CA1261943A - Respirating gas supply method and apparatus therefor - Google Patents

Respirating gas supply method and apparatus therefor

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Publication number
CA1261943A
CA1261943A CA 553180 CA553180A CA1261943A CA 1261943 A CA1261943 A CA 1261943A CA 553180 CA553180 CA 553180 CA 553180 A CA553180 A CA 553180A CA 1261943 A CA1261943 A CA 1261943A
Authority
CA
Grant status
Grant
Patent type
Prior art keywords
gas
line
port
valve
fig
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
CA 553180
Other languages
French (fr)
Inventor
Leonard M. Sieracki
Gerald Durkan
Kevin C.S. Chen
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
KIRCALDIE RANDALL AND MCNAB
Original Assignee
KIRCALDIE RANDALL AND MCNAB
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Publication date
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Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61NELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00Electrotherapy; Circuits therefor
    • A61N1/18Applying electric currents by contact electrodes
    • A61N1/32Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3601Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of respiratory organs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0051Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes with alarm devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/06Respiratory or anaesthetic masks
    • A61M16/0666Nasal cannulas or tubing
    • A61M16/0672Nasal cannula assemblies for oxygen therapy
    • A61M16/0677Gas-saving devices therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/08Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816Joints or connectors
    • A61M16/0841Joints or connectors for sampling
    • A61M16/0858Pressure sampling ports
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/08Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816Joints or connectors
    • A61M16/0841Joints or connectors for sampling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0015Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors
    • A61M2016/0018Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical
    • A61M2016/0021Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with a proportional output signal, e.g. from a thermistor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0015Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors
    • A61M2016/0018Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical
    • A61M2016/0024Accessories therefor, e.g. sensors, vibrators, negative pressure inhalation detectors electrical with an on-off output signal, e.g. from a switch
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A61M2016/0033Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
    • A61M2016/0039Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the inspiratory circuit
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/05General characteristics of the apparatus combined with other kinds of therapy
    • A61M2205/054General characteristics of the apparatus combined with other kinds of therapy with electrotherapy
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00Measuring parameters of the user
    • A61M2230/60Muscle strain, i.e. measured on the user

Abstract

ABSTRACT
In various embodiment of a respirating gas supply method and apparatus a control circuit (32) responsive to a sensor (28) operates valve means (26) to supply pulses of respirating gas through a single hose cannula (48) to an in vivo respiratory system when negative pressure indicative of inspiration is sensed by the sensor (28). The control circuit (32) operates the valve (26) to communicate the in vivo respiratory system with a supply of gas (20) only if the negative pressure sensed by the sensor (28) does not occur within a predetermined yet selectively variable required minimum delay interval between successive pulsed applications of gas to the in vivo respiratory system. The pulse of gas applied to the in vivo respiratory system can be spiked pulses or square pulses. Humidifiers, nebulizers, and sources of a second gas are provided in accordance with various embodiments.
Upon the detection of an appropriate apnea event, respirating gas supply apparatus according to various embodiments supply stimulus to the upper airway passages of an in vivo respiratory system in an effort to dislodge any occlusion or obstruction in the upper airway passages. In one embodiment the stimulus applied is a high pressure pulse of gas. In another embodiment an electrical signal is applied to an electromyographic electrode (270) positioned in proximity to a nerve controlling a muscle or organ which may obstruct the upper airway passge.

Description

RESPIRATING GAS SUPPLY METHOD
AND APPARATUS THEREFOR
BACKGROUND

Thls is a division of application Seria] Number 442,491 filed 2 December, 1983.

This invention pertains to appa~atus and methods for providins supplemental resplrating gas, such as o~ygen, to an in vivo respiratory system,. an~
to~ methods of OGerating respirating gas sup~lt~
apparatus so that apnea events caused by the occ].usion of upper airway passages in the in vivo respiratory syst3m are remedied United States Patent Wo; 4,414,982 issued November 15, 1983 to Durkan illustrates a method of ; suppl~inq respirating gas wherein a dose or pulse of gas is supplied to an in vivo respiratory sys~em subs~antiallt~ at the beginning of inspiration. United States Patent No.
4,41a,982 also discloses a primaxily fluidically-operated apparatus comprising a demand gas circuit. The fLuidic appara~us comprising the demand gas circuit carries out the method described above and, by virtue of the method, is significantly smaller and more compact than other demand ~20 ~ gas-tt~pe apparatus which supply respirating gas essentially :~ :
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throu~hout the duration oF inspiration. While this fluidic aQparatus has pcoven e~tremelv efEective in such pcoducts as home o~Y~gen concent~ators and o~ygen dillusion cr deli~ery systems, for e:~ample, a further reduc~i^n in ove!all ap~aratus si~e would further enhance the utilit~ of such ~coducts.
Many devices, including those deplcted in United States Patent No. 4,414,982, are adapted to monitor oc sense pressure direction in an in vivo respirator;~ system throughout the res2iratory cycle and to selectiqel~ sup~ly gas in accordance wlth the pressure direction in the in vi~o respirator~ system In this res~ect, the in vi~o respirator~ system c~eates a negati~Je pressure upon inspiration and create positive pressure upon e~halatian In certain instances it is advzntageous to supply pulses oF gas such as these described in ~rnîted States Patent No. 4,414,982 b~t in such a manner thac a pulse is not n~cessarily supplied for every - 20 detection oE negative pressure in the in vi~o respiratory system For e:cam~le, should the-in vlvo respiratory system attempt to inspire toc fre~uently, an apParatus operating strictlv In the manner describea ln United States Patent No. 4,414,ga2 ~- 25 would in some instances cause the i~ Vi~Jo respiratar~
system to overo~ygenate. ~hile breathing rate control circuits and override circuits have been disclcsed in the prior art (such as U.S. patents 4,206,754 to C~x ~ and 4,141,754 to Ismach, Eor e~ample~ these circuits are incompatable with the device described in the reEerenced application~
~ nited States ~atent No. 4,414,982 also illustrates the usage of a "s~lit" or "double hose" cannula which interEaces the in ~i~o res?ication syste~ throuch the nares ~ith the sensins ' :

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and gas supply elements Oe the apparatus disclosed therein. Althoush the ap~aratus performs su~erbly using tne double hose cannula, employment oE a s;.ngle hose cannula rather than a double'hose cannula would enable ~oth the senslng of the pcessure direction in the in vivo respiratocy system and the deliver~r Oe res~lrating gas to the in vivo res~iratory syste.~ to be accomplished through the same hose. ~Slngle hose cannulae, being less e~pensi~e to manufacture ancl more convenient for the ph~l~sician and user, are generally more prevalent on the mar'~et than double hose cannula~ Thus, it would be advan~ageous to adap~:
sys~e~s such as that disclosed in the referenced 'application for compatibllity with a single hose 15 cannula. . ' -; Moreover,'it is generally pre~'erable to humidiy respirating gas before suppl~ing the ~as to an in ~tivo respiration.system~ In some circumstances it is desirable to nebulize the respirating gas with ~' 20 medication before supplying the gas to the in vivo respirati~n sys~em. Alt~ough humidifiers and nebull~ers ha~e long been.used with ox~gen sup~l~t : systems, it is not evldent fram the prior art how a ~ humidifier or nebulizer can be appropriatel~r utilized : 25 with ap~aratus such as those descrlbed in United States : Patent No. 4,414,982, especially if apparatus of that type ace used wi~h.a single hose cannula as discussed above ~.great danger in utilizing humidiEiers and/or nebulizers with either ., single or double hose c~a'nnula systems is the transfer : oE moisture through the hose leading to sensing means . ~ .
used to determine the direction Qf p~essure in the in vivo system. ~loistu~e in the hose leading to the sensing means conta.~.inates the sensoc and tends to considecablv shocten the Li~e o~ the sensoc-: ~ :

- - - . . , In some situations it may also be desir.able to sup~ly another gas, such as an anesthetic gas~ to in vivo respiratoey s~ys~em along with the su~ly o~
respirating gas. In suc~ situations, the dosage oE
second gas mus`t usually be in controlled r~lation to the amount oE respirating gas supplied simultaneously therewith. Moreover, a serious problem results i.n a demand gas-type de~Jice when medicating gas is continually ~pJlie~ regar~less o~ the abilit~ or , inabil-ty of the in vivo system to demand the ,~ ~, . . . . .
respLratln~ gas.
. United States Patent No. 4,414,982 discloses .. . ~ - , .
a respirator appara~us includina~a~pre~ominately .
fluidically operated apnea event cïrcult whïch signaLs - I5 the occurrence of an apnea event after the lapse of a predetermined time interval since the last lnspiration : attempted by an in vivo respiratory system One cause or . apnea events such as those detected ~y the apparatus of ~ United States Patent No. 4,414,982 is the occlusion of upper ~ 20 airways, such as the oropharyngeal airway, in the in vivo :~ respiratory system.
In the above respec~, i-t has been su~gested by Remmers et aL. ("Pathogenesis of Upper Airwa~
: Occlusion During Sleep", ~ournal of Applied Physio:Logy 1978; 4~:931~38) that in some in vivo respiratory s2ystems ~ the subatmospheric or negative pressure occasined during ; inspiration sucks the tongue and so~t palate against the posteriar oropharyngeal wall. Other causes and conditions associated with upper airway obstruct.ion/
30:occlusion are summarized by Sullivan et al.
("Reversal of Obstructive Sleep~Apnoea By Continuous : ~ :: :

