Patent Publication Number: US-2021187228-A1

Title: Endotracheal devices and methods for using an endotracheal device

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims priority from pending U.S. Provisional Patent Application 62/832,947, filed on Apr. 12, 2019, the disclosure of which is included by reference herein in its entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     Technical Field 
     This invention is generally related to endotracheal or intubation devices and the use of endotracheal or intubation devices, for example, in operating rooms, emergency rooms, and by first responders. Specifically, aspects of the invention include endotracheal devices having an external conduit, an internal conduit within the external conduit, and a rod that can be used to move the internal conduit within the external conduit to treat patients. 
     Description of Related Art 
     Endotracheal tubes (or ETTs) are conventional supra-glottic (that is, above the glottic or laryngeal opening) devices used, for example, during surgery, to—among other things—maintain access to the trachea of the patient. Endotracheal tubes are also conventional tubes specially designed with inflatable cuffs to seal airways and effectively support oxygenation and ventilation, for example, during surgery. 
     In the existing art, especially during thoracic surgery, endotracheal tubes may be used to isolate one lung from the other. For example, a thoracic surgeon may require that the lungs be isolated and a single lung be ventilated when performing certain procedures, for instance, lobectomy, bronchopulmonary lavage, and esophagogastrectomy, among other procedures. 
     One device that is may be used to isolate the lungs is a relatively rigid tubular device referred to as “double-lumen endotracheal tube” (DLT). When using a DLT, the user, for example, an anesthesiologist, inserts a tube having two lumens into the trachea through which to ventilate the lungs. One of the two lumens is positioned in the left or right bronchial main stem and the other lumen remains in the trachea. However, though DLTs can provide an effective means for isolating a lung, DLTs can be bulky and thus cumbersome to manipulate by the user, such as, an anesthesiologist. In addition, DLTs typically must be left in place in the patient for a few days after surgery if the patient is transferred to intensive care after surgery. 
     However, it is well recognized in the art that in the use of ETTs the manipulation and positioning of the tube in the airway, for example, in a bronchus, can be difficult without undo diligence and care. Of course, these prior art devices and practices are being performed on patients, where misstep or error can be harmful, if not life threatening. 
     Aspects of the invention address these and other disadvantages of the prior art by providing a unique ETT that not only avoids the inconveniences and complications of the prior art, but also can provide unique opportunities for improved techniques and improved patient treatment and outcome. 
     SUMMARY OF THE INVENTION 
     Aspects of the present invention may, for example, be used for lung isolation, among other procedures, and may facilitate the positioning and/or orienting of tubes within the trachea and bronchi. In addition, according to aspects of the invention, once the, for example, thoracic surgery is completed, the inner conduit or tube of the present invention can be withdrawn from the patient. In other aspects, the inner conduit or tube of the present invention may be left in place within the patient. Aspects of the present invention may also be less bulky and less cumbersome to handle and position within the patient compared to existing devices. In short, aspects of the present invention may be easier to use by the anesthesiologist and thus easier to isolate a lung of a patent than existing devices. 
     In the following discussion, aspects of the invention may be referred to as “endotracheal devices”; however, aspects of the invention may be referred to as “intubation devices” or “endobronchial devices,” for example, depending upon the use, function, and/or positioning of the aspect disclosed. 
     Aspects of the present invention address the disadvantages of the existing art by providing endotracheal devices having two cooperating conduits or tubes, an external conduit and an internal conduit positioned within the external conduit, and a manipulation rod or wire mounted to the internal conduit which may be used to move the internal conduit, for example, telescopically, within the external conduit to treat patients. Embodiments of the invention and the many aspects the embodiments are summarized in the following descriptions. 
     One embodiment of the invention is an endotracheal device comprising or including: a first elongated conduit having an internal dimension, a proximal end, and an open distal end; a second elongated conduit having an external dimension less than the internal dimension of the first conduit, an open proximal end in fluid communication with the first elongated conduit, and an open distal end; and a manipulation rod operatively mounted to the second conduit, the manipulation rod adapted to allow an operator to move the second conduit within the first conduit. In one aspect, the manipulation rod may be adapted to allow the operator to translate the second conduit within the first conduit and/or rotate the second conduit within the first conduit. 
