CA2086127A1

CA2086127A1 - Automated gas delivery system for blood gas exchange devices

Info

Publication number: CA2086127A1
Application number: CA002086127A
Authority: CA
Inventors: Gaylord L. Berry; Yansong Shan
Original assignee: Individual
Current assignee: Cardiopulmonics Inc
Priority date: 1990-07-03
Filing date: 1991-06-27
Publication date: 1992-01-04
Also published as: JPH06503725A; US5158534A; AU8103891A; WO1992000777A1; EP0537236A4; EP0537236A1

Abstract

A system for delivering oxygen to a gas permeable membrane oxygenator is disclosed. The system may include an integral source of gas (10) under pressure and a source of vacuum (12). A first mass flow controller (106) is connected to the source of gas (10) upsteam in the gas flow from the gas exchange device (14). A pressure valve (112) is positioned in the gas flow between the first mass flow controller (106) and the gas exchange device (14). An atmospheric vent (110) is positioned between the pressure valve (112) and the first mass flow controller (106). A second mass flow controller (128) is positioned downstream from the gas exchange device (14) and is connected to the source of vacuum (12). A central controller (130) commands the pressure valve (112) to maintain the pressure at the inlet of the gas exchange device (14) at a subatmospheric pressure. The second mass flow controller (128) is commanded to maintain a rate of flow which is desired through the gas exchange device (14). The first mass flow controller (106) is commanded to maintain a rate of flow higher than the second mass flow controller (128) to ensure that a sufficient flow of gas is available through the pressure valve (112) and the gas exchange device (14). The excess gas is exhausted through the vent (110). The present invention ensures sufficient gas flow at the gas exchange device (14) to provide transfer of gases with the blood. Also, the pressure of the gas within the gas exchange device (14) is low enough that outgassing through bubbles into the blood is avoided.

Description

~ 9~/G0777 2 ~ ~ 6 ~ 2 ~ PCT/~Sg~

AUTOMATED GAS DELIVE~Y SYSTEM
FOR
BLOOD GAS EXCXANGE DEVICES

BACKGRO ND
1. The Field of the InventionO
The present invention relat:es to methods and apparatus for performing extrapulmonary blood gas exchange wherein blood receives oxygen and releases carbon dioxide. More particularly, the present invention relates to systems used to deliver ventilatory gases to extrapulmonary blood gas exchange devices.
20 The Prior Art.
Thousands of patients in hospitals suffer from inadequate blood gas exchange, which include~ both inadequate blood oxygenation and inadequate removal o~
carbon dioxide (CO2). These conditions are commonly cau~ed by varying degrees of respiratory inadequacy usually associated with ~cute lung illnesses such as pneumoniti~, atelec~asis, fluid in the lung, ox obstruction o~ pulmonary ventilation. ~arious heart and circulatory aliments such a~s heart disease and shock can adversely affect the flow of blood and thereby also reduce the rate of blood gas exchange.~
Currently the most widely used methods of treating these types of blood gas exchang~ inadequacies involve ;
increasing the flow of oxygen through the lungs by either increasing the oxygen concentration of the inspired gas2s or by mechanically ventilating the lungs. Both methods result in placing further strain on the lungs, which may be diseased and unable to function at full capacity. In order to allow disea~sed or injured organs to heal it is generally ~5 ~ :

.: .
~ .

W092/00777 PCT/U~gl/~609 20~6127 2 best to allow these organs a pe:riod of rest followed by a gradual increase in activity.
Various devices have been developed which are capable, at least for a limited period of time, of taking over the gas exchange function of the lungs. Many blood oxygenator~
~re in common use and are employed most frequently during heart surgery. Such commonly available device~ are capable of providing blood oxygenation and carbon dioxide removal sufficient to carry the patient through the surgical procedure but are not intended to provide pulmonary support for more than the hours required to perform the surgery.
These oxygenators include devices which bubble oxygen into the blood as the blood flows through the device. This is usually followed by a portion of the device which removes the bubbles in the blood to make it acceptable for reintroduction into the patient.
Another group of blood oxygenators employ gas permeable membranes. These devices take many different shapes and confi~urations; however, the basic concept of operation is the same in all of these devices. Blood flows on one side of the gas permeable membranes while a ~entilatory gas, i.e., oxygen, flows on the other side o~
the membrane. As the blood ~lows through the device the ~_ oxygen diffuses, on a molecular level, across the gas permeable membrane and enters the blood. Likewise, carbon - dioxide present in the blood di~uses across the gas permeable membrane and enters the gas phase.
Of the available blood oxygenators, thos~
incorporating gas permeable membranes may be best used in long term applications (e.q~, one to seven days~ as a pulmonary assist device for a patient suffering from acute respiratory failure. In the case of cardiopulmonary bypass where all of the patien~'s gas exchange needs must be supplied by the oxygenator, cons~ant attention by a trained ~092/00777 2 ~ 7 PCT/US91/~09 perfusionist is necessary to guard the welfare o~ the patient.
The use of a blood oxygenator as a pulmonary assist device also requires constant vigilance if maximum blood gas transfer is to take place. As will be appreciated, the condition of the patient may change from hour to hour, or minute to minute. Such changes often requixe a change in the operation of a blood oxygenator in order to maintain efficient blood gas transfer. Significantly, some changes in a patient's condition can lead to serious consequences if corresponding changes are not mad~ in the oxygenator's operation. For example, "outgassing," or the forcing of undissolved gas through the membrane into the blood as bubbles where they can form gas emboli, may occur if the blood phase pressure drops dramatically a~d the gas phase pressure at the permeable membrane is allowed to remain above the blood phase pressure.
In general, perfusionists are able to satis~actorily control the operational characteristics a~ blood oxygenators using manual control techniques over the duration of a surgical procsdure lasting many hours with an acceptably law incidence of operator and e~uipment related accidents. It will, however, be appreciated that as the 2~ length o~ time a patient is undergoing pulmonary support increases ~o several days, the likelihood of operator error greatly increases. Furthermore, many o~ the parameter which must be considered in order to maximiæe patient welfar~ are not easily ascertainable using manual techniques. All of these considerations must be addressed when planning ~o use a pulmonary assist device on a long term basis.
In view of the foregoing, it would be an advance in the art to provide a blood oxygenator gas delivery system whlch is sa~er to use than previous available ~entilatory W~9~/00777 P~ 91/~ ~
, f,._~., 2~8~27 4 gas delivery systems and which can be used with a membrane oxygenator to more efficiently transfer oxyge.n to, a~d carbon dioxide from, the blood. It would also be an advance in the art to provide a blood oxygenator gas delivery system wherein the gas phase is always ~aintained at a low enough pressure to ~n~;ure that fsrmation of gas emboli in the blood does not occur and wher~in the flow o~
the gas is precisely and aukomatioally controlled. It would be yet another advance in the axt to provide a blood oxygenator gas delivery system which may be easily set up and operated for long periods of time without constant attention ~rom a technician.

