Patent Grant
11364358
Patients with respiratory ailments may be treated with respiratory assist devices that deliver supplemental breathing gas to a patient. In some instances, respiratory assist devices may be used for high flow therapy (“HFT”). During HFT, a high flow rate of breathing gas (typically 8 liters per minute (“LPM”) or greater) is delivered to a patient via a nasal cannula to increase a patient's fraction of inspired oxygen (FiO2), while simultaneously decreasing a patient's work of breathing. Additionally, some HFT devices may heat and humidify the delivered breathing gas to reduce patient discomfort.
Patients using respiratory assist devices may also benefit from administration of nebulized medications. Nebulizers allow aerosolized liquid and powder respiratory medications, such as bronchodilators (e.g., Albuterol (Ventolin®), Salbutamol (Proventil®), Levosalbutamol/Levalbuterol (Xopenex®)) for treating asthma or Chronic Obstructive Pulmonary Disease (“COPD”) to be administered through inhalation directly into a patient's lungs. Nebulizers may be connected to respiratory assist devices to supply nebulized medication together with supplemental breathing gas. Such systems can allow a patient to receive the medication without stopping use of a respiratory assist device.
In some cases, a combination of nebulized medication and HFT can be used to assist patients experiencing respiratory distress and provide a comfortable and effective management of cardiopulmonary conditions. A challenge associated with delivering nebulized medication via a high-flow system is the condensation of moisture from the mixture of heated and humidified breathing gas and nebulized medication. Condensation in a ventilation circuit presents both clinical and mechanical challenges, as the condensate can build up to limit flow through the system and also collect and stagnate, which presents a biologic hazard to the patient.
Disclosed herein are systems, methods, and devices for nasal cannulas allowing simultaneous delivery of breathing gas and aerosolized (e.g., nebulized) medicament to a patient's nares during respiratory therapy. Utilizing separate flow paths and separate cannula outlets for the heated and humidified breathing gas and for the aerosolized medicament, these systems, methods, and devices reduce condensation of the aerosolized medicament by delaying mixing of the flow of aerosolized medicament and the flow of heated and humidified breathing gas until the flows exit the cannula. The heated and humidified breathing gas may mix with the aerosolized medicament within the nares of a patient or proximal to the nares of a patient after exiting the cannula. For example, by delaying the mixing of the flows, these systems, methods, and devices prevent a drop in the temperature of the heated and humidified breathing gas as the heated and humidified breathing gas flows through the respiratory therapy system. By preventing this temperature drop, condensation of the humidity from the breathing gas is reduced or avoided. Since nebulized medicament tends to condense together with condensed moisture in the heated and humidified breathing gas, preventing the condensation in the breathing gas also prevents condensation and subsequent waste of the nebulized medicament. Thus, by delaying the mixing of the flows, these systems, methods, and devices increase the overall efficiency of medicament delivery by reducing the condensate that can build up to limit flow through the system and also collect and stagnate, which presents a biologic hazard to the patient.
Furthermore, the systems provide a non-intrusive, low profile interface without sacrificing the efficiency of the medicament delivery. For example, instead of physically coupling the nebulizer directly to a facepiece of a nasal cannula, the systems, methods, and devices allow the nebulizer to be moved away from the patient (e.g., >20 cm, >40 cm, >60 cm, >80 cm, >1 m, >3 m away). This separation (i) allows a caregiver to interact with the nebulizer (e.g., change or refill medication, power the nebulizer on or off, or change the settings of the nebulizer) without having to reach uncomfortably close to the patient's face; (ii) affords the patient a greater range of activities during therapy (e.g., eating or drinking); and (iii) reduces the amount of noise from the nebulizer that reaches the patient, thus providing a quieter environment for the patient.
Moreover, providing heated breathing gas in parallel with aerosolized medicament increases the temperature of the gas inhaled by the patient compared to delivery of aerosolized medicament alone (e.g., by 0.5° C., 1° C., 2° C., 5° C., 10° C., or greater). The increase in temperature of the aerosolized medicament brings the temperature of the medicament closer to the patient's temperature before inhalation and decreases the temperature gradient between the patient's nostrils and the incoming flow. This reduces or eliminates a potentially unpleasant cool feeling inside the patient's nostrils, which improves the comfort of the patient during treatment.
