US2845928A - Bronchopulmonary therapeutic apparatus - Google Patents

Description

Aug. 5, 1958 R. DENTON 2,845,928.

BRONCHOPULMONARYI THERAPEUTIC APPARATUS Filed Jan-. 28, 1953 4 Sheets-Sheet 1 22 24 J 82' Q as 4 FIG. RQBERT BENTON INVENTOR.

Aug. 5, 1958 R. DENTON BRCNCHOPULMONARY THERAPEUTiZC APPARATUS 4 Sheets-Sheet 2 Filed Jan. 28, .1953

ISBb s FIG. 7

ROBERT DENTON INVENTOR.

FIG. 6

romvs Y Aug. 5, 1958 R. DENTON 2,

BRONCHOPULMONARY THERAPEUTIC APPARATUS Filed Jan. 28, 1953 4 Sheets-Sheet 3.

INSPIRATION ROBERT DEN r0/v INVENTOR.

R. YDENTON BRONCi-IOPULMONARY THERAPEUTIC APPARATUS Filed Jan. 28, 1953 Aug. 5, 1958 4 Sheets-Sheet 4 United States Patent BRONCHOPULMONARY THERAPEUTIC APPARATUS Robert Denton, Oakland, Calif., assignor to Misto Gen Equipment Co., Oakland, Calif., a corporation of California This invention relates to techniques of treatment for medical patients suffering from primary and/ or secondary ailments involving one or more of the components of the respiratory system. This application is a continuation in part of my copending application Ser. No. 287,344 filed May 12, 1952, and now abandoned.

Techniques of treatment of the bronchial system include one involved and improved upon by this invention and known in the art as aerosol therapy which refers to the utilization of a gas, such as air or pure oxygen, as one component of a vehicle for the application to the membranes lining the respiratory tract of a medicinal agent such as the antibiotic penicillin or a shrinking agent, another component of the vehicle being water in which the medicinal agent is initially dissolved so that the medicine in solution may be carried therein to and deposited on the infected areas of the upper and lower respiratory tract portions. Both of these vehicles are, as will be evident, essential and of medicinal or therapeutic significance to the patient in addition to their vehicular capacity in the therapy.

The action in generating aerosol is provided in part by means of an instrument known as a nebulizer. This instrument utilizes air or another gas for breaking the liquid body or solution into drops small enough to be mixed and to be carried by the gas and/or air into the lungs. The nebulizer applies the gas to a water solution of drugs to form the drops and to form the mixture by utilizing expansive energy pre-stored in the gas by compression. The liquid is, incident to operation upon it by the gas and the nebulizer, translated partly to the vapor state and partly to the suspended liquid state in droplet form known as supersaturation of the gas with the liquid.

In addition to the specific types of problems of treatment for the application of nebulized-liquid-oxygen to various types of normal cases, there is the special one characterized by the tracheotomized patient who is also confined in a mechanical respirator, popularly known as the Iron Lung. A tracheotomized patient is one provided with an opening at the base of his throat adjoining the chest which opening by-passes the throat, nose and mouth to atmosphere and being usually employed because of the incapacity of these organs to function in a normal manner, as in the case of many poliomyelitis patients. The hole through the throat is termed a tracheal opening. In by-passing the throat and the nose, inspiration through the tracheal opening eliminates even the possibility that the inspired air will be moistened in the nose and in the throat as it is usually moistened naturally. Dry room air or dry oxygen passing directly into the trachea and bronchial tree is responsible for severe damage to the entire respiratory tract. If this type of patient retains the lung and diaphragm power to breath naturally he can be given oxygen therapy in a tent of the open top type. Those who are unable to breath under their own power are placed in the mechanical respirator. The physical structure of a mechanical respirator is such that the tent 2,845,928 Patented Aug. 5,1958

cannot be readily accommodated to the patient in such a manner that the nebulized-liquid-oxygen atmosphere can easily be applied to the tracheal opening and at the same time exclude air. By apparatus for the purpose herein described the same treatment that persons not confined to the respirator receive may in the essentials be provided for the respiratorized patient who must have oxygen and moisture pumped into and out of his lungs via the tracheal opening to maintain the normal function of the lungs to support life.

