US 2480980 A
Description (OCR text may contain errors)
Filed Oct. 12,
F. H. TERHAAR RESPIRATOR APPARATUS 5 Sheets-Sheet 1 y PM I \NVENTOR FERDINAND H TERHAAR ATTORNEY W W49. F. H. TERHAAR RESPIRATOR APPARATUS 3 Sheets-Sheet 2 Filed Oct. 12, 1946 mm ?7 9 H R n O R J TA N N 3 R E H Wm T l T A H D N N M m w .H, VI F B 0 6 L p F. H. TERHfiAR mzsrmnon APPARATUS 5 Sheets-Sheet 3 Filed Oct. 12. 1946 INVENTOR FERDNAND H.
TERHAAR ATY Patented Sept. 6, 1949 UNITED STATES PATENT OFFICE 2,480,980 RESPIRATOR APPARATUS. Ferdinand H. Terhaar, Los Angeles, Calif. Application October 12, 1946, Serial No. 703,032
This invention relates generally to therapeutic appliances, and relates more particularly to respirator apparatus or appliances of this character for use as an aid in improving pulmonary and systemic circulation and in the treatment of various ailments.
The apparatus in which this invention is embodied consists of a rigid two-part shell which may be of any suitable material, such as a transparent plastic or the like. Theparts of the shell, when fitted together, surround the chest, and rubber seals or sheet bands are used to close off the openings against the body. This shell is then connected by a hose to a mechanical power unit, including a bellows, which is driven by an electric motor. This motor driven bellows drives air into and draws air from the shell through the hose, and creates alternately a negative and a positive pressure of air surrounding the chest, and the cycle may be synchronized with the patients breathing. This has the effect of expanding the chest, when a negative pressure is created, causing the patient to inhale, and of compressing the chest, when a positive pressure is created, causing the patient to exhale. By suitably controlling the valves of the motor-driven pump mechanism, the breathing pulsations can be made so that the breathing will occur without effort, that is, the pulsations are timed to suit the respiratory rate of the patient, or the valves may be so controlled as to secure any other desired pulsation cycle having different breathing characteristics. It is therefore an object of the invention to provide a device having the above characteristics.
The parts of the shell are provided with a suitable seal between their adjacent edges, and it is necessary to also provide air seals between the arm and neck openings and the adjacent portions of the patients body; and it is another object of the invention to provide an improved neck seal which is so constructed and arranged that it can be easily fitted to the neck of the patient, and may be adjusted to various neck sizes.
Another object is to provide a comfortable neck seal so that the patient experiences no discomfort even though remaining in the shell for protracted periods of time.
A still further object of the invention is to provide a neck seal which is substantially airtight against both inward and outward pressures.
These advantages result from the structural arrangement of the neck seal, which comprises two diaphragm-like portions, which are sealingly secured to the respective upper and lower parts of the shell about the neck opening. The free end parts of each diaphragm extend-outwardly of the neck opening and. haveportions that are folded inwardly to form envelopes, and the sides are clipped together close to the patients neck and adjacent the shell.
It is still another object of the invention to provide a neck or throat seal which is simple in construction and effective in its functioning.
The shell is made considerably larger than the size of the patient which it is designed to accommodate, so that such patient is in no manner restricted or constricted. This shell extends to approximately the region of the patients diaphragm, or somewhat below the lower ribs. Thus, the chest region is completely surrounded by the rigid shell or casing, but other parts of the body are free.
A shell of a given size is adapted to accommodate patients of various sizes, and it is, therefore, necessary to provide a waist seal which is adapted to be attached to different sized waists.
It is another object of the invention to provide a waist seal which will cause chest respiration and will not cause undesirable pressures on the patients waist or abdominal region.
A further feature of the invention is to provide an arrangement of this character which may be secured to the patient without undue disturbance, and wherein the weight of the patient aids in effecting the seal.
