TW200301145A - Breathing circuits having unconventional respiratory conduits and systems and methods for optimizing utilization of fresh gases - Google Patents

Abstract

A breathing circuit comprising first and second conduits is disclosed, wherein at least one of the conduits is a non-conventional conduit. A multilumen unilimb breathing circuit is also disclosed having first and second conduits, wherein when the proximal ends of said first and second conduits are each connected to an inlet and outlet fitting, respectively, movement of the distal end of the first conduit causes a corresponding movement of the distal end of the second conduit. In an embodiment, at least one of said conduits is coiled. In another embodiment, a coiled conduit is contained within an outer flexible conduit that is axially extendable and compressible, forming a unilimb multilumen respiratory circuit. The outer flexible conduit may be pleated to provide for axial extension and contraction. The multilumen respiratory circuit can provide a variable rebreathing volume. In an embodiment, at least one tube in a multilumen respiratory conduit is radially collapsible and radially expandable to a maximum radius for carrying respiratory gases to and from a patient. Also disclosed are methods and systems of optimizing utilization of fresh gases during artificial or assisted ventilation, including administering anesthesia.

Description

20ϋ3〇, ί 1, | 5 发明 Description of the invention [Technical field to which the invention belongs] The present invention relates to a feces loading, which can be used to resuscitate patients and / or provide patient anesthesia and / or assist patients with artificial ventilation; more specifically, Regarding a breathing circuit, which is an interactive adjustable length fluid carrying member; a multi-lumen breathing circuit using a non-conventional catheter; a method that can provide freshness when anesthesia and / or assisted artificial ventilation is provided Systems and methods for optimal use of gases (ie, 'anesthetics and oxygen'). [Prior art] Assisted ventilation systems and / or artificial ventilation systems are an integral part of modern medicine. Generally, such systems can provide fresh gas to a patient from the same source (for example, from an anesthesia or a ventilator) and direct the used gas away from the patient. The fresh fluorine system is introduced through a channel different from the used gas' and therefore requires at least one gas channel. A typical circuit has two wings (that is, there are two independent pipes). The ends of the tubes of a breathing circuit are usually separated by a cymbal connector on the patient or the other distal end of the circuit. The connector can place the distal end (patient end) of the tube in a parallel fixed position, or the connector can be a gamma tube with two tubes connected at a fixed angle. Traditional breathing tubes are corrugated and elastic 'to allow them to move while avoiding folding or tangling of the tubes. Recently, the use of ducts with expandable and extendable auxiliary pleats has become increasingly popular. A commonly used tube is ULTRA-FLEX® (available from Ku n g

Systems Corporation, Noblesville, Indiana, USA) 4 FLEXITUBE (R) or ISOFLEX® can assist in expanding or contracting the opening or closing of one or more folds to increase the length of the whole round. Regardless of whether the folds are in the open or closed position, the wall of the pipe remains corrugated to reduce the chance of entanglement or folding when the pipe is folded. Respiratory care and emergency intensive care unit (ICU) non-rebreathing system

In a non-rebreathable respiratory system that can be used in respiratory care and emergency intensive care units, a one-way valve allows gas to flow to a patient through an inspiratory conduit (i. The used gas from the patient is passed through an expiratory conduit to an exhaust pipe. Circulating C02 absorption and Mapleson type respiratory system

In a "circulation system", a check valve allows gas to flow to a patient through a first or suction pipe, while another check valve allows the used gas from the patient to flow through a second or Exhalation pipeline to a "recirculation module" or "scrubber circuit" to achieve the purpose of recirculating part of the gas, the "recirculation module" or "cleaning circuit" generally includes a carbon dioxide absorber, In order to eliminate exhaled carbon dioxide and achieve the purpose of "clean gas". After that, the cleaned gas is combined with the fresh gas from the anesthesia machine, and this mixed gas is referred to herein as "refreshing gas."

gases). " Part of or all of the fresh gas can be re-used by the patient. Excess gas will be directed to an exhaust pipe and / or a recovery pipe. Therefore, the fresh gas and the cleaned gas in the cleaning circuit are immersed in the coffee and fresh air, and then sent to the first pipeline to the pipeline 彳 Cui to a "11 used rolling body from a second" to ... return first "in order to re-circulate and / or discharge. It is generally believed that the anesthetic gas concentration in the low-flow anesthesia body in the circulatory system continues with the initial concentration as # _ /, _, which causes the fresh gas / chendu slave to continue to mount (concentrated production in the volatilizer) . ρ _ π _ delay is lower than that from the used gas and / 嗖 ρ, temporarily miscellaneous] bricks due to this or ... shuttle / dilution, leakage 'and absorption and / or cause, rubber and system Caused by adsorption by other materials. Therefore, low-flow anesthesia gas, including the use of a fully enclosed anesthesia system, is practically feasible, but its application is extremely limited.

In the Mapleson AF type (MapleS0n AF Sun ^^^ yP), the fresh air system is transmitted through a fresh gas delivery / supply tube into the breathing tube of the I see, where the role of the breathing tube is to provide disease ^ ^ ^ The body and receives the gas used by the patient. Generally speaking, the diameter of the fresh gas delivery / supply tube is small so that it can only be used as a fresh gas delivery or supply tube, not a beer straw ( That is, if the patient in the circulatory system can directly suction: the pipeline).-The Mayson D-type circuit (the most commonly used circuit of all Mayson type circuits) is not used, so 'fresh gas' The flow rate needs to be high enough to minimize the re-inhalation of CO. During inhalation, the patient will inhale fresh gas from the inlet of the fresh gas delivery / supply tube and inhale gas from the general breathing tube. The gas may be fresh gas and alveoli. A gas mixture of exhaled gas. High flow of fresh gas can flush the breath ", forcing the exhaled gas from the alveoli to leave the gas pipeline. The Bain Circuit 200301145 An example of a modified version of a single wing is commonly referred to as a "ban circuit" or "Bain", detailed in U.S. Patent No. 3,856,05 1; where a fresh gas delivery line is inserted through the wall of a common breathing tube The proximal end of the common breathing tube, rather than the distal end, and the transmission tube extends along the length of the common breathing tube, making its transport end close to the distal end of the common breathing tube. This creates a single element different from the two-element circuit. Wing circuit. The connection between the fresh gas transmission pipeline and the common breathing tube is sealed.

Another example of the Mayson D-type circuit is detailed in U.S. Patent No. 5,12 1,746; an elastic bellows is divided by an inner wall into a large flow channel and a small flow channel, and is connected with A common bayonet type connector is connected to the patient end, and is connected to the machine with a double friction fit connector. An improved circuit of this patent is used to construct a circuit (Vital Signs, Inc. of Totowa, New Jersey, USA) sold under the trade name Limb 0 ™. The Universal F® Circuit

Reference is made to U.S. Patent No. 4,265,235 to Fukunaga, which describes a universal single wing device that can be used in different respiratory systems and provides many advantages over the prior art. The Fukunaga device sold under the brand name of universal F® (King systems Corporation, Noblesville, Indiana, USA) uses a space-saving "co-axial" design, or "tube within a tube) ”design for inhaling and expelling breath. This design has several advantages, such as reducing the volume of the breathing device connected to the patient. In addition, the device itself can also be used as an artificial nose, as the 7 used to meet in the single-wing device with two opposite airflows, the used gas can warm and maintain the humidity of the inhaled gas. The Universal F2® Technology Refers to U.S. Patent No. 5,778, δ72 of Fukunaga, which describes an example of a single-wing multi-chamber circuit, which is sold under the F2TM or universal F2® trade name (King Systems Corporation, Noblesville, Indiana, USA) 'has improved artificial ventilation systems and methods of providing assisted ventilation and anesthesia. The F2 system provides secure and fast connection and removal of a multi-cavity (ie, coaxial) system component from the far end. This design allows faster replacement and use of other breathing circuit components, improves system performance, and reduces medical waste and costs. Generally, the universal F2 @ is used in a circulation system with a carbon dioxide absorber. For more information on this F2TM technology, please contact King Systems Corporation ° For more information on respiratory, anesthesia and assisted ventilation technology, see US Patent No. 3,556,097 'US Patent No. 4,007,737, US Patent No. 4 No. 1 88,946, U.S. Patent No. 4,265,235, U.S. Patent No. 4,463,755, U.S. Patent No. 4,232,667, U.S. Patent No. 5,2 8 4,160, and U.S. Patent No. 5,778,872. Australian Patent No. 93,941, British Patent No. 1,270,946, Dorsch, JA, and Dorsch, SE, Understanding Anesthesia Equipment: Construction, Care, And Complications, Williams & Wilkins Co.? Baltimore (1 974) and Andrews, JJ, "Inhaled Anesthetic Delivery Systems" in Anesthesia, 4th Ed. Miller, Ronald, MD, Editor, Churchill 8 Jing Jing; care has often reminded Qi and blood monitoring titration pathology problems. Used, for example, to put in the humidity, call it a mutual induction or an effective anaesthesia system and a new-generation, new-generation breathing catheter. Hospitals, medical staff, and related companies are always looking for ways to improve medical care. Many monitoring standards have also been implemented to ensure that desired treatments are safely implemented. For example, in the field of respiratory care and anesthesia, the use of non-invasive and invasive monitoring methods is routine, such as warning monitoring systems that can block and / or interrupt airflow to users, systems that monitor inhalation: System, saturation oxygen monitoring by pulse oximeter: monitoring of moving gas and blood of the aspirator. These technologies and devices make it possible for continuous patients, and also allow medical care workers to more accurately adjust or necessary doses of anesthetic gas or drugs, and easily detect problems caused by patient conditions or medical equipment or settings failure For this reason, there is an urgent need for an anesthesia system that can make the best use of this type of monitoring equipment and reduce the anesthetic waste gas. The medical profession often and frequently provides respiratory care. Respiratory care includes, for example, artificial ventilation techniques such as assisted ventilation and / or oxygen therapy. Some devices are used for respiratory care, including breathing circuits, ferrules, HME (heat and parent switches), endotracheal tubes, laryngeal masks, laryngeal tubes, and respiratory masks. Stiff tubes or flexible bellows made of ^ plastic or elastic stone tube have been widely used for more than a century. In order to prevent the exchange, the factory's reserve, early use "breathing circuit is discarded after one use; a more expensive reusable breathing circuit that can be sterilized by high temperature is used. Both breathing circuits are very expensive to produce and / or use. Circuit killing requires a lot of manpower and high processing costs; but the same 'a single-use disposable breathing circuit can prevent cross-contamination, but it will increase the extra cost of hospital use.

