MX2008007080A - Endotracheal tube and intubation system including same - Google Patents

Abstract

An endotracheal tube (20) for mechanically ventilating patients is disclosed. The endotracheal tube comprises a distal end (20a) for insertion into the patient's airway (2), past the vocal chords (3), through the subglottal region (4), and into the patient's lung (5);and a proximal end (20b) for connection to a mechanical ventilator (6). The endotracheal tube further comprises a cuff (22) at the distal end of the endotracheal? tube to be located in the subglottal region of the patient below the vocal chords, an inflating lumen (23) for inflating the cuff, and a suction lumen (24) having a suction inlet port (24a) leading from the outer surface of the endotracheal tube, and to be located in the subglottal region, for evacuating secretions and/or rinsing fluid from the subglottal region during the mechanical ventilation of the patient. The distal end of the endotracheal tube is formed with an outer surface configuration (25) effective to prevent blockage of the suction inlet port by the cuff or by tracheal mucosal tissue of the patient during a negative pressure condition in thesuction lumen.

Description

ENDOTRAQUEAL TUBE AND INTUBATION SYSTEM INCLUDING THE SAME DESCRIPTION OF THE INVENTION The present invention relates to endotracheal tubes for mechanically ventilating patients, and also an intubation system including such tubes. In the medical treatment of patients requiring respiratory assistance, it is often necessary to insert an endotracheal tube into the patient's windpipe, through the head or nose, to connect the tube to a ventilator which periodically drives the air into the lungs. through the tube. The inner or distal end of the tube typically consists of an inflatable fold that inflates on contact with the inner wall of the trachea. However, when using such endotracheal tubes, problems arise with respect to bodily secretions that progressively pass between the inner surface of the trachea and the outer surface of the fold. The evacuation of accumulated secretions in the subglottic region above the fold is required to avoid a lung infection associated with the ventilator, commonly called VAP or Ventilator Associated Pneumonia. Attempts have been made in the past to overcome these problems by regulating the crease pressure and / or suctioning secretions from between the wall of the trachea and the endotracheal tube. The removal of such Suction secretions generally require insertion into the subglottic section of an external lumen that has a suction inlet port located above the sealing crease. Another alternative is to use a suction lumen integrally formed in the wall of the endotracheal tube. In any case, the suction lumen is connected to a source of negative pressure, thus expelling the secretions within the subglottic region. However, there is a tendency for the suction lumen to become blocked, particularly during long-term intubation. Attempts have been made to prevent or reduce such blocking of the suction lumen by irrigating the suction channel between successive suctions. However, such attempts have not been successful frequently, thus the patient is subject to an increased risk of lung infection. An object of the present invention is to provide an endotracheal tube, and also an intubation system, which has advantages over what was mentioned in the above. Another object of the invention is to provide such a tube and intubation system which reduces the possibilities of blocking the suction inlet port of the suction lumen, and more effectively evacuates the secretions and / or rinsing fluid from the subglottic region during the mechanical ventilation of the patient.

