Patent Grant
11759594
Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57.
The presently disclosed subject matter relates to providing adjustable humidification using heat and moisture exchangers (HME) as part of breathing assistance using a breathing assistance apparatus. The present invention also relates to breathing apparatus that are compact and can be maneuvered to convenient locations. Such breathing apparatus could be (although are not limited to) continuous positive airway pressure (CPAP), bilevel, auto titration apparatus or non-invasive ventilators or any other breathing apparatus that provides pressure and/or airflow to a patient. Such apparatus can use adjustable humidification.
Breathing apparatus are used to provide breathing assistance to patients. Examples of such breathing apparatus are CPAP (continuous positive airway pressure), bi-level and/or autotitration PAP (positive airway pressure) apparatus that provide pressure support to a patient for treating obstructive sleep apnea or other breathing disorders. Other examples of such breathing apparatus are ventilators (such as non-invasive ventilation—NIV) that provide assisted breathing or flow therapy.
Often as part of therapy and/or for comfort it is desirable to humidify the air provided to the patient by the breathing apparatus.
It is an object of the presently disclosed subject matter to provide an apparatus and/or method for adjustable humidification alone or as part of a breathing apparatus.
It is an alternative object of the presently disclosed subject matter to provide a breathing apparatus that is portable and/or can be positioned in more convenient locations during used.
In one aspect the presently disclosed subject matter invention may be said to comprise an adjustable HME for use with a breathing apparatus to humidify air comprising:
Preferably the HME material is spiral wound on a spindle and the adjuster manipulates the spindle to tighten or loosen the spiral of HME material and/or adjust the diameter of the spiral.
Preferably the adjuster comprises adjustable apertures for altering the inlet airflow and/or patient air flow over surfaces of the HME material to alter the exchange of moisture and/or humidity.
Preferably the adjustable apertures comprise two sets of apertures and corresponding cover(s), a first set being arranged on the outlet side of the flow path and a second set being arranged on the inlet side of the flow path.
Preferably the cover is a slidable cover that is moveable relative to the first set and second set apertures to cover none, part or all of the apertures of each set, wherein covering some or all of the first set of apertures reduces patient air flow to atmosphere through the first set to increase patient air flow through the HME material to increase the exchange of humidity.
Preferably the cover is a rotatable cover that is moveable relative to the first set and second of set apertures to cover none, part or all of the apertures of each set, wherein covering some or all of the first set of apertures reduces patient air flow to atmosphere through the first set to increase patient air flow through the HME material to increase the exchange of humidity.
Preferably the cover is a rotatable cover that is moveable relative to the first set of apertures to cover none, part or all of the apertures of each set, wherein covering some or all of the first set of apertures diverts some or all of the patient air flow past the HME material through the second set of apertures to decrease patient air flow through the HME material to decrease the exchange of humidity.
Preferably the HME material comprises a sheet with raised portions.
Preferably the HME material is coiled, layered and/or stack to form air paths.
Preferably the HME material is metal or polymer.
Preferably the HME further comprises a valve in the air flow wherein the adjuster manipulates the valve to control the volume of air flow over the HME material.
Preferably the HME material provides a condensation and absorption surface further comprising a valve in the air flow and the adjuster manipulates the valve to control the volume of air flow.
Preferably the HME further comprises a HME chamber with a tubular extension with an aperture coaxially rotatably coupled to a patient duct with an aperture, wherein the apertures form the valve and the adjuster manipulates the valve by rotating the tubular extension relative to the patient duct to alter alignment of the apertures.
In another aspect the presently disclosed subject matter comprises an adjustable HME for use with a breathing apparatus to humidify air comprising:
In another aspect the present invention may be said to consist in an adjustable HME for use with a breathing apparatus to humidify air comprising:
In another aspect the present invention relates to a breathing system or breathing apparatus comprising an adjustable HME that is directly or indirectly between an outlet and the patient, according to any paragraph above.
Preferably the adjustable HME further comprises bias flow holes at a distal end of the HME with respect to the patient after the HME material so exhaled patient airflow laden with humidity passes over the HME material prior to passing through the bias flow holes to ambient.
In another aspect the present invention may be said to consist in an HME comprising metal mesh or metal covered mesh.
Preferably the metal is copper or aluminium.
In another aspect the present invention may be said to consist in an HME comprising a molecular sieve.
Preferably the HME comprises zeolite granules or synthetic zeolite granules.
In another aspect the present invention may be said to consist in metal mesh (such as aluminium or copper) or metal covered plastic mesh for use in an HME.
In another aspect the present invention may be said to consist in zeolite granules or synthetic zeolite granules for use in an HME.
Preferably the HME material is aluminium mesh, Zeolite granules, or metal covered mesh.
In another aspect the present invention may be said to consist in an HME with HME material comprising a water chamber surrounding and in fluid communication with the HME material.
In another aspect the present invention may be said to consist in a compact breathing apparatus for providing flow or pressure to a patient, comprising: a housing with an inlet for receiving air and an outlet for providing airflow to a patient, a blower in the housing, the blower comprising an impeller coupled to a motor, wherein upon operation the blower rotates the impeller to draw air from the inlet and pass it to the outlet, wherein the breathing apparatus is sufficiently compact to enable portability and placement of the breathing apparatus in a range of convenient locations.
