Method and system for controlling breathing

• US 20070240718A1
• Filed: 04/17/2006
• Published: 10/18/2007
• Est. Priority Date: 04/17/2006
• Status: Active Grant

• Current Assignee: The Periodic Breathing Foundation, LLC
• Original Assignee: Robert Daly
• Inventors: Daly, Robert
• Granted Patent: US 7,900,626 B2
• Time in Patent Office: Days
• US Class Current: 128/204.220
• CPC Class Codes: A61B 5/0836 Measuring rate of CO2 production
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0045 Means for re-breathing exhaled gases, e.g. for hyperventilation treatment
• CPC Class Codes: A61M 16/0057 Pumps therefor
• CPC Class Codes: A61M 16/0066 Blowers or centrifugal pumps
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/04 Tracheal tubes catheters in general A61M25/00
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 16/0605 Means for improving the adaptation of the mask to the patient
• CPC Class Codes: A61M 16/0633 with forehead support
• CPC Class Codes: A61M 16/0666 Nasal cannulas or tubing devices for improving normal breathing through the nose A61F5/08; nose filters A62B23/06; outside holding devices A61M25/02
• CPC Class Codes: A61M 16/0683 Holding devices therefor
• CPC Class Codes: A61M 16/0694 Chin straps
• CPC Class Codes: A61M 16/08 Bellows; Connecting tubes having means for taking samples G01N1/22; Water traps; Patient circuits
• CPC Class Codes: A61M 16/0875 Connecting tubes
• CPC Class Codes: A61M 16/12 by mixing different gases
• CPC Class Codes: A61M 16/20 Valves specially adapted to medical respiratory devices
• CPC Class Codes: A61M 16/202 electrically actuated
• CPC Class Codes: A61M 16/209 : Relief valves
• CPC Class Codes: A61M 2016/0027 : pressure meter
• CPC Class Codes: A61M 2016/0036 : in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2016/103 : the CO2 concentration
• CPC Class Codes: A61M 2230/005 : Parameter used as control input for the apparatus
• CPC Class Codes: A61M 2230/202 : partial carbon oxide pressure, e.g. partial dioxide pressure (P-CO2)
• CPC Class Codes: A61M 2230/432 : partial CO2 pressure (P-CO2)
• CPC Class Codes: Y10S 128/911 : Unilimb inhalation-exhalation breathing tubes
• CPC Class Codes: Y10S 128/914 : Rebreathing apparatus for increasing carbon dioxide content in inhaled gas

Abstract

The present invention relates to a method and a system for controlling breathing of a patient. A system for controlling breathing of a patient includes a respiratory conduit. The respiratory conduit is configured to be coupled to a patient interface device and is further configured to be coupled to a pressurized air generating device. The respiratory conduit includes at least two air flow control devices, positioned between the patient interface device and the pressurized air generating device. The respiratory conduit includes at least two volumes, wherein one volume is positioned between a first air flow control device and a second air flow control device and another volume is positioned between a second air flow control device and a third air flow control device.

Claims

1. A system for controlling breathing of a patient, comprising

a respiratory conduit;

said respiratory conduit is configured to be coupled to a patient interface device;

said respiratory conduit is further configured to be coupled to a pressurized air generating device;

said respiratory conduit includes at least two air flow control devices, positioned between said patient interface device and said pressurized air generating device; and

said respiratory conduit includes at least two volumes, wherein one volume is positioned between a first air flow control device and a second air flow control device and another volume is positioned between a second air flow control device and a third air flow control device.

2. The system according to claim 1, wherein said volumes are partial dead space volumes configured to accumulate at least a portion of breath expired by the patient.

3. The system according to claim 1, wherein said patient interface device is selected from a group consisting of a nasal mask, an oral mask, an orofacial mask, a nasal prong device, an intra-oral device, and an endotracheal tube.

4. The system according to claim 3, wherein said patient interface device is configured to create a substantially sealed connection between said respiratory conduit and a breathing airway passage of the patient.

5. The system according to claim 1, wherein said respiratory conduit includes an auxiliary air flow control device located substantially adjacent to said patient interface device configured to control flow of air to the airway of the patient.

6. The system according to claim 4, wherein said auxiliary air flow control device is controlled by the patient.

7. The system according to claim 1, wherein said respiratory conduit includes an anti-asphyxiation valve configured to create an access to air and to bypass said respiratory conduit, if said pressurized air generating device fails, and located substantially adjacent to said patient interface device.

8. The system according to claim 1, wherein said air flow control devices are configured to adjust said rate of gas flow through said air flow control devices based on at least one physiological variable of the patient.

9. The system according to claim 1, wherein said air flow control devices and said volumes are configured to control

a rate of excretion of gas from said respiratory conduit;

and

a concentration of said gas in the blood of the patient.

