U.S. patent number 3,812,878 [Application Number 05/342,702] was granted by the patent office on 1974-05-28 for fail-safe breathing circuit and valve assembly for use therewith.
This patent grant is currently assigned to Bird Corporation. Invention is credited to Forrest M. Bird, Henry L. Pohndorf.
United States Patent |
3,812,878 |
Bird , et al. |
May 28, 1974 |
FAIL-SAFE BREATHING CIRCUIT AND VALVE ASSEMBLY FOR USE
THEREWITH
Abstract
Breathing circuit for use in supplying gas under pressure to the
airway of a patient having a control with an inspiratory and
expiratory phase for controlling the supply of gas. Means is
provided for supplying the gas to the patient to ventilate the
patient. An exhalation valve which is controlled by the controller
controls the flow of expiratory gases from the patient. Manual
means is provided for ventilating the patient in the event of
failure of the controller. A first valve assembly having an
inspiratory one-way valve and an expiratory one-way valve is
provided for maintaining the inspiratory and expiratory gases
separate. The first valve assembly is coupled to a second valve
assembly which is coupled to the exhalation valve assembly. A
resuscitation bulb is coupled to the second valve assembly and is
utilized for supplying gas under pressure through the second valve
assembly and through the inspiratory one-way check valve to the
airway of the patient.
Inventors: |
Bird; Forrest M. (Palm Springs,
CA), Pohndorf; Henry L. (Palm Springs, CA) |
Assignee: |
Bird Corporation (Palm Spring,
CA)
|
Family
ID: |
26879550 |
Appl.
No.: |
05/342,702 |
Filed: |
March 19, 1973 |
Related U.S. Patent Documents
|
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
Issue Date |
|
|
183822 |
Sep 27, 1971 |
|
|
|
|
Current U.S.
Class: |
137/512;
137/855 |
Current CPC
Class: |
A61M
16/00 (20130101); A61M 16/0833 (20140204); Y10T
137/7838 (20150401); Y10T 137/7891 (20150401) |
Current International
Class: |
A61M
16/00 (20060101); F16k 015/16 () |
Field of
Search: |
;137/512,525.3,525.5 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Cline; William R.
Attorney, Agent or Firm: Flehr Hohbach Test Albritton &
Herbert
Parent Case Text
This is a division of application Ser. No. 183,822 filed Sept. 27,
1971.
Claims
We claim:
1. In a valve assembly for controlling the flow of a gas, a body
having a chamber therein, said body being formed with first, second
and third passages in communication with said chamber, a one-way
check valve mounted in said first passage permitting gas to flow
only into said chamber, an additional one-way check valve mounted
in said third passage permitting gas to flow only out of said
chamber, said one-way check valves each including first and second
rings, a member formed of an elastomer disposed between said first
and second rings, said member having a circumferential margin
formed with an arcuate slit which subtends over 270.degree. to
provide a flapper valve member positioned centrally of said margin
and connected therewith by a hinge portion of said member, one of
said rings being provided with a valve seat, said first and second
rings being provided with inclined surfaces engaging opposite sides
of said margin and applying a bias to said flapper member so that
the flapper valve member is yieldably urged into engagement with
the valve seat, and means securing said first and second rings and
said member into a unitary assembly.
2. In a check valve assembly, a valve housing, first and second
rings mounted in juxtaposed relationship in said housing, a member
formed of elastomer and having an outer annular margin disposed
between said first and second rings, said member being formed with
an arcuate slit therein subtending over 270.degree. of said margin
to define an inner circular flapper-type valve member moveable in
said rings and with the un-slit portion of said member between said
flapper-type valve and the margin defining an integral hinge, one
of said rings being provided with a valve seat, said first and
second rings being provided at their facing sides with inclined
surfaces engaging opposite sides of said margin and holding the
same at an inclination with respect to said member to yieldably
bias the latter into engagement with said valve seat.