Preferably the apparatus further comprises a flexible air inlet tube with an air inlet and an outlet coupled to the housing inlet wherein the flexible air inlet tube can be manipulated to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
Preferably the flexible air inlet tube is formed from a malleable material to enable manipulation of the tube into a range of geometric configurations to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
Preferably the flexible air inlet tube has reinforcing to enable manipulation of the flexible air inlet tube into a range of geometric configurations to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
Preferably the reinforcing is a malleable elongated insert (e.g. flexible wire) that can be positioned and retained in a range of geometric configurations to manipulate and hold the flexible air inlet tube into the range of geometric configurations.
Preferably the flexible air inlet tube is made from silicon rubber and/or has an internal diameter to wall section ratio of 3:1 (or anywhere from 3:1 to 6:1) to prevent occlusion of the flexible air inlet tube upon manipulation or external force.
Preferably the apparatus further comprises an HME (optionally adjustable) coupled directly or indirectly to the housing outlet to humidify air flow provided to the patient.
Preferably the apparatus further comprises a patient conduit and patient interface, wherein the HME and patient conduit are coupled between the housing outlet and the patient interface.
Preferably the patient conduit comprises exhaust vents to enable washout of CO2 from patient expiration.
Preferably the exhaust vents are placed in a connector between the patient conduit on the patient interface, and the HME has exhaust vents, wherein upon connection of the HME between the patient conduit and the patient interface, the exhaust vents on the patient conduit are occluded.
Preferably the HME comprises a flexible hose for coupling to the patient interface, wherein the flexible hose has a 15 mm internal diameter (or anywhere between 10-20 mm) and/or is 50 to 100 mm long.
Preferably there are no external configuration controls accessible for user manipulation, and optionally further comprising a wireless interface for wireless configuration and/or interrogation of the apparatus using a remote device.
Preferably the patient conduit is approximately 800 to 1000 mm long and/or 15 mm internal diameter (or anywhere between 10-20 mm).
Preferably the housing comprises two abutting halves with a flexible outer cover over the abutment, and optionally the housing is an extended oval shape with dimensions of 110×120×45 mm, or anywhere between 80-120 mm×80-120 mm×40-60 mm.
Preferably the flexible air inlet tube terminates in a replaceable filter element.
Preferably the filter element has a housing with openings at the end and along the side, and optionally is in the shape of a cone.
Preferably the flow generator housing halves are internally lined with a sound deadening material.
In another aspect the present invention may be said to consist in an adjustable HME for use with a breathing apparatus to humidify air comprising: an inlet for coupling to a source of air, and an outlet for delivering air to a patient and an air flow path between them, HME material in the flow path, and exposed to the air flow path to exchange heat and moisture and/or humidity between patient air flow and an inlet air flow, adjustable apertures for altering the inlet airflow and/or patient air flow over surfaces of the HME material to alter the exchange of moisture and/or humidity.
Preferably the adjustable apertures comprise one or more apertures and one or more corresponding covers moveable relative to the apertures to cover none, part or all of the apertures to control inlet air flow and patient air flow through the apertures.
Preferably the adjustable apertures comprise two sets of apertures and corresponding cover(s), a first set being arranged on the outlet side of the flow path and a second set being arranged on the inlet side of the flow path.
Preferably the HME further comprises a housing around the HME material and air flow path, wherein the adjustable apertures are in the housing to control patient air flow and/or inlet air flow to atmosphere.
Preferably the cover is a slidable cover that is moveable relative to the first set and second set apertures to cover none, part or all of the apertures of each set, wherein covering some or all of the first set of apertures reduces patient air flow to atmosphere through the first set to increase patient air flow through the HME material to increase the exchange of humidity.
Preferably the cover is a rotatable cover that is moveable relative to the first set and second of set apertures to cover none, part or all of the apertures of each set, wherein covering some or all of the first set of apertures reduces patient air flow to atmosphere through the first set to increase patient air flow through the HME material to increase the exchange of humidity.
Preferably the cover is a rotatable cover that is moveable relative to the first set of apertures to cover none, part or all of the apertures of each set, wherein covering some or all of the first set of apertures diverts some or all of the patient air flow past the HME material through second set of apertures to decrease patient air flow through the HME material to decrease the exchange of humidity.
Preferably the HME material is sheet material with raised portions and is one or more of:
In another aspect the present invention may be said to consist in an HME according to any of the paragraphs above, wherein the HME is incorporated into an interface.
In another aspect the present invention may be said to consist in an HME according to any of the paragraphs above, wherein the HME is a modular HME configure to be connected between a mask shell or housing and a mask frame.
In another aspect the present invention may be said to consist in an HME according to any of the paragraphs above An HME for use with a breathing apparatus to humidify air comprising: an inlet for coupling to a source of air, and an outlet for delivering air to a patient and an air flow path between them, HME material in the flow path, and exposed to the air flow path to exchange heat and moisture and/or humidity between patient air flow and an inlet air flow, wherein the HME material is sheet material with raised portions and is coiled, layered and/or stacked.
Preferably the HME material is metal mesh or metal covered mesh or polymer mesh.
