Patent Description:
Various devices are available to stabilize a patient and facilitate his breathing, feeding and medication delivery. Such devices are used in patients during surgical procedures, after certain traumas including spinal cord injuries, and in patients suffering from certain medical conditions including advanced Alzheimer disease. These devices include endotracheal tubes, airway devices, feeding tubes, oral airways, nasal cannulas and the like.

Because human anatomy varies significantly from a patient to a patient, properly placing a medical device in a patient's trachea requires a significant skill and is a task laced with inherent risk. The task becomes even more complicated because the insertion procedure may have to be performed immediately at an accident site, on pediatric patients, in a nursing home, on a battlefield or at a natural disaster site where many patients have to be attended at the same time.

The process of placing a breathing tube in a patient is called intubation. Devices such as laryngoscopes, videolaryngoscopes, fiberoptic scopes, as well as other proprietary videoscopes have been developed. These devices provide accuracy for initial placement, but do not provide continuous visualization or mobility of the image after a medical device has been placed in a patient. Newer devices, such as Vivasight SL or DL endotracheal tubes, provide continuous visualization, but are costly because they depend on a single use of disposable cameras and they are not transferrable from one medical device to another. The Totaltrack VLM supraglottic airway has a proprietary reusable camera for only its one device, and it cannot be transferred to other medical devices.

<CIT>, which is considered to represent the most relevant prior art, discloses an intubation assistance apparatus includes a main body and an intubation assistance instrument detachably mounted to the main body.

<CIT> discloses reusable video laryngoscopes that are insertable into transparent or non-transparent disposable sheaths having clear optically clear viewing windows that receive contact with camera lens.

<CIT> discloses an airway device including a camera which provides constant visualization of a patient's tissues.

<CIT> discloses an airway management device including a tubular member dimensioned for introducing air into a trachea of a mammal, an inflatable oral cavity balloon and an inflatable esophageal balloon to prevent air from entering the esophagus.

<CIT> discloses a medical device comprising a visualization device combined with an endotracheal tube.

Thus, there remains the need for improved devices which can be easily monitored remotely by a qualified personal during placement and after placement for an adverse reaction. After a medical device has been placed in a patient, the need remains to monitor in real time the patient's possible adverse reactions such as for example, aspiration, airway secretion, apnea, etc..

At least some of these needs are addressed by present medical devices which are equipped with a portable universal flexible visualization device in which a camera is contained within a separate camera tube and which transmits information that can be accessed and monitored remotely and simultaneously from several patients in real time.

Provided is a medical device comprising a flexible visualization device sealed to, attached slidably to or otherwise combined with at least one of the following second devices: an endotracheal tube, a supraglottic airway device, a ventilator adaptive cap, a dilator, a tracheostomy device, a nasal trumpet, an oral airway comprising a tubal body with a central passageway, the tubal body being made of two half-cylinders which can rotate and convert the central passageway from completely enclosed into only partially enclosed and comprising a lateral opening, an esophageal stethoscope, a laryngoscope, a speculum, a nasal cannula, a feeding tube, a suction tube, a suction catheter, and an endotracheal changing tube; and wherein the flexible visualization device comprises a camera tube with a distal end and proximal end, the distal end being sealed with a transparent material and a camera being placed inside of the camera tube through an opening at the proximal end. The camera is disposable or re-usable and is retractable from the camera tube on demand. The second device has a proximal end and a distal end, wherein the camera tube is attached to the second device either internally or externally along the proximal-distal axis. These medical devices can be further equipped with at least one of the following a bougie, a flexible stylet and a sound- and temperature-monitoring device. In some embodiments, the visualization device is sealed, attached or otherwise connected externally to the second device. In other embodiments, the visualization device can be placed inside of the second device. Various endotracheal tubes equipped with the visualization device are contemplated as well, including an endotracheal tube which comprises a sleeve through which the visualization device can be inserted, an endotracheal tube into which the visualization device is placed internally through a ventilator adaptive cap and an endotracheal tube to which the visualization device is attached externally.

Further embodiments provide an oral airway device comprising a tubal body with a central lumen and a visualization device attached to the tubal body, wherein the diameter of the lumen is such that an endotracheal tube can be placed insider the lumen and wherein the visualization device comprises a camera tube sealed at the distal end with a transparent material and a camera placed inside the tube through the opening at the proximal end, end wherein the camera tube is positioned along the tubal body. The visualization device can be attached to the tubal body either internally or externally. The oral airway device can further comprise a removable handle which can be connected to the oral airway device with a holder.

Further embodiments provide an oral airway device with a rotating central passageway made of two half-cylinders, a first external half-cylinder and second internal half-cylinder, wherein the second half-cylinder fits inside the first half -cylinder and can glide inside the first half-cylinder along the proximal-distal axis of the first half-cylinder and wherein the second half-cylinder can also rotate inside the first half-cylinder and thereby create a completely enclosed central passageway or only partially enclosed central passageway with a lateral opening, and wherein the first half-cylinder and the second half-cylinder can be completely separated from each other.

Other embodiments provide a supraglottic ventilating tube with camera, comprising a ventilating tube with the distal end and the proximal end and equipped with a visualization device comprising a camera tube attached externally along the ventilating tube, and a camera which can be placed inside the camera tube, wherein an inflatable cuff which wraps around the ventilating tube and the camera tube being positioned under the cuff.

Methods of using the device are described but do not form part of the invention.

Another embodiment provides a tubeless intubating device, comprising an ellipsoid body attached to a handle and a visualization device attached to the intubating device, wherein the visualization device comprises a camera tube and a camera which can be placed and removed from the camera tube and wherein the ellipsoid body comprises a lumen and canal which opens beneath the handle.

Other embodiments provide a sliding endotracheal cuff device, comprising a tube with the distal end and the proximal end, a rail attached externally on the tube along the proximal-distal axis, wherein the rail has a groove which opens inside the tube, wherein the device further comprises a cuff which wraps around the tube externally at the distal portion of the tube, and wherein the device further comprises a camera tube attached externally to the tube along the proximal-distal axis, and a camera which can be positioned inside and removed from the camera tube.

Further embodiments include an assembly in which an oral airway device is inserted inside of a carrier which comprises a tubal body with a lumen and a first balloon which caps the distal end of the carrier. The carrier has a lumen opening proximal to the first balloon and the carrier has a second balloon circumventing the tubal body of the carrier proximally to the lumen. The carrier may further optionally comprise a third balloon circumventing the body of the carrier proximally to the second balloon. The balloons can be inflated with an inflating means. Methods of intubating and extubating a patient with the carrier assembly are described but do not form part of the invention.

The present invention provides improved medical devices equipped with a visualization device for intubation, ventilation, feeding and monitoring of a patient. Methods for rapid and accurate placement of a medical device in a patient and remote continuous real-time monitoring of the patient after the placement are described but not claimed.

These medical devices are equipped with a visualization device in which a camera is placed in a separate sealed camera tube. As the camera does not come in contact with a patient, there is no need to sterilize the camera and the same camera can be reused in many applications. Thus, the same camera can be switched between different medical devices which monitor internal organs such as medical devices that are placed in patient's airway, larynx, gastrointestinal tract, chest or vaginal cavity. In some embodiments, the camera is disposable.

One embodiment provides a flexible visualization device as shown in <FIG> and its further embodiments as shown in <FIG>. A visualization device, generally <NUM>, in <FIG> comprises a camera tube <NUM> with a distal end <NUM> and a proximal end <NUM>. The camera tube <NUM> can be a plastic tubing. In some embodiments, the camera tube <NUM> may comprise a fiber-optic material. The camera tube <NUM> is sealed at the distal end <NUM> with a transparent material <NUM>. The diameter of camera tube <NUM> is designed in such a way that a camera <NUM> with wire <NUM> can be inserted inside of the camera tube <NUM> through an opening at the proximal end <NUM> and moved down the camera tube <NUM> toward the distal end <NUM>, so that the camera <NUM> transmits continuously images obtained through the transparent material <NUM>. The length of the camera tube <NUM> can vary and it can be adjusted dependent on the length of a medical device with which the visualization device is to be used. For example, the length of the camera tube <NUM> may be longer when the visualization device <NUM> is used with a feeding tube in comparison to the length of the camera tube <NUM> when the visualization device <NUM> is used with an endotracheal tube. In some embodiments, the visualization device obtains images and transmits wirelessly, broadcasts or records this information to at least one device positioned at a remote location.

Because the camera tube <NUM> is sealed at the distal end <NUM> with the transparent material <NUM>, the camera <NUM> does not come in contact with patient's tissues or fluids and therefore, the camera <NUM> does not have to be sterilized or to be disposable, and it can be reused in further applications. However, the camera <NUM> can be disposable in some applications. The camera <NUM> can be loaded with a chip and equipped to obtain and transmit digital images in real time. The camera <NUM> is further connected by an electric wire <NUM> to an image receiving and processing device (not shown) such as a computer equipped with a monitor or a computer network. The camera <NUM> may also be in communication wirelessly with an image-receiving device located at any location, including multiple locations and remote locations. Because the length and diameter of the camera tube <NUM> can be adjusted based on patient's needs, the visualization device <NUM> is suitable for a broad variety of patients, including pediatric patients and adult patients with abnormal anatomy or trauma.

As the visualization device <NUM> is bendable and flexible, the visualization device <NUM> is easy to insert in a patient and remove from the patient. The camera <NUM> may have its own light source. As the visualization device <NUM> transmits images from a patient in real time, it can be used for guiding a medical device for proper placement. Thus, some aspects of this disclosure are concerned with non-claimed methods for rapid and accurate placement of a medical device inside of a patient, including a non-claimed method for guided and rapid placement into patient's airway, larynx, gastrointestinal tract, chest or vaginal cavity under continuous visualization.

As shown in embodiment of <FIG>, the visualization device <NUM> can be further equipped with a stylet <NUM> which can be sealed onto or otherwise attached to the camera tube <NUM> externally on at least one side of the camera tube <NUM> along the proximal-to-distal (<NUM>-<NUM>) axis of the camera tube <NUM>. The stylet <NUM> can be made of metal wire or some other sturdy material with the purpose to keep the otherwise flexible visualization device <NUM> in a particular shape. In some embodiments, the stylet <NUM> can be of the same length as the camera tube <NUM>. In other embodiments, the stylet <NUM> is shorter than the camera tube <NUM> such that at a least a portion of the camera tube <NUM> on either the proximal end <NUM> or distal end <NUM>, or on the both ends <NUM> and <NUM> is not in contact with the stylet <NUM>. As shown in <FIG>, the stylet <NUM> can be bent into various shapes and it retains the shape into which it has been bent, which permits for visualization device <NUM>, which is otherwise flexible, to retain a particular shape.

In alternative embodiments, the visualization device <NUM> can be equipped with a bougie which can be attached to the camera tube12 externally on at least one side of the camera lumen <NUM> along the proximal-distal (<NUM>-<NUM>) axis of the visualization device <NUM>.

The bougie can be made of various materials, including plastic material which is bendable. As the bougie is bendable, but keeps a shape into which it is bent, the bougie is suitable for guiding the visualization device <NUM> inside of a patient. In some embodiments, the bougie can be of the same length as the camera tube <NUM>. In other embodiments, the bougie can be made shorter or longer than the camera tube <NUM> such that only a portion of the camera tube <NUM> is in contact with the bougie. In some embodiments, the bougie protrudes on at least the distal end <NUM>.

The visualization device <NUM> can be further equipped with a portable light source (not shown) which can be either built-in the camera <NUM> or it can be built-in the camera tube <NUM>. In alternative, a light source can remain outside the camera tube <NUM> on the proximal end <NUM>, but still be placed such that the light source sheds light inside of the camera tube <NUM>.

In embodiments of <FIG>, the camera tube <NUM> can be disposable, while the camera <NUM> is reusable without the need of sterilization. However, the camera <NUM> can be also disposable in at least some embodiments.

During placement in a patient, a visualization device <NUM> either alone or in combination with another medical device is positioned such that it is inserted with its distal end <NUM> in the patient under continuous visualization with the camera <NUM>.

