly and is prevented from returning
to pipe 166 by a one-way valve 178 in the pipe 170. However, this
part of the circuit differs from the circuit shown in FIG. 1 in
that a further solenoid valve 206 is included at the junction of
pipe 170 and main branch pipe 182. The valve 206 is also similar to
valves 200 and 46' and selectively permits compressed air to pass
along pipe 170 without access to branch pipe 182 and then to pass
from the underside of diaphragm 100 along pipe 170 and out through
the branch pipe 182 and orifice assembly 180.
The arrangement of valves shown in FIG. 2 reduces the loss of
oxygen and compressed air when compared with the FIG. 1 circuit.
Further, when compressed air is needed to collapse the bellows 78
in the embodiment shown in FIG. 1 there was a loss of compressed
air because it was bleeding through orifice 176, through orifice
assembly 180, and through orifice 156. In the FIG. 2 embodiment,
when the compressed air is collapsing the bellows 78, there is no
loss of compressed air pressure at any other part of the
circuit.
The FIG. 2 embodiment also differs from the FIG. 1 embodiment in
that the sigh is provided in a different manner. The electrical
circuit feeding the solenoid valves 46' and 140 includes a relay
and resistance indicated diagrammatically at 208. When a sigh is to
be produced, the relay brings the resistance into the circuit
feeding the solenoid and thereby holds the solenoid valves 46' and
140 open for a longer period. As a result the patient receives more
breathing mixture. An advantage of this sigh arrangement is that
while the sigh breathing mixture is being forced to the patient,
the bellows 64 is receiving oxygen for the same period. When this
oxygen is drawn into bellows 78 it is sufficient to ensure that the
resulting air to oxygen ratio in the breathing mixture remains at
the desired setting after a sigh cycle.
Although two embodiments of the pneumatic circuit have been
described, it is of course possible to delete part of one circuit
and incorporate parts of the other. For instance, the valve 206
which supplies the orifice assembly 180 could be deleted if
preferred to obviate the possibility that valve 206 will stick and
hold the patient in an inflated position. Also, if adequate
supplies of compressed air are available the circuit shown in FIG.
1 may be preferred in order to reduce the cost incurred in using
the solenoid valves 46' and 200 described with reference to FIG.
2.
This completes the description of two embodiments of pneumatic
circuits suitable for use in the invention. Next, the electrical
circuits associated with the control of the pneumatic circuits will
be described.
Reference is made to FIG. 3, which shows an electrical circuit
suitable for controlling the pneumatic circuit shown in FIG. 1. The
electrical circuit is required to open and close the solenoid
valves 46, 140 and 162 at predetermined intervals in a breathing
cycle. Once the solenoid valves have been opened, the compressed
air supply and the oxygen supply are applied to the pneumatic
circuit as previously described.
The electrical circuit consists of five sub-circuits which are
indicated along the bottom of FIG. 3. The sub-circuits are: a cycle
timer circuit which is adjustable for controlling both the
inhalation period during which breathing mixture is supplied to the
patient, and the exhalation period during which the patient
exhales; a pressure control circuit which can be adjusted to set
the upper and lower pressure limits of the pneumatic cycle as
applied to the patient; a sigh circuit which is adjustable for
controlling the time between sighs and is adapted to periodically
activate solenoid valve 162 (FIG. 1) at an instant when the
solenoid valve 140 is activated; an alarm circuit for indicating
low oxygen pressure, prolonged low pressure at the tube 40 (FIG.
1), and excessive breathing mixture pressure; and a power fail
alarm circuit which indicates to the user that the power supply to
the main circuit has failed. The sub-circuits will be described in
the order in which they were introduced, i.e., from left to right
of FIG. 3.
A cycle timer circuit includes timers T1 and T2 for respectively
controlling the inhalation period during which breathing mixture is
forced to the patient and the exhalation period. The timers T1, T2
have respective potentiometers r1 and r2 which are ganged together
and so arranged that for similar settings of r1, r2, the timers T1
and T2 produce substantially equal time delays. A further
potentiometer r2a is in series with potentiometer r2 so that the
exhalation period can be increased relative to the inhalation
period by adjustment of potentiometer r2a.
Respective relays R1 and R2 are activated by timers T1 and T2 such
that when electrical power is initially applied to one of the
timers, there is a delay followed by activation of the associated
relay. Each of the relays R1, R2 remains activated until the power
is disconnected by its associated timer at which time the relay
drops out. Four contacts C1,C2,C3 and C4 are associated with relay
R1 and relay R2 is associated with contact C5.
The cycle timer circuit is coupled to compressed air solenoid valve
140 and oxygen solenoid valve 46 previously described with
reference to FIG. 1. Switch 190 which was described in FIG. 1 for
selectively introducing oxygen supply into the pneumatic circuit is
ganged with a further switch 214 for energizing light bulb 216 to
give a visual indication that the oxygen supply 29 is connected to
the pneumatic circuit.
For the purposes of describing the cycle timer circuit in detail,
it will be assumed that the switches 190, 214 are closed. When a
main switch 218 adjacent the supply terminals 220, 222 is closed, a
bulb 219 indicates that the electrical circuit is energized. For
simplicity of description it will be assumed that electrical
current flows from terminal 220 to terminal 222, so that initially,
current flows to the light bulb 216 to indicate that electrical
power is available. At this instant current also flows to conductor
224 which is connected to a first part 226 of a ganged selector
switch 227 (FIG. 5) having five parts. Broken lines 228, 230
indicate that the part 226 is ganged to respective second, third,
fourth and fifth parts 232, 234, 236 and 238 of the selector
switch. Each part can selectively connect a respective centre
contact to one of three outer contacts. In each case, the upper of
the three contacts indicates connection to a fully automatic cycle,
the intermediate contact indicates connection to a semi-automatic
cycle, and the lower contact indicates connection to a cycle
triggered by the patient. As drawn, the switch parts 226, 232 are
in the "automatic" position so that the cycle timer circuit will
control the inhalation and exhalation periods.