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' Positive Airway Pressure Applied Through The Nares", The ancet, ADril 12, 1981, pp 862-865) Sullivan et al report treatments foc o~structive sleep apnoe~ syndrome whereln low levels oE pcessure (in the range of 4 5 to S 1~ cm water) were continuousl~ a~plied to provide a pneuma~ic splint for the nasopharyngeal airway.
United States patent 4,155,356 to Vene~as discloses a respiration assistTng method and apDaratus comprising means for generating a series or pressure pulses and me~ns ~or transmitting the pressure pulses to air passageways in the lungs. The transmlssian means comprises a tube placed in t~e trac~ea so that - pressure waves created by the pressure pulses out~ard displace walls of collapsed air pass~geways in the lS lungs and maintain such outward displacement durin~
ex,Diration Venegas provides no means ~or the se~sing of conditions ln the lungs nor does he coordlnate the application o~ pressure pulses in time relation with the occurrence of such coQditions.
In view o~ the foregoing, it is arl ob~ect oE
this inven~ion to pravide a respirat~ng g~s supply apparatus which, upon the detection o~ an apprapriate apnea event caused by the occlusion or obs~ructian of ~ upper airway ~assages in an in vivo respir~tory sYstem~
attempts to remedy the occlusioQ ar obstruction in the upper air~ay passages.
It is an object of the present inventiorl to provide a demand respirating gas supply methad and ap~aratus ~hich prevents overoxygenation by supplying a fixed volume dose oE respirating gas per unit time to an in vivo respirator~ system.

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An advantage of the invention i5 the provision of a demand respirating gas supply met:hod and apparatus which employs a single hose cannula, t:hereby allowing pressure ~ensing and gas supply to be accomplished through the same line.
A further advantage of one embodiment of the invention is the provision of a method and apparatus for supplying spiked shaped pulses Oe gas at the beglnning of an inspiration.
An advantaae of another embodiment of the invention is the provision of a method and apparatus for supplying square shape~ ulses of gas at the beginning of an inspiratlon.
Yet another advantase o~ the invention is the provision of a com~act respirating gas supply apparatus.
Still another advantage of the invention is the employment of humidifiers, nebulizers, and -the like without deleterious impact upon a sensor used in a 20 - respirating supply gas apparatus~
SU~ ~ RY
In vari~us embodiments of a respirating gas supply method and apparatus, a control circuit responsive to a sensor operates a valve to supply doses or pulses of respirating gas throuqh a single hose cannula to an in vivo respiratory system when negative pressure indicative of inspiration is sensed by the sensor. The control circuit operates the valve to communicate the in vivo respiratory system with a supply of gas only if the negative pressure sensed by the sensor does not occur within a predetermined yet selectively variable required minimum delay inverval between successive pulsed application of the gas to the in vivo respiratory system.

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In some embodiments, a three-way valve having ports connected to the sensor, the gas supply, and the single hose cannula is used. In another embodiment, a four-way valve facilitates usage of the apparatus in conjunction with a humidifier and/or a nebullzer.
In one embodiment a respirating gas supply apparatus has a sensor comprislng a biased fluidic amplifier and a pressure-to-electric (P~E~ switch.
Apparatus according to the,embodiments described herein can'be operated to supply spike,~
pulses or square pulses oE gas depending on whether a flowmeter is connected between the suppl~ oE gas on the valve~ , , The control circuit of the respirating gas 15 ,supply apparatus also has means for d~etermining i-f the in vivo respiratory system has failed to demand a pulse of gas after the elapse of a predetermined but selectively variable,maximum time inverval. Upon ~etecting such an apnea e~ent, the apparatus activates various indicator or alarm means and operates the valve to supply an additional pulse or pulses o~ gas to the ' in vivo respiratory system.
Upon the detection of an appropriate apnea event, respirating gas supply apparatus accordins~ to various embo~iments supply stimulus to the upper airway ~. . .
' passages of an in vivo respiratory system in an e~fort ts~ dislodge any oclusion or obstruction in the uppe-r airway passages. In one embodiment the stimulus appLied is a high pressure pulse o~ gas. In another embodiment an electrical signal is applied to an electromyographic electrode (279) positioned in proximity to a ner~e controlliny a muscle or orgcln which may obstruct the upper airway passage.
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BRIEF DESCRIPTION OF THE DRAWINGS
The foregoing and other objects, features and advanta~es of the invention will be apparent from the following mo~e particuLa~ description of the preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reeerence characters refer to the saMe parts throu~hout diEerent views. The drawings are not necessarily to sca:Le, emphasis instead being placed upon illustrating the principles of the i~vention.
Fig. lA is a ~chematic diagram showinq a gas supply apparatus according to an embodiment o~ the invention wherein gas is supplied in a spiked pulse mode;
Fig. lB is a schematic dia~ram showlng a gas supply apparatus according to an embodiment ~f ~he invention wherein gas is supplied in a s~uare pulse mode;
Fig lC is a schematic diagram showing a gas supply apparatus according to an embodiment of the - invention wherein sensing means comprises a fluidic ampliEier;
Fig. 2 is a schematic diagram showing a gas supply apparatus according to an embodiment of the ~5 invention wherein supply gas is humidified;
Fig. 3 is a schem2tic diagram showing a gas supply apparatus accordiny to another embodiment of the invention wherein supply gas is humidifi d;
Fig. 4A is a graph illustrating a spiked pulse method of supplying gas accordinq to a mode of the invention;
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Fig. 4B is a graph illustrating a square ; pulse method o~ supplying gas according to a mode of the invention;
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Fig 5 is a schematic diagram showing a control means according to an embodiment of the invention;
Fig. 6 is a schematic diagram showing a gas supply apparatus according to another embodiment of the invention wherein a second gas is also supplied;
Fig. 7A is a plan view of a fluid amplifier of the embodiment oE the gas supply apparatus oE Fig.
lC;
Fig. 7B i~ a graph illustrating the output pressure gain curve for the ~luidic amplifier shown in Fig. 7A; and, Figs. 8A, 8B, and 8C are schematic diagrams showing differing embodiments of gas supply apparatus which detect apnea events and attempt to remedy apnea events caused by occlusion of upper airway passages in . . . the in vivo respiratory system.
DETAILED DESCRI~TION OF TE~E DRP~:WI~GS
The respirating gas supply system of the emb~d iment of Fig. lA comprises a source o~ gas 20; a flowmeter 22; a fluidic capacitance 24; valve m~ans 26;
sensing means 28; and, control means 3~.
~ Source 20 is typically a source of oxygen : ~ gas. Depending upon the partlcular environment of use, - 25 source 20 may be a portable tank or a wall supply, for example. Source 20 is connected by line 34 to the ~lowmeter 22. As used herein unless ot~erwise indicated, any fluid conveying means, such as a duct, pipe, channel, or o~ther closea fluid conduit, i, referred to as a line.
While the flowmeter 22 may be of any conventional type, a ball float-type Elowmeter manufactured by Dwyer is suggested as one acceptable model~ The flowmeter illustrated in Flg. lA comprises a needle valve (not shown) which has an inherent resistance FR to the flow of gas. The flowmeter . .
. . : ' ~;

