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WO1998044975A1 - Procede et appareil de ventilation differentielle des poumons - Google Patents

Procede et appareil de ventilation differentielle des poumons Download PDF

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Publication number
WO1998044975A1
WO1998044975A1 PCT/US1998/005444 US9805444W WO9844975A1 WO 1998044975 A1 WO1998044975 A1 WO 1998044975A1 US 9805444 W US9805444 W US 9805444W WO 9844975 A1 WO9844975 A1 WO 9844975A1
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WO
WIPO (PCT)
Prior art keywords
passageway
inspiratory
lung
volume
flow
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.)
Ceased
Application number
PCT/US1998/005444
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English (en)
Inventor
Jacob Moalem
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Individual
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Individual
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Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to AU65710/98A priority Critical patent/AU6571098A/en
Publication of WO1998044975A1 publication Critical patent/WO1998044975A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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. ventilators; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0402—Special features for tracheal tubes not otherwise provided for
    • A61M16/0404—Special features for tracheal tubes not otherwise provided for with means for selective or partial lung respiration
    • 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. ventilators; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • 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. ventilators; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter

Definitions

  • the present invention relates to method and apparatus for differential ventilation of user's lungs and, more particularly, to method and apparatus for selectively ventilating two lungs of different compliance with a predetermined ratio of gas volumes. Further, the present invention provides method and apparatus for selectively treating lungs suffering from gas leakage by selectively ventilating the two lungs with a predetermined ratio of gas flows.
  • Diseases characterized in changes of a lung's compliance include: (a) diseases wherein fluids accumulate within and adjacent the alveoli, which fluids causes the lung to be less compliant and more resistant to ventilation. Examples are: bronchopleural fistulae, pneumonia, pulmonary edema and hemorrhage; (b) abnormal development or destruction of the alveolar tissue participating in the process of gas exchange; (c) destruction of elastic tissue and formation of connective tissue within the lungs.
  • Leakage of gases from a lung may result from tearing or perforation of the lung. Such leakage may prevent ventilation of specific areas within the lung.
  • the above diseases may be classified into two main groups: diseases wherein a lung's resistance to ventilation increases with relation to a healthy lung; and diseases wherein a lung's resistance to ventilation decreases with relation to a healthy lung.
  • a unilateral lung disease may cause the injured lung to become more resistive to ventilation, or alternatively, less resistive to ventilation with relation to a healthy lung.
  • Consequences of such a unilateral disease include increase in CO2 concentration and decrease in blood oxidation within the injured lung. Ventilation of two lungs having different compliance at a certain higher pressure, using one breathing machine, so as to treat the problem of oxidation within the injured lung may cause further damage due to excessive pressure on the healthy lung.
  • Method and device enable, for example, to ventilate each lung at a specific pressure, thereby forcing an injured lung to ventilate a certain minimal tidal volume while maintaining a normal tidal volume at the normal lung, by using a single respirator.
  • a method according to the present invention comprises the steps of:
  • the regulating element may be a pneumatic resisting element.
  • the regulating element may be a pressure regulator.
  • the regulating element may be a flow regulator.
  • the method further comprises the step of: measuring a first volume of fluid expired by the first lung and a second volume of fluid expired by the second lung; and comparing the first and second volumes.
  • the regulation may be proportional to the difference between the first volume and the second volume.
  • the regulation may be proportional to the ratio between the first volume and the second volume.
  • the measurement is performed at a given expiratory phase and the regulation is performed at a subsequent inspiratory phase.
  • the measurement is performed at a given expiratory phase and the regulation is performed during said expiratory phase.
  • the regulation is automatically performed by means of a controlling element electrically connected to the regulating element.
  • the method comprises: measuring a first volume of fluid pumped within the first inspiratory passageway and a second volume of fluid pumped within the second inspiratory passageway; and comparing the first and second volumes.
  • the method comprises: measuring a first flow-rate of fluid flowing within the first inspiratory passageway and a second flow-rate of fluid flowing within the second inspiratory passageway; and comparing the first and second flow-rates.
  • An apparatus preferably comprises:
  • a controlling element electrically connected to the first and second volume measuring elements and to the regulating element for automatically controlling the regulating element based on the first and second volumes measured by the first and second volume measuring elements, such that a predetermined ratio is achieved between the first volume of fluid expired by the first lung and the second volume of fluid expired by the second lung.
