The invention is directed to a balloon-like structure for positioning within a cavity in the human or animal body, for example within a lumen or some other interior space, in particular as an integral part of a catheter, in such a way that the stated cavity on the one hand is filled as completely as possible, i.e., without residual space, but on the other hand largely maintains its shape or is not deformed by the balloon body.
Catheter applications in the body of a patient in many cases require balloon-like components that sealingly close off or tamponade in a space-filling manner a lumen or an interior space, wherein the sealing and/or tamponading function of the particular balloon is maintained even if the cross-sectional area of the lumen to be sealed, i.e., the volume of the space to be tamponaded, fluctuates intermittently or cyclically, for example, due to the physiological function of the particular structure or due to movements of the body. In addition, for balloon components that are placed in the body on a long-term basis, the force that is transmitted by the balloon to the adjacent tissue and structures should be in a range that preserves perfusion and rules out pressure-related lesions.
Basic approaches to the problem of efficient, tissue-compatible sealing of an organ or cavity have already been presented in EP 1 061 984 A1, with specific reference to sealing the trachea with respect to secretions of the pharynx. The special quality of the tracheal seal described therein is based essentially on the use of very thin-walled balloon films made of polyurethane (PUR). The circumference of the balloon (cuff) that is formed during manufacture exceeds the circumference of the tracheal portion to be sealed, which results in the formation of a typical invagination pattern of the balloon envelope when the residually dimensioned balloon is filled within the trachea, which is smaller relative to the balloon. The residual balloon material, i.e., the excess material along the circumference of the balloon, forms into radial invaginations, i.e., following the pattern of wheel spokes. At their blind end, i.e., the end pointing toward the center of the balloon, these invaginations form specific channel-like formations that follow the longitudinal axis of the balloon and allow the free flow of secretions or liquids. The formation of such invaginations is crucial for the low-pressure behavior and maintaining the perfusion of the adjacent structures. The principle of invagination of a residually dimensioned balloon envelope ensures that for closing off the particular lumen or space, the envelope does not have to be converted into the state of a force-intensive expansion, but, rather, may “fold” into the particular lumen or interior space in question of the patient without tension, which is possible even for balloon filling pressure values that only slightly exceed the particular local pressure. The particular shape and size of the lumen or other cavity of the patient are thus maintained.
EP 1 061 984 A1 describes, for a residually dimensioned balloon envelope made of PUR, a region having a certain wall thickness, namely, 5 to 20 μm, in which, for a balloon envelope placed in situ, channel-like formations arise whose inner diameter inhibits the free flow of a secretion or has a capillary, stasis-like effect on the secretion. The diameters of the tubules described in EP 1 061 984 A1 are less than 0.11 mm, advantageously less than 0.05 mm.
In addition to the material-specific design of the envelope itself, the diameter of the tubules that form in each case at the end position of the invaginations of the cuff envelope during the course of a tracheal ventilation situation is a function essentially of the particular filling pressure prevailing at that moment in the balloon. When the filling pressure decreases, the channel-like structures begin to expand, and the tubules, starting from the particular blind end of the invaginations, successively open toward the tracheal-side base or the opening of the invaginations. Upon a further drop in the filling pressure in the balloon, the invagination opens up toward the tracheal mucosa and goes into a configuration having an approximately U-shaped or also W-shaped pattern in the radial direction. As a function of the particular extent of the opening of the invaginations or the cross-sectional area of the tubules that effectively develops, this results in an effective sealing capability of the cuff at a certain point in time.
Within the scope of this type of sealing or tamponading balloon technology, a particular challenge is the sealing of organs or spaces whose internal pressure undergoes cyclical fluctuations, as is the case for the trachea or the esophagus, for example. Both structures are subjected to continuous, cyclical pressure fluctuations in the thorax which are generated by the patient's own breathing. For unassisted breathing as well as machine-assisted breathing of the patient, the particular generated thoracic pressures correspond to the filling pressure of the tracheal sealing cuff.
If the thoracic pressure prevailing in the thoracic cavity drops during inspiration by the patient, this transient decrease in pressure is transferred to the tracheal and esophageal walls, which in turn results in a pressure reduction in corresponding tracheally or esophageally positioned balloon structures. At the moment when pressure on the tracheal or esophageal wall is relieved, the cross-sectional areas of the channel-like formations at the end position expand synchronously, which over the phase of the expansion results in an enlarged passage for secretions and liquids, which may lead to a complete loss of the seal of the balloon and bolus-like aspiration.
The special dependency of the sealing efficiency of tracheal tube cuffs on the thoracic work of breathing by the patient is addressed, among other sources, by Badenhorst et al. (“Changes in cuff pressure during respiratory support,” C. H. Badenhorst, Critical Care Medicine 1987, 15; 4, 300-302). Badenhorst describes cuff pressure values for individual patients, which started at approximately 20 mbar and extended up to the subatmospheric range, and which thus largely followed the intrathoracic pressure values prevailing in the thorax of the breathing patient.
