US 20090107494 A1
Spontaneous respiration is detected by sensors. An additional amount of oxygen is administered to the lungs via a jet gas current at the end of an inhalation procedure. Breathing volume, absorption of oxygen during inhalation, and clearance of carbon dioxide during exhalation are improved. If required, the exhalation procedure of the patient can be arrested or slowed by a countercurrent to avoid a collapse of the respiration paths. An apparatus including an oxygen pump can be connected to an oxygen source and includes a tracheal prosthesis that can be connected via a catheter. The respiration detections sensors are connected to a control unit for activating the oxygen pump. The tracheal prosthesis includes a tubular support body with a connection for the catheter, and the sensors are associated with the support body. The tracheal prosthesis and jet catheter are dimensioned so the patient can freely breathe and speak without restriction.
1. An apparatus for supplementing respiration of a spontaneously breathing patient comprising:
an oxygen-bearing gas source,
patient respiration sensors for detecting spontaneous respiration phases of the patient
a catheter adapted to be inserted into the respiratory system of the patient and fluidly connected to the oxygen-bearing gas source, and
a control unit in communication with the patient respiration sensors, the control unit adapted and configured to determine a need for an additional amount of gas based on the patient's need as determined by a measurement of the patient's respiration and to control the oxygen-bearing gas source to deliver a volume of gas to the patient through the catheter in synchrony with a portion of the patient's spontaneous breathing pattern when the patient needs respiratory support.
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25. A method for supplementing the respiration of a spontaneously breathing patient comprising the steps of:
inserting a catheter into the respiratory system of the patient so that the catheter does not hinder the patient's ability to speak or breathe spontaneously through the upper airway,
determining the phases of spontaneous respiration of the patient with respiration sensors including beginning and end of breath phases,
administering a supplemental volume of oxygen-bearing gas based on the patient's need as determined by a measurement of the patient's respiration to the lungs at a gas flow speed of greater than 100 m/sec., wherein the delivery is synchronized with a portion of the patient's spontaneous respiration phases.
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60. A method for supplementing the respiration of a spontaneously breathing patient comprising the steps of:
inserting an oxygen-bearing gas delivery device into the respiratory system of the patient,
detecting spontaneous respiration of the patient with respiration sensors,
identifying an inhalation phase and an exhalation phase using information from the respiration sensors,
synchronizing delivery of a volume of oxygen-bearing gas based on the patient's need as determined by a measurement of the patient's respiration to the patient during an inhalation phase to augment inspiration or during an exhalation phase to augment exhalation, and wherein the delivered volume of the oxygen-bearing gas is increased, decreased, switched-on or switched-off based on feedback from the respiration sensors.
61. A device for supplementing the respiration of a spontaneously breathing patient comprising
sensors for monitoring the spontaneous respiration of the patient
a catheter configured to be inserted into the respiratory system of the patient,
a control unit communicating with the sensors configured to identify an inhalation and an exhalation phase of the patient's spontaneous respiration and the need for supplemental gas volume based on the patient's need as determined by a measurement of the patient's respiration wherein the control unit is further configured to administer a supplemental amount of oxygen-bearing gas through the catheter synchronously with either an inhalation phase or an exhalation phase, and
wherein the supplemental volume of the oxygen-bearing gas is increased, decreased, switched-on or switched-off based on feedback from the sensors.
62. A system for supplementing the respiration of a spontaneously breathing patient, comprising:
a transtracheal catheter adapted for placement in an airway of a patient and comprising at least one respiration sensor, wherein the transtracheal catheter is configured to not obstruct an airway of the patient; and
a wearable mobile respiratory device comprising:
a control unit in communication with the respiration sensor, the control unit configured to determine the need for additional volume based on the patient's need as determined by a measurement of the patient's respiration and to control the delivery of a volume of supplemental gas to the patient in synchrony with a portion of the patient's spontaneous breathing pattern when the need for breath augmentation is determined.
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determining at or near a peak of the inhalation phase whether the volume of oxygen-bearing gas is needed by the patient.
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determining at or near a peak of the exhalation phase whether more carbon dioxide needs to be exhaled by the patient.
