EP0483305A1 - Procede et dispositif de surveillance et de regulation de la pression dans le manchon de tubes tracheens - Google Patents

Procede et dispositif de surveillance et de regulation de la pression dans le manchon de tubes tracheens

Info

Publication number
EP0483305A1
EP0483305A1 EP91907852A EP91907852A EP0483305A1 EP 0483305 A1 EP0483305 A1 EP 0483305A1 EP 91907852 A EP91907852 A EP 91907852A EP 91907852 A EP91907852 A EP 91907852A EP 0483305 A1 EP0483305 A1 EP 0483305A1
Authority
EP
European Patent Office
Prior art keywords
pressure
cuff
signals
values
correspond
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP91907852A
Other languages
German (de)
English (en)
Inventor
Manfred PFÄNDER
Werner Rainer
Arnold Taber
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Original Assignee
Siemens AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Siemens AG filed Critical Siemens AG
Publication of EP0483305A1 publication Critical patent/EP0483305A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/044—External cuff pressure control or supply, e.g. synchronisation with respiration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0402—Special features for tracheal tubes not otherwise provided for
    • A61M16/0404—Special features for tracheal tubes not otherwise provided for with means for selective or partial lung respiration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A61M16/0454—Redundant cuffs
    • A61M16/0459—Redundant cuffs one cuff behind another
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/105—Filters
    • A61M16/106—Filters in a path
    • A61M16/107—Filters in a path in the inspiratory path

