WO2011022802A1 - Method and device for endobronchial aspiration of secretions - Google Patents

Method and device for endobronchial aspiration of secretions Download PDF

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Publication number
WO2011022802A1
WO2011022802A1 PCT/BR2010/000291 BR2010000291W WO2011022802A1 WO 2011022802 A1 WO2011022802 A1 WO 2011022802A1 BR 2010000291 W BR2010000291 W BR 2010000291W WO 2011022802 A1 WO2011022802 A1 WO 2011022802A1
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WIPO (PCT)
Prior art keywords
aspiration
endobronchial
probe
secretion
bronchi
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PCT/BR2010/000291
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French (fr)
Portuguese (pt)
Inventor
Marcos Pinotti Barbosa
Shirley Lima Campos
Daniel Neves Rocha
Claysson Bruno Santos Vimieiro
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Universidade Federal De Minas Gerais - Ufmg
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Publication of WO2011022802A1 publication Critical patent/WO2011022802A1/en

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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
    • A61M16/0463—Tracheal tubes combined with suction tubes, catheters or the like; Outside connections
    • 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
    • A61M16/0486—Multi-lumen tracheal tubes

Definitions

  • the present invention relates to the development of a technique for aspirating secretions from the lower respiratory tract and a probe for aspiration of these fluids, having the right and left main bronchi as anatomical reference points.
  • Airway aspiration is an important intervention in the care of adult, pediatric and neonatal patients with artificial airways and / or unable to expel respiratory tract secretions voluntarily. It is a routine invasive procedure, essential for airway management and maintenance of its permeability in critically ill patients in intensive care units, or in inpatient, emergency room, operating room units. , health posts, mobile care, home care, among others (Celik, SS; Elbas, NO The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs., 2000; Jun; 16 (3): 191-8; Donald, KJ; Robertson, VJ; Tsebelis, K.
  • the procedure consists of introducing a probe connected to a source of vacuum into an individual's airway to remove secretions from the respiratory tract.
  • the literature recognizes the modalities of naso or oropharyngeal aspiration, in which an aspiration probe is inserted into the nasal cavity or oral cavity towards the pharynx, respectively; nasotracheal tube, in which an aspiration tube is inserted into the nasal cavity toward the trachea; oro or endotracheal tube, in which the tube is inserted into the endotracheal tube or tracheostomy tube towards the trachea and can be performed in open aspiration system where the patient is disconnected from the oxygen source and / or mechanical ventilation during the procedure or in a closed system where mechanical ventilation is not interrupted during aspiration (AARC American Association for Respiratory Care: Clinical Practice Guideline Endotracheal suctioning of mechanically ventilated adults and children with artificial airways Respir Care, 1993; 38: 500-504; Day, T.;
  • subglottic aspiration or drainage is to aspirate the secretion located above the endotracheal tube cuff, specifically into the subglottic space.
  • the procedure is performed by inserting an aspiration probe through the oral cavity, following an endotracheal tube / tracheostomy tube towards the subglottic space or by attaching the vacuum to a dorsal lumen that opens above the cuff.
  • a specific endotracheal tube for performing this type of aspiration (Dezfulian, C; Shojania, K.; Collard, HR; Kim, HM; Matthay, MA; Saint, Sanjay.
  • the technical recommendation consists of: (i) assessing the need and indication of airway aspiration (monitoring the patient); (ii) select and check equipment: vacuum generator system, sterile aspiration probe, sterile and procedural gloves, glasses, mask and apron, sterile tray, saline or sterile water, oxygen release system; (iii) pre-oxygenate and hyperinflate the patient with the use of a hand-held amb ⁇ / resuscitator or mechanical ventilator; (iv) inserting the probe; (v) if necessary, instill sterile saline to assist in secretion removal; (vi) release the vacuum with pressure setting for less than 10-15 seconds; (vii) remove and clean the probe; (viii) re-oxygenate and hyperinflate the patient; (ix) monitor patient and evaluate outcomes (AARC American Association for Respiratory Care: Clinical Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care.
  • the probes are siliconized, generally made of polyvinyl chloride.
  • the probes consist of a proximal head or end (where a vacuum release connector or valve is located), a body (relative to the sterile transparent tube), and a distal or insertion tail or end (represented by the portion). end of the probe body, into which fluid flow holes are concentrated).
  • the number of holes these vary from one to five (mostly three holes) at their insertion end, one being located at the tip (front hole) and the others at the sides (side holes) of this end.
  • a suction valve provided with a chambered body where a selective obstruction device is mounted and a ball valve which allows or not a probe to pass through a patient connection
  • a kit which allows the correct arrangement of the suction device, and also comprises a plastic housing attic and a tube, which represent suitable means for disposing of said device after use.
  • Such patent refers to endotracheal suction, in which the probe is inserted to the level of the trachea.
  • PI9302608-0 deals with a secretion aspiration apparatus consisting of a plastic container coupled to the hermetic occlusion cap by pressure mechanism, from which externally expand nozzles for union with the aspiration probe and for union with the vacuum source and internally expanding nozzles with fenestrated device that ends in bulkhead for retention and collection of secretions.
  • PI9101362-3 deals with a nasopharyngeal tube indicated for nasopharyngeal packing in the presence of bleeding or epistaxis. anterior or posterior, cavum bleeding, postoperative septoplasty, rhinoplasty, polypectomy, nasal biopsy, reduction of nasal fracture of any nature, in the presence of bleeding and other surgical procedures, in addition to polytrauma of the face, with nasal bleeding. It consists of a non-toxic flaccid rubber tubular structure consisting basically of three elements: head, body and tail, having three standard sizes: small, medium and large. Two smaller and larger balloons are attached to the probe body, which adapt to the different measurements of the nostril opening diameter and the nasal cavity space of its users. Patents PI0016691-0, PI9306287-7, W09321984 and
  • US20020179090 refer to different shapes of endotracheal suction probes, the first being on an endotracheal catheter and seal divider assembly with valve; the second is a respiratory support system that includes a suction catheter device, a suction control valve, and a ventilator manifold. The last two deal with the description of the applicability of aspiration probes to perform the procedure maintaining pressurization of the respiratory system, preventing hypoxemia and loss of lung volume.
  • patent PI0307203-7 on the adaptation of heat and moisture exchanger for closed suction catheter assembly and system having a cleaning of improved catheter
  • patent PI0115779-5 on a turbulent air cleaning method and apparatus for catheter assemblies
  • patent PI0115074-0 which deals with an improved closed suction catheter assembly adapter and system containing the same.
  • PI0016353-8 describes an apparatus comprising an endotracheal catheter and an improved valve multipath assembly. It is related to a flap valve or other internal component for use with multiple suction and respiratory suction catheter assemblies. This flap valve or other internal component provides an assembly with an improved mechanism for cleaning the catheter tip without removing excess air from the breathing circuit to which the endotracheal catheter is attached. More specifically, the present invention relates primarily to a closed system endotracheal catheter system that provides improved catheter cleaning while minimizing air drawn from the patient's ventilation circuit by providing at least one protrusion on at least one valve surface. with tab or other internal component.
  • the patent PI9611530-0 deals with a disposable mask that has a suction catheter for exhaled air removal and is not intended for the removal of secretions.
  • PI0203908-7 relates to an orotracheal or nasotracheally positioned endotracheal tube for continuous or intermittent aspiration of short- and long-term intraluminal respiratory secretions and a container for collection of microbiological material and endotracheal continuous aspiration process.
  • Incorporation of a suction probe into the endotracheal tube has also been described in WO 2004071553 and in PI9815297-1.
  • the endotracheal or tracheotomy tube has a central lumen for supplying and conducting respiratory air with an inflatable sealing sheath and an aspiration duct located above or below the sheath and terminating outside the tube.
  • Utility model MU8700394-5 refers to an endotracheal cannula of bibronchial intubation for concomitant intubation of both source bronchi.
  • the bibronchial cannula is introduced until its bronchial branches warm the carina, a final position easily identified by the evident resistance to progression.
  • Double lumen endotracheal tube is used in patients who need different mechanical ventilation modes for each lung and is not characterized as device or suction probe is actually a type of artificial airway with well-defined applicability. Such an intubation system may lead to the risk of occlusion of any of the bronchi.
  • Risks and complications related to endotracheal aspiration include arrhythmias, laryngospasms, mucosal trauma, micro atelectasis, hypoxemia, decreased arterial oxygen saturation, bradycardia and tachycardia, arterial hypertension, increased intracranial pressure, infections, changes in blood pressure. carbon dioxide partial pressure, cyanosis, bronchoconstriction, and cardiac arrest (Guglielminotti, J .; Desmonts, JM; Dureuil, B. Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients. Chest 1998; 1 13: 1335-1338; Moore, T.
  • endotracheal suction probes are simple elements designed to aspirate into the carina region and / or within the artificial airway, restricting themselves to removing accumulated secretions in these areas and / or more fluid secretions that have been displaced from the periphery.
  • the trachea which may not be sufficient to promote respiratory tract hygiene, considerably reducing efficacy and increasing the need for daily procedure repetitions.
  • the need for procedure repetitions should be considered in the context that open-system aspiration probes are disposable and therefore discarded after each procedure, and that closed-system probes are replaced daily or according to hospital routine.
  • the time-efficiency and time-to-procedure ratios per patient should also be considered.
  • the aspiration probe must be designed and designed to optimize the efficiency of the procedure. If the procedure does not present a satisfactory efficiency, that is, after the aspiration is performed, it is verified by the clinical evaluation that there is still persistence of secretion in the patient's respiratory system due to the inability to remove the accumulated secretion volume, the health professional should repeat the procedure. respecting a sufficient interval for the return to baseline clinical conditions and complete recovery of the patient, which increases the time devoted by the professional to perform the aspiration in its entirety. Therefore, the development of new methods and new probes that increase aspiration efficiency is of great value to this health area.
  • Another limitation of the conventional technique is that it does not allow selective aspiration for only one lung for patients with unilateral lung disease whose secretion accumulation occurs in a specific lung.
  • the conventional probe has a single tube and aspiration is performed by the endotracheal method, ie the end of the probe is at trachea height and above the carina, aspiration removes only the volume of spare secretion that has been displaced to the region. of the carina and interior of the endotracheal tube / tracheostomy tube, not ensuring bronchial hygiene. Additionally, this method aspirates air volume from both lungs, reducing lung volume bilaterally. Solution to prior art problems
  • the present invention aims to present the method and the endobronchial aspiration probe for secretions.
  • the invention proposes a method for aspirating secretions from the lower respiratory tract, having as source anatomical points the source bronchi, i.e. the right and left main bronchi.
  • the source bronchi i.e. the right and left main bronchi.
  • aspiration of secretions would occur at the endobronchial level.
  • the endobronchial aspiration method aims to increase the efficiency of the aspiration procedure.
  • the invention of said method and specific probe is based on the assumption that certain volumes of pulmonary secretion remain lodged in the main bronchi even after endotracheal aspiration because they cannot be moved to the carina or into the artificial airway.
  • the endobronchial aspiration method of airway aspiration is to introduce a specific endobronchial aspiration tube into the subject's airway for suction of biological fluids from the lower respiratory tract.
  • the procedure may be performed in patients by nasal or oral insertion of the probe and in patients using endotracheal tube or tracheostomy tube, coupling the probe to the hospital vacuum network or portable aspiration devices in various environments ( outpatient, home and others).
  • endotracheal tube / tracheostomy tube will be inserted into this airway until the The probe body is correctly positioned within the endotracheal tube / tracheostomy tube, allowing the healthcare professional to decide, as the case may be, whether the negative pressure released by the suction valve actuation (intermittent valve for localized vacuum application at the proximal end of the endobronchial tube) will be applied to both bronchi simultaneously, or if there is a need to aspirate only secretions from a specific lung through the right main bronchus or the left main bronchus. Instillation, according to the conventional technique, will be performed if there is a need to fluidize the secretions to assist in their removal.
  • the suction valve actuation intermittent valve for localized vacuum application at the proximal end of the endobronchial tube
  • the removal of the endobronchial suction tube from the airway will preferably be performed in the expiratory phase by gentle movements. Then the patient will be re-oxygenated, hyperinflated and monitored.
  • endotracheal, nasopharyngeal, oropharyngeal and / or subglottic aspiration follow. Cleaning the endobronchial aspiration probe will follow the routine of the professional and / or health facility.
  • Endobronchial aspiration has the advantage that it can remove a greater amount of pulmonary secretion, as it reaches the main bronchi and perhaps the thicker secretions and / or installed in these source bronchi and / or that were not displaced to the trachea by mechanical processes. Therefore, it is presented as a superior technique to endotracheal aspiration, which is limited to removing excess secretions lodged in the endotracheal tube / tracheostomy tube or in the carina region, which may be inefficient for bronchial hygiene and adequate airway permeability.
