Process control for liquid ventilation and related procedures

• US 5,335,650 A
• Filed: 10/13/1992
• Issued: 08/09/1994
• Est. Priority Date: 10/13/1992
• Status: Expired due to Term

• Current Assignee: Temple University of The Commonwealth System of Higher Education
• Original Assignee: Temple University of The Commonwealth System of Higher Education
• Inventors: Shaffer, Thomas H., Wolfson, Marla R.
• Primary Examiner(s): Burr, Edgar S.
• Assistant Examiner(s): RACITI, ERIC
• Application Number:
  US07/960,611
• Time in Patent Office: 665 Days
• Field of Search: 128/200.24, 128/204.23, 128/913, 128/716, 128/720, 128/725, 128/898, 604/20, 604/22, 604/49, 604/24, 514/23
• US Class Current: 128/200.24
• CPC Class Codes: A61M 16/0054 Liquid ventilation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 2016/1025 the O2 concentration
• CPC Class Codes: A61M 2202/0476 Oxygenated solutions
• CPC Class Codes: Y10S 128/913 Breathable liquids

Abstract

A process is provided for controlling a ventilation procedure wherein a liquid ventilation system passes a breathing liquid through at least a portion of a patient'"'"'s pulmonary pathways. In this process, desired ranges for certain process parameters associated with the liquid ventilation system are established. These desired ranges are input into a central processing unit. Initial settings for the liquid ventilation system are then made such that the actual conditions which will initially occur during the liquid ventilation procedure fall within their respective desired ranges. Thereafter, the liquid ventilation procedure is commenced. During the liquid ventilation procedure, conditions which relate to the established ranges are continually monitored by appropriate sensors. The monitored information is also input into the central processing unit. The central processing unit is designed to compare the actually-occurring monitored conditions to their respective desired ranges and determine if there is a difference. If there is a difference, the central processing unit generates signals which are designed to correct the discrepancy. These signals can be designed to trigger alarms which instruct an operator to make the appropriate adjustments and/or to activate a servo-controlled valving network.

Claims

1. A process for guiding, monitoring and regulating a liquid ventilation system wherein said ventilation system is designed to circulate a breathing liquid through at least a portion of a patient'"'"'s pulmonary pathways, and wherein said liquid ventilation system includes a liquid circuit component, a gas circuit component and a temperature circuit component, said process comprising the steps of:

(a) establishing a set of desired ranges for process parameters associated with the liquid circuit, the gas circuit and the temperature circuit components of said liquid ventilation system, correlating said set of established desired ranges to the physiological needs of the patient, and representing said set of established desired ranges by a first set of signals;

(b) inputting the first set of signals in to a micro-processor;

(c) establishing the patient'"'"'s initial ventilatory profile by making initial adjustments to the liquid circuit, the gas circuit and the temperature circuit components of said liquid ventilation system such that actual conditions of said liquid ventilation system'"'"'s liquid circuit, gas circuit and temperature circuit components, occurring while a breathing liquid circulates through at least a portion of said patient'"'"'s pulmonary pathways, fall within the purview of their corresponding established desired ranges;

(d) circulating a breathing liquid through at least a portion of said patient'"'"'s pulmonary pathways in accordance with said patient'"'"'s initial ventilatory profile;

(e) monitoring a set of actual conditions of said liquid ventilation system'"'"'s liquid circuit, gas circuit and temperature circuit components which occur while said breathing liquid is circulating through at least a portion of said patient'"'"'s pulmonary pathways, and representing said set of monitored actual conditions by a second set of signals, said monitored set of actual conditions correspond with said set of established desired ranges;

(f) inputting the second set of signals into said micro-processor

(g) implementing said micro-processor to determine whether said second set of signals fall within the purview of their corresponding ranges represented by said first set of signals, and representing instances wherein said second set of signals fall outside of said first set of signals by a third set of signals; and

(h) making subsequent adjustments to said patient'"'"'s initial ventilatory profile by implementing said third set of signals such that said second set of signals fall within the purview of their corresponding ranges represented by said first set of signals.

2. A process in accordance with claim 1 further comprising the steps of:

monitoring the breathing liquid'"'"'s pressures, flow rates and volumes, as in step (e);

deriving a second set of signals based upon said monitoring of the breathing liquid'"'"'s pressures, flow rates and volumes;

feeding said second set of signals based upon said monitoring of the breathing liquid'"'"'s pressures, flow rates and volumes into the liquid circuit component of said liquid ventilation system; and

regulating the circulation of a breathing liquid through at least a portion of said patient'"'"'s pulmonary pathways with the liquid circuit component of said liquid ventilation system by utilizing information gained from the second set of signals based upon said monitoring of the breathing liquid'"'"'s pressures, flow rates and volumes.

3. A process in accordance with claim 2 further comprising the steps of:

assessing the respiratory gas levels and tracer gas levels contained in samples of said breathing liquid before the breathing liquid is inspired by the patient and after the breathing liquid is expired by the patient; and

having the liquid circuit component of said liquid ventilation system utilize the information gained from the assessment of said breathing liquid'"'"'s respiratory gas levels and tracer gas levels.

4. A process in accordance with claim 1 further comprising the steps of:

monitoring as in step (e) the inspiratory and expiratory gas levels contained in at least the following areas;

in samples of gases before they are blended with the breathing liquid,

in samples of the breathing liquid after it has been expired by said patient, and

in samples of blood taken from said patient'"'"'s circulatory system while the breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways;

deriving a second set of signals based upon said monitored inspiratory and expiratory gas levels;

feeding the second set of signals pertaining to said monitored inspiratory and expiratory gas levels back into the gas circuit component of said liquid ventilation system; and

regulating the partial pressures, tensions and concentrations of gases in the liquid ventilation system'"'"'s gas circuit component and liquid circuit component, as well as in the patient, with the gas circuit component of said liquid ventilation system by utilizing information gained from the second set of signals based upon said monitored inspiratory and expiratory gas levels.

