CA1211333A - Endotracheal tube - Google Patents
Endotracheal tubeInfo
- Publication number
- CA1211333A CA1211333A CA000441435A CA441435A CA1211333A CA 1211333 A CA1211333 A CA 1211333A CA 000441435 A CA000441435 A CA 000441435A CA 441435 A CA441435 A CA 441435A CA 1211333 A CA1211333 A CA 1211333A
- Authority
- CA
- Canada
- Prior art keywords
- tube
- cuff
- air
- air tube
- trachea
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0434—Cuffs
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0434—Cuffs
- A61M16/0454—Redundant cuffs
- A61M16/0459—Redundant cuffs one cuff behind another
Abstract
IMPROVED ENDOTRACHEAL TUBE
Abstract An endotracheal device comprises an air tube adapted to be inserted through the oral or nasal passage and into the trachea to provide an air passage for respirating a patient.
The air tube includes an inflatable cuff mounted at the distal end, and a membrane containing a cushioning material disposed along the air tube adjacent the cuff in a position to prevent direct contact between the air tube and the cricoarytenoid joint and its surrounding tissues.
Abstract An endotracheal device comprises an air tube adapted to be inserted through the oral or nasal passage and into the trachea to provide an air passage for respirating a patient.
The air tube includes an inflatable cuff mounted at the distal end, and a membrane containing a cushioning material disposed along the air tube adjacent the cuff in a position to prevent direct contact between the air tube and the cricoarytenoid joint and its surrounding tissues.
Description
lZ1~333 Field of the Invention This invention relates generally to the area of endotracheal tubes, and, more particularl~, to an improved ¦l endotracheal tuke capable of reducing the incidence and se~ter-5 ¦ ¦ ity of cricoarytenoid trauma.
¦I Back~round of the_Invention : !I Endotracheal tubes have been routinely used for a ¦ number of decades to prevent upper airway obstruction or to 1 facilitate artificial ventilation of unconscious or anes-l thetized patients. Early designs of endotracheal tubes consis-¦ ted of a relatively pliable tube shaped for insertion through ¦ the oral passage and into the trachea, and adapted to connect ¦ to a respirator for the introduction of air into the lungs. To ;¦ avoid the escape of air from the trachea out the oral and nasal passages, improved endotracheal tubes were later introduced ~¦ which included an inflatable bag-like structure or cuff dis-¦I posed about the exterior surface of the tube at the distal end.
These newer endotracheal tubes, which are in common use toda , ~ 1l are inserted into the trachea such that the cuff is disposed a ¦ few centimeters below the larynx. Once in place, the cuff is ; 1¦ inflated by a source of air and creates an airtight seal ¦I between the tube and tracheal wall. This effectively pxevents air being pumped b~ a respirator into the lungs from escaping 25 1I the trachea and entering the oral and nasal passages~
¦ Furthex research resulted in the development of 'I two-cuff endotracheal tubes which generally consist of an ,' , esophageal cu~f and an oral cuff. Properly positioned in a l' patient, the two-cuff endotracheal tubes are operable to seal 30 1I the esophagus and prevent the contents of the stomach from .1 i -2-' entering the lungs, while also preventing the escape of air being pumped into the lungs ~rom the trachea.
, These improvements of endotracheal tubes have ~ncour-¦ aged physicians to prescribe prolonged endotracheal inkubation5 j of from several days to two or more week~ for some patients.
However, particularly over longer intubation periods, several problems have been identified in the use of existing endo-tracheal tube designs. It was discovered that in an effort to Il create a non-leak seal between the cuff and walls of the 1¦ trachea that the pressure applied by the ouff had a tendency to ¦ damage the ciliated endothelium of the trachea and occlude the blood perfusion of -the tracheal mucosa after a period of time leading to tissue necrosis. In addition, it was found that some patients experienced laryngeal dysfunction due to contact of the endotracheal tube within the posterior endolarynx.
Initial studies of the problems encountered in the use of known endotxacheal tubes resulted in attempts at im-proved designs such as disclosed in U.S. Patent No., 4,091,816 to Elam. The Elam patent discloses an endo-tracheal tube with a ¦ double cuff arrangement wherein a standard cuff is mounted on i the exterior surface of the tube adjacent its distal end, and a second cuff is disposed upwardly along the tube from the lower cuff. The two cuffs are interconnected so that air pumped into ¦l one cuff may be transferred to the other. With the endo-2S !l tracheal tube of Elam properly positioned in a patient, the ~1 lower cuff is disposed a few centimeters below the larynx within the mid-trachea and the upper cuff a few centimeters above the larynx.
Il The interconnection between the two cuffs in the Elam : 30 il patent is intended to solve the problem created by over-pressurizing the single cu~fs found in prior art endotracheal .~ .
I tubes to avoid damage to the ciliated endothelium of the ,I trachea and possible tissue necrosis. The volume of air in ~he , Il lower cuff which seals the trachea is kransferable to the upper ¦
~ cuff to avoid undue pressuxe on the tracheal walls while ', maintaining an airtight seal between the tube and tracheal walls.
In addition, the Elam patent suggests that laryngeal dysfunction is brought about by contact o~ the endotracheal I, tube with the vocal cords of the larynx, particularly as a i result of the to-and-fro motion of the tube induced by the operation of the respirator as it provides air to the lungs.
i To reduce the abrasion to the vocal cords caused by such tube ; 'I motion, the two cuffs along the Elam endotracheal tube are deliberately placed on either side of the larynx. This ar-l¦ rangement is intended to anchor the tube in relation to the larynx so as to prevent or at least limit the to-and-fro i movement of the tube ayainst the vocal cords.
