|Publication number||US3707151 A|
|Publication date||Dec 26, 1972|
|Filing date||Feb 16, 1971|
|Priority date||Feb 16, 1971|
|Publication number||US 3707151 A, US 3707151A, US-A-3707151, US3707151 A, US3707151A|
|Inventors||Richard Robert Jackson|
|Original Assignee||Richard Robert Jackson|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (5), Referenced by (74), Classifications (8)|
|External Links: USPTO, USPTO Assignment, Espacenet|
United States Patent Jackson [451 Dec. 26, 1972  SELF-INFLATING ENDOTRACHEAL TUBE  Inventor: Richard Robert Jackson, 8 Trinity Road, Marblehead, Mass. 01945 221 Filed: Feb. 16, 1971 211 Appl.No.: 115,249
' Related US. Application Data  Continuation-impart of Ser. Nos. 427,601, Jan. 25, 1965, abandoned, and Ser. No, 719,994, April 9, 1968, Pat. No. 3,565,079.
Primary Examiner-Dalton L. Truluck Attorney-John Noel Williams [5 7] ABSTRACT Endotracheal tubes with cufi's that self-inflate during inspiration and remain inflated during expiration, in which the Coanda effect is employed to lead air into }LtS.:l|. ..128/35l61l28/;;?013 the cuff for inflation Shown is a tube having an open I! 0 m i g th gh it ll i t th ff volume a surface  new se'rch "128/ 349 arranged to lead air into the cuff during inspiration,
, 128/325 344 and a check valve to prevent outward flow of air. Also shown is a cuff having openings arranged to lead air  References cued into the cuff during expiration. The cuffs shown are UNITED STATES PATENTS substantially larger than the trachea and are of thin film material. 3,460,541 8/1969 Doherty ..l28/35l 3,565,079 2/1971 Jackson 128/351 2 Claims, 8 Drawing Figures I2 22 230 2m 1 t, 2 1 L y \g I Qi Q i t l SELF-INFLATING ENDOTRACHEAL TUBE This application is a continuation-in-part of my application of the same title, Ser. No. 427,601, filed Jan. 25, 1965, now abandoned, and of my application of the same title, Ser. No. 719,994, filed Apr. 9, 1968 now U.S. Pat. No. 3,565,079.
The present invention relates generally to medical and surgical equipment and is more particularly concemed with the provision of means for maintaining normal breathing of the patient during surgical operations and the like.
A primary object of the instant invention is the provision of a novel and improved endotracheal tube.
An important object of the instant invention is the provision of an endotracheal tube having a self-inflating cuff.
Another object of this invention is the provision of an endotracheal tube having a self-inflating cuff that automatically inflates during inspiration through the tube and which remains inflated during expiration therethrough.
Another object is the provision of an endotracheal tube having a self-inflating cuff that makes a good seal with the wall of the trachea but which nevertheless minimizes the likelihood of trauma at the area of the trachea wall where the seal is made. I i
A further object of the instant invention is the provision of a self-inflating endotracheal tube having novel and improved structural means for automatically causing inflation of the inflatable cuff during inspiration of the patient and for maintaining the cuff inflated during expiration.
Another object is the provision of an endotracheal tube of the character described that is relatively simple and inexpensive to manufacture and which therefore may be disposable after use.
According to the invention it is realized that the Coanda effect, by which a laminar flow stream of air tends to hug and follow the direction of a surface, may be employed advantageously to guide air into the cuff for inflation purposes.
According to other aspects of the invention the Coanda surfaces comprise walls defining openings, with the axes of the openings forming acute angles with the axis of the tube. According to one feature the entrances of these openings to the bore of the tube are spaced distally from the outlet of the openings into the volume of the cuff. According to another feature the entrances of these openings are spaced proximally of the outlets into the volume of the cuff and a check valve lying over this outlet is arranged to prevent backflow of air from the cuff back through the opening.
Preferred embodiments of the invention feature generally tubular cuffs having diameter substantially larger than that of the trachea in which the tube is adapted to be inserted, and feature cuffs formed of thin film material.
Other objects, features and advantages of the invention will become apparent as the description thereof proceeds when considered in connection with the accompanying illustrative drawings.