Definitions

  • Inhalation anesthesia with endotracheal intubation and controlled ventilation is carried out by means of anesthetic mixtures of gases and vapors generated in our own mixers.
  • Gas is supplied to the patient through a plastic tube that is inserted into the trachea and connected to a ventilator.
  • the endotracheal tube is provided with an inflatable cuff at its distal end - hereinafter also referred to as the cuff.
  • This cuff is inflated by supplying air through a connecting tube leading to the outside until the tracheal lumen is completely closed above the distal end of the endotracheal tube.
  • the cuff is indispensable in order to avoid incomplete closure of the tracheal lumen with the gas escaping between the wall of the trachea and the cuff wall.
  • the nitrogen oxide (N 2 0) is of great importance and is always more or less present in the gas mixture balanced by the addition of other anesthetic drugs.
  • the cuff is inflated intermittently by an additional connection to the patient ventilator via a control line for controlling the cuff pressure.
  • These relatively complex devices are designed in such a way that the cuff pressure changes constantly in synchronism with the ventilation pressure.
  • a cuff pressure corresponding to the pre-inflation pressure results at a ventilation pressure equal to zero.
  • a further device for limiting the cuff pressure to a maximum value and / or to a minimum value is provided.
  • DE-A-33 27 342 and DE-A-32 04 110 devices are also known for detecting and evaluating the pressure in the balloon cuff of a tracheal tube, which also work with the aid of the ventilator and are equipped with alarm devices which can be switched on when the specified limit values are exceeded or not reached.
  • the cuff is blocked during the inspiration phase until no more escape of inspiration air can be heard.
  • any leaks that may occur - be it due to a loss of elasticity of the trachea in the area of contact with the cuff or due to increased ventilation pressure - must be blocked again, which in turn is done by means of a syringe used for blocking and by ear. Because of this effect, the modern high volume low pressure cuff endotracheal tubes for intubation anesthesia are also considered unsuitable. Additions to the
  • Blocking system with a control mechanism with continuous monitoring or blocking with anesthetic gas mixture or with liquid are said to be unreliable.
  • the proposed rediffusion system for limiting the rise in pressure due to nitrous oxide diffusion provides that the laughing gas diffusing into the cuff diffuses quantitatively into the room air via a correspondingly dimensioned pilot balloon.
  • the nitrous oxide diffusion out of the pilot balloon must be much more efficient than the nitrous oxide diffusion into the cuff.
  • the object of the invention is to provide a device and a method suitable for operating the device in order to avoid exceeding and falling below predetermined limit pressure values in the cuff or in the cuff during the duration of anesthesia, so that the above-mentioned injuries and / or complications or an incomplete closure between the endotracheal tube and the wall of the trachea can be avoided.
  • a device according to the invention for solving this problem and a method for operating such a device are specified in claims 1 and 7, respectively.
  • Advantageous embodiments of the invention are the subject matter of patent claims 2 to 6 and 8. The content of these cited claims is thus also intended to form part of the description.
  • the nitrogen oxide or laughing gas penetrates into all cavities of the organism and also diffuses through the cuff wall.
  • This cuff wall is exposed to the diffusion of nitrogen oxide on the entire lateral surface adjacent to the wall of the trachea and on the ring surface facing the bronchial tubes, while a significantly smaller surface, namely the ring surface facing the glotis, is exposed to air.
  • a cuff pressure of approximately 30 mm Hg on the tracheal wall is already considered to be an impediment to its capillary perfusion. This pressure value should therefore not be reached or exceeded when the cuff is first inflated or during the further course of the anesthesia.
  • an increase in volume / increase in pressure in the cuff can be monitored by means of a manometer, due to the diffusion of e.g. Nitrous oxide in the cuff. Due to the fact that the trachea can hardly be relieved after the initial inflation of the cuff, the anesthetic gas diffusing into the cuff leads to a significant increase in cuff pressure.
  • the device preferably comprises an electronic manometer with a continuous pressure value display, an input for the pressure limit values to be specified, a display which signals the reaching of these limit values acoustically and optically, and at least one motor-driven pump unit, e.g. an electromotive peristaltic pump which is operated as a function of the difference between the limit values and the measured values and thereby keeps the cuff pressure approximately constant within the predetermined limits.
  • a motor-driven pump unit e.g. an electromotive peristaltic pump which is operated as a function of the difference between the limit values and the measured values and thereby keeps the cuff pressure approximately constant within the predetermined limits.
  • the cuff pressure in the cuff (s) is increased or decreased and thus kept within the desired limits.
  • a device has two pressure transducers and two motor-driven peristaltic pumps for connection to endotracheal tubes, such as "Carlens” tubes or the like, which are suitable for separate ventilation of the lungs, equipped with two separate sleeves with their own connecting tubes, and are arranged on a single tracheal tube.
  • endotracheal tubes such as "Carlens” tubes or the like
  • FIG. 1 shows in section an endotracheal tube E inserted into a trachea T with the cuff C not yet inflated, the tracheal lumen not being closed according to the drawing;
  • FIG. 2 shows a representation according to FIG. 1 a trachea T with an inserted tracheal tube E with an inflated cuff (cuff C), ready for use for controlled ventilation of the patient;
  • FIG. 3 shows the endotracheal tube E inserted into the trachea T (shown in section) during the controlled ventilation and showing the diffusion of the anesthetic gas (nitrogen oxide N 2 O);
  • Figure 4 shows an inserted endotracheal tube of the "Carlens” type, which is suitable for separate ventilation of the lungs;
  • FIG. 5 shows a pressure (mm Hg) -time (min.) Diagram which illustrates the typical course of the pressure in the cuff with continued diffusion of the nitrogen oxide pulse;
  • FIG. 6 shows a functional diagram with a control unit of the device according to the invention for monitoring and regulating the cuff pressure, in the embodiment with two pressure transducers and two motor-operated peristaltic pumps.
  • a comparison of the supplied signal with a desired pressure value takes place, which would be determined with a certain hysteresis (eg 1 cm H 2 0).
  • the difference between the two signals (setpoint and actual value) is additionally amplified by an amplifier 12 which is controlled by the multiplexer 5.
  • the output signal of the multiplexer 5 then controls the pump means that can be driven by electric motors M, Ml, for example the peristaltic pumps P, Pl.
  • the polarity of the current flowing from the amplifier 12 will be such that the direction of rotation of the motors M, Ml drives the pumps P, Pl in such a way that they suck in outside air through a filter in order to draw them over the connecting tubes R / Rl, R2 in the cuffs C / Cl, C2 and so the pressure p / pl, p2 to
  • the minimum pressure required for the respective patient to seal the cuff against the trachea is established during intubation in a manner known per se when blocking by means of e.g. generated by a syringe. This for the respective patient
  • 35 th specific pressure is adjustable via the keyboard 13.
  • the pressure value to be entered is determined by means of a pulse generator 11 converted into an analog signal and fed to the following elements of the control unit: d) the input selector 6, then the A / D converter 7 and then the display 8; e) the window comparator 9, in which the supplied signal
  • the alarm logic unit 16 has five inputs:
  • an alarm for negative pressure is provided if the pressure p / pl, p2 in the cuffs C / Cl, C2 is less than the lower limit value entered on the keyboard 13 (for example in the case of volume shrinkage in the cuffs due to cuff damage or cardiosurgical ones Intervene with the heart-lung machine, whereby the use of anesthetic gas may be temporarily interrupted, which results in the anesthetic gas diffusing from the cuff into the environment and thus a lowering of the cuff pressure).
  • an alarm in the event of overpressure is provided in the invention if the cuff pressure p / pl, p2 exceeds the upper limit value entered on the keyboard 13 (for example caused by an ongoing diffusion of the anesthetic gas into the interior of the cuff). .
  • the alarm logic switching element 16 sends out a signal i which acts on the amplifier 12 and thus interrupts the operation of the motors M, Ml and thus stops the pneumatic part of the device according to the invention. After determining and eliminating the causes that led to the triggering of the warning, this operating state is canceled again by actuating a special switching element on the keyboard 13.
  • a digital-to-analog converter 10 is arranged between the pulse generator 11 and the window comparator 9 or the input selector 6 for signal conversion.
  • A denotes an arrow for identifying the ventilation gas supply (anesthetic gas supply) through the tube.
  • the arrows AI and A2 indicate the anesthetic gas flows to the lungs.
  • the lung-side tube openings are designated by the reference symbols L / L1, L2.
  • the arrow indicates the direction of diffusion of the anesthetic gas into the cuff.
  • the arrow sl marks the direction of diffusion of the anesthetic gas from the cuff.
  • the area s indicates the contact area of the cuff on the inner wall of the trachea.