Conductor 224 terminates at switch part 226 and is electrically
coupled to conductors 240 and 242. Considering first conductor 240,
this conductor terminates at a closed contact C4 where it meets
further conductors 244 and 246. A manual switch 248 in conductor
246 is provided for calibrating the sigh circuit (as will be
described) and is normally open so that no current is flowing in
conductor 246. Conductor 244 however, carries current to solenoid
valves 46 and 140 thereby energizing the valves and permitting
oxygen and compressed air to flow into the pneumatic circuit.
Considering now the other conductor, 242, current flows from
conductor 242 through selector switch part 232 and then by way of
conductor 250, conductor 252, closed contacts C5 and conductor 254
to timer T1 thereby energizing the timer and starting the
inhalation time delay. During this delay, breathing mixture is
being forced to the patient by compressed air introduced to the
pneumatic circuit through open solenoid valve 140. At the end of
the inhalation delay, the relay R1 is energized thereby closing
contact C1 and permitting current to flow from conductor 250
through conductor 256 to energize timer T2. At the same time as the
contact C1 closes, the contact C4 opens cutting off current to the
solenoid valves 46, 140 whereupon both valves close cutting off
oxygen and compressed air from the pneumatic circuit. The patient's
inhalation period has now ended and the exhalation period has
begun, the duration of the exhalation period being determined by
the delay of timer T2. Eventually, relay R2 is energized thereby
opening contacts C5 and cutting off power to timer T1. Contacts C1
and C4 then return to their original position as drawn and the
valves 46, 140 are again opened and the cycle is repeated.
The first delay during which breathing mixture is forced to the
patient will be substantially equal to the second delay during
which the patient exhales if the potentiometer r2a is set at zero
resistance. As potentiometer r2a is introduced into the circuit the
exhalation delay increases.
In the automatic cycle, the patient does not trigger any of the
functions. The complete cycle is controlled by timers T1 and T2.
However, in the semi-automatic cycle the patient may trigger a new
cycle by attempting to inhale. If he does not inhale however, the
cycle reverts to automatic thereby ensuring that the patient
receives breathing mixture. In order to provide the semi-automatic
cycle the pressure control circuit must be coupled to the cycle
timer circuit.
The pressure control circuit is associated with a pressure control
meter 260 which receives signals from sensing device 192 (FIG. 1).
The meter 260 has adjustable upper and lower limit indicators 262,
264 associated with respective control knobs 266, 268. A needle 270
is responsive to pressure fluctuations relayed from pressure
sensing device 192 (FIG. 1). Relays RL and RH are coupled to the
meter 260 and are respectively actuated as needle 270 sweeps over
limits 264, 262 in a clockwise direction (as drawn). As the needle
returns in an anti-clockwise direction, the relays RH, RL are
de-energized when the needle passes over respective limits 262,
264. As drawn, contacts associated with relays RL and RH are shown
in the position they would be in when the needle is between limits
262, 264. Relay RL controls contacts C6, C7 and C8, and relay RH
controls contacts C9 and C10. Respective third and fourth parts
234, 236 of the control switch determine the mode of operation of
the pressure control circuit.
With the control switch in the "automatic" position as drawn, the
lower limit 264 is set well below atmospheric pressure and the
upper limit 262 is set slightly above the pressure developed by the
preset volume delivered to the patient's lungs. As the ventilator
cycles, the needle 270 will sweep back and forth responding to
pressure fluctuations. If for any reason the needle should pass the
upper limit 262, the relay RH will be energized and contact C10
will close. As a result, current will flow from contact C10 through
switch fourth part 236 and by way of conductor 272 to alarm buzzer
B3. An alarm bulb 274 is wired in parallel with buzzer B3 to give a
visual indication that a high pressure condition exists. Once the
needle 270 falls below upper limit 262, the relay RH is
de-energized and the contacts C10 open thereby cutting off buzzer
B3 and bulb 274. The contact C9 which is also operated by relay RH
receives current only when the switch first part 226 is in the
"patient triggered" position.
Should the needle 270 fall below the limit 264 it indicates that
the patient has attempted to take in a breath and has reduced the
pressure below limit 264. As a result, contact C6 is closed by the
de-activation of relay RL and an assist bulb 276 is illuminated to
indicate that the patient has attempted to take a breath. At the
same instant contact C8 is closed and the contact C7 is opened.
However, these three contacts have no effect with the selector
switch in the automatic position. Thus with the selector switch at
"automatic" should the needle 270 pass the upper limit 262, buzzer
B3 and bulb 274 are energized.
Consider next the situation when the control switch is in the
"semi-automatic" position and the needle 270 is in the position
shown in the drawing and moving toward limit 262. The patient is
receiving a breathing mixture controlled by timer T1. However,
should the patient attempt to breathe he may do so in such a
fashion that the needle 270 would pass the upper limit 262 and the
buzzer B3 and light 274 would then be actuated as previously
described. It is therefore preferable to set the upper limit
slightly higher than in the automatic cycle to avoid unnecessary
activation of buzzer B3 and light 274. After the inhalation period
set by timer T1, timer T2 commences the exhalation period and the
needle falls to lower limit 264 ready to commenc a new cycle after
timer T2 is de-activated. However, a new cycle can be triggered by
the patient as will now be explained.
