Esophageal tracheal intubator airway

• US 5,513,627 A
• Filed: 01/27/1995
• Issued: 05/07/1996
• Est. Priority Date: 01/27/1995
• Status: Expired due to Fees

• Current Assignee: Kanton Zurich Vertreten Durch Die Erziehungsdirektion
• Original Assignee: Gary H. Flam
• Inventors: Flam, Gary H.
• Primary Examiner(s): Bennett, Christopher A.
• Assistant Examiner(s): RACITI, ERIC
• Application Number:
  US08/380,015
• Time in Patent Office: 466 Days
• Field of Search: 128/207.14, 128/207.15, 128/200.26, 128/206.26, 128/10, 128/11, 128/911, 128/912, 128/4, 128/15, 128/16, 604/96-103, 604/174, 604/23
• US Class Current: 128/200.26
• CPC Class Codes: A61M 16/0409 with mean for closing the oesophagus
• CPC Class Codes: A61M 16/0415 with access means to the stomach
• CPC Class Codes: A61M 16/0445 Special cuff forms, e.g. undulated
• CPC Class Codes: A61M 16/0463 combined with suction tubes, catheters or the like; Outside connections
• CPC Class Codes: A61M 16/0486 Multi-lumen tracheal tubes
• CPC Class Codes: A61M 16/0488 Mouthpieces; Means for guiding, securing or introducing the tubes guiding or introducing with laryngoscopes A61B1/267; holding devices on the body A61M25/02
• CPC Class Codes: A61M 16/0493 with means for protecting the tube from damage caused by the patient's teeth, e.g. bite block

Abstract

An esophageal tracheal intubator airway device which allows rapid blind access to the larynx and esophagus of a patient for lung ventilation, stomach suctioning, fiberscopic examination of the upper respiratory and upper gastrointestinal tracts, and passage of an endotracheal tube into the trachea. The device has a conical positioning element which conforms to the base of the throat beneath the epiglottis and an elongate tubular esophageal conduit which extends through the positioning element and rearwardly therefrom in an arcuate curve. The esophageal conduit is sized to allow passage of a gastric suction tube and related medical instruments therethrough into the patient'"'"'s esophagus. A laryngeal channel extends inwardly from the positioning element proximal end and curves outwardly to define an opening through the side wall of the positioning element. The channel is sized to allow passage of a cuffed endotracheal tube and related medical instruments therethrough into the patient'"'"'s larynx and trachea. An inflatable tubular ring secured to the positioning element side wall surrounds the opening and when inflated, forms a sealing relation around the patient'"'"'s laryngeal inlet while causing the positioning element to back out relative to the throat a sufficient distance for a lip at its proximal end to lift the tip of the epiglottis up and out of the way of the side wall opening.

Claims

1. An esophageal tracheal intubator airway device to facilitate rapid blind access to the larynx and esophagus of a patient for lung ventilation, stomach suctioning or fiberscopic examination of the upper respiratory and upper gastrointestinal tracts, and passage of an endotracheal tube into the trachea comprising:

a generally tapered positioning element receivable through the mouth having a distal end, a proximal end, and a side wall extending therebetween configured to conform with the base of the throat behind the epiglottis;

an elongate tubular esophageal conduit having a distal portion extending longitudinally through said positioning element and secured thereto with a distal tip end flush with said positioning element distal end, the remaining portion extending rearwardly from said positioning element proximal end in a gently curved arcuate configuration, and having an interior diameter of sufficient size to allow passage of a gastric suction tube and related medical instruments therethrough into the patient'"'"'s esophagus;

a laryngeal channel in said positioning element extending inwardly a distance from its proximal end laterally adjacent said esophageal conduit and curving outwardly to define an opening through its said side wall;

said opening being positioned to become generally aligned with the patient'"'"'s larynx when said positioning element is disposed in the base of the throat behind the epiglottis, and said laryngeal channel having an interior diameter of sufficient size to allow passage of a cuffed endotracheal tube and related medical instruments therethrough into the patient'"'"'s larynx and trachea;

a generally oval-shaped inflatable tubular member secured to said positioning element side wall substantially surrounding said opening configured to form a sealing relation around the patient'"'"'s laryngeal inlet when inflated; and

an inflation tube having a distal end connected with said inflatable member and a proximal end adapted to be connected to inflation means for inflating said inflatable tubular member.

2. An esophageal tracheal intubator airway device according to claim 1 wherein

said positioning element is formed of soft semi-flexible material which will conform to the interior surfaces of the patient'"'"'s throat against which it is placed without traumatizing the throat.

3. An esophageal tracheal intubator airway device according to claim 1 wherein

said positioning element is a generally conical-shaped positioning member having a rounded distal end and a tapered side wall diverging rearwardly therefrom and terminating in a wider proximal end.

