FR2813197A1 - Assisted respiration system for patient comprises inner duct for delivering nebulised liquid into inhaled gas - Google Patents

Abstract

A system, comprising a tube (4) forming a main gas channel (5) connected by its distal end (3) to the patient's airway and an auxiliary channel (8) for an inhaled gas, incorporates at least one inner duct (21), some 200 - 300 microns in diameter, to deliver a liquid to be nebulised. A system, comprising a tube (4) forming a main gas channel (5) connected by its distal end (3) to the patient's airway and an auxiliary channel (8) for an inhaled gas, incorporates at least one inner duct (21), some 200 - 300 microns in diameter, to deliver a liquid to be nebulised. The duct enters the main channel through the tube's proximal end and has an oblique outlet (23) close to that of the auxiliary channel (8). Outside the tube (4) the duct has a section (24) that rises approximately vertically.

Description

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The present invention relates to a device for respiratory assistance usable on patients whose spontaneous breathing is absent or insufficient whether or not they are placed under artificial respiration. It further relates to a system for administering a nebulized product (drug, anesthetic, etc.) to a patient receiving respiratory assistance. Various devices are known, such as masks, probes or oral, nasal, endotracheal, tracheotomy tubes, intended to make the connection between an artificial respiration and / or anesthesia apparatus and the respiratory system of a patient. These devices, essentially in the form of tubes, may, as appropriate, include immobilization means such as lugs or flanges in the vicinity of the proximal end, for holding on the patient's mouth or nose or even inflatable balloons near the distal end, for friction retention in the trachea.

The known devices have significant drawbacks. Thus, for example, when a tube of known type is disconnected from the artificial respirator and the patient needs oxygen-enriched air, it is necessary to introduce into said tube a probe connected to an oxygen source. Furthermore, in cases of insufficient spontaneous breathing, the patient must necessarily remain connected to the ventilator until complete recovery of spontaneous breathing.

Also, in order to remedy these drawbacks, respiratory aid devices have already been proposed, for example by European document EP 0 701 834, which, in addition to the main channel formed by the tube, comprise at least one auxiliary channel, for example formed in the wall of said

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 tube, allowing the injection of a jet of breathing gas (oxygen, air or air-oxygen mixture), continuous or impulse, intended for the ventilation of the patient, this auxiliary channel opening into the main channel near the distal end of the last.

Furthermore, in this European document, it has been proposed to provide a plurality of such auxiliary channels, some of which are supplied in common with breathing assistance breathing gas, while at least one of the others is used to introduce, during respiratory assistance, medicinal or anesthetic products in gaseous form nebulized in the respiratory tract of a patient. This introduction of such gaseous products is of great importance, as is emphasized by the subsequent document US-5,964,223.

However, such use of some of said auxiliary channels for administering medicinal or anesthetic products has some drawbacks. First of all, it neutralizes auxiliary channels to the detriment of the supply of respiratory assistance gas. In addition, it communicates to the respiratory system a complicated and fixed configuration, even when a nebulization of drugs or similar products is not necessary. Finally, it requires complex and expensive means to route the products to be nebulized through said auxiliary channels.

The main object of the present invention is to remedy this drawback.

To this end according to the invention, the respiratory assistance device comprising a tube which forms a main channel and which is intended to be connected by its distal end to a respiratory tract of a patient so that said main channel connects, to the exterior, the respiratory system of said patient, said device further comprising at least one auxiliary channel allowing the injection of a breathable gas jet of respiratory assistance in

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 said respiratory system and opening into said main channel in the vicinity of the distal end of the latter, is remarkable in that it comprises at least one attached duct, supplied with liquid nebuliser product and housed in said main channel, said penetrating duct in said main channel through the proximal orifice of said tube and opening into said main channel in the vicinity of the outlet, in the latter, of said auxiliary channel.

