Novel expandable architected breathing tube for improving airway securement in emergency care

David Berard,Juan David Navarro,Gregg Bascos,Angel Harb,Yusheng Feng,Robert De Lorenzo,R Lyle Hood,David Restrepo

doi:10.1016/j.jmbbm.2020.104211

Abstract

Life-saving interventions utilize endotracheal intubation to secure a patient's airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all.

Highlights

In emergency care, one of the first and most important steps is ensuring patient ventilation, as success or failure directly affects patients’ chance of survival [1]
Respiratory intubation and mechanical ventilation was the third most common procedure performed in U.S hospital stays and the second most common procedure performed by emergency medicine residents during the 2010s [2, 3]
The expanding lattice cylinder has demonstrated the ability to produce radial pressures on a tracheal phantom tube within ranges clinically recommended for endotracheal intubation

Summary

Introduction

One of the first and most important steps is ensuring patient ventilation, as success or failure directly affects patients’ chance of survival [1]. Endotracheal intubation (ETI) is a difficult procedure even in controlled environments [5]. Probes with a smaller diameter than the ETT, such as a bougie or stylet, are commonly used as guides for placement during intubation. An ETT that can contract to a near-bougie diameter would eliminate the need for a guiding device and streamline this critical procedure, reducing the chance of patient injury. The combined advantages of reducing the number of steps and number of devices used in the intubation procedure are advantageous on many levels. Since the film can inflate freely, the cuff behaves like a donut-shaped balloon. This produces a concentrated point of contact at the outermost radial

Methods

Results

Discussion

Conclusion