U.S. patent number 3,908,987 [Application Number 05/401,130] was granted by the patent office on 1975-09-30 for controlled positive end pressure expiratory device.
Invention is credited to John R. Boehringer.
United States Patent |
3,908,987 |
Boehringer |
September 30, 1975 |
Controlled positive end pressure expiratory device
Abstract
A controlled positive end expiratory pressure device comprises a
vertically disposed passageway having a frustoconical segment at
its lower end in which is supported a ball. The bottom of the
passageway is adapted to communicate with a source of expiratory
air such that the expiratory air tends to raise the ball off its
support at the bottom of the passageway in order to provide a path
for flow of the expiratory air around the ball. In this manner, the
device acts as a calibrated end pressure means for providing a
positive end expiratory pressure for the test subject or patient,
thereby providing for enhanced pulmonary function. The device is
designed to be universal in that it can be used intraoperatively on
common anesthesia machines or post operatively on common ventilator
machines. In one form, it is a hand held, self-controlled, lung
exerciser.
Inventors: |
Boehringer; John R. (Wynnewood,
PA) |
Family
ID: |
23586428 |
Appl.
No.: |
05/401,130 |
Filed: |
September 27, 1973 |
Current U.S.
Class: |
482/13 |
Current CPC
Class: |
A63B
23/18 (20130101) |
Current International
Class: |
A63B
23/00 (20060101); A63B 23/18 (20060101); A63B
023/00 () |
Field of
Search: |
;128/145R,145A,2.08
;137/533.11,533.13,133.15 ;272/57F ;73/209
;131/205,214,222,224 |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Apley; Richard J.
Assistant Examiner: Taylor; Joseph R.
Attorney, Agent or Firm: Paul & Paul
Claims
I claim:
1. A controlled positive end pressure expiratory device comprising
a vertically disposed passageway terminated at the lower end by a
frustoconical segment adapted to communicate at the bottom thereof
with a source of expiratory air, and a spherical ball having a
calibrated size and effective weight, said passageway being adapted
to receive said spherical ball, said ball being freely movable
vertically within said passageway above said segment and
supportable by said segment between the top and bottom thereof,
said ball defining means for exerting a substantial predetermined
back pressure function to said source of expiratory air, in order
to provide significant resistance to the expiration of air by a
user.
2. A device, as recited in claim 1, wherein the angular
displacement, from vertical, of the sidewalls of said
frusto-conical segment is 10.degree..
3. A device, as recited in claim 1, wherein said passageway
includes a top cover having an opening therein, said cover and
opening being adapted to retain said ball in said passageway and to
assure an escape of air from said passageway.
4. A device, as recited in claim 1, further including means for
directing air entering said lower segment from the bottom thereof
in a stream aimed generally outwardly and tangentially with respect
to said frusto-conical segment and entering said segment off-center
with respect thereto.
5. A device, as recited in claim 1, wherein said passageway
communicates through the bottom thereof with a horizontally
disposed member adapted to be held in the mouth of a test subject,
the overall configuration of said device being substantially
similar to that of a hand held smoke pipe.
6. A device as recited in claim 1 wherein said segment comprises a
first portion having sidewalls disposed at 5.degree.-20.degree.
from vertical, and a second section having substantially greater
disposition to vertical to support said ball in nonjamming
fashion.
7. A device as described in claim 1 wherein said passageway defines
a plurality of cavities, each including a spherical ball defining
means for exerting a predetermined back pressure function to
expiratory air in said passageway.
8. A device as described in claim 7 wherein said housing means
comprises a plurality of separate interlocking portions, each such
portion defining one of said cavities and input and exhaust ports
therefor, whereby a plurality of portions may be stacked upon one
another to produce aggregate devices having variable back pressure
devices.
9. A device, as recited in claim 7 wherein each of said cavities
includes a frustoconical segment above and vertically adjacent the
next successive cavity, said segments each having a first
circumference at its upper end and a second circumference at its
lower end, said second circumference being smaller than said first
circumference and communicating with and being smaller than the top
circumference of the next lower cavity.
10. A device, as recited in claim 9, wherein the angular
inclination, from vertical, of said second frusto-conical segment
is the same as that of said first or lower segment.