Thus, all the auxiliary channels can be used to supply the patient with respiratory assistance gas. The configuration of the respiratory assistance device is all the more simplified. In addition, thanks to the invention, the supply of said conduit attached to the product to be nebulized is completely separated from the rest of the device, so that said attached conduit can cause the product to nebulize by gravity and / or capillarity. For this purpose, the internal diameter of the added pipe is of the order of 200 to 300 microns and, outside said tube, the added pipe is at least approximately vertical.

It will be noted that, in the respiratory assistance device according to the present invention, it is the breathable respiratory assistance gas exiting from said auxiliary channel which, by licking the distal end of said attached duct, nebulizes the product supplied by the latter. .

Said added duct could be made integral with said tube. However, in order to be able to eliminate said attached duct when it is no longer useful or when said tube must be connected to an artificial respirator, it is advantageous that said duct is attached to said tube in a removable manner, for example by means of a clamp placed astride the edge of the proximal orifice of said tube.

In order to increase the exchange surface between the breathable respiratory assistance gas and the product to be nebulized passing through said

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 duct, the distal end of the latter may have the shape of a bevel.

Furthermore, to prevent the jet of breathable gas from directly hitting the mucosa, risking by its kinetic energy to traumatize the mucosa, it is advantageous that, as described in European patent EP-A-0 390 684, at less the distal end of said auxiliary channel opening into the main channel is parallel to this and that, opposite the distal orifice of said auxiliary channel, there are provided means for deflecting said jet of breathable ventilation gas inwards of said main channel.

Thus, the jet of breathable gas under low pressure passing through said auxiliary channel is deflected towards the axis of the main channel, when it enters the latter. Downstream of said deflection means, that is to say inside the main channel, the pressure of said jet of breathable gas drops and the jet exits at an even lower pressure through the distal orifice of the tube. Experience has shown that downstream of the distal outlet of the tube, the pressure is low and kept constant throughout the respiratory space. This pressure is dependent on the flow of breathing gas in the auxiliary channels. As a result, with the respiratory assistance device according to the invention, it is possible to bring the mixture of the respiratory assistance respiratory gas and the nebulized product directly into the lungs, at the level of the hull, and thus to eliminate the dead space. that exists in current probes.

Of course, in this case, the distal end of said attached duct is located in the vicinity of said deflection means, to allow nebulization and entrainment of the liquid product to be nebulized by said breathable respiratory assistance gas.

In the event that it would be useful to administer to the patient during respiratory assistance, simultaneously or not, several medicinal or anesthetic products, it is advantageous that said duct

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 has several internal channels, possibly supplied with different products.

Furthermore, the present invention relates to a system for administering a nebulized product into a respiratory tract of a patient, said patient being on respiratory assistance using a respiratory assistance device comprising a tube which forms a main channel and which is intended to be connected by its distal end to said respiratory tract of the patient so that said main channel connects, externally, the respiratory system of said patient, said device further comprising at least one auxiliary channel for blowing a jet gaseous breathable in said respiratory system and opening into said main channel in the vicinity of the distal end of the latter.

According to the invention, this system comprises a conduit intended to be supplied with liquid nebuliser product and provided with fixing means making it possible to attach it to said respiratory assistance device so that said conduit penetrates into said main channel of said tube to through the proximal orifice of the latter and opens into said main channel in the vicinity of the outlet, into the latter, of said auxiliary channel.

The figures of the appended drawing will make it clear how the invention can be implemented. In these figures, identical references designate similar elements.

Figure 1 is a schematic and partial view, in enlarged axial section, of an embodiment of the device of the invention.

Figures 2 and 3 are cross sections, respectively along lines II-II and III-III of Figure 1.

Figure 4 schematically and partially illustrates an alternative embodiment of the attached conduit.

In FIG. 1, there is shown, schematically and on a large scale, the only proximal 2 and distal 3 ends of an embodiment

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 monolithic station 1 of the device according to the invention. This monolithic embodiment can constitute, for example, an oro-nasal endotracheal tube with or without balloon, a pediatric endotracheal tube, a gas monitoring probe, an endobronchial probe, a nasopharyngeal probe, an anatomical intubation probe for children , a Neonatal Code probe, a Gedel cannula probe, a nasal oxygen therapy probe, a nasal or bucconasal mask or a nasal balloon for sleep apnea treatment.