In one aspect, a nasal cannula for delivering humidified breathing gas and aerosolized medication includes a first prong with a first outlet, in which the first outlet has a longitudinal axis, and a length along the longitudinal axis. The nasal cannula also includes a second prong with a second outlet. The nasal cannula also includes a first medicament outlet disposed adjacent to the first prong and arranged to pass aerosolized medicament substantially parallel to the longitudinal axis. The nasal cannula also includes a first tube with an inlet for receiving breathing gas, which is in fluid communication with the first and second prongs. The nasal cannula also includes a second tube with an inlet for receiving aerosolized medicament, which is in fluid communication with the first medicament outlet, and in which the first tube is not in fluid communication with the second tube along the length of the second tube.
In certain implementations, the first medicament outlet is offset from the first outlet along the longitudinal axis in order to improve efficiencies. For example, in certain implementations, the first medicament outlet is offset from the first outlet with respect to a direction of breathing gas flow through the first outlet. For example, the first medicament outlet may be upstream from the first outlet with respect to the direction of breathing gas flow through the first outlet. The amount of the offset may vary. For example, the first medicament outlet may be offset by more than about 1 mm and less than about 3 cm along the longitudinal axis. Additionally or alternatively, the arrangement of the first outlet, the second outlet, and the first medicament outlet may vary. For example, in certain implementations, the first medicament outlet is substantially concentric with the first outlet, while in other implementations, the first medicament outlet is not substantially concentric with the first outlet. In certain implementations, the first medicament outlet includes a third prong having a third length. The length of the third prong may vary. For example, the third length may be less than, equal to, or greater than the first length. In some implementations, the third prong extends along the first prong and shares a common border with the first prong. Additionally or alternatively, in some implementations, the nasal cannula may include a plurality of medicament outlets. For example, the nasal cannula may include a second medicament outlet disposed adjacent to the second prong and arranged to pass aerosolized medicament substantially parallel to the longitudinal axis.
In some implementations, the first prong and the second prong extend from a facepiece, which may allow for more intuitive, ergonomic, and direct application of the treatment. For example, the facepiece may be substantially orthogonal to the longitudinal axis and have a first end and a second end opposite, the first end. In some implementations, the first tube is coupled to the first end and the second tube is coupled to the second end. In other implementations, the first tube is coupled to each of the first and second ends. In some implementations the medicament outlet is disposed on the facepiece between the first prong and the second prong.
The dimensions of the first tube and the second tube may vary. For example, in some implementations, the first and/or second tube may have an internal diameter of about 5 mm or more. In other implementations, the first and/or second tube may have an internal diameter of about 10 mm or more. In some implementations, the first and/or second tubes have a length of about 20 cm or more. In some implementations, the first and/or second tubes have an internal volume of about 20 cm3 or greater. In other implementations, the first and/or second tubes have an internal volume of about 70 cm3 or greater.
The cross-sectional areas of the first outlet, second outlet, and medicament outlet may also vary. For example, in certain implementations, the first outlet of the nasal cannula has a first cross-sectional area, and the first medicament outlet has a second cross-sectional area, wherein the second cross-sectional area is less than (or greater than) the first cross-sectional area. For example, the second cross-sectional area may be about one third of the first cross-sectional area or greater. The flow resistance from the second inlet to the first medicament outlet may vary. For example, in some implementations, the flow resistance from the second inlet to the first medicament outlet is less than 1 psi at a flow rate of 1 LPM.
In another aspect, a method for delivering humidified breathing gas and nebulized medication includes passing heated and humidified breathing gas through a first conduit to a first outlet and a second outlet of a nasal cannula, passing an aerosolized medicament through a second conduit to a third outlet, wherein the third outlet is adjacent to the first outlet and aligned substantially parallel to the first outlet, and wherein that the heated and humidified breathing gas mixes with the aerosolized medicament after exiting the nasal cannula. In some implementations, the length of the first and/or second conduit may vary. For example, the first and/or second conduit may have a length of about 10 cm or greater. In some implementations, the second conduit is not in fluid communication with the first conduit along the length of the first conduit. In certain implementations, the third outlet is offset from the first outlet along a longitudinal axis of the first outlet.