Any of the visualization devices <NUM> described above can be attached, sealed or otherwise connected to a disposable or non-disposable medical device either externally or internally and as described in more detail below. Various medical devices for pediatric and adult patients can be built such that the camera device tube <NUM> is sealed or attached to the medical device during manufacturing. In some embodiments, the visualization device <NUM> can slide or glide along the medical device to which the visualization device <NUM> is attached. For example, the camera tube <NUM> of the visualization device <NUM> can be equipped with a set of rings, a rail or a half-cylinder which will allow the camera tube <NUM> to slide or glide along the medical device to which the visualization device <NUM> is attached.

In other embodiments, the visualization device <NUM> can be sold as a kit which can be attached by a medical practitioner to a pre-made medical device for pediatric and adult patients, based on a particular patient's individual needs. The length of the camera tube <NUM> can vary such that the camera tube <NUM> is of the same or similar length with a medical device to which the visualization device <NUM> is sealed, attached or otherwise connected to.

Having the ability to verify placement for a medical device in real time from near and far allows several experts to assist and verify placement. This is accomplished by equipping the medical device with the visualization device <NUM>. In some embodiments, a non-claimed method is described in which the visualization device <NUM> is used for placing a medical device in a patient in ambulances, on battlefields, in nursing homes or hospitals. The visualization device <NUM> provides the ability to monitor in real time a patient. Because the visualization device <NUM> may interact with a plethora of devices disposable and otherwise, the non-claimed use of the device <NUM> on various medical devices provides for a non-claimed method in which a medical practitioner can customize a proper device for each patient or situation. Having the same camera equipment that can interact with various medical devices provides economy of scale such that even the smallest of organizations can have all the proper vigilance and technology.

At least in some embodiments the visualization device <NUM> can be used in assembly with at least one medical device as described in more detail below. A non-claimed method in which the visualization device <NUM> is used on an airway device allows continuous visualization of any of the following in a patient in real time: nasopharynx, pharynx/hypo pharynx, supraglottic structures, airway, internal organ anatomy, vocal cords during normal and abnormal ventilation. This non-claimed method also allows detection of abnormal anatomy and abnormal vocal cord movements.

Referring to <FIG>, this embodiment provides an endotracheal device, generally <NUM>. The endotracheal device <NUM> comprises an endotracheal tube <NUM> with a distal end 32A and a proximal end 32B. The visualization device <NUM> is sealed or otherwise attached externally on at least one side of the endotracheal tube <NUM>, along the proximal-distal (32B-32A) axis of the endotracheal tube <NUM>. The visualization device <NUM> comprises essentially of all elements as shown in <FIG>, with the camera <NUM> inserted inside of the camera tube <NUM> through an opening at the proximal end <NUM> of the camera tube <NUM>, all the way down to the distal end <NUM> and the opening of the distal end <NUM> being sealed with the transparent material <NUM>. Because the camera <NUM> is positioned inside of the sealed camera tube <NUM>, the camera <NUM> does not come into contact with a patient and the camera <NUM> does not need to be sterilized and can be reused in multiple applications. Thus, the camera <NUM> does not have to be disposable or to be sterilized before further applications. However, the camera <NUM> can be disposable in at least some applications.

As the camera <NUM> is contained inside of the separate camera tube <NUM> which is positioned externally on the endotracheal tube <NUM>, a diameter of the camera tube <NUM> is not limited by a diameter of the endotracheal tube <NUM>. Thus, the diameter of the camera tube <NUM> can be larger or smaller than the diameter of the endotracheal tube <NUM>.

Thus, the visualization device <NUM> can be used on endotracheal devices for pediatric patients and patients with abnormal anatomy. In some embodiments, the visualization device <NUM> has a diameter larger than that of the endotracheal tube <NUM>.

The camera <NUM> is connected by electric wire <NUM> to an external device such as a computer and monitor (not shown). At least in some embodiments, the visualization device <NUM> is further equipped with a light source <NUM>. The light source <NUM> can be kept outside of the camera tube <NUM>, but in proximity with the proximal end <NUM> of the visualization tube <NUM> so that the light source <NUM> sheds light inside of the camera tube <NUM>. In alternative embodiments, the light source <NUM> can be built-in the camera tube <NUM> or in further embodiments, the light source <NUM> can be built-in the camera <NUM>.

At least in some applications, the camera <NUM> is a digital camera equipped with a chip and it collects and transmits images continuously. The camera <NUM> can be connected wirelessly or hard-wired with a computer network (not shown) which collects and analyzes images obtained by the camera <NUM>. This arrangement permits for remote, continuous and real time monitoring of the endotracheal device <NUM> during placement and after-placement in a patient. Thus, an accurate and rapid placement of the endotracheal device <NUM> can be achieved. Further and because the visualization device <NUM> continues to acquire images after the endotracheal device <NUM> is placed inside of a patient, the patient can be monitored in real time for adverse reactions such as bleeding, airway obstruction, shifting or malfunctioning, etc. of the endotracheal device <NUM> and other reactions. The endotracheal device <NUM> may continue to transmit images and information for as long as it remains in a patient.

In some embodiments, the endotracheal tube <NUM> is further fitted with a cuff <NUM> at its distal end 32A. In other embodiments, the endotracheal tube <NUM> is not fitted with the cuff <NUM>. The cuff <NUM> can be inflated with a device <NUM> after the endotracheal device <NUM> is placed in a patient and its proper positioning inside of the patient is verified by images obtained with the visualization device <NUM>.

The endotracheal device <NUM> can be further equipped with a sound-monitoring device <NUM> which is sealed onto or otherwise attached externally on one side of the endotracheal tube <NUM> along the proximal-distal axis (32B-32A) of the endotracheal tube <NUM>. The sound-monitoring device <NUM> can be a microphone placed inside of a plastic tube <NUM>. It monitors heart beats and breathing tones and can be connected by wire or wirelessly to a remote device which collects and monitors patient's vital signals. In the embodiment of <FIG>, the visualization device <NUM> is placed proximally to the cuff <NUM> and externally to the endotracheal tube <NUM>. It will be understood that the endotracheal device <NUM> can be built with any endotracheal tube <NUM>, including single-lumen and double-lumen tubes. The endotracheal device <NUM> can be used for either pediatric or adult patients. The endotracheal device <NUM> can be made in various sizes.

In another embodiment and as shown in <FIG>, an endotracheal device, generally <NUM>, comprises an endotracheal tube <NUM> with a distal end 52A and a proximal end 52B, and a visualization device <NUM> placed inside of the endotracheal tube <NUM> through an opening in the proximal end 52B. In this embodiment, the visualization device <NUM> is attached to a built-in ventilator adaptable cap <NUM> which connects the endotracheal device <NUM> to a ventilator (not shown) through an outlet <NUM>. The built-in ventilator adaptable cap <NUM> comprises an opening <NUM> through the cap <NUM>. The visualization device <NUM> is passed through the opening <NUM> and is placed inside of the endotracheal tube <NUM>. The built-in ventilator adaptable cap <NUM> is then connected with the endotracheal tube <NUM> at the proximal end 52B of the endotracheal tube <NUM>.

The visualization device <NUM> is the same as the visualization device <NUM> of <FIG> and it comprises a camera tube <NUM> with a sealed distal end <NUM> and an open proximal end <NUM>. A camera <NUM> is placed inside of the camera tube <NUM> through the proximal end <NUM> of the camera tube <NUM>. The camera <NUM> is connected by electrical wire <NUM> to an image-monitoring device (not shown). In some embodiments, the camera <NUM> is connected wireless to an image-monitoring device (not shown). The camera <NUM> collects images continuously and in real time through a transparent material <NUM> with which the distal end <NUM> of the camera tube <NUM> is sealed. The images can be transmitted to a remote location.

The endotracheal tube <NUM> can be optionally equipped with a cuff <NUM> at the distal end 52A such that the cuff <NUM> wraps around the endotracheal tube <NUM> and the cuff <NUM> can be inflated with a device <NUM>, once the endotracheal device <NUM> is properly placed inside of a patient's airway. As can be seen from <FIG>, the distal end <NUM> of the visualization device <NUM> extends distally from the distal end 52A of the endotracheal tube <NUM> and below the cuff <NUM> such that even when the cuff <NUM> is inflated with a device <NUM> after placement in a patient, the visualization device <NUM> can still record images inside of a patient's body and below the cuff <NUM>. Further, the endotracheal device <NUM> may have an elliptical opening <NUM> at the distal end 52A and the visualization device <NUM> can be positioned inside of the endotracheal tube <NUM> such that the distal end <NUM> of the visualization device <NUM> aligns with or is in close proximity with the elliptical opening <NUM> of the endotracheal tube <NUM>.

Referring to <FIG>, further embodiments provide a visualization device <NUM> assembled with a built-in ventilator adaptable cap <NUM> which connects to a ventilator (not shown) by an outlet <NUM>. The visualization device <NUM> is inserted through an opening <NUM> in the built-in ventilator adaptable cap <NUM> as shown in <FIG>. As shown in <FIG>, the visualization device <NUM> can be further equipped with a light source <NUM> which can be a part of the camera tube <NUM> or it can be built in the camera <NUM>, or it can remain outside the built-in ventilator adaptable cap <NUM>. The visualization device <NUM> is assembled with the built-in ventilator adaptable cap <NUM> as shown in <FIG> and can be then used in an endotracheal tube as described in connection with <FIG> or in a supraglottic device or with a laryngeal mask or with any other medical device to which a built-in ventilator adaptable cap <NUM> can be attached. As shown in <FIG>, the camera tube <NUM> has a distal end <NUM> and a proximal end <NUM>. The camera <NUM> is placed inside of the tube <NUM> through an opening in the proximal end <NUM> and moved all the way down to the distal end <NUM> which is sealed with a transparent material <NUM>. The camera <NUM> collects images through the transparent material <NUM> and transmits the images in real time to a monitoring device which can be located remotely.

Further embodiments for a built-in ventilator adaptable cap <NUM> equipped with a visualization device <NUM> are shown in <FIG> and <FIG>. As can be appreciated from <FIG>, the visualization device <NUM> comprises the camera <NUM> inside of the camera tube <NUM>. The visualization device <NUM> is inserted through the ventilator adaptable cap <NUM>. As shown in the embodiment of <FIG>, a plastic clear sleeve <NUM> can be attached over the adaptable cap <NUM> such that the sleeve <NUM> can slide up and down as shown in <FIG> in the proximal-distal direction, which allows the visualization device <NUM> to remain sterile during insertion and removal. As the visualization device <NUM> is inserted and removed through the sleeve <NUM>, the visualization device <NUM> remains sterile and free of contamination. The sleeve <NUM> is long enough to maintain the whole visualization device <NUM> outside the ventilation cap and remain sterile. A further embodiment is shown in <FIG> in which the visualization device <NUM> is inserted through the sleeve <NUM> as shown in <FIG>, except a bougie <NUM> is added through a bougie tube <NUM>.

The bougie <NUM> can be replaced with a flexible guided stylet <NUM> as shown in the insert to <FIG> which rotates and guides a stylet inside of a patient, which is protected from patient's tissues. If the tube <NUM> is used with a stylet, then the tube <NUM> has to be sealed at the distal end. Additional tubes can be attached and placed through the sleeve <NUM>. Such tubes include, but are not limited to a suctions tube and a tool tube which can be used for delivering biopsy forceps and other tools. The assembly of the built-in ventilator adaptable cap <NUM> and visualization device <NUM> with the sleeve <NUM> can be used with any medical device to which a built-in ventilator adaptable cap can be attached, including an endotracheal tube as described in connection with <FIG>, a supraglottic device or with a laryngeal mask airway. If an embodiment with a bougie or stylet is used as described in connection with <FIG>, the bougie <NUM> can protrude distally or slide independently from a medical device and guide the medical device movement inside of a patient during placement under visualization with the visualization device <NUM>.

