Patent Publication Number: US-2021187229-A1

Title: Endotracheal Tube Mount

Description:
FIELD OF THE INVENTION 
     The present invention relates generally to medical devices, and more particularly to endotracheal tubes and accessories. 
     BACKGROUND OF THE INVENTION 
     Oral intubation is often a necessary technique for establishing an airway in patients during surgery or other medical procedures. For prolonged intubation, an endotracheal tube is usually fastened to a patient so that it remains within the airway. The patient&#39;s mouth is typically closed, or partially closed, around the tube, such that the lips rest on the tube. This is known to cause sores or blisters on the lips. An improved device for reducing the length and location of exposure between the lips and endotracheal tube is needed. 
     SUMMARY OF THE INVENTION 
     An endotracheal tube mount includes an armature including a central rib having opposed ends and a tube holder assembly mounted to the armature for horizontal movement along the rib between the opposed ends. The tube holder assembly includes a shuttle which rides on the central rib between the opposed ends and tube holder means which are coupled to the shuttle and are for holding an endotracheal tube in a position below the rib. In the mount, one of the armature and tube holder assembly includes vertical adjustment means for adjusting the position of the endotracheal tube vertically with respect to the rib. 
     The above provides the reader with a very brief summary of some embodiments described below. Simplifications and omissions are made, and the summary is not intended to limit or define in any way the scope of the invention or key aspects thereof. Rather, this brief summary merely introduces the reader to some aspects of some embodiments in preparation for the detailed description that follows. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Referring to the drawings: 
         FIGS. 1A and 1B  are front perspective views of an endotracheal tube mount; 
         FIGS. 2 and 3  are top and bottom perspective views of the endotracheal tube mount of  FIG. 1A , respectively; 
         FIG. 4  is a front perspective view of the endotracheal tube mount of  FIG. 1A  applied to a patient; 
         FIGS. 5A and 5B  are front perspective views of an endotracheal tube mount; 
         FIG. 6  is a bottom perspective view of the endotracheal tube mount of  FIG. 5A , respectively; 
         FIG. 7  is a front perspective view of the endotracheal tube mount of  FIG. 5A  applied to a patient; 
         FIGS. 8A and 8B  are front perspective views of an endotracheal tube mount; 
         FIG. 9  is a bottom perspective view of the endotracheal tube mount of  FIG. 8A , respectively; 
         FIG. 10  is a front perspective view of the endotracheal tube mount of  FIG. 8A  applied to a patient; 
         FIGS. 11A and 11B  are front perspective views of an endotracheal tube mount; 
         FIG. 12  is a bottom perspective view of the endotracheal tube mount of  FIG. 11A , respectively; and 
         FIG. 13  is a front perspective view of the endotracheal tube mount of  FIG. 11A  applied to a patient. 
     
    
    
     DETAILED DESCRIPTION 
     Reference now is made to the drawings, in which the same reference characters are used throughout the different figures to designate the same elements.  FIGS. 1A-3  illustrate an endotracheal tube mount  10 , and  FIG. 4  shows that mount  10  applied to a patient  11 . The mount  10  includes an armature  12  which is placed over the patient  11  and a tube holder assembly  13  which holds an endotracheal tube  14  applied to the patient  11 . In this embodiment, the armature  12  has a horizontal adjustment means which moves the tube  14  horizontally across the user&#39;s mouth, and the tube holder assembly  13  has a vertical adjustment means which moves the tube  14  vertically in the user&#39;s mouth, so that the tube  14  can be moved and positioned both laterally between the user&#39;s lips and also vertically against either the upper lip or the lower lip, thereby reducing wear against the lips at any one particular location. In other embodiments, the vertical adjustment means is carried in the tube holder assembly. In this way, in all of the embodiments, at least one of the armature and tube holder assembly includes the vertical adjustment means for adjusting the position of the endotracheal tube vertically with respect to the rib. 
     The armature  12  includes a central rib  20  having opposed ends  21  and  22  and a front  23  (shown better in  FIG. 3 ) and an opposed back  24 . The rib  20  is arcuate between the ends  21  and  22 . The ends  21  and  22  are formed integrally to ears  25  and  26 , to which pads  27  and  28  are affixed, respectively. The pads  27  and  28  are soft, flexible, compressive pads, and preferably have adhesive inner faces so that they can be secured on the patient  11  in operation. The ears  25  and  26  also include loops  29  to which an elastic band can be engaged, which elastic band is used to fasten the mount  10  about the head of the patient  11 . 
     A pad  30  is carried on the front  23  of the rib  20 . The pad  30  is soft and compressive; when the mount  10  is used with a patient, the pad  30  spaces the rib  20  apart from the philtrum of the patient so that the rib  20  does not rub or rest directly against the face of the patient  11 . The pad  30  is preferably adhesively fixed to the front  23  of the rib  20 , but may be formed integrally, sonically welded, or secured in some like fashion. 