U.S. Patent No. 5,901,705 to Leagre discloses a sleeve and a filter for a breathing circuit, wherein the filter and a tubular sleeve or sheath can enclose the breathing circuit during use. The filter holder has two monks, one for connection to the patient and the other for connection to the distal end of the breathing circuit. The sleeve is connected to the outside of the filter holder and extends towards the proximal end of the breathing circuit. After use, the filter and sleeve are discarded, and the breathing circuit can be reused by multiple patients. The filter and sleeve reduce the need for disinfection after each use of the circuit. The sleeve is made of lightweight and inexpensive materials to reduce the manufacturing cost of the sleeve parts. It is known that a transparent extruded film made of polyethylene, polypropylene, or polyallyl (the thickness of the film is similar to the thickness of a plastic food bag that is generally resistant to heavy objects) can be used as a sleeve member. The sleeve does not serve as a channel for exhaust gas removal. No. 5,377,670 reveals a way to reduce breathing

advantage.

Smith's U.S. Patent No.

Specific purposes and requirements, but the patents and prior art mentioned in the first 10 200301115 do not disclose a device in which at least one breathing catheter is managed by a non-conventional (also referred to herein as "new era") tube It is composed of roads or pipes (i.e., different from rigid walls, pipes, corrugated pipes or folded pipes). It has both axiality and radially flexible, but exceeds a certain radius of the catheter and / Or volume, it does not have compliance. "Path ^

"Elasticity" means that the diameter V of the catheter can be greatly reduced or the cross-sectional area of the catheter can be folded or relaxed compared to traditional catheters with stiff walls. This is different from axiily bending in that it does not significantly change the cross-sectional area of the bend of the catheter. Unlike traditional catheters with stiff walls, the cross-sectional area of the bend of the catheter will change significantly once it is bent. The traditional breathing instructor with a rigid wall of the front implement remains unpatched when not in use and when the pressure difference between the inside and the outside of the tube is used to provide inspiration and / or receive exhaled gas. Because the traditional breathing tube with rigid wall in front has no axial folding when not in use, it requires more storage and transportation space, and it requires a thicker tube wall to provide sufficient rigidity to avoid undesired Folding that may occur during use or use. Therefore, a higher amount of plastic is needed to make such catheters, which increases manufacturing costs and the volume of waste generated. _ In general, the obedience of the circuit (that is, the expansion of the road officer's volume under operating pressure) is undesirable because it interferes with the accuracy and precision of the gas being applied. Furthermore, excessive compliance can lead to insufficient carcass reaching the patient's lungs. The present invention finds that as long as a breathing catheter, and preferably an inhalation catheter, the gas can be maintained without deformity (patency), the catheter does not need a traditional catheter or tubing (i.e., can It maintains a fixed diameter and / or a fairly stiff or rigid corrugated plastic tube when not in use) and will always remain unpatched. However, according to the present invention, the suction catheter should provide low resistance and very low compliance when used to meet the requirements of spontaneous breathing and assisted ventilation. Preferably, the breathing catheter can allow airflow at any time ' even under negative pressure, and the breathing line can provide positive pressure even under spontaneous breathing.

Definitions To further illustrate the invention and the prior art, certain terms will be defined in the specification and below. In this context, the term “artificial or assisted ventilation” shall include “controlled and spontaneous ventilation” in both acute and chronic situations, including anaesthetic situations. Fresh gas includes oxygen commonly used in flowmeters and volatilizers, and the like

(enflurane), isoflurane, desflurane, sevoflurane and other anesthetic gases. The end of the catheter leading to the patient is here the distal end, and the end of the catheter facing or connected to the breathing gas is called the proximal end. Similarly, components and other devices at the end or distal end of the airway (ie, connected to or directed away from the device (ie, endotracheal tube, laryngeal mask, throat, mask, etc.) are referred to herein as distal components and Tips and components and other devices near the end or breathing circuit are referred to herein as proximal components and tips. Therefore, the “adapter stew” adapter or connector will be located on the 3rd or patient side of the circuit, earth, & 12 200301115 It is generally believed that the proximal end of the multi-chamber single-wing breathing circuit is located at the end of the circuit machine and separates at least two independent fluid channels. The fluid channels are close to each other and parallel or in a coaxial relationship in the loop system, so that at least one channel can be connected to One suction gas source, and the other fluid channel can be connected to the exhaust gas spaced apart from the suction gas. A proximal end may also include a rigid mount that allows two independent fluid channels to meet therein, for example, a Y-type fitting, preferably with a septum. The use of a near-end assembly at the proximal end of a single-wing circuit is a new concept brought about by the F2® invention. For the first time, the disassembly and assembly of multiple pipelines at the proximal end of auxiliary ventilation can be performed by using a Matching near pieces makes it easy. Different from the proximal end, when a proximal component is included, the proximal component can maintain the spatial relationship of the proximal end of the pipeline forming a multi-lumen circuit. Therefore, the general understanding of the proximal group of a breathing circuit is that it allows the pipeline to be easily connected to a proximal end to provide inhaled and exhaled gas from a spaced gas. In one embodiment of the present invention, the pipeline may be directly connected to a proximal end; in other embodiments, the pipeline may be connected to a proximal component that can engage a proximal matching component. The proximal component may include a filtering device, Or can be connected to a filter, filter. The term "conduit" broadly encompasses fluid-carrying elements and is not limited to commonly used bellows, such as those used in breathing and / or circuits currently sold (i.e., a conduit having one or more The walls define chambers of various shapes and diameters, and can carry bellows for inhaled gas to or from exhaled gas away from the patient). For example, the road body of the container can be connected to one by one, and the Y can make the phase of the multi-chamber maintainable components of the machine end group more realistic.

