The present disclosure relates generally to tracheal tubes and, more particularly, to novel extendable tracheal tubes.
This section is intended to introduce the reader to various aspects of art that may be related to various aspects of the present disclosure, which are described and/or claimed below. This discussion is believed to be helpful in providing the reader with background information to facilitate a better understanding of the various aspects of the present disclosure. Accordingly, it should be understood that these statements are to be read in this light, and not as admissions of prior art.
Tracheal tubes may be utilized to define a clear passageway for air, other gases, and medicaments to the trachea and lungs, thus providing an artificial airway for spontaneous or mechanical ventilation of a patient. Such tracheal tubes may include endotracheal tubes and tracheostomy tubes. Endotracheal tubes, for example, are typically introduced into the trachea and may be used to establish an open airway into the lungs. The proximal end of the endotracheal tube may include a connector to attach various devices such as ventilators, manual respirators, suctioning equipment, nebulizers, vaporizers, and so forth. The distal end of the tracheal tube may include an inflatable cuff suitable for creating a seal between the outside of the tube and the interior of the passage in which the tube or device is inserted. In this way, substances can only flow through the passage via the tube or other medical device, allowing a medical practitioner to maintain control over the type and amount of substances flowing into and out of the patient.
In certain circumstances, the endotracheal tube may be securely attached to the patient's mouth, for example, by using a tracheal tube holder and/or tape. However, if the patient's neck or jaw were to move or if the clinician where move the patient to another location, the movement may dislodge the cuff out of its original position. Such movement may require repositioning of the tube and cuff, and possibly removal and replacement of the tube.
Moreover, at times it may be useful to extend such tubes beyond the point at which they originally terminate outside the patient's mouth (or neck). Conventional tubes do not permit such adjustment without movement and/or replacement of the tube.
Advantages of the disclosed techniques may become apparent upon reading the following detailed description and upon reference to the drawings in which:
One or more specific embodiments of the present techniques will be described below. In an effort to provide a concise description of these embodiments, not all features of an actual implementation are described in the specification. It should be appreciated that in the development of any such actual implementation, as in any engineering or design project, numerous implementation-specific decisions must be made to achieve the developers' specific goals, such as compliance with system-related and business-related constraints, which may vary from one implementation to another. Moreover, it should be appreciated that such a development effort might be complex and time consuming, but would nevertheless be a routine undertaking of design, fabrication, and manufacture for those of ordinary skill having the benefit of this disclosure.
A tracheal tube, such as an endotracheal tube, may be used to seal a patient's airway and provide positive pressure to the lungs when properly inserted into a patient's trachea. Positioning the tracheal tube at a desired position within the trachea, for example during endotracheal intubation, may improve the performance of the tracheal tube and reduce clinical complications. In particular, the distal inserted end of the endotracheal tube may be positioned in the patient's trachea at a location substantially between the patient's vocal cords and carina. If the tube cuff is not inserted far enough past the vocal cords, for example, the tube may become more easily dislodged. If the tube is inserted too far into the trachea, such as past the carina, then the tube may only function to adequately ventilate one of the lungs, rather than both. Thus, a well positioned and proper seal against the tracheal passageway allows a ventilator to perform efficiently.
Provided herein are extendable tracheal tube systems and methods that facilitate the placement of the tracheal tube relative to certain anatomical structures, and the maintenance of a proper seal once the tracheal tube has been so placed. Such extendable tracheal tubes may include embodiments capable of allowing for an extension and retraction of the tracheal tube in an axial direction while maintaining a secure placement at both the distal and proximal ends. That is the tracheal tube may be placed in the trachea and include embodiments that allow the tracheal tube to extend and retract axially in accordance with certain patient movements, such as movements of the head or neck, or movements resulting from relocating the patient. By maintaining a proper airway seal, the disclosed embodiments allow for increased efficiency and convenience in patient ventilation and airway management.