, Careful study of the effects of prolonged endo-il tracheal intubation has provided a much more accurate apprec-; 20 il iation of the true cause of laryngeal injury than suggested in ; , the prior art. It is clear that laryngeal dysfunction is brought about by mechanical trauma of the endotracheal tube as it rides within the posterior endolarynx. This mechanical trauma is imposed by constant and ongoing forces applied by the ' tube which are xelated to respirator-induced tube mcvement, patient movement and reflex laryngeal movement against the tube.
Importantly, it has been discovered that such mechan-, ical trauma is directed to a large extent against the aryten-oids and in particular the cricoarytenoid joint and surrounding tissue where the endotracheal tube actually rests when properly :~2~L~33~
positioned in a patient. As an inherent result of the ~hape o~
I existing endotracheal tubes, the cricoarytenoid joint region ¦li becomes a fulcrum or pivot point about which the tube pi~ots Il and moves in response to orces applied to the tube by opera ~¦ tion of a respirator or by movement of the patient's head and neck.
It has been observed and determined that the re-sultant effect of such mechanical trauma is potentially serious I, laryngeal dysfunction. One specific form of laryngeal dysfunc-jl tion observed is the initiation of traumatic cricoarytenoidarthritis. While generally not permanent, even transient laryngeal dysfunction resulting from cricoarytenoid arthritis ¦ may be serious to some patients. As has been documented, the development of cricoarytenoid arthritis may result in a loss or impairment o~ the laryngeal sphincteric function wherein the cricoarytenoid joint fails to fully close the tracheal tube during swallowing or open during respiration~ Without proper sphincteric function to fully seal the trachea, aspiration may ~1 occur with the accompanying adverse pulmonary effects. Aspir- ¦
20 11 ation is always dangerous, but it can be catastrophic for an ¦ already accutely or chronically ill patient with minimal ¦I reser~es. Failure of the cricoarytenoid joint to fully open may result in a compromised airway into the trachea where the ,1 ~Tocal cords do not move open because of the injury to the joint 25 i1~ and surrounding tissue. In some cases, injury to the cricoarytenoid joint and surrounding tissue may result in permanent scarring. Any scarring at this site is extraordin-arily difficult to correct surgically and may necessitate a permanent tracheotomy.
i -5-. .
~z~3~3 It is therefore an object of this inven~ion to Il provide an improved endotracheal tube which eliminates ox ak ! least reduces laryngeal dysfunction. I
I It is anothex object of this inve~tion to provide an 5 1 ¦ improved endotracheal tube capable of cushioning and protecting ¦
the cricoarytenoid joint region to assure proper laryngeal sphincteric function upon extubation of the tube.
i¦ It is a further object of this invention to provide ¦ an improved tracheal tube having the dual capability of sealing l the trachea without damage to -the tracheal walls while pro-Il tecting the cricoarytenoid joint region from trauma. I
Il I
Summary of the Invention Il These and other objects are accomplished in this 1 invention of an endotracheal device comprising an elongated il pliable air tube shaped for insertion through the oral or nasalpassage and into the trachea to provide a passage for pumping air into the lungs~ The distal end of the tube is provided with a bay-like membrane or cuff which is adapted to be in-20 1I flated once the tube is positioned in the txachea so as to I create a seal between the tube and trachea without exertingtraumatizing forces against the tracheal mucosa or ciliated endothelium of th~ trachea.
The endotracheal device further includes a second l cuff or mernbrane mounted on the exterior surface of the air tube in a position to contact and cushion the cricoar~tenoid joint when the tube is placed ln the proper position within the ~ trachea. The cushioning membrane rnay be filled with air either ¦ before or after insertion of the tube or may contain a resil-.
l ient substance such as silicon or a suitable equivalent. The membrane is spaced from the lower cuff at the distal end of the ~2~3~
tube and may extend only partially about thc exterior circumference o:~ the tube. The membrane contacts the cricoaryteno:i.d joint thus urging the endotracheal tube upwardly out of direct contact there~/.ith, and adjacent or into engagement with the vocal cor~s of the laryn~.
~iechanical trauma to the cricoarytenoid joint caused by motion of the t~lbe with:in the poster-lal endolarynx is thus effect:ively avoided to eliminate or at least sub-stantially reduce cricoarytenoid injury.
In summary of the above, therefore, tlle present invention may be broadly considered as providing an endotracheal tube adapted for insertion through the oral or nasal passage of a patient -to provide a passage for artificial respiration comprising:
an elongated, flexible air tube having a proximal end portion adapted to be located .external to the patient and a distal end portion adapted to be located lithin the trachea; means for sealing the air tube with respect to the trachea; and cushioning means covering at least a portion of the external wall surface of said air tube and being located with respect to said ends thereof such that on insertion of said tube in said patient said cushioning means rests against the cricoarytenoid joint and prevents contact of said air tube with the cricoarytenoid joint and surroungind tissue to red~lce the incidence and severity of cricoarytenoid trauma.
" ~}.~
-~2~ ;3 Description _ the Drawings The structure, operation and at~vantages of this invention will become apparent upon consideration of the following discuss.ion taken in conjunction with the accompanying dra-l:ings wherein.
~ igure 1 is a perspective vie~ of the improved endotracheal tube herein;
Figure 2 is a partial cross-sectional, partial schematic view of the endotracheal tube herein installed in a patient; and Figure 3 is a cross-sectional vie~ tal~en generally along line 3-3 of Figure 2.
