TWI281870B - 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

Ϊ 281870 狄, invention description [Technical field] The present invention relates to a device for resuscitating a patient and/or providing patient anesthesia and/or assisting a patient in artificial ventilation; more related to a breathing circuit Interactively adjustable length fluid carrying parts (fluid ea„ying such as singular; a multi-chamber breathing circuit using a non-conventional catheter; _ seeding in drunken and/or assisted artificial ventilation' can bring fresh gas (ie , anesthetic and oxygen) systems and methods for optimal use.

[Prior Art] Auxiliary ventilation systems and/or artificial ventilation systems are an integral part of modern medicine. In general, such systems can provide fresh gas to a patient from the same source (e.g., from an anesthesia or a ventilator) and direct the used gas away from the patient. The fresh gas system is introduced by a different passage than the used gas, so at least two gas passages are required. The general circuit has two wings (ie, there are two separate pipes). The end of the tubing of a breathing circuit is typically spaced apart by a connector or another distal end of the circuit located on the patient. The connector can place the distal end of the tube (patient end) in a parallel fixed position, or the connector can be a gamma tube with two tubes that meet at a fixed angle. Traditional breathing tubes are corrugated and elastic in material to allow for movement while avoiding folding or twisting of the tubing. Recently, it has been apt to use pipes that can be axially expanded and contracted (like an accordion). A commonly used tube similar to an accordion or a folded tube is ULTRA-FLEX® (available from Systems Corporation, Noblesville, Indiana, USA) 4 1281870 FLEXITUBE® or isoflEX8, which is axially expanded or contracted in the open or closed position. One or more pleats are used to adjust the length of the tube. Regardless of whether the folds are in the open or closed position, the tube wall remains corrugated to reduce twisting or folding caused by the tube being folded. Respiratory care and emergency intensive care unit (icU) type non-rebreathing system In a non-repetitive inhalation respiratory system that can be used in respiratory care and emergency intensive care units, a check valve allows gas to pass through An inspirat 〇 conduit flows to a patient, and another check valve causes the used gas from the patient to flow to an exhaust conduit via an expiratory conduit. Circulating C〇2 absorption and Mapleson type beer suction system In a "circulatory system", a one-way valve allows gas to flow to a patient via a first conduit or suction line, and another check valve The purpose of recycling part of the gas is achieved by flowing the used gas from the patient through a second pipe or exhalation pipe to a "recycling module" or "scrubber circuit". The "recycling module" or "cleaning circuit" generally includes a carbon dioxide absorber to exclude exhaled carbon dioxide and achieve "clean gas". Thereafter, the purged gas is combined with fresh gas from an anesthesia machine, which is referred to herein as "refreshed gases." Some or all of the fresh gas can be used for the suction of the patient. Excess gas will be directed to an exhaust gas line and/or a recovery line. Therefore, the fresh gas is mixed with the cleaned gas in the cleaning circuit as a diameter of the 1281870 pipe body, and the height of the liquid pipe is set to ▲ body height [open gas, and then sent to the first pipe, The used gas is carried by a second pass to a "cleaning circuit" for recirculation and/or discharge. It is generally believed that the low-flow anesthetic gas in the circulatory system causes the concentration of anesthetic fluoride in the fresh gas to continuously decrease to a much lower concentration (revolution in the volatilizer) as it recirculates. This type of concentration reduction problem may be due to dilution and leakage of used gases and/or clean gases, and absorption and/or adsorption due to plastics, rubber and other materials in the system. Therefore, low amounts of anesthetic gases, including fully enclosed anesthetic gases using the circulatory system, are theoretically feasible, but their application is extremely limited. In the Mapleson AF type circuit, fresh gas is delivered to a common sump via a fresh gas delivery/supply tube, where the current sip is used to provide patient gas and receive it from the patient. Used gas. In general, the fresh gas delivery/supply tube is so small that it only loses * as a fresh gas delivery or supply tube, rather than a breathing tube (ie, if the patient in the circulatory system can directly inhale) Pipeline) A Meppesen D-type circuit (the most commonly used circuit in all Meppes-type circuits) does not use valves, so the flow rate of fresh gas must be high enough to minimize C 〇 2 re-intake. . When inhaling, the patient inhales fresh gas from the fresh gas delivery tube inlet and inhales the gas from the general snorkel, which may be a mixture of fresh gas and the gas exhaled by the alveoli. The fresh gas at the flow flushes the breathing tube, forcing the gas exhaled from the alveoli to take care of the gas line. The Bain Circuit 1281870 An example of a modified single-wing version of the Meppesen D-type circuit is generally referred to as "Ban Circuit" or "Bain", as detailed in US Patent No. 3,856, No. 51; a gas delivery conduit is inserted through the proximal end 'not the distal end' of the wall of the common snorkel and the delivery conduit extends along the length of the common snorkel so that its distal end is adjacent to the common snorkel remote. Thus a single-wing circuit is created in both components. The fresh gas delivery line is in a sealed connection with the common breathing tube. Another example of a Meppesen D-type circuit is described in detail in U.S. Patent No. 5,12,746; an elastic bellows is divided by an inner wall into a large flow passage and a small flow passage, and A common bayonet type connector (bayonet type connect〇〇 is attached to the patient end and attached to the machine with a double friction fit connector. An improved circuit of this patent is used to construct The Limb 0 tm trade name is sold under the %» circuit (V ita 1 S igns, I n c. 〇f T 〇t 〇wa, N ew J seysey, USA). The Universal F® Circuit No. 4,265,235 to Fukunaga, which describes a universal single-wing device that can be used in different respiratory systems, and which provides many advantages over the prior art. This is sold under the generic F® trade name (King Systems).

The Fukunaga device from Corporation, Noblesville, Indiana, USA) uses a space-saving "co-ax ia 1" design, or a "tube within a tube" design for inhaled gases. And excluding exhaled gas use This design has several advantages, such as reducing the volume of breathing equipment connected to the patient. In addition, the device itself can also function as an artificial nose because the two 1281870 reverse airflows meet within the single wing device. The used gas warms and maintains the humidity of the inhaled gas. U.S. Patent No. 5,778,872 to Fukunaga, which incorporates a single-wing multi-cavity circuit, sold under the trade name F2TM or universal f2® (King)

The devices of Systems Corporation, Noblesville, Indiana, USA) have completely altered the artificial ventilation system and provided methods for assisted ventilation and anesthesia. The F^tm system provides a safe and fast connection and disassembly of a multi-cavity (e.g., coaxial) system component from the proximal end. This design allows faster replacement partners to use other breathing circuit components to improve system performance and reduce medical waste and costs. In general, the universal 卩@ and 卩2@ are used in a circulatory system with a carbon dioxide absorber. For more information on this F2 technology, please contact King Systems Corporation. For more information on respiratory, anesthesia and assisted ventilation technologies, see US Patent No. 3,556,097, US Patent No. 4,007,737, US Patent No. 4,1,88,946, 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. 5,284,160, 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: Constructiony Care, And Complications, Williams & Wilkins Co.? Baltimore (1974) and Andrews, JJ,, Inhaled Anesthetic Delivery Systems 95 in Anesthesia, 4th Ed. Miller, Ronald, MD, Editor, 1281870

Churchill Livingstone, Inc., Ν·Υ· (i 986). The entire contents of all of the references cited herein are hereby incorporated by reference. Cost-effective anesthesia systems and non-practical new generations of breathing tubes Hospitals, health care workers and related businesses are always looking for ways to improve medical care. Many monitoring standards have also been implemented to ensure that the desired medical care has been safely implemented. For example, in the field of respiratory care and anesthesia, non-invasive and invasive monitoring methods have been routinely used, for example, a warning monitoring system that alerts the user to airflow obstruction and/or interruption, can monitor inhalation and The system of end_tidal gas, saturated oxygen monitoring by pulse oximeter, arterial blood gas and mixed vascular blood gas monitoring. These technologies and devices make it possible to continuously monitor patients, and also allow medical care providers to more accurately adjust or titrate the necessary anesthetic gas or drug dose, and easily detect problems caused by patient pathology or due to medical equipment or Set the problem caused by the failure. Therefore, there is a need for an anesthesia system that optimizes the use of such expensive monitoring instruments and is used to reduce anesthesia. Respiratory care is often and increasingly frequently provided by the medical community. Respiratory care includes, for example, artificial ventilation techniques such as assisted ventilation and/or oxygen therapy. Some devices are often used for respiratory care, including breathing circuits, filters, heat and m〇isture exchangers (HME), tracheal intubation laryngeal masks, larynx, and respiratory masks. A breathing circuit consisting of a rigid tube or elastic bellows made of rubber, plastic or elastic tube has been used worldwide for more than a century. To prevent cross-contamination, the “single-use” breathing circuit is discarded after use-- or, in the case of a high-temperature sterilization, the 1281870 is more expensive than the reusable breath. ; ^ and 35 roads. The production and/or use of two types of beer suction circuits are very expensive. The circuit sterilization requires a lot of manpower and high treatment. The same 'only use-time-abandoned breathing circuit can prevent cross-contamination _, which will increase the hospital's extra The cost. μ one

U.S. Patent No. 2, to Leagre, discloses a sleeve and a filter for use in a breathing circuit in which a sputum and a tubular sleeve or sheath can enclose the breathing circuit during use. The squat holder has two squats, one for connecting to the patient and the other for connecting to the far end of the beer suction circuit. The sleeve is attached to the exterior of the cartridge holder and extends adjacent to the suction circuit. After use, the filter and sleeve are discarded, and the breathing circuit can be reused by multiple patients. The filter is a volume M i 4 > "The device and the ferrule can reduce the need for disinfection after the mother-use circuit. The sleeve is made of light weight and low cost material to reduce the manufacture of the sleeve part. Cost. A transparent, extruded film made of polyethylene, polypropylene or polyallyl (the thickness of which is similar to the thickness of a plastic knee bag that can withstand heavy loads) is known as a sleeve member. The effect is quite good. The sleeve is not used as a passage to remove exhaust gases.

