DE102018113154A1 - Endotrachealtubusadapter - Google Patents

Abstract

Endotracheal tube adapter (1) having a volume (2) accessible via at least three ports (3, 4, 5, 6) of the endotracheal tube adapter (1), the endotracheal tube adapter (1) being connected to an endotracheal tube (3) via a third port (5). 7) adapted for endotracheal insertion into a patient; wherein a first connection (3) has a first sealing means (8), so that a first catheter (9) can be inserted into the volume (2) via the first connection (3) sealed against an environment (10).

Description

The present invention is in the field of respiration of patients and their examination and treatment in the respiratory tract.

The main object of the present invention is to make the ventilation of a patient safer and to provide suitable devices and methods therefor.

An important aspect of patient ventilation is generally the safety of the patient. In conventional ventilation systems, there is a risk that builds up in the lungs at largely or completely displaced airways too high pressure. Although it is easily possible to measure the pressure in the line of a breathing tube or catheter, the reading available there is not sufficiently representative of the actual pressure in the lungs. For example, if tissue obstructs the aspiration of gas from the lung, but not the supply of gas (air, oxygen, and sometimes other gas), the pressure in the lung increases, although the measurement in the conduit results in a low pressure.

The object of the present invention is therefore the provision of devices and methods which enable safe ventilation of a patient, in particular during an examination or operation.

To solve this problem an endotracheal tube adapter according to claim 1. Further advantageous embodiments and applications are given in the dependent claims. It should be noted that the features listed individually in the claims can be combined with each other in any technologically meaningful manner and define further embodiments of the invention. In addition, the features specified in the claims are specified and explained in more detail in the description, wherein further preferred embodiments of the invention are shown.

An endotracheal tube adapter is proposed. The endotracheal tube adapter has a volume accessible via at least three ports of the endotracheal tube adapter, the endotracheal tube adapter being connectable via a third port to an endotracheal tube suitable for endotracheal insertion into a patient. A first connection of the endotracheal tube adapter has a first sealing means, so that a first catheter can be introduced into the volume via the first connection sealed against an environment (and, if appropriate, can be arranged to be displaceable relative to the first connection along a longitudinal axis of the first catheter).

In particular, a second connection has a second sealing means, so that a second catheter can be introduced into the volume via the second connection which is sealed relative to an environment (and can optionally be arranged displaceably along a longitudinal axis of the second catheter relative to the second connection).

In particular, the first catheter and / or the second catheter is removable from the respective port (eg for cleaning or replacement).

A fourth connection is designed in particular suitable for the connection of a valve and / or a ventilator.

An endotracheal tube or respiratory tube is a respiratory aid in the anesthesia, intensive care and emergency medicine field, which is inserted via endotracheal intubation. Such a tube usually consists of a thin, open at both ends tube forming a lumen. A cuff can be arranged shortly above a distal opening or a distal end (that is to say between a proximal end and a distal end) and can be inflated or reduced again via a further lumen. The cuff, when inflated, can seal the trachea so that air leakage from the lung past the endotracheal tube can be prevented. Thus, a build-up of pressure in the lungs (via a supply and possibly removal of respiratory gases) is made possible exclusively via the endotracheal tube adapter). Furthermore, a surgical environment external to the patient may be protected from contaminants that might be from the patient's airways. Furthermore, the cuff can prevent the tube from contacting the respiratory tissue, thereby damaging the airway.

At the proximal end of the endotracheal tube has a (in particular normalized) connector, via which the endotracheal tube is connectable to the third port.

In particular, the endotracheal tube adapter is intended to simplify the ventilation of a patient and to combine several measures required for ventilation in one component. For this purpose, the endotracheal tube adapter has a volume that connects at least three connections to one another in terms of fluid technology. In particular, the first port and the second port are arranged so that a catheter (general name for a hose or a tube having at least one lumen) or z. Legs Pressure measuring device extend through these connections and in each case through the third port and thereby within the volume kinking of the catheter (with reduction of a flow-through cross section of the respective lumen of the catheter) or buckling of a pressure measuring device is prevented. Furthermore, the introduction of catheters or lumens or a pressure measuring device is simplified by the endotracheal tube adapter, since these are now guided through the endotracheal tube adapter or the endotracheal tube and do not contact the tissue of the respiratory tract (at least initially).