Preferably the material is expanded material to form the raised portions.
Preferably the material is woven material.
Preferably the HME material is pressed/welded material.
In another aspect the present invention may be said to consist in an HME material comprising a sheet with raised portions.
Preferably the material is coiled, layered and/or stack to form air paths.
Preferably the material is expanded material to form raised portions.
Preferably the material is woven material.
Preferably the material is pressed/welded material.
Preferably the material is metal or polymer.
In another aspect the present invention may be said to consist in an HME comprising metal mesh or metal covered mesh, which is optionally non-corrosive.
Preferably the metal is copper or aluminium.
In another aspect the present invention may be said to consist in an HME comprising a polymer, such as nylon or polypropylene.
In another aspect the present invention may be said to consist in a modular HME configured to retrofit to a patient interface.
Preferably the HME comprises a housing configured to couple between a mask shell and mask frame of a patient interface.
Preferably the HME comprises HME material according as described in any paragraph above.
In another aspect the present invention may be said to consist in a modular HME that is an adjustable HME according to any paragraph above.
In another aspect the present invention may be said to consist in a bias flow hole cover for a patient interface, optionally adjustable to cover none, some or all of the bias flow holes of a patient interface.
In another aspect the present invention may be said to consist in a compact breathing apparatus for providing flow or pressure to a patient, comprising: a housing with an inlet for receiving air and an outlet for providing airflow to a patient, a blower in the housing, the blower comprising an impeller coupled to a motor, wherein upon operation the blower rotates the impeller to draw air from the inlet and pass it to the outlet, wherein the breathing apparatus is sufficiently compact to enable portability and placement of the breathing apparatus in a range of convenient locations.
Preferably the breathing apparatus further comprises a flexible air inlet tube with an air inlet and an outlet coupled to the housing inlet wherein the flexible air inlet tube can be manipulated to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
Preferably the flexible air inlet tube is formed from a malleable material to enable manipulation of the tube into a range of geometric configurations to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
Preferably the flexible air inlet tube has reinforcing to enable manipulation of the flexible air inlet tube into a range of geometric configurations to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
Preferably the reinforcing is a malleable elongated insert (e.g. flexible wire) that can be positioned and retained in a range of geometric configurations to manipulate and hold the flexible air inlet tube into the range of geometric configurations.
Preferably the flexible air inlet tube is made from silicon rubber and/or has an internal diameter to wall section ratio of 3:1 (or anywhere from 3:1 to 6:1) to prevent occlusion of the flexible air inlet tube upon manipulation or external force.
Preferably the breathing apparatus further comprises an HME (optionally adjustable) coupled directly or indirectly to the housing outlet to humidify air flow provided to the patient.
Preferably the patient conduit is approximately 800 to 1000 mm long and/or 15 mm internal diameter (or anywhere between 10-20 mm).
Preferably the housing comprises two abutting halves with a flexible outer cover over the abutment, and optionally the housing is an extended oval shape with dimensions of 110×120×45 mm, or anywhere between 80-120 mm×80-120 mm×40-60 mm.
In another aspect the present invention may be said to consist in a compact breathing apparatus for providing flow or pressure to a patient, comprising: a housing with an inlet for receiving air and an outlet for providing airflow to a patient, a blower in the housing, the blower comprising an impeller coupled to a motor, wherein upon operation the blower rotates the impeller to draw air from the inlet and pass it to the outlet, and a flexible air inlet tube with an air inlet and an outlet coupled to the housing inlet wherein the flexible air inlet tube can be manipulated to position the air inlet away from occlusions when the compact breathing apparatus is placed in a convenient location.
In this specification where reference has been made to patent specifications, other external documents, or other sources of information, this is generally for the purpose of providing a context for discussing the features of the disclosure. Unless specifically stated otherwise, reference to such external documents is not to be construed as an admission that such documents, or such sources of information, in any jurisdiction, are prior art, or form part of the common general knowledge in the art.
It is intended that reference to a range of numbers disclosed herein (for example, 1 to 10) also incorporates reference to all rational numbers within that range (for example, 1, 1.1, 2, 3, 3.9, 4, 5, 6, 6.5, 7, 8, 9 and 10) and also any range of rational numbers within that range (for example, 2 to 8, 1.5 to 5.5 and 3.1 to 4.7) and, therefore, all sub-ranges of all ranges expressly disclosed herein are hereby expressly disclosed. These are only examples of what is specifically intended and all possible combinations of numerical values between the lowest value and the highest value enumerated are to be considered to be expressly stated in this application in a similar manner.
The term “comprising” as used in this specification means “consisting at least in part of”. When Interpreting each statement in this specification that includes the term “comprising”, features other than that or those prefaced by the term may also be present. Related terms such as “comprise” and “comprises” are to be interpreted in the same manner.
To those skilled in the art to which the invention relates, many changes in construction and widely differing embodiments and applications of the invention will suggest themselves without departing from the scope of the invention as defined in the appended claims. The disclosures and the descriptions herein are purely illustrative and are not intended to be in any sense limiting.
Where specific integers are mentioned herein which have known equivalents in the art to which this invention relates, such known equivalents are deemed to be incorporated herein as if individually set forth.