Smith's U.S. Patent No. 5,377,67 () discloses a casing or envelope (_~) for reducing the heat exchange between the bellows of the breathing circuit and the surrounding gas, and thus the outer casing of the sucking circuit or The envelope is used as a heat insulating device. The outer casing or envelope is not a passage for inhaling and receiving beer gas. U.S. Patent No. 5,983,896, the entire disclosure of which is incorporated herein by reference. While the above apparatus can accomplish its individual specific purposes and requirements, the aforementioned 10 1281870 patent and prior art do not disclose a device in which at least one of the respiratory catheters is of a conventional (herein referred to as "new generation" (newera)") consisting of a pipe or pipe (that is, different from a pipe with a hard wall, a pipe, a wave pipe or a pipe), which has both axial and radial flexibility, but exceeds A certain radius and/or volume of the catheter is only slightly or non-compliant. "Radial elasticity" means that the diameter of the catheter can be greatly reduced or collapsible compared to conventional catheters with rigid walls. Relax the duct cross-sectional area. This differs from the axial bend I. bendmg) in that it does not significantly change the cross-sectional area of the bend of the conduit 'unlike the traditional guide f with a hard wall, the bend, its duct-curved The cross-sectional area will vary greatly. Conventional breathing catheters with a rigid wall of the former rig remain patency when not in use and when used to provide inspiratory and/or exhaled gases causing a pressure differential between the inside and outside of the tube. Since the conventional breathing tube of the front rig has a hard wall that cannot be axially folded without use, it requires more storage and transportation space, and it requires a thicker wall to provide sufficient hardness to avoid being used or Folding that may occur in use. Therefore, a higher amount of plastic is required to manufacture such a conduit, which increases the manufacturing cost and the volume of waste generated. In general, the compliance of the loop (i.e., the expansion and expansion of the loop tube volume under operating pressure) is undesirable because it interferes with the accuracy and precision of the applied gas. Furthermore, excessive obedience can result in insufficient gas reaching the patient's lungs. μ The present invention finds that as long as the breathing catheter, and preferably the inspiratory catheter, maintains no patency in inhalation and exhalation, the catheter does not require a conventional catheter or tubing with a hard wall (ie, When not in use, keep a fixed diameter and / / 1281870 is quite hard or stiff corrugated plastic tube) as always for patency. However, the respiratory catheter of the present invention should provide low resistance and extremely low compliance when used to meet the requirements of spontaneous breathing and assisted ventilation. Preferably, the breathing tube allows airflow to flow at all times, even under negative pressure, and the breathing line provides positive pressure even under spontaneous breathing. Definitions To further illustrate the present invention and the prior art, certain terms are defined in the specification and below. As used herein, the term "artificial 〇r assisted ventilation" shall include "controlled and spontaneous ventilation" in acute and chronic conditions (including anesthesia) (c〇ntr〇lled an (j spontaneous) Ventilation). Fresh gases include oxygen commonly used in flow meters and volatilizers and such as nitrogen dioxide, _ alkane, enflurane, isoflurane, desflurane, seven An anesthetic gas such as flurane (sev〇flurane). The catheter end leading to the patient is referred to herein as the distal end, and the catheter end facing or connected to the breathing gas is referred to herein as the proximai end. Similarly, the components and other devices at the distal end or the distal end of the breathing circuit (ie, devices connected to or directed to the patient's respiratory tract (ie, endotracheal tubes, laryngeal masks, hoses, masks, etc.)) are referred to herein as far End assembly and end; and other components of the assembly and the end or proximal end of the breathing circuit, referred to herein as the proximal assembly and the end. Thus, a distal adapter or connector (c〇nnect〇r) ) will be in the first circuit The distal end or the patient end. The proximal end of the multi-chambered single-wing breathing circuit is located at the end of 12 1281870 of the loop machine and is separated by at least two independent fluid passages which are parallel to each other in the loop or in the same (four) So that at least the fluid passage can be connected to a source of suction gas, and the other fluid passage can be connected to an exhaust gas outlet that is spaced apart from the suction gas helium. - The proximal end can also include - two separate fluid passages A rigid seat that will be synthesized into a shared passage, for example, a Y-type fitting, preferably used with a septum. A proximal assembly is used at the proximal end of a single-winged loop. The combination is a new concept brought about by the universal invention. For the first time, the connection and interruption of the plurality of pipelines at the proximal end of the auxiliary ventilation machine can be facilitated by using a matching proximal assembly. The proximal end differs in that when a proximal assembly includes multiple lumens, the proximal assembly can maintain the spatial relationship of the proximal end of the tubing forming a multi-lumen circuit. Thus, generally a breath The knowledge of the proximal assembly of the circuit is that it allows the line to be easily connected to a proximal end to provide inhaled and exhaled gases from individually spaced gas helium. In some embodiments of the invention, the tantalum is directly connected. To a proximal end; in other embodiments, the line can be connected to a proximal assembly that can engage a proximal end. The proximal assembly can include a filtering device or can be coupled to a proximal connection. Filters at the end. ^ The term "catheter" is used broadly to include fluid-carrying members and is not limited to conventionally used bellows, such as those used in currently available breathing and/or anesthesia circuits (ie, 'catheter, its A bellows having a chamber defined by one or more walls, of various shapes and diameters, and capable of carrying a gas for inhalation to a patient or carrying a gas exhaled by a patient. For example, a catheter that can be used with the present invention can comprise an elastic fiber or plastic layer (eg, a film or sheet made of a plastic such as polyethylene, having a circle (four) or tube 13 when it contains fluid. 1281870 Shape 'but when not fluidized or emptied, may be folded or loosened in shape of the tube) and/or elastic tube with smooth walls, straight, corrugated, foldable, and/or spiralable. Accordingly, certain embodiments of the present invention are substantially different from the concepts and design of conventional breathing catheters. According to the present invention, the inhalable gas is carried to the patient or the exudate gas leaving the patient from a patient, which has a maximum volume and/or diameter (or maximum cross-sectional area) both in the axial direction and in the axial direction. Its cross-sectional shape is not circular) the elasticity 'has a cross section of different shapes, and provides a low-cost device that can provide effective and practical (four) assisted ventilation to the patient. Non-traditional- or non-conventional-catheter refers to a catheter used in a breathing circuit to carry a patient's inhaled and/or exhaled gas, which is made and/or possessed from materials that have not previously been used in assisted ventilation or anesthesia machines. Shapes that have never been used before to carry inhaled and exhaled gases between the patient and the machine or between other mammals and machines. The term "inhalation and/or exhalation gas" carried by the patient, where the gas system is supplied to the patient from the source (ie, the ventilator) and the exhaust gas is from the same conduit and/or other conduit Provided to an exhaust vent (ie/auxiliary ventilator). For example, a spiral inhalation or exhalation catheter used in accordance with the present invention is a non-conventional catheter. Similarly, a catheter made from an elastic, gas impermeable fiber (such as, but not limited to, an extruded polyethylene, polypropylene, or polyethylene film) in accordance with the present invention is also a non-study 2 - The catheter is radially expandable to a maximum diameter and volume under the pressure of the general assisted breathing, and is foldable when the internal pressure is lower than the ambient pressure (ambient press or: the pressure of the auxiliary beer suction). Means that the pressure normally encountered in the guide is generally equal to atmospheric pressure. Such a catheter can remain undistorted when using 14 1281870, but can also be loosened or folded (depending on the case, folding may require some degree of Auxiliary can be achieved to very small diameters, lengths, and volumes, especially when the internal pressure of the catheter is significantly lower than the external pressure of the catheter. For the sake of brevity, the term "SuaveTM elastic tube" is used herein to describe a flexible breathing catheter that delivers gas (ie, a gas for inhalation and exhaled exhaust) between a patient and a ventilating machine or respiratory care device, wherein the catheter can be radially folded when not in use, and Expanded to a maximum predetermined diameter (or maximum cross-sectional area; maximum diameter and maximum radius of the largest cross-sectional area when the cross-section is non-circular) and volume during use (such ducts are hereinafter referred to as "Suave tubes" or "Suave Catheter"; any product name or product that is added to the TM or ® symbol will retain its original trademark rights. When expanding to its maximum diameter (ie, the maximum cross-sectional area), Suave Tubes will exhibit compliance with conventional bellows or conventional folding tubes (eg ULTRA-FLEX®) in assisted ventilation applications. The “sUaveTM Elastic Tube” can also be axially expanded or contracted. “Suave Tube” It is cheaper to manufacture than conventional ducted or worn-shaped catheters (e.g., catheters formed from bellows). The preferred radial folding catheters for use in the present invention provide human and other mammalian assisted ventilation and/or Or experiencing pressure to swell, the compliance is less than about 50%, preferably less than about 2%, more preferably less than about 1%, and even more preferably less than about 5%. The best is about less than 2%. Used for this The preferred radially folded conduit 'has a minimum cross-sectional area (hereinafter referred to as "inflated cross-sectional area") when fully expanded to meet the desired flow characteristics, and is folded to "fold the cross-sectional area". (c〇llapSed cross_secti〇rial area) preferably 疋 less than about 90% of the expanded cross-sectional area, more preferably less than about 7〇% of the expansion 15 1281870 cross-sectional area 'more preferably less than about 50% of the expansion section More preferably, the area is less than about 25% of the expanded cross-sectional area, and most preferably less than about 1% of the expanded cross-sectional area. In one example, the "Suave tube" is shipped and retained in a folded form, and It can be folded without any extra effort after expansion, except that it is occasionally compressed when discarded. This minimizes manufacturing, shipping and storage costs. In some embodiments, gravity can cause the "8" tube to naturally fold to varying degrees when the pressure is insufficient. The requirements of the breathing circuit Usually, depending on the needs of the surgical site, the need for artificial ventilation or anesthesia may be fixed in a strange position, so the required catheter length will also be different. This is also true for patients who are diagnosed, for example, MRI, imaging, etc. There is therefore a need for an elastic breathing catheter that adjusts the length of the catheter for inhaling fresh gas and the length of the exhaled exhaust conduit while minimizing problems such as disassembly, clogging, and entanglement. At the same time, the weight of the required breathing tube must also be very light. Furthermore, for cost-effective considerations, health care providers (ie, 'hospitals, physicians, emergency surgery centers, nursing homes, etc.) also require inexpensive breathing circuits and/or inexpensive methods to provide artificial ventilation or anesthesia to the need The patient for this service. The breathing circuit can be classified according to how the breathing circuit (4) c〇2 is used. (7) 2 can be removed by means of "wash GUt" depending on the incoming fresh gas stream (ie, no Cq2 absorbent, such as a Meppesen type circuit), or using such as lime and its analogs. The c〇2 absorbent (10) follows the route of the k). Therefore, the general anesthesia circuit is supplied in the form of a circulation circuit ((3) 2 16 1281870 absorption system) or a Meppesen type circuit. Because some of the repetitive respiratory systems of the Meppesen type require high levels of fresh gas, the circulation loop is the most widely used system. Breathing systems that use low-flow fresh gas streams are advantageous because they reduce the amount of fresh gas (for example, anesthetic gas) and the amount of gas produced, while being environmentally friendly (reducing environmental pollution) and saving costs. However, a major concern with anesthesia using low-flow techniques is the efficiency and unpredictability of the fresh gas used, especially with regard to the concentration of anesthetic gas supplied to the patient's alveoli or for inhalation by the patient. (i.e., a dose that maintains the patient's dose that does not wake up during surgery or restores consciousness). Furthermore, the current concentration of volatile anesthetic gas and the concentration of inhaled anesthetic gas are still inconsistent. Another concern with the circulation loop is the interaction between volatile anesthetic gases and c〇2 absorbents (for example, soda lime), which has recently been reported to produce toxic substances. This concern also includes carbon monoxide and Compound A formed during the alkaline lime degradation of volatile anesthetic gases. For example, the presence of carbon monoxide has been found in anesthetic gases, including the use of circulatory systems of dentane, enflurane, lsoHurane, desflurane. Furthermore, for systems using heptafluorocarbon, sevoflurane is known to be degraded to alkenes and compound A in the presence of soda lime, which are known to be nephrotoxic in clinical practice. In addition, it is also necessary to reduce the amount of expensive anesthetic gas and breathing gas in the circulation system and the Meppesen type system. A major concern with the prior art single-wing breathing circuit is that the inhaled or fresh gas lines are not broken or blocked during use (i.e., broken or blocked due to twisting). To this end, it is emphasized that the proximal end of the suction gas line must be rigidly joined to the 17 1281870 on the fresh gas inlet assembly, while the distal end can be moved with the distal end of the outlet conduit (ie, the exhaust conduit), thus creating a variable Invalid space dead space). Despite the striking new findings in U.S. Patent No. 5,778,872 to Fukunaga, it is pointed out that the proper ineffective space in the breathing circuit can actually bring benefits, that is, 'normal carbon dioxide can be produced without hypoxia, but a circuit is needed. It still has the lowest and/or a fixed dead space regardless of the loop, while still being flexible and safe. In addition, there is a need for a system that can use anesthetic gases more cost effectively and safely in a safe and predictable mode. At the same time, the respiratory system must also be suitable for both adult and pediatric patients, or at least for many types of patients, 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, safer, and/or easier to operate and use than prior art circuits or systems. [Contents] An embodiment of the invention includes a breathing circuit wherein at least one of the breathing tubes is a non-known catheter. . Therefore 'in a single-wing, two-wing, or multi-wing circuit