10. The system according to claim 9, wherein said air flow control devices and said volumes are configured to allow a range of amounts of said gas readily excreted from said respiratory conduit to be equal to a range of production of said gas by the patient.

11. The system according to claim 1, wherein said gas is carbon dioxide.

12. The system according to claim 1, wherein said first air flow control device is configured to allow an escape of an amount of said gas that is lower than or equal to the amount of said gas produced by the patient at a time.

13. The system according to claim 12, wherein said second air flow control device is configured to allow an escape of an amount of said gas that is based on

said amount of gas allowed to escape from said first air flow control device, and

a maximum total amount of gas produced by the patient at a time.

14. The system according to claim 13, wherein said third air flow control device is configured to allow an escape of air that is based on said amount of air allowed to escape from said first and said second air flow control devices to prevent re-breathing of excess amount of said gas by the patient.

15. The system according to claim 1, wherein

said respiratory conduit is configured to be rotatably coupled to said patient interface device.

16. The system according to claim 1, wherein said respiratory conduit includes a protective cover configured to prevent damage to said respiratory conduit.

17. The system according to claim 1, further comprising a collector configured to be coupled to said respiratory conduit and further configured to collect condensation during breathing of the patient.

18. A method for stabilizing breathing of a patient, comprising controlling a level of carbon dioxide in a blood of the patient using the system of claim 1.

19. A method for stabilizing breathing of a patient, comprising increasing a level of oxygen in a blood of the patient using the system of claim 1.

20. A system for controlling breathing of a patient, comprising:

a respiratory conduit configured to be coupled a patient interface device;

said respiratory conduit is configured to be coupled to a pressurized air supply device, wherein said pressurized air supply device supplies air to the patient;

wherein said respiratory conduit includes

a first valve located substantially adjacent to said patient interface device, said first valve includes a first opening configured to control an escape of gas;

a second valve including a second opening configured to control an escape of gas;

a first volume connector coupled to said first valve and said second valve, said first volume connector is configured to contain a mixture of said air as supplied by said pressurized air supply device and said gas as generated by the patient;

a third valve including a third fixed opening configured to control an escape of air;

a second volume connector coupled to said second valve and said third valve, wherein said second volume connector is configured to contain a mixture of said air as supplied by said pressurized air supply device and said gas as generated by the patient; and

a third connector coupled to said third valve and said air supply device.

21. The system according to claim 20, wherein said patient interface device is configured to create a substantially sealed connection to a breathing airway of the patient and said respiratory conduit.

22. The system according to claim 20, wherein said patient interface device includes a first opening configured to control escape of air from said patient interface device.

23. The system according to claim 20, wherein an amount of gas contained in said second volume connector is substantially equal to an amount of said gas expired by the patient during a single breath minus an amount of gas accumulated in the first volume connector.

24. The system according to claim 20, wherein an amount of gas allowed to escape from said first valve is determined by the amount of air allowed to escape from said first valve, the amount of air and said gas contained in said first connector, the amount of air and said gas allowed to escape from the second valve, and the amount of air and said gas contained in said second connector.

25. The system according to claim 20, wherein an amount of gas allowed to escape from said second valve is determined by the amount of air allowed to escape from said first valve, the volume of said first connector, the amount of air allowed to escape from said second valve, and the amount of air and said gas contained in said second connector.

26. The system according to claim 20, wherein an amount of air allowed to escape from said third valve is determined by the total amount of said air allowed to escape from said first and second valves, and air supplied by said pressurized air supply device, and the amount of air configured to expel an excessive amount of said gas from said respiratory conduit.

27. The system according to claim 20, wherein at least a portion of an amount of gas that does not escape from said first valve is re-breathed by the patient.

28. The system according to claim 20, wherein at least a portion of an amount of gas that does not escape from said second valve is re-breathed by the patient.

29. The system according to claim 20, wherein at least a portion of an amount of gas that exceeds the amount of gas accumulated in said first volume connector plus the amount of gas accumulated in said second volume connector is completely expelled from said respiratory conduit through said third valve.

30. The system according to claim 20, wherein said respiratory conduit includes an auxiliary air flow control device located substantially adjacent to said patient interface device.

31. The system according to claim 20, wherein said respiratory conduit includes an anti-asphyxiation valve configured to control flow of air into the airway of the patient.

32. A method for stabilizing breathing of a patient, comprising controlling a level of carbon dioxide in a blood of the patient using the system of claim 20.

33. A method for stabilizing breathing of a patient, comprising increasing a level of oxygen in a blood of the patient using the system of claim 20.

