EP1379306A1 - Dispositif pour la respiration artificielle - Google Patents

Dispositif pour la respiration artificielle

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Publication number
EP1379306A1
EP1379306A1 EP02735246A EP02735246A EP1379306A1 EP 1379306 A1 EP1379306 A1 EP 1379306A1 EP 02735246 A EP02735246 A EP 02735246A EP 02735246 A EP02735246 A EP 02735246A EP 1379306 A1 EP1379306 A1 EP 1379306A1
Authority
EP
European Patent Office
Prior art keywords
aerosol
perfluorocarbon
ventilation
patient
gas
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.)
Ceased
Application number
EP02735246A
Other languages
German (de)
English (en)
Inventor
Michael Kandler
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.)
Individual
Original Assignee
Individual
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Priority claimed from DE10118146A external-priority patent/DE10118146A1/de
Priority claimed from DE10133247A external-priority patent/DE10133247A1/de
Application filed by Individual filed Critical Individual
Publication of EP1379306A1 publication Critical patent/EP1379306A1/fr
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0026—Blood substitute; Oxygen transporting formulations; Plasma extender
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/02—Halogenated hydrocarbons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0054—Liquid ventilation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0463—Tracheal tubes combined with suction tubes, catheters or the like; Outside connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0475—Tracheal tubes having openings in the tube
    • A61M16/0477—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids
    • A61M16/0484—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids at the distal end
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M11/00—Sprayers or atomisers specially adapted for therapeutic purposes
    • A61M11/06—Sprayers or atomisers specially adapted for therapeutic purposes of the injector type
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816—Joints or connectors
    • A61M16/0833—T- or Y-type connectors, e.g. Y-piece
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES 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
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/04—Liquids
    • A61M2202/0468—Liquids non-physiological
    • A61M2202/0476—Oxygenated solutions

Definitions

  • the invention relates to a device for artificial ventilation of a patient by supplying a perfluorocarbon, the device having an aerosol generator, with the aid of which an aerosol of the perfluorocarbon is formed.
  • a cause of respiratory distress syndrome RDS, also known as hyaline membrane disease, which is particularly common in premature infants, is the lack of natural lung surfactant. In adults, this syndrome can occur after damage to the lungs, for example due to shock-inducing trauma, burns or infection.
  • the endogenous surfactant has the vital function of reducing the surface tension of the natural fluid film on the alveoli. The consequence of a ' surfactan ' is an increase in the surface tension and a collapse of the alveoli (atalectasis) and often of the entire lungs.
  • the collapsed area of the lungs cannot be ventilated and cannot participate in the gas exchange.
  • the same amount of work has to be done with each breath as when the first time the air was filled with air.
  • the breathing work of the spontaneously breathing patient is massively increased.
  • the following strain on the body leads to its exhaustion, the strain on the lungs leads to an intensification of the pathological condition. Due to insufficient supply of the body with oxygen and toxic accumulation of carbon dioxide in the body, this leads to especially in newborns, at a mortality rate of up to over 30%.
  • the ventilation measures can be used in different forms (e.g. continuous positive air pressure, CPAP; intermittent mandatory ventilation, IMV).
  • CPAP continuous positive air pressure
  • IMV intermittent mandatory ventilation
  • the pressurized breathing gas e.g. an oxygen-air mixture
  • considerable shear forces act on the walls of the respiratory tract and alveoli.
  • the stretching effects of the described process lead to a further intensification of the disease in the form of an increase in lung damage.
  • surfactant can be instilled as a medication through the endotracheal tube (ventilation tube that is inserted into the trachea).
  • endotracheal tube ventilation tube that is inserted into the trachea.
  • Perfluorocarbons are polyfluorinated carbons, ie compounds whose carbon skeleton is at least partially perfluorinated but which can also contain other halogen substituents, such as bromine. They are clear, chemically completely inert compounds that have long been used in many technical fields. In medicine, too, they were used as a blood substitute as a substitute for surfactants before they were discovered, since oxygen, carbon dioxide and other gases are very readily soluble in them, which means that they have a two to three times greater oxygen and CO 2 capacity than blood. They therefore have a double effect, on the one hand as a surfactant-like substance and on the other hand as a means of transport for gases, especially oxygen and carbon dioxide.
