AT525784A1 - Intubation aid with steerable catheter - Google Patents

Abstract

The invention relates to an intubation aid with a controllable catheter (1) and handle (2), the catheter (1) consisting of a semi-rigid, manually formable catheter section (1a) and a flexible catheter section (1b) that can be controlled via the control element (3a). and the semi-rigid catheter part (1a) is fixed to the handle (2).

Description

The invention relates to an intubation aid with a steerable catheter, which is intended to enable the trachea (windpipe) to be sought out and consequently the endotracheal tube (ETT, "breathing tube") to be inserted into the trachea, particularly in the case of a difficult airway, according to the preamble of claim 1.

In anesthesia, for endotracheal intubation (ITN) - the introduction of the breathing tube into the trachea, especially in the case of a difficult airway, (1) (video) laryngoscopy with intubation aid (stylet, catheter) or (2) ITN established with the help of a bronchoscope:

(1) If the anatomical conditions are difficult, a conventional laryngoscope cannot see the level of the vocal cords or the voice box (larynx) and therefore a video laryngoscope (VLS) with optics in the front area of the laryngoscope spatula is used (representation of the optical information from the spatula tip, e.g. on a display on the handle), revealing the larynx and vocal cords. However, visual representation of the difficult anatomical structures does not ensure successful endotracheal ITN:

The flexible ETT must follow the curve of the blade of the VLS in order to get into the field of view of the VLS (its optical axis) and thus also to the vocal cord level. This requires a malleable and at the same time rigid intubation catheter that can be adapted to the curvature of the VLS spatula. This is inserted into the ETT and thus serves as a guide and splint. In the difficult airway, there is often a divergence between the optical axis of the VLS and thus the ETT to the longitudinal axis of the larynx-trachea. Despite the use of an optimal intubation catheter (e.g. S-Guide/VMB), this circumstance can mean that the ETT cannot be advanced into the trachea, making ITN impossible.

(2) The bronchoscopic ITN, which can only be used in the clinical area, is now the gold standard for the difficult endotracheal ITN and thus the best method to date to visit the larynx, the vocal cord level and, above all, the tracheobronchial system. However, the prerequisites for this are very good trained users and excellent teamwork. The user needs both hands to guide the BSK and the airway must also be kept open, e.g. by a slotted Guedel tube and possibly also by an anesthesiologist, so that the view of the larynx is clear.

The image information from the BSK tip is usually displayed on a monitor via the fiber optics of the BSK.

Furthermore, in principle, the BSK does not provide for oxygen administration and thus apneic oxygenation of the patient, as is provided via the central channel of modern intubation catheters (e.g. S-Guide/VBM company), during the ITN procedure. Even if the respective anesthesia team thinks about the possibility of apneic oxygenation via the bronchoscope under massive time pressure: In order to maintain this passive function of modern ITN catheters, you have to connect an oxygen source to the connection of the suction channel and thus modify its function on the one hand and on the other hand, keep the suction button actively pressed to ensure oxygen flow. Alternatively, with the BSK you can use the working channel, which is also not intended for this purpose and is poorly suited (no adequate oxygen connection option, small diameter and thus high resistance in the channel and resulting poor flow). Apart from the fact that the BSK is not the gold standard for rapid intubation (Rapid Sequence Induction - RSI) in unfasted patients, the risk of aspiration of stomach contents into the lungs is increased in these patients, but the (video) laryngoscope together with an intubation catheter. The alternative that may not be possible for various reasons (e.g. a patient is comatose, massive bleeding) would otherwise be the already mentioned awake intubation. However, an unfasted patient may also have a difficult airway.

With the passage of the BSK tip through the vocal cord level, the trachea can now be seen, but the larynx and the vocal cord level can no longer be seen. The advancement of an ETT through the vocal cord plane into the trachea is therefore not possible under visual conditions. It happens that during bronchoscopic intubation the ETT cannot be advanced into the trachea (e.g. due to the position of the ETT in relation to the larynx or trachea despite bronchoscopic guidance, anatomical conditions, a collapsed airway) and due to the lack of a view of the larynx and the vocal cord level lacks the possibility to determine the problem and to fix it in a targeted manner.