In particular, ventilation of the patient takes place via one of the connections. In particular, a pressure measurement of the airways takes place via a (other or the same) connection or a catheter introduced into the endotracheal tube adapter or a pressure measuring device.

The pressure measurement can take place via a lumen, but also via a cable, a pressure measuring line, a wire or the like (a pressure measuring device), wherein the pressure measuring device extends into the endotracheal tube adapter via the one connection.

In particular, a further connection for secretion suction from the respiratory tract or for connecting an alternative ventilator is provided.

The endotracheal tube adapter thus makes it possible, in particular, to connect different ventilators with the respiratory passages of a patient in a simple manner.

In particular, a pressure measurement can be carried out via the first catheter or via the pressure measuring device. In particular, a secretion suction can be carried out via the second catheter. Ventilation of a patient is preferably possible via the first catheter as an alternative or in addition to the pressure measurement (at least supply of a guest flow, in particular also controlled removal of a gas flow, so that a patient exclusively via the first catheter or a lumen of the first catheter with a gas flow (z B. breathing air, oxygen or the like) can be ventilated (ie fluid connection of all respiratory tract with an area outside the patient exclusively via the first catheter).

In particular, the endotracheal tube assembly further comprises a pressure sensor, in particular designed as part of the pressure measuring device or the pressure measuring lumen of the first catheter, via which a varying pressure (in the airways) with an accuracy of less than two mbar [millibar], in particular less than one mbar , preferably less than 0.5 mbar, is measurable.

Preferably, the pressure sensor can detect and signal a changing pressure with a time delay of at most 50 ms [milliseconds], in particular at most 30 ms, preferably at most 10 ms.

In particular, no conversion or adjustment of the measured values of the pressure, eg. B. in a control unit, required. This can be achieved in particular by detecting the pressure as independently as possible from a change in the volume flow. In particular, a supply and removal of a respiratory gas is proposed here, wherein on the one hand during delivery and on the other hand during the discharge a very constant volume flow is set, these two flow rates preferably have only a small deviation from each other. It is further proposed that the pressure is measured via a pressure measuring device or pressure measuring lumen independent of the ventilation or ventilation lumen.

In particular, a ventilation of the patient can be precisely controlled via the pressure sensor. Due to the accurate measurement of the pressure (and the small time delay between the measurement signal and pressure curve), the ventilation can be controlled so that damage to the respiratory tract is at least reduced or possibly completely prevented.

In particular, a pressure of the respiratory tract can be measured via the pressure sensor, with a gas being supplied to the respiratory tract or being removed from the respiratory tract. The pressure sensor operates in particular over a volume flow range of 0 to 15 liters / minute, in particular from 0 to 25 liters / minute, with the specified accuracy.

In particular, the pressure sensor is arranged at a distal end of the pressure measuring device or the first catheter.

In particular, the (for the pressure measurement provided) first catheter or the pressure measuring device on a marker, so that a user the place of pressure measurement (ie the end of the first catheter or the distal end of the pressure measuring device) in relation to the distal end of the Endotrachealtubusadapter can determine connected Endotrachealtubus or the first catheter or the pressure measuring device relative to the first port can move accordingly far.

In particular, the marking on the first catheter or on the compensated Pressure measuring device, a length of Endotrachealtubusadapters between the proximal end and the distal end (possibly including a beveled distal end, so that a pressure sensor is always located within the Endotrachealtubus). In this way, the marking on the first catheter or on the pressure measuring device could be compared directly with a length of the endotracheal tube (that is to say without the endotracheal tube adapter).

In particular, at least one sealant (possibly both sealant) is designed so that the volume is sealed against an environment. Sealed means that a fluid exchange via the sealant (at the intended pressure conditions) is not possible. In particular, at least one sealing means is designed so that the respective catheter or a pressure measuring device relative to the sealing means is displaceable without the sealing means loses its sealing effect.

Preferably, at least one sealing means (possibly both sealing means) is designed so that there is a frictional resistance, by means of which an unintentional displacement of the catheter or the pressure measuring device relative to the seal is prevented.