The Invention consists in the foregoing and also envisages constructions of which the following gives examples only.
Preferred embodiments of the drawings will be described with reference to the following drawings, of which:
The presently disclosed subject matter relates to an adjustable HME, and a breathing apparatus comprising or utilising an adjustable HME for providing humidified air to a patient.
The presently disclosed subject matter relates also to an HME material comprising mesh material with raised portions that are stacked, layered or coiled to form air paths.
The presently disclosed subject matter relates also to a breathing apparatus that is portable and/or can be positioned in more convenient locations during used.
Breathing Apparatus with HME
An HME comprises an HME material that works generally as follows. Inlet airflow passes through the HME material such as a porous material such as foam, paper, or a substance that acts as a condensation and absorption surface often impregnated with hygroscopic salts such as calcium chloride, to enhance the water-retaining capacity. As the patient inspires (inlet airflow), the heat and water from the patients' previously expired breath (patient airflow) are released from the HME material into the inlet airflow and so condition the inspired air by humidifying and heating it. Embodiments described herein could use new HME materials described herein, or HME materials known to those skilled in the art.
Adjustable HMEs
Various embodiments of adjustable HMEs are described, including embodiments that involve adjusting the airflow through the HME and/or HME material to adjust or control humidity.
A preferred humidity of air provided to a patient, from a therapy or health perspective, is around 25 mg/L to 32 mg/L of water. However, a patient may prefer less humidity depending on their preference for how comfortable it feels to breathe highly humidified air. Additionally, 100% relative humidity can cause rainout in the patient interface or conduits, so it may be appropriate to deliver, for 85% relative humidity at 34° C., which is what a patient's breath is at.
Further, an HME's effectiveness at providing humidity may depend on the surrounding environment. For example, performance may be negatively affected by cold ambient temperatures, say a cold bedroom. In such a situation, an HME may deliver a sub-optimal humidity. As the room temperature rises, an HME may become more effective, possibly too effective, causing rainout in the patient interface. Therefore, the difficulty with prior art (non-adjustable) HMEs is that often they work too well (or not well enough) and provide a humidity above (or below) that which is required.
HME with Reconfigurable HME Material
An adjustable HME 18 according to the presently disclosed subject matter used in a breathing system such as that of
Referring to the non-limiting exemplary embodiment in
As the inlet 22 and patient 30 air flows travel past the HME material 25, they contact opposite surfaces of the HME material 25 and humidity from the patient air flow 30 is disposed in the inlet air flow 22 to humidify the air 27 delivered to the patient. An adjuster 29 allows adjustment of configuration of the HME material 25 and/or inlet/patient air flow paths 22, 30 to adjust the amount of humidity exchanged. The HME material 25 can take many configurations. The HME material configuration, and in particular the surface area contacting the inlet 22 and patient 30 air flows can be adjusted to increase/decrease the surface area to increase or decrease the humidity exchange, thus adjusting the humidity of the outlet air 28 delivered to the patient.
Alternatively or additionally, the HME material configuration can be adjusted to control the volume/level of inlet 22 and patient 30 air flows presented to the surface of the HME material 25, thus adjusting the humidity of the outlet air 28 delivered to the patient. Altering the HME configuration in any manner to alter: a) the surface area of HME material presented to air flows, b) airflow rate, c) volume of air presented to the surface area, and/or d) residence time of the airflow on the surface area of the HME can alter the humidity provided. Generally, the HME configuration controls the amount of airflow that bypasses the HME or HME material to control the level of humidification.
Possible Arrangements of HME with Adjustable HME Materials
Humidity in the patient air flow 30 contacts the surface(s) of the HME material 38, and is “deposited” on the surface. That is, the HME material acts as a condensation and absorption surface that absorbs the humidity. Heat and water from the patients' previously expired breath are released from the HME material into the inlet airflow 22 and so condition the inspired air 22 by humidifying and heating it. The inlet air flow 22 contacts the surface(s) of the HME material 38 and picks up the humidity deposited by the patient airflow 30 as the heat and water from the patients' previously expired breath (patient airflow) are released from the HME material into the inlet airflow.
To adjust the level of humidity or moisture exchanged, and thus the humidity delivered to the patient, the spindle 39 can be rotated (e.g., clockwise or counterclockwise) using the actuator 29 to tighten and loosen the spiral wound HME material 38. This increases and decreases the gap 38a size respectively, and/or the size (e.g. diameter) of the spiral overall, which in turn alters the volume of inlet, outlet and patient flows presented to the HME material, which in turn alters the humidity transferred.
Depending on the configuration of the spiral and/or the spindle, different humidity control effects can be achieved. By way of non-limiting example, referring to
In contrast, as shown in
Depending on the configuration of the spiral 38 and the operation of the spindle 29, loosening and tightening the spiral may have a different effect to that described with reference to
Referring to the non-limiting exemplary embodiment shown in
In contrast, referring to an adjusted configuration shown in
Yet another non-limiting exemplary embodiment is shown in
In all the examples above, the tightening, loosening, rotating or retracting of the HME material can be controlled to differing degrees, which correspondingly affects the amount of humidity transferred to the inlet air flow. Other configurations might have other humidity control effects, and the examples above are exemplary only.