Further, the disclosed techniques allow for the customization of the tracheal tube length. Generally, tracheal tubes are available in a subset of sizes from which doctors may select the closest approximate size for a particular patient. The difference in tube sizes may generally reflect both differences in the length of the tube as well as different tube diameters. In particular, doctors may wish to select, for example, an endotracheal tube with an appropriate length in order to allow the tube to be easily inserted into the patient while providing a length suitable for connection to an external device, such as a ventilator. The disclosed embodiments allow for a tracheal tube capable of having an extendable or retractable length. Indeed, the clinician is able resin the tracheal tube length even after the patient has been intubated. Accordingly, the tracheal tube may be custom fit to comformably support any number of patient anatomies and patient types.
With the foregoing in mind and turning now to
The tracheal tube 12 may include any suitable number of lumens, such as lumen 20, that may be appropriately sized and shaped for inflation and deflation of an inflatable cuff 22, for suction and evacuation of fluids, and so forth. Once the tracheal tube 10 is placed at the desired location, the clinician may then use the lumen 20 to inflate the cuff 22. When inflated, the cuff 22 generally expands into the surrounding trachea to seal the tracheal passage around the tracheal tube 10, for example, to facilitate the controlled delivery of gases, medicines, and other substances, via a medical device (e.g., through the tube). The seal also aids in maintaining a secure distal placement of the tracheal tube 10 by exerting an expansive force against the tracheal walls, resulting in an interference fit. The proximal end portion 16 of the tracheal tube 10 may then be secured to the patient mouth by using, for example, an endotracheal tube holder and/or tape. The proximal portion 16 of the tracheal tube 10 may include an end connector 24 (e.g., a standard 15 mm, 8.5 mm, or 8 mm end connector, or any suitably sized or configured connector). The end connector 24 includes a lower end suitable for coupling the end connector 24 to the tracheal tube 10 and an upper end suitable for coupling the end connector 24 to a variety of medical airway systems, such as ventilators, manual respirators, suctioning equipment, nebulators, vaporizers, tee connectors, and so forth. It should be noted that some tubes may not include a sealing cuff, or may include more than one cuff, and the lumens in the wall of the tube will be provided and terminated accordingly.
In certain embodiments, the distal end portion 14 and the proximal end portion 16 may be capable of moving axially relative to each other. That is, the proximal end portion 16 may be capable of “sliding” into or out of the distal end portion 14 (or vice versa), so as to allow an extension or retraction in the length of the tracheal tube 10. Such capabilities allow the inflatable cuff 22 to remain securely disposed at a desired distal position inside the trachea. The cuff 22 is capable of remaining at the desired distal position owing to the contact resulting from the expansion of the cuff 22 against the tracheal walls, which will typically be sufficient to allow moving the end portions 14 and 16 relative to each other. Accordingly, the patient may undergo movements of the neck, jaw, and so forth, without dislodging the cuff 22 from its original position. Indeed, such techniques may allow the tracheal tube 10 to maintain a secure and proper seal in the patient airway system, even during activities such as the moving of the patient. The portions of the tube may be similarly moved on purpose, such as when desired to reconnect devices to the proximal end of the tube, to adjust connections and fits of the proximal tube end, and so forth.
The obturator 12, which may be optional in some cases, may be useful in aiding in the intubation and/or the extubation of the tracheal tube 10. For example, during intubation, the obturator may be inserted into the tracheal tube 10 through the proximal end portion 16 and the distal end portion 14, so as to aid in maintaining rigidity and/or control, such as a torsional or angular positioning and axial rigidity, of the tracheal tube 10. Additionally, the obturator 12 may include techniques such as an inflatable end 26, a pump handle 28, and an air valve 30 suitable for securely attaching the obturator to the tracheal tube 10, as described in more detail below with respect to
In certain embodiments, the OD of the depicted proximal end portion 16 may be approximately 1 mm-15 mm, which may vary depending on whether the patient is a neonatal patient, a pediatric patient or an adult patient. In these embodiments, the inner diameter (ID) of the proximal end portion 16 may be approximately the same diameter as the OD of distal end portion 14, slightly smaller than the OD of the distal end portion 14, or slightly larger than the OD of the distal end portion 14. In certain examples, the ID of the proximal end portion 16 may be within 0.1 mm, 0.25 mm, 0.5 mm, 0.75 mm, 1.0 mm of the OD of the distal end portion 14.