Although the instant invention is illustrated and described in connection with an endotracheal tube, it will be understood that forms of the invention function also in connection with tracheotomy tubes used as an artificial airway in the neck to create a direct passage for air to enter the trachea without passing through the mouth. Thus, it will be understood that all reference in the specification and claims herein to endotracheal tubes, applies equally to tracheotomy tubes, and hence, for the purpose of this application, the term endotracheal tube is construed broadly as covering tracheotomy tubes as well.
In the drawings which illustrate the best mode presently contemplated for carrying out the instant invention:
FIG. 1 is a fragmentary elevational view, partly in section, showing an endotracheal tube embodying the instant invention in operation position within the trachea of a patient;
FIG. 2 is a view of a large scale of a portion of the tube of FIG. 1 during inspiration and FIG. 3 is a similar view during expiration; I
FIG. 4 is a diagrammatic view illustrating the Coanda effect;
FIG. 5 is a fragmentary elevational view, partly in section, of a further endotracheal tube;
FIGS. 6 and 7 are views similar to FIGS. 2 and 3 respectively but related to the embodiment of FIG. 5;
FIG.'8 is a view similar to FIG. 2 of another ernbodiment.
Referring now to FIG. 1, there is shown an endotracheal tube 10 in operative position in the trachea 12 of a patient, having passages 14 and 16 leading to the left and right lungs of the patient. The tube 10 is of conventional construction in that it comprises a hollow open-ended tube of any flexible non-toxic material, such as certain well known types of plastic that are used for this purpose. The tube 10 has a proximal end 18 and a distal end 20, the latter terminating in a beveled form, as is well known and conventional in the art.
Secured to the tube 10 adjacent its distal end 20 is an inflatable cuff or balloon 22, said cuff being generally tubular in configuration and being constructed of any suitable flexible film material, such as extremely thin latex, e.g., of less than 0.002 inch thickness. The cuff 22 is secured to the tube 10 by any suitable means, so as to tightly bind the cuff to the tube in air-tight relation with respect thereto. In the form of my invention illustrated in FIGS. 1, 2 and 3, it is important to note that there is communication between the interior of tube 10 and the interior of cuff 22. Expressed differently, the wall of the tube 10 is perforate. It is also important to note that the length of the cuff is preferably short relative to the overall length of the tube within the trachea. Furthermore, the diameter of the cuff 22 is substantially larger than the diameter of the trachea l2, e.g. of 1% inch diameter in comparison to a trachea of inch diameter, and even though this may result in some folding of the cuff 22 on itself when inflated, this is not detrimental in any way, since the extreme thinness of the material of which cuff 22 is constructed enables the cuff to easily fold upon itself, even at low pressures, while at the same time maintaining a good air-tight seal with the surrounding trachea.
The openings 24 into the cuff, of which there are four in this embodiment, have axes A set at acute angles a e.g., of 35 to the axis X of the bore of the tube, and the entrance 21 at the bore is spaced substantially proximally from the outlet 23 into the cuff 22.
These openings may comprise drilled holes of 3/32 inch diameter.
Over the outlet 23 is a check valve 25, here in the form of a loose-fitting latex sleeve secured air-tight about the tube at the left end and free to open up at the right end to allow air into the tube and free to close down and seal to prevent loss of air from the cuff.
In operation and use, the endotracheal tube is inserted into the trachea in the usual manner, using sterile lubricant to facilitate introduction. The fact that the cuff 22 is not inflated during introduction of the tube 10 further facilitates its insertion into the trachea. Once the tube 10 has been positioned in the patients trachea, the air flow produced when respiration is being assisted by the anesthesiologist, will automati cally cause inflation of the cuff 22, and it will stay inflated. Expressed differently, the flow of air toward the lungs tends to lie close and follow the tube inner wall 27. The slope of the wall 29 defining the opening is in effect a continuation of wall 27 and the air tends to follow-wall 29 see FIG. 4, and enter the cuff see FIG. 2 where it is trapped. As a result of the preferred character of the cuff, i.e., its high flexibility, its oversize shape relative to the trachea, and its short length, the air creates an effective seal between the cuff and the surrounding wall of the trachea. The effectiveness of this seal is further enhanced by the adhesion of the thin latex cuff 22 to the surrounding portion of the trachea, this adhesion being caused by mucous normally present on the wall of the trachea.