     In one aspect, the first conduit further comprises an opening through which the manipulation rod accesses the second conduit, wherein movement of the manipulation rod moves the second conduit within the first conduit. In one aspect, the opening may be an elongated slot, in another aspect, the opening may include a fluid-sealing element. 
     In anther aspect, the device may further include a rod receiver mounted to the first conduit, and the rod receiver may have an opening to receive the manipulation rod. The opening in the rod receiver may include a fluid sealing element. The opening in the rod receiver may a circumferentially directed slot. 
     In one aspect, the device may further include a projection, tab, or bar connecting the manipulation rod to the second conduit. 
     In another aspect, the device may further include at least one inflatable cuff mounted to one of the first conduit and the second conduit. 
     Another embodiment of the invention is a method for treating a patient. The method may comprise or include: introducing to a cavity within the patient a device comprising: a first elongated conduit having an internal dimension, a proximal end, and an open distal end; a second elongated conduit having an external dimension less than the internal dimension of the first conduit, an open proximal end in fluid communication with the first elongated conduit, and an open distal end; and a manipulation rod operatively mounted to the second conduit; and moving the second conduit within the first conduit with the manipulation rod to position the distal end of the second conduit within the patient. The step of moving the second conduit within the first conduit may comprise translating and/or rotating the second conduit within the first conduit. 
     In one aspect, the cavity within the patient being treated may be an airway, such as, a trachea or bronchus. 
     In another aspect, the method may further include introducing and/or extracting a fluid from the cavity. 
     In another aspect, the method may further include inflating at least one inflatable cuff on the first conduit and/or the second conduit to obstruct fluid flow passed the cuff. 
     These and other aspects, features, and advantages of this invention will become apparent from the following detailed description of the various aspects of the invention taken in conjunction with the accompanying drawings 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The subject matter, which is regarded as the invention, is particularly pointed out and distinctly claimed in the claims at the conclusion of the specification. The foregoing and other objects, features, and advantages of the invention will be readily understood from the following detailed description of aspects of the invention taken in conjunction with the accompanying drawings in which: 
         FIG. 1  is a side view of an endotracheal device according to one aspect of the invention. 
         FIG. 2  is a top view of the endotracheal device shown in  FIG. 1 . 
         FIG. 3  is a detailed cross-sectional view of the endotracheal device shown in  FIG. 1  as identified by Detail  3  in  FIG. 1 . 
         FIG. 4  is a cross-sectional view of the endotracheal device shown in  FIGS. 1 and 2  having the internal translatable conduit in a first position according to an aspect of the invention. 
         FIG. 5  is a cross sectional view of the endotracheal device shown in  FIG. 4  having the internal translatable conduit in a second position according to an aspect of the invention. 
         FIG. 6  is a partial view of the endotracheal device shown in  FIGS. 1 through 5  positioned in an airway, shown in cross section, according to an aspect of the invention. 
         FIG. 7  is a cross-sectional view of another endotracheal device according to an aspect of the invention. 
         FIG. 8  is a side view of another endotracheal device according to an aspect of the invention. 
         FIG. 9  is a top view of the endotracheal device shown in  FIG. 8 . 
     
    
    
     DETAILED DESCRIPTION OF ASPECTS OF THE INVENTION 
       FIG. 1  is a side view of an endotracheal device  10  according to one aspect of the invention.  FIG. 2  is a top view of the endotracheal device  10  shown in  FIG. 1 . As shown, endotracheal device  10  typically includes a first elongated conduit  12 , second elongated conduit  14  positioned for movement within first elongated conduit, and a manipulation rod or wire i 6  operatively mounted to the second conduit  14 , the manipulation rod  16  is adapted to allow an operator to move the second conduit  14  within the first conduit  12 . According to aspects of the invention, manipulation wire or rod  16  may be adapted to translate and/or rotate second conduit  14  within the first conduit  12 . 
