US20200178780A1 - Video Laryngoscope Systems - Google Patents
Video Laryngoscope Systems Download PDFInfo
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- US20200178780A1 US20200178780A1 US16/792,565 US202016792565A US2020178780A1 US 20200178780 A1 US20200178780 A1 US 20200178780A1 US 202016792565 A US202016792565 A US 202016792565A US 2020178780 A1 US2020178780 A1 US 2020178780A1
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- laryngoscope
- blade
- intubation
- imaging unit
- patient
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- 238000002627 tracheal intubation Methods 0.000 claims abstract description 67
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- 238000002576 laryngoscopy Methods 0.000 description 7
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- 210000003437 trachea Anatomy 0.000 description 4
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- 239000002023 wood Substances 0.000 description 4
- 210000003238 esophagus Anatomy 0.000 description 3
- 210000003800 pharynx Anatomy 0.000 description 3
- 238000010586 diagram Methods 0.000 description 2
- 210000002409 epiglottis Anatomy 0.000 description 2
- 238000005286 illumination Methods 0.000 description 2
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- 210000002396 uvula Anatomy 0.000 description 2
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- 230000028327 secretion Effects 0.000 description 1
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00002—Operational features of endoscopes
- A61B1/00039—Operational features of endoscopes provided with input arrangements for the user
- A61B1/00042—Operational features of endoscopes provided with input arrangements for the user for mechanical operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00002—Operational features of endoscopes
- A61B1/00039—Operational features of endoscopes provided with input arrangements for the user
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00002—Operational features of endoscopes
- A61B1/00043—Operational features of endoscopes provided with output arrangements
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- A61B1/0005—Display arrangement combining images e.g. side-by-side, superimposed or tiled
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- A61B1/00002—Operational features of endoscopes
- A61B1/00043—Operational features of endoscopes provided with output arrangements
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- A61B1/00052—Display arrangement positioned at proximal end of the endoscope body
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- A—HUMAN NECESSITIES
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00163—Optical arrangements
- A61B1/00174—Optical arrangements characterised by the viewing angles
- A61B1/00181—Optical arrangements characterised by the viewing angles for multiple fixed viewing angles
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/045—Control thereof
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
- A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
- A61B1/051—Details of CCD assembly
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- A—HUMAN NECESSITIES
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- A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
-
- 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
- A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
Definitions
- the present disclosure is directed toward video laryngoscope systems.
- Video laryngoscopy for assisting tracheal intubation is a commonplace medical procedure alongside traditional direct view laryngoscopy and indirect view laryngoscopy using optical view tubes. Tracheal intubation can be further facilitated by the use of a video stylet in conjunction with a video laryngoscope.
- Video laryngoscopy includes a handheld video laryngoscope and a display screen for instantaneously displaying an anatomically defined sequence of progressively imaged physiological structures during the manipulation of a laryngoscope blade from an initial blade insertion into a patient's mouth to a final blade position for assisting tracheal intubation.
- the anatomically defined sequence of progressively imaged physiological structures includes the following intubation significant landmarks: (1) the tongue and uvula, (2) the epiglottis, (3) the posterior cartilages and interarytenoid notch, (4) the glottic opening, and (5) the vocal cords.
- a laryngoscope including a handle, a blade holding element, a detachable blade, means for viewing the laryngeal inlet of a patient and means for adjusting the viewing field.
- the Patel disclosure discloses the laryngoscope is configured to be usable with at least two different detachable blades including inter alia straight blades, curved blades, and so-called difficult intubation blades.
- Patel paragraph [0013] discloses a blade holding element with a multi-camera system including two adjacent fixed cameras directed to two different viewing fields and intended to be used with different blades. Patel paragraph [0013] also discloses means for switching from one camera to the other so that a clinician may select to use the first camera for when the laryngoscope is fitted with a standard blade and the second camera when a difficult intubation blade is used.
- Patel paragraph [0014] discloses a blade holding element with a single movable or tiltable camera and mechanical or electronic means for remotely changing the position of the camera for positioning in a desired position to provide a clear, non-distorted view of a patient's laryngeal inlet.
- U.S. Pat. No. 5,800,344 to Wood, Sr. et al, discloses a video laryngoscope having an image sensor assembly mounted thereon for providing video imaging of a patient's airway passage.
