NZ766784A - Ventilation mask - Google Patents

Abstract

The present invention relates to improvements in anaesthesia masks and ventilation masks. One of the drawbacks of mask ventilation is that it requires constant contact between the provider’s hands and the patient’s face to hold the mask in place. Furthermore, situations arise during surgery that require rapid intubation of a patient. Full face masks, i.e., masks covering both the nose and mouth of a patient, are problematic in emergency situations since a mask must be removed to uncover the mouth of a patient for intubation. The nasal ventilation mask of the invention provides at least the features of a body having an interior forming a nasal cavity, a gas channel, and an exterior opening, wherein the nasal cavity is configured to cover a patient’s nose while leaving a mouth of the patient uncovered and the gas channel is separated from the nasal cavity and an end tidal CO2 port fluidly coupled to the exterior opening through the gas channel of the body, which address drawbacks of the prior art.

Description

VENTILATION MASK This ation claims priority from US. Provisional Application Serial No. 62/039,759, filed August 20, 2014 and from U.S. Provisional ation Serial No. 62/078,677, filed November 12, 2014 and from US. Provisional Application Serial No. 62/161,041, filed May '13, 2015 the contents of which are orated herein by reference.

The present ion relates to improvements in anesthesia masks and ventilation masks.

During surgery a patient usually is placed under anesthesia. The most common delivery system consists of canisters ning anesthesia gases and oxygen, a system of regulating the gas flow and the patient’s breathing, and a device ensuring the potency of the patient’s airway for breathing, oxygenation and the ry of the anesthetic gas mixture. A ventilation mask is used to provide oxygen to the patient either during emergency and/or elective airway ment, which includes but is not limited to; before a patient is anesthetized for surgery, while the patient is anesthetized, if the patient is sedated during the surgery or procedure, while the patient is recovering from anesthesia, after the patient has recovered from anesthesia, or during any event where a patient requires supplemental oxygen.

However, one of the drawbacks ofmask ventilation is that it requires constant contact between the provider’s hands and the patient’s face to hold the mask in place and keep the patient in the sniffing position in order to ensure that oxygen and etic gases do not leak out into the air and that the patient’s airway remains patent. If the provider does not maintain the patient in the sniffing position, a dangerous complication known as upper airway obstruction may occur. The reason the provider needs to m continuous mask holding and maneuvering is the human anatomy and logy. When muscles of the jaw, tongue and upper airway relax due to sedatives and/or muscle relaxants given to the t for sedation and/or anesthesia, the upper airway (mouth, pharynx, larynx) may become partially obstructed and possibly completely closed. Wherein, when the jaw of the patient drops and the tongue cts the airway resulting in snoring al obstruction) or apnea (complete inability for oxygen to pass via the upper airway into the lungs). Another problem exists when a provider fails to administer enough anesthesia or sedation or it begins to wear off and the'patient begins to move. This can cause the patient’s airway to t as well since the patient’s head and neck position are no longer in the sniffing position. Patient movement during surgery can also be dangerous because it , can cause the n to make a mistake, particularly in eye, ear, nose, neck, head, and throat surgery.

Furthermore, situations arise during surgery that e rapid intubation of a patient. Full face masks, i.e. masks covering both the nose and mouth of a t are problematic in emergency situations since a mask must be removed to uncover the mouth ofa patient for intubation. However, removing the mask also removes oxygen support. As will be bed below, the present invention in one aspect addresses the aforesaid and other disadvantages of the prior art.

The present invention, in another aspect relates to pulmonary resuscitation (CPR) masks.

Cardiopulmonary resuscitation, commonly known as CPR is an emergency procedure performed in an effort to manually preserve intact brain function until further measures may be taken to restore spontaneous blood circulation and breathing in a person (hereinafter the “subject” or “victim”) who is in cardiac arrest. CPR also is indicated in those who are unresponsive with no breathing such as in the case of a drowning victim or victim of electrical shock, or abnormal breathing, for example agonol respiration.

CPR involves chest compressions at least two inches deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pumping blood through the heart and thus the body. The rescuer also may provide breaths by either exhaling directly into the t’s mouth, or through a CPR mask into the subject’s mouth and/or nose (collectively “mouth—to—mouth resuscitation”), or using a device that pushes air into the subject’s lungs through the subject’s mouth and/0r nose. The s of externally providing ventilation is termed “artificial respiration”. Current recommendations place emphasis on high-quality chest compressions over cial ation; however, when coupled with high-quality chest compressions, artificial respiration provides potentially the st benefit to the patient.

