CA2093663C - Device for intratracheal and intratracheal pulmonary ventilation - Google Patents
Device for intratracheal and intratracheal pulmonary ventilationInfo
- Publication number
- CA2093663C CA2093663C CA002093663A CA2093663A CA2093663C CA 2093663 C CA2093663 C CA 2093663C CA 002093663 A CA002093663 A CA 002093663A CA 2093663 A CA2093663 A CA 2093663A CA 2093663 C CA2093663 C CA 2093663C
- Authority
- CA
- Canada
- Prior art keywords
- patient
- ventilation
- ventilatory assistance
- providing
- catheter
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
- 238000009423 ventilation Methods 0.000 title claims abstract description 52
- 230000002685 pulmonary effect Effects 0.000 title claims abstract description 12
- 238000000034 method Methods 0.000 claims abstract description 41
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 claims abstract description 40
- 229910052760 oxygen Inorganic materials 0.000 claims abstract description 40
- 239000001301 oxygen Substances 0.000 claims abstract description 40
- 239000007789 gas Substances 0.000 claims abstract description 36
- 230000036387 respiratory rate Effects 0.000 claims abstract description 20
- 210000003437 trachea Anatomy 0.000 claims abstract description 14
- 230000003519 ventilatory effect Effects 0.000 claims description 23
- 239000000203 mixture Substances 0.000 claims description 19
- 238000005399 mechanical ventilation Methods 0.000 claims description 8
- MYMOFIZGZYHOMD-UHFFFAOYSA-N Dioxygen Chemical compound O=O MYMOFIZGZYHOMD-UHFFFAOYSA-N 0.000 claims description 2
- 238000011010 flushing procedure Methods 0.000 claims description 2
- 229910001882 dioxygen Inorganic materials 0.000 claims 1
- 208000036366 Sensation of pressure Diseases 0.000 abstract 1
- 210000004072 lung Anatomy 0.000 description 15
- 230000029058 respiratory gaseous exchange Effects 0.000 description 8
- 241000283903 Ovis aries Species 0.000 description 5
- 229910002092 carbon dioxide Inorganic materials 0.000 description 5
- 230000003434 inspiratory effect Effects 0.000 description 5
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 description 4
- 238000010586 diagram Methods 0.000 description 4
- 239000000463 material Substances 0.000 description 4
- 230000002269 spontaneous effect Effects 0.000 description 4
- 208000004852 Lung Injury Diseases 0.000 description 3
- 206010069363 Traumatic lung injury Diseases 0.000 description 3
- 231100000515 lung injury Toxicity 0.000 description 3
- 230000000241 respiratory effect Effects 0.000 description 3
- 208000032589 Diaphragmatic Congenital Hernias Diseases 0.000 description 2
- 206010056342 Pulmonary mass Diseases 0.000 description 2
- 239000001569 carbon dioxide Substances 0.000 description 2
- 201000005890 congenital diaphragmatic hernia Diseases 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 238000002618 extracorporeal membrane oxygenation Methods 0.000 description 2
- 239000003550 marker Substances 0.000 description 2
- 239000004033 plastic Substances 0.000 description 2
- 229920001296 polysiloxane Polymers 0.000 description 2
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 2
- 208000035967 Long Term Adverse Effects Diseases 0.000 description 1
- 241001465754 Metazoa Species 0.000 description 1
- 101100345589 Mus musculus Mical1 gene Proteins 0.000 description 1
- 206010038687 Respiratory distress Diseases 0.000 description 1
- 239000004809 Teflon Substances 0.000 description 1
- 229920006362 Teflon® Polymers 0.000 description 1
- 230000003444 anaesthetic effect Effects 0.000 description 1
- 230000004872 arterial blood pressure Effects 0.000 description 1
- 210000001367 artery Anatomy 0.000 description 1
- 210000000621 bronchi Anatomy 0.000 description 1
- 230000000747 cardiac effect Effects 0.000 description 1
- 230000001143 conditioned effect Effects 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000029142 excretion Effects 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 239000011810 insulating material Substances 0.000 description 1
- 230000002045 lasting effect Effects 0.000 description 1
- 230000003902 lesion Effects 0.000 description 1
- 239000012528 membrane Substances 0.000 description 1
- 238000012986 modification Methods 0.000 description 1
- 230000004048 modification Effects 0.000 description 1
- 230000010355 oscillation Effects 0.000 description 1
- 230000003534 oscillatory effect Effects 0.000 description 1
- QVGXLLKOCUKJST-BJUDXGSMSA-N oxygen-15 atom Chemical compound [15O] QVGXLLKOCUKJST-BJUDXGSMSA-N 0.000 description 1
- 238000011084 recovery Methods 0.000 description 1
- 210000002345 respiratory system Anatomy 0.000 description 1
- 229920002379 silicone rubber Polymers 0.000 description 1
- 239000004945 silicone rubber Substances 0.000 description 1
- 239000008223 sterile water Substances 0.000 description 1
- 229910052715 tantalum Inorganic materials 0.000 description 1
- GUVRBAGPIYLISA-UHFFFAOYSA-N tantalum atom Chemical compound [Ta] GUVRBAGPIYLISA-UHFFFAOYSA-N 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0402—Special features for tracheal tubes not otherwise provided for
- A61M16/042—Special features for tracheal tubes not otherwise provided for with separate conduits for in-and expiration gas, e.g. for limited dead volume
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/32—General characteristics of the apparatus with radio-opaque indicia
Abstract
A method and apparatus for intratracheal ventilation (ITV) and intratracheal pulmonary ventilation (ITPV) in which a catheter (1) positioned in a patient's trachea at the carina (6) supplies a constant supply of fresh oxygen containing gas (13, 14, 15) to flush anatomical dead space. By positioning the catheter (1) in the patient's trachea, the dead space of the trachea is by-passed and the trachea is only utilized for expiration. By providing a timed expiratory valve (9) in the ITPV mode, lower pres-sures and fresh oxygen flow rates may be utilized with respiratory rates from 10 to 120/min. or higher.
Description
~ WO 92/07604 2 ~ ~ 3 ~ 6 3 PCr/US91~0815~
Device for Intratracheal and Intra~racl~eal Pulmonar,v Ventilation T~rhn; cal Field The present invention relates to intratracheal 5 ventilation and intratracheal pulmonary ventilation methods and apparatus. More particularly, the present invention relates to methods and devices for intratracheal ventilation and intratracheal pulmonAry ventilation .