There is further proposed an endotracheal tube assembly comprising at least the disclosed endotracheal tube adapter and an endotracheal tube having a distal end and a proximal end. The endotracheal tube is connected to the third port via the proximal end. The endotracheal tube assembly further includes a first catheter extending through the first port into the volume (and, if desired, slidably disposed along a longitudinal axis of the first catheter opposite the first port).

In particular, the endotracheal tube assembly includes a second catheter extending through the second port into the volume (and, if desired, slidably disposed along a longitudinal axis of the second catheter opposite the second port).

In particular, the first catheter at least one pressure measuring lumen or the Endotrachealtubusanordnung on a pressure measuring device, via which a pressure in the region of the distal end (in the airway of a patient) or beyond to outside the endotracheal tube is measurable. In particular, the first catheter or the pressure measuring device can be displaced far beyond the distal end into the respiratory tract of the patient, so that a pressure measurement can take place at a suitable point in the respiratory tract of a patient. Preferably, the first catheter or the pressure measuring device is displaceable only at most to the distal end of the endotracheal tube, so that the pressure measurement takes place within the endotracheal tube. This can prevent contamination of the pressure measuring lumen due to contacting tissue of the respiratory tract.

In particular, the (for the pressure measurement provided) first catheter or the pressure measuring device on a marker, so that a user can determine the location of the pressure measurement (ie the end of the first catheter or the pressure measuring device) in relation to the distal end of the endotracheal tube or the first catheter or the pressure measuring device relative to the first terminal can move accordingly far.

In particular, the first catheter has at least one ventilation lumen via which a gas flow through the first catheter can be conveyed at least as far as the distal end or even beyond the endotracheal tube. In particular, the ventilation lumen has a flow cross-section of at most 35 mm ² [millimeter ² ]. In particular, the ventilation lumen is embodied so stable that a gas flow of at least 10 liters / minute, preferably of at least 15 liters / minute, can be sucked away (ie by application of a negative pressure).

In particular, the first connection has an inner diameter of at most 20 millimeters, in particular of at most 15 millimeters. The inner diameter defines the opening cross-section of the first port, via which volume is accessible from the outside.

In particular, the second catheter has a suction lumen adapted to remove secretion from a region of the distal end or beyond outside the endotracheal tube. In particular, the second catheter may be displaced far beyond the distal end into the respiratory tract of the patient, so that a suction of secretion may take place at a suitable location in the respiratory tract of a patient.

In particular, the second connection has an inner diameter of at most 20 millimeters, in particular of at most 15 millimeters. The inner diameter defines the opening cross-section of the second port, via which volume is accessible from the outside.

In particular, the endotracheal tube adapter has a fourth connection.

The fourth port may be closed by a removable closure. The closure is removable, allowing over the fourth port with the shutter removed, the volume is accessible from the outside.

In particular, at least one valve is arranged at the fourth connection. The valve may alternatively also be arranged on the first connection or the second connection.

Preferably, the at least one valve is a check valve. The check valve in particular allows only a flow through the valve in one direction. In particular, a suction of breathing air through the patient is made possible via the check valve, wherein an outflow of breathing air from the respiratory passages through the check valve is in particular at least impeded (or even prevented).

In particular, the at least one valve is provided to maintain a PEEP (positive end-expiratory pressure) in the airway.

Preferably, the at least one valve is electronically controlled.

In particular, a plurality of valves which have complementary functions can also be arranged at the fourth connection.

In particular, a hand-held ventilation bag may be arranged at the fourth connection, preferably connected to the fourth connection via the at least one valve.

In particular, a ventilator may be arranged at the fourth connection to support the patient's own breathing or to regulate the ventilation of the patient.

In particular, the fourth connection has an inner diameter of at most 20 millimeters, in particular of at most 15 millimeters. The inner diameter defines the opening cross-section of the fourth connection, via which volume is accessible from the outside.

The third port may have an inner diameter of at most 30 millimeters.

In particular, the endotracheal tube adapter extends along an axis (without bending), wherein the third connection and at least one further connection, preferably the second connection, are arranged in particular substantially flush with one another along the axis. In particular, the first connection is arranged at an angle of between 30 and 60 degrees of angle, preferably of 45 degrees of angle, to the axis, preferably inclined towards the second connection.

In particular, the fourth connection is arranged at an angle of 60 to 120 degrees, preferably 90 degrees, to the axis.