Further embodiments for an endotracheal device equipped with a visualization device, generally <NUM>, are shown in <FIG>. As can be appreciated from <FIG>, the visualization device <NUM> which comprises the camera <NUM> inside of the camera tube <NUM> can be inserted inside of an endotracheal tube <NUM> through an opening <NUM> on one side of the endotracheal tube <NUM>. As shown in the embodiment of <FIG>, a plastic sleeve <NUM> can be attached over the opening <NUM> such that the sleeve <NUM> can slide up and down as shown in <FIG>, which facilitates keeping the visualization device <NUM> sterile while it is moved in or out of the endotracheal tube <NUM>. As the visualization device <NUM> is inserted and removed from the endotracheal tube <NUM> through the sleeve <NUM>, the visualization device <NUM> remains sterile and free of contamination. The visualization device <NUM> can be removed entirely from the endotracheal tube <NUM> through the sleeve <NUM> and remain sterile. The endotracheal tube <NUM> may be equipped with a cuff <NUM> positioned near the distal end 86A. The visualization device <NUM> can move inside the endotracheal tube <NUM> along the proximal-distal (86B-86A) axis such that the visualization device <NUM> is distal to the cuff <NUM> or the visualization device <NUM> can protrude outside the endotracheal tube <NUM> distally as shown in <FIG>. This permits for obtaining images from a patient with the visualization device <NUM> after the cuff <NUM> is inflated with a device <NUM> and obtaining the images from the area in a patient's body which is distal to the cuff <NUM>. This distal to the cuff <NUM> area is available for monitoring after the cuff <NUM> is inflated because of the visualization device <NUM> in which the camera <NUM> collects images through the transparent material <NUM> at the distal end <NUM>.

The visualization device can slide up and down inside of an endotracheal tube, which permits advancement and retraction of the camera tube <NUM> while maintaining sterility of an endotracheal tube into which the visualization device <NUM> can be inserted as described above. The camera <NUM> can be easily advanced inside of the camera tube <NUM> and provide inspection of the endotracheal tube through its length as well as distal to the tip of the endotracheal tube.

Further embodiments for an endotracheal device, generally <NUM>, equipped with a visualization device <NUM> are shown in <FIG>. Additional tubes can be attached to the tube <NUM> or be placed adjacent to the tube <NUM>. Such tubes include, but are not limited to a suction tube, a tube for delivering instruments such as forceps, a bougie or flexible stylet. As can be appreciated from <FIG>, the visualization device <NUM> comprises the camera <NUM> inside of the camera tube <NUM> positioned externally on the endotracheal tube <NUM> and along the proximal-distal (102B-102A) axis. As shown in the embodiment of <FIG>, a plastic sleeve <NUM> can be attached to the endotracheal tube <NUM> such that the sleeve <NUM> can slide up and down outside the endotracheal tube <NUM> as shown in <FIG>, which facilitates the movement of the visualization device <NUM> along the proximal-distal (102B-102A) axis of the endotracheal tube <NUM>. As the visualization device <NUM> is inserted and removed through the sleeve <NUM>, the visualization device <NUM> remains sterile and free of contamination. The endotracheal tube <NUM> may be equipped with a cuff <NUM> wrapped around the endotracheal tube <NUM> near its distal end 102A. The visualization device <NUM> moves outside the endotracheal tube <NUM> along the proximal-distal axis 102B-102A such that the visualization device <NUM> can be proximal to the cuff <NUM>. This also permits for obtaining images from a patient with the visualization device <NUM> after the cuff <NUM> is inflated with a device <NUM>. The camera tube <NUM> can slide proximal or distal of the cuff <NUM>. Thus, at least in some embodiments, the camera tube <NUM> would be into a sealed tunnel.

<FIG> depicts a further embodiment of an endotracheal device, generally <NUM>. The device <NUM> can be equipped with the visualization device <NUM> and the sound tube <NUM> described in connection with <FIG> (not shown). The endotracheal device is further equipped with a bougie <NUM> which can slide up and down along the proximal-distal (116B-116A) axis inside of a tube <NUM> which is attached externally to the endotracheal tube <NUM>. The endotracheal tube <NUM> is equipped with a cuff <NUM> located in proximity to a distal end 110A of the tube. The cuff <NUM> can be inflated with a device <NUM> after the endotracheal device <NUM> is placed inside of a patient. The visualization device <NUM> can be sealed or attached to the endotracheal tube <NUM> either outside or inside as described above in connection with embodiments provided by <FIG>, <FIG>, <FIG>, <FIG>, <FIG>, <FIG>. The bougie <NUM> guides the movement of the endotracheal device <NUM> during placement in a patient under visualization with the visualization device <NUM> and permits guided sliding down the medical device over the bougie <NUM> inside of the patient's airway.

Further embodiments of a visualization device, generally <NUM>, are shown in <FIG>. As shown in <FIG>, the camera tube <NUM> can be equipped with at least one, and preferably two external rings <NUM> which are sealed or otherwise connected by means <NUM> to the camera tube <NUM>. In some embodiments, one ring <NUM> is positioned at about <NUM>/<NUM> of the camera tube length from the proximal end <NUM> and the other ring is positioned at about <NUM>/<NUM> of the camera tube length from the proximal end. While in the embodiment of <FIG>, the camera tube <NUM> is equipped with two rings <NUM>, other embodiments include those in which more than <NUM> rings are used or only one ring is used. The positioning of the rings along the proximal-distal (<NUM>-<NUM>) axis of the camera tube <NUM> can also vary. Other modalities include a clasp or a plastic band to hold the camera tube <NUM>.

As in all other embodiments, the camera tube <NUM> has a distal end <NUM> sealed with a transparent material <NUM> and a proximal end <NUM> with an opening through which a camera <NUM> is inserted into the camera tube <NUM>. As shown in <FIG>, the visualization device <NUM> can be further equipped with a tube <NUM> sealed or otherwise attached externally along the proximal-distal (<NUM>-<NUM>) axis of the camera tube <NUM>. A bougie <NUM> is placed inside of the tube <NUM> such that a distal end 116A of the bougie <NUM> protrudes distally over the camera tube <NUM>, while its proximal end 116B extends outside the visualization device <NUM> proximally and can be used by a medical provider to rotate the distal end 116A and in this way guide the movement of the visualization device <NUM> along with a medical device to which it is attached.

As shown in <FIG>, the visualization device <NUM> can be further equipped with a light source <NUM> which can be either built in the camera tube <NUM>, built in the camera <NUM> or it can be kept outside the visualization device <NUM> and outside the patient's body. The visualization device <NUM> is attached to a medical device with the rings <NUM>, and this permits for customized positioning of the visualization device <NUM> as it can slide up and down along a proximal-distal axis of a medical device.

As shown in a cross-sectional view in <FIG>, the ring <NUM> can be of any diameter in order to fit on a medical device of choice. As shown further in <FIG>, at least in some embodiments the ring <NUM> may have a clasp <NUM> such that the diameter of the ring <NUM> can be adjusted according to a diameter of a medical device to which the visualization device <NUM> is attached with the rings <NUM>.

An embodiment as shown in <FIG> provides an assembly, generally <NUM>, in which the visualization device <NUM> is attached with the rings <NUM> to an endotracheal tube <NUM>. The rings <NUM> can slide up and down along the proximal-distal (52B-52A) axis of the endotracheal tube <NUM>, and in this way the position of the visualization device <NUM> can be adjusted with respect to the endotracheal tube <NUM>. Further, the rings <NUM> can rotate around the endotracheal tube <NUM>, which permits altering the positioning of the camera device <NUM> if images are needed from a different area inside of a patient.

Because the rings <NUM> can be adjustable, the visualization device <NUM> can be used with an endotracheal tube of any size, including those for pediatric patients. Further, the visualization device <NUM> with at least two rings connected externally to the camera tube <NUM> can be provided as a kit, and a medical practitioner can assemble the visualization device with any conventional endotracheal tube or any other conventional medical device for which visualization and monitoring are needed at the time of treatment.

Further non-claimed aspects of the disclosure describe an intubation method in which an endotracheal tube, including any of the endotracheal tubes described above and equipped with the visualization device as described above, is placed in patient's airway and positioned under the patient's vocal cords under constant visualization by the visualization device <NUM>.

Referring to <FIG>, it depicts a side view of a supraglottic airway device, generally <NUM>. Any standard endotracheal tube known in the art and an endotracheal device of <FIG> is shown in the insert on the left of <FIG> can be used in combination with the supraglottic airway device <NUM>.

The supraglottic airway device <NUM> comprises a supraglottic tubal body <NUM> with a distal end 131A and a proximal end 131B and a lumen <NUM>. The supraglottic airway device <NUM> includes a designated intubation tube <NUM> which is inserted into the lumen <NUM> and into which an endotracheal device <NUM> can be placed as shown in <FIG>. The distal end 133A of the intubation tube <NUM> ends with an elliptical opening <NUM> which is located distally from a cuff <NUM> which can be inflated with a device <NUM>. The intubation tube <NUM> has a plurality of holes <NUM> distributed throughout its body to allow ventilation from outlet <NUM> through tubal body <NUM>.

While a standard endotracheal device, including an endotracheal device <NUM>, may be equipped with a visualization device, the supraglottic airway device <NUM> comprises its own visualization device <NUM> which is placed in the lumen <NUM>. The visualization device <NUM> comprises a camera tube <NUM> with a distal end <NUM> and a proximal end <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. The camera tube <NUM> is sealed or otherwise attached externally to the intubation tube <NUM> along the proximal-distal (131B-131A) axis. The supraglottic device <NUM> can be further equipped with a bougie <NUM> which is located inside of the tube <NUM>. The tube <NUM> is placed inside of the lumen <NUM> and such that the distal end 116A of the bougie <NUM> protrudes from the tube <NUM> and outside the supraglottic tubal body <NUM> through an elliptical opening <NUM> which is located on the supraglottic tubal body <NUM> slightly proximally from the distal end 131A. The elliptic opening <NUM> of the supraglottic tubal body <NUM> overlaps partially with the elliptic opening <NUM> of the intubation tube <NUM>. The bougie tube has its own opening through <NUM>.

At the distal end 131A, the tubal body <NUM> is capped with a balloon <NUM> which can be inflated with a device <NUM>. In some embodiments, the bougie <NUM> can be replaced with a flexible guided stylet <NUM> shown on the right of <FIG>.

In addition to the visualization device <NUM>, the supraglottic device <NUM> can be also equipped with a sound- and temperature-monitoring device <NUM> which is located inside a tube <NUM> which is sealed or otherwise attached externally to the tubal body <NUM> along the proximal-distal (131B-131A) axis. The sound device <NUM> can monitor patient's heart beat and breathing after the supraglottic device <NUM> is placed inside of the patient. On its proximal end 131B, the tubal body <NUM> may be connected to a ventilator (not shown) though an outlet <NUM>. Because the supraglottic device <NUM> can ventilate in a closed circuit through the tubal body <NUM>, an endotracheal tube <NUM> can be placed inside of the intubation tube <NUM> without the need to stop ventilation and therefore, the supraglottic device <NUM> provides continuous ventilation, continuous visualization in real time through the visualization device <NUM> and continuous sound and temperature monitoring by the sound monitoring device <NUM> with a temperature probe. This real time information can be transferred or stored to multiple distant monitoring sites.

Other advantages for the supraglottic airway device include the ability to intubate, extubate and to easily reintubate if needed under continuous ventilation and the ability to continuously visualize vocal cords and supraglottic structures. The device <NUM> is suitable for applications in children and adults. Further, the device <NUM> is equipped with the cuff <NUM> for blocking the pharynx and the balloon <NUM> which blocks the esophagus after the device <NUM> is placed in a patient. Furthermore, an endotracheal tube can be placed just proximal to the vocal cords in the tubal body <NUM>. This permits ventilation through <NUM> and tubal body <NUM> uninterrupted.