1:~ BRIEF SUMMARY OF THE INVENTION
The present invention is a system for controlled delivery of ventilatory gases which includes means for adjusting the pressure of a ventilatory gas which is delivered to the gas permeable membrane of a blood gas exchange device, such as an extracorporeal or intracorporeal blood gas exchange device. The means for adjusting the pressure of the gas ensures that the pressure of the ventil tory gas pres2nt at the gas permeable membrane is maintained at a pressure which is at least below the central venous pressure of the patient in the case of an intracorporeal gas exchange device and at least below the ambiant atmospheric pressure in the case of an extracorporeal gas exchange device. Preferably/ the gas phase pr~ssure at the gas permeable membrane is maintained below the ambient atmospheric pressure at all times. By keeping the pressure of the gas phase at the gas permeable membrane to such a low value, outgassing and formation of gas e~boli in the patient's blood is aYoided.
Also included in the present invention is a means ~or regulating the mass of the gas flowing to the gas permeable 3~

77 2 0 3 612 7 Pcr/us~l/o~os membrane to ensure that sufficient gas flows through the pulmonary assist device to maintain proper gas transfer.
Importantly, in order to support a patient's meta~olism a minimum amount of carbon dioxide must pass out of the patient's blood and oxygen must pass into the red blood cells. The means ~or regulating the mass o~ the gas flowing to the gas permeable membrane ensures that the gas flow is sufficient to ensure a minimum amount to oxygen is present at the gas permeable membrane and that the gas flow is sufficient to remove the carbon dioxide which passes out of the blood.
By including a means for adjusting the pressure o~ the gas at the gas permeable membrane, safety is assured. By ad~usting the ~as phase pressure at the gas permeable membrane to a value which is at least less than the patient's central venous pressure in the case of an intracorporeal gas exchange device, or preferably less than the ambient atmospheric pressure in the case o~ all gas ex~hange devices, outgassing of oxygen into the blood and the formation of gas emboli is avoided. The formation o~
gas emboli is potentially life threateningO .
While the means for adjusting the pressure of the gas safely provides that outgassing and air emboli are avoided, the means for regulating the mass of the gas flowing to the gas permeable membrane safely ensures that su~ficient oxygen and carbon dioxide trans~er will occur across the gas permeable membrane. Thus, gas exchange is carried out with the greatest safe_y and e~fectivenessO

. . . . . : - : . : ` - . . - . :. ~ - , .. . . . . . . . .

W~92/00777 2 0 ~ 6 1 ~ 7 PC~/USgl/O~Og BRIEF DESCRIPTION OF THE DRAWINGS
Figure 1 is a block diagram of a presently pre~erred embodiment of the gas delivery system for blood oxygenators of the present invention.
Figures 2A-2B are a ~low chart showing the steps carried out by the system represented in Figure 1.
Figure 3 is a diagram showing another apparatus which may be used to carry out the method of the present invention.
Figures 4A-4F are detailed schematic circuit diagrams of one presently preferred implementation of the central controller portion of the system represented in Figuxe 1.

