Extrathoracic Augmentation of the Respiratory Pump

• US 20110313332A1
• Filed: 05/13/2011
• Published: 12/22/2011
• Est. Priority Date: 05/13/2010
• Status: Active Grant

• Current Assignee: Nemours Foundation
• Original Assignee: Nemours Foundation
• Inventors: Wolfson, Marla R., Rahman, Tariq, Schaffer, Thomas H.
• Granted Patent: US 9,687,415 B2
• Time in Patent Office: Days
• US Class Current: 601/41
• CPC Class Codes: A61H 2201/107 Respiratory gas
• CPC Class Codes: A61H 2201/5002 Means for controlling a set of similar massage devices acting in sequence at different locations on a patient
• CPC Class Codes: A61H 2201/5097 wireless
• CPC Class Codes: A61H 2230/045 used as a control parameter for the apparatus
• CPC Class Codes: A61H 2230/207 partial O2-value
• CPC Class Codes: A61H 2230/425 used as a control parameter for the apparatus
• CPC Class Codes: A61H 31/00 Artificial respiration or heart stimulation, e.g. heart massage artificial respiration by treatment with gas or air, e.g. mouth-to-mouth respiration A61M16/00; applying electric currents by contact electrodes for stimulation, e.g. heart pace-makers A61N1/36 ; teaching or training models, demonstration models for medical purposes G09B23/288
• CPC Class Codes: A61H 31/02 "Iron-lungs" , i.e. involving chest expansion by applying underpressure thereon, whether or not combined with gas breathing means
• CPC Class Codes: A61H 9/0071 by localized pressure, e.g. air streams or jets

Abstract

Systems and methods for assisting respiration extrathoracically, particularly useful for augmenting respiration in neonatal patients, including providing a positive pressure to a torso area of a patient. The positive pressure may be delivered to the torso area of the patient while the torso area is exposed to an ambient pressure, such as by providing positive pressure with high frequency gas jets that are positioned in proximity to the torso area. The positive pressure may be delivered to different parts of the torso area of the patient at different times, such as by controlling gas jets independently. The positive pressure may also be controlled in coordination with a gas flow and concentration to the patient'"'"'s airway, such as by increasing the positive pressure as a gas flow pressure delivered to the patient'"'"'s airway is reduced. The gas flow to the patient'"'"'s airway may be provided by, for example, a high-flow nasal cannula (HFNC) mechanism or a continuous positive airway pressure (CPAP) mechanism that is controlled in coordination with the positive pressure based upon a desired respiratory function of the patient. The control of the gas flow and the positive pressure may be based on an input of patient monitored parameters and/or calculated values based on the patient monitored parameters.

Claims

1. An apparatus comprising:

a pressure delivery mechanism configured to augment respiratory function of a patient by applying a positive exterior pressure to at least a portion of a torso area of the patient without sealing the portion of the patient'"'"'s torso area from ambient pressure.

2. The apparatus of claim 1, wherein said pressure delivery mechanism applies positive pressure without contacting the torso area of the patient.

3. The apparatus of claim 2, wherein said pressure delivery mechanism includes a plurality of gas outlets that are configured to apply pressurized gas to the at least portion of the torso area of the patient.

4. The apparatus of claim 3, further comprising a control system to regulate the output of said plurality of gas outlets to apply the pressurized gas to different areas of the torso area of the patient at different times.

5. The apparatus of claim 4, wherein said control system is operatively connected to said pressure delivery mechanism to control the pressure delivery mechanism based upon a desired respiratory function of the patient, and to control the delivery of a gas to the patient'"'"'s airway in coordination with operation of said pressure delivery mechanism.

6. The apparatus of claim 5, wherein said control system is further configured to control said pressure delivery mechanism based on an input of patient monitored parameters including at least one of a respiratory rate, a tidal volume, a pressure development, a rib cage motion, and an abdominal motion.

7. The apparatus of claim 5, wherein said control system is further configured to control said pressure delivery mechanism based on calculated values of patient monitored parameters, the calculated values including at least one of phase angle and minute ventilation.

8. The apparatus of claim 3, further comprising a support structure for substantially retaining said gas outlets in predetermined adjustable positions relative to the patient'"'"'s torso area.

9. The apparatus of claim 3, wherein said plurality of gas outlets include at least one high frequency gas jet.

10. The apparatus of claim 1, further comprising a gas supply mechanism to control a gas flow and concentration to the patient'"'"'s airway.

11. The apparatus of claim 10, further comprising a control system configured to regulate the positive exterior pressure provided by said pressure delivery mechanism and the gas flow and concentration to the patient'"'"'s airway provided by said gas supply mechanism.

12. The apparatus of claim 11, wherein said control system is operable to regulate said gas supply mechanism to provide approximately 5-8 cm H₂O of pressure in a first state corresponding to an inhalation phase and approximately 2-5 cm H₂O of pressure in a second state corresponding to an exhalation phase, and to control said pressure delivery mechanism to deliver a relatively low pressure mean approximately 2-5 cm H₂O with a high frequency amplitude +/−

20 cm H₂O at approximately 3-10 Hz in the first state and a relatively high pressure mean approximately 5-8 cm H₂O with a high frequency amplitude +/−

20 cm H₂O at approximately 3-10 Hz in the second state.

13. The apparatus of claim 10, wherein said gas supply mechanism includes a continuous positive airway pressure (CPAP) mechanism controlled in coordination with operation of said pressure delivery mechanism, and wherein said pressure delivery mechanism is configured to apply a high frequency positive exterior pressure to the at least a portion of the torso area of the patient.

