Device for artificial respiration with an endotracheal tube

• US 7,481,222 B2
• Filed: 05/08/2002
• Issued: 01/27/2009
• Est. Priority Date: 05/10/2001
• Status: Expired due to Fees

• Current Assignee: Hajo Reissmann
• Original Assignee: Hajo Reissmann
• Inventors: Reissmann, Hajo
• Primary Examiner(s): Douglas; Steven O
• Application Number:
  US10/477,263
• Publication Number:
  US 20040231673A1
• Time in Patent Office: 2,456 Days
• Field of Search: 12820714-20718, 128/200.24, 128/200.28, 128/206.26, 128/911, 128/912, 604/93.01, 604/96.01, 604/98.01, 604/102.01, 604/118, 604/119, 604/128, 600/531
• US Class Current: 128/207.14
• CPC Class Codes: A61M 16/0096 High frequency jet ventilation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/04 Tracheal tubes catheters in general A61M25/00
• CPC Class Codes: A61M 16/042 with separate conduits for in-and expiration gas, e.g. for limited dead volume
• 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 16/1045 Devices for humidifying or heating the inspired gas by using recovered moisture or heat from the expired gas
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2016/0042 in the expiratory circuit
• CPC Class Codes: Y10S 128/911 Unilimb inhalation-exhalation breathing tubes
• CPC Class Codes: Y10S 128/912 Connections and closures for tubes delivering fluids to or from the body

Abstract

A device for ventilation, comprising

• • a ventilator for providing a stream of gas for ventilation at an outlet,
  • a hose for inspiration air one end of which is connected to the outlet,
  • a double-lumen endotracheal tube one lumen of which, at its end distal to the patient, is connected to the other end of the hose for inspiration air,
  • flow meters for measuring the streams of gas in the two lumina of the endotracheal tube,
  • pressometers for measuring the pressures at the ends distal to the patient of the two lumina,
  • an evaluation means for determining the flow resistance in a lumen flowed through by gas because of the stream of gas measured therein and the pressures measured, and
  • a means for outputting an information about the flow resistance of the lumina.

Claims

1. A device for ventilation of a patient, the device comprising

a ventilator having an outlet for providing a stream of gas for ventilation and an inlet for receiving a stream of expired gas,

a double-lumen endotracheal tube having an end distal to the patient and a tracheal end that engages the patient'"'"'s trachea, wherein, at the end distal to the patient, a lumen for inspiratory gas is connected to the ventilator outlet and a separate lumen for expiratory gas is connected to the ventilator inlet such that, during ventilation, a stream of gas is only flowing through one lumen at a time,

a flow meter located at the end of the double-lumen endotracheal tube distal to the patient and connected to the inspiratory lumen and a separate flow meter located at the end of the double-lumen endotracheal tube distal to the patient and connected to the expiratory lumen, and

a pressometer located at the end of the double-lumen endotracheal tube distal to the patient and connected to the inspiratory lumen and a separate pressometer located at the end of the double-lumen endotracheal tube distal to the patient and connected to the expiratory lumen, the pressometers being adapted for alternating between measuring the pressure directly at the end distal to the patient of the double-lumen endotracheal tube and the pressure at the tracheal end of the double-lumen endotracheal tube depending upon which lumen through which gas is flowing.

2. The device according to claim 1 wherein one or more of the flow meters or pressometers are integrated in the ventilator.

3. The device according to claim 1 comprising valve means located at the ventilator inlet for connecting the with one or both of the environment and the outlet.

4. The device according to claim 1, further comprising

a closable opening at the end distal to the patient of the expiratory lumen to sealingly introduce a suction catheter up to the tracheal end of the endotracheal tube.

5. The device according to claim 1, further comprising a means for applying a high frequency oscillating pressure to the end distal to the patient of the inspiratory lumen.

6. The device according to claim 1, further comprising

a computer for determining the flow resistance in the inspiratory lumen and the expiratory lumen, based on measurements from the flow meters and the pressometers.

7. The device according to claim 1, further comprising an evaluation means for determining the flow resistance in an individual lumen.

8. The device according to claim 1, further comprising a means for outputting an information about the flow resistance of the lumina.

9. The device according to claim 1, further comprising at least one membrane permeable to water in a wall between the inspiratory lumen and the expiratory lumen of the endotracheal tube.

10. The device according to claim 9, wherein the membrane passes water from the expired breath in the expiratory lumen to the inspiratory lumen.

11. The device according to claim 9, further comprising means for heating the stream of ventilation gas.

12. The device according to claim 9, wherein the membrane comprises a filter.

13. The device according to claim 1, wherein the endotracheal tube comprises an asymmetric endotracheal tube.

14. The device according to claim 13, wherein the expiratory lumen has a larger cross-section than the inspiratory.

15. The device according to claim 1, wherein one lumen of the endotracheal tube is enveloped by the other lumen of the endotracheal tube.