  • perfluorocarbons have also been used to treat the lungs and in the field of artificial fluid ventilation.
  • WO 95/31 191 discloses a method for facilitating the breathing of a patient, in which a liquid containing perfluorocarbon is filled into the lungs, in order thereby to enable the patient to breathe without a ventilator.
  • EP 583 358 B1 describes the use of liquid fluorohydrocarbons as medicinal products for partial use
  • Partial liquid ventilation The Fluorocarbon liquid used in an amount of 0.1% to 50% of the patient's total lung capacity.
  • Aerosol technology is therefore increasingly developing into small dosing inhalers, in which individual sprays are to be inhaled by the patient, but which are not aimed at prolonged ventilation.
  • Dirnagel the most important obstacle to methodological improvements is in Atemw.- Lurgikrh. Volume 1 2, No. 5, 1 986, page 21 2 to 21 5, the strong dependence of aerosol deposition on factors that have nothing to do with the technique of aerosol generation, but on the behavior of the patient and the anatomical and functional state of his respiratory tract be determined.
  • aerosols are already used in artificially ventilated patients, their use has so far been restricted to the admixture of drugs to a breathing gas.
  • EP 908 1 78 A1 which, like the aforementioned EP 583 358, deals with partial liquid ventilation using perfluorocarbons, an aerosol on the fluorocarbon with a medicinal product is mentioned, but there is no indication of the administration of the Respiratory fluid itself, still on a device that would be suitable.
  • Nozzle nebulizers and ultrasound nebulizers have also been used, but the aerosol was administered separately from breathing gas / liquid (Matthys, Lung (1 990) Suppl.:645-652; Montgomery et al., CHEST (1 995), page 774).
  • the object of the present invention was therefore to provide a device for artificial ventilation of a patient with the aid of a perfluorocarbon in aerosol form, which at least partially avoids the disadvantages of the liquid ventilation methods of the prior art.
  • the object is achieved by a device for ventilating a patient by supplying a perfluorocarbon to the lungs, the device having a respirator, an aerosol generator and a tube system with a tube area connecting the tubes, in contact with the patient and comprising an endotracheal tube, wherein the device is characterized in that the aerosol generator is arranged in the tube area carrying gas in the inhalation and exhalation phase or distal thereof in the patient.
  • Aerosols of perfluorocarbon allowed as a ventilation medium are not known in the prior art.
  • the device according to the invention thus enables a new type of ventilation with the aid of Perfluorocarbons, which are administered in the form of an aerosol.
  • the device according to the invention makes it possible to get by with a minimal amount of perfluorocarbon and to distribute this amount evenly very quickly over the entire surface of the lungs. Another advantage is that there is no fluid accumulation and the lung volume is not reduced by fluid filling. The influence on the patient is therefore significantly less and the risk, which is inevitable when the breathing mechanism changes due to fluid in the lungs, is reduced. In addition, the device according to the invention is easy to handle.
  • a ventilator suitable as the basis of the device according to the invention can be any standard ventilator which supplies the breathing gas to the patient via an endotracheal tube or a similar device.
  • the Nelcor Infantstar 950 C is suitable.
  • the respirator used in the device according to the invention will be one that has a tube system made up of at least two ventilation tubes. Respiratory gas is led to the patient through one of these tubes and away from the patient through the other. Usually, both hoses are brought together at a certain point by a Y-piece.
  • the Y-piece is usually connected to the endotracheal tube via a tube connector.
  • This connector (tube connector) is provided on many ventilators so that endotracheal tubes of different diameters can be connected to the Y-piece, depending on whether the patient is an animal, a child or an adult.
  • the tube area through which the ventilation medium can flow in both directions is called the tube area referred to, which is gas-carrying in the inhalation and exhalation phase.