The device 1 comprises a tube 4, flexible or preformed (to adapt to the morphology of the patient) delimiting a main channel 5 opening, through the orifice 6, at the proximal end 2 and, through the orifice 7, at the distal end 3.

Thus, the main channel 5 is capable of ensuring the passage between the orifices 6 and 7, one of which (the orifice 7) is intended to be located inside the respiratory tract of a patient, and the another (orifice 6) is intended to be outside of said patient. This orifice 6 can open into the open air and, in this case, the patient can breathe in fresh air and breathe out the stale air through the main channel 5. One can also connect the orifice 6 to a source of breathable gas under pressure and provide a system of one-way valves, so that the patient inhales the breathable gas from said source through said main channel 5 and exhales the stale gas in the open air, also through this main channel.

The diameter of the main channel 5 is of the order of a few millimeters. Satisfactory tests have been carried out with diameters of 3 mm, 7 mm, 8 mm and 12 mm.

Furthermore, in the thickness of the wall of the tube 4, auxiliary channels 8 are provided, extending over almost the entire length of the main channel 5. These auxiliary channels 8 are intended to be connected to

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 a source of pressurized breathing gas. For example, this pressure is at most equal to 0.5 bar and it is adjustable.

As shown in FIGS. 1 and 3, the connection to the source of pressurized breathing gas can be achieved by means of a ring 9, sealingly surrounding the tube 4, on the side of the proximal end 2, and delimiting a sealed annular chamber 10 around said tube. The auxiliary channels 8 are placed in communication with the chamber 10, by means of local cut-outs 11 from the wall of the tube 4, and said chamber 10 is connected to said source of breathable gas by a conduit 12. Of course, the proximal ends of the channels 8 are closed, for example by plugs 13, introduced from the proximal end face 18 of the tube 4.

The auxiliary channels 8 have a smaller diameter than that of the main channel 5. The diameter of the auxiliary channels 8 is preferably less than 1 mm and, advantageously, it is of the order of 400 to 800 microns. On the distal side, the auxiliary channels 8 open into a recess 14 in the internal wall 15 of the tube 4. The recess 14 is annular and centered on the axis 16 of the distal end 3. It has a face 14a, substantially transverse or slightly inclined so as to constitute a widening of the main channel 5, into which said auxiliary channels 8 open through their orifices 17, as well as a face 14b along the face 14a and converging in the direction of the axis 16.

Preferably, between the converging inclined face 14b and the distal orifice 7, the internal wall 15 has a part 15a slightly flared towards the outside, as illustrated by the angle A in FIG. 1.

Thus, when the auxiliary channels 8 are supplied with breathable gas under pressure through the elements 9 to 12, the corresponding gas jets strike the inclined face 14b, which deflects them in the direction of the axis 16 (arrows F in the figure 1), generating in the vicinity thereof

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 vacuum zone favoring the gas circulation inside the main channel 5, from the proximal orifice 6 towards the distal orifice 7. This thus promotes patient inspiration.

Preferably, the distance between each of the orifices 17 and the orifice 7 is of the order of 1 to 2 cm.

At least one additional channel 20 is provided in the thickness of the tube 4 in order to open into 20A in the vicinity of the distal end 19 of the tube 4 and serve as a pressure tap.

Furthermore, the device 1 comprises an attached conduit 21, for example of a flexible plastic material, supplied with a liquid product to be nebulized (drug, anesthetic, etc.) and housed in said main channel 5 of the tube 4, said conduit 21 penetrating into said main channel 5 through the proximal orifice 6 thereof and emerging, in said channel 5, in the vicinity of the orifices 17 of said auxiliary channels 8. For this purpose, the distal end 22 of the conduit 21 is located opposite the recess 14. This distal end 22 is also terminated by a bevel orifice 23, making it possible to increase the section of said conduit 21, the internal diameter of the latter being of the order of 200 to 300 microns .

