U.S. patent number 3,794,026 [Application Number 05/277,628] was granted by the patent office on 1974-02-26 for ventilating apparatus embodying selective volume or pressure operation and catheter means for use therewith.
Invention is credited to Harry Barry Jacobs.
United States Patent |
3,794,026 |
Jacobs |
February 26, 1974 |
VENTILATING APPARATUS EMBODYING SELECTIVE VOLUME OR PRESSURE
OPERATION AND CATHETER MEANS FOR USE THEREWITH
Abstract
A ventilating and resuscitator system for emergency and
non-emergency uses which provides selective pressure or volume
modes of operation. The control of flow of inflating pressurized
gas, under pressures between 20 and 100 psi, is subject to either
manual control or automatic control wherein the automatic control
takes over ventilation or is responsive to the conditions of the
patient. In the automatic mode, pressure responsive means such as
pressure switches, which are responsive to the minimum or negative
maximum as well as positive pressure variations in the thoracic
intrapulmonary region, are utilized to program and control the
inflation and deflation cycles. In addition, alarm means are
provided to warn the attending personnel of patient failure, and to
automatically secure a flow of breathing gas to the patient,
overriding other control means. There is also provided means
whereby, at desired intervals, the patient obtains ventilation
effects equivalent to "sigh" type inhale and exhale cycles. The
arrangement further provides a triple lumen catheter, preferably of
total diameter of 0.5 to 2.0 millimeters, a flow line connected to
each lumen, a pressure monitoring line and a valving system
interconnecting the two minor flow lines and the pressure
monitoring line whereby each minor flow line is alternately and
cyclically connected to the pressure monitoring line. This
arrangement maintains the pressure monitoring line free of mucous
and other body secretions. While the invention is preferably
practiced with a new triple lumen catheter means, other catheter
means may be used. A novel inserter for the triple lumen catheter
is also disclosed.
Inventors: |
Jacobs; Harry Barry (Reston,
VA) |
Family
ID: |
27369601 |
Appl.
No.: |
05/277,628 |
Filed: |
August 3, 1972 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
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162944 |
Jul 15, 1971 |
|
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59206 |
Jul 29, 1970 |
3682166 |
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Current U.S.
Class: |
128/200.13;
128/204.26; 128/202.22; 128/207.15 |
Current CPC
Class: |
A61M
25/007 (20130101); A61M 25/04 (20130101); A61M
16/0051 (20130101); A61M 16/0465 (20130101); A61M
16/0009 (20140204); A61M 16/0452 (20140204); A61M
16/0479 (20140204); A61M 16/0475 (20140204); A61M
16/0484 (20140204); A61M 16/0486 (20140204); A61M
25/0068 (20130101); A61M 25/0668 (20130101); A61M
16/16 (20130101); A61M 25/0606 (20130101); A61M
16/0493 (20140204); A61M 2016/0027 (20130101); A61M
16/0472 (20130101); A61M 25/0082 (20130101); A61M
2025/004 (20130101); A61M 2025/0073 (20130101) |
Current International
Class: |
A61M
25/00 (20060101); A61M 25/04 (20060101); A61M
16/00 (20060101); A61M 25/02 (20060101); A61M
16/04 (20060101); A61M 25/06 (20060101); A61M
16/16 (20060101); A61M 16/10 (20060101); A61m
016/00 () |
Field of
Search: |
;128/351,349,145.5,145.6,145.7,145.8,142,142.2,2.05,2.08 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Dunne; G. F.
Parent Case Text
This application is a continuation-in-part of my U.S. Patent
application Ser. No. 162,944, filed July 15, 1971, which in turn is
a continuation-in-part of my application Ser. No. 59,206, filed
July 29, 1970, now Pat. No. 3,682,166.
Claims
What is claimed is:
1. A ventilating system comprising:
a first conduit for conducting breathing gas;
triple lumen catheter means having two pressure-sensing lumens
adapted to be inserted into a body cavity;
second and third conduits connecting said first conduit to one and
the other lumens, respectively;
a pressure monitor line including sensing means for monitoring the
pressure condtions in the body cavity;
and cyclically actuated valve means including operating means
therefor for inter-connecting said first conduit with said second
conduit
and said third conduit with said pressure monitor line for one
cycle, and thereafter interconnecting said first conduit with said
third conduit and said second conduit with said pressure monitor
line for the following cycle, whereby each of the second and third
conduits serve cyclically and alternately as a breathing gas
carrying conduit and as a pressure monitoring conduit to thereby
maintain the conduits free of body secretions.
2. A ventilating system as claimed in claim 1, wherein the
ventilating system comprises a source of pressurized breathing gas
and a source of gas under low pressure, including sub-atmospheric
pressure cyclically operated inflate and deflate valves connecting
said sources of gas sequentially and alternately to an outlet
conduit, said outlet conduit being connected to said first
conduit.
3. A ventilating system as claimed in claim 2, wherein a catheter
control valve is provided which in one position connects said
outlet conduit to the first conduit, and in a second position
connects said outlet to conduit to a conduit leading to a single
lumen catheter.
4. A ventilating system as claimed in claim 2, wherein a single
motor means is provided to cyclically drive the deflate and inflate
valves and the valve means.
5. A ventilating system as claimed in claim 4, wherein control
means are provided to energize said motor means, said control means
being in a normal state wherein the motor means is not energized,
and pressure responsive means responsive to a predetermined low
pressure in the pressure monitor line to change the state of the
control means to energize said motor means.
6. A ventilating system as claimed in claim 5, wherein said motor
means comprises an air motor having a supply line, and said control
means comprises a normally closed, supply valve in said supply
line, means for opening said valve to permit the operation of the
motor, and connecting means for interconnecting said pressure
responsive means to said opening means to control the operation of
said opening means.
7. A ventilating system as claimed in claim 5, wherein said
pressure responsive means is a low pressure responsive switch.
8. A ventilating system as claimed in claim 6, wherein said
pressure responsive means is a low pressure, normally open switch,
and responds to said predetermined low pressure to close and
thereby energize said opening means to open said supply valve.
9. A ventilating system as claimed in claim 8, wherein a manually
controlled override switch is provided in parallel with said
pressure responsive switch to open said valve.
10. A ventilating system as claimed in claim 8, wherein said
connecting means comprises conductor means, periodically operated
means for opening said conductor means for a predetermined
interval, and flow responsive means responsive to a predetermined
low or no flow in said first conduit for closing said conductor
means during said interval.
11. A ventilating system as claimed in claim 10, wherein said
periodically operated means comprises cooperating fixed and movable
contact means intermediate said conductor means, said fixed contact
means having adjustable spaced portions to form an opening in the
conductor means, and said movable contact means being driven by a
timing means, and wherein said flow responsive means controls the
operation of a switch means to bridge said opening upon a
predetermined drop in flow.
12. A ventilating system as claimed in claim 11 wherein said flow
responsive means comprises a first normally open switch which is
closed upon full flow to cause movement of said bridging switch
means to non-bridging position, and a second normally open switch
which is closed in response to full flow, and wherein said system
further includes second conductor means connecting said second
switch to the first conductor means between the low pressure
responsive switch and the periodically operated means.
13. A ventilating system as claimed in claim 12, wherein a first
high pressure switch is connected to the pressure monitor line and
is responsive to a predetermined high pressure in said line, and a
third conductor means connecting said high pressure switch to said
first conductor means between said periodically operated device and
said valve opening means.
14. A ventilating system as claimed in claim 1, wherein the
ventilating system comprises a source of pressurized gas, a fourth
conduit connecting said source and said first conduit, and pressure
regulating means in said fourth conduit.
15. A ventilating system as claimed in claim 14, wherein said
conduit includes a plurality of parallel branches, a pressure
regulating valve in each branch and a selector valve for
selectively connecting any of said branches to the first
conduit.
16. A ventilating system as claimed in claim 14, including first
motor means for cyclically operating said valve means, and first
control means responsive to pressure variations in said pressure
monitor lines for controlling the energization of said first motor
means.
17. A ventilating system as claimed in claim 16, wherein a cut-off
valve is provided in the third conduit upstream of said valve
means, second motor means to actuate said cut-off valve to an open
or closed position and second control means responsive to pressure
variations in said pressure monitor line for controlling the
energization of said motor means.
18. A ventilating system as claimed in claim 17, wherein said first
and second motor means are electrical motor means, and the first
and second control means are pressure operated switches responsive
to pressure existing in the pressure monitor line.
19. A ventilating system as claimed in claim 18, wherein the first
control mean comprises a first low pressure responsive switch and
first conductor means connecting said switch to said first motor
means to energize the same and actuate said valve means to a
sequential cyclic position.
20. A ventilating system as claimed in claim 19, wherein the second
control means comprise a second low pressure switch and a high
pressure switch, second conductor means connecting said second low
pressure switch to said second motor means, third conductor means
connecting said high pressure switch to said second motor means,
said second motor means opening said cut-off valve when said second
low pressure switch closes in response to a predetermined low
pressure, and clsoing the cut-off valve when the high pressure
switch responds to a predetermined high pressure.
21. A ventilating system as claimed in claim 20, wherein a sigh
pressure switch is provided which is responsive to a higher
pressure in the pressure monitor line than that preset pressure to
which the high pressure switch responds, and a timer selector
device is inserted in said third conductor to connect either the
high pressure switch or sigh pressure switch to the third conductor
to energize said second motor means to close the cutoff valve.
22. A ventilating system as claimed in claim 20, wherein a third
low pressure-responsive switch is provided, together with alarm
means and fourth conductor means, said fourth conductor means
connecting said third low pressure switch and said alarm to
activate the alarm upon reaching a predetermined low pressure.