     In one aspect, an endotracheal device  10  may be referred to as “an endotracheal tube (ETT)” or “an endotracheal tube device.” In another aspect, each of first elongated conduit  12  and second elongated conduit  14  may be referred to as “an endotracheal tube.” For example, in one aspect, device  10  may be referred to as “an endotracheal tube within an endotracheal tube” or “an ETT within an ETT.” It is envisioned that the inventors and/or others may conceive of other appropriate designations for aspects of the invention. 
     In one aspect, the first elongated conduit  12  typically has an internal dimension  18 , for example, an inside diameter or inside width; a proximal end  20 ; and an open distal end  22 ; and second elongated conduit  14  typically has an external dimension  24 , for example, an outside diameter or outside width, less than the internal dimension  18  of the first conduit  12 ; an open proximal end  26 ; and an open distal end  28 . Typically, open proximal end  26  of second elongated conduit  14  may be in fluid communication with the interior of the first elongated conduit  12 . 
     As shown in  FIGS. 1 and 2 , endotracheal device  10  may include one or more inflatable cuffs or balloon cuffs adapted to substantially obstruct the annular cavity in which the cuffs are located when inflated to prevent fluid flow past the balloon cuff. In one aspect, the first elongated conduit  12  may include one or more balloon cuffs  30 , for example, at least one balloon cuff  30  located proximate the distal end  22  of conduit  12 . According to aspects of the invention, cuff  30  (and any inflatable cuff disclosed herein) may operate and function as a conventional cuff as known in the art, for example, cuff  30  may inflate or expand when filled with a fluid, for example, pressurized gas, such as, air, and deflate when the fluid is depressurized or removed from the cuff  30 . When inflated, balloon cuff  30  may obstruct the annular cavity between the outside surface of conduit  12  and the internal surface (not shown) of the cavity or passage into which conduit  12  is positioned. In one aspect, the second elongated conduit  14  may include one or more balloon cuffs  32 ,  34 , for example, at least one balloon cuff  32  located proximate the proximal end  26  of conduit  14  and one balloon cuff  34  located proximate the distal end  28  of conduit  14 . When inflated, balloon cuffs  32  and  34  may obstruct the annular cavity between the outside surface of conduit  14  and the internal surface of conduit  12  and/or the internal surface (not shown) of the cavity or passage into which conduit  14  is positioned. Balloon cuffs  3 o,  32 , and  34  may be inflated via one or more conduits or lumens (not shown in  FIGS. 1 and 2 ), as typical in the art. See  FIG. 7  for typical balloon cuff inflation conduits or lumens that may be used. 
     As shown in  FIGS. 1 and 2 , according to aspects of the invention, manipulation wire or rod  16  is typically connected to second conduit  14  and accesses conduit  14  via a rod receiver or rod channel  38 . According to aspects of the invention, wire or rod  16  may be any elongated structure operatively connected to second conduit  14  whereby movement of rod  16  effects movement, for example, translation (as indicated by double arrow  19 ) and/or rotation of conduit  14 . As shown in  FIGS. 1 and 2 , rod  16  may comprise an elongated cylindrical structure or element, for example, a circular cylindrical element, elliptical cylinder element, polygonal cylindrical element, and the like. Rod  16  may be solid or hollow, for example, tubular. Rod  16  may be relatively rigid or flexible. In one aspect, rod  16  may comprise a relatively rigid filament, a wire, or a thin rod. As shown in  FIG. 1 , in one aspect, rod  16  may include a structure  17  adapted to facilitate handling and/or manipulation of rod  16 , such as, a knob or a bulb. The rod  16  or the knob or bulb  17  may be knurled to facilitate handling. 
     Rod receiver  38  may typically comprise a structure or housing positioned and adapted to receive rod  16  and allow rod  16  to access and move conduit  14  within conduit  12 . In one aspect, rod receiver  38  may be adapted to receive rod i 6  and allow rod  16  to access and move conduit  14  while minimizing or preventing the passage of fluid from device  10 , for example, from rod receiver  38  and/or conduit  12 . As shown in  FIGS. 1 and 2 , rod receiver  38  may comprise a housing having sides  40 , a top  42 , and a bottom  44 . Though, in one aspect, the housing of rod receiver  38  may be hexagonal or square in cross section, as shown in  FIGS. 1 and 2 , in another aspect, the housing of rod receiver  38  may be curved, for example, circular or elliptical in cross section. 