68. The method of
detecting gas composition in the airway to determine whether to adjust the delivery of the supplemental volume of oxygen-bearing gas.
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This patent application claims priority to U.S. Ser. No. 60/718,318, “Systems, Methods and Apparatus for Respiratory Support for a Patient”, filed Sep. 20, 2005, which is incorporated herein by reference in its entirety.
The present invention relates generally to respiratory systems and more particularly to specialized systems, methods, and devices for enhanced ventilation of a patient.
In order for the body to take in oxygen and give off carbon dioxide, two components of the respiratory bronchial system must function—the lungs as a gas-exchanging organ and the respiratory pump as a ventilation organ that transports air into the lungs and back out again. The breathing center in the brain, central and peripheral nerves, the osseous thorax and the breathing musculature as well as free, stable respiratory paths are necessary for a correct functioning of the respiratory pump.
In certain diseases there is a constant overload on or exhaustion of the respiratory pump. A typical syndrome is pulmonary emphysema with flat-standing diaphragms. Flat-standing diaphragms do not have the ability to contract. In the case of pulmonary emphysema, respiratory paths are usually extremely slack and tend to collapse. As a consequence of the flattened, over-extended diaphragms, the patient cannot inhale deeply enough. In addition, the patient cannot exhale sufficiently due to collapsing respiratory paths. This results in an insufficient respiration with an undersupply of oxygen and a rise of carbon dioxide in the blood, i.e. a ventilatory insufficiency.
The treatment for inhalation difficulty often involves a breathing device. A home ventilator is an artificial respirator for supporting or completely relieving the respiratory pump. Artificial respiration can be applied non-invasively via a nose or mouth mask that the patient can put on and take off as needed. However, the nose or mouth mask prevents the patient from breathing and speaking freely, and is very invasive.
Another treatment option is invasive ventilation. Invasive ventilation is usually applied via a cuffed endotracheal tube that is passed through the mouth and the larynx and into the windpipe, or is applied via a tracheostomy. The tracheostomy involves an opening placed in the trachea by an operation. A catheter about the diameter of a finger with a blocking balloon or cuff is inserted via the opening into the trachea and connected to a ventilator that applies cyclic positive pressure. This procedure makes sufficiently deep respiration possible, but prevents the patient from speaking.
In addition to home ventilation with a mask and invasive ventilation, there is also transtracheal administration of oxygen via thinner catheters. U.S. Pat. Nos. 5,181,509 or 5,279,288 disclose corresponding embodiments. In this manner, a highly dosed administration of oxygen is administered to the patient in a continuous stream with a permanently adjusted frequency. The flow rate of oxygen is regulated manually by a regulator. However, simulation of the natural breathing process of a patient is not achieved because the depth of breathing is not enhanced. Some common problems associated with these transtracheal catheters are irritations and traumas of the sensitive inner skin of the windpipe (tracheal mucosa). It is a common observation that the tip of the small catheter strikes against the inner wall of trachea as a consequence of the respiratory movement. In addition to this mechanical trauma, the surrounding tissue is dried out by the high flow oxygen stream.
Furthermore, so-called “Montgomery T-tubes” can be inserted into the trachea and a patient can obtain oxygen via a shank of the T-piece external to the patient. In needed, the patient can draw off secretions using a suction catheter and a vacuum pump. The patient can breathe freely and speak when the front shank is closed; however, normal artificial positive pressure ventilation is not possible via the Montgomery T-tube since the introduced air escapes upward into the oral cavity or the pharyngeal area. An additional limitation of the above-referenced therapies is the impaired mobility of the patient because of inadequate ventilation or because of the bulk of the apparatuses.
Jet ventilators are state of the art, but these devices are not synchronized with a patient's breathing. On the other hand, invasive ventilators with cuffed tubes are synchronized because there is a direct feedback of the pressure inside the inflated lung to the sensors inside the respirator. However, there are no respiratory systems that use feedback from sensors in the body to properly synchronize and control the ventilator.
