US2309361A - Respirator - Google Patents

Description

Jan. 26, 1943. I F. H. TERHAAR RESPIRATORS Filed sept. 14, 1940 3 Sheets-Sheet l Jan. 2s, 1943.

F. H. TERHAAR 2,309,361

RESPIRATORS Filed sept. 14, 1940 l 3 sheets-sheet 2 fly 7.

@A7270 r e'ys:

Jan, 26, 1943. F. H. TRHAAR RESPIRATORS Filecfsep'c 14, 1940 a sheets-sheet s Patented Jan. 26, 1943 RESPIRATOR Ferdinand H. Terhaar, Los Angeles, Calif.assign or to Portable Lung, Inc., Los Angeles, Calif., a corporation of California Application September 14, 1940, Serial No. 356,797

(Cl. 12S-30) 1 Claim.

This invention relates to mechanical respirators and to mechanical respiratory systems. This application is a continuation in part of my previous applications, Ser. No. 259,449, iiled March 2, 1939, and Ser. No. 282,948, iiled July 5, 1939. The features of the invention may be broadly summarized by saying that it provides appliances which are simple and light in weight, easily transported and quickly and easily applied; and, when applied, give to the patient the least possible encumbrance against freedom `of movement and normal activity. And my respiratory system also involves a most efficient and highly advantageous action for causing mechanical respiration, together with ventilation for that limited part of the patients body which is enclosed.

I need not name the many cases in which respiration is a major factor, as those cases are well known to the medical profession. In all such cases where mechanical respiration is necesssary, immediate availability and quick application are the initial matters of major concern to the attending physican or institution. The mechanical respirators which have commonly .been used in the past have been cumbrous and complicated, dilicult of transportation, and intricate and time consuming in application to the patient. Most, if `not all of those which have been used, have been in the nature of casings which enclose the Whole body and to which pressure pulsations are applied by a correspondingly heavy and cumbrous pump mechanism.

I understand that casings or jackets have been proposed to enclose only the patients torso, but in those proposals the patient has not been allowed the maximum natural freedom which is desirable, nor has the accompanying respirational system been such as to promote respiration with the desired efliciency, or to give the patients body any desirable ventilation. And in most, if not all, of such proposals, the devices are not capable of being easily and quickly applied.

My invention provides several features of advantage over those which have been previously used or proposed, among which advantages I may mention those which I have indicated `before, and particularly those of cheapness, simplicity, and light weight and the consequent immediate availability for instant use; the natural freedom which is allowed the patient to carry on normal modes `of life; the provision of an improved and highly eicient respirational system; and the elimination of certain disadvantageous features of all prior systems, such as lack of ventilation, and binding and constriction of the enclosed portions of the patients body. Further `objects of the invention, andthe corresponding accomplishmentsl and advantages, will appear.

The invention will be best understood from `the following detailed description of preferred and illustrative forms which are illustrated in the accompanying drawings. The invention includes two major portions, the jacket and its appurtenances which enclose the upper portion of the patients body, the pulsating mechanism which applies pressure pulsations to the jacket, and it also includes certain cooperative actions between the pulsating mechanism and the jacket and appurtenances, as will be described. In the drawmgs:

Fig. l'is a front View of the jacket with certain of its appurtenances attached;

Fig. 2 is a section on line 2 2 of Fig. 1 showing the waist band attached, b-ut Without the neck band;

Fig. 3 is a half plan View of the jacket;

Fig. 4 is a developed View of the waist band;

Fig. 5 is an enlarged detail taken as indicated by lines 5-5 on Figs. 2 and 6;

Fig. 5a is an enlarged detail section taken as indicated by line 5a-5a on Fig. 3

Fig. 6 is an elevation of the parts shown in Fig. 5;

Fig."7 is a front elevation .of the power driven pulsating unit in its case, with the front of the case open;

Fig. 8 is a section on line 8--8 of Fig. 7, with part of the bellows shown in elevation;

Fig. 9 is a plan of the power driven pulsating unit;

Fig. 10 is an` .enlarged sectional detail on line lll-.Ill of Fig. 9; l

Fig. 11 is an enlarged sectional detail on lines II-Il of Fig. 9;

