JPH06503730A - Pressure control device for endotracheal tube and cuff - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] Pressure control device for endotracheal tube e-cuff Background of the invention The present invention relates to a pressure control device. In particular, it It concerns the control of pressure within the tube system, and more specifically, the endotracheal The pressure inside the tube cuff and the airway pressure, i.e. the lumen of the endotracheal tube. is concerned with a simple device for maintaining a constant pressure difference between the pressure of In order to perform positive pressure ventilation of the worker's lungs and intensive respiratory treatment while administering intoxicating gas, A tube (called an endotracheal tube) is inserted into the trachea. "cuff" A soft ring-shaped piece that can be crushed with a relatively large volume known as A hollow bag is attached to the exterior of the endotracheal tube at the tracheal end.

To prevent gas from escaping through the endotracheal tube, this bag or The cuff is inflated with air so that it forms a pneumothorax with the viscous wall of the trachea. It will be done. The inflated cuff is secured to the endotracheal tube below the vocal cords within the trachea. Ru.

To prevent gas from escaping through the cuff, place the cuff at a pressure higher than the airway pressure. It needs to be expanded. However, the commonly used method of doing this results in This can result in cuff pressures that are much higher than the peak inflation pressure used for ventilation. There are often Among the other reasons why this happens are injections for that purpose. rapid and inadvertent initial overinflation with a The volume of air is warmed to body temperature and inflates the cuff, and nitrogen oxides and other There is a diffusion of anesthetic gas into the inside of the turnip.

Excessive cuff pressure can damage the perfusion (blood supply) to the mucosal lining of the trachea. and include, for example, necrosis, tuberculosis, or stenosis of the tracheal mucosa. May cause complications. The higher the cuff pressure used, the more As the leakage becomes weaker, there is a greater risk of causing permanent damage.

The cuff/stem achieves the desired purpose, i.e. the endotracheal tube 7-hole. should ensure that the lowest cuff pressure required is used. The device is The cuff pressure is just above the airway pressure, which means that changes in airway pressure can be transmitted to the cuff. Preferably, the pressure is automatically maintained.

Conventional technology φ To achieve this ideal, several initiatives, each of complexity, are described. There is. For example, the most relevant of the many applications is U.S. Pat. No. 4,825,862.

・U.S. Patent Application No. 4,850,349 (Falano J.) Although it does not require a partial gas supply, it can prevent over-expansion and the diffusion of nitrogen oxides into the system. associated with said fixed cuff volume device, including failure to compensate for small amounts of leakage. Incur various problems. Additionally, certain devices may have a limited range of cuff volumes or dimensions. only works.

U.S. Pat. ) (describes a device that appears to solve some problem; however, it is It is more sophisticated, larger, heavier, and more expensive. It also provides power to the device. Requires external high pressure gas to supply.

Key to invention According to the present invention, the endotracheal tube is disposed between the gas supply machine and the breathing apparatus. and means for connecting to a cuff inflation port of a breathing apparatus; During positive pressure ventilation, the intratrachea is powered by a gas supply to the Pressure to maintain a constant or nearly constant pressure difference with the lumen of the tube It is a regulator. This regulator is activated when the gas supplied to the breathing apparatus flows through its valve. It is equipped with a threshold valve that generates a nearly constant pressure difference. Kono Shiki~＼Value Valve (Koyo) The pressure difference generated can be fixed or adjustable. Also, the regulator is connected to the upstream side. Equipped with a means of connection. The connecting means transmits the upstream pressure to the cuff and The upstream pressure of the airway pressure is a constant pressure equal to or approximately equal to the threshold valve setting. This is to maintain a certain level of pressure. Furthermore, what happens due to incorrect concatenation? To avoid any danger, the regulator is equipped with a one-way relief that allows gas to flow in the opposite direction. A valve is formed.

Brief description of the drawing Figure 1 shows the cuff pressure regulator, its attachment to the anesthesia machine and breathing apparatus, and the endotracheal tube. of a device utilizing the invention, illustrating its attachment to the pilot tube of a tube cuff; Schematic representation of relative positions.

FIG. 2 schematically shows a longitudinal section of a regulator forming a first exemplary embodiment of the invention. .

FIG. 3A schematically depicts a longitudinal section of a regulator forming a second exemplary embodiment of the invention. vinegar.

FIG. 3B shows an external view of a portion of FIG. 3A.