  • the present invention successfully addresses the shortcomings of the presently known configurations by providing method and apparams which enable to selectively ventilate lungs of different compliance at a predetermined ratio of volumes by using a single respirator. Further, the present invention enables to continuously and automatically regulate the ratio of ventilated volumes at a given respiratory cycle based on the volumes ventilated by the lungs at the preceding respiratory cycle.
  • FIG. 1 is a schematic illustration of a device according to the present invention.
  • FIG. 2 is an example of experimental results illustrating the operation of method and device according to the present invention. DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • the present invention is of a method and apparatus for selectively ventilating user's lungs having different compliances with a predetermined ratio of gas volumes. Further, the present invention is of method and apparatus wherein differential ventilation of the lungs at a given cycle is regulated according to the ratio of volumes ventilated by the lungs at a preceding cycle.
  • Figure 1 illustrates an apparatus according to the present invention.
  • the apparatus includes a single respirator 10 for supplying fluid, such as air, at a certain pressure to lungs 100a and 100b of a patient.
  • fluid such as air
  • Respirator 10 is connected via inspiratory passageways 12a and 12b to respective endobronchial tubes 36a and 36b, the endobronchial tubes being in fluid communication with lungs 100a and 100b, respectively.
  • Endobronchial tubes 36a and 36b may be any of the endobronchial tubes known in the art.
  • lung 100a as the more resistive lung
  • lung 100b as the less resistive lung
  • lung 100a The higher resistance to ventilation of lung 100a may result from any injury which decrease the compliance of the lung, such as fluid accumulation within the lung, formation of connective tissue in place of the elastic tissue, and the like.
  • Lung 100b may be a normal lung or a less injured, and therefore more compliant lung.
  • lung 100b may result, for example, from tearing or perforation of the lung.
  • lung 100a is a normal lung or a less injured lung.
  • a pneumatic regulating element 18 is connected in serial connection to lung 100b, which is the less resistive lung.
  • Pneumatic regulating element 18 may be a resisting element such as a conventional valve enabling a continuous or discrete flow of fluid.
  • the electrical equivalent resistance of regulating element 18 is preferably equal to the difference between the equivalent resistances of lung 100a and lung 100b.
  • the total equivalent resistance of passageway 12a and lung 100a equals the total equivalent resistance of passageway 12b and lung 100b.
  • the ratio of the volumes ventilated within lungs 100a and 100b depends on the selected resistance of regulating element 18.
  • an apparatus according to the present invention enables to achieve a predetermined ratio of ventilated volumes within lungs 100a and 100b, simply by changing the resistance of regulating element 18.
  • regulating element 18 may be a conventional pressure regulator.
  • regulating element 18 may be a conventional flow controller.
  • an apparatus further includes controlling electronic circuitry 20 electrically connected to regulating element 18 for continuously controlling regulating element 18.
  • the control of regulating element 18 is preferably carried out according to the rate of tidal volumes expired by lung 100a and 100b.
  • an apparatus preferably includes volume-measuring elements, 38a and 38b, connected to respective expiratory passageway, 34a and 34b, for measuring volumes expired by lungs 100a and 100b, respectively.
  • Volume-measuring elements 38a and 38b may be conventional volume- meters.
  • volume-measuring elements 38a and 38b may include respective flow-meters, 24a and 24b, and respective integrators, 26a and 26b, for integrating the flow deflated by each lung over a time interval and thereby providing volume measurements.
  • the time interval within which the flow measurements are carried out is of a great significance. Since the more resistive lung is ventilated at a higher pressure, the gases are expired from such lung at a higher flow rate, particularly at the beginning of the expiratory phase. Therefore, a flow measurement taken at a time interval during the beginning of the expiratory phase may show a false rate of expired volumes.
  • volume or flow measurements are preferably taken at the inspiratory, rather than the expiratory path. Accordingly, as shown in FIG. 1 , flow meters 12a and 12b and respective integrators 16a and 16b are preferably connected to inspiratory passageways 12a and 12b, for measuring flows or volumes of gases pumped into the lungs.
  • an apparatus preferably includes volume measuring elements both at the inspiratory and expiratory passageways so as to enable treatment of various diseases.
  • volume measuring elements both at the inspiratory and expiratory passageways so as to enable treatment of various diseases.
  • Such configuration enables, for example, to identify cases wherein gases are leaked from or accumulated within the lungs as well as to quantitate such leakage or accumulation.
  • electronic circuitry 20 When treating diseases wherein the more injured lung is more resistive to ventilation, electronic circuitry 20 preferably controls the operation of regulating element 18 according to the rate of tidal volumes expired by lungs
  • electronic circuitry 20 When treating diseases wherein the more injured lung is less resistive to ventilation, electronic circuitry 20 preferably controls the operation of regulating element 18 according to the rate of flows or volumes pumped into lungs 100a and 100b, which is given by the rate of flows or volumes measured by flow-meters 14a and 14b and integrators 16a and 16b.
  • Electronic circuitry 20 may compare the values of the volumes measured by volume measuring elements 38a and 38b and determine the difference between such values.