Whether the breathing disorder is COPD/emphysema, fibrosis, sleep apnea, or otherwise, difficult breathing is a serious, often life-threatening problem. Therefore, there is an existing need for a respiratory system that provides a more efficient method for supporting the respiration of a patient that can be used to treat many disorders, are minimally invasive, mobile and taken along by the patient, and/or reliable in use. Moreover, there is a need for respiratory support systems that simulate the patient's spontaneous respiration without adversely affecting the patient's ability to speak. Additionally, there is a need for a respiratory support system capable of using pressure or flow signals from inside the body to properly synchronize and control a ventilator.
The invention includes systems, methods, and apparatuses that improve the quality of life for patients that require respiratory support. These respiratory systems, methods, and apparatuses can provide a more efficient way of supporting the respiration of a patient by providing additional oxygen when needed in accordance with the principles of the invention.
In one embodiment, a tracheal prosthesis and a catheter in accordance with the principles of the invention can provide for respiratory support that can be synchronized with the spontaneous respiration of the patient and still allow the patient to speak.
Additional features, advantages, and embodiments of the invention may be set forth or apparent from consideration of the following detailed description, drawings, and claims. Moreover, it is to be understood that both the foregoing summary of the invention and the following detailed description are exemplary and intended to provide further explanation without limiting the scope of the invention as claimed.
The accompanying drawings, which are included to provide a further understanding of the invention, are incorporated in and constitute a part of this specification, illustrate preferred embodiments of the invention and together with the detailed description serve to explain the principles of the invention.
In the drawings:
The present invention, in a preferred embodiment, provides systems, methods, and apparatus for supporting the respiration of a patient. This can be accomplished by providing controlled synchronized ventilation with a directed flow of an oxygen-bearing gas. The oxygen-bearing gas may be substantially pure oxygen, mixtures of oxygen and nitrogen, mixtures of oxygen and inert gases, ambient air, or various combinations thereof. In addition, the oxygen-bearing gas may include fragrances, aerosolized drugs, humidification or heating. The oxygen-bearing gas can be provided as needed upon inhalation and/or expiration, preferably, based upon sensing of the patient's spontaneous breathing.
By providing a jet boost of an oxygen-bearing gas upon inspiration, as needed, the patient can inhale more oxygen. Preferably, the additional oxygen is administered at the end of inhalation, in particular, after the peak of inspiratory flow is detected. The administration of additional oxygen can improve the depth of ventilation during inhalation. However, the additional oxygen may be administered at any point during inhalation. Additionally, a countercurrent or counter pulse during expiration can be delivered, which creates a back-pressure in the airways similar to the pursed lips breathing strategy applied by physiotherapists in order to avoid a collapse of the respiration paths. By providing an oxygen-bearing gas upon expiration through counter pulses (e.g. bursts or pulses of oxygen-bearing gas directed against the direction of the flow during expiration), a dynamic collapse of the airways can be minimized or prevented, over inflation of the lung can be minimized, and clearance of carbon dioxide from the lungs can be improved. Therefore, in accordance with the principles of the invention, whether used for inhalation and/or exhalation, breathing requires less energy and the patient's pain, dyspnea and exhaustion are relieved. Moreover, the systems and methods of the invention can be used for treatment of many breathing disorders, including, but not limited to, COPD, emphysema, fibrosis, and sleep apnea.
As shown, the respiration support of patient P in accordance with the principles of the invention can be implemented in a system, method, or apparatus that may be compact and/or portable. Other systems are contemplated including, for example, providing for use with a ventilator or oxygen source as shown in
In accordance with the embodiment of
The system of
The sensors allow the patient P's breathing to be monitored continuously so that a jet flow of oxygen-bearing gas can be supplied in accordance with the principles of the invention, that is, when a deeper breath is needed. In particular, at the end of an inhalation process of the lungs, an additional volume (oxygen) can be administered to patient P, as discussed in more detail below. This respiratory flow is illustrated in the right half of
In addition, the exhalation process of the patient can be braked or slowed by a countercurrent. As a consequence thereof, the respiratory flow shifts during exhalation along the curve designated by A2. This purposeful resistance acting opposite to the exhalation prevents a collapsing of the respiratory paths during exhalation. In this manner, the exhalation volume can be increased by the volume also shown darkened and designated by A3. The amount of carbon dioxide that is exhaled can be increased by a statistically significant amount. The amount of carbon dioxide that is exhaled can be increased by at least 5%. Preferably, the amount of carbon dioxide exhaled is increased from 5% to 30%. More preferably, the amount of carbon dioxide exhaled is increased about 20% to 30%.