4. An esophageal tracheal intubator airway device according to claim 1 wherein

said esophageal conduit is formed of flexible material of sufficient stiffness to serve as a handle for manually manipulating said positioning element.

5. An esophageal tracheal intubator airway device according to claim 1 wherein

said positioning element has a generally flat proximal end with an anterior lip extending radially outward to one side configured to engage the epiglottis.

6. An esophageal tracheal intubator airway device according to claim 4 wherein

said inflatable tubular member is secured on the side wall of said positioning element a predetermined distance relative to said positioning element anterior lip and is sized and shaped to form a seal around the patient'"'"'s laryngeal inlet in the inflated condition, and when inflated to push said positioning element and anterior lip outwardly relative to the throat distance sufficient to engage said anterior lip on the epiglottis and lift the tip of the epiglottis up and out of the way of said laryngeal channel opening on said positioning element side wall.

7. An esophageal tracheal intubator airway device according to claim 1 further comprising

an endotracheal tube having a distal end slidably received in said laryngeal channel.

8. An esophageal tracheal intubator airway device according to claim 7 wherein

said endotracheal tube has an inflatable cuff surrounding its distal end and an inflation tube having a distal end connected with said inflatable cuff and a proximal end adapted to be connected to inflation means for inflating said cuff, whereby

said endotracheal tube may be temporarily secured within said laryngeal channel with its distal end flush with said opening in said positioning element side wall by inflating said cuff to engage the interior diameter of said laryngeal channel to facilitate insertion of said positioning element and said endotracheal tube as a single unit into the mouth of the patient and through the throat past the epiglottis until said positioning element comes to rest in the base of the throat, and

after said inflatable tubular member is inflated, said cuff may be deflated and said endotracheal tube moved relative to said positioning element.

9. An esophageal tracheal intubator airway device according to claim 1 further comprising

a clip means movably connected with said esophageal conduit near its proximal end and having a laterally extending portion configured to releasably receive and hold the proximal end of an endotracheal tube or related medical instrument in a position generally parallel to said esophageal conduit.

10. An esophageal tracheal intubator airway device according to claim 9 wherein

said clip means is movable relative to said esophageal conduit and said endotracheal tube or related medical instrument held thereby to be positioned between the upper and lower teeth of the patient to function as a bite block, and

said clip means is formed of relatively stiff resilient material sufficiently soft to prevent trauma to the teeth and gums while at the same time preventing said esophageal conduit and said endotracheal tube or related medical instrument held thereby from being compressed or damaged by the patient biting on them.

11. A method for rapid blind esophageal tracheal intubation of plural tubes from outside the mouth of a patient into the upper respiratory and upper gastrointestinal tracts, for lung ventilation, stomach suctioning or fiberscopic examination, and passage of an endotracheal tube into the trachea comprising the steps of:

providing a generally tapered positioning element having a distal end, a proximal end, and a side wall configured to conform with the base of the throat behind the epiglottis, an anterior lip extending radially outward to one side of said proximal end, an elongate tubular esophageal conduit having a distal portion extending longitudinally therethrough and a proximal portion extending rearwardly from said positioning element, a laryngeal channel in said positioning element extending inwardly a distance from said proximal end and curving outwardly to define an opening through said side wall, an inflatable tubular member secured to said side wall surrounding said opening configured to form a sealing relation around the patient'"'"'s laryngeal inlet when inflated, and an inflation tube connected with said inflatable tubular member for inflating said inflatable tubular member;

said esophageal conduit having an interior diameter of sufficient size to allow passage of a gastric suction tube and related medical instruments therethrough into the patient'"'"'s esophagus, and said laryngeal channel having an interior diameter of sufficient size to allow passage of an endotracheal tube and related medical instruments therethrough into the patient'"'"'s larynx and trachea;

installing the distal portion of an endotracheal tube into said laryngeal channel and temporarily fixing its distal end flush with the opening in the side wall of said positioning element;

inserting said positioning element with said endotracheal tube installed, as a single unit, into the mouth of the patient, through the throat past the epiglottis until said positioning element distal end enters the esophageal opening and said anterior lip is disposed just behind the epiglottis with said inflatable tubular member around the patient'"'"'s laryngeal inlet;

forming a seal around the patient'"'"'s laryngeal inlet and lifting the tip of the epiglottis up and out of the way of said positioning element laryngeal channel opening by inflating said inflatable tubular member with sufficient pressure to form a seal around the laryngeal inlet and simultaneously cause said positioning element to back outwardly relative to the throat a sufficient distance to cause said anterior lip to engage and lift the tip of the epiglottis up and out of the way of said laryngeal channel opening on said positioning element side wall; and

if stomach suction or fiberscopic examination is required, passing a gastric suction tube or related medical instrument through said esophageal conduit relative to said positioning element into the patient'"'"'s esophagus or upper gastrointestinal tracts, as appropriate; and

if lung ventilation or fiberscopic examination is required, passing said endotracheal tube or related medical instrument through said laryngeal channel relative to said positioning element into the patient'"'"'s trachea or upper respiratory tract, as appropriate.