Referring to <FIG> and <FIG>, an alternative embodiment for an airway device, generally <NUM>, is provided. This device can be used in pediatric and adult patients as it is adoptable to different sizes. It provides continuous visualization of supraglottic structures and it can be advanced, retracted, or rotated, side to side to provide direct visualization of vocal cords. As can be appreciated from <FIG> and <FIG>, the airway device <NUM> comprises a tubal body <NUM> with a distal end 152A and a proximal end 152B and a lumen <NUM>. The tubal body <NUM> may be connected to a ventilator through an outlet <NUM>. A visualization device <NUM> is sealed or otherwise attached inside of the tubal body <NUM> along the proximal-distal (152B-152A) axis on at least one side. The visualization device <NUM> comprises a camera tube <NUM> with a distal end <NUM> and a proximal end <NUM>. The camera tube <NUM> is sealed at the distal end <NUM> with a transparent material <NUM>. The proximal end <NUM> of the camera tube <NUM> remains open and a camera <NUM> is inserted in the camera tube <NUM> through the proximal end <NUM>. The camera <NUM> does not come in contact with a patient's body and it does not have to be sterilized, it does not have to be disposable, although it may be disposable in at least some applications. The visualization device <NUM> can be further equipped with a light source which can be built in the camera tube <NUM> or be a part of the camera <NUM>. In alternative, a light source may be left outside the camera tube <NUM>, but still shed enough light inside of the camera tube <NUM> for the camera <NUM> to obtain images inside of a patient's body.

Methods of using the device are described but do not form part of the invention. An intubation tube <NUM> is placed inside of the lumen <NUM> of the tubal body <NUM> along the proximal-distal (152B-152A) axis. The intubation tube <NUM> shares a lumen <NUM> with a bougie <NUM> which is inserted inside the lumen <NUM> along the proximal-distal (152B-152A) axis such that a distal end 116A of the bougie <NUM> may protrude outside the tubal body <NUM> at the distal end 152A and proximal end 116B may protrude outside the tubal body <NUM> and the proximal end 152B can be used by a medical practitioner to guide the movement of the airway device <NUM> with the bougie <NUM> during placement in a patient, including advancing the bougie <NUM> through patient's vocal cords under direct visualization by camera <NUM>. The intubation tube <NUM> has a plurality of holes <NUM> distributed along the intubation tube <NUM>.

At least in some embodiments, the airway device <NUM> is further equipped with a sound- and temperature-monitoring device <NUM> which can be inserted in a tube <NUM> which is sealed or otherwise attached inside of the tubal body152 along the proximal-distal (152B-152A) axis such as the distal end of the sound-monitoring device <NUM> is positioned at or near the distal end 152A of the tubal body <NUM>, which is also equipped with a cuff <NUM> along the perimeter of the tubal body <NUM> at the distal end 152A. The intubation tube <NUM> is designed such that at least in some embodiments the intubation tube <NUM> has a ramp <NUM> at the distal end 152A of the airway device <NUM>. A standard endotracheal tube, including those described in various embodiments above, can be placed inside of the lumen <NUM> in the intubation tube <NUM> for positioning in a patient.

As shown in <FIG>, a ventilator adaptable cap <NUM> and a lid <NUM> are attached to the tubal body <NUM> at the proximal end 152B. The endotracheal tube is inserted into the device <NUM> through the cap <NUM>. Using the cap <NUM> with the lid <NUM> on the airway device <NUM> is preferred when ventilation is accomplished through an outlet <NUM>.

Yet another embodiment for an oral airway device, generally <NUM>, is provided as shown in <FIG>. As can be appreciated from <FIG>, the airway device <NUM> comprises a tubal body <NUM> with a distal end 172A and a proximal end 172B. The tubal body <NUM> ends with two ramps <NUM> and <NUM> at the distal end 172B. As can be appreciated from a side view in <FIG> and cross-sectional views of the tubal body <NUM> in <FIG>, the tubal body <NUM> is made of two half-cylinders <NUM> and <NUM>. The half-cylinder <NUM> is slightly smaller in diameter than the half-cylinder <NUM>. The tubal body <NUM> can be present in one of the two forms: as a full cylinder shown in <FIG> or as a half-cylinder as shown in <FIG>. The half-cylinder <NUM> and the half-cylinder <NUM> are connected by means such that the half-cylinder <NUM> can rotate and retract into the half-cylinder <NUM>. The half-cylinder form of <FIG> is achieved by the half-cylinder <NUM> rotating at about <NUM> degrees and aligning with the half-cylinder <NUM> such that the half-cylinder <NUM> is located inside of the half-cylinder <NUM> as shown in <FIG>.

A visualization device, generally <NUM>, is sealed or otherwise attached externally to the half-cylinder <NUM> along the proximal-distal (172B-172A) axis. The visualization device <NUM> comprises of a camera tube <NUM> with a distal end <NUM> and a proximal end <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. A camera <NUM> is placed through an opening at the proximal end <NUM> into the camera tube <NUM> and is moved inside the camera tube <NUM> to the distal end <NUM>. Similarly to all other embodiments, the camera <NUM> does not come in contact with a patient's body, and it does not have to be disposable, does not have to be sterilized and it can be reused in multiple devices. The camera <NUM> is connected with wire <NUM> to at least one monitoring device and it transmits images in real time. The camera <NUM> can be connected wirelessly to at least one monitoring device which can be positioned at some remote location. A light source can be added as described in connection with the visualization device in other applications.

The half-cylinder <NUM> ends in two ramps <NUM> and <NUM> at the distal end 172A. The ramp <NUM> is smaller in size than the ramp <NUM> and the two ramps are superimposed over each other such as the smaller ramp <NUM> is proximal to a lumen <NUM> created by half-cylinders <NUM> and <NUM> when they are in the full-cylinder form as shown in <FIG>, while the ramp <NUM> is distal to the lumen <NUM>. The ramps <NUM> and <NUM> are flexible and absorb the shock from sliding and releasing an endotracheal tube which can be delivered into a patient by the oral airway device <NUM>. The ramps also facilitate the removal of the oral airway device <NUM> after the endotracheal tube is placed inside of the patient.

As shown in <FIG>, the oral airway intubating device <NUM> can be further equipped with a bougie <NUM> which can be inserted into a tube <NUM> along the proximal-distal (172B-172A) axis such that a distal end 116A of the bougie <NUM> protrudes distally from the oral airway device <NUM> and a proximal end 116B protrudes outside the oral airway device proximately and can be used to manipulate the distal end 116A of the bougie <NUM> such that it guides the movement of the airway device <NUM> during placement in a patient. The bougie tube <NUM> is located on the smaller half-cylinder <NUM> and it shares the lumen <NUM> with the tubal body <NUM>.

A further embodiment provides a dilator with a visualization device, generally <NUM> in <FIG>. As can be appreciated from <FIG>, the dilator <NUM> comprises a tubal body <NUM> with a proximal end 192B and a distal end 192A. A certain distal portion of the tubal body <NUM> is tapered into a conical shape 192C such that the opening at the distal end 192A of the tubal body <NUM> is significantly smaller in diameter in comparison to an opening at the proximal end 192B. A visualization device <NUM> is positioned inside of a lumen <NUM> of the tubal body <NUM> and along the proximal-distal (192B-192A) axis. The visualization device <NUM> may be sealed or otherwise attached inside of the tubal body <NUM>. The visualization device <NUM> is essentially the same device as shown in <FIG>, and it comprises a camera tube <NUM> with a proximal end <NUM> and a distal end <NUM>. The distal end <NUM> of the camera tube <NUM> is in close proximity with the distal end 192A of the tubal body <NUM>. A camera <NUM> which can be either disposable or reusable is placed inside of the camera tube <NUM> through an opening at the proximal end <NUM> and all the way down to the distal end <NUM> of the camera tube <NUM>, which is sealed with a transparent material <NUM>. Just like other embodiments, the visualization device <NUM> can be equipped with a light source located outside of the dilator <NUM> or built in the camera tube <NUM>. In some embodiments, the light source can be built in the camera <NUM>.

As shown in <FIG>, the camera <NUM> is connected by electrical wire <NUM> to a monitoring device (not shown). In some embodiments, the camera <NUM> can be in communication with a monitoring device wirelessly. A guide wire at the proximal end 194A is positioned inside of the lumen <NUM> of the tubal body <NUM>. A proximate end 194B of the guide wire <NUM> protrudes outside of the tubal body <NUM> at the proximal end 192B. The visualization device <NUM> verifies appropriate placement of the dilator device <NUM> and allows mobility of continuous visualization as dilation proceeds. The dilator device <NUM> is especially well suited for use with the Seldinger technique.

Further embodiments provide various tracheostomy tubes equipped with a visualization device. <FIG> depicts a side view of an embodiment for a tracheostomy device, generally <NUM>. The device <NUM> comprises a tubal body <NUM> with a distal end 202A and a proximal end 202B. An inflatable cuff <NUM> is wrapped around the tubal body <NUM> in some proximity to the distal end 202A, but never at the very distal end 202A. The cuff <NUM> can be inflated with a device <NUM> after proper placement of the device <NUM> in a patient. At the proximal end 202B, the tubal body <NUM> protrudes through a plastic plate <NUM> such that some portion of the tubal body <NUM> is proximal to the plastic plate and will remain outside of a patient's neck after the device <NUM> is positioned in the patient. The plastic plate <NUM> may be oval in shape with the tubal body <NUM> protruding from the plate in the middle of the oval plastic plate <NUM>. The plastic plate <NUM> may have two openings <NUM>, one on each side of the plate such that the device <NUM> can be secured around patient's neck with some bandage by tying the device <NUM> through the openings <NUM> around patient's neck.

In the embodiment of <FIG>, the visualization device <NUM> is sealed or otherwise attached to the tubal body <NUM> externally. The visualization device <NUM> comprises a camera tube <NUM> which is sealed or otherwise attached externally along the proximal-distal (202B-202A) axis to the tubal body <NUM>. The camera tube <NUM> is placed under the cuff <NUM> such that the cuff <NUM> wraps over the camera tube <NUM> and a distal end <NUM> of the camera tube <NUM> is distal to the cuff <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. A proximal end <NUM> of the camera tube <NUM> protrudes through the plastic plate <NUM> and remains outside of patient's neck. A camera <NUM> can be placed inside of the camera tube <NUM> through an opening in the proximal end <NUM>. The camera <NUM> is not disposable, does not need to be sterilized and can be easily removed from the camera tube <NUM>. The camera <NUM> is connected by electrical wire <NUM> to a monitoring device. In further embodiments, the camera <NUM> can be in communication with a monitoring device wirelessly. A light source can be added to the visualization device <NUM> as was described in other embodiments above.

<FIG> depicts another embodiment for a tracheosomy device, generally <NUM>. In this embodiment, the device <NUM> comprises of the same tubal body <NUM>, cuff <NUM>, plate <NUM> and other components as was discussed in connection with the device <NUM>. However, unlike the device <NUM>, a visualization device <NUM> is placed inside of a lumen <NUM> of the tubal body <NUM>. The visualization device <NUM> comprises a camera tube <NUM> with a distal end <NUM> and a proximal end <NUM>. The camera tube <NUM> may be sealed or otherwise attached internally to the tubal body <NUM> along the proximal-distal (202B-202A) axis such as the distal end <NUM> of the camera tube <NUM> is in close proximity with the distal end 202A of the tubal body <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. A camera <NUM> is placed inside of the camera tube <NUM> through an opening at the proximal end <NUM> which remains outside of the patient's neck after the device <NUM> is placed in the patient. The camera <NUM> is connected by electrical wire <NUM> to a monitoring device. In other embodiments, the camera <NUM> communicates with a monitoring device wirelessly. In some embodiments, the visualization device <NUM> comprises a light source.

A further embodiment provides a nasal trumpet with a visualization device, generally <NUM> in <FIG>. The trumpet <NUM> comprises a tubal body <NUM> with a proximal end 222B and a distal end 222A. Two fasteners <NUM> are attached at the proximal end 222B of the tubal body <NUM>. After placing the trumpet <NUM> in a patient, the proximal portion of the tubal body <NUM> with the fasteners <NUM> remains outside of the patient, and the fasteners <NUM> can be used to secure the trumpet <NUM> around the patient's head.