5. A process in accordance with claim 4 further comprising the steps of:

gaining information from an on-line assessment of tracer gases; and

determining at least one physiological parameter with the gas circuit component of said liquid ventilation system by utilizing information gained from an on-line assessment of tracer gases, said physiological parameter being determined is selected from the group consisting of;

oxygen consumption, carbon dioxide production, respiratory quotient, cardiac output, effective pulmonary blood flow, diffusional dead space, anatomic dead space, intrapulmonary and extrapulmonary shunts, diffusional capacity and lung tissue water.

6. A process in accordance with claim 1 further comprising the steps of:

monitoring the patient'"'"'s internal and external body temperatures while said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways as in step (e);

deriving a second set of signals based upon the monitoring of said patient'"'"'s internal and external body temperatures;

feeding the second set of signals based upon the monitoring of said patient'"'"'s internal and external body temperatures back into the temperature circuit component of said liquid ventilation system; and

regulating the patient'"'"'s internal and external body temperatures while said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways with the temperature circuit component of said liquid ventilation system by utilizing information gained from the second set of signals based upon the monitoring of said patient'"'"'s internal and external body temperatures.

7. A process in accordance with claim 1 further comprising the step of:

making at least the following initial adjustments to the liquid circuit, gas circuit and temperature components of the liquid ventilation system during step (c);

a starting lung liquid volume, the breathing liquid'"'"'s initial pressure, initial tidal lung liquid volume, the breathing liquid'"'"'s initial flow rate, an initial concentration of oxygen in a specific volume of said breathing liquid prior to said breathing liquid being inspired by said patient, a resting lung liquid volume, a peak inspiratory air way pressure, a peak expiratory air way pressure, a peak alveolar pressure, a peak esophageal pressure, an initial breathing frequency, a timing ratio of inspiratory-to-expiratory liquid flow, the patient'"'"'s core body temperature, and the temperature of the breathing liquid prior to it being inspired by said patient.

8. A process in accordance with claim 1 further comprising the step of:

making the initial adjustments to the liquid circuit, gas circuit and temperature components of the liquid ventilation system during step (c) such that the actual conditions of the liquid ventilation system'"'"'s liquid circuit, gas circuit and temperature circuit components, monitored in step (e), fall within the following ranges;

a starting lung liquid volume ranging from between about 20 to about 30 ml/kg, the breathing liquid'"'"'s initial pressure ranging from between about -50 to about 50 cmH₂ O, a tidal lung liquid volume ranging from between about 10 to about 20 ml/kg, the breathing liquids initial flow rate ranging from between about -300 to about 300 ml/min/kg, an initial concentration of oxygen in a specific volume of breathing liquid ranging from between about 100 to about 600 mmHg, a resting lung liquid volume ranging from between about 20 to about 40 ml/kg, a peak inspiratory airway pressure ranging from between about 80 to about 100 cmH₂ O, a peak expiratory airway pressure ranging from between about -80 to about -100 cmH₂ O, peak alveolar and esophageal pressures ranging from between about 15 to about 20 cmH₂ O, a breathing frequency ranging from between about 3 to about 8 breaths per minute, a timing ratio of inspiratory-to-expiratory gas ranging from between about 1;

2 to about 1;

4, the patient'"'"'s core body temperature ranging from between about 25°

to about 39°

C., and the breathing liquid'"'"'s temperature, prior to it being inspired by said patient, ranging from between about 20°

to about 42°

C.

9. A process in accordance with claim 1 further comprising the step of:

establishing minimum and maximum values for at least the following parameters associated with the liquid circuit component of said liquid ventilation system in step (a);

the breathing liquid'"'"'s pressure for when it is being circulated through at least a portion of said patient'"'"'s pulmonary pathways, the breathing liquid'"'"'s tidal lung liquid volume for when it is being circulated through at least a portion of said patient'"'"'s pulmonary pathways, the breathing liquid'"'"'s resting lung liquid volume for when it is being circulated through at least a portion of said patient'"'"'s pulmonary pathways, the breathing liquid'"'"'s flow rate for when it is being circulated through at least a portion of said patient'"'"'s pulmonary pathways, an amount of oxygen to be absorbed by the patient from a specific volume of said breathing liquid as said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways, and an amount of carbon dioxide to be absorbed from said patient by a specific volume of said breathing liquid as said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways.

10. A process in accordance with claim 1 further comprising the step of:

establishing minimum and maximum values for at least the following parameters associated with the gas circuit component of said liquid ventilation system in step (a);

a concentration of oxygen in a specific volume of gas being blended with said breathing liquid, a concentration of oxygen in a specific volume of said breathing liquid prior to said breathing liquid is inspired by said patient, a concentration of oxygen in a specific volume of said breathing liquid after said breathing liquid is expired by said patient, a concentration of carbon dioxide in a specific volume of said breathing liquid after said breathing liquid is expired by said patient, and a concentration of oxygen in said patient'"'"'s circulatory system while said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways.

11. A process in accordance with claim 1 further comprises the step of:

establishing minimum and maximum values for at least the following parameters associated with the temperature circuit component of said liquid ventilation system in step (a);

the breathing liquid'"'"'s temperature prior to said breathing liquid being inspired by said patient, the patient'"'"'s internal body temperature while said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways, and the patient'"'"'s external body temperature of while said breathing liquid is being circulated through at least a portion of said patient'"'"'s pulmonary pathways.