It is therefore an object of this invention to provide apparatus for applying a medicinal atmosphere to a tracheotomized patient.

Other objects and advantages of the invention will become evident from a consideration of the following description wherein reference is made to the accompanying drawings, in which:

Fig. 1 is a fragmentary elevational view, partially in section, of a nebulizer, to which there have been added certain features of construction;

Fig. 2 is a section at line 2-2 of Fig. 1 restricted to element 38 thereof;

Fig. 3 is a fragmentary section along the upper end of line 33 of Fig. 1; 1

Fig. 4 is an enlargement of the jet apparatus;

Figs. 5, 6, and 7 illustrate details of the apparatus of this invention;

Figs. 8 and 9 illustrate in a somewhat diagrammatic manner the path of aerosol taken during operation of the apparatus;

Fig. 10 is a top plan view of a modified form of a tracheotomy aerosol administering apparatus for patients who must be moved;

Fig. 11 is a cross-sectional view taken along line 11-11 of Fig. 10; and

Fig. 12 is a cross-sectional view similar to Fig. '11 but showing a further modification thereof.

The aerosol nebulizer apparatus is shown to include a suitable glass vessel or jar 10 having a screw threaded neck 12. For attachment to the neck 12 there is provided a cast metal body 14 having several functional features. The body 14 provides a jar cover portion 16 which is formed to fit the jar neck 12 and to form a seal with it. Body 14 further provides a cup portion .18 defining an injection, nebulizing, mixing, separating and expansion chamber 20. The cover and cup portions include a common top and bottom partition 22 having a drain opening 24 for the equalization of pressures within the jar and the chamber 20 and for the return of condensed liquid collected in chamber 20.

The body 14 is further provided with an opening v26 concentric upon an axis (horizontal in the drawing) substantially perpendicular to the common vertical axis of the jar and'cover. An annular supporting ring 28 is formed integral with the cup wall and surrounds opening 26 on the inside of the cup. The opening 26 is disposed at a substantial distance above the bottom of the cup and the bottom portion 22 of the cup is joined to the wall and ring by a boss 30. A vertical cylindrical hole 32' having its axis parallel to the axis of the cover 16 is disposed through the boss 30 inside the ring 28, and the integral portions therewith of the bottom cover 22, for the reception of a draft tube 34. The upper rim of cup 18 is cylindrical and provides a fiat rim 36 in a plane perpendicular to the cup axis.

A dispensing nozzle 38 (Figs. 1, 2) is provided to release the cloud of nebulae from chamber 20 into the surrounding atmosphere, or to the tracheotomy attach ment to be described. Nozzle 38 comprises a cover portion 40 having an annular externally cylindrical skirt 42 for rotatable reception and adjustment Within the rim of cup 18 and has an annular shoulder 44 to abut the rim 36. The skirt 42 is further provided with .a peripheral groove 46 into which the ends of two or more screws 48, threaded through the wall of cup 18, project for detaining and securing the nozzle 30 in any .angular position on the cuprim.

Nozzle 38 is further provided with a relatively large off-center passage 50 through the flat portion 52 of the cover. A domelike deflector 54 is formed integrally with the cover portion 52 around opening 50. The deflector terminates in a plane slightly off perpendicular to provide openings 56 through a suitable grid of parallel bars 58. It will be observed that this nozzle provides relatively free passage of the mixture of gas and nebulized solution from the chamber 20 through its outlet.

A thin-walled tube 60 is secured to flange Z8 concentric of the opening 26 and projects into chamber 20 so as to form a radial opening from tube 60 between its free vend 62 and the adjacent wall portion 64 of the cup. Adjacent its secured end, tube 60 is provided with longitudinal notches 66 and 66' '(Fig. 3) for the reception and the positioning in opening 26 of an assembly comprising an outer body 68 having radial legs 78 and 78 the tips of which, in the operation of assembling, slide axially through opening 26 into the notches and dispose their ends against the inside of flange 28. One notch 66' adjoins the hole 32 and receives a leg 70 having a threaded hole therein for the reception of the threaded upper end of the tube 34. The three-port opening formed between flange 28 and body 68 by legs 70 and 70' and tube 60, permits free flow of atmospheric air or other gas through opening 26 into chamber space 28 and when the unit is disposed inside the open-top tent the oxygenric-h atmosphere therein is recirculated and further charged with the oxygen and the liquid nebulae, thus maintaining a high concentration in the tent.