In order to provide the above objects and features in the waist seal, said seal is constructed of two thin sheets of elastic material, such as rubber or other soft elastic material, which is impervious to air. One sheet is attached to the bottom portion of the shell, and is so arranged as to be extended longitudinally therefrom. The other sheet is attached to the upper half of the shell in such a way that when the shell is placed over the patient in registration with the lower half, the second mentioned sheetextends over the abdomen of the patient. The sides of the upper sheet are tucked under the patient. The upper corners of the lower-sheet are then drawn tightly about the lower edge portion of the shell, and secured by suitable means. Thereafter, the sides of the lower sheet are brought up about the patients body, and the sheets then secured by a suitable belt or belts, there being one belt adjacent the lower ends of the sheets, which is drawn about the patients body,and another belt which may be used about an intermediate portion 3 of the sheets. The tightness of these belts may be varied under various conditions.
The invention also contemplates the use of an extension or abdominal shield which may be detachably secured to the lower end of the upper half of the shell, and which produces abdominal respiration.
In order that the advantageous features of the invention may be fully understood, a brief reference to certain physiological facts concerning bodily cir culatidn' will be giveri This circulation is governed in a large measure, by the same laws that control the flow of liquids in a closed system of cylindrical elastic tubes. Theheart changes its shape and position with eaehbreath. 1
change in The movement .of the ribs and th'e the elastic portion of the lungs are essential to the proper functioning of thepulm'onary'circulation. Further, proper diaphragmati'c action is important for the return flow of the venous qd- I The circulatoryl'sy's tein serves two primary purposes, the nourishme t-0mm tissues and the removal ofwast premiers. A'h y. disturbance of its functions injures" the tissues, even the heart muscle 'it's'e 'eit'h'er by gradual malnutritlOll of b Y SIOW i l'l t liicafibll;
'Ihe heart; iunctions to distribute blood i and the diaphragmassists in venous return. Damage to cardiac'structure bi inti r'ferencewith the normal exc'ursio'n of medis nra m has serious consequences was indiyiduals well'being. It is a well-known fact in physiology. that venous blood is drawn to the right}' side'of';the heart by the increase in negative thoracic pressure during. inspiration, and the downward movementor the diaphragm, and'is inera se'd asthe excursion becomes greater. Thisffiinctionalvalueis often lost through disease, whichleaves the patient in a condition .in which he cannot exercise this function to "the extent of 'its'"normal"value, hence aggravating'lfiscondition; g I V The actidn'of 'tne presen yqevise, as it afiects circulation, can besummarized as followsi First,
it'controls" the movement of-"the ribs and the dowhwardbullof the diaphragm, thereby controlling'the' intra-jt oracic negative pressure and influencing the variant return. Second'it alternatly. changes the atmospheric pressure surrounding? the chest, to either above" or below that which"exis ts over' the which rernains'constant', thereby assisting the flow in the surface vessels upward and downward. Third," with *eac'hreduetionfof the atmosh'eriepressure ov'e'i' meanest; causin'g'an inhale, th'e 'rubben'b'aiids over the abdomen" and arms perform afmass milking the -situate; vessels and releasing them when the ressure is reversed;
These three; influences, accomplished mechanically, but i without any-particular consciousnesson the part of'the patient-give an=impetus todevicehas-a multiplicity ofuses. For ir'istari'c(55inrespiratory failure, it-
the circulation; and'the can be used: as a respirator; In surgery it is advantageous in:post-surgical recovery. or shock, Inperipheral or in pre su rgeryl' preparation.- vascular disease it may be used to establish col: lateral circulation; In cardiac conditions; it may be usedas an aid; in supplying-blood and oxygen to cardiacmuscles, and it ;n1 ay be used torelieve- The foregoing. are but splanchnic congestion.
a few; oftheuses to beput. H
Other objects and-advantages of theinventionhich the invention may rest of the torso and aginghnotioh toward the heart,
) 'ditions corresponding to the inhale phase;
Fig.. 4 is aisimilar view but showing the application of the apparatus in a way to restrict pressure pulsation in the chest area of the patient;-
Fig. 5 is a transverse vertical section taken Fig. 6 isa -transversevertical section taken.
on line-6 6 -of-'Fig; Z-shoWing-the arrangement of therubber sheets oraprons preparatory, to.