  • the remaining tube areas are only gas-carrying either in the inhalation phase or in the exhalation phase.
  • This area which carries gas during the inhalation and exhalation phases thus comprises the endotracheal tube, if present the tube connector and the base of the Y-piece.
  • the aerosol generator is arranged in such a way that the aerosol is formed in the tube area carrying gas in the inhalation and exhalation phase or distally thereof in the patient.
  • this means that the aerosol generator is arranged in such a way that the aerosol is formed in the region labeled "P" or distally thereof.
  • the distance that the aerosol must travel in a tube or tube to the patient is preferably as short as possible.
  • the aerosol generator is particularly preferably arranged directly in the endotracheal tube.
  • the aerosol generator is preferably arranged such that the aerosol is formed inside the patient, preferably in the region of the trachea (so that distribution in the deep airways is ensured) and even more preferably in the region of the lungs.
  • the aerosol generator can also be arranged distally from the end of the endotracheal tube, that is to say it can project into the patient beyond the endotracheal tube. In this embodiment, any contact of the aerosol with tube walls is avoided, so that the aerosol can be freely distributed in the trachea or the bronchi or lungs (depending on the arrangement).
  • the formation of the aerosol in the patient's body allows very good control of the properties of the aerosol, such as the size of the aerosol particles, the droplet size spectra, the fog densities and amounts of mist. If an aerosol is applied using a mask or a mouthpiece or hose, it can happen that larger amounts of aerosolized substance are wasted. If, however, the aerosol is formed in the patient's body, the smaller distance that the aerosol droplets have to travel to the surface of the lungs makes it easier to control the size, distribution and quantity. This avoids condensation of the aerosol in the ventilation hose and thus the amount of aerosol that is supplied to the patient is reduced.
  • the aerosol generator according to the invention is a device at the end of which the aerosol emerges. It can consist of a nozzle, a hose, a catheter or a similar device.
  • the catheter tip can be arranged in the interior of the tube area carrying gas in the inhalation and exhalation phase, preferably in the endotracheal tube.
  • the catheter tip is particularly preferably at the end of the endotracheal tube, or it protrudes somewhat beyond it into the patient.
  • the present invention it is also possible and preferred for the present invention to design the endotracheal tube so that it itself takes over the function of an aerosol generator.
  • cavities in particular tubes, can be arranged in the walls of the endotracheal tube, which have openings either on the inner wall of the endotracheal tube or in the outer wall or both. These openings can then act like a nozzle, the aerosol being formed at the openings.
  • the manner in which the aerosol is generated is not critical to the present invention and can be carried out by all suitable methods, such as, for example, using a single-component nozzle, a two-component nozzle, atomization by centrifugal force, condensation, evaporation, propellant gas, dispersion, ultrasound, nozzle atomization etc. (see above). Ultrasonic and nozzle atomization are particularly preferred. Combinations can also be advantageous under certain circumstances.
  • Each type of aerosol generation can be combined with a catheter.
  • the aerosol is preferably generated by mixing the perfluorocarbon with a suitable ventilation medium.
  • the ventilation medium is preferably an air-oxygen mixture, but other suitable mixtures or air or oxygen can also be used as such.
  • the device particularly preferably has a nebulization catheter.
  • a suitable catheter is, for example, the Trudell nebulization catheter from Trudeil Medical Group.
  • This technique consists of a very small catheter (0.1 to 2 mm outer diameter, depending on the type) and uses a pressurized liquid / pressurized gas nebulization technique to form an aerosol at the extreme end of the catheter. It consists of a single extrusion with multiple gas and liquid capillaries. These capillaries converge and end in tiny openings at the very end of the catheter. Gas and liquid flow through the respective capillaries and exit through the openings. The close contact between the gas and the liquid result in an extremely efficient nebulization with low gas flow rates ranging from about 1 ml / min to 0.05 l / min. Any gas mixture with a pressure above 50 psi can be used to operate this system.