  • electronic circuitry 20 sends a signal to regulating element 18 so as to compensate for the difference.
  • regulating element 18 is a pneumatic resisting element
  • the signal sent by electronic circuitry 20 changes the resistance of the resisting element.
  • regulating element 18 is a pressure regulator
  • the signal sent by electronic circuitry 20 changes the pressure produced by the pressure regulator.
  • the compensation may be continuously carried out during the same expiratory phase. However, in order to prevent the system from reaching instability due to changes over time of the ratio of the volume measured, the compensation is preferably performed at the inspiratory phase of the next expiratory cycle. This way, the compensation is carried out only after the entire tidal volumes expired by each lung are measured.
  • electronic circuitry 20 may compare the values of the volumes or flow-rates measured by flow-meters 14a and 14b and respective integrators 16a and 16b, and determine the difference between such values. In the event that such a difference exists, electronic circuitry 20 sends a signal to regulating element 18 so as to compensate for the difference. The compensation may be carried out during the same inspiratory phase. Alternatively, the compensation may be carried out during the next expiratory phase of the same respiratory cycle.
  • 3/2 pneumatic valves 22a and 22b are used to separate passageways 12a and 12b from the respective expiratory passageways 34a and 34b.
  • Valves 22a and 22b feamre two states: a first state wherein fluid communication is established between inspiratory passageways, 12a and 12b, and the respective endobronchial tubes, 36a and 36b; and a second state wherein fluid communication is established between endobronchial tubes, 36a and 36b, and the respective expiratory passageways, 34a and 34b.
  • Pneumatic valves 22a and 22b may be any of the 3/2 pneumatic valves known in the art, such as electrically controlled or pressure regulated pneumatic valves.
  • unidirectional valves may be used to selectively direct the fluid within inspiratory passageways 12a and 12b, and within expiratory passageways 34a and 34b.
  • valves 22a and 22b are preferably placed as close as possible to the respective lungs 100a and 100b, so as to minimize the "dead space", i.e. the volume wherein inspired gases are mixed with expired gases, thereby providing more accurate measurements of volumes and flows of expired gases.
  • An apparatus preferably includes pressure meters, 28a and 28b, for measuring pressures within the respective lungs, 100a and 100b. Further, the apparatus preferably includes maximal threshold pressure valves, 30a and 30b, so as to prevent the formation of excessive pressure within lungs 100a and 100b. An additional maximal threshold pressure valve 44 is preferably connected to respirator 44.
  • a positive-end-expiratory pressure (PEEP) valve may be placed at the end of expiratory passageway 34a, so as to maintain a minimal desired pressure within lung 100.
  • An additional PEEP valve (not shown) may be placed at the end of expiratory passageway 34b.
  • An apparatus preferably includes a display unit 40 electrically connected to volume-measuring elements 38a and 38b and to electronic circuitry 20, for continuously displaying clinical parameters such as: expired volumes measured by volume measuring elements 38a and 38b; pressures within lungs 100a and 100b as measured by pressure- meters 28a and 28b, and the like.
  • FIG. 2 shows experimental results illustrating the operation of method and apparatus according to the present invention.
  • the results shown refer to a disease wherein the more resistive lung is an injured lung, and the less resistive lung is a normal lung.
  • the gas volume ventilated by the injured lung (lung 100a) during the first respiratory cycle (denoted as 1) is much smaller than the gas volume ventilated by the normal lung (lung 100b).
  • the injured lung is ventilated at higher pressures so as to achieve a minimal threshold of ventilation within the lung.
  • the difference between the measured expired volumes is compensated for, such that the gas volumes ventilated by the injured lung (lung 100a) increase, whereas the gas volumes ventilated by the normal lung (lung 100b) are preferably maintained at a constant value, or are slightly decrease.
  • the gas volume ventilated by the injured lung approximately equals the gas volume ventilated by the normal lung, both ventilated volumes featuring a desired value.
  • the pressure within the normal lung is approximately maintained at a constant value due to compensation.
  • method and apparatus according to the present invention enable, for example, to increase ventilation within the injured lung while maintaining a normal value of ventilation within the normal lung, using a single respirator.
  • respirator 10 pumps air into inspiratory passageways 12a and 12b.
  • Pneumatic valves 22a and 22b are set to allow selective fluid communication between inspiratory passageways, 12a and 12b, and the respective endobronchial tubes, 36a and 36b;
  • valves 22a and 22b are set to allow • selective fluid communication between endobronchial tubes, 36a and
  • volume-measuring elements 38a and 38b measure the volumes expired by lungs 100a and 100b, respectively.
  • the flows of the expired gases are measured by flowmeters 24a and 24b, and are then integrated over a time interval which equals the entire time of the expiratory phase by means of integrators 26a and 26b;
  • the results of the measurements are then transferred to controlling electronic circuitry 20.
  • Electronic circuitry 20 preferably compares the results. In the event that a difference between the volumes measured exists, electronic circuitry 20 sends a signal to pneumatic regulating element 18 so as to compensate for the difference.
  • the compensating signal is sent to regulating element 18 at the next inspiratory phase.
  • tidal volumes ventilated by lungs 100a and 100b are preferably equal, thereby enabling symmetrical ventilation of the lungs.