The trademark right of the trade name is not derogated from the facts of the article. 'It includes at least a first mail that can be connected to an embodiment of the invention including a multi-chamber breathing circuit, and a second catheter, wherein the first And the proximal end of the second catheter 18 1281870 other inlet or outlet assembly, and movement of the distal end of the first catheter can cause the distal end of the second catheter to also move relatively. Thus, the loop elements can interact such that when an element is extended or retracted relative to the shaft, a second element can also be made to extend or contract the same length of the shaft. This type of loop is referred to herein as an f3tm pinch loop or a ten thousand F3W loop. In one embodiment, at least one of the conduits is a spiral. In another embodiment, a helical tube system is included in an outer flexible tube that can extend or contract along the shaft to form a single-wing multi-chamber breathing circuit, also referred to herein as an F-spiralTM circuit (Fc). 〇iiTMcircuit). In one embodiment, an outer flexible conduit can be a folded tube or a non-conventional conduit for providing extension and contraction along the shaft. In one embodiment, an accordion-type tube (ie,) is internally separated by a common wall of resilient plastic or non-breathable fibers to allow for radial expansion of a cavity while sharing the common wall. The other cavity can shrink at the same time. In another embodiment, a non-conventional catheter can be connected side by side with the bellows by continuous or spaced apart. In addition, two or more Suave tubes can be used simultaneously to create a multi-cavity SuaveTM tube breathing tube. These multi-cavity SuaveTM tube breathing tubes can be manufactured by elastic plastic extrusion, which is almost identical to the way plastic bags are made. However, unlike radial bonding when forming a plastic bag, such conduits are thermally bonded in the axial direction to form individual gas transfer chambers. The proximal and distal ends of the respiratory catheter device of the present invention can be coupled to the proximal and distal components, respectively, to facilitate the connection of the patient to the machine during operation, respectively. The present invention-embodiment includes a multi-lumen breathing catheter comprising at least first and second elastic tubes, wherein the first & second elastic tubes are individually connected to an inlet assembly and an outlet assembly, And among them, the plastic tube of the prior art has a tube formed of a non-adhesive. This type of respiratory catheter is 22: base: the type of elastic plastic (spontaneous or artificial ventilation) will not & the call and exhalation of the catheter is unobstructed), but not used (also p' maintain inhalation and piping can Folded form to transport or survive the age:: All fingers are stacked. The tubes of this type of catheter are side by side, connected to each other at intervals: the row should form a multi-chamber breath and its shape can be changed greatly. : The other tube is harder than the rest of the tube: the ... the proximal end can be - promoted with a breathing gas source, an exhaust gas with recycled gas c 〇 2W, 戈 $ 彳 for the anesthesia machine can be used or a The connection between gas passage devices such as a breathing mask and an endotracheal tube. The present invention also relates to a flat person 1 ^ ^ ^ for optimal use of fresh gas in human ventilation or assisted ventilation (including administration of anesthetic gas) New systems and new methods. In an embodiment, a modified Meppesen D-type system is combined with a modified (10) absorption cycle system to produce a more efficient system in which the system can be more versatile and The predicted mode will come The drunk gas is optimally utilized. The undiluted fresh gas is supplied to the patient's k side (ie, the distal end of the circuit), and the used gas is circulated by the 3 C〇2 absorbent cleaning circuit. This system ensures the patient. It will receive fresh gas with a more precise concentration (close to the oxygen concentration of the anesthesia machine flow meter and the concentration of the volatile anesthetic material). In addition, the gas recirculation allows the gas to be removed after removing the CO2. Re-use, in order to provide a low-flow anesthetic gas. As a result, the use of fresh gas can be optimized. In addition, by using a single-wing multi-chamber breathing circuit, at least ~ 20 1281870 respiratory catheters can vary in size. By adjusting the volume, or by using two length-adjustable components, the anesthetic concentration can be safely adjusted and recalled, and the best use of the same breathing catheter or circuit can be applied to adults and Children's patients. The road does not require individual packaging, but more than one loop can be packaged. The advantage of packing several circuits together is that the package can be made It is also compact and 'reducing storage and shipping costs, as well as the amount of waste. In addition, you only need to open one bag or one box instead of several bags to save assembly time. All the above savings will become more comprehensive. Considerable, because it can make the best use of the operation room (that is, reduce the time between the operations to wait for the professional 'because it can reduce the cleaning and assembly time of the operation room). Therefore, the present invention is known In addition to the cost of the device, it is also possible to make the health care more cost-effective. The circuit and system of the invention are relatively simple, small in size and light in weight, which is helpful for storage and transportation, and uses a relatively small amount of plastic. The resulting medical waste "is also safe and practical, easy to use, protects the environment and promotes the economic benefits of artificial ventilation. The present invention will be more fully understood from the following description and detailed description. To assist the understanding of the present invention, certain components of the following drawings are not shown and/or represented in a simplified form. For example, the & edge of the 'space component is not shown, while the wall thickness and the relative tube diameter are not drawn to scale. L-through mode] F3 circuit - circuit with non-known catheter (new generation catheter)

