Abstract:
A respiratory valve apparatus with a housing having an inner chamber, an endotracheal tube connection port, a respirator connection port and a resuscitation bag connection port. A valve positioned within the inner chamber can switch the flow between a manual resuscitation bag port and a ventilator port enabling the patient to be treated without having to disconnect the respirator support system to thereby connect the resuscitation bag. This prevents the loss of positive end expiratory pressure (PEEP) in the lungs and guards against lung collapse and hemodynamic compromise. The valve includes preloaded seals that will create minimal dragging during valve actuation and work under both positive and negative pressure. The apparatus includes a tethered cover for closure of the resuscitation bag port for sealably covering the port when a bag is not attached or the ventilator connector during patient transport. A sealing arrangement within the resuscitator bag port insures that PEEP in maintained when the resuscitator bag adapter is inserted into the housing.

Description:
FIELD OF INVENTION 
       [0001]    This invention relates to respiratory valves apparatus used in endotracheal medical procedures involving a respirator, a resuscitation bag, and a suction catheter. In particular, the present invention is a respiratory valve apparatus that facilitates rapid switching between a respirator, or breathing machine, and a resuscitation bag while maintaining ventilation functions and without losing positive end expiratory pressure (PEEP). 
       BACKGROUND OF THE INVENTION 
       [0002]    Respiratory support systems are commonly used to support the respiratory system of a critically ill patient for maintaining optimal blood oxygen levels, as well as optimal carbon dioxide levels and acid base balance. Typically, a prior art respiratory support system includes a tracheal tube, positioned either directly through the nose or mouth into the trachea of a patient. A multi-ported manifold is connected to the endotracheal tube at one port position, and a source of breathable gas is connected at a second port. The respiratory support system assists the patient in maintaining adequate blood oxygenation levels without overtaxing the patient&#39;s heart and lungs. 
         [0003]    While a patient is attached to the respiratory support system, it is periodically necessary to aspirate fluids and or secretions from the patient&#39;s trachea and lungs. In the past, in order to accomplish aspiration and positive pressure ventilation, it was necessary to disassemble part of the respiratory support system, either by removing the ventilator manifold or by opening a port thereof and inserting a small diameter suction tube down the tracheal tube and into the patient&#39;s trachea and lungs. The fluid was then suctioned from the patient and the suction catheter was removed and the respiratory support system reassembled. However, due to the interruption of respiratory support during this procedure, a patient&#39;s blood oxygen can often drop and the carbon dioxide can change to unacceptable levels. Additionally, unless a sufficient positive end expiratory pressure (PEEP) level is maintained, then the lungs might collapse. This creates a dangerous condition for the patient because the lungs can be difficult, and sometimes impossible, to reinflate. 
         [0004]    Patients may have fluid drawn from their lungs as often as six times a day and sometimes more, possibly over long periods of time. For this reason, it is critical to provide a respiratory device which will minimize patient discomfort. In addition, such a device could be widely used in treating pediatric patients, especially premature infants, as well as adults, who are subject to respiratory problems and may need frequent aspirations. As a result of the extremely large number of aspirations necessary on various patients in any period, it is important that the price of the respiratory device be as low as possible since vast numbers will be used. It is also important that the device be sufficiently inexpensive so that it may be discarded after a single use. Hence, it is desirable to simplify such devices and reduce the number of parts in order to reduce costs and increase reliability. 
         [0005]    U.S. Pat. No. 5,746,199 to Bayron et al teaches a rotary valve with multiple ports, any two of which can be aligned with openings in the casing to provide through passages for delivering breathable gases to an endotracheal tube. The valve has a handle that cooperates with detents on the casing to secure the position of the rotary valve. However, any catheter inserted and removed through the endotracheal tube and valve ports that are connected with the ventilation ports provides a contact pathway for infectious organisms to the ventilators. 
         [0006]    The manufacture of this rotary valve, as well as the other rotary valves mentioned here, requires precise control of the circular tolerances of the rotary valve and casing to prevent leakage around the valve. Such safety concerns increase the costs of manufacture and quality control measures. 