The chamber comprises a tubular extension 47 (see
As shown in the non-limiting exemplary embodiment, the HME 41 comprises a curved outer housing in two parts. The first part 50a is fixed to/integrated with the inlet duct 44a and has (housing) bias flow holes 51. The orientation shown in
Altering the flow 30 alters the level of inlet 22, outlet 28 and patient 30 flows that contact the surface of the HME material 46, thus altering humidity exchange. For example, as shown in
Additionally, it is possible to partially align the apertures 49, 48 whereby some of the patient airflow passes through the HME material and some bypasses it—thus provide humidity between the maximum and minimum. Humidity level is controlled by controlling the degree to which the apertures 49, 48 are aligned (thus increasing or decreasing the combined aperture size and controlling how much patient flow goes through the HME material versus bypassing it). Indicia 55 (see e.g.,
Other variations and embodiments are possible also. For example, a water filled/impregnated sponge can be added to the HME for extra humidity in high mask or mouth leak situations. A heated or insulated HME and mask connection tube variant would work better at lower temperatures.
In another variation to
HME with Reconfigurable Bypass Airflow Holes
By way of non-limiting example, generally the volume/level of inlet air 22 and patient air 30 flows, and hence the effectiveness of the HME material 25, is adjusted by controlling the volume of inlet air 22 and patient air 30 that bypasses the HME material 25. It is to be understood that higher volume flow of inlet air 22 and/or patient air 30 leads to increased uptake of humidity inside the HME material 25 and higher HME effectiveness. While, reduced volume flow of inlet air 22 and/or patient air 30 subsequently decreases uptake of humidity inside the HME material 25 and lower HME effectiveness.
Adjustment of inlet air 22 and/or patient air 30 flow can be achieved by altering the volume, surface area and/or position of the opened bias flow holes 31. For example, in a first configuration, bias flow holes 31 are open proximate the inlet duct 23 end, while closed at the outlet duct end 26. This configuration forces the entirety of the patient air 30 flow through the HME material 25 before passing through the bias flow holes 31, and provides higher levels of heat, moisture and/or humidity to be retained by HME material 25, thus provides for higher levels of heat, moisture, and/or humidity to be added to inlet air flow 22.
In a second configuration, bias flow holes 31 are closed proximate the inlet duct 23 end, while open at the outlet duct end 26. This configuration allows volume of patient air 30 flow to exit to ambient through the open bias flow holes 31 before reaching the HME material 25, thereby bypassing the HME and reducing levels of heat, moisture and/or humidity to be retained by HME material 25, thus provides for reduced levels of heat, moisture, and/or humidity to be added to inlet air flow 22.
In a third configuration, bias flow holes may be open on both the inlet duct 23 end and the outlet duct 26 end, thereby providing for a variable or medium level of heat, moisture and/or humidity to be retained by HME material 25, thus provides for variable or medium levels of heat, moisture, and/or humidity to be added to inlet air flow 22.
The volume or effective surface area of bias flow holes 31 may be equal on both ends. Alternatively one end may have a higher net volume of bias flow holes 31, for example the inlet duct 23 end may have a higher effective surface area of bias flow holes 31, or the outlet duct 26 end may have a higher effective surface area of bias flow holes 31. The effect of having bias flow holes on both sides reduces the overall volume of inlet air 22 and/or patient air 30 flow through the HME material 25, as the flows may pass through the respective bias flow holes and exit to ambient prior to reaching the HME material 25. The adjustment of the bias flow holes may be achieved through a number of configurations, such as through a slider or twister mechanisms, which will be further described in detail below.
Possible Arrangements of Reconfigurable Bypass Airflow Holes
In use, to adjust the level of humidity exchanged, and thus the humidity delivered to the patient, the slider 60 is adjustably moved along the slider track 62. The slider 60 functions by altering the effective surface area of the open bias flow holes 31 by closing (in the form of covering up) whole or portions of bias flow holes 31 on one side, while opening (in the form of uncovering) whole or portions of bias flow holes 31 on another side.
For example, in a first configuration, bias flow holes 31 are open proximate the inlet duct 23 end, while closed at the outlet duct end 26. This configuration forces the entirety of the patient air 30 flow through the HME material 25 before passing through the bias flow holes 31. As more exhaled patient air 30 flow passes through and deposits humidity on the HME material 25, this configuration provides higher amounts of heat, moisture and/or humidity to the inlet flow 22.
In a second configuration, bias flow holes 31 are closed proximate the inlet duct 23 end, while open at the outlet duct end 26. This configuration allows a portion of patient air 30 flow to exit to ambient through the open bias flow holes 31 before reaching the HME material 25, effectively bypassing the HME, reducing amount of humidity deposited on the HME material and therefore reducing the amount of heat, moisture and/or humidity available to the inlet flow 22.
In a third configuration, slider 60 is positioned such that bias flow holes are open on both the inlet duct 23 end and the outlet duct 26 end. This configuration provides a middle ground between either of the first two configurations, as patient air flow 30 is passed to both through ambient and the HME material 25. The slider 60 may also be adjusted such that there are even or uneven volume of open bias flow holes on either side of the HME material 25. The slider 60 may be adjusted according to any of the above configurations according to the desired humidity settings.