  • Inflation lung mechanics deteriorates markedly after saline instillation and open endotracheal suctioning in mechanically ventilated healthy piglets Pediatr Pulmonol 2007; Jan; 42 (1): 10-4; Heinze, H.; Sedemund-Adib, B.; Heringlake, M.; Gosch, UW; Eichler, W. Functional residual capacity changes after different endotracheal suction methods Anesth Analg. 107 (3): 941-4).
  • the same preventive measures performed before, during and after the endotracheal aspiration procedure which include hyperoxygenation and hyperinflation techniques, may be performed to minimize these undesirable effects on endobronchial aspiration.
  • endobronchial aspiration has the advantage of allowing the selection of different levels of negative pressure for aspiration of each source bronchus in the face of special needs.
  • the present invention aims to protect the endobronchial aspiration technique described above, as well as the device, known as endobronchial aspiration probe, specific to the execution of said technique, whose working principle can be applied to open system or system aspiration. closed (single or with adaptations / accessories).
  • the technique may be used not only as a relief or therapy for the indication / need for bronchial hygiene, but also as a method for obtaining a secretion sample for examination (microbiological, cytological, other), since the secretion is removed under sterile conditions.
  • Figure 1 shows a simplified view of the human airway, with the endotracheal tube and endobroncheal suction tube inserted into the right and left main bronchi.
  • Figure 2 shows the endobronchial secretion aspiration probe, the body of which consists of two tubes with Y-shaped ends and different lengths.
  • Figure 3 shows the endobronchial secretion aspiration probe, the body of which consists of two Y-shaped tube ends and a suction valve / vacuum connector for each tube at its proximal end.
  • Figure 4 shows the endobronchial secretion aspiration probe, the body of which is comprised of two tubes with Y-shaped ends having a distal end separator.
  • Figure 5 shows the endobronchial secretion aspiration probe, the body of which is composed of a single cylindrical tube, split only at its distal end in Y-shape.
  • Figure 6 shows the endobronchial secretion aspiration probe, the body of which is composed of a single cylindrical tube with its distal end made in a curved shape.
  • the endobronchial secretion aspiration probe has two cylindrical tubes (1) arranged in parallel and joined to allow insertion into the endotracheal tube / tracheostomy tube.
  • the tubes (1) are separated in Y-shape to allow each end to be inserted into each of the bronchi (right and left).
  • the tubes (1) are made with this curved end ( Figure 2), the ends being directed to opposite sides, so that after passing the end of the endotracheal tube / tracheostomy tube, they separate into the trachea, taking the correct direction for insertion into the bronchi.
  • the distal end of the tubes (1) may have different lengths for the tips (2) and (3), to give maximized probe efficiency.
  • the probe should be inserted into the endotracheal tube / tracheostomy tube so that the tubes (1) make the same radius of curvature in the passage to the trachea. This will ensure that the probe tips (2) and (3) correctly positioned so as not to allow both to be inserted into the same bronchus.
  • the probe tubes (1) may also be made with some type of marking or using different colors to guide the operator to position each end on its respective bronchus according to its length. Another possibility is to make the proximal end of the tubes (1) of different lengths, following, for example, the same configuration as the distal end, which can be defined according to the anatomy of the pulmonary bronchi ( Figure 3).
  • the tubes (1) are also separated to allow selective aspiration of the bronchi (left or right) or both bronchi.
  • This selectivity is defined when applying negative pressure to the system, where the operator can connect to the pressure system the two ends (4) of the probe for bilateral aspiration, or only one end for unilateral aspiration. It is also possible to use different negative pressure values for each lung if desired. Simply connect each end (4) of the pipe (1) to a different negative pressure line or split the pressure line using two control valves set to different negative pressure values.
  • the probe should be inserted into the endotracheal tube / tracheostomy tube until opposition to movement is encountered. This opposition will correspond to the contact of the Y-shaped tip with the similarly shaped Carina.
  • the probe may also have a separator (5) ( Figure 4) at the distal end to ensure proper placement of the two tubes in the left and right bronchi. It may also have a suction valve (6) / vacuum connector for each tube (1) designated for each main bronchus ( Figure 3).
  • a separator (5) Figure 4
  • suction valve (6) / vacuum connector for each tube (1) designated for each main bronchus ( Figure 3).
  • Such a probe allows aspiration in open or closed system, and in the latter case, does not restrict the presence of accessories, such as instillation route, connector for aerosol administration and bacterial filters, nebulization, among others. It also allows conventional endotracheal, nasopharyngeal, oropharyngeal and subglottic aspiration.
  • the endobronchial secretion aspiration probe proposed in this patent may have other configurative variations, as described below, without limitation.
  • the probe may comprise a single cylindrical tube split only at its distal Y-shaped end ( Figure 5) to enable insertion into the left or right bronchi. In this case the probe will not allow selective aspiration for each lung. However, the simplified geometry will facilitate insertion into the endotracheal tube / tracheostomy tube.
  • the probe may also have a separator (5) at the distal end to ensure proper positioning of the two tips on the left and right bronchi, ie, so as not to allow both to be inserted into the same bronchus.
  • the probe may comprise a single cylindrical tube, with its distal end made in a curved shape ( Figure 6), to enable insertion into the left or right bronchi, according to the clinical case.
  • the probe will not allow selective aspiration for each lung.
  • the simplified geometry will facilitate insertion into the endotracheal tube / tracheostomy tube.
  • the probe may include the solutions described above.
  • the probe will consist of three modules, to allow the operator to select which one will be most suitable for each application.
  • the first module is applied to perform conventional endotracheal aspiration and has a conventional cylindrical tube with length for aspiration to the Carina.
  • the second is applied to perform the aspiration unilateral endobronchial tube and has a cylindrical tube with its distal end made in curved shape, to allow its insertion to the left or right bronchi, according to the clinical case.
  • the third is applied to perform bilateral endobronchial aspiration and has a cylindrical tube with its split Y-shaped distal end, to enable each end to be inserted into each of the bronchi (right and left).
  • each probe module At the end portion of the distal end of each probe module are front and side holes for passage of respiratory tract secretions into the probe.
  • the probe body modules are detachable so that the operator can select which module to insert into the endotracheal tube / tracheostomy cannula, according to each patient's clinical case.
  • All endobronchial tube solutions described above may be used and / or applied for open or closed system aspiration.
  • the endobronchial suction probe specification can be performed by two measures: outside diameter and length of the probe, so that the same outside diameter of the probe can be suitable for aspirating secretions with different respiratory tract lengths.
  • the probe may have a holder to control the length of the probe to be inserted for aspiration to suit the characteristics of each patient and the type of artificial airway, endotracheal tube or tracheostomy tube.

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Abstract

A device for endobronchial aspiration of secretions consisting of two adjacent cylindrical tubes (1) made of flexible material and separated at distal ends for insertion into main bronchi of a patient in order to provide selective aspiration of secretions.

Description

MÉTODO E SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES  ENDOBRONCHIAL SECTION SECTION METHOD AND ASPIRATION
A presente invenção refere-se ao desenvolvimento de uma técnica para a aspiração de secreções provenientes do trato respiratório inferior e de uma sonda para aspiração destes fluidos, tendo como pontos anatómicos de referência, os brônquios principais direito e esquerdo. The present invention relates to the development of a technique for aspirating secretions from the lower respiratory tract and a probe for aspiration of these fluids, having the right and left main bronchi as anatomical reference points.
Estado da Técnica State of the Art
A aspiração de vias aéreas é uma importante intervenção no cuidado de pacientes adultos, pediátricos e neonatais com via aérea artificial e/ou incapazes de expelir as secreções do trato respiratório voluntariamente. Trata-se de um procedimento invasivo, de rotina, essencial no manejo de vias aéreas e manutenção de sua permeabilidade em pacientes sob situações de estado crítico em unidades de terapia intensiva, ou em pacientes em unidades de internação, pronto-atendimento, centro-cirúrgico, postos de saúde, atendimento móvel, home care, entre outros (Celik, S. S.; Elbas, N. O. The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs., 2000; Jun; 16(3):191-8; Donald, K. J.; Robertson, V. J.; Tsebelis, K. Setting safe and effective suction pressure: the effect of using a manometer in the suction circuit. Intensive Care Med., 2000; Jan; 26(1):15-0; Carvalho, Werther Brunow; Johnston, Cíntia. Análise comparativa dos sistemas de aspiração traqueal aberto e fechado. Rev. Assoe. Med. Bras 2007; 53(2): 95-107). Airway aspiration is an important intervention in the care of adult, pediatric and neonatal patients with artificial airways and / or unable to expel respiratory tract secretions voluntarily. It is a routine invasive procedure, essential for airway management and maintenance of its permeability in critically ill patients in intensive care units, or in inpatient, emergency room, operating room units. , health posts, mobile care, home care, among others (Celik, SS; Elbas, NO The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs., 2000; Jun; 16 (3): 191-8; Donald, KJ; Robertson, VJ; Tsebelis, K. Intensive Care Med., 2000; Jan; 26 (1): 15-0; Carvalho, Werther Brunow; Johnston, Cíntia Comparative analysis of open and closed tracheal suction systems Rev. Assoe Med. Bras 2007; 53 (2): 95-107).
O procedimento consiste em introduzir uma sonda conectada a uma fonte de vácuo, na via aérea de um indivíduo, para retirada de secreções do trato respiratório. A literatura reconhece as modalidades de aspiração naso ou orofaríngea, na qual uma sonda de aspiração é inserida na cavidade nasal ou cavidade oral em direção a faringe, respectivamente; nasotraqueal, na qual uma sonda de aspiração é inserida na cavidade nasal em direção a traquéia; oro ou endotraqueal, na qual a sonda é inserida no tubo endotraqueal ou cânula de traqueostomia em direção a traquéia, podendo ser realizada em sistema aberto de aspiração, onde o paciente é desconectado da fonte de oxigénio e/ou ventilação mecânica durante a execução do procedimento, ou em sistema fechado, onde a ventilação mecânica não é interrompida durante a aspiração (AARC American Association for Respiratory Care: Clinicai Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care, 1993; 38:500-504; Day, T.; Farnell, S.; Wilson-Barnett, J. Suctioning: a review of current research recommendations. Intensive and Criticai Care Nursing, 2002; 18, 79-89). The procedure consists of introducing a probe connected to a source of vacuum into an individual's airway to remove secretions from the respiratory tract. The literature recognizes the modalities of naso or oropharyngeal aspiration, in which an aspiration probe is inserted into the nasal cavity or oral cavity towards the pharynx, respectively; nasotracheal tube, in which an aspiration tube is inserted into the nasal cavity toward the trachea; oro or endotracheal tube, in which the tube is inserted into the endotracheal tube or tracheostomy tube towards the trachea and can be performed in open aspiration system where the patient is disconnected from the oxygen source and / or mechanical ventilation during the procedure or in a closed system where mechanical ventilation is not interrupted during aspiration (AARC American Association for Respiratory Care: Clinical Practice Guideline Endotracheal suctioning of mechanically ventilated adults and children with artificial airways Respir Care, 1993; 38: 500-504; Day, T.; Farnell, S.; Wilson-Barnett, J. Suctioning: a review of current research recommendations. Intensive and Critical Care Nursing, 2002; 18, 79-89).
Outra modalidade, denominada de aspiração ou drenagem subglótica, geralmente realizada após a aspiração endotraqueal, consiste em aspirar a secreção localizada acima do balonete do tubo endotraqueal, especificamente, no espaço subglótico. O procedimento é executado por meio da inserção de uma sonda de aspiração pela cavidade oral, seguindo um trajeto peri-tubo endotraqueal/cânula de traqueostomia em direção ao espaço subglótico ou ainda, acoplando o vácuo a um lúmen dorsal que se abre acima do manguito de um tubo endotraqueal específico para execução deste tipo de aspiração (Dezfulian, C; Shojania, K.; Collard, H.R; Kim, H. M.; Matthay, M. A.; Saint, Sanjay. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis. The American Journal of Medicine, 2005; 118, 11- 18). Another modality, called subglottic aspiration or drainage, usually performed after endotracheal aspiration, is to aspirate the secretion located above the endotracheal tube cuff, specifically into the subglottic space. The procedure is performed by inserting an aspiration probe through the oral cavity, following an endotracheal tube / tracheostomy tube towards the subglottic space or by attaching the vacuum to a dorsal lumen that opens above the cuff. a specific endotracheal tube for performing this type of aspiration (Dezfulian, C; Shojania, K.; Collard, HR; Kim, HM; Matthay, MA; Saint, Sanjay. Subglottic secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis The American Journal of Medicine, 2005; 118, 11-18).