In studying the problem to be overcome by means of the present invention, it was observed that blocking the suction lumen during mechanical ventilation of the patient is often caused by the movement of a portion of the fold, or by the mucosal tissue of the patient's trachea. , over the suction inlet port during the negative pressure condition in the suction lumen. Accordingly, it was found that by forming the distal end of the endotracheal tube with an outer surface configuration to prevent blockage of the suction inlet port by the fold, or by the mucosal tissue of the patient's trachea, secretions and / or rinsing fluid, could be removed more effectively from the subglottic region during mechanical ventilation of the patient with a danger of reduced blockage of the suction lumen. Therefore, according to one aspect of the present invention, an endotracheal tube is provided for mechanically ventilating patients, including a distal end for insertion into the patient's airway, beyond the vocal cords, through the region. subglottic, and towards the patient's lung; and a proximal end for connection to a mechanical fan; a fold at the distal end of the endotracheal tube and also to be located in the subglottic region of the patient below the vocal cords; an inflation lumen for inflate the fold; and a suction lumen having a suction inlet port leading from the outer surface of the endotracheal tube, and to be located in the subglottic region, to evacuate the secretions and / or rinsing fluid from the subglottic region during mechanical ventilation of the patient; characterized in that the distal end of the endotracheal tube is formed with an effective external surface configuration to prevent blockage of the suction inlet port by the fold, or by the mucosal tissue of the patient's trachea, during a negative pressure condition in the patient. The suction lumen When studying the above problem, it was further observed that the negative pressure exerted by the suction lumen caused the creation of a space delimited between the vocal cords and the upper side of the fold, causing the adhesion of the fold or tissue of the suction port. It was therefore found that by ventilating the subglottic space with an external or integrated lumen, the blocking of the suction inlet port by the fold, or by the mucosal tissue of the patient's trachea and / or the trachea, could be prevented more effectively. secretions, during the mechanical ventilation of the patient. According to other characteristics of the preferred embodiments of the invention described in the following, the endotracheal tube comprises a lumen of ventilation that leads from the external surface of the endotracheal tube and also- to be located in the subglottic region of the patient, to ventilate the subglottic region to the atmosphere to avoid the creation of vacuum within the subglottic space. In accordance with other features in some preferred embodiments, the outer surface configuration of the endotracheal tube includes a protrusion adjacent the suction inlet port and projects radially outwardly from the outer surface of the endotracheal tube into the effective suction inlet port. to prevent such blocking of the suction inlet port. In a described embodiment, the protuberance is formed integrally in the wall of the endotracheal tube as a thickened portion thereof, and in another described embodiment, it has the form of an inflatable element carried by the wall of the endotracheal tube. In the preferred described embodiments, the ventilation lumen is used intermittently to ventilate and to analyze air that escapes from the lungs, particularly CO2, into the subglottic region. In some disclosed embodiments, the proximal end of the suction lumen is constructed for selective connection to a suction source, or to a source of flushing fluid to circulate a flushing fluid through the subglottic region. Therefore, in such embodiments, the suction lumen is also used as the flushing fluid lumen. However, other modalities are described, where separate suction and flushing fluid lumens are provided in the endotracheal tube. Therefore, according to another aspect of the present invention, an endotracheal tube for mechanically ventilating patients is provided, including: a distal end for insertion into the patient's airway, beyond the vocal cords, through the subglottic region, and toward the patient's lung, and a proximal end for connection to a mechanical ventilator; a fold at a distant end of the endotracheal tube to be located in the subglottic region of the patient below the vocal cords; an inflation lumen to inflate the fold; a suction lumen integrally formed in a wall of the endotracheal tube and having a suction inlet port. located to evacuate secretions and / or flushing fluid from the subglottic region during patient ventilation; and a rinse lumen integrally formed in a wall of the tracheal tube and having a flush exit port to be located in the subglottic region of the patient to circulate a flushing fluid through the subglottic region to be removed by the suction lumen.

In the preferred described embodiment, the endotracheal tube further comprises a ventilation lumen integrally formed in a wall of the endotracheal tube and having an air suction inlet located for pumping the air to a CO2 analyzer or for ventilating the subglottic space during the suction of secretions to avoid conditions of vacuum under pressure in the subglottic space. In accordance with other characteristics of that preferred described embodiment, the outer wall of the endotracheal tube further includes at least one recess extending on one side of the suction and flushing lumens from the proximal end of the endotracheal tube to the distal end thereof. located in the subglottic region of the patient, the suction inlet port and the flushing exit port that are located within the recess so as to reduce the possibility of blockage of the suction inlet port by the fold or by the mucosal tissue endotracheal of the patient during a negative pressure condition in the suction lumen. Preferably, the outer wall of the endotracheal tube includes two of the recesses that hang the suction and rinsing lumens, there being a suction inlet port and a rinsing liquid outlet port in each of the recesses.

