MXPA98001769A - High-flow nebulizer for oxig variable concentration - Google Patents

Abstract

A nebulizer (10) for providing a selected oxygen concentration and a total flow of respiratory gas, including at least two oxygen nozzles (102, 104, 106 and 108), each oxygen nozzle having an outlet. A pressurized oxygen supply tube is connected, in fluid communication, to each nozzle. A liquid outlet (80) corresponding to each nozzle (102, 104, 106 and 108), is located near the outlet of the nozzle of the corresponding nozzle to nebulize liquids from the outlet of the nozzle (102, 104, 106 and 108). ). A liquid supply source (174) is connected, in liquid communication to each liquid outlet (80). A mechanism for regulating oxygen is provided, which is in fluid communication with at least one of the oxygen nozzles (102, 104, 106 and 108) to selectively select at least one oxygen nozzle, and to prevent the gas flows from that oxygen nozzle so

Description

HIGH-FLOW NEBULIZER WITH VARIABLE OXYGEN CONCENTRATION BACKGROUND OF THE INVENTION Technical Field The present invention relates to a nebulizer, and more specifically to a nebulizer with an adjustable oxygen concentration range capable of maintaining a high total gas flow.

BACKGROUND OF THE PRIOR ART Nebulizers are used in medical applications to entrain a medicinal liquid or water in a high-velocity flow of a pressurized carrier gas, such as oxygen, to supply the medicinal liquid or water entrained in the form of fine vapor. or aerosol to the lungs of a patient. In most therapeutic applications, the carrier gas is oxygen. For reasons of simplicity, this report will refer to the carrier gas as oxygen, but it is not intended that this limit the different types of gases that can be used as a carrier gas with the high-flux nebulizer of variable oxygen concentration. Michaels et al., US Patent No. 4,595,002, describe a nebulizer design that has been quite commercially successful. The Michaels nebulizer has a nozzle that directs a high-pressure, low-velocity oxygen stream near a conventionally constructed Venturi tube to draw fluid from a reservoir through the Venturi tube so that the oxygen stream carries the liquid from the Venturi tube. . The nebulized liquid and oxygen flow directly into a mixing chamber defined by a cylindrical housing. An opening or vent hole in the cylindrical housing allows the ambient air to be drawn into the mixing chamber by the oxygen stream, of high speed and of relatively low pressure, such that the oxygen concentration is diluted. In addition, Michaels describes a collar that surrounds the cylindrical body, and the collar has a window that can be aligned or misaligned with respect to the ventilation hole of the housing by rotating the collar relative to the housing, thereby increasing or decreasing the effective opening of the orifice. ventilation. In addition, Michaels tells us that the collar has a graduation that is graduated to reflect the concentrations of oxygen that are inspired and that are the result of the window opening a selected amount. In this way, the nebulizer described in the Michaels patent offers a clinical, convenient and precise control of the concentration of oxygen in a stream of respiratory gases and nebulized liquid flowing to the patient. The nebulizer described by Michaels is very efficient to supply mixtures of oxygen and air containing less than 40% oxygen. But at concentrations of oxygen greater than 40% it has been found that the structure described by Michaels supplies a total volume of respiratory gas flow (oxygen and ambient air) of less than 40 liters per minute. However, when a patient has respiratory problems, the patient often needs 40 liters per minute or more of respiratory gases. In order to provide the patient with sufficient volume of respiratory gas flow with high oxygen concentration, clinicians need to use two or three nebulizers, such as the one described in Michaels' patent, contacted in parallel. In previous inventions efforts have been made to offer a unique nebulizer that can provide a wide range of oxygen concentrations, while providing sufficient amount of respiratory gases even at high oxygen concentrations. U.S. Patent No. 4,612,926, to Boiarski et al., Constitutes an example of the prior techniques for trying to solve this need. Boiarski describes a nebulizer that can be connected to a standard 50 psig oxygen source to deliver nebulized air to a patient with oxygen concentrations ranging from less than 30% to 100%, while maintaining a flow volume of at least 40 liters per minute even for relatively pure oxygen flows. Boiarski states that he has been able to achieve this by providing a structure somewhat similar to the one described above with respect to Michaels, but that included a second oxygen nozzle with valves that is not related to a Venturi liquid supplier. In the invention of Boiarski the valve of the second nozzle allows the clinician to increase the volume of oxygen flow when the amount of ambient air that can be aspirated decreases, closing the hole corresponding to the ambient air. The description of Boiarski has several problems that prevent him from effectively solving the need to offer a single nebulizer capable of supplying a large volume of oxygen concentrations and at the same time providing sufficient volume of respiratory gas flow. Specifically, Boiarski's invention does not provide liquid to the second nozzle to perform a nebulization. Consequently, with Boiarski's invention a very complex structure is needed, including a baffle that deflects oxygen from the second nozzle to prevent it from interfering with the nebulization of the liquid, causing oxygen to exit through a first nozzle. This baffle also considerably reduces the oxygen velocity (from 300 m / s to 5 m / s), which results in an increase in pressure above the air entrainment window, which would make it difficult to control the total volume of air properly. flow and the percentage of oxygen when there are high concentrations of oxygen. What is more, with Boiarski's invention, two independent adjustments are needed (that of the air entrainment window and that of the second nozzle) to alter oxygen concentrations at the same time that adequate flow volumes are maintained, which makes that Boiarski's invention is difficult for a clinician to use. With Boiarski's invention, the clinician is not given any way of ascertaining the total volume of respiratory gas flow that is being delivered to the patient, so that the clinician can accurately regulate the second oxygen nozzle as they open and close. the ventilation holes for entraining the ambient air. In addition to the fact that this makes the use of the Boiarski nebulizer difficult, this deficiency of its nebulizer causes the risk of inadvertently closing the ventilation holes entraining the ambient air, without opening the second valve at the same time. which would not reach the patient the necessary volume of respiratory gases, and would result in respiratory failure. The company Medical Molding Corporation of America sells a nebulizer with the name of MI STY OX, with which it tries to solve the problem of providing the patient with sufficient air flow with a wide range of oxygen concentrations (21% -100%) . With the MISTY OX, it is necessary to connect it to a separate compressed air source, in addition to connecting it to a standard 50 psig oxygen source. This requirement of having a second supply of pressurized gas makes the MISTY OX nebulizer not suitable for many clinical applications, especially outside the intensive care units. The present invention aims to solve one or more of the problems discussed above.

