Methods and apparatus for closed-circuit ventilation therapy

• US 6,041,777 A
• Filed: 12/01/1995
• Issued: 03/28/2000
• Est. Priority Date: 12/01/1995
• Status: Expired due to Fees

• Current Assignee: Alliance Pharmaceutical Corporation
• Original Assignee: Alliance Pharmaceutical Corporation
• Inventors: Schutt, Ernest G., Faithfull, Nicholas Simon
• Primary Examiner(s): Millir, V.
• Assistant Examiner(s): Deane, Jr., William J.
• Application Number:
  US08/566,023
• Time in Patent Office: 1,579 Days
• Field of Search: 128/200.24, 128/203.12, 128/204.18, 128/913, 604/20
• US Class Current: 128/200.24
• CPC Class Codes: A61M 16/0009 with sub-atmospheric pressure, e.g. during expiration
• CPC Class Codes: A61M 16/0054 Liquid ventilation
• CPC Class Codes: A61M 16/0081 Bag or bellow in a bottle
• CPC Class Codes: A61M 16/1055 bacterial
• CPC Class Codes: A61M 16/1065 in the expiratory path
• CPC Class Codes: A61M 16/22 Carbon dioxide-absorbing devices ; Other means for removing carbon dioxidecartridges with absorbing substances for respiratory apparatus A62B19/00
• CPC Class Codes: A61M 2016/102 Measuring a parameter of the content of the delivered gas
• 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

Methods and apparatus are provided which allow for closed-circuit ventilation for the treatment or diagnosis of disorders. The closed-circuit ventilation apparatus of the present invention provide a closed-circuit respirator that isolates the gas flow path from the ventilator apparatus. This allows the prolonged administration of expensive materials such as fluorochemicals without excessive loss due to evaporation. As such the provided methods an apparatus are particularly applicable to liquid ventilation including partial liquid ventilation and total liquid ventilation.

Claims

1. A process for closed-circuit partial liquid ventilation therapy comprising the steps of:

introducing at least one non-anesthetic gas or vapor into pulmonary air passages of a respiring patient;

capturing expiratory gas from said patient in a closed-circuit respirator in fluid-conducting communication with said pulmonary air passages, said expiratory gas comprising carbon dioxide and at least a portion of said introduced gas or vapor;

circulating said expiratory gas through a gas flow path defined by said closed-circuit respirator wherein at least a portion of said carbon dioxide is removed; and

thereafter reintroducing at least a portion of the circulated expiratory gas comprising said introduced gas or vapor into the pulmonary air passages of the patient.

2. The process of claim 1 wherein said non-anesthetic gas or vapor comprises the gaseous phase of a fluid present in the pulmonary air passages.

3. The process of claim 1 wherein said gas or vapor is a bioactive agent.

4. The process of claim 1 wherein said gas or vapor is a respiratory promoter.

5. The process of claim 4 wherein said respiratory promoter is a fluorochemical.

6. The process of claim 5 wherein said fluorochemical respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane, and mixtures thereof.

7. The process of claim 5 wherein said fluorochemical respiratory promoter is perfluorooctyl bromide.

8. The process of claim 5 wherein said fluorochemical is a liquid at body temperature.

9. The process of claim 1 further comprising the step of pressurizing at least a portion of said gas flow path to effect positive pressure ventilation of said patient.

10. The process of claim 7 further comprising the step of effecting positive pressure ventilation of the patient by applying pressure to said gas flow path from a mechanical ventilator operably associated with said closed-circuit respirator.

11. The process of claim 10 wherein said respiratory promoter is perfluorooctyl bromide.

12. The process of claim 1 further comprising the step of:

providing said closed-circuit respirator by affixing a ventilating conduit to a patient-connector capable of establishing fluid-conducting communication with pulmonary air passages of a patient and a variable volume reservoir, wherein said patient-connector is placed in fluid-conducting communication with said variable volume reservoir.

13. The process of claim 12 wherein said variable volume reservoir comprises a chamber bifurcated by a gas impermeable compliant membrane wherein said chamber is separated into said variable volume reservoir and a compression reservoir isolated from each other;

establishing fluid-conducting communication between said pulmonary air passages and said variable volume reservoir; and

operably associating a mechanical ventilator with said closed-circuit respirator by establishing fluid-conducing communication between said mechanical ventilator and said compression reservoir.

