summary of the endotracheal tube
SUMMARY OF THE ENDOTRACHEAL TUBE
In accordance with the present invention, there is provided a tubular device for insertion into the body of a living being, which device includes means for aligning the axis of the tubular device relative to the internal body structure. With respect to one embodiment of the invention there is provided an endotracheal tube airway device for insertion through a patient's mouth or nasal passage into the trachea to provide a passage for respiration. The device is comprised of an elongated flexible tube having upper and lower end portions wherein the lower end portion is inserted into the mid-trachea portion below the larynx while the upper end portion remains outside the mouth or nasal passage. An upper inflatable-deflatable cuff fixed above the larynx surrounds a predetermined portion of the posterior round of the tube. The upper cuff is operative when inflated to engage the posterior portion of the pharynx to effect an alignment of the tube relative to the larynx wherein the axis of the tube portion within the larynx is maintained central therto such that the tube is away from the posterior portion thereof. The device includes means for inflating and deflating the upper cuffs.
In accordance with another aspect of the present invention, there is provided a device as set forth above including a lower inflatable-deflatable cuff spaced from the upper cuff to be positioned a predetermined distance below the larynx. The lower cuff is opoerative upon inflation to sealingly engage the inner wall of the trachea. Means, separate from the upper cuff, are provided for inflating and deflating the lower cuff.
More specifically, the upper cuff and lower cuff are respectively positioned on a tube such that when inserted into the patient, the upper end of the lower cuff would be a few centimeters below the cricoid arch, and a lower end of the upper cuff would be a few centimeters above the arytenoid cartilages. In this respect, the upper cuff which surrounds only a predetermined portion of the posterior round of the tube is therefore positioned in the pharynx. Means for inflating and deflating the respective cuffs are comprised of separate and distinct channels or ducts within the wall of the tube which extend from the cuffs to the upper end portion of the tube. Appropriate fittings connectable to a syringe are provided for inflation and deflation of the cuffs. The lower cuff has an elongated, cylindrical, barrel-like configuration. This configuration effects axial alignment of the lower portion of the tube with the axis of the trachea. The upper cuff is disposed on the posterior side of the flexible tube to inflate toward the back, posterior surface of the pharynx. In this respect, the upper cuff is generally unidirectional in that it inflates away from the tube in one direction toward the posterior of the pharynx. The upper cuff is operative upon inflation to force the tube toward the epiglottis and tongue to position the tube away from the posterior portion of the larynx. A fully inflated upper cuff preferably extends aproximately 2-3 centimeters from the outer circumferential surface of the tube and displaces the tube from the posterior portion of the pharynx accordingly.
An important aspect of the present invention is that the configuration of the upper cuff allows the physician to monitor the position of the tube in relation to the larynx and modify inflation of the cuff accordingly. In this respect, the upper cuff does not completely occupy and seal the passage through the pharynx, and thus the inflation postion, as well as the condition of the larynx, can be monitored by means of flexible fiber optic scopes inserted around the sides of the upper cuff through the mouth or the nose. In another respect, because the upper cuff does not occupy the full extent of the pharyngeal lumen, it allows passage of other tubes alongside, such as a tube through the esophagus into the stomach. This permits other medical procedures to be conducted during intubation.
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