A American Association of Respiratory Care e diversos autores fazem recomendações para a execução da técnica de aspiração endotraqueal, na qual uma sonda de aspiração de diâmetro apropriado ao tubo endotraqueal/cânula de traqueostomia do paciente é conectada a uma fonte de vácuo e introduzida, de forma estéril, na via aérea artificial. A pressão negativa adequada é aplicada durante a retirada da sonda da via aérea inferior com movimentos rotatórios suaves para prosseguir com a aspiração da naso e orofaringe (AARC American Association for Respiratory Care: Clinicai Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care, 1993; 38:500-504; Wood, C. J. Endotracheal suctioning: a literature review. Intensive and Criticai Care Nursing., 1998; 14, 124-136; Blackwood, B. Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). Journal of Advanced Nursing., 1999; 29 (4): 928-34; Pedersen, C. M.; Rosendahl-Nielsenb, M.; Hjermindc, J.;Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient -What is the evidence? Intensive and Criticai Care Nursing, 2009; 25, 21-30). The American Association of Respiratory Care and several authors make recommendations for performing the endotracheal suction technique, in which a suction probe of appropriate diameter to the patient's endotracheal tube / tracheostomy cannula is connected to a vacuum source and introduced into a vacuum. sterile, in the artificial airway. Appropriate negative pressure is applied during withdrawal of the lower airway probe with gentle rotational movements to proceed with nasal and oropharyngeal aspiration (AARC American Association for Respiratory Care: Clinical Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways Respir Care, 1993; 38: 500-504; Wood, CJ Endotracheal suctioning: a literature review. Intensive and Critical Care Nursing., 1998; 14, 124-136; Blackwood, B. Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). Journal of Advanced Nursing., 1999; 29 (4): 928-34; Pedersen, CM; Rosendahl-Nielsenb, M .; Hjermindc, J.; Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient -What is the evidence? Intensive and Critical Care Nursing, 2009; 25, 21-30).
A recomendação técnica consiste em: (i) avaliar a necessidade e indicação da aspiração de vias aéreas (monitorar o paciente); (ii) selecionar e checar equipamentos: sistema gerador de vácuo, sonda de aspiração estéril, luvas estéreis e de procedimento, óculos, máscara e avental, bandeja estéril, solução salina ou água estéril, sistema de liberação de oxigénio; (iii) pré- oxigenar e hiperinsuflar o paciente com o uso de ambú/ressuscitador manual ou pelo ventilador mecânico; (iv) inserir a sonda; (v) caso necessário, instilar solução salina estéril para auxiliar na remoção de secreções; (vi) liberar o vácuo com ajuste de pressão por tempo inferior a 10-15 segundos; (vii) remover e limpar a sonda; (viii) re-oxigenar e hiperinsuflar o paciente; (ix) monitorar o paciente e avaliar os resultados (AARC American Association for Respiratory Care: Clinicai Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care., 1993; 38:500-504). The technical recommendation consists of: (i) assessing the need and indication of airway aspiration (monitoring the patient); (ii) select and check equipment: vacuum generator system, sterile aspiration probe, sterile and procedural gloves, glasses, mask and apron, sterile tray, saline or sterile water, oxygen release system; (iii) pre-oxygenate and hyperinflate the patient with the use of a hand-held ambú / resuscitator or mechanical ventilator; (iv) inserting the probe; (v) if necessary, instill sterile saline to assist in secretion removal; (vi) release the vacuum with pressure setting for less than 10-15 seconds; (vii) remove and clean the probe; (viii) re-oxygenate and hyperinflate the patient; (ix) monitor patient and evaluate outcomes (AARC American Association for Respiratory Care: Clinical Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care., 1993; 38: 500-504).
Uma série de documentos recomendam que a sonda de aspiração deva ser inserida até a carina (ponto anatómico de bifurcação da traquéia em brônquios principais ou brônquios-fonte) e retraída 1-2 cm antes de aplicar a pressão negativa (Wood, C. J. Can nurses safely assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques? Intensive Crit Care Nurs, 1998; Aug; 14(4):170-8; Celik, S. S.; Elbas, N. O. The standard of suction for patients undergoing endotracheal intubation. Intensive Crit Care Nurs., 2000; Jun; 16(3):191-8; Day, T; Farnel!, S.; Wilson-Barnett, J. Suctioning: a review of current research recommendations. Intensive and Criticai Care Nursing, 2002; 18, 79-89; Pedersen, C. M.; Rosendahl-Nielsenb, M.; Hjermindc, J.;Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient - What is the evidence? Intensive and Criticai Care Nursing, 2009; 25, 21-30) ou que a sucção seja realizada somente dentro do tubo endotraqueal, estimando o comprimento da sonda de aspiração a ser inserido pela medida de comprimento idêntica do tubo endotraqueal (Pedersen, C. M.; Rosendahl-Nielsenb, M.; Hjermindc, J.; Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient - What is the evidence? Intensive and Criticai Care Nursing, 2009; 25, 21-30). Tais autores recomendam limitar a profundidade da inserção da sonda de aspiração em função de efeitos adversos da aplicação da pressão negativa nos pulmões. A number of documents recommend that the aspiration probe be inserted into the carina (anatomical point of trachea bifurcation in main or source bronchi) and retracted 1-2 cm before applying negative pressure (Wood, CJ). assess the need for endotracheal suction in short-term ventilated patients, instead of using routine techniques Intensive Crit Care Nursing, 1998; Aug; 14 (4): 170-8; Celik, SS; Elbas, NO undergoing endotracheal intubation Intensive Crit Care Nursing, 2000; Jun; 16 (3): 191-8; Day, T.; Farnel !, S.; Wilson-Barnett, J. Suctioning: A Review of Current Research recommendations. Intensive and Critical Care Nursing, 2002; 18, 79-89; Pedersen, CM; Rosendahl-Nielsenb, M .; Hjermindc, J.; Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient - What is the evidence? Intensive and Critical Care Nursing, 2009; 25, 21-30) or that suction is performed only within the endotracheal tube, estimating the length of the aspiration probe to be inserted by measuring the identical length of the endotracheal tube (Pedersen, CM; Rosendahl-Nielsenb, M .; Hjermindc, J. Egerodd, Ingrid, Endotracheal suctioning of the adult intubated patient - What is the evidence (Intensive and Critical Care Nursing, 2009; 25, 21-30). These authors recommend limiting the depth of aspiration probe insertion due to adverse effects of applying negative pressure to the lungs.
Numa descrição das sondas de aspiração endotraqueais convencionais, estas são siliconizadas, geralmente fabricadas em cloreto de polivinila. De forma simplificada, as sondas sáo constituídas de uma cabeça ou extremidade proximal (onde se localiza um conector ou válvula para liberação de vácuo), um corpo (referente ao tubo transparente estéril) e uma cauda ou extremidade distai ou de inserção (representada pela porção final do corpo da sonda, na qual concentram-se orifícios para a passagem de fluidos). Quanto ao número de orifícios, estes variam de um a cinco (em sua maioria, três orifícios) em sua extremidade de inserção, sendo um localizado na ponta (orifício frontal) e os demais nas laterais (orifícios laterais) desta extremidade. A maioria dos modelos possui válvula de sucção para aplicação da pressão negativa localizada em sua extremidade proximal (sendo a pressão negativa liberada por meio de oclusão do orifício desta válvula), outros não, de modo que a liberação do vácuo é feita ao comprimir/descomprimir o circuito que conecta a sonda ao sistema gerador de vácuo. Os modelos de sondas de aspiração em sistema fechado também possuem uma conexão em "Y" que proporciona o acoplamento simultâneo do tubo endotraqueal/cânula de traqueostomia, circuito do ventilador mecânico e a extremidade distai da própria sonda, uma via de instilação com válvula anti-refluxo, conector para administração de aerossol e uma bainha ou luva plástica recobrindo a sonda, evitando o contato direto do profissional com o corpo da sonda. Outros modelos possuem adaptações para conexão de filtros bacterianos, nebulização e demais acessórios. Independente da modalidade de aplicação (sistema aberto ou fechado) e da presença de acessórios, tais sondas são designadas segundo o seu diâmetro externo por uma unidade denominada French, que equivale a 3,3.10"4 m (Wood, C. J. Endotracheal suctioning: a literature review. Intensive and Criticai Care Nursing, 1998; 14, 124-136). Em buscas realizadas nos bancos de patentes, foram encontradas diversas tecnologias para aspiração de secreções. Entre elas, a patente PI9804529-6 trata de um kit para realização de aspiração de secreções em pacientes intubados ou traqueostomizados compreendendo uma válvula de sucção dotada de um corpo que conta com uma câmara, onde é montado um dispositivo de obstrução seletiva e uma válvula de esfera, que permite ou não a passagem de uma sonda através de uma conexão paciente/ventilador. A patente em questão prevê também um kit que permite a disposição correta do dispositivo para aspiração, e compreende ainda um invólucro plástico e um tubo, que representam os meios adequados para o descarte do mencionado dispositivo apos o seu uso. Tal patente refere-se a aspiração endotraqueal, na qual a sonda é inserida até o nível da traquéia. In a description of conventional endotracheal aspiration probes, they are siliconized, generally made of polyvinyl chloride. Put simply, the probes consist of a proximal head or end (where a vacuum release connector or valve is located), a body (relative to the sterile transparent tube), and a distal or insertion tail or end (represented by the portion). end of the probe body, into which fluid flow holes are concentrated). As for the number of holes, these vary from one to five (mostly three holes) at their insertion end, one being located at the tip (front hole) and the others at the sides (side holes) of this end. Most models have a suction valve for applying negative pressure located at its proximal end (negative pressure being released by occluding the orifice of this valve), others do not, so that vacuum is released by compressing / decompressing the circuit that connects the probe to the vacuum generator system. Closed-suction probe models also have a "Y" connection that provides simultaneous coupling of the endotracheal tube / tracheostomy tube, mechanical ventilator circuit, and distal end of the probe itself, an instillation port with anti-valve. reflux, connector for administration of aerosol and a sheath or plastic sleeve covering the probe, avoiding direct contact of the professional with the body of the probe. Other models have adaptations for connecting bacterial filters, nebulization and other accessories. Regardless of the mode of application (open or closed system) and the presence of fittings, such probes are designated by their outside diameter by a unit called French, which is equivalent to 3.3.10 "4 m (Wood, CJ Endotracheal suctioning: a literature). Intensive and Critical Care Nursing, 1998; 14, 124-136) In patent bank searches, several technologies for secretion aspiration have been found, among which patent PI9804529-6 deals with a vacuum aspiration kit. of secretions in intubated or tracheostomized patients comprising a suction valve provided with a chambered body where a selective obstruction device is mounted and a ball valve which allows or not a probe to pass through a patient connection The patent in question also provides for a kit which allows the correct arrangement of the suction device, and also comprises a plastic housing attic and a tube, which represent suitable means for disposing of said device after use. Such patent refers to endotracheal suction, in which the probe is inserted to the level of the trachea.
A patente PI9302608-0 trata de um aparelho para aspiração de secreções que consiste em um recipiente plástico acoplado a tampa de oclusão hermética por mecanismo de pressão, da qual se expandem externamente bicos para união com a sonda de aspiração e para união com o tubo da fonte de vácuo e internamente expandindo-se bicos de união com dispositivo fenestrado que termina em anteparo para retenção e coleta de secreções. PI9302608-0 deals with a secretion aspiration apparatus consisting of a plastic container coupled to the hermetic occlusion cap by pressure mechanism, from which externally expand nozzles for union with the aspiration probe and for union with the vacuum source and internally expanding nozzles with fenestrated device that ends in bulkhead for retention and collection of secretions.
A patente PI9101362-3 trata de uma sonda nasofaríngea indicada para o tamponamento nasofaríngeo, em presença de hemorragia ou epistaxe anterior ou posterior, sangramento do cavum, pós-operatório de septoplastia, rinoplastia, polipectomia, biópsia nasal, redução de fratura nasal de qualquer natureza, em presença de sangramento e outros procedimentos cirúrgicos, além de politraumatismo da face, com sangramento nasal. É constituída de uma estrutura tubular de borracha flácida, não tóxica, composta basicamente de três elementos: cabeça, corpo e cauda, possuindo três tamanhos padrão: pequena, media e grande. Ao corpo da sonda são acoplados dois balões, um menor e outro maior, que se adaptam às diferentes medidas do diâmetro de abertura da narina e do espaço da cavidade nasal de seus usuários. As patentes PI0016691-0, PI9306287-7, W09321984 ePI9101362-3 deals with a nasopharyngeal tube indicated for nasopharyngeal packing in the presence of bleeding or epistaxis. anterior or posterior, cavum bleeding, postoperative septoplasty, rhinoplasty, polypectomy, nasal biopsy, reduction of nasal fracture of any nature, in the presence of bleeding and other surgical procedures, in addition to polytrauma of the face, with nasal bleeding. It consists of a non-toxic flaccid rubber tubular structure consisting basically of three elements: head, body and tail, having three standard sizes: small, medium and large. Two smaller and larger balloons are attached to the probe body, which adapt to the different measurements of the nostril opening diameter and the nasal cavity space of its users. Patents PI0016691-0, PI9306287-7, W09321984 and
US20020179090 referem-se a diferentes formatos de sondas de aspiração para uso endotraqueal, sendo, a primeira sobre um conjunto de catéter endotraqueal e divisor com selo e válvula; a segunda sobre um sistema de suporte respiratório que inclui um dispositivo de catéter de aspiração, uma válvula de controle de aspiração e um coletor de ventilador. As duas últimas tratam da descrição de aplicabilidade de sondas de aspiração para execução do procedimento mantendo a pressurização do sistema respiratório, prevenindo a hipoxemia e a perda de volume pulmonar. US20020179090 refer to different shapes of endotracheal suction probes, the first being on an endotracheal catheter and seal divider assembly with valve; the second is a respiratory support system that includes a suction catheter device, a suction control valve, and a ventilator manifold. The last two deal with the description of the applicability of aspiration probes to perform the procedure maintaining pressurization of the respiratory system, preventing hypoxemia and loss of lung volume.
