U.S. patent application number 13/980928 was filed with the patent office on 2013-11-07 for apparatus, systems, and methods for accessing the airway with medical instruments without interruption of assisted respiration.
This patent application is currently assigned to INTERMOUNTAIN INVENTION MANAGEMENT, LLC. The applicant listed for this patent is Samuel Brown, Troy Jesse Orr. Invention is credited to Samuel Brown, Troy Jesse Orr.
Application Number | 20130296653 13/980928 |
Document ID | / |
Family ID | 46516065 |
Filed Date | 2013-11-07 |
United States Patent
Application |
20130296653 |
Kind Code |
A1 |
Brown; Samuel ; et
al. |
November 7, 2013 |
APPARATUS, SYSTEMS, AND METHODS FOR ACCESSING THE AIRWAY WITH
MEDICAL INSTRUMENTS WITHOUT INTERRUPTION OF ASSISTED
RESPIRATION
Abstract
Systems for use in assisted respiration can permit insertion of
one or more elongated medical instruments into the proximal and/or
distal airway of a patient during administration of assisted
respiration, which may, in some instances, proceed with a patient
awake or only minimally sedated. In some systems, a bite block is
coupled with a mask and is movable relative to the mask such that
the system is capable of accommodating differing patient
anatomies.
Inventors: |
Brown; Samuel; (Salt Lake
City, UT) ; Orr; Troy Jesse; (Draper, UT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Brown; Samuel
Orr; Troy Jesse |
Salt Lake City
Draper |
UT
UT |
US
US |
|
|
Assignee: |
INTERMOUNTAIN INVENTION MANAGEMENT,
LLC
Salt Lake City
UT
|
Family ID: |
46516065 |
Appl. No.: |
13/980928 |
Filed: |
January 19, 2012 |
PCT Filed: |
January 19, 2012 |
PCT NO: |
PCT/US12/21814 |
371 Date: |
July 22, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61435301 |
Jan 22, 2011 |
|
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|
Current U.S.
Class: |
600/114 ;
128/200.26; 128/205.13; 128/205.25; 128/206.21 |
Current CPC
Class: |
A61B 1/00154 20130101;
A61M 16/0683 20130101; A61M 16/0078 20130101; A61M 2210/0625
20130101; A61M 16/0633 20140204; A61B 1/2676 20130101; A61M 16/0488
20130101; A61B 1/00165 20130101; A61M 16/0816 20130101; A61M
16/0493 20140204; A61M 16/0833 20140204; A61M 16/0825 20140204;
A61M 16/06 20130101; A61M 16/208 20130101; A61M 2210/005 20130101;
A61M 16/0495 20140204; A61M 16/0463 20130101; A61M 2210/0625
20130101 |
Class at
Publication: |
600/114 ;
128/206.21; 128/205.25; 128/205.13; 128/200.26 |
International
Class: |
A61M 16/04 20060101
A61M016/04; A61B 1/267 20060101 A61B001/267; A61B 1/00 20060101
A61B001/00; A61M 16/06 20060101 A61M016/06; A61M 16/00 20060101
A61M016/00 |
Claims
1-19. (canceled)
20. A system for use in assisted respiration, the system
comprising: a mask that defines a cavity configured to encompass
the mouth of a patient, wherein the mask comprises a shell that
defines an adapter opening configured to be coupled with an
assisted respiration source adapter, and wherein the adapter
opening is sufficiently large to permit passage of at least one
elongated medical instrument through it such that a distal end of
the medical instrument can be advanced through the airway of the
patient from a position exterior to the mask; and a bite block
coupled to the mask without any portion thereof extending through
the adapter opening of the shell, the bite block defining a
passageway through which at least one elongated medical instrument
can pass, wherein the bite block is sufficiently rigid to maintain
the passageway open when biting forces are applied to the bite
block by a patient, and wherein the bite block is movable relative
to the mask such that a plurality of different orientations of the
bite block relative to the mask are possible so that the system is
able to accommodate differing patient anatomies.
21. The system of claim 20, further comprising an assisted
respiration source adapter coupled to the mask, wherein the adapter
is configured to be coupled with an assisted respiration source of
one or more pressurized or unpressurized gases and to permit
transfer of one or more gases through the shell of the mask.
22. The system of claim 21, further comprising the assisted
respiration source, wherein the assisted respiration source
comprises one or more of a non-invasive positive pressure
ventilation system and a bag configured for use in bag valve mask
ventilation.
23. The system of claim 21, wherein the adapter defines a first
passageway through which at least one of an endotracheal tube and a
fiberscope can be advanced through the adapter opening of the shell
and further defines a second passageway through which one or more
gases from the assisted respiration source can pass, wherein the
second passageway is in fluid communication with the first
passageway.
24. The system of claim 23, wherein the first passageway comprises
a valve through which at least one of an endotracheal tube and a
fiberscope can be advanced.
25. The system of claim 24, wherein the second passageway comprises
a one-way valve.
26. The system of claim 20, wherein the bite block is coupled to
the mask via a conduit.
27. The system of claim 26, wherein the conduit is flexible.
28-45. (canceled)
46. A system for use in assisted respiration, the system
comprising: a mask that defines a cavity configured to encompass
the mouth of a patient, wherein the mask comprises a shell that
defines an adapter opening configured to be coupled with an
assisted respiration source adapter, and wherein the adapter
opening is sufficiently large to permit passage of at least one
elongated medical instrument through it such that a distal end of
the medical instrument can be advanced through the airway of the
patient from a position exterior to the mask; a bite block defining
a passageway through which an elongated medical instrument can
pass; and a conduit coupled with the bite block and configured to
be coupled with the mask, wherein the conduit is configured to
permit movement of the bite block relative to the mask when the
conduit is coupled to the mask such that a plurality of different
orientations of the bite block relative to the mask are possible so
that the system is able to accommodate differing patient
anatomies.
47. The system of claim 46, further comprising an assisted
respiration source adapter coupled to the mask, wherein the adapter
is configured to be coupled with an assisted respiration source of
one or more pressurized or unpressurized gases and to permit
transfer of one or more gases through the shell of the mask.
48. The system of claim 47, further comprising the assisted
respiration source, wherein the assisted respiration source
comprises one or more of a non-invasive positive pressure
ventilation system and a bag configured for use in bag valve mask
ventilation.
49. The system of claim 47, wherein the adapter defines a first
passageway through which at least one of an endotracheal tube and a
fiberscope can be advanced through the adapter opening of the shell
and further defines a second passageway through which one or more
gases from the assisted respiration source can pass, wherein the
second passageway is in fluid communication with the first
passageway.
50. The system of claim 49, wherein the first passageway comprises
a valve through which at least one of an endotracheal tube and a
fiberscope can be advanced.
51. The system of claim 49, wherein the second passageway comprises
a one-way valve.
