The present invention generally relates to wound care. More particularly, this invention relates to storage and delivery devices for the application of a therapeutic gas or a mixture of gases to a wound.
Therapeutic gases may be used to treat wounds or other conditions, including acute wounds, chronic wounds, pressure ulcers, and diabetic foot ulcers. For example, a dressing may be applied to a chronic wound to form an airtight seal, and a supply of therapy gas may be connected via a tube to the dressing to blanket the wound with the therapy gas. Transdermal oxygen therapy may accelerate wound healing by various mechanisms including: energizing ischemic cells to stimulate the natural healing process and promoting the production of collagen, granulation tissue, new blood vessels and skin. Ozone (O3) therapy may be administered for the treatment of diabetic foot ulcers and other disorders. Nitric oxide (NO), carbon dioxide (CO), and hydrogen sulfide (H2S) also may be useful for the topical treatment of wounds, conditions, or disorders. A need exists for new therapeutic gas storage and delivery devices and systems that may improve patient outcomes and expand access to patients with limited mobility or clinical support.
Hence, the present invention is directed to a mobile system for the application of transdermal oxygen, other therapeutic gases, or mixtures thereof to a wound. A mobile system for therapeutically delivering pressurized therapy gas to a wound may include an inflatable structure for creating a sealed cavity around the wound. The inflatable structure may include a flexible container for receiving pressurized gas. The flexible container may include an interior chamber for containing pressurized gas, and an opening in the interior chamber for receiving pressurized gas. The flexible container further may include a wound-facing surface which includes a dimple, and an aperture within the dimple. A first lumen may fluidly connect to the aperture for delivering pressurized therapy gas to the aperture, and a second lumen may fluidly connect to the opening for delivering pressurized gas to the interior chamber. A first pump may include a first intake port fluidly connected to a first reservoir of therapy gas at a first pressure, and a first discharge port fluidly connected to the first lumen for supplying therapy gas from the first reservoir at a second pressure that is greater than the first pressure. A second pump may include a second intake port fluidly connected to a second reservoir of gas at a third pressure, and a second discharge port fluidly connected to the second lumen for supplying pressurized gas from the second reservoir at a fourth pressure that is greater than the third pressure. The mobile system may include a plurality of operable configurations. In a first operable configuration, the interior chamber may contain a first volume of gas from the second reservoir at the third pressure, and in a second operable configuration, the interior chamber contains a second volume of gas from the second reservoir at the fourth pressure. In the second operable configuration, the first discharge port may supply therapy gas from the first reservoir to the aperture at the second pressure to treat the wound.
In the accompanying drawings, which form a part of the specification and are to be read in conjunction therewith and in which like reference numerals (or designations) are used to indicate like parts in the various views:
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Additionally, the gas storage tank 22 may be disposable. The gas storage tank may be sized for portability and weight, the desired delivery pressure near the wound site, clinical needs and/or a prescribed treatment duration. For example, the gas storage tank may be a pressure cylinder capable of supplying therapy gas continuously for 7-10 days at a service pressure of at least 1.5 psig.
In use, the system 14 may be used to deliver therapy gas for wound treatment. The therapy gas may include oxygen, ozone, chlorine dioxide, nitrogen, nitric oxide, medical grade air, or a mixture thereof to the wound bed. For example, one therapy gas may be a gaseous mixture of 1% (by mass) nitric oxide (NO) and 99% (by mass) nitrogen (N2). In this example, nitric oxide may be considered a therapeutic agent and nitrogen may be considered a carrier gas.
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Accordingly, the portable therapy gas storage and delivery assembly 14 may be selectively adjusted to supply therapy gas continuously (at a constant or variable rate of flow) for up to 7-10 days at a desired regulator output pressure and/or flow rate. For example, preliminary test results indicate that a minimum pressure of 5 psig may be required to effectively kill bacteria in a chronic wound that is undergoing continuous transdermal gas therapy. In one therapeutic configuration, the regulator may be set to deliver a therapy gas at a substantially constant rate of flow (e.g., 3.3 mL/hr) while maintaining a steady output pressure of at least 5 psig for approximately 7 days. The therapy gas may be a mixture of medical grade air and nitric oxide. The nitric oxide may be 1% (by mass) of the gas mixture when measured at standard temperature and pressure. The regulator output pressure may be set to maintain a steady output pressure of approximately 5 psig. Nevertheless, the therapeutic configuration may be modified, adjusted, or optimized based on one or more considerations or factors that may include, without limitation, the composition of the therapy gas, the altitude of the treatment location, the clinical objective of the treatment, and the efficacy of trial therapies studied in a laboratory and/or clinical setting.