Referring to Fig. 1, there is shown a solid, A τ embodiment of the present invention comprising a multi-chamber breathing circuit, also referred to as an F-spiral top circuit, having an adjustable element of 21 l28l87〇-u (iv), which has an option. This embodiment is here a near-end component 10 of 0^^^^ and an optional back-off component 20. First conduit 30 The helical spring tube has a proximal end 32, a helically flexible tube, and a retracted end 34. The first end 32 is coupled to a proximal assembly member, and the distal end 34 of the first "near guide" is coupled to a withdrawal assembly 20. In another embodiment, the M^ proximal assembly 10 can provide a proximal connector to the tube 30. The vertices, the shape and the space relationship of the end 32 and the group pe 1 U may be different, so as to connect any one of them, as described in U.S. Patent No. 5,778,872 to Fukunaga. In a preferred embodiment, the second or outer f 4q is elastic and corrugated and is made of -transparent (or translucent). Preferred bellows include, for example, ULTRA-FLEX, when it is from the axis When the compression form extends in the axial direction (or vice versa), the length of the shaft can be maintained (that is, it will not rebound, that is, the accordion-type folding tube). In addition, the ULTRA-FLEX® tube, when bent It can maintain its f-angle and curvature without significantly reducing its inner diameter. This type of bellows suitable for use in the present invention can also be used from System Systems C〇rp·, Noblesville, IN, USAw ultra. Flex circuit, ULTRA-FLEX, or for Best Company (Baxter c〇rp 〇f ruler (10)

Pipes of the Is〇flexTM circuit sold by Lake’IL, USA). The tube may also integrally form a distal and/or proximal assembly wherein the assembly has a thicker wall and is stiffer than the tube, or may be joined or welded to a suitably shaped component as desired. From the foregoing summary and definition, it will be apparent to those skilled in the art For example, the diameters of the first and second conduits (3〇, 4〇) 22 1281870 may vary depending on the use. In addition, the outer tube 40 and the inner tube 3 can be replaced by a SuavJM tube. In addition, those skilled in the art will appreciate that a spiral elastic member can change its overall axial configuration without changing the shape of the wear surface of its chamber. The outer tube 40 terminates in a selective distal outer component 2 that is designed to be easily attached to a patient device, such as a tube, a laryngeal tube, a laryngeal mask, or an anesthetic mask. In an embodiment, the distal end 34 of the first tube can be directly connected to the interior of the second tube. Alternatively, the distal end of the first tube can be directly connected to the interior of the second tube 4〇 at a point where the series is disposed along the length of the tube 40. The first tube 3 can also be wound around the outside of the tube 40 and periodically connected to the outside thereof. ...with reference to the selective distal assembly 20, the end 34 to which the first tube 3 is connected is shown. In one embodiment, the distal assembly is coupled to a selective internal distal assembly that is coupled to the distal end 34 of the first official 30. The length of the assembly 20 can be extended, and the connection points between the thin _, and the member 20 and the optional distal inner component can be adjusted along the axis, 1 and providing a predetermined dead space. Referring to Fig. 2, a, first, the second conduit 40 is extended along the axis, causing the first conduit 3 to also be blush ye ^ ^ extended. Choose the length, diameter, and engross. The number of spirals in the inch distance, the K of the Fenzen tube 30 extension, and the elasticity of the first tube 30 prevent the first guide and the field from being able to block the entanglement of the airflow without sacrificing the single wing and returning. At the same time, it is also possible to provide a spiral 30: Τ performance, the tendency of the outer tube 4 收缩 to shrink along the axis, should not t or rebound. Preferably, the elasticity of the helix, or the proximal end 32 of the helix extending further to its maximum inward bore 30, is detached from the proximal end assembly 10 as the outer tube 4 turns axially, and likewise, it is not 23 1281870: The distal end 34 of the inner tube 30 is caused to move axially with the distal end of the tube 4〇. 0 - Tube 30 can be manufactured from medical grade plastics, for example, as a plastic for sucking gas samples, or as a plastic for intravascular fluid devices. Preferably, a tube (for example, an accordion tube, a spiral tube, etc.) that can be axially extended and folded or compressed is used as the first tube (which may be an inner tube or an outer tube), and wherein the first or inner tube Or adjacent tubes, which are also expanded or compressed in synchronism with the first tube, which promotes safety during disassembly and reduces the chance of clogging and entanglement. This also promotes the control of rebreathing and provides more flexibility and cost-effectiveness in manufacturing while reducing storage and shipping costs. φ Double Helix Circuit Embodiment Referring to Figures 5A-B, an embodiment of a new circuit is shown. The two spiral tubes 6〇 and 62 are in a spiral relationship parallel to each other and form a double spiral loop. The tubes may be joined together at one or more external points, one tube may be formed in another or the tubes may be separated by a common wall and form two chambers. Referring to Figure 5B, the effect between the components during expansion is shown in an enlarged view, while also showing the arrangement of a proximal end assembly 7A and a proximal end 80 when used in a circulatory system. The arrow showing the flow shows the inhaled gas channel from the FGF (fresh airflow) inlet and the channel to the exhaled gas outlet. The distal ends of the tubes 6 and 62 are connected to their distal assembly 72 by a connecting tube 74. Fig. 5c-d shows another embodiment of the double helix in the 5A-B diagram. Spiral tubes 6 and 620 are attached to a proximal assembly 700' which connects the tubes to the proximal end 8 of the circulatory system. It is to be understood that the spirals of the 60 and 60 are overlapped and wound, and the columns can be selectively connected at a plurality of fixed points. The proximal and distal openings of tubes 600 and 620 are separated. The assembly of 24 1281870 can be attached to the exterior or interior of the walls of tubes 600 and 620. The distal ends of tubes 600 and 62 are connected to a distal assembly 7〇2 by a connecting tube 704. Sliding Inner Tube Embodiment Referring to Figures 6A-B, the operation and assembly of a primary circuit embodiment in accordance with the present invention are shown. A first tube 90 is slidably inserted into a proximal assembly 92 via a seal assembly 94. The proximal end of a second tube 96 is attached to the proximal assembly 92, removing a portion of the tube 96, thereby showing the first tube 90 therein. Tube 96 can be axially compressed and extended' and can be fabricated from tubes such as ultra-flex® tubes. The first tube 90 has a smooth wall portion that allows it to slide into and out of the assembly 92 in response to the axial compression and extension of the tube 96. The axial interaction of the return elements with each other can be achieved by a direct connection of the distal end of the tube 90 to the distal end of the tube 96 via a common distal assembly or other operative connection technique or device. Two-Hand Accordion Circuit Embodiment Referring to Figures 7A-B, the operation and assembly of a primary circuit embodiment in accordance with the present invention are shown. T is connected to each other at the proximal end of the dual coaxial accordion tube 98 and 1 or to a proximal assembly. Tubes 98 and 1 can both be ULTRA-FLEX® tubes. A partition flange or a perforated disk 1〇2 can be placed between the inner tube and the Z tube to optimize the flow. The axial interaction of the loop elements with one another can be achieved by direct connection of the distal ends of the tubes to each other via a common distal assembly or other operative connection technique or device, such as by a distal end of the tube 98 or at the distal end of the tube 98. Upper dividing flange or hole-shaped disk 1〇2 〇 25 2581870 bellows circuit embodiment..., 8AB diagram 'shows the operation of bellows sheath according to the present embodiment and ^ [, 式吕环实> *邛 and components. A relatively smooth tube wall has a fixed declination with a shr6 and a retractable waveform. Elastic ::: Straighten at r application and return to its original predetermined yaw angle = 'External B 108 can be contracted and extended simultaneously with tube 1〇6. A sub- or perforated disk 102 can be placed between the inner and outer tubes to optimize flow. As with the other circuit embodiments, the axial interaction of the loop elements with each other can be achieved by direct coupling of the distal ends of the tubes to each other via a "remote" remote assembly or other operative connection technique or device. In addition, many types of materials can be used. For example, the total (10) may be ULTRA.FLEX, and the tube 1G6 may be a flexible or elastic fiber or plastic. Preferably, the axial resilience (i.e., the tendency to re-helix or contract) of the conduit within the loop of the present invention is insufficient to allow the proximal end to fall off from the inlet of the suction gas when the circuit is fully extended. For example, in Figure 8B, the tendency of the tube 106 to rebound to its compressed or relaxed state when the assembly is stationary and the conduits 106 and 108 are fully extended, as shown in Figure 8A, should not be sufficient to allow the proximal end of the tube 106 to self The proximal assembly 110 is detached. As described above, the tube 1〇6 can be made of a fiber or a plastic sheath having a radial elasticity. Thus, the tube 6 can be a SuaveTM tube, and/or the tube 108 can also be a SuaveTM tube. For example, the inner or outer tube of the breathing catheter according to this embodiment of the present invention can be relaxed or folded when not in use and expanded to a desired shape when needed. Additional chambers may also be added in this or other embodiments. Hybrid Loop Embodiment (HYBRID CIRCUIT EMBODIMENT) 26 Sharing the common wall, or having a separate straight embodiment different from the other chambers, can be divided into two halves by a conventional plastic tube and a viscous plastic film between the two halves. Formed, or formed by sticking a long, semi-circular plastic matching two halves with an elastic plastic film. 1281870 A hybrid circuit that contains at least a conventional catheter with a minimum of ten peaks (i.e., polyethylene) that defines a two chamber within the guide. Fig. 9A-B shows a brother of the present invention having a common wall. Pieces and their operation. The first and second tubes 116 and 118 have a common wall 12 八 which is inflated and contracted, and the same can be axially :::: with the partition wall 122. This embodiment may have a material with a fold to form the material of ULTRA-FLEX 8. Alternatively, the Tanjung partition wall can be formed by an elastic plastic film, which allows the two chambers to be worn and accommodated. For example, when one chamber has a force of two, the wall expands toward the lower pressure chamber to make the volume higher and the volume is smaller. The volume of the high pressure chamber becomes larger. Preferably, the wall has a maximum diameter under guard operation conditions. Additional chamber relaxation loop embodiments may also be included. FIG. 10 shows another embodiment of the assembly of FIG. 8 and its operation. The second conduit is housed by a smooth plastic film 140 such as a SuaveTM tube. Or a first conduit 15 〇, the first conduit comprising a tube. The outer tube or the second catheter can be folded when not in use, and the inner guide can be maintained during the respiratory care operation and during normal use. This embodiment makes the statement of Fig. 8 clearer, since the plastic film or the plurality of road vehicles are sized by the co-expansion of the expansion, e.g., 122, and the breathing of the chamber. This last bomb 'and is formed therein, a bellows 150 holds its straight tube