The proximal end 24 of the conduit 21, outside the main channel 5 of the tube 4, is directed upwards and is at least approximately vertical.

The part 25 of the conduit 21 located inside the main channel 5 is integral with the internal branch 26 of a clamp 27 disposed astride the edge of the proximal orifice 6 of the tube 4, the other branch 28 of said clamp 27 being external to the tube 4. The branches 26 and 28 of said part 27, arranged longitudinally relative to the tube 4, press the wall of the latter between them.

Thus, the vertical proximal end 24 of the conduit 21 being supplied with a nebulizable liquid product (which is symbolized by the arrow).

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 che 29 in Figure 1), said product (drug, anesthetic, ...) descends by gravity and / or capillarity and appears at the distal orifice 23 of said conduit. There, it is in contact with the jets of breathing assistance breathing gas, brought by the auxiliary channels 8 and deflected by the inclined face 14b. These gaseous jets participate in the nebulization of said product, then in the transport of this product thus nebulized up to the patient's lung.

As shown in FIG. 4, the attached duct may consist of a duct 30 comprising several channels 31, opening into the bevelled distal end face 31 of said duct 30 intended to be brought opposite the inclined face 14b in place of the beveled opening 23. Thus, it is possible to administer to the patient, simultaneously or not, several nebulized products.

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Claims (9)

CLAIMS 1. Respiratory assistance device comprising a tube (4) which forms a main channel (5) and which is intended to be connected by its distal end (3) to a respiratory tract of a patient so that said main channel ( 5) connects the respiratory system of said patient to the outside, said device further comprising at least one auxiliary channel (8) making it possible to inject a breathable gas jet into said respiratory system and opening into said main channel (5) in the vicinity of the distal end (3) of the latter, characterized in that it comprises at least one attached duct (21), supplied with liquid spray product and housed in said main channel (5), said duct (21) penetrating into said main channel (5) through the proximal orifice (6) of said tube (4) and opening into said main channel (5) in the vicinity of the outlet, in the latter, of said auxiliary channel (8). 2. Device according to claim 1, characterized in that the internal diameter of said attached duct (21) is of the order of 200 to 300 microns. 3. Device according to one of claims 1 or 2, characterized in that, outside of said tube (4), said attached duct is ascending and at least approximately vertical (24). 4. Device according to one of claims 1 or 3, characterized in that said conduit (21) is attached to said tube (4) removably. 5. Device according to claim 4, characterized in that said conduit (21) is fixed to said tube (4) by means of a clamp (27) disposed astride the edge of said proximal orifice (6). 6. Device according to any one of claims 1 or 5, characterized in that the distal end (22) of said attached duct (21) has the shape of a bevel (23). <Desc / Clms Page number 11>  7. Device according to any one of claims 1 to 6, wherein, opposite the distal orifice (17) of said auxiliary channel (8), means (14b) are provided for deflecting said jet of breathable ventilation gas towards the interior of said main channel (5), characterized in that the distal end (22) of said conduit (21) is located in the vicinity of said deflection means (14b). 8. Device according to one of claim 1 or 7, characterized in that said attached duct (30) comprises a plurality of independent channels (31). 9. System for administering a nebulized product into a respiratory tract of a patient, said patient being on respiratory assistance using a respiratory assistance device comprising a tube (4) which forms a main channel (5) and which is intended to be connected by its distal end (3) to said patient's respiratory tract so that said main channel (5) connects, externally, the respiratory system of said patient, said device further comprising at least one auxiliary channel (8) allowing a breathable gas jet to be injected into said respiratory system and opening into said main channel (5) in the vicinity of the distal end (3) of the latter, characterized in that it comprises a duct (21) intended to be supplied with liquid nebuliser product and provided with fixing means (27) making it possible to attach it to said respiratory assistance device, so that said duct (21) penetrates into said main channel ( 5) of said tube (4) through the proximal orifice (6) of the latter and opens into said main channel (5) in the vicinity of the outlet, in the latter, of said auxiliary channel (8).