ABSTRACT OF THE INVENTION The present invention relates to a nebulizer that provides the patient with an adjustable percentage of inspired oxygen, at the same time maintaining a selected flow volume of respiratory gases and nebulized liquid. The nebulizer includes at least two oxygen nozzles, each having an inlet and an outlet. A pressurized oxygen supply source is connected in fluid communication with the inlet of each nozzle. The liquid outlet corresponding to each nozzle is located near the outlet of the corresponding nozzle to nebulize the liquid from the outlet of the liquids with an oxygen current flowing from the outlet of each nozzle. A liquid supply source is connected in liquid communication with each liquid outlet. A valve is provided to regulate oxygen that is in fluid communication with at least one of the gas nozzles, so as to select a nozzle at least and prevent oxygen from flowing from that single nozzle. In addition, the nebulizer may have a liquid control mechanism that is functionally related to the liquid supply source, to allow and prevent, as desired, the liquid from flowing through a selected liquid outlet. In a preferred embodiment of the nebulizer a functionally related coordinator is included, between the liquid control and the oxygen regulation valve, to make the liquid control impede the flow of the same through a liquid outlet, when the valve Oxygen regulation selectively prevents gas from flowing from the corresponding nozzle, and makes the liquid control allows the flow of the same through the liquid outlet when the oxygen regulation valve selects the nozzle. In addition, the nebulizer may include a housing having a wall and a mixing chamber thereon, to receive oxygen and nebulized liquid from the outlets of the oxygen nozzle and the corresponding liquid outlets. The wall has at least one ventilation hole for the ambient air, so as to provide a flow of ambient air to the mixing chamber and an outlet for exhausting the nebulized liquid, gas and ambient air. A controller for the vent hole is provided in functional relation to the ambient air vent, to selectively adjust the effective size of the ambient air vent, between fully open and fully closed. Preferably, a communication structure is provided between the oxygen regulating valve and the ventilation orifice control, so that the ventilation orifice controller decreases its effective size beyond a selected amount, the oxygen regulation valve automatically increase the number of selected nozzles and, as the controller of the ventilation hole is being regulated, increase the effective size of the ventilation hole, the oxygen regulation valve automatically decreases the number of selected nozzles. The oxygen regulation valve may consist of a cylinder having a first and a second end and a hole through the wall of the cylinder corresponding to each oxygen nozzle, each hole being separated longitudinally, along the wall of the cylinder between the first end and the second end. There is a conduit that connects each hole with the corresponding nozzle inlet. A plunger having a cylindrical side wall with an open end corresponding to the first end of the cylinder, and a closed end defining a fluid overpressure chamber within the plunger is arranged in the cylinder. The outer diameter of the plunger is smaller than the inner diameter of the cylinder, in order to define an annular space between them. The plunger includes a hole in the side wall between the fluid overpressure chamber and outside the fluid overpressure chamber, and a radial seal between its closed end and the orifice, forming a fluid-tight seal between the inside of the cylinder and the side wall of the plunger. A source of pressurized gas is in fluid communication with the open end of the plunger. A regulator is provided to move the plunger longitudinally inside the cylinder in a first direction to select the selected nozzles by moving the seal between the hole corresponding to the nozzle and the second end of the cylinder, and in a second direction to prevent the flow from shifting to the selected nozzles by moving the seal between the corresponding hole and the first end of the cylinder. A second embodiment of the nebulizer that provides a selected volume of gas flow that entrains a liquid, includes a cylindrical housing having a closed end and a connector structure at the closed end, for connecting a pressurized gas supply source in communication with the inside the cylindrical housing. A disk of the primary nozzle, having at least two gas nozzles, is positioned near the closed end of the cylindrical housing but separated therefrom. A valve disk having an outer diameter smaller than the internal diameter of the housing is placed between the primary nozzle disk and the closed end of the cylindrical housing with integral valves in the valve disk in functional relation to one of the two nozzles of gas, at least. The valves that are in the valve disc can be operated between a selected position and a closed position, to selectively selectively close the corresponding gas nozzle. An actuator that is in the cylinder is functionally related to each valve to drive each valve between a selected position and a closed position by a relative rotation made between the valve disc and the housing. A liquid outlet corresponding to each gas nozzle is located near the gas outlet of the corresponding nozzle to nebulize liquids from the liquid outlet in a stream of carrier gas flowing from the gas outlet of each nozzle. A liquid supply source is connected in liquid communication with the liquid outlet. The second embodiment may also include a disk of the secondary nozzle having an upper part and a lower part, the secondary nozzle disk having a hole therein that conforms to each of the liquid outlets. There is a groove in the upper part of the secondary nozzle disc corresponding to each liquid outlet and extends between a common liquid supply orifice and each outlet. The upper part of the secondary nozzle disk abuts a lower surface of the primary nozzle disk in close fluid relation, whereby the grooves form fluid-tight conduits of the disk. A liquid supply tube extends between the common liquid supply port and a liquid supply source, thereby providing the liquid to each of the liquid outlets due to the negative pressure created by a pressurized gas flow to through the gas nozzles. The nebulizer described in this report allows the percentage of carrier gas (usually oxygen) to be regulated between 28% and 100%, while maintaining the total flow volume of respiratory gases emanating from the nebulizer to at least 40 liters per minute. 'The nebulizer also provides automatic regulation of the number of selected oxygen nozzles as the ambient air orifice is opened or closed, to automatically ensure that a selected volume of respiratory gases can be selected, since the oxygen concentration It can be regulated with a simple operation. The nebulizer offers these important advantages over the nebulizers of previous inventions, without needing another source of compressed oxygen apart from the standard 50 psig oxygen connection that is usually found in hospitals and other clinical institutions. This feature makes it easier for the nebulizer to be used outside the intensive care unit in most hospitals, and in non-critical hospitals, and also in home medical care applications. The versatility of the nebulizer allows hospitals and other health care institutions not to have in their inventory more than this single nebulizer to provide a wide range of concentrations of carrier gas, while maintaining the required volume of respiratory gas flow . In addition, the nebulizer operates with simple mechanical connections and can be manufactured with relatively inexpensive injection molded parts, which results in a nebulizer that is not expensive to manufacture but which, nevertheless, is very precise and easy to handle.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a perspective view of a first embodiment of the high flow nebulizer with adjustable oxygen concentration of the present invention attached to a bottle with medicaments; Figure 2 is an exploded view or composition diagram of the nebulizer of Figure 1; Figure 3 is a plan view of the nebulizer of Figure 1; Figure 4 is a cross-sectional view of the nebulizer of Figure 1 taken along line 4-4 of Figure 3. Figure 5 is a cross-sectional view of the nebulizer of Figure 1 taken along the line 5- 5 of Figure 3; Figure 6 is a cross-sectional view of the nebulizer housing; Figure 6A is a cross-sectional view taken along line 6A-6A of the Figure 6; Figure 6B is an elevational view of the stepped drag protector illustrated in Figure 6, with the liquid drag windows drawn in transparent lines; Figure 7 in a cross-sectional view of the interior frame of the nebulizer illustrated in FIG.

Figure 2; Figure 8 is a bottom-up view of the inner frame of the nebulizer illustrated in Figure 7; Figure 9 is a cross-sectional view of the oxygen control cylinder illustrated in Figure 2; Figure 10 is a bottom-up view of the oxygen control cylinder of Figure 8; Figure 1 1 is a cross-sectional view of the plunger illustrated in Figure 2; Figure 12 is an enlarged cross-sectional view of a liquid drag window of the inner frame illustrated in Figure 7; Figure 13 is an elevational view of the liquid entrainment window of Figure 12; Figure 14 is an enlarged view of a cross section of the annular division illustrated in Figure 7; Figure 15 is a cross-sectional view illustrating the alignment of the first nozzle and the second nozzle; Figure 16 is a graph of the total flow of the respiratory gas as a function of the percentage of inspired oxygen (FI02) of the high-flow nebulizer with adjustable oxygen concentration; and Figure 17 is a diagram illustrating the degree of rotation of the control collar with which the oxygen nozzles are selected. Figure 18 is a sectional, perspective view of a second embodiment of the high flow oxygen concentrator with adjustable oxygen concentration of the present invention; Figure 19 is a partial view of the exploded view or composition diagram of the nebulizer of Figure 18; Figure 20 is an exploded view or perspective composition diagram of the nebulizer disk assembly of Figure 18; Figure 21 is a perspective view, from bottom to top, of the disc of the nebulizer valve of Figure 18; Figure 22 is a perspective view, taken from the top, of the secondary nozzle disk of the nebulizer of Figure 18; Figure 23 illustrates a valve that closes the primary nozzle; Figure 24 illustrates a valve that selects a primary nozzle; Figure 25 A-E is a linear illustration of the actuator of the arciform valve, which interacts with the cams of the second, third and fourth valves; Figure 26 is a cross-sectional side view of an alternative embodiment of the liquid supply structure that is used in the nebulizer of Figure 18; Figure 27 is a bottom-up view of the secondary nozzle disk of the alternate embodiment of Figure 26; Figure 28 illustrates the structure of the inverted siphon that is used in the alternate embodiment of Figure 26.