         [0007]    Other prior art devices have attempted to maintain a continuous flow of oxygen from the respirator device through to the lungs, while allowing for insertion and retraction of the suction catheter. However, such devices fail to provide an operable system capable of performing both manual and machine assisted respiration without disconnecting the respirator. Manual respiration with a resuscitation bag during suction is a preferred method among many practitioners because it optimizes removal of fluids in the lungs while maintaining PEEP and maintaining cardiopulmonary and hemodynamic balance. U.S. Pat. No. 4,351,328 discloses a device for simultaneous respiration and endotracheal suctioning of a critically ill patient. This device requires a specialized sealing port for insertion and retraction of the suction catheter to maintain the integrity of the respiration system. While machine assisted respiration is occurring, no switchover to manual resuscitation methods is provided. 
         [0008]    U.S. Pat. No. 5,343,857 discloses an accessory port capable of receiving a specially designed male adaptor on a suction catheter. The accessory port consists of a normally closed valve which is forced open by the male adaptor, and returns to its closed position upon retraction of the adaptor. The adaptor sealably interacts with the accessory port so as to inhibit pressure loss from the manifold. A similar device is disclosed in U.S. Pat. No. 5,309,902. 
         [0009]    As detailed in the background discussions of these prior art disclosures, there are many difficulties associated with maintaining continuous pressure from the respiration supply device. More particularly, it is often desirable to be able to manually inflate the lungs with a resuscitation bag at different rates and different volumes in order to facilitate complete aspiration of mucous and liquid from the lungs. With the extra “hands-on” control offered by the resuscitation bag, a doctor or technician can simulate expectory coughing actions and the like through quick inflation and deflation bursts. Moreover, PEEP can be easily maintained with the resuscitation bag, while the suction catheter is repeatedly inserted and retracted from the lungs as needed. 
         [0010]    Other interface devices require the respirator source to be disconnected in order to attach the desired resuscitation bag. Once aspiration is complete, this presents a problem with maintaining PEEP when the resuscitation bag is disconnected and the respirator source is reconnected. Even if performed in a timely and efficient manner, this switchover operation can jeopardize the patient&#39;s life if PEEP is not maintained. Hence, it is important to minimize this switchover time, while also providing for attachment of the resuscitation bag. Other devices remain connected to the respirator source and do not allow for use of a resuscitation bag. 
         [0011]    U.S. Pat. No. 5,207,641 discloses a switching device with a rotary valve having aspiration, insufflation, and intermediate flushing positions. An oxygen port and suction port are included with a catheter port. These ports allow suction and insufflation to alternately occur through the continuously inserted catheter, without withdrawal of the catheter tube from the lungs. While providing a neutral valve position, this arrangement might still encounter problems such as blow-back of mucous through the inserted catheter, and/or clogging of the valve parts by suctioned mucous. 
         [0012]    U.S. Pat. No. 3,780,736 discloses a surgical valve assembly for urinary bladder irrigation and drainage. This valve has four ports and provides a core for interconnecting any two of the four ports. The core allows irrigation fluids to flow from one port to another, but the &#39;736 device does not disclose a valve for introduction and withdrawal of a suction catheter through the device in either of two switched positions, and the &#39;736 device does not disclose ports for receiving air from a respirator in one switched position or alternatively from a resuscitation bag in the other switched position. 
         [0013]    Given the frequent insertion and withdrawal of the suction catheter, a protective bag, or sleeve, would also be a useful addition to existing suction catheter devices. This bag would prevent external contact with the catheter thereby maintaining a sterile device for reinsertion into the patient. U.S. Pat. No. 5,073,164 discloses a specialized catheter which incorporates a protective sleeve. A bag which can be sealably attached around any existing suction catheter would be even more versatile than the incorporated sleeve. 
         [0014]    Accordingly, what is lacking in the art is a compact, inexpensive, improved, simplified respiratory device which can accommodate the introduction of a catheter into a patient&#39;s lungs separated from the respiratory valve while maintaining connection with an external respirator source, and which will subsequently allow uninterrupted respiratory switchover to a resuscitation bag to maintain optimal ventilation. 