4-8 variously illustrate the components generally described in connection with FIG. 3A.

Brief description of the drawing FIG. 1 shows an anesthetic gas supply device IO. Cuff pressure regulator of the invention to outlet 16 of it! 8 is installed. The turnip pressure regulator has a tubular installation at location 19 and pipe 2o. Breathing device! Attached to 22. Endotracheal tube 3o is attached to breathing apparatus W122 I get kicked. An endotracheal tube cuff 3 is placed near the tracheal end 30A of the endotracheal tube. 2 is installed. It is expanded by gas via pilot tube 36 That is, it is maintained in a pressurized state. Ventilation means (in this case mechanical ventilation) device 38) intermittently pressurizes the breathing apparatus to achieve reliable airway pressure ventilation. can. FIG. 2 is for use in connection with the apparatus generally described in connection with FIG. A first example of a pressure regulator is shown. FIG. 4 is sometimes referred to.

Cuff pressure regulator 9 has a body 9A. The body is the anesthetic gas supply in Figure 1. It is attached to the outlet 16 of the feeder 10 by an inlet passage 13 . The entrance passage is ■50 22 ■ Form a tight push fit into the outlet 16 according to the male-female probe installation. It has a round surface 11. The supplied anesthetic gas flows through the regulator in the direction of arrow A. ! Ie 16 separates the upstream passage 13 from the downstream outlet passage 14 . little (tomo 1 Two passageways 15 are formed through the septum 16 to allow the anesthetic gas to pass through the regulator 9. Let it flow. The downstream side of the bulkhead 16 includes any passages 15 and 15 within its periphery. and a valve seat edge 17 is provided surrounding all the passages 15. The spring on the edge of the valve seat When the valve seat 20 is pressed more into contact and there is zero gas flow or reverse gas flow, Forming an airtight seal of the valve seat edge 17.

The regulator 9 has a crosscut 18 for communicating with the artificial (upstream) passage 13 . Mouth 18 to the pyrobot tube 36 in the form of a light non-distensible tube, configured on the outside thereof The pipe attachment for connection constitutes part 19. This allows the inlet passage 13 and the endotracheal channel to The change in gas pressure between the tube cuff 32 and the inside of the tube cuff 32 is matched (FIG. 1).

A valve 26 with a rigid disk-shaped seat 2o having a central axial stabilizing rod 23 is threaded. Through a passageway 35 provided in the central axial direction of an adjustable tube 34 made of It slides freely and is held in place by a compression spring 28.

Valve seat 20 includes at least one passage 22 . Gas flows through that passage, as shown by arrow A. It can flow in the opposite direction. If the device is in the recommended orientation by design, This will happen if they are inadvertently connected in the opposite direction. Diameter of upstream seal edge 21 exceeds the outer boundary of the more centrally located passageway or hole 22. Deflection possible The diameter of the flexible disc-shaped flap 25 is longer than the diameter of the sealing edge 21, but shorter than the diameter of The deflectable flap 25 is obstructed when the gas flows backwards. The flap 25 is arranged on the upstream surface of the valve seat 2o so that it opens without injury. Ga When the gas flows correctly through the regulator in the direction of arrow A, the flap 25 will cause the gas to pass through the seat 2o. The valve 26 opens against the force of the spring 28 to prevent downstream flow. The side pressure is maintained above the downstream pressure by an amount determined by spring 28.

The disc 25 can be held in place by the dumbbell-shaped portion 24 of the spindle 26. , the deflectable elastic flap 25 has a central hole. The disc 25 is connected to the spindle. 26 at the upstream end. Normally the flexible elastic flap 25 is closed. 022 of the spindle is closed. Ga in the opposite direction to arrow A If a flow of gas occurs (under improper connection or conditions of use), the gas You can freely pass through 22. The spindle seat 2o, the center and the axial direction and the flange 33 of the pipe 30 provided with the screw disposed in the As a result, the spring 28 is kept in a compressed state.

The tube 30 is threaded to maintain the spring in a concentric position with the central passage 25. The smooth cylindrical part 34 on which the spring slides and the force of the spring can be changed appropriately. The support is drilled to allow adjustment of the axial position of the tube 30 to and a portion 31 provided with a screw to be screwed into the holding structure 40. screw The position of the provided tube 30 is determined by a screwdriver placed in the slot 32 of the tube 30. It can be adjusted by

Another example is that the regulator can be L-shaped and the tube 3o can extend through the side of the regulator. The downstream passage is set at an angle to both the upstream passage and the valve seat so that the A knob is provided to allow the force of the spring to be adjusted while the regulator is in use.