The body 68 is bored centrally to leave a sleeve portion 72 for receiving in the outer end of the bore a closely fitted internal sleeve 74 having an externally beveled flange '76 abutting the internally beveled end of the outer sleeve 72 as shown. The sleeves 72 and 74 form an internal chamber 78 with which the passage of tube 34 communicates. The sleeve 72 also provides a nozzle portion 80 having an axial cylindrical hole 82 extending from chamber 78 into tube 60 near its outer end as shown. The sleeve 74 is of a diameter to position it concentric inside sleeve 72 and provides a central passageway 84 terminated by an internal nozzle base 86. A straight cylindrical tube 88 is secured in the nozzle base with its axis coincident with the axis of hole 82. The tube 88 extends through chamber 78 and to a predetermined distance into bore 82. The length of the portion of tube 88 within the .bore 82 is siginficant as will be pointed out. This length may be adjusted by filing ofi the tip, or left end as seen in 'Fig. 4, for the purpose of adjusting the ratio of nebulae to oxygen.

The sleeve 72 is provided with a coupling thread 90 by means of which a suitable coupling to a flexible pressure hose may be attached for securing sleeve 74 in place and for conducting oxygen through nozzle tube 88.

The bore 82 is preferably circularly cylindrical and the tube 88 is likewise preferably of uniform internal and external diameters. In one successful embodiment of the invention the bore 82 is about 1.313 inches long and .040 inch in diameter. The outside diameter of tube 88 is about .032 inch and its inside diameter is about .018 inch. Withthe pressure of the oxygen delivered at 84 being in the range from fifteen to one hundred pounds per square inch, the stream of oxygen passing through tube 88 is restricted to that required by the patient and the minimum losses occur over the tent top edge. The velocity of the stream of oxygen as it leaves tube 88 and as it is released to the bore 82 surrounding the orifice of tube 88 is very high and maintains a very low pressure at that region. Accordingly, the liquid solution in vessel is forced by atmospheric pressure, up through tube 34 and into the chamber 78 surrounding tube 88, whence it is drawn in the shape of a tubular column of liquid concentrically out and around the central nozzle 88 past its tip. The length of tube 88 in the bore 82, and the cross section and length of this tubular space, determine for the most part the amount of solution which can pass through its length in unit time, the pressures at the inlet and outlet of this passage being fixed by the oxygen pressure. The pressure conditions, for any particular assembly of the parts, are determined by the pressure applied at 84.

With the arrangement as described several bodies 68 having different sizes of the hole 82, are interchangeably fixed in opening 26. This requires only the removal of cover 14 from vessel 10, and the unscrewing of tube 34 which tube constitutes the mechanical means of securement of body 68 in position within ring 28. It is clear that the sleeve 74 with tube 88 may itself be readily replaced by similar sleeves having nozzle tube 88 of different dimensions so that different quantities of air and pressures and pressure drops may be provided for, and so that, in the case of clogging in operation, a swift replacement may be eflected.

In the operation of the nebulizer as such, atmospheric air is drawn through part 26 and serves to supplement the requirement for dispersion of the droplets of solution into the atmosphere as the droplets are formed. The formation is greatly facilitated because the gas is released inside the moving tube of liquid solution escaping from the hole 82 and expands rapidly and radially in rupturing the thin tubular film of concentric solution.

The entire unit shown in Figs. 1 to 4 is, as hereinafter described, placed in the tent occupied by the patient. By this method of administration the freed previously treated supersaturated oxygen-rich atmosphere within the tent is continually being drawn into the inlet at 26 and into tube 60. Thus, the treated atmosphere within the tent is free of unnecessary dilution, from which it would not be free were previously untreated atmosphere or air from outside the tent, brought into inlet 26.