- the Wood disclosure discloses a fixed position image sensor and an image sensor assembly slidably mounted on a track formed on a curved section of a laryngoscope body so that sliding of the image sensor assembly along the track adjusts the distance of the assembly from a target and the orientation angle of the image sensor assembly.
- U.S. Pat. No. 8,398,545 to Chen et al. discloses a video laryngoscope with a movable image capturing unit similar to the Wood disclosure.
- the Chen disclosure discloses a laryngoscope with a side mounted display and also a laryngoscope with an external display for reducing the volume and size of the laryngoscope.
- U.S. Pat. No. 8,652,033 to Berci et al. discloses a video intubation system that provides multiple streams to be simultaneously presented to a user.
- a video laryngoscope provides a first image stream and a video stylet provides a second image stream.
- the two image streams may be presented to the user on two different side-by-side monitors or a single monitor provided with a split screen.
- the video intubation system presents a user with a view of the upper portion of a patient's anatomy via the laryngoscope as well as being presented with a view in front of the video stylet as the stylet is advanced through the trachea.
- US Patent Application Publication No. US 2012/0116156 to Lederman discloses a medical device includes a tube, at least one imaging sensor coupled to an endoscope in the tube, and a monitor application to monitor positioning of the tube in a medical patient by identifying expected anatomical features in images provided by the at least one sensor.
- the Lederman disclosure also discloses a method for endotracheal intubation including receiving imaging frames from a sensor located in an endotracheal tube inserted through a patient's and processing the image frames to identify progression of anatomical features consistent with a proper placement of the endotracheal tube.
- the Lederman disclosure discloses image processing to identify vocal cords, trachea, the esophagus, carina, and the like.
- the present invention is directed toward video laryngoscope systems including an image capture module with at least two stationary imaging units longitudinally deployed along a laryngoscope blade for generating a corresponding number of different real-time video streams during manipulation of a laryngoscope blade from an initial blade insertion into a patient's mouth to a final blade position for assisting intubations of patients.
- the present invention is based on the notion that a clinician performing an intubation will be assisted by the ability to select at least one real-time video stream from at least two different real-time video streams at a series of continuous locations of a laryngoscope blade along a patient's airway passage to orient the location of a laryngoscope blade tip in the patient's airway passage and recognize the aforesaid intubation significant landmarks.
- the video laryngoscope systems of the present invention include a controller for controlling operation of the imaging module including inter alia real-time video display during intubation procedures, real-time video recording of intubation procedures, and the like.
- the controller preferably includes user controls which can be readily operated by a clinician performing an intubation, for example, for selecting which one or more real time video streams he wants to be view at a particular instance on a display screen.
- user controls can be preferably provisioned on a laryngoscope handle for finger/thumb operation during an intubation.
- video laryngoscope systems of the present invention can include touch display screens for touch screen operation similar to a smartphone.
- one or more real time video streams can be displayed on a display screen in accordance with a default setup which can be overridden by a clinician.
- the video laryngoscope systems of the present invention can include image processing software for processing the captured real time video streams prior to their display as disclosed in inter alia the aforementioned Lederman disclosure, the aforementioned Qui disclosure, and the like.
- image processing software for processing the captured real time video streams prior to their display as disclosed in inter alia the aforementioned Lederman disclosure, the aforementioned Qui disclosure, and the like.
- processing includes inter alia improving contour definition, improving boundary definition, automatic recognition of intubation significant landmarks, and the like.
- the video laryngoscope systems of the present invention preferably employ conventional imaging units.
- imaging units preferably include an illumination source, for example, a LED, and the like, for illuminating a patient's airway passage during intubation.
- imaging units include a digital imaging sensor, for example, a CCD, a CMOS chip, and the like.
- the laryngoscope blades can be provisioned with anti-fogging arrangements for preventing fogging of the digital imaging sensors.
- One or more of the digital imaging sensors can be tiltable similar to the aforementioned Patel disclosure.
- the video laryngoscope systems of the present invention can include mechanical or electronic means for remotely changing the tilt of a tiltable digital imaging sensor for positioning in a desired position.
- the video laryngoscope systems of the present invention can include a laryngoscope mounted display screen similar to the aforementioned Chen disclosure or an external display screen similar to the aforementioned Berci disclosure.
- Laryngoscope mounted display screens can be mounted to enable traditional direct view laryngoscopy as well as video laryngoscopy.
- laryngoscope mounted display screens can be mounted to enable video laryngoscopy only.
