US3454000A - Apparatus for the mechanical ventilation of a patient - Google Patents

Description

APPARATUS FOR THE MECHANICAL VENTILATION OF A PATIENT Filed June 23, 1966 Sheet of 2 t 33 32 I6 29 \M 34 h 1 LB 36 33 compasssso 39 AIR Fig.

INVENTORS Forrest M Bird By Henry L. Pohndort Attorneys July 8, 1969 F. M, BIRD ET AL APPARATUS FOR THE MECHANICAL VENTILATION OF A PATIENT Filed June 23,

Sheet 2 INVENTORS Forrest M Bird By Henry L. Pohndorf Attorneys United States Patent 3,454,000 APPARATUS FOR THE MECHANICAL VENTILATION OF A PATIENT Forrest M. Bird, 212 NW. Cerritos, Palm Springs, Calif. 92262, and Henry L. Pohndorf, 1227 Brewster Drive, El Cerrito, Calif. 94530 Filed June 23, 1966, Ser. No. 559,972 Int. Cl. A6111 31/00; A62b 7/02 U.S. Cl. 128-28 6 'Claims ABSTRACT OF THE DISCLOSURE Apparatus for the ventilation of a patient having a respirator, a patient adapter and a pneumatic belt all of which are under the control of the respirator.

pulmonary chemotherapy, it is desirable or necessary to enhance the mechanical ventilation particularly in the lower part of the lungs which normally is obtained by the respirator. There is, therefore, a need for a new and improved apparatus for the mechanical ventilation of a patient.

In general, it is an object of the present invention to provide apparatus for the mechanical ventilation of a patient which enhances the ventilation of the lungs of the patient.

Another object of the invention is to provide apparatus of the above character which includes a respirator and a pneumatic belt utilized in combination to increase the ventilation to the patient.

Another object of the invention is to provide apparatus of the above character to reduce functional residual capacity during intermittent or continuous mechanical ventilation of the patient with obstructive pulmonary disease.

Another object of the invention is to provide apparatus of the above character which increases the tendency for venous return during the continuous mechanical ventilation of the patient with circulatory hypovolemia.

Another object of the invention is to provide apparaus of the above character in which the pneumatic belt cannot be over-inflated.

Another object of the invention is to provide apparatus of the above character which enhances topical pulmonary chemotherapy.

Another object of the invention is to provide apparatus of the above character which functions both during the inspiratory and expiratory pattern of the patient.

Another object of the inventon is to provide apparatus of the above character in which cardiopulmonary treatment is enhanced.

Another object of the invention is to provide apparatus of the above character which can be readily placed upon and removed from the patient.

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.

Referring to the drawings:

3,454,000 Patented July 8, 1969 FIGURE 1 is an elevational view of apparatus incorporating the present invention for the mechanical ventilation of a patient for intensive care.

FIGURE 2 is an elevational view of apparatus incorporating the present invention for mechanically ventilating a patient for use in topical pulmonary chemotherapy.

FIGURE 3 is a perspective view of the pneumatic belt which is used in the apparatus shown in FIGURES 1 and 2.

FIGURE 4 is an enlarged detail view of a portion of the pneumatic belt shown in FIGURE 3.

FIGURE 5 is. an illustration showing the manner in which the pneumatic belt is normally positioned on the patient.

In general, the apparatus for mechanically ventilating a patient consists of a respirator which has an inhalation phase and an exhalation phase in its operative cycle. The respirator also includes a controller having :an inlet which is adapted to be connected to a supply of gas under pressure and an outlet. It also includes a main control valve means which is disposed in the controller and is movable between open and closed positions to control the flow of gas from the inlet to the outlet with the main control valve means being in an open position during the inhalation phase of the respirator and in a closed position during the exhalation phase of the respirator. The respirator also includes a main conduit having a passage therein and is adapted to be connected to a patient adapter and also to the outlet of the controller. A pneumatic belt is positioned on the patient and is provided with at least one expandable bladder. Means is provided for connecting the expandable bladder to the controller so that the bladder is expanded and contracted in phase with the respirator.

