Patent Publication Number: US-2023143691-A1

Title: Device and system for respiratory support

Description:
FIELD OF THE INVENTION 
     The present invention relates to a device and a system for positive pressure ventilation (PPV) and continuous positive airway pressure (CPAP) treatment for e.g. neonatal resuscitation and initial respiratory support. 
     BACKGROUND OF THE INVENTION 
     Positive pressure ventilation (PPV) and continuous positive airway pressure (CPAP) are two types of mechanical respiratory support commonly used for resuscitation and stabilisation of newborn infants. Which of the two respiratory support systems to use depends on whether the infant is breathing or not. While PPV is used for the non-breathing infant, CPAP is used for the breathing infant. An infant that is not breathing after birth should be ventilated. This can be accomplished with PPV using e.g. a face mask, or an endotracheal tube. In the majority of cases a mask is used. If the infant starts to breathe or was breathing after birth, support of ventilation using CPAP is the recommended treatment for several conditions. After return of spontaneous breathing some infants will still need PPV intermittently if they do not breathe adequately or stop breathing. This is particularly common when treating premature neonates. Thus, both types of support are common and often the need changes during the resuscitation period. During both PPV and CPAP the distending pressure helps the lung to maintain aeration. This is referred to as positive end expiratory pressure (PEEP) when providing PPV and is, for this type of device, functionally equivalent to CPAP. 
     A device and system which can provide both positive pressure ventilation and continuous positive airway pressure is disclosed in WO2012/108826. The device comprises a first fresh gas flow tube arranged to provide a first fresh gas flow, a second fresh gas flow tube, a variable flow CPAP generator, a connector connectable to any infant interface, and a pressure release valve. The variable flow CPAP generator comprises a first connection portion to which the first fresh gas flow tube is connected, a second connection portion to which the infant interface connector is connected, and a third connection portion which is an outlet of the variable flow CPAP generator having an open end. The second fresh gas flow tube bypasses the variable CPAP generator and is arranged to provide a second fresh gas flow which is added to the first fresh gas flow in the positive pressure ventilation mode when the open end of the outlet is occluded. Thereby, in the PPV mode, the pressure is increased at a higher rate than if only the first fresh gas flow had been used, which allows for a shortened inspiratory rise time. The system can be used for non-invasive ventilation and provides a low imposed work of breathing for the breathing child treated with CPAP and an easy switch between PPV and CPAP respiratory support without change of equipment. 
     For an optimal functioning of the system it is necessary to adjust the fresh gas flow supplied during resuscitation through the use of the second fresh gas flow. Adding the second fresh gas flow in the PPV mode provides an adjustable rise time, which e.g. can be shortened by increasing the second fresh gas flow. This is desirable to provide a stable and efficient ventilation. However, applying the second fresh gas flow is not possible in all medical installations, due to e.g. lack of outputs at the gas source for connecting the second fresh gas flow tube. Further, the second fresh gas flow increases the complexity of the device and may increase the risk of user errors with potentially serious consequences. Consequently, making use of a second fresh gas flow through the second fresh gas flow tube is not always possible resulting in a less efficient resuscitation treatment. 
     Therefore, there is a need within the technical field of devices providing both PPV and CPAP to overcome the problems that exist today. 
     SUMMARY OF THE INVENTION 
     It is an object of the present invention to provide a device for PPV and CPAP treatment that alleviates the above-mentioned problems. The object is achieved by a device for PPV and CPAP treatment according to the present invention as disclosed herein. 
     Thus, in accordance with an aspect of the present invention, there is provided a device for positive pressure ventilation and continuous positive airway pressure treatment comprising:
         a fresh gas flow inlet arranged to receive a fresh gas flow from a fresh gas flow tube connectable thereto;   a patient interface end which is connectable with a patient interface;   an outlet having an open end; and   several variable flow CPAP generators, wherein each of the several variable flow CPAP generators is connected with the fresh gas flow inlet, the patient interface end and the outlet of the device.       

