WO2020129077A1

WO2020129077A1 - Rescue dynamic ventilating device

Info

Publication number: WO2020129077A1
Application number: PCT/IN2019/050105
Authority: WO
Inventors: Nirav KOTAK; Atul WALZADE; Ashish PATYAL; Kalyanaraman ANANTHANARAYANAN
Original assignee: Kotak Nirav; Walzade Atul; Patyal Ashish; Ananthanarayanan Kalyanaraman
Priority date: 2018-12-17
Filing date: 2019-02-09
Publication date: 2020-06-25

Abstract

Rescue Dynamic ventilating device is a cost effective ventilating device which can be used to secure airway for conventional ventilation thus providing effective airway protection, oxygenation, removal of CO2 and also can be used as rescue device in cases of failed endotracheal intubation and also rescue patients from various extubation responses.It can be used to ventilate patient even in cases of difficult airway without changing any airway device. It has compact design hence can be used even in cases of reduced mouth opening. It offers a much larger lumen for ventilation once in trachea as the ventilating internal diameter of tube is much larger, hence better ventilation.

Description

RESCUE DYNAMIC VENTILATING DEVICE

FIELD OF INVENTION

This invention relates to cost effective ventilating device which can be used to secure airway for conventional ventilation and also can be used as rescue device in cases of failed endotracheal intubation and also rescue patients from various extubation responses.

BACKGROUND AND PRIOR ART OF INVENTION

The expression“endotracheal tube” generally designates an appropriate size tube that is inserted through the mouth into the trachea. Orotracheal intubation consists of inserting a tube through the mouth, the laryngeal inlet and into the trachea of a patient. This procedure is commonly performed in medical conditions in patients who are unable to protect their airways, are at risk of pulmonary aspiration and those that require assistance with mechanical ventilation. It is also commonly performed to enable mechanical ventilation for safe general anaesthesia during surgery. An orotracheal tube is inserted under direct vision through the vocal cords normally in an unconscious patient. However some patients are known to be difficult to intubate under direct laryngoscopy, especially if there are anatomical abnormalities and any disease state causing change in normal orotracheal anatomy or if the larynx lies particularly anteriorly. Other patients are unexpectedly found during direct laryngoscopy to be difficult to intubate this way. Intubation of these patients may be more successful using indirect laryngoscopy. This can be performed using a videolaryngoscope such as those sold under the trademarks Airtraq and GlideScope and also with fiberoptic or fibreless flexible bronchoscope. While in absence of above specialized airway equipment we can still secure airway with supraglottic devices like Laryngeal mask airway, Laryngeal tube,combitube or front of neck access such as

Tracheostomy tube or Cricothyrodectomy equipment. Significant and potentially detrimental hemodynamic changes associated with both laryngoscopy and tracheal intubation are also attenuated and are of shorter duration with the use of the laryngeal mask airway. Compared with an endotracheal tube, the anesthetic requirement for tolerance of the Laryngeal mask airway has also been reported to be less. During emergence from anesthesia the Supraglottic airway devices are better tolerated, with lesser incidence of hyperactive airway responses (e.g., coughing, laryngospasm, breath holding) and hyperdynamic pressure responses than with an endotracheal tube. For suppressing above responses to endotracheal tube, Baileys manoeuvre is used when endotracheal tube is exchanged with supraglottic airway devises. The anatomic placement of supraglottic devises avoids any damage to the trachea and vocal cords with also a reduced incidence of postoperative sore throat as well as hoarseness

LMA(laryngeal mask Airway) were initially used primarily in the operating room setting, but recently have become useful in emergency situations as an important accessory device for management of the difficult airway. It is designed to occupythe patient’s hypopharynx and cover the supraglottic structures, thereby allowing ventilation through trachea.

The Laryngeal Tube is a supraglottic airway device for the use in general anesthesia or in emergency as an adjunct to secure the airway during difficult airway management

The Combitube— also known as the esophageal tracheal airway or esophageal tracheal double lumen airway— is a blind insertion airway device which consists of a cuffed, double-lumen tube that is inserted through the patient's mouth. Usually, the distal tube enters the esophagus, where the cuff is inflated and ventilation is provided through the proximal tube which opens at the level of the larynx. In the rare instance where the distal tube intubates the trachea, ventilation is provided through the distal tube.

DISADVANAGES OF THE ABOVE MENTIONED DEVICES:

Prolonged face mask use can cause Ocular and facial nerve injuries associated with prolonged pressure. Combitubescan cause serious complications such as aspiration, esophagus perforation and cranial nerve dysfunction. Oesophagial intubation of Combitube will give rise to pressure necrosis of laryngeal mucosa because of constant cuff pressure. Combitubecannot be used for long term tracheal intubation and ventilation because the external diameter is bigger than the ventilating internal diameter , causing increased airway pressure, inadequate ventilation inadequate oxygenation, retention of C02 leading to raised Intracranial tension or Intra ocular pressure.

Supraglottic airway devises if used as in Bailey's manoeuvrethough haveadvantages, will be time consuming and expensive. Primary disadvantage of LMA is the inability to isolate the airway and to protect against the risk of aspiration. Regurgitation and aspiration have been reported with the use of the LMA.

The use of Laryngeal tubes not recommended in patient with an intact gag reflex,

known oesophageal disease, and patient who have ingested caustic substances. Laryngeal tube cannot be used for tracheal intubation. As it is toobulky, cannot be used in difficult mouth opening. It cannot be used for long term ventilation as there is risk of presser necrosisby laryngeal cuff.