- ' f~3 inherent resistance is dependent~ inter alia, on the dimensions of the needle valve and the needle orifice. The flowmete~ 22 is connected to the capacitance by line 36.
Capacitance 36 is shown as a tank but in another embodiment i5 mecely a relatively long length of tubing. As seen hereinaEter, the volume of capacitance 24, the flowmeter inherent resistance FR, the inherent resistance VR of the valve 26, and the interrelationship between these factors in~luence the amplitude of a pulse o~ gas produced by the respirating gas supply system oE Fig. lA.
The valve means 26 of the embodiment of Fig.
lA is a three-way two posltion solenoid-actuatea spool valve having ports 26a, 26b, and 26c in its bore~ Port :~' 26a is connected by line 46 (a singIe hose) to a means 48 for applying gas to an in vivo,respiratory system.
' Althaugh the particular means shown in Fig. lA is a : single hose cannula, it should be understood that other suitable devices, such as an endatrachial tube or a hand resuscitator, for example, may be,.employed. The a~oresaid line 40 ultimately ~onr.ects ~ort 26b to the source 20~ Port 26c is connected by l'ine 50 to the sensing means 28.
:~ : 25 As shown in the Fig. 1 representation of the valve 26, ~he spool oE valve 26 is biased to its first . : : position to connect port 26a to port 26c so that the cannula 48 (and hence in vivo respiratory system (not shown) including nares in which the cannula 4a is ; ; 30 : inserted) is;ln fluidic communication ~ith the sensing : means 28. It should be understood that the val.ve 26 ; can be operated to move the spool to.its second pasition to connect port 26a with port 26b so that a ,: , ~ pulse of gas is suppled to the in ~ivo respiratory " ~ 35 : system through the single hose 46. When connected in ~ ' this manner, the valve 26 has an inherent resistance VR
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to the flow of gas which is dependent on the si::e of the orifice connecting port 26a to port 26b.
The valve 2~ is electrically controlled by control means 32 in the manner hereinafter described.
~hile the valve 26 shown in Fig. lA is of a type manufactured by Lee as model LFAA 120031~H, any comparable model can be used.
The sensing means 28 of Fig. 1 comprises suitable means Eor sensing a negative Eluidic pressure applied along line S0 and for generating an electrical signal in accordance with the sensing oE the negati~e fluidic pressure. In one embodiment the sensor 28 comprises a pressure-to-elec~ric (P/E~ switchr such as ! a Model E P/E Switch manufactured by the Dietz Company which can sense pressures as low as 0.02 inches (column of water). In this embodiment, the negative input port of the P/E switch is connected to the line 50 while the positive input port is le~t open to ambient. L~rg~
diaphragms used in state-of-the-art P/E switch technology, such as ~the two inch diameter diaph~agm of the Dietz Model E P/E, have considerable internal volume and hence, for some environments of use r a signiicantly long time response. Many P/E switches must also be mounted horizontally to achieve maximum sensitivity, but mounting the switches horizontally presents another problem -- acceleration sensitivity of ~; the diaphragm.
The sensing means 28C o Fig~ lC comprises means 29 for sensing positive fluidic pressure ~nd for ;~ 30 generating an electrical signai in accordance with the sensed fluidic pressure, as well as ampliEication ~eans such as fluid amplifi~r 30~ ~he fluid amplifier 30 depicted in Eig lC is a biased turbulent proportional amplifier shown in more detail in Fig. 7A
;~ 35 The biased fluidic amplifier 30 has a power in~ut stream 30; two control ports 30b and 30c; and, : .
:: -'~ , .~ :
~: ~ ' . ,,' -: .
~, two output ports 30d and 30e. The power stream input port 30a is connected by the line ~ ultimately to the .. source 20. A variable restrictor 52 on line ~ is used to limit the magnitude of flow and pressure of flow of the input stream ana thus the sensitivity oE tlle fluidic amplifier 30. Control port ~8b is connected by . . ' line 5~ -to port 26c of the ~alve' 26 such that ne~ative pressure in line 50 (created by inspiration in the in . vivo respiratory system) deflects the power stream to . 10 outp t port 30d. The am~lifier. 30 is biased such that-. non-negative pressure in line 50 results in the power . stream passing through the output port 30e. . . - ..
. . The amplifier structure of Fig. 7A . .
.' ' illustra.es the biased nature of the amplifier 30. T~e ... 15 amplifier 30 is configured wlth an of-set spli~ter ' ' That is, the power input stream 30a is cantec~ so 'chat, absent control signals at ports 30~ (also labeled C~
. . and 30c (Ci), the output is normally biased to the left .' ' . output port 30e. (L) When negative pressure is appli a throu~h port 3~b, the output switches to' por.t 30d :. -When the negative pressure ceases, the ou-tput' . - ..-.. automatically switches back to port 30e. In.a .' ... pre~erred embodiment the amplifier 3.0 operates with a .
.;.': ' low power supply so that the jet is laminar. T:~e.
;. 25 output pressure gain curve for the ~iui~ amplifier 3Q
:. . af ~i~. .7~ is $hown in Fig. 7B. . '~- . -': . :
-A fluidic. amplifier o~ t~ type manufacturea .: by TriTec, Inc. as Model No AW12* unctions we:Ll as . - .
.
~' 'the amplifier 30 of Fig. 7A to give a sensitivity to ; 30 negative pressures at least as low as G.02. cm water~S
but for the use shown, especially considering the.
operating parameters of the P/E switch 31, a sensitivity ~; o~ approximately 0.5 cm water is sufficient. It : should be understood by those skilled in the art: that : 35 other fluidic elements, such as a NOR gace, can be con~i~ured with the circuitry shown. to yield acceptabl~
~; . r esults .
In the ernbodiment of Fig lC a pressur.e-to-:; electr ic (P/E) switch 31 is used as the means Eor :: ~

' ~ .
:

.
sensing positive pressure alld for generatiIlg an electrical signal in accoedance with the sensed fluidic pressure. The P~E switch 31 illustrated in ~i~. C is a conventional P/E switch such as that manuEacture~ by ~airchild as Model PSF 100A. The positive input port o~ the P/E switch 31 is connected to the output port 30d oE sensor 30 by line 5~ while the negative inplIt.
. port thereo is open to ambient. For the particular . sensing means 28 illustrated in Fig lC, the P/E switch .: lQ 31 shuld be sensitive enough to switch when positive -.
. pressure as low as 0 5 cm of water is incident thereon When P/E s~itch 31 receives such pressure, P/E switch 31 closes a switch 36 as see~ hereinafter with reference to ~i~. 5.
Referring now a~ain to the em~odiment o~ Fig .. . lA, it shou~d be understood that o~her types o~ se~sing means 28 may be employed Those skilled in the art ~ : recognize that ~iE operating requirements permit~ a ; . thermistor system can be utilized, provided the : 20 thermistor system is made direction sensitive ~y .utilizing two thermistors and appropria~e time delay measurement circuitr~) Ordinarily, how~ver, the flo~-type ~as oppose~ to pressure-type) sensitivity of a . thermistor prevents the thermistor from sensing ~lo-~
~: ~ 25 . rapidly enou~h to facilitate the supply o~ an o~ygen ..
. pulse early in inspiration, such as in the ma~ner . . taught in U S~ patent a~plication Serial ~o ~ ,654.
.
; . In ano~her embcdiment, a pressu.re transudcer fu~c~ions as the sens mg means 2~. The pressure transducer can 30. be a solid s~ate, a capacitance, or an electro-mechanical (diaphra~m-ty~e) transducer, dependin~ on : ~ the sensitivity requi~ed Transducers provi.de a : : analo~ signal ancl rec~uire rather complex electr:ical : . circuitry. A suitable solicl state crystal may someday be developed to function as the sensing means 28 in : accordance with aesired sensitivity requirements ;

:, ~
.:

':
: ' -14~

The respirating gas supply system of Fig~ lB
resembles the system of Fig. lA but does not ha~Je the flowmeter 22. As seen hereinafte~, the system of Fig.
lA produces a spiked pulse of gas whereas the system of Fig. lB produces a square pulse o~ gas.
The respirating gas supply system of he embodiment of Fig. 2 b~sically resembles the system of Fig. lB but, rather than employ a three-way valve, utilizes a four-way two-position valve 58 as its valve lQ means. The four-wa~ valve 58 has four ports in its bore: port 58a connect~d by the line 46 to the cannula 48; port 58b connected by line 42 ultimately to the source 20; port 58c connected by line 50 to cont:rol port 28b of sensor 28; and, port 53d connected by a line 60 to an input o a humidifier 62. ~alve $8 can be any conventional four-way two position valve,~ such as the' solenoid-actuated spaol val~e mo~el 8345El manufactured by ASCO. As shown in the Fig. 2 representation of valve 58, the valve 58 is ~iac;ed in a 2a first position to connect port 58a to port 58c so that cannula 48 (and hen~e the in vivo respiratory system) is in fluidic communication with the sensor 28~ It should be understood that the valve 58 can be actuated : to a secand position to connect port'58b to port: 58d.
When this occurs, gas is supplied through the valve 58 and line 60 to the input of'.h.umidifier 62 Humidifier 6~ ~s a bubble type humidif'ier, : : such as the madel 003-01 humidifier availa~le from : Respiratory Care, Inc. Humidifier 62 yields a 3~ humi~ified gas flow on line 64 connected to the output of the humidiier 62. Line :64 connects with a l.ine 46 :;' at point 66. A variable resistanc'e 64R on line 64 insures that upon inspiration the path of least resistance throu~h line 46 and the valcJe 53 rather than through line 46.
It should be understood that the apparat'us oE

. :