Proximal anesthesia patients who use this invention with this 13 2ΰϋ ^ 〇1ΐ4 ▼ Catheter may contain an elastic fiber or a plastic layer (such as a film or thin layer made of plastic such as polyethylene, when it contains The fluid has a cylindrical or tube shape, but when it is free of fluid or emptied, the shape of the tube can be folded or relaxed) and / or an elastic tube, which is smooth-walled, straight, corrugated, indexable, and / Or can be spiral. Accordingly, some embodiments of the present invention are substantially different from the concept and design of the conventional beer suction catheter. According to the present invention, an embodiment of an elastic guide that carries inhalable gas to a patient or leaves a patient with exhaled gas from a patient, which has a maximum volume and / or a straight (or maximum cut) not only in the radial and axial directions Area, its cross-sectional shape is not circular), and it also has different shapes of cross-sections, and provides low-cost equipment that can provide respiratory care (that is, provide effective and consistent auxiliary ventilation to patients). Non-traditional-or non-conventional-catheter refers to a catheter used in the breathing circuit to carry strings, two, and / or exhaled breath, made of materials that have never been used to assist ventilation or anesthesia machines and / Or have a shape that has never been used before, to carry the gas for breathing in and out between the patient and the machine or between other mammals and the machine. Carrying the patient's inhaled and / or exhaled gas at the point where the gas system supplies gas from a source (i.e., a breather) via a conduit > ~, and the exhaust is from the same conduit and / or other conduit Provided to an exhaust gas exhaust / B x a screw open space 17, auxiliary gas engine). For example, the eaves used in accordance with the present invention: a rotary suction or exhalation catheter is an unconventional-catheter. Similarly, one of the materials used in the extrusion invention is made of elastic, air-impermeable fibers (such as, but not limited to, wound: shaped polyethylene, polypropylene, or polyethylene-based film). Known-catheter, which can be stretched radially to-.. / Diameter and body under the pressure of general assisted breathing, and when the internal pressure is lower than the ambient pressure 14 200301145 (ambient pressure) or lower than the general assisted breathing Foldable when under pressure. Ambient pressure refers to the pressure normally encountered outside the guide, which is generally equal to atmospheric pressure. This type of catheter can remain undistorted during use, but can also be relaxed or folded (depending on the situation, folding may require some degree of assistance to achieve) to a minimum diameter, length, and volume, especially when the catheter When the internal pressure is significantly lower than the external pressure of the catheter. For the "brevity" goal, "SuaveTM flexible tube" Ioka is used here to describe a gas used to carry gas between a patient and a ventilator or respiratory care device (i.e., gas for inhalation and Exhaled exhaust gas) elastic breathing guide, wherein the catheter can be radially folded when not in use, and can be expanded to a maximum predetermined diameter (or maximum cross-sectional area when in use; when the cross-section is not circular) The maximum diameter and maximum radius of Guna's maximum cross-sectional area) and volume (hereinafter this type of catheter is hereinafter referred to as "R Suave tube" or "Suave tube"; any product name used herein or the product with TM or ⑧ Still retains its original trademark rights). When expanded to its maximum diameter (ie, maximum cross-sectional area), a “Suave tube” in assisted ventilation applications will exhibit the same compliance as a traditional bellows or a traditional bellows tube (eg, ultra_flex @). The "SuaveTM Elastic Tube" can also expand or contract axially. "Tubes_ are cheaper to manufacture than traditional stiff wall or cross-section catheters (such as those formed by bellows). The preferred radial folded catheter used in the present invention expands to provide pressure when exposed to pressure. Human and other mammals have assisted ventilation and / or anesthesia, and their compliance is less than about 50/0, preferably less than about 20%, more preferably about less than, and even more preferably less than about 5%, The best is about less than 2%. The preferred 15 2ΰυ3〇ΐ 1, | used in the present invention, has a small cross-sectional area (hereinafter referred to as “expanded cross-section”) when it is sufficiently expanded to meet the desired flow characteristics. Area (inflated cross-sectional area) ") and can be folded so that its" folded cross-sectional area (c0Uapsed cr0ss_ sectional area) "is preferably less than about 90% of the expanded cross-sectional area, more preferably less than An expanded cross-sectional area of about 70%, and more preferably, is less than about 50%. The expanded cross-sectional area is more preferably less than about 25% of the expanded wear area, and most preferably less than about 100/0. In one example, the "Suave tube" is transported and stored in a folded form, and it can be folded without much effort after expansion, except for occasional compression when discarded. This minimizes manufacturing, shipping, and storage costs. In some embodiments, when the pressure is insufficient, gravity can cause the "tube" to fold naturally to varying degrees. Elements of the breathing circuit Usually depending on the needs of the surgical site, a patient in need of artificial ventilation or anesthesia may be fixed in a peculiar posture, so the required catheter length will vary. The same is true for patients who are diagnosed, for example, mri, cT scanmetian, etc. Therefore, there is a need for an elastic breathing catheter whose length of the guide g for inhaling fresh gas and the length of the exhaling exhaust pipe can be adjusted, and at the same time, the problems of disassembly, blockage, entanglement and the like can be minimized. At the same time, the required breathing catheters must also be lightweight. # ， For cost-effectiveness considerations, health ... manufacturing providers (ie, hospitals, medical arsenics, emergency surgery centers, nursing homes, etc.) also need low-cost banks and coquettish roads; 4 restrooms and V & and / or low prices Methods to provide artificial ventilation or anesthesia to patients in need of this service. 16. According to the method of how to remove CO2 from the breathing tube, the bacteria in the breathing tube can be removed in a way of "wash, 77> washout", which depends on the fresh gas in the IL Depending on the flow (ie, no CO 2 absorbent is needed, such as a Mebolin-type circuit), or a CO absorbent such as Lyme Soda and the like is used (eg, a recycle circuit). Therefore, the general anesthesia circuit is supplied in the form of a circulation circuit (c02 absorption system) or a Mayson-type circuit. Because the Mebson type requires a high flow of fresh gas for the rebreathing system, the% circuit has become the most widely used system. The respiratory system that can use low-flow fresh gas has advantages, because it can reduce the consumption of fresh gas (for example, anesthesia = body) and the amount of exhaust gas generated, and at the same time it is more environmentally friendly (reducing environmental pollution and reducing the cost). However, a major concern with low flow technology in anesthesia is the efficiency of the fresh gas used and its unpredictability, especially with regard to the concentration of anesthetic gas supplied to the patient's alveoli or for inhalation by the patient. End point (that is, a dose that will not prevent patients from waking up or regaining consciousness during surgery without excess). Further = the current concentration of sex gas and inhaled sex gas The concentration of the two is still not the same. Another concern of the circulation loop is the effect between the volatile anesthetic gas and the CO2 absorbent (for example, Lyme Soda), and recent reports have pointed out that the effect can be toxic. Substances. This concern also includes carbon monoxide and compound A formed during the degradation of volatile anesthetic gases by Lyme Soda. For example, oxygen has been found in anesthetic gases The presence of carbon ° includes circulation systems using ifiranes, enflurane, isofurane, and desflurane. In addition, there are systems for using sevoflurane In terms of 'known sage burn' in the presence of Lyme Soda, it will be degraded into dilute hydrocarbons 17 200301115 and compounds A. These compounds are known to have nephrotoxicity at clinical concentrations. In addition, the circulatory system needs to be reduced In Mebson-type systems, it is expensive: the amount of exhaust gas from anesthetic gas and breathing gas.

One of the main concerns of the prior art single-wing breathing circuit is that the inhaled or fresh gas lines will not be disconnected or blocked during use (ie, disconnected or blocked due to tangling). For this reason, it is emphasized that the proximal end of the suction gas line needs to be rigidly connected to the fresh gas inlet assembly, and the distal end can be moved with the distal end of the outlet duct (ie, the exhaust duct), thus creating a variable void (varial dead space). Although U.S. Patent No. 5,778,872 to Fukunaga

The amazing new discovery in the number states that 'the proper ineffective space in the breathing circuit can actually bring benefits, that is, normal carbon dioxide blood can be produced without hypoxia, but a circuit is still needed, which is still no matter how the circuit is used Have a minimum and / or a fixed dead space, while still being flexible and safe. There is also a need for a system that can use anaesthetic gas more economically and efficiently in a safe and predictable mode. At the same time, the respiratory system must be suitable for both adult and pediatric patients, or at least for many types of patients, in order to reduce the cost of preparing different sizes of respiratory systems. In addition, there is a need for a breathing circuit and system that is simpler, lighter, more cost-effective, safe, and / or easier to operate and use than a prior art circuit or system. [Content] An embodiment of the present invention includes a breathing circuit, wherein at least one breathing catheter is a non-conventional catheter. Therefore, in a single-winged or double-winged circuit, a non-conventional catheter can be used in a patient or other mammals. And / or exhale. For example, in a real J r, the loop Φ stone, shell is a spiral tube. This type :: The catheter can be referred to as a stack or a vef, or (the V reference referred to herein can be referred to as the F3TM circuit or universal F3TM catheter loss). The trademark right of the B product name is not diminished by the fact that this item is cited-and the embodiment includes-a multi-chamber breathing circuit that includes at least the first

-Individual entry: The proximal ends of the second and second catheters can be connected to the ^-^, and the cattle, and the movement of the proximal end of the first catheter can cause # — to ground. Therefore, the circuit elements can interact with each other. When the field element is extended or contracted with respect to the axis, a second element 2 can be extended or contracted with an axis of the same length. This type of circuit is here Ran :, F3: M shrink circuit or universal F3TM circuit. In another embodiment, v & snails, coils. In another embodiment, a spiral tube system is contained in an external elastic tube that can extend or contract along the axis to form a single-wing multi-chamber breathing circuit, which may also be referred to herein as an F-spiral TM circuit c. iiTi circuit).

In one embodiment, an external elastic catheter may be a folded organ or a non-conventional catheter to provide extension or contraction along the axis. In one embodiment, an accordion-type tube (ie, an ULTRA-FLEX® tube) is separated by a common wall made of elastic plastic or air-impermeable fiber to allow a cavity to expand radially while , The other cavity sharing the common wall can contract at the same time. In another embodiment, a non-conventional catheter may be connected side-by-side with the folded tube by continuously or spacedly. In addition, two or more Suave tubes can be used simultaneously to create a multi-lumen SuaveTM tube breathing catheter. This type of 2003200301115 multi-lumen SuaveTM tube breathing catheter can be made by extruding plastics in an almost the same way as plastic bags. However, unlike radial bonding when forming plastic bags, these catheters are thermally bonded axially to form individual gas delivery cavities. The proximal end and the distal end of the breathing catheter device of the present invention can be connected with a proximal component and a distal component, respectively, so as to promote the connection between the patient and the machine during operation, respectively.

An embodiment of the present invention includes a multi-lumen breathing catheter including at least first and second elastic tubes, wherein the proximal ends of the first and second elastic tubes can be individually connected to an inlet assembly and an outlet assembly, and at least one of them The elastic tube system comprises a non-conventional plastic tube material (that is, a tube formed of an elastic plastic such as polyethylene base). This type of breathing catheter is capable of maintaining the catheter in a condition where it is breathing (spontaneous breathing or artificial ventilation) is not deformed (ie, maintaining the inhalation and exhalation catheters unobstructed), but can be folded almost completely when not in use. Such catheters can be transported or stored in a folded form. The tubes forming the multi-lumen breathing catheter can be arranged side by side, connected to each other at a distance, or one tube is in the other, and its shape can be greatly changed. The distal and proximal ends of each tube may be formed from a stiffer material than the other parts of the tube, or connected to a component to facilitate communication with a source of breathing gas, an exhaust outlet, a C02 absorber of recyclable gas, Or a connection between a gas channel device such as a breathing mask and an endotracheal tube. The present invention also relates to a new system and method for optimal use of fresh gas during artificial ventilation or assisted ventilation (including administration of anesthetic gas). In one embodiment, a modified Mayson D-type system and a modified CO 2 20 absorption system are available. Body, this is the oxygen body. The degree of inhalation and induction of Du Li fresh air is not limited. All the majors will take care of them. Therefore, this is a more comprehensive and predictable model to optimize the use of anesthetic gas on the patient's side (also That is, the far end of the circuit) provides undiluted fresh gas and circulates the used gas with a cleaning circuit containing CO2 absorbent, which ensures that the patient will receive a more precise concentration 4 (close to the gas concentration of the anesthesia machine flow meter) And the concentration setting value of the volatile anesthetic vaporizer) In addition, the gas is recirculated so that the gas can be reused after removing CO2, so as to provide a reliable low-flow anesthetic gas. As a result, the utilization of the new body can be optimized. In addition, the size of at least one breathing catheter in the single-wing multi-chamber exhalation path eight can be varied to adjust its volume 'or by using two length-adjustable elements, the anesthetic concentration and rebreathing volume can be safely adjusted and Make the best use of it, the same call officer or circuit can also be integrated for adult and child patients. W does not require individual packaging, but more than one circuit can be packaged. The advantage of packaging several circuits together is that the packaging can be lower than f ', while reducing storage and transportation costs, and the amount of waste. Opening a bag or case instead of several bags can also save assembly time. The saving situation described above will become quite considerable in general, because it can be used for the best use (that is, reducing the waiting time between operations, because it can reduce the cleaning and assembly of the operating room time). In addition to saving equipment costs, this Maoming can further make the health side more cost-effective. The circuit and system of the present invention are relatively simple, light in weight, and facilitate storage and transportation. The use of a small amount of plastic results in a small amount of medical waste, and is safe, practical and easy to use.