- the display screens can display side-by-side image streams similar to aforementioned Berci disclosure.
- the video laryngoscope systems of the present invention can also be used with a video stylet for providing a stylet video stream for display on the display monitor.
- the video stylets can be re-usable items or disposable single use items.
- the clinician can select to display a real time video stream from a video stylet on the display screen either by itself or together with a real time video stream from one of the blade mounted imaging units.
- the present invention can be readily applied to the differing approaches regarding re-usable components and disposable single use components as exemplified in commercially available video laryngoscope systems.
- video laryngoscope systems include inter alia the C-MAC by Karl Storz Endo vision, Inc., Charlton, Mass., USA, the Glidescope by Verathon, and the like.
- disposable single use components include electronic sub-components.
- disposable single use components are employed for sterility purposes only and do not include electronic sub-components.
- the present invention can also be readily applied to disposable laryngoscope blades for detachable attachment to laryngoscope handles.
- the disposable laryngoscope blades can be made from metal or plastic.
- Suitable metal laryngoscope blades are disclosed in commonly assigned U.S. Pat. No. 7,736,304 to Pecherer.
- Suitable plastic laryngoscope blades are disclosed in commonly assigned U.S. Pat. No. 5,879,304 to Shucman et al.
- the video laryngoscope systems of the present invention can be implemented with a wide range of conventional laryngoscope blade shapes and sizes for assisting in regular intubation and so-called difficult intubations.
- the laryngoscope blade shapes include inter alia Miller blades, Macintosh blades, Foregger-Magill blades, and the like.
- the laryngoscope blades can be optionally provided with a guide channel for guiding an endotracheal tube.
- FIG. 1 is a combined pictorial view and block diagram of a video laryngoscope system for use with an endotracheal tube for intubation of a patient;
- FIG. 2 is a pictorial view of a laryngoscope blade including a daisy chain of four imaging units of an image capture module of a video laryngoscope;
- FIG. 3 is an enlarged view of the daisy chain of the image capture module
- FIG. 4 is a schematic diagram showing three Field Of View (FOV) arrangements of the image capture module
- FIG. 5 is a pictorial view of a laryngoscope handle including finger/thumb operated controls.
- FIGS. 6A to 6C show the use of the video laryngoscope system for assisting an intubation of a patient.
- FIGS. 1 to 5 show a video laryngoscope system 100 for use with an endotracheal tube 200 and a video stylet 300 for assisting tracheal intubations of patients.
- the video laryngoscope system 100 is preferably in communication with a healthcare facility computer system 400 including a healthcare facility database 401 for storing computer files 402 .
- the video laryngoscope system 100 can generate patient intubation files compatible with standard Electronic Medical Record (EMR) programs.
- EMR Electronic Medical Record
- the video laryngoscope system 100 can be in wired or wireless communication with the healthcare facility computer system 400 .
- the video laryngoscope system 100 includes a handheld video laryngoscope 101 having a laryngoscope handle 102 and a laryngoscope blade 103 transversely extending from the laryngoscope handle 102 and terminating at a distal laryngoscope blade tip 104 .
- the laryngoscope handle 102 includes a power source 106 preferably in the form of a rechargeable battery and an onboard display screen 107 .
- the laryngoscope blade 103 has an underside blade surface 108 for deploying against a patient's tongue on insertion of the laryngoscope blade 103 into his mouth and an upperside blade surface 109 opposite the underside blade surface 108 .
- the video laryngoscope 101 includes an image capture module 111 including stationary imaging units 112 deployed along the laryngoscope blade 103 at increasing lengths from the distal laryngoscope blade tip 104 .
- the imaging units 112 are each capable of independently and simultaneously generating a real-time video stream of a patient's airway passage during an intubation for selective display on the display screen 107 .
- the video laryngoscope system 100 includes a controller 113 for controlling the operation of the image capture module 111 including inter alia real-time video display during intubation procedures, real-time video recording of intubation procedures, and the like.
- the controller 113 can also control the operation of the video stylet 300 .
- the controller 113 is preferably in wireless communication with the video stylet 300 .
- FIG. 2 shows the upperside blade surface 109 has a stepped configuration for forming an elongated guide channel 114 for supporting an endotracheal tube 200 during an intubation.
- the upperside blade surface 109 includes a major blade surface 116 parallel and opposite the underside blade surface 108 , an upright blade surface 117 generally perpendicular to the major blade surface 116 and an uppermost blade surface 118 generally parallel to the major blade surface 116 and tapering thereto wards.