       SUMMARY OF THE INVENTION 
       [0015]    The present invention provides a respiratory valve apparatus that is an improvement over applicant&#39;s prior U.S. Pat. No. 6,886,561 entitled “Respiratory Valve” and issued on May 3, 2005, the entire contents of which is hereby expressly incorporated by reference. The ventilating valve switches between a manual resuscitation bag port and a ventilator port. A patient can thereby receive continuous support from a respirator or an attached resuscitation bag, depending upon the position of the valve. By providing an efficient switchover between the respirator and resuscitation bag, a patient can be treated in such a manner without having to disconnect the respirator support system to thereby connect the resuscitation bag. This prevents the loss of positive end expiratory pressure (PEEP) in the lungs and guards against lung collapse and hemodynamic compromise. Likewise, the valve arrangement creates a closed fluid system thereby greatly diminishing the likelihood of accidental contamination either from the patient to care giver or care giver to patient. 
         [0016]    Additional features include a tethered cover for the resuscitation bag port when a resuscitation bag is not attached or the ventilator connector during patient transport. 
         [0017]    It is therefore an object of the present invention to provide a respiratory valve apparatus which can switch between an attached external respirator support system and an attached resuscitation bag. 
         [0018]    It is still another object of the present invention to provide an inner reciprocating valve assembly contained within the apparatus which closes the respirator port and opens the resuscitation bag port in one position and opens the respirator port and closes the resuscitation bag port in another position. 
         [0019]    It is another object to provide the reciprocating valve with preloaded seals that create minimal dragging during valve actuation. 
         [0020]    It is a further object of the present invention to provide seals that work under both positive and negative pressure. 
         [0021]    It is another object of the present invention to provide a universal adapter to connect to different conventional resuscitation bags. 
         [0022]    It is still another object of the present invention to provide a sealing arrangement within the resuscitator bag port that insures that positive end expiratory pressure (PEEP) in maintained when the resuscitator bag adapter is inserted into the housing. 
         [0023]    Other objects and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention. The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0024]      FIG. 1  shows a partial cross section of one embodiment of the respiratory valve assembly of this invention with the respirator port closed and the resuscitation bag port open; 
           [0025]      FIG. 1A  shows a partial perspective view of the respiratory valve assembly of  FIG. 1  with the respirator port open; 
           [0026]      FIG. 2  shows an a partial cross section as in  FIG. 1  with the respirator port closed; 
           [0027]      FIG. 2A  shows a plan view of a guide shown in  FIG. 2 ; 
           [0028]      FIG. 2B  shows a perspective of the cylinder valve shown in  FIG. 2 ; 
           [0029]      FIG. 3  shows a perspective of another embodiment of the respiratory valve assembly of this invention with a resuscitation bag; 
           [0030]      FIG. 4  shows a top plan view of the respiratory valve assembly of  FIG. 3 , partially in section; 
           [0031]      FIG. 5  shows a side view of the valve assembly of  FIG. 4 , partially in section; 
           [0032]      FIG. 6  shows a perspective of another embodiment of the respiratory valve assembly of this invention; 
           [0033]      FIG. 7  shows a cross section of the valve assembly of  FIG. 6  with the respirator port closed; and 
           [0034]      FIG. 8  shows a cross section of  FIG. 6  with the respirator port open. 
           [0035]      FIG. 9  show an exploded perspective of the respiratory valve and catheter. 
           [0036]      FIG. 10  shows a perspective view of the respiratory valve with catheter and bag attached. 
           [0037]      FIG. 11  is a cross sectional of an alternative embodiment of the respiratory valve with the respirator port open and the resuscitation bag port closed. 
           [0038]      FIG. 12  is a cross sectional view of the embodiment shown in  FIG. 11  with the resuscitator bag adapter inserted and positioning the respiratory valve such that the respirator port is closed and the resuscitation bag is open. 
           [0039]      FIG. 13  is an enlarged sectional side view of the valve piston seal arrangement. 
           [0040]      FIG. 14  is an enlarged perspective sectional view of the valve piston seal arrangement. 
           [0041]      FIG. 15  is an enlarged side view of the exterior of the valve piston. 
           [0042]      FIG. 16  is an isometric view of the valve piston sub assembly. 
           [0043]      FIG. 17  is an exterior view of the respiratory housing showing a tethered cap in sealing engagement with the resuscitation bag port. 
           [0044]      FIG. 18  is a sectional side view of the respiratory valve arrangement similar to that shown in  FIG. 11  but which an alternative sealing arrangement between the valve housing and the resuscitation bag adapter. 
           [0045]      FIG. 19  is a sectional side view of the respiratory valve wherein the valve housing includes a catheter entry port with a flexible orifice and an endotracheal tube connection port. 