:
:

the embodiment of Fig. 2 can be connected in the manner of Fig. lA (that is, with a flowmeter) to opera.e in a spiked pulse mode rather than a square pulse mode.
The respirating gas supply system of the embodiment of Fig. 3 basically resembles the system of Fig. lB but further incorporates the humidifier 62. A
line 65 connects to line 46 at point 67. The l:ine 65 connects the point 67 to the input of the humidifier 62. Line 64 from the output of the humidifier 62 terminates in a noz~le 68 of a venturi 70. The venturi 70 is connected on line 46 i~termediate the port 58a of valve 58 and the cannula 48. ~ variable resistance 65R
on line 65 insures that upon inspiration the path of least resistance is through the li~e 46 and the valve 26 rather than through line 65. Resistance 65R also serves to control the flow into the humidi~ier 62 through line 65. The venturi 70 shown is a type F-4417-10 available from Airlogic, although any comparable venturi is suitable. Again, it should be understood that the embodiment of Fig. 3 can, iL
desired, incorporate a flowmeter in order to ope~rate in a spiked pulse mode.
It should be understood by those skilled i~
the art that a device for administering medication, such as a nebuliæer, can be connected in the systems af Figs. 2 Gr 3 in essentially the same respective manners as the humidiEier 62 shown therein.
T~e respira~ing gas supply apparatus o~ the embodiment of Fig. 6 basically resembles the emhodiment ~ 30 of Fig. lB but further includes means or suppling a ;~ ~ second gas to the in vivo respiratory system. The apparatus of Flg. 6 further comprises a source 120 of a - second gas (such as an anesthetic gas, for example), a ; capacitance 124; and, second valve means 126. Source 120 is connected to ca~acitance 124 by line 134;
capacitance 12~ is conne-ted to the valve means 126 by :: :

,~; ~ - "' . . ' ~ ' : , line 142. The apparatus of the embodiment of Fig. 6 can be used, if desired, with a humidi~ier in the manner described above with reference to either Fig. 2 or Fig. 3.
Valv~ 126 is a two-way two position solenoid-actuated spool valve having port 126a and 126b in its bore. The central spool of valve 126 is biased in a first position as shown in Fig. 6 so that ports 126a and 126b are not co~municating. Port 126b of valve 126 1~ is connected by linè 144 to a point 146 where line 144 joins line 46. A variable resistance 147 on line 144 insures that upon inspiration the path oE least resistance is through the line 46 and valve 26 cather than through line 144. The solenaid valve 126 is ~ 15 electrically connected by lines L3' and L3 to the ;~ control means 32. In other embcdiments the solenold valve is mechanically connected to a control means.
The control means 32 of the embodimen~ of Fig. 5 is suitable for use with apparatus constructed ~Q in accor~ance with any of the foregoing embodiments.
Control means 32 is a circuit comprising four NAND
gates l72, 74, 76, and 78); four NOR gates (80, 82, 84, and 86,~; three transistors (Tl, T2, and T3); a ';55 - timer chip 88; a 556 dual timer chip 90; 1EDs 92 and ~4; pie20 electric ~ember 96; and, various resistances and capacitances as hereinafter designated.
As used with reference to Fig. 5, the notation 'lLX" denotes an electrical line (as opposed to ` a fluidic line) where X is a appropriate referer~ce 3~ number. For example, controller 32 includes a ]ine rl connected to a high DC voltage supply ~not shown) and line L2 connected to a low DC voltage supply (also not ; shown). The potential difEerence across Ll and L2 is between 12 and lS volts DC.
.~
,:, .. :
~ ~:

.. . .. .

The 556 dual timer chip 90 shown in Fig. 5 is a 14 pin chip manufactuced by National Semlconductor as : part number L~ 556CN. It should be understood ~hat any comp3rable 556 dual t.imer chip is sui~able for the circuit of Fig. 5. For the particular chip shown, pins 1~7 correspond to pins of a first timer in the dual timer while plns 8-14 correspond to pins of a second timer. The pins are labeled as follows:

PIN D~SCRIPTIONS FOR 556 C~IIP

DESC~IPTION TIMER 1 TI~sER 2 discharge 1 13 threshold 2 12 con-trol voltage 3 11 reset 4 10 output 5 9 trigger 6 8 ground 7 operating voltage 14 ~: The pin connections for the first timer of the 556 dual timer 90 are as follows: Pins 1 and 2 ~re : connected to line L2 through a series combination of resistor Rl and a laoK variable potential resistance R2. Pins 1 and 2 are also connected to line L2. through capacitance Cl. Pin 3 is connected to line L2 through : 25 :capacitor C2. Pin 4 is connected directly to ].ine Ll. Pin 5 is connected to the base of transistor Tl through resistor R3. Pin 5 is also connected to the anode of LED 92 (the cathode of LE~ 92 being connec-ted through resistor R4 to the line L2~. Pin 6 is : 30 connected through cat~acitor C3 to the output terminal of NO~ 80. Pin 6 is also connected to line Ll through : ::
:- the resistor Rl~ ancl to :Line L2 thcough the resistor ~ RlS. Pin 7 is conn~ ~:ed clirectly to line L2.

- , , The pin conn~ctions for the second ti~ner of the 556 dual timer 90 are as follows: Pin 8 is connected throush capacitor C4 to the output te~:minal of NO~ 84, as well as to line Ll through the resi-~tor R16 and to line L2 through the resistor R17. Pln 9 is connected to both input terminals oE NAND 74. Pin 10 is-connected dicectly to line Ll and to a point 102 discussed hereinaEter. Pin 11 is connected through capacitance C5 to line L2. Pins 12 and 13 are ~connected to line Ll throug-h a series combination of ~ resistor R5 and a 100K variable potential resistor : R6. Pins 12 and 13 are also connected to line L2 throu~h capacitance C6. Pin 14 is connected directly ~ to llne Ll.
- 15 ~ The 555 timer chip 88 shown in Fig. 5 is an ~ ; eight pin chip manufactured by National Semiconductor .: as part number L~ 555C~. It should be understood that any comparable 555 chip is suitable for the circuitry ~; - of Fig. S~ For the particular chip shown the.pins are 2a labeled as follows:
,~
~ DESCRIPTION PIN
-- _ .

ground trigger : output 3 ,~
: : ~5 reset 4 ~ control~ 5 `: ~ threshold 6 : discharge 7 - ~ operating voltage 8 ,, :
: 3~ The pin connections for the 555 timer chip 88 are as follows: Pin 1 is connected directly to line L2. Pin 2 is connected to the output oE NO~ 82 and to the base of transistor T2. Pin 3 is connected to both ::~ . ' :

inputs of NOR 86 and to a point 98. Pin 4 is di.rectly connected to line Ll. Pin 5 is connected to line L2 through capacitor C7. Pins 6 and 7 are connected to line L2 through capacitance C8. Pins 6 and 7 are also connected to line Ll t~rough a series combination oE
resistances, the combination including a resistor R7 and anyone oE a group of parallel-arranged resistances such as resistances Ra, Rb, and Rc.... Which of- the parallel-arranged resistances is used depends on the manual positioning of a switch 100 as described hereinafter. Pins 6 and 7 are also connected to the emitter of transistor T2. Pin 8 is connected d:irectly to the line Llo M~D 72 has a first input terminal 72a connected to line L1 through resistance R8 and connected to L2 through. the switch 36. A secon~ input terminal 72b of the NAND 72 is connected to the output terminal of NAND 74. The output terminal of N~ND 72 is connected to a first input terminal 80a o~ NOR 80, as welI as to both input terminals of the followin~: ~OR
82, NOR 84, and NAND 76. The first input terminal 80a o~ N~R 80 is also connected to a point 104 inter~ediate the output terminal of NOR 86 and the anode of LED
94. The second input terminal 80b of NOR 80 is connected to line L2 through resistor R9. The lines L4, L5, L6, and L7 shown in Fig 5 are connected to urther devices, such as instrumentation which, unless : otherwise noted herein, do not form part of the present invention.
30: Transistor Tl is a NP~ transist~r, such as ~; ~ the type availa.ble from GE as part GE-66A. The emitter of transistor Tl is connected directly to line L2. The collector of transistor Tl is isolated from line L2 by a diode D1 (IN 4005) and is connected to the positive : 35 terminal of appropriate valve means (such as valve 26 or valve 58) by line L3. Line L8 is connected to the ' ~

, ' ' negative (or ground) terminal of the appropriate valve means.
Transistor T2 is a PNP transistor, such as the type available from GE as part G~ -65. The emitter S of transistor T2 is connected to pins 6 and 7 of timer 88. The base of transistor T2 is connected to ~he output oE the NOR 82. The collector of the transistor T2 is directly connected to line L2~
.Fig. 5 also includes an alarm circuit generally denoted as 100. A point 102 of alarm circuits 10C is connected both to line LL and (~hrough capacitor C9) to line L2. Terminal 96b o~ 'che piezo electric 96 is connected to point 102 through resistance R10 and to the base of transistor T3 through resistor Rll. Terminal 96a of the piezo 96 is connected to point 102 through resistance R12.
~ Termi~-al 96c of the piezo electric 96 i5 connected to : point 98 and to the emitter o transistor T3. The ;~ alarm circuit 100j when activated, functions as an oscillator and drives ~here~or to produce audib:Le ~ oscillation. It should be understood thay any conventional circuit, including buzzers and elec:tro-: mechanical alarms, may be utilized instead.
Transistor T3 is a NPN transistor, such as ~ ~5 the type available from GE as part GE-66A. The co.llector of transistor T3 is connected through ; resistor R12 to the poin~ 102. The other connections ~ of the transistor~T3 are described above.
`~ : The NOR gate 86 has its output terminal connected to the anode of the LED 94. The c~thode of the LED g4 i5 connected through resistor 13 to the line : L2.
; . Conventional NOR gates can be used for the MORs 80, 82, 8`4 and 86 and conventional MAMD gat:es can ~ ~ be used for the MANDs 72,~74, 75 and 78 utilized in the `~ ~: 35 controller of Fig. 5. For the embodiment oE Fig. 5, , : :