- the image capture module 111 preferably includes a so-called imaging unit daisy chain 119 of a series of at least two longitudinally spaced apart rigidly mounted imaging units 112 and in this case four imaging units 112 stationary mounted on the laryngoscope blade 103 .
- the imaging unit daisy chain 119 is preferably deployed on the upright blade surface 117 . Alternatively, it can be deployed on the uppermost blade surface 118 as shown in dashed lines.
- the imaging unit daisy chain 119 can be permanently or detachably mounted on the laryngoscope blade 103 .
- FIG. 2 also shows a display screen 107 remote from the video laryngoscope 101 and simultaneously displaying two different real-time video streams captured by two different imaging units 112 .
- each imaging unit 112 includes one or more illumination sources 121 and a digital imaging sensor 122 .
- the digital imaging sensors 122 include inter alia a camera and one or more lenses.
- An exemplary wafer level CMOS camera is the 1.3M pixel camera cube from Kushan Q Technology Ltd which has a maximum diagonal FOV of 66°.
- the imaging units 122 can have the same magnification and Field of View (FOV). Alternatively, the imaging units 122 can have different magnifications and FOVs.
- the image capture module 111 includes at least a pair of imaging units 112 having a leading imaging unit 123 proximate the distal laryngoscope blade tip 104 and a trailing imaging unit 124 behind the leading imaging unit 123 relative to the distal laryngoscope blade tip 104 .
- the length denoted L the trailing imaging unit 124 is behind the leading imaging unit 123 relative to the distal laryngoscope blade tip 104 depends on blade size and is at least 1 cm.
- FIG. 4 shows three exemplary FOV arrangements as follows: First, the imaging units 123 and 124 have a non-overlapping FOV arrangement 126 . Second, the imaging units 123 and 124 have a partially overlapping FOV arrangement 127 . And third, the imaging units 123 and 124 have a fully overlapping FOV arrangement 128 with one FOV within the other FOV.
- the imaging units 123 and 124 can be at different distances from the internal structures of a patient's airway passage that they are imaging at a particular location of the laryngoscope blade 103 therealong during an intubation, the leading imaging unit 123 and the trailing imaging unit 124 image different sized areas of different locations of a patient's airway passage at a particular location of the laryngoscope blade 103 .
- FIG. 5 shows the controller 113 preferably includes finger/thumb operated controls 129 on the video laryngoscope 101 for enabling a clinician performing an intubation to readily operate the controller 113 to select which one or more real-time video streams he wants to view on the display screen 107 during the intubation.
- the finger/thumb operated controls 129 can include inter alia push buttons, rotatable thumbscrews, and the like.
- the display screen 107 can be a touchscreen for touchscreen operation. A clinician can also select to display the real time video stream from the video stylet 300 on the display screen 107 .
- a clinician typically selects to display the real time video stream from the video stylet 300 after the laryngoscope blade 103 is in its final blade position and the clinician has introduced the endotracheal tube 200 along the guide channel 114 thereby obstructing the blade mounted imaging units 112 .
- FIGS. 6A to 6C The use of a video laryngoscope system 100 with a leading imaging unit 123 and a trailing imaging unit 124 is now described with reference to FIGS. 6A to 6C .
- FIG. 6A shows that on initial blade insertion into a patient's mouth, the leading imaging unit 123 obtains a close-up view of the vallecula region of a patient while the trailing imaging unit 124 obtains a view of the patient's uvula and posterior pharynx.
- FIG. 6B shows that as the video laryngoscope 101 is advanced down the patient's airway passage, the views obtained by the imaging units change.
- FIG. 4B shows that as laryngoscope handle 102 is tilted upward, thereby advancing the laryngoscope blade 103 , the leading imaging unit 123 is positioned to obtain a close up view of a patient's vocal cords while the trailing imaging unit 124 is positioned to obtain a view of his interarytrnoid notch.
- FIG. 6C shows that as the laryngoscope handle 102 is further tilted upward, thereby further advancing the laryngoscope blade 103 , the leading imaging unit 123 may be advanced so as to obtain a closer view of vocal cords of the patient, while the trailing imaging unit 124 may be positioned so as to maintain a view of the interarytrnoid notch and the esophagus thereby increasing the certainty of correct endotracheal tube placement.