34. A system for controlling breathing of a patient, comprising:

a respiratory conduit configured to be coupled to a patient interface device of the patient;

said respiratory conduit is configured to be coupled to a pressurized air supply device, wherein said pressurized air supply device supplies air to the patient at the other end;

wherein said respiratory conduit includes

a first valve located adjacent said patient interface device and includes a first opening configured to control escape of said gas during the breathing process;

a second valve that includes a second opening configured to control escape of gas during the breathing process;

a first volume connector connecting said first valve and said second valve and configured to control supply of gas to the patient during the breathing process;

a third valve that includes a third opening configured to control escape of gas during the breathing process;

a second volume connector connecting said second valve and said third valve and configured to control supply of gas to said first volume connector; and

a third connector connecting said second valve and said air supply device.

35. The system according to claim 34, wherein said patient interface device is configured to create a substantially sealed connection between said respiratory conduit and a patient breathing airway.

36. The system according to claim 34, wherein said patient interface device includes a first opening configured to control escape of air from said patient interface device.

37. A method for stabilizing breathing of a patient, comprising controlling a level of carbon dioxide in a blood of the patient using the system of claim 34.

38. A method for stabilizing breathing of a patient, comprising increasing a level of oxygen in a blood of the patient using the system of claim 34.

39. A method of controlling breathing of a patient, wherein air is supplied to the patient using a patient interface device coupled to an air supply device using a respiratory conduit that includes multiple controllable openings and volume connectors positioned along the length of the respiratory conduit, comprising:

determining a rate of production of gas generated by the patient;

measuring a rate of flow and a concentration of gas at each of the multiple controllable openings;

adjusting sizes of the multiple controllable openings based on said measuring; and

adjusting sizes of said multiple volume connectors based on at least one of said determining and said measuring;

wherein air supplied to the patient includes a mixture of air supplied by the air supply device and a gas generated by the patient.

40. The method according to claim 39, further comprising:

determining an increase in a pressure of gas in the arterial blood of the patient, wherein said determining includes

measuring said pressure of gas contained in the arterial blood of the patient using time-based monitoring selected from the group consisting of;

end-tidal gas monitoring, transcutaneous gas monitoring, and arterial blood gas analysis; and

calculating a desired changes in pressure of said gas in the arterial blood of the patient based on said measuring.

41. The method according to claim 39, wherein said gas is carbon dioxide.

42. The method according to claim 39, further comprising

modifying sizes of the multiple controllable openings and the multiple volume connectors, wherein said modifying includes

monitoring an amount of said gas escaping from each of the multiple controllable openings and the multiple volume connectors;

and

measuring a rate of flow and a concentration of gas at each of the multiple controllable openings;

adjusting sizes of said multiple volume connectors based on at least one of said determining and said measuring;

wherein gas supplied to the patient is a mixture of gas supplied by the gas supply device and gas produced by the patient during breathing.

43. The method according to claim 42, wherein said modifying is performed as a result of a collapse of the patient breathing airway.

44. The method according to claim 43, further comprising

adjusting pressure of air supplied to the patient during breathing until the patient breathing airway is no longer collapsed.

45. The method according to claim 39, wherein said calculating further comprises

estimating the amount of said gas produced by the patient using at least one characteristic selected from a group consisting of:

age, gender, body mass, percent lean body mass and the partial pressure of said gas in the arterial blood of the patient.

46. The method according to claim 39, wherein said calculating further comprises

determining the sizes of the multiple controllable openings and multiple volume connectors using a predetermined simulation of normal breathing of the patient.

47. The method according to claim 39, wherein a rate of air flow through one of the multiple controllable openings is based on a rate of flow through at least one other one of the multiple controllable openings.

48. The method according claim 47, wherein said determining further comprises

calculating a minimum, a maximum, and a mean amount of gas escaping from each of the multiple controllable openings during breathing;

and

based on said calculating, adjusting a size of at least one of the multiple controllable openings and at least one size of each of the volume connectors.

49. The method according to claim 39, wherein a rate of flow of a gas through at least a first air controllable opening and at least a second controllable opening is calculated based on an expected rate of production of said gas by the patient, expected respiration rate of the patient, expected depth of respiration by the patient, and an expected concentration of said gas in the air expired by the patient.

50. The method according to claim 39, wherein a volume of expired gas by the patient that is re-breathed by the patient is continuously adjusted based on a volume of gas allowed to escape from said multiple controllable openings and a volume of gas contained in said multiple volume connectors.

51. An apparatus for controlling flow of carbon dioxide to a patient during breathing, comprising

a carbon dioxide mixing device coupled to the patient interface device;

the carbon dioxide mixing device is configured to be coupled to a pressurized air supply device;

the carbon dioxide mixing device includes multiple ventilation orifices interchangeably connected with multiple dead spaces, wherein said multiple ventilation orifices control supply of carbon dioxide to the patient and volume of carbon dioxide in said multiple dead spaces;

a means for measuring airflow through each of said multiple ventilation orifices;

a means of detecting a concentration of carbon dioxide in the measured airflow;

a means of adjusting airflow through each of said multiple ventilation orifices based on said detection of said content of carbon dioxide; and

a means of adjusting sizes of said multiple dead spaces based on said detection of said concentration of carbon dioxide and said adjusting of said airflow through each of said multiple ventilation orifices.