A visualization device <NUM> is sealed or otherwise attached to the tubal body <NUM> externally along the proximal-distal (222B-222A) axis. The visualization device <NUM> comprises a camera tube <NUM> with a proximal end <NUM> and a distal end <NUM>. The distal end is in near proximity with the distal end 222A of the tubal body <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. A camera <NUM> is placed inside of the camera tube <NUM> through an opening at the proximal end <NUM>. The camera <NUM> is moved all the way to the distal end <NUM> and collects images in real time inside of a patient's body during placement of the device <NUM> as well as after the device <NUM> has been properly placed and secured. As in other embodiments, the camera <NUM> does not come in contact with patient's body, does not have to be sterilized and can be reused in multiple devices or in different patients. The camera <NUM> communicates with a monitoring device (not shown) either with electrical wire <NUM> or wirelessly, or both.

Further embodiments provide various oral airways as shown in <FIG>, and <FIG>. Referring to <FIG>, an oral airway with a visualization device, generally <NUM>, comprises a tubal body <NUM> with a lumen <NUM>. The tubal body is slightly curved in a hook-like shape along the proximal-distal (232B-232A) axis. A visualization device <NUM> is placed inside of the lumen <NUM> of the tubal body <NUM>. The visualization device <NUM> comprises a camera tube <NUM> and a camera <NUM>. The camera tube <NUM> may be sealed or otherwise attached internally to the tubal body <NUM> inside of the lumen <NUM> and along the proximal-distal (232B-232A) axis. The camera tube <NUM> has a proximal end <NUM> and a distal end <NUM>. The distal end <NUM> is in close proximity with the distal end 232A of the tubal body <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>.

The camera tube <NUM> has an opening at the proximal end <NUM> through which the camera <NUM> is inserted into the camera tube <NUM> all the way to the distal end <NUM>. The camera <NUM> communicates with a monitoring device either wirelessly or by electrical wire <NUM>. The embodiment shown in <FIG> is the same as in <FIG>, except a light source <NUM> is added to the visualization device <NUM>. The light source <NUM> may remain outside of the camera tube <NUM> or it may be built in the camera tube <NUM> or it may be a part of the camera <NUM>.

The embodiment shown in <FIG> is the same as that of the <FIG>, except two whistles 234A and 234B are added inside of the lumen <NUM> of the tubal body <NUM>. The whistle 234B is located at the proximal end of the tubal body <NUM> and it produces a sound when a patient breathes in. The whistle 234A is located at the distal end of the tubal body <NUM> and it produces a sound when the patient breathes out.

Further embodiments include an oral airway as shown in <FIG>, but further equipped with a sound and temperature monitoring device which is also placed inside of the lumen <NUM> and transmits information to a monitoring device which can be positioned at a remote location.

The embodiment of <FIG> is an intubating airway device with a visualization device, generally <NUM>. The intubating airway device <NUM> comprises a tubal body <NUM> with a lumen <NUM> in which an endotracheal tube can be placed. A visualization device <NUM> comprises a camera tube <NUM> with a distal end <NUM> and a proximal end <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. A camera <NUM> is placed inside of the camera tube <NUM> through an opening at the proximal end <NUM>. The camera tube <NUM> is placed inside the lumen <NUM> of the tubal body <NUM>.

A bougie <NUM> is added inside of the tubal body <NUM> such that the bougie <NUM> is inserted in a tube <NUM> which shares the lumen with the lumen <NUM> along the proximal-distal (232B-232A) axis. A portion 116A of the bougie <NUM> protrudes outside the distal end 232A of the tubal body <NUM>. A portion 116B of the bougie <NUM> protrudes outside the tubal body <NUM> from the proximal end 232B and over vocal cords. An endotracheal tube can be positioned inside the lumen <NUM> and the bougie <NUM> is used under constant visualization from the camera <NUM> to guide the placement of the endotracheal tube through patient's vocal cords. The distal end <NUM> of the camera tube <NUM> is in proximity with the distal portion 116A of the bougie <NUM> and therefore, the guided placement takes place under constant visualization.

<FIG> is the same intubating airway device with a visualization device, <NUM> of <FIG>, but with an endotracheal tube <NUM> inserted inside of the lumen <NUM> of the tubal body <NUM> of the intubating airway device <NUM>. As can be appreciated from <FIG>, any endotracheal device can be easily inserted and removed by sliding through the lumen <NUM>. Thus, the intubating airway device <NUM> can be used to intubate, extubate and reintubate under continuous visualization. The device provides continued visualization during intubation and extubation as well as during ventilation via the camera <NUM> in the camera tube <NUM>. Thus, the device <NUM> can be used for intubating and extubating without lifting the patient's mandible, tongue or soft tissues of the oral airways and this method is one of the embodiments.

<FIG> provide a further embodiment for an oral airway intubating/extubating device. As can be seen from the figures, a handle <NUM> can be connected to the proximal end 232B of the oral airway intubating/extubating device <NUM>. The handle <NUM> can be made of any suitable sturdy material such as for example, plastic, wood or metal. The handle <NUM> can be of any shape and size that would provide a sufficient grip for a hand of a medical provider. In some embodiments, the handle <NUM> is a cylinder. In other embodiments, it can be made in any other shape suitable for gripping by a hand. On one end, the handle <NUM> has a means <NUM> for attaching to a holder <NUM> which is connected the proximal surface 232C of the oral airway intubating/extubating device <NUM>, as shown in <FIG>. The means <NUM> can be made in any shape suitable for connection to the holder <NUM>. In some embodiments, the means <NUM> can be in a shape of a cylinder as shown in <FIG>. In some embodiments, the holder <NUM> can be in a shape of a half-cylinder slightly bigger in diameter than the means <NUM> as shown in <FIG> such as that the means <NUM> fits tightly inside the holder <NUM>.

When the handle <NUM> is connected to the holder <NUM>, a medical service provider can use the handle <NUM> to lift the patient's mandible and tongue. Thus, intubation/extubation can be easily accomplished on any patient, including patients who are unconscious and by any medical service provider, including those who are of small physical statute. Because the handle <NUM> can be disconnected from the holder <NUM>, the handle <NUM> can be removed after it is no longer in use. It can be reconnected with the holder <NUM> later if needed for further manipulations of the patient's lower jaw and/or tongue.

<FIG> and <FIG> provide a further embodiment for an oral airway intubating/extubating device with a rotating central passageway, generally <NUM>. The oral airway intubating/extubating device with a rotating central passageway comprises of two half-cylinders, an inner half-cylinder <NUM> and outer half-cylinder <NUM>. The half-cylinder <NUM> is smaller in diameter and fits inside the larger half-cylinder <NUM> such as the inner half-cylinder <NUM> can slide proximally and distally inside the outer half-cylinder <NUM>, as shown in <FIG>. At least in some applications, the inner half-cylinder <NUM> can be removed completely from the device <NUM>, such as only the outer half-cylinder <NUM> remains inserted in a patient, as shown in <FIG>.

As can be appreciated from <FIG>, the inner half-cylinder <NUM> may be longer than the outer half-cylinder <NUM> and the inner half-cylinder <NUM> can slide distally and proximally inside the outer half-cylinder <NUM>. As can be appreciated from <FIG>, a camera tube <NUM> can be attached externally along the outer half-cylinder <NUM> in some embodiments and a camera <NUM> can be placed inside the camera tube <NUM> and provide continuous visualization during intubation and extubation.

In other embodiments, the camera tube <NUM> can be positioned inside the inner half-cylinder <NUM>, as shown in <FIG> such that the camera <NUM> provides continuous visualization during intubation and extubation.

As can be appreciated from <FIG>, the inner half-cylinder <NUM> can rotate inside the outer half-cylinder <NUM> such that the two half-cylinders may create a completely enclosed passageway as shown in <FIG> or the half-cylinders may create a passageway which is not fully enclosed and remains open on at least one side as shown in <FIG>. In some embodiments, the inner half-cylinder <NUM> may have at least one retractable extension <NUM> which when extended outside the half-cylinder <NUM> locks the half-cylinder <NUM> in a position on the half-cylinder <NUM> and prevents the half-cylinder <NUM> from sliding further distally along the outer half-cylinder <NUM>.

<FIG> and <FIG> depict two different ways of inserting an endotracheal tube <NUM> inside the oral airway intubating/extubating device with a rotating central passageway <NUM>. As shown in <FIG>, the endotracheal tube <NUM> can be conveniently placed inside the rotating central passageway of the oral airway intubating/extubating device <NUM>. In alternative and as shown in <FIG>, the endotracheal tube <NUM> can be first placed inside the inner half-cylinder <NUM> which is then inserted insider the outer cylinder <NUM>. This assembly permits flexibility and makes insertion of endotracheal tubes of various sizes, including small pediatric endotracheal tubes, very accurate and under constant visualization of a camera. Further and because the inner half-cylinder <NUM> can slide along the proximal-distal axis, the intubation can be accurate and customized for a particular patient to fit the patient's size and anatomy. Alternatively, the device <NUM> may be placed over the endotracheal tube <NUM> which is already in place in a patient in order to provide constant visualization and a conduit for extubation and possible reintubation.

Further embodiments provide a supraglottic airway device with a visualization device. Referring to <FIG>, it depicts a supraglottic airway device with a visualization device, generally <NUM>. It comprises a body <NUM> with a lumen <NUM> into which a sound-monitoring device <NUM> is placed. The body <NUM> may have a cylinder-like shape tapered at the distal end, and with the distal end the body <NUM> protruding with a tongue-like tip <NUM>. At least a portion of the body <NUM> surface is slightly curved toward the lumen <NUM> and creates a surface <NUM>. The visualization device, generally <NUM>, comprises a camera tube <NUM> with a distal end <NUM> which is sealed with a transparent material <NUM>, and a camera <NUM> which is placed inside of the camera tube <NUM> through an opening at the proximal end of the camera tube <NUM>. The camera tube is positioned externally on surface <NUM> along the distal-proximal axis of the body <NUM>. The camera tube <NUM> is connected with the surface <NUM> by a sliding means <NUM> such that the camera tube <NUM> can slide along the 242A-242B axis on the surface <NUM>.

The camera <NUM> is placed inside of the camera tube <NUM> and because the camera tube <NUM> is sealed at the distal end <NUM>, the camera <NUM> does not come in contact with a patient and the camera <NUM> does not need to be sterilized and it can be reused in other applications. The camera <NUM> is connected by electric wire <NUM> or wirelessly to a monitoring device. The camera <NUM> is not disposable and can be reused in other applications.

The device <NUM> is further equipped with a bougie tube <NUM> which is also located on the surface <NUM> and is connected to the surface <NUM> with a sliding means <NUM> such that the bougie tube <NUM> can slide along the 242A-242B axis. <FIG> provides an alternative embodiment for the device <NUM>, in which the sound and temperature monitoring device <NUM> can protrude through an opening at the <NUM> tip.

A further embodiment provides a one-piece video-laryngoscope with a visualization device, generally <NUM>, as shown in <FIG>. The video-laryngoscope <NUM> comprises a tubal body <NUM> which has a proximal end 252B and a distal end 252A. The tubal body <NUM> extends with a scoop-like portion <NUM> at the distal end 252A. The scoop-like portion <NUM> curves horizontally such that the distal end 254A of the scoop-like portion <NUM> is nearly parallel to the proximal end 254B of the scoop-like portion. The tubal body <NUM> has an opening <NUM> near its distal end 252A. A visualization device <NUM> which comprises a camera <NUM> placed inside of a camera tube <NUM> is placed through the opening <NUM> such that the distal end <NUM> of the camera tube <NUM> may be in proximity with the proximal end 254A of the scoop-like portion <NUM>. The device can be easily inserted to an upper esophagus and visualize vocal cords.

However, the position of the distal end <NUM> can be adjusted as needed by sliding the camera tube <NUM> through the opening <NUM>. The distal end <NUM> is sealed with a transparent material <NUM> such that the camera <NUM> does not come in contact with a patient's body and therefore, the camera <NUM> does not need to be sterilized and it can be reused in multiple applications. The camera <NUM> is inserted into the camera tube <NUM> through an opening at the proximal end <NUM>. The camera <NUM> is connected to at least one monitoring device either by electrical wire <NUM> or wirelessly.

