Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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An Apparatus for Oxygenating a Patent
~arm blood cells rely on a continuous and adequate demand-
orientated supply of oxygen so that even brief interruption in
the supply of oxygen can cause irreparable demage in and on the
cells, particularly of the central nervous system and the
cardiac circulatory system.
A shortage of oxygen, hypoxia, can be caused principally by
inadequate supply, disorders of the pulmonary function, dis-
orders in the conveyance of oxygen through the blood or a lack
of haemoglobin and also by disorders in the cardiac circulatory
sy~tem. In emergency medicine as well as in internal clinical
- supply, therefore, it is standard practice to supply oxygen to
a patient. Within the framework of what is referred to as pre-
oxygenation, above all be~ore any intubation, it is vitally
necessary to cover the patient's oxygen demand in the dangerous
period prior to completion of the intubation or in the event of
intubation complications.
In such and other cases, it is vital to enrich the storage space
in the lungs with pure oxygen and at the same time also to
ensure that other gases present in the body or in the inspired
air, above all nitrogen, are as far as possible kept completely
away. In most cases, this is either not achieved at all or is
achieved only very inadequately by conventional pre-oxygenation
methods. Known oxygenation apparatuses are masks, pharyngeal
tubes and nasal-pharyngeal tubes, referred to as just tubes.
The disad~antages of these apparatus, described in the literatu-
re ~e. g. R. G. Sandersen [ed.]: The Cardiac Patient, Philadel-
phia, W. B. Saunders, 1972, pages 310), are above all
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- insufficient humidification and warming of the gaQ,
- oxygen concentration is never 100 %,
- re-inhalation of respired air (CO2- and N2-enrichment),
- leaks in the system (absorption of Nz) and
- a very high oxygen flow.
The problem on which the invention is based therefore resideq in
providing an apparatus for supplying oxygen to a patient
(oxygenation), by means of which, simultaneously witp the
enrichment of oxygen, undesired other gases couldas far as
possible be kept completely out of the pulmonary space.
In addition, it is intended to eliminate the above-mentioned
drawbacks o~ prior art apparatus.
According to the invention, this apparatus of oxygenatlng a
patient is provided with an oxygen applicator for supplying
oxygen via the nose and is characterized in that the oxygen
applicator is so constructed that it supplies pure oxygen in a
directed flow (nasoral) solely via the nose (nasal) and in that
the apparatus additionally comprises a one-way valve adapted to
be inserted at least substantially in sealing-tight fashion into
the mouth ~oral) of the patient and which opens only during gas
outflow, otherwise closing and allowing excess oxygen and
respired air to escape solely through the mouth.
In principle, it is possible with this apparatus to ensure on
the one hand
- a directed ~low, namely a separation of inhalation (100 % 2
via the nose) and exhalation (excess 2~ N2 and C02 via the
oral valve), i. e. a "nasoral" system is achieve, and
- a physiological flow, namely humidification and heating, is
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retained via the nose without $ncrea~ing the dead space and
avoiding any re-inhalation~
This apparatus ensures that if breathing is present or in the
process of ceasing (apnoea) only pure (warmed and humidified)
oxygen can reach the patient's respiratory passages and lungs,
all gases which should be eliminated (nitrogen, laughing gasr
carbon dioxide) are completely (N2, N20) or physiologically (CO2)
dicharged through the oral valve.
Even if the patient is unable to breathe independently, this
apparatus is capable of allowing the patent tG "inhale" only
pure oxygen (referred to as apnoic oxygenation), since the one-
way valve prevents the uncontrolled and undesired penetration of
ambient air and thus large quantities of nitrogen. This functi~
ons for an unlimited period. As soon as respiration cease~,
intentionally (for untubation) or unintentionally ~an emergen-
CY) t the oral valve can be removed if it is ensured that excess
oxygen escapes through the mouth. In this situation, thereapeu-
tic measures can be undertaken via the mouth (e. g. vacuum
extraction, intubation, haemostasis), but also diagnostlc
measures are possible (e. g. bronchoscopy, laryngoscopy).
Doctor, nurse or auxiliary also have both hands free for any
necessary routine or acutely desired measure such as for example
in an emergency the setting up of instruments for artificial
respiration and the corresponding drugs or also the provision of
a peripherovenous access for the administration of life saving
or also anaesthesiologically vital medicaments or blood or blood
substitutes. Also, doctor, lay helper or auxiliary will have
both hands free for resuscitation measures such as for example
extrathoracic cadiac massage, defibrillation, injections or
infusions. A further advantage of the apparatus resides in the
fact that it even allows a lay person significantly and w$thout
risk to increase the existing supply of oxygen which is minimal
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under normal conditions, which i of great benefit over the
entire range of extraclinical and intraclinical patent care for
daily routine work. Assitance on the part of the patient is
unnecessary. Thus, the apparatus can be advantageously used in
cases of hypoxia of varying origin or for pre-oxygenation prior
to intubation. With these cases, the apparatus according to the
invention will a priori reduce the overall risk which exists
especially by reason of possible obstacles to intubation.