Conventional CPR masks are held in place by hand, by the CPR provider, or may be retained in on by straps that extend behind the head of the subject or victim. While CPR masks may assist in ventilation of a subject or Victim who is not breathing, when a rescuer provides mouth—to—mouth and/or nose-to-mouth itation, the air provided contains a significant amount of C03 which is lethal.

As will be discussed below, the t invention in another aspect addresses the aforesaid and other disadvantages of the prior art.

The t ion in one aspect provides an ed ventilation/anesthesia mask that overcomes the aforesaid and other problems of the prior art. More ularly, there is provided a nasal ventilation/anesthesia mask comprising one or more offset gas openings to allow the provider to have a clear view of the mouth and airway during direct laryngoscopy and intubation, which consists of a ventilation port to supply oxygen and other gases during anesthesia Via Non— ve Positive Pressure Ventilation (NIPPV) and which is connected to an anesthesia circuit which can measure end-tidal C02 from the nose, an oral opening port under the nose for scavenging anesthesia gases and end—tidal C02 that are expelled orally from the patient; a gas seavenging/end—tidal C02 port ted to a channel inside the mask that is isolated from the nasal cavity, and an oxygen port for supplying post op oxygen. Completing the mask are a plurality of tabs or s, preferably three, or four, for strapping the mask to the patient’s head or for tying the mask down to the operating table, e.g._, in accordance with the teachings of our co— pending PCT application PCT/USl4/44934 and on eo-pending PCT application PCT/U81 5/34277.

In one ment of the invention there is provided a nasal ventilation mask having an 02 port for introducing oxygen into the mask, a ventilation port and a gas monitoring attachment integral to or attached to the ation port. In such embodiment, the gas monitoring port includes a luer lock.

In another embodiment of the invention, there is provided a nasal ventilation mask having an exterior opening under a nose region in the mask, over the patient’s lip region, that allow gases expelled orally to be scavenged and ported to a scavenger device, said mask optionally further including a Scavenger line for diverting a portion of the expelled gas to be monitored for end-tidal C02, and, wherein a connector ably is provided at point where the end-tidal C02 monitoring line intercepts the Scavenger line, effectively diverting the gas flow, resulting in a ve pressure relative to the end—tidal C02 line whereby to pemiit gasses to be sampled from the scavenger line.

In such ment, the mask may r comprise an anesthesiologist lled 2-way, 3 port valve permitting an anesthesiologist to switch between separately monitoring nasal and oral expulsions of end—tidal CO2 or monitoring them simultaneously when the valve is open to both, wherein, when the Oral end—tidal C02 monitoring port is chosen, the end—tidal CO2 monitoring line preferably also serves to scavenge other ventilation gasses during anesthesia.

The present invention also provides a nasal ventilation mask having tabs or eyelets for attaching the mask anteriorly with the mask anchor, or posteriorly with a traditional anesthesia mask strap, said mask further optionally characterized by one or both of the following features: (a) allowing only one combined anterior—posterior head strap to be attached, where the posterior head strap can attach to the mask alone, or can attach to the mask and then to a surface, which will prevent movement of the patient’s head and/or neck; or (b) securing the patient’s head with a head strap to the support e, where the patient’s head will stay in a desired position and the support surface will stay in the desired position when the provider changes the head and/or neck angles.

In yet' another embodiment of the invention there is provided a nasal mask characterized by one or more of the ing features: (a) n the mask is usable as an oxygen transport mask or as a Ventilation mask providing 02 and anesthesia gases and for monitoring end-tidal CO2 simultaneously; (b) having ports for ring end-tidal CO2 via one or more ports, that can be used for CPAP pre-operatively, intra—operatively, and post-operatively; (0) having ports for ring end—tidal CO2 via one or more ports, that can be connected to a resuscitator bag in such a way that the patient’s mouth and airway are not obstructed by the res uscitator bag to allow for direct laryngoscopy and intubation; (d) wherein the mask is attachable anteriorly with a mask anchor, or posterior]y with a traditional anesthesia mask strap; and (e) having an 02 port for introducing oxygen into the mask, a ventilation port and a gas monitoring attachment integral to or attached to the ation port, wherein the gas monitoring port preferably es a luer lock The present invention also provides an anesthesia mask having a built in scavenger system for collecting anesthetic gases that leak out around the mouth and/or nose.