DETAILED DESCRIPTION OF T~E_PREFERRED EMBO IMENTS
Reference will now be made to the drawings wherein like structures will be provided with like reference designations.
Proper oxygenation of a patient's blood is critical to the survival of a patient. In accordance with the currant state of the art, during a surgical procedure involving puimonary bypass, a highly trained perfusionist attends ~o the oxygenatio~ de~ices. The duties of the perfusionist includes making sure that sufficient blood gas transfer 2~ takes place and that bubbles formed in the blood do not enter the patient' 5 circulato~y system where they might form gas emboli in vital organs causing blockage of blood flow to critical areas.
Due to the attentive care provided by p~rfusioni~ts, the number o~ injuries and ~a~alities occurring due to perfusion errors during cardiopulmonary bypass is very low.
Nevertheless, the human errors of a per~usionist do result in ~atal mistakes during cardiopulmonary bypass procedure~.
5urgical procedurPs involving cardiopulmonary bypass may 3~ last many hours.

wo g~ao777 2 0 ~ 612 7 P~/US9~/O~O9 ~ , In contrast to the duration of many surgical procedures involving cardiopulmonary bypass, the use of pulmonary assist devices during acute respiratory failure S is necessary for long periods o~ time (~ g~, days or weeks rather than hours). The longter duration of providing pulmonary assist during acute respiratory failure makes the likelihood of human error much more significant.
Moreover~ when using intracorporeal gas exchange devices such as those described in U.S. Patent Nos.

4,583,969 and 4,850,958 it is more difficult to accurately control the ~low of gas, and control the pressure of the gas, where the gas permeable membrane is wholly hidden in the patient's body.
15 A further concern which is encountered when dealing with intracorporeal, e.q., intravenous, gas exchange devices is that conditions within the body may change relatively quic~ly. The changes which occur within a patient's body may go unnoticed using prior art techniques and appropriate corrections can go unmade. The fact that the gas permeable membrane is within the patient1s body requires that corrections be made synchronously wi~h changing conditions to avoid ~he occurrence of outgas$ing~
When using intravenous gas exchange devices, any gas bubbles which do form due to outgassing will immediately travel to the patient's blood stream without any opportunity to be noticed and eliminated.
As will be better appreciated after examination of this disclosure, the embodiments and methods of the present invention provicle the greatest possible safety for a patient during complete cardiopulmonary bypass or whose li~e functions are being supported by a pulmonary assist device. First, the present invention assures that th2 gas phase pressure present at the gas permeable membrane of the membrane oxygenator is low enough that outgassing does not -: . :,, . ,~ . :,: , .. ..... . . ...... . .
. ~ , . ~ .- , . . : , , : . : , . , : .

W092/00777 PC~/~S91/~0~
20~6127 - ~

occur. Second, the present invention assures that sufficient gas flows past the gas permeable membrane so that adequate oxygen and carbon dioxide trans~er takes 5 place.
Referring now to Figure 1, a block diagram of the presently preferred embodiment of the present i~vention is provided.
As repr~sented in Figure 1~ the e~bodiments o~ khe 1o present invention are intended to be used with a memhrane gas exchange device, represented at 14 and having an inlet and an outlet, which may be either an extracorporeal device or an intracorporeal (intravenous or intra-arterial) device. As explained, the need for the present invention 1~ is greatest when a gas exchange device is implanted into a patient where outgassing may have disastrous results and the relatively long term use o~ the device makes constant attention by an attendant unsuitable. Also represented in Figure 1 is a gas source 10 and a vacuum source 12. The gas source 10 may bs a commonly available source of ventilatory gas, e., oxygen, such as a pressurized tank, which can be incorporated into the embodiment of the present invention or independent thereo~. Alternatively, the gas source lO may be the oxygen distribution system of a medical facility such as a hospital.
Also represented in Figure 1 is a tank pre~sure regulator 16 which is commonly known in the art. Those skilled in the art will understand the advantage~ of ragulating the gas source 10 to stabilize the pressure which is supplied and also how to carry out the regulation.
The vacuum source 12 represented in Figure 1 ~ay be an independent source of vacuum such as that supplied by the vacuum distribution system of a medical facility or, prefera~ly, a dedicated source of vacuum which i5 incorporated into the embodiment o~ the present inventionO
:
..

~092/00777 2 0 3 ~ 1 2 7 PCT/~ U~9 , . ,.. ;~ ~,. . .

In the case of a dedicated vacuum source, it is preferred that one commercially available from KNF Neuberger, Inc~
model no~ PV392-726-12.89 be used. I~ will also be appreciated that regulation of the source of vacuum, to some extent, may be desirable so that the pressure exert2d is relatively constant.
As shown in Figure 1, a gas ~low or gas stream is established from the gas source 10 through an ga~ exchange device 1~ to the vacuum source 12. In ~igure 1, the gas flow path is indicated by heavier lines (102, 108, 114, 120, and 124) with arrows showing the direction of the flow and lighter lines (132) being used to represent electrical control/data signal paths. For example, it is pre~erred l~ that the heavier lines represent 1/8 inch inner diameter tubing which is suita~le for use in medical applications.
The structures of the preferred embodiment described herein are intended to ensure the greatest possible saPety to the patient both by providing adequate gas ~low at the gas permeable membrane and by preventing any incidents of outgassing.
Shown in Figure 1 is a connector 100 which functions as a means for receiving a ga under pressure from a gas source. In the illustrated embodiment, the gas source is an external tank of oxygen. Other supplies of ventilatory gases a~ described above and as Xnown in the art can also serve as a gas source and the means for receiving a gas under pressure is intended to in lude any structure performing an eg~livalent function to that performed by the connector 100. Also represented in Figure 1 is another connector 104 which is the presently preferred example of the means for connecting to a source of vacuum.
Represented in Figure 1 are two pressure sen~ors 116 (P2) and 126 (P3). Each of the pressure sensors 116 and 126 are pre~erably those which are commercially availahle W~92/~777 PCT/U59~ 6~g 2086~2~ - ~