21 200301145 The economic benefits of protecting the environment and promoting artificial ventilation. The contents of the present invention will be better understood through the following drawings and detailed description. To help understand the present invention, in the following drawings, certain components are not shown and / or shown in simplified form. For example, the pillars or flanges of the space components are not shown 'while the wall thickness and relative tube diameter are not scaled out. [Embodiment] F3 circuit-circuit with unconventional catheter (new generation catheter)

Referring to Fig. 1, an embodiment of the present invention is shown, including a multi-chamber breathing circuit having elements that can interact with each other and whose length can be adjusted. This embodiment is also referred to herein as an F-spiral w circuit, which has a selective proximal component 10 and a selective distal component 20. The first catheter 30 is a spiral elastic tube having a proximal end 32 and a distal end 34. The proximal end 32 of the first catheter 30 is connected to a proximal assembly 10, and the distal end 34 of the first catheter 30 is connected to the distal assembly 2 (). In another embodiment, the proximal assembly ι0 may provide a proximal connector to the tube 30. The diameter, shape, and spatial relationship of the end 32 and the component 10 may be different, so as to connect any standard "f2Tm type" proximal end, such as described in US Patent No. 5,778,872 to Fukunaga. In the preferred embodiment, the second or outer f 4Q is elastic and corrugated, and is made of a transparent (or translucent) material. Preferred bellows include, for example, the ULTRA-FLEX stern tube, and when the repressive heart is wide, > Yukita can maintain the length of its shaft when it extends from the shaft compressed form (or vice versa) (ie, it will not It will rebound, which is an organ-like folded tube). In addition, the Ultra_flexi, when f is curved, < without substantially reducing the odor of its inner diameter, 22 degrees. This type of appropriate corrugation is used in the present invention Tubes can also be used for ULTRAFLEX circuits, ULTRA_FLEX® tubes purchased from King System Corp., Noblesville, IN, USA; or used for sale by Baxter Corp. of Round Lake, IL, USA IsoflexTM circuit tube. The tube can also be integrated into a distal and / or proximal component, which is thicker and stiffer than the tube, or can be connected or welded with an appropriately shaped component as required From the above abstracts and definitions, those skilled in the art should understand that there are still many variations of many embodiments of the present invention. For example, the diameters of the first and second conduits (30, 40) can be changed according to the use situation. Change. Also The outer tube 40 and the inner tube 30 can be replaced by SuaveTM tubes. In addition, those skilled in the art should understand that a spiral elasticity can change the overall axial configuration without changing the cross-sectional shape of its cavity. The external officer 40 terminates in a selective distal external component 20, which is designed to be easily connected to a patient device, such as an endotracheal tube, a laryngeal tube, a laryngeal mask, or an anesthesia mask. In one embodiment The distal end 34 of the first tube may be directly connected to the interior of the second tube 40 at a series of points set along the length of the tube 40, and periodically to the outside thereof. Reference makeup selective distal component 2 〇, shown on the back end 34 connected to the first tube 30. In one embodiment, the distal assembly 20 is connected to a selective inner π 卩 distant 鳊 assembly, which can be connected to the first tube The length of the component can be extended, and the connection point between the component 20 and the component in the selective distal end can be adjusted along the axis, which provides a predetermined invalid space. 23 2ΰϋ3011ί5

Referring to Fig. 2, it can be seen that the second duct 40 extends along the axis, so that the first guide 30 also extends along the axis. Proper selection of length, diameter, number of spirals per inch, and elasticity of the-duct 30 can appropriately prevent the entanglement phenomenon that may block the air flow when the V-th moss 30 is extended, Without sacrificing the performance of the single-wing circuit, the spiral 30 shrinks or rebounds when the outer tube 40 contracts along the axis. Preferably, the elasticity of the spiral, or the tendency to re-screw, should not cause the proximal end 32 of the inner tube 30 to fall off the proximal component when the outer tube extends axially to its maximum distance. It also does not cause the distal end 34 of the inner tube 30 to move axially with the distal end of the tube 40. It is made of medical-grade plastic, for example, plastic for the P port of breathing gas, or Plastics for intravascular fluid devices.

It is preferable to use a tube (eg, an accordion tube, a spiral tube, etc.) that can be axially extended and folded or compressed as the first tube (which may be an inner tube or an outer tube), and the second or inner tube Or the adjacent pipe, also expands or compresses in synchronization with the first pipe. This can promote safety during disassembly and reduce the chance of blocking and tangling. This can also promote rebreathing control, provide more flexibility and cost benefits during manufacturing, and reduce storage and shipping costs. Double Spiral Circuit Implementation Referring to Figure 5 A-B, an embodiment of a new circuit is shown. The two spiral tubes and 62 are in a spiral relationship parallel to each other and form a double spiral circuit. These tubes can be connected at multiple external points, a tube can be formed in a tube, or a tube can be separated by a common wall and form two chambers. Refer to Figure 5B 'Expanding the effect between elements to expand The figure shows that on the same day, 24 ZQUdOil15 shows its arrangement relationship with a proximal component 70 and a proximal component 80 when used in a circulatory system. The arrow showing the flow rate shows the intake gas path from the FGF (fresh air) inlet and the path to the exhaled gas outlet. The distal ends of the tubes 60 and 62 are connected to their distal assembly 72 with a connecting tube 74. Figures 5C-D show another embodiment of the double helix in Figures 5A-B. The spiral tubes 600 and 62 are connected to a proximal assembly 700, which connects each tube to the proximal end 80 for the circulation system. It should be noted that the spirals of the tubes 600 and 620 are overlapped with each other, and are optionally connected at a plurality of fixed points. The proximal and distal openings of the tubes 600 and 62 are separated, and the assembly can be connected to the outside or inside of the walls of the tubes 600 and 62. The distal ends of the tubes 600 and 620 are connected to a distal component 702 by a connecting tube 704. Embodiment of sliding inner tube Refer to Fig. 6 and Figs. 6A-B 'to show the operation and components of the first embodiment of the circuit according to the present invention. A first tube 90 is slid into a proximal assembly 92 via a sealing assembly 94. The proximal end of a second tube 96 is connected to the proximal component%, and a part of the tube 96 is removed to show the first tube 90 inside it. The tube can be compressed and extended axially, and can be made of a tube such as ULTRA-FLEX (S tube. The first tube 90 has a smooth wall portion that allows it to slide in and slide in response to the tube's axial compression and extension.出 组合 92。 The axial effect of the loop elements on each other can be achieved by a common distal assembly or other operative connection technology or device directly connecting the distal end of the tube 90 to the distal end of the tube 96 to achieve a two-handed organ embodiment 25 With reference to Figures 7A-B, the operation and components of the county ’s primary circuit embodiment are not according to the present invention. They can be connected to each other at the proximal ends of the biaxial accordion. ^ Fei 98 and 100, or Connected to a proximal component Lu 98 and 100 can both be ULTRA-FLEX ^ 〇 You can put * called + two pillars or hole-shaped discs 102 between the inner tube and the outer tube to achieve the best makeup performance, State. The axial interaction of the loop elements with each other can be via a common remote component 1 ^ 4 times /, his known connection technology or Pei Zhi's remote ends are directly connected to each other, and Jie, yt ... and Achieve 'e.g. borrow-close to the distal end of tube 98 or space support on s 98 迤 钿Column or hole-shaped disk 102. The embodiment of the bellows circuit is shown in Figs. 8A-B; Lower and lower parts. A tube with a relatively smooth tube wall 1 06 has a wave shape with a fixed offset gj ^ Yawaki. It can be contracted. The tube 106 made of elastic material can straighten the girder when extended, and Return to its original predetermined deflected angle contraction shape.-The outer I 108 can be contracted and extended at the same time as the f 106. A hollow branch or a hole-shaped I i Q2 can be placed between the inner tube and the outer tube to optimize the flow. Like :: The same as other circuit embodiments, the axial effects of the material elements with each other can be passed through:-a common distal assembly or other operative connection technology or device to move the opposite ends of the tube to each other; fish pull, earth connection In addition, many types of materials can be used. For example, the official 108 can be an ULTRA-FLEX® tube, and the tube 106 can be an elastic and radial elastic fiber or a plastic sheath. Preferably, when the circuit is fully extended, The axial elasticity (i.e., the tendency to re-spiral or contract) of the catheter within the circuit of the present invention is ^ ^ It is known that it comes off from an inhaled gas inlet. For example, in the dip chart & Ang SB chart, when the component is stationary and the duct 1% and 108 completely extend the flavor, Jisi & 1 06 rebounds to Its tendency to compress or relax, shown in Figure 8A, should not be enough to allow the proximal end of the tube 106 to fall off the proximal component ii. As mentioned above, the tube 106 may be a fiber or plastic with radial elasticity The sheath 10. Therefore, the tube 106 can be a SuaveTM tube, and / or the tube 108 can also be a tube. For example, the inner or outer tube of the breathing catheter according to this embodiment of the present invention is not It can be relaxed or folded during use, and expanded to the desired shape when needed. Additional chambers can also be added in this or other embodiments. Hybrid Circuit Example (HYBRID CIRCUIT) A hybrid circuit includes at least a conventional catheter and at least one elastic plastic film (ie, polyvinyl). The elastic plastic film can define two or more lumens in the catheter. Figures 9A-B show a hybrid circuit assembly with a common wall of the present invention and its operation. The first and second tubes 116 and 118 share a common wall 20 that can be expanded and contracted axially, and a common partition wall 12 that can also be expanded and contracted axially. This embodiment may be made of a material with a zipper, such as the material used to form ULTRA-FLEX®. Alternatively, the common partition wall 122 can also be formed by an elastic plastic film, which can allow the cross-section sizes of the two chambers to be matched and to accommodate the use conditions. For example, when the pressure in one chamber is higher than the other chamber, the wall will inflate the volume of the high-pressure chamber and become larger than before. Preferably, the wall has a maximum diameter under respiratory care operating conditions. It may also include an additional chamber ' which may share the common wall or have a separate diameter from the other chambers. This embodiment can be formed by cutting a conventional catheter into two halves' and sticking an elastic plastic film between the two halves; or by extruding a long, semi-circular plastic between the two matching halves A 27-elastic plastic pouch is glued to form a relaxing circuit embodiment. Figure 10 shows another form of the component of Figure 8 and its operation. The second conduit is formed by a smooth plastic film such as a SuaveTM tube. 140 An inner tube or first tube 15 is housed, the first tube containing a bellows. The outer tube or the second tube is foldable when not in use, while the inner tube 15 maintains its diameter during suction care operations and during normal non-use. This embodiment makes the original description of Fig. 8 clearer, because one of the pipes has radial elasticity. In a preferred embodiment, the breathing catheter j 4 丨 includes a proximal assembly 142 bonded to the proximal ends of the tubes 140 and 150. Proximal components facilitate connections to the corresponding proximal ends. A distal assembly 51 is connected to the distal ends of the tubes 140 and 150. The distal end of the tube 150 is connected to the post 52. The radial struts 152 are not solid rings, but have gaps 153 to hold the gas flowing from the common zone 154 into the tube 140. Although the tube 14 can be folded under the condition of 1 # which is not in use. When in use, whether it is inhaled or exhaled, there must be sufficient gas flow to expand to its maximum diameter and volume (depending on its system). Is used for inspiration or expiration), and there is no or almost no folding at the maximum radius. The axial post 155 is connected to the radial post 152 and grasps the distal end of the inner tube 150. The tube 150 may be connected to a radial strut. The axial extension of the radial struts 152 and / or the axial struts 155 may provide a relatively high and rigid dead space. As described in other embodiments, the distal component, such as the distal element 1 5 1 'can be modified to provide a sliding connection between the distal component seat and the connector to the inner catheter', wherein the ineffective space can be adjusted to a desired volume of. 28