More in particular, as shown in FIGURE 1 of the drawings, the apparatus for mechanically ventilating a patient consists of a respirator 11 and a pneumatic belt assembly 12. The respirator 11 is connected to an in-line nebulizer 13 and a micro nebulizer 14. It is also con nected to a water trap 16, an exhaust valve assembly 17 and a patient adapter 18. The respirator can be of any suitable type, as for example, the positive-negative phase respirator which is shown in US. Letters Patent 3,191,- 596 and marketed under the trademark Mark 8 by the Bird Corporation of Palm Springs, Calif. As disclosed in said US. Letters Patent, such a resiprator is of a type which has an inhalation phase and an exhalation phase in its operative cycle. It includes a controller 21 having an inlet 22 which is adapted to be connected to a supply of gas under pressure. The controller also has a main outlet 23. It includes main control valve means (not shown) disposed in the controller movable between open and closed positions to control the flow of gas from the inlet to the outlet.The main control valve means is in an open position during the inhalation phase of the respirator and is in a closed position during the exhalation phase of the respirator. The respirator is also provided with an additional outlet 26 which is supplied with positive pressure during the expiratory phase of the respirator and an outlet 27 which is provided with positive pressure during the inspiratory phase of the respirator.

The main outlet 23 is connected by a large tube 28 to an inlet 29 of the in-line nebulizer 13. The in-line nebulizer 13 can be of a type described in copending application Ser. No. 447,852, filed Apr. 13, 1965, now Patent No. 3,353,536. The in-line nebulizer is provided with an outlet 31 which has the micro nebulizer 14 mounted thereon. The micro nebulizer can be of the type described in US. Letters Patent 3,172,406. The micro nebulizer is provided with an inlet 32 which is closed with a stopper 33. It is also provided with an outlet 34 which is connected by a large tube 36 to one end of the oval shaped water trap 16. The other end of the water trap is connected to a large tube .37 which .is connected to .a patient adapted 18 which in the form shown in FIGURE 1 is of the endotracheal type. The water trap 16 is a type well known to those skilled in .the art and is provided with a drain tube.39. The outlet 27 is .connected by a small tube 41 to a T 42 mounted on the in-line nebulizer 13. A small tube 43 :iS also connected to the T 42 and is connected to the exhalation valve assembly 17. The exhalation valve assembly 17 is also connected to the patient adapter 18 by .a large .tube 44.

The outlet 26 is connected by a small tube 46 to the inlet 47 of a venturi assembly 48. The venturi assembly 48 is provided with a pair .of outlets 51 and 52 (see FIG- URE 4) which are connected to the pneumatic .belt assembly 12 as hereinafter described.

The pneumatic belt assembly 12 consists of an elongate belt 56 which is formed of a suitable flexible material such as cloth or canvas. Since the belt is to be utilized on a patient, it is desirable that the .belt be relatively porous. As can be .Seen, the belt 5.6 is of .a substantially uniform width and is of sufficient length so that it can encircle the body of the patient. The belt 56 is formed with a pair of pockets 57 and 58 which extend in opposite directions from the .center of the belt. .As can be seen from FIGURE 3, the pockets have substantially the same width as the belt and have a length such that the two pockets substantially cover the patients chest. Suitable means is provided for opening and closing the pockets and consists of a zipper closure 59 for each of the pockets.

Each of the pockets is adapted to receive a bladder 61 of a suitable type, as for example, a rubber bladder which has a substantially rectangular configuration which is adapted to fit in each of the pockets 57 and 58 as shown. Each of the bladders is provided with a tube 62 formed integral therewith through which the bladder can be inflated and deflated. Each of the bladders is also provided with a fitting 63 which i closed with a plug 64 The bladders 61 can be readily inserted through the zippered closure 59 provided on the pockets 57 and 58.

Suitable means is provided for securing the belt about the patient which is also adjustable. As shown in the drawings, such means consists of Velcro-type fastening mean in which a strip 66 of Velcro eyes is mounted on the inside of o e side of the :belt .56 and a strip v67 carrying Velcro hooks is mounted on the outside of th ot er en f t e b lt. By ng gi g e tw strips th belt can be comfortably fastened about the chest of the pat ent- The venturi assembly 48 consists of a body 71 which is provided with ,a venturi-like flow passage 72 extending therethrough and having an outwardly flared inlet end 73. The body 71 is provided with .an enlarged outwardly flared portion 71a which accommodates the enlarged inlet end 7,3 f-or the passage .72. The other end of the body is provided with a bifurcated portion 7112 which has the nipples 51 and .52. A removable .body 76 in the form .of a cap is threaded onto the end portion 71a and which includes the inlet fitting 47.. A flow passage 77 with a reducing taper is provided in the inlet fitting 47 and has its ,outlet forming a jet nozzle 78 in axial alignment with the passage 72in the body 71 so that gases jetting through the passage 77 and out the nozzle 78 will .cause a venturi effect in the passage 72 to aspirate the chamber 79 in the cap 76. The bodyor cap 76 is provided with at least one vhole 80 to permit atmospheric air .to enter the chamber 79 and the venturi like passageway 72.