14. The process of claim 13 further comprising the step of effecting positive pressure ventilation of the patient by using said mechanical ventilator to generate pressure waves to actuate said gas impermeable membrane whereby pressure is exerted on said gas flow path.

15. The process of claim 12 further comprising the step of pressurizing said variable volume reservoir to effect positive pressure ventilation of said patient.

16. The process of claim 15 further comprising the step of effecting positive pressure ventilation of the patient by applying pressure to said variable volume reservoir using a mechanical ventilator operably associated with said closed-circuit respirator.

17. A modular apparatus for closed-circuit partial liquid ventilation therapy whereby at least a portion of gas or vapor exhaled by a patient attached thereto is treated to remove carbon dioxide and returned to the patient, said apparatus comprising:

a patient-connector capable of establishing fluid-conducting communication with pulmonary air passages of a patient;

a variable volume reservoir containing a gas or vapor;

a ventilating conduit sealingly affixed to said patient-connector and said variable volume reservoir wherein said patient-connector is placed in fluid-conducting communication with said variable volume reservoir to provide a closed-circuit respirator defining a gas flow path; and

a carbon dioxide separator in fluid-conducting communication with said gas flow path.

18. The apparatus of claim 17 wherein said ventilating conduit comprises an expiratory ventilating conduit defining an expiratory gas flow path and an inspiratory ventilating conduit defining an inspiratory gas flow path, said inspiratory and expiratory ventilating conduits having a proximal end and a distal end.

19. The apparatus of claim 18 wherein the proximal ends of said inspiratory ventilating conduit said and expiratory ventilating conduit are sealingly attached to said patient-connector and the distal ends of said inspiratory and expiratory ventilating conduits are sealingly attached to said variable volume reservoir.

20. The apparatus of claim 18 further comprising a respiratory promoter contained in said gas flow path.

21. The apparatus of claim 20 wherein said respiratory promoter is a fluorochemical.

22. The apparatus of claim 21 wherein said fluorochemical respiratory promoter is perfluorooctyl bromide.

23. The apparatus of claim 21 wherein said fluorochemical respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane and mixtures thereof.

24. The apparatus of claim 20 wherein said respiratory promoter is selected from the group consisting of gases, liquids and vapors.

25. The apparatus of claim 20 wherein said respiratory promoter is a liquid breathing agent.

26. The apparatus of claim 17 wherein said variable volume reservoir comprises a chamber bifurcated by a gas impermeable compliant membrane, said compliant membrane separating said chamber into a compression reservoir and said variable volume reservoir isolated from one another, said variable reservoir in fluid-conducting communication with said ventilating conduit.

27. The apparatus of claim 26 further comprising a mechanical ventilator capable of providing positive pressure ventilation, said mechanical ventilator operably associated with said compression reservoir of said chamber whereby operation of the ventilator will transmit a pressure wave through said compliant membrane into said variable volume reservoir.

28. The apparatus of claim 27 further comprising a respiratory promoter contained in said gas flow path.

29. The apparatus of claim 28 wherein said respiratory promoter is perfluorooctyl bromide.

30. The apparatus of claim 17 further comprising a nebulizer in fluid-conducting communication with said gas flow path.

31. The apparatus of claim 17 further comprising a gas injector in fluid-conducting communication with said gas flow path.

32. A modular apparatus for closed-circuit partial liquid ventilation therapy comprising:

a patient-connector capable of establishing fluid-conducting communication with pulmonary air passages of a patient;

a ventilating conduit sealingly affixed to said patient-connector to provide a closed-circuit respirator defining a gas flow path, said closed-circuit respirator operably associated with a mechanical ventilator; and

a carbon dioxide separator in fluid-conducting communication with said gas flow path.

33. The apparatus of claim 32 wherein said ventilating conduit comprises an expiratory ventilating conduit defining an expiratory gas flow path, an inspiratory ventilating conduit defining an inspiratory gas flow path and a recovery ventilating conduit having a first end and a second end defining a recovery gas flow path, said inspiratory and expiratory ventilating conduits having a proximal end and a distal end.

34. The apparatus of claim 33 wherein the proximal ends of said inspiratory ventilating conduit and said expiratory ventilating conduit are sealingly attached to said patient-connector and the distal ends of said inspiratory and expiratory ventilating conduits are sealingly attached to said first and second ends of said recovery ventilating conduit respectively, wherein fluid-conducting communication is established between said distal end of said inspiratory ventilating conduit and said distal end of expiratory ventilating conduit.