'Figure 11 shows the components and operation of a single-wing Huming Road M Gan Wuyu and the instructor, of which a first elastic tube 160 is a conventional bomb ^ # J4 tube' which can be used during non-use and respiratory treatment operations Maintain a fixed direct coupling. J Straight K, the second tube 170 is a non-conventional plastic tube, which can be folded radially without the need to maintain the surname τ ^ and keep deformation. In a preferred embodiment, the tube is 17 rabbit-c Feng-SuaveTM elastic tube. A new proximal assembly 162 is shown, of which the cylinder axis rolling flow system is introduced into two independent chambers 163 and 164, which respectively have J ’two independent Fu 165 and

166 ', that is,' independent, non-interfering monks' means that the other monks can be used or cut off without blocking or interfering with the entry and exit of the monks. The distal assembly 172 has axial walls 173 and 174, which can be remote from the distal ends of the receivers 160 and 170. Fortunately, the extension to the walls 173 and 174 allows Yi to adjust * g, and the invalid space on the listening side can be adjusted. The connecting pillar 1 75 has a gap 1 76 which can provide the space between the surnames μ, π, and Λ_ Dai Daishe Weifu Wall 1 7 4 and the wall 1 7 3 while maintaining their deformation. Figure 12 shows a two non-conventional catheters (or tubes 18 and 19, also known as Suave tubes. The distal ends of the two tubes are connected by a distal component 182, and the proximal end is connected by a proximal component 1 92 连接） of the formation of a single-wing breathing duct

Components and their operations. The tube 190 includes a spiral tube 200. The tube 200 has a higher radial stiffness than the tube 190 in which it is contained, and thus can help maintain the outer tube 190 from deformation. t 200 can be used for gas samples or other applications. For example, the tube 190 may provide aspirated gas. The tube 190 series is maintained undistorted by the official 200, and the tubes 180 and 190 series have a fixed axial length. The helical nature of the tube 200 allows the tubes 18 and 19 to be axially folded. In the embodiment, the tube 200 includes a metal wire or a plastic wire that can maintain its extended length, which is different from the case of having axial elasticity in other embodiments. The inner wall of the tube 1929 can be selectively connected to the tube 200 periodically at fixed points to provide uniform folding and extension of the tube 190. In one embodiment, the tube 200 is a solid wire. Assembly 1 92 provides rapid connection of the breathing catheter to a corresponding multi-lumen proximal end. Although the outlet 201 of the tube 200 is shown through the wall of the module 192, the module 192 may have a cavity that can connect the tube 200 to a corresponding inlet or outlet.

The above non-limiting embodiments have described a groin suction catheter, also known as a multi-lumen single-wing breathing catheter, which has both axial and / or radial compression or contraction characteristics. However, the breathing tube does not need to expand or contract in the vehicle. An embodiment may include a conventional corrugated catheter of a fixed length or a smooth elastic tube or a ULTRA-FLEX® tube with a tubular configuration, and the second catheter may be a non-conventional catheter. Therefore, the length of the breathing catheter can be fixed, and one or more of the tubes can expand or contract radially.

A breathing catheter or a single-wing breathing catheter of the present invention can be easily connected to a breathing apparatus or a ventilator by a proximal assembly of the breathing catheter or by a distal end (e.g., as described in U.S. Patent No. 6,003,511). By connecting the corresponding proximal end of the proximal component to a single-wing breathing catheter of the present invention, and then to the corresponding proximal end; in this way, the breathing catheter of the present invention can quickly and safely connect many different types of breathing devices. (Not limited to anesthesia machines and artificial ventilators). It can be connected directly or indirectly through a filter. The suction catheter of the present invention can be connected to a single-filter or a multi-chamber filter, or can be prepared by integrating it with a single-chamber or multi-chamber filter-body shaping. The proximal end of the instrument holder can be designed to quickly and safely remotely connect to the remote end of the ^ 30 20030li 45. The distal end can be matched with the proximal end of the respiratory catheter.

The breathing catheter of the present invention can also be used for ventilation during patient transfer or when connected to a gas source (i.e., oxygen source after anesthesia care setting, intensive care unit, etc.). Therefore, the breathing catheter of the present invention is a multipurpose breathing catheter. Rather than using a new device (e.g., a responsible emergency bag for patient transfer), the same breathing catheter of the present invention can be used to provide oxygen during patient transfer (e.g., to PACU or other locations). After the patient has been transferred (for example, from the operating room to the PACU), the same breathing tube can be used at the PACU to provide oxygen to the patient 'without the need for an additional oxygen supply device, such as an oxygen tube or a T-piece set Nasal tube or clean oxygen mask. Meibosen D plastic system and cyclic C02 absorption system

Reference is now made to Figures 3A-D, which is a schematic diagram of a Mayson D-type system, in which fresh air flow 1 (FGF) is transmitted to a remote component 3 via a fresh air transfer tube 2 (shown in the main drawing). It is better to refer to the numbered arrow 2 elements to understand the operation of the system. For example, when inhaling, the air system is the same, from the fresh air inlet 1 and the bag 7 through the flow channels a and b (detailed in the illustration below the 38th ', and refer to the symbols and arrows: (1 2 3 4 ) + (7 6 5 " flow to lung 4. When exhaling, the air flow from lung 4 flows through the following flow =)) Zeng a, and b, to the exhaust gas outlet 8:45 67S. Lane ^ Figure 3B is a schematic diagram of a usage system. The shift is inserted at the proximal end of the circuit and located at the far end of the circuit. The characteristic of the Mebson d road of the "Bain Circuit" is that the fresh air delivery tube 2 series' extends through the breathing tube 5 so that it has a distal end 3 31 & the picture shows a theft 12, and the inspection m shield% The CO2 absorption system is reproduced in ancient direct reading (that is, Xing Er has a C0, 啜 跄 inspiratory catheter s-directional valve) 4 and 9, as well as Jie, Tu Ye 5 and expiratory catheter 8. Meet Yan entrance 1 and bag 1 at Yanyan component 6 :, 'Qi system at the same time to refresh the illustrations, and refer to the movement (detailed in (3 12c) in the bottom of Figure 3A ... 6 7) ^ (1〇1 2 4 5 and arrows: When the air is qi, the air flow from the lung 7 passes through the following ::,) to the lung 7. Exhalation gas outlet 11: (1 2 3 Ί 1 / motorized channel c 'And d, flow to 2) + (7 6 8 9 1〇n ,. Figure 3D shows a cycle of the C02 absorption system. TM π 丨 乂 ★ Shan Zhicong-Gu' ,,, Xian 'its use A universal… or wide ratio. F2tm_-type Kinki assembly is equipped. Circuit. The suction duct 5 is coaxially located at the distal end of the proximal end of the Hoeing Guide 8. It should be noted that in the circulation system, the 'fresh gas system is in the% absorber. The Merbson D-type system, which is merged with the recirculated clean gas at or near the C02 absorber and carried by a common duct and found to be '°', is provided at the end of the circuit. A fresh gas.