~ , however, the ~AND~ illustrated are parts 4011 manufactured by National Semiconductor and the NORs are parts 4001B manu~actured by ~ationa~ Semiconductor.
The suggested values for the resistances and capacitances for the embodiment of Fig. 5 are as follows:

RESISTANCES CAPACITANCES

Rl= 10K ~ C1= 10~ .
R2= (variabl~) C2= 0.02 R3= lK C3= 0.1 R4= 2K C4= 0.1 R5= 10K C5= 0.02 R6= (variable) C6= 22 R7= 1.2K C7= 0O02 R8= 2K C8= 220fU
. . R9= 20K C9= 10 R10= 220K
R11= 10K
: : R12= 510K
R13= 2K
Rl~= lM
R15= lM
R16- lM
R17= lM
: 25 In the vperation o the respirating gas ~ supply system of the embodiment of Fig. lA,.gas from :~` the source 20:is passed th~rough line 34 to the : flowmeter 22. The needle valve (not shown) in .: ~ flowmeter 22 is set to contr:ol the rate of flow through ~ .
; 30 the fIowmeter 22. Gas ~lowing through the flowmeter 22 continues through line 36 to the capacitance 24. From capacitance 24 the gas passes Into line 42. ~The gas in : line 42 does not pass through the valve 26 until the valve 26 is actuated so that port 26b thereoE is .
:
: .

:: :
, .

~ '~

:
, connected to port 26a in the manner hereinafter described.
The cannula 48 is inserted in the nares of an in vivo respiratory s~stem. When a negative pressure is created by an attempted inspiration by the in vivo respiratory system, the neqative pressure is applied to the single ~ose 46.
For the apparatus shown in the embodi~ent oE
~ig. L~, valve 26 is normally in the posi~ion shown in Fig. lA with port 26a connected to port 26c. Upon inspiration a negative pressure is created in line 50. In the embodiment described above wherein sensor 28 is a P/E switch, for example, the negative pressure in line 50 acts upon the negative pressure input: port of the P/E switch. The P/E switch acc~rdingly closes the switch 3G of Fig~ 5.
For the appacatus shown in the embodiment of Fig. lC, the negative pressure in line 50 created by inspiration is applied to the control port 30b oE
fluidic amplifier 30. The negative pressure at control port 30b causes the power stream input of ampli~ier 30 to be deElected so that output occurs at the output port 30d rather than at the output port 3ae to which it is normally biased. The output from port 30d creates positive fluid signal on line 54 which is applied to the positive input port P/E s~Yitch 31. The P/E switch 31 accordingly closes the switch 36 of Fig. S.
` ~ With respect to the controller ~2 as depicted in Fig. 5, the closing of switch 36 completes a circuit between lines Ll and L2 and cau~es a false signal to be applied to input~port 72a oE NAND 72. Since the input port 72b normall~ receives a true signal (except when the negative pressure is sensed during a required minimum dela~ interval after the next preceeding application of gas in the manner hereirlaEter described), the output of NAND 7') iS true : , .: - .-,:
'~ : :
~ ~ ' ,, - ' , .

Accordingly, input terminal aoa of NOR gate 80 goes true. Likewise, all input terminals of NAND 76, ~OR
82, and NOR 84 ace true.
Unless an apnea event is detected as hereinafter described, or unless a true signal is received on line L4, the input terminal 80b i5 false.
At this point, the output o NOR ~ate 80 is false. The output oE NOR ~4 is also false.
False outputs fcom the NOR sates 80 and 84 are applied to pins 6 and 8 of the dual timer 90 Pin 6 is the trigger input of the Eirst timer included in the dual timer 90; pin 8 is the trigger input of the second timer included in the dual timer 90. As result of trigger pins 6 and 8 going from true to false, the outputs from corresponding pins 5 and 9 go true.
Cutput pin 5 o the dual timer 90 going true causes transistor Tl to conauct, so that a current is established on line L3~ The resultant electrical signal on line L3 causes the solenoid valve 26 to move from its normally biased position as shown i~ Fig. lA
to its second position where port 26b thereof is ~ connected to port 26a.
- Connecting port 26~ of the solenoid valve 26 to port 26a enables the gas in line 42 to be ; 25 transmitted throu~h the valve 26. It should be recalled that both the flowmeter 22 and the valve 26 ~-~ have inherent resitances to the flow o~ gas. ~'he resistance F~ of the flowmeter is generally greater than the resistance ~R of the valve 26~ Thus, as the valve 26 moves to connect port 26a to ports 26~, pressure in line 42 drops and, if the valve 26 remains - ~ in this position long enough, the rate of flow of the gas eventually is dictated by the resistance FR of the flowmeter 22.
Valve 26 thus allows a pulse of gas to pass from line 42 thcough valve 26, thcoush line 46 and :

' . . . :

. .
:: . . , , ,. ~ .: ~, .

-23a-cannula 48, and into the in vivo respiratory system.
As seen hereinafter, the duration of the pulse is determined by the length of the time the valve 26 remains in the position wherein port 26b is connected S to port 26a. The amplitude of the pulse is a function of the flow rate through t~e valvç 26. Incorporation of the flow~eter 22 and to the fluid suppl~ circuit of Fig. lA causes the pulse of gas produced to have a spike shape such as that shown in Fig. 4A. While the pulse of gases is being supplied, the LED g2 conducts to provide a visual indication of the same since the signal applied to transistor Tl is also applied to the LED 92 anode.
When the output pin 5 o~ the dual timer 90 goes false the pulse of gas supplied through the valve 26 is caused to terminate. In this respect,`a false ~; signal from pin 5 stops the transistor Tl from conducting, so that the signal on line L3 goes false.
A false signal on line L3 causes the solenoid valve 2 to return to its normall~ biased position as sh~wn in Fig. lA.
The time at wnich the outpu~ pin 5 of dual timer 30 goes false depends on the voltage value supplied to pin 2 of the dual timer 90. The voltage value at pin 2 of the dual timer gO is dependen. on the value chosen f~r the lOOK variable potential resistor R2. In this respect, the pulse of gas is suppl:ied until the voltage at pin 2 becomes two-thirds o~ the vol~age difference seen across pins 7 and 14. For the embodiment de~cribed herein with reference to the circuit values mentioned above, when the resistance value of resistor R2 is 35K, for example, a pulse of 0.5 seconds duration will be supplied.
As mentioned above, both timers in the dual timer 90 were triggered so that the output pins 5 and 9 became true. A true sL~nal on pin 5 moved the solenoid ~: :
'~

. : ~ .. .. : .; ,, . . :
: : . , . : . `' :' : : ~ ~.
' . ",'' ~:: `'

-2~-valve 26 as described hereinbefore. A true on pin 9, however, causes the N~ND gate 74 to go false, so that a false signal is supplied to the input terminal 7~b of NAND 72. The output of N~ND 72 thus goes true and remains true as long as pin 9 of the dual timer 90 is true.
While the output of NAND 72 remains l:rue, pin 6 of tne dual timer 90 cannot be triggered false. In this respect, pin 6 of the dual timer ~0 remains false and cannot transiti~on from true to false while pin 9 is true. This means that should the in vivo respiratory system attempt to inspire while pin 9 of dual timer 90 is still true, the attempted inspiration will have no eEfect on pin 6 of the dual timer 90, and hence no e~fect on the valve 26 so that an additional pulse of gas is not supplied. ~urther attempted inspirations are ineffectual until the output pin ~ of dual timer 90 goes false. The time at which the output pîn 9 of dual - timer goes false is selectively variable b~ the value chosen for the lOOK potential variable resistor R6. R6 affects the voltage value applied to the th.eshold pin 12 of the dual timer gO, which determines when the output pin 9 goes false.
Th~ value chosen for the resistor R6 determines a re~uired minimum interval between .
successive applications of gas to ~he in vivo respiratory system. This enables ~he apparat~s to 5upply a fixed volume dose o~ resplrating gas to the in vivo respiratory system per unit time. For the suggested circuit values given hereinbefore, resistor R6 chosen to have a value oE 73K gives a delay interval of 2.0 seconds. That is, when a negative pressure is sensed in the in vivo respiratory system, controller 32 ; will not permit a pulse of gas to be applied to the in vivo respirato~y system unless the required delay interval has elapsed since the sensing of negative .~ .
~:' ' ' , , ,.,.. -.. : , : - -- :: , ~ - , ~ : -. ~ . . . - , ., .
::
. . .