The dilemma of the situations described above can only be solved by combining VLS + BSK. However, in addition to the need for two devices with probably limited availability, especially the BSK, two experienced and equally well-rehearsed users are required. Except that the combined use of VLS+BSK is not yet established in difficult airway management.

In summary, the joint use of a (video) laryngoscope with a controllable intubation aid, which represents a combination of features of a conventional intubation aid and a bronchoscope, results in the following advantages (optionally equipped with an optical system in the sense of a tracheoscope):

- Permanent view of the larynx and the vocal cords during intubation with the possibility of targeted correction of the position of the endotracheal tube to successfully overcome an otherwise invisible obstacle to intubation (e.g. the ETT is located at the epiglottis), as is otherwise the case with ITN with a VLS and BSK

- full one-handed controllability of the flexible part of the intubation aid protruding over the ETT for locating the trachea, combined with the now continuous guidance of the ETT during intubation as with a BSK, which makes it possible to overcome the deviation between the ETT-larynx axis and the larynx-trachea axis without any problems is. With the BSK, only the tip can be controlled and the user's second hand is therefore required to guide the main part of the device. However, with the controllable ITN aid, the user can control the position of the catheter tip with one hand using the handle and its operating elements, since the flexible main part of the BSK has been replaced here by the semi-rigid catheter part fixed to the handle. Optionally, the controllable intubation aid can be designed with a semi-rigid part that can also be adjusted using a lever on the handle. This could be to a lesser extent than the fully flexible portion of the catheter in the course

- Possibility of apneic oxygenation through O2 insufflation or suction of liquids during the intubation process via a central channel.

- ITN can be performed by a “trained” person: - 1st hand: VLS

- 2nd hand: the controllable intubation aid with the option of placing the ETT using the integrated mechanism (alternatively manually with the help of the anesthetist) under VLS view (determination of the ITN depth as usual using the optional black ring-shaped marking proximal to the cuff balloon on the ETT, via the ITN depth scale in centimeters on the ETT, verification of bilateral ventilation of the lungs by means of auscultation or, in the case of a version of the device as a "tracheoscope", by displaying the trachea through an optical system at the tip of the catheter and with image transmission, e.g. to a display on the catheter handle or via the display of the VLS)

- bronchoscopic or videolaryngoscopic awake intubation is usually no longer necessary if the airway is known to be difficult (and a minimum mouth opening of approx. 2 cm for the VLS) - these patients also have the comfort of the ITN being performed under anesthesia. If the risk is very high, awake intubation is not necessary; successful videolaryngoscopy is sufficient to put the patient under anesthesia before the ITN.

- Cost reduction from more than 6,000 euros for a VLS+ (disposable) BSK (McGrath, Storz, Olympus) to less than 3,000 euros from VLS (e.g. McGrath) including a controllable intubation catheter

7 The combination of VLS and steerable intubation catheter significantly shortens the phase between apnea and patient oxygenation. The VLS shows the larynx on the display and at the same time keeps the airway open for the intubation aid, which makes it possible to quickly find the trachea and thus deliver oxygen to the lungs. Otherwise, the interruption of the oxygen supply usually only ends when the ITN is terminated and ventilation via the respirator is resumed.

7 Potentially uncomplicated technical implementation of the intubation aid in a version for telemedical or automated ITN as an attachment to a robot arm

Required preparation of the ETT and the steerable intubation aid

the ITN: the ETT is pushed onto the semi-rigid part of the intubation aid via the flexible part in front of the ITN and then fixed

1.2. figure enumeration

Figures 1, 2, 3 and 4:

FIG. 1 shows the intubation aid in a side view

FIG. 2 shows the intubation aid in a rear view with a detailed view with regard to 3a and 3b

FIG. 3 shows the catheter tip 12 in a front view

FIG. 4 shows the sleeve 6 in a detailed view

Designation of the features used in Figures 1, 2, 3 and 4: Feature 1: Catheter

Feature 1a: semi-rigid catheter portion that can be manually shaped or optionally additionally adjusted to a small extent via a mechanism Feature 1b: flexible, controllable catheter portion