securing-theIn-about the patient; 1
Fig. '7 is a longitudinal vertical-sectional view.
showing the pocket -portion-of. -one of. the parts of the neck seal;-
Fig- 8-is a view otthe apparatus .asseen from i 9is-averticalsection.taken-on.line 99 Fig. 10 is a perspective viewof. .the. .shell withabdominal shield? attached.
the extension or thereto; and
Fig. 11 is afragmentary-longitudinal vertical sectional view similar-t0 Figr-Z .illustratingthe apparatus shown in Filer-.10; adjustedrionuse in sub-- jecting the chest and 'stomach regions of a patient to pressure'pulsations.
Referring: more thedevice coin-prisesa shell or jacket of relativelyflight weight, rigid; transparent material, suchv as plastic, or the-like, .altheugh'any other suitable materialmay. be used. back part or half-I'D, anda front part or half I l, the back being. shaped 'to-iconfo'rm to the human back for greater' comfort rated along. a artingpmne,
shown, there aretwo shoulder clamps, and'a clampat each side adjacen'tthe lower-end of the assembldshell. These clampsmay be ofany well-known typeand',v character as to permit together. I
The shelll provides a=cavityor pressure chamberfor receptionflofthe upper portion .of a patients body, includingsthe shouldersand chest,
andthe interior cavity of theshellis of considerably larger size than the size: of :the patient for which-it isdesigned', so that r the patients body is in no manner restrictedor constricted bythe shell. If desired, diiferent sized shells maybe.
provided for. the 'whole range of patient sizes and these shells may. benested, one Withinthe other, to facilitate transportation particularly. to the drawings,
The shell comprises a The parts are sepa-- and-when assembled are sealed along, this plane by a sealing gasket l2 and T as shown, comprises at suitable locations. As-
-i f.-'desired, may; be of such quick locking of the parts of the devicesi- The:
shell also has arm, neck and waist openings l4, l5 and I6 respectively, each portion (front and back) of the shell having a part defining substantially half of the respective openings.
When treating a patient it is necessary for the arm, neck and waist openings to be sealed, and the present invention provides means for this purpose. The arm openings, as shown, are sealed by tubular members or sleeves l1, are formed of flexible material, which is substantially impervious to air, such as rubber or some rubber-like composition, and are resiliently attached at one end of respective flanges 18 about the arm openings M. The other end of the members I! is adapted to fit about the arms l9 of the patient, and is brought into suitable sealing engagement with said arms by means of an elastic strap or ties 2|], which are of rubber or the like, and are tightened to provide the proper degree of construction. One end of each tie 20 is secured, by vulcanizing or the like, to the respective sleeves, and said ties are wound about the outer ends of said sleeves. The free ends of the ties 20 are disposed beneath one or more wrappings thereof to prevent accidental loosenin thereof.
The means for sealing the neck opening, which is considered as being at the top or upper end of the shell, comprises a pair of flexible sheet-like parts 22 and 23 of rubber, or other suitable material. The part 22 has its inner end portion secured within the front shell part II along the neck opening l5 by means of a generally semiannular clamping member 24 attached adjacent the neck opening, screws 25 or the like being used for attaching the parts to the shell half H. The member 22 extends outwardly of the neck opening l5, and its inner portion is reinforced so as to inhibit undue movement thereof under the iniluence of pressure pulsations. The end portion 26 of the member 22 is turned or folded inwardly, as best shown in Fig. 9, and the side edges 21 are secured to the adjacent side edges of the main body of the sheet so as to form an inwardly opening pocket 32 as shown in Fig. 'l, for a purpose to be hereinafter described. The lower member 23 has its inner end portion similarly clamped by a semi-annular clamping member 28 attached to the body of the shell, adjacent the neck opening, by screws 29. The outer end portion of the member 23 has a part 3!] which is folded inwardly and secured alon its side edges in a manner similar to that of the part 26 of member 22. The patients neck, of course, extends through the neck opening and the seal is rendered fully effective by means of clamps 31, which are clamped at the sides of the members 22 and 23 adjacent the patients neck and adjacent the upper end of the shell, to provide the proper degree of construction without rendering the patient uncomfortable. The neck seal thus formed, is effective to prevent the passage of air either inwardly or outwardly of the neck opening. Inward pressure results when the pressure within the seal is below atmosphere and urges the parts 22 and 23 against the neck of the patient to prevent the entrance of air into the shell. When the pressure within the shell is above atmospheric pressure, there is outward pressure on the neck seal, and said pressure causes separation of the envelope parts so that the inturn portions 26 and 30 are pressed against the neck of the patient and prevent the escape of air from the device. Thus there is provided a very effective neck opening seal which causes the patient no discomfort.