In certain implementations, the aerosolized medicament is entrained by the flow of heated and humidified breathing gas out of the first outlet. In some implementations, the heated and humidified breathing gas is passed through the first conduit at a rate of about 8 LPM or greater. In some implementations, the aerosolized medicament is passed through the second conduit at a rate of about 2 LPM or less. In certain implementations, an inlet of the first conduit is adjacent to an inlet of the second conduit.
In another aspect, the respiratory therapy system for delivering humidified breathing gas and nebulized medication includes a nasal cannula and a nebulizer. The nasal cannula includes a first prong having a first outlet and a longitudinal axis; a second prong having a second outlet; a first medicament outlet disposed adjacent to the first prong and arranged to pass aerosolized medicament substantially parallel to the longitudinal axis; a first tube in fluid communication with the first and second prongs; and a second tube having a second length, wherein the first tube is not in fluid communication with the second tube along the length of the first tube. The nebulizer is in fluid communication with the first medicament outlet through the second tube.
In some implementations, the respiratory therapy system further includes a source of pressurized driving gas in fluid communication with the second tube, wherein the source of pressurized driving gas supplies gas that carries the aerosolized medicament to the patient. In certain implementations, the respiratory therapy system also includes a source of heated and humidified breathing gas in fluid communication with the first and second prongs. In certain implementations, the first medicament outlet is offset from the first outlet along the longitudinal axis. In some implementations, the first medicament outlet is substantially concentric with the first outlet.
In some implementations, the respiratory therapy system includes a second medicament outlet disposed adjacent to the second prong and arranged to pass aerosolized medicament substantially parallel to the longitudinal axis. In some implementations, the first prong and the second prong extend from a facepiece, the facepiece being substantially orthogonal to the longitudinal axis and having a first end and a second end opposite the first end. In some implementations, the first tube is coupled to the first end and the second tube is coupled to the second end. In other implementations, the first tube is coupled to each of the first and second ends. In certain implementations, the second tube has an internal diameter of about 5 mm or more. In some implementations, the second tube has a length of about 2 feet or more. In some implementations, the second tube has an internal volume of about 20 cm3 or greater.
Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombination (including multiple dependent combinations and subcombinations), with one or more other features described herein. For example, any of the nasal cannulas described herein having a single medicament outlet may include two medicament outlets (e.g., one for each breathing gas prong). Similarly, any of the nasal cannulas described herein may be implemented with a guiding element such as a hood, a bill, or a groove to facilitate the slipstream effect. Furthermore, while certain implementations are discussed with regard to high flow therapy (“HFT”), it should be noted that the systems, methods, and devices are not necessarily limited to HFT. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented.
The foregoing and other objects and advantages will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:
To provide an overall understanding of the systems, devices, and methods described herein, certain illustrative embodiments will be described. Although the embodiments and features described herein are specifically described for use in connection with a high flow therapy system, it will be understood that all the components and other features outlined below may be combined with one another in any suitable manner and may be adapted and applied to other types of respiratory therapy and respiratory therapy devices, including low flow oxygen therapy, continuous positive airway pressure therapy (CPAP), mechanical ventilation, oxygen masks, Venturi masks, and tracheotomy masks.
The systems, devices and methods described herein provide a nasal cannula that allows simultaneous administration of aerosolized medicament and respiratory therapy. The nasal cannula allows for delivery of both breathing gas and aerosolized medicament by separate flow paths and separate cannula outlets that are not in fluid communication with each other. Separation of the flow of breathing gas and aerosolized medicament is beneficial because it prevents cooling of the humidified gas which could lead to condensation of moisture from the humidified gas. Condensation of the moisture may be undesirable because condensate tends to nucleate around the particles of aerosolized medicament, thus removing the particles from the gas in which they are suspended. Therefore, preventing or reducing condensation by separating the flow of aerosolized medicament and heated and humidified breathing gas prevents or reduces the loss of the aerosolized medicament. Preventing or reducing the loss of aerosolized medicament increases the efficiency of therapy and enables more accurate calculation of the effective dosage of medicament received by the patient during therapy.