     On the back  24  of the rib  20  is a track  31 . The track  31  is raised off the back  24  of the rib  20  by an inner wall or web  32  extending centrally along the rib  20  along the full length of the rib  20 . Because the track  31  is spaced off the back  24  of the rib  20 , the inner web  32  defines opposed upper and lower channels  33  and  34  between the track  31  and the rib  20 . The upper and lower channels  33  and  34  open upwardly and downwardly, respectively, and are slender channels behind the rib  20  acting as a guide, as will be explained. 
     A large plurality of vertical depressions  35  are formed into the track  31 . These depressions  35  are discrete and spaced apart from each other, and each is generally rectangular. They extend approximately halfway into the track  30  and so are blind depressions. The upper and lower channels  33  and  34 , together with the depressions  35 , cooperate to engage with and allow horizontal movement of the tube holder assembly  13 . 
     The tube holder assembly  13  holds the tube  14  in an adjustable position below the rib  20 , as shown in  FIG. 1A . The tube holder assembly  13  is mounted to the track  31  of the armature  12  for horizontal movement along the track  31  between the opposed ends  21  and  22  of the rib  20 . The tube holder assembly  13  further includes vertical adjustment means for vertical movement of the tube  14  with respect to the rib  20 . In this way, the tube holder assembly  13  positions the tube  14  bother horizontally and vertically with respect to the mouth of the patient  11 . 
     The tube holder assembly  13  includes a shuttle  40  which rides on the rib  20  between its opposed ends  21  and  22 . The shuttle  40  includes a C-shaped block having a base  42  and opposed upper and lower arms  43  and  44  which extend rectilinearly forward and then toward each other, so as to define an open slot  45 . Opposite the base  42 , the upper and lower arms  43  and  44  do not contact each other; rather, their ends are slightly spaced apart from each other to form a gap (not shown) in communication with the slot  45 . When the shuttle  40  is fit to the track  31 , the base  42  rides just above the depressions  35  in the track  31 , the upper and lower arms  43  and  44  each extend around the track  31 , and the gap between the arms  43  and  44  accommodates the web  32  connecting the track  31  to the rib  20 . When the shuttle  40  moves horizontally along the track  31 , the upper arm  43  and lower arm  44  slide within the upper channel  33  and lower channel  34 , respectively, and the gap between the upper and lower arms  43  and  44  slides over the web  32 . This interaction guides the movement of the shuttle  40  and prevents the shuttle  40  from inadvertently coming free of the rib  20 . 
     The shuttle  40  includes tabs  50  for locking the position of the shuttle  40  along the track  31 . The tabs  50 , best shown in  FIG. 2 , are on opposed sides of the shuttle  40 . They extend outward from the shuttle  40 , diagonally away from the track  31 , and are biased forwardly toward the track  31  on sprung, flexible arms  51 . The tabs  50  have forwardly-directed teeth  52  which move into and out of the depressions  35  in the track to engage with them. The tabs  50  are biased forwardly, and when the tabs  50  are forward, the teeth  52  engage with the depressions  35  and prevent lateral movement of the shuttle  40  along the track  31 . Because the depressions  35  are discrete and spaced-apart, engagement of the teeth  52  in the depressions  35  indexes the shuttle  40  along the track  31 . Squeezing the tabs  50  backward and toward each other causes the tabs  50  to pivot away from the track  31  and the teeth  52  to move out of the depressions  35 , thereby breaking the engagement of the tabs  50  and depressions  35 , so that the shuttle  40  may be freely moved along the track  31 . 
     Referring now to  FIGS. 1A and 2 , a slide  53  is coupled to the shuttle  40  and constitutes part of the tube holder assembly  13 . A short connecting web  54  extends from the base  42  of the shuttle  40  to the slide  53 . The slide  53  is similar in construction to the block  41  of the shuttle  40 : it includes a base  55  and two arms  56  and  57  which extend rectilinearly rearward and then toward each other, so as to define an open slot  60 . Opposite the base  55 , the arms  56  and  57  do not contact each other; rather, their free ends are slightly spaced apart from each other to form a gap  61  in communication with the slot  60 . The slot  60  and gap  61  receive a track of a tube holder means  70  which holds the tube  14  in position below the rib  20 ; the slide  53  couples the tube holder means  70  to the shuttle  40  of the armature  12 . 
     The tube holder means  70  includes a vertical guide  71  extending upward from a base  72 , a clamp  73  projecting forward from the base  72  to hold the tube  14 , and a crimp  74  for securing a strap  75  around the tube  14 . Turning now primarily to  FIG. 1B , the vertical guide  71  includes a base  80 , a track  81 , and a web  82  extending transversely to the base  80  and track  81 , connecting the base  80  to the track  81  and spacing the two slightly apart from each other. Because the track  81  is spaced apart from the base  80  by the web  82 , the web  82  defines opposed, separate, lateral channels  86  and  87  between the track  81  and the base  80 . The channels  86  and  87  open laterally, and are slender channels acting as guides. When the slide  53  is fit to the vertical guide  71 , the base  55  of the slide  53  rides just off the track  81 , and the arms  56  and  57  each extend around the track  81  into the channels  86  and  87 , respectively. The gap  61  between the arms  56  and  57  accommodates the web  82  in the guide  71 . When the slide  53  moves vertically along the vertical guide  71 , the arms  56  and  57  slide within the channels  86  and  87 , respectively, and the gap  61  slides over the web  82 . This interaction guides the vertical movement of the slide  53  and prevents the slide  53  from inadvertently coming free of the vertical guide  71 . As such, the slide  53  and the vertical guide  71  cooperate to define the vertical adjustment means of the tube holder assembly  13 . 