     This provides a simplified device for CPAP and PPV treatment, particularly intended for resuscitation and stabilisation of infants. The device is easy to use and allows rapid switch between PPV and CPAP without change of equipment. A safe and quick switch between these types of respiratory support will improve care for an unstable child and lead to higher quality in resuscitation with reduced mortality and morbidity. 
     Providing several variable flow CPAP generators, each connected with the fresh gas flow inlet, the patient interface end and the outlet of the device, allows operating at a higher drive flow, i.e. with a higher fresh gas flow provided to the fresh gas flow inlet of the device, while maintaining the same stable pressure at the patient interface end in the CPAP mode, as compared to when providing one sole variable flow CPAP generator. Further, in the PPV mode, when the outlet of the device is occluded, the higher fresh gas flow used for the device will be delivered to the patient, resulting in a rapid increase of the pressure and generating an inflation breath. 
     The provision of a fresh gas flow inlet simplifies gas supply to the device, since one sole driver flow of fresh gas is needed for the device, i.e. for the one sole fresh gas flow inlet. This further allows for a reduction in size of the device with respect to when two driver flows are required, thereby also facilitating the handling and use of the same. A further advantage with providing only one driver flow for the device as herein disclosed is that it allows integration of the device in both low tech and high-tech ventilator equipment, requiring only one gas output channel for fresh gas supply from the ventilator equipment. That is, the device can be installed in a system comprising just one gas output channel for fresh gas supply. This allows integration of the device with existing CPAP drivers and ventilators without any modification of the hardware. Additionally, another advantage is that providing humidification of the flow to the fresh gas flow inlet is simple, as opposed to for a device comprising two driver flows. 
     The driver flow, i.e. the fresh gas flow supplied to the fresh gas flow inlet, can be set to an amount that allows for a desired CPAP to be generated by the variable flow CPAP generators. When the open end of the outlet of the device is occluded, corresponding to the PPV mode, the entire driver flow will reach the patient interface end and, further, the patient, resulting in an increased flow for the inflation breath. The driver flow being increased with respect to a device comprising only one variable flow CPAP generator providing the same level of CPAP in the CPAP mode provides for an decreased rise time of the pressure when the outlet of the device is occluded, which is advantageous. 
     For purposes of this invention, the words “infant” and “child” are intended to encompass a patient such as a newborn, and a neonatal child which is in need of neonatal resuscitation and initial respiratory support. The words are also intended to encompass children and toddlers of up to around 10 kg of weight. The fresh gas flow is adapted to the weight and size of the child such that a desirable respiratory rate is attained. For purposes of this invention, the wording “fresh gas flow” is air, oxygen or a mixture of these that flows through the system and its parts, and the wording “fresh gas flow tube” is wherein the fresh gas flows. 
     For purposes of this invention, the wording “variable flow CPAP generator” is a device intended to encompass any continuous positive airway pressure device where the CPAP level is adjusted by varying the fresh gas flow. 
     For the purposes of this invention, the wording “driver flow” will be used as a synonym to the fresh gas flow provided to the fresh gas flow inlet of the device. 
     For purposes of this invention, the word “patient interface” is intended to encompass any interface that is suitable for connecting to a patient, e.g. an infant or child, such as a pair of nasal prongs, a mask, an endotracheal tube or any other suitable device. 
     There are different ways of arranging the device in order to achieve the advantages set forth above. 
     In accordance with an embodiment of the device, each of the variable flow CPAP generators comprises a first connection portion connected with the fresh gas flow inlet, a second connection portion connected with the patient interface end, and a third connection portion connected with the outlet of the device. This provides for a compact arrangement of the several variable flow CPAP generators, and a compact device. In operation, the fresh gas flow entering the fresh gas flow inlet of the device will further be divided between the several first connection portions of the several CPAP generators to flow therethrough. The second connection portions of the variable flow CPAP generators being connected with the patient interface end of the device provide a stable level of CPAP at the patient interface end when the device operates in the CPAP mode. Finally, providing the third connection portions of the several variable flow CPAP generators connected with the outlet of the device allows for a smooth operation of the device, as it can be set in the PPV mode simply by occluding the one outlet of the device. Further, providing variable flow CPAP generators with first, second, and third connection portions as previously described is advantageous since such variable flow CPAP generators generally provide a stable level of CPAP and low imposed work of breathing for the patient when used. 