In the current literature on the sealing behavior of residually dimensioned tracheal tube cuffs, so-called high-volume, low-pressure cuffs, the particular capability of certain types of cuffs for ensuring an effective secretion seal is determined using static observation models. Thus, for example, in a study by Bassi et al. (“An in vitro study to assess determinant features associated with fluid sealing in the design of endotracheal tube cuffs and exerted tracheal pressures,” Bassi et al., Critical Care Medicine, 2013; 41:518-526), a rigid tube was intubated with various tracheal tubes, followed by installation of a water column above the tracheal tube cuff acted on by filling pressure. For conventional PVC-based cuff types, the leakage determined in the static model was already in the range of several milliliters per minute at an applied, recommended filling pressure of 30 mbar. Strictly PUR-based, very thin-walled cuff types still allowed a reliable sealing effect even when the filling pressure was reduced to 15 mbar. However, for filling pressures below 15 mbar, even PUR balloons having wall thicknesses of less than 20 μm showed an initial expansion of the secretion-conducting, channel-like formations, wherein, the same as for the PVC cuffs manufactured with much thicker walls, the cross sections of the tubules from the blind end of the particular invagination toward their base opened in a droplet shape and ultimately allowed more secretions and liquids to pass through.
In summary, static models are not able to accommodate the described cyclically fluctuating changes in the tracheal cross-sectional area as a scalable factor. Thus, they are unsuitable for depicting the clinically effective quality of a balloon-based seal in the trachea under pressure fluctuations.
In order to improve the efficiency of sealing balloon components under the conditions of organ-synchronous cyclical fluctuations of the balloon filling pressure, the object of the invention is to provide novel types of cuff designs that ensure efficient sealing behavior even when the filling pressure of the balloon continuously fluctuates over a pressure amplitude ranging from 30 mbar to 5 mbar.
Within the scope of a generic balloon-like structure, this object is achieved in that the balloon is made of a multilayer balloon film material, at least one layer being made of an elastically deformable polyurethane (PUR) and at least one other layer being made of a nonelastic material such as polyvinyl chloride (PVC), wherein the at least one PUR layer is made of a thermoplastic PUR of a type having a water absorption of 5% or less according to DIN ISO 62, preferably having a water absorption of 2% or less according to DIN ISO 62.
The present invention thus describes approaches for improving the sealing behavior of soft film-like balloon bodies having a sealing and/or tamponading action, which are introduced into independently motile or also into passively motile organs or spaces in the body, where they may be permanently positioned, also and in particular when the particular internal pressure in the organ and/or the particular configuration of the space go(es) through changes intermittently, continuously, or in particular also in a cyclically fluctuating manner. The walls of the balloon bodies according to the invention have a specific, multilayer combined structure made up of nonelastically deforming and elastically deforming material layers.
The balloon film material includes one or more layers of an elastically deforming material together with one or more layers of a plastically deforming nonelastic material, wherein the nonelastic layer counteracts the straightening properties of the elastic layer in the event of planar folds or bends in the balloon film material.
For balloon components which have a corresponding multilayer structure and which form fold-like invaginations of the residual balloon envelope in situ upon placement and being acted on by filling pressure, the elastic straightening and opening properties of the cross-sectionally loop- or channel-like formations are reduced by the material composite which includes an nonelastic material, so that for intermittent or cyclical fluctuations of the balloon filling pressure, in relation to single-layer balloon envelopes made of elastic material, for example PUR, and having the same wall thickness, cross-sectional areas of the secretion-conducting cross-sectional areas at the end position that are smaller, and under the conditions of fluctuating filling pressure that are smaller overall and fluctuate to a lesser extent, form within the loop- and tubule-like structures. The behavior of such combinations, in which the wall thickness of the incorporated PUR layer is reduced to the smallest possible proportion of the overall wall thickness of the balloon envelope, is particularly advantageous.
If the balloon is formed in a blow molding process from a previously manufactured multilayer raw tubular material, the proportional PUR layer in the molding process has a stabilizing effect, and for balloon envelopes formed with particularly thin walls, also allows good symmetry of the balloon body, wherein the raw tube to be converted, when acted on by blowing pressure, successively transforms via a uniform spindle shape into a uniform spherical balloon shape, and subsequently expands into the particular blow mold and assumes its shape. The elastic properties of PUR allow, in addition to uniform symmetry, the qualitatively stable formation of balloon components having extremely low overall wall thicknesses in the range of 5 to 20 microns, for example, and in application also impart high mechanical load capacity, puncture resistance, and generally very good dimensional stability under transient and also long-term exceedances of the particular working filling pressures.