B~chq~ vu-1d Art _ _ Congenital diaphragmatic hernia (CDH) currently carries a mortality in excess of 50 percent. PresQntly, there exists a need for a reliable procedure for providing the nPrq~sqry ventilation treatment for 15 patients 6uffering from CDEI.
Recent laboratory and clinical evidence strongly implicates mechanical ventilation (MV) at high peak inspiratory pressure (PIP) in the emergence of respiratory distress ~-ylldr~ - (RDS) in the neonate, child 20 and adult. Recovery from severe lung injury is oftentimes facilitated through the use of extracorporeal membrane oxygenation (ECM0), or extracorporeal carbon dioxide removal (ECC02R), while airway pIeS_ur ~:, are markedly reduced (lung rest); here, the bulk of C02 is 25 removed by the extracorporeal membrane lung (ML), allowing lower tidal volumes (VT), respiratory rates (RR), and PIP. Such lung rest cannot be attained only with the use of an extracorporeal ML.
Conventional r~ n; ~Al plll r qry ventilation as 30 presently utilized is not considered effective at very high respiratory rates, in part because of unavoidable dead space ventilation.
.
7~'0 92/07604 2 ~ 9 3 6 6 3 PCI`/7~,'S91/08155.
~ .
The effect of~ the anatomical dead space on C02 removal has been well recognized. In the adult and child, .`IV (or spontaneous breathing) at frequencies in excess of 60/min is oftentimes not effective.
Although work has been made in the field of pl71 -ry ventilation, there remains a need for a method and apparatus which allows for respiratory rates which are well below what is presently considered practical.
U. 5 . Patent No . 4, 082, 093 to Fry et al discloses the use of a -?tor valve for use with a ventilation system. A positive end expiratory ~7~5~ULe (PEEP) valve is also fl~rni ched to maintain an artificial residual pressure in the lungs. The magnitude of PEEP may be varied from cycle to cycle. The ~_ Anqc7tor valve functions to hold the lung pressure constant at the end of the expiratory cycle.
U.S. Patent No. 4,141,356 to Smargiassi discloses a respiratory system with both ascisted and spontaneous modes of breathing. A control circuit responds to the patient ' s breathing pattern to alter the system between the two modes, in accordance With a predeter7-~7;nPd pattern. As illustrated in figure 1, the system also includes regulators 10 and 12 which are used to feed a mixture of both air and oxygen.
U.S. Patent No. 4,202,330 to Jariabka discloses a small tube 13 which is inserted into the trachea for administering oxygen. The tube is connected to a conduit 20 which is connected at 31 to a valving means 30. A
second conduit 40 is connected to the inlet 32 of the 3 0 valve and the other end of the conduit is connected to an oxygen supply 50 which supplies oxygen at a low temperature .
-W0 92/07604 2 0 9 3 ~ ~ 3 PCr~l~'S9110815~
U.S. Patent No. 4,224,939 to Lang discloses a p~ Ary ventilation system in which a respirator feeds air at a controllable pressure, volume, rate, and respiratory freguency to a hum;~;f;~r The hllmi~l;f;er 5 i5 s lrPli~ with sterile, heated water. Tube sections g and 12 which supply the conditioned air to an endotracheal tube are connected to an inflatable bag 10 by tee 11.
U.S. Patent No. 4,232,667 to Chalon et al discloses 10 a ventilating system in which both oxygen and an anaesthetic are controllably passed by a flow meter through an inspiratory limb 16 and a small endotracheal tube which is positioned at the approximate level of the carina. An expiratory limb 18 :,ull~Ju--ds the inspiratory 15 limb 16. The expiratory limb i~ connected to ~n expiratory valve 34. The limbs are provided with spacing ribs 20 to prevent kinking.
U.S. Patent No. 4,421,113 to Gedeon et al discloses a lung ventilator for carrying out mandatory minute 20 volume (2~MV) treatment. The breathing gas source delivers a volume of gas which is at least equal to the maximum volume that may be required. An inspiratory line is connected to the patient's airway for spontaneous breathing. A ventilator is connected to the breathing 25 gas source and is actuated by a signal to deliver a mandatory breath of a predet~rm i n-~d tidal volume to the patient .
U.S. Patent No. 4,773,411 to Downs discloses a respiratory method and apparatus which establishes a 30 continuous positive airway pressure (CPAP) to enhance functional residual capacity (FRC). Instead of imposing cycles of elevated airway pressure above a CPAP, airway ~'0 92/07604 2 0 ~ 3 6 ~ 3 PCr/US91/08155~
~Lt:S~ULC~ release ventilation (APRV) is utilized to achieve a~, ~ation of alveolar ventilation and carbon dioxide excretion through intermittent cycles of reduced airway pressure below the CPAP ~Les~uLe level. Breathing 5 gas may be supplied by a variety of devices including a tight f itting tracheal tube .
U.S. Patent No. 4,593,690 to Sheridan et al discloses an endotracheal tube having an inflatable balloon cuff which is designed so a to be bendable in various 10 directions.
U.S. Patent No. 4,716,896 to A~ n discloses an endotracheal tube 4 0 which is inserted through the mouth of a patient. Within the endotracheal tube is a catheter 10 which delivers a fluid. The catheter has apertures 15 18a and 18b at its distal end. The catheter may be made of various plastic materials.
U.S. Patent No. 4,892,095 to Nakhgevany discloses an endotracheal tube having a diffuser 22 ~t its end.
The present invention is an i ~.v. t over existing 20 methods and apparatus utilized in pulmonary ventilation .
Di6closure of the Invention It is according one object of the present invention to provide a method of ventilatory assistance to a 25 patient.
Another object of the present invention is to provide a method of intratracheal ventilation and intratracheal pulmonary ventilation.
A further object of the present invention is to 30 provide a method of intratracheal and intratracheal pulmonary ventilation which allows for low peak airway pIt:sDuL~s and respiratory rates well beyond what is U'O 92/07604 2 ~ 9 3 ~ 6 3 PCI IUS91 /0815~
presently considered practical.
A 6till further object of the present invention is to provide an apparatus for intratracheal and intratracheal p~ ry ventilation which allows for low 5 peak airway ~resauL~s and respiratory rates well beyond what is presently considered practical.
According to the present invention there is provided a method of providing ventilatory assistance to a patient which comprises:
positioning a distal end of a catheter in an area near the carina of a patient; and supplying a continuous supply of an oxygen containing gas mixture to the patient through the catheter.
The present invention further provides a method of providing ventilatory assistance to a patient which comprises continuously flushing anatomical dead space of the patient with a fresh supply of an oxygen containing gas mixture.