Description
BACKGROUND OF THE INVENTION
Respirators and ventilators of many types have heretofore been
provided which are of the automatic type. In the past in case of
failure of such respirators or ventilators, it has been necessary
to completely disconnect such a respirator or ventilator from the
patient and to utilize other means such as a manual resuscitator on
the patient. This has resulted in considerable delay in ventilation
of the patient which can cause great danger to the patient
particularly if he is under intensive care. There is, therefore, a
need for a new and improved respiratory apparatus which overcomes
this objection.
SUMMARY OF THE INVENTION AND OBJECTS
The breathing circuit of the present invention is for use in
supplying gas under pressure to the airway of a patient. A
controller having an inspiratory and expiratory phase in its
operative cycle is provided for cyclically applying gas under
pressure. A first valve assembly is also provided which has a body
having a chamber therein. The body is formed with first, second and
third passages therein in communication with said chamber. A
one-way expiratory check valve is mounted in said first passage and
only permits gas to flow into said chamber. A one-way inspiratory
check valve is mounted in the third passage and only permits gas to
flow out of said chamber. A second valve assembly is provided which
comprises a body. A diaphragm assembly is disposed in the body of
the second valve assembly and forms first and second chambers
within the body of the second valve assembly on opposite sides of
the diaphragm assembly. The body of the second valve assembly is
formed with first and second passages in communication with said
first chamber and a third passage in communication with said second
chamber. The diaphragm assembly is movable to occlude said first
passage in said body of said second valve assembly. The diaphragm
assembly carries one-way valve means which permits gas to flow only
from said second chamber to said first chamber. The body of the
second valve assembly carries one-way valve means which permits gas
outside the body of the second valve assembly to flow into the
second chamber. A compression bulb is coupled to the third passage
of the second valve assembly. An exhalation valve assembly is
provided and comprises a body having first and second flow passages
therein in communication with each other. The second passage is
open to ambient. A valve member is mounted in the body of the
exhalation valve assembly. Means is provided in the body of the
exhalation valve assembly for yieldably urging the valve member
into a position to occlude said first passage in said body of the
exhalation valve assembly. Means is provided for coupling the first
passage of the second valve assembly to the first passage of the
exhalation valve assembly. Means is also provided for coupling the
second passage of the second valve assembly to the second passage
of the first valve assembly. A patient adapter is provided which is
adapted to be connected to the airway of a patient. Means is
provided for coupling the gas supplied by the controller to the
patient adapter and to the third passage of said first valve
assembly. Means is also provided for coupling the patient adapter
to the first passage of the first valve assembly. When desired,
means is provided for supplying a jet of gas during the expiratory
phase of the controller in the expiratory flow passage to create a
sub-ambient condition in the expiratory flow passage.
In general, it is an object of the present invention to provide a
breathing circuit which is fail-safe.
Another object of the invention is to provide a breathing circuit
of the above character which can be manually overridden to continue
ventilation of the patient in the event of failure of the automatic
controller.
Another object of the invention is to provide a breathing circuit
of the above character which does not require any switching to
transfer from automatic to manual operation.
Another object of the invention is to provide a breathing circuit
of the above character which permits the operator to monitor the
resistance of the patient's lungs.
Another object of the invention is to provide a breathing circuit
of the above character in which the inspiratory phase can be
aided.
Another object of the invention is to provide a breathing circuit
of the above character which utilizes a particularly novel
overriding safety valve.
Another object of the invention is to provide a safety valve
assembly which can be utilized in conjunction with a breathing
circuit to permit manual override in the event of failure of the
automatic controller.
Another object of the invention is to provide a valve assembly of
the above character which does not develop undesirable flutter
during operation in a breathing circuit.
Additional objects and features of the invention will appear from
the following description in which the preferred embodiments are
set forth in detail in conjunction with the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is a partial plan view disclosing a breathing circuit
incorporating the present invention.
FIG. 2 is an enlarged cross-sectional view of the overriding safety
valve assembly utilized in the breathing circuit shown in FIG.