     In a preferred embodiment, as can be seen in  FIGS. 1A and 2 , the web  82  has ribbed lateral surfaces and the terminal edges of the arms  56  and  57  are complementally ribbed, such that the complemental ribs engage with each other so as to lock the slide  53  in indexed vertical positions along the vertical guide  71 . 
     The vertical guide  71  extends upward from the base  72 , to which it is integrally and monolithically formed. The base is a short, solid body having a roughly rectangular cross-section. It has a front  90  and a rear  91 . The clamp  73  is formed integrally and monolithically to the front  90  as an extension thereof. The clamp  73  is a cylindrical clamp, being a severed hollow tube with an elongate opening  92  extending parallel to its axis. The opening  92  is approximately the same dimension as the radius of the cylindrical clamp  73 , and the clamp  73  preferably has an inner diameter which is just smaller than the outer diameter of the tube  14 . The clamp  73  is constructed from a pliant, flexible, and resilient material or combination of materials, such as plastic, so that the opening  92  can be enlarged to pass the tube  14  through the opening  92 . The opening  92  of the clamp  73  then returns to its previous dimension, smaller than the diameter of the tube  14 , and the tube  14  is snugly retained in the clamp  73 . This snug retention holds the tube  14  and prevents relevant axial and rotational movement of the tube with respect to the clamp  73 . 
     The tube  14  is also secured by the strap  75  in the crimp  74 . The strap  75  is a thin, flexible ribbon or length of plastic. The rear  91  of the tube holder means  70  includes a solid rectangular prismatic body with an elongate socket  93  (best seen in  FIG. 2 ) oriented with an upward opening behind the vertical guide  71 . The socket  93  is open, but an arm  94  above the socket  93  is hinged to pivot between an unlocked position (as shown in  FIGS. 2 and 3 ) and a locked position (as shown in  FIGS. 1A and 1B ). The socket  93  and arm  94  cooperate to define the crimp  74 . The arm  94  is hinged to the body proximate the bottom of the vertical guide  71 , and so its free end projects rearwardly away from the tube holder means  70 . In the unlocked position, the arm  94  is up, out of the socket  93 , and the strap  75  may be placed into the socket  93  or removed therefrom. In the locked position, the arm  94  is depressed into the socket  93 , where it may capture the strap  75 . The socket  93  has a triangular-shaped cross-section, and the underside of the arm  94  has a complemental, triangular, downward projection which snaps into the socket  93 . When the strap  75  is placed into the socket  93  and the arm  94  is closed in the socket  93  in the locked position, the strap  75  is crimped in the socket  93  and thus retained therein. Further reinforcing this retention is a catch  95  formed at the end of the tube holder means  70 . The catch  95  is a lip that hangs over the socket  93 . The catch  95  has a sloped upper face  96 ; when the arm  94  is moved downward toward the locked position, the arm  94  encounters the sloped upper face  96 , pushes the catch  95  out of the way, and the arm  94  snaps under the catch  95 . The catch  95  returns to its previous position and prevents the arm  94  from inadvertently rising upward out of the locked position. The arm  94  is snugly retained between the top of the socket  93  and the underside of the catch  95 . When the arm  94  is to be moved out of the locked position, the back of the catch  95  is depressed, which pivots the catch  95  backward and allows the arm  94  to clear the catch  95 . 
     Referring to  FIG. 4 , in operation, the mount  10  is useful for holding the tube  14  in the mouth of a patient  11  and allowing the tube  14  to be moved into a variety of locations. The pads  27  and  28  are adhesively fixed to the cheeks of the patient  11  so as to position the pad  30  roughly at the philtrum. The tube  14  is inserted into the mouth and throat of the patient  11 , but can be moved. By depressing the tabs  50 , the shuttle  40  is disengaged with the depressions  35  in the track  31  and can be slid laterally across the track  31 , along the double-arrowed, arcuate line A. This allows a health worker to locate the tube  14  at either of the corners of the mouth, centrally in the mouth, or in some location therebetween. Moreover, the tube holder means  70  can be moved up and down on the slide  53  along the double-arrowed, arcuate line B, so that a health worker can place the tube  14  more against the upper lip or more against the lower lip. For example, if a health worker notices that the right side of the mouth of the patient  11  is becoming irritated such that a sore may develop, the health worker can slide the shuttle  40  to the left so as to position the tube  14  at the left side of the mouth (as in  FIG. 1B ). If the health worker then notices that the upper left side of the mouth is developing a sore, then the worker can move the slide  53  up on the vertical guide  71 , such that the tube  14  moves down against the lower lip (as in  FIG. 4 ). 