Detailed Description of the Preferred Embodiment A first embodiment of the high-flux nebulizer with adjustable oxygen concentration 10 of the present invention, threaded to a fluid reservoir to a drug bottle 12 of Figure 1 is illustrated. The elements of the nebulizer 10, the which are clearly seen in Figure 1, include a housing 14 for the cylindrical nebulizer, which has an inlet 16 and an outlet 18 for the pressurized gas. A conventional screw cap 20 is illustrated in transparent lines introduced into the inlet 16 of pressurized gas. Descending from the lower part of the housing 14 of the nebulizer is the inverted siphon 22, which goes towards the bottle 12. Surrounding a portion of the housing 14 of the nebulizer, there is a flow control collar 24 having a window 26 of ambient air and a regulating lever 28. In operation, the pressurized gas inlet 16 is connected to a carrier gas supply source (not shown), which is almost always oxygen, at a pressure that is generally 50 psig, or approximately, joining a conduit (not shown) of the source of pressurized gas to the inlet of pressurized gas 16 and holding a junction in the pressurized gas conduit will give the inlet 16 of pressurized gas by means of the screw cap 20. The housing 14 of the nebulizer is threaded to a bottle 12 for supplying liquids, one end being distant from the inverted siphon 22 inside the liquid that is inside the bottle. At the moment when pressurized gas flows into the inlet 16, the liquid in the bottle 12 is withdrawn towards the nebulizer through the inverted siphon 22, entrained in the carrier gas and mixed with any air entering through the window 26 of ambient air. The resulting mixture of air, carrier gas and nebulized liquid flows out through outlet 18, which in turn is supplied to the patient through a respiratory support system (not shown). The operation of the nebulizer 10 and the interaction of its components will be explained in more detail below. Figure 2 is an exploded view or composition diagram of the first embodiment of the nebulizer 10, wherein the components thereof and their relative positions during assembly are illustrated. The flow control collar 24 fits over the upper part of the housing 14, surrounding a portion of the housing 14. Between the components located inside the housing 14 is included an outer cylinder 30 that receives a control cylinder 32 of oxygen, which in turn receives a plunger 34. Once assembled, the outer cylinder 30, the oxygen control cylinder 32 and the plunger 34, are received in the upper part of the inner frame 36. One end of the inverted siphon 22 is received in a female receptacle at the bottom of the inner frame 36. Then, the inner frame 36 is received at the bottom of the housing 14. The various components assembled and in cross section are shown in Figures 4 and 5.; such components will be described in greater detail below. The housing 14 of the cylindrical nebulizer is shown transversely in the Figures 6, 6A and 6B. In addition to the inlet 16 and the outlet 18 for the pressurized gas, same as described above, the housing 14 of the cylindrical nebulizer includes an internally threaded base 38 for screwing to an external thread (not shown) in the upper part of the bottle 12 Above the base 38 is the central portion 39 of the housing 14. The outlet 18 is located in the central portion 39. Above the outlet 18 are a pair of air entraining holes 40 through the side wall of the housing of the nebulizer, being separated from each other by 180 °. In Figure 6 only one air-entraining orifice 40 is shown, although both can be seen in Figure 6A. Between the air-entraining holes 40 are the arcuate grooves 42 through the side wall on opposite sides of the housing 14. Each of the arcuate grooves 42 extends through an approximately 100 ° arc through the housing wall. 14 of the nebulizer. An inclined annular projection 46 joins an upper portion 48 and the central portion 39 of the housing 14 of the nebulizer. Descending from the upper part 50 of the housing 14 of the nebulizer, inside the upper portion 48, there is a stepped arciform drive protector 52. The stepped drag protector 52 is shown in greater detail in Figure 6B, which will be discussed more fully below. Also extending downwardly from the upper portion 50 of the housing 14, along the longitudinal axis of the housing 14, there is a cylinder 54 which controls the plunger and which has a pair of slots 56 elongated and 180 ° apart, extending axially upwardly. from shore 58 of the bottom. Figure 6A is a cross-sectional view of Figure 6 illustrating the air entrainment orifices 40, the arcuate stepped liquid entrainer 52 and the cylinder 54 of the plunger control. The inner frame 36 is described with reference to Figures 7, 8 and 2. The inner frame 36 has a general cylindrical shape. It includes a lower portion 60 of uniform diameter and has a pair of openings 62 for access of mixed air, spaced 180 ° circumferentially. Above the mixed air access openings 62, a pair of connecting arms 66 extend in opposite directions, starting from the cylindrical side wall of the inner frame 36. Above the connecting arms 66 there is an annular division 70 which extends radially outwardly from an upper portion 72 of the uniform internal diameter of the inner frame 36. A distant edge of the annular division 70 is constituted by a semicircular protrusion 71, which is shown in greater detail in Figure 14. Axially spaced and at 90 ° intervals , above the annular partition 70 there are four windows 74 for liquid access. As best seen in Figures 12 and 13, a flange 76 extends outwardly from the portion 72 of uniform diameter and frames each of the windows 74 of the liquid access. Preferably, the ridges should protrude between 0.002 and 0.005 inches. In the embodiment that is illustrated in particular herein, the liquid access windows 74 and the flanges 76 are square; however, the liquid access windows 74 and the flanges 76 could have any shape, even circular. Within an inner frame 36, between the lower portion 60 of uniform diameter and the upper portion 72 of uniform diameter, there is a perforated plate 78. As best seen in Figure 8, the perforated plate 78 has 4 outlets 80 for delivery of liquids. Each outlet 80 for supplying liquids has a feed channel 82 that is in fluid communication with a secondary or liquid nozzle 84. On the upper surface of the perforated plate 78 there is a pair of keyed protuberances 86. With reference to Figure 2 , a flap 88 extends from the inner frame 36 and develops between the lower part of the annular division 70 and the lower edge 90 of the frame member. Within the fin 88 a conduit is formed (not shown), same extending along the vane 88 between a hole 92 for supplying liquids in the annular division 70 (see Figure 8) and a hole (not shown) that is located in the lower edge of the vane 88. The inverted siphon 22 is configured so that it fits into the hole in the lower edge of the vane 88, as indicated in Figure 2. The oxygen control cylinder 32 is shown transversely in Figure 9. The control cylinder 32 of oxygen has an annular flange 100 around a lower edge. Extending through the annular flange is a first primary nozzle 102, a second primary nozzle 104, a third primary nozzle 106 and a fourth primary nozzle 108. The operation of the nebulizer 10 will be discussed in more detail below. For now, the reader it should be understood that the nebulizer selects the nozzles 104, 106 and 108 when the driving holes 40 are closed. The holes of each of the four primary nozzles are sized to provide the necessary volume of oxygen flow when the air-entraining holes 40 are closed. The diameter of the first primary nozzle 102 is about 0.017", the diameter of the second primary nozzle 104 is about 0.025", the diameter of the third primary nozzle 106 is about 0.034"and the diameter of the fourth Primary nozzle 108 is approximately 0.042". The nozzles increase in size because when the ambient air holes are closed, the size of each additionally selected nozzle must increase in diameter in order to provide an adequate flow. As illustrated in Figure 9, within the lower surface of the oxygen control cylinder 32 is a pair of keyed depressions 1 10 spaced apart to receive the keyed protuberances 86 of the inner frame 36. The interior of the oxygen control cylinder 32 includes the first cylindrical section 112, the second cylindrical section 1 14, the third cylindrical section 1 16 and the fourth cylindrical section 1 18, of larger diameter of less axial length, and each cylindrical section is separated by an annular projection. Four orifices 120 for oxygen flow (two are shown in Figure 9) extend through the cylindrical side wall 138 of the oxygen control cylinder 32, and they are radially spaced at 90 degree intervals and axially at length of the first chamber 1 12 interior. Each of the holes 120 terminates at the outer surface of the cylindrical side wall at the upper end of an oxygen supply slot 124 (see Figure 2). At the bottom of each air supply groove 124 is one of the primary nozzles 102, 104, 106 and 108. Shaped on the wall of the second inner chamber 14, there is a pair of threaded grooves 126.

The outer cylinder 30 is illustrated in Figure 2, and has a cylindrical side wall 130 having a T-flange 132 at its upper edge (see Figure 4). Radially separated at 90 ° intervals and extending axially and longitudinally from the bottom of the ring flange at T 132, there are four liquid supply slots 134 (only two are shown in Figure 2).

The plunger 34 is shown transversely in Figure 10. The plunger 34 has a cylindrical side wall 138 with an upper part 140 open and a lower part 142 closed. The cylindrical side wall 138 has a front portion 144 with an annular O-ring groove 146 that receives a plunger O-ring 148. Just above the front portion 144, there are a pair of holes 150 for oxygen, 180 ° apart, which extend between an overpressure chamber 152 within the cylindrical side wall 138 and the exterior of the plunger 34. The holes for the Oxygen 150 are in a central portion 154 of reduced diameter of the side wall 138 cylindrical. A rear portion 156 of the cylindrical side wall 138 has more or less the same diameter as the front portion 144. A pair of threaded fastening studs 158 extend radially from the rear portion 156 and are 180 ° apart from each other. The flow control collar 24 is best seen in Figure 2. The collar has a pair of ambient air windows 26 spaced 180 ° which have approximately the same dimensions as the air entrainment holes 40 in the housing 14 of the nebulizer. At the top of the flow control collar is an inclined upper projection 160 defining an open circular top portion of the flow control collar 24. The control lever 28 extends longitudinally along a lower protector 161 of the flow control collar 24.