Detailed Descri~tion of the Invention : P~eferring now to Figure 1, the endotracheal ;device accorsling ~o this invention includes an air tube having a distal end 12 and a proximal end 14 adapted for connection to a respirator (not shown). The tube 10 is shaped for insertion through the oral passage 16, past the epiglottis 18 and posterior pharyngeal wall 20, and then through the larynx .22 so that the distal end 12 of the tube 10 enters several centimeters into the trachea 24. Adjacent the distal end 12 of the 7~
., 3;~3 tube 10 is a bag-like membrane or cuf 26 which is mounted to the exkerior sur~ace of the tube 10 and extends outwardly ¦ therefrom. The cuff 26 is inflatable by means of a tube 23 ¦¦ connected to a sourre of air (not shown). With the tracheal ¦ tube 10 in proper position in a patient, the cu~ 26 e~tends beyond the larynx 22 and into the trachea 24. Con~entionally, ~ the cuff 26 is inflated with sufficient pressure so as to 1~ create a seal between the distal end 12 of the tube 10 which I prevents the escape of air upwardly through the trachea 24 and ,l out the oral passage 16. Preferably, the pressure used to ¦ inflate the cuff 26 is monitored to create a good seal without exerting undue pressure on the walls of the trachea 24 which can lead to damage as discussed above. The structure and Il materials used in the fabrication of the endotracheal device i discussed thus far is typical of that found in many conven-~i tional endotracheal tubes for artificial ventilation of uncon-scious or anesthesized patients or to prevent upper airway obstruction.
'l, It has been found that an important limitation of ; 20 '1 prior art endotracheal tubes, such as the endotracheal device I thus far described, is the creation of laryngeal dysfunction in i some patients. As illustrated in Figure 2, the air tube 10 is shaped such that it contacts the tongue 30 near its proximal end 14 and the area of the larynx 22 adjacent its distal end l' 12. Specifically, it has been found that typical endotracheal tubes directly contact the ar~tenoids 32, the cricoarytenoid joint 34 and surrounding tissue. The cricoarytenoid joint 34 operates to sphincter or close together the ary-tenoids 32 during swallowing so that solid or liquid material passes intQ
the esophagus 35 and not the trachea 24. To avoid aspiration and the accompanying pulmonary effectsr such as pneumonia, the ~L21~333 cricoarytenoid joint 34 must function to seal the trachea 24 fluld tight. In addition, during respiration the crico-arytenoid joint 34 must fully open to provide a~ unrestricted l airway for passage of air in the trachea 24 and lungs.
5 11 As mentioned above, endotracheal tubes inherently impose a degree of mechanical trauma within the posterial ¦ endolarynx. This trauma is caused by ~o and fro movement of Il the tube in response to the operation of the respirator, and ¦~ also tube rnovement induced by reflex and laryngeal movements ¦¦ against the tube resulting from swallowing and movement of the ¦ head and neck. Considering the positioning of the tube in the ¦ posterial endolarynx as shown in Figure 1 and discussed above, lt was discovered that the cricoarytenoid joint 34 and sur-! rounding tissue in effect functions as a pivot point or fulcrum ¦ on which the tube pivots as a result of such laryngeal and tubemovements. As a result, of this relatively severe stress ¦¦ placed on the sensitive cricoarytenoid joint 34, laryngeal ¦l dysfunction in the form of traumatic cricoarytenoid arthritis 1¦ and permanent scarring of the cricoarytenoid joint region can I be developed in an unacceptable number of patients.
,1 In view of the cause of such laryngeal dysfunction, Il the endotracheal tube 10 of this invention includes a second il cuff or membrane 36 mounted on the exterior surface of the tube jl 10. The second cuff or membrane 36 may be formed of the same 25 il material as the standard curf 26, and is mounted to tube 10 by an adhesive or any other suitable means. Membrane 36 is ,I disposed adjacent to the cuff 26 at a point along the endo-tracheal tube 10 which is coincident with the cricoarytenoid joint 34 when the tube 10 is properly placed within the trachea l 24~ The membrane 36 rests directly on the cricoarytenoid joint 34 thus disposing the endotracheal tube 10 outwardly out of _9_ ~2~333 , contact therewith and adjacent to or in engagement with the vocal cords 38 of the larynx 22.
,¦ The membrane 36 is attached to the exterior surface ¦1 of endotracheal tube 10 along at least a portion o the circum- ¦
~11 ference thereof. Membrane 36 may be inflated with air after insertion of the tube 10 within the trachea 24, as is cuf 26, or may be preinfla-ted by means of a tube 31 connected to a source of air (not shown). ~lternately, the membrane 36 may be I, filled with a resilient, cushioning material such as a sponge ~ or silicon rubber. It is contemplated that membrane 36 may be spaced fxom or adjacent to cuff 26 along tube 10, provided that Il it completely protects the cricoarytenoid joint 34 from engage- ¦
i¦ men~ with tube 10. The membrane 36 is resilient and provides a ¦ cushioning effect to reduce transmittal of traumatic forces to ¦ the cricoarytenoid joint 34 caused by motion of the endo-¦~ tracheal tube 10. As shown in Figures 1 and 2, the membrane 36 ,1 is relatively small in size and thus would not impair the attendant's vision during insertion of the endotracheal tube 10 Il or interfere with extubation of the tube 10.
' It is believed that the addition of membrane 36 to the endotracheal tube 10 of this invention will greatly reduce the chances of aspiration, permanent scarring or other serious laryngeal dysfunc-tion. Although it is possible that contact of I the tube 10 with the vocal cords 38 may increase trauma or , abrasion of the vocal cords 38, it is believed that the vocal cords 38 are much better able to withstand such trauma than the cricoarytenoid joint 34 and suxrounding tissue. Obviously, transient abrasion to the vocal cords 38 is much more pre-ferable than trauma lnduced arthritis to the cricoarytenoid joint 34 in view of the relative seriousness of the damage :
which can result from a failure of the sphinteric func~ion sf the cricoarytenoid joint 34.