52-82. (canceled)
83. An assembly for use with a mask for assisted respiration,
wherein the mask comprises a shell that defines an adapter opening
that is sufficiently large to permit passage of at least one
elongated medical instrument through it such that a distal end of
the medical instrument can be advanced through the airway of the
patient from a position exterior to the mask, the assembly
comprising: an assisted respiration source adapter configured to be
selectively coupled with the mask at the adapter opening; a conduit
coupled with the assisted respiration source adapter, wherein an
outer surface of the conduit is sized to pass through the adapter
opening; and a bite block coupled with the conduit, wherein the
bite block defines a passageway through which at least one
elongated medical instrument can pass, wherein an outer surface of
the bite block is sized to pass through the adapter opening, and
wherein the conduit is configured to permit movement of the bite
block relative to the mask when adapter is coupled to the mask such
that a plurality of different orientations of the bite block
relative to the mask are possible so that the system is able to
accommodate differing patient anatomies.
84. The assembly of claim 83, wherein the adapter is configured to
be coupled with an assisted respiration source of one or more
pressurized or unpressurized gases and to permit transfer of one or
more gases through the shell of the mask.
85. The assembly of claim 84, wherein the assisted respiration
source comprises one or more of a non-invasive positive pressure
ventilation system and a bag configured for use in bag valve mask
ventilation.
86. The assembly of claim 84, wherein the adapter defines a first
passageway through which one or more of an endotracheal tube and a
fiberscope can be advanced through the adapter opening of the shell
and further defines a second passageway through which one or more
gases from the assisted respiration source can pass, wherein the
second passageway is in fluid communication with the first
passageway.
87. The assembly of claim 86, wherein the first passageway
comprises a valve through which one or more of an endotracheal tube
and a fiberscope can be advanced.
88. The assembly of claim 87, wherein the second passageway
comprises a one-way valve.
89. The assembly of claim 83, wherein the bite block is rigid or
semi-rigid.
90. The assembly of claim 83, wherein the conduit is flexible.
91-99. (canceled)
100. An adapter for use with a mask for assisted respiration,
wherein the mask comprises a shell that defines an adapter opening
that is sufficiently large to permit passage of at least one
elongated medical instrument through it such that a distal end of
the medical instrument can be advanced through the airway of the
patient from a position exterior to the mask, the assembly
comprising: a housing that defines a first passageway and a second
passageway that are in fluid communication with each other, wherein
the first passageway defines a longitudinal axis that is configured
to be generally aligned with the adapter opening of the mask and
the mouth of a patient when the adapter is coupled with the mask
and the mask is coupled with the patient, and wherein the second
passageway is configured to permit one or more gases to pass
through it from an assisted respiration source; a connector that is
configured to selectively couple the housing with the mask; and a
valve through which one or more medical instruments can be inserted
through the first passageway.
101. The adapter of claim 100, wherein the second passageway
comprises a one-way valve that permits gases to flow toward the
first passageway.
102-117. (canceled)
Description
TECHNICAL FIELD
[0001] The present disclosure relates generally to masks used for
assisted respiration.
BRIEF DESCRIPTION OF THE DRAWINGS
[0002] The written disclosure herein describes illustrative
embodiments that are non-limiting and non-exhaustive. Reference is
made to certain of such illustrative embodiments that are depicted
in the figures, in which:
[0003] FIG. 1 is a perspective view of an embodiment of a system
that is configured for use in assisted respiration and in
intubating a patient;
[0004] FIG. 2 is an exploded perspective view of the system of FIG.
1, but without an embodiment of a strap that is shown in FIG.
1;
[0005] FIG. 3 is a cross-sectional view of the system of FIG. 1
taken along the view line 3-3 in FIG. 1;
[0006] FIGS. 4A-4C are cross-sectional views of a portion of the
system of FIG. 1 showing an embodiment of a bite block in a variety
of different positions;
[0007] FIG. 5A is a front perspective view of the bite block of
FIGS. 4A-4C;
[0008] FIG. 5B is a rear perspective view thereof;
[0009] FIG. 5C is a bottom plan view thereof;
[0010] FIG. 5D is a cross-sectional view thereof taken along the
view line 5D-5D in FIG. 5C;
[0011] FIGS. 6A-6E are cross-sectional views of the system of FIG.1
coupled with a patient that depict various stages of an intubation
process facilitated by use of a fiberoptic videoscope or other
elongated medical instrument;
[0012] FIG. 7 is a perspective view of an embodiment of a pushing
tube;
[0013] FIGS. 8A-8B are cross-sectional views of the system of FIG.
1 coupled with a patient that depict various stages of another
intubation process such as that depicted in FIGS. 4A-4E that
utilizes the pushing tube of FIG. 7;
[0014] FIG. 9 is a cross-sectional view of another embodiment of a
system that is configured for use in assisted respiration and in
endotracheally intubating a patient;
[0015] FIGS. 10A-10C are cross-sectional views of a portion of the
system of FIG. 9 showing an embodiment of a bite block in a variety
of different positions;
[0016] FIGS. 11A-11C are cross-sectional views of a portion of
another embodiment of a system that is configured for use in
assisted respiration and in intubating a patient showing an
embodiment of a bite block in a variety of different positions;
[0017] FIG. 12 is a cross-sectional view of another embodiment of a
system that is configured for use in assisted respiration and in
intubating a patient;
[0018] FIG. 13A is a front perspective view of another embodiment
of a bite block;
[0019] FIG. 13B is a rear perspective view thereof;
[0020] FIG. 13C is a bottom plan view thereof;
[0021] FIG. 13D is a cross-sectional view thereof taken along the
view line 13D-13D in FIG. 13C;
[0022] FIG. 14 is a rear perspective view of another embodiment of
a bite block; and
[0023] FIGS. 15A-15D are perspective views of a process for
augmenting an adapter so as to have instrument insertion
capabilities.
DETAILED DESCRIPTION
[0024] Various embodiments of systems disclosed herein can be used
in procedures that access the airway of a patient, such as
bronchoscopy or fiberoptic tracheal intubation, without disrupting
administration of assisted respiration to the patient, such as the
administration of noninvasive positive pressure ventilation
(NIPPV). Certain systems can include masks through which oxygen,
air, or a combination of those gases, whether pressurized or
unpressurized, can be administered. In some embodiments, a bite
block that is coupled to a mask can be readily adjusted relative to
the mask and inserted into the mouth of a patient such that the
bite block can accommodate the specific anatomy of the patient. In
other or further embodiments, the bite block can include features
that can aid in advancing instruments for bronchoscopy and/or
fiberoptic tracheal intubation into the airway of a patient.
[0025] Certain prior art procedures for emergency situations
involving patients who have compromised or arrested breathing are
known. In some instances, such patients may suffer from severe
respiratory failure and/or cardiopulmonary arrest. In some
procedures, an oral airway may first be inserted into the patient's
mouth. A face mask may then be placed over the patient's mouth and
nose. The face mask (e.g., a bag valve mask) may be connected to an
inflatable bag to maintain at least minimal oxygen flow to the
lungs in the short term. This particular process of artificial
ventilation is sometimes referred to as "bagging" the patient, and
may be suitable for initially stabilizing the patient. In order to
support the patient's respiration during cardiopulmonary
resuscitation, and to prevent aspiration of stomach contents, an
endotracheal tube may be placed into the trachea. Longer-term care
usually involves continued artificial ventilation and attaching the
patient to a ventilator (e.g., by means of the endotracheal tube).