The systems, methods, and devices also improve patient comfort by locating the nebulizer and the gas source at a distance from the patient (e.g., 5 ft, 10 ft, 15 ft, 20 ft, or any other suitable length), rather than near or on the patient. This reduces the noise that reaches the patient from the gas source or the nebulizer (e.g., due to gas compressors). Additionally, placement of the nebulizer and gas source at a distance from the patient reduces bulk around the patient, particularly around the patient's face. This placement is enabled by the reduction in condensation achieved by separating the flow paths. Since less condensation occurs, more of the medicament can travel a longer distance through tubing without depositing onto the sides of the tubing.
The length of tubing between the nebulizer and the cannula can also improve delivery of the medicament by providing a hanging volume (i.e., the volume of tubing through which the aerosol travels). The hanging volume stabilizes the aerosol particles by filtering out large aerosol particles which adhere to the interior of the tubing along its length. Filtering out the larger particles can be desirable because large aerosol particles tend to deposit in the patient's upper respiratory tract, which can cause patient discomfort, instead of traveling to the lower airways, where the medicament is typically most effective. Thus, the hanging volume provided by the length of tubing can improve the delivery of medicament by stabilizing the aerosol.
Additionally, providing heated and humidified breathing gas to the patient along with the aerosol can increase patient comfort by counterbalancing the cooling and drying sensations associated with the delivery of aerosol to the nare. This is because the heated and humidified breathing gas warms the aerosolized medicament, causing the patient to feel less of a temperature gradient than when aerosol alone is provided. The heated and humidified breathing gas may also produce a wake or a slipstream that helps direct the aerosolized medicament toward the patient's nare. This can increase the percentage of medication delivered to the point of respiration and decrease the amount of medication which does not enter the nare.
The first prong 102 has a longitudinal axis 106 and a height 108 in the direction of the longitudinal axis 106, and the second prong 110 has a longitudinal axis 109 and a height 111 in the direction of the longitudinal axis 109. The first prong 102 and second prong 110 are oriented so that the flow of heated and humidified breathing gas 152 from each is directed substantially along the longitudinal axes 106 and 109, respectively. The outlet 104 of the first prong 102 has an inner diameter 153, an outer diameter 155, and a cross-sectional area 105. Similarly, the outlet 112 of the second prong 110 has an inner diameter 156, an outer diameter 157, and a cross-sectional area 180. The outer diameters 155 and 157 of the first and second prongs 102 and 110 may be selected so as not to occlude the patient's nare to facilitate exhalation and increase patient comfort. Preferably, the outer diameters 155 and 157 are determined so as to block about 50% of the nare or less (e.g., 40%, 30%, 20%, or less). For example, the prongs 102 and 110 may have an outer diameter of 8 mm or less (e.g., 7 mm, 6 mm, 5 mm, 4 mm, 3 mm, 2 mm). In some implementations, the outer diameter 155 of the first prong 102 is equal to the outer diameter 157 of the second prong 110. In other implementations, the outer diameter 155 of the first prong 102 and the outer diameter 157 of the second prong 110 are different. For example, in certain implementations, the outer diameter 155 of the first prong 102 is decreased to accommodate the placement and size of the medicament outlet 114 so that the combined size of the first prong 102 and third prong 113 do not occlude the patient's nare. Although diameters of the outlets 104 and 112 are discussed, in some implementations, the outlets 104 and 112 have non-circular cross-sections. The first prong 102 and the second prong 110 are separated on the facepiece 120 by a distance 150 selected for patient comfort. Similarly, the heights 108 and 111 of the first prong 104 and second prong 110 are selected so that the prongs 102 and 110 enter the patient's nares without causing discomfort.