Dentre as patentes envolvendo melhoramentos e/ou adaptações ao sistema fechado de aspiração, podem ser citados alguns exemplos, tais como, a patente PI0307203-7 sobre a adaptação de trocador de calor e umidade para conjunto de catéter de sucção fechado e sistema possuindo uma limpeza de catéter melhorada, a patente PI0115779-5 sobre um método e aparelho de limpeza com ar turbulento para conjuntos de catéter e a patente PI0115074-0 que trata de um adaptador de conjunto de catéter de sucção fechada melhorada e sistema contendo o mesmo. Among the patents involving improvements and / or adaptations to the closed suction system, some examples may be cited, such as patent PI0307203-7 on the adaptation of heat and moisture exchanger for closed suction catheter assembly and system having a cleaning of improved catheter, patent PI0115779-5 on a turbulent air cleaning method and apparatus for catheter assemblies, and patent PI0115074-0 which deals with an improved closed suction catheter assembly adapter and system containing the same.
A patente PI0016353-8 descreve de um aparelho que compreende um catéter endotraqueal e um conjunto de via múltipla com válvula aperfeiçoada. Está relacionada a uma válvula com aba aperfeiçoada ou outro componente interno para uso com conjuntos de catéter de sucção respiratório e via múltipla. Essa válvula com aba ou outro componente interno fornece um conjunto com um mecanismo aperfeiçoado para limpeza da ponta do catéter sem retirar uma quantidade excessiva de ar do circuito respiratório ao qual o catéter endotraqueal é anexado. Mais especificamente, a presente invenção está relacionada principalmente a um sistema de catéter endotraqueal de sistema fechado que fornece uma limpeza melhorada do catéter enquanto minimiza o ar retirado do circuito de ventilação do paciente pelo fornecimento de pelo menos uma protrusão em pelo menos uma superfície da válvula com aba ou outro componente interno. PI0016353-8 describes an apparatus comprising an endotracheal catheter and an improved valve multipath assembly. It is related to a flap valve or other internal component for use with multiple suction and respiratory suction catheter assemblies. This flap valve or other internal component provides an assembly with an improved mechanism for cleaning the catheter tip without removing excess air from the breathing circuit to which the endotracheal catheter is attached. More specifically, the present invention relates primarily to a closed system endotracheal catheter system that provides improved catheter cleaning while minimizing air drawn from the patient's ventilation circuit by providing at least one protrusion on at least one valve surface. with tab or other internal component.
Quanto à associação de dispositivos de ventilação aos sistemas de aspiração, a patente PI9611530-0 trata de uma máscara descartável que possui um catéter de sucção para remoção de ar exalado, não sendo destinado para remoção de secreções. A patente PI0203908-7 refere-se a um tubo endotraqueal de posicionamento orotraquel ou nasotraqueal para aspiração contínua ou intermitente de secreções respiratórias intraluminais de curta e longa permanência e recipiente para coleta de material microbiológico e processo de aspiração contínua endotraqueal. A incorporação de uma sonda de aspiração ao tubo endotraqueal também foi descrita em WO 2004071553 e no documento PI9815297-1. Neste último, o tubo endotraqueal ou de traqueotomia possui um lúmen central para suprimento e condução de ar respiratório com uma bainha de vedação inflável e um duto de aspiração, situado acima ou abaixo da bainha e terminando externamente ao tubo. Regarding the association of ventilation devices with aspiration systems, the patent PI9611530-0 deals with a disposable mask that has a suction catheter for exhaled air removal and is not intended for the removal of secretions. PI0203908-7 relates to an orotracheal or nasotracheally positioned endotracheal tube for continuous or intermittent aspiration of short- and long-term intraluminal respiratory secretions and a container for collection of microbiological material and endotracheal continuous aspiration process. Incorporation of a suction probe into the endotracheal tube has also been described in WO 2004071553 and in PI9815297-1. In the latter, the endotracheal or tracheotomy tube has a central lumen for supplying and conducting respiratory air with an inflatable sealing sheath and an aspiration duct located above or below the sheath and terminating outside the tube.
O modelo de utilidade MU8700394-5 refere-se a uma cânula endotraqueal de intubação bibronquial para intubação concomitante de ambos os brônquios-fonte. A cânula bibronquial é introduzida até que seus ramos bronquiais acavalguem a carina, posição final facilmente identificada pela resistência evidente à progressão. Tubo endotraqueal de duplo lúmen é utilizado em pacientes que tem necessidades de modos ventilatórios mecânicos diferenciados para cada pulmão, não se caracterizando como dispositivo ou sonda de aspiração, constitui na realidade, um tipo de via aérea artificial com aplicabilidade bem definida. Tal sistema de intubação pode levar ao risco de oclusão de algum dos brônquios. Utility model MU8700394-5 refers to an endotracheal cannula of bibronchial intubation for concomitant intubation of both source bronchi. The bibronchial cannula is introduced until its bronchial branches warm the carina, a final position easily identified by the evident resistance to progression. Double lumen endotracheal tube is used in patients who need different mechanical ventilation modes for each lung and is not characterized as device or suction probe is actually a type of artificial airway with well-defined applicability. Such an intubation system may lead to the risk of occlusion of any of the bronchi.
Problemas do estado da técnica No entanto, na tentativa de remover secreções de origem do trato respiratório durante a aspiração de vias aéreas são ocasionados traumatismos mecânicos e repercussões fisiológicas. State of the art problems However, attempting to remove source secretions from the respiratory tract during airway aspiration causes mechanical trauma and physiological repercussions.
Dentre os riscos e complicações relacionadas à aspiração endotraqueal têm-se as arritmias, laringoespasmos, traumatismos de mucosas, micro-atelectasias, hipoxemia, queda na saturação arterial de oxigénio, bradicardias e taquicardias, hipertensão arterial, aumento de pressão intracraniana, infecções, alterações na pressão parcial de gás carbónico, cianose, broncoconstricção e parada cardíaca (Guglielminotti, J.; Desmonts, J. M.; Dureuil, B. Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients. Chest 1998; 1 13:1335-1338; Moore, T. Suctioning techniques for the removal of respiratory secretions. Nursing Standard 2003; 18 (9):47-53; Oh H.; Seo W. A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia. J Clin Nurs. 2003; 12(6):912-24). Tais complicações têm relação com a ausência de padronização metrológica na realização do procedimento. Componentes como nível de pressão negativa, tempo de aspiração, formato, tipo de ponta e calibre ideal da sonda de aspiração para realização da técnica ainda são discutidos (Carroll, P. Safe suctioning. Registered Nurse 1994. v. 57 (5):32-36; Glass, C. A.; Grap, M. J. Ten tips for safer suctioning. American Journal of Nursing, 995 May (5): 51- 53; Scanlan, G. L; Wilkins, R. L; Stoller, J. K. Fundamentos da terapia respiratória de Egan. 7 edição. São Paulo: Manole, 2000. Cap.29: Tratamento das vias aéreas, p. 609-50; Santos, A. C; Zanette, S. A. Assistência fisiátrica a pacientes em terapia intensiva In: Barreto, S. S. M.; Vieira, S. R. R.; Pinheiro, C. T. S. Rotinas em terapia intensiva. 3 Edição. Porto Alegre: Artmed Editora, 2001. Cap. 69. p. 607; Pryor, J. A.; Webber, B. A. Fisioterapia para problemas respiratórios e cardíacos. 2 Edição. Rio de Janeiro: Guanabara Koogan, 2002. Cap.8: Técnicas fisioterápicas. p.115-6; Pedersen, C. M.; Rosendahl-Nielsenb, M.; Hjermindc, J.;Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient -What is the evidence? Intensive and Criticai Care Nursing, 2009; 25, 21-30). Risks and complications related to endotracheal aspiration include arrhythmias, laryngospasms, mucosal trauma, micro atelectasis, hypoxemia, decreased arterial oxygen saturation, bradycardia and tachycardia, arterial hypertension, increased intracranial pressure, infections, changes in blood pressure. carbon dioxide partial pressure, cyanosis, bronchoconstriction, and cardiac arrest (Guglielminotti, J .; Desmonts, JM; Dureuil, B. Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients. Chest 1998; 1 13: 1335-1338; Moore, T. Suctioning techniques for the removal of respiratory secretions Nursing Standard 2003; 18 (9): 47-53; Oh H .; Seo W. The meta-analysis of the effects of various interventions on preventing endotracheal suction-induced hypoxemia. Clin Nurs, 2003; 12 (6): 912-24). Such complications are related to the absence of metrological standardization in the procedure. Components such as negative pressure level, aspiration time, shape, tip type, and ideal suction probe gauge for the technique are still discussed (Carroll, P. Safe suctioning. Registered Nurse 1994. v. 57 (5): 32 -36; Glass, CA; Grap, MJ Ten Tips for Safer Suction American Journal of Nursing, 995 May (5): 51-53; Scanlan, G.L; Wilkins, R.L; Stoller, JK Fundamentals of Respiratory Therapy de Egan 7 edition São Paulo: Manole, 2000. Chapter 29: Treatment of the airways, 609-50 Santos, A. C, Zanette, SA Physical care for intensive care patients In: Barreto, SSM; Vieira, SRR; Pinheiro, CTS Intensive care routines. 3 Edition. Porto Alegre: Artmed Publisher, 2001. Chapter 69. p. 607; Pryor, JA; Webber, BA Physiotherapy for respiratory and heart problems. 2 Edition. Rio de Janeiro: Guanabara Koogan, 2002. Cap.8: Physical Therapy Techniques. p.115-6; Pedersen, CM; Rosendahl-Nielsenb, M .; Hjermindc, J.; Egerodd, Ingrid. Endotracheal suctioning of the adult intubated patient -What is the evidence? Intensive and Critical Care Nursing, 2009; 25, 21-30).
No que diz respeito às lesões em mucosas das vias aéreas e às repercussões respiratórias e hemodinâmicas, alguns fatores que contribuem para a sua ocorrência, vêm sendo identificados, entre os quais, o uso de técnica e sondas de aspiração inadequadas e nível de vácuo excessivo (Auler JR, J. O. C; Amaral, R. V. G. Assistência ventilatória mecânica. São Paulo: Atheneu, 1995; Gemma, M.; Tommasino, C; Cerri, M.; Giannotti, A.; Piazzi, B.; Borghi, T. Intracranial effects of endotracheal suctioning in the acute phase of head injury. J Neurosurg Anesthesiol. 2002; Jan;14(1):50-4; Lorente, L; Lecuona, M.; Jiménez, A.; Mora, M. L.; Sierra, A. Tracheal suction by closed system without daily change versus open system, Intensive Care Medicine 2006; Apr;32(4):538-44). Regarding airway mucosal lesions and respiratory and hemodynamic repercussions, some factors contributing to its occurrence have been identified, including the use of inadequate aspiration technique and probes and excessive vacuum level ( Auler JR, JO C; Amaral, RVG Mechanical ventilatory assistance Sao Paulo: Atheneu, 1995; Gemma, M.; Tommasino, C.; Cerri, M.; Giannotti, A.; Piazzi, B.; Borghi, T. Intracranial effects Neurosurg Anesthesiol 2002; Jan; 14 (1): 50-4; Lorente, L.; Lecuona, M.; Jiménez, A.; Mora, ML; Sierra, A. Tracheal suction by closed system without daily change versus open system, Intensive Care Medicine 2006; Apr; 32 (4): 538-44).