As the needle sweeps towards limit 264, the timers T1 and T2 are
both energized and the exhalation delay period is in progress, the
contacts C1 to C5 being in the opposite mode to that drawn. Current
is flowing through contact C1 to timer T2 and through contact C5 to
timer T1. Should the patient try to take a breath at this point he
will reduce the pressure and needle 270 will fall past the
pre-adjusted limit 264 so that relay RL will be de-activated and
contact C7 will open. Current to timer T1 was passing from switch
first part 226 through contact C7 and then by way of switch second
part 232, conductor 252, contact C5, and conductor 254 to timer T1.
When contact C7 opens, current is no longer flowing to timer T1 and
the cycling circuit re-sets. As a result contact C4 closes and
current flows from switch first part 226 by way of conductor 240
and contact C4 to open the solenoid valves 46, 140. The pressure
then rises to being needle 270 above lower limit 264 whereupon
contact C7 again closes and current is available at timer T1 for an
automatic cycle. Thus, the difference between the automatic and
semi-automatic cycles is that the patient is allowed to commence a
new cycle by attempting to take a breath. However, if he fails to
attempt to breathe before the set exhalation period is complete,
the automatic cycle begins a new breathing cycle.
Next, the "patient triggered" position of the selector switch will
be described. The cycle is now controlled by the patient without
using timers T1 and T2. Commencing with the needle 270 in the
position shown, and the patient about to attempt to inhale. Upon
inhaling, pressure drops until needle 270 reaches lower limit 264
which is set so that the patient must attempt to inhale in order to
bring needle 270 below lower limit 264. Relay RL is now
de-energized so that contact C8 is closed. Switch third part 234
and contact C8 together form a switch across latch terminals 182 of
relay RH so that relay RH is energized thereby closing contact C9
to commence a pressure cycle. The valves 46 and 140 are then opened
as a result of current passing from switch part 226 through
conductor 278, and then by way of contact C9 and conductor 280 to
the valve 140 and 46. As soon as needle 270 passes upwardly across
limit 264 the contact C8 opens and contact C9 remains in position
until it is disturbed by needle 270 passing upper limit 262. When
the needle 270 reaches the upper limit 262 the relay RH opens
contacts C9 thereby de-energizing the solenoid valves 46, 140.
Contact C10 although closed, is not in the circuit. The pressure
then begins to drop but the contact C9 remains open, this contact
being of a type having no preferred position. This mode is of use
only if the patient is capable of initiating breathing and simply
requires assistance.
Next the sigh circuit will be described. Power for the sigh circuit
is drawn through the selector switch fifth part 238 which is
arranged so that the sigh circuit will be operational when the
switch is in either the "automatic" or "semi-automatic" positions.
The sigh circuit is isolated when the selector switch is in the
"patient triggered" position.
The sigh circuit includes a timer T3 having a potentiometer r3 and
associated with a relay R3 having contacts C11 and C12, a relay R4
associated with contacts C13, C14, a relay R5 associated with
contacts C15, C16, and a relay R6 associated with contacts C17, C18
and C19. Contacts C2 and C3 of relay R1 in the cycle timer circuit
are associated with the sigh circuit and for simplicity of drawing,
these contacts are duplicated in the sigh circuit between relays R5
and R3.
The sigh circuit has a timer T3 and associated potentiometer r3 for
adjusting the timer to give delays of the order of 1 to 7 minutes.
For proper timing, the sigh circuit must be arranged to commence
supplying an extra volume of compressed air through solenoid valve
162 (also shown in FIG. 1) at the same time that valve 140
associated with the cycle timer circuit begins to open. The timer
T3 is of a type which when actuated immediately actuates the relay
R3 and when the power is no longer applied to the timer T3 there is
a time delay before the relay R3 is de-energized.
It will be convenient for the purposes of description to consider
an instant in the cycle at which the timer T3 has actuated relay
R3. As a result both contacts C11, C12 will be open and there is no
complete circuit through which current can flow from conductor 282.
After the time delay set by T3, the relay R3 will be de-activated
and contacts C11, C12 will close. As a result, current will flow
through contact C11 thereby energizing timer T3. However, before
relay R3 can open contacts C11 and C12, current passes from
conductor 282, through conductor 284 and then by way of contact
C12, conductor 286, closed contact C17 and conductor 288 to
energize relay R5. This closes contact C15 so that current from
conductor 284 now passes to conductor 286 by way of contact C15
rather than by way of contact C12 which now opens under the
influence of relay R3.
Relay R5 now maintains contacts C15, C16 in a closed position
irrespective of the timer T3. If relay R1 is not energized, contact
C3 prevents current flow from conductor 290 and closed contacts
C16. A conductor 292 coupled to conductor 290 also leads to open
contacts C18, C19 and C14. As a result, the sequence is stopped
until such time as relay R1 is activated after an inhalation
period.
Upon activation of relay R1, conductor C3 closes and current flows
through conductor 294, closed contact C13 and on to energize relay
R6. At the same instant, contact C2 opens thereby cutting off
current to contact C19 which at this instant is closing because
relay R6 is energized. However, current from conductor 292 passes
by way of conductor 296 to closed contact C18 which permits current
to flow through contact C13 and back to relay R6. Relay R6 is now
maintained in the activated position irrespective of relays R3 and
R5 and timer T3. C17 has now opened thereby de-energizing relay
R5.
The cycle can progress no further until the relay R1 is again
de-energized signifying the commencement of a new inhalation
period. Upon de-energizing relay R1, contact C3, which is now
isolated by open contact C16, opens, and contact C2 closes. As a
result current flows through contact C2 and then by way of
conductor 298 and closed contact C19 both to solenoid valve 162 and
conductor 300 which energizes relay R4. A warning light 302 is
wired in parallel with the solenoid valve 162 to indicate that the
valve is now open. Upon energizing relay R4, contact C13 is opened
thereby cutting off current supply to relay R6. However, because
contact C14 is now closed current passes by way of contact C2,
conductor 298 and conductor 304, contact C14 and conductor 300 to
the solenoid valve 162. As a result, the valve 162 will remain open
until R4 is de-energized.