The combination according to the invention of one or more PVC-based material layers with a PUR layer that mechanically stabilizes the balloon body is also advantageous for reducing permeability effects of water molecules, which are typical for PUR. When a water-permeable PUR layer is joined to a PVC layer, which has much better barrier properties against polar substances than does PUR, in particular the condensation and accumulation of water in the balloon may be reduced.
In order to keep the overall wall thickness of a balloon film having a multilayer structure according to the invention as low as possible, i.e., in a preferred range of 5 to 30 microns, the invention proposes the use of types of PUR that are characterized by the lowest possible swelling tendency of the balloon wall due to the absorption of water molecules. Such swelling effects are known primarily for nonthermoplastic polyurethanes. The invention therefore preferably uses thermoplastic types of PUR having a water absorption of less than 4%, preferably less than 2%, according to DIN ISO 62 in the exposed aqueous environment, for example the types from the product line “Pellethane 2363” from Lubrizol Inc. or the product line “Elastollan 1100” from BASF AG.
Further features, properties, advantages, and effects on the basis of the invention result from the following description of several preferred embodiments of the invention, with reference to the drawings. In the drawings:
Within the scope of the invention, the wall layers made of PVC and PUR may also be arranged inside the layer composite in such a way that the PVC layer is situated on the balloon outer side.
In addition to two-layer balloon walls, for example three-layer embodiments are also possible in which the PUR layer is preferably “sandwiched” between two PVC layers. For an overall wall thickness of 30 microns, the distribution of the individual layers may have, for example, a 12-μm PVC layer on the outside, a 6-μm PUR layer in the middle, and a 12-μm PVC layer on the outside. This embodiment is particularly advantageous in limiting undesirable migration effects of polar substances such as water.
The invaginations each have a web-like, flatly closed portion 5, while a loop-like formation 6 is formed at the blind end of each invagination, pointing toward the balloon center. In the region of the loop that forms, the wall of the balloon envelope makes a 180-degree turn, thus generating a pronounced opening effect on the loop-like formation due to the elastic straightening properties of the PUR layer integrated into the wall. This results in the particular sealing effect of the balloon that is effective at a certain point in time, as a function of the size of the cross-sectional area of the particular loop-like formation, and also the greatest possible avoidance or reduction of cyclical sudden changes in diameter of the loop. Due to capillary effects on secretions that are present within the loop, small cross-sectional areas of the loop act in a flow-inhibiting manner, all the way to complete stasis of the secretion or the loop contents. The inhibiting effect of the free flow of the secretion is lost with increasing expansion or enlargement of the cross-sectional area of the loop.
In addition to the particular property with regard to elastic straightening of the balloon wall that is turned in a loop-like manner, the sealing-relevant cross-sectional area of the loop-like formation 6 is determined by the filling pressure which prevails at that moment in the balloon, and which in particular is exerted against the two wall layers 5a and 5b of the web-like portion 5 of the invagination 4 and flatly presses them together in a tightly sealing manner, an open lumen remaining in the region of the turn of the two wall layers, i.e., at the blind end of the invagination in question.
The overall wall thickness of a balloon designed according to the invention preferably should not exceed 30 μm. In the preferred design of the balloon, the ratio of the proportional wall thickness of the PUR layer to the proportional wall thickness of the PVC layer is between 1:2 and 1:4, and preferably is 1:3.
For example, for a specific layer combination described in
For cyclical fluctuations of the balloon filling pressure of, for example, 20 changes per minute and pressure amplitudes or pressure extreme values between 30 mbar and 5 mbar, the sealing properties of the balloon according to the invention, for example in the specific use for tracheal secretion sealing, are largely maintained. Pump-like, cyclically “milking” effects, synchronously following the patient's own breathing, on the loop-like formation 6 or on the channels that form the loops, as described in the medical literature for thick-walled, single-layer PVC-based cuffs having a wall thickness of 70 to 120 microns, are absent for the most part in a tracheal tube cuff designed according to the invention.
Using the example of a cylindrical sealing balloon, as used, for example, as a secretion-sealing tracheal tube cuff,
Number | Date | Country | Kind |
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10 2019 003 482.1 | May 2019 | DE | national |
This patent application claims benefit of International (PCT) Patent Application No. PCT/IB2020/054684, filed 18 May 2020 by Creative Balloons GmbH for BALLOON HAVING A MULTI-LAYER WALL STRUCTURE FOR THE TISSUE-CONSERVING LOW-PRESSURE SEALING OF OPENINGS AND CAVITIES IN THE BODY OF A PATIENT, IN PARTICULAR IN THE CASE OF CYCLICALLY FLUCTUATING FILLING PRESSURE VALUES, which patent application, in turn, claims benefit of German Patent Application No. DE 10 2019 003 482.1, filed 16 May 2019. The two (2) above-identified patent applications are hereby incorporated herein by reference.
Filing Document | Filing Date | Country | Kind |
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PCT/IB20/54684 | 5/18/2020 | WO |