Prior art techniques are only of use in unconscious patients or in
patients unable to respire without assistance; they would not be
tolerated in awake or semi-conscious patients who are at least
partially respiring without assistance. In awake or semi-conscious
patients, the transition from non-invasive assisted respiration to
invasive (e.g., via endotracheal tube) is quite dangerous. Current
techniques require induction of a comatose state and/or chemical
paralysis and at least temporary separation from the oxygen source,
which techniques may be associated with profound decrease in blood
oxygen levels or blood pressure, or even cardiopulmonary
arrest.
[0026] For example, a conventional approach to making a transition
to an endotracheal tube involves induction of a comatose state with
or without chemical paralysis, discontinuing respiration, and
completely removing the mask and oral airway to expose the mouth.
The physician then inserts a rigid laryngoscope blade into the
patient's mouth and then inserts the endotracheal tube through the
patient's mouth and upper airway and into the trachea in a
conventional manner. The rigid laryngoscope blade is inserted into
the mouth and advanced through the upper airway with an appropriate
amount of force to distort the naturally curved airway so that the
glottis is in straight alignment for direct visualization by the
operator.
[0027] If the patient suffers from cardiopulmonary arrest, cardiac
chest compressions are generally interrupted during this time
because energy transmission from the vigorous cardiac chest
compressions can cause an uncontrolled bouncing movement of the
head and neck. Such movement of the head and neck can impair
controlled manipulation of the laryngoscope for visualization and
tube placement. Moreover, uncontrolled movement of the laryngoscope
blade during forceful manipulation of the upper airway tissues can
result in severe or life-threatening injury.
[0028] Endotracheal intubation with the rigid laryngoscope blade
may require a significant amount of time, even if the patient is
motionless. The procedure can be more difficult if the patient is
less than completely cooperative and relaxed, if the patient's
airway has suffered trauma, and/or if the tongue has fallen back to
close the airway. The patient is generally not breathing during
this time, or may not be breathing sufficiently to maintain
adequate blood oxygen levels, particularly in situations of cardiac
arrest. If the transition process takes more than several seconds,
the physician may be forced to temporarily abandon the effort and
return to resuscitation by reinserting the oral airway and
replacing the face mask, and resuming cardiac chest compressions.
The transition process may be repeated several times before the
endotracheal tube is successfully inserted. In addition, the speed
with which the transition process must be completed increases the
chances of practitioner mistakes, such as unintended injury to the
patient during the intubation procedure. Irreversible damage to
vital organs such as the brain and heart can occur after about 30
seconds of interruption of artificial ventilation, and in an even
shorter time in the absence of cardiac chest compressions.
[0029] Endotracheal tubes may also be used in emergency situations
that have not yet resulted in cardiopulmonary arrest, such as to
ventilate patients suffering severe respiratory failure who may be
conscious or semi-conscious. A conventional approach can require a
patient to lie still, unconscious and/or paralyzed, while the
physician inserts a rigid laryngoscope blade into the patient's
mouth and trachea. Delivery of ventilation and/or oxygen is
interrupted during this period. The endotracheal tube is then
inserted into the trachea while the laryngoscope blade keeps the
patient's airway open. Profound decreases in blood oxygen or
arterial blood pressure, and even cardiopulmonary arrest, can
complicate the process of endotracheal intubation because of the
usual requirement to sedate, temporarily cease assisted
ventilation, and possibly paralyze the patient.
[0030] Certain embodiments disclosed herein can address,
ameliorate, resolve, and/or eliminate one or more of the
shortcomings of prior art devices and procedures, such as those
just described. For example, some embodiments permit fiberoptic
bronchoscopy or fiberoptic tracheal intubationin to proceed while a
patient is receiving NIPPV and/or while the patient is awake or
minimally sedated. In particular, certain embodiments could
substantially decrease risk associated with transition to invasive
assisted respiration by allowing the procedure to occur while the
patient remains awake or minimally sedated and at least partly
contributing to his/her own respiration. In some embodiments, a
system includes a bite block that is coupled with a face mask in
such a manner that a position of the bite block can be readily
adjusted relative to the mask, and thus the system can be readily
adjusted to conform to the anatomy of any particular patient. The
bite block can be used to open the mouth of a patient to provide
rapid access to the patient's airway. For example, in some
embodiments, the bite block is positioned within the oral cavity so
as to maintain the mouth in an open position and may be quickly
positioned in the patient so that little preparation time is used
in order to secure the mask to the patient, thereby providing
assisted respiration to the patience as well as access to the
patient's airway for the insertion of various instruments. Other
features and advantages of embodiments discussed herein will be
evident from the present disclosure.
[0031] The term "couple" (and any derivatives thereof) is a broad
term used herein in its ordinary sense. The term is sufficiently
broad to cover instances of both direct coupling, in which there is
direct contact between coupled components, and indirect coupling,
in which contact between the coupled components is not necessarily
present and yet one or more positions of and/or movements of a
first component relative to a second component are constrained,
such as may be due to one or more intermediate components that are
connected to each of the first and second components.
[0032] FIG.1 illustrates an embodiment of a system 100 that can be
used in assisted respiration and to provide access to the airway of
a patient. The system 100 includes a mask 102 that can be
configured for placement over the mouth and/or nose of a patient
(see, e.g., FIG. 6A). The system 100 can further comprise an
attachment assembly 104 by which the mask 102 can be coupled to the
head and face of a patient. In the illustrated embodiment, the
attachment assembly 104 comprises a plurality of flexible straps or
bands 106, which may be stretchable or resiliently deformable. Any
suitable arrangement for the attachment assembly 104 is
possible.
[0033] The system 100 further includes a bite block 108 that can be
configured for placement in the oral cavity of a patient. The bite
block 108 can be coupled with the mask 102 and can be movable
relative thereto so as to permit the system 100 to accommodate a
variety of different patient anatomies. The system 100 also
includes an adapter 110 that can be coupled with the mask 102. The
adapter 110 can be configured to provide oxygen and/or other gases
(e.g., air) to the mask 102. The adapter 110 can further be
configured to assist in, or permit, the insertion of one or more
instruments in to the airway of a patient. For example, the adapter
110 can be configured to permit the passage of a fiberscope or
other instrument into the airway of a patient, and may further
permit an endotracheal tube to be passed over a fiberscope into the
patient. The adapter 110 can permit the insertion of such
instruments while simultaneously providing oxygen and/or other
gases to the patient. In some embodiments, the assisted respiration
source adapter 110 is coupled with the bite block 108.
[0034] FIGS. 2 and 3 depict additional views of the system 100,
absent the attachment assembly 104. In the illustrated embodiment,
the adapter 110 comprises two separate assemblies 117, 119. An
insertion assembly 117, which may also be referred to as an
insertion portal or insertion adapter, is configured to allow the
insertion of various devices into the airway of a patient through
the mask 102. An assisted respiration source assembly 119, which
may also be referred to as an assisted respiration source adapter,
is configured to be coupled with an assisted respiration source 205
(see FIG. 6A) so as to receive oxygen and/or other gases (e.g.,
air) and direct them to the mask 102. The adapter 110, as a
composite of the assemblies 117, thus itself may be referred to as
an insertion assembly, insertion portal, insertion adapter,
assisted respiration source assembly, and/or assisted respiration
source adapter.