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Abstract
Description
- This application is a continuation of U.S. patent application Ser. No. 14/891,137, filed on Nov. 13, 2015, which is a National Stage Application of International Application No. PCT/IL2014/050426, filed on May 15, 2014, which claims priority to foreign Israel Patent Application No. IL 226379, filed on May 16, 2013, the disclosures of which are incorporated herein by reference in their entirety.
- The present disclosure is directed toward video laryngoscope systems.
- Video laryngoscopy for assisting tracheal intubation is a commonplace medical procedure alongside traditional direct view laryngoscopy and indirect view laryngoscopy using optical view tubes. Tracheal intubation can be further facilitated by the use of a video stylet in conjunction with a video laryngoscope.
- Video laryngoscopy includes a handheld video laryngoscope and a display screen for instantaneously displaying an anatomically defined sequence of progressively imaged physiological structures during the manipulation of a laryngoscope blade from an initial blade insertion into a patient's mouth to a final blade position for assisting tracheal intubation. The anatomically defined sequence of progressively imaged physiological structures includes the following intubation significant landmarks: (1) the tongue and uvula, (2) the epiglottis, (3) the posterior cartilages and interarytenoid notch, (4) the glottic opening, and (5) the vocal cords.
- Challenges often arise to hinder recognition of progressively imaged physiological structures. For example, recognition of the epiglottis may be hindered owing to its visual similarity to the mucosa of the posterior pharynx, and accumulation of blood, secretions, and/or vomitus in the posterior pharynx. Improper identification of certain landmarks can lead to errors in intubations. For example, if the esophagus and glottic opening are confused, esophageal, rather than tracheal, intubation may occur.
- US Patent Application Publication No. US 2012/0190929 to Patel et al. (hereinafter the Patel disclosure) discloses a laryngoscope including a handle, a blade holding element, a detachable blade, means for viewing the laryngeal inlet of a patient and means for adjusting the viewing field. The Patel disclosure discloses the laryngoscope is configured to be usable with at least two different detachable blades including inter alia straight blades, curved blades, and so-called difficult intubation blades.
- Patel paragraph [0013] discloses a blade holding element with a multi-camera system including two adjacent fixed cameras directed to two different viewing fields and intended to be used with different blades. Patel paragraph [0013] also discloses means for switching from one camera to the other so that a clinician may select to use the first camera for when the laryngoscope is fitted with a standard blade and the second camera when a difficult intubation blade is used.
- Patel paragraph [0014] discloses a blade holding element with a single movable or tiltable camera and mechanical or electronic means for remotely changing the position of the camera for positioning in a desired position to provide a clear, non-distorted view of a patient's laryngeal inlet.
- U.S. Pat. No. 5,800,344 to Wood, Sr. et al, (hereinafter the Wood disclosure) discloses a video laryngoscope having an image sensor assembly mounted thereon for providing video imaging of a patient's airway passage. The Wood disclosure discloses a fixed position image sensor and an image sensor assembly slidably mounted on a track formed on a curved section of a laryngoscope body so that sliding of the image sensor assembly along the track adjusts the distance of the assembly from a target and the orientation angle of the image sensor assembly.
- U.S. Pat. No. 8,398,545 to Chen et al. (hereinafter the Chen disclosure) discloses a video laryngoscope with a movable image capturing unit similar to the Wood disclosure. The Chen disclosure discloses a laryngoscope with a side mounted display and also a laryngoscope with an external display for reducing the volume and size of the laryngoscope.
- U.S. Pat. No. 8,652,033 to Berci et al. (hereinafter the Berci disclosure) discloses a video intubation system that provides multiple streams to be simultaneously presented to a user. A video laryngoscope provides a first image stream and a video stylet provides a second image stream. The two image streams may be presented to the user on two different side-by-side monitors or a single monitor provided with a split screen. The video intubation system presents a user with a view of the upper portion of a patient's anatomy via the laryngoscope as well as being presented with a view in front of the video stylet as the stylet is advanced through the trachea.
- US Patent Application Publication No. US 2011/0263935 to Qiu (hereinafter the Qui disclosure) discloses an intubation system for intubations based on an airway pattern indicating a trachea opening. The airway pattern is determined from analysis of airway data detected by a trachea identifying device disposed on a movable guide stylet of the intubation system. Qui FIG. 4 shows a guide stylet 46 with light sources 62, image capture devices 64a and 64b on either side of a laser pointer 70, gas exchange detectors 66 and control cable 68. Qiu para [0050] discloses the image capture devices may be a video camera to continually capture images or a still camera to capture still images. In another example, the image capture devices may be a thermal camera or an infrared camera to capture thermal images.