       FIGS. 5A-6  illustrate an endotracheal tube mount  110 , and  FIG. 7  shows that mount  110  applied to the patient  11 . The mount  110  includes an armature  112  which is placed over the patient  11  and a tube holder assembly  113  which holds the endotracheal tube  14  applied to the patient  11 . In this embodiment, the armature  112  has a horizontal adjustment means which moves the tube  14  horizontally across the user&#39;s mouth, and the tube holder assembly  113  has a vertical adjustment means which moves the tube  14  vertically in the user&#39;s mouth, so that the tube  14  can be moved and positioned both laterally between the user&#39;s lips and also vertically against either the upper lip or the lower lip, thereby reducing wear against the lips at any one particular location. 
     Many of the structural elements and features of the mount  110  are identical to those of the mount  10 . As such, the same names and references characters are used to identify such common structural elements and features, with those of the mount  110  being marked with a prime (“′”) symbol to distinguish them from those of the mount  10 . Moreover, common structural elements and features of the mount  110  may not be described in detail below for simplicity and may not be illustrated in the drawings. The reader will understand the structure, arrangement, and function of the common structural elements and features from the description of them with respect to the mount  10 . For example, the armature  112  includes a rib  20 ′, ends  21 ′ and  22 ′, front  23 ′, back  24 ′, ears  25 ′ and  26 ′, pads  27 ′ and  28 ′, pad  30 ′, track  31 ′, web  32 ′, upper and lower channels  33 ′ and  34 ′, and depressions  35 ′. 
     The tube holder assembly  113  is different from the tube holder assembly  13  of the mount  10 . It includes the shuttle  40 ′, block  41 ′, base  42 ′, upper and lower arms  43 ′ and  44 ′, slot  45 ′, tabs  50 ′, arms  51 ′, teeth  52 ′, slide  53 ′, base  55 ′, arms  56 ′ and  57 ′, slot  60 ′, and gap  61 ′, but it has a different tube holder means  120 . The slot  60 ′ and gap  61 ′ receive a track of a tube holder means  120  which holds the tube  14  in position below the rib  20 ′; the slide  53 ′ couples the tube holder means  120  to the shuttle  40 ′ of the armature  112 . 
     The tube holder means  120  includes a vertical guide  121  extending upward from a base  122  to which a tie  131  is fastened for securing the tube  14 . The vertical guide  121  includes a base  123 , a track  124 , and a web  125  extending transversely to the base  123  and track  124 , connecting the base  123  to the track  124  and spacing the two slightly apart from each other. Because the track  124  is spaced apart from the base  123  by the web  125 , the web  125  defines opposed, separate, lateral channels  126  and  127  between the track  124  and the base  123 . The channels  126  and  127  open laterally, and are slender channels acting as guides. When the slide  53 ′ is fit to the vertical guide  121 , the base  55 ′ of the slide  53   s  rides just off the track  124 , and the arms  56 ′ and  57 ′ each extend around the track  124  into the channels  126  and  127 , respectively. The gap  61 ′ between the arms  56 ′ and  57 ′ accommodates the web  125  in the guide  121 . When the slide  53 ′ moves vertically along the vertical guide  121 , the arms  56 ′ and  57 ′ slide within the channels  126  and  127 , respectively, and the gap  61 ′ slides over the web  125 . This interaction guides the vertical movement of the slide  53 ′ and prevents the slide  53 ′ from inadvertently coming free of the vertical guide  121 . As such, the slide  53 ′ and the vertical guide  121  cooperate to define the vertical adjustment means of the tube holder assembly  113 . 
     The vertical guide  121  extends upward from the base  122 , to which it is integrally and monolithically formed. The base  122  is a short, solid body having a roughly rectangular cross-section. It is formed with a hole  130  extending laterally through the body. A tie  131  is passed through the hole  130  for wrapping around the tube  14 . The tie  131  is flexible, malleable, and durable, and holds the shape in which it is arranged. As such, the tie  131  is wrapped around the tube  14  to hold the tube  14  closely to the base  122 . The base  122  has a concave underside to accommodate the curvature of the tube  14 . 