23. A ventilating system as claimed in claim 22, wherein a delay
relay is provided in said fourth conductor means to delay the
energization of the alarm for an adjustable time interval.
24. A ventilating system as claimed in claim 22, wherein a timer
selector device and a fifth conductor means are provided to be
energized by said alarm, said timer selector device alternately and
sequentially connecting said fifth conductor means to said first
conductor means and said second conductor means, whereby said first
motor means cyclically operates said valve means and said second
motor means opens said cutoff valve.
25. A ventilating system as claimed in claim 17, wherein a bypass
line is provided around said cutoff valve, shut-off valve means in
said bypass being arranged to close the bypass when said cutoff
valve is in open position, said cutoff valve and shutoff valve
means being arranged for joint actuation by said second motor
means.
26. A ventilating system as claimed in claim 17, wherein an
adjustable throttle valve is provided in said bypass.
27. A ventilating system as claimed in claim 8, further including a
second low pressure switch which is closed in response to a
predetermined low pressure in the pressure monitor line, a delay
relay connected to said switch to be energized thereby upon
closure, and a switch means connected to said delay relay and to
said opening means to be energized by said relay after a delay,
thereby energizing the opening means to open the supply valve.
28. A ventilating system as claimed in claim 1, further including a
three-way valve in a conduit which is connected to a lumen of the
triple lumen catheter means downstream of said cyclically actuated
valve means, a source of pressurized breathing gas, a pipe
connecting said source to said three-way valve, and an adjustable
throttle valve in said pipe upstream of said three-way valve, the
three-way valve thereby connecting said lumen to either said
cyclically actuated valve means or to said pressurized gas
source.
29. A ventilating system as claimed in claim 28, further including
a cut-off valve which is provided in said pipe upstream of said
adjustable throttle valve, and means connecting said cut-off valve
and said three-way valve for joint cooperative movements.
30. A ventilating system as claimed in claim 29, including a pipe
means which interconnects said pressurized gas source, a shut-off
valve and a pressure regulator valve, said valves being serially
arranged in said pipe line for selectively increasing the pressure
in the low pressure source in accordance with the setting of the
pressure regulating valve.
31. A ventilating system as claimed in claim 1, including a
nebulizer fitted with quick-attaching valves, fluid level control
means and a reservoir for administering medication with nebulized
water vapor for passage to and through a catheter inserted into the
respiratory system of the patient.
Description
Until the present invention, there have been three methods for
controlling the breathing of a person who does not breathe on his
own or who needs assistance.
The first method consists of placing a mask over the face,
oncluding the mouth and nose, and forcing air or oxygen through it.
The second method consists of placing a large tube, approximately 5
to 10 millimeters in diameter, and a sealing balloon into the
windpipe. The third method consists of performing a tracheostomy
operation on the neck, and putting a large tube of 5-10 millimeter
diameter with a balloon around it into the windpipe.
Using the conventional intubation procedure in an emergency, it is
especially difficult to insert the tube through the mouth, and it
is dangerous to perform the tracheostomy operation in a matter of
less than a minute. The usual routine in the absence of tracheal
obstruction is to place the mask unit over the face and to pump air
into the lungs, rather than risk an emergency tracheostomy.
However, the mask forces air into the stomach and increases the
chance of regurgitation up into the back of the mouth and down into
the lungs. When the mask is removed prior to inserting the tube
through the mouth into the windpipe, the person gets no ventilation
whatsoever for the length of time that this procedure takes. Also,
these procedures usually must wait until the patient is almost dead
in order to proceed without difficulty. Many lives are lost because
of the inadequate time for surgery and because of loss of control
of the airway system in the first 3 minutes following the cessation
of respiration.
The novel catheter of the present invention can be inserted
prophylactically and automatically take over ventilation. Delay of
over a few minutes with the other procedures causes irreversible
brain damage.
In the use of chronic ventilation at the present time, two methods
are employed, either with the large tube through the nose or mouth
into the windpipe with the sealing balloon inflated, or the
operation on the neck, placing the large tube into the windpipe and
having the balloon inflated. With most of the present machines, the
balloon must usually be inflated because the ventilation will not
work properly with an air leak. Many modifications have been made
of the large tube and balloon portion, but all exhibit a constant
or almost constant pressure which causes erosions and destruction
of tissue in that location, and this leads to scarring and
narrowing in the subsequent weeks.
GENERAL STATEMENT OF THE INVENTION
The novel method and equipment are devised for immediate control of
ventilation, e.g. in less than 15 seconds. A catheter means can be
inserted by any trained doctor, nurse, or technician in a safe,
secure fashion. This consists of placing a very small plastic tube
of 0.5 to 2.0 millimeters in diameter through the skin into the
windpipe; and by use of high pressures through this new ventilating
machine, which forces large volumes of oxygenated gas cyclically
through the catheter, one can assist or control the ventilation of
a person. The pressure used is from 40 to 80 psi. This tube is
formed around a long needle. The needle is inserted into the
windpipe and, when the position is known by withdrawing air through
it, the catheter outer unit is advanced into the windpipe and the
needle is removed. The relative position of the catheter to the
windpipe is secured and checked by the return of air and the
machine unit is attached. The specific arrangement of catheter and
needle is partially disclosed in the parent co-pending application,
Ser. No. 59,206, now Pat. No. 3,682,166.
Through the use of a triple lumen catheter (one larger proximal
lumen and two smaller distal lumens), inserted through a break-away
trochar, the machine can be controlled by the patient or it can
control the patient's respiration and continually monitors the
distal intrapulmonic pressure, through the alternate cycled use of
the distal smaller double lumen component. The larger proximal
catheter forces in the oxygenated gas while one of the smaller
catheters is cleansed of nearby mucus by gas flow through it, and
the alternately cycled smaller distal catheter transmits the distal
intrapulmonic tracheal pressure to the machine.
Through the use of this new ventilating machine and tiny catheter
unit, the catheter being approximately one-half to 2 millimeters in
diameter, a person can be ventilated immediately with oxygen, air,
or anesthetic gases, and even in the presence of a leak coming out
of the mouth, adequate and even over-adequate ventilation is always
achieved. This is a safe and secure procedure. The equipment can
control or assist a person's breathing, does not cause pressure
destruction of the inside of the trachea by constantly inflated
balloons, and does not leave any scars on the neck following its
removal. The novel equipment can also be used in the presence of
injury to the face or of congenital deformities. In newborns and
children, the catheter means can be inserted through the mouth into
the windpipe and secured against the lip without causing any
pressure damage inside the windpipe.
The machine includes a ventilation and a pressure monitor which can
take over and breathe for the patient when the respiration stops or
becomes ineffective, and also sounds an alarm. By the use of one
valve, the machine performs either as a volume-type respirator or a
pressure-type respirator, depending upon the disease and patient
requirement. In each of these modes it will function in the control
or assist mode, has sigh control, and provides positive expiratory
pressure, together with the alarm circuitry to alert attending
personnel. At any point, the ventilating device can be operated
manually. This machine delivers 100 percent humidification, warms
the breathing gases, and functions as a nebulizer.
A main object of this invention is to provide a ventilating
arrangement to be used with the ventilating machine disclosed in my
above-mentioned co-pending applications, Ser. No. 59,206, filed
July 29, 1970, now Pat. No. 3,682,166, and Ser. No. 162,944, filed
July 15, 1971, or with other similar ventilating machines, whereby
various modes of ventilation, such as pressure mode, volume mode,
etc., are provided.
A further object is to provide the above modes of operation with
means to select the desired mode quickly, either by manual means or
by automatic means, and to provide further pressure-responsive
means whereby the operations are assisted and controlled by
pressure variation in the patient's thoracic intrapulmonic regions,
these further means being controlled manually by personnel or
automatically by mechanical program means.
A further object is to provide a machine capable of working with an
internal pressure of up to 80 psi and capable of delivering
oxygenated gas to specially designed, narro lumen catheters up to
the above high pressure.
A further object is to provide a machine capable of alternating
flow of gases and pressure sensing functions to tiny distal
catheters while the main flow is through a small proximal
catheter.
A further object is to provide a means whereby the narrow lumen
catheters may be inserted percutaneously into the trachea either
over an inner hollow trochar guide (single lumen) or through a
hollow split-away trochar guide for the triple lumen catheter.
A further object is to provide for the following modes of
ventilation operations and means to select any of them:
operation in the volume mode
operation in the volume mode control cycle
operation in the colume mode assist cycle
respiration monitor, alarm, and ventilation take-over in the volume
assist or volume control mode
volume mode low positive expiratory pressure
volume mode assist or control sigh cycle
manually controlled ventilation, humidification
pressure mode operation
pressure mode assist cycle with sigh control
pressure mode control cycle with sigh control
pressure mode low positive expiratory pressure
A further object is to provide an efficient, disposable and easily
connectable nebulizing means for the novel ventilating
arrangement.