Além disso, a aspiração não remove apenas a secreção, como também os gases na árvore traqueobrônquica e unidades alveolares, o que pode ocasionar redução do volume pulmonar, colapsos e consequentemente, atelectasias. Em função disto, foram desenvolvidas várias técnicas de re- oxigenação e hiperinsuflação pulmonar, as quais são descritas na literatura (Demir, F.; Dramali, A. Requirement for 100% oxygen before and after closed suction. J Adv Nurs. 2005; Aug; 51(3):245-51 ; Reissmann, H.; Bohm, S. H.; Suarez-Sipmann, F.; Tusman, G.; Buschmann, C; Maisch, S.; Pesch, T.; Thamm, O.; Plumers, C; Schulte, A. M.; Esch, J.; Hedenstierna, G. Suctioning through a double-lumen endotracheal tube helps to prevent alveolar collapse and to preserve ventilation. Intensive Care Medicine. 2005; Mar;31(3):431-4; Lasocki, S.; Lu, Q.; Sartorius, A.; Fouillat, D.; Remerand, F.; Rouby, J. J. Open and closed-circuit endotracheal suctioning in acute lung injury: efficiency and effects on gas exchange. Anesthesiology. 2006; Jan; 104(1):39-47; Maggiore, S. M. Endotracheal suctioning, ventilator-associated pneumonia, and costs: open or closed issue? Intensive Care Medicine. 2006; Apr;32(4):485-7). Outro problema deve-se quando a técnica é executada de maneira ineficaz, não removendo toda a secreção instalada no trato respiratório, cujo acúmulo pode levar a obstrução da via aérea e morte súbita (Kuzenski, B. M. Effect of negative pressure on tracheobronchial trauma. Nurs Res, 1978 Jul- Aug; 27(4):260-3; Wood, C. J. Endotracheal suctioning: a literature review. Intensive and Criticai Care Nursing, 1998; 14, 124-136; Lu, Q.; Capderou, A.; Cluzel, P. et al. A Computed Tomographic Scan Assessment of Endotracheal Suctioning-Induced Bronchoconstriction in Ventilated Sheep. Am J Respir Crit Care Med vol 162. p. 1898-1904, 2000; Gould, D. A.; Baun, M. M. The role of the pulmonary afferent receptors in producing hemodynamic changes during hyperinflation and endotracheal suctioning in an oleie acid-injured animal model of acute respiratory failure. Biol Res Nurs. 2000; Jan; 1 (3): 179-89). Embora alguns estudos afirmem que a aspiração em sistema fechado previne a perda do volume pulmonar em comparação com a aspiração em sistema aberto, outros afirmam que não há diferença entre os sistemas quanto à prevenção de hipoxemia e incidência de pneumonias e que, adicionalmente, o sistema fechado apresenta uma capacidade reduzida de remoção de secreções (Day, T.; Farneli, S.; Wilson-Barnett, J. Suctioning: a review of current research recommendations. Intensive and Criticai Care Nursing, 2002; 18, 79-89; Lasocki, S.; Lu, Q.; Sartorius, A.; Fouillat, D.; Remerand, F.; Rouby, J. J. Open and closed-circuit endotracheal suctioning in acute lung injury: efficiency and effects on gas exchange. Anesthesiology. 2006; Jan; 104(1):39-47). In addition, aspiration not only removes secretion, but also gases in the tracheobronchial tree and alveolar units, which can lead to reduced lung volume, collapse and consequently atelectasis. As a result, several pulmonary oxygenation and hyperinflation techniques have been developed and described in the literature (Demir, F.; Dramali, A. Requirement for 100% oxygen before and after closed suction. J Adv Nurs. 2005; Aug ; 51 (3): 245-51; Reissmann, H.; Bohm, SH; Suarez-Sipmann, F.; Tusman, G.; Buschmann, C.; Maisch, S.; Pesch, T .; Thamm, O .; Plumers, C., Schulte, AM; Esch, J .; Hedenstierna, G. Suctioning through a double-lumen endotracheal tube helps to prevent alveolar collapse and preserve ventilation., Intensive Care Medicine. 2005; Mar; 31 (3): 431- 4; Lasocki, S.; Lu, Q .; Sartorius, A.; Fouillat, D.; Remerand, F.; Rouby, JJ Open and closed-circuit endotracheal suctioning in acute lung injury: efficiency and effects on gas exchange. Anesthesiology. 2006; Jan; 104 (1): 39-47; Maggiore, SM Endotracheal suctioning, ventilator-associated pneumonia, and costs: open or closed issue? Intensive Care Medicine. 2006; Apr; 32 (4): 485-7). Another problem is when the technique is performed ineffectively, not removing all the secretion installed in the respiratory tract, which accumulation can lead to airway obstruction and sudden death (Kuzenski, BM Effect of negative pressure on tracheobronchial trauma. Nurs Res 1978 Jul-Aug; 27 (4): 260-3; Wood, CJ Endotracheal suctioning: the literature review Intensive and Critical Care Nursing, 1998; 14, 124-136; Lu, Q .; Capderou, A.; Cluzel , P. A Computed Tomographic Scan Assessment of Endotracheal Suctioning-Induced Bronchoconstriction in Ventilated Sheep Am J Respiration Crit Care Med vol 162. P. 1898-1904, 2000; Gould, DA; Baun, MM The role of the pulmonary afferent receptors in producing hemodynamic changes during hyperinflation and endotracheal suctioning in an acid-injured animal model of acute respiratory failure Biol Res Nurs 2000; Jan; 1 (3): 179-89). Although some studies claim that closed-system aspiration prevents lung volume loss compared to open-system aspiration, others state that there is no difference between systems in preventing hypoxemia and incidence of pneumonia, and that in addition the system closed has a reduced secretion removal capacity (Day, T.; Farneli, S.; Wilson-Barnett, J. Suctioning: a review of current research recommendations. Intensive and Critical Care Nursing, 2002; 18, 79-89; Lasocki , S .; Lu, Q .; Sartorius, A.; Fouillat, D.; Remerand, F .; Rouby, JJ Open and closed-circuit endotracheal suctioning in acute lung injury: efficiency and effects on gas exchange. Jan; 104 (1): 39-47).
O número de procedimentos de aspiração das vias aéreas realizadas por dia em cada paciente com via aérea artificial e/ou incapaz de expelir as secreções do trato respiratório voluntariamente varia bastante, pois depende da patologia de base, condições clínicas, produção de secreção, entre outros. Embora alguns autores preconizem que o procedimento deva ser executado em intervalos regulares a fim de manter a integridade da via aérea, há recomendações sobre não determinar horários e/ou número de procedimentos ao dia, sendo suprema a avaliação profissional da necessidade do paciente (AARC American Association for Respiratory Care: Clinicai Practice Guideline. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways. Respir Care, 1993; 38:500-504; Avena, M. J.; Carvalho, W. B.; Beppu, O. S. Avaliação da mecânica respiratória e da oxigenação pré e pós- aspiração de secreção em crianças submetidas à ventilação pulmonar mecânica. Rev Assoe Med Bras., 2003; 49: 156-161). Em termos de exemplificação, num estudo envolvendo 457 pacientes internados em unidade de terapia intensiva com diagnóstico de pós-operatório de cirurgia cardíaca, distúrbios cardiológicos, respiratórios, digestivos, neurológicos, traumatológicos ou toxicológicos, a média foi de 8,1 ±2,7 procedimentos/dia em sistema aberto e 7,9±2,6 procedimentos/dia em sistema fechado (Lorente, L; Lecuona, M.; Jiménez, A.; Mora, M. L.; Sierra, A. Tracheal suction by closed system without daily change versus open system, Intensive Care Medicine 2006; Apr;32(4):538-44). The number of airway aspiration procedures performed per day in each patient with artificial airway and / or unable to expel respiratory tract secretions voluntarily varies greatly as it depends on the underlying pathology, clinical conditions, secretion production, among others. . Although some authors advocate that the procedure should be performed at regular intervals in order to maintain airway integrity, there are recommendations not to determine time and / or number of procedures per day, and the professional assessment of patient need is paramount (AARC American Association for Respiratory Care: Guideline Clinical Practice Endotracheal suctioning of mechanically ventilated adults and children with artificial airways Respiratory Care, 1993; 38: 500-504; Avena, MJ; Carvalho, WB; Beppu, OS Evaluation of respiratory mechanics and oxygenation pre and post secretion aspiration in children submitted to mechanical pulmonary ventilation Rev Assoe Med Bras., 2003; 49: 156-161). In terms of exemplification, in a study involving 457 patients admitted to an intensive care unit diagnosed with postoperative cardiac surgery, cardiac, respiratory, digestive, neurological, traumatic or toxicological disorders, the average was 8.1 ± 2.7. procedures / day in open system and 7.9 ± 2.6 procedures / day in closed system (Lorente, L; Lecuona, M .; Jiménez, A .; Mora, ML; Sierra, A. Tracheal suction by closed system without daily change versus open system, Intensive Care Medicine 2006; Apr; 32 (4): 538-44).
Assim, considerando o elevado número de pacientes que necessitam do procedimento e a frequência de execução diária em cada um destes pacientes, evidencia-se a importância clínica, social e mercadológica da disponibilização de equipamentos e/ou dispositivos que garantam a eficiência da remoção de secreções. Thus, considering the high number of patients who need the procedure and the frequency of daily execution in each of these patients, the clinical, social and marketing importance of providing equipment and / or devices that guarantee the efficiency of secretion removal is evident. .
Neste contexto, as sondas de aspiração endotraqueais são elementos simples destinados a aspirar na região da carina e/ou no interior da via aérea artificial, restringindo-se a remover as secreções acumuladas nestas áreas e/ou as secreções mais fluidas que foram deslocadas da periferia para a traquéia, o que pode não ser suficiente para promover a higiene do trato respiratório, reduzindo consideravelmente a eficácia e aumentando a necessidade de repetições do procedimento ao dia. A necessidade de repetições do procedimento deve ser considerada no âmbito que as sondas de aspiração em sistema aberto são descartáveis e, portanto, desprezadas após cada procedimento, e que as sondas para sistema fechado são substituídas diariamente ou de acordo com a rotina do hospital. As relações tempo-eficiência e tempo de execução do procedimento por paciente também devem ser consideradas. Diante do fato que o tempo de aplicação da pressão negativa durante a aspiração deve ser limitado em função de seus efeitos indesejáveis, a sonda de aspiração deve ser concebida e projetada de modo a otimizar a eficiência do procedimento. Caso o procedimento não apresente uma eficiência satisfatória, ou seja, após a execução da aspiração seja constatado pela avaliação clínica que ainda há persistência de secreção no sistema respiratório do paciente por incapacidade de remoção do volume de secreção acumulado, o profissional da saúde deverá repetir o procedimento, respeitando um intervalo suficiente para o retorno às condições clínicas basais e a completa recuperação do paciente, o que aumenta o tempo dedicado pelo profissional à execução da aspiração em sua totalidade. Portanto, o desenvolvimento de novos métodos e novas sondas que aumentem a eficiência da aspiração é de grande valia para esta área da saúde. In this context, endotracheal suction probes are simple elements designed to aspirate into the carina region and / or within the artificial airway, restricting themselves to removing accumulated secretions in these areas and / or more fluid secretions that have been displaced from the periphery. for the trachea, which may not be sufficient to promote respiratory tract hygiene, considerably reducing efficacy and increasing the need for daily procedure repetitions. The need for procedure repetitions should be considered in the context that open-system aspiration probes are disposable and therefore discarded after each procedure, and that closed-system probes are replaced daily or according to hospital routine. The time-efficiency and time-to-procedure ratios per patient should also be considered. Given the fact that the time of application of negative pressure during aspiration should be limited due to its undesirable effects, the aspiration probe must be designed and designed to optimize the efficiency of the procedure. If the procedure does not present a satisfactory efficiency, that is, after the aspiration is performed, it is verified by the clinical evaluation that there is still persistence of secretion in the patient's respiratory system due to the inability to remove the accumulated secretion volume, the health professional should repeat the procedure. respecting a sufficient interval for the return to baseline clinical conditions and complete recovery of the patient, which increases the time devoted by the professional to perform the aspiration in its entirety. Therefore, the development of new methods and new probes that increase aspiration efficiency is of great value to this health area.
