WO1990001350A1

WO1990001350A1 - Endotracheal tube

Info

Publication number: WO1990001350A1
Application number: PCT/GB1989/000933
Authority: WO
Inventors: Patricia Moore
Original assignee: Patricia Moore
Priority date: 1988-08-12
Filing date: 1989-08-14
Publication date: 1990-02-22
Also published as: GB8819248D0; GB2223407A

Abstract

An endotracheal tube (10) has a tapering end portion formed with a port (18) and defining a small diameter orifice (16). To insert the tube (10), a pilot member such as a fibroptic endoscope is first passed through the body portion (12) and orifice (18) before being negotiated down the patient's tracheo-bronchial tree. The tube (10) is then easily slid down the inserted pilot member which is subsequently withdrawn. Alternative means of locating the end of the endotracheal tube relative to the pilot member and of allowing the passage of gases are disclosed.

Description

Endotracheal tube.

This invention relates to a modification of conven¬ tional endotracheal tubes which facilitate intubation into the tracheo-bronchial (TB) tree.

There are some patients in whom intubation of the TB tree is difficult for antomical or pathological reasons. In such patients it is common practice to facilitate intubation by passing a long, relatively fine, semi-rigid introducer into the TB tree. This may be done blindly using, for example, a gum elastic bougit, or endoscopically using a fibre optic laryngo¬ scope. When the introducer is in situ, the endotracheal tube may be slid over it into the trachea. Sometimes this procedure is easy and atraumatic to accomplish: sometimes not. Commonly used endotracheal tubes are of uniform diameter and have bevelled presenting tips. Because the internal diameter of the E.T. tube is greater than the external diameter of the introducer, the tip of the tube may enter the larynx at some distance from the path taken by the introducer and the bevel may catch on the vocal cords or arytenoid cartilages thus preventing its own passage between the vocal cords.

Similarly, if the nasal route is used, a bevelled tube of uniform diameter may be very difficult to mani¬ pulate through the nose and into the oropharynx and trauma may be caused by the tip of the tube to the posterior nasopharyngeal wall.

It is an aim of present invention to provide an endotracheal tube which may be easily introduced to the TB tree after insertion of a pilot member. According to the present invention there is provi¬ ded an endotracheal tube having at its leading end locat¬ ing means for locating the tube for sliding movement relative to an elongate pilot member which has previously been introduced into the tracheo-bronchial tree, thus facilitating insertion. Preferably the locating means are constituted by a terminal orifice defined by a tapered end portion of the tube, the tapered portion being provi¬ ded with one or more ports or other forms of orifice to permit the passage of gases.

Alternatively the locating means may be an annulus set within the end portion of the tube or indeed any formation which can partly or completely embrace the pilot member. In one preferred embodiment the locating means are constituted by an end portion of the tube having terminal portions which overlap in the circum¬ ferential direction.

Although the invention may be carried out in a variety of ways two particular embodiments thereof will now be described, by way of example, with reference to the accompanying drawings in which

Figure 1 is a perspective of the leading end of an endotracheal tube according to the invention,

Figure 2 is a similar view of a modification of the tube of Fig. 1; and

Figure 3 is a detail in axial section through an end portion of the tube of Fig. 1. An endotracheal tube 10 has a leading end as shown in Fig. 1 comprising a uniform diameter portion (which may be any type of endotracheal tube and may be cuffed) which tapers through an intermediate portion 14 to define a small diameter terminal orifice 16 which is coaxial with the body portion 12. A lobe-shaped port 18 is formed in the intermediate portion 14.

To insert the tube 10 a flexible elongate pilot member, conveniently a fibroptic endoscope 19 (see Fig. 3) , which is an easy sliding fit in the orifice 16 is first passed through the body portion 12 and orifice 16. The pilot member is then negotiated down the TB tree until it extends well beyond the desired limit of insertion of the tube 10. It is then an easy matter to slide the endotracheal tube 10 down the inserted pilot member, and then to withdraw the pilot member.

The tube 20 having a body portion 22 and shown in Fig. 2 is inserted in a similar way, but differs structurally from the tube 10 in having a tapering end portion 24 and a terminal orifice 26 which are coaxial with the body portion 22, and two ports 28 formed in the tapering portion 24.

As shown in Fig. 3 the end portion 14 of the endotracheal tube 10 is formed so as to present a smooth transition between the surface of a tapering end portion 14 and the surface of a fibroptic endoscope 19. The tube 20 has a similar terminal configuration and details of the ports have been omitted.

Further points to be noted are: 1. An endotracheal tube may go down the right main bronchus or the left main bronchus which is a matter that is routinely monitored during intubation; the side ports of tubes according to the present invention should ensure the venting of both lungs, especially if the tube is stabilised in the trachea by having the inflated cuff very close to the tapered terminal portion.

2. Friction on the pilot member is kept to a minimum by having only a very short terminal length of the tube of minimum internal diameter; a lubricant may be used to facilitate sliding the tube over the pilot member.

3. The terminal orifice does not necessarily have to be perpendicular to the longitudinal axis of the tube as shown in the drawings, and may be inclined so as to form a miniature bevel.

4. Although it is possible to insert the pilot member through one or more ports, one can ensure, as insertion is performed under direct vision, that the pilot member passes through the terminal orifice of the tube. The small size of the terminal orifice would lead to increased resistance to air flow; however this drawback is overcome by the presence of the one or more side ports which extend to the region of maximum internal diameter of the tube.

5. The provision of two side ports as in the Fig. 2 embodiment gives an initial cross-section which may be favourable to facilitate passage of the tube through the nose and vocal cords; as will be appreciated the lateral placement of the ports reduces the effective transverse dimension of the tube in a direction across the ports .

6. Provision of one or two side ports may facilitate removal of a pilot member having a highly angulated terminal portion by allowing the elbow of the pilot member to be received in a port.

7. The terminal tapered portion of the endotracheal tube may be formed as a spiral, for example a continuation of the helical wire reinforcement of an armoured tube.

Claims

CLAIMS :

1. An endotracheal tube having at its leading end locating means for locating the tube for sliding movement relative to an elongate pilot member which has previously been introduced into the tracheo-bronchial tree, whereby insertion of the endotracheal tube is facilitated.

2. A tube as claimed in claim 1, in which the locating means are constituted by a terminal orifice defined by a tapered end portion of the tube.

3. A tube as claimed in claim 1, in which the locating means are constituted by an annulus set within the end portion of the tube.

4. A tube as claimed in claim 1, in which the locating means are constituted by end portions of the tube which overlap in the circumferential direction.

5. A tube as claimed in any preceding claim, in which the leading end of the tube is provided with at least one further orifice to permit the passage of gases there¬ through.

6. A tube as claimed in claim 5 as appendant to claim 2 , 3 or 4, in which the leading end of the tube is provided with one or more ports.

7. A tube as claimed in claim 5 as appendant to claim 2, 3 or 4, in which the leading end of the tube is provided with two ports.

8. A tube as claimed in claim 5 as appendant to claim 2, in which the tapered end portion of the tube is formed as a spiral.

9. A tube as claimed in any preceding claim, in which the terminal orifice is inclined to the axis of the tube.