     In accordance with an embodiment of the device, the device further comprises an inlet chamber arranged at the fresh gas flow inlet, a patient interface chamber arranged at the patient interface end, and an outlet chamber arranged at the outlet of the device, wherein each of the several variable flow CPAP generators is connected with the fresh gas flow inlet, the patient interface end, and the outlet through the inlet chamber, the patient interface chamber and the outlet chamber, respectively. That is, the inlet chamber, the patient interface chamber, and the outlet chamber are common to the several variable flow CPAP generators, as are the fresh gas flow inlet, the patient interface end, and the outlet of the device. This provides a compact device which is easy to handle. 
     In accordance with an embodiment of the device, the device comprises three variable flow CPAP generators, each of which comprises a first connection portion connected with the fresh gas flow inlet, a second connection portion connected with the patient interface end, and a third connection portion connected with the outlet of the device. In another embodiment of the device, the number of variable flow CPAP generators is four. Generally, any number of variable flow CPAP generators larger than one can be provided according to the inventive concept. The drive flow can then be adapted to the patient on which the device is to be used, in order to provide the desired CPAP in the CPAP mode. For smaller infants, such as neonates, a device comprising two variable flow CPAP generators may be sufficient to provide the desired rise time when operated in the PPV mode. For a larger child, e.g. having a weight of around 10 kg, it may be advantageous to use a device comprising three or four variable flow CPAP generators in order to achieve the desired rise time for that patient when operated in the ventilation mode. It will be understood from the present disclosure that the higher the number of variable flow CPAP generators in the device, the higher driver flow can be used, resulting in a faster pressure increase, i.e. shortened rise time, in the PPV mode. Preferably, the number of variable flow CPAP generators is between two and four. Providing between two and four variable flow CPAP generators does not necessarily contribute to a larger device for PPV and CPAP treatment as the variable flow CPAP generators could be fitted within the outer measures of devices known in the art. However, providing more than four variable flow CPAP generators is also conceivable within the concept of the present invention. 
     In accordance with an embodiment of the device, it further comprises a pressure release connection portion having a first end connected with the patient interface end of the device and a second end connectable with a pressure release tube. The pressure release connection portion is generally tubular and extends through a portion of the device between the patient interface end and a side wall of the device, forming an internal passage there through. A pressure release tube is connectable with the hole through the side wall provided by the second end of the pressure release connection portion. 
     According to another aspect of the present invention, there is provided a system for PPV and CPAP treatment comprising a device as disclosed herein, a fresh gas flow tube, a fresh gas source connected with the fresh gas flow inlet by means of the fresh gas flow tube, and a pressure release valve arranged to prevent an excessive positive pressure in a PPV mode. Thus, the system includes the fresh gas source and a pressure release valve which is set to a specific opening pressure adapted to suit the patient to be treated. 
     In accordance with an embodiment of the system, it is arranged such that when the open end of the outlet of the device is occluded, the pressure will increase from the variable flow CPAP generators until an opening pressure of the pressure release valve is reached, which increase in pressure results in an inspiratory flow, whereby the pressure in the system will remain at the set PPV pressure until the occlusion is removed from the outlet, and when the occluded outlet is opened, the pressure will return to the set CPAP level, whereby the reduction in pressure leads to an expiratory flow. 
     In accordance with an embodiment of the system, it is arranged such that during spontaneous breathing, the patient flow and the fresh gas flow leave the system through the variable flow CPAP generators keeping the positive pressure within the airway of the patient stable, by varying the flow that generates the CPAP, whereby the CPAP in the airway can be adjusted as needed. 
