Methods and apparatus for reducing tracheal infection using subglottic irrigation, drainage and servoregulation of endotracheal tube cuff pressure

摘要

An integrated system providing a mechanical and chemical barrier against the spread of infected secretions into the distal trachea is disclosed. An endotracheal tube used for patient airway management and provides a means to conveniently irrigate and drain the subglottic region below the vocal cords and above an inflated cuff. The subglottic region accumulates liquid secretions that may channel past an inflated endotracheal tube cuff, providing the necessary bacterial inoculum leading to bronchitis and nosocomial pneumonia. An irrigation channel delivers liquids such as saline or antibiotic and antifungal medications for mucosal hydration, and bactericidal action against infected subglottic secretions. An outer sleeve surrounding the endotracheal tube forms a suction lumen for removing the secretions. The tapered and compliant nature of this sleeve at body temperature allows a large suction channel without the need to greatly enlarge the outside diameter of the endotracheal tube at the vocal cord level. Electronic and mechanical controls provide regulated volume infusion and regulated suction. In addition, cuff pressure is servoregulated to the lowest pressure that provides a tracheal seal and rapid adjustment of cuff pressure so that peak airway pressures are attenuated, thus preserving mucosal perfusion. Pneumonia and patient mortality are thus prevented.