Patent Application
20160250432
The present disclosure relates to medical devices and, more particularly, to video-enabled intubation and oropharyngolaryngoscopy.
The practice of clinical medicine has been aided with the implementation of high-resolution micro cameras that project real-time images that would otherwise not be practically visible. Various devices have been designed with the inclusion of a camera to facilitate use, including but not limited to the endoscope for evaluation of the gastrointestinal tract, the laparoscope to make abdominal surgery less invasive, and the videolaryngoscope to facilitate the placement of a breathing tube. The use of unidirectional, single camera technology as currently designed, however, is limited in scope and often dangerous, as nearby and or surrounding friable anatomic structures can be difficult or impossible to visualize. Hence, manipulation of these devices near such structures can lead to damage. Trauma of this sort is avoidable with proper visualization.
For example, direct laryngoscopy refers to the placement of a laryngoscope blade into a patient's mouth in order to expose the glottis and facilitate successful intubation (placement of a breathing tube, otherwise known as an endotracheal tube [ETT]) under direct visualization. Typically, a rigid stylet is inserted into the ETT prior to attempted intubation to facilitate its proper placement. Several advanced airway devices exist to aid in cases of failure or contraindication of direct laryngoscopy, notably the videolaryngoscope (VL). VL utilize a high-resolution micro camera at the end of a rigid laryngoscope to allow a line of sight to visualize glottic structures, such as the vocal cords, through which the ETT will be passed. Furthermore, this mode of intubation allows for neck neutrality, decreased patient stimulation, and improved ease of intubation.
The use of a VL, however, is not without risk. Multiple reports have been published that illustrate trauma to the oropharyngeal structures (including the soft palate, tonsil, palatopharyngeal arch, palatoglossal arch) caused by force placed on these structures during the passage of a rigid, styleted ETT. The mucosa in the pharynx is vascular and easily traumatized with minimal force. Additionally, important vascular and neural structures reside in the oropharyngeal cavity. Once traumatized, the oral structures easily swell and obscure further video or direct laryngoscopy. This may ultimately lead to failure to secure an airway, a subsequent decline in oxygenation, and eventual death.
In order to decrease risk of injury to oropharyngeal structures, manuals for the commonly used VLs instruct users to directly visualize the oropharynx as the styleted ETT is being passed. This approach is impractical, however, for at least two distinct reasons. First, it is unsafe to lose visualization of the glottis during attempted intubation. By diverting attention and focus from maintenance of a good glottic view, one can easily lose visualization of the glottis since even small movements by the operator can obscure glottic views. Often, once lost, adequate views that were carefully obtained can be difficult or impossible to recreate. Secondly, there is tremendous variability in the dimensions of pharyngeal structures amongst patients. Anecdotal experience has demonstrated that in many healthy patients, the tip of the ETT cannot be seen by direct visualization while it is advanced through the oropharynx towards the glottis. Furthermore, patients who require the use of VL intubation are often those with risk factors that will worsen the likelihood of successful intubation and eliminate the visibility of oropharyngeal structures during attempted intubation. Due to the current design of the VL, these inherent “blind spots” present regions of the oropharynx that are high risk for injury during VL.
According to an embodiment of the present invention, a multi-camera intubation device is disclosed. The device includes a blade having distal and proximal ends separated by an elongated body, and a first camera located on the elongated body a distance from the distal end of the blade and providing a unidirectional, forward field of view. The device also includes a second camera located on the elongated body a distance proximal to the first camera and providing a field of view substantially orthogonal to the field of view of the first camera. In exemplary embodiments the distance of the second camera from the first can be adjustable.
According to an embodiment of the present invention, a multi-camera intubation device is disclosed. The device includes a blade having distal and proximal ends separated by an elongated body forming a radius adapted to conform to a contour of an oropharynx. The device further includes a first camera located on the elongated body a distance from the distal end of the blade and providing a unidirectional, forward, laryngeal field of view. The device further includes a second camera located on the elongated body a distance proximal to the first camera and providing a pharyngeal field of view substantially orthogonal to the field of view of the first camera to visualize a pharyngeal structure. In exemplary embodiments the distance of the second camera from the first can be adjustable.