     In accordance with an embodiment of the system, the pressure release valve is connected with one of the patient interface end and the outlet of the device. These are two alternative ways of arranging the pressure release valve in the system, where the main aim is to arrange it in a position where the pressure of interest is measurable in a reliable way. Arranging the pressure release valve in connection with the outlet of the device allows for removal of a pressure release tube and a pressure release connection portion, providing a compact device and system. 
     In accordance with an embodiment of the system comprising a device having a pressure release connection portion, the pressure release valve is connected with the pressure release connection portion. In an embodiment of this system, it further comprises a pressure release tube at which the pressure release valve is arranged. This may be a more familiar way of arranging the pressure release valve for a user. 
     According to an embodiment of the system, it further comprises a pressure measuring device. Thereby, it is possible to easily monitor the operation of the system and make desirable adjustments of the fresh gas flow. Preferably, the pressure measuring device is arranged at the patient interface end of the device. In accordance with an embodiment of the system having a device comprising a pressure release connection portion, the pressure measuring device is connected with the patient interface end through the pressure release connection portion. Naturally, the main aim is to arrange the pressure measuring device in a position where the pressure of interest is measurable in a reliable and accurate way. 
     The different embodiments of the system can be summarized as a system comprising a device having a fresh gas flow inlet connected with several variable flow CPAP generators, in turn connected with a common patient interface end and an outlet of the device. The system further comprises a fresh gas flow tube connected at one end to the fresh gas flow inlet and at the other end to a fresh gas source for supplying a fresh gas flow to the device. A pressure release valve is further comprised in the system, being connected with one of the outlet and the patient interface end of the device. Optionally, the system comprises a pressure measuring device arranged at the patient interface end of the device for accurate and reliable measuring of the pressure thereat. 
     The device as disclosed herein can be used in PPV and CPAP treatment for neonatal resuscitation and initial respiratory support. 
     The system as disclosed herein can be used for PPV and CPAP treatment for neonatal resuscitation and initial respiratory support. 
     These and other aspects, and advantages of the invention will be apparent from and elucidated with reference to the embodiments described hereinafter. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention will now be described in more detail and with reference to the appended drawings. The drawings are included to provide a further understanding of the present invention and are incorporated in and are a part of this specification. Other embodiments of the present invention, and many of the intended advantages of the present invention, will be readily appreciated as they become better understood by reference to the following detailed description. The elements of the drawings are not necessarily to scale relative to each other. The same reference numerals designate corresponding similar parts. 
         FIG.  1    is a schematic, partly cut-away, illustration of an embodiment of the device according to the present invention; 
         FIG.  2    is a schematic, partly cut-away, illustration of another embodiment of the device according to the present invention; 
         FIG.  3    is a schematic cross-sectional illustration of yet another embodiment of the device according to the present invention; 
         FIGS.  4 - 5    are schematic cross-sectional illustrations of embodiments of the system according to the present invention; 
         FIGS.  6   a - b    schematically illustrate flows of the system shown in  FIG.  4    during positive pressure ventilation, i.e. PPV mode; and 
         FIG.  7    schematically illustrates flows in the system shown in  FIG.  4    during spontaneous ventilation, i.e. CPAP mode. 
     
    
    
     DESCRIPTION OF PREFERRED EMBODIMENTS 
     Examples of different embodiments of the present invention are provided. Common for the embodiments of the device for PPV and CPAP treatment described herein is that they comprise a fresh gas flow inlet  2 , a patient interface end  3 , an outlet  4  having an open end  5 , and several variable CPAP generators  6 , each connected with the fresh gas flow inlet  2 , the patient interface end  3 , and the outlet  4 . More particularly, the device further comprises an inlet chamber  21  at the fresh gas flow inlet  2 , a patient interface chamber  31  at the patient interface end  3 , and an outlet chamber  41  at the outlet  4 . Each of the variable flow CPAP generators  6  is connected with the fresh gas flow inlet  2 , the patient interface end  3 , and the outlet  4  through the inlet chamber  21 , the patient interface chamber  31 , and the outlet chamber  41 , respectively. That is, the inlet chamber  21 , the patient interface chamber  31 , and the outlet chamber  41  are common to the several variable flow CPAP generators  6 , as are the fresh gas flow inlet  2 , the patient interface end  3 , and the outlet  4  of the device. 
