U.S. patent number 3,565,079 [Application Number 04/719,994] was granted by the patent office on 1971-02-23 for self-inflating endotracheal tube.
Invention is credited to Richard Robert Jackson.
United States Patent |
3,565,079 |
|
February 23, 1971 |
SELF-INFLATING ENDOTRACHEAL TUBE
Abstract
Endotracheal tubes with cuffs that self-inflate during
inspiration and remain inflated during expiration. Shown are distal
openings on the outside of the tube into the cuff volume. Also
shown is a tube having an opening through its wall into the cuff
volume, and a flutter valve to restrict the flow of air. The cuffs
shown are substantially larger than the trachea and are of thin
film material.
Inventors: |
Richard Robert Jackson
(Marblehead, MA 01945) |
Family
ID: |
24892232 |
Appl.
No.: |
04/719,994 |
Filed: |
April 9, 1968 |
Current U.S.
Class: |
128/207.15 |
Current CPC
Class: |
A61M
16/045 (20140204); A61M 16/04 (20130101) |
Current International
Class: |
A61M
16/04 (20060101); A61m 025/00 () |
Field of
Search: |
;128/348--351,344,325,246 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Martinez "An Improved Cuffed Tracheotomy Tube for Use With
Intermittent .
Positive Pressure Breathing" Jo. Thorac. & Card. Surg., Vol.
47-3, Mar .
64 pp 404--405 128--351.
|
Primary Examiner: Dalton L. Truluck
Attorney, Agent or Firm: John Noel Williams
Parent Case Text
This application is a continuation-in-part of my copending
application of the same title, Ser. No. 427,601, filed Jan. 25,
1965, now abandoned.
Claims
I claim:
1. A self-inflating endotracheal tube comprising an elongated,
flexible, open-ended hollow tube having a proximal and distal end,
an inflatable cuff secured to said tube adjacent the distal end
thereof, and means for automatically causing inflation of said cuff
in response to inspiration through said tube and for maintaining
said cuff inflated during expiration therethrough, the portion of
said tube extending through said cuff being imperforate and said
means comprising openings in the vicinity of the distal end of said
cuff adapted to receive a backflow of air flowing along the outside
of said tube.
2. The endotracheal tube of claim 1 further characterized in that
the said cuff is generally tubular in configuration and has a
diameter substantially larger than that of the trachea in which the
tube is adapted to be inserted.
3. The endotracheal tube of claim 2 further characterized in that
said cuff is of thin, film material.
4. The endotracheal tube of claim 1 further characterized in that
said cuff is of thin film material sized and shaped to permit it to
fold upon itself when inflated in the trachea into a substantial
teardrop configuration with the large end of the teardrop near the
proximal end.
5. A self-inflating endotracheal tube comprising an elongated,
flexible, open-ended hollow tube having a proximal and distal end,
an inflatable cuff secured to said tube adjacent the distal end
thereof, and means for automatically causing inflation of said cuff
in response to inspiration through said tube and for maintaining
said cuff inflated during expiration therethrough, the portion of
said tube extending through said cuff being constructed to prevent
flow of air from within said cuff to the interior of said tube when
the pressure in said cuff is higher, said means comprising openings
in the vicinity of the distal end of said cuff adapted to receive a
backflow of air flowing along the outside of said tube and said
cuff being of thin film material and sized and shaped to permit it
to fold upon itself when inflated in the trachea into a substantial
teardrop configuration with the large end of the teardrop near the
proximal end.
6. The endotracheal tube of claim 5 wherein said openings comprise,
at least in part, passages defined beneath the distal end of the
cuff.
7. The endotracheal tube of claim 6 further characterized in that
said passages comprise grooves in the outer surface of the distal
end of the endotracheal tube.
8. The endotracheal tube of claim 7 wherein said grooves are
distributed around the circumference of the tube, a reduced
diameter hub portion of the cuff secured about said grooves, the
grooves being longer than the axial length of the hub and having
portions lying beyond said hub on both sides thereof.