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The mechanical pump 40 may be a miniature diaphragm pump which may be driven by a DC motor. At standard conditions, the pump may operate over a pressure range of approximately 0 kPa to 165 kPa and a vacuum range of approximately 0 mmHg to 500 mmHg absolute. The maximum unrestricted flow of the pump may be approximately 2.5 liters per minute (LPM). Operation of the mechanical pump may be controlled via pulse width modulation of the DC motor. One commercially available pump which may be suitable for this application is a 2.5 LPM CTS Micro Diaphragm Pump manufactured by Parker Hannifin Corporation. Although a diaphragm pump may be used to inflate the wound dressing 36, any suitable fluid delivery system (e.g., a spring loaded piston) may be used to pressurize the inflatable structure 38 provided that the inflatable structure securely positions the therapy gas discharge structure (e.g., the aperture) proximate the wound and creates a gas tight seal between the edge of the dimple and the abutting surface (e.g., tissue, gasket material, sealant).
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The wound dressing 36 further may include a gasket 48 and sealing materials which may be placed in direct contact with skin adjacent to the wound to create a sealed chamber about the wound. For example, a gasket material 48 formed from silicone may be cut by a caregiver to fit the wound site. The silicone material may include a metal foil coating.
Additionally, the gasket material 48 may include an adhesive surface to seal the gasket to the patient's skin in an effort to prevent leaks from developing between the wound dressing and the patient's skin. Additional adhesives or sealants may be used to isolate the cavity. The inflatable structure 38 and any gasket materials and sealants used to create the sealed cavity about the wound may be compatible with skin contact. The sealed cavity then may be filled with therapy gas to provide an atmosphere of therapy gas proximate the wound.
The inflatable structure 38 may be shaped for a particular anatomy to help secure the dimple 44 about the wound. In one embodiment, the inflatable structure 38 may be rectangular in shape, and the therapy gas discharge site 46 may be located in the middle of the rectangular shape. The inflatable structure 38 may be draped over the wound and inflated to create a sealed cavity about the wound. Using an inflatable structure (e.g., a bladder) 38 to create a sealed cavity about the wound may distribute compressive forces applied to the patient by the dressing 36. This may prevent concentrated forces from being applied to the patient. The inflatable structure 38 may be connected to a mechanical pump 40 via a conduit 50, such as flexible tubing 26. The pump 40 may be a hand pump, a spring loaded piston, an electrically operated mechanical pump, or other suitable pump provided the pump supplies sufficient fluid flow rates and discharge pressure to expand the inflatable structure 38 and achieve a sealed cavity about the wound. Components of the apparatus 10 may be contained in a housing 52 which may be secured to the wound dressing.
The wound dressing 36 may include a cuff 54 or similar garment to secure the inflatable structure 38 to the patient. In one embodiment, the cuff 54 or other garment wraps around the inflatable structure 38 to fix the inflatable structure with respect to the wound. The cuff may be secured, for example, by one or more straps or a plurality of hook and latch structures (e.g., Velcro strips).
The treatment system 10 further may include a control circuit 56 for regulating operation of the gas storage and delivery apparatus 14 and the pressurized dressing delivery apparatus 16. The treatment system 10 may include a power supply 21 for supplying electricity to the air pump 40 and the control circuit 56. The control circuit may monitor process variables from the gas storage and delivery apparatus 14, the pressurized dressing and delivery apparatus 16, the user interface 20, and the power supply 21. The control circuit 56 may include a microprocessor and memory, an application specific integrated circuit (ASIC), and/or a microcontroller 58 that is in electrical communication with other components and sensors in order to regulate operation of the treatment system 10. For example, the control circuit 56 may monitor and analyze the therapy gas flow rate and discharge pressure from the therapy gas storage tank to regulate operation of the mechanical pump.
Additionally, the control circuit 56 may monitor and analyze the therapy gas delivery pressure and flow rate between the pressure regulator 26 and the therapy gas discharge structure 46. Also, the control circuit 56 may monitor and analyze the fluid pressure in the inflatable structure 38, as well as operating parameters of the air pump 40. The control circuit 56 further may include a user interface 20 for powering the system on and off, as well as announcing the operational state of each process apparatus 14, 16. For example, the user interface 20 may include a power button and a display 20.
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Based on sensor data signals for monitored process variables, the control circuit 56 may regulate operation of the system 10. For example, the control circuit 56 may monitor the pressure of the inflatable structure 38 and control operation of the air pump 40 to maintain a desired pressure. Similarly, the control circuit 56 may monitor the pressure and discharge rate of therapy gas exiting the storage tank 22 and the pressure and discharge rate of therapy gas exiting the pressure regulator 26 to track and assess system performance. The control circuit 56 may be configured to generate audible or visual alarm based on high and low pressure measurements, differential pressure measurements, and therapy gas flow rates.