- US Patent Application Publication No. US 2012/0116156 to Lederman (hereinafter the Lederman disclosure) discloses a medical device includes a tube, at least one imaging sensor coupled to an endoscope in the tube, and a monitor application to monitor positioning of the tube in a medical patient by identifying expected anatomical features in images provided by the at least one sensor. The Lederman disclosure also discloses a method for endotracheal intubation including receiving imaging frames from a sensor located in an endotracheal tube inserted through a patient's and processing the image frames to identify progression of anatomical features consistent with a proper placement of the endotracheal tube. In particular, the Lederman disclosure discloses image processing to identify vocal cords, trachea, the esophagus, carina, and the like.
- The present invention is directed toward video laryngoscope systems including an image capture module with at least two stationary imaging units longitudinally deployed along a laryngoscope blade for generating a corresponding number of different real-time video streams during manipulation of a laryngoscope blade from an initial blade insertion into a patient's mouth to a final blade position for assisting intubations of patients. The present invention is based on the notion that a clinician performing an intubation will be assisted by the ability to select at least one real-time video stream from at least two different real-time video streams at a series of continuous locations of a laryngoscope blade along a patient's airway passage to orient the location of a laryngoscope blade tip in the patient's airway passage and recognize the aforesaid intubation significant landmarks.
- The video laryngoscope systems of the present invention include a controller for controlling operation of the imaging module including inter alia real-time video display during intubation procedures, real-time video recording of intubation procedures, and the like. The controller preferably includes user controls which can be readily operated by a clinician performing an intubation, for example, for selecting which one or more real time video streams he wants to be view at a particular instance on a display screen. Such user controls can be preferably provisioned on a laryngoscope handle for finger/thumb operation during an intubation. Alternatively, video laryngoscope systems of the present invention can include touch display screens for touch screen operation similar to a smartphone. Alternatively, one or more real time video streams can be displayed on a display screen in accordance with a default setup which can be overridden by a clinician.
- The video laryngoscope systems of the present invention can include image processing software for processing the captured real time video streams prior to their display as disclosed in inter alia the aforementioned Lederman disclosure, the aforementioned Qui disclosure, and the like. Such processing includes inter alia improving contour definition, improving boundary definition, automatic recognition of intubation significant landmarks, and the like.
- The video laryngoscope systems of the present invention preferably employ conventional imaging units. Such imaging units preferably include an illumination source, for example, a LED, and the like, for illuminating a patient's airway passage during intubation. Such imaging units include a digital imaging sensor, for example, a CCD, a CMOS chip, and the like. The laryngoscope blades can be provisioned with anti-fogging arrangements for preventing fogging of the digital imaging sensors. One or more of the digital imaging sensors can be tiltable similar to the aforementioned Patel disclosure. Also, the video laryngoscope systems of the present invention can include mechanical or electronic means for remotely changing the tilt of a tiltable digital imaging sensor for positioning in a desired position.
- The video laryngoscope systems of the present invention can include a laryngoscope mounted display screen similar to the aforementioned Chen disclosure or an external display screen similar to the aforementioned Berci disclosure. Laryngoscope mounted display screens can be mounted to enable traditional direct view laryngoscopy as well as video laryngoscopy. Alternatively, laryngoscope mounted display screens can be mounted to enable video laryngoscopy only. The display screens can display side-by-side image streams similar to aforementioned Berci disclosure.
- Also, as similar to the aforementioned Berci disclosure, the video laryngoscope systems of the present invention can also be used with a video stylet for providing a stylet video stream for display on the display monitor. The video stylets can be re-usable items or disposable single use items. The clinician can select to display a real time video stream from a video stylet on the display screen either by itself or together with a real time video stream from one of the blade mounted imaging units.