Means is provided for supporting the main tubes 36 vand 37 and the Water trap 16 find consists of a radial rod .81 carr y a fit ng :82 which is mounted up n the inlet pipe support stand 22 and is secured thereto .by set screw 83.

As indicated previously, the apparatus shown in FIG URE 1 is particularly intended for intensive care. The apparatus shown in FIGURE 2 is very similar to that shown in FIGURE 1 ith he e p o t at t is p ti ularly intended for topical pulmonary chemotherapy. As also shown in FIGURE 2, the apparatus has been simplified in that the nebulizer 13 and the micro nebulizer 14 have been omitted as well as has been the water trap 16. A breathing head 86 which is provided with a patient adapter 87 has been substituted for the exhalation valve assembly 17 and the patient adapter 18. The micro nebulizer 14 has been mounted directly upon the breathing head 86. The breathing head 86 .can be of a type described in Us. Letters Patent 3,191,596.

Operation and use of the apparatus for the mechanical ventilation of a patient may now be briefly described. Let it be assumed that the apparatus shown in FIGURE 1 is to be utilized for the intensive care of a patient. The pneumatic belt assembly 12 is generally fitted snugly around the patients chest approximately 2-3 inches below the xiphoid process (V of the rib cage) so that the bladders 61 of the belt are just below the leaves of the diaphragm as shown in FIGURE 5. As shown in FIGURE 5, the tube 46 leading to the venturi assembly 48 should be down (away from the patients head) and the Y formed by the body 71 and the bifurcated portion 71b should be facing upwardly toward the patients head.

As explained previously, the tube 46 is connected to the respirator 11. The nebulizers 13 and 14 are filled in the proper manner. Thereafter, the respirator 11 is placed in operation and passes through the inhalation phase and the exhalation phase in its operative cycle in a manner well known to those skilled in the art. During the inspiratory phase, air under positive pressure is supplied through the main large tube 28, through the nebulizer 13 and through the micro nebulizer 14 to the patient adapter 18 which is in the form of a tracheotomy fitting, and thence to the trachea and lungs of the patient. At the same time, air

under positive pressure is supplied through the line 27 to the exhalation valve 17 to keep the exhalation valve 17 in a closed position during the inspiratory phase. During this time, no air under pressure is supplied to the small tube 46 to the pneumatic belt assembly 12.

Upon initiation of the expiratory phase by the respirator 11, the positive pressure in the line 27 is removed and the exhalation valve assembly 17 is permitted .to open to thereby permit the patient to exhale through the exhalation valve. At the same time, positive pressure is applied through the line 46 which causes a jet of air to pass from the nozzle 78 and into the venturi-like passage 72 to create a pQsitive pressure in both of the bladders 61 of the pneumatic belt assembly. The jet of air passing through the venturi-like passage 72 serves to aspirate atmospheric air through opening into the passage 72 to inflate the bladders 61. During the exhalation phase, the bladders 61 are always inflated to a safe pressure by this feature and .are never over-inflated because the aspiration of atmospheric air through the opening 78 into the passage will continue until a predetermined positive pressure is reached in the bladders 61. Over-pressures are eliminated because only .a certain pressure will be produced by the jet of air passing through the venturi-like passage 72. In this way, it can be seen that a molecular barrier of gas is provided which builds up against the chest of the patient.

Thus, at the start of expiration, infra-abdominal :pressures are gradually increased by the inflation of the bladders 61 to a preselected value by external pressures applied against the upper abdomen. The increased intraabdominal pressure during the expiratory phase serves to increase tendencies for venous return while concomitantly causing an upward force against the diaphragm. The upward force against the diaphragm elevates intra-thoracic pressure, increasing air flow from the lung, thus serving to reduce functional residual gases within the lung. As soon as the expiratory :phase has been completed, pressure is removed from the tube 46 and the venturi-like assembly is deactivated and the bladders 61 are emptied through the ports or openings 78 provided in the venturi assembly 48 to contract the bladders, The gases are again supplied under positive pressure by the respirator to the patient adapter 18 to increase intra-thoracic pressures by the gas flowing into the lung under positive pressure. Upon completion of the inspiratory phase and initiation of the expiratory phase, the same sequence takes place.