Outra limitação da técnica convencional está no fato de não permitir realizar a aspiração seletiva para apenas um pulmão, no caso de pacientes que apresentem pneumopatias unilaterais, cujo acúmulo de secreção ocorra em um pulmão específico. Como a sonda convencional possui um tubo único e a aspiração é realizada pelo método endotraqueal, ou seja, a extremidade da sonda se encontra na altura da traquéia e acima da carina, a aspiração remove apenas o volume de secreção sobressalente que foi deslocado para a região da carina e interior do tubo endotraqueal/cânula de traqueostomia, não garatindo a higiene brônquica. Adicionalmente, este método aspira o volume aéreo de ambos os pulmões, reduzindo o volume pulmonar bilateralmente. Solução para os problemas do estado da técnica Another limitation of the conventional technique is that it does not allow selective aspiration for only one lung for patients with unilateral lung disease whose secretion accumulation occurs in a specific lung. As the conventional probe has a single tube and aspiration is performed by the endotracheal method, ie the end of the probe is at trachea height and above the carina, aspiration removes only the volume of spare secretion that has been displaced to the region. of the carina and interior of the endotracheal tube / tracheostomy tube, not ensuring bronchial hygiene. Additionally, this method aspirates air volume from both lungs, reducing lung volume bilaterally. Solution to prior art problems
Diante destes problemas, soluções tecnológicas para o controle e monitoração da pressão negativa em sistemas de aspiração foram desenvolvidas (PI0802006-0), da mesma forma que, estudos sobre a relação diâmetro externo da sonda/diâmetro interno do tubo endotraqueai e/ou cânula de traqueostomia (Singh, N. C; Kissoon, N.; Frewen, T.; Tiffin, N. Physiological responses to endotracheal and oral suctioning in pediatric patients: the influence of endotracheal tube sizes and suction pressures. Clin Intensive Care. 1991 ; 2(6):345-50; Day, T.; Wainwright, S.; Wilson-Barnett, J. An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units. Journal of Clinicai Nursing, 2001 ; 0: 682-696). In view of these problems, technological solutions for the control and monitoring of negative pressure in aspiration systems were developed (PI0802006-0), as well as studies on the external diameter of the probe / internal diameter of the endotracheal tube and / or cannula. tracheostomy (Singh, N.C; Kissoon, N.; Frewen, T.; Tiffin, N. Physiological responses to endotracheal and oral suctioning in pediatric patients: the influence of endotracheal tube sizes and suction pressures. Clin Intensive Care. 1991; 2 (6): 345-50; Day, T.; Wainwright, S.; Wilson-Barnett, J. Evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units Journal of Clinical Nursing, 2001; : 682-696).
Quanto à efetividade questionada da aspiração de secreções apresentada nos estudos e na prática clínica envolvendo sistema aberto e sistema fechado de aspiração, bem como após uma análise das sondas de aspiração disponíveis comercialmente para ambos os sistemas, a presente invenção tem como objetivo apresentar o método e a sonda para aspiração endobronquial de secreções. Regarding the questioned effectiveness of secretion aspiration presented in studies and clinical practice involving open system and closed system aspiration, as well as after an analysis of commercially available aspiration probes for both systems, the present invention aims to present the method and the endobronchial aspiration probe for secretions.
Com isso, a invenção propõe um método para a aspiração de secreções provenientes do trato respiratório inferior, tendo como pontos anatómicos de referência, os brônquios-fonte, ou seja, os brônquios principais direito e esquerdo. Assim, ao invés da aplicação da pressão negativa limitar-se ao interior do tubo endotraqueal/cânula de traqueostomia ou dá-se em nível da carina, a aspiração de secreções ocorreria em nível endobronquial. O método de aspiração endobronquial tem como objetivo aumentar a eficiência do procedimento de aspiração. Thus, the invention proposes a method for aspirating secretions from the lower respiratory tract, having as source anatomical points the source bronchi, i.e. the right and left main bronchi. Thus, instead of applying negative pressure being limited to the endotracheal tube / tracheostomy tube or at the carina level, aspiration of secretions would occur at the endobronchial level. The endobronchial aspiration method aims to increase the efficiency of the aspiration procedure.
Apresenta também uma nova sonda para aspiração de vias aéreas, com geometria que possibilita o posicionamento adequado da sua extremidade dentro dos brônquios principais, além de permitir uma aspiração seletiva para cada brônquio-fonte, possibilitando definir se a aspiração será realizada unilateral ou bilateralmente. Permite ainda, a critério do profissional de saúde, a seleção de níveis diferenciados de pressão negativa para execução da aspiração em cada brônquio-fonte. It also features a new airway aspiration probe with geometry that allows proper placement of its extremity within the main bronchi, and allows selective aspiration for each source bronchus, allowing to define whether aspiration will be performed unilaterally or bilaterally. It also allows, at the discretion of the health professional, the selection of different levels of negative pressure to perform aspiration in each source bronchus.
A invenção do referido método e sonda específica baseia-se no pressuposto que determinados volumes de secreção pulmonar permanecem alojados nos brônquios principais, mesmo após a aspiração endotraqueal, em função de não conseguir serem deslocados até a carina ou ao interior da via aérea artificial. The invention of said method and specific probe is based on the assumption that certain volumes of pulmonary secretion remain lodged in the main bronchi even after endotracheal aspiration because they cannot be moved to the carina or into the artificial airway.
Descrição da Tecnologia O método de aspiração endobronquial de aspiração de vias aéreas consiste em introduzir uma sonda específica para aspiração endobronquial na via aérea do indivíduo para sucção de fluidos biológicos oriundos do trato respiratório inferior. O procedimento poderá ser realizado em pacientes por meio da inserção da sonda por via nasal ou oral e em pacientes sob uso de tubo endotraqueal ou cânula de traqueostomia, acoplando a sonda à rede de vácuo hospitalar ou aos aparelhos de aspiração portáteis, em diversos ambientes (hospitalar, ambulatorial, domiciliar e outros). Technology Description The endobronchial aspiration method of airway aspiration is to introduce a specific endobronchial aspiration tube into the subject's airway for suction of biological fluids from the lower respiratory tract. The procedure may be performed in patients by nasal or oral insertion of the probe and in patients using endotracheal tube or tracheostomy tube, coupling the probe to the hospital vacuum network or portable aspiration devices in various environments ( outpatient, home and others).
O procedimento técnico assemelha-se a descrição de execução da aspiração endotraqueal estabelecida na literatura, no entanto, diferencia-se pela possibilidade de selecionar se a aspiração será realizada unilateral ou bilateralmente em função da geometria construtiva da sonda que possibilita tal aspiração seletiva. Também permite uma alteração da profundidade de inserção da sonda de aspiração, que ultrapassa a carina e atinge os brônquios principais. Na técnica proposta, em um paciente com necessidade de aspiração de secreções, após selecionar e checar os equipamentos, pré-oxigená-lo e hiperinsuflá-lo, uma sonda específica para a aspiração endobronquial, de diâmetro e comprimento apropriados ao diâmetro da traquéia/tubo endotraqueal/cânula de traqueostomia, será inserida nesta via aérea até que o corpo da sonda fique corretamente posicionado no interior do tubo endotraqueal/cânula de traqueostomia, permitindo ao profissional de saúde decidir, conforme o caso clínico, se a pressão negativa liberada por meio do acionamento da válvula de sucção (válvula intermitente para a aplicação do vácuo localizada na extremidade proximal da sonda endobronquial), será aplicada para ambos os brônquios simultaneamente, ou se há a necessidade de aspirar somente as secreções oriundas de um pulmão específico, por meio do brônquio principal direito ou do brônquio principal esquerdo. Quanto à instilação, conforme técnica convencional, será efetuada caso haja a necessidade de fluidificar as secreções a fim de auxiliar na remoção destas. A retirada da sonda de aspiração endobronquial da via aérea, preferencialmente, será executada na fase expiratória por meio de movimentos suaves. Em seguida, o paciente será re-oxigenado, hiperinsuflado e monitorado. A critério do profissional de saúde seguem-se a aspiração endotraqueal, da nasofaringe, orofaringe e/ou subglótica. A limpeza da sonda de aspiração endobronquial seguirá rotina do profissional e/ou estabelecimento de saúde. The technical procedure resembles the description of execution of endotracheal aspiration established in the literature, however, differs by the possibility of selecting whether the aspiration will be performed unilaterally or bilaterally according to the constructive geometry of the probe that enables such selective aspiration. It also allows a change in the insertion depth of the aspiration probe, which extends beyond the carina and reaches the main bronchi. In the proposed technique, in a patient in need of secretion aspiration, after selecting and checking the equipment, pre-oxygenate and hyperinflate it, a specific endobronchial aspiration probe, with a diameter and length appropriate to the diameter of the trachea / tube. endotracheal tube / tracheostomy tube, will be inserted into this airway until the The probe body is correctly positioned within the endotracheal tube / tracheostomy tube, allowing the healthcare professional to decide, as the case may be, whether the negative pressure released by the suction valve actuation (intermittent valve for localized vacuum application at the proximal end of the endobronchial tube) will be applied to both bronchi simultaneously, or if there is a need to aspirate only secretions from a specific lung through the right main bronchus or the left main bronchus. Instillation, according to the conventional technique, will be performed if there is a need to fluidize the secretions to assist in their removal. The removal of the endobronchial suction tube from the airway will preferably be performed in the expiratory phase by gentle movements. Then the patient will be re-oxygenated, hyperinflated and monitored. At the discretion of the healthcare professional, endotracheal, nasopharyngeal, oropharyngeal and / or subglottic aspiration follow. Cleaning the endobronchial aspiration probe will follow the routine of the professional and / or health facility.
A aspiração endobronquial possui como vantagem a possibilidade de remover uma maior quantidade de secreção pulmonar, em função de atingir os brônquios principais e porventura, as secreções mais espessas e/ou instaladas nestes brônquios-fonte e/ou que não foram deslocadas para a traquéia por processos mecânicos. Portanto, apresenta-se como uma técnica superior à aspiração endotraqueal, a qual limita-se a remover o excesso de secreções que se alojam no tubo endotraqueal/cânula de traqueostomia ou na região da carina, o que pode ser ineficiente para a higiene brônquica e adequada permeabilidade da via aérea. Neste contexto, ratifica-se que a higiene brônquica inadequada com consequente acúmulo de secreções leva a piora ventilatória, pneumonias, infecções, aumento da permanência hospitalar quando em internação, podendo ocorrer até a morte súbita por obstrução da via aérea. Além disso, a aspiração endobronquial permite ao profissional de saúde selecionar o pulmão a ser submetido ao processo por meio da seleção do brônquio-fonte, o que se torna importante diante de patologias unilaterais. Endobronchial aspiration has the advantage that it can remove a greater amount of pulmonary secretion, as it reaches the main bronchi and perhaps the thicker secretions and / or installed in these source bronchi and / or that were not displaced to the trachea by mechanical processes. Therefore, it is presented as a superior technique to endotracheal aspiration, which is limited to removing excess secretions lodged in the endotracheal tube / tracheostomy tube or in the carina region, which may be inefficient for bronchial hygiene and adequate airway permeability. In this context, it is confirmed that inadequate bronchial hygiene with consequent accumulation of secretions leads to worsening of the ventilator, pneumonia, infections, increased hospital stay when hospitalized, and may even lead to sudden death due to airway obstruction. In addition, endobronchial aspiration allows health professionals to select the lung to be submitted to the process by selecting the source bronchus, which becomes important in the face of unilateral pathologies.
Quanto ao risco de se ter uma maior perda de volume e colapso pulmonar em função da aspiração endobronquial ser mais profunda, tal fato já ocorre durante o procedimento de aspiração de secreções em nível endotraqueal, independente do sistema de aspiração (aberto ou fechado) ou da modalidade ventilatória (Almgren, B.; Wickerts, C. J.; Heinonen, E.; Hogman, M. Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest 2004; 125:1077-1080; Cunha-Goncalves, D.; Perez-de-Sá. V.; Ingimarsson. J.; Werner, O.; Larsson. A. Inflation lung mechanics deteriorates markedly after saline instillation and open endotracheal suctioning in mechanically ventilated healthy piglets. Pediatr Pulmonol. 2007; Jan;42(1):10-4; Heinze, H.; Sedemund-Adib, B.; Heringlake, M.; Gosch, U. W.; Eichler, W. Functional residual capacity changes after different endotracheal suctioning methods. Anesth Analg. 2008; Sep;107(3):941-4). No entanto, as mesmas medidas preventivas realizadas antes, durante e após o procedimento de aspiração endotraqueal, as quais incluem técnicas de hiperoxigenação e hiperinsuflação, poderão ser executadas para minimizar estes efeitos indesejáveis na aspiração endobronquial. As for the risk of greater volume loss and lung collapse due to deeper endobronchial aspiration, this fact already occurs during the endotracheal secretion aspiration procedure, regardless of the aspiration system (open or closed) or the ventilatory modality (Almgren, B.; Wickerts, CJ; Heinonen, E.; Hogman, M. Side effects of endotracheal suction in pressure- and volume-controlled ventilation. Chest 2004; 125: 1077-1080; Cunha-Goncalves, D. ; Perez-de-Sá. V .; Ingimarsson J .; Werner, O .; Larsson A. Inflation lung mechanics deteriorates markedly after saline instillation and open endotracheal suctioning in mechanically ventilated healthy piglets Pediatr Pulmonol 2007; Jan; 42 (1): 10-4; Heinze, H.; Sedemund-Adib, B.; Heringlake, M.; Gosch, UW; Eichler, W. Functional residual capacity changes after different endotracheal suction methods Anesth Analg. 107 (3): 941-4). However, the same preventive measures performed before, during and after the endotracheal aspiration procedure, which include hyperoxygenation and hyperinflation techniques, may be performed to minimize these undesirable effects on endobronchial aspiration.