11. A device, as recited in claim 9, wherein the angular
inclination, from vertical, of said second frusto-conical segment
is less than that of said first or lower segment.
12. A device, as recited in claim 9, wherein the angular
inclination, from vertical, of said first segment is
37.degree.-41.degree. and that of said second segment is
8.degree.-12.degree..
13. A controlled positive end pressure expiratory device comprising
a vertically disposed passageway with a circular opening at its
lower end adapted to communicate with a source of expiratory air,
and a spherical ball having a calibrated size and effective weight,
said passageway being adapted to receive said spherical ball having
a diameter greater than that of said opening and being freely
movable vertically within said passageway and above said opening,
said ball defining means for exerting a substantial predetermined
back pressure function to said source of expiratory air, in order
to provide significant resistance to the expiration of air by a
user.
14. A device as described in claim 13 wherein said means for
exerting operates responsively to the specific gravity of said
ball, the diameter of said ball, and the size of said opening.
15. A device as described in claim 14, and further including means
for varying force exerted by said ball against flow of expiratory
air from said opening.
16. A device as described in claim 14, wherein said device is
provided with means for sampling the expiratory air flowing in said
passageway.
Description
This invention pertains to a controlled positive pressure
expiratory device, and more particularly to a convenient, sanitary
means for providing a controlled positive pressure of known
calibration and relatively free flow characteristics for use in the
protocol known as positive end expiratory pressure or "PEEP" either
during surgery intraoperatively or on ventilator machines used to
support or to assist breathing.
A person's ability to inspire and expire a sufficient quantity of
air is usually seriously impaired by many diseases of the
respiratory system. Therapeutically, it is often desirable
forceably to increase the lung effectiveness and capacity of such
patients by providing them with a means or device providing an end
expiratory pressure against which the lungs of the patient must be
actuated to provide for enhanced pulmonary function.
It is therefore the general object of the present invention to
provide a simple, sanitary, aesthetically pleasing, controlled
positive end expiratory pressure device which is economical to
manufacture, easy to use, and reasonably precise in providing a
predetermined level of positive end expiratory pressure for a
patient.
It is a more specific object of this invention to provide a
relatively simple, disposable, easily useable, controlled positive
end expiratory pressure device dependent totally on gravity and not
easily susceptible to mechanical malfunction or calibration
error.
These objects, and others which will become apparent in the course
of the subsequent discussion, are met, briefly, by a device
consisting of a vertically disposed passageway terminated at its
lower end with a frusto-conical segment in which is supported (or
which is adapted to support) a spherical ball which is freely
movable within the passageway above the point of its support. The
passageway at its bottom communicates with a source of expiratory
air from the test subject to patient. The dimensions of the
passageway and frusto-conical segment, as well as the dimensions
and mass of the ball are calibrated to provide a predetermined
positive end expiratory pressure for pulmonary patients.
In one preferred form of this invention, the device communicates at
its bottom end with a horizontally disposed air passageway adapted
to be held in the mouth of a user such that the overall
configuration of the device resembles a conventional smoke pipe and
may be used as such by the respiratory patient to exercise and
thereby to enhance his lung function in a convenient and
aesthetically pleasing manner.
The invention may be better understood by reference to the
following detailed description taken in conjunction with the
subjoined claims and the attached drawings, in which:
FIG. 1 is a top view of the preferred form of the invention;
FIG. 2 is a sectional view, in the plane 2--2, of the device shown
in FIG. 1;
FIG. 3 is a partial sectional view of the device shown in FIG. 3,
the section taken along the plane 3--3 of FIG. 2; and
FIG. 4 is a sectional view of another form of the present
invention.
FIG. 5 shows still another alternative embodiment.
Referring more specifically to FIG. 1, there is shown a top view of
one particular preferred form of the positive end expiratory
pressure device of the present invention. More particularly, this
device consists of spherical ball 2 supported above the smaller
lower circumference 4 of a frusto-conical lower segment of a
vertically disposed passageway defined by sidewall 6 and covered by
a top closure 8 having an opening 10 therein of shape and size to
retain spherical ball 2 within the passageway defined by sidewall 6
and ensuring an air passageway around spherical ball 2 with
spherical ball 2 forced against top closure 8. In the configuration
of top closure 8 shown in FIG. 1, opening 10 is an elongated oval.
