AU2015200180A1 - Methods, systems and devices for humidifying a respiratory tract - Google Patents

Abstract

Abstract: Systems and methods are provided for humidifying ventilation gas. Systems and methods may include a nasal interface apparatus for receiving ventilation gas 5 from gas delivery tubing and for humidifying ventilation gas. The nasal interface apparatus may have one or more channels within the nasal interface to deliver gas from a gas delivery circuit to a patient's nose; one or more structures in fluid communication with the one or more channels to direct ventilation gas to the patient's nose; and a hygroscopic material within the nasal interface in the flow path of the 10 ventilation gas. Figure 17. 6124336_1 (GHMatters) P92825.AU.1 DENISET

Description

METHODS, SYSTEMS AND DEVICES FOR HUMIDIFYING A RESPIRATORY TRACT 5 FIELD OF THE INVENTION The present invention relates to the field of ventilation therapy for persons suffering from respiratory and breathing disorders, such as respiratory insufficiency and sleep apnea. More specifically, the present invention relates to methods and apparatus for providing humidification to a patient receiving artificial ventilation. 10 BACKGROUND OF INVENTION There are a range of clinical syndromes that require some form of ventilation therapy. These syndromes may include hypoxemia, various forms of respiratory insufficiency, and airway disorders. There are also non-respiratory and non-airway 15 diseases that require ventilation therapy, such as congestive heart failure and neuromuscular disease, respectively. Typically, patients receiving gas through these ventilation therapy systems require the addition of humidification to the gas being delivered to prevent the gas from drying the airways. Additionally, it is also known that with oxygen therapy, if 20 oxygen is delivered for an extended time at flow rates greater than 6 lpm, the airways will dry, and artificial humidification is required. In existing systems, humidification is added by passing the delivered gas through the vapor phase of a humidifier or bubbling the gas through water. For mechanical ventilators, the gas delivery tubing, or patient circuit, that fluidly transmits 25 the breathing gas from the ventilator to the patient in existing systems is sized to provide for low pressure drop between the ventilator and the patient. This tubing is sized at 15mm or 22mm inside diameter. To prevent the vapor from condensing within the tubing, an adjunctive technique of heating the gas delivery tubing or thermally insulating it with protective sheathing is commonly applied. 30 A new generation of mechanical ventilators is emerging that utilizes smaller tubing to transport the breathing gas to patients. The gas delivery tubing of this new generation of ventilators is in the range of 2-14 mm inside diameter, compared to 15 mm or 22 mm inside diameter for currently available systems. Correspondingly, the pressures achieved within the new gas delivery tubing can be 0-80 psig higher than 1 6124336_1 (GHMatters) P92825.AU.1 DENISET ambient pressure, whereas the pressure inside of tubing from currently available ventilators is typically within 1 psig of ambient pressure. Due to the smaller diameter and higher pressure of the gas delivery circuit of newer mechanical ventilator systems, there is a corresponding need for new humidification systems. 5 Additionally, some of the new generations of mechanical ventilators utilize an open airway technology, wherein the air passage between the ventilator and the patient is not sealed, as it is in traditional mechanical ventilator systems. The systems utilizing open airway technology provide for ambient air to be entrained near the patient interface via a venturi system in addition to the gas delivered from the 10 ventilator, wherein the gas delivered to the patient is the combination of the gas delivered from the ventilator plus the entrained air. With the newer open systems, it may be challenging and inefficient to add humidification to the delivered gas using conventional methods. Therefore, a need exists for new humidification technologies compatible with the open airway technology. 15 Furthermore, the new generations of mechanical ventilators are designed to emphasize use during walking and mobility, whereas existing ventilation systems tend to limit mobility to applications such as when patients are confined to a wheelchair. Existing humidification systems typically use water tubs that are large and orientation sensitive, and are typically heated by systems that consume more power than is 20 practical to power by a portable battery source. For these reasons, existing systems are typically only used to provide humidification when the patient is stationary. Therefore, an additional need exists for humidification technologies that are small, lightweight and portable. Existing humidification systems typically do not have precise control of the 25 amount of water introduced into the system, and they are not synchronized with the patient's breathing patterns. Typically, existing systems can provide humidification levels above 90% relative humidity, even though some studies have shown that patients typically cannot perceive a benefit for humidification levels above 50% relative humidity. Additionally, because existing systems either have continuous 30 intentional leaks or exhalation flows, and because patients nominally exhale twice as long as they inspire, existing humidification systems can consume up to three times the water that is required if the systems only provided water during the patient's inspiratory cycle. Additionally, by providing more humidification than is required by the patient's needs, existing humidification systems often have problems with 2 6124336_1 (GHMatters) P92825.AU.1 DENISET excessive "rainout" or condensation in the tubing, leading to the requirement of water traps in the tubing to catch excess water to prevent adverse effects due to patients and equipment aspirating water that collects in the system. Additionally, when used during sleep, some patients complain of the existing humidification systems soaking 5 their pillows with water because of the excess humidity provided. For these and other reasons, an additional need exists for humidification systems that can precisely control the amount of humidification added and/or to synchronize the humidification with the patients' breathing patterns. Because existing systems typically heat water to vaporize it, they can 10 experience performance degradations that are caused by solids that are left behind by other water sources containing dissolved solids, such as tap water, and for this reason, they typically require the use of distilled water with their systems. However, users of humidification systems would prefer not to have to deal with the expense and inconvenience of acquiring distilled water for their systems. Therefore, an additional 15 need exists for humidification systems that do not require distilled or other specialized water. SUMMARY OF INVENTION The present invention may solve the limitations of prior systems with unique 20 features that allow delivery of humidification to small diameter, higher pressure, and open airway gas delivery circuits. A first aspect of the invention provides a system for humidifying ventilation gas, the system comprising: a ventilator; a patient circuit in fluid communication with the ventilator at a proximal end and fluidly connected to a patient airway at a distal 25 end, wherein the patient circuit has an inner diameter of approximately 2 - 14 mm; a fluid reservoir; a humidification