     Referring to  FIG. 7 , in operation, the mount  110  is useful for holding the tube  14  in the mouth of a patient  11  and allowing the tube  14  to be moved into a variety of locations. The pads  27 ′ and  28 ′ are adhesively fixed to the cheeks of the patient  11  so as to position the pad  30 ′ roughly at the philtrum. The tube  14  is inserted into the mouth and throat of the patient  11 , but can be moved. By depressing the tabs  50 ′, the shuttle  40 ′ is disengaged with the depressions  35 ′ in the track  31 ′ and can be slid laterally across the track  31 ′. This allows a health worker to locate the tube  14  at either of the corners of the mouth, centrally in the mouth, or in some location therebetween. Moreover, the tube holder means  120  can be moved up and down on the slide  53 ′, so that a health worker can place the tube  14  more against the upper lip or more against the lower lip. For example, if a health worker notices that the right side of the mouth of the patient  11  is becoming irritated such that a sore may develop, the health worker can slide the shuttle  40 ′ to the left so as to position the tube  14 ′ at the left side of the mouth (as in  FIG. 5B ). If the health worker then notices that the upper left side of the mouth is developing a sore, then the worker can move the slide  53 ′ up on the vertical guide  121 , such that the tube  14  moves down against the lower lip (as in  FIG. 7 ). 
       FIGS. 8A-9  illustrate an endotracheal tube mount  210 , and  FIG. 10  shows that mount  210  applied to a patient  11 . The mount  210  includes an armature  212  which is placed over the patient  11  and a tube holder assembly  213  which holds an endotracheal tube  14  applied to the patient  11 . In this embodiment, the armature  212  has a horizontal adjustment means which moves the tube  14  horizontally across the user&#39;s mouth, and it also has a vertical adjustment means which moves the tube  14  vertically in the user&#39;s mouth. In this way, the armature  212  allows the tube  14  to be moved and positioned both laterally between the user&#39;s lips and also vertically against either the upper lip or the lower lip, thereby reducing wear against the lips at any one particular location. 
     The armature  212  includes a central rib  220  having opposed ends  221  and  222  and a front  223  (shown better in  FIG. 9 ) and an opposed back  224 . The rib  220  is arcuate between the ends  221  and  222 . The ends  221  and  222  terminate in tracks, which are coupled to ears  225  and  226 , to which pads  227  and  228  are affixed, respectively. The pads  227  and  228  are soft, flexible, compressive pads, and preferably have adhesive inner faces so that they can be secured on the patient  11  in operation. The ears  225  and  226  also include loops  229  to which an elastic band can be engaged, which elastic band is used to fasten the mount  210  about the head of the patient  11 . 
     The ends  221  and  222  of the and the ears  225  and  226  are coupled to each other to form the vertical adjustment means of the armature  212 . There are two identical vertical adjustment means, one located at each end  221  and  222 , and so only one will be discussed with the understanding that the description applies equally to both. The ear  225  terminates at its inner end with a vertical guide  230  including an elongate base  231 , a coextensive track  232 , and a web  233  extending transversely between the base  231  and track  232 , connecting the base  231  and track  232  and spacing them slightly apart from each other. Because the track  232  is spaced apart from the base  231  by the web  233 , the web  233  defines opposed, separate, lateral channels  234  and  235  between the track  232  and the base  231 . The channels  234  and  235  open vertically to the sides, and are slender channels acting as guides for a slide  240 . 
     The slide  240  includes a short base  241  and two arms  242  and  243  which extend rectilinearly rearward and then toward each other, so as to define an open slot  244  between the arms  242  and  243  and the base  241 . Opposite the base  241 , the arms  242  and  243  do not contact each other; rather, their free ends are slightly spaced apart from each other to form a gap (not shown) in communication with the slot  244 . The slot  244  and gap receive the track  232  of the vertical guide  230  when the slide  240  is fit onto the vertical guide  230 . When the slide  240  is applied to the vertical guide  230 , the base  231  of the slide  240  rides just off the track  232 , and the arms  242  and  243  each extend around the track  232  into the channels  234  and  235 , respectively. The gap between the arms  242  and  243  accommodates the web  233  in the guide  230 . When the slide  240  moves vertically along the vertical guide  230 , the arms  242  and  243  slide within the channels  234  and  235 , respectively, and the gap slides over the web  233 . This interaction guides the vertical movement of the slide  240  and prevents the slide  240  from inadvertently coming free of the vertical guide  230 . As such, the vertical guide  230  and slide  240  mounted thereto cooperate to define the vertical adjustment means of the armature  212 . And, as noted above, both ends  221  and  222  of the rib  220  include identical structure. 
     In a preferred embodiment, as can be seen in the vertical guide  230  proximate the end  222  in  FIG. 8A , the web  233  has ribbed lateral surfaces. Preferably, the terminal edges of the arms  242  and  243  are complementally ribbed, such that the complemental ribs engage with each other so as to lock the slide  240  in indexed vertical positions along the vertical guide  230 . 
     A pad  250  is carried on the front  223  of the rib  220 . The pad  250  is soft and compressive; when the mount  210  is used with a patient, the pad  250  spaces the rib  220  apart from the philtrum of the patient so that the rib  220  does not rub or rest directly against the face of the patient  11 . The pad  250  is preferably adhesively fixed to the front  223  of the rib  220 , but may be formed integrally, sonically welded, or secured in some like fashion to the rib  220 . 