from Sensyn with pressure sensor :Ll6 preferahly being model no. 142SCOlD and pre~sure sensor 126 being model no.
142SC05D. Another pressure sensor ~referred to as Pl in the programming cod~ appended hereto) which is not represented in Figure 1 can be positioned to sense the pressure of the gas in line 102.
It will be appraciated that ~the pressure sensed by the pressure sensor 126 will be less than the pressure sensed by the pressure sensor 116, depending on the mass flow rate of the ventillatory gas. Thus, a significant pressure drop occurs across the gas exchange device 14. F.ach o~ the pressure sensors 116 and 126 outputs an electrical signal output corresponding to the pressure which is sensed.
As shown in Figure 1, two mass flow controllers 106 and 128 are positioned in the gas flow. The mass ~low controllers are pref~rably those which are co~mercially available from MXS Instruments, Inc. of Andov~r, Massachusetts utilizing appara.tus and methods described in U.S. Patent No. 4,464,93~. Ik is preferred that mass flow controller 106 be model no. 1159B-05000RB-SP sensing a flow range of from O to 5000 standard cubic centimet~rs per minute (sc~m). It is also preferred that mass flow controller 128 be model no. 1159B-05000B-SP sensing a ~low range of from O to 3000 sccm. ~he preferred mass ~low controllers are capable of sensing and controlling the mass of the gas flowing therethrough with a high degree of precision.
Each of the described mass flow controllers are an example of a ~low control means or a means for~regulating the mass of the gas flowing to the ~as permeable membrane.
As taught herein, the present invention may be carried out in other forms including only one mass flow controller or an equivalent functioning devic:e. Thus, any stxucture performing ~unctions which are equivalent to ~hose caxried ~092/00777 2 0 ~ fi 12 7 PCT/US91/~ ~9 ~ 11 out by one of the mass flow contxollers described herein is intended to fall within the scope of the means for regulating the mass of the gas flowing to the gas permeable membrane of the gas exchange device.
Also represented in Figure 1 is a pressure valve 112 and a vent ~.10. The function of pressure valve 112 and vent 110 is to adjust the pressure of the gas present within the gas exchange device. Since the avoidance of outgassing is of crucial importance in the embodiments o~
the present invention, the pressure of the gas within the gas exchange device must be kept at least as low as the patient's csntral venous pressure in the case of an intracorporeal gas transfer device and, as is done in the case`of the described em~odiment, preferably at least ~s low as the a~bient atmospheric pressure.
The pressure valve 112 is preferably one al50 available from MKS Instruments, Inc. as model no. 0248A-5000Q~V. The pressure valve 112 is adapted to receive an 20 electrical signal command and adjusts its output pressure ::
accordingly.
With pressure valv~ 112 commanded to maintain a subatmospheric pressure, preferably 15mm Hg, the vacuum exerted by the vacuum source 1~ downstream from the 2~ pressure valve 112 causes gas to be drawn through the pressure valve 112. In order to ensure enough flow through the gas exchange device 14, the flow rate through mass flow controller 106 is set higher than the flow rate through mass flow controller 128. In the described embodiment, it is preferred that the flow through mass ~low controller 106 is set at about 20 per cent higher than the flow through mass flow controller 128.
In order to prevent a build up of pressure on the upstream side of the pressure valve 112, the vent 110 is 3_ provided. The vent 110 has a cross sectional area which is : .