The distal end portion 14 and the proximal end portion 16 may be of any suitable length. For example, the distal end portion 14 may be 50 mm-175 mm in length, and the proximal end portion 16 may also be 50 mm-175 mm in length. Suitable materials for the end portions 14, 16 may include polyvinyl chloride (PVC), polyethylene terephthalate (PET), low-density polyethylene (LDPE), silicone, rubber, polypropylene, acrylonitrile butadiene styrene (ABS), neoprene, polyisoprene, and/or polyurethane. Indeed, the end portions 14 and 16 may be manufactured out of different materials and then assembled together into the tracheal tube 10. In one embodiment, a robotic device or a human operator may assemble the tracheal tube 10 by inserting the distal end portion 14 into the opening 36 of the proximal end portion 16. Accordingly, the tracheal tube 10 arrives at a clinical location with the distal end portion 14 inserted into proximal end portion 16 (or vice versa).
In other embodiments, the tracheal tube 10 does not have the distal end portion 14 inserted during manufacturing. Instead, the clinician is able to first select the end portions 14, 16 suitable for a given type and size of patient and then custom manufacture the tracheal tube 10 in situ by inserting one end portion inside of the other end portion. For example, the clinician may desire to combine a distal end portion 14 having a longer length with a proximal end portion 14 also having a longer length so as to accommodate a larger patient. Accordingly, the clinician may be able to custom fit end portions 14, 16, so as to more comformably fit a variety of patient types (e.g., neonates, children, and adults) and sizes. Further, the end portions 14, 16 may incorporate certain features, such as those described in more detail below with respect to
The clinician may then adjust overall length of the tracheal tube 10 by extending or retracting the end portions 14, 16 to a length suitable for intubation into the patient. Indeed, the techniques disclosed herein allow a clinician to custom fit the length of the tracheal tube 10 to more comfortably fit a wide variety of patient types and sizes. Accordingly, the bore 42 may include a plurality of markings 44 along the outside walls of the bore that may be used to determine an overall length of the tracheal tube from the tracheal tube inflatable end 26 to the tracheal tube's end connector 24. Indeed, in certain embodiments, the markings 44 may be found along the entire length of the bore 42. Once the tracheal tube 10 has been adjusted to a suitable length, the clinician may intubate the patient, for example, by using a laryngoscope and by using the obturator 12 as a guide. When the tracheal tube 12 is at a desirable position, the clinician may then open the air valve 30, causing the inflatable end 26 to deflate. The obturator 12 may then be removed from the patient's airway. The tracheal tube 10 may be secured in place by inflating the cuff 22 and by taping the proximal end of the tracheal tube 10 near the end connector 24 to the patient's mouth.
The inflatable end 26 may also be used to reposition the distal end portion 14 while keeping the proximal end portion 16 in place. For example, the clinician may notice during intubation that the distal end of the tracheal tube 10 is either too far up or too far down the patient's airway. Accordingly, the clinician may position the inflatable end 26 inside of the distal end portion 14 and then inflate the inflatable end 26. The inflatable end 26 may then expand against the inner walls of the distal end portion 14, causing a strong interference fit with the distal end portion 14. The clinician may then be able to reposition the distal end portion 14 to a more desirable position by moving the obturator 12 relative to the proximal end portion 16. Such positioning capabilities may allow the clinician to dispose the distal end portion 14 at a precise location in the trachea useful for proper patient airway management.
The obturator 12 may also be useful during patient extubation. In one extubation example, the clinician may extubate the patient by first inserting the obturator 12 through the entire length of the tracheal tube 10 until the inflatable end 26 emerges through the distal opening 18. The inflatable end 26 may then be inflated so as to cover up the distal opening 18. The clinician may then extubate the patient by exerting a pulling force on the obturator 12 outwardly from the patient's mouth, causing the inflatable end 26 to lodge against the distal opening 18. The continued exertion of the pulling force in the outwardly direction may then remove the tracheal tube 10 from the patient's airway. Indeed, techniques such as the use of the obturator 12, as well as other techniques discussed in more detail below with respect to
In certain embodiments, such as those depicted in
As the distal end portion 14 moves in a distal direction and the proximal end portion 16 moves in a proximal direction, the rear area 50 of the edge 46 may come in contact with the rear area 54 of the edge 52, as depicted in