The provision for entry of a part of the ambient atmosphere through inlet 26, irrespective of whether the entire device is within the tent or whether it receives air to 26 from outside the tent, benefits the mixing process in that it permits adequate flow of aerosol from the outlet port. The aerosol mixture of oxygen and solution excapes from nozzle at high velocity in the direction of chamber 20, wall portion 64 and the end of tube 62.

The radial expansion of the oxygen tends to throw the small particles of solution radially toward, and effectually throws the large ones against, the surrounding inside surface of tube 60. This tendency is, as respects the small particles, resisted by the atmosphere aspirated through opening 26 more effectually than in respect of the large particles due to their relative areas and masses being more easily influenced. The ambient atmosphere rushes in therethrough, being continually induced to such movement by the effect of high velocity fluid escaping at 82. The aspirated atmosphere serves to disperse the solution in the oxygen and tends to prevent deposit of the small liquid particles on the inside surface of tube 60. Substantially only the desired small particles of .5 micron to 8 microns in diameter, pass upwardly in chamber 20 to outlet 50, the larger ones striking the walls of tube 60 or at 64, or when their kinetic energy-is spent in some cases, falling to the drain 24. (Note: one micron equals one-millionth of a meter.)

The tube 60 and the chamber formation together perform an additional function which is to give direction to the supersaturated mixture of gas and liquid to cause it to escape at 50, instead of tending merely to circulate back to the zone of low pressure near nozzle 80.

The tube 62 terminates adjacent wall 64 and the surrounding region appears to be somewhat above atmospheric pressure so' that flow is in the direction of the nozzle 54. p

In order to convey the nebulized atmosphere from nebulizer 11 to the tracheal opening in a patient the apparatus hereinafter described is provided. The apparatus of Figs. 5-7 may be used in connection with a mechanical respirator in which the tracheotomized patient is resting and which respirator is usually provided with a flexible collar or diaphragm surrounding the patients neck. Suitable support for the nebulizer 11 may be provided in the form of an arm 115 (Fig. 5) which maybe secured to the respirator.

A special tracheotomy oxygen dispensing adapter 143 (Figs. 5-9) for the nebulizer is provided and includes a tube 145 and a conoidal flared portion 147 joined by the small end thereof to one end of the tube 145. The large end of the flared portion 147 is mechanically formed to receive quick detachable and attachable support in a relatively gas-tight sealed relation with the discharge openings 56 of the nebulizer unit 11. As shown in Fig. 5, the provisions for these results include at the lateral sides of lug 139 a pair of upwardly disposed pins 149 receivable in holes 149 formed as shown at the top of the end of flared portion 147. The holes receive the pins 149 and the remainder of the end of the part 147 rests in sup ported and sealing relation to the hood 38, cover 52 and wall 18 due to the weight of adapter 143. This support is clearly illustrated in Fig. 5 and by reason thereof the entire weight of the tracheotomy adapter 143 is carried on the apparatus, and not by the patients neck in any sensible degree. When it is desired to have the patients neck mobile, other equipment is provided, as will be described.

The portions 145 and 147 are preferably formed of suitably rigid transparent plastic material. Transparency is of substantial advantage as will be pointed out, and the plastic material as such being relatively infrangible will stand against abusive impacts. The tube 145 has a bend at 151 (Fig. 5) therein intermediate its ends and about an approximately vertical axis as shown in the adapted positions in the drawings. This bend 151 is provided in order to continue the tube on past the tracheotomy opening for important reasons to be explained, and because the tracheotomy is usually actually near to or within the plane of the collar surrounding the neck opening of the respirator.