27 1281870 is radially flexible. In a preferred embodiment, the breathing tube 141 includes a proximal assembly 142 that is bonded to the proximal ends of the tubes 140 and 150. The proximal assembly facilitates the connection to the corresponding proximal end. A remote assembly 1 5 1 is attached to the tube! 4 〇 and 150 on the far end. The distal end of the tube 150 is attached to the flange 152. The radial flange 1 52 is not a solid circle % ' but has a gap 153 to allow gas to flow from the common zone 1 54 into the tube 140. Although the tube 140 can be folded when not in use, it can be inflated to its maximum diameter and volume as long as there is sufficient gas flow, whether in inspiratory or expiratory conditions (as it is used) Depending on inspiration or exhalation) 'and there is no or almost no folding at maximum radius. The axial flange 155 is coupled to the radial flange 152 and grasps the distal end of the inner tube 15A. Tube 150 can be attached to the radial flange. The axial extension of the radial flange ι 52 and or the axial flange I" provides a high and fixed dead space. As described in other embodiments, the distal assembly, such as the distal assembly, can be modified To provide a sliding connection between the distal assembly base and the connector to the inner catheter, wherein the dead space can be adjusted to a desired volume. Figure 11 shows a single-wing breathing catheter assembly and its operation, wherein a first elasticity The tube 160 is a conventional elastic tube that maintains a fixed diameter during non-use and respiratory therapy operations; the second f 17G is a non-conventional plastic f that is not deformed without being deformed Radially folded. In a preferred embodiment, the tube 170 is a SuaveTM flexible tube. A new proximal ridge is shown, and the coaxial flow of the member 162 is introduced into two separate chambers 1 6 3 And 164 knives have two independent 阜 165 and 166 that do not interfere with each other, that is, i: iL, non-interfering 阜 means that they can be used or cut separately without blocking or interfering with one 进The other end of the distal assembly 1 72 has a shaft 28 1281870 and 174 1. The distal ends of the tubes 160 and 170 can be connected. The axial wall m and the extension allow the dead space to be adjusted. The connecting flange i75 has a basin 6 which can provide space between the maintaining wall m and the wall 173 without deformation. π丨7 affixed according to Fig. 12 shows that the distal end of the two non-known catheters (or tubes 180 and 丨90, also: SUave tube) are connected by a distal end assembly 182, the proximal end of which is The proximal assembly 192 is connected to form a single-wing breathing catheter assembly = 喿作 & 19〇 includes a spiral tube 2〇〇 compared to the inclusion of the inner * s 190 δ '官 2〇〇 It has a high radial hardness and therefore helps to maintain: the external f 190 is not deformed. f 2〇〇 can be used for gas samples or other purposes. For example, f 19〇 can provide inhaled gas. The tube is maintained without deformation, and the tubes 18 and 19 have a fixed axial length. The helix of the tube allows the tube 180 & 19 to be axially folded. In an embodiment 2 & It includes a metal wire or a plastic wire that maintains its extended length, unlike the case where the other embodiments have axial elasticity. The inner wall of the tube 190 is optional. Optionally connected to the f 200 Ji at a periodic point to provide a uniform folding and extension of the f 190. In one embodiment, the tube 2〇〇 is a solid line. * The assembly I92 provides a quick connection of the breathing tube to A corresponding multi-lumen proximal end. Although the outlet 201 of the tube 2 is shown passing through the wall of the assembly 192, the assembly 192 can have a tube 2 〇〇 connected to a corresponding inlet or outlet outer chamber. The above non-limiting embodiments have depicted respiratory catheters, which are also referred to as multi-lumen early-wing breathing catheters, which have both axial and/or radial expandable or contractile properties. However, the breathing tube does not need to expand in the axial direction 29 1281870 or contract. An embodiment may comprise a fixed length of a conventional corrugated catheter or a smooth elastic tube of tubular configuration or the second catheter may be a conventional catheter. Thus, the length of the breathing catheter can be solid 1 and one or more of the tubes can expand or contract radially. A breathing catheter or single-wing breathing catheter of the present invention can be easily coupled to a respirator or ventilator by a proximal end 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 proximal end of the proximal assembly to the present invention-single-wing breathing catheter to the corresponding proximal end; thus, the breathing catheter of the present invention can quickly and safely connect many different types of breathing apparatus (not limited to anesthesia machines and artificial ventilators). It can be connected directly or indirectly via a filter. The breathing catheter of the present invention can be attached to a single filter or to a multi-chamber filter or can be integrally formed with a single or multi-chamber filter. The proximal end of the filter holder can be designed to be quickly and safely attached to the proximal end of a machine, and the distal end of the filter holder can conform to the proximal end of the breathing tube. The breathing catheter of the present invention can also be used for ventilation during delivery to a patient or when connected to a source of gas (i.e., an anesthetic care setting, an oxygen source of an intensive care unit, etc.). Thus, the respiratory catheter of the present invention is a versatile respiratory catheter B and is otherwise provided with a new device (e.g., an expensive emergency bag for transferring a patient), the same breathing catheter of the present invention can be used to provide oxygen during transfer to a patient ( For example, to PACU or other locations). After the patient has been transferred (for example, from the opener to the PACU), the same breathing catheter can be used in the pACU to provide oxygen to the patient without the need to use an additional oxygen supply, such as an oxygen tube or a T-piece. Nasal tube or clean oxygen mask. 30 1281870 The Meppesen D-type system and the cyclic CO 2 absorption system are now referred to in Figure 3A-D. Figure 3A is a schematic diagram of a Meppesen d-type system in which fresh gas flow (FGF) is passed through a fresh gas flow tube 2 ( The schematic diagram is transmitted to a remote component 3. It is preferred to refer to the arrows and elements with labels to understand the operation of the system. For example, when inhaling, the gas system is simultaneously from the fresh gas inlet 1 and the bag 7 through the flow channels a and b (detailed in the illustration below the 3A diagram, with reference to the symbols and arrows: (1 - 2 - 3 - 4 ) + (7^6^544)) to the lungs 4. When exhaling, the airflow from the lungs 4 flows through the following flow passages &, and b' to the exhaust gas outlets 8: 4 - 5 - 6 - > 7 - >