-25~ f~
pressure which resulted in the next preceding applica1:ion of gas to the in vivo respiratory system. In this manner, the in vivo respiratory system is protected from over oxygenation should the in vivo respiratory system attempt an abnormally true number of inspirations. Without this protection feature, the in vivo respiratory system would dangerously be supplied excess pulses oP gas when attempted inspirations are too frequent.
The foregoing method of requiring the elapse of a minimum delay interval between successive applications of gas to the in vivo respiratory system also enables the appara'us of the embodiment discussed herein to be operated when desired in accordance with the method described in United States Patent No.
4,4l4,982. The pulse has a duration which can be less than the duration of the inspiration.
When the apparatus of the embodiment of Fig. lA, for example, is op~rated in accordance with a mode of the method oP
United States Patent No. 4,414,982, the valve 26 returns to its normally biased position with port 26a connected to port 26c long before the negative pressure in the in vivo respiratory system has ceased. In this respect, the pulse of gas is supplied for a time period which is a fraction of the duration of inspiration.
Without the protective function of the second timer (and the effect of output pin 9 of the dual timer 90 on NAND 80 to prevent trigger pin 6 of the dual timer 90 from going from true to false), an additional pulse of gas would be supplied for the same inspiration. Thus, the protective function provided by the second timer of the dual timer 90 of controller 32 allows the valve 26 to return to its normally biasad position and provides a buPfer time interval in which the valve 26 cannot again be ~; 3o .: ~

., ............. ..

. .
~: :

. ~ :

actuated. Thus, controller 32 facilitates the usage of a single simple valve rather than a series of valves Moreover, controller 32 and the valve means associated therewith facilitates the use of a single hose 46 leading to a single hose cannula 48, which allows both negative pressure and positive pressure to be transmited through the same line 46.
;The operation of the embodiment of Fig. lB
basically resembles that of the embodiment of Fig. lA, but, rather than supplying a spiked pulse, the embodiment of Fig. lB supplies a square pulse such as that shown in Fig. 4B. The square pulse results from the fact that there is no flowmeter in the line connecting the source 20 the the valve 26. Thus, the pressure in the capacitance 2~ -- whether it be merely a length oE tubing or a tubing and a tank -- is the pressure of the source 22 rather than the pressure determined by the inherent resistance o~ the flowmeter. Thus, when valve 26 is opened to connect port 26a and port 26b, the only limiting influence on the flow of gas is the inherent resistance of the valve 26. ~ithout the inherent resistance FR of the flcwmeter to dampen the pulse, the pulse assumes a : square shape~ It is currently thou~ht that the s~uare shape mode allows a more accurate~dosage o~ volume flow to the cannula 48.
The operation of the embodiment of Fig. 2 also basic resembles that of Fig lA but further supplies a humidified pulse of gas to the in vivo ; 30 respiratory system. In the same manner described with :re~erence to the:Fig. lA embodiment, controller 32 ~:~caùses valve 58 to move to a position where a port 58b communicates with port 58d when an appropriate negative pressure is detected in the in vivo respiratory system. A pulse of gas then passes through line 60 to humidifier 62. A humidified pulse oE gas leaves .

t' ' , ,, .,. ' ' `
'` " , o,~ .r -~7-humidifier 62 and travels to the in vivo respiratory system on line 64 and 45. In this manner moisture provided by the humidifiees 62 does not contaminate ports 58a and 58c o valve 58, nor the sensor 28 connected thereto by line 50.
It should be apparent by the operatlon of the embodiment oE Fig. 1~ that the operation of the embodiment of Fig. 3 is substantially the same except that in the Fig. 3 embodiment the pulse of gas is zlso humidified by humidifier 62 before it passes to the in vivo respiratory s~stem. The pulse of gas leaves the valve 26 through line 46. A point 67 the pulse divides so tha-t a pulse first portion continues to travel on : line 46 to the input o~ venturi 70 and a pulse second :~ 15 pcrtion is supplied on line 65 to the input of the ~ humidifier 62. The resulting humidified gas Erom the .

humidifier 62 is applied on line 64 to nozzle 68 of the : . venturi 70~. The pulse of gas leaving venturi 70 is thus humidiEièd for application to cannula 48. Use of venturi 70 in this manner eliminates the need o~
additional or more complicated valving means and protects the humidifier 62 from higher pressures it might otherwise receive.

: With respect to the emhodiment of Fig. 6, a true signal on line L3 causes not only the valve 26 to allow the passage oE a pulse oE a ~irst gas therethrough,:but also causes the valve 126 to be actuated to connect the source 120 o~ the second gas to the cannula 48. In this respect, the true signal on 30 lines L3 and L3' cause valve 126 to be actuated so t~at port 126a is communicable ~ith port 126b. A pulse of second gas is thereh~ supplied through lines 144 and 46 to the cannula 48.
:: The duration of the pulse oE the second gas is determined in the same manner as the duration oE the pulse o~ the ~irst gas. The amplitude oE the pulse oE

.. -. ~ .: .
: ' . :
.

the second gas is determined in much the same manner as the amplitude of the first gas, being dependent on the inherent resista~ce VR of the valve 126 and the pressure of the source 120. It should be understood that, if deslred, the apparatus of Fig. 6 can operate in the spiked pulse mode by connecting a flowmeter between valve 126 and source 120.
The system of Fig 6 provides the same protective features for the in vi~o respiratory system as do any of the Eoregoing embodiments. Additionally, the second gas tsuch as an anesthetic), is supplied only when the Eirst gas ~such as oxygen) is also being supplied.
It has been described abo~e how the controller 3~ protects the in ~ivo respiratory system from overoxygenation should the in vivo respiratory sytem attempt an abnormally high number o~ -inspirations. The following ~iscussion illustrates how ~the controller 32 indicates that the in vivo - ~~0 respiratory system is failing to attempt a further inspiration within a maximum time interval.
As mentioned above, when an inspiratLon (negative pressure from the in vivo réspiratory system) is sensed, both input terminals of NOR 82 are true.
The resultant false output of ~OR 82 is applied to input pin 2 of the timer 88, as well as to the base of transistor T2. Transistor T2, bein~ a PNP type, conducts to discharge capacitor C8. The transition from a true ~o a false input ot pin 2 of timer 8~
30~ results in a true output on pin 3 of time~ 83. ~he ~`true output signal from pin 3 is applied to alarm circuit 100 so that the piezo element 96 therein remains inactive. Likewise, the true output si~nal from pin 3 is applied to both input terminals oE NOR
86, resultins in a false output signal ~rom ~OR 86 at point 10~. The false output from NOR 86 does not ~ - - .................................... .

:-:

>~ 3`3 trigger the LED 94 nor does it affect input terminal 80b of NOR 80.
When negative pressure is not sensed in the in vivo respiratory system, the output signal from NAN~
72 is false. This false output signal, appliecl to both input terminals of NOR 82, results in a true output from NOR 82. The true output signal from NO~ 82 is applied to the base of transistor T2, causing 1'2 to stop conducting. Pin 2 Oe timer 8~ is prevented from trisgering. As tra~sistor T2 stops conductin~, capacitor C8 charges up. When capacitor ca charges up to the threshold level of pin 6 o timer 88, the output pin 3 of timer 88 goes false. A false output on pin 3 of timer 88 energlzes the alarm circuit l00 so that an audible signal is produced by the pie o element 96 in a conventional manner. False signals applied to both input terminals o~ NOR 86 result in a true ~utput - signal at point 104~ The true signal at point 104 energizes the LED 94 to indicate an apneic event.
The true signal at point 104 is also applied to the input terminal 80b of NOR 80. Since the output signal of NAND 72 applied to terminal 80a o~ NOR 80 is false, the output terminal of NO~ 80 goes false. The transition ~rom true to false at pin 6 of the timer 88 causes a pulse of gas to be supplied ;to the in vivo respiratory system in the manner described above. If no further attempted inspiration is sensed, se~uential pulses of gas are supplied in ~he same m~nner.
From the ~oregoing it should be apparent that a timer 90 provides a maximum time interval, and that the in vivo respiratory system must attempt a further inspiration before the expiration o~ the maximum time interval. If the maximum time interval ls e~ceeded by the lapse of time from a next preceeding application of a pulse oE gas to a sensing of negative pressure, the timer 90 Eunctions to activate both the audible alarm :: :

:, ..
:~ .

of circuit 100 and the visible alarm of LED 94, as well as to trigger timer 90 so that a further pulse of gas is provided. The duration of the maximum time interval depends on the particular valve of the resistance Ra, Rb, Rc,...manually chosen by the switch 100. This resistance valve determining the rate at which capacitor C8 charges, which in turn determines the time at which the threshold voltage applied to pin 60 of the timer 88 is sufficiently high for the output state of pin 3 thereof to change.
The apparatus of the embodiment of Fig. 8A
somewhat resembles the apparatus of the embodi~ent of Fig. lC~ but the apparatus of Fig. 8 has its sensor 28C' adapted for compatibility with an apnea detection and occlusion prevention (ADOP) circuit 200~ The ADOP
circuit 200 is a predominately fluidica~ly operated circuit comprising a first fluidic timing circuit 202;
a fluidic NOR gate 204; a second fluidic timing circuit 206; and, valve means 208.
The sensor circuit 28C' resembles the circuit 28 of Fig. 5 with two exceptions: (1) point 104 intermediate LED 94 and NOR 86 is not tiea to the input terminal 80b of ~OR 80, and (2) the output port 30c of fluidic amDlifier 30 is connectea by a line 210 to a ; 25 point 212 in the first timing circuit 202.
Point 212 of the timing circuit 202 is connected by parallel lines 214 and 216 to a point 218. Intermediate points 210 and 212, line 214 has a fluid resistance 220 thereon while Iine 215 has an ~; 30 exhaust means, such as a mushroom valve 222, thereon.
The mushroom exhaust valve 222 is oriented so that a fluid signal from point 210 is transmitted to point 2I2, but a fluid signal from point 212 to the valve 222 is rapidl~l exhausted to atmosehere.