While the invention has been described with reference to a preferred embodiment, it will be understood by those skilled in the art that various changes may be made and equiva-len~s may be substituted for elements thereof without departing from tha scope of the invention. In addition, many modifica ti.ons may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope ~hereof. Therefore, it is intended that the invention not be limited to the particular emb~diment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the appended claims.
I What is claimed is:
, !
'. 1 I';
. . .
.1' '
¦I Back~round of the_Invention : !I Endotracheal tubes have been routinely used for a ¦ number of decades to prevent upper airway obstruction or to 1 facilitate artificial ventilation of unconscious or anes-l thetized patients. Early designs of endotracheal tubes consis-¦ ted of a relatively pliable tube shaped for insertion through ¦ the oral passage and into the trachea, and adapted to connect ¦ to a respirator for the introduction of air into the lungs. To ;¦ avoid the escape of air from the trachea out the oral and nasal passages, improved endotracheal tubes were later introduced ~¦ which included an inflatable bag-like structure or cuff dis-¦I posed about the exterior surface of the tube at the distal end.
These newer endotracheal tubes, which are in common use toda , ~ 1l are inserted into the trachea such that the cuff is disposed a ¦ few centimeters below the larynx. Once in place, the cuff is ; 1¦ inflated by a source of air and creates an airtight seal ¦I between the tube and tracheal wall. This effectively pxevents air being pumped b~ a respirator into the lungs from escaping 25 1I the trachea and entering the oral and nasal passages~
¦ Furthex research resulted in the development of 'I two-cuff endotracheal tubes which generally consist of an ,' , esophageal cu~f and an oral cuff. Properly positioned in a l' patient, the two-cuff endotracheal tubes are operable to seal 30 1I the esophagus and prevent the contents of the stomach from .1 i -2-' entering the lungs, while also preventing the escape of air being pumped into the lungs ~rom the trachea.
, These improvements of endotracheal tubes have ~ncour-¦ aged physicians to prescribe prolonged endotracheal inkubation5 j of from several days to two or more week~ for some patients.
However, particularly over longer intubation periods, several problems have been identified in the use of existing endo-tracheal tube designs. It was discovered that in an effort to Il create a non-leak seal between the cuff and walls of the 1¦ trachea that the pressure applied by the ouff had a tendency to ¦ damage the ciliated endothelium of the trachea and occlude the blood perfusion of -the tracheal mucosa after a period of time leading to tissue necrosis. In addition, it was found that some patients experienced laryngeal dysfunction due to contact of the endotracheal tube within the posterior endolarynx.
Initial studies of the problems encountered in the use of known endotxacheal tubes resulted in attempts at im-proved designs such as disclosed in U.S. Patent No., 4,091,816 to Elam. The Elam patent discloses an endo-tracheal tube with a ¦ double cuff arrangement wherein a standard cuff is mounted on i the exterior surface of the tube adjacent its distal end, and a second cuff is disposed upwardly along the tube from the lower cuff. The two cuffs are interconnected so that air pumped into ¦l one cuff may be transferred to the other. With the endo-2S !l tracheal tube of Elam properly positioned in a patient, the ~1 lower cuff is disposed a few centimeters below the larynx within the mid-trachea and the upper cuff a few centimeters above the larynx.
Il The interconnection between the two cuffs in the Elam : 30 il patent is intended to solve the problem created by over-pressurizing the single cu~fs found in prior art endotracheal .~ .
I tubes to avoid damage to the ciliated endothelium of the ,I trachea and possible tissue necrosis. The volume of air in ~he , Il lower cuff which seals the trachea is kransferable to the upper ¦
~ cuff to avoid undue pressuxe on the tracheal walls while ', maintaining an airtight seal between the tube and tracheal walls.
In addition, the Elam patent suggests that laryngeal dysfunction is brought about by contact o~ the endotracheal I, tube with the vocal cords of the larynx, particularly as a i result of the to-and-fro motion of the tube induced by the operation of the respirator as it provides air to the lungs.
i To reduce the abrasion to the vocal cords caused by such tube ; 'I motion, the two cuffs along the Elam endotracheal tube are deliberately placed on either side of the larynx. This ar-l¦ rangement is intended to anchor the tube in relation to the larynx so as to prevent or at least limit the to-and-fro i movement of the tube ayainst the vocal cords.
, Careful study of the effects of prolonged endo-il tracheal intubation has provided a much more accurate apprec-; 20 il iation of the true cause of laryngeal injury than suggested in ; , the prior art. It is clear that laryngeal dysfunction is brought about by mechanical trauma of the endotracheal tube as it rides within the posterior endolarynx. This mechanical trauma is imposed by constant and ongoing forces applied by the ' tube which are xelated to respirator-induced tube mcvement, patient movement and reflex laryngeal movement against the tube.
Importantly, it has been discovered that such mechan-, ical trauma is directed to a large extent against the aryten-oids and in particular the cricoarytenoid joint and surrounding tissue where the endotracheal tube actually rests when properly :~2~L~33~
positioned in a patient. As an inherent result of the ~hape o~
I existing endotracheal tubes, the cricoarytenoid joint region ¦li becomes a fulcrum or pivot point about which the tube pi~ots Il and moves in response to orces applied to the tube by opera ~¦ tion of a respirator or by movement of the patient's head and neck.