In particular, the endotracheal tube adapter may have exactly three or more than three ports.

There is further proposed a method for ventilating a patient via the described endotracheal tube assembly, wherein a pressure of the airway is measured over the first catheter (and a pressure gauge lumen).

In particular, the first catheter has (in addition to or as an alternative to the pressure measuring lumen) at least one ventilation lumen via which ventilation of the patient is carried out.

In particular, a secretion is sucked out of the patient's airway via the second catheter.

In particular, the second catheter can be exchanged at least intermittently, so that instead of the suction of secretion at least temporarily a pressure monitoring or pressure control (eg via a valve to ensure a PEEP) or ventilation via an alternative ventilator (eg Handbeatmungsbeutel or the like) can be done.

In particular, a maximum pressure of the airway is limited via at least one valve arranged on the fourth connection (or on the first or second connection). In particular, the valve can be designed as a safety valve that can prevent at least an overpressure in the airways in which a volume flow can flow out of the airways via the valve. Alternatively or additionally, a negative pressure in the airways via the valve can be prevented, in which the valve opens at a certain suction pressure and a volume flow via the valve is supplied to the respiratory tract.

More specifically, at a first rate of change of pressure of the airway that is less than a limit speed, at least one valve disposed at the fourth port is closed and at a second rate of change of airway pressure greater than a limit speed, the at least one valve opens.

The first catheter in particular has an inflatable cuff.

By means of the inflatable cuff, the first catheter can be sealed against the wall of the trachea or bronchus.

The airway above (i.e., towards the endotracheal tube) of the cuff is then potentially outwardly open, while the airway below (i.e., toward the patient's airway) of the cuff is closed to the outside.

The proposed endotracheal tube adapter or the endotracheal tube arrangement can be used for controlled ventilation with suction-assisted expiration. A pressure measurement in the ventilated lung then creates the possibility of a z. B. on the in WO 2008/113752 A1 to control the described gas flow reversing element based ventilator so that the gas flows to and from the patient with regard to their strength and duration to the respective ventilation situation can be adjusted exactly.

From the WO 2008/113752 A1 a gas flow reversing element is known, which allows the emergency ventilation of a human through a relatively thin lumen. Thus, oxygen can be introduced into the lungs and gas can be sucked out of the lungs in sufficient quantity. The high flow rate in both directions, despite a small lumen diameter, can maintain oxygen supply and carbon dioxide disposal (eg in emergencies).

In particular, ventilation (delivery of respiratory gases into and removal of gases from the respiratory tract) of a patient should be effected exclusively via the endotracheal tube adapter or the endotracheal tube. Preference is also the discharge of gases (at any time) to control. This is made possible in particular by an (artificial) limitation of a maximum volume flow that can flow out of the respiratory tract. The removal of gases is then controlled, allowing accurate pressure measurement.

In particular, this is made possible by the sealing of the respiratory tract via the endotracheal tube adapter (with the sealing means and the closure or valve) or via the endotracheal tube (with the cuff). This sealing to the outside in particular allows a particularly accurate pressure measurement both with regard to a currently existing pressure and to a pressure curve.

In particular, the endotracheal tube adapter has a volume of not more than 50 milliliters, preferably not more than 25 milliliters, particularly preferably not more than 15 milliliters, limited by the connections or the sealing means. The volume is in particular at least 5 milliliters.

In particular, the maximum volume flow in the discharge of gases should not exceed the maximum volume flow during the supply of gases (or at most by 20%). Preferably, during the supply or during the removal of gases (that is, except the changeover between removal and supply), the smallest possible change in the volume flow (ie, volume per unit time) should take place. Accurate control of the ventilation is again possible via the exact pressure measurement, so that damage to the respiratory tract can be limited to a possible minimum or even completely prevented.

The details, features and advantageous embodiments discussed above in connection with the endotracheal tube adapter can accordingly also occur in the endotracheal tube arrangement and the method described here, and vice versa. In that regard, reference is made in full to the statements there for a more detailed characterization of the features.

By way of precaution, it should be noted that the numerical terms used here ("first", "second",...) Primarily (only) serve to distinguish a plurality of similar objects, variables or processes, ie in particular no dependence and / or order of these objects, quantities or mandate processes to one another. If a dependency and / or order are required, this is explicitly stated here or it obviously results for the person skilled in the art when studying the concretely described embodiment.