Fig. 12 is an enlarged sectional detail on line |2I2 of Fig. 9;

Fig. 13 is a detail section on line |3-I3 of Fig. 10;

Fig. 14 is an enlarged detail section on Ill- I4 -of Fig. 7;

Fig. 15 is an enlarged detail section on line |5-I5 of Fig. 7; y

Figs. 16 and 17 are respectively `elevation and plan of the detachably and readily applicable hand operating member for the pulsating unit;

Fig. 18 is a plan of the pad which is used interiorly of the metal jacket; and

Fig. 19 is a front elevation showing the jacket, with its appurtenances as applied toa person.

line

openings in the jacket, that is, the waist opening,

the arm openings, and the neck opening. Thefront half is generally designated by the numeral Il and the rear half by the numeral I2. When assembled, the jacket has a neck opening I3, two i arm o-penings I4 and a waist opening I5, each intersected by the parting plane. Where the edges of the halves meet each other they are provided with external flanges I6, these iianges being located at the tops of the shoulder portions and at the lower side portions of the jacket. Dowel pins I'I are provided for registration, and each pair of flanges is provided with a quickly operable clamping device, generally designated as It, and shown in detail in Figs. 5 and 6. As there shown, the clamping device consists of a threaded rod I9 `which is pivoted at 25 to one of the jacket halves at its flange I6. At each clamp the flanges are slotted at 2I to allow the clampingrod I9 tobe raised and lowered, and the outer screwthreaded end of the clamping rod carries a pivoted and screw-threadedly adjustable cam member 22 provided with a handle 23. This type of Vadjustable clamping device is well known and needs no further particular description. It is adopted for my purposes because of its quickness and ease of operation, and the fact that it will hold the jacket halves tightly together. A gasket strip 25 is provided along all the meeting edges of the jacket halves, and preferably cemented or otherwise secured to one of the halves so as always to be in proper place. When the halves are tightly clamped together the gasket strips provide a pressure tight joint. Figs. 5 and 6 show how the gasket strips lie between the flanges I. Fig. 5a shows how these 'gaskets 25 extend along the meetingV edges of the two halves to the extremities of those edges at the points where the edges intersect the jacket openings. Each of the openingsis provided with an external flange or bead 21, and the gaskets have end portions 25a which lie between the meeting edges of the external flanges, as is clearly shown in Fig. 5a. With the gaskets so positioned, 4a pressure tight joint can be effected completely around each of the jacket openings Vbetween the jacket and the beaded inner edge'30 of the elastic band 3| which encircles the part of the patients body protruding through each jacket opening.

Four such elastic bands 3| are provided, one for the neck opening, two for the arm openings, and one vfor the waist opening. Those for the neck andV arms are substantially similar in construction, except for size and length. Each of these three elastic bands is preferably made of thin rubber and of a diameter, in its outer portion, to t the neck or arms snugly but with light constriction. Each of these bands has at its inner end the beaded or otherwise thickened portion of such a 4diameter as to tightly resiliently grip around and behind the flange 21, to make a pressure-tight joint, and each of these bands is of some substantial dimension in lengthwise direction so as t0 extend upwardly along the neck or outwardly along the arm a substantial distance and so as to lie flatly against the neck or arms, as is indicated in Fig. 19. And each of these elastic sealing bands is provided with either one or a pair of elastic ties 32 which may be wrapped around the band 3l under any desired tension. By this means the constricting tension of the sealing band may be adjusted to a nicety, so that the sealing band will then operate in a manner which will be described later.

For simplicity of construction and application, each of the neck and arm bands may be made in tubular form, as they may easily be slipped over the patients head and arms when applying them. They may, however, be made like the waist band, which is preferably made as an ended elastic band adapted to be wrapped around the patients waist. This particular band, which is designated generally as 3Ia, is shown developed in Fig. 4. It has an elastic body piece 35 with a beaded or otherwise thickened portion 36 at its upper edge adapted to iit around and behind the waist flange or bead 2l of the metal jacket. This body portion 35 of the waist band is wrapped around theY patients waist and around bead 2l, pulled to the desired constriction, and then secured in place by a cooperating strap and buckle 3T, 38, which is attached to bead 36, and bythe buckle or snap band 3S which is attached medially, at 40, to band 35. This securing band 39 is also preferably of elastic material and is provided with suitable means, such as a series of snap buttons 4I, for securing its ends together at any selected tension and constriction. The arrangement is such that the band 39 may also have its tension and constriction adjusted to a nicety, for the purpose of the operation later described.

