Abstract:
An intubation method and system including the insertion of an endotracheal tube into a patient airway, inflating an cuff associated with the endotracheal tube at a location in the patient airway below the vocal cords, monitoring carbon dioxide concentration in the patient airway at a carbon dioxide monitoring location between the cuff and the vocal cords and adjusting inflation of the cuff based at least in part on the monitoring in order that the cuff inflation generally prevents leakage of carbon dioxide past the cuff.

Description:
FIELD OF THE INVENTION 
     The present invention relates to intubation systems and methodologies generally. 
     BACKGROUND OF THE INVENTION 
     The following U.S. Patents are believed to represent the state of the art: U.S. Pat. Nos. 6,062,223; 5,937,861; 5,819,723; 5,765,559; 5,752,921; 5,582,167; 5,582,166; 5,579,762; 5,067,497; 4,825,862; 4,770,170; 4,501,273; 4,305,392; 4,159,722; 3,794,036 &amp; 3,504,676. 
     SUMMARY OF THE INVENTION 
     The present invention seeks to provide improvements to intubation systems and methods. 
     There is thus provided in accordance with a preferred embodiment of the present invention an intubation method including:
         insertion of an endotracheal tube into a patient airway;   inflating a cuff associated with the endotracheal tube at a location in the patient airway below the vocal cords;   monitoring carbon dioxide concentration in the patient airway at a carbon dioxide monitoring location between the cuff and the vocal cords; and   adjusting inflation of the cuff based at least in part on the monitoring in order that the cuff inflation generally prevents leakage of carbon dioxide past the cuff.       

     Preferably, inflation of the cuff is adjusted to provide a minimum inflation pressure, which prevents leakage of carbon dioxide past the cuff. 
     In accordance with a preferred embodiment of the present invention, the method also includes suctioning secretions at a suctioning location between the cuff and the vocal cords. 
     Preferably, the suctioning location is located between the cuff and the carbon dioxide monitoring location. 
     In accordance with a preferred embodiment of the present invention, adjusting inflation is performed by medical personnel based on information received from the carbon dioxide monitoring. Alternatively adjusting inflation may be performed automatically based on information received from the carbon dioxide monitoring. 
     Preferably, the method includes inserting into the patient airway of a carbon dioxide monitoring conduit extending to the carbon dioxide monitoring location. 
     Additionally or alternative, the method includes inserting into the patient airway of a suctioning conduit extending to the suctioning location. 
     The carbon dioxide monitoring conduit may also serve as a suctioning conduit extending to a suctioning location. 
     In accordance with one embodiment of the present invention, the insertion of an endotracheal tube into a patient airway includes insertion of at least one of a carbon dioxide monitoring conduit and a suctioning conduit disposed therewithin. 
     There is also provided in accordance with a preferred embodiment of the present invention an intubation system including:
         an endotracheal tube adapted for insertion into a patient airway;   an inflatable cuff associated with the endotracheal tube and arranged to be located at a location in the patient airway below the vocal cords;   a carbon dioxide monitor operative to monitor carbon dioxide concentration in the patient airway at a carbon dioxide monitoring location between the cuff and the vocal cords; and   an inflatable cuff inflator operative for enabling adjustment of inflation of the cuff based at least in part on an output from the carbon dioxide monitor in order that the cuff inflation generally prevents leakage of carbon dioxide past the cuff.       