35. The apparatus of claim 34 further comprising a variable volume reservoir in fluid-conducting communication with said closed-circuit respirator.

36. The apparatus of claim 34 further comprising a gas moving apparatus in fluid-conducting communication with said closed-circuit respirator.

37. The apparatus of claim 32 further comprising a respiratory promoter contained in said gas flow path.

38. The apparatus of claim 37 wherein said respiratory promoter is selected from the group consisting of gases, liquids and vapors.

39. The apparatus of claim 37 wherein said respiratory promoter is a liquid breathing agent.

40. The apparatus of claim 37 wherein said respiratory promoter is a fluorochemical.

41. The apparatus of claim 40 wherein said fluorochemical respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane and mixtures thereof.

42. The apparatus of claim 40 wherein said fluorochemical respiratory promoter is perfluorooctyl bromide.

43. The apparatus of claim 32 further comprising a nebulizer in fluid-conducting communication with said gas flow path.

44. The apparatus of claim 32 further comprising a gas injector in fluid-conducting communication with said gas flow path.

45. A process for closed-circuit partial liquid ventilation comprising:

connecting an exogenous closed-circuit respirator defining a gas flow path to the pulmonary air passages of a respiring patient;

introducing a respiratory promoter into said pulmonary air passages;

capturing expiratory gas from said patient in said closed-circuit respirator, said expiratory gas comprising carbon dioxide and at least a portion of said introduced respiratory promoter;

separating at least a portion of said carbon dioxide to provide a treated gas comprising said respiratory promoter; and

reintroducing said treated gas into the pulmonary air passages of the patient.

46. The process of claim 45 further comprising the step of administering a respiratory promoter to said pulmonary air passages of said respiring patient prior to said connecting step.

47. The process of claim 45 wherein said respiratory promoter is a liquid breathing agent.

48. The process of claim 45 wherein said respiratory promoter is a fluorochemical.

49. The process of claim 48 wherein said fluorochemical is a liquid at body temperature.

50. The process of claim 48 wherein said fluorochemical respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane, and mixtures thereof.

51. The process of claim 48 wherein said fluorochemical respiratory promoter is perfluorooctyl bromide.

52. The process of claim 45 further comprising the step of pressurizing at least a portion of said gas flow path to effect positive pressure ventilation of said patient.

53. The process of claim 52 further comprising the step of effecting positive pressure ventilation of the patient by applying pressure to said gas flow path from a mechanical ventilator operably associated with said closed-circuit respirator.

54. The process of claim 53 wherein said respiratory promoter is perfluorooctyl bromide.

55. The process of claim 45 further comprising the step of:

providing said closed-circuit respirator by affixing a ventilating conduit to a patient-connector capable of establishing fluid-conducting communication with pulmonary air passages of a patient and a variable volume reservoir, wherein said patient-connector is placed in fluid-conducting communication with said variable volume reservoir.

56. The process of claim 55 wherein said variable volume reservoir comprises a chamber bifurcated by a gas impermeable compliant membrane wherein said chamber is separated into said variable volume reservoir and a compression reservoir isolated from each other;

establishing fluid-conducting communication between said pulmonary air passages and said variable volume reservoir; and

operably associating a mechanical ventilator with said closed-circuit respirator by establishing fluid-conducting communication between said mechanical ventilator and said compression reservoir.

57. The process of claim 56 further comprising the step of effecting positive pressure ventilation of the patient by using said mechanical ventilator to generate pressure waves to actuate said gas impermeable membrane wherein pressure is exerted on said gas flow path.

58. The process of claim 55 further comprising the step of pressurizing said variable volume reservoir to effect positive pressure ventilation of said patient.

59. The process of claim 58 further comprising the step of effecting positive pressure ventilation of the patient by applying pressure to said variable volume reservoir using a mechanical ventilator operably associated with said closed-circuit respirator.

60. A process for closed-circuit total liquid ventilation comprising:

establishing fluid-conducting communication between pulmonary air passages of a patient and a fluid flow path defined by a closed circuit-liquid respirator, said fluid flow path and said pulmonary air passages substantially filled with a circulating liquid respiratory promoter;

oxygenating the circulating liquid respiratory promoter by introducing oxygen into the closed-circuit liquid respirator to provide oxygenated liquid respiratory promoter;

circulating said oxygenated liquid respiratory promoter through the fluid flow path and said pulmonary air passages to provide circulating expiratory fluid comprising carbon dioxide; and

separating at least a portion of said carbon dioxide from the circulating expiratory fluid by passing the expiratory fluid through a liquid scrubber in fluid-conducting communication with said fluid flow path to provide circulating liquid respiratory promoter.