     On the back  224  of the rib  220  is a track  251 . The track  251  is raised off the back  224  of the rib  220  by an inner wall or web  252  extending centrally along the rib  220  along the full length of the rib  220 . Because the track  251  is spaced off the back  224  of the rib  220 , the inner web  252  defines opposed upper and lower channels  253  and  254  between the track  251  and the rib  220 . The upper and lower channels  253  and  254  open upwardly and downwardly, respectively, and are slender channels behind the rib  220  acting as a guide, as will be explained. 
     A large plurality of vertical depressions  255  are formed into the track  251 . These depressions  255  are discrete and spaced apart from each other, and each is generally rectangular. They extend approximately halfway into the track  250  and so are blind depressions. The upper and lower channels  253  and  254 , together with the depressions  255 , cooperate to engage with and allow horizontal movement of the tube holder assembly  213 . 
     The tube holder assembly  213  is a tube holder means, structured and arranged to hold the tube  14  in an adjustable position below the rib  220 , as shown in  FIG. 8A . The tube holder assembly  213  is mounted to the track  251  of the armature  212  for horizontal movement along the track  251  between the opposed ends  221  and  222  of the rib  220 . The tube holder assembly  213  includes a body with an upper portion  260  and a lower portion  261 . The upper and lower portions  260  and  261  are integrally and monolithically formed. The upper portion  260  extends generally downward away from the rib  251 , and the lower portion  261  extends rearwardly away from the bottom of the upper portion  260 . The upper portion  260  rides on the rib  220  between its opposed ends  221  and  222 . 
     The upper portion  260  includes an open slot  262  that receives the track  251 . The upper portion  260  includes a gap (not shown) which is a thin break or sever in the upper portion  260  in communication with the slot  262 ; the gap accommodates and rides over the web  252  connecting the track  251  to the rib  220 . In this way, the upper portion  260  defines a shuttle, somewhat similar to the shuttle  40  in the mount  10 . The upper portion  260  has an upper arm  263  and a lower arm  264  extending around and defining the slot  262 . The free ends of the upper and lower arms are spaced apart by the gap. 
     When the upper portion  260  is fit to the track  251 , it rides just above the depressions  255  in the track  251 , and when the upper portion  260  moves horizontally along the track  251 , the upper arm  263  and lower arm  264  slide within the upper channel  253  and lower channel  354 , respectively, and the gap between the upper and lower arms  263  and  264  slides over the web  252 . This interaction guides the movement of the upper portion  260  and prevents the upper portion  260  from inadvertently coming free of the rib  220 . 
     The upper portion  260  includes tabs  265  for locking the position of the upper portion  260  along the track  251 . The tabs  265 , best shown in  FIG. 8B , are on opposed sides of the upper portion  260 . They extend outward from the upper portion  260 , diagonally away from the track  251 , and are biased forwardly toward the track  251  on sprung, flexible arms. The tabs  265  have forwardly-directed teeth  266  which move into and out of the depressions  255  in the track to engage with them. The tabs  265  are biased forwardly, and when the tabs  265  are forward, the teeth  266  engage with the depressions  255  and prevent lateral movement of the upper portion  260  along the track  251 . Because the depressions  255  are discrete and spaced-apart, engagement of the teeth  266  in the depressions  255  indexes the upper portion  260  along the track  251 . Squeezing the tabs  265  backward and toward each other causes the tabs  265  to pivot away from the track  251  and the teeth  266  to move out of the depressions  255 , thereby breaking the engagement of the tabs  265  and depressions  255 , so that the upper portion  260  may be freely moved along the track  232 . 
     The lower portion  261  of the tube holder assembly  213  is formed to the upper portion  260  and extends below and rearward from the base of the upper portion  260 . The rear portion  261  includes a clamp  270  projecting forwardly to hold the tube  14 , and a crimp  272  for securing a strap  273  around the tube  14 . The clamp  270  projects forwardly from the base of the lower portion  261  of the tube holder assembly  231 . The clamp  270  is formed integrally and monolithically to the lower portion  261  as an extension thereof. The clamp  270  is a cylindrical clamp, being a severed hollow tube with an elongate opening  271  extending parallel to its axis. The opening  271  is approximately the same dimension as the radius of the cylindrical clamp  270 , and the clamp  270  preferably has an inner diameter which is just smaller than the outer diameter of the tube  14 . The clamp  270  is constructed from a pliant, flexible, and resilient material or combination of materials, such as plastic, so that the opening  271  can be enlarged to pass the tube  14  through the opening  271 . The opening  271  of the clamp  270  then returns to its previous dimension, smaller than the diameter of the tube  14 , and the tube  14  is snugly retained in the clamp  270 . This snug retention holds the tube  14  and prevents relevant axial and rotational movement of the tube with respect to the clamp  270 . 