The third prong 113 extends alongside of the first prong 102 and shares a common wall 121 (shown in
The cross-sectional area 107 of the medicament outlet 114 is less than the first cross sectional area 105 of the first outlet 104. In certain implementations, the second cross-sectional area 107 is about one third of the first cross-sectional area 105 or greater. This can prevent the flow resistance of aerosolized medicament from being excessively high, which could limit the delivery of aerosol or potentially alter the aerosol characteristics. While the medicament outlet 114 is located dorsal to the first prong 102 in cannula 100, in some implementations, the medicament outlet 114 may be located dorsally to the second prong 110, ventrally to either of the prongs 102 or 110, between the prongs 102 and 110, or in any other acceptable position. Similarly, although the medicament outlet 114 is shown as located on a separate third prong 113, the medicament outlet 114 may also be formed as an opening in the facepiece 120, positioned within the first or second prongs 102 or 110, or positioned in any other acceptable location.
The heated and humidified breathing gas 152 may be delivered through the first tube 116 at a rate of 8 LPM or greater (e.g., 10 LPM, 12 LPM, 14 LPM, 16 LPM, 40 LPM, etc.), while the aerosolized medicament may be delivered at a rate of 2 LPM or less (e.g., 1.5 LPM, 1 LPM, 0.5 LPM). This difference in volume flow rates causes the velocity of humidified breathing gas 182 exiting the first outlet 104 to be significantly higher than the velocity of aerosolized medicament 186 out of the medicament outlet 114. This difference in exit velocities produces a slipstream 188 around the first outlet 104. The slipstream 188 carries the aerosolized medicament 186 into the patient's nare with the humidified breathing gas 182. The use of the slipstream 188 allows the medicament outlet 114 to deliver the aerosolized medicament 186 to the patient's nares without being inserted into the patient's nares. Maintaining the medicament outlet 114 and third prong 113 outside the patient's nares decreases the area of the nares which is occluded, which may improve patient comfort and facilitate exhalation. For this reason, height 134 of the third prong 113 is less than height 108 of the first prong 102, which causes an offset between the medicament outlet 114 and the first outlet 104 along the longitudinal axis 106. The offset between the first outlet 104 and the medicament outlet 114 may be 1 mm, 2 mm, 4 mm, 5 mm, 10 mm, or any suitable distance.
In use, the aerosolized medicament can be provided by a nebulizer (not shown), such as a jet nebulizer or a vibrating mesh nebulizer. The aerosolized medicament may also include corticosteroids, antibiotics, opioid analgesics, or any other type of medicament amendable to respiratory delivery. Once generated, the aerosolized medicament 154 travels a length L2 through the second tube 118. The aerosolized medicament may be driven by a compressed gas through the second tube 118 to the medicament outlet 114. While only one tube (e.g., second tube 118) is shown, the second tube may include two or more tubes connected in series which span the distance between the source of aerosolized medicament and the nasal cannula 100. The second tube 118 has an inner diameter 164 and an outer diameter 166. The inner diameter 164 of the second tube 118 may be 5 mm or more. In some implementations, the inner diameter 164 of the second tube 118 may be 10 mm or more over a portion of its length. The length L2 of the second tube 118 may be 20 cm or more. The flow resistance through the second tube 118 from the second inlet 128 to the medicament outlet 114 is less than 1 psi at a flow rate of 1 LPM (e.g., 0.5 psi, 0.25 psi, or 0.1 psi). In some implementations, the flow rate of aerosolized medicament during operation is 2 LPM or less. In certain implementations, the flow rate may be lower than 1 LPM, such as 0.25, 0.5, or 0.75 LPM.
The internal volume of the second tube 118 along its length L2 functions as a holding chamber and provides a hanging volume for the aerosol. This hanging volume improves the delivery of the aerosolized medicament 154 by filtering out larger aerosol particles which are more likely to adhere to the interior of the second tube 118. This filtering can be beneficial because the larger particles may be unable to travel into the patient's lower airways where the medicament is often needed most. The larger particles can tend to deposit in a patient's upper respiratory tract (e.g., nostrils, mouth, and throat), causing patient discomfort. Thus, the hanging volume provided by the second tube 118 can improve drug delivery by stabilizing the aerosol. In some implementations, the second tube 118 has an internal volume of 20 cm3 or greater. In certain implementations, the second tube 118 has an internal volume of 70 cm3 or greater. After the aerosolized medicament 154 exits the hanging volume of the second tube 118, the aerosolized medicament 154 enters the facepiece 120.
