US 5,819,723 AGranted

Methods and apparatus for reducing tracheal infection

AssigneeThomas Jefferson University

InventorJeffrey I. Joseph

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Abstract

An integrated system providing a mechanical and chemical barrier against the spread of infected secretions into the distal trachea is disclosed. An endotracheal tube is used for patient airway management and provides a means to conveniently irrigate and drain the subglottic region below the vocal cords and above an inflated cuff. The subglottic region accumulates liquid secretions that may channel past an inflated endotracheal tube cuff, providing the necessary bacterial inoculum leading to bronchitis and nosocomial pneumonia. An irrigation channel delivers liquids such as saline or antibiotic and antifungal medications for mucosal hydration, and bactericidal action against infected subglottic secretions. An outer sleeve surrounding the endotracheal tube forms a suction lumen for removing the secretions. Electronic and mechanical controls provide regulated volume infusion and regulated suction.

Claims45

Dependent claims

An integrated system providing an improved mechanical and chemical barrier against the spread of acidic or infected secretions into the distal trachea comprising an endotracheal tube, wherein the endotracheal tube comprises:

a thin walled, compliant outer sheath;
defining a suction channel concentric with an outer wall of the endotracheal tube for removing acidic or infected secretions from a subglottic region below the vocal cords and above an inflated cuff, the outer sheath terminating immediately above the inflated endotracheal tube cuff;
and
an irrigation channel integral with the outer wall for delivering a non-viscous liquid to the subglottic region for tissue hydration and the dilution of bacterial inoculum, used in combination with an outer sleeve suction channel to provide a mechanical irrigation and drainage of the subglottic region in a manner similar to surgical management of an infected body space, whereby topical delivery of an antibiotic and antifungal solution to the subglottic region provides a chemical barrier against the distal spread of infected secretions, thereby significantly decreasing the number of bacteria and the degree of infectivity of those liquid secretions that pass the inflated cuff, and further, the irrigation channel also provides for the irrigation and drainage of a dilute solution of topical local anesthetic, whereby the local anesthetics produce a numbing field block for awake intubated patients, thereby providing an integrated system for the topical delivery of therapeutic medication requiring rapid access to a highly vascular mucous membrane, such as antihypertensive and antianginal medications, the system further comprising an electronic and mechanical control device for regulating and integrating irrigation, suction, and cuff pressure, wherein subglottic irrigation will cease if suction or cuff pressure regulation malfunction and wherein an alarm condition is indicated if any one of irrigation, suction and cuff pressure regulation are not functional.

1 more element

A system for intubating a patient with a tracheal tube having a proximal and a distal end and having an inflatable cuff disposed near the distal end of the tracheal tube, a subglottic suction lumen having a distal end terminating at an opening proximal of and superior to the inflatable cuff, and an irrigation lumen having a distal end terminating at an opening proximal of and superior to the inflatable cuff, comprising:

a cuff pressure regulator for controlling the pressure in the inflatable cuff and having a compressor and a relief valve adaptable to be in flow communication with the inflatable cuff and an electronic pressure regulator adaptable to cycle the compressor and supply pressure to the cuff if pressure within the cuff is less than a predetermined minimum pressure and open the relief valve if pressure within the cuff exceeds a predetermined maximum pressure;
a suction regulator, for controlling the suction through the subglottic suction lumen that is adaptable to suction in a suglottic region exterior to the tracheal tube and proximal to the inflatable cuff, the suction regulator having a pump in flow communication with the subglottic suction lumen;
and
a control device for regulating and integrating irrigation through the irrigation lumen, suction through the subglottic suction lumen, and cuff pressure in the inflatable cuff, wherein subglottic irrigation will cease if suction or cuff pressure regulation malfunction and wherein an alarm condition is indicated if any one of irrigation, suction and cuff pressure regulation are not functional.

1 more element

Dependencies are inferred from the claim text.

Facts

Application: 08/702,676Filed 30 Aug 1996 · continuation in part
Priority: 2 Mar 1994
Granted: 13 Oct 1998
Term ends: Not estimatedThe source records don’t support an estimate.

Classification7 codes

A61M 16/044
Cuffs: external cuff pressure control or supply, e.g. synchronisation with respiration
A61M 16/0463
Tracheal tubes: combined with suction tubes, catheters or the like; Outside connections
A61M 16/0479
With incorporated means for delivering or removing fluids: above the cuff, e.g. giving access to the upper trachea
A61M 16/0486
Tracheal tubes: multi-lumen tracheal tubes