A fixed support structure 4o placed inside the downstream passage 14 is provided with a screw. A central threaded hole 42 to hold the tube 30 in place and direct the gas in either direction. at least one orifice located at the periphery to allow free flow to the It is equipped with a system 4I.

In use (mainly referring to FIGS. 1 and 2), the regulator 9 is connected to the outlet 1 of the anesthetic gas supply device 10. 6 and the regulator 9 is connected to the inlet 2 which is attached to the endotracheal tube 30 of the breathing apparatus. Attached to 4,26. Ventilators such as mechanical ventilation 1238 for positive pressure ventilation Air means are provided. The upstream passage 13 of the regulator 9 also has a port 18 and a pipe installed at the location 19. The pilot tube 36 is connected to the inside of the cuff 32. As a result, the anesthetic gas Anesthesia breathing device through the regulator! 22, the constant (or There is a pressure difference upstream of the regulator (approximately constant) depending on the flow characteristics of the regulator and the It is maintained between the side passage 13 and the downstream passage 14. The breathing apparatus 22 and therefore the endotracheal tube A higher upstream pressure is maintained than the downstream portion leading directly to tube 3o or airway pressure. and is transmitted to the endotracheal tube cuff 32.

When a positive pressure is generated by the ventilator during the inhalation phase of controlled ventilation, airway pressure Due to the increase in force, the pressure inside regulator 9 likewise increases. Supply gas regulator valve As it continues to flow through the regulator, the pressure difference across the regulator remains constant and therefore the downstream pressure Any rise in the flow rate is transmitted to the upstream part, which is connected to the upstream passage 13 and the side hole 18. And the pilot! 36 etc. to ensure adequate flow of gas from the endotracheal tube cuff 32. available. Therefore, the cuff pressure is maintained constantly higher than the airway pressure by the regulator 9. be done. A decrease in airway pressure, such as occurs during the passive exhalation phase, simultaneously reduces the pressure in the regulator 9. The pyrolysis reduces the force and therefore removes the gas that has accumulated in the cuff during the inhalation phase. It flows into the upstream passage 13 through the cut pipe 3 and the side hole 8. That is, The cuff pressure is equal to the airway pressure set across the regulator 9 valve. The pressure is reduced to a higher pressure.

The amount of gas inside the endotracheal tube cuff 32 is constantly changing and is set across the regulator 9. allows the pressure in the system to be equalized apart from the specified pressure difference .

Special benefits due to the ease of powering the breathing apparatus with anesthetic gas is obtained. It overcomes the problems of constant volume cuff devices. Also, therefore the book The invention overcomes the potential dangers of conventional devices that were supplied from an external high pressure gas source. wear clothes That is, the high pressure gas source must be covered with a safe release such as a pressure relief valve. must be attached to the The present invention can solve such a safety escape even in such a case. I can't close the gas valve.

If the regulator device 9 is connected to the outlet rather than the inlet of the anesthesia breathing apparatus. , the potential danger of the unidirectional flow device is that it spins through the mouth 22 and said flap 25. This is removed by means of reversing the flow through the dollar valve seat 20. Thereby This device is much safer to use in a clinical environment and therefore achieves the objectives of the invention. It is something that can be achieved.

Figures 3-8 They are used in a manner similar to that described in connection with Figure 2, and are Another aspect of the regulator that can be used in place of regulator 9 is shown.

3A and 3B show a regulator 42 having a cylindrical body 42A. that body A stepped hole B is provided in the hole B. The hole has the largest entrance ■, and the entrance is the entrance passage. 44 and outlet passage 46 to outlet end 0 . The gas flow through regulator 42 is It is usually in the direction of arrow A.

At the eighth step 54 there is provided a rigid support disk 66, shown in FIG.

The support disk 66 includes a central hole 64 and a number of holes, typically holes 68.

At step 56 in hole B is provided a rigid mounting disc 70, shown in FIG.

The mounting disc 70 includes an outer ring of holes 76 and an inner ring 74. both holes The ring has radial arms, typically a center-mounted support ring with a hole 72 extending therethrough. They are separated by an arm 80 extending from the group 78.