9. A self-inflating endotracheal tube comprising an elongated,
flexible, open-ended hollow tube having a proximal and distal end,
and an inflatable cuff secured to said tube adjacent the distal end
thereof, said cuff having at least one slit therein, said slit
located in the distal portion of said cuff for entry of air from
the trachea, the portion of said tube extending through said cuff
being imperforate.
10. The endotracheal tube of claim 9 further characterized in that
said cuff is of thin, flexible film material.
11. The endotracheal tube of claim 10 further characterized in that
the said cuff is generally tubular in configuration and has a
diameter substantially larger than that of the trachea in which the
tube is adapted to be inserted.
12. The endotracheal tube of claim 9 wherein said slits are
elongated and extend generally parallel to the axis of the hollow
tube.
13. The endotracheal tube of claim 9 wherein said slits are
elongated and extend generally perpendicular to the axis of the
hollow tube.
14. An endotracheal tube comprising an elongated, flexible
open-ended hollow tube having a proximal and a distal end, said
tube being provided with a generally radially extending aperture
therethrough adjacent the distal end thereof, an inflatable cuff
overlying said aperture and sealed to the tube at its ends on
either side of the aperture whereby to form a fluid chamber
intermediate the walls of the tube and cuff, and a flexible sheet
secured over said opening and having a slit therein in registry
with said opening, said flexible sheet being oriented so that when
the pressure of the fluid within the hollow tube increases above
that in the chamber, the slit in the flexible sheet will open and
the fluid will flow into the chamber, thereby inflating the cuff,
said flexible sheet thereafter operating to restrict fluid flow out
of the cuff.
15. An endotracheal tube comprising an elongated, flexible
open-ended hollow tube having a proximal and a distal end, said
tube being provided with a generally extending aperture
therethrough adjacent the distal end thereof, an inflatable cuff
overlying said aperture and sealed to the tube at its ends on
either side of the aperture whereby to form a fluid chamber
intermediate the walls of the tube and cuff, a flexible check valve
on the hollow tube and normally covering the aperture, an air scoop
member positioned to divert air moving toward the distal end into
said aperture and thus through said check valve into said cuff,
said flexible check valve being oriented so that when the pressure
of the fluid within the hollow tube increases above that in the
chamber, the flexible check valve will open and the fluid will flow
into the chamber, thereby inflating the cuff, said check valve
thereafter operating to restrict fluid flow out of the cuff.
Description
The present invention relates generally to medical and surgical
equipment and is more particularly concerned with the provision of
means for maintaining normal breathing of of the patient during
surgical operations and the like.
A primary object of the instant invention is the provision of a
novel and improved endotracheal tube.
An important object of the instant invention is the provision of an
endotracheal tube having a self-inflating cuff.
Another object of this invention is the provision of an
endotracheal tube having a self-inflating cuff that automatically
inflates during inspiration through the tube and which remains
inflated during expiration therethrough.
Another object is the provision of an endotracheal tube having a
self-inflating cuff that makes a good seal with the wall of the
trachea but which nevertheless minimizes the likelihood of trauma
at the area of the trachea wall where the seal is made.
A further object of the instant invention is the provision of a
self-inflating endotracheal tube having novel and improved
structural means for automatically causing inflation of the
inflatable cuff during inspiration of the patient and for
maintaining the cuff inflated during expiration.
Another object is the provision of an endotracheal tube of the
character described that is relatively simple and inexpensive to
manufacture and which therefore may be disposable after use.
Other object, features and advantages of the invention will become
apparent as the description thereof proceeds when considered in
connection with the accompanying illustrative drawings.
In the drawings which illustrate the best mode presently
contemplated for carrying out the instant invention:
FIG. 1 is a fragmentary elevational view, partly in section,
showing an endotracheal tube embodying the instant invention in
operation position within the trachea of a patient;
FIG. 2 is a right-hand end view of the tube shown in FIG. 1;
FIG. 3 is a fragmentary elevational view, partly in section, of a
further modified endotracheal tube, with the cuff removed for
convenience of illustration;
FIG. 4 is a top plan view of a portion of the tube illustrated in
FIG. 3;
FIG. 5 is a view of another embodiment in operation within the
trachea and
FIG. 6 is a cross-sectional view taken on line 6-6 of this
embodiment;
FIG. 7 is a view of another embodiment in operation within the
trachea;
FIG. 8 is a side view of this embodiment;
FIG. 9 is a view of another embodiment in operation within the
trachea;
FIG. 10 is a side view, partly in cross section of this embodiment;
and
FIG. 11 is a cross-sectional view taken on line 11-11 of FIG.