[0035] In the illustrated embodiment, the insertion assembly 117
comprises a housing 112 that is shaped substantially as a T-joint.
As shown in FIG. 3, the housing 112 defines an insertion channel or
passageway 124 through which instruments can be passed into the
airway of a patient while the mask 102 is in place. The housing 112
further defines a portion of a respiration channel or passageway
126 through which gases can pass from an assisted respiration
source 205 (see FIG. 6A). The insertion passageway 124 is in fluid
communication with the respiration passageway 126, such that the
gases from the assisted respiration source 205 also are permitted
to pass through the insertion passageway 124 and into the mask
102.
[0036] With reference again to both FIGS. 2 and 3, the insertion
assembly 117 can include a valve 118 of any suitable variety. In
the illustrated embodiment, the valve 118 comprises a septum that
includes one or more slits 120. The valve 118 can be held against
an open end of the housing 112 via a collar 122. As shown in FIG.
3, the valved end of the housing 112 can define a port 123 through
which instruments may be inserted.
[0037] As shown in FIGS. 2 and 3, the assisted respiration source
assembly 119 can comprise diverter 114, which can be configured to
direct a flow path of gases from an assisted respiration source
along a path that is angled away from or otherwise does not
interfere with instruments that may be inserted through the port
123 of the insertion assembly 117. In the illustrated embodiment,
the diverter 114 comprises an elbow joint. A first end of the
diverter 114 can comprise a connection interface that is configured
to couple with the housing 112 in any suitable manner. A second end
of the diverter 114 may comprise a connection interface that is
configured to couple with an assisted respiration source 205 in any
suitable manner. In the illustrated embodiment, the second end of
the diverter 114 is coupled with a connector 116, which defines the
suitable interface for connection to an assisted respiration source
205.
[0038] The assisted respiration source assembly 119 can comprise a
valve 128 that is configured to control a direction of gas flow
through the assembly 119. In the illustrated embodiment, the valve
128 comprises a one-way valve, such that gas flow is preferentially
permitted into the mask. Any suitable arrangement for the assisted
respiration source assembly 119 is possible. For example, some
assisted respiration source assemblies 119 that are directly
connected to masks for NIPPV applications are known in the art, and
can be suitable for use in the adapter 110.
[0039] In the illustrated embodiment, the insertion assembly 110 is
coupled with a connection assembly 130, which is coupled with the
bite block 108. The connection assembly 130 can be configured to
secure the bite block 108 to the mask 102, yet permit the bite
block 108 to move relative to the mask 102, as discussed further
below. In the illustrated embodiment, the connection assembly 130
comprises a conduit 132 and a connector sleeve 140. The conduit 132
can comprise any suitable material and may be rigid, semi-rigid, or
flexible. In the illustrated embodiment, the conduit 132 comprises
a flexible material that is resiliently deformable. The conduit 132
can define a passage through which gases can be delivered from the
adapter 110 to the bite block 108. In the illustrated embodiment, a
sidewall of the conduit 132 is substantially solid or uninterrupted
such that the gases are delivered directly to the bite block 108
without leakage into the mask 102 through the conduit. Other
arrangements of the conduit 132 are also possible. For example, in
some embodiments, the conduit 132 can include one or more openings
in its sidewall.
[0040] In other embodiments, the connection assembly 130 may
comprise other suitable attachment devices to secure the bite block
108 to the mask 102. For example, in some embodiments, the
connection assembly 130 includes one or more tethers or leashes in
place of the conduit 132.
[0041] The connector sleeve 140 comprises a plurality of stops 144,
142 that are configured to maintain the bite block 108 coupled
therewith in a movable fashion. In the illustrated embodiment, a
forward stop 144 comprises an outwardly extending lip or flange
that encircles the connector sleeve 140. A rearward stop 142
comprises two outwardly extending protrusions (only one of which is
shown) that can act as a keying system for coupling the bite block
108 to the connector sleeve 140 and maintaining the bite block 108
in the coupled state.
[0042] The bite block 108 can include a coupling ring 168 that is
configured to cooperate with the connector sleeve 140 to couple the
bite block 108 with the connector sleeve 140 and also to permit the
bite block 108 to move in a constrained manner when the connector
sleeve 140 and the bite block 108 are coupled with each other. The
coupling ring 168 defines an upper notch 164 and a lower notch 166
that are sized to permit the outwardly extending rearward stops 142
to pass through. In order to couple the bite block 108 with the
connector sleeve 140, the notches 164, 166 are aligned with the
stops 142, the bite block 108 is advanced over the connector sleeve
140, and the bite block 108 is then rotated to lock the bite block
108 in place. The bite block 108 thus may be rotatable relative to
the connector sleeve 140 about a central axis of the connector
sleeve 140. The bite block 108 can remain coupled with the
connector sleeve 140 over a large rotational range, although the
bite block 108 can be decoupled from the connector sleeve 140 by
again aligning the notches 164, 166 with the stops 142 and
retracting the bite block 108 from the connector sleeve 140.
[0043] In other embodiments, the bite block 108 may be permanently
attached to the connector sleeve 140 and may be fixed relative to
at least that portion to which it is connected. For example, the
bite block 108 may be integrally formed with the connector sleeve
140. In still other embodiments, the connector sleeve 140 may be
eliminated and the bite block 108 may be directly connected to the
conduit 132 and/or may be integrally formed therewith. Other
suitable arrangements for the conduit 132, the connector sleeve
140, and/or the bite block 108 are also possible.
[0044] The mask 102 can include a structural shell 150. In some
embodiments, the mask 102 further includes a pad or cushion 154
that extends about a periphery of the shell 150 and is configured
to interface with the face of a patient. The shell 150 can define
an adapter opening 152 through which instruments may be passed
through the mask 102 and into the airway of a patient. The adapter
110 can be attached to the mask 102 at the adapter opening 152. Any
suitable arrangement for coupling the adapter 110 to the mask 102
is contemplated. In the illustrated embodiment, the housing 112 of
the adapter 110 includes a connector 125 of any suitable variety,
such as a deformable snap or clip, which interacts with an inwardly
projecting rim 155 that is defined about the adapter opening
152.
[0045] Any suitable method may be used to assemble the system 100.
As depicted in FIG. 2 via a broken line, in the illustrated
embodiment, the connection assembly 130 is sized so as to be
inserted through the adapter opening 152 of the shell 150. The
connection assembly 130 thus can be inserted through the adapter
opening 152 and the housing 112 of the adapter 110 can be connected
to the shell 150. Thereafter, the bite block 108 can be attached to
the connector sleeve 140 in a manner such as discussed above. In
other embodiments, the connection assembly 130 may be coupled
directly to the shell 150. In still other embodiments, the
connection assembly 130 can be connected to the adapter 110 after
the adapter 110 has been coupled to the shell 150.