1.
FIG. 3 is a cross-sectional view taken along the line 3--3 of FIG.
2.
FIG. 4 is a greatly enlarged portion of one of the one-way check
valves of the safety valve assembly shown in FIG. 2.
FIG. 5 is an enlarged cross-sectional view of the non-rebreathing
valve assembly utilized in the breathing circuit shown in FIG.
1.
FIG. 6 is an enlarged cross-sectional view of the exhalation valve
assembly utilized in the breathing circuit shown in FIG. 1.
DESCRIPTION OF PREFERRED EMBODIMENTS
A fail-safe breathing circuit incorporating the present invention
is shown in FIG. 1. As shown therein, it consists of a conventional
stand 11, only a part of which is shown. Such a stand includes a
vertical tube or pipe 12 through which a gas such as oxygen is
supplied and which is to be utilized in the fail-safe breathing
circuit. The pipe 12 is provided with a gooseneck and is directly
connected by a fitting 13 to a controller 14. If desired, before
the gas is supplied to the controller 14, it can be passed through
a blender (not shown) of the type described in U.S. Pat. No.
3,727,627 issued Apr. 17, 1973.
The controller 14 is of a conventional type supplied under the
designation of "MARK 8" by Bird Corporation of Palm Springs,
California. This controller is also described in U.S. Pat. No.
3,191,596. As described therein, the controller has an inhalation
phase and an exhalation phase in its operative cycle. The
controller has an inlet which is adapted to be connected to a
source of gas under pressure. The controller is provided with an
outlet 16 which, as hereinafter described, is adapted to be
connected to the airway of a patient. The controller includes a
main control valve in the controller which is movable between open
and closed positions to control the flow of gas from the inlet to
the outlet. The controller also includes means for operating the
main control valve so that the main control valve is in an open
position during the inhalation phase and in a closed position
during the exhalation phase. This means includes means for sensing
when a predetermined pressure is reached in the outlet for shifting
the main control valve from an open position to a closed position.
Thus, it can be seen that the controller 14 supplies gas under
pressure at the outlet 16 during the inspiratory phase. The length
of the inspiratory phase and the expiratory phase can be readily
controlled by adjusting appropriate controls on the controller
14.
The controller 14 is also provided with an outlet 18 which is
supplied with gas under positive pressure when the main control
valve in the controller is in the open position or, in other words,
the controller is in the inspiratory phase. The controller is also
provided with an additional outlet 19 which is supplied with gas
under positive pressure when the main control valve is in a closed
position or, in other words, when the controller is in the
expiratory phase.
A fitting 21 is removably mounted in the large outlet 16 and has a
large flexible plastic tube 22 connected thereto The other end of
the tube 22 is connected to another fitting 23 mounted in one leg
of a tee 24. Another leg of the tee 24 is mounted upon the inlet of
a large nebulizer 27 which is utilized for humidifying the gas that
is supplied to it. The nebulizer is of the type described in U.S.
Pat. No. 3,353,536. The nebulizer 27 is provided with an outlet 28
which has one leg of another tee 29 mounted therein. A fitting 31
is mounted within another leg of the tee 29 and has connected
thereto a large flexible plastic tube 32 which has its other end
connected to a bifurcated patient wye or adapter 33. The patient
wye is adapted to be connected to the airway of the patient in a
suitable manner such as by means of a face mask, an endotracheal
tube and the like.
In the event that it is desired to supply medication to the air or
gas which is being delivered to the patient, an additional
nebulizer 36 is mounted on the other leg of the tee 29. The
nebulizer 36 is of a type described in U.S. Pat. No. 3,172,402.
Gas under positive pressure is supplied to the nebulizer 27 to
nebulize the liquid contained therein by connecting a flexible tube
37 to the outlet 18 and to a fitting 38 provided on the nebulizer
27. Alternatively, or in addition, the same tube 37 can be
connected to the nebulizer 36 for nebulizing the liquid which is
carried by the nebulizer 36.