Other variations of the adjustable bias flow holes 31 are also possible.
In one configuration, the shell 65 is rotated to close the bias flow holes 31 proximate the inlet duct 22 and open the bias flow holes 31 proximate the outlet duct 26. In this configuration, more patient air 30 flow will exit to ambient and bypass the HME material 25, and thus reducing the amount of heat, moisture and/or humidity available to the inlet flow 22.
In another configuration, the shell 65 is rotated to open the bias flow holes 31 proximate the inlet duct 22 and close the bias flow holes 31 proximate the outlet duct 26. This configuration will have the effect of directing more patient air 30 flow through the HME material 25 before exiting the bias flow holes, thereby increasing the amount of heat, moisture and/or humidity available to the inlet flow 22
Various modifications of adjusting HME effectiveness through the adjustment of bias flow holes upstream and downstream of the HME material 25 will be apparent to those skilled in the art without departing from the nature of the invention.
Referring to the non-limiting exemplary embodiment shown in
Generally, such small bias flow holes provide for quieter bias flow with less entrained air or draft. However, such small bias flow holes are also more susceptible to being clogged by condensation, for example. Being located on the on the inlet side of the HME allows for smaller bias flow holes, because moisture that may clog such small bias flow holes is generally deposited or retained within the HME or HME material.
Adjustable HMEs in Use
Referring to
A number of commercially available patient interfaces 15 on the market today also provide ventilation holes either on the interfaces 15 or on the elbows 230. Such ventilation holes provide exit outlet for carbon dioxide and exhale patient air flow to ambient. However such ventilation holes would interfere with the working of the adjustable HMEs 18 as described above and with the bias flow holes 31 already built into the adjustable HMEs 18. Referring to
New HME Materials
New types of HME material could be used in an HME, beyond those known and used by those skilled in the art. The new HME materials described below could be used in any of the adjustable HME embodiments described above, or alternatively in non-adjustable HMEs 90, such as shown in
A first type of HME material that could be used is aluminium mesh/grille 100 or expanded sheet, such as shown in
The aluminium mesh can be washed, sterilised or otherwise cleaned to reduce containments and bacteria without losing performance. Aluminium also allows for rapid cooling and heating to keep the material at the dew point to improve efficiency of humidity transfer. These effects are important as known HME materials, such as foams, are rather delicate, thus are difficult to handle or clean without damage.
Alternatively, a copper mesh could be used, or a mesh of any other suitable metal with suitable heat conduction/retention properties. The aluminium/copper/metal mesh can be produced by a process of expanded metal meshes with a “raised surface”. For expanded metal, preferably between 15,000 mm2 and 780,000 mm2 of sheet metal is used. Preferably 33,000 mm2 and 132,000 mm2 of sheet metal is used. More preferably 75,000 mm2 to 110,000 mm2 of sheet metal used. The mesh has diamonds that have a width x and height y. The lattice of the mesh has thickness z. The diamond size, lattice thickness and number and density of diamonds can be configured to create the desired humidity transfer. The preferred dimension of the aluminium/copper/metal mesh is between 22 mm-120 mm in length, and 19 mm-60 mm in diameter. More preferably, the mesh dimension is between 40 mm-60 mm in length, and 40-50 mm in diameter. Even more preferably, the mesh dimension is 40 mm in length and 50 mm in diameter.
In addition to metals, polymer materials in mesh form having raised surfaces may also be used as the HME material. As such, the above description with respect to metal materials applies to polymers as well. In particular nylon, polypropylene, thermoplastic elastomers, and copolyester thermoplastic elastomers (for example as sold as Arnitel®, a water permeable polymer) may be used as the HME material as formed into mesh materials have a raised surface. Polymer materials provide for similar durability and cleaning benefits as described above with respect to metal mesh.
The HME material may also be arranged or stacked in series relative to each other. For example, coils of the aluminium or copper mesh could be stacked relative to each other in a series with respect to the flow path to increase surface area and improve water/moisture retaining capability.
Shown in
Shown in
Shown in
Shown in
An alternative HME material could be a plastic mesh with a metal coating, such as aluminium or copper. This would be thinner and lighter and would allow for more HME material to be packed in an HME, thus improving volume of water transfer in and out of the gas flow. Another alternative HME material could be a plastic mesh coated with either hydrophilic or hydrophobic materials.
An alternative HME material is a molecular sieve such as zeolite granules (particles) 110 as shown in
Another alternative HME material could be nano-fibre. Such nano-fibre material could be made using polyelectrolyte polymer (PSS), also known as polysalts, having hygroscopic characteristics similar to electrolytes. The polyelectrolyte polymer can be combined with another material to create structure. For example, an HME material can be made by blending polyamide66 (PA66) and polyelectrolyte polymer into an electrospun nano-fibre material. This material would behave similarly to materials impregnated with calcium chloride salts (per HME known in the art), with the further advantage of preventing loss or dissolution of polyelectrolyte polymer when washed. Therefore such nano-fibre material can be cleaned and re-used without losing its hygroscopic properties.