The invention and the technical environment will be explained in more detail with reference to the figure. It should be noted that the invention should not be limited by the embodiment shown. In particular, unless explicitly stated otherwise, it is also possible to extract partial aspects of the facts explained in the figure and to combine them with other components and findings from the present description.

1 shows an endotracheal tube assembly 16 with an endotracheal tube adapter 1 ,

The endotracheal tube adapter 1 has a volume 2 on that over four ports here 3 . 4 . 5 . 6 of the endotracheal tube adapter 1 is accessible, with the endotracheal tube adapter 1 via a third connection 5 with an endotracheal tube 7 connectable, which is designed for endotracheal insertion into a patient suitable. A first connection 3 of the endotracheal tube adapter 1 has a first sealant 8th on, leaving a first catheter 9 over the opposite of an environment 10 sealed first connection 3 in the volume 2 is insertable (and possibly along a longitudinal axis 11 of the first catheter 9 opposite the first connection 3 slidable can be arranged).

The second connection 4 has a second sealant 12 on, leaving a second catheter 13 over the opposite of an environment 10 sealed second connection 4 in the volume 2 is insertable (and possibly along a longitudinal axis 11 of the second catheter 13 opposite the second connection 4 slidable can be arranged). About the second catheter 13 can z. As a secretion from the respiratory tract. That's the second catheter 13 with a suction lumen 21 executed.

A fourth connection 6 is for connecting a valve 14 and a ventilator 15 suitably executed. The fourth connection 6 can with a closure 22 closed (indicated here).

The endotracheal tube adapter 1 extends along an axis 25 (without bending), with the third connection 5 and the second connection 4 substantially in alignment with each other along the axis 25 are arranged. The first connection 3 is at an angle of about 45 degrees to the axis 25 arranged and thereby to the second connection 4 inclined.

The fourth connection 6 is at an angle of 90 degrees to the axis 25 arranged.

Just above a distal opening or a distal end 17 (ie between a proximal end 18 and a distal end 17 ) is a cuff 24 at the endotracheal tube 7 arranged, which is inflatable or reducible again via a further lumen. At the proximal end 18 indicates the endotracheal tube 7 a (in particular normalized) connector over which the endotracheal tube 7 to the third port 5 is connectable.

Here is about the first catheter 9 and via the pressure measuring device 23 (both extend over the first port 3 in the volume 2 ) a pressure measurement feasible. About the second catheter 13 a secretion suction is feasible. About the first catheter 9 In addition to the pressure measurement, a ventilation of a patient is possible (at least supply of a gas flow, in particular also controlled removal of a gas flow), so that a patient at least temporarily exclusively via the first catheter 9 or a ventilation lumen 20 of the first catheter 9 with a gas stream (eg breathing air, oxygen or the like) can be ventilated.

The first catheter 9 has a pressure measuring lumen 19 and the endotracheal tube assembly 16 a pressure measuring device 23 on, over the or a pressure in the region of the distal end 17 (in the airway of a patient) is measurable. Present is the first catheter 9 or the pressure measuring device 23 only at most to the distal end 17 of the endotracheal tube 7 slidable, allowing the pressure measurement within the endotracheal tube 7 he follows. This can cause contamination of the pressure measuring lumen 19 be prevented as a result of contacting tissue of the respiratory tract.

At the fourth connection 6 is a valve 14 arranged. At the fourth connection 6 and with the fourth connection 6 over the valve 14 Connected is a hand-held breathing bag as a respirator 15 arranged.

LIST OF REFERENCE NUMBERS

1

Endotrachealtubusadapter

2

volume

3

first connection

4

second connection

5

third connection

6

fourth connection

7

endotracheal tube

8th

first sealant

9

first catheter

10

Surroundings

11

longitudinal axis

12

second sealant

13

second catheter

14

Valve

15

ventilator

16

Endotrachealtubusanordnung

17

distal end

18

proximal end

19

Pressure measuring lumen

20

ventilation lumen

21

suction lumen

22

shutter

23

Pressure measuring device

24

Cuff

25

axis

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• WO 2008/113752 A1 [0059, 0060]

Claims (21)