Further objects and advantages of this invention will be apparent
from the following description and accompanying drawings in
which:
FIG. 1 is a schematic view of the resuscitating or ventilating
apparatus described in my co-penidng application, Ser. No. 162,944,
filed July 15, 1971, with some additions thereto for illustrating
how the novel arrangement cooperates therewith;
FIG. 2 illustrates the alternate positions of the inflate and
deflate valves;
FIG. 3 is a schematic and diagrammatic illustration of the novel
ventilating machine which is connected to the ventilating apparatus
of FIG. 1, for obtaining selectively the various volume or pressure
operations under manual or patient assist control with the valves
set in position for volume-type ventilation;
FIG. 4 is a portion of FIG. 3, but illustrates the several valves
and other ports shifted to positions opposite from their positions
shown in FIG. 3 for carrying out pressure type ventilation;
FIG. 5 is a cross-section through the nebulizer;
FIG. 6 shows the single lumen patient adaptor means with inner
needle-trochar member and attached syringe;
FIG. 7 shows a cross-sectional view through the skin anchoring
flange level;
FIG. 8 shows the patient adaptor means assuming its pre-molded
curve, within the trachea, after the needle-trochar member has been
removed;
FIG. 9 shows the distal half of the single lumen patient adaptor
means with proximal partial tracheal obstructing balloon
transiently inflated during its pressurized gas conducting
cycle;
FIG. 10 is a cross-sectional view through the single lumen patient
adaptor means and partial tracheal obstructing balloon at the
catheter wedge gas inlet to the balloon chamber;
FIGS. 11A and 11B show the triple lumen patient adaptor means
passing through the break-away trochar, following removal of inner
needle guide and attached syringe;
FIG. 12 is a cross-sectional view through the triple lumen patient
adaptor means at the proximal partial tracheal obstructing balloon
level and gas inlet wedge passing through blunt split sided
trochar;
FIGS. 13A and 13B show the triple lumen patient adaptor means
assuming its proximal pre-molded curve after insertion through the
skin into the trachea and removal of the break-away trochar
member;
FIG. 14 shows one of the catheters of the longer double lumen pair
serving as the minor pressurized gas conducting and self-cleansing
lumen with its corresponding distal catheter serving as the
pressure conducting catheter, and the proximal partial obstructing
tracheal balloon transiently inflated;
FIG. 15 is a cross-sectional view of the triple lumen patient
adaptor means of FIG. 14 at the level of the proximal partial
obstructing tracheal balloon and wedge gas inlet site showing the
transient inflation of the balloon;
FIG. 16 shows the alternate distal catheter of the double lumen
distal pair serving as the minor pressurized gas conducting and
self-cleansing lumen with its corresponding distal member serving
as the pressure conducting catheter, and shows the proximal partial
obstructing tracheal balloon transiently inflated;
FIG. 17 shows the proximal portion of the single lumen orally
inserted patient adaptor means with its multi-level anchoring and
compression withstanding ridges, and distal gas jet diffusing
member plus cross section of the proximal portion at level of a
compression withstanding and anchoring ridge;
FIG. 18 shows the proximal portion of the triple lumen orally
inserted patient adaptor means with its multi-level anchoring and
compression, and gas jet diffusing member attached to the main
inflating lumen, plus cross section of the proximal portion at the
level of a compression withstanding and anchoring ridge;
FIG. 19 shows a thin distal pressure sensing transducer in
conjunction with the single lumen patient adaptor means, passing
through said patient adaptor means and relaying distal
intrapulmonic pressure values to its attached controlling
ventilating means.
The basic cyclic ventilating apparatus and the humidifying means,
illustrated in FIG. 1 and FIG. 2, will be sufficiently described
herebelow so that their cooperation with the novel, additional
volume and pressure ventilating means is clearly disclosed. For
further disclosure of the details of construction and applications
of the basic ventilating and humidifying systems, reference may be
had to the above-mentioned parent applications, Ser. Nos. 59,206,
now Pat. No. 3,682,166 and 162,944.
The system comprises a source of gas under high pressure (40-80
psi) 15. This source may be compressed air, pure oxygen, or air
fortified with a higher percentage of oxygen than normal
atmospheric air. The source 15 is connected by conduit means 16 and
16' to a sputum trap 17. From sputum trap 17, a conduit means 18
extends to the catheter inserted into the trachea of the
patient.
Conduit means 16-16' has a series of three-way valves 21, 22 and 23
inserted therein. Valve 21 has a handle means 24 to move it to a
selected position. While valves 22 and 23 are shown
diagrammatically as two separate plug means, their passages may be
incorporated in a single plug valve device at axially spaced
planes. To illustrate the unitary operation of valves 22 and 23, a
handle 25 is provided for each valve, the handle being connected
for joint movement by a connecting link means 26. Valves 22 and 23
rotate in opposite 90.degree. directions.
Suction or vacuum source 27 has conduits 28 and 29 extending
therefrom with conduit 29 connected to deflate valve means 30, and
conduit 28 connected to valve 21.
A two-way valve means 31 is located between conduits 16 and 16' and
functions as an inflate valve. For illustrative purposes, valves 30
and 31 are shown as separate valves. However, they work in unison
by connecting means 32 which connects them to reduction gear drive
33.
It is preferable that the outlet ports 34A of the several passages
34 in valves 30 and 31 be of a tapered configuration. Outlet port
34A is elongated in the direction of valve movement and may be of
elliptical or diamond configuration whereby the flow from the valve
to the conduits connected thereto is gradually initiated and
gradually cut off. The duration of time of fluid flow may be
regulated by the length of the longer axis of the port
configuration.
Reduction gear device is driven by fluid motor 35, connected by
conduit 36 to conduit 16 and thus to source 15. The speed of motor
35 is regulated by an adjustable throttle valve means 37 inserted
in line 36, which valve is diagrammatically illustrated as an
adjustable choke valve.
A three-way valve 40 is connected by conduit 41 to valve 30 and by
conduit 41' to valve 31. The function of valve 40 is to control the
ratio of inflation pulses or phases to deflation phases during a
revolution of valves 30-31. It may be termed an inflation and
deflation phase control valve. A conduit 42 connects valve 30 to
conduit 16'. A branch conduit 43 connects conduit 42 to valve 40. A
conduit 45 connects valves 22 and 23.
To control the rate of flow of the oxygenated gas in accordance
with the age and size of the patient, throttle or choke valve 47 is
inserted in line 16 upstream of valve 31, and a similar valve 47A
is inserted in conduit 45. Valve 47 controls the rate of flow when
the system operates automatically. Valve 47a controls the rate of
flow during manual control of ventilation. The rate of flow of
deflation gas from the patient may be controlled by throttle valve
48 inserted in suction line 29.
FIG. 1 illustrates the positions of the several valves in the
system for automatic operation of the ventilating system. Air under
suitable pressure flows from source 15 through conduits 16 and 16'
and through the connecting passages in valves 21, 22, 31 and 23 to
the sputum trap and, from there by conduit means 18, to the
catheter. Thus, air with the proper selected percentage of oxygen
flows to the patient at a rate controlled by throttle valve 47.
At this phase of the cycle; valve 30 cuts off the several
connecting conduits and valve 40 from suction conduit 29.
Valve means 31 and 30 are continuously rotated in the direction of
the arrows 49 at the proper desired speed by air motor 35. Assuming
the setting of the valves in FIG. 1 to be 0.degree., at 90.degree.
of rotation valve 31 blocks flow from conduit 16 to conduit 16',
and valve 30 connects suction source 27 and conduit 29 to conduit
41 and, through valve 40, to conduits 43, 42 and 16', and thereby
the catheter is connected to the suction source whereby deflation
or exhalation of the patient is aided. At 180.degree. of rotation,
valve 31 still blocks the air flow to conduit 16', and valve 30
connects conduit 42 to conduit 29 and, therethrough, to suction
source 27. At 270.degree. of rotation, valve 31 still blocks flow
to conduit 16' and valve 30 still connects conduit 42 to conduit
29. At 360.degree. of rotation, valves 30 and 31 again assume the
positions of FIG. 1 and air is again delivered to the patient to
aid in the inhalation phase of breathing.
Thus, a single cycle or rotation of valve 30 and 31 results in one
inflation and three deflation phases. Under certain conditions, it
may be desirable to have the same extent of inflation and
deflation. Inflation and deflation phase control valve 40 effects
this last-named operation. If valve 40 is moved by its handle 50 to
the position illustrated in FIG. 2, the following connections occur
during a single cycle or rotation of valve means 30 and 31:
at 0.degree., valve 31 connects conduits 16 and 16' and suction
conduit 29 is cut off from all connection by valve 30;
at 90.degree. of rotation in the direction of arrows 49, valve 31
disconnects conduits 16 and 16' and connects conduits 16 and 41',
and, through the passages in valve 40, conduits 41', 43, 42 and 16'
are interconnected for a second inflation phase, while deflation
(suction) is blocked;
at 180.degree. of rotation, conduit 16 is cut off from the other
conduits by valve 31, and suction conduit 29 is connected by valve
30 to conduits 42, 16', and 18 to the catheter for the deflation
phase;
at 270.degree. of rotation, valve 31 still cuts off flow from
conduit 16 and valve 30 connects conduits 29, 42 and 16' for a
second deflation phase;
at 360.degree. of rotation, the valves assume the positions
illustrated in FIG. 2, e.g. the 0.degree. position, in which an
inflation phase is initiated.
Thus, with valve 40 in the position of FIG. 2, there are two
inflation and two deflation phases during a cycle or a revolution
of the valve means 30 and 31.
Under certain conditions, the patient cannot be subject to the
automatic inflation and deflation, and the operator must manipulate
the inflation and deflation phases in accordance with the abnormal
conditions in the patient. Valves 22 and 23 are shifted by means of
their handles from their positions of FIG. 1 to their opposite
positions. Valves 30, 31 and 40 are by-passed, and at the same
time, flow to motor 35 is shut off by valve 22. Thus, valves 22 and
23 interconnect conduit 16 to 16' at sputum trap 17 by means of
conduit 45 which by-passes the valve means 30, 31 and 40 and their
interconnected conduits.