Body System "F3 Combination TM System" Figure 4 and Figure 4A show a novel respiratory assisted ventilation system using the present invention. The fresh gas from the gas source 1 (that is, the anesthesia machine). The eight-flow device 70 flows through the fresh gas transfer tube 2 (schematic diagram). The splitter 70 flow-sensitive knife (or located in a CO2 absorber) provides a fresh gas input to the Fu circulation system. The shunt can close the input fu on top of the CO2 absorber 12, so that fresh gas can be directly introduced into the breathing duct ... the protective system is selectively determined 'by the cleaning circuit (usually close to the employee)' , C〇2 ^ ^ to improve / fresh gas 32 2〇003〇i.ll5

End, 3 (ie, the F GF bypasses the cleaning module, so it does not mix with the cleaned gas). A seal can be used instead of a shunt, and the source of fresh gas can come from many different locations. In this embodiment, the tube 2, like the "shift circuit", is rigidly connected to a proximal assembly 50, and the fresh gas system is directly transmitted to the distal end 3 of the breathing catheter, and is continuously fed The common inspiratory / expiratory tube $ in 'is also referred to herein as a rebreathing tube. However, referring to Figure 4C, unlike the "shift circuit", the volume of the tube and the concentration of its contents can be changed by changing the size of the catheter $, so that the concentration of inhaled gas can be determined according to the condition of each patient Adjust and control rebreathing. For example, the tube 5 may be a ULTRA-FLEX® tube. The control purpose can be achieved by adjusting the size of the tube 5, for example, by adjusting the length of the tube 5 axially (depending on the data of the suction and / or final gas concentration provided by the monitoring device to determine the volume and content of the burette).

The new system of the present invention is different from the traditional circulation system in that the fresh gas delivery system in the system of the present invention comes directly from the anesthesia machine and is not mixed or diluted at the end of the machine / washing circuit. Because the flow of fresh gas is delivered very close to the patient, the concentration of anesthetic gas inhaled is almost equal to the concentration at which the delivery takes place. Therefore, the anesthesiologist can rely on the concentration of the anesthetic gas indicated on the flow meter and volatilizer, and use this concentration as the inhalation concentration. The difference between this new system and the Mayson D-type system is that the exhaled gas in the system of the present invention is not completely discarded, but can be used again in the form of "refreshing gas". This novel "F system" provides amazing improvements in the quality and control of inhalation and anesthesia ventilation, while also avoiding the waste of anesthetic gas. If a spiral fresh gas tube is used, when the tube 5 is contracted, the tube 2 will also be spiraled. 33 20U301115 Contracted 'as shown in Figure 4C. The fresh gas pipe 2 may also have other shapes, and may be provided as an inner pipe or an outer pipe with respect to the pipe 5. If the tube 2 is a smooth wall, it can slide in or out of a component, as shown in Figure 6. Preferably, the volume of the tube 5 is adjusted to be higher than the final volume (ντ) during use, thereby reducing the mixing of fresh gas and "cleaned gas". This maximizes the use of fresh gas (narcotic gas) while also optimizing the control of oxygen and carbon dioxide. In a preferred embodiment, the length of the rebreathing tube can be varied for multiple uses. The same respiratory system can be used for many purposes, such as operating rooms, emergency intensive care units, emergency rooms, respiratory care units, adults, children, etc. Figure 4B shows an enlarged view of the proximal assembly 52, which can be connected to the breathing tube 5 and the fresh gas tube 2 or removed from the breathing tube 5 and the fresh gas tube 2. The figure also shows an additional proximal end 6. Proximal 6 can be an F2® adapter or a gamma adapter. Referring to FIG. 4A, the system components preferably include a storage bag or venting device 10, and an exhaust gas outlet 11, which is connected to a cleaner, a CO2 absorber 12, inspection valves 40 and 90, and an air suction duct 5. The operation of the expiratory catheter 8, and a proximal end 60 system connected to the proximal end assembly 50 is preferably understood with reference to the arrows and elements with the numbers. For example, in a preferred embodiment, when inhaling, the air system flows from the fresh air source and the bag 7 / ventilation device to the lung 4 at the same time: (1 2 3 4) + ( 10 1 2 4 0 5, 6, 5 3 4)). When exhaling, the airflow from the lung 4 flows to the exhaust gas outlet 11 via the following flow sequence: (1 2 3 5) + (4 3 56 8, 9〇l〇u ”34 Therefore, in a preferred embodiment A novel intoxication system is provided, which includes a recirculation module; repeatedly & the rebreathing & end openings are operatively connected to a recirculation module to feed the recirculation module Group or receiving gas from the recirculation module; a remote inlet of the fresh rolled body, the remote inlet is located in the rebreathing repellent 5¾ 3 3 乂 部 部 刀 S 疋 4 and operated in a return assembly To the distal end of the rebreathing tube. The recirculation module preferably includes a cleaning circuit, the cleaning circuit 4 includes at least two check valves, an exhalation input tube, a C02 absorber 12, and an exhaust pipe A clean gas outlet tube; and a squeeze bag and / or aeration device. In a preferred embodiment, a detachable filter device is connected to the proximal end of the rebreathing catheter 5; the filter device can also be integrated On the catheter 5. One of the preferred embodiments of this novel system is referred to herein as r F3 combination tm The system can make the best use of fresh gas and the most effective and safe system. Known the low flow anesthesia method can reduce the amount of anesthetic exhaust gas used, so the higher flow anesthesia method is superior, and therefore the low flow anesthesia method is more economical and can reduce Health insurance costs. Furthermore, this method can keep the inhaled gas at a better humidity and temperature. In addition, it can also reduce the gas released from the system into the environment 'reduce the pollution of the operating room and provide a safer work Environment and lower air pollution. However, despite the advantages of low flow anesthesia, the application of its method and related systems is limited by many unsafe factors. Therefore, there is an urgent need to improve these systems and methods. Traditional use of C 〇2 Absorber's anesthesia circulation breathing system uses high flow of fresh gas, that is, fresh gas with a flow rate higher than 5 liters per minute (FGF > 5 L / min) 35; as for the Meberson D system The fresh gas flow rate is higher than 7 liters per minute. However, more than 90% of the newly delivered fresh gas system is wasted. High-flow fresh gas is used. One of the many reasons is the fear that when a low-flow anesthetic gas is provided to the patient, the final anesthetic dose may be too high or insufficient. When using a high-flow fresh gas, the concentration of the inhaled gas (anaesthetic gas) may be assumed ^ FI or F!) Is equal to the agrochemical level of the delivered gas (FD or FD = set concentration of the vaporizer). However, this assumption is not applicable to the case of low-flow anesthetic gas. Reducing FGF will cause the delivered gas concentration (FD) and The concentration gradient (concentration difference) between the inhaled concentrations (FI) gradually rises, partly due to the continuous increase in the dilution of the fresh gas concentration by the cleaning gas in the system. For example, when the FGF is lower than each During a period of 3 liters per minute, there is a significant difference (approximately 20%) between the concentration of the inhaled gas and the concentration of the transmitted gas. This may lead to insufficient anesthesia in the patient. Therefore, it is generally not recommended to use low flow anesthesia, unless the flow rate is constantly adjusted and carefully controlled inhalation concentration and final gas concentration when drunk. The examples test the following hypotheses: (a) the concentration of inhaled and delivered gas (FI / FD) changes with time and the flow rate of fresh gas; (b) under low flow f ' Improve FI / FD ratio. Compare the effect of low FGF on the inhaled gas concentration and the delivered gas concentration (ie, the anesthetic gas concentration value displayed by the volatilizer setting) in a general anesthesia condition. With the consent of the medical institution and the patient, a total of 36 healthy adult (AsA type i) patients undergoing voluntary surgery were included in this experiment. This experiment was performed in accordance with standard anesthesia methods. With the assistance of 1 mg / kg perianum bile test, anesthesia was induced by thiopental and endotracheal intubation. Initially, a standard anesthesia circulation system equipped with a CO 2 absorber was used to maintain the volatile anesthesia setting at a high flow rate (5 liters / minute) of a 3/2 N20-02 mixture and 1.5% isofluoride. Intermittent positive pressure ventilation in the traditional mode (the final volume is 10 ml / kg, the ventilation frequency is 10-12 breaths / minute, and the inspiration / expiration ratio = 1:

2) Mechanical ventilation of the patient's lungs. These parameters have remained fixed during the study. A mass spectrometer (Medical Gas Analyzer 100; Perkin-Elmer, Pomona, CA) was used to continuously monitor a portion of the anesthesia gas concentration (FD), inhalation (FI), and final stage (FEI). In test I, first let high-flow fresh gas (FGF > 5 L / min) flow stably for 15 minutes, and then change to lower flow fgF (selected from 4L / min (n = 3), SL / mininyhZL / minCnyhlL / mii ^ nM), and 0.5L / min (n = 6)),