     The tube  14  is also secured by the strap  273  in the crimp  272 . The strap  273  is a thin, flexible ribbon or length of plastic. The lower portion  261  includes a solid rectangular prismatic body with an elongate socket  274  (similar to the socket  93  of the mount  10 ) oriented with an upward opening behind the upper portion  260 . The socket  274  is open, but an arm  275  above the socket  274  is hinged to pivot between an unlocked position (as shown in  FIG. 9 ) and a locked position (as shown in  FIGS. 8A, 8B , and  10 ). The socket  274  and arm  275  cooperate to define the crimp  272 . The arm  275  is hinged to the body of the tube holder assembly  213  proximate the base of the upper portion  260 , and so its free end projects rearwardly away from the upper portion  260 . In the unlocked position, the arm  275  is up, out of the socket  274 , and the strap  273  may be placed into the socket  274  or removed therefrom. In the locked position, the arm  275  is depressed into the socket  274 , where it may capture the strap  273 . The socket  274  has a triangular-shaped cross-section (identical to that of the socket  93 ), and the underside of the arm  275  has a complemental, triangular, downward projection which snaps into the socket  274 . When the strap  273  is placed into the socket  274  and the arm  275  is closed in the socket  274  in the locked position, the strap  273  is crimped in the socket  274  and thus retained therein. Further reinforcing this retention is a catch  276  formed at the end of the tube holder means  70 . The catch  276  is a lip that hangs over the socket  274 . The catch  276  has a sloped upper face  277 ; when the arm  275  is moved downward toward the locked position, the arm  275  encounters the sloped upper face  277 , pushes the catch  276  out of the way, and the arm  275  snaps under the catch  276 . The catch  276  returns to its previous position and prevents the arm  275  from inadvertently rising upward out of the locked position. The arm  275  is snugly retained between the top of the socket  274  and the underside of the catch  276 . When the arm  275  is to be moved out of the locked position, the back of the catch  276  is depressed, which pivots the catch  276  backward and allows the arm  275  to clear the catch  276 . 
     Referring to  FIG. 10 , in operation, the mount  210  is useful for holding the tube  14  in the mouth of a patient  11  and allowing the tube  14  to be moved into a variety of locations. The pads  227  and  228  are adhesively fixed to the cheeks of the patient  11  so as to position the pad  250  roughly at the philtrum. The tube  14  is inserted into the mouth and throat of the patient  11 , but can be moved. By depressing the tabs  265 , the upper portion  260  is disengaged with the depressions  255  in the track  251  and can be slid laterally across the track  251 , thereby moving the tube holder assembly  213  horizontally. This allows a health worker to locate the tube  14  at either of the corners of the mouth, centrally in the mouth, or in some location therebetween. 
     Moreover, the rib  220  can be moved up and down on its two slides  240  fit in the tracks  232 , so that a health worker can place the tube  14  more against the upper lip or more against the lower lip. For example, if a health worker notices that the right side of the mouth of the patient  11  is becoming irritated such that a sore may develop, the health worker can slide the upper portion  260  to the left so as to position the tube  14  at the left side of the mouth (as in  FIG. 8B ). If the health worker then notices that the lower left side of the mouth is developing a sore, then the worker can move the slides  240  up on the vertical guides  230 , such that the tube  14  moves up against the upper lip. 
       FIGS. 11A-12  illustrate an endotracheal tube mount  310 , and  FIG. 13  shows that mount  310  applied to a patient  11 . The mount  310  includes an armature  312  which is placed over the patient  11  and a tube holder assembly  313  which holds an endotracheal tube  14  applied to the patient  11 . In this embodiment, the armature  312  has a horizontal adjustment means which moves the tube  14  horizontally across the user&#39;s mouth, and it also has a vertical adjustment means which moves the tube  14  vertically in the user&#39;s mouth. In this way, the armature  312  allows the tube  14  to be moved and positioned both laterally between the user&#39;s lips and also vertically against either the upper lip or the lower lip, thereby reducing wear against the lips at any one particular location. 
     Many of the structural elements and features of the mount  310  are identical to those of the mount  110 . As such, the same names and references characters are used to identify such common structural elements and features, with those of the mount  310  being marked with a prime (“′”) symbol to distinguish them from those of the mount  110 . Moreover, common structural elements and features of the mount  310  may not be described in detail below for simplicity and may not be illustrated in the drawings. The reader will understand the structure, arrangement, and function of the common structural elements and features from the description of them with respect to the mount  10 . For example, the armature  312  includes a rib  220 ′, ends  221 ′ and  222 ′, front  223 ′, back  224 ′, ears  225 ′ and  226 ′, pads  227 ′ and  228 ′, loops  229 ′, vertical guides  230 ′, base  231 ′, track  232 ′, web  233 ′, channels  234 ′ and  235 ′, slide  240 ′, base  241 ′, arms  242 ′ and  243 ′, slot  244 ′, pad  250 ′, track  251 ′, web  252 ′, upper and lower channels  253 ′ and  254 ′, and depressions  255 . 