It could as easily be any of a variety of other shapes or forms,
including a plurality of circular holes or, in fact, any shape
other than a simple circle located on the axis of the vertically
disposed passageway. The reason such a simple axially disposed
circle would not be acceptable is that it would be susceptible to
being closed by forcing spherical ball 2 against, and seated
within, such a circular opening during a forceable expiration such
as a cough. Furthermore, this design is foolproof in that if
installed upside down, it disables itself. In the commercial
embodiment of the device shown in FIG. 1, there is a large arrow on
the side of the body showing proper flow direction.
The details of top closure 8 and opening therein 10 may be better
seen in the sectional view, FIG. 2, of the device shown in FIG. 1
taken along the plane 2--2, and in the sectional view of FIG. 3
taken along the plane 3--3 of FIG. 2.
As best seen in FIG. 2, the device shown in FIG. 1 includes a
vertically disposed passageway 12 with a lower frusto-conical
segment 14 in which spherical ball 2 is supported, and through
which passageway 12 is adapted to communicate through passageway 16
with a source of expiratory air from a test subject or patient.
As shown in FIG. 2, in the preferred form of the present invention,
lower frusto-conical segment 14 is inclined, with respect to the
vertical, at an angle of about 37.degree.-41.degree.; this angle
depends more specifically on the weight and diameter of the ball 2
and the diameter of the lower circumference 4. Vertical passageway
12 is also defined by an upper frusto-conical section vertically
adjacent the lower conical section 14, the upper frusto-conical
section terminating at its lower end with a circumference
coinciding with the upper circumference of lower frusto-conical
section 14, the upper frusto-conical section extending to the top
closure 8 of the device, and having an angular inclination, with
respect to the vertical, on the order of 8.degree.-12.degree., most
preferably about 10.degree. for the commerical embodiment
previously referred to.
While this preferred form of the invention includes a double
frusto-conical segment, vertically disposed passageway 12 may
consist of a continuous frusto-conical section of constant angular
inclination, with respect to the vertical, on the order of
5.degree.-20.degree.. Preferably, however, a lower frusto-conical
section of greater annular inclination acts as a throat for
vertically disposed passageway 12, as well as a support for
spherical ball 2 and provides for a number of improved functions,
i.e., prevents jamming, promotes sealing, provides a massive
surface not able to chip, etc.
By carefully manufacturing the device, the taper of passageway 12
urges the ball to float in an air stream at or below the pressure
at which the ball will seat thus giving a valve which will have
simultaneously in one design low resistance to high flow (such as a
cough) but accurate sensitivity to pressure to lift the ball from
the seat. The low resistance to high pressure is important to
prevent rupture of lung tissue and pneumothorax which might be
caused by a forced exhalation, such as a cough, through a flow
dependent resistance.
In another form of the present invention, as shown in FIG. 4,
vertical passageway 12 communicates at its lower end with a
horizontally extended member 18 adapted to be held in the mouth by
a patient or user, the overall configuration of horizontally
disposed member 18 and the housing of vertically disposed
passageway 12 resembling that of an ordinary hand held smoke pipe
so that the user can be encouraged to exercise his lung function
using the device in the manner of a conventional smoke pipe.
While the device of the present invention, as described and
illustrated, generally includes a lower frusto-conical segment in a
vertically disposed passageway supporting a spherical ball, the
spherical ball may instead rest simply in a circular opening not
including a frusto-conical segment. Because calibration of such
devices is more difficult and functioning of the device is not as
effective as that with the frusto-conical segment, this is a
non-preferred form of the present invention. While, such a simple
circular opening is used in a commercial embodiment of the smoke
pipe lung exerciser of the present invention, it is probably not
suitable for other applications because it is not inherently safe
in that the ball may stick in the opening since the angle of the
sidewall of the opening on which the ball is seated is generally
below the angle of repose of the materials in question. Similarly,
another, though much less preferred, form of the present invention
is that in which the shape of the ball is changed. For example, a
vertically guided rod (to which a variable amount of weight may be
attached) with a specifically designed lower seating surface may be
used. A simple spherical ball, however, provides a constant mass
regardless of orientation and has less of a tendency to stick than
other non-spherical shapes. The spherical ball shape is therefore
preferred.