As will be more particularly described in the following, endotracheal tubes constructed in accordance with the above features more effectively evacuate secretions and / or rinsing fluid from the subglottic region during mechanical ventilation of the patient, and prevent blockage of the suction inlet port by the fold, or by the mucosal tissue of the patient's trachea, during the negative pressure condition in the suction lumen. Other features and advantages of the invention will be apparent from the description in the following. BRIEF DESCRIPTION OF THE DRAWINGS The invention is described herein, by way of example only, with reference to the accompanying drawings, in which: Figure 1 illustrates with diagrams one form of the intubation system of the prior art to which the present invention; Figure 2 is an elongated fragmentary view illustrating the distal end of the endotracheal tube used in the system of Figure 1, and particularly the subglottic region through which the tube passes; Figure 3 is a cross-sectional view along the line III-III of Figure 2; Figures 4 and 5 are fragmentary views illustrating two ways in which the lumen of. suction is frequently blocked during the mechanical ventilation of a patient in this way evacuation of secretions from the subglottic region is avoided; Figure 6 illustrates a construction of the endotracheal tube according to the present invention to prevent blockage of the suction lumen, Figure 7 is a cross-sectional view along the lines VII-VII of Figure 6; Figure 8 illustrates a modification in the construction of the endotracheal tube of Figure 6, particularly at the location of the protrusion preventing the suction inlet port from being blocked; Figure 9 illustrates another modification in the construction of the endotracheal tube, particularly in the nature of the protrusion to prevent blockage of the suction inlet port; Figure 10 illustrates another modification in the construction of the endotracheal tube to include separate suction and rinse fluid lumens; Figure 11 is a flow diagram illustrating the operation of an intubation system using the endotracheal tube of Figures 7 or 8, for example; Figure 12 is a time diagram of the operation illustrated in the flow diagram of Figure 11; Figure 13 is a flow diagram illustrating the operation of an intubation system using the endotracheal tube of Figure 10, which has separate suction and rinse fluid lumens.; Figure 14 is a time diagram of the operation illustrated in the flow diagram of Figure 13; Figure 15 is an elevation view illustrating another endotracheal tube constructed in accordance with the present invention; and Figure 16 is a cross-sectional view along the line XVI-XVI of Figure 15. It is to be understood that the foregoing drawings, and the description in the following, are provided primarily for the purpose of facilitating the understanding of the conceptual aspects of the invention and possible modalities thereof, including what is currently considered to be a preferred embodiment. With the interest of clarity and brevity, no attempt is made to provide more details than necessary to enable one skilled in the art to use his routine experience and design to understand and practice the described invention. Furthermore, it should be understood that the modalities described are by way of example only, and that the invention is capable of having modalities of other forms and applications than those described herein. The Intubation System of Figures 1-5 The preferred embodiments of the present invention described in the following relate primarily to the type of intubation system for mechanically ventilating patients as illustrated in Figures 1-3. Such a system utilizes an endotracheal tube, generally designated 10, having a distal end 10a for insertion into the patient's airways 2, beyond the vocal cords, through the subglottic region 4 and into the lungs 5 of the patient. The proximal end 10b of the endotracheal tube 10 can be connected to a mechanical fan 6, as well as to a large number of control devices as will be described more particularly below. As previously indicated, such endotracheal tubes generally include a main lumen 11 for ventilating the patient, and a fold 12 'at the distal end 10a of the tube to be located in the subglottic region 4 of the patient, below the vocal cords. Such tubes also include an inflation lumen 13 through the tube for inflating the fold by a fold inflator 7 at the proximal end 10b of the tube; and a suction lumen 14 having an inlet port 14a leading from the external surface of the endotracheal tube, and to be located in the subglottic region 4. The suction lumen 14 is connected, at the proximal end 10 of the endotracheal tube, to a suction device 8 or to a vacuum port with a wall to evacuate secretions from the subglottic region during mechanical ventilation of the patient. In one embodiment of the invention described in the following, the subglottic region is also irrigated with a flushing fluid, in which case the suction lumen 14 would be used to evacuate the flushing fluid introduced