If desired, a flange or bead 33 may be pro- 6 vided about the neck opening so that the edge thereof is rounded and smooth.
Means for sealing the waist opening [6, which is considered as being at the bottom or lower end of the shell, comprises a pair of sheet-like aprons, indicated generally at 35 and 36, for the back and front shell parts respectively. The aprons are of rubber or other suitable material, and from ten to fourteen inches wide and of sufficient length to extend to the lower end of the abdominal area. The upper edge portion of the rear apron 35 is disposed adjacent the lower end of the rear shell part l0 and is secured to said part along a limited intermediate section by means of a metal strip 31 and rivets 38. Extending laterally of the side edges of the apron 35, adjacent the attached end, are oppositely extending resilient straps 39, each of which has a metallic eye or ring 4|] secured to the free end thereof, for a purpose to be hereinafter described. Adjacent the lower or free end of the apron 35 is an elastic belt or strap 4| of rubber or the like, which is secured at an intermediate portion to the outer side of the apron 35 as by vulcanizing or the like. The length of the belt 4| is substantially greater than the width of the apron 35 so that said belt may be passed about the body of the patient and secured. It is to be noted that one end of the belt 4| is provided with a metallic eye or ring 42, for use in securing the ends of said belt together. There is also provided an intermediate belt 43 of similar material, and said belt is secured at an intermediate part to the outer side of the apron 35 by vulcanizing, or the like. The belt 43 is also provided with a metallic eye or ring indicated at 44.
The front apron 36 is secured at a central portion of its upper edge to the lower edge portion of the front shell member I l, by means of a plate 45 and screws 46. The end portions of the plate 45 are turned outwardly to form hooks 41.
The front half ll of the shell is provided with an opening 50, which may be described as being generally of keyhole shape, and is adapted to detachably receive a fitting 5| of well-known character, which is attached to a flexible air hose 52, leading from a suitable pumping mechanism 53. This pumping mechanism is of known type so that no further description thereof is deemed to be necessary.
If desired, a hole 54 similar to hole 50, may be provided in the rear shell 10, so that the fitting 5| may be attached to the back of the shell under certain conditions of use, as when it is necessary for the patient to lie face downward. One of the openings 50, 54, is closed by a plate 55 secured to the respective shell portion by screws 56. In the drawings, the hole 54 is shown as thus closed by the plate 55 inasmuch as the hose 52 is shown as being connected to the front shell portion H. However, should the opening 54 be used for the hose connection, the opening 50 would be closed instead.
As above described, all of the opening seals are provided with their adjustable clamps and resilient ties and belts so that each may be secured about the respective arm, neck and waist members with just the right amount of pressure or constriction. The sealing bands of the arm and waist seals are adjusted so that, with the proper adjustment of the mechanism 53, to give the desired bellows pressures, each positive pressure pulsation will lift the resilient sealing bands with the result that a small amount of air escapes under the bands on each positive pressure pulegesa eso asation. -Thus, on eaelr pos-itivepulsation; asiriall amount of the airQ and amorresponding Fraction oft-the- :positive -pressure; escaapeunder the 'arm "and: waist seals. This serves the :double "purpose rof relievingi some ofthe positive pressure and I-nialnngit lower than-it otherwise would be; and :uausing a slow movement iof air "fr-om the eentndlyconnected :hose, *through the shell and out through its several :openings i to thoroughly venifilate all'i-parts of the patients enclosed torso. A padf-not'showngmay be provided 'on-which the patient may lie, and said 'padflallows theair to extend the effects of ventilation to those'parts rof ithe doody which-may-be resting thereon. And turther; the ventilation action has the effect-f periodically lifting the sealing 'ibands from the patients s'kin, "ventilating :those portions of the sk in which would otherwise have their-pores -constantly sealedibythe rubber band.