It is randomly assigned, while maintaining the original setting on the volatilizer (1.5% isofluoride). F !, FET, and fd were repeatedly measured to compare FI / FD ratios and perform statistical analysis. The results are shown in Figure 14. The results show that when the FGF decreases, the FI / FD ratio decreases significantly at the same time. In addition, the results of this experiment also show that when the traditional circulatory system is used, there is indeed a significant difference between F! And FD values, and some data points are low in the flow; g is outside the boundary of the anesthesia method. Table 1 shows the results of the data from Wujian Π, in which 12 patients were randomly assigned to use the conventional circulatory system (n = 6) in the case of low flow (lL / min) FGF, and the combination of F3 Group B of the TM system. It can be noticed in Table 1 that the ratio of the concentration of the F3 combined TM system to the ratio of fi / Fd 37 20U30il15 has greatly improved. In addition, the difference between & and dagger values is shown to be very small and the new system also provides better correlation. This can support the aforementioned rhetoric 5 :, 'that is, by using the "F3 group of people tm 佥 ～ 丄 0 0 丄 | food, and σ system", low-flow anesthesia can be safely administered, and excessive anaesthesia dose can be avoided Or insufficient phenomenon. With the current F3 combined τμ system, the anesthesiologist will be able to control the concentration of anesthetic gas inhaled by the patient in a more accurate and predictable mode. Therefore, low-flow anesthesia can be safely and reliably administered without expensive multi-gas monitoring equipment. In addition, it can also speed up the recovery process after waking up from anesthesia at the end of surgery and anesthesia. This can be achieved by directly providing high-flow oxygen at the end to quickly flush out the anaesthetic gas remaining in the lungs and breathing circuit. Rapid resuscitation during anesthesia can save time and money in resuscitation. Therefore, using this F3 combined TM circuit and / or method can save anesthesia gas and oxygen, and at the same time minimize pollution and health risks, so it can effectively improve the respiratory / anaesthesia system. This can also reduce overall health care costs while optimizing patient health care. Figure 15 shows the continuous (simultaneous and simultaneous monitoring) of the gas concentration of FD, inhalation (Fi), and terminal (FET) gas under the condition of low-flow anesthesia gas flow (1L / min) and volatiles set to 1.2% isoflurane. Change over time. It can be noticed that there is a significant difference between the FD gas concentration (that is, the set concentration of the volatilizer) and the Fl and Fet gas concentrations. 0 38 200301115 Table 1 In the case of low-flow isoflurane anesthesia gas flow (lL / min), the comparison is based on the conventional System and F3 Combination ™ System F_ @ distant F! And F / FD ratio ^ Patient No. 3 Volatile Setting (Fd) Volume% Group A (n = 6) No FGF shunt (ie, the gas system consists of Provided on the machine side) (FD)% by volume (F, / Fd) Group B (n = 6) FGF shunt (ie, the gas system is provided by the patient side) (FD)% by volume (f / fd) 1 1.5 0.92 0.61 1.46 ----- 0.97 _ 2 1.5 0.96 0.64 1.20 0.80 3 1.5 1.00 0.67 1.20 0.80 4 1.5 1.20 0.80 1.45 0.97-5 1.5 0.89 0.59 1.20 0.80 6 1.5 0.95 0.63 1.35 0.90 _ average 1.5 0.99 0.66 1.31 0.87 ± SD ± 0.0 ± 0.11 ± (X088 ± 0.13 ± 0.08

Fi. Inhalation concentration; FD _ transmission concentration (such as volatile device setting); Ft / FD: concentration ratio is very clear. The present invention provides a method, which can provide auxiliary ventilation or anesthesia, where the fresh gas system comes at a low flow rate. Supply, for example, a flow rate of 1 liter per minute (generally, low flow rate refers to a flow rate of 0.5 to less than 5 liters / minute, or in the preferred embodiment, less than 3 liters / minute), and can By adjusting the volume of the proximal end of the breathing tube of the fresh air inlet, the 39 concentration ratio of Fi / Fd is maintained in a desired range, such as about 0 * δ 0 or more. In a preferred embodiment, the fresh air flow rate used is between 、 / 、 拉, ', ν 1 liter / is between 3 and 3 liters / minute; more preferably is about i liter / minute i 2 Liter / Min. An Exemplary Configuration The present invention allows the use of smaller breathing tubes and their disposable components. Currently, multiple circuits are required for one day of surgery. Therefore, the circuit needs to be stored in the operating room or near the operating room. During the preparation of each procedure, a new circuit must be removed from the sterile bag and its packaging discarded. If you are not careful when unpacking, you will most likely damage the circuit. Since the present invention can reduce the number of circuit components to be discarded, the number of circuit components required for each new operation can be reduced. In addition, because it can be contracted axially and in some embodiments it can also be contracted radially, the assembly can be made smaller, requires less packaging, is easier to store, and can be shipped. Referring to FIG. 16, an exemplary configuration box 200 is shown. A breathing tube 2 10 is not shown in the block diagram, and is selectively enclosed in a thin plastic protective film 212. Preferably, the respiratory catheter 21 is not individually packaged. In one embodiment, the configuration box 200 includes a row of holes 214 on its face and top to facilitate removal or rotation or pivoting of a portion of the box. There may be a sealing tape 216 above the hole a " to reduce the chance of accidental opening or destruction. A configuration box containing a variety of different catheters is available, such as 4, 6, 8, 10, 12, 15, 24, or more than 100 breathing catheters. The lid can be closed by gravity or sealed by the user. This type of configuration box can be loaded 40 2003011 15 In addition to the need to seal individual disposable circuit components in a separate bag, it also reduces the time required to open and remove the contents of the bag ^. This configuration box can also reduce the amount of exhaust gas produced compared to individually packaged conduits, because it uses less material and therefore requires less material to discard. In one embodiment, the cross-sectional shape of the breathing catheter is substantially cylindrical. Therefore, the thickness and length of the configuration box should be sufficient to accommodate a breathing tube in a compressed state, and its height is proportional to the number of breathing tubes contained therein. The holes in the box cover extend along one side of the box, and the box can be opened by the holes to obtain the sequentially arranged catheters. As shown in the single-wing breathing catheter in Figures 13 (a) and (b), the multi-lumen instructor of the present invention has a variety of types to choose from, and 1 can be compressed into a relatively small volume for convenient transportation and storage. As a result, many of these catheters fit into the configuration box described above. Referring to FIG. 13 again, (a) an inflated breathing catheter; and (b) a compressed breathing catheter. An outer tube or a non-b 4 —Suave tube, and an inner tube 230 is a spiral tube, wherein the spiral lumen has a relatively rigid cross-sectional shape. When compressed, excess material in the Suave tube becomes wrinkled. By periodically connecting the tube 22 to the inner tube at each fixed point, the wrinkles can be uniformly distributed. The proximal assembly 24o is coaxial with the spiral tube 230 connected to an internal tube 242 or the distal end of the spiral tube 230 integrated with the internal tube 242, but other variations are possible. In another embodiment, a rigid inner pipe and a rigid outer pipe are held together by a rigid compartment device to form a proximal assembly, = the inner official road and the outer pipe are connected On this proximal component. "Dagger, this hair 41 2ϋϋ301115 In Mingrong machinery, it is connected with the spiral tube to the near-shaped to unrestricted one tube at the same time, and it is transported at the same time. The improvement of the two-type guide [Tu Xu Optimization, the manufacturing depends on the available parts, materials, and technology. The inner tube 242 can be integrated into a rigid spiral tube 230 in one step. In another step, the screw and the screw 2304 are synthesized. The inner inner pipe 242 is connected with an appropriate compartment device * such as an outer pipe such as pipe 244. A Suave pipe can then be connected to the outer & road 2 4 4. An inner module 2 4 8 and The single-ended component 246 of the outer component 250 can be connected to a corresponding tube before the Suave tube is connected to the proximal component. The distal component 246 can also complete the action of being connected to the tube in a series. For example, when the end of the tube 230 is connected to the inner tube 242, the inner assembly 248 can be integrated into the distal end of the official 230. A combination of various construction steps can also be used. Those skilled in the art should be able to Understand the F3 combination TM circuit described here and the arrangement in the single-wing tube, Can be used in a two-wing arrangement with at least one Suave tube or a spiral tube in order to significantly reduce manufacturing and storage costs. Therefore, the exemplary embodiment of the present invention and its use have been described in detail above. Explains other variations, descriptions, and definitions of terms used in the embodiment. For example, the sizes of the tubes in the circuit can be different from each other and can be stored in more than one chamber. | With the present invention, large-diameter or small-diameter tubes can be used. And the circulatory system and Mebson-type system can be built. The above real examples are only for illustration, the present invention can still have many variations and simple explanations] 42 2 ^ U3Gl i, | 5 Figure i shows once A constricted first spiral catheter, which is located in a compressed first guide S, where the proximal ends of two catheters (the first and second catheters) are connected to a different proximal component, where The first catheter is clearly seen, so a part of the second catheter is not shown. Figure 2 shows the figure after the clothes are unfolded in Figure i. Figure 3 AD shows a Mepson D-type system and Operation of the cyclic co2 reabsorption system 4A-C Shows the components and operation of a system built in accordance with the present invention, where 4B-C shows an embodiment of the present invention using a spiral tube in a tube, where the outer tube is an accordion tube (ie, Ultra_FLex @ 管). Figure 5 AD shows the components and operation of a system built in accordance with the present invention, which is an embodiment of the present invention using a double spiral tube circuit. Figures 6A-B show a sliding inner tube embodiment of the present invention. The assembly and its operation, in which the smooth-walled conventional suction line is inserted through a component into an axially expandable and foldable tube. Figure 7 AB shows a biaxial accordion-type tube constructed in accordance with the present invention. The components of a system and their operations. Figures 8A-B show a bellows or element assembly and its operation according to an embodiment of the accordion-type pipe according to the present invention. Some of the outer pipes have been removed to make it easier for the reader to see the inner pipe structure. Figures 9A-B show the components of the embodiment of the common shrinkage wall according to the present invention and their operation '... The outer tube has been removed to make it easier for the reader to see the internal structure. Fig. 10 shows components and operations of another version of the embodiment of Fig. 43 200301115, wherein the first tube is formed by a smooth plastic film, a Suave tube, which contains an inner tube or a second tube. The second duct is composed of a corrugated tube, and part of the outer tube has been removed to make it easier for the reader to see the inner tube structure. At the same time, a middle section has been removed to match the size of the figure. Although the outer tube or the first tube can be folded when not in use, the inner tube can maintain its diameter without deformation under respiratory care operations and when not in use.