Outro fator, embora não se tenha um consenso quanto ao nível de pressão negativa a ser aplicado (objeto de estudos recentes), reconhece-se que o grau de colapso pulmonar está relacionado com o nível de pressão negativa aplicada (Brandstater, B.; uallem, M. Atelectasia following tracheal suctioning in infants. Anesthesiology, 31 :468-473, 1969), de forma que o risco de redução do volume pulmonar poderá ser minimizado com o uso da técnica e pressões negativas correias. Another factor, although there is no consensus on the level of negative pressure to be applied (object of recent studies), it is recognized that the degree of pulmonary collapse is related to the level of applied negative pressure (Brandstater, B .; uallem , M. Atelectasia following tracheal suctioning in infants, Anesthesiology, 31: 468-473, 1969), so that the risk of reduced lung volume can be minimized with the use of the technique and correct negative pressures.
Em relação a este fato, a aspiração endobronquial traz como vantagem a possibilidade de permitir a seleção de níveis diferenciados de pressão negativa para a aspiração de cada brônquio-fonte diante de necessidades especiais. Regarding this fact, endobronchial aspiration has the advantage of allowing the selection of different levels of negative pressure for aspiration of each source bronchus in the face of special needs.
Assim, a presente invenção visa proteger a técnica de aspiração endobronquial descrita acima, bem como o dispositivo, denominado como sonda de aspiração endobronquial, específico para a execução da referida técnica, cujo princípio de funcionamento poderá ser aplicado para a aspiração em sistema aberto ou sistema fechado (simples ou com adaptações/acessórios). Thus, the present invention aims to protect the endobronchial aspiration technique described above, as well as the device, known as endobronchial aspiration probe, specific to the execution of said technique, whose working principle can be applied to open system or system aspiration. closed (single or with adaptations / accessories).
A técnica poderá ser utilizada não apenas como de alívio ou terapêutica diante da indicação/necessidade de higiene brônquica, mas também como um método de obtenção de amostra de secreção para exames (microbiológico, citológico, outros), uma vez que a secreção é removida sob condições estéreis. The technique may be used not only as a relief or therapy for the indication / need for bronchial hygiene, but also as a method for obtaining a secretion sample for examination (microbiological, cytological, other), since the secretion is removed under sterile conditions.
Breve descrição das figuras As figuras abaixo relacionadas descrevem, de forma não limitante, a sonda proposta na presente patente, sendo: BRIEF DESCRIPTION OF THE FIGURES The following related figures describe, without limitation, the probe proposed in the present patent, being:
A Figura 1 mostra uma vista simplificada das vias aéreas humana, com o tubo endotraqueal e a sonda para aspiração endobronqueal inserida até os brônquios principais direito e esquerdo. A Figura 2 mostra a sonda para aspiração endobronquial de secreções, cujo corpo é composto por dois tubos com extremidades confeccionadas em formato de Y e com comprimentos diferentes. Figure 1 shows a simplified view of the human airway, with the endotracheal tube and endobroncheal suction tube inserted into the right and left main bronchi. Figure 2 shows the endobronchial secretion aspiration probe, the body of which consists of two tubes with Y-shaped ends and different lengths.
A Figura 3 mostra a sonda para aspiração endobronquial de secreções, cujo corpo é composto por dois tubos com extremidades confeccionadas em formato de Y e com uma válvula de sucção/conector de vácuo para cada tubo na sua extremidade proximal. A Figura 4 mostra a sonda para aspiração endobronquiaí de secreções, cujo corpo é composto por dois tubos com extremidades confeccionadas em formato de Y, possuindo um separador na extremidade distai. A Figura 5 mostra a sonda para aspiração endobronquiaí de secreções, cujo corpo é composto por um tubo cilíndrico único, bipartido apenas na sua extremidade distai em formato de Y. Figure 3 shows the endobronchial secretion aspiration probe, the body of which consists of two Y-shaped tube ends and a suction valve / vacuum connector for each tube at its proximal end. Figure 4 shows the endobronchial secretion aspiration probe, the body of which is comprised of two tubes with Y-shaped ends having a distal end separator. Figure 5 shows the endobronchial secretion aspiration probe, the body of which is composed of a single cylindrical tube, split only at its distal end in Y-shape.
A Figura 6 mostra a sonda para aspiração endobronquiaí de secreções, cujo corpo é composto por um tubo cilíndrico único com sua extremidade distai confeccionada em formato curvo. Figure 6 shows the endobronchial secretion aspiration probe, the body of which is composed of a single cylindrical tube with its distal end made in a curved shape.
Descrição detalhada da Tecnologia Detailed Description of Technology
De acordo com o quanto ilustram as figuras, a sonda para aspiração endobronquiaí de secreções possui dois tubos (1) cilíndricos dispostos paralelamente e unidos de forma a permitir sua inserção no tubo endotraqueal/cânula de traqueostomia. Na extremidade distai da sonda (inserida nas vias aéreas), os tubos (1) são separados em formato de Y, para possibilitar que cada uma das pontas seja inserida em cada um dos brônquios (direito e esquerdo). Os tubos (1) são confeccionados com esta extremidade em formato curvo (Figura 2), sendo as pontas direcionadas para lados opostos, de forma que após ultrapassar o final do tubo endotraqueal/cânula de traqueostomia, eles se separem dentro da traquéia, tomando a direção correta para inserção nos brônquios. As shown in the figures, the endobronchial secretion aspiration probe has two cylindrical tubes (1) arranged in parallel and joined to allow insertion into the endotracheal tube / tracheostomy tube. At the distal end of the probe (inserted into the airway), the tubes (1) are separated in Y-shape to allow each end to be inserted into each of the bronchi (right and left). The tubes (1) are made with this curved end (Figure 2), the ends being directed to opposite sides, so that after passing the end of the endotracheal tube / tracheostomy tube, they separate into the trachea, taking the correct direction for insertion into the bronchi.
Devido à variabilidade anatómica dos brônquios pulmonares, a extremidade distai dos tubos (1) podem apresentar comprimentos diferentes para as pontas (2) e (3), para conferir uma eficiência maximizada para a sonda. Due to the anatomical variability of the pulmonary bronchi, the distal end of the tubes (1) may have different lengths for the tips (2) and (3), to give maximized probe efficiency.
A sonda deve ser inserida no tubo endotraqueal/cânula de traqueostomia de forma que os tubos (1) façam o mesmo raio de curvatura na passagem até a traquéia. Isto irá garantir que as pontas (2) e (3) da sonda estejam corretamente posicionadas, de forma a não permitir que as ambas sejam inseridas dentro do mesmo brônquio. Os tubos (1) da sonda também poderão ser confeccionados com algum tipo de marcação ou utilizando cores diferentes, de forma a orientar o operador a posicionar cada ponta no seu respectivo brônquio, de acordo com o seu comprimento. Outra possibilidade é confeccionar a extremidade proximal dos tubos (1) com comprimentos diferentes, seguindo, por exemplo, a mesma configuração da extremidade distai, que pode ser definida de acordo com a anatomia dos brônquios pulmonares (Figura 3). The probe should be inserted into the endotracheal tube / tracheostomy tube so that the tubes (1) make the same radius of curvature in the passage to the trachea. This will ensure that the probe tips (2) and (3) correctly positioned so as not to allow both to be inserted into the same bronchus. The probe tubes (1) may also be made with some type of marking or using different colors to guide the operator to position each end on its respective bronchus according to its length. Another possibility is to make the proximal end of the tubes (1) of different lengths, following, for example, the same configuration as the distal end, which can be defined according to the anatomy of the pulmonary bronchi (Figure 3).
Na extremidade proximal da sonda (externa às vias aéreas), os tubos (1) também são separados para possibilitar a aspiração seletiva dos brônquios (esquerdo ou direito) ou em ambos os brônquios. Esta seletividade é definida no momento de aplicar a pressão negativa ao sistema, onde o operador pode conectar ao sistema de pressão as duas pontas (4) da sonda para a aspiração bilateral, ou apenas a uma das pontas para a aspiração unilateral. Também é possível utilizar valores de pressões negativas diferentes para cada pulmão, caso seja desejado. Para isso basta conectar cada ponta (4) do tubo (1) a uma linha de pressão negativa diferente ou dividir a linha de pressão utilizando duas válvulas de controle ajustadas para valores de pressões negativas distintas. A sonda deverá ser inserida no tubo endotraqueal/cânula de traqueostomia até que se encontre uma oposição ao movimento. Esta oposição irá corresponder ao contato da ponta em formato de Y com a Carina, que possui formato semelhante. At the proximal end of the probe (external to the airways), the tubes (1) are also separated to allow selective aspiration of the bronchi (left or right) or both bronchi. This selectivity is defined when applying negative pressure to the system, where the operator can connect to the pressure system the two ends (4) of the probe for bilateral aspiration, or only one end for unilateral aspiration. It is also possible to use different negative pressure values for each lung if desired. Simply connect each end (4) of the pipe (1) to a different negative pressure line or split the pressure line using two control valves set to different negative pressure values. The probe should be inserted into the endotracheal tube / tracheostomy tube until opposition to movement is encountered. This opposition will correspond to the contact of the Y-shaped tip with the similarly shaped Carina.
A sonda também poderá possui um separador (5) (Figura 4) na extremidade distai, para garantir o posicionamento adequado dos dois tubos nos brônquios esquerdo e direito. Poderá possuir também uma válvula (6) de sucção/conector de vácuo para cada tubo (1), designado para cada brônquio principal (Figura 3). Tal sonda permite a aspiração em sistema aberto ou fechado, sendo que neste último caso, não restringe a presença de acessórios, tais como, via de instilação, conector para administração de aerossol e filtros bacterianos, nebulização, entre outros. Permite também a aspiração endotraqueal, nasofaringe, orofaringe e subglótica convencionais. The probe may also have a separator (5) (Figure 4) at the distal end to ensure proper placement of the two tubes in the left and right bronchi. It may also have a suction valve (6) / vacuum connector for each tube (1) designated for each main bronchus (Figure 3). Such a probe allows aspiration in open or closed system, and in the latter case, does not restrict the presence of accessories, such as instillation route, connector for aerosol administration and bacterial filters, nebulization, among others. It also allows conventional endotracheal, nasopharyngeal, oropharyngeal and subglottic aspiration.
A sonda para aspiração endobronquial de secreções proposta nesta patente pode apresentar outras variações configurativas, conforme descrito a seguir, de forma não limitante. The endobronchial secretion aspiration probe proposed in this patent may have other configurative variations, as described below, without limitation.
A sonda poderá compreender um tubo cilíndrico único, bipartido apenas na sua extremidade distai em formato de Y (Figura 5) para possibilitar sua inserção até os brônquios esquerdo ou direito. Neste caso a sonda não possibilitará a aspiração seletiva para cada pulmão. Contudo, a geometria simplificada facilitará a sua inserção no tubo endotraqueal/cânula de traqueostomia. A sonda também poderá possui um separador (5) na extremidade distai, para garantir o posicionamento adequado das duas pontas nos brônquios esquerdo e direito, ou seja, de forma a não permitir que as ambas sejam inseridas dentro do mesmo brônquio. The probe may comprise a single cylindrical tube split only at its distal Y-shaped end (Figure 5) to enable insertion into the left or right bronchi. In this case the probe will not allow selective aspiration for each lung. However, the simplified geometry will facilitate insertion into the endotracheal tube / tracheostomy tube. The probe may also have a separator (5) at the distal end to ensure proper positioning of the two tips on the left and right bronchi, ie, so as not to allow both to be inserted into the same bronchus.
Alternativamente a sonda poderá compreender um tubo cilíndrico único, com sua extremidade distai confeccionada em formato curvo (Figura 6), para possibilitar sua inserção até os brônquios esquerdo ou direito, de acordo com o caso clínico. Neste caso a sonda não possibilitará a aspiração seletiva para cada pulmão. Contudo, a geometria simplificada facilitará a sua inserção no tubo endotraqueal/cânula de traqueostomia. Alternatively the probe may comprise a single cylindrical tube, with its distal end made in a curved shape (Figure 6), to enable insertion into the left or right bronchi, according to the clinical case. In this case the probe will not allow selective aspiration for each lung. However, the simplified geometry will facilitate insertion into the endotracheal tube / tracheostomy tube.