Thus it will be seen that the cuff 22 automatically inflates immediately and effectively as soon as assisted or controlled respirations are initiated to the patient. The cuff remains inflated during expiration through tube 10 as a result of the air trapped in the cuff by the check valve. Passage of air into and out of the patients lungs may therefore by effectively controlled during surgical procedures. The extreme thinness of the cuff 22 minimizes the likelihood of trauma at the portion of the trachea at which the seal is made. Furthermore, the self-inflating characteristics of the endotracheal tube prevent over-or under-inflation of the cuff.
The endotracheal tube may be withdrawn while still inflated. The squashy" or pliable character of the cuff permitting it to pass softly past the vocal chords without damage to the chords.
Referring to FIG. 5 in this embodiment the entrance 21a to the opening is distal of the outlet 23a into the cuff, the opening again lying at acute angle a to the axis X of the bore of the tube.
On inspiration, Coanda effect does not work in this embodiment. But during inspiration the force of the respirator or other pressure source is at work inflating the lungs. Hence a positive pressure l" exists in the tube while near-atmospheric pressure exists between the tube and the trachea. The result is inflation of the cuff. Air flows into the cuff and seals the cuff against the tracheal wall as a result of pressure differential despite the fact that the air has reversed its flow path.
On expiration things are different. Here the Coanda effect acts to guide air in, using the somewhat less forceful flow of air to advantage.
It will be understood that during lullsi.e., while there is neither expiration or inspiration, air may flow out of the cuff, but no matter since there is no flow at that time to keep captured.
Referring now to FIG. 8, a slightly modified form of the present invention is illustrated. In this form, a tube 30, generally similar to the aforedescribed tube 10, has secured thereto a cuff 32 which is generally similar to the aforedescribed cuff 22. In this construction, too,
the cuff is imperforate, while the tube 30 is provided with an opening 34, said opening providing communication between cuff 32 and the interior of tube 30. The opening 34 is in the form of a notch or cutout which extends angularly toward the distal end 36 of the tube and which is sufficiently deep so as to extend substantially diametrically across the tube 30. The cutout 34 inclines back toward the proximal end 38 of the tube to a slight' degree, as illustrated at 40.
in operation and use, the tube 30 is inserted into the trachea of the patient in the usual manner. Firm pressure on the breathing bag immediately causes inflation of cuff 32 since the opening 34 permits passage of air from the tube into the cuff during the inspiratory phase of assisted or controlled respirations. The specific configuration of the opening 34, as hereinbefore described, enables the opening to perform as anair guide, which maintains inflation of the cuff during expiration. Expressed differently, the air guide 34 directs air into the cuff 32 during expiration, thus maintaining the cuff inflated during this phase. Here again, although the pressure differential is slight, the preferred shape and character of the cuff enables its proximal end to distend. If the patient is allowed to breathe spontaneously, an occasional assisted respiration may be necessary in order to keep the cuff inflated. It has been found that the cuff 32 provides an extremely effective seal during inspiration, but is not quite as effective during expiration, although still effective enough to'provide a satisfactory seal. The seal formed by cuff 32, as is true also in connection with the seal formed by the aforedescribed cuff 22, is not normally sufficiently effective to prevent the passage of secretions and blood through the trachea, although, as hereinbefore stated, these seals are sufficiently effective to enable good respiratory control to be achieved.
' As will'be seen, all forms of the present invention provide for automatic inflationof the cuff during the inspiratory phase of the respiration cycle, and at the same time, the cuff is maintained sufficiently inflated during expiration to retain an effective seal. The simplicity of construction of the various forms of the instant invention hereinbefore described make it feasible for the tubes to be disposable after each use.
While there is shown and described herein certain specific structure embodying the invention, it will be manifest to those skilled in the art that various modifications and rearrangements of the parts may be made without departing from the spirit and scope of the underlying inventive concept and that the same is not limited to the particular forms herein shown and described except insofar as indicated by the scope of the appended claims.