The same apparatus can be used universally, namely both in
emergency medicine (patient conscious or unconscious, breathing
present or faltering) and also in anaesthesiology (pre-operati-
ve: pre~oxygenation, post-operative: recovery room), in intensi-
ve care (weaning of respirator), in otorhinolaryngology (laryn-
goscopy), in pulmology (bronchoscopy) and in dental, oral and
maxillary treatment (oral surgery).
An essential feature of the apparatus according to the inventlon
is that the introduction of the oxygen takes place ~olely ~ia
the noseO Oxygen overflow and exhalation pass through the mouth
which is prevented from drawing in air by the one-way valve.
The oxygen applicator can be constructed in various ways and its
supply part can for example take the form of a nasal catheter.
Expediently, however, an oxygen applicator in the form o~ a mask
will be used, the mask covering only the nose. Preferably, this
mask is so constructed that it can be placed over the no~e in a
sub~tantially sealing-tight manner.
In per se known manner, the oxygen applicator can be connected
to an oxygen bag interposed between the oxygen source and the
oxygen applicator, allowing the inhalation proce~s to be
observed. In addition to or instead of the oxygen bag, an
acoustic or visual signal may be provided on the oxygen ap-
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plicator and/or on the one-way valve, to be triggered when the
desired inhalation or exhalation takeq place or when gas is
flowing in or out.
In order to guarantee a unique ~innerhospital and prehospital)
application of the oxygen bag the setting as described below
should be followed: The oxygen bag connected to the oxygen tube
2 of the oxygen applicator 1 comprises a 22 mm 0 connection
~DIN-ISO 5356 part I) allowing for direct connection to both the
oxygen applicator 1 as well as to any endotracheal intubation
tubes, the comprised 6 and 15 mm 0 connecting combination
additionally allows for both dlrect connection to the central
oxygen supply via the installed ventilationi system (15 mm 0,
DIN-ISO 7228) and, via the integrated 6 mm connector ~IS0 594~1)
to mobile oxygen supply sources (e. g. oxygen cylinders~.
After performance of endotracheal intubation (one-way valvs 3
removed), clamped-sealing and deconnection of the oxygen bag
from the oxygen tube 2, the described setting provides the
posqibility to maintain oxygenation/denitrogenation (mobile
oxygenation, e. g. ~or transport of patient~ from the induction
room to the operation theatre and from operation theatre to the
recovery room or intensive care unit, for any measure of patent
positioning).
As stated abo~e, the one-way valve is so constructed that it can
be inserted in substantially sealing-tight manner into the
patient's mouth. For this purpose, the one~way valve is expe-
diently provided with a flexible sealing plate which is in-
troduced into the patient's mouth in ~ront of the top and bottom
jaws and between them and the lips. It is especially expedient
if there is adjacent to this sealing plate a tubular member
which projects into the pharyngeal space and on which the
patient is able to bite in order to maintain the sealing plate
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in a sealing-tight position.
However, it is of course also possible for the one-way valve to
be sealed in other ways such as ~or example by a possiblv
inflatable rubber balloon which fits tightly in the mouth
opening during inflation.
The two devices which form part of the apparatus according to
the invention, the oxygen applicator and the one-way valve, can
he provided separately from each other, as a set. However, it is
expedient for them to be connected to each other so that the
user, the doctor, the nurse or the auxiliary, always has both
devices available together, ready for use.
The accompanying drawing shows an embodiment of the apparatus
according to the invention diagrammatically and in vertical
section.
The apparatus acccording to the invention consists of the oxygen
applicator 1 and the one-way valve 3. The oxygen applicator
device 1 takes the form of a mask with two sealing lip9 7 and 8
which are applied above and below the nose and allow oxygen to
be supplied solely via the nose. The oxygen applicator 1 is
connected to an oxygen tube 2 which is connected to an oxygen
cylinder, possibly via an oxygen bag.
The one-way valve 3 has a ~lexible sealing plate 5 which can be
inserted in a qubstantially sealing-tight manner between the
lips and jaws (teeth) of the patient. Adjacent to this sealing
plate 5 is a tubular member 6 on which the patient bite In the
widened out front part of the one-way valve which is outside the
mouth, there are the valve members 4 which are so constructed
that they spread apart from one another during exhalation or
during gas outflow, whereas they are otherwise pressed in
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~ealing-tight manner on one another ~for example during the
inhalation process) and prevent the ingress of ambient airO
Under clinical conditions, the denitrogenation as well as the
ventilation of the patient can be controlled by endexpiratory
gas sampling using either mass spectrometry (2~ CO2, M2) or
capnometry (2~ C2) For this occasion the one-way valve 3
comprises a special and closable gas outlet 9 allowing for the
connection of the respective analysing system (ISO 594/1) and
thus for continuous gas sampling ~side stream).