Uma outra configuração para a sonda poderá englobar as soluções descritas anteriormente. Neste caso a sonda será composta por três módulos, para permitir ao operador selecionar qual deles será mais indicado para cada aplicação. O primeiro módulo é aplicado para realizar a aspiração endotraqueal convencional e possui um tubo cilíndrico convencional com comprimento para a aspiração até a Carina. O segundo é aplicado para realizar a aspiração endobronquial unilateral e possui um tubo cilíndrico com sua extremidade distai confeccionada em formato curvo, para possibilitar sua inserção até os brônquios esquerdo ou direito, de acordo com o caso clínico. O terceiro é aplicado para realizar a aspiração endobronquial bilateral e possui um tubo cilíndrico com sua extremidade distai bipartido em formato de Y, para possibilitar que cada uma das pontas seja inserida em cada um dos brônquios (direito e esquerdo). Na porção final da extremidade distai de cada módulo da sonda localizam-se orifícios frontal e laterais para a passagem das secreções do trato respiratório para o interior da sonda. Neste caso, os módulos do corpo da sonda são destacáveis, de forma que o operador poderá selecionar qual módulo deverá ser inserido no tubo endotraqueal/cânula de traqueostomia, de acordo com o caso clínico de cada paciente. Another configuration for the probe may include the solutions described above. In this case the probe will consist of three modules, to allow the operator to select which one will be most suitable for each application. The first module is applied to perform conventional endotracheal aspiration and has a conventional cylindrical tube with length for aspiration to the Carina. The second is applied to perform the aspiration unilateral endobronchial tube and has a cylindrical tube with its distal end made in curved shape, to allow its insertion to the left or right bronchi, according to the clinical case. The third is applied to perform bilateral endobronchial aspiration and has a cylindrical tube with its split Y-shaped distal end, to enable each end to be inserted into each of the bronchi (right and left). At the end portion of the distal end of each probe module are front and side holes for passage of respiratory tract secretions into the probe. In this case, the probe body modules are detachable so that the operator can select which module to insert into the endotracheal tube / tracheostomy cannula, according to each patient's clinical case.
Todas as soluções de sonda endobronquial descritas acima podem ser utilizadas e/ou aplicadas para a aspiração em sistema aberto ou fechado. All endobronchial tube solutions described above may be used and / or applied for open or closed system aspiration.
A especificação da sonda de aspiração endobronquial poderá ser realizada por duas medidas: diâmetro externo e comprimento da sonda, de modo que um mesmo diâmetro externo da sonda possa ser adequado para aspirar secreções com diferentes comprimentos do trato respiratório. Na sua extremidade proximal, a sonda pode possui um suporte para controlar o comprimento da sonda a ser inserida para a aspiração, de forma a se adequar às características de cada paciente e ao tipo de via aérea artificial, tubo endotraqueal ou cânula de traqueostomia. The endobronchial suction probe specification can be performed by two measures: outside diameter and length of the probe, so that the same outside diameter of the probe can be suitable for aspirating secretions with different respiratory tract lengths. At its proximal end, the probe may have a holder to control the length of the probe to be inserted for aspiration to suit the characteristics of each patient and the type of artificial airway, endotracheal tube or tracheostomy tube.

Claims

REIVINDICAÇÕES
1. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, caracterizada por compreender dois tubos (1) cilíndricos unidos e dispostos paralelamente, onde sua extremidade distai os tubos (1) são separados, para possibilitar que cada uma das pontas seja inserida em cada um dos brônquios (direito e esquerdo) para realizar a aspiração endobronquial unilateral ou bilateral. 1. Endometrial secretion aspiration probe, characterized in that it comprises two cylindrical tubes (1) joined and arranged in parallel, where their distal end the tubes (1) are separated, to enable each end to be inserted into each of the bronchi ( right and left) to perform unilateral or bilateral endobronchial aspiration.
2. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada pelos tubos (1) serem confeccionados com as extremidades distais em formato curvo, sendo as pontas direcionadas para lados opostos. Endobronchial secretion aspiration probe according to claim 01, characterized in that the tubes (1) are made with distal ends in a curved shape, the ends being directed to opposite sides.
3. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada pelos tubos (1) serem confeccionados com as extremidades distais com comprimentos diferentes para as pontas (2) e (3). ENDOBRONCHIAL SECRECTION SUCTION PROBE, according to claim 01, characterized in that the tubes (1) are made with distal ends with different lengths for the ends (2) and (3).
4. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada pelos tubos (1) serem separados na extremidade proximal para possibilitar a aspiração seletiva dos brônquios (esquerdo ou direito) ou em ambos os brônquios Endobronchial secretion aspiration probe according to claim 01, characterized in that the tubes (1) are separated at the proximal end to allow selective aspiration of the bronchi (left or right) or both bronchi.
5. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 04, caracterizada pelos tubos (1) da sonda serem confeccionados com a extremidade proximal com comprimentos diferentes para orientar o operador a posicionar cada ponta no seu respectivo brônquio. ENDOBRONCHIAL SECRECTION SUCTION PROBE, according to claim 04, characterized in that the probe tubes (1) are made with the proximal end of different lengths to guide the operator to position each end in its respective bronchus.
6. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 04, caracterizada pelos tubos (1) da sonda compreenderem algum tipo de marcação para orientar o operador a posicionar cada ponta no seu respectivo brônquio. ENDOBRONCHIAL SECRECTION SUCTION Probe according to claim 04, characterized in that the probe tubes (1) comprise some type of marking to guide the operator to position each end in its respective bronchus.
7. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada por compreender um separador (5) na extremidade distai, para garantir o posicionamento adequado dos dois tubos nos brônquios esquerdo e direito. ENDOBRONCHIAL SECRECTION SUCTION Probe according to claim 01, characterized in that it comprises a separator (5) at the distal end to ensure proper positioning of the two tubes in the left and right bronchi.
8. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada por compreender orifícios frontal e laterais na porção final da extremidade distai, para a passagem das secreções do trato respiratório para o interior da sonda. ENDOBRONCHIAL SECRETUS SUCTION PROBE According to claim 01, characterized in that it comprises front and side holes in the end portion of the distal end for the passage of respiratory tract secretions into the probe.
9. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada por permitir a utilização de valores de pressões negativas diferentes para cada brônquio pulmonar. ENDOBRONCHIAL SECRECTION SUCTION Probe according to claim 01, characterized in that it allows the use of different negative pressure values for each pulmonary bronchus.
10. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada por compreender uma válvula (6) de sucção/conector de vácuo para cada tubo (1) designado para cada brônquio principal. ENDOBONCHIAL SECRETUS Suction Probe according to claim 01, characterized in that it comprises a suction valve (6) / vacuum connector for each tube (1) designated for each main bronchus.
11. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada por permitir a aspiração em sistema aberto ou fechado, sendo que neste último caso, não restringe a presença de acessórios, tais como, via de instilação, conector para administração de aerossol e filtros bacterianos, nebulização. ENDOBRONCHIAL SECRECTION SUCTION Probe according to claim 01, characterized in that it allows the aspiration in open or closed system, and in the latter case, it does not restrict the presence of accessories such as, via instillation, connector for administration. aerosol and bacterial filters, nebulization.
12. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 01 , caracterizada por permitir a aspiração endotraqueal, nasofaringe, orofaringe e subglótica convencionais. ENDOBRONCHIAL SECTION SECTION Suction probe according to claim 01, characterized in that it allows conventional endotracheal, nasopharyngeal, oropharyngeal and subglottic aspiration.
13. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, caracterizada por compreender um tubo cilíndrico único, bipartido na sua extremidade distai para possibilitar sua inserção até os brônquios esquerdo ou direito, para realizar a aspiração endobronquial unilateral ou bilateral. 13. Endometrial secretion aspiration probe, characterized in that it comprises a single cylindrical tube, split at its distal end to enable its insertion into the bronchi. left or right to perform unilateral or bilateral endobronchial aspiration.
14. SONDA DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, caracterizada por compreender um tubo cilíndrico único, com sua extremidade distai confeccionada em formato curvo, para possibilitar sua inserção até os brônquios esquerdo ou direito, para realizar a aspiração endobronquial unilateral. 14. Endometrial secretion aspiration probe, characterized in that it comprises a single cylindrical tube, with its distal end made in a curved shape, to enable its insertion into the left or right bronchi, to perform unilateral endobronchial aspiration.
15. SONDA DE ASPIRAÇÃO DE SECREÇÕES, caracterizada por compreender três módulos distintos, utilizados para realizar a aspiração endotraqueal, aspiração endobronquial unilateral e aspiração endobronquial bilateral, dispostos de forma a permitir ao operador selecionar qual deles será utilizado para realizar a aspiração. 15. Secretion aspiration probe, comprising three distinct modules used to perform endotracheal aspiration, unilateral endobronchial aspiration and bilateral endobronchial aspiration, arranged to allow the operator to select which one will be used for aspiration.
16. SONDA DE ASPIRAÇÃO DE SECREÇÕES, de acordo com a reivindicação 15, caracterizada pelo primeiro módulo compreender um tubo cilíndrico convencional com comprimento para a aspiração até a Carina, para realizar a aspiração endotraqueal. Secretion aspiration probe according to Claim 15, characterized in that the first module comprises a conventional cylindrical tube with a length for aspiration to Carina for performing endotracheal aspiration.
17. SONDA DE ASPIRAÇÃO DE SECREÇÕES, de acordo com a reivindicação 15, caracterizada pelo segundo módulo compreender um tubo cilíndrico com sua extremidade distai confeccionada em formato curvo, para possibilitar sua inserção até os brônquios esquerdo ou direito, para realizar a aspiração endobronquial unilateral. Secretion aspiration probe according to Claim 15, characterized in that the second module comprises a cylindrical tube with its distal end made in a curved shape to enable its insertion into the left or right bronchi for unilateral endobronchial aspiration.
18. SONDA DE ASPIRAÇÃO DE SECREÇÕES, de acordo com a reivindicação 15, caracterizada pelo terceiro módulo compreender um tubo cilíndrico com sua extremidade distai bipartido para possibilitar sua inserção até os brônquios esquerdo e direito, para realizar a aspiração endobronquial bilateral. Secretion aspiration probe according to claim 15, characterized in that the third module comprises a cylindrical tube with its split distal end to enable its insertion into the left and right bronchi for bilateral endobronchial aspiration.
19. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, caracterizado por permitir a aspiração de secreções localizadas no trato respiratório, tendo os brônquios principais direito e esquerdo como pontos anatómicos de referência para início da aspiração. 19. The method of aspiration of secretions, characterized by allowing the aspiration of secretions located in the tract. respiratory tract, with the right and left main bronchi as anatomical reference points for the beginning of aspiration.
20. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por permitir selecionar se a aspiração será realizada unilateral ou bilateralmente. The method of secretion aspiration according to claim 19, which allows selecting whether aspiration will be performed unilaterally or bilaterally.
21. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por permitir a seleção de níveis diferenciados de pressão negativa para a aspiração de cada brônquio-fonte diante de necessidades especiais. The method of secretion endocardial aspiration according to claim 19, characterized in that it allows the selection of different levels of negative pressure for aspiration of each source bronchus in the face of special needs.
22. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por consistir em introduzir uma sonda por via nasal, oral, tubo endotraqueal ou cânula de traqueostomia, para aspiração endobronquial na via aérea do indivíduo para sucção de fluidos biológicos oriundos do trato respiratório inferior. The method of secretion endocardial aspiration according to claim 19, which comprises introducing a nasal, oral, endotracheal tube or tracheostomy tube for endobronchial aspiration into the individual's airway for suction of biological fluids from of the lower respiratory tract.
23. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por ser aplicado ao sistema aberto ou fechado de aspiração. The method of secretion aspiration according to claim 19, characterized in that it is applied to the open or closed aspiration system.
24. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por promover uma perda de volume e colapso pulmonar em apenas um pulmão nos casos de aspiração unilateral. The method of secretion aspiration according to claim 19, characterized in that it promotes lung volume loss and collapse in only one lung in cases of unilateral aspiration.
25. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por remover uma maior quantidade de secreção pulmonar, em função de atingir os brônquios principais e porventura, as secreções mais espessas e/ou instaladas nestes brônquios-fonte e/ou que não foram deslocadas para a traquéia por processos mecânicos. The method of secretion endocardial aspiration according to claim 19, characterized in that it removes a greater amount of pulmonary secretion as a result of reaching the main bronchi and perhaps the thicker secretions and / or installed in these source bronchi and / or that were not displaced to the trachea by mechanical processes.
26. MÉTODO DE ASPIRAÇÃO ENDOBRONQUIAL DE SECREÇÕES, de acordo com a reivindicação 19, caracterizado por poder ser aplicado à rede de vácuo hospitalar ou aos aparelhos de aspiração portáteis, em ambientes hospitalares, ambulatorial e domiciliar. The method of secretion aspiration according to claim 19, characterized in that it can be applied to the hospital vacuum network or portable aspiration devices in hospital, outpatient and home environments.
PCT/BR2010/000291 2009-08-31 2010-08-31 Method and device for endobronchial aspiration of secretions WO2011022802A1 (en)

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