Figure 3B is a schematic diagram of the Meppesen D-type system using Bain Circuit. The shift circuit is characterized in that the fresh air delivery tube 2 is inserted at the end of the proximal end of the circuit and extends through the breathing tube 5 such that a distal end 3 is located at the distal end of the circuit. Figure 3C shows a cyclic c〇2 absorption system with a so-called absorption. 12. Check valves (i.e., check valves) 4 and 9, and at the distal assembly 6 will be == and the beer conduit 8. At the time of inhalation, the gas system is also fresh from I! :10 through the flow channel... (detailed in the figure below and the arrow below the figure: (1—2 — 3 – 7) + (ι〇——4 — When, from the lungs 7 Μ — ~ 7)) > claws to the lungs 7. The expiratory flow from the lungs 7 is via the following outlets ~2,3-12 and 6 s Q channels dd, flowing to the exhaust gas F2TM type 3::/"a cycle C〇2 absorption system, its use-configuration The ...-component F8 or universal F2% way. The inspiratory catheter "糸31 1281870 coaxially located at the distal end of the proximal end of the expiratory catheter 8. It is noted that in the circulatory system, the fresh gas system is combined with the recirculating clean gas at or near the C〇2 absorber and carried to the patient by a common conduit. In contrast, the Meppesen D-type system provides a fresh gas at the far end of the loop. The gas-saving system "F3TM combined system refers to Figure 4" Figure 4A shows an auxiliary ventilation system using a novel breathing circuit of the present invention. Fresh air from a gas source (i.e., an anesthesia machine) flows through the splitter 70 through fresh Air flow tube 2 (schematic diagram). The installation of the splitter 7〇 is selectively determined by providing a fresh gas in the purge circuit (typically near the C〇2 absorber or in the c〇2 absorber). Entering the helium to improve a circulation system. The shunt can be used to close the fresh gas input port on the C〇2 absorber 12 so that fresh gas can be directly introduced into the distal end of the breathing tube 3 (ie, the FGF bypasses the cleaning module, thus It will not be mixed with the cleaned gas.) A seal can be used instead of the splitter, and the fresh gas source can be fixedly placed from many different positions. In this embodiment, the tube 2 is connected as a "shift circuit". a proximal assembly, 50, and the fresh air system is delivered directly to the distal end 3 of the breathing catheter and continuously fed into the common inspiratory/expiratory catheter $, also referred to herein as a rebreathing tube Tube). However, referring to the chemical map, the same as the "shift circuit" +, the volume of the tube and the content of the contents can be changed by changing the size of the catheter 5, so that the concentration of the inhaled gas can be adjusted according to the condition of each patient. And control to breathe again. For example, the tube $ can be a ULTRA-FLEX® tube. By adjusting the size of the tube 5 for control purposes, 32 Ϊ 281870 by axially adjusting the length of the tube 5 (depending on the data provided by the monitoring device, the volume of the gas to the end of the tube is used to titrate the volume and its contents). Gas and// The new system of the present invention differs from the conventional circulation system in that the delivery system of the novel two gas of the present invention is directly derived from an anesthesia machine and is not mixed or diluted at the end of the machine/cleaning. Because the fresh gas flow is transmitted very close to the string, the road = line, so the concentration of the inhaled anesthetic gas is almost equal to the density of the transmission. The λ ' anesthesiologist can rely on the gas/intensity indicated on the flow meter and the vaporizer and use this concentration as the inhalation concentration. The new system of the present invention differs from the Drunken D-type system in that the exhaled gas in the system of the present invention is not completely tared, but can be reused in the form of "returning fresh gas". This new _ ° "= system" in the quality and control of inhalation and anesthesia ventilation R 4 ; people's improvement, while avoiding the waste of anesthetic gas. If the fresh gas tube is rotated, the tube 2 will also spirally contract when the tube 5 contracts, as shown in the figure. The fresh gas tube 2 can also have other shapes and can be arranged as an inner or outer tube with respect to the tube. If the tube 2 is a smooth wall, it can slide, or out of a component, as shown in Figure 6. Preferably, the volume of the tube 5 is adjusted to be higher than the tidal volume (VT) during use to reduce the mixing of fresh gas with "frozen gas". This maximizes the use of fresh gas (anesthetic gas) while also optimizing oxygen and carbon dioxide control. In a preferred embodiment, the length of the snorkel can be varied for multiple uses. The same respiratory system can be used for a variety of purposes, such as for the operation of the knife room, emergency care unit, emergency room, respiratory care unit, adults, children, etc. Figure 4B shows an enlarged view of a proximal assembly 52 that can be attached to the breathing conduit 5 and the fresh gas tube 2, or detached from the breathing conduit 5 and fresh gas 33 l28l87. An additional proximal end 6 is also shown. The proximal end 6 can be an -F2® adapter or a Y-adapter. Referring to Figure 4A, the system-grade member preferably includes a storage bag or venting device 10, an exhaust gas outlet n, which is connected to a cleaner, a c〇2 absorber 12, an inspection valve 4, and 9, suction a gas conduit 5, an expiratory catheter 8, and a proximal end 6 connected to the proximal assembly 5〇

The operation of the system is preferably understood by reference to arrows and elements having labels. For example, in a preferred embodiment, during inhalation, the gas system simultaneously flows from the fresh gas stream source 1 and the bag 7/ventilator 10 to the lungs 4 in the following directions: + -4 〇 45, 645 sh4)). When exhaling, the airflow from the lungs 4 flows to the exhaust gas outlet 丨j via the following flow sequence: (142 — 3 — 5) + (4 — 3 — 5 — ”. Due to the system, the end opening to the distal end Into a remote group, a preferred valve, a gas wheel, a detachable example, a new venting and hemp, in a preferred embodiment

The utility model comprises a recirculation module; a re-snoring tube operatively connected to a recirculation module for providing a gas waste circulation module or receiving gas from the recirculation module; a fresh gas port, The distal access is located in the distal portion of the snorkel or in the positional assembly and is operatively coupled to the distal end of the snorkel. The recirculation system includes a purge circuit that can include at least two single exhalation input conduits, a (3)" and a receiver 12, an exhaust pipe, a blown tube: and a squeeze bag and/or a venting device. The filter device unloaded in a preferred embodiment is attached to the proximal end of the rebreathing catheter 5; the iliac body can also be integrated into the catheter 5. This novel system is referred to as the "F3 CombinationTM System". 34 1281870 The system that can make the best use of fresh gas and is the most sturdy and uniform. The low-flow anesthesia method is known to reduce the amount of anesthetic gas used, because it can reduce the amount of anesthetic gas used. Superior, and therefore low anesthesia is more economical and can reduce health care costs. Moreover, such methods can capture the inhaled gas at a preferred humidity and temperature. In addition, it can reduce the amount of gas released from the system and released to the dilemma, reduce the pollution of the operating room, and provide a safer deduction of the Queen's work environment and lower work dyeing. . However, despite the advantages of low-flow anesthesia, the application of the 1 method and related systems is limited by many unsafe factors. Therefore, there is an urgent need to improve these systems and methods. The traditional anesthetic respiratory system using C〇2 absorbers uses high-flow fresh gas, ie, a flow rate higher than 5 liters per minute (FGF > 5 L/min) 7 fresh gas; as for the Meppesen D-type system The fresh gas flow rate used was 7 liters per minute. However, as a result, up to 9〇% of new transmissions of fresh air systems have been wasted. One of the many reasons for using high-flow fresh gas is that when the low-flow anesthetic gas is supplied to the patient, the given anesthetic may be too high or insufficient. When using a high flow of fresh gas, the concentration of the inhaled gas (anesthetic gas) (FI or F) is assumed to be equal to the delivered gas concentration (FD or Fd = volatilizer set concentration). However, this assumption does not apply to low-flow anesthetic gases. Lowering FGF causes the concentration gradient (concentration difference) between the delivered gas concentration (FD) and the patient's inhaled concentration (FI) to gradually increase, partly due to the fact that the fresh gas concentration is diluted due to the cleaning gas in the system. Increased. For example, there is a significant difference (about 20%) between the inhaled gas concentration and the transport gas concentration during a FGF of less than 3 liters per minute. This may be 35 1281870