In yet another embodiment, the present invention provides a chin strap for application to the submental space, ed to a nasal mask, for applying pressure to force a wearer’s tongue against the soft palate and induce an obstruction of the retro- glossal space, y to reduce or prevent leakage of gases out of the patient’s mouth and allow the patient to breath out of the nose, wherein the chin strap also has the ability to release pressure, if needed, during exhalation to prevent an expiratory obstruction.

In another aspect the present invention provides an improved CPR mask for mouth—to—mouth and/or nose-to-mouth resuscitation and includes a C02 absorber that ates re-breathing of rescuer or provider exhaled CO2 by the victim. More particularly, the present disclosure provides a CPR mask, which es a C02 filter or absorber built into the mask or mask inlet for absorbing C02 being exhaled by the rescuer or provider.

That is to say, there is provided a CPR mask for mouth—to-mouth and/or nose— to-mouth resuscitation, comprising a body shaped to cover the nose and/or mouth of a victim, said mask including a C02 absorber for eliminating at least in part rescuer exhaled C02 delivered to the victim.

In one embodiment, the C02 absorber is coated on an inside e of the mask.

In another embodiment, the mask includes a ventilation tube, n the C02 absorber is located in the ventilation tube.

In still another ment the mask includes one-way valve and/or straps for g the mask to the head of the victim.

In one embodiment the mask includes a compliant periphery to conform to the face of a . In such embodiment, the periphery may include a soft, compliant air bladder, or resiliently deformable foam cushion.

In yet another embodiment, the mask includes a ical filter incorporated into the inside of the mask, or orated into the ventilation tube.

In still yet another embodiment of the invention, there is provided a CPR mask as above chcribed, further characterized by one or more of the following features: (a) including a one—way valve; (b) including straps for holding the mask to the head of the victim; (c) n the mask further includes a compliant periphery to conform to the face of a wearer, wherein the periphery preferably includes a soft, compliant air bladder or a resiliently deformable foam cushion; and Further features and advantages of the present invention will be seen from the following detailed description, taken in conjunction with the accompany drawings, wherein Figs. la and lb are front view and top views ofa nasal ventilation mask in accordance with the first embodiment of the present invention; Figure 2 is an inside View of the Fig. la ation mask; Figs. 3a and 3b are plan views showing the ventilation mask in ance with the present invention on a patient’s head; Figs. 4a and 4b are views similar to Figs. 3a and 3b showing a chin Strap attached to the mask; Figs. 5 a and 5b show an alternative configuration of the nasal mask with an end-tidal CO2 monitor in accordanec with the present invention; I\) U! Fig. 6 is a side elevational view of an alternative configuration of nasal mask ation system in accordance with the t invention; Fig. 7 is a plan view of an alternative embodiment of nasal ventilation mask With a C02 monitor in accordance with the present invention; Fig. 8 is a plan View of yet another alter..a.ive configuration of nasal mask with a C02 r in accordance with the present ion; Fig. 9 is a view, in partial cross—section ofa CPR mask in accordance with the first embodiment of the present invention; and Fig. 10 is a side elevational View of a second embodiment of a CPR mask in accordance with the present ion.

A nasal ventilation mask 10 in ance with a first embodiment of the present invention is illustrated in Figures la and lb. Optimally it contains 4 gas openings, but can contain less or more than four as well. The first is the ventilation ‘ port 12 that supplies O2 and other gasses either during anesthesia or for NIPPV in critically ill patients and allows for any end-tidal C02 that is expelled nasally to be retrieved from the patient. The second is an Oral opening 14 under the nose but isolated from the nasal cavity d by the mask over the patient’s nose. The e of opening 14 is for scavenging esia gases and end-tidal CO2 that are expelled orally from the patient. In addition to reducing or eliminating anesthetic gasses trom entering the Operating Room and becoming a hazard, it allows for the cnd~tidal CO2 expelled from the patient’s lungs and escaping orally to be monitored.

