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III IIII US005492109A United States Patent (19) 11 Patent Number: 5,492,109 Hirschl Et Al

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III IIII US005492109A United States Patent (19) 11 Patent Number: 5,492,109 Hirschl Et Al III IIII US005492109A United States Patent (19) 11 Patent Number: 5,492,109 Hirschl et al. 45) Date of Patent: Feb. 20, 1996 54) LIQUED VENTILATOR WITH "Experimental Pathology After Respiration ... ", Gollanet WENTURI-NDUCING PATIENT al, pp. 249-262, Experimental Medicine & Surgery, V26, #4, CONNECTOR Dec. 1968. "Dogs Breathe Water”, Scientific Newsletter, Apr. 6, 1965, 75 Inventors: Ronald B. Hirschl, Whitmore Lake; V. 87, #15, p. 229. Jean P. Montoya; Scott I. Merz, both "Perfusion of whole animals... heart-lung machine", Clark of Ann Arbor, all of Mich. Jr. et al., pp. 1764-1770, Federation Proceedings, V.29, #5, Sep/Oct. 1970. (73) Assignee: The Regents of the University of "Fluorocarbon Liquid Oxygenator', Dundas, pp. Michigan, Ann Arbor, Mich. 1771-1777, Federation Proceedings, V.29, #5, Sep./ Oct-1970. (21) Appl. No.: 147,057 "Compliance and Diffusion . fluorocarbon fluid', Gollan et al., pp. 1725-1729, Federation Proceedings, V29, #5, 22 Filled: Nov. 3, 1993 Sep./Oct.-1970. (51) Int. Cl. .............................. A62B 7/06; A62B 9/06; "Survival and histopathologic... liquid breathing,” Patel et A61M 16/00 al, pp. 1740-1745, Federation Proceedings, V29, #5, Sep./ 52 U.S. Cl. ................................ 128/201.21; 128/204.25; Oct-1970. 128/913; 128/207.14 Oxygen Consumption & Carbon Dioxide Prod. During 58) Field of Search ............................... 128/913, 201.21, Liquid Ventilation-Hirschl-May 16, 1992, Univ of Michi 128/204.18, 207.14,911, 912, 204.25 garl. (List continued on next page.) 56 References Cited Primary Examiner-Kimberly L. Asher U.S. PATENT DOCUMENTS Attorney, Agent, or Firm-Harness, Dickey & Pierce 4,232,665 11/1980 Vaseen .................................... 128/913 57 ABSTRACT 4,867,153 9/1989 Lorenzen et al. 128/205.2 5,158,536 10/1992 Sekins et al. ............................. 604/20 An involuntary respiratory apparatus for perfusing and entraining a breathable liquid from the lungs of a patient. FOREIGN PATENT DOCUMENTS The system includes a number of components which are 0858824 8/1981 U.S.S.R. ................................ 28/913 interconnected by a conduit so as to form a substantially WO9219232 11/1992 WIPO. closed loop, single path circuit. The various components WO9309833 5/1993 WIPO. include a reservoir, a pump, an oxygenator, aheat exchanger, an endotracheal tube, a Y-connector, a valve and a controller. OTHER PUBLICATIONS To simulate inspiration, the controller closes the valve, which is located downstream of the Y-connector, thereby "A Mechanical Respirator for Control of Liquid Breathing', forcing the liquid into the lungs of the patient. After a tidal Moskowitz, pp. 1751-1752, Federation Proc, V29, #5, volume of liquid has been perfused into the patient's lungs, Sep./Oct. 1970 the controller opens the valve. The Y-connector is shaped "Discussion of Liquid Breathing", Rahn, pp. 1753-1754, such that the flow of liquid through its inspiratory limb will Federation Proceedings, V29, #5, Sep./Oct.-1970. cause the liquid in the patient's lungs to be entrained into the "Survival of Mammals...", Clark Jr. et al., pp. 1755-1756, flow out of the Y-connector. In this manner, the Y-connector Science, vol. 152, Jun. 24, 1966. operates as an ejector pump and allows the apparatus to "Required Properties of Liquids ... ", Kylstra, pp. 1724, continuously perfuse the liquid through the single path Federation Proceedings, V29, #5, Sep/Oct-1970. circuit. "Long-Term Survival of Dogs . ', Modell et al., pp. 1731-1736., V29#5, Sep/ Oct-1970. 9 Claims, 2 Drawing Sheets 5,492,109 Page 2 OTHER PUBLICATIONS A New Experimental Approach for the Study of Cardiop The American Physiological Society, pp. 2322-2323, Air- ulmonary Physiology During Early Development-Wolf way & Alveolar Pressures During Perfluorocarbon Breath- son-1988, American Physiological Society, pp. ing in Infant Lambs-Curtis-1990. 1436-1439. U.S. Patent Feb. 20, 1996 Sheet 1 of 2 5,492,109 U.S. Patent Feb. 20, 1996 Sheet 2 of 2 5,492,109 5,492,109 1. 