When the aerosolized medicament 154 and the heated and humidified gas 152 enter the facepiece 120, the flows are kept separate by partition 115 (shown in
Additionally, the delivery of the aerosolized medicament 154 and the heated and humidified breathing gas 152 by separate tubes allows a source of the aerosolized medicament 154 (e.g., a nebulizer) to be disconnected without interrupting the delivery of the heated and humidified breathing gas. Unlike systems that use a T or Y adaptor to connect a nebulizer to a respiratory therapy circuit, the cannula 100 involves no junction point between the flow of aerosolized medicament and the flow of breathing gas. Thus, removal of the source of aerosolized medicament does not introduce another opening in the breathing gas circuit. Thus, the source of aerosolized medicament can be simply removed without having to place a plug or cap in its place.
Furthermore, delivering heated and humidified gas 152 together with the aerosolized medicament 154 can increase patient comfort compared to delivering the aerosolized medicament 154 alone. This is because the heated and humidified breathing gas 152 mixes with the aerosolized medicament 154 as both flows exit the cannula 100, thus increasing the temperature of the aerosolized medicament 154. Since the temperature of the mixture is closer to the patient's body temperature compared to the aerosolized medicament alone, the sensation of a temperature gradient in the nare is decreased.
While the nasal cannula 100 of
The first tube 316 is connected to a first end 322 of the facepiece 320 and is in fluid communication with the first and second prongs 302 and 310. Similarly, the second tube 318 is connected to a second end 324 of the facepiece 320 and is also in fluid communication with the first and second prongs 302 and 310. The first and second tubes 316 and 318 deliver heated and humidified gas to the first and second prongs 302 and 310. In parallel, the first tube delivers aerosolized medicament to the medicament outlet 314. Placement of the medicament outlet 314 between the prongs facilitates entrainment and allows aerosolized medicament to be delivered by the slipstream effect into both nares rather than only one. Such a configuration may facilitate the delivery of the aerosolized medicament in the event that a single nare becomes occluded. While two tubes (e.g., first tube 316 and second tube 318) deliver heated and humidified gas in nasal cannula 300, in some implementations, a single tube provides the heated and humidified gas to both the first and second prongs 302. In such implementations, the tube for delivering the aerosolized medicament may extend through the facepiece 320 while remaining separate from the flow of heated and humidified gas, which may flow to the first and second prongs 302 and 310 through the remaining volume inside the facepiece.
The nasal cannula 300 of
While the nasal cannula 500 of
The first tube 616 connects to the facepiece 620 at a first end 622 and provides the heated and humidified gas with a first directionality 661 to the first outlet 604. The second tube 618 connects to the facepiece 620 at a second end 624 and provides heated and humidified breathing gas with a second directionality 663 to the second outlet 612. In some implementations, there is a wall or partition 615 between the first prong 602 and the second prong 610 within the facepiece 620 to prevent turbulent mixing of the humidified air with the first directionality 661 and second directionality 663 before exiting through the outlets (e.g., first outlet 604 and second outlet 612). The third tube 630 is attached to an upper portion 650 of the facepiece 620. In some implementations, the third tube 630 is attached to the facepiece 620 at an end such as the second end 624 next to the connection to the second tube 618 for stability or may attach in any other suitable location. In certain implementations, the heated and humidified gas is provided to the first prong 602 and the second prong 610 by a single tube such that there are only two tubes in use, one carrying heated and humidified gas and the other carrying aerosolized medicament.