           [0046]      FIG. 20  is an exploded sectional side view of the respiratory valve and removeable housing that includes a catheter entry port with a flexible orifice and an endotracheal tube connection port. 
           [0047]      FIG. 21  is a sectional side view of the respiratory valve of an alternate embodiment wherein the helical spring is replaced with a resilient diaphragm. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0048]    Although the invention is described in terms of a several embodiments, it will be readily apparent to those skilled in this art that other various modifications, rearrangements and substitutions can be made without departing from the spirit of the invention. The scope of the invention is defined by the claims appended hereto. 
         [0049]    Referring now to  FIGS. 1 and 2 , the assembly has a housing  12  and an inner chamber  14 . The housing  12  includes an upper access port which is a suction catheter entry port  16  located on the top and an endotracheal tube connection port  18  located on the bottom. The entry port  16  has a flexible orifice  24  covering the top and may include a saline injection port  20 , shown in  FIG. 3 , which can be covered by a hingably attached plug  22 . Port  20  might alternatively use a sealable orifice. The sealable orifice may be closed with a cap of resilient material having diametrical cuts forming openable flaps. Alternatively, the aspiration port  16  may be used for administering a saline solution. An endotracheal tube  26  can be removably attached to the endotracheal connection port  18 . 
         [0050]    In the embodiment shown in  FIGS. 1-2 , the housing  12  is an elongated L-shaped tubular structure with the respirator port  32  at one end and the endotracheal connection port  18  at the other end. The resuscitation bag port  28  extends from the shaft of the L-shaped housing. 
         [0051]    The valve  11  is a hollow cylinder  35  with an open top  36 , a closed bottom, and an opening  37  in the side wall. The opening  37  is aligned with the endotracheal tube port  18  so that air from the resuscitation bag flows through the resuscitation bag port, through the cylinder and into the endotracheal tube port while the remainder of the cylinder wall blocks the respirator port. The reciprocating valve  11  slides partially within the resuscitation bag port  28  and the inner chamber  14  intermediate the ends of the L-shaped housing. The reciprocating valve  11  and the resuscitation bag port are normal to the respirator valve port  32 . The valve  11  is moved by the universal resuscitation bag adapter  113  in the port  28 . As the valve moves, it opens the resuscitation bag port  28  and closes the respirator port  32 . The valve  11  has a valve stem  112  that telescopes through a valve spacer  114 . The universal resuscitation bag adapter  113  serves to connect different resuscitation bags to the respiratory bag. In the event the respiratory valve is supplied as part of a kit, including a resuscitation bag, the adapter may not be present. 
         [0052]    The spacer  114  has an outer ring with the circumference fixed to the resuscitation bag port wall. The spacer  114  is a stop for the spring  124 . The ring may have spokes  115  and a hub  116 , as shown in  FIG. 2A . The hub  116  is of such diameter to permit the sliding movement of the valve stem  112  there through. The movement of the valve stem  112  through hub  116  and the circumferential sliding contact between valve  11  and the resuscitation bag port acts as a valve guide. 
         [0053]    The valve  11  has a circular solid valve bottom face  117  of a diameter to close the valve seat  125  at the inner end of the resuscitation bag port  28 , as shown in  FIG. 1 . The circular face  117  also forms one end of the cylindrical sleeve  35 . The length and diameter of the sleeve  35  is such to close the respiratory port, as shown in  FIG. 2 . As shown in  FIGS. 1 and 1A , the solid plate and the sleeve are stopped and sealed by the circular valve seat  120 . As shown in  FIG. 2B , the upper edge of the sleeve  35  is formed with a ring  121  which slides along the inside of the resuscitation bag port to further stabilize the reciprocation of the valve  11 . The ring supports the end of the valve stem with chord bars  122 . The ring  121  may also be similar in form to the valve spacer  114 . The upper end of the valve stem  112  has a retainer  123 . The retainer  123  may be in the form of a cross bar, as shown, or a perforated ring to allow air passage. 