Gas concentration. Therefore, it is generally not recommended to use low flow anesthesia to adjust the flow rate and carefully monitor the inhalation concentration and the lake end example to test the following hypotheses: (a) Inhalation and delivery gas concentration ratio (FI/FD) is over time and fresh The gas flow rate is changed; at low flow rates, the "F3tm combination system" can be used to improve the ratio of FI/FD compared to the general inhalation conditions of low FGF to the patient's inhaled gas concentration and delivery gas concentration (ie 'displayed by the volatilizer setting The effect of the concentration of anesthetic gas). After receiving the consent of the hospital and the patient, a total of 34 healthy (Asa Class I) adult patients who underwent voluntary surgery were enrolled in the trial. This experiment was performed according to standard anesthesia method. With the help of 丨mg/kg amber choline, anaesthesia was induced by thiopental and endotracheal intubation. Initially, the volatile anesthesia was set to maintain a high flow (5 liter/min) 3/2 N20-〇2 mixture and 1.5% isoflurane in a standard anesthesia circulation system equipped with a C〇2 absorber. The patient's lungs were mechanically ventilated in a conventional mode of intermittent positive pressure ventilation (tidal volume 10 ml/kg, venting frequency 10-12 breaths/min, and inspiratory/expiratory ratio = 1:2). The above parameters have remained erratic during the course of the study. A portion of the delivery (fd), inhalation (FI), and tidal (FET) anesthetic gas concentrations were continuously monitored by a mass spectrometer (Medical Gas Analyzer 100; Perkin-Elmer, Pomona, CA). In Test I, first let the high-flow fresh gas (FGF > 5 L/min) stabilize the flow 36 1281870 for 15 minutes' and then change to the lower flow fgF (selected from 4L/min (n = 3), 3L/ Min(n = 3), 2L/min(n = 3), lL/min(n = 6), and 〇.5L/min(n = 6)), which are randomly assigned 'while and maintain the original volatilizer The setting (丨·5 % isofluorocarbon). The F!, FET, and Fr) were repeatedly measured to compare the ratio of FI/FD and perform statistical analysis. The results are shown in Figure 14. The results show that when the FGF is lowered, the ratio of FI/FD is also significantly reduced. In addition, the results of this test also show that there is a significant difference between the F! and FD values when using the traditional circulatory system, and pointed out the limitation of the use of the low-flow anesthesia method. Table 1 shows no data from the test π. Under low flow (1 L/min) FGF, 12 patients were randomly assigned to group A using the conventional circulatory system (n = 6), and the F3TM combination system (F3tm) was used. Group B of c〇MB〇system). It can be noted that in Table 1, the B group of the F3tm combination system is used, and the ratio of the concentration to the ratio of f/fd is greatly improved. In addition, it shows that the difference between Fi and & values is minimal and the new system provides better correlation. This supports the assumption that the low-flow anesthesia can be safely applied by using the "F3 CombinationTM System" and that the anesthetic dose is too high or insufficient. With the current F3 CombinationTM system, the anesthesiologist will be able to control the concentration of anesthetic gas inhaled by the patient in a more precise and predictable mode, even if there is no expensive multi-gas monitoring device, safe and reliable. Low flow anesthesia. In addition, it can speed up the surgery and anesthesia at the end of anesthesia (f; the recovery process from the gf under the brother. This can quickly rinse off the residual gas in the lungs and breathing circuit by directly providing high-flow oxygen at the distal end. The achievement of rapid recovery from anesthesia can save time and money for anesthesia. Therefore, using this F3 combination tm loop and / or method can save anesthetic gas and 37 1281870 oxygen, while also reducing pollution and health hazards. It is the lowest, so it can effectively improve the respiratory/anesthesia system. This can also reduce the overall cost of health care, while at the same time optimizing the patient's health care.

Figure 15 shows continuous and simultaneous monitoring of transport (FD), inhalation (F〇 and tidal (FET) gas concentrations with low flow anesthetic airflow (lL/min) and a volatilizer set to 1.2% isoflurane. Time change. It can be noticed that there is a significant difference between the FD gas concentration (ie, the set value of the volatilizer) and the F! and FET gas concentrations.

38 1281870 Table 1 In the case of a low-flow isoflurane anesthetic airflow (lL/min), the combination of the conventional system and the F3TM FGF shunt to the distal end of the loop and the Fi/Fo ratio combination system volatilize the patient Set Group A (n=6) Group B (n=6) No. 3 (FD) Volume % No FGF shunt (ie, split by machine side FGF (ie, gas supplied by the patient side) Gas supply) (FD Volume 〇/〇 (Fi/Fd) (FD) vol% (Fi/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 Soil SD ±0.0 ±0.11 ±0.088 ±0.13 Soil 0.08 F!: Inhalation concentration; FD: Conveying concentration (such as volatilizer setting); FWd :: Concentration ratio is very clear, The present invention provides a method of providing assisted ventilation or anesthesia in which a fresh gas system is supplied at a low flow rate, such as a flow rate of 1 liter per minute (a generally considered low flow rate refers to a flow rate between 〇·5 and below). 5 liters/minute, or in the preferred embodiment, less than 3 l / min), and can adjust the concentration of the F / / FD concentration ratio 39 1281870 by adjusting the volume of the proximal end of the fresh air inlet to the desired range ', for example, about 〇.约约升/分二: 升实: Between the clocks; more preferably between about 4 liters / minute to 20 / _ ^ liter / knife an exemplary configuration: Ming allows the use of smaller suction ducts and In the disposable group J, the human surgery requires a variety of circuits. Therefore, it is necessary to store the circuit in a place where the wind is supplied to the operating room or close to the operating room. During each preparation process, a new route must be taken from the sterile bag and discarded ". Loading & Fruits are not careful when opening, and it is very likely to break the loop. Because the present invention reduces the number of circuit components that must be discarded, the number of circuit components that are reached by each new procedure can be reduced. Moreover, because it can be axially contracted' and in some embodiments can also be radially contracted, the assembly, breathing circuit can be manufactured in a relatively small, less packaged, easy to store, transport style. Referring to Fig. 16, an exemplary configuration box 2 is shown. A breathing tube 21G is shown in the block diagram, selectively encased in a thin plastic protective film 212. Preferably, the breathing catheter 210 is not individually packaged. In one embodiment, the configuration box 200 includes a row of apertures 214 at its face and top for facilitating removal or pivoting or pivoting of the portion of the cartridge. A sealing tape 216 can be placed over the aperture 214 to reduce the chance of accidental opening or destruction. A configuration box containing a variety of different numbers of catheters can be provided, for example, containing 4, 6, 8, 1 〇, 12, 15, 24, $(10) or more breathing catheters. The lid can be closed by gravity or sealed by the user. Loading this type of configuration box eliminates the need to seal individual disposable circuit packs in a separate bag, while also reducing the time it takes to open and take the contents of the 40 1281870 out of the bag. The box can also reduce the amount of waste produced compared to individual packaged conduits, as less material is used and less material is discarded. In one embodiment, the cross-sectional shape of the breathing tube is substantially such that the thickness and length of the configuration box are sufficient to accommodate a compressed state and the height of the cavity is positive with the number of breathing conduits contained therein. Extending, and the box can be used to obtain a conduit arranged in order by holes. As shown in Figure 13 (a) and (b) for single-wing breathing catheters, the tube is available in a variety of versions and can be compressed to a relatively small size for transport and storage. Therefore, many of these catheters can be properly placed in the cartridge. Referring again to Fig. 13, there are shown (a) an expanded state and (b) a compressed state of the breathing tube. An outer tube or first conduit tube, and an inner tube 230 is a spiral tube, wherein the spiral tube has a rigid cross-sectional shape. When compressed, the excess material in the Suave tube is folded. The wrinkles are evenly distributed by periodically placing the tube 220 at each of the fixed points and the inner tube. The proximal assembly 240 is coaxial with the helical tube 230 attached thereto or the helical end coupled to the inner conduit 242, although other variations are possible. In another embodiment, a rigid inner tube and a rigid, rigid compartment device hold it together to form a proximal end set and the outer tube is attached to the proximal assembly. Therefore, the manufacture of the breathing catheter is optimized, which is based on the available materials of the present invention, due to the cylindrical shape. The respiratory response. The lid is opened to take the multi-cavity guide volume of the invention to facilitate the configuration of the breathing tube; 'for a Suave, there is a considerable amount of wrinkle 230 connection, and the inner tube 242 tube 230 is far from the outer tube. The inner tube is a mechanical, zero 41 1281870 piece, material, and technology permissible by the present invention. The inner tube 24 2 can be integrally formed with the rigid spiral tube 230 in one step. In another step, the inner tube 242, which is integrally formed with the spiral tube 23, is connected to an outer line such as the line 244 by a suitable compartment means. A Suave tube can then be attached to the outer line 244. A single distal member 246 having an inner member 248 and an outer member 250 can be coupled to a corresponding tube prior to being coupled to the proximal assembly. The return assembly 246 can also complete the action of being attached to the tube in a series of steps. For example, when the proximal end of the tube 23A is connected to the inner tube 242, the inner component 248 can be integrally formed to the distal end of the tube 230. A combination of various construction steps can also be used. It will be appreciated by those skilled in the art that the F3 combination TM loops described herein are not limited to the arrangement of the single-wing tubes, but can also be used in a two-wing arrangement in which at least one of the tubes is a Suave tube or a spiral tube so that Significantly reduce manufacturing, shipping and storage costs. Thus, the illustrative embodiments of the invention and their uses are detailed above. Other variations, descriptions, and definitions of nouns used in the embodiments are also described. For example, the conduit sizes in the loop can be different from each other and can exist above two chambers. With the present invention, a large diameter or small diameter type of conduit can be used, and both the circulatory system and the Meppesen type system can be constructed. The above embodiments are merely illustrative and many variations and modifications are possible in the present invention. [Simple diagram of the diagram] Figure 1 shows a retracted first spiral catheter, which is located in a compressed 42 1281870 second conduit, and re-attacks to a similar v/, two conduits (first and second) The proximal end of the catheter is connected to the proximal assembly 1 between the Js. Therefore, a portion of the second catheter is clearly visible as a portion of the first catheter is not shown. Figure 2 shows the eighth. The figure after the file is expanded. Brother 3A-D Figure _ ; System operation. ..., - the Meppesen D-type system and the cyclic co2 reabsorption diagram are not components of a system constructed in accordance with the present invention and wherein: c shows that the use of the - spiral tube in the tube of the present invention - in the tube The tube is an accordion tube (ie, a ULTRA FLEX8 tube). Figure AD shows an embodiment of the invention in which the system and the system of the system constructed in accordance with the present invention are not used. 6A-B show an assembly of the embodiment of the sliding inner tube of the present invention and a conventional inspiratory line in which a smooth wall is inserted through an assembly into an axially expandable and foldable tube. 7A-B are diagrams showing the components of a system and its operation in accordance with an embodiment of the biaxial accordion tube of the present invention. Figure 8A-B shows the assembly of the bell or sheath and its operation in accordance with an embodiment of the accordion tube of the present invention, wherein a portion of the outer tube has been removed to provide a clear view of the inner tube structure. 9A-B are diagrams showing the operation of the assembly of the embodiment of the common shrink wall according to the present invention, wherein a portion of the outer tube has been removed to facilitate the reader to see the inner structure. Figure 10 shows another embodiment of the eighth embodiment A version of a component and a device thereof, wherein the first conduit is formed by a smooth plastic film, a Suave tube, 9 is connected to it, and its operation and tube operation 43 1281870 3: inner & or second conduit The second conduit is composed of a bellows, and part of the outer tube has been removed to facilitate the reader to see the inner tube structure while also removing an intermediate section to match the size of the figure. A catheter can be folded when not in use, and the inner tube can maintain its diameter without deformation under the condition of respiratory care operation. The π-graph shows the assembly of a single-wing breathing catheter and its operation, wherein the first elastic tube is A conventional elastic bellows or folded tube which maintains a fixed diameter under normal conditions and respiratory care operation; and the second conduit is a non-known plastic tube which can be maintained without maintenance Without deformation Folded radially. Figure 12 shows a single-wing breathing catheter assembly and its operation formed by two non-known catheters (ie, Suave tubes with their proximal and distal ends attached to each other). Including a spiral tube, the spiral tube is relatively rigid in radial direction compared to the outer tube that is enclosed therein, thereby helping to maintain the shape of the outer tube without deformation. Sections 13 (a) and (b) The figure shows an inflated suction catheter (a) and a compressed breathing catheter (b), wherein the outer tube or the first catheter is a Suave tube, and part of the outer tube has been removed 'to facilitate the reader to see clearly The inner tube structure; and wherein the inner tube is a spiral tube, wherein the inner surface of the spiral tube has a rigid cross-sectional shape. Figure 14 shows the inhalation (Fi) and delivery (Fd) under a low flow anesthetic gas (FGF) gradient. The concentration of isoflurane. Figure 15 shows the low flow anesthetic gas (1 liter FGF gas per minute) (the volatile set value is a quirk of isoflurane), inhalation (Fi) and tide 44 1281870 (FET) concentration Relationship to the transfer (FD) concentration. Figure 16 shows an example of the configuration. A configuration box of a plurality of respiratory catheters, wherein the breathing catheter is represented by a block diagram. [Simplified description of the component symbol] Fresh air bag inspection valve C〇2 absorber distal outer component spiral pipe shunt slide-out assembly sealing assembly Coaxial accordion tube first catheter second catheter common wall common partition wall respiratory catheter tube inner tube 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 > 220 242