Valve 21 is then manipulated by the operator from one position to
another by handle 24. The position shown in solid lines is the
inflate position wherein oxygenated pressure gas, regulated by
throttle valve 47A, flows from source 15 to conduits 16, 45, 16',
18 to the catheter. When deflation is desired, valve 21 is moved
counter clockwise 90.degree. to the dotted line positions of handle
24. In this deflate position, suction source 27 is connected by the
valve means to conduits 16, 45, 16', 18 and the catheter. The
duration of the inflation and deflation phases will be regulated by
the operator in accordance with the requirements of the patient who
is under his visual observation.
The humidifying means comprises a tank 60, preferably made of
stainless steel or other material which may be subjected to
sterilization and can withstand high internal pressure. The tank
has a high pressure gas input pipe 61 which is secured by a
conventional, quick-acting, detachable coupling means 62 to high
pressure pipe 63. Pipe 63 is connected to conduit 16 upstream of
throttle valve 47. A throttle valve 64 is inserted in pipe 63 for
controlling the rate of flow of humidifying gas and also for
shutting off the flow through the pipe. A pipe connected to a
suitable water supply is joined to pipe 63 upstream of coupling
means 62. A check valve 67, opening toward tank 60, is inserted in
pipe 65. For controlling the temperature and the degree of vapor
saturation of the humidified breathing mixture, an electric heater
means 68 is provided and is controlled by adjustable thermostat 69,
whereby any desired temperature may be selected.
Tank 60 may be provided with a transparent sight tube 71, whereby
the water level may be visually observed. A drainage valve 72 for
emptying the tank whenever desired is inserted at the bottom of
tank 60.
A tank outlet pipe 73 is secured to the top of tank 60. Pipe 73 may
have a heat exchange means therein in the form of a heavy metal
tube 74 to condense any excess water vapor which will drain back to
the tank. Pipe 73 may have a finned portion in lieu of tube 74 to
act as a heat exchanger to permit the outside air to cool and
condense any excess water vapor generated in the tank.
Outlet pipe 73 is connected by a conventional, quickly detachable
coupling means 75 to pipe 77, connected to pipe 16 between throttle
valve 47 and valve 31, preferably close to valve 31. A check valve
78, opening toward conduit 16, is inserted in pipe 77. Pipe 77
terminates in a shut-off valve 79, whereby pipe 77 may be closed to
drain outlet 80 or be opened thereto. An optional throttle valve 82
may be inserted in pipe 77 to control the flow of humidified gas
and may be used in conjunction with throttle valve 64 in line
63.
A gas disperser 83 may be connected to the open end of tube 61,
whereby the gas is dispersed into numerous paths to increase the
bubbling effect. Disperser 83 may be in the form of a hollow
cylindrical body having numerous parts in its cylindrical wall, or
it may assume any other well-known structure for breaking up a flow
of fluid into numerous paths as, for example, a porous body,
perforations in the walls of inlet tube 61, or any other similar
structure.
In order to insure that the bubbling gas picks up only atomized or
vaporized water particles, a baffle means comprising spaced
perforated plates 85 is placed above the water level. Unduly large
droplets or particles of water would impact against the plates and
would not be carried along by the gas stream to outlet pipe 73.
The application of the humidifying system is initiated when
application of the ventilating system is initiated, assuming
throttle valve 64 is set to permit the desired flow of gas to tank
60, and the tank is partly filled with water, as illustrated in
FIG. 1. Check valve 67 is closed under the pressure of the gas
flowing in pipe 63. The gas flows through the open ends of inlet
pipe 61 and through the gas dispersion unit 83 close to the bottom
of tank 60 and bubbles through the preperly heated water. The fine
bubbling causes atomization and vaporization of the water, and the
outgoing gas at outlet pipe 73 is saturated with water moisture.
Massive bubbling and very large water particles are blocked and
returned to the water by baffle means 83. Excess moisture is
condensed by passing through cooling means 74. The humidified gas
then passes through pipe 77 and joins the gas flowing to the
inflating valve 31.
The amount of moisture may be controlled by regulating the flow of
gas in pipe 63 by throttle valve 31.
To replenish the water in tank 60, valve 64 is closed to sotp the
flow of gas in pipe 63 and valve 79 is actuated to connect pipe 77
to the drain 80. Shut-off valve 86 in pipe 65 is opened and, under
such pressure conditions, water flows through pipe 65 and check
valve 67 into pipes 63 and 61 and the tank 60. The water level may
be observed through sight tube 71, and when it reaches the desired
height, valve 79 is turned to disconnect pipes 73 and 77 from the
drain 80. This action stops the flow of water, and valve 83 in pipe
65 is closed to secure this inflow. By opening and regulating valve
64, the flow through pipe 63 is again resumed and humidified gas
flows to valve 31.
If sterilization of tank 60 is desired, it may be quickly
disconnected from pipes 63 and 77 by means of quick-acting coupling
means 62 and 75. Although the ventilation otherwise proceeds
normally, in this instance humidification is absent. Thermostat 69
may be detachably plugged into the heater means.
Check valve 67 may be eliminated and check valve 77 may be replaced
by a normally shut-off valve similar to valve 86. Thus, in
replenishing tank 60, valves 86 and 79 would be opened to permit
water to flow into the tank and the shut-off valve replacing valve
77 would be closed.
The above disclosed apparatus arrangement is sufficient in cases
where a single lumen catheter 100 is used in controlled volume mode
ventilation. In many instances, it is necessary to utilize a triple
lumen catheter 101 because it is desired to monitor the patient's
pressure condition and to assist as well as control ventilation. In
such instances, the proximal lumen serves as the gas breathing
mixture and suction conduit while the distal lumens are alternately
connected to pressure sensors and similar devices and to the
pressurized gas to cleanse the lumen and prevent blockage.
In order to cover various conditions which may occur in the
patient, the invention provides for optional choices of volume
control of the breathing gas or pressure control. In addition,
manual control of inflation and deflation cycles and choice of
degree and flow of inflating and deflating gas pressure are also
provided. Further patient assist modes of breathing control are
also provided.
Catheter 101 is a three-lumen catheter with a larger proximal and
smaller double lumen distal portion, all having the staggered side
openings, being formed with end lumens 102 and 103 in catheter
conduits 104 and 105 and larger proximal catheter 105A with lumen
105B. While any triple lumen catheter may be used, or even three
separate closely spaced single catheters may be used, it is
contemplated that the improved triple lumen catheter disclosed
herebelow will be used for the reasons and advantages set forth in
this application.
The flow of breathing gas to the catheters is controlled by a
conventional three-way valve 107 inserted in conduit 16 upstream of
valve 23. Valve 107 may be termed the pressure or volume mode
selector valve. In the volume mode, conduit 110 connects valve 109
to valves 111 and 112. Valve 111 is connected to conduits 113 and
114, which are connected to conduit 115, and is also connected to
conduit 116. Valve 112 is connected to conduits 118 and 119, which
are connected to conduit 120, and is also connected to conduit 121.
Conduits 115 and 120 are connected to sputum traps 123 and 124,
respectively, and therethrough to conduits and openings 105-103 and
104-102.
The main ventilating gas flow to the larger proximal catheter 105A
goes via conduit 110A (prior to the connection of conduit 110 to
valves 111 and 112). This flows on and off with each ventilation
cycle while the distal smaller catheters alternate pressure sensing
functions and minor pressurized gas conducting-cleansing
functions.
In the volume mode, valves 111 and 112 are cyclically driven in the
directions of the arrows, preferably by motor 35, through a
schematically shown connecting means 125. If desired, valves 111
and 112 may be cyclically actuated by other means. While valves 111
and 112 are schematically disclosed as rotary valves, in actual use
they may be any type, such as single plug or disc valves, piston
valves, etc. It is obvious that it is within the skill of a worker
in the art to design a valve means which would perform the
functions of valve means 111-112.
Conduits 116 and 121 are connected to a three-way valve 126 by
conduit 127. A conduit 129 connects valve 126 to a pressure sensor
means 130 which, for disclosure purposes, is a pressure-responsive
switch. Any other type of pressure-responsive means may be utilized
to sense the variation of pressure in conduit 129 and actuate
desired devices. For example, a piezoelectric means or similar
means having electrical characteristics may be used to generate
signals in accordance with pressure variations in pipe 129 and
thereby control the various control means. In the drawing, the
several switches of the invention are shown as blocks identified by
-PS for pressure switches responsive to very low or negative
thoracic intrapulmonary pressure, and by +PS for the higher
pressure existing at the end of an inflation phase or at a sigh
state.
For volume mode assist cycle operation, it is desired that a
certain volume of breathing gas be fed to the patient upon a
predetermined fall in the patient's intrapulmonary pressure. To
carry out this function, a normally closed valve 132 is inserted in
air motor supply line 36. The valve is controlled by a spring
biased solenoid means 133 which is connected by means of cable or
conductor 134 to pressure switch 130. Thus, valve 132 is maintained
closed until solenoid 133 is energized by the various switch means
and controls.
Valves 109 and 126 are interconnected for joint operation by a
schematically illustrated connecting means 135. A switch 136 is
inserted in cable 134 and is connected to means 135. The
arrangement is such that, when valve 109 is in its volume mode
position (FIG. 3), valve 126 is also in its volume mode position
and switch 136 is closed. When valve 109 is actuated to pressure
mode position (FIG. 4), valve 129 is also shifted and switch 136 is
open, thus maintaining solenoid 133 in its de-energized state,
keeping valve 132 closed and motor unit 35 inoperative in the
pressure mode.