w092/00777 2 0 86 27 ~

sufficient to allow the necessa:ry amount of gas to escape without undue resistance. During normal operation, gas is continually exhausted to some extent through the vent 110.
Thus, the entry of contaminants through the vent 110 against the flow of the gas is not a significant concern.
The pressure valve 112 i~; one prPsently preferred example of a pressure control means or a means for adjusting the pressure o~ the gas received from the gas source 10 so as to prevent outgassing. As will ~e explained shortly and as appreciated by those skilled in the art, other arrangements and devices can perform functions equi~alent to those performed by the described pressure valve. Xt is intended that such other arrange-ments and devices be included within the ~cope o~ the mean~for adjusting the pressure of the gas included in the present invention.
Still referring to Figure 1, a bacteriological filter 118, such as is commercially available in the art, i5 present in the gas flow immediately before the gas exchange device 14. A liquid trap 120 is al50 present in the gas flow immediately after the gas exchange device 14. The liquid trap 120 is used ~o remove any liquid which has appeared in the gas flsw after passing through the gas exchange device and which might otherwise interfere with the operation of the mass flsw controller 128.
Also representPd in Figure 1 is a central controll~r 130. The components which yenerate, or respond to, electrical control signals are connected to the central controller 130 by various control lines as repxe~ented at 132. The celltral controller 130 pre~erably includes a microproces~or 130A, an analog to digital converter 130B, and a digital to analog converter 130C, if necessary, to communicate with the other components. The central '5 ~ 092/00777 ~ 2 ~ PCT/USg~ 9 controller 130 is the presently pr~ferre~ example of a control means of the present invention.
A user interface, 136 in Fi.gure 6~ may comprise visual and/or audio signals and displays to indicate to medical perscnnel the operational status of the system. For example, in the described embodiment, six LEDs 136A~136F, or abnormal operating indicator~s, are provided to indicate to medical personnel that po:rtions o~ the system are operating in a normal state or that a problem is present.
Also represented in connection with the user interface 130 i5 a digital display H, or a flow rate display, and a user operable control 135G with which the user can select the ~low rate through the gas exchange device. The user interface 136 communicates with the central controller 130 by way of a bus represented at 13 A detail~d schematic diagram of the presently preferred con~iguration ~or the central controller 130 is provided in Figures 4A-4F.
A~ter examining the structure of the described embodiment, those skilled in the art will appreciate that other equivalent arrangements may be used to accomplish the objectives of the present invention. For example, a single mass flow controller (functioning as a means for regulating the mass o~ the gas stream) could be located upstream from the gas exchange device, a pressure sensor positioned immediately at the inlet to the gas exchange device, and a pressure valve ~funrtioning as a means ~or regulating the pressure) located do~nstreâm ~rom the gas exchange device.
In another example of a potential embodiment within the scope of the present invention, a single mass flow co~troller could be positioned in the ~low stream downstream from the gas exchange device with a vent and ,5 pressure valve positioned upstream ~rom the gas exchange .
. -, .
.

W092/0~777 2 ~ ~ ~ 1 2 ~ P~T/U~91/~o9 devioe as represented in Figure 1. Furthermore, a single mass flow controller could be positioned downstream ~rom the gas exchange device and a variable vacuum pump utilized 5 to vary the pressure exerted thereon. While such arrangements are possible, they are not presently preferred because of they present potentially unstable operation using presently availa~le components. sinGP it is an objective to provide the safest possible implementation o~
the present invention, the described ~mbodiment is preferred. It is within the scope of the present invention, however, to utilize other arrangements of the described structures to accomplish the same or equivalent functions.
1~ The operation of the structures represented in Figure 1 is controlled principally by microprocessor 130A. It is to be appreciated that devices other than the descxibed microprocessor and its associated devices can function a~
the control means of the present invention.
zo Reference will now be made to the flow chart of Figures 2A-2B and to the block diagram of Figure 1 ko describe the presently preferred method of the present invention. Beginning at Start 200 in Figure 2A, th~ flow through the gas exchange d~vicP is set to zero as represented ?t step 202. ~ zero flow control command is read at step 204 by the controller 130 and tha apparatus waits until the flow sensed by the mass flow controller is actually zero.
Referring still to Figure 2A, in the next step 208 the pressure sensors 116 and 126 are read. As explained, it is crucial to maintain the gas phase pressure within the gas exchange device 14 at a value which is at least less than the lowest blood pressure of the patient, in the case of an intracorporeal gas exchange device, and preferably less than the ambient atmospheric pressure in all cases. This ,~

. . . , - : : , , -~092J00777 2 0 ~12 7 PC~/US91/~09 ~7 .

is accomplished in the ~escribed embodiment by maintaining the pressure in the gas exchange device at a subatmospherlc value. Reading pressure sensors 116 and 126 provides a check that the pressure at th~ gas permeable membrane is within acceptable values. If necessary, the pressure may b~ regulated by altering the command presented to th~
pressure valve 112 by the central controll~r 130 a~
indicated at step 210.
The flow sensors which are integral with the mass flow cont~ollers 105 and 128 are read as shown at step 214 and a dynamics analysis step 216 takes place wher~in thP
described embodiment analyzes the characteristics of the flow of gas through the particular gas exchang~ devic~ in conjunction with a particular patient and yas exchan~e device. As an example o~ a useful type of dynamic ~nalysis which may be carried out is to dete~mine the resistance o~
the gas exchange device to the flow of gas th~rethrough by examining the pressure drop across the gas exchang0 de~ice and the flow therethrough. Other types of dynamic analysis may also be beneficially carried out.
Per~ormed next is a series o~ steps which are included within the dashed box labeled safety check 218. The ~teps of included within the safety check 21~ are intend~d to 2~ ~ind and id~nti~y the source of an "out-of-to~eran~e~' va~ue so that co~rective act:ion can be taken.
At step 220, the p~ess~l~e at the inlet c~f the gas ~h~H~ d~lce lP~J sensed ~y p~ess~e senst~ q ~ B
pare~ lto ~ ~laY~n~ lPI~O~
n~ ~alll~ i9 ~XC~ , tn~n a ~ci~ion i~ ma~e a~
step ZZ0 to t.u~n ;~ t~; p~e~ u~e ~aaYe 1~ y ~e se~ al controller 130 (step Z2Z~ and enter into a diagnostic and ,,.
alarm ~o~tine as indicated a~ step 232. The tole~nce press~re ~or the inlet o~ the gas exchange de~ice ~PI~TO~ ~ :

.