to the subglottic region as well as the secretions of the subglottic region. In some intubation systems, the proximal end of the suction lumen 14 may be connected either to a suction device 8, or to a monitor 9 for monitoring the composition, particularly the CO 2 content, of the air in the lungs removed by the lumen 14 of suction. Monitoring the composition of exhaled air can be used to control inflation pressure of the fold in order to minimize leakage while at the same time preventing damage to the patient's airway. As previously indicated, secretion evacuation by suction lumen 14 was often made difficult by blocking the suction lumen particularly during long-term intubation. It was found that this was generally caused by the blocking of the suction inlet port 14a either by the fold 12 (as shown). in Figure 4), or by the mucosal tissue of the patient's trachea, as shown in Figure 5, during the negative pressure condition of the suction lumen. Modality of Figures 6 and 7 Figures 6 and 7 illustrate an embodiment of an endotracheal tube, generally designated 20, particularly its remote end 20a, constructed in accordance with the present invention to avoid the above problems. The endotracheal tube 20 includes the main lumen 21, fold 22, and inflation lumens 23 for inflating the fold. It also includes a suction lumen 24 having a suction inlet port 24a leading from the outer surface of the tube and to be located in the subglottic region, as described above with respect to Figures 1-3, to evacuate the secretions and / or flushing fluid of the subglottic region during the mechanical ventilation of the patient. In accordance with the present invention, the distal end 20a of the endotracheal tube 20 is formed with an external configuration effective to prevent blockage of the suction inlet port 24a by the fold 22, or by the mucosal tissue of the patient's trachea, during a condition of negative pressure in the suction lumen. In the embodiment of the invention illustrated in Figures 6 and 7, the outer surface of the endotracheal tube is form with a protrusion 25 adjacent the suction inlet port 24a and projecting radially outwardly from the outer surface of the tube in the section inlet port, so as to be effective to prevent blockage of the inlet port of the tube. suction either by fold 22, or mucosal tissue of the trachea within the patient's airway 2, during a negative pressure condition in the suction lumen. In the embodiment of the invention illustrated in Figures 6 and 7, the protrusion is integrally formed in the wall of the endotracheal tube 20 as a thickened portion thereof and is located in the space between the suction inlet port 24a and the fold 22 Preferably, the protrusion must have a round outer surface projecting radially outwardly from the suction inlet port 24a to prevent blockage of that port either by the fold 22 or by the mucosal tissue of the trachea. The endotracheal tube illustrated in Figures 6 and 7 includes a further feature, ie a ventilation lumen 26 formed integrally with, and extending through, the endotracheal tube wall 20 to vent the subglottic region to the atmosphere. Such a ventilation lumen thereby prevents an undue accumulation of negative pressure within the subglottic region 4 so that the suction inlet port 24a of the suction lumen 24 can blocked by fold 22 or by the mucosal tissue of the trachea. As will be described in the following, the ventilation lumen 26 can also be used to monitor the composition, particularly the CO 2 of exhaled exhaled air evacuated from the subglottic region, similar to the function performed in the prior art by suction lumen 14 and the monitor C02 of Figure 1. • The Mode of Figure 8 Figure 8 illustrates the remote end 30a of another endotracheal tube 30 constructed in accordance with the present invention, which also includes the basic elements described in the above with with respect to Figures 6 and 7, mainly a main lumen 31, a fold 32, an inflation lumen 33, and a suction lumen 34 having a suction inlet port 34a to be located in the subglottic region of the patient. In this case, the distal end of the endotracheal tube is formed with a protrusion 35 located adjacent to, but on the opposite side of the suction inlet port 24a so as to project radially outwardly from the outer surface of the endotracheal tube into the lumen of suction inlet and to be effective to prevent blockage of suction inlet port. The endotracheal tube 30 illustrated in Figure 8 also includes the ventilation lumen 36 formed integrally in the wall of the tube and having a port 36a to be located in the subglottic region 4 to avoid an undue accumulation of a negative pressure within that region during the mechanical ventilation of the patient. As will be more particularly described in the following, and as described above with respect to the ventilation lumen 26 of Figures 6 and 7, the ventilation lumen 36 of Figure 8 can also be used, not only to ventilate the subglottic region. to the atmosphere, but also to analyze the composition, particularly the C02 content, of the exhaled