- The present invention can be readily applied to the differing approaches regarding re-usable components and disposable single use components as exemplified in commercially available video laryngoscope systems. Such commercially available video laryngoscope systems include inter alia the C-MAC by Karl Storz Endo vision, Inc., Charlton, Mass., USA, the Glidescope by Verathon, and the like. In some implementations, disposable single use components include electronic sub-components. In other implementations, disposable single use components are employed for sterility purposes only and do not include electronic sub-components. The present invention can also be readily applied to disposable laryngoscope blades for detachable attachment to laryngoscope handles. The disposable laryngoscope blades can be made from metal or plastic. Suitable metal laryngoscope blades are disclosed in commonly assigned U.S. Pat. No. 7,736,304 to Pecherer. Suitable plastic laryngoscope blades are disclosed in commonly assigned U.S. Pat. No. 5,879,304 to Shucman et al.
- The video laryngoscope systems of the present invention can be implemented with a wide range of conventional laryngoscope blade shapes and sizes for assisting in regular intubation and so-called difficult intubations. The laryngoscope blade shapes include inter alia Miller blades, Macintosh blades, Foregger-Magill blades, and the like. The laryngoscope blades can be optionally provided with a guide channel for guiding an endotracheal tube.
- In order to understand the invention and to see how it can be carried out in practice, preferred embodiments will now be described, by way of non-limiting examples only, with reference to the accompanying drawings in which similar parts are likewise numbered, and in which:
-
FIG. 1 is a combined pictorial view and block diagram of a video laryngoscope system for use with an endotracheal tube for intubation of a patient; -
FIG. 2 is a pictorial view of a laryngoscope blade including a daisy chain of four imaging units of an image capture module of a video laryngoscope; -
FIG. 3 is an enlarged view of the daisy chain of the image capture module; -
FIG. 4 is a schematic diagram showing three Field Of View (FOV) arrangements of the image capture module; -
FIG. 5 is a pictorial view of a laryngoscope handle including finger/thumb operated controls; and -
FIGS. 6A to 6C show the use of the video laryngoscope system for assisting an intubation of a patient. -
FIGS. 1 to 5 show avideo laryngoscope system 100 for use with anendotracheal tube 200 and avideo stylet 300 for assisting tracheal intubations of patients. Thevideo laryngoscope system 100 is preferably in communication with a healthcarefacility computer system 400 including ahealthcare facility database 401 for storing computer files 402. Thevideo laryngoscope system 100 can generate patient intubation files compatible with standard Electronic Medical Record (EMR) programs. Thevideo laryngoscope system 100 can be in wired or wireless communication with the healthcarefacility computer system 400. - The
video laryngoscope system 100 includes ahandheld video laryngoscope 101 having alaryngoscope handle 102 and alaryngoscope blade 103 transversely extending from thelaryngoscope handle 102 and terminating at a distallaryngoscope blade tip 104. The laryngoscope handle 102 includes apower source 106 preferably in the form of a rechargeable battery and anonboard display screen 107. Thelaryngoscope blade 103 has anunderside blade surface 108 for deploying against a patient's tongue on insertion of thelaryngoscope blade 103 into his mouth and anupperside blade surface 109 opposite theunderside blade surface 108. - The
video laryngoscope 101 includes animage capture module 111 includingstationary imaging units 112 deployed along thelaryngoscope blade 103 at increasing lengths from the distallaryngoscope blade tip 104. Theimaging units 112 are each capable of independently and simultaneously generating a real-time video stream of a patient's airway passage during an intubation for selective display on thedisplay screen 107. - The
video laryngoscope system 100 includes acontroller 113 for controlling the operation of theimage capture module 111 including inter alia real-time video display during intubation procedures, real-time video recording of intubation procedures, and the like. Thecontroller 113 can also control the operation of thevideo stylet 300. Thecontroller 113 is preferably in wireless communication with thevideo stylet 300. -
FIG. 2 shows theupperside blade surface 109 has a stepped configuration for forming anelongated guide channel 114 for supporting anendotracheal tube 200 during an intubation. Theupperside blade surface 109 includes amajor blade surface 116 parallel and opposite theunderside blade surface 108, anupright blade surface 117 generally perpendicular to themajor blade surface 116 and anuppermost blade surface 118 generally parallel to themajor blade surface 116 and tapering thereto wards. - The