12. The method according to claim 11 wherein said step of installing said endotracheal tube comprises:

installing said endotracheal tube into said laryngeal channel with its distal end flush with the opening in the side wall of said positioning element;

installing the distal end of a fiberscope through said endotracheal tube; and

thereafter

moving said endotracheal tube and said fiberscope together or independently relative to one another and relative to said positioning element to pass said endotracheal tube and said fiberscope into the patient'"'"'s trachea or upper respiratory tract, as appropriate.

13. The method according to claim 11 including the further steps of:

removing said gastric suction tube or related medical instrument by pulling it out of said esophageal conduit relative to said positioning element; and

removing said endotracheal tube or related medical instrument by pulling it outward through said laryngeal channel relative to said positioning element.

14. The method according to claim 11 including the further steps of:

removing said gastric suction tube or related medical instrument by pulling it out of said esophageal conduit relative to said positioning element;

deflating said inflatable tubular member;

removing said positioning element by pulling it out of the patient'"'"'s throat and mouth along the length of said endotracheal tube or related medical instrument and relative thereto until said laryngeal channel clears the proximal end thereof; and

thereafter

leaving said endotracheal tube or related medical instrument in the patient'"'"'s trachea or upper respiratory tract for lung ventilation or fiberscopic examination, as appropriate.

15. A method for rapid blind esophageal tracheal intubation of plural tubes from outside the mouth of a patient into the upper respiratory and upper gastrointestinal tracts, for lung ventilation, stomach suctioning or fiberscopic examination, and passage of an inflatable cuff endotracheal tube into the trachea comprising the steps of:

providing a generally tapered positioning element having a distal end, a proximal end, and a side wall configured to conform with the base of the throat behind the epiglottis, an anterior lip extending radially outward to one side of said proximal end, an elongate tubular esophageal conduit having a distal portion extending longitudinally therethrough and a proximal portion extending rearwardly from said positioning element, a laryngeal channel in said positioning element extending inwardly a distance from said proximal end and curving outwardly to define an opening through said side wall, an inflatable tubular member secured to said side wall substantially surrounding said opening configured to form a sealing relation around the patient'"'"'s laryngeal inlet when inflated, and an inflation tube connected with said inflatable tubular member for inflating said inflatable tubular member;

said esophageal conduit having an interior diameter of sufficient size to allow passage of a gastric suction tube and related medical instruments therethrough into the patient'"'"'s esophagus, and said laryngeal channel having an interior diameter of sufficient size to allow passage of an inflatable cuff endotracheal tube and related medical instruments therethrough into the patient'"'"'s larynx and trachea;

installing the distal portion of an inflatable cuff endotracheal tube into said laryngeal channel with its distal end flush with the opening in the side wall of said positioning element, and inflating the cuff of said inflatable cuff endotracheal tube to engage the interior diameter of said laryngeal channel and maintain said distal end flush with the opening in the side wall of said positioning element;

inserting said positioning element with said inflatable cuff endotracheal tube installed, as a single unit, into the mouth of the patient, through the throat past the epiglottis until said positioning element distal end enters the esophageal opening and said anterior lip is disposed just behind the epiglottis with said inflatable tubular member around the patient'"'"'s laryngeal inlet;

forming a seal around the patient'"'"'s laryngeal inlet and lifting the tip of the epiglottis up and out of the way of said positioning element laryngeal channel opening by inflating said inflatable tubular member with sufficient pressure to form a seal around the laryngeal inlet and simultaneously cause said positioning element to back outwardly relative to the throat a sufficient distance to cause said anterior lip to engage and lift the tip of the epiglottis up and out of the way of said laryngeal channel opening on said positioning element side wall; and

if lung ventilation or fiberscopic examination is required, deflating said cuff of said inflatable cuff endotracheal tube and moving said inflatable cuff endotracheal tube relative to said positioning element to pass said inflatable cuff endotracheal tube through said laryngeal channel into the patient'"'"'s trachea or upper respiratory tract or to remove said endotracheal tube from said positioning element, as appropriate; and

if stomach suction or fiberscopic examination is required, passing a gastric suction tube or related medical instrument through said esophageal conduit relative to said positioning element into the patient'"'"'s esophagus or upper gastrointestinal tracts, as appropriate.