The purpose of the thickening or beading of the sealing band edges is to insure that a tight sealing t be secured at the junctures with the jacket, while at the same time the constrictions on the encircled body portions are or may be very light. The body encircling tensions may then be adjustably increased to just the desired constrictions. Y

Within the jacket I provide a pad which has a body portion 46 of a suitable length and width to occupy substantially the entire interior back surface of the jacket, or the interior forward surface, or either side surface. The pad is loose and not attached tothe metal jacket in any permanent fashion. It has a neck opening 4I and two extensions G3 which extend at opposite sides of the neck opening, s0 that these extensions 48 may lie over the patients shoulders to provide shoulder pads for the support of the jacket when the patient is erect or reclining. Such positions of the shoulder extensions are shown in Fig. A2. The pad also has cut-away edges 5G to accommodate the patients arms and to allow ample freedom of arm and shoulder movement. And in connection with arm and shoulder freedom, I draw attention to the fact that the upper shoulder portions of the jacket, indicated by the lines S in Fig. l, extend outwardly at very slight slopel and preferably inv straight lines. Also the arm openings at I4, and the accompanying arm opening flanges 21, are made amply large, are located as close as may be to the side of the body of the jacket, and are located nearly in vertical planes. These arrangements provide that the jacket, via the pad 45, rests on the patients shoulders at areas fairly close to the neck, leavingthe shoulder proper, and the arms, free for movement. Fig. 5a shows more clearly how the arm opening islocated very close to the side of the jacket, allowing'only sufficient space between flange 21 and Vthe wall of the jacket for the insertion of the elastic bead 3%. Also Fig. 5a shows how the viianges l are terminated vjust short of flanges 21 so as not to interfere with the proper and pressure-tight applicatio-n of the elastic beads 3i).

The whole interior oi the metal jacket is smooth surfaced without any rib or other pro- 4tuberances and is formed in its various portions to t the body surface evenly so that the patient can lie comfortably in any position. At the same time 'the jacket is made considerably larger than the size of patient for which it is designed so that the patient is in no manner restricted or constricted. Two or three different sizes are provided for the whole range of patient sizes.

Pad 45 is preferably made oi some suitable and relatively soft fabric and padding material, and is quilted so as to provide definitely formed series of transverse and longitudinal grooves 55 for purposes of ventilation of the patients body. rThis provision for ventilation, as well as certain provisions of the body engaging bands for the same purpose, is one of the features of my invention. i

Front half I i of the jacket is provided with an opening 5@ which may be described as being generally oi key-hole shape and adapted detachably to take a fitting 5l on the end of air hose 58. Fitting 5"! is sho-wn more particularly in Fig. '7. It

has two securing lugs 59 adapted to pass through the key-hole opening 5E in one position, and then rotation of the fitting through a quarter turn throws the lugs behind the inner Surface of the jacket wall and holds the fitting tightly against the jacket. While fittings of this type are well known, it is used here because of its ease and quickness of application.

The other end of hose 58 connects with the portable pulsating unit which will now be described. This unit is preferably mounted in a convenient carrying case 5S, in which the hose 58 may be conveniently carried in the front cover 6 I. The mechanism of the pulsating unit includes a bellows 62 and a driving mechanism of such type that the bellows may be driven either by power or, in an emergency, by hand.