In some implementations in which the medicament outlet is formed as a slit in a facepiece rather than as a prong, it may be desirable to include an element to direct the flow of the aerosolized medicament from the medicament outlet into the slipstream produced by the humidified gas. For example,
While the nasal cannula 700 includes a directional element 736 for a medicament outlet formed as a slit, a directional element can also be included in implementations in which the medicament outlet is included in a prong. For example,
While the nasal cannulas 700 and 800 of
While the cannulas 100, 500, and 600 of
While the flow of the humidified gas and the aerosolized medicament are kept separate within the facepiece 120 by a partition 115 in the nasal cannula 100 of
Although the nasal cannulas 100, 500, and 600 of
The location of the medicament outlet 1214 within the first prong 1202 causes some mixing within the first prong 1202 rather than only in the nare external to the cannula after both flows have exited the medicament outlet 1214 and first outlet 1204, respectively. This may increase the temperature of the gas and aerosol mixture when it enters the nare, improving patient comfort. Though the medicament outlet 1214 is shown to be located concentrically within the prong 1202 and upstream from first outlet 1204 for the heated and humidified gas in
While the nasal cannulas 100, 300, 500, 600, 800 and 1100 of
The second tube 1318 connected to the first medicament outlet 1314 provides aerosolized medicament to the first medicament outlet 1314. The first medicament outlet can be detachably affixed at the first connection point 1350 located at the first nasal prong 1302 or at a second connection point 1352 located at the second nasal prong 1310. The first medicament outlet 1314 can be detached from either of the first connection point 1350 and second connection point 1352. The first medicament outlet 1314 can be attached at either of the first connection point 1350 proximal to the first prong 1302 and second connection point 1352 proximal to the second prong 1310 such that the first medicament outlet 1314 delivers aerosolized medicament into the slipstream of the first prong 1302 or the second prong 1310. The first medicament outlet 1314 can be attached at the first connection point 1350 proximal to the first prong 1302 and can be detached from the first connection point 1350 and moved to the second connection point 1352 proximal to the second prong 1310, such that the first medicament outlet 1314 is moved from a first nare to the contralateral nare. The ability to move the first medicament outlet 1314 from the first prong 1302 to a second prong 1310 allows the continued delivery of medicament to a patient if one of the nares is occluded.
In some implementations, the first medicament outlet 1314 is attached at a first connection point 1350 located on a dorsal side of the first prong 1302. In other implementations, the first medicament outlet 1314 is inserted into the first prong 1302, such that the first prong 1302 surrounds the first medicament outlet 1314. In some implementations, the first connection point 1350 is configured as a clasp into which a side of the medicament outlet 1314 is inserted. In other implementations, the first connection point is configured as a restraining strap which is looped around the medicament outlet to restrain it into a position on the facepiece. For example, the strap may be a tape, a Velcro strap or any other suitable strap for restraining the medicament outlet 1314. In some implementations, the medicament outlet 1314 is located on a third prong configured to fit to the shape of the facepiece at either of the first prong 1302 or the second prong 1310, for example using a snap-fit.
The nasal cannulas described above can be incorporated into a respiratory therapy system, such as the illustrative respiratory therapy system 1400 shown in
The respiratory therapy system 1400 also includes a nebulizer unit 1480 which includes a liquid inlet 1486, a liquid reservoir 1482 holding a volume of liquid medicament 1484, an air inlet 1487 for compressed gas to aerosolize the liquid, and a passage 1488 to an outlet 1465 which connects to an inlet 1428 of a second tube 1418. The second tube 1418 supplies the aerosolized medicament to the nasal cannula 1401 along the tubing 1418 having length L2. L1 and L2 may be the same length or different lengths. L1 and L2 may be long enough to locate the gas source 1490 and nebulizer 1480 at a distance from the patient such that the noise associated with the gas source 1490 and nebulizer 1480 is decreased for the patient. L2 may be a large distance (e.g., 5 ft, 10 ft, 15 ft, 20 ft, 30 ft, 40 ft, or any other suitable length) which functions as a hanging volume of aerosolized medicament to stabilize the aerosol and increase efficacy of the medicament delivery to the patient. Large aerosol particles are likely to adhere to the sides of the tube 1418 along the length L2, and are thus less likely to reach the patient. Large aerosol particles often deposit in the upper respiratory tract, causing irritation and discomfort to the patient. Furthermore, these particles often do not reach the lower respiratory tract where the medicament is typically most needed. Thus, the removal of large aerosolized medicament particles results in a more uniform distribution of smaller sized particles which are able to reach the lower respiratory tract of a patient for effective delivery of medicament. Additionally, the second tubing 1418 with length L2 has an inner and outer diameter as shown in