air from the lungs escaping to that region, for example, to control the pressure within the fold 32 in order to produce the contact of the lungs. desired tissue without damaging the surrounding tissue. The Modality of Figure 9 Figure 9 illustrates the far end 40a of another endotracheal tube 40 constructed in accordance with the present invention of structure similar to that described in the above 'with respect to Figure 8. However, in the tube 40 endotracheal of Figure 9, the protrusion, thus generally designated 45, has the shape of an inflatable element or balloon which, when inflated, projects radially outwardly from the outer surface of the tube in the inlet port suction and thus effectively prevents blockage of the inlet port of suction. The inflatable element 45 may have a bubble configuration as shown, or another configuration, for example, annular configuration. In all other senses, the endotracheal tube 40 illustrated in Figure 9 is constructed and used in the same manner as described above with respect to Figure 8. The Modality of Figure 10 Figure 10 illustrates the far end 50a of an endotracheal tube 50 constructed in a manner similar to that of Figures 6 and 7, except that the endotracheal tube of Figure 10 further includes a rinsing lumen 57 for rinsing or irrigating the subglottic region 4. In such a case, the flushing lumen 57 has an exit port 57a communicating with the subglottic region, preferably at the distal end thereof adjacent the fold 52. Thus, by providing the endotracheal tube with a lumen 57 of separate rinse, separated from the suction lumen 54, each lumen can be controlled to maximize its respective function, i.e. to rinse the subglottic region by means of the rinse lumen, and extract the secretions as well as the rinse fluid, from the subglottic region by the suction lumen. Where a separate rinse lumen is not provided, as described above with respect to Figures 5-9, for example, the suction lumen could also be used to rinse the subglottic region, and therefore could be controlled to perform its suction function and rinsing function alternately, as will be described in the following with respect to Figures 11 and 12. In all In other senses, the endotracheal tube 50 illustrated in Figure 10 is constructed in the same manner as described above, to include a main lumen 51, crease 52, inflation lumen 53, suction line 54 having a lumen 54a entrance, 55 protuberance and ventilation 56 lumen. Operation Examples The flow diagram of Figure 11, and the timing diagram of Figure 12, illustrate an example of operation of the endotracheal tube described in the above illustrated in Figures 6-8, where there is no rinse lumen. separate, but the suction lumen is also used to rinse. The flow diagram and time diagram corresponding to Figures 13 and 14 illustrate the corresponding operation of the endotracheal tube where a separate rinse lumen is provided, as illustrated in Figure 9. During both types of operations, the ventilation lumen , for example 26, 36, 46, 56, is used intermittently, alternating to ventilate the subglottic region to the atmosphere, and to measure the C02 content of the exhaled air that escapes from the lungs and discharges from the subglottic region. Therefore, in the case where a separate rinse lumen is not provided (Figures 10 and 11), the suction lumen (for example, 24) is also used for rinsing, and is therefore controlled to perform in a alternating its functions of suction and rinsing as shown in blocks 60-68, Figure 10. The ventilation lumen 26 is also used intermittently, to alternately perform its ventilation function and its CO2 measurement functions. In the example operation illustrated in Figures 11 and 12, it will be noted that the suction stage is accompanied by the ventilation step to prevent the formation of underpressure. As can be seen in step 67 of Figure 11, after the rinsing line connected to the suction lumen 24 has been closed, the ventilation lumen, for example, 26, is used to allow the completion of the stage 68 of measurement. Figures 13 and 14 are corresponding flow and time diagrams illustrating the operation of the endotracheal tube where a separate rinsing lumen is provided as in the case of the rinsing lumen 57 of Figure 10, so that the rinsing can be a continuous operation, while the suction is applied periodically in synchrony with the ventilation operation. As it is shown in the blocks 70-77 of Figure 13, and in the functional time of Figure 14, the CO2 measurement operation is performed, however, between the suction operations and is combined with the ventilation operations. The Modality of Figures 15 and 16 Figures 15 and 16 illustrate an endotracheal tube to include all of the anterior lumens formed as passages through the endotracheal tube wall, generally designated 80. Thus, the endotracheal tube 80 includes a main lumen 81, a fold 82 at the distal end 81a of the tube, an inflation lumen 83 for inflating / deflating the fold, a suction lumen 84 for evacuating secretions and / or rinsing fluid from the subglottic region 4, a lumen 86 for