     The tube holder assembly  313  is different from the tube holder assembly  213  of the mount  210 . The tube holder assembly  313  is a tube holder means, structured and arranged to hold the tube  14  in an adjustable position below the rib  220 ′, as shown in  FIG. 11A . The tube holder assembly  313  is mounted to the track  251 ′ of the armature  312  for horizontal movement along the track  251 ′ between the opposed ends  221 ′ and  222 ′ of the rib  220 ′. The tube holder assembly  313  includes a body with an upper portion  320 . The upper portion  320  extends generally downward away from the rib  251 , terminating in a base  321 . The upper portion  320  rides on the rib  220 ′ between its opposed ends  221 ′ and  222 ′. 
     The upper portion  320  includes an open slot  322  that receives the track  261 ′. The upper portion  320  includes a gap (not shown) which is a thin break or sever in the upper portion  320  in communication with the slot  322 ; the gap accommodates and rides over the web  252 ′ connecting the track  251 ′ to the rib  220 ′. In this way, the upper portion  320  defines a shuttle, somewhat similar to the shuttle  40  in the mount  10 . The upper portion  320  has an upper arm  323  and a lower arm  324  extending around and defining the slot  322 . The free ends of the upper and lower arms are spaced apart by the gap. 
     When the upper portion  320  is fit to the track  251 , it rides just above the depressions  255  in the track  251 , and when the upper portion  320  moves horizontally along the track  251 , the upper arm  323  and lower arm  324  slide within the upper channel  253 ′ and lower channel  254 ′, respectively, and the gap between the upper and lower arms  323  and  324  slides over the web  252   s . This interaction guides the movement of the upper portion  320  and prevents the upper portion  320  from inadvertently coming free of the rib  220 ′. 
     The upper portion  320  includes tabs  325  for locking the position of the upper portion  320  along the track  251 ′. The tabs  325 , best shown in  FIG. 11B , are on opposed sides of the upper portion  320 . They extend outward from the upper portion  320 , diagonally away from the track  251 ′, and are biased forwardly toward the track  251 ′ on sprung, flexible arms. The tabs  325  have forwardly-directed teeth  326  which move into and out of the depressions  255 ′ in the track to engage with them. The tabs  325  are biased forwardly, and when the tabs  325  are forward, the teeth  326  engage with the depressions  255 ′ and prevent lateral movement of the upper portion  320  along the track  251 ′. Because the depressions  255 ′ are discrete and spaced-apart, engagement of the teeth  326  in the depressions  255 ′ indexes the upper portion  320  along the track  251 ′. Squeezing the tabs  325  backward and toward each other causes the tabs  325  to pivot away from the track  251 ′ and the teeth  326  to move out of the depressions  255 ′, thereby breaking the engagement of the tabs  325  and depressions  255 ′, so that the upper portion  320  may be freely moved along the track  232 ′. 
     The base  321  of the tube holder assembly  313  is formed to the upper portion  320  and extends below and just slightly rearward from the upper portion  320 . A tie  330  is fastened to the base  321  for securing the tube  14 . A hole  331  is formed entirely through the base  321  laterally. The tie  330  is constructed from a flexible, malleable, and durable material, and it holds the shape into which it is arranged. The tie  330  is passed through the hole  331  and then wrapped around the tube  14  under the base  321  of the tube holder assembly  313  to hold the tube  14  closely to the base  321 . The base  321  has a concave underside to accommodate the curvature of the tube  14 . 
     Referring to  FIG. 13 , in operation, the mount  310  is useful for holding the tube  14  in the mouth of a patient  11  and allowing the tube  14  to be moved into a variety of locations. The pads  227 ′ and  228 ′ are adhesively fixed to the cheeks of the patient  11  so as to position the pad  250 ′ roughly at the philtrum. The tube  14  is inserted into the mouth and throat of the patient  11 , but can be moved. By depressing the tabs  325 , the upper portion  320  is disengaged with the depressions  255 ′ in the track  251 ′ and can be slid laterally across the track  251 ′, thereby moving the tube holder assembly  313  horizontally. This allows a health worker to locate the tube  14  at either of the corners of the mouth, centrally in the mouth, or in some location therebetween. 
     Moreover, the rib  220  can be moved up and down on its two slides  240 ′ fit in the tracks  230 ′, so that a health worker can place the tube  14  more against the upper lip or more against the lower lip. For example, if a health worker notices that the right side of the mouth of the patient  11  is becoming irritated such that a sore may develop, the health worker can slide the upper portion  320  to the left so as to position the tube  14  at the - of the mouth (as in  FIG. 11B ). If the health worker then notices that the lower left side of the mouth is developing a sore, then the worker can move the slides  240 ′ up on the vertical guides  230 ′, such that the tube  14  moves up against the upper lip. 
     A preferred embodiment is fully and clearly described above so as to enable one having skill in the art to understand, make, and use the same. Those skilled in the art will recognize that modifications may be made to the description above without departing from the spirit of the invention, and that some embodiments include only those elements and features described, or a subset thereof. To the extent that modifications do not depart from the spirit of the invention, they are intended to be included within the scope thereof.