Landscapes

  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Emergency Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)
  • Measuring Fluid Pressure (AREA)

Abstract

Un procédé et un dispositif permettent de surveiller (14, 15) électroniquement et d'égaliser la pression à l'intérieur du manchon (cuff) de tubes endotrachéens, afin d'obtenir une respiration artificielle contrôlée pendant l'anesthésie par inhalation au moyen de gaz qui se diffusent, par exemple de l'oxyde nitreux (N2O) ou des mélanges de gaz contenant des composants gazeux qui se diffusent. L'impulsion du convertisseur de pression (1, 2) relié aux manchons des tubes est amplifiée de manière appropriée (3, 4), parvient à un multiplexeur analogique (5), est conduite de celui-ci jusqu'à un commutateur logique d'alarme (16) et est affichée sur un dispositif d'affichage numérique (8). Des électromoteurs (M, M1) sont entraînés dans l'un ou l'autre sens de rotation au moyen d'un circuit comparateur à fenêtre (comparateur à fenêtre 9) procédant à l'évaluation (12) de la différence entre des valeurs de mesure et des valeurs limites, de sorte que des pompes (P, P1) provoquent l'augmentation ou la diminution requises de la pression (volume) dans les manchons afin de maintenir la pression dans les manchons dans les limites voulues.
EP91907852A 1990-04-24 1991-04-23 Procede et dispositif de surveillance et de regulation de la pression dans le manchon de tubes tracheens Withdrawn EP0483305A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT4817A IT1241932B (it) 1990-04-24 1990-04-24 Dispositivo per la misurazione ed il controllo della pressione allo interno della cuffia di tubi da anestesia generale con intubazione endotracheale e ventilazione meccanica
IT4817 1990-04-24

Publications (1)

Publication Number Publication Date
EP0483305A1 true EP0483305A1 (fr) 1992-05-06

Family

ID=11114264

Family Applications (1)

Application Number Title Priority Date Filing Date
EP91907852A Withdrawn EP0483305A1 (fr) 1990-04-24 1991-04-23 Procede et dispositif de surveillance et de regulation de la pression dans le manchon de tubes tracheens

Country Status (3)

Country Link
EP (1) EP0483305A1 (fr)
IT (1) IT1241932B (fr)
WO (1) WO1991016097A1 (fr)

Families Citing this family (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE4222220A1 (de) * 1992-07-07 1994-01-13 Deutsche Aerospace Verfahren zur Messung und Regelung des Druckes in der Dichtmanschette eines Trachealtubus
US5342298A (en) * 1992-07-31 1994-08-30 Advanced Cardiovascular Systems, Inc. Automated fluid pressure control system
KR100971118B1 (ko) * 2008-06-25 2010-07-20 연세대학교 산학협력단 석션기능이 있는 기침 보조장치
US8448636B2 (en) 2008-12-31 2013-05-28 Manu B. Singh Methods and apparatus for safe application of an intubation device

Family Cites Families (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4285340A (en) * 1979-03-16 1981-08-25 Gezari Walter A Apparatus for controlling the pressure in a tracheal cuff
DE3204110C2 (de) * 1982-02-06 1984-08-02 Gerhard Dr.med. 7800 Freiburg Meuret Trachealtubus zur künstlichen Beatmung und Respirator zum Anschluß an diesen Tubus
DE3327342A1 (de) * 1983-07-29 1985-02-07 Peter 7800 Freiburg Pedersen Vorrichtung zur erfassung und auswertung des druckes in der ballonmanschette eines geschlossenen trachealtubus
DE3435900A1 (de) * 1984-09-29 1986-04-10 Siemens AG, 1000 Berlin und 8000 München Einrichtung zum intermittierenden aufblasen eines cuffs fuer ein patienten-beatmungsgeraet
DE3629126A1 (de) * 1986-08-27 1988-03-10 Draegerwerk Ag Druckueberwachungsvorrichtung fuer eine atmungsvorrichtung

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See references of WO9116097A1 *

Also Published As

Publication number Publication date
IT9004817A0 (it) 1990-04-24
IT1241932B (it) 1994-02-01
IT9004817A1 (it) 1991-10-24
WO1991016097A1 (fr) 1991-10-31

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