61. The process of claim 60 further comprising the step of thereafter reintroducing said circulating liquid respiratory promoter to the pulmonary air passages.

62. The process of claim 60 wherein said liquid respiratory promoter is a fluorochemical.

63. The process of claim 62 wherein said fluorochemical liquid respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane, and mixtures thereof.

64. The process of claim 60 further comprising oxygenating said circulating liquid respiratory promoter subsequent to said separating step.

65. An apparatus for closed-circuit total liquid ventilation therapy comprising:

a closed-circuit liquid respirator operably associated with a liquid ventilator, said liquid respirator comprising a patient-connector capable of establishing fluid-conducting communication with pulmonary air passages of a patient and a ventilating conduit sealingly affixed to said patient-connector, said ventilating conduit defining a fluid flow path;

a closed-circuit vapor separator defining a vapor flow path comprising a carbon dioxide separator in fluid-conducting communication with said vapor flow path; and

a gas exchanger in fluid-conducting communication with said vapor flow path and said fluid flow path.

66. The apparatus of claim 65 wherein said closed-circuit liquid respirator comprises a pump in fluid-conducting communication with said gas flow path.

67. The apparatus of claim 65 further comprising a respiratory promoter contained in said fluid flow path.

68. The apparatus of claim 67 wherein said respiratory promoter is a fluorochemical.

69. The apparatus of claim 68 wherein said fluorochemical respiratory promoter is perfluorooctyl bromide.

70. The apparatus of claim 68 wherein said fluorochemical respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane and mixtures thereof.

71. An apparatus for closed-circuit liquid ventilation therapy comprising:

a closed-circuit liquid respirator operably associated with a liquid ventilator, said liquid respirator comprising a patient-connector capable of establishing fluid-conducting communication with pulmonary air passages of a patient and a ventilating conduit sealingly affixed to said patient-connector, said ventilating conduit defining a fluid flow path; and

a liquid scrubber in fluid-conducting communication with said fluid flow path.

72. The apparatus of claim 71 wherein said liquid scrubber is modular.

73. The apparatus of claim 71 further comprising a respiratory promoter contained in said fluid flow path.

74. The apparatus of claim 73 wherein said fluorochemical respiratory promoter is perfluorooctyl bromide.

75. The apparatus of claim 73 wherein said respiratory promoter is a fluorochemical.

76. The apparatus of claim 75 wherein said fluorochemical respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane and mixtures thereof.

77. A process for closed-circuit total liquid ventilation comprising:

establishing fluid-conducting communication between pulmonary air passages of a patient and a fluid flow path defined by a closed circuit-liquid respirator, said fluid flow path and said pulmonary air passages substantially filled with a circulating liquid respiratory promoter;

oxygenating the circulating liquid respiratory promoter by introducing oxygen into the closed-circuit liquid respirator to provide oxygenated liquid respiratory promoter;

circulating said oxygenated liquid respiratory promoter through the fluid flow path and said pulmonary air passages to provide expiratory fluid comprising carbon dioxide;

introducing an effective carbon dioxide disassociating amount of oxygen to said expiratory fluid to form an expiratory vapor comprising carbon dioxide;

isolating said expiratory vapor comprising carbon dioxide in a closed-circuit vapor separator in fluid-conducting communication with said fluid flow path, said closed-circuit vapor separator defining a vapor flow path comprising a carbon dioxide separator; and

contacting said carbon dioxide separator with said expiratory vapor wherein at least a portion of said carbon dioxide is separated to provide a modified vapor.

78. The process of claim 77 wherein said liquid respiratory promoter is a fluorochemical.

79. The process of claim 78 wherein said fluorochemical liquid respiratory promoter selected from the group consisting of FC-75, FC-77, RM-101, Hostinert 130, APF-145, APF-140, APF-125, perfluorodecalin, perfluorooctyl bromide, perfluorobutyltetrahydrofuran, perfluoropropyl-tetrahydropyran, dimethyladamantane, trimethyl-bicyclo-nonane, and mixtures thereof.

80. The process of claim 78 wherein said liquid respiratory promoter is perfluorooctyl bromide.

81. The process of claim 77 further comprising the step of reintroducing said modified vapor to said fluid flow path.