         [0054]    The resuscitation bag adapter will engage the retainer  123 , such as shown in  FIG. 1 . A coil spring  124  is mounted about the valve stem and held in place by the retainer  123 . The other end of the coil spring rests on the valve spacer  114 . In this manner, the spring is compressed as the resuscitation bag adapter  113  moves the valve to close the ventilator port. The retainer  123  slidably contacts the inside of the resuscitation bag port. The inner wall of the resuscitation bag port also has two opposing longitudinal grooves  126 . The ends of the retainer  123  slide in the grooves  126  in response to pressure from the adapter  113 . The grooves maintain alignment of the opening  37  in the valve cylinder with the endotracheal tube port  18 . The enlarged portion may or may not be present in order to accommodate the conventional resuscitation bag fittings. 
         [0055]    As shown in  FIG. 1 , the tubular adapter  113  has opposite bayonet slots  33  in the side wall. The slots cooperate with opposing lugs  34  on the resuscitation bag port wall to guide movement of the adapter and lock the port open while the bag is being used. 
         [0056]    Therefore, as shown in  FIG. 1 , with the respirator valve port  32  closed, the patient can receive manual resuscitation bag breathing augmentation through the inner chamber of the valve assembly. A resuscitation bag, as shown in  FIG. 3 , may be connected to the universal resuscitation bag adapter and the valve assembly will automatically move the valve to close the respirator port and open the resuscitation bag port, as shown in  FIG. 1A . When the bag is disconnected, the adapter is rotated to unlock the bayonet fitting and the valve assembly automatically re-establishes the airway between the respirator and the patient. 
         [0057]    A connection to the patient is located at the bottom of the L-shaped valve assembly, usually by an endotracheal tube attached to the valve assembly. As shown in  FIGS. 1 and 2 , the aspirator port  16  is in line with the endotracheal port  18 . This suction tube port is normally closed either by a removable cap or a resealing entry  24 . The suction tube is linearly displaced from the reciprocating valve, the resuscitation bag and the respirator to avoid direct contact with any contamination in the suction tube. 
         [0058]    In the embodiment shown in  FIGS. 3-5 , a cruciform valve assembly has a resuscitation bag attachment port  28  extending out one side, oriented approximately 90 degrees from the entry port  16  and endotracheal tube connection port  18 . This port  28  can be sealably covered by a hingably attached cover  30 . On the opposite side of the bag attachment port  28  is a respirator attachment port  32  for attaching an external respirator device. 
         [0059]    In this embodiment, the linear displacement of the suction tube from the valve is accomplished by a bifurcated valve stem  212 . As shown, a valve spring  224  is coiled about each element of the split stem with one end contacting a retainer  223  on each split. Alternatively, a single coil spring could encircle the bifurcated valve stem. The retainer may be a cross bar, as shown in  FIG. 1  or a perforated disk. The other end of the coil spring contacts the back side of the resuscitation bag port valve spacer  214 . 
         [0060]    The spacer  214  is fixed about its circumference in the resuscitation bag port  28 . The spacer  214  is perforated, as is spacer  114 , but has two apertures for sliding engagement with the bifurcated valve stem  212 . Each spring  224  rests on the spacer  214  and is compressed by the valve retainer  223  as the valve reciprocates toward the respirator port. 
         [0061]    The valve  211  is a solid disk and has a diameter very close to the diameter of the resuscitation bag port and the respirator port to form an edge seal with each port when seated therein. Alternatively, each port may have an internal valve seat to contact the opposite faces of the circular valve, as shown in  FIGS. 4 and 5 . These valve seats also serve as stops for the reciprocating movement of the valve. One face of the valve closes the resuscitation bag port  28  at seat  225  and the other face  218  of the valve face seats in the respirator port  32  at valve seat  217 . 
         [0062]    In this manner, the valve stem is housed in the resuscitation bag port while that port is closed. A suction tube may be inserted directly through the aspiration port into the endotracheal connection port without contacting either valve, as shown in  FIGS. 9-10 . With the respirator port closed by the valve, an aspirator tube may pass between the elements of the split valve stem  212 . To provide better reciprocatory support, each element of the split valve stem may be formed with a semicircular outer surface with the same diameter as the valve  218 . 
         [0063]    The embodiment shown in  FIGS. 6-8  provides a smaller profile for the valve assembly. This smaller embodiment would be extremely useful when working with infants and children. In this embodiment, the operation and structure of valve  11  is the same as the L-shaped valve assembly of  FIGS. 1-2 . The angular relations between the ports have been modified to reduce the overall size of the device. The suction catheter entry port  16  enters the housing  12  downstream from the resuscitation bag port and valve  11  to provide the linear displacement between the suction catheter and the valve. In all other respects, the valve assembly and operation are the same. 