The third opening is the Gas Scavenging / end-tidal CO2 port 16 that is connected to the opening by a channel 18 inside the mask (see Figure 2) that is isolated from the nasal . The Gases, including any expelled end-tidal CO2, leave the mask through port 16 and are guided by a tube 20 to a gas ging filter and end-tidal CO2 monitor 32 (see Figure 3) that samples gas from the gas scavenging line. The fourth opening is an 02 port 22 that is capped off during anesthesia, but may be connected to an 02 source (not shown) either pre—operation, intra-operation, or post- operation. When 02 is ed, the Ventilation tube is detached from the ventilation port 12 so that dal CO2 and be expelled nasally. A gas hood 24 located under the nose around the oral opening 14 extends beyond the mask as shown. It is optionally included in order to extend the influence of the Oral Opening 14 in the mask in order to contain a greater percentage of the expelled gases from the patient.

The mask also includes three eyelets or tabs 60, 62,. 64, or four eyelets or tabs 66 68, 70, 72 (Fig. 7) for attaching a chin strap or head strap, as described below, or for attaching straps to the operating table in accordance with the teachings of our co- pending application PCT/USl4/44934 or our co—pending PCT application PCT/US l 5/34277.

An interior view of the nasal ation mask 10 of the present invention is illustrated in Figure 2. The ventilation port 12 and 02 port 22, are connected to the nasal cavity 26. Orally expelled gases travel from the Oral opening 14 on the outside of the mask through Gas Channel 18 and out the Gas Scavenger & end-tidal C02 monitoring port 16 on to the Scavenger device and end—tidal CO2 monitor. The Gas channel 18 separates the Nasal cavity 26 created by the ventilation mask over the nose and the Oral regions of the patient.

When 02 or 02 and esia gasses and are being supplied to the patient, they travel to the nasal cavity 26 through a ventilation circuit 28 attached to the ventilation port 12, and a cap shown in phantom at 30, seals the 02 port. Post operation, the cap 30 can be removed from the 02 port 22 and an 02 line ed to the port, supplying 02 to the patient. The ventilation circuit 28 is removed from the ventilation port 12 and the nasal cavity 26 is open to the atmosphere where end-tidal CO2 can be expelled y.

The gas circuit for both the Nasal Mask ation/ end—tidal CO2 monitor Oral Gas Seavenger/ end—tidal CO2 monitoring lines are illustrated in s 3a and 3b. Figurc 3a shows nasal gas flow from the Nasal cavity 26 connected to the Ventilation Circuit 28 and to the end—tidal CO2 monitoring equipment 32. Figure 3b shows the orally expelled gasses entering the Oral opening and flowing through the Gas Scavenger line to a recovery device 34 and the associated line that is connected to the ger line and flows to the end-tidal CO2 monitoring ent. Note that the g to the scavenger line should be positioned approximately 90° to the scavenger gas flow in order for the local pressure to be higher than it would be if the opening were perpendicular to the gas flow. If it were perpendicular, a negative pressure would prevent the end-tidal CO2 monitoring line from being able to sample the flow due to the negative pressure gradient.

Referring also to Figures 4a and 4b, a chin strap 36 also can be applied to the submental space, attached to the nasal mask 10, and apply a pressure to force the tongue against the soft palate and induce an obstruction of the retro—glossal space, which will help prevent any leak of gases out of the patient’s mouth and allow the patient to breath out of the nose. The chin strap 36 also has the ability to e pressure, if needed, during exhalation to prevent an expiratory obstruction and allow end—tidal C02 and other gases to be released out the mouth.

In an alternate ration, the gas circuit for both the Nasal Mask ation and end-tidal C02 monitoring are illustrated in Figures 5a and 5b. The figure shows a 2-Way, 3 Port valve 40 that connects the Nasal circuit to the end—tidal CO2 monitoring equipment. The esiologist decides which region, the nasal, oral region, or both simultaneously, should be red for end-tidal C02.

A side view of the ate configuration for the nasal mask ventilation and monitoring end-tidal C02 expulsion from the oral airway is illustrated in Figure 6.

Note the 2—Way, 3 Port valve 40 has been turned in the direction of the mouth for ng end—tidal C02.

The nasal ventilation mask also allows only one combined anterior-posterior head strap to be attached, where the posterior head strap can attach to the mask alone, or can attach to the mask and then to a e, which will prevent movement of the patient’s head and/or neck. By securing the patient’s head with the head strap to the support surface, the patient’s head will stay in the desired position and the support surface will stay in the desired position when the provider changes the head and/or neck angles.