A further alternative HME material may comprise polymer materials including nylon, polypropylene, thermoplastic elastomers, and copolyester thermoplastic elastomers (for example as sold as Arnitel®, a water permeable polymer). Suitable polymer materials may be processed according to any of the above arrangements similar to aluminium/copper/metal mesh, such as coiled up in a mesh or netting that include a raised surface. The polymer materials may also be arranged or stacked in a series relative to each other (see e.g.,
Even when using an HME there is not 100% efficiency in recycling humidity, not all water is captured and/or transferred back to the inhalation gas flow. In a further embodiment, a supply of water is provided to the HME to replace water that escapes from the HME or other parts of the breathing system. The supply of water is provided in a chamber 121 that is provided to an adjustable or non-adjustable HME 120. An embodiment shown comprising an adjustable HME is shown in
Incorporating HMEs into Patient Interface
As described above, an HME can be included in the patient interface itself, rather than between the patient interface and/or conduit and/or CPAP apparatus.
HME Integrated into Patient Interface
In one embodiment, rather than coupling the HME 18 between a patient interface 15 and a flow generator, the HME 18 can instead be integrated directly into a patient interface 15. Integrated HME 18 into a patient interface 15 advantageously provides a compact form so that it is easier for patients to use, requiring no separate HME parts. It is also discovered that integrating HME 18 into the patient interface 15 is a solution to the problem of carbon dioxide (CO2) build-up inside the patient interface when used with an adjustable or non-adjustable HME. The HME 18 to be integrated may comprise any embodiments of adjustable HMEs herein described, or a standard non-adjustable HME.
The patient interface 200 comprises an inlet 221 for receiving air from a breathing apparatus; the inlet 221 is fluidly connected with an elbow 230 or a conduit 240. A chamber 220 is defined between the inlet 221 and the interior of the patient interface to house the HME 210. An HME adjuster (not shown) substantially as described above manipulates the HME material 211 to adjust the surface area exposed on the HME material 211 and hence the amount of humidity exchanged. In use, airflow passes from the conduit 240 and/or the elbow 230 into the chamber 220 through the HME material 211, picking up any humidity from the HME 210, and inhaled by the patient. Exhaled air from the patient passes through the HME material 211 and deposits water/moisture on the material. The exhaled air from the patient passes the HME material 211 and deposits humidity onto the material. Exhaled air from the patient may also exit to ambient through ventilation outlets 205 on the patient interface or bias flow holes 231 on the HME 210 (not shown) or elbow 230. In one embodiment, an adjuster 206 in the form of a movable slider/cover 206 may be used to open or close the ventilation outlets 205, and hence amount of airflow to ambient through such outlets 205. It may be desirable to stop or reduce airflow to ambient via the ventilation outlets 205 on the patient interface 200 such that exhaled airflow primarily passes through the HME material 211 and deposit humidity onto the HME material 211. The airflow subsequently exits through the bias holes 231 either on the HME or the elbow 230. However it may be necessary to adjust the ventilation outlets 205 on the patient interface 200 to reduce CO2 build-up inside the patient interface 200.
In one embodiment, the ventilation outlets 500 are located adjacent nasal area of the patient interface, and comprise small ventilation holes. While the adjuster 510 is a slider which can be configured to open, partially cover, or fully cover the ventilation holes. In another embodiment, the ventilation outlet 500 is a vertical slit, slot or gap, and a slider may be used to open, partially cover or fully over the vertical slot or gap.
Additionally, different positions of the ventilation adjusters may be labelled corresponding to how much air is allowed to flow through the ventilation holes. Examples of labels may include numerals, alphabets or any other suitable labels to denote the relative degree of which the ventilation holes are open.
Modular HME for Connection to Patient Interface
Various modifications of integrated and modular HME for patient interfaces will be apparent to those skilled in the art without departing from the nature of the invention.
An adjustable ventilator for a patient interface as described above with reference to
Compact CPAP
Breathing apparatus such as CPAP apparatus, non-invasive ventilators, bilevel, auto titration apparatus or the like provide therapy is that assists patient health.
Traditional apparatus are usually very bulky, and typically sit on a bedside table in a home environment. The bulk means that they are not easily portable, and also difficult to place in convenient locations—such as close to the patient. For example, a CPAP apparatus, which is typically used when a patient is asleep in bed, must be placed by the bedside table or similar. This is awkward when the patient is in bed and is not necessarily the best location for ease of use. When breathing apparatus become more difficult to use, often it means they are less likely to be used and patient compliance diminishes. Embodiments described here provide more convenient CPAP apparatus.
Overview of Apparatus
The breathing apparatus 700 comprises a main housing 710 for a blower/flow generator with a housing air inlet 711 for receiving ambient air and a housing air outlet 712 for providing pressurised air to a patient. A motor 720 (see
Upon operation of the motor 720, the impeller 731 rotates in the housing 710 and draws in ambient air through the flexible air inlet tube 713, pressurises it and directs the pressurised air out the outlet 712 through the patient conduit 714, optionally but preferably through the HME 715 where it is humidified, and to the patient via the patient interface 716.
The term “compact breathing apparatus” 700 can refer to the housing 710 and its internal components only, or alternatively also to the housing 710 in combination with one or more peripheral devices (such as although not limited to the air inlet tube 713, the patient conduit 714, the HME 715, the patient interface 716 and the like).
Components of the compact breathing apparatus will now be described in further detail.