The embodiment of <FIG> is the same as that of <FIG>, except a light source <NUM> is added to the visualization device <NUM> as described in connection with the light source <NUM> in other medical devices above. A bougie <NUM> in a tube <NUM> is also added through the opening <NUM>, and the distal end 116A of the bougie <NUM> can be manipulated at the proximal end 116B such that the placement of the device <NUM> is guided under continuous visualization with the camera <NUM>.

A further embodiment includes a vaginal speculum with visualization device, generally <NUM> as shown in <FIG>. Any speculum <NUM>, including disposable, generally known and used for a pelvic exam can be equipped with a visualization device, generally <NUM>, which comprises a camera <NUM> placed inside of a camera tube <NUM>. The camera tube <NUM> can be attached to the speculum <NUM> or to some other instrument. The camera <NUM> is placed in the camera tube <NUM> through an opening at a proximal end <NUM> and is moved all the way toward the distal end <NUM> which is sealed with a transparent material <NUM>. The camera <NUM> connected to at least one monitoring device by electric wire <NUM> or the camera <NUM> can be connected wirelessly.

Further embodiments relate to various tubing equipped with a visualization device shown in <FIG> and as described in more detail below.

<FIG> refer to various embodiments for a nasal cannula with a visualization device, generally <NUM>. <FIG> shows the positioning of a nasal cannula <NUM> on patient's head with a visualization device <NUM> added to one of the two nostril tubes. The nasal cannula <NUM> can be any nasal cannula known in the art and used by medical practitioners. The visualization device <NUM> is as described in connection with <FIG> and comprises a camera <NUM> inserted inside of a camera tube <NUM>. The camera tube <NUM> is sealed or otherwise attached externally along at least one nostril tube <NUM> of the nasal cannula <NUM> as shown in more detail in <FIG>. This nasal cannula with the visualization device <NUM> provides continuous visualization of vocal cords, upper esophagus. The cannula can be used to determine whether vocal cords are moving correctly, if there is any abnormal anatomy and the color of the patient's tissues.

As shown in <FIG>, the nasal cannula with the visualization device can be properly positioned through patient's nostrils as the positioning is guided and constantly visualized with the camera device <NUM>. The distal end <NUM> of the camera tube <NUM> aligns with the distal end of at least one nostril tube <NUM>. As shown in <FIG>, the nasal cannula with the visualization device can be further equipped with an external stethoscope <NUM>, which can be placed on patient's chest externally and monitors breathing and heart-beat sounds.

<FIG> and <FIG> show the same embodiment as in <FIG> and <FIG>, except the visualization device <NUM> is equipped with a light source <NUM> as was described in connection with the light source <NUM> in other embodiments.

A further embodiment includes a feeding tube with a visualization device, generally <NUM>, as shown in <FIG>. A visualization device, generally <NUM>, is sealed or otherwise attached externally along the proximal-distal (282A-282B) axis of a feeding tube <NUM>. The visualization device <NUM> is essentially the same as described in connection with <FIG> and other embodiments above. It comprises a camera tube <NUM> with a proximal end <NUM> and a distal end <NUM>. A camera <NUM> with wire <NUM> is inserted into the camera tube <NUM> through an opening at the proximal end <NUM> and is slid all the way to the distal end <NUM> which is sealed with a transparent material <NUM>. The camera <NUM> does not come in contact with a patient's body and can be reused in multiple devices. Any feeding tubes known in the art can be used in this embodiment, including a feeding tube with a stylet <NUM> as shown in <FIG>. The feeding tube <NUM> can be equipped with an adaptor <NUM> at the proximal end 282A. The feeding tube <NUM> may further comprise a plurality of holes <NUM> at the distal end 282B for food distribution.

Further embodiments provide various suction tubes equipped with a visualization device, generally <NUM>, as shown in <FIG>. Any suction tube including but not limited to the nasal gastric tubes known in the art can be used and in general a suction tube <NUM> with an adaptor <NUM> at a proximal end 292B is suitable, as shown in <FIG>. A visualization device, generally <NUM>, comprises a camera tube <NUM> and a camera <NUM> with wire <NUM>. The camera <NUM> is inserted into the camera tube <NUM> through an opening at a proximal end <NUM> and is slid all the way to the distal end <NUM> of the camera tube <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. The camera <NUM> can transmit information to a remote location.

The camera tube <NUM> is placed inside of the suction tube <NUM> through an opening <NUM> at the proximal end 292B of the suction tube <NUM>. The camera tube <NUM> is then aligned with the length of the suction tube <NUM> such that the distal end <NUM> of the camera tube <NUM> is in close proximity with the distal end 292A of the suction tube <NUM>.

<FIG> is a further embodiment of a suction tube with a visualization device, generally <NUM> as shown in <FIG>, but it is further equipped with a bougie <NUM> placed inside of a tube <NUM> which is placed inside of the suction tube <NUM> through an opening <NUM>. A distal end 116A of the bougie <NUM> can protrude outside the distal end 292A of the suction tube <NUM> and can be manipulated by a medical practitioner with a proximal end 116B which protrudes outside a patient such as the placement of the suction tube <NUM> is guided under constant visualization with the camera <NUM> through the distal end <NUM> of the camera tube <NUM>. The bougie <NUM> under constant visualization from the camera <NUM> permits rapid and accurate placement of the device <NUM> in a patient. The bougie <NUM> can be used to guide the placement of the device <NUM> and moving it left or right in the trachea.

Referring to <FIG>, this embodiment provides a suction catheter with a visualization device, generally <NUM>. The suction catheter <NUM> is not flexible and can be any suction catheter known in the art. A visualization device, generally <NUM>, is positioned inside the suction catheter <NUM> through an opening <NUM> which is in near proximity with a proximal end 302B of the suction catheter <NUM>. The visualization device <NUM> comprises a camera <NUM> with wire <NUM> which is placed inside of a camera tube <NUM> through an opening at a proximal end <NUM> of the camera tube <NUM> and then the camera <NUM> is slid to the distal end <NUM> which is sealed with a transparent material <NUM>. The distal end <NUM> of the camera tube <NUM> is aligned with the distal end 302A of the suction catheter <NUM>, while the proximal end <NUM> of the camera tube <NUM> protrudes outside the patient's body such as the camera <NUM> can be pulled out from the camera tube <NUM> as needed. In other embodiments, the suction tube is placed externally and this combination can work with suction caps.

Referring to <FIG>, this embodiment provides an endotracheal changing tube with a visualization device, generally <NUM>. An endotracheal changing tube can be any endotracheal changing tube as known in the art. A visualization device, generally <NUM>, comprises a camera <NUM> with wire <NUM> which is placed inside of a camera tube <NUM> through an opening at a proximal end <NUM> of the camera tube <NUM> and slid all the way to a distal end <NUM> of the camera tube <NUM>. The distal end <NUM> is sealed with a transparent material <NUM>. The visualization device <NUM> is placed inside of the endotracheal changing tube <NUM> through an opening <NUM> in the changing tube <NUM> such as the camera tube <NUM> is aligned with the changing tube <NUM> along the proximal-distal (312B-312A) axis, and the distal end <NUM> of the camera tube <NUM> is in close proximity with the distal end 312A of the changing tube <NUM>. In other embodiments, the camera tube <NUM> can be placed outside of the endotracheal changing tube or it can be fitted externally onto an endotracheal changing tube known in the art.

Further embodiments include a supraglottic ventilating tube with camera, generally <NUM> as shown in <FIG>. As can be appreciated from <FIG>, the device <NUM> comprises a tube <NUM> with the distal end 361A and the proximal end 361B. The device <NUM> is equipped with a visualization device <NUM> as described in connection with <FIG> and which comprises a camera tube <NUM> attached externally to the device <NUM>. A disposable camera <NUM> can be inserted into the camera tube <NUM> along with a light source <NUM>. In proximity to the distal end 361A, the device <NUM> comprises an inflatable cuff <NUM> which wraps around the tube <NUM>. The cuff <NUM> can be inflated with a means <NUM> after the esophageal camera tube is positioned in a patient.

As can be appreciated from <FIG>, the camera tube <NUM> is positioned under the cuff <NUM> such that the cuff <NUM> wraps over the camera tube <NUM>. The camera tube <NUM> can slide along the tube <NUM> such that images with the camera <NUM> can be taken either proximally or distally from the cuff <NUM> after the cuff <NUM> is inflated in the patient.

As shown in <FIG> and <FIG>, the device <NUM> can be placed inside the intubating/extubating oral airway device <NUM>, including the intubating/extubating oral airway device <NUM> shown in <FIG>. As can be appreciated from <FIG>, the device <NUM> can be easily inserted into a patient with help of the intubating/extubating oral airway device <NUM>. Supraglottic ventilating tube can be positioned under the direct and continuous visualization into patient's hypopharynx. The device <NUM> can be removed after the insertion is completed.

Further embodiments provide a tubeless intubating device shown in <FIG>, generally <NUM>. The tubeless intubating device <NUM> has the upper surface shown in <FIG> and the bottom surface shown in <FIG>. The tubeless intubating device <NUM> comprises an ellipsoid body <NUM> which has an upper oval surface <NUM> with a lumen opening 374A on the upper oval surface <NUM> of the ellipsoid body <NUM> as shown in <FIG>. The upper oval surface <NUM> is connected to the bottom half-ellipsoid surface <NUM> as shown in <FIG> such that the distal end <NUM> of the ellipsoid body <NUM> is tapered because the bottom half-ellipsoid surface <NUM> is tapered at the distal end <NUM>. The ellipsoid body <NUM> encloses a lumen <NUM> which opens onto the upper oval surface <NUM> with the lumen opening 374A. The lumen <NUM> opens on the proximal side of the bottom half-ellipsoid surface <NUM> with a canal <NUM> which connects to the bottom half-ellipsoid surface <NUM> and extends beneath the bottom half-ellipsoid surface <NUM>. The bottom half-ellipsoid surface <NUM> also connects to a handle <NUM>.

The handle <NUM> comprises three parts connected together: the proximal part 380A, the middle part 380B and the distal part 380C. The proximal part 380A may be made in flat rectangle shape with a ring-holder <NUM> attached on the bottom surface of the proximal part 380A. The 380A part bends down at about a <NUM> degree angle at its distal part where it connects to the middle part 380B. The middle part 380B is also of flat rectangle shape and may vary in length. As can be seen from <FIG>, the canal <NUM> is connected to the bottom surface of the middle part 380B at the distal portion of the middle part 380B. The middle part 380B connects to the distal part 380C at its distal end. The middle part 380B bends up at about a <NUM> degree angle at the distal part and connects to the distal part 380C. The distal part 380C connects by its distal end to the oval upper surface <NUM> of the ellipsoid body <NUM>.

A visualization device, generally <NUM>, comprising the camera tube <NUM> and camera <NUM> which can be inserted into the camera tube <NUM>, is attached to the handle <NUM> on its upper surface such as the visualization device <NUM> extends along the handle <NUM> from its proximal end 380A at which the camera <NUM> is inserted insider the camera tube <NUM> and all the way into the distal portion 380C. Just like in other embodiments, the camera tube <NUM> is sealed with a transparent material <NUM> at its distal end such as the camera <NUM> does not come into direct contact with the patient's body and can be reused. Just like in other embodiments, the camera tube <NUM> can slide along the proximal-distal axis of the handle <NUM>. The visualization device <NUM> may further comprises a light source <NUM> which can be inserted into the camera tube <NUM> along with the camera <NUM>. In some embodiments the ellipsoid body <NUM> can comprise an inflatable cuff <NUM> which can be inflated with a means <NUM>.

In some embodiments, the handle <NUM> can be made of flexible material. In other embodiments, the tubeless intubating device <NUM> can be designed without the cuff <NUM>. In some embodiments, the camera tube <NUM> is fixed to the handle <NUM>. In some embodiments, the camera tube <NUM> includes a light source. In other embodiments, the camera tube <NUM> has no additional light source.