The gas that is properly humidified and supplied with the desired
medicine is supplied to the patient through the wye 33. Expiratory
gases from the patient pass into the large tube 41 connected to the
wye. The tube 41 is secured to a fitting 42 which is mounted in a
check valve assembly 43 of a valve assembly 45. The check valve
assembly 43 is mounted on one of the legs of a tee 44 which forms
part of the valve assembly 45. The tee 44 forms a body having a
chamber 37' therein and first, second and third flow passages 38,
39 and 40 therein, respectively, which are in communication with
the chamber 37'. The other leg of the tee 44 immediately opposite
the leg on which the check valve assembly 43 is mounted has another
check valve assembly 46 mounted thereon. The check valve assembly
46 is also connected to one of the legs of the tee 24. The leg of
the tee 44 at right angles to the other legs of the tee 44 is
mounted in a coupling 48. The coupling 48 is mounted upon a
non-rebreathing valve assembly 51. A sleeve 52 is mounted in the
valve assembly 51 and is connected to an exhalation valve assembly
53. A compression bulb or bag 56 is also mounted on the
non-rebreathing valve assembly 51. A fitting 57 is mounted in the
exhalation valve assembly 53 and is connected by a tube 58 to the
fitting 38 of the nebulizer 27. A fitting 59 is mounted in the tee
44 and is connected by a tube 61 to the outlet 19 of the controller
14.
The construction of the two check valve assemblies 43 and 46 and
the tee 44 is shown in detail in FIG. 2. As shown therein, the tee
44 is provided with a nozzle 66 which is provided equi-distant
between the ends of the opposite legs. The nozzle 66 has a port 67
which is in communication with a passage 68 provided in the nozzle
and which is adapted to receive the fitting 59 hereinbefore
described. The nozzle 66 is in axial alignment with a venturi-like
passage 71 provided in the other leg of the tee 44. The passage 71
opens into the passage 40 which is adapted to receive a coupling if
so desired.
The check valve assembly 43 is shown in detail in FIGS. 3 and 4. As
shown therein, it consists of a pair of rings 76 and 77 formed out
of a suitable material such as plastic. The ring 76 is provided
with an annular inclined surface 78 which is inclined at a suitable
angle such as 45.degree. which is adapted to cooperate with a
similar surface 79 provided on the ring 77. It is also inclined at
a suitable angle as, for example, 45.degree.. The ring 77 is also
provided with an additional annular surface 81 which is adapted to
serve as a valve seat. The ring 76 is provided with a circular
opening 82 which is substantially larger than the opening 83
provided in the ring 77. A valve member 84 is provided which is
yieldably urged into engagement with the valve seat 81. The valve
member 84 is formed in a particular manner as hereinafter described
to provide a preload which keeps the valve member 84 in a closed
position. Thus, for the valve member, a fairly low durometer or
fairly soft elastomer is chosen. The elastomer is formed into a
circular disc 86 having a thickness of approximately one-sixteenth
of an inch. The valve member 84 is then formed in the partial shape
of a circular disc 86 by cutting an arcuate slit 87 in the disc
which extends through an angle greater than 270.degree. and
preferably as much as 315.degree. as shown in FIG. 3. This leaves
the central portion of the disc 86 as a flapper valve member 84.
The disc 86 is then placed between the two rings 76 and 77 so that
the outer margin of the disc is engaged by the inclined surfaces 78
and 79. The rings 76 and 77 are pressed together which serves to
compress the outer margin of the disc and in particular to compress
the disc at the hinge portion 86a which urges the outer extremity
of the valve member 84 downwardly to preload the same against the
seat 81. After the desired amount of preload has been obtained, the
rings 76 and 77 are cemented in place and are held in place on one
end of the tee 44 by adaptor sleeve 91 which is secured to the tee
44. The sleeve 91 is provided with a shoulder 92 that engages the
outer ring 77 and serves to hold rings 76 and 77 in place so that
they firmly clamp the disc 86 to apply the desired amount of
preloading to the valve member 84.