device; and a channel between the humidification device and a distal end of the patient circuit. Embodiments of the present invention include a nasal interface apparatus for receiving ventilation gas from gas delivery tubing and for humidifying ventilation gas, 30 the apparatus may include one or more channels within the nasal interface to deliver gas from a gas delivery circuit to one or more structures, wherein the one or more structures may be in fluid communication with the one or more channels to direct ventilation gas to the patient's nose; and a hygroscopic material within the nasal interface in the flow path of the ventilation gas. 3 6124336_1 (GHMatters) P92825.AU.1 DENISET In certain embodiments, the one or more structures may be one or more nasal pillows, and wherein the hygroscopic material may be located within the one or more nasal pillows or within a cushion attached to the one or more nasal pillows. At least one pressure sensor device may be provided, wherein the at least one pressure sensor 5 is located on a patient side of the hygroscopic material. The gas delivery circuit may have an inside diameter of approximately 2 - 14 mm. The system may be used with a portable ventilation system. Delivery of the humidified ventilation gas may be servo controlled, wherein the servo controls humidification levels based on the patient's need, and wherein the servo predictively controls humidification levels. The servo 10 may consider gas flow delivered to the patient, ambient temperatures, ambient humidity, and combinations thereof The humidified ventilation gas may be delivered in synchrony with the patient's breathing cycle. More humidified ventilation gas may be delivered during the patient's inspiratory phase than during the patient's expiratory phase. Heated tubing may be provided. Energy may be applied to the heating tubing 15 in synchrony with the patient's need and the patient's breathing cycle. Embodiments of the present invention may include a method for delivering humidified ventilation gas, the method including providing a nasal interface including: one or more channels within the nasal interface to deliver gas from a gas delivery circuit to one or more structures, wherein the one or more structures are in 20 fluid communication with the one or more channels to direct ventilation gas to the patient's nose; and a hygroscopic material within the nasal interface in the flow path of the ventilation gas; and delivering humidified ventilation gas to the patient. In certain embodiments, the one or more structures may be one or more nasal pillows, and wherein the hygroscopic material may be located within the one or more 25 nasal pillows or within a cushion attached to the one or more nasal pillows. At least one pressure sensor may be provided, wherein the at least one pressure sensor may be located on a patient side of the hygroscopic material. The gas delivery circuit may have an inside diameter of approximately 2 - 14 mm. Delivery of the humidified ventilation gas may be controlled with a servo. The humidified ventilation gas may 30 be delivered in synchrony with the patient's breathing cycle. A system for humidifying ventilation gas comprises a ventilator; a patient circuit in fluid communication with the ventilator at a proximal end and fluidly connected to a patient airway at a distal end, wherein the patient circuit has an inner 4 6124336_1 (GHMatters) P92825.AU.1 DENISET diameter of approximately 2 - 14 mm; a fluid reservoir; a humidification device; and a channel between the humidification device and a distal end of the patient circuit. In certain embodiments of the present invention, a patient interface may be provided, wherein the patient interface may be a nasal interface, an oral interface, or a 5 transtracheal interface. The fluid may be water, a drug solution, or combinations thereof A drug may be delivered alternatively with humidification. The ventilator may be portable. The channel may end proximal to an end of the patient circuit, such that a jet venturi created by the gas in the patient circuit entrains vapor from the channel. The fluid reservoir may be pressurized by gas from the ventilator. A 10 misting screen may be provided at a distal end of the channel. A second channel may be provided for delivering gas to create a jet prior to the misting screen. A hydrophilic media cartridge may be provided within the channel. A capillary force vaporizer may be provided. A vibrating mesh nebulizer may be provided. An aerosolizing catheter may be provided. A gas flow channel surrounding the channel may be provided. The 15 channel may surround a gas flow channel. A vortex heat separator may be provided for providing hot gas to a humidifier and cold gas to the ventilator. Delivery of the humidified ventilation gas may be servo controlled. The humidified ventilation gas may be delivered in synchrony with the patient's breathing cycle. An average flow rate of gas delivered by the ventilator may be greater than approximately 6 lpm. The 20 delivery of humidified gas may be controlled to within 50 to 95% relative humidity to prevent rainout within the patient circuit. Embodiments of the present invention may include a method of treating respiratory and breathing disorders, the method including: providing a ventilation system comprising: a ventilator; a patient circuit in fluid communication with the 25 ventilator at a proximal end and fluidly connected to a patient airway at a distal end, wherein the patient circuit has an inner diameter of approximately 2 - 14 mm; a fluid reservoir; a humidification device; and a channel between the humidification device and a distal end of the patient circuit; and providing ventilation gas to a patient. Certain embodiments may include controlling delivery of the humidified 30 ventilation gas with a servo. The humidified ventilation gas may be delivered in synchrony with the patient's breathing cycle. A drug solution may be delivered alternatively with the humidified ventilation gas. An average flow rate of gas delivered by the ventilator may be greater than approximately 6 lpm. 5 6124336_1 (GHMatters) P92825.AU.1 DENISET Embodiments of the present invention may include an apparatus for delivering humidified ventilation gas, the apparatus including: one or more tubes with an inner diameter of approximately 2 - 14 mm; and one or more heaters along the length of the one or more tubes, wherein the one or more tubes are adapted to deliver humidified 5 ventilation gas to a patient. Certain embodiments may include the one or more heaters controlled by a controller to deliver heat in synchrony with the patient's need and the patient's breathing cycle. The one or more heaters may be controlled by a controller to deliver heat in based on environmental conditions. 10 Additional features, advantages, and embodiments of the invention are set forth or apparent from consideration of the following detailed description, drawings and claims. Moreover, it is to be understood that both the foregoing summary of the invention and the following detailed description are exemplary and intended to provide further explanation without limiting the scope of the invention as claimed. 15 BRIEF DESCRIPTIONS OF THE FIGURES The accompanying non-limiting drawings, which are included to provide a further understanding of embodiments of the invention and other embodiments are incorporated in and constitute a part of this specification, illustrate embodiments of 20 the invention and other embodiments together with the detailed description serve to explain the principles of the invention. In the drawings: Fig. 1 is a system schematic of the invention, according to an exemplary embodiment. Fig. 2A shows a prior art pass-over or pass-through bubble system. 