venting the subglottic region to the atmosphere, and a rinse lumen 87 for introducing a rinse or irrigation fluid into the subglottic region. It will be seen from Figure 16 that the suction lumen 84 and the flushing lumen 87 are formed on the same side of the endotracheal tube in radial alignment, and are separated by a division 88 integrally formed with the wall of the endotracheal tube. It will also be seen from Figure 16 that the outer surface of the endotracheal tube 80 is formed with a pair of recesses 85a, 85b extending longitudinally. on opposite sides of suction lumen 84 and rinsing lumen 87. The suction lumen 84 includes two suction inlet ports 84a, 84b, one in each of the two recesses 85a, 85b; similarly, the flushing lumen 87 includes two exit ports 87a, 87b, one in each of the recesses 85a, 85b, to introduce the rinsing fluid into the subglottic region. Therefore, it will be appreciated that the outer surface of the endotracheal tube 80 on the opposite sides of the two recesses 85a, 85b, projects outwardly from the suction inlet ports 84a, 84b, and is therefore effective to prevent blockage of these lumens either by fold 82, or by the mucosal tissue of the patient's trachea, during a condition of negative pressure in the suction lumen. It will also be appreciated that the two flushing fluid outlet ports 87a and 87b of the flushing lumen 87, also formed in the recesses 85a and 85b adjacent the suction inlet ports 84a, 84b, further reduce the possibility of blocking those ports. of entry during the mechanical ventilation of the patient. The endotracheal tube 80 further includes a radio-opaque strip 89 integrally formed in the wall of the tube on the opposite side of the inflation lumen 83. As an example, the endotracheal tube 80 illustrated in Figures 15 and 16 can be made of silicon having a internal diameter of 8 mm, and an outer diameter of 11.5 mm. The Shore Hardness should be available to the maximum. The external diameter of the tube can be increased, but preferably it should not exceed 12.5 mm. Other preferred dimensions appear in the drawings. However, it will be appreciated that other materials could be used, for example, polyvinyl chloride, and that the dimensions could vary according to the requirements of any particular application. While the invention has been described with respect to several preferred embodiments, it will be appreciated that these are merely by way of example, and that many other variations, modifications and applications of the invention can be made.

Claims (15)

1. CLAIMS 1. An endotracheal tube for mechanically ventilating patients, characterized in that it includes a distal end for insertion into the patient's airway, beyond the vocal cords, through the subglottic region, and into the patient's lung; and a proximal end for connection to a mechanical fan; a fold at the distal end of the endotracheal tube to be located in the subglottic region of the patient below the vocal cords; an inflation lumen to inflate the fold; a suction lumen having a suction inlet port that leads from the outer surface of the endotracheal tube, and to be located in the subglottic region, to evacuate secretions and / or rinsing fluid from the subglottic region during mechanical ventilation of the patient; and a ventilation lumen that leads from the external surface of the endotracheal tube and also to be located in the subglottic region of the patient, to ventilate the subglottic region to the atmosphere. The endotracheal tube according to claim 1, characterized in that the proximal end of the suction lumen is constructed for its selective connection to the suction source, or to a source of rinsing fluid for circulating a flushing fluid through the subglottic region. The endotracheal tube according to claim 1, further characterized in that it comprises a separate rinse lumen for connection to a * / * / source of flushing fluid to circulate a flushing fluid through the subglottic region to be removed by the suction lumen. The endotracheal tube according to claim 1, characterized in that the ventilation lumen is constructed for its selective connection to the atmosphere or to an analysis device to analyze the composition of the air escape from the lungs towards the subglottic region. 5. An intubation system, characterized in that it comprises: an endotracheal tube for mechanically ventilating patients, including a distal end for insertion into the patient's respiratory tract, beyond the vocal cords, through the subglottic region, and toward the lung of the patient; and a proximal end for connection to a mechanical fan; a fold at the distal end of the endotracheal tube to be located in the subglottic region of the patient below the vocal cords; an inflation lumen to inflate the fold; and a suction lumen having a suction inlet port leading from the outer surface of the endotracheal tube, and to be located in the subglottic region, to evacuate the secretions and / or rinsing fluid from the subglottic region during mechanical ventilation of the patient, wherein the proximal end of the suction lumen is constructed for its selective connection to a suction source, or to a source of flushing fluid to circulate a flushing fluid through the subglottic region; a suction source that can be connected to the proximal end of the endotracheal tube; a source of flushing fluid that can be connected to the proximal end of the endotracheal tube; a control device for selectively connecting the proximal end of the endotracheal tube to either the suction source or the fluid source of the fluid. 