What is claimed is:
l. A self-inflating endotracheal tube comprising an elongated, flexible, open-ended hollow tube having a proximal and distal end, an inflatable cuff of generally tubular configuration and a diameter substantially larger than that of the trachea in which the tube is adapted to be inserted, said cuff being of thin, film material and secured to said tube adjacent the distal end thereof, and means for automatically causing inflation of said cuff in response to inspiration through said tube and for maintaining said cuff inflated during expiration therethrough, the portion of said tube extending through said cuff having an opening including a coanda surface exposed to air flow toward the proximal end in the expiration direction to guide air flowing through said tube into said cuff, said coanda surface comprising a surface sloped at an acute angle to the axis of said tube, said surface being on the upstream side, relative to flow of air in the expiration direction, of said opening and sloping from the interior of the tube outwardly in the downstream direction relative to said flow whereby air flowing in the expiration direction tends to hug and follow said surface through an obtuse angle path into said cuff for maintaining inflation.
2. A self-inflating endotracheal tube comprising an elongated, flexible, open-ended hollow tube having a proximal and distal end, an inflatable cuff secured to said tube adjacent the distal end thereof, and means for automatically causing inflation of said cuff in response to inspiration through said tube and for maintaining said cuff inflated during expiration therethrough, the portion of said tube extending through said cuff being perforate and including a Coanda surface exposed to air flow toward the proximal to guide end expiration air
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US2813531 *||Sep 26, 1955||Nov 19, 1957||Albert F Lee||Cannula|
|US3460541 *||Oct 6, 1966||Aug 12, 1969||George O Doherty||Endotracheal intubation tubes|
|US3565079 *||Apr 9, 1968||Feb 23, 1971||Richard Robert Jackson||Self-inflating endotracheal tube|
|GB1113484A *||Title not available|
|GB1153863A *||Title not available|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US3788326 *||Aug 3, 1972||Jan 29, 1974||H Jacobs||Distally perforated catheter for use in ventilating system|
|US4019515 *||Dec 8, 1975||Apr 26, 1977||Daniel Kornblum||Enemata administering device|
|US4020849 *||Dec 1, 1975||May 3, 1977||Jackson Richard R||Cuff inflation for tracheal tubes|
|US4290428 *||Aug 16, 1979||Sep 22, 1981||Durand Alain J M||Catheter with bulb|
|US4324235 *||Mar 24, 1980||Apr 13, 1982||Beran Anthony V||Endotracheal tube|
|US4456000 *||Aug 24, 1983||Jun 26, 1984||Angiomedics Corporation||Expandable occlusion apparatus|
|US4686985 *||Apr 24, 1986||Aug 18, 1987||Lottick Edward A||Anal dilator and occluder|
|US5035705 *||Jul 7, 1989||Jul 30, 1991||Scimed Life Systems, Inc.||Method of purging a balloon catheter|
|US5085636 *||Oct 11, 1990||Feb 4, 1992||Scimed Life Systems, Inc.||Balloon catheter with inflation-deflation valve|
|US5100385 *||Sep 28, 1990||Mar 31, 1992||C. R. Bard, Inc.||Fast purge balloon dilatation catheter|
|US5176636 *||Jul 18, 1991||Jan 5, 1993||Wild John J||Device for intubation of human passages for diagnostic and therapeutic purposes|
|US5217434 *||Oct 15, 1991||Jun 8, 1993||Scimed Life Systems, Inc.||Innerless dilatation catheter with balloon stretch valve|
|US5221260 *||Aug 21, 1991||Jun 22, 1993||Scimed Life Systems, Inc.||Innerless dilatation balloon catheter|
|US5235973 *||May 15, 1991||Aug 17, 1993||Gary Levinson||Tracheal tube cuff inflation control and monitoring system|
