Surgery – Respiratory method or device – Respiratory gas supply means enters mouth or tracheotomy...
Patent
1996-08-22
1998-06-30
Millin, Vincent
Surgery
Respiratory method or device
Respiratory gas supply means enters mouth or tracheotomy...
12820026, 12820714, 12820716, A61M 1600
Patent
active
057718881
DESCRIPTION:
BRIEF SUMMARY
BACKGROUND OF THE INVENTION
1. Field of the Invention
The invention relates to a tracheal cannula for the mechanical respiration of tracheotomised patients, the cannula having a cuff which encloses and seals the proximal section which can be inserted concentrically in the trachea, a curved section arranged above the cuff and an inner cannula which can be inserted concentrically into the cannula from the distal end thereof, an exhalation opening being provided in the cannula above the cuff sealing the trachea and approximately in the extension of the longitudinal axis of the bent section insertable in the trachea.
2. Description of the Prior Art
In order to prevent the danger of asphyxiation, it is necessary in certain cases to carry out a tracheotomy rather than intubation in order to provide mechanical respiration to a patient. After opening the trachea during this operation, a specially provided cannula having a length of approximately 10 cm and an internal diameter of approximately 1 cm is inserted. A so-called core, i.e. a second, inner cannula, is then inserted into this cannula from its distal end. This core is provided at its outer end with a connecting element, a so-called connector, for connection to a respirator.
In contrast to natural respiration, which by the activity of the diaphragm and the intercostal musculature produces a balance between atmospheric pressure and the intrapulmonary pressure, in mechanical respiration a specific air volume is forced through the tracheal cannula and the trachea into the lungs. This produces a pressure inside the lungs which is greater than atmospheric pressure. So that the pressure required to this end can be built up, it is necessary for the trachea to be sealed by a balloon (cuff) which lies in the trachea beneath the larynx. This sealing ensures that the air contained in the lungs can only escape through the trachea cannula as soon as a corresponding valve is opened in the respirator.
Thus, in mechanical respiration using a tracheal cannula, the airways located above the cuff sealing the trachea are completely bypassed. The exhalation volume can therefore no longer flow through the larynx. However, in order to produce sounds it is necessary for the exhalation flow to be forced through the closed glottis so that the vocal chords can be caused to vibrate. If there is no possibility of causing the air columns to vibrate with the aid of the vocal chords, then the patient cannot express any vowel sounds. These correspond to sounds of different pitch, strength and tone colour generated by the larynx. Whilst the patient can still produce noises with the aid of his lips, teeth, tongue and palate, and can therefore produce individual consonants, communication is entirely ruled out without vowel sounds.
U.S. Pat. No. 4,852,565 describes a tracheal cannula for mechanical respiration. It comprises an outer cannula which can be inserted in the trachea and a core, which can be introduced into the outer cannula and comprises an inner cannula and a connector for connection to a respirator. In order to carry out independent respiration, one or more openings are provided in the outer cannula above a cuff sealing the trachea and approximately in the extension of the longitudinal axis of the bent section which can be inserted into the trachea. However, in order to allow for respiration through the upper part of the trachea and in particular through the larynx, it is necessary to withdraw the inner cannula from the outer cannula, since the inner cannula seals the relevant openings in the outer cannula in its inserted state. The distal end of the outer cannula is then closed by means of a plug, so that the patient is forced to breathe independently and both the inhalation and the exhalation volumes have to flow through the larynx, so that the patient is able to speak as usual. However, because a complete separation from the respirator is necessary, application is limited to patients whose process of recovery is advanced to the point where they can breathe independently for at
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Millin Vincent
Rusch AG
Srivastava V.
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