JPS6215233B2 - - Google Patents

Description

BACKGROUND OF THE INVENTION (Technical Field) The present invention relates to an endotracheal tube configured so that the insertion position (depth) within the trachea can be accurately determined when the tube is inserted into the trachea. (Prior Art and its Problems) An endotracheal tube is inserted into a patient's trachea for anesthesia, respiratory management, and the like. Intubation is performed under direct vision by expanding the trachea with a laryngoscope, but once the tube passes through the glottis, the tip of the tube cannot be confirmed at all, and conventionally the tube tip position has been determined by relying on feeling or by checking the tube length marked at the tube base. I am guessing. In addition, some uncuffed endotracheal tubes have recently been found to have a mark that is visible near the glottis when the tube tip is placed in the appropriate position to determine the subglottic position of the tube tip. It is impossible to visually observe from the side, and the distal end must be observed from the base of the tube, which makes it impossible to get a sense of the distance between the glottis and the mark, and even if the aim is to pass the mark. The distance traveled was uncertain. The above-mentioned appropriate position means that the tip of the tube is located between the tracheal carina and the glottis, and this varies depending on the patient's age and other factors. That is, the appropriate size of the endotracheal tube also differs depending on the age of the patient.
It would be convenient if the appropriate intubation position, which differs depending on the age of the patient, could be instructed to the tube, since it could be done easily and without the need for skill, unlike conventional methods, but this type of intubation has not been developed in the past. Nakatsuta. OBJECTS OF THE INVENTION Accordingly, an object of the present invention is to provide an endotracheal tube that allows easy visual confirmation of the appropriate intubation depth of the endotracheal tube. According to the present invention, in the endotracheal tube, the tube has a distance D measured from the bevel start of the tube to the proximal side of the tube as follows: D≦L-l=ad-d/tanθ where L: glottis Length from to the carina of the trachea l: Length of the bevel part of the tube a: Coefficient according to race d: Outer diameter of the tube θ: Expressed by the inclination angle of the tip of the bevel part, and insertion is stopped near the position of distance D. By configuring the device to have a mark, the above object can be achieved. Furthermore, it is preferable to provide at least one passage mark between the insertion stop mark and the bevel start part, since the glottis can always be positioned between the passage mark and the stop mark. be. Of course, the endotracheal tube and cuff may be attached or not. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The endotracheal tube of the present invention will be described in detail below with reference to preferred embodiments shown in the accompanying drawings. Currently, as endotracheal tubes, a cuffless endotracheal tube 1 (see FIG. 1) and a cuffed endotracheal tube 2 (see FIG. 2) are generally used. In both figures, 3 is a tube, 4 is a distal bevel, 5 is a proximal intubation mark, 6 is a cuff, 7 is a means for inflating the cuff, and a second tube 8,
It consists of a pilot balloon 9 and an end plug 10. As described above, it has conventionally been difficult or uncertain to position such endotracheal tube 1 or 2 in the proper position within the trachea, that is, between the glottis and the tracheal carina. Not only with a tube without a cuff, but also with a tube with a cuff, after the cuff passes through the glottis, the cuff cannot be seen visually, and the patient is left fumbling around, similar to the case with a tube without a cuff.
Therefore, some tubes have mark 5 attached to the proximal end of the tube, but since the proper position within the trachea varies depending on the age of the patient, as will be explained later, these marks 5 still leave uncertainty, and it is difficult for experienced The current situation is that Therefore, in order to introduce the endotracheal tube to the appropriate intubation depth, that is, between the glottis and the tracheal carina, we investigated the relationship between age changes in the length of the trachea and the applicable intubation tube. It turns out that there are surprisingly few. In other words, it has been found that, although many studies have been made on the appropriate tube size (outer diameter) for proper intubation of endotracheal tubes, no research and development has been conducted on the appropriate intubation depth. The inventors of the present invention are the authors of “Clinical Anesthesia Practice” by Tsutomu Oyama.
We conducted a study to determine the appropriate intubation position based on the detailed data described on page 37 (shown in Table 1). In addition, in Table 1, French size means tube outer diameter (mm) x 3. From this table, the length L from the glottis to the carina of the trachea is plotted in relation to the French size (outer diameter of the tube), as shown in FIG. In Figure 3,
The arrows indicate changes in the length L of the glottis-tracheal carina with age and the relationship between the applicable tube size and L, which fall within the almost constant band shown by the straight line and . I understand that. Since the tube should not enter or touch the bronchus beyond the tracheal carina during intubation, it should be secured by attaching it to the innermost side of the band. Therefore, it can be seen that the deepest length of tube intubation needs to be less than the value shown by the straight line in FIG. 3. By the way, as shown in FIGS. 1, 2, and 4, a bevel portion 4 is provided at the tip of the tube to facilitate insertion of the endotracheal tube. If the intubation depth is shallow and the bevel section 4 is in a position that touches the glottis, leakage will occur in the oral cavity (part of the gas ejected from the bevel section will flow backwards toward the oral cavity), making it impossible to completely secure the airway and ensuring the desired intubation. There is a risk that adequate respiratory control, which is the objective of Similarly, if the length l of the bevel portion 4 is longer than the length L from the glottis to the carina of the trachea, leakage will occur into the oral cavity, so it is necessary that L≧l (L−l≧0). . In FIG. 3, the length l of the bevel portion is illustrated as a straight line. As shown in an enlarged view in FIG. 4, the bevel portion 4 is a portion obtained by obliquely cutting the tube 3 at a tip angle θ, and an opening, that is, a breathing portion is located on the oblique side to ensure safety. Generally, the tip angle θ is 30° to 45