It has been observed and determined that the re-sultant effect of such mechanical trauma is potentially serious I, laryngeal dysfunction. One specific form of laryngeal dysfunc-jl tion observed is the initiation of traumatic cricoarytenoidarthritis. While generally not permanent, even transient laryngeal dysfunction resulting from cricoarytenoid arthritis ¦ may be serious to some patients. As has been documented, the development of cricoarytenoid arthritis may result in a loss or impairment o~ the laryngeal sphincteric function wherein the cricoarytenoid joint fails to fully close the tracheal tube during swallowing or open during respiration~ Without proper sphincteric function to fully seal the trachea, aspiration may ~1 occur with the accompanying adverse pulmonary effects. Aspir- ¦
20 11 ation is always dangerous, but it can be catastrophic for an ¦ already accutely or chronically ill patient with minimal ¦I reser~es. Failure of the cricoarytenoid joint to fully open may result in a compromised airway into the trachea where the ,1 ~Tocal cords do not move open because of the injury to the joint 25 i1~ and surrounding tissue. In some cases, injury to the cricoarytenoid joint and surrounding tissue may result in permanent scarring. Any scarring at this site is extraordin-arily difficult to correct surgically and may necessitate a permanent tracheotomy.
i -5-. .
~z~3~3 It is therefore an object of this inven~ion to Il provide an improved endotracheal tube which eliminates ox ak ! least reduces laryngeal dysfunction. I
I It is anothex object of this inve~tion to provide an 5 1 ¦ improved endotracheal tube capable of cushioning and protecting ¦
the cricoarytenoid joint region to assure proper laryngeal sphincteric function upon extubation of the tube.
i¦ It is a further object of this invention to provide ¦ an improved tracheal tube having the dual capability of sealing l the trachea without damage to -the tracheal walls while pro-Il tecting the cricoarytenoid joint region from trauma. I
Il I
Summary of the Invention Il These and other objects are accomplished in this 1 invention of an endotracheal device comprising an elongated il pliable air tube shaped for insertion through the oral or nasalpassage and into the trachea to provide a passage for pumping air into the lungs~ The distal end of the tube is provided with a bay-like membrane or cuff which is adapted to be in-20 1I flated once the tube is positioned in the txachea so as to I create a seal between the tube and trachea without exertingtraumatizing forces against the tracheal mucosa or ciliated endothelium of th~ trachea.
The endotracheal device further includes a second l cuff or mernbrane mounted on the exterior surface of the air tube in a position to contact and cushion the cricoar~tenoid joint when the tube is placed ln the proper position within the ~ trachea. The cushioning membrane rnay be filled with air either ¦ before or after insertion of the tube or may contain a resil-.
l ient substance such as silicon or a suitable equivalent. The membrane is spaced from the lower cuff at the distal end of the ~2~3~
tube and may extend only partially about thc exterior circumference o:~ the tube. The membrane contacts the cricoaryteno:i.d joint thus urging the endotracheal tube upwardly out of direct contact there~/.ith, and adjacent or into engagement with the vocal cor~s of the laryn~.
~iechanical trauma to the cricoarytenoid joint caused by motion of the t~lbe with:in the poster-lal endolarynx is thus effect:ively avoided to eliminate or at least sub-stantially reduce cricoarytenoid injury.
In summary of the above, therefore, tlle present invention may be broadly considered as providing an endotracheal tube adapted for insertion through the oral or nasal passage of a patient -to provide a passage for artificial respiration comprising:
an elongated, flexible air tube having a proximal end portion adapted to be located .external to the patient and a distal end portion adapted to be located lithin the trachea; means for sealing the air tube with respect to the trachea; and cushioning means covering at least a portion of the external wall surface of said air tube and being located with respect to said ends thereof such that on insertion of said tube in said patient said cushioning means rests against the cricoarytenoid joint and prevents contact of said air tube with the cricoarytenoid joint and surroungind tissue to red~lce the incidence and severity of cricoarytenoid trauma.
" ~}.~
-~2~ ;3 Description _ the Drawings The structure, operation and at~vantages of this invention will become apparent upon consideration of the following discuss.ion taken in conjunction with the accompanying dra-l:ings wherein.
~ igure 1 is a perspective vie~ of the improved endotracheal tube herein;
Figure 2 is a partial cross-sectional, partial schematic view of the endotracheal tube herein installed in a patient; and Figure 3 is a cross-sectional vie~ tal~en generally along line 3-3 of Figure 2.
Detailed Descri~tion of the Invention : P~eferring now to Figure 1, the endotracheal ;device accorsling ~o this invention includes an air tube having a distal end 12 and a proximal end 14 adapted for connection to a respirator (not shown). The tube 10 is shaped for insertion through the oral passage 16, past the epiglottis 18 and posterior pharyngeal wall 20, and then through the larynx .22 so that the distal end 12 of the tube 10 enters several centimeters into the trachea 24. Adjacent the distal end 12 of the 7~
., 3;~3 tube 10 is a bag-like membrane or cuf 26 which is mounted to the exkerior sur~ace of the tube 10 and extends outwardly ¦ therefrom. The cuff 26 is inflatable by means of a tube 23 ¦¦ connected to a sourre of air (not shown). With the tracheal ¦ tube 10 in proper position in a patient, the cu~ 26 e~tends beyond the larynx 22 and into the trachea 24. Con~entionally, ~ the cuff 26 is inflated with sufficient pressure so as to 1~ create a seal between the distal end 12 of the tube 10 which I prevents the escape of air upwardly through the trachea 24 and ,l out the oral passage 16. Preferably, the pressure used to ¦ inflate the cuff 26 is monitored to create a good seal without exerting undue pressure on the walls of the trachea 24 which can lead to damage as discussed above. The structure and Il materials used in the fabrication of the endotracheal device i discussed thus far is typical of that found in many conven-~i tional endotracheal tubes for artificial ventilation of uncon-scious or anesthesized patients or to prevent upper airway obstruction.