         [0064]    In each of the embodiments, the inner chamber  14  provides a conduit between the entry port  16  and endotracheal tube connection port  18  whereby a suction catheter can be inserted through the valve assembly  10 . A resuscitation bag, not shown, can be attached to the resuscitation bag port  28 . With the endotracheal tube  26  attached to the connection port  18 , the respiratory valve assembly  10  could be positioned over a patient&#39;s mouth with the endotracheal tube extending into the patient. A catheter could be inserted through the inner chamber and the resuscitation bag could be used to manually provide volumetric units of air into the patient&#39;s lungs. By skillfully combining the manual inflation actions with the suction catheter procedure, optimum clearing of the lungs can be accomplished. At which time the suction catheter may be removed from the assembly. 
         [0065]    When the bag is removed from the respiratory valve, the reciprocating valve  11  closes resuscitation bag port and opens the respirator attachment port  32  so that the respirator connection will now be breathably connected to the patient without loss of PEEP in the patient&#39;s lungs. The suction catheter can then be reinserted and withdrawn as needed through the assembly  10 . 
         [0066]      FIG. 6  illustrates a valve seat  120  matching the circumference of the internal valve  11  extending through the respirator port. As an alternative, the interior wall of the respirator port may be molded to form a seat for the bottom of the valve  11 , as shown in  FIGS. 7-8 . This same structure may be used in the respiratory valve shown in  FIGS. 1-2 . 
         [0067]    Referring now to  FIG. 9 , a perspective view of the respiratory valve assembly  10  is shown with an exploded view of the additional bag-like attachment  60  and an attachment fixture  62 . The attachment fixture  62  is tubular in shape and removably attaches, via snug frictional contact or otherwise, with the catheter entry port  16 . While the preferred embodiment would likely be constructed of opaque plastic, a transparent version of the attachment fixture  62  shows an inner conical guide  64  which steers an inserted catheter down through the center portion of the orifice  24 . This eases catheter insertion through the orifice  24  because the center part of the orifice is more flexible and less resistant than the edges. The bag-like attachment  60  is threaded over the suction catheter  66  and the bottom end  67  of the bag is secured around the fixture  62  with a strip of seal forming adhesive tape  68 , or other such materials. The upper end  61  of the bag  60  is secured around the upper attachment fixture  70  by another strip of seal forming adhesive tape  72 . Also shown is a saline adaptor port  63  for flushing out the system which extends outwards for convenient access and has a hingably attached cover  65 . In lieu of, or in addition to, the hingably attached cover  65 , the port  63  might include a bendable, or hingable flap  75  within the extension tube which would allow for injection of saline in one direction, and which would spring back into position to prevent further escape of gas and/or fluids when the saline injection device is withdrawn. 
         [0068]    Referring now to  FIG. 10 , a perspective view of the assembled device  74  is shown. The guide fixture  62  fits over the entry port  16  so as not to block the saline injection port  20 . The adhesive tape strip  68  wraps around and secures the bottom bag end  67  to the fixture  62 . The conical guide section  64  is then placed over the center of the orifice  24 . The upper end  61  of the bag  60  is sealably constricted around the upper attachment fixture  70  via the adhesive tape strip  72 . This guide fixture  62  shows an alternative saline port  69  which is located flush on the side of the fixture  62  and which uses a sealable orifice  71 . Any saline port configuration can be used as appropriate. 
         [0069]    In the embodiment shown in  FIGS. 11 through 18  the valve housing  302  is a generally T shaped tubular structure has an inner chamber  306  with the respirator port  310  at one end of the T and the patient, or endotracheal port  308 , at the other end of the T. The resuscitation bag port  311  extends perpendicularly with respect to ports  308  and  310 . 