As a consequence, the invention may avoid insufficient respiration from an undersupply of oxygen and an increase of carbon dioxide in the blood. The patient P may be significantly less stressed and more mobile, and may perceive less or no shortage of air.
The sensors for detecting and monitoring respiration will now be discussed in more detail. To detect spontaneous respiration of the patient P, sensors can be associated with an end of the catheter that is disposed in the trachea of the patient P. In one embodiment, the invention can include connecting the catheter to a tracheal prosthesis (e.g.
In one embodiment, as shown in
In the tracheal prosthesis 2 according to
In another embodiment, a separate coupling 18 is provided on the connection 7 in the tracheal prosthesis 3 according to
The tracheal prosthesis, when used, can comprise various configurations, shapes and dimensions. For example, the tube could be T-shaped or L-shaped or otherwise. The size, shape, and/or cross-section can vary, for example, to accommodate removal or to direct the catheter. The tracheal prosthesis could be a portion of a tube having, for example, a semi circular cross-section. Furthermore, expandable and self-expandable prongs or petals can be used at the tracheal opening to secure the prosthesis in place. In one embodiment, the prosthesis can include a tubular member with a tracheal side opening including prongs or petals surrounding, in whole or in part, the access hole. The prongs or petals may function like a rivet in the neck opening. The tracheal prosthesis can also be coated to avoid mucus retention, prevent the formation of granulation tissue, or can act as a drug-releasing device. The tracheal prosthesis may also include other coatings, such as lubricious coatings and hydrogel anesthetics. Thus, the tracheal prosthesis can serve as a guide for the catheter, to hold sensing devices, serve as a drug delivery device, and/or to minimize mucus plugs that can form on the catheter tip.
In addition to internal sensors, external sensors can be provided.
One embodiment where sensors are provided on the catheter is shown in
The catheter 28 can be introduced into the support body 36, as shown in
In another embodiment shown in
In another embodiment, as shown in
Other sensors can be used in accordance with the invention. For example, sensors and/or secondary control sensors could be: respibands (chest wall strain gages), respitrace signals (conductance plethysmographs), pressure sensors inside or outside the body, transthoracic electrical impedance measuring devices, flow sensors at the mouth or nose (pneumotachographs), and/or capnometers (carbon-dioxide sensors). Moreover, the sensors in accordance with the invention can communicate data or information to the control unit by any devices, mechanisms, or methods. For example, communication can occur by way of wire, wireless, or remote transmission. The advantage of using non-thermistor sensors is that the thermistor approach may have the disadvantage of the thermistor head collecting airway mucus, which could be corrected for in a variety of ways such as with cleaning. However, other non-thermistor sensors may be less susceptible to annoyances like mucus collection. Further, with thermistor sensors, inevitable changes in ambient temperature, while compensatable in the thermistor signal processing algorithms, are potentially problematic to system reliability. Therefore, the other types of sensors stated above may be advantageous over thermistor sensors, or in addition to the thermistor sensors.
In addition to measuring the respiration pattern, it is often desirable to measure airway pressure for safety reasons, for which thermistor sensors may not be the best approach. Therefore, some of the sensors mentioned above can also be used as a safety control device. For example, pressure sensors can be used to sense the inspiration of the patient (like the thermistors), but they can also be used to sense a high pressure in the trachea and shut off the jet machine in order to prevent baro-trauma (damage from high pressure).
An oxygen-bearing gas is provided on demand by the gas pump 1. The gas pump 1 is schematically shown in
The gas pump 1 functions in the apparatus during the support of respiration as follows. When valve V1 is open from c to a (b to c closed) and valve V2 is open from b to e (e to d closed), piston 20 moves to the left in the plane of the figure and the oxygen flows via outlet 22 and jet catheter 5 to the patient P. An additional amount of oxygen E3 is administered during the inhalation process of the patient P.