6. The intubation system according to claim 5, characterized in that: the endotracheal tube further comprises a ventilation lumen; The intubation system further comprises an analysis device connected to the proximal end of the ventilation lumen to analyze the escape of air from the lungs to the subglottic region; and the control device also selectively connects the proximal end of the ventilation lumen to the atmosphere or to the analysis device. 7. An intubation system characterized in that it comprises: an endotracheal tube according to claim 3; a suction source connected to the proximal end of the suction lumen; a source of rinsing fluid that can be connected to the proximal end of the rinsing lumen to circulate a rinsing fluid through the subglottic region to be removed by the suction lumen; and a control device for selectively connecting the proximal end of the endotracheal tube to either the suction source or the rinsing fluid source. 8. The intubation system according to claim 7, characterized in that: the intubation system further comprises an analysis device connected to the proximal end of the ventilation lumen to analyze the escape of air from the lungs towards the subglottic region; and the control device also selectively connects the proximal end of the ventilation lumen to the atmosphere or to the analysis device. 9. The endotracheal tube according to claim 1, characterized in that: the suction lumen is integrally formed in a wall of the endotracheal tube; the outer surface of the wall is formed with a recess extending from the suction inlet port to the proximal end of the endotracheal tube; and the suction inlet port is formed in the recess in the outer surface of the endotracheal tube so that the external surface of the endotracheal tube adjacent to the recess projects radially outwardly from the underneath and thereby prevents blockage of the lumen of the endotracheal tube. suction inlet. 10. The endotracheal tube according to claim 9, characterized in that there are two recesses formed in the wall of the external surface of the endotracheal tube on opposite sides of the suction lumen, the suction lumen including a suction inlet port in each one of the two recesses. 11. The endotracheal tube according to claim 10, characterized in that the endotracheal tube it also comprises a rinsing lumen for circulating a rinsing liquid through the subglottic region. The endotracheal tube according to claim 11, characterized in that the suction lumen and the flushing lumen are formed in a radially aligned relationship in a wall of the endotracheal tube between the two recesses and are separated by a division formed integrally in the endotracheal tube wall; and wherein the rinse lumen includes a flushing liquid outlet in each of the two recesses. 13. An endotracheal tube for mechanically ventilating patients, characterized in that it includes: a distal end for insertion into the patient's airway, beyond the vocal cords, through the subglottic region, and into the patient's lung, and a proximal end for connection to a mechanical fan; a fold at the distal end of the endotracheal tube to be located in the subglottic region of the patient below the vocal cords; an inflation lumen to inflate the fold; a suction lumen integrally formed in a wall of the endotracheal tube and having; a suction inlet port located to evacuate secretions and / or rinsing fluid from the subglottic region during patient ventilation; and a flushing lumen integrally formed in a wall of the tracheal tube and having a flush exit port to be located in the subglottic region of the patient to circulate a flushing fluid through the subglottic region to be removed through the lumen of the patient. suction. The endotracheal tube according to claim 13, characterized in that the outer wall of the endotracheal tube further includes at least one recess extending on one side - of the suction and rinsing lumens from the proximal end of the endotracheal tube to the endotracheal tube. Distant end to be located in the subglottic region of the patient, the suction inlet port and the rinsing outlet port which are located within the recess so as to reduce the possibility of blockage of the suction inlet port by the fold or by endotracheal mucosal tissue of the patient during a negative pressure condition in the suction lumen. The endotracheal tube according to claim 14, characterized in that the suction lumen and the flushing lumen are formed in a radially aligned relationship in the wall of the endotracheal tube and are separated by a division formed integrally in the wall.