[0046] With reference to FIG. 3, the mask 102 can define a cavity
156 that is sized to receive at least a portion of the nose and the
lips of a patient therein. The cavity 156 can extend to the bottom
edge of the cushion 154, which as previously mentioned, can be
configured to encompass at least a portion of the nose and the
mouth of a patient. The bite block 108 can be configured to move
relative to the mask 102 so as to be able to accommodate differing
patient anatomies, as discussed further hereafter. In some
embodiments, a distal end 162 of the bite block 108 can be
positioned at an exterior of the cavity 156 defined by the mask
102. The distal end 162 may be positioned deep within the oral
cavity of the patient, but spaced from the pharynx, as discussed
further below.
[0047] In some embodiments, a proximal end 160 of the bite block
108 is positioned at an interior of the cavity 156 when the system
100 is in a resting, initial, or unused state. When the system 100
is coupled to a patient, the bite block 108 can be adjusted to fit
in the mouth of the patient and thus can be moved relative to the
mask 102. The proximal end 160 of the bite block 108 may remain
within the cavity 156 of the mask 102 throughout the adjustment,
and can remain spaced from the adapter opening 152 of the shell
150. The flexible conduit 132 can be bent, deformed, or otherwise
displaced to permit the adjustment of the bite block 108.
[0048] FIGS. 4A-4C illustrate various adjustments or movements of
the bite block 108 that can be made relative to the shell 150 of
the mask 102, which can allow the system 100 to be adjusted or
conform to a particular patient. With reference to FIG. 4A, the
bite block 108 can translate toward or away from the shell 150
along the connector sleeve 140, as depicted by the double-headed
arrow. The translational movement can be limited by interaction
between the coupling ring 168 of the bite block 108 and the forward
and rearward stops 144, 142. Although not depicted by an arrow, the
bite block 108 likewise can rotate relative to the connector sleeve
140 about a longitudinal central axis, which may be common to the
bite block 108 and the connector sleeve 140.
[0049] As shown in FIG. 4B, the bite block 108 likewise can be
permitted to move laterally (e.g., up, down, side-to-side, etc.)
relative to the shell 150, as depicted by the double-headed arrow.
The flexible conduit 132 can be deformed so as to permit such
movement.
[0050] As shown in FIG. 4C, the bite block 108 can per permitted to
rotate relative to the shell 150 about a variety of axes other than
the longitudinal central axis defined by the connector sleeve 140.
The flexible conduit 132 can be deformed so as to permit such
movement. Accordingly, the bite block 108 can have multiple degrees
of freedom of movement relative to the shell 150. Other suitable
arrangements that allow for movement of the bite block 108 are also
possible, as discussed further below.
[0051] FIGS. 5A-5D illustrate an embodiment of the bite block 108,
which can include features that assist in orientation and/or
advancement of medical instruments into the airway of a patient.
The bite block 108 can include an upper bite plate 170 and a lower
bite plate 172 that are shaped and sized to contact one or more
upper teeth and one or more lower teeth, respectively. A patient
thus can bite against the upper and lower bite plates 170, 172 so
as to maintain the bite block 108 within the mouth of the patient.
In the illustrated embodiment, each of the upper and lower bite
plates 170, 172 is substantially rectangular and planar, although
other suitable configurations are also possible.
[0052] The upper and lower bite plates 170, 172 cooperate to define
a forward end of passageway 173 through which an elongated medical
instrument may pass. As further discussed below, the bite block 108
can be particularly helpful in positioning a fiberscope that is
advanced through the passageway 173. The passageway 173 can be
sufficiently large to permit an endotracheal tube to be passed over
such a fiberscope through the passageway 173.
[0053] The bite block 108 can include a guide plate 174 that
extends rearwardly from the upper bite plate 170. An upper surface
of the guide plate 174 can be contoured so as to be able to fit
against or near a roof of a mouth of a patient. For example, the
upper surface can be convexly rounded (see FIG. 5D), although other
configurations are also possible. A lower surface of the guide
plate 174 can be concavely rounded. In the illustrated embodiment,
the guide plate 174 angles upwardly from the upper bite plate
170.
[0054] The guide plate 174 can be sized so as to be maintained
within the oral cavity of a patient when the patient bites on the
bite plates 170, 172. In particular, the guide plate 174 can be
sufficiently short that it does not extend into the pharynx. In
some embodiments, the guide plate 174 may be restricted to the hard
palette region of the roof of the mouth, and may be configured so
as not to trigger a pharyngeal or gag reflex in the patient.
[0055] Sidewalls 176, 178 can extend downwardly from the guide
plate 174 at lateral sides of the bite block 108. Each sidewall
176, 178 may decrease in height in a rearward direction. For
example, in the illustrated embodiment the sidewalls are
substantially triangular. As can be seen in FIG. 5C, the sidewalls
176, 178 can angle inwardly in a rearward direction toward an
imaginary vertically extending central longitudinal plane LP. In
the illustrated embodiment, the guide plate 174 and the sidewalls
176, 178 angle inwardly at a large angle near the distal end 162 of
the bite block 108, but define a more shallow angle at a position
that is spaced from the distal end 162. The distal end 162 of the
bite block 108 may be substantially pointed, although the tip
thereof may be rounded so as to prevent trauma to the mouth of a
patient.
[0056] A base plate 179 can extend rearwardly from the lower bite
plate 172 and can border a lower end of the sidewalls 176, 178. The
base plate 179 can be substantially shorter than the guide plate
174. The rearward edges of the base plate 179 and the sidewalls
176, 178 may be shaped to accommodate and/or rest against the
tongue of a patient. In the illustrated embodiment, the base plate
179 is angled downwardly from the lower bite plate 172. In some
embodiments, the base plate 179 can be configured to contact a
tongue of a patient, and may hold down the tongue so as to prevent
it from blocking a pathway through the oral cavity and into the
pharynx.
[0057] The upward and downward angling of the guide plate 174 and
the base plate 179, respectively, can assist in positioning the
bite block 108 within the mouth of the patient. For example, the
angled surfaces of the plates 174, 179 can urge teeth that clamp
down against the plates toward the upper and lower bite plates 170,
172, respectively.
[0058] The guide plate 174 can include an entrance region 180 at a
forward end of the guide plate 174 and an exit region 182 at a
rearward end of the guide plate 174. In some embodiments, the
sidewalls 176, 178 can border the guide plate 174 from the entrance
region 180 to the exit region 182. The guide plate 174 and/or the
sidewalls 176, 178 can be substantially funnel shaped. For example,
the lower surface of the guide plate can funnel from the entrance
region 180 to the exit region 182. The exit region 182 thus can
define a smaller transverse width than does the entrance region
180.