'l, It has been found that an important limitation of ; 20 '1 prior art endotracheal tubes, such as the endotracheal device I thus far described, is the creation of laryngeal dysfunction in i some patients. As illustrated in Figure 2, the air tube 10 is shaped such that it contacts the tongue 30 near its proximal end 14 and the area of the larynx 22 adjacent its distal end l' 12. Specifically, it has been found that typical endotracheal tubes directly contact the ar~tenoids 32, the cricoarytenoid joint 34 and surrounding tissue. The cricoarytenoid joint 34 operates to sphincter or close together the ary-tenoids 32 during swallowing so that solid or liquid material passes intQ
the esophagus 35 and not the trachea 24. To avoid aspiration and the accompanying pulmonary effectsr such as pneumonia, the ~L21~333 cricoarytenoid joint 34 must function to seal the trachea 24 fluld tight. In addition, during respiration the crico-arytenoid joint 34 must fully open to provide a~ unrestricted l airway for passage of air in the trachea 24 and lungs.
5 11 As mentioned above, endotracheal tubes inherently impose a degree of mechanical trauma within the posterial ¦ endolarynx. This trauma is caused by ~o and fro movement of Il the tube in response to the operation of the respirator, and ¦~ also tube rnovement induced by reflex and laryngeal movements ¦¦ against the tube resulting from swallowing and movement of the ¦ head and neck. Considering the positioning of the tube in the ¦ posterial endolarynx as shown in Figure 1 and discussed above, lt was discovered that the cricoarytenoid joint 34 and sur-! rounding tissue in effect functions as a pivot point or fulcrum ¦ on which the tube pivots as a result of such laryngeal and tubemovements. As a result, of this relatively severe stress ¦¦ placed on the sensitive cricoarytenoid joint 34, laryngeal ¦l dysfunction in the form of traumatic cricoarytenoid arthritis 1¦ and permanent scarring of the cricoarytenoid joint region can I be developed in an unacceptable number of patients.
,1 In view of the cause of such laryngeal dysfunction, Il the endotracheal tube 10 of this invention includes a second il cuff or membrane 36 mounted on the exterior surface of the tube jl 10. The second cuff or membrane 36 may be formed of the same 25 il material as the standard curf 26, and is mounted to tube 10 by an adhesive or any other suitable means. Membrane 36 is ,I disposed adjacent to the cuff 26 at a point along the endo-tracheal tube 10 which is coincident with the cricoarytenoid joint 34 when the tube 10 is properly placed within the trachea l 24~ The membrane 36 rests directly on the cricoarytenoid joint 34 thus disposing the endotracheal tube 10 outwardly out of _9_ ~2~333 , contact therewith and adjacent to or in engagement with the vocal cords 38 of the larynx 22.
,¦ The membrane 36 is attached to the exterior surface ¦1 of endotracheal tube 10 along at least a portion o the circum- ¦
~11 ference thereof. Membrane 36 may be inflated with air after insertion of the tube 10 within the trachea 24, as is cuf 26, or may be preinfla-ted by means of a tube 31 connected to a source of air (not shown). ~lternately, the membrane 36 may be I, filled with a resilient, cushioning material such as a sponge ~ or silicon rubber. It is contemplated that membrane 36 may be spaced fxom or adjacent to cuff 26 along tube 10, provided that Il it completely protects the cricoarytenoid joint 34 from engage- ¦
i¦ men~ with tube 10. The membrane 36 is resilient and provides a ¦ cushioning effect to reduce transmittal of traumatic forces to ¦ the cricoarytenoid joint 34 caused by motion of the endo-¦~ tracheal tube 10. As shown in Figures 1 and 2, the membrane 36 ,1 is relatively small in size and thus would not impair the attendant's vision during insertion of the endotracheal tube 10 Il or interfere with extubation of the tube 10.
' It is believed that the addition of membrane 36 to the endotracheal tube 10 of this invention will greatly reduce the chances of aspiration, permanent scarring or other serious laryngeal dysfunc-tion. Although it is possible that contact of I the tube 10 with the vocal cords 38 may increase trauma or , abrasion of the vocal cords 38, it is believed that the vocal cords 38 are much better able to withstand such trauma than the cricoarytenoid joint 34 and suxrounding tissue. Obviously, transient abrasion to the vocal cords 38 is much more pre-ferable than trauma lnduced arthritis to the cricoarytenoid joint 34 in view of the relative seriousness of the damage :
which can result from a failure of the sphinteric func~ion sf the cricoarytenoid joint 34.
While the invention has been described with reference to a preferred embodiment, it will be understood by those skilled in the art that various changes may be made and equiva-len~s may be substituted for elements thereof without departing from tha scope of the invention. In addition, many modifica ti.ons may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope ~hereof. Therefore, it is intended that the invention not be limited to the particular emb~diment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the appended claims.
I What is claimed is:
, !
'. 1 I';
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Claims (11)
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. An endotracheal tube adapted for insertion through the oral or nasal passage of a patient to provide a passage for artificial respiration comprising:
an elongated, flexible air tube having a proximal end portion adapted to be located external to the patient and a distal end portion adapted to be located within the trachea;
means for sealing the air tube with respect to the trachea; and cushioning means covering at least a portion of the external wall surface of said air tube and being located with respect to said ends thereof such that on insertion of said tube in said patient said cushioning means rests against the cricoarytenoid joint and prevents contact of said air tube with the cricoarytenoid joint and surrounding tissue to reduce the incidence and severity of cricoarytenoid trauma.
an elongated, flexible air tube having a proximal end portion adapted to be located external to the patient and a distal end portion adapted to be located within the trachea;
means for sealing the air tube with respect to the trachea; and cushioning means covering at least a portion of the external wall surface of said air tube and being located with respect to said ends thereof such that on insertion of said tube in said patient said cushioning means rests against the cricoarytenoid joint and prevents contact of said air tube with the cricoarytenoid joint and surrounding tissue to reduce the incidence and severity of cricoarytenoid trauma.