The check valve assembly 46 is constructed in a similar manner
although it is yieldably urged towards a closed position in a
direction opposite that for the check valve assembly 43. For that
reason, it will not be described in detail.
It has been found that by constructing the check valve assembly in
this manner, it is possible to preload the valve members so that
they will remain closed while opening very easily. The preloading
is sufficient to minimize any tendency to flutter during
physiological flow of gas through the breathing circuit. Expiratory
resistance provided by such a check valve assembly has been
minimized. An elastomer force acts upon the hinge of the valve
member to provide the desired amount of resistance to opening.
The compression bulb 56 is in the form of a flexible reservoir. It
is formed by a balloon type bag formed of a suitable material such
as molded rubber or plastic. It is important that the bag have a
good memory, that is, that it will recoil to its original shape
after it has been squeezed or collapsed.
The non-rebreathing valve assembly 51 which is used as a part of
the breathing circuit shown in FIG. 1 is shown in detail in FIG. 5.
It is also described in copending application Ser. No. 183,823,
filed Sept. 27, 1971. As shown therein, it consists of a body 112.
A diaphragm assembly 113 is mounted within the body and forms
chambers 114 and 116 on opposite sides of the diaphragm assembly
within the body. As shown, the body 112 can be formed in two parts
which can be identified as first and second parts or top and bottom
parts 117 and 118. Both of the parts are cylindrical and generally
cup-shaped. Thus, the first part 117 is provided with a planar
circular wall 121 which has formed integral therewith a depending
internally threaded side wall 122. A cylinder 123 is formed
integral with the wall 121 and extends vertically or outwardly
therefrom at right angles. A smaller tube or cylinder 124 is
provided within the cylinder 123 and is supported by an annular rib
126 which is formed integral with the cylinder 123 and the cylinder
124. The cylinder or tube 124 is provided with a flow passage 127
which opens to atmosphere or ambient and which is in communication
with the first chamber 114 to provide an expiratory port as
hereinafter described. The lower extremity of the tube 124 forms a
valve seat adapted to be engaged by the diaphragm assembly 113 to
close the expiratory port.
The first part is also provided with a cylindrical extension 128
formed integral with the cylindrical extension 123 and extending at
right angles thereto. This cylindrical extension is provided with a
flow passage 129 which is adapted to be placed in communication
with the airway of the patient as hereinafter described. The
passage 129 is in communication with an annular passage 131 which
is formed between the outer surface of the inner cylinder 124 and
the inner surface of the outer cylinder 123 below the rib 126. This
annular passage 131, as can be seen from the drawing, is in
communication with the chamber 114 on one side of the diaphragm
assembly 113.
The second part 118 is also provided with a circular planar wall
136 and an upstanding externally threaded circular side wall 137
which is formed integral with the wall 136. The second part is
formed with a cylindrical extension 138 which extends at right
angles or vertically from the planar circular wall 136. The
cylindrical extension 138 is provided with a flow passage 139 which
can be considered to be an inlet passage that is in communication
with the chamber 116 formed on the other side of the diaphragm
assembly 113. A plurality of holes or openings 141 are formed in
the wall 136 between the side wall 137 and the cylindrical
extension 138. The holes or openings 141 are equally spaced in a
circle around the cylindrical extension 138 and are in
communication with ambient on one side and in communication with
the chamber 116 on the other side. One-way valve means is provided
for closing the holes or openings 141 and consists of an annular
resilient member 142 formed of a suitable material such as rubber.
The resilient member 142 is carried by the second part and has its
inner margin seated in an annular recess 143 provided in the second
part 118. The outer annular margin of the resilient member 142 is
free so that it can act as a one-way flapper valve for normally
occluding the holes or openings 141 and so that gases can only pass
one way through the openings 141, that is from ambient into the
chamber 116.