Endotracheal tube adapter (1) having a volume (2) accessible via at least three ports (3, 4, 5, 6) of the endotracheal tube adapter (1), the endotracheal tube adapter (1) being connected to an endotracheal tube (3) via a third port (5). 7) adapted for endotracheal insertion into a patient; wherein a first connection (4) has a first sealing means (8), so that a first catheter (9) can be introduced into the volume (2) via the first connection (4) sealed relative to an environment (10). Endotracheal tube adapter (1) after Claim 1 in which a second connection (4) has a second sealing means (12), so that a second catheter (13) can be introduced into the volume (2) via the second connection (4) sealed relative to an environment (10). Endotracheal tube adapter (1) according to one of the preceding claims, wherein a fourth connection (6) is designed to be suitable for connecting a valve (14) or a ventilator (15). An endotracheal tube assembly (16), comprising at least one endotracheal tube adapter (1) according to any one of the preceding claims, an endotracheal tube (7) having a distal end (17) and a proximal end (18), the endotracheal tube (7) being extended beyond the proximal end (18 ) is connected to the third port (5) and a first catheter (9) extending through the first port (3) into the volume (2). Endotrachealtubusanordnung (16) according to Claim 4 additionally comprising a second catheter (13) extending through the second port (4) into the volume (2). Endotracheal tube assembly (16) according to one of the preceding Claims 4 and 5 wherein the first catheter (9) at least one pressure measuring lumen (19) or the Endotrachealtubusanordnung (16) has a pressure measuring device (23) via which a pressure in the region of the distal end (17) is measurable. Endotrachealtubusanordnung (16) according to Claim 6 additionally comprising a pressure sensor, over which a changing pressure with an accuracy of less than two mbar [millibars] can be measured. Endotrachealtubusanordnung (16) according to Claim 7 wherein the pressure sensor can detect and signal a changing pressure with a time delay of at most 50 ms [milliseconds]. Endotracheal tube assembly (16) according to one of the preceding Claims 4 to 8th wherein the first catheter (9) has at least one ventilation lumen (20) via which a gas flow through the first catheter (9) at least to the distal end (17) or beyond to outside the Endotrachealtubus (7) is conveyed. Endotracheal tube assembly (16) according to one of the preceding Claims 4 to 9 , wherein at least the first catheter (9) relative to the first terminal (3) along a longitudinal axis (11) is displaceable. Endotracheal tube assembly (16) according to one of the preceding Claims 4 to 10 wherein the second catheter (13) has a suction lumen (21) adapted to remove secretion from a portion of the distal end (17) or beyond the endotracheal tube (7). Endotracheal tube assembly (16) according to one of the preceding Claims 4 to 11 wherein the endotracheal tube adapter (1) has a fourth connection (6), wherein the fourth connection (6) is designed to be closed by a closure (22). Endotracheal tube assembly (16) according to one of the preceding Claims 4 to 12 wherein the endotracheal tube adapter (1) has a fourth connection (6), wherein at the fourth connection (6) at least one valve (14) is arranged. Endotrachealtubusanordnung (16) according to Claim 13 wherein the at least one valve (14) is a check valve. Endotracheal tube assembly (16) according to one of the preceding Claims 13 and 14 wherein the at least one valve (14) is electronically controlled. Endotracheal tube assembly (16) according to one of the preceding Claims 4 to 15 wherein the third port (5) has an inner diameter of at most 30 millimeters. A method of ventilating a patient via an endotracheal tube assembly (16) according to any one of the preceding Claims 4 to 16 ; wherein a pressure of the airway is measured via the first catheter (9) or via the pressure measuring device (23). Method according to Claim 17 in that the first catheter (9) has at least one ventilation lumen (20) via which ventilation of the patient is carried out. Method according to one of the preceding Claims 17 and 18 , wherein via the second catheter (13) a secretion is sucked out of the airway of the patient. Method according to one of the preceding Claims 17 to 19 wherein the endotracheal tube adapter (1) has a fourth connection (6), wherein a maximum pressure of the airway is limited via at least one valve (14) arranged on the fourth connection (6). Method according to one of the preceding Claims 17 to 20 wherein at a first rate of change of airway pressure less than a threshold speed, at least one valve (14) located at the third port is closed and at a second rate of change of airway pressure greater than a threshold speed a valve (14) is opened.

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