The control circuit 56 may be configured to implement prescribed functions. For example, without limitation, the control circuit 56 may be configured to report on elapsed treatment time, perform a purge of therapy gas from the wound dressing, and monitor power supply levels. Other functionality may be programmed or configured into the control circuit components as well. For example, a microcontroller may instruct the system to shut off gas flow from the storage tank 22 in the event that therapy gas is leaking from the cavity 44 at an unacceptable rate. In another example, a microcontroller may be programmed to prevent over-inflation of the inflatable structure 38.
The control circuit 56 further may be implemented to monitor sensor data which report one or more vital signs of the patient undergoing treatment with the device. For example, the inflatable structure 38 may include sensors for measuring skin temperature, pulse rate, respiration rate, or blood pressure. The control circuit 56 may monitor one or more of these vital signs of the patient to provide process control feedback, including safety alarms to prevent harm or excessive discomfort to the patient. For example, the control circuit 56 may instruct the system 10 to turn off or reduce the pressure of the inflatable bladder 38 should a vital sign measurement (e.g., the pulse rate or blood pressure) depart from a target level or range of values.
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The size and configuration of the housing 52 may depend on the nature or location of the wound being treated. Accordingly, the size and configuration of the housing 52 may be determined, in part, by the size and configuration of the gas storage tank 22 and power supply 21. In the disclosed embodiment, the housing 52, cuff 54 and inflatable structure 38 are shown in a mobile device, which may be similar to commercially available wrist-fitting blood pressure monitoring systems.
In use, the gas storage tank 22 may be filled from a high pressure supply of medical grade gas. A shut-off valve 24 on the gas storage tank 22 may be closed, and the regulator 26 of the gas delivery device may be disconnected from the shutoff valve 24. The shut-off valve 24 on the gas storage tank may then be connected to the source of medical grade gas 11. For example, the shut-off valve on the gas storage tank may be connected to a gas cylinder containing USP grade nitric oxide 1% in nitrogen with a supply pressure of approximately 100 psig. The shut-off valve 24 may then be opened to allow the gas storage tank 22 to fill with the therapeutic gas mixture. After the gas storage tank 22 is charged, the shut off valve 24 is closed, the source of medical gas 11 is disconnected from the shut-off valve, and the regulator 26 is reconnected to the shut-off valve. The regulator 26 then may be adjusted to deliver gas at a target delivery pressure. For example, the regulator 26 may be set to reduce the tank discharge pressure from approximately 100 psig to substantially equal to or greater than 5 psig.
The wound area may be prepared by cleaning the wound area and securing a silicone gasket about the wound. The gasket 48 may include an adhesive material on the side facing the patient's skin in order to prevent fugitive emissions of therapy gas from escaping between the skin and the inflatable structure 38. The inflatable structure then may be placed over the wound and gasket 18. Additional sealant may be placed between the silicone gasket 18 and the inflatable structure 38 to prevent fugitive emissions of therapy gas from breaking through the interface of the silicone gasket and the inflatable structure. The cuff then may be placed around the inflatable structure and synched to hold the wound dressing firmly against the patient.
The shut-off valve 24 may be opened to release therapy gas to the wound dressing assembly 36. The therapy gas may fill the cavity formed by the dimple 44 in the inflatable structure 38 and the silicone gasket 18. The control circuit 56 may be powered on, and a microcontroller (or equivalent device(s)) may activate the air pump 40 to inflate the inflatable structure 38. Periodically, as active agent(s) in the therapy gas are consumed and exhausted, the atmosphere in the cavity may be purged to allow fresh therapy gas to recharge the chamber with active agent(s). This may be done manually by a user or automatically under the regulation of the control unit. Purging the cavity may include: closing the shut-off valve 24; opening the bleed valve (or purge valve) 30; allowing the pressure in the cavity to subside; and then opening the shut-off valve 24. Residual active agents in the purge gas (e.g., NO) may be removed by a suitable treatment process. After the exhausted therapy gas is purged and fresh therapy gas is supplied to the cavity, the bleed valve 30 may be closed to seal the apparatus 14 and start another treatment cycle. After treatment has been completed, the control circuit may be powered off, and the disposable components removed from the system 10 and discarded.
The gas storage assembly 14″ may be configured and designed to store therapy gas at pressures lower than the delivery pressure of the therapy gas at the wound site. For example, the gas storage assembly 14″ may be designed to store therapy gas at approximately 1.5 psig. The gas storage assembly 14″ may be designed to supply the mechanical pump and delivery assembly 19 with therapy gas for a target time period. The target time period may correspond with a desired treatment cycle. For example, the therapy gas storage assembly 14″ may be designed to supply the pump and delivery assembly 19 with therapy gas for approximately 7 days.