.

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-31~
Point 212 of the timing circuit 206 is connected by line 224 to a first capacitance, such as variable colume elastomeric capacitance 226. Capacitance 226 is adapted to function in the manner of a comparable capacitance similarly depicted in United States Patent No. 4,414,982, but has a considerably longer potential voiume for rea,ons seen hereinafter. Point 22~ of circuit 202 is connected by line 228 of the NOR gate 226.
NOR gat~ 204 comprises a power stream input port 204a connected to a source 230; a control po~t 204b; a first output port 204c; and, a second output port 204d. Line 228 is connected to the control port 204b. A line 232 is connected from output port 204d to the second fluidic timing circuit 206. NOR gate 204 is of a type that, unless a signal is applied at port 204b to deflect output to port 204d, provides output at port 204c.
Output port 204d of NOR gate 204 is connected by lines 23~ and 234 to a positive pressure input terminal of a conventional pressure-to-electric tP/E) switch 236. Switch 236 is connected by an electrical line L9 to indicator means 240 which includes, for example, one or more oE the following:
audible alarm means, visual alarm means, and counter means.
The ~econd fluidic timing circuit 206 is essentially a fluidic one-shot comprising a first output port 206a vented to atmosphere; a second output port 206b connected via line 240 to the valve 208 a first input port ~06c connected to a sGurce 203;
a second input port 206d; and, a third input port 206e. Input port 206d is connected by line 232 to output port 204d of the NOR
204. The fluidic timing circuit 206 further comprises a substantially closed-loop fluidic path 242 which has a first end thereof communicating ~

. ~, `_l. . ~

'~
:", with port 204d and a second end thereo~ communicating with port 20~e. The fl-lidic path 244 has thereon one or more timing means, such as a fluid restrictive device 246 and/or a capacitance device 248. As shcwn in the embodim-ent of Fig. 8, the restrictive device 246 is a variable resistor and the capacitance 24t3 is a variable capacitance, such as an elastomeric balloon.
The restrictive device 246 and capacitance 248 can be intecchanged with similar restrictive devices Qr capacitances having~different values and c~pacitances as desired.
As mentioned above, output port 206b of the fluidic timing circuit 206 is connected via line 240 to the valve means 208. Valve 208 as shown is a two-way~
two position solenoid spool valve, such as an PbLCON
Series A Model 7986 valve. Although any suitable conventional valve may be utilized. Valve 208 has two -port 208a and 208b in its bore. Valve 208 is ~onnected so that a positive pressure on line 240 moves the valve ~20 208 into the position shown in Fig. 8A wherein port `~ 208a thereaf is connected to port 20t3b.
Port 208b of valve 208 is connected by line 250 to a point 2~2 on line. A fluidic resistor 25~ on - line 250 insures that the path of least resistance from the cannula 48 is through the line ~6 and through the valve 26 rather than through line 250.
~; Port 208a of valve 208 is connected by a line 256 to a capacitance 258, which in turn is connected by ;~ ~ line 260 to a flowmeter 252. Flowmeter 262 is connected by line 264 to a pressure regulator 266.
~ Pressure regulator 266 is connected to a source 268.
^~ The embodi~ent of Fig. 8B basically resembles ~ the embodiment o~ Fig. 8A but does not employ t:he `-~ second fluidic timing ciccuit 206 and the valve means 208. Instead, the po itive pressure port of the P/E
~; switch 236 is directly connected to the output port : : -. .
.
. , ,.,, :, . , :

: .

204d of NO~ 20~. The electrical output of the P/E
switch 236 is connected a electrical line L10 t~ a conventional electrom~ographic electrode 270.
Electrode 270 is positioned under the chin oE a patient in close proximity to a hypoglossal nerve (the twelfth cranial nerve).
The opeeation of the apparatus of the ernbodiment oE Fig. 8A basically resembles the operation of the embodiment of Fig. lC. ~owever, with the controller 32' of Fi~g. ~A, when the timer 88 of controller 32' determines that the in vlvo resplratory system has not attempted a further inspiration before the e~piration of a first maximum time lnterval, timer 90 ls not trlggered to provide a further pulse o.
gas. Moreover, althoug~ a short apnea event correspondlng to the first maximum time intervat has already occurred and been indicted by LED 94 and alarm circuit 100, the embodiment of Fig. 8A urther functions to (1) deter~ine when the in vivo respiratory system has failed to attempt a further inspirat:ion before the inspiration of a second ma~imum time : . interval (the second maximum time lnterval being greater than the first macimum time interv~l and indicative of a long apnea event), and (2) to p~ovide a . 25 high pressure pulse of gas to the in vivo respiratory system in an attempt to dislodge any occlusion or obstruction in the upper airway passages of the in vivo respiratory system~
~:: In the above regard, when output indicative of non-negative pressure in the in vivo respiratory system occurs at port 30e of ampliEier 30, the output is applied to the first fluidic timing circuit 202.
; The fluidic output signal travels around line 216 of : circuit 202, closing the mushroom valve 222. Fr.om thence the signal i5 applied to the variable capacicance 2 6 on line 224. The fluid signal is .

--3~--continuosly applied to the variable capacitance device 226 so long as output occurs at port 30e of amplifier 30 .
In normal breathing the output of amplifier 30 will switch to port 30d long before the variable capacitance device 226 is filled to its maximuM
capacity. In this regard, it is recalled that amplifier 30 switches its output from port 30e to port 30d when an inspiration is sensed. In this case, the patient is breathin`g satisfactorily and there is no apneic event.
In abnormal breathing, however, when the patient fails to inspire, amplifier 30 continues to generate a fluid signal on output port 30e.
Accordingly, the variable capacitance device 226 continues to expand until it is inflated to its maximum capacity. When the variable capacitance device 2~6 is inflated to a pressure which expands it to its maximum capacity, the fluid pressure builds on line 228 and causes the power stream entering port 204a o NOR ~ate ; 204 to switch from output port 204c to output port ; 204d. In this manner, the NOR gate 20~ creates a fl~id ;~ signal on line 232. The fluid signal on llnes 232 and 234 are connected to the pressure/electric s~itch 236 which converts the fluid si~nal on line 234 to an electric signal on line L9. The electric signc~l can perform various diagnostic operations, such as activate , an electrocardiogram (ECG) monitor, an alarm, or a counter Various sizes and types of elastomeric balloons or other appropriate devices may be chosen for the variable capacitance device 226. Factors to be considered in making the choice of which device to use include the elastomeric tension exerted by the device and the ma~imum ~luid-storing capacity o the device.
For example, if it weLe desired that the apneic event ~ .

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.

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circuit 200 indicate that the patient has not inspired within a 60 second-second maximum time interval, the device 226 should be selected so that it can accommodate the volume of fluid generated by amplifier 30 for that 40 second period ~ithout triggering a s~itch in NOR gate 204. Of course, should the patient inspire beEore the variable capacitance device 226 reaches its maximum pressurized caoacity, the device 226 acting in conjunction with the mushroom valve 222 is quickly de~lated~in the manner described above.
It should be evident from Fig. 8A that, absent a fluid signal on line 232, the power stream entering port 206c of ~he circuit 206 ls vented to - atmosphere through output port 206a ~owever, when the lS fluid signal is applied on line 206d, the power stream entering at port 206c is deflected to the output port 206b for a period of time in the manner hereinafter described.
Upon application o~ the fluid signal on line 232 to the port 206d of the second circuit 206, the power stream enter ing port 206c is deflected from the output port 206a to the output port 2a6b, thereby creating a fluid signal on line 240 which is applied to the vaLve means 208. The fluid signal on line 232 is also applied to the fluidic path 244 whlch has thereon ~ timing means~(such as the resistance 246 and the `~ ~ capacitance device 2~8). The timing means delays the passage of the first fluid signal around the closed loop fluidic path 244 for a pre-determined time. That is, an appr~opriate value is chosen for the resistance of the varia~le resistor 246 and a capacitance device 248 of appropriate maximum capacity is chosen so that the first fluid signal travelling around the closed loop fluidic circuit 244 will be delayed for a pre-determined time before the signal reaches the port 206eof the fluidic circuit 206. When the fluid signal `

:
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~: ' .?~

travelling around the closed loop fluidic path 244 reaches the port 206e, the fluidic pressure on each side of the power stream entering at port 206c is equalized so that the power stream is no longer deflected out the port 206b but instead is again vented to atmosphere through the port 206a.
The valve 208 receivés a supply of ~as ultimately from source 268 but can transmit the gas only when a fluidic signal is applied on line 240 in the manner described above, When a fluidic signal is applied on line 240, the valve 208 is operated to connect port 208a thereof to port 208b for a time period whose duration is determined by the duration o the signal on line 240. As seen above, this duration o~ the signal on line 240 ls determined by the selected values associated with the resistance and capacitance of the d'elay loop 244~
~ Valve 208 functions to provide a high pressure pulse of gas to through line 250 to ,the single '~ 20 hose cannul~ 48 in an effort to dislod~e an upper airway obstruction or occlusion which may have caused ~,~ the long apnea event. In some instance the pressure supplied by the pulse should,be as high as 50 pounds per square inch~ The amplitude of the pulse is ~ 25 controllable through the various devices (re~ulator '~ ~ 266, capacitance 258, flowmeter 262] shown connected intermediate valve 208 and source 268.
It should be understood that various methods can be used to operate''the apparatus of FigO 8A. For example, in one mode of operation a high pressure pulse of limited duration is applied. In another embodiment the fluid circuit 206 can be adapted so that a high ;~ pressure pulse trails off to a continuous flow of lesser pressure It can yet be envisioned that a series of hish pressure pulses can be applied in a pro~ra~nable manner.