25 Fig. 2B shows an enlarged view of the prior art pass-over or pass-through bubble system of Fig. 2A. Fig. 2C shows a modified version of the humidity system of Fig. 2A. Fig. 3A shows a vapor entrainment system, according to an exemplary embodiment. 30 Fig. 3B shows an enlarged view of the vapor entrainment system of Fig. 3A. Fig. 4 shows an aerosolization system, according to an exemplary embodiment. Fig. 5 shows a moisture feed system, according to an exemplary embodiment. 6 6124336_1 (GHMatters) P92825.AU.1 DENISET Figs. 6A shows a moisture feed misting system, according to an exemplary embodiment. Fig. 6B shows an enlarged view of the moisture feed misting system of Fig. 6A. 5 Fig. 7 shows a moisture entrainment system, according to an exemplary embodiment. Fig. 8 shows a cartridge entrainment system, according to an exemplary embodiment. Fig. 9 shows a cartridge pass-through system, according to an exemplary 10 embodiment. Fig. 10 shows an embodiment with a capillary force vaporizer, according to an exemplary embodiment. Fig. 11 A shows an embodiment with a nebulizer, according to an exemplary embodiment. 15 Fig. 11 B shows an exemplary humidification system, which may be used with the nebulizer system of Fig. IA. Fig. 11 C is a schematic of a humidification system as shown in Fig. 11 B. Fig. 12 shows an embodiment with an aerosolizer, according to an exemplary embodiment. 20 Fig. 13A shows an embodiment with aerosol gas channels, according to exemplary embodiment. Fig. 13B shows a detail of an alternate gas delivery circuit distal end, according to an exemplary embodiment. Fig. 14A shows an embodiment for delivering humidified gas using additional 25 gas flow channels, according to exemplary embodiment. Fig. 14B shows a detail of an alternative embodiment of Fig. 14A, according to an exemplary embodiment. Fig. 15 shows a humidification system for a ventilator, according to an exemplary embodiment. 30 Fig. 16 shows a system for heated humidified gas, according to an exemplary embodiment. Fig. 17 shows a nasal interface with a hygroscopic material incorporated therein, according to an exemplary embodiment. 7 6124336_1 (GHMatters) P92825.AU.1 DENISET DETAILED DESRIPTION OF THE EMBODIMENTS A humidification system is described for use in conjunction with a ventilation therapy system. The humidification system may be suited for integration into a small bore, high- pressure ventilation gas delivery system. It can be appreciated that while 5 the invention applies to the above application, this invention may have inherent advantages over conventional artificial humidification systems, and, as such, can also be applied to conventional ventilation systems, and to oxygen therapy systems, as well as drug delivery systems. The humidification system can be used in conjunction with a patient interface, 10 which may include a full face, nasal, oral, or transtracheal patient interface. The humidity and/or aerosol can be added to the patient interface, such as the nasal mask or transtracheal tube, or can be applied directly to the airway, or can be applied to the gas delivery circuit conducting the ventilation gas to the patient. The humidity or aerosol can be delivered in parallel with the ventilation gas, or can be 15 combined with the ventilation gas. Ideally, the humidity particles are less than 15 microns if being generated remotely and delivered, or less than 20 micron if generated near the entry to the patient airway, to not conduct bacteria to the airway. An average flow rate of gas delivered by the ventilator may be greater than approximately 6 lpm. Humidification can be added to the gas delivery circuit by active heated 20 humidification or aerosolizing moisture particles into the gas delivery system, typically into or from the patient interface mask or connection, or a heat moisture exchange (HME), or combinations thereof To prevent rainout from occurring in the interface mask or connection, the mask or connection may have a drainage line to scavenge any moisture that is 25 collecting. Embodiments of the present invention may improve humidification to decrease water consumption and improve mobility of patients. General concepts applicable to all active humidification systems may include delivery of moisture timed with patients' breathing patterns. Use of heated tubing may be provided. 30 Heated tubing may be fixed, controlled by environmental conditions, timed by breathing patterns, and/or served to breathing patterns. Embodiments of the present invention may also address humidification within small tubes, generally less than 15 mm inner diameter. Small inner diameter tubes 8 6124336_1 (GHMatters) P92825.AU.1 DENISET typically are characterized by high pressure delivered by a blower/ventilator, and a high pressure drop along the tube. Within small tube systems, traditional humidification systems are described herein. Traditional may refer to systems that do not rely on entrainment for 5 developing fluid flow through the system. According to embodiments of the present invention, pressure drop along a tube makes the relative humidity percentage decrease. This effect may counterbalance the increase of relative humidity percentage due to the cooling of the gas along the length of the tube. The result may be that rainout is prevented and gas with relative humidity percentage between about 50 and 10 about 99 is delivered to the patient. In preferred embodiments, the delivery of humidified gas is controlled to within 50 to 95% relative humidity to prevent rainout within the patient circuit. Within small tubes, entrainment systems are described herein. Generally, the flow of breathable gas to the patient (Qp) is made of (1) flow from the ventilator 15 (Qjet) that creates the entrainment effect, and (2) entrained flow (Qent). Humidification of the entrained gas (Qent) may be humidified directly. Alternatively or additionally, the flow from the ventilator (Qjet), which may be air, oxygen, etc., may be humidified. Benefits of humidifying the flow of breathable gas (Qjet) may include increasing the density of the gas delivered to the patient, which may increase 20 the entrainment effect. A humidification device or system may be positioned anywhere along the flow path of the breathable gas (Qjet), from before a ventilator up to an entrainment nozzle itself. The humidification liquid may or may not be heated. If heated by the humidification system, the humidification system may use a capillary forced vaporizer. If not heated by the humidification system, the flow of breathable 25 gas (Qjet) may or may not be heated by a separate heater. In these configurations, the humidification system may use a hydrophilic media cartridge with additional water feeding line, an ultrasonic nebulizer, an airbrush-style aerosol generator (where a high speed jet of gas entrains liquid and nebulizes the liquid), vibrating mesh nebulizer, etc. 30 In embodiments of the present invention, humidification may be provided within a patient interface using direct moisture delivery technology, moisture reuse technology, and/or a combination thereof. Direct moisture delivery technologies may be provided in the patient interface. The humidification liquid may or may not be heated. If heated by the humidification 9 6124336_1 (GHMatters) P92825.AU.1 DENISET system, the humidification system may use a capillary forced vaporizer. If not heated by the humidification system, the flow of breathable gas (Qjet) may or may not be