When the device is to =be-used, the arear -shell portion lfi is disposed on a suitable support, :such asabed indicated generally at till, withthe "rear apron -'extended longitudinally therefrom and lyingflat on'the support S0. 'The' patient isthen placed in the rear-shell part ll], and the front 'shell part II attached. The armyneck and waist openings are then "sealed.
In reg-ardtothe seals ll torthe-arm openings, they are slipped over-the arms-and resil'iently attached over the beads 48. Thereafter the ties 20- are 1 secured. -As -tothe -neck opening, the clamps 31 are attached sufficiently close to the neck "so as to form an airtight seal.
Theapron -36 of the front shell p'o'rti'on H is draped over the patients body, an'd 'the side edges B'I'are tucked underso that the pat1ents weight aids in the 'formation of a -tight seal. The strap portions 39 are thendrawnup o'ver the'lower end portion of the-shell;- and-the'rings '40 secured to the hooks 41, as best shown in Fig. 5. Theends of the belt- M are brought about the patients body and *se cured' b means of the ring 42,- as shown in' Fig. 1. In o'rder to secure the belt in the adjusted-position; the free end portion" 62' is tucked b'eneaththe adjacent portion of'thebelt. The belt' i3maybesimilarly attached. With two belts, '41 and 43; neither of said belts need be very tight in order to i provide asuitable seal. 'However, under-some'conditions the belt 43 is loosely secured, for purposes-to be hereinafter described, so"th'at the'"belt"4| must be drawn sufii'ciently lti'ght td'pr'ovide a properseal.
' The above-described .apparatus functions to control the movement of the"ribs' 'and the'downward'pull of the diaphragm, thereby" controlling the intrathoracic negative pressure and influencingthe return of venous blood;'it also alternately changes the atmospheric pressure surrounding thechest to either above or blow 'thatexi's'ting over the rest of the patients body,-which remains constant, thereby assisting lthe' fiowlin the surface vessels upwardly and downwardly.
ith each reduction of atmospheric pressure over the chest, causing an inhale,-- the sealsover the arms, neck and abdomen (perform a massaging motion toward-the heart milkingwhe surface vesselsand releasing them when the pressure is reversed. Further, when a :partial vacuum is created in the shell; that-ia'when the'pressureatherein: is below a'tmosphericzpressure, blood is induced to :fiow 'baok 'to rthe h'eart 'more quickly. in other-Words, fthe blood is drawn'away from the 'feet and the brain,- and in-- drawing the blood away from the brain the possibility -of"a cerebral hemorrhage is greatly'reduced.
Itis to be understood, of course, that by' various settings of the'pumping mechanismyvario'us eiiects can be produced on the bloodstream, and. various types of pathology maybe treated.
Under some conditions, as where'the'patient has an abdominal surgical wound, the bolt-43'is not drawn so tightly so that it does not put any pressure on the patients abdomen, such an arrangement being shown in Figs. 2 and 3. This arrangement, which is used for chestbreathihg, shows, Fig. 2, distention of the apron"36"under the influence of positive super-atmospheric pressure within the device, the belt d3 limiting outward movement of the apron 36. "In Fig. 3fthe apron 36 is shown as being drawn inwardly under the influence of negative or sub-atmospheric pressure in the device. It will be apparent 'from the" drawings that the abdominal wound, shown in Fig. 3, as being covered by a dressingfi l is not subjected to any mechanical pressure. "In other words, the pressiu'e 0n thestomach 'or'abdominal portion of the'patients'body, is an air pressure and not a mechanical pressure.