45 2441281870 Outer pipe inner component outer component clearance common zone proximal end proximal component chamber remote distal component connection pipe 阜 separation flange or fluted disk venting flange inlet outlet configuration box plastic protective film hole sealing tape 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 8 , 11 , 201 200 212 214 216

46

Claims (1)

1281870 W year ('month'''''''''''''''''''''''''''''''''' The catheter has a proximal end and a distal end, wherein the first catheter proximal end is operatively coupled to a breathing gas inlet, and the second conduit is operatively coupled to a breathing gas outlet, and the shaft Extending or contracting the distal end of the second catheter may cause the distal end of the first catheter to also extend or contract axially correspondingly. 2. The circuit of claim 1 wherein the circuit is a single-wing circuit 3. The circuit of claim 1, wherein the first conduit comprises a first spiral tube and the conduit can expand or contract to a corresponding length in response to expansion or contraction of the second conduit. 4. The circuit of claim 1, wherein at least a portion of the first conduit is located inside the second conduit. 5. The circuit of claim 3, having a circuit selected from the group consisting of Arrangement: (a) its The second conduit includes a second spiral tube; (b) at least a portion of the first conduit includes a first spiral tube, the first spiral tube is helical about at least a portion of the second conduit; (c) wherein the second conduit The catheter includes a second helical tube, wherein the first and second tubes each have a distal end 47 1281870 and a proximal end, and the first and second ends are operatively coupled together, and The second spiral tube of the third guiding bag 3, wherein at least a part of the first and the second tube systems are in a parallel spiral relationship with each other. 6. The patent area is the first one of the households, wherein the first The proximal component of the first and second polities. The guide has a circuit at the proximal end thereof. The circuit described in claim 6 is the circuit of the first and second conduits. The end has a common distal assembly. 8. The circuit of claim 7 wherein the distal assembly comprises a rigid space or directly connects the first distal end. The distal end of the catheter is coupled to the second catheter 9. For example, the scope of the patent application is used to adjust the first departure. The circuit of item 8, wherein the distal end of the distal end of the catheter and the distal end of the catheter: the tube and the second tube, each tube is connected to the proximal end Connected to a breathing gas that can be radially folded into a multi-chamber breathing circuit when not in use, at least comprising a proximal end and a distal end of the tube, wherein the breathing gas inlet, and the second tube proximal body outlet, the towel At least one of the tubes of the present invention, wherein the tube has a line selected from the group consisting of: (a) - at least a portion of the tube is located (b) the tube is connected by a fixed spacing on its outer surface; and (c) the tube is connected by its distal end by a distal end assembly, and at least a portion of the tube is attached to each other The interval is very far. 1 2. The circuit of claim 10, wherein the radially foldable at least one tube has an approximation when subjected to pressure expansion to provide assisted ventilation and/or anesthesia by a human or other mammal. Less than 20% compliance. 1 3 - The circuit of claim 10, wherein the radially foldable at least one tube, when expanded under pressure to provide assisted ventilation and/or anesthesia by a human or other mammal, has a About less than 1 〇 ° /. Obedience. 1 4. The circuit of claim 10, wherein the radially foldable at least one tube has a minimum cross-sectional area under full inflation and foldable when not in use, allowing full inflation to expand The folded cross-sectional area of the minimum cross-sectional area is less than 90% of the expanded cross-sectional area. The circuit of claim 12, wherein the radially foldable at least one tube has a minimum cross-sectional area under full inflation, and the 49 1281870 is foldable when not in use to fully inflate The folded cross-sectional area of the minimum cross-sectional area under expansion is about 1% or less of the expanded cross-sectional area. 1 6. A ventilation or anesthesia system comprising at least one recirculation module; a re-snorkel having a proximal opening operatively coupled to the recirculation module for receiving gas from the recirculation module or providing Exhaust gas to the recirculation module; and a distal input port of fresh gas, wherein the distal input port is located at a distal portion of the rebreath or on a distal component, the distal component is Operatively coupled to the distal end of the snorkel, wherein the snorkel has an adjustable volume proximate to the distal assembly, wherein adjustment can be adjusted by adjusting the volume of the snorkel proximal to the distal assembly The concentration of fresh gas in a patient or mammal connected to the system. The system of claim 16, wherein the recirculation module comprises a cleaning circuit. 1 8. A method of providing low flow anesthesia or breathing gas to a human or other mammal, the method comprising the steps of: providing a fresh gas stream of a patient's desired gas and a cleaned gas stream consisting of a recycle gas stream, wherein The fresh air stream and the clean air stream are supplied to a human or other mammal via a breathing circuit having a distal end and a proximal end and including a first tube and a second tube, wherein the second tube has a distal end And a near 50 1281870 end, wherein the proximal end is operatively coupled to a cleaning module to clean and recirculate at least a portion of the received exhaled exhaust gas, and the first tube has an output port, which is Operatively coupled to the distal end of the circuit, wherein the first tube provides fresh gas to the human or other mammal by the distal end of the circuit. 1. The method of claim 18, wherein the second tube has an adjustable volume proximate to the first tube to which the circuit is connected, wherein the second tube can be adjusted by adjusting the volume of the second tube The concentration of fresh gas applied. The method of claim 18, wherein the fresh gas system is supplied in a volume of from about 0.5 liters to about 5 liters per minute. 21. The method of claim 18, wherein the FVFd concentration ratio is maintained above about 〇8 by adjusting the second tube volume. 51