     In accordance with one embodiment of the present invention, the inflator includes an adaptive inflator, which is operative to inflate the cuff to a minimum inflation pressure, which prevents leakage of carbon dioxide past the cuff. 
     Preferably, the system also includes a suctioner operative for suctioning secretions at a suctioning location between the cuff and the vocal cords. 
     In accordance with a preferred embodiment of the present invention, the system includes at least one of a carbon dioxide monitoring conduit coupled to the carbon dioxide monitor and extending therefrom to the carbon dioxide monitoring location and a suctioning conduit extending to a suctioning location. 
     In accordance with one embodiment of the present invention, the carbon dioxide monitoring conduit also serves as the suctioning conduit and also couples a suctioner operative for suctioning secretions to a suctioning location between the cuff and the vocal cords. 
     Alternatively a separate suctioning conduit may be provided for coupling a suctioner operative for suctioning secretions to a suctioning location between the cuff and the vocal cords. 
     At least one or both of the carbon dioxide monitoring conduit and the suctioning conduct may be located internally of the endotracheal tube. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention will be understood and appreciated from the following detailed description, taken in conjunction with the drawings in which: 
         FIG. 1  is a simplified pictorial illustration of a intubation system and functionality constructed and operative in accordance with a preferred embodiment of the present invention, and 
         FIGS. 2A ,  2 B,  2 C and  2 D are simplified diagrammatic illustrations of four alternative embodiments of the system of FIG.  1 . 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Reference is now made to  FIG. 1 , which is a simplified pictorial illustration of an intubation system and functionality constructed and operative in accordance with a preferred embodiment of the present invention. 
     As seen in  FIG. 1 , there is preferably provided an intubation system and method wherein an endotracheal tube  10  is inserted into a patient airway. An inflatable cuff  12  is preferably associated with the endotracheal tube  10  and arranged to be located at a location in the patient airway  11  below the vocal cords. Both the endotracheal tube  10  and the inflatable cuff  12  may be entirely conventional or alternatively may be adapted to integrate features of the present invention, as described hereinbelow. The endotracheal tube  10  may be coupled to a ventilator (not shown) in a conventional manner and the inflatable cuff  12  may be connected to a manually operated or automatically operated inflation device (not shown), also in a conventional manner. 
     In accordance with a preferred embodiment of the present invention a carbon dioxide monitor  14  is provided and is operative to monitor carbon dioxide concentration in the patient airway  11  at a carbon dioxide monitoring location  16  between the cuff  12  and the vocal cords. Preferably a carbon dioxide monitoring conduit  18  is provided for coupling the monitor  14  to the monitoring location  16 . 
     A suctioning device  20  is preferably provided for suctioning secretions at a suctioning location  22  between the cuff  12  and the vocal cords. 
     It is a particular feature of the present invention that the carbon dioxide monitor  14  provides an accurate indication of adequate sealing of the patient&#39;s airway  11  by the inflated cuff  12 , thus enabling minimum effective inflation to be provided, thereby to minimize damage to the patient&#39;s airway  11 . The accurate and minimally invasive sealing of the patient&#39;s airway  11  combined with operation of suctioning device for removal of secretions at suctioning location  22  upstream of the cuff  12  enables infections to be reduced by effectively preventing such secretions to enter the airway  11  downstream of the cuff  12 . This effective preventing is the result both of highly effective sealing of the airway  11  and of removal of such secretions upstream of the cuff  12 . It is appreciated that the efficacy of the suction produced by suctioning device  20  at suctioning location  22  is enhanced by the provision of highly effecting sealing of the airway at cuff  12 . 
     It is appreciated that in accordance with one embodiment of the invention, the cuff inflator may operate automatically based on an accurate output from the carbon dioxide monitor. 
     Reference is now made to  FIGS. 2A ,  2 B,  2 C,  2 D are simplified diagrammatic illustrations of four alternative embodiments of the system of FIG.  1 . Turning to  FIG. 2A , there is seen a first embodiment of the invention wherein an endotracheal tube  100  is inserted into a patient airway  111  and an inflatable cuff  112 , associated therewith and inflated at a location in the patient airway  111  below the vocal cords. The endotracheal tube  100  is typically, but need not be, coupled to a ventilator  114 . Cuff  112  is connected via an inflation conduit  116  to a manually operated or automatically operated cuff inflator  118 . 
     In accordance with a preferred embodiment of the present invention shown in  FIG. 2A , a carbon dioxide monitor  120  is coupled via a carbon dioxide monitor conduit  122 , external of the endotracheal tube  100 , to a carbon dioxide monitoring location  124 , between the cuff  112  and the vocal cords. A suctioning device  126  is also coupled to the conduit  122  for suctioning secretions at a suctioning location, which in this embodiment is identical to the carbon dioxide monitoring location  124 . 
     Turning to  FIG. 2B , there is seen a second embodiment of the invention wherein an endotracheal tube  200  is inserted into a patient airway  211  and an inflatable cuff  212 , associated therewith and inflated at a location in the patient airway  211  below the vocal cords. The endotracheal tube  200  is typically, but need not be, coupled to a ventilator  214 . Cuff  212  is connected via an inflation conduit  216  to a manually operated or automatically operated cuff inflator  218 . 
     In accordance with a preferred embodiment of the present invention shown in  FIG. 2B , a carbon dioxide monitor  220  is coupled via a carbon dioxide monitor conduit  222 , internal of the endotracheal tube  200  to a carbon dioxide monitoring location  224 , between the cuff  212  and the vocal cords. A suctioning device  226  is also coupled to the conduit  222  for suctioning secretions at a suctioning location, which in this embodiment is identical to the carbon dioxide monitoring location  224 . 
     Turning to  FIG. 2C , there is seen a third embodiment of the invention wherein an endotracheal tube  300  is inserted into a patient airway  311  and an inflatable cuff  312 , associated therewith and inflated at a location in the patient airway  311  below the vocal cords. The endotracheal tube  300  is typically, but need not be, coupled to a ventilator  314 . Cuff  312  is connected via an inflation conduit  316  to a manually operated or automatically operated cuff inflator  318 . 
     In accordance with a preferred embodiment of the present invention shown in  FIG. 2C , a carbon dioxide monitor  320  is coupled via a carbon dioxide monitor conduit  322 , exterior of the endotracheal tube  300 , to a carbon dioxide monitoring location  324 , between the cuff  312  and the vocal cords. 
     In this embodiment, a suctioning device  326  is coupled to a separate suctioning conduit  328 , also external of the endotracheal tube  300 , for suctioning secretions at a suctioning location  330 , which is preferably upstream of the carbon dioxide monitoring location  324 . 
     Turning to  FIG. 2D , there is seen a fourth embodiment of the invention wherein an endotracheal tube  400  is inserted into a patient airway  411  and an inflatable cuff  412 , associated therewith and inflated at a location in the patient airway  411  below the vocal cords. The endotracheal tube  400  is typically, but need not be, coupled to a ventilator  414 . Cuff  412  is connected via an inflation conduit  416  to a manually operated or automatically operated cuff inflator  418 . 
     In accordance with a preferred embodiment of the present invention shown in  FIG. 2D , a carbon dioxide monitor  420  is coupled via a carbon dioxide monitor conduit  422 , interior of the endotracheal tube  400 , to a carbon dioxide monitoring location  424 , between the cuff  412  and the vocal cords. 
     In this embodiment, a suctioning device  426  is coupled to a separate suctioning conduit  428 , also internal of the endotracheal tube  400 , for suctioning secretions at a suctioning location  440 , which is preferably upstream of the carbon dioxide monitoring location  424 . 
     It will be appreciated by persons skilled in the art that the present invention is not limited by what has been particularly shown and described hereinabove. Rather the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove as well as variations and modifications which would occur to persons skilled in the art upon reading the specification and which are not in the prior art.