Also provided by the present invention is an apparatus for providing ventilation assistance to a patient which comprises a catheter, means for positioning the catheter in an area near the carina of the patient, and means for providing a continuous supply of an oxygen containing gas mixture to the patient through the catheter.
Brief Des~riPtion of l)rawinas The present invention will now be described with reference to the annexed drawings, which are given by way of non-limiting examples only in which:
Figure 1 is a schematic diagram illustrating the ventilation system utilized according to one ';- L
of the present invention.
Device for Intratracheal and Intra~racl~eal Pulmonar,v Ventilation T~rhn; cal Field The present invention relates to intratracheal 5 ventilation and intratracheal pulmonary ventilation methods and apparatus. More particularly, the present invention relates to methods and devices for intratracheal ventilation and intratracheal pulmonAry ventilation .
B~chq~ vu-1d Art _ _ Congenital diaphragmatic hernia (CDH) currently carries a mortality in excess of 50 percent. PresQntly, there exists a need for a reliable procedure for providing the nPrq~sqry ventilation treatment for 15 patients 6uffering from CDEI.
Recent laboratory and clinical evidence strongly implicates mechanical ventilation (MV) at high peak inspiratory pressure (PIP) in the emergence of respiratory distress ~-ylldr~ - (RDS) in the neonate, child 20 and adult. Recovery from severe lung injury is oftentimes facilitated through the use of extracorporeal membrane oxygenation (ECM0), or extracorporeal carbon dioxide removal (ECC02R), while airway pIeS_ur ~:, are markedly reduced (lung rest); here, the bulk of C02 is 25 removed by the extracorporeal membrane lung (ML), allowing lower tidal volumes (VT), respiratory rates (RR), and PIP. Such lung rest cannot be attained only with the use of an extracorporeal ML.
Conventional r~ n; ~Al plll r qry ventilation as 30 presently utilized is not considered effective at very high respiratory rates, in part because of unavoidable dead space ventilation.
.
7~'0 92/07604 2 ~ 9 3 6 6 3 PCI`/7~,'S91/08155.
~ .
The effect of~ the anatomical dead space on C02 removal has been well recognized. In the adult and child, .`IV (or spontaneous breathing) at frequencies in excess of 60/min is oftentimes not effective.
Although work has been made in the field of pl71 -ry ventilation, there remains a need for a method and apparatus which allows for respiratory rates which are well below what is presently considered practical.
U. 5 . Patent No . 4, 082, 093 to Fry et al discloses the use of a -?tor valve for use with a ventilation system. A positive end expiratory ~7~5~ULe (PEEP) valve is also fl~rni ched to maintain an artificial residual pressure in the lungs. The magnitude of PEEP may be varied from cycle to cycle. The ~_ Anqc7tor valve functions to hold the lung pressure constant at the end of the expiratory cycle.
U.S. Patent No. 4,141,356 to Smargiassi discloses a respiratory system with both ascisted and spontaneous modes of breathing. A control circuit responds to the patient ' s breathing pattern to alter the system between the two modes, in accordance With a predeter7-~7;nPd pattern. As illustrated in figure 1, the system also includes regulators 10 and 12 which are used to feed a mixture of both air and oxygen.
U.S. Patent No. 4,202,330 to Jariabka discloses a small tube 13 which is inserted into the trachea for administering oxygen. The tube is connected to a conduit 20 which is connected at 31 to a valving means 30. A
second conduit 40 is connected to the inlet 32 of the 3 0 valve and the other end of the conduit is connected to an oxygen supply 50 which supplies oxygen at a low temperature .
-W0 92/07604 2 0 9 3 ~ ~ 3 PCr~l~'S9110815~
U.S. Patent No. 4,224,939 to Lang discloses a p~ Ary ventilation system in which a respirator feeds air at a controllable pressure, volume, rate, and respiratory freguency to a hum;~;f;~r The hllmi~l;f;er 5 i5 s lrPli~ with sterile, heated water. Tube sections g and 12 which supply the conditioned air to an endotracheal tube are connected to an inflatable bag 10 by tee 11.
U.S. Patent No. 4,232,667 to Chalon et al discloses 10 a ventilating system in which both oxygen and an anaesthetic are controllably passed by a flow meter through an inspiratory limb 16 and a small endotracheal tube which is positioned at the approximate level of the carina. An expiratory limb 18 :,ull~Ju--ds the inspiratory 15 limb 16. The expiratory limb i~ connected to ~n expiratory valve 34. The limbs are provided with spacing ribs 20 to prevent kinking.
U.S. Patent No. 4,421,113 to Gedeon et al discloses a lung ventilator for carrying out mandatory minute 20 volume (2~MV) treatment. The breathing gas source delivers a volume of gas which is at least equal to the maximum volume that may be required. An inspiratory line is connected to the patient's airway for spontaneous breathing. A ventilator is connected to the breathing 25 gas source and is actuated by a signal to deliver a mandatory breath of a predet~rm i n-~d tidal volume to the patient .
U.S. Patent No. 4,773,411 to Downs discloses a respiratory method and apparatus which establishes a 30 continuous positive airway pressure (CPAP) to enhance functional residual capacity (FRC). Instead of imposing cycles of elevated airway pressure above a CPAP, airway ~'0 92/07604 2 0 ~ 3 6 ~ 3 PCr/US91/08155~
~Lt:S~ULC~ release ventilation (APRV) is utilized to achieve a~, ~ation of alveolar ventilation and carbon dioxide excretion through intermittent cycles of reduced airway pressure below the CPAP ~Les~uLe level. Breathing 5 gas may be supplied by a variety of devices including a tight f itting tracheal tube .
U.S. Patent No. 4,593,690 to Sheridan et al discloses an endotracheal tube having an inflatable balloon cuff which is designed so a to be bendable in various 10 directions.
U.S. Patent No. 4,716,896 to A~ n discloses an endotracheal tube 4 0 which is inserted through the mouth of a patient. Within the endotracheal tube is a catheter 10 which delivers a fluid. The catheter has apertures 15 18a and 18b at its distal end. The catheter may be made of various plastic materials.
U.S. Patent No. 4,892,095 to Nakhgevany discloses an endotracheal tube having a diffuser 22 ~t its end.
The present invention is an i ~.v. t over existing 20 methods and apparatus utilized in pulmonary ventilation .
Di6closure of the Invention It is according one object of the present invention to provide a method of ventilatory assistance to a 25 patient.