2 LIQUID VENTILATOR WITH ventilation results in no adverse morphological, biochemical VENTUR-INDUCING PATIENT or histological effects. CONNECTOR In the United States, liquid ventilation has only been clinically studied in a few instances. Generally, these sys tems have been gravity systems where, during inspiration, BACKGROUND AND SUMMARY OF THE oxygenated perfluorocarbon is placed into a reservoir and INVENTION : allowed to drain into the patient's lungs under the influence The present invention generally relates to pulmonary of gravity. During expiration, another reservoir is placed ventilation and, more particularly, to a pulmonary ventilator below the level of the patient's lungs and the perfluorocar 10 bon is allowed to drain from the lungs, again under the using a "breathable liquid". influence of gravity. As used herein, the phrase "breathable liquid” is meant to refer to liquids which are capable of delivering oxygen to, In the laboratory, complex liquid ventilation systems and removing carbon dioxide from, the pulmonary system or utilizing modern extracorporeal life support technology lungs of a patient. Examples of "breathable liquids' include, have been described and used. Specifically, these systems but are not limited to, saline, silicone, vegetable oils, per 15 have required the use of multiple roller pumps and multiple fluorochemicals and others. One of the presently preferred fluid reservoirs in order to provide control over all the "breathable liquids' is perfluorocarbon liquid. Hereinafter, parameters of inspiration, expiration, oxygenation and car the phrase "perfluorocarbon liquid” is used in place of bon dioxide removal. These systems have also necessitated "breathable liquids'. This use, however, is not intended to the use multiple loop or bypass circuits for the perfluoro 20 carbon ensure adequate inspiration and expiration. The restrict the present invention specifically thereto. systems have also included, in addition to the bypass circuit, Perfluorocarbon liquids, also known as perfluorocarbons the use of multiple valves to properly direct the perfluoro or simply PFC's, are derived from common organic com carbon into the lungs during inspiration and through the pounds in which fluorine atoms have replaced carbon bound bypass circuit during expiration. The multiple valve and hydrogen atoms. PFC's are colorless, odorless, non-fam 25 bypass systems have typically included a valve located in mable liquids which have a high dielectric strength and the circuit both before and after the patient, on what are resistivity. They are substantially insoluble in water, are known as the inspiratory limbs and expiratory limbs of the denser than water, exhibit low surface tensions, and have circuit. The valves are manipulated during inspiration and low viscosities. Perhaps the most unique characteristic of expiration so that the perfluorocarbon is either directed into PFC's is their high affinity for gases, dissolving up to twenty 30 the lungs (during inspiration) or diverted through the bypass times as much oxygen and over three times as much carbon circuit. dioxide as water. Like other materials which are widely used As the above discussion reveals, these prior liquid ven in the practice of medicine, PFC's are extremely biocom tilation systems are quite complex and, often, too cumber patible and non-toxic. In addition to liquid ventilation, some to make clinical application practical. The need for a perfluorocarbon liquids have found utility as artificial blood 35 simplified and reliable liquid ventilation system is therefore substitutes, in lung lavage (washing) and medical treatments obvious. such as convective lung hypothermia. In achieving its main objective, namely, providing posi Pulmonary ventilation with various breathable liquids has tive pressure, tidal volume liquid ventilation, the present been investigated from time to time during the last three invention overcomes and substantially alleviates the prob decades and the ability to provide for adequate oxygenation 40 and the elimination of carbon dioxide during liquid venti lems associated with the known prior systems. lation has been demonstrated. It was first demonstrated in Another object of the present invention is to provide a liquid ventilator which reduces the mechanical complexity the early 1960's that mammals could be submerged in of a liquid ventilation system through the adoption of a more hyperoxygenated saline, could breath the oxygenated liquid simplified design. A related object is to allow both inspira and could successfully resume gas breathing thereafter. 45 Because of the practical difficulties involved with dissolving tion and expiration while eliminating the need for a bypass sufficient quantities of oxygen in saline (high pressures are circuit. required) and because the saline rinsed away much of the Still another object of this invention is to provide a liquid surfactant lining in the lung alveoli, the saline approach to ventilation system in which the breathable liquid is continu liquid ventilation was eventually abandoned. These prob 50 ously being moved or pumped through the system. lems were overcome in the mid 1960's when PFC's were In achieving the above and other objects, the present first used to support the respiration of various small animals. invention provides a pulmonary ventilator in which the The biocompatibility and various other properties of certain breathable liquid, preferably perfluorocarbon, is recirculated PFC's has led to a significant body of ongoing research
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