       FIG. 3  is a cross-sectional view of the Detail  3  shown in  FIG. 1 , and illustrates one mechanism for mounting rod or wire i 6  to second conduit  14  via rod receiver  38 . According to aspects of the invention, any conventional means may be used for attaching rod  16  to second conduit  14  where the movement of rod  16  effects the movement of second conduit  14 . As shown in  FIG. 3 , in one aspect, rod  16  may be mounted to conduit  14  by one or more projections, tabs, plates, rods, or bars  46 . The one or more projections  46  may be mounted to rod  16  and second conduit  14  by conventional means, for example, via mechanical fasteners or/an adhesive. In one aspect, the one or more projections  46  may be integrally molded to rod  16  and/or to conduit  14 . 
     As also shown in  FIG. 3 , in one aspect, rod receiver  38  may include one or fluid sealing devices or elements  48 , for example, one or more fluid sealing devices or elements  48  about a hole or slot  50  in top  42  of rod receiver  38  through which rod  16  passes into rod receiver  38 . Device  10  may also include one or more sealing devices  52  (shown in phantom in  FIG. 3 ) about an aperture or slot  54  between rod receiver  38  and conduit  12 . According to aspects of the invention, the aperture of slot  54  may provide a passage for rod  16  to access conduit  14 . 
       FIG. 4  is a cross sectional view of the endotracheal device  10  shown in  FIGS. 1, 2, and 3  having the internal translatable conduit  14  in a first position according to an aspect of the invention.  FIG. 5  is a cross sectional view of the endotracheal device  10  shown in  FIG. 4  having the internal translatable conduit  14  shown in a second position, different from the first position shown in  FIG. 4 , according to an aspect of the invention. 
     As shown in  FIGS. 4 and 5 , according to aspects of the invention, an operator, for example, an anesthesiologist (though aspects of the invention may be used by, for example, any health care professional or first responder), may manipulate rod  16  as indicated by double arrow  19 , to translate rod  16  and internal second conduit  14  from, for example, the first position shown in  FIG. 4 , to the second position shown in  FIG. 5 . For example, in one aspect of the invention, an operator may first position device  10  in an airway, for example, through the trachea of a patient, and while the second conduit  14  is positioned in the first position shown in  FIG. 14 , then, with or without the inflation of cuffs  3 o,  32 , and/ 34 , advance the position of internal second conduit  14  from the first position shown in  FIG. 4  to the second position shown in  FIG. 5  using the rod  16 . The translation or advancement of rod  16  and conduit  14  may be practiced with or without visual videographic or x-ray imaging assistance, and/or with or without the use of a guiding device, such as, a “bougie,” as known in the art. 
       FIG. 6  is a partial view of the endotracheal device  10  shown in  FIGS. 1 through 6  positioned in an airway  6 o, shown in cross section, according to an aspect of the invention. In this non-limiting depiction of one use of an aspect of the invention, the airway  6 o shown in  FIG. 6  includes a portion of a trachea  62 , for example, a human trachea (also known as “the windpipe”), and portions of the right main bronchus  64  and left main bronchus  66  leading to the lungs (not shown). 
     As shown in  FIG. 6 , according to one aspect of the invention, with the use of manipulation rod  16  (not shown in  FIG. 6 ), the inner conduit  14  of endotracheal device  10  may be extended from, for example, the outer conduit  12 , and directed into one of the bronchi  64  or  66 . As shown in  FIG. 6 , inflation cuff  30  about conduit  12  may be inflated against the inner surface of trachea  62  to minimize or prevent passage of fluids, such as, bodily liquids or gases, through the annular cavity about conduit  12 . In addition, inflation cuff  34  about conduit  14  may be inflated against the inner surface of left main bronchus  66  to minimize or prevent passage of fluids, such as, bodily fluids or gases, between the annular cavities about conduit  14 . 