[0059] The bite block 108 can be configured to constrain movement
of a tip of a fiberscope or other elongated medical instrument that
is advanced through the passageway 173 so as to cause the
fiberscope to exit the bite block 108 at a position that is
generally along and towards a midline of a patient. Such an
arrangement can assist a practitioner in successfully locating the
larynx and the trachea of the patient. For example, a distal tip of
a fiberscope can be inserted into the passageway 173 and urged
along the lower surface of the guide plate 174. Due to the
curvature of the guide plate 174, the distal tip can be directed to
a center line of the guide plate 174 (e.g., a line defined by the
central longitudinal plane LP), which can be generally aligned with
a midline of the patient. The fiberscope as whole may be aligned
with the center line of the guide plate 174 and/or midline of the
patient. The practitioner thus may be provided with useful
information regarding a position of the distal tip of the
fiberscope as it exits the bite block 108 and/or is advanced
through the airway of a patient. The bite block 108 may also
maintain the fiberscope generally aligned with the midline of the
patient as the fiberscope is advanced through the airway. As
maintenance of a fiberscope in alignment with the midline (e.g., in
alignment with the central longitudinal plane LP) can be a major
impediment to effective fiberoptic intubation of the trachea, bite
blocks 108 that include features such as just described can be
particularly useful in efficient and successful fiberoptic
intubation of the trachea.
[0060] In the illustrated embodiment, the bite plate 108 is
symmetrical about the longitudinal plane LP. Such an arrangement
can be useful in conforming to a symmetrical anatomy of a patient,
and may assist in centering a fiberscope.
[0061] As shown in FIG. 5A, the lateral sides of the bite block can
include openings 184, 186 through which oxygen and/or other gases
can escape without entering the mouth of a patient when the bite
block 108 is secured in the mouth of the patient. The gases can be
received into the cavity 156 of the mask 102, and may be inhaled
through the nose of the patient.
[0062] With reference to FIGS. 5A, 5B, and 5D, the bite block 108
can include one or more stops 190, 192 that are configured to
prevent the bite block 108 from being inserted past a desired
position within the mouth of a patient. In the illustrated
embodiment, the stops 190, 192 comprise flange portions that extend
upwardly from the upper bite plate 170 and downwardly from the
lower bite plate 172, respectively.
[0063] The bite block 108 can be configured to withstand biting by
a patient so as to maintain the passageway 173 open. In some
embodiments, the bite block 108 comprises a rigid or semi-rigid
material, such as any suitable plastic material. In the illustrated
embodiment, the openings 184, 186 can reduce the structural
integrity of the bite block 108. The upper bite plate 170 and the
lower bite plate 172 may be integral with or rigidly attached to
the guide plate 174 and the base plate 179, respectively, such that
large displacements of the bite plates 170, 172 are nevertheless
prevented. The coupling ring 168 may also help to prevent large
displacements of the bite plates 170, 172 under a compressive
biting force of a patient.
[0064] FIGS. 6A-6E depict various stages of an illustrative method
of using the system 100 with a patient P. In many instances, the
patient is permitted to remain fully awake or is only partially
sedated while the method is carried out. With reference to FIG. 6A,
the adapter 110, the conduit 132, and the bite block 108 may all be
pre-coupled with the mask 102. The bite block 108 can be inserted
into the oral cavity 200 of the patient P. The bite block 108 can
be sized and dimensioned to be constrained within the oral cavity
(e.g., to not extend into the pharynx or beyond) when the patient's
teeth clamp against the bite plates 170, 172 of the bite block
108.
[0065] The bite block 108 can be repositioned relative to the mask
102 so as to have an appropriate fit within the oral cavity 200
while the mask 102 fits securely against the face of the patient P.
In the illustrated embodiment, the conduit 132 is bent or displaced
from a resting position to accommodate the repositioning of the
bite block 108.
[0066] The connector 116 can be secured to any suitable interface
of an assisted respiration source 205. In the illustrated
embodiment, a corrugated tube 204 couples the assisted respiration
source 205 to the connector 116. The assisted respiration source
205 can be configured to deliver oxygen, and optionally other gases
(e.g., air) to the patient P. The gases can be unpressurized or
pressurized, depending on the application. In some instances, the
assisted respiration source 205 comprises any suitable ventilation
machine, such as, for example, ventilation machines that are
commonly used in NIPPV applications. Such NIPPV applications can
include continuous positive airway pressure (CPAP) and/or variable
or bilevel positive airway pressure (VPAP or BiPAP). In other or
further instances, the assisted respiration source 205 may comprise
a bag, which can be configured for use in bag valve mask
ventilation procedures.
[0067] In the illustrated embodiment, pressurized air flows into
the adapter 110 from the assisted respiration source 205, thereby
opening the valve 128. The air is thus permitted to flow through
the conduit 132 and through the bite block 108 into the airway of
the patient P. Some air can exit from the bite block 108 through
the side openings 184, 186 into the cavity 156 of the mask 102, and
may thereafter be breathed in through the nose of the patient.
[0068] As shown in FIG. 6B, an elongated medical instrument 209 of
any suitable variety can be inserted through the port 123 and
through the bite block 108 into the airway of the patient P. In
some instances, the medical instrument 209 can comprise any
suitable device or probe, such as a fiberscope 210, a light wand,
an intubating stylet, a fiberoptic intubating stylet, a specialized
suction device, etc. As the fiberscope 210 is inserted through the
port 123, the valve can maintain a seal therewith so as to prevent
oxygen or air from exiting the adapter 110 thereat. A distal end of
the fiberscope 210 can be advanced against the guide plate 174 of
the bite block 108 and can be funneled toward the exit region 182
in a manner such as described above. The bite block 108 thus can
assist in orienting the fiberscope 210 generally along a midline of
the patient P. The fiberscope 210 can be thus manipulated from a
position that is exterior to the mask 102.
[0069] With reference to FIG. 6C, once the fiberscope 210 has been
advanced past the distal end of the bite block 108, it can be
advanced into the trachea 212 of the patient P. Various techniques
for guiding a fiberscope 210 through the airway of a patient are
known.
[0070] FIG. 6D illustrates that after the fiberscope 210 has been
positioned as desired, another elongated medical instrument 219 can
be inserted into the patient via the system 100. The medical
instrument 219 can comprise any suitable cannula, such as an
endotracheal tube 220. The endotracheal tube 220 can be advanced
over the fiberscope 210 or similar medical instrument, through the
insertion port 123, through the bite block 108, and into the
trachea 212. The endotracheal tube 220 can be thus manipulated from
a position exterior to the mask 102. The endotracheal tube 220 can
cause greater deformation of the valve 118, which can substantially
maintain a seal with the endotracheal tube 220. Once a distal end
of the endotracheal tube 220 is in a desired position within the
trachea 212, a balloon cuff 222 can be inflated via a port 224 to
secure the endotracheal tube 220 in place in any suitable manner,
such as those known in the art.
[0071] With reference to FIG. 6E, once the endotracheal tube 220 is
positioned as desired and secured in place, the system 100 can be
removed. In particular, the fiberscope 210 can be withdrawn through
the endotracheal tube 220. The bite block 108 can be removed from
the mouth of the patient P and the adapter 110, the mask 102, the
conduit 132, and the bite block 108 can be withdrawn over a
proximal end of the endotracheal tube 220. The proximal end of the
endotracheal tube 220 can then be coupled with an assisted
respiration source 205 (see FIG. 6A) in any suitable manner.