The high flow nebulizer with variable oxygen concentration 10 is shown fully assembled (excluding the screw cap 20) in Figures 5 and 6, which are cross-sectional views taken along the corresponding lines indicated in Figure 3. Plunger 34 is housed mainly inside the oxygen control cylinder 32. Although not visible in Figures 4 and 5, the threaded fastening studs 158 of the plunger 34 are received within the threaded grooves 126 of the oxygen control cylinder 32. The outer cylinder 30 fits over the oxygen control cylinder 32 with an O-ring 172 which is captured between the fourth inner chamber 1 18, the lower face of the inwardly extending portion of the T-flange 132 of the outer cylinder 30 and the flow control cylinder 54. When the nebulizer 10 is fully assembled, the O-ring 172 prevents high-pressure oxygen from escaping into the liquid suction chamber 174. The plunger 34, the oxygen control cylinder 32 and the outer cylinder 30 are received within the interior of the upper portion 72 of uniform diameter of the inner frame 36. The keyed depressions 1 10 which are in the bottom of the oxygen control cylinder 32 are aligned with the protrusions in chavetadas 86, and receive them, which extend from the upper surface of the perforated plate 78 that is inside the inner frame 36 (see Figure 4). The inner frame 36 is inserted into the lower part of the housing 14 of the cylindrical nebulizer and is aligned so that the threaded fastening studs 158 of the plunger 34 are received within the elongated slots 56 of the piston control cylinder 54. Further, with reference to Figure 5, the connecting arms 66 of the inner frame 36 fit into the arcuate grooves 42 in the cylindrical side wall of the housing 14 of the cylindrical nebulizer, and extend through such grooves. The connecting arms 66 are integrally injection molded in the inner frame 36 and are sufficiently flexible so that when the inner frame 36 slides inside the housing 14 of the nebulizer, the arms 66 come out, pressing, through the slits 42. The annular division 70 contacts the inner projection 42 which is inside the housing 14 of the nebulizer. As best seen in Figure 4, the arcuate circular rim 71 (which extends approximately 0.002 to 0.005 inches) makes contact with the interior of the housing 14 in the inner projection 47 formed a liquid tight seal and defining a annular liquid suction chamber 174 between the inner frame 36 and the interior of the nebulizer housing 14. The arciform stepped liquid drag protector 52 covers a portion of the exterior of the upper part of the inner frame 36, as can be seen in FIG. Figures 4 and 5 and, as seen in Figure 5, depending on the relative orientation existing between the housing 14 of the nebulizer and the inner frame 36, may cover one or more of the liquid drive windows 74. it will be discussed in more detail below with respect to the operation of the nebulizer The ridges 76 (see Figures 12 and 13) protrude sufficiently from the frame in 36 (0.002 to 0.005 inches) so as to provide an adequate seal with the inner surface of the arciform stepped liquid entrainer 52. As can be seen in Figures 4 and 5, the inclined projection 160 of the flow control collar 24 rests on the annular inclined projection 46 of the housing 14 of the nebulizer. The connecting arms 66 extending through the arcuate grooves 42 and 44 in the side wall of the housing 14 of the nebulizer, make contact with the inside of the collar 24, as can be seen in Figure 5. The ambient air windows 26 they align and misalign with the air-entraining openings 40 in the nebulizer housing 14 by rotating the collar 24 to control the ambient air mixture, as will be discussed in more detail below. Once the components of the nebulizer are assembled as discussed above, as can be seen in Figure 5, the liquid supply grooves 134 of the outer cylinder 30, together with the inner wall of the upper portion 72 of uniform diameter of the inner frame 36 , define the liquid supply conduits between the liquid access windows 74 and the secondary nozzles 82. With reference to Figure 4, the air supply grooves 122 of the oxygen control cylinder 32 cooperate with the interior surface of the cylindrical lateral wall 130 of the outer cylinder 30 to thereby define the oxygen supply conduits for supplying oxygen between the oxygen orifices 120 and the primary nozzles 102, 104 106 and 108. Figure 15 illustrates the first primary nozzle 102 aligned with a nozzle secondary or liquid 84. Each of the other primary nozzles 104, 106 and 108 are similarly aligned with a to liquid nozzle 84. With reference to Figure 4, the pressurized oxygen flows through the inlet 16 into the plenum chamber of the plunger 152, outside the orifice 150, through an oxygen flow orifice 120, through the corresponding oxygen supply conduit and outwardly from the first primary nozzle 102. With reference to Figures 5 and 15, the high oxygen velocity in the primary nozzle 102 creates a negative pressure at the outlet of the secondary nozzle 84, which draws liquid by the inverted siphon 22, through a liquid supply orifice 92 existing in the annular division 70 (see Figure 8), towards the liquid suction chamber 174, through the liquid drag window 74, through the corresponding liquid supply conduit 134, through the feed channel 82 to the secondary nozzle 84 where the high speed oxygen nebulizes the liquid The first primary nozzle 102 is always open and so is the corresponding liquid drive window 74, so that at least this pair of nozzles are nebulizing liquids. Figures 4 and 5 illustrate the nebulizer 10 only with the primary nozzle 102 and the corresponding window 74 for entraining selected liquids. In this way, the plunger 34 is withdrawn from the first inner chamber of the oxygen control cylinder 32 so that the o-ring 148 of the plunger is above all but the oxygen hole 120 corresponding to the primary nozzle 102. At the same time , the arciform stepped liquids drag guard 52 covers each of the liquid entrainment windows 74, with the exception of that related to the secondary nozzle corresponding to the primary nozzle 102 (see Figure 6B). In this embodiment, also the air-entraining openings 40 are completely aligned with the ambient air windows 26, so that the maximum amount of ambient air is available to mix it with the ier gas and the nebulized liquid as it leaves the air. pair of selected nozzles. The ambient air is drawn into the mixing or access openings 62 by means of the negative pressure created by the high velocity oxygen leaving the primary nozzle 102, and the ambient air, oxygen and the nebulized liquid are mixed in the chamber of mixing 61 which is in the lower portion 60 of uniform diameter of the inner frame 36. Next, the mixture of gases and liquids flows out from the bottom of the mixing chamber 61 and out of the outlet 18 to be supplied to the patient . If a clinician wishes to increase the percentage of oxygen delivered to a patient, the collar 24 would turn clockwise relative to the housing 14 of the nebulizer. As the collar is rotated, the ambient air windows 26 become completely misaligned with respect to the air entrainment ports 40, thereby reducing the effective opening for ambient air entering the mixing chamber. Because the connecting arms 66 of the inner frame 36 are fixedly connected to the flow control collar 24, and that the oxygen control cylinder 32 is joined by a keyed connection to the perforated plate 78 of the inner frame 36, the oxygen control cylinder 32 rotates together with the collar 24. The elongated slots 56, which receive the threaded fastening studs 158, prevent the plunger 34 from rotating together with the oxygen control cylinder 32. However, because the threaded fastening studs 158 screw threaded grooves 126 of the interior of the oxygen control cylinder 32, the plunger 34 is driven downward, as seen in Figures 4 and 5, or to cylinder 32 for oxygen control. Once the collar has been rotated sufficiently so that the o-ring 148 of the plunger is between the next ier gas hole 122 and the bottom of the oxygen control cylinder 32 (approximately 45 °, as can be seen in the Figure 17), then the ier gas can already be introduced into the next orifice 122 and flow to the second primary nozzle 104 through the corresponding ier gas supply groove 124. Simultaneously, as air is allowed to flow to the next carrier gas port 122, the outer cylinder 30 is rotated relative to the arcuate stepped liquid entrainer 52 which is fixed to the upper portion 50 of the nebulizer housing 14, which causes that the corresponding liquid access window 74 is left uncovered. In this way, liquid is allowed to flow from the liquid suction chamber 174 through the liquid access window 74 and through the corresponding liquid supply groove 134 through the feed channel and into the corresponding nozzle secondary 84. As a result, two nozzles are now selected and the ambient air windows 26 have been completely misaligned from the air-entraining openings 40, thereby closing the air-entraining openings 40 providing a greater concentration of air. oxygen, at the same time that the oxygen flow is increased in order to maintain a volume of acceptable total flow of respiratory gases for the patient. In the same way, if the collar is turned more clockwise relative to the housing 14 of the nebulizer, the air entrainment apertures 40 are closed further while additional pairs of nozzles are selected by the downward movement of the piston 30 and the simultaneous rotation of the arciform stepped liquid drag guard 52 until the air-entraining openings 40 are completely closed and the four nozzles are selected to nebulize liquid and supply it to the patient. Turning the collar counterclockwise relative to the housing will stop the flow of liquid and air to the different nozzles by causing the plunger 34 to move upwardly within the oxygen control cylinder 32 and according to the stepped liquid trapping protector 52 simultaneously seals the corresponding liquid access windows, at the same time that the ambient air windows 26 align with the air entrainment openings 40 to thus admit more air. However, even when the plunger is further removed from the inner cylinder, a pair of liquid and air nozzles will still be selected. The upper portion 48 of the housing 14 of the nebulizer is shaped to be received inside a toroidal heater (not shown), to heat the liquid that is inside the liquid suction chamber 174. As is well known in the art. technique, the use of such a heater will increase the temperature of the liquid, thereby increasing the moisture content to deliver aerosol to the patient. Figure 18 illustrates a second embodiment of the high flow nebulizer with adjustable oxygen concentration 10 'of the present invention. For ease of reference, similar elements of the second embodiment of the nebulizer 10 'will have identical reference numbers including the prime sign ("'"). The second embodiment of the nebulizer 10 'includes a cylindrical housing 14' of the nebulizer having a pressurized gas inlet 16 'and an outlet (not shown). A conventional screw cap (not shown) can be attached, optionally, to the inlet of pressurized gas 16 '. The inverted siphon 22 '(or liquid supply tube) descends from the bottom of the components of the nebulizer. It is intended that a flow control collar having an ambient air window and a regulating lever as illustrated in Figure 1 be used with the second embodiment of Figure 18, although for reasons of clarity it is not illustrated in the drawings. In general, the second embodiment 10 'operates in a manner similar to the first embodiment 10 described above, although the internal components are configured very differently for reasons of ease of manufacture.