In the preferred forms of the present invention, expiratory air
passes up through the bottom of a vertically disposed chamber, as
shown in both FIGS. 2 and 4, and, in order to escape upwardly
therethrough, raises spherical ball 2, of predetermined size and
mass to provide a controlled amount of positive end pressure
against which the expiratory air must act in order to raise
spherical ball 2 off its supporting surface within vertically
disposed passageway 12.
The expiratory air then raises spherical ball 2 off its support in
the lower end of the vertically disposed passageway 12, the amount
by which the ball is raised being determined by the weight and size
of the ball, the dimensions of the passageway and the air (or gas)
flow present. The passageway may be vertically calibrated so that
the distance the ball is raised can be used as an indication of the
expiratory flow. More normally, the device is used as an end
expiratory pressure regulator to encourage and to develop lung
function and no such vertical calibration is required.
In one particular form of the present invention, a device such as
that shown in FIG. 2, has a diameter at the lower circumference of
the lower frusto-conical section 14 of 0.591 inch and a diameter at
the upper circumference of frusto-conical section segment 14 of
0.615 inch with the angular inclination of the sidewalls of
frusto-conical section 14, with respect to vertical, being
39.degree..
The angular inclination of the upper frusto-conical segment is
10.degree., and the spherical ball 2 supported therein, which is
composed of stainless steel, has a diameter of 0.625 inch and a
weight of 16.33 grams.
The basic variation in end pressure is obtained by varying ball
material (glass, nylon, stainless steel), and varying orifice
diameters to suit. The ball may also be hollowed out to change its
effective weight or mass may be added above the ball to increase
its effective weight, but these are not preferred embodiments.
The devices of this invention may be configured such that the
valves can be stacked one on another (as in FIG. 4) to give
addition of pressures such as 2.5 plus 5 give 7.5 cm H.sub.2 O
total end pressure. In the commercial embodiments of this
invention, the devices are clearly labeled with large color coded
one-half inch high numbers on the side of the body placed so that
the adaptor system does not interfere with it.
The devices of this invention are generally designed so that they
can be disabled by turning them 90.degree. from the vertical. A
side port version is produced which makes the valve a suitable
device for drawing samples of expired gas conveniently into a
sample container.
In order further to enhance the utility of embodiments of the
present invention other modifications may also be made. For
example, increased flexibility may result if the ball 2 is provided
with an adaptable weight facility. That is, it may be recognized
that variation of the force with which the ball 2 bears down in the
passageway 16 proportionally varies the resistance of the ball 2 to
input air flow. Thus, this force, or "effective weight" of the ball
may be changed either by directly altering the mass of the ball, or
by exerting forces such as magnetic force upon the ball 2. One
manner in which the mass of the ball 2 may be altered directly is
to connect to the ball 2 a shaft which protrudes upwardly and out
of the device. If such a shaft is conditioned for attachment of
weights, any desired mass variation of the ball 2 may result.
While this invention has been described with respect to particular
forms thereof, it should not be interpreted as limited thereto.
Instead, the appended claims are intended to cover all such
equivalent modifications of the present invention as would be
obvious to those skilled in the art, and within the true spirit and
scope of the present invention. For example, the sidewall 6 may be
cylindrical in shape and terminated by a hemispherical surface,
rather than the frusto-conical shape shown. Similarly, variation of
the orifice, diameter of the ball, and specific gravity of the ball
will have a predictable effect on the back pressure produced during
zero flow and during flow conditions. Likewise, the device may be
modified as shown in FIG. 5 for a simpler exerciser. In that
embodiment, a stem 501 defines a mouthpiece part 504 which
communicates with a cavity 505 in a body segment 502. Segment 502
is shown connected with a cap 503 defining a cavity 506 which
exhausts via part 507. The size of the cavities 505 and 506 and
parts 504 and 507, together with the orientation of the stem 501
relative to the air flow path, provide an inherent flow resistance
function which, although less severe than foregoing embodiments,
does provide a useful exerciser configuration.
* * * * *