     With reference to  FIG.  1   , according to a first embodiment of the device  100 , the device  100  comprises three variable flow CPAP generators  6 , arranged adjacent to each other. Each of the variable flow CPAP generators  6  comprises a first connection portion  10 , a second connection portion  11 , and a third connection portion  12 . The first connection portions  10  of the variable flow CPAP generators  6  are connected with the fresh gas flow inlet  2 , the second connection portions  11  are connected with the patient interface end  3 , and the third connection portions  12  are connected with the outlet  4  of the device  100 . More particularly, the first connection portions  10  of the variable flow CPAP generators  6  are connected with the fresh gas flow inlet  2  through the inlet chamber  21 . The inlet chamber  21  is generally delimited by the inner walls of a tubular portion extending between the fresh flow gas inlet  2  and the first connection portions  10  of the variable flow CPAP generators  6 . Correspondingly, the second connection portions  11  are connected with the patient interface end  3  through the patient interface chamber  31 . The patient interface chamber  31  is generally defined by a tubular portion extending between the second connection portions  11  and the patient interface end  3 . It may, however, be of any other shape suitable for the purpose of providing a common chamber connecting the second connection portions  11  of the variable flow CPAP generators  6  to the common patient interface end  3  of the device  100 . The patient interface end  3  of the device  100  is further connectable with any patient interface, such as for example a face mask, nasal prongs, or an endotracheal tube. 
     In a corresponding manner, the third connection portions  12  of the variable flow CPAP generators  6  are connected with the outlet  4  of the device  100  through the outlet chamber  41 . The outlet chamber  41  is typically tubular and arranged as a protruding tube ending, which extends between the second connection portions  12  and the outlet  4  having a free open end  5 . The three variable flow CPAP generators  6  of the exemplifying embodiment shown in  FIG.  1    are thus arranged in parallel, extending between the common fresh flow gas flow inlet  2 , patient interface end  3  and outlet  4  of the device  100 , providing a compact device  100 . 
     In the exemplifying embodiment shown in  FIG.  1   , the second and third connection portions  11 ,  12  of each variable flow CPAP generator  6  are arranged at an angle to each other. The first connection portion  10  is connected with the third connection portion  12  at an angle, and is further arranged substantially coaxially with the second connection portion  11 . Such a geometry of the variable flow CPAP generators  6  is advantageous as it provides a stable CPAP generated by the variable flow CPAP generators  6 , and a low imposed work of breathing for the patient when in use. However, providing several variable flow CPAP generators  6  in the device  100  having a different geometry is also conceivable within the concept of the present invention. 
     With reference to  FIG.  2   , according to another embodiment of the device  200 , the device  200  comprises four variable flow CPAP generators  6 . Each of the four variable flow CPAP generators  6  comprises a first connection portion  10 , a second connection portion  11 , and a third connection portion  12 . The first connection portions  10  of the variable flow CPAP generators  6  are connected with the fresh gas flow inlet  2 , the second connection portions  11  are connected with the patient interface end  3 , and the third connection portions  12  are connected with the outlet  4  of the device  200 . Also in this embodiment, the first connection portions  10  of the variable flow CPAP generators  6  are connected with the fresh gas flow inlet  2  through the inlet chamber  21 . Correspondingly, the second connection portions  11  are connected with the patient interface end  3  through the patient interface chamber  31 , and the third connection portions  12  of the variable flow CPAP generators  6  are connected with the outlet  4  of the device  100  through the outlet chamber  41 . The outlet chamber  41  is typically tubular and arranged as a protruding tube ending, which extends between the second connection portions  12  and the outlet  4  having a free open end  5 . The patient interface end  3  of the device  100  is connectable with any patient interface, such as for example a face mask, nasal prongs, or an endotracheal tube. The four variable flow CPAP generators  6  are arranged in parallel, extending between the fresh flow gas flow inlet  2 , the patient interface end  3  and the outlet of the device  4 , providing a compact device  200 . 