Still with reference to Figure 18 and Figure 19, the cylindrical housing 14 'consists of an upper portion 202 and a lower portion 204. The cylindrical upper portion 202 and the lower cylindrical portion 204 are held together by a pair of fasteners 206 (only one of them is shown) located on opposite sides of the upper part 202 of the housing. The fasteners 206 include an arcuate edge 208 that fits into an arcuate depression 210 of an interior surface of the bottom 204 of the cylindrical housing. A pair of recesses 209 that are on the upper edge of the bottom 204 form the arcuate grooves 42 * between the top 202 of the housing and the bottom 204 of the housing. Within the upper portion 202 of the cylindrical housing, there is a disc assembly 212. The disc assembly 212 consists of the valve disc 214, a disc 216 of the primary nozzle, a disc 218 of the secondary nozzle, a seal 220 and a retainer 222 that are sandwiched together in contact relation. Figure 20 illustrates the disk assembly 212 in an exploded view. The valve disc 214 is integrally molded with a semi-rigid thermoplastic such as polyethylene or polypropylene. The valve disc 14 includes a valve 224 for the second primary nozzle, a valve 226 for the third primary nozzle and a valve 228 for the fourth primary nozzle. The valve disc 214 also includes a first and a second keyed hole 230 and 232, and, optionally, a keyed slot 234, whose functions will be discussed below with respect to the construction of the disk assembly 212. The valve disc 214 it also includes a hole 236 for the pressurized gas. Each of the valves of the second primary nozzle, the third primary nozzle and the fourth primary nozzle, 224, 226 and 228, are integrally molded with the valve disc 214 and include a valve opening cam, 238 A, 238B, and 238C, and a valve closing cam 240A, 240B and 240C, which extends upwardly at opposite ends of an elongate lever 242, which pivots about an integral joint 244. The cams of the opening valve 238 A, 238B and 238C of the second valve of the primary nozzle, and of the third and fourth valves, extend in incremental quantities for the reasons that will be discussed below regarding the characteristics of the valve actuator , Figure 25. With reference to Figure 21, a stopper 246 A, 246B and 246C descends from the bottom of the elongated lever 242 under the closing cam 240 of the valve (see Figures 25 and 26). These plugs are sized to cover the corresponding primary nozzle, as illustrated in Figure 23. Referring again to Figure 21, an annular separator 248 surrounds the first keyed hole 230 and the second keyed hole 232, and an annular separator. 250 extends from the center of the bottom of the valve disc. The disc 216 of the primary nozzle is illustrated from above in FIG. 20, and includes a first primary nozzle 252, a second primary nozzle 254, a third primary nozzle 256 and a fourth primary nozzle 258 of incremental diameters. Each of the first, second, third and fourth primary or gas nozzles, are only orifices that pass through the disk 216 of the primary nozzle, as best illustrated in Figures 23 and 24 with the output of the nozzle at the bottom of the primary nozzle disc. Like the valve disc 214, the disc 216 of the primary nozzle also includes a first keyed hole 260 and a second keyed hole 262, plus an optional keyed slot 264. The disc 216 of the primary nozzle is preferably made of a thermoplastic such as polyethylene or polypropylene which can be easily adhered to the annular spacers 248 and 250 of the valve disc by ultrasonic welding, chemical welding, diffusion welding or other similar procedure, which will be discussed in more detail below. The disc 218 of the secondary nozzle is illustrated more clearly in Figure 22, and is also integrally molded of a thermoplastic such as polyethylene or polypropylene. The disc 218 of the secondary nozzle has an upper part 270 of the disc, a lower part 272 of the disc and a side wall 274. An annular ring groove 276 is formed in the side wall 274. From the upper part 270 of the disc from the secondary nozzle extends a first key 278, a second key 280 and an optional rectangular key 282. The first and second keys, 278 and 280, have a size that fits without gaps in the first hole 230 and in the second hole 232 keyed in the valve disc 2Í4, and in the first keyed hole 260 and in the second hole keyed 262 of disc 216 of the primary nozzle. Preferably, the first hole 230 and the second keyed hole 232, plus the first key and the second key, 278 and 280, are of different size or of different cross-sectional shape in order to facilitate an adequate alignment of the discs 214, 216 and 218. Alternatively or in addition to, the rectangular key 282 is provided both to facilitate alignment and to reinforce the disk assembly 212. In the center of the upper part 270 of the disk is a hole for liquid supply or a liquid conduit. liquids 284 consisting of a hole extending between the upper part 270 of the disc and the lower part 272 of the disc. With reference to Figure 18, from the bottom 272 of the disc 218 of the secondary nozzle an annular sleeve 286 extends around the liquid conduit 284. Referring again to Figure 22, there is a transverse groove 288 formed at the top 270 of the disc, and in the center of the cross is the liquid conduit 284. Near the end of each arm of the transverse groove 288 are the first secondary nozzle 290, the second secondary nozzle 292, the third secondary nozzle 294 and the fourth secondary nozzle 296. As discussed below, having the disc assembly 212 already assembled, the first, second, third and fourth secondary nozzles, 290,292,294 and 296, align with the first, the second, the third and the fourth primary nozzles, 252, 254, 256 and 258 (see examples in Figure 23). An arcuate flange 298 extends downwardly from the bottom 272 of the disk 218 of the secondary nozzle on opposite sides along a portion of the circumference of the bottom 272 of the disk. A connecting arm 66 'extends radially from each of the flanges 298. With reference to Figure 20, the seal 220 consists of the second, third and fourth butterfly valves, 302, 304 and 306, attached to the body 220 of the valve through a live joint 308. The seal 220 is preferably made of a flexible material, such as silicone rubber. The second, third and fourth butterfly valves, 302, 304 and 306, correspond to the second, third and fourth secondary nozzles 292, 294 and 296, respectively. A hole 310 corresponds to the first secondary nozzle 290. A pair of keyed holes 312 receive the keys extending from the bottom 272 of the disc 218 of the secondary nozzle (but not shown). Finally, the disc 220 has as its center a hole 214 whose dimensions are suitable for receiving the annular sleeve 286 of the disc 218 of the secondary nozzle. Still with reference to Figure 20, the retainer 222 has at its center a first hole 216 that receives the annular sleeve 286, and a first, second, third and fourth recesses, 218, 220, 222 and 224, corresponding to the second , third and fourth butterfly valves 302, 304 and 306, and the orifice 310. Finally, the retainer 222 includes the keyed holes 226 corresponding to the keyed holes 310 of the flap joint 220. The retainer 222 is integrally molded with the same material as the valve disc 214, the disc 216 of the primary nozzle and the disc 218 of the secondary nozzle. The disk assembly is interleaved as illustrated in Figure 20 and is heat-bonded, solvent-bonded or ultrasonically bonded to a disk assembly 212 illustrated in Figure 19. As discussed above, the first and second keys 278 and 280, provide the proper orientation and alignment of the disks 214, 216 and 218. After attaching the disks to the disc assembly 212, the O-ring 332 is placed in the groove 276 of the annular O-ring of the disc 218. the secondary nozzle. Then, this disk assembly 212 is placed between the upper part 202 of the cylindrical housing, and the lower part 204, with the connecting arms 66 'resting on the recesses 209 of the lower part of the cylindrical housing defining the arcuate grooves 42'. Next, the upper portion 202 of the cylindrical housing is aligned with the fasteners 206 of the guides 330, and the upper portion 202 of the cylindrical housing and the lower portion 204 of the cylindrical housing are snapped together, holding the disc assembly 212 therebetween. , which can be seen better in Figure 18.