|US5269296 *||Feb 17, 1993||Dec 14, 1993||Landis Robert M||Nasal continuous positive airway pressure apparatus and method|
|US5318021 *||Jun 5, 1991||Jun 7, 1994||Alessi David M||Endotracheal tube with automatic cuff inflation and deflation|
|US5358486 *||Aug 11, 1992||Oct 25, 1994||C. R. Bard, Inc.||Multiple layer high strength balloon for dilatation catheter|
|US5380282 *||Sep 21, 1993||Jan 10, 1995||Scimed Life Systems, Inc.||Balloon catheter assembly|
|US5452715 *||Dec 29, 1993||Sep 26, 1995||Boussignac; Georges||Tube for assisting breathing|
|US5454789 *||Sep 27, 1994||Oct 3, 1995||Scimed Life Systems, Inc.||Innerless dilatation balloon catheter|
|US5477852 *||Nov 19, 1993||Dec 26, 1995||Airways Ltd., Inc.||Nasal positive airway pressure apparatus and method|
|US5487383 *||Apr 20, 1993||Jan 30, 1996||Levinson; Gary||Tracheal tube cuff inflation control and monitoring system|
|US5490837 *||Mar 2, 1994||Feb 13, 1996||Scimed Life Systems, Inc.||Single operator exchange catheter having a distal catheter shaft section|
|US5531689 *||Jun 6, 1995||Jul 2, 1996||Scimed Life Systems, Inc.||Innerless dilatation balloon catheter|
|US5538002 *||Oct 20, 1994||Jul 23, 1996||Boussignac; Georges||Device for respiratory assistance|
|US5638813 *||Jun 7, 1995||Jun 17, 1997||Augustine Medical, Inc.||Tracheal tube with self-supporting tracheal tube cuff|
|US5645533 *||Jan 26, 1995||Jul 8, 1997||Scimed Life Systems, Inc.||Apparatus and method for performing an intravascular procedure and exchanging an intravascular device|
|US5657752 *||Mar 28, 1996||Aug 19, 1997||Airways Associates||Nasal positive airway pressure mask and method|
|US5687715 *||Dec 22, 1995||Nov 18, 1997||Airways Ltd Inc||Nasal positive airway pressure apparatus and method|
|US5755690 *||Oct 21, 1994||May 26, 1998||C. R. Bard||Multiple layer high strength balloon for dilatation catheter|
|US5797877 *||May 24, 1996||Aug 25, 1998||Boston Scientific Corporation||Medical device balloons containing thermoplastic elastomers|
|US5833706 *||May 18, 1995||Nov 10, 1998||Scimed Life Systems, Inc.||Single operator exchange perfusion catheter having a distal catheter shaft section|
|US5919162 *||Dec 11, 1992||Jul 6, 1999||Scimed Technology, Inc.||Balloon catheter with inflation/deflation valve|
|US5947927 *||Mar 23, 1998||Sep 7, 1999||Scimed Life Systems, Inc.||Convertible catheter having a single proximal lumen|
|US5976107 *||Mar 6, 1997||Nov 2, 1999||Scimed Life Systems. Inc.||Catheter having extendable guide wire lumen|
|US6086556 *||Aug 4, 1998||Jul 11, 2000||Boston Scientific Corporation||Medical device balloons containing thermoplastic elastomers|
|US6132824 *||Aug 6, 1997||Oct 17, 2000||Schneider (Usa) Inc.||Multilayer catheter balloon|
|US6136258 *||Apr 24, 1995||Oct 24, 2000||Boston Scientific Corporation||Method of forming a co-extruded balloon for medical purposes|
|US6482348||Apr 3, 2000||Nov 19, 2002||Boston Scientific Corporation||Method of forming a co-extruded balloon for medical purposes|
|US6629951 *||Jul 18, 2001||Oct 7, 2003||Broncus Technologies, Inc.||Devices for creating collateral in the lungs|
|US6896842||Apr 24, 2000||May 24, 2005||Boston Scientific Corporation||Medical device balloons containing thermoplastic elastomers|
|US7156090 *||Jan 17, 2003||Jan 2, 2007||Hiroaki Nomori||Tracheostomy tube|
|US7462162||Jul 19, 2004||Dec 9, 2008||Broncus Technologies, Inc.||Antiproliferative devices for maintaining patency of surgically created channels in a body organ|
|US7513256 *||Nov 11, 2003||Apr 7, 2009||Oren Gavriely||Intra-airway ventilation|
|US7585289||Jun 22, 2005||Sep 8, 2009||Boston Scientific Scimed, Inc.||Co-extruded medical balloon|