Another object of the present invention is to provide a method of intratracheal ventilation and intratracheal pulmonary ventilation.
A further object of the present invention is to 30 provide a method of intratracheal and intratracheal pulmonary ventilation which allows for low peak airway pIt:sDuL~s and respiratory rates well beyond what is U'O 92/07604 2 ~ 9 3 ~ 6 3 PCI IUS91 /0815~
presently considered practical.
A 6till further object of the present invention is to provide an apparatus for intratracheal and intratracheal p~ ry ventilation which allows for low 5 peak airway ~resauL~s and respiratory rates well beyond what is presently considered practical.
According to the present invention there is provided a method of providing ventilatory assistance to a patient which comprises:
positioning a distal end of a catheter in an area near the carina of a patient; and supplying a continuous supply of an oxygen containing gas mixture to the patient through the catheter.
The present invention further provides a method of providing ventilatory assistance to a patient which comprises continuously flushing anatomical dead space of the patient with a fresh supply of an oxygen containing gas mixture.
Also provided by the present invention is an apparatus for providing ventilation assistance to a patient which comprises a catheter, means for positioning the catheter in an area near the carina of the patient, and means for providing a continuous supply of an oxygen containing gas mixture to the patient through the catheter.
Brief Des~riPtion of l)rawinas The present invention will now be described with reference to the annexed drawings, which are given by way of non-limiting examples only in which:
Figure 1 is a schematic diagram illustrating the ventilation system utilized according to one ';- L
of the present invention.
2 0 9 3 6 ~ 3 PCr/US91/081SS
of the present inventio~
Figure 2 is a schematic diagram illustrating the catheter utilized in accordance with one ~mho~ L of the present invention.
5 Best Mode for ~Arrvinq Qut the Invention The pre6ent invention is directed to a method of intratracheal ventilation (ITV) or intratracheal plll ry ventilation (ITPV) in which fresh, humidified air/oxygen i5 introduced at a constant flow rate through lO a patient ' s trachea at a position adj acent or near the patient ' s carina .
In operaticn, the fresh, humidified air/oxygen is introduced through a very small catheter with a diffuser at its distal end which is placed through an endotracheal lS or tracheostomy tube, or may be possibly passed percutaneously to rest at the level of the carina. The continuous gas flow is provided at a rate of about 2 to 4 times anatomical dead space/breath. Dead space, as described below, is detDrminD~ from the volume of the 20 trachea and tracheostomy or endotracheal tube utilized, which, for example in an adult is about 120 cc.
The method of the precent invention may be utilized either with or without conventional ~ 1n;c~1 ventilation. When utilized without conventional 25 mechanical ventilation, the ITV method of the present invention may be utilized in combination with CPAP.
With continuous gas flow, in the constant or continuous positive airway p~ ULe: (CPAP) mode the breathing is controlled by the patient. In the ITPV controlled 30 ventilation mode of operation which does not utilize conventional --ch~nic~1 vèntilation, a timed expiratory valve sets the respiratory rate while a minute flow of WO 9~07604 2 0 ,~ ~ ~ 6 3 PCr/~lS91/081s5 .
air/oxygen determines tidal volume (vT) /breath 2nd hence peak inspir2tory pressure (PIP). In this mode the trachea is bypassed, since the fresh air/oxygen is introduced at the patient ' s carina, and the trachea is 5 therefore used only for expiration. By bypassing the trachea, the anatomical dead space is effectively reduced 50 that fresh air/oxygen flow rates of approximately 0 . 5 of the anatomical dead space/breath are acceptable. In the ITPV mode it ha6 been det~minecl that suitable 10 respiratory rates of 10-120/min. or higher may be used.
When used in conjunction with a conventional r--hi~nic~l ventilation (NV), the NV is operated in the pressure control mode at low tidal volumes tVT), and hence low peak inspiratory pressure (PIP), with RR
15 adjusted to effect adequate alveolar ventilation.
The method of the present invention effectively eliminates the anatomical dead space ventilation, thereby allowing respiratory rates well beyond what is now considered practical. As an aftereffect, the peak airway 20 pressures remain very low, thus avoidiny further harm or aggravation to a patient whose lungs are damaged.
The technique of the present invention is distinct from high ~requency ventilation, as tidal volumes remain within the normal range, governed by the compliance of 25 individual lung units; unlike high frequency ventilation/oscillation, with much lower tidal volumes, and very much higher respiratory/oscillatory rates. In laboratory studies, excellent gas py,h:,nrJe was accomplished in lungs as small as 12 % of normal volume 30 - at very low peak airway pressures.
WO 92/07604 2 ~ 9 3 6 6 3 PCI/~'S9l/081~
In studies in healthy animals conducted during the course of the present invention, VT has been reduced as low as 1-2 ml/kg, while keeping PIP at 3-4 cm H20 above PEEP, at frequencies of 120/min. No long term adverse effects resulted utilizing the method/apparatus of the present invention.
The use of ITV alone, or the use of ITV with CPAP, or the use of ITV in combination with a convention NV, greatly facilitates alveolar ventilation both in the low and high fre~uency range. This mode of ventilation both i5 distinct from high frequency ventilation, as small or near normal tidal volumes can be used while still effecting excellent C02 removal.
When the anatomical dead space is con~ i nllo~51 y flushed with fresh air/oxygen, useful ventilation can be extended to well over 60/min. This allows high RR and low VT, and hence low PIP, greatly reducing, or eliminating high airway p~-:S_uL~ induced lung injury.
Figure 1 is a schematic diagram illustrating the ventilation system utilized according to one ~ L
of the present invention. As illustrated in Fig. 1, a small catheter 1 is connected at one end by an adapter 2, e.g., silicone connector, to a means 3 for humidifying and controlling the temperature of an air/oxygen feed.
The distal end of the catheter 1 includes a diffuser 4 which, in use is positioned through a tracheostomy or endotracheal tube 5 to a level adjacent or near a patient's carina 6. The diffuser 4 is preferably formed integral to the distal end of the catheter and is made from suitable material for medical applications, e.g., silicone rubber. Likewise, the catheter is made from suitable material for medical applications, e.g., WO 9t/07604 2 0 9 3 ~ ~ ~ PCr/USgl/08~55 g silicone or teflon. In a preferred ~mho~ , the dif fuser includes a detectable marker or tag such as a radio opaque tantalum marker which may be utilized to assure proper positioning o~ the diffuser adjacent or 5 near the patient ' 5 carina .