The length l of the bevel portion changes depending on this angle. It is between the straight line indicating the range where the tip of the tube does not contact the tracheal carina or enter the bronchus and the straight line indicating the length l of the bevel portion 4, and is shown with diagonal lines in Fig. 3. Part tube outer diameter d
and the length L from the glottis to the carina of the trachea gives the appropriate intubation depth of the endotracheal tube. If an intubation stop mark 12 (see Figs. 1 and 2) is provided on the tube 3 at a distance D measured from the bevel start 11 (see Fig. 4) to the tube base, it will be safe and reliable. Visual intubation can be performed. In order to prevent the tip of the tube from touching the tracheal carina or entering the bronchus, the length L from the glottis to the tracheal carina must be
It is necessary that the sum of the distance D from (see FIG. 4) to the intubation stop mark 12 provided in the direction toward the proximal side of the tube and the length l of the bevel portion 4 described above is not long. Expressing this in a formula, L≧D+l, and from this, D≦L−l. Therefore, the distance D at which the stop mark 12 is provided is expressed by the following formula. D≦L−l=ad−d/tanθ In FIG. 3, the length of the bevel portion is illustrated as a straight line. The bevel portion is a portion obtained by cutting the tube 3 obliquely at a tip angle θ, as shown in an enlarged view in FIG. 4, and an opening, that is, a breathing portion is located on the oblique side for safety. Generally, the tip angle θ is 30° to 45°, and the length l of the bevel portion changes depending on this angle. In this way, the outside of the tube, which is shown with diagonal lines in Figure 3, is obtained by subtracting the straight line showing the length l of the bevel part from the straight line showing the range where the tube tip does not contact the tracheal carina or enter the bronchus. The range between the diameter d and the glottis-tracheal bifurcation length L provides the appropriate intubation depth. Therefore, an intubation stop mark 12 (see FIGS. 1 and 2) should be provided on the tube 3 at a distance D measured from the bevel start 11 (see FIG. 4) toward the base of the tube. This allows for safe and reliable visual intubation. The distance D at which the stop mark 12 is provided, that is, the distance D from straight line to straight line is expressed by the following formula. D=L-l=ad-d/tanθ In the above formula, L: Length from the glottis to the carina of the trachea l: Length of the bevel portion of the tube a: Coefficient depending on race d: Outside diameter of the tube θ: Bevel portion Tip inclination angle Note that Table 1 is data for Japanese people, and if you calculate a from the straight line in Figure 3 based on this data, it will be 50/8, but this is because the length of the trachea is thought to differ depending on the race. , a or the straight line should be determined based on the trachea measurement data of each race. In addition to the stop mark 12 described above, at least one passing mark 13 may be provided between the stop mark 12 and the bevel start portion 11. This is particularly effective in the case of the cuff atracheal tube 1 shown in FIG. Although the passage mark 13 is not necessarily installed, if the passage mark 13 is installed, at least one passage mark 13 will pass through the glottis before the stop mark 12 reaches the glottis during tube intubation. By confirming that the stop mark 12 is approaching the glottis, the intubation can be performed even more safely and reliably. That is, the passage mark 13 can be used as a preliminary mark for the stop mark 12. It is more preferable to provide a plurality of passing marks, for example, at equal intervals, because the degree of approach of the stop mark to the glottis can be determined based on the number of passing marks that have passed through the glottis. In addition, the second
In the case of the cuffed endotracheal tube 2 shown in the figure, since the confirmation means is that the cuff 6 passes through the glottis, it can be considered that the cuff serves as a passage mark. Since the stop mark 12 and the pass mark 13 are visually confirmed, they must be placed on the tube 3 so that they are both clearly visible and clearly distinguishable. Therefore, in general, the stop mark 12 is made large or thick, and the passing mark 13 is made small or thin, or the stop mark is given a special pattern to make them distinguishable. Both of them are preferably attached continuously or discontinuously to the entire outer periphery of the tube 3 so that they can be confirmed regardless of the visual position. Specific effects of the invention Regardless of whether the endotracheal tube of the present invention is cuffed or not, the endotracheal tube has conventional stop marks,
This is done while visually checking the passing marks. As the endotracheal tube 1 or 2 is inserted into the trachea, first at least one passage mark 13 or cuff 6 disappears from view after passing through the glottis. If the intubation is stopped before the stop mark 12 passes through the glottis, the tip of the tube will fall within the appropriate safety range shown with diagonal lines in FIG. There will be no fear of having enough. Intubation with the tube of the present invention is performed by visual confirmation of the marks, so it is extremely easy to operate and can be performed reliably.
Its reliability is incomparable compared to conventional methods that involve many uncertain elements such as the mark 5 on the tube base side. The stop mark is placed at a position determined by the tube diameter, i.e., the age of the patient, so the user only has to decide what tube diameter to use for the patient and intubate safely and reliably. be able to. The stop mark is placed at a predetermined position based on data measured based on race or changes in body size over time, and has a very wide range of applications. 【table】