  • An oxygen-air mixture is particularly suitable for the present invention, but it can also other conventional ventilation gases known to those skilled in the art can be used.
  • the jointly controlled supply of gas and liquid in a separate device is also possible.
  • the fluid can be introduced in coordination with the inspiratory phase of a ventilator or continuously by syringe by hand or by machine.
  • the catheter releases more than 95% of the original volume of fluid into the lungs.
  • the particle size of the aerosol droplets can be adjusted in advance or selected by regulating the ratio of solution / liquid. This can also be achieved by choosing a suitable catheter type. As a result, aerosols with average aerosol particle diameters of approximately 5 ⁇ m and above can be achieved, depending on the desired output and gas flow.
  • perfluorocarbons which are also suitable for partial liquid ventilation can be used as perfluorocarbons.
  • Perfluorocarbons are understood to mean non-toxic, preferably liquid, fluorinated carbon compounds which are suitable for gas exchange and which are therefore suitable for the ventilation of human or animal patients. Instead of fluorine, they can also be substituted with other halogens.
  • Perflubron perfluorooctyl bromide, PFOB, C 8 F 17 Br
  • perfluorodecalin C 10 F 18
  • F2-Chemicals GB FC 77 (C 8 F 17 O), FC 5080 (C 8 F 18 ) are particularly suitable.
  • the amount of perfluorocarbon in aerosol form which is advantageously used depends, in particular, on the properties of the respective perfluorocarbon or perfluorocarbon mixture vapor pressure and viscosity. It is important that the lung surface is reached by the aerosol in such a way that sufficient gas exchange can take place and that the lung surface is adequately coated with perfluorocarbon. The surface of the lungs should be wetted, but larger fluid collections are not necessary and not desirable.
  • Another aspect of the present invention is the use of an aerosol generator to generate an aerosol of a perfluorocarbon suitable for ventilation of a patient in combination with a ventilation device. Any of the above-mentioned aerosol generators can be used as the aerosol generator.
  • Another aspect of the present invention is the use of perfluorocarbons in the form of aerosols as artificial agents
  • Perfluorocarbon is used. Perfluorocarbons in the form of
  • Aerosols are therefore suitable as agents for the treatment of ARDS and RDS
  • Another aspect of the present invention is therefore a
  • Endotracheal tube encompasses and in contact with the patient tube area in aerosol form and supplies the lungs.
  • Another embodiment of the present invention is that the perfluorocarbons are used in combination with drugs.
  • the perfluorocarbon supplied as an aerosol also fulfills the transport function for the medicinal product.
  • the distribution of the medication to be introduced is made possible in lung areas that are difficult to access or previously closed.
  • the medicament is introduced into the perfluorocarbon by means of a suitable process, such as emulsification, micellation or also by means of additional mediators.
  • the drugs may also be added to the perfluorocarbon, e.g. packaged in liposomes or viral vehicles, such as vectors.
  • the appropriate type of admixture or packaging of the medicinal product can be used by the person skilled in the art depending on the substances used. It is also possible to use the drug in the form of PulmoSpheresTM (available from Alliance) in combination with the perfluorocarbon.
  • the present invention allows targeted and more effective treatment of serious diseases such as cystic fibrosis.
  • Figure 1 shows a device according to the invention, consisting of a conventional ventilator (1) which is connected to the patient (4) by an endotracheal tube (2) and an aerosol generator (3).
  • a conventional ventilator (1) which is connected to the patient (4) by an endotracheal tube (2) and an aerosol generator (3).
  • two tubes (5, 6) Connected to the ventilator are two tubes (5, 6) through which breathing gas can flow. Gas always flows through one tube (5) towards the patient (inhalation), through the other tube (6) always away from the patient (exhalation).
  • the two tubes (5, 6) meet at a Y-piece (7) and are thus connected to the endotracheal tube by a tube connector (8).
  • the tube area labeled P is the gas-carrying area in the inhalation and exhalation phases.
  • the aerosol generator is arranged in such a way that the aerosol is formed in area P, which is gas-carrying both in the inhalation and exhalation phases, here in particular at the end of the endotracheal tube.