From the foregoing, it can be seen that the apparatus is under the control of the respirator and passes through the inhalation phase and exhalation phase under the control of the respirator. The pneumatic belt assembly 12 operating in conjunction with the respirator 11 serves to increase the ventilation of the lung of the patient and is particularly suitable for intensive care. The operation of the embodiment shown in FIGURE 2 is substantially identical to that described in conjunction with FIGURE 1 and differs only in that it is provided with a breathing head assembly which is particularly adapted for topical pulmonary chemotherapy. In all other respects, the mode of operation is substantially identical to that shown in FIG- URE 1.

The apparatus can be used for reducing functional residual capacity during the intermittent or continuous mechanical ventilation of a patient with obstructive pulmonary disease. It also can be used for increasing the tendency for venous return during the continuous mechanical ventilation of a :patient with circulatory hypovolemia.

Although the apparatus has been described in conjunction with a respirator of the positive-negative phase type, the pneumatic belt assembly can be utilized in conjunction with a positive phase respirator. When such a respirator is used, it is desirable to utilize a parallel booster such as the type described in FIGURE 1 of application Ser. No. 476,508, filed Aug. 2, 1965. Such a parallel booster could be utilized in conjunction with a respirator of the type described in U.S. letters Patent 3,068,856. When such a respirator is used, the parallel cartridge delivers gas to create negativity duringexpiration. This gas, which is delivered to the negative venturi, is actually positive pressure gas and could be utilized for pressurizing the pneumatic belt assembly 12. during the expiratory phase of the respirator.

It is apparent from the foregoing that we have provided an apparatus for mechanical ventilation of a :patient which enhances the ventilation of the patient. The pneumatic belt assembly which is utilized is one that can be readily attached to the patient.

We claim:

1. In apparatus for mechanically ventilating a patient, a respirator having an inhalation phase and an exhalation phase in its operative cycle, said respirator including a controller having an inlet which is adapted to be connected to a supply of gas under pressure, said controller also having a main outlet and first and second additional outlets, main control valve means disposed in said controller and movable between open and closed positions to control the flow of gas from said inlet to said main outlet, said main control valve means being in an open position during the inhalation phase of the respirator and in a closed position during the exhalation phase of the respirator, said respirator including means whereby gas is supplied under positive pressure to said first additional outlet during the inhalation phase and to the second additional outlet during the exhalation phase, a patient adapter, a main conduit having a passage therethrough and connecting the patient adapter to the main outlet of the controller, an exhalation valve assembly connected to the patient adapter, means connecting said first additional outlet to said exhalation valve assembly for closing said exhalation valve during the inhalation phase, a pneumatic belt adapted to be positioned about the chest of the patient, said pneumatic belt having at least one expandable bladder, and means connecting the expandable bladder to the second additional outlet so that the bladder is expanded under the control of the respirator during the exhalation phase and contracts during the inhalation phase of the respirator.

2. Apparatus as in claim 1 wherein said means connecting the expandable bladder to the second additional outlet includes a venturi assembly, said venturi assembly having a venturi-like passage therein means forming a nozzle for directing a stream of gas through the venturilike passage, and means permitting atmospheric air to be introduced into the venturi-like passage in addition to the gas being introduced through the nozzle.

3. Apparatus as in claim 2 wherein said means permitting atmospheric air to be introduced into the venturilike pasage comprises a cap-like body having at least one opening therein which opens to the atmosphere, said nozzle being mounted in said body.

4. Apparatus as in claim 1 wherein said pneumatic belt is formed with a pair of pockets therein and wherein an expandable bladder is disposed in each of said pockets and wherein both of said bladders are connected to said second additional outlet.

5. Apparatus as in claim 1 wherein said. means connecting said expandable bladder to the second additional outlet includes means for preventing overinfiation of the bladder.

6. Apparatus as in claim 1 wherein said belt is formed of a flexible material having a pair of pockets disposed intermediate the ends of the belt, an inflatable bladder disposed in each of said pockets, said belt also including means for detachably placing the belt on the patient and wherein said means connecting said inflatable bladder to said second additional outlet includes means for connecting both of said bladders to said controller so that both of said bladders are expanded and contracted simultaneously.

References Cited UNITED STATES PATENTS 2,071,215 2/1937 Petersen 12828 2,169,784 8/1939 Andersen 12830.2 2,436,853 3/ 1948 Coleman 128-30.2 2,699,163 1/1955 Engstrom 12830.2 3,191,596 6/1965 Bird et a1 128145.5 3,368,550 2/1968 Glascock 12830.2

FOREIGN PATENTS 762,285 4/ 1934 France.

1,129,643 1/ 1957 France.

CHARLES F. ROSENBAUM, Primary Examiner.

US Cl. X.R.

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