At the end of the inhalation period, relay R1 is again energized
and contact C2 is opened. This cuts off the supply of current to
the valve 162 and to relay R4. Contacts C13 and C14 then return to
their original positions and the circuit has completed the sigh.
While the sigh has been in progress, the timer T3 has started a new
cycle and after a significant delay, it will again trip the relay
R3 and begin a new sigh cycle.
The next part of the electrical circuit is the alarm circuit.
Beginning at the top of the alarm circuit, a conductor 306 connects
the back of switch 214 in the cycle timer to a pressure switch 308
which responds to low oxygen pressure to set off a buzzer B1 and
alarm bulb 310, provided that the switch 214 is closed.
The next part of the alarm circuit is concerned with low pressure
at the tube 40 (FIG. 1). A pressure switch 312 closes if the
pressure drops and remains below a minimum (typically 7 cms. of
water) for more than a predetermined period set by a timer T4. A
conductor 314 carries current to the switch 312 and upon the
pressure dropping below the predetermined figure, the timer T4 will
be energized. After the time delay built into the timer, (typically
about 7 seconds) the relay R8 will be energized to close contact
C20. A conductor 316 then carries current from conductor 314,
through closed contact C20 to energize a buzzer B2 and alarm bulb
318. This alarm will be energized should there be a major leak in
the supply of breathing mixture to the patient, or if the patient
fails to trigger a new cycle when the selector switch is in the
"patient triggered" position.
The alarm circuit also consists of the buzzer B3 which as
previously described will be energized should the pressure of the
breathing mixture supplied to the patient exceed the upper limit
262.
The last part of the electrical circuit consists of a power fail
alarm. The switch 218 is ganged to a further switch 320 in a
separate circuit containing a battery 322. When switches 218, 320
are closed, a relay R7 is energized and a contact C21 is opened to
prevent flow of current around the low voltage circuit. Should the
power fail, relay R7 releases contact C21 which completes the low
current circuit and activates a buzzer, B4 and warning light 324.
As soon as power is restored, the relay R7 is again activated and
the lower power circuit is broken.
Although the electrical circuit has been described with reference
to three modes, i.e., automatic, semi-automatic and patient
triggered, the electrical circuit can be simplified should it be
desired to simply incorporate one of these modes of operation.
Further if it is not necessary to include the sigh circuit, this
can be deleted.
As previously discussed with reference to FIGS. 1 and 2, it is
sometimes desirable to incorporate solenoid valves 46', 200 and 206
in order to limit compressed air and oxygen losses. In such a case,
the electrical circuit would incorporate solenoids 46', 140, 200
and 206 in parallel in place of the solenoids 46 and 140 shown in
parallel in FIG. 3. The sigh circuit described with reference to
FIG. 3 is specifically for use with the FIG. 1 embodiment. However,
the FIG. 1 circuit can be modified to match the FIG. 2 pneumatic
circuit embodiment. As shown in FIG. 2, the FIG. 1 bypass pipe and
valves 162 and 164 have been removed, regulator 168 is coupled
directly to the compressed air supply 35 and solenoid valve 200 is
introduced into the compressed air control pipe 166. The length of
the inhalation period is increased when a sigh is to be produced by
introduction of a resistance into the electrical circuit at
208.
Reference is now made to FIG. 4 which shows a modification to be
made to the FIG. 3 circuit in order to increase the length of
inhalation period when a sigh is being produced to match the FIG. 2
embodiment. Parts common to those already described have the same
numerals in order to relate the FIG. 4 change to the circuit
already described with reference to FIG. 3. In FIG. 3, the
potentiometer r1 is connected directly to the timer T1, and the
potentiometers r2 and r2a are connected in series across timer T2.
In FIG. 4 the potentiometer r1 is connected to a normally closed
contact C22 in parallel with a potentiometer r4, As previously
described potentiometers r1 and r2 are ganged together to move in
unison so that if potentiometer r2a is at zero resistance the
inhalation and exhalation times are substantially equal. Contact
C22 is added to relay R4 shown in FIG. 3 so that when the sign is
about to take place the contact C22 is opened by relay R4 and
potentiometer R4 is brought into the timer circuit T1. As a result,
the inhalation period is extended with a proportionate increase in
the volume of breathing mixture received by the patient together
and in the volume of oxygen entering the oxygen bellows.
Potentiometer r2 a continues to dictate whether or not the
inhalation and exhalation periods will be equal or whether the
exhalation period will be longer than inhalation period except
when, there is a sigh inhation.
As previously described, in this embodiment a sigh increase the
length of time during which oxygen solenoid valve 46 and the
compressed air solenoid valve 140 are open. The concentration of
oxygen in the breathing mixture therefore remains substantially
constant in the subsequent inhalation.
Reference is now made to FIGS. 5 and 6 which show an automatic
therapeutic ventilator 330 built according to the invention. The
ventilator incorporates the pneumatic circuit described with
reference to FIG. 1, and in FIG. 6, the parts of the ventilator are
shown in the same position as the diagrammatic parts of FIG. 2.
Ventilator 330 consists of a base 332 supporting T-shaped end
members 334, 336 disposed at the front and back of the base 332.
Upright panels 338, 340 are located in slots 342 and extend
rearwardly in spaced-apart relation between end members 334, 336.
The members 334, 336 also define four pairs of opposed grooves 344,
346, 348 and 350 for respectively receiving oxygen tray 352,
breathing mixture tray 354 spirometer tray 356, and humidifier tray
358. The trays have respective outwardly turned lips 360, 364 and
366 for slidably engaging in the grooves.