|US7708712||Jul 19, 2004||May 4, 2010||Broncus Technologies, Inc.||Methods and devices for maintaining patency of surgically created channels in a body organ|
|US7781038||May 27, 2004||Aug 24, 2010||Boston Scientific Scimed, Inc.||Medical device balloons containing thermoplastic elastomers|
|US8409167||Oct 5, 2006||Apr 2, 2013||Broncus Medical Inc||Devices for delivering substances through an extra-anatomic opening created in an airway|
|US8608724||Nov 4, 2010||Dec 17, 2013||Broncus Medical Inc.||Devices for delivering substances through an extra-anatomic opening created in an airway|
|US8709034||May 13, 2011||Apr 29, 2014||Broncus Medical Inc.||Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall|
|US8784400||May 16, 2012||Jul 22, 2014||Broncus Medical Inc.||Devices for delivering substances through an extra-anatomic opening created in an airway|
|US8857436||Mar 23, 2009||Oct 14, 2014||Barreto Gilson||Intermittent low-pressure orotracheal intubation device|
|US8932316||Apr 7, 2014||Jan 13, 2015||Broncus Medical Inc.||Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall|
|US9345532||May 11, 2012||May 24, 2016||Broncus Medical Inc.||Methods and devices for ablation of tissue|
|US9421070||Dec 18, 2014||Aug 23, 2016||Broncus Medical Inc.||Methods and devices for diagnosing, monitoring, or treating medical conditions through an opening through an airway wall|
|US9486229||May 11, 2012||Nov 8, 2016||Broncus Medical Inc.||Methods and devices for excision of tissue|
|US9533128||Oct 31, 2012||Jan 3, 2017||Broncus Medical Inc.||Devices for maintaining patency of surgically created channels in tissue|
|US20030136412 *||Jan 17, 2003||Jul 24, 2003||Hiroaki Nomori||Tracheostomy tube|
|US20050043752 *||Jul 19, 2004||Feb 24, 2005||Broncus Technologies, Inc.||Methods and devices for maintaining patency of surgically created channels in a body organ|
|US20050060041 *||Jul 19, 2004||Mar 17, 2005||Broncus Technologies, Inc.||Methods and devices for maintaining surgically created channels in a body organ|
|US20050166926 *||Apr 1, 2005||Aug 4, 2005||Hiroaki Nomori||Tracheostomy tube|
|US20090025729 *||Dec 18, 2006||Jan 29, 2009||Hiroaki Nomori||Tracheotomy Tube and Method of Using the Same|
|US20100016834 *||Apr 13, 2009||Jan 21, 2010||Innoventions Ltd.||Device, system, and method for releasing substances in a body cavity|
|US20120132212 *||Mar 23, 2010||May 31, 2012||C. R. Bard, Inc.||Endotracheal Tube with Multi-Mode Valve and Method of Using Same|
|DE102008052438A1||Oct 21, 2008||Apr 22, 2010||Willy Rüsch GmbH||Trachealtubus|
|EP0640355A1 *||Jul 29, 1994||Mar 1, 1995||Georges Boussignac||Tube for respiratory assistance|
|EP2179761A1||Oct 20, 2009||Apr 28, 2010||Willy Rüsch GmbH||Tracheal tube|
|EP2411076A1 *||Mar 23, 2009||Feb 1, 2012||Barreto Gilson||Intermittent low-pressure orotracheal intubation device|
|EP2411076A4 *||Mar 23, 2009||Aug 6, 2014||Barreto Gilson||Intermittent low-pressure orotracheal intubation device|
|WO1999066975A1 *||Jun 18, 1999||Dec 29, 1999||Pacey John A||Ventilation catheter|
|WO2007069766A1 *||Dec 18, 2006||Jun 21, 2007||Hiroaki Nomori||Tracheotomy tube and method of using the same|
|WO2010108242A1 *||Mar 23, 2009||Sep 30, 2010||Barreto Gilson||Intermittent low-pressure orotracheal intubation device|
|WO2015089270A1 *||Dec 11, 2014||Jun 18, 2015||The General Hospital Corporation Dba Massachusetts General Hospital||Method and apparatus for providing artificial ventilation to a trachea of a patient|
|WO2016010998A3 *||Jul 14, 2015||Mar 24, 2016||Texas Tech University System||Self-deployed cuff and skirt tracheal tube|
|U.S. Classification||128/207.15, 604/96.1|
|International Classification||A61M25/00, A61M16/04|
|Cooperative Classification||A61M2016/0452, A61M25/0075, A61M16/04|