With reference to Figure 18, the joining, by means of heat, of the disk assembly results in the annular spacers 248 and 250 of the valve disc 214 being attached to the upper part of the disk 216 of the primary nozzle. The lower part of the disc 216 of the primary nozzle is attached to the upper part 270 of the disc 218 of the secondary nozzle in fluid-tight contact, so that the transverse grooves 288 define sealed fluid-tight disc conduits. With the disc assembly 212 installed as illustrated in Figure 18, the highly pressurized gas from the inlet 16 'fills the gap 340 that is above the valve disc and can flow freely between the valves 224, 226 and 228 , and also through the orifice 236 of pressurized gas to the plenum chamber 342 defined between the valve disc 214 and the disc 212 of the primary nozzle by the annular spacers 248 and 250. The adherent bonds discussed above prevent the gas Highly pressurized have access to the transverse slots 288. The O-ring 232 provides a fluid-tight seal that prevents leakage of highly pressurized gas between the disk assembly and the wall 40 'of the housing 14 of the nebulizer. During operation, the pressurized gas is introduced into the inlet 16 ', fills the gap 340 and the overpressure chamber 342. The first primary nozzle 252 has no valves, so that the high pressure gas always flows through the first primary valve 252 and first secondary valve 290. The high oxygen velocity in the first primary nozzle 252 creates a negative pressure in the first secondary nozzle, which causes the liquid to rise through the inverted siphon 22 'from a liquid reservoir (not shown) through the liquid conduit 284 and into the transverse grooves 288. When only the primary valve is selected, the same negative pressure that draws the fluid into the inverted siphon 22 'to create the nebulization, also causes the second , the third and fourth butterfly valves, 102, 104 and 106, are dragged on the second, third and fourth secondary nozzle to seal the nozzles llas and avoid aspiration of air to maintain the vacuum. Although not illustrated with respect to the second embodiment of the high flow nebulizer with adjustable oxygen concentration 10 ', as with the first embodiment 10, the connecting arms 66' extend through the arcuate grooves 42 'and make contact with a flow control collar (not shown) having ambient air windows, which can be aligned and misaligned with respect to the ambient air openings 40 '. As will be discussed in more detail below, as the flow control collar 24 is rotated counterclockwise (with respect to the upper part of the housing 14 'of the nebulizer), the openings 40 of ambient air are blocked by the flow control collar. However, as in the first embodiment, in order to maintain an adequate total gas flow, when the flow control collar is rotated more in the counterclockwise direction, possibly the second, the third and the fourth primary nozzles are selected as the ambient air openings 40 'are blocked, thereby maintaining a total flow of nebulized gas above the acceptable minimum, at the same time that the oxygen concentration can be controlled to fluctuate between 28% and 100% inspired oxygen. This is illustrated graphically in Figures 16 and 17 and is further explained below.

Descending from the inner surface of the upper portion 344 of the housing 14 'is a stepped inner cam actuator 346 and a stepped outer cam actuator 348. Although these stepped inner and outer cam actuators are annular, Figures 25A-25E show linearly the profile of the external cam actuator 348 and its interaction with valve opening cam 238A, 238B and 238C. This is representative of the inner cam actuator and the valve closing cams 240A, 240B and 240C. With the collar 24 positioned so as not to block the air-entraining openings 40 ', the valve opening cams 238A, 238B and 238C are aligned as indicated in Figure 25A with respect to the outer actuator of the cam 348. In this position, none of the valve opening cams 238 A, 238B or 238C are actuated by the operation of the outer cam 248. By turning the collar 24 approximately 45 ° counterclockwise, as seen looking down on Figure 18, the first stepped surface 360 of the actuator 348 of the upper cam makes contact with the opening cam of the valve 238A of the second valve 224 of the primary nozzle and presses it. Simultaneously, the inner actuator 146 of the step cam stops contacting the valve closing cam 240A. This causes the elongated lever 242 to pivot on the integral link 244 to remove the plug 246 from the second primary nozzle 254, as illustrated in Figure 24. In turn, the pressurized air flowing through the second primary nozzle 254 creates a negative pressure which causes the nebulizing liquid to be drawn into the corresponding arm of the transverse groove 288 towards the second secondary nozzle 292. The force of the pressurized air also opens, deflecting it, the second throttle valve 302. By rotating the clockwise, the same will cause the actuator 346 of the stepped inner cam to make contact with the closing cam 240A of the valve, at the same time that the stepped outer cam stops contacting simultaneously with the opening cam 348 of the valve, thus allowing the plug 246 to be driven towards the second primary nozzle 254 and thus prevent the flow of gas through the valve. to second primary nozzle 254. See Figure 23. This, in turn, causes the flow of liquid through the transverse groove 282A to stop and allows the vacuum created by the first primary nozzle 252 to drive the throttle valve 302 so that it comes into contact with the second secondary nozzle 292. As illustrated in Figure 25C, if the collar 24 is rotated about 13 ° more in the counterclockwise direction, this causes the second stepped surface 262 of the actuator of the outer cam 348 presses the valve opening cam 238B of the third primary nozzle 226, at the same time that the stepped cam actuator releases the valve closing cam 242B, thereby the third nozzle is selected. With reference to Figure 25D, if another 12 ° is rotated, counterclockwise, the collar 24, this causes the third stepped surface 364 to contact the valve opening cam 238C. , with which the fourth primary nozzle is selected. The collar 24 can be rotated another 30 ° so that it has a total rotation of approximately 100 °, whereby the air-entraining openings 40 'will be completely blocked and only pure oxygen will be delivered to the patient. This action is controlled in such a way that the percentage of oxygen inspired by each degree of rotation is modified in the manner discussed below with respect to Figures 16 and 17. In this way, the main difference between the first embodiment of the nebulizer 10 and the second of the nebulizer 10 ', resides in the disc structure of the second embodiment 10'. - Both structures provide adjustable oxygen concentrations, while maintaining an adequate flow of respiratory gases. As an alternative to provide the seal 220 and the seal 222, a divided inverted siphon 22 'can be used, which provides four liquid supply conduits (370A-370B), with a liquid supply channel corresponding to each of the liquid supply channels 288, as illustrated in its mounted form in Figure 26. More specifically, in this embodiment the lower part of the disk 218 of the secondary nozzle has a transverse groove 350 which receives the walls of the inner partition 352 of the reversing valve. The dimensions of the inverted siphon 22 'which has the division 352, are such that, with reference to Figure 26, the outer wall 354 of the inverted siphon 22' coincides with an interior passage 356 of the annular sleeve 286, at the same time as the end The interior partition 352 is received in the transverse grooves 350. When assembled in this way, each of the conduits 370A-370D defined by the interior partition 352, are basically like an independent inverted siphon, thereby avoiding the need to use the butterfly valves previously mentioned. In this way, when only the first pair of nozzles has been selected, the fluid will be drawn into the corresponding fluid conduit and no liquid will be drawn into the other channels until their corresponding valves are selected. The inverted siphon 22 'can be extruded together with the partition 352, or the partition 352 can be inserted and then joined to an inner surface of the outer wall 354. As seen in Figure 10 with respect to the first embodiment, the first, the second, the third and fourth primary nozzles (102, 104, 106 and 108) have a diameter that is increasing, as described above. The same can be said about the second embodiment illustrated in Figure 20. Conventional nebulizers used in the medical field have total gas flows ranging from 100 liters per minute to 28% oxygen, and from 8 to 10 liters per minute with 100% oxygen. This happens because as the oxygen graduation in the nebulizer is increased, the effective size of the air entrainment openings 40 is reduced, while the flow through the oxygen nozzle is kept constant, decreasing, accordingly, the total gas flow supplied to the patient. The high flow nebulizer with adjustable oxygen concentration maintains the necessary flow of respiratory gases by selecting additional nozzles of increasing effective diameter as the openings 40 for ambient air are closed. The diameter of the nozzles is calculated so that they retain a minimum acceptable amount of total gas flow delivered to the patient (40 liters per minute or more when connected to an oxygen source of 50-60 psig). Figure 16 is a graph of the total flow of the nebulizer as a function of the percentage of oxygen in the respiratory gas stream. Figure 17, which is exactly below Figure 16, is a diagram of the degree of rotation of the collar relative to the housing 180 of the nebulizer, indicating the stroke 182 of the plunger and the point at which the different nozzles are selected. During operation, clinicians only need to connect the pressurized gas inlet to a source of pressurized oxygen that is approximately 50 psig, as discussed above. Then, the valve of the pressurized oxygen source opens completely (or adjusts to "damage"). As discussed below, the high-flow nebulizer with variable oxygen concentration automatically regulates the volume of oxygen flow to maintain the desired total gas flow, thereby preventing the clinician from having to regulate the valve of the oxygen source. pressurized; which makes the nebulizer easier to use and also benefits the patient's safety. In addition, no extra meter is needed to measure the flow in relation to the pressurized oxygen source, so that the nebulizer can be used safely and efficiently. If only the first nozzle is selected, the total oxygen flow will be 7 liters per minute at a fraction of inspired oxygen (F 102) of 28%. The total flow at the outlet of the nebulizer is calculated as follows: Total Flow = 0.2 Flow x 0.78 FI02 - 0.21, 7 l / m x 0.78 = 78 l / m 0.28 - 0.21 The figure 0.78 is the percentage of nitrogen in the air, and 0.21 is the percentage of oxygen in the air. If the oxygen flow remains constant, the total flow decreases as F 102 increases. Thus, Figure 16 indicates that when the openings 40 for ambient air are reduced, thereby increasing the F 102, the total flow of gas rapidly decreases to about 40 l / m of an F 102 of 34, at which time the second nozzle is selected. By selecting the second nozzle, the total oxygen flow increases to 15 l / m, thereby increasing the total flow to 84 l / m. As F102 approaches 50, the total gas flow decreases rapidly to 40 l / m until the third nozzle is selected at F 102 of 50. Then, the oxygen flow is increased to 25 liters per minute with a total flow of 67 l / m. As F 102 approaches 70, the total gas flow again decreases to approximately 40 l / m when the fourth nozzle is selected, which is the last one, and the oxygen flow increases to 40 liters per minute, ensuring , in this way, that even in an F102 of a 100% oxygen concentration, the total flow of respiratory gas supplied to the patient will not fall below 40 liters per minute. The high-flux nebulizer with adjustable oxygen concentration described herein provides inspired oxygen concentrations ranging from 28% to 100%, while maintaining the volume of flow delivered to the patient by at least 40 l / m. Consequently, the high flow nebulizer with adjustable oxygen concentration eliminates the need to have many nebulizers in parallel in order to provide an adequate volume of flow to the patient. In addition, the high-flow nebulizer with adjustable oxygen concentration automatically selects additional nozzles when the ambient air openings are closed, in order to maintain the necessary flow volume. The carrier gas supply and the liquid supply are selected and stopped simultaneously as the actual size of the ambient air openings increases or decreases respectively. In this way, the nebulizer offers a precise and error-free supply of the desired oxygen concentration without having to do anything other than turn the flow control collar, without risk of the patient not reaching the volume of Respiratory gas flow necessary. The high flow nebulizer with adjustable oxygen concentration only needs a normal 50 psig oxygen connection, so it can be used in most hospitals, medical institutions and at home. The first embodiment of the nebulizer 10 'consists solely of six main components which can be easily constructed with injection molding of a thermoplastic. The second embodiment consists of only 8 or 10 components that are injection molded and easy to assemble. As a result, both embodiments of the nebulizer can be manufactured and assembled quickly, also easily and economically. The relatively few moving parts of the nebulizer result in it being very reliable and easy to use. Finally, because only one nebulizer is needed to provide a very wide range of oxygen concentrations, hospitals using the high-flow nebulizer with adjustable oxygen concentration will not need to have different models of nebulizers in their inventory in order to adjust to the different needs of their patients. Moreover, since the needs of the patients regarding the oxygen concentration are different during the application of a therapy, the nebulizer does not need to be replaced, which could interrupt a critical therapy, but only be regulated by rotating the flow control collar.