     Though one specific airway that may be accessed by aspects of the invention is shown in  FIG. 6 , according to other aspects of the invention, endotracheal device  10  may be used in any human or animal cavity, passage, or airway to access and isolate portions of the cavity, passage, or airway. For example, in one aspect of the invention, device  10  may be used to isolate a lung during thoracic surgery, for example, during a lobectomy, a pneumonectomy, a pleural decortication, a bullectomy, bronchopulmonary lavage, an esophagogastrectomy, a thymectomy, or a mediastinal mass resections, among thoracic surgeries. 
       FIG. 7  is a cross-sectional view of another endotracheal device  100  according to an aspect of the invention. Endotracheal device  100  may include any one or more of the aspects and features of endotracheal device  10  shown in  FIGS. 1 through 6 . Among other things, endotracheal device  100  discloses several ancillary features that may be provided for aspects of the invention, including balloon cuff inflation conduits and fluid sampling or venting conduits. 
     As shown in  FIG. 7 , in one aspect, device  100  may include the features disclosed for device  10 , including a first external conduit  112  and second internal conduit  114 , and one or more manipulation rods or wires  116  mounted to internal conduit  114  and translatable, as indicated by double arrow  119 , and/or rotatable (see  FIGS. 8 and 9 ), and a rod receiver  138 , as disclosed herein. Rod  116  may include a mounting bar or tab  146  that connects rod  116  to conduit  114 . According to the aspect shown in  FIG. 7 , device  100  may also include one or more balloon cuffs  130  about conduit  112 , and one or more balloon cuffs  132 ,  134  about conduit  114 , as disclosed herein. 
     As shown in  FIG. 7 , device  100  may include one or more connectors or couplings  102  adapted to engage one or more conduits in fluid communication with an external fluid source (not shown) or an external fluid receiver (not shown). For example, in one aspect, coupling  102  may be in fluid communication with a source of treatment fluid, for example, an oxygen-containing gas. Coupling  102  may be a conventional 15 mm connector, and may be threadably mounted to the proximal end of conduit  112 . 
     As shown in  FIG. 7 , device  100  may include inflation conduits or lumens  104 ,  106 , and  108  in fluid communication with the inflation cuffs  130 ,  132 , and  134 , respectively. As is conventional, lumens  104 ,  106 , and  108  may be in fluid communion with a source of pressurized gas, such as, air, to inflate or deflate cuffs  130 ,  132 , and  134 , respectively. As shown in  FIG. 7 , in one aspect, lumens  104 ,  106 , and  108  may be operatively connected to inflation pilot balloons  105 ,  107 , and  109 , respectively, as known in the art, though any source of pressurized gas may be used to inflate inflation cuffs  130 ,  132 , and  134 . 
     As shown, inflation lumen  104  associated with cuff  130  may be mounted to or within and extend along conduit  112 . 
     According to aspects of the invention shown in  FIG. 7 , since cuffs  132  and  134  may be mounted and move, for example, translate and/or rotate, with conduit  114 , inflation lumens  106  and  108  may be mounted to or within conduit  114  and be adapted to maintain fluid communication with cuffs  132  and  134  with the movement of conduit  114 . In one aspect of the invention, lumens  106  and  108  may pass through conduit  112  and/or rod receiver  138  and then mount to and extend along conduit  114  to access cuffs  132  and  134 , respectively, while allowing for the movement of conduit  114 . In one aspect, a portion of lumen  106  and/or a portion of lumen  108  may be unmounted and be allowed to freely flex and/or deflect along an unsecured length of lumens  106  and/or  108  within device  100  such that lumens  106  and  108  do not restrict or interfere with the movement of conduit  114 . In one aspect, lumen  106  and/or lumen  108  may access conduit  114  as disclosed in pending U.S. application Ser. No. 16/255,983, the disclosure of which is included by reference herein. For example, lumen  106  and/or lumen  108  may pass along or within rod  116 , pass across or within projection  146 , and then along or within conduit  114  to access cuff  132  and/or cuff  134 . 