According to another embodiment of the present invention, a method of intubating using a multi-camera intubation device is disclosed. The method includes the step of inserting a blade into a body cavity, the blade having distal and proximal ends separated by an elongated body with first and second cameras located thereon. The first camera is located a predetermined distance from the distal end of the blade and provides a unidirectional, forward field of view. The second camera is located proximal to the first camera and providing a field of view that is substantially orthogonal to the field of view of said first camera. The method also includes the step of viewing, on a display, a video output of the second camera to detect tissue obstructions. The method further includes, guided by the blade, the step of inserting a tube into the body cavity in a manner that minimizes trauma to the tissue obstructions detected by the second camera. In exemplary embodiments the tube comprises a rigid stylet.
Other objects, features, and advantages will be apparent to persons of ordinary skill in the art from the following detailed description and the accompanying drawings.
The above and/or other exemplary features and advantages of the preferred embodiments of the present disclosure will become more apparent through the detailed description of exemplary embodiments thereof with reference to the accompanying drawings, in which:
Throughout the drawings, like reference numbers and labels should be understood to refer to like elements, features, and structures.
Exemplary embodiments of the present disclosure will now be described more fully with reference to the accompanying drawings. The matters exemplified in this description are provided to assist in a comprehensive understanding of various embodiments disclosed with reference to the accompanying figures. Accordingly, those of ordinary skill in the art will recognize that various changes and modifications of the embodiments described herein can be made without departing from the scope and spirit of the claimed inventions. Descriptions of well-known functions and constructions are omitted for clarity and conciseness. To aid in clarity of description, the terms “upper,” “lower,” “above,” “below,” “left” and “right,” as used herein, provide reference with respect to orientation of the accompanying drawings and are not intended to be limiting.
Exemplary embodiments of the present invention introduce a multi-camera intubation device, for example, a video oropharyngolaryngoscope (VOPL). A VOPL in accordance with present embodiments comprise two cameras: one to present a view of the glottis similar to that which is currently in practice with VL to facilitate successful intubation; the second lateral camera would provide a panoramic view of oropharyngeal structures during passage of an ETT. This additional camera can be located on the side of the VOPL blade at the level of the soft palate, palatopharyngeal arch, palatoglossal arch and tonsil. Exemplary embodiments locate the second camera on the right side because laryngoscopes are customarily designed such that the ETT is passed through the right side of the mouth. It would provide a view of approximately 5 cm length by 4 cm width of oropharyngeal structures that would otherwise remain unseen. This second camera, which can utilize a wide-angle lens, can provide a panoramic image that will be transmitted to a section of the VOPL monitor. The camera can have a non-fog, wide-angle lens so that a lateral, wide view of the soft palatine, glossal, and tonsillar structures are fully visualized. As the styleted ETT is inserted, the tip of the ETT will be easily visualized in the display in real time as it passes through the pharynx, towards the glottis. With the oropharyngeal structures in view, the ETT can be safely advanced. The trauma to these structures during intubation will thus be avoided. In addition, the operator can gain important knowledge of the oropharyngeal structures and oral cavity of each patient. VOPL fundamentally transforms the design, functionality and safety of VL.
Referring now to
In an exemplary embodiment of the method of intubation, the user would first place the intubating device 100 in the subject's oral cavity through direct vision. Next, the intubating device 100 would be advanced such that an image of the subject's glottis is visible through the distal camera 20. The styleted intubating tube would then be placed in the subject's mouth via direct vision. The intubating tube should then be advanced towards the subject's glottis until it can no longer be seen under direct visualization. The styleted intubating tube should then be carefully advanced while visualizing its passage through the oropharynx on a display of the second camera 30. The styleted intubating tube should be advanced until its tip is visualized on the display of the first camera 20. The styleted intubating tube should then be advanced through the subject's glottic opening. The stylet should be withdrawn and the intubating tube should be advanced further until the cuff of the intubating tube is past the vocal cords. The intubating tube is then to be held in place while the intubating device 100 is removed from the mouth.
While the invention has been described in connection with preferred embodiments, it will be understood by those of ordinary skill in the art that other variations and modifications of the preferred embodiments described above may be made without departing from the scope of the invention. Other embodiments will be apparent to those of ordinary skill in the art from a consideration of the specification or practice of the invention disclosed herein. The specification and the described examples are considered as exemplary only, with the true scope and spirit of the invention indicated by the following claims.
This application claims the benefit of U.S. Provisional Application No. 61/889,524, filed Oct. 10, 2013, which is hereby incorporated by reference in its entirety
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US14/58704 | 10/1/2014 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 61889524 | Oct 2013 | US |