  • Figure 2 shows a Trudell catheter (9) that is inserted into an endotracheal tube (22).
  • the aerosol (10) is formed at the tip of the catheter in the patient's body.
  • Figure 3 shows the arterial oxygen partial pressure (PaO 2 ) as mean ⁇ SEM before and after induction of lung failure, during therapy with aerosol-PFC, FRC-PLV, LV-PLV, control and during the observation phase after treatment in surfactant-depleted newborn piglets.
  • Figure 4 shows the PaCO 2 as mean ⁇ SEM before and after induction of lung failure, during therapy with aerosol PFC, FRC-PLV, LV-PLV, control and during the observation phase after treatment in surfactant-depleted newborn piglets.
  • Figure 5 shows the terminal compliance C20 / c as mean + SEM to determine the terminal dynamic compliance and lung expansion.
  • High C20 / c values indicate high terminal dynamic compliance and a reduction in lung overextension. Obtained before and after induction of lung failure, during therapy with aerosol-PFC, FRC-PLV, LV-PLV, control and during the observation phase after treatment in surfactant-depleted newborn piglets.
  • a particle size spectrum of 5 to 20 ⁇ m could be achieved with this device.
  • Ketanest S ⁇ (ketamine), 1.0 mg / kg Dormicum 15 and 2.5 ⁇ g / kg fentanyl, followed by a continuous infusion of 1.5 mg / kg / h midazolam, 0.01mg / kg / hr fentanyl, and 1 5mg / kg / h ketamine S.
  • the animals were tracheotomized and an endotracheal tube (Mallinckrodt ®, ID 4.0 mm) was placed above the tracheal bifurcation cm with its distal end 3.5.
  • Endotracheal pressure was measured through a 5 Ch catheter 10 mm above the bifurcation. The position of both was checked by rigid bronchoscopy. Mechanical ventilation was started after insertion of the endotracheal tube. The animals were relaxed with 0.2 mg / kgKG Norcuron "(Vecuronium), followed by a continuous infusion of 0.2 mg / kgKG / h Vecuronium. In addition, a repetitive dose of fentanyl of 5 g / kgKG was injected iv.
  • a 4.5 Ch Schleuse (Cook ® , Germany) was surgically placed in the right jugular vein, through which a 4 C h thermodilution catheter (Arrow ⁇ , Erding, Germany) was inserted to measure pulmonary artery pressure and cardiac output, and a 20 gage was placed in the right femoral artery Surgical cannula (Arrow ' 5 ) and introduced a Paratrend-7 fluorescence sensor for online measurement of blood gases.
  • the arterial blood gas analysis was carried out at intervals of 15 minutes during the therapy and at intervals of thirty minutes during the observation phase. (ABL 330, Radiometer Copenhagen, Denmark).
  • the respiratory volumes were measured with a hot wire anemometer (MIM ⁇ GmbH, Krugzeil) and displayed with the neonatal breathing monitor Florian 15 NRM-200 (MIM ").
  • MIM ⁇ GmbH, Krugzeil the hot wire anemometer
  • the conventional ventilation (intermittent mandatory ventilation, IMV) was carried out with the newborn ventilator Infant Star 950 (Mallinckrodt, Hennef, Germany).
  • the breathing gas was heated to 39 ° and humidified (MR 700, Fischer & Paykel, Welzheim, Germany)
  • the respiratory rate was 50 breaths / min, a peak pressure (PIP) of 32 cm H 2 O and a positive end-expiratory pressure (PEEP) of 8 cm H 2 O were set.
  • PIP peak pressure
  • PEEP positive end-expiratory pressure
  • Lung failure was induced by repetitive bronchoalveolar lavages with physiological saline (0.9%) with a lavage volume of 30 ml / kg each. A PaO 2 of less than 80 mm Hg for a period of one hour was required as a success criterion for sufficient lung damage.