10.
Although the instant invention is illustrated and described in
connection with an endotracheal tube, it will be understood that
all forms of the invention hereinafter described function equally
as well in connection with tracheotomy tubes used as an artificial
airway in the neck to create a direct passage for air to enter the
trachea without passing through the mouth, as is well known in the
art. Thus, it will be understood that all reference in the
specification and claims herein to endotracheal tubes, applies
equally to tracheotomy tubes, and hence, for the purpose of this
application, the term endotracheal tube is construed broadly as
covering tracheotomy tubes as well.
Referring now to the drawings, and more particularly to FIGS. 1 and
2 thereof, there is shown an endotracheal tube 10 in operative
position in the trachea 12 of a patient, having passages 14 and 16
leading to the left and right lungs of the patient. The tube 10 is
of conventional construction in that it comprises a hollow
open-ended tube of any flexible nontoxic material, such as certain
well known types of plastic that are used for this purpose. The
tube 10 has a proximal end 18 and a distal end 20, the latter
terminating in a beveled form, as is well known and conventional in
the art.
Secured to the tube 10 adjacent its distal end 20 is an inflatable
cuff or balloon 22, said cuff being generally tubular in
configuration and being constructed of any suitable flexible film
material, such as extremely thin latex, e.g. of less than .002 inch
thickness. The cuff 22 is secured to the tube 10 by any suitable
means, such as, for example, by winding silk suture 24 around
opposite hub portions 26 of the cuff so as to tightly bind the cuff
to the tube in airtight relation with respect thereto. In the form
of my invention illustrated in FIGS. 1 and 2, it is important to
note that there is no communication between the interior of tube 10
and the interior of cuff 22. Expressed differently, the wall of the
tube 10 is imperforate. It is also important to note that the
length of the cuff is preferably short relative to the overall
length of the tube within the trachea. Furthermore, the diameter of
the cuff 22 is substantially larger than the diameter of the
trachea 12, e.g. of 1 1/2 inch diameter in comparison to a trachea
of three-fourths inch diameter, and even though this may result in
some folding of the cuff 22 on itself when inflated, this is not
detrimental in any way, since the extreme thinness of the material
of which cuff 22 is constructed enables the cuff to easily fold
upon itself, even at low pressures, while at the same time
maintaining a good airtight seal with the surrounding trachea. The
cuff 22 is provided with a series of radially spaced slits 28,
located adjacent the distal end of the cuff, the purpose of said
slits now to be described.
In operation and use, the endotracheal tube 10 is inserted into the
trachea in the usual manner, using sterile lubricant to facilitate
introduction. The fact that the cuff 22 is not inflated during
introduction of the tube 10 further facilitates its insertion into
the trachea. Once the tube 10 has been positioned in the patient's
trachea, the pressure differential which exists between the
patient's lungs and the patient's throat, when respiration is being
assisted by the anesthesiologist, will automatically cause
inflation of the cuff 22. Expressed differently, the pressure in
the patient's lungs is relatively high as compared to the
relatively low or atmospheric pressure that exists in the trachea
12 surrounding tube 10. As a result of this pressure differential,
and the preferred character of the cuff, i.e. its high flexibility,
its oversize shapes relative to the trachea, and its short length,
the relatively high pressure air is forced through slits 28 to
inflate cuff 22, thereby creating an effective seal between the
cuff and the surrounding wall of the trachea. The effectiveness of
this seal is further enhanced by the adhesion of the thin latex
cuff 22 to the surrounding portion of the trachea, said adhesion
being caused by mucus normally present on the wall of the
trachea.