A flexible disk 86 shown in FIG. 7 is mounted downstream of the vtS disk 70. Ru. Disc 86 is attached to spindle 60 by central hole 88.

A flexible disk 98 shown in FIG. 8 is mounted on the upstream side of the mounting disk 70. . The disc 98 has a shape and axial position similar to that of the inner ring of the hole 74 in the disc 70. A corresponding hole 74.1 passes through it. The radial arm 80.1 is attached to the mounting disc 70. Similarly corresponds to the system 80. Central ring 78.1 aligned with support ring 78 of disc 70 do. Ring 78 has a hole 96 therein. Through that hole, the spindle 60 passes through the disk 9th. and extend it.

The spindle 60 (114) is axially centered by a center hole 64.72. and are supported within a support disc 66 and a mounting disc 70, respectively. spindle 60 has an integral boss 62. The boss 62 is the end for the flexible disk 86. Functions as a stop. Spring 7 Tsunya 90 is fixed to the right end of the spindle. , serves as a stop for the left end of spring 92. The right end of that spring plus Push the disc 98 through the tick collar 94. Support disk 70 and flexible disk 9 8 means that the hole 74 of the disk 70 and the arm 80 are the hole 74.1 of the disk 98 and the arm 80.1. aligned with the gas flow through hole 74.74.1 when opened. be mounted in such a way as to impose the least amount of constraints.

The spring 92 drives the spindle 60 to the left so that the hole 74.1 in the disc 100 and the support disc Supports disk 86 unless lifted by gas flow through corresponding holes 74 of 70 Press toward the downstream side of the disk 70. In this case, the disk 86 is pulled away from the support disk 70. separated, allowing gas to leak into the endotracheal tube 30 through outlet port #i46. I will do it.

The inlet passage 44 has an outlet tapping formed by a lateral hole 34 opening in the outlet pipe 48. will be accomplished. Thereby, the regulator 42 has a biloft corresponding to the pilot tube 36 of FIG. connected to the main pipe.

This JI! The regulator is configured in a manner similar to regulator 9 described in conjunction with rJIJ in Figure 2. generally works. The regulator 42 is connected to the outlet 16 of the anesthetic gas supply filo ( Figure 1), and the regulator 42 is a breathing device! It is attached to the entrance of 22. The breathing apparatus , a mechanical ventilation system connected to the endotracheal tube 30 and for providing positive pressure ventilation. Ventilation means such as a station 38 are provided. The upstream passage 44 of the regulator 42 is connected to the port 34. A tube 48 connects the pilot tube 3 to the interior of the cuff 2. As a result, anesthesia As the gas flows through the regulator 42 and into the anesthesia breathing bag @ 22, a constant (or (nearly constant) pressure difference is adjusted depending on the characteristics of the spring and the flow characteristics of the regulator. is maintained between downstream passageway 44 and downstream passageway 46 of the vessel. breathing apparatus 22, thus Direct access to endotracheal tube 30 or airway pressure. Higher upstream pressure than downstream part Force is maintained and transmitted to the endotracheal tube cuff 32.

When a suppression is generated by the ventilator during the suction phase of controlled ventilation Additionally, the increase in airway pressure causes a corresponding increase in the pressure within regulator 42. supply Gas flows across regulator valve 70 in the direction of arrow A through hole 74.1 in disc 98 and through disc 7. 0 through the hole 74, displacing the disc 86 against the action of the spring 92, and the resulting As a result, the spindle 60 is pulled to the right, causing gas to move through the disc system from the inlet passageway 44. Allowing flow to exit passage 46. In this normal flow state~1 Since the pressure difference across the regulator remains constant, any increase in downstream pressure It is then passed through the upstream passageway 44, the side hole 34, and the biro. A suitable gas flow from the foot tube 3 or the like is conducted to the endotracheal tube cuff 32. death Therefore, the cuff pressure is always maintained higher than the airway pressure by the regulator 42. passive call When a drop in airway pressure occurs, such as occurs during the air phase, the pressure inside regulator 42 increases. At the same time, the gas accumulated during the intake phase is removed from the pilot pipe 3. The water can flow to the outside through the side hole 34 to the upstream passage 44. vinegar That is, equal to the M discharge pressure set across the valve disk 704 of the regulator 42 Cuff decompression occurs to a pressure above airway pressure. Gas inside endotracheal tube cuff 2 The position of the pressure is constantly changing and the specific pressure differential set across regulator 9 to equalize the pressure inside the device.