heated by a separate heater. In these configurations, the humidification system may use a hydrophilic media cartridge with additional water feeding line, an ultrasonic 5 nebulizer, an airbrush-style aerosol generator, vibrating mesh nebulizer, etc. Reuse of moisture may be provided in the patient interface. No external moisture may be required for this type of system. A moisture reuse system may be positioned within a manifold, within a nasal pillow, and combinations thereof. In particular, a heat and moisture exchanger may be used within one or more nasal 10 pillows. For accurate sensor readings, a pressure sensor device may be located proximal to the patient, between the patient and a heat and moisture exchanger. Additional benefits of moisture reuse systems may include diffused venting of air streams and/or muffling that may result in reduced noise. Combinations of humidification technology may also be used to improve 15 water efficiency. For example, a heat and moisture exchanger may be combined with a hydrophilic cartridge fed with water, which may be pre-heated or not pre-heated. Fig. 1 is a block diagram describing a ventilation system 101 using an embodiment of the invention. The ventilation system 101 may typically provide air, oxygen or some combination thereof to a patient, but could additionally provide 20 alternate therapeutic gases. The ventilation system 101 can be self-contained with a battery and gas supply to enable it to be borne by the patient, so that the patient can ambulate and participate in activities of daily living. A ventilator 115 may provide ventilation gas. Other optional features of the ventilation system 101 may include a transmitter/receiver, pedometer, actigraphy sensor, a pulse oximeter, a C0 2 monitor, a 25 blender, a pressurized air supply or generator, a liquid oxygen (LOX) system, a respiration sensor, etc. A humidifier 105 can be integral or external to the ventilation system 101. However, unlike prior systems, humidified gas can be delivered through the gas delivery channel of the gas delivery circuit, through another lumen in the gas delivery 30 circuit, or through a separate cannula or tubing. For extended use, when the patient is likely to be stationary, the humidification system can be a stationary system and capable of delivering a relative high amount of humidity, and for periods of mobility, the patient can either not receive humidification, or use a portable humidification system that is capable of delivering relatively a small amount of humidity, due to size 10 6124336_1 (GHMatters) P92825.AU.1 DENISET and energy consumption constraints. Also unlike prior systems, some of the humidification techniques disclosed in this invention can be synchronized with the patient's breathing and the humidity introduced into the system can be precisely controlled, thereby reducing the quantity of water required by the system, reducing 5 the amount of condensation in the system, and reducing the amount of power required to drive the system. The ventilation system 101 may be portable, for example, less than about 10 pounds, and may have small bore tubing, for example, with an inner diameter less than 15 mm. Traditional humidification systems are not portable and utilize large 10 bore tubing (typically 15mm or 22 mm ID). Portability and small-bore tubing create unique issues when delivering humidification. A drug delivery module 127 can optionally be incorporated internally or externally to the ventilator system 101. Due to challenges with current aerosolized drug delivery inhalers, the present invention can be used to propel and deposit 15 medication particles deep in the respiratory system, without a carrier propellant. Because a patient's using the therapy often also requires prescription medication, this may be a convenient and efficient way to administer the medication. The drug delivery module 127 may deliver drugs together with humidification, alternatively with humidification, or combinations thereof A controller may determine and/or 20 tailor when drugs are delivered by the drug delivery module 127. Embodiments of the present invention may be used in systems that create an entrainment effect. Figs. 2A - 2C illustrate prior art pass-over or pass-through systems that entrain humidified gas and/or ambient air. Figs. 3 - 10 illustrate how embodiments of the present invention are integrated into entrainment systems. 25 Figs. 2A - 2C show prior art pass-over or pass-through bubble systems. In Fig. 2A, a ventilator 201 delivers gas 203 through a patient circuit 205 to a patient 207. A pass-over 209 and/or a pass-through 211 may provide gas to a humidifier/vaporizer/aerosolizer 213. The humidifier/vaporizer/aerosolizer 213 may have water, an aqueous solution, etc. 215 and a vapor phase 217. For a pass-over 209, 30 the gas may pass through the vapor phase 217 only. For a pass-through 211, the gas may pass through the liquid phase 215 and/or the vapor phase 217. The gas may collect vapor or moisture in the humidifier/vaporizer/aerosolizer 213. Humidity may be created using a heated humidifier or an aerosolizer. Some aerosolizers may self generate a flow source. Vapor may reach the patient without a flow source due to 11 6124336_1 (GHMatters) P92825.AU.1 DENISET expansion. After exiting the humidifier/vaporizer/aerosolizer 213, the humidified gas may pass through a vapor channel 219. As shown in Fig. 2B, the vapor channel 219 may be located proximal to the ventilation gas delivery channel 221. One or more sensing lines 223 may be present 5 proximal to the patient circuit 205 to sense various parameters, such as pressure, temperature, humidity, flow, respiration, etc. In the particular embodiment of Fig. 2B, the distal end of the patient circuit 205 may terminate outside the patient airway 225. The delivery of gas 203 may entrain ambient air 227 into the patient airway 225. Alternatively, the patient circuit 205 may terminate at or inside the patient airway 10 225. Fig. 2C shows a pass-over 209 where the humidifier/vaporizer/aerosolizer 213 is separate from the ventilator 201. The humidifier/vaporizer/ aerosolizer 213 and the ventilator 201 may be separate devices and/or integrated. Figs. 3A - 3B illustrate a vapor entrainment system. In Fig. 3A, a ventilator 15 301 delivers gas 303 via a jet Venturi through a patient circuit 305 to a patient 307. A humidifier/vaporizer/aerosolizer 309 may have water, an aqueous solution, etc. 311 and a vapor phase 313. Humidity can be created using a heated humidifier or an aerosolizer 325. The heating or aerosolizing element can be in the reservoir or in the tubing to the patient. After exiting the humidifier/vaporizer/aerosolizer 309, 20 humidified gas may pass through a vapor channel 315. Fig. 3B is a detail of the patient end of the device. The vapor channel 315 may be located proximal to a ventilation gas delivery channel 317. One or more sensing lines 319 may be present proximal to the patient circuit 305 to sense various parameters, such as pressure, temperature, humidity, flow, respiration, etc. In the 25 particular embodiment of Fig. 3B, the distal end of the patient circuit 305 may terminate outside a patient airway 321. The delivery of gas 303 may entrain ambient air 323 into the patient airway 321. Alternatively, the patient circuit 305 may terminate at or inside the patient airway 321. Humid gas may be draw into the patient airway 321 by the ventilatorjet Venturi. 30 Fig. 4 shows an aerosolization system. A ventilator 401 may deliver gas 403 through a patient circuit 405 to a patient 407. Liquid may be fed to an aerosolizer/vaporizer 409 from a reservoir 413 through a conduit 411. From the aerosolizer/vaporizer 409, the liquid may create a vapor and a self-generated flow source that propels the vapor to the patient 407. 