When valve V1 is open from b to c (c to a closed) and valve V2 is open from e to d (b to e closed), piston 20 moves to the right in the plane of the figure and the flow of oxygen takes place in the direction of valve V3. Valve V3 is connected to the ambient air via an outlet 23. In the instance in which valve V3 is open from d to g, the oxygen flows off without expiration brake. That means that the exhalation process is not braked by a countercurrent.
If valve V3 is closed from d to g and open from d to f, the oxygen flows via access path 24 in the direction of the outlet 22 and the catheter 5 in order to be administered to the patient P during the exhalation process and in order to break the respiratory flow. The countercurrent prevents a collapsing of the respiratory paths and keeps them open, making a deeper exhalation possible.
Furthermore, valve V4 is located in access path 24 of the apparatus, via which the flow through (f to a) can be variably adjusted. This advantageously can be a proportional valve with pulse-width modulation.
As discussed above, the catheter preferably includes a jet nozzle. Any type of jet nozzle can be used to achieve the necessary jet flow. The jet flow speed in accordance with the invention can be significantly higher than 100 m/s. By comparison, the speed through a conventional ventilator tube or mask is significantly lower than 100 m/s. When the jet flow rate is high enough, there is enough speed so that directed flow is accomplished and no sealing tube cuff would be necessary. Under normal ventilation, the volumetric inspiratory flow rate is in the range of about 500 m3 to 1000 cm3 in 2 seconds. A peak inspiratory flow maximum can be 1000 cm3/second. In the case of normal invasive ventilation, the flow of 1000 cm3/s (peak) goes through a tube of approximately 8 mm diameter. The speed of this gas stream, determined by dividing the volumetric inspiratory flow rate by the area of the tube, is 1000 cm3/(0.4)2 cm2*Pi=2000 cm/s=20 m/s. During jet ventilation, approximately half of this flow goes through a jet cannula of 1.5 mm diameter. As the flow profile is rectangular, the peak flow rate is 500 cm3/s. Therefore, the speed of the jet gas stream is 500 cm3/(0.075)2 cm2*Pi=28313 cm/s=283 m/s. In accordance with a preferred embodiment of the invention, 100 ml (cm3) are pressed through a catheter of approx 1.5 mm diameter in half a second. Preferably, the peak flow for this embodiment is 100 cm3 in 0.25 seconds=400 cm3/s. The speed of this gas stream is 400 cm3/(0.075)2 cm2*Pi=22650 cm/s=226 m/s. In other preferred embodiments, the speed of the gas stream is from approximately 100 m/s to approximately 300 m/s. Preferably, the speed of the gas stream is from approximately 200 m/s to approximately 300 m/s. Preferably, the speed of the gas stream is from approximately 250 m/s to approximately 300 m/s.
When the tip of the catheter touches the wall of the trachea, there is a potential risk of tissue damage. The catheter tip or the high flow gas stream can harm the mucosa. To efficiently and effectively direct the air inside the body, the catheter can be configured to provide a directed flow of oxygen. In particular, the catheter is preferably configured so that the exit of air from the catheter output end can expel and direct air down the center of the trachea to avoid directing the jet flow of oxygen against the tracheal wall. Also, the catheter tips are preferably configured to minimize venturi and the mucus formation proximal to the venturi on the outer wall of the catheter. A shielding Montgomery T-tube as described above can be used to overcome that problem. In
Referring now to
Regardless, the flow can be directed towards the mouth or back into the lungs as desired. The flow brake for the expiratory flow of the patient can be adjusted from disturbance (pursed lips effect) or to augmentation (venturi principle). The whole catheter preferably does not have more than 4 mm outer diameter, but can be very versatile. This embodiment, like the other embodiments of the invention, can also be used to apply vibratory flow to the respiratory paths to improve mucus clearance.