     With reference now to  FIG.  3   , according to yet another embodiment, the device  300  comprises three variable flow CPAP generators  6  arranged as described with respect to  FIG.  1   . Due to the cross-sectional illustration of  FIG.  3   , only one of the variable flow CPAP generators  6  is visible therein. Furthermore, the device  300  comprises a pressure release connection portion  14  having a first end  16  and a second end  17 . The first end  16  is connected with the patient interface end  3  of the device  300  and the second end  17  is connectable to a pressure release tube  15 , see  FIG.  5   . More particularly, the first end  16  is connected with the patient interface end  3  through the patient interface chamber  31 . The pressure release connection portion  14  is generally tubular and extends partially in parallel with the second connection portions  11  of the variable flow CPAP generators  6 , and partially at an angle thereof towards a side wall  18  of the device, see  FIG.  5   . This embodiment is useful in a system that will be described with reference to  FIG.  5   . It should be noted that the pressure release connection portion  14  is applicable to a device having any number of variable flow CPAP generators. 
     A first embodiment of the system  400 , as shown in  FIG.  4   , comprises the embodiment of the device  100  described with reference to  FIG.  1   . Due to the cross-sectional illustration shown in  FIG.  4   , only one of the three variable flow CPAP generators  6  is visible therein. The system  400  further comprises a fresh gas source  20 , which provides a fresh gas flow to the fresh gas flow inlet  2  through a fresh gas flow tube  22  of the system  400 . The level of CPAP is adjusted at the fresh gas source  20 . The system further comprises a pressure release valve  7  and a pressure measuring device  8 . The pressure release valve  7  is here arranged in connection with the outlet  4  of the device  100 . More particularly, the system  400  further comprises an outlet tube  19  connected with the outlet  4  of the device  100 . The pressure release valve  7  is arranged along the outlet tube  19 . The outlet tube  19  comprises an open end  23 . The pressure measuring device  8  is arranged at the patient interface end  3  of the device  100 . The pressure measuring device  8  can be omitted in all embodiments, however, if there is no interest in measuring the pressure. 
     With reference to  FIG.  5   , according to a second embodiment of the system  500 , the system  500  comprises the device  300  as described with reference to  FIG.  3   , i.e. the device comprising a pressure release connection portion  14 . As for the embodiment shown in  FIG.  4   , due to the cross-sectional illustration of the system  500 , only one of the variable flow CPAP generators  6  is visible in  FIG.  5   . The system  500  further comprises a pressure release tube  15  connected with the pressure release connection portion  14 . The pressure release valve  7  is arranged at an end of the pressure release tube  15  which is distal to the pressure release connection portion  14 . The pressure measuring device  8  is here arranged at the pressure release tube  15  between the pressure release valve  7  and the pressure release connection portion  14 . 
     The system is operated as follows. Reference will be made to the first embodiment of the system  400 , but the second embodiment of the system  500  has a corresponding operation. Oxygen concentration and fresh gas flow are adjusted by a standard blender and a flow meter. The fresh gas flow could be varied and is typically set to between 5 and 15 litres per minute. Typically, the fresh gas flow provided is between 10 and 12 litres per minute. A fresh gas flow in this range should prevent rebreathing, provide flow to achieve an adequate inspiration flow, volume and time, and provide some allowance for leakage at the patient interface. However, a fresh gas flow above 15 litres per minute is also possible to provide, particularly for treatment of an older child. The system is further configured such that this range of supplied fresh gas flow generates a level of CPAP of 3-10 cm H 2 O. In a preferred embodiment, the generated level of CPAP is 5-6 cm H 2 O. 
     The fresh gas flow is used to drive the variable flow CPAP generators  6 . The fresh gas flow to the variable flow CPAP generators  6  is always adjustable. In the exemplifying embodiment of the device  100  comprising three variable flow CPAP generators  6 , a typical value of the fresh gas flow provided to the fresh gas flow inlet  2  is 5-15 liters per minute, typically generating a CPAP level of 3-10 cm H 2 O. To provide higher levels of CPAP, the flow driving the variable flow CPAP generators  6  can be increased further. 
