THEREFORE, THE PHASITRONÒ PROVIDES FOR A BASIC LUNG PROTECTIVE STRATEGY TO PREVENT PREFERENTIAL AIRWAY BAROTRAUMA.

The patient breathes through a physiological interface called a Phasitron® delivering high flow sub tidal (mini-bursts) of air into the lungs at rates of from 100-300 times each minute.  During the delivery of the percussive bursts of air into the lungs, a continued wedge pressure is maintained to stabilize the peripheral pulmonary airways, while a percussive high velocity flow penetrates the bronchial airways and enhances endobronchial secretion mobilization.

A dense therapeutic aerosol mist is delivered into the lungs during therapeutic percussion, which serves to reduce the adhesive and cohesive forces of retained airway secretions.

During the therapeutic percussive interval there is a cyclical intrapulmonary exchange of respiratory gases, which serves to flush out carbon dioxide and renew oxygen within the bronchiolar airways and their alveoli. This therapeutic lung recruitment (TLR)ä is administered by, the IPVÒ family of percussive therapeutic lung recruitment ventilators (Percussionators®).

PATHOPHYSIOLOGY OF BONCHITIS

When the peripheral pulmonary airways of the lungs are partially obstructed the patient is able to marginally increase the diameter of the bronchioles and their alveoli during peak spontaneous inhalation followed by the early bronchiolar collapse during exhalation. This causes distal bronchial-alveolar air trapping by maintaining a continuous semi inflational pressure, potentially stretching the bronchiolar walls as well as the alveoli they serve.

Over time; when the bronchiolar and pulmonary capillaries attached to the walls of the bronchioles and their alveoli are stretched and narrowed, the reduction in bronchiolar peristaltic blood flow causes the alveolar tissues they serve, to become ischemic leading to an ultimate tissue necrosis causing; Diffuse Obstructive Pulmonary Emphysema, which is called end lung disease when the basic architecture of the lungs is irreparably damaged.

During recent years certain clinicians have employed (long term) constant positive airway pressure “against the pulmonary airways” delivered through non-invasive pulmonary airway introductions as well as invasive endotracheal tubes etc. This creates a continuous mechanically graded alveolar inflation pressure during spontaneous respiration encroaching upon the normal alveolar inhalational inflation and exhalational deflation. Thus, similar to physiological obstructive air trapping the alveolar bronchial blood flow can be encroached upon (over time) leading to a potential ischemia.

Typical continuous positive airway pressure (CPAP) during spontaneous ventilation preventing the bronchiolar airways and their alveoli to passively empty to an end resting position, encroaching upon normal phasic bronchiolar and pulmonary vesicular perfusive peristalsis.

courtesy  Null et al

The above cross section in a Preterm Lamb lung is employed to reveal the potential for an ischemia with a progressive peripheral lung necrosis secondary to the continuous maintenance of CV alveolar CPAP during spontaneous non-invasive ventilation.

When a Percussive Intrapulmonary Ventilation (IPV®) is programmed (over time) during a non-invasive or invasive spontaneous ventilation “NCPAP Alveolar Separation” is not revealed.

The above non-invasive oscillatory Intrapulmonary Percussive Ventilation (IPV®) demonstrates the positive i/e ratio with a slight enhanced vesicular peristalsis, dramatically reducing the potential for peripheral lung necrosis during Oscillatory Demand Positive Airway Pressure (OD-PAP) programming, as opposed to a constant positive airway pressure.

MECHANICAL PERCUSSIVE INDUCED VESICULAR PERISTALSIS
The Intrapulmonary Percussive Ventilation (IPV®) protocol has the ability to enhance physiological “Intrathoracic Vesicular Peristalsis” (venous pump). The above documentation serves to document the wedging of a Swan Catheter into the effective pulmonary circulation demonstrating a percussive oscillatory enhancement to pulmonary blood flow.

Withdrawal of the Swan Catheter from the affected pulmonary circulation terminates the “mechanically enhanced Physiological Vesicular Peristalsis serving as evidence of the enhancement to blood flow through the Bronchial and Pulmonary Vessels attached to the alveolar walls”.

IN BRIEF SUMMARY

Intrapulmonary Percussive Ventilation (IPV®) programmed as a NON- INVASIVE or INVASIVE Oscillatory Demand Positive Airway Pressure  (OD-PAP), provides for a relatively “low mean airway pressure” while maintaining an effective expansion and contraction (peristalsis) of the  bronchioles and their alveoli, during Oscillatory Percussive Ventilation allowing an unobstructed Spontaneous Breathe Through.

Of note is, the periodic Sinusoidal Increase in PIP for an increased Convective Ventilation component, enhancing “CO2 wash out” while increasing the potential effect of an enhanced Vesicular Peristalsis.

The Oscillatory Percussive ventilatory scheduling can reduce the potential for Lung Injury through a conceived “LUNG PROTECTIVE STRATEGY.

Additionally, Intrathoracic Pulmonary and Bronchial circulations as well as the Lymph circulations are augmented by a mechanical Intrapulmonary Vesicular Peristalsis.

THE SINUSOIDAL BRONCHOTRON® CAN BE SCHEDULED TO PROVIDE FOR A SINUSOIDAL VDR® (HFPV) TYPE OF PERCUSSIVE OSCILLATORY PROGRAMMING FOR PERIPHERAL LUNG VENTILATION AND CIRCULATORY RECRUITMENT AND MAINTENANCE.

During recent years certain clinicians have employed constant positive airway pressure “against the pulmonary airways” delivered through non- invasive pulmonary airway introductions as well as invasive endotracheal tubes etc. This creates a continuous graded bronchiolar and alveolar inflation pressure during spontaneous respiration encroaching upon the normal peristaltic alveolar inhalational inflation and exhalational deflation. Thus, similar to pathophysiological obstructive air trapping the alveolar bronchial blood flow can be encroached upon leading to a potential mechanical induced ischemia.

THE TRANS RESPIRATOR® F00038-2 SPECIAL TRANSPORT PACKAGING OF THE SINUSOIDAL BRONCHOTRON F00038-1 FOR THERAPEUTIC LUNG RECRUITMENT AND MAINTENANCE