12 6124336_1 (GHMatters) P92825.AU.1 DENISET Fig. 5 shows a moisture feed system. A ventilator 501 may deliver gas 503 through a patient circuit 505 to a patient 507. The ventilator 501 may pressurize a reservoir 509 via a feed pressure conduit 511. Liquid droplets may be drawn from the reservoir 509 via a vapor channel 513 into the patient airway by a jet Venturi created 5 by gas 503 exiting the patient circuit 505. The liquid may be aerosolized before it reaches the patient. The liquid may be heated or aerosolized with an element in the patient circuit 505. Figs. 6A - 6B show a moisture feed misting system. As shown in Fig. 6A, a ventilator 601 may deliver gas 603 through a patient circuit 605 to a patient 607. The 10 ventilator 601 may pressurize a reservoir 609 via a feed pressure conduit 611. Liquid droplets may be drawn from the reservoir 609 via a fluid delivery channel 613 into the patient airway by a jet Venturi created by gas 603 exiting the patient circuit 605. The liquid may be aerosolized before it reaches the patient. The liquid may be heated or aerosolized with an element in the patient circuit 605. Fig. 6B is a detail of the patient 15 end of the device. The fluid delivery channel 613 may be located proximal to a ventilation gas delivery channel 615. A secondary gas delivery channel 623 and/or jet 625 may create a mist at a misting screen 627. One or more sensing lines 617 may be present proximal to the patient circuit 605 to sense various parameters, such as pressure, temperature, humidity, flow, respiration, etc. In the particular embodiment 20 of Fig. 6B, the distal end of the patient circuit 605 may terminate outside a patient airway 619. The delivery of gas 603 may entrain ambient air 621 into the patient airway 621. Alternatively, the patient circuit 605 may terminate at or inside the patient airway 621. Humid gas may be draw into the patient airway 621 by the ventilator jet Venturi. 25 Fig. 7 shows a moisture entrainment system. A ventilator 701 may deliver gas 703 through a patient circuit 705 to a patient 707. Liquid may be fed to an aerosolizer/vaporizer 709 from a reservoir 713 through a conduit 711. From the aerosolizer/vaporizer 709, the liquid may be sucked to the patient 707 by a jet Venturi created by the ventilator 701. The liquid may be aerosolized before it reaches the 30 patient 707, for example, using a Capillary Force Vaporizer (CFV), which does not require a gas flow source. Fig. 8 shows a cartridge entrainment system. A ventilator 801 may deliver gas 803 through a patient circuit 805 to a patient 807. Liquid may be drawn or pressure fed to a hydrophilic media cartridge 809 from a reservoir 813 through a conduit 811. 13 6124336_1 (GHMatters) P92825.AU.1 DENISET From the hydrophilic media cartridge 809, the liquid may be drawn out into the patient circuit 805 by a jet Venturi created by the ventilator 801. Fig. 9 shows a cartridge pass-through system. A ventilator 901 may deliver gas 903 through a patient circuit 905 to a patient 907. Liquid may be drawn or 5 pressure fed to a hydrophilic media cartridge 909 from a reservoir 913 through a conduit 911. A flow source, preferably from the ventilator 901, may be fed through a conduit 915 through the hydrophilic media cartridge 909. From the hydrophilic media cartridge 909, the liquid may be delivered to the patient 907 via a delivery conduit 917 separate from the patient circuit 905. 10 Figs. 13A - 13B show embodiments with aerosol gas channels. Fig. 13A shows a fluid channel 1301 entering an aerosol gas channel 1303 prior to exiting the device. The meeting of the gas with the fluid may create humidity. Fig. 13B shows an alternative embodiment with two conduits 1305, 1307 transferring fluid from the fluid channel 1301 to the aerosol gas channel 1303. Fluid may be drawn or pressure 15 fed from a reservoir 1309 that may be pressurized via a conduit 1311 in fluid communication with a ventilator 1313. A ventilation gas delivery circuit 1315 may deliver gas through a patient circuit 1317. Embodiments of the present invention may also be integrated into or used with non- entrainment-based systems. 20 Fig. 10 shows an embodiment of a ventilator 1001 with a capillary force vaporizer 1003 feeding vaporized gas to a patient interface 1005. A capillary force vaporizer 1003 is a subsystem that wicks liquid from a liquid reservoir into a miniaturized heating element where the liquid is converted to a heated vapor. The capillary force vaporizer may be located proximal to the ventilator, in the patient 25 interface, or in the patient circuit. In the preferred embodiment, the capillary force vaporizer is located proximal to the ventilator and the vapor is delivered to the patient interface via the patient circuit along with the flow from the ventilator. To prevent the vapor from condensing in the tubing, the tubing can be heated or the patient circuit can have features to insulate the walls of the patient circuit from ambient temperature. 30 Fig. 11A shows an embodiment of a ventilator 1101 with a nebulizer 1103, such as a vibrating mesh nebulizer or ultrasonic nebulizer, feeding nebulized humidification to a patient interface 1105. The nebulizer 1103 may be located proximal to the ventilator, in the patient interface, or in the patient circuit. In the preferred embodiments, the nebulizer is located in the ventilator and the vapor is 14 6124336_1 (GHMatters) P92825.AU.1 DENISET delivered to the patient interface via the patient circuit along with the flow from the ventilator. If the nebulizer is located proximal to the ventilator, the tubing can be heated to assist in the conversion of the nebulized liquid to vapor and to provide a comfortable temperature gas to the patient. Figs. 11 B and 11 C show an embodiment 5 of a vibrating mesh nebulizer located at the patient interface for an open airway ventilation system. Fig. 11 B shows an exemplary humidification system. Features of a connector may include a syringe-powered liquid feed system 1701, power and control wiring 1703, a vibrating mesh adapter 1705, rapid prototyped adapter 1707, openings 1709 to 10 increase aerosol flow, a modified swivel connector 1711, and/or a ventilator patient circuit 1713. Fig. 1 IC is a schematic of a humidification system as shown in Fig. 11B. A ventilator 1801 may include a graphical user interface 1803, a processor 1805, a liquid feed system power and wiring device 1807, a power source 1809, and/or a 15 liquid reservoir 1811. A gas delivery lumen 1813 may lead to a tracheostomy tube 1815. A pressure sensing lumen 1817 may also run from the ventilator 1801 to a tracheostomy tube 1815. Vibrating mesh nebulizer power and control wiring 1819 may lead from the ventilator 1801 to a vibrating mesh nebulizer 1821. The vibrating mesh nebulizer 1821 may be in fluid communication 1823 with the liquid reservoir 20 1811. A swivel or other type of connector 1825 may couple the vibrating mesh nebulizer 1821 with the tracheostomy tube 1815. Fig. 12 shows a ventilator 1201 with an aerosolizing catheter 1203 feeding aerosolized gas to a patient interface 1205. An aerosolizing catheter 1203 is a subsystem that transports liquid from a liquid reservoir to a miniaturized aerosolizing 25 tip where the liquid is converted to an aerosol. A driving pressure is used to feed liquid through the aerosolizing catheter and create the aerosol. In a preferred embodiment, pressure from the ventilator is used to create the driving pressure. The