The pressurized and treated breathing gas travels through the first tube 1416 with length L1 to arrive at the nasal cannula 1401. Meanwhile, the aerosolized medicament particles continuously flow from the nebulizer 1480 to the cannula 1401 through the second tube 1418 having length L2. The nasal cannula 1402 includes a facepiece 1420, a first prong 1402, a first outlet 1404, a second prong 1410, a second outlet 1412, a medicament outlet 1414, a first tube 1416, and a second tube 1418. The nasal cannula 1401 may have the features of any of the cannulas described herein or a combination thereof. The nasal cannula 1401 has a facepiece 1420 connected to the first tubing 1416 at a first end 1422 which supplies the breathing gas to the first and second prongs 1402 and 1410. The second tube 1418 having length L2 is connected to the facepiece 1420 at a second end 1424 and supplies aerosolized medicament to the medicament outlet 1414. Supplying aerosolized medicament and breathing gas to the nasal cannula 1401 by two separate lengths of tubing L1 and L2 allows the gas source 1490 and the nebulizer 1480 to be located at a distance from the patient so that the patient is more comfortable without the noise or bulk of these instruments nearby. The separate lengths of tubing 1416 and 1418 keep the aerosolized medicament and the breathing gas separate until mixing in the nare or just prior to entering the nare. The separation of the aerosol and gas decrease incidence of condensation of the humidified gas as it cools. The condensation of the humidified gas can trap aerosolized medicament particles in the condensate. Thus, by preventing the mixing of the humidified gas and aerosol along the flow path, the amount of aerosol delivered to the patient is increased.
In step 1502, heated and humidified breathing gas is passed through a first conduit, such as a length of tubing 1416, to a first outlet and a second outlet of a nasal cannula, such as nasal cannula 100, 300, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300, or 1401. The breathing gas may be supplied to the cannula through a length of tubing L1 from a gas source, such as gas source 1490. Additionally, the tubing may be attached to the facepiece of the nasal cannula, which includes a first prong and a second prong for supplying the breathing gas to the nares of a patient. In such cases, the breathing gas may flow through the tubing into the facepiece and out through the outlets and located on the prongs 1302 and 1410. The rate at which the heated and humidified breathing gas is passed through the first conduit may vary. For example, the heated and humidified breathing gas may pass through the first conduit at a rate of about 8 LPM or greater.
In step 1504, an aerosolized medicament is passed through a second conduit, such as a length of tubing, to a third outlet of the nasal cannula. The rate at which the aerosolized medicament is passed through the second conduit may vary. For example, aerosolized medicament may pass through the second conduit at a rate of about 2 LPM or less. The aerosolized medicament may be delivered from a source, such as a nebulizer, distal from the patient. The aerosolized medicament may then flow through a length of tubing L2 to the facepiece of the nasal cannula. The facepiece may include a wall or partition which keeps the aerosolized medicament separated from the breathing gas. The length of tubing may also attach to the outside of the facepiece. The aerosolized medicament is passed from the tubing to a third outlet which is directed toward a nare of a patient in order to supply medicament to the patient. In some implementations, the second conduit may have a length of about 10 cm or greater. Additionally or alternatively, the third outlet may be adjacent to the first outlet and aligned substantially parallel to the first outlet.
The heated and humidified gas of step 1502 and the aerosolized medicament of step 1504 are not in fluid communication along the length of their respective tubes. The heated and humidified breathing gas mixes with the aerosolized medicament upon exiting the cannula. After exiting, the aerosolized medicament is entrained by the flow of the heated and humidified gas. The medicament outlet may be positioned in order to expel the aerosolized medicament into the slipstream of the high flow heated and humidified gas. The medicament is then borne into the nare by the slipstream effect.
The foregoing is merely illustrative of the principles of the disclosure, and the systems, devices, and methods can be practiced by other than the described embodiments, which are presented for purposes of illustration and not of limitation. It is to be understood that the systems, devices, and methods disclosed herein, while shown for use in high flow therapy systems, may be applied to systems, devices, and methods to be used in other ventilation circuits.
Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombination (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented.
Examples of changes, substitutions, and alterations are ascertainable by one skilled in the art and could be made without departing from the scope of the information disclosed herein. All references cited herein are incorporated by reference in their entirety and made part of this application.
This application claims the benefit of U.S. Provisional Application No. 62/187,095, filed on Jun. 30, 2015, which is hereby incorporated herein by reference in its entirety.
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