As is indicated above there is a tendency for air to flow from the
distal end of the endotracheal tube and the lungs outwardly along
the outside of the endotracheal tube. This tendency exists both for
inspiration and expiration when the patient is being assisted by
the use of a breathing bag. The cuff initially causes partial
blockage of this air, so that the pressure at the distal side of
the cuff approaches that within the lungs, and the pressure on the
proximal side approaches atmospheric. Accordingly, air enters the
cuff through the slits and acts to distend the proximal wall of the
cuff. This improves the blockage, and increases the pressure
differential across the cuff. Also, air passing through the
constriction defined by the tracheal wall and the cuff may increase
in speed, and produce a venturi effect to assist in drawing the
flexible film wall of the cuff toward the tracheal wall. In any
event further entry of air and progressive distention of the cuff
occurs until the limits of the trachea are reached and a
substantially perfect seal achieved, all occurring in a fraction of
a second.
Thus it will be seen that the cuff 22 automatically inflates
immediately and effectively as soon as assisted or controlled
respirations are initiated to the patient. The cuff remains
inflated during expiration through tube 10 as a result of the air
pressure in the lungs being greater than that at the distal end of
the tube (the only relaxation of the cuff may occur upon completion
of expiration and even this can be prevented by a valve on the
ventilator which prevents the pressure in the tube from dropping to
atmospheric pressure). Passage of air into and out of the patient's
lungs may therefore be effectively controlled during surgical
procedures. The extreme thinness of the cuff 22 minimizes the
likelihood of trauma at the portion of the trachea at which the
seal is made. Furthermore, the self-inflating characteristics of
the endotracheal tube prevent over- or under-inflation of the cuff,
this being of particular importance where the tube is being used in
connection with a tracheotomy.
The seal formed by cuff is not normally sufficiently effective to
prevent the passage of secretions and blood through the trachea,
although, as hereinbefore stated, the seal is sufficiently
effective to enable good respiratory control to be achieved.
Referring now to FIGS. 3 and 4, a further modified form of my
invention is illustrated. In this form, the tube 42 is provided
with an opening 48 communicating with the interior of the cuff (not
shown). A flexible sheet 46 is secured over opening 48 and is
provided with a slit 44 in registry with said opening. Thus, the
sheet 46 and slit 44 act, in effect, as a flutter valve for
permitting inflation of the cuff and at the same time maintaining
sufficient inflation during expiration so as to retain an effective
seal. More specifically, as high pressure air is introduced to the
patient through tube 42, it will pass through opening 44 to inflate
the cuff. When the pressure in the cuff equalizes the pressure
inside of tube 42, the cuff will be inflated, and no further air
will pass therein. When pressure inside of tube 42 commences to
drop, air will commence to slowly exit from the cuff through slit
44; however, this exit will be sufficiently delayed by the
aforedescribed valve or slit so as to maintain an effective seal
until the inspiratory phase of the cycle begins once again. This
form of my invention is particularly applicable to tracheotomy
tubes since the air pressure in the cuff is maintained at a more
constant level than in the case in the aforedescribed forms of the
invention. This constant seal prevents passage of blood or
secretions or food into the lung of the patient, an ever-present
danger where prolonged artificial respiration via tracheotomy is
being performed.
A preferred form of my invention using a flutter valve is shown in
FIGS. 5 and 6. In this case the flutter valve 46a is formed by a
loose-fitting thin rubber tube surrounding the endotracheal tube
42a. The distal end of the opening 44a is defined by a portion or
tab 45 of the endotracheal tube 42a that extends at an angle A
inwardly toward the tube axis B. This portion forms an air scoop
for air passing through the tube on inspiration. It has been found
that this air scoop is effective to direct the air through the
valve and into the cuff 32. In particular it makes the initial
inflation of the cuff occur with less air flow and pressure in the
tube than is the case with the embodiment of FIGS. 3 and 4.