aerosolizing catheter can either be inserted into the patient circuit, or incorporated into the patient circuit such that the patient circuit has a lumen dedicated to transporting 30 liquid from the liquid source to the aerosolizing tip. The aerosolizing tip may be located proximal to the ventilator, in the patient interface, or in the patient circuit. In the preferred embodiment, the aerosolizing tip is located proximal to the patient interface or within the patient interface, such that the aerosol is delivered to the patient with minimal interaction between the aerosol and the walls of the patient 15 6124336_1 (GHMatters) P92825.AU.1 DENISET interface. To optimize patient comfort, the portion of the aerosolizing catheter that transports liquid from the liquid reservoir to the aerosolizing tip may be heated. Figs. 14A - 14B show embodiments for delivering humidified gas using additional gas flow channels. In Fig. 14A, a fluid channel 1401 may be surrounded 5 by a gas flow channel 1403, which may terminate at substantially the same position as the fluid channel 1401. At the termination point of the channels 1401, 1403, the fluid may be aerosolized and delivered to a patient interface or directly to an airway. In Fig. 14B, a gas flow channel 1405 may be surrounded by a fluid channel 1407, which may terminate at substantially the same position as the gas flow channel 1405. At the 10 termination point of the channels 1405, 1407, the fluid may be aerosolized and delivered to a patient interface or directly to an airway. In an additional embodiment, either the system constituted by 1403 and 1401 or 1405 and 1407 can concentric to the ventilation gas delivery channel at the entrainment port location or, more generally, can be the jet portion of the venturi pump. In this embodiment, the gas flow 15 1403 or 1405 will aerosolize the fluid in the channels respectively 1401 and 1407. The resulting aerosolized mixture of fluid and gas will be the jet that will entrain the air into the ventilation gas delivery channel. The increased density of the gas/aerosol mixture will provide an increase of entrainment performance, effectively entraining more air with the same gas flow. 20 Humidification sources, such as the capillary force vaporizer, vibrating mesh nebulizer and aerosolizing catheter, can be controlled to provide humidification levels that are dependent upon patient need. For instance, one or more humidification sensors can be located between the humidification source and the patient, and the amount of humidification added by these subsystems can be servo controlled to 25 provide a target humidification level that meets the patient's needs but prevents rainout, for example, 75% relative humidity. Alternately, the humidification subsystem can be characterized such that the control system can predictively set the output of the humidification source based on known characterization of the humidification subsystem and other variables such as the gas flow delivered to the 30 patient, ambient temperature, ambient humidity, and combinations thereof The controller for the humidification system can be a standalone subsystem, or in a preferred embodiment, can be integrated with the ventilator. Preferably, the humidification sources can be controlled in synchrony with the patient's breathing cycle, such that more humidity is added during the patient's 16 6124336_1 (GHMatters) P92825.AU.1 DENISET inspiratory phase and less or no humidity is added during the patient's expiratory phase. Those skilled in the art would recognize that the large bore tubing used in practice today contains a large internal volume (approximately 750 ml for 22mm tubing), making it challenging or impossible to synchronize humidity levels with the 5 patient's breathing pattern at the patient connection port while providing humidification at the ventilator end of the tubing because of the very significant phase delay introduced by the tubing. By comparison, the internal volume of small bore tubing embodied in this invention (approximately 50 ml for 6 mm tubing) introduces only minimal inaccuracies due to phase delay. 10 The main cause of "rainout", or condensation of water within the delivery tube, is the increase of the relative humidity above saturation due to the cooling of the humidified breathable gas flowing into the delivery tube. The use of small bore tubing requires high pressure levels (40psig or higher) to be generated by the mechanical ventilator to obtain appropriate treatment pressure values at the patient 15 interface. The high pressure drop along small bore tubes may be employed to counteract the increase of relative humidity that leads to water condensation as mentioned above. As the pressure of the breathable gas decreases from the patient distal to the proximal portions of the delivery tube, the relative humidity decreases correspondingly. This effect is used to keep a high and constant relative humidity, 20 making sure that no condensed water forms in the delivery tube. The magnitude of this effect is dependent on the actual flow delivered to the patient since the higher the required flow, the higher the pressure drop along the delivery tube and the higher the pressure generated by the ventilator must be. The heat loss along the tube is also dependent upon the flow rate of the gas; in particular it may be lower at lower flow 25 rates. At low flow rate values, the increase of relative humidity due to temperature drop of the breathable gas may be lower, as well as the decrease of relative humidity due to the pressure drop along the delivery tube. The opposite may happen at higher flow rates. This mechanism of compensation of the two mentioned effects may be naturally synchronized with the breathing cycle of the patient. The effect may only be 30 used when small bore tubes are utilized since bigger bore tubes (15mm ID or more) may not require pressure levels where this phenomenon is of appreciable magnitude. Additionally, if heated tubing is utilized, the energy applied to the heater can be controlled in synchrony with the patient's needs and breathing cycle, allowing for a highly optimized system. Heated tubes preferably are small-bore tubes with an inner 17 6124336_1 (GHMatters) P92825.AU.1 DENISET diameter of approximately 2 - 14 mm. One of skill in the art would understand that heated tubes can employ electrical elements to provide heat. The electric power provided to the heater can be synchronized with the patient breathing cycle and/or humidity needs during the breathing cycle. The use of small bore tubes may provide a 5 small thermal inertia to the system, effectively allowing a fast response and precise temperature/humidity control of the gas delivery system. Fig. 15 shows a humidification system for a ventilator. A ventilator 1501 may include an oxygen input 1503 a patient circuit output 1505. A water supply 1507 may be included, which may be gravity fed. The patient circuit output 1505 may include a 10 humidity adapter assembly 1509. A water inlet 1511 may lead to a bias spring 1513 or similar device, which may then lead to a reservoir 1515. The reservoir may be approximately 5 ml or any other appropriate size. Augmentation from the ventilator 1501 may be fed 1517 into the reservoir 1515. An output 1519 may be provided to a patient circuit 1521. An approximately 2 psig spring 1523 may prevent overfilling 15 during exhalation. Fig. 16 shows a system for heated humidified gas. A source 1601, such as a gas cylinder or pump, may provide gas at approximately 100 psig or more. The source 1601 may provide gas to a regulator 1603 that regulates gas