The oxygen tray 252 supports a generally bell-shaped transparent
plastic casing 368 containing an oxygen bellows 370 and a rod 372
coupled to a disc 374 for compressing the bellows 370. As better
seen in FIG. 6, the rod 372 extends through the disc 374 and
projects into a shallow depression 476 in end wall 378 of bellows
370. Casing 368 defines an opening 380 providing guidance for the
rod 372 and openings 381 to permit the bellows 370 to expand as
oxygen is forced into the bellows. The casing 368 has an
outwardly-extending rim 382 which traps an outwardly-extending
flange at the mouth of bellows 370 against tray 352 to seal the
bellows. Casing 368 is held in place against the bellows flange 384
by four rotary latches 386 engaging a pressure ring 387 on the
casing rim 382 and a scale 385 indicates the volume of oxygen in
bellows 368.
Trays 354, 356 and 358 have respective casings 388, 390 and 392
attached to them by respective rotary latches 394, 396 and 398.
A bellows 400 for receiving oxygen and air is contained in casing
388 and held in place in similar fashion to bellows 270 with which
it is interchangeable. However, bellows 400 contains a disc 402 for
extending the bellows. The disc 402 has a central opening 404
providing clearance for shallow depression 406 in the end wall of
the bellows 400 for locating the disc 402 centrally of the bellows
end wall. A spirometer bellows 408 is contained in casing 390 and
is associated with a disc 410 and rod 412 for collapsing bellows
408. Bellows 408 is also interchangeable with bellows 380 and
400.
As better seen in FIG. 6, an oxygen conduit 414 extends downwardly
and horizontally from an opening 416 in tray 352 to connect the
bellows 370 to an oxygen control valve assembly 418 attached to
panel 338. Conduit 414 extends through an opening 420 in panel 338
and into an oxygen port 422 in valve assembly 418. The port 422
defines an annular groove containing an elastomeric O-ring 424
which seals about a projecting end of conduit 414.
An elongated slot 426 extends downwardly from the top of panel 338
and is adapted to engage in an annular groove 428 adjacent an end
of an elbow 430 attached to air filter 432. Once in position in
slot 426, the open end of elbow 430 is positioned for receiving an
end of an air inlet conduit 434 attached to tray 354. The conduit
434 leads air from filter 432 through a flap valve 436 into bellows
400. A similar flap valve 437 is associated with an end of an
oxygen output conduit 438 which terminates at an end 440 aligned
with an opening 442 in panel 338. An oxygen outlet port 444 is in
registration with opening 442 and defines an annular recess
containing an elastomeric O-ring 446 which seals about end 440 of
conduit 438.
A connecting conduit 448 extends from an opening 450 in tray 354
terminating at an end 452 for engaging in opening 454 in panel
338.
Ends 433, 452 and 440 of respective conduits 434, 448, and 438
extend in generally parallel relation so that when the tray 354
engages in the grooves 346, the end 433 engages in the end of air
filter elbow 430, the end 448 projects through opening 454 in panel
338, and end 440 engages in O-ring 448 of port 444.
Casing 388 includes an opening 456 for registration over a
resilient seal 458 associated with the compressed air supply. The
seal is located in the top of base 332 and has an inwardly
projecting radial lip 460 adapted to flex upwardly under the
influence of compressed air to sealingly engage against the casing
388 about the opening 456. When the tray 354 is engaged in the
grooves 346, the casing 388 slips into place over the seal 458 and
is in correct registration over the seal when the tray is fully
engaged with the grooves 346.
Humidifier tray 358 has a conduit 462 for carrying breathing
mixture into a humidifier 463. The conduit 462 terminates at its
end in a cylindrical coupling 464 for receiving end 452 of
connecting conduit 448. Tray 358 also includes a humidifier outlet
conduit for transporting humidified breathing mixture from
humidifier 463 to a breathing control valve assembly 468. When tray
358 is engaged in grooves 350, the coupling 464 projects through an
opening 470 in panel 340 and engages over end 452 of connecting
conduit 448 in an air tight joint.
The humidifier 463 consists of an oval housing attached by its
upper end to the tray 358 and extending downwardly to an open lower
end 474. An elctrical heating element is attached to tray 458 and
extends downwardly inside housing 472 for heating water 478
contained in casing 392. A cable 480 extends from the element 475
and terminates in a plug 482 engaging in a receptacle 484 which is
coupled conventionally to a power source (not shown).
When the trays 352, 354 and 358 are in place in their respective
grooves 344, 346 and 350, the pneumatic circuit for preparing
humidified breathing mixture and supply it at an end 486 of
humidifier outlet conduit 466 is complete.
Spirometer tray 356 includes a connecting tube 488 having an end
490 for engaging in breathing control valve assembly 468. The tube
488 includes a valve 489 and terminates at its other end in flap
valve 492 for permitting exhaled breath to pass through tube 488
and into bellows 408. Valve 489 allows the user to divert exhaled
breath through an outlet 493 if the breath is to be collected for
analysis.
The exhaled breath can escape from bellows 408 only when a poppet
valve 494 is opened. A compressed air control pipe 496 extends from
poppet valve assembly 498 terminating at an end 500 projecting
beyond tray 356 for automatically engaging in a connecting block
502 when the tray 356 is moved into place along groove 348.