  • the animals were randomized to one of the following treatment groups: 1. Aerosol-PFC, 2nd FRC-PLV, 3rd Iow-volume (LV) -PLV, 4th control (IMV). The ventilation settings were not changed to ensure the comparability of the groups.
  • the aerosol PFC received 10 ml / kg / h FC77 ' 5 (C 8 F 18 and C 8 F 16 O, density 1, 78 g / cm 3 , 3M °, Neuss, G ermany) (2 0, 3 1) through an A eroso I catheter (oxygen jet sol generator, Trudell Medical Inc. TM , Toronto, Canada), (particle diameter 5-8 ⁇ m).
  • the catheter consists of bundled capillaries that carry gas and liquid up to the tip of the catheter form an aerosol there by convergent course. A highly effective atomization could be achieved with a gas flow of 0.05 liters oxygen / min.
  • the LV-PLV group received 10 ml / kg / h FC77 ⁇ in liquid endotracheal.
  • the lungs of the FRC-PLV group were filled with 30 ml / kg FC77 ' 5 over a period of 30 minutes, followed by a substitution of 20 ml / kg / min to compensate for the loss of evaporation.
  • the control group was ventilated with IMV.
  • the special ventilation was ended after two hours and monitored over a period of six hours under IMV ventilation.
  • the oxygenation index (01) was calculated using the following formula: ([MAP (cmH 2 O) x FiO 2 / PaO 2 (mmHg)] x100) (16).
  • the oil increases with increased mean airway pressure (MAP) and increased inspiratory oxygen concentration (FiO 2 ), the oil falls with increasing PaO 2 .
  • MAP mean airway pressure
  • FOA 2 inspiratory oxygen concentration
  • the oil falls with increasing PaO 2 .
  • the oil dropped 29.9 ⁇ 3.4 to 1 7.1 ⁇ 3.8 during the first 30 minutes of aerosol-PFC therapy.
  • the drop in oil in the first 30 minutes was significantly faster and stronger in the FRC-PLV group (from 31 .3 ⁇ 1.5 to 5.1 ⁇ 0.6), but after two hours of treatment the oil was aerosol-PFC and both groups FRC-PLV significantly lower than in the LV-PLV and the control group (p ⁇ 0.001).
  • VEI ventilation efficacy index
  • the VEI in the FRC-PLV group was significantly higher than the VEI in the control group (0.099 ⁇ 0.011 vs.0.071 ⁇ 0.011; p ⁇ 0.05).
  • the VEI in the FRC-PLV group decreased to baseline levels prior to initiation of therapy, but not in the aerosol-PFC group. (Table 1).
  • the dynamic compliance in the Aerosol-PFC and FRC-PLV group improved within 15 minutes.
  • High C20 / c values indicate high terminal dynamic compliance and a reduction in lung overextension (17).
  • the C20 / c was significantly (p ⁇ 0.01) higher than in the control and LV-PLV groups (Fig. 5).
  • the FRC-PLV group had significantly higher C20 / c values than the control and LV-PLV groups (p ⁇ 0.001) after two hours of treatment, this positive effect ended immediately after the end of therapy. In the following observation period there was no significant difference to the control group.
  • thermodilution catheter The absence of an air leak and the position of the thermodilution catheter were checked with X-ray fluoroscopy. The endotracheal pressure was identical in all groups. Tension pneumothorax occurred in an animal of the LV-PLV group during the observation phase.
  • Ventilation with aerosolized perfluorocarbon improved pulmonary gas exchange and lung mechanics as much as partial liquid ventilation and the effect lasted longer.
  • Perfluorocarbon-associated gas exchange improves oxygenation, lung mechanics, and survival in a model of adult respiratory distress syndrome. Crit. Care Med. 24 (3): 466-474.
  • Vaporized perfluorocarbon improves oxygenation and pulmonary function in an ovine model of acute respiratory distress syndrome.

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  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

L'invention concerne un dispositif pour la respiration artificielle d'un patient par amenée d'un perfluorocarbone. Le dispositif selon l'invention est caractérisé en ce qu'il comprend un générateur d'aérosol (3) à l'aide duquel un aérosol du perfluorocarbone est formé.