         [0070]    The valve piston  304  is hollow and generally cylindrical in shape having an open top  324  including a plurality of apertures, a closed bottom, and, an opening  342  formed in the side wall. The opening  342  is aligned with the patient, or endotracheal, port  308  so that air from the resuscitation bag flows through the resuscitation bag port  311  through the valve piston  304  and into the endotracheal port  308  while the remainder of the valve piston  304  blocks the respirator connection port  310 . The reciprocating valve piston  304  and the resuscitation bag port are oriented in the same direction and each is positioned normal to the respirator connection port  310  and the endotracheal port  308 . The valve is moved downward relative to the housing  302  by a resuscitation bag adapter  340  that is inserted into resuscitation bag port  311 , as best seen in  FIG. 12 . As the valve piston  304  moves downward it opens the resuscitation bag port  311  and closes the respirator port  310 . The valve piston  304  has a valve stem  314  that telescopes through a chord bar  316  that is supported adjacent an upper portion of cylindrical wall  312 . The valve stem  314  connects at its upper end to a centrally positioned aperture supported by spokes  320 . Spokes  320  are directed radially inward from the inner cylindrical surface of cylindrical sleeve  318 . The lower annular surface on resuscitator bag adapter  340  is configured to operatively engage the upper annular surface of cylindrical sleeve  318  so as to move cylindrical sleeve downward upon insertion of the resuscitator adapter  340 . The downward movement of cylindrical sleeve  318  imparts a downward movement of valve piston  304  via its connection with radial arms  320  and valve stem  314 . The resuscitation bag adapter  340  serves to connect different resuscitation bags to the resuscitation valve housing. In the event the respiratory valve is supplied as part of a kit, including a resuscitation bag, the adapter may not be present. 
         [0071]    A helical spring  322  is positioned within an annular pocket formed between the inner cylindrical surface of the housing  302  and the outer cylindrical surface of cylindrical wall  312 . One end of the helical spring  322  is positioned against the housing  302  at the bottom of the annular pocket. The opposite end of spring  322  is biased against a lower annular surface on cylindrical sleeve  318 . The helical spring  322  serves to bias the cylindrical sleeve  318  and attached valve stem  314  and valve piston  304  to an upper position such as shown in  FIG. 11 . The chord bar  316  limits the upward travel of valve piston  304  within the housing  302 . 
         [0072]    A patient connector conduit  332  is attached to the housing  302  via a rotatable connection  334 . Likewise a ventilator connector is attached to housing  302  via rotatable connection  338 . 
         [0073]    As shown in  FIGS. 11 and 12 , the resuscitation bag port  311  has an annular recess  328  formed on the inner cylindrical wall of the housing  302 . Contained within recess  328  is an annular seal  330 . Annular seal  330  in conjunction with a taper lock insures that positive end expiratory pressure (PEEP) in maintained when the resuscitator bag adapter  340  is inserted into the housing  302 . 
         [0074]    When the resuscitator bag adapter  340  is not in use a cap  326  is used to seal the resuscitator port  311 . As illustrated in  FIG. 17 , a tether  360  is used to attach the cap  326  to the housing  302 . The cap  326  can also be used to seal off the ventilator connector  336  during patient transport. 
         [0075]    The valve piston  304  and valve piston sub assembly are illustrated in  FIGS. 13 through 17 . The valve piston  304  consists of a rigid inner piston  350  and a resilient compressible outer piston  340 . The rigid piston  350  can be formed from any suitable metallic or synthetic material. The piston  350  includes an opening  342 A in the side wall that is aligned with the patient connection port  308  so that air from the resuscitation bag port  311  flows through the valve piston  304  and into the patient port  308 . The piston  350  is open at the bottom and includes an open top  324  formed with a plurality of apertures as shown in  FIG. 14 . The top  324  includes a valve stem  314  that extends upwards therefrom. Positioned below the opening  342 A is a lower annular channel  352  formed on the external cylindrical surface of piston  350 . Likewise, located above the opening  342 A is an upper annular channel  354  formed on the external surface of the piston  350 . The outer piston  340  is resilient and is preferably formed from a silicon material however a thermoplastic could be used as well. The outer piston has an open top and a closed bottom. Like piston  350 , piston  340  has an opening  342 B in the side wall that is generally coextensive with opening  342 A. Positioned below the opening  342 B on the exterior cylindrical surface of the piston  340  is a lower annular rib  344 . The rib  344  is flanked above and below by annular groves. The rib  344  has a radial dimension that is slightly greater than the diameter of the smooth outer surface of the piston  340 , on the order of 0.006 of an inch. Lower annular channel  352  is positioned directly behind the annular rib  344  to allow for slight deformation of the sleeve along the extent of the rib  344 . Similarly, positioned above the opening  342 B on the exterior cylindrical surface of the piston  340  is an upper annular rib  346 . The annular rib  346  is flanked above and below by annular groves. The rib  346  has a radial dimension that is slightly greater than the diameter of the smooth outer surface of the piston  340 , on the order of 0.006 of an inch. Upper annular channel  354  is positioned directly behind the annular rib  346  to allow for slight deformation of the sleeve along the extent of rib  346 . The ribs  344  and  346  form seals having a dynamic design that work equally well while under either positive or negative pressures. The configuration allows for ease of preload/compression of the seals with minimal dragging during valve piston movement. The annular channels behind the seals allow for somewhat constant compression forces inside a tapered/drafted cylinder. The ribs  344  and  346  will maintain a seal up to +/−2.5 psi. As seen in  FIG. 15  resilient rib  345  extends generally perpendicular between ribs  344  and  346 . A second rib, not illustrated, flanks the opposite side of opening  342 B in the same manner as rib  345 .  FIG. 16  is a perspective of the valve piston sub assembly including valve piston  394 , chord bar  316  within an annular support, stem  314  and cylindrical sleeve  320  that supports spokes  320 . 