The poppet valve assembly 498 consists of relatively rigid disc 504
for supporting a circular rubber seal 506 adapted to engage about
an opening 508 in tray 356. The seal and disc 504 are positioned
adjacent a head of a bolt 510 which extends downwardly through a
spacer 512, a limit bar 514, a diaphragm 576 and engages in a nut
518. The Bar 514 is relatively narrow and rectangular in plan view
so that it does not block passage of exhaled breath through opening
508 when the poppet valve is open. A central portion of the
diaphragm 516 is trapped between the limit bar 514 and the nut 518,
and the periphery of the diaphragm is trapped between an upper
frame member 520 on the underside of tray 356 and a block 522. With
the poppet valve 494 open, exhaled breath is free to pass through
opening 508 and escape past frame member 520. The poppet valve 494
is held in the open position by compressed air applied through pipe
496 and duct 524 below diaphragm 516. An orifice 526 leads from
duct 524 to atmosphere for bleeding pressure from below diaphragm
516 as previously described with reference to FIG. 1. Thus when the
compressed air supply is no longer available to pipe 496, pressure
in duct 524 and below diaphragm 516 bleeds through orifice 526 and
the poppet valve 494 closes.
Compressed air is supplied to the block 502 by way of a control
pipe 528 leading from a main compressed air inlet pipe 530. Pipe
528 is coupled by a T-connector 532 to pipe 530 and to a flexible
control pipe 536 which is coupled at its other end to the control
valve assembly 468, as will be described. An end 538 of compressed
air pipe 530 projects outside base 332 for connecting a compressed
air supply to the ventilator. The other end of pipe 530 is attached
to a lower half 540 of compressed air valve assembly 542. Lower
half 540 includes upwardly projecting outlets 544, 546 fed by a
main bore 548. An orifice 550 extends downwardly from the main bore
548 for bleeding compressed air from below a flexible portion of a
diaphragm 554 which also includes a flap 556 adapted to close
outlet 544. The flexible portion 552 seals a vent port 558 when
compressed air is applied through outlet 546 to the underside of
the flexible portion 552. As previously described, when the
flexible portion 552 seals the vent port 558, the flap 556 is
opened and compressed air passes through a short pipe 560 set in
seal 458 and into casing 388. The lower end of pipe 560 is engaged
in an O-ring 562 housed in the upper half of valve assembly
542.
The oxygen control valve assembly 418 is interchangeable with the
compressed air valve assembly 542 just described. However, the
valve assembly 418 controls flow of oxygen from oxygen input
conduit 564 which has a first end 566 outside the base 332 for
connection to an oxygen supply. The other end of conduit 564 is
coupled to the valve assembly 418 for supplying oxygen through
oxygen conduit 414 and then permitting a measured quantity of
oxygen to pass from bellows 370 back through the valve assembly 418
and into oxygen output conduit 438 which feeds the oxygen into the
breathing mixture bellows 400.
The breathing control valve assembly 468 is a friction fit on the
respective ends 490, 486 of connecting tube 488 and humidifier
outlet conduit 466. The construction of valve assembly 468 will be
described with reference to FIG. 7. A breathing mixture outlet
conduit 568 and an exhalation input tube 570 extend from the valve
assembly 468 to a Y-connector 572 connecting the conduit 568 and
tube 570 to a tube 574. A trachael tube 576 is attached to end of
tube 574 for insertion into a trachael incision in the patient and
branch pipe 578 is connected to the Y-connector for relaying
pressure changes to a pressure sensing device 580 which would in
practice be within the base 332 but which is shown separately for
clarity of drawing. The device 580 is associated with the pressure
control circuit shown in FIG. 3.
The pressure regulators, flow valves, solenoid valves, orifice
assembly and one-way valve appearing in the base 332 are arranged
as described with reference to FIG. 1. In FIG. 6 these parts are
given the numerals by which they were referred to in FIG. 1 so that
ready reference can be made between FIGS. 1 and 6.
As seen in FIG. 5, the base 332 includes a control panel 582 on
which the controls described with reference to FIGS. 1 and 3 are
located. In order to simplify description and relate FIGS. 1 and 3
to FIG. 5, the controls are simply numbered according to the
numerals they carried in FIGS. 1 and 3.
Reference is next made to FIG. 7 which shows the breathing control
valve assembly 468. A first half 582 is located relative to a
second half 584 by a peripheral lip 585 on second half 584 which
also locates a diaphragm 586. Fasteners 588 (FIG. 6) pass through
the halves to compress the diaphragm 568 about a flap 590 and a
flexible portion 592. The fasteners 588 permit ready disassembly
for autoclaving and for replacing diaphragm 568.
The first half 582 defines an inlet duct 594 for leading from
humidifier outlet conduit 466 (FIG. 5) and delivering breathing
mixture to an intermediate duct 596 which terminates at the
underside of flap 590 for preventing return flow back into duct
596. When the breathing mixture is pressurized, the flap 590 moves
into the position indicated in broken outline to permit the mixture
to enter an outlet duct 598 in second half 584. The breathing
mixture outlet conduit 568 (FIG. 5) is of flexible plastic and can
be frictionally engaged in outlet duct 598 for completing the
pneumatic path to the patient.
The inlet duct 594 is connected to intermediate duct 596 by a
blow-off duct 600. As better seen in FIG. 8, this duct opens out at
a valve seat 602 for combining with a rubber disc 604 on a cover
606 to normally prevent loss of breathing mixture out of blow-off
duct 600. The cover 606 is pivotally attached to a lever 608 which
is pivotally mounted between lugs 610 on the bottom of first half
582. A counter weight 612 is slidably engaged on the lever adjacent
its distal end for holding the disc 604 against valve seat 602 to
prevent loss of breathing mixture. However, if the pressure of the
breathing mixture becomes excessive, the disc 604 is forced off
seat 602 to permit breathing mixture to escape. This ensures that
if no one responds to the high pressure alarm, the pressure can not
exceed a maximum set by the position and magnitude of counter
weight 612.