A regulator device @42 shall be connected to the outlet instead of the inlet of the anesthesia breathing apparatus. , the potential steepness of the one-way flow Hrll is caused by the spindle valve seat 7o and the outside of the hole 74. through the side ring and the flap 98 whose outer edge is axially displaced. It is removed by a configuration that allows it to flow through the air. Under normal flow conditions, The viewable disc 98 is pressed against the disc 70 and the gas flows inside the holes 74.1 and 74. Allow it to flow only through the ring. Thereby, this device can be used in clinical settings It is much safer to do so and thus fulfills the purpose of it's design. .

IG3A FIG.8 Copy and translation of correction band) Submission band (Article 184-8 of the Patent Law) 5.3. 1 Heisei Year Month Day

Claims (1)

[Claims] 1. In a cuff pressure regulator for connection to a tracheal cuff, 1. a source of breathing gas; Inlet (11, 44) connected to (10) and outlet connected to breathing apparatus (22) (14, 46) and in use supply breathing gas from the source (10) to said regulator. from the inlet (11, 44) to the outlet (14, 46) and assemble the cuff (32) through the The pressure generated in the breathing apparatus (30) is controlled by the regulator. A body (9A, 42A) that follows force changes, and 2 the inlet (11, 44) and the outlet. The pressure regulator body (9A) is used to create a pressure difference between the ports (14, 46) , 42A) and a spring-loaded valve structure (20, 86); For connecting to the tracheal cuff (32), the valve of the body (9, 42) A port (18, 34) and A cuff pressure regulator comprising: 2. The pressure regulator according to claim 1, wherein the valve structure includes: 1 a valve seat (17, 70); , 2 Valve closing member (20, 86) (pressure at inlet (11, 44) , 86) tends to rise from the valve seat (17, 20). ) and 3 Elasticity that tries to push the closing member (20, 86) toward the valve seat (17, 20) a biasing device (28, 92); A cuff pressure regulator comprising: 3. The pressure regulator according to claim 2, wherein the valve seat (17, 70) comprises at least one valve seat (17, 70). consisting of a valve plate (16, 70) having holes (15, 74), and a valve closing member ( 20, 86) is composed of a valve closing disc (20, 86), and the valve closing disc is elastic. Elastically pressed against the downstream side of the plate (16, 70) by the biasing device (28, 92) and thereby close the hole (15, 75) in the valve seat (16, 70). cuff pressure regulator. 4. 4. A pressure regulator according to claim 3, wherein the valve plate (70) has an inner ring (74) of holes. ) and an outer circular ring (76) of holes, and a valve closing disc (86) on the inner side (74). Close the aligned holes and place a valve closing disc (98) on the opposite side of the valve plate (70) from the closing disc (86). ), the valve closing disc (98) is pressed against the upstream side of the plate (70); When the pressure at the inlet (44) exceeds the pressure at the outlet (46), the outside (76) A cuff pressure regulator characterized by closing holes lined with. 5. 5. The pressure regulator according to claim 4, wherein the valve plate (70) has an inlet (44) and an outlet (44). 46), and the closing disc (86) is fixed within the body (42A) between the plate (70) and between the outlet (46) and the closing disc (98) between the inlet (44) and the plate (70). , passing through both discs (86, 98) and plate (70) and axially with respect thereto. There is a spindle (60) that moves freely in the direction, and a spring (92) is attached to the spindle (60). between the receiver (90) and the closing disc (98), and the spindle (60) is placed above it. has a collar (62), and a closing disc (86) is located between the collar (62) and the plate (70). , so that when there is no pressure in the body (42A), the spring (60 ) presses the closing disc (98) against the plate (70) and presses the collar (62) against the closing disc. (86) and hold the closing disc (86) against the plate (70). A cuff pressure regulator featuring: 6. the endotracheal tube having an inflatable cuff surrounding the endotracheal tube; In a closed endotracheal tube device, a cap according to any of the preceding claims. a cuff pressure regulator (9, 42) and a cuff inflation and deflation duct (36); A cuff inflation and deflation duct (36) connects the mouth (18, 34) to the cuff (32). By doing so, the cuff (32) changes in response to the pressure inside the breathing apparatus (22). a cuffed trachea, characterized in that it is subjected to pressure at the inlet (13, 44); Inner tube device.