As illustrated in Fig5. 1 and 2, the catheter is passed through a conventional f itting 7 which is connected to the tracheostomy or endotracheal tube 5 and includes ports 8 and 9 which may be connected to a 10 mechanical ventilator, including a balloon, and a positive end expiratory ~L?5~u~ ~ regulator, respectively.
According to the present invention the f itting 7 is modified as illustrated to allow passage of the catheter 1 through the tracheostomy or endotracheal tube 5.
The means 3 for humidifying and controlling the temperature of an air/oxygen feed i5 connected to adapter 2 by a sufficient length of tubing lO. In order to ensure that the temperature of the air/oxygen feed is maintained after being adjusted by the means for humidifying and controlling the temperature of an air/oxygen feed, both the tubing 10 and the portion of the catheter which extends from fitting 7 to the tubing lO are covered or wrapped by a suitable insulating material such as multiple layers of a thin plastic wrap.
The means 3 for humidifying and controlling the temperature of an air/oxygen feed includes a reservoir 11 which is filled with sterile water and heated by a suitable means such as an electrical heater to a temperature of about 37 C. The top of the reservoir 11 is closed by a cover having two ports or fittings to which an air/oxygen supply tubing 12 and tubing member 10 are connected. Air/oxygen is suppl-ied to the WO 92/07604 2 0 9 ~ ~ 6 3 PCr/llS91/0817 . ~ 10 air/oxygen supply tubing 12 from a suitable, metered source 13 of air and oxygen which allows for individual metering of both a source of air 14 and oxygen 15 at room temperature.
Figure 2 is a schematic diagram illustrating the catheter utilized in accordance with one embodiment of the present invention. AB illustrated in Fig. 2, the difruser 4 is preferably formed integral to the distal end of the catheter and includes a plurality of gas passage ports along the length thereof.
In operation, the catheter is passed through the tracheostomy or endotracheal tube 5 so as to position the diffuser 4 at or near the level of the patient ' s carina .
In order to prevent kinking of the catheter, the catheter may be inserted and positioned with the aid of a guide wire .
In operation, the oxygen content of the air/oxygen mixture supplied to the catheter may be adjusted from 21.1 to 100 percent. Thus the mixture may range from pure air to pure oxygen as noco~:8~ry.
In tests utilizing the system illustrated in Fig. 1, a gas flow rate of about 8 . 4 liters/minute was provided utilizing a gas flow ~el DUL-~ of about 5 p5i; a gas flow rate of about 13.4 liters/minute was provided u1-;1;7;n~
a gas flow pl_s~uL" of about 10 psi; and a gas flow rate of about 17.7 liters/minute was provided utilizing a gas flow pressure of ~ about 15 psi.
In tests utilizing the system illustrated in Fig. 1, the de;ld space of the trachea and tracheostomy or endotracheal tube was det~rm; nod to be about 120 cc.
Thus, utilizing a re. ' -' gas flow of 2 times the dead space/breath whe= used in conj ~nction with a -~ wo g2/07604 2 ~ 9 3 6 6 3 PC~/US9110815~
mechanical ventilator, or while on CPAP, or on spontaneous unassisted ventilation, the following equation was utilized to ~lPt~rmin~ constant gas flow rates at predet~rminPd re6piratory rates:
Flow Rate = Respiratory Rate x 2 x Dead Space From this equation the following flow rates were calculated utilizing the 5ystem illustrated in Fig. l.
Resirato r~ Rate Flow Rate 20 min l 4800 cc/min 40 min l 9600 cc/min 60 min l 14400 cc/min 80 min l 19200 cc/min When used as ITPV, the required flow rates are greatly reduced, as gas flow remains nearly constant at 15 about 4-5 l/min. at all respiratory rates, the reason being that all fresh gas is delivered bypassing the tracheal dead space.
The following non-limiting examples are presented to illustrate features and characteristics of the present 20 invention which is not to be considered as being limited thereto. In the examples and throughout lung percentages are by volume.
E le l In a series of young healthy lambs of approximately 25 lO kg the left lung (total of 43 ~), plus the right lower and cardiac lobe (81 %), plus the right middle lobe (RML) (88 %) were ~c,yL~ssively excluded from gas exchange. In some tests the lobes were surgically removed: in other tests the bronchi and pulmonary 3 0 arteries to the respective lobes were tied .
Lambs were sedated and para~yzed. Tests were conducted ut~lizing a contFolled mode ~IV (Servo 900 C), 4 2 ~ 9 3 ~ ~ 3 PCI/US9l/0815~
a tidal volume (VT) not more than 20 ml/kg based on L~ ;n;n~ lung mass, a respiratory rate (RR) up to 120/min, a PIP of 12-15 cm H20 and a PEEP of 3 cm H20.
Those lambs with the~ right upper lobe (RUL) and RML
tl9 9~ I~ ;n;ng lungs) were weaned to room air on MV
within 48 hours. Ventilating RUL (12 % of lung mass) alone reguired higher VT and PIP to provide adequate alveolar ventilation, but resulted in RDS and death within 8 hours.
lo r le 2 In this example, the ventilation system/method of the present invention was tested for comparison with the re6ult6 from Example 1 above.
A continuous flow o~ a humidified mixture of air and oxygen was pa66ed directly into the trachea at the level of the carina through a diffuser at a rate 4 times the projected tidal volume for the L~ ;n;n~ lung, effectively eliminating the tracheal anatomical dead space. A single valve controlled the expiration frerluency.
In this example, lambs with only RUL r . ; n i n~ were weaned to room air within 2 hours, at a RR of 60-120/min;
PIP 14-19 cm H20, respectively; PEEP 3 cm EI20; mean plllr ry artery pressure (mPAP) 30-35 mm Hg. The same lungs subsequently managed on conventional ~V at "optimal" settings, following a brief "hcn~y ~ period", PIO~LC s~ively deteriorated, and the lambs died after 12 hours from severe RDS. No tracheal lesion were detected in studies lasting up to 3 days.
The ventilation method of the present invention was found to be distinct from high frequency ventilation and its variants, ;n;- rl~ as relatively normal tidal volumes ~ WO 92/07604 2 0 9 3 ~ 6 ~ PCI/US91108155 are used in proportion to the L- ;n;nq healthy lung ma6s. The method of the present invention allows p~ ry ventilation at high rates, with a markedly reduced effective anato~nical dead space; it results in 5 normal airway pressures, no evidence of lung injury, and a low mPAP.
It i~; believed intratracheal ventilation will impact patient management before, and during all stages of current practices in MV.