The diaphragm assembly 113 consists of a diaphragm 146 formed of a
suitable material such as Silastic. The diaphragm 146 is provided
with an annular lip portion 146a which is adapted to be clamped
between the first and second parts 117 and 118. Cooperative means
is provided for fastening together the first and second parts to
form a unitary assembly and consists of threading the two parts
together as shown in FIG. 2. The diaphragm 146 is provided with an
annular downwardly extending convolution 146b to impart a memory to
the diaphragm so that it will hold itself in a predetermined
position within the body 112. The diaphragm 146 is reinforced by
suitable means such as by bonding to a rigid circular plate or disc
147. The disc 147 is formed of a suitable material such as
metal.
The inner or central portion of the diaphragm assembly 113 is
adapted to be engaged by the innermost or lowermost extremity of
the cylinder 124 provided in the first part. The central portion
146c of the diaphragm 146 underlies the passage 127 in the cylinder
124. A plurality of holes or openings 148 in the diaphragm are
spaced in a circle around the central portion 146c outside the
cylinder 124 and inside the convoluted portion 146b. Holes or
openings 150 are provided in the plate 147 in registration with the
holes 148 and establish communication between the chambers 114 and
116. One-way valve means is provided for occluding the holes or
openings 150 and consists of a circular flapper valve member 149
formed of a suitable material such as Silastic which covers the top
of the plate 147. Suitable means is provided for securing the
central portion of the flapper valve member 149 to the inner
portion of the diaphragm 146 and to the disc 147 and consists of a
tit 151 formed integral with the flapper valve member 149 and which
extends through holes 152 and 153 provided in the disc 147 and the
diagpragm 146. As shown in the drawing, the tit 151 is provided
with an enlarged portion 151a so that when the tit 151 is in place,
the enlarged portion 151a is on the other side of the diaphragm 146
and will retain the valve member 149. Thus, it can be seen that the
flapper valve member 149 only permits gases to flow in one
direction through the diaphragm assembly 113, namely in an upward
direction as viewed in FIG. 5. The flapper valve 149 in conjunction
with the holes or openings 148 and 150 forms a multi-orificed
directional flapper valve which is used as hereinafter
described.
The exhalation valve 53 is generally of the type disclosed in U.S.
Pat. No. 3,688,794 issued Sept. 5, 1970. It consists of a body 191
(see FIG. 6) which is provided with an inlet passageway 192 that is
in communication with an outlet passage 193 at right angles to the
inlet passageway 192. A mushroom-shaped valve member 194 is adapted
to seat against the valve seat 196 to interrupt the communication
between the passages 192 and 193. The valve member 194 is yieldably
urged into engagement with the valve seat 196 by a spring 197
mounted concentrically on a sleeve 198 formed integral with the
valve member 194. The other end of the spring 197 is mounted in a
well 199 formed within a valve guide member 201 disposed within the
body 191. The valve member 201 is provided with a cylindrical
portion 201a which is provided with spaced ribs 202 extending
axially thereof and with an annular skirt-like portion 201b. A
guide stem 203 is slidably mounted in the sleeve 198 and is mounted
in a diaphragm 204. The outer annular margin of the diaphragm 204
is clamped to the body by a cap 206 which is threaded into the body
191. A chamber 207 is formed between the cap 206 and the diaphragm
204 and is in communication with a passage 208 in the cap 206. The
passage 208 has fitting 57 mounted therein. The inlet 192 of the
exhalation valve has the sleeve 52 mounted therein. The outlet
passage 193 is open to atmosphere or ambient as shown.
Operation of the fail-safe breathing circuit may now be briefly
described as follows. Let it be assumed that the bifurcated patient
adapter wye 33 has been connected to the patient in a suitable
manner and that the controller 14 has been adjusted to provide the
desired length of time for the inspiratory phase and the desired
length of time for the expiratory phase. The gas to be supplied to
the patient flows from the pipe 12 through the controller 14 and
out the main outlet 16 through the large tube 22 to the tee 24.