W~92/00777 2 ~ ~ 6 ~ 2 7 PCT/~S~

may be 0mm Hg, for example, if the target pressure for the pressure valve 112 is set at -15mm Hg.
If the pressure at the :inlet of the gas exchange device (PIN) is less than the expected value (PINTOL) at step 220, then the process proce~ds to step 224 where it i~
determined whether the pressure at the outlet of the gas exchange device tPOUT) is greater than the tolerance value (POUTTOL) as sensed by the pressure sensor 126. If the pressure at the outlet of the gas exchange device is greater than the tolerance value, then the diagnostic and alarm routine 232 is entered. If the pressure at the outlet of the gas exchange device is less than or equal to the proper value, the process moves on to step 228.
Similarly, to the previous steps, in step 228, i~ the gas ~low through mass flow controller 12B (F#2) is greater than or less than (i.e., unequal) to the flow command presented to the mass flow controller 128 (F#2SET), then the diagnostic and alarm routine 232 is invoked. In the operation of the described embodiment, it is the ~low through mass flow controller 128 which is of crucial importance since that gas flow is also the precise flow through the gas exchange device. Also, in step 230, lf the gas flow through mass flow controller 1~.8 is greater than ~:
2 - the gas flow through mass flow controller 106 l then the diagnostic and alarm routine 23~ is called. ;
If the decisions made at steps 220, 224, 228, and 230 are all "no, " the state of the system is normal a~;
indicated at step 234. If a~ter calling the diagnostic and 30 alarm routine 232 an abnormality is detected in the system (as represented at 236), the decision at step 238 is made to rerun the loop which comprises the steps o~ the eafety check 218 to continue to alert the user of the abnormality.
which has been detected.

_ _ ~0 92/~0777 2 ~ g 6 ~ 2 7 PCT/lJ91/~ 9 I~ the state of the system is normal, the user interface 136 is checked for the flow co~mand which may have been input tstep 240) and the flow command entered thereat is read (step 242). The flow co~mand is entered into the central controller 130 of the described embodiment and is determined ~y a medical professional in accordance with the needs of the patient and considering the particular gas exchange device being used. When the operational parameters are altered, care must be taken to avoid exceeding the pressure which can be tolerated in the gas exchange device. Occurrences such as "overshoot" which might occur when the pressure valve 112 or the mass flow controllers 106 and 128 are presented with an altered com~and. Moreover, the embodiment should be designed such that electrical and physical noise does not cause the significant problems.
When using the described embodiment, the flow command causes the mass flow controller 128 to be set to the ~low rate which will result in that rate of ~low through the gas exchange device. The mass ~low controller 106, which is positioned upstream from the gas exchange device 14, is set to maint~in a flow a specific amount, pre~erably 20 per cent above that maintained by mass flow controller 12B.
~_ once the flow command is read ~step 242) the flow is controlled by the ~ystem and a loop beginning at step 208 is entered and repeated. The gas flow continues to ~e controll~d (step 244) until the system is shut down as represented at the End step 246 shown in the flow chart.
3Q It will be appreciated that with mass flow controllers 106 and 128 commanded a~ described, there will he a continual flow of gas out of the vent 110 and the ~low set by the mass flow controller 128 will be the actual gas flow at the gas permeable membrane through the gas exchange device. Once the flow command has been read and .

W092/00777 PCT/US~1/04~9 208~27 18 ~ .

implemented, the described embodiment will provide that the suf f icient ~low through the ga'; exchange device 14 occurs without interruption.
Figure 3 is a diagram showing the arrangement o~
another apparatus which may be used to manually carry out the method of the present inven1:ionO Represented in Figure 3 is a tanX 300 containing pressurized gas. A pressure regulator 302 is manually changed to increa~e or decrease the pressure of the gas leaving the tank 300 and the pressure at the inlet of the mPmbrane gas exchange device 312. Flow control valve 304 is manually adjusted to maintain the desired yas flow into the gas exchange device 312. The pressure gauges 306 and 315 measure the pressure at the inlet and the outlet of the membrane gas exchange device 312. Relief valves 30~-B and filter 310 are positioned upstream from the membrane gas transfer device 312. A liquid trap 314 is positioned immediately down-stream ~rom the membrane gas exchange device. Another ~low control valve 318, positioned i~mediately upstream ~rom the vacuum pump 320, is adjusted to set the flow through the meDbrane gas exchange device 312 to the desired value.
Figures 4A-4F provide detailed schematic diagrams o~
the presently preferred circuit implementation of th~
central controller 130 which may be included in the present invention. It will be appreciated that the circuit represented in Figures 4A-4F is merely exemplary of the arran~ements and devices which can be incorporated into the presen~ invention. Also, the boxed designations shown in Figures 4A-4F indicate the circuit interconnections ~etween the figures.
Provided below in Table A is a list of the parts re~erenced in Figures 4A-4F. The reference deslgnations included in Figures 4A-~F are those which are commonly used ~in the art in such schematic diagrams.