Figure 11 shows the components and operation of a single-wing breathing catheter, where the first elastic tube is a conventional elastic bellows or folded tube, which can maintain a fixed diameter under normal conditions and respiratory care operation conditions; as for The second catheter is a non-conventional plastic tube, which can be folded radially without maintaining deformation. Figure 12 shows the assembly and operation of a single-wing breathing catheter formed by two non-conventional catheters (i.e., Suave tube, the proximal and distal ends of which are connected to each other). One of the tubes includes a spiral tube, which is more rigid in the radial direction than the outer tube in which it is housed, and thus helps maintain the shape of the outer tube without deformation.

Figures 13 (a) and (b) show an inflated breathing catheter (a) and a compressed breathing catheter (b). The outer tube or the first tube is a Suave tube, and some of the outer tubes have been Removed to make it easier for the reader to see the structure of the inner tube; and the inner tube is a spiral tube, and the inner cavity of the spiral tube has a rigid cross-sectional shape. Figure 14 shows the concentration of isoflurane inhaled (FJ and delivery (FD) under a low flow anesthetic gas (FGF) gradient. Figure 15 shows a low flow anesthetic gas (1 liter of FGF gas per minute) 44 200301115 ( The set value of the volatilizer is a constant 1.2% isoflurane, and the relationship between the inhalation (fo and the final concentration (fet) to the delivery (fd) concentration. Figure 16 shows an example of a configuration with multiple respiratory catheters The configuration box, in which the breathing catheter is represented by a block diagram. [Elements of the symbol brief description] Fresh air lung bag check valve co2 absorber distal outer assembly spiral tube shunt assembly seal assembly coaxial accordion tube first catheter Common wall of the second catheter Common partition wall Respiratory catheter tube 1 4, 7 7 > 10 4, 9, 40, 90 12 20 60 '62, 200, 230, 600, 602 70 92 94 98 > 100 30, 106, 116, 150 40, 108-118, 140 120, 173, 174 122 210, 141 2, 5, 5 ', 8, 8', 90, 96, 98, 160 > 170 ^ 180, 190, 220

45 200301115 Inner and outer piping Inner and outer components Gap common area Proximity Proximity component chamber Distal distal component connection tube Fu space pillar or hole-shaped disk Axial pillar inlet and outlet configuration box Plastic protective film Hole sealing tape 242 244 248 250 153 > 176 154 6, 32, 80, 800 50, 52, 70, 110, 142, 162, 192, 240, 246, 700 163, 164 3, 34 3, 6, 72, 151, 182 , 702 74 '704 165, 166 102 > 152 155 1 8, 11, 201 200 212 214 216

46

Claims (1)

200301145 Patent application scope 1. A multi-chamber breathing circuit including at least a first and a distal end of each catheter, wherein the proximal end of the first catheter is operatively connected to an inlet for inhaled gas And the second catheter is operatively connected to an inhaled gas outlet ^ q D, and at the same time extending or contracting the distal end of the second catheter axially can cause the official distal end of the first wing to also correspond to the axial direction Extend or contract. Forcing road ', where the circuit is a single-wing circuit as described in item 1 of the patent application scope. 3. As described in item 1 of the scope of the patent application, n is a universal circuit, in which the first catheter package " the first spiral tube, and the catheter is contracted > in response to the expansion of the second pilot camp Or shrink and expand or contract a corresponding length. Part of the female stated the scope of the first item of the patent scope in the first h, where the guidance department is located inside the second conduit. 5. According to the patent application scope No. 3, the tenth, the tenth, the Mr, the circuit of the hall, it has an arrangement selected from the following α: (a) where the second s contains a second spiral tube; (B) A at least a part of the first guiding technique spiral tube # if f S l contains a first spiral battalion, at least a part of the catheter of the first giant system spiral square is a second catheter; (〇where the second The life s includes a second spiral tube, the first and second battalions of A 〃zhong 礒 both have a distal end and a proximal end, and the distal ends of the first and second tubes are operatively connected together, and ( d) wherein the second conduit includes a second spiral tube, in which a portion of the first and second piping systems are in a circling relationship in parallel with each other. 0 6 • The circuit described in item 1 of the scope of patent application, wherein The first and second catheters have a common proximal assembly at their proximal ends. 7 • The circuit according to any of claims 1 to 6 of the declared patent scope, wherein the first and second catheters are in the The distal end has a common distal assembly. 8 • The circuit described in item 7 of the patent application scope, wherein The distal end rigid assembly comprises a first space or directly to the distal end of the catheter is connected to the distal end of the second conduit. 9. The circuit according to item 8 of the scope of the patent application, the distal assembly can be used to adjust the axial distance between the distal end of the first catheter and the distal end of the second catheter. 10. A multi-chamber breathing circuit comprising at least a first tube and a second tube, each tube having a proximal end and a distal end, wherein the proximal end of the first tube is operatively connected to an inhalation A gas inlet 'and the second tube system is operatively connected to an intake gas outlet, wherein at least one of the tubes can be radially folded when not in use. 48 2 ^ 03011ι 11. The circuit described in item 10 of the scope of patent application, wherein the tube has an arrangement selected from the following: (a) —at least a part of the tube is located inside another tube; (b) The tubing is connected at a fixed interval on its outer surface; and (0) the tubing is connected from its distal end by a distal assembly, and at least a part of the tubing is far apart from each other. The circuit according to item 10, wherein the at least one tube that expands radially to provide assisted ventilation and / or anesthesia for humans or other mammals has an obedience of less than about 20% 13. The circuit as described in item 10 of the scope of the patent application, wherein the radial finger and the at least one tube that expands under pressure to provide auxiliary ventilation and / or anesthesia for humans or other mammals are Has a compliance of about less than 10%. 14. The circuit described in claim 10 of the patent scope, wherein the at least one tube that can be foldable radially has a minimum cross-sectional area under full inflation. And can be folded when not in use, so The folded wear area of the minimum cross-sectional area under full inflation is about 90% or less of the expanded cross-sectional area. The circuit described in item 2 of the patent application scope, wherein the at least one tube that can be radially folded It has a minimum cross-sectional area under full inflation and can be folded when not in use, so that the minimum cross-sectional area under full inflation and expansion is 49 15. 2ϋ03011! 5 The folded cross-sectional area is approximately below the expansion cross-sectional area t ιο% 1 6 · — a ventilation or anesthesia system, equipped with 5 small — it contains at least a recirculation module; a rebreathing tube, the proximal opening of which can be reversed, the main recirculation module is pressed in "," Waste oxygen or supply exhaust gas to the recirculation module; and a fresh gas remote " input Fu, where the remote input Fu system is located at the distal end of the rebreathing tube Qiba J or 疋 located at A distal component is operatively connected to the distal end of the rebreathing tube, wherein the rebreathing tube has an adjustable volume that is approximately equal to the volume of the proximal component, wherein the Yi Wang connected the fresh gas concentration on the patient or mammal of the system, which can be adjusted by adjusting the volume of the rebreathing tube about the volume of the proximal component. 7. If the scope of patent application The system described in item 16 > Mou Park, wherein the recirculation module includes a cleaning circuit. 1 8. A method for providing a low flow of anesthetic or breathing gas to a human or other mammal Method 'The method includes the following steps: · Provide a fresh air machine desired by the patient and a clean air stream consisting of a recirculated air stream, wherein the fresh air & clean and clean air stream is via-* 有 -distal and near The second tube includes a distal end and a proximal end, and the proximal tube system can be Operatively connected to a cleaning module to clean and 50 2003011, | 5 recirculate at least a part of the exhaled exhaust gas received, and the first pipe has an output fu, which is operatively connected to the circuit remote Wherein the distal end of the first loop by piping to provide fresh gas to a human or other mammal body. 19. The method as described in item 18 of the scope of patent application, wherein the second tube has an adjustable volume, which is approximately equal to the volume of the first tube connected to the circuit. The concentration of the applied fresh gas can be borrowed. It is adjusted by adjusting the volume of the second tube. 20. The method according to item 18 of the scope of patent application, wherein the fresh gas is supplied in a volume of about 0.5 to 5 liters per minute. 2 1. The method according to the scope of patent application: Item 18, wherein the FI / FD concentration ratio is maintained above about 0.8 by adjusting the volume of the second tube. 51