Although the present invention has been described with re~erence to particular means, materials and e~bodiments, from the foregoing description, one skilled in the art can ascertain the essential characteristics of the present invention and various changes and 15 modifications may be made to adapt the various uses and characteristics thereof without departing from the spirit and scope of the pre~ent invention as described in the wnich follo~.
, .~
of the present inventio~
Figure 2 is a schematic diagram illustrating the catheter utilized in accordance with one ~mho~ L of the present invention.
5 Best Mode for ~Arrvinq Qut the Invention The pre6ent invention is directed to a method of intratracheal ventilation (ITV) or intratracheal plll ry ventilation (ITPV) in which fresh, humidified air/oxygen i5 introduced at a constant flow rate through lO a patient ' s trachea at a position adj acent or near the patient ' s carina .
In operaticn, the fresh, humidified air/oxygen is introduced through a very small catheter with a diffuser at its distal end which is placed through an endotracheal lS or tracheostomy tube, or may be possibly passed percutaneously to rest at the level of the carina. The continuous gas flow is provided at a rate of about 2 to 4 times anatomical dead space/breath. Dead space, as described below, is detDrminD~ from the volume of the 20 trachea and tracheostomy or endotracheal tube utilized, which, for example in an adult is about 120 cc.
The method of the precent invention may be utilized either with or without conventional ~ 1n;c~1 ventilation. When utilized without conventional 25 mechanical ventilation, the ITV method of the present invention may be utilized in combination with CPAP.
With continuous gas flow, in the constant or continuous positive airway p~ ULe: (CPAP) mode the breathing is controlled by the patient. In the ITPV controlled 30 ventilation mode of operation which does not utilize conventional --ch~nic~1 vèntilation, a timed expiratory valve sets the respiratory rate while a minute flow of WO 9~07604 2 0 ,~ ~ ~ 6 3 PCr/~lS91/081s5 .
air/oxygen determines tidal volume (vT) /breath 2nd hence peak inspir2tory pressure (PIP). In this mode the trachea is bypassed, since the fresh air/oxygen is introduced at the patient ' s carina, and the trachea is 5 therefore used only for expiration. By bypassing the trachea, the anatomical dead space is effectively reduced 50 that fresh air/oxygen flow rates of approximately 0 . 5 of the anatomical dead space/breath are acceptable. In the ITPV mode it ha6 been det~minecl that suitable 10 respiratory rates of 10-120/min. or higher may be used.
When used in conjunction with a conventional r--hi~nic~l ventilation (NV), the NV is operated in the pressure control mode at low tidal volumes tVT), and hence low peak inspiratory pressure (PIP), with RR
15 adjusted to effect adequate alveolar ventilation.
The method of the present invention effectively eliminates the anatomical dead space ventilation, thereby allowing respiratory rates well beyond what is now considered practical. As an aftereffect, the peak airway 20 pressures remain very low, thus avoidiny further harm or aggravation to a patient whose lungs are damaged.
The technique of the present invention is distinct from high ~requency ventilation, as tidal volumes remain within the normal range, governed by the compliance of 25 individual lung units; unlike high frequency ventilation/oscillation, with much lower tidal volumes, and very much higher respiratory/oscillatory rates. In laboratory studies, excellent gas py,h:,nrJe was accomplished in lungs as small as 12 % of normal volume 30 - at very low peak airway pressures.
WO 92/07604 2 ~ 9 3 6 6 3 PCI/~'S9l/081~
In studies in healthy animals conducted during the course of the present invention, VT has been reduced as low as 1-2 ml/kg, while keeping PIP at 3-4 cm H20 above PEEP, at frequencies of 120/min. No long term adverse effects resulted utilizing the method/apparatus of the present invention.
The use of ITV alone, or the use of ITV with CPAP, or the use of ITV in combination with a convention NV, greatly facilitates alveolar ventilation both in the low and high fre~uency range. This mode of ventilation both i5 distinct from high frequency ventilation, as small or near normal tidal volumes can be used while still effecting excellent C02 removal.
When the anatomical dead space is con~ i nllo~51 y flushed with fresh air/oxygen, useful ventilation can be extended to well over 60/min. This allows high RR and low VT, and hence low PIP, greatly reducing, or eliminating high airway p~-:S_uL~ induced lung injury.
Figure 1 is a schematic diagram illustrating the ventilation system utilized according to one ~ L
of the present invention. As illustrated in Fig. 1, a small catheter 1 is connected at one end by an adapter 2, e.g., silicone connector, to a means 3 for humidifying and controlling the temperature of an air/oxygen feed.
The distal end of the catheter 1 includes a diffuser 4 which, in use is positioned through a tracheostomy or endotracheal tube 5 to a level adjacent or near a patient's carina 6. The diffuser 4 is preferably formed integral to the distal end of the catheter and is made from suitable material for medical applications, e.g., silicone rubber. Likewise, the catheter is made from suitable material for medical applications, e.g., WO 9t/07604 2 0 9 3 ~ ~ ~ PCr/USgl/08~55 g silicone or teflon. In a preferred ~mho~ , the dif fuser includes a detectable marker or tag such as a radio opaque tantalum marker which may be utilized to assure proper positioning o~ the diffuser adjacent or 5 near the patient ' 5 carina .
As illustrated in Fig5. 1 and 2, the catheter is passed through a conventional f itting 7 which is connected to the tracheostomy or endotracheal tube 5 and includes ports 8 and 9 which may be connected to a 10 mechanical ventilator, including a balloon, and a positive end expiratory ~L?5~u~ ~ regulator, respectively.
According to the present invention the f itting 7 is modified as illustrated to allow passage of the catheter 1 through the tracheostomy or endotracheal tube 5.
The means 3 for humidifying and controlling the temperature of an air/oxygen feed i5 connected to adapter 2 by a sufficient length of tubing lO. In order to ensure that the temperature of the air/oxygen feed is maintained after being adjusted by the means for humidifying and controlling the temperature of an air/oxygen feed, both the tubing 10 and the portion of the catheter which extends from fitting 7 to the tubing lO are covered or wrapped by a suitable insulating material such as multiple layers of a thin plastic wrap.
The means 3 for humidifying and controlling the temperature of an air/oxygen feed includes a reservoir 11 which is filled with sterile water and heated by a suitable means such as an electrical heater to a temperature of about 37 C. The top of the reservoir 11 is closed by a cover having two ports or fittings to which an air/oxygen supply tubing 12 and tubing member 10 are connected. Air/oxygen is suppl-ied to the WO 92/07604 2 0 9 ~ ~ 6 3 PCr/llS91/0817 . ~ 10 air/oxygen supply tubing 12 from a suitable, metered source 13 of air and oxygen which allows for individual metering of both a source of air 14 and oxygen 15 at room temperature.