Fig. 7 illustrates yet another embodiment of the invention, in which a patient is being provided oxygen Via an 02 line connected to the 02 port on the ation mask. The exhaled gasses are exhausted to the atmosphere Via the ventilation port 12 as illustrated in Fig. 7. If the patient is unconscious due to anesthesia, there is a desire to assure that the C02 is being exhaled. This can be accomplished by adding a “T- Shaped” gas monitoring attachment 50 that slides onto the mask ventilation port 12.

The main body of the attachment 50 which is tubular in shape allows exhaled gasses to be exhausted to the atmosphere. To the side of the attachment is a tubular opening 52, nominally at a 90° angle off to the side. The end of this g 52 can have a luer lock or any other kind of securing connection. d gas from the main flow can be sampled through this opening if a gas monitoring line 54 connected to a gas monitor is attached to the gas monitoring line interface.

An alternative ch for accomplishing the same gas sampling feature is illustrated in Fig. 8. In this embodiment, the gas monitoring line interface is an integral element of the mask ventilation port 12. In this configuration, 02 flows into the 02 port Via a supply line and the exhaust gases are passed to the atmosphere Via the ventilation port 12. The side of the ventilation port 12 is a tubular opening 56, nominally at 90° angle off to the side. The end of this opening can have a luer lock or any other kind of securing tion. d gas from the main flow can be sampled through this opening if a gas monitoring line connected to a gas monitor is attached to the gas monitoring line surface.

Referring to Fig. 9, there is shown a first embodiment of a CPR mask in accordance with another aspect of our ion, designated 110, to affect rescue breathing, mouth-to—mouth resuscitation or any other CPR procedure requiring ncy breathing assistance. Mask 1 10 is shaped to cover the ncsc and/or mouth of a Victim, and includes a soft and compliant periphery 112 to conform to the face of a victim upon application of moderate force to obtain a tight— titting mask seal.

Typically the periphery 112 of the mask includes a soft, compliant air bladder 114 or resiliently deformable foam cushion or the like.

. A ventilation tube 116 is attached to an integral inlet port 118 protruding from the mask through which air may be supplied by the rescuer by exhaling into the tube.

Ventilation tUbe 1 16 or inlet port 118 typically includes a one-way valve 120 that permits air to enter the mask h tube 116. Ventilation tube 116 and its associated valve 120 may be formed integrally with the port 1 18, or may be a replaceable, disposable element or package. (Fig. 10).

The inside surface 122 of mask 110 is coated in part by a C02 absorbing material such as activated carbon or a zeolite. Also, certain minerals such as serpentinite ageously may be employed. Typically, these materials are sorted to optimal size and encased in a filter material 124 bound to the inside surface 122 of the mask 110. Alternatively, the inside surface 122 of the mask 110 may be coated with a C02 absorbing polymer such as polyethylenimine containing fumed silica or the like as reported in Scientific American, January 6, 2012, page 33. atively, as shown in Fig. 10, a C02 filter 126 containing CO2 ing al may be incorporated into ation tube 1 16.

In use, the rescuer places the CPR mask 110 over the nose and/or mouth of a Victim to initiate emergency ventilation of the victim. The rescuer applies moderate force to obtain a substantially air—tight seal against the victim’s face, and ventilation is then supplied by the rescuer by exhaling into the ventilation tube 116. While the exhaust from the rescuer contains C02, most of the C02 will be removed by the C02 filter material.

Mask 110 may be formed in different sizes, for example, adult size, youth size and child size, to accommodate different size faces. A feature and advantage of the CPR mask of the present invention is that significantly s the amount of C02 administered to the victim. Also, the mask helps to protect both victim and rescuer in an emergency situation by preventing er of disease.

Various changes may be made in the above invention without departing from the spirit and scope thereof. For example, a biological filter (shown in phantom at l0 130 in Fig. 10) also may be incorporated into the mask or the ventilation tube 116.

Additionally, the mask may include straps 132 for strapping the mask to the ’s head, thus freeing the rescuer from having to press the mask t the victim’s face.

Still other changes are possible.