It is found that after initial inflation the cuff 32 remains
inflated throughout the breathing cycle. It may be withdrawn from
the trachea while still inflated due to its extreme pliability and
the relatively low pressure of inflation (no higher than the
pressure of the ventilator). Where desired, the flutter valve 46a
may be provided with a slit or other means by which air can leave
as the cuff is withdrawn from between the vocal chords.
A preferred form of my invention using slits in the cuff is shown
in FIGS. 7 and 8. The slits 28a in this embodiment extend
transversely of the axis B of the tube there being two rows located
at the distal end of the cuff 22a. It is found that these slits are
readily opened (as shown in FIG. 7) by the effect of ventilator air
pressure and readily admit the cuff-inflating air. FIG. 7 also
shows that the inflating air concentrates in the proximal end of
the cuff. According to observations of the endotracheal tube when
disposed in a glass cylinder, it is found that the cuff 22a assumes
the form shown when, as preferred, the cuff is oversize relative to
the trachea and of such flexibility (e.g. less than .002 inch thick
latex film) as to be capable of folding upon itself. In this
teardrop form the cuff extends from its proximal point of
attachment first toward the proximal end of the tube, then
reverses, quickly attaining the maximum diameter and then tapers
slowly toward its distal point of attachment. Sealing against the
tracheal wall is thus accomplished at the proximal end of the cuff,
and the bulk of the cuff in that region provides amply for
self-adjustment of the cuff to the contour of the trachea.
So long as the openings in the cuff are in the vicinity of the
distal end of the cuff (that is, not in the proximal portions) self
inflation is possible. According to the presently preferred
embodiment the openings are formed in the outer wall of the distal
portion of the endotracheal tube itself. Referring to FIGS. 9--11 a
series of elongated grooves 60 are formed in the outer surface of
the endotracheal tube 62, distributed about the circumference of
the tube. These grooves extend in the direction of the length of
the tube, in this embodiment in excess of one-half inch.
The distal end of the cuff 22b is secured to the tube 62 by a hub
margin 23 of reduced diameter. This margin 23 is so sized and
positioned that a portion, 1.sub.1 of each groove 60 lies within
the cuff 22 b, on the proximal side of margin 23, and another
portion, 1.sub.3, lies on the distal side of the margin, beyond the
cuff. Thus there are provided openings in the vicinity of the
distal end of the cuff which admit backflow of air flowing along
the outside of the tube. The cuff accordingly inflates, as shown in
FIG. 10, in the form similar to that of FIG. 8.
It has been suggested by others for ease of manufacture that a
separate tip member be molded with properly sized grooves, and
adhesively secured to the tube proper. Embodiments following this
suggestion have been tested and have been found to produce a very
good seal.
It is preferred for the embodiments of FIGS. 5--10 that the cuff be
provided with reduced diameter hubs at each end, these hubs being
adhesively secured to the tube. Where the cuff is latex and the
tube plastic an adhesive marketed as "Eastman 910" is found
effective.
In the embodiments of FIGS. 5 and 6 a substantially airtight seal
is formed at both ends. In the embodiments of FIGS. 7--11 the hub
at the proximal end is sealed substantially airtight, and at the
distal end is secured sufficiently strongly to resist being
dislodged as the tube is inserted between the vocal chords, into
the trachea. In some instances elastic stretching of the cuff to
fit the tube may prove sufficient to provide the desired seal and
attachment.
In the embodiment of FIGS. 1, 2; 7, 8; and 9--11 the cuff is shown
without openings. Thus communication between the cuff and the
inside of the tube is prevented during respiration. An opening
covered with a flutter valve and scoop as shown in FIGS. 5 and 6
could alternatively be provided in the other embodiments (albeit at
extra expense), and still the tube would be operationally
imperforate during the respiration period, and hence within the
scope of the invention.
Other modifications of the specific details are possible within the
spirit and scope of the claims.
As will be seen, all forms of the present invention provide for
automatic inflation of the cuff during the inspiratory phase of the
respiration cycle, and at the same time, the cuff is maintained
sufficiently inflated during expiration to retain an effective
seal. The simplicity of construction of the various forms of the
instant invention hereinbefore described make it feasible for the
tubes to be disposable after each use.
* * * * *