The tubeless intubating device <NUM> can be used for intubating a patient with an endotracheal tube of any size under continuous visualization of the camera <NUM>. The tubeless intubating device <NUM> can be also used for extubation and for reintubation of a patient. It can also act as a supraglottic device with an endotracheal tube inflated with the cuff <NUM>.

As shown in <FIG>, an endotracheal tube <NUM> can be loaded onto the tubeless intubating device <NUM> such that the proximal end of the endotracheal tube <NUM> is secured on the tubeless intubating device <NUM> with the ring holder <NUM>. It will be appreciated that any endotracheal tube can be loaded into the device <NUM> and inserted into a patient. As can be seen in <FIG>, the endotracheal tube <NUM> in this embodiment is equipped with a cuff <NUM>. The endotracheal tube cuff <NUM> can be inflated after it is loaded into the device <NUM> and secured in place with the ring holder <NUM>. It will be appreciated that the embodiments of the device <NUM> shown in <FIG> are equipped with the cuff <NUM> and the cuff <NUM> of the structure can be inflated in the hypopharynx.

The distal end of the endotracheal tube <NUM> is then passed through the canal <NUM> and through the lumen <NUM> such that the distal end of the endotracheal tube <NUM> protrudes from the lumen opening 374A on the upper oval surface of the ellipsoid body <NUM>, as shown in <FIG>. The endotracheal tube <NUM> can slide along the proximal-dorsal axis of the tubeless intubating device <NUM> such that a longer or shorter portion of the endotracheal tube <NUM> protrudes from the lumen opening 374A.

As can be further appreciated from <FIG>, after the tubeless intubating device <NUM> delivers and assists in placing the endotracheal tube <NUM> in the patient under direct and continuous visualization, the tubeless intubating device <NUM> can be easily removed from the patient while the endotracheal tube <NUM> remains safely in place under continual vision. Thus, the tubeless device <NUM> can be used with a standard endotracheal tube to intubate and extubate a patient. The device <NUM> can be also used as a supraglottic device.

Further embodiments of the tubeless intubating device <NUM> are shown in <FIG>. As shown in <FIG> and can be particularly appreciated from <FIG>, the tubeless intubating device <NUM> in these embodiments does not comprise a cuff. Nevertheless and just like the tubeless intubating device <NUM> of <FIG>, the device <NUM> of <FIG> has the upper surface shown in <FIG> and the bottom surface shown in <FIG>. The tubeless intubating device <NUM> comprises an ellipsoid body <NUM> which has an upper oval surface <NUM> with a lumen opening 374A on the upper oval surface <NUM> of the ellipsoid body <NUM> as shown in <FIG>. The upper oval surface <NUM> is connected to the bottom half-ellipsoid surface <NUM> as shown in <FIG> such that the distal end <NUM> of the ellipsoid body <NUM> is tapered because the bottom half-ellipsoid surface <NUM> is tapered at the distal end <NUM>. The ellipsoid body <NUM> encloses a lumen <NUM> which opens onto the upper oval surface <NUM> with the lumen opening 374A. The lumen <NUM> opens on the proximal side of the bottom half-ellipsoid surface <NUM> as shown in <FIG>. The bottom half-ellipsoid surface <NUM> also connects to a handle <NUM>. This embodiment of the device <NUM> does not comprise a canal.

A visualization device, generally <NUM>, comprising the camera tube <NUM> and camera <NUM> which can be inserted into the camera tube <NUM>, is attached to the handle <NUM> on its upper surface such as the visualization device <NUM> extends along the handle <NUM> from its proximal end 380A at which the camera <NUM> is inserted insider the camera tube <NUM> and all the way into the distal portion 380C. Just like in other embodiments, the camera tube <NUM> is sealed with a transparent material <NUM> at its distal end such as the camera <NUM> does not come into direct contact with the patient's body and can be reused. Just like in other embodiments, the camera tube <NUM> can slide along the proximal-distal axis of the handle <NUM>. The visualization device <NUM> may further comprises a light source <NUM> which can be inserted into the camera tube <NUM> along with the camera <NUM>.

As shown in <FIG>, the device <NUM> can be used for intubation and extubation of a patient with a supraglottic airway, generally <NUM> in <FIG>. The device <NUM> can also be used for placement of a laryngeal mask airway. As shown in <FIG>, the supraglottic airway <NUM> is secured in the device <NUM> with the ring holder <NUM> such that the distal end of the device <NUM> is aligned with the distal end of the device <NUM> and the lumen <NUM> of the device <NUM> is aligned with the lumen <NUM> of the device <NUM> and secured. Because the assembly of the devices <NUM> and <NUM> is equipped with the camera device <NUM>, it provides continuous visualization of patient's supraglottic structure during placement.

Further embodiments provide a sliding endotracheal cuff device, generally <NUM> as shown in <FIG>. As can be appreciated from <FIG>, an endotracheal tube <NUM> comprises a tube <NUM> with a proximal end 412A and a distal end 412B with a rail <NUM> along the proximal-distal axis (412A-412B) designed such that the endotracheal tube <NUM> fits inside the device <NUM> and the rail <NUM> fits into the rail <NUM> of the device <NUM>. The device <NUM> can then slide along the proximal-distal axis 412A-412B on the endotracheal tube <NUM> as shown in <FIG>. The details of the device <NUM> design are further explained in connection with <FIG>. As can be appreciated from 27C, the rail <NUM> has a groove <NUM> facing inside the tube <NUM>. The groove <NUM> is designed such that the rail <NUM> of the endotracheal tube <NUM> fits inside the groove <NUM> and can slide along the rail <NUM>. The rail design permits to easily remove the endotracheal tube <NUM> from the device <NUM> while the device <NUM> remains in place in a patient. In alternative, the device <NUM> can be removed, while the endotracheal tube <NUM> remains in place in the patient. Because the device <NUM> remains in place, changing from one endotracheal tube <NUM> to another can be easily accomplished. Further because the cuff <NUM> is presented on a separate device, an endotracheal component can remain in place if what needs to be replaced is only a cuff. While in drawings of <FIG>, the device <NUM> is shown a cylinder, this device can be a half-cylinder in other embodiments.

As can be further appreciated from <FIG>, some embodiments for the device <NUM> comprise an additional tube <NUM> which can be used for delivering drugs, suction and tools such as for example forceps and bougie. Further embodiments for the device <NUM> include an embodiment of <FIG> in which the cuff <NUM> can move along the rail <NUM>. Yet further embodiments for device <NUM> include an embodiment of <FIG>, where the distal portion 402A of the tube <NUM> comprises mesh <NUM>. As can be further appreciated from <FIG>, the cuff <NUM> can inflate over the mesh <NUM>.

As can be appreciated from <FIG>, the camera tube <NUM> may be fixed along the body <NUM> or it can slide proximally and distally along the body <NUM>. Overall, the device <NUM> prevents a problem of broken seal after the device has been in place in a patient for a period of time.

Further embodiments provide an endotracheal tube, generally <NUM>, as shown in <FIG>. The device <NUM> comprises a tube <NUM> with the proximal end 432A and the distal end 432B. A visualization device <NUM> is positioned along the proximal-distal axis (432A-432B) of the tube <NUM>. As can be appreciated from <FIG>, the visualization device <NUM> comprises a camera tube <NUM> sealed with a transparent material <NUM> at the distal end. A camera <NUM> can be placed inside the camera tube <NUM>. The camera tube <NUM> comprises a rail <NUM> running along the camera tube <NUM>. The tube <NUM> further comprises a half-cylinder <NUM> attached on the side opposite to the side of the tube <NUM> to which the rail <NUM> is attached. The half-cylinder <NUM> has a diameter such that the visualization device <NUM> can be easily snap over the tube <NUM> of the endotracheal tube <NUM> with the half-cylinder <NUM>. Thus, the visualization device <NUM> in this embodiment can be easily assembled with any endotracheal tube and it can also be easily removed from the endotracheal tube when visualization is no longer needed. Importantly, the camera tube can be detached at any time. Thus, this device is similar to a laryngoscope, yet the camera tube can be removed at any time if no longer needed. Thus, one of the advantages of this device is a rail which permits gliding along any other tubal device.

Further embodiments provide a sliding camera tube with rail, generally <NUM> as shown in <FIG>. As can be appreciated from <FIG>, the camera tube <NUM> comprises a tube into which a camera <NUM> can be inserted. The tube <NUM> is sealed at the distal end with transparent material <NUM>. A rail <NUM> runs along the tube <NUM>. The tube <NUM> is attached to a half-cylinder <NUM> which has a diameter such as the camera tube <NUM> can be easily assembled with an endotracheal tube or any other tube and it can glide along the endotracheal tube or any other tube. As can be appreciated from <FIG>, the camera tube <NUM> can easily slide into a laryngoscope which is equipped with a rail <NUM> along which the camera tube <NUM> can slide. As can be appreciated from <FIG>, after the camera tube <NUM> is positioned on the laryngoscope, the camera <NUM> can be inserted into the tube <NUM>.

As can be further appreciated from <FIG>, the camera tube <NUM> can be easily removed from the laryngoscope and assembled with any other device. For example, the camera tube <NUM> can be placed on an endotracheal tube as was discussed in connection with <FIG>. Thus, the device provide intubation during laryngoscopy and after the removal of the device <NUM> from the device <NUM>.

Further embodiments provide a supraglottic airway device with built in endoscope guide, generally <NUM>, as shown in <FIG> and <FIG>. As can be appreciated from <FIG>, the device <NUM> comprises a camera tube <NUM> which is positioned externally long the body of the device <NUM>. The device <NUM> is further equipped with a half-cylinder endoscope guide <NUM> which runs externally along the body 451of the device <NUM>, beneath a cuff <NUM> and creates a semi-lumen. The device <NUM> can be used for placing a supraglottic airway with an endoscope in place. The device <NUM> is adoptable to endoscopes of all sizes. The device <NUM> can be placed after an endoscope is already inserted in a patient. The device <NUM> is able to ventilate a patient under continuous visualization during endoscopy. As can be further appreciated from <FIG>, the device <NUM> can be positioned in the patient's oral cavity <NUM> and then it can be easily removed from the endoscope semi-lumen <NUM>.

<FIG> and <FIG> provide further embodiments for an assembly with a naso-gastric tube with a visualization device <NUM>, generally <NUM>. The visualization device <NUM> comprises a camera tube <NUM> with a camera <NUM> which can be inserted inside the camera tube <NUM>. The naso-gastric tube <NUM> comprises a valve <NUM>. The assembly <NUM> further comprises an oxygen tube with perforations, <NUM>, which can be connected to a source of oxygen <NUM>. As can be appreciated from <FIG> and <FIG>, the perforations <NUM> are located at the distal end of the tube <NUM> and this permits localization of the perforations in the mid pharynx to deliver oxygen to a patient as shown in <FIG>. The length of the camera tube <NUM>, oxygen tube <NUM> and naso-gastric tube <NUM> are calculated such that the assembly is flexible and the camera tube <NUM> can be located in the mid pharynx. However, the camera tube <NUM> can slide on the gastric tube <NUM> to travel to the distal gastric tube <NUM> providing continuous visualization of patient's gastric organs. A person of skill will appreciate that in some embodiments, the assembly <NUM> comprises a naso-gastric tube <NUM> as shown in <FIG>, while in other embodiments, the assembly <NUM> comprises a feeding tube <NUM> in place of the naso-gastric tube <NUM>.

<FIG> is a further embodiment of an oral airway with a camera device, generally <NUM>. The oral airway comprises a tubal body <NUM> with a lumen <NUM> similar to tubal bodies of other oral airways described in this disclosure. The camera device <NUM> comprises a camera tube <NUM> which is sealed at its distal end with transparent material <NUM> and into which a camera <NUM> can be placed.