The system in accordance with the principles of the invention can be implantable. In one embodiment, the system including the jet catheter and system sensors can be implanted inside the body. Although it is possible to implant the pump, it is contemplated that tubing attached to the pump can be connected to a connector exposed from the body. The pump tubing can be attached to the connector in a conventional manner so that the oxygen-bearing gas flows through the implanted jet catheters into the patient in accordance with the principles of the invention. The system can be tailored to the needs of the patient. The jet pressure and timing and duration of the pulses can be monitored and controlled and adjusted as necessary based on the patient's respiratory condition and general status. As shown in
As mentioned above, the principles of the invention can be used in treating and/or assisting in the treatment of a variety of breathing disorders and/or breathing difficulties. In such treatments, the invention can provide an oxygen-bearing gas into any of the airways of the patient. In one such embodiment, instead of directing the oxygen-bearing gas into the lungs, the oxygen-bearing gas can be directed into the upper airways, including, for example, using a catheter and, more particularly, a tracheal or coated catheter.
In one embodiment, an oxygen-bearing gas can be directed into the upper airways to treat or assist in the treatment of sleep apnea. Sleep apnea is a serious sleep disorder that occurs when a person's breathing is interrupted repeatedly during their sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night. One type of sleep apnea can be referred to as obstructive sleep apnea (OSA). OSA is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses during sleep. Currently, sleep apnea can be treated by continuous positive airway pressure (CPAP) treatment in which a patient wears a mask over the nose and/or mouth. An air blower forces air through the upper airway. The air pressure is adjusted so that it is just enough to prevent the upper airway tissue from collapsing during sleep. The pressure is constant and continuous, and the flow rate is sometimes adjusted by bilevel positive airways pressure (BiPAP) machines, depending on need. CPAP can prevent airway closure while in use, but apnea episodes return when CPAP is stopped or it is used improperly. The use of the nasal mask and oral delivery of gas/oxygen/ambient air is cumbersome and inhibits the patient. In contrast, in accordance with the principles of the invention, the oxygen-bearing gas can be provided to the patient by way of a catheter, including a tracheal catheter. The oxygen-bearing gas can be provided to the patient based upon the breathing monitored by sensors in accordance with the invention. This includes sensors placed in the upper airway tissues that sense tissue movement or collapse. These sensors could communicate to the pump via wireless or hard wire. The sensors can detect the breathing cycles and based upon that information the oxygen flow and volume can be controlled. The oxygen-bearing gas can be provided continuously, intermittently, or pulsed as needed. Alternatively, as discussed above, the oxygen-bearing gas can be provided in a jet flow. Further, the portable respiration device can be programmed such that a continuous flow of oxygen-bearing gas is delivered and a jet boost is activated only if necessary. As a result, the oxygen can be tailored to the patient's needs.
The invention can be used to treat any kind of disease where alveolar ventilation and oxygen uptake are impaired. This includes chronic obstructive airway pulmonary diseases including lung emphysema, as well as restrictive diseases such as pulmonary fibrosis, sarcoidosis, pleural adhesions, chest-wall diseases, neuromuscular diseases, and phrenic nerve paralysis. Basically, whenever a patient has a problem breathing deeply enough, the invention can be helpful.
In contrast to the present invention, typical invasive ventilation is provided all the time, but a patient cannot exercise at all (walk carry something, etc.). The patient has a tube in the throat and is fixed to a bed (usually in intensive care). Non-invasive ventilation with a mask is sometimes provided in order to help the patient's weak breathing muscles recover. For example, if the patient is ventilated overnight, the diaphragm and auxiliary muscles can rest, and the patient can perform better at daytime. However, whenever the patient would need help most (during exercise), the patient has to breathe on their own. With the minimally invasive or percutaneous ventilation and the synchronized jet from the system in accordance with the invention, support is given when needed (e.g., during exercise).
Although the foregoing description is directed to the preferred embodiments of the invention, it is noted that other variations and modifications will be apparent to those skilled in the art, and may be made departing from the spirit or scope of the invention. Moreover, features described in connection with one embodiment of the invention may be used in conjunction with other embodiments, even if not explicitly stated above. The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims, rather than by the foregoing description. All changes, which come within the meaning and range of equivalency of the claims, are to be embraced within their scope.