         [0076]      FIG. 18  shows an alternative embodiment for the seal located in resuscitator port  311 . In this embodiment the housing  302  includes an annular groove  372  located on the external surface of the cylindrical housing  302  in a region proximate to the resuscitator inlet port. The seal  370  includes and annular portion  376 , a radially directed inward portion  374  at the lower end of the seal  370  and a second radially directed inward portion  378  at the upper end of the seal  370 . The lower radially directed portion  374  is sized and configured to fit within annular groove  372  to retain the seal  370  to the housing  302 . The upper radially directed portion  378  is sized and configured to extend over the top of annular surface of the resuscitator port  311 . As shown the upper radially directed portion  378  will sealingly cooperate with the external wall of the resuscitator adaptor  340 . Likewise a cap  326  will sealingly engage portions  376  and  378  of seal  370 . 
         [0077]      FIG. 19  is a an alternate embodiment of the respiratory valve wherein the valve housing  402  includes a catheter entry port  416 A with a flexible orifice  424 A and an endotracheal tube connection port  418 A for connection to endotracheal tube  426 A. 
         [0078]      FIG. 20  is an exploded sectional side view of the respiratory valve and removable housing  414  that includes a catheter entry port  416 B with a flexible orifice  424 B and an endotracheal tube connection port  418 B for connection to endotracheal tube  426 B. Housing  414  is sized and configured to be removably connected to housing  302  in a fluid tight fashion with connector  336 . 
         [0079]      FIG. 21  is an alternate embodiment wherein the helical spring  322  of the prior embodiment is replaced with a resilient elastomeric diaphragm  522 . Diaphragm  522  has an enlarged upper annular portion  524  that is coextensive with a depending cylindrical portion  526 . The upper annular portion  524  is anchored between cylindrical wall  528  and annular stem support  530 . The lower end of the cylindrical portion is either attached or integral with the valve piston  304 . As shown, the diaphragm  522  is in a neutral state where it will return in the absence of a force exerted by resuscitation bag adapter  340 . 
         [0080]    The respiratory valve assembly, a resuscitation bag, an endotracheal tube, and a suction tube may be supplied as a surgical tray or kit. This organization presents the physician and nurses with all the equipment to perform a complete procedure. All of the components are sized to securely fit together and are located in the same kit. 
         [0081]    All patents and publications mentioned in this specification are indicative of the levels of those skilled in the art to which the invention pertains. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference. 
         [0082]    It is to be understood that while certain forms of the invention are illustrated, it is not to be limited to the specific forms or arrangements of parts herein described and shown. It will be apparent to those skilled in the art that various changes may be made without departing from the scope of the invention and the invention is not to be considered limited to what is shown in the drawings and descriptions. 
         [0083]    One skilled in the art will readily appreciate that the present invention is well adapted to carry out the objectives and obtain the ends and advantages mentioned, as well as those inherent therein. The embodiments, methods, procedures and techniques described herein are presently representative of the preferred embodiments, are intended to be exemplary and are not intended as limitations on the scope. Changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the appended claims. Although the invention has been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes for carrying out the invention which are obvious to those skilled in the art are intended to be within the scope of the following claims.