~ ~ ~ J
~92/00777 P~ 91/~

TABLE A
Item Quantity Refer nce_Desiqnation ~art No.
1 4 u6,U2,Uda6,u8 74LS374 2 1 Ul Z~681 4 1 U15 74LS13~
1 U7 74LS~41 6 l U9 741 :
~ 1 XSTL 7O3728mhz ~ Psys,fl,f2,Sys 11 7 R33,R34,R35,R36,R37,R38, RESISTOR ~
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12 2 R66,R104 50k ~.
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In view of the foregoing, it will be appreciated that the present invention provides a blood gas exchange delivery system which is safer to u~e than previous available manual or automatic ventilatory ga~ delivery systems and which maintains more efficient oxygen and carbon dioxide transfer with the blood than previously known devices. The present invention also advantageously 2~ maintains the gas phase pressure within the gas pe~mea~le membrane gas exchange device at a pressure below the central venous pressure of the patient to ensure that formation of yas e~boli in the blood does not occur. : :
Mor~over, embodiments of the present invention may be easily set up and operated for long periods o~ time without constant attention from a technician.
The pres~nt invention may be embodied in other specific ~orms without departing from its spirit or essential characteristics. The described embodiments are , .

~ 09~/007~7 2 0 8 612 7 PCTtUS91/~9 to be considered in ~ll respect~ only as illustrative and not restrictive. The scopa of t:he invention isi, therefore, indicated by the appended c:Laims rather than by the foregoing description. All ch~nges which come within the meaning and range of equivalency of the claims are to be embraced within their scope.
~hat is claimed is:

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Claims

1. A system for controlled delivery of gases to a blood gas exchange device having a gas permeable membrane adapted for carrying out gas transfer with a patient's blood flowing therethrough, the system comprising:
means for receiving a gas under pressure from a gas source;
means for adjusting the pressure of the gas received from the gas source to a pressure at the gas permeable membrane which is less than the blood phase pressure adjacent to the gas permeable membrane and for ensuring that undissolved gas is not forced into the patient's blood so as to avoid the formation of gas emboli: and means for regulating the mass of the gas flowing to the gas permeable membrane to ensure that sufficient gas flows through the blood gas exchange device.

2. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 1 wherein the means for adjusting the pressure comprises a pressure valve, the means for regulating comprises a mass flow controller, and the means for receiving a gas comprises a connector.

3. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 1 wherein the means for adjusting the pressure of the gas comprises:
a pressure valve positioned upstream from the blood gas exchange device; and a vent to the atmosphere positioned in the gas stream between the means for receiving a gas and the pressure valve, the vent to the atmosphere venting any excess gas not allowed to continue in the gas stream to the blood gas exchange device by the pressure valve.

4. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 3 wherein the means for regulating the mass of the gas comprises a first mass flow controller.

5. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 4 wherein the first mass flow controller is positioned in the gas flow downstream from the blood gas exchange device and wherein the system further comprising a second mass flow controller positioned in the gas flow between the vent and the means for receiving a gas.

6. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 5 wherein the means for adjusting the pressure of the gas further comprises means for connecting to a source of vacuum positioned in the gas flow downstream from the second mass flow controller.

7. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 6 further comprising control means for coordinating the operation of the first mass flow controller, the second mass flow controller, and the pressure valve.

8. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 7 further comprising:

a first pressure sensor positioned to sense the pressure at the inlet of the blood gas exchange device;
a second pressure sensor positioned to sense the pressure at the outlet of the blood gas exchange device, the first and the second pressure sensors providing data to the control means; and a liquid trap positioned in the gas flow downstream from the blood gas exchange device.

9. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 1 further comprising a central controller adapted for controlling the means for adjusting the pressure and the means for regulating the mass flow, the central controller comprising:
a microprocessor;
an analog to digital convertor; and a digital to analog convertor.

10. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 9 further comprising a user interface, the user interface comprising:
a plurality of abnormal operating indicators;
a flow rate display; and a user operated flow rate input control.

11. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 1 further comprising a pressurized tank of gas serving as a gas source and a vacuum pump serving as a source of vacuum.

12. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 1 wherein the means for adjusting the pressure of the gas received from the gas source comprises means for adjusting the a pressure at the gas permeable membrane to less than the patient's central venous pressure.

13. A system for controlled delivery of gases to a blood gas exchange device as defined in claim 1 wherein the means for adjusting the pressure of the gas received from the gas source comprises means for adjusting the a pressure at the gas permeable membrane to less than the ambient atmospheric pressure.

14. A system for delivering a gas to a membrane oxygenator, the membrane oxygenator being capable of at least partially supporting the pulmonary function of a patient, the system comprising:
an inlet which is adapted to be connected to a gas source supplying the gas at a pressure greater than the patient's central venous pressure, flow control means for regulating the mass of the gas flowing through the membrane oxygenator from the gas source;
pressure control means for adjusting the pressure of the gas within the membrane oxygenator;
an outlet which is adapted to be connected to a vacuum source having a pressure which is less than the ambient atmospheric pressure; and central control means for operating the pressure means and the flow control means such that the flow of the gas is sufficient to ensure gas transfer through the membrane of the oxygenator and the pressure of the gas within the membrane oxygenator is low enough that outgassing of the gas through the membrane as bubbles into the blood is avoided.

15. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 14 wherein the flow control means comprises:
inlet flow control means connected to the inlet of the membrane oxygenator; and outlet flow control means connected to the outlet of the membrane oxygenator.

16. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 15 wherein the pressure control means is positioned in the gas flow between the inlet of the membrane oxygenator and the inlet flow control means and wherein an atmosphere vent is positioned in the gas flow between the pressure control means and the inlet flow control means.

17. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 16 further comprising:
an oxygenator inlet pressure sensor means positioned at the inlet of the membrane oxygenator;
and an oxygenator outlet pressure sensor means positioned at the outlet of the membrane oxygenator.

18. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 17 further comprising:
a first bacteriological filter positioned in the gas flow on the inlet side of the membrane oxygenator;
and a first liquid trap positioned in the gas flow on the outlet side of the membrane oxygenator.

19. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 14 further comprising a vacuum pump.

20. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 14 wherein the gas is a ventilatory gas.

21. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 20 wherein the ventilatory gas is oxygen n

22. A system for delivering a gas to a membrane oxygenator which is capable of at least partially supporting the pulmonary function of a patient as defined in claim 14 wherein the membrane oxygenator is an intracorporeal membrane oxygenator.

23. A system for delivering a gas to the gas permeable membrane of a membrane oxygenator used to transfer oxygen into a patient's blood and carbon dioxide out of the patient's blood, the membrane oxygenator having an inlet and an outlet, the system being adapted for receiving a gas flow from a source of gas providing the gas at a higher than ambient pressure and being adapted for connection to a source of vacuum providing a pressure at lower than ambient pressure, the system comprising:
a first mass flow controller adapted to be connected to the source of gas;
a pressure valve positioned in the gas flow between the first mass flow controller and the gas permeable membrane of the membrane oxygenator;
an atmospheric vent positioned in the gas flow between the pressure valve and the gas permeable membrane, a second mass flow controller adapted to be connected to the source of vacuum; and control means for controlling the first mass flow controller, the second mass flow controller, and the pressure valve such that there is sufficient gas flow at the gas permeable membrane to provide transfer of gases between the blood and the gas flow and such that the pressure of the gas within the membrane.
oxygenator at the gas permeable membrane is low enough that outgassing of the gas through the membrane as bubbles into the blood is avoided.

24. A system for delivering a gas to the gas permeable membrane of a membrane oxygenator used to transfer oxygen into the blood and carbon dioxide out of the blood as defined in claim 23 further comprising:
a first pressure sensor positioned to sense the pressure at the inlet of the membrane oxygenator;
a second pressure sensor positioned to sense the pressure at the outlet of the membrane oxygenator, the first and the second pressure sensors providing data to the control means; and a liquid trap positioned in the gas flow downstream from the membrane oxygenator.

25. A system for delivering a gas to the gas permeable membrane of a membrane oxygenator used to transfer oxygen into the blood and carbon dioxide out of the blood as defined in claim 23 wherein the control means comprises a microprocessor and wherein the system further comprises a user interface, the user interface comprising-a plurality of abnormal operating indicators;
a flow rate display; and a user operated flow rate input control.

26. A system for delivering a gas to the gas permeable membrane of a membrane oxygenator used to transfer oxygen into the blood and carbon dioxide out of the blood as defined in claim 23 further comprising a pressurized tank of gas serving as a gas source and a vacuum pump serving as a source of vacuum.

27. A method of delivering a gas to a membrane oxygenator having an inlet and an outlet and adapted for at least partially supporting the pulmonary function of patient, the method comprising the steps of:
receiving a flow of a gas from a gas source at a pressure higher than the ambient atmospheric pressure and directing the gas flow into the inlet of the membrane oxygenator;
adjusting the pressure of the gas flowing into the inlet of the membrane oxygenator to be below the blood phase pressure immediately adjacent to the membrane of the membrane oxygenator such that outgassing through the membrane is avoided; and regulating the mass of the gas flow from the membrane oxygenator to be at least a desired value such that adequate transfer of oxygen and carbon dioxide occurs between the patient's blood and the gas flowing through the membrane oxygenator.

28. A method of delivering a gas to a membrane oxygenator as defined in claim 27 wherein the step of adjusting the pressure of the gas flowing into the inlet of the membrane oxygenator comprises the steps of:
applying a vacuum to the outlet of the membrane oxygenator; and adjusting the pressure at the inlet of the membrane oxygenator to be less than the ambient atmospheric pressure.

29. A method of delivering a gas to a membrane oxygenator as defined in claim 28 wherein the step of regulating the mass of the gas flow from the membrane oxygenator comprises the steps of:
regulating the mass of the gas flow from the gas source to be greater than the mass of the gas flow from the membrane oxygenator; and venting the excess gas.

30. A method of delivering a gas to a membrane oxygenator as defined in claim 27 wherein the step of adjusting the pressure of the gas flowing into the inlet of the membrane oxygenator comprises the steps of:
applying a vacuum to the outlet of the membrane oxygenator; and adjusting the pressure at the inlet of the membrane oxygenator to be less than the ambient atmospheric pressure.