14. The apparatus of claim 10, wherein said gas supply mechanism includes a high-flow nasal cannula (HFNC) mechanism controlled in coordination with operation of said pressure delivery mechanism, and wherein said pressure delivery mechanism is configured to apply a high frequency positive exterior pressure to the at least a portion of the torso area of the patient.

15. A method of assisting respiration, particularly useful for augmenting respiration in neonatal patients, said method comprising the steps of:

positioning a portion of a patient'"'"'s torso in an environment open to ambient pressure and proximate to a positive pressure device for applying a positive pressure to the torso of the patient; and

applying positive pressure to the portion of the torso area of the patient via the positive pressure device during at least an exhalation phase and during a time in which the portion of the patient'"'"'s torso area is substantially exposed to the ambient pressure.

16. The method of claim 15, further comprising the step of applying the positive pressure to different areas of the torso area of the patient at different times via the positive pressure device.

17. The method of claim 15 further comprising the step of controlling the application of positive pressure to the torso area via the positive pressure device based on an input of patient monitored parameters including at least one of a respiratory rate, a tidal volume, a pressure development, a rib cage motion, and an abdominal motion.

18. The method of claim 15 further comprising the step of controlling the application of positive pressure to the torso area via the positive pressure device based on calculated values of patient monitored parameters, the calculated values including at least one of phase angle and minute ventilation.

19. The method of claim 15, further comprising the step of delivering a gas to the patient'"'"'s airway via a gas supply device.

20. The method of claim 19 further comprising the step of controlling the application of positive pressure to the torso area via the positive pressure device and the delivery of gas to the patient'"'"'s airway via the gas supply device in coordination to augment the patient'"'"'s respiratory function.

21. The method of claim 20, wherein the pressure of gas delivered to the patient'"'"'s airway is controlled to provide approximately 5-8 cm H₂O of pressure in a first state corresponding to an inhalation phase and approximately 2-5 cm H₂O of pressure in a second state corresponding to an exhalation phase, and the positive pressure applied to the patient'"'"'s torso area is control to deliver a relatively low pressure mean approximately 2-5 cm H₂O with a high frequency amplitude +/−

20 cm H₂O at approximately 3-10 Hz in the first state and a relatively high pressure mean approximately 5-8 cm H₂O with a high frequency amplitude +/−

20 cm H₂O at approximately 3-10 Hz in the second state.

22. The method of claim 19, wherein the positive pressure applied to the patient'"'"'s torso area is increased as a pressure of gas delivered to the patient'"'"'s airway is reduced.

23. The method of claim 22, wherein said step of delivering a gas to the patient'"'"'s airway includes delivering the gas via a continuous positive airway pressure (CPAP) mechanism in coordination with the application of positive pressure to the portion of the torso area of the patient, and wherein said step of applying positive pressure to the portion of the torso area of the patient includes applying a high frequency gas pressure to the portion of the torso area of the patient.

24. The method of claim 22, wherein said step of delivering a gas to the patient'"'"'s airway includes delivering the gas via a high-flow nasal cannula (HFNC) mechanism in coordination with the application of positive pressure to the portion of the torso area of the patient, and wherein said step of applying positive pressure to the portion of the torso area of the patient includes applying a high frequency gas pressure to the portion of the torso area of the patient.

25. The method of claim 15, wherein said step of applying a positive pressure to at least a portion of the patient'"'"'s torso area comprises blowing a gas directly against an area of the patient'"'"'s skin via the positive pressure device.

26. The method of claim 15, wherein said step of applying a positive pressure to at least a portion of the patient'"'"'s torso area comprises applying the pressure from a plurality of gas outlets included in the positive pressure device, the method further comprising the step of adjusting an operating position of the gas outlets relative to the patient'"'"'s torso area.

27. A method of assisting respiration extrathoracically, said method comprising the steps of:

positioning a portion of a patient'"'"'s torso area in an environment open to ambient pressure;

providing a pressure delivery mechanism in proximity to the torso area of the patient;

providing a gas supply mechanism to deliver a gas to the patient'"'"'s airway; and

while the portion of the patient'"'"'s torso area is in the environment open to ambient pressure, controlling a pressure of the gas supply mechanism in coordination with a pressure provided by the positive pressure subsystem.

28. An extrathoracic breathing augmentation apparatus comprising:

an adjustable housing configured to be positioned in a number of predetermined positions with respect to a torso area of a patient; and

a pressure delivery mechanism including a plurality of gas jets supported by said housing, said plurality of jets being configured to apply a positive pressure to at least a portion of the torso area of the patient; and

wherein at least two of said plurality of gas jets are configured to be activated separately from one another.

29. The apparatus of claim 28, further comprising:

a control system operatively connected to said pressure delivery mechanism to control the pressure delivery mechanism based upon a desired respiratory function of the patient,

and wherein said control system is further operable to control the delivery of a gas to the patient'"'"'s airway in coordination with said pressure delivery mechanism.

30. The apparatus of claim 28, further comprising a gas supply mechanism to control a gas flow and concentration to the patient'"'"'s airway.

31. The apparatus of claim 30, wherein said gas supply mechanism includes a continuous positive airway pressure (CPAP) mechanism.

32. The apparatus of claim 30, wherein said gas supply mechanism includes a high-flow nasal cannula (HFNC) mechanism.

33. The apparatus of claim 28, wherein said plurality of gas jets includes at least two high frequency gas jets configured to provide high frequency pulses about two different mean pressures, the apparatus further comprising:

a control system operatively connected to said pressure delivery mechanism to control the pressure delivery mechanism based upon a desired respiratory function of the patient, and to control the delivery of a gas to the patient'"'"'s airway in coordination with said pressure delivery mechanism such that two different pressures of gas delivered to the patient'"'"'s airway are coordinated with the two different mean pressures of the high frequency gas jets.