The pump and delivery assembly 19 may include a mechanical pump 40′ which is fluidly connected to the therapy gas storage assembly 14″. The mechanical pump 40′ may pressurize the therapy gas from the storage assembly to provide a supply of therapy gas to the dressing 36 and wound headspace (at a constant or variable rate of flow) at a higher pressure than the pressure of the therapy gas in the storage assembly. For example, the mechanical pump and delivery system 19 may pressurize the therapy gas from the storage assembly 14′ to supply therapy gas to the wound headspace within the dressing at approximately 5 psig.
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The gas storage tank may be formed from a suitable thermoset material, thermoplastic material, a polymer composition, a fiberglass material or other material. For example, the gas storage tank may be formed from a metal or a metal alloy (e.g., steel, aluminum, or stainless steel). The material further may include a glass fiber or synthetic fiber reinforcing material (e.g., nylon or Kevlar). Additionally, the gas storage tank may be constructed from a combination of materials. For example, the tank may be constructed with a metal liner with full composite overwrap (e.g., aluminum, with a carbon fiber composite). In another example, the tank may be constructed from a polymer (e.g., high-density polyethylene or HDPE) liner with carbon fiber or hybrid carbon/glass fiber composite materials.
The mechanical pump 40′ may deliver therapy gas from the gas storage tank 22′ to a pressure regulator 26′. The pressure regulator 26′ may reduce and regulate the pressure of the therapy gas supplied by the mechanical pump 40′ to deliver and maintain a steady output pressure within the dressing 36 at the wound. For example, the mechanical pump may deliver therapy gas at a substantially constant rate of flow (e.g., 3.3 mL/hr) and at a pressure in excess of 6 psig, and the regulator may reduce or regulate the pressure of the therapy gas supplied by the mechanical pump to maintain a steady output pressure of approximately 5 psig.
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The wound dressing 36 further may include a gasket 48 and sealing materials which may be placed in direct contact with skin adjacent to the wound to create a sealed chamber about the wound. For example, a gasket material 48 formed from silicone may be cut by a caregiver to fit the wound site. The silicone material may include a metal foil coating. Additionally, the gasket material may include an adhesive surface to seal the gasket to the patient's skin in an effort to prevent leaks from developing between the wound dressing and the patient's skin. Additional adhesives or sealants may be used to isolate the chamber. Preferably, the inflatable device 38 and any gasket materials 48 and sealants used to create the sealed cavity about the wound may be compatible with skin contact. The sealed cavity may then be filled with therapy gas to topically treat the wound.
The inflatable structure 38 may be shaped for a particular anatomy to help secure the dimple about the wound. In one embodiment, the inflatable structure 38 may be generally rectangular in shape, and the therapy gas discharge site 44 may be located in the middle of the inflatable structure. The inflatable structure may be draped over the wound and inflated to create a tightly sealed chamber. Using an inflatable structure (e.g., a bladder) to create a tightly sealed chamber may distribute compressive forces applied to the patient by the dressing. The inflatable structure may be configured and dimensioned to surround a particular anatomy (e.g., a toe, a foot, an arm, a leg, a torso, and such.) The inflatable structure may be adapted for use in treating dogs, horses or other animals.
Various gases may be administered to a wound in an intermittent, sequential, or combined configuration to address a particular therapeutic goal. For example, nitric oxide may be applied to kill bacteria; and then oxygen may be applied to enhance growth factors and granulation. In another example, ozone may be applied to kill bacteria, followed by the application of oxygen to enhance growth factors and granulation. In yet another example, nitric oxide may be applied to kill bacteria and then nitrogen or carbon dioxide may be administered to enhance angiogenesis.
While it has been illustrated and described what at present are considered to be embodiments of the present invention, it will be understood by those skilled in the art that various changes and modifications may be made, and equivalents may be substituted for elements thereof without departing from the true scope of the invention. For example, a different pump may be used to inflate the inflatable structure or to pressurize a low pressure supply of therapy gas. In another example, the fabric cover may be disposable and thus the cuff may be reusable with one or more replacement fabric covers. Additionally, features and/or elements from any embodiment may be used singly or in combination with other embodiments. Therefore, it is intended that this invention not be limited to the particular embodiments disclosed herein, but that it have the full scope defined by the language of the following claims, and equivalents thereof.
This application claims the benefit of U.S. Provisional Application No. 62/127,743 filed on Mar. 3, 2015, the content of which is incorporated by reference herein in its entirety.
Number | Date | Country | |
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62127743 | Mar 2015 | US |