pressure to a predetermined and/or desired level. In certain embodiments, this may be 20 approximately 100 psig. The gas is then provided to a vortex heat separator 1605, where hot gas may be provided to a second regulator 1607, where the gas pressure is regulated to a predetermined and/or desired level. In certain embodiments, this may be approximately 50 psig. A flow control valve 1609 may then provide the hot gas to a humidifier 1611. From the vortex heat separator 1605, cold gas may be provided to 25 a third regulator 1613, where the gas pressure is regulated to a predetermined and/or desired level. The third regulator 1613 may provide the cold gas to a heat exchanger 1619. In certain embodiments, this may be approximately 50 psig. The cold gas may be provided to a ventilator 1615. Warm and humidified gas from the humidifier may be combined with the cold gas from the ventilator prior to, within or separate from a 30 patient interface 1617. Fig. 17 shows a nasal interface 1701 with a hygroscopic material 1703 incorporated therein. Hygroscopic material captures the heat and moisture from a patient's exhaled breaths and returns the heat and moisture to the patient's inspired gas. It is a passive technology that requires no further complicating factors such as 18 6124336_1 (GHMatters) P92825.AU.1 DENISET electricity and moisture feed to establish a heat/humidification target for a patient, thereby providing a simple implementation of a heat/moisture system for ventilation. Examples of suitable hygroscopic materials include commercially available heat and moisture exchangers (HME), and hygroscopically treated heat and moisture 5 exchangers (HHMIE) such as paper or polypropylene inserts treated with hygroscopic chemicals, usually calcium or lithium chloride, to enhance moisture retention. The hygroscopic material 1703 may be porous. In certain embodiments, all or nearly all of the patient's inspired and/or expired gas may pass through the hygroscopic material 1703. In these embodiments, nasal pillows 1705 may seal the patient's nose. 10 Preferably all the flow exhaled by the patient and all the flow inhaled by the patient should pass through the hygroscopic material to optimize heat and moisture retention during the expiration phase and maximize the heating and humidification of the breathable gas inhaled by the patient. Optimal sizes are generally dependent upon the material used, its thickness and the fluid- dynamic design of the patient interface. A 15 preferred embodiment may have most of the surface of the hygroscopic element exposed to the flow exhaled and inhaled by the patient, and may have a thickness of preferably about 2 to about 20mm and a surface area of about 150 to about 800mm2 Embodiments of the present invention integrate hygroscopic material within a nasal interface to provide a patient interface that heats and humidifies the patient gas. 20 The hygroscopic material 1703 may be located anywhere in a gas flow path within the nasal interface 1701. In a preferred embodiment, the hygroscopic material 1703 may be located within a pillows portion 1705 of the nasal interface 1701 or within cushions attached to the pillows portion 1705. The pillows portion 1705 may extend into and/or contact the nose of a patient, and may extend into a manifold portion 1707 25 of the nasal interface. One or more channels 1709 may provide a gas flow path through the nasal interface 1701 from inputs 1713 from a patient delivery circuit to outlets 1711 near or in the patient's nose. One or more sensing ports 1715 may detect pressure, humidity or other variables. Preferably, the one or more sensing ports 1715 are located on a patient side of the hygroscopic material 1703 to produce more 30 accurate readings. The hygroscopic element can be used in conjunction with any of the previously disclosed active humidification systems to minimize the amount of water required by the ventilation system. Whenever a hygroscopic element is present, the delivery of humidification can be timed to the breathing cycle of the patient and the 19 6124336_1 (GHMatters) P92825.AU.1 DENISET delivery of active humidification can be decreased or even suspended during certain phases of the breathing cycle, such as during exhalation. This may allow for optimal humidification of the patient ensuring minimal use of water and energy, thus increasing the portability of the ventilation device. 5 A location within the pillows portion 1705 may provide several advantages: (1) By incorporating the hygroscopic material 1703 in direct proximity to the patient's nose, there a maximized efficiency because of the negligible heat loss between the hygroscopic material and the patient. (2) Both the hygroscopic material 1703 and the pillows interface 1705 may be 10 made from compliant materials, and therefore co-locating these materials provides the smallest possible implementation of the patient interface without sacrificing function of either material. (3) Both the pillows interface 1705 and the hygroscopic material 1703 may be user-exchangeable components that are periodically changed to maintain system 15 performance and cleanliness. Therefore, co-locating the pillows 1705 and hygroscopic materials 1703 may provide for the simplest user maintenance experience. (4) The location of the hygroscopic material 1703 may minimize sound for at the patient gas entry point. Sound may propagate through both the air and the patient. 20 The hygroscopic material 1703 acts to diffuse gas flow prior to the ventilation gas entering the patient, and, therefore, reducing the noise levels of the gas flow. Additionally, the hygroscopic material 1703 may diffuse gas flow exhaled by the patient to the ambient and or the gas flow vented to the ambient from the patient interface therefore, reducing the noise. 25 One or more controllers may regulate the systems and methods of the present invention. The one or more controls may include one or more processors and one or more memories. The one or more controls may control the ventilator and/or the humidification systems. The one or more controls may receive signals from one or more sensors and process those signals to create a new signal to send to the ventilator 30 and/or humidifier to adjust gas delivery parameters. Although the foregoing description is directed to embodiments of the invention, it is noted that other variations and modifications will be apparent to those skilled in the art, and may be made departing from the spirit or scope of the invention. Moreover, features described in connection with one embodiment of the invention 20 6124336_1 (GHMatters) P92825.AU.1 DENISET may be used in conjunction with other embodiments, even if not explicitly stated above. The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. 5 It is to be understood that, if any prior art publication is referred to herein, such reference does not constitute an admission that the publication forms a part of the common general knowledge in the art, in Australia or any other country. In the claims which follow and in the preceding description of the invention, except where the context requires otherwise due to express language or necessary 10 implication, the word "comprise" or variations such as "comprises" or "comprising" is used in an inclusive sense, i.e. to specify the presence of the stated features but not to preclude the presence or addition of further features in various embodiments of the invention. This application is a divisional child of AU2011308548 the entire contents of 15 which are hereby incorporated by reference. 21 6124336_1 (GHMatters) P92825.AU.1 DENISET