What is claimed: 1. A nasal ventilation mask comprising: a body having an interior forming a nasal cavity, a gas channel, and an exterior opening, wherein the nasal cavity is configured to cover a patient’s nose while leaving a mouth of the patient uncovered and the gas channel is separated from the nasal cavity; an O2 port fluidly coupled to the nasal cavity and configured for introducing oxygen into the nasal ; a ventilation port fluidly coupled to the nasal cavity and configured for directing a gas toward or away from the nasal cavity; and an end-tidal CO2 port fluidly coupled to the exterior opening through the gas channel of the body, wherein the exterior opening is adapted to scavenge a gas expelled orally by a wearer, and the gas channel is configured to direct the gas expelled orally from the exterior opening to the end-tidal CO2 port. 2. The nasal ventilation mask of Claim 1, comprising a gas hood located under the nose region of the mask and extending from an outer surface of the mask around the exterior opening to enhance the collection of etic gases around the patient's mouth. 3. The nasal ventilation mask of any one of Claims 1 and 2, wherein the endtidal CO2 port is configured to couple with a ring line, and the ventilation port is configured to couple with a ventilation line that is different than the ring line. 4. The nasal ventilation mask of any one of Claims 1-3, wherein the gas channel is configured to isolate the gas expelled orally from the nasal cavity.

. The nasal ventilation mask of any one of Claims 1-4, n the gas channel is configured to direct a gas expelled nasally toward the end-tidal CO2 port. 6. The nasal ventilation mask of any one of Claims 1-5, wherein the mask ses a gas monitoring attachment. 7. The nasal ation mask of any one of Claims 1-6, further comprising a removable cap configured to be coupled to and obstruct the O2 port. 8. The nasal ventilation mask of any one of Claims 1-7, further comprising tabs or s for ing the mask anteriorly with a mask anchor, or iorly with a traditional anesthesia mask strap. 9. The nasal ventilation mask of any one of Claims 1-8, wherein the ventilation port and the end-tidal CO2 port are offset such that there is clear view to an airway of the patient.

. The nasal ventilation mask of any one of Claims 1-9, n the nasal cavity is open to atmosphere when a ventilation circuit is not coupled to the ventilation port. 11. The nasal ventilation mask of any one of Claims 1-10, wherein the end-tidal CO2 port comprises a luer lock. 1/9 . iation SO2 PgrtPOp ' ) """"" 12 umar ort Scavenger & C02 Monitoring Port 14 Gas Scavenger & C02 Monitoring Port 16 ,,,———?Gas & C02 Out éraliy Expeilleél Gases Figure 1b SUBSTITUTE SHEET (RULE 26) tom a Sm H. cm mg: NO H tog aanwgwmwn. NO concuzaam co .533on H 29% m5 go m Q8 mcmu—O .839on Ucm raga2:8588 :8 boasmNN N 0 macs—u m5 5908 nmuma No w.Om 9n1--“ mp ”Em. to; mammo N mfiwfimmc<wNOu congsfiigzmsoé ...8__8xm.>__eo 83.6 m» m.“—. 225233xmmE , coszcm> S --..v tom ...................... Nmy cosmficg it Lw Q Emwfiummc< , or: t8 :55 oEWBEoEtea 3 Cw>mum Vw mmmmo 59.95 mmU 6U NO cosmEcm> SUBSTITUTE SHEET (RULE 26) Ventilation Circuit 02 & Anethesia‘2A8C02 & Excess . : : ° To CO Gas In sra 2 Monitor Gas out To Scavenger Figure 3a.

RecoverDevicey Ventilation Circuit g i To C02 Monitor To Scavenger Figure 3b , R5235? Ventilation Circuit Chin Strap V“ /' 36 Figure 4a Ventilation venger / - s ,\ TOR ecover / Chin32trap ngzilcey Figure 4b SUBSTITUTE SHEET (RULE 26) Ventilation Circuit A TO C02 i i Monitor }\\V 2—Way, 3~Port Va Ive Opened to Nasal . r , Figure Ventiiation Circuit ' n)"‘ / i \ 2—Way, 3—Port Valve \2/}7\/ Opened to Oral Monitor Figure 5b SUBSTITUTE SHEET (RULE 26) TO C02 Monitor Ventilation .......... 2—Way, 3—Port Valve Opened to Oral Monitor Figure 6 SUBSTITUTE SHEET (RULE 26) ‘ To Gas Monitor Gags Monitoringh Line Interface Monitoring. . Exhaled 50 Patient- ~— Ventilation Side Front Port View View . Interface Gas Monitoring Attachment Ventilation SUBSTITUTE SHEET (RULE 26) /,}I' " To Gas Monitor Exhaled Patient Gas 62635 ring I Gas Monitoring: Line Interface I Ventilation 02 Port SUBSTITUTE SHEET (RULE 26) 9/9 ‘ Figure 10 .

SUBSTITUTE SHEET (RULE 26)