Methods, Systems and Devices for Desufflating a Lung Area

Abstract

Methods, systems and devices are described for temporarily or permanently evacuating stagnating air from a diseased lung area, typically for the purpose of treating COPD. Evacuation is accomplished by displacing the stagnant CO 2 -rich air with a readily diffusible gas using a trans-luminal indwelling catheter specially configured to remain anchored in the targeted area for long term treatment without supervision. Elevated positive gas pressure in the targeted area is then regulated via the catheter and a control unit to force under positive pressure effusion of the diffusible gas out of the area into neighboring areas while inhibiting infusion of other gases thus effecting a gradual gas volume decrease and deflation of the targeted area, thereby reducing volume of ineffective areas, increasing tidal volume of better areas, and improving lung mechanics.

1 . An apparatus for improving lung mechanics, the apparatus comprising a DLMW gas delivery system comprising:
 a. a supply of DLMW gas;   b. a catheter delivery system connected at one end to the supply of DLMW gas and connected to the patients lung airway at the other end;   c. a control system to control the delivery of the DLMW gas from the supply to the lung through the catheter such that diseased areas of the lung exhibiting poor ventilation are reduced in volume so that the lung mechanics can improve;   
       and wherein improved lung mechanics is selected from the group of decreased dynamic hyperinflation, decreased static hyperinflation, diaphragm position, accessory muscles, reduced residual volume, increased tidal volume. 
     
     
         2 . An apparatus for increase the tidal volume of a lung area by reducing the residual volume of a neighboring target diseased lung area using Diffusible Low Molecular Weight (DLMW) gas, the apparatus comprising:
 a. a supply of diffusible low molecular weight (DLMW) gas comprising a diffusivity of at least 10 4  cm2/sec, and a molecular weight of 2-20 atomic mass units;   b. a catheter with one end adapted to be connected to the supply of DLMW gas and the opposite end adapted to be placed in an airway leading to said target lung area, wherein the catheter comprises an airway anchor adapted to secure the catheter in a position in the airway for extended periods without occluding the airway and without requiring continuous supervision from a person;   c. a control unit in connection to the supply of DLMW gas, comprising a gas delivery control system adapted to provide controlled delivery of the DLMW gas into the target lung area, said controlled delivery comprising reducing the volume of the lung area.   
     
     
         3 . An apparatus for reducing the residual volume of a target lung area using Diffusible Low Molecular Weight (DLMW) gas, the apparatus comprising:
 a. a supply of diffusible low molecular weight (DLMW) gas;   b. a catheter with one end adapted to be connected to the supply of DLMW gas and the opposite distal end adapted to be placed in an airway leading to said target lung area;   c. a control unit in connection to the supply of DLMW gas, comprising a gas delivery control system adapted to provide controlled delivery of the DLMW gas into the target lung area, said controlled delivery comprising reducing the volume of the lung area.   
     
     
         4 . An apparatus as in  claim 3  wherein the catheter further comprises a non occlusive anchor at the distal end, wherein the anchor secures the catheter distal end in position for an extended period of more than 30 minutes without occluding the airway and without requiring supervision from a person. 
     
     
         5 . An apparatus as in  claim 3  wherein the gas delivery control system is adapted to control the pressure of DLMW gas in the lung area to a desired pressure level. 
     
     
         6 . An apparatus as in  claim 3  wherein the DLMW gas comprises a molecular weight of 2-20 atomic mass units and a diffusivity of at least 10 4  cm2/sec. 
     
     
         7 . An apparatus as in  claim 3  wherein the catheter comprises a lumen for gas delivery and a lumen for gas removal. 
     
     
         8 . An apparatus as in  claim 3  wherein the gas delivery control system is adapted to control the increase in volume in a neighboring lung area. 
     
     
         9 . An apparatus as in  claim 3  wherein the gas delivery control system is adapted to improve lung mechanics by one or more of the following: improve gas exchange in a neighboring lung area; improve ventilation in a neighboring lung area; increase volume in a neighboring lung area; improve lung muscle resting position. 
     