::

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The embodiment of Fig. 8s functions much in the manner of Fig. 8A but, rather than supply a high pressure pulse of gas through a valve means, uses the P~E switch 236 to generate an electrical signal on line L10 for application to the electrode 270. Electrode 270, positioned under the chin in close proximity to a nerve controlling a muscle or the like, such as the hypoylossal nerve for the tongue, provides stimulus for the muscle to dislodge itself from the upper airway so that the movement of the muscle and associated organs can gain be in coocdin~ion with the diaphragm of the in vivo respiratory system.
Fig. 8C illustrates a further embodiment of the invention which accomplishes objectives similar to that of the embcdiment of Fig. 8A. The apparatus of Fig. 8C resembles the apparatus o~ Fig. 6. The ; controller 32' of Fig. 8C, however, does not have its poi~t 104 connected to the input terminal 80b of NOR
80. Rather, point 104 is connected by line L7 to a two-position two port solenoid spool valve 272. Valve 272 of Fig. 8C is connected to a source 268 in much the same manner as valve 20~ of Fig. 8A is connected to source 268.
In the operation of the embod}ment of Fig.
8C, whenever controller 32' determines that an apnea event ~having a duration corresponding to a predetermined yet variably selectable maximum time interval established by the position of switch lQO~
occurs, a high pressure pulse of gas is supplied through the operation of valve 272 in a manner easily understood from the foregoing other embodiments.
It should be understood that sensing means ~ 28C of the embodiment of Fig. lC may be used with any `~ of the embodiments disclosed herein. Also, each of the disclosed embodiments may be appropeiately modified as ; ~ ~ discussed above to ope~a~e in either a spilced pulse o~
: .

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a s~uare pulse rnode. Further, it should be unclerstood by those skilled in the art that the solenoid operated spool valves disclosed herein may be replaced with latching solenoid valves, such as the Neutronics Series 11 valve.
The embodiments of the invention in which an exclusive property or privilege is claimed are defined by the following:

.
: .

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, :
:~:
~: :

: , .

Claims (21)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN
EXCLUSIVE PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS
FOLLOWS:
1. An apparatus for sensing negative pressure indicative of inspiration in an in vivo respiratory system and for supplying gas to said in vivo respiratory system, said apparatus comprising:
means for sensing negative pressure in said in vivo system;
valve means operable for selectively supplying said gas to said in vivo system;
control means responsive to said sensing means for operating said valve means whereby said gas is supplied to said in vivo system for at least a portion of the time duration of an occurrence of sensed negative pressure;
first timer means connected to said sensing means for determining when a first predetermined time interval has elapsed since the last occurrence of negative pressure in said in vivo system; and, means responsive to said first timer means for stimulating a nerve associated with upper airway in vivo neuro-muscular tissue that will displace said tissue when stimulated whereby an upper airway passage in said in vivo respiratory system is not occluded, said stimulation occurring upon the elapse of said predetermined time interval.
2. The apparatus of claim 1, wherein said in vivo tissue is a tongue.
3. The apparatus of claim 2, wherein said in vivo tissue comprises pharyngeal muscles.
4. The apparatus of claim 1 further comprising second timer means connected to said sensing means for determining when a second predetermined time interval less than said first predetermined time interval has elapsed since the last occurrence of negative pressure in said in vivo system without a further occurrence of negative pressure in said in vivo system; and, counter means for counting the number of events wherein the time interval between successive occurrences of negative pressure in said in vivo system is greater than said second predetermined time interval.
5. The apparatus of claim 1, wherein said airway is the oropharyngeal airway.
6. The apparatus of claim 1, wherein said nerve is the hypoglossal nerve.
7. A method for supplying gas to an in vivo respiratory system and for monitoring the condition of said in vivo respiratory system, said method comprising the steps of:
sensing negative pressure in said in vivo respiratory system;
using valve means to selectively supply gas to said in vivo system;
controlling the operation of said valve means whereby gas is supplied to said in vivo system for at least a portion of the time duration of an occurrence of sensed negative pressure;
determining when a first predetermined time interval has elapsed since the last occurrence of negative pressure in said in vivo system; and, stimulating a nerve associated with upper airway in vivo neuro-muscular tissue that will displace said tissue when stimulated whereby an upper airway passage in said in vivo respiratory system is not occluded, said stimulation occurring upon the elapse of said first predetermined time interval.
8. The method of claim 7, wherein said in vivo organ is a tongue.
9. The method of claim 7, wherein said in vivo organ comprises pharyngeal muscles.
10. The method of claim 7, wherein said airway is the oropharyngeal airway.
11. The method of claim 7, wherein said nerve is the hypoglossal nerve.
12. An apparatus for detecting an apnea event in an in vivo respiratory system and for removing an upper airway obstruction associated with an obstructive apnea event, said apparatus comprising;
means for sensing negative pressure in said in vivo system;
first timer means connected to said sensing means for determining when a predetermined time interval has elapsed since the last occurrence of negative pressure in said in vivo system; and, means responsive to said first timer means for stimulating a nerve associated with upper airway neuro-muscular tissue that will displace said tissue when stimulated to dislodge an occlusion of an upper airway passage in said in vivo respiratory system, said stimulation occurring upon the detection of the elapse of said pre-determined time interval.
13. The apparatus of claim 12, wherein said in vivo tissue is a tongue.
14. The apparatus of claim 12, wherein said in vivo tissue comprises pharyngeal muscles.
15. The apparatus of claim 12, wherein said airway is the oropharyngeal airway.
16. The apparatus of claim 12, wherein said nerve is the hypoglossal nerve.
17. A method of detecting an apnea event in an in vivo respiratory system and of removing an upper airway obstruction associated with an obstructive apnea event, said method comprising the steps of:
sensing negative pressure in said in vivo respiratory system;
determining when a predetermined time interval has elapsed since the last occurrence of negative pressure in said in vivo system; and stimulating a nerve associated with upper airway neuro-muscular tissue that will displace said tissue when stimulated to dislodge an occlusion of an upper airway passage in said in vivo respiratory system, said stimulation occurring upon the elapse of said first predetermined time interval.
18. The method of claim 17, wherein said in vivo tissue is a tongue.
19. The method of claim 17, wherein said in vivo tissue comprises pharyngeal muscles.
20. The method of claim 17, wherein said airway is the oropharyngeal airway.
21. The method of claim 17, wherein said nerve is the hypoglossal nerve.
CA 553180 1982-12-03 1987-11-30 Respirating gas supply method and apparatus therefor Expired CA1261943A (en)

Priority Applications (8)

Application Number Priority Date Filing Date Title
US06446543 US4506666A (en) 1982-12-03 1982-12-03 Method and apparatus for rectifying obstructive apnea
US06446542 US4462398A (en) 1982-12-03 1982-12-03 Respirating gas supply method and apparatus therefor
US06446810 US4461293A (en) 1982-12-03 1982-12-03 Respirating gas supply method and apparatus therefor
US446,543 1982-12-03
US446,542 1982-12-03
US446,810 1982-12-03
CA 442491 CA1261943C (en) 1982-12-03 1983-12-02
CA 553180 CA1261943A (en) 1982-12-03 1987-11-30 Respirating gas supply method and apparatus therefor

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
CA 553180 CA1261943A (en) 1982-12-03 1987-11-30 Respirating gas supply method and apparatus therefor

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US4570631A (en) 1986-02-18 grant
US4519387A (en) 1985-05-28 grant
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US4462398A (en) 1984-07-31 grant
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US4506666A (en) 1985-03-26 grant
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EP0127675A4 (en) 1987-01-22 application
CA1231416A1 (en) 1988-01-12 grant
US4461293A (en) 1984-07-24 grant
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WO1984002080A1 (en) 1984-06-07 application
CA1261943C (en) 1989-09-26 grant

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