Figure 2 is a schematic diagram illustrating the catheter utilized in accordance with one embodiment of the present invention. AB illustrated in Fig. 2, the difruser 4 is preferably formed integral to the distal end of the catheter and includes a plurality of gas passage ports along the length thereof.
In operation, the catheter is passed through the tracheostomy or endotracheal tube 5 so as to position the diffuser 4 at or near the level of the patient ' s carina .
In order to prevent kinking of the catheter, the catheter may be inserted and positioned with the aid of a guide wire .
In operation, the oxygen content of the air/oxygen mixture supplied to the catheter may be adjusted from 21.1 to 100 percent. Thus the mixture may range from pure air to pure oxygen as noco~:8~ry.
In tests utilizing the system illustrated in Fig. 1, a gas flow rate of about 8 . 4 liters/minute was provided utilizing a gas flow ~el DUL-~ of about 5 p5i; a gas flow rate of about 13.4 liters/minute was provided u1-;1;7;n~
a gas flow pl_s~uL" of about 10 psi; and a gas flow rate of about 17.7 liters/minute was provided utilizing a gas flow pressure of ~ about 15 psi.
In tests utilizing the system illustrated in Fig. 1, the de;ld space of the trachea and tracheostomy or endotracheal tube was det~rm; nod to be about 120 cc.
Thus, utilizing a re. ' -' gas flow of 2 times the dead space/breath whe= used in conj ~nction with a -~ wo g2/07604 2 ~ 9 3 6 6 3 PC~/US9110815~
mechanical ventilator, or while on CPAP, or on spontaneous unassisted ventilation, the following equation was utilized to ~lPt~rmin~ constant gas flow rates at predet~rminPd re6piratory rates:
Flow Rate = Respiratory Rate x 2 x Dead Space From this equation the following flow rates were calculated utilizing the 5ystem illustrated in Fig. l.
Resirato r~ Rate Flow Rate 20 min l 4800 cc/min 40 min l 9600 cc/min 60 min l 14400 cc/min 80 min l 19200 cc/min When used as ITPV, the required flow rates are greatly reduced, as gas flow remains nearly constant at 15 about 4-5 l/min. at all respiratory rates, the reason being that all fresh gas is delivered bypassing the tracheal dead space.
The following non-limiting examples are presented to illustrate features and characteristics of the present 20 invention which is not to be considered as being limited thereto. In the examples and throughout lung percentages are by volume.
E le l In a series of young healthy lambs of approximately 25 lO kg the left lung (total of 43 ~), plus the right lower and cardiac lobe (81 %), plus the right middle lobe (RML) (88 %) were ~c,yL~ssively excluded from gas exchange. In some tests the lobes were surgically removed: in other tests the bronchi and pulmonary 3 0 arteries to the respective lobes were tied .
Lambs were sedated and para~yzed. Tests were conducted ut~lizing a contFolled mode ~IV (Servo 900 C), 4 2 ~ 9 3 ~ ~ 3 PCI/US9l/0815~
a tidal volume (VT) not more than 20 ml/kg based on L~ ;n;n~ lung mass, a respiratory rate (RR) up to 120/min, a PIP of 12-15 cm H20 and a PEEP of 3 cm H20.
Those lambs with the~ right upper lobe (RUL) and RML
tl9 9~ I~ ;n;ng lungs) were weaned to room air on MV
within 48 hours. Ventilating RUL (12 % of lung mass) alone reguired higher VT and PIP to provide adequate alveolar ventilation, but resulted in RDS and death within 8 hours.
lo r le 2 In this example, the ventilation system/method of the present invention was tested for comparison with the re6ult6 from Example 1 above.
A continuous flow o~ a humidified mixture of air and oxygen was pa66ed directly into the trachea at the level of the carina through a diffuser at a rate 4 times the projected tidal volume for the L~ ;n;n~ lung, effectively eliminating the tracheal anatomical dead space. A single valve controlled the expiration frerluency.
In this example, lambs with only RUL r . ; n i n~ were weaned to room air within 2 hours, at a RR of 60-120/min;
PIP 14-19 cm H20, respectively; PEEP 3 cm EI20; mean plllr ry artery pressure (mPAP) 30-35 mm Hg. The same lungs subsequently managed on conventional ~V at "optimal" settings, following a brief "hcn~y ~ period", PIO~LC s~ively deteriorated, and the lambs died after 12 hours from severe RDS. No tracheal lesion were detected in studies lasting up to 3 days.
The ventilation method of the present invention was found to be distinct from high frequency ventilation and its variants, ;n;- rl~ as relatively normal tidal volumes ~ WO 92/07604 2 0 9 3 ~ 6 ~ PCI/US91108155 are used in proportion to the L- ;n;nq healthy lung ma6s. The method of the present invention allows p~ ry ventilation at high rates, with a markedly reduced effective anato~nical dead space; it results in 5 normal airway pressures, no evidence of lung injury, and a low mPAP.
It i~; believed intratracheal ventilation will impact patient management before, and during all stages of current practices in MV.
Although the present invention has been described with re~erence to particular means, materials and e~bodiments, from the foregoing description, one skilled in the art can ascertain the essential characteristics of the present invention and various changes and 15 modifications may be made to adapt the various uses and characteristics thereof without departing from the spirit and scope of the pre~ent invention as described in the wnich follo~.
, .~
Claims (23)
1. A method of providing ventilatory assistance to a patient which comprises:
positioning a distal end of a catheter in an area near the carina of a patient; and supplying a continuous supply of an oxygen containing gas mixture to the patient through the catheter while mechanically ventilating the patient.
positioning a distal end of a catheter in an area near the carina of a patient; and supplying a continuous supply of an oxygen containing gas mixture to the patient through the catheter while mechanically ventilating the patient.
2. A method of providing ventilatory assistance to a patient according to claim 1, wherein said catheter is positioned within said patient by means of an endotracheal tube.
3. A method of providing ventilatory assistance to a patient according to claim 1, wherein said catheter is positioned within said patient by means of a tracheostomy tube.
4. A method of providing ventilatory assistance to a patient according to claim 2, wherein said oxygen containing gas mixture is supplied at a sufficient flow rate to continuously flush the anatomical dead space with a fresh supply of said oxygen containing gas mixture.