Feature 2: handle

Feature 3a: Control for feature 1b

Feature 3b: optional control for feature 1a

Feature 4: Connection adapter to the catheter channel

Feature 5: Catheter Channel

Feature 6: expandable sleeve with enlarged head

Feature 7: Control of feature 6

Feature 8: Endotracheal tube fixation

Feature 9: optional fiber optics

Feature 10: optional light source

Feature 11: optional display

Feature 12: Catheter tip

As can be seen from FIG. 1, an intubation catheter 1 is combined with a handle 2 . However, a conventional intubation catheter 1 consists only of a semi-rigid catheter part 1a, which is manually adapted to the curvature of the selected laryngoscope spatula. The tip of the catheter part 1a and the tip of the previously pushed endotracheal tube (ETT) point together in the same direction as the laryngoscope spatula tip in order to reach the larynx. Due to difficult anatomical conditions with a strong deviation between the ETT larynx axis and the larynx-trachea axis, it can happen that the tip of the ETT guided by catheter part 1a reaches the larynx, but cannot advance it into the trachea and thus the endotracheal one intubation is unsuccessful. So that such a difficult endotracheal intubation can be carried out, the catheter portion 1b is attached to the catheter portion 1a.

In contrast to 1a, the catheter portion 1b is flexible and can be controlled to a large extent (shown in dashed lines in FIG. 1 by way of example). The catheter portion 1b is positioned through the larynx and into the trachea via the control element 3a and a mechanism connected thereto. The guidance of the ETT tip to the larynx through catheter section 1a is seamlessly taken over by catheter section 1b and allows the ETT to overcome the transition from larynx to trachea.

The catheter channel which ends at the catheter tip 12 begins at the connection adapter 4 . An oxygen source or a suction device can be connected to the connection adapter 4.

So that no additional hand is needed to advance the ETT, the intubation aid has a sleeve 6 which can be extended and retracted via the operating element 7 . The operating element 7 is part of the sleeve 6. The sleeve 6 encloses the catheter 1 and, like the ETT, slides along the catheter 1 and does not change the shape of the catheter section 1a. In order to be able to push the ETT in front of you, sleeve 6 has a widened head.

The semi-flexible or spring-loaded endotracheal tube fixation 8 holds the ETT or its tip in position at the transition from catheter section 1a to catheter section 1b until it is advanced into the trachea.

Optionally, a display 11 can be attached to the handle 2 . Display 11 is used to display optical information from the catheter tip 12 if you want to extend the intubation aid to a tracheoscope.

FIG. 3 shows the catheter tip 12 in a front view. The catheter channel 5 ends at the tip 12. To use the intubation aid as a tracheoscope, a fiber optic 9, which transmits its information to a display via a camera, and a light source 10 for illuminating the trachea can optionally be integrated into the catheter 1.

FIG. 4 shows the sleeve 6 and its operating element 7 in a detailed view.

In terms of gender-fair language, it is pointed out that

the grammatical masculine plural forms, such as “patients”, refer to all gender identities.

Claims (4)

1. Intubationhilfe with controllable catheter (1) and handle (2), characterized in that the catheter (1) consists of a semi-rigid, manually formable catheter part (1a) and a flexible catheter part (1b) that can be controlled via the control element (3a). consists and that the semi-rigid catheter portion (1a) is fixed to the handle (2). 2. Intubationhilfe with controllable catheter (1) and handle (2) according to claim 1, characterized in that in the handle (2) a catheter (1) enclosing, extendable sleeve with a widened head (6) and control element (7) integrated is to be able to push a previously pushed endotracheal tube in front of you. 3. Intubationhilfe with controllable catheter (1) and handle (2) according to claim 1, characterized in that the handle (2) is provided with a spring-loaded or semi-flexible endotracheal tube fixation (8). 4. Intubationhilfe with controllable catheter (1) and handle (2), characterized in that the catheter (1) has a semi-rigid, manually formable and via the control element (3b) additionally readjustable catheter part (1a), as well as a flexible, via the Control element (3a) has a controllable catheter part (1b), and that the semi-rigid catheter part (1a) is fixed to the handle (2). RECENTLY FILED CLAIMS