[0072] FIGS. 7 and 8A illustrate a pusher 230 that can aid in using
the system 100 with different patient anatomies, where an
endotracheal tube 220 may have a fixed length. The pusher 230 can
include a slit or opening 232 through which the pusher 230 can be
placed over the fiberscope 210 or through which the fiberscope 210
may be inserted. As shown in FIG. 8A. In some instances, the system
100 may be used with a patient P who has a long neck, such that the
endotracheal tube 220 might be advanced through the airway of the
patient a greater distance in order to arrive at the desired
position. The pusher 230 thus may be advanced through the insertion
port 123 and over the fiberscope 210 so as to advance the
endotracheal tube 220 to the desired position.
[0073] As shown in FIG. 8B, the pusher 230 may be removed along
with the fiberscope 210 and the system 100, while leaving the
endotracheal tube 220 in place. A proximal end of the endotracheal
tube 200 may be positioned closer to the mouth of the patient in
FIG. 8B than it is to the mouth of the patient in FIG. 6E.
[0074] The pusher 230 also can aid in using the system 100 with
differently dimensioned endotracheal tubes. Certain endotracheal
tubes are manufactured in different diametrical sizes and different
lengths, but are designed for use with standard laryngoscope
procedures. An endotracheal tube of this variety thus may be
manipulated directly so as to position a distal end thereof only a
short distance from the mouth of a patient once the tube is in
place. The mask 102 and/or the insertion port 123 can prevent
direct access to this region at which a distal end of such
endotracheal tubes is typically positioned. Accordingly, the pusher
230 can allow for indirect access to the typical area at which the
distal end of an endotracheal tube is positioned, and thus can
assist in moving an endotracheal tube into its usual orientation
relative to the patient. Such placement of the endotracheal tube
can proceed while maintaining gas delivery to the patient without
interruption, or substantially without interruption, and without
removal of the mask 102.
[0075] FIG. 9 illustrates another embodiment of a system 300 that
can resemble the system 100 described above in certain respects.
Accordingly, like features are designated with like reference
numerals, with the leading digits incremented to "3." Relevant
disclosure set forth above regarding similarly identified features
thus may not be repeated hereafter. Moreover, specific features of
the system 300 may not be shown or identified by a reference
numeral in the drawings or specifically discussed in the written
description that follows. However, such features may clearly be the
same, or substantially the same, as features depicted in other
embodiments and/or described with respect to such embodiments.
Accordingly, the relevant descriptions of such features apply
equally to the features of the system 300. Any suitable combination
of the features and variations of the same described with respect
to the system 100 can be employed with the system 300, and vice
versa. This pattern of disclosure applies equally to further
embodiments depicted in subsequent figures and described
hereafter.
[0076] The system 300 includes a mask 302 that includes a shell
350. The mask 302 defines a cavity 356. An insertion assembly 317
that includes a housing member 312 can be coupled with the shell
350. The system 300 further includes a connection member 330, which
consists of a flexible conduit 332. In the illustrated embodiment,
the flexible conduit 332 comprises a corrugated tube having a
series of outwardly extending rings 331. A proximal end of the
connection member 330 is directly coupled with the housing member
312, and a distal end of the connection member 330 is directly
coupled with a bite block 308. A proximal end 360 of the bite block
360 is positioned within the cavity 356 of the shell 350 when the
system 300 is in a pre-use state, whereas a distal end 362 of the
bite block 360 is at a position exterior to the cavity 356.
[0077] As shown in FIGS. 10A-10C, the bite block 308 can be
moveable or adjustable relative to the shell 350, such that the
system 300 can readily accommodate differing patient anatomies.
FIG. 10A illustrates that the flexible conduit 332 can be
extendible and/or compressible in a longitudinal direction, such
that the bite block 308 can move directly away from or toward the
shell 350. FIG. 10B illustrates that the flexible conduit 332 can
permit the bite block 308 to move laterally relative to the shell
350. FIG. 10C illustrates that the flexible conduit 332 can permit
rotation of the bite block 308 relative to the shell 350 about an
axis other than a longitudinal axis through the flexible conduit
332. Although not depicted by arrows, the flexible conduit may
further permit slight rotation of the bite block 308 about a
longitudinal axis of the conduit 332 (e.g., the flexible conduit
332 may be configured to twist).
[0078] FIGS. 11A-11C illustrate another embodiment of a system 400
in which a bite block 408 has multiple degrees of freedom of
movement relative to a shell 450 portion of a mask. An insertion
assembly 417 can include a housing member 412. The housing member
412 can define a conduit 432. In some embodiments, the housing
member 412 is rigid or semi-rigid, and the conduit 432 thus may be
rigid or semi-rigid and can resist being bent or deformed. The
housing member 412 can be connected to the shell 450 at a
connection interface 401, which comprises a ball-and-socket joint
in the illustrated embodiment. In particular, the housing member
412 includes a substantially spherically shaped protrusion that is
configured to rotate within a substantially spherically shaped
casing 451 defined by the shell 450.
[0079] As shown in FIG. 11A, the housing member 412 can define a
forward stop 444 and a rearward stop 442 at a distal region of the
conduit 432. The bite block 408 can move longitudinally between the
stops 442, 444. As shown in FIG. 11B, the conduit 432, and hence
the bite block 408, can rotate relative to the shell 450. In some
instances, the rotation can be about axes other than a longitudinal
axis of the conduit 432. In other or further instances, the
rotation can be about the longitudinal axis. For example, the
housing member 412 can be configured to rotate about its
longitudinal axis within the shell 450 and/or the bite block 408
can be configured to rotate relative to the conduit 432 about the
longitudinal axis. As shown in FIG. 11C, in some embodiments, the
bite block 408 may fit loosely at the end of the conduit 432 and
may be configured to rotate relative thereto.
[0080] FIG. 12 illustrates another embodiment of a system 500,
which includes a shell 550, which defines an adapter opening 552
and at least a portion of a cavity 556, and a bite block 508 that
is capable of being adjusted relative to the shell 500. An
insertion assembly 517 can include a housing member 512 that
defines a conduit 532 similar to the conduit 432 described above.
The housing member 512 can be connected to the shell 550 at a
connection interface 501. In the illustrated embodiment, the
connection interface 501 is configured to permit the housing member
512 to slide relative to the shell 550. The housing member 512 can
include one or more flanges 533 that are configured to block or
close the adapter opening 552 of the shell 550 regardless of the
position to which the housing member 512 is slid relative to the
shell 550. As shown by the double-headed arrows, the bite block 508
can have multiple degrees of freedom of movement relative to the
shell 550.
[0081] FIGS. 13A-13D illustrate another embodiment of a bite block
608 that can resemble the bite block 108 described above. The bite
block 608 can include features that assist in orientation and/or
advancement of medical instruments into the airway of a patient.
The bite block 608 can include an upper bite plate 670 and a lower
bite plate 672 that are substantially rectangular and planar,
although other suitable configurations are also possible. The upper
and lower bite plates 670, 672 cooperate to define a forward end of
passageway 673 through which an elongated medical instrument may
pass. The passageway 673 can be devoid of a coupling ring, such as
the coupling ring 168 described above, such that a forward end of
the passageway 673 may be larger than a forward end of the
passageway 173 described above.