Bellows 62 is preferably constructed with two cfrcular end plates 93, the upper one of which is secured to the upper wall of case 6B. Over these two end plates, and secured thereto by clamping bands 64, I utilize a flexible bellows body 65 of a suitable air tight fabric. Around the center of the tubular fabric G5 I place a resilient constricting ring 66, which might be of rubber but is more preferably in the form of a coiled spring. 'Ihe function of this spring is to cause the tubular fabric 65 always to collapse inwardly, as shown in Figs. 7 and 8. By causing the fabric always to collapse and bend in the same direction its life is much prolonged, and the minimum capacity of the bellows, on each compression stroke, is caused to be uniform. The lower bellows disk 63 has a downwardly extending connecting rod 61 which connects at 63 with a crank 69 driven from motor 10. Motor shaft il carries a drive pulley which is made up of two conically faced pulley flanges 12 and 13. Pulley harige 'i2 is fixed to shaft 1| while flange i3 is splined to the shaft and is pressed toward flange T2 by spring 14. Motor 'IU is mounted on a base 'i5 pivoted at 15a at one end. The motor is mounted near the other end of the base and the base has a rubber or felt bumper 'iE which is `supported ona transversely movable'wedge lT|(see'1ig. 14). 'The wedge'is movable by a screw 18 operated by hand wheel 19. Adjustment'of Ywedge moves the lefthand end (Fig. "1) of motor base 'l5 up and down about pivot 1B; and thus moves the motor shaft toward or away from transmission shaft 8i?. Transmission shaft' carries a belt wheel 8| and belt 82 runs over 4that belt wheel and the pulley on the motor shaft. The belt being of fixed length, the movement of motor Hl to and from belt wheel 8| causes the pulley anges i2 and 'F3 to move toward or away from each other to change the effective size of the motor pulley and thus to change the ratio of the speed reduction of the motor drive. Belt wheel 8l drives a speed reduction mechanism contained in casing 83 from which cranklis driven. The range fof adjustable speed reduction is such that the bellows may bequickly'adjusted to any desirable or necessary respirational speed which any patient may require, the medium speed being about lll pulsations a minute.

Incase of current failure or any other emergency'making it temporarily impossible to drive the bellows Yby power,the hand operating lever is provided. The inner perforated end Vof this lever S5 is easily and quickly connectible atthe pin 86 `with'a central part of connecting rod 6l; and the lever has a pivot pin 3'. adapted to be `placed in a suitable hook-shaped fulcrum support 33 which Ais conveniently mounted on the upper part of the gear reduction case 83. The hand operating lever is'thus quickly and easily applied and may be used for driving the lbellows by hand after the connection of the connecting rod 61 with the crank at 68 has been released. A slot 39 in case Si) provides that the handle end of the lever protrudes to a convenient position outside ,the case.

The fixed upper bellows plate 63 is provided with a manually adjustable valve 9S to` provide an adjustable restricted communication with atmosphere on both the compression and expansion strokes of the bellows. Preferably this valveis in the form of a disk Qi mounted on a screw-threaded valve rod 92 and adapted to be moved to and from a seat on the upper face of plate 63 by turning the hand wheel or knob 93 which is located above the upper wall of case 60. rlhe screw-threaded valve stem 92 is threaded into a boss or web 94 which crosses the valve opening 95- in plate 53. Screens or strainers 96 of metal or fabric are also provided to prevent entry of any objectionable foreign matter, insects or the like, into the bellows; the screens also act to suppress whistling noises when the bellows is operating.

The bellows also carries a pressure gage |00, the mounting of which is shown in detail in Fig. 12. Pressure gages of the type here shown are well known and need no description. The mounting includes a clamp ring |62 and a cylindric ring |03 which, through bolts |05, attach the pressure gage to the inner face of upper bellows plate 63 so that the gage is directly exposed to the pressure within the bellows and so that its face may be seen through apertures |06 in plate 63 and the upper wall of casing 6e.

The hose connection to the bellows comprises` a nipple |95 which extends upward from bellows plate 63 through the top of casing ed and into which the end of hose 5S may be easily and quickly slipped. The end of `the hose has a resilient expander 58a to cause itto make a tight fit in nipple |05.

"It`is one ofthe features of my complete apparatus that it is of comparatively light weight and capable of being packed into small compass `for transportation. The pulsating unit is comthat the patient is recumbent, he may be lifted and the rear half of the jacket placed beneath him. The fact that the jacket is divided into rear and front halves on a transverse parting plane makes it unnecessary to pass any portion of .the patients anatomy through any opening in order tov apply the jacket. The front half of the jacket is then applied to the rear haif and quickly clamped in place. The neck and arm rubbers are then slipped into place and resiliently tied with the rubber ties to the tightness desired. The waist band is slipped under the patients waist and secured at the desired tightness as has been previously described. The hose is connected and the complete apparatus is then ready for immediate operation either by power or by hand.