In the pressure mode, a conduit 138 connects pressure source 15 at
conduit 77-16 to supply humidified gas to the patient, to branches
139, each branch having an adjustable throttle valve 140 therein to
regulate the rate of flow. If desired, an adjustable reducing or
constant pressure maintaining valve 141 may be inserted in line
138, whereby the pressure of the breathing mixture may be varied to
suit the conditions of the patient. A conventional selector valve
142 connects either branch 139 to conduit 143 which is connected to
valve 109.
The pressure mode circuit comprises conduit 146, connecting valve
109 and two-way valve 147. Valve 147 is connected by conduit 149 to
valves 150 and 151. Valve 150 is connected to conduit 115 and
therethrough to lumen 105 and openings 103 in catheter 101. Valve
151 is connected by conduits 156 and 157 to conduit 158 which is
connected to conduit 120 and therethrough to lumen 104 and opening
102 of catheter 101.
The above arrangement to the distal pair of catheters alternates
them in their pressure sensing functions and minor pressurized gas
conducting-cleansing functions. The main gas flow is to the
proximal catheter 105A. This flow is through conduit 149A
connecting conduit 149, between valves 145-173 and valves 150-151,
to main catheter 105A.
Valves 150 and 151 are connected by conduits 160 and 161 to valve
126. Valves 150 and 151 are interconnected by connecting means,
such as shaft 162, for joint operation. It is obvious that valves
150 and 151 may be replaced by a single valve device designed to
make the several conduit interconnections now made by the valves.
Means 162 is actuated by a four-lobed ratchet means 163 connected
to shaft 162. Means 163 is actuated in steps of 90.degree. by a
device which may be an electric solenoid or a pressure fluid
actuator. Preferably, the device comprises a spring biased
pawl-like plunger 164 which rotates ratchet 163 90.degree. each
time the solenoid 165 is energized, and thus moves valves 150 and
151 from their positions of FIG. 3 to their opposite positions of
FIG. 4.
Valve 147 is actuated to its open or closed position preferably by
an electric means. The means may comprise a solenoid having a
closing coil 170 and an opening coil 171. A conduit 172 bypasses
valve 147 and has therein an on-off valve 173. Valve 173 is set at
90.degree. to valve 147 and is connected to rotate with valve 147.
An adjustable throttle valve 174 is inserted in bypass 172 upstream
of valve 173.
In order to actuate the various valves in the several contemplated
modes of operation, including the assist mode, that is, aiding the
patient in his breathing, a network of switches, or similar means,
is provided, which switches are responsive to the level of the
pressures in the patient's body at the locations wherein catheter
101 is inserted. A conductor 175 connects solenoid 165 to a
pressure sensitive switch 176 connected to pressure line 129.
Switch 176 closes to energize solenoid 165 upon a predetermined low
pressure in line 129.
An adjustable pressure switch 178 is connected to line 129, this
switch being responsive to a predetermined low pressure which may
be negative. An adjustable pressure switch 179, responsive to a
predetermined higher pressure than switch 178, and an adjustable
pressure switch 180, responsive to an upper limit pressure, or
sigh, which is higher than that to which 179 is responsive, are
connected to line 129. A pressure responsive or alarm switch 182 is
connected to line 129 and, upon a predetermined low pressure, which
signifies that in the patient's spontaneous breathing function each
respiration is adequate, plus predetermined high pressure which
means that the ventilating machine is working, closes and energizes
an adjustable delay relay 183. However, if the spontaneous low or
machine assisted or controlled high positive pressures are not
reached after a given time interval, the delay relay 183
de-energizes and its contacts energizes an alarm device 184. Alarm
184 may be of any design and it functions to give an audible or
visual signal to the attending personnel that the patient's
breathing or ventilating machine is failing or has failed. Alarm
184 also functions to energize other devices and conductors, such
as conductor 187 which is connected to a timer and selector device
186. A second conductor 188 connects device 186 to conductor 175.
The operation of device 186 is described further on.
Switch 178 is connected by conductor 190 to coil 171. Switch 179 is
connected by a conductor 191 to a timer and selector device 192.
Switch 180 is also connected to device 192 by a conductor 194.
Device 192 is connected by a conductor 195 to coil 170.
Device 192 is a timing device which can be set so that it
interconnects either conductor 191 and switch 179 or conductor 194
and switch 180 to conductor 195 and thus move valve 147 to its
closed position. The timing cycles may be adjusted to vary the
selected number of interconnections per hour and further adjusted
so that the time intervals wherein either switches 179 or 180 are
connected to coil 170 may be varied.
Any resettable commercial timer may be used, but certain timers are
preferred; namely, the timer available from Coulter Electronics,
Hialeah, Florida under Crawford U.S.P. 3,187,319, the
alarm-triggering apparatus of Soltau U.S.P. 3,383,674, the timer
from Arvin Industries of Columbus, Ohio under Davisson U.S.P.
3,559,072, and the Bowes Engineering Fluidic Timer Model I-101 from
the Bowes Engineering Company, Silver Spring, Maryland. The
all-purpose timer of Dimco-Gray Company may also be used or an
adjustable clock-timer which is motor operated may be used.
Device 186 is also a timed selector which may be adjusted to
connect energized conductor 187 to a conductor 197, which is
connected to conductor 190, a certain number of times per minute
and for a definite time interval. Thus, device 186 connects
energized alarm 184 a definite number of times per minute to coil
171 to open valve 147. At the same time, device 186 also connects
energized conductor 187 to conductor 188 and therethrough to
conductor 175 and solenoid 165. Device 186 may also be manually
activated to thythmically control respiration by energization and
de-energization of coils 171-170 to operate valve 147-173, and
solenoid 165-163 to operate valves 150-151.
This invention is further provided with means for sigh respiration
which is the periodic deeper respiration normally performed by a
breathing individual, a moderate number of times per hour. This is
controlled by timer selector 192 periodically (pre-set 0 to 100 per
hour) choosing the higher pressure valve 180 (rather than high
pressure valve 179) to close valve 147 through 195-170, and
therefore build up higher pressure and therefore a deeper
inhalation cycle.
In the volume mode, an adjustable flow responsive device 200 is
inserted in line 110. Device 200 may assume any well-known
flowmeter form, but is is illustrated schematically as comprising a
pivoted vane 201 in a casing and biased by an adjustable spring 202
to a neutral position. Flow of fluid in pipe 110 impinges on the
vane to move it to close a normally open switch 204 which is
connected by conductor 205 to conductor 134. When no or adjustable
low flow is present in pipe 110, spring 202 moves vane 201 to a
neutral position wherein it engages a normally closed switch 206 to
open it, that is, switch 206 is closed when flow takes place within
pipe 110 and the vane is in contact with switch 204.
Thus, switch 204 is actuated to closed position by a predetermined
amount of breathing gas flowing within conduit 110 and is opened
upon no flow or upon an adjustable minimum flow in conduit 110.
A timer and switching selector device 210 is inserted in cable or
conductor 134. A relatively high pressure switch 211 connected to
line 129 is connected to conductor 134 by conductor 212. A manually
operated override switch 214 to hold valve 132 open is connected to
conductor 134 by conductor 215 in parallel with switches 130 and
204.
Device 210, shown schematically, comprises a wiper arm 217
connected to one side of conductor 134 and driven by an adjustable
timer motor 218 whereby arm 217 may rotate from, say, one to one
hundred revolutions per hour. The other side of conductor 134 is
connected to an adjustable segmental contact 219 which may comprise
two relatively movable segments 220 and 221, whereby the
interrupted portion or space 223 between the opposed ends of
contact 219 may be varied. The opposed ends of contact 219 forming
space 223 may be interconnected by a magnetic relay switch
comprising solenoid 225 and contact 226 controlled by flowmeter
switch 206 through conductor 207. When 206 is closed, that is, when
fluid is flowing in line 110, the solenoid 225 is energized and
contact 226 is pulled up to open space 223. Thus, as wiper 217
moves across contact 219, current in conductor 134 flows to
solenoid 133 to keep valve 132 open. When wiper 217 moves across
space 223, the circuit is opened and valve 132 closes only when
there is fluid flowing in conduit 110. However, when no flow takes
place in conduit 110, switch 206 is opened by vane 201, solenoid
225 is de-energized, and contact 226 is actuated by gravity or by a
spring means to contact and bridge the opposed ends of contact 219
and short circuit spacd 223. Wiper 217, in its sweep, engages
contact 226 which forms a closed circuit to maintain valve 132 open
and thereby continue operation of motor 35 to actuate the deflating
valve 30 and thereafter valve 31 to continue the operation.
This sequence for the volume mode sigh operation can also be
performed by electronic means such as bias control on the grid of a
vacuum tube or solid state conductor, by one skilled in the art
without changing its basic function.
An automatically resettable relay 227 reset by 183 is connected to
delay relay 183 by conductor 229 whereby 227 is in parallel with
alarm 184. Relay 227 may also be manually operated. Relay 227 is
connected by conductor 230 to conductor 134. Thus if the patient
fails to breathe or does not breathe deeply enough, pressure switch
182 does not re-energize delay relay 183 within the adjustable
delay time and it (183) then energizes the alarm 184 plus relay
227. Relay 227 if placed in the automatic emergency assist mode
only ventilates one time because pressure switch 182 will then be
re-energized and reset relay 227 open again. If, however, relay 227
is placed in the emergency control mode, then only a manual reset
will turn it off. Relay 227, when energized maintains solenoid 133
energized through conductors 230-134 and switch 136. When
energized, solenoid 133 holds valve 132 open so that motor 35
continues its cyclical motion of valves 30-31.