5. A method of providing ventilatory assistance to a patient according to claim 4, wherein said flow rate of said oxygen containing gas mixture is 2 to 4 times the anatomical dead space per breath.
6. A method of providing ventilatory assistance to a patient according to claim 2, wherein pulmonary ventilation of the patient is controlled by a timed expiratory valve and the patient's trachea is used only for expiration.
7. A method of providing ventilatory assistance to a patient according to claim 6, wherein pulmonary ventilation of the patient is controlled at a respiratory rate of above 10 min-1.
8. A method of providing ventilatory assistance to a patient according to claim 3, wherein said oxygen containing gas mixture is supplied at a sufficient flow rate to continuously flush the anatomical dead space with a fresh supply of said oxygen containing gas mixture.
9. A method of providing ventilatory assistance to a patient according to claim 8, wherein said flow rate of said oxygen containing gas mixture is 2 to 4 times the anatomical dead space per breath.
10. A method of providing ventilatory assistance to a patient according to claim 3, wherein pulmonary ventilation of the patient is controlled by a timed expiratory valve and the patient's trachea is used only for expiration.
11. A method of providing ventilatory assistance to a patient according to claim 9, wherein pulmonary ventilation of the patient is controlled at respiratory rate of above 10 min-1.
12. A method of providing ventilatory assistance to a patient according to claim 1, further comprising providing a gas diffuser on said distal end of said catheter.
13. A method of providing ventilatory assistance to a patient according to claim 1, wherein said catheter is positioned by means of a guide wire.
14. A method of providing ventilatory assistance to a patient according to claim 1, wherein said oxygen containing gas mixture comprises from 21.1 to 100 vol.% oxygen gas.
15. A method of providing ventilatory assistance to a patient according to claim 1, wherein said oxygen containing gas mixture is humidified and supplied at a temperature of about 37°C.
16. A method of providing ventilatory assistance to a patient which comprises continuously flushing anatomical dead space of the patient with a fresh supply of an oxygen containing gas mixture while mechanically ventilating the patient.
17. A method of providing ventilatory assistance to a patient according to claim 16, wherein said oxygen containing gas mixture is provided at a flow rate of 2 to 4 times the anatomical dead space per breath.
18. A method of providing ventilatory assistance to a patient according to claim 16, wherein ventilation of the patient is controlled at a respiratory rate of above 60 min-1.
19. An apparatus for providing ventilation assistance to a patient which comprises a fitting connected to a tracheostomy of endotracheal tube, said fitting having at least two ports for connecting said fitting to a mechanical ventilator and a pressure regulator, a catheter, means for positioning said catheter through said tracheostomy or endotracheal tube to an area near the carina of the patient, and means for providing a continuous supply of an oxygen containing gas mixture to the patient through the catheter.
20. An apparatus for providing ventilation assistance to a patient according to claim 19, further comprising an expiratory valve which principally controls the patient's expiratory rate.
21. A method of providing ventilatory assistance to a patient according to claim 1, wherein said mechanical ventilation is performed by a timed expiratory valve.
22. A method of providing ventilatory assistance to a patient according to claim 16, wherein said mechanical ventilation is performed by a timed expiratory valve.
23. An apparatus for providing ventilation assistance to a patient according to claim 19, wherein said mechanical ventilator comprises a timed expiratory valve.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US606,967 | 1990-10-31 | ||
| US07/606,967 US5255675A (en) | 1990-10-31 | 1990-10-31 | Device for intratracheal ventilation and intratracheal pulmonary ventilation |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2093663A1 CA2093663A1 (en) | 1992-05-01 |
| CA2093663C true CA2093663C (en) | 1996-09-03 |
Family
ID=24430264
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002093663A Expired - Fee Related CA2093663C (en) | 1990-10-31 | 1991-10-31 | Device for intratracheal and intratracheal pulmonary ventilation |
Country Status (11)
| Country | Link |
|---|---|
| US (1) | US5255675A (en) |
| EP (1) | EP0555343B1 (en) |
| JP (1) | JPH0761364B2 (en) |
| AT (1) | ATE161197T1 (en) |
| AU (1) | AU650306B2 (en) |
| CA (1) | CA2093663C (en) |
| DE (1) | DE69128484T2 (en) |
| DK (1) | DK0555343T3 (en) |
| ES (1) | ES2113381T3 (en) |
| GR (1) | GR3026274T3 (en) |
| WO (1) | WO1992007604A1 (en) |
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-
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- 1990-10-31 US US07/606,967 patent/US5255675A/en not_active Expired - Lifetime
-
1991
- 1991-10-31 EP EP91920232A patent/EP0555343B1/en not_active Expired - Lifetime
- 1991-10-31 ES ES91920232T patent/ES2113381T3/en not_active Expired - Lifetime
- 1991-10-31 DE DE69128484T patent/DE69128484T2/en not_active Expired - Fee Related
- 1991-10-31 AT AT91920232T patent/ATE161197T1/en not_active IP Right Cessation
- 1991-10-31 CA CA002093663A patent/CA2093663C/en not_active Expired - Fee Related
- 1991-10-31 JP JP4500914A patent/JPH0761364B2/en not_active Expired - Fee Related
- 1991-10-31 WO PCT/US1991/008155 patent/WO1992007604A1/en active IP Right Grant
- 1991-10-31 AU AU89498/91A patent/AU650306B2/en not_active Ceased
- 1991-10-31 DK DK91920232.5T patent/DK0555343T3/en active
-
1998
- 1998-03-04 GR GR970402316T patent/GR3026274T3/en unknown
Also Published As
| Publication number | Publication date |
|---|---|
| AU8949891A (en) | 1992-05-26 |
| DK0555343T3 (en) | 1998-03-02 |
| JPH0761364B2 (en) | 1995-07-05 |
| DE69128484T2 (en) | 1998-07-23 |
| EP0555343A1 (en) | 1993-08-18 |
| GR3026274T3 (en) | 1998-06-30 |
| WO1992007604A1 (en) | 1992-05-14 |
| CA2093663A1 (en) | 1992-05-01 |
| DE69128484D1 (en) | 1998-01-29 |
| AU650306B2 (en) | 1994-06-16 |
| US5255675A (en) | 1993-10-26 |
| JPH06502564A (en) | 1994-03-24 |
| ES2113381T3 (en) | 1998-05-01 |
| EP0555343A4 (en) | 1993-09-22 |
| EP0555343B1 (en) | 1997-12-17 |
| ATE161197T1 (en) | 1998-01-15 |
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