This gas is prevented from entering the tee 44 because of the check
valve assembly 46. As can be seen from FIG. 2, the check valve
member 84 only opens in an opposite direction and, therefore,
prevents gas from passing downwardly into the tee 44. Thus, the gas
which is supplied by the controller 14 passes into the nebulizer 27
where water is vaporized so that the gas is humidified. The
nebulizer operates because of the positive pressure supplied on the
tube 37 from the outlet 18. As also explained previously, suitable
medicinal preparations may also be supplied to the gas by the
nebulizer 36. Thus, the gas, after it has been humidified and the
proper medicinal preparation broken up in suspended particles and
placed in the gas, is supplied to the large tube 32 to the patient
wye 33 and thence to the proximal airway of the patient. The lungs
of the patient are inflated during the inspiratory phase.
The application of gas pressure through tube 58 to the exhalation
valve assembly 53 keeps the exhalation valve closed during
inspiratory phase to prevent venting of inspiratory gases to the
atmosphere.
Upon termination of the inspiratory phase by the controller 14, gas
under pressure is no longer supplied through the outlets 16 and 18.
The expiratory phase begins and the gas in the lungs is expelled by
the patient during the expiratory phase through the patient wye 33
and through the large tube 41. The expiratory gases pass upwardly
through the check valve assembly 43 opening the one-way flapper
valve member 84 and thence passing into the tee 44 through the
passage 71 through the sleeve 48 and into the passage 129 of the
non-rebreathing valve assembly 51. The expiratory gases then pass
into the annular passage 131 into the chamber 114 to move the
diaphragm assembly 113 downwardly so that the chamber 114 is vented
through the passage 127 to the exhalation valve assembly 53. The
valve member 194 of the exhalation valve assembly is moved upwardly
against the yieldable force of the spring 197 to thereby vent the
passage to atmosphere through the passage 193 in the exhalation
valve assembly.
The valve member 194 is permitted to move to the open position
because gas pressure is no longer supplied to the tube 58 to apply
a pressure to the top of the diaphragm 204 which would keep the
valve member 194 in a closed position. The application of gas
pressure to the line 58 ceases as soon as the controller 14
terminates the inspiratory phase. Thus, it can be seen that during
the inspiratory phase, the positive pressure applied to the tube 37
retains the mechanical exhalation valve 53 in a closed
position.
The gas pressure supplied by the outlet 19 by the controller 14 is
controlled so that the gas in line 61 is supplied at the very end
of the end of the expiratory phase. This introduces a jet of gas
under pressure through the port 67 of the nozzle 66 which is
directed into the venturi-like passageway 71. This jet serves to
entrain gases within the tee 44 and to create a sub-ambient
pressure within the tee which serves to hold the upper or
inspiratory valve member 84 of the check valve assembly 46 in a
more tightly closed position while opening farther the lower or
expiratory valve member 84 of the check valve assembly 43. This
sub-ambient pressure is thus transferred to the airway of the
patient to overcome expiratory resistance in the lungs of the
patient. The directional flow introduced by pressurized jet 67 and
the added gas therefrom further urges valves 51 and 53 open,
effectively reducing resistance of the non-rebreathing valve
assembly 51 and the exhalation valve assembly 53 to the expiratory
flow to zero.
Thus, it can be seen that a complete breathing circle or circuit
has been provided in which the one-way check valve assembly 43 acts
as an expiratory valve component. It permits expiratory gas to flow
up through the same and thence through the non-rebreathing valve
assembly 51 and through the exhalation valve assembly 53.