EP02735246A 2001-04-11 2002-04-11 Dispositif pour la respiration artificielle Ceased EP1379306A1 (fr)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
DE10118146A DE10118146A1 (de) 2001-04-11 2001-04-11 Vorrichtung zur künstlichen Beatmung
DE10118146 2001-04-11
DE10133247 2001-07-09
DE10133247A DE10133247A1 (de) 2001-07-09 2001-07-09 Vorrichtung zur künstlichen Beatmung
PCT/EP2002/004057 WO2002083222A1 (fr) 2001-04-11 2002-04-11 Dispositif pour la respiration artificielle

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Families Citing this family (8)

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Publication number Priority date Publication date Assignee Title
WO2003047603A2 (fr) * 2001-12-04 2003-06-12 Minnesota High-Tech Resources, Llc Melanges de gaz respirables permettant de modifier la temperature corporelle
US7607436B2 (en) * 2002-05-06 2009-10-27 The Research Foundation Of State University Of New York Methods, devices and formulations for targeted endobronchial therapy
EP2249700B1 (fr) * 2008-02-07 2019-04-24 Koninklijke Philips N.V. Dispositif pour mesurer et prédire la stabilité respiratoire d'un patient
AU2012335937B2 (en) 2011-11-07 2017-05-25 Mallinckrodt Hospital Products IP Limited Apparatus and method for monitoring nitric oxide delivery
US10426913B2 (en) 2011-11-07 2019-10-01 Mallinckrodt Hospital Products IP Limited Apparatus and method for monitoring nitric oxide delivery
MX2015012177A (es) * 2013-03-13 2017-08-02 Mallinckrodt Hospital Products Ip Ltd Dispositivos y metodos para monitorizar la oxigenacion durante el tratamiento con el suminitro de oxido nitrico.
RU2521975C1 (ru) * 2013-06-20 2014-07-10 Шолекс Девелопмент Гмбх Комбинированный аэрозольный препарат на основе салметерола и флутиказона для лечения заболеваний органов дыхания
US10232101B2 (en) 2015-02-12 2019-03-19 Boston Scientific Scimed, Inc. Gas exchange devices and related methods of use

Family Cites Families (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5141674A (en) * 1984-03-08 1992-08-25 Phares Pharmaceutical Research N.V. Methods of preparing pro-liposome dispersions and aerosols
DE3636669C2 (de) * 1986-10-28 2001-08-16 Siemens Ag Anordnung zur Zufuhr von Aerosol zu den Luftwegen und/oder Lungen eines Patienten
EP0583358B1 (fr) * 1991-05-03 1998-12-02 Alliance Pharmaceutical Corporation Respiration liquide partielle des fluorocarbones
ES2147753T3 (es) * 1992-03-10 2000-10-01 Univ Duke Tubo endotraqueal con dispositivo para la generacion de aerosol.
DE4300880C2 (de) * 1993-01-15 1996-03-21 Draegerwerk Ag Ultraschallvernebler mit Dosiereinheit
IL114154A0 (en) * 1994-06-17 1995-10-31 Trudell Medical Ltd Nebulizing catheter system and methods of use and manufacture
US5642730A (en) * 1994-06-17 1997-07-01 Trudell Medical Limited Catheter system for delivery of aerosolized medicine for use with pressurized propellant canister
US5531219A (en) * 1994-11-04 1996-07-02 Alliance Pharmaceutical Corp. Use of liquid fluorocarbons to facilitate pulmonary drug delivery
US6433040B1 (en) * 1997-09-29 2002-08-13 Inhale Therapeutic Systems, Inc. Stabilized bioactive preparations and methods of use
US6946117B1 (en) * 1997-09-29 2005-09-20 Nektar Therapeutics Stabilized preparations for use in nebulizers
US6016800A (en) * 1997-10-24 2000-01-25 Century; Theodore J. Intrapulmonary aerosolizer

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO02083222A1 *

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