     According to one aspect of the invention, as shown in  FIG. 7 , lumens  106  and  108  may access conduit  114  via tab or bar  146  mounted between rod  116  and conduit  114  where lumens  106  and  108  move with rod  116  and bar  146 . 
     In one aspect of the invention, device  100  may include one or more other ancillary lumens or conduits no having a proximal end  111  and a distal end  113 . For example, in one aspect, one or more lumens or conduits  110  may include one or more open ends, holes, or orifices  115  adjacent to distal end  113 . According to aspects of the invention, the one or more orifices or holes  115  may be provided in or on conduit  112  (for example, evenly distributed in, about and/or along the distal end of conduit  112 ). In one aspect, one or more lumens or conduits  110  may communicate via proximal end in with one or more external fluid sources (not shown) and/or one or more external fluid receivers (not shown). According to aspects of the invention, the one or more lumens or conduits  110  may be used to introduce one or more fluids to or extract one or more fluids from an internal cavity or passage, such as, a trachea, a bronchus, an esophagus, or another cavity or passage into which device  110  is placed. The proximal ends in of one or more lumens or conduits  110  may communicate with external sources, for example, sources of medication, or treatments, for example, vacuum or fluid pressure, by conventional means. In one aspect, lumens or conduits  110  may be used to inflate or deflate an internal cavity, for example, a lung. 
     In one aspect of the invention, lumen or conduit  110  and hole  115  and/or conduit  117  and hole  119  may be associated with an image-capturing device  140 , shown in phantom in  FIG. 9 . For example, in one aspect, hole  15  and/or hole  119  may be image capturing apertures, conduit  110  and/or conduit  115  may be one or more wires or cables, for example, a fiber optic cable, adapted to transmit signals corresponding to the images captured by the aperture  115  and/or aperture  119  to image capturing device  140 . The images captured may be still images or moving images. Image capturing device  140  may be any device adapted to receive and store, locally or remotely, signals associated with the images captured by aperture  115  and/or aperture  119 . Image capturing aperture  140  may be adapted to capture images in the visual spectrum, or in any range of the electromagnetic spectrum desired, including x-ray images, infrared images, and microwave images, and the like. 
     In another aspect, one or more lumens or conduits  117  (only a representative portion of which is shown in phantom in  FIG. 7 ) may be associated with internal conduit  114  and have one or more orifices  119  in the distal end of internal conduit  114  to provide similar functions as lumens  110 , for example, the introduction or removal of a fluid from an internal cavity adjacent the distal end of conduit  114 . In one aspect, the one or more lumens or conduits  117  having one or more orifices  119  (shown in phantom) may be associated with internal conduit  114  and may be adapted to accommodate the movement of internal conduit  114  in a fashion similar to lumens  106  and  108 , as disclosed herein. For example, the one or more lumens or conduits  117  associated with internal conduit  114  may include a portion that is unmounted and freely flexes along an unsecured length such as to not restrict or interfere with the movement of conduit  114 , and/or the one or more lumens or conduits  117  associated with internal conduit  114  may access conduit  114  via tab or bar  146  mounted between rod  116  and conduit  114  and move with rod  116  and bar  146 . 
       FIG. 8  is a cross sectional view of another endotracheal device  200  according to an aspect of the invention.  FIG. 9  is a top view of the endotracheal device  200  shown in  FIG. 8 . 
     As shown in  FIGS. 8 and 9 , in this aspect, device  200  (and device  10 ]and device  100 ) may include the features disclosed for device  10 , including a first external conduit  212  and second internal conduit  214 , and one or more manipulation rods or wires  216  mounted to internal conduit  214  and translatable (as indicated by double arrow  219 ), and a rod receiver  238 , as disclosed herein. Rod  216  may include one or more mounting projections, bars, or tab  246  that connects rod  216  to conduit  214 . According to the aspect shown in  FIGS. 8 and 9 , device  200  may also include one or more balloon cuffs  230  about conduit  212 , and one or more balloon cuffs  232 ,  234  about conduit  214 , and appropriate cuff inflation lumens (not shown), as disclosed herein. 