[0082] The bite block 608 can include a guide plate 674, sidewalls
676, 678, and a base wall 679. As shown in FIG. 13C, the sidewalls
676, 678 may taper gradually inward toward a central longitudinal
plane LP of the bite block 608. A distal end 662 of the bite block
608 can be substantially flat. The bite block 608 can include
lateral openings 684, 686 and upper and lower stops 690, 692 such
as similarly numbered features discussed above.
[0083] FIG. 14 illustrates another embodiment of a bite block 708
that can resemble the bite blocks 108, 608 described above. The
bite block 708 can be configured for use in altering a
configuration of a mask portion of a system. For example, the bite
block 708 can be used in retrofitting a mask and/or can be inserted
through an opening in the mask without removing the mask from a
patient, as discussed further below.
[0084] The bite block 708 can include an upper bite landing or
plate 770 (see FIG. 15C) and a lower bite landing or plate 772. The
upper and lower bite plates 770, 772 are substantially rectangular
and planar, although other suitable configurations are also
possible. The upper and lower bite plates 770, 772 can be formed as
recesses in a body 771, which is shaped substantially cylindrically
in the illustrated embodiment.
[0085] The body 771 can define a guide plate 774, sidewalls 776,
778, and a base wall 779, which may smoothly transition from one to
another. The sidewalls 776, 778 can define one or more lateral
openings 784, 786. An inner surface of the body can be concavely
rounded and can assist in centering a fiberscope in manners such as
discussed above. An outer diameter of the bite block 708 can be
sufficiently small to permit the bite block 708 to pass through an
adapter opening of a mask, as discussed hereafter.
[0086] FIGS. 15A-15D illustrate a system 700 such as the systems
discussed above, and depict various stages of an illustrative
method of adjusting or retrofitting a mask 702. The mask 702 can
include a shell 750 that defines an adapter opening 752 (FIG.
15B).
[0087] As shown in FIG. 15A, an assisted respiration source
assembly 719 can initially be coupled with the mask 702 at the
adapter opening 752. The assisted respiration source assembly 719
can resemble the assisted respiration source assembly 119 discussed
above, and can be configured to deliver oxygen and optionally
additional gases to the patient via the mask 702. However, the
assisted respiration source assembly 719 can be devoid of features
that would permit the insertion of medical devices through the
adapter opening 752.
[0088] As shown in FIG. 15B, the assisted respiration source
assembly 719 can be removed from the mask 702. For example, if it
is determined that a medical instrument should be delivered to the
airway of the patient, the assisted respiration source assembly 719
can be removed so as to expose the adapter opening 752.
[0089] As shown in FIG. 15C, an insertion assembly 717 can be
coupled with the mask 702 at the adapter opening 752. The insertion
assembly 717 can be coupled with a connection member 730, such as a
flexible conduit 732, which can in turn be coupled with the bite
block 708. The bite block 708 and the flexible conduit 732 can be
advanced through the adapter opening 752, and the insertion
assembly 717 can be coupled with the mask 702. In some embodiments,
the assisted respiration source assembly 719 can be attached to the
insertion assembly 717.
[0090] As shown in FIG. 15D, the coupled insertion assembly 717 and
assisted respiration source assembly 719 can cooperate as an
adapter 710, such as the adapter 110 discussed above. One or more
elongated medical devices can be inserted through the insertion
assembly 717 in manners such as discussed above with respect to the
insertion assembly 117. In some instances, the insertion assembly
717 may be used without the conduit 730 and/or without the bite
block 708.
[0091] In some instances, the adaptation, retrofitting, or
adjustment of the mask 702 can take place prior to placement of the
mask 702 on the patient. In other instances, the adjustment can
take place while the patient is wearing the mask 702.
[0092] As previously mentioned, while the drawings and written
description have focused on illustrative devices, systems, and
methods related to the placement of an endotracheal tube, it is to
be understood that embodiments may be used in any other suitable
context, such as contexts where other elongated medical instruments
are inserted into an airway of the patient when it is desirable to
provide assisted respiration to the patient. In some instances,
embodiments may be used with procedures that enter the esophagus or
stomach. Accordingly, in various embodiments, elongated medical
instruments may be inserted into upper and/or lower aerodigestive
tracts.
[0093] It will be understood by those having skill in the art that
changes may be made to the details of the above-described
embodiments without departing from the underlying principles
presented herein. For example, any suitable combination of various
embodiments, or the features thereof, is contemplated.
[0094] Any methods disclosed herein comprise one or more steps or
actions for performing the described method. The method steps
and/or actions may be interchanged with one another. In other
words, unless a specific order of steps or actions is required for
proper operation of the embodiment, the order and/or use of
specific steps and/or actions may be modified.
[0095] References to approximations are made throughout this
specification, such as by use of the terms "about" or
"approximately." For each such reference, it is to be understood
that, in some embodiments, the value, feature, or characteristic
may be specified without approximation. For example, where
qualifiers such as "about," "substantially," and "generally" are
used, these terms include within their scope the qualified words in
the absence of their qualifiers. For example, where the term
"substantially planar" is recited with respect to a feature, it is
understood that in further embodiments, the feature can have a
precisely planar orientation.
[0096] Reference throughout this specification to "an embodiment"
or "the embodiment" means that a particular feature, structure or
characteristic described in connection with that embodiment is
included in at least one embodiment. Thus, the quoted phrases, or
variations thereof, as recited throughout this specification are
not necessarily all referring to the same embodiment.
[0097] Similarly, it should be appreciated that in the above
description of embodiments, various features are sometimes grouped
together in a single embodiment, figure, or description thereof for
the purpose of streamlining the disclosure. This method of
disclosure, however, is not to be interpreted as reflecting an
intention that any claim require more features than those expressly
recited in that claim. Rather, as the following claims reflect,
inventive aspects lie in a combination of fewer than all features
of any single foregoing disclosed embodiment.
[0098] The claims following this written disclosure are hereby
expressly incorporated into the present written disclosure, with
each claim standing on its own as a separate embodiment. This
disclosure includes all permutations of the independent claims with
their dependent claims. Moreover, additional embodiments capable of
derivation from the independent and dependent claims that follow
are also expressly incorporated into the present written
description. These additional embodiments are determined by
replacing the dependency of a given dependent claim with the phrase
"any of the preceding claims up to and including claim [x]," where
the bracketed term "[x]" is replaced with the number of the most
recently recited independent claim. For example, for the first
claim set that begins with independent claim 1, claim 3 can depend
from either of claims 1 and 2, with these separate dependencies
yielding two distinct embodiments; claim 4 can depend from any one
of claims 1, 2, or 3, with these separate dependencies yielding
three distinct embodiments; claim 5 can depend from any one of
claims 1, 2, 3, or 4, with these separate dependencies yielding
four distinct embodiments; and so on.
[0099] Recitation in the claims of the term "first" with respect to
a feature or element does not necessarily imply the existence of a
second or additional such feature or element. Embodiments of the
invention in which an exclusive property or privilege is claimed
are defined as follows.
* * * * *