16. A method for determining the flow resistance of an endotracheal tube comprising:

(a) providing a ventilation system comprising;

(i) a ventilator having an outlet for providing a stream of gas for ventilation and an inlet to which a stream of expired gas is fed;

(ii) a double-lumen endotracheal tube having an end distal to the patient and a tracheal end that engages the patient'"'"'s trachea, wherein, at the end distal to the patient, a lumen for inspiratory gas is connected to the ventilator outlet and a separate lumen for expiratory gas is connected to the ventilator inlet such that, during ventilation, a stream of gas is only flowing through one lumen at a time;

(iii) a flow meter located at the end of the double-lumen endotracheal tube distal to the patient and connected to the inspiratory lumen and a separate flow meter located at the end of the double-lumen endotracheal tube distal to the patient and connected to the expiratory lumen; and

(iv) a pressometer located at the end of the double-lumen endotracheal tube distal to the patient and connected to the inspiratory lumen and a separate pressometer located at the end of the double-lumen endotracheal tube distal to the patient and connected to the expiratory lumen, the pressometers being adapted to alternate between measuring the pressure directly at the end distal to the patient of the double-lumen endotracheal tube and the pressure at the tracheal end of the double-lumen endotracheal tube depending upon which lumen through which gas is flowing;

(b) calculating the flow of gas in one or both lumina;

(c) calculating the pressure of the gas in one or both lumina; and

(d) determining the flow resistance within the endotracheal tube based on the calculated gas flow and gas pressure.

17. The method of claim 16, wherein one or more of the flow meters and pressometers are located on the ventilator.

18. The method of claim 16, wherein the device further comprises evaluation means for determining the flow resistance within the endotracheal tube.

24. The method of claim 16, wherein step (c) comprises using the pressometer connected to the lumen through which gas is flowing to measure the gas pressure directly at the end distal to the patient of the lumen through which gas is flowing and using the pressometer connected to the lumen through which gas is not flowing to measure the gas pressure at the tracheal end of the lumen through which gas is flowing.

25. The method of claim 24, comprising using the gas pressure directly at the end distal to the patient of the lumen through which gas is flowing and the gas pressure at the tracheal end of the lumen through which gas is flowing to calculate the pressure loss of the lumen through which gas is flowing.

26. The method of claim 16, comprising alternating between determining flow resistance of the inspiratory lumen and the expiratory lumen of the double-lumen endotracheal tube.

27. The method of claim 16, comprising using the determined flow resistance to evaluate whether the endotracheal tube is kinked or clogged and whether corrective actions are required.

19. A method for increasing moisture content in air inspired by a patient through an endotracheal tube, the method comprising:

(a) providing a ventilation system comprising;

(i) a ventilator having an outlet for providing a stream of gas for ventilation;

(ii) a double-lumen endotracheal tube, having an inspiratory lumen for transmission of the gas for ventilation from the ventilator and a separate expiratory lumen for transmission of air expired by the patient, the inspiratory lumen and the expiratory lumen being separated by a wall; and

(iii) at least one membrane permeable to water located in the wall between the inspiratory lumen and the expiratory lumen of the endotracheal tube; and

(b) initiating inspiration and expiration of air through the endotracheal tube such that moisture from the expired air condenses on the side of the membrane adjacent the expiratory lumen, the moisture exchanges through the membrane, and is re-absorbed in the inspiratory lumen by the stream of gas for ventilation provided by the ventilator.

20. The method of claim 19, further comprising heating the stream of gas in the inspiratory lumen.

21. The method of claim 19, wherein one lumen of the endotracheal tube is enveloped by the other lumen of the endotracheal tube.

22. A method of removing clogging matter from an endotracheal tube during intubation of a patient while maintaining tracheal pressure, the method comprising:

(a) providing a ventilation system comprising;

(i) a ventilator having an outlet for providing a stream of gas for ventilation and an inlet for receiving a stream of expired gas;

(ii) a double-lumen endotracheal tube, having an end distal to the patient and a tracheal end that engages the patient'"'"'s trachea, wherein, as the end distal to the patient, a lumen for inspiratory gas is connected to the ventilator outlet and a separate lumen for expiratory gas is connected to the ventilator inlet such that, during ventilation, a stream of gas is only flowing through one lumen at a time;

(iii) a closable opening in the expiratory lumen;

(iv) a flow meter located at the end of the endotracheal tube distal to the patient and connected to the inspiratory lumen and a separate flow meter located at the end of the endotracheal tube distal to the patient and connected to the expiratory lumen;

(v) a pressometer located at the end of the endotracheal tube distal to the patient and connected to the inspiratory lumen and a separate pressometer located at the end of the endotracheal tube distal to the patient and connected to the expiratory lumen, the pressometers being adapted to alternate between measuring the pressure directly at the end distal to the patient of the endotracheal tube and the pressure at the tracheal end of the endotracheal tube depending upon which lumen through which gas is flowing; and

(vi) evaluation means for determining the flow resistance in a lumen in relation to the gas flow and the gas pressure of the lumen;

(b) sealingly introducing through the closable opening a device for removal of clogging matter in the expiratory lumen;

(c) removing the clogging matter from the expiratory lumen; and

(d) maintaining and regulating tracheal pressure by continuously evaluating gas flow and gas pressure and continuously increasing or decreasing the stream of gas provided by the ventilator to compensate for pressure changes arising from said removal of the clogging matter.

23. The method of claim 22, wherein step (d) comprises using the pressometer connected to the lumen through which gas is flowing to measure the gas pressure directly at the end distal to the patient of the lumen through which gas is flowing and using the pressometer connected to the lumen through which gas is not flowing to measure the gas pressure at the tracheal end of the lumen through which gas is flowing.