In Fig. e' both the belts 4| and 43 are shown as being secured about the p'atients-bc'idy, the belt 43 not being drawn as tight as'belt ll, but is drawn close to the abdomen. -The"advantage of this arrangement, as hereinabovepointed-out, is that it is not necessary to draw either of the belts as tightly as is required where a single'belt is used, and the massaging action is enhanced. Thus, the patient is subjected to less pressure from the secured waist seal. The arrangement shown in Fig. 4 is also used for chest breathing only, and in this arrangement, wherein two belts are used, there is an added massaging action in the region of the waist seal.
Due to the fact that in the present device the shell encompasses only the chest region of the body, patients may sit up in bed; or even stand upon the floor. Further, the device does not interfere with splints on the arms or'legs.
For the treatment of some conditions it has been found desirable to 1 provide abdominal breathing, and in order to induce-such breathing with the present apparatus, a relatively rigid extension or abdominal shield 6-5 is provided, said shield being narrower at its free end'tfi than at its attached end El The attached endlfl of the shield is curved to conform to the edge of "the waist opening it defined by the front shell portion H, and abuts against said edge. Thesides of the shield are curved inwardly'and toward the free end as, which has an upwardly curved notch-like portion 58 to better conform to the patients body.
The means for attachment-of this "shield tothe front shell member H comprises-a plurality of fasteners, each including a metal strip 69, secured to the adjacent portion'of the shield-by rivets =1! 6. There is a fastener adjacent the sides of the shield 65, and an intermediate fastener adjacent the longitudinal center of'the shield.
front shell part II. The parts of the fastener strips '69 adjacent the slots H, are received-under heads 13 of the bolts 72, whichare tightened by -'meanS of wing nuts 14. 'The strap 4l*is'- fastened about the pa-tients body,---as "has"-already been described,- while thestrap 43 encompasses the Shield, it being understood that the apron 36 is disposed over the shield, and is also encompassed by the belt 43.
Adjustment of the free end of the abdominal shield 65 may be made, as indicated by the dotted line positions in Fig. 10, by positioning said shield as desired and then tightening the wing nuts it. This adjustment is made possible by reason of the slots H.
While the shell .of the present device may be made of metal, such as aluminum or an alloy thereof, it has been found advantageous to form said shell of a clear or transparent plastic for the psychological effect on the patient who is generally conscious when being treated with the device. The patient thus knows that the attending physician can see what is happening within the shell and can take appropriate steps at all times to make any necessary adjustments of the apparatus.
1. In apparatus of the character described: a rigid transparent shell defining a pressure chamber for reception of the chest portion of a person to be treated, said shell having arm, neck and waist openings; means for sealing the arm openings with respect to the arms of said person; means for sealing the neck opening with respect to the neck of said person; means for sealing the waist opening, said means comprising elastic front and rear aprons secured centrally along an edge portion to the front and back respectively of the shell adjacent said waist opening; means for securing said aprons in sealing engagement with the shell about the waist opening; and means for sealingly securing the free end portions of the aprons about the waist of said person.
2. In apparatus of the character described: a
rigid shell defining a pressure chamber for reception of the chest portion of a person to be treated, said shell comprising separable front and rear portions, and having arm, neck and waist openings; means for sealing the arm openings with respect to the arms of said person; means for sealing the neck opening with respect to the neck of said person, said latter means comprising a pair of front and rear sheet-like parts, each of which is connected to respective parts of the shell at the neck opening and have a portion, adjacent the free end thereof, turned inwardly and attached along its side edges" to the adjacent edge portions of the rest of the sheet-like part, whereby inwardly opening pockets are formed in the neck seal; clamps for se-' curing the associated edge margins of said sheetlike parts; and means for sealing the waist opening with respect to the waist of said person.
FERDINAND H. TERHAAR.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS Number Name Date 966,787 Benner Aug. 9, 1910 2,309,361 Terhaar Jan. 26 1943 2,360,476 Church Oct. 17, 1944 2,383,821 Scanlon Aug. 28, 1945 FOREIGN PATENTS Number Country Date 527,744 Great Britain Oct. 15, 1940 OTHER REFERENCES Plastics, January 1946, pages 29-30.