Housing
The housing 710 comprises preferably two shell halves (710a seen in
Referring to
The CPAP apparatus preferably has a power source comprising a plug pack that connects to a wall socket. A power cable is permanently fixed to the housing 710 to prevent inadvertent disconnection and prevent a non-approved plug pack from being used. Alternatively an external or internal chargeable battery could be used, optionally chargeable using inductive power transfer. Other power sources could also be envisaged by those skilled in the art.
Air Inlet Tube
The flexible air inlet tube 713 is provided to reduce the chance that the air inlet to the breathing apparatus 700 is occluded when the breathing apparatus is placed in a convenient location. This is particularly a problem that could be faced by the present compact breathing apparatus 700, as it may be used in places other than a bedside table or other traditional locations—rather it may be used on or In a bed or similar. The risk is that when used in such convenient locations, the air inlet 713a could become occluded and prevent the breathing apparatus 700 from operating correctly, or worse create a danger to the patient. The flexible air inlet tube 713 is made of a flexible material such as silicone rubber or the like so that it can be manipulated (by for example bending, stretching, twisting or the like) into a range of different geometric configurations to (during use) place the air inlet tube 713 so that air inlet 713a is in a position so it is free from occlusion. Preferably, the air inlet tube 713 also has an internal diameter wall ratio of 3:1 so that upon manipulation and/or external forces the tube 713 wall will not collapse, thus avoiding occlusion. However, other ratios are possible. For example, the tube could have a wall diameter in the range of 2.5 mm to 6 mm and a total diameter in the range of 16 mm to 20 mm. The length of the tube is preferably short, for example somewhere between 150 mm-300 mm. Preferably additionally, not only is the air inlet tube 713 flexible, but it is also malleable so it is easily retained/maintained in the chosen geometric configuration that it has been manipulated into, but then also easily reconfigured into another geometric configuration as required. To create a malleable air inlet tube 713, either the tube 713 itself can be made from a malleable material and/or it can comprise one or more malleable reinforcement elements 717. The malleable material that the air inlet tube 713 can be made from could be one or more of: ductile metal insert of steel or aluminium, deformable plastic or polyester or liquid crystal polymer, separate plastic links that can swivel inside each other, concertina deformable tube, or the like.
The malleable reinforcement element 717 can be an insert (such as a bendable wire or the like) that takes the form of a spine 717 that runs internally or externally to the air inlet tube 713. Manipulating the tube 713 into the chosen geometric configuration will also manipulate the spine 717 due to its malleability, and due to its retention properties will retain the tube 713 in the chosen geometry (in addition to any retention properties of the tube 713 material itself). Manipulation of the air inlet tube 713 will be described further below with reference to use of the breathing apparatus in relation to
Patient Conduit
Referring to
Heat and Moisture Exchanger
In the preferred embodiment, an HME 715 is coupled to the patient end connector 714b of the patient conduit 714. A standard or adjustable HME 715 could be provided. The HME can take many forms. In one example, as shown in
Apparatus Use
Use of the compact CPAP apparatus 1 will now be described with reference to
The risk of placing the breathing apparatus 700 in a convenient location (as opposed to placing it in the usual manner on a clear bedside table or similar) is that the air inlet 714a might become occluded. The present invention reduces this risk by way of the flexible air inlet tube 713 that can be manipulated into a geometric configuration relative to the placement of the breathing apparatus so that the air inlet 713a is placed in a position that is not occluded, and is at low risk of being occluded due to movement of the patient 771 and/or that apparatus 700 throughout the night.
An example of use is shown in
Additional Features
In an example, the flexible hose for the HME for coupling to the patient interface, has a 15 mm internal diameter (possibly anywhere between 10-20 mm) and/or is 50 to 100 mm long. These dimensions are exemplary only.
Preferably the breathing apparatus has no external configuration controls accessible for user manipulation. That is, no externally accessible controls for general operation, configuration or instruction of the apparatus (it might however have an external power switch, which would not be considered an external control in that case). The apparatus instead comprises a wireless user interface for wireless configuration and/or interrogation of the apparatus using a remote device, such as a smartphone, computer, remote control or the like. This would allow settings by a user and allow a user to view data and performance and for transfer to a server for viewing by third parties. The CPAP apparatus could activate (switch on and off) based on detecting patient breath, which would negate the need for a power switch. Alternatively, the apparatus has factory settings that are left as is, such as in an autotitration CPAP apparatus where operation can occur without external user adjustment.
In an example, the patient conduit is approximately 800 to 1000 mm long and/or 15 mm (or anywhere between 10-20 mm) internal diameter although these are exemplary dimensions only.
In an example, the housing is an extended oval shape with dimensions of 110×120×45 mm, but the dimensions can be anywhere between 80-120 mm×80-120 mm×40-60 mm (although these dimensions are exemplary dimensions only).
Preferably the flow generator housing halves are internally lined with a sound deadening material.
The present specification describes HMEs, both adjustable and non-adjustable, with various possible HME materials and material configurations. It also describes the incorporation (either integrated or retro fit) of any of the above HMEs in a patient interface. It also describes a compact CPAP apparatus with adjustable inlet. The embodiments described could be used in any combination.
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