At the peak of the bend portion 151 on the bottom or patients side thereof, the tube wall is provided with an outlet or breathing hole 153, Fig. 5, through which the oxygen-aerosol-gas is drawn by the patient into the tracheal opening from the tracheotomy adapter tube 143, and through which the patient also exhales. Securely cemented in gas sealed relation to the lower side of the bent portion 151 is a gland block forming cushion 155 of soft spongy material such as of synthetic rubber which will not pass gas through its body except through a holed port 156 thereof in registry with the hole 153. The pressure exerted by the apparatus is that only of the expansive force of this gland 155 on the patients throat around the opening, adjusted by the support for the nebulizer as described. As seen in Figs. 5 through 7 the block 155 contacts only the top surface of a Vaseline saturated gauze pad or bandage 158 having a hole 158a therethrough the rim 15812 of which hole is entirely spaced from flange 157a of the tracheotomy tube 157. The lubricated pad 158 forms a sealing gasket between block 155 and the skin S of the patient around the tracheotomy tube 157. It is important that the flange 157:: of the tracheotomy tube be entirely free of contact with the block 155.

In order to insure to the patient the delivery through the tracheal opening of a pure aerosol atmosphere the tube 145 is extended by an extension part 145a beyond the tracheotomy port 153 a substantial distance to an end 162 thereof which end is open to the atmosphere. The length .of this exhaust portion, approximately 'six inches, is determined so as to prevent, in great degree, the rehreathing' of lung expired gases; and secondarily to avoid the dilution of the oxygen with ambient atmosphere. These functions are illustrated in Figs. 8 and 9. In Fig. 8 it is shown by the arrows that, during the inspiration, oxygen from the extended portion of the tube tends to return toward the hole 153 but in the main the oxygen in this region serves only as a stopper or buffer against entry of am bient air. Most of the inspired oxygen comes directly through the part of tube on the nebulizer side of tracheotomy port 153. Ambient air at the exhaust end of the tube is thus sealed off at almost exactly atmospheric conditions.

In the expiration the expired gases move freely through the exhaust part 145a of the tube to atmosphere. However, at the terminal phase of expiration, the last volume of expired gas is forced out of the part 145a by oxygen from the nebulizer so that only fresh oxygen and vapor (aerosol) remain in the tube 145 for the following inspiration. It will be observed that recirculation of am bient air through the generator corresponding to that when in the tent is not available in this tracheotomy apparatus.

In order to provide a clear space adjoining the tracheal opening, in which space the bent portion 151 of the tube may be positioned by the flared end portion 147 thereof as described without interference; and in order that, in the absence of the adapter, an attendant may have quick access into the tracheal opening, the respirator is provided with the standard deflecting rod 164 (Fig. 5) having a bow shape and the rod is rotatably supported about the coincident substantially horizontal axes of its aligned straight ends in slide blocks which may be 'adjustably fastened on brackets for movement of the blocks toward and away from the respirator and for rotation of the bowed portion of the rod to force the diaphragm collar into the respirator against the tension therein and thus clear the required access space for access therein by the bent portion 151 of the adapter. The tracheotomy adapter 143 is thus accommodated to and 'by previously used standard respirator equipment.

Mucous must be removed from time to time to prevent strangulation of the patient; It will now be appreciated that transparency of the tube 145, particularly at the top side of the bent portion 151, is of importance because through this portion and holes 153 and 156 the degree of accumulation of such mucous can be observed without interrupting the operation of the apparatus.

For the respiratorized tracheotomy patients who must be moved about in the respirator or who can and should be permitted to move their heads, a tracheotomy aerosol administering apparatus components are shown in Figs. l0, l1 and 12. In this apparatus the generator 11 may be rigidly mounted at any point nearby but preferably on the respirator. The dome type nozzle 38 shown in Fig. 1 is replaced by a nozzle-like dispensing adapter cover 38' having a tubular nozzle 38a.