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  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Emergency Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)

Abstract

L'invention a pour objet un procédé et un appareil de ventilation différentielle des poumons à compliance différente avec un rapport de volumes prédéterminé, qui utilise un seul respirateur. Le procédé consiste à pomper un fluide dans une première (12a) et une seconde (12b) voies inspiratoires, la première se trouvant en communication fluidique avec un poumon plus résistant (100a) et la seconde se trouvant en communication fluidique avec un poumon moins résistant (100b); et à réguler l'écoulement du fluide à l'intérieur de la deuxième voie au moyen d'un élément de régulation (18), ce dernier étant automatiquement commandé par un élément de commande (20) en fonction des volumes expirés par les premier et second poumons. L'appareil comprend un respirateur unique (10); une première (12a) et une seconde (12b) voies inspiratoires en communication fluidique avec les premier (100a) et second (100b) poumons, respectivement, le premier poumon résistant mieux à la ventilation que le second; un élément de régulation pneumatique (18) relié à la deuxième voie et servant à réguler l'écoulement d'un fluide à l'intérieur de la deuxième voie; et un élément de commande (20) servant à commander automatiquement l'élément de régulation sur la base des volumes expirés par les premier et second poumons.
PCT/US1998/005444 1997-04-04 1998-03-23 Procede et appareil de ventilation differentielle des poumons Ceased WO1998044975A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU65710/98A AU6571098A (en) 1997-04-04 1998-03-23 Method and apparatus for differential lung ventilation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US08/932,837 1997-04-04
US93283797 1997-04-04

Publications (1)

Publication Number Publication Date
WO1998044975A1 true WO1998044975A1 (fr) 1998-10-15

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PCT/US1998/005444 Ceased WO1998044975A1 (fr) 1997-04-04 1998-03-23 Procede et appareil de ventilation differentielle des poumons

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WO (1) WO1998044975A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006067822A1 (fr) 2004-12-20 2006-06-29 Tito Mario Franco Passannanti Appareil de ventilation assistee

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4233984A (en) * 1978-06-30 1980-11-18 Walling Peter T Respiratory ventilating device
US4598706A (en) * 1983-03-04 1986-07-08 Polska Akademia Nauk Instytut Biocybernetyki I Inzynierii Biomedycznej Apparatus for independent ventilation of two lungs with selective use of positive end-expiratory pressures

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4233984A (en) * 1978-06-30 1980-11-18 Walling Peter T Respiratory ventilating device
US4598706A (en) * 1983-03-04 1986-07-08 Polska Akademia Nauk Instytut Biocybernetyki I Inzynierii Biomedycznej Apparatus for independent ventilation of two lungs with selective use of positive end-expiratory pressures

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2006067822A1 (fr) 2004-12-20 2006-06-29 Tito Mario Franco Passannanti Appareil de ventilation assistee

Also Published As

Publication number Publication date
AU6571098A (en) 1998-10-30

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