Exhaled breath from the patient comes from exhalation input tube
570 into inlet duct 614 in second half 584. The tube 570 is of
similar construction to conduit 568 and is a friction fit in duct
614. Breath from duct 614 enters an annular chamber 616 about a
valve seat 618. The flexible portion 592 of diaphragm 586 is held
against the valve seat 618 by compressed air from flexible control
pipe 536 which is a friction fit over a stub 620 threaded into
first half 584. Compressed air is fed to pipe 536 during the
inhalation period thereby creating a pressure in a depression 622
on the underside of flexible portion 592 which forces portion 592
onto valve seat 618.
At the commencement of the exhalation period, the pressure in the
depression 622 and pipe 536 is allowed to decrease as previously
described by bleeding air from orifice assembly 180 (FIGS. 1 and
6). The flexible portion 592 then leaves valve seat 618 and exhaled
breath passes from inlet duct 614, into chamber 616 and out through
outlet duct 624. The exhaled breath then passes into connecting
tube 488 (FIG. 5) which feeds it to the spirometer.
Reference is now made to FIG. 9 which shows a connection between
end 490 of tube 488 and the outlet duct 624. An annular groove 626
is provided adjacent the mouth of duct 624 for containing an
elastomeric O-ring 628. Upon pushing the valve assembly 584 (FIG.
5) on to tube 488, the end 490 enters the O-ring 628 and seals the
tube 488 into duct 624. Compression of the O-ring provides adequate
friction to maintain the assembled position.
FIG. 9 is typical of the pneumatic seals used in the ventilator. A
similar seal is used between end 486 of humidifier outlet conduit
46 and inlet duct 594 in first half 582 of valve assembly 468. Also
between humidifier coupling 464 and end 452 of connecting conduit
448, and between compressed air control pipe 496 and connecting
block 502.
Reference is next made to FIG. 10 which shows the construction of
flap valves 436, 437 which respectively permit air and oxygen to
enter the breathing mixture bellows 400 during the exhalation
period. Oxygen output conduit 438 leads oxygen to an opening 630 in
tray 354 and air inlet conduit 434 leads air to an opening 632 in
the tray. The openings are covered by an elongated flexible member
634 having cnetral holes 636, for receiving a pair of studs 638
(one of which is shown). Each stud has a conical portion 640, a
cylindrical intermediate portion 642 and a cylindrical end portion
of reduced diameter for engaging in a corresponding one of a pair
of openings 644 in the tray 354. The end portion 645 is
sufficiently long to pass through the tray and have its leading end
deformed to lock it to the tray. Once in place in the tray, the
stud 638 provides a simple connection for the flexible member 634.
Holes 636 are of substantially the same diameter as stud
intermediate portion 642 so that the flexible member can be pushed
over the conical portions 640 of the studs and snapped into
position about the intermediate portions 642.
A light wire spring 646 having a kidney-like shape is adapted to
engage under the conical portions 640 of the studs 638 to hold the
flexible member 634 in position over openings 630, 632 against
gravitational forces.
FIG. 11 shows the flap valve 692 in assembled condition on
spirometer tray 356. Valve 492 is similar in construction to valves
436, 437 and indicates how the parts shown in FIG. 10 would appear
when assembled.
Flap valve 492 has a flexible member 648 covering an opening 650 in
tray 356 for receiving exhaled breath from connecting tube 488. The
member 648 is held in place by two studs 652 of similar shape and
function to studs 638 (FIG. 10).
Should it be necessary to replace one of the flexible members 634
(FIG. 10) or 648 (FIG. 11) they can be pulled off the respective
studs 638, 652 and a new member snapped over the studs as
previously described.
Referring again to FIG. 5 it will be seen that the parts of the
ventilator which must be autoclaved can be removed quickly and
simply without the need for special tools. Further if a set of
replacement trays and associated parts is available, the ventilator
can be stripped of the old parts and new parts inserted within a
relatively short time.
The structural embodiment of the ventilator shown in FIGS. 5 to 11
incorporates the FIG. 1 pneumatic circuit and the FIG. 3 electrical
circuit. If the FIG. 2 pneumatic circuit and the FIG. 4
modification to the electrical circuit are to be incorporated, then
the valves and other parts would be changed to match those
described with reference to FIGS. 2 and 4. The structural features
of the embodiment shown in FIGS. 5 to 11 would remain unaffected.
It is therefore a matter of expected skill to incorporate the
circuits shown in FIGS. 2 and 4, into the FIG. 5 embodiment in
place of other parts in the manner described when previously
comparing FIG. 1 and 2 and FIGS. 3 and 4.
For simplicity of description, a number of auxiliary devices have
been omitted. For instance, it is common to include a water trap
after the humidifier to ensure that no water droplets find their
way into the patient's lungs. Also, it would be desirable in some
instances to include a meter for measuring the concentration of
oxygen in the breathing mixture continuously in order to ensure
that the desired oxygen percentage is maintained. Devices of this
kind are conventional and are not part of the present
invention.
In use, the ventilator is first attached to an artificial lung so
that the operation of the ventilator can be checked. This is
important to ensure that there are no pneumatic leaks and in
particular that the spirometer is collecting a volume of exhaled
breath equal to the volume of breathing mixture forced into the
lung. Once satisfied with the operation of the ventilator, the
physician then decides which mode of operation is to be used and
whether or not oxygen us to be included. Assuming that the mode is
automatic without oxygen, then the physician estimates the volume
of air required per minite together with the number of inhalations
per minute required. The inhalation and exhalation periods are set
on potentiometers r1, r2, and r2a and the volume per breadth is set
on the flow control valve 142 (FIG. 1 and FIG. 5). Subsequent
re-adjustment of the potentiometers will not affect the volume rate
of flow of air to the patient unless the potentiometer r2a is used
to increase the exhalation period. The ventilator is then coupled
to the patient. In the foregoing description, a tracheal tube 576
(FIG. 5) was used. However, in practice a face mask can be used in
an emergency. When the ventilator is to be used over prolonged
periods, the ventilator would be coupled by intubation, that is by
insertion of a tracheal tube.