2. The endotracheal device of claim 1 wherein said cushioning means is an air-inflatable membrane attached at least part way about the outer surface of said air tube along a portion of the length thereof.
3. The endotracheal device of claim l wherein said cushioning means is a membrane pre-inflated with air and attached at least part way about the outer surface of said air tube along a portion of the length thereof.
4. The endotracheal device of claim 1 wherein said cushioning means is a membrane containing pliable, resilient material.
5. The endotracheal device of claim 1 wherein said sealing means is an inflatable cuff mounted to the distal end of said air tube inserted within the trachea, said cushioning means being spaced from said cuff in the direc-tion of said proximal end of said tube.
6. An endotracheal device for respirating a patient comprising:
a flexible air tube having a proximal end, distal end and outer surface, said air tube being adapted for insertion through the oral or nasal passage and into the trachea of the patient with said distal end being disposed within said trachea, said air tube providing a passage for respiration of the patient;
a first air-inflatable cuff adjacent said distal end of said tube, said cuff being inflatable to create a seal between said air tube and said trachea when inserted in the patient; and a second cuff covering at least a portion of said outer surface of said air tube adjacent said inflatable cuff, said second cuff being positioned along said air tube with respect to said end portion thereof such that on insertion of said tube in said patient said second cuff rests against the cricoarytenoid joint to prevent contact of said air tube with the cricoarytenoid joint and surrounding tissue to reduce the incidence and severity of cricoarytenoid trauma.
a flexible air tube having a proximal end, distal end and outer surface, said air tube being adapted for insertion through the oral or nasal passage and into the trachea of the patient with said distal end being disposed within said trachea, said air tube providing a passage for respiration of the patient;
a first air-inflatable cuff adjacent said distal end of said tube, said cuff being inflatable to create a seal between said air tube and said trachea when inserted in the patient; and a second cuff covering at least a portion of said outer surface of said air tube adjacent said inflatable cuff, said second cuff being positioned along said air tube with respect to said end portion thereof such that on insertion of said tube in said patient said second cuff rests against the cricoarytenoid joint to prevent contact of said air tube with the cricoarytenoid joint and surrounding tissue to reduce the incidence and severity of cricoarytenoid trauma.
7. The endotracheal device of claim 6 wherein said second cuff is a membrane sealed to a portion of the outer surface of said tube and containing a flexible, cushioning material.
8. The endotracheal device of claim 7 wherein said second cuff is inflated with air.
9. The endotracheal device of claim 7 wherein said second cuff contains a liquid.
10. The endotracheal device of claim 6 wherein said second cuff is an air-inflatable membrane attached at least part way about said outer surface of said air tube along at least a portion of the length thereof.
11. The endotracheal device of claim 6 wherein said second cuff is a membrane pre-inflated with air and attached at least part way about the outer surface of said air tube along at least a portion of the length thereof.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US06/448,632 US4538606A (en) | 1982-12-10 | 1982-12-10 | Endotracheal tube |
| US448,632 | 1982-12-10 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1211333A true CA1211333A (en) | 1986-09-16 |
Family
ID=23781048
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000441435A Expired CA1211333A (en) | 1982-12-10 | 1983-11-18 | Endotracheal tube |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US4538606A (en) |
| EP (1) | EP0112139B1 (en) |
| JP (1) | JPS59115022A (en) |
| CA (1) | CA1211333A (en) |
| DE (1) | DE3376296D1 (en) |
Families Citing this family (32)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| BR8504438A (en) * | 1985-09-09 | 1987-04-14 | Dario De Oliveira Fauza | TRACHEOSTOMY CANULA |
| US4700700A (en) * | 1986-09-15 | 1987-10-20 | The Cleveland Clinic Foundation | Endotracheal tube |
| US5156159A (en) * | 1988-10-11 | 1992-10-20 | University Of Florida | CO2 diagnostic monitor with rupturable container |
| US4928687A (en) * | 1988-10-11 | 1990-05-29 | The University Of Florida | CO2 diagnostic monitor |
| GB8825550D0 (en) * | 1988-11-01 | 1988-12-07 | Feldman S | Pharyngeal airway |
| US5033466A (en) * | 1989-02-28 | 1991-07-23 | Weymuller Jr Ernest | Doble-cuffed endotracheal tube |
| US5269296A (en) * | 1991-10-29 | 1993-12-14 | Landis Robert M | Nasal continuous positive airway pressure apparatus and method |
| US5477852A (en) * | 1991-10-29 | 1995-12-26 | Airways Ltd., Inc. | Nasal positive airway pressure apparatus and method |
| US5687715A (en) * | 1991-10-29 | 1997-11-18 | Airways Ltd Inc | Nasal positive airway pressure apparatus and method |