Now let it be assumed that the controller 14 has failed for some
reason and that it is desired to continue to supply gases to the
patient being treated. This can be accomplished immediately by
merely compressing the compression bulb 56. The compression bulb
supplies gases under pressure to the inlet 139 which moves the
diaphragm assembly 113 upwardly to close the expiratory port formed
by the passage 124. The gas under pressure enters the holes 148 and
150 and moves the outer margin of the flapper valve 149 upwardly to
permit the gases to enter the chamber 114 and thence through the
annular passage 131 into the passage 129. These gases then pass
through the sleeve 48 and into the tee 44. These gases cannot move
downwardly through the check valve assembly 43 because the check
valve member 84 can only move in an upward direction. Therefore,
the gases move upwardly through the check valve assembly 46 by
moving the yieldable check valve member 84 upwardly to permit the
gases to flow into the tee 24 and thence through the nebulizer 27.
The gases then are supplied to the tube 32 to the patient wye 33
and to the proximal airway of the patient.
As soon as the lungs of the patient have been filled, the
compression bulb 56 is released which creates a sub-ambient
pressure below the diaphragm assembly 113 permitting the diaphragm
assembly 113 to move downwardly. The expiratory gases from the
lungs of the patient again pass through the tube 41 upwardly
through the expiratory valve 43 through the sleeve 48 to the
non-rebreathing valve assembly 51 through the passage 129, thence
through the annular passage 131 into chamber 114 which also helps
to push the diaphragm assembly 113 downwardly to permit the
expiratory gases to pass into the passage 127 and then through the
exhalation valve assembly 53 to the atmosphere. When the
compression bulb 56 is released, a sub-ambient pressure is created
in the chamber 116 which causes the check valve member 142 to raise
to permit air to enter through the openings 141 to pass into the
compression bulb 56 until it is filled and the pressure in the
chamber 116 reaches ambient.
As soon as the compression bulb 56 is filled, the inspiratory phase
can again be commenced by compression of the compression bulb 56 to
cause inspiratory gases to flow in the manner hereinbefore
described to fill the lungs of the patient.
It can be seen from the foregoing that there has been provided
means for providing continuing ventilation to the patient should
the controller 14 fail. The controller 14 can be considered to be a
mechanical ventilator. Upon failure of the mechanical ventilator, a
dynamic airway to the patient is immediately established in the
manner hereinbefore described and the inspiratory and expiratory
phases can be controlled merely by operation of the compression
bulb 56 by the operator.
In the foregoing operation, it should be noted that the check valve
assembly 46 serves as an inspiratory valve and is only utilized
during manual ventilation of the patient by use of the compression
bulb 56. During automatic operation and control of the controller
14, the one-way check valve assembly 46 remains closed. The tee 44
with its check valve assemblies 43 and 46 serves as an overriding
safety valve assembly.
The compression bulb 56 also makes it possible to sigh the patient
being ventilated. The sigh is equivalent to a deep breath. This is
accomplished by the operator merely squeezing the compression bulb
during the inspiratory phase of the controller 14 to supply
additional gas under pressure to the lungs of the patient through
the path hereinbefore described. This is often done by providing
three of such deep sighs by squeezing the compression bulb 56
during three successive inspiratory phases of the controller 14 to
thereby stretch the lungs of the patient three successive times
approximately every seven minutes. This stretches the lungs of the
patient and makes them stay more compliant so that they can be more
readily ventilated by the breathing circle which includes the
controller 14. An operator such as an anesthiologist can by the
feel of the compression bulb 56 used for inflating the lungs
ascertain the resistance of the patient's lungs to the inflation
with a greater tidal volume. This gives certain information to the
operator as to the condition of the lungs of the patient.
Thus, it can be seen that the breathing circle or circuit which has
been provided is fail-safe; that is, if the controller 14 should
malfunction, the breathing circuit is such that ventilation for the
patient can be immediately continued merely by operation of the
compression bulb 56 by the operator. There is no need to make any
changes in the breathing circuit and, therefore, a minimum of time
is lost.
It should be pointed out that the breathing circuit will operate
satisfactorily without the need of establishing a sub-ambient
pressure within the tee 44. When this is the case, the tube 61 can
be eliminated. The passage 68 in the tee 44 can be plugged.
* * * * *