Once the machine is running on "automatic," the physician observes
the pressure meter to ensure that the pressure applied to the
patient's lungs is not excessive. If the pressure is too high, it
can be reduced by increasing the rate of breathing thereby reducing
the length of the inhalation period. The upper limit 262 (FIG. 3)
is then positioned just above the maximum pressure applied to the
lungs so that if there is a reduction in the volume of the
patient's lungs due to the collection of secretion and the like,
the needle 270 will pass the limit 262 and set off the high
pressure alarm. The low pressure limit 264 is set arbitrarily below
atmospheric pressure.
It will not be unusual for the physician to alter the number of
inhalations per minute once the machine beings to operate. The
condition of the patient's lungs together with other problems
affecting passage of air into his lungs will dictate to a large
degree the rate of inhalations per minute. This is because if there
are any restrictions, it is preferable to extend the inhalation
period so that the air has a longer period to pass the restriction
and enter the pateint's lungs. In many cases, the physician will
not know the exact condition of the patient's lungs so that his
estimate of the required number of inhalations per minute may be
subject to correction after the machine has been started.
If a sigh is required, the procedure will depend upon whether the
FIG. 1 embodiment or the FIG. 2 embodiment of the pneumatic circuit
is in use. In the FIG. 1 embodiment, the flow valve 164 is first
closed and then the switch 248 (FIG. 3) is closed to introduce the
sigh. Switch 248 is held in the closed position and the flow valve
164 is opened slowly so that its affect upon the volume of air
forced into the patient's lungs can be observed on the pressure
meter and the bellows volume scales. When the valve 164 is open
sufficiently, the switch 248 is released and the period between
sighs is set arbitrarily by adjustment of potentiometer r3 (FIGS. 3
and 5). Every time the sigh takes place, the needle 270 (FIG. 3)
will pass the pressure upper limit 262 setting off the high
pressure alarm as an indication that the sigh is operating.
In the FIG. 2 embodiment of the pneumatic circuit, the sigh is
obtained by extending the inhalation period using the FIG. 4
electrical circuit. In this case, the ganged potentiometers r4, r5
are turned to zero so that they have no affect on the inhalation
period. Switch 248 (FIG. 3) is then closed and potentiometers r4,r5
turned to introduce their respective resistances into the timing
circuits. The effect of this is again evident on the pressure meter
and bellows scales and once a suitable sigh has been developed, the
switch 248 is released and the period between sighs is set on
potentiometer r3 (FIG.3) as previously described.
Should it be desired at this stage to introduce oxygen into the air
supply to the patient, it is done simply by switching an oxygen
circuit switch 190 (FIG. 5) and opening the oxygen flow valve 48
(FIG. 1). Because the breathing mixture bellows 78 (FIG. 1) will
draw in a fixed volume each time it extends during the exhalation
period, the volume of breathing mixture applied to the patient per
minute is set by the control valve 142 and the potentiometer r1
provided that the exhalation period is not increased with reference
to the inhalation period. Consequently, the introduction of oxygen
into the oxygen bellows 64 simply reduces the volume of air
subsequently drawn into the bellows 78.
The combined weights of disc 374 and rod 372 apply a force on the
oxygen bellows so that the oxygen in the bellows is slightly
pressurized. When the oxygen begins to flow from the oxygen bellows
into the breathing mixture bellows, the oxygen will precede the air
into the breathing mixture bellows because the oxygen is
pressurized and the air suffers a slight pressure drop in passing
through the air filter. This effect can be emphasized by giving the
flap valves correspondingly different opening characteristics. The
breathing mixture bellows will therefore always receive all of the
oxygen before it accepts air to fill up the breathing mixture
bellows. Also the oxygen concentration can be increased, decreased
or even eliminated without changing the volume of breathing mixture
forced into the patient during each inhalation period.
The arrangement of the ventilator places the humidifier quite near
to the patient so that as the air passes through the humidifier, it
picks up moisture and the air is warmed so that the humidifier
effectively replaces the patient's nasal passages which would
normally humidify air and warm it before it enters the lungs.
If the ventilator is to be used in the semi-automatic mode, the
ventilator is set up as previously described with reference to the
automatic mode. However, the inhalation and exhalation periods are
chosen so that the patient normally attempts to inhale before the
next inhalation period commences. As a result, if he is capable of
attempting to breathe he will do so before the end of the automatic
exhalation period and trigger the pressure meter to start an
inhalation period. Otherwise, the set up is the same as for the
automatic mode.
In the case of the patient triggered mode, the patient is in full
control of the ventilator. The ventilator will not start a new
inhalation until the patient attempts to breathe at which point
breathing mixture will be forced to the patient until such time as
the pressure in the patient's lungs reaches a maximum set on the
upper limit of the pressure meter. If the patient breathes deeply,
he will receive more breathing mixture before the upper limit is
reached, whereas if he does not breathe so deeply the limit will be
reached faster. After exhalation, the patient will then again
attempt to breathe whereupon the needle will pass the lower limit
and a new inhalation period will begin. As a result, the patient is
free to breathe at his own pace, to take deep breaths whenever he
feels it is necessary, and to slow down his breathing rate if he so
wishes. Further, by progressively increasing the negative pressure
required to trigger the inhalation period, the effort required by
the patient to initiate an inhalation can be increased as he
regains his strength and ability so that a patient who has been
dependant upon the ventilator for a prolonged period can be trained
and encouraged towards complete recovery.
* * * * *