image capture module 111 preferably includes a so-called imagingunit daisy chain 119 of a series of at least two longitudinally spaced apart rigidly mountedimaging units 112 and in this case fourimaging units 112 stationary mounted on thelaryngoscope blade 103. The imagingunit daisy chain 119 is preferably deployed on theupright blade surface 117. Alternatively, it can be deployed on theuppermost blade surface 118 as shown in dashed lines. The imagingunit daisy chain 119 can be permanently or detachably mounted on thelaryngoscope blade 103. -
FIG. 2 also shows adisplay screen 107 remote from thevideo laryngoscope 101 and simultaneously displaying two different real-time video streams captured by twodifferent imaging units 112. -
FIG. 3 shows eachimaging unit 112 includes one ormore illumination sources 121 and adigital imaging sensor 122. Thedigital imaging sensors 122 include inter alia a camera and one or more lenses. An exemplary wafer level CMOS camera is the 1.3M pixel camera cube from Kushan Q Technology Ltd which has a maximum diagonal FOV of 66°. Theimaging units 122 can have the same magnification and Field of View (FOV). Alternatively, theimaging units 122 can have different magnifications and FOVs. - The
image capture module 111 includes at least a pair ofimaging units 112 having a leadingimaging unit 123 proximate the distallaryngoscope blade tip 104 and a trailingimaging unit 124 behind the leadingimaging unit 123 relative to the distallaryngoscope blade tip 104. The length denoted L the trailingimaging unit 124 is behind the leadingimaging unit 123 relative to the distallaryngoscope blade tip 104 depends on blade size and is at least 1 cm. In view of their longitudinal spaced apart configuration and theimaging units FIG. 4 shows three exemplary FOV arrangements as follows: First, theimaging units non-overlapping FOV arrangement 126. Second, theimaging units FOV arrangement 127. And third, theimaging units FOV arrangement 128 with one FOV within the other FOV. - Based on a particular implemented FOV arrangement and taking into account the
imaging units laryngoscope blade 103 therealong during an intubation, the leadingimaging unit 123 and the trailingimaging unit 124 image different sized areas of different locations of a patient's airway passage at a particular location of thelaryngoscope blade 103. -
FIG. 5 shows thecontroller 113 preferably includes finger/thumb operatedcontrols 129 on thevideo laryngoscope 101 for enabling a clinician performing an intubation to readily operate thecontroller 113 to select which one or more real-time video streams he wants to view on thedisplay screen 107 during the intubation. The finger/thumb operatedcontrols 129 can include inter alia push buttons, rotatable thumbscrews, and the like. Also, thedisplay screen 107 can be a touchscreen for touchscreen operation. A clinician can also select to display the real time video stream from thevideo stylet 300 on thedisplay screen 107. A clinician typically selects to display the real time video stream from thevideo stylet 300 after thelaryngoscope blade 103 is in its final blade position and the clinician has introduced theendotracheal tube 200 along theguide channel 114 thereby obstructing the blade mountedimaging units 112. - The use of a
video laryngoscope system 100 with a leadingimaging unit 123 and a trailingimaging unit 124 is now described with reference toFIGS. 6A to 6C . -
FIG. 6A shows that on initial blade insertion into a patient's mouth, the leadingimaging unit 123 obtains a close-up view of the vallecula region of a patient while the trailingimaging unit 124 obtains a view of the patient's uvula and posterior pharynx. -
FIG. 6B shows that as thevideo laryngoscope 101 is advanced down the patient's airway passage, the views obtained by the imaging units change.FIG. 4B shows that as laryngoscope handle 102 is tilted upward, thereby advancing thelaryngoscope blade 103, the leadingimaging unit 123 is positioned to obtain a close up view of a patient's vocal cords while the trailingimaging unit 124 is positioned to obtain a view of his interarytrnoid notch. -
FIG. 6C shows that as thelaryngoscope handle 102 is further tilted upward, thereby further advancing thelaryngoscope blade 103, the leadingimaging unit 123 may be advanced so as to obtain a closer view of vocal cords of the patient, while the trailingimaging unit 124 may be positioned so as to maintain a view of the interarytrnoid notch and the esophagus thereby increasing the certainty of correct endotracheal tube placement. - While the invention has been described with respect to a limited number of embodiments, it will be appreciated that many variations, modifications, and other applications of the invention can be made within the scope of the appended claims.
Claims (20)
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EP2996539B1 (en) | 2020-10-14 |
EP2996539A4 (en) | 2017-02-08 |
CA2912512A1 (en) | 2014-11-20 |
CA2912512C (en) | 2020-01-07 |
AU2014266805A1 (en) | 2015-12-10 |
AU2014266805B2 (en) | 2017-06-15 |
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EP2996539A1 (en) | 2016-03-23 |
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