| US5791341A (en) * | 1995-12-19 | 1998-08-11 | Bullard; James Roger | Oropharyngeal stent with laryngeal aditus shield and nasal airway with laryngeal aditus shield |
| US5657752A (en) * | 1996-03-28 | 1997-08-19 | Airways Associates | Nasal positive airway pressure mask and method |
| CA2220285C (en) * | 1996-11-06 | 2006-10-03 | Archibald I.J. Brain | Endotracheal tube construction |
| GB9718534D0 (en) * | 1997-09-01 | 1997-11-05 | Palazzo Mark G A | Tubular structures |
| US7462162B2 (en) | 2001-09-04 | 2008-12-09 | Broncus Technologies, Inc. | Antiproliferative devices for maintaining patency of surgically created channels in a body organ |
| ATE258768T1 (en) * | 1999-08-05 | 2004-02-15 | Broncus Tech Inc | METHOD AND DEVICES FOR PRODUCING COLLATERAL CHANNELS IN THE LUNGS |
| AU2001249308A1 (en) * | 2000-03-24 | 2001-10-15 | Johns Hopkins University | Peritoneal cavity device and method |
| US7708712B2 (en) | 2001-09-04 | 2010-05-04 | Broncus Technologies, Inc. | Methods and devices for maintaining patency of surgically created channels in a body organ |
| US20050060041A1 (en) * | 2001-09-04 | 2005-03-17 | Broncus Technologies, Inc. | Methods and devices for maintaining surgically created channels in a body organ |
| US8308682B2 (en) | 2003-07-18 | 2012-11-13 | Broncus Medical Inc. | Devices for maintaining patency of surgically created channels in tissue |
| US8409167B2 (en) | 2004-07-19 | 2013-04-02 | Broncus Medical Inc | Devices for delivering substances through an extra-anatomic opening created in an airway |
| EP2203104B1 (en) * | 2007-10-09 | 2016-11-16 | Cook Medical Technologies LLC | Systems, devices and methods having an overtube for accessing a bodily opening |
| US8974379B2 (en) | 2008-03-06 | 2015-03-10 | Cook Medical Technologies Llc | Medical systems for accessing an internal bodily opening |
| JP5528432B2 (en) | 2008-05-15 | 2014-06-25 | クック メディカル テクノロジーズ エルエルシー | System, apparatus and method for accessing a body opening |
| US20100006103A1 (en) * | 2008-07-10 | 2010-01-14 | Mcginnis William J | Endotracheal-oximeter device, system and method of using same |
| US8771170B2 (en) * | 2008-08-01 | 2014-07-08 | Microaccess, Inc. | Methods and apparatus for transesophageal microaccess surgery |
| US8834361B2 (en) * | 2009-05-15 | 2014-09-16 | Cook Medical Technologies Llc | Systems, devices and methods for accessing a bodily opening |
| WO2012158530A1 (en) | 2011-05-13 | 2012-11-22 | Broncus Technologies, Inc. | Methods and devices for ablation of tissue |
| US8709034B2 (en) | 2011-05-13 | 2014-04-29 | Broncus Medical Inc. | Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall |
| WO2013078235A1 (en) | 2011-11-23 | 2013-05-30 | Broncus Medical Inc | Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall |
| WO2014089519A1 (en) * | 2012-12-07 | 2014-06-12 | Bartlett Ii Rush L | System for reducing local discomfort |
| US9956383B2 (en) | 2013-03-15 | 2018-05-01 | Cook Medical Technologies Llc | Medical devices and methods for providing access to a bodily passage during dilation |
| US11033702B2 (en) | 2015-10-30 | 2021-06-15 | The Research Foundation For The State University Of New York | Acute pulmonary pressurization device and method of use |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| GB1178813A (en) * | 1967-04-05 | 1970-01-21 | George O Doherty | Intubation Tubes |
| US3915173A (en) * | 1974-07-08 | 1975-10-28 | Ansur Inc | Intubation device for the inhalation of gasses |
| US4090518A (en) * | 1975-08-25 | 1978-05-23 | Elam James O | Esophago-pharyngeal airway |
| US4091816A (en) * | 1977-01-28 | 1978-05-30 | Elam James O | Double cuffed endotracheal tube |
| US4233984A (en) * | 1978-06-30 | 1980-11-18 | Walling Peter T | Respiratory ventilating device |
| US4235239A (en) * | 1978-09-15 | 1980-11-25 | Elam James O | Cuffed endotrachael tube and method |
| US4341210A (en) * | 1978-09-15 | 1982-07-27 | Elam James O | Cuffed endotracheal tube and method |
| US4327720A (en) * | 1979-01-22 | 1982-05-04 | Bronson Paul A | Esophageal-endotracheal airway |
| US4230108A (en) * | 1979-03-13 | 1980-10-28 | Young Sharon L | Apparatus and method for sealing esophageal entrance to trachea above and below |
| FR2453634A1 (en) * | 1979-04-13 | 1980-11-07 | Electro Mecanique Lab | Measurement of laryngo-tracheal passage - uses inserted flexible plastics balloon which is inflated to press against walls of passage |
| US4423725A (en) * | 1982-03-31 | 1984-01-03 | Baran Ostap E | Multiple surgical cuff |
-
1982
- 1982-12-10 US US06/448,632 patent/US4538606A/en not_active Expired - Fee Related
-
1983
- 1983-11-18 CA CA000441435A patent/CA1211333A/en not_active Expired
- 1983-12-09 DE DE8383307516T patent/DE3376296D1/en not_active Expired
- 1983-12-09 EP EP83307516A patent/EP0112139B1/en not_active Expired
- 1983-12-09 JP JP58231635A patent/JPS59115022A/en active Pending
Also Published As
| Publication number | Publication date |
|---|---|
| US4538606A (en) | 1985-09-03 |
| JPS59115022A (en) | 1984-07-03 |
| DE3376296D1 (en) | 1988-05-26 |
| EP0112139A1 (en) | 1984-06-27 |
| EP0112139B1 (en) | 1988-04-20 |
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Legal Events
| Date | Code | Title | Description |
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| MKEX | Expiry |