     The outlet  4  of the variable flow CPAP generator  6  has an open end  5 . In the system  400  shown in  FIG.  4   , the outlet tube  19  is connected with the open-ended outlet  4  of the device and has an open end  23 . If the open end  23  of the outlet tube  19  is occluded, see  FIGS.  4  and  6     a , the pressure delivered to the infant will increase from the pressure set by the variable CPAP generators  6  until the opening pressure of the pressure release valve  7  is reached. In the system  500  comprising the device  300  described with reference to  FIG.  3   , occlusion of the open end  5  of the outlet  4  of the device  300  will have the same effect. A typical value for the pressure release valve  7  to open is around 20-30 cm H 2 O. The increase in pressure results in an inspiratory flow. The pressure in the system  400  will remain at the set positive pressure ventilation pressure until the outlet occlusion is removed. When the occluded open end  5  is opened, see  FIG.  6   b   , the pressure delivered to the patient will return to the set CPAP level and this reduction in pressure will lead to an expiratory flow. 
     During spontaneous breathing, the infant flow and the fresh gas flow leaves the system  400  through the variable flow CPAP generators  6 , see  FIG.  7   . This keeps the positive pressure within the airway stable. By varying the driver flow, i.e. the fresh gas flow that generates the CPAP pressure, the CPAP level in the airway can be adjusted as needed. 
     The patient interface end  3  can be designed in any suitable form such to be suitable for connection with a patient interface. Further, the patient interface can assume a variety of designs suitable for establishing a connection to the patient nasal airways, not shown. Thus, the patient interface can include an opposing pair of nasal prongs, a mask, an endotracheal tube or any other suitable devices. 
     The system  400 ,  500  could have a backup system for malfunctioning of the pressure release valve  7 . This could either be an alarm, a second release valve or a system that cuts the fresh gas flow. 
     The pressure measuring device  8  should be positioned as close to the patient as possible to provide accurate recording of the pressure of the gas delivered to the patient. The accuracy will depend on the flow resistance of the patient interface and, for an infant, a low resistance interface should be used if possible. The embodiment of the device described with reference to  FIGS.  1  and  2    could be regarded as beneficial since there will be less tubes needed in the system  400 . 
     Notably, the device, in accordance with principles of the present invention is useful with a wide variety of patient interface configurations that may or may not incorporate some or all of the features described above with respect to the patient interface. Thus, the patient interface is in no way limiting. 
     Notably, the device, in accordance with principles of the present invention is useful with a wide variety of variable flow CPAP generators that may or may not incorporate some or all of the features described above with respect to the variable flow CPAP generators  6 . Thus, the model of the variable flow CPAP generators  6  is in no way limiting. 
     Notably, the device, in accordance with principles of the present invention, is useful with a wide variety of pressure release valves  7  or similar devices that achieve the purpose of releasing air depending on the pressure in the system. Thus, the model or type of pressure release valve is in no way limiting. 
     Notably, the device, in accordance with principles of the present invention is useful with a wide variety of pressure measuring devices  8  or similar devices that achieve the purpose of measuring the pressure in the system. Thus, the model or type pressure measuring devices is in no way limiting. 
     A typical CPAP level for resuscitating or stabilising an infant is in the range of 4-10 cm H 2 O. A typical peak pressure for PPV is 20-30 cm H 2 O. It is obtained by occluding the system and having a correctly adjusted pressure release valve. 
     Above embodiments of the device and system according to the present invention as defined in the appended claims have been described. These should only be seen as merely non-limiting examples. As understood by the person skilled in the art, many modifications and alternative embodiments are possible within the scope of the invention as defined by the appended claims. 
     It is to be noted that for the purposes of his application, and in particular with regard to the appended claims, the word “comprising” does not exclude other elements or steps, and the word “a” or “an” does not exclude a plurality, which per se will be evident to a person skilled in the art.