     As shown in  FIGS. 8 and 9 , in this aspect, device  200  is adapted to rotate and/or translate internal conduit  214  within external conduit  212  by means of rod  216 . As shown most clearly in  FIG. 9 , in this aspect, rod receiver  238  comprises a cylindrical housing that at least partially surrounds external conduit  212  and provides a channel or slot  250  for the movement of rod  216 . In this aspect, the shape and location of slot  250  in rod receiver  238  allows an operator to translate rod  216  within slot  240 , as indicated by arrow  252 , and thereby rotate internal conduit  214  within external conduit  212 . In a fashion similar to hole  50  shown in  FIG. 3 , slot  250  may include a sealing device or sealing element (not shown) adapted to minimize or present leakage of fluid through slot  250 . In the aspect shown in  FIGS. 8 and 9 , conduit  212  may include one or more circumferentially directed passages or slots  254  (shown in phantom) to allow passage of projection  246  about conduit  212  during the arcuate translation of rod  216  within slot  250 . 
     In one aspect of the invention, in order to allow the translation and/or rotation of internal conduit  214  within external conduit  216  by means of rod  246 , the external conduit  212  may be omitted within the extents of the housing of rod receiver  238  allowing rod  216  and, for example, projection  246  unencumbered access to internal conduit  214  to translate and/or rotate internal conduit  214 . According to this aspect, the housing of rod receiver  238  may provide a chamber for accessing internal conduit  214  with rod  216  and allowing rod  216  and one or more projections  246  unencumbered access to conduit  214 , while providing appropriate sealing devices or elements about any penetrations into the housing of rod receiver  238 . 
     According to aspect of the invention, the arc length of slot  250  may range from 5 degrees to 360 degrees, for example, from 15 degrees to 270 degrees, or from 5 degrees to 180 degrees, as suggested by the aspect shown in  FIG. 9 . 
     The use of any one of the endotracheal devices disclosed herein may be practiced with or without the use of a guidance device, that is, a device used to assist the user in guiding the insertion and placement of the endotracheal devices disclosed herein. According to aspects of the invention, any conventional guidance device may be used, including a thin surgical instrument, or “bougie,” as known in the art, that is, a “hard bougie” or a “soft bougie”; a bronchoscope, for example, a fiber optic bronchoscope; or any elongated rod, tube, wire, conduit, or structure that can be used to assist the user in guiding the insertion and placement of the endotracheal devices disclosed herein. According to one aspect of the invention, the guidance device may be placed within the passage or airway of the patient, and, while in place, any one of the endotracheal devices disclosed herein may be inserted into the airway while threading the guidance device through, for example, the internal conduit of an endotracheal device disclosed herein. Guidance devices that may be used when practicing aspects of the invention may include an Eschmann-style tracheal tube introducer or bougie provided by various manufactures, such as, Teleflex Inc. Insertion of aspects of the invention into a passage or an airway may be facilitated by lubricating the endotracheal device prior to insertion. 
     Though many different aspects of the present invention have been presented disclosed individually or in combination herein for the sake of facilitating disclosure, it is envisioned that any one or more of the aspects or features disclosed herein may be combined with any one or more other aspects of features disclosed herein. 
     The endotracheal devices and their subcomponents disclosed herein may be fabricated from any conventional material, for example, any conventional plastic material, elastomeric material, and even wood or metal. In one aspect, the materials from which the components of the invention, for example, the first conduit, the second conduit, and/or the manipulation rod, are made may provide for at least some flexibility, deformability, and/or malleability to the components. That is, in some aspects, the components, such as, the first conduit, the second conduit, and/or the manipulation rod, may be bent, deformed, or otherwise manipulated during handling by an operator, such as, an anesthesiologist, to introduce, position, and/or orient the devices as desired within a cavity or passage of a patient, for example, in an airway. In one aspect, the components disclosed herein may be fabricated from a polyamide (PA), for example, nylon; a polyethylene (PE), both high-density polyethylene (HDPE) and low-density polyethylene (LDPE); a polyethylene terephthalate (PET); a polypropylene (PP); a polyester (PE); a polytetrafluoroethylene (PTFE); a polystyrene (PS); an acrylonitrile butadiene styrene (ABS); a polycarbonate (PC); or a polyvinylchloride (PVC); among other plastics. 