At times it is desired to use a slight positive pressure during the
exhalation phase, in lieu of suction, in the volume mode. To
accomplish this operation, a three-way valve 236 (FIG. 1) is
inserted in suction conduit 29, and a conduit 237 connects the
valve to pressure conduit 16. A conventional, adjustable
pressure-flow regulator 238 is inserted in conduit 237. By
adjusting regulator 238, the pressure of the fluid in conduit 237
may be reduced and maintained constant at any desired pressure. A
flowmeter or pressure gauge 239 may be inserted in line 237 to
facilitate the adjustment of the desired degree of flow or pressure
in line 237. By moving the handle of valve 236 from the solid line
position to the dotted line position, valve 236 cuts off the
suction source 27 from that portion of conduit 29 downstream of the
valve and connects the portion to conduit 237 and pressure
regulating valve 238.
Thus, the deflating fluid going to valve 30, under certain
conditions, will be under selected degrees of low positive
pressure.
At time it is desired to connect a lumen 105B of catheter 101
directly to source 16. To accomplish this, a conduit 240 (FIGS. 1
and 3) is connected to source 16 and to a valve 231 in conduit 105C
before the sputum trap 124A. A normally closed shut-off valve 241
connected to valve 231 by connecting means 232, and an adjustable
throttle valve 242, is inserted in pipe 240. When circumstances so
require, valve 241 is opened and valve 231, via connecting means
232 is moved to the position in FIG. 4 connecting conduit 240 to
means 105C, 124A and to catheter 105A and lumen 105B. Breathing gas
flows from source 16 directly to lumen 105B at the rate determined
by manual controlling valve 242. Pressure gauges 245 are inserted
in the several pipes wherever pressure readings are desired.
Volume Mode Operation
For the volume mode operation, valve 107 is placed in the position
of FIG. 3 wherein the single lumen catheter 100 is cut off from
conduit 16'. In this position, conduits 16' and 108 are
interconnected. Interconnected valves 109 and 126 are placed in
their positions of FIG. 3 by their interconnection 135 and switch
136 is closed to connect pressure switch 130 to solenoid 133.
Valves 111 and 112 are rotated in the direction of the arrows by
their operative connection 125 to the shaft driven by motor 35. In
the valve positions of FIG. 3, the ventilating valves 30 and 31 are
connected by conduit 16', valve 107, conduit 108, valve 109,
conduit 110 with its associated flowmeter 200 and switch units,
conduit 110A - catheter 105A, valve 111, conduits 113 and 115,
sputum trap 123 to catheter 105 and its opening 103. Thus, catheter
lumen 105A forms the main ventilating path and catheter 105 acts as
the minor ventilating and self cleansing path. Catheter lumen 104
acts as the pressure monitor line in view of its connection by
means 124, 120, 118, valve 112, 121, 127, valve 126 and to the
several pressure switches connected to line 129. When valves 111
and 112 are rotated to the position of FIG. 4, catheter lumen 104
becomes the minor ventilating and self-cleansing path in view of
its connection to conduit 110 by means 124, 120, 119, valve 112,
conduit 110; conduit 110 - catheter 105A again becomes the main
ventilating path; and catheter lumen 105 becomes the pressure
sensing line in view of its connection to conduit 129 by means 123,
115, 114, valve 111, 116, 127, valve 126, conduit 129. The
alternate use of the lumens 104 and 105 as minor ventilating
self-cleansing and pressure monitor conduit means is of great
advantage because the alternate flow of ventilating fluid in the
lumens keeps the lumens empty of mucous and other secretions which
tend to enter the catheter openings and plug the lumens.
Thus, pressure sensing conduit 129 is always in free communication
with the pressure conditions existing in the thoracic
intra-pulmonic portion of the body as measured in the
tracheo-bronchial tree.
Volume Mode Control Operation
In the volume mode control cycle, ventilation of the patient is
completely controlled and determined by the ventilator actions of
valves 30 and 31. Pressure switch 130 is bypassed by the manual
energization of switch 214. It should be noted that device 210
still supplies a sigh by periodically stopping motor 35 during the
flow period in pipe 110 up to the pressure allowed by high pressure
switch 211. Solenoid 133 is thus de-energized periodically when
there is flow in pipe 110 and arm 217 traverses space 223 and valve
132 is periodically closed to stop flow to motor 35 to hold valves
30 and 31 open until the sigh pressure is reached in the
patient.
Volume Mode Assist Cycle
In this operation, the patient assists in and controls the
triggering of the ventilating cycles. Override switch 214 is in its
open position. Low pressure switch 130 senses the predetermined low
or negative pressure (whenever the patient initiates a breath) for
which it is set and closes to energize conductor 134 and solenoid
133 to open valve 132. As before, flow from conduit 16' passes
alternately through valves 111 and 112 and thereby alternately to
lumens 104 and 105, whereby each lumen serves alternately as a
pressure monitor and minor gas-conducting cleansing function. The
main gas flow is through 110-110A-105C to catheter 105A. When flow
occurs in pipe 110, switch 204 and switch 206 are closed. Switch
204 through conductor 205 to 134 then energizes solenoid 133 to
keep valve 132 open and the motor turning. 204 supplies the only
energy to 133 because pressure switch 130 is now open because of
higher intra-pulmonary pressure present with maximum flow through
110 and lumen 105. Motor 35 keeps valves 30 and 31 turning until
flow ceases. Whe inflate valve 31 closes, flow in pipe 110 ceases,
vane 210 returns to neutral and switch 204 opens, switch 130 having
opened when lung inflation has reached the pressure above the
predetermined low pressure. When switches 204 and 130 open,
solenoid 133 is de-energized, valve 132 closes and motor 35 stops,
thus ending the inflation cycle. When the patient again initiates
another breathing cycle, switch 130 responds to the low pressure to
energize solenoid 133 and reopen valve 132 to start ventilator
motor 35. It should be noted that when no flow occurs in pipe 110,
switch 206 is held open by vane 210 and contact 226 bridges space
223 of device 210 so that the circuit through conductor 134 is
complete at that time.
Volume Mode Control Cycle
In the volume mode control cycle, the machine ventilates the
patient irrespective of his efforts or lack of efforts at
respiration. The override control switch 214 is manually turned on
and via conductor 215 and 134 continually (except for the optional
and adjustable periodic sigh cycle) energizes solenoid 133 to keep
valve 132 open thus continually having motor 35 rotate
inflate-deflate valves 31-30 at the rate set by throttle valve 37
and at the flow rate by throttle valve 47 in conduit 16.
Respiration Monitor, Alarm and Ventilation Take Over In Volume
Assist or Volume Control Mode
However, when there is very weak or no breathing, alarm pressure
switch 182, which is adjustably set to close below the minimally
acceptable pressure in line 129, remains open and therefore delay
relay 183 de-energizes after a predetermined time interval, if the
negative pressure in pipe 129 still has not been reached, and
closes its contacts and causes the actuation of alarm device 184.
Device 184 actuates a bell, light or similar device to call
attention. At the same time, delay relay 183 also energizes self
and manually resettable relay 227 to close and thereby energizes
conductor 230 leading to conductor 134. The result is that solenoid
133 is energized, valve 132 is opened to drive motor 35 and
initiate ventilation by valves 30 and 31. If the resettable relay
227 was placed in automatic mode then it must be manually reset to
stop the automatic ventilating continuous cycling. However, if it
was placed in the assist mode, then with that cycle, low-high
pressure alarm switch 182 is actuated, energizes delay relay 183
and it resets 227.
Volume Mode Low Positive Expiratory Pressure
This provision is used both in the assist or control volume mode to
help maintain the lungs at a partial inflation during the
exhalation phase of respiration, under certain medical and
physiological conditions, such as, pulmonary edema, hyaline
membrane disease, shock lung, and lack of surfactant. This is
achieved through valve 236 in suction conduit 29 when moved to
dotted line position wherein the deflate valve 30 is connected to
pressure conduit 16 through conduit 237 and adjustable
pressure-flow regulator 238. Thus the deflate half of the
respiratory cycle will act as a partial inflation by maintaining a
lower adjustable flow through valve 30, conduit 16', valve 107,
conduit 108, valve 109, conduit 110, the readjusted flowmeter and
switch unit 200 for the new pressure conditions, through valve 111
and 112 and then to triple lumen catheter 101, and through conduit
110A, 105C to main catheter 105A of the triple lumen catheter
101.
Volume Mode Assist or Control Sigh Cycle
The volume mode sigh cycle operates mechanically and electrically
the same in both the control or assist modes. Spring or gravity
solenoid 225, when not energized, maintains contact 226 bridged
across portion 223. However, with the onset of flow in 110 and
through flowmeter 200, switch 206 is closed and through conductor
207 energizes 225 to retract 226 from space 223. When wiper 217 is
within or crosses adjustable spaced open portion 223 (adjustable by
movable segments 220 and 221 of segmental contact 219) energy
through conductor 134 is interrupted. This de-energizes solenoid
133, closes valve 132, and stops the motor and inflate valve 31 in
the maximal flow position (set by adjustable flowmeter unit 200).
Maximal gas flow is maintained to the patient until either wiper
217 makes contact with 221 past the open portion 223 or until the
higher sigh pressure is reached and adjustable sigh pressure switch
211 closes and remains closed until re-opened by low or negative
adjustable pressure level sensed from 129. Switch 211, through
conductor 212 bypassing 210 energizes line 134 and restarts the
motor and moves valve 31 to stop flow to line 110. Only when wiper
217 is in open portion 223 with 225 energized can the sigh take
place. Sigh motor 218 has an adjustable rate from 0-100 times per
hour. However, switch 211 also acts as a safety during the assist
cycle in that should flow responsive switch unit 204 fail to
energize conductors 205 and 134 and thereby cause the closure of
inflate valve 31 during the volume assist cycle, 211 will remain
energized until re-set by a low or negative pressure from conduit
129 - double lumen catheter 101.