Claims (22)

1. Wis claimed is: 1. A nebulizer tprovides a selected volume of flow of a gas tcarries a nebulized liquid, the nebulizer consisting of the following: at least two gas nozzles, each gas nozzle having an outlet for the gas; means for connecting the gas in fluid communication to a supply source of pressurized carrier gas and each gas nozzle; a liquid outlet corresponding to each gas nozzle, positioned near the gas outlet of the corresponding nozzle to nebulize liquid from the liquid outlet in a stream of carrier gas flowing from the gas outlet of each nozzle; means for connecting, in liquid communication, each liquid outlet and a liquid supply source; and means for regulating the gas in fluid communication with at least one of the gas nozzles, to selectively select at least one gas nozzle and prevent gas from flowing from tgas nozzle at least.
2. 2. The nebulizer of claim 1, further including means for controlling liquids functionally related to the liquid communication means, to selectively allow and prevent the flow of liquids through a selected liquid outlet.
3. The nebulizer of claim 2, further including coordinating functionally related means between the liquid control means and the gas regulating means, to cause the liquid control means to impede the flow of liquids through the liquid. liquid outlet when the gas regulating means selectively prevents gas from flowing from a corresponding gas nozzle, and to cause the liquid control means to allow the flow of liquids through the liquid outlet when the liquid Gas regulation selectively select the gas nozzle.
4. 4. The nebulizer of claim 3, which includes several gas nozzles and a corresponding plurality of outlets for liquids, each liquid outlet being located near a different gas nozzle to thereby define pairs of liquid outlet gas nozzles, coordinating the means of coordinating the flow of gas and liquids through pairs of liquid outlet gas nozzles.
5. 5. The nebulizer of claim 2, further including: a housing having a wall and a mixing chamber within the wall, for receiving gas and nebulized liquid from the gas outlets and the corresponding outlets of liquids, having the wall at least one ambient air opening for supplying a flow of ambient air to the mixing chamber, and one outlet for exhausting the nebulized liquid, gas and ambient air; and ventilation control means functionally related to the ambient air opening, to selectively modify the effective size of the ambient air opening, between fully open and fully closed.
6. 6. The nebulizer of claim 5, further including linking means for linking the gas regulation means and means for controlling the ventilation holes, so twhen the control means of the ventilation holes are regulated to reducing the effective size of the ventilation holes, the gas regulation means automatically increase the number of selected nozzles, and when the control means of the ventilation holes are regulated to increase the effective size of the ventilation openings, the means Gas regulation automatically reduce the number of selected nozzles.
7. 7. The nebulizer of claim 3, further including: a housing constituted by a wall and a mixing chamber within the wall, to receive gas and liquid nebulized from the gas outlet and the corresponding outlets of liquids, having the wall by at least one ventilation hole of ambient air to provide a flow of ambient air to the mixing chamber and one outlet to exhaust liquid, gas and ambient air nebulized; means for controlling the ventilation openings to selectively modify the effective size of the ventilation openings of ambient air, between fully open and completely closed; and linking means for linking the gas regulation means and the control means of the ventilation holes, so that when the control means of the ventilation holes are regulated to reduce the effective size of the ventilation holes, the Gas regulation means automatically increase the number of selected nozzles, and when regulating the control means of the ventilation holes to increase the effective size of the ventilation holes, the gas regulation means automatically reduce the number of selected nozzles .
8. 8. The nebulizer of claim 1, wherein the means for regulating the gas are constituted by: a cylinder having a first end and a second end, plus an orifice through the wall of the cylinder corresponding to each gas nozzle, each hole longitudinally spaced along the wall of the cylinder between the first end and the second end; a conduit that connects each orifice with the corresponding nozzle inlet; a piston disposed inside the cylinder, said piston having a cylindrical side wall with one end open and the other end closed, so as to define a fluid overpressure chamber, the outside diameter of the piston being smaller than the inside diameter of the cylinder, thus defining an annular space therebetween, the plunger including a hole in the side wall between the fluid overpressure chamber and outside the fluid overpressure chamber, including the plunger, in addition, means between the closed end and the orifice, for thus forming a fluid-tight seal between the inside of the cylinder and the side wall of the plunger, the gas connection means being in fluid communication with the open end of the plunger; and means for selectively moving the plunger within the cylinder in a first longitudinal direction to select the chosen nozzles by moving the sealing means between the hole corresponding to the nozzle and the second end of the cylinder, and in a second longitudinal direction to prevent there is flow towards the selected nozzles by moving the sealing means between the corresponding hole and the first end of the cylinder.
9. 9. The nebulizer of claim 8, wherein the selective movement means is threaded with an inner surface of the cylinder, threaded means on the plunger and means for preventing the piston from rotating together with the cylinder, whereby the relative rotation between the cylinder and the plunger in a first rotational direction will cause the plunger to move longitudinally towards the second end of the cylinder, and the relative rotation in a second rotational direction will cause the plunger to move longitudinally and move away from the second end of the cylinder.
10. 10. The nebulizer of claim 8, further including: a housing having a wall and a mixing chamber within the wall for receiving gas and nebulized liquids from the gas outlet and the related liquid outlets, the wall having at least one ventilation hole of ambient air to supply a flow of ambient air to the mixing chamber, and one outlet to exhaust the liquid, gas and ambient air nebulized; a collar having a wall surrounding a portion of an outer surface of the housing, the collar including a window for selectively modifying the effective size of the ambient air vent, between fully open and completely closed, varying the degree of that such a window is aligned with the ventilation hole; and connecting means between the collar and the plunger for moving the plunger in the first longitudinal direction as the effective size of the air vent hole is closed, and for moving the plunger in the second longitudinal direction as the effective size of the air hole is opened. air ventilation.
11. The nebulizer of claim 9, further including: a cylindrical housing having a wall and a mixing chamber within the wall for receiving gas and nebulized liquids from the gas outlet and the related liquid outlets, the wall having at least one ambient air vent hole for supplying an ambient air flow to the mixing chamber, and one outlet for exhausting the nebulized liquid, gas and ambient air; a cylindrical collar having a wall surrounding a portion of an exterior surface of the housing, the collar including a window for selectively modifying the effective size of the ambient air vent, between fully open by rotating the collar relative to the housing, in a first rotational direction to align the window and the vent, and Completely closed by rotating the collar in a second opposite rotational direction so that the window and ventilation hole are in an unaligned position; and connecting means between the cylindrical collar and the plunger, to move the plunger in the second longitudinal direction, relative to the cylinder, as the cylindrical collar is rotated in the first longitudinal rotational direction, and to move the plunger in the first direction with relation to the cylinder, when the cylindrical collar is rotated in the second rotational direction.