[Brief explanation of the drawing]

1 and 2 are partial side views of an uncuffed endotracheal tube and a cuffed endotracheal tube of the present invention, and FIG.
The figure is a graph showing the range of safe and reliable intubation between the glottis and the tracheal carina, and FIG. 4 is an enlarged side view of the bevel portion of the tube. Explanation of symbols, 1... Cuff atracheal tube, 2
...Intratracheal tube with cuff, 3...Tube, 4
...Bevel part, 5...Mark, 6...Cuff, 7...
... Cuff inflation means, 8 ... Second tube, 9 ... Pilot balloon, 10 ... End plug, 11
...bevel start, 12...stop mark, 13...
passing mark.

Claims (1)

[Scope of Claims] 1. In an endotracheal tube, the tube includes:
The distance D measured from the bevel start of the tube to the proximal side of the tube is expressed as follows: D≦L-l=ad-d/tanθ Where, L: Length from the glottis to the tracheal carina l: The length of the bevel of the tube Length a: Coefficient according to race d: Outer diameter of the tube θ: Intratracheal tube characterized by having an insertion stop mark in the vicinity of the position of the distance D, expressed by the inclination angle of the tip of the bevel part. 2. In the endotracheal tube, the tube:
The distance D measured from the bevel start of the tube to the proximal side of the tube is expressed as follows: D≦L-l=ad-d/tanθ Where, L: Length from the glottis to the tracheal carina l: The length of the bevel of the tube Length a: Coefficient depending on race d: Outer diameter of tube θ: Represented by the inclination angle of the tip of the bevel part, there is an insertion stop mark near the position of the distance D, and this insertion stop mark and the bevel start part An endotracheal tube characterized in that it has at least one passage mark between.