Manually Controlled Ventilation (Bypass of Volume-Pressure
Circuitry)
When hand rate controlled ventilation is desired, interconnected
valves 241 (FIG. 1) and 231 are moved to connect pressurized gas
source 16 through conduit 240 to conduit 105C and then to main gas
flow lumen 105A of triple lumen catheter 101. In its shifted
position, valve 231 disconnects conduit 149A - 110A upstream
therefrom from sputum trap 124A and connects conduit 105C
downstream therefrom and sputum trap 124A to conduit 240. Then
ventilation rate is set by the operator through valves 241-231 and
the flow rate is adjusted by throttle valve 242. If desired, the
humidifier circuit (conduits 63, 77, and valve 47) may be inserted
between the gas pressure source 15 and valve 21 to allow
humidification to proceed even in the manual mode, without
interfering with the suction provision. In that case, the motor 35
must be electric. However, a separate parallel conduit from the
pressure source 15 to the air motor, controlled by the valve linked
to 22 may be used, to allow humidification on all modes of
operation.
Pressure Mode Operation
In the pressure-mode operation, the mode selector valve 109 and
valve 126 (through their connecting means 135) are turned to their
pressure positions illustrated in FIG. 4 wherein valve 126 connects
conduits 160 and 129. Switch 136 is opened and valve 109
disconnects conduits 108 and 110. Flow from the source 15 through
the humidifier line 77-16 reaches valve 109 through conduit means
138, 139 throttle valves 140, selector valve 142 and conduit 143.
Valves 140 are adjusted to give two different rates of flow. Valve
142 connects either of branches 139 to conduit 143. If more
different rates are desired, the numbers of branches and throttles
therein, 139-140, may be increased. The flow from 143 passes
through valve 109 into conduit 146, valve 147 (when open), conduit
149, (conduit 149A, 105C to main gas catheter 105A), valve 150,
conduits 153, 154, 115, sputum trap 123 and into lumen 105 and the
patient.
Thus, the patient receives inflate pressure fluid. The other distal
lumen 104 becomes the pressure monitor line in view of its
connection to pressure sensing conduit 129 by means 124, 120, 158,
156, valve 151, 161, 160 and valve 126.
As discussed previously and below, valves 150 and 151 alternate
minor gas pressure conduction and intra-pulmonary pressure sensing
conduction to and from catheter lumens 105 and 104, respectively,
while the main gas flow is through conduit 149, 149A, valve 231,
conduit 105C to main proximal catheter 105A with its lumen
105B.
Pressure Mode Assist Cycle and Sigh Control
At a predetermined low or negative pressure (patient's inspiratory
breathing effort) in line 129, switch 176 is closed whereby
conductor 175 and solenoid 165 are energized to cause a forward
movement of pawl 164 to advance interconnected valves 150 and 151
90.degree. to the positions of FIG. 4. At the same time, low
pressure switch 178 is also actuated to closed position to energize
conductor 190 and coil 171 to move valve 147 to open position of
FIG. 4. In these valve positions (FIG. 4) flow takes place through
conduit 146, valve 147, conduit 149, (conduit 149A, valve 231,
conduit 105C, larger catheter 105A and to its proximal lumen 105B),
open valve 151, conduit 157, 158 to conduit 120 and lumen 104.
Lumen 105 becomes the pressure monitor via means 115, 154, 152,
valve 150, 160, valve 126 and conduit 129. When the intra-pulmonic
pressure attains a predetermined higher value than the lower or
negative pressure, pressure switch 179 is closed and conductor 191
is energized. Timer selector 192 usually connects conductor 191 to
conductor 195 and coil 170 to move valve 147 to the closed
position. Valves 150 and 151 remain in their position during the
exhale cycle.
At the next inhale cycle, the action of switches 176, 178 and 179
are repeated. Switch 176 actuates pawl and ratchet means 163-164 to
advance valves 150 and 151 another 90.degree. (FIG. 3 positions;
low pressure switch 178 energizes coil 171 to open valve 147; and
at a higher pressure (end of the inspiration cycle), switch 179
energizes coil 170 (through timer selector 192) to move valve 147
to the closed position.
Pressure switch 180 connected to conduit 129 is the sigh responsive
switch and is set to be activated to closed position at an
adjustable, predetermined higher pressure than switch 179. It is
connected by conductor 194 to timer selector 192 which periodically
connects it to conductor 195 and off coil 170 to close inflate
valve 147. Timer selector 192 is so adjusted that it connects
conductor 191 and switch 179 to conductor 195 a major portion of
the time cycles while conductor 194 and switch 180 are connected
intermittently and evenly interspersed the remaining minor portion
of the time cycles. After valve 147 is moved to closed position in
response to switch 180, the exhale cycle starts and, at the proper
low pressure, switch 178 is again activated to restart the inhale
cycle. This periodically causes a sigh (sigh rate adjustable by
192) per hour and for only one isolated respiratory cycle.
Pressure Mode Control Cycle with Sigh Control
If the patient does not breath or generate a sufficient negative
inspiratory effort, or one of deep enough value to energize
switches 176, 178 and 182, the alarm 184 is energized by switch
182, after the adjustable delay due to delay relay 183. Alarm 184,
in addition to giving a visual or audible signal, energizes
conductor 187, which conductor timer device 186 connects at
adjustable pre-set given intervals to conductors 197 and 190 to
energize coil 171 and move valve 147 to the open position. This
permits a flow of breathing gas to the valves 150 and 151 as well
as through conduit 149A, 105C and therefrom to the patient. The
flow continues until the pre-set high intra-pulmonic pressure is
reached and either pressure switches 179 or 180 are activated to
return valve 147 to the closed position. At the end of the exhale
cycle, either alarm 184 is again activated by the manual pre-set
assist alarm mode, or low pressure switches 176 and 178 take over
for a new cycle. However, alarm 184 may be pre-set in the alarm
control mode and then timer 186 initiates controlled respiration
with 179 and 180 closing valve 147 at the pre-set positive
pressures as described above.
The timer device 186 may also be arranged to interconnect
conductors 187 and 188 at the selected time intervals to energize
conductor 175 and solenoid 165 to advance the valves 150 and 151
90.degree. to a new position to alternate the pressure monitor
function of the lumens.
Pressure Mode, Low Positive Expiratory Pressure
In certain disease states, it is desirable to maintain continual
positive pressure in the lungs during the exhale phase to prevent
the alveoli (air sac) from completely collapsing. This value is
adjustable from 0 to 10 cm. of water pressure. This is accomplished
in bypass 172 which is secured to valve 173 on the same shaft 162
as valve 147 but is disposed 90.degree. thereto to the bypass -
closing rotating valve 147. Throttle valve 174 is adjusted to give
the desired exhale positive pressure by the rate of gas flow it
delivers to the patient during the exhale cycle. Switches 176 and
178 are adjusted to respond to the new positive low pressures to
initiate the inspiration phase. As before, each lumen serves
alternately as a flow catheter and as a pressure monitor
catheter.
Valve 173 is open in the deflate or exhale phase and valve 147 is
closed at that time. At the initiation of the inspiratory phase by
a low or negative pressure switch, valve 147 is actuated to the
open position and valve 173 is in closed position (FIG. 4). This
low positive expiratory pressure can function during the assist or
controlled pressure modes.
The manually controlled ventilation works similarly as previously
described following the volume mode description.
Nebulization Function in Volume and Pressure Modes
As shown in FIGS. 3 and 4, a nebulizer is inserted in line 110
following the flowmeter unit 200 in the volume section, and in line
146 between valve 109 and conduit entrance 172 before the pressure
valve 147 and 173. As shown in a more close-up view in FIG. 5, the
nebulizer itself is connected to the conduit by connection to two
conduits labeled 248A and 248B. These are plug-in or screw-on high
pressure sealing connectors 250A and 250B as is common in the
present state of the art. The pressurized gas flows both down the
long conduit shown in fragmentary view as well as up conduit 148B
through connecting and one way valve means 250A and down into the
nebulizer tank circuit. The nebulizer tank consists of high
pressurized outer steel cylinder 246 and a connecting top portion
screw-on or snap-on but retained air tight and waterproof by the
fastening means 245. Inside this is located the plastic or other
disposable material container with the sterile nebulization fluid
within and shown at the water level both in the main tank section
and in the nebulization fluid level site tube 244. The
pre-sterilized nebulization fluid in its disposable container has a
plastic or rubber plugs at both ends which are perforated by
members 243A and 243B which then are connected to the circuitry.
243A and 243B are very narrow gauge adjustable lumens of
approximately 28 to 30 gauge size. By gravity and by differential
pressure to be described, the nebulization fluid flows down 240B
through one way valve and connecting means 250B drips into the
pressurized gas conducting conduit shown in fragmentary view. This
conduit is either 110 in the volume mode or 146 in the pressure
mode. The throttle valve 249 only minimally constricts this
pressurized gas conducting conduit and in so doing creates a slight
differential pressure between 248A and 248B which then helps push
the negulization fluid through 243B besides being dependent upon
gravity. The drop of fluid entering the conduit, shown in
fragmentary view, is then nebulized by the massive flow through
that line. Observing the water level in FIG. 5, the amount of fluid
remaining can always be known. The disposable plastic unit 247 as
described previously and the labeled 247A and 247B rubber or
plastic perforatable sealed connectors always remain sterile and
easily insertable. This is the description of the preferred
embodiment although modification in its shape and form can
obviously be made by anyone in the art without changing its basic
function.