The camera device <NUM> is placed inside the lumen <NUM>. The oral airway device <NUM> can provide continuous visualization of patient's supraglottic structure including the vocal cords in patients with positive ventilation pressure and also in patients ventilating spontaneously. The oral intubating device <NUM> can be used to place an endotracheal tube through the vocal cords without lifting the mandible. As in previous embodiments, the device <NUM> provides a continuous visualization after the endotracheal tube is placed and during extubation. It should be understood that this camera tube can slide proximal and distal to the tip of the device <NUM>. A bougie <NUM> is also placed inside the lumen <NUM> and it can be moved along the proximal-distal axis and guide positioning of the camera device <NUM> which also can move along the proximal-distal axis. The device <NUM> further comprises a suction catheter <NUM> which is also placed inside the lumen <NUM> and which can move along the proximal-distal axis inside the lumen <NUM>. As can be appreciated by a person of skill, an endotracheal tube can be placed inside the lumen <NUM> to intubate a patient.

<FIG> are further embodiments of an endotracheal tube <NUM> with an externally attached camera tube <NUM> into which a camera <NUM> can be placed, and a suction tube <NUM> which is also attached externally to the endotracheal tube <NUM> as shown in <FIG>. As shown in <FIG> other devices can be externally attached to the endotracheal tube <NUM>, such as a medication dispensing device <NUM> as shown in <FIG> and biopsy forceps <NUM> as shown in <FIG>. Additionally, a ventilating tube can be placed in can be added to the assembly. An additional balloon can be added circumferentially around the camera tube to provide ventilation. This system can be also used to separate ventilation between the left and right bronchus. Because the camera tube <NUM> and the suction tube <NUM> are secured on the endotracheal tube <NUM> with a set of rings, the attachment is flexible and each of the camera tube <NUM> and suction tube <NUM> can rotate <NUM> degrees around the endotracheal tube <NUM>. In addition to be able to rotate around the endotracheal tube <NUM>, the camera tube <NUM> and suction tube <NUM> can slide along the proximal-distal axis of the endotracheal tube. The camera tube <NUM> is sealed at the distal end with transparent material <NUM> and this allows the camera <NUM> to visualize the external structures in the airway including but not limited to the vocal cords.

<FIG> are further embodiments of an oral airway device, generally <NUM>, that allows for continuous visualization of the patient's vocal cords. As shown in <FIG>, the device comprises a tubal body <NUM> with a lumen <NUM> into which an endotracheal tube <NUM> or any other similar device can be inserted. The tubal body <NUM> has a proximal end 502A and a distal end 502B. The visualization device <NUM> is positioned along the tubal body <NUM> externally and it comprises a camera tube <NUM> sealed at the distal end with transparent material <NUM>, and a camera <NUM> which can be used in multiple applications as it does not come into a direct contact with the patient's body. The positioning of the camera device provides for continuous visualization in the anteriorly lumen. An additional tubal body with a lumen <NUM> is attached along the proximal-distal axis of the tubal body <NUM>. This additional tubal body <NUM> can be used for positioning an esophageal blocker <NUM> which can be then placed in the patient's esophagus under direct visualization with the visualization device <NUM>. The esophageal blocker <NUM> is equipped with a balloon <NUM> at the distal end. The balloon <NUM> can be inflated with a means <NUM> and seal the patient's upper esophagus. In addition, the device <NUM> is equipped with a second balloon <NUM> which is circumferential and runs around the bodies <NUM> and <NUM>, and located proximally to the balloon <NUM>. The balloon <NUM> can be used to inflate with a means <NUM> and used for sealing the upper pharynx. Thus, the device <NUM> may act as a supraglottic airway with the endotracheal tube <NUM> pulled back proximally in the device <NUM> with the endotracheal tube <NUM> inflated.

Alternatively and as shown in <FIG>, the endotracheal tube <NUM> may be removed and a ventilator cap <NUM> can be placed proximally in the central oral airway lumen to ventilate the patient as a supraglottic device. The device <NUM> may allow ventilating as a supraglottic airway under continuous and direct visualization with the visualization device <NUM>. The device may also revert back to place an endotracheal under direct visualization.

<FIG> provide a further embodiment for an oral airway device, generally <NUM>, but in which the visualization device <NUM> is positioned internally and inside the lumen <NUM>. <FIG> includes an endotracheal tube <NUM> which can be placed inside the lumen <NUM>, as was discussed in connection with <FIG>. Further and as shown in <FIG>, the device <NUM> can be also used a ventilation cap <NUM>.

One of the significant differences between the oral airway device <NUM> as embodied in <FIG> versus the embodiments of <FIG>, the device <NUM> in of <FIG> does not comprise a balloon. The body <NUM> of the device <NUM> however, comprises at least one retractable extension <NUM>.

As shown in <FIG>, the oral airway device <NUM> of <FIG> can be used in a combination with a carrier device <NUM>. As shown in <FIG>, the carrier device <NUM> comprises a tubal body <NUM> with a lumen <NUM>. Two balloons are sealed to the carrier body <NUM>. The first balloon, <NUM>, caps the distal end of the carrier body <NUM>. The first balloon <NUM> can be inflated with a means <NUM>. The second balloon, <NUM>, is proximal to the first balloon <NUM>, and it rounds around the carrier body <NUM>. The second balloon <NUM> can be inflated with a means <NUM>.

The carrier body <NUM> comprises an opening <NUM> which is located on the carrier body <NUM> between the first balloon <NUM> and the second balloon <NUM>. Thus, the lumen <NUM> opens with the opening <NUM> on the carrier body <NUM>. The carrier body <NUM> is equipped with a glide rail <NUM> which runs along at least a part of the carrier body <NUM>. The carrier body <NUM> is further equipped with a handle <NUM> which allows the carrier device <NUM> to be pushed, pulled and or turned from side to side.

As can be appreciated from <FIG>, the oral airway device <NUM> can be inserted into the lumen <NUM> of the carrier device <NUM>. The extension <NUM> of the body <NUM> can glide along the glide rail <NUM> until the device <NUM> is positioned inside the lumen <NUM>. As can be appreciated from <FIG>, the device <NUM> can glide up and down inside the carrier <NUM>, this allows an endotracheal tube to be placed proximally in its central lumen <NUM>.

As shown in previous embodiments, the device <NUM> as a whole maybe advanced distally or brought proximally to align the central lumen between the two balloons <NUM> and <NUM> to visualize the vocal cords. An endotracheal tube thus can be advanced under direct and continuous visualization by the camera device <NUM>. If needed, the endotracheal tube can be withdrawn from the trachea altogether or partially within the proximal lumen <NUM> (balloon on endotracheal tube inflated) to be converted to a supraglottic device.

The balloons <NUM> and <NUM> can be inflated and thus occluding the upper esophagus distally and pharynx proximally. This can be accomplished under direct and continuous vision of both the vocal cords, glottic structures and upper esophagus and hypo pharynx by the visualization device <NUM>. The ventilating cap <NUM> can be placed in the central proximal lumen <NUM> if an endotracheal tube is absent.

<FIG> depicts an oral airway device <NUM> with a camera tube <NUM> positioned in the patient's mouth. The camera tube <NUM> is as in prior embodiments with sealed distal end and open proximal end. The oral airway device <NUM> has a central lumen <NUM> to allow an endotracheal tube <NUM> to enter and slide down distally. The oral airway device <NUM> has a curvature and length to allow the oral airway device <NUM> to go under the epiglottis and actually touch the patient's vocal cords. Thus, no lifting of the mandible or tissue is needed. This new methodology of intubation allows greater ease and less skill to master then all the other forms of intubation such as laryngoscopy, videolaryngoscopy or fiberoptic intubation.

Once the distal end of the oral airway device <NUM> is touching or just proximal to the patient's vocal cord, the endotracheal tube <NUM> can slide proximal to distal in the central lumen <NUM> through the vocal cords under direct and continuous visualization by the camera <NUM>. Once the endotracheal tube <NUM> is placed and secured the oral airway device <NUM> still maintains direct and continuous visualization of the endotracheal tube <NUM> and the patient's vocal cords.

The further details of the oral airway device <NUM> can be appreciated from <FIG> where it is shown that the side <NUM> of the oral airway device <NUM> is open to allow the endotracheal tube <NUM> to be removed laterally from the central lumen <NUM> of the oral airway device <NUM> if needed. As can be further appreciated from <FIG>, the device <NUM> can be further equipped with a cap <NUM> which can be designed in multiple different sizes and can be placed or removed to add or shorten the oral airway device <NUM> to properly adjust to patients of different sizes. The cap <NUM> still has a side <NUM> removed as shown in <FIG> to allow an endotracheal tube to be removed from the central portion of the oral airway device <NUM> laterally. In addition, the cap <NUM> can be removed and rotated <NUM> degrees to help hold the endotracheal tube in place.

<FIG> and <FIG> depict a nasopharyngeal airway device, generally <NUM>. The device comprises a tubal body <NUM> with a camera tube <NUM> positioned internally. The distal end of the camera tube <NUM> is sealed with transparent material <NUM>. A camera <NUM> is placed inside the camera tube <NUM>. The tubal body <NUM> has a closed distal end with an occluding soft balloon <NUM> just proximal to the tip of the body <NUM>. The balloon <NUM> can be inflated with a means <NUM>. Proximally, to the distal balloon <NUM> is an open lumen (vocal cord visualization lumen) <NUM> that has the distal camera tube <NUM> situated to view anteriorly towards the vocal cords. The vocal cord visualization lumen <NUM> is proximate to the main lumen <NUM> in the nasopharyngeal airway tubal body <NUM>. The lumen <NUM> runs proximally to the distal end merging into the visualization opening <NUM> that houses the camera tube <NUM>.

A larger balloon <NUM> maybe placed proximal to the vocal cord visualization camera lumen <NUM>. The balloon <NUM> may be inflated with a means <NUM>. The balloon <NUM> may occlude the posterior pharynx. Additionally, another balloon <NUM> could be situated proximally to the pharyngeal cuff balloon <NUM>, as shown in <FIG>. The balloon <NUM> can be inflated with a means <NUM>.

These balloons ideally occlude the upper esophagus (hypopharynx), pharynx and nasal septum. These balloons may have separate pilot cuffs or share one pilot cuff to one or more balloons. A standard <NUM> cap (not shown) maybe attached to the proximal portion of the nasopharyngeal device to provide positivity pressure ventilation with a sealed hypopharynx and pharynx with the balloons in place and inflated.

As shown in <FIG>, the device <NUM> is placed in a patient and the balloons are inflated in the nasal septum, pharynx and hypopharynx. The visualization camera lumen <NUM> can be easily aligned to the vocal cords visualized anteriorly under direct and continuous visualization. A ventilator cap is available to be placed proximally to provide positive pressure ventilation. This device can be a rescue device to provide continual visualization of the vocal cords while maintaining a closed system.

Claim 1:
A medical device comprising a flexible visualization device (<NUM>) sealed to, attached slidably to or otherwise combined with at least one of the following second devices: an oral airway (<NUM>) comprising a tubal body (<NUM>) with a central passageway, the tubal body (<NUM>) being made of two half-cylinders (<NUM>, <NUM>) which can rotate and convert the central passageway from completely enclosed into only partially enclosed and comprising a lateral opening, a supraglottic airway device (<NUM>), an endotracheal tube, a tubeless intubating device (<NUM>), a sliding endotracheal cuff device (<NUM>), a ventilator adaptive cap, a dilator (<NUM>), a tracheostomy device (<NUM>), a nasal trumpet (<NUM>), an esophageal stethoscope, a stylet (<NUM>, <NUM>), a bougie (<NUM>), a speculum (<NUM>), a nasal cannula (<NUM>), a feeding tube (<NUM>), a suction tube (<NUM>), a suction catheter (<NUM>), and an endotracheal changing tube (<NUM>); and wherein the flexible visualization device (<NUM>) comprises a camera tube (<NUM>) with a distal end (<NUM>) and proximal end (<NUM>), the distal end (<NUM>) being sealed with a transparent material and a camera (<NUM>) being placed inside of the camera tube (<NUM>) through an opening at the proximal end (<NUM>), and wherein the camera (<NUM>) is disposable or re-usable; wherein the camera (<NUM>) is retractable from the camera tube (<NUM>) on demand; and, wherein the second device has a proximal end and a distal end, wherein the camera tube (<NUM>) is attached to the second device either internally or externally along the proximal-distal axis.