12. 12. The nebulizer of claim 1, wherein the nebulizer further includes an elongated cylindrical housing having a selected inner diameter, and the gas connection means is at a closed end of the cylinder, and the means for regulating the gas consist of : a first disc whose outer diameter is smaller than the inner diameter of the housing, the first disc having an integral valve operable between a selected position and a closed position corresponding to at least one of the two gas nozzles, to selectively select and close a corresponding gas nozzle; means for maintaining the first disk near the closed end of the cylinder, the integral valve being in functional relation to the two gas nozzles at least; and actuating means in the cylinder functionally related to the valve for actuating the valve between the selected position and the closed position by a relative rotation between the first disk and the housing.
13. 13. The nebulizer of claim 12, wherein the integral valve consists of: an elongated lever having a first end and a second end pivoting between the ends of the lever about an axis perpendicular to its length and parallel to an upper surface of the disk; a cam for opening the valve, which is on the upper surface of the lever near the first end of the lever; a plug near the second end of the lever, which is on the lower surface of the lever; and means for biasing the lever in the closed position with the plug by closing a corresponding gas nozzle; the valve being actuated by the driving means, towards a selected position, by depressing the cam of the valve, thereby pivoting the lever to a selected position, with the stopper already separated from a corresponding gas nozzle.
14. 14. The nebulizer of claim 13, wherein the elongate lever is integrally formed with the disc in a single piece, and the diverting means are constituted by an integral articulation existing between the disc and the lever.
15. 15. The nebulizer of claim 13, wherein the biasing means is constituted by a valve closing cam on the upper surface of the lever near the second end, and a valve closure element located in the housing of the valve. the valve, by depressing the closing element of the valve to the closing cam of the valve and the stopper closes a corresponding gas nozzle when the actuating means is not depressing the valve cam, and the closing element of the valve it releases the closing cam from the valve when the actuating means is depressing the valve cam.
16. 6. A nebulizer to provide a selected volume of flow and a selected concentration of a gas that entrains a nebulized liquid, the nebulizer consisting of: at least two nozzles, each nozzle having a gas outlet; means for connecting a pressurized gas supply source and each nozzle in fluid communication; a liquid outlet located near the gas outlet of each nozzle to nebulize liquids from the liquid outlet in a gas stream flowing from the gas outlet of each nozzle; means for connecting in liquid communication each liquid outlet and a liquid supply source; means for regulating the gas in fluid communication with at least one of the gas nozzles, to selectively select that gas nozzle and to prevent gas from flowing from at least that gas nozzle; a housing having a wall and a mixing chamber within the wall, for receiving gas and nebulized liquids from the gas outlets and related liquid outlets, the wall having at least one ambient air vent hole for supplying a flow of ambient air to the mixing chamber, and an outlet to exhaust liquid, gas and ambient air nebulized; and ventilation control means for selectively regulating the effective size of the ambient air vent, between fully open and completely closed.
17. 17. A nebulizer for providing a selected flow volume and a selected gas concentration that entrains a nebulized liquid, said nebulizer comprising the following: at least two nozzles, each having a gas inlet and a gas outlet; means for connecting in fluid communication a pressurized gas supply source and the gas inlet of each nozzle; at least one liquid outlet located near the gas outlet of at least one nozzle, for nebulizing liquid from the liquid outlet in a gas stream flowing from the gas outlet of one nozzle at least; means for connecting in liquid communication each liquid outlet and a liquid supply source; means for regulating the gas in fluid communication with at least one of the gas nozzles, to selectively select that gas nozzle at least and to prevent gas from flowing from that gas nozzle at least; a housing having a wall and a mixing chamber within the wall, for receiving gas and nebulized liquids from the gas outlets and related liquid outlets, the wall having at least one ambient air vent hole to provide a ambient air flow to the mixing chamber, and an outlet to exhaust the liquid, gas and ambient air nebulized; ventilation control means for selectively regulating the effective size of the ambient air hole, between fully open and completely closed; and linking means for linking the gas regulation means and the ventilation control means, so that when the ventilation control means are regulated to reduce the effective size of the ventilation orifice more than a selected amount, the means of Gas regulation automatically increase the number of selected nozzles, and when the ventilation control means are regulated to increase the effective size of the vent hole more than a selected amount, the gas regulation means automatically reduce the number of selected nozzles.
18. 18. A nebulizer for providing a selected flow volume of a gas entraining a liquid, the nebulizer comprising the following: a cylindrical housing having a closed end; means for connecting the gas at the closed end of the cylindrical housing, for connecting a pressurized gas supply source in communication with the interior of the cylindrical housing; a disk of the primary nozzle having at least two gas nozzles, each gas nozzle having a hole in the primary nozzle disk defining a gas outlet in a lower surface of the primary nozzle disk; first means for locating the disc of the primary nozzle near the closed end of the cylindrical housing, but separated therefrom; a valve disc having an outer diameter smaller than the inner diameter of the housing, the valve disc having an integral valve which operates between a selected and a closed position corresponding to at least one of the two gas nozzles, for selectively selectively closing a corresponding gas nozzle; second positioning means for locating the valve disc between the primary nozzle disk and the closed end of the cylindrical housing, the integral valve remaining in functional relationship with at least two gas nozzles; actuating means in the cylinder functionally related to the valve, for actuating the valve between the selected and closed position by a relative rotation between the valve disc and the housing; a liquid outlet corresponding to each gas nozzle, positioned near the gas outlet of the corresponding nozzle to nebulize liquids from the liquid outlet in a stream of carrier gas flowing from the gas outlet of each nozzle; and means for connecting in liquid communication each liquid outlet with a liquid supply source.
19. 1 . The nebulizer of claim 18, further including: a disk of the secondary nozzle having an upper part and a lower part, the secondary nozzle disk having a hole therein that forms each of the liquid outlets, including, in its upper part, the secondary nozzle disk a slot corresponding to each liquid outlet that extends between a common liquid supply orifice and each outlet, the secondary nozzle disk being connected to a lower surface of the liquid disc. the primary nozzle in fluid-tight relation, with which the grooves make fluid-tight conduits in the disc; and a liquid supply tube that extends between the common liquid supply port and a liquid supply source and the means for connection in liquid communication include the liquid supply tube and the fluid-tight disc conduits. .
20. 20. The nebulizer of claim 18, further including means functionally related to the liquid communication means, to allow the flow of liquids through an outlet when a corresponding gas nozzle is chosen, and to prevent the flow of liquids through an outlet when a corresponding gas nozzle is closed.
21. 21. The nebulizer of claim 19, wherein the liquid supply tube includes a longitudinal interior partition, in fluid-tight contact with the interior of the liquid supply tube, dividing such division by the liquid supply tube in two tube conduits. different ones corresponding to each disc duct, and the nebulizer also contains means for joining the liquid supply tube to the liquid supply orifice, each tube duct being in fluid-tight connection with a different disc duct, with which liquids will only be supplied to a liquid outlet once the corresponding gas nozzle has been selected.
22. 22. The nebulizer of claim 19, further including: a butterfly valve near the bottom of the secondary nozzle disk, functionally related to each liquid outlet, the valve being entrained to cover and seal the liquid outlet when it closes the corresponding gas nozzle by means of the vacuum created by the pressurized gas flowing from a selected nozzle, and by opening the throttle valve, by the impulse, when the corresponding gas nozzle is selected.