Connecting, Integral, Single and Triple Lumen Catheters
The ventilating machine (FIGS. 1-4) forces air or oxygen under high
pressure (30-100 pounds per square inch) through the catheter into
the trachea, and even in the presence of the air leak through the
mouth (retrograde flow), pressures of 15 to 35 cm. water are easily
attainable (same pressure reached as present machines that use a
closed system - large tube and balloon cuff).
When the gas flow is discontinued, the patient exhales out of the
normal oral route. In complete upper airway expiratory obstruction
(above the catheter entrance site) suction is cyclically provided
to aid exhalation. Using the single lumen catheter system the
patient's ventilation is controlled by the ventilating machine, but
with the triple lumen catheter and ventilating system, the patient
can control the machine and therefore the assist ventilating mode
plus measurement of intrapulmonic pressure as well as gas analysis
is made possible. The larger proximal lumen conducts the
ventilating gas while one of the other distal lumens alternately
transmits the intra-tracheal (intra-pulmonic) pressure level to the
sensing device, and conducts the minor high pressurized gas self
cleansing flow.
The single lumen patient adaptor means (FIGS. 6-10, 17, 19) has a
pressurized gas conduit 251 which conducts the pressurized gas from
its connecting hub 256 to its terminal open lumen 264 plus side
holes 261. The thick walled inner hollow needle-trochar member 252
traverses the entire length of the pressurized gas conducting
conduit 251 and extends beyond each end for a short distance (FIG.
6). The distal portion 293 has a sharp leveled cutting edge plus a
small opening 299 which transmits air, when properly located within
the trachea, to the proximal syringe 258. The syringe connecting
member 259 fits snugly into the needle-trochar hub 257 and is an
air tight connection. Air is transmitted through lumen 297 of the
needle-trochar unit into the syringe 258, when in proper position
by pulling on plunger unit 260. Following proper position, the
catheter 251, is advanced into the trachea 265, holding the
needle-trochar unit stable. When the catheter flange 253 and hub
portion 255 reach the skin the needle-trochar is removed. The
catheter assumes a pre-molded 90.degree. curve whose radius is one
half the respective tracheal diameter, this curve being shown as
curve 254 in FIG. 8 and which stabilizes it aimed down the trachea,
without pressure on the tracheal wall. Hub 256 has screw locking
prong 291 which can screw lock onto the gas conduit from the
ventilating machine, as well as receiving its receptable within
said hub.
The side holes 261 provided along the catheter act as a safety
valve when the end lumen 264 may be located at a poor angle in
relation to the tracheal lumen. They also aid in lateral
transmission of the pressurized gas (up to 75%) when the terminal
porous gas diffusing member 287 is attached (FIG. 17). In this
instance, insertion is within the breakaway needle trochar when
placed through the skin, or passed without a trochar via the oral
route. The porous gas diffusing member 287 decreases the constant
aimed site of the single gas jet and diminished any local effect
possible from it. The catheter has a skin anchoring flange 253
(FIGS. 6, 7, 8) which is firmly fixed and solid with the distal hub
portion 255 and a solid part of catheter 251. This flange has holes
254 through which it may be sutured to the skin at the neck
entrance site or tapes or strings attached to hold it in place on
the neck.
Snugly placed around the catheter 251 and firmly integral to it is
a balloon 263. As the pressurized gas flows down the catheter 251
it meets a small degree of resistance at the pre-molded, resiliant,
inner projecting catheter gas inlet wedge 262 (FIGS. 6, 8, 9, 10).
This wedge is held flat in position by the inner needle-trochar
unit but when the needle-trochar unit is removed, the gas inlet
wedge partially springs into the lumen and by its presence channels
some gas through its lumen and and distends the balloon 262. This
proximal tracheal partial obstructing balloon effectively decreases
the tracheal opening and therefore decreases the retrograde leak
only while the pressurized gs is flowing in catheter 251. This
allows the lungs to be distended to the same final pressure and
volume by a lesser amount of the pressurized gas.
The single lumen catheter can be passed via the naso-pharyngeal or
oro-pharyngeal route between the vocal cords and positioned into
the trachea. This method is especially desirous in infants and
small children. The catheter 251 then does not have pre-molded
curve 294 but is straight and has multi-level anchoring and
compression withdranding ridges 285. These allow the catheter to be
sutured or taped or tied in proper position through holes 286 at
the correct level for each individual patient and prevents catheter
251 from bending to the degree where it will narrow its lumen and
also prevents the teeth and gums from compressing the lumen.
The triple lumen patient adaptor means (FIGS. 11-16, 18) utilizes
the larger proximal lumen as the main gas conducting catheter while
it allows one distal lumen to act as the pressurized gas conducting
self cleansing conduit while at the same time the other distal
lumen transmits the tracheal (intra-pulmonic) pressure to the
ventilating machine. As in the single lumen variety there is a
similar skin anchoring flange 253 but with three hubs 261, 262,
263. Each catheter 264, 265, 266 has its own respective lumen 267,
268, 269; respective side holes 270, 271, 272 but only the larger
main proximal catheter has a gas wedge inlet 273 to its proximal
partial obstructing tracheal balloon 274. As shown in FIGS. 14, 15,
16, 18 the main proximal lumen always acts as the main pressurized
gas conducting conduit, while one distal lumen is cleansed by the
minor gas flow and, at the same time, the other distal catheter
transmits the intra-tracheal pressure back to the ventilating
machine. With the next respiration cycle the other distal catheter
conducts the gas cleansing flow while the former distal catherer
now transmits the tracheal pressure.
The triple lumen patient adaptor means is inserted through a novel
breakaway 3/4inch long trochar (FIGS. 11, 13). The trochar unit
consists of a thick walled sharp straight inner needle 275, the
same diameter as the triple lumen patient adaptor means used, with
an attached syringe 276. Snugly fitting around this sharp hollow
needle is a shorter blunt flat-ended trochar 277 which allows the
triple lumen patient adaptor means to pass through it. This blunt
trochar has a split shaft 278 and split hub 279 with attached
separate wing handles 280, 281. When assembled, the sharp inner
needle extends 2 mm. longer than the blunt flat-ended hollow
trochar. This is thrust through the skin, then through the
crico-thyroid membrane (or crico-tracheal membrane) into the
trachea. When air is aspirated back, the intra-luminal position is
assured and the blunt trochar is advanced 4 mm. further, and held
in place while the inner longer needle unit is removed. Next the
triple lumen patient adaptor is passed through the blunt
split-sided trochar down into the trachea. This is passed until the
skin anchoring flange 253 reaches the separate wing handles 280,
281 of the trochar unit. At that moment the blunt split-sided
trochar is pulled out of the trachea until its distal blunt end
leaves the skin surface, leaving most of the triple lumen patient
adaptor means within the trachea. The separate wing handles are
grasped and bent toward each other, splitting open the whole blunt
trochar member 277 (FIG. 13) by the separation of the split shaft
edges, and causing it to fall away from the triple lumen patient
adaptor means which remains within the trachea. This triple lumen
unit has a blunt sliding stiffening rod 282 placed within the
larger proximal lumen which now aids the triple lumen patient
adaptor means placement further within the trachea by pushing it
until the anchoring flange 253 is flush with the skin surface. Then
this inner stiffening rod 282 is removed, the pre-molded
self-returning 90.degree. curve 264 is assumed and the entire
triple lumen patient adaptor means connected to its control
ventilating and pressure regulating means. This advancement is also
aided by the extra stiffness incorporated in the proximal one-half
cm. of the catheter.
The triple lumen separating wall 283 (septum) divides the major gas
inflating proximal lumen from the pressure sensing lumens. The wall
284 (septum) separates each of the narrower alternate pressure
sensing, self-cleansing lumens.
The triple lumen patient adaptor means may be passed via the oral
route between the vocal cords and it also has the anchoring 286 and
compression withstanding ridges 285 as well as the porous gas jet
diffusing member 287 on the main inflating lumen.
The triple lumen patient adaptor means could be constructed of
three parallel tubular lumens (one larger proximal abd two narrower
distal lumens) when passed via the oral route.
The single lumen patient adaptor means may have a thin, narrow
pressure sensing transducer 288 placed distal to it and have the
pressure sensing information conductor 289 passed through it (FIG.
19) or through a separate route to the controlling ventilating
means with which it works to measure the trachea (intra-pulmonic)
pressures and utilize this pressure data to regulate, control and
monitor the ventilation of the patient.
The length between the wider, larger proximal lumen of the triple
lumen patient adaptor means and the distal, narrower double lumen
pressure sensing, self-cleansing means is from 1.5 to 15 cm.
depending upon the size of the patient it is utilized in. The
larger proximal lumen diameter is from 0.5 to 2 mm. depending upon
the size of the patient. The ratio of the single lumen patient
adaptor means (and main lumen of the triple lumen patient adaptor
means) to the tracheal diameter is from 1:6 to 1:50 depending upon
the size of the patient, patient disease, patient age and lung
compliance as well as whether or not the proximal partial tracheal
obstruction balloon is utilized. The patient adaptor means
construction is such as to withstand pressures up to 100 psi.
These patient adaptor means can remain in place and be utilized
intermittently with the ventilator to give intermittent positive
pressure breathing treatments, instillation and nebulization of
mucolytic agents and antibiotics as well as measurements of expired
air content of oxygen and carbon dioxide.
The catheter means for use with the present ventilating apparatus
is the subject matter of my co-pending application entitled
"Distally Perforated Catheter for Use in Ventilating System" filed
on the same date that this application is filed. The nebulizer of
the system is claimed herein whereas the new distal perforated
catheters for single, double and triple lumen structures are
claimed in said co-pending application just referred to.
* * * * *