52. A method for controlling flow of carbon dioxide to a patient during breathing, using an air supply device coupled to a patient interface device placed on the patient, the patient interface device is coupled to a carbon dioxide mixing device, which is coupled to the air supply device, the carbon dioxide mixing device includes multiple ventilation orifices interchangeably connected with multiple dead spaces, wherein said multiple ventilation orifices control supply of carbon dioxide to the patient and volume of carbon dioxide in said multiple dead spaces, comprising

measuring airflow through each of said multiple ventilation orifices;

detecting a content of carbon dioxide in the measured airflow;

adjusting airflow through each of said multiple ventilation orifices based on said detecting of said concentration of carbon dioxide; and

adjusting sizes of said multiple dead spaces based on said detection of said concentration of carbon dioxide and said adjusting of said airflow through each of said multiple ventilation orifices.

53. The method according to claim 52, wherein said adjusting sizes step further comprises

adjusting sizes of said multiple dead spaces and said multiple ventilation orifices based on a relationship between _co2 and _E, wherein _co2 is a rate of excretion of carbon dioxide by the patient per minute;

_E is a total rate of ventilation per minute by the patient;

wherein a curve representing said relationship between _co2 and _E contains at least two discontinuities;

said discontinuities are determined using the lengths of

a hypoventilatory traverse segment caused by a placement of at least a first ventilation orifice in said carbon dioxide mixing device;

a first respiratory plateau segment caused by a placement of at least a first dead space in said carbon dioxide mixing device;

a eucapnic traverse segment caused by a placement of at least a second ventilation orifice in said carbon dioxide mixing device;

a second respiratory plateau segment caused by a placement of at least a second dead space in said carbon dioxide mixing device; and

a hyperventilatory traverse segment caused by a placement of at least a third ventilation orifice in said carbon dioxide mixing device.

54. The method according to claim 53, wherein said hypoventilatory traverse segment has a slope defined by a relationship between volume of air breathed by the patient during a breathing interval and an amount of carbon dioxide exhaled by the patient in said breathing interval.

55. The method according to claim 53, wherein during said eucapnic traverse segment, an additional volume of carbon dioxide escapes from at least a second ventilation orifice of said carbon dioxide mixing device, wherein said additional volume is determined based on the volume of carbon dioxide that escaped from at least a first ventilation orifice.

56. The method according to claim 53, wherein during said hyperventilatory traverse segment, an additional volume of carbon dioxide escapes from at least a third ventilation orifices of said carbon dioxide mixing device, wherein said additional volume is determined based on a volume of carbon dioxide that escaped from at least first and second ventilation orifices.

57. The method according to claim 52, further comprising

determining a target mean arterial concentration of carbon dioxide based on said adjusting sizes step.

58. The method according to claim 52, wherein said adjusting sizes step is automatic.

59. The method according to claim 52, wherein said adjusting sizes step is manual.

60. A method for controlling breathing of a patient using a respiratory conduit configured to be coupled to a patient interface device and a pressurized air generating device, wherein the conduit includes at least two air flow control devices positioned between the patient interface device and the pressurized air generating device and at least two volumes, wherein a first volume is positioned between a first air flow device and a second air flow device, and a second volume is positioned between the second air flow device and a third air flow device, the method comprising

receiving gas in the conduit, wherein the gas originates from an expiratory breath of the patient;

and

allowing escape of gas from the at least two air flow control devices;

wherein a portion of the received gas escapes from the first air flow control device and another portion of the received gas travels through the first volume to the second air flow control device;

wherein a part of the another portion of the received gas escapes from the second air flow control device and another part of the another portion of the received gas travels through the second volume to the third air flow control device; and

wherein the another part of the another portion of the received gas escapes from the third air flow control device.

61. A method for controlling breathing of a patient, comprising

determining a rate of excretion of gas by the patient as a function of a rate of ventilation of a patient during hypoventilation by the patient, wherein the determining is made until a maximum concentration of the excreted gas is reached;

based on the determining, maintaining the rate of excretion of the gas by the patient at a predetermined level;

stabilizing the rate of excretion of the gas by the patient as a function of the rate of ventilation of the patient based on an expected rate of excretion of the gas by the patient, wherein the stabilizing is performed until a maximum concentration of the gas is reached;

inhibiting an excretion of the gas by the patient during hyperventilation of the patient; and

increasing the excretion of the gas by the patient to control breathing of the patient during the hyperventilation of the patient.