An applicator 151 is strapped, by means of a band 151a extending around the patients neck and hooked in hooks 151b of the applicator, against a washer-shaped gauze patch 158, saturated with Vaseline to constitute it a gas impervious packing and lying on the patients throat as a gasket about the tracheotomy. A sponge contact ring 155' is cemented to the lower end of a tubular portion 1510 of the, applicator 151 and the upper end of the tubular portion 151a includes an inwardly disposed annular flange 151n formed with a flat top surface portion 151m and surrounding a suctioning access part 151d through flange 151n. A transparent window forming, and flat bottom sealing cover form-ing, member 151e having a flat undersurface and diametrically opposite slots 151i and fastening lug ports 151g drops over lug heads 151k fastened to the flange 151n as shown, and upon rotation is cammed by heads 151h against the top surface 151m. The weight of applicator 151 islargcly carried .by a hook 1510 secured rigidly at 151p .to applicator 151', and elastically .suspended as by .a spring 151! the upper end 15.11 of which is :also fixed to the respirator.

The applicator 151'is provided'with like inlet and outlet tube parts 145' and 162' corresponding to parts 145 and 162 of the modification of Fig. 5. Tube 145' and applicator 38' are joined by a flexible plastic gas impermeable tube 145c of uniform interiorly smooth finished section. The tube 145c is held in a tubular shape in any straight or curved position by an in-fitted helical coil 14515 of stainless steel wire, thus providing an insured passage of flexible character which is visible inten'orly to ascertain that it is clear of any obstruction. By reason of this flexibility the patient may move or be moved readily without readjustment of the generator and without developing unbearably uncomfortable strains on the patients flesh in the vicinity of the tracheotomy. The stainless steel coil 14% is corrosion proof and the smooth finish on the inside of the tube allows all condensate to drain as formed so that no dangerously large bodies of condensate collect.

The fiow of aerosol is adjusted to a nicety by means of an adjustable choke 162c of rubber having a central orifice 162d the diameter of which may be increased by drawing the cufi portion 1626 on or oil the bead 162i.

In Fig. 12 another form of the applicator is shown. The sponge contactor 155" is cemented to strap attachment base 152]) to which band 151a is attached at eyes 151]). The larger mass of the applicator comprising tube 152c is joined to base 152b through a bellows type joint 152e which is capable of bending and of expansion up and down. Thus the great mass of the applicator is supported by the spring and only the sponge is partially supported by the patient.

I claim:

1. Apparatus for treating a tracheotomized patient, said apparatus comprising: an aerosol generator for generating and issuing an eflluent of a mixture of a nebulized liquid in a gas, enclosed conduit means communieating at one end with said generator, having its other end open to the atmosphere, and provided with an outlet intermediate said ends which outlet may be positioned in communicating relationship with a tracheal opening 8 in a patient for continuously conveying said eflluent .to and past said outlet and outwardly of said one end for permitting periodic introduction of said eifiuent into the patient, said conduit means being provided with a trans parent portion adjacent :said outlet for permitting visual observance of said outlet through said portion.

2. Apparatus for treating a tracheotomized patient, said apparatus comprising: an aerosol generator for generating and issuing an efiluent of a mixture of a nebulized liquid in a gas, enclosed conduit means communicating at one end with said generator, having its other end open to the atmosphere, and provided with an outlet intermediate said ends which outlet may be positioned in communicating relationship with a tracheal opening in a patient for continuously conveying said eflluent to and past said outlet and outwardly of said one end for permitting periodic introduction of said effiuent into the patient, and gasket means surrounding said outlet.

3. Apparatus for treating a tracheotomized patient, said apparatus comprising: an aerosol generator for generating and issuing an effluent of a mixture of a nebulized liquid in a gas, enclosed conduit means communicating at one end with said generator, having its other end open to the atmosphere, and provided with an outlet intermediate said ends which outlet may be positioned in communicating relationship with a tracheal opening in a patient for continuously conveying said efiluent to and past said outlet and outwardly of said one end for permitting periodic introduction of said eflluent into the patient, and a variable choke on said outlet.

References Cited in the file of this patent UNITED STATES PATENTS 2,432,946 Theunissen Dec. 16, 1947 2,584,450 Holt Feb. 5, 1952 2,593,134 Gibbon Apr. 15, 1952 2,605,764 Adams Aug. 5, 1952 2,624,337 Gibbon Ian. 6, 1953 2,699,775 Cameto Jan. 18, 1955 FOREIGN PATENTS 502,531 Great Britain Mar. 20, 1939

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