Claims (20)

1. A system for humidifying ventilation gas, the system comprising: 5 a ventilator; a patient circuit in fluid communication with the ventilator at a proximal end and fluidly connected to a patient airway at a distal end, wherein the patient circuit has an inner diameter of approximately 2 - 14 mm; a fluid reservoir; 10 a humidification device; and a channel between the humidification device and a distal end of the patient circuit.

2. The system of claim 1, further comprising a patient interface, wherein the patient interface is a nasal interface, an oral interface, or a transtracheal interface. 15

3. The system of claim 1, wherein the fluid is water, a drug solution, or combinations thereof

4. The system of claim 1, wherein a drug is delivered alternatively with humidification.

5. The system of claim 1, wherein the ventilator is portable. 20

6. The system of claim 1, wherein the channel ends proximal to an end of the patient circuit, such that a jet venturi created by the gas in the patient circuit entrains vapor from the channel.

7. The system of claim 1, wherein the fluid reservoir is pressurized by gas from the ventilator. 25

8. The system of claim 1, further comprising a misting screen at a distal end of the channel.

9. The system of claim 8, further comprising a second channel for delivering gas to create a jet prior to the misting screen.

10. The system of claim 1, further comprising a hydrophilic media 30 cartridge within the channel.

11. The system of claim 1, further comprising a capillary force vaporizer.

12. The system of claim 1, further comprising a vibrating mesh nebulizer.

13. The system of claim 1, further comprising an aerosolizing catheter. 1 6124336_1 (GHMatters) P92825.AU.1 DENISET

14. The system of claim 1, further comprising a gas flow channel surrounding the channel.

15. The system of claim 1, wherein the channel surrounds a gas flow channel. 5

16. The system of claim 1, further comprising a vortex heat separator for providing hot gas to a humidifier and cold gas to the ventilator.

17. The system of claim 1, wherein delivery of the humidified ventilation gas is servo controlled.

18. The system of claim 1, wherein the humidified ventilation gas is 10 delivered in synchrony with the patient's breathing cycle.

19. The system of claim 1, wherein an average flow rate of gas delivered by the ventilator is greater than approximately 6 1pm.

20. The system of claim 1, wherein the delivery of humidified gas is controlled to within 50 to 95% relative humidity to prevent rainout within the patient 15 circuit. 2 6124336_1 (GHMatters) P92825.AU.1 DENISET