     The endotracheal devices disclosed herein may also be provided in a broad range of sizes and dimensions, for example, depending upon the size or age of the patient being treated. Aspects of the invention may be adapted for use with adults, children, infants, and neonates. In one aspect, embodiments of the invention may be used for veterinary treatment, for example, with animals. For example, the endotracheal devices may have an overall length ranging from about 2 inches to about 2 feet, but may typically range in length from about 4 inches to about 12 inches, for example, about 10 inches in length. Similarly, the endotracheal devices disclosed herein may have an overall width ranging from about 1 inch to about 6 inches, but may typically range in width from about 2 inches to about 3 inches, for example, about 2½ inches in width. 
     The internal conduits and the external conduits of the devices disclosed herein may have cross-sectional dimensions, for example, diameters or widths, ranging from 2 millimeters [mm] to 100 mm, but typically have cross-sectional dimensions ranging from 5 mm to 20 mm, for example, from 8 mm to 12 mm. For instance, in one aspect, the internal diameter of the external conduit ( 12 ) disclosed herein may be 9 mm, and the internal diameter of the internal conduit ( 14 ) disclosed herein may be 6 mm. 
     Accordingly, in one aspect of the invention, any one of the distal ends of the conduits or tubes disclosed herein may be substantially non-beveled, for example, having an exposed cross-section substantially perpendicular to the axis of the tube. In another aspect, any one of the distal ends of the tubes or conduits disclosed herein may have a bevel, directed in a predetermined direction, for example, having a bevel directed in an anterior direction of the patient. The bevel may have a bevel angle ranging from 30 degrees to 60 degrees, for example, a 45-degree bevel. 
     Though various aspects and embodiments of the invention are disclosed herein that can be used or adapted for endotracheal insertion or intubation during surgery, it is envisioned that aspects of the invention may be adapted for any application where patient or victim treatment or intubation is advantageous, that includes in the emergency room (ER), in the operating room (OR), or by first responders, paramedics, and emergency medical technicians (EMTs) at accidents or other calamities. It is envisioned that aspects of the invention may be particularly advantageous for neurosurgery and/or brain surgery where the prevention of coughing, which may undesirably induce intra-cranial pressure (ICP) during extubation, is desired. Other applications of aspects of the invention are bronchoscopy thoracic surgery, obstetrics, cardiac catheterization, laparoscopic procedures, and plastic surgery, among other medical procedures, and training, for example, training of anesthesiologists. 
     As disclosed herein, aspects of the invention include endotracheal devices and their method of use that address many of the disadvantages of prior art devices and methods. 
     While various embodiments have been described above, it should be understood that these embodiments and their many aspects have been presented by way of example, and not limitation. It will be apparent to persons skilled in the relevant art that various changes in form and detail can be made therein without departing from the spirit and scope of the invention. Moreover, it is to be understood that the various embodiments of the invention, although different, are not necessarily mutually exclusive. Furthermore, a particular feature, structure, or characteristic described herein in connection with one embodiment may be implemented within other embodiments without departing from the scope of the invention. In addition, it is to be understood that the location or arrangement of individual elements within each disclosed embodiment may be modified without departing from the scope of the invention. The detailed description presented herein, therefore, is not to be taken in a limiting sense, and the scope of the present invention is defined only by the appended claims, appropriately interpreted, along with the full range of equivalents to which the claims are entitled. 
     Although the term “at least one” may often be used in the specification, claims and drawings, the terms “a”, “an”, “the”, “said”, etc. also signify “at least one” or “the at least one” in the specification, claims and drawings. 
     While several aspects of the present invention have been described and depicted herein, alternative aspects may be effected by those skilled in the art to accomplish the same objectives. Accordingly, it is intended by the appended claims to cover all such alternative aspects as fall within the true spirit and scope of the invention.