In case of difficult intubation if ETT doesn't pass into trachea for prolong duration thenrisk of hypoxia, retention of C02 leading to raised Intracranial tension, Intra ocular pressure or hyperdynamic responses especially in elderly patient, hypertensive patient or patient with heart disese.in this emergency situation search for rescue devises and more experience person will lead to vital time lapse and increased expenses. In case of difficult airway front of neck devises are used which are more invasive can cause bleeding. It is also time consuming and require expertise. They can cause long term complication like tracheal stenosis.

ADVANTAGES OF THIS INVENTION:

1 . Can be used to ventilate patient even in cases of difficult airway WITHOUT changing any airway device or tubes or calling for extra personnel thus preventing any hypoxia, also prevention of any presser responses because of time saved in difficult intubation.

2. Cost effective as no extra airway instruments or tubes or extra persons for help required.

3. Advantage over laryngeal tube is can be used as a normal endotracheal tube which is not possible

4. It has compact design as compare to other supraglottic airway devises hence can be u sed even in cases of reduced mouth opening.

5. Advantage over combitube is it offers a much larger lumen for ventilation once in trachea as the ventilating internal diameter of tube is much larger, hence better ventilation.

6. Also can be used as LMA during Bailey's manoeuvre without changing tube thus saving cost of extra instruments also saving time and preventing hypoxia.

7. ETTs are gold standard for airway protection, oxygenation, and removalof C02.The above devise has all the above advantage of ETT as well as advantages of SGA.

8. Ocular and facial nerve injuries associated with prolonged face mask use are also

avoided.

OBJECTS OF THE INVENTION:

The main object of this invention is to give a novel airway device for intubation which can be used in all airways especially difficult airway and also rescue patients from various extubation responses. It can be used to ventilate patient even in cases of difficult airway without changing any airway device DETAILED DESCRIPTION OF INVENTION:

Fig 1 is longitudinal structure of Rescue Dynamic ventilating device (vertical cross section) which shows Larger ventilating tube(1 ), Smaller supraglotic ventilating tube(2), Distal cuff over larger ventilating tube(3), Proximal dynamic pharyngeal cuff(4), Distal cuff inflating channel(5), Proximal dynamic cuff inflating pores(6), supraglotic ventilating tube distal opening(7), distal cuff pilot bulb(8), incisor mark for distal tube while in trachea(9), black line on larger tube

corresponding to glottis(10), proximal large tube universal connector(1 1 )

Fig 2 shows transverse section in which Diagram A shows cross section of the device distal to the smaller ventilating tube it shows Larger ventilating tube(1 ) and Distal cuff inflating channel ( 5) Diagram B shows cross section of both larger and smaller tube at the level of Proximal dynamic pharyngeal cuff ( 4). It also shows distal cuff inflating channel (5) Proximal dynamic cuff inflating pores(6) and supraglotic ventilating tube distal opening ( 7)

Fig. 3 shows Rescue Dynamic ventilating device with larger ventilating tube (1 ) into trachea (13) with distal cuff inflated and ventilation occurring through proximal large tube universal connector (1 1 ). It also shows air flow (15) through larger ventilating tube directly into trachea while inspiration.

Fig 4 shows Rescue Dynamic ventilating device with larger ventilating tube (1 ) into esophagus with smaller supraglottic ventilating tube (2) lying above the esophagus into hypopharynx . Diagram A shows inspiration through the smaller supraglottic ventilating tube (2) only, with distal cuff (3) inflated into esophagus thus avoiding any air entry into esophagus, thus only ventilating only trachea (16). It also shows airflow through supraglotic ventilating small tube while inspiration (16) which causes dynamic cuff inflation while positive pressure ventilation (17) with the dynamic cuff approximating pharyngeal space while ventilation (18) and avoiding any air escaping above hypopharynx. Diagram B shows proximal cuff deflated while passive exhalation (19) thus allowing passive expiration (20)

A single embodiment of the invention has been described herein. Many variation could be made without departing from the spirit of invention. All sizes are available which can be used in patients of variable age. The length and size will be variable depending on length and size required for particular patient age.

Claims

CLAIMS-

1 . Rescue dynamic ventilating device can used as normal endotracheal intubation as well as supraglottic airway device with dynamic cuff and also can be placed as rescue device if normal intubation is failed.

2. Rescue dynamic ventilating device as set forth in claim number one can be used to ventilate patient even in cases of difficult airway WITHOUT changing any airway device or tubes or calling for extra personnel thus preventing any hypoxia, also prevention of any pressure responses because of time saved in difficult intubation.

3. Rescue dynamic ventilating device as set forth in claim number one is Cost effective as no extra airway instruments or tubes or extra persons for help required.

4. Rescue dynamic ventilating device as set forth in claim number one can be used as a normal endotracheal tube which is not possible

5. Rescue dynamic ventilating device as set forth in claim number one has compact

design as compare to other supraglottic airway devises hence can be used even in cases of reduced mouth opening.

6. Rescue dynamic ventilating device as set forth in claim number one can offers a much larger lumen for ventilation once in trachea as the ventilating internal diameter of tube is much larger, hence better ventilation.

7. Rescue dynamic ventilating device as set forth in claim number one can be used as LMA during Bailey's manoeuvre without changing tube thus saving cost of extra instruments also saving time and preventing hypoxia.

8. Rescue dynamic ventilating device as set forth in claim number one can be useful in airway protection, oxygenation, removal of C02

9. Rescue dynamic ventilating device as set forth in claim number one has less chance of ocular or facial nerve injury do to pressure on them.