     
         10 . An apparatus as in  claim 3  wherein the catheter is adapted with a lumen to exhaust gas out of the target lung area. 
     
     
         11 . An apparatus as in  claim 3  wherein the distal end of said catheter comprises both a non-occlusive anchor for anchoring in said bronchus, and a radially inflatable occlusive member which comprises a means to intermittently inflate to occlude the annular space around said catheter in the said area's feeding bronchus, and optionally wherein said catheter and said pneumatic control unit automatically work in unison such that said inflation and occlusion is synchronized with said DLMW gas delivery. 
     
     
         12 . A catheter as in claim  56  wherein said anchoring member occludes said bronchus intermittently wherein said pneumatic control unit comprises a means to synchronized delivery of said DLMW gas with said occlusion of said bronchus. 
     
     
         13 . An apparatus as in  claim 3  wherein said control unit comprises a control algorithm for producing one or more of the following gas delivery profiles: constant, intermittent, oscillatory, synchronize said DLMW gas delivery and optionally said gas exhaust with the patient's breathing pattern for the purpose of maintaining a desired pressure in said targeted lung area. 
     
     
         14 . An apparatus as in  claim 3  wherein the control unit controls gas delivery by one or more of the following: said targeted lung area pressure is measured through a lumen in the catheter in communication with a pressure sensing means; multiple pressure sensing ports integral to the catheter to measure flow into and out of the catheter; a gas concentration measuring means. 
     
     
         15 . An apparatus as in  claim 3  wherein said control unit is integrated with a mechanical ventilator 
     
     
         16 . An apparatus as in  claim 3  wherein said pneumatic control unit is adapted for ambulatory use portable and wearable by the user, for example with a belt clip, fanny pack or shoulder strap and optionally includes a replaceable or refillable DLMW gas cartridge. 
     
     
         17 . A catheter as in  claim 3  further comprising one or more of the following: wherein said catheter shaft comprises a de-coupling means, said means permitting a disconnection of the proximal end of said catheter from balance of said catheter; wherein said catheter shaft comprises a concentric connection means, said means further comprising an anchoring feature at the point of entry to the body and optionally providing a sealing feature at the point of entry to the body. 
     
     
         18 . An apparatus as described in  claim 3  further comprising a means to delivery a therapeutic agent selected from the group of: a mucolytic, an agent to increase or decrease tissue diffusivity, bronchodilators, surface tension modifiers, 
     
     
         19 . An apparatus as in  claim 3  further comprising one or more of the following: the catheter anchor comprises a radially compressible structure with a resting diameter concentric to said catheter shaft typically 2-20 mm in diameter, such as but not limited a wire structure attached to the shaft of said catheter, such as but not limited to a wire framed cylindrical or spherical structure, such as but not limited to straight non-crossing wires, woven wires and braided wires; the catheter comprises an outer concentric sleeve wherein said sleeve is axially slide-able with respect to said catheter shaft and further wherein said anchoring member is compressed into a radially collapsed state between said catheter shaft and said sleeve and further wherein upon moving said catheter or said sleeve axially, said anchoring member is released and freely radially expands towards its resting diameter, said expansion producing tension against said bronchial wall, said tension typically 0.5-3.0 lbs force and preferably 0.75-1.5 lbs force; the catheter comprises an inflatable anchoring member and comprises an inflation or deflation means for elective inflation; the catheter comprises an outer catheter and an inner catheter wherein said inner catheter includes said non-occlusive anchor at its distal end wherein said inner catheter and anchor protrudes from the distal tip of said outer catheter; the catheter comprises an outer diameter of typically 0.5-4.0 millimeters, most preferably 2-3 millimeters and a gas delivery lumen of typically 0.25-2 millimeters, most preferably 0.5 millimeters, and optionally comprising a gas exhaust lumen of a diameter of typically 0.25-3 millimeters, most preferably 2 millimeters, and further comprising a length of typically 80-200 centimeters, most preferably 100-140 centimeter.