One of the major features of advantage of my apparatus and system resides in its provisions for obtaining not only proper respirational speed for any patient but also for obtaining the proper degree of pressure changes, and the interior ventilation which is highly desirable particularly if a patient is to be confined for any length of time. I have described how the speed may be adjustably varied to suit the patient. With the pressure control valve 90 in any given position it will be immediately understood how, upon reciprocation of the bellows, a subatmospheric pressure is obtained in the bellows and in the connected jacket when the bellows expands; and how a positive pressure above atmosphere is obtained when the lbellows contracts. Assuming that no air escapes from or leaks into the whole system except through the control valve El!) the alternating plus and minus pressures (with reference to atmosphere) will be equal. It is desirable however that the plus pressure pulsation be, if anything, less than the minus pressure pusation, so that the general effect is to keep the patients lungs relatively expanded rather than relatively contracted. I accomplish that end, and also the highly desirable ventilation, by providing the rubber sealing bands in such conformation, and adjusting them so, as to act as valves to allow escape oi some air at each positive pressure pulsation. I have stated that the several rubber bands are-relatively long so that they lie f ment of control valve 90 to give the desired bellows pressures, each positive pressure pulsation will lift the resilient sealing bands with the result that a small amount of air escapes under the bands on each positive pressure pulsatlon. Thus,

von each positive pulsation, a small amount of the air, and a corresponding fraction of the positive pressure, .escape under the sealing bands. This serves the double purpose of relieving some of the positive pressure and making it lower than it otherwise would be, and causing a slow movement of air from the centrally connected hose, through the jacket and out through its several openings to thoroughly v entilateA all parts of the patients .enclosed torso. And the rib-bed pad allows that moving air to eXtend the eects of ventilation to those parts of the body which may be resting on the pad. And further, the ventilation action has the effect of periodically lifting the sealing 'bands from the patients skin, ventilating those portions of the skin which would otherwise have their pores constantly sealed by the rub-ber band; and also has a gentle massaging eect.

On each negative pressure pulsation the several sealing ybands act like check valves, resuming Contact with the'patients body and preventing entry of air directly from atmosphere. As a consequence ci the whole mode of operation which I have described, the negative pressure on each pulsation is somewhat greater than the positive pressure; and on each negative pulsation of the bellows suicient air enters the bellows through valve 9E! to take the place of that which has been driven out on the preceding positive pulsation. Due to the open atmospheric communication, allowing the bellows to take in air on each suction stroke, the action of the bellows is self equalizing, tending at all times to keep the range of pulsating pressures balanced about atmospheric pressure. The total range may be varied widely, from about 2 millimeters (of mercury) to as much as twenty millimeters.

I have mentioned that my apparatus and system are capable, of use in any situation in which the patient may be, allowing great freedoms. It also allows great freedoms for other operations on or treatments of the patient. For instance, one of its important uses is in connection with an artificial fever machine, where patients are liab-le to respiratory difficulties and occasional failure. My respiration jacket may be readily applied to a patient in the chamber of a fever therapy machine, with the connecting hose extending through the wall of the chamber at the neck opening or other place. In fact the respiratory jacket may be more or less permanently mounted in the fever therapy machine chamber, to make a combination fever and mechanical respiration machine.

I have said that they jacket is composed of some suitable rigid material. That material may be electrically non-conductive, such as various available plastics; allowing direct electrical treatment of the patients body. And a transparent plastic may be used to facilitate observation if desired,

I claim: f

In a mechanical respirator system which-in cludes a pulsator pump adapted to raise alternately positive Vand negative pressure pulsations with reference to atmospheric pressure and which also includes a jacket adapted to enclose a patients chest and having openings adapted to pass the patients neck, arms and waist, said jacket being in pressure communication with said pulsator pump, the improvements which comprise, in combination: a restricted air intake passageway opening inside said respirator system and through which predetermined quantities of atmospheric air are drawn in during negative pressure pulsations, a resilient sealing band making a, sealed joint with the jacket around